Colorado / Vail Health Hospital
CMS certification 060096 · Vail, CO · 1 entry in CMS's price-transparency list
Vail Health Hospital: charges and Medicare payments
Vail Health Hospital reported 90 Medicare inpatient stays across 5 DRGs in 2024. Across them it charged 1.99 times what it was paid. Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 27 stays at an average charge of $46,631, 48% below the national average. It also billed 1,375 outpatient services, charging 4.72 times what Medicare paid.
- 1Medicare inpatient stays 90
- 2Charge ÷ paid, inpatient 1.99×
- 3Rank in CO (highest ratio = 1) –
- 4CMS price-transparency actions 1
Inpatient stays
For the 5 DRGs that can be compared with the national average, Vail Health Hospital charged more than the national average in 1 (20%). 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 | 27 | $46,631 | -48% | $33,013 |
| 455 Combined Anterior and Posterior Spinal Fusion without CC/MCC | 17 | $211,059 | +4% | $84,869 |
| 193 Simple Pneumonia and Pleurisy with MCC | 16 | $41,277 | -31% | $22,209 |
| 468 Revision of Hip or Knee Replacement without CC/MCC | 15 | $72,634 | -41% | $44,449 |
| 483 Major Joint or Limb Reattachment Procedures of Upper... | 15 | $88,553 | -30% | $41,357 |
Outpatient services
Against the Colorado average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Vail Health Hospital charged $46,631 on average, 59% less than the Colorado average of $113,091, and was paid $33,013 against a state average of $16,848. For Combined Anterior and Posterior Spinal Fusion without CC/MCC (DRG 455), Vail Health Hospital charged $211,059 on average, 25% less than the Colorado average of $281,308, and was paid $84,869 against a state average of $41,656. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Vail Health Hospital charged $41,277 on average, 40% less than the Colorado average of $68,465, and was paid $22,209 against a state average of $11,488. For Revision of Hip or Knee Replacement without CC/MCC (DRG 468), Vail Health Hospital charged $72,634 on average, 58% less than the Colorado average of $172,248, and was paid $44,449 against a state average of $23,721. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $51,005 was 43% below the state average of $89,547. For Level 6 Musculoskeletal Procedures (outpatient APC 5116), its average charge of $74,501 was 35% below the state average of $114,973. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $40,189 was 33% below the state average of $59,796. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $16,791 was 51% below the state average of $34,074.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Vail Health Hospital in Vail, CO, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2026-04-29 (CMS case 7653)
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.