Add ue prost a/e acrylic cost in Wisconsin

Add UE prost a/e acrylic ยท HCPCS L7404

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $334.76 โ€“ $689.69 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $513.34 โ€“ $684.45 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $513.34 โ€“ $1,320.99 4