CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Licking Memorial Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71250
  • Insurance Median: $2,486
  • Cash Discount Price: $3,143
  • vs. Medicare Baseline: 23.27x Medicare
The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Licking Memorial Hospital is $2,486. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,143. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 23.27x the Medicare baseline. Located in 1320 West Main Street, Newark, OH.
Cash / Self-Pay
$3,143

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,486

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: $3,143 (2943%)
Insurance Median: $2,486 (2327%)
Cash: $3,143 (2943% of Medicare)
Ins. Median: $2,486 (2327% 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 2327% of the Medicare baseline (a markup of 2227%). 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 $99 93%
Aetna $101 - $2,910 95%
Blue Cross Blue Shield $101 95%
Champva [500001] $101 95%
Cigna $101 - $3,171 95%
Humana $101 - $3,417 95%
Medicare (plans) $101 95%
UnitedHealthcare $101 - $2,995 95%
Veterans Administration [100068] $101 95%
Wellcare By Allwell [450104] $101 95%
Molina Marketplace [100106] $161 151%
Medical Mutual [100114] $1,519 - $2,924 1422%
Medben [700068] $1,933 - $3,453 1810%
Benicomp [70090] $2,072 - $2,642 1940%
Consociate Health 6 Degrees [100059] $2,210 - $2,818 2069%
Consociate Health [100029] $2,210 - $2,818 2069%
Allied Benefit Systems [100015] $2,259 - $2,882 2115%
Geha [100039] $2,259 - $2,882 2115%
Gravie Administrative Services [100165] $2,259 - $2,882 2115%
Meritain [100063] $2,259 - $2,882 2115%
Optima [700069] $2,259 - $2,882 2115%
Trustmark Small Business Benefits [100263] $2,259 - $2,882 2115%
Webtpa [100127] $2,259 - $2,882 2115%
Healthscope [100157] $2,348 - $2,995 2198%
Surest [100016] $2,348 - $2,995 2198%
United Medical Resources [700071] $2,348 - $2,995 2198%
American Postal Workers [100089] $2,486 - $3,171 2327%
Antidote Health Plan Of Ohio [70006803] $2,486 - $3,171 2327%
Coresource [100002] $2,486 - $3,523 2327%
Great West Life [700064] $2,486 - $3,171 2327%
National Association Of Letter Carriers [100067] $2,486 - $3,171 2327%
Ohio Healthy Luminare Health [100264] $2,486 - $3,171 2327%
Ohio Healthy [100255] $2,486 - $3,171 2327%
Ohio Ppo Connect [70006801] $2,486 - $3,171 2327%
Osu Prime Care [100254] $2,486 - $3,171 2327%
Quality Care Partners [70006802] $2,486 - $3,171 2327%
The Health Plan [100261] $2,486 - $3,171 2327%
Wellfleet Group, Llc [100164] $2,486 - $3,171 2327%
Coventry [100010] $2,549 - $3,252 2386%
Pan American Life [700070] $2,549 - $3,252 2386%
Ohio Health Choice [100109] $2,652 - $3,382 2483%
Administrative Concepts [100006] $2,679 - $3,417 2508%
Carefactor [100087] $2,679 - $3,417 2508%
Philadelphia American Life [100260] $2,679 - $3,523 2508%
Reliance Standard-Asrm [100258] $2,679 - $3,417 2508%

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