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 simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $551.50 | $1,103.00 | $404.56 – $1,571.00 | 6 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $551.50 | $1,103.00 | $404.56 – $1,571.00 | 6 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $551.50 | $1,103.00 | $404.56 – $1,571.00 | 6 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $478.00 | $956.00 | $199.67 – $2,845.00 | 6 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $309.00 | $618.00 | $199.67 – $2,845.00 | 6 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $478.00 | $956.00 | $199.67 – $2,845.00 | 6 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $551.50 | $1,103.00 | $199.67 – $1,571.00 | 6 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $551.50 | $1,103.00 | $199.67 – $1,571.00 | 6 |
| Ghs sleep study unattended CPT 95800 | $696.50 | $1,393.00 | $214.89 – $221.21 | 4 |
| Ghs somatosensory testing lower extremit CPT 95926 | $164.00 | $328.00 | $214.89 – $221.21 | 4 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,081.00 | $2,162.00 | $854.62 – $879.75 | 4 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $106.00 | $212.00 | $48.30 – $49.72 | 4 |
| Ghs sphenopalatine ganglion block CPT 64505 | $532.50 | $1,065.00 | $305.48 – $1,010.00 | 6 |
| Ghs spont nystagmus CPT 92541 | $56.00 | $112.00 | $132.41 – $136.30 | 4 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $269.50 | $539.00 | $103.59 – $106.64 | 4 |
| Ghs st - eval for alt comm CPT 92567 | $40.50 | $81.00 | $37.17 – $38.26 | 4 |
| Ghs strapping shoulder - 29240 CPT 29240 | $395.00 | $790.00 | $132.41 – $2,845.00 | 6 |
| Ghs st - re-eval for alt comm CPT 92597 | $369.50 | $739.00 | $71.86 – $73.97 | 4 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $80.50 | $161.00 | $46.60 – $47.97 | 4 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $375.50 | $751.00 | $211.68 – $217.91 | 4 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,005.00 | $2,010.00 | $511.00 – $1,010.00 | 6 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $441.00 | $882.00 | $404.56 – $1,010.00 | 6 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $1,087.00 | $2,174.00 | $1,010.00 – $3,276.00 | 6 |
| Ghs trypsin (fecal) CPT 84488 | $10.50 | $21.00 | $7.45 – $12.24 | 5 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $374.50 | $749.00 | $245.48 – $2,845.00 | 6 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $245.48 – $2,845.00 | 6 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $24.79 – $40.75 | 5 |
| Ghs urine, porphyrins quant CPT 84120 | $67.50 | $135.00 | $15.00 – $24.66 | 5 |
| Ghs vaginal delivery only CPT 59409 | $2,174.50 | $4,349.00 | $2,004.00 – $5,978.00 | 5 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $3,769.50 | $7,539.00 | $371.37 – $382.29 | 4 |
| Ghs windowing of cast CPT 29730 | not published | not published | $161.72 – $2,845.00 | 6 |
| Giardia ag if CPT 87269 | not published | not published | $13.88 – $20.11 | 5 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $15.01 – $24.67 | 5 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $237.46 – $244.44 | 4 |
| Gi inhouse confirmation CPT 87045 | $19.00 | $38.00 | $9.63 – $15.82 | 5 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $3,299.54 – $10,995.00 | 5 |
| Gi protein loss CPT 78282 | not published | not published | $397.85 – $409.55 | 4 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $1,724.00 | $3,448.00 | $902.63 – $3,276.00 | 5 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $925.49 – $952.71 | 4 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $902.63 – $3,276.00 | 5 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $902.63 – $3,276.00 | 5 |
| Gjb2 gene full sequence CPT 81252 | $586.50 | $1,173.00 | $103.14 – $121.34 | 5 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $62.75 – $73.82 | 5 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.70 – $42.00 | 5 |
| Glassia injection HCPCS J0257 | not published | not published | $5.75 – $5.92 | 4 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $37.17 – $38.26 | 4 |
| Glaucoma surgery CPT 66150 | not published | not published | $3,338.00 – $5,978.00 | 6 |
| Glaucoma surgery CPT 66155 | not published | not published | $3,338.00 – $5,978.00 | 6 |
| Glaucoma surgery CPT 66160 | not published | not published | $1,571.00 – $5,978.00 | 6 |
| Glaucoma surgery CPT 66170 | not published | not published | $2,296.74 – $5,978.00 | 6 |
| Glove finger flexion right lg xl HCPCS L3912 | $60.03 | $120.06 | not published | 0 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $186.10 – $191.57 | 4 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $151.97 – $156.44 | 4 |
| Glucagon plasma - sendout CPT 82943 | $66.00 | $132.00 | $14.58 – $23.96 | 5 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $46.99 – $77.26 | 5 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $51.51 – $84.67 | 5 |
| Glucagon tolerance test CPT 82946 | not published | not published | $18.13 – $25.27 | 5 |
| Glucose 1 hr post dose CPT 82950 | $22.50 | $45.00 | $4.84 – $7.97 | 5 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.17 – $10.16 | 5 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $26.50 | $53.00 | $3.35 – $3.92 | 5 |
| Glucose blood quantitative CPT 82947 | $20.00 | $40.00 | $4.01 – $6.58 | 5 |
| Glucose body fluid CPT 82945 | $20.00 | $40.00 | $4.01 – $6.58 | 5 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $188.50 | $377.00 | $58.71 – $60.44 | 4 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $49.00 | $98.00 | $13.13 – $21.59 | 5 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $20.00 | $40.00 | $4.00 – $6.58 | 5 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.81 – $0.81 | 1 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $39.43 – $39.43 | 1 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | not published | not published | $11.26 – $11.59 | 4 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $82.00 | $164.00 | $18.95 – $31.16 | 5 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $151.38 – $248.88 | 5 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $81.50 | $163.00 | $18.89 – $31.06 | 5 |
| Gonioscopy CPT 92020 | not published | not published | $132.41 – $136.30 | 4 |
| Goniotomy CPT 65820 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | not published | not published | $748.34 – $770.35 | 4 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $34.68 | $69.35 | not published | 0 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $146.46 | $292.91 | not published | 0 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $3,256.29 – $8,246.00 | 6 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $40.33 | $80.66 | not published | 0 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $1,672.95 | $3,345.90 | not published | 0 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $3,586.25 | $7,172.50 | not published | 0 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $163.02 | $326.03 | not published | 0 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $252.54 | $505.08 | not published | 0 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $77.62 | $155.25 | not published | 0 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $90.56 | $181.13 | not published | 0 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $4,013.75 | $8,027.50 | not published | 0 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $349.60 | $699.20 | not published | 0 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.64 – $0.64 | 1 |
| Great toe-hand transfer CPT 26551 | not published | not published | $3,338.00 – $10,995.00 | 5 |
| Great toe with reduction 28495 CPT 28495 | $372.50 | $745.00 | $245.48 – $2,845.00 | 6 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $2,053.37 – $3,276.00 | 5 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $3,338.00 – $8,246.00 | 5 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $511.00 – $2,004.00 | 2 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $3,338.00 – $8,246.00 | 5 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $48.50 | $97.00 | $12.44 – $12.81 | 4 |
| Growth hormone antibody CPT 86277 | not published | not published | $16.05 – $26.39 | 5 |
| Growth hormone panel CPT 80428 | not published | not published | $68.03 – $111.79 | 5 |
| Growth hormone panel CPT 80430 | not published | not published | $131.52 – $135.80 | 5 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $35.92 – $79.38 | 5 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $1,547.00 – $1,547.00 | 1 |
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.