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 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, 2018. 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

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) 564-4500.

Comprehensive Charge List (PDF)
Comprehensive Charge List (XML)

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.

Aerosol, MDI, IBBP, NEBTX Treatment Initial $78.90
Aerosol, MDI, IPPB, NEBTX Treatment Subsequent $78.90
Bronchospasm Evaluation $349.75
Echocardiogram Complete $1,635.25
EKG $141.65
Exercise Therapy Phase II $187.30
Pulmonary Lab Diffusing Capacity $175.15
Pulmonary Rehab Phase III $5.00
Stress Test with Drug and Isotope $1,078.15
Thoracic Gas Volume $175.15

Aerosol, MDI, IBBP, NEBTX Treatment Initial

$78.90

Aerosol, MDI, IPPB, NEBTX Treatment Subsequent

$78.90

Bronchospasm Evaluation

$349.75

Echocardiogram Complete

$1,635.25

EKG

$141.65

Exercise Therapy Phase II

$187.30

Pulmonary Lab Diffusing Capacity

$175.15

Pulmonary Rehab Phase III

$5.00

Stress Test with Drug and Isotope

$1,078.15

Thoracic Gas Volume

$175.15

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 $596.30
Critical Care - First Hour $1,570.80
Emergency Room (ER) Problem Focused Straightforward $159.15
ER Detailed Exam High Complex $785.65
ER Detailed Exam Moderate Complex $564.30
ER Problem Focused Low Complex $315.00
ER Problem Focused Moderate Complex $425.65
Laceration Repair with Sutures $682.40

Cast/Splint Procedure

$596.30

Critical Care - First Hour

$1,570.80

Emergency Room (ER) Problem Focused Straightforward

$159.15

ER Detailed Exam High Complex

$785.65

ER Detailed Exam Moderate Complex

$564.30

ER Problem Focused Low Complex

$315.00

ER Problem Focused Moderate Complex

$425.65

Laceration Repair with Sutures

$682.40

Room & Care - Per Day Charges

Coronary Care Acute $1,876.00
Inpatient Rehabilitation $1,768.00
Intensive Care Acute $2,258.00
Medical-Surgical $1,065.00
Medical-Surgical Isolation $1,238.00
Nursery $988.00
Post Partum $1,065.00
Psychiatric $1,521.00

Coronary Care Acute

$1,876.00

Inpatient Rehabilitation

$1,768.00

Intensive Care Acute

$2,258.00

Medical-Surgical

$1,065.00

Medical-Surgical Isolation

$1,238.00

Nursery

$988.00

Post Partum

$1,065.00

Psychiatric

$1,521.00

Laboratory Charges

The following charges reflect the Hospital’s 30 most common Laboratory procedures.

ALT/SGPT $36.50
Basic Metabolic Panel $162.00
Care Lipid Panel $157.20
CBC with Differential $92.20
CBC without Differential Blood Count $91.60
Collection Charge/Venipuncture $22.85
Comprehensive Metabolic Panel $226.15
Creatinine, Serum $45.25
Culture, Blood $79.05
Culture, Urine $43.00
ER CBC with Differential $92.20
ER Urinalysis $86.35
Hematocrit $21.80
Hemoglobin $21.80
Hemoglobin A1C $72.75
Lipase, Serum $72.45
Liver Hepatic Function $216.15
Magnesium $33.20
Micro Albumin/Creatinine $199.25
Organism Identification $37.65
Partial Thromboplastin Time $84.50
Prothrombin Time $44.55
Renal Panel $145.30
Throat Strep Screen Culture $77.15
Thyroid Stimulating Hormone $202.70
Toxicology Urine $889.75
Troponin I $145.30
Urinalysis Profile $86.35
Venipuncture $22.85
Vitamin D Level $224.05

ALT/SGPT

$36.50

Basic Metabolic Panel

$162.00

Care Lipid Panel

$157.20

CBC with Differential

$92.20

CBC without Differential Blood Count

$91.60

Collection Charge/Venipuncture

$22.85

Comprehensive Metabolic Panel

$226.15

Creatinine, Serum

$45.25

Culture, Blood

$79.05

Culture, Urine

$43.00

ER CBC with Differential

$92.20

ER Urinalysis

$86.35

Hematocrit

$21.80

Hemoglobin

$21.80

Hemoglobin A1C

$72.75

Lipase, Serum

$72.45

Liver Hepatic Function

$216.15

Magnesium

$33.20

Micro Albumin/Creatinine

$199.25

Organism Identification

$37.65

Partial Thromboplastin Time

$84.50

Prothrombin Time

$44.55

Renal Panel

$145.30

Throat Strep Screen Culture

$77.15

Thyroid Stimulating Hormone

$202.70

Toxicology Urine

$889.75

Troponin I

$145.30

Urinalysis Profile

$86.35

Venipuncture

$22.85

Vitamin D Level

$224.05

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.

Amniocentesis $361.25
C-Section Delivery $6,657.15
Labor Care – First 6 Hours $959.05
Normal Vaginal Delivery $4,343.00

Amniocentesis

$361.25

C-Section Delivery

$6,657.15

Labor Care – First 6 Hours

$959.05

Normal Vaginal Delivery

$4,343.00

Occupational & Physical Therapy Charges

The following charges reflect the most common services offered by our Occupational and Physical Therapy department. Patients may have additional charges, depending on the services performed.

Electrical Stimulation Unattended $56.05
Gait Training - 15 Minutes $80.85
Neuromuscular Re-Education - 15 Minutes $98.20
Occupational Therapy Evaluation $240.10
Occupational Therapy, Therapeutic Exercise - 15 Minutes $170.05
Physical Therapy Evaluation $240.10
Physical Therapy, Therapeutic Exercise - 15 Minutes $205.30
Therapeutic Activity - 15 Minutes $111.90
Transfer Training - 15 minutes $120.35
Vasopneumatic Treatment $105.80

Electrical Stimulation Unattended

$56.05

Gait Training - 15 Minutes

$80.85

Neuromuscular Re-Education - 15 Minutes

$98.20

Occupational Therapy Evaluation

$240.10

Occupational Therapy, Therapeutic Exercise - 15 Minutes

$170.05

Physical Therapy Evaluation

$240.10

Physical Therapy, Therapeutic Exercise - 15 Minutes

$205.30

Therapeutic Activity - 15 Minutes

$111.90

Transfer Training - 15 minutes

$120.35

Vasopneumatic Treatment

$105.80

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 $1,211.50
Recovery Room - First Half Hour $831.10
Surgery - Additional Half Hour $1,150.15
Surgery - First Half Hour $3,051.95

Major General Anesthesia

$1,211.50

Recovery Room - First Half Hour

$831.10

Surgery - Additional Half Hour

$1,150.15

Surgery - First Half Hour

$3,051.95

X-Ray & Radiological Procedures

The following charges reflect the Hospital’s 30 most common X-Ray and Radiological procedures.

Abdomen Single Anterior/Posterior View $343.75
Cervical Spine 2 Views Anterior and Lateral $512.15
Chest and Left Lateral X-ray $369.65
Chest X-ray Single View $262.55
Complete 2nd Trimester Ultrasound Pregnancy $903.40
CT Abdomen & Pelvis with Contrast $5,313.95
CT Abdomen & Pelvis without Contrast $4,650.95
CT Angiography with & without Contrast $3,623.20
CT Cervical Spine without Contrast $2,263.55
CT Chest with Contrast $2,210.30
CT Chest without Contrast $2,210.30
CT Head/Brain without Contrast $1,852.05
CT Lung Low Dose $636.00
Dexa - Bone Density Study $677.45
Digital Mammogram Screening $261.85
Endovaginal Ultrasound $598.25
Left Foot (3 Views minimum) $440.10
Left Hand (3 Views Minimum) $440.10
Left Knee (1 or 2 Views) $461.10
Lumbosacral Spine $633.20
MRI Brain without Contrast $2,769.40
MRI Lumbar Spine without Contrast $2,769.40
Nuclear Medicine Heart Imaging (after stress test) $6,191.30
Portable Chest Single View $262.55
Right Hand (3 Views) $440.10
Right Knee (1 or 2 views) $461.10
Screening Bilateral Breast Tomosynthesis $25.00
Technetium Sestamibi Dose (used with Cardiolite stress tests) $436.60
Ultrasound Gallbladder Limited $918.55
Ultrasound Kidneys Limited $598.25

Abdomen Single Anterior/Posterior View

$343.75

Cervical Spine 2 Views Anterior and Lateral

$512.15

Chest and Left Lateral X-ray

$369.65

Chest X-ray Single View

$262.55

Complete 2nd Trimester Ultrasound Pregnancy

$903.40

CT Abdomen & Pelvis with Contrast

$5,313.95

CT Abdomen & Pelvis without Contrast

$4,650.95

CT Angiography with & without Contrast

$3,623.20

CT Cervical Spine without Contrast

$2,263.55

CT Chest with Contrast

$2,210.30

CT Chest without Contrast

$2,210.30

CT Head/Brain without Contrast

$1,852.05

CT Lung Low Dose

$636.00

Dexa - Bone Density Study

$677.45

Digital Mammogram Screening

$261.85

Endovaginal Ultrasound

$598.25

Left Foot (3 Views minimum)

$440.10

Left Hand (3 Views Minimum)

$440.10

Left Knee (1 or 2 Views)

$461.10

Lumbosacral Spine

$633.20

MRI Brain without Contrast

$2,769.40

MRI Lumbar Spine without Contrast

$2,769.40

Nuclear Medicine Heart Imaging (after stress test)

$6,191.30

Portable Chest Single View

$262.55

Right Hand (3 Views)

$440.10

Right Knee (1 or 2 views)

$461.10

Screening Bilateral Breast Tomosynthesis

$25.00

Technetium Sestamibi Dose (used with Cardiolite stress tests)

$436.60

Ultrasound Gallbladder Limited

$918.55

Ultrasound Kidneys Limited

$598.25

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 insurances 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) 564-4500 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 interest free and have no service fees.

Licking Memorial Hospital 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. Applications may be obtained at the Cashier Office located adjacent to the Hospital lobby or by calling (220) 564-4500.

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