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 |
|---|---|---|---|---|
| Ghs inj neurolytic intercostal nerve CPT 64620 | $753.00 | $1,506.00 | $880.23 – $1,547.00 | 6 |
| Ghs inj neurolytic other perph nerve CPT 64640 | $753.00 | $1,506.00 | $880.23 – $1,547.00 | 6 |
| Ghs inj tendon origin/insertion CPT 20551 | $227.00 | $454.00 | $305.48 – $1,010.00 | 6 |
| Ghs inj transforaminal cerv ea add bil CPT 64480 | $913.50 | $1,827.00 | $511.00 – $2,004.00 | 2 |
| Ghs inj transforaminal cerv single bil CPT 64479 | $753.00 | $1,506.00 | $880.23 – $1,547.00 | 6 |
| Ghs insertion of needle - bone CPT 36680 | $333.00 | $666.00 | $444.58 – $2,845.00 | 6 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $584.00 | $1,168.00 | $404.56 – $1,571.00 | 6 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $885.00 | $1,770.00 | $511.00 – $1,571.00 | 6 |
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | $2,895.50 | $5,791.00 | $1,571.00 – $3,276.00 | 6 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | $93.00 | $186.00 | $511.00 – $511.00 | 1 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $882.50 | $1,765.00 | $248.65 – $1,010.00 | 6 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | $86.50 | $173.00 | $46.60 – $47.97 | 4 |
| Ghs IV infusion bamlanivimab/etesevimab HCPCS M0245 | $299.00 | $598.00 | not published | 0 |
| Ghs IV infusion casirivimab/imdevimab HCPCS M0243 | $225.00 | $450.00 | not published | 0 |
| Ghs IV infusion sotrovimab HCPCS M0247 | $225.00 | $450.00 | not published | 0 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $3,608.50 | $7,217.00 | $328.72 – $1,010.00 | 6 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $360.00 | $720.00 | $444.58 – $1,571.00 | 6 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $584.00 | $1,168.00 | $404.56 – $2,845.00 | 6 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $478.00 | $956.00 | $404.56 – $2,845.00 | 6 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $478.00 | $956.00 | $404.56 – $2,845.00 | 6 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $494.50 | $989.00 | $404.56 – $2,845.00 | 6 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $524.00 | $1,048.00 | $404.56 – $2,845.00 | 6 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $741.50 | $1,483.00 | $404.56 – $2,845.00 | 6 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $584.00 | $1,168.00 | $404.56 – $1,571.00 | 6 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $649.50 | $1,299.00 | $511.00 – $1,571.00 | 6 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $556.00 | $1,112.00 | $404.56 – $1,571.00 | 6 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $618.00 | $1,236.00 | $511.00 – $1,571.00 | 6 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $618.00 | $1,236.00 | $404.56 – $1,571.00 | 6 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | not published | not published | $735.52 – $1,571.00 | 6 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | $680.00 | $1,360.00 | $404.56 – $1,571.00 | 6 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | $1,854.00 | $3,708.00 | $1,571.00 – $3,276.00 | 6 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | $741.50 | $1,483.00 | $404.56 – $1,571.00 | 6 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $43.50 | $87.00 | $8.77 – $14.42 | 5 |
| Ghs mbp CPT 83873 | $75.50 | $151.00 | $17.54 – $28.85 | 5 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $244.50 | $489.00 | not published | 0 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $244.50 | $489.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $98.50 | $197.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $244.50 | $489.00 | not published | 0 |
| Ghs musc test done w/n test comp CPT 95886 | $167.50 | $335.00 | not published | 0 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $192.50 | $385.00 | not published | 0 |
| Ghs musc tst done w/n tst non ext CPT 95887 | $192.50 | $385.00 | not published | 0 |
| Ghs myocardial strain img spckl track CPT 93356 | $329.00 | $658.00 | not published | 0 |
| Ghs nailbed repair/nail removal CPT 11760 | $478.00 | $956.00 | $511.00 – $2,845.00 | 6 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $1,408.00 | $2,816.00 | $880.23 – $1,547.00 | 6 |
| Ghs nerve blk intercostal, single level CPT 64420 | $1,084.00 | $2,168.00 | $702.49 – $1,547.00 | 6 |
| Ghs nerve block axillary nerve CPT 64417 | $708.50 | $1,417.00 | $880.23 – $1,547.00 | 6 |
| Ghs nerve block brachial plexus CPT 64415 | $473.00 | $946.00 | $880.23 – $1,547.00 | 6 |
| Ghs nerve block celiac plexus CPT 64530 | $753.00 | $1,506.00 | $880.23 – $1,547.00 | 6 |
| Ghs nerve block interscaline CPT 64510 | $753.00 | $1,506.00 | $880.23 – $1,547.00 | 6 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $753.00 | $1,506.00 | $880.23 – $1,547.00 | 6 |
| Ghs nerve block sciatic nerve CPT 64445 | $685.00 | $1,370.00 | $702.49 – $1,547.00 | 6 |
| Ghs nerve block suprascapular CPT 64418 | $753.00 | $1,506.00 | $702.49 – $1,547.00 | 6 |
| Ghs ng placement w fluoro guidance CPT 43752 | $397.00 | $794.00 | $444.58 – $2,845.00 | 6 |
| Ghs o2 saturation CPT 82810 | $40.50 | $81.00 | $9.97 – $14.64 | 5 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $128.06 – $131.82 | 4 |
| Ghs o2 uptake rest & indirect CPT 94690 | $111.00 | $222.00 | $58.71 – $60.44 | 4 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | not published | not published | $46.60 – $47.97 | 4 |
| Ghs opcc repair cvp without subq port CPT 36575 | $886.50 | $1,773.00 | $624.29 – $1,571.00 | 6 |
| Ghs opcc repair cvp w subq port CPT 36576 | $886.50 | $1,773.00 | $1,547.00 – $1,612.67 | 6 |
| Ghs optokenetic CPT 92544 | $70.00 | $140.00 | $128.06 – $131.82 | 4 |
| Ghs oscillating trac CPT 92545 | not published | not published | $214.89 – $221.21 | 4 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $91.00 | $182.00 | not published | 0 |
| Ghs osteopathic manipulative tx, 3-4 regions CPT 98926 | $85.50 | $171.00 | not published | 0 |
| Ghs ot dds rom CPT 95851 | not published | not published | $6.69 – $6.89 | 4 |
| Ghs ot group caregiver training CPT 97552 | $15.00 | $30.00 | not published | 0 |
| Ghs ot prosthetic training/15 min CPT 97761 | $95.50 | $191.00 | $40.72 – $41.92 | 4 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $51.00 | $102.00 | $61.14 – $62.94 | 4 |
| Ghs ot work hardening-additional hours CPT 97546 | $37.50 | $75.00 | not published | 0 |
| Ghs pacing - transcutaneous CPT 92953 | $618.00 | $1,236.00 | $657.77 – $1,547.00 | 5 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $664.00 | $1,328.00 | $511.00 – $2,004.00 | 2 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $667.50 | $1,335.00 | $511.00 – $2,004.00 | 2 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $21.50 | $43.00 | $26.83 – $79.56 | 2 |
| Ghs peritonsillar abscess i andd CPT 42700 | $328.50 | $657.00 | $235.71 – $1,010.00 | 6 |
| Ghs phenylketonurid CPT 84030 | $95.50 | $191.00 | $5.61 – $9.23 | 5 |
| Ghs picc line insert < 5 CPT 36568 | $2,019.50 | $4,039.00 | $1,010.00 – $1,612.67 | 6 |
| Ghs plngl fx pm cl CPT 26725 | $288.00 | $576.00 | $245.48 – $2,845.00 | 6 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $4.40 – $7.21 | 5 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $3,587.50 | $7,175.00 | $854.62 – $879.75 | 4 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $132.41 – $136.30 | 4 |
| Ghs ppd (tb intradermal) CPT 86580 | $18.00 | $36.00 | $7.74 – $29.56 | 5 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $43.00 | $86.00 | $9.85 – $16.20 | 5 |
| Ghs protein, misc fluid CPT 84160 | not published | not published | $5.72 – $8.68 | 5 |
| Ghs protoporphyrins fract CPT 84202 | $66.00 | $132.00 | $14.64 – $24.06 | 5 |
| Ghs pr without cont pulse ox CPT 94625 | $129.50 | $259.00 | $58.71 – $60.44 | 4 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $54.50 | $109.00 | $12.50 – $20.53 | 5 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $482.00 | $964.00 | not published | 0 |
| Ghs quinidine CPT 80194 | $87.00 | $174.00 | $14.89 – $24.47 | 5 |
| Ghs refill of implantable pump CPT 95990 | $247.00 | $494.00 | $328.72 – $511.00 | 5 |
| Ghs removal intranasal foreign body CPT 30300 | $316.50 | $633.00 | $132.41 – $2,845.00 | 6 |
| Ghs removal pharyngeal foreign body CPT 42809 | $382.00 | $764.00 | $444.58 – $1,010.00 | 6 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $2,060.00 | $4,120.00 | $1,600.27 – $3,895.00 | 6 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $4,776.50 | $9,553.00 | $3,256.29 – $8,246.00 | 6 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $58.00 | $116.00 | $16.21 – $21.61 | 5 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $4.40 – $7.21 | 5 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | not published | not published | $14.19 – $20.11 | 5 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $4.36 – $5.95 | 5 |
| Ghs semen analysis fert CPT 89320 | $69.50 | $139.00 | $12.56 – $20.21 | 5 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $10.04 – $14.94 | 5 |
| Ghs sensitivity (per antimicro) CPT 87184 | not published | not published | $7.63 – $11.56 | 5 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $478.00 | $956.00 | $404.56 – $1,571.00 | 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.