Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

TRL Micro Hands

Professional

Both

$200.00

Hospital Charge Code	22200294
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

TRL Micro Mod Face

Professional

Both

$500.00

Hospital Charge Code	22200290
Hospital Revenue Code	222
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$350.00
Rate for Payer: Cash Price	$250.00
Rate for Payer: Multiplan PHCS	$300.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$350.00
Rate for Payer: UHCCP Medicaid	$175.00

TRL Micro Mod Face-PP#1 50%

Professional

Both

$639.00

Hospital Charge Code	22200291
Hospital Revenue Code	222
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$447.30
Rate for Payer: Cash Price	$319.50
Rate for Payer: Multiplan PHCS	$383.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$447.30
Rate for Payer: UHCCP Medicaid	$223.65

TRL Micro Mod Face-PP#2/3 25%

Professional

Both

$318.00

Hospital Charge Code	22200510
Hospital Revenue Code	222
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$222.60
Rate for Payer: Cash Price	$159.00
Rate for Payer: Multiplan PHCS	$190.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$222.60
Rate for Payer: UHCCP Medicaid	$111.30

TRL Micro Neck

Professional

Both

$300.00

Hospital Charge Code	22200292
Hospital Revenue Code	222
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$210.00
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 Micro Neck-PP #1 50%

Professional

Both

$383.00

Hospital Charge Code	22200293
Hospital Revenue Code	222
Min. Negotiated Rate	$134.05
Max. Negotiated Rate	$268.10
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 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	$133.70
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	$280.00
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	$210.00
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	$268.10
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	$133.70
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	$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

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	$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

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	$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

TRL Nano Face

Professional

Both

$200.00

Hospital Charge Code	22200278
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

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	$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

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	$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

TRL Nano Hands

Professional

Both

$100.00

Hospital Charge Code	22200284
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

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	$90.30
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	$44.10
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	$105.00
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	$134.40
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	$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

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	$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

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	$1,540.00
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

Know your out-of-pocket cost for care.

All Charges