Add ue prost a/e ultlite mat cost in Wisconsin

Add UE prost a/e ultlite mat ยท HCPCS L7401

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $206.62 โ€“ $425.74 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $316.84 โ€“ $422.45 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $316.84 โ€“ $815.33 4