Afo molded ankle gauntlet cost in Wisconsin

Afo molded ankle gauntlet ยท HCPCS L1904

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $271.31 โ€“ $550.12 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $416.04 โ€“ $554.72 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $416.04 โ€“ $1,070.61 4