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 |
|---|---|---|---|---|
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $9.08 | $15.13 | not published | 0 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $24,919.74 | $41,532.90 | not published | 0 |
| Digoxin total therapeutic drug level CPT 80162 | $146.40 | $488.00 | not published | 0 |
| Dilate esophagus 1/mult pass CPT 43450 | $5,030.09 | $8,383.48 | $947.76 – $966.72 | 3 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $434.70 | $1,449.00 | not published | 0 |
| Dilator fascial 10fx20cm HCPCS C2627 | $525.14 | $1,750.46 | not published | 0 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $9.00 | $15.00 | not published | 0 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $9.00 | $15.00 | not published | 0 |
| Dmpk gene detc abnor allele CPT 81234 | $215.70 | $719.00 | not published | 0 |
| Dna antibody native/double stranded CPT 86225 | $210.00 | $700.00 | not published | 0 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $264.00 | $440.00 | not published | 0 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $103.95 | $173.25 | not published | 0 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $984.60 | $3,282.00 | not published | 0 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $500.40 | $1,668.00 | not published | 0 |
| Dornhoffer fixed part w/window HCPCS L8614 | $42,603.37 | $142,011.25 | not published | 0 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | $1,210.21 | $2,017.01 | not published | 0 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $114.38 | $190.63 | not published | 0 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $450.90 | $1,503.00 | not published | 0 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $450.90 | $1,503.00 | not published | 0 |
| Drainage external ear complex 69005 CPT 69005 | $1,041.90 | $3,473.00 | not published | 0 |
| Drainage external ear simple 69000 CPT 69000 | $450.90 | $1,503.00 | not published | 0 |
| Drainage mouth roof lesion CPT 42000 | $144.60 | $482.00 | not published | 0 |
| Drainage of arm bursa 23931 CPT 23931 | $1,041.90 | $3,473.00 | not published | 0 |
| Drainage of mouth lesion CPT 41009 | $481.20 | $1,604.00 | not published | 0 |
| Drainage of rectal abscess CPT 45005 | $2,102.40 | $7,008.00 | not published | 0 |
| Drain blood from under nail 11740 CPT 11740 | $135.90 | $453.00 | not published | 0 |
| Drain finger abscess;simple 26010 CPT 26010 | $125.70 | $419.00 | not published | 0 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $125.70 | $419.00 | not published | 0 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $144.00 | $480.00 | not published | 0 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $259.20 | $864.00 | not published | 0 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | $20,526.34 | $68,421.13 | not published | 0 |
| Drng of eyelid abscess 67700 CPT 67700 | $184.20 | $614.00 | not published | 0 |
| Drng of finger abscess comp 26011 CPT 26011 | $1,041.90 | $3,473.00 | not published | 0 |
| Drng of scrotum abscess 55100 CPT 55100 | $1,742.70 | $5,809.00 | not published | 0 |
| Dronabinol 2.5mg oral HCPCS Q0167 | $11.81 | $19.69 | not published | 0 |
| Drop lock knee HCPCS L2182 | $129.22 | $430.72 | not published | 0 |
| Drop lock retainer each HCPCS L2785 | $44.21 | $147.36 | not published | 0 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $4,301.70 | $14,339.00 | not published | 0 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | $2,851.94 | $9,506.48 | not published | 0 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $11,540.14 | $38,467.13 | not published | 0 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $2,696.95 | $8,989.84 | not published | 0 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | $16,133.03 | $53,776.77 | not published | 0 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $22,978.22 | $76,594.08 | not published | 0 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | $16,197.55 | $53,991.85 | not published | 0 |
| Drug assay posaconazole CPT 80187 | $52.50 | $175.00 | not published | 0 |
| Drug assay rufinamide CPT 80210 | $31.20 | $104.00 | not published | 0 |
| Drug assay vedolizumab CPT 80280 | $230.10 | $767.00 | not published | 0 |
| Drug assay voriconazole CPT 80285 | $45.30 | $151.00 | not published | 0 |
| Drug asy hydroxychloroquine CPT 80220 | $63.90 | $213.00 | not published | 0 |
| Drug test def 1-7 classes HCPCS G0480 | $180.30 | $601.00 | not published | 0 |
| Drug test prsmv instrmnt CPT 80306 | $31.50 | $105.00 | not published | 0 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $121.50 | $405.00 | not published | 0 |
| Drvvt confirm - quest CPT 85597 | $36.00 | $120.00 | not published | 0 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $1,377.90 | $4,593.00 | not published | 0 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $370.20 | $1,234.00 | not published | 0 |
| Duragen 1x1 5ea/bx HCPCS C9354 | $11,220.02 | $37,400.08 | not published | 0 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | $16,233.82 | $27,056.36 | not published | 0 |
| Ear irrigation 69209 CPT 69209 | $71.40 | $238.00 | not published | 0 |
| Ecg 12 lead tracing only CPT 93005 | $180.30 | $601.00 | not published | 0 |
| Ecg external < 48 hours recording CPT 93225 | $700.20 | $2,334.00 | not published | 0 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $1,016.10 | $3,387.00 | not published | 0 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,533.30 | $5,111.00 | not published | 0 |
| Echocardiography doppler color flow mapping CPT 93325 | $189.00 | $630.00 | not published | 0 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $2,276.70 | $7,589.00 | not published | 0 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $958.50 | $3,195.00 | not published | 0 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $186.30 | $621.00 | not published | 0 |
| Echo transesophageal intraop CPT 93318 | $524.40 | $1,748.00 | not published | 0 |
| E equine encephalitis igg CPT 86652 | $65.10 | $217.00 | not published | 0 |
| Egd remove foreign body CPT 43247 | $573.90 | $1,913.00 | not published | 0 |
| Egd remove lesion snare CPT 43251 | $5,805.90 | $9,676.50 | $2,045.28 – $2,045.28 | 1 |
| Electrd sq emblem s-icd HCPCS C1896 | $8,917.75 | $29,725.85 | not published | 0 |
| Electrolyte panel CPT 80051 | $111.00 | $370.00 | not published | 0 |
| Encephalitis, california igg/igm CPT 86651 | $68.40 | $228.00 | not published | 0 |
| Encephalitis, st louis igg/igm CPT 86653 | $68.40 | $228.00 | not published | 0 |
| Endo ak/hip alignable system HCPCS L5920 | $734.85 | $2,449.49 | not published | 0 |
| Endo below knee alignable sy HCPCS L5910 | $505.17 | $1,683.89 | not published | 0 |
| Endo bk ultra-light material HCPCS L5940 | $694.71 | $2,315.69 | not published | 0 |
| Endo knee-shin frct swg & st HCPCS L5812 | $782.91 | $2,609.70 | not published | 0 |
| Endo knee-shin mnl lck ultra HCPCS L5811 | $1,010.07 | $3,366.91 | not published | 0 |
| Endoscpy nsl/sns w/cntrl nsl hmrrgh CPT 31238 | $1,110.60 | $3,702.00 | not published | 0 |
| Endo, single, pulmonary HCPCS C1601 | $5,128.95 | $17,096.50 | not published | 0 |
| Endoskel knee-shin mnl lock HCPCS L5810 | $691.76 | $2,305.88 | not published | 0 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $131.14 | $218.56 | not published | 0 |
| Eo, adj lock joint prefab ot HCPCS L3761 | $678.97 | $2,263.25 | not published | 0 |
| Eo elas w/metal jnts pre ots HCPCS L3710 | $193.86 | $646.19 | not published | 0 |
| Epilepsy gen seq alys panel CPT 81419 | $3,856.50 | $12,855.00 | not published | 0 |
| Epinephrine 1 mg/ml im kit - adult HCPCS J0169 | $990.00 | $1,650.00 | not published | 0 |
| Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution HCPCS J0166 | $9.00 | $15.00 | not published | 0 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $552.61 | $921.01 | not published | 0 |
| Epstein barr early antigen antibody CPT 86663 | $150.90 | $503.00 | not published | 0 |
| Epstein barr nuclear antigen antibody CPT 86664 | $73.20 | $244.00 | not published | 0 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $72.00 | $240.00 | not published | 0 |
| Eptifibatide 0.75 mg/ml intravenous solution HCPCS J1327 | $455.40 | $759.00 | not published | 0 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $93.04 | $155.06 | not published | 0 |
| ER Visit (level 1, minor) CPT 99281 | $266.10 | $887.00 | not published | 0 |
| ER Visit (level 2) CPT 99282 | $531.30 | $1,771.00 | not published | 0 |
| ER Visit (level 3) CPT 99283 | $1,018.50 | $3,395.00 | not published | 0 |
| ER Visit (level 4) CPT 99284 | $1,619.40 | $5,398.00 | not published | 0 |
| ER Visit (level 5, high severity) CPT 99285 | $2,391.00 | $7,970.00 | not published | 0 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) in sterile water intravenous soln HCPCS J1806 | $788.70 | $1,314.50 | 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.