CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: St Marys Hospital Superior

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71250
  • Insurance Median: $1,225
  • Cash Discount Price: $1,339
  • vs. Medicare Baseline: 11.47x Medicare
The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at St Marys Hospital Superior is $1,225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,339. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.47x the Medicare baseline. Located in 3500 Tower Ave, Superior, WI.
Cash / Self-Pay
$1,339

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,225

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: $1,339 (1254%)
Insurance Median: $1,225 (1147%)
Cash: $1,339 (1254% of Medicare)
Ins. Median: $1,225 (1147% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1147% of the Medicare baseline (a markup of 1047%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Itasca Med Care $106 99%
Primewest $106 99%
Advocare/Security Health $580 543%
Blue Cross Blue Shield $580 - $1,455 543%
Freedom Blue Ppo $580 543%
Healthpartners Care Msho / Mcr Adv $580 543%
Imcare Msho Pcc Prime $580 543%
Imcare Msho Ref Req $580 543%
Medica Advantage Solutions $580 543%
Medica Msho/Dual Solutions $580 543%
Medica Prime Solution Group $580 543%
Medica Uplan $580 543%
Medicare (plans) $580 543%
Nd Va Administration $580 543%
Platinum Blue/Vantage Blue $580 543%
Primewest Msho $580 543%
Secure Blue Msho $580 543%
Ubh Cost Plan $580 543%
Ubh Msho $580 543%
Ucare Msho $580 543%
UnitedHealthcare $580 - $1,640 543%
Blue Plus Pmap Pcc Prime $696 - $997 652%
Healthpartners Care Pmap $728 682%
Medica Access $728 - $1,138 682%
Sanford Healthplan $777 - $818 727%
Ucare $1,192 1116%
Healthpartners $1,225 - $1,444 1147%
Medica $1,274 - $1,415 1193%
Wea $1,305 - $1,395 1222%
Security Health $1,395 1306%
America'S Ppo $1,404 1314%
Cigna $1,413 - $1,444 1323%
Healthpartners Pcc Prime $1,413 - $1,444 1323%
Medica Choice $1,457 1364%
Wps $1,504 - $1,522 1408%
Aetna $1,540 1442%
Healtheos $1,558 1459%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3500 Tower Ave, Superior, WI 54880
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals