CMS Price Transparency Data

CT scan, pelvis

Facility: Holy Family Memorial

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,648
Cash Discount Price: $1,586
vs. Medicare Baseline: 15.43x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Holy Family Memorial is $1,648. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,586. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.43x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$1,586

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,648

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: $1,586 (1485%)

Insurance Median: $1,648 (1543%)

Cash: $1,586 (1485% of Medicare)

Ins. Median: $1,648 (1543% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1543% of the Medicare baseline (a markup of 1443%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$101 - $1,470	95%
Community Care Incorporated	$101	95%
Health Partners	$101 - $1,875	95%
Humana	$101	95%
Icare	$101	95%
Molina	$101 - $109	95%
Network Health Plan	$101 - $1,033	95%
Security Health Plan	$101 - $2,307	95%
UnitedHealthcare	$101 - $1,565	95%
Allwell	$103	96%
Medical College Of Wisconsin	$952	891%
Centivo	$1,154 - $1,327	1080%
Health Payment Systems	$1,175	1100%
Dean Health Plan	$1,442	1350%
Sheboygan Employers Health Network	$1,730	1620%
Chorus Community Health Plan	$1,854	1736%
Trilogy	$1,903	1782%
Cigna	$2,076	1944%
Wps Health Plan	$2,134	1998%
Aspirus	$2,307	2160%
Healtheos	$2,307	2160%
Multiplan/Private Healthcare Systems	$2,307	2160%
Preferred One	$2,307	2160%
Healthsmart	$2,394	2241%
First Health Network	$2,538	2376%

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 $1,586.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Holy Family Memorial is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72192.
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.