Licking Memorial Health Systems

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Patients & Visitors > Before You Arrive > Patient Pricing

Patient Pricing
General Charge List

In compliance with state law, Licking Memorial Hospital (LMH) is providing this price list containing our charges for room and care, Emergency Department (ED), operating room, delivery, physical therapy and other procedures. The Hospital’s charges are the same for all patients, but a patient’s responsibility may vary depending on payment plans negotiated with individual health insurers. Uninsured or underinsured patients should consult with our registration and billing staff to determine whether they qualify for discounts. These prices are correct as of January 1, 2025.

Charges for Hospital-based anesthesiologists, radiologists, hospitalists, pathologists and ED physician services are not included in the prices listed. To obtain this information for the radiologists, please call 1 (800) 841-4236. To obtain charge information for the anesthesiologists, hospitalists, pathologists and ED physicians, please call (220) 564-4024. Additional pricing information for Licking Memorial Hospital services also can be obtained by calling (220) 564-4024.

Good Faith Estimate for Cost of Services

In compliance with federal law, if you do not have health insurance or if you plan to self-pay for your services, Licking Memorial Health Systems can provide you with a good faith estimate of expected charges for an item or service upon your request. You may request this good faith estimate when you schedule your service. If you request a good faith estimate, one will be provided to you before your scheduled service. Please know that if you request a good faith estimate, it may not be available at the time of scheduling or during a same day appointment.

Comprehensive Charge List

Cardiopulmonary Charges

Breathing Exercise $331.90
Bronchospasm Evaluation $525.95
Carbon Monoxide Diffusing Capacity $263.50
CPAP Non-emergent $423.00
Electrocardiogram, Tracing $213.10
Inhalation Treatment $118.75
Phase II Outpatient Cardiac Rehabilitation with Continuous ECG Monitoring $281.75
Stress Test with Drug and Isotope $1,621.25
Transthoracic Echocardiogram Complete $2,458.95
Ventilator, Subsequent Day $962.75

Emergency Department Charges

Cast/Splint Procedure $896.70
Critical Care – First Hour $2,361.95
Laceration Repair with Sutures $1,026.15
Level 1 Emergency Room Visit $239.45
Level 2 Emergency Room Visit $473.70
Level 3 Emergency Room Visit $640.10
Level 4 Emergency Room Visit $848.65
Level 5 Emergency Room Visit $1,181.50

Room & Care - Per Day Charges

Coronary Care Acute $2,821.55
Inpatient Rehabilitation $2,657.20
Intensive Care Acute $3,395.65
Medical-Surgical $1,601.95
Medical-Surgical Isolation $1,862.80
Nursery $1,485.25
Post Partum $1,601.95
Psychiatric $2,288.00

Laboratory Charges

Assay of Ferritin $138.90
Assay of Urine Creatinine $184.35
B Type Natriuretic Peptide $170.85
Basic Metabolic Panel $243.80
Bilirubin Direct $92.05
CBC with Differential $138.80
CBC without Differential $137.85
Comprehensive Metabolic Panel $340.15
Culture, Blood $119.00
Culture, Urine $64.80
Gram Negative Sensitivity $54.50
Gram Positive Blood Culture $71.50
Hemoglobin A1C $109.55
Lactic Acid Level $151.70
Lipase, Serum $109.05
Lipid Panel $236.50
Magnesium $50.10
Microalbumin $132.50
Organism Identification $56.75
Procal $412.25
Prothrombin Time $67.15
Renal Function Panel $218.65
Surgical Pathology, Level IV $689.80
Throat Strep Screen Culture $116.20
Thyroid Stimulating Hormone $304.95
Troponin I $218.65
Urinalysis Profile $129.90
Venipuncture $34.50
Vitamin B12 Level $145.70
Vitamin D Level $336.95

Labor & Delivery Charges

C-section $12,038.05
Labor Care – First 6 Hours $1,442.25
Normal Vaginal Delivery $8,410.25

Rehabilitation Services Charges

Occupational Therapy (OT) Evaluation $361.15
OT, Self-care/Home Management Training - Each 15 Minutes $181.15
OT, Therapeutic Activity – Each 15 Minutes $168.40
OT, Therapeutic Exercises – Each 15 Minutes $255.85
Physical Therapy (PT) Evaluation $361.15
PT, Gait Training Therapy $121.65
PT, Manual Therapy – Each 15 Minutes $181.40
PT, Neuromuscular Re-education – Each 15 Minutes $147.70
PT, Therapeutic Exercises – Each 15 Minutes $308.90
PT, Transfer Training – Each 15 Minutes $181.15

Operating Room Charges

Major General Anesthesia $1,821.75
Operating Room Level I - Initial 30 Minutes $4,734.35
Operating Room Level II - Initial 30 Minutes $5,448.95
Operating Room Level III - Initial 30 Minutes $6,550.60
Operating Room Level IV - Initial 30 Minutes $7,860.75
Operating Room Level V - Initial 30 Minutes $9,289.95
Operating Room Level VI - Initial 30 Minutes $10,719.15
Operating Room Level VII - Initial 30 Minutes $13,101.20
Operating Room Time - Each Additional 30 Minutes $1,729.55
Recovery Room Time - Each 30 Minutes In First Hour $1,249.85

X-Ray & Radiological Charges

CT Abdomen & Pelvis with Contrast $7,990.35
CT Abdomen & Pelvis without Contrast $6,993.40
CT Angiography with & without Contrast $5,448.10
CT Cervical Spine without Contrast $3,403.70
CT Chest with Contrast $3,323.65
CT Chest without Contrast $3,323.65
CT Head/Brain without Contrast $2,784.95
Dexa Bone Density $1,018.70
Diagnostic Mammography, including CAD, Unilateral $464.75
LDCT Lung Cancer Screening $956.45
Mammography Breast Screening Tomosynthesis, Bilateral $56.80
Mammography Breast Screening, Bilateral $393.90
MRI Brain without Contrast 4,164.30
Needle Localization by X-ray $868.35
Nuclear Medicine Heart Perfusion SPECT $9,309.55
Technetium Sestamibi Dose (used with Cardiolite stress tests) $111.45
Ultrasound Abdomen Limited $1,381.35
Ultrasound Breast Limited, Unilateral $652.10
Ultrasound Pelvis Transvaginal $899.60
X-ray Abdomen (1 View) $517.00
X-ray Ankle (Minimum 3 Views) $630.45
X-ray Chest (1 View) $394.80
X-ray Chest (2 Views) $555.95
X-ray Foot (Minimum 3 Views) $661.85
X-ray Hand (Minimum 3 Views) $661.85
X-ray Hip, Unilateral (2 or 3 Views) $620.70
X-ray Knee (1 or 2 Views) $693.45
X-ray Lumbar Spine (2 or 3 Views) $952.20
X-ray Shoulder (4 Views) $756.50
X-ray Wrist (Minimum 3 Views) $661.85

Hospital Billing Policies