Add le poly knee custom kafo cost in Wisconsin

Add LE poly knee custom KAFO ยท HCPCS L2387

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $114.75 โ€“ $230.00 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $175.95 โ€“ $234.60 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $175.95 โ€“ $452.78 4