Add ue prost b/e acrylic cost in Missouri

Add UE prost b/e acrylic · HCPCS L7403

Hospital City Cash price Negotiated range Payers
SSM Health Cardinal Glennon Children's Hospital Saint Louis not published $268.87 – $268.87 1
SSM Health Saint Louis University Hospital Saint Louis not published $316.05 – $541.49 6