CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Licking Memorial Hospital

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77066
  • Insurance Median: $488
  • Cash Discount Price: $596
  • vs. Medicare Baseline: 3.11x Medicare
The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Licking Memorial Hospital is $488. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $596. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 3.11x the Medicare baseline. Located in 1320 West Main Street, Newark, OH.
Cash / Self-Pay
$596

Average discount available for prompt cash payment at this facility.

Insurance Median
$488

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)
Cash / Self-Pay: $596 (380%)
Insurance Median: $488 (311%)
Cash: $596 (380% of Medicare)
Ins. Median: $488 (311% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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 311% of the Medicare baseline (a markup of 211%). 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 63%
Aetna $101 - $492 64%
Blue Cross Blue Shield $101 - $512 64%
Champva [500001] $101 64%
Cigna $101 - $537 64%
Humana $101 - $578 64%
Medicare (plans) $101 64%
UnitedHealthcare $101 - $507 64%
Veterans Administration [100068] $101 64%
Wellcare By Allwell [450104] $101 64%
Molina Marketplace [100106] $162 103%
Medical Mutual [100114] $328 - $495 209%
Medben [700068] $417 - $584 266%
Benicomp [70090] $447 285%
Consociate Health 6 Degrees [100059] $477 304%
Consociate Health [100029] $477 304%
Allied Benefit Systems [100015] $488 311%
Geha [100039] $488 311%
Gravie Administrative Services [100165] $488 311%
Meritain [100063] $488 311%
Optima [700069] $488 311%
Trustmark Small Business Benefits [100263] $488 311%
Webtpa [100127] $488 311%
Healthscope [100157] $507 323%
Surest [100016] $507 323%
United Medical Resources [700071] $507 323%
American Postal Workers [100089] $537 342%
Antidote Health Plan Of Ohio [70006803] $537 342%
Coresource [100002] $537 - $596 342%
Great West Life [700064] $537 342%
National Association Of Letter Carriers [100067] $537 342%
Ohio Healthy Luminare Health [100264] $537 342%
Ohio Healthy [100255] $537 342%
Ohio Ppo Connect [70006801] $537 342%
Osu Prime Care [100254] $537 342%
Quality Care Partners [70006802] $537 342%
The Health Plan [100261] $537 342%
Wellfleet Group, Llc [100164] $537 342%
Coventry [100010] $550 350%
Pan American Life [700070] $550 350%
Ohio Health Choice [100109] $572 364%
Administrative Concepts [100006] $578 368%
Carefactor [100087] $578 368%
Philadelphia American Life [100260] $578 - $596 368%
Reliance Standard-Asrm [100258] $578 368%

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