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 |
|---|---|---|---|---|
| Low back disk surgery CPT 63030 | not published | not published | $4,007.00 – $13,397.00 | 5 |
| Low cost skin substitute app HCPCS C5271 | $1,018.50 | $2,037.00 | $511.00 – $2,670.00 | 3 |
| Low cost skin substitute app HCPCS C5273 | not published | not published | $2,670.00 – $6,716.00 | 3 |
| Low cost skin substitute app HCPCS C5275 | $1,018.50 | $2,037.00 | $511.00 – $2,670.00 | 3 |
| Low cost skin substitute app HCPCS C5277 | not published | not published | $511.00 – $2,670.00 | 3 |
| Low cost skin substitute app HCPCS C5272 | $119.50 | $239.00 | $511.00 – $2,004.00 | 2 |
| Low cost skin substitute app HCPCS C5274 | not published | not published | $511.00 – $2,004.00 | 2 |
| Low cost skin substitute app HCPCS C5276 | not published | not published | $511.00 – $2,004.00 | 2 |
| Low cost skin substitute app HCPCS C5278 | not published | not published | $511.00 – $2,004.00 | 2 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,705.00 | $3,410.00 | $174.56 – $179.69 | 4 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,349.00 | $2,698.00 | $347.20 – $357.41 | 4 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,046.50 | $2,093.00 | $104.04 – $107.10 | 4 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,187.00 | $6,374.00 | $347.20 – $357.41 | 4 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,233.50 | $4,467.00 | $347.20 – $357.41 | 4 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,735.50 | $3,471.00 | $237.46 – $244.44 | 4 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $241.00 | $482.00 | $104.04 – $107.10 | 4 |
| Lower jaw bone graft CPT 21215 | not published | not published | $5,418.00 – $10,995.00 | 6 |
| Low frequency non-thermal Ultrasound CPT 97610 | $402.00 | $804.00 | $199.67 – $205.54 | 4 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $15.30 – $16.70 | 4 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $4,007.00 – $13,397.00 | 6 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $4,007.00 – $13,397.00 | 6 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $4,007.00 – $13,397.00 | 6 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $4,007.00 – $13,397.00 | 6 |
| Lso corset front HCPCS L0972 | $94.70 | $189.41 | not published | 0 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | $131.44 | $262.89 | not published | 0 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | $230.29 | $460.58 | not published | 0 |
| Lso s/c shell/panel custom HCPCS L0640 | $829.04 | $1,658.07 | not published | 0 |
| Lso s/c shell/panel prefab HCPCS L0639 | $850.77 | $1,701.54 | not published | 0 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $22.43 – $36.85 | 5 |
| Lumbar diskogram s&i CPT 72295 | $1,650.50 | $3,301.00 | $1,943.35 – $2,000.51 | 4 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $4,339.00 – $17,920.08 | 5 |
| Lumizyme injection HCPCS J0221 | not published | not published | $210.72 – $216.92 | 4 |
| Lung function test (mbc/mvv) CPT 94200 | not published | not published | $58.71 – $60.44 | 4 |
| Lung Function Test (Spirometry) CPT 94010 | $73.00 | $146.00 | $214.89 – $221.21 | 4 |
| Lung perfusion imaging CPT 78580 | $521.50 | $1,043.00 | $397.85 – $409.55 | 4 |
| Lung transplant double CPT 32853 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Lung transplant single CPT 32851 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Lung transplant with bypass CPT 32852 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Lung transplant with bypass CPT 32854 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $211.27 – $217.48 | 4 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $41.13 – $44.08 | 4 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $223.00 | $446.00 | $323.33 – $332.84 | 4 |
| Lutetium lu 177 vipivotide HCPCS A9607 | not published | not published | $260.96 – $268.63 | 4 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $28.78 – $2,845.00 | 6 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $20.45 – $33.62 | 5 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $8,134.14 – $13,397.00 | 5 |
| Lymphatics/lymph node imaging CPT 78195 | $1,005.50 | $2,011.00 | $540.36 – $556.26 | 4 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $37.29 – $94.66 | 5 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $50.01 – $82.19 | 5 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $87.66 – $198.99 | 5 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $48.54 – $79.79 | 5 |
| Lymph vessel x-ray arm/leg CPT 75801 | $1,024.50 | $2,049.00 | $624.29 – $642.65 | 4 |
| Lymph vessel x-ray arms/legs CPT 75803 | $1,024.50 | $2,049.00 | $1,566.60 – $1,612.67 | 4 |
| Lymph vessel x-ray trunk CPT 75805 | $1,666.00 | $3,332.00 | $3,142.32 – $3,234.74 | 4 |
| Lymph vessel x-ray trunk CPT 75807 | $1,666.00 | $3,332.00 | $3,142.32 – $3,234.74 | 4 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $511.00 – $1,571.00 | 6 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $1,010.00 – $5,978.00 | 6 |
| Lysis penil circumic lesion CPT 54162 | $3,274.00 | $6,548.00 | $1,571.00 – $5,978.00 | 6 |
| Macro exam dissect molec study ea CPT 88387 | $31.00 | $62.00 | $7.74 – $16.63 | 2 |
| Macroscopic exam arthropod CPT 87168 | $23.50 | $47.00 | $4.36 – $7.15 | 5 |
| Macroscopic exam parasite CPT 87169 | $14.00 | $28.00 | $4.40 – $7.15 | 5 |
| Magnesium CPT 83735 | $32.00 | $64.00 | $6.83 – $11.23 | 5 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | not published | not published | $1.35 – $1.35 | 1 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $237.46 – $244.44 | 4 |
| Makena, 10 mg HCPCS J1726 | not published | not published | $20.86 – $54.64 | 2 |
| Malaria antibody CPT 86750 | $129.00 | $258.00 | $13.45 – $22.12 | 5 |
| Male sling procedure CPT 53440 | not published | not published | $1,571.00 – $29,725.00 | 6 |
| Mammosite ced HCPCS C1728 | $2,180.23 | $4,360.46 | not published | 0 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Manipulate finger w/anesth CPT 26340 | $2,349.50 | $4,699.00 | $511.00 – $1,647.34 | 6 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $1,600.27 – $3,895.00 | 6 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $81.50 | $163.00 | $132.41 – $136.30 | 4 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $81.50 | $163.00 | $132.41 – $136.30 | 4 |
| Manipulation of hip joint CPT 27275 | not published | not published | $1,571.00 – $3,276.00 | 6 |
| Manipulation of spine CPT 22505 | not published | not published | $1,571.00 – $3,276.00 | 6 |
| Manipulat palm cord post inj CPT 26341 | $180.50 | $361.00 | $245.48 – $1,010.00 | 6 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | not published | not published | $7.05 – $7.05 | 1 |
| Mannitol for inhaler HCPCS J7665 | not published | not published | $17.78 – $17.78 | 1 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $5.17 – $6.23 | 5 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | $246.00 | $492.00 | not published | 0 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $511.00 – $2,004.00 | 2 |
| Map tachycard site(s) CPT 93609 | $395.50 | $791.00 | $5,980.00 – $5,980.00 | 1 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | not published | not published | $53.54 – $55.11 | 4 |
| Marker biop eviva buckle ss HCPCS A4648 | $592.02 | $1,184.04 | not published | 0 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | not published | not published | $1,279.08 – $1,316.70 | 4 |
| Marsupialization liver lesion 47300 CPT 47300 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Mastectomy partial CPT 19301 | not published | not published | $3,304.00 – $5,978.00 | 6 |
| Mast mod rad CPT 19307 | not published | not published | $4,007.00 – $10,995.00 | 6 |
| Mastoidectomy CPT 69501 | not published | not published | $5,418.00 – $10,995.00 | 6 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $5,418.00 – $6,050.24 | 6 |
| Mastoids complete CPT 70130 | $413.50 | $827.00 | $104.04 – $107.10 | 4 |
| Mastoid surgery revision CPT 69603 | not published | not published | $5,418.00 – $10,995.00 | 6 |
| Mastopexy CPT 19316 | not published | not published | $3,338.00 – $8,246.00 | 6 |
| Mast radical CPT 19305 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Mast rad urban type CPT 19306 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Mast simple complete CPT 19303 | not published | not published | $3,338.00 – $8,246.00 | 6 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $35.79 – $58.85 | 5 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $27.84 – $33.62 | 5 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $43.70 – $71.82 | 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.