Add ue prost s/d ultlite mat cost in Missouri

Add UE prost s/d ultlite mat · HCPCS L7402

Hospital City Cash price Negotiated range Payers
SSM Health Cardinal Glennon Children's Hospital Saint Louis not published $270.55 – $270.55 1
SSM Health Saint Louis University Hospital Saint Louis not published $318.03 – $544.86 6