Replace pretibial shell cost in Wisconsin

Replace pretibial shell ยท HCPCS L4130

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $288.11 โ€“ $636.50 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $441.79 โ€“ $589.05 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $441.79 โ€“ $1,136.87 4