California / Mercy San Juan Medical Center
CMS certification 050516 · Carmichael, CA · 2 entries in CMS's price-transparency list
Mercy San Juan Medical Center: charges and Medicare payments
Mercy San Juan Medical Center reported 3,432 Medicare inpatient stays across 100 DRGs in 2024. Across them it charged 6.53 times what it was paid — among the higher ratios in California, number 72 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: 400 stays at an average charge of $121,886, 35% above the national average. It also billed 1,771 outpatient services, charging 9.56 times what Medicare paid.
- 1Medicare inpatient stays 3,432
- 2Charge ÷ paid, inpatient 6.53×
- 3Rank in CA (highest ratio = 1) 72 of 247
- 4CMS price-transparency actions 2
Inpatient stays
For the 100 DRGs that can be compared with the national average, Mercy San Juan Medical Center charged more than the national average in 97 (97%). 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 | 400 | $121,886 | +35% | $20,997 |
| 291 Heart Failure and Shock with MCC | 242 | $86,958 | +54% | $13,990 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 108 | $161,122 | +61% | $21,920 |
| 193 Simple Pneumonia and Pleurisy with MCC | 106 | $102,850 | +72% | $13,902 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 78 | $110,788 | +99% | $11,216 |
| 177 Respiratory Infections and Inflammations with MCC | 78 | $107,052 | +52% | $17,569 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 76 | $72,153 | +47% | $11,337 |
| 690 Kidney and Urinary Tract Infections without MCC | 75 | $58,198 | +54% | $8,929 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 73 | $98,645 | +95% | $12,191 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 70 | $81,022 | +10% | $17,161 |
| 689 Kidney and Urinary Tract Infections with MCC | 68 | $89,827 | +75% | $13,214 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 62 | $107,220 | +41% | $16,431 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 60 | $62,155 | +55% | $8,755 |
| 682 Renal Failure with MCC | 60 | $117,281 | +78% | $16,711 |
| 189 Pulmonary Edema and Respiratory Failure | 56 | $74,309 | +29% | $13,404 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 52 | $111,658 | +85% | $13,525 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 52 | $358,218 | +56% | $53,209 |
| 603 Cellulitis without MCC | 50 | $52,022 | +40% | $9,787 |
| 378 Gastrointestinal Hemorrhage with CC | 48 | $75,007 | +54% | $10,821 |
| 377 Gastrointestinal Hemorrhage with MCC | 47 | $137,515 | +61% | $21,013 |
| 683 Renal Failure with CC | 47 | $68,765 | +69% | $9,879 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 38 | $229,817 | +69% | $28,896 |
| 308 Cardiac Arrhythmia and Conduction Disorders with MCC | 37 | $103,180 | +82% | $12,872 |
| 312 Syncope and Collapse | 37 | $73,726 | +62% | $9,580 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 36 | $57,347 | +59% | $8,650 |
| 481 Hip and Femur Procedures except Major Joint with CC | 35 | $153,815 | +53% | $21,877 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 35 | $60,771 | +64% | $8,688 |
| 637 Diabetes with MCC | 33 | $95,745 | +44% | $18,835 |
| 100 Seizures with MCC | 31 | $202,906 | +115% | $21,953 |
| 025 Craniotomy and Endovascular Intracranial Procedures with MCC | 30 | $248,007 | +7% | $45,082 |
| 552 Medical Back Problems without MCC | 30 | $84,163 | +72% | $10,332 |
| 699 Other Kidney and Urinary Tract Diagnoses with CC | 30 | $71,915 | +51% | $10,932 |
| 389 Gastrointestinal Obstruction with CC | 27 | $61,534 | +58% | $8,795 |
| 321 Percutaneous Cardiovascular Procedures with Intraluminal... | 26 | $238,973 | +46% | $42,894 |
| 391 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 26 | $91,265 | +50% | $13,864 |
| 445 Disorders of The Biliary Tract with CC | 26 | $86,902 | +49% | $11,854 |
| 286 Circulatory Disorders except AMI, with Cardiac... | 25 | $139,276 | +24% | $22,975 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 24 | $149,884 | +46% | $22,896 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 23 | $147,072 | +58% | $20,087 |
| 638 Diabetes with CC | 23 | $62,408 | +50% | $9,999 |
| 897 Alcohol, Drug Abuse or Dependence without Rehabilitation... | 23 | $72,331 | +95% | $9,480 |
| 066 Intracranial Hemorrhage or Cerebral Infarction without... | 22 | $66,331 | +57% | $7,785 |
| 101 Seizures without MCC | 22 | $81,125 | +66% | $10,095 |
| 194 Simple Pneumonia and Pleurisy with CC | 22 | $65,533 | +71% | $10,882 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 22 | $159,511 | +39% | $27,579 |
| 811 Red Blood Cell Disorders with MCC | 22 | $89,657 | +32% | $15,151 |
| 023 Craniotomy with Major Device Implant or Acute Complex Cns... | 21 | $283,361 | +1% | $53,616 |
| 184 Major Chest Trauma with CC | 21 | $137,252 | +147% | $11,557 |
| 305 Hypertension without MCC | 21 | $62,821 | +57% | $8,421 |
| 394 Other Digestive System Diagnoses with CC | 21 | $92,081 | +96% | $13,609 |
| 617 Amputation of Lower Limb for Endocrine, Nutritional and... | 21 | $112,441 | +29% | $20,671 |
| 069 Transient Ischemia without Thrombolytic | 20 | $70,149 | +39% | $8,925 |
| 314 Other Circulatory System Diagnoses with MCC | 20 | $137,403 | +45% | $20,004 |
| 472 Cervical Spinal Fusion with CC | 20 | $158,305 | +11% | $36,812 |
| 252 Other Vascular Procedures with MCC | 19 | $170,865 | 0% | $34,265 |
| 287 Circulatory Disorders except AMI, with Cardiac... | 19 | $97,346 | +52% | $11,861 |
| 070 Other Cerebrovascular Disorders with MCC | 18 | $127,823 | +68% | $18,943 |
| 444 Disorders of The Biliary Tract with MCC | 18 | $92,370 | +11% | $17,240 |
| 480 Hip and Femur Procedures except Major Joint with MCC | 18 | $218,985 | +58% | $31,021 |
| 086 Traumatic Stupor and Coma <1 Hour with CC | 17 | $75,671 | +11% | $17,209 |
Showing the 60 most frequent of 100 DRGs.
Outpatient services
Against the California average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Mercy San Juan Medical Center charged $121,886 on average, 15% less than the California average of $143,063, and was paid $20,997 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Mercy San Juan Medical Center charged $86,958 on average, 14% less than the California average of $100,739, and was paid $13,990 against a state average of $15,556. For Intracranial Hemorrhage or Cerebral Infarction with MCC (DRG 064), Mercy San Juan Medical Center charged $161,122 on average, 8% less than the California average of $174,368, and was paid $21,920 against a state average of $24,500. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Mercy San Juan Medical Center charged $102,850 on average, 1% less than the California average of $103,761, and was paid $13,902 against a state average of $15,112. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $36,639 was 12% below the state average of $41,628. For Level 3 Vascular Procedures (outpatient APC 5183), its average charge of $25,802 was 15% below the state average of $30,190. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $53,700 was 32% above the state average of $40,544. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $119,777 was 10% above the state average of $109,149.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Mercy San Juan Medical Center in Carmichael, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2024-02-05 (CMS case 595)
- Met Requirements — 2025-06-09 (CMS case 4996)
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.