CMS Price Transparency Data

Hospital observation (per hour)

Facility: Licking Memorial Hospital

Billing Code: G0378 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0378
Insurance Median: $94
Cash Discount Price: $114
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Hospital observation (per hour) at Licking Memorial Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1320 West Main Street, Newark, OH.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

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Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medical Mutual [100114]	$39 - $125	N/A
Blue Cross Blue Shield	$46 - $129	N/A
Medben [700068]	$50 - $147	N/A
Benicomp [70090]	$53 - $113	N/A
Consociate Health 6 Degrees [100059]	$57 - $120	N/A
Consociate Health [100029]	$57 - $120	N/A
Webtpa [100127]	$58 - $123	N/A
Aetna	$58 - $124	N/A
Geha [100039]	$58 - $123	N/A
Gravie Administrative Services [100165]	$58 - $123	N/A
Meritain [100063]	$58 - $123	N/A
Optima [700069]	$58 - $123	N/A
Trustmark Small Business Benefits [100263]	$58 - $123	N/A
Allied Benefit Systems [100015]	$58 - $123	N/A
Surest [100016]	$60 - $128	N/A
UnitedHealthcare	$60 - $128	N/A
United Medical Resources [700071]	$60 - $128	N/A
Healthscope [100157]	$60 - $128	N/A
National Association of Letter Carriers [100067]	$64 - $135	N/A
American Postal Workers [100089]	$64 - $135	N/A
Antidote Health Plan of Ohio [70006803]	$64 - $135	N/A
The Health Plan [100261]	$64 - $135	N/A
Quality Care Partners [70006802]	$64 - $135	N/A
Ohio PPO Connect [70006801]	$64 - $135	N/A
Osu Prime Care [100254]	$64 - $135	N/A
Great West Life [700064]	$64 - $135	N/A
Wellfleet Group, LLC [100164]	$64 - $135	N/A
Ohio Healthy [100255]	$64 - $135	N/A
Coresource [100002]	$64 - $150	N/A
Cigna	$64 - $135	N/A
Ohio Healthy Luminare Health [100264]	$64 - $135	N/A
Pan American Life [700070]	$66 - $139	N/A
Coventry [100010]	$66 - $139	N/A
Ohio Health Choice [100109]	$68 - $144	N/A
Philadelphia American Life [100260]	$69 - $150	N/A
Humana	$69 - $146	N/A
Reliance Standard-Asrm [100258]	$69 - $146	N/A
Carefactor [100087]	$69 - $146	N/A
Administrative Concepts [100006]	$69 - $146	N/A

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $114.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Licking Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0378.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.