One of the most difficult, yet important, issues you must decide as the owner of a medical spa or cosmetic medical practice is how much to charge for your products or services. While there is no one single right way to determine your pricing strategy, fortunately there are some guidelines that will help you with your decision.

Before we get to the actual pricing models, here are some of the factors that you need to consider:

* Positioning - How are you positioning yourself in the market? Is pricing going to be a key part of that positioning? If you're running a business based on price, you're always going to be trying to keep your prices as low as possible (or at least lower than your competitors). On the other hand, if you're positioning your business as an exclusive luxury product, a price that's too low may actually hurt your image.

The pricing has to be consistent with the positioning. People really do hold strongly to the idea that you get what you pay for.

* Demand Curve - How will your pricing affect demand? You're going to have to do some basic market research to find this out, even if it's informal. Get 10 people to answer a simple questionnaire, asking them, "Would you buy this product/service at X price? Y price? Z price?" For a larger venture, you'll want to do something more formal, of course -- perhaps hire a market research firm. But even a sole practitioner can chart a basic curve that says that at X price, X' percentage will buy, at Y price, Y' will buy, and at Z price Z' will buy.

* Cost - Calculate the fixed and variable costs associated with your product or service. How much is the "cost of goods", i.e., a cost associated with each item sold or service delivered, and how much is "fixed overhead", i.e., it doesn't change unless your medical practice changes dramatically in size? Remember that your gross margin (price minus cost of goods) has to amply cover your fixed overhead in order for you to turn a profit. Many physicians under-estimate this and it gets them into trouble.

* Environmental factors - Are there any legal or other constraints on pricing? For example, in some cases, doctors, insurance companies and Medicare will only reimburse a certain price (If you even take third party reimbursement.). Also, what possible actions might your competitors take? Will too low a price from you trigger a price war? Many doctors and medical spas have been burned in a price war with a competitor. Find out what external factors may affect your pricing.

The next step is to determine your pricing objectives. What are you trying to accomplish with your pricing?

* Short-term profit maximization - While this sounds great, it may not actually be the optimal approach for long-term profits. This approach is common in medical spas that are bootstrapping, as cash flow is the overriding consideration. It's also common among smaller businesses hoping to attract venture funding by demonstrating profitability as soon as possible. For this reason you should be very careful about claims of some of the current batch of medical franchises that are only offering minimal services.

* Short-term revenue maximization - This approach seeks to maximize long-term profits by increasing market share and lowering costs through economy of scale. For a well-funded company, or a newly public company, revenues are considered more important than profits in building investor confidence. Higher revenues at a slim profit, or even a loss, show that the company is building market share and will likely reach profitability. Amazon.com, for example, posted record-breaking revenues for several years before ever showing a profit, and its market capitalization reflected the high investor confidence those revenues generated.

* Maximize quantity - There are a couple of possible reasons to choose the strategy. It may be to focus on reducing long-term costs by achieving economies of scale. This approach might be used by a company well-funded by its founders and other "close" investors. Or it may be to maximize market penetration - particularly appropriate when you expect to have a lot repeat customers. The plan may be to increase profits by reducing costs, or to upsell existing customers on higher-profit products down the road. In general, with medical treatments, more patients means more income.

* Maximize profit margin - This strategy is most appropriate when the number of sales is either expected to be very low or sporadic and unpredictable. Many physicians and medical spas are forced to adopt this strategy if they are unable to generate high patient flow for treatments like Thermage, Restylane and other fixed cost treatments. This typically leads to price gouging by physicians and unhappy patients.

* Differentiation - At one extreme, being the low-cost leader is a form of differentiation from the competition. At the other end, a high price signals high quality and/or a high level of service. Some people really do order lobster just because it's the most expensive thing on the menu.

* Survival - In certain situations, such as a price war, market decline or market saturation, you must temporarily set a price that will cover costs and allow you to continue operations.

Now that we have the information we need and are clear about what we're trying to achieve, we're ready to take a look at specific pricing methods to help us arrive at our actual numbers.

As we said earlier, there is no "one right way" to calculate your pricing. Once you've considered the various factors involved and determined your objectives for your pricing strategy, now you need some way to crunch the actual numbers. Here are four ways to calculate prices:

* Cost-plus pricing - Set the price at your production cost, including both cost of goods and fixed costs at your current volume, plus a certain profit margin. For example, your medical treatments cost $20 in raw materials and production costs, and at current sales volume (or anticipated initial sales volume), your fixed costs come to $30 per unit. Your total cost is $50 per unit. You decide that you want to operate at a 100% markup, so you add $50 (50% x $50) to the cost and come up with a price of $100 per unit.

So long as you have your costs calculated correctly and have accurately predicted your sales volume, you will always be operating at a profit.

* Target return pricing - Set your price to achieve a target return-on-investment (ROI). For example, let's use the same situation as above, and assume that you have $10,000 invested in the company. Your expected sales volume is 1,000 units in the first year. You want to recoup all your investment in the first year, so you need to make $10,000 profit on 1,000 units, or $10 profit per unit, giving you again a price of $60 per unit.

* Value-based pricing - Price your product based on the value it creates for the customer. This is usually the most profitable form of pricing, if you can achieve it. The most extreme variation on this is "pay for performance" pricing for services, in which you charge on a variable scale according to the results you achieve. Let's say that your widget above saves the typical customer $1,000 a year in, say, energy costs. In that case, $60 seems like a bargain - maybe even too cheap. If your product reliably produced that kind of cost savings, you could easily charge $200, $300 or more for it, and customers would gladly pay it, since they would get their money back in a matter of months. However, there is one more major factor that must be considered.

* Psychological pricing - Ultimately, you must take into consideration the consumer's perception of your price, figuring things like:

o Positioning - If you want to be the "low-cost leader", you must be priced lower than your competition. If you want to signal high quality, you should probably be priced higher than most of your competition.

o Popular price points - There are certain "price points" (specific prices) at which people become much more willing to buy a certain type of product. For example, "under $100" is a popular price point. "Enough under $20 to be under $20 with sales tax" is another popular price point, because it's "one bill" that people commonly carry. Meals under $5 are still a popular price point, as are entree or snack items under $1 (notice how many fast-food places have a $0.99 "value menu"). Dropping your price to a popular price point might mean a lower margin, but more than enough increase in sales to offset it.

o Fair pricing - Sometimes it simply doesn't matter what the value of the product is, even if you don't have any direct competition. There is simply a limit to what consumers perceive as "fair". If it's obvious that your product only cost $20 to manufacture, even if it delivered $10,000 in value, you'd have a hard time charging two or three thousand dollars for it -- patients would just feel like they were being gouged. A little market testing will help you determine the maximum price patients will perceive as fair.

Now, how do you combine all of these calculations to come up with a price? Here are some basic guidelines:

* Your price must be enough higher than costs to cover reasonable variations in sales volume. If your sales forecast is inaccurate, how far off can you be and still be profitable? Ideally, you want to be able to be off by a factor of two or more (your sales are half of your forecast) and still be profitable.

* You have to make a living. Have you figured salary for yourself in your costs? If not, your profit has to be enough for you to live on and still have money to reinvest in the company.

* Your price should almost never be lower than your costs or higher than what most consumers consider "fair". This may seem obvious, but many entrepreneurs seem to miss this simple concept, either by miscalculating costs or by inadequate market research to determine fair pricing. Simply put, if people won't readily pay enough more than your cost to make you a fair profit, you need to reconsider your business model entirely. How can you cut your costs substantially? Or change your product positioning to justify higher pricing?

Pricing is a tricky business. You're certainly entitled to make a fair profit on your product, and even a substantial one if you create value for your customers. But remember, something is ultimately worth only what someone is willing to pay for it.