CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Holy Family Memorial

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74176
  • Insurance Median: $1,813
  • Cash Discount Price: $1,813
  • vs. Medicare Baseline: 7.44x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Holy Family Memorial is $1,813. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,813. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.44x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.
Cash / Self-Pay
$1,813

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,813

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $1,813 (744%)
Insurance Median: $1,813 (744%)
Cash: $1,813 (744% of Medicare)
Ins. Median: $1,813 (744% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 744% of the Medicare baseline (a markup of 644%). 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
Blue Cross Blue Shield $230 - $1,470 94%
Community Care Incorporated $230 94%
Health Partners $230 - $2,142 94%
Humana $230 94%
Icare $230 94%
Molina $230 - $248 94%
Network Health Plan $230 - $1,033 94%
Security Health Plan $230 - $2,637 94%
UnitedHealthcare $230 - $1,565 94%
Allwell $234 96%
Medical College Of Wisconsin $1,088 446%
Health Payment Systems $1,175 482%
Centivo $1,318 - $1,516 541%
Dean Health Plan $1,648 676%
Sheboygan Employers Health Network $1,978 811%
Chorus Community Health Plan $2,119 869%
Trilogy $2,175 892%
Cigna $2,373 973%
Wps Health Plan $2,439 1001%
Aspirus $2,637 1082%
Healtheos $2,637 1082%
Multiplan/Private Healthcare Systems $2,637 1082%
Preferred One $2,637 1082%
Healthsmart $2,736 1122%
First Health Network $2,900 1190%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2300 Western Ave, Manitowoc, WI 54221
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Acute Care Hospitals