Southside Regional Medical Center
200 Medical Park Blvd., Petersburg, VA · Bonsecours · · NPI 1720623853
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 |
|---|---|---|---|---|
| 24 hr ambulatory b/p monitor CPT 93786 | $107.10 | $357.00 | not published | 0 |
| 2d tte w or without fol w/con,co HCPCS C8923 | $891.60 | $2,972.00 | not published | 0 |
| 2nd order venous cath CPT 36012 | $843.00 | $2,810.00 | not published | 0 |
| 3d ech img cgen car anomal CPT 93319 | $560.10 | $1,867.00 | not published | 0 |
| 3-d radiotherapy plan CPT 77295 | $5,227.80 | $17,426.00 | not published | 0 |
| 3d recon without postprocess indpndt CPT 76376 | $198.90 | $663.00 | not published | 0 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $46.50 | $155.00 | not published | 0 |
| Abd aorta w/runoff s&i CPT 75630 | $4,625.10 | $15,417.00 | not published | 0 |
| Abd/low ext cath 1st CPT 36245 | $2,782.80 | $9,276.00 | not published | 0 |
| Abd/low ext cath 2nd CPT 36246 | $2,782.80 | $9,276.00 | not published | 0 |
| Abd/low ext cath 3rd CPT 36247 | $1,366.20 | $4,554.00 | not published | 0 |
| Abd/low ext cath addl CPT 36248 | $732.30 | $2,441.00 | not published | 0 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $4,433.10 | $14,777.00 | not published | 0 |
| Abdominal CT scan (with contrast) CPT 74160 | $4,084.20 | $13,614.00 | not published | 0 |
| Abdominal CT scan (without contrast) CPT 74150 | $3,010.50 | $10,035.00 | not published | 0 |
| Abdominal MRI (with and without contrast) CPT 74183 | $1,689.60 | $5,632.00 | not published | 0 |
| Abdominal MRI (with contrast) CPT 74182 | $2,479.20 | $8,264.00 | not published | 0 |
| Abdominal MRI (without contrast) CPT 74181 | $2,326.80 | $7,756.00 | not published | 0 |
| Abdominal pad HCPCS L1270 | $198.97 | $663.23 | not published | 0 |
| Abdominal paracentesis w/image guidance CPT 49083 | $4,085.32 | $11,585.00 | $884.93 – $902.63 | 3 |
| Abdominal Ultrasound (complete) CPT 76700 | $1,893.30 | $6,311.00 | not published | 0 |
| Abdominal Ultrasound (limited) CPT 76705 | $924.00 | $3,080.00 | not published | 0 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $765.00 | $2,550.00 | not published | 0 |
| Abduct control hip semi-flex HCPCS L1630 | $507.15 | $1,690.51 | not published | 0 |
| Abduction bar jointed adjust HCPCS L2300 | $604.36 | $2,014.54 | not published | 0 |
| Abduction rotation bar shoe HCPCS L3140 | $213.72 | $712.40 | not published | 0 |
| Abduct rotation bar without shoe HCPCS L3150 | $195.43 | $651.43 | not published | 0 |
| Abl1 gene CPT 81170 | $496.20 | $1,654.00 | not published | 0 |
| Ablate arrhythmia add on CPT 93655 | $1,437.00 | $4,790.00 | not published | 0 |
| Ablate bone tumor(s) cryo perq 20983 CPT 20983 | $5,087.40 | $16,958.00 | not published | 0 |
| Ablate bone tumor(s) perq CPT 20982 | $2,575.20 | $8,584.00 | not published | 0 |
| Ablate heart dysrhythm focus CPT 93650 | $4,761.90 | $15,873.00 | not published | 0 |
| Ablate inf turbinate submuc 30802 CPT 30802 | $22,869.28 | $38,115.47 | $1,513.86 – $1,544.13 | 3 |
| Ablate inf turbinate superf 30801 CPT 30801 | $11,455.20 | $19,092.00 | $1,513.86 – $1,544.13 | 3 |
| Ablation cardiac vagal inputs atrium CPT 93799 | $147.30 | $491.00 | not published | 0 |
| Ablation of upper extremity nerves rf CPT 64999 | $594.00 | $1,980.00 | not published | 0 |
| Abscess drain retroperitoneal surg code CPT 49406 | $1,895.40 | $6,318.00 | not published | 0 |
| Access & clsr pq fem art endogft dlvry w/img uni CPT 34713 | $390.30 | $1,301.00 | not published | 0 |
| Acetaminophen level CPT 80143 | $36.00 | $120.00 | not published | 0 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $390.65 | $651.08 | not published | 0 |
| Acetone qualitative CPT 82009 | $44.70 | $149.00 | 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 | $48.00 | $80.00 | not published | 0 |
| Acetylcysteine non-comp unit HCPCS J7608 | $104.51 | $174.18 | not published | 0 |
| Acute hepatitis panel CPT 80074 | $354.30 | $1,181.00 | not published | 0 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $206.64 | $344.40 | not published | 0 |
| Adapter b 8 channel 10cm HCPCS C1883 | $10,180.73 | $33,935.78 | not published | 0 |
| Add le poly knee custom kafo HCPCS L2387 | $458.27 | $1,527.57 | not published | 0 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $53.87 | $89.79 | not published | 0 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $1,332.40 | $2,220.66 | not published | 0 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $192.60 | $642.00 | not published | 0 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $210.60 | $702.00 | not published | 0 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $408.60 | $1,362.00 | not published | 0 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $131.10 | $437.00 | not published | 0 |
| Administration immunization 1 vaccine CPT 90471 | $952.00 | $1,586.67 | $70.25 – $71.65 | 3 |
| Administration immunization each additional vaccine CPT 90472 | $179.10 | $597.00 | not published | 0 |
| Administration vaccine influenza virus HCPCS G0008 | $13.20 | $44.00 | not published | 0 |
| Administration vaccine pneumococcal HCPCS G0009 | $19.20 | $64.00 | not published | 0 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $35,236.37 | $58,727.28 | not published | 0 |
| _afb id by dna probe rflx ast CPT 87149 | $87.60 | $292.00 | not published | 0 |
| #afb mycobacteria suscep. #1 CPT 87190 | $61.50 | $205.00 | not published | 0 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $315.00 | $1,050.00 | not published | 0 |
| Afo molded ankle gauntlet HCPCS L1904 | $1,083.56 | $3,611.86 | not published | 0 |
| Afo molded plas rig ant tib HCPCS L1945 | $2,473.49 | $8,244.96 | not published | 0 |
| Afo molded to patient plasti HCPCS L1940 | $1,034.59 | $3,448.65 | not published | 0 |
| Afo rig ant tib tcf/= custom HCPCS L1932 | $2,142.14 | $7,140.47 | not published | 0 |
| Afo sing bar clasp attach sh HCPCS L1910 | $673.24 | $2,244.13 | not published | 0 |
| Afo sing solid stirrup calf HCPCS L1980 | $969.28 | $3,230.94 | not published | 0 |
| Afo sing upright with adjust s HCPCS L1920 | $986.19 | $3,287.30 | not published | 0 |
| Afo spiral molded to pt plas HCPCS L1950 | $1,846.20 | $6,154.01 | not published | 0 |
| Afo sprng wir drsflx calf bd HCPCS L1900 | $684.90 | $2,283.01 | not published | 0 |
| Afo supramalleolar custom HCPCS L1907 | $1,350.85 | $4,502.82 | not published | 0 |
| Afo tib fx cast plaster mold HCPCS L2106 | $1,892.19 | $6,307.29 | not published | 0 |
| Afo tibial fracture rigid HCPCS L2116 | $1,850.28 | $6,167.59 | not published | 0 |
| Afo tibial fracture soft HCPCS L2112 | $1,211.12 | $4,037.06 | not published | 0 |
| Afo, walk boot type, cus fab HCPCS L4631 | $3,809.40 | $12,698.00 | not published | 0 |
| Afo w/ankle joint, prefab HCPCS L1971 | $1,533.60 | $5,112.00 | not published | 0 |
| Ak/knee disartic pelvic band HCPCS L5697 | $188.26 | $627.55 | not published | 0 |
| Ak/knee disartic silesian ba HCPCS L5698 | $234.14 | $780.47 | not published | 0 |
| Ak sleeve susp neoprene/equa HCPCS L5695 | $424.16 | $1,413.88 | not published | 0 |
| Albumin body fluid quantitative each specimen CPT 82042 | $39.30 | $131.00 | not published | 0 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $458.05 | $763.42 | not published | 0 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $457.56 | $762.60 | not published | 0 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $57.00 | $190.00 | not published | 0 |
| Albumin serum plasma or whole blood CPT 82040 | $52.80 | $176.00 | not published | 0 |
| Albuterol ipratrop non-comp HCPCS J7620 | $6.00 | $10.00 | not published | 0 |
| Albuterol non-comp con HCPCS J7611 | $17.86 | $29.77 | not published | 0 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $33.60 | $112.00 | not published | 0 |
| Alkaline phosphatase CPT 84075 | $56.70 | $189.00 | not published | 0 |
| Allergen alpha lactalbumin ige CPT 86008 | $70.80 | $236.00 | not published | 0 |
| Allergen egg white ige CPT 86003 | $22.50 | $75.00 | not published | 0 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $6,707.64 | $22,358.79 | not published | 0 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $13,227.30 | $44,091.00 | not published | 0 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | $16,597.84 | $55,326.13 | not published | 0 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $10,322.51 | $34,408.38 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $46,859.15 | $156,197.16 | not published | 0 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $31,458.77 | $104,862.56 | not published | 0 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $26,622.34 | $88,741.13 | not published | 0 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $25,136.66 | $83,788.88 | not published | 0 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $8,240.44 | $27,468.13 | 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.