Wisconsin / St Nicholas Hospital
CMS certification 520044 · Sheboygan, WI
St Nicholas Hospital: charges and Medicare payments
St Nicholas Hospital reported 98 Medicare inpatient stays across 5 DRGs in 2024. Across them it charged 3.46 times what it was paid. Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 41 stays at an average charge of $48,081, 47% below the national average. It also billed 639 outpatient services, charging 7.08 times what Medicare paid.
- 1Medicare inpatient stays 98
- 2Charge ÷ paid, inpatient 3.46×
- 3Rank in WI (highest ratio = 1) –
- 4CMS price-transparency actions 0
Inpatient stays
For the 5 DRGs that can be compared with the national average, St Nicholas 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 | 41 | $48,081 | -47% | $15,325 |
| 177 Respiratory Infections and Inflammations with MCC | 16 | $41,979 | -41% | $11,403 |
| 189 Pulmonary Edema and Respiratory Failure | 14 | $39,152 | -32% | $8,863 |
| 291 Heart Failure and Shock with MCC | 14 | $36,448 | -35% | $9,802 |
| 193 Simple Pneumonia and Pleurisy with MCC | 13 | $35,314 | -41% | $9,941 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 1 Intraocular Procedures | 190 | $10,429 | $2,112 |
| Comprehensive Observation Services | 99 | $18,165 | $2,472 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 43 | $10,608 | $1,453 |
| Level 5 Urology and Related Services | 41 | $26,550 | $4,527 |
| Level 1 Nerve Procedures | 39 | $10,710 | $1,722 |
| Level 5 Musculoskeletal Procedures | 38 | $50,796 | $11,698 |
| Level 2 Upper GI Procedures | 31 | $11,513 | $1,732 |
| Level 3 Vascular Procedures | 28 | $14,270 | $2,901 |
| Level 4 Urology and Related Services | 26 | $16,841 | $3,076 |
| Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 19 | $20,811 | $3,149 |
| Level 1 Laparoscopy and Related Services | 17 | $40,943 | $5,017 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 16 | $22,470 | $2,587 |
| Level 3 Musculoskeletal Procedures | 14 | $16,984 | $2,946 |
| Level 3 Urology and Related Services | 14 | $18,682 | $1,854 |
| Level 2 Vascular Procedures | 13 | $6,893 | $1,458 |
| Level 2 Laparoscopy and Related Services | 11 | $44,743 | $8,662 |
Against the Wisconsin average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), St Nicholas Hospital charged $48,081 on average, 19% less than the Wisconsin average of $59,481, and was paid $15,325 against a state average of $16,719. For Respiratory Infections and Inflammations with MCC (DRG 177), St Nicholas Hospital charged $41,979 on average, 19% less than the Wisconsin average of $52,035, and was paid $11,403 against a state average of $14,345. For Pulmonary Edema and Respiratory Failure (DRG 189), St Nicholas Hospital charged $39,152 on average, 3% less than the Wisconsin average of $40,535, and was paid $8,863 against a state average of $10,823. For Heart Failure and Shock with MCC (DRG 291), St Nicholas Hospital charged $36,448 on average, 8% less than the Wisconsin average of $39,564, and was paid $9,802 against a state average of $10,862. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $10,429 was 9% below the state average of $11,485. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $18,165 was 3% above the state average of $17,717. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $10,608 was 19% above the state average of $8,908. For Level 5 Urology and Related Services (outpatient APC 5375), its average charge of $26,550 was 5% above 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.