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 |
|---|---|---|---|---|
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $9.00 | $15.00 | not published | 0 |
| Lacer molded to patient mode HCPCS L2330 | $547.71 | $1,825.69 | not published | 0 |
| Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 | $163.48 | $272.47 | not published | 0 |
| Lactate dehydrogenase (ldh) CPT 83615 | $70.50 | $235.00 | not published | 0 |
| Lactated ringers intravenous solution HCPCS J7120 | $84.00 | $140.00 | not published | 0 |
| Lactic acid CPT 83605 | $74.70 | $249.00 | not published | 0 |
| Lateral thoracic extension HCPCS L1210 | $364.98 | $1,216.61 | not published | 0 |
| Lateral trochanteric pad HCPCS L1290 | $115.91 | $386.38 | not published | 0 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $33,090.00 | $110,300.00 | not published | 0 |
| Lead capillary CPT 83655 | $9.60 | $32.00 | not published | 0 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $36,635.59 | $122,118.65 | not published | 0 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $9,099.75 | $30,332.50 | not published | 0 |
| Legg perthes orthosis trilat HCPCS L1720 | $2,200.60 | $7,335.34 | not published | 0 |
| Legg perthes orth scottish r HCPCS L1730 | $1,857.80 | $6,192.68 | not published | 0 |
| Legg perthes patten bottom t HCPCS L1755 | $2,670.99 | $8,903.31 | not published | 0 |
| Leg perthes orth toronto typ HCPCS L1700 | $2,320.92 | $7,736.39 | not published | 0 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,032.90 | $3,443.00 | not published | 0 |
| Lens, intraocular (new tech) HCPCS C1780 | $140.63 | $468.78 | not published | 0 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $1,654.50 | $5,515.00 | not published | 0 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $1,977.13 | $6,590.43 | not published | 0 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $496.35 | $1,654.50 | not published | 0 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $130.26 | $217.10 | not published | 0 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $92.40 | $154.00 | not published | 0 |
| Levetiracetam therapeutic drug level CPT 80177 | $30.90 | $103.00 | not published | 0 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $40.26 | $67.10 | not published | 0 |
| Liberta rc ipg HCPCS C1820 | $51,181.96 | $170,606.53 | not published | 0 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $29.57 | $49.28 | not published | 0 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $39.60 | $66.00 | not published | 0 |
| Lift heel adj small gl60404sm HCPCS L3332 | $110.02 | $366.75 | not published | 0 |
| Lift heel adjustable med HCPCS L3334 | $56.88 | $189.61 | not published | 0 |
| Lifts elevation metal extens HCPCS L3330 | $844.24 | $2,814.14 | not published | 0 |
| Ligation internal/common carotid artery 37605 CPT 37605 | $2,069.10 | $6,897.00 | not published | 0 |
| Ligation/major artery/extremity 37618 CPT 37618 | $2,511.60 | $8,372.00 | not published | 0 |
| Limited ankle motion ea jnt HCPCS L2200 | $61.81 | $206.04 | not published | 0 |
| Limited motion knee joint HCPCS L2184 | $172.80 | $575.99 | not published | 0 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $300.96 | $501.60 | not published | 0 |
| Lipase CPT 83690 | $88.20 | $294.00 | not published | 0 |
| Lipoprotein blood quant CPT 83704 | $37.80 | $126.00 | not published | 0 |
| Lipoprotein direct measurement ldl CPT 83721 | $99.00 | $330.00 | not published | 0 |
| Lip surgery procedure CPT 40799 | $144.60 | $482.00 | not published | 0 |
| Listeria monocytogenes CPT 86723 | $71.70 | $239.00 | not published | 0 |
| Lithium therapeutic drug level CPT 80178 | $102.90 | $343.00 | not published | 0 |
| Liver Function Test CPT 80076 | $162.30 | $541.00 | not published | 0 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $9.00 | $15.00 | not published | 0 |
| Lo rig pos pnl l1-l5 pre ots HCPCS L0641 | $257.34 | $857.80 | not published | 0 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | $105.76 | $352.52 | not published | 0 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $173.70 | $579.00 | not published | 0 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $990.30 | $3,301.00 | not published | 0 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $422.70 | $1,409.00 | not published | 0 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $1,699.80 | $5,666.00 | not published | 0 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,699.80 | $5,666.00 | not published | 0 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $730.80 | $2,436.00 | not published | 0 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $287.10 | $957.00 | not published | 0 |
| Lso corset front HCPCS L0972 | $157.01 | $523.37 | not published | 0 |
| Lso flex no ri stays pre ots HCPCS L0628 | $169.65 | $565.51 | not published | 0 |
| Lso full corset HCPCS L0976 | $223.04 | $743.48 | not published | 0 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | $253.14 | $843.80 | not published | 0 |
| Lso sag-coronal panel custom HCPCS L0638 | $2,503.26 | $8,344.20 | not published | 0 |
| Lso sag-co shell pnl pre ots HCPCS L0651 | $1,932.59 | $6,441.96 | not published | 0 |
| Lso sag ctr rigi pos pre ots HCPCS L0643 | $241.62 | $805.41 | not published | 0 |
| Lso sagit rigid panel prefab HCPCS L0635 | $1,490.60 | $4,968.68 | not published | 0 |
| Lso sagittal rigid panel cus HCPCS L0636 | $2,022.51 | $6,741.70 | not published | 0 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | $389.12 | $1,297.07 | not published | 0 |
| Lso sc r pos/lat pnl pre ots HCPCS L0649 | $427.77 | $1,425.90 | not published | 0 |
| Lso s/c shell/panel custom HCPCS L0640 | $1,419.92 | $4,733.08 | not published | 0 |
| Lumbar bolster pad HCPCS L1030 | $116.81 | $389.36 | not published | 0 |
| Lumbar derotation pad HCPCS L1240 | $135.67 | $452.23 | not published | 0 |
| Lumbar or lumbar rib pad HCPCS L1040 | $132.26 | $440.87 | not published | 0 |
| Lumbar sling HCPCS L1090 | $150.11 | $500.38 | not published | 0 |
| Lung Function Test (Spirometry) CPT 94010 | $234.90 | $783.00 | not published | 0 |
| Lung perfusion imaging CPT 78580 | $997.20 | $3,324.00 | not published | 0 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $146,411.74 | $244,019.56 | not published | 0 |
| Lvad shower bag heartmate HCPCS Q0501 | $496.35 | $1,654.50 | not published | 0 |
| Magnesium CPT 83735 | $58.50 | $195.00 | not published | 0 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $34.32 | $57.20 | not published | 0 |
| Mammosite ced HCPCS C1728 | $5,004.86 | $16,682.88 | not published | 0 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $99.60 | $332.00 | not published | 0 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $150.90 | $503.00 | not published | 0 |
| Man's shoe oxford brace HCPCS L3225 | $110.11 | $367.02 | not published | 0 |
| Marker biop eviva buckle ss HCPCS A4648 | $9,347.92 | $31,159.75 | not published | 0 |
| Matrion 1 sq cm HCPCS Q4201 | $12,797.56 | $42,658.53 | not published | 0 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $53,754.70 | $179,182.35 | not published | 0 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $123.00 | $410.00 | not published | 0 |
| Mayo aathr protein s free CPT 85306 | $75.00 | $250.00 | not published | 0 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $159.30 | $531.00 | not published | 0 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $41.40 | $138.00 | not published | 0 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $47.40 | $158.00 | not published | 0 |
| Mayo alpha 1 antitrypsin CPT 82103 | $129.60 | $432.00 | not published | 0 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $54.00 | $180.00 | not published | 0 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $222.30 | $741.00 | not published | 0 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $106.50 | $355.00 | not published | 0 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $415.50 | $1,385.00 | not published | 0 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $1,827.00 | $6,090.00 | not published | 0 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $151.80 | $506.00 | not published | 0 |
| Mayo antithrombin iii antigen CPT 85301 | $9.60 | $32.00 | not published | 0 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $27.60 | $92.00 | not published | 0 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $26.10 | $87.00 | not published | 0 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $18.90 | $63.00 | not published | 0 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $164.10 | $547.00 | not published | 0 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $11.10 | $37.00 | 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.