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 |
|---|---|---|---|---|
| Drainage of urethra abscess 53060 CPT 53060 | $1,979.00 | $3,958.00 | $2,004.00 – $5,978.00 | 5 |
| Drainage of urinary leakage CPT 53080 | not published | not published | $693.95 – $5,978.00 | 6 |
| Drainage of urinary leakage CPT 53085 | not published | not published | $2,080.35 – $5,978.00 | 5 |
| Drain bladder by trocar/cath CPT 51101 | not published | not published | $854.62 – $3,276.00 | 6 |
| Drain blood from under nail 11740 CPT 11740 | $146.50 | $293.00 | $132.41 – $2,845.00 | 6 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | $2,174.50 | $4,349.00 | $1,643.67 – $3,895.00 | 6 |
| Drain cath image guided visceral pq CPT 49405 | $2,242.00 | $4,484.00 | $1,643.67 – $6,716.00 | 6 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $603.00 | $1,206.00 | $702.49 – $1,547.00 | 6 |
| Drain chest lesion CPT 21502 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Drain chst dry seal exp thorastat HCPCS A7041 | $74.52 | $149.04 | not published | 0 |
| Drain finger abscess;simple 26010 CPT 26010 | $394.00 | $788.00 | $199.67 – $2,845.00 | 6 |
| Drain lower leg bursa CPT 27604 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Drain lower leg lesion 27603 CPT 27603 | $4,019.00 | $8,038.00 | $1,571.00 – $5,978.00 | 6 |
| Drain neck/chest lesion 21501 CPT 21501 | $1,393.00 | $2,786.00 | $1,571.00 – $5,978.00 | 6 |
| Drain open lung lesion 32200 CPT 32200 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Drain ostomy pouch w/flange HCPCS A5063 | $8.80 | $17.60 | not published | 0 |
| Drain ovarn cyst abd CPT 58805 | $3,532.00 | $7,064.00 | $3,221.58 – $5,978.00 | 5 |
| Drain ovary abscess open CPT 58820 | not published | not published | $3,221.58 – $5,978.00 | 6 |
| Drain pancreatic pseudocyst 48510 CPT 48510 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Drain penis lesion CPT 54015 | not published | not published | $1,643.67 – $4,314.00 | 6 |
| Drain shoulder bone lesion CPT 23035 | not published | not published | $1,600.27 – $5,978.00 | 6 |
| Drain shoulder bursa 23031 CPT 23031 | not published | not published | $2,890.77 – $5,978.00 | 6 |
| Drain shoulder lesion CPT 23030 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Drain thigh/knee lesion 27301 CPT 27301 | $1,393.00 | $2,786.00 | $2,890.77 – $5,978.00 | 6 |
| Drain thyroid/tongue cyst CPT 60000 | not published | not published | $1,010.00 – $3,276.00 | 6 |
| Drain to peritoneal cavity CPT 49062 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $349.50 | $699.00 | $199.67 – $1,571.00 | 6 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $349.50 | $699.00 | $199.67 – $1,010.00 | 6 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $639.50 | $1,279.00 | $404.56 – $1,571.00 | 6 |
| Dressing change not for burn w/anes 15852 CPT 15852 | $862.00 | $1,724.00 | $511.00 – $2,845.00 | 6 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | $1,738.88 | $3,477.76 | not published | 0 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | $4,020.00 | $8,040.00 | $1,547.00 – $1,547.00 | 1 |
| Drm agrft f/s/n/h/f/g/m ea CPT 15136 | not published | not published | $511.00 – $2,004.00 | 2 |
| Drm agrft t/a/l ea addl CPT 15131 | not published | not published | $511.00 – $2,004.00 | 2 |
| Drng appendix abscess open 44900 CPT 44900 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Drng hand tendon sheath 26020 CPT 26020 | $4,933.00 | $9,866.00 | $1,571.00 – $3,344.08 | 6 |
| Drng of eyelid abscess 67700 CPT 67700 | $600.50 | $1,201.00 | $315.88 – $1,010.00 | 6 |
| Drng of finger abscess comp 26011 CPT 26011 | $1,631.50 | $3,263.00 | $1,010.00 – $3,276.00 | 6 |
| Drng of hydrocele 55000 CPT 55000 | $1,057.50 | $2,115.00 | $704.73 – $2,845.00 | 6 |
| Drng of mouth lesion 40801 CPT 40801 | $1,173.50 | $2,347.00 | $511.00 – $1,571.00 | 6 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | $3,532.00 | $7,064.00 | $3,221.58 – $5,978.00 | 6 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $1,571.00 – $3,344.08 | 6 |
| Drng of palm single bursa 26025 CPT 26025 | not published | not published | $1,010.00 – $3,344.08 | 6 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $1,010.00 – $3,276.00 | 6 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $3,299.54 – $5,978.00 | 6 |
| Drng of scrotum abscess 55100 CPT 55100 | $1,775.00 | $3,550.00 | $1,010.00 – $3,276.00 | 6 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | $1,265.50 | $2,531.00 | $1,547.00 – $1,547.00 | 1 |
| Drng ovary abscess perqt 58822 CPT 58822 | $1,939.00 | $3,878.00 | $3,304.00 – $8,246.00 | 2 |
| Drng peritoneal abscess open 49020 CPT 49020 | $2,607.50 | $5,215.00 | $1,547.00 – $1,547.00 | 1 |
| Drng salivary gland simple 42300 CPT 42300 | $1,906.00 | $3,812.00 | $1,010.00 – $3,276.00 | 6 |
| Drng salivary gland submax/subling 42310 CPT 42310 | $766.50 | $1,533.00 | $511.00 – $1,010.00 | 6 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $28.75 – $28.75 | 1 |
| Drop lock knee HCPCS L2182 | $79.18 | $158.36 | not published | 0 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $537.68 | $1,075.37 | not published | 0 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $16.04 | $32.09 | not published | 0 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $18.63 | $37.26 | not published | 0 |
| Drsg sht 5.625x4.625in std HCPCS A6025 | $25.36 | $50.72 | not published | 0 |
| Drsg surg adh 11x11 3/4 occl drap wnd 28x30 HCPCS A6259 | $3.85 | $7.70 | not published | 0 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $226.68 | $453.37 | not published | 0 |
| Drug admin & hemodynmic meas CPT 93463 | $472.50 | $945.00 | $511.00 – $511.00 | 1 |
| Drug assay caffeine CPT 80155 | $29.50 | $59.00 | $23.16 – $40.50 | 5 |
| Drug assay posaconazole CPT 80187 | $80.50 | $161.00 | $27.65 – $32.53 | 5 |
| Drug assay rufinamide CPT 80210 | $62.00 | $124.00 | $27.65 – $32.53 | 5 |
| Drug assay vedolizumab CPT 80280 | $180.50 | $361.00 | $39.34 – $46.28 | 5 |
| Drug assay voriconazole CPT 80285 | $80.50 | $161.00 | $27.65 – $32.53 | 5 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $19.01 – $22.37 | 5 |
| Drug of abuse screen urine CPT 80305 | $67.50 | $135.00 | $12.85 – $17.95 | 5 |
| Drug screening tapentadol CPT 80372 | not published | not published | $0.03 – $29.64 | 2 |
| Drug screen quant tiagabine CPT 80199 | $97.00 | $194.00 | $27.65 – $29.56 | 5 |
| Drug/substance nos 4-6 CPT 80376 | not published | not published | $0.03 – $29.64 | 2 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $199.24 – $208.68 | 5 |
| Drug test def 1-7 classes HCPCS G0480 | $217.50 | $435.00 | $95.93 – $120.15 | 5 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $251.86 – $259.27 | 5 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $147.59 – $164.42 | 5 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $63.38 – $95.77 | 5 |
| Drug test prsmv instrmnt CPT 80306 | not published | not published | $17.48 – $23.94 | 5 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $163.50 | $327.00 | $63.38 – $95.77 | 5 |
| Drvvt confirm - quest CPT 85597 | $40.00 | $80.00 | $18.34 – $30.14 | 5 |
| Dry needling (97799) CPT 97799 | $47.50 | $95.00 | not published | 0 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $1,010.00 – $8,246.00 | 6 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $2,980.00 | $5,960.00 | $1,943.35 – $5,978.00 | 5 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $404.56 – $1,010.00 | 6 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | $444.00 | $888.00 | $404.56 – $2,845.00 | 6 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $511.00 – $1,010.00 | 6 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $511.00 – $2,845.00 | 6 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $547.36 – $1,547.00 | 6 |
| Ductogram sgl duct CPT 77053 | $452.50 | $905.00 | $237.46 – $244.44 | 4 |
| Duodenal exclusion CPT 48547 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Duodenal motility study CPT 91022 | not published | not published | $371.37 – $511.00 | 5 |
| Duplex scan bilateral study 93985 CPT 93985 | $285.00 | $570.00 | $237.46 – $244.44 | 4 |
| Duplex scan unilateral study 93986 CPT 93986 | $137.50 | $275.00 | $104.04 – $107.10 | 4 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $478.00 | $956.00 | $104.04 – $107.10 | 4 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $637.50 | $1,275.00 | $214.89 – $221.21 | 4 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $378.00 | $756.00 | $237.46 – $244.44 | 4 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $86.82 – $89.38 | 4 |
| Dxa bone density axl vrt fx CPT 77085 | $267.00 | $534.00 | $104.04 – $107.10 | 4 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $128.06 – $131.82 | 4 |
| Dx bronchoscope/brush 31623 CPT 31623 | $1,745.00 | $3,490.00 | $1,571.00 – $3,276.00 | 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.