Add ue prost b/e acrylic cost in Wisconsin

Add UE prost b/e acrylic ยท HCPCS L7403

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $221.80 โ€“ $456.97 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $340.11 โ€“ $453.48 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $340.11 โ€“ $875.22 4