Northbay Medical Center
1200 B Gale Wilson Blvd, Fairfield, CA 94533 · 124 Priced Procedures · 67% Patient Recommendation
Typical commercial prices here are +6% above the fair benchmark (1.06×) even after accounting for local nurse/doctor wages and patient complexity.
3-Star CMS clinical quality rating paired with 1.06× fair market pricing.
Specialty Drug & Surgical Margin Engine
Northbay Medical Center concentrates commercial margin in outpatient surgical suites (0.6× Medicare) and specialty drug infusions (6.0× Medicare) relative to routine diagnostics (8.8×). Comparing freestanding ambulatory surgery centers or specialty pharmacy options before treatment yields substantial savings.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.94× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 0% of shoppable procedures (25/100 Cash Honesty)
- 2-Star CMS clinical rating with 67% patient recommendation (66/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (29.7% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (1.06× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Commercial insurance median sits at 1.00× Fair BaseRate (1.3× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Upper-quartile procedures (Q75 1.22×) jump +22% above the median procedure ratio (Q50 1.00×)
- Consolidated metro market (HHI 3,516) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Northbay Medical Center
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 124 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Spinal fusion, single level (inpatient stay) MS-DRG Code: 451 | $37,789 | 1.2× |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $22,934 | 1.2× |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $22,778 | 1.2× |
| Heart stent placement (inpatient stay) MS-DRG Code: 322 | $20,864 | 1.2× |
| Rabies immune globulin HCPCS Code: 90375 | $14,801 | 46.0× |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $9,522 | 1.2× |
| Total knee replacement CPT Code: 27447 | $7,794 | 0.6× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $4,104 | 0.7× |
| Total hip replacement CPT Code: 27130 | $3,951 | 0.3× |
| Hepatitis B immune globulin HCPCS Code: 90371 | $3,511 | 23.3× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $3,128 | 0.9× |
| Cataract surgery with lens implant CPT Code: 66984 | $3,094 | 1.2× |
| Bunion correction surgery CPT Code: 28296 | $2,327 | 0.7× |
| Trauma team activation HCPCS Code: G0390 | $1,958 | 1.3× |
| C-section delivery (full package) CPT Code: 59510 | $1,763 | 0.6× |
| Vaginal delivery (full package) CPT Code: 59400 | $1,542 | 0.6× |
| Inguinal hernia repair CPT Code: 49505 | $1,508 | 0.4× |
| Colonoscopy with biopsy CPT Code: 45380 | $1,358 | 1.1× |
| Breast lump removal CPT Code: 19120 | $1,358 | 0.4× |
| Upper endoscopy with biopsy CPT Code: 43239 | $1,253 | unverified |
| Colonoscopy (diagnostic) CPT Code: 45378 | $1,270 | unverified |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $803 | 1.4× |
| Injection procedure for pain management HCPCS Code: G0260 | $736 | 0.9× |
| Hospital observation (per hour) HCPCS Code: G0378 | $627 | 7.3× |
| Psychological testing by technician CPT Code: 96138 | $506 | 1.3× |
Audit a Bill or Quote at Northbay Medical Center (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $26,945
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (29.7% of gross = $26,945).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask Northbay Medical Center's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)
Your bill ($90,694) is $59,919 above the denoised Fair BaseRate ($30,775) and 3.9× the $23,504 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (29.7% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)Source: CMS Hospital Care Compare (1,032 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Northbay Medical Center.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.