| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| River Falls Area Hospital | , River Falls | G0109 | $20 [source] | 3 years ago |
| Howard Young Medical Center Inc Of Woodruff Wisconsin | 240 Maple Street, Woodruff | G0109 | $21 [source] | 3 years ago |
| Ascension Ne Wisconsin-St Elizabeth Campus | 1506 S Oneida St, Appleton | G0109 | $25 [source] | 3 years ago |
| Ascension Calumet Hospital | 614 Memorial Dr, Chilton | G0109 | $39 [source] | 3 years ago |
| Chippewa Valley Hospital & Oakview Care Center, Inc. | 1220 3Rd Ave W, Durand | G0109 | $48 [source] | 3 years ago |
| Aspirus Wausau Hospital | 333 Pine Ridge Blvd, Wausau | G0109 | $56 [source] | 3 years ago |
| Aspirus Riverview Hospital | 410 Dewey St, Wisconsin Rapids | G0109 | $56 [source] | 3 years ago |
| Aspirus Langlade Hospital | 110 E 5Th Ave, Antigo | G0109 | $56 [source] | 3 years ago |
| Upland Hills Health | 800 Compassion Way, Dodgeville | G0109 | $69 [source] | 3 years ago |
| Aurora Medical Center Kenosha | 10400 75Th St, Kenosha | G0109 | $75 [source] | 3 years ago |
| Aurora Lakeland Medical Center | W3930 County Road Nn, Elkhorn | G0109 | $75 [source] | 3 years ago |
| Aurora Medical Center Burlington | 252 Mchenry St, Burlington | G0109 | $75 [source] | 3 years ago |
| Aurora Baycare | 1160 Kepler Dr, Green Bay | G0109 | $75 [source] | 3 years ago |
| Aurora Medical Center Of Manitowoc County | 5000 Memorial Dr, Two Rivers | G0109 | $75 [source] | 3 years ago |
| Aurora Medical Center Summit | 36500 Aurora Dr, Oconomowoc | G0109 | $75 [source] | 3 years ago |
| Aurora Medical Center Bay Area | 3003 University Dr, Marinette | G0109 | $75 [source] | 3 years ago |
| Aurora St Luke's South Shore | 5900 S Lake Dr, Cudahy | G0109 | $75 [source] | 3 years ago |
| Aurora Medical Center Of Oshkosh | 855 N Westhaven Dr, Oshkosh | G0109 | $75 [source] | 3 years ago |
| Aurora Medical Center Grafton | 975 Port Washington Road, Grafton | G0109 | $75 [source] | 3 years ago |
| Prairie Ridge Health | 1515 Park Ave, Columbus | G0109 | $106 [source] | 3 years ago |
| Watertown Regional Medical Center | 125 Hospital Drive, Watertown | G0109 | $160 [source] | 3 years ago |