Licking Memorial Health Systems - Measurably different...for your health
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, 2024.

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

In compliance with regulations, Licking Memorial Hospital is providing this comprehensive charge list in the link below which contains inpatient and outpatient services or items provided by the Hospital, also known as a chargemaster.  It is not a helpful tool for patients to comparison shop between hospitals or to estimate what healthcare services are going to cost them out of their own pocket.  For more information about the cost of your care, please contact our patient financial services staff at (220) 564-1500.

Comprehensive Charge List (CSV)


Price Transparency – Price Estimates for Shoppable Services

Individuals are able to receive an estimate of their expected healthcare expenses for many of the common services offered at Licking Memorial Hospital.  Click on the link below to use the Self-Service Patient Estimate tool.  This estimate will be based on your insurance plan and coverage, as well as the agreement that LMH has with your plan.  For more information, or if a service is not listed, please contact the Licking Memorial Hospital Billing Office at (220) 564-1500 for assistance Monday through Friday, 7:30 a.m. to 5:00 p.m.

Patient Estimates

Licking Memorial Hospital is committed to providing information for individuals to make informed healthcare choices.  A personalized cost estimate may be provided based on hospital services that individuals expect to receive and their specific insurance coverage.  It is important to note that these files do not include physician services or professional fees for any other ancillary services for either employed or non-employed practitioners who may provide care.  Charges are dependent upon the individual's medical condition at the time that services are rendered.

Cardiopulmonary Charges
The following charges reflect the most common services offered by our Cardiopulmonary Department. Patients may have additional charges, depending on the services ordered by the physician.
 
Bronchospasm Evaluation
$496.20
Carbon Monoxide Diffusing Capacity
$248.60
CPAP Non-emergent
$399.05
Electrocardiogram, Tracing
$201.05
Inhalation Treatment
$112.05
Phase II Outpatient Cardiac Rehabilitation with Continuous ECG Monitoring
$265.80
Stress Test with Drug and Isotope
$1,529.50
Thoracic Gas Volume
$428.25
Transthoracic Echocardiogram Complete
$2,319.75
Ventilator, Subsequent Day
$908.25
Emergency Department Charges
Emergency Department charges are based on the level of emergency care provided to our patients. The levels reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures.
 
Cast/Splint Procedure
$845.95
Critical Care – First Hour
$2,228.25
Laceration Repair with Sutures
$968.05
Level 1 Emergency Room Visit
$225.90
Level 2 Emergency Room Visit
$446.90
Level 3 Emergency Room Visit
$603.85
Level 4 Emergency Room Visit
$800.60
Level 5 Emergency Room Visit
$1,114.60
Room & Care - Per Day Charges
Coronary Care Acute
$2,661.85
Inpatient Rehabilitation
$2,506.80
Intensive Care Acute
$3,203.45
Medical-Surgical
$1,511.25
Medical-Surgical Isolation
$1,757.35
Nursery
$1,401.20
Post Partum
$1,511.25
Psychiatric
$2,158.50
Laboratory Charges
The following charges reflect the Hospital’s 30 most common Laboratory procedures.
 
B Type Natriuretic Peptide
$161.20
Basic Metabolic Panel
$230.00
CBC with Differential
$130.95
CBC without Differential
$130.05
Comprehensive Metabolic Panel
$320.90
Culture, Blood
$112.25
Culture, Urine
$61.15
Fibrin Degradation Products, D-dimer, Quantitative
$135.95
Gram Negative Sensitivity
$51.40
Gram Positive Blood Culture
$67.45
Hemoglobin A1C
$103.35
Hepatic Function Panel
$306.75
Lactic Acid Level
$143.10
Lipase, Serum
$102.90
Lipid Panel
$223.10
Magnesium
$47.25
Microalbumin/Creatinine
$282.80
Organism Identification
$53.55
Partial Thromboplastin Time
$120.00
Procal
$388.90
Prothrombin Time
$63.35
Renal Function Panel
$206.25
Surgical Pathology, Level IV
$650.75
Throat Strep Screen Culture
$109.60
Thyroid Stimulating Hormone
$287.70
Troponin I
$206.25
Urinalysis Profile
$122.55
Venipuncture
$32.55
Vitamin B12 Level
$137.45
Vitamin D Level
$317.90
Labor & Delivery Charges
The following list does not include charges for anesthesia, drugs or supplies required for a particular delivery room procedure. Fees for physician services or anesthesia administration also are not reflected and will be billed separately by your physician.
 
C-Section Delivery
$11,356.65
Labor Care – First 6 Hours
$1,360.60
Normal Vaginal Delivery
$7,934.20
Rehabilitation Services Charges
The following charges reflect the most common services offered by our Rehabilitation Services Department. Patients may have additional charges, depending on the services performed.
 
Occupational Therapy (OT) Evaluation
$340.70
OT, Self-care/Home Management Training - Each 15 Minutes
$170.90
OT, Therapeutic Activity – Each 15 Minutes
$158.85
OT, Therapeutic Exercises – Each 15 Minutes
$241.35
Physical Therapy (PT) Evaluation
$340.70
PT, Gait Training Therapy
$114.75
PT, Manual Therapy – Each 15 Minutes
$171.15
PT, Neuromuscular Re-education – Each 15 Minutes
$139.35
PT, Therapeutic Exercises – Each 15 Minutes
$291.40
PT, Transfer Training – Each 15 Minutes
$170.90
Operating Room Charges
Operating Room charges are based on the complexity level for a particular operation and the amount of time the surgery takes to complete. The following list does not include charges for anesthesia, drugs or supplies required for a particular procedure. Fees for physician services or anesthesia administration also are not reflected and will be billed separately by your physician.
 
Major General Anesthesia
$1,718.65
Operating Room Level I - Initial 30 Minutes
$4,466.35
Operating Room Level II - Initial 30 Minutes
$5,140.50
Operating Room Level III - Initial 30 Minutes
$6,179.80
Operating Room Level IV - Initial 30 Minutes
$7,415.80
Operating Room Level V - Initial 30 Minutes
$8,764.10
Operating Room Level VI - Initial 30 Minutes
$10,112.40
Operating Room Level VII - Initial 30 Minutes
$12,359.60
Operating Room Time - Each Additional 30 Minutes
$1,631.65
Recovery Room Time - Each 30 Minutes In First Hour
$1,179.10
X-Ray & Radiological Charges
The following charges reflect the Hospital’s 30 most common X-Ray and Radiological procedures.
 
CT Abdomen & Pelvis with Contrast
$7,538.05
CT Abdomen & Pelvis without Contrast
$6,597.55
CT Angiography with & without Contrast
$5,139.70
CT Cervical Spine without Contrast
$3,211.05
CT Chest with Contrast
$3,135.50
CT Chest without Contrast
$3,135.50
CT Head/Brain without Contrast
$2,627.30
CT Lumbar Spine without Contrast
$3,412.45
Dexa Bone Density
$961.05
Diagnostic Mammography, including CAD, Unilateral
$438.45
LDCT Lung Cancer Screening
$902.30
Mammography Breast Screening Tomosynthesis, Bilateral
$53.60
Mammography Breast Screening, Bilateral
$371.60
Needle Localization by X-ray
$819.20
Nuclear Medicine Heart Perfusion SPECT
$8,782.60
Technetium Sestamibi Dose (used with Cardiolite stress tests)
$619.40
Ultrasound Abdomen Limited
$1,303.15
Ultrasound Breast Limited, Unilateral
$615.20
Ultrasound Pelvis Transvaginal
$848.70
X-ray Abdomen (1 View)
$487.75
X-ray Ankle (Minimum 3 Views)
$594.75
X-ray Chest (1 View)
$372.45
X-ray Chest (2 Views)
$524.50
X-ray Foot (Minimum 3 Views)
$624.40
X-ray Hand (Minimum 3 Views)
$624.40
X-ray Hip, Unilateral (2 or 3 Views)
$585.55
X-ray Knee (1 or 2 Views)
$654.20
X-ray Lumbar Spine (2 or 3 Views)
$898.30
X-ray Shoulder (4 Views)
$713.70
X-ray Wrist (Minimum 3 Views)
$624.40
Hospital Billing Policies
Licking Memorial Hospital (LMH) has a trained staff of professionals to help you with your billing and collection needs. As a courtesy to our patients, LMH submits claims to all applicable insurances provided at the time of registration.

After all insurance companies have paid their portion, LMH will send a statement to the responsible party. If you are unable to pay the amount due, please call (220) 564-1500 to discuss your payment options with a patient account representative. Our office hours are 7:30 a.m. to 5:00 p.m., Monday through Friday. LMH payment plans are free of interest and service fees.

LMH provides basic, medically necessary, hospital-level services free of charge to Ohio residents with incomes at or below the federal poverty income guidelines. In accordance with our mission, LMH also discounts bills to Licking County residents who earn no more than 250 percent of the federal poverty income guidelines. Application forms are available on the Assistance & Financial Aid section of the website, through MyChart.LMHealth.org, or by calling (220) 564-1500.

Please see the Billing section of the website for more information.