Updated April 2026
Simple Pneumonia and Pleurisy with MCC
DRG 193 · Respiratory · 2,593 hospitals · 531,255 discharges
Simple Pneumonia and Pleurisy with MCC (DRG 193) averages $14,174 in total Medicare payment across 2,593 US hospitals, with a wide spread from $4,442 to $32,651 — about 7× cheapest to most expensive. The Medicare average for this DRG runs modestly below the all-procedure national mean of $15,878.
Simple Pneumonia and Pleurisy with MCC (DRG 193) is a Respiratory procedure tracked in CMS Inpatient Payment files. Across the United States, 2,593 hospitals report payment data for 531,255 total discharges, with an average Medicare payment of $14,174 (median $13,679). A $32,651 maximum and $4,442 minimum on the same DRG procedure is normal for the Medicare payment system — DRG codes bundle cases that may differ in complexity, and hospital wage-index adjustments alone can move payments by 30% across regions.
Looking across all states, 2,593 hospitals report the procedure with 531,255 total documented discharges. State-by-state breakouts show wider variation than the national average suggests. For patients with elective scheduling on Simple Pneumonia and Pleurisy with MCC, 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.
What This DRG Covers
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 MCC is one of the highest-volume Medicare admissions in the country, with 531,255 reported discharges. High volume means CMS averages are statistically robust and small per-case differences add up to meaningful national spend.
Why Hospital Prices Vary
Across 2,593 hospitals, the price spread is roughly 7×. That is a meaningful gap and a reminder that the average payment alone is a poor planning number — the cheapest and most expensive facilities are often in the same metro.
Medicare standardizes payment using DRG weights, but the dollar figure each hospital actually receives is modulated by the regional wage index, indirect medical education adjustment for teaching hospitals, disproportionate share adjustment for safety-net facilities, and outlier payments for unusually long or complex stays. Two hospitals coding the exact same DRG can therefore report meaningfully different totals without anything “wrong” happening at either site.
For non-Medicare patients, the more relevant figure is the negotiated commercial rate or cash-pay rate — disclosed in machine-readable form under the CMS Hospital Price Transparency Rule. Many hospital systems also publish patient-friendly cost-estimation tools that combine plan-specific deductibles with the negotiated rate.
Quality Matters Alongside Price
Picking a hospital based on the lowest published price for a single DRG is rarely a complete decision. The CMS Hospital Compare (Care Compare) program publishes risk-adjusted measures of mortality, readmission, complication, infection, and patient experience for every Medicare-participating hospital. For surgical DRGs in particular, the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators flag complications that an aggregate star rating may not surface on its own.
Volume is another signal worth weighing. For complex procedures (cardiac surgery, joint replacement, major oncology), hospital-level case volume correlates with outcomes in published research, even after risk adjustment. CMS publishes case counts on Care Compare alongside outcome measures.
Lowest-Cost Reporting Hospitals
Lowest reported Medicare totals for this DRG. Pricing is informational and should be considered alongside CMS quality measures.
Highest-Cost Reporting Hospitals
Highest reported Medicare totals. High totals frequently reflect academic referral centers and complex case mix.
Frequently Asked Questions
How much does simple pneumonia and pleurisy with mcc cost on Medicare?
Simple Pneumonia and Pleurisy with MCC (DRG 193) averages $14,174 in total Medicare payment across 2,593 US hospitals reporting this code. The 25th-percentile facility reports $11,489, the median is $13,679, and the 75th percentile is $16,373.
Why does this procedure cost so much more at one hospital than another?
The spread for Simple Pneumonia and Pleurisy with MCC runs from $4,442 to $32,651 — about 7× cheapest to most expensive. Variation comes from regional Medicare wage indexes, hospital case mix, teaching status, length-of-stay differences, and outlier-payment adjustments. The CMS Hospital Price Transparency Rule publishes machine-readable rate files that allow direct comparisons against negotiated rates.
Are these the prices a privately insured patient would pay?
No. Figures on this page are Medicare DRG payments — what CMS pays the hospital for treating a Medicare beneficiary. Privately insured patients are billed under their plan's negotiated network rate, which is published in each hospital's price-transparency file. For an uninsured patient, the relevant figure is the cash-pay rate, also disclosed under federal price-transparency rules.
What does the DRG code mean?
DRG 193 (Simple Pneumonia and Pleurisy with MCC) is a Medicare Diagnosis Related Group — the unit CMS uses to bundle similar admissions for payment. Each DRG has a fixed weight that, multiplied by the hospital's base rate, produces the standardized payment. Around 750 DRGs cover the full range of inpatient admissions; this code falls in the Respiratory category.
Should I pick a hospital just because it has the lowest price?
No. Cost is one input — quality of care, surgeon experience, facility volume, and your specific clinical situation matter at least as much. The CMS Care Compare site publishes risk-adjusted mortality, readmission, complication, and patient-experience measures for every Medicare-participating hospital. Always discuss options with your physician before any planned admission.
See the methodology page for DRG sourcing, payment-system context, and known limitations of Medicare-only data.
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.