California / Novato Community Hospital
CMS certification 050131 · Novato, CA · 1 entry in CMS's price-transparency list
Novato Community Hospital: charges and Medicare payments
Novato Community Hospital reported 446 Medicare inpatient stays across 15 DRGs in 2024. Across them it charged 3.92 times what it was paid — among the lower ratios in California, number 188 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: 163 stays at an average charge of $70,734, 22% below the national average. It also billed 701 outpatient services, charging 5.61 times what Medicare paid.
- 1Medicare inpatient stays 446
- 2Charge ÷ paid, inpatient 3.92×
- 3Rank in CA (highest ratio = 1) 188 of 247
- 4CMS price-transparency actions 1
Inpatient stays
For the 15 DRGs that can be compared with the national average, Novato Community Hospital charged more than the national average in 8 (53%). 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 | 163 | $70,734 | -22% | $20,598 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 50 | $42,764 | -13% | $11,946 |
| 291 Heart Failure and Shock with MCC | 44 | $57,182 | +1% | $13,832 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 30 | $100,873 | +8% | $22,350 |
| 455 Combined Anterior and Posterior Spinal Fusion without CC/MCC | 25 | $244,352 | +20% | $51,532 |
| 690 Kidney and Urinary Tract Infections without MCC | 19 | $39,220 | +4% | $9,158 |
| 193 Simple Pneumonia and Pleurisy with MCC | 16 | $44,780 | -25% | $14,115 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 15 | $108,727 | +6% | $23,262 |
| 389 Gastrointestinal Obstruction with CC | 14 | $43,707 | +12% | $11,808 |
| 378 Gastrointestinal Hemorrhage with CC | 12 | $57,684 | +19% | $11,122 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 12 | $38,587 | -4% | $8,929 |
| 481 Hip and Femur Procedures except Major Joint with CC | 12 | $94,468 | -6% | $22,650 |
| 689 Kidney and Urinary Tract Infections with MCC | 12 | $52,564 | +2% | $12,741 |
| 177 Respiratory Infections and Inflammations with MCC | 11 | $50,355 | -29% | $17,532 |
| 603 Cellulitis without MCC | 11 | $35,807 | -4% | $9,524 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 5 Musculoskeletal Procedures | 284 | $88,984 | $18,221 |
| Comprehensive Observation Services | 106 | $33,742 | $3,794 |
| Level 6 Musculoskeletal Procedures | 54 | $105,822 | $25,953 |
| Level 4 Musculoskeletal Procedures | 42 | $48,381 | $9,983 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 39 | $14,326 | $2,218 |
| Level 1 Laparoscopy and Related Services | 35 | $40,670 | $8,058 |
| Level 2 Upper GI Procedures | 25 | $13,676 | $2,657 |
| Level 1 Intraocular Procedures | 23 | $16,684 | $3,255 |
| Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 20 | $29,304 | $4,832 |
| Level 2 Musculoskeletal Procedures | 18 | $9,975 | $2,245 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 17 | $24,550 | $3,968 |
| Level 3 Musculoskeletal Procedures | 14 | $33,283 | $4,520 |
| Level 2 Breast/Lymphatic Surgery and Related Procedures | 13 | $37,443 | $9,103 |
| Level 5 Gynecologic Procedures | 11 | $42,412 | $6,946 |
Against the California average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Novato Community Hospital charged $70,734 on average, 51% less than the California average of $143,063, and was paid $20,598 against a state average of $23,020. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Novato Community Hospital charged $42,764 on average, 44% less than the California average of $76,120, and was paid $11,946 against a state average of $12,552. For Heart Failure and Shock with MCC (DRG 291), Novato Community Hospital charged $57,182 on average, 43% less than the California average of $100,739, and was paid $13,832 against a state average of $15,556. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Novato Community Hospital charged $100,873 on average, 27% less than the California average of $137,972, and was paid $22,350 against a state average of $21,800. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $88,984 was 18% below the state average of $109,149. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $33,742 was 19% below the state average of $41,628. For Level 6 Musculoskeletal Procedures (outpatient APC 5116), its average charge of $105,822 was 20% below the state average of $132,087. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $48,381 was 30% below the state average of $69,476.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Novato Community Hospital in Novato, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-08-05 (CMS case 6166)
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.