CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Holy Family Memorial

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,570
Cash Discount Price: $2,475
vs. Medicare Baseline: 7.21x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Holy Family Memorial is $2,570. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,475. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 7.21x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$2,475

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,570

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $2,475 (694%)

Insurance Median: $2,570 (721%)

Cash: $2,475 (694% of Medicare)

Ins. Median: $2,570 (721% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 721% of the Medicare baseline (a markup of 621%). 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	$340 - $2,364	95%
Community Care Incorporated	$340	95%
Health Partners	$340 - $2,925	95%
Humana	$340	95%
Icare	$340	95%
Molina	$340 - $367	95%
Network Health Plan	$340 - $1,880	95%
Security Health Plan	$340 - $3,600	95%
UnitedHealthcare	$340 - $2,440	95%
Allwell	$346	97%
Medical College Of Wisconsin	$1,485	417%
Health Payment Systems	$1,551	435%
Centivo	$1,800 - $2,070	505%
Dean Health Plan	$2,250	631%
Sheboygan Employers Health Network	$2,700	758%
Chorus Community Health Plan	$2,894	812%
Trilogy	$2,970	833%
Cigna	$3,240	909%
Wps Health Plan	$3,330	934%
Aspirus	$3,600	1010%
Healtheos	$3,600	1010%
Multiplan/Private Healthcare Systems	$3,600	1010%
Preferred One	$3,600	1010%
Healthsmart	$3,735	1048%
First Health Network	$3,960	1111%

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 $2,475.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

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 70553.
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.