Sentara Careplex Hospital: charges and Medicare payments

Sentara Careplex Hospital reported 1,390 Medicare inpatient stays across 38 DRGs in 2024. Across them it charged 3.86 times what it was paid — mid-range in Virginia, number 30 of 66 hospitals with at least 100 stays (state median 3.6×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 385 stays at an average charge of $57,346, 36% below the national average. It also billed 2,220 outpatient services, charging 6.33 times what Medicare paid.

1Medicare inpatient stays 1,390
2Charge ÷ paid, inpatient 3.86×
3Rank in VA (highest ratio = 1) 30 of 66
4CMS price-transparency actions 0

Average charge per stay at Sentara Careplex Hospital, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 38 DRGs that can be compared with the national average, Sentara Careplex Hospital charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.

DRG	Stays	Avg charge	vs US	Avg paid
871 Septicemia or Severe Sepsis without MV >96 Hours with MCC	385	$57,346	-36%	$15,277
280 Acute Myocardial Infarction, Discharged Alive with MCC	109	$54,934	-28%	$11,938
291 Heart Failure and Shock with MCC	106	$39,073	-31%	$10,628
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	50	$30,848	-37%	$8,878
853 Infectious and Parasitic Diseases with O.R. Procedures with...	47	$122,331	-47%	$35,715
682 Renal Failure with MCC	38	$37,307	-43%	$11,143
698 Other Kidney and Urinary Tract Diagnoses with MCC	37	$41,222	-44%	$12,528
287 Circulatory Disorders except AMI, with Cardiac...	36	$47,526	-26%	$8,960
193 Simple Pneumonia and Pleurisy with MCC	35	$38,100	-36%	$10,698
377 Gastrointestinal Hemorrhage with MCC	35	$50,697	-41%	$13,193
812 Red Blood Cell Disorders without MCC	35	$28,574	-36%	$8,915
378 Gastrointestinal Hemorrhage with CC	33	$33,196	-32%	$9,053
177 Respiratory Infections and Inflammations with MCC	30	$43,203	-39%	$12,441
189 Pulmonary Edema and Respiratory Failure	28	$39,695	-31%	$10,300
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	27	$61,176	-39%	$14,007
286 Circulatory Disorders except AMI, with Cardiac...	23	$58,743	-48%	$14,124
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	22	$41,363	-26%	$9,598
281 Acute Myocardial Infarction, Discharged Alive with CC	22	$43,706	-13%	$7,291
190 Chronic Obstructive Pulmonary Disease with MCC	20	$27,265	-46%	$9,452
308 Cardiac Arrhythmia and Conduction Disorders with MCC	20	$32,072	-43%	$9,577
481 Hip and Femur Procedures except Major Joint with CC	19	$55,657	-45%	$14,654
811 Red Blood Cell Disorders with MCC	19	$58,948	-14%	$14,350
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	18	$32,250	-47%	$10,289
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	17	$44,693	-31%	$10,811
309 Cardiac Arrhythmia and Conduction Disorders with CC	17	$31,136	-14%	$6,848
854 Infectious and Parasitic Diseases with O.R. Procedures with...	16	$47,549	-52%	$14,844
460 Spinal Fusion except Cervical without MCC	15	$95,281	-44%	$25,309
252 Other Vascular Procedures with MCC	14	$124,824	-27%	$25,593
330 Major Small and Large Bowel Procedures with CC	13	$104,886	-12%	$19,599
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	13	$55,030	-46%	$14,837
208 Respiratory System Diagnosis with Ventilator Support <=96...	12	$116,032	-15%	$20,262
603 Cellulitis without MCC	12	$21,090	-43%	$8,354
683 Renal Failure with CC	12	$28,746	-29%	$7,536
253 Other Vascular Procedures with CC	11	$103,648	-21%	$21,523
314 Other Circulatory System Diagnoses with MCC	11	$41,621	-56%	$16,478
470 Major Hip and Knee Joint Replacement or Reattachment of...	11	$57,166	-39%	$14,084
637 Diabetes with MCC	11	$40,077	-40%	$10,985
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	11	$27,868	-25%	$7,581

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Level 2 Excision/ Biopsy/ Incision and Drainage	247	$12,222	$1,381
Level 1 Endovascular Procedures	237	$31,251	$2,798
Comprehensive Observation Services	210	$22,940	$2,314
Level 3 Electrophysiologic Procedures	179	$90,106	$20,190
Level 5 Musculoskeletal Procedures	169	$42,040	$11,322
Level 3 Vascular Procedures	121	$16,639	$2,755
Level 1 Nerve Procedures	109	$13,654	$1,655
Level 3 Urology and Related Services	88	$15,705	$1,756
Level 6 Musculoskeletal Procedures	84	$55,868	$16,182
Level 3 Excision/ Biopsy/ Incision and Drainage	83	$27,095	$2,401
Level 1 Intraocular Procedures	64	$13,415	$2,002
Level 4 Musculoskeletal Procedures	54	$30,269	$6,133
Level 2 Endovascular Procedures	54	$31,001	$4,973
Level 2 Vascular Procedures	48	$7,376	$1,394
Level 1 Breast/Lymphatic Surgery and Related Procedures	46	$24,703	$3,317
Level 3 Pacemaker and Similar Procedures	43	$46,487	$9,286
Level 1 Laparoscopy and Related Services	42	$29,729	$4,925
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	39	$19,875	$3,010
Level 3 Intraocular Procedures	38	$17,337	$4,548
Level 2 Breast/Lymphatic Surgery and Related Procedures	37	$38,147	$5,562
Level 3 Musculoskeletal Procedures	32	$17,281	$2,816
Level 3 Endovascular Procedures	28	$55,339	$9,283
Level 4 Vascular Procedures	22	$32,579	$4,782
Level 4 Endovascular Procedures	22	$79,655	$15,228
Level 2 Pacemaker and Similar Procedures	22	$30,411	$7,392

Against the Virginia average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Sentara Careplex Hospital charged $57,346 on average, 12% less than the Virginia average of $65,235, and was paid $15,277 against a state average of $16,367. For Acute Myocardial Infarction, Discharged Alive with MCC (DRG 280), Sentara Careplex Hospital charged $54,934 on average, 4% less than the Virginia average of $57,438, and was paid $11,938 against a state average of $13,197. For Heart Failure and Shock with MCC (DRG 291), Sentara Careplex Hospital charged $39,073 on average, 4% less than the Virginia average of $40,795, and was paid $10,628 against a state average of $11,030. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Sentara Careplex Hospital charged $30,848 on average, 17% less than the Virginia average of $37,022, and was paid $8,878 against a state average of $8,962. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $12,222 was 9% above the state average of $11,217. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $31,251 was 2% below the state average of $31,869. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $22,940 was 18% above the state average of $19,506. For Level 3 Electrophysiologic Procedures (outpatient APC 5213), its average charge of $90,106 was 46% below the state average of $167,325.

Price-transparency record

No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.

Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.

Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.