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 |
|---|---|---|---|---|
| Small bowel endoscopy/stent 44370 CPT 44370 | not published | not published | $4,007.00 – $8,246.00 | 6 |
| Smallpox&monkeypox vac 0.5ml CPT 90611 | not published | not published | $0.01 – $0.01 | 4 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $29.50 | $59.00 | $5.50 – $9.00 | 5 |
| Smear gram stain CPT 87205 | $23.50 | $47.00 | $4.36 – $7.15 | 5 |
| Smear nasal eosinophil CPT 89190 | $28.00 | $56.00 | $5.91 – $7.97 | 5 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $25.50 | $51.00 | $6.11 – $10.04 | 5 |
| Smear wet mount CPT 87210 | $23.50 | $47.00 | $5.94 – $7.15 | 5 |
| Smn1 gene full gene sequence CPT 81336 | not published | not published | $307.38 – $361.62 | 5 |
| Smn1 gen nown famil seq vrnt CPT 81337 | not published | not published | $188.90 – $222.24 | 5 |
| Smpd1 gene common variants CPT 81330 | not published | not published | $47.94 – $56.40 | 5 |
| Snrpn/ube3a gene CPT 81331 | $194.50 | $389.00 | $52.09 – $61.28 | 5 |
| So airplane w/wo joint cf HCPCS L3674 | $569.77 | $1,139.54 | not published | 0 |
| So cap design without jnts cf HCPCS L3671 | $357.08 | $714.15 | not published | 0 |
| Socket insert below knee HCPCS L5655 | $248.40 | $496.80 | not published | 0 |
| Socket insert without lock mech HCPCS L5679 | $477.66 | $955.31 | not published | 0 |
| Sock fracture or equal each HCPCS L3995 | $30.02 | $60.03 | not published | 0 |
| Sock wool above knee HCPCS L8430 | $21.22 | $42.44 | not published | 0 |
| Sodium 24 hour urine CPT 84300 | $23.00 | $46.00 | $5.16 – $8.15 | 5 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | not published | not published | $6.97 – $6.97 | 1 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | not published | not published | $3.47 – $3.47 | 1 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | not published | not published | $1.75 – $1.75 | 1 |
| Sodium chloride 3 % ivpb HCPCS J7131 | not published | not published | $0.40 – $0.40 | 1 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | not published | not published | $5.54 – $5.54 | 1 |
| Sodium hyaluronate 20 mg/2 ml syringe HCPCS J7321 | not published | not published | $94.62 – $203.20 | 2 |
| Sodium serum/plasma/whole blood CPT 84295 | $23.00 | $46.00 | $4.91 – $8.06 | 5 |
| Soft interface below knee se HCPCS L2820 | $69.86 | $139.73 | not published | 0 |
| Software meas of cardiac vol HCPCS G0183 | not published | not published | $86.61 – $89.15 | 4 |
| So gsap cl fr cpy nmbr&mcrst CPT 81463 | not published | not published | $1,372.22 – $1,412.58 | 4 |
| So gsap cll fr dna/dna&rna CPT 81462 | not published | not published | $1,219.75 – $1,255.62 | 4 |
| So gsap cll fr mcrstl ins CPT 81464 | not published | not published | $3,354.28 – $3,452.94 | 4 |
| So gsap dna cpy nmbr&mcrstl CPT 81458 | not published | not published | $1,067.28 – $1,098.67 | 4 |
| Somatosensory testing CPT 95927 | not published | not published | $214.89 – $221.21 | 4 |
| Somatropin injection HCPCS J2941 | not published | not published | $92.46 – $410.33 | 2 |
| So neo gsap dna/dna&rna CPT 81459 | not published | not published | $3,049.34 – $3,139.03 | 4 |
| So neo gsap dna mcrstl ins CPT 81457 | not published | not published | $914.81 – $941.71 | 4 |
| Sotalol hydrochloride IV HCPCS C9482 | not published | not published | $25.55 – $26.30 | 4 |
| So vest canvas/web pre ots HCPCS L3675 | $94.70 | $189.41 | not published | 0 |
| Spacer bag/reservoir HCPCS A4627 | $20.18 | $40.37 | not published | 0 |
| Sp bone agrft morsel add-on CPT 20937 | not published | not published | $2,004.00 – $8,246.00 | 2 |
| Sp bone agrft struct add-on CPT 20938 | not published | not published | $2,004.00 – $8,246.00 | 2 |
| Sp bone algrft morsel add-on CPT 20930 | not published | not published | $511.00 – $2,004.00 | 2 |
| Special physics consult CPT 77370 | $673.50 | $1,347.00 | $133.76 – $137.70 | 4 |
| Special radiation dosimetry CPT 77331 | $222.00 | $444.00 | $133.76 – $137.70 | 4 |
| Special radiation treatment CPT 77470 | $1,894.50 | $3,789.00 | $549.89 – $566.06 | 4 |
| Special supplies phys/qhp CPT 99070 | $18.63 | $37.26 | not published | 0 |
| Special teletx port plan CPT 77321 | $713.50 | $1,427.00 | $372.63 – $383.59 | 4 |
| Specific gravity body fluid CPT 84315 | $12.50 | $25.00 | $3.35 – $4.20 | 5 |
| Specimen fat stain CPT 89125 | not published | not published | $6.00 – $7.24 | 5 |
| Speech audiometry complete CPT 92556 | not published | not published | $58.71 – $60.44 | 4 |
| Speech evaluation complex CPT 70371 | $388.00 | $776.00 | $237.46 – $244.44 | 4 |
| Speech recep thresh CPT 92555 | not published | not published | $58.71 – $60.44 | 4 |
| Sperm antibody test CPT 89325 | not published | not published | $10.88 – $17.89 | 5 |
| Sperm evaluation test CPT 89329 | not published | not published | $19.98 – $35.16 | 5 |
| Sperm identification CPT 89257 | not published | not published | $51.86 – $53.39 | 5 |
| Sperm isolation complex CPT 89261 | not published | not published | $51.86 – $53.39 | 5 |
| Sperm isolation simple CPT 89260 | not published | not published | $51.86 – $53.39 | 5 |
| Sperm washing 58323 CPT 58323 | not published | not published | $201.20 – $1,010.00 | 6 |
| Sphenoid sinus surgery CPT 31051 | not published | not published | $3,338.00 – $10,995.00 | 6 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | not published | not published | $2,762.33 – $8,246.00 | 6 |
| Spinal bone allograftstructural 20931 CPT 20931 | not published | not published | $511.00 – $2,004.00 | 2 |
| Spinal bone autograftlocal 20936 CPT 20936 | not published | not published | $2,004.00 – $8,246.00 | 2 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,811.00 | $3,622.00 | $702.49 – $1,547.00 | 5 |
| Spine device implant surgery HCPCS C9757 | not published | not published | $4,007.00 – $13,397.00 | 5 |
| Spirmtry w/brnchdil inf-2 yr CPT 94012 | not published | not published | $214.89 – $221.21 | 4 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $321.50 | $643.00 | $371.37 – $382.29 | 4 |
| Spirometry up to 2 yrs old CPT 94011 | not published | not published | $128.06 – $131.82 | 4 |
| Spleen imaging CPT 78185 | $381.50 | $763.00 | $397.85 – $409.55 | 4 |
| Splenectomy total open 38100 CPT 38100 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Splice spleen/kidney veins CPT 37181 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Splicing of ureters CPT 50770 | not published | not published | $1,547.00 – $1,547.00 | 1 |
| Splint arm vnyl coated padded lft med HCPCS Q4051 | $28.98 | $57.96 | not published | 0 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $269.62 | $539.24 | not published | 0 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $26.40 | $52.79 | not published | 0 |
| Splint finger 4 prong foam sm HCPCS A4570 | $15.52 | $31.05 | not published | 0 |
| Splint finger fold over sm HCPCS L3924 | $83.00 | $166.00 | not published | 0 |
| Splint finger frog med HCPCS L3927 | $18.63 | $37.26 | not published | 0 |
| Splint fing stax assort 1-7in HCPCS Q4049 | $8.28 | $16.56 | not published | 0 |
| Splint func pos polyflex ii med HCPCS L3999 | $32.60 | $65.21 | not published | 0 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $63.66 | $127.31 | not published | 0 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | $5,132.50 | $10,265.00 | $1,571.00 – $8,246.00 | 6 |
| Split blood or products CPT 86985 | $254.50 | $509.00 | $64.18 – $174.12 | 5 |
| Splt agrft f/s/n/h/f/g/m ea CPT 15121 | not published | not published | $511.00 – $3,304.00 | 2 |
| Sprchoroidal spc njx rx agt CPT 67516 | not published | not published | $328.72 – $511.00 | 5 |
| Sputum specimen collection CPT 89220 | $87.50 | $175.00 | $29.60 – $174.12 | 5 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | not published | not published | $4,229.26 – $4,353.65 | 4 |
| Srs cranial lesion complex CPT 61798 | not published | not published | $13,397.00 – $13,397.00 | 1 |
| Srs cranial lesion simple CPT 61796 | not published | not published | $13,397.00 – $13,397.00 | 1 |
| Srs cran les complex addl CPT 61799 | not published | not published | $3,276.00 – $3,276.00 | 1 |
| Srs cran les simple addl CPT 61797 | not published | not published | $3,276.00 – $3,276.00 | 1 |
| Srsf2 gene common variants CPT 81348 | not published | not published | $178.91 – $210.48 | 5 |
| Srs linear based CPT 77372 | $10,508.50 | $21,017.00 | $7,329.93 – $7,545.51 | 4 |
| Srs multisource CPT 77371 | $17,099.50 | $34,199.00 | $7,329.93 – $7,545.51 | 4 |
| Srs spinal lesion CPT 63620 | not published | not published | $13,397.00 – $13,397.00 | 1 |
| Srs spinal lesion addl CPT 63621 | not published | not published | $3,276.00 – $3,276.00 | 1 |
| Staggered spondaic word test CPT 92572 | not published | not published | $128.06 – $131.82 | 4 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $302.50 | $605.00 | $110.68 – $113.94 | 4 |
| Staph a dna amp probe CPT 87640 | not published | not published | $35.79 – $58.85 | 5 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $373.00 | $746.00 | $103.75 – $106.81 | 4 |
| Stem cells total count CPT 86367 | $168.00 | $336.00 | $63.24 – $81.67 | 5 |
| Stenger test pure tone CPT 92565 | not published | not published | $58.71 – $60.44 | 4 |
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.