How many shoppable procedure prices are published for Licking Memorial Hospital?

Licking Memorial Hospital in Newark, OH currently has 93 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Licking Memorial Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Licking Memorial Hospital's median negotiated commercial rate is 1.2× the regionally adjusted fair BaseRate benchmark.

What is Licking Memorial Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Licking Memorial Hospital an overall hospital quality rating of 2 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 219 Beds · urban Updated: 03/16/2026

Licking Memorial Hospital

1320 West Main Street, Newark, OH 43055 · 93 Priced Procedures · 67% Patient Recommendation

CMS Overall Rating 2 / 5 Stars

Above Fair Market · Negotiate

1.16×vs. Fair Market Price

Typical commercial prices here are +16% above the fair benchmark (1.16×) even after accounting for local nurse/doctor wages and patient complexity.

59/100 · Caution

59/100Self-Pay Cash Beats Insurance 22% of the Time

File Completeness51

Price Logic79

Peer Alignment64

Clean Billing83

Real Cash Discount10

High-Markup Tier

3-Star CMS clinical quality rating paired with 1.16× fair market pricing.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

Licking Memorial Hospital prices shoppable and inpatient services (0.9× to 1.0× Medicare, divergence 1.11×) in alignment with regional hospital peers (1.16× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.

#86 of 137 in OH · 62nd State Percentile#1,896 of 3,385 in U.S. · 55th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.76× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 22% of shoppable procedures (25/100 Cash Honesty)
2-Star CMS clinical rating with 67% patient recommendation (63/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (71.7% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.1× markup over Medicare rates
Captive ER (1.3×) & laboratory (2.9×) services average 1.11× higher multiples than routine shoppable care (0.9×)
Specialty infusion drugs (J-codes) average 1.1× Medicare — verify per-unit billing on itemized statements
Unnegotiated chargemaster list prices average 13.4× Medicare (25¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

0.9× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.11× Divergence

1.0× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+7% Upper Tail

Q25 0.76× · Q50 0.90× · Q75 0.96×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

0.9× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.1× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.5× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

1.3× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

2.9× MedicareFair

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.1× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

22% Cash Edge · 25/100Watchout

CMS Clinical Safety & Star ValueIntegrity & Outcomes

2 CMS · 63/100Elevated

Procedure Prices at Licking Memorial Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 93 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	$47,644	$14,622	$19,087	0.8×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	$66,542	$14,527	$19,432	0.7×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	$83,844	$13,369	$17,936	0.7×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	$27,208	$6,505	$8,223	0.8×
Sleep study (overnight, in lab) CPT Code: `95810`	$4,297	$828	$1,021	0.8×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$2,607	$756	$583	1.3×
Group therapy session CPT Code: `90853`	$509	$509	$100	5.1×
Blood transfusion CPT Code: `36430`	$1,106	$425	$498	0.9×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$8,470	$336	$448	0.8×
MRI, brain (with and without contrast) CPT Code: `70553`	$5,796	$336	$511	0.7×
Family therapy session CPT Code: `90847`	$284	$284	$173	1.6×
Psychotherapy session (45 minutes) CPT Code: `90834`	$246	$246	$166	1.5×
Psychotherapy session (60 minutes) CPT Code: `90837`	$264	$264	$181	1.5×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$2,022	$230	$272	0.8×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$7,413	$230	$303	0.8×
MRI, lower back (no contrast) CPT Code: `72148`	$4,414	$230	$338	0.7×
MRI, brain (no contrast) CPT Code: `70551`	$4,414	$230	$343	0.7×
MRI, knee or other leg joint CPT Code: `73721`	$6,621	$230	$369	0.6×
CT scan, head (with contrast) CPT Code: `70460`	$3,220	$169	$242	0.7×
CT scan, head (with and without contrast) CPT Code: `70470`	$4,169	$169	$258	0.7×
Office visit, established patient (20-29 min) CPT Code: `99213`	$507	$128	$87	1.5×
Hospital observation (per hour) HCPCS Code: `G0378`	$114	$114	$86	1.3×
Office visit, established patient (30-39 min) CPT Code: `99214`	$888	$128	$123	1.0×
X-ray, pelvis CPT Code: `72170`	$508	$101	$110	0.9×
X-ray, chest (single view) CPT Code: `71045`	$419	$84	$92	0.9×
X-ray, shoulder CPT Code: `73030`	$1,059	$84	$92	0.9×
X-ray, foot CPT Code: `73630`	$1,052	$84	$92	0.9×
X-ray, chest (two views) CPT Code: `71046`	$589	$84	$93	0.9×
X-ray, neck (cervical spine) CPT Code: `72040`	$816	$84	$93	0.9×
X-ray, hand CPT Code: `73130`	$1,052	$84	$93	0.9×
X-ray, hip CPT Code: `73502`	$658	$84	$93	0.9×
X-ray, ankle CPT Code: `73610`	$1,002	$84	$93	0.9×
X-ray, lower back CPT Code: `72110`	$1,100	$101	$112	0.9×
Ultrasound, abdomen (limited) CPT Code: `76705`	$1,172	$101	$126	0.8×
Ultrasound, pelvis CPT Code: `76856`	$1,493	$101	$130	0.8×
Ultrasound, thyroid and neck CPT Code: `76536`	$1,031	$101	$132	0.8×
Ultrasound, abdomen (complete) CPT Code: `76700`	$3,172	$101	$134	0.8×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$596	$101	$148	0.7×
Screening mammogram (both breasts) CPT Code: `77067`	$375	$83	$123	0.7×
CT scan, head (no contrast) CPT Code: `70450`	$2,952	$101	$160	0.6×
CT scan, pelvis CPT Code: `72192`	$2,984	$101	$163	0.6×
CT scan, sinuses CPT Code: `70486`	$2,883	$101	$166	0.6×
CT scan, chest (no contrast) CPT Code: `71250`	$3,143	$101	$167	0.6×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$3,834	$101	$168	0.6×
CT scan, neck (cervical spine) CPT Code: `72125`	$3,608	$101	$169	0.6×
Breathing treatment (nebulizer) CPT Code: `94640`	$106	$106	$201	0.5×
Hepatitis C antibody test CPT Code: `86803`	$457	$457	$15	30.5×
Pneumococcal vaccine HCPCS Code: `90732`	$312	$312	$140	2.2×
Typhoid vaccine HCPCS Code: `90675`	$1,022	$314	$347	0.9×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$237	$133	$56	2.4×
Drug screening test HCPCS Code: `G0480`	$309	$114	$116	1.0×
Blood antibody screen CPT Code: `86850`	$162	$50	$46	1.1×
Flu vaccine injection HCPCS Code: `G0008`	$46	$45	$48	0.9×
Colorectal cancer screening HCPCS Code: `G0010`	$60	$45	$49	0.9×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$226	$57	$64	0.9×
Speech therapy (language evaluation) CPT Code: `92507`	$478	$72	$86	0.8×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$361	$11	$11	1.0×
Blood test, vitamin D CPT Code: `82306`	$357	$30	$31	1.0×
Pneumonia vaccine injection HCPCS Code: `G0009`	$60	$45	$49	0.9×
Orthotic fitting and training CPT Code: `97760`	$183	$43	$51	0.8×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$138	$3	$3	1.0×
Blood test, calcium CPT Code: `82310`	$76	$5	$5	1.0×
Blood test, creatinine (kidney) CPT Code: `82565`	$72	$5	$5	1.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$147	$14	$14	1.0×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$74	$10	$10	1.0×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$192	$33	$40	0.8×
Blood test, glucose (blood sugar) CPT Code: `82947`	$96	$4	$4	1.0×
Blood test, lipase CPT Code: `83690`	$173	$7	$7	1.0×
Blood test, magnesium CPT Code: `83735`	$93	$7	$7	1.0×
Blood test, potassium CPT Code: `84132`	$65	$5	$5	1.0×
Blood test, PSA (prostate screen) CPT Code: `84153`	$279	$19	$19	1.0×
Blood test, sodium CPT Code: `84295`	$65	$5	$5	1.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$56	$4	$4	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$110	$8	$8	1.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$135	$6	$6	1.0×
Culture, bacterial CPT Code: `87070`	$114	$9	$9	1.0×
Flu vaccine (high dose) HCPCS Code: `90656`	$24	$24	$25	1.0×
Blood test, thyroid (TSH) CPT Code: `84443`	$323	$17	$18	0.9×
Blood test, vitamin B12 CPT Code: `82607`	$104	$15	$16	0.9×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$251	$13	$14	0.9×
Culture, blood CPT Code: `87040`	$126	$10	$11	0.9×
Blood test, basic metabolic panel CPT Code: `80048`	$258	$8	$9	0.9×
Blood test, liver function panel CPT Code: `80076`	$345	$8	$9	0.9×
Blood test, amylase CPT Code: `82150`	$173	$6	$7	0.9×
Physical therapy (gait training) CPT Code: `97116`	$129	$27	$33	0.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$179	$31	$38	0.8×
Speech therapy (group session) CPT Code: `92508`	$316	$22	$27	0.8×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$174	$30	$38	0.8×
Occupational therapy (self-care training) CPT Code: `97535`	$192	$30	$38	0.8×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$71	$4	$5	0.8×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$271	$27	$35	0.8×
Physical therapy (manual therapy) CPT Code: `97140`	$192	$26	$34	0.8×
Blood test, hemoglobin CPT Code: `85018`	$35	$2	$3	0.7×

Showing top 25 high-impact procedures of 93 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 71.7%

Audit a Bill or Quote at Licking Memorial Hospital (Zero PHI Required)

CMS CCN: 360218

CPT 871

Select Procedure to Audit:

Fair BaseRate™ $19,087

Medicare Rate $14,117

Self-Pay Cash $47,644

Insurer Median $14,622

1. Amount on Your Bill or Quote ($) Pre-filled with Licking Memorial Hospital’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $34,156 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $34,156

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (71.7% of gross = $34,156).

Step 2 · Cash vs. Insurance Arbitrage Published Cash: $47,644

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Licking Memorial Hospital's published 45 CFR § 180 self-pay cash rate is $47,644 (vs. $14,622 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$28,557 Above Fair BaseRate

Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)

Your bill ($47,644) is $28,557 above the denoised Fair BaseRate ($19,087) and 3.4× the $14,117 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

EIN: 314379519

Filing Period: 193701

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (71.7% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Safety Composite63/100

Would Recommend67%

Rated 9 or 10 (HCAHPS)70%

Median ER Wait190 min

Left ER Before Seen4%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Hip/Knee Complication Rate3.3%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

C. diff Hospital-Onset Infectionsame

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Licking Memorial Hospital. Prior administrative notices do not necessarily reflect current compliance status.

2025-02-14·administrative_or_closure
Closure Notice
Recorded
2024-11-07·warning_notice
Warning Notice
Recorded
2023-06-08·administrative_or_closure
Closure Notice
Recorded
2023-05-16·cap_corrective_action
CAP Request
Recorded
2023-02-10·warning_notice
Warning Notice
Recorded

Source: CMS Hospital Care Compare (603 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Above-Benchmark Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Licking Memorial Hospital.

Price Index: 1.98× regional baseline

Quality: 53/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

WellCare

-59.6%

Molina

-53.1%

Median Household Income$81,033U.S. Census ACS

Local Uninsured Share5.4%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 59/100 · Caution CMS CCN 360218 EIN 314379519

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 360218) ↗ Verify IRS Form 990 (EIN 314379519) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage03/16/2026

Validated Rate Rows23,466 (CMS v2.0.0)

File Integrity DigestVerified · CCN 360218

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy