| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Ascension Calumet Hospital | 614 Memorial Dr, Chilton | J0698 | $5 [source] | 4 years ago |
| Orthopaedic Hospital Of Wisconsin | 475 W River Woods Pkwy, Milwaukee | J0698 | $7 [source] | 4 years ago |
| Aspirus Divine Savior Hospital | 2817 New Pinery Rd, Portage | J0698 | $48 [source] | 4 years ago |
| Watertown Regional Medical Center | 125 Hospital Drive, Watertown | J0698 | $117 [source] | 4 years ago |
| Chippewa Valley Hospital & Oakview Care Center, Inc. | 1220 3Rd Ave W, Durand | J0698 | $141 [source] | 4 years ago |