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 |
|---|---|---|---|---|
| Acoustic refl threshold tst CPT 92568 | $71.50 | $143.00 | $37.17 – $38.26 | 4 |
| Acromp/acromionectomy prtl CPT 23130 | not published | not published | $3,256.29 – $10,995.00 | 6 |
| Acth stimulation panel CPT 80402 | not published | not published | $88.70 – $145.75 | 5 |
| Acth stimulation panel CPT 80406 | not published | not published | $79.83 – $131.21 | 5 |
| Actigraphy testing CPT 95803 | $37.50 | $75.00 | $58.71 – $60.44 | 4 |
| Actinotherapy uv light CPT 96900 | $40.00 | $80.00 | $37.17 – $38.26 | 4 |
| Acup 1/> w/estim 1st 15 min CPT 97813 | $100.50 | $201.00 | not published | 0 |
| Acup 1/> w/estim ea addl 15 CPT 97814 | $100.50 | $201.00 | not published | 0 |
| Acup 1/> without estim ea add 15 CPT 97811 | $85.50 | $171.00 | not published | 0 |
| Acup 1/> wo estim 1st 15 min CPT 97810 | $85.50 | $171.00 | not published | 0 |
| Acute hepatitis panel CPT 80074 | $235.00 | $470.00 | $48.58 – $79.85 | 5 |
| Acute venous thrombus image CPT 78456 | $638.00 | $1,276.00 | $1,288.43 – $1,326.33 | 4 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | not published | not published | $0.13 – $0.13 | 1 |
| #acylcarnitineprfl CPT 82017 | $77.00 | $154.00 | $17.21 – $28.28 | 5 |
| Acylcarnitines qual CPT 82016 | not published | not published | $16.82 – $23.24 | 5 |
| Adapter b 8 channel 10cm HCPCS C1883 | $485.94 | $971.87 | not published | 0 |
| Adding walker to prev cast CPT 29440 | $156.50 | $313.00 | $161.72 – $2,845.00 | 6 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | not published | not published | $0.87 – $0.87 | 1 |
| Adenovirus ag ia CPT 87301 | not published | not published | $12.22 – $20.11 | 5 |
| Adenovirus antibody,serum - quest CPT 86603 | $55.00 | $110.00 | $13.13 – $21.58 | 5 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $20.11 – $22.85 | 5 |
| Adhesiolysis tube ovary 58740 CPT 58740 | not published | not published | $4,007.00 – $5,978.00 | 2 |
| Adhesive, liquid or equal HCPCS A4364 | $18.63 | $37.26 | not published | 0 |
| Adh-sendout CPT 84588 | $147.50 | $295.00 | $34.62 – $56.92 | 5 |
| Adj gastric band via subq port CPT 43999 | $1,359.50 | $2,719.00 | $902.63 – $3,276.00 | 5 |
| Adjmt/revj ext fixj sys anes CPT 20693 | not published | not published | $3,304.00 – $8,246.00 | 6 |
| Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 | not published | not published | $2,053.37 – $3,895.00 | 6 |
| Adjustment gastric band HCPCS S2083 | $375.00 | $750.00 | $2,004.00 – $2,004.00 | 1 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | not published | not published | $0.61 – $0.61 | 1 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $188.50 | $377.00 | $71.65 – $73.76 | 4 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $373.50 | $747.00 | $71.65 – $73.76 | 4 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $762.50 | $1,525.00 | $328.72 – $338.39 | 4 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $540.00 | $1,080.00 | $328.72 – $338.39 | 4 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $173.50 | $347.00 | $71.65 – $73.76 | 4 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $250.50 | $501.00 | $71.65 – $73.76 | 4 |
| Administration immunization 1 vaccine CPT 90471 | $20.50 | $41.00 | $71.65 – $73.76 | 4 |
| Administration immunization each additional vaccine CPT 90472 | $20.50 | $41.00 | not published | 0 |
| Administration immunization first component each vaccine CPT 90460 | $49.00 | $98.00 | not published | 0 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | not published | not published | $71.65 – $73.76 | 4 |
| Administration vaccine hepatitis b HCPCS G0010 | $49.00 | $98.00 | $46.60 – $47.97 | 4 |
| Administration vaccine influenza virus HCPCS G0008 | $20.50 | $41.00 | $46.60 – $47.97 | 4 |
| Administration vaccine pneumococcal HCPCS G0009 | $20.50 | $41.00 | $46.60 – $47.97 | 4 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | not published | not published | $43.00 – $44.27 | 4 |
| Adrenal cortex & medulla img CPT 78075 | $872.50 | $1,745.00 | $1,288.43 – $1,326.33 | 4 |
| Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Adrenalin epinephrine inject HCPCS J0171 | not published | not published | $2.12 – $2.12 | 1 |
| Advance care planning each additional 30 min 99498 CPT 99498 | $100.50 | $201.00 | not published | 0 |
| Aep hearing status deter i&r CPT 92651 | not published | not published | $214.89 – $221.21 | 4 |
| Aep neurodiagnostic i&r CPT 92653 | $746.50 | $1,493.00 | $214.89 – $221.21 | 4 |
| Aep thrshld est mlt freq i&r CPT 92652 | $746.50 | $1,493.00 | $214.89 – $221.21 | 4 |
| Afamelanotide implant, 1 mg HCPCS J7352 | not published | not published | $3,002.29 – $3,090.59 | 4 |
| Afamitresgene autoleucel HCPCS Q2057 | not published | not published | $0.02 – $809,151.00 | 4 |
| _afb id by dna probe rflx ast CPT 87149 | $67.50 | $135.00 | $20.45 – $33.62 | 5 |
| #afb mycobacteria suscep. #1 CPT 87190 | not published | not published | $7.46 – $9.48 | 5 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $170.00 | $340.00 | $117.67 – $198.26 | 5 |
| Aff2 gen aly detc abnl allel CPT 81171 | not published | not published | $139.74 – $164.40 | 5 |
| Aff2 gen alys charac alleles CPT 81172 | not published | not published | $280.33 – $329.80 | 5 |
| Aflibercept injection HCPCS J0178 | not published | not published | $786.99 – $810.14 | 4 |
| Afo molded to patient plasti HCPCS L1940 | $436.77 | $873.54 | not published | 0 |
| Afo rig ant tib tcf/= custom HCPCS L1932 | $706.39 | $1,412.78 | not published | 0 |
| Afo tib fx semi-rigid l2114 HCPCS L2114 | $404.68 | $809.37 | not published | 0 |
| Afo, walk boot type, cus fab HCPCS L4631 | $1,180.94 | $2,361.87 | not published | 0 |
| Afo w/ankle joint, prefab HCPCS L1971 | $275.31 | $550.62 | not published | 0 |
| After cataract laser surgery CPT 66821 | $897.00 | $1,794.00 | $547.36 – $1,571.00 | 6 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $228.07 – $241.66 | 4 |
| Air conduction bilat CPT 92552 | $55.50 | $111.00 | $132.41 – $136.30 | 4 |
| Air injection into abdomen 49400 CPT 49400 | not published | not published | $511.00 – $2,004.00 | 2 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | not published | not published | $128.06 – $131.82 | 4 |
| Ak/knee disartic silesian ba HCPCS L5698 | $88.50 | $176.99 | not published | 0 |
| Ak sleeve susp neoprene/equa HCPCS L5695 | $157.84 | $315.68 | not published | 0 |
| Albumin body fluid quantitative each specimen CPT 82042 | $24.50 | $49.00 | $7.94 – $8.68 | 5 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $21.66 – $22.29 | 4 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | not published | not published | $54.14 – $55.73 | 4 |
| Albumin ischemia modified CPT 82045 | not published | not published | $34.62 – $56.92 | 5 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $28.00 | $56.00 | $5.90 – $9.71 | 5 |
| Albumin serum plasma or whole blood CPT 82040 | $23.00 | $46.00 | $5.05 – $8.30 | 5 |
| Albuterol comp con HCPCS J7610 | not published | not published | $3.26 – $3.26 | 1 |
| Albuterol comp unit HCPCS J7609 | not published | not published | $1.35 – $1.35 | 1 |
| Albuterol ipratrop non-comp HCPCS J7620 | not published | not published | $0.53 – $0.53 | 1 |
| Albuterol non-comp con HCPCS J7611 | not published | not published | $0.45 – $0.45 | 1 |
| Albuterol non-comp unit HCPCS J7613 | not published | not published | $0.21 – $0.21 | 1 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $132.00 | $264.00 | $0.03 – $20.72 | 5 |
| Alcohols biomarkers 3/more CPT 80322 | not published | not published | $0.03 – $17.64 | 2 |
| Alcohol/subs interv 15-30mn HCPCS G0396 | $36.00 | $72.00 | not published | 0 |
| Aldesleukin injection HCPCS J9015 | not published | not published | $3,405.65 – $3,505.81 | 4 |
| Aldosterone suppression eval CPT 80408 | not published | not published | $128.01 – $210.41 | 5 |
| Alefacept HCPCS J0215 | not published | not published | $106.19 – $106.19 | 1 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $2,478.49 – $2,551.39 | 4 |
| Alginate dressing <=16 sq in HCPCS A6196 | $20.18 | $40.37 | not published | 0 |
| Alginate drsg >16 <=48 sq in HCPCS A6197 | $73.83 | $147.66 | not published | 0 |
| Alginate drsg wound filler HCPCS A6199 | $38.82 | $77.63 | not published | 0 |
| Alglucerase injection HCPCS J0205 | not published | not published | $107.17 – $107.17 | 1 |
| Alkaline phosphatase CPT 84075 | $24.50 | $49.00 | $5.28 – $8.68 | 5 |
| Allergen alpha lactalbumin ige CPT 86008 | $42.00 | $84.00 | $18.29 – $26.57 | 5 |
| Allergen egg white ige CPT 86003 | $38.00 | $76.00 | $5.32 – $8.76 | 5 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $16.00 | $32.00 | $8.13 – $13.37 | 5 |
| Allergy injections; 2 or more 95117 CPT 95117 | $20.50 | $41.00 | $46.60 – $47.97 | 4 |
| Allergy injection; single 95115 CPT 95115 | $20.50 | $41.00 | $46.60 – $47.97 | 4 |
| Allergy Skin Testing CPT 95004 | not published | not published | $854.62 – $879.75 | 4 |
| Allg patch or app # of tests 95044 CPT 95044 | $445.00 | $890.00 | $854.62 – $879.75 | 4 |
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.