CMS Price Transparency Data

X-ray, lower back

Facility: St Marys Hospital Superior

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $187
Cash Discount Price: $344
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at St Marys Hospital Superior is $187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $344. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.75x the Medicare baseline. Located in 3500 Tower Ave, Superior, WI.

Cash / Self-Pay

$344

Average discount available for prompt cash payment at this facility.

Insurance Median

$187

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: $344 (322%)

Insurance Median: $187 (175%)

Cash: $344 (322% of Medicare)

Ins. Median: $187 (175% 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
Itasca Med Care	$106	99%
Primewest	$106	99%
Advocare/Security Health	$149	140%
Blue Cross Blue Shield	$149 - $373	140%
Freedom Blue Ppo	$149	140%
Healthpartners Care Msho / Mcr Adv	$149	140%
Imcare Msho Pcc Prime	$149	140%
Imcare Msho Ref Req	$149	140%
Medica Advantage Solutions	$149	140%
Medica Msho/Dual Solutions	$149	140%
Medica Prime Solution Group	$149	140%
Medica Uplan	$149	140%
Medicare (plans)	$149	140%
Nd Va Administration	$149	140%
Platinum Blue/Vantage Blue	$149	140%
Primewest Msho	$149	140%
Secure Blue Msho	$149	140%
Ubh Cost Plan	$149	140%
Ubh Msho	$149	140%
Ucare Msho	$149	140%
UnitedHealthcare	$149 - $421	140%
Blue Plus Pmap Pcc Prime	$179	168%
Healthpartners Care Pmap	$187	175%
Medica Access	$187	175%
Sanford Healthplan	$199	186%
Ucare	$306	286%
Healthpartners	$314 - $363	294%
Medica	$327 - $363	306%
Wea	$335 - $358	314%
Security Health	$358	335%
America'S Ppo	$360	337%
Cigna	$363	340%
Healthpartners Pcc Prime	$363	340%
Medica Choice	$374	350%
Wps	$391	366%
Aetna	$395	370%
Healtheos	$400	374%

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 $344.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Marys Hospital Superior is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72110.
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.