CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Holy Family Memorial

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $279
  • Cash Discount Price: $264
  • vs. Medicare Baseline: 2.21x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Holy Family Memorial is $279. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $264. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.21x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.
Cash / Self-Pay
$264

Average discount available for prompt cash payment at this facility.

Insurance Median
$279

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)
Cash / Self-Pay: $264 (209%)
Insurance Median: $279 (221%)
Cash: $264 (209% of Medicare)
Ins. Median: $279 (221% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $126.25 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 221% of the Medicare baseline (a markup of 121%). 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 $119 - $182 94%
Community Care Incorporated $119 94%
Health Partners $119 - $312 94%
Humana $119 94%
Icare $119 94%
Molina $119 - $129 94%
Network Health Plan $119 - $140 94%
Security Health Plan $119 - $384 94%
UnitedHealthcare $119 - $203 94%
Allwell $122 97%
Medical College Of Wisconsin $158 125%
Centivo $192 - $221 152%
Dean Health Plan $240 190%
Health Payment Systems $271 215%
Sheboygan Employers Health Network $288 228%
Chorus Community Health Plan $309 245%
Trilogy $317 251%
Cigna $346 274%
Wps Health Plan $355 281%
Aspirus $384 304%
Healtheos $384 304%
Multiplan/Private Healthcare Systems $384 304%
Preferred One $384 304%
Healthsmart $398 315%
First Health Network $422 334%

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