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 |
|---|---|---|---|---|
| Full mouth x-ray of teeth CPT 70320 | $265.50 | $531.00 | $237.46 – $244.44 | 4 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | $2,798.50 | $5,597.00 | $1,571.00 – $3,276.00 | 6 |
| Full thick gft/scalp/arm/leg/20sqcm or< 15220 CPT 15220 | $2,798.50 | $5,597.00 | $1,571.00 – $3,276.00 | 6 |
| Full thick gft/scalp/arm/leg/add 20sqcm 15221 CPT 15221 | $1,417.00 | $2,834.00 | $511.00 – $2,670.00 | 2 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | $2,798.50 | $5,597.00 | $2,053.37 – $3,895.00 | 6 |
| Fundus photography with i&r 92250 CPT 92250 | $156.50 | $313.00 | $132.41 – $136.30 | 4 |
| Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr HCPCS J1940 | not published | not published | $1.09 – $1.09 | 1 |
| Fuse bile ducts and bowel 47785 CPT 47785 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse esophagus & intestine CPT 43340 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse esophagus & intestine CPT 43341 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse esophagus & stomach CPT 43320 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse gallbladder & bowel CPT 47740 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse gallbladder & bowel CPT 47741 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse/graft added joint CPT 26863 | not published | not published | $511.00 – $3,304.00 | 2 |
| Fuse liver ducts & bowel CPT 47765 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse pancreas and bowel CPT 48548 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse pancreas cyst and bowel CPT 48540 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse pancreas cyst and bowel 48520 CPT 48520 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fuse upper gi structures CPT 47721 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fusion/graft of finger joint CPT 26862 | not published | not published | $3,256.29 – $8,246.00 | 6 |
| Fusion/graft of hand joint CPT 26844 | not published | not published | $3,304.00 – $8,246.00 | 6 |
| Fusion of ankle joint open CPT 27870 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Fusion of big toe joint CPT 28750 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Fusion of big toe joint CPT 28755 | not published | not published | $3,338.00 – $7,416.07 | 6 |
| Fusion of facial/other nerve CPT 64866 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fusion of finger jnt add-on CPT 26861 | not published | not published | $511.00 – $2,670.00 | 2 |
| Fusion of finger joint CPT 26860 | not published | not published | $3,256.29 – $8,246.00 | 6 |
| Fusion of finger tendons CPT 26471 | not published | not published | $1,571.00 – $3,344.08 | 6 |
| Fusion of finger tendons CPT 26474 | not published | not published | $1,571.00 – $3,276.00 | 6 |
| Fusion of foot bones CPT 28730 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Fusion of foot bones CPT 28735 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Fusion of foot bones CPT 28740 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Fusion of hand joint CPT 26843 | not published | not published | $3,304.00 – $8,246.00 | 6 |
| Fusion of knee CPT 27580 | not published | not published | $4,007.00 – $13,397.00 | 5 |
| Fusion of knuckle CPT 26850 | not published | not published | $3,338.00 – $8,246.00 | 6 |
| Fusion of knuckle joint CPT 26516 | not published | not published | $1,010.00 – $8,246.00 | 6 |
| Fusion of knuckle joints CPT 26517 | not published | not published | $3,256.29 – $8,246.00 | 6 |
| Fusion of knuckle joints CPT 26518 | not published | not published | $3,304.00 – $8,246.00 | 6 |
| Fusion of knuckle with graft CPT 26852 | not published | not published | $3,338.00 – $8,246.00 | 6 |
| Fusion of skull arteries CPT 61711 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fusion of spermatic ducts CPT 54900 | not published | not published | $2,080.35 – $5,978.00 | 6 |
| Fusion of spermatic ducts CPT 54901 | not published | not published | $3,338.00 – $5,978.00 | 6 |
| Fusion of tendons at wrist CPT 25300 | not published | not published | $3,256.29 – $8,246.00 | 6 |
| Fusion of tendons at wrist CPT 25301 | not published | not published | $3,256.29 – $8,246.00 | 6 |
| Fusion of thumb CPT 26841 | not published | not published | $3,338.00 – $8,246.00 | 6 |
| Fusion of tibiofibular joint CPT 27871 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Fusion of toes CPT 28280 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Fusion of ureter & bowel CPT 50810 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fusion of ureter & kidney CPT 50740 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fusion of ureter & kidney CPT 50750 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Fxn gene charac alleles CPT 81285 | not published | not published | $280.33 – $329.80 | 5 |
| Fxn gene detc abnor alleles CPT 81284 | not published | not published | $139.74 – $164.40 | 5 |
| Fxn gene full gene sequence CPT 81286 | not published | not published | $280.33 – $329.80 | 5 |
| Fxn gene known famil variant CPT 81289 | not published | not published | $188.90 – $222.24 | 5 |
| G6pc gene CPT 81250 | not published | not published | $59.66 – $70.19 | 5 |
| G6pd full gene sequence CPT 81249 | not published | not published | $612.00 – $720.00 | 5 |
| G6pd gene alys cmn variant CPT 81247 | not published | not published | $178.31 – $209.77 | 5 |
| G6pd known familial variant CPT 81248 | not published | not published | $382.76 – $450.30 | 5 |
| Ga-67 gallium 0.1 mci HCPCS A9556 | $85.00 | $170.00 | not published | 0 |
| Ga-68 gallium 68 dotatate HCPCS A9587 | $79.50 | $159.00 | $50.62 – $52.11 | 4 |
| Gabapentin non-blood CPT 80355 | not published | not published | $0.03 – $29.64 | 2 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | $96.00 | $192.00 | $21.49 – $35.32 | 5 |
| Galactokinase - sendout CPT 82759 | not published | not published | $21.91 – $36.01 | 5 |
| Galactose transferase test CPT 82776 | not published | not published | $11.97 – $14.05 | 5 |
| Galectin-3 CPT 82777 | not published | not published | $21.36 – $46.46 | 5 |
| Gallbladder Removal (Laparoscopic) CPT 47562 | not published | not published | $4,007.00 – $13,397.00 | 5 |
| Gallium ga-68 dotatoc HCPCS C9067 | not published | not published | $3.68 – $3.79 | 4 |
| Gallium ga-68 psma-11, ucla HCPCS A9594 | not published | not published | $370.77 – $381.68 | 4 |
| Gallium ga-68 psma-11 ucsf HCPCS A9593 | not published | not published | $561.13 – $577.64 | 4 |
| Gallium illuccix 1 millicure HCPCS A9596 | not published | not published | $488.09 – $502.45 | 4 |
| Gallium locametz 1 millicuri HCPCS A9800 | not published | not published | $369.75 – $380.62 | 4 |
| Gallium nitrate injection HCPCS J1457 | not published | not published | $5.41 – $5.41 | 1 |
| Galsulfase injection HCPCS J1458 | not published | not published | $507.35 – $534.20 | 4 |
| Gamma globulin > 10 cc inj HCPCS J1560 | not published | not published | $173.89 – $179.00 | 4 |
| Gamma globulin 1 cc inj HCPCS J1460 | not published | not published | $50.01 – $51.48 | 4 |
| Gammaglobulin iga CPT 82784 | $43.00 | $86.00 | $9.49 – $15.59 | 5 |
| Gammaglobulin ige CPT 82785 | $72.00 | $144.00 | $16.79 – $27.61 | 5 |
| Gamma glutamyltransferase CPT 82977 | $34.50 | $69.00 | $7.34 – $12.07 | 5 |
| Gammaplex injection HCPCS J1557 | not published | not published | $64.96 – $66.87 | 4 |
| Gamunex-c/gammaked HCPCS J1561 | not published | not published | $49.94 – $51.41 | 4 |
| Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr HCPCS J1570 | not published | not published | $79.98 – $79.98 | 1 |
| Ganciclovir long act implant HCPCS J7310 | not published | not published | $43,248.00 – $43,248.00 | 1 |
| Gardner vag dna amp probe CPT 87511 | not published | not published | $35.79 – $58.85 | 5 |
| Gardner vag dna quant CPT 87512 | not published | not published | $42.60 – $70.00 | 5 |
| Gastric analy w/ph ea spec CPT 82930 | $23.50 | $47.00 | $6.84 – $9.20 | 5 |
| Gastric emptying imag study CPT 78265 | $1,098.50 | $2,197.00 | $397.85 – $409.55 | 4 |
| Gastric emptying imag study CPT 78266 | $1,313.50 | $2,627.00 | $540.36 – $556.26 | 4 |
| Gastric motility studies CPT 91020 | not published | not published | $371.37 – $511.00 | 5 |
| Gastric mucosa imaging CPT 78261 | not published | not published | $397.85 – $409.55 | 4 |
| Gastrin test CPT 82938 | not published | not published | $18.04 – $29.66 | 5 |
| Gastroduodenostomy CPT 43810 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Gastroesophageal reflux study CPT 78262 | $1,504.50 | $3,009.00 | $397.85 – $409.55 | 4 |
| Gastroesophageal reflux test CPT 91034 | not published | not published | $371.37 – $511.00 | 5 |
| Gastrointestinal repair CPT 43360 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Gastrointestinal repair CPT 43361 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Gastrojejunostomy;w/o vagotomy 43820 CPT 43820 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Gastrojejunostomy w/vagotomy CPT 43825 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Gastro/jejuno tube, std HCPCS B4087 | $379.50 | $759.00 | not published | 0 |
| Gastroplasty duodenal switch CPT 43845 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Gastrostomy open neonatal CPT 43831 | not published | not published | $902.63 – $3,276.00 | 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.