Licking Memorial Health Systems

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

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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 board, 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, 2020. 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 (740) 522-3774. To obtain charge information for the anesthesiologists, hospitalists, pathologists and ED physicians, please call (220) 564-1530. Additional pricing information for Licking Memorial Hospital services can be obtained by calling (220) 564-4500.

Comprehensive Charge List

Inpatient Average Charge per Diagnostic Related Grouping

Cardiopulmonary Charges

Aerosol, MDI, IBBP, NEB Treatment Initial $88.70
Aerosol, MDI, IPPB, NEB Treatment Subsequent $88.70
Bronchospasm Evaluation $393.00
Echocardiogram Complete $1,837.40
EKG $159.20
Exercise Therapy Phase II $210.50
Pulmonary Lab Diffusing Capacity $196.85
Pulmonary Rehab Phase III $5.00
Stress Test with Drug and Isotope $1,211.45
Thoracic Gas Volume $339.20

Emergency Department Charges

Cast/Splint Procedure $670.05
Critical Care - First Hour $1,764.95
Emergency Room (ER) Problem Focused Straightforward $178.85
ER Detailed Exam High Complex $882.80
ER Detailed Exam Moderate Complex $634.10
ER Problem Focused Low Complex $353.95
ER Problem Focused Moderate Complex $478.30
Laceration Repair with Sutures $766.75

Room & Care - Per Day Charges

Coronary Care Acute $2,108.00
Inpatient Rehabilitation $1,986.00
Intensive Care Acute $2,538.00
Medical-Surgical $1,197.00
Medical-Surgical Isolation $1,391.00
Nursery $1,110.15
Post Partum $1,197.00
Psychiatric $1,709.00

Laboratory Charges

ALT/SGPT $41.05
Basic Metabolic Panel $182.10
Care Lipid Panel $176.65
CBC with Differential $103.65
CBC without Differential Blood Count $102.95
Chlamydia RNA Detection Test $191.45
Comprehensive Metabolic Panel $254.15
Culture, Blood $88.85
Culture, Urine $48.35
ER CBC with Differential $103.65
ER Urinalysis $97.05
Gonorrhea RNA Detection Test $191.45
Hemoglobin A1C $81.80
Lab Culture Gram Negative Sensitivity $40.65
Lactic Acid Level $113.35
Lipase, Serum $81.45
Liver Hepatic Function $242.90
Magnesium $37.35
Micro Albumin/Creatinine $223.95
Organism Identification $42.35
Partial Thromboplastin Time $95.00
Prothrombin Time $50.10
Renal Panel $163.30
Throat Strep Screen Culture $86.75
Thyroid Stimulating Hormone $227.80
Troponin I $163.30
Urinalysis Profile $97.05
Venipuncture $25.75
Vitamin B12 Level $108.85
Vitamin D Level $251.75

Labor & Delivery Charges

Amniocentesis $899.65
C-Section Delivery $7,654.30
Labor Care – First 6 Hours $1,077.60
Normal Vaginal Delivery $5,054.10

Occupational & Physical Therapy Charges

Gait Training - 15 Minutes $90.85
Neuromuscular Re-Education - 15 Minutes $110.35
Occupational Therapy Evaluation $269.85
Occupational Therapy, Therapeutic Exercise - 15 Minutes $191.10
Physical Therapy Evaluation $269.85
Physical Therapy, Manual Therapy - 15 Minutes $135.55
Physical Therapy, Therapeutic Exercise - 15 Minutes $230.75
Therapeutic Activity - 15 Minutes $125.80
Transfer Training - 15 minutes $135.30
Vasopneumatic Treatment $118.90

Operating Room Charges

Major General Anesthesia $1,361.25
Recovery Room - First Half Hour $933.90
Surgery - Additional Half Hour $1,292.35
Surgery - First Half Hour $3,429.25

X-Ray & Radiological Procedures

Abdomen Single Anterior/Posterior View $386.30
Chest and Left Lateral X-ray $415.40
Chest X-ray Single View $295.00
Complete 2nd Trimester Ultrasound Pregnancy $1,015.10
CT Abdomen & Pelvis with Contrast $5,970.80
CT Abdomen & Pelvis without Contrast $5,225.85
CT Angiography with & without Contrast $4,071.05
CT Cervical Spine without Contrast $2,543.40
CT Chest with Contrast $2,483.55
CT Chest without Contrast $2,483.55
CT Head/Brain without Contrast $2,081.00
CT Lumbar Spine without Contrast $2,702.90
CT Lung Low Dose $714.65
Dexa - Bone Density Study $761.20
Digital Mammogram Screening $294.30
Endovaginal Ultrasound $672.20
Left Knee (1 or 2 Views) $581.15
Lumbosacral Spine $711.50
MRI Brain without Contrast $3,111.75
MRI Lumbar Spine without Contrast $3,111.75
Nuclear Medicine Heart Imaging (after stress test) $6,956.60
Portable Abdomen X-Ray $386.30
Portable Chest Single View $295.00
Right Foot (3 Views) $494.55
Right Hand (3 Views) $494.55
Right Knee (1 or 2 views) $518.15
Screening Bilateral Breast Tomosynthesis $42.40
Technetium Sestamibi Dose (used with Cardiolite stress tests) $490.60
Ultrasound Gallbladder Limited $1,032.15
Ultrasound Kidneys Limited $672.20

Hospital Billing Policies