Replace non-molded calf lace cost in Wisconsin

Replace non-molded calf lace ยท HCPCS L4055

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $150.25 โ€“ $332.62 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $230.40 โ€“ $307.20 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $230.40 โ€“ $592.90 4