Add ue prost b/e acrylic cost in Pennsylvania

Add UE prost b/e acrylic · HCPCS L7403

Hospital City Cash price Negotiated range Payers
AHN WEXFORD HOSPITAL WEXFORD not published $210.18 – $794.04 13
GROVE CITY HOSPITAL GROVE CITY not published $223.68 – $794.04 13