SSM Health St Mary's Hospital - Madison: charges and Medicare payments

SSM Health St Mary's Hospital - Madison reported 5,197 Medicare inpatient stays across 148 DRGs in 2024. Across them it charged 4.3 times what it was paid — among the higher ratios in Wisconsin, number 14 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: 384 stays at an average charge of $67,914, 25% below the national average. It also billed 3,996 outpatient services, charging 5.69 times what Medicare paid.

1Medicare inpatient stays 5,197
2Charge ÷ paid, inpatient 4.3×
3Rank in WI (highest ratio = 1) 14 of 55
4CMS price-transparency actions 0

Average charge per stay at SSM Health St Mary's Hospital - Madison, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 148 DRGs that can be compared with the national average, SSM Health St Mary's Hospital - Madison charged more than the national average in 2 (1%). 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	384	$67,914	-25%	$15,465
291 Heart Failure and Shock with MCC	265	$42,076	-25%	$9,864
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	124	$72,113	-28%	$16,030
177 Respiratory Infections and Inflammations with MCC	116	$55,032	-22%	$12,585
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	114	$46,607	-16%	$7,679
280 Acute Myocardial Infarction, Discharged Alive with MCC	100	$51,538	-32%	$12,857
378 Gastrointestinal Hemorrhage with CC	100	$34,347	-29%	$7,630
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	97	$41,073	-16%	$7,988
267 Endovascular Cardiac Valve Replacement and Supplement...	95	$141,767	-36%	$36,401
481 Hip and Femur Procedures except Major Joint with CC	93	$66,931	-34%	$15,710
274 Percutaneous and Other Intracardiac Procedures without MCC	83	$100,273	-36%	$24,007
193 Simple Pneumonia and Pleurisy with MCC	80	$44,209	-26%	$10,557
322 Percutaneous Cardiovascular Procedures with Intraluminal...	79	$66,139	-42%	$14,537
853 Infectious and Parasitic Diseases with O.R. Procedures with...	76	$156,757	-32%	$41,515
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	73	$32,282	-20%	$6,202
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	63	$67,821	-34%	$15,859
543 Pathological Fractures and Musculoskeletal and Connective...	61	$38,596	-21%	$8,224
377 Gastrointestinal Hemorrhage with MCC	58	$50,817	-40%	$13,740
220 Cardiac Valve and Other Major Cardiothoracic Procedures...	57	$192,288	-30%	$40,075
321 Percutaneous Cardiovascular Procedures with Intraluminal...	56	$89,779	-45%	$22,257
309 Cardiac Arrhythmia and Conduction Disorders with CC	55	$30,245	-16%	$6,748
330 Major Small and Large Bowel Procedures with CC	52	$68,170	-43%	$17,866
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	50	$26,781	-28%	$6,309
493 Lower Extremity and Humerus Procedures except Hip, Foot and...	49	$77,932	-35%	$17,974
690 Kidney and Urinary Tract Infections without MCC	49	$30,888	-18%	$6,393
236 Coronary Bypass without Cardiac Catheterization without MCC	48	$145,655	-31%	$30,050
281 Acute Myocardial Infarction, Discharged Alive with CC	48	$37,667	-25%	$7,099
683 Renal Failure with CC	47	$30,461	-25%	$6,976
552 Medical Back Problems without MCC	46	$41,082	-16%	$7,351
418 Laparoscopic Cholecystectomy without C.D.E. with CC	45	$63,279	-32%	$12,527
287 Circulatory Disorders except AMI, with Cardiac...	44	$47,410	-26%	$8,651
025 Craniotomy and Endovascular Intracranial Procedures with MCC	43	$119,310	-48%	$33,201
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	43	$42,985	-34%	$10,599
682 Renal Failure with MCC	43	$45,522	-31%	$12,082
698 Other Kidney and Urinary Tract Diagnoses with MCC	43	$55,638	-24%	$14,368
100 Seizures with MCC	42	$76,343	-19%	$17,026
189 Pulmonary Edema and Respiratory Failure	42	$38,434	-33%	$9,854
467 Revision of Hip or Knee Replacement with CC	41	$89,553	-43%	$26,244
689 Kidney and Urinary Tract Infections with MCC	41	$37,831	-26%	$8,709
312 Syncope and Collapse	40	$30,822	-32%	$6,774
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	40	$43,231	-28%	$9,921
480 Hip and Femur Procedures except Major Joint with MCC	39	$105,372	-24%	$23,014
243 Permanent Cardiac Pacemaker Implant with CC	38	$71,917	-35%	$17,207
286 Circulatory Disorders except AMI, with Cardiac...	38	$63,062	-44%	$17,187
813 Coagulation Disorders	38	$40,374	-50%	$12,348
057 Degenerative Nervous System Disorders without MCC	36	$43,407	-23%	$10,411
234 Coronary Bypass with Cardiac Catheterization or Open...	36	$192,113	-29%	$38,284
660 Kidney and Ureter Procedures for Non-Neoplasm with CC	36	$38,578	-43%	$10,329
219 Cardiac Valve and Other Major Cardiothoracic Procedures...	35	$257,392	-35%	$61,720
854 Infectious and Parasitic Diseases with O.R. Procedures with...	35	$56,382	-43%	$15,352
023 Craniotomy with Major Device Implant or Acute Complex Cns...	32	$186,124	-34%	$41,637
178 Respiratory Infections and Inflammations with CC	32	$34,861	-23%	$7,451
445 Disorders of The Biliary Tract with CC	32	$39,825	-32%	$8,703
884 Organic Disturbances and Intellectual Disability	32	$43,302	-31%	$12,714
101 Seizures without MCC	31	$40,259	-17%	$7,060
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	30	$46,315	-24%	$10,014
603 Cellulitis without MCC	30	$30,175	-19%	$6,958
470 Major Hip and Knee Joint Replacement or Reattachment of...	29	$59,690	-36%	$14,316
308 Cardiac Arrhythmia and Conduction Disorders with MCC	28	$43,045	-24%	$9,366
394 Other Digestive System Diagnoses with CC	28	$30,930	-34%	$7,331

Showing the 60 most frequent of 148 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	616	$20,966	$2,522
Level 1 Endovascular Procedures	558	$24,914	$3,035
Level 5 Musculoskeletal Procedures	305	$41,890	$12,129
Level 5 Urology and Related Services	292	$20,663	$4,817
Level 3 Endovascular Procedures	208	$42,629	$10,220
Level 2 Excision/ Biopsy/ Incision and Drainage	203	$10,137	$1,513
Level 4 Urology and Related Services	157	$15,515	$3,238
Level 4 Musculoskeletal Procedures	153	$27,566	$6,600
Level 2 Upper GI Procedures	145	$9,497	$1,757
Level 1 Laparoscopy and Related Services	124	$26,389	$5,361
Level 3 Vascular Procedures	114	$11,077	$2,934
Level 3 Excision/ Biopsy/ Incision and Drainage	106	$16,979	$2,653
Level 3 Electrophysiologic Procedures	102	$93,689	$21,754
Level 2 Endovascular Procedures	87	$22,450	$5,330
Level 3 Urology and Related Services	84	$8,230	$1,867
Level 2 Vascular Procedures	81	$6,383	$1,481
Level 3 Pacemaker and Similar Procedures	81	$35,838	$9,960
Level 2 Laparoscopy and Related Services	67	$38,906	$9,603
Level 6 Musculoskeletal Procedures	64	$63,901	$17,359
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	62	$11,674	$3,230
Level 4 Endovascular Procedures	48	$68,630	$16,029
Level 2 Breast/Lymphatic Surgery and Related Procedures	43	$29,933	$6,087
Level 3 Upper GI Procedures	40	$17,999	$3,575
Level 2 Pacemaker and Similar Procedures	39	$30,451	$7,931
Level 4 Vascular Procedures	34	$26,985	$5,010

Against the Wisconsin average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), SSM Health St Mary's Hospital - Madison charged $67,914 on average, 14% more than the Wisconsin average of $59,481, and was paid $15,465 against a state average of $16,719. For Heart Failure and Shock with MCC (DRG 291), SSM Health St Mary's Hospital - Madison charged $42,076 on average, 6% more than the Wisconsin average of $39,564, and was paid $9,864 against a state average of $10,862. For Intracranial Hemorrhage or Cerebral Infarction with MCC (DRG 064), SSM Health St Mary's Hospital - Madison charged $72,113 on average, 5% more than the Wisconsin average of $68,633, and was paid $16,030 against a state average of $17,545. For Respiratory Infections and Inflammations with MCC (DRG 177), SSM Health St Mary's Hospital - Madison charged $55,032 on average, 6% more than the Wisconsin average of $52,035, and was paid $12,585 against a state average of $14,345. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $20,966 was 18% above the state average of $17,717. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $24,914 was 5% above the state average of $23,760. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $41,890 was 17% below the state average of $50,282. For Level 5 Urology and Related Services (outpatient APC 5375), its average charge of $20,663 was 19% below the state average of $25,384.

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.