Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

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	$357.00
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	$175.00
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	$223.30
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 Neck - PP #2/3 25%

Professional

Both

$159.00

Hospital Charge Code	22200488
Hospital Revenue Code	222
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$111.30
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 Shoulders

Professional

Both

$350.00

Hospital Charge Code	22200244
Hospital Revenue Code	222
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$245.00
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 Shoulders-PP#1 50%

Professional

Both

$446.00

Hospital Charge Code	22200245
Hospital Revenue Code	222
Min. Negotiated Rate	$156.10
Max. Negotiated Rate	$312.20
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 Shoulders-PP#2/ 3 25%

Professional

Both

$223.00

Hospital Charge Code	22200489
Hospital Revenue Code	222
Min. Negotiated Rate	$78.05
Max. Negotiated Rate	$156.10
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 SPOT TREATMENT UP TO 5

Professional

Both

$100.00

Hospital Charge Code	22200260
Hospital Revenue Code	222
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$70.00
Rate for Payer: Cash Price	$50.00
Rate for Payer: Multiplan PHCS	$60.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$70.00
Rate for Payer: UHCCP Medicaid	$35.00

BBLP UPPER ARMS

Professional

Both

$700.00

Hospital Charge Code	22200248
Hospital Revenue Code	222
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$490.00
Rate for Payer: Cash Price	$350.00
Rate for Payer: Multiplan PHCS	$420.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$490.00
Rate for Payer: UHCCP Medicaid	$245.00

BBLP Upper Arms-PP #1 50%

Professional

Both

$893.00

Hospital Charge Code	22200249
Hospital Revenue Code	222
Min. Negotiated Rate	$312.55
Max. Negotiated Rate	$625.10
Rate for Payer: Cash Price	$446.50
Rate for Payer: Multiplan PHCS	$535.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$625.10
Rate for Payer: UHCCP Medicaid	$312.55

BBLP Upper Arms-PP #2/3 25%

Professional

Both

$446.00

Hospital Charge Code	22200491
Hospital Revenue Code	222
Min. Negotiated Rate	$156.10
Max. Negotiated Rate	$312.20
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 Upper legs/thigh-PP#1 50%

Professional

Both

$1,659.00

Hospital Charge Code	22200255
Hospital Revenue Code	222
Min. Negotiated Rate	$580.65
Max. Negotiated Rate	$1,161.30
Rate for Payer: Cash Price	$829.50
Rate for Payer: Multiplan PHCS	$995.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,161.30
Rate for Payer: UHCCP Medicaid	$580.65

BBLP UPPER LEGS/THIGHS

Professional

Both

$1,300.00

Hospital Charge Code	22200254
Hospital Revenue Code	222
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$910.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Multiplan PHCS	$780.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$910.00
Rate for Payer: UHCCP Medicaid	$455.00

BBLP Uppr leg/thigh-PP#2/3 25%

Professional

Both

$828.00

Hospital Charge Code	22200494
Hospital Revenue Code	222
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$579.60
Rate for Payer: Cash Price	$414.00
Rate for Payer: Multiplan PHCS	$496.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$579.60
Rate for Payer: UHCCP Medicaid	$289.80

BBLV Chest

Professional

Both

$250.00

Hospital Charge Code	22200275
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$175.00
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

BBLV Chest - PP #1 50%

Professional

Both

$319.00

Hospital Charge Code	22200276
Hospital Revenue Code	222
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$223.30
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

BBLV Chest - PP #2/3 25%

Professional

Both

$159.00

Hospital Charge Code	22200502
Hospital Revenue Code	222
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$111.30
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

BBLV Full Face

Professional

Both

$250.00

Hospital Charge Code	22200269
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$175.00
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

BBLV Full Face-PP #1 50%

Professional

Both

$319.00

Hospital Charge Code	22200270
Hospital Revenue Code	222
Min. Negotiated Rate	$111.65
Max. Negotiated Rate	$223.30
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

BBLV Full Face-PP#2/3 25%

Professional

Both

$159.00

Hospital Charge Code	22200499
Hospital Revenue Code	222
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$111.30
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

BBLV Neck

Professional

Both

$200.00

Hospital Charge Code	22200273
Hospital Revenue Code	222
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$140.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Multiplan PHCS	$120.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$140.00
Rate for Payer: UHCCP Medicaid	$70.00

BBLV Neck - PP #1 50%

Professional

Both

$256.00

Hospital Charge Code	22200274
Hospital Revenue Code	222
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$179.20
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

BBLV Neck - PP #2/3 25%

Professional

Both

$127.00

Hospital Charge Code	22200501
Hospital Revenue Code	222
Min. Negotiated Rate	$44.45
Max. Negotiated Rate	$88.90
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

BBLV Partial Face

Professional

Both

$95.00

Hospital Charge Code	22200271
Hospital Revenue Code	222
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$66.50
Rate for Payer: Cash Price	$47.50
Rate for Payer: Multiplan PHCS	$57.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$66.50
Rate for Payer: UHCCP Medicaid	$33.25

BBLV Partial Face-PP#1 50%

Professional

Both

$122.00

Hospital Charge Code	22200272
Hospital Revenue Code	222
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$85.40
Rate for Payer: Cash Price	$61.00
Rate for Payer: Multiplan PHCS	$73.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$85.40
Rate for Payer: UHCCP Medicaid	$42.70

Know your out-of-pocket cost for care.

All Charges