| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Howard Young Medical Center Inc Of Woodruff Wisconsin | 240 Maple Street, Woodruff | G0396 | $39 [source] | 3 years ago |
| Ascension Calumet Hospital | 614 Memorial Dr, Chilton | G0396 | $59 [source] | 3 years ago |
| Ascension Ne Wisconsin-St Elizabeth Campus | 1506 S Oneida St, Appleton | G0396 | $61 [source] | 3 years ago |
| Chippewa Valley Hospital & Oakview Care Center, Inc. | 1220 3Rd Ave W, Durand | G0396 | $111 [source] | 3 years ago |
| Prairie Ridge Health | 1515 Park Ave, Columbus | G0396 | $120 [source] | 3 years ago |