Replace afo soft interface cost in Wisconsin

Replace AFO soft interface ยท HCPCS L4392

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $14.14 โ€“ $28.34 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $21.68 โ€“ $28.91 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $21.68 โ€“ $55.80 4