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 |
|---|---|---|---|---|
| X-ray thoracolumbar spine >=2 views CPT 72080 | $112.50 | $225.00 | $86.61 – $89.15 | 4 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $145.50 | $291.00 | $86.61 – $89.15 | 4 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $183.00 | $366.00 | $104.04 – $107.10 | 4 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $208.00 | $416.00 | $86.61 – $89.15 | 4 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $102.00 | $204.00 | $86.61 – $89.15 | 4 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $678.00 | $1,356.00 | $174.56 – $179.69 | 4 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $458.50 | $917.00 | $174.56 – $179.69 | 4 |
| X-ray wrist 2 views (both sides) CPT 73100 | $171.00 | $342.00 | $86.61 – $89.15 | 4 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $174.56 – $179.69 | 4 |
| Xylose absorption test blood &/or urine CPT 84620 | $54.50 | $109.00 | $13.17 – $19.86 | 5 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.71 – $1.76 | 4 |
| Yersinia antibody CPT 86793 | not published | not published | $13.45 – $22.12 | 5 |
| Yttrium y-90 ibritumomab ther HCPCS A9543 | not published | not published | $57,961.04 – $59,665.78 | 4 |
| Ziconotide injection HCPCS J2278 | not published | not published | $10.34 – $10.65 | 4 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | not published | not published | $1.54 – $1.59 | 4 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $52.34 – $76.02 | 5 |
| Zika virus igm antibody CPT 86794 | $96.50 | $193.00 | $17.19 – $24.96 | 5 |
| Zinc paste band w >=3"<5"/yd HCPCS A6456 | $7.24 | $14.49 | not published | 0 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | not published | not published | $20.01 – $20.01 | 1 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | not published | not published | $8.04 – $8.27 | 4 |
| Zolbetuximab-clzb 100 mg intravenous solution HCPCS J1326 | not published | not published | $34.38 – $35.39 | 4 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | not published | not published | $15.58 – $15.58 | 1 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $197.12 – $231.90 | 5 |
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.