Southampton Medical Center
100 Fairview Dr., Franklin, VA · Bonsecours · · NPI 1851936983
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| 2d tte w or without fol w/con,co HCPCS C8923 | $800.70 | $2,669.00 | not published | 0 |
| 3d recon without postprocess indpndt CPT 76376 | $298.50 | $995.00 | not published | 0 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $898.50 | $2,995.00 | not published | 0 |
| Abdominal CT scan (with contrast) CPT 74160 | $898.50 | $2,995.00 | not published | 0 |
| Abdominal CT scan (without contrast) CPT 74150 | $422.70 | $1,409.00 | not published | 0 |
| Abdominal MRI (with and without contrast) CPT 74183 | $1,699.80 | $5,666.00 | not published | 0 |
| Abdominal MRI (with contrast) CPT 74182 | $2,124.60 | $7,082.00 | not published | 0 |
| Abdominal MRI (without contrast) CPT 74181 | $913.50 | $3,045.00 | not published | 0 |
| Abdominal pad HCPCS L1270 | $123.64 | $412.14 | not published | 0 |
| Abdominal paracentesis w/image guidance CPT 49083 | $573.90 | $1,913.00 | not published | 0 |
| Abdominal Ultrasound (complete) CPT 76700 | $422.70 | $1,409.00 | not published | 0 |
| Abdominal Ultrasound (limited) CPT 76705 | $453.30 | $1,511.00 | not published | 0 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $573.90 | $1,913.00 | not published | 0 |
| Abduct control hip semi-flex HCPCS L1630 | $315.15 | $1,050.50 | not published | 0 |
| Abduction bar jointed adjust HCPCS L2300 | $375.55 | $1,251.85 | not published | 0 |
| Abduction rotation bar shoe HCPCS L3140 | $132.81 | $442.69 | not published | 0 |
| Abduct rotation bar without shoe HCPCS L3150 | $121.44 | $404.80 | not published | 0 |
| Abl1 gene CPT 81170 | $496.20 | $1,654.00 | not published | 0 |
| Ablation of upper extremity nerves rf CPT 64999 | $283.50 | $945.00 | not published | 0 |
| Acetaminophen level CPT 80143 | $36.00 | $120.00 | not published | 0 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $262.02 | $436.70 | not published | 0 |
| Acetone qualitative CPT 82009 | $70.50 | $235.00 | not published | 0 |
| Acetylcholine receptor modulating antibody CPT 86043 | $109.20 | $364.00 | not published | 0 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $22.40 | $37.33 | not published | 0 |
| Acetylcysteine non-comp unit HCPCS J7608 | $86.41 | $144.02 | not published | 0 |
| Acne surgery 10040 CPT 10040 | $237.60 | $792.00 | not published | 0 |
| Acute hepatitis panel CPT 80074 | $264.90 | $883.00 | not published | 0 |
| Adapter b 8 channel 10cm HCPCS C1883 | $6,326.39 | $21,087.98 | not published | 0 |
| Add le poly knee custom kafo HCPCS L2387 | $284.77 | $949.24 | not published | 0 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $36.14 | $60.23 | not published | 0 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $941.47 | $1,569.12 | not published | 0 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $0.01 | $0.01 | not published | 0 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $0.01 | $0.01 | not published | 0 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $205.80 | $686.00 | not published | 0 |
| Administration immunization 1 vaccine CPT 90471 | $194.10 | $647.00 | not published | 0 |
| Administration immunization each additional vaccine CPT 90472 | $164.40 | $548.00 | not published | 0 |
| Administration vaccine influenza virus HCPCS G0008 | $13.20 | $44.00 | not published | 0 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $24,129.25 | $40,215.42 | not published | 0 |
| _afb id by dna probe rflx ast CPT 87149 | $56.40 | $188.00 | not published | 0 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $328.80 | $1,096.00 | not published | 0 |
| Afo molded ankle gauntlet HCPCS L1904 | $673.33 | $2,244.44 | not published | 0 |
| Afo molded plas rig ant tib HCPCS L1945 | $1,537.05 | $5,123.49 | not published | 0 |
| Afo molded to patient plasti HCPCS L1940 | $642.91 | $2,143.02 | not published | 0 |
| Afo rig ant tib tcf/= custom HCPCS L1932 | $1,331.14 | $4,437.15 | not published | 0 |
| Afo sing bar clasp attach sh HCPCS L1910 | $418.36 | $1,394.52 | not published | 0 |
| Afo sing solid stirrup calf HCPCS L1980 | $602.32 | $2,007.74 | not published | 0 |
| Afo sing upright with adjust s HCPCS L1920 | $612.83 | $2,042.76 | not published | 0 |
| Afo spiral molded to pt plas HCPCS L1950 | $1,147.25 | $3,824.16 | not published | 0 |
| Afo sprng wir drsflx calf bd HCPCS L1900 | $425.60 | $1,418.68 | not published | 0 |
| Afo supramalleolar custom HCPCS L1907 | $839.43 | $2,798.09 | not published | 0 |
| Afo tib fx cast plaster mold HCPCS L2106 | $1,175.82 | $3,919.40 | not published | 0 |
| Afo tibial fracture rigid HCPCS L2116 | $1,149.78 | $3,832.59 | not published | 0 |
| Afo tibial fracture soft HCPCS L2112 | $752.60 | $2,508.66 | not published | 0 |
| Afo, walk boot type, cus fab HCPCS L4631 | $2,367.19 | $7,890.64 | not published | 0 |
| Afo w/ankle joint, prefab HCPCS L1971 | $952.99 | $3,176.64 | not published | 0 |
| Ak/knee disartic pelvic band HCPCS L5697 | $116.99 | $389.97 | not published | 0 |
| Ak/knee disartic silesian ba HCPCS L5698 | $145.50 | $484.99 | not published | 0 |
| Ak sleeve susp neoprene/equa HCPCS L5695 | $263.58 | $878.59 | not published | 0 |
| Albumin body fluid quantitative each specimen CPT 82042 | $69.90 | $233.00 | not published | 0 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $462.00 | $770.00 | not published | 0 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $114.00 | $380.00 | not published | 0 |
| Albumin serum plasma or whole blood CPT 82040 | $70.50 | $235.00 | not published | 0 |
| Albuterol ipratrop non-comp HCPCS J7620 | $9.00 | $15.00 | not published | 0 |
| Albuterol non-comp con HCPCS J7611 | $9.00 | $15.00 | not published | 0 |
| Albuterol non-comp unit HCPCS J7613 | $9.00 | $15.00 | not published | 0 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $33.60 | $112.00 | not published | 0 |
| Alkaline phosphatase CPT 84075 | $27.90 | $93.00 | not published | 0 |
| Allergen alpha lactalbumin ige CPT 86008 | $20.70 | $69.00 | not published | 0 |
| Allergen egg white ige CPT 86003 | $25.80 | $86.00 | not published | 0 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $4,168.18 | $13,893.94 | not published | 0 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $8,219.56 | $27,398.52 | not published | 0 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | $10,314.04 | $34,380.12 | not published | 0 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $6,414.50 | $21,381.66 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $29,118.67 | $97,062.24 | not published | 0 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $19,548.74 | $65,162.48 | not published | 0 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $16,543.35 | $55,144.49 | not published | 0 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $15,620.14 | $52,067.12 | not published | 0 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $5,120.68 | $17,068.93 | not published | 0 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $5,848.66 | $19,495.53 | not published | 0 |
| Alpha-fetoprotein tumor marker CPT 82105 | $65.10 | $217.00 | not published | 0 |
| Alprostadil for injection HCPCS J0270 | $1,117.67 | $1,862.79 | not published | 0 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $58,082.38 | $96,803.96 | not published | 0 |
| Alt/sgpt CPT 84460 | $70.50 | $235.00 | not published | 0 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $19.58 | $32.64 | not published | 0 |
| Ammonia CPT 82140 | $105.00 | $350.00 | not published | 0 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | $2,067.90 | $6,893.00 | not published | 0 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $72.60 | $121.00 | not published | 0 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $59.40 | $99.00 | not published | 0 |
| Amylase CPT 82150 | $73.20 | $244.00 | not published | 0 |
| Ana ds-dna CPT 86226 | $47.40 | $158.00 | not published | 0 |
| Analysis gene f2 20210g>a variant CPT 81240 | $21.60 | $72.00 | not published | 0 |
| Analysis gene f5 leiden variant CPT 81241 | $24.90 | $83.00 | not published | 0 |
| An fluoro guide for cvp CPT 77001 | $581.40 | $1,938.00 | not published | 0 |
| Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 | $990.00 | $1,650.00 | not published | 0 |
| Anidulafungin injection HCPCS J0348 | $1,259.87 | $2,099.79 | not published | 0 |
| Ankle X-ray CPT 73610 | $225.90 | $753.00 | not published | 0 |
| Anterior asis pad HCPCS L1250 | $117.98 | $393.27 | not published | 0 |
| Anterior swing band HCPCS L2335 | $419.35 | $1,397.83 | not published | 0 |
| Anterior thoracic derotation HCPCS L1260 | $140.70 | $469.00 | not published | 0 |
| Anterior thoracic extension HCPCS L1220 | $324.93 | $1,083.09 | not published | 0 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.