Wisconsin / SSM Health St Mary's Hospital - Janesville
CMS certification 520208 · Janesville, WI · 2 entries in CMS's price-transparency list
SSM Health St Mary's Hospital - Janesville: charges and Medicare payments
SSM Health St Mary's Hospital - Janesville reported 448 Medicare inpatient stays across 18 DRGs in 2024. Across them it charged 4.45 times what it was paid — among the higher ratios in Wisconsin, number 10 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: 100 stays at an average charge of $50,090, 45% below the national average. It also billed 996 outpatient services, charging 5.57 times what Medicare paid.
- 1Medicare inpatient stays 448
- 2Charge ÷ paid, inpatient 4.45×
- 3Rank in WI (highest ratio = 1) 10 of 55
- 4CMS price-transparency actions 2
Inpatient stays
For the 18 DRGs that can be compared with the national average, SSM Health St Mary's Hospital - Janesville 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 | 100 | $50,090 | -45% | $13,584 |
| 291 Heart Failure and Shock with MCC | 78 | $40,942 | -27% | $8,879 |
| 177 Respiratory Infections and Inflammations with MCC | 29 | $52,526 | -26% | $11,545 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 25 | $45,066 | -8% | $8,109 |
| 543 Pathological Fractures and Musculoskeletal and Connective... | 20 | $37,673 | -23% | $7,652 |
| 193 Simple Pneumonia and Pleurisy with MCC | 18 | $42,374 | -29% | $9,269 |
| 194 Simple Pneumonia and Pleurisy with CC | 18 | $31,008 | -19% | $6,594 |
| 603 Cellulitis without MCC | 18 | $30,196 | -19% | $6,486 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 16 | $53,311 | -30% | $10,804 |
| 378 Gastrointestinal Hemorrhage with CC | 16 | $35,583 | -27% | $6,764 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 16 | $47,596 | -35% | $11,720 |
| 178 Respiratory Infections and Inflammations with CC | 15 | $39,018 | -14% | $6,850 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 14 | $39,119 | -3% | $5,792 |
| 683 Renal Failure with CC | 14 | $26,520 | -35% | $6,411 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 13 | $37,914 | -25% | $8,023 |
| 312 Syncope and Collapse | 13 | $42,498 | -7% | $8,279 |
| 690 Kidney and Urinary Tract Infections without MCC | 13 | $29,779 | -21% | $6,659 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 12 | $39,661 | -34% | $8,001 |
Outpatient services
Against the Wisconsin average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), SSM Health St Mary's Hospital - Janesville charged $50,090 on average, 16% less than the Wisconsin average of $59,481, and was paid $13,584 against a state average of $16,719. For Heart Failure and Shock with MCC (DRG 291), SSM Health St Mary's Hospital - Janesville charged $40,942 on average, 3% more than the Wisconsin average of $39,564, and was paid $8,879 against a state average of $10,862. For Respiratory Infections and Inflammations with MCC (DRG 177), SSM Health St Mary's Hospital - Janesville charged $52,526 on average, 1% more than the Wisconsin average of $52,035, and was paid $11,545 against a state average of $14,345. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), SSM Health St Mary's Hospital - Janesville charged $45,066 on average, 32% more than the Wisconsin average of $34,158, and was paid $8,109 against a state average of $8,925. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $9,877 was 14% below the state average of $11,485. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $21,011 was 19% above the state average of $17,717. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $41,459 was 18% below the state average of $50,282. For Level 2 Upper GI Procedures (outpatient APC 5302), its average charge of $6,584 was 43% below the state average of $11,645.
Price-transparency record
CMS's enforcement list records these actions for a hospital named SSM Health St Mary's Hospital - Janesville in Janesville, WI, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2023-05-30 (CMS case 1164)
- Met Requirements — 2025-04-17 (CMS case 3910)
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.