| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Ascension Calumet Hospital | 614 Memorial Dr, Chilton | J0875 | $19 [source] | 4 years ago |
| Midwest Orthopedic Specialty Hospital, Llc | 10101 S 27Th St, Franklin | J0875 | $32 [source] | 4 years ago |
| Orthopaedic Hospital Of Wisconsin | 475 W River Woods Pkwy, Milwaukee | J0875 | $46 [source] | 4 years ago |
| Aurora Medical Center Bay Area | 3003 University Dr, Marinette | J0875 | $80 [source] | 4 years ago |
| Aurora Baycare | 1160 Kepler Dr, Green Bay | J0875 | $92 [source] | 4 years ago |
| Aurora Medical Center Of Manitowoc County | 5000 Memorial Dr, Two Rivers | J0875 | $95 [source] | 4 years ago |
| Aurora Medical Center Grafton | 975 Port Washington Road, Grafton | J0875 | $130 [source] | 4 years ago |
| Aurora Medical Center Of Oshkosh | 855 N Westhaven Dr, Oshkosh | J0875 | $130 [source] | 4 years ago |
| Aurora Medical Center Summit | 36500 Aurora Dr, Oconomowoc | J0875 | $130 [source] | 4 years ago |
| Aurora Sheboygan Memorial Medical Center | 2629 N 7Th St, Sheboygan | J0875 | $133 [source] | 4 years ago |
| Aurora West Allis Medical Center | 8901 W Lincoln Ave, Milwaukee | J0875 | $137 [source] | 4 years ago |
| Aurora Lakeland Medical Center | W3930 County Road Nn, Elkhorn | J0875 | $139 [source] | 4 years ago |
| Aurora Medical Center Burlington | 252 Mchenry St, Burlington | J0875 | $139 [source] | 4 years ago |
| Aurora St Luke's South Shore | 5900 S Lake Dr, Cudahy | J0875 | $140 [source] | 4 years ago |
| Aurora Medical Center Kenosha | 10400 75Th St, Kenosha | J0875 | $155 [source] | 4 years ago |
| Aurora Sinai Medical Center | 945 N 12Th St, Milwaukee | J0875 | $167 [source] | 4 years ago |
| Aurora St. Luke's Medical Center | 2900 W Oklahoma Ave, Milwaukee | J0875 | $169 [source] | 4 years ago |
| Aurora Medical Center Of Washington County | 1032 E Sumner St, Hartford | J0875 | $202 [source] | 4 years ago |
| Chippewa Valley Hospital & Oakview Care Center, Inc. | 1220 3Rd Ave W, Durand | J0875 | $5,870 [source] | 4 years ago |