Palomar Health Downtown Campus: charges and Medicare payments

Palomar Health Downtown Campus reported 2,878 Medicare inpatient stays across 80 DRGs in 2024. Across them it charged 10.08 times what it was paid — among the higher ratios in California, number 23 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: 342 stays at an average charge of $176,671, 96% above the national average. It also billed 1,431 outpatient services, charging 15.13 times what Medicare paid.

1Medicare inpatient stays 2,878
2Charge ÷ paid, inpatient 10.08×
3Rank in CA (highest ratio = 1) 23 of 247
4CMS price-transparency actions 0

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

Inpatient stays

For the 80 DRGs that can be compared with the national average, Palomar Health Downtown Campus charged more than the national average in 79 (99%). 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	342	$176,671	+96%	$17,030
291 Heart Failure and Shock with MCC	153	$105,283	+87%	$10,128
193 Simple Pneumonia and Pleurisy with MCC	122	$126,156	+111%	$11,223
177 Respiratory Infections and Inflammations with MCC	121	$145,166	+106%	$13,288
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	90	$100,072	+104%	$9,428
689 Kidney and Urinary Tract Infections with MCC	80	$98,168	+91%	$8,849
698 Other Kidney and Urinary Tract Diagnoses with MCC	78	$128,082	+74%	$12,817
690 Kidney and Urinary Tract Infections without MCC	75	$76,721	+103%	$6,665
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	66	$76,066	+89%	$7,431
481 Hip and Femur Procedures except Major Joint with CC	63	$158,564	+57%	$18,036
683 Renal Failure with CC	60	$77,559	+91%	$7,992
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	55	$115,411	+91%	$12,003
378 Gastrointestinal Hemorrhage with CC	52	$88,334	+82%	$7,530
322 Percutaneous Cardiovascular Procedures with Intraluminal...	51	$133,097	+16%	$15,153
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	48	$194,262	+95%	$17,532
853 Infectious and Parasitic Diseases with O.R. Procedures with...	45	$397,444	+74%	$46,062
552 Medical Back Problems without MCC	43	$134,214	+175%	$8,182
309 Cardiac Arrhythmia and Conduction Disorders with CC	40	$86,102	+138%	$6,527
603 Cellulitis without MCC	39	$67,263	+80%	$8,398
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	39	$73,554	+98%	$6,271
274 Percutaneous and Other Intracardiac Procedures without MCC	38	$171,492	+9%	$18,424
682 Renal Failure with MCC	38	$114,320	+73%	$11,311
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	37	$115,635	+108%	$8,735
455 Combined Anterior and Posterior Spinal Fusion without CC/MCC	37	$186,199	-8%	$25,204
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	36	$138,521	+35%	$16,292
190 Chronic Obstructive Pulmonary Disease with MCC	35	$94,195	+86%	$7,752
308 Cardiac Arrhythmia and Conduction Disorders with MCC	32	$109,833	+94%	$10,866
312 Syncope and Collapse	32	$89,092	+96%	$7,734
189 Pulmonary Edema and Respiratory Failure	31	$137,774	+139%	$9,176
194 Simple Pneumonia and Pleurisy with CC	31	$83,706	+118%	$8,238
493 Lower Extremity and Humerus Procedures except Hip, Foot and...	30	$185,184	+56%	$19,128
377 Gastrointestinal Hemorrhage with MCC	29	$145,941	+71%	$11,867
389 Gastrointestinal Obstruction with CC	29	$67,154	+73%	$6,407
208 Respiratory System Diagnosis with Ventilator Support <=96...	28	$285,097	+110%	$28,851
178 Respiratory Infections and Inflammations with CC	27	$100,169	+121%	$7,908
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	26	$87,448	+43%	$10,980
023 Craniotomy with Major Device Implant or Acute Complex Cns...	25	$395,457	+41%	$50,174
394 Other Digestive System Diagnoses with CC	24	$102,915	+119%	$8,107
482 Hip and Femur Procedures except Major Joint without CC/MCC	23	$117,198	+50%	$15,996
699 Other Kidney and Urinary Tract Diagnoses with CC	22	$108,764	+129%	$7,961
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	21	$112,914	+165%	$8,234
637 Diabetes with MCC	21	$105,611	+59%	$11,802
083 Traumatic Stupor and Coma >1 Hour with CC	20	$163,698	+123%	$12,729
280 Acute Myocardial Infarction, Discharged Alive with MCC	20	$162,011	+114%	$14,776
897 Alcohol, Drug Abuse or Dependence without Rehabilitation...	20	$113,234	+205%	$9,133
281 Acute Myocardial Infarction, Discharged Alive with CC	19	$99,998	+98%	$7,795
870 Septicemia or Severe Sepsis with MV >96 Hours	19	$474,543	+47%	$60,435
025 Craniotomy and Endovascular Intracranial Procedures with MCC	18	$352,248	+52%	$27,508
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	18	$146,487	+125%	$12,724
480 Hip and Femur Procedures except Major Joint with MCC	18	$205,147	+48%	$20,921
638 Diabetes with CC	18	$80,370	+93%	$8,934
086 Traumatic Stupor and Coma <1 Hour with CC	17	$216,593	+217%	$11,297
100 Seizures with MCC	17	$203,142	+115%	$17,487
321 Percutaneous Cardiovascular Procedures with Intraluminal...	17	$240,940	+47%	$24,354
602 Cellulitis with MCC	17	$93,560	+56%	$10,929
917 Poisoning and Toxic Effects of Drugs with MCC	17	$140,039	+87%	$15,347
057 Degenerative Nervous System Disorders without MCC	16	$123,877	+119%	$9,492
313 Chest Pain	16	$74,764	+87%	$7,212
330 Major Small and Large Bowel Procedures with CC	16	$248,756	+109%	$19,655
811 Red Blood Cell Disorders with MCC	15	$121,781	+79%	$9,350

Showing the 60 most frequent of 80 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	527	$51,028	$2,709
Level 5 Musculoskeletal Procedures	222	$88,607	$9,770
Level 1 Endovascular Procedures	59	$38,936	$2,891
Level 2 Excision/ Biopsy/ Incision and Drainage	55	$14,123	$1,309
Level 3 Electrophysiologic Procedures	50	$221,938	$17,022
Level 3 Vascular Procedures	49	$33,160	$3,093
Level 3 Urology and Related Services	47	$21,269	$2,080
Level 3 Endovascular Procedures	44	$86,381	$8,917
Level 2 Upper GI Procedures	43	$12,136	$1,906
Level 3 Pacemaker and Similar Procedures	42	$57,924	$8,742
Level 1 Laparoscopy and Related Services	32	$65,761	$4,627
Level 3 Excision/ Biopsy/ Incision and Drainage	30	$18,875	$2,196
Level 2 Laparoscopy and Related Services	30	$112,724	$9,337
Level 5 Urology and Related Services	29	$45,315	$4,439
Level 4 Vascular Procedures	25	$65,426	$6,326
Level 4 Musculoskeletal Procedures	23	$76,361	$6,302
Level 2 Musculoskeletal Procedures	21	$21,976	$1,755
Level 4 Airway Endoscopy	20	$46,816	$2,403
Level 4 Endovascular Procedures	17	$125,491	$13,321
Level 3 Musculoskeletal Procedures	16	$40,074	$2,791
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	14	$46,308	$2,077
Level 3 Airway Endoscopy	12	$15,293	$1,133
Level 2 Vascular Procedures	12	$13,084	$1,838
Level 4 Urology and Related Services	12	$47,968	$4,001

Against the California average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Palomar Health Downtown Campus charged $176,671 on average, 23% more than the California average of $143,063, and was paid $17,030 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Palomar Health Downtown Campus charged $105,283 on average, 5% more than the California average of $100,739, and was paid $10,128 against a state average of $15,556. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Palomar Health Downtown Campus charged $126,156 on average, 22% more than the California average of $103,761, and was paid $11,223 against a state average of $15,112. For Respiratory Infections and Inflammations with MCC (DRG 177), Palomar Health Downtown Campus charged $145,166 on average, 17% more than the California average of $124,302, and was paid $13,288 against a state average of $18,986. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $51,028 was 23% above the state average of $41,628. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $88,607 was 19% below the state average of $109,149. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $38,936 was 4% below the state average of $40,544. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $14,123 was 4% below the state average of $14,749.

Price-transparency record

No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.

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.