California / Adventist Health Simi Valley
CMS certification 050236 · Simi Valley, CA · 3 entries in CMS's price-transparency list
Adventist Health Simi Valley: charges and Medicare payments
Adventist Health Simi Valley reported 1,680 Medicare inpatient stays across 55 DRGs in 2024. Across them it charged 8.01 times what it was paid — among the higher ratios in California, number 39 of 247 hospitals with at least 100 stays (state median 5.18×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 270 stays at an average charge of $139,998, 55% above the national average. It also billed 1,026 outpatient services, charging 8.27 times what Medicare paid.
- 1Medicare inpatient stays 1,680
- 2Charge ÷ paid, inpatient 8.01×
- 3Rank in CA (highest ratio = 1) 39 of 247
- 4CMS price-transparency actions 3
Inpatient stays
For the 55 DRGs that can be compared with the national average, Adventist Health Simi Valley charged more than the national average in 55 (100%). 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 | 270 | $139,998 | +55% | $18,497 |
| 291 Heart Failure and Shock with MCC | 112 | $105,743 | +88% | $12,341 |
| 177 Respiratory Infections and Inflammations with MCC | 65 | $132,137 | +87% | $16,024 |
| 193 Simple Pneumonia and Pleurisy with MCC | 63 | $92,389 | +55% | $12,172 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 52 | $125,206 | +65% | $14,845 |
| 689 Kidney and Urinary Tract Infections with MCC | 52 | $93,869 | +83% | $10,371 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 52 | $75,657 | +54% | $9,418 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 48 | $104,267 | +106% | $10,388 |
| 552 Medical Back Problems without MCC | 46 | $98,524 | +102% | $10,178 |
| 189 Pulmonary Edema and Respiratory Failure | 41 | $104,543 | +82% | $11,677 |
| 690 Kidney and Urinary Tract Infections without MCC | 38 | $61,347 | +62% | $7,223 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 38 | $354,931 | +55% | $50,199 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 37 | $129,283 | +39% | $17,737 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 36 | $101,647 | +82% | $9,268 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 36 | $87,900 | +46% | $12,088 |
| 377 Gastrointestinal Hemorrhage with MCC | 32 | $144,004 | +69% | $18,142 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 32 | $66,106 | +65% | $8,041 |
| 682 Renal Failure with MCC | 31 | $116,200 | +76% | $13,424 |
| 683 Renal Failure with CC | 30 | $69,151 | +70% | $8,451 |
| 603 Cellulitis without MCC | 25 | $56,758 | +52% | $8,194 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 24 | $61,232 | +65% | $7,547 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 23 | $121,625 | +22% | $17,022 |
| 308 Cardiac Arrhythmia and Conduction Disorders with MCC | 23 | $102,506 | +81% | $11,397 |
| 378 Gastrointestinal Hemorrhage with CC | 23 | $74,120 | +53% | $9,228 |
| 312 Syncope and Collapse | 22 | $76,381 | +68% | $8,260 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 20 | $68,778 | +90% | $7,130 |
| 321 Percutaneous Cardiovascular Procedures with Intraluminal... | 20 | $232,541 | +42% | $26,866 |
| 310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC | 19 | $42,587 | +48% | $5,604 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 19 | $154,771 | +35% | $17,115 |
| 069 Transient Ischemia without Thrombolytic | 18 | $97,190 | +93% | $7,642 |
| 389 Gastrointestinal Obstruction with CC | 18 | $57,524 | +48% | $7,356 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 17 | $116,912 | +59% | $15,376 |
| 394 Other Digestive System Diagnoses with CC | 16 | $62,276 | +32% | $8,937 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 16 | $159,708 | +56% | $22,778 |
| 100 Seizures with MCC | 15 | $102,288 | +8% | $17,595 |
| 391 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 15 | $84,442 | +38% | $12,094 |
| 481 Hip and Femur Procedures except Major Joint with CC | 15 | $141,825 | +41% | $19,019 |
| 917 Poisoning and Toxic Effects of Drugs with MCC | 15 | $88,930 | +19% | $15,738 |
| 066 Intracranial Hemorrhage or Cerebral Infarction without... | 14 | $86,193 | +104% | $6,608 |
| 393 Other Digestive System Diagnoses with MCC | 14 | $93,858 | +22% | $14,882 |
| 202 Bronchitis and Asthma with CC/MCC | 13 | $88,031 | +91% | $9,140 |
| 281 Acute Myocardial Infarction, Discharged Alive with CC | 13 | $73,272 | +45% | $8,511 |
| 811 Red Blood Cell Disorders with MCC | 13 | $121,664 | +78% | $13,270 |
| 812 Red Blood Cell Disorders without MCC | 13 | $52,498 | +18% | $8,640 |
| 194 Simple Pneumonia and Pleurisy with CC | 12 | $93,096 | +143% | $7,859 |
| 287 Circulatory Disorders except AMI, with Cardiac... | 12 | $106,866 | +67% | $10,258 |
| 480 Hip and Femur Procedures except Major Joint with MCC | 12 | $221,402 | +60% | $27,045 |
| 602 Cellulitis with MCC | 12 | $110,890 | +84% | $13,610 |
| 638 Diabetes with CC | 12 | $59,870 | +44% | $8,614 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 11 | $189,720 | +40% | $25,349 |
| 286 Circulatory Disorders except AMI, with Cardiac... | 11 | $159,320 | +42% | $20,826 |
| 329 Major Small and Large Bowel Procedures with MCC | 11 | $270,011 | +26% | $37,861 |
| 536 Fractures of Hip and Pelvis without MCC | 11 | $57,859 | +54% | $7,190 |
| 660 Kidney and Ureter Procedures for Non-Neoplasm with CC | 11 | $95,090 | +41% | $12,353 |
| 854 Infectious and Parasitic Diseases with O.R. Procedures with... | 11 | $135,102 | +37% | $18,554 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 469 | $29,963 | $3,325 |
| Level 5 Musculoskeletal Procedures | 95 | $102,617 | $15,997 |
| Level 1 Laparoscopy and Related Services | 73 | $47,855 | $7,016 |
| Level 1 Endovascular Procedures | 69 | $30,087 | $3,972 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 61 | $5,426 | $1,961 |
| Level 4 Urology and Related Services | 42 | $28,384 | $4,286 |
| Level 2 Upper GI Procedures | 31 | $12,443 | $2,275 |
| Level 5 Urology and Related Services | 30 | $33,237 | $6,362 |
| Level 3 Electrophysiologic Procedures | 24 | $152,100 | $28,063 |
| Level 2 Laparoscopy and Related Services | 20 | $68,736 | $12,637 |
| Level 4 Musculoskeletal Procedures | 16 | $71,625 | $8,792 |
| Level 3 Endovascular Procedures | 16 | $93,008 | $13,503 |
| Level 2 Musculoskeletal Procedures | 15 | $14,773 | $1,871 |
| Level 2 Vascular Procedures | 15 | $29,103 | $1,799 |
| Level 3 Airway Endoscopy | 14 | $10,373 | $2,012 |
| Level 1 Breast/Lymphatic Surgery and Related Procedures | 13 | $23,912 | $4,686 |
| Level 3 Pacemaker and Similar Procedures | 12 | $75,544 | $13,108 |
| Level 2 Breast/Lymphatic Surgery and Related Procedures | 11 | $45,864 | $8,017 |
Against the California average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Adventist Health Simi Valley charged $139,998 on average, 2% less than the California average of $143,063, and was paid $18,497 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Adventist Health Simi Valley charged $105,743 on average, 5% more than the California average of $100,739, and was paid $12,341 against a state average of $15,556. For Respiratory Infections and Inflammations with MCC (DRG 177), Adventist Health Simi Valley charged $132,137 on average, 6% more than the California average of $124,302, and was paid $16,024 against a state average of $18,986. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Adventist Health Simi Valley charged $92,389 on average, 11% less than the California average of $103,761, and was paid $12,172 against a state average of $15,112. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $29,963 was 28% below the state average of $41,628. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $102,617 was 6% below the state average of $109,149. For Level 1 Laparoscopy and Related Services (outpatient APC 5361), its average charge of $47,855 was 26% below the state average of $64,351. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $30,087 was 26% below the state average of $40,544.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Adventist Health Simi Valley in Simi Valley, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2023-12-06 (CMS case 2105)
- Closure Notice — 2024-03-21 (CMS case 2105)
- Met Requirements — 2025-04-23 (CMS case 4080)
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.