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  5. /Case rate

APR-DRG 193

SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Reported by 2 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$15.4k

Average

$20.0k

Median

$20.0k

High

$24.6k

Hospitals reporting this code

#HospitalLocation
1Sanford Aberdeen Medical CenterAberdeen, SD$12.8k$15.1k$15.4k$17.5k$1.6k
2Catholic Health Initiatives-Iowa CorpWest Des Moines, IA$22.4k$24.6k$24.6k$24.6k$274

Look up this code directly

Ask Claude or any MCP client for APR-DRG 193 pricing at a specific hospital — see how to connect.

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