Wisconsin / SSM Health Monroe Hospital
CMS certification 520028 · Monroe, WI · 1 entry in CMS's price-transparency list
SSM Health Monroe Hospital: charges and Medicare payments
SSM Health Monroe Hospital reported 424 Medicare inpatient stays across 19 DRGs in 2024. Across them it charged 3.25 times what it was paid — mid-range in Wisconsin, number 33 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: 72 stays at an average charge of $53,593, 41% below the national average. It also billed 1,462 outpatient services, charging 7.17 times what Medicare paid.
- 1Medicare inpatient stays 424
- 2Charge ÷ paid, inpatient 3.25×
- 3Rank in WI (highest ratio = 1) 33 of 55
- 4CMS price-transparency actions 1
Inpatient stays
For the 19 DRGs that can be compared with the national average, SSM Health Monroe 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 | 72 | $53,593 | -41% | $16,063 |
| 291 Heart Failure and Shock with MCC | 51 | $32,361 | -43% | $11,159 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 32 | $33,633 | -31% | $10,358 |
| 193 Simple Pneumonia and Pleurisy with MCC | 29 | $37,742 | -37% | $11,938 |
| 177 Respiratory Infections and Inflammations with MCC | 28 | $37,927 | -46% | $14,031 |
| 378 Gastrointestinal Hemorrhage with CC | 24 | $29,579 | -39% | $9,084 |
| 389 Gastrointestinal Obstruction with CC | 23 | $32,376 | -17% | $7,516 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 19 | $38,868 | -49% | $12,810 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 18 | $30,004 | -25% | $7,408 |
| 189 Pulmonary Edema and Respiratory Failure | 17 | $47,853 | -17% | $11,290 |
| 194 Simple Pneumonia and Pleurisy with CC | 15 | $30,012 | -22% | $7,076 |
| 603 Cellulitis without MCC | 14 | $29,216 | -22% | $7,970 |
| 690 Kidney and Urinary Tract Infections without MCC | 13 | $25,607 | -32% | $7,018 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 13 | $95,621 | -58% | $36,678 |
| 281 Acute Myocardial Infarction, Discharged Alive with CC | 12 | $33,432 | -34% | $8,495 |
| 543 Pathological Fractures and Musculoskeletal and Connective... | 11 | $29,159 | -41% | $9,896 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 11 | $41,219 | -32% | $12,086 |
| 683 Renal Failure with CC | 11 | $24,175 | -41% | $8,113 |
| 689 Kidney and Urinary Tract Infections with MCC | 11 | $31,407 | -39% | $9,376 |
Outpatient services
Against the Wisconsin average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), SSM Health Monroe Hospital charged $53,593 on average, 10% less than the Wisconsin average of $59,481, and was paid $16,063 against a state average of $16,719. For Heart Failure and Shock with MCC (DRG 291), SSM Health Monroe Hospital charged $32,361 on average, 18% less than the Wisconsin average of $39,564, and was paid $11,159 against a state average of $10,862. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), SSM Health Monroe Hospital charged $33,633 on average, 2% less than the Wisconsin average of $34,158, and was paid $10,358 against a state average of $8,925. For Simple Pneumonia and Pleurisy with MCC (DRG 193), SSM Health Monroe Hospital charged $37,742 on average, 6% less than the Wisconsin average of $40,070, and was paid $11,938 against a state average of $11,231. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $13,348 was 16% above the state average of $11,485. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $16,945 was 4% below the state average of $17,717. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $1,913 was 14% below the state average of $2,237. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $5,593 was 37% below the state average of $8,908.
Price-transparency record
CMS's enforcement list records these actions for a hospital named SSM Health Monroe Hospital in Monroe, WI, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-08-01 (CMS case 6079)
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.