Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

BBL AA Partial Face-PP#1 50%

Professional

Both

$256.00

Hospital Charge Code	22200268
Hospital Revenue Code	222
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$256.00
Rate for Payer: Buckeye Medicare Advantage	$256.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Multiplan PHCS	$153.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$179.20
Rate for Payer: UHCCP Medicaid	$89.60

BBL AA Partial Face-PP#2/3 25%

Professional

Both

$127.00

Hospital Charge Code	22200498
Hospital Revenue Code	222
Min. Negotiated Rate	$44.45
Max. Negotiated Rate	$127.00
Rate for Payer: Buckeye Medicare Advantage	$127.00
Rate for Payer: Cash Price	$63.50
Rate for Payer: Multiplan PHCS	$76.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$88.90
Rate for Payer: UHCCP Medicaid	$44.45

BBLP Cheeks

Professional

Both

$250.00

Hospital Charge Code	22200240
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$250.00
Rate for Payer: Buckeye Medicare Advantage	$250.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Multiplan PHCS	$150.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$175.00
Rate for Payer: UHCCP Medicaid	$87.50

BBLP Cheeks-PP #1 50%

Professional

Both

$319.00

Hospital Charge Code	22200241
Hospital Revenue Code	222
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$319.00
Rate for Payer: Buckeye Medicare Advantage	$319.00
Rate for Payer: Cash Price	$159.50
Rate for Payer: Multiplan PHCS	$191.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$223.30
Rate for Payer: UHCCP Medicaid	$111.65

BBLP Cheeks-PP #2/3 25%

Professional

Both

$159.00

Hospital Charge Code	22200487
Hospital Revenue Code	222
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$159.00
Rate for Payer: Buckeye Medicare Advantage	$159.00
Rate for Payer: Cash Price	$79.50
Rate for Payer: Multiplan PHCS	$95.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$111.30
Rate for Payer: UHCCP Medicaid	$55.65

BBLP Chest

Professional

Both

$350.00

Hospital Charge Code	22200246
Hospital Revenue Code	222
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$350.00
Rate for Payer: Buckeye Medicare Advantage	$350.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Multiplan PHCS	$210.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$245.00
Rate for Payer: UHCCP Medicaid	$122.50

BBLP Chest - PP #1 50%

Professional

Both

$446.00

Hospital Charge Code	22200247
Hospital Revenue Code	222
Min. Negotiated Rate	$156.10
Max. Negotiated Rate	$446.00
Rate for Payer: Buckeye Medicare Advantage	$446.00
Rate for Payer: Cash Price	$223.00
Rate for Payer: Multiplan PHCS	$267.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$312.20
Rate for Payer: UHCCP Medicaid	$156.10

BBLP Chest - PP #2/3 25%

Professional

Both

$223.00

Hospital Charge Code	22200490
Hospital Revenue Code	222
Min. Negotiated Rate	$78.05
Max. Negotiated Rate	$223.00
Rate for Payer: Buckeye Medicare Advantage	$223.00
Rate for Payer: Cash Price	$111.50
Rate for Payer: Multiplan PHCS	$133.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$156.10
Rate for Payer: UHCCP Medicaid	$78.05

BBLP Feet

Professional

Both

$250.00

Hospital Charge Code	22200258
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$250.00
Rate for Payer: Buckeye Medicare Advantage	$250.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Multiplan PHCS	$150.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$175.00
Rate for Payer: UHCCP Medicaid	$87.50

BBLP Feet - PP #1 50%

Professional

Both

$319.00

Hospital Charge Code	22200259
Hospital Revenue Code	222
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$319.00
Rate for Payer: Buckeye Medicare Advantage	$319.00
Rate for Payer: Cash Price	$159.50
Rate for Payer: Multiplan PHCS	$191.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$223.30
Rate for Payer: UHCCP Medicaid	$111.65

BBLP Feet - PP #2/3 25%

Professional

Both

$159.00

Hospital Charge Code	22200496
Hospital Revenue Code	222
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$159.00
Rate for Payer: Buckeye Medicare Advantage	$159.00
Rate for Payer: Cash Price	$79.50
Rate for Payer: Multiplan PHCS	$95.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$111.30
Rate for Payer: UHCCP Medicaid	$55.65

BBLP FOREARMS

Professional

Both

$550.00

Hospital Charge Code	22200250
Hospital Revenue Code	222
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$550.00
Rate for Payer: Buckeye Medicare Advantage	$550.00
Rate for Payer: Cash Price	$275.00
Rate for Payer: Multiplan PHCS	$330.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$385.00
Rate for Payer: UHCCP Medicaid	$192.50

BBLP Forearms - PP #1 50%

Professional

Both

$702.00

Hospital Charge Code	22200251
Hospital Revenue Code	222
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$702.00
Rate for Payer: Buckeye Medicare Advantage	$702.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Multiplan PHCS	$421.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$491.40
Rate for Payer: UHCCP Medicaid	$245.70

BBLP Forearms - PP #2/3 25%

Professional

Both

$350.00

Hospital Charge Code	22200492
Hospital Revenue Code	222
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$350.00
Rate for Payer: Buckeye Medicare Advantage	$350.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Multiplan PHCS	$210.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$245.00
Rate for Payer: UHCCP Medicaid	$122.50

BBLP Full Face

Professional

Both

$450.00

Hospital Charge Code	22200238
Hospital Revenue Code	222
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$450.00
Rate for Payer: Buckeye Medicare Advantage	$450.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Multiplan PHCS	$270.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$315.00
Rate for Payer: UHCCP Medicaid	$157.50

BBLP Full Face-PP #1 50%

Professional

Both

$575.00

Hospital Charge Code	22200239
Hospital Revenue Code	222
Min. Negotiated Rate	$201.25
Max. Negotiated Rate	$575.00
Rate for Payer: Buckeye Medicare Advantage	$575.00
Rate for Payer: Cash Price	$287.50
Rate for Payer: Multiplan PHCS	$345.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$402.50
Rate for Payer: UHCCP Medicaid	$201.25

BBLP Full Face-PP#2/3 25%

Professional

Both

$286.00

Hospital Charge Code	22200486
Hospital Revenue Code	222
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$286.00
Rate for Payer: Buckeye Medicare Advantage	$286.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Multiplan PHCS	$171.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$200.20
Rate for Payer: UHCCP Medicaid	$100.10

BBLP Hands

Professional

Both

$250.00

Hospital Charge Code	22200252
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$250.00
Rate for Payer: Buckeye Medicare Advantage	$250.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Multiplan PHCS	$150.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$175.00
Rate for Payer: UHCCP Medicaid	$87.50

BBLP Hands - PP #1 50%

Professional

Both

$319.00

Hospital Charge Code	22200253
Hospital Revenue Code	222
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$319.00
Rate for Payer: Buckeye Medicare Advantage	$319.00
Rate for Payer: Cash Price	$159.50
Rate for Payer: Multiplan PHCS	$191.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$223.30
Rate for Payer: UHCCP Medicaid	$111.65

BBLP Hands - PP #2/3 25%

Professional

Both

$159.00

Hospital Charge Code	22200493
Hospital Revenue Code	222
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$159.00
Rate for Payer: Buckeye Medicare Advantage	$159.00
Rate for Payer: Cash Price	$79.50
Rate for Payer: Multiplan PHCS	$95.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$111.30
Rate for Payer: UHCCP Medicaid	$55.65

BBLP LOWER LEGS

Professional

Both

$800.00

Hospital Charge Code	22200256
Hospital Revenue Code	222
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$800.00
Rate for Payer: Buckeye Medicare Advantage	$800.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Multiplan PHCS	$480.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$560.00
Rate for Payer: UHCCP Medicaid	$280.00

BBLP Lower Legs-PP#1 50%

Professional

Both

$1,020.00

Hospital Charge Code	22200257
Hospital Revenue Code	222
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Buckeye Medicare Advantage	$1,020.00
Rate for Payer: Cash Price	$510.00
Rate for Payer: Multiplan PHCS	$612.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$714.00
Rate for Payer: UHCCP Medicaid	$357.00

BBLP Lower Legs-PP#2/3 25%

Professional

Both

$510.00

Hospital Charge Code	22200495
Hospital Revenue Code	222
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$510.00
Rate for Payer: Buckeye Medicare Advantage	$510.00
Rate for Payer: Cash Price	$255.00
Rate for Payer: Multiplan PHCS	$306.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$357.00
Rate for Payer: UHCCP Medicaid	$178.50

BBLP Neck

Professional

Both

$250.00

Hospital Charge Code	22200242
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$250.00
Rate for Payer: Buckeye Medicare Advantage	$250.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Multiplan PHCS	$150.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$175.00
Rate for Payer: UHCCP Medicaid	$87.50

BBLP Neck - PP #1 50%

Professional

Both

$319.00

Hospital Charge Code	22200243
Hospital Revenue Code	222
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$319.00
Rate for Payer: Buckeye Medicare Advantage	$319.00
Rate for Payer: Cash Price	$159.50
Rate for Payer: Multiplan PHCS	$191.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$223.30
Rate for Payer: UHCCP Medicaid	$111.65

Know your out-of-pocket cost for care.

All Charges