Prohealth Care · Oconomowoc, WI
35
In-network payers
394
Disclosed rate categories
156
Beds
4
Care quality
Prohealth Oconomowoc Memorial Hospital is a 156-bed voluntary non-profit - private hospital in Oconomowoc, WI, affiliated with Prohealth Care. Below you'll find publicly disclosed negotiated rates and facility details, including 35 in-network payers and 394 disclosed rate categories.
CCN (Medicare provider number)
520062
NPI
1366420531
Type
Short Term Acute Care Hospital
Ownership
Voluntary Non-Profit - Private
Beds
156
Care Quality
4
Insurance acceptance may vary by specific plan, network status, and services required. Contact your insurance provider or the hospital's billing department to confirm coverage details.
The 24 services Prohealth Oconomowoc Memorial Hospital most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.
Book a demo to see hidden insurer names, more payer rates, and hospital data.
Childbirth · Inpatient
MS-DRG 807
$9,552 - $10,185
from 2 insurers · median $9,868
CMS lists this service as CPT 59400, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports neonatal nursery services to CMS
Childbirth · Inpatient
MS-DRG 788
$12,834 - $15,480
from 2 insurers · median $14,157
CMS lists this service as CPT 59510, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 788, so these are facility case rates.
Hospital reports neonatal nursery services to CMS
Medicine & Surgery · Inpatient
MS-DRG 470
$30,373 - $44,128
from 2 insurers · median $37,251
28 Medicare discharges for this DRG in CMS hospital data
Gynecology
CPT 58558
$6,359 - $9,287
from 3 insurers · median $6,406
13 Medicare claims in Level 4 Gynecologic Procedures (CMS 2024)
CT imaging
CPT 74177
$644 - $6,457
from 3 insurers · median $1,043
Common here, based on CMS Medicare volume
Childbirth · Inpatient
MS-DRG 807
$9,552 - $10,185
from 2 insurers · median $9,868
CMS lists this service as CPT 59610, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports neonatal nursery services to CMS
Cardiology and vascular testing
CPT 93306
$1,698 - $2,479
from 2 insurers · median $2,089
Common here, based on CMS Medicare volume
Gynecology
CPT 58571
$9,611 - $30,411
from 2 insurers · median $20,011
Typical for a hospital with this service line
Digestive procedures
CPT 45385
$3,652 - $5,344
from 2 insurers · median $4,498
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 47562
$9,611 - $22,909
from 3 insurers · median $12,664
Typical for a hospital with this service line
Digestive procedures
CPT 43239
$2,904 - $5,344
from 2 insurers · median $4,124
Common here, based on CMS Medicare volume
Nuclear imaging
CPT 78452
$2,053 - $5,435
from 3 insurers · median $3,894
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45380
$3,652 - $5,344
from 2 insurers · median $4,498
Common here, based on CMS Medicare volume
Urology
CPT 52000
$2,068 - $3,865
from 3 insurers · median $3,848
118 Medicare claims in Level 2 Urology and Related Services (CMS 2024)
Digestive procedures
CPT 49650
$9,611 - $22,909
from 2 insurers · median $16,260
Typical for a hospital with this service line
Medicine & Surgery
CPT 66984
$6,406 - $6,662
from 2 insurers · median $6,534
Typical for a hospital with this service line
Mammography
CPT 77067
$166 - $350
from 2 insurers · median $258
Common here, based on CMS Medicare volume
Medicine & Surgery · Inpatient
MS-DRG 473
$37,609 - $39,534
from 2 insurers · median $38,572
Hospital reports orthopedic surgery services to CMS
X-ray and bone density
CPT 71046
$104 - $320
from 3 insurers · median $242
Common here, based on CMS Medicare volume
Orthopedics and pain
CPT 27446
$11,695 - $37,584
from 3 insurers · median $28,888
403 Medicare claims in Level 5 Musculoskeletal Procedures (CMS 2024)
Medicine & Surgery
CPT 42820
$6,406 - $17,279
from 2 insurers · median $11,843
Typical for a hospital with this service line
MRI imaging
CPT 70553
$644 - $5,350
from 3 insurers · median $1,043
Common here, based on CMS Medicare volume
CT imaging
CPT 70450
$188 - $311
from 2 insurers · median $249
Common here, based on CMS Medicare volume
Urology
CPT 50590
$9,465 - $11,588
from 3 insurers · median $9,611
30 Medicare claims in Level 4 Urology and Related Services (CMS 2024)
Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.
| Insurer | Services | Median % of Medicare | Above nearby | Below nearby |
|---|---|---|---|---|
| Insurer A* | 11 | 395% | 4 | 3 |
| Insurer B* | 23 | 292% | 11 | 8 |
| Insurer C* | 23 | 181% | 6 | 14 |
How we chose these services: 5 appear in this hospital's own Medicare claims, 10 are common here based on CMS Medicare volume, and 9 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for Prohealth Oconomowoc Memorial Hospital.
791 Summit Avenue, Oconomowoc, WI 53066
(262) 569-9400
The nearest hospitals of similar type and size. Their rates are compared with Prohealth Oconomowoc Memorial Hospital for the same insurers and services above.
Aurora Medical Center Summit
Rates about the same as Prohealth Oconomowoc Memorial Hospital (20 services)
Watertown Regional Medical Center
Rates about the same as Prohealth Oconomowoc Memorial Hospital (21 services)
Froedtert Menomonee Falls Hospital
Rates about the same as Prohealth Oconomowoc Memorial Hospital (21 services)
St. Francis Hospital
▼ Rates typically 12% lower than Prohealth Oconomowoc Memorial Hospital (21 services)
Marshfield Medical Center Beaver Dam
▲ Rates typically 25% higher than Prohealth Oconomowoc Memorial Hospital (21 services)
Aurora Lakeland Medical Center
Rates about the same as Prohealth Oconomowoc Memorial Hospital (20 services)
Prohealth Waukesha Memorial Hospital
Aspirus Rhinelander Hospital
All Saints Hospital Spring Street
Midwest Orthopedic Specialty Hosp
About Prohealth Oconomowoc Memorial Hospital's rates and hospital price transparency.
For MRI brain before and after contrast (CPT 70553), published negotiated rates at Prohealth Oconomowoc Memorial Hospital range from $644 to $5,350 across 3 insurers. UnitedHealthcare's rate is $644. The median at nearby comparable hospitals is $2,132. What a patient pays depends on their plan's deductible, coinsurance and network status.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Prohealth Oconomowoc Memorial Hospital range from $644 to $6,457 across 3 insurers. Blue Cross Blue Shield's rate is $1,043. The median at nearby comparable hospitals is $1,691. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Colonoscopy with polyp removal (CPT 45385), published negotiated rates at Prohealth Oconomowoc Memorial Hospital range from $3,652 to $5,344 across 2 insurers. UnitedHealthcare's rate is $5,344. The median at nearby comparable hospitals is $4,095. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Vaginal delivery, hospital stay (MS-DRG 807), published negotiated rates at Prohealth Oconomowoc Memorial Hospital range from $9,552 to $10,185 across 2 insurers. Blue Cross Blue Shield's rate is $10,185. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Prohealth Oconomowoc Memorial Hospital range from $166 to $350 across 2 insurers. UnitedHealthcare's rate is $166. The median at nearby comparable hospitals is $300. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Major lower-extremity joint replacement without MCC (MS-DRG 470), published negotiated rates at Prohealth Oconomowoc Memorial Hospital range from $30,373 to $44,128 across 2 insurers. Blue Cross Blue Shield's rate is $30,373. The median at nearby comparable hospitals is $30,891. What a patient pays depends on their plan's deductible, coinsurance and network status.
Prohealth Oconomowoc Memorial Hospital has 156 beds. Facility type: Short Term Acute Care Hospital.
Prohealth Oconomowoc Memorial Hospital is located at 791 Summit Avenue, Oconomowoc, WI 53066. Its main phone number is (262) 569-9400.
Prohealth Oconomowoc Memorial Hospital's CMS Certification Number (CCN), also called its Medicare provider number, is 520062.
The National Provider Identifier (NPI) on file for Prohealth Oconomowoc Memorial Hospital is 1366420531.
Prohealth Oconomowoc Memorial Hospital is affiliated with Prohealth Care.
Prohealth Oconomowoc Memorial Hospital lists 35 in-network payers, including Aetna, Ameri Health, Aspirus Health Plan, Avera Health Plans, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
394 disclosed rate categories. Each shows the payer, category, code type and group with its code range, and contract type, along with how the rate compares with the state average.
Under 45 CFR Part 180, every US hospital must publish a machine-readable file of its standard charges, including gross charges, discounted cash prices and payer-specific negotiated rates, in the CMS template format. PayerPrice can help hospitals publish and maintain these files.
A chargemaster (charge description master, or CDM) is a hospital's master list of billable items, with codes, descriptions and gross charges. A chargemaster review looks at those lines for accuracy and pricing. PayerPrice can help hospitals review their chargemaster; contact us to discuss your needs.
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The data on this page comes from the files hospitals and payers publish. We help hospitals publish theirs correctly, and take a fresh look at their chargemaster.
We turn your chargemaster and payer contracts into the CMS template file, then keep it current as rates change.
{
"description": "MRI of brain (no contrast)",
"code_information": [
{ "code": "611", "type": "RC" },
{ "code": "70551", "type": "CPT" }
],
"standard_charges": [{
"setting": "outpatient",
"minimum": 250,
"maximum": 400,
"gross_charge": 1200,
"discounted_cash": 1080,
"payers_information": [
{
"payer_name": "Platform Health Insurance",
"plan_name": "PPO",
"methodology": "fee schedule",
"standard_charge_dollar": 400
},
{
"payer_name": "Region Health Insurance",
"plan_name": "HMO",
"methodology": "fee schedule",
"standard_charge_dollar": 250
}
]
}]
}Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.
What a review covers