Add le poly knee custom kafo cost in Oklahoma

Add LE poly knee custom KAFO ยท HCPCS L2387

Hospital City Cash price Negotiated range Payers
SSM Health St. Anthony Hospital - Shawnee Shawnee not published $190.18 โ€“ $370.85 8
SSM Health St. Anthony Hospital - Midwest Midwest City not published $190.18 โ€“ $406.99 8
SSM Health St. Anthony Hospital - Oklahoma City Oklahoma City not published $190.18 โ€“ $406.99 10