| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Ascension Ne Wisconsin-St Elizabeth Campus | 1506 S Oneida St, Appleton | G0104 | $115 [source] | 3 years ago |
| Howard Young Medical Center Inc Of Woodruff Wisconsin | 240 Maple Street, Woodruff | G0104 | $144 [source] | 3 years ago |
| Ascension Calumet Hospital | 614 Memorial Dr, Chilton | G0104 | $171 [source] | 3 years ago |
| Chippewa Valley Hospital & Oakview Care Center, Inc. | 1220 3Rd Ave W, Durand | G0104 | $521 [source] | 3 years ago |
| Prairie Ridge Health | 1515 Park Ave, Columbus | G0104 | $527 [source] | 3 years ago |
| Aspirus Riverview Hospital | 410 Dewey St, Wisconsin Rapids | G0104 | $571 [source] | 3 years ago |
| Aspirus Stevens Point Hospital | 5409 Vern Holmes Dr, | G0104 | $571 [source] | 3 years ago |
| Aspirus Wausau Hospital | 333 Pine Ridge Blvd, Wausau | G0104 | $571 [source] | 3 years ago |
| Aspirus Divine Savior Hospital | 2817 New Pinery Rd, Portage | G0104 | $688 [source] | 3 years ago |
| Aspirus Medford Hospital | 135 S Gibson St, Medford | G0104 | $688 [source] | 3 years ago |
| Aspirus Langlade Hospital | 110 E 5Th Ave, Antigo | G0104 | $688 [source] | 3 years ago |
| Ascension Sacred Heart Rehabilitation Hospital | 2323 N Lake Dr, Milwaukee | G0104 | $1,093 [source] | 3 years ago |
| Upland Hills Health | 800 Compassion Way, Dodgeville | G0104 | $1,334 [source] | 3 years ago |
| Orthopaedic Hospital Of Wisconsin | 475 W River Woods Pkwy, Milwaukee | G0104 | $1,898 [source] | 3 years ago |
| Ascension Se Wisconsin Hospital-St Joseph Campus | 5000 W Chambers St, Milwaukee | G0104 | $2,530 [source] | 3 years ago |
| Ascension All Saints Hospital | 1320 Wisconsin Ave, Racine | G0104 | $2,530 [source] | 3 years ago |
| Midwest Orthopedic Specialty Hospital, Llc | 10101 S 27Th St, Franklin | G0104 | $2,530 [source] | 3 years ago |
| Ascension St Francis Hospital | 3237 S 16Th St, Milwaukee | G0104 | $2,530 [source] | 3 years ago |
| Watertown Regional Medical Center | 125 Hospital Drive, Watertown | G0104 | $5,262 [source] | 3 years ago |