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 |
|---|---|---|---|---|
| CT guidance for needle placement CPT 77012 | $1,137.00 | $2,274.00 | not published | 0 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $2,266.50 | $4,533.00 | not published | 0 |
| CT guid cryo ablat intramuscular CPT 20999 | $3,601.50 | $7,203.00 | $245.48 – $511.00 | 5 |
| CT guid parench tis ablat CPT 77013 | $1,392.50 | $2,785.00 | not published | 0 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $75.00 | $150.00 | $86.61 – $89.15 | 4 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | $963.00 | $1,926.00 | $347.20 – $357.41 | 4 |
| CT hrt w/3d image CPT 75572 | $545.00 | $1,090.00 | $347.20 – $357.41 | 4 |
| CT limited or localized follow-up study CPT 76380 | $675.50 | $1,351.00 | $86.61 – $89.15 | 4 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $1,330.50 | $2,661.00 | $174.56 – $179.69 | 4 |
| CT lower extremity without contrast (both sides) CPT 73700 | $974.00 | $1,948.00 | $104.04 – $107.10 | 4 |
| CT lwr extremity w/o&w/dye CPT 73702 | $1,431.00 | $2,862.00 | $174.56 – $179.69 | 4 |
| CT neck soft tissue w/contrast CPT 70491 | $946.00 | $1,892.00 | $174.56 – $179.69 | 4 |
| CT neck soft tissue without contrast CPT 70490 | $932.00 | $1,864.00 | $104.04 – $107.10 | 4 |
| CT neck soft tissue without & w/contrast CPT 70492 | $1,321.00 | $2,642.00 | $174.56 – $179.69 | 4 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $1,460.00 | $2,920.00 | $174.56 – $179.69 | 4 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $1,154.00 | $2,308.00 | $174.56 – $179.69 | 4 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $923.00 | $1,846.00 | $104.04 – $107.10 | 4 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | $255.50 | $511.00 | $235.71 – $1,010.00 | 6 |
| CT scan for localization CPT 77011 | $1,909.00 | $3,818.00 | not published | 0 |
| CT scan for therapy guide CPT 77014 | $469.00 | $938.00 | not published | 0 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $3,108.00 | $6,216.00 | $347.20 – $357.41 | 4 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $2,319.00 | $4,638.00 | $347.20 – $357.41 | 4 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $1,625.50 | $3,251.00 | $237.46 – $244.44 | 4 |
| CT thoracic spine w/contrast CPT 72129 | $1,241.50 | $2,483.00 | $174.56 – $179.69 | 4 |
| CT thoracic spine without contrast CPT 72128 | $1,010.50 | $2,021.00 | $104.04 – $107.10 | 4 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $478.50 | $957.00 | $104.04 – $107.10 | 4 |
| CT t-spine w /wo contrast CPT 72130 | $1,705.00 | $3,410.00 | $174.56 – $179.69 | 4 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,330.50 | $2,661.00 | $347.20 – $357.41 | 4 |
| CT upper extremity without contrast (both sides) CPT 73200 | $974.00 | $1,948.00 | $104.04 – $107.10 | 4 |
| CT uppr extremity w/o&w/dye CPT 73202 | $1,431.00 | $2,862.00 | $174.56 – $179.69 | 4 |
| Cuffs adj lock with active con HCPCS L3740 | $723.98 | $1,447.97 | not published | 0 |
| Cultr oocyte/embryo <4 days CPT 89250 | not published | not published | $52.48 – $174.54 | 5 |
| Cultr oocyte/embryo <4 days CPT 89251 | not published | not published | $52.48 – $174.54 | 5 |
| Cult skin graft fnhfg 15155 CPT 15155 | not published | not published | $1,571.00 – $8,246.00 | 6 |
| Cult skin grft t/arm/leg CPT 15150 | not published | not published | $1,571.00 – $3,276.00 | 6 |
| Culture aerobic additional method definitive id each CPT 87077 | $43.00 | $86.00 | $8.24 – $13.55 | 5 |
| Culture afb any source CPT 87116 | $54.50 | $109.00 | $11.02 – $18.12 | 5 |
| Culture anaerobic additional method definitive id each CPT 87076 | $63.00 | $126.00 | $8.24 – $13.55 | 5 |
| Culture anaerobic except blood CPT 87075 | $49.00 | $98.00 | $9.66 – $15.86 | 5 |
| Culture bacteria anaerobic CPT 87073 | not published | not published | $9.85 – $15.82 | 5 |
| Culture bacterial urine HCPCS P7001 | not published | not published | $32.75 – $47.50 | 2 |
| Culture bact stool aero addl path ea CPT 87046 | $7.50 | $15.00 | $9.63 – $15.82 | 5 |
| Culture body fluid CPT 87070 | $45.50 | $91.00 | $8.79 – $14.44 | 5 |
| Culture fungi definitive id mold CPT 87107 | $14.00 | $28.00 | $10.53 – $17.30 | 5 |
| Culture fungi definitive id yeast CPT 87106 | $52.00 | $104.00 | $10.53 – $17.30 | 5 |
| Culture fungi other (except blood) CPT 87102 | $41.50 | $83.00 | $8.58 – $14.09 | 5 |
| Culture fungi skin/hair/nail CPT 87101 | not published | not published | $7.86 – $12.92 | 5 |
| Culture mycobacteria definitive id each isolate CPT 87118 | not published | not published | $14.90 – $18.35 | 5 |
| Culture mycoplasma any source CPT 87109 | $79.50 | $159.00 | $15.70 – $25.80 | 5 |
| Culture of specimen by kit CPT 87084 | $45.50 | $91.00 | $14.44 – $28.42 | 5 |
| Culture quantitative aerobic other source CPT 87071 | $10.50 | $21.00 | $10.09 – $15.82 | 5 |
| Culture screening strep group a CPT 87081 | $35.50 | $71.00 | $6.76 – $11.11 | 5 |
| Culture type pulse field gel CPT 87152 | not published | not published | $7.89 – $8.77 | 5 |
| Culture typing added method CPT 87158 | not published | not published | $7.89 – $8.77 | 5 |
| Culture typing glc/hplc CPT 87143 | not published | not published | $12.77 – $21.01 | 5 |
| Culture typing immunologic CPT 87147 | $27.00 | $54.00 | $5.28 – $8.68 | 5 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | $109.50 | $219.00 | $222.42 – $261.67 | 5 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $105.00 | $210.00 | $35.79 – $60.32 | 5 |
| Culture urine each isolate CPT 87088 | not published | not published | $8.25 – $13.57 | 5 |
| Culture virus isolation CPT 87250 | not published | not published | $19.95 – $32.78 | 5 |
| Curette/treat cornea CPT 65435 | not published | not published | $992.09 – $3,276.00 | 6 |
| Curette/treat cornea CPT 65436 | not published | not published | $2,004.00 – $5,978.00 | 6 |
| Cutter lead HCPCS C1773 | $1,929.76 | $3,859.52 | not published | 0 |
| Cv line/pic reposition CPT 36597 | $814.50 | $1,629.00 | $1,010.00 – $1,612.67 | 6 |
| Cyanocobalamin unsat binding capacity CPT 82608 | $66.00 | $132.00 | $14.61 – $24.01 | 5 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | not published | not published | $3.52 – $3.52 | 1 |
| Cyclic citrullinated peptide antibody CPT 86200 | $56.00 | $112.00 | $13.21 – $21.71 | 5 |
| Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 | not published | not published | $0.49 – $0.51 | 4 |
| Cyclophosphamide 25 mg capsule HCPCS J8530 | not published | not published | $2.33 – $2.33 | 1 |
| Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 | not published | not published | $198.56 – $198.56 | 1 |
| Cyclosporine 2 hour CPT 80158 | $120.00 | $240.00 | $18.41 – $30.28 | 5 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | not published | not published | $2.31 – $2.31 | 1 |
| Cyclosporine oral 100 mg HCPCS J7502 | not published | not published | $6.12 – $6.12 | 1 |
| Cylinder pump set 20cm titan zero angl HCPCS C1813 | $12,988.40 | $25,976.80 | not published | 0 |
| Cyp2c19 gene com variants CPT 81225 | $1,059.00 | $2,118.00 | $297.19 – $350.16 | 5 |
| Cyp2c9 gene com variants CPT 81227 | $133.00 | $266.00 | $178.31 – $210.10 | 5 |
| Cyp2d6 gene com variants CPT 81226 | $1,711.50 | $3,423.00 | $459.93 – $541.91 | 5 |
| Cyp3a4 gene common variants CPT 81230 | not published | not published | $178.31 – $209.77 | 5 |
| Cyp3a5 gene common variants CPT 81231 | not published | not published | $178.31 – $209.77 | 5 |
| Cystatin c CPT 82610 | $57.50 | $115.00 | $18.89 – $22.80 | 5 |
| Cystic fibrosis cftr CPT 81223 | not published | not published | $508.98 – $598.80 | 5 |
| Cystine urine quantitative CPT 82131 | $77.00 | $154.00 | $23.44 – $28.28 | 5 |
| Cysto cgen post urtl valves CPT 52400 | not published | not published | $3,304.00 – $5,978.00 | 6 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $306.00 | $612.00 | $347.20 – $357.41 | 4 |
| Cysto impl 4 or more HCPCS C9740 | not published | not published | $4,007.00 – $13,397.00 | 5 |
| Cysto insj dev ischmc rmdlg CPT 53865 | not published | not published | $3,304.00 – $9,675.01 | 5 |
| Cysto, litho, vacuum kidney HCPCS C9761 | not published | not published | $3,338.00 – $9,675.01 | 5 |
| Cystometrogram w/up 51727 CPT 51727 | not published | not published | $693.95 – $2,845.00 | 6 |
| Cystorrhaphy wound comp 51865 CPT 51865 | not published | not published | $3,338.00 – $8,246.00 | 2 |
| Cystorrhaphy wound simple 51860 CPT 51860 | not published | not published | $2,670.00 – $9,675.01 | 5 |
| Cysto rx balo cath urtl strx CPT 52284 | not published | not published | $3,304.00 – $5,978.00 | 5 |
| Cystoscopy and biopsy CPT 52007 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Cystoscopy and radiotracer CPT 52250 | not published | not published | $3,338.00 – $5,978.00 | 6 |
| Cystoscopy and treatment CPT 52214 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Cystoscopy and treatment CPT 52224 | $1,526.50 | $3,053.00 | $1,571.00 – $5,978.00 | 6 |
| Cystoscopy and treatment CPT 52234 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Cystoscopy and treatment CPT 52235 | not published | not published | $3,304.00 – $5,978.00 | 6 |
| Cystoscopy and treatment CPT 52240 | not published | not published | $3,304.00 – $5,978.00 | 6 |
| Cystoscopy and treatment CPT 52260 | not published | not published | $1,571.00 – $3,276.00 | 6 |
| Cystoscopy and treatment CPT 52265 | not published | not published | $1,010.00 – $2,141.53 | 6 |
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.