Updated April 2026
Simple Pneumonia and Pleurisy with CC in Puerto Rico
34 Puerto Rico hospitals report Medicare totals for this DRG, averaging $6,968 (well below the $10,407 national mean), with a 2× spread from $4,255 to $9,856. 0 carry an A grade, 0 carry an F.
The Respiratory procedure Simple Pneumonia and Pleurisy with CC carries DRG code 194 in the CMS classification system. 2,888 hospitals in Puerto Rico report payment data, averaging $10,407 per procedure — median $10,090, ranging from $3,586 to $23,424. The $3,586-to-$23,424 payment range is wide: the same DRG code can attract very different reimbursements across hospitals, reflecting differences in cost structure, patient complexity within the DRG, and regional pricing dynamics. The Medicare DRG system bundles cases by diagnosis-and-procedure groupings, so payment differences within a single DRG mostly track hospital-specific factors rather than case-mix.
Within Puerto Rico, the 2,888 hospitals reporting this procedure span the full range of ownership types and hospital sizes. The state-specific average ($10,407) is shaped by which hospitals in the state see enough volume to report the DRG code at all. For patients with elective scheduling on Simple Pneumonia and Pleurisy with CC, the cost-comparison logic is straightforward: the per-procedure payment range is meaningfully wide, so the hospital chosen affects total cost. For patients in an emergency, the choice is functionally fixed — but the listed prices still matter for insurance-coverage and out-of-pocket planning.
About This Procedure
Respiratory DRGs include pneumonia, COPD, ventilator-supported respiratory failure, and chronic lung disease. Length of stay drives most of the cost spread, especially for ventilator cases that cross the 96-hour threshold.
Simple Pneumonia and Pleurisy with CC is Medicare DRG 194 in the Respiratory category. National Medicare average for this DRG is $10,407 across 2,888 reporting hospitals. The state-level view here filters that universe down to Puerto Rico only.
Cost Picture in Puerto Rico
Puerto Rico's average for this DRG sits well below the national Medicare mean. State-level differences are explained primarily by the regional Medicare wage index — the multiplier CMS applies to standardize DRG payments to local labor costs — alongside hospital case mix and the concentration of academic referral centers in the state's larger metros.
Within the state, the 2× spread between the lowest- and highest-reporting facility usually reflects length-of-stay differences, complication adjustments for sicker patients, teaching-status add-ons, and outlier payments for unusually long stays. Two hospitals reporting the same DRG can post meaningfully different totals without anything “wrong” happening at either site. For non-Medicare patients, the more relevant figure is the negotiated commercial rate published in each hospital's machine-readable file under the CMS Hospital Price Transparency Rule.
Quality Alongside Price
For a planned admission, the most useful complement to the cost view is the hospital-specific quality data on CMS Care Compare. The site publishes risk-adjusted measures of mortality, readmission, complication, infection, and patient experience for every Medicare-participating hospital. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators feed many of these CMS measures.
For complex procedures, hospital-level case volume correlates with outcomes in published research, even after risk adjustment. CMS publishes case counts on Care Compare alongside outcome measures.
Hospitals in Puerto Rico Reporting Simple Pneumonia and Pleurisy with CC
Sorted lowest to highest Medicare total payment. Pricing is informational and should be considered alongside CMS quality measures.
Frequently Asked Questions
How much does simple pneumonia and pleurisy with cc cost in Puerto Rico?
Simple Pneumonia and Pleurisy with CC (DRG 194) averages $6,968 in total Medicare payment across 34 Puerto Rico hospitals reporting this code. Within the state, payments span $4,255 to $9,856 — about 2× from cheapest to most expensive.
Is Simple Pneumonia and Pleurisy with CC more or less expensive in Puerto Rico than nationally?
Puerto Rico's state-level average of $6,968 sits well below the national Medicare average of $10,407 for this DRG. State differences are driven primarily by the regional Medicare wage index, case mix, and the share of high-acuity referral hospitals.
Why is the spread between hospitals so wide?
Variation within a state runs 2× because the same DRG can come with different lengths of stay, complication adjustments, teaching-status add-ons, and outlier payments. The CMS Hospital Price Transparency Rule publishes machine-readable rate files that allow direct comparisons against negotiated commercial rates, which often differ from Medicare totals.
Are these the prices a privately insured patient would pay?
No. Figures here are Medicare DRG payments. Privately insured patients are billed under their plan's negotiated network rate, published in each hospital's price-transparency file. Uninsured patients should ask the hospital for the cash-pay rate, also disclosed under federal price-transparency rules.
Should I choose a hospital based only on price?
No. HospitalCostData is informational. Surgeon experience, hospital volume for the procedure, complication rates, and your specific clinical situation matter at least as much as price. Always discuss options with your physician and review CMS Care Compare quality data alongside any pricing benchmark.
See the methodology page for DRG sourcing and Medicare wage-index context.
Sources & Citations
- CMS Medicare Inpatient Hospital Payments (IPPS). DRG-level average covered charges, total payments, and Medicare payments per facility. data.cms.gov
- CMS Hospital Compare (Care Compare). Star ratings, mortality, readmission, safety-of-care, and patient-experience measures. medicare.gov/care-compare
- CMS Hospital Price Transparency Rule. Standard charge files required from every Medicare-participating hospital. cms.gov/hospital-price-transparency
- Agency for Healthcare Research and Quality (AHRQ). National benchmarks, quality indicators, and clinical context for hospital outcome measures. ahrq.gov
Dataset last refreshed: April 2026. Underlying CMS files are public domain. Suggested citation: “HospitalCostData, hospitalcostdata.com, accessed May 24, 2026.”
This page is informational only and does not constitute medical, legal, or financial advice. Care decisions should be made with a licensed physician.
Source: CMS Hospital Price Transparency, 2026.