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 |
|---|---|---|---|---|
| Repair lip full thkns =<one-half vert height CPT 40652 | $317.40 | $1,058.00 | not published | 0 |
| Repair rpr lac tongue floor mouth > 2.6 cm/cmplx CPT 41252 | $144.60 | $482.00 | not published | 0 |
| Repair rpr lip full thickness vermilion only CPT 40650 | $317.40 | $1,058.00 | not published | 0 |
| Repair tendon extensor foot 1/2 each tendon CPT 28208 | $2,067.90 | $6,893.00 | not published | 0 |
| Repair tendon/muscle forearm/wrist prime sngl ea CPT 25260 | $2,067.90 | $6,893.00 | not published | 0 |
| Repair tongue lac <2.5cm past 1/3 tongue 41251 CPT 41251 | $144.60 | $482.00 | not published | 0 |
| Replace duod/jej tube perc CPT 49451 | $573.90 | $1,913.00 | not published | 0 |
| Replace g/c tube perc CPT 49450 | $377.10 | $1,257.00 | not published | 0 |
| Repl trach puncture dilator HCPCS L8514 | $153.87 | $512.90 | not published | 0 |
| Restorigin 1 sq cm HCPCS Q4191 | $3,970.80 | $13,236.00 | not published | 0 |
| Resuscitation cardiopulmonary CPT 92950 | $1,426.20 | $4,754.00 | not published | 0 |
| Reticulocyte automated CPT 85045 | $55.50 | $185.00 | not published | 0 |
| Revise/replace knee joint CPT 27486 | $29,033.08 | $48,388.47 | $13,415.89 – $13,684.21 | 3 |
| Revise/replace knee joint CPT 27487 | $47,812.57 | $79,687.62 | $18,322.11 – $18,688.55 | 3 |
| Revision of cervix CPT 57720 | $1,964.10 | $6,547.00 | not published | 0 |
| Revision of eyelid CPT 67961 | $1,468.50 | $4,895.00 | not published | 0 |
| Revision of knee joint CPT 27446 | $31,125.08 | $51,875.13 | $13,415.89 – $13,684.21 | 2 |
| Revision of penis CPT 54435 | $2,226.60 | $7,422.00 | not published | 0 |
| Rheumatoid factor quantitative CPT 86431 | $66.60 | $222.00 | not published | 0 |
| Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe HCPCS J2791 | $852.46 | $1,420.76 | not published | 0 |
| Rho d immune globulin inj HCPCS J2790 | $852.46 | $1,420.76 | not published | 0 |
| Rib gusset (elastic) each HCPCS L1280 | $130.34 | $434.47 | not published | 0 |
| Ring flange plas/leather mol HCPCS L1110 | $474.99 | $1,583.30 | not published | 0 |
| Ring flange plastic/leather HCPCS L1100 | $283.30 | $944.33 | not published | 0 |
| Ring fx reform 11-13x17mm HCPCS L8610 | $1,457.62 | $4,858.72 | not published | 0 |
| Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln HCPCS J9311 | $24,859.48 | $41,432.47 | not published | 0 |
| Rocker bottom, contact afo HCPCS L2232 | $144.92 | $483.06 | not published | 0 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $36.43 | $60.72 | not published | 0 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | $345.00 | $1,150.00 | not published | 0 |
| Rpl picc wo subq port/pump incl image guidnc w/s&i CPT 36584 | $1,120.50 | $3,735.00 | not published | 0 |
| Rpr xtnsr tndn leg prim without grft ea tndn CPT 27664 | $17,924.74 | $29,874.57 | $7,582.44 – $7,734.09 | 2 |
| Rsv assay w/optic CPT 87807 | $121.50 | $405.00 | not published | 0 |
| Rubella antibody igg CPT 86762 | $45.90 | $153.00 | not published | 0 |
| Rubeola antibody igg CPT 86765 | $149.70 | $499.00 | not published | 0 |
| Russell viper venom diluted CPT 85613 | $62.10 | $207.00 | not published | 0 |
| Salmonella antibody CPT 86768 | $19.80 | $66.00 | not published | 0 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $1,032.90 | $3,443.00 | not published | 0 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $713.40 | $2,378.00 | not published | 0 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $1,032.90 | $3,443.00 | not published | 0 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $832.80 | $2,776.00 | not published | 0 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $644.10 | $2,147.00 | not published | 0 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $760.80 | $2,536.00 | not published | 0 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $697.50 | $2,325.00 | not published | 0 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $624.30 | $2,081.00 | not published | 0 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $9,678.82 | $32,262.75 | not published | 0 |
| Screening Colonoscopy (average risk) HCPCS G0121 | $4,034.05 | $6,723.42 | $971.77 – $991.20 | 3 |
| Screening Colonoscopy (high risk) HCPCS G0105 | $4,089.19 | $6,815.32 | $971.77 – $991.20 | 3 |
| Screening hepatitis b non-obstetric high risk HCPCS G0499 | $46.50 | $155.00 | not published | 0 |
| Screening Mammogram CPT 77067 | $144.30 | $481.00 | not published | 0 |
| Screening prostate cancer PSA HCPCS G0103 | $74.40 | $248.00 | not published | 0 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $178,551.99 | $595,173.29 | not published | 0 |
| Sevelamer carbonate 800 mg tablet HCPCS J0601 | $9.00 | $15.00 | not published | 0 |
| Sewho cap design without jnts cf HCPCS L3961 | $2,281.01 | $7,603.37 | not published | 0 |
| Sf3b1 gene common variants CPT 81347 | $319.50 | $1,065.00 | not published | 0 |
| Shave sgl skin lsn t/a/l 0.5cm/< CPT 11300 | $259.20 | $864.00 | not published | 0 |
| Sheath below knee HCPCS L8400 | $24.06 | $80.19 | not published | 0 |
| Sheath gldlight lasr 12fx50cm HCPCS C2629 | $5,501.21 | $18,337.38 | not published | 0 |
| Sheath laser cavaclear 14f HCPCS C1603 | $8,264.23 | $27,547.43 | not published | 0 |
| Sho arthrs srg xtnsv dbrdmt CPT 29823 | $13,140.87 | $21,901.45 | $7,734.09 – $7,734.09 | 1 |
| Shoe clubfoot wedge HCPCS L3380 | $73.99 | $246.63 | not published | 0 |
| Shoe dennis browne splint bo HCPCS L3640 | $64.54 | $215.14 | not published | 0 |
| Shoe heel new leather standa HCPCS L3455 | $60.72 | $202.40 | not published | 0 |
| Shoe heel new rubber standar HCPCS L3460 | $51.25 | $170.85 | not published | 0 |
| Shoe heel pad & depress for HCPCS L3480 | $92.95 | $309.83 | not published | 0 |
| Shoe heel sach cushion type HCPCS L3450 | $157.42 | $524.75 | not published | 0 |
| Shoe heel thomas extend to b HCPCS L3470 | $92.95 | $309.83 | not published | 0 |
| Shoe heel thomas with wedge HCPCS L3465 | $87.32 | $291.08 | not published | 0 |
| Shoe lift elev heel/sole neo HCPCS L3310 | $110.45 | $368.18 | not published | 0 |
| Shoe metatarsal bar between HCPCS L3410 | $138.48 | $461.61 | not published | 0 |
| Shoe metatarsal bar wedge ro HCPCS L3400 | $60.72 | $202.40 | not published | 0 |
| Shoe outflare wedge HCPCS L3390 | $73.99 | $246.63 | not published | 0 |
| Shoe post-op mens m HCPCS L3260 | $181.99 | $606.65 | not published | 0 |
| Shoe sole wedge between sole HCPCS L3370 | $73.99 | $246.63 | not published | 0 |
| Shoe sole wedge outside sole HCPCS L3360 | $53.11 | $177.03 | not published | 0 |
| Shoe wedge sach HCPCS L3340 | $127.15 | $423.83 | not published | 0 |
| Sho heel count plast reinfor HCPCS L3430 | $239.06 | $796.86 | not published | 0 |
| Sho insert w arch toe filler HCPCS L5000 | $771.94 | $2,573.13 | not published | 0 |
| Sho lift taper to metatarsal HCPCS L3300 | $77.80 | $259.32 | not published | 0 |
| Shoulder Arthroscopy (Rotator Cuff Repair) CPT 29827 | $13,140.87 | $21,901.45 | $7,582.44 – $7,734.09 | 3 |
| Shoulder MRI (with and without contrast) CPT 73223 | $1,699.80 | $5,666.00 | not published | 0 |
| Shoulder MRI (with contrast) CPT 73222 | $2,542.20 | $8,474.00 | not published | 0 |
| Shoulder MRI (without contrast) CPT 73221 | $913.50 | $3,045.00 | not published | 0 |
| Shoulder X-ray CPT 73030 | $225.30 | $751.00 | not published | 0 |
| Shrinker prosth above knee HCPCS L8460 | $125.97 | $419.91 | not published | 0 |
| Shrinker prosth below knee HCPCS L8440 | $88.61 | $295.38 | not published | 0 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $4,798.05 | $15,993.50 | not published | 0 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $143.10 | $477.00 | not published | 0 |
| Sickling rbc CPT 85660 | $26.70 | $89.00 | not published | 0 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $861.06 | $1,435.10 | not published | 0 |
| Sinus CT scan (with and without contrast) CPT 70488 | $608.70 | $2,029.00 | not published | 0 |
| Sinus CT scan (with contrast) CPT 70487 | $863.40 | $2,878.00 | not published | 0 |
| Sinus CT scan (without contrast) CPT 70486 | $422.70 | $1,409.00 | not published | 0 |
| Sio flex pelvisacral custom HCPCS L0622 | $398.72 | $1,329.06 | not published | 0 |
| Sio rig pnl pelv/sac pre ots HCPCS L0623 | $264.01 | $880.03 | not published | 0 |
| Skin Biopsy CPT 11102 | $125.70 | $419.00 | not published | 0 |
| Sleeve fing rolyan med HCPCS L3933 | $289.69 | $965.62 | not published | 0 |
| Sling pelv split sam med HCPCS L0621 | $128.62 | $428.74 | not published | 0 |
| Sling suprapubic suburetheral HCPCS C1771 | $11,249.41 | $37,498.03 | not published | 0 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $33.60 | $112.00 | not published | 0 |
| Smear gram stain CPT 87205 | $73.20 | $244.00 | 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.