Sentara Careplex Hospital
3000 Coliseum Drive, Hampton, VA 23666 · 119 Priced Procedures · 70% Patient Recommendation
Typical commercial prices here are +37% above the fair benchmark (1.37×) even after accounting for local nurse/doctor wages and patient complexity.
3-Star CMS clinical quality rating paired with 1.37× fair market pricing.
Wide Procedure Spread · Upper-Quartile Skew Pricer
Sentara Careplex Hospital prices routine shoppable procedures at 2.1× Medicare (median 1.10× Fair BaseRate) while upper-quartile commercial rates jump +112% to 2.33× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.97× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 17% of shoppable procedures (99/100 Cash Honesty)
- 4-Star CMS clinical rating with 70% patient recommendation (70/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (15.8% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (1.37× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Commercial insurance median sits at 1.10× Fair BaseRate (2.1× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Upper-quartile procedures (Q75 2.33×) jump +112% above the median procedure ratio (Q50 1.10×)
- Consolidated metro market (HHI 2,784) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Sentara Careplex Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 119 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Spinal fusion, single level (inpatient stay) MS-DRG Code: 451 | $66,042 | 2.1× |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $39,712 | 2.1× |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $39,434 | 2.0× |
| Heart stent placement (inpatient stay) MS-DRG Code: 322 | $36,043 | 2.0× |
| Total hip replacement CPT Code: 27130 | $31,497 | unverified |
| Total knee replacement CPT Code: 27447 | $31,497 | unverified |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $18,514 | unverified |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $15,938 | unverified |
| Inguinal hernia repair CPT Code: 49505 | $10,964 | unverified |
| Bunion correction surgery CPT Code: 28296 | $10,020 | 2.9× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $10,020 | unverified |
| Cataract surgery with lens implant CPT Code: 66984 | $7,067 | 2.8× |
| Breast lump removal CPT Code: 19120 | $4,896 | unverified |
| Colonoscopy with biopsy CPT Code: 45380 | $3,665 | 2.9× |
| Trauma team activation HCPCS Code: G0390 | $3,599 | 2.5× |
| Upper endoscopy with biopsy CPT Code: 43239 | $2,778 | 2.8× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $1,874 | 1.8× |
| Blood transfusion CPT Code: 36430 | $1,351 | 2.7× |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $1,210 | 2.1× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $1,165 | 1.2× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $1,105 | 2.5× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $1,105 | 2.2× |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $756 | 2.8× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $756 | 2.5× |
| MRI, lower back (no contrast) CPT Code: 72148 | $756 | 2.2× |
Audit a Bill or Quote at Sentara Careplex Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $25,027
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (15.8% of gross = $25,027).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask Sentara Careplex Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)
Your bill ($158,501) is $127,726 above the denoised Fair BaseRate ($30,775) and 6.7× the $23,504 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (15.8% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)Source: CMS Hospital Care Compare (720 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Sentara Careplex Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.