Regional Medical Center of San Jose
Regional Medical Center of San Jose, a federal government hospital in San Jose, CA, charges 17.0x the Medicare reimbursement rate across all 52 procedures analyzed.
San Jose, CA 95116 · Acute Care Hospitals · CMS Rating: 3/5
About the analyst
Priya Iyengar leads the billing code review team at BillRazor Research. She analyzes NCCI bundling edits, DRG coding, and regional rate variation. Expertise: NCCI bundling, DRG analysis, regional pricing.
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Billing patterns — government-federal
Federal Government Hospitals (VA/DoD) in our dataset show distinct billing patterns compared to other ownership types. These 14 facilities demonstrate an average markup of 4.1x Medicare rates, which falls within the mid-range compared to other hospital categories. VA and DoD hospitals typically operate under federal pricing structures that may differ significantly from private healthcare facilities. Patients should be aware that while these hospitals serve specific populations (veterans and military families), their charge patterns can still vary considerably from Medicare benchmarks. The billing structure at federal facilities often reflects government healthcare pricing models, which may include different cost accounting methods and reimbursement frameworks. Veterans eligible for VA care and military beneficiaries using DoD facilities should verify their coverage status and understand any potential differences between posted charges and their actual financial responsibility under federal healthcare programs.
Pricing grade
F
Very high
Avg markup vs Medicare
16.99x
Charge / Medicare rate
Max markup
25.2x
Worst procedure
Procedures analyzed
52
With pricing data
Outlier procedures
100%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $268,572 | $134,286 | — | 25.2x |
| TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC | 069 | $202,446 | $101,223 | — | 25.1x |
| CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC | 025 | $998,475 | $499,237 | — | 24.1x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $137,870 | $68,935 | — | 23.5x |
| TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC | 083 | $312,296 | $156,148 | — | 22.5x |
| TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC | 082 | $723,139 | $361,570 | — | 22.4x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $314,975 | $157,488 | — | 20.7x |
| SIMPLE PNEUMONIA AND PLEURISY WITH CC | 194 | $179,813 | $89,906 | — | 20.6x |
| SYNCOPE AND COLLAPSE | 312 | $183,415 | $91,708 | — | 20.2x |
| TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC | 086 | $267,787 | $133,893 | — | 19.9x |
| HYPERTENSION WITHOUT MCC | 305 | $159,128 | $79,564 | — | 19.7x |
| OTHER DISORDERS OF NERVOUS SYSTEM WITH CC | 092 | $211,412 | $105,706 | — | 19.5x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $174,047 | $87,024 | — | 19.3x |
| HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC | 521 | $703,196 | $351,598 | — | 19.1x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 064 | $406,652 | $203,326 | — | 18.9x |
| MEDICAL BACK PROBLEMS WITHOUT MCC | 552 | $202,280 | $101,140 | — | 18.7x |
| GASTROINTESTINAL OBSTRUCTION WITH CC | 389 | $159,575 | $79,787 | — | 18.6x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $269,928 | $134,964 | — | 18.3x |
| TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC | 605 | $184,726 | $92,363 | — | 17.7x |
| HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | 481 | $392,626 | $196,313 | — | 17.3x |
| INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC | 853 | $975,878 | $487,939 | — | 17.1x |
| RENAL FAILURE WITH CC | 683 | $171,336 | $85,668 | — | 17.1x |
| HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | 522 | $418,670 | $209,335 | — | 17x |
| DIABETES WITH MCC | 637 | $272,953 | $136,476 | — | 16.4x |
| OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC | 314 | $423,219 | $211,609 | — | 16.3x |
| DIABETES WITH CC | 638 | $159,874 | $79,937 | — | 16.2x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | 641 | $138,048 | $69,024 | — | 16.2x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $185,540 | $92,770 | — | 16.1x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $229,939 | $114,970 | — | 15.9x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | 280 | $281,608 | $140,804 | — | 15.8x |
| CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC O | 023 | $1,029,642 | $514,821 | — | 15.6x |
| RENAL FAILURE WITH MCC | 682 | $263,334 | $131,667 | — | 15.5x |
| SEIZURES WITHOUT MCC | 101 | $156,095 | $78,047 | — | 15.3x |
| KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | 690 | $138,893 | $69,447 | — | 15.2x |
| SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS | 870 | $1,128,445 | $564,222 | — | 14.9x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | 871 | $332,332 | $166,166 | — | 14.8x |
| MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | 470 | $295,463 | $147,731 | — | 14.8x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $206,035 | $103,018 | — | 14.6x |
| SEIZURES WITH MCC | 100 | $300,857 | $150,428 | — | 14.5x |
| KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 689 | $197,261 | $98,631 | — | 14.3x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $118,319 | $59,160 | — | 14.3x |
| RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS | 208 | $438,680 | $219,340 | — | 14.1x |
| OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | 394 | $148,779 | $74,389 | — | 14.1x |
| GASTROINTESTINAL HEMORRHAGE WITH MCC | 377 | $264,036 | $132,018 | — | 13.8x |
| OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC | 699 | $163,777 | $81,889 | — | 13.7x |
| RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | 177 | $308,572 | $154,286 | — | 13.5x |
| RED BLOOD CELL DISORDERS WITH MCC | 811 | $212,008 | $106,004 | — | 13.3x |
| OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC | 270 | $676,838 | $338,419 | — | 13.2x |
| ENDOCRINE DISORDERS WITH MCC | 643 | $242,932 | $121,466 | — | 13x |
| PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC | 243 | $330,260 | $165,130 | — | 12.6x |
Showing 50 of 52 procedures
How REGIONAL MEDICAL CENTER OF SAN JOSE compares to nearby hospitals
Comparison based on average markup ratios from federal hospital pricing data (FY 2024). Chargemaster rates are gross charges — they are not what most insured patients pay. Actual costs depend on your insurance plan, negotiated rates, and coverage terms. This comparison is for informational purposes only and does not constitute medical, financial, or legal advice. Verify costs directly with your provider and insurer.
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
FAQ — government-federal hospital billing
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use