California / Santa Clara Valley Medical Center
CMS certification 050038 · San Jose, CA · 5 entries in CMS's price-transparency list
Santa Clara Valley Medical Center: charges and Medicare payments
Santa Clara Valley Medical Center reported 4,108 Medicare inpatient stays across 114 DRGs in 2024. Across them it charged 4.87 times what it was paid — mid-range in California, number 140 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: 654 stays at an average charge of $177,462, 97% above the national average. It also billed 2,211 outpatient services, charging 7.14 times what Medicare paid.
- 1Medicare inpatient stays 4,108
- 2Charge ÷ paid, inpatient 4.87×
- 3Rank in CA (highest ratio = 1) 140 of 247
- 4CMS price-transparency actions 5
Inpatient stays
For the 114 DRGs that can be compared with the national average, Santa Clara Valley Medical Center charged more than the national average in 112 (98%). 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 | 654 | $177,462 | +97% | $35,210 |
| 291 Heart Failure and Shock with MCC | 285 | $114,368 | +103% | $22,182 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 137 | $81,150 | +65% | $17,251 |
| 177 Respiratory Infections and Inflammations with MCC | 105 | $139,298 | +97% | $30,067 |
| 193 Simple Pneumonia and Pleurisy with MCC | 93 | $134,256 | +125% | $24,599 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 84 | $103,855 | +72% | $21,641 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 82 | $516,081 | +125% | $122,949 |
| 690 Kidney and Urinary Tract Infections without MCC | 76 | $62,359 | +65% | $13,942 |
| 189 Pulmonary Edema and Respiratory Failure | 72 | $164,856 | +186% | $26,671 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 69 | $159,760 | +118% | $32,032 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 67 | $73,955 | +100% | $13,849 |
| 683 Renal Failure with CC | 65 | $76,563 | +88% | $15,597 |
| 312 Syncope and Collapse | 62 | $72,816 | +60% | $15,516 |
| 870 Septicemia or Severe Sepsis with MV >96 Hours | 58 | $659,122 | +104% | $140,739 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 55 | $119,092 | +114% | $18,742 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 54 | $172,116 | +72% | $31,871 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 53 | $118,284 | +134% | $18,952 |
| 378 Gastrointestinal Hemorrhage with CC | 52 | $70,145 | +44% | $16,362 |
| 481 Hip and Femur Procedures except Major Joint with CC | 51 | $143,760 | +43% | $30,407 |
| 603 Cellulitis without MCC | 50 | $67,543 | +81% | $16,428 |
| 689 Kidney and Urinary Tract Infections with MCC | 50 | $111,548 | +117% | $22,965 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 48 | $72,688 | +101% | $13,484 |
| 377 Gastrointestinal Hemorrhage with MCC | 47 | $149,418 | +75% | $30,961 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 44 | $63,509 | +58% | $14,109 |
| 638 Diabetes with CC | 43 | $72,417 | +74% | $15,784 |
| 308 Cardiac Arrhythmia and Conduction Disorders with MCC | 41 | $129,415 | +129% | $21,454 |
| 682 Renal Failure with MCC | 40 | $144,981 | +120% | $26,710 |
| 314 Other Circulatory System Diagnoses with MCC | 37 | $184,601 | +95% | $38,380 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 36 | $165,490 | +118% | $29,065 |
| 699 Other Kidney and Urinary Tract Diagnoses with CC | 34 | $83,845 | +77% | $18,705 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 32 | $319,542 | +135% | $60,118 |
| 178 Respiratory Infections and Inflammations with CC | 28 | $72,655 | +60% | $16,433 |
| 552 Medical Back Problems without MCC | 28 | $71,018 | +45% | $16,626 |
| 854 Infectious and Parasitic Diseases with O.R. Procedures with... | 28 | $193,347 | +97% | $41,059 |
| 069 Transient Ischemia without Thrombolytic | 27 | $70,898 | +41% | $14,259 |
| 884 Organic Disturbances and Intellectual Disability | 27 | $94,184 | +51% | $22,713 |
| 101 Seizures without MCC | 26 | $68,070 | +40% | $15,243 |
| 389 Gastrointestinal Obstruction with CC | 26 | $51,385 | +32% | $13,898 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 26 | $133,438 | +30% | $31,519 |
| 563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,... | 25 | $67,677 | +59% | $14,861 |
| 083 Traumatic Stupor and Coma >1 Hour with CC | 24 | $95,830 | +31% | $21,896 |
| 194 Simple Pneumonia and Pleurisy with CC | 24 | $80,564 | +110% | $14,903 |
| 394 Other Digestive System Diagnoses with CC | 24 | $76,645 | +63% | $16,297 |
| 812 Red Blood Cell Disorders without MCC | 24 | $69,991 | +58% | $15,760 |
| 057 Degenerative Nervous System Disorders without MCC | 23 | $158,256 | +179% | $29,602 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 23 | $184,093 | +61% | $28,464 |
| 070 Other Cerebrovascular Disorders with MCC | 22 | $162,951 | +114% | $30,204 |
| 372 Major Gastrointestinal Disorders and Peritoneal Infections... | 22 | $89,252 | +88% | $18,762 |
| 813 Coagulation Disorders | 22 | $96,244 | +20% | $24,359 |
| 919 Complications of Treatment with MCC | 22 | $136,695 | +54% | $32,234 |
| 092 Other Disorders of Nervous System with CC | 21 | $66,524 | +29% | $16,237 |
| 184 Major Chest Trauma with CC | 21 | $74,768 | +35% | $17,705 |
| 252 Other Vascular Procedures with MCC | 21 | $274,883 | +61% | $60,529 |
| 175 Pulmonary Embolism with MCC or Acute Cor Pulmonale | 20 | $148,453 | +128% | $23,323 |
| 191 Chronic Obstructive Pulmonary Disease with CC | 20 | $82,678 | +109% | $13,897 |
| 202 Bronchitis and Asthma with CC/MCC | 20 | $94,082 | +104% | $15,543 |
| 391 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 19 | $119,526 | +96% | $28,419 |
| 480 Hip and Femur Procedures except Major Joint with MCC | 19 | $247,491 | +78% | $48,955 |
| 605 Trauma To The Skin, Subcutaneous Tissue and Breast without... | 19 | $71,942 | +55% | $15,186 |
| 071 Other Cerebrovascular Disorders with CC | 18 | $130,187 | +158% | $25,779 |
Showing the 60 most frequent of 114 DRGs.
Outpatient services
Against the California average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Santa Clara Valley Medical Center charged $177,462 on average, 24% more than the California average of $143,063, and was paid $35,210 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Santa Clara Valley Medical Center charged $114,368 on average, 14% more than the California average of $100,739, and was paid $22,182 against a state average of $15,556. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Santa Clara Valley Medical Center charged $81,150 on average, 7% more than the California average of $76,120, and was paid $17,251 against a state average of $12,552. For Respiratory Infections and Inflammations with MCC (DRG 177), Santa Clara Valley Medical Center charged $139,298 on average, 12% more than the California average of $124,302, and was paid $30,067 against a state average of $18,986. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $29,327 was 30% below the state average of $41,628. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $13,582 was 8% below the state average of $14,749. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $17,771 was 15% below the state average of $20,986. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $4,516 was 7% below the state average of $4,853.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Santa Clara Valley Medical Center 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 — 2023-04-14 (CMS case 968)
- Closure Notice — 2023-08-01 (CMS case 968)
- Warning Notice — 2025-03-26 (CMS case 3117)
- Closure Notice — 2025-06-27 (CMS case 3117)
- Warning Notice — 2026-06-08 (CMS case 7972)
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.