Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

TRL Micro Neck-PP #2/3 25%

Professional

Both

$191.00

Hospital Charge Code	22200511
Hospital Revenue Code	222
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$191.00
Rate for Payer: Buckeye Medicare Advantage	$191.00
Rate for Payer: Cash Price	$95.50
Rate for Payer: Multiplan PHCS	$114.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$133.70
Rate for Payer: UHCCP Medicaid	$66.85

TRL Micro Partial Face-4 Areas

Professional

Both

$400.00

Hospital Charge Code	22200288
Hospital Revenue Code	222
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$400.00
Rate for Payer: Buckeye Medicare Advantage	$400.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Multiplan PHCS	$240.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$280.00
Rate for Payer: UHCCP Medicaid	$140.00

TRL Micro Superficial Face

Professional

Both

$300.00

Hospital Charge Code	22200286
Hospital Revenue Code	222
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$300.00
Rate for Payer: Buckeye Medicare Advantage	$300.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Multiplan PHCS	$180.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$210.00
Rate for Payer: UHCCP Medicaid	$105.00

TRL MicSuprfcl Face-PP#1 50%

Professional

Both

$383.00

Hospital Charge Code	22200287
Hospital Revenue Code	222
Min. Negotiated Rate	$134.05
Max. Negotiated Rate	$383.00
Rate for Payer: Buckeye Medicare Advantage	$383.00
Rate for Payer: Cash Price	$191.50
Rate for Payer: Multiplan PHCS	$229.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$268.10
Rate for Payer: UHCCP Medicaid	$134.05

TRL MicSuprfcl Face-PP#2/3 25%

Professional

Both

$191.00

Hospital Charge Code	22200508
Hospital Revenue Code	222
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$191.00
Rate for Payer: Buckeye Medicare Advantage	$191.00
Rate for Payer: Cash Price	$95.50
Rate for Payer: Multiplan PHCS	$114.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$133.70
Rate for Payer: UHCCP Medicaid	$66.85

TRL Nano Chest

Professional

Both

$200.00

Hospital Charge Code	22200282
Hospital Revenue Code	222
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$200.00
Rate for Payer: Buckeye Medicare Advantage	$200.00
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

TRL Nano Chest -PP #1 50%

Professional

Both

$256.00

Hospital Charge Code	22200283
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

TRL Nano Chest -PP #2/3 25%

Professional

Both

$127.00

Hospital Charge Code	22200506
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

TRL Nano Face

Professional

Both

$200.00

Hospital Charge Code	22200278
Hospital Revenue Code	222
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$200.00
Rate for Payer: Buckeye Medicare Advantage	$200.00
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

TRL Nano Face -PP#1 50%

Professional

Both

$256.00

Hospital Charge Code	22200279
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

TRL Nano Face-PP#2/3 25%

Professional

Both

$127.00

Hospital Charge Code	22200504
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

TRL Nano Hands

Professional

Both

$100.00

Hospital Charge Code	22200284
Hospital Revenue Code	222
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$100.00
Rate for Payer: Buckeye Medicare Advantage	$100.00
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

TRL Nano Hands - PP #1 50%

Professional

Both

$129.00

Hospital Charge Code	22200285
Hospital Revenue Code	222
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$129.00
Rate for Payer: Buckeye Medicare Advantage	$129.00
Rate for Payer: Cash Price	$64.50
Rate for Payer: Multiplan PHCS	$77.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$90.30
Rate for Payer: UHCCP Medicaid	$45.15

TRL Nano Hands - PP #2/3 25%

Professional

Both

$63.00

Hospital Charge Code	22200507
Hospital Revenue Code	222
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$63.00
Rate for Payer: Buckeye Medicare Advantage	$63.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Multiplan PHCS	$37.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$44.10
Rate for Payer: UHCCP Medicaid	$22.05

TRL Nano Neck

Professional

Both

$150.00

Hospital Charge Code	22200280
Hospital Revenue Code	222
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$150.00
Rate for Payer: Buckeye Medicare Advantage	$150.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Multiplan PHCS	$90.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$105.00
Rate for Payer: UHCCP Medicaid	$52.50

TRL Nano Neck -PP#1 50%

Professional

Both

$192.00

Hospital Charge Code	22200281
Hospital Revenue Code	222
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$192.00
Rate for Payer: Buckeye Medicare Advantage	$192.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Multiplan PHCS	$115.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$134.40
Rate for Payer: UHCCP Medicaid	$67.20

TRL Nano Neck-PPV#2/3 25%

Professional

Both

$95.00

Hospital Charge Code	22200505
Hospital Revenue Code	222
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$95.00
Rate for Payer: Buckeye Medicare Advantage	$95.00
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

TRL SINGLE LESION PER SPOT

Professional

Both

$100.00

Hospital Charge Code	22200304
Hospital Revenue Code	222
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$100.00
Rate for Payer: Buckeye Medicare Advantage	$100.00
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

TRLUML PERIP ATHRC ILIAC ART

Professional

Both

$2,200.00

Service Code	HCPCS 0238T
Hospital Charge Code	76102739
Hospital Revenue Code	360
Min. Negotiated Rate	$770.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Buckeye Medicare Advantage	$2,200.00
Rate for Payer: Cash Price	$1,100.00
Rate for Payer: Multiplan PHCS	$1,320.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,540.00
Rate for Payer: UHCCP Medicaid	$770.00

TRLUML PERIP ATHRC RENAL AR(P

Professional

Both

$2,200.00

Service Code	HCPCS 0234T
Hospital Charge Code	510P0023
Hospital Revenue Code	510
Min. Negotiated Rate	$770.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Buckeye Medicare Advantage	$2,200.00
Rate for Payer: Cash Price	$1,100.00
Rate for Payer: Multiplan PHCS	$1,320.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,540.00
Rate for Payer: UHCCP Medicaid	$770.00

TRLUML PERIP ATHRC RENAL AR(T

Facility

$14,797.00

Service Code	HCPCS 0234T
Hospital Charge Code	510T0023
Hospital Revenue Code	510
Min. Negotiated Rate	$1,923.61
Max. Negotiated Rate	$14,205.12
Rate for Payer: Aetna Commercial	$11,393.69
Rate for Payer: Anthem POS/PPO/Traditional	$11,541.66
Rate for Payer: Cash Price	$7,398.50
Rate for Payer: Cigna Commercial	$12,281.51
Rate for Payer: First Health Commercial	$14,057.15
Rate for Payer: Humana Commercial	$12,577.45
Rate for Payer: Medical Mutual Of Ohio HMO	$12,133.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$10,920.19
Rate for Payer: Molina Healthcare Benefit Exchange	$4,439.10
Rate for Payer: Ohio Health Choice Commercial	$13,021.36
Rate for Payer: Ohio Health Group HMO	$11,097.75
Rate for Payer: Ohio Health Group PPO Differential	$2,959.40
Rate for Payer: Ohio Health Group PPO No Differential	$1,923.61
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,587.07
Rate for Payer: PHCS Commercial	$14,205.12
Rate for Payer: United Healthcare All Payer	$13,021.36

TRLUML PERIP ATHRC RENAL AR(T

Facility

$14,797.00

Service Code	HCPCS 0234T
Hospital Charge Code	510T0023
Hospital Revenue Code	510
Min. Negotiated Rate	$1,923.61
Max. Negotiated Rate	$14,205.12
Rate for Payer: Aetna Commercial	$11,393.69
Rate for Payer: Anthem Medicaid	$5,088.69
Rate for Payer: Anthem Medicare Advantage/PPO	$9,513.29
Rate for Payer: Anthem POS/PPO/Traditional	$11,541.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,318.61
Rate for Payer: CareSource Just4Me Medicare	$12,842.94
Rate for Payer: Cash Price	$7,398.50
Rate for Payer: Cash Price	$7,398.50
Rate for Payer: Cigna Commercial	$12,281.51
Rate for Payer: First Health Commercial	$14,057.15
Rate for Payer: Humana Commercial	$12,577.45
Rate for Payer: Humana KY Medicaid	$5,088.69
Rate for Payer: Humana Medicare Advantage	$9,513.29
Rate for Payer: Kentucky WC Medicaid	$5,140.48
Rate for Payer: Medical Mutual Of Ohio HMO	$12,133.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$10,920.19
Rate for Payer: Molina Healthcare Benefit Exchange	$11,415.95
Rate for Payer: Molina Healthcare Medicaid	$5,190.79
Rate for Payer: Ohio Health Choice Commercial	$13,021.36
Rate for Payer: Ohio Health Group HMO	$11,097.75
Rate for Payer: Ohio Health Group PPO Differential	$2,959.40
Rate for Payer: Ohio Health Group PPO No Differential	$1,923.61
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,587.07
Rate for Payer: PHCS Commercial	$14,205.12
Rate for Payer: United Healthcare All Payer	$13,021.36

TRLUML PERIP ATHRC RENAL ART

Facility

$16,997.00

Service Code	HCPCS 0234T
Hospital Charge Code	50000001
Hospital Revenue Code	510
Min. Negotiated Rate	$2,209.61
Max. Negotiated Rate	$16,317.12
Rate for Payer: Aetna Commercial	$13,087.69
Rate for Payer: Anthem Medicaid	$5,845.27
Rate for Payer: Anthem Medicare Advantage/PPO	$9,513.29
Rate for Payer: Anthem POS/PPO/Traditional	$13,257.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,318.61
Rate for Payer: CareSource Just4Me Medicare	$12,842.94
Rate for Payer: Cash Price	$8,498.50
Rate for Payer: Cash Price	$8,498.50
Rate for Payer: Cigna Commercial	$14,107.51
Rate for Payer: First Health Commercial	$16,147.15
Rate for Payer: Humana Commercial	$14,447.45
Rate for Payer: Humana KY Medicaid	$5,845.27
Rate for Payer: Humana Medicare Advantage	$9,513.29
Rate for Payer: Kentucky WC Medicaid	$5,904.76
Rate for Payer: Medical Mutual Of Ohio HMO	$13,937.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$12,543.79
Rate for Payer: Molina Healthcare Benefit Exchange	$11,415.95
Rate for Payer: Molina Healthcare Medicaid	$5,962.55
Rate for Payer: Ohio Health Choice Commercial	$14,957.36
Rate for Payer: Ohio Health Group HMO	$12,747.75
Rate for Payer: Ohio Health Group PPO Differential	$3,399.40
Rate for Payer: Ohio Health Group PPO No Differential	$2,209.61
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,269.07
Rate for Payer: PHCS Commercial	$16,317.12
Rate for Payer: United Healthcare All Payer	$14,957.36

TRLUML PERIP ATHRC RENAL ART

Facility

$16,997.00

Service Code	HCPCS 0234T
Hospital Charge Code	51000023
Hospital Revenue Code	510
Min. Negotiated Rate	$2,209.61
Max. Negotiated Rate	$16,317.12
Rate for Payer: Aetna Commercial	$13,087.69
Rate for Payer: Anthem Medicaid	$5,845.27
Rate for Payer: Anthem Medicare Advantage/PPO	$9,513.29
Rate for Payer: Anthem POS/PPO/Traditional	$13,257.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,318.61
Rate for Payer: CareSource Just4Me Medicare	$12,842.94
Rate for Payer: Cash Price	$8,498.50
Rate for Payer: Cash Price	$8,498.50
Rate for Payer: Cigna Commercial	$14,107.51
Rate for Payer: First Health Commercial	$16,147.15
Rate for Payer: Humana Commercial	$14,447.45
Rate for Payer: Humana KY Medicaid	$5,845.27
Rate for Payer: Humana Medicare Advantage	$9,513.29
Rate for Payer: Kentucky WC Medicaid	$5,904.76
Rate for Payer: Medical Mutual Of Ohio HMO	$13,937.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$12,543.79
Rate for Payer: Molina Healthcare Benefit Exchange	$11,415.95
Rate for Payer: Molina Healthcare Medicaid	$5,962.55
Rate for Payer: Ohio Health Choice Commercial	$14,957.36
Rate for Payer: Ohio Health Group HMO	$12,747.75
Rate for Payer: Ohio Health Group PPO Differential	$3,399.40
Rate for Payer: Ohio Health Group PPO No Differential	$2,209.61
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,269.07
Rate for Payer: PHCS Commercial	$16,317.12
Rate for Payer: United Healthcare All Payer	$14,957.36

TRLUML PERIP ATHRC RENAL ART

Facility

$16,997.00

Service Code	HCPCS 0234T
Hospital Charge Code	50000001
Hospital Revenue Code	510
Min. Negotiated Rate	$2,209.61
Max. Negotiated Rate	$16,317.12
Rate for Payer: Aetna Commercial	$13,087.69
Rate for Payer: Anthem POS/PPO/Traditional	$13,257.66
Rate for Payer: Cash Price	$8,498.50
Rate for Payer: Cigna Commercial	$14,107.51
Rate for Payer: First Health Commercial	$16,147.15
Rate for Payer: Humana Commercial	$14,447.45
Rate for Payer: Medical Mutual Of Ohio HMO	$13,937.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$12,543.79
Rate for Payer: Molina Healthcare Benefit Exchange	$5,099.10
Rate for Payer: Ohio Health Choice Commercial	$14,957.36
Rate for Payer: Ohio Health Group HMO	$12,747.75
Rate for Payer: Ohio Health Group PPO Differential	$3,399.40
Rate for Payer: Ohio Health Group PPO No Differential	$2,209.61
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,269.07
Rate for Payer: PHCS Commercial	$16,317.12
Rate for Payer: United Healthcare All Payer	$14,957.36

Know your out-of-pocket cost for care.

All Charges