CMS Price Transparency Data

CT scan, pelvis

Facility: St Marys Hospital Superior

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $1,221
  • Cash Discount Price: $1,335
  • vs. Medicare Baseline: 11.43x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at St Marys Hospital Superior is $1,221. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,335. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.43x the Medicare baseline. Located in 3500 Tower Ave, Superior, WI.
Cash / Self-Pay
$1,335

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,221

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: $1,335 (1250%)
Insurance Median: $1,221 (1143%)
Cash: $1,335 (1250% of Medicare)
Ins. Median: $1,221 (1143% 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 1143% of the Medicare baseline (a markup of 1043%). 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 $578 541%
Blue Cross Blue Shield $578 - $1,450 541%
Freedom Blue Ppo $578 541%
Healthpartners Care Msho / Mcr Adv $578 541%
Imcare Msho Pcc Prime $578 541%
Imcare Msho Ref Req $578 541%
Medica Advantage Solutions $578 541%
Medica Msho/Dual Solutions $578 541%
Medica Prime Solution Group $578 541%
Medica Uplan $578 541%
Medicare (plans) $578 541%
Nd Va Administration $578 541%
Platinum Blue/Vantage Blue $578 541%
Primewest Msho $578 541%
Secure Blue Msho $578 541%
Ubh Cost Plan $578 541%
Ubh Msho $578 541%
Ucare Msho $578 541%
UnitedHealthcare $578 - $1,634 541%
Blue Plus Pmap Pcc Prime $693 - $993 649%
Healthpartners Care Pmap $726 680%
Medica Access $726 - $1,134 680%
Sanford Healthplan $775 - $815 726%
Ucare $1,188 1112%
Healthpartners $1,221 - $1,439 1143%
Medica $1,270 - $1,410 1189%
Wea $1,300 - $1,391 1217%
Security Health $1,391 1302%
America'S Ppo $1,400 1311%
Cigna $1,409 - $1,439 1319%
Healthpartners Pcc Prime $1,409 - $1,439 1319%
Medica Choice $1,452 1359%
Wps $1,499 - $1,517 1403%
Aetna $1,535 1437%
Healtheos $1,553 1454%

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