Silicon gel insert w/wo lock cost in Wisconsin

Silicon gel insert w/wo lock ยท HCPCS L6692

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $385.18 โ€“ $772.09 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $590.65 โ€“ $787.53 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $590.65 โ€“ $1,519.93 4