Add ue prost a/e ultlite mat cost in Missouri

Add UE prost a/e ultlite mat · HCPCS L7401

Hospital City Cash price Negotiated range Payers
SSM Health Cardinal Glennon Children's Hospital Saint Louis not published $250.51 – $250.51 1
SSM Health Saint Louis University Hospital Saint Louis not published $294.46 – $504.49 6