CMS Price Transparency Data

CT scan, pelvis

Facility: Holy Family Memorial

Billing Code: 72192 (CPT)

The BaseRate · fair price high confidence
A fair price for this
$101
about 0.9× the $107 Medicare rate · typically $101–$297
modeled estimate · not a bill or quote
What this hospital charges insurers
$103
About the fair price
about $2 over the fair price · 1.0× Medicare
Medicare pays $107 Fair price $101 This hospital $103 Cash price $1,586 Hospital's list price $2,884

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 0 charge more and 5 charge less, among the 9 WI hospitals compared.

Cheapest $49 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, pelvis is about $101 (about 0.9× the $107 Medicare rate). Holy Family Memorial charges insurers about $103, or about $1,586 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 $2,076 1944%
Humanamajor $101 95%
Dean Health Plan $1,442 1350%
Health Net $1,730 1620%
HealthPartners $101 - $1,875 95%
Molina $101 - $109 95%
Security Health Plan $101 - $2,307 95%
+ 13 smaller / regional plans $101 - $2,307
Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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Facility Profile & Credentials

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