Sentara Martha Jefferson Hospital
500 Martha Jefferson Drive, Charlottesville, VA · Sentara · · NPI 1346248663
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 |
|---|---|---|---|---|
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $1,010.00 – $5,479.92 | 6 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $1,010.00 – $3,602.64 | 6 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $1,010.00 – $5,479.92 | 6 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $5,978.00 – $5,978.00 | 1 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $313.50 | $627.00 | $237.46 – $244.44 | 4 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $3,508.06 – $8,246.00 | 5 |
| Urethrocystography void s&i CPT 74455 | $301.00 | $602.00 | $237.46 – $244.44 | 4 |
| Uric acid blood CPT 84550 | $22.00 | $44.00 | $4.61 – $7.57 | 5 |
| Uric acid urine CPT 84560 | $22.50 | $45.00 | $5.18 – $7.97 | 5 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.79 – $6.18 | 5 |
| Urinalysis microscopic only CPT 81015 | $24.50 | $49.00 | $3.11 – $5.09 | 5 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $2.21 – $3.64 | 5 |
| Urinalysis (with microscopy) CPT 81001 | $40.00 | $80.00 | $3.23 – $5.32 | 5 |
| Urinalysis (without microscopy) CPT 81003 | $25.50 | $51.00 | $2.30 – $3.77 | 5 |
| Urinary pouch w/barrier HCPCS A5071 | $5.70 | $11.39 | not published | 0 |
| Urinary reflex study CPT 51792 | not published | not published | $58.71 – $2,845.00 | 6 |
| Urine Culture Test CPT 87086 | $41.00 | $82.00 | $8.23 – $13.54 | 5 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $132.41 – $2,845.00 | 6 |
| Urine pregnancy test CPT 81025 | $63.50 | $127.00 | $8.78 – $10.61 | 5 |
| Urine screen for bacteria CPT 81007 | not published | not published | $4.31 – $31.48 | 5 |
| Urine shunt to intestine CPT 50815 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $3.60 – $2,004.00 | 3 |
| Urofollitropin, 75 iu HCPCS J3355 | not published | not published | $338.27 – $338.27 | 1 |
| Urography, antegrade CPT 74425 | $375.50 | $751.00 | $347.20 – $357.41 | 4 |
| Urography inf drip &/or bolus CPT 74410 | $642.50 | $1,285.00 | $174.56 – $179.69 | 4 |
| Use 1st target lesion CPT 76982 | $336.50 | $673.00 | $104.04 – $107.10 | 4 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | not published | not published | $13.13 – $13.64 | 4 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | not published | not published | $298.02 – $433.75 | 2 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $6,716.00 – $13,152.83 | 5 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $72.96 | $145.92 | $305.52 – $305.52 | 1 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $72.96 | $145.92 | $277.94 – $277.94 | 1 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $65.55 | $131.10 | $294.65 – $294.65 | 1 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $43.89 | $87.78 | $165.90 – $165.90 | 1 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $32.68 | $65.36 | $123.89 – $123.89 | 1 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $142.03 – $142.03 | 1 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | not published | not published | $133.02 – $133.02 | 1 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $335.59 – $335.59 | 1 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | not published | not published | $59.86 – $59.86 | 1 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | not published | not published | $157.80 – $157.80 | 1 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $157.80 – $157.80 | 1 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | not published | not published | $41.32 – $41.32 | 1 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | not published | not published | $42.24 – $42.24 | 1 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | not published | not published | $34.85 – $34.85 | 1 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | not published | not published | $128.48 – $128.48 | 1 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | not published | not published | $37.29 – $37.29 | 1 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | not published | not published | $17.43 – $17.43 | 1 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | not published | not published | $46.31 – $46.31 | 1 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | not published | not published | $121.92 – $121.92 | 1 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | not published | not published | $69.65 – $69.65 | 1 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $20.66 – $20.66 | 1 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | not published | not published | $252.26 – $252.26 | 1 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | not published | not published | $487.60 – $487.60 | 1 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $493.57 – $493.57 | 1 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | not published | not published | $591.38 – $591.38 | 1 |
| Vaccine rabies im CPT 90675 | not published | not published | $319.95 – $329.36 | 4 |
| Vaccinia vrs vac 0.3 ml perq CPT 90622 | not published | not published | $0.01 – $0.01 | 4 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | not published | not published | $4,007.00 – $8,246.00 | 6 |
| Vag hyst incl t/o complex CPT 58291 | not published | not published | $4,007.00 – $10,995.00 | 5 |
| Vag hyst including t/o CPT 58262 | not published | not published | $4,007.00 – $8,246.00 | 6 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $4,007.00 – $10,995.00 | 5 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $4,007.00 – $10,995.00 | 5 |
| Vag hyst w/enterocele repair CPT 58270 | not published | not published | $4,007.00 – $8,246.00 | 6 |
| Vaginal bx CPT 58999 | not published | not published | $201.20 – $511.00 | 5 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | not published | not published | $3,221.58 – $5,978.00 | 5 |
| Vaginal hysterectomy CPT 58260 | not published | not published | $4,007.00 – $8,246.00 | 6 |
| Vaginectomy partial w/nodes CPT 57109 | not published | not published | $2,004.00 – $5,978.00 | 5 |
| Vagnc compl rmvl paravag tis CPT 57111 | not published | not published | $3,304.00 – $8,246.00 | 2 |
| Vagnc compl rmvl vag wall CPT 57110 | not published | not published | $1,547.00 – $3,304.00 | 2 |
| Vagotomy pfrmd w/prtl dstl gstrct 43635 CPT 43635 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Vagotomy & pylorus repair CPT 43641 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Vagotomy & pylorus repair 43640 CPT 43640 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Valproic acid total therapeutic drug level CPT 80164 | $77.50 | $155.00 | $13.81 – $22.72 | 5 |
| Valrubicin injection HCPCS J9357 | not published | not published | $1,349.81 – $1,389.51 | 4 |
| Valvuloplasty aortic CPT 92986 | $4,673.50 | $9,347.00 | $5,664.24 – $13,397.00 | 5 |
| Valvuloplasty aortic valve CPT 33390 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Valvuloplasty aortic valve CPT 33391 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Valvuloplasty mitral CPT 92987 | $5,401.50 | $10,803.00 | $5,980.00 – $13,397.00 | 5 |
| Valvuloplasty pulmonary CPT 92990 | $8,670.50 | $17,341.00 | $5,980.00 – $13,397.00 | 5 |
| Valvuloplasty/tv without ring insert 33463 CPT 33463 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Valvuloplasty/tv w/ring insertion 33464 CPT 33464 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Vancomycin hcl injection HCPCS J3370 | not published | not published | $5.19 – $5.19 | 1 |
| Vancomycin peak therapeutic drug level CPT 80202 | $81.00 | $162.00 | $13.81 – $22.72 | 5 |
| Vanomycin dna amp probe CPT 87500 | not published | not published | $35.79 – $58.85 | 5 |
| Vantas implant HCPCS J9225 | not published | not published | $13,174.05 – $13,174.05 | 1 |
| Varicella zoster antibody igg CPT 86787 | $58.00 | $116.00 | $13.14 – $21.60 | 5 |
| Varicella-zoster immue globin im CPT 90396 | not published | not published | $2,409.06 – $2,479.91 | 4 |
| Vasc emb/occ w/prs cath HCPCS C9797 | not published | not published | $3,304.00 – $29,725.00 | 5 |
| Vasc graft into carpal bone CPT 25430 | not published | not published | $3,256.29 – $10,995.00 | 6 |
| Vasectomy CPT 55250 | $944.50 | $1,889.00 | $1,571.00 – $5,978.00 | 6 |
| Vedolizumab 300 mg intravenous solution HCPCS J3380 | not published | not published | $21.74 – $22.38 | 4 |
| Veeg cont 2-12 hrs CPT 95713 | $3,769.50 | $7,539.00 | $371.37 – $382.29 | 4 |
| Veeg ea 12-26hr cont mntr CPT 95716 | $3,769.50 | $7,539.00 | $854.62 – $879.75 | 4 |
| Veeg intrmnt 2-12 hrs CPT 95712 | $3,769.50 | $7,539.00 | $371.37 – $382.29 | 4 |
| Veeg unmon 12-26 hrs CPT 95714 | $3,769.50 | $7,539.00 | $371.37 – $382.29 | 4 |
| Veeg unmon 2-12 hrs CPT 95711 | $3,769.50 | $7,539.00 | $214.89 – $221.21 | 4 |
| Vein bypass grft fem-popliteal 35583 CPT 35583 | not published | not published | $1,547.00 – $1,547.00 | 1 |
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.