Updated April 2026
Simple Pneumonia and Pleurisy with MCC in California
195 California hospitals report Medicare totals for this DRG, averaging $19,200 (well above the $14,174 national mean), with a 3× spread from $10,688 to $32,651. 3 carry an A grade, 12 carry an F.
Simple Pneumonia and Pleurisy with MCC (DRG 193) is a Respiratory procedure tracked in CMS Inpatient Payment files. Across California, 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.
Within California, the 2,593 hospitals reporting this procedure span the full range of ownership types and hospital sizes. The state-specific average ($14,174) 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 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.
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 MCC is Medicare DRG 193 in the Respiratory category. National Medicare average for this DRG is $14,174 across 2,593 reporting hospitals. The state-level view here filters that universe down to California only.
Cost Picture in California
California's average for this DRG sits well above 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 3× 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 California Reporting Simple Pneumonia and Pleurisy with MCC
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 mcc cost in California?
Simple Pneumonia and Pleurisy with MCC (DRG 193) averages $19,200 in total Medicare payment across 195 California hospitals reporting this code. Within the state, payments span $10,688 to $32,651 — about 3× from cheapest to most expensive.
Is Simple Pneumonia and Pleurisy with MCC more or less expensive in California than nationally?
California's state-level average of $19,200 sits well above the national Medicare average of $14,174 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 3× 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.