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 |
|---|---|---|---|---|
| Opn tx nasomax fx w/fixj CPT 21346 | not published | not published | $3,338.00 – $6,050.24 | 5 |
| Opn tx nasomax fx w/graft CPT 21348 | not published | not published | $4,007.00 – $10,995.00 | 5 |
| Opn tx orbit fx combined CPT 21387 | not published | not published | $4,007.00 – $10,995.00 | 5 |
| Opn tx orbit fx periorbital CPT 21386 | not published | not published | $4,007.00 – $10,995.00 | 5 |
| Opn tx orbit fx transantral CPT 21385 | not published | not published | $4,007.00 – $10,995.00 | 6 |
| Opn tx orbit fx w/bone grft CPT 21408 | not published | not published | $4,441.00 – $10,995.00 | 6 |
| Opn tx orbit fx w/implant CPT 21407 | not published | not published | $4,007.00 – $10,995.00 | 6 |
| Opn tx orbit fx without impl 21406 CPT 21406 | not published | not published | $3,338.00 – $10,995.00 | 6 |
| Opn tx orbit periorbtl implt CPT 21390 | not published | not published | $5,418.00 – $10,995.00 | 6 |
| Opn tx orbit periorbt w/grft CPT 21395 | not published | not published | $5,891.41 – $10,995.00 | 5 |
| Opps service,sched team conf HCPCS G0175 | not published | not published | $415.26 – $427.47 | 4 |
| Oprelvekin injection HCPCS J2355 | not published | not published | $1,191.39 – $1,191.39 | 1 |
| Opscpy extnd on/mac draw CPT 92202 | not published | not published | $58.71 – $60.44 | 4 |
| Opscpy extnd rta draw uni/bi CPT 92201 | not published | not published | $58.71 – $60.44 | 4 |
| Optical endomicroscpy interp CPT 88375 | not published | not published | $15.25 – $125.69 | 2 |
| Optx acrclv dslc aq/chrn grf CPT 23552 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Optx acromclv dislc aqt/chrn CPT 23550 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx acute shoulder dislc CPT 23660 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx carpl scphd fx int fixj CPT 25628 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx clavicular fx w/int fix CPT 23515 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx complicated mndblr fx CPT 21470 | not published | not published | $4,007.00 – $10,995.00 | 6 |
| Optx cranfcl sep comp mlt CPT 21433 | not published | not published | $3,338.00 – $10,995.00 | 5 |
| Optx cranfcl sep w/wiring CPT 21432 | not published | not published | $3,338.00 – $10,995.00 | 5 |
| Optx crnfcl sep comp mlt int CPT 21436 | not published | not published | $3,338.00 – $10,995.00 | 5 |
| Optx crnfc sep comp int&/xtr CPT 21435 | not published | not published | $3,338.00 – $10,995.00 | 5 |
| Optx crpl fx oth/thn scph ea CPT 25645 | not published | not published | $3,256.29 – $13,397.00 | 6 |
| Optx gr hmrl tbrs fx int fix CPT 23630 | not published | not published | $4,007.00 – $13,397.00 | 6 |
| Optx lunate dislocation CPT 25695 | not published | not published | $1,571.00 – $7,416.07 | 6 |
| Optx medial ankle fx CPT 27766 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx mndblr cndylr fx CPT 21465 | not published | not published | $3,338.00 – $10,995.00 | 6 |
| Optx mndblr fx wo ntrdntl CPT 21461 | not published | not published | $3,338.00 – $10,995.00 | 6 |
| Optx mndblr fx xtrnl fixj CPT 21454 | not published | not published | $4,007.00 – $6,050.24 | 6 |
| Optx mndblr/max alv ridge fx CPT 21445 | $2,804.00 | $5,608.00 | $3,338.00 – $10,995.00 | 6 |
| Optx palatal/max fracture CPT 21422 | $2,907.00 | $5,814.00 | $4,007.00 – $10,995.00 | 5 |
| Optx palatal/max fx comp CPT 21423 | not published | not published | $3,338.00 – $10,995.00 | 5 |
| Optx partclr fx&/dslc elbw w CPT 24587 | not published | not published | $4,007.00 – $13,397.00 | 6 |
| Optx post ankle fx CPT 27769 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx prox humrl fx w/int fix CPT 23615 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Optx prx hmrl fx fix rpr rpl CPT 23616 | not published | not published | $3,338.00 – $17,920.08 | 6 |
| Optx radial shaft fracture CPT 25515 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx rad/uln dislc aqt/chrnc CPT 25676 | not published | not published | $1,571.00 – $7,416.07 | 6 |
| Optx rdcrpl/ntrcrpl dislc 1+ CPT 25670 | not published | not published | $3,304.00 – $7,416.07 | 6 |
| Optx rdl shft fx&cltx rad/ul CPT 25525 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Optx rdl shft fx&dstl rad/ul CPT 25526 | not published | not published | $4,007.00 – $13,397.00 | 6 |
| Optx rdl&uln shft fx rds&uln CPT 25575 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx rdl&uln shft fx rds/uln CPT 25574 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx scapular fx w/int fixj CPT 23585 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx sho dislc fx CPT 23670 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx sho dislc neck fx fixj CPT 23680 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx strclv dslc aq/chrn grf CPT 23532 | not published | not published | $3,338.00 – $7,416.07 | 6 |
| Optx strnclav dislc aqt/chrn CPT 23530 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx thigh fx CPT 27269 | not published | not published | $2,670.00 – $7,416.07 | 5 |
| Optx tmprmand dislocation CPT 21490 | not published | not published | $3,299.54 – $10,995.00 | 6 |
| Optx trns-scphprlnr fx dislc CPT 25685 | not published | not published | $3,304.00 – $7,416.07 | 6 |
| Optx ulnar shft fx int fixj CPT 25545 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Optx ulnar styloid fracture CPT 25652 | not published | not published | $3,304.00 – $13,397.00 | 6 |
| Oral aprepitant HCPCS J8501 | not published | not published | $7.95 – $7.95 | 1 |
| Oral busulfan HCPCS J8510 | not published | not published | $10.32 – $10.63 | 4 |
| Oral everolimus HCPCS J7527 | not published | not published | $6.47 – $6.47 | 1 |
| Oral hiv-1/hiv-2 screen HCPCS G0435 | not published | not published | $12.22 – $20.26 | 5 |
| Oral methotrexate (jylamvo) HCPCS J8611 | not published | not published | $18.84 – $19.39 | 4 |
| Oral methotrexate (xatmep) HCPCS J8612 | not published | not published | $23.13 – $23.81 | 4 |
| Oral netupitant, palonosetro HCPCS J8655 | not published | not published | $431.35 – $444.04 | 4 |
| Orbitocranial approach/skull CPT 61584 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Orbitocranial approach/skull CPT 61585 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Orbitocranial approach/skull CPT 61592 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Orchiectomy partial CPT 54522 | not published | not published | $3,304.00 – $5,978.00 | 6 |
| Orchiopexy (fowler-stephens) CPT 54650 | not published | not published | $3,338.00 – $8,246.00 | 5 |
| Orchiopexy ingun/scrot appr CPT 54640 | not published | not published | $3,338.00 – $8,246.00 | 6 |
| Organic acids total quant ea spec CPT 83918 | $67.00 | $134.00 | $24.07 – $27.60 | 5 |
| Oritavancin 1,200 mg intravenous solution HCPCS J2406 | not published | not published | $43.33 – $44.60 | 4 |
| Oritavancin 400 mg intravenous solution HCPCS J2407 | not published | not published | $29.25 – $30.11 | 4 |
| Oropharyngeal biopsy 42800 CPT 42800 | $2,283.50 | $4,567.00 | $1,544.13 – $1,589.55 | 5 |
| Orphenadrine citrate 30 mg/ml injection solution HCPCS J2360 | not published | not published | $38.93 – $38.93 | 1 |
| Ortho elbow without jnt cstm w/fit&adj HCPCS L3702 | $144.38 | $288.77 | not published | 0 |
| Ortho elbow w/lock w/ft&adj HCPCS L3760 | $634.46 | $1,268.91 | not published | 0 |
| Ortho ewhf rigd without jnt cstm w HCPCS L3765 | $332.76 | $665.51 | not published | 0 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | $332.76 | $665.51 | not published | 0 |
| Ortho hnd/fngr without jnt cstm w/fit&adj HCPCS L3913 | $155.77 | $311.54 | not published | 0 |
| Ortho hnd/fngr w/jnt cstm w/fit&adj HCPCS L3921 | $155.77 | $311.54 | not published | 0 |
| Ortho hnd metcrpl fx prefb w/fit&adj HCPCS L3917 | $54.34 | $108.68 | not published | 0 |
| Ortho hnd without jnt w/fit&adj HCPCS L3919 | $78.66 | $157.32 | not published | 0 |
| Orthopantogram CPT 70355 | $180.00 | $360.00 | $86.61 – $89.15 | 4 |
| Orthop traing supvj phys/qhp CPT 92066 | not published | not published | $58.71 – $60.44 | 4 |
| Ortho shoe add half sole HCPCS L3530 | $18.63 | $37.26 | not published | 0 |
| Orthosis lso rigd frm hyperex HCPCS L0472 | $257.20 | $514.40 | not published | 0 |
| Orthovisc inj per dose HCPCS J7324 | not published | not published | $116.83 – $120.26 | 4 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | $219.94 | $439.88 | not published | 0 |
| Ortho wrst/hnd w/jnt cstm w/fit&adj HCPCS L3905 | $582.19 | $1,164.38 | not published | 0 |
| Oscillation chest wall mechanical per session CPT 94669 | $99.50 | $199.00 | $217.93 – $224.34 | 4 |
| Osmolality blood CPT 83930 | $31.50 | $63.00 | $6.74 – $11.09 | 5 |
| Osmolality urine CPT 83935 | $32.00 | $64.00 | $6.96 – $11.42 | 5 |
| Ostectomy complete 1st metatarsal head 28111 CPT 28111 | not published | not published | $3,256.29 – $5,978.00 | 6 |
| Ostectomy scapula partial CPT 23190 | not published | not published | $3,256.29 – $8,246.00 | 6 |
| Osteoart algrft w/surf & b1 CPT 20932 | not published | not published | $511.00 – $2,004.00 | 2 |
| Osteochondral knee allograft CPT 27415 | not published | not published | $3,304.00 – $13,397.00 | 5 |
| Osteochondral knee autograft CPT 27416 | not published | not published | $3,338.00 – $10,995.00 | 6 |
| Osteochondral talus autogrft CPT 28446 | not published | not published | $3,338.00 – $13,397.00 | 6 |
| Osteopath manip tx/5-6 body region 98927 CPT 98927 | $52.00 | $104.00 | not published | 0 |
| Osteoplasty humerus CPT 24420 | not published | not published | $3,304.00 – $10,995.00 | 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.