| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Ascension Calumet Hospital | 614 Memorial Dr, Chilton | J2993 | $3,480 [source] | 4 years ago |
| Chippewa Valley Hospital & Oakview Care Center, Inc. | 1220 3Rd Ave W, Durand | J2993 | $3,493 [source] | 4 years ago |
| Orthopaedic Hospital Of Wisconsin | 475 W River Woods Pkwy, Milwaukee | J2993 | $7,021 [source] | 4 years ago |
| Watertown Regional Medical Center | 125 Hospital Drive, Watertown | J2993 | $7,545 [source] | 4 years ago |