healthcosts.net
New Patient Office Visit (level 5) at Sanford USD Medical Center
1305 W 18th St, Sioux Falls, SD · Sanford Health · · NPI 1821017880
$962.40
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.
$1,203.00
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.
$77.76 with Sanford Health Plan vs $322.92 with Blue Cross Blue Shield of Minnesota — 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 | SD Exchange True | $77.76 | ↓ -92% |
| Sanford Health Plan | Group Health/True | $88.67 | ↓ -91% |
| Sanford Health Plan | SD Exchange Commercial | $91.49 | ↓ -90% |
| Health Partners | State Employees | $98.49 | ↓ -90% |
| Sanford Health Plan | Commercial/ND Pers | $104.31 | ↓ -89% |
| Health Partners | Commercial | $114.66 | ↓ -88% |
| Security Health Plan | Commercial | $161.70 | ↓ -83% |
| United Healthcare | CSP Top 20 | $197.86 | ↓ -79% |
| Medica | Choice | $198.16 | ↓ -79% |
| Sanford Health Plan Align | Medicare Replacement | $198.51 | ↓ -79% |
| Ucare | Commercial | $206.65 | ↓ -79% |
| Medica | Elect | $211.97 | ↓ -78% |
| Ucare | Medicare Replacement | $213.13 | ↓ -78% |
| Aetna | Medicare Replacement | $215.22 | ↓ -78% |
| Blue Cross Blue Shield of Minnesota | Medicare Replacement | $215.22 | ↓ -78% |
| Great Plains Medicare Advantage | Medicare Replacement | $215.22 | ↓ -78% |
| Health Partners | Medicare Replacement | $215.22 | ↓ -78% |
| United Healthcare | Medicare Replacement | $215.22 | ↓ -78% |
| Primewest | Medicare Replacement | $219.40 | ↓ -77% |
| Aetna | Commercial | $224.91 | ↓ -77% |
| United Healthcare | Commercial | $259.01 | ↓ -73% |
| First Choice Health Network | Commercial | $264.60 | ↓ -73% |
| Healthez | Commercial | $264.60 | ↓ -73% |
| Multiplan | Commercial | $264.60 | ↓ -73% |
| Blue Cross Blue Shield of Minnesota | Commercial | $322.92 | ↓ -66% |
| Blue Cross Blue Shield of Minnesota | PMAP | $322.92 | ↓ -66% |
| Blue Cross Blue Shield of Minnesota | State Employees | $322.92 | ↓ -66% |
| Wellmark | HMO/PPO | not published by hospital | — |
| Ucare | Medicaid Managed Care | not published by hospital | — |
| Primewest | Medicaid Managed Care | not published by hospital | — |
Visitor-reported prices
Comments
New Patient Office Visit (level 5) at other South-dakota hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Sanford Clear Lake Medical Center | Clear Lake | $302.40 | $193.91 – $340.20 |
| Sanford Aberdeen Medical Center | Aberdeen | $390.40 | $198.51 – $426.60 |