Prohealth Care · Waukesha, WI
38
In-network payers
401
Disclosed rate categories
400
Beds
3
Care quality
Prohealth Waukesha Memorial Hospital is a 400-bed voluntary non-profit - private hospital in Waukesha, WI, affiliated with Prohealth Care. Below you'll find publicly disclosed negotiated rates and facility details, including 38 in-network payers and 401 disclosed rate categories.
CCN (Medicare provider number)
520008
NPI
1629056890
Type
Short Term Acute Care Hospital
Ownership
Voluntary Non-Profit - Private
Beds
400
Care Quality
3
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 Waukesha 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
$8,837 - $10,352
from 3 insurers · median $9,759
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
$10,648 - $13,909
from 3 insurers · median $11,449
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
CT imaging
CPT 74177
$644 - $6,437
from 2 insurers · median $3,541
Common here, based on CMS Medicare volume
Gynecology
CPT 58558
$6,595 - $8,715
from 2 insurers · median $7,655
30 Medicare claims in Level 4 Gynecologic Procedures (CMS 2024)
Medicine & Surgery
CPT 47562
$10,464 - $12,361
from 2 insurers · median $11,412
128 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Gynecology
CPT 58571
$10,464 - $21,047
from 2 insurers · median $15,756
58 Medicare claims in Level 2 Laparoscopy and Related Services (CMS 2024)
Digestive procedures
CPT 45385
$5,665 - $5,825
from 2 insurers · median $5,745
Common here, based on CMS Medicare volume
Digestive procedures
CPT 49650
$10,464 - $11,869
from 2 insurers · median $11,167
128 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Childbirth · Inpatient
MS-DRG 807
$8,837 - $10,352
from 3 insurers · median $9,759
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
Medicine & Surgery · Inpatient
MS-DRG 216
$171,139 - $176,472
from 2 insurers · median $173,805
Hospital reports cardiac thoracic surgery services to CMS
MRI imaging
CPT 70553
$644 - $5,035
from 2 insurers · median $2,840
Common here, based on CMS Medicare volume
Digestive procedures
CPT 43239
$3,785 - $5,665
from 2 insurers · median $4,725
Common here, based on CMS Medicare volume
Digestive procedures
CPT 47563
$10,464 - $16,488
from 2 insurers · median $13,476
128 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Medicine & Surgery · Inpatient
MS-DRG 460
$60,648
negotiated rate
28 Medicare discharges for this DRG in CMS hospital data
Medicine & Surgery
CPT 55866
$12,540 - $39,436
from 2 insurers · median $25,988
58 Medicare claims in Level 2 Laparoscopy and Related Services (CMS 2024)
Mammography
CPT 77067
$166 - $343
from 2 insurers · median $255
Common here, based on CMS Medicare volume
Nuclear imaging
CPT 78452
$2,053 - $4,396
from 2 insurers · median $3,225
Common here, based on CMS Medicare volume
Nuclear imaging
CPT 78815
$2,297 - $6,879
from 2 insurers · median $4,588
Common here, based on CMS Medicare volume
Urology
CPT 52000
$3,901 - $4,159
from 2 insurers · median $4,030
220 Medicare claims in Level 2 Urology and Related Services (CMS 2024)
Urology
CPT 50590
$9,269 - $10,464
from 2 insurers · median $9,867
125 Medicare claims in Level 4 Urology and Related Services (CMS 2024)
MRI imaging
CPT 72148
$385 - $3,488
from 2 insurers · median $1,936
Common here, based on CMS Medicare volume
X-ray and bone density
CPT 71046
$104 - $299
from 2 insurers · median $201
Common here, based on CMS Medicare volume
MRI imaging
CPT 74183
$644 - $4,885
from 2 insurers · median $2,765
Common here, based on CMS Medicare volume
Gynecology
CPT 58661
$10,464 - $13,828
from 2 insurers · median $12,146
Typical for a hospital with this service line
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* | 22 | 363% | 15 | 3 |
| Insurer B* | 24 | 169% | 3 | 18 |
| Insurer C* | 4 | - | 0 | 0 |
How we chose these services: 9 appear in this hospital's own Medicare claims, 10 are common here based on CMS Medicare volume, and 5 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 Waukesha Memorial Hospital.
725 American Avenue, Waukesha, WI 53188
(262) 928-1000
The nearest hospitals of similar type and size. Their rates are compared with Prohealth Waukesha Memorial Hospital for the same insurers and services above.
West Allis Memorial Hospital
▲ Rates typically 19% higher than Prohealth Waukesha Memorial Hospital (21 services)
Froedtert Hospital
▲ Rates typically 8% higher than Prohealth Waukesha Memorial Hospital (21 services)
Froedtert Menomonee Falls Hospital
Rates about the same as Prohealth Waukesha Memorial Hospital (21 services)
Ascension Se Wisconsin Hospital - St. Joseph Campus
▲ Rates typically 10% higher than Prohealth Waukesha Memorial Hospital (21 services)
St. Francis Hospital
Rates about the same as Prohealth Waukesha Memorial Hospital (21 services)
Aurora Sinai Medical Center
▲ Rates typically 13% higher than Prohealth Waukesha Memorial Hospital (19 services)
Ascension Wisconsin Hospital - Waukesha
Prohealth Oconomowoc Memorial Hospital
Mayo Clinic Health System - Franciscan Healthcare La Crosse
Froedtert Community Hospital - New Berlin
About Prohealth Waukesha Memorial Hospital's rates and hospital price transparency.
For MRI brain before and after contrast (CPT 70553), published negotiated rates at Prohealth Waukesha Memorial Hospital range from $644 to $5,035 across 2 insurers. UnitedHealthcare's rate is $644. The median at nearby comparable hospitals is $3,117. 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 Waukesha Memorial Hospital range from $644 to $6,437 across 2 insurers. Aetna's rate is $6,437. The median at nearby comparable hospitals is $2,415. 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 Waukesha Memorial Hospital range from $5,665 to $5,825 across 2 insurers. Aetna's rate is $5,825. The median at nearby comparable hospitals is $3,902. 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 Waukesha Memorial Hospital range from $8,837 to $10,352 across 3 insurers. Blue Cross Blue Shield's rate is $9,759. 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 Waukesha Memorial Hospital range from $166 to $343 across 2 insurers. UnitedHealthcare's rate is $166. The median at nearby comparable hospitals is $266. What a patient pays depends on their plan's deductible, coinsurance and network status.
Prohealth Waukesha Memorial Hospital has 400 beds. Facility type: Short Term Acute Care Hospital.
Prohealth Waukesha Memorial Hospital is located at 725 American Avenue, Waukesha, WI 53188. Its main phone number is (262) 928-1000.
Prohealth Waukesha Memorial Hospital's CMS Certification Number (CCN), also called its Medicare provider number, is 520008.
The National Provider Identifier (NPI) on file for Prohealth Waukesha Memorial Hospital is 1629056890.
Prohealth Waukesha Memorial Hospital is affiliated with Prohealth Care.
Prohealth Waukesha Memorial Hospital lists 38 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.
401 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