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 |
|---|---|---|---|---|
| Ot evaluation high complexity patient/family CPT 97167 | $202.20 | $674.00 | not published | 0 |
| Ot evaluation low complexity patient/family CPT 97165 | $202.20 | $674.00 | not published | 0 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $202.20 | $674.00 | not published | 0 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | $105.60 | $352.00 | not published | 0 |
| Ot re-evaluation patient/family CPT 97168 | $68.10 | $227.00 | not published | 0 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | $119.40 | $398.00 | not published | 0 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | $155.40 | $518.00 | not published | 0 |
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | $119.40 | $398.00 | not published | 0 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | $119.40 | $398.00 | not published | 0 |
| Outrigger HCPCS L1080 | $78.06 | $260.20 | not published | 0 |
| Outrigger bil with vert extens HCPCS L1085 | $261.29 | $870.98 | not published | 0 |
| Oxytocin 10 unit/ml injection solution HCPCS J2590 | $75.90 | $126.50 | not published | 0 |
| Pacemaker leadless 19.5f 32.2mm ra HCPCS C1605 | $41,279.77 | $137,599.25 | not published | 0 |
| Paclitaxel 6 mg/ml concentrate,intravenous HCPCS J9267 | $435.60 | $726.00 | not published | 0 |
| Paclitaxel protein-bound 100 mg intravenous suspension HCPCS J9264 | $5,972.63 | $9,954.38 | not published | 0 |
| Palingen or palingen xplus HCPCS Q4173 | $9,612.64 | $32,042.15 | not published | 0 |
| Panitumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9303 | $27,392.15 | $45,653.58 | not published | 0 |
| Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr HCPCS J2470 | $29.48 | $49.13 | not published | 0 |
| Parathormone (pth) intact CPT 83970 | $278.40 | $928.00 | not published | 0 |
| Parathyroid planar imaging CPT 78070 | $533.40 | $1,778.00 | not published | 0 |
| Paricalcitol HCPCS J2501 | $99.99 | $166.65 | not published | 0 |
| Paring/cutting benign hyperkeratotic lesion single CPT 11055 | $125.70 | $419.00 | not published | 0 |
| Partial removal finger bone CPT 26236 | $996.90 | $3,323.00 | not published | 0 |
| Partial removal of toe CPT 28160 | $14,045.87 | $23,409.78 | $3,419.10 – $3,487.49 | 3 |
| Particle matristem matrix 1000mg micron-q4118-cost per mg HCPCS Q4118 | $7,246.71 | $24,155.70 | not published | 0 |
| Passy muir valve metal trach HCPCS L8501 | $664.27 | $2,214.22 | not published | 0 |
| Patten bottom HCPCS L2370 | $477.42 | $1,591.41 | not published | 0 |
| Pdgfra gene CPT 81314 | $545.10 | $1,817.00 | not published | 0 |
| Pd hl 3.5in 4d med rbr mld 6432 HCPCS L3350 | $34.12 | $113.72 | not published | 0 |
| Pelv band/spread bar thigh c HCPCS L1640 | $706.17 | $2,353.91 | not published | 0 |
| Pelvic control band & belt b HCPCS L2640 | $468.75 | $1,562.51 | not published | 0 |
| Pelvic control band & belt u HCPCS L2630 | $345.39 | $1,151.31 | not published | 0 |
| Pelvic control hip heavy dut HCPCS L2620 | $372.94 | $1,243.14 | not published | 0 |
| Pelvic control pelvic sling HCPCS L2580 | $647.37 | $2,157.91 | not published | 0 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $913.80 | $3,046.00 | not published | 0 |
| Pelvic CT scan (with contrast) CPT 72193 | $898.50 | $2,995.00 | not published | 0 |
| Pelvic CT scan (without contrast) CPT 72192 | $422.70 | $1,409.00 | not published | 0 |
| Pelvic & hip control thigh c HCPCS L1680 | $1,583.92 | $5,279.73 | not published | 0 |
| Pelvic MRI (with and without contrast) CPT 72197 | $1,699.80 | $5,666.00 | not published | 0 |
| Pelvic MRI (without contrast) CPT 72195 | $913.50 | $3,045.00 | not published | 0 |
| Pelvic Ultrasound (complete) CPT 76856 | $457.50 | $1,525.00 | not published | 0 |
| Pelvic Ultrasound (limited) CPT 76857 | $354.00 | $1,180.00 | not published | 0 |
| Pelv & thor control gluteal HCPCS L2650 | $206.43 | $688.11 | not published | 0 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | $22,739.27 | $37,898.79 | not published | 0 |
| Penile rear tip xtnd 0.5cm HCPCS C2622 | $19,622.83 | $65,409.44 | not published | 0 |
| Pericardiocentesis wwo imaging CPT 33016 | $1,033.50 | $3,445.00 | not published | 0 |
| Pericardiotomy/clot/for bod remove 33020 CPT 33020 | $838.80 | $2,796.00 | not published | 0 |
| Permanent tear duct plug HCPCS A4263 | $190.27 | $634.23 | not published | 0 |
| Peroneal straps pair pre ots HCPCS L0980 | $25.50 | $84.99 | not published | 0 |
| Pertuzu, trastuzu, 10 mg HCPCS J9316 | $52,604.51 | $87,674.18 | not published | 0 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | $158.92 | $529.72 | not published | 0 |
| Pfc sigma fem post aug sz3 8mm HCPCS C1776 | $51,930.62 | $173,102.06 | not published | 0 |
| Ph body fluid CPT 83986 | $60.60 | $202.00 | not published | 0 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $138.25 | $230.42 | not published | 0 |
| Phenobarbital therapeutic drug level CPT 80184 | $170.40 | $568.00 | not published | 0 |
| Phentolaine mesylate inj HCPCS J2760 | $2,770.68 | $4,617.80 | not published | 0 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $9.00 | $15.00 | not published | 0 |
| Phenylep ketorolac opth soln HCPCS J1097 | $3,115.20 | $5,192.00 | not published | 0 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | $9.17 | $15.29 | not published | 0 |
| Phenytoin total therapeutic drug level CPT 80185 | $24.90 | $83.00 | not published | 0 |
| Phlebotomy therapeutic CPT 99195 | $222.00 | $740.00 | not published | 0 |
| Phosphorus CPT 84100 | $70.50 | $235.00 | not published | 0 |
| Phys blood bank serv reactj CPT 86078 | $134.70 | $449.00 | not published | 0 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $56.45 | $94.09 | not published | 0 |
| Pillow shldr abduc inflat univ HCPCS L3960 | $1,082.82 | $3,609.40 | not published | 0 |
| Pin caspar distraction 12mm HCPCS C1821 | $15,221.40 | $50,738.00 | not published | 0 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $39.60 | $66.00 | not published | 0 |
| Plas shoe insert w ank joint HCPCS L2180 | $155.95 | $519.84 | not published | 0 |
| Plastic mod low ext pad/line HCPCS L2275 | $221.70 | $739.01 | not published | 0 |
| Plastic mold recipro hip & c HCPCS L2627 | $3,188.26 | $10,627.52 | not published | 0 |
| Platelet automated CPT 85049 | $41.70 | $139.00 | not published | 0 |
| Platelets pheresis leukocytes reduced each unit HCPCS P9035 | $855.00 | $2,850.00 | not published | 0 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $855.90 | $2,853.00 | not published | 0 |
| Plating chrome/nickel pr bar HCPCS L2750 | $116.59 | $388.64 | not published | 0 |
| Plethysmography lung volumes/airway resistance CPT 94726 | $120.90 | $403.00 | not published | 0 |
| Pneum full leg splnt pre ots HCPCS L4370 | $195.13 | $650.44 | not published | 0 |
| Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 | $33.30 | $111.00 | not published | 0 |
| Postop app non-wgt bear dsg HCPCS L5450 | $377.09 | $1,256.98 | not published | 0 |
| Postop app non-wgt bear dsg HCPCS L5460 | $876.17 | $2,920.58 | not published | 0 |
| Postop dsg & 1 cast chg ak/d HCPCS L5420 | $2,105.15 | $7,017.18 | not published | 0 |
| Post-operative body jacket HCPCS L1310 | $2,677.91 | $8,926.36 | not published | 0 |
| Potassium 24 hour urine CPT 84133 | $57.90 | $193.00 | not published | 0 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | $264.00 | $440.00 | not published | 0 |
| Potassium serum/plasma/whole blood CPT 84132 | $57.90 | $193.00 | not published | 0 |
| Pr amput fgr/thumb prim/sec any joint/phal sgl incl neurectomies w dir clsr CPT 26951 | $2,067.90 | $6,893.00 | not published | 0 |
| Pr application of long arm splint CPT 29105 | $88.80 | $296.00 | not published | 0 |
| Pr application splint static short arm CPT 29125 | $143.40 | $478.00 | not published | 0 |
| Pr biopsy skin punch single lesion CPT 11104 | $259.20 | $864.00 | not published | 0 |
| Pr correction hammertoe CPT 28285 | $42,720.19 | $71,200.32 | $7,582.44 – $7,734.09 | 3 |
| Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< CPT 97597 | $125.70 | $419.00 | not published | 0 |
| Prealbumin CPT 84134 | $157.20 | $524.00 | not published | 0 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | $9.00 | $15.00 | not published | 0 |
| Prednisone 1 mg tablet HCPCS J7512 | $9.00 | $15.00 | not published | 0 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $423.90 | $1,413.00 | not published | 0 |
| Pregnancy Ultrasound (first trimester) CPT 76801 | $423.90 | $1,413.00 | not published | 0 |
| Prep bk ptb open end socket HCPCS L5535 | $2,891.30 | $9,637.68 | not published | 0 |
| Prep bk ptb thermopls molded HCPCS L5530 | $2,521.01 | $8,403.37 | not published | 0 |
| Pressure max expiratory/inspiratory CPT 94799 | $151.50 | $505.00 | not published | 0 |
| Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref CPT 86977 | $159.90 | $533.00 | not published | 0 |
| Pretreat rbc absorption reference CPT 86978 | $159.90 | $533.00 | 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.