Simple pneumonia and pleurisy with complications in Wisconsin
What 23 hospitals in Wisconsin charged and were paid for a Medicare hospital stay for simple pneumonia and pleurisy with complications (DRG 194), from 2024 Medicare claims.
Average charge
$28,163
Hospital list price billed
Average payment
$7,255
Medicare + patient + other payers
Medicare paid
$5,116
Average per stay
State rank
#16 of 47
1 = lowest average payment
Hospitals in Wisconsin billed an average of $28,163 for simple pneumonia and pleurisy with complications, about 3.9 times the average total payment of $7,255. That payment is 9% below the U.S. average of $7,941.
These are averages for patients with original (fee-for-service) Medicare. Private insurance pays different, negotiated prices, and what you owe depends on your plan's deductible and coinsurance. Use these figures to compare hospitals, not as a quote.
Paid $7,255Billed $28,163
About 26¢ was paid for every $1 hospitals in Wisconsin billed for this stay.
Medicare prices this stay in 3 versions, by how sick the patient was. Compare them in Wisconsin:
Wisconsin hospitals: simple pneumonia and pleurisy with complications
Every Wisconsin hospital that billed Medicare for this stay at least 11 times. Click a column to sort.
| Hospital | Stays | Avg charge | Avg payment | Medicare paid |
|---|---|---|---|---|
| Waukesha Memorial HospitalWaukesha | 46 | $27,980 | $5,454 | $4,128 |
| Luther Hospital Mayo Health SystemEau Claire | 33 | $25,157 | $6,923 | $4,900 |
| Froedtert SouthKenosha | 25 | $29,863 | $6,515 | $5,405 |
| Oconomowoc Mem HsptlOconomowoc | 24 | $24,786 | $5,468 | $4,040 |
| Ascension SE Wisconsin HospitalMilwaukee | 24 | $21,128 | $8,068 | $5,219 |
| Froedtert Mem Lutheran HsptlMilwaukee | 24 | $31,250 | $10,485 | $5,610 |
| Wheaton Franciscan Healthcare- All SaintsRacine | 20 | $20,850 | $7,321 | $5,881 |
| University of Wi Hospitals & Clinics AuthorityMadison | 19 | $40,026 | $10,296 | $6,631 |
| Columbia St Marys Hsptl Milw (Col & Milw Campus)Milwaukee | 18 | $32,854 | $7,638 | $5,816 |
| St Mary's HospitalMadison | 18 | $35,829 | $7,245 | $4,566 |
| SSM Health St Mary's Hospital - JanesvilleJanesville | 18 | $31,008 | $6,594 | $4,545 |
| Mayo Clinic Health System-Franciscan Medical CenterLa Crosse | 17 | $21,454 | $7,459 | $5,517 |
| Aurora Med Ctr KenoshaKenosha | 17 | $27,933 | $8,831 | $4,503 |
| Meriter HsptlMadison | 16 | $27,507 | $6,660 | $5,267 |
| UW Hlth Partners - Watertown Regional Medical CtrWatertown | 16 | $24,660 | $7,038 | $5,023 |
| Aurora St Lukes Medical CenterMilwaukee | 16 | $47,219 | $7,698 | $5,862 |
| Monroe ClinicMonroe | 15 | $30,012 | $7,076 | $5,341 |
| Gundersen Luth Med CtrLa Crosse | 15 | $18,080 | $7,414 | $5,725 |
| Aurora West Allis Medical CenterWest Allis | 15 | $33,509 | $7,189 | $4,611 |
| St Elizabeth HsptlAppleton | 13 | $14,558 | $6,692 | $5,236 |
| Mercy Hlth Sys CorpJanesville | 13 | $34,840 | $6,623 | $4,955 |
| Aurora Sheboygan Mem Med CtrSheboygan | 11 | $24,462 | $6,259 | $5,072 |
| St Clare Hsptl Hlth SvcsBaraboo | 11 | $22,867 | $7,958 | $5,783 |
Lowest and highest payments in Wisconsin
Among hospitals with at least 11 Medicare hospital stays. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| Waukesha Memorial HospitalWaukesha, WI | $5,454 |
|---|---|
| Oconomowoc Mem HsptlOconomowoc, WI | $5,468 |
| Aurora Sheboygan Mem Med CtrSheboygan, WI | $6,259 |
| Froedtert SouthKenosha, WI | $6,515 |
| SSM Health St Mary's Hospital - JanesvilleJanesville, WI | $6,594 |
Highest
| Froedtert Mem Lutheran HsptlMilwaukee, WI | $10,485 |
|---|---|
| University of Wi Hospitals & Clinics AuthorityMadison, WI | $10,296 |
| Aurora Med Ctr KenoshaKenosha, WI | $8,831 |
| Ascension SE Wisconsin HospitalMilwaukee, WI | $8,068 |
| St Clare Hsptl Hlth SvcsBaraboo, WI | $7,958 |
Simple pneumonia and pleurisy with complications in other states
Questions
How much does simple pneumonia and pleurisy with complications cost in Wisconsin?
In 2024 Medicare data, a hospital stay for simple pneumonia and pleurisy with complications (DRG 194) at 23 hospitals in Wisconsin was billed at $28,163 on average, while the average total payment was $7,255, of which Medicare paid $5,116. Your own cost depends on your insurance, deductible and the hospital.
Why are hospital charges so much higher than payments?
Charges are a hospital's list prices. Medicare pays fixed rates set in advance, and private insurers negotiate their own discounts, so almost nobody pays the full charge. For this stay in Wisconsin, average charges were 3.9 times the average payment. Uninsured patients can ask the hospital about its financial assistance (charity care) policy and cash prices.
Source: CMS, Medicare Inpatient Hospitals by Provider and Service, 2024. Average total payment includes Medicare's payment, the patient's deductible and coinsurance, and any other payer. CMS omits hospitals with fewer than 11 hospital stays for privacy. About the data.