CMS Price Transparency Data

X-ray, chest (single view)

Facility: Holy Family Memorial

Billing Code: 71045 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71045
Insurance Median: $138
Cash Discount Price: $105
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a X-ray, chest (single view) at Holy Family Memorial is $138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.55x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$138

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $105 (118%)

Insurance Median: $138 (155%)

Cash: $105 (118% of Medicare)

Ins. Median: $138 (155% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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.

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	$29 - $84	33%
Medical College Of Wisconsin	$63	71%
Centivo	$76 - $88	85%
Community Care Incorporated	$84	94%
Health Partners	$84 - $124	94%
Humana	$84	94%
Icare	$84	94%
Molina	$84 - $90	94%
Network Health Plan	$84 - $399	94%
Security Health Plan	$84 - $153	94%
UnitedHealthcare	$84 - $597	94%
Allwell	$85	96%
Dean Health Plan	$96	108%
Sheboygan Employers Health Network	$115	129%
Chorus Community Health Plan	$123	138%
Trilogy	$126	142%
Cigna	$138	155%
Wps Health Plan	$141	159%
Aspirus	$153	172%
Healtheos	$153	172%
Multiplan/Private Healthcare Systems	$153	172%
Preferred One	$153	172%
Healthsmart	$159	179%
First Health Network	$168	189%
Health Payment Systems	$244	274%

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 $105.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71045.

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 71045.
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.