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Established Patient Office Visit (level 4) at Sanford Sheldon Medical Center
118 N 7th Ave, Sheldon, IA · Sanford Health · · NPI 1841200623
$160.00
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$200.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$57.00 with Sanford Health Plan Align vs $180.00 with Multiplan — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Sanford Health Plan Align | Medicare Replacement | $57.00 | ↓ -64% |
| Ucare | Medicare Replacement | $61.20 | ↓ -62% |
| Aetna | Medicare Replacement | $61.80 | ↓ -61% |
| Blue Cross Blue Shield of North Dakota | Medicare Replacement | $61.80 | ↓ -61% |
| Great Plains Medicare Advantage | Medicare Replacement | $61.80 | ↓ -61% |
| Health Partners | Medicare Replacement | $61.80 | ↓ -61% |
| United Healthcare | Medicare Replacement | $61.80 | ↓ -61% |
| Primewest | Medicare Replacement | $63.00 | ↓ -61% |
| Wellmark | HMO | $100.00 | ↓ -38% |
| Wellmark | PPO | $104.00 | ↓ -35% |
| Sanford Health Plan | Group Health/True | $107.16 | ↓ -33% |
| Sanford Health Plan | SD Exchange True | $107.16 | ↓ -33% |
| Security Health Plan | Commercial | $110.00 | ↓ -31% |
| Sanford Health Plan | Commercial/ND Pers | $126.06 | ↓ -21% |
| Sanford Health Plan | SD Exchange Commercial | $126.06 | ↓ -21% |
| Health Partners | State Employees | $132.00 | ↓ -18% |
| Health Partners | Commercial | $150.00 | ↓ -6% |
| Medica | Choice | $165.00 | ↑ +3% |
| United Healthcare | Commercial + Top 20 | $167.00 | ↑ +4% |
| Aetna | Commercial | $173.80 | ↑ +9% |
| Ucare | Commercial | $175.72 | ↑ +10% |
| Medica | Elect | $176.40 | ↑ +10% |
| First Choice Health Network | Commercial | $180.00 | ↑ +13% |
| Healthez | Commercial | $180.00 | ↑ +13% |
| Multiplan | Commercial | $180.00 | ↑ +13% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 4) at other Iowa hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UnityPoint Health - Iowa Lutheran Hospital | Des Moines | $192.00 | $88.83 – $184.05 |
| MercyOne New Hampton Medical Center | New Hampton | $659.10 | $42.60 – $258.00 |
| UnityPoint Health - Allen Hospital | Waterloo | $192.00 | $88.83 – $184.05 |
| MercyOne Elkader Medical Center | Elkader | $272.00 | $56.78 – $272.00 |
| MercyOne Genesis Davenport West Medical Center | Davenport | $134.40 | not published |
| MercyOne Dubuque Medical Center | Dubuque | $209.00 | $5.10 – $33.12 |
| MercyOne Dyersville Medical Center | Dyersville | $167.70 | $88.83 – $290.40 |
| MercyOne Clinton Medical Center | Clinton | $209.00 | $49.07 – $209.00 |