California / Petaluma Valley Hospital
CMS certification 050136 · Petaluma, CA · 4 entries in CMS's price-transparency list
Petaluma Valley Hospital: charges and Medicare payments
Petaluma Valley Hospital reported 448 Medicare inpatient stays across 18 DRGs in 2024. Across them it charged 6.93 times what it was paid — among the higher ratios in California, number 59 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: 123 stays at an average charge of $121,469, 35% above the national average. It also billed 767 outpatient services, charging 10.25 times what Medicare paid.
- 1Medicare inpatient stays 448
- 2Charge ÷ paid, inpatient 6.93×
- 3Rank in CA (highest ratio = 1) 59 of 247
- 4CMS price-transparency actions 4
Inpatient stays
For the 18 DRGs that can be compared with the national average, Petaluma Valley Hospital charged more than the national average in 18 (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 | 123 | $121,469 | +35% | $19,270 |
| 291 Heart Failure and Shock with MCC | 45 | $97,197 | +72% | $13,627 |
| 193 Simple Pneumonia and Pleurisy with MCC | 32 | $114,641 | +92% | $14,120 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 28 | $92,574 | +89% | $12,107 |
| 683 Renal Failure with CC | 24 | $65,118 | +60% | $9,741 |
| 177 Respiratory Infections and Inflammations with MCC | 22 | $154,778 | +119% | $18,790 |
| 189 Pulmonary Edema and Respiratory Failure | 20 | $105,883 | +84% | $13,107 |
| 481 Hip and Femur Procedures except Major Joint with CC | 19 | $153,576 | +52% | $21,683 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 18 | $313,579 | +37% | $53,306 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 17 | $117,948 | +61% | $16,228 |
| 682 Renal Failure with MCC | 16 | $115,850 | +76% | $14,945 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 14 | $80,754 | +34% | $13,332 |
| 689 Kidney and Urinary Tract Infections with MCC | 13 | $76,040 | +48% | $11,954 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 12 | $160,560 | +72% | $20,040 |
| 603 Cellulitis without MCC | 12 | $57,989 | +56% | $9,608 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 11 | $106,542 | +91% | $10,708 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 11 | $70,147 | +94% | $8,498 |
| 690 Kidney and Urinary Tract Infections without MCC | 11 | $65,707 | +74% | $8,882 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 1 Intraocular Procedures | 314 | $16,722 | $3,107 |
| Comprehensive Observation Services | 155 | $58,745 | $3,654 |
| Level 2 Intraocular Procedures | 62 | $26,023 | $5,427 |
| Level 5 Urology and Related Services | 55 | $57,693 | $6,907 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 42 | $14,386 | $2,123 |
| Level 3 Musculoskeletal Procedures | 28 | $30,716 | $4,321 |
| Level 4 Musculoskeletal Procedures | 26 | $73,223 | $9,543 |
| Level 4 Urology and Related Services | 26 | $46,433 | $4,653 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 16 | $28,973 | $3,793 |
| Level 5 Musculoskeletal Procedures | 16 | $133,001 | $17,529 |
| Level 2 Upper GI Procedures | 14 | $14,478 | $2,395 |
| Level 2 Musculoskeletal Procedures | 13 | $21,825 | $2,014 |
Against the California average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Petaluma Valley Hospital charged $121,469 on average, 15% less than the California average of $143,063, and was paid $19,270 against a state average of $23,020. For Heart Failure and Shock with MCC (DRG 291), Petaluma Valley Hospital charged $97,197 on average, 4% less than the California average of $100,739, and was paid $13,627 against a state average of $15,556. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Petaluma Valley Hospital charged $114,641 on average, 10% more than the California average of $103,761, and was paid $14,120 against a state average of $15,112. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Petaluma Valley Hospital charged $92,574 on average, 22% more than the California average of $76,120, and was paid $12,107 against a state average of $12,552. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $16,722 was 20% below the state average of $20,986. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $58,745 was 41% above the state average of $41,628. For Level 2 Intraocular Procedures (outpatient APC 5492), its average charge of $26,023 was 35% below the state average of $40,214. For Level 5 Urology and Related Services (outpatient APC 5375), its average charge of $57,693 was 13% above the state average of $51,167.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Petaluma Valley Hospital in Petaluma, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2021-08-25 (CMS case 178)
- CAP Request — 2022-07-27 (CMS case 178)
- Closure Notice — 2022-08-29 (CMS case 178)
- Met Requirements — 2025-07-14 (CMS case 5727)
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.