CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Licking Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $6,928
  • Cash Discount Price: $8,470
  • vs. Medicare Baseline: 19.44x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Licking Memorial Hospital is $6,928. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,470. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 19.44x the Medicare baseline. Located in 1320 West Main Street, Newark, OH.
Cash / Self-Pay
$8,470

Average discount available for prompt cash payment at this facility.

Insurance Median
$6,928

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: $8,470 (2376%)
Insurance Median: $6,928 (1944%)
Cash: $8,470 (2376% of Medicare)
Ins. Median: $6,928 (1944% 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 1944% of the Medicare baseline (a markup of 1844%). 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
Tricare $330 93%
Aetna $336 - $6,996 94%
Blue Cross Blue Shield $336 94%
Champva [500001] $336 94%
Cigna $336 - $7,623 94%
Humana $336 - $8,216 94%
Medicare (plans) $336 94%
UnitedHealthcare $336 - $7,199 94%
Veterans Administration [100068] $336 94%
Wellcare By Allwell [450104] $336 94%
Molina Marketplace [100106] $538 151%
Medical Mutual [100114] $4,658 - $7,030 1307%
Medben [700068] $5,929 - $8,300 1663%
Benicomp [70090] $6,352 1782%
Consociate Health 6 Degrees [100059] $6,776 1901%
Consociate Health [100029] $6,776 1901%
Allied Benefit Systems [100015] $6,928 1944%
Geha [100039] $6,928 1944%
Gravie Administrative Services [100165] $6,928 1944%
Meritain [100063] $6,928 1944%
Optima [700069] $6,928 1944%
Trustmark Small Business Benefits [100263] $6,928 1944%
Webtpa [100127] $6,928 1944%
Healthscope [100157] $7,199 2020%
Surest [100016] $7,199 2020%
United Medical Resources [700071] $7,199 2020%
American Postal Workers [100089] $7,623 2139%
Antidote Health Plan Of Ohio [70006803] $7,623 2139%
Coresource [100002] $7,623 - $8,470 2139%
Great West Life [700064] $7,623 2139%
National Association Of Letter Carriers [100067] $7,623 2139%
Ohio Healthy Luminare Health [100264] $7,623 2139%
Ohio Healthy [100255] $7,623 2139%
Ohio Ppo Connect [70006801] $7,623 2139%
Osu Prime Care [100254] $7,623 2139%
Quality Care Partners [70006802] $7,623 2139%
The Health Plan [100261] $7,623 2139%
Wellfleet Group, Llc [100164] $7,623 2139%
Coventry [100010] $7,818 2193%
Pan American Life [700070] $7,818 2193%
Ohio Health Choice [100109] $8,131 2281%
Administrative Concepts [100006] $8,216 2305%
Carefactor [100087] $8,216 2305%
Philadelphia American Life [100260] $8,216 - $8,470 2305%
Reliance Standard-Asrm [100258] $8,216 2305%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1320 West Main Street, Newark, OH 43055
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals