California / Regional Medical Center of San Jose
CMS certification 050125 · San Jose, CA · 4 entries in CMS's price-transparency list
Regional Medical Center of San Jose: charges and Medicare payments
Regional Medical Center of San Jose reported 1,352 Medicare inpatient stays across 35 DRGs in 2024. Across them it charged 14.89 times what it was paid — among the higher ratios in California, number 2 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: 456 stays at an average charge of $358,489, 297% above the national average. It also billed 386 outpatient services, charging 24.84 times what Medicare paid.
- 1Medicare inpatient stays 1,352
- 2Charge ÷ paid, inpatient 14.89×
- 3Rank in CA (highest ratio = 1) 2 of 247
- 4CMS price-transparency actions 4
Inpatient stays
For the 35 DRGs that can be compared with the national average, Regional Medical Center of San Jose charged more than the national average in 35 (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 | 456 | $358,489 | +297% | $24,621 |
| 291 Heart Failure and Shock with MCC | 107 | $250,300 | +344% | $15,756 |
| 193 Simple Pneumonia and Pleurisy with MCC | 56 | $228,524 | +282% | $16,775 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 53 | $209,079 | +326% | $12,670 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 51 | $419,140 | +320% | $25,404 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 32 | $271,448 | +387% | $14,290 |
| 189 Pulmonary Edema and Respiratory Failure | 32 | $226,829 | +294% | $15,348 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 31 | $627,730 | +174% | $55,688 |
| 177 Respiratory Infections and Inflammations with MCC | 30 | $275,184 | +290% | $20,036 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 30 | $664,120 | +389% | $35,486 |
| 552 Medical Back Problems without MCC | 29 | $182,425 | +273% | $12,253 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 28 | $261,011 | +333% | $16,911 |
| 683 Renal Failure with CC | 28 | $157,802 | +288% | $12,272 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 27 | $287,730 | +279% | $18,590 |
| 312 Syncope and Collapse | 27 | $171,719 | +277% | $10,981 |
| 690 Kidney and Urinary Tract Infections without MCC | 27 | $163,766 | +333% | $10,291 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 25 | $232,112 | +216% | $19,335 |
| 682 Renal Failure with MCC | 22 | $181,641 | +175% | $17,313 |
| 481 Hip and Femur Procedures except Major Joint with CC | 19 | $434,926 | +332% | $25,009 |
| 069 Transient Ischemia without Thrombolytic | 18 | $199,463 | +295% | $10,760 |
| 389 Gastrointestinal Obstruction with CC | 18 | $141,523 | +264% | $10,284 |
| 638 Diabetes with CC | 18 | $181,704 | +336% | $11,322 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 18 | $145,195 | +292% | $9,659 |
| 101 Seizures without MCC | 17 | $185,937 | +281% | $11,634 |
| 689 Kidney and Urinary Tract Infections with MCC | 17 | $161,467 | +215% | $14,447 |
| 870 Septicemia or Severe Sepsis with MV >96 Hours | 17 | $1,167,753 | +261% | $68,511 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 16 | $168,041 | +365% | $9,576 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 15 | $163,415 | +307% | $10,155 |
| 884 Organic Disturbances and Intellectual Disability | 15 | $160,375 | +157% | $19,284 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 14 | $383,606 | +312% | $25,484 |
| 194 Simple Pneumonia and Pleurisy with CC | 13 | $161,184 | +320% | $10,565 |
| 100 Seizures with MCC | 12 | $419,856 | +345% | $28,403 |
| 896 Alcohol, Drug Abuse or Dependence without Rehabilitation... | 12 | $347,255 | +346% | $21,032 |
| 086 Traumatic Stupor and Coma <1 Hour with CC | 11 | $327,891 | +380% | $16,443 |
| 637 Diabetes with MCC | 11 | $243,900 | +267% | $16,284 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 1 Intraocular Procedures | 82 | $60,640 | $3,282 |
| Comprehensive Observation Services | 79 | $102,210 | $3,855 |
| Level 3 Vascular Procedures | 46 | $98,008 | $4,489 |
| Level 1 Endovascular Procedures | 46 | $136,110 | $4,528 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 33 | $56,250 | $4,001 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 22 | $47,189 | $2,283 |
| Level 3 Pacemaker and Similar Procedures | 21 | $185,319 | $15,010 |
| Level 4 Musculoskeletal Procedures | 16 | $155,771 | $10,066 |
| Level 3 Musculoskeletal Procedures | 15 | $78,386 | $4,316 |
| Level 2 Musculoskeletal Procedures | 13 | $45,186 | $2,264 |
| Level 5 Urology and Related Services | 13 | $135,664 | $7,286 |
Against the California average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Regional Medical Center of San Jose charged $358,489 on average, 151% more than the California average of $143,063, and was paid $24,621 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Regional Medical Center of San Jose charged $250,300 on average, 148% more than the California average of $100,739, and was paid $15,756 against a state average of $15,556. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Regional Medical Center of San Jose charged $228,524 on average, 120% more than the California average of $103,761, and was paid $16,775 against a state average of $15,112. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Regional Medical Center of San Jose charged $209,079 on average, 175% more than the California average of $76,120, and was paid $12,670 against a state average of $12,552. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $60,640 was 189% above the state average of $20,986. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $102,210 was 146% above the state average of $41,628. For Level 3 Vascular Procedures (outpatient APC 5183), its average charge of $98,008 was 225% above the state average of $30,190. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $136,110 was 236% above the state average of $40,544.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Regional Medical Center of San Jose in San Jose, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2023-07-12 (CMS case 300)
- Closure Notice — 2023-10-27 (CMS case 300)
- Warning Notice — 2025-04-14 (CMS case 3665)
- Closure Notice — 2025-06-27 (CMS case 3665)
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.