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  5. /Case rate

APR-DRG 626-4

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Reported by 30 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

$5.1k

Average

$20.1k

Median

$18.3k

High

$53.2k

Hospitals reporting this code

#HospitalLocation
1Natchez Hospital Company LLCNatchez, MS$16.0k$16.2k$16.3k$17.3k$400
2Wesley Health System LLCHattiesburg, MS$16.0k$16.0k$16.2k$17.3k$416
3Jackson HMA LLCMS 39204, MS$16.0k$16.2k$16.2k$17.3k$386
4Vicksburg Healthcare LLCVicksburg, MS$16.0k$16.0k$16.2k$17.3k$416
5Brandon HMA LLCBrandon, MS$16.0k$16.2k$16.3k$17.3k$400
6River Oaks Hospital LLCFlowood, MS$16.0k$16.2k$17.3k$25.6k$3.0k
7McAllen Hospitals, LPMcAllen, TX—$19.1k$19.2k—$161
8McAllen Hospitals, LPEdinburg, TX—$19.1k$19.2k—$161
9Northwest Texas Healthcare System, Inc.Amarillo, TX—$19.5k$19.8k—$437
10The George Washington University HospitalWashington, DC—$43.9k$43.8k—$192
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