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  5. /Case rate

APR-DRG 199

PNEUMOTHORAX WITH MCC

Reported by 16 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

$1.6k

Average

$8.2k

Median

$5.7k

High

$29.4k

Hospitals reporting this code

#HospitalLocation
1Sanford Aberdeen Medical CenterAberdeen, SD$17.2k$20.2k$20.6k$23.5k$2.1k
2The Mercy Hospital IncSpringfield, MA$5.7k$15.9k$15.1k$15.9k$2.4k
3St Joseph Mercy Ann ArborYpsilanti, MI$825$1.6k$1.6k$5.2k$20
4St Mary Mercy LivoniaLivonia, MI$825$1.6k$1.6k$1.6k$14
5Mercy Health Hackley CampusMuskogen, MI$1.6k$1.6k$1.6k$6.0k$14
6St Joseph Mercy OaklandPontiac, MI$700$1.6k$1.6k$11.9k$14
7Mercy Health Saint MarysGrand Rapids, MI$923$1.6k$1.6k$4.7k$14
8Holy Cross Hospital-Ft. LauderdaleFt. Lauderdale, FL$2.2k$2.7k$3.0k$4.3k$751
9Mercy Medical Center - DubuqueDubuque, IA$10.0k$11.0k$11.0k$11.0k$122
10Mercy Health Services-Iowa Corp.Mason City, IA$7.3k$8.1k$8.1k$8.1k$90
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