Add ue prost s/d acrylic cost in Wisconsin

Add UE prost s/d acrylic ยท HCPCS L7405

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $437.78 โ€“ $902.01 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $671.31 โ€“ $895.08 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $671.31 โ€“ $1,727.50 4