How do I look up my Sentara fee schedule?

Check the executed provider agreement and its amendments first, then confirm the rates against recent remittances or the payer portal. Public machine-readable files provide useful benchmarks, but they do not override the contract or show the exact payment for a particular claim. PayerPrice makes the Sentara records it tracks searchable by code, provider, plan, and market.

What are Sentara machine readable files?

CMS requires most non-grandfathered group health plans and issuers offering non-grandfathered group or individual coverage to publish machine-readable files. The files contain in-network negotiated rates and out-of-network allowed amounts and billed charges, and they are updated monthly. A published record does not by itself prove that the rate applies to a specific provider, service, or claim.

How do Sentara reimbursement rates compare to Medicare?

There is no reliable payer-wide Medicare multiple for Sentara. A sound comparison uses the same code, year, locality, care setting, and provider type. Some products follow Medicaid, state, bundled, or capitated methods instead, so a Medicare percentage may not apply.

How can I negotiate higher Sentara reimbursement rates?

Use the current contract, recent remittances, service mix, and published rates from comparable plans and providers. Present the rates you are requesting, show the expected financial effect, and document your assumptions.

Payer contract guide

Official sources linked below

Negotiating with Sentara: Fee Schedule and Reimbursement Rate Benchmarks for 2026

Sentara Health Plans is the health-plan business of the nonprofit Sentara Health system. Sentara unified the Optima Health and Virginia Premier brands under Sentara Health Plans in January 2024. PayerPrice structures the published Sentara rate records it tracks so contract teams can compare the same plan, market, and provider type.

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SEN

Sentara Health Plans

Virginia commercial, Medicare, Medicaid, and individual plans

Plans tracked

Providers (NPIs)

Rate observations

MRF publication cadence

Monthly

Last refresh

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Sentara Overview

Sentara Health Plans, at a glance

Sentara Health Plans is the health-plan business of the nonprofit Sentara Health system. Sentara unified the Optima Health and Virginia Premier brands under Sentara Health Plans in January 2024.

Older contracts and data may still use the Optima Health or Virginia Premier name. Check the legal entity and current product before comparing those records with Sentara data.

Payer sources

Sentara Health Plans: About Us

Sentara reimbursement can vary by product, network, provider contract, service details, and geographic location. Match those attributes before relying on a parent-brand benchmark.

Quick Facts

OFFICIAL PAYER + PAYERPRICE DATA

Payer Type	Regional health plan within Sentara Health
Total Membership
Market Share
Plan Types	Employer Individual & Family Medicare Medicaid
Plans Tracked in PayerPrice
Data Source	Machine Readable Files (TiC Rule)
Data Freshness	Updated monthly

Negotiation Playbook

How to negotiate better Sentara reimbursement rates

Use these four steps to check the current contract, choose comparable rates, and prepare a specific proposal for Sentara.

Step 1

Benchmark your current rates

Start with the executed contract and recent remittances. Confirm which rates are in use before comparing them with published data.

Step 2

Prioritize material services

Use paid claims to find the services that matter most financially. The priority list should reflect your practice, not an arbitrary number of codes.

Step 3

Build a comparable peer set

Compare published rates from the same plan and market for similar providers. Use them as context; they do not prove what another provider was paid on a specific claim.

Step 4

Build the negotiation case

Show the current terms, matched benchmarks, expected financial effect, and proposed rates. Spell out any assumptions.

Build a proposal the payer can evaluate.

Match published rates to the contract's network and market, then apply your own service mix to estimate the financial effect.

See our full payer contract negotiations guide for the deep dive.

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Reimbursement Rates · National Avg.

Sentara rates for commonly billed CPT codes

These national-average in-network rates come from the latest available PayerPrice dataset. The table also shows the Medicare allowed amount for each selected CPT code. The provider contract and claim details determine the actual reimbursement.

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CPT	Description	Category
99214	Office Visit, Established (Moderate)	E&M	View rates
99213	Office Visit, Established (Low)	E&M	View rates
99215	Office Visit, Established (High)	E&M	View rates
90837	Psychotherapy, 60 min	Psychiatry	View rates
90834	Psychotherapy, 45 min	Psychiatry	View rates
90791	Psychiatric Diagnostic Evaluation	Psychiatry	View rates
70450	CT Head/Brain without Contrast	Radiology	View rates
73721	MRI Lower Extremity Joint	Radiology	View rates
45378	Diagnostic Colonoscopy	Surgery	View rates

Rates shown are national averages. Actual Sentara reimbursement varies by market, plan, geographic location, and provider contract. For provider-level detail by NPI or Tax ID, run a free sample report.

Sentara Machine Readable Files

How to read Sentara machine-readable files

Under the Transparency in Coverage requirements, most non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage must publish machine-readable files with in-network negotiated rates and out-of-network allowed amounts and billed charges. See the CMS guidance for plans and issuers. CMS's technical clarification states that the files are updated monthly.

PayerPrice makes the Sentara records it tracks searchable by billing code, provider, plan, and market.

Search Sentara rates without opening raw files

sentara_in-network-rates_example.jsonILLUSTRATIVE

2 "reporting_entity_name": "Sentara Health Plans",

3 "plan_name": "Sentara PPO",

4 "version": "1.3.0",

5 "in_network": [

6 { "billing_code": "99214",

7 "negotiated_rates": [

8 { "npi": 1538156793,

9 "negotiated_price": 162.84, "service_code": "11"

10 "billing_class": "professional" },

11 { "npi": 1972658421,

12 "negotiated_price": 148.20, "service_code": "11" },

13 // additional negotiated-rate rows

14 ]

15 },

16 // additional billing codes

17 ]

18}

rate observations in latest dataset

Frequently asked

Common questions about Sentara fee schedules

A Sentara fee schedule sets reimbursement terms for covered services in a provider agreement. The contract may use code-based prices or another payment method. PayerPrice organizes the published Sentara rate records it tracks for comparison.

For Sentara contract leads

Compare published Sentara rates for similar providers.

Start with a sample of published Sentara rate data, then narrow the comparison by plan, market, billing code, and provider attributes.

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Your sample includes

Published rate records from Sentara

CPT and Medicare comparisons, where available

Filters for plan, market, and provider

Guidance for reading machine-readable files