Wisconsin / Prohealth Oconomowoc Memorial Hospital
CMS certification 520062 · Oconomowoc, WI · 3 entries in CMS's price-transparency list
Prohealth Oconomowoc Memorial Hospital: charges and Medicare payments
Prohealth Oconomowoc Memorial Hospital reported 364 Medicare inpatient stays across 17 DRGs in 2024. Across them it charged 4.73 times what it was paid — among the higher ratios in Wisconsin, number 5 of 55 hospitals with at least 100 stays (state median 3.47×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 63 stays at an average charge of $48,761, 46% below the national average. It also billed 1,020 outpatient services, charging 6.46 times what Medicare paid.
- 1Medicare inpatient stays 364
- 2Charge ÷ paid, inpatient 4.73×
- 3Rank in WI (highest ratio = 1) 5 of 55
- 4CMS price-transparency actions 3
Inpatient stays
For the 17 DRGs that can be compared with the national average, Prohealth Oconomowoc Memorial Hospital charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 63 | $48,761 | -46% | $12,269 |
| 291 Heart Failure and Shock with MCC | 56 | $39,913 | -29% | $9,061 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 29 | $73,271 | -21% | $12,643 |
| 194 Simple Pneumonia and Pleurisy with CC | 24 | $24,786 | -35% | $5,468 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 20 | $27,955 | -30% | $5,294 |
| 690 Kidney and Urinary Tract Infections without MCC | 19 | $23,239 | -39% | $5,095 |
| 177 Respiratory Infections and Inflammations with MCC | 17 | $36,360 | -48% | $10,028 |
| 468 Revision of Hip or Knee Replacement without CC/MCC | 16 | $118,877 | -4% | $19,905 |
| 481 Hip and Femur Procedures except Major Joint with CC | 16 | $83,664 | -17% | $13,216 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 16 | $31,915 | -35% | $7,379 |
| 483 Major Joint or Limb Reattachment Procedures of Upper... | 15 | $93,639 | -26% | $18,836 |
| 193 Simple Pneumonia and Pleurisy with MCC | 14 | $32,498 | -46% | $8,910 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 14 | $22,457 | -38% | $5,010 |
| 378 Gastrointestinal Hemorrhage with CC | 12 | $33,476 | -31% | $6,637 |
| 603 Cellulitis without MCC | 11 | $21,956 | -41% | $5,764 |
| 683 Renal Failure with CC | 11 | $32,955 | -19% | $6,010 |
| 689 Kidney and Urinary Tract Infections with MCC | 11 | $30,044 | -41% | $7,942 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 5 Musculoskeletal Procedures | 403 | $62,134 | $11,922 |
| Comprehensive Observation Services | 233 | $16,300 | $2,442 |
| Level 2 Urology and Related Services | 118 | $5,332 | $615 |
| Level 6 Musculoskeletal Procedures | 51 | $93,487 | $16,941 |
| Level 3 Urology and Related Services | 50 | $10,266 | $1,856 |
| Level 1 Nerve Procedures | 34 | $14,942 | $1,759 |
| Level 4 Urology and Related Services | 30 | $20,368 | $3,176 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 23 | $10,383 | $1,477 |
| Level 3 Vascular Procedures | 20 | $15,077 | $2,904 |
| Level 4 Musculoskeletal Procedures | 16 | $51,899 | $6,517 |
| Level 5 Urology and Related Services | 16 | $24,574 | $4,714 |
| Level 3 Musculoskeletal Procedures | 13 | $24,618 | $2,768 |
| Level 4 Gynecologic Procedures | 13 | $16,648 | $2,848 |
Against the Wisconsin average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Prohealth Oconomowoc Memorial Hospital charged $48,761 on average, 18% less than the Wisconsin average of $59,481, and was paid $12,269 against a state average of $16,719. For Heart Failure and Shock with MCC (DRG 291), Prohealth Oconomowoc Memorial Hospital charged $39,913 on average, 1% more than the Wisconsin average of $39,564, and was paid $9,061 against a state average of $10,862. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Prohealth Oconomowoc Memorial Hospital charged $73,271 on average, 8% more than the Wisconsin average of $68,121, and was paid $12,643 against a state average of $14,934. For Simple Pneumonia and Pleurisy with CC (DRG 194), Prohealth Oconomowoc Memorial Hospital charged $24,786 on average, 9% less than the Wisconsin average of $27,387, and was paid $5,468 against a state average of $7,149. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $62,134 was 24% above the state average of $50,282. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $16,300 was 8% below the state average of $17,717. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $5,332 was 138% above the state average of $2,237. For Level 6 Musculoskeletal Procedures (outpatient APC 5116), its average charge of $93,487 was 36% above the state average of $68,804.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Prohealth Oconomowoc Memorial Hospital in Oconomowoc, WI, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2024-11-21 (CMS case 2949)
- CAP Request — 2025-02-26 (CMS case 2949)
- Closure Notice — 2025-04-14 (CMS case 2949)
A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.