California / Ahmc Seton Medical Center
CMS certification 050289 · Daly City, CA · 4 entries in CMS's price-transparency list
Ahmc Seton Medical Center: charges and Medicare payments
Ahmc Seton Medical Center reported 258 Medicare inpatient stays across 11 DRGs in 2024. Across them it charged 6.77 times what it was paid — among the higher ratios in California, number 62 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: 100 stays at an average charge of $153,282, 70% above the national average. It also billed 551 outpatient services, charging 8.13 times what Medicare paid.
- 1Medicare inpatient stays 258
- 2Charge ÷ paid, inpatient 6.77×
- 3Rank in CA (highest ratio = 1) 62 of 247
- 4CMS price-transparency actions 4
Inpatient stays
For the 11 DRGs that can be compared with the national average, Ahmc Seton Medical Center charged more than the national average in 11 (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 | 100 | $153,282 | +70% | $21,838 |
| 291 Heart Failure and Shock with MCC | 22 | $108,262 | +92% | $14,854 |
| 177 Respiratory Infections and Inflammations with MCC | 19 | $121,166 | +72% | $17,969 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 18 | $106,982 | +41% | $17,234 |
| 682 Renal Failure with MCC | 18 | $99,201 | +50% | $16,209 |
| 193 Simple Pneumonia and Pleurisy with MCC | 15 | $88,196 | +48% | $15,341 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 15 | $384,011 | +68% | $55,915 |
| 377 Gastrointestinal Hemorrhage with MCC | 14 | $101,270 | +19% | $18,676 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 14 | $84,189 | +72% | $11,576 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 12 | $239,144 | +76% | $30,709 |
| 689 Kidney and Urinary Tract Infections with MCC | 11 | $64,149 | +25% | $13,430 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 1 Intraocular Procedures | 302 | $20,202 | $3,315 |
| Comprehensive Observation Services | 105 | $45,167 | $3,913 |
| Level 3 Electrophysiologic Procedures | 32 | $196,888 | $33,844 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 27 | $22,928 | $2,318 |
| Level 2 Upper GI Procedures | 26 | $28,342 | $2,664 |
| Level 3 Endovascular Procedures | 21 | $101,628 | $15,694 |
| Level 1 Endovascular Procedures | 15 | $31,926 | $4,665 |
| Level 2 Endovascular Procedures | 12 | $47,253 | $8,170 |
| Level 3 Vascular Procedures | 11 | $36,430 | $4,142 |
Against the California average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Ahmc Seton Medical Center charged $153,282 on average, 7% more than the California average of $143,063, and was paid $21,838 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Ahmc Seton Medical Center charged $108,262 on average, 7% more than the California average of $100,739, and was paid $14,854 against a state average of $15,556. For Respiratory Infections and Inflammations with MCC (DRG 177), Ahmc Seton Medical Center charged $121,166 on average, 3% less than the California average of $124,302, and was paid $17,969 against a state average of $18,986. For Acute Myocardial Infarction, Discharged Alive with MCC (DRG 280), Ahmc Seton Medical Center charged $106,982 on average, 14% less than the California average of $123,896, and was paid $17,234 against a state average of $19,122. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $20,202 was 4% below the state average of $20,986. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $45,167 was 9% above the state average of $41,628. For Level 3 Electrophysiologic Procedures (outpatient APC 5213), its average charge of $196,888 was 4% below the state average of $205,167. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $22,928 was 55% above the state average of $14,749.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Ahmc Seton Medical Center in Daly City, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- CAP Request — 2023-06-05 (CMS case 1627)
- Closure Notice — 2023-09-28 (CMS case 1627)
- Warning Notice — 2026-04-08 (CMS case 7387)
- Closure Notice — 2026-07-13 (CMS case 7387)
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.