Prohealth Waukesha Memorial Hospital: charges and Medicare payments

Prohealth Waukesha Memorial Hospital reported 1,954 Medicare inpatient stays across 64 DRGs in 2024. Across them it charged 4.77 times what it was paid — among the higher ratios in Wisconsin, number 4 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: 224 stays at an average charge of $56,812, 37% below the national average. It also billed 2,832 outpatient services, charging 8.27 times what Medicare paid.

1Medicare inpatient stays 1,954
2Charge ÷ paid, inpatient 4.77×
3Rank in WI (highest ratio = 1) 4 of 55
4CMS price-transparency actions 0

Average charge per stay at Prohealth Waukesha Memorial Hospital, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 64 DRGs that can be compared with the national average, Prohealth Waukesha Memorial Hospital charged more than the national average in 1 (2%). 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	224	$56,812	-37%	$13,037
291 Heart Failure and Shock with MCC	164	$37,546	-33%	$8,665
690 Kidney and Urinary Tract Infections without MCC	74	$23,817	-37%	$5,093
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	72	$31,328	-36%	$7,143
274 Percutaneous and Other Intracardiac Procedures without MCC	68	$107,094	-32%	$22,148
378 Gastrointestinal Hemorrhage with CC	58	$37,712	-22%	$6,661
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	56	$32,469	-19%	$5,560
193 Simple Pneumonia and Pleurisy with MCC	53	$44,575	-25%	$8,618
177 Respiratory Infections and Inflammations with MCC	50	$37,896	-46%	$10,339
194 Simple Pneumonia and Pleurisy with CC	46	$27,980	-27%	$5,454
689 Kidney and Urinary Tract Infections with MCC	45	$29,389	-43%	$7,411
280 Acute Myocardial Infarction, Discharged Alive with MCC	34	$44,807	-41%	$10,963
603 Cellulitis without MCC	33	$25,913	-31%	$6,015
698 Other Kidney and Urinary Tract Diagnoses with MCC	33	$37,048	-50%	$10,345
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	31	$37,563	-33%	$6,924
481 Hip and Femur Procedures except Major Joint with CC	31	$81,202	-19%	$14,868
330 Major Small and Large Bowel Procedures with CC	30	$130,620	+10%	$19,156
178 Respiratory Infections and Inflammations with CC	29	$31,371	-31%	$6,711
460 Spinal Fusion except Cervical without MCC	29	$155,320	-9%	$30,930
312 Syncope and Collapse	28	$32,981	-28%	$5,859
389 Gastrointestinal Obstruction with CC	28	$31,459	-19%	$5,594
552 Medical Back Problems without MCC	28	$27,280	-44%	$6,877
190 Chronic Obstructive Pulmonary Disease with MCC	27	$34,255	-32%	$8,472
267 Endovascular Cardiac Valve Replacement and Supplement...	27	$206,061	-7%	$35,737
309 Cardiac Arrhythmia and Conduction Disorders with CC	27	$32,798	-9%	$5,207
683 Renal Failure with CC	26	$27,644	-32%	$6,056
308 Cardiac Arrhythmia and Conduction Disorders with MCC	25	$30,797	-46%	$8,798
853 Infectious and Parasitic Diseases with O.R. Procedures with...	24	$122,673	-46%	$30,664
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	23	$23,363	-37%	$6,025
682 Renal Failure with MCC	23	$40,644	-38%	$10,062
281 Acute Myocardial Infarction, Discharged Alive with CC	21	$40,224	-20%	$6,425
310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC	21	$18,702	-35%	$3,902
191 Chronic Obstructive Pulmonary Disease with CC	20	$23,823	-40%	$5,534
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	20	$47,198	-22%	$9,560
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	18	$53,247	-47%	$10,718
394 Other Digestive System Diagnoses with CC	18	$28,916	-39%	$6,608
202 Bronchitis and Asthma with CC/MCC	17	$38,773	-16%	$6,820
638 Diabetes with CC	17	$32,684	-22%	$6,209
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	16	$53,142	-18%	$9,428
322 Percutaneous Cardiovascular Procedures with Intraluminal...	16	$83,328	-27%	$12,604
388 Gastrointestinal Obstruction with MCC	16	$33,425	-51%	$9,990
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	16	$73,672	-28%	$13,604
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	16	$21,905	-49%	$5,932
812 Red Blood Cell Disorders without MCC	16	$35,840	-19%	$6,325
057 Degenerative Nervous System Disorders without MCC	15	$31,830	-44%	$8,601
270 Other Major Cardiovascular Procedures with MCC	15	$134,166	-48%	$36,913
377 Gastrointestinal Hemorrhage with MCC	15	$60,690	-29%	$12,812
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	15	$45,527	-25%	$9,056
287 Circulatory Disorders except AMI, with Cardiac...	14	$46,409	-27%	$7,540
372 Major Gastrointestinal Disorders and Peritoneal Infections...	14	$34,396	-28%	$6,678
418 Laparoscopic Cholecystectomy without C.D.E. with CC	14	$88,275	-5%	$11,394
699 Other Kidney and Urinary Tract Diagnoses with CC	14	$29,360	-38%	$6,614
070 Other Cerebrovascular Disorders with MCC	13	$58,290	-23%	$11,860
189 Pulmonary Edema and Respiratory Failure	13	$54,091	-6%	$8,619
243 Permanent Cardiac Pacemaker Implant with CC	13	$73,697	-34%	$15,756
948 Signs and Symptoms without MCC	13	$27,441	-28%	$5,241
286 Circulatory Disorders except AMI, with Cardiac...	12	$60,846	-46%	$15,302
321 Percutaneous Cardiovascular Procedures with Intraluminal...	12	$91,268	-44%	$22,176
329 Major Small and Large Bowel Procedures with MCC	12	$194,249	-10%	$37,900
917 Poisoning and Toxic Effects of Drugs with MCC	12	$36,834	-51%	$9,561

Showing the 60 most frequent of 64 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	644	$17,590	$2,464
Level 2 Urology and Related Services	220	$5,125	$611
Level 2 Excision/ Biopsy/ Incision and Drainage	187	$12,447	$1,454
Level 1 Endovascular Procedures	153	$23,591	$2,945
Level 3 Urology and Related Services	131	$11,287	$1,856
Level 1 Laparoscopy and Related Services	128	$45,919	$5,216
Level 4 Urology and Related Services	125	$20,195	$3,156
Level 5 Urology and Related Services	117	$34,449	$4,682
Level 2 Upper GI Procedures	100	$14,301	$1,733
Level 3 Vascular Procedures	92	$20,643	$2,904
Level 3 Excision/ Biopsy/ Incision and Drainage	71	$20,833	$2,560
Level 3 Endovascular Procedures	66	$60,231	$10,014
Level 4 Musculoskeletal Procedures	60	$41,946	$6,517
Level 2 Laparoscopy and Related Services	58	$76,579	$9,372
Level 2 Breast/Lymphatic Surgery and Related Procedures	53	$43,012	$5,941
Level 3 Electrophysiologic Procedures	52	$120,524	$21,581
Level 2 Vascular Procedures	46	$5,834	$1,443
Level 1 Nerve Procedures	44	$11,882	$1,727
Level 2 Endovascular Procedures	38	$35,198	$5,207
Level 4 Endovascular Procedures	36	$62,230	$11,559
Level 3 Pacemaker and Similar Procedures	35	$48,010	$9,721
Level 1 Breast/Lymphatic Surgery and Related Procedures	32	$28,090	$3,472
Level 3 Musculoskeletal Procedures	31	$21,893	$2,949
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	30	$42,907	$2,984
Level 4 Gynecologic Procedures	30	$15,797	$2,772

Against the Wisconsin average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Prohealth Waukesha Memorial Hospital charged $56,812 on average, 4% less than the Wisconsin average of $59,481, and was paid $13,037 against a state average of $16,719. For Heart Failure and Shock with MCC (DRG 291), Prohealth Waukesha Memorial Hospital charged $37,546 on average, 5% less than the Wisconsin average of $39,564, and was paid $8,665 against a state average of $10,862. For Kidney and Urinary Tract Infections without MCC (DRG 690), Prohealth Waukesha Memorial Hospital charged $23,817 on average, 14% less than the Wisconsin average of $27,765, and was paid $5,093 against a state average of $6,984. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Prohealth Waukesha Memorial Hospital charged $31,328 on average, 8% less than the Wisconsin average of $34,158, and was paid $7,143 against a state average of $8,925. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $17,590 was 1% below the state average of $17,717. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $5,125 was 129% above the state average of $2,237. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $12,447 was 40% above the state average of $8,908. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $23,591 was 1% below the state average of $23,760.

Price-transparency record

No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.

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.