Novato Community Hospital
Novato Community Hospital in Novato, CA charges 4.8x the Medicare reimbursement rate across 13 analyzed procedures at this nonprofit-private facility.
Novato, CA 94945 · Acute Care Hospitals · CMS Rating: 5/5
About the analyst
Michael Glenn reviews CMS datasets and drug pricing at BillRazor Research. He focuses on NADAC acquisition costs and procedure coding accuracy. Expertise: drug pricing, NADAC data, CPT coding.
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Pricing grade
C
Average
Avg markup vs Medicare
4.78x
Charge / Medicare rate
Max markup
6.55x
Worst procedure
Procedures analyzed
13
With pricing data
Outlier procedures
0%
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 |
|---|---|---|---|---|---|
| COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | 455 | $233,572 | $116,786 | — | 6.6x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | 641 | $43,421 | $21,710 | — | 5.8x |
| MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | 470 | $97,281 | $48,640 | — | 5.6x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $39,324 | $19,662 | — | 5.3x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $60,770 | $30,385 | — | 4.9x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $57,518 | $28,759 | — | 4.7x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $45,568 | $22,784 | — | 4.6x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $43,284 | $21,642 | — | 4.4x |
| HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | 481 | $90,956 | $45,478 | — | 4.3x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $56,960 | $28,480 | — | 4.3x |
| CELLULITIS WITHOUT MCC | 603 | $36,404 | $18,202 | — | 4.2x |
| RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | 177 | $71,869 | $35,935 | — | 3.7x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | 871 | $69,034 | $34,517 | — | 3.7x |
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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.
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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