Sentara Martha Jefferson Hospital
Sentara Martha Jefferson Hospital in Charlottesville, VA publishes cash prices for 46 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Click a procedure to compare it with other hospitals nearby.
500 Martha Jefferson Drive, Charlottesville, VA 22911 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Chgr-Ct Abd/Pelvis W/ Contrast | $2,319.00 | $4,638.00 | 50% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Chgr-Ct Abd/Pelvis W/ Contrast | $2,319.00 | $4,638.00 | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 Chgr-Ct Head Region W/O Contrast | $845.50 | $1,691.00 | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Chgr-Ct Head Region W/O Contrast | $845.50 | $1,691.00 | 50% |
| CT scan of the pelvis, with contrast dye CPT 72193 Chgr-Ct Pelvis W / Contrast | $1,131.00 | $2,262.00 | 50% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Chgr-Ct Pelvis W / Contrast | $1,131.00 | $2,262.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Chgr-Mammo Screen Conv Diag Bilat | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Chgr-Mammo-Post Clip Placement-Bilat | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Chgr-Contrast Enhanced Mammogram Bilat | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Chgr-Mammo-Diagnostic-Bilat Birads 0 | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts CPT 77066 Chgr-Digital Diagnostic Mammogram | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Chgr-Mammo Screen Conv Diag Bilat | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Chgr-Mammo-Post Clip Placement-Bilat | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Chgr-Contrast Enhanced Mammogram Bilat | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Chgr-Mammo-Diagnostic-Bilat Birads 0 | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Chgr-Digital Diagnostic Mammogram | $340.50 | $681.00 | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 Chgr-Mammo-Post Clip Placement-Unilat | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 Chgr-Mammo Screen Conv Diag Unilat | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 Chgr-Digital Diagnostic Mammo Unilat | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 Chgr-Contrast Enhanced Mammogram Unilat | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 Chgr-Mammo-Diagnostic-Unilat Birads 0 | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Chgr-Mammo-Diagnostic-Unilat Birads 0 | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Chgr-Contrast Enhanced Mammogram Unilat | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Chgr-Digital Diagnostic Mammo Unilat | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Chgr-Mammo Screen Conv Diag Unilat | $278.00 | $556.00 | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Chgr-Mammo-Post Clip Placement-Unilat | $278.00 | $556.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Chgr-Mr Lower Ext W/O Contrast | $1,757.00 | $3,514.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Chgr-Mr Lower Ext W/O Contrast | $1,757.00 | $3,514.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Chgr-Mri Low Joint W/Wo Contrast | $3,790.50 | $7,581.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Chgr-Mri Low Joint W/Wo Contrast | $3,790.50 | $7,581.00 | 50% |
| MRI of the brain, no contrast dye CPT 70551 Chgr-Mr Face, Orbit, Head, Neck W/O Contrast | $1,629.50 | $3,259.00 | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Chgr-Mr Face, Orbit, Head, Neck W/O Contrast | $1,629.50 | $3,259.00 | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 Chgr - Mri Screen, Iac W&W/O Contrast | $2,977.50 | $5,955.00 | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 Chgr-Mr Head W/Wo Contrast | $2,977.50 | $5,955.00 | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Chgr - Mri Screen, Iac W&W/O Contrast | $2,977.50 | $5,955.00 | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Chgr-Mr Head W/Wo Contrast | $2,977.50 | $5,955.00 | 50% |
| MRI of the lower back, no contrast dye CPT 72148 Chgr-Mr Lumbar Spine W / O Contrast | $1,735.50 | $3,471.00 | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Chgr-Mr Lumbar Spine W / O Contrast | $1,735.50 | $3,471.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us Preg Uterus After 1St Trimest 1/1St Gestation | $428.00 | $856.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Chgr-Us Ob Complete >=14 Wks | $428.00 | $856.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us Preg Uterus After 1St Trimest 1/1St Gestation | $428.00 | $856.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Chgr-Us Ob Complete >=14 Wks | $428.00 | $856.00 | 50% |
| Screening mammogram, both breasts both sides CPT 77067 Scr Mammo Bi Incl Cad | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts CPT 77067 Chgr-Digital Screening Mammogram | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts CPT 77067 Chgr-Mammography Digital Implants | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts CPT 77067 Chgr-Mammodigital Screening Employee Campaig | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts one side CPT 77067 Chgr-Mammo Digital Screening Unilat | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Scr Mammo Bi Incl Cad | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts inpatient CPT 77067 Chgr-Mammodigital Screening Employee Campaig | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts inpatient CPT 77067 Chgr-Mammography Digital Implants | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts inpatient CPT 77067 Chgr-Digital Screening Mammogram | $307.50 | $615.00 | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 Chgr-Mammo Digital Screening Unilat | $307.50 | $615.00 | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Study-Reduce Svc | $2,370.50 | $4,741.00 | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Study Apnea/Narco | $2,370.50 | $4,741.00 | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Study Apnea&Eeg | $2,370.50 | $4,741.00 | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Study-Reduce Svc | $2,370.50 | $4,741.00 | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Study Apnea&Eeg | $2,370.50 | $4,741.00 | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Study Apnea/Narco | $2,370.50 | $4,741.00 | 50% |
| Transvaginal pelvic ultrasound CPT 76830 Chgr-Us Transvaginal | $423.50 | $847.00 | 50% |
| Transvaginal pelvic ultrasound CPT 76830 Chg - Ultrasound Transvaginal | $423.50 | $847.00 | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Chgr-Us Transvaginal | $423.50 | $847.00 | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Chg - Ultrasound Transvaginal | $423.50 | $847.00 | 50% |
| Ultrasound of the abdomen, complete CPT 76700 Chg - Ultrasound Abdomen | $500.00 | $1,000.00 | 50% |
| Ultrasound of the abdomen, complete CPT 76700 Chgr-Us Abdomen Complete | $500.00 | $1,000.00 | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Chgr-Us Abdomen Complete | $500.00 | $1,000.00 | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Chg - Ultrasound Abdomen | $500.00 | $1,000.00 | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 Chg - Spine Lumbar Minimum Four View | $335.00 | $670.00 | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 Chgr-Lspine Comp | $335.00 | $670.00 | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Chg - Spine Lumbar Minimum Four View | $335.00 | $670.00 | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Chgr-Lspine Comp | $335.00 | $670.00 | 50% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Chgl Basic Metabolic Panel | $43.00 | $86.00 | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Chgl Basic Metabolic Panel | $43.00 | $86.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Chgl Lipid Panel Complete | $73.50 | $147.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Chgl Lipid Cascade | $73.50 | $147.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Chgl Lipid Panel Hdl Ratio | $73.50 | $147.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Chgl Lipid Panel Complete | $73.50 | $147.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Chgl Lipid Panel Hdl Ratio | $73.50 | $147.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Chgl Lipid Cascade | $73.50 | $147.00 | 50% |
| Complete blood count (CBC) with differential CPT 85025 Chgl (Qu) Severe Combined Immunodeficiency (Scid) Panel, S/O | $8.50 | $17.00 | 50% |
| Complete blood count (CBC) with differential CPT 85025 Chgl Cbc With Diff | $46.50 | $93.00 | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Chgl (Qu) Severe Combined Immunodeficiency (Scid) Panel, S/O | $8.50 | $17.00 | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Chgl Cbc With Diff | $46.50 | $93.00 | 50% |
| Complete blood count (CBC), no differential CPT 85027 Chgl Cbc Without Diff | $39.00 | $78.00 | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Chgl Cbc Without Diff | $39.00 | $78.00 | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 Chgl Comprehensive Metabolic Panel | $63.50 | $127.00 | 50% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Chgl Comprehensive Metabolic Panel | $63.50 | $127.00 | 50% |
| Kidney function blood test panel CPT 80069 Chgl Renal Function Panel | $52.00 | $104.00 | 50% |
| Kidney function blood test panel inpatient CPT 80069 Chgl Renal Function Panel | $52.00 | $104.00 | 50% |
| Liver function blood test panel CPT 80076 Chgl Hepatic Function Panel | $49.00 | $98.00 | 50% |
| Liver function blood test panel inpatient CPT 80076 Chgl Hepatic Function Panel | $49.00 | $98.00 | 50% |
| Obstetric blood test panel CPT 80055 Chgl Prenatal Panel | $144.50 | $289.00 | 50% |
| Obstetric blood test panel inpatient CPT 80055 Chgl Prenatal Panel | $144.50 | $289.00 | 50% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Chgl Psa Total - %Free Psa | $81.50 | $163.00 | 50% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Chgl Psa Total - %Free Psa | $81.50 | $163.00 | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Chgl Prostatic Spec Ag | $84.00 | $168.00 | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Chgl Prostatic Spec Ag | $84.00 | $168.00 | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Chgl Ptt | $36.00 | $72.00 | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Chgl Ptt | $36.00 | $72.00 | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Chgl (Qu) Arsenic, Serum/Plasma, S/O | $5.50 | $11.00 | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $25.50 | $51.00 | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Chgl Pt-Inr Poc | $25.50 | $51.00 | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Chgl Pt/Inr | $25.50 | $51.00 | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Chgl (Qu) Arsenic, Serum/Plasma, S/O | $5.50 | $11.00 | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Chgl Pt/Inr | $25.50 | $51.00 | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $25.50 | $51.00 | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Chgl Pt-Inr Poc | $25.50 | $51.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Chgl (Qu) Chronic Urticaria Panel, S/O | $18.50 | $37.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Chgl Lc-Viracor Tsh | $30.50 | $61.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Chgl Thyroid Cascade | $77.00 | $154.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Chgl Thyroid Replacement | $77.00 | $154.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Chga-Tsh | $77.00 | $154.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Chgl (Qu) Chronic Urticaria Panel, S/O | $18.50 | $37.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Chgl Lc-Viracor Tsh | $30.50 | $61.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Chgl Thyroid Replacement | $77.00 | $154.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Chgl Thyroid Cascade | $77.00 | $154.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Chga-Tsh | $77.00 | $154.00 | 50% |
| Urinalysis with microscope exam, automated CPT 81001 Chgl Urinalysis W/Micro | $40.00 | $80.00 | 50% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Auto W/Scope | $40.00 | $80.00 | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Auto W/Scope | $40.00 | $80.00 | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Chgl Urinalysis W/Micro | $40.00 | $80.00 | 50% |
| Urinalysis with microscope exam, manual CPT 81000 N-Autom Urine Dip W Micro | $11.00 | $22.00 | 50% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 N-Autom Urine Dip W Micro | $11.00 | $22.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Auto W/O Scope | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Chgl Ph Urine | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Chgl Urine Specific Gravity | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Dipstick Urine | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Chgl Bile Urine | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Chgl Urinalysis | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Chgl Protein Urine Screen | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 Chgl Ketones Urine Stat | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Dipstick Urine | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Chgl Urinalysis | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Chgl Bile Urine | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Chgl Urine Specific Gravity | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Chgl Ph Urine | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Chgl Ketones Urine Stat | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Chgl Protein Urine Screen | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Auto W/O Scope | $25.50 | $51.00 | 50% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Nonauto W/O Scope | $24.50 | $49.00 | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Nonauto W/O Scope | $24.50 | $49.00 | 50% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy, diagnostic CPT 45378 Diagnostic Colonoscopy | $1,164.50 | $2,329.00 | 50% |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic Colonoscopy | $1,164.50 | $2,329.00 | 50% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Discission Cataract Yag Laser | $897.00 | $1,794.00 | 50% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Discission Cataract Yag Laser | $897.00 | $1,794.00 | 50% |
| Left heart catheterization, diagnostic one side CPT 93452 Chgr-Cd Left Hrt Cath W / Ventrclgrphy | $6,582.50 | $13,165.00 | 50% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Chgr-Cd Left Hrt Cath W / Ventrclgrphy | $6,582.50 | $13,165.00 | 50% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Njx Interlaminar Lmbr/Sac, Img | $1,157.50 | $2,315.00 | 50% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Interlaminar Lmbr/Sac, Img | $1,157.50 | $2,315.00 | 50% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Njx Interlaminar Lmbr/Sac | $1,144.50 | $2,289.00 | 50% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Njx Interlaminar Lmbr/Sac | $1,144.50 | $2,289.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Esi L/S,Transforamn-W/Wo Fluor | $779.00 | $1,558.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Proc-Esi L/S W/Osed Tranforamn | $779.00 | $1,558.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Proc-Esi L/S W/Osed Tranforamn | $779.00 | $1,558.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Esi L/S,Transforamn-W/Wo Fluor | $779.00 | $1,558.00 | 50% |
| Prostate biopsy CPT 55700 Prostate/Us Or Mri/Bx | $1,301.50 | $2,603.00 | 50% |
| Prostate biopsy CPT 55700 Bx Prostate Needle Or Punch | $1,301.50 | $2,603.00 | 50% |
| Prostate biopsy inpatient CPT 55700 Bx Prostate Needle Or Punch | $1,301.50 | $2,603.00 | 50% |
| Prostate biopsy inpatient CPT 55700 Prostate/Us Or Mri/Bx | $1,301.50 | $2,603.00 | 50% |
| Removal of a breast lump, open surgery CPT 19120 Chg - Removal Of Breast Lesion | $1,637.00 | $3,274.00 | 50% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Chg - Removal Of Breast Lesion | $1,637.00 | $3,274.00 | 50% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Group psychotherapy session CPT 90853 Group Psych Not Multi-Family | $78.00 | $156.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 Group Psych Not Multi-Family | $78.00 | $156.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Chg-Exercise - Isokinetic | $65.50 | $131.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Exercise - Therapeutic-Ot 15Mn | $65.50 | $131.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Athletic Training Therapeutic Exercises | $65.50 | $131.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Exercise Therapeutic -15 Min | $65.50 | $131.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Chg-Exercise - Isokinetic | $65.50 | $131.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Athletic Training Therapeutic Exercises | $65.50 | $131.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Exercise - Therapeutic-Ot 15Mn | $65.50 | $131.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Exercise Therapeutic -15 Min | $65.50 | $131.00 | 50% |
| Psychotherapy session, 30 minutes CPT 90832 Indiv Therapy (30 Min) | $114.50 | $229.00 | 50% |
| Psychotherapy session, 30 minutes CPT 90832 Chg - Psytx Pt&/Family 30 Minutes | $114.50 | $229.00 | 50% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Chg - Psytx Pt&/Family 30 Minutes | $114.50 | $229.00 | 50% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Indiv Therapy (30 Min) | $114.50 | $229.00 | 50% |
| Psychotherapy session, 45 minutes CPT 90834 Indiv Therapy (45 Min) | $247.00 | $494.00 | 50% |
| Psychotherapy session, 45 minutes CPT 90834 Chg - Psychotherapy,45Min W/Pt,Fmly | $247.00 | $494.00 | 50% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Chg - Psychotherapy,45Min W/Pt,Fmly | $247.00 | $494.00 | 50% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Indiv Therapy (45 Min) | $247.00 | $494.00 | 50% |
| Psychotherapy session, 60 minutes CPT 90837 Chg - Psytx Pt&/Family 60 Minutes | $308.50 | $617.00 | 50% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Chg - Psytx Pt&/Family 60 Minutes | $308.50 | $617.00 | 50% |
Source file: https://www.sentara.com/Documents/s/sentaramarthajeffersonhospitalstandardchargesxlsx-1395290