CMS Price Transparency Data

X-ray, pelvis

Facility: Sanford Usd Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $178
Cash Discount Price: $392
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Sanford Usd Medical Center is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $392. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.67x the Medicare baseline. Located in 1305 W 18Th St Post Office Box 5039, Sioux Falls, SD.

Cash / Self-Pay

$392

Average discount available for prompt cash payment at this facility.

Insurance Median

$178

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $392 (367%)

Insurance Median: $178 (167%)

Cash: $392 (367% of Medicare)

Ins. Median: $178 (167% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Sanford Health Plan	$28	26%
Blue Cross Blue Shield	$49 - $138	46%
Sanford Health Plan Align	$101	95%
Ucare	$108 - $344	101%
Aetna	$110 - $375	103%
Health Partners	$110 - $191	103%
Medicare (plans)	$110	103%
UnitedHealthcare	$110 - $432	103%
Primewest	$112 - $115	105%
Security Health Plan	$270	253%
Medica	$330 - $353	309%
First Choice Health Network	$441	413%
Healthez	$441	413%
Multiplan	$441	413%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $392.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72170.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sanford Usd Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72170.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.