CMS Price Transparency Data

CT scan, pelvis

Facility: Licking Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $2,537
  • Cash Discount Price: $2,984
  • vs. Medicare Baseline: 23.75x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Licking Memorial Hospital is $2,537. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,984. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 23.75x the Medicare baseline. Located in 1320 West Main Street, Newark, OH.
Cash / Self-Pay
$2,984

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,537

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: $2,984 (2794%)
Insurance Median: $2,537 (2375%)
Cash: $2,984 (2794% of Medicare)
Ins. Median: $2,537 (2375% 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 2375% of the Medicare baseline (a markup of 2275%). 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 - $3,245 95%
Blue Cross Blue Shield $101 95%
Champva [500001] $101 95%
Cigna $101 - $3,536 95%
Humana $101 - $3,811 95%
Medicare (plans) $101 95%
UnitedHealthcare $101 - $3,340 95%
Veterans Administration [100068] $101 95%
Wellcare By Allwell [450104] $101 95%
Molina Marketplace [100106] $161 151%
Medical Mutual [100114] $1,610 - $3,261 1507%
Medben [700068] $2,049 - $3,850 1918%
Benicomp [70090] $2,196 - $2,947 2056%
Consociate Health 6 Degrees [100059] $2,342 - $3,143 2193%
Consociate Health [100029] $2,342 - $3,143 2193%
Allied Benefit Systems [100015] $2,395 - $3,214 2242%
Geha [100039] $2,395 - $3,214 2242%
Gravie Administrative Services [100165] $2,395 - $3,214 2242%
Meritain [100063] $2,395 - $3,214 2242%
Optima [700069] $2,395 - $3,214 2242%
Trustmark Small Business Benefits [100263] $2,395 - $3,214 2242%
Webtpa [100127] $2,395 - $3,214 2242%
Healthscope [100157] $2,489 - $3,340 2330%
Surest [100016] $2,489 - $3,340 2330%
United Medical Resources [700071] $2,489 - $3,340 2330%
American Postal Workers [100089] $2,635 - $3,536 2467%
Antidote Health Plan Of Ohio [70006803] $2,635 - $3,536 2467%
Coresource [100002] $2,635 - $3,929 2467%
Great West Life [700064] $2,635 - $3,536 2467%
National Association Of Letter Carriers [100067] $2,635 - $3,536 2467%
Ohio Healthy Luminare Health [100264] $2,635 - $3,536 2467%
Ohio Healthy [100255] $2,635 - $3,536 2467%
Ohio Ppo Connect [70006801] $2,635 - $3,536 2467%
Osu Prime Care [100254] $2,635 - $3,536 2467%
Quality Care Partners [70006802] $2,635 - $3,536 2467%
The Health Plan [100261] $2,635 - $3,536 2467%
Wellfleet Group, Llc [100164] $2,635 - $3,536 2467%
Coventry [100010] $2,702 - $3,626 2530%
Pan American Life [700070] $2,702 - $3,626 2530%
Ohio Health Choice [100109] $2,811 - $3,772 2632%
Administrative Concepts [100006] $2,840 - $3,811 2659%
Carefactor [100087] $2,840 - $3,811 2659%
Philadelphia American Life [100260] $2,840 - $3,929 2659%
Reliance Standard-Asrm [100258] $2,840 - $3,811 2659%

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