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 |
|---|---|---|---|---|
| Dest mal lesion tal 1.1-2.0cm 17262 CPT 17262 | $318.00 | $636.00 | $199.67 – $2,845.00 | 6 |
| Dest mal lesion tal 2.1-3.0cm 17263 CPT 17263 | $345.50 | $691.00 | $199.67 – $2,845.00 | 6 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $1,677.50 | $3,355.00 | $1,010.00 – $5,978.00 | 6 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $337.50 | $675.00 | $511.00 – $2,004.00 | 2 |
| Destroy internal hemorrhoids destroy 46930 CPT 46930 | $551.50 | $1,103.00 | $1,190.90 – $4,441.00 | 6 |
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $106.50 | $213.00 | $199.67 – $2,845.00 | 6 |
| Destroy vulva lesion extensive 56515 CPT 56515 | not published | not published | $2,053.37 – $3,895.00 | 6 |
| Destroy vulva lesion simple 56501 CPT 56501 | $3,028.00 | $6,056.00 | $2,004.00 – $3,276.00 | 5 |
| Destruct ben lesion 15/> 17111 CPT 17111 | $271.50 | $543.00 | $199.67 – $2,845.00 | 6 |
| Destruct cut vasl lesions 10-50cm 17107 CPT 17107 | not published | not published | $511.00 – $1,010.00 | 6 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | not published | not published | $404.56 – $1,010.00 | 6 |
| Destruct cut vasl lesions >50cm 17108 CPT 17108 | not published | not published | $1,010.00 – $3,276.00 | 6 |
| Destruction 2-14 lesions 17003 CPT 17003 | $10.50 | $21.00 | $511.00 – $2,004.00 | 2 |
| Destruction anal lesion(s) CPT 46910 | not published | not published | $2,053.37 – $3,276.00 | 5 |
| Destruction anal lesion(s) CPT 46924 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | not published | not published | $404.56 – $1,010.00 | 6 |
| Destruction benign lesions < 14 lesions CPT 17110 | $119.00 | $238.00 | $199.67 – $2,845.00 | 6 |
| Destruction by injection tx of nerve 64630 CPT 64630 | $750.00 | $1,500.00 | $880.23 – $1,571.00 | 6 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $578.50 | $1,157.00 | $511.00 – $2,004.00 | 2 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $2,844.00 | $5,688.00 | $1,943.35 – $5,978.00 | 6 |
| Destruction ciliary body CPT 66700 | not published | not published | $1,571.00 – $3,276.00 | 6 |
| Destruction ciliary body CPT 66720 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Destruction ciliary body CPT 66740 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | $419.00 | $838.00 | $199.67 – $2,845.00 | 6 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Destruction les conjunctiva CPT 68135 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | $377.50 | $755.00 | $404.56 – $2,845.00 | 6 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | not published | not published | $404.56 – $1,010.00 | 6 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $371.50 | $743.00 | $404.56 – $2,845.00 | 6 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $371.50 | $743.00 | $404.56 – $1,010.00 | 6 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | $325.50 | $651.00 | $404.56 – $2,845.00 | 6 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $1,010.00 – $3,276.00 | 6 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $273.00 | $546.00 | $404.56 – $1,010.00 | 6 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $2,670.00 – $6,716.00 | 6 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Destruction vag lesions simple 57061 CPT 57061 | not published | not published | $2,004.00 – $5,978.00 | 5 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | $3,036.50 | $6,073.00 | $2,053.37 – $3,276.00 | 5 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $30.63 – $33.62 | 5 |
| Detect agnt mult dna direc CPT 87800 | not published | not published | $44.54 – $67.24 | 5 |
| Devel tst phys/qhp 1st hr CPT 96112 | $228.00 | $456.00 | $128.06 – $131.82 | 4 |
| Device ablt adv novasure HCPCS C1886 | $2,324.10 | $4,648.19 | not published | 0 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $2,375.00 | $4,750.00 | not published | 0 |
| Device intraute mirena HCPCS J7298 | not published | not published | $3,218.77 – $3,218.77 | 1 |
| Device tiss remov myosure reach HCPCS C1782 | $789.72 | $1,579.43 | not published | 0 |
| Devise bowel pouch CPT 44316 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $114.50 | $229.00 | not published | 0 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $247.50 | $495.00 | $86.61 – $89.15 | 4 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $104.99 – $108.08 | 4 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $3.10 – $3.10 | 1 |
| Dexamethasone 4 mg tablet HCPCS J8540 | not published | not published | $0.19 – $0.19 | 1 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | not published | not published | $0.29 – $0.29 | 1 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $200.06 – $214.84 | 4 |
| Dexamethasone panel CPT 80420 | not published | not published | $120.77 – $169.97 | 5 |
| Dexmedetomidine film, 1 mcg HCPCS J1105 | not published | not published | $1.21 – $1.21 | 1 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | not published | not published | $60.65 – $66.21 | 4 |
| Dextran 40 infusion HCPCS J7100 | not published | not published | $105.52 – $105.52 | 1 |
| Dextran 75 infusion HCPCS J7110 | not published | not published | $32.70 – $32.70 | 1 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | not published | not published | $3.29 – $3.29 | 1 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | not published | not published | $21.57 – $21.57 | 1 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | not published | not published | $5.01 – $5.01 | 1 |
| Dextrose 5 % IV bolus HCPCS J7070 | not published | not published | $10.02 – $10.02 | 1 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $99.50 | $199.00 | $22.67 – $37.28 | 5 |
| Diabetes (HbA1c) Test CPT 83036 | $48.50 | $97.00 | $9.90 – $16.27 | 5 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $37.00 | $74.00 | not published | 0 |
| Diab manage trn ind/group HCPCS G0109 | $29.50 | $59.00 | $16.13 – $16.60 | 4 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $1,571.00 – $3,276.00 | 6 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $3,304.00 – $10,995.00 | 6 |
| Diagnostic anoscopy CPT 46601 | not published | not published | $444.58 – $1,010.00 | 6 |
| Diagnostic anoscopy & biopsy CPT 46607 | $516.00 | $1,032.00 | $1,190.90 – $4,314.00 | 6 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $155.00 | $310.00 | $132.41 – $2,845.00 | 6 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $90.00 | $180.00 | $198.65 – $2,845.00 | 6 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $138.00 | $276.00 | $198.65 – $2,845.00 | 6 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $340.50 | $681.00 | $110.66 – $113.91 | 4 |
| Diagnostic Mammogram (one breast) CPT 77065 | $278.00 | $556.00 | $86.31 – $88.85 | 4 |
| Diagnostic radio unlisted proc CPT 76499 | not published | not published | $86.61 – $89.15 | 4 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $1,739.50 | $3,479.00 | $511.00 – $2,004.00 | 2 |
| Dialysis one evaluation CPT 90945 | $447.00 | $894.00 | $415.26 – $427.47 | 4 |
| Diathermy eg microwave CPT 97024 | $18.00 | $36.00 | $7.30 – $7.52 | 4 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | not published | not published | $23.77 – $23.77 | 1 |
| Dicyclomine injection HCPCS J0500 | not published | not published | $41.47 – $41.47 | 1 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.15 – $0.64 | 3 |
| Diffusing capacity CPT 94729 | $244.50 | $489.00 | not published | 0 |
| Digital analysis of eeg CPT 95957 | $388.00 | $776.00 | not published | 0 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $511.00 – $2,670.00 | 2 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | not published | not published | $24.54 – $24.54 | 1 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | not published | not published | $5,271.59 – $5,426.64 | 4 |
| Digoxin total therapeutic drug level CPT 80162 | $78.00 | $156.00 | $13.55 – $22.26 | 5 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | not published | not published | $114.19 – $114.19 | 1 |
| Dilate biliary duct/ampulla CPT 47542 | $477.00 | $954.00 | $511.00 – $2,004.00 | 2 |
| Dilate esophagus CPT 43453 | not published | not published | $1,010.00 – $3,276.00 | 6 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $902.63 – $3,276.00 | 6 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | $6,476.50 | $12,953.00 | $1,547.00 – $1,571.00 | 2 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | $6,476.50 | $12,953.00 | $1,547.00 – $1,571.00 | 2 |
| Dilate ic vasospasm init CPT 61640 | $9,068.50 | $18,137.00 | $1,547.00 – $3,895.00 | 2 |
| Dilate tear duct opening CPT 68801 | not published | not published | $444.58 – $2,845.00 | 6 |
| Dilate urethra stricture CPT 53600 | $438.50 | $877.00 | $248.65 – $1,010.00 | 6 |
| Dilate urethra stricture CPT 53601 | $226.50 | $453.00 | $132.41 – $1,010.00 | 6 |
| Dilate urethra stricture CPT 53605 | not published | not published | $1,571.00 – $3,602.64 | 6 |
| Dilate urethra stricture CPT 53621 | $200.50 | $401.00 | $248.65 – $1,010.00 | 6 |
| Dilation/female urethra/initial 53660 CPT 53660 | $280.00 | $560.00 | $128.06 – $2,845.00 | 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.