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 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, 2021.

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) 564-1500. Additional pricing information for Licking Memorial Hospital services also can be obtained by calling (220) 564-1500.

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 (XML)

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.

LMH Shoppable Services (XML)

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.

Inpatient Average Charge per Diagnostic Related Grouping

In compliance with regulations, Licking Memorial Hospital is providing information on the average inpatient charge per diagnosis-related group (DRG) in the link below. 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.

Average Charge by DRG(PDF)
Average Charge by DRG(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, IPPB, NEB Treatment Initial $94.05
Aerosol, MDI, IPPB, NEB Treatment Subsequent $94.05
Aterial Blood Draw $125.50
Bronchospasm Evaluation $416.60
Echocardiogram Complete $1,947.65
EKG $168.75
Exercise Therapy Phase II $223.15
Pulmonary Lab Diffusing Capacity $208.70
Stress Test with Drug and Isotope $1,284.15
Ventilator, Subsequent Day $762.55

Aerosol, MDI, IPPB, NEB Treatment Initial

$94.05

Aerosol, MDI, IPPB, NEB Treatment Subsequent

$94.05

Aterial Blood Draw

$125.50

Bronchospasm Evaluation

$416.60

Echocardiogram Complete

$1,947.65

EKG

$168.75

Exercise Therapy Phase II

$223.15

Pulmonary Lab Diffusing Capacity

$208.70

Stress Test with Drug and Isotope

$1,284.15

Ventilator, Subsequent Day

$762.55

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 $710.25
Critical Care - First Hour $1,870.85
Emergency Room (ER) Problem Focused Straightforward $189.60
ER Detailed Exam High Complex $935.80
ER Detailed Exam Moderate Complex $672.15
ER Problem Focused Low Complex $375.20
ER Problem Focused Moderate Complex $507.00
Laceration Repair with Sutures $812.80

Cast/Splint Procedure

$710.25

Critical Care - First Hour

$1,870.85

Emergency Room (ER) Problem Focused Straightforward

$189.60

ER Detailed Exam High Complex

$935.80

ER Detailed Exam Moderate Complex

$672.15

ER Problem Focused Low Complex

$375.20

ER Problem Focused Moderate Complex

$507.00

Laceration Repair with Sutures

$812.80

Room & Care - Per Day Charges

Coronary Care Acute $2,235.00
Inpatient Rehabilitation $2,105.00
Intensive Care Acute $2,690.00
Medical-Surgical $1,269.00
Medical-Surgical Isolation $1,475.00
Nursery $1,176.80
Post Partum $1,269.00
Psychiatric $1,812.00

Coronary Care Acute

$2,235.00

Inpatient Rehabilitation

$2,105.00

Intensive Care Acute

$2,690.00

Medical-Surgical

$1,269.00

Medical-Surgical Isolation

$1,475.00

Nursery

$1,176.80

Post Partum

$1,269.00

Psychiatric

$1,812.00

Laboratory Charges

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

B Type Natriuretic Protein $135.30
Basic Metabolic Panel $193.05
Care Lipid Panel $187.25
CBC with Differential $109.90
CBC without Differential Blood Count $109.15
Comprehensive Metabolic Panel $269.40
COVID-19 High Throughput $214.65
Culture, Blood $94.20
Culture, Urine $51.25
ER CBC with Differential $109.90
ER Urinalysis $102.90
Hemoglobin A1C $86.75
Lab Culture Gram Negative Sensitivity $43.10
Lactic Acid Level $120.15
Lipase, Serum $86.35
Liver Hepatic Function $257.50
Magnesium $39.60
Micro Albumin/Creatinine $237.40
Organism Identification $44.90
Partial Thromboplastin Time $100.70
Procalcitonin Level $326.45
Prothrombin Time $53.15
Renal Panel $173.10
Throat Strep Screen Culture $92.00
Thyroid Stimulating Hormone $241.50
Troponin I $173.10
Urinalysis Profile $102.90
Venipuncture $27.30
Vitamin B12 Level $115.40
Vitamin D Level $266.90

B Type Natriuretic Protein

$135.30

Basic Metabolic Panel

$193.05

Care Lipid Panel

$187.25

CBC with Differential

$109.90

CBC without Differential Blood Count

$109.15

Comprehensive Metabolic Panel

$269.40

COVID-19 High Throughput

$214.65

Culture, Blood

$94.20

Culture, Urine

$51.25

ER CBC with Differential

$109.90

ER Urinalysis

$102.90

Hemoglobin A1C

$86.75

Lab Culture Gram Negative Sensitivity

$43.10

Lactic Acid Level

$120.15

Lipase, Serum

$86.35

Liver Hepatic Function

$257.50

Magnesium

$39.60

Micro Albumin/Creatinine

$237.40

Organism Identification

$44.90

Partial Thromboplastin Time

$100.70

Procalcitonin Level

$326.45

Prothrombin Time

$53.15

Renal Panel

$173.10

Throat Strep Screen Culture

$92.00

Thyroid Stimulating Hormone

$241.50

Troponin I

$173.10

Urinalysis Profile

$102.90

Venipuncture

$27.30

Vitamin B12 Level

$115.40

Vitamin D Level

$266.90

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.

Amniocentesis $953.65
C-Section Delivery $8,113.60
Labor Care – First 6 Hours $1,142.30
Normal Vaginal Delivery $5,357.35

Amniocentesis

$953.65

C-Section Delivery

$8,113.60

Labor Care – First 6 Hours

$1,142.30

Normal Vaginal Delivery

$5,357.35

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.

Gait Training - 15 Minutes $96.30
Neuromuscular Re-Education - 15 Minutes $117.00
Occupational Therapy Evaluation $286.05
Occupational Therapy, Therapeutic Exercise - 15 Minutes $202.60
Physical Therapy Assistant, Therapeutic Exercise - 15 Minutes $244.60
Physical Therapy Evaluation $286.05
Physical Therapy, Manual Therapy - 15 Minutes $143.70
Physical Therapy, Therapeutic Exercise - 15 Minutes $244.60
Therapeutic Activity - 15 Minutes $133.35
Transfer Training - 15 minutes $143.45

Gait Training - 15 Minutes

$96.30

Neuromuscular Re-Education - 15 Minutes

$117.00

Occupational Therapy Evaluation

$286.05

Occupational Therapy, Therapeutic Exercise - 15 Minutes

$202.60

Physical Therapy Assistant, Therapeutic Exercise - 15 Minutes

$244.60

Physical Therapy Evaluation

$286.05

Physical Therapy, Manual Therapy - 15 Minutes

$143.70

Physical Therapy, Therapeutic Exercise - 15 Minutes

$244.60

Therapeutic Activity - 15 Minutes

$133.35

Transfer Training - 15 minutes

$143.45

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 $1,442.95
Recovery Room - First Half Hour $989.95
Surgery - Additional Half Hour $1,369.90
Surgery - First Half Hour $3,635.05

Major General Anesthesia

$1,442.95

Recovery Room - First Half Hour

$989.95

Surgery - Additional Half Hour

$1,369.90

Surgery - First Half Hour

$3,635.05

X-Ray & Radiological Procedures

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

Abdomen Single Anterior/Posterior View $409.50
Chest and Left Lateral X-ray $440.35
Chest X-ray Single View $312.70
Complete 2nd Trimester Ultrasound Pregnancy $1,076.05
CT Abdomen & Pelvis with Contrast $6,329.05
CT Abdomen & Pelvis without Contrast $5,539.40
CT Angiography with & without Contrast $4,315.35
CT Cervical Spine without Contrast $2,696.00
CT Chest with Contrast $2,632.60
CT Chest without Contrast $2,632.60
CT Head/Brain without Contrast $2,205.90
CT Lumbar Spine without Contrast $2,865.10
CT Lung Low Dose $757.55
Dexa - Bone Density Study $806.90
Digital Mammogram Screening $312.00
Early Complete Fetal Ultrasound Transabdominal $1,076.05
Endovaginal Ultrasound $712.55
Left Knee (1 or 2 Views) $549.25
Lumbosacral Spine $754.20
MRI Brain without Contrast $3,298.50
Nuclear Medicine Heart Imaging (after stress test) $7,374.00
Portable Abdomen X-Ray $409.50
Portable Chest Single View $312.70
Right Hand (3 Views) $524.25
Right Knee (1 or 2 views) $549.25
Screening Bilateral Breast Tomosynthesis $44.95
Technetium Sestamibi Dose (used with Cardiolite stress tests) $520.05
Ultrasound Abdomen Limited $1,094.10
Ultrasound Gallbladder Limited $1,094.10
Ultrasound Kidneys Limited $712.55

Abdomen Single Anterior/Posterior View

$409.50

Chest and Left Lateral X-ray

$440.35

Chest X-ray Single View

$312.70

Complete 2nd Trimester Ultrasound Pregnancy

$1,076.05

CT Abdomen & Pelvis with Contrast

$6,329.05

CT Abdomen & Pelvis without Contrast

$5,539.40

CT Angiography with & without Contrast

$4,315.35

CT Cervical Spine without Contrast

$2,696.00

CT Chest with Contrast

$2,632.60

CT Chest without Contrast

$2,632.60

CT Head/Brain without Contrast

$2,205.90

CT Lumbar Spine without Contrast

$2,865.10

CT Lung Low Dose

$757.55

Dexa - Bone Density Study

$806.90

Digital Mammogram Screening

$312.00

Early Complete Fetal Ultrasound Transabdominal

$1,076.05

Endovaginal Ultrasound

$712.55

Left Knee (1 or 2 Views)

$549.25

Lumbosacral Spine

$754.20

MRI Brain without Contrast

$3,298.50

Nuclear Medicine Heart Imaging (after stress test)

$7,374.00

Portable Abdomen X-Ray

$409.50

Portable Chest Single View

$312.70

Right Hand (3 Views)

$524.25

Right Knee (1 or 2 views)

$549.25

Screening Bilateral Breast Tomosynthesis

$44.95

Technetium Sestamibi Dose (used with Cardiolite stress tests)

$520.05

Ultrasound Abdomen Limited

$1,094.10

Ultrasound Gallbladder Limited

$1,094.10

Ultrasound Kidneys Limited

$712.55

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.