CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Holy Family Memorial

Billing Code: 71250 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$104

about 1.0× the $107 Medicare rate · typically $103–$301

modeled estimate · not a bill or quote

What this hospital charges insurers

$103

About the fair price

about $1 under the fair price · 1.0× Medicare

Medicare pays $107 Fair price $104 This hospital $103 Cash price $793 Hospital's list price $1,442

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 0 charge more and 4 charge less, among the 9 WI hospitals compared.

Cheapest $55 Priciest $103

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a CT scan, chest (no contrast) is about $104 (about 1.0× the $107 Medicare rate). Holy Family Memorial charges insurers about $103, or about $793 in cash — about the fair price. Located in Manitowoc, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna✓ Humana AetnaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$101 - $1,565	95%
Blue Cross Blue Shieldmajor	$101 - $1,470	95%
Cignamajor	$1,038	972%
Humanamajor	$101	95%
Dean Health Plan	$721	675%
Health Net	$865	810%
HealthPartners	$101 - $937	95%
Molina	$101 - $109	95%
Security Health Plan	$101 - $1,154	95%
+ 13 smaller / regional plans	$101 - $1,175

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 793), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 71250.

Insurance Before you use insurance

Call your insurance company to confirm Holy Family Memorial is in-network.
Ask your insurer whether prior approval is required for CPT code 71250.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Holy Family Memorial

Compare: CT scan, chest (no contrast) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.