Breast prosthes without adhesive cost in Wisconsin

Breast prosthes w/o adhesive ยท HCPCS L8030

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $210.51 โ€“ $442.11 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $322.79 โ€“ $430.39 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $322.79 โ€“ $830.65 4