CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Licking Memorial Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $300
  • Cash Discount Price: $375
  • vs. Medicare Baseline: 2.38x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Licking Memorial Hospital is $300. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $375. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.38x the Medicare baseline. Located in 1320 West Main Street, Newark, OH.
Cash / Self-Pay
$375

Average discount available for prompt cash payment at this facility.

Insurance Median
$300

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)
Cash / Self-Pay: $375 (297%)
Insurance Median: $300 (238%)
Cash: $375 (297% of Medicare)
Ins. Median: $300 (238% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $126.25 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 238% of the Medicare baseline (a markup of 138%). 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 $82 65%
Aetna $83 - $345 66%
Blue Cross Blue Shield $83 - $359 66%
Champva [500001] $83 66%
Cigna $83 - $376 66%
Humana $83 - $405 66%
Medicare (plans) $83 66%
UnitedHealthcare $83 - $355 66%
Veterans Administration [100068] $83 66%
Wellcare By Allwell [450104] $83 66%
Molina Marketplace [100106] $133 105%
Medical Mutual [100114] $183 - $347 145%
Medben [700068] $233 - $409 185%
Benicomp [70090] $250 - $313 198%
Consociate Health 6 Degrees [100059] $267 - $334 211%
Consociate Health [100029] $267 - $334 211%
Allied Benefit Systems [100015] $273 - $342 216%
Geha [100039] $273 - $342 216%
Gravie Administrative Services [100165] $273 - $342 216%
Meritain [100063] $273 - $342 216%
Optima [700069] $273 - $342 216%
Trustmark Small Business Benefits [100263] $273 - $342 216%
Webtpa [100127] $273 - $342 216%
Healthscope [100157] $283 - $355 224%
Surest [100016] $283 - $355 224%
United Medical Resources [700071] $283 - $355 224%
American Postal Workers [100089] $300 - $376 238%
Antidote Health Plan Of Ohio [70006803] $300 - $376 238%
Coresource [100002] $300 - $418 238%
Great West Life [700064] $300 - $376 238%
National Association Of Letter Carriers [100067] $300 - $376 238%
Ohio Healthy Luminare Health [100264] $300 - $376 238%
Ohio Healthy [100255] $300 - $376 238%
Ohio Ppo Connect [70006801] $300 - $376 238%
Osu Prime Care [100254] $300 - $376 238%
Quality Care Partners [70006802] $300 - $376 238%
The Health Plan [100261] $300 - $376 238%
Wellfleet Group, Llc [100164] $300 - $376 238%
Coventry [100010] $308 - $385 244%
Pan American Life [700070] $308 - $385 244%
Ohio Health Choice [100109] $320 - $401 253%
Administrative Concepts [100006] $323 - $405 256%
Carefactor [100087] $323 - $405 256%
Philadelphia American Life [100260] $323 - $418 256%
Reliance Standard-Asrm [100258] $323 - $405 256%

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