Add ue prost be/wd, ultlite cost in Pennsylvania

Add UE prost be/wd, ultlite · HCPCS L7400

Hospital City Cash price Negotiated range Payers
AHN WEXFORD HOSPITAL WEXFORD not published $174.93 – $660.87 13
GROVE CITY HOSPITAL GROVE CITY not published $186.17 – $660.87 13