Santa Clara Valley Medical Center
Santa Clara Valley Medical Center in San Jose charges 5.4x the Medicare reimbursement rate on average, with 62% of its 104 analyzed procedures showing significant price variations.
San Jose, CA 95128 · 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
Government hospitals in our dataset demonstrate distinct billing patterns compared to other ownership types. With 374 facilities analyzed, these hospitals show an average markup of 4.2x Medicare rates, which typically falls below the industry average for comparable services. Government hospitals often maintain more standardized pricing structures due to regulatory oversight and public accountability requirements. Patients may encounter charges above the benchmark for certain procedures, though the potential difference between government hospital billing and private facilities can vary significantly by service type and geographic region. Common charge patterns include transparent itemization of services and adherence to established fee schedules. Patients should be aware that government hospitals frequently offer financial assistance programs and sliding scale payment options based on income eligibility. These facilities often provide detailed cost estimates upon request and maintain patient financial counselors to discuss billing arrangements before treatment when possible.
Pricing grade
D
High
Avg markup vs Medicare
5.41x
Charge / Medicare rate
Max markup
10.26x
Worst procedure
Procedures analyzed
104
With pricing data
Outlier procedures
61.5%
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 |
|---|---|---|---|---|---|
| PSYCHOSES | 885 | $160,327 | $80,164 | — | 10.3x |
| PNEUMOTHORAX WITH CC | 200 | $136,046 | $68,023 | — | 8x |
| DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC | 057 | $153,666 | $76,833 | — | 7.7x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $65,552 | $32,776 | — | 7.5x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | 641 | $84,763 | $42,382 | — | 7.1x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $190,004 | $95,002 | — | 6.8x |
| RESPIRATORY NEOPLASMS WITH MCC | 180 | $219,629 | $109,814 | — | 6.8x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | 308 | $142,700 | $71,350 | — | 6.7x |
| CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC | 433 | $110,658 | $55,329 | — | 6.6x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $88,186 | $44,093 | — | 6.6x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $90,108 | $45,054 | — | 6.6x |
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | 190 | $118,101 | $59,051 | — | 6.5x |
| DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC | 056 | $192,887 | $96,443 | — | 6.4x |
| PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE | 175 | $146,206 | $73,103 | — | 6.4x |
| ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC | 897 | $83,087 | $41,543 | — | 6.3x |
| OTHER DISORDERS OF NERVOUS SYSTEM WITH CC | 092 | $114,142 | $57,071 | — | 6.3x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | 066 | $65,764 | $32,882 | — | 6.2x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $73,520 | $36,760 | — | 6.2x |
| RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC | 178 | $108,923 | $54,462 | — | 6.1x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | 286 | $277,083 | $138,542 | — | 6.1x |
| HEART FAILURE AND SHOCK WITH CC | 292 | $77,958 | $38,979 | — | 6x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $69,627 | $34,814 | — | 6x |
| NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC | 070 | $152,881 | $76,440 | — | 6x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $92,456 | $46,228 | — | 6x |
| ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY | 884 | $143,367 | $71,683 | — | 5.9x |
| NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC | 071 | $81,517 | $40,759 | — | 5.9x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $110,489 | $55,244 | — | 5.8x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | 280 | $137,653 | $68,826 | — | 5.8x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $138,839 | $69,420 | — | 5.8x |
| DIABETES WITH CC | 638 | $94,472 | $47,236 | — | 5.8x |
| MEDICAL BACK PROBLEMS WITHOUT MCC | 552 | $80,269 | $40,135 | — | 5.7x |
| GASTROINTESTINAL OBSTRUCTION WITH CC | 389 | $66,503 | $33,251 | — | 5.7x |
| BRONCHITIS AND ASTHMA WITH CC/MCC | 202 | $80,164 | $40,082 | — | 5.7x |
| ENDOCRINE DISORDERS WITH CC | 644 | $86,661 | $43,331 | — | 5.7x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $138,678 | $69,339 | — | 5.7x |
| RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS | 208 | $311,178 | $155,589 | — | 5.6x |
| OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | 394 | $82,207 | $41,104 | — | 5.6x |
| MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC | 435 | $215,396 | $107,698 | — | 5.5x |
| GASTROINTESTINAL OBSTRUCTION WITH MCC | 388 | $149,968 | $74,984 | — | 5.5x |
| ENDOCRINE DISORDERS WITH MCC | 643 | $119,477 | $59,738 | — | 5.5x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $82,236 | $41,118 | — | 5.5x |
| OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC | 314 | $185,253 | $92,627 | — | 5.5x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES O | 246 | $268,602 | $134,301 | — | 5.5x |
| LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | 418 | $134,855 | $67,427 | — | 5.5x |
| RED BLOOD CELL DISORDERS WITHOUT MCC | 812 | $73,080 | $36,540 | — | 5.4x |
| KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | 690 | $66,703 | $33,351 | — | 5.4x |
| TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC | 084 | $73,668 | $36,834 | — | 5.4x |
| RENAL FAILURE WITH CC | 683 | $69,971 | $34,986 | — | 5.4x |
| CELLULITIS WITHOUT MCC | 603 | $83,665 | $41,832 | — | 5.4x |
| POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC | 917 | $133,970 | $66,985 | — | 5.4x |
Showing 50 of 104 procedures
How SANTA CLARA VALLEY MEDICAL CENTER 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 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