CMS Price Transparency Data

X-ray, pelvis

Facility: St Marys Hospital Superior

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $208
  • Cash Discount Price: $228
  • vs. Medicare Baseline: 1.95x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at St Marys Hospital Superior is $208. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $228. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.95x the Medicare baseline. Located in 3500 Tower Ave, Superior, WI.
Cash / Self-Pay
$228

Average discount available for prompt cash payment at this facility.

Insurance Median
$208

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: $228 (213%)
Insurance Median: $208 (195%)
Cash: $228 (213% of Medicare)
Ins. Median: $208 (195% 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.

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
Advocare/Security Health $99 93%
Blue Cross Blue Shield $99 - $247 93%
Freedom Blue Ppo $99 93%
Healthpartners Care Msho / Mcr Adv $99 93%
Imcare Msho Pcc Prime $99 93%
Imcare Msho Ref Req $99 93%
Medica Advantage Solutions $99 93%
Medica Msho/Dual Solutions $99 93%
Medica Prime Solution Group $99 93%
Medica Uplan $99 93%
Medicare (plans) $99 93%
Nd Va Administration $99 93%
Platinum Blue/Vantage Blue $99 93%
Primewest Msho $99 93%
Secure Blue Msho $99 93%
Ubh Cost Plan $99 93%
Ubh Msho $99 93%
Ucare Msho $99 93%
UnitedHealthcare $99 - $279 93%
Itasca Med Care $106 99%
Primewest $106 99%
Blue Plus Pmap Pcc Prime $118 - $169 110%
Healthpartners Care Pmap $124 116%
Medica Access $124 - $193 116%
Sanford Healthplan $132 - $139 124%
Ucare $203 190%
Healthpartners $208 - $245 195%
Medica $217 - $241 203%
Wea $222 - $237 208%
Security Health $237 222%
America'S Ppo $239 224%
Cigna $240 - $245 225%
Healthpartners Pcc Prime $240 - $245 225%
Medica Choice $248 232%
Wps $256 - $259 240%
Aetna $262 245%
Healtheos $265 248%

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