Virginia / Augusta Health

CMS certification 490018 · Fishersville, VA · 3 entries in CMS's price-transparency list

Augusta Health: charges and Medicare payments

Augusta Health reported 2,363 Medicare inpatient stays across 77 DRGs in 2024. Across them it charged 3.44 times what it was paid — mid-range in Virginia, number 38 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: 259 stays at an average charge of $33,910, 62% below the national average. It also billed 5,429 outpatient services, charging 6.88 times what Medicare paid.

1Medicare inpatient stays 2,363
2Charge ÷ paid, inpatient 3.44×
3Rank in VA (highest ratio = 1) 38 of 66
4CMS price-transparency actions 3

Average charge per stay at Augusta Health, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 77 DRGs that can be compared with the national average, Augusta Health charged more than the national average in 5 (6%). 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	259	$33,910	-62%	$16,092
291 Heart Failure and Shock with MCC	210	$23,867	-58%	$10,349
194 Simple Pneumonia and Pleurisy with CC	78	$17,644	-54%	$6,405
683 Renal Failure with CC	60	$19,585	-52%	$6,983
481 Hip and Femur Procedures except Major Joint with CC	57	$79,345	-21%	$16,092
378 Gastrointestinal Hemorrhage with CC	56	$24,808	-49%	$8,285
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	53	$25,295	-55%	$8,206
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	49	$23,569	-52%	$8,551
177 Respiratory Infections and Inflammations with MCC	45	$37,054	-48%	$12,687
885 Psychoses	45	$28,819	-35%	$10,875
690 Kidney and Urinary Tract Infections without MCC	44	$18,666	-51%	$6,251
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	43	$26,016	-35%	$6,434
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	43	$81,007	-21%	$16,800
322 Percutaneous Cardiovascular Procedures with Intraluminal...	41	$111,997	-2%	$16,055
189 Pulmonary Edema and Respiratory Failure	40	$27,921	-52%	$11,867
193 Simple Pneumonia and Pleurisy with MCC	40	$27,422	-54%	$10,194
682 Renal Failure with MCC	39	$31,270	-53%	$11,607
603 Cellulitis without MCC	38	$15,675	-58%	$7,283
309 Cardiac Arrhythmia and Conduction Disorders with CC	34	$20,181	-44%	$5,788
178 Respiratory Infections and Inflammations with CC	33	$27,715	-39%	$7,673
243 Permanent Cardiac Pacemaker Implant with CC	32	$105,425	-5%	$18,871
377 Gastrointestinal Hemorrhage with MCC	31	$44,630	-48%	$14,008
389 Gastrointestinal Obstruction with CC	30	$19,908	-49%	$6,243
638 Diabetes with CC	30	$22,701	-46%	$7,583
280 Acute Myocardial Infarction, Discharged Alive with MCC	29	$39,732	-48%	$12,549
330 Major Small and Large Bowel Procedures with CC	27	$129,709	+9%	$19,682
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	27	$18,250	-57%	$7,016
455 Combined Anterior and Posterior Spinal Fusion without CC/MCC	26	$219,071	+8%	$46,349
321 Percutaneous Cardiovascular Procedures with Intraluminal...	25	$119,395	-27%	$25,831
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	25	$24,657	-33%	$6,077
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	24	$36,869	-63%	$15,604
071 Other Cerebrovascular Disorders with CC	24	$25,318	-50%	$8,309
281 Acute Myocardial Infarction, Discharged Alive with CC	24	$46,252	-8%	$7,774
286 Circulatory Disorders except AMI, with Cardiac...	23	$53,913	-52%	$19,991
308 Cardiac Arrhythmia and Conduction Disorders with MCC	23	$30,127	-47%	$9,319
552 Medical Back Problems without MCC	23	$22,773	-53%	$7,590
689 Kidney and Urinary Tract Infections with MCC	23	$21,410	-58%	$9,092
287 Circulatory Disorders except AMI, with Cardiac...	22	$45,748	-28%	$10,312
470 Major Hip and Knee Joint Replacement or Reattachment of...	22	$89,738	-4%	$17,894
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	22	$25,170	-58%	$11,249
698 Other Kidney and Urinary Tract Diagnoses with MCC	22	$24,303	-67%	$12,743
190 Chronic Obstructive Pulmonary Disease with MCC	21	$22,324	-56%	$8,566
191 Chronic Obstructive Pulmonary Disease with CC	21	$18,225	-54%	$6,674
441 Disorders of Liver except Malignancy, Cirrhosis or Alcoholic...	20	$41,107	-52%	$14,230
418 Laparoscopic Cholecystectomy without C.D.E. with CC	19	$80,849	-13%	$12,765
520 Back and Neck Procedures except Spinal Fusion without CC/MCC	19	$62,519	-21%	$11,098
390 Gastrointestinal Obstruction without CC/MCC	18	$17,620	-37%	$4,817
853 Infectious and Parasitic Diseases with O.R. Procedures with...	18	$112,622	-51%	$40,810
312 Syncope and Collapse	17	$23,654	-48%	$7,788
244 Permanent Cardiac Pacemaker Implant without CC/MCC	16	$83,694	-10%	$14,124
314 Other Circulatory System Diagnoses with MCC	16	$41,226	-57%	$17,615
329 Major Small and Large Bowel Procedures with MCC	16	$183,464	-15%	$52,998
282 Acute Myocardial Infarction, Discharged Alive without CC/MCC	15	$48,262	+11%	$6,188
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	15	$27,327	-55%	$9,904
480 Hip and Femur Procedures except Major Joint with MCC	15	$91,676	-34%	$22,951
482 Hip and Femur Procedures except Major Joint without CC/MCC	15	$71,709	-8%	$13,951
057 Degenerative Nervous System Disorders without MCC	14	$23,143	-59%	$10,643
394 Other Digestive System Diagnoses with CC	14	$33,553	-29%	$7,323
854 Infectious and Parasitic Diseases with O.R. Procedures with...	14	$47,887	-51%	$15,700
242 Permanent Cardiac Pacemaker Implant with MCC	13	$132,353	-18%	$26,662

Showing the 60 most frequent of 77 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Level 1 Intraocular Procedures	1,299	$9,413	$2,235
Comprehensive Observation Services	698	$13,154	$2,628
Level 5 Musculoskeletal Procedures	539	$79,526	$12,558
Level 1 Nerve Procedures	355	$6,669	$1,850
Level 4 Urology and Related Services	246	$19,204	$3,337
Level 2 Excision/ Biopsy/ Incision and Drainage	208	$4,970	$1,563
Level 5 Urology and Related Services	159	$27,926	$4,951
Level 4 Musculoskeletal Procedures	139	$46,116	$6,875
Level 2 Upper GI Procedures	138	$7,127	$1,828
Level 1 Laparoscopy and Related Services	121	$53,840	$5,431
Level 3 Urology and Related Services	121	$12,655	$1,969
Level 3 Vascular Procedures	116	$17,577	$3,081
Level 2 Intraocular Procedures	108	$27,131	$3,930
Level 3 Electrophysiologic Procedures	99	$97,006	$22,681
Level 2 Musculoskeletal Procedures	97	$6,622	$1,528
Level 3 Pacemaker and Similar Procedures	85	$60,579	$10,312
Level 1 Endovascular Procedures	71	$26,841	$3,155
Level 3 Excision/ Biopsy/ Incision and Drainage	68	$15,217	$2,747
Level 3 Musculoskeletal Procedures	68	$19,063	$3,092
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	50	$36,261	$3,344
Level 6 Musculoskeletal Procedures	49	$103,156	$17,973
Level 3 Extraocular, Repair, and Plastic Eye Procedures	46	$10,019	$2,259
Level 3 Endovascular Procedures	44	$82,106	$10,419
Level 4 Vascular Procedures	42	$22,796	$5,312
Level 1 Breast/Lymphatic Surgery and Related Procedures	40	$21,998	$3,611

Against the Virginia average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Augusta Health charged $33,910 on average, 48% less than the Virginia average of $65,235, and was paid $16,092 against a state average of $16,367. For Heart Failure and Shock with MCC (DRG 291), Augusta Health charged $23,867 on average, 41% less than the Virginia average of $40,795, and was paid $10,349 against a state average of $11,030. For Simple Pneumonia and Pleurisy with CC (DRG 194), Augusta Health charged $17,644 on average, 40% less than the Virginia average of $29,342, and was paid $6,405 against a state average of $7,299. For Renal Failure with CC (DRG 683), Augusta Health charged $19,585 on average, 38% less than the Virginia average of $31,514, and was paid $6,983 against a state average of $7,782. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $9,413 was 20% below the state average of $11,766. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $13,154 was 33% below the state average of $19,506. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $79,526 was 5% below the state average of $83,920. For Level 1 Nerve Procedures (outpatient APC 5431), its average charge of $6,669 was 46% below the state average of $12,264.

Price-transparency record

CMS's enforcement list records these actions for a hospital named Augusta Health in Fishersville, VA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:

Warning Notice — 2024-02-09 (CMS case 1378)
CAP Request — 2024-05-16 (CMS case 1378)
Closure Notice — 2024-06-21 (CMS case 1378)

A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.

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.