California / Northbay Medical Center

CMS certification 050367 · Fairfield, CA · 4 entries in CMS's price-transparency list

Northbay Medical Center: charges and Medicare payments

Northbay Medical Center reported 2,456 Medicare inpatient stays across 75 DRGs in 2024. Across them it charged 10.28 times what it was paid — among the higher ratios in California, number 21 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: 419 stays at an average charge of $232,743, 158% above the national average. It also billed 1,737 outpatient services, charging 18.35 times what Medicare paid.

1Medicare inpatient stays 2,456
2Charge ÷ paid, inpatient 10.28×
3Rank in CA (highest ratio = 1) 21 of 247
4CMS price-transparency actions 4

Average charge per stay at Northbay Medical Center, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 75 DRGs that can be compared with the national average, Northbay Medical Center charged more than the national average in 75 (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	419	$232,743	+158%	$23,658
291 Heart Failure and Shock with MCC	165	$161,065	+186%	$15,080
193 Simple Pneumonia and Pleurisy with MCC	96	$167,010	+179%	$15,481
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	74	$139,375	+184%	$12,778
177 Respiratory Infections and Inflammations with MCC	70	$212,725	+201%	$19,666
689 Kidney and Urinary Tract Infections with MCC	64	$113,937	+122%	$13,924
280 Acute Myocardial Infarction, Discharged Alive with MCC	63	$192,633	+154%	$19,152
190 Chronic Obstructive Pulmonary Disease with MCC	49	$159,767	+216%	$14,472
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	48	$188,237	+88%	$31,191
853 Infectious and Parasitic Diseases with O.R. Procedures with...	47	$675,275	+195%	$59,256
189 Pulmonary Edema and Respiratory Failure	46	$154,986	+169%	$15,106
378 Gastrointestinal Hemorrhage with CC	45	$139,010	+186%	$11,933
481 Hip and Femur Procedures except Major Joint with CC	45	$321,814	+219%	$24,654
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	44	$123,446	+122%	$12,334
377 Gastrointestinal Hemorrhage with MCC	40	$222,473	+161%	$21,119
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	39	$103,896	+159%	$9,775
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	39	$160,962	+167%	$16,710
690 Kidney and Urinary Tract Infections without MCC	39	$101,164	+167%	$9,792
603 Cellulitis without MCC	38	$90,747	+143%	$10,798
389 Gastrointestinal Obstruction with CC	37	$111,671	+187%	$9,941
698 Other Kidney and Urinary Tract Diagnoses with MCC	35	$192,442	+162%	$19,361
100 Seizures with MCC	34	$221,547	+135%	$23,159
309 Cardiac Arrhythmia and Conduction Disorders with CC	34	$98,309	+172%	$9,271
312 Syncope and Collapse	33	$108,279	+138%	$10,706
322 Percutaneous Cardiovascular Procedures with Intraluminal...	32	$466,555	+307%	$22,067
682 Renal Failure with MCC	31	$175,912	+167%	$17,989
683 Renal Failure with CC	28	$135,401	+233%	$11,104
329 Major Small and Large Bowel Procedures with MCC	24	$840,441	+291%	$74,615
812 Red Blood Cell Disorders without MCC	23	$160,008	+260%	$11,189
281 Acute Myocardial Infarction, Discharged Alive with CC	22	$140,450	+178%	$11,054
552 Medical Back Problems without MCC	21	$118,166	+142%	$11,866
194 Simple Pneumonia and Pleurisy with CC	19	$123,119	+221%	$10,065
208 Respiratory System Diagnosis with Ventilator Support <=96...	19	$366,513	+170%	$32,534
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	19	$155,507	+155%	$15,633
870 Septicemia or Severe Sepsis with MV >96 Hours	19	$1,098,893	+240%	$147,031
025 Craniotomy and Endovascular Intracranial Procedures with MCC	18	$587,290	+154%	$56,895
308 Cardiac Arrhythmia and Conduction Disorders with MCC	18	$187,004	+230%	$17,065
638 Diabetes with CC	18	$119,401	+187%	$10,973
069 Transient Ischemia without Thrombolytic	17	$131,429	+161%	$9,910
070 Other Cerebrovascular Disorders with MCC	17	$184,937	+143%	$20,920
388 Gastrointestinal Obstruction with MCC	17	$151,171	+121%	$16,672
418 Laparoscopic Cholecystectomy without C.D.E. with CC	17	$379,555	+307%	$22,911
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	17	$117,815	+218%	$9,439
101 Seizures without MCC	16	$129,204	+165%	$11,080
286 Circulatory Disorders except AMI, with Cardiac...	16	$280,211	+150%	$26,145
314 Other Circulatory System Diagnoses with MCC	16	$186,892	+97%	$24,819
074 Cranial and Peripheral Nerve Disorders without MCC	15	$122,223	+128%	$12,675
394 Other Digestive System Diagnoses with CC	15	$118,964	+153%	$11,575
432 Cirrhosis and Alcoholic Hepatitis with MCC	15	$169,114	+77%	$22,020
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	15	$344,895	+237%	$25,504
699 Other Kidney and Urinary Tract Diagnoses with CC	15	$160,641	+238%	$12,226
267 Endovascular Cardiac Valve Replacement and Supplement...	14	$336,829	+52%	$57,657
393 Other Digestive System Diagnoses with MCC	14	$272,845	+255%	$19,785
454 Combined Anterior and Posterior Spinal Fusion with CC	14	$694,696	+148%	$76,652
854 Infectious and Parasitic Diseases with O.R. Procedures with...	14	$310,290	+216%	$24,143
071 Other Cerebrovascular Disorders with CC	13	$146,486	+190%	$12,725
242 Permanent Cardiac Pacemaker Implant with MCC	13	$300,038	+87%	$38,571
543 Pathological Fractures and Musculoskeletal and Connective...	13	$130,650	+166%	$12,942
637 Diabetes with MCC	13	$141,465	+113%	$16,569
643 Endocrine Disorders with MCC	13	$198,042	+167%	$19,321

Showing the 60 most frequent of 75 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	661	$67,950	$3,929
Level 5 Musculoskeletal Procedures	115	$256,656	$18,892
Level 3 Vascular Procedures	95	$63,106	$4,548
Level 2 Excision/ Biopsy/ Incision and Drainage	76	$25,891	$2,333
Level 1 Laparoscopy and Related Services	73	$201,962	$8,213
Level 2 Endovascular Procedures	59	$97,166	$8,223
Level 3 Endovascular Procedures	58	$174,557	$15,797
Level 3 Urology and Related Services	57	$88,847	$2,931
Level 1 Endovascular Procedures	55	$103,986	$4,696
Level 5 Urology and Related Services	54	$179,389	$7,335
Level 3 Electrophysiologic Procedures	53	$287,419	$33,455
Level 4 Urology and Related Services	46	$136,595	$5,016
Level 4 Musculoskeletal Procedures	43	$208,179	$10,092
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	41	$133,241	$4,978
Level 3 Pacemaker and Similar Procedures	34	$93,897	$15,334
Level 2 Upper GI Procedures	29	$48,169	$2,662
Level 3 Excision/ Biopsy/ Incision and Drainage	27	$91,956	$4,088
Level 2 Musculoskeletal Procedures	24	$40,160	$2,312
Level 4 Vascular Procedures	23	$166,137	$7,907
Level 3 Musculoskeletal Procedures	22	$170,733	$4,657
Level 4 Airway Endoscopy	22	$96,928	$5,388
Level 2 Breast/Lymphatic Surgery and Related Procedures	15	$247,337	$9,377
Level 2 Vascular Procedures	15	$39,452	$2,305
Level 4 Gynecologic Procedures	15	$143,554	$4,259
Level 4 Endovascular Procedures	13	$251,486	$25,160

Against the California average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Northbay Medical Center charged $232,743 on average, 63% more than the California average of $143,063, and was paid $23,658 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Northbay Medical Center charged $161,065 on average, 60% more than the California average of $100,739, and was paid $15,080 against a state average of $15,556. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Northbay Medical Center charged $167,010 on average, 61% more than the California average of $103,761, and was paid $15,481 against a state average of $15,112. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Northbay Medical Center charged $139,375 on average, 83% more than the California average of $76,120, and was paid $12,778 against a state average of $12,552. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $67,950 was 63% above the state average of $41,628. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $256,656 was 135% above the state average of $109,149. For Level 3 Vascular Procedures (outpatient APC 5183), its average charge of $63,106 was 109% above the state average of $30,190. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $25,891 was 76% above the state average of $14,749.

Price-transparency record

CMS's enforcement list records these actions for a hospital named Northbay Medical Center in Fairfield, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:

CAP Request — 2024-09-26 (CMS case 2704)
Closure Notice — 2024-12-23 (CMS case 2704)
Warning Notice — 2026-02-26 (CMS case 7111)
Closure Notice — 2026-05-29 (CMS case 7111)

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.