CMS Price Transparency Data

X-ray, pelvis

Facility: Licking Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $416
  • Cash Discount Price: $508
  • vs. Medicare Baseline: 3.89x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Licking Memorial Hospital is $416. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $508. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.89x the Medicare baseline. Located in 1320 West Main Street, Newark, OH.
Cash / Self-Pay
$508

Average discount available for prompt cash payment at this facility.

Insurance Median
$416

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: $508 (476%)
Insurance Median: $416 (389%)
Cash: $508 (476% of Medicare)
Ins. Median: $416 (389% 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 389% of the Medicare baseline (a markup of 289%). 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 - $420 95%
Blue Cross Blue Shield $101 - $437 95%
Champva [500001] $101 95%
Cigna $101 - $458 95%
Humana $101 - $493 95%
Medicare (plans) $101 95%
UnitedHealthcare $101 - $432 95%
Veterans Administration [100068] $101 95%
Wellcare By Allwell [450104] $101 95%
Molina Marketplace [100106] $161 151%
Medical Mutual [100114] $280 - $422 262%
Medben [700068] $356 - $498 333%
Benicomp [70090] $381 357%
Consociate Health 6 Degrees [100059] $407 381%
Consociate Health [100029] $407 381%
Allied Benefit Systems [100015] $416 389%
Geha [100039] $416 389%
Gravie Administrative Services [100165] $416 389%
Meritain [100063] $416 389%
Optima [700069] $416 389%
Trustmark Small Business Benefits [100263] $416 389%
Webtpa [100127] $416 389%
Healthscope [100157] $432 404%
Surest [100016] $432 404%
United Medical Resources [700071] $432 404%
American Postal Workers [100089] $458 429%
Antidote Health Plan Of Ohio [70006803] $458 429%
Coresource [100002] $458 - $508 429%
Great West Life [700064] $458 429%
National Association Of Letter Carriers [100067] $458 429%
Ohio Healthy Luminare Health [100264] $458 429%
Ohio Healthy [100255] $458 429%
Ohio Ppo Connect [70006801] $458 429%
Osu Prime Care [100254] $458 429%
Quality Care Partners [70006802] $458 429%
The Health Plan [100261] $458 429%
Wellfleet Group, Llc [100164] $458 429%
Coventry [100010] $469 439%
Pan American Life [700070] $469 439%
Ohio Health Choice [100109] $488 457%
Administrative Concepts [100006] $493 462%
Carefactor [100087] $493 462%
Philadelphia American Life [100260] $493 - $508 462%
Reliance Standard-Asrm [100258] $493 462%

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