ST. JOSEPH'S HOSPITAL - BREESE - Price Transparency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Site,Svc_Cd,HCPC/Cpt_Cd,CDM_Svc_Descr,Rev_Cd, Quantity/Units , Hopsital_Cdm_Chg , Self_Pay_Chg , Minimum_Negotiated_Chg , Maximum_Negotiated_Chg , Aetna , Aetna HSHS , Aetna MCR , BC EXCHANGE , BC MEDICARE , BCBS OF ILLINOIS PPO , BLUE CROSS BLUE SHIELD  IL HMO , BLUE CROSS BLUE SHIELD IPA IL , BLUE CROSS SIHCA , CARELINK , CIGNA , CLEAR SPRING HEALTH MEDICARE ADV ," ESSENCE, L.L.P. ", FIRST HEALTH NETWORK , HEALTH ALLIANCE MEDICAL PLAN EXCHANGE ," HEALTH ALLIANCE MEDICAL PLANS, INC. ", HEALTH ALLIANCE MEDICARE , HEALTH ALLIANCE PPO , HEALTHLINK , HEALTHLINK CASINO QUEEN , HEALTHLINK PPO , HEARTLAND HOSPICE , HOPETRUST , HUMANA , HUMANA MEDICARE , ILLINOIS BREAST AND CERVICAL CANCER PROGRAM , MERIDIAN HMO MCD , MOLINA MEDICAID , MULTIPLAN , NAPHCARE , PHYSICIANS HEALTH ASSOCIATION OF IL BCBS HMO , PROVIDER NETWORK OF AMERICA , SAE MEMORIAL HOSPICE , ST CLAIR COUNTY HOUSING AUTHORITY , UHC CATERPILLAR , UNITED HEALTH ALL PAYOR , UNITED HEALTH CARE MEDICARE , WELLFIRST 
ST. JOSEPH'S HOSPITAL - BREESE,12000001,N/A,HC DAILY SERVICE GENERAL,120,1 ,$929.00 ,$603.85 ,$534.18 ,"$8,930.00 ","$1,810.00 ",$554.61 , Inpt Medicare ,$534.18 , Inpt Medicare ,$640.08 ,$871.00 ,$871.00 ,$871.00 ,"$1,656.00 ",$510.95 , Inpt Medicare , Inpt Medicare ,$696.75 ,$464.50 ,$464.50 , Inpt Medicare ,$464.50 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,$789.65 , Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,$743.20 , Inpt Medicare +90% ,$871.00 ,$836.10 , Inpt Medicare ,"$8,930.00 ","$1,436.00 ","$1,436.00 ", Inpt Medicare ,$603.85 
ST. JOSEPH'S HOSPITAL - BREESE,12000002,N/A,HC DAILY SERVICE SWING BED,120,1 ,$454.00 ,$295.10 ,$261.05 ,"$8,930.00 ","$1,810.00 ",$271.04 , Inpt Medicare ,$261.05 , Inpt Medicare ,$312.81 ,$871.00 ,$871.00 ,$871.00 ,"$1,656.00 ",$249.70 , Inpt Medicare , Inpt Medicare ,$340.50 ,$227.00 ,$227.00 , Inpt Medicare ,$227.00 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,$385.90 , Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,$363.20 , Inpt Medicare +90% ,$871.00 ,$408.60 , Inpt Medicare ,"$8,930.00 ","$1,436.00 ","$1,436.00 ", Inpt Medicare ,$295.10 
ST. JOSEPH'S HOSPITAL - BREESE,12000006,N/A,HC DAILY SERVICE W/TELEMETRY,120,1 ,"$2,266.00 ","$1,472.90 ","$1,302.95 ","$8,930.00 ","$1,810.00 ","$1,352.80 ", Inpt Medicare ,"$1,302.95 ", Inpt Medicare ,"$1,561.27 ",$871.00 ,$871.00 ,$871.00 ,"$1,656.00 ","$1,246.30 ", Inpt Medicare , Inpt Medicare ,"$1,699.50 ","$1,133.00 ","$1,133.00 ", Inpt Medicare ,"$1,133.00 ","$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,"$1,926.10 ", Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,"$1,812.80 ", Inpt Medicare +90% ,$871.00 ,"$2,039.40 ", Inpt Medicare ,"$8,930.00 ","$1,436.00 ","$1,436.00 ", Inpt Medicare ,"$1,472.90 "
ST. JOSEPH'S HOSPITAL - BREESE,12100001,N/A,HC DAILY SERVICE,121,1 ,$902.28 ,$586.48 ,$518.81 ,"$8,930.00 ","$1,810.00 ",$538.66 , Inpt Medicare ,$518.81 , Inpt Medicare ,$621.67 ,$871.00 ,$871.00 ,$871.00 ,"$1,656.00 ",$496.25 , Inpt Medicare , Inpt Medicare ,$676.71 ,$451.14 ,$451.14 , Inpt Medicare ,$451.14 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,$766.94 , Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,$721.82 , Inpt Medicare +90% ,$871.00 ,$812.05 , Inpt Medicare ,"$8,930.00 ","$1,436.00 ","$1,436.00 ", Inpt Medicare ,$586.48 
ST. JOSEPH'S HOSPITAL - BREESE,12200001,N/A,HC DAILY SERVICE OBSTETRICS,122,1 ,$929.00 ,$603.85 ,$534.18 ,"$8,930.00 ","$1,810.00 ",$554.61 , Inpt Medicare ,$534.18 , Inpt Medicare ,$640.08 ,$871.00 ,$871.00 ,$871.00 ,"$1,656.00 ",$510.95 , Inpt Medicare , Inpt Medicare ,$696.75 ,$464.50 ,$464.50 , Inpt Medicare ,$464.50 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,$789.65 , Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,$743.20 , Inpt Medicare +90% ,$871.00 ,$836.10 , Inpt Medicare ,"$8,930.00 ","$1,436.00 ","$1,436.00 ", Inpt Medicare ,$603.85 
ST. JOSEPH'S HOSPITAL - BREESE,12300001,N/A,HC DAILY PEDIATRIC,123,1 ,$929.00 ,$603.85 ,$534.18 ,"$8,930.00 ","$1,810.00 ",$554.61 , Inpt Medicare ,$534.18 , Inpt Medicare ,$640.08 ,$871.00 ,$871.00 ,$871.00 ,"$1,656.00 ",$510.95 , Inpt Medicare , Inpt Medicare ,$696.75 ,$464.50 ,$464.50 , Inpt Medicare ,$464.50 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,$789.65 , Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,$743.20 , Inpt Medicare +90% ,$871.00 ,$836.10 , Inpt Medicare ,"$8,930.00 ","$1,436.00 ","$1,436.00 ", Inpt Medicare ,$603.85 
ST. JOSEPH'S HOSPITAL - BREESE,17000001,N/A,HC DAILY SERVICE NURSERY,170,1 ,$663.00 ,$430.95 ,$381.23 ,$583.00 ,$543.00 ,$395.81 , Inpt Medicare ,$381.23 , Inpt Medicare ,$456.81 ,$871.00 ,$871.00 ,$871.00 ,$497.00 ,$364.65 , Inpt Medicare , Inpt Medicare ,$497.25 ,$331.50 ,$331.50 , Inpt Medicare ,$331.50 ,$583.00 ,$583.00 ,$583.00 , Inpt Medicare , Inpt Medicare +150% ,$563.55 , Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,$530.40 , Inpt Medicare +90% ,$871.00 ,$596.70 , Inpt Medicare ,$583.00 ,$671.00 ,$671.00 , Inpt Medicare ,$430.95 
ST. JOSEPH'S HOSPITAL - BREESE,17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,$844.00 ,$548.60 ,$485.30 ,$583.00 ,$543.00 ,$503.87 , Inpt Medicare ,$485.30 , Inpt Medicare ,$581.52 ,$871.00 ,$871.00 ,$871.00 ,$497.00 ,$464.20 , Inpt Medicare , Inpt Medicare ,$633.00 ,$422.00 ,$422.00 , Inpt Medicare ,$422.00 ,$583.00 ,$583.00 ,$583.00 , Inpt Medicare , Inpt Medicare +150% ,$717.40 , Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,$672.20 , Inpt Medicare +90% ,$871.00 ,$759.60 , Inpt Medicare ,$583.00 ,$671.00 ,$671.00 , Inpt Medicare ,$548.60 
ST. JOSEPH'S HOSPITAL - BREESE,17200002,N/A,HC DAILY INFANT SERVICE LEV 2,172,1 ,"$1,924.00 ","$1,250.60 ","$1,106.30 ",$583.00 ,$543.00 ,"$1,148.63 ", Inpt Medicare ,"$1,106.30 ", Inpt Medicare ,"$1,325.64 ",$591.00 ,$591.00 ,$591.00 ,$497.00 ,"$1,058.20 ", Inpt Medicare , Inpt Medicare ,"$1,443.00 ",$962.00 ,$962.00 , Inpt Medicare ,$962.00 ,$583.00 ,$583.00 ,$583.00 , Inpt Medicare , Inpt Medicare +150% ,"$1,635.40 ", Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,"$1,539.20 ", Inpt Medicare +90% ,$591.00 ,"$1,731.60 ", Inpt Medicare ,$583.00 ,$671.00 ,$671.00 , Inpt Medicare ,"$1,250.60 "
ST. JOSEPH'S HOSPITAL - BREESE,20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$1,924.00 ","$1,250.60 ","$1,106.30 ","$8,930.00 ","$2,174.00 ","$1,148.63 ", Inpt Medicare ,"$1,106.30 ", Inpt Medicare ,"$1,325.64 ","$1,183.00 ","$1,183.00 ","$1,183.00 ","$1,988.00 ","$1,058.20 ", Inpt Medicare , Inpt Medicare ,"$1,443.00 ",$962.00 ,$962.00 , Inpt Medicare ,$962.00 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,"$1,635.40 ", Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,"$1,539.20 ", Inpt Medicare +90% ,"$1,183.00 ","$1,731.60 ", Inpt Medicare ,"$8,930.00 ","$1,916.00 ","$1,916.00 ", Inpt Medicare ,"$1,250.60 "
ST. JOSEPH'S HOSPITAL - BREESE,20600002,N/A,HC DAILY SERVICE IMCU,206,1 ,"$1,632.00 ","$1,060.80 ",$938.40 ,"$8,930.00 ","$2,174.00 ",$974.30 , Inpt Medicare ,$938.40 , Inpt Medicare ,"$1,124.45 ","$1,183.00 ","$1,183.00 ","$1,183.00 ","$1,988.00 ",$897.60 , Inpt Medicare , Inpt Medicare ,"$1,224.00 ",$816.00 ,$816.00 , Inpt Medicare ,$816.00 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,"$1,387.20 ", Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,"$1,305.60 ", Inpt Medicare +90% ,"$1,183.00 ","$1,468.80 ", Inpt Medicare ,"$8,930.00 ","$1,916.00 ","$1,916.00 ", Inpt Medicare ,"$1,060.80 "
ST. JOSEPH'S HOSPITAL - BREESE,26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$332.00 ,$215.80 ,$175.58 ,$368.72 ,$282.20 ,$198.20 ,$175.58 ,$190.90 ,$175.58 ,$228.75 ,$282.20 ,$282.20 ,$282.20 ,"$1,988.00 ","$1,058.20 ", Inpt Medicare , Inpt Medicare ,"$1,443.00 ",$962.00 ,$962.00 , Inpt Medicare ,$962.00 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,"$1,635.40 ", Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,"$1,539.20 ", Inpt Medicare +90% ,$282.20 ,$298.80 ,$175.58 ,$275.56 ,$263.94 ,$263.94 ,$175.58 ,$215.80 
ST. JOSEPH'S HOSPITAL - BREESE,26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$55.00 ,$35.75 ,$31.63 ,$312.44 ,$46.75 ,$32.84 ,$36.42 ,$31.63 ,$36.42 ,$37.90 ,$46.75 ,$46.75 ,$46.75 ,"$1,988.00 ",$897.60 , Inpt Medicare , Inpt Medicare ,"$1,224.00 ",$816.00 ,$816.00 , Inpt Medicare ,$816.00 ,"$8,930.00 ","$8,930.00 ","$8,930.00 ", Inpt Medicare , Inpt Medicare +150% ,"$1,387.20 ", Inpt Medicare , N/A , Inpt Medicaid , Inpt Medicaid ,"$1,305.60 ", Inpt Medicare +90% ,$46.75 ,$49.50 ,$36.42 ,$45.65 ,$43.73 ,$43.73 ,$36.42 ,$35.75 
ST. JOSEPH'S HOSPITAL - BREESE,26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$551.22 ,$358.29 ,$175.58 ,$551.22 ,$468.54 ,$329.08 ,$175.58 ,$316.95 ,$175.58 ,$379.79 ,$468.54 ,$468.54 ,$468.54 , N/A ,$374.83 ,$175.58 ,$175.58 ,$413.42 ,$391.37 ,$391.37 ,$175.58 ,$391.37 ,$457.51 ,$457.51 ,$457.51 , N/A ,$438.95 ,$468.54 ,$175.58 ,$551.22 ,$199.85 ,$199.85 ,$468.54 ,$368.72 ,$468.54 ,$496.10 ,$175.58 ,$457.51 ,$438.22 ,$438.22 ,$175.58 ,$358.29 
ST. JOSEPH'S HOSPITAL - BREESE,26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$86.00 ,$55.90 ,$36.42 ,$312.44 ,$73.10 ,$51.34 ,$36.42 ,$49.45 ,$36.42 ,$59.25 ,$73.10 ,$73.10 ,$73.10 , N/A ,$58.48 ,$36.42 ,$36.42 ,$64.50 ,$61.06 ,$61.06 ,$36.42 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$86.00 ,$73.10 ,$36.42 ,$86.00 ,$312.44 ,$82.99 ,$73.10 ,$76.48 ,$73.10 ,$77.40 ,$36.42 ,$71.38 ,$68.37 ,$68.37 ,$36.42 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$118.00 ,$76.70 ,$57.79 ,$199.85 ,$100.30 ,$70.45 ,$57.79 ,$67.85 ,$57.79 ,$81.30 ,$100.30 ,$100.30 ,$100.30 , N/A ,$80.24 ,$57.79 ,$57.79 ,$88.50 ,$83.78 ,$83.78 ,$57.79 ,$83.78 ,$97.94 ,$97.94 ,$97.94 , N/A ,$118.00 ,$100.30 ,$57.79 ,$118.00 ,$199.85 ,$113.87 ,$100.30 ,$121.35 ,$100.30 ,$106.20 ,$57.79 ,$97.94 ,$93.81 ,$93.81 ,$57.79 ,$76.70 
ST. JOSEPH'S HOSPITAL - BREESE,26000005,96368,HC INFUS CONCURRENT,260,1 ,$118.00 ,$76.70 ,$67.85 ,$199.85 ,$100.30 ,$70.45 , N/A ,$67.85 , N/A ,$81.30 ,$100.30 ,$100.30 ,$100.30 , N/A ,$80.24 , N/A , N/A ,$88.50 ,$83.78 ,$83.78 , N/A ,$83.78 ,$97.94 ,$97.94 ,$97.94 , N/A , N/A ,$100.30 , N/A ,$118.00 ,$199.85 ,$113.87 ,$100.30 , N/A ,$100.30 ,$106.20 , N/A ,$97.94 ,$93.81 ,$93.81 , N/A ,$76.70 
ST. JOSEPH'S HOSPITAL - BREESE,27000012,N/A,HC PAD BREAST NURSING,270,1 ,$24.00 ,$15.60 ,$13.80 ,$24.00 ,$20.40 ,$14.33 , N/A ,$13.80 , N/A ,$16.54 ,$20.40 ,$20.40 ,$20.40 , N/A ,$16.32 , N/A , N/A ,$18.00 ,$17.04 ,$17.04 , N/A ,$17.04 ,$19.92 ,$19.92 ,$19.92 , N/A , N/A ,$20.40 , N/A ,$24.00 , N/A , N/A ,$20.40 , N/A ,$20.40 ,$21.60 , N/A ,$19.92 ,$19.08 ,$19.08 , N/A ,$15.60 
ST. JOSEPH'S HOSPITAL - BREESE,27000014,N/A,HC SET CYSTO IRRIGATION TUBING,270,1 ,$19.00 ,$12.35 ,$10.93 ,$19.00 ,$16.15 ,$11.34 , N/A ,$10.93 , N/A ,$13.09 ,$16.15 ,$16.15 ,$16.15 , N/A ,$12.92 , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.77 ,$15.77 ,$15.77 , N/A , N/A ,$16.15 , N/A ,$19.00 , N/A , N/A ,$16.15 , N/A ,$16.15 ,$17.10 , N/A ,$15.77 ,$15.11 ,$15.11 , N/A ,$12.35 
ST. JOSEPH'S HOSPITAL - BREESE,27000020,N/A,HC WARMER BAIR HUGGER,270,1 ,$21.00 ,$13.65 ,$12.08 ,$21.00 ,$17.85 ,$12.54 , N/A ,$12.08 , N/A ,$14.47 ,$17.85 ,$17.85 ,$17.85 , N/A ,$14.28 , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.43 ,$17.43 ,$17.43 , N/A , N/A ,$17.85 , N/A ,$21.00 , N/A , N/A ,$17.85 , N/A ,$17.85 ,$18.90 , N/A ,$17.43 ,$16.70 ,$16.70 , N/A ,$13.65 
ST. JOSEPH'S HOSPITAL - BREESE,27000021,N/A,HC TRAY ARTHROGRAM,270,1 ,$32.00 ,$20.80 ,$18.40 ,$32.00 ,$27.20 ,$19.10 , N/A ,$18.40 , N/A ,$22.05 ,$27.20 ,$27.20 ,$27.20 , N/A ,$21.76 , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.56 ,$26.56 ,$26.56 , N/A , N/A ,$27.20 , N/A ,$32.00 , N/A , N/A ,$27.20 , N/A ,$27.20 ,$28.80 , N/A ,$26.56 ,$25.44 ,$25.44 , N/A ,$20.80 
ST. JOSEPH'S HOSPITAL - BREESE,27000055,N/A,HC MASK ANESTHESIA,270,1 ,$120.00 ,$78.00 ,$69.00 ,$120.00 ,$102.00 ,$71.64 , N/A ,$69.00 , N/A ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A , N/A ,$102.00 , N/A ,$120.00 , N/A , N/A ,$102.00 , N/A ,$102.00 ,$108.00 , N/A ,$99.60 ,$95.40 ,$95.40 , N/A ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000073,N/A,HC DETECTOR CARBON DIOXIDE,270,1 ,$24.00 ,$15.60 ,$13.80 ,$24.00 ,$20.40 ,$14.33 , N/A ,$13.80 , N/A ,$16.54 ,$20.40 ,$20.40 ,$20.40 , N/A ,$16.32 , N/A , N/A ,$18.00 ,$17.04 ,$17.04 , N/A ,$17.04 ,$19.92 ,$19.92 ,$19.92 , N/A , N/A ,$20.40 , N/A ,$24.00 , N/A , N/A ,$20.40 , N/A ,$20.40 ,$21.60 , N/A ,$19.92 ,$19.08 ,$19.08 , N/A ,$15.60 
ST. JOSEPH'S HOSPITAL - BREESE,27000093,N/A,HC MATTRESS WARMING,270,1 ,$87.00 ,$56.55 ,$50.03 ,$87.00 ,$73.95 ,$51.94 , N/A ,$50.03 , N/A ,$59.94 ,$73.95 ,$73.95 ,$73.95 , N/A ,$59.16 , N/A , N/A ,$65.25 ,$61.77 ,$61.77 , N/A ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A , N/A ,$73.95 , N/A ,$87.00 , N/A , N/A ,$73.95 , N/A ,$73.95 ,$78.30 , N/A ,$72.21 ,$69.17 ,$69.17 , N/A ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,27100021,N/A,HC CAST ARM SYNTHETIC,271,1 ,$26.00 ,$16.90 ,$14.95 ,$26.00 ,$22.10 ,$15.52 , N/A ,$14.95 , N/A ,$17.91 ,$22.10 ,$22.10 ,$22.10 , N/A ,$17.68 , N/A , N/A ,$19.50 ,$18.46 ,$18.46 , N/A ,$18.46 ,$21.58 ,$21.58 ,$21.58 , N/A , N/A ,$22.10 , N/A ,$26.00 , N/A , N/A ,$22.10 , N/A ,$22.10 ,$23.40 , N/A ,$21.58 ,$20.67 ,$20.67 , N/A ,$16.90 
ST. JOSEPH'S HOSPITAL - BREESE,27100024,N/A,HC CAST LEG SYNTHETIC,271,1 ,$95.00 ,$61.75 ,$54.63 ,$95.00 ,$80.75 ,$56.72 , N/A ,$54.63 , N/A ,$65.46 ,$80.75 ,$80.75 ,$80.75 , N/A ,$64.60 , N/A , N/A ,$71.25 ,$67.45 ,$67.45 , N/A ,$67.45 ,$78.85 ,$78.85 ,$78.85 , N/A , N/A ,$80.75 , N/A ,$95.00 , N/A , N/A ,$80.75 , N/A ,$80.75 ,$85.50 , N/A ,$78.85 ,$75.53 ,$75.53 , N/A ,$61.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100038,N/A,HC CPAP MASK,271,1 ,$150.00 ,$97.50 ,$86.25 ,$150.00 ,$127.50 ,$89.55 , N/A ,$86.25 , N/A ,$103.35 ,$127.50 ,$127.50 ,$127.50 , N/A ,$102.00 , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$124.50 ,$124.50 ,$124.50 , N/A , N/A ,$127.50 , N/A ,$150.00 , N/A , N/A ,$127.50 , N/A ,$127.50 ,$135.00 , N/A ,$124.50 ,$119.25 ,$119.25 , N/A ,$97.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100096,N/A,HC NASAL PHANYNGEAL AIRWAY,271,1 ,$18.00 ,$11.70 ,$10.35 ,$18.00 ,$15.30 ,$10.75 , N/A ,$10.35 , N/A ,$12.40 ,$15.30 ,$15.30 ,$15.30 , N/A ,$12.24 , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.94 ,$14.94 ,$14.94 , N/A , N/A ,$15.30 , N/A ,$18.00 , N/A , N/A ,$15.30 , N/A ,$15.30 ,$16.20 , N/A ,$14.94 ,$14.31 ,$14.31 , N/A ,$11.70 
ST. JOSEPH'S HOSPITAL - BREESE,27100106,N/A,HC OXYGEN DAILY,271,1 ,$375.00 ,$243.75 ,$215.63 ,$375.00 ,$318.75 ,$223.88 , N/A ,$215.63 , N/A ,$258.38 ,$318.75 ,$318.75 ,$318.75 , N/A ,$255.00 , N/A , N/A ,$281.25 ,$266.25 ,$266.25 , N/A ,$266.25 ,$311.25 ,$311.25 ,$311.25 , N/A , N/A ,$318.75 , N/A ,$375.00 , N/A , N/A ,$318.75 , N/A ,$318.75 ,$337.50 , N/A ,$311.25 ,$298.13 ,$298.13 , N/A ,$243.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100114,N/A,HC PEAK FLOWMETER,271,1 ,$70.00 ,$45.50 ,$40.25 ,$70.00 ,$59.50 ,$41.79 , N/A ,$40.25 , N/A ,$48.23 ,$59.50 ,$59.50 ,$59.50 , N/A ,$47.60 , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A , N/A ,$59.50 , N/A ,$70.00 , N/A , N/A ,$59.50 , N/A ,$59.50 ,$63.00 , N/A ,$58.10 ,$55.65 ,$55.65 , N/A ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100155,N/A,HC THERABAND PER FOOT,271,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100167,N/A,HC WARMING BLANKET DISPOSABLE,271,1 ,$59.00 ,$38.35 ,$33.93 ,$59.00 ,$50.15 ,$35.22 , N/A ,$33.93 , N/A ,$40.65 ,$50.15 ,$50.15 ,$50.15 , N/A ,$40.12 , N/A , N/A ,$44.25 ,$41.89 ,$41.89 , N/A ,$41.89 ,$48.97 ,$48.97 ,$48.97 , N/A , N/A ,$50.15 , N/A ,$59.00 , N/A , N/A ,$50.15 , N/A ,$50.15 ,$53.10 , N/A ,$48.97 ,$46.91 ,$46.91 , N/A ,$38.35 
ST. JOSEPH'S HOSPITAL - BREESE,27100187,N/A,HC BAG DRAINAGE,271,1 ,$21.00 ,$13.65 ,$12.08 ,$21.00 ,$17.85 ,$12.54 , N/A ,$12.08 , N/A ,$14.47 ,$17.85 ,$17.85 ,$17.85 , N/A ,$14.28 , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.43 ,$17.43 ,$17.43 , N/A , N/A ,$17.85 , N/A ,$21.00 , N/A , N/A ,$17.85 , N/A ,$17.85 ,$18.90 , N/A ,$17.43 ,$16.70 ,$16.70 , N/A ,$13.65 
ST. JOSEPH'S HOSPITAL - BREESE,27100188,N/A,HC SLING ARM,271,1 ,$105.00 ,$68.25 ,$60.38 ,$105.00 ,$89.25 ,$62.69 , N/A ,$60.38 , N/A ,$72.35 ,$89.25 ,$89.25 ,$89.25 , N/A ,$71.40 , N/A , N/A ,$78.75 ,$74.55 ,$74.55 , N/A ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A , N/A ,$89.25 , N/A ,$105.00 , N/A , N/A ,$89.25 , N/A ,$89.25 ,$94.50 , N/A ,$87.15 ,$83.48 ,$83.48 , N/A ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100197,N/A,HC ADHESIVE STOMAHESIVE,271,1 ,$70.00 ,$45.50 ,$40.25 ,$70.00 ,$59.50 ,$41.79 , N/A ,$40.25 , N/A ,$48.23 ,$59.50 ,$59.50 ,$59.50 , N/A ,$47.60 , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A , N/A ,$59.50 , N/A ,$70.00 , N/A , N/A ,$59.50 , N/A ,$59.50 ,$63.00 , N/A ,$58.10 ,$55.65 ,$55.65 , N/A ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100201,N/A,HC CANNULA NASAL OXYGEN,271,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27100204,N/A,HC CIRCUIT BREATHING,271,1 ,$29.00 ,$18.85 ,$16.68 ,$29.00 ,$24.65 ,$17.31 , N/A ,$16.68 , N/A ,$19.98 ,$24.65 ,$24.65 ,$24.65 , N/A ,$19.72 , N/A , N/A ,$21.75 ,$20.59 ,$20.59 , N/A ,$20.59 ,$24.07 ,$24.07 ,$24.07 , N/A , N/A ,$24.65 , N/A ,$29.00 , N/A , N/A ,$24.65 , N/A ,$24.65 ,$26.10 , N/A ,$24.07 ,$23.06 ,$23.06 , N/A ,$18.85 
ST. JOSEPH'S HOSPITAL - BREESE,27100207,N/A,HC DRESSING BANDAGE ELASTIC,271,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27100209,N/A,HC ENEMA BAG,271,1 ,$22.00 ,$14.30 ,$12.65 ,$22.00 ,$18.70 ,$13.13 , N/A ,$12.65 , N/A ,$15.16 ,$18.70 ,$18.70 ,$18.70 , N/A ,$14.96 , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.26 ,$18.26 ,$18.26 , N/A , N/A ,$18.70 , N/A ,$22.00 , N/A , N/A ,$18.70 , N/A ,$18.70 ,$19.80 , N/A ,$18.26 ,$17.49 ,$17.49 , N/A ,$14.30 
ST. JOSEPH'S HOSPITAL - BREESE,27100210,N/A,HC KIT CANISTER SUCTION,271,1 ,$21.00 ,$13.65 ,$12.08 ,$21.00 ,$17.85 ,$12.54 , N/A ,$12.08 , N/A ,$14.47 ,$17.85 ,$17.85 ,$17.85 , N/A ,$14.28 , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.43 ,$17.43 ,$17.43 , N/A , N/A ,$17.85 , N/A ,$21.00 , N/A , N/A ,$17.85 , N/A ,$17.85 ,$18.90 , N/A ,$17.43 ,$16.70 ,$16.70 , N/A ,$13.65 
ST. JOSEPH'S HOSPITAL - BREESE,27100211,N/A,HC PAD DEFIBRILLATOR,271,1 ,$183.60 ,$119.34 ,$105.57 ,$183.60 ,$156.06 ,$109.61 , N/A ,$105.57 , N/A ,$126.50 ,$156.06 ,$156.06 ,$156.06 , N/A ,$124.85 , N/A , N/A ,$137.70 ,$130.36 ,$130.36 , N/A ,$130.36 ,$152.39 ,$152.39 ,$152.39 , N/A , N/A ,$156.06 , N/A ,$183.60 , N/A , N/A ,$156.06 , N/A ,$156.06 ,$165.24 , N/A ,$152.39 ,$145.96 ,$145.96 , N/A ,$119.34 
ST. JOSEPH'S HOSPITAL - BREESE,27100216,N/A,HC SET FLUID WARMER,271,1 ,$27.00 ,$17.55 ,$15.53 ,$27.00 ,$22.95 ,$16.12 , N/A ,$15.53 , N/A ,$18.60 ,$22.95 ,$22.95 ,$22.95 , N/A ,$18.36 , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.41 ,$22.41 ,$22.41 , N/A , N/A ,$22.95 , N/A ,$27.00 , N/A , N/A ,$22.95 , N/A ,$22.95 ,$24.30 , N/A ,$22.41 ,$21.47 ,$21.47 , N/A ,$17.55 
ST. JOSEPH'S HOSPITAL - BREESE,27100228,N/A,HC STOCK ANTIEMBOLISM THIGH,271,1 ,$48.00 ,$31.20 ,$27.60 ,$48.00 ,$40.80 ,$28.66 , N/A ,$27.60 , N/A ,$33.07 ,$40.80 ,$40.80 ,$40.80 , N/A ,$32.64 , N/A , N/A ,$36.00 ,$34.08 ,$34.08 , N/A ,$34.08 ,$39.84 ,$39.84 ,$39.84 , N/A , N/A ,$40.80 , N/A ,$48.00 , N/A , N/A ,$40.80 , N/A ,$40.80 ,$43.20 , N/A ,$39.84 ,$38.16 ,$38.16 , N/A ,$31.20 
ST. JOSEPH'S HOSPITAL - BREESE,27100229,N/A,HC STRAINER URINE,271,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100240,N/A,HC CAUTERY GROUNDING PAD,271,1 ,$23.00 ,$14.95 ,$13.23 ,$23.00 ,$19.55 ,$13.73 , N/A ,$13.23 , N/A ,$15.85 ,$19.55 ,$19.55 ,$19.55 , N/A ,$15.64 , N/A , N/A ,$17.25 ,$16.33 ,$16.33 , N/A ,$16.33 ,$19.09 ,$19.09 ,$19.09 , N/A , N/A ,$19.55 , N/A ,$23.00 , N/A , N/A ,$19.55 , N/A ,$19.55 ,$20.70 , N/A ,$19.09 ,$18.29 ,$18.29 , N/A ,$14.95 
ST. JOSEPH'S HOSPITAL - BREESE,27100255,N/A,HC ELECTRODE DEFIB FAST PATCH,271,1 ,$71.58 ,$46.53 ,$41.16 ,$71.58 ,$60.84 ,$42.73 , N/A ,$41.16 , N/A ,$49.32 ,$60.84 ,$60.84 ,$60.84 , N/A ,$48.67 , N/A , N/A ,$53.69 ,$50.82 ,$50.82 , N/A ,$50.82 ,$59.41 ,$59.41 ,$59.41 , N/A , N/A ,$60.84 , N/A ,$71.58 , N/A , N/A ,$60.84 , N/A ,$60.84 ,$64.42 , N/A ,$59.41 ,$56.91 ,$56.91 , N/A ,$46.53 
ST. JOSEPH'S HOSPITAL - BREESE,27100256,N/A,HC ELECTRODE FETAL SCALP,271,1 ,$29.00 ,$18.85 ,$16.68 ,$29.00 ,$24.65 ,$17.31 , N/A ,$16.68 , N/A ,$19.98 ,$24.65 ,$24.65 ,$24.65 , N/A ,$19.72 , N/A , N/A ,$21.75 ,$20.59 ,$20.59 , N/A ,$20.59 ,$24.07 ,$24.07 ,$24.07 , N/A , N/A ,$24.65 , N/A ,$29.00 , N/A , N/A ,$24.65 , N/A ,$24.65 ,$26.10 , N/A ,$24.07 ,$23.06 ,$23.06 , N/A ,$18.85 
ST. JOSEPH'S HOSPITAL - BREESE,27100281,N/A,HC PACK HOT/ COLD LARGE,271,1 ,$25.00 ,$16.25 ,$14.38 ,$25.00 ,$21.25 ,$14.93 , N/A ,$14.38 , N/A ,$17.23 ,$21.25 ,$21.25 ,$21.25 , N/A ,$17.00 , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.75 ,$20.75 ,$20.75 , N/A , N/A ,$21.25 , N/A ,$25.00 , N/A , N/A ,$21.25 , N/A ,$21.25 ,$22.50 , N/A ,$20.75 ,$19.88 ,$19.88 , N/A ,$16.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100292,E0710,HC RESTRAINTS,271,1 ,$20.13 ,$13.08 ,$11.57 ,$20.13 ,$17.11 ,$12.02 , N/A ,$11.57 , N/A ,$13.87 ,$17.11 ,$17.11 ,$17.11 , N/A ,$13.69 , N/A , N/A ,$15.10 ,$14.29 ,$14.29 , N/A ,$14.29 ,$16.71 ,$16.71 ,$16.71 , N/A , N/A ,$17.11 , N/A ,$20.13 , N/A , N/A ,$17.11 , N/A ,$17.11 ,$18.12 , N/A ,$16.71 ,$16.00 ,$16.00 , N/A ,$13.08 
ST. JOSEPH'S HOSPITAL - BREESE,27100324,N/A,HC DRESSING SELF ADHESIVE ROLL,271,1 ,$13.00 ,$8.45 ,$7.48 ,$13.00 ,$11.05 ,$7.76 , N/A ,$7.48 , N/A ,$8.96 ,$11.05 ,$11.05 ,$11.05 , N/A ,$8.84 , N/A , N/A ,$9.75 ,$9.23 ,$9.23 , N/A ,$9.23 ,$10.79 ,$10.79 ,$10.79 , N/A , N/A ,$11.05 , N/A ,$13.00 , N/A , N/A ,$11.05 , N/A ,$11.05 ,$11.70 , N/A ,$10.79 ,$10.34 ,$10.34 , N/A ,$8.45 
ST. JOSEPH'S HOSPITAL - BREESE,27100325,N/A,HC SPACER MDI,271,1 ,$43.00 ,$27.95 ,$24.73 ,$43.00 ,$36.55 ,$25.67 , N/A ,$24.73 , N/A ,$29.63 ,$36.55 ,$36.55 ,$36.55 , N/A ,$29.24 , N/A , N/A ,$32.25 ,$30.53 ,$30.53 , N/A ,$30.53 ,$35.69 ,$35.69 ,$35.69 , N/A , N/A ,$36.55 , N/A ,$43.00 , N/A , N/A ,$36.55 , N/A ,$36.55 ,$38.70 , N/A ,$35.69 ,$34.19 ,$34.19 , N/A ,$27.95 
ST. JOSEPH'S HOSPITAL - BREESE,27100328,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T1,271,1 ,$175.00 ,$113.75 ,$100.63 ,$175.00 ,$148.75 ,$104.48 , N/A ,$100.63 , N/A ,$120.58 ,$148.75 ,$148.75 ,$148.75 , N/A ,$119.00 , N/A , N/A ,$131.25 ,$124.25 ,$124.25 , N/A ,$124.25 ,$145.25 ,$145.25 ,$145.25 , N/A , N/A ,$148.75 , N/A ,$175.00 , N/A , N/A ,$148.75 , N/A ,$148.75 ,$157.50 , N/A ,$145.25 ,$139.13 ,$139.13 , N/A ,$113.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100329,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T2,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100330,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T3,271,1 ,$438.00 ,$284.70 ,$251.85 ,$438.00 ,$372.30 ,$261.49 , N/A ,$251.85 , N/A ,$301.78 ,$372.30 ,$372.30 ,$372.30 , N/A ,$297.84 , N/A , N/A ,$328.50 ,$310.98 ,$310.98 , N/A ,$310.98 ,$363.54 ,$363.54 ,$363.54 , N/A , N/A ,$372.30 , N/A ,$438.00 , N/A , N/A ,$372.30 , N/A ,$372.30 ,$394.20 , N/A ,$363.54 ,$348.21 ,$348.21 , N/A ,$284.70 
ST. JOSEPH'S HOSPITAL - BREESE,27100331,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T4,271,1 ,$500.00 ,$325.00 ,$287.50 ,$500.00 ,$425.00 ,$298.50 , N/A ,$287.50 , N/A ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 , N/A , N/A ,$375.00 ,$355.00 ,$355.00 , N/A ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A , N/A ,$425.00 , N/A ,$500.00 , N/A , N/A ,$425.00 , N/A ,$425.00 ,$450.00 , N/A ,$415.00 ,$397.50 ,$397.50 , N/A ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100332,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T5,271,1 ,$550.00 ,$357.50 ,$316.25 ,$550.00 ,$467.50 ,$328.35 , N/A ,$316.25 , N/A ,$378.95 ,$467.50 ,$467.50 ,$467.50 , N/A ,$374.00 , N/A , N/A ,$412.50 ,$390.50 ,$390.50 , N/A ,$390.50 ,$456.50 ,$456.50 ,$456.50 , N/A , N/A ,$467.50 , N/A ,$550.00 , N/A , N/A ,$467.50 , N/A ,$467.50 ,$495.00 , N/A ,$456.50 ,$437.25 ,$437.25 , N/A ,$357.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100333,V5290,HC ALD TRANSMITTER MICROPHONE T1,271,1 ,$175.00 ,$113.75 ,$100.63 ,$175.00 ,$148.75 ,$104.48 , N/A ,$100.63 , N/A ,$120.58 ,$148.75 ,$148.75 ,$148.75 , N/A ,$119.00 , N/A , N/A ,$131.25 ,$124.25 ,$124.25 , N/A ,$124.25 ,$145.25 ,$145.25 ,$145.25 , N/A , N/A ,$148.75 , N/A ,$175.00 , N/A , N/A ,$148.75 , N/A ,$148.75 ,$157.50 , N/A ,$145.25 ,$139.13 ,$139.13 , N/A ,$113.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100334,V5290,HC ALD TRANSMITTER MICROPHONE T2,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100335,V5290,HC ALD TRANSMITTER MICROPHONE T3,271,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100336,V5290,HC ALD TRANSMITTER MICROPHONE T4,271,1 ,$450.00 ,$292.50 ,$258.75 ,$450.00 ,$382.50 ,$268.65 , N/A ,$258.75 , N/A ,$310.05 ,$382.50 ,$382.50 ,$382.50 , N/A ,$306.00 , N/A , N/A ,$337.50 ,$319.50 ,$319.50 , N/A ,$319.50 ,$373.50 ,$373.50 ,$373.50 , N/A , N/A ,$382.50 , N/A ,$450.00 , N/A , N/A ,$382.50 , N/A ,$382.50 ,$405.00 , N/A ,$373.50 ,$357.75 ,$357.75 , N/A ,$292.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100337,V5290,HC ALD TRANSMITTER MICROPHONE T5,271,1 ,$500.00 ,$325.00 ,$287.50 ,$500.00 ,$425.00 ,$298.50 , N/A ,$287.50 , N/A ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 , N/A , N/A ,$375.00 ,$355.00 ,$355.00 , N/A ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A , N/A ,$425.00 , N/A ,$500.00 , N/A , N/A ,$425.00 , N/A ,$425.00 ,$450.00 , N/A ,$415.00 ,$397.50 ,$397.50 , N/A ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100338,V5267,HC HEARING AID ACCESSORY NOS T1,271,1 ,$90.00 ,$58.50 ,$51.75 ,$90.00 ,$76.50 ,$53.73 , N/A ,$51.75 , N/A ,$62.01 ,$76.50 ,$76.50 ,$76.50 , N/A ,$61.20 , N/A , N/A ,$67.50 ,$63.90 ,$63.90 , N/A ,$63.90 ,$74.70 ,$74.70 ,$74.70 , N/A , N/A ,$76.50 , N/A ,$90.00 , N/A , N/A ,$76.50 , N/A ,$76.50 ,$81.00 , N/A ,$74.70 ,$71.55 ,$71.55 , N/A ,$58.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100339,V5267,HC HEARING AID ACCESSORY NOS T2,271,1 ,$105.00 ,$68.25 ,$60.38 ,$105.00 ,$89.25 ,$62.69 , N/A ,$60.38 , N/A ,$72.35 ,$89.25 ,$89.25 ,$89.25 , N/A ,$71.40 , N/A , N/A ,$78.75 ,$74.55 ,$74.55 , N/A ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A , N/A ,$89.25 , N/A ,$105.00 , N/A , N/A ,$89.25 , N/A ,$89.25 ,$94.50 , N/A ,$87.15 ,$83.48 ,$83.48 , N/A ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100340,V5267,HC HEARING AID ACCESSORY NOS T3,271,1 ,$120.00 ,$78.00 ,$69.00 ,$120.00 ,$102.00 ,$71.64 , N/A ,$69.00 , N/A ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A , N/A ,$102.00 , N/A ,$120.00 , N/A , N/A ,$102.00 , N/A ,$102.00 ,$108.00 , N/A ,$99.60 ,$95.40 ,$95.40 , N/A ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100341,V5267,HC HEARING AID ACCESSORY NOS T4,271,1 ,$150.00 ,$97.50 ,$86.25 ,$150.00 ,$127.50 ,$89.55 , N/A ,$86.25 , N/A ,$103.35 ,$127.50 ,$127.50 ,$127.50 , N/A ,$102.00 , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$124.50 ,$124.50 ,$124.50 , N/A , N/A ,$127.50 , N/A ,$150.00 , N/A , N/A ,$127.50 , N/A ,$127.50 ,$135.00 , N/A ,$124.50 ,$119.25 ,$119.25 , N/A ,$97.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100342,V5267,HC HEARING AID ACCESSORY NOS T5,271,1 ,$200.00 ,$130.00 ,$115.00 ,$200.00 ,$170.00 ,$119.40 , N/A ,$115.00 , N/A ,$137.80 ,$170.00 ,$170.00 ,$170.00 , N/A ,$136.00 , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A , N/A ,$170.00 , N/A ,$200.00 , N/A , N/A ,$170.00 , N/A ,$170.00 ,$180.00 , N/A ,$166.00 ,$159.00 ,$159.00 , N/A ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100343,V5267,HC HEARING AID ACCESSORY NOS T6,271,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100344,V5267,HC HEARING AID ACCESSORY NOS T7,271,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100345,V5267,HC HEARING AID ACCESSORY NOS T8,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100346,V5267,HC HEARING AID ACCESSORY NOS T9,271,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100347,V5267,HC HEARING AID ACCESSORY NOS T10,271,1 ,$450.00 ,$292.50 ,$258.75 ,$450.00 ,$382.50 ,$268.65 , N/A ,$258.75 , N/A ,$310.05 ,$382.50 ,$382.50 ,$382.50 , N/A ,$306.00 , N/A , N/A ,$337.50 ,$319.50 ,$319.50 , N/A ,$319.50 ,$373.50 ,$373.50 ,$373.50 , N/A , N/A ,$382.50 , N/A ,$450.00 , N/A , N/A ,$382.50 , N/A ,$382.50 ,$405.00 , N/A ,$373.50 ,$357.75 ,$357.75 , N/A ,$292.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100348,V5267,HC HEARING AID ACCESSORY NOS T11,271,1 ,$500.00 ,$325.00 ,$287.50 ,$500.00 ,$425.00 ,$298.50 , N/A ,$287.50 , N/A ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 , N/A , N/A ,$375.00 ,$355.00 ,$355.00 , N/A ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A , N/A ,$425.00 , N/A ,$500.00 , N/A , N/A ,$425.00 , N/A ,$425.00 ,$450.00 , N/A ,$415.00 ,$397.50 ,$397.50 , N/A ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100349,V5267,HC HEARING AID ACCESSORY NOS T12,271,1 ,$550.00 ,$357.50 ,$316.25 ,$550.00 ,$467.50 ,$328.35 , N/A ,$316.25 , N/A ,$378.95 ,$467.50 ,$467.50 ,$467.50 , N/A ,$374.00 , N/A , N/A ,$412.50 ,$390.50 ,$390.50 , N/A ,$390.50 ,$456.50 ,$456.50 ,$456.50 , N/A , N/A ,$467.50 , N/A ,$550.00 , N/A , N/A ,$467.50 , N/A ,$467.50 ,$495.00 , N/A ,$456.50 ,$437.25 ,$437.25 , N/A ,$357.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100350,V5267,HC HEARING AID ACCESSORY NOS T13,271,1 ,$600.00 ,$390.00 ,$345.00 ,$600.00 ,$510.00 ,$358.20 , N/A ,$345.00 , N/A ,$413.40 ,$510.00 ,$510.00 ,$510.00 , N/A ,$408.00 , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$498.00 ,$498.00 ,$498.00 , N/A , N/A ,$510.00 , N/A ,$600.00 , N/A , N/A ,$510.00 , N/A ,$510.00 ,$540.00 , N/A ,$498.00 ,$477.00 ,$477.00 , N/A ,$390.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100351,V5050,HC HEARING AID MONAURAL IN EAR T1,271,1 ,$200.00 ,$130.00 ,$115.00 ,$200.00 ,$170.00 ,$119.40 , N/A ,$115.00 , N/A ,$137.80 ,$170.00 ,$170.00 ,$170.00 , N/A ,$136.00 , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A , N/A ,$170.00 , N/A ,$200.00 , N/A , N/A ,$170.00 , N/A ,$170.00 ,$180.00 , N/A ,$166.00 ,$159.00 ,$159.00 , N/A ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100352,V5050,HC HEARING AID MONAURAL IN EAR T2,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100353,V5050,HC HEARING AID MONAURAL IN EAR T3,271,1 ,$525.00 ,$341.25 ,$301.88 ,$525.00 ,$446.25 ,$313.43 , N/A ,$301.88 , N/A ,$361.73 ,$446.25 ,$446.25 ,$446.25 , N/A ,$357.00 , N/A , N/A ,$393.75 ,$372.75 ,$372.75 , N/A ,$372.75 ,$435.75 ,$435.75 ,$435.75 , N/A , N/A ,$446.25 , N/A ,$525.00 , N/A , N/A ,$446.25 , N/A ,$446.25 ,$472.50 , N/A ,$435.75 ,$417.38 ,$417.38 , N/A ,$341.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100354,V5050,HC HEARING AID MONAURAL IN EAR T4,271,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100355,V5050,HC HEARING AID MONAURAL IN EAR T5,271,1 ,$875.00 ,$568.75 ,$503.13 ,$875.00 ,$743.75 ,$522.38 , N/A ,$503.13 , N/A ,$602.88 ,$743.75 ,$743.75 ,$743.75 , N/A ,$595.00 , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$726.25 ,$726.25 ,$726.25 , N/A , N/A ,$743.75 , N/A ,$875.00 , N/A , N/A ,$743.75 , N/A ,$743.75 ,$787.50 , N/A ,$726.25 ,$695.63 ,$695.63 , N/A ,$568.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100356,V5050,HC HEARING AID MONAURAL IN EAR T6,271,1 ,"$1,050.00 ",$682.50 ,$603.75 ,"$1,050.00 ",$892.50 ,$626.85 , N/A ,$603.75 , N/A ,$723.45 ,$892.50 ,$892.50 ,$892.50 , N/A ,$714.00 , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ", N/A , N/A ,$892.50 , N/A ,$892.50 ,$945.00 , N/A ,$871.50 ,$834.75 ,$834.75 , N/A ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100357,V5050,HC HEARING AID MONAURAL IN EAR T7,271,1 ,"$1,225.00 ",$796.25 ,$704.38 ,"$1,225.00 ","$1,041.25 ",$731.33 , N/A ,$704.38 , N/A ,$844.03 ,"$1,041.25 ","$1,041.25 ","$1,041.25 ", N/A ,$833.00 , N/A , N/A ,$918.75 ,$869.75 ,$869.75 , N/A ,$869.75 ,"$1,016.75 ","$1,016.75 ","$1,016.75 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,225.00 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,041.25 ","$1,102.50 ", N/A ,"$1,016.75 ",$973.88 ,$973.88 , N/A ,$796.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100358,V5050,HC HEARING AID MONAURAL IN EAR T8,271,1 ,"$1,400.00 ",$910.00 ,$805.00 ,"$1,400.00 ","$1,190.00 ",$835.80 , N/A ,$805.00 , N/A ,$964.60 ,"$1,190.00 ","$1,190.00 ","$1,190.00 ", N/A ,$952.00 , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,162.00 ","$1,162.00 ","$1,162.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ","$1,260.00 ", N/A ,"$1,162.00 ","$1,113.00 ","$1,113.00 ", N/A ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100359,V5050,HC HEARING AID MONAURAL IN EAR T9,271,1 ,"$1,575.00 ","$1,023.75 ",$905.63 ,"$1,575.00 ","$1,338.75 ",$940.28 , N/A ,$905.63 , N/A ,"$1,085.18 ","$1,338.75 ","$1,338.75 ","$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,307.25 ","$1,307.25 ","$1,307.25 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ","$1,417.50 ", N/A ,"$1,307.25 ","$1,252.13 ","$1,252.13 ", N/A ,"$1,023.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100360,V5050,HC HEARING AID MONAURAL IN EAR T10,271,1 ,"$1,750.00 ","$1,137.50 ","$1,006.25 ","$1,750.00 ","$1,487.50 ","$1,044.75 ", N/A ,"$1,006.25 ", N/A ,"$1,205.75 ","$1,487.50 ","$1,487.50 ","$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,452.50 ","$1,452.50 ","$1,452.50 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ","$1,575.00 ", N/A ,"$1,452.50 ","$1,391.25 ","$1,391.25 ", N/A ,"$1,137.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100361,V5050,HC HEARING AID MONAURAL IN EAR T11,271,1 ,"$1,925.00 ","$1,251.25 ","$1,106.88 ","$1,925.00 ","$1,636.25 ","$1,149.23 ", N/A ,"$1,106.88 ", N/A ,"$1,326.33 ","$1,636.25 ","$1,636.25 ","$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,597.75 ","$1,597.75 ","$1,597.75 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ","$1,732.50 ", N/A ,"$1,597.75 ","$1,530.38 ","$1,530.38 ", N/A ,"$1,251.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100362,V5050,HC HEARING AID MONAURAL IN EAR T12,271,1 ,"$2,100.00 ","$1,365.00 ","$1,207.50 ","$2,100.00 ","$1,785.00 ","$1,253.70 ", N/A ,"$1,207.50 ", N/A ,"$1,446.90 ","$1,785.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,743.00 ","$1,743.00 ","$1,743.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,743.00 ","$1,669.50 ","$1,669.50 ", N/A ,"$1,365.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100363,V5050,HC HEARING AID MONAURAL IN EAR T13,271,1 ,"$2,275.00 ","$1,478.75 ","$1,308.13 ","$2,275.00 ","$1,933.75 ","$1,358.18 ", N/A ,"$1,308.13 ", N/A ,"$1,567.48 ","$1,933.75 ","$1,933.75 ","$1,933.75 ", N/A ,"$1,547.00 ", N/A , N/A ,"$1,706.25 ","$1,615.25 ","$1,615.25 ", N/A ,"$1,615.25 ","$1,888.25 ","$1,888.25 ","$1,888.25 ", N/A , N/A ,"$1,933.75 ", N/A ,"$2,275.00 ", N/A , N/A ,"$1,933.75 ", N/A ,"$1,933.75 ","$2,047.50 ", N/A ,"$1,888.25 ","$1,808.63 ","$1,808.63 ", N/A ,"$1,478.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100364,V5050,HC HEARING AID MONAURAL IN EAR T14,271,1 ,"$2,450.00 ","$1,592.50 ","$1,408.75 ","$2,450.00 ","$2,082.50 ","$1,462.65 ", N/A ,"$1,408.75 ", N/A ,"$1,688.05 ","$2,082.50 ","$2,082.50 ","$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,033.50 ","$2,033.50 ","$2,033.50 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ","$2,205.00 ", N/A ,"$2,033.50 ","$1,947.75 ","$1,947.75 ", N/A ,"$1,592.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100365,V5050,HC HEARING AID MONAURAL IN EAR T15,271,1 ,"$2,625.00 ","$1,706.25 ","$1,509.38 ","$2,625.00 ","$2,231.25 ","$1,567.13 ", N/A ,"$1,509.38 ", N/A ,"$1,808.63 ","$2,231.25 ","$2,231.25 ","$2,231.25 ", N/A ,"$1,785.00 ", N/A , N/A ,"$1,968.75 ","$1,863.75 ","$1,863.75 ", N/A ,"$1,863.75 ","$2,178.75 ","$2,178.75 ","$2,178.75 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,625.00 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,231.25 ","$2,362.50 ", N/A ,"$2,178.75 ","$2,086.88 ","$2,086.88 ", N/A ,"$1,706.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100366,V5050,HC HEARING AID MONAURAL IN EAR T16,271,1 ,"$2,800.00 ","$1,820.00 ","$1,610.00 ","$2,800.00 ","$2,380.00 ","$1,671.60 ", N/A ,"$1,610.00 ", N/A ,"$1,929.20 ","$2,380.00 ","$2,380.00 ","$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,324.00 ","$2,324.00 ","$2,324.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ","$2,520.00 ", N/A ,"$2,324.00 ","$2,226.00 ","$2,226.00 ", N/A ,"$1,820.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100367,V5060,HC HEARING AID MONAURAL BEHIND EAR T1,271,1 ,$200.00 ,$130.00 ,$115.00 ,$200.00 ,$170.00 ,$119.40 , N/A ,$115.00 , N/A ,$137.80 ,$170.00 ,$170.00 ,$170.00 , N/A ,$136.00 , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A , N/A ,$170.00 , N/A ,$200.00 , N/A , N/A ,$170.00 , N/A ,$170.00 ,$180.00 , N/A ,$166.00 ,$159.00 ,$159.00 , N/A ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100368,V5060,HC HEARING AID MONAURAL BEHIND EAR T2,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100369,V5060,HC HEARING AID MONAURAL BEHIND EAR T3,271,1 ,$525.00 ,$341.25 ,$301.88 ,$525.00 ,$446.25 ,$313.43 , N/A ,$301.88 , N/A ,$361.73 ,$446.25 ,$446.25 ,$446.25 , N/A ,$357.00 , N/A , N/A ,$393.75 ,$372.75 ,$372.75 , N/A ,$372.75 ,$435.75 ,$435.75 ,$435.75 , N/A , N/A ,$446.25 , N/A ,$525.00 , N/A , N/A ,$446.25 , N/A ,$446.25 ,$472.50 , N/A ,$435.75 ,$417.38 ,$417.38 , N/A ,$341.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100370,V5060,HC HEARING AID MONAURAL BEHIND EAR T4,271,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100371,V5060,HC HEARING AID MONAURAL BEHIND EAR T5,271,1 ,$875.00 ,$568.75 ,$503.13 ,$875.00 ,$743.75 ,$522.38 , N/A ,$503.13 , N/A ,$602.88 ,$743.75 ,$743.75 ,$743.75 , N/A ,$595.00 , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$726.25 ,$726.25 ,$726.25 , N/A , N/A ,$743.75 , N/A ,$875.00 , N/A , N/A ,$743.75 , N/A ,$743.75 ,$787.50 , N/A ,$726.25 ,$695.63 ,$695.63 , N/A ,$568.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100372,V5060,HC HEARING AID MONAURAL BEHIND EAR T6,271,1 ,"$1,050.00 ",$682.50 ,$603.75 ,"$1,050.00 ",$892.50 ,$626.85 , N/A ,$603.75 , N/A ,$723.45 ,$892.50 ,$892.50 ,$892.50 , N/A ,$714.00 , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ", N/A , N/A ,$892.50 , N/A ,$892.50 ,$945.00 , N/A ,$871.50 ,$834.75 ,$834.75 , N/A ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100373,V5060,HC HEARING AID MONAURAL BEHIND EAR T7,271,1 ,"$1,225.00 ",$796.25 ,$704.38 ,"$1,225.00 ","$1,041.25 ",$731.33 , N/A ,$704.38 , N/A ,$844.03 ,"$1,041.25 ","$1,041.25 ","$1,041.25 ", N/A ,$833.00 , N/A , N/A ,$918.75 ,$869.75 ,$869.75 , N/A ,$869.75 ,"$1,016.75 ","$1,016.75 ","$1,016.75 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,225.00 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,041.25 ","$1,102.50 ", N/A ,"$1,016.75 ",$973.88 ,$973.88 , N/A ,$796.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100374,V5060,HC HEARING AID MONAURAL BEHIND EAR T8,271,1 ,"$1,400.00 ",$910.00 ,$805.00 ,"$1,400.00 ","$1,190.00 ",$835.80 , N/A ,$805.00 , N/A ,$964.60 ,"$1,190.00 ","$1,190.00 ","$1,190.00 ", N/A ,$952.00 , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,162.00 ","$1,162.00 ","$1,162.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ","$1,260.00 ", N/A ,"$1,162.00 ","$1,113.00 ","$1,113.00 ", N/A ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100375,V5060,HC HEARING AID MONAURAL BEHIND EAR T9,271,1 ,"$1,575.00 ","$1,023.75 ",$905.63 ,"$1,575.00 ","$1,338.75 ",$940.28 , N/A ,$905.63 , N/A ,"$1,085.18 ","$1,338.75 ","$1,338.75 ","$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,307.25 ","$1,307.25 ","$1,307.25 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ","$1,417.50 ", N/A ,"$1,307.25 ","$1,252.13 ","$1,252.13 ", N/A ,"$1,023.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100376,V5060,HC HEARING AID MONAURAL BEHIND EAR T10,271,1 ,"$1,750.00 ","$1,137.50 ","$1,006.25 ","$1,750.00 ","$1,487.50 ","$1,044.75 ", N/A ,"$1,006.25 ", N/A ,"$1,205.75 ","$1,487.50 ","$1,487.50 ","$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,452.50 ","$1,452.50 ","$1,452.50 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ","$1,575.00 ", N/A ,"$1,452.50 ","$1,391.25 ","$1,391.25 ", N/A ,"$1,137.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100377,V5060,HC HEARING AID MONAURAL BEHIND EAR T11,271,1 ,"$1,925.00 ","$1,251.25 ","$1,106.88 ","$1,925.00 ","$1,636.25 ","$1,149.23 ", N/A ,"$1,106.88 ", N/A ,"$1,326.33 ","$1,636.25 ","$1,636.25 ","$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,597.75 ","$1,597.75 ","$1,597.75 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ","$1,732.50 ", N/A ,"$1,597.75 ","$1,530.38 ","$1,530.38 ", N/A ,"$1,251.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100378,V5060,HC HEARING AID MONAURAL BEHIND EAR T12,271,1 ,"$2,100.00 ","$1,365.00 ","$1,207.50 ","$2,100.00 ","$1,785.00 ","$1,253.70 ", N/A ,"$1,207.50 ", N/A ,"$1,446.90 ","$1,785.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,743.00 ","$1,743.00 ","$1,743.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,743.00 ","$1,669.50 ","$1,669.50 ", N/A ,"$1,365.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100379,V5060,HC HEARING AID MONAURAL BEHIND EAR T13,271,1 ,"$2,275.00 ","$1,478.75 ","$1,308.13 ","$2,275.00 ","$1,933.75 ","$1,358.18 ", N/A ,"$1,308.13 ", N/A ,"$1,567.48 ","$1,933.75 ","$1,933.75 ","$1,933.75 ", N/A ,"$1,547.00 ", N/A , N/A ,"$1,706.25 ","$1,615.25 ","$1,615.25 ", N/A ,"$1,615.25 ","$1,888.25 ","$1,888.25 ","$1,888.25 ", N/A , N/A ,"$1,933.75 ", N/A ,"$2,275.00 ", N/A , N/A ,"$1,933.75 ", N/A ,"$1,933.75 ","$2,047.50 ", N/A ,"$1,888.25 ","$1,808.63 ","$1,808.63 ", N/A ,"$1,478.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100380,V5060,HC HEARING AID MONAURAL BEHIND EAR T14,271,1 ,"$2,450.00 ","$1,592.50 ","$1,408.75 ","$2,450.00 ","$2,082.50 ","$1,462.65 ", N/A ,"$1,408.75 ", N/A ,"$1,688.05 ","$2,082.50 ","$2,082.50 ","$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,033.50 ","$2,033.50 ","$2,033.50 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ","$2,205.00 ", N/A ,"$2,033.50 ","$1,947.75 ","$1,947.75 ", N/A ,"$1,592.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100381,V5060,HC HEARING AID MONAURAL BEHIND EAR T15,271,1 ,"$2,625.00 ","$1,706.25 ","$1,509.38 ","$2,625.00 ","$2,231.25 ","$1,567.13 ", N/A ,"$1,509.38 ", N/A ,"$1,808.63 ","$2,231.25 ","$2,231.25 ","$2,231.25 ", N/A ,"$1,785.00 ", N/A , N/A ,"$1,968.75 ","$1,863.75 ","$1,863.75 ", N/A ,"$1,863.75 ","$2,178.75 ","$2,178.75 ","$2,178.75 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,625.00 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,231.25 ","$2,362.50 ", N/A ,"$2,178.75 ","$2,086.88 ","$2,086.88 ", N/A ,"$1,706.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100382,V5060,HC HEARING AID MONAURAL BEHIND EAR T16,271,1 ,"$2,800.00 ","$1,820.00 ","$1,610.00 ","$2,800.00 ","$2,380.00 ","$1,671.60 ", N/A ,"$1,610.00 ", N/A ,"$1,929.20 ","$2,380.00 ","$2,380.00 ","$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,324.00 ","$2,324.00 ","$2,324.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ","$2,520.00 ", N/A ,"$2,324.00 ","$2,226.00 ","$2,226.00 ", N/A ,"$1,820.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100383,V5130,HC HEARING AID BINAURAL IN EAR T1,271,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100384,V5130,HC HEARING AID BINAURAL IN EAR T2,271,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100385,V5130,HC HEARING AID BINAURAL IN EAR T3,271,1 ,"$1,050.00 ",$682.50 ,$603.75 ,"$1,050.00 ",$892.50 ,$626.85 , N/A ,$603.75 , N/A ,$723.45 ,$892.50 ,$892.50 ,$892.50 , N/A ,$714.00 , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ", N/A , N/A ,$892.50 , N/A ,$892.50 ,$945.00 , N/A ,$871.50 ,$834.75 ,$834.75 , N/A ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100386,V5130,HC HEARING AID BINAURAL IN EAR T4,271,1 ,"$1,400.00 ",$910.00 ,$805.00 ,"$1,400.00 ","$1,190.00 ",$835.80 , N/A ,$805.00 , N/A ,$964.60 ,"$1,190.00 ","$1,190.00 ","$1,190.00 ", N/A ,$952.00 , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,162.00 ","$1,162.00 ","$1,162.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ","$1,260.00 ", N/A ,"$1,162.00 ","$1,113.00 ","$1,113.00 ", N/A ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100387,V5130,HC HEARING AID BINAURAL IN EAR T5,271,1 ,"$1,750.00 ","$1,137.50 ","$1,006.25 ","$1,750.00 ","$1,487.50 ","$1,044.75 ", N/A ,"$1,006.25 ", N/A ,"$1,205.75 ","$1,487.50 ","$1,487.50 ","$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,452.50 ","$1,452.50 ","$1,452.50 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ","$1,575.00 ", N/A ,"$1,452.50 ","$1,391.25 ","$1,391.25 ", N/A ,"$1,137.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100388,V5130,HC HEARING AID BINAURAL IN EAR T6,271,1 ,"$2,100.00 ","$1,365.00 ","$1,207.50 ","$2,100.00 ","$1,785.00 ","$1,253.70 ", N/A ,"$1,207.50 ", N/A ,"$1,446.90 ","$1,785.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,743.00 ","$1,743.00 ","$1,743.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,743.00 ","$1,669.50 ","$1,669.50 ", N/A ,"$1,365.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100389,V5130,HC HEARING AID BINAURAL IN EAR T7,271,1 ,"$2,450.00 ","$1,592.50 ","$1,408.75 ","$2,450.00 ","$2,082.50 ","$1,462.65 ", N/A ,"$1,408.75 ", N/A ,"$1,688.05 ","$2,082.50 ","$2,082.50 ","$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,033.50 ","$2,033.50 ","$2,033.50 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ","$2,205.00 ", N/A ,"$2,033.50 ","$1,947.75 ","$1,947.75 ", N/A ,"$1,592.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100390,V5130,HC HEARING AID BINAURAL IN EAR T8,271,1 ,"$2,800.00 ","$1,820.00 ","$1,610.00 ","$2,800.00 ","$2,380.00 ","$1,671.60 ", N/A ,"$1,610.00 ", N/A ,"$1,929.20 ","$2,380.00 ","$2,380.00 ","$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,324.00 ","$2,324.00 ","$2,324.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ","$2,520.00 ", N/A ,"$2,324.00 ","$2,226.00 ","$2,226.00 ", N/A ,"$1,820.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100391,V5130,HC HEARING AID BINAURAL IN EAR T9,271,1 ,"$3,150.00 ","$2,047.50 ","$1,811.25 ","$3,150.00 ","$2,677.50 ","$1,880.55 ", N/A ,"$1,811.25 ", N/A ,"$2,170.35 ","$2,677.50 ","$2,677.50 ","$2,677.50 ", N/A ,"$2,142.00 ", N/A , N/A ,"$2,362.50 ","$2,236.50 ","$2,236.50 ", N/A ,"$2,236.50 ","$2,614.50 ","$2,614.50 ","$2,614.50 ", N/A , N/A ,"$2,677.50 ", N/A ,"$3,150.00 ", N/A , N/A ,"$2,677.50 ", N/A ,"$2,677.50 ","$2,835.00 ", N/A ,"$2,614.50 ","$2,504.25 ","$2,504.25 ", N/A ,"$2,047.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100392,V5130,HC HEARING AID BINAURAL IN EAR T10,271,1 ,"$3,500.00 ","$2,275.00 ","$2,012.50 ","$3,500.00 ","$2,975.00 ","$2,089.50 ", N/A ,"$2,012.50 ", N/A ,"$2,411.50 ","$2,975.00 ","$2,975.00 ","$2,975.00 ", N/A ,"$2,380.00 ", N/A , N/A ,"$2,625.00 ","$2,485.00 ","$2,485.00 ", N/A ,"$2,485.00 ","$2,905.00 ","$2,905.00 ","$2,905.00 ", N/A , N/A ,"$2,975.00 ", N/A ,"$3,500.00 ", N/A , N/A ,"$2,975.00 ", N/A ,"$2,975.00 ","$3,150.00 ", N/A ,"$2,905.00 ","$2,782.50 ","$2,782.50 ", N/A ,"$2,275.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100393,V5130,HC HEARING AID BINAURAL IN EAR T11,271,1 ,"$3,850.00 ","$2,502.50 ","$2,213.75 ","$3,850.00 ","$3,272.50 ","$2,298.45 ", N/A ,"$2,213.75 ", N/A ,"$2,652.65 ","$3,272.50 ","$3,272.50 ","$3,272.50 ", N/A ,"$2,618.00 ", N/A , N/A ,"$2,887.50 ","$2,733.50 ","$2,733.50 ", N/A ,"$2,733.50 ","$3,195.50 ","$3,195.50 ","$3,195.50 ", N/A , N/A ,"$3,272.50 ", N/A ,"$3,850.00 ", N/A , N/A ,"$3,272.50 ", N/A ,"$3,272.50 ","$3,465.00 ", N/A ,"$3,195.50 ","$3,060.75 ","$3,060.75 ", N/A ,"$2,502.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100394,V5130,HC HEARING AID BINAURAL IN EAR T12,271,1 ,"$4,200.00 ","$2,730.00 ","$2,415.00 ","$4,200.00 ","$3,570.00 ","$2,507.40 ", N/A ,"$2,415.00 ", N/A ,"$2,893.80 ","$3,570.00 ","$3,570.00 ","$3,570.00 ", N/A ,"$2,856.00 ", N/A , N/A ,"$3,150.00 ","$2,982.00 ","$2,982.00 ", N/A ,"$2,982.00 ","$3,486.00 ","$3,486.00 ","$3,486.00 ", N/A , N/A ,"$3,570.00 ", N/A ,"$4,200.00 ", N/A , N/A ,"$3,570.00 ", N/A ,"$3,570.00 ","$3,780.00 ", N/A ,"$3,486.00 ","$3,339.00 ","$3,339.00 ", N/A ,"$2,730.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100395,V5130,HC HEARING AID BINAURAL IN EAR T13,271,1 ,"$4,550.00 ","$2,957.50 ","$2,616.25 ","$4,550.00 ","$3,867.50 ","$2,716.35 ", N/A ,"$2,616.25 ", N/A ,"$3,134.95 ","$3,867.50 ","$3,867.50 ","$3,867.50 ", N/A ,"$3,094.00 ", N/A , N/A ,"$3,412.50 ","$3,230.50 ","$3,230.50 ", N/A ,"$3,230.50 ","$3,776.50 ","$3,776.50 ","$3,776.50 ", N/A , N/A ,"$3,867.50 ", N/A ,"$4,550.00 ", N/A , N/A ,"$3,867.50 ", N/A ,"$3,867.50 ","$4,095.00 ", N/A ,"$3,776.50 ","$3,617.25 ","$3,617.25 ", N/A ,"$2,957.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100396,V5130,HC HEARING AID BINAURAL IN EAR T14,271,1 ,"$4,900.00 ","$3,185.00 ","$2,817.50 ","$4,900.00 ","$4,165.00 ","$2,925.30 ", N/A ,"$2,817.50 ", N/A ,"$3,376.10 ","$4,165.00 ","$4,165.00 ","$4,165.00 ", N/A ,"$3,332.00 ", N/A , N/A ,"$3,675.00 ","$3,479.00 ","$3,479.00 ", N/A ,"$3,479.00 ","$4,067.00 ","$4,067.00 ","$4,067.00 ", N/A , N/A ,"$4,165.00 ", N/A ,"$4,900.00 ", N/A , N/A ,"$4,165.00 ", N/A ,"$4,165.00 ","$4,410.00 ", N/A ,"$4,067.00 ","$3,895.50 ","$3,895.50 ", N/A ,"$3,185.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100397,V5130,HC HEARING AID BINAURAL IN EAR T15,271,1 ,"$5,250.00 ","$3,412.50 ","$3,018.75 ","$5,250.00 ","$4,462.50 ","$3,134.25 ", N/A ,"$3,018.75 ", N/A ,"$3,617.25 ","$4,462.50 ","$4,462.50 ","$4,462.50 ", N/A ,"$3,570.00 ", N/A , N/A ,"$3,937.50 ","$3,727.50 ","$3,727.50 ", N/A ,"$3,727.50 ","$4,357.50 ","$4,357.50 ","$4,357.50 ", N/A , N/A ,"$4,462.50 ", N/A ,"$5,250.00 ", N/A , N/A ,"$4,462.50 ", N/A ,"$4,462.50 ","$4,725.00 ", N/A ,"$4,357.50 ","$4,173.75 ","$4,173.75 ", N/A ,"$3,412.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100398,V5130,HC HEARING AID BINAURAL IN EAR T16,271,1 ,"$5,600.00 ","$3,640.00 ","$3,220.00 ","$5,600.00 ","$4,760.00 ","$3,343.20 ", N/A ,"$3,220.00 ", N/A ,"$3,858.40 ","$4,760.00 ","$4,760.00 ","$4,760.00 ", N/A ,"$3,808.00 ", N/A , N/A ,"$4,200.00 ","$3,976.00 ","$3,976.00 ", N/A ,"$3,976.00 ","$4,648.00 ","$4,648.00 ","$4,648.00 ", N/A , N/A ,"$4,760.00 ", N/A ,"$5,600.00 ", N/A , N/A ,"$4,760.00 ", N/A ,"$4,760.00 ","$5,040.00 ", N/A ,"$4,648.00 ","$4,452.00 ","$4,452.00 ", N/A ,"$3,640.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100399,V5140,HC HEARING AID BINAURAL BEHIND EAR T1,271,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100400,V5140,HC HEARING AID BINAURAL BEHIND EAR T2,271,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100401,V5140,HC HEARING AID BINAURAL BEHIND EAR T3,271,1 ,"$1,050.00 ",$682.50 ,$603.75 ,"$1,050.00 ",$892.50 ,$626.85 , N/A ,$603.75 , N/A ,$723.45 ,$892.50 ,$892.50 ,$892.50 , N/A ,$714.00 , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ", N/A , N/A ,$892.50 , N/A ,$892.50 ,$945.00 , N/A ,$871.50 ,$834.75 ,$834.75 , N/A ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100402,V5140,HC HEARING AID BINAURAL BEHIND EAR T4,271,1 ,"$1,400.00 ",$910.00 ,$805.00 ,"$1,400.00 ","$1,190.00 ",$835.80 , N/A ,$805.00 , N/A ,$964.60 ,"$1,190.00 ","$1,190.00 ","$1,190.00 ", N/A ,$952.00 , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,162.00 ","$1,162.00 ","$1,162.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ","$1,260.00 ", N/A ,"$1,162.00 ","$1,113.00 ","$1,113.00 ", N/A ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100403,V5140,HC HEARING AID BINAURAL BEHIND EAR T5,271,1 ,"$1,750.00 ","$1,137.50 ","$1,006.25 ","$1,750.00 ","$1,487.50 ","$1,044.75 ", N/A ,"$1,006.25 ", N/A ,"$1,205.75 ","$1,487.50 ","$1,487.50 ","$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,452.50 ","$1,452.50 ","$1,452.50 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ","$1,575.00 ", N/A ,"$1,452.50 ","$1,391.25 ","$1,391.25 ", N/A ,"$1,137.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100404,V5140,HC HEARING AID BINAURAL BEHIND EAR T6,271,1 ,"$2,100.00 ","$1,365.00 ","$1,207.50 ","$2,100.00 ","$1,785.00 ","$1,253.70 ", N/A ,"$1,207.50 ", N/A ,"$1,446.90 ","$1,785.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,743.00 ","$1,743.00 ","$1,743.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,743.00 ","$1,669.50 ","$1,669.50 ", N/A ,"$1,365.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100405,V5140,HC HEARING AID BINAURAL BEHIND EAR T7,271,1 ,"$2,450.00 ","$1,592.50 ","$1,408.75 ","$2,450.00 ","$2,082.50 ","$1,462.65 ", N/A ,"$1,408.75 ", N/A ,"$1,688.05 ","$2,082.50 ","$2,082.50 ","$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,033.50 ","$2,033.50 ","$2,033.50 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ","$2,205.00 ", N/A ,"$2,033.50 ","$1,947.75 ","$1,947.75 ", N/A ,"$1,592.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100406,V5140,HC HEARING AID BINAURAL BEHIND EAR T8,271,1 ,"$2,800.00 ","$1,820.00 ","$1,610.00 ","$2,800.00 ","$2,380.00 ","$1,671.60 ", N/A ,"$1,610.00 ", N/A ,"$1,929.20 ","$2,380.00 ","$2,380.00 ","$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,324.00 ","$2,324.00 ","$2,324.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ","$2,520.00 ", N/A ,"$2,324.00 ","$2,226.00 ","$2,226.00 ", N/A ,"$1,820.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100407,V5140,HC HEARING AID BINAURAL BEHIND EAR T9,271,1 ,"$3,150.00 ","$2,047.50 ","$1,811.25 ","$3,150.00 ","$2,677.50 ","$1,880.55 ", N/A ,"$1,811.25 ", N/A ,"$2,170.35 ","$2,677.50 ","$2,677.50 ","$2,677.50 ", N/A ,"$2,142.00 ", N/A , N/A ,"$2,362.50 ","$2,236.50 ","$2,236.50 ", N/A ,"$2,236.50 ","$2,614.50 ","$2,614.50 ","$2,614.50 ", N/A , N/A ,"$2,677.50 ", N/A ,"$3,150.00 ", N/A , N/A ,"$2,677.50 ", N/A ,"$2,677.50 ","$2,835.00 ", N/A ,"$2,614.50 ","$2,504.25 ","$2,504.25 ", N/A ,"$2,047.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100408,V5140,HC HEARING AID BINAURAL BEHIND EAR T10,271,1 ,"$3,500.00 ","$2,275.00 ","$2,012.50 ","$3,500.00 ","$2,975.00 ","$2,089.50 ", N/A ,"$2,012.50 ", N/A ,"$2,411.50 ","$2,975.00 ","$2,975.00 ","$2,975.00 ", N/A ,"$2,380.00 ", N/A , N/A ,"$2,625.00 ","$2,485.00 ","$2,485.00 ", N/A ,"$2,485.00 ","$2,905.00 ","$2,905.00 ","$2,905.00 ", N/A , N/A ,"$2,975.00 ", N/A ,"$3,500.00 ", N/A , N/A ,"$2,975.00 ", N/A ,"$2,975.00 ","$3,150.00 ", N/A ,"$2,905.00 ","$2,782.50 ","$2,782.50 ", N/A ,"$2,275.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100409,V5140,HC HEARING AID BINAURAL BEHIND EAR T11,271,1 ,"$3,850.00 ","$2,502.50 ","$2,213.75 ","$3,850.00 ","$3,272.50 ","$2,298.45 ", N/A ,"$2,213.75 ", N/A ,"$2,652.65 ","$3,272.50 ","$3,272.50 ","$3,272.50 ", N/A ,"$2,618.00 ", N/A , N/A ,"$2,887.50 ","$2,733.50 ","$2,733.50 ", N/A ,"$2,733.50 ","$3,195.50 ","$3,195.50 ","$3,195.50 ", N/A , N/A ,"$3,272.50 ", N/A ,"$3,850.00 ", N/A , N/A ,"$3,272.50 ", N/A ,"$3,272.50 ","$3,465.00 ", N/A ,"$3,195.50 ","$3,060.75 ","$3,060.75 ", N/A ,"$2,502.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100410,V5140,HC HEARING AID BINAURAL BEHIND EAR T12,271,1 ,"$4,200.00 ","$2,730.00 ","$2,415.00 ","$4,200.00 ","$3,570.00 ","$2,507.40 ", N/A ,"$2,415.00 ", N/A ,"$2,893.80 ","$3,570.00 ","$3,570.00 ","$3,570.00 ", N/A ,"$2,856.00 ", N/A , N/A ,"$3,150.00 ","$2,982.00 ","$2,982.00 ", N/A ,"$2,982.00 ","$3,486.00 ","$3,486.00 ","$3,486.00 ", N/A , N/A ,"$3,570.00 ", N/A ,"$4,200.00 ", N/A , N/A ,"$3,570.00 ", N/A ,"$3,570.00 ","$3,780.00 ", N/A ,"$3,486.00 ","$3,339.00 ","$3,339.00 ", N/A ,"$2,730.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100411,V5140,HC HEARING AID BINAURAL BEHIND EAR T13,271,1 ,"$4,550.00 ","$2,957.50 ","$2,616.25 ","$4,550.00 ","$3,867.50 ","$2,716.35 ", N/A ,"$2,616.25 ", N/A ,"$3,134.95 ","$3,867.50 ","$3,867.50 ","$3,867.50 ", N/A ,"$3,094.00 ", N/A , N/A ,"$3,412.50 ","$3,230.50 ","$3,230.50 ", N/A ,"$3,230.50 ","$3,776.50 ","$3,776.50 ","$3,776.50 ", N/A , N/A ,"$3,867.50 ", N/A ,"$4,550.00 ", N/A , N/A ,"$3,867.50 ", N/A ,"$3,867.50 ","$4,095.00 ", N/A ,"$3,776.50 ","$3,617.25 ","$3,617.25 ", N/A ,"$2,957.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100412,V5140,HC HEARING AID BINAURAL BEHIND EAR T14,271,1 ,"$4,900.00 ","$3,185.00 ","$2,817.50 ","$4,900.00 ","$4,165.00 ","$2,925.30 ", N/A ,"$2,817.50 ", N/A ,"$3,376.10 ","$4,165.00 ","$4,165.00 ","$4,165.00 ", N/A ,"$3,332.00 ", N/A , N/A ,"$3,675.00 ","$3,479.00 ","$3,479.00 ", N/A ,"$3,479.00 ","$4,067.00 ","$4,067.00 ","$4,067.00 ", N/A , N/A ,"$4,165.00 ", N/A ,"$4,900.00 ", N/A , N/A ,"$4,165.00 ", N/A ,"$4,165.00 ","$4,410.00 ", N/A ,"$4,067.00 ","$3,895.50 ","$3,895.50 ", N/A ,"$3,185.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100413,V5140,HC HEARING AID BINAURAL BEHIND EAR T15,271,1 ,"$5,250.00 ","$3,412.50 ","$3,018.75 ","$5,250.00 ","$4,462.50 ","$3,134.25 ", N/A ,"$3,018.75 ", N/A ,"$3,617.25 ","$4,462.50 ","$4,462.50 ","$4,462.50 ", N/A ,"$3,570.00 ", N/A , N/A ,"$3,937.50 ","$3,727.50 ","$3,727.50 ", N/A ,"$3,727.50 ","$4,357.50 ","$4,357.50 ","$4,357.50 ", N/A , N/A ,"$4,462.50 ", N/A ,"$5,250.00 ", N/A , N/A ,"$4,462.50 ", N/A ,"$4,462.50 ","$4,725.00 ", N/A ,"$4,357.50 ","$4,173.75 ","$4,173.75 ", N/A ,"$3,412.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100414,V5140,HC HEARING AID BINAURAL BEHIND EAR T16,271,1 ,"$5,600.00 ","$3,640.00 ","$3,220.00 ","$5,600.00 ","$4,760.00 ","$3,343.20 ", N/A ,"$3,220.00 ", N/A ,"$3,858.40 ","$4,760.00 ","$4,760.00 ","$4,760.00 ", N/A ,"$3,808.00 ", N/A , N/A ,"$4,200.00 ","$3,976.00 ","$3,976.00 ", N/A ,"$3,976.00 ","$4,648.00 ","$4,648.00 ","$4,648.00 ", N/A , N/A ,"$4,760.00 ", N/A ,"$5,600.00 ", N/A , N/A ,"$4,760.00 ", N/A ,"$4,760.00 ","$5,040.00 ", N/A ,"$4,648.00 ","$4,452.00 ","$4,452.00 ", N/A ,"$3,640.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100415,V5171,HC HEARING AID CROS MONAURAL IN EAR T1,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100416,V5171,HC HEARING AID CROS MONAURAL IN EAR T2,271,1 ,$525.00 ,$341.25 ,$301.88 ,$525.00 ,$446.25 ,$313.43 , N/A ,$301.88 , N/A ,$361.73 ,$446.25 ,$446.25 ,$446.25 , N/A ,$357.00 , N/A , N/A ,$393.75 ,$372.75 ,$372.75 , N/A ,$372.75 ,$435.75 ,$435.75 ,$435.75 , N/A , N/A ,$446.25 , N/A ,$525.00 , N/A , N/A ,$446.25 , N/A ,$446.25 ,$472.50 , N/A ,$435.75 ,$417.38 ,$417.38 , N/A ,$341.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100417,V5171,HC HEARING AID CROS MONAURAL IN EAR T3,271,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100418,V5171,HC HEARING AID CROS MONAURAL IN EAR T4,271,1 ,$875.00 ,$568.75 ,$503.13 ,$875.00 ,$743.75 ,$522.38 , N/A ,$503.13 , N/A ,$602.88 ,$743.75 ,$743.75 ,$743.75 , N/A ,$595.00 , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$726.25 ,$726.25 ,$726.25 , N/A , N/A ,$743.75 , N/A ,$875.00 , N/A , N/A ,$743.75 , N/A ,$743.75 ,$787.50 , N/A ,$726.25 ,$695.63 ,$695.63 , N/A ,$568.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100419,V5171,HC HEARING AID CROS MONAURAL IN EAR T5,271,1 ,"$1,050.00 ",$682.50 ,$603.75 ,"$1,050.00 ",$892.50 ,$626.85 , N/A ,$603.75 , N/A ,$723.45 ,$892.50 ,$892.50 ,$892.50 , N/A ,$714.00 , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ", N/A , N/A ,$892.50 , N/A ,$892.50 ,$945.00 , N/A ,$871.50 ,$834.75 ,$834.75 , N/A ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100420,V5171,HC HEARING AID CROS MONAURAL IN EAR T6,271,1 ,"$1,225.00 ",$796.25 ,$704.38 ,"$1,225.00 ","$1,041.25 ",$731.33 , N/A ,$704.38 , N/A ,$844.03 ,"$1,041.25 ","$1,041.25 ","$1,041.25 ", N/A ,$833.00 , N/A , N/A ,$918.75 ,$869.75 ,$869.75 , N/A ,$869.75 ,"$1,016.75 ","$1,016.75 ","$1,016.75 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,225.00 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,041.25 ","$1,102.50 ", N/A ,"$1,016.75 ",$973.88 ,$973.88 , N/A ,$796.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100421,V5171,HC HEARING AID CROS MONAURAL IN EAR T7,271,1 ,"$1,400.00 ",$910.00 ,$805.00 ,"$1,400.00 ","$1,190.00 ",$835.80 , N/A ,$805.00 , N/A ,$964.60 ,"$1,190.00 ","$1,190.00 ","$1,190.00 ", N/A ,$952.00 , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,162.00 ","$1,162.00 ","$1,162.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ","$1,260.00 ", N/A ,"$1,162.00 ","$1,113.00 ","$1,113.00 ", N/A ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100422,V5171,HC HEARING AID CROS MONAURAL IN EAR T8,271,1 ,"$1,575.00 ","$1,023.75 ",$905.63 ,"$1,575.00 ","$1,338.75 ",$940.28 , N/A ,$905.63 , N/A ,"$1,085.18 ","$1,338.75 ","$1,338.75 ","$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,307.25 ","$1,307.25 ","$1,307.25 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ","$1,417.50 ", N/A ,"$1,307.25 ","$1,252.13 ","$1,252.13 ", N/A ,"$1,023.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100423,V5171,HC HEARING AID CROS MONAURAL IN EAR T9,271,1 ,"$1,750.00 ","$1,137.50 ","$1,006.25 ","$1,750.00 ","$1,487.50 ","$1,044.75 ", N/A ,"$1,006.25 ", N/A ,"$1,205.75 ","$1,487.50 ","$1,487.50 ","$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,452.50 ","$1,452.50 ","$1,452.50 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ","$1,575.00 ", N/A ,"$1,452.50 ","$1,391.25 ","$1,391.25 ", N/A ,"$1,137.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100424,V5171,HC HEARING AID CROS MONAURAL IN EAR T10,271,1 ,"$1,925.00 ","$1,251.25 ","$1,106.88 ","$1,925.00 ","$1,636.25 ","$1,149.23 ", N/A ,"$1,106.88 ", N/A ,"$1,326.33 ","$1,636.25 ","$1,636.25 ","$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,597.75 ","$1,597.75 ","$1,597.75 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ","$1,732.50 ", N/A ,"$1,597.75 ","$1,530.38 ","$1,530.38 ", N/A ,"$1,251.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100425,V5171,HC HEARING AID CROS MONAURAL IN EAR T11,271,1 ,"$2,100.00 ","$1,365.00 ","$1,207.50 ","$2,100.00 ","$1,785.00 ","$1,253.70 ", N/A ,"$1,207.50 ", N/A ,"$1,446.90 ","$1,785.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,743.00 ","$1,743.00 ","$1,743.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,743.00 ","$1,669.50 ","$1,669.50 ", N/A ,"$1,365.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100426,V5171,HC HEARING AID CROS MONAURAL IN EAR T12,271,1 ,"$2,275.00 ","$1,478.75 ","$1,308.13 ","$2,275.00 ","$1,933.75 ","$1,358.18 ", N/A ,"$1,308.13 ", N/A ,"$1,567.48 ","$1,933.75 ","$1,933.75 ","$1,933.75 ", N/A ,"$1,547.00 ", N/A , N/A ,"$1,706.25 ","$1,615.25 ","$1,615.25 ", N/A ,"$1,615.25 ","$1,888.25 ","$1,888.25 ","$1,888.25 ", N/A , N/A ,"$1,933.75 ", N/A ,"$2,275.00 ", N/A , N/A ,"$1,933.75 ", N/A ,"$1,933.75 ","$2,047.50 ", N/A ,"$1,888.25 ","$1,808.63 ","$1,808.63 ", N/A ,"$1,478.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100427,V5171,HC HEARING AID CROS MONAURAL IN EAR T13,271,1 ,"$2,450.00 ","$1,592.50 ","$1,408.75 ","$2,450.00 ","$2,082.50 ","$1,462.65 ", N/A ,"$1,408.75 ", N/A ,"$1,688.05 ","$2,082.50 ","$2,082.50 ","$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,033.50 ","$2,033.50 ","$2,033.50 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ","$2,205.00 ", N/A ,"$2,033.50 ","$1,947.75 ","$1,947.75 ", N/A ,"$1,592.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100428,V5171,HC HEARING AID CROS MONAURAL IN EAR T14,271,1 ,"$2,625.00 ","$1,706.25 ","$1,509.38 ","$2,625.00 ","$2,231.25 ","$1,567.13 ", N/A ,"$1,509.38 ", N/A ,"$1,808.63 ","$2,231.25 ","$2,231.25 ","$2,231.25 ", N/A ,"$1,785.00 ", N/A , N/A ,"$1,968.75 ","$1,863.75 ","$1,863.75 ", N/A ,"$1,863.75 ","$2,178.75 ","$2,178.75 ","$2,178.75 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,625.00 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,231.25 ","$2,362.50 ", N/A ,"$2,178.75 ","$2,086.88 ","$2,086.88 ", N/A ,"$1,706.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100429,V5171,HC HEARING AID CROS MONAURAL IN EAR T15,271,1 ,"$2,800.00 ","$1,820.00 ","$1,610.00 ","$2,800.00 ","$2,380.00 ","$1,671.60 ", N/A ,"$1,610.00 ", N/A ,"$1,929.20 ","$2,380.00 ","$2,380.00 ","$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,324.00 ","$2,324.00 ","$2,324.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ","$2,520.00 ", N/A ,"$2,324.00 ","$2,226.00 ","$2,226.00 ", N/A ,"$1,820.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100430,V5171,HC HEARING AID CROS MONAURAL IN EAR T16,271,1 ,"$2,850.00 ","$1,852.50 ","$1,638.75 ","$2,850.00 ","$2,422.50 ","$1,701.45 ", N/A ,"$1,638.75 ", N/A ,"$1,963.65 ","$2,422.50 ","$2,422.50 ","$2,422.50 ", N/A ,"$1,938.00 ", N/A , N/A ,"$2,137.50 ","$2,023.50 ","$2,023.50 ", N/A ,"$2,023.50 ","$2,365.50 ","$2,365.50 ","$2,365.50 ", N/A , N/A ,"$2,422.50 ", N/A ,"$2,850.00 ", N/A , N/A ,"$2,422.50 ", N/A ,"$2,422.50 ","$2,565.00 ", N/A ,"$2,365.50 ","$2,265.75 ","$2,265.75 ", N/A ,"$1,852.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100431,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T1,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100432,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T2,271,1 ,$525.00 ,$341.25 ,$301.88 ,$525.00 ,$446.25 ,$313.43 , N/A ,$301.88 , N/A ,$361.73 ,$446.25 ,$446.25 ,$446.25 , N/A ,$357.00 , N/A , N/A ,$393.75 ,$372.75 ,$372.75 , N/A ,$372.75 ,$435.75 ,$435.75 ,$435.75 , N/A , N/A ,$446.25 , N/A ,$525.00 , N/A , N/A ,$446.25 , N/A ,$446.25 ,$472.50 , N/A ,$435.75 ,$417.38 ,$417.38 , N/A ,$341.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100433,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T3,271,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100434,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T4,271,1 ,$875.00 ,$568.75 ,$503.13 ,$875.00 ,$743.75 ,$522.38 , N/A ,$503.13 , N/A ,$602.88 ,$743.75 ,$743.75 ,$743.75 , N/A ,$595.00 , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$726.25 ,$726.25 ,$726.25 , N/A , N/A ,$743.75 , N/A ,$875.00 , N/A , N/A ,$743.75 , N/A ,$743.75 ,$787.50 , N/A ,$726.25 ,$695.63 ,$695.63 , N/A ,$568.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100435,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T5,271,1 ,"$1,050.00 ",$682.50 ,$603.75 ,"$1,050.00 ",$892.50 ,$626.85 , N/A ,$603.75 , N/A ,$723.45 ,$892.50 ,$892.50 ,$892.50 , N/A ,$714.00 , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ", N/A , N/A ,$892.50 , N/A ,$892.50 ,$945.00 , N/A ,$871.50 ,$834.75 ,$834.75 , N/A ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100436,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T6,271,1 ,"$1,225.00 ",$796.25 ,$704.38 ,"$1,225.00 ","$1,041.25 ",$731.33 , N/A ,$704.38 , N/A ,$844.03 ,"$1,041.25 ","$1,041.25 ","$1,041.25 ", N/A ,$833.00 , N/A , N/A ,$918.75 ,$869.75 ,$869.75 , N/A ,$869.75 ,"$1,016.75 ","$1,016.75 ","$1,016.75 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,225.00 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,041.25 ","$1,102.50 ", N/A ,"$1,016.75 ",$973.88 ,$973.88 , N/A ,$796.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100437,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T7,271,1 ,"$1,400.00 ",$910.00 ,$805.00 ,"$1,400.00 ","$1,190.00 ",$835.80 , N/A ,$805.00 , N/A ,$964.60 ,"$1,190.00 ","$1,190.00 ","$1,190.00 ", N/A ,$952.00 , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,162.00 ","$1,162.00 ","$1,162.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ","$1,260.00 ", N/A ,"$1,162.00 ","$1,113.00 ","$1,113.00 ", N/A ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100438,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T8,271,1 ,"$1,575.00 ","$1,023.75 ",$905.63 ,"$1,575.00 ","$1,338.75 ",$940.28 , N/A ,$905.63 , N/A ,"$1,085.18 ","$1,338.75 ","$1,338.75 ","$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,307.25 ","$1,307.25 ","$1,307.25 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ","$1,417.50 ", N/A ,"$1,307.25 ","$1,252.13 ","$1,252.13 ", N/A ,"$1,023.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100439,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T9,271,1 ,"$1,750.00 ","$1,137.50 ","$1,006.25 ","$1,750.00 ","$1,487.50 ","$1,044.75 ", N/A ,"$1,006.25 ", N/A ,"$1,205.75 ","$1,487.50 ","$1,487.50 ","$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,452.50 ","$1,452.50 ","$1,452.50 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ","$1,575.00 ", N/A ,"$1,452.50 ","$1,391.25 ","$1,391.25 ", N/A ,"$1,137.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100440,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T10,271,1 ,"$1,925.00 ","$1,251.25 ","$1,106.88 ","$1,925.00 ","$1,636.25 ","$1,149.23 ", N/A ,"$1,106.88 ", N/A ,"$1,326.33 ","$1,636.25 ","$1,636.25 ","$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,597.75 ","$1,597.75 ","$1,597.75 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ","$1,732.50 ", N/A ,"$1,597.75 ","$1,530.38 ","$1,530.38 ", N/A ,"$1,251.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100441,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T11,271,1 ,"$2,100.00 ","$1,365.00 ","$1,207.50 ","$2,100.00 ","$1,785.00 ","$1,253.70 ", N/A ,"$1,207.50 ", N/A ,"$1,446.90 ","$1,785.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,743.00 ","$1,743.00 ","$1,743.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,743.00 ","$1,669.50 ","$1,669.50 ", N/A ,"$1,365.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100442,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T12,271,1 ,"$2,275.00 ","$1,478.75 ","$1,308.13 ","$2,275.00 ","$1,933.75 ","$1,358.18 ", N/A ,"$1,308.13 ", N/A ,"$1,567.48 ","$1,933.75 ","$1,933.75 ","$1,933.75 ", N/A ,"$1,547.00 ", N/A , N/A ,"$1,706.25 ","$1,615.25 ","$1,615.25 ", N/A ,"$1,615.25 ","$1,888.25 ","$1,888.25 ","$1,888.25 ", N/A , N/A ,"$1,933.75 ", N/A ,"$2,275.00 ", N/A , N/A ,"$1,933.75 ", N/A ,"$1,933.75 ","$2,047.50 ", N/A ,"$1,888.25 ","$1,808.63 ","$1,808.63 ", N/A ,"$1,478.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100443,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T13,271,1 ,"$2,450.00 ","$1,592.50 ","$1,408.75 ","$2,450.00 ","$2,082.50 ","$1,462.65 ", N/A ,"$1,408.75 ", N/A ,"$1,688.05 ","$2,082.50 ","$2,082.50 ","$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,033.50 ","$2,033.50 ","$2,033.50 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ","$2,205.00 ", N/A ,"$2,033.50 ","$1,947.75 ","$1,947.75 ", N/A ,"$1,592.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100444,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T14,271,1 ,"$2,625.00 ","$1,706.25 ","$1,509.38 ","$2,625.00 ","$2,231.25 ","$1,567.13 ", N/A ,"$1,509.38 ", N/A ,"$1,808.63 ","$2,231.25 ","$2,231.25 ","$2,231.25 ", N/A ,"$1,785.00 ", N/A , N/A ,"$1,968.75 ","$1,863.75 ","$1,863.75 ", N/A ,"$1,863.75 ","$2,178.75 ","$2,178.75 ","$2,178.75 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,625.00 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,231.25 ","$2,362.50 ", N/A ,"$2,178.75 ","$2,086.88 ","$2,086.88 ", N/A ,"$1,706.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100445,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T15,271,1 ,"$2,800.00 ","$1,820.00 ","$1,610.00 ","$2,800.00 ","$2,380.00 ","$1,671.60 ", N/A ,"$1,610.00 ", N/A ,"$1,929.20 ","$2,380.00 ","$2,380.00 ","$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,324.00 ","$2,324.00 ","$2,324.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ","$2,520.00 ", N/A ,"$2,324.00 ","$2,226.00 ","$2,226.00 ", N/A ,"$1,820.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100446,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T16,271,1 ,"$3,000.00 ","$1,950.00 ","$1,725.00 ","$3,000.00 ","$2,550.00 ","$1,791.00 ", N/A ,"$1,725.00 ", N/A ,"$2,067.00 ","$2,550.00 ","$2,550.00 ","$2,550.00 ", N/A ,"$2,040.00 ", N/A , N/A ,"$2,250.00 ","$2,130.00 ","$2,130.00 ", N/A ,"$2,130.00 ","$2,490.00 ","$2,490.00 ","$2,490.00 ", N/A , N/A ,"$2,550.00 ", N/A ,"$3,000.00 ", N/A , N/A ,"$2,550.00 ", N/A ,"$2,550.00 ","$2,700.00 ", N/A ,"$2,490.00 ","$2,385.00 ","$2,385.00 ", N/A ,"$1,950.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100447,V5160,HC HEARING AID DISPENSING FEE BINAURAL,271,1 ,$407.00 ,$264.55 ,$234.03 ,$407.00 ,$345.95 ,$242.98 , N/A ,$234.03 , N/A ,$280.42 ,$345.95 ,$345.95 ,$345.95 , N/A ,$276.76 , N/A , N/A ,$305.25 ,$288.97 ,$288.97 , N/A ,$288.97 ,$337.81 ,$337.81 ,$337.81 , N/A , N/A ,$345.95 , N/A ,$407.00 , N/A , N/A ,$345.95 , N/A ,$345.95 ,$366.30 , N/A ,$337.81 ,$323.57 ,$323.57 , N/A ,$264.55 
ST. JOSEPH'S HOSPITAL - BREESE,27100448,V5200,HC HEARING AID DISPENSING FEE CROS,271,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100449,V5240,HC HEARING AID DISPENSING FEE BICROS,271,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100450,V5241,HC HEARING AID DISPENSING FEE MONAURAL,271,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100451,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T1,271,1 ,$40.00 ,$26.00 ,$23.00 ,$40.00 ,$34.00 ,$23.88 , N/A ,$23.00 , N/A ,$27.56 ,$34.00 ,$34.00 ,$34.00 , N/A ,$27.20 , N/A , N/A ,$30.00 ,$28.40 ,$28.40 , N/A ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A , N/A ,$34.00 , N/A ,$40.00 , N/A , N/A ,$34.00 , N/A ,$34.00 ,$36.00 , N/A ,$33.20 ,$31.80 ,$31.80 , N/A ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100452,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T2,271,1 ,$50.00 ,$32.50 ,$28.75 ,$50.00 ,$42.50 ,$29.85 , N/A ,$28.75 , N/A ,$34.45 ,$42.50 ,$42.50 ,$42.50 , N/A ,$34.00 , N/A , N/A ,$37.50 ,$35.50 ,$35.50 , N/A ,$35.50 ,$41.50 ,$41.50 ,$41.50 , N/A , N/A ,$42.50 , N/A ,$50.00 , N/A , N/A ,$42.50 , N/A ,$42.50 ,$45.00 , N/A ,$41.50 ,$39.75 ,$39.75 , N/A ,$32.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100453,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T3,271,1 ,$60.00 ,$39.00 ,$34.50 ,$60.00 ,$51.00 ,$35.82 , N/A ,$34.50 , N/A ,$41.34 ,$51.00 ,$51.00 ,$51.00 , N/A ,$40.80 , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.80 ,$49.80 ,$49.80 , N/A , N/A ,$51.00 , N/A ,$60.00 , N/A , N/A ,$51.00 , N/A ,$51.00 ,$54.00 , N/A ,$49.80 ,$47.70 ,$47.70 , N/A ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100454,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T4,271,1 ,$70.00 ,$45.50 ,$40.25 ,$70.00 ,$59.50 ,$41.79 , N/A ,$40.25 , N/A ,$48.23 ,$59.50 ,$59.50 ,$59.50 , N/A ,$47.60 , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A , N/A ,$59.50 , N/A ,$70.00 , N/A , N/A ,$59.50 , N/A ,$59.50 ,$63.00 , N/A ,$58.10 ,$55.65 ,$55.65 , N/A ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100455,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T5,271,1 ,$80.00 ,$52.00 ,$46.00 ,$80.00 ,$68.00 ,$47.76 , N/A ,$46.00 , N/A ,$55.12 ,$68.00 ,$68.00 ,$68.00 , N/A ,$54.40 , N/A , N/A ,$60.00 ,$56.80 ,$56.80 , N/A ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A , N/A ,$68.00 , N/A ,$80.00 , N/A , N/A ,$68.00 , N/A ,$68.00 ,$72.00 , N/A ,$66.40 ,$63.60 ,$63.60 , N/A ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100456,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T6,271,1 ,$90.00 ,$58.50 ,$51.75 ,$90.00 ,$76.50 ,$53.73 , N/A ,$51.75 , N/A ,$62.01 ,$76.50 ,$76.50 ,$76.50 , N/A ,$61.20 , N/A , N/A ,$67.50 ,$63.90 ,$63.90 , N/A ,$63.90 ,$74.70 ,$74.70 ,$74.70 , N/A , N/A ,$76.50 , N/A ,$90.00 , N/A , N/A ,$76.50 , N/A ,$76.50 ,$81.00 , N/A ,$74.70 ,$71.55 ,$71.55 , N/A ,$58.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100457,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T7,271,1 ,$100.00 ,$65.00 ,$57.50 ,$100.00 ,$85.00 ,$59.70 , N/A ,$57.50 , N/A ,$68.90 ,$85.00 ,$85.00 ,$85.00 , N/A ,$68.00 , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$83.00 ,$83.00 ,$83.00 , N/A , N/A ,$85.00 , N/A ,$100.00 , N/A , N/A ,$85.00 , N/A ,$85.00 ,$90.00 , N/A ,$83.00 ,$79.50 ,$79.50 , N/A ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100458,V5265,HC EAR MOLD/INSERT DISPOSABLE ANY TYPE T1,271,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100459,V5265,HC EAR MOLD/INSERT DISPOSABLE ANY TYPE T2,271,1 ,$7.00 ,$4.55 ,$4.03 ,$7.00 ,$5.95 ,$4.18 , N/A ,$4.03 , N/A ,$4.82 ,$5.95 ,$5.95 ,$5.95 , N/A ,$4.76 , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.81 ,$5.81 ,$5.81 , N/A , N/A ,$5.95 , N/A ,$7.00 , N/A , N/A ,$5.95 , N/A ,$5.95 ,$6.30 , N/A ,$5.81 ,$5.57 ,$5.57 , N/A ,$4.55 
ST. JOSEPH'S HOSPITAL - BREESE,27100460,V5265,HC EAR MOLD/INSERT DISPOSABLE ANY TYPE T3,271,1 ,$17.50 ,$11.38 ,$10.06 ,$17.50 ,$14.88 ,$10.45 , N/A ,$10.06 , N/A ,$12.06 ,$14.88 ,$14.88 ,$14.88 , N/A ,$11.90 , N/A , N/A ,$13.13 ,$12.43 ,$12.43 , N/A ,$12.43 ,$14.53 ,$14.53 ,$14.53 , N/A , N/A ,$14.88 , N/A ,$17.50 , N/A , N/A ,$14.88 , N/A ,$14.88 ,$15.75 , N/A ,$14.53 ,$13.91 ,$13.91 , N/A ,$11.38 
ST. JOSEPH'S HOSPITAL - BREESE,27100461,V5266,HC HEARING AID BATTERY,271,1 ,$0.60 ,$0.39 ,$0.35 ,$0.60 ,$0.51 ,$0.36 , N/A ,$0.35 , N/A ,$0.41 ,$0.51 ,$0.51 ,$0.51 , N/A ,$0.41 , N/A , N/A ,$0.45 ,$0.43 ,$0.43 , N/A ,$0.43 ,$0.50 ,$0.50 ,$0.50 , N/A , N/A ,$0.51 , N/A ,$0.60 , N/A , N/A ,$0.51 , N/A ,$0.51 ,$0.54 , N/A ,$0.50 ,$0.48 ,$0.48 , N/A ,$0.39 
ST. JOSEPH'S HOSPITAL - BREESE,27100462,V5266,HC HEARING AID BATTERY RECHARGEABLE,271,1 ,$20.00 ,$13.00 ,$11.50 ,$20.00 ,$17.00 ,$11.94 , N/A ,$11.50 , N/A ,$13.78 ,$17.00 ,$17.00 ,$17.00 , N/A ,$13.60 , N/A , N/A ,$15.00 ,$14.20 ,$14.20 , N/A ,$14.20 ,$16.60 ,$16.60 ,$16.60 , N/A , N/A ,$17.00 , N/A ,$20.00 , N/A , N/A ,$17.00 , N/A ,$17.00 ,$18.00 , N/A ,$16.60 ,$15.90 ,$15.90 , N/A ,$13.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100463,V5275,HC EAR MOLD IMPRESSION,271,1 ,$25.00 ,$16.25 ,$14.38 ,$25.00 ,$21.25 ,$14.93 , N/A ,$14.38 , N/A ,$17.23 ,$21.25 ,$21.25 ,$21.25 , N/A ,$17.00 , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.75 ,$20.75 ,$20.75 , N/A , N/A ,$21.25 , N/A ,$25.00 , N/A , N/A ,$21.25 , N/A ,$21.25 ,$22.50 , N/A ,$20.75 ,$19.88 ,$19.88 , N/A ,$16.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100464,V5283,HC ALD NECK LOOP INDUCTION RECEIVER,271,1 ,$80.00 ,$52.00 ,$46.00 ,$80.00 ,$68.00 ,$47.76 , N/A ,$46.00 , N/A ,$55.12 ,$68.00 ,$68.00 ,$68.00 , N/A ,$54.40 , N/A , N/A ,$60.00 ,$56.80 ,$56.80 , N/A ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A , N/A ,$68.00 , N/A ,$80.00 , N/A , N/A ,$68.00 , N/A ,$68.00 ,$72.00 , N/A ,$66.40 ,$63.60 ,$63.60 , N/A ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100465,N/A,HC HEARING SUPPLY SHIPPING T1,271,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27100466,N/A,HC HEARING SUPPLY SHIPPING T2,271,1 ,$19.99 ,$12.99 ,$11.49 ,$19.99 ,$16.99 ,$11.93 , N/A ,$11.49 , N/A ,$13.77 ,$16.99 ,$16.99 ,$16.99 , N/A ,$13.59 , N/A , N/A ,$14.99 ,$14.19 ,$14.19 , N/A ,$14.19 ,$16.59 ,$16.59 ,$16.59 , N/A , N/A ,$16.99 , N/A ,$19.99 , N/A , N/A ,$16.99 , N/A ,$16.99 ,$17.99 , N/A ,$16.59 ,$15.89 ,$15.89 , N/A ,$12.99 
ST. JOSEPH'S HOSPITAL - BREESE,27100467,N/A,HC HEARING SUPPLY SHIPPING T3,271,1 ,$24.99 ,$16.24 ,$14.37 ,$24.99 ,$21.24 ,$14.92 , N/A ,$14.37 , N/A ,$17.22 ,$21.24 ,$21.24 ,$21.24 , N/A ,$16.99 , N/A , N/A ,$18.74 ,$17.74 ,$17.74 , N/A ,$17.74 ,$20.74 ,$20.74 ,$20.74 , N/A , N/A ,$21.24 , N/A ,$24.99 , N/A , N/A ,$21.24 , N/A ,$21.24 ,$22.49 , N/A ,$20.74 ,$19.87 ,$19.87 , N/A ,$16.24 
ST. JOSEPH'S HOSPITAL - BREESE,27100468,N/A,HC HEARING SUPPLY SHIPPING T4,271,1 ,$49.99 ,$32.49 ,$28.74 ,$49.99 ,$42.49 ,$29.84 , N/A ,$28.74 , N/A ,$34.44 ,$42.49 ,$42.49 ,$42.49 , N/A ,$33.99 , N/A , N/A ,$37.49 ,$35.49 ,$35.49 , N/A ,$35.49 ,$41.49 ,$41.49 ,$41.49 , N/A , N/A ,$42.49 , N/A ,$49.99 , N/A , N/A ,$42.49 , N/A ,$42.49 ,$44.99 , N/A ,$41.49 ,$39.74 ,$39.74 , N/A ,$32.49 
ST. JOSEPH'S HOSPITAL - BREESE,27100469,V5267,HC HEARING AID SUPPLY NOS T1,271,1 ,$1.00 ,$0.65 ,$0.58 ,$1.00 ,$0.85 ,$0.60 , N/A ,$0.58 , N/A ,$0.69 ,$0.85 ,$0.85 ,$0.85 , N/A ,$0.68 , N/A , N/A ,$0.75 ,$0.71 ,$0.71 , N/A ,$0.71 ,$0.83 ,$0.83 ,$0.83 , N/A , N/A ,$0.85 , N/A ,$1.00 , N/A , N/A ,$0.85 , N/A ,$0.85 ,$0.90 , N/A ,$0.83 ,$0.80 ,$0.80 , N/A ,$0.65 
ST. JOSEPH'S HOSPITAL - BREESE,27100470,V5267,HC HEARING AID SUPPLY NOS T2,271,1 ,$3.50 ,$2.28 ,$2.01 ,$3.50 ,$2.98 ,$2.09 , N/A ,$2.01 , N/A ,$2.41 ,$2.98 ,$2.98 ,$2.98 , N/A ,$2.38 , N/A , N/A ,$2.63 ,$2.49 ,$2.49 , N/A ,$2.49 ,$2.91 ,$2.91 ,$2.91 , N/A , N/A ,$2.98 , N/A ,$3.50 , N/A , N/A ,$2.98 , N/A ,$2.98 ,$3.15 , N/A ,$2.91 ,$2.78 ,$2.78 , N/A ,$2.28 
ST. JOSEPH'S HOSPITAL - BREESE,27100471,V5267,HC HEARING AID SUPPLY NOS T3,271,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100472,V5267,HC HEARING AID SUPPLY NOS T4,271,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27100473,V5267,HC HEARING AID SUPPLY NOS T5,271,1 ,$10.00 ,$6.50 ,$5.75 ,$10.00 ,$8.50 ,$5.97 , N/A ,$5.75 , N/A ,$6.89 ,$8.50 ,$8.50 ,$8.50 , N/A ,$6.80 , N/A , N/A ,$7.50 ,$7.10 ,$7.10 , N/A ,$7.10 ,$8.30 ,$8.30 ,$8.30 , N/A , N/A ,$8.50 , N/A ,$10.00 , N/A , N/A ,$8.50 , N/A ,$8.50 ,$9.00 , N/A ,$8.30 ,$7.95 ,$7.95 , N/A ,$6.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100474,V5267,HC HEARING AID SUPPLY NOS T6,271,1 ,$25.00 ,$16.25 ,$14.38 ,$25.00 ,$21.25 ,$14.93 , N/A ,$14.38 , N/A ,$17.23 ,$21.25 ,$21.25 ,$21.25 , N/A ,$17.00 , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.75 ,$20.75 ,$20.75 , N/A , N/A ,$21.25 , N/A ,$25.00 , N/A , N/A ,$21.25 , N/A ,$21.25 ,$22.50 , N/A ,$20.75 ,$19.88 ,$19.88 , N/A ,$16.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100475,V5267,HC HEARING AID SUPPLY NOS T7,271,1 ,$35.00 ,$22.75 ,$20.13 ,$35.00 ,$29.75 ,$20.90 , N/A ,$20.13 , N/A ,$24.12 ,$29.75 ,$29.75 ,$29.75 , N/A ,$23.80 , N/A , N/A ,$26.25 ,$24.85 ,$24.85 , N/A ,$24.85 ,$29.05 ,$29.05 ,$29.05 , N/A , N/A ,$29.75 , N/A ,$35.00 , N/A , N/A ,$29.75 , N/A ,$29.75 ,$31.50 , N/A ,$29.05 ,$27.83 ,$27.83 , N/A ,$22.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100476,V5267,HC HEARING AID SUPPLY NOS T8,271,1 ,$40.00 ,$26.00 ,$23.00 ,$40.00 ,$34.00 ,$23.88 , N/A ,$23.00 , N/A ,$27.56 ,$34.00 ,$34.00 ,$34.00 , N/A ,$27.20 , N/A , N/A ,$30.00 ,$28.40 ,$28.40 , N/A ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A , N/A ,$34.00 , N/A ,$40.00 , N/A , N/A ,$34.00 , N/A ,$34.00 ,$36.00 , N/A ,$33.20 ,$31.80 ,$31.80 , N/A ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100477,V5267,HC HEARING AID SUPPLY NOS T9,271,1 ,$50.00 ,$32.50 ,$28.75 ,$50.00 ,$42.50 ,$29.85 , N/A ,$28.75 , N/A ,$34.45 ,$42.50 ,$42.50 ,$42.50 , N/A ,$34.00 , N/A , N/A ,$37.50 ,$35.50 ,$35.50 , N/A ,$35.50 ,$41.50 ,$41.50 ,$41.50 , N/A , N/A ,$42.50 , N/A ,$50.00 , N/A , N/A ,$42.50 , N/A ,$42.50 ,$45.00 , N/A ,$41.50 ,$39.75 ,$39.75 , N/A ,$32.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100478,V5267,HC HEARING AID SUPPLY NOS T10,271,1 ,$60.00 ,$39.00 ,$34.50 ,$60.00 ,$51.00 ,$35.82 , N/A ,$34.50 , N/A ,$41.34 ,$51.00 ,$51.00 ,$51.00 , N/A ,$40.80 , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.80 ,$49.80 ,$49.80 , N/A , N/A ,$51.00 , N/A ,$60.00 , N/A , N/A ,$51.00 , N/A ,$51.00 ,$54.00 , N/A ,$49.80 ,$47.70 ,$47.70 , N/A ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100479,V5267,HC HEARING AID SUPPLY NOS T11,271,1 ,$70.00 ,$45.50 ,$40.25 ,$70.00 ,$59.50 ,$41.79 , N/A ,$40.25 , N/A ,$48.23 ,$59.50 ,$59.50 ,$59.50 , N/A ,$47.60 , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A , N/A ,$59.50 , N/A ,$70.00 , N/A , N/A ,$59.50 , N/A ,$59.50 ,$63.00 , N/A ,$58.10 ,$55.65 ,$55.65 , N/A ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100480,V5267,HC HEARING AID SUPPLY NOS T12,271,1 ,$80.00 ,$52.00 ,$46.00 ,$80.00 ,$68.00 ,$47.76 , N/A ,$46.00 , N/A ,$55.12 ,$68.00 ,$68.00 ,$68.00 , N/A ,$54.40 , N/A , N/A ,$60.00 ,$56.80 ,$56.80 , N/A ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A , N/A ,$68.00 , N/A ,$80.00 , N/A , N/A ,$68.00 , N/A ,$68.00 ,$72.00 , N/A ,$66.40 ,$63.60 ,$63.60 , N/A ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100481,V5267,HC HEARING AID SUPPLY NOS T13,271,1 ,$90.00 ,$58.50 ,$51.75 ,$90.00 ,$76.50 ,$53.73 , N/A ,$51.75 , N/A ,$62.01 ,$76.50 ,$76.50 ,$76.50 , N/A ,$61.20 , N/A , N/A ,$67.50 ,$63.90 ,$63.90 , N/A ,$63.90 ,$74.70 ,$74.70 ,$74.70 , N/A , N/A ,$76.50 , N/A ,$90.00 , N/A , N/A ,$76.50 , N/A ,$76.50 ,$81.00 , N/A ,$74.70 ,$71.55 ,$71.55 , N/A ,$58.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100484,N/A,HC ROLL CAST FIBERGLASS,271,1 ,$43.00 ,$27.95 ,$24.73 ,$43.00 ,$36.55 ,$25.67 , N/A ,$24.73 , N/A ,$29.63 ,$36.55 ,$36.55 ,$36.55 , N/A ,$29.24 , N/A , N/A ,$32.25 ,$30.53 ,$30.53 , N/A ,$30.53 ,$35.69 ,$35.69 ,$35.69 , N/A , N/A ,$36.55 , N/A ,$43.00 , N/A , N/A ,$36.55 , N/A ,$36.55 ,$38.70 , N/A ,$35.69 ,$34.19 ,$34.19 , N/A ,$27.95 
ST. JOSEPH'S HOSPITAL - BREESE,27100488,N/A,HC PAD HEATING,271,1 ,$17.00 ,$11.05 ,$9.78 ,$17.00 ,$14.45 ,$10.15 , N/A ,$9.78 , N/A ,$11.71 ,$14.45 ,$14.45 ,$14.45 , N/A ,$11.56 , N/A , N/A ,$12.75 ,$12.07 ,$12.07 , N/A ,$12.07 ,$14.11 ,$14.11 ,$14.11 , N/A , N/A ,$14.45 , N/A ,$17.00 , N/A , N/A ,$14.45 , N/A ,$14.45 ,$15.30 , N/A ,$14.11 ,$13.52 ,$13.52 , N/A ,$11.05 
ST. JOSEPH'S HOSPITAL - BREESE,27100497,N/A,HC STRAP CATHETER,271,1 ,$13.00 ,$8.45 ,$7.48 ,$13.00 ,$11.05 ,$7.76 , N/A ,$7.48 , N/A ,$8.96 ,$11.05 ,$11.05 ,$11.05 , N/A ,$8.84 , N/A , N/A ,$9.75 ,$9.23 ,$9.23 , N/A ,$9.23 ,$10.79 ,$10.79 ,$10.79 , N/A , N/A ,$11.05 , N/A ,$13.00 , N/A , N/A ,$11.05 , N/A ,$11.05 ,$11.70 , N/A ,$10.79 ,$10.34 ,$10.34 , N/A ,$8.45 
ST. JOSEPH'S HOSPITAL - BREESE,27100499,V5172,HC HEARING AID CROS MONAURAL IN CANAL T1,271,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100500,V5172,HC HEARING AID CROS MONAURAL IN CANAL T2,271,1 ,$525.00 ,$341.25 ,$301.88 ,$525.00 ,$446.25 ,$313.43 , N/A ,$301.88 , N/A ,$361.73 ,$446.25 ,$446.25 ,$446.25 , N/A ,$357.00 , N/A , N/A ,$393.75 ,$372.75 ,$372.75 , N/A ,$372.75 ,$435.75 ,$435.75 ,$435.75 , N/A , N/A ,$446.25 , N/A ,$525.00 , N/A , N/A ,$446.25 , N/A ,$446.25 ,$472.50 , N/A ,$435.75 ,$417.38 ,$417.38 , N/A ,$341.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100501,V5172,HC HEARING AID CROS MONAURAL IN CANAL T3,271,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100502,V5172,HC HEARING AID CROS MONAURAL IN CANAL T4,271,1 ,$875.00 ,$568.75 ,$503.13 ,$875.00 ,$743.75 ,$522.38 , N/A ,$503.13 , N/A ,$602.88 ,$743.75 ,$743.75 ,$743.75 , N/A ,$595.00 , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$726.25 ,$726.25 ,$726.25 , N/A , N/A ,$743.75 , N/A ,$875.00 , N/A , N/A ,$743.75 , N/A ,$743.75 ,$787.50 , N/A ,$726.25 ,$695.63 ,$695.63 , N/A ,$568.75 
ST. JOSEPH'S HOSPITAL - BREESE,27100503,V5172,HC HEARING AID CROS MONAURAL IN CANAL T5,271,1 ,"$1,050.00 ",$682.50 ,$603.75 ,"$1,050.00 ",$892.50 ,$626.85 , N/A ,$603.75 , N/A ,$723.45 ,$892.50 ,$892.50 ,$892.50 , N/A ,$714.00 , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ", N/A , N/A ,$892.50 , N/A ,$892.50 ,$945.00 , N/A ,$871.50 ,$834.75 ,$834.75 , N/A ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100504,V5172,HC HEARING AID CROS MONAURAL IN CANAL T6,271,1 ,"$1,225.00 ",$796.25 ,$704.38 ,"$1,225.00 ","$1,041.25 ",$731.33 , N/A ,$704.38 , N/A ,$844.03 ,"$1,041.25 ","$1,041.25 ","$1,041.25 ", N/A ,$833.00 , N/A , N/A ,$918.75 ,$869.75 ,$869.75 , N/A ,$869.75 ,"$1,016.75 ","$1,016.75 ","$1,016.75 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,225.00 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,041.25 ","$1,102.50 ", N/A ,"$1,016.75 ",$973.88 ,$973.88 , N/A ,$796.25 
ST. JOSEPH'S HOSPITAL - BREESE,27100505,V5172,HC HEARING AID CROS MONAURAL IN CANAL T7,271,1 ,"$1,400.00 ",$910.00 ,$805.00 ,"$1,400.00 ","$1,190.00 ",$835.80 , N/A ,$805.00 , N/A ,$964.60 ,"$1,190.00 ","$1,190.00 ","$1,190.00 ", N/A ,$952.00 , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,162.00 ","$1,162.00 ","$1,162.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ","$1,260.00 ", N/A ,"$1,162.00 ","$1,113.00 ","$1,113.00 ", N/A ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100506,V5172,HC HEARING AID CROS MONAURAL IN CANAL T8,271,1 ,"$1,575.00 ","$1,023.75 ",$905.63 ,"$1,575.00 ","$1,338.75 ",$940.28 , N/A ,$905.63 , N/A ,"$1,085.18 ","$1,338.75 ","$1,338.75 ","$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,307.25 ","$1,307.25 ","$1,307.25 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ","$1,417.50 ", N/A ,"$1,307.25 ","$1,252.13 ","$1,252.13 ", N/A ,"$1,023.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100507,V5172,HC HEARING AID CROS MONAURAL IN CANAL T9,271,1 ,"$1,750.00 ","$1,137.50 ","$1,006.25 ","$1,750.00 ","$1,487.50 ","$1,044.75 ", N/A ,"$1,006.25 ", N/A ,"$1,205.75 ","$1,487.50 ","$1,487.50 ","$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,452.50 ","$1,452.50 ","$1,452.50 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ","$1,575.00 ", N/A ,"$1,452.50 ","$1,391.25 ","$1,391.25 ", N/A ,"$1,137.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100508,V5172,HC HEARING AID CROS MONAURAL IN CANAL T10,271,1 ,"$1,925.00 ","$1,251.25 ","$1,106.88 ","$1,925.00 ","$1,636.25 ","$1,149.23 ", N/A ,"$1,106.88 ", N/A ,"$1,326.33 ","$1,636.25 ","$1,636.25 ","$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,597.75 ","$1,597.75 ","$1,597.75 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ","$1,732.50 ", N/A ,"$1,597.75 ","$1,530.38 ","$1,530.38 ", N/A ,"$1,251.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100509,V5172,HC HEARING AID CROS MONAURAL IN CANAL T11,271,1 ,"$2,100.00 ","$1,365.00 ","$1,207.50 ","$2,100.00 ","$1,785.00 ","$1,253.70 ", N/A ,"$1,207.50 ", N/A ,"$1,446.90 ","$1,785.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,743.00 ","$1,743.00 ","$1,743.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ","$1,890.00 ", N/A ,"$1,743.00 ","$1,669.50 ","$1,669.50 ", N/A ,"$1,365.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100510,V5172,HC HEARING AID CROS MONAURAL IN CANAL T12,271,1 ,"$2,275.00 ","$1,478.75 ","$1,308.13 ","$2,275.00 ","$1,933.75 ","$1,358.18 ", N/A ,"$1,308.13 ", N/A ,"$1,567.48 ","$1,933.75 ","$1,933.75 ","$1,933.75 ", N/A ,"$1,547.00 ", N/A , N/A ,"$1,706.25 ","$1,615.25 ","$1,615.25 ", N/A ,"$1,615.25 ","$1,888.25 ","$1,888.25 ","$1,888.25 ", N/A , N/A ,"$1,933.75 ", N/A ,"$2,275.00 ", N/A , N/A ,"$1,933.75 ", N/A ,"$1,933.75 ","$2,047.50 ", N/A ,"$1,888.25 ","$1,808.63 ","$1,808.63 ", N/A ,"$1,478.75 "
ST. JOSEPH'S HOSPITAL - BREESE,27100511,V5172,HC HEARING AID CROS MONAURAL IN CANAL T13,271,1 ,"$2,450.00 ","$1,592.50 ","$1,408.75 ","$2,450.00 ","$2,082.50 ","$1,462.65 ", N/A ,"$1,408.75 ", N/A ,"$1,688.05 ","$2,082.50 ","$2,082.50 ","$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,033.50 ","$2,033.50 ","$2,033.50 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ","$2,205.00 ", N/A ,"$2,033.50 ","$1,947.75 ","$1,947.75 ", N/A ,"$1,592.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100512,V5172,HC HEARING AID CROS MONAURAL IN CANAL T14,271,1 ,"$2,625.00 ","$1,706.25 ","$1,509.38 ","$2,625.00 ","$2,231.25 ","$1,567.13 ", N/A ,"$1,509.38 ", N/A ,"$1,808.63 ","$2,231.25 ","$2,231.25 ","$2,231.25 ", N/A ,"$1,785.00 ", N/A , N/A ,"$1,968.75 ","$1,863.75 ","$1,863.75 ", N/A ,"$1,863.75 ","$2,178.75 ","$2,178.75 ","$2,178.75 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,625.00 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,231.25 ","$2,362.50 ", N/A ,"$2,178.75 ","$2,086.88 ","$2,086.88 ", N/A ,"$1,706.25 "
ST. JOSEPH'S HOSPITAL - BREESE,27100513,V5172,HC HEARING AID CROS MONAURAL IN CANAL T15,271,1 ,"$2,800.00 ","$1,820.00 ","$1,610.00 ","$2,800.00 ","$2,380.00 ","$1,671.60 ", N/A ,"$1,610.00 ", N/A ,"$1,929.20 ","$2,380.00 ","$2,380.00 ","$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,324.00 ","$2,324.00 ","$2,324.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ","$2,520.00 ", N/A ,"$2,324.00 ","$2,226.00 ","$2,226.00 ", N/A ,"$1,820.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100514,V5172,HC HEARING AID CROS MONAURAL IN CANAL T16,271,1 ,"$2,850.00 ","$1,852.50 ","$1,638.75 ","$2,850.00 ","$2,422.50 ","$1,701.45 ", N/A ,"$1,638.75 ", N/A ,"$1,963.65 ","$2,422.50 ","$2,422.50 ","$2,422.50 ", N/A ,"$1,938.00 ", N/A , N/A ,"$2,137.50 ","$2,023.50 ","$2,023.50 ", N/A ,"$2,023.50 ","$2,365.50 ","$2,365.50 ","$2,365.50 ", N/A , N/A ,"$2,422.50 ", N/A ,"$2,850.00 ", N/A , N/A ,"$2,422.50 ", N/A ,"$2,422.50 ","$2,565.00 ", N/A ,"$2,365.50 ","$2,265.75 ","$2,265.75 ", N/A ,"$1,852.50 "
ST. JOSEPH'S HOSPITAL - BREESE,27100515,V6254,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T8,271,1 ,$120.00 ,$78.00 ,$69.00 ,$120.00 ,$102.00 ,$71.64 , N/A ,$69.00 , N/A ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A , N/A ,$102.00 , N/A ,$120.00 , N/A , N/A ,$102.00 , N/A ,$102.00 ,$108.00 , N/A ,$99.60 ,$95.40 ,$95.40 , N/A ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100516,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T9,271,1 ,$130.00 ,$84.50 ,$74.75 ,$130.00 ,$110.50 ,$77.61 , N/A ,$74.75 , N/A ,$89.57 ,$110.50 ,$110.50 ,$110.50 , N/A ,$88.40 , N/A , N/A ,$97.50 ,$92.30 ,$92.30 , N/A ,$92.30 ,$107.90 ,$107.90 ,$107.90 , N/A , N/A ,$110.50 , N/A ,$130.00 , N/A , N/A ,$110.50 , N/A ,$110.50 ,$117.00 , N/A ,$107.90 ,$103.35 ,$103.35 , N/A ,$84.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100517,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T10,271,1 ,$140.00 ,$91.00 ,$80.50 ,$140.00 ,$119.00 ,$83.58 , N/A ,$80.50 , N/A ,$96.46 ,$119.00 ,$119.00 ,$119.00 , N/A ,$95.20 , N/A , N/A ,$105.00 ,$99.40 ,$99.40 , N/A ,$99.40 ,$116.20 ,$116.20 ,$116.20 , N/A , N/A ,$119.00 , N/A ,$140.00 , N/A , N/A ,$119.00 , N/A ,$119.00 ,$126.00 , N/A ,$116.20 ,$111.30 ,$111.30 , N/A ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100518,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T11,271,1 ,$150.00 ,$97.50 ,$86.25 ,$150.00 ,$127.50 ,$89.55 , N/A ,$86.25 , N/A ,$103.35 ,$127.50 ,$127.50 ,$127.50 , N/A ,$102.00 , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$124.50 ,$124.50 ,$124.50 , N/A , N/A ,$127.50 , N/A ,$150.00 , N/A , N/A ,$127.50 , N/A ,$127.50 ,$135.00 , N/A ,$124.50 ,$119.25 ,$119.25 , N/A ,$97.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100519,N/A,HC SYSTEM MONITR NOVII PTCH,271,1 ,$116.85 ,$75.95 ,$67.19 ,$116.85 ,$99.32 ,$69.76 , N/A ,$67.19 , N/A ,$80.51 ,$99.32 ,$99.32 ,$99.32 , N/A ,$79.46 , N/A , N/A ,$87.64 ,$82.96 ,$82.96 , N/A ,$82.96 ,$96.99 ,$96.99 ,$96.99 , N/A , N/A ,$99.32 , N/A ,$116.85 , N/A , N/A ,$99.32 , N/A ,$99.32 ,$105.17 , N/A ,$96.99 ,$92.90 ,$92.90 , N/A ,$75.95 
ST. JOSEPH'S HOSPITAL - BREESE,27100523,N/A,HC PORT BREATHING CIRCUIT,271,1 ,$51.00 ,$33.15 ,$29.33 ,$51.00 ,$43.35 ,$30.45 , N/A ,$29.33 , N/A ,$35.14 ,$43.35 ,$43.35 ,$43.35 , N/A ,$34.68 , N/A , N/A ,$38.25 ,$36.21 ,$36.21 , N/A ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A , N/A ,$43.35 , N/A ,$51.00 , N/A , N/A ,$43.35 , N/A ,$43.35 ,$45.90 , N/A ,$42.33 ,$40.55 ,$40.55 , N/A ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,27200189,N/A,HC 12 FR ESOPHAGEAL STEHOSCOPE,272,1 ,$28.00 ,$18.20 ,$16.10 ,$28.00 ,$23.80 ,$16.72 , N/A ,$16.10 , N/A ,$19.29 ,$23.80 ,$23.80 ,$23.80 , N/A ,$19.04 , N/A , N/A ,$21.00 ,$19.88 ,$19.88 , N/A ,$19.88 ,$23.24 ,$23.24 ,$23.24 , N/A , N/A ,$23.80 , N/A ,$28.00 , N/A , N/A ,$23.80 , N/A ,$23.80 ,$25.20 , N/A ,$23.24 ,$22.26 ,$22.26 , N/A ,$18.20 
ST. JOSEPH'S HOSPITAL - BREESE,27200226,N/A,HC ADHESIVE DERMABOND,272,1 ,$79.00 ,$51.35 ,$45.43 ,$79.00 ,$67.15 ,$47.16 , N/A ,$45.43 , N/A ,$54.43 ,$67.15 ,$67.15 ,$67.15 , N/A ,$53.72 , N/A , N/A ,$59.25 ,$56.09 ,$56.09 , N/A ,$56.09 ,$65.57 ,$65.57 ,$65.57 , N/A , N/A ,$67.15 , N/A ,$79.00 , N/A , N/A ,$67.15 , N/A ,$67.15 ,$71.10 , N/A ,$65.57 ,$62.81 ,$62.81 , N/A ,$51.35 
ST. JOSEPH'S HOSPITAL - BREESE,27200240,N/A,HC AMNIOTOMY HOOK,272,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27200338,N/A,HC BIOPSY DEVICE NEEDLE CORE,272,1 ,$139.00 ,$90.35 ,$79.93 ,$139.00 ,$118.15 ,$82.98 , N/A ,$79.93 , N/A ,$95.77 ,$118.15 ,$118.15 ,$118.15 , N/A ,$94.52 , N/A , N/A ,$104.25 ,$98.69 ,$98.69 , N/A ,$98.69 ,$115.37 ,$115.37 ,$115.37 , N/A , N/A ,$118.15 , N/A ,$139.00 , N/A , N/A ,$118.15 , N/A ,$118.15 ,$125.10 , N/A ,$115.37 ,$110.51 ,$110.51 , N/A ,$90.35 
ST. JOSEPH'S HOSPITAL - BREESE,27200571,N/A,HC BREAST PUMP KIT,272,1 ,$85.00 ,$55.25 ,$48.88 ,$85.00 ,$72.25 ,$50.75 , N/A ,$48.88 , N/A ,$58.57 ,$72.25 ,$72.25 ,$72.25 , N/A ,$57.80 , N/A , N/A ,$63.75 ,$60.35 ,$60.35 , N/A ,$60.35 ,$70.55 ,$70.55 ,$70.55 , N/A , N/A ,$72.25 , N/A ,$85.00 , N/A , N/A ,$72.25 , N/A ,$72.25 ,$76.50 , N/A ,$70.55 ,$67.58 ,$67.58 , N/A ,$55.25 
ST. JOSEPH'S HOSPITAL - BREESE,27200712,N/A,HC CATHETER PLUG,272,1 ,$26.00 ,$16.90 ,$14.95 ,$26.00 ,$22.10 ,$15.52 , N/A ,$14.95 , N/A ,$17.91 ,$22.10 ,$22.10 ,$22.10 , N/A ,$17.68 , N/A , N/A ,$19.50 ,$18.46 ,$18.46 , N/A ,$18.46 ,$21.58 ,$21.58 ,$21.58 , N/A , N/A ,$22.10 , N/A ,$26.00 , N/A , N/A ,$22.10 , N/A ,$22.10 ,$23.40 , N/A ,$21.58 ,$20.67 ,$20.67 , N/A ,$16.90 
ST. JOSEPH'S HOSPITAL - BREESE,27200747,N/A,HC CATH ARGYLE THORACIC,272,1 ,$30.00 ,$19.50 ,$17.25 ,$30.00 ,$25.50 ,$17.91 , N/A ,$17.25 , N/A ,$20.67 ,$25.50 ,$25.50 ,$25.50 , N/A ,$20.40 , N/A , N/A ,$22.50 ,$21.30 ,$21.30 , N/A ,$21.30 ,$24.90 ,$24.90 ,$24.90 , N/A , N/A ,$25.50 , N/A ,$30.00 , N/A , N/A ,$25.50 , N/A ,$25.50 ,$27.00 , N/A ,$24.90 ,$23.85 ,$23.85 , N/A ,$19.50 
ST. JOSEPH'S HOSPITAL - BREESE,27200828,N/A,HC CATH FOLEY TEMPERATURE PROBE 16FR,272,1 ,$108.00 ,$70.20 ,$62.10 ,$108.00 ,$91.80 ,$64.48 , N/A ,$62.10 , N/A ,$74.41 ,$91.80 ,$91.80 ,$91.80 , N/A ,$73.44 , N/A , N/A ,$81.00 ,$76.68 ,$76.68 , N/A ,$76.68 ,$89.64 ,$89.64 ,$89.64 , N/A , N/A ,$91.80 , N/A ,$108.00 , N/A , N/A ,$91.80 , N/A ,$91.80 ,$97.20 , N/A ,$89.64 ,$85.86 ,$85.86 , N/A ,$70.20 
ST. JOSEPH'S HOSPITAL - BREESE,27200832,N/A,HC CATH TRAY WITH FOLEY,272,1 ,$39.00 ,$25.35 ,$22.43 ,$39.00 ,$33.15 ,$23.28 , N/A ,$22.43 , N/A ,$26.87 ,$33.15 ,$33.15 ,$33.15 , N/A ,$26.52 , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$32.37 ,$32.37 ,$32.37 , N/A , N/A ,$33.15 , N/A ,$39.00 , N/A , N/A ,$33.15 , N/A ,$33.15 ,$35.10 , N/A ,$32.37 ,$31.01 ,$31.01 , N/A ,$25.35 
ST. JOSEPH'S HOSPITAL - BREESE,27200849,N/A,HC CATHETER - FOLEY,272,1 ,$25.00 ,$16.25 ,$14.38 ,$25.00 ,$21.25 ,$14.93 , N/A ,$14.38 , N/A ,$17.23 ,$21.25 ,$21.25 ,$21.25 , N/A ,$17.00 , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.75 ,$20.75 ,$20.75 , N/A , N/A ,$21.25 , N/A ,$25.00 , N/A , N/A ,$21.25 , N/A ,$21.25 ,$22.50 , N/A ,$20.75 ,$19.88 ,$19.88 , N/A ,$16.25 
ST. JOSEPH'S HOSPITAL - BREESE,27201077,N/A,HC DIS INCENTIVE SPIROMETER,272,1 ,$97.00 ,$63.05 ,$55.78 ,$97.00 ,$82.45 ,$57.91 , N/A ,$55.78 , N/A ,$66.83 ,$82.45 ,$82.45 ,$82.45 , N/A ,$65.96 , N/A , N/A ,$72.75 ,$68.87 ,$68.87 , N/A ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A , N/A ,$82.45 , N/A ,$97.00 , N/A , N/A ,$82.45 , N/A ,$82.45 ,$87.30 , N/A ,$80.51 ,$77.12 ,$77.12 , N/A ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,27201083,N/A,HC DISP. OXIMETER SENSOR,272,1 ,$47.00 ,$30.55 ,$27.03 ,$47.00 ,$39.95 ,$28.06 , N/A ,$27.03 , N/A ,$32.38 ,$39.95 ,$39.95 ,$39.95 , N/A ,$31.96 , N/A , N/A ,$35.25 ,$33.37 ,$33.37 , N/A ,$33.37 ,$39.01 ,$39.01 ,$39.01 , N/A , N/A ,$39.95 , N/A ,$47.00 , N/A , N/A ,$39.95 , N/A ,$39.95 ,$42.30 , N/A ,$39.01 ,$37.37 ,$37.37 , N/A ,$30.55 
ST. JOSEPH'S HOSPITAL - BREESE,27201147,N/A,HC DRESSING ADAPTIC 3X8,272,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27201148,N/A,HC DRESSING AQUACELL W/HYDROFIBER,272,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27201165,N/A,HC MORGAN LENS,272,1 ,$115.20 ,$74.88 ,$66.24 ,$115.20 ,$97.92 ,$68.77 , N/A ,$66.24 , N/A ,$79.37 ,$97.92 ,$97.92 ,$97.92 , N/A ,$78.34 , N/A , N/A ,$86.40 ,$81.79 ,$81.79 , N/A ,$81.79 ,$95.62 ,$95.62 ,$95.62 , N/A , N/A ,$97.92 , N/A ,$115.20 , N/A , N/A ,$97.92 , N/A ,$97.92 ,$103.68 , N/A ,$95.62 ,$91.58 ,$91.58 , N/A ,$74.88 
ST. JOSEPH'S HOSPITAL - BREESE,27201247,N/A,HC ENDOTRACH TUBE HOLDER,272,1 ,$27.00 ,$17.55 ,$15.53 ,$27.00 ,$22.95 ,$16.12 , N/A ,$15.53 , N/A ,$18.60 ,$22.95 ,$22.95 ,$22.95 , N/A ,$18.36 , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.41 ,$22.41 ,$22.41 , N/A , N/A ,$22.95 , N/A ,$27.00 , N/A , N/A ,$22.95 , N/A ,$22.95 ,$24.30 , N/A ,$22.41 ,$21.47 ,$21.47 , N/A ,$17.55 
ST. JOSEPH'S HOSPITAL - BREESE,27201248,N/A,HC ENDOTRACHEAL TUBE (DUAL LUMEN),272,1 ,$19.00 ,$12.35 ,$10.93 ,$19.00 ,$16.15 ,$11.34 , N/A ,$10.93 , N/A ,$13.09 ,$16.15 ,$16.15 ,$16.15 , N/A ,$12.92 , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.77 ,$15.77 ,$15.77 , N/A , N/A ,$16.15 , N/A ,$19.00 , N/A , N/A ,$16.15 , N/A ,$16.15 ,$17.10 , N/A ,$15.77 ,$15.11 ,$15.11 , N/A ,$12.35 
ST. JOSEPH'S HOSPITAL - BREESE,27201250,N/A,HC EPIDURAL TRAY SNGL USE,272,1 ,$54.00 ,$35.10 ,$31.05 ,$54.00 ,$45.90 ,$32.24 , N/A ,$31.05 , N/A ,$37.21 ,$45.90 ,$45.90 ,$45.90 , N/A ,$36.72 , N/A , N/A ,$40.50 ,$38.34 ,$38.34 , N/A ,$38.34 ,$44.82 ,$44.82 ,$44.82 , N/A , N/A ,$45.90 , N/A ,$54.00 , N/A , N/A ,$45.90 , N/A ,$45.90 ,$48.60 , N/A ,$44.82 ,$42.93 ,$42.93 , N/A ,$35.10 
ST. JOSEPH'S HOSPITAL - BREESE,27201279,N/A,HC FECAL MANAGEMENT KIT,272,1 ,$276.00 ,$179.40 ,$158.70 ,$276.00 ,$234.60 ,$164.77 , N/A ,$158.70 , N/A ,$190.16 ,$234.60 ,$234.60 ,$234.60 , N/A ,$187.68 , N/A , N/A ,$207.00 ,$195.96 ,$195.96 , N/A ,$195.96 ,$229.08 ,$229.08 ,$229.08 , N/A , N/A ,$234.60 , N/A ,$276.00 , N/A , N/A ,$234.60 , N/A ,$234.60 ,$248.40 , N/A ,$229.08 ,$219.42 ,$219.42 , N/A ,$179.40 
ST. JOSEPH'S HOSPITAL - BREESE,27201282,N/A,HC FEEDING TUBE,272,1 ,$32.00 ,$20.80 ,$18.40 ,$32.00 ,$27.20 ,$19.10 , N/A ,$18.40 , N/A ,$22.05 ,$27.20 ,$27.20 ,$27.20 , N/A ,$21.76 , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.56 ,$26.56 ,$26.56 , N/A , N/A ,$27.20 , N/A ,$32.00 , N/A , N/A ,$27.20 , N/A ,$27.20 ,$28.80 , N/A ,$26.56 ,$25.44 ,$25.44 , N/A ,$20.80 
ST. JOSEPH'S HOSPITAL - BREESE,27201302,N/A,HC FINE MARKING PEN,272,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27201521,N/A,HC KIT INTRODUCER,272,1 ,$16.00 ,$10.40 ,$9.20 ,$16.00 ,$13.60 ,$9.55 , N/A ,$9.20 , N/A ,$11.02 ,$13.60 ,$13.60 ,$13.60 , N/A ,$10.88 , N/A , N/A ,$12.00 ,$11.36 ,$11.36 , N/A ,$11.36 ,$13.28 ,$13.28 ,$13.28 , N/A , N/A ,$13.60 , N/A ,$16.00 , N/A , N/A ,$13.60 , N/A ,$13.60 ,$14.40 , N/A ,$13.28 ,$12.72 ,$12.72 , N/A ,$10.40 
ST. JOSEPH'S HOSPITAL - BREESE,27201738,N/A,HC NIPPLE SHIELD,272,1 ,$17.00 ,$11.05 ,$9.78 ,$17.00 ,$14.45 ,$10.15 , N/A ,$9.78 , N/A ,$11.71 ,$14.45 ,$14.45 ,$14.45 , N/A ,$11.56 , N/A , N/A ,$12.75 ,$12.07 ,$12.07 , N/A ,$12.07 ,$14.11 ,$14.11 ,$14.11 , N/A , N/A ,$14.45 , N/A ,$17.00 , N/A , N/A ,$14.45 , N/A ,$14.45 ,$15.30 , N/A ,$14.11 ,$13.52 ,$13.52 , N/A ,$11.05 
ST. JOSEPH'S HOSPITAL - BREESE,27201894,N/A,HC PRESSURE CATHETER IUPC,272,1 ,$172.00 ,$111.80 ,$98.90 ,$172.00 ,$146.20 ,$102.68 , N/A ,$98.90 , N/A ,$118.51 ,$146.20 ,$146.20 ,$146.20 , N/A ,$116.96 , N/A , N/A ,$129.00 ,$122.12 ,$122.12 , N/A ,$122.12 ,$142.76 ,$142.76 ,$142.76 , N/A , N/A ,$146.20 , N/A ,$172.00 , N/A , N/A ,$146.20 , N/A ,$146.20 ,$154.80 , N/A ,$142.76 ,$136.74 ,$136.74 , N/A ,$111.80 
ST. JOSEPH'S HOSPITAL - BREESE,27201896,N/A,HC PREVENA INCISION SYSTEM,272,1 ,"$1,560.00 ","$1,014.00 ",$897.00 ,"$1,560.00 ","$1,326.00 ",$931.32 , N/A ,$897.00 , N/A ,"$1,074.84 ","$1,326.00 ","$1,326.00 ","$1,326.00 ", N/A ,"$1,060.80 ", N/A , N/A ,"$1,170.00 ","$1,107.60 ","$1,107.60 ", N/A ,"$1,107.60 ","$1,294.80 ","$1,294.80 ","$1,294.80 ", N/A , N/A ,"$1,326.00 ", N/A ,"$1,560.00 ", N/A , N/A ,"$1,326.00 ", N/A ,"$1,326.00 ","$1,404.00 ", N/A ,"$1,294.80 ","$1,240.20 ","$1,240.20 ", N/A ,"$1,014.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27201938,N/A,HC PULSE OXIMETER PROBE DISP,272,1 ,$39.00 ,$25.35 ,$22.43 ,$39.00 ,$33.15 ,$23.28 , N/A ,$22.43 , N/A ,$26.87 ,$33.15 ,$33.15 ,$33.15 , N/A ,$26.52 , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$32.37 ,$32.37 ,$32.37 , N/A , N/A ,$33.15 , N/A ,$39.00 , N/A , N/A ,$33.15 , N/A ,$33.15 ,$35.10 , N/A ,$32.37 ,$31.01 ,$31.01 , N/A ,$25.35 
ST. JOSEPH'S HOSPITAL - BREESE,27202002,N/A,HC SCD SLEEVE KNEE,272,1 ,$110.00 ,$71.50 ,$63.25 ,$110.00 ,$93.50 ,$65.67 , N/A ,$63.25 , N/A ,$75.79 ,$93.50 ,$93.50 ,$93.50 , N/A ,$74.80 , N/A , N/A ,$82.50 ,$78.10 ,$78.10 , N/A ,$78.10 ,$91.30 ,$91.30 ,$91.30 , N/A , N/A ,$93.50 , N/A ,$110.00 , N/A , N/A ,$93.50 , N/A ,$93.50 ,$99.00 , N/A ,$91.30 ,$87.45 ,$87.45 , N/A ,$71.50 
ST. JOSEPH'S HOSPITAL - BREESE,27202120,N/A,HC STAPLER SKIN,272,1 ,$18.00 ,$11.70 ,$10.35 ,$18.00 ,$15.30 ,$10.75 , N/A ,$10.35 , N/A ,$12.40 ,$15.30 ,$15.30 ,$15.30 , N/A ,$12.24 , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.94 ,$14.94 ,$14.94 , N/A , N/A ,$15.30 , N/A ,$18.00 , N/A , N/A ,$15.30 , N/A ,$15.30 ,$16.20 , N/A ,$14.94 ,$14.31 ,$14.31 , N/A ,$11.70 
ST. JOSEPH'S HOSPITAL - BREESE,27202600,N/A,HC SUTURE,272,1 ,$15.00 ,$9.75 ,$8.63 ,$15.00 ,$12.75 ,$8.96 , N/A ,$8.63 , N/A ,$10.34 ,$12.75 ,$12.75 ,$12.75 , N/A ,$10.20 , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.45 ,$12.45 ,$12.45 , N/A , N/A ,$12.75 , N/A ,$15.00 , N/A , N/A ,$12.75 , N/A ,$12.75 ,$13.50 , N/A ,$12.45 ,$11.93 ,$11.93 , N/A ,$9.75 
ST. JOSEPH'S HOSPITAL - BREESE,27202634,N/A,HC SYRINGE ASEPTO,272,1 ,$6.00 ,$3.90 ,$3.45 ,$6.00 ,$5.10 ,$3.58 , N/A ,$3.45 , N/A ,$4.13 ,$5.10 ,$5.10 ,$5.10 , N/A ,$4.08 , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.98 ,$4.98 ,$4.98 , N/A , N/A ,$5.10 , N/A ,$6.00 , N/A , N/A ,$5.10 , N/A ,$5.10 ,$5.40 , N/A ,$4.98 ,$4.77 ,$4.77 , N/A ,$3.90 
ST. JOSEPH'S HOSPITAL - BREESE,27202656,N/A,HC TAPE MEDIPORE 4 INCH,272,1 ,$19.00 ,$12.35 ,$10.93 ,$19.00 ,$16.15 ,$11.34 , N/A ,$10.93 , N/A ,$13.09 ,$16.15 ,$16.15 ,$16.15 , N/A ,$12.92 , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.77 ,$15.77 ,$15.77 , N/A , N/A ,$16.15 , N/A ,$19.00 , N/A , N/A ,$16.15 , N/A ,$16.15 ,$17.10 , N/A ,$15.77 ,$15.11 ,$15.11 , N/A ,$12.35 
ST. JOSEPH'S HOSPITAL - BREESE,27202665,N/A,HC THORACENTESIS TRAY,272,1 ,$167.00 ,$108.55 ,$96.03 ,$167.00 ,$141.95 ,$99.70 , N/A ,$96.03 , N/A ,$115.06 ,$141.95 ,$141.95 ,$141.95 , N/A ,$113.56 , N/A , N/A ,$125.25 ,$118.57 ,$118.57 , N/A ,$118.57 ,$138.61 ,$138.61 ,$138.61 , N/A , N/A ,$141.95 , N/A ,$167.00 , N/A , N/A ,$141.95 , N/A ,$141.95 ,$150.30 , N/A ,$138.61 ,$132.77 ,$132.77 , N/A ,$108.55 
ST. JOSEPH'S HOSPITAL - BREESE,27202743,N/A,HC TRAY CATH,272,1 ,$27.00 ,$17.55 ,$15.53 ,$27.00 ,$22.95 ,$16.12 , N/A ,$15.53 , N/A ,$18.60 ,$22.95 ,$22.95 ,$22.95 , N/A ,$18.36 , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.41 ,$22.41 ,$22.41 , N/A , N/A ,$22.95 , N/A ,$27.00 , N/A , N/A ,$22.95 , N/A ,$22.95 ,$24.30 , N/A ,$22.41 ,$21.47 ,$21.47 , N/A ,$17.55 
ST. JOSEPH'S HOSPITAL - BREESE,27202759,N/A,HC TRAY EPIDURAL CONTINUOUS,272,1 ,$21.00 ,$13.65 ,$12.08 ,$21.00 ,$17.85 ,$12.54 , N/A ,$12.08 , N/A ,$14.47 ,$17.85 ,$17.85 ,$17.85 , N/A ,$14.28 , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.43 ,$17.43 ,$17.43 , N/A , N/A ,$17.85 , N/A ,$21.00 , N/A , N/A ,$17.85 , N/A ,$17.85 ,$18.90 , N/A ,$17.43 ,$16.70 ,$16.70 , N/A ,$13.65 
ST. JOSEPH'S HOSPITAL - BREESE,27202807,N/A,HC TRAY SPINAL,272,1 ,$39.00 ,$25.35 ,$22.43 ,$39.00 ,$33.15 ,$23.28 , N/A ,$22.43 , N/A ,$26.87 ,$33.15 ,$33.15 ,$33.15 , N/A ,$26.52 , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$32.37 ,$32.37 ,$32.37 , N/A , N/A ,$33.15 , N/A ,$39.00 , N/A , N/A ,$33.15 , N/A ,$33.15 ,$35.10 , N/A ,$32.37 ,$31.01 ,$31.01 , N/A ,$25.35 
ST. JOSEPH'S HOSPITAL - BREESE,27202916,N/A,HC TUBING DISP CO2,272,1 ,$27.00 ,$17.55 ,$15.53 ,$27.00 ,$22.95 ,$16.12 , N/A ,$15.53 , N/A ,$18.60 ,$22.95 ,$22.95 ,$22.95 , N/A ,$18.36 , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.41 ,$22.41 ,$22.41 , N/A , N/A ,$22.95 , N/A ,$27.00 , N/A , N/A ,$22.95 , N/A ,$22.95 ,$24.30 , N/A ,$22.41 ,$21.47 ,$21.47 , N/A ,$17.55 
ST. JOSEPH'S HOSPITAL - BREESE,27203100,N/A,HC SET QUICK PRESSURE MONITOR,272,1 ,$339.00 ,$220.35 ,$194.93 ,$339.00 ,$288.15 ,$202.38 , N/A ,$194.93 , N/A ,$233.57 ,$288.15 ,$288.15 ,$288.15 , N/A ,$230.52 , N/A , N/A ,$254.25 ,$240.69 ,$240.69 , N/A ,$240.69 ,$281.37 ,$281.37 ,$281.37 , N/A , N/A ,$288.15 , N/A ,$339.00 , N/A , N/A ,$288.15 , N/A ,$288.15 ,$305.10 , N/A ,$281.37 ,$269.51 ,$269.51 , N/A ,$220.35 
ST. JOSEPH'S HOSPITAL - BREESE,27203239,N/A,HC PUTTY,272,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27203255,N/A,HC CPM PADS,272,1 ,$66.00 ,$42.90 ,$37.95 ,$66.00 ,$56.10 ,$39.40 , N/A ,$37.95 , N/A ,$45.47 ,$56.10 ,$56.10 ,$56.10 , N/A ,$44.88 , N/A , N/A ,$49.50 ,$46.86 ,$46.86 , N/A ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A , N/A ,$56.10 , N/A ,$66.00 , N/A , N/A ,$56.10 , N/A ,$56.10 ,$59.40 , N/A ,$54.78 ,$52.47 ,$52.47 , N/A ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,27203503,N/A,HC CANNULA NASAL HEATED HI FLOW,272,1 ,$63.00 ,$40.95 ,$36.23 ,$63.00 ,$53.55 ,$37.61 , N/A ,$36.23 , N/A ,$43.41 ,$53.55 ,$53.55 ,$53.55 , N/A ,$42.84 , N/A , N/A ,$47.25 ,$44.73 ,$44.73 , N/A ,$44.73 ,$52.29 ,$52.29 ,$52.29 , N/A , N/A ,$53.55 , N/A ,$63.00 , N/A , N/A ,$53.55 , N/A ,$53.55 ,$56.70 , N/A ,$52.29 ,$50.09 ,$50.09 , N/A ,$40.95 
ST. JOSEPH'S HOSPITAL - BREESE,27203509,N/A,HC CATHETER FOLEY 3W,272,1 ,$46.00 ,$29.90 ,$26.45 ,$46.00 ,$39.10 ,$27.46 , N/A ,$26.45 , N/A ,$31.69 ,$39.10 ,$39.10 ,$39.10 , N/A ,$31.28 , N/A , N/A ,$34.50 ,$32.66 ,$32.66 , N/A ,$32.66 ,$38.18 ,$38.18 ,$38.18 , N/A , N/A ,$39.10 , N/A ,$46.00 , N/A , N/A ,$39.10 , N/A ,$39.10 ,$41.40 , N/A ,$38.18 ,$36.57 ,$36.57 , N/A ,$29.90 
ST. JOSEPH'S HOSPITAL - BREESE,27203511,N/A,HC BAG LEG URINARY,272,1 ,$14.00 ,$9.10 ,$8.05 ,$14.00 ,$11.90 ,$8.36 , N/A ,$8.05 , N/A ,$9.65 ,$11.90 ,$11.90 ,$11.90 , N/A ,$9.52 , N/A , N/A ,$10.50 ,$9.94 ,$9.94 , N/A ,$9.94 ,$11.62 ,$11.62 ,$11.62 , N/A , N/A ,$11.90 , N/A ,$14.00 , N/A , N/A ,$11.90 , N/A ,$11.90 ,$12.60 , N/A ,$11.62 ,$11.13 ,$11.13 , N/A ,$9.10 
ST. JOSEPH'S HOSPITAL - BREESE,27203518,A6222,HC DRESSING VASELINE GAUZE,623,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27203521,A6234,HC DRESSING DUODERM <16 SQ CM,272,1 ,$40.00 ,$26.00 ,$23.00 ,$40.00 ,$34.00 ,$23.88 , N/A ,$23.00 , N/A ,$27.56 ,$34.00 ,$34.00 ,$34.00 , N/A ,$27.20 , N/A , N/A ,$30.00 ,$28.40 ,$28.40 , N/A ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A , N/A ,$34.00 , N/A ,$40.00 , N/A , N/A ,$34.00 , N/A ,$34.00 ,$36.00 , N/A ,$33.20 ,$31.80 ,$31.80 , N/A ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203527,A6402,HC DRESSING GAUZE,623,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,27203531,C1751,HC CATHETER CV TRIPLE-LUMEN,272,1 ,$255.00 ,$165.75 ,$146.63 ,$255.00 ,$216.75 ,$152.24 , N/A ,$146.63 , N/A ,$175.70 ,$216.75 ,$216.75 ,$216.75 , N/A ,$173.40 , N/A , N/A ,$191.25 ,$181.05 ,$181.05 , N/A ,$181.05 ,$211.65 ,$211.65 ,$211.65 , N/A , N/A ,$216.75 , N/A ,$255.00 , N/A , N/A ,$216.75 , N/A ,$216.75 ,$229.50 , N/A ,$211.65 ,$202.73 ,$202.73 , N/A ,$165.75 
ST. JOSEPH'S HOSPITAL - BREESE,27203532,C1751,HC CATHETER CV DUAL-LUMEN,272,1 ,$645.00 ,$419.25 ,$370.88 ,$645.00 ,$548.25 ,$385.07 , N/A ,$370.88 , N/A ,$444.41 ,$548.25 ,$548.25 ,$548.25 , N/A ,$438.60 , N/A , N/A ,$483.75 ,$457.95 ,$457.95 , N/A ,$457.95 ,$535.35 ,$535.35 ,$535.35 , N/A , N/A ,$548.25 , N/A ,$645.00 , N/A , N/A ,$548.25 , N/A ,$548.25 ,$580.50 , N/A ,$535.35 ,$512.78 ,$512.78 , N/A ,$419.25 
ST. JOSEPH'S HOSPITAL - BREESE,27203533,C1751,HC CATHETER CV SINGLE-LUMEN,272,1 ,$397.00 ,$258.05 ,$228.28 ,$397.00 ,$337.45 ,$237.01 , N/A ,$228.28 , N/A ,$273.53 ,$337.45 ,$337.45 ,$337.45 , N/A ,$269.96 , N/A , N/A ,$297.75 ,$281.87 ,$281.87 , N/A ,$281.87 ,$329.51 ,$329.51 ,$329.51 , N/A , N/A ,$337.45 , N/A ,$397.00 , N/A , N/A ,$337.45 , N/A ,$337.45 ,$357.30 , N/A ,$329.51 ,$315.62 ,$315.62 , N/A ,$258.05 
ST. JOSEPH'S HOSPITAL - BREESE,27203535,N/A,HC TRAY LUMBAR PUNCTURE,272,1 ,$66.00 ,$42.90 ,$37.95 ,$66.00 ,$56.10 ,$39.40 , N/A ,$37.95 , N/A ,$45.47 ,$56.10 ,$56.10 ,$56.10 , N/A ,$44.88 , N/A , N/A ,$49.50 ,$46.86 ,$46.86 , N/A ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A , N/A ,$56.10 , N/A ,$66.00 , N/A , N/A ,$56.10 , N/A ,$56.10 ,$59.40 , N/A ,$54.78 ,$52.47 ,$52.47 , N/A ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,27203537,N/A,HC CATHETER RADIAL ARTERY,272,1 ,$33.00 ,$21.45 ,$18.98 ,$33.00 ,$28.05 ,$19.70 , N/A ,$18.98 , N/A ,$22.74 ,$28.05 ,$28.05 ,$28.05 , N/A ,$22.44 , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.39 ,$27.39 ,$27.39 , N/A , N/A ,$28.05 , N/A ,$33.00 , N/A , N/A ,$28.05 , N/A ,$28.05 ,$29.70 , N/A ,$27.39 ,$26.24 ,$26.24 , N/A ,$21.45 
ST. JOSEPH'S HOSPITAL - BREESE,27203539,N/A,HC TRANSDUCER,272,1 ,$33.00 ,$21.45 ,$18.98 ,$33.00 ,$28.05 ,$19.70 , N/A ,$18.98 , N/A ,$22.74 ,$28.05 ,$28.05 ,$28.05 , N/A ,$22.44 , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.39 ,$27.39 ,$27.39 , N/A , N/A ,$28.05 , N/A ,$33.00 , N/A , N/A ,$28.05 , N/A ,$28.05 ,$29.70 , N/A ,$27.39 ,$26.24 ,$26.24 , N/A ,$21.45 
ST. JOSEPH'S HOSPITAL - BREESE,27203560,N/A,HC CATHETER IV,272,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27203562,N/A,HC CATHETER SUCTION,272,1 ,$16.00 ,$10.40 ,$9.20 ,$16.00 ,$13.60 ,$9.55 , N/A ,$9.20 , N/A ,$11.02 ,$13.60 ,$13.60 ,$13.60 , N/A ,$10.88 , N/A , N/A ,$12.00 ,$11.36 ,$11.36 , N/A ,$11.36 ,$13.28 ,$13.28 ,$13.28 , N/A , N/A ,$13.60 , N/A ,$16.00 , N/A , N/A ,$13.60 , N/A ,$13.60 ,$14.40 , N/A ,$13.28 ,$12.72 ,$12.72 , N/A ,$10.40 
ST. JOSEPH'S HOSPITAL - BREESE,27203564,N/A,HC CATHETER UMBILICAL ARTERY,272,1 ,$60.00 ,$39.00 ,$34.50 ,$60.00 ,$51.00 ,$35.82 , N/A ,$34.50 , N/A ,$41.34 ,$51.00 ,$51.00 ,$51.00 , N/A ,$40.80 , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.80 ,$49.80 ,$49.80 , N/A , N/A ,$51.00 , N/A ,$60.00 , N/A , N/A ,$51.00 , N/A ,$51.00 ,$54.00 , N/A ,$49.80 ,$47.70 ,$47.70 , N/A ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203572,N/A,HC DRESSING BIOPATCH,272,1 ,$18.00 ,$11.70 ,$10.35 ,$18.00 ,$15.30 ,$10.75 , N/A ,$10.35 , N/A ,$12.40 ,$15.30 ,$15.30 ,$15.30 , N/A ,$12.24 , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.94 ,$14.94 ,$14.94 , N/A , N/A ,$15.30 , N/A ,$18.00 , N/A , N/A ,$15.30 , N/A ,$15.30 ,$16.20 , N/A ,$14.94 ,$14.31 ,$14.31 , N/A ,$11.70 
ST. JOSEPH'S HOSPITAL - BREESE,27203575,N/A,HC DRESSING TELFA,272,1 ,$6.00 ,$3.90 ,$3.45 ,$6.00 ,$5.10 ,$3.58 , N/A ,$3.45 , N/A ,$4.13 ,$5.10 ,$5.10 ,$5.10 , N/A ,$4.08 , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.98 ,$4.98 ,$4.98 , N/A , N/A ,$5.10 , N/A ,$6.00 , N/A , N/A ,$5.10 , N/A ,$5.10 ,$5.40 , N/A ,$4.98 ,$4.77 ,$4.77 , N/A ,$3.90 
ST. JOSEPH'S HOSPITAL - BREESE,27203576,N/A,HC DRESSING V.A.C.,272,1 ,$123.00 ,$79.95 ,$70.73 ,$123.00 ,$104.55 ,$73.43 , N/A ,$70.73 , N/A ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 , N/A , N/A ,$92.25 ,$87.33 ,$87.33 , N/A ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A , N/A ,$104.55 , N/A ,$123.00 , N/A , N/A ,$104.55 , N/A ,$104.55 ,$110.70 , N/A ,$102.09 ,$97.79 ,$97.79 , N/A ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,27203579,N/A,HC KIT CATHETER FEMALE/INFANT/CHILD,272,1 ,$21.00 ,$13.65 ,$12.08 ,$21.00 ,$17.85 ,$12.54 , N/A ,$12.08 , N/A ,$14.47 ,$17.85 ,$17.85 ,$17.85 , N/A ,$14.28 , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.43 ,$17.43 ,$17.43 , N/A , N/A ,$17.85 , N/A ,$21.00 , N/A , N/A ,$17.85 , N/A ,$17.85 ,$18.90 , N/A ,$17.43 ,$16.70 ,$16.70 , N/A ,$13.65 
ST. JOSEPH'S HOSPITAL - BREESE,27203586,N/A,HC SALEM SUMP,272,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27203589,N/A,HC STYLET INTUBATING,272,1 ,$18.00 ,$11.70 ,$10.35 ,$18.00 ,$15.30 ,$10.75 , N/A ,$10.35 , N/A ,$12.40 ,$15.30 ,$15.30 ,$15.30 , N/A ,$12.24 , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.94 ,$14.94 ,$14.94 , N/A , N/A ,$15.30 , N/A ,$18.00 , N/A , N/A ,$15.30 , N/A ,$15.30 ,$16.20 , N/A ,$14.94 ,$14.31 ,$14.31 , N/A ,$11.70 
ST. JOSEPH'S HOSPITAL - BREESE,27203590,N/A,HC SYRINGE PUMP SYRINGE,272,1 ,$32.00 ,$20.80 ,$18.40 ,$32.00 ,$27.20 ,$19.10 , N/A ,$18.40 , N/A ,$22.05 ,$27.20 ,$27.20 ,$27.20 , N/A ,$21.76 , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.56 ,$26.56 ,$26.56 , N/A , N/A ,$27.20 , N/A ,$32.00 , N/A , N/A ,$27.20 , N/A ,$27.20 ,$28.80 , N/A ,$26.56 ,$25.44 ,$25.44 , N/A ,$20.80 
ST. JOSEPH'S HOSPITAL - BREESE,27203597,N/A,HC TUBING ANY,272,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27203689,N/A,HC COVER PROBE,272,1 ,$20.00 ,$13.00 ,$11.50 ,$20.00 ,$17.00 ,$11.94 , N/A ,$11.50 , N/A ,$13.78 ,$17.00 ,$17.00 ,$17.00 , N/A ,$13.60 , N/A , N/A ,$15.00 ,$14.20 ,$14.20 , N/A ,$14.20 ,$16.60 ,$16.60 ,$16.60 , N/A , N/A ,$17.00 , N/A ,$20.00 , N/A , N/A ,$17.00 , N/A ,$17.00 ,$18.00 , N/A ,$16.60 ,$15.90 ,$15.90 , N/A ,$13.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203719,C1729,HC CATHETER CENTESIS ONE STEP,272,1 ,$39.00 ,$25.35 ,$22.43 ,$39.00 ,$33.15 ,$23.28 , N/A ,$22.43 , N/A ,$26.87 ,$33.15 ,$33.15 ,$33.15 , N/A ,$26.52 , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$32.37 ,$32.37 ,$32.37 , N/A , N/A ,$33.15 , N/A ,$39.00 , N/A , N/A ,$33.15 , N/A ,$33.15 ,$35.10 , N/A ,$32.37 ,$31.01 ,$31.01 , N/A ,$25.35 
ST. JOSEPH'S HOSPITAL - BREESE,27203846,N/A,HC SYSTEM VACUUM ASSIST MUSHROOM CAP,272,1 ,$99.00 ,$64.35 ,$56.93 ,$99.00 ,$84.15 ,$59.10 , N/A ,$56.93 , N/A ,$68.21 ,$84.15 ,$84.15 ,$84.15 , N/A ,$67.32 , N/A , N/A ,$74.25 ,$70.29 ,$70.29 , N/A ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A , N/A ,$84.15 , N/A ,$99.00 , N/A , N/A ,$84.15 , N/A ,$84.15 ,$89.10 , N/A ,$82.17 ,$78.71 ,$78.71 , N/A ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,27203847,N/A,HC NEEDLE INTRAOSSEOUS,272,1 ,$375.00 ,$243.75 ,$215.63 ,$375.00 ,$318.75 ,$223.88 , N/A ,$215.63 , N/A ,$258.38 ,$318.75 ,$318.75 ,$318.75 , N/A ,$255.00 , N/A , N/A ,$281.25 ,$266.25 ,$266.25 , N/A ,$266.25 ,$311.25 ,$311.25 ,$311.25 , N/A , N/A ,$318.75 , N/A ,$375.00 , N/A , N/A ,$318.75 , N/A ,$318.75 ,$337.50 , N/A ,$311.25 ,$298.13 ,$298.13 , N/A ,$243.75 
ST. JOSEPH'S HOSPITAL - BREESE,27203849,N/A,HC DRESSING WOUND PICO,272,1 ,$714.00 ,$464.10 ,$410.55 ,$714.00 ,$606.90 ,$426.26 , N/A ,$410.55 , N/A ,$491.95 ,$606.90 ,$606.90 ,$606.90 , N/A ,$485.52 , N/A , N/A ,$535.50 ,$506.94 ,$506.94 , N/A ,$506.94 ,$592.62 ,$592.62 ,$592.62 , N/A , N/A ,$606.90 , N/A ,$714.00 , N/A , N/A ,$606.90 , N/A ,$606.90 ,$642.60 , N/A ,$592.62 ,$567.63 ,$567.63 , N/A ,$464.10 
ST. JOSEPH'S HOSPITAL - BREESE,27203871,N/A,HC NASAL RHINO ROCKET,272,1 ,$132.12 ,$85.88 ,$75.97 ,$132.12 ,$112.30 ,$78.88 , N/A ,$75.97 , N/A ,$91.03 ,$112.30 ,$112.30 ,$112.30 , N/A ,$89.84 , N/A , N/A ,$99.09 ,$93.81 ,$93.81 , N/A ,$93.81 ,$109.66 ,$109.66 ,$109.66 , N/A , N/A ,$112.30 , N/A ,$132.12 , N/A , N/A ,$112.30 , N/A ,$112.30 ,$118.91 , N/A ,$109.66 ,$105.04 ,$105.04 , N/A ,$85.88 
ST. JOSEPH'S HOSPITAL - BREESE,27203875,N/A,HC SYSTEM DRESSING WOUND VAC THERAPY,272,1 ,"$1,521.00 ",$988.65 ,$874.58 ,"$1,521.00 ","$1,292.85 ",$908.04 , N/A ,$874.58 , N/A ,"$1,047.97 ","$1,292.85 ","$1,292.85 ","$1,292.85 ", N/A ,"$1,034.28 ", N/A , N/A ,"$1,140.75 ","$1,079.91 ","$1,079.91 ", N/A ,"$1,079.91 ","$1,262.43 ","$1,262.43 ","$1,262.43 ", N/A , N/A ,"$1,292.85 ", N/A ,"$1,521.00 ", N/A , N/A ,"$1,292.85 ", N/A ,"$1,292.85 ","$1,368.90 ", N/A ,"$1,262.43 ","$1,209.20 ","$1,209.20 ", N/A ,$988.65 
ST. JOSEPH'S HOSPITAL - BREESE,27204583,N/A,HC LARYNGOSCOPE GLIDESCOPE,272,1 ,$120.00 ,$78.00 ,$69.00 ,$120.00 ,$102.00 ,$71.64 , N/A ,$69.00 , N/A ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A , N/A ,$102.00 , N/A ,$120.00 , N/A , N/A ,$102.00 , N/A ,$102.00 ,$108.00 , N/A ,$99.60 ,$95.40 ,$95.40 , N/A ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204603,N/A,HC TRAY UMBILICAL CATH,272,1 ,$151.00 ,$98.15 ,$86.83 ,$151.00 ,$128.35 ,$90.15 , N/A ,$86.83 , N/A ,$104.04 ,$128.35 ,$128.35 ,$128.35 , N/A ,$102.68 , N/A , N/A ,$113.25 ,$107.21 ,$107.21 , N/A ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A , N/A ,$128.35 , N/A ,$151.00 , N/A , N/A ,$128.35 , N/A ,$128.35 ,$135.90 , N/A ,$125.33 ,$120.05 ,$120.05 , N/A ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,27204607,N/A,HC TUBE NASOGASTRIC,272,1 ,$6.00 ,$3.90 ,$3.45 ,$6.00 ,$5.10 ,$3.58 , N/A ,$3.45 , N/A ,$4.13 ,$5.10 ,$5.10 ,$5.10 , N/A ,$4.08 , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.98 ,$4.98 ,$4.98 , N/A , N/A ,$5.10 , N/A ,$6.00 , N/A , N/A ,$5.10 , N/A ,$5.10 ,$5.40 , N/A ,$4.98 ,$4.77 ,$4.77 , N/A ,$3.90 
ST. JOSEPH'S HOSPITAL - BREESE,27204622,N/A,HC MARKER BIOPSY SITE,272,1 ,$182.00 ,$118.30 ,$104.65 ,$182.00 ,$154.70 ,$108.65 , N/A ,$104.65 , N/A ,$125.40 ,$154.70 ,$154.70 ,$154.70 , N/A ,$123.76 , N/A , N/A ,$136.50 ,$129.22 ,$129.22 , N/A ,$129.22 ,$151.06 ,$151.06 ,$151.06 , N/A , N/A ,$154.70 , N/A ,$182.00 , N/A , N/A ,$154.70 , N/A ,$154.70 ,$163.80 , N/A ,$151.06 ,$144.69 ,$144.69 , N/A ,$118.30 
ST. JOSEPH'S HOSPITAL - BREESE,27204623,N/A,HC NEEDLE GUIDE,272,1 ,$22.00 ,$14.30 ,$12.65 ,$22.00 ,$18.70 ,$13.13 , N/A ,$12.65 , N/A ,$15.16 ,$18.70 ,$18.70 ,$18.70 , N/A ,$14.96 , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.26 ,$18.26 ,$18.26 , N/A , N/A ,$18.70 , N/A ,$22.00 , N/A , N/A ,$18.70 , N/A ,$18.70 ,$19.80 , N/A ,$18.26 ,$17.49 ,$17.49 , N/A ,$14.30 
ST. JOSEPH'S HOSPITAL - BREESE,27204654,N/A,HC BAG RESUSCITATE INFANT,272,1 ,$33.00 ,$21.45 ,$18.98 ,$33.00 ,$28.05 ,$19.70 , N/A ,$18.98 , N/A ,$22.74 ,$28.05 ,$28.05 ,$28.05 , N/A ,$22.44 , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.39 ,$27.39 ,$27.39 , N/A , N/A ,$28.05 , N/A ,$33.00 , N/A , N/A ,$28.05 , N/A ,$28.05 ,$29.70 , N/A ,$27.39 ,$26.24 ,$26.24 , N/A ,$21.45 
ST. JOSEPH'S HOSPITAL - BREESE,27204656,N/A,HC BAG RESUSCITOR,272,1 ,$63.00 ,$40.95 ,$36.23 ,$63.00 ,$53.55 ,$37.61 , N/A ,$36.23 , N/A ,$43.41 ,$53.55 ,$53.55 ,$53.55 , N/A ,$42.84 , N/A , N/A ,$47.25 ,$44.73 ,$44.73 , N/A ,$44.73 ,$52.29 ,$52.29 ,$52.29 , N/A , N/A ,$53.55 , N/A ,$63.00 , N/A , N/A ,$53.55 , N/A ,$53.55 ,$56.70 , N/A ,$52.29 ,$50.09 ,$50.09 , N/A ,$40.95 
ST. JOSEPH'S HOSPITAL - BREESE,27204714,N/A,HC SUCTION YANKAUER,272,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27204755,N/A,HC DEVICE BREAST BIOPSY,272,1 ,$587.00 ,$381.55 ,$337.53 ,$587.00 ,$498.95 ,$350.44 , N/A ,$337.53 , N/A ,$404.44 ,$498.95 ,$498.95 ,$498.95 , N/A ,$399.16 , N/A , N/A ,$440.25 ,$416.77 ,$416.77 , N/A ,$416.77 ,$487.21 ,$487.21 ,$487.21 , N/A , N/A ,$498.95 , N/A ,$587.00 , N/A , N/A ,$498.95 , N/A ,$498.95 ,$528.30 , N/A ,$487.21 ,$466.67 ,$466.67 , N/A ,$381.55 
ST. JOSEPH'S HOSPITAL - BREESE,27204760,N/A,HC BLANKET BAIR HUGGER,272,1 ,$39.00 ,$25.35 ,$22.43 ,$39.00 ,$33.15 ,$23.28 , N/A ,$22.43 , N/A ,$26.87 ,$33.15 ,$33.15 ,$33.15 , N/A ,$26.52 , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$32.37 ,$32.37 ,$32.37 , N/A , N/A ,$33.15 , N/A ,$39.00 , N/A , N/A ,$33.15 , N/A ,$33.15 ,$35.10 , N/A ,$32.37 ,$31.01 ,$31.01 , N/A ,$25.35 
ST. JOSEPH'S HOSPITAL - BREESE,27204771,N/A,HC BLADE LARYNGOSCOPE,272,1 ,$36.00 ,$23.40 ,$20.70 ,$36.00 ,$30.60 ,$21.49 , N/A ,$20.70 , N/A ,$24.80 ,$30.60 ,$30.60 ,$30.60 , N/A ,$24.48 , N/A , N/A ,$27.00 ,$25.56 ,$25.56 , N/A ,$25.56 ,$29.88 ,$29.88 ,$29.88 , N/A , N/A ,$30.60 , N/A ,$36.00 , N/A , N/A ,$30.60 , N/A ,$30.60 ,$32.40 , N/A ,$29.88 ,$28.62 ,$28.62 , N/A ,$23.40 
ST. JOSEPH'S HOSPITAL - BREESE,27204772,N/A,HC BLADE LARYNGEAL,272,1 ,$171.60 ,$111.54 ,$98.67 ,$171.60 ,$145.86 ,$102.45 , N/A ,$98.67 , N/A ,$118.23 ,$145.86 ,$145.86 ,$145.86 , N/A ,$116.69 , N/A , N/A ,$128.70 ,$121.84 ,$121.84 , N/A ,$121.84 ,$142.43 ,$142.43 ,$142.43 , N/A , N/A ,$145.86 , N/A ,$171.60 , N/A , N/A ,$145.86 , N/A ,$145.86 ,$154.44 , N/A ,$142.43 ,$136.42 ,$136.42 , N/A ,$111.54 
ST. JOSEPH'S HOSPITAL - BREESE,27204821,N/A,HC CONNECTOR STRAIGHT,272,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,27204860,N/A,HC HEMOSTAT MATRIX,272,1 ,$952.41 ,$619.07 ,$547.64 ,$952.41 ,$809.55 ,$568.59 , N/A ,$547.64 , N/A ,$656.21 ,$809.55 ,$809.55 ,$809.55 , N/A ,$647.64 , N/A , N/A ,$714.31 ,$676.21 ,$676.21 , N/A ,$676.21 ,$790.50 ,$790.50 ,$790.50 , N/A , N/A ,$809.55 , N/A ,$952.41 , N/A , N/A ,$809.55 , N/A ,$809.55 ,$857.17 , N/A ,$790.50 ,$757.17 ,$757.17 , N/A ,$619.07 
ST. JOSEPH'S HOSPITAL - BREESE,27204865,N/A,HC INTRODUCER/SHEATH,272,1 ,$42.00 ,$27.30 ,$24.15 ,$42.00 ,$35.70 ,$25.07 , N/A ,$24.15 , N/A ,$28.94 ,$35.70 ,$35.70 ,$35.70 , N/A ,$28.56 , N/A , N/A ,$31.50 ,$29.82 ,$29.82 , N/A ,$29.82 ,$34.86 ,$34.86 ,$34.86 , N/A , N/A ,$35.70 , N/A ,$42.00 , N/A , N/A ,$35.70 , N/A ,$35.70 ,$37.80 , N/A ,$34.86 ,$33.39 ,$33.39 , N/A ,$27.30 
ST. JOSEPH'S HOSPITAL - BREESE,27204869,N/A,HC IV ANGIOCATH,272,1 ,$18.00 ,$11.70 ,$10.35 ,$18.00 ,$15.30 ,$10.75 , N/A ,$10.35 , N/A ,$12.40 ,$15.30 ,$15.30 ,$15.30 , N/A ,$12.24 , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.94 ,$14.94 ,$14.94 , N/A , N/A ,$15.30 , N/A ,$18.00 , N/A , N/A ,$15.30 , N/A ,$15.30 ,$16.20 , N/A ,$14.94 ,$14.31 ,$14.31 , N/A ,$11.70 
ST. JOSEPH'S HOSPITAL - BREESE,27204887,N/A,HC KIT CATHETER FEMALE,272,1 ,$19.24 ,$12.51 ,$11.06 ,$19.24 ,$16.35 ,$11.49 , N/A ,$11.06 , N/A ,$13.26 ,$16.35 ,$16.35 ,$16.35 , N/A ,$13.08 , N/A , N/A ,$14.43 ,$13.66 ,$13.66 , N/A ,$13.66 ,$15.97 ,$15.97 ,$15.97 , N/A , N/A ,$16.35 , N/A ,$19.24 , N/A , N/A ,$16.35 , N/A ,$16.35 ,$17.32 , N/A ,$15.97 ,$15.30 ,$15.30 , N/A ,$12.51 
ST. JOSEPH'S HOSPITAL - BREESE,27204894,N/A,HC KIT CHEST TUBE INSERTION,272,1 ,$359.00 ,$233.35 ,$206.43 ,$359.00 ,$305.15 ,$214.32 , N/A ,$206.43 , N/A ,$247.35 ,$305.15 ,$305.15 ,$305.15 , N/A ,$244.12 , N/A , N/A ,$269.25 ,$254.89 ,$254.89 , N/A ,$254.89 ,$297.97 ,$297.97 ,$297.97 , N/A , N/A ,$305.15 , N/A ,$359.00 , N/A , N/A ,$305.15 , N/A ,$305.15 ,$323.10 , N/A ,$297.97 ,$285.41 ,$285.41 , N/A ,$233.35 
ST. JOSEPH'S HOSPITAL - BREESE,27204936,N/A,HC NEEDLE NERVE BLOCK ECHOGENIC,272,1 ,$33.00 ,$21.45 ,$18.98 ,$33.00 ,$28.05 ,$19.70 , N/A ,$18.98 , N/A ,$22.74 ,$28.05 ,$28.05 ,$28.05 , N/A ,$22.44 , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.39 ,$27.39 ,$27.39 , N/A , N/A ,$28.05 , N/A ,$33.00 , N/A , N/A ,$28.05 , N/A ,$28.05 ,$29.70 , N/A ,$27.39 ,$26.24 ,$26.24 , N/A ,$21.45 
ST. JOSEPH'S HOSPITAL - BREESE,27204937,N/A,HC NEEDLE NERVE BLOCK STIMULATING,272,1 ,$36.00 ,$23.40 ,$20.70 ,$36.00 ,$30.60 ,$21.49 , N/A ,$20.70 , N/A ,$24.80 ,$30.60 ,$30.60 ,$30.60 , N/A ,$24.48 , N/A , N/A ,$27.00 ,$25.56 ,$25.56 , N/A ,$25.56 ,$29.88 ,$29.88 ,$29.88 , N/A , N/A ,$30.60 , N/A ,$36.00 , N/A , N/A ,$30.60 , N/A ,$30.60 ,$32.40 , N/A ,$29.88 ,$28.62 ,$28.62 , N/A ,$23.40 
ST. JOSEPH'S HOSPITAL - BREESE,27204941,N/A,HC NEEDLE EPIDURAL,272,1 ,$18.00 ,$11.70 ,$10.35 ,$18.00 ,$15.30 ,$10.75 , N/A ,$10.35 , N/A ,$12.40 ,$15.30 ,$15.30 ,$15.30 , N/A ,$12.24 , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.94 ,$14.94 ,$14.94 , N/A , N/A ,$15.30 , N/A ,$18.00 , N/A , N/A ,$15.30 , N/A ,$15.30 ,$16.20 , N/A ,$14.94 ,$14.31 ,$14.31 , N/A ,$11.70 
ST. JOSEPH'S HOSPITAL - BREESE,27204944,N/A,HC NEEDLE SPINAL WHITACRE,272,1 ,$27.00 ,$17.55 ,$15.53 ,$27.00 ,$22.95 ,$16.12 , N/A ,$15.53 , N/A ,$18.60 ,$22.95 ,$22.95 ,$22.95 , N/A ,$18.36 , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.41 ,$22.41 ,$22.41 , N/A , N/A ,$22.95 , N/A ,$27.00 , N/A , N/A ,$22.95 , N/A ,$22.95 ,$24.30 , N/A ,$22.41 ,$21.47 ,$21.47 , N/A ,$17.55 
ST. JOSEPH'S HOSPITAL - BREESE,27204949,N/A,HC HOLDER ENDOTRACH NEOBAR,272,1 ,$21.73 ,$14.12 ,$12.49 ,$21.73 ,$18.47 ,$12.97 , N/A ,$12.49 , N/A ,$14.97 ,$18.47 ,$18.47 ,$18.47 , N/A ,$14.78 , N/A , N/A ,$16.30 ,$15.43 ,$15.43 , N/A ,$15.43 ,$18.04 ,$18.04 ,$18.04 , N/A , N/A ,$18.47 , N/A ,$21.73 , N/A , N/A ,$18.47 , N/A ,$18.47 ,$19.56 , N/A ,$18.04 ,$17.28 ,$17.28 , N/A ,$14.12 
ST. JOSEPH'S HOSPITAL - BREESE,27204966,N/A,HC OSTOMY POUCH,272,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27204968,N/A,HC OSTOMY PASTE,272,1 ,$28.00 ,$18.20 ,$16.10 ,$28.00 ,$23.80 ,$16.72 , N/A ,$16.10 , N/A ,$19.29 ,$23.80 ,$23.80 ,$23.80 , N/A ,$19.04 , N/A , N/A ,$21.00 ,$19.88 ,$19.88 , N/A ,$19.88 ,$23.24 ,$23.24 ,$23.24 , N/A , N/A ,$23.80 , N/A ,$28.00 , N/A , N/A ,$23.80 , N/A ,$23.80 ,$25.20 , N/A ,$23.24 ,$22.26 ,$22.26 , N/A ,$18.20 
ST. JOSEPH'S HOSPITAL - BREESE,27204988,N/A,HC BAG INFUSION PRESSURE,272,1 ,$60.00 ,$39.00 ,$34.50 ,$60.00 ,$51.00 ,$35.82 , N/A ,$34.50 , N/A ,$41.34 ,$51.00 ,$51.00 ,$51.00 , N/A ,$40.80 , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.80 ,$49.80 ,$49.80 , N/A , N/A ,$51.00 , N/A ,$60.00 , N/A , N/A ,$51.00 , N/A ,$51.00 ,$54.00 , N/A ,$49.80 ,$47.70 ,$47.70 , N/A ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204997,N/A,HC PROTECTOR HEEL ELBOW,272,1 ,$41.73 ,$27.12 ,$23.99 ,$41.73 ,$35.47 ,$24.91 , N/A ,$23.99 , N/A ,$28.75 ,$35.47 ,$35.47 ,$35.47 , N/A ,$28.38 , N/A , N/A ,$31.30 ,$29.63 ,$29.63 , N/A ,$29.63 ,$34.64 ,$34.64 ,$34.64 , N/A , N/A ,$35.47 , N/A ,$41.73 , N/A , N/A ,$35.47 , N/A ,$35.47 ,$37.56 , N/A ,$34.64 ,$33.18 ,$33.18 , N/A ,$27.12 
ST. JOSEPH'S HOSPITAL - BREESE,27204999,N/A,HC SENSOR PULSE OX,272,1 ,$42.00 ,$27.30 ,$24.15 ,$42.00 ,$35.70 ,$25.07 , N/A ,$24.15 , N/A ,$28.94 ,$35.70 ,$35.70 ,$35.70 , N/A ,$28.56 , N/A , N/A ,$31.50 ,$29.82 ,$29.82 , N/A ,$29.82 ,$34.86 ,$34.86 ,$34.86 , N/A , N/A ,$35.70 , N/A ,$42.00 , N/A , N/A ,$35.70 , N/A ,$35.70 ,$37.80 , N/A ,$34.86 ,$33.39 ,$33.39 , N/A ,$27.30 
ST. JOSEPH'S HOSPITAL - BREESE,27205016,N/A,HC SET PRESSURE MONITOR,272,1 ,$32.00 ,$20.80 ,$18.40 ,$32.00 ,$27.20 ,$19.10 , N/A ,$18.40 , N/A ,$22.05 ,$27.20 ,$27.20 ,$27.20 , N/A ,$21.76 , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.56 ,$26.56 ,$26.56 , N/A , N/A ,$27.20 , N/A ,$32.00 , N/A , N/A ,$27.20 , N/A ,$27.20 ,$28.80 , N/A ,$26.56 ,$25.44 ,$25.44 , N/A ,$20.80 
ST. JOSEPH'S HOSPITAL - BREESE,27205029,N/A,HC STATLOCK DEVICE FOLEY,272,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27205046,N/A,HC SYRINGE ATOMIZER MUCOSAL,272,1 ,$26.91 ,$17.49 ,$15.47 ,$26.91 ,$22.87 ,$16.07 , N/A ,$15.47 , N/A ,$18.54 ,$22.87 ,$22.87 ,$22.87 , N/A ,$18.30 , N/A , N/A ,$20.18 ,$19.11 ,$19.11 , N/A ,$19.11 ,$22.34 ,$22.34 ,$22.34 , N/A , N/A ,$22.87 , N/A ,$26.91 , N/A , N/A ,$22.87 , N/A ,$22.87 ,$24.22 , N/A ,$22.34 ,$21.39 ,$21.39 , N/A ,$17.49 
ST. JOSEPH'S HOSPITAL - BREESE,27205060,N/A,HC TRAY PICC LINE,272,1 ,$508.40 ,$330.46 ,$292.33 ,$508.40 ,$432.14 ,$303.51 , N/A ,$292.33 , N/A ,$350.29 ,$432.14 ,$432.14 ,$432.14 , N/A ,$345.71 , N/A , N/A ,$381.30 ,$360.96 ,$360.96 , N/A ,$360.96 ,$421.97 ,$421.97 ,$421.97 , N/A , N/A ,$432.14 , N/A ,$508.40 , N/A , N/A ,$432.14 , N/A ,$432.14 ,$457.56 , N/A ,$421.97 ,$404.18 ,$404.18 , N/A ,$330.46 
ST. JOSEPH'S HOSPITAL - BREESE,27205063,N/A,HC TRAY SUTURE REMOVAL,272,1 ,$7.00 ,$4.55 ,$4.03 ,$7.00 ,$5.95 ,$4.18 , N/A ,$4.03 , N/A ,$4.82 ,$5.95 ,$5.95 ,$5.95 , N/A ,$4.76 , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.81 ,$5.81 ,$5.81 , N/A , N/A ,$5.95 , N/A ,$7.00 , N/A , N/A ,$5.95 , N/A ,$5.95 ,$6.30 , N/A ,$5.81 ,$5.57 ,$5.57 , N/A ,$4.55 
ST. JOSEPH'S HOSPITAL - BREESE,27205074,N/A,HC TUBE TRACH,272,1 ,$142.00 ,$92.30 ,$81.65 ,$142.00 ,$120.70 ,$84.77 , N/A ,$81.65 , N/A ,$97.84 ,$120.70 ,$120.70 ,$120.70 , N/A ,$96.56 , N/A , N/A ,$106.50 ,$100.82 ,$100.82 , N/A ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A , N/A ,$120.70 , N/A ,$142.00 , N/A , N/A ,$120.70 , N/A ,$120.70 ,$127.80 , N/A ,$117.86 ,$112.89 ,$112.89 , N/A ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,27205078,N/A,HC TUBE RECTAL,272,1 ,$6.00 ,$3.90 ,$3.45 ,$6.00 ,$5.10 ,$3.58 , N/A ,$3.45 , N/A ,$4.13 ,$5.10 ,$5.10 ,$5.10 , N/A ,$4.08 , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.98 ,$4.98 ,$4.98 , N/A , N/A ,$5.10 , N/A ,$6.00 , N/A , N/A ,$5.10 , N/A ,$5.10 ,$5.40 , N/A ,$4.98 ,$4.77 ,$4.77 , N/A ,$3.90 
ST. JOSEPH'S HOSPITAL - BREESE,27205086,N/A,HC CANISTER WOUND VAC,272,1 ,$69.15 ,$44.95 ,$39.76 ,$69.15 ,$58.78 ,$41.28 , N/A ,$39.76 , N/A ,$47.64 ,$58.78 ,$58.78 ,$58.78 , N/A ,$47.02 , N/A , N/A ,$51.86 ,$49.10 ,$49.10 , N/A ,$49.10 ,$57.39 ,$57.39 ,$57.39 , N/A , N/A ,$58.78 , N/A ,$69.15 , N/A , N/A ,$58.78 , N/A ,$58.78 ,$62.24 , N/A ,$57.39 ,$54.97 ,$54.97 , N/A ,$44.95 
ST. JOSEPH'S HOSPITAL - BREESE,27205088,N/A,HC KIT DRESSING WOUND VAC INSTILL CASSETTE/TUBE,272,1 ,$140.25 ,$91.16 ,$80.64 ,$140.25 ,$119.21 ,$83.73 , N/A ,$80.64 , N/A ,$96.63 ,$119.21 ,$119.21 ,$119.21 , N/A ,$95.37 , N/A , N/A ,$105.19 ,$99.58 ,$99.58 , N/A ,$99.58 ,$116.41 ,$116.41 ,$116.41 , N/A , N/A ,$119.21 , N/A ,$140.25 , N/A , N/A ,$119.21 , N/A ,$119.21 ,$126.23 , N/A ,$116.41 ,$111.50 ,$111.50 , N/A ,$91.16 
ST. JOSEPH'S HOSPITAL - BREESE,27205091,N/A,HC KIT DRESSING WOUND VAC PREVENA PEEL N PLACE,272,1 ,"$1,158.30 ",$752.90 ,$666.02 ,"$1,158.30 ",$984.56 ,$691.51 , N/A ,$666.02 , N/A ,$798.07 ,$984.56 ,$984.56 ,$984.56 , N/A ,$787.64 , N/A , N/A ,$868.73 ,$822.39 ,$822.39 , N/A ,$822.39 ,$961.39 ,$961.39 ,$961.39 , N/A , N/A ,$984.56 , N/A ,"$1,158.30 ", N/A , N/A ,$984.56 , N/A ,$984.56 ,"$1,042.47 ", N/A ,$961.39 ,$920.85 ,$920.85 , N/A ,$752.90 
ST. JOSEPH'S HOSPITAL - BREESE,27205148,C1751,HC KIT POWER PICC,272,1 ,$798.00 ,$518.70 ,$458.85 ,$798.00 ,$678.30 ,$476.41 , N/A ,$458.85 , N/A ,$549.82 ,$678.30 ,$678.30 ,$678.30 , N/A ,$542.64 , N/A , N/A ,$598.50 ,$566.58 ,$566.58 , N/A ,$566.58 ,$662.34 ,$662.34 ,$662.34 , N/A , N/A ,$678.30 , N/A ,$798.00 , N/A , N/A ,$678.30 , N/A ,$678.30 ,$718.20 , N/A ,$662.34 ,$634.41 ,$634.41 , N/A ,$518.70 
ST. JOSEPH'S HOSPITAL - BREESE,27205182,N/A,HC NEEDLE INTRAOSSEOUS/STABILIZER KIT,272,1 ,$79.00 ,$51.35 ,$45.43 ,$79.00 ,$67.15 ,$47.16 , N/A ,$45.43 , N/A ,$54.43 ,$67.15 ,$67.15 ,$67.15 , N/A ,$53.72 , N/A , N/A ,$59.25 ,$56.09 ,$56.09 , N/A ,$56.09 ,$65.57 ,$65.57 ,$65.57 , N/A , N/A ,$67.15 , N/A ,$79.00 , N/A , N/A ,$67.15 , N/A ,$67.15 ,$71.10 , N/A ,$65.57 ,$62.81 ,$62.81 , N/A ,$51.35 
ST. JOSEPH'S HOSPITAL - BREESE,27205183,N/A,HC MASK AIRWAY DOUBLE ENTRY PORT,272,1 ,$32.00 ,$20.80 ,$18.40 ,$32.00 ,$27.20 ,$19.10 , N/A ,$18.40 , N/A ,$22.05 ,$27.20 ,$27.20 ,$27.20 , N/A ,$21.76 , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.56 ,$26.56 ,$26.56 , N/A , N/A ,$27.20 , N/A ,$32.00 , N/A , N/A ,$27.20 , N/A ,$27.20 ,$28.80 , N/A ,$26.56 ,$25.44 ,$25.44 , N/A ,$20.80 
ST. JOSEPH'S HOSPITAL - BREESE,27205262,N/A,HC BRONCHOSCOPE,272,1 ,$810.00 ,$526.50 ,$465.75 ,$810.00 ,$688.50 ,$483.57 , N/A ,$465.75 , N/A ,$558.09 ,$688.50 ,$688.50 ,$688.50 , N/A ,$550.80 , N/A , N/A ,$607.50 ,$575.10 ,$575.10 , N/A ,$575.10 ,$672.30 ,$672.30 ,$672.30 , N/A , N/A ,$688.50 , N/A ,$810.00 , N/A , N/A ,$688.50 , N/A ,$688.50 ,$729.00 , N/A ,$672.30 ,$643.95 ,$643.95 , N/A ,$526.50 
ST. JOSEPH'S HOSPITAL - BREESE,27205283,N/A,HC AIRWAY ORAL NASAL,272,1 ,$22.00 ,$14.30 ,$12.65 ,$22.00 ,$18.70 ,$13.13 , N/A ,$12.65 , N/A ,$15.16 ,$18.70 ,$18.70 ,$18.70 , N/A ,$14.96 , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.26 ,$18.26 ,$18.26 , N/A , N/A ,$18.70 , N/A ,$22.00 , N/A , N/A ,$18.70 , N/A ,$18.70 ,$19.80 , N/A ,$18.26 ,$17.49 ,$17.49 , N/A ,$14.30 
ST. JOSEPH'S HOSPITAL - BREESE,27205298,N/A,HC CATHETER FOLEY COUDE,272,1 ,$44.00 ,$28.60 ,$25.30 ,$44.00 ,$37.40 ,$26.27 , N/A ,$25.30 , N/A ,$30.32 ,$37.40 ,$37.40 ,$37.40 , N/A ,$29.92 , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.52 ,$36.52 ,$36.52 , N/A , N/A ,$37.40 , N/A ,$44.00 , N/A , N/A ,$37.40 , N/A ,$37.40 ,$39.60 , N/A ,$36.52 ,$34.98 ,$34.98 , N/A ,$28.60 
ST. JOSEPH'S HOSPITAL - BREESE,27205310,N/A,HC KIT ENEMA,272,1 ,$19.00 ,$12.35 ,$10.93 ,$19.00 ,$16.15 ,$11.34 , N/A ,$10.93 , N/A ,$13.09 ,$16.15 ,$16.15 ,$16.15 , N/A ,$12.92 , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.77 ,$15.77 ,$15.77 , N/A , N/A ,$16.15 , N/A ,$19.00 , N/A , N/A ,$16.15 , N/A ,$16.15 ,$17.10 , N/A ,$15.77 ,$15.11 ,$15.11 , N/A ,$12.35 
ST. JOSEPH'S HOSPITAL - BREESE,27205320,N/A,HC NEEDLE PORT-A-CATH,272,1 ,$9.00 ,$5.85 ,$5.18 ,$9.00 ,$7.65 ,$5.37 , N/A ,$5.18 , N/A ,$6.20 ,$7.65 ,$7.65 ,$7.65 , N/A ,$6.12 , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A , N/A ,$7.65 , N/A ,$9.00 , N/A , N/A ,$7.65 , N/A ,$7.65 ,$8.10 , N/A ,$7.47 ,$7.16 ,$7.16 , N/A ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,27205324,N/A,HC PAD ABDOMNINAL,272,1 ,$6.00 ,$3.90 ,$3.45 ,$6.00 ,$5.10 ,$3.58 , N/A ,$3.45 , N/A ,$4.13 ,$5.10 ,$5.10 ,$5.10 , N/A ,$4.08 , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.98 ,$4.98 ,$4.98 , N/A , N/A ,$5.10 , N/A ,$6.00 , N/A , N/A ,$5.10 , N/A ,$5.10 ,$5.40 , N/A ,$4.98 ,$4.77 ,$4.77 , N/A ,$3.90 
ST. JOSEPH'S HOSPITAL - BREESE,27205326,N/A,HC SENSOR INFANT ADHESIVE,272,1 ,$30.00 ,$19.50 ,$17.25 ,$30.00 ,$25.50 ,$17.91 , N/A ,$17.25 , N/A ,$20.67 ,$25.50 ,$25.50 ,$25.50 , N/A ,$20.40 , N/A , N/A ,$22.50 ,$21.30 ,$21.30 , N/A ,$21.30 ,$24.90 ,$24.90 ,$24.90 , N/A , N/A ,$25.50 , N/A ,$30.00 , N/A , N/A ,$25.50 , N/A ,$25.50 ,$27.00 , N/A ,$24.90 ,$23.85 ,$23.85 , N/A ,$19.50 
ST. JOSEPH'S HOSPITAL - BREESE,27205332,N/A,HC SYRINGE TOOMEY,272,1 ,$7.00 ,$4.55 ,$4.03 ,$7.00 ,$5.95 ,$4.18 , N/A ,$4.03 , N/A ,$4.82 ,$5.95 ,$5.95 ,$5.95 , N/A ,$4.76 , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.81 ,$5.81 ,$5.81 , N/A , N/A ,$5.95 , N/A ,$7.00 , N/A , N/A ,$5.95 , N/A ,$5.95 ,$6.30 , N/A ,$5.81 ,$5.57 ,$5.57 , N/A ,$4.55 
ST. JOSEPH'S HOSPITAL - BREESE,27205338,N/A,HC CATHETER STRAIGHT,272,1 ,$7.00 ,$4.55 ,$4.03 ,$7.00 ,$5.95 ,$4.18 , N/A ,$4.03 , N/A ,$4.82 ,$5.95 ,$5.95 ,$5.95 , N/A ,$4.76 , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.81 ,$5.81 ,$5.81 , N/A , N/A ,$5.95 , N/A ,$7.00 , N/A , N/A ,$5.95 , N/A ,$5.95 ,$6.30 , N/A ,$5.81 ,$5.57 ,$5.57 , N/A ,$4.55 
ST. JOSEPH'S HOSPITAL - BREESE,27205339,N/A,HC KIT DRESSING,272,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,27205345,N/A,HC DRESSING GAUZE STRETCH,272,1 ,$8.00 ,$5.20 ,$4.60 ,$8.00 ,$6.80 ,$4.78 , N/A ,$4.60 , N/A ,$5.51 ,$6.80 ,$6.80 ,$6.80 , N/A ,$5.44 , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.64 ,$6.64 ,$6.64 , N/A , N/A ,$6.80 , N/A ,$8.00 , N/A , N/A ,$6.80 , N/A ,$6.80 ,$7.20 , N/A ,$6.64 ,$6.36 ,$6.36 , N/A ,$5.20 
ST. JOSEPH'S HOSPITAL - BREESE,27205371,C1894,HC SHEATH INTRODUCER 8FR,272,1 ,$120.09 ,$78.06 ,$69.05 ,$120.09 ,$102.08 ,$71.69 , N/A ,$69.05 , N/A ,$82.74 ,$102.08 ,$102.08 ,$102.08 , N/A ,$81.66 , N/A , N/A ,$90.07 ,$85.26 ,$85.26 , N/A ,$85.26 ,$99.67 ,$99.67 ,$99.67 , N/A , N/A ,$102.08 , N/A ,$120.09 , N/A , N/A ,$102.08 , N/A ,$102.08 ,$108.08 , N/A ,$99.67 ,$95.47 ,$95.47 , N/A ,$78.06 
ST. JOSEPH'S HOSPITAL - BREESE,27205378,N/A,HC MARKER BIOPSY BREAST STEREOTATIC,272,1 ,$182.00 ,$118.30 ,$104.65 ,$182.00 ,$154.70 ,$108.65 , N/A ,$104.65 , N/A ,$125.40 ,$154.70 ,$154.70 ,$154.70 , N/A ,$123.76 , N/A , N/A ,$136.50 ,$129.22 ,$129.22 , N/A ,$129.22 ,$151.06 ,$151.06 ,$151.06 , N/A , N/A ,$154.70 , N/A ,$182.00 , N/A , N/A ,$154.70 , N/A ,$154.70 ,$163.80 , N/A ,$151.06 ,$144.69 ,$144.69 , N/A ,$118.30 
ST. JOSEPH'S HOSPITAL - BREESE,27205386,N/A,HC HANDLE LARYNGEAL BLADE,272,1 ,$16.00 ,$10.40 ,$9.20 ,$16.00 ,$13.60 ,$9.55 , N/A ,$9.20 , N/A ,$11.02 ,$13.60 ,$13.60 ,$13.60 , N/A ,$10.88 , N/A , N/A ,$12.00 ,$11.36 ,$11.36 , N/A ,$11.36 ,$13.28 ,$13.28 ,$13.28 , N/A , N/A ,$13.60 , N/A ,$16.00 , N/A , N/A ,$13.60 , N/A ,$13.60 ,$14.40 , N/A ,$13.28 ,$12.72 ,$12.72 , N/A ,$10.40 
ST. JOSEPH'S HOSPITAL - BREESE,27205388,N/A,HC BLADE LARYNGOSCOPE MACINTOSH,272,1 ,$51.00 ,$33.15 ,$29.33 ,$51.00 ,$43.35 ,$30.45 , N/A ,$29.33 , N/A ,$35.14 ,$43.35 ,$43.35 ,$43.35 , N/A ,$34.68 , N/A , N/A ,$38.25 ,$36.21 ,$36.21 , N/A ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A , N/A ,$43.35 , N/A ,$51.00 , N/A , N/A ,$43.35 , N/A ,$43.35 ,$45.90 , N/A ,$42.33 ,$40.55 ,$40.55 , N/A ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,27205400,N/A,HC SURGICEL HEMOSTAT 4X8,272,1 ,$166.00 ,$107.90 ,$95.45 ,$166.00 ,$141.10 ,$99.10 , N/A ,$95.45 , N/A ,$114.37 ,$141.10 ,$141.10 ,$141.10 , N/A ,$112.88 , N/A , N/A ,$124.50 ,$117.86 ,$117.86 , N/A ,$117.86 ,$137.78 ,$137.78 ,$137.78 , N/A , N/A ,$141.10 , N/A ,$166.00 , N/A , N/A ,$141.10 , N/A ,$141.10 ,$149.40 , N/A ,$137.78 ,$131.97 ,$131.97 , N/A ,$107.90 
ST. JOSEPH'S HOSPITAL - BREESE,27205423,N/A,HC CANISTER WOUND VAC 150ML,272,1 ,$60.84 ,$39.55 ,$34.98 ,$60.84 ,$51.71 ,$36.32 , N/A ,$34.98 , N/A ,$41.92 ,$51.71 ,$51.71 ,$51.71 , N/A ,$41.37 , N/A , N/A ,$45.63 ,$43.20 ,$43.20 , N/A ,$43.20 ,$50.50 ,$50.50 ,$50.50 , N/A , N/A ,$51.71 , N/A ,$60.84 , N/A , N/A ,$51.71 , N/A ,$51.71 ,$54.76 , N/A ,$50.50 ,$48.37 ,$48.37 , N/A ,$39.55 
ST. JOSEPH'S HOSPITAL - BREESE,27205425,N/A,HC VAPOR CLEAR FILTER,272,1 ,$28.08 ,$18.25 ,$16.15 ,$28.08 ,$23.87 ,$16.76 , N/A ,$16.15 , N/A ,$19.35 ,$23.87 ,$23.87 ,$23.87 , N/A ,$19.09 , N/A , N/A ,$21.06 ,$19.94 ,$19.94 , N/A ,$19.94 ,$23.31 ,$23.31 ,$23.31 , N/A , N/A ,$23.87 , N/A ,$28.08 , N/A , N/A ,$23.87 , N/A ,$23.87 ,$25.27 , N/A ,$23.31 ,$22.32 ,$22.32 , N/A ,$18.25 
ST. JOSEPH'S HOSPITAL - BREESE,27205428,N/A,HC INFANT SUCTION DEVICE,272,1 ,$15.15 ,$9.85 ,$8.71 ,$15.15 ,$12.88 ,$9.04 , N/A ,$8.71 , N/A ,$10.44 ,$12.88 ,$12.88 ,$12.88 , N/A ,$10.30 , N/A , N/A ,$11.36 ,$10.76 ,$10.76 , N/A ,$10.76 ,$12.57 ,$12.57 ,$12.57 , N/A , N/A ,$12.88 , N/A ,$15.15 , N/A , N/A ,$12.88 , N/A ,$12.88 ,$13.64 , N/A ,$12.57 ,$12.04 ,$12.04 , N/A ,$9.85 
ST. JOSEPH'S HOSPITAL - BREESE,27205429,N/A,HC BLADE LARYNGOSCOPE LATEX FREE,272,1 ,$76.00 ,$49.40 ,$43.70 ,$76.00 ,$64.60 ,$45.37 , N/A ,$43.70 , N/A ,$52.36 ,$64.60 ,$64.60 ,$64.60 , N/A ,$51.68 , N/A , N/A ,$57.00 ,$53.96 ,$53.96 , N/A ,$53.96 ,$63.08 ,$63.08 ,$63.08 , N/A , N/A ,$64.60 , N/A ,$76.00 , N/A , N/A ,$64.60 , N/A ,$64.60 ,$68.40 , N/A ,$63.08 ,$60.42 ,$60.42 , N/A ,$49.40 
ST. JOSEPH'S HOSPITAL - BREESE,27205441,N/A,HC ENVIRONMENTAL TEST KIT,272,1 ,$145.50 ,$94.58 ,$83.66 ,$145.50 ,$123.68 ,$86.86 , N/A ,$83.66 , N/A ,$100.25 ,$123.68 ,$123.68 ,$123.68 , N/A ,$98.94 , N/A , N/A ,$109.13 ,$103.31 ,$103.31 , N/A ,$103.31 ,$120.77 ,$120.77 ,$120.77 , N/A , N/A ,$123.68 , N/A ,$145.50 , N/A , N/A ,$123.68 , N/A ,$123.68 ,$130.95 , N/A ,$120.77 ,$115.67 ,$115.67 , N/A ,$94.58 
ST. JOSEPH'S HOSPITAL - BREESE,27800553,A4648,HC TISSUE MARKER IMPLANTABLE,278,1 ,$367.50 ,$238.88 ,$211.31 ,$367.50 , N/A ,$219.40 , N/A ,$211.31 , N/A ,$253.21 ,$312.38 ,$312.38 ,$312.38 , N/A ,$249.90 , N/A , N/A ,$275.63 ,$260.93 ,$260.93 , N/A ,$260.93 ,$305.03 ,$305.03 ,$305.03 , N/A , N/A ,$312.38 , N/A ,$367.50 , N/A , N/A ,$312.38 , N/A ,$312.38 ,$330.75 , N/A ,$305.03 ,$292.16 ,$292.16 , N/A ,$238.88 
ST. JOSEPH'S HOSPITAL - BREESE,30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$55.00 ,$35.75 ,$31.63 ,$55.00 ,$46.75 ,$32.84 , N/A ,$31.63 , N/A ,$37.90 ,$46.75 ,$46.75 ,$46.75 , N/A ,$37.40 , N/A , N/A ,$41.25 ,$39.05 ,$39.05 , N/A ,$39.05 ,$45.65 ,$45.65 ,$45.65 , N/A , N/A ,$46.75 , N/A ,$55.00 , N/A , N/A ,$46.75 , N/A ,$46.75 ,$49.50 , N/A ,$45.65 ,$43.73 ,$43.73 , N/A ,$35.75 
ST. JOSEPH'S HOSPITAL - BREESE,30000010,36415,HC VENIPUNCTURE,300,1 ,$35.00 ,$22.75 ,$1.51 ,$35.00 ,$29.75 ,$20.90 ,$3.00 ,$20.13 ,$3.00 ,$24.12 ,$29.75 ,$29.75 ,$29.75 , N/A ,$23.80 ,$3.00 ,$3.00 ,$26.25 , N/A , N/A ,$3.00 , N/A ,$29.05 ,$29.05 ,$29.05 , N/A ,$7.50 ,$29.75 ,$3.00 ,$3.00 ,$1.51 ,$1.51 ,$29.75 ,$6.30 ,$29.75 ,$31.50 ,$3.00 ,$29.05 ,$27.83 ,$27.83 ,$3.00 ,$22.75 
ST. JOSEPH'S HOSPITAL - BREESE,30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$345.00 ,$224.25 ,$30.97 ,$345.00 ,$293.25 ,$205.97 ,$104.19 ,$198.38 ,$104.19 ,$237.71 ,$293.25 ,$293.25 ,$293.25 , N/A ,$234.60 ,$104.19 ,$104.19 ,$258.75 ,$244.95 ,$244.95 ,$104.19 ,$244.95 ,$286.35 ,$286.35 ,$286.35 , N/A ,$260.47 ,$293.25 ,$104.19 ,$345.00 ,$30.97 ,$30.97 ,$293.25 ,$218.80 ,$293.25 ,$310.50 ,$104.19 ,$286.35 ,$274.28 ,$274.28 ,$104.19 ,$224.25 
ST. JOSEPH'S HOSPITAL - BREESE,30000101,89051,HC CELL CT BODY FLUID W/DIFF,300,1 ,$169.00 ,$109.85 ,$5.60 ,$169.00 ,$143.65 ,$100.89 ,$5.60 ,$97.18 ,$5.60 ,$116.44 ,$143.65 ,$143.65 ,$143.65 ,$138.58 ,$114.92 ,$5.60 ,$5.60 ,$126.75 ,$119.99 ,$119.99 ,$5.60 ,$119.99 ,$140.27 ,$140.27 ,$140.27 , N/A ,$14.00 ,$143.65 ,$5.60 ,$169.00 ,$20.56 ,$20.56 ,$143.65 ,$11.76 ,$143.65 ,$152.10 ,$5.60 ,$140.27 ,$134.36 ,$134.36 ,$5.60 ,$109.85 
ST. JOSEPH'S HOSPITAL - BREESE,30000104,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$64.00 ,$41.60 ,$4.27 ,$64.00 ,$54.40 ,$38.21 ,$4.27 ,$36.80 ,$4.27 ,$44.10 ,$54.40 ,$54.40 ,$54.40 ,$52.48 ,$43.52 ,$4.27 ,$4.27 ,$48.00 ,$45.44 ,$45.44 ,$4.27 ,$45.44 ,$53.12 ,$53.12 ,$53.12 , N/A ,$10.68 ,$54.40 ,$4.27 ,$64.00 ,$4.47 ,$4.47 ,$54.40 ,$8.97 ,$54.40 ,$57.60 ,$4.27 ,$53.12 ,$50.88 ,$50.88 ,$4.27 ,$41.60 
ST. JOSEPH'S HOSPITAL - BREESE,30000105,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$64.00 ,$41.60 ,$7.33 ,$64.00 ,$54.40 ,$38.21 ,$7.33 ,$36.80 ,$7.33 ,$44.10 ,$54.40 ,$54.40 ,$54.40 ,$52.48 ,$43.52 ,$7.33 ,$7.33 ,$48.00 ,$45.44 ,$45.44 ,$7.33 ,$45.44 ,$53.12 ,$53.12 ,$53.12 , N/A ,$18.33 ,$54.40 ,$7.33 ,$64.00 ,$20.56 ,$20.56 ,$54.40 ,$15.39 ,$54.40 ,$57.60 ,$7.33 ,$53.12 ,$50.88 ,$50.88 ,$7.33 ,$41.60 
ST. JOSEPH'S HOSPITAL - BREESE,30000112,89320,HC SEMEN ANALYSIS COMPLETE,300,1 ,$189.00 ,$122.85 ,$12.31 ,$189.00 ,$160.65 ,$112.83 ,$12.31 ,$108.68 ,$12.31 ,$130.22 ,$160.65 ,$160.65 ,$160.65 ,$154.98 ,$128.52 ,$12.31 ,$12.31 ,$141.75 ,$134.19 ,$134.19 ,$12.31 ,$134.19 ,$156.87 ,$156.87 ,$156.87 , N/A ,$30.78 ,$160.65 ,$12.31 ,$189.00 ,$20.56 ,$20.56 ,$160.65 ,$25.85 ,$160.65 ,$170.10 ,$12.31 ,$156.87 ,$150.26 ,$150.26 ,$12.31 ,$122.85 
ST. JOSEPH'S HOSPITAL - BREESE,30000131,G0480,HC DRUG CONFIRMATION EA PROC 1-7 CLASSES-90,301,1 ,$204.00 ,$132.60 ,$19.38 ,$240.30 ,$173.40 ,$121.79 ,$114.43 ,$117.30 ,$114.43 ,$140.56 ,$173.40 ,$173.40 ,$173.40 ,$167.28 ,$138.72 ,$114.43 ,$114.43 ,$153.00 ,$144.84 ,$144.84 ,$114.43 ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A ,$204.00 ,$173.40 ,$114.43 ,$204.00 ,$19.38 ,$19.38 ,$173.40 ,$240.30 ,$173.40 ,$183.60 ,$114.43 ,$169.32 ,$162.18 ,$162.18 ,$114.43 ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,30000213,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$146.00 ,$94.90 ,$30.97 ,$218.80 ,$124.10 ,$87.16 ,$104.19 ,$83.95 ,$104.19 ,$100.59 ,$124.10 ,$124.10 ,$124.10 , N/A ,$99.28 ,$104.19 ,$104.19 ,$109.50 ,$103.66 ,$103.66 ,$104.19 ,$103.66 ,$121.18 ,$121.18 ,$121.18 , N/A ,$146.00 ,$124.10 ,$104.19 ,$146.00 ,$30.97 ,$30.97 ,$124.10 ,$218.80 ,$124.10 ,$131.40 ,$104.19 ,$121.18 ,$116.07 ,$116.07 ,$104.19 ,$94.90 
ST. JOSEPH'S HOSPITAL - BREESE,30000230,99001,HC LAB HANDLING CHARGE SPECIMEN,300,1 ,$59.00 ,$38.35 ,$33.93 ,$59.00 ,$50.15 ,$35.22 , N/A ,$33.93 , N/A ,$40.65 ,$50.15 ,$50.15 ,$50.15 , N/A ,$40.12 , N/A , N/A ,$44.25 ,$41.89 ,$41.89 , N/A ,$41.89 ,$48.97 ,$48.97 ,$48.97 , N/A , N/A ,$50.15 , N/A ,$59.00 , N/A , N/A ,$50.15 , N/A ,$50.15 ,$53.10 , N/A ,$48.97 ,$46.91 ,$46.91 , N/A ,$38.35 
ST. JOSEPH'S HOSPITAL - BREESE,30000252,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$59.00 ,$38.35 ,$12.05 ,$59.00 ,$50.15 ,$35.22 ,$12.05 ,$33.93 ,$12.05 ,$40.65 ,$50.15 ,$50.15 ,$50.15 ,$48.38 ,$40.12 ,$12.05 ,$12.05 ,$44.25 ,$41.89 ,$41.89 ,$12.05 ,$41.89 ,$48.97 ,$48.97 ,$48.97 , N/A ,$30.13 ,$50.15 ,$12.05 ,$59.00 ,$20.56 ,$20.56 ,$50.15 ,$25.31 ,$50.15 ,$53.10 ,$12.05 ,$48.97 ,$46.91 ,$46.91 ,$12.05 ,$38.35 
ST. JOSEPH'S HOSPITAL - BREESE,30000260,36600,HC ARTERIAL PUNCTURE,300,1 ,$312.57 ,$203.17 ,$30.97 ,$312.57 ,$265.68 ,$186.60 ,$104.19 ,$179.73 ,$104.19 ,$215.36 ,$265.68 ,$265.68 ,$265.68 , N/A ,$212.55 ,$104.19 ,$104.19 ,$234.43 ,$221.92 ,$221.92 ,$104.19 ,$221.92 ,$259.43 ,$259.43 ,$259.43 , N/A ,$260.47 ,$265.68 ,$104.19 ,$312.57 ,$30.97 ,$30.97 ,$265.68 ,$218.80 ,$265.68 ,$281.31 ,$104.19 ,$259.43 ,$248.49 ,$248.49 ,$104.19 ,$203.17 
ST. JOSEPH'S HOSPITAL - BREESE,30000263,N/A,HC HEALTH FAIR PULMONARY SCREEN,300,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,30002012,36415,HC KIT DRAW  AND  PROCESSING,300,1 ,$35.00 ,$22.75 ,$1.51 ,$35.00 ,$29.75 ,$20.90 ,$3.00 ,$20.13 ,$3.00 ,$24.12 ,$29.75 ,$29.75 ,$29.75 , N/A ,$23.80 ,$3.00 ,$3.00 ,$26.25 , N/A , N/A ,$3.00 , N/A ,$29.05 ,$29.05 ,$29.05 , N/A ,$7.50 ,$29.75 ,$3.00 ,$3.00 ,$1.51 ,$1.51 ,$29.75 ,$6.30 ,$29.75 ,$31.50 ,$3.00 ,$29.05 ,$27.83 ,$27.83 ,$3.00 ,$22.75 
ST. JOSEPH'S HOSPITAL - BREESE,30002015,89050,HC BODY FLUID CELL COUNT,300,1 ,$108.00 ,$70.20 ,$4.72 ,$108.00 ,$91.80 ,$64.48 ,$4.72 ,$62.10 ,$4.72 ,$74.41 ,$91.80 ,$91.80 ,$91.80 ,$88.56 ,$73.44 ,$4.72 ,$4.72 ,$81.00 ,$76.68 ,$76.68 ,$4.72 ,$76.68 ,$89.64 ,$89.64 ,$89.64 , N/A ,$11.80 ,$91.80 ,$4.72 ,$108.00 ,$20.56 ,$20.56 ,$91.80 ,$9.91 ,$91.80 ,$97.20 ,$4.72 ,$89.64 ,$85.86 ,$85.86 ,$4.72 ,$70.20 
ST. JOSEPH'S HOSPITAL - BREESE,30002016,89051,HC CELL CT BODY FLUID W/DIFF T2,300,1 ,$169.00 ,$109.85 ,$5.60 ,$169.00 ,$143.65 ,$100.89 ,$5.60 ,$97.18 ,$5.60 ,$116.44 ,$143.65 ,$143.65 ,$143.65 ,$138.58 ,$114.92 ,$5.60 ,$5.60 ,$126.75 ,$119.99 ,$119.99 ,$5.60 ,$119.99 ,$140.27 ,$140.27 ,$140.27 , N/A ,$14.00 ,$143.65 ,$5.60 ,$169.00 ,$20.56 ,$20.56 ,$143.65 ,$11.76 ,$143.65 ,$152.10 ,$5.60 ,$140.27 ,$134.36 ,$134.36 ,$5.60 ,$109.85 
ST. JOSEPH'S HOSPITAL - BREESE,30002023,G0483,HC TOX SCREEN CHAIN OF CUSTODY URINE,300,1 ,$87.00 ,$56.55 ,$19.38 ,$182.70 ,$73.95 ,$51.94 ,$87.00 ,$50.03 ,$87.00 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$87.00 ,$87.00 ,$65.25 ,$61.77 ,$61.77 ,$87.00 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$87.00 ,$73.95 ,$87.00 ,$87.00 ,$19.38 ,$19.38 ,$73.95 ,$182.70 ,$73.95 ,$78.30 ,$87.00 ,$72.21 ,$69.17 ,$69.17 ,$87.00 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30002031,36415,HC VENIPUNCTURE,300,1 ,$35.00 ,$22.75 ,$1.51 ,$35.00 ,$29.75 ,$20.90 ,$3.00 ,$20.13 ,$3.00 ,$24.12 ,$29.75 ,$29.75 ,$29.75 , N/A ,$23.80 ,$3.00 ,$3.00 ,$26.25 , N/A , N/A ,$3.00 , N/A ,$29.05 ,$29.05 ,$29.05 , N/A ,$7.50 ,$29.75 ,$3.00 ,$3.00 ,$1.51 ,$1.51 ,$29.75 ,$6.30 ,$29.75 ,$31.50 ,$3.00 ,$29.05 ,$27.83 ,$27.83 ,$3.00 ,$22.75 
ST. JOSEPH'S HOSPITAL - BREESE,30002033,36416,HC CAPILLARY COLLECTION,300,1 ,$55.00 ,$35.75 ,$31.63 ,$55.00 ,$46.75 ,$32.84 , N/A ,$31.63 , N/A ,$37.90 ,$46.75 ,$46.75 ,$46.75 , N/A ,$37.40 , N/A , N/A ,$41.25 ,$39.05 ,$39.05 , N/A ,$39.05 ,$45.65 ,$45.65 ,$45.65 , N/A , N/A ,$46.75 , N/A ,$55.00 , N/A , N/A ,$46.75 , N/A ,$46.75 ,$49.50 , N/A ,$45.65 ,$43.73 ,$43.73 , N/A ,$35.75 
ST. JOSEPH'S HOSPITAL - BREESE,30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$389.00 ,$252.85 ,$6.56 ,$389.00 ,$330.65 ,$232.23 ,$10.56 ,$223.68 ,$10.56 ,$268.02 ,$330.65 ,$330.65 ,$330.65 ,$318.98 ,$264.52 ,$10.56 ,$10.56 ,$291.75 ,$276.19 ,$276.19 ,$10.56 ,$276.19 ,$322.87 ,$322.87 ,$322.87 , N/A ,$26.40 ,$330.65 ,$10.56 ,$10.56 ,$6.56 ,$6.56 ,$330.65 ,$22.18 ,$330.65 ,$350.10 ,$10.56 ,$322.87 ,$309.26 ,$309.26 ,$10.56 ,$252.85 
ST. JOSEPH'S HOSPITAL - BREESE,30100121,80164,HC VALPROIC ACID,301,1 ,$147.00 ,$95.55 ,$8.26 ,$147.00 ,$124.95 ,$87.76 ,$13.54 ,$84.53 ,$13.54 ,$101.28 ,$124.95 ,$124.95 ,$124.95 ,$120.54 ,$99.96 ,$13.54 ,$13.54 ,$110.25 ,$104.37 ,$104.37 ,$13.54 ,$104.37 ,$122.01 ,$122.01 ,$122.01 , N/A ,$33.85 ,$124.95 ,$13.54 ,$147.00 ,$8.26 ,$8.26 ,$124.95 ,$28.43 ,$124.95 ,$132.30 ,$13.54 ,$122.01 ,$116.87 ,$116.87 ,$13.54 ,$95.55 
ST. JOSEPH'S HOSPITAL - BREESE,30100124,80170,HC GENTAMICIN,301,1 ,$109.00 ,$70.85 ,$8.26 ,$109.00 ,$92.65 ,$65.07 ,$16.38 ,$62.68 ,$16.38 ,$75.10 ,$92.65 ,$92.65 ,$92.65 ,$89.38 ,$74.12 ,$16.38 ,$16.38 ,$81.75 ,$77.39 ,$77.39 ,$16.38 ,$77.39 ,$90.47 ,$90.47 ,$90.47 , N/A ,$40.95 ,$92.65 ,$16.38 ,$109.00 ,$8.26 ,$8.26 ,$92.65 ,$34.40 ,$92.65 ,$98.10 ,$16.38 ,$90.47 ,$86.66 ,$86.66 ,$16.38 ,$70.85 
ST. JOSEPH'S HOSPITAL - BREESE,30100139,80200,HC TOBRAMYCIN,301,1 ,$134.00 ,$87.10 ,$8.26 ,$134.00 ,$113.90 ,$80.00 ,$16.13 ,$77.05 ,$16.13 ,$92.33 ,$113.90 ,$113.90 ,$113.90 ,$109.88 ,$91.12 ,$16.13 ,$16.13 ,$100.50 ,$95.14 ,$95.14 ,$16.13 ,$95.14 ,$111.22 ,$111.22 ,$111.22 , N/A ,$40.33 ,$113.90 ,$16.13 ,$134.00 ,$8.26 ,$8.26 ,$113.90 ,$33.87 ,$113.90 ,$120.60 ,$16.13 ,$111.22 ,$106.53 ,$106.53 ,$16.13 ,$87.10 
ST. JOSEPH'S HOSPITAL - BREESE,30100157,82009,HC ACETONE SERUM,301,1 ,$61.00 ,$39.65 ,$3.20 ,$61.00 ,$51.85 ,$36.42 ,$4.52 ,$35.08 ,$4.52 ,$42.03 ,$51.85 ,$51.85 ,$51.85 ,$50.02 ,$41.48 ,$4.52 ,$4.52 ,$45.75 ,$43.31 ,$43.31 ,$4.52 ,$43.31 ,$50.63 ,$50.63 ,$50.63 , N/A ,$11.30 ,$51.85 ,$4.52 ,$61.00 ,$3.20 ,$3.20 ,$51.85 ,$9.49 ,$51.85 ,$54.90 ,$4.52 ,$50.63 ,$48.50 ,$48.50 ,$4.52 ,$39.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$95.00 ,$61.75 ,$7.20 ,$95.00 ,$80.75 ,$56.72 ,$8.17 ,$54.63 ,$8.17 ,$65.46 ,$80.75 ,$80.75 ,$80.75 ,$77.90 ,$64.60 ,$8.17 ,$8.17 ,$71.25 ,$67.45 ,$67.45 ,$8.17 ,$67.45 ,$78.85 ,$78.85 ,$78.85 , N/A ,$20.43 ,$80.75 ,$8.17 ,$95.00 ,$7.20 ,$7.20 ,$80.75 ,$17.16 ,$80.75 ,$85.50 ,$8.17 ,$78.85 ,$75.53 ,$75.53 ,$8.17 ,$61.75 
ST. JOSEPH'S HOSPITAL - BREESE,30100165,82040,HC ALBUMIN SERUM,301,1 ,$75.00 ,$48.75 ,$3.20 ,$75.00 ,$63.75 ,$44.78 ,$4.95 ,$43.13 ,$4.95 ,$51.68 ,$63.75 ,$63.75 ,$63.75 ,$61.50 ,$51.00 ,$4.95 ,$4.95 ,$56.25 ,$53.25 ,$53.25 ,$4.95 ,$53.25 ,$62.25 ,$62.25 ,$62.25 , N/A ,$12.38 ,$63.75 ,$4.95 ,$75.00 ,$3.20 ,$3.20 ,$63.75 ,$10.40 ,$63.75 ,$67.50 ,$4.95 ,$62.25 ,$59.63 ,$59.63 ,$4.95 ,$48.75 
ST. JOSEPH'S HOSPITAL - BREESE,30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$118.00 ,$76.70 ,$2.57 ,$118.00 ,$100.30 ,$70.45 ,$5.78 ,$67.85 ,$5.78 ,$81.30 ,$100.30 ,$100.30 ,$100.30 ,$96.76 ,$80.24 ,$5.78 ,$5.78 ,$88.50 ,$83.78 ,$83.78 ,$5.78 ,$83.78 ,$97.94 ,$97.94 ,$97.94 , N/A ,$14.45 ,$100.30 ,$5.78 ,$118.00 ,$2.57 ,$2.57 ,$100.30 ,$12.14 ,$100.30 ,$106.20 ,$5.78 ,$97.94 ,$93.81 ,$93.81 ,$5.78 ,$76.70 
ST. JOSEPH'S HOSPITAL - BREESE,30100186,82140,HC AMMONIA,301,1 ,$207.00 ,$134.55 ,$7.20 ,$207.00 ,$175.95 ,$123.58 ,$14.57 ,$119.03 ,$14.57 ,$142.62 ,$175.95 ,$175.95 ,$175.95 ,$169.74 ,$140.76 ,$14.57 ,$14.57 ,$155.25 ,$146.97 ,$146.97 ,$14.57 ,$146.97 ,$171.81 ,$171.81 ,$171.81 , N/A ,$36.43 ,$175.95 ,$14.57 ,$207.00 ,$7.20 ,$7.20 ,$175.95 ,$30.60 ,$175.95 ,$186.30 ,$14.57 ,$171.81 ,$164.57 ,$164.57 ,$14.57 ,$134.55 
ST. JOSEPH'S HOSPITAL - BREESE,30100188,82150,HC AMYLASE,301,1 ,$125.00 ,$81.25 ,$6.48 ,$125.00 ,$106.25 ,$74.63 ,$6.48 ,$71.88 ,$6.48 ,$86.13 ,$106.25 ,$106.25 ,$106.25 ,$102.50 ,$85.00 ,$6.48 ,$6.48 ,$93.75 ,$88.75 ,$88.75 ,$6.48 ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A ,$16.20 ,$106.25 ,$6.48 ,$125.00 ,$7.20 ,$7.20 ,$106.25 ,$13.61 ,$106.25 ,$112.50 ,$6.48 ,$103.75 ,$99.38 ,$99.38 ,$6.48 ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$58.00 ,$37.70 ,$3.20 ,$58.00 ,$49.30 ,$34.63 ,$5.02 ,$33.35 ,$5.02 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$5.02 ,$5.02 ,$43.50 ,$41.18 ,$41.18 ,$5.02 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$12.55 ,$49.30 ,$5.02 ,$58.00 ,$3.20 ,$3.20 ,$49.30 ,$10.54 ,$49.30 ,$52.20 ,$5.02 ,$48.14 ,$46.11 ,$46.11 ,$5.02 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$80.00 ,$52.00 ,$3.20 ,$80.00 ,$68.00 ,$47.76 ,$5.02 ,$46.00 ,$5.02 ,$55.12 ,$68.00 ,$68.00 ,$68.00 ,$65.60 ,$54.40 ,$5.02 ,$5.02 ,$60.00 ,$56.80 ,$56.80 ,$5.02 ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A ,$12.55 ,$68.00 ,$5.02 ,$80.00 ,$3.20 ,$3.20 ,$68.00 ,$10.54 ,$68.00 ,$72.00 ,$5.02 ,$66.40 ,$63.60 ,$63.60 ,$5.02 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100212,82306,HC VITAMIN D 25 OH,301,1 ,$96.00 ,$62.40 ,$19.38 ,$96.00 ,$81.60 ,$57.31 ,$29.60 ,$55.20 ,$29.60 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$29.60 ,$29.60 ,$72.00 ,$68.16 ,$68.16 ,$29.60 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$74.00 ,$81.60 ,$29.60 ,$96.00 ,$19.38 ,$19.38 ,$81.60 ,$62.16 ,$81.60 ,$86.40 ,$29.60 ,$79.68 ,$76.32 ,$76.32 ,$29.60 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30100214,82310,HC CALCIUM,301,1 ,$81.00 ,$52.65 ,$3.20 ,$81.00 ,$68.85 ,$48.36 ,$5.16 ,$46.58 ,$5.16 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$5.16 ,$5.16 ,$60.75 ,$57.51 ,$57.51 ,$5.16 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$12.90 ,$68.85 ,$5.16 ,$81.00 ,$3.20 ,$3.20 ,$68.85 ,$10.84 ,$68.85 ,$72.90 ,$5.16 ,$67.23 ,$64.40 ,$64.40 ,$5.16 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100215,82330,HC CALCIUM IONIZED,301,1 ,$56.00 ,$36.40 ,$7.20 ,$56.00 ,$47.60 ,$33.43 ,$13.68 ,$32.20 ,$13.68 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$13.68 ,$13.68 ,$42.00 ,$39.76 ,$39.76 ,$13.68 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$34.20 ,$47.60 ,$13.68 ,$56.00 ,$7.20 ,$7.20 ,$47.60 ,$28.73 ,$47.60 ,$50.40 ,$13.68 ,$46.48 ,$44.52 ,$44.52 ,$13.68 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30100222,82374,HC BICARBONATE,301,1 ,$118.00 ,$76.70 ,$3.20 ,$118.00 ,$100.30 ,$70.45 ,$4.88 ,$67.85 ,$4.88 ,$81.30 ,$100.30 ,$100.30 ,$100.30 ,$96.76 ,$80.24 ,$4.88 ,$4.88 ,$88.50 ,$83.78 ,$83.78 ,$4.88 ,$83.78 ,$97.94 ,$97.94 ,$97.94 , N/A ,$12.20 ,$100.30 ,$4.88 ,$118.00 ,$3.20 ,$3.20 ,$100.30 ,$10.25 ,$100.30 ,$106.20 ,$4.88 ,$97.94 ,$93.81 ,$93.81 ,$4.88 ,$76.70 
ST. JOSEPH'S HOSPITAL - BREESE,30100237,82435,HC CHLORIDE,301,1 ,$52.00 ,$33.80 ,$3.20 ,$52.00 ,$44.20 ,$31.04 ,$4.60 ,$29.90 ,$4.60 ,$35.83 ,$44.20 ,$44.20 ,$44.20 ,$42.64 ,$35.36 ,$4.60 ,$4.60 ,$39.00 ,$36.92 ,$36.92 ,$4.60 ,$36.92 ,$43.16 ,$43.16 ,$43.16 , N/A ,$11.50 ,$44.20 ,$4.60 ,$52.00 ,$3.20 ,$3.20 ,$44.20 ,$9.66 ,$44.20 ,$46.80 ,$4.60 ,$43.16 ,$41.34 ,$41.34 ,$4.60 ,$33.80 
ST. JOSEPH'S HOSPITAL - BREESE,30100238,82436,HC CHLORIDE URINE,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$5.75 ,$52.90 ,$5.75 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$5.75 ,$5.75 ,$69.00 ,$65.32 ,$65.32 ,$5.75 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$14.38 ,$78.20 ,$5.75 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$12.08 ,$78.20 ,$82.80 ,$5.75 ,$76.36 ,$73.14 ,$73.14 ,$5.75 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30100241,82465,HC CHOLESTEROL,301,1 ,$87.00 ,$56.55 ,$3.20 ,$87.00 ,$73.95 ,$51.94 ,$4.35 ,$50.03 ,$4.35 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$4.35 ,$4.35 ,$65.25 ,$61.77 ,$61.77 ,$4.35 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$10.88 ,$73.95 ,$4.35 ,$87.00 ,$3.20 ,$3.20 ,$73.95 ,$9.14 ,$73.95 ,$78.30 ,$4.35 ,$72.21 ,$69.17 ,$69.17 ,$4.35 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$125.00 ,$81.25 ,$3.20 ,$125.00 ,$106.25 ,$74.63 ,$6.51 ,$71.88 ,$6.51 ,$86.13 ,$106.25 ,$106.25 ,$106.25 ,$102.50 ,$85.00 ,$6.51 ,$6.51 ,$93.75 ,$88.75 ,$88.75 ,$6.51 ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A ,$16.28 ,$106.25 ,$6.51 ,$125.00 ,$3.20 ,$3.20 ,$106.25 ,$13.67 ,$106.25 ,$112.50 ,$6.51 ,$103.75 ,$99.38 ,$99.38 ,$6.51 ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$173.00 ,$112.45 ,$7.20 ,$173.00 ,$147.05 ,$103.28 ,$11.55 ,$99.48 ,$11.55 ,$119.20 ,$147.05 ,$147.05 ,$147.05 ,$141.86 ,$117.64 ,$11.55 ,$11.55 ,$129.75 ,$122.83 ,$122.83 ,$11.55 ,$122.83 ,$143.59 ,$143.59 ,$143.59 , N/A ,$28.88 ,$147.05 ,$11.55 ,$173.00 ,$7.20 ,$7.20 ,$147.05 ,$24.26 ,$147.05 ,$155.70 ,$11.55 ,$143.59 ,$137.54 ,$137.54 ,$11.55 ,$112.45 
ST. JOSEPH'S HOSPITAL - BREESE,30100262,82565,HC CREATININE,301,1 ,$71.00 ,$46.15 ,$3.20 ,$71.00 ,$60.35 ,$42.39 ,$5.12 ,$40.83 ,$5.12 ,$48.92 ,$60.35 ,$60.35 ,$60.35 ,$58.22 ,$48.28 ,$5.12 ,$5.12 ,$53.25 ,$50.41 ,$50.41 ,$5.12 ,$50.41 ,$58.93 ,$58.93 ,$58.93 , N/A ,$12.80 ,$60.35 ,$5.12 ,$5.12 ,$3.20 ,$3.20 ,$60.35 ,$10.75 ,$60.35 ,$63.90 ,$5.12 ,$58.93 ,$56.45 ,$56.45 ,$5.12 ,$46.15 
ST. JOSEPH'S HOSPITAL - BREESE,30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$96.00 ,$62.40 ,$3.20 ,$96.00 ,$81.60 ,$57.31 ,$5.18 ,$55.20 ,$5.18 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$5.18 ,$5.18 ,$72.00 ,$68.16 ,$68.16 ,$5.18 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$12.95 ,$81.60 ,$5.18 ,$96.00 ,$3.20 ,$3.20 ,$81.60 ,$10.88 ,$81.60 ,$86.40 ,$5.18 ,$79.68 ,$76.32 ,$76.32 ,$5.18 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30100266,82575,HC CREATININE CLEARANCE,301,1 ,$40.00 ,$26.00 ,$7.20 ,$40.00 ,$34.00 ,$23.88 ,$9.46 ,$23.00 ,$9.46 ,$27.56 ,$34.00 ,$34.00 ,$34.00 ,$32.80 ,$27.20 ,$9.46 ,$9.46 ,$30.00 ,$28.40 ,$28.40 ,$9.46 ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A ,$23.65 ,$34.00 ,$9.46 ,$40.00 ,$7.20 ,$7.20 ,$34.00 ,$19.87 ,$34.00 ,$36.00 ,$9.46 ,$33.20 ,$31.80 ,$31.80 ,$9.46 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$243.00 ,$157.95 ,$19.38 ,$243.00 ,$206.55 ,$145.07 ,$64.41 ,$139.73 ,$64.41 ,$167.43 ,$206.55 ,$206.55 ,$206.55 ,$199.26 ,$165.24 ,$64.41 ,$64.41 ,$182.25 ,$172.53 ,$172.53 ,$64.41 ,$172.53 ,$201.69 ,$201.69 ,$201.69 , N/A ,$161.03 ,$206.55 ,$64.41 ,$243.00 ,$19.38 ,$19.38 ,$206.55 ,$135.26 ,$206.55 ,$218.70 ,$64.41 ,$201.69 ,$193.19 ,$193.19 ,$64.41 ,$157.95 
ST. JOSEPH'S HOSPITAL - BREESE,30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$85.00 ,$55.25 ,$3.20 ,$85.00 ,$72.25 ,$50.75 ,$3.93 ,$48.88 ,$3.93 ,$58.57 ,$72.25 ,$72.25 ,$72.25 ,$69.70 ,$57.80 ,$3.93 ,$3.93 ,$63.75 ,$60.35 ,$60.35 ,$3.93 ,$60.35 ,$70.55 ,$70.55 ,$70.55 , N/A ,$9.83 ,$72.25 ,$3.93 ,$85.00 ,$3.20 ,$3.20 ,$72.25 ,$8.25 ,$72.25 ,$76.50 ,$3.93 ,$70.55 ,$67.58 ,$67.58 ,$3.93 ,$55.25 
ST. JOSEPH'S HOSPITAL - BREESE,30100312,82947,HC GLUCOSE,301,1 ,$85.00 ,$55.25 ,$3.20 ,$85.00 ,$72.25 ,$50.75 ,$3.93 ,$48.88 ,$3.93 ,$58.57 ,$72.25 ,$72.25 ,$72.25 ,$69.70 ,$57.80 ,$3.93 ,$3.93 ,$63.75 ,$60.35 ,$60.35 ,$3.93 ,$60.35 ,$70.55 ,$70.55 ,$70.55 , N/A ,$9.83 ,$72.25 ,$3.93 ,$85.00 ,$3.20 ,$3.20 ,$72.25 ,$8.25 ,$72.25 ,$76.50 ,$3.93 ,$70.55 ,$67.58 ,$67.58 ,$3.93 ,$55.25 
ST. JOSEPH'S HOSPITAL - BREESE,30100313,82950,HC GLUCOSE SCREEN,301,1 ,$66.00 ,$42.90 ,$3.20 ,$66.00 ,$56.10 ,$39.40 ,$4.75 ,$37.95 ,$4.75 ,$45.47 ,$56.10 ,$56.10 ,$56.10 ,$54.12 ,$44.88 ,$4.75 ,$4.75 ,$49.50 ,$46.86 ,$46.86 ,$4.75 ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A ,$11.88 ,$56.10 ,$4.75 ,$66.00 ,$3.20 ,$3.20 ,$56.10 ,$9.98 ,$56.10 ,$59.40 ,$4.75 ,$54.78 ,$52.47 ,$52.47 ,$4.75 ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$120.00 ,$78.00 ,$7.20 ,$120.00 ,$102.00 ,$71.64 ,$12.87 ,$69.00 ,$12.87 ,$82.68 ,$102.00 ,$102.00 ,$102.00 ,$98.40 ,$81.60 ,$12.87 ,$12.87 ,$90.00 ,$85.20 ,$85.20 ,$12.87 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$32.18 ,$102.00 ,$12.87 ,$120.00 ,$7.20 ,$7.20 ,$102.00 ,$27.03 ,$102.00 ,$108.00 ,$12.87 ,$99.60 ,$95.40 ,$95.40 ,$12.87 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$38.00 ,$24.70 ,$3.92 ,$38.00 ,$32.30 ,$22.69 ,$3.92 ,$21.85 ,$3.92 ,$26.18 ,$32.30 ,$32.30 ,$32.30 ,$31.16 ,$25.84 ,$3.92 ,$3.92 ,$28.50 ,$26.98 ,$26.98 ,$3.92 ,$26.98 ,$31.54 ,$31.54 ,$31.54 , N/A ,$9.80 ,$32.30 ,$3.92 ,$38.00 ,$7.20 ,$7.20 ,$32.30 ,$8.23 ,$32.30 ,$34.20 ,$3.92 ,$31.54 ,$30.21 ,$30.21 ,$3.92 ,$24.70 
ST. JOSEPH'S HOSPITAL - BREESE,30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$157.00 ,$102.05 ,$7.20 ,$157.00 ,$133.45 ,$93.73 ,$11.57 ,$90.28 ,$11.57 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$11.57 ,$11.57 ,$117.75 ,$111.47 ,$111.47 ,$11.57 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$28.93 ,$133.45 ,$11.57 ,$157.00 ,$7.20 ,$7.20 ,$133.45 ,$24.30 ,$133.45 ,$141.30 ,$11.57 ,$130.31 ,$124.82 ,$124.82 ,$11.57 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$101.00 ,$65.65 ,$3.20 ,$101.00 ,$85.85 ,$60.30 ,$6.04 ,$58.08 ,$6.04 ,$69.59 ,$85.85 ,$85.85 ,$85.85 ,$82.82 ,$68.68 ,$6.04 ,$6.04 ,$75.75 ,$71.71 ,$71.71 ,$6.04 ,$71.71 ,$83.83 ,$83.83 ,$83.83 , N/A ,$15.10 ,$85.85 ,$6.04 ,$101.00 ,$3.20 ,$3.20 ,$85.85 ,$12.68 ,$85.85 ,$90.90 ,$6.04 ,$83.83 ,$80.30 ,$80.30 ,$6.04 ,$65.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100409,83690,HC LIPASE,301,1 ,$118.00 ,$76.70 ,$3.20 ,$118.00 ,$100.30 ,$70.45 ,$6.89 ,$67.85 ,$6.89 ,$81.30 ,$100.30 ,$100.30 ,$100.30 ,$96.76 ,$80.24 ,$6.89 ,$6.89 ,$88.50 ,$83.78 ,$83.78 ,$6.89 ,$83.78 ,$97.94 ,$97.94 ,$97.94 , N/A ,$17.23 ,$100.30 ,$6.89 ,$118.00 ,$3.20 ,$3.20 ,$100.30 ,$14.47 ,$100.30 ,$106.20 ,$6.89 ,$97.94 ,$93.81 ,$93.81 ,$6.89 ,$76.70 
ST. JOSEPH'S HOSPITAL - BREESE,30100416,83721,HC CHOLESTEROL LDL,301,1 ,$123.00 ,$79.95 ,$7.20 ,$123.00 ,$104.55 ,$73.43 ,$10.50 ,$70.73 ,$10.50 ,$84.75 ,$104.55 ,$104.55 ,$104.55 ,$100.86 ,$83.64 ,$10.50 ,$10.50 ,$92.25 ,$87.33 ,$87.33 ,$10.50 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$26.25 ,$104.55 ,$10.50 ,$123.00 ,$7.20 ,$7.20 ,$104.55 ,$22.05 ,$104.55 ,$110.70 ,$10.50 ,$102.09 ,$97.79 ,$97.79 ,$10.50 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,30100417,83735,HC MAGNESIUM,301,1 ,$79.00 ,$51.35 ,$3.20 ,$79.00 ,$67.15 ,$47.16 ,$6.70 ,$45.43 ,$6.70 ,$54.43 ,$67.15 ,$67.15 ,$67.15 ,$64.78 ,$53.72 ,$6.70 ,$6.70 ,$59.25 ,$56.09 ,$56.09 ,$6.70 ,$56.09 ,$65.57 ,$65.57 ,$65.57 , N/A ,$16.75 ,$67.15 ,$6.70 ,$79.00 ,$3.20 ,$3.20 ,$67.15 ,$14.07 ,$67.15 ,$71.10 ,$6.70 ,$65.57 ,$62.81 ,$62.81 ,$6.70 ,$51.35 
ST. JOSEPH'S HOSPITAL - BREESE,30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$268.00 ,$174.20 ,$19.38 ,$268.00 ,$227.80 ,$160.00 ,$39.26 ,$154.10 ,$39.26 ,$184.65 ,$227.80 ,$227.80 ,$227.80 ,$219.76 ,$182.24 ,$39.26 ,$39.26 ,$201.00 ,$190.28 ,$190.28 ,$39.26 ,$190.28 ,$222.44 ,$222.44 ,$222.44 , N/A ,$98.15 ,$227.80 ,$39.26 ,$268.00 ,$19.38 ,$19.38 ,$227.80 ,$82.45 ,$227.80 ,$241.20 ,$39.26 ,$222.44 ,$213.06 ,$213.06 ,$39.26 ,$174.20 
ST. JOSEPH'S HOSPITAL - BREESE,30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$101.00 ,$65.65 ,$16.85 ,$101.00 ,$85.85 ,$60.30 ,$41.28 ,$58.08 ,$41.28 ,$69.59 ,$85.85 ,$85.85 ,$85.85 ,$82.82 ,$68.68 ,$41.28 ,$41.28 ,$75.75 ,$71.71 ,$71.71 ,$41.28 ,$71.71 ,$83.83 ,$83.83 ,$83.83 , N/A ,$101.00 ,$85.85 ,$41.28 ,$101.00 ,$16.85 ,$16.85 ,$85.85 ,$86.69 ,$85.85 ,$90.90 ,$41.28 ,$83.83 ,$80.30 ,$80.30 ,$41.28 ,$65.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100676,84030,HC NEWBORN SCREEN PKU,301,1 ,$155.50 ,$101.08 ,$3.20 ,$155.50 ,$132.18 ,$92.83 ,$5.50 ,$89.41 ,$5.50 ,$107.14 ,$132.18 ,$132.18 ,$132.18 ,$127.51 ,$105.74 ,$5.50 ,$5.50 ,$116.63 ,$110.41 ,$110.41 ,$5.50 ,$110.41 ,$129.07 ,$129.07 ,$129.07 , N/A ,$13.75 ,$132.18 ,$5.50 ,$155.50 ,$3.20 ,$3.20 ,$132.18 ,$11.55 ,$132.18 ,$139.95 ,$5.50 ,$129.07 ,$123.62 ,$123.62 ,$5.50 ,$101.08 
ST. JOSEPH'S HOSPITAL - BREESE,30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$58.00 ,$37.70 ,$3.20 ,$58.00 ,$49.30 ,$34.63 ,$5.18 ,$33.35 ,$5.18 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$5.18 ,$5.18 ,$43.50 ,$41.18 ,$41.18 ,$5.18 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$12.95 ,$49.30 ,$5.18 ,$58.00 ,$3.20 ,$3.20 ,$49.30 ,$10.88 ,$49.30 ,$52.20 ,$5.18 ,$48.14 ,$46.11 ,$46.11 ,$5.18 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30100684,84100,HC PHOSPHORUS,301,1 ,$97.00 ,$63.05 ,$3.20 ,$97.00 ,$82.45 ,$57.91 ,$4.74 ,$55.78 ,$4.74 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$4.74 ,$4.74 ,$72.75 ,$68.87 ,$68.87 ,$4.74 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$11.85 ,$82.45 ,$4.74 ,$97.00 ,$3.20 ,$3.20 ,$82.45 ,$9.95 ,$82.45 ,$87.30 ,$4.74 ,$80.51 ,$77.12 ,$77.12 ,$4.74 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,30100691,84132,HC POTASSIUM,301,1 ,$81.00 ,$52.65 ,$3.20 ,$81.00 ,$68.85 ,$48.36 ,$4.76 ,$46.58 ,$4.76 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$4.76 ,$4.76 ,$60.75 ,$57.51 ,$57.51 ,$4.76 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$11.90 ,$68.85 ,$4.76 ,$81.00 ,$3.20 ,$3.20 ,$68.85 ,$10.00 ,$68.85 ,$72.90 ,$4.76 ,$67.23 ,$64.40 ,$64.40 ,$4.76 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100694,84133,HC POTASSIUM URINE,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$4.73 ,$52.90 ,$4.73 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$4.73 ,$4.73 ,$69.00 ,$65.32 ,$65.32 ,$4.73 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$11.83 ,$78.20 ,$4.73 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$9.93 ,$78.20 ,$82.80 ,$4.73 ,$76.36 ,$73.14 ,$73.14 ,$4.73 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30100700,84155,HC PROTEIN TOTAL,301,1 ,$58.00 ,$37.70 ,$3.20 ,$58.00 ,$49.30 ,$34.63 ,$3.67 ,$33.35 ,$3.67 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$3.67 ,$3.67 ,$43.50 ,$41.18 ,$41.18 ,$3.67 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$9.18 ,$49.30 ,$3.67 ,$58.00 ,$3.20 ,$3.20 ,$49.30 ,$7.71 ,$49.30 ,$52.20 ,$3.67 ,$48.14 ,$46.11 ,$46.11 ,$3.67 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$3.67 ,$52.90 ,$3.67 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$3.67 ,$3.67 ,$69.00 ,$65.32 ,$65.32 ,$3.67 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$9.18 ,$78.20 ,$3.67 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$7.71 ,$78.20 ,$82.80 ,$3.67 ,$76.36 ,$73.14 ,$73.14 ,$3.67 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$4.00 ,$52.90 ,$4.00 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$4.00 ,$4.00 ,$69.00 ,$65.32 ,$65.32 ,$4.00 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$10.00 ,$78.20 ,$4.00 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$8.40 ,$78.20 ,$82.80 ,$4.00 ,$76.36 ,$73.14 ,$73.14 ,$4.00 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30100721,84295,HC SODIUM,301,1 ,$81.00 ,$52.65 ,$3.20 ,$81.00 ,$68.85 ,$48.36 ,$4.81 ,$46.58 ,$4.81 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$4.81 ,$4.81 ,$60.75 ,$57.51 ,$57.51 ,$4.81 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$12.03 ,$68.85 ,$4.81 ,$81.00 ,$3.20 ,$3.20 ,$68.85 ,$10.10 ,$68.85 ,$72.90 ,$4.81 ,$67.23 ,$64.40 ,$64.40 ,$4.81 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100724,84300,HC SODIUM URINE,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$5.06 ,$52.90 ,$5.06 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$5.06 ,$5.06 ,$69.00 ,$65.32 ,$65.32 ,$5.06 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$12.65 ,$78.20 ,$5.06 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$10.63 ,$78.20 ,$82.80 ,$5.06 ,$76.36 ,$73.14 ,$73.14 ,$5.06 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30100740,84439,HC T4 FREE,301,1 ,$101.00 ,$65.65 ,$9.02 ,$101.00 ,$85.85 ,$60.30 ,$9.02 ,$58.08 ,$9.02 ,$69.59 ,$85.85 ,$85.85 ,$85.85 ,$82.82 ,$68.68 ,$9.02 ,$9.02 ,$75.75 ,$71.71 ,$71.71 ,$9.02 ,$71.71 ,$83.83 ,$83.83 ,$83.83 , N/A ,$22.55 ,$85.85 ,$9.02 ,$101.00 ,$9.69 ,$9.69 ,$85.85 ,$18.94 ,$85.85 ,$90.90 ,$9.02 ,$83.83 ,$80.30 ,$80.30 ,$9.02 ,$65.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$122.00 ,$79.30 ,$9.69 ,$122.00 ,$103.70 ,$72.83 ,$16.80 ,$70.15 ,$16.80 ,$84.06 ,$103.70 ,$103.70 ,$103.70 ,$100.04 ,$82.96 ,$16.80 ,$16.80 ,$91.50 ,$86.62 ,$86.62 ,$16.80 ,$86.62 ,$101.26 ,$101.26 ,$101.26 , N/A ,$42.00 ,$103.70 ,$16.80 ,$122.00 ,$9.69 ,$9.69 ,$103.70 ,$35.28 ,$103.70 ,$109.80 ,$16.80 ,$101.26 ,$96.99 ,$96.99 ,$16.80 ,$79.30 
ST. JOSEPH'S HOSPITAL - BREESE,30100746,84450,HC AST,301,1 ,$95.00 ,$61.75 ,$3.20 ,$95.00 ,$80.75 ,$56.72 ,$5.18 ,$54.63 ,$5.18 ,$65.46 ,$80.75 ,$80.75 ,$80.75 ,$77.90 ,$64.60 ,$5.18 ,$5.18 ,$71.25 ,$67.45 ,$67.45 ,$5.18 ,$67.45 ,$78.85 ,$78.85 ,$78.85 , N/A ,$12.95 ,$80.75 ,$5.18 ,$95.00 ,$3.20 ,$3.20 ,$80.75 ,$10.88 ,$80.75 ,$85.50 ,$5.18 ,$78.85 ,$75.53 ,$75.53 ,$5.18 ,$61.75 
ST. JOSEPH'S HOSPITAL - BREESE,30100747,84460,HC ALT,301,1 ,$102.00 ,$66.30 ,$3.20 ,$102.00 ,$86.70 ,$60.89 ,$5.30 ,$58.65 ,$5.30 ,$70.28 ,$86.70 ,$86.70 ,$86.70 ,$83.64 ,$69.36 ,$5.30 ,$5.30 ,$76.50 ,$72.42 ,$72.42 ,$5.30 ,$72.42 ,$84.66 ,$84.66 ,$84.66 , N/A ,$13.25 ,$86.70 ,$5.30 ,$102.00 ,$3.20 ,$3.20 ,$86.70 ,$11.13 ,$86.70 ,$91.80 ,$5.30 ,$84.66 ,$81.09 ,$81.09 ,$5.30 ,$66.30 
ST. JOSEPH'S HOSPITAL - BREESE,30100750,84478,HC TRIGLYCERIDES,301,1 ,$89.00 ,$57.85 ,$3.20 ,$89.00 ,$75.65 ,$53.13 ,$5.74 ,$51.18 ,$5.74 ,$61.32 ,$75.65 ,$75.65 ,$75.65 ,$72.98 ,$60.52 ,$5.74 ,$5.74 ,$66.75 ,$63.19 ,$63.19 ,$5.74 ,$63.19 ,$73.87 ,$73.87 ,$73.87 , N/A ,$14.35 ,$75.65 ,$5.74 ,$89.00 ,$3.20 ,$3.20 ,$75.65 ,$12.05 ,$75.65 ,$80.10 ,$5.74 ,$73.87 ,$70.76 ,$70.76 ,$5.74 ,$57.85 
ST. JOSEPH'S HOSPITAL - BREESE,30100755,84481,HC T3 FREE,301,1 ,$126.00 ,$81.90 ,$9.69 ,$126.00 ,$107.10 ,$75.22 ,$16.94 ,$72.45 ,$16.94 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$103.32 ,$85.68 ,$16.94 ,$16.94 ,$94.50 ,$89.46 ,$89.46 ,$16.94 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$42.35 ,$107.10 ,$16.94 ,$126.00 ,$9.69 ,$9.69 ,$107.10 ,$35.57 ,$107.10 ,$113.40 ,$16.94 ,$104.58 ,$100.17 ,$100.17 ,$16.94 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,30100758,84484,HC TROPONIN QN,301,1 ,$210.00 ,$136.50 ,$7.20 ,$210.00 ,$178.50 ,$125.37 ,$12.47 ,$120.75 ,$12.47 ,$144.69 ,$178.50 ,$178.50 ,$178.50 ,$172.20 ,$142.80 ,$12.47 ,$12.47 ,$157.50 ,$149.10 ,$149.10 ,$12.47 ,$149.10 ,$174.30 ,$174.30 ,$174.30 , N/A ,$31.18 ,$178.50 ,$12.47 ,$210.00 ,$7.20 ,$7.20 ,$178.50 ,$26.19 ,$178.50 ,$189.00 ,$12.47 ,$174.30 ,$166.95 ,$166.95 ,$12.47 ,$136.50 
ST. JOSEPH'S HOSPITAL - BREESE,30100761,84520,HC BUN,301,1 ,$65.00 ,$42.25 ,$3.20 ,$65.00 ,$55.25 ,$38.81 ,$3.95 ,$37.38 ,$3.95 ,$44.79 ,$55.25 ,$55.25 ,$55.25 ,$53.30 ,$44.20 ,$3.95 ,$3.95 ,$48.75 ,$46.15 ,$46.15 ,$3.95 ,$46.15 ,$53.95 ,$53.95 ,$53.95 , N/A ,$9.88 ,$55.25 ,$3.95 ,$3.95 ,$3.20 ,$3.20 ,$55.25 ,$8.30 ,$55.25 ,$58.50 ,$3.95 ,$53.95 ,$51.68 ,$51.68 ,$3.95 ,$42.25 
ST. JOSEPH'S HOSPITAL - BREESE,30100765,84550,HC URIC ACID,301,1 ,$99.00 ,$64.35 ,$3.20 ,$99.00 ,$84.15 ,$59.10 ,$4.52 ,$56.93 ,$4.52 ,$68.21 ,$84.15 ,$84.15 ,$84.15 ,$81.18 ,$67.32 ,$4.52 ,$4.52 ,$74.25 ,$70.29 ,$70.29 ,$4.52 ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A ,$11.30 ,$84.15 ,$4.52 ,$99.00 ,$3.20 ,$3.20 ,$84.15 ,$9.49 ,$84.15 ,$89.10 ,$4.52 ,$82.17 ,$78.71 ,$78.71 ,$4.52 ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,30100802,84702,HC HCG QN,301,1 ,$192.00 ,$124.80 ,$9.69 ,$192.00 ,$163.20 ,$114.62 ,$15.05 ,$110.40 ,$15.05 ,$132.29 ,$163.20 ,$163.20 ,$163.20 ,$157.44 ,$130.56 ,$15.05 ,$15.05 ,$144.00 ,$136.32 ,$136.32 ,$15.05 ,$136.32 ,$159.36 ,$159.36 ,$159.36 , N/A ,$37.63 ,$163.20 ,$15.05 ,$192.00 ,$9.69 ,$9.69 ,$163.20 ,$31.61 ,$163.20 ,$172.80 ,$15.05 ,$159.36 ,$152.64 ,$152.64 ,$15.05 ,$124.80 
ST. JOSEPH'S HOSPITAL - BREESE,30100808,84703,HC HCG QL,301,1 ,$101.00 ,$65.65 ,$7.20 ,$101.00 ,$85.85 ,$60.30 ,$7.52 ,$58.08 ,$7.52 ,$69.59 ,$85.85 ,$85.85 ,$85.85 ,$82.82 ,$68.68 ,$7.52 ,$7.52 ,$75.75 ,$71.71 ,$71.71 ,$7.52 ,$71.71 ,$83.83 ,$83.83 ,$83.83 , N/A ,$18.80 ,$85.85 ,$7.52 ,$101.00 ,$7.20 ,$7.20 ,$85.85 ,$15.79 ,$85.85 ,$90.90 ,$7.52 ,$83.83 ,$80.30 ,$80.30 ,$7.52 ,$65.65 
ST. JOSEPH'S HOSPITAL - BREESE,30100810,88720,HC BILICHECK TEST,301,1 ,$27.00 ,$17.55 ,$3.20 ,$27.00 ,$22.95 ,$16.12 ,$5.02 ,$15.53 ,$5.02 ,$18.60 ,$22.95 ,$22.95 ,$22.95 ,$22.14 ,$18.36 ,$5.02 ,$5.02 ,$20.25 ,$19.17 ,$19.17 ,$5.02 ,$19.17 ,$22.41 ,$22.41 ,$22.41 , N/A ,$12.55 ,$22.95 ,$5.02 ,$27.00 ,$3.20 ,$3.20 ,$22.95 ,$10.54 ,$22.95 ,$24.30 ,$5.02 ,$22.41 ,$21.47 ,$21.47 ,$5.02 ,$17.55 
ST. JOSEPH'S HOSPITAL - BREESE,30100838,83033,HC FETAL HGB QI,301,1 ,$71.00 ,$46.15 ,$7.20 ,$71.00 ,$60.35 ,$42.39 ,$8.00 ,$40.83 ,$8.00 ,$48.92 ,$60.35 ,$60.35 ,$60.35 ,$58.22 ,$48.28 ,$8.00 ,$8.00 ,$53.25 ,$50.41 ,$50.41 ,$8.00 ,$50.41 ,$58.93 ,$58.93 ,$58.93 , N/A ,$20.00 ,$60.35 ,$8.00 ,$71.00 ,$7.20 ,$7.20 ,$60.35 ,$16.80 ,$60.35 ,$63.90 ,$8.00 ,$58.93 ,$56.45 ,$56.45 ,$8.00 ,$46.15 
ST. JOSEPH'S HOSPITAL - BREESE,30100845,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$42.00 ,$27.30 ,$1.62 ,$42.00 ,$35.70 ,$25.07 ,$5.04 ,$24.15 ,$5.04 ,$28.94 ,$35.70 ,$35.70 ,$35.70 ,$34.44 ,$28.56 ,$5.04 ,$5.04 ,$31.50 ,$29.82 ,$29.82 ,$5.04 ,$29.82 ,$34.86 ,$34.86 ,$34.86 , N/A ,$12.60 ,$35.70 ,$5.04 ,$42.00 ,$1.62 ,$1.62 ,$35.70 ,$10.58 ,$35.70 ,$37.80 ,$5.04 ,$34.86 ,$33.39 ,$33.39 ,$5.04 ,$27.30 
ST. JOSEPH'S HOSPITAL - BREESE,30100993,80055,HC PRENATAL PANEL,301,1 ,$352.00 ,$228.80 ,$6.56 ,$352.00 ,$299.20 ,$210.14 ,$47.81 ,$202.40 ,$47.81 ,$242.53 ,$299.20 ,$299.20 ,$299.20 ,$288.64 ,$239.36 ,$47.81 ,$47.81 ,$264.00 ,$249.92 ,$249.92 ,$47.81 ,$249.92 ,$292.16 ,$292.16 ,$292.16 , N/A ,$119.53 ,$299.20 ,$47.81 ,$352.00 ,$6.56 ,$6.56 ,$299.20 ,$100.40 ,$299.20 ,$316.80 ,$47.81 ,$292.16 ,$279.84 ,$279.84 ,$47.81 ,$228.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$221.00 ,$143.65 ,$7.20 ,$221.00 ,$187.85 ,$131.94 ,$19.31 ,$127.08 ,$19.31 ,$152.27 ,$187.85 ,$187.85 ,$187.85 ,$181.22 ,$150.28 ,$19.31 ,$19.31 ,$165.75 ,$156.91 ,$156.91 ,$19.31 ,$156.91 ,$183.43 ,$183.43 ,$183.43 , N/A ,$48.28 ,$187.85 ,$19.31 ,$221.00 ,$7.20 ,$7.20 ,$187.85 ,$40.55 ,$187.85 ,$198.90 ,$19.31 ,$183.43 ,$175.70 ,$175.70 ,$19.31 ,$143.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101075,80048,HC BASIC METABOLIC PANEL,301,1 ,$330.00 ,$214.50 ,$6.56 ,$330.00 ,$280.50 ,$197.01 ,$8.46 ,$189.75 ,$8.46 ,$227.37 ,$280.50 ,$280.50 ,$280.50 ,$270.60 ,$224.40 ,$8.46 ,$8.46 ,$247.50 ,$234.30 ,$234.30 ,$8.46 ,$234.30 ,$273.90 ,$273.90 ,$273.90 , N/A ,$21.15 ,$280.50 ,$8.46 ,$8.46 ,$6.56 ,$6.56 ,$280.50 ,$17.77 ,$280.50 ,$297.00 ,$8.46 ,$273.90 ,$262.35 ,$262.35 ,$8.46 ,$214.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101078,80051,HC ELECTROLYTE PANEL,301,1 ,$243.00 ,$157.95 ,$6.56 ,$243.00 ,$206.55 ,$145.07 ,$7.01 ,$139.73 ,$7.01 ,$167.43 ,$206.55 ,$206.55 ,$206.55 ,$199.26 ,$165.24 ,$7.01 ,$7.01 ,$182.25 ,$172.53 ,$172.53 ,$7.01 ,$172.53 ,$201.69 ,$201.69 ,$201.69 , N/A ,$17.53 ,$206.55 ,$7.01 ,$243.00 ,$6.56 ,$6.56 ,$206.55 ,$14.72 ,$206.55 ,$218.70 ,$7.01 ,$201.69 ,$193.19 ,$193.19 ,$7.01 ,$157.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101080,80053,HC COMPREHENSIVE METABOLIC PANEL,301,1 ,$389.00 ,$252.85 ,$6.56 ,$389.00 ,$330.65 ,$232.23 ,$10.56 ,$223.68 ,$10.56 ,$268.02 ,$330.65 ,$330.65 ,$330.65 ,$318.98 ,$264.52 ,$10.56 ,$10.56 ,$291.75 ,$276.19 ,$276.19 ,$10.56 ,$276.19 ,$322.87 ,$322.87 ,$322.87 , N/A ,$26.40 ,$330.65 ,$10.56 ,$10.56 ,$6.56 ,$6.56 ,$330.65 ,$22.18 ,$330.65 ,$350.10 ,$10.56 ,$322.87 ,$309.26 ,$309.26 ,$10.56 ,$252.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101082,80061,HC LIPID PANEL,301,1 ,$296.00 ,$192.40 ,$6.56 ,$296.00 ,$251.60 ,$176.71 ,$13.39 ,$170.20 ,$13.39 ,$203.94 ,$251.60 ,$251.60 ,$251.60 ,$242.72 ,$201.28 ,$13.39 ,$13.39 ,$222.00 ,$210.16 ,$210.16 ,$13.39 ,$210.16 ,$245.68 ,$245.68 ,$245.68 , N/A ,$33.48 ,$251.60 ,$13.39 ,$296.00 ,$6.56 ,$6.56 ,$251.60 ,$28.12 ,$251.60 ,$266.40 ,$13.39 ,$245.68 ,$235.32 ,$235.32 ,$13.39 ,$192.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101084,80069,HC RENAL PANEL,301,1 ,$274.00 ,$178.10 ,$6.56 ,$274.00 ,$232.90 ,$163.58 ,$8.68 ,$157.55 ,$8.68 ,$188.79 ,$232.90 ,$232.90 ,$232.90 ,$224.68 ,$186.32 ,$8.68 ,$8.68 ,$205.50 ,$194.54 ,$194.54 ,$8.68 ,$194.54 ,$227.42 ,$227.42 ,$227.42 , N/A ,$21.70 ,$232.90 ,$8.68 ,$274.00 ,$6.56 ,$6.56 ,$232.90 ,$18.23 ,$232.90 ,$246.60 ,$8.68 ,$227.42 ,$217.83 ,$217.83 ,$8.68 ,$178.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101088,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$331.00 ,$215.15 ,$6.56 ,$331.00 ,$281.35 ,$197.61 ,$8.17 ,$190.33 ,$8.17 ,$228.06 ,$281.35 ,$281.35 ,$281.35 ,$271.42 ,$225.08 ,$8.17 ,$8.17 ,$248.25 ,$235.01 ,$235.01 ,$8.17 ,$235.01 ,$274.73 ,$274.73 ,$274.73 , N/A ,$20.43 ,$281.35 ,$8.17 ,$331.00 ,$6.56 ,$6.56 ,$281.35 ,$17.16 ,$281.35 ,$297.90 ,$8.17 ,$274.73 ,$263.15 ,$263.15 ,$8.17 ,$215.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101089,80150,HC AMIKACIN - 90,301,1 ,$58.00 ,$37.70 ,$8.26 ,$58.00 ,$49.30 ,$34.63 ,$15.08 ,$33.35 ,$15.08 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$15.08 ,$15.08 ,$43.50 ,$41.18 ,$41.18 ,$15.08 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$37.70 ,$49.30 ,$15.08 ,$58.00 ,$8.26 ,$8.26 ,$49.30 ,$31.67 ,$49.30 ,$52.20 ,$15.08 ,$48.14 ,$46.11 ,$46.11 ,$15.08 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101091,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$148.00 ,$96.20 ,$8.26 ,$148.00 ,$125.80 ,$88.36 ,$14.57 ,$85.10 ,$14.57 ,$101.97 ,$125.80 ,$125.80 ,$125.80 ,$121.36 ,$100.64 ,$14.57 ,$14.57 ,$111.00 ,$105.08 ,$105.08 ,$14.57 ,$105.08 ,$122.84 ,$122.84 ,$122.84 , N/A ,$36.43 ,$125.80 ,$14.57 ,$148.00 ,$8.26 ,$8.26 ,$125.80 ,$30.60 ,$125.80 ,$133.20 ,$14.57 ,$122.84 ,$117.66 ,$117.66 ,$14.57 ,$96.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101093,80157,HC CARBAMAZEPINE FREE - 90,301,1 ,$78.00 ,$50.70 ,$8.26 ,$78.00 ,$66.30 ,$46.57 ,$13.25 ,$44.85 ,$13.25 ,$53.74 ,$66.30 ,$66.30 ,$66.30 ,$63.96 ,$53.04 ,$13.25 ,$13.25 ,$58.50 ,$55.38 ,$55.38 ,$13.25 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$33.13 ,$66.30 ,$13.25 ,$78.00 ,$8.26 ,$8.26 ,$66.30 ,$27.83 ,$66.30 ,$70.20 ,$13.25 ,$64.74 ,$62.01 ,$62.01 ,$13.25 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101094,80158,HC CYCLOSPORINE - 90,301,1 ,$71.00 ,$46.15 ,$8.26 ,$71.00 ,$60.35 ,$42.39 ,$18.05 ,$40.83 ,$18.05 ,$48.92 ,$60.35 ,$60.35 ,$60.35 ,$58.22 ,$48.28 ,$18.05 ,$18.05 ,$53.25 ,$50.41 ,$50.41 ,$18.05 ,$50.41 ,$58.93 ,$58.93 ,$58.93 , N/A ,$45.13 ,$60.35 ,$18.05 ,$71.00 ,$8.26 ,$8.26 ,$60.35 ,$37.91 ,$60.35 ,$63.90 ,$18.05 ,$58.93 ,$56.45 ,$56.45 ,$18.05 ,$46.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101096,80162,HC DIGOXIN LEVELS,301,1 ,$124.00 ,$80.60 ,$8.26 ,$124.00 ,$105.40 ,$74.03 ,$13.28 ,$71.30 ,$13.28 ,$85.44 ,$105.40 ,$105.40 ,$105.40 ,$101.68 ,$84.32 ,$13.28 ,$13.28 ,$93.00 ,$88.04 ,$88.04 ,$13.28 ,$88.04 ,$102.92 ,$102.92 ,$102.92 , N/A ,$33.20 ,$105.40 ,$13.28 ,$124.00 ,$8.26 ,$8.26 ,$105.40 ,$27.89 ,$105.40 ,$111.60 ,$13.28 ,$102.92 ,$98.58 ,$98.58 ,$13.28 ,$80.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101099,80168,HC ETHOSUXIMIDE - 90,301,1 ,$50.00 ,$32.50 ,$8.26 ,$50.00 ,$42.50 ,$29.85 ,$16.34 ,$28.75 ,$16.34 ,$34.45 ,$42.50 ,$42.50 ,$42.50 ,$41.00 ,$34.00 ,$16.34 ,$16.34 ,$37.50 ,$35.50 ,$35.50 ,$16.34 ,$35.50 ,$41.50 ,$41.50 ,$41.50 , N/A ,$40.85 ,$42.50 ,$16.34 ,$50.00 ,$8.26 ,$8.26 ,$42.50 ,$34.31 ,$42.50 ,$45.00 ,$16.34 ,$41.50 ,$39.75 ,$39.75 ,$16.34 ,$32.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101100,80169,HC EVEROLIMUS - 90,301,1 ,$151.00 ,$98.15 ,$8.26 ,$151.00 ,$128.35 ,$90.15 ,$13.73 ,$86.83 ,$13.73 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$13.73 ,$13.73 ,$113.25 ,$107.21 ,$107.21 ,$13.73 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$34.33 ,$128.35 ,$13.73 ,$151.00 ,$8.26 ,$8.26 ,$128.35 ,$28.83 ,$128.35 ,$135.90 ,$13.73 ,$125.33 ,$120.05 ,$120.05 ,$13.73 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101102,80171,HC GABAPENTIN PLASMA - 90,301,1 ,$148.00 ,$96.20 ,$8.26 ,$148.00 ,$125.80 ,$88.36 ,$21.67 ,$85.10 ,$21.67 ,$101.97 ,$125.80 ,$125.80 ,$125.80 ,$121.36 ,$100.64 ,$21.67 ,$21.67 ,$111.00 ,$105.08 ,$105.08 ,$21.67 ,$105.08 ,$122.84 ,$122.84 ,$122.84 , N/A ,$54.18 ,$125.80 ,$21.67 ,$148.00 ,$8.26 ,$8.26 ,$125.80 ,$45.51 ,$125.80 ,$133.20 ,$21.67 ,$122.84 ,$117.66 ,$117.66 ,$21.67 ,$96.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101104,80175,HC LAMOTRIGINE - 90,301,1 ,$151.00 ,$98.15 ,$8.26 ,$151.00 ,$128.35 ,$90.15 ,$13.25 ,$86.83 ,$13.25 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$13.25 ,$13.25 ,$113.25 ,$107.21 ,$107.21 ,$13.25 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$33.13 ,$128.35 ,$13.25 ,$151.00 ,$8.26 ,$8.26 ,$128.35 ,$27.83 ,$128.35 ,$135.90 ,$13.25 ,$125.33 ,$120.05 ,$120.05 ,$13.25 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101106,80177,HC LEVETIRACETAM - 90,301,1 ,$151.00 ,$98.15 ,$8.26 ,$151.00 ,$128.35 ,$90.15 ,$13.25 ,$86.83 ,$13.25 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$13.25 ,$13.25 ,$113.25 ,$107.21 ,$107.21 ,$13.25 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$33.13 ,$128.35 ,$13.25 ,$151.00 ,$8.26 ,$8.26 ,$128.35 ,$27.83 ,$128.35 ,$135.90 ,$13.25 ,$125.33 ,$120.05 ,$120.05 ,$13.25 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101107,80178,HC LITHIUM,301,1 ,$99.00 ,$64.35 ,$6.61 ,$99.00 ,$84.15 ,$59.10 ,$6.61 ,$56.93 ,$6.61 ,$68.21 ,$84.15 ,$84.15 ,$84.15 ,$81.18 ,$67.32 ,$6.61 ,$6.61 ,$74.25 ,$70.29 ,$70.29 ,$6.61 ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A ,$16.53 ,$84.15 ,$6.61 ,$99.00 ,$8.26 ,$8.26 ,$84.15 ,$13.88 ,$84.15 ,$89.10 ,$6.61 ,$82.17 ,$78.71 ,$78.71 ,$6.61 ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101109,80183,HC OXCARBAZEPINE - 90,301,1 ,$53.00 ,$34.45 ,$8.26 ,$53.00 ,$45.05 ,$31.64 ,$13.25 ,$30.48 ,$13.25 ,$36.52 ,$45.05 ,$45.05 ,$45.05 ,$43.46 ,$36.04 ,$13.25 ,$13.25 ,$39.75 ,$37.63 ,$37.63 ,$13.25 ,$37.63 ,$43.99 ,$43.99 ,$43.99 , N/A ,$33.13 ,$45.05 ,$13.25 ,$53.00 ,$8.26 ,$8.26 ,$45.05 ,$27.83 ,$45.05 ,$47.70 ,$13.25 ,$43.99 ,$42.14 ,$42.14 ,$13.25 ,$34.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101111,80184,HC PHENOBARBITAL,301,1 ,$143.00 ,$92.95 ,$8.26 ,$143.00 ,$121.55 ,$85.37 ,$15.30 ,$82.23 ,$15.30 ,$98.53 ,$121.55 ,$121.55 ,$121.55 ,$117.26 ,$97.24 ,$15.30 ,$15.30 ,$107.25 ,$101.53 ,$101.53 ,$15.30 ,$101.53 ,$118.69 ,$118.69 ,$118.69 , N/A ,$38.25 ,$121.55 ,$15.30 ,$143.00 ,$8.26 ,$8.26 ,$121.55 ,$32.13 ,$121.55 ,$128.70 ,$15.30 ,$118.69 ,$113.69 ,$113.69 ,$15.30 ,$92.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101112,80185,HC PHENYTOIN TOTAL,301,1 ,$136.00 ,$88.40 ,$8.26 ,$136.00 ,$115.60 ,$81.19 ,$13.25 ,$78.20 ,$13.25 ,$93.70 ,$115.60 ,$115.60 ,$115.60 ,$111.52 ,$92.48 ,$13.25 ,$13.25 ,$102.00 ,$96.56 ,$96.56 ,$13.25 ,$96.56 ,$112.88 ,$112.88 ,$112.88 , N/A ,$33.13 ,$115.60 ,$13.25 ,$136.00 ,$8.26 ,$8.26 ,$115.60 ,$27.83 ,$115.60 ,$122.40 ,$13.25 ,$112.88 ,$108.12 ,$108.12 ,$13.25 ,$88.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101114,80186,HC PHENYTOIN FREE - 90,301,1 ,$50.00 ,$32.50 ,$8.26 ,$50.00 ,$42.50 ,$29.85 ,$13.76 ,$28.75 ,$13.76 ,$34.45 ,$42.50 ,$42.50 ,$42.50 ,$41.00 ,$34.00 ,$13.76 ,$13.76 ,$37.50 ,$35.50 ,$35.50 ,$13.76 ,$35.50 ,$41.50 ,$41.50 ,$41.50 , N/A ,$34.40 ,$42.50 ,$13.76 ,$50.00 ,$8.26 ,$8.26 ,$42.50 ,$28.90 ,$42.50 ,$45.00 ,$13.76 ,$41.50 ,$39.75 ,$39.75 ,$13.76 ,$32.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101115,80188,HC PRIMIDONE - 90,301,1 ,$56.00 ,$36.40 ,$8.26 ,$56.00 ,$47.60 ,$33.43 ,$16.59 ,$32.20 ,$16.59 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$16.59 ,$16.59 ,$42.00 ,$39.76 ,$39.76 ,$16.59 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$41.48 ,$47.60 ,$16.59 ,$56.00 ,$8.26 ,$8.26 ,$47.60 ,$34.84 ,$47.60 ,$50.40 ,$16.59 ,$46.48 ,$44.52 ,$44.52 ,$16.59 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101116,80192,HC PROCAINEAMIDE - 90,301,1 ,$51.00 ,$33.15 ,$8.26 ,$51.00 ,$43.35 ,$30.45 ,$16.75 ,$29.33 ,$16.75 ,$35.14 ,$43.35 ,$43.35 ,$43.35 ,$41.82 ,$34.68 ,$16.75 ,$16.75 ,$38.25 ,$36.21 ,$36.21 ,$16.75 ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A ,$41.88 ,$43.35 ,$16.75 ,$51.00 ,$8.26 ,$8.26 ,$43.35 ,$35.18 ,$43.35 ,$45.90 ,$16.75 ,$42.33 ,$40.55 ,$40.55 ,$16.75 ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101118,80195,HC RAPAMYCIN (SIROLIMUS) - 90,301,1 ,$78.00 ,$50.70 ,$8.26 ,$78.00 ,$66.30 ,$46.57 ,$13.73 ,$44.85 ,$13.73 ,$53.74 ,$66.30 ,$66.30 ,$66.30 ,$63.96 ,$53.04 ,$13.73 ,$13.73 ,$58.50 ,$55.38 ,$55.38 ,$13.73 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$34.33 ,$66.30 ,$13.73 ,$78.00 ,$8.26 ,$8.26 ,$66.30 ,$28.83 ,$66.30 ,$70.20 ,$13.73 ,$64.74 ,$62.01 ,$62.01 ,$13.73 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101119,80197,HC TACROLIMUS - 90,301,1 ,$96.00 ,$62.40 ,$8.26 ,$96.00 ,$81.60 ,$57.31 ,$13.73 ,$55.20 ,$13.73 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$13.73 ,$13.73 ,$72.00 ,$68.16 ,$68.16 ,$13.73 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$34.33 ,$81.60 ,$13.73 ,$96.00 ,$8.26 ,$8.26 ,$81.60 ,$28.83 ,$81.60 ,$86.40 ,$13.73 ,$79.68 ,$76.32 ,$76.32 ,$13.73 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101120,80198,HC THEOPHYLLINE,301,1 ,$135.00 ,$87.75 ,$8.26 ,$135.00 ,$114.75 ,$80.60 ,$14.14 ,$77.63 ,$14.14 ,$93.02 ,$114.75 ,$114.75 ,$114.75 ,$110.70 ,$91.80 ,$14.14 ,$14.14 ,$101.25 ,$95.85 ,$95.85 ,$14.14 ,$95.85 ,$112.05 ,$112.05 ,$112.05 , N/A ,$35.35 ,$114.75 ,$14.14 ,$135.00 ,$8.26 ,$8.26 ,$114.75 ,$29.69 ,$114.75 ,$121.50 ,$14.14 ,$112.05 ,$107.33 ,$107.33 ,$14.14 ,$87.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101124,80201,HC TOPIRAMATE - 90,301,1 ,$105.00 ,$68.25 ,$8.26 ,$105.00 ,$89.25 ,$62.69 ,$11.92 ,$60.38 ,$11.92 ,$72.35 ,$89.25 ,$89.25 ,$89.25 ,$86.10 ,$71.40 ,$11.92 ,$11.92 ,$78.75 ,$74.55 ,$74.55 ,$11.92 ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A ,$29.80 ,$89.25 ,$11.92 ,$105.00 ,$8.26 ,$8.26 ,$89.25 ,$25.03 ,$89.25 ,$94.50 ,$11.92 ,$87.15 ,$83.48 ,$83.48 ,$11.92 ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101125,80202,HC VANCOMYCIN,301,1 ,$147.00 ,$95.55 ,$8.26 ,$147.00 ,$124.95 ,$87.76 ,$13.54 ,$84.53 ,$13.54 ,$101.28 ,$124.95 ,$124.95 ,$124.95 ,$120.54 ,$99.96 ,$13.54 ,$13.54 ,$110.25 ,$104.37 ,$104.37 ,$13.54 ,$104.37 ,$122.01 ,$122.01 ,$122.01 , N/A ,$33.85 ,$124.95 ,$13.54 ,$147.00 ,$8.26 ,$8.26 ,$124.95 ,$28.43 ,$124.95 ,$132.30 ,$13.54 ,$122.01 ,$116.87 ,$116.87 ,$13.54 ,$95.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101126,80203,HC ZONISAMIDE - 90,301,1 ,$131.00 ,$85.15 ,$8.26 ,$131.00 ,$111.35 ,$78.21 ,$13.25 ,$75.33 ,$13.25 ,$90.26 ,$111.35 ,$111.35 ,$111.35 ,$107.42 ,$89.08 ,$13.25 ,$13.25 ,$98.25 ,$93.01 ,$93.01 ,$13.25 ,$93.01 ,$108.73 ,$108.73 ,$108.73 , N/A ,$33.13 ,$111.35 ,$13.25 ,$131.00 ,$8.26 ,$8.26 ,$111.35 ,$27.83 ,$111.35 ,$117.90 ,$13.25 ,$108.73 ,$104.15 ,$104.15 ,$13.25 ,$85.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101131,80299,HC THERAPEUTIC DRUG OTHER - 90,301,1 ,$136.00 ,$88.40 ,$8.26 ,$136.00 ,$115.60 ,$81.19 ,$18.64 ,$78.20 ,$18.64 ,$93.70 ,$115.60 ,$115.60 ,$115.60 ,$111.52 ,$92.48 ,$18.64 ,$18.64 ,$102.00 ,$96.56 ,$96.56 ,$18.64 ,$96.56 ,$112.88 ,$112.88 ,$112.88 , N/A ,$46.60 ,$115.60 ,$18.64 ,$136.00 ,$8.26 ,$8.26 ,$115.60 ,$39.14 ,$115.60 ,$122.40 ,$18.64 ,$112.88 ,$108.12 ,$108.12 ,$18.64 ,$88.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101133,80306,HC DRUG SCREEN PRESUMPTIVE INSTRMNT ASSIST DIR OPTICAL T2,301,1 ,$235.00 ,$152.75 ,$7.20 ,$235.00 ,$199.75 ,$140.30 ,$17.14 ,$135.13 ,$17.14 ,$161.92 ,$199.75 ,$199.75 ,$199.75 ,$192.70 ,$159.80 ,$17.14 ,$17.14 ,$176.25 ,$166.85 ,$166.85 ,$17.14 ,$166.85 ,$195.05 ,$195.05 ,$195.05 , N/A ,$42.85 ,$199.75 ,$17.14 ,$235.00 ,$7.20 ,$7.20 ,$199.75 ,$35.99 ,$199.75 ,$211.50 ,$17.14 ,$195.05 ,$186.83 ,$186.83 ,$17.14 ,$152.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101137,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4,301,1 ,$340.00 ,$221.00 ,$19.38 ,$340.00 ,$289.00 ,$202.98 ,$62.14 ,$195.50 ,$62.14 ,$234.26 ,$289.00 ,$289.00 ,$289.00 ,$278.80 ,$231.20 ,$62.14 ,$62.14 ,$255.00 ,$241.40 ,$241.40 ,$62.14 ,$241.40 ,$282.20 ,$282.20 ,$282.20 , N/A ,$155.35 ,$289.00 ,$62.14 ,$340.00 ,$19.38 ,$19.38 ,$289.00 ,$130.49 ,$289.00 ,$306.00 ,$62.14 ,$282.20 ,$270.30 ,$270.30 ,$62.14 ,$221.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101140,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T1-90,301,1 ,$31.04 ,$20.18 ,$17.85 ,$65.18 ,$26.38 ,$18.53 ,$31.04 ,$17.85 ,$31.04 ,$21.39 ,$26.38 ,$26.38 ,$26.38 ,$25.45 ,$21.11 ,$31.04 ,$31.04 ,$23.28 ,$22.04 ,$22.04 ,$31.04 ,$22.04 ,$25.76 ,$25.76 ,$25.76 , N/A ,$31.04 ,$26.38 ,$31.04 ,$31.04 ,$19.38 ,$19.38 ,$26.38 ,$65.18 ,$26.38 ,$27.94 ,$31.04 ,$25.76 ,$24.68 ,$24.68 ,$31.04 ,$20.18 
ST. JOSEPH'S HOSPITAL - BREESE,30101141,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T2-90,301,1 ,$160.00 ,$104.00 ,$19.38 ,$160.00 ,$136.00 ,$95.52 ,$62.14 ,$92.00 ,$62.14 ,$110.24 ,$136.00 ,$136.00 ,$136.00 ,$131.20 ,$108.80 ,$62.14 ,$62.14 ,$120.00 ,$113.60 ,$113.60 ,$62.14 ,$113.60 ,$132.80 ,$132.80 ,$132.80 , N/A ,$155.35 ,$136.00 ,$62.14 ,$160.00 ,$19.38 ,$19.38 ,$136.00 ,$130.49 ,$136.00 ,$144.00 ,$62.14 ,$132.80 ,$127.20 ,$127.20 ,$62.14 ,$104.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101143,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4-90,301,1 ,$340.00 ,$221.00 ,$19.38 ,$340.00 ,$289.00 ,$202.98 ,$62.14 ,$195.50 ,$62.14 ,$234.26 ,$289.00 ,$289.00 ,$289.00 ,$278.80 ,$231.20 ,$62.14 ,$62.14 ,$255.00 ,$241.40 ,$241.40 ,$62.14 ,$241.40 ,$282.20 ,$282.20 ,$282.20 , N/A ,$155.35 ,$289.00 ,$62.14 ,$340.00 ,$19.38 ,$19.38 ,$289.00 ,$130.49 ,$289.00 ,$306.00 ,$62.14 ,$282.20 ,$270.30 ,$270.30 ,$62.14 ,$221.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101147,80323,HC NICOTINE URINE - 90,301,1 ,$46.00 ,$29.90 ,$19.38 ,$46.00 ,$39.10 ,$27.46 , N/A ,$26.45 , N/A ,$31.69 ,$39.10 ,$39.10 ,$39.10 ,$37.72 ,$31.28 , N/A , N/A ,$34.50 ,$32.66 ,$32.66 , N/A ,$32.66 ,$38.18 ,$38.18 ,$38.18 , N/A , N/A ,$39.10 , N/A ,$46.00 ,$19.38 ,$19.38 ,$39.10 , N/A ,$39.10 ,$41.40 , N/A ,$38.18 ,$36.57 ,$36.57 , N/A ,$29.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101150,80346,HC BENZODIAZEPINES 1-12  -90,301,1 ,$44.00 ,$28.60 ,$19.38 ,$44.00 ,$37.40 ,$26.27 , N/A ,$25.30 , N/A ,$30.32 ,$37.40 ,$37.40 ,$37.40 ,$36.08 ,$29.92 , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.52 ,$36.52 ,$36.52 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$19.38 ,$19.38 ,$37.40 , N/A ,$37.40 ,$39.60 , N/A ,$36.52 ,$34.98 ,$34.98 , N/A ,$28.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101151,80349,HC CANNABINOIDS NATURAL -90,301,1 ,$30.00 ,$19.50 ,$7.20 ,$30.00 ,$25.50 ,$17.91 , N/A ,$17.25 , N/A ,$20.67 ,$25.50 ,$25.50 ,$25.50 ,$24.60 ,$20.40 , N/A , N/A ,$22.50 ,$21.30 ,$21.30 , N/A ,$21.30 ,$24.90 ,$24.90 ,$24.90 , N/A , N/A ,$25.50 , N/A ,$30.00 ,$7.20 ,$7.20 ,$25.50 , N/A ,$25.50 ,$27.00 , N/A ,$24.90 ,$23.85 ,$23.85 , N/A ,$19.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101153,80359,HC METHYLENEDIOXYAMPHETAMINES MDA MDEA MDMA -90,301,1 ,$214.00 ,$139.10 ,$7.20 ,$214.00 ,$181.90 ,$127.76 , N/A ,$123.05 , N/A ,$147.45 ,$181.90 ,$181.90 ,$181.90 ,$175.48 ,$145.52 , N/A , N/A ,$160.50 ,$151.94 ,$151.94 , N/A ,$151.94 ,$177.62 ,$177.62 ,$177.62 , N/A , N/A ,$181.90 , N/A ,$214.00 ,$7.20 ,$7.20 ,$181.90 , N/A ,$181.90 ,$192.60 , N/A ,$177.62 ,$170.13 ,$170.13 , N/A ,$139.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101154,80361,HC OPIATES 1 OR MORE -90,301,1 ,$36.00 ,$23.40 ,$19.38 ,$36.00 ,$30.60 ,$21.49 , N/A ,$20.70 , N/A ,$24.80 ,$30.60 ,$30.60 ,$30.60 ,$29.52 ,$24.48 , N/A , N/A ,$27.00 ,$25.56 ,$25.56 , N/A ,$25.56 ,$29.88 ,$29.88 ,$29.88 , N/A , N/A ,$30.60 , N/A ,$36.00 ,$19.38 ,$19.38 ,$30.60 , N/A ,$30.60 ,$32.40 , N/A ,$29.88 ,$28.62 ,$28.62 , N/A ,$23.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101158,82024,HC ACTH -90,301,1 ,$70.00 ,$45.50 ,$16.85 ,$81.10 ,$59.50 ,$41.79 ,$38.62 ,$40.25 ,$38.62 ,$48.23 ,$59.50 ,$59.50 ,$59.50 ,$57.40 ,$47.60 ,$38.62 ,$38.62 ,$52.50 ,$49.70 ,$49.70 ,$38.62 ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A ,$70.00 ,$59.50 ,$38.62 ,$70.00 ,$16.85 ,$16.85 ,$59.50 ,$81.10 ,$59.50 ,$63.00 ,$38.62 ,$58.10 ,$55.65 ,$55.65 ,$38.62 ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101159,82040,HC ALBUMIN-90,301,1 ,$75.00 ,$48.75 ,$3.20 ,$75.00 ,$63.75 ,$44.78 ,$4.95 ,$43.13 ,$4.95 ,$51.68 ,$63.75 ,$63.75 ,$63.75 ,$61.50 ,$51.00 ,$4.95 ,$4.95 ,$56.25 ,$53.25 ,$53.25 ,$4.95 ,$53.25 ,$62.25 ,$62.25 ,$62.25 , N/A ,$12.38 ,$63.75 ,$4.95 ,$75.00 ,$3.20 ,$3.20 ,$63.75 ,$10.40 ,$63.75 ,$67.50 ,$4.95 ,$62.25 ,$59.63 ,$59.63 ,$4.95 ,$48.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101162,82085,HC ALDOLASE-90,301,1 ,$78.00 ,$50.70 ,$7.20 ,$78.00 ,$66.30 ,$46.57 ,$9.71 ,$44.85 ,$9.71 ,$53.74 ,$66.30 ,$66.30 ,$66.30 ,$63.96 ,$53.04 ,$9.71 ,$9.71 ,$58.50 ,$55.38 ,$55.38 ,$9.71 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$24.28 ,$66.30 ,$9.71 ,$78.00 ,$7.20 ,$7.20 ,$66.30 ,$20.39 ,$66.30 ,$70.20 ,$9.71 ,$64.74 ,$62.01 ,$62.01 ,$9.71 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101163,82088,HC ALDOSTERONE-90,301,1 ,$123.00 ,$79.95 ,$16.85 ,$123.00 ,$104.55 ,$73.43 ,$40.75 ,$70.73 ,$40.75 ,$84.75 ,$104.55 ,$104.55 ,$104.55 ,$100.86 ,$83.64 ,$40.75 ,$40.75 ,$92.25 ,$87.33 ,$87.33 ,$40.75 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$101.88 ,$104.55 ,$40.75 ,$123.00 ,$16.85 ,$16.85 ,$104.55 ,$85.58 ,$104.55 ,$110.70 ,$40.75 ,$102.09 ,$97.79 ,$97.79 ,$40.75 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101164,82103,HC ALPHA-1 ANTITRYPSIN TOTAL-90,301,1 ,$91.00 ,$59.15 ,$7.20 ,$91.00 ,$77.35 ,$54.33 ,$13.44 ,$52.33 ,$13.44 ,$62.70 ,$77.35 ,$77.35 ,$77.35 ,$74.62 ,$61.88 ,$13.44 ,$13.44 ,$68.25 ,$64.61 ,$64.61 ,$13.44 ,$64.61 ,$75.53 ,$75.53 ,$75.53 , N/A ,$33.60 ,$77.35 ,$13.44 ,$91.00 ,$7.20 ,$7.20 ,$77.35 ,$28.22 ,$77.35 ,$81.90 ,$13.44 ,$75.53 ,$72.35 ,$72.35 ,$13.44 ,$59.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101165,82104,HC ALPHA-1 ANTITRYPSIN PHENO-90,301,1 ,$187.00 ,$121.55 ,$7.20 ,$187.00 ,$158.95 ,$111.64 ,$14.46 ,$107.53 ,$14.46 ,$128.84 ,$158.95 ,$158.95 ,$158.95 ,$153.34 ,$127.16 ,$14.46 ,$14.46 ,$140.25 ,$132.77 ,$132.77 ,$14.46 ,$132.77 ,$155.21 ,$155.21 ,$155.21 , N/A ,$36.15 ,$158.95 ,$14.46 ,$187.00 ,$7.20 ,$7.20 ,$158.95 ,$30.37 ,$158.95 ,$168.30 ,$14.46 ,$155.21 ,$148.67 ,$148.67 ,$14.46 ,$121.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101166,82105,HC ALPHA FETOPROTEIN SERUM-90,301,1 ,$95.00 ,$61.75 ,$7.20 ,$95.00 ,$80.75 ,$56.72 ,$16.77 ,$54.63 ,$16.77 ,$65.46 ,$80.75 ,$80.75 ,$80.75 ,$77.90 ,$64.60 ,$16.77 ,$16.77 ,$71.25 ,$67.45 ,$67.45 ,$16.77 ,$67.45 ,$78.85 ,$78.85 ,$78.85 , N/A ,$41.93 ,$80.75 ,$16.77 ,$95.00 ,$7.20 ,$7.20 ,$80.75 ,$35.22 ,$80.75 ,$85.50 ,$16.77 ,$78.85 ,$75.53 ,$75.53 ,$16.77 ,$61.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101172,82131,HC AMINO ACID QN SINGLE-90,301,1 ,$68.00 ,$44.20 ,$7.20 ,$68.00 ,$57.80 ,$40.60 ,$22.98 ,$39.10 ,$22.98 ,$46.85 ,$57.80 ,$57.80 ,$57.80 ,$55.76 ,$46.24 ,$22.98 ,$22.98 ,$51.00 ,$48.28 ,$48.28 ,$22.98 ,$48.28 ,$56.44 ,$56.44 ,$56.44 , N/A ,$57.45 ,$57.80 ,$22.98 ,$68.00 ,$7.20 ,$7.20 ,$57.80 ,$48.26 ,$57.80 ,$61.20 ,$22.98 ,$56.44 ,$54.06 ,$54.06 ,$22.98 ,$44.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101175,82139,HC AMINO ACIDS 6+ QN CSF-90,301,1 ,$357.00 ,$232.05 ,$7.20 ,$357.00 ,$303.45 ,$213.13 ,$16.87 ,$205.28 ,$16.87 ,$245.97 ,$303.45 ,$303.45 ,$303.45 ,$292.74 ,$242.76 ,$16.87 ,$16.87 ,$267.75 ,$253.47 ,$253.47 ,$16.87 ,$253.47 ,$296.31 ,$296.31 ,$296.31 , N/A ,$42.18 ,$303.45 ,$16.87 ,$357.00 ,$7.20 ,$7.20 ,$303.45 ,$35.43 ,$303.45 ,$321.30 ,$16.87 ,$296.31 ,$283.82 ,$283.82 ,$16.87 ,$232.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101176,82140,HC AMMONIA-90,301,1 ,$207.00 ,$134.55 ,$7.20 ,$207.00 ,$175.95 ,$123.58 ,$14.57 ,$119.03 ,$14.57 ,$142.62 ,$175.95 ,$175.95 ,$175.95 ,$169.74 ,$140.76 ,$14.57 ,$14.57 ,$155.25 ,$146.97 ,$146.97 ,$14.57 ,$146.97 ,$171.81 ,$171.81 ,$171.81 , N/A ,$36.43 ,$175.95 ,$14.57 ,$207.00 ,$7.20 ,$7.20 ,$175.95 ,$30.60 ,$175.95 ,$186.30 ,$14.57 ,$171.81 ,$164.57 ,$164.57 ,$14.57 ,$134.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101177,82150,HC AMYLASE-90,301,1 ,$125.00 ,$81.25 ,$6.48 ,$125.00 ,$106.25 ,$74.63 ,$6.48 ,$71.88 ,$6.48 ,$86.13 ,$106.25 ,$106.25 ,$106.25 ,$102.50 ,$85.00 ,$6.48 ,$6.48 ,$93.75 ,$88.75 ,$88.75 ,$6.48 ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A ,$16.20 ,$106.25 ,$6.48 ,$125.00 ,$7.20 ,$7.20 ,$106.25 ,$13.61 ,$106.25 ,$112.50 ,$6.48 ,$103.75 ,$99.38 ,$99.38 ,$6.48 ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101178,82157,HC ANDROSTENEDIONE-90,301,1 ,$109.00 ,$70.85 ,$16.85 ,$109.00 ,$92.65 ,$65.07 ,$29.28 ,$62.68 ,$29.28 ,$75.10 ,$92.65 ,$92.65 ,$92.65 ,$89.38 ,$74.12 ,$29.28 ,$29.28 ,$81.75 ,$77.39 ,$77.39 ,$29.28 ,$77.39 ,$90.47 ,$90.47 ,$90.47 , N/A ,$73.20 ,$92.65 ,$29.28 ,$109.00 ,$16.85 ,$16.85 ,$92.65 ,$61.49 ,$92.65 ,$98.10 ,$29.28 ,$90.47 ,$86.66 ,$86.66 ,$29.28 ,$70.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101179,82164,HC ANGIOTENSIN 1 ENZYME (ACE)-90,301,1 ,$96.00 ,$62.40 ,$7.20 ,$96.00 ,$81.60 ,$57.31 ,$14.60 ,$55.20 ,$14.60 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$14.60 ,$14.60 ,$72.00 ,$68.16 ,$68.16 ,$14.60 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$36.50 ,$81.60 ,$14.60 ,$96.00 ,$7.20 ,$7.20 ,$81.60 ,$30.66 ,$81.60 ,$86.40 ,$14.60 ,$79.68 ,$76.32 ,$76.32 ,$14.60 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101180,82172,HC APOLIPOPROTEIN SERUM-90,301,1 ,$58.00 ,$37.70 ,$7.20 ,$58.00 ,$49.30 ,$34.63 ,$21.09 ,$33.35 ,$21.09 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$21.09 ,$21.09 ,$43.50 ,$41.18 ,$41.18 ,$21.09 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$52.73 ,$49.30 ,$21.09 ,$58.00 ,$7.20 ,$7.20 ,$49.30 ,$44.29 ,$49.30 ,$52.20 ,$21.09 ,$48.14 ,$46.11 ,$46.11 ,$21.09 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101181,82175,HC ARSENIC-90,301,1 ,$72.00 ,$46.80 ,$8.78 ,$72.00 ,$61.20 ,$42.98 ,$18.97 ,$41.40 ,$18.97 ,$49.61 ,$61.20 ,$61.20 ,$61.20 ,$59.04 ,$48.96 ,$18.97 ,$18.97 ,$54.00 ,$51.12 ,$51.12 ,$18.97 ,$51.12 ,$59.76 ,$59.76 ,$59.76 , N/A ,$47.43 ,$61.20 ,$18.97 ,$72.00 ,$8.78 ,$8.78 ,$61.20 ,$39.84 ,$61.20 ,$64.80 ,$18.97 ,$59.76 ,$57.24 ,$57.24 ,$18.97 ,$46.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101182,82180,HC VITAMIN C (ASCORBIC ACID)-90,301,1 ,$58.00 ,$37.70 ,$7.20 ,$58.00 ,$49.30 ,$34.63 ,$9.89 ,$33.35 ,$9.89 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$9.89 ,$9.89 ,$43.50 ,$41.18 ,$41.18 ,$9.89 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$24.73 ,$49.30 ,$9.89 ,$58.00 ,$7.20 ,$7.20 ,$49.30 ,$20.77 ,$49.30 ,$52.20 ,$9.89 ,$48.14 ,$46.11 ,$46.11 ,$9.89 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101184,82232,HC BETA 2 MICROGLOBULIN-90,301,1 ,$94.00 ,$61.10 ,$16.18 ,$94.00 ,$79.90 ,$56.12 ,$16.18 ,$54.05 ,$16.18 ,$64.77 ,$79.90 ,$79.90 ,$79.90 ,$77.08 ,$63.92 ,$16.18 ,$16.18 ,$70.50 ,$66.74 ,$66.74 ,$16.18 ,$66.74 ,$78.02 ,$78.02 ,$78.02 , N/A ,$40.45 ,$79.90 ,$16.18 ,$94.00 ,$16.85 ,$16.85 ,$79.90 ,$33.98 ,$79.90 ,$84.60 ,$16.18 ,$78.02 ,$74.73 ,$74.73 ,$16.18 ,$61.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101191,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$47.00 ,$30.55 ,$3.20 ,$47.00 ,$39.95 ,$28.06 ,$5.32 ,$27.03 ,$5.32 ,$32.38 ,$39.95 ,$39.95 ,$39.95 ,$38.54 ,$31.96 ,$5.32 ,$5.32 ,$35.25 ,$33.37 ,$33.37 ,$5.32 ,$33.37 ,$39.01 ,$39.01 ,$39.01 , N/A ,$13.30 ,$39.95 ,$5.32 ,$47.00 ,$3.20 ,$3.20 ,$39.95 ,$11.17 ,$39.95 ,$42.30 ,$5.32 ,$39.01 ,$37.37 ,$37.37 ,$5.32 ,$30.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101196,82300,HC CADMIUM-90,301,1 ,$67.00 ,$43.55 ,$8.78 ,$67.00 ,$56.95 ,$40.00 ,$23.64 ,$38.53 ,$23.64 ,$46.16 ,$56.95 ,$56.95 ,$56.95 ,$54.94 ,$45.56 ,$23.64 ,$23.64 ,$50.25 ,$47.57 ,$47.57 ,$23.64 ,$47.57 ,$55.61 ,$55.61 ,$55.61 , N/A ,$59.10 ,$56.95 ,$23.64 ,$67.00 ,$8.78 ,$8.78 ,$56.95 ,$49.64 ,$56.95 ,$60.30 ,$23.64 ,$55.61 ,$53.27 ,$53.27 ,$23.64 ,$43.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101197,82306,HC VITAMIN D 25 OH-90,301,1 ,$18.00 ,$11.70 ,$10.35 ,$37.80 ,$15.30 ,$10.75 ,$18.00 ,$10.35 ,$18.00 ,$12.40 ,$15.30 ,$15.30 ,$15.30 ,$14.76 ,$12.24 ,$18.00 ,$18.00 ,$13.50 ,$12.78 ,$12.78 ,$18.00 ,$12.78 ,$14.94 ,$14.94 ,$14.94 , N/A ,$18.00 ,$15.30 ,$18.00 ,$18.00 ,$19.38 ,$17.37 ,$15.30 ,$37.80 ,$15.30 ,$16.20 ,$18.00 ,$14.94 ,$14.31 ,$14.31 ,$18.00 ,$11.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101199,82308,HC CALCITONIN-90,301,1 ,$78.00 ,$50.70 ,$16.85 ,$78.00 ,$66.30 ,$46.57 ,$26.79 ,$44.85 ,$26.79 ,$53.74 ,$66.30 ,$66.30 ,$66.30 ,$63.96 ,$53.04 ,$26.79 ,$26.79 ,$58.50 ,$55.38 ,$55.38 ,$26.79 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$66.98 ,$66.30 ,$26.79 ,$78.00 ,$16.85 ,$16.85 ,$66.30 ,$56.26 ,$66.30 ,$70.20 ,$26.79 ,$64.74 ,$62.01 ,$62.01 ,$26.79 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101203,82340,HC CALCIUM URINE QN TIMED-90,301,1 ,$153.00 ,$99.45 ,$6.03 ,$153.00 ,$130.05 ,$91.34 ,$6.03 ,$87.98 ,$6.03 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$6.03 ,$6.03 ,$114.75 ,$108.63 ,$108.63 ,$6.03 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$15.08 ,$130.05 ,$6.03 ,$153.00 ,$7.20 ,$7.20 ,$130.05 ,$12.66 ,$130.05 ,$137.70 ,$6.03 ,$126.99 ,$121.64 ,$121.64 ,$6.03 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101205,82365,HC CALCULUS ANLYS INFRARED-90,301,1 ,$81.00 ,$52.65 ,$7.20 ,$81.00 ,$68.85 ,$48.36 ,$12.90 ,$46.58 ,$12.90 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$12.90 ,$12.90 ,$60.75 ,$57.51 ,$57.51 ,$12.90 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$32.25 ,$68.85 ,$12.90 ,$81.00 ,$7.20 ,$7.20 ,$68.85 ,$27.09 ,$68.85 ,$72.90 ,$12.90 ,$67.23 ,$64.40 ,$64.40 ,$12.90 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101208,82378,HC CARBINOEMBRYONIC AG (CEA)-90,301,1 ,$87.00 ,$56.55 ,$7.20 ,$87.00 ,$73.95 ,$51.94 ,$18.96 ,$50.03 ,$18.96 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$18.96 ,$18.96 ,$65.25 ,$61.77 ,$61.77 ,$18.96 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$47.40 ,$73.95 ,$18.96 ,$87.00 ,$7.20 ,$7.20 ,$73.95 ,$39.82 ,$73.95 ,$78.30 ,$18.96 ,$72.21 ,$69.17 ,$69.17 ,$18.96 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101209,82379,HC CARNITINE TOTAL AND FREE QN-90,301,1 ,$215.00 ,$139.75 ,$7.20 ,$215.00 ,$182.75 ,$128.36 ,$16.87 ,$123.63 ,$16.87 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$16.87 ,$16.87 ,$161.25 ,$152.65 ,$152.65 ,$16.87 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$42.18 ,$182.75 ,$16.87 ,$215.00 ,$7.20 ,$7.20 ,$182.75 ,$35.43 ,$182.75 ,$193.50 ,$16.87 ,$178.45 ,$170.93 ,$170.93 ,$16.87 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101210,82380,HC CAROTENE-90,301,1 ,$58.00 ,$37.70 ,$7.20 ,$58.00 ,$49.30 ,$34.63 ,$9.22 ,$33.35 ,$9.22 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$9.22 ,$9.22 ,$43.50 ,$41.18 ,$41.18 ,$9.22 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$23.05 ,$49.30 ,$9.22 ,$58.00 ,$7.20 ,$7.20 ,$49.30 ,$19.36 ,$49.30 ,$52.20 ,$9.22 ,$48.14 ,$46.11 ,$46.11 ,$9.22 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101211,82384,HC CATECHOLAMINE FRACTION-90,301,1 ,$113.00 ,$73.45 ,$16.85 ,$113.00 ,$96.05 ,$67.46 ,$25.25 ,$64.98 ,$25.25 ,$77.86 ,$96.05 ,$96.05 ,$96.05 ,$92.66 ,$76.84 ,$25.25 ,$25.25 ,$84.75 ,$80.23 ,$80.23 ,$25.25 ,$80.23 ,$93.79 ,$93.79 ,$93.79 , N/A ,$63.13 ,$96.05 ,$25.25 ,$113.00 ,$16.85 ,$16.85 ,$96.05 ,$53.03 ,$96.05 ,$101.70 ,$25.25 ,$93.79 ,$89.84 ,$89.84 ,$25.25 ,$73.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101212,82390,HC CERULOPLASMIN-90,301,1 ,$80.00 ,$52.00 ,$7.20 ,$80.00 ,$68.00 ,$47.76 ,$10.74 ,$46.00 ,$10.74 ,$55.12 ,$68.00 ,$68.00 ,$68.00 ,$65.60 ,$54.40 ,$10.74 ,$10.74 ,$60.00 ,$56.80 ,$56.80 ,$10.74 ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A ,$26.85 ,$68.00 ,$10.74 ,$80.00 ,$7.20 ,$7.20 ,$68.00 ,$22.55 ,$68.00 ,$72.00 ,$10.74 ,$66.40 ,$63.60 ,$63.60 ,$10.74 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101213,82397,HC CHEMILUMINESCENT ASSAY-90,301,1 ,$153.00 ,$99.45 ,$7.20 ,$153.00 ,$130.05 ,$91.34 ,$14.12 ,$87.98 ,$14.12 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$14.12 ,$14.12 ,$114.75 ,$108.63 ,$108.63 ,$14.12 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$35.30 ,$130.05 ,$14.12 ,$153.00 ,$7.20 ,$7.20 ,$130.05 ,$29.65 ,$130.05 ,$137.70 ,$14.12 ,$126.99 ,$121.64 ,$121.64 ,$14.12 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101216,82480,HC CHOLINESTERASE PSEUDO-90,301,1 ,$58.00 ,$37.70 ,$7.20 ,$58.00 ,$49.30 ,$34.63 ,$7.87 ,$33.35 ,$7.87 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$7.87 ,$7.87 ,$43.50 ,$41.18 ,$41.18 ,$7.87 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$19.68 ,$49.30 ,$7.87 ,$58.00 ,$7.20 ,$7.20 ,$49.30 ,$16.53 ,$49.30 ,$52.20 ,$7.87 ,$48.14 ,$46.11 ,$46.11 ,$7.87 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101218,82495,HC CHROMIUM SERUM-90,301,1 ,$99.00 ,$64.35 ,$8.78 ,$99.00 ,$84.15 ,$59.10 ,$20.28 ,$56.93 ,$20.28 ,$68.21 ,$84.15 ,$84.15 ,$84.15 ,$81.18 ,$67.32 ,$20.28 ,$20.28 ,$74.25 ,$70.29 ,$70.29 ,$20.28 ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A ,$50.70 ,$84.15 ,$20.28 ,$99.00 ,$8.78 ,$8.78 ,$84.15 ,$42.59 ,$84.15 ,$89.10 ,$20.28 ,$82.17 ,$78.71 ,$78.71 ,$20.28 ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101219,82507,HC CITRATE-90,301,1 ,$65.00 ,$42.25 ,$7.20 ,$65.00 ,$55.25 ,$38.81 ,$27.80 ,$37.38 ,$27.80 ,$44.79 ,$55.25 ,$55.25 ,$55.25 ,$53.30 ,$44.20 ,$27.80 ,$27.80 ,$48.75 ,$46.15 ,$46.15 ,$27.80 ,$46.15 ,$53.95 ,$53.95 ,$53.95 , N/A ,$65.00 ,$55.25 ,$27.80 ,$65.00 ,$7.20 ,$7.20 ,$55.25 ,$58.38 ,$55.25 ,$58.50 ,$27.80 ,$53.95 ,$51.68 ,$51.68 ,$27.80 ,$42.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101220,82523,HC COLLAGEN CROSS LINKS ANY METHOD-90,301,1 ,$140.00 ,$91.00 ,$11.11 ,$140.00 ,$119.00 ,$83.58 ,$18.68 ,$80.50 ,$18.68 ,$96.46 ,$119.00 ,$119.00 ,$119.00 ,$114.80 ,$95.20 ,$18.68 ,$18.68 ,$105.00 ,$99.40 ,$99.40 ,$18.68 ,$99.40 ,$116.20 ,$116.20 ,$116.20 , N/A ,$46.70 ,$119.00 ,$18.68 ,$140.00 ,$11.11 ,$11.11 ,$119.00 ,$39.23 ,$119.00 ,$126.00 ,$18.68 ,$116.20 ,$111.30 ,$111.30 ,$18.68 ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101221,82525,HC COPPER-90,301,1 ,$68.00 ,$44.20 ,$8.78 ,$68.00 ,$57.80 ,$40.60 ,$12.41 ,$39.10 ,$12.41 ,$46.85 ,$57.80 ,$57.80 ,$57.80 ,$55.76 ,$46.24 ,$12.41 ,$12.41 ,$51.00 ,$48.28 ,$48.28 ,$12.41 ,$48.28 ,$56.44 ,$56.44 ,$56.44 , N/A ,$31.03 ,$57.80 ,$12.41 ,$68.00 ,$8.78 ,$8.78 ,$57.80 ,$26.06 ,$57.80 ,$61.20 ,$12.41 ,$56.44 ,$54.06 ,$54.06 ,$12.41 ,$44.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101222,82530,HC CORTISOL FREE-90,301,1 ,$121.00 ,$78.65 ,$7.20 ,$121.00 ,$102.85 ,$72.24 ,$16.71 ,$69.58 ,$16.71 ,$83.37 ,$102.85 ,$102.85 ,$102.85 ,$99.22 ,$82.28 ,$16.71 ,$16.71 ,$90.75 ,$85.91 ,$85.91 ,$16.71 ,$85.91 ,$100.43 ,$100.43 ,$100.43 , N/A ,$41.78 ,$102.85 ,$16.71 ,$121.00 ,$7.20 ,$7.20 ,$102.85 ,$35.09 ,$102.85 ,$108.90 ,$16.71 ,$100.43 ,$96.20 ,$96.20 ,$16.71 ,$78.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101224,82542,HC CHROMO SPECTROMETRY -90,301,1 ,$190.00 ,$123.50 ,$7.20 ,$190.00 ,$161.50 ,$113.43 ,$24.09 ,$109.25 ,$24.09 ,$130.91 ,$161.50 ,$161.50 ,$161.50 ,$155.80 ,$129.20 ,$24.09 ,$24.09 ,$142.50 ,$134.90 ,$134.90 ,$24.09 ,$134.90 ,$157.70 ,$157.70 ,$157.70 , N/A ,$60.23 ,$161.50 ,$24.09 ,$190.00 ,$7.20 ,$7.20 ,$161.50 ,$50.59 ,$161.50 ,$171.00 ,$24.09 ,$157.70 ,$151.05 ,$151.05 ,$24.09 ,$123.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101225,82550,HC CREATINE KINASE (CPK) TOTAL-90,301,1 ,$125.00 ,$81.25 ,$3.20 ,$125.00 ,$106.25 ,$74.63 ,$6.51 ,$71.88 ,$6.51 ,$86.13 ,$106.25 ,$106.25 ,$106.25 ,$102.50 ,$85.00 ,$6.51 ,$6.51 ,$93.75 ,$88.75 ,$88.75 ,$6.51 ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A ,$16.28 ,$106.25 ,$6.51 ,$125.00 ,$3.20 ,$3.20 ,$106.25 ,$13.67 ,$106.25 ,$112.50 ,$6.51 ,$103.75 ,$99.38 ,$99.38 ,$6.51 ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101226,82552,HC CREATINE KINASE (CPK) ISO-90,301,1 ,$44.00 ,$28.60 ,$7.20 ,$44.00 ,$37.40 ,$26.27 ,$13.39 ,$25.30 ,$13.39 ,$30.32 ,$37.40 ,$37.40 ,$37.40 ,$36.08 ,$29.92 ,$13.39 ,$13.39 ,$33.00 ,$31.24 ,$31.24 ,$13.39 ,$31.24 ,$36.52 ,$36.52 ,$36.52 , N/A ,$33.48 ,$37.40 ,$13.39 ,$44.00 ,$7.20 ,$7.20 ,$37.40 ,$28.12 ,$37.40 ,$39.60 ,$13.39 ,$36.52 ,$34.98 ,$34.98 ,$13.39 ,$28.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101231,82570,HC CREATININE OTH SOURCE-90,301,1 ,$96.00 ,$62.40 ,$3.20 ,$96.00 ,$81.60 ,$57.31 ,$5.18 ,$55.20 ,$5.18 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$5.18 ,$5.18 ,$72.00 ,$68.16 ,$68.16 ,$5.18 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$12.95 ,$81.60 ,$5.18 ,$96.00 ,$3.20 ,$3.20 ,$81.60 ,$10.88 ,$81.60 ,$86.40 ,$5.18 ,$79.68 ,$76.32 ,$76.32 ,$5.18 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101233,82595,HC CRYOGLOBULIN QL OR SQN-90,301,1 ,$94.00 ,$61.10 ,$6.47 ,$94.00 ,$79.90 ,$56.12 ,$6.47 ,$54.05 ,$6.47 ,$64.77 ,$79.90 ,$79.90 ,$79.90 ,$77.08 ,$63.92 ,$6.47 ,$6.47 ,$70.50 ,$66.74 ,$66.74 ,$6.47 ,$66.74 ,$78.02 ,$78.02 ,$78.02 , N/A ,$16.18 ,$79.90 ,$6.47 ,$94.00 ,$7.20 ,$7.20 ,$79.90 ,$13.59 ,$79.90 ,$84.60 ,$6.47 ,$78.02 ,$74.73 ,$74.73 ,$6.47 ,$61.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101234,82600,HC CYANIDE-90,301,1 ,$70.00 ,$45.50 ,$8.78 ,$70.00 ,$59.50 ,$41.79 ,$19.40 ,$40.25 ,$19.40 ,$48.23 ,$59.50 ,$59.50 ,$59.50 ,$57.40 ,$47.60 ,$19.40 ,$19.40 ,$52.50 ,$49.70 ,$49.70 ,$19.40 ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A ,$48.50 ,$59.50 ,$19.40 ,$70.00 ,$8.78 ,$8.78 ,$59.50 ,$40.74 ,$59.50 ,$63.00 ,$19.40 ,$58.10 ,$55.65 ,$55.65 ,$19.40 ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101236,82608,HC VITAMIN B-12 BINDING CAPACITY-90,301,1 ,$61.00 ,$39.65 ,$7.20 ,$61.00 ,$51.85 ,$36.42 ,$14.32 ,$35.08 ,$14.32 ,$42.03 ,$51.85 ,$51.85 ,$51.85 ,$50.02 ,$41.48 ,$14.32 ,$14.32 ,$45.75 ,$43.31 ,$43.31 ,$14.32 ,$43.31 ,$50.63 ,$50.63 ,$50.63 , N/A ,$35.80 ,$51.85 ,$14.32 ,$61.00 ,$7.20 ,$7.20 ,$51.85 ,$30.07 ,$51.85 ,$54.90 ,$14.32 ,$50.63 ,$48.50 ,$48.50 ,$14.32 ,$39.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101237,82626,HC DHEA-90,301,1 ,$65.00 ,$42.25 ,$7.20 ,$65.00 ,$55.25 ,$38.81 ,$25.27 ,$37.38 ,$25.27 ,$44.79 ,$55.25 ,$55.25 ,$55.25 ,$53.30 ,$44.20 ,$25.27 ,$25.27 ,$48.75 ,$46.15 ,$46.15 ,$25.27 ,$46.15 ,$53.95 ,$53.95 ,$53.95 , N/A ,$63.18 ,$55.25 ,$25.27 ,$65.00 ,$7.20 ,$7.20 ,$55.25 ,$53.07 ,$55.25 ,$58.50 ,$25.27 ,$53.95 ,$51.68 ,$51.68 ,$25.27 ,$42.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101238,82627,HC DHEA SULFATE-90,301,1 ,$67.00 ,$43.55 ,$16.85 ,$67.00 ,$56.95 ,$40.00 ,$22.23 ,$38.53 ,$22.23 ,$46.16 ,$56.95 ,$56.95 ,$56.95 ,$54.94 ,$45.56 ,$22.23 ,$22.23 ,$50.25 ,$47.57 ,$47.57 ,$22.23 ,$47.57 ,$55.61 ,$55.61 ,$55.61 , N/A ,$55.58 ,$56.95 ,$22.23 ,$67.00 ,$16.85 ,$16.85 ,$56.95 ,$46.68 ,$56.95 ,$60.30 ,$22.23 ,$55.61 ,$53.27 ,$53.27 ,$22.23 ,$43.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101240,82652,HC VITAMIN D (1 25 DIHYDROXY)-90,301,1 ,$99.00 ,$64.35 ,$19.38 ,$99.00 ,$84.15 ,$59.10 ,$38.50 ,$56.93 ,$38.50 ,$68.21 ,$84.15 ,$84.15 ,$84.15 ,$81.18 ,$67.32 ,$38.50 ,$38.50 ,$74.25 ,$70.29 ,$70.29 ,$38.50 ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A ,$96.25 ,$84.15 ,$38.50 ,$99.00 ,$19.38 ,$19.38 ,$84.15 ,$80.85 ,$84.15 ,$89.10 ,$38.50 ,$82.17 ,$78.71 ,$78.71 ,$38.50 ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101241,82656,HC ELASTASE PANCREATIC EL1 FECAL QL OR SQN-90,301,1 ,$321.00 ,$208.65 ,$7.20 ,$321.00 ,$272.85 ,$191.64 ,$11.53 ,$184.58 ,$11.53 ,$221.17 ,$272.85 ,$272.85 ,$272.85 ,$263.22 ,$218.28 ,$11.53 ,$11.53 ,$240.75 ,$227.91 ,$227.91 ,$11.53 ,$227.91 ,$266.43 ,$266.43 ,$266.43 , N/A ,$28.83 ,$272.85 ,$11.53 ,$321.00 ,$7.20 ,$7.20 ,$272.85 ,$24.21 ,$272.85 ,$288.90 ,$11.53 ,$266.43 ,$255.20 ,$255.20 ,$11.53 ,$208.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101245,82668,HC ERYTHROPOIETIN-90,301,1 ,$101.00 ,$65.65 ,$7.20 ,$101.00 ,$85.85 ,$60.30 ,$18.79 ,$58.08 ,$18.79 ,$69.59 ,$85.85 ,$85.85 ,$85.85 ,$82.82 ,$68.68 ,$18.79 ,$18.79 ,$75.75 ,$71.71 ,$71.71 ,$18.79 ,$71.71 ,$83.83 ,$83.83 ,$83.83 , N/A ,$46.98 ,$85.85 ,$18.79 ,$101.00 ,$7.20 ,$7.20 ,$85.85 ,$39.46 ,$85.85 ,$90.90 ,$18.79 ,$83.83 ,$80.30 ,$80.30 ,$18.79 ,$65.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101246,82670,HC ESTRADIOL-90,301,1 ,$119.00 ,$77.35 ,$16.85 ,$119.00 ,$101.15 ,$71.04 ,$27.94 ,$68.43 ,$27.94 ,$81.99 ,$101.15 ,$101.15 ,$101.15 ,$97.58 ,$80.92 ,$27.94 ,$27.94 ,$89.25 ,$84.49 ,$84.49 ,$27.94 ,$84.49 ,$98.77 ,$98.77 ,$98.77 , N/A ,$69.85 ,$101.15 ,$27.94 ,$119.00 ,$16.85 ,$16.85 ,$101.15 ,$58.67 ,$101.15 ,$107.10 ,$27.94 ,$98.77 ,$94.61 ,$94.61 ,$27.94 ,$77.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101247,82670,HC ESTRADIOL FREE-90,301,1 ,$33.00 ,$21.45 ,$16.85 ,$58.67 ,$28.05 ,$19.70 ,$27.94 ,$18.98 ,$27.94 ,$22.74 ,$28.05 ,$28.05 ,$28.05 ,$27.06 ,$22.44 ,$27.94 ,$27.94 ,$24.75 ,$23.43 ,$23.43 ,$27.94 ,$23.43 ,$27.39 ,$27.39 ,$27.39 , N/A ,$33.00 ,$28.05 ,$27.94 ,$33.00 ,$16.85 ,$16.85 ,$28.05 ,$58.67 ,$28.05 ,$29.70 ,$27.94 ,$27.39 ,$26.24 ,$26.24 ,$27.94 ,$21.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101248,82671,HC ESTROGEN FRACTIONATED-90,301,1 ,$183.00 ,$118.95 ,$16.85 ,$183.00 ,$155.55 ,$109.25 ,$32.30 ,$105.23 ,$32.30 ,$126.09 ,$155.55 ,$155.55 ,$155.55 ,$150.06 ,$124.44 ,$32.30 ,$32.30 ,$137.25 ,$129.93 ,$129.93 ,$32.30 ,$129.93 ,$151.89 ,$151.89 ,$151.89 , N/A ,$80.75 ,$155.55 ,$32.30 ,$183.00 ,$16.85 ,$16.85 ,$155.55 ,$67.83 ,$155.55 ,$164.70 ,$32.30 ,$151.89 ,$145.49 ,$145.49 ,$32.30 ,$118.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101249,82672,HC ESTROGEN TOTAL-90,301,1 ,$78.00 ,$50.70 ,$16.85 ,$78.00 ,$66.30 ,$46.57 ,$21.70 ,$44.85 ,$21.70 ,$53.74 ,$66.30 ,$66.30 ,$66.30 ,$63.96 ,$53.04 ,$21.70 ,$21.70 ,$58.50 ,$55.38 ,$55.38 ,$21.70 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$54.25 ,$66.30 ,$21.70 ,$78.00 ,$16.85 ,$16.85 ,$66.30 ,$45.57 ,$66.30 ,$70.20 ,$21.70 ,$64.74 ,$62.01 ,$62.01 ,$21.70 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101250,82677,HC ESTRIOL-90,301,1 ,$30.00 ,$19.50 ,$16.85 ,$50.78 ,$25.50 ,$17.91 ,$24.18 ,$17.25 ,$24.18 ,$20.67 ,$25.50 ,$25.50 ,$25.50 ,$24.60 ,$20.40 ,$24.18 ,$24.18 ,$22.50 ,$21.30 ,$21.30 ,$24.18 ,$21.30 ,$24.90 ,$24.90 ,$24.90 , N/A ,$30.00 ,$25.50 ,$24.18 ,$30.00 ,$16.85 ,$16.85 ,$25.50 ,$50.78 ,$25.50 ,$27.00 ,$24.18 ,$24.90 ,$23.85 ,$23.85 ,$24.18 ,$19.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101251,82679,HC ESTRONE-90,301,1 ,$87.00 ,$56.55 ,$16.85 ,$87.00 ,$73.95 ,$51.94 ,$24.95 ,$50.03 ,$24.95 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$24.95 ,$24.95 ,$65.25 ,$61.77 ,$61.77 ,$24.95 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$62.38 ,$73.95 ,$24.95 ,$87.00 ,$16.85 ,$16.85 ,$73.95 ,$52.40 ,$73.95 ,$78.30 ,$24.95 ,$72.21 ,$69.17 ,$69.17 ,$24.95 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101253,82705,HC FECAL FAT QUALITATIVE-90,301,1 ,$73.00 ,$47.45 ,$3.20 ,$73.00 ,$62.05 ,$43.58 ,$5.10 ,$41.98 ,$5.10 ,$50.30 ,$62.05 ,$62.05 ,$62.05 ,$59.86 ,$49.64 ,$5.10 ,$5.10 ,$54.75 ,$51.83 ,$51.83 ,$5.10 ,$51.83 ,$60.59 ,$60.59 ,$60.59 , N/A ,$12.75 ,$62.05 ,$5.10 ,$73.00 ,$3.20 ,$3.20 ,$62.05 ,$10.71 ,$62.05 ,$65.70 ,$5.10 ,$60.59 ,$58.04 ,$58.04 ,$5.10 ,$47.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101255,82726,HC FATTY ACIDS VERY LONG CHAIN-90,301,1 ,$644.00 ,$418.60 ,$7.20 ,$644.00 ,$547.40 ,$384.47 ,$19.75 ,$370.30 ,$19.75 ,$443.72 ,$547.40 ,$547.40 ,$547.40 ,$528.08 ,$437.92 ,$19.75 ,$19.75 ,$483.00 ,$457.24 ,$457.24 ,$19.75 ,$457.24 ,$534.52 ,$534.52 ,$534.52 , N/A ,$49.38 ,$547.40 ,$19.75 ,$644.00 ,$7.20 ,$7.20 ,$547.40 ,$41.48 ,$547.40 ,$579.60 ,$19.75 ,$534.52 ,$511.98 ,$511.98 ,$19.75 ,$418.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101259,82747,HC FOLIC ACID RBC-90,301,1 ,$94.00 ,$61.10 ,$4.47 ,$94.00 ,$79.90 ,$56.12 ,$17.65 ,$54.05 ,$17.65 ,$64.77 ,$79.90 ,$79.90 ,$79.90 ,$77.08 ,$63.92 ,$17.65 ,$17.65 ,$70.50 ,$66.74 ,$66.74 ,$17.65 ,$66.74 ,$78.02 ,$78.02 ,$78.02 , N/A ,$44.13 ,$79.90 ,$17.65 ,$94.00 ,$4.47 ,$4.47 ,$79.90 ,$37.07 ,$79.90 ,$84.60 ,$17.65 ,$78.02 ,$74.73 ,$74.73 ,$17.65 ,$61.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101262,82784,HC GAMMAGLOBULIN-90,301,1 ,$100.00 ,$65.00 ,$7.20 ,$100.00 ,$85.00 ,$59.70 ,$9.30 ,$57.50 ,$9.30 ,$68.90 ,$85.00 ,$85.00 ,$85.00 ,$82.00 ,$68.00 ,$9.30 ,$9.30 ,$75.00 ,$71.00 ,$71.00 ,$9.30 ,$71.00 ,$83.00 ,$83.00 ,$83.00 , N/A ,$23.25 ,$85.00 ,$9.30 ,$100.00 ,$7.20 ,$7.20 ,$85.00 ,$19.53 ,$85.00 ,$90.00 ,$9.30 ,$83.00 ,$79.50 ,$79.50 ,$9.30 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101263,82785,HC GAMMAGLOBULIN IGE-90,301,1 ,$125.00 ,$81.25 ,$7.20 ,$125.00 ,$106.25 ,$74.63 ,$16.46 ,$71.88 ,$16.46 ,$86.13 ,$106.25 ,$106.25 ,$106.25 ,$102.50 ,$85.00 ,$16.46 ,$16.46 ,$93.75 ,$88.75 ,$88.75 ,$16.46 ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A ,$41.15 ,$106.25 ,$16.46 ,$125.00 ,$7.20 ,$7.20 ,$106.25 ,$34.57 ,$106.25 ,$112.50 ,$16.46 ,$103.75 ,$99.38 ,$99.38 ,$16.46 ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101265,82787,HC IMMUNOGLOBULIN SUBCLASSES-90,301,1 ,$67.00 ,$43.55 ,$8.02 ,$67.00 ,$56.95 ,$40.00 ,$8.02 ,$38.53 ,$8.02 ,$46.16 ,$56.95 ,$56.95 ,$56.95 ,$54.94 ,$45.56 ,$8.02 ,$8.02 ,$50.25 ,$47.57 ,$47.57 ,$8.02 ,$47.57 ,$55.61 ,$55.61 ,$55.61 , N/A ,$20.05 ,$56.95 ,$8.02 ,$67.00 ,$11.11 ,$11.11 ,$56.95 ,$16.84 ,$56.95 ,$60.30 ,$8.02 ,$55.61 ,$53.27 ,$53.27 ,$8.02 ,$43.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101268,82941,HC GASTRIN-90,301,1 ,$86.00 ,$55.90 ,$16.85 ,$86.00 ,$73.10 ,$51.34 ,$17.63 ,$49.45 ,$17.63 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$17.63 ,$17.63 ,$64.50 ,$61.06 ,$61.06 ,$17.63 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$44.08 ,$73.10 ,$17.63 ,$86.00 ,$16.85 ,$16.85 ,$73.10 ,$37.02 ,$73.10 ,$77.40 ,$17.63 ,$71.38 ,$68.37 ,$68.37 ,$17.63 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101274,82955,HC G6PD ENZYME QN-90,301,1 ,$57.00 ,$37.05 ,$7.20 ,$57.00 ,$48.45 ,$34.03 ,$9.70 ,$32.78 ,$9.70 ,$39.27 ,$48.45 ,$48.45 ,$48.45 ,$46.74 ,$38.76 ,$9.70 ,$9.70 ,$42.75 ,$40.47 ,$40.47 ,$9.70 ,$40.47 ,$47.31 ,$47.31 ,$47.31 , N/A ,$24.25 ,$48.45 ,$9.70 ,$57.00 ,$7.20 ,$7.20 ,$48.45 ,$20.37 ,$48.45 ,$51.30 ,$9.70 ,$47.31 ,$45.32 ,$45.32 ,$9.70 ,$37.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101276,82985,HC FRUCTOSAMINE-90,301,1 ,$9.00 ,$5.85 ,$5.18 ,$18.90 ,$7.65 ,$5.37 ,$9.00 ,$5.18 ,$9.00 ,$6.20 ,$7.65 ,$7.65 ,$7.65 ,$7.38 ,$6.12 ,$9.00 ,$9.00 ,$6.75 ,$6.39 ,$6.39 ,$9.00 ,$6.39 ,$7.47 ,$7.47 ,$7.47 , N/A ,$9.00 ,$7.65 ,$9.00 ,$9.00 ,$7.20 ,$7.20 ,$7.65 ,$18.90 ,$7.65 ,$8.10 ,$9.00 ,$7.47 ,$7.16 ,$7.16 ,$9.00 ,$5.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101279,83003,HC GROWTH HORMONE (HGH)-90,301,1 ,$62.00 ,$40.30 ,$16.67 ,$62.00 ,$52.70 ,$37.01 ,$16.67 ,$35.65 ,$16.67 ,$42.72 ,$52.70 ,$52.70 ,$52.70 ,$50.84 ,$42.16 ,$16.67 ,$16.67 ,$46.50 ,$44.02 ,$44.02 ,$16.67 ,$44.02 ,$51.46 ,$51.46 ,$51.46 , N/A ,$41.68 ,$52.70 ,$16.67 ,$62.00 ,$16.85 ,$16.85 ,$52.70 ,$35.01 ,$52.70 ,$55.80 ,$16.67 ,$51.46 ,$49.29 ,$49.29 ,$16.67 ,$40.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101282,83013,HC H PYLORI BREATH TEST-90,301,1 ,$282.00 ,$183.30 ,$19.38 ,$282.00 ,$239.70 ,$168.35 ,$67.36 ,$162.15 ,$67.36 ,$194.30 ,$239.70 ,$239.70 ,$239.70 ,$231.24 ,$191.76 ,$67.36 ,$67.36 ,$211.50 ,$200.22 ,$200.22 ,$67.36 ,$200.22 ,$234.06 ,$234.06 ,$234.06 , N/A ,$168.40 ,$239.70 ,$67.36 ,$282.00 ,$19.38 ,$19.38 ,$239.70 ,$141.46 ,$239.70 ,$253.80 ,$67.36 ,$234.06 ,$224.19 ,$224.19 ,$67.36 ,$183.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101283,83018,HC HEAVY METAL QN EACH-90,301,1 ,$133.00 ,$86.45 ,$8.78 ,$133.00 ,$113.05 ,$79.40 ,$21.96 ,$76.48 ,$21.96 ,$91.64 ,$113.05 ,$113.05 ,$113.05 ,$109.06 ,$90.44 ,$21.96 ,$21.96 ,$99.75 ,$94.43 ,$94.43 ,$21.96 ,$94.43 ,$110.39 ,$110.39 ,$110.39 , N/A ,$54.90 ,$113.05 ,$21.96 ,$133.00 ,$8.78 ,$8.78 ,$113.05 ,$46.12 ,$113.05 ,$119.70 ,$21.96 ,$110.39 ,$105.74 ,$105.74 ,$21.96 ,$86.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101285,83021,HC HEMOGLOBIN FRACT QN-90,301,1 ,$63.00 ,$40.95 ,$6.80 ,$63.00 ,$53.55 ,$37.61 ,$18.06 ,$36.23 ,$18.06 ,$43.41 ,$53.55 ,$53.55 ,$53.55 ,$51.66 ,$42.84 ,$18.06 ,$18.06 ,$47.25 ,$44.73 ,$44.73 ,$18.06 ,$44.73 ,$52.29 ,$52.29 ,$52.29 , N/A ,$45.15 ,$53.55 ,$18.06 ,$63.00 ,$6.80 ,$6.80 ,$53.55 ,$37.93 ,$53.55 ,$56.70 ,$18.06 ,$52.29 ,$50.09 ,$50.09 ,$18.06 ,$40.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101289,83051,HC HEMOGLOBIN PLASMA-90,301,1 ,$52.00 ,$33.80 ,$7.20 ,$52.00 ,$44.20 ,$31.04 ,$7.31 ,$29.90 ,$7.31 ,$35.83 ,$44.20 ,$44.20 ,$44.20 ,$42.64 ,$35.36 ,$7.31 ,$7.31 ,$39.00 ,$36.92 ,$36.92 ,$7.31 ,$36.92 ,$43.16 ,$43.16 ,$43.16 , N/A ,$18.28 ,$44.20 ,$7.31 ,$52.00 ,$7.20 ,$7.20 ,$44.20 ,$15.35 ,$44.20 ,$46.80 ,$7.31 ,$43.16 ,$41.34 ,$41.34 ,$7.31 ,$33.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101292,83090,HC HOMOCYSTEINE-90,301,1 ,$106.00 ,$68.90 ,$16.85 ,$106.00 ,$90.10 ,$63.28 ,$17.92 ,$60.95 ,$17.92 ,$73.03 ,$90.10 ,$90.10 ,$90.10 ,$86.92 ,$72.08 ,$17.92 ,$17.92 ,$79.50 ,$75.26 ,$75.26 ,$17.92 ,$75.26 ,$87.98 ,$87.98 ,$87.98 , N/A ,$44.80 ,$90.10 ,$17.92 ,$106.00 ,$16.85 ,$16.85 ,$90.10 ,$37.63 ,$90.10 ,$95.40 ,$17.92 ,$87.98 ,$84.27 ,$84.27 ,$17.92 ,$68.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101294,83497,HC HYDROXYINDOLACET 5 (HIAA)-90,301,1 ,$65.00 ,$42.25 ,$9.69 ,$65.00 ,$55.25 ,$38.81 ,$12.90 ,$37.38 ,$12.90 ,$44.79 ,$55.25 ,$55.25 ,$55.25 ,$53.30 ,$44.20 ,$12.90 ,$12.90 ,$48.75 ,$46.15 ,$46.15 ,$12.90 ,$46.15 ,$53.95 ,$53.95 ,$53.95 , N/A ,$32.25 ,$55.25 ,$12.90 ,$65.00 ,$9.69 ,$9.69 ,$55.25 ,$27.09 ,$55.25 ,$58.50 ,$12.90 ,$53.95 ,$51.68 ,$51.68 ,$12.90 ,$42.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101295,83498,HC HYDROXYPROGESTERONE 17D-90,301,1 ,$120.00 ,$78.00 ,$16.85 ,$120.00 ,$102.00 ,$71.64 ,$27.17 ,$69.00 ,$27.17 ,$82.68 ,$102.00 ,$102.00 ,$102.00 ,$98.40 ,$81.60 ,$27.17 ,$27.17 ,$90.00 ,$85.20 ,$85.20 ,$27.17 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$67.93 ,$102.00 ,$27.17 ,$120.00 ,$16.85 ,$16.85 ,$102.00 ,$57.06 ,$102.00 ,$108.00 ,$27.17 ,$99.60 ,$95.40 ,$95.40 ,$27.17 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101297,83516,HC MLT NON INFECT QL/SQ-90,301,1 ,$120.00 ,$78.00 ,$6.45 ,$120.00 ,$102.00 ,$71.64 ,$11.53 ,$69.00 ,$11.53 ,$82.68 ,$102.00 ,$102.00 ,$102.00 ,$98.40 ,$81.60 ,$11.53 ,$11.53 ,$90.00 ,$85.20 ,$85.20 ,$11.53 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$28.83 ,$102.00 ,$11.53 ,$120.00 ,$6.45 ,$6.45 ,$102.00 ,$24.21 ,$102.00 ,$108.00 ,$11.53 ,$99.60 ,$95.40 ,$95.40 ,$11.53 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101302,83519,HC QN RIA-90,301,1 ,$218.00 ,$141.70 ,$6.45 ,$218.00 ,$185.30 ,$130.15 ,$18.40 ,$125.35 ,$18.40 ,$150.20 ,$185.30 ,$185.30 ,$185.30 ,$178.76 ,$148.24 ,$18.40 ,$18.40 ,$163.50 ,$154.78 ,$154.78 ,$18.40 ,$154.78 ,$180.94 ,$180.94 ,$180.94 , N/A ,$46.00 ,$185.30 ,$18.40 ,$218.00 ,$6.45 ,$6.45 ,$185.30 ,$38.64 ,$185.30 ,$196.20 ,$18.40 ,$180.94 ,$173.31 ,$173.31 ,$18.40 ,$141.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101303,83520,HC IMMUNOASSAY QN OTHER-90,301,1 ,$168.00 ,$109.20 ,$6.45 ,$168.00 ,$142.80 ,$100.30 ,$17.27 ,$96.60 ,$17.27 ,$115.75 ,$142.80 ,$142.80 ,$142.80 ,$137.76 ,$114.24 ,$17.27 ,$17.27 ,$126.00 ,$119.28 ,$119.28 ,$17.27 ,$119.28 ,$139.44 ,$139.44 ,$139.44 , N/A ,$43.18 ,$142.80 ,$17.27 ,$168.00 ,$6.45 ,$6.45 ,$142.80 ,$36.27 ,$142.80 ,$151.20 ,$17.27 ,$139.44 ,$133.56 ,$133.56 ,$17.27 ,$109.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101306,83520,HC IMMUNOASSAY QN ENZYME-90,301,1 ,$366.68 ,$238.34 ,$6.45 ,$366.68 ,$311.68 ,$218.91 ,$17.27 ,$210.84 ,$17.27 ,$252.64 ,$311.68 ,$311.68 ,$311.68 ,$300.68 ,$249.34 ,$17.27 ,$17.27 ,$275.01 ,$260.34 ,$260.34 ,$17.27 ,$260.34 ,$304.34 ,$304.34 ,$304.34 , N/A ,$43.18 ,$311.68 ,$17.27 ,$366.68 ,$6.45 ,$6.45 ,$311.68 ,$36.27 ,$311.68 ,$330.01 ,$17.27 ,$304.34 ,$291.51 ,$291.51 ,$17.27 ,$238.34 
ST. JOSEPH'S HOSPITAL - BREESE,30101307,83525,HC INSULIN TOTAL-90,301,1 ,$86.00 ,$55.90 ,$9.69 ,$86.00 ,$73.10 ,$51.34 ,$11.43 ,$49.45 ,$11.43 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$11.43 ,$11.43 ,$64.50 ,$61.06 ,$61.06 ,$11.43 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$28.58 ,$73.10 ,$11.43 ,$86.00 ,$9.69 ,$9.69 ,$73.10 ,$24.00 ,$73.10 ,$77.40 ,$11.43 ,$71.38 ,$68.37 ,$68.37 ,$11.43 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101308,83527,HC INSULIN FREE-90,301,1 ,$25.40 ,$16.51 ,$12.95 ,$27.20 ,$21.59 ,$15.16 ,$12.95 ,$14.61 ,$12.95 ,$17.50 ,$21.59 ,$21.59 ,$21.59 ,$20.83 ,$17.27 ,$12.95 ,$12.95 ,$19.05 ,$18.03 ,$18.03 ,$12.95 ,$18.03 ,$21.08 ,$21.08 ,$21.08 , N/A ,$25.40 ,$21.59 ,$12.95 ,$25.40 ,$16.85 ,$16.85 ,$21.59 ,$27.20 ,$21.59 ,$22.86 ,$12.95 ,$21.08 ,$20.19 ,$20.19 ,$12.95 ,$16.51 
ST. JOSEPH'S HOSPITAL - BREESE,30101312,83615,HC LACTATE DEHYDRO (LDH)-90,301,1 ,$101.00 ,$65.65 ,$3.20 ,$101.00 ,$85.85 ,$60.30 ,$6.04 ,$58.08 ,$6.04 ,$69.59 ,$85.85 ,$85.85 ,$85.85 ,$82.82 ,$68.68 ,$6.04 ,$6.04 ,$75.75 ,$71.71 ,$71.71 ,$6.04 ,$71.71 ,$83.83 ,$83.83 ,$83.83 , N/A ,$15.10 ,$85.85 ,$6.04 ,$101.00 ,$3.20 ,$3.20 ,$85.85 ,$12.68 ,$85.85 ,$90.90 ,$6.04 ,$83.83 ,$80.30 ,$80.30 ,$6.04 ,$65.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101313,83625,HC LDH ISOENZYMES-90,301,1 ,$42.00 ,$27.30 ,$7.20 ,$42.00 ,$35.70 ,$25.07 ,$12.79 ,$24.15 ,$12.79 ,$28.94 ,$35.70 ,$35.70 ,$35.70 ,$34.44 ,$28.56 ,$12.79 ,$12.79 ,$31.50 ,$29.82 ,$29.82 ,$12.79 ,$29.82 ,$34.86 ,$34.86 ,$34.86 , N/A ,$31.98 ,$35.70 ,$12.79 ,$42.00 ,$7.20 ,$7.20 ,$35.70 ,$26.86 ,$35.70 ,$37.80 ,$12.79 ,$34.86 ,$33.39 ,$33.39 ,$12.79 ,$27.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101316,83655,HC LEAD-90,301,1 ,$67.00 ,$43.55 ,$8.78 ,$67.00 ,$56.95 ,$40.00 ,$12.11 ,$38.53 ,$12.11 ,$46.16 ,$56.95 ,$56.95 ,$56.95 ,$54.94 ,$45.56 ,$12.11 ,$12.11 ,$50.25 ,$47.57 ,$47.57 ,$12.11 ,$47.57 ,$55.61 ,$55.61 ,$55.61 , N/A ,$30.28 ,$56.95 ,$12.11 ,$67.00 ,$8.78 ,$8.78 ,$56.95 ,$25.43 ,$56.95 ,$60.30 ,$12.11 ,$55.61 ,$53.27 ,$53.27 ,$12.11 ,$43.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101319,83695,HC LIPOPROTEIN-90,301,1 ,$73.00 ,$47.45 ,$7.20 ,$73.00 ,$62.05 ,$43.58 ,$14.32 ,$41.98 ,$14.32 ,$50.30 ,$62.05 ,$62.05 ,$62.05 ,$59.86 ,$49.64 ,$14.32 ,$14.32 ,$54.75 ,$51.83 ,$51.83 ,$14.32 ,$51.83 ,$60.59 ,$60.59 ,$60.59 , N/A ,$35.80 ,$62.05 ,$14.32 ,$73.00 ,$7.20 ,$7.20 ,$62.05 ,$30.07 ,$62.05 ,$65.70 ,$14.32 ,$60.59 ,$58.04 ,$58.04 ,$14.32 ,$47.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101325,80335,HC ANTIDEPRESSANTS TRYCLIC 1-2  -90,301,1 ,$52.00 ,$33.80 ,$19.38 ,$52.00 ,$44.20 ,$31.04 , N/A ,$29.90 , N/A ,$35.83 ,$44.20 ,$44.20 ,$44.20 ,$42.64 ,$35.36 , N/A , N/A ,$39.00 ,$36.92 ,$36.92 , N/A ,$36.92 ,$43.16 ,$43.16 ,$43.16 , N/A , N/A ,$44.20 , N/A ,$52.00 ,$19.38 ,$19.38 ,$44.20 , N/A ,$44.20 ,$46.80 , N/A ,$43.16 ,$41.34 ,$41.34 , N/A ,$33.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101326,83735,HC MAGNESIUM-90,301,1 ,$79.00 ,$51.35 ,$3.20 ,$79.00 ,$67.15 ,$47.16 ,$6.70 ,$45.43 ,$6.70 ,$54.43 ,$67.15 ,$67.15 ,$67.15 ,$64.78 ,$53.72 ,$6.70 ,$6.70 ,$59.25 ,$56.09 ,$56.09 ,$6.70 ,$56.09 ,$65.57 ,$65.57 ,$65.57 , N/A ,$16.75 ,$67.15 ,$6.70 ,$79.00 ,$3.20 ,$3.20 ,$67.15 ,$14.07 ,$67.15 ,$71.10 ,$6.70 ,$65.57 ,$62.81 ,$62.81 ,$6.70 ,$51.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101327,83785,HC MANGANESE-90,301,1 ,$163.00 ,$105.95 ,$8.78 ,$163.00 ,$138.55 ,$97.31 ,$26.65 ,$93.73 ,$26.65 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$26.65 ,$26.65 ,$122.25 ,$115.73 ,$115.73 ,$26.65 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$66.63 ,$138.55 ,$26.65 ,$163.00 ,$8.78 ,$8.78 ,$138.55 ,$55.97 ,$138.55 ,$146.70 ,$26.65 ,$135.29 ,$129.59 ,$129.59 ,$26.65 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101328,83789,HC MASS SPEC QN EACH-90,301,1 ,$188.00 ,$122.20 ,$7.20 ,$188.00 ,$159.80 ,$112.24 ,$24.11 ,$108.10 ,$24.11 ,$129.53 ,$159.80 ,$159.80 ,$159.80 ,$154.16 ,$127.84 ,$24.11 ,$24.11 ,$141.00 ,$133.48 ,$133.48 ,$24.11 ,$133.48 ,$156.04 ,$156.04 ,$156.04 , N/A ,$60.28 ,$159.80 ,$24.11 ,$188.00 ,$7.20 ,$7.20 ,$159.80 ,$50.63 ,$159.80 ,$169.20 ,$24.11 ,$156.04 ,$149.46 ,$149.46 ,$24.11 ,$122.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101329,83825,HC MERCURY-90,301,1 ,$81.00 ,$52.65 ,$8.78 ,$81.00 ,$68.85 ,$48.36 ,$16.26 ,$46.58 ,$16.26 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$16.26 ,$16.26 ,$60.75 ,$57.51 ,$57.51 ,$16.26 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$40.65 ,$68.85 ,$16.26 ,$81.00 ,$8.78 ,$8.78 ,$68.85 ,$34.15 ,$68.85 ,$72.90 ,$16.26 ,$67.23 ,$64.40 ,$64.40 ,$16.26 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101330,83835,HC METANEPHRINES-90,301,1 ,$110.00 ,$71.50 ,$16.85 ,$110.00 ,$93.50 ,$65.67 ,$16.94 ,$63.25 ,$16.94 ,$75.79 ,$93.50 ,$93.50 ,$93.50 ,$90.20 ,$74.80 ,$16.94 ,$16.94 ,$82.50 ,$78.10 ,$78.10 ,$16.94 ,$78.10 ,$91.30 ,$91.30 ,$91.30 , N/A ,$42.35 ,$93.50 ,$16.94 ,$110.00 ,$16.85 ,$16.85 ,$93.50 ,$35.57 ,$93.50 ,$99.00 ,$16.94 ,$91.30 ,$87.45 ,$87.45 ,$16.94 ,$71.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101333,83873,HC MYELIN BASIC PROTEIN (CSF)-90,301,1 ,$66.00 ,$42.90 ,$7.20 ,$66.00 ,$56.10 ,$39.40 ,$17.20 ,$37.95 ,$17.20 ,$45.47 ,$56.10 ,$56.10 ,$56.10 ,$54.12 ,$44.88 ,$17.20 ,$17.20 ,$49.50 ,$46.86 ,$46.86 ,$17.20 ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A ,$43.00 ,$56.10 ,$17.20 ,$66.00 ,$7.20 ,$7.20 ,$56.10 ,$36.12 ,$56.10 ,$59.40 ,$17.20 ,$54.78 ,$52.47 ,$52.47 ,$17.20 ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101334,83874,HC MYOGLOBIN-90,301,1 ,$113.00 ,$73.45 ,$7.20 ,$113.00 ,$96.05 ,$67.46 ,$12.92 ,$64.98 ,$12.92 ,$77.86 ,$96.05 ,$96.05 ,$96.05 ,$92.66 ,$76.84 ,$12.92 ,$12.92 ,$84.75 ,$80.23 ,$80.23 ,$12.92 ,$80.23 ,$93.79 ,$93.79 ,$93.79 , N/A ,$32.30 ,$96.05 ,$12.92 ,$113.00 ,$7.20 ,$7.20 ,$96.05 ,$27.13 ,$96.05 ,$101.70 ,$12.92 ,$93.79 ,$89.84 ,$89.84 ,$12.92 ,$73.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101336,83880,HC BNP NATRIURETIC PEPTIDE-90,301,1 ,$138.00 ,$89.70 ,$19.38 ,$138.00 ,$117.30 ,$82.39 ,$39.26 ,$79.35 ,$39.26 ,$95.08 ,$117.30 ,$117.30 ,$117.30 ,$113.16 ,$93.84 ,$39.26 ,$39.26 ,$103.50 ,$97.98 ,$97.98 ,$39.26 ,$97.98 ,$114.54 ,$114.54 ,$114.54 , N/A ,$98.15 ,$117.30 ,$39.26 ,$138.00 ,$19.38 ,$19.38 ,$117.30 ,$82.45 ,$117.30 ,$124.20 ,$39.26 ,$114.54 ,$109.71 ,$109.71 ,$39.26 ,$89.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101337,83883,HC NEPHELOMETRY EA ANALYTE-90,301,1 ,$96.00 ,$62.40 ,$11.11 ,$96.00 ,$81.60 ,$57.31 ,$13.60 ,$55.20 ,$13.60 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$13.60 ,$13.60 ,$72.00 ,$68.16 ,$68.16 ,$13.60 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$34.00 ,$81.60 ,$13.60 ,$96.00 ,$11.11 ,$11.11 ,$81.60 ,$28.56 ,$81.60 ,$86.40 ,$13.60 ,$79.68 ,$76.32 ,$76.32 ,$13.60 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101339,83915,HC NUCLEOTIDASE 5 -90,301,1 ,$116.00 ,$75.40 ,$7.20 ,$116.00 ,$98.60 ,$69.25 ,$11.15 ,$66.70 ,$11.15 ,$79.92 ,$98.60 ,$98.60 ,$98.60 ,$95.12 ,$78.88 ,$11.15 ,$11.15 ,$87.00 ,$82.36 ,$82.36 ,$11.15 ,$82.36 ,$96.28 ,$96.28 ,$96.28 , N/A ,$27.88 ,$98.60 ,$11.15 ,$116.00 ,$7.20 ,$7.20 ,$98.60 ,$23.42 ,$98.60 ,$104.40 ,$11.15 ,$96.28 ,$92.22 ,$92.22 ,$11.15 ,$75.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101340,83916,HC OLIGOCLONAL BANDS-90,301,1 ,$99.00 ,$64.35 ,$7.20 ,$99.00 ,$84.15 ,$59.10 ,$27.39 ,$56.93 ,$27.39 ,$68.21 ,$84.15 ,$84.15 ,$84.15 ,$81.18 ,$67.32 ,$27.39 ,$27.39 ,$74.25 ,$70.29 ,$70.29 ,$27.39 ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A ,$68.48 ,$84.15 ,$27.39 ,$99.00 ,$7.20 ,$7.20 ,$84.15 ,$57.52 ,$84.15 ,$89.10 ,$27.39 ,$82.17 ,$78.71 ,$78.71 ,$27.39 ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101342,83919,HC ORGANIC ACIDS QL-90,301,1 ,$229.00 ,$148.85 ,$7.20 ,$229.00 ,$194.65 ,$136.71 ,$16.45 ,$131.68 ,$16.45 ,$157.78 ,$194.65 ,$194.65 ,$194.65 ,$187.78 ,$155.72 ,$16.45 ,$16.45 ,$171.75 ,$162.59 ,$162.59 ,$16.45 ,$162.59 ,$190.07 ,$190.07 ,$190.07 , N/A ,$41.13 ,$194.65 ,$16.45 ,$229.00 ,$7.20 ,$7.20 ,$194.65 ,$34.55 ,$194.65 ,$206.10 ,$16.45 ,$190.07 ,$182.06 ,$182.06 ,$16.45 ,$148.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101344,83937,HC OSTEOCALCIN-90,301,1 ,$90.00 ,$58.50 ,$16.85 ,$90.00 ,$76.50 ,$53.73 ,$29.85 ,$51.75 ,$29.85 ,$62.01 ,$76.50 ,$76.50 ,$76.50 ,$73.80 ,$61.20 ,$29.85 ,$29.85 ,$67.50 ,$63.90 ,$63.90 ,$29.85 ,$63.90 ,$74.70 ,$74.70 ,$74.70 , N/A ,$74.63 ,$76.50 ,$29.85 ,$90.00 ,$16.85 ,$16.85 ,$76.50 ,$62.69 ,$76.50 ,$81.00 ,$29.85 ,$74.70 ,$71.55 ,$71.55 ,$29.85 ,$58.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101345,83945,HC OXALATE-90,301,1 ,$73.00 ,$47.45 ,$7.20 ,$73.00 ,$62.05 ,$43.58 ,$14.45 ,$41.98 ,$14.45 ,$50.30 ,$62.05 ,$62.05 ,$62.05 ,$59.86 ,$49.64 ,$14.45 ,$14.45 ,$54.75 ,$51.83 ,$51.83 ,$14.45 ,$51.83 ,$60.59 ,$60.59 ,$60.59 , N/A ,$36.13 ,$62.05 ,$14.45 ,$73.00 ,$7.20 ,$7.20 ,$62.05 ,$30.35 ,$62.05 ,$65.70 ,$14.45 ,$60.59 ,$58.04 ,$58.04 ,$14.45 ,$47.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101348,83986,HC PH BODY FLUID NOT BLOOD-90,301,1 ,$102.00 ,$66.30 ,$3.20 ,$102.00 ,$86.70 ,$60.89 ,$3.58 ,$58.65 ,$3.58 ,$70.28 ,$86.70 ,$86.70 ,$86.70 ,$83.64 ,$69.36 ,$3.58 ,$3.58 ,$76.50 ,$72.42 ,$72.42 ,$3.58 ,$72.42 ,$84.66 ,$84.66 ,$84.66 , N/A ,$8.95 ,$86.70 ,$3.58 ,$102.00 ,$3.20 ,$3.20 ,$86.70 ,$7.52 ,$86.70 ,$91.80 ,$3.58 ,$84.66 ,$81.09 ,$81.09 ,$3.58 ,$66.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101349,83992,HC PHENCYCLIDINE (PCP)-90,301,1 ,$44.04 ,$28.63 ,$8.78 ,$44.04 ,$37.43 ,$26.29 , N/A ,$25.32 , N/A ,$30.34 ,$37.43 ,$37.43 ,$37.43 ,$36.11 ,$29.95 , N/A , N/A ,$33.03 ,$31.27 ,$31.27 , N/A ,$31.27 ,$36.55 ,$36.55 ,$36.55 , N/A , N/A ,$37.43 , N/A ,$44.04 ,$8.78 ,$8.78 ,$37.43 , N/A ,$37.43 ,$39.64 , N/A ,$36.55 ,$35.01 ,$35.01 , N/A ,$28.63 
ST. JOSEPH'S HOSPITAL - BREESE,30101351,83993,HC CALPROTECTIN STOOL-90,301,1 ,$229.00 ,$148.85 ,$7.20 ,$229.00 ,$194.65 ,$136.71 ,$19.63 ,$131.68 ,$19.63 ,$157.78 ,$194.65 ,$194.65 ,$194.65 ,$187.78 ,$155.72 ,$19.63 ,$19.63 ,$171.75 ,$162.59 ,$162.59 ,$19.63 ,$162.59 ,$190.07 ,$190.07 ,$190.07 , N/A ,$49.08 ,$194.65 ,$19.63 ,$229.00 ,$7.20 ,$7.20 ,$194.65 ,$41.22 ,$194.65 ,$206.10 ,$19.63 ,$190.07 ,$182.06 ,$182.06 ,$19.63 ,$148.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101352,84030,HC NEWBORN SCREEN PKU-90,301,1 ,$176.00 ,$114.40 ,$3.20 ,$176.00 ,$149.60 ,$105.07 ,$5.50 ,$101.20 ,$5.50 ,$121.26 ,$149.60 ,$149.60 ,$149.60 ,$144.32 ,$119.68 ,$5.50 ,$5.50 ,$132.00 ,$124.96 ,$124.96 ,$5.50 ,$124.96 ,$146.08 ,$146.08 ,$146.08 , N/A ,$13.75 ,$149.60 ,$5.50 ,$176.00 ,$3.20 ,$3.20 ,$149.60 ,$11.55 ,$149.60 ,$158.40 ,$5.50 ,$146.08 ,$139.92 ,$139.92 ,$5.50 ,$114.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101353,84066,HC PHOSPHATASE ACID PROSTATIC-90,301,1 ,$58.00 ,$37.70 ,$7.20 ,$58.00 ,$49.30 ,$34.63 ,$9.66 ,$33.35 ,$9.66 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$9.66 ,$9.66 ,$43.50 ,$41.18 ,$41.18 ,$9.66 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$24.15 ,$49.30 ,$9.66 ,$58.00 ,$7.20 ,$7.20 ,$49.30 ,$20.29 ,$49.30 ,$52.20 ,$9.66 ,$48.14 ,$46.11 ,$46.11 ,$9.66 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101354,84075,HC ALKALINE PHOSPHATASE-90,301,1 ,$58.00 ,$37.70 ,$3.20 ,$58.00 ,$49.30 ,$34.63 ,$5.18 ,$33.35 ,$5.18 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$5.18 ,$5.18 ,$43.50 ,$41.18 ,$41.18 ,$5.18 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$12.95 ,$49.30 ,$5.18 ,$58.00 ,$3.20 ,$3.20 ,$49.30 ,$10.88 ,$49.30 ,$52.20 ,$5.18 ,$48.14 ,$46.11 ,$46.11 ,$5.18 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101356,84080,HC ALK PHOS ISOENZ-90,301,1 ,$73.00 ,$47.45 ,$7.20 ,$73.00 ,$62.05 ,$43.58 ,$14.78 ,$41.98 ,$14.78 ,$50.30 ,$62.05 ,$62.05 ,$62.05 ,$59.86 ,$49.64 ,$14.78 ,$14.78 ,$54.75 ,$51.83 ,$51.83 ,$14.78 ,$51.83 ,$60.59 ,$60.59 ,$60.59 , N/A ,$36.95 ,$62.05 ,$14.78 ,$73.00 ,$7.20 ,$7.20 ,$62.05 ,$31.04 ,$62.05 ,$65.70 ,$14.78 ,$60.59 ,$58.04 ,$58.04 ,$14.78 ,$47.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101358,84105,HC PHOSPHORUS URINE-90,301,1 ,$153.00 ,$99.45 ,$3.20 ,$153.00 ,$130.05 ,$91.34 ,$5.78 ,$87.98 ,$5.78 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$5.78 ,$5.78 ,$114.75 ,$108.63 ,$108.63 ,$5.78 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$14.45 ,$130.05 ,$5.78 ,$153.00 ,$3.20 ,$3.20 ,$130.05 ,$12.14 ,$130.05 ,$137.70 ,$5.78 ,$126.99 ,$121.64 ,$121.64 ,$5.78 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101361,84120,HC PORPHYRINS QN FRACT-90,301,1 ,$71.00 ,$46.15 ,$7.20 ,$71.00 ,$60.35 ,$42.39 ,$14.71 ,$40.83 ,$14.71 ,$48.92 ,$60.35 ,$60.35 ,$60.35 ,$58.22 ,$48.28 ,$14.71 ,$14.71 ,$53.25 ,$50.41 ,$50.41 ,$14.71 ,$50.41 ,$58.93 ,$58.93 ,$58.93 , N/A ,$36.78 ,$60.35 ,$14.71 ,$71.00 ,$7.20 ,$7.20 ,$60.35 ,$30.89 ,$60.35 ,$63.90 ,$14.71 ,$58.93 ,$56.45 ,$56.45 ,$14.71 ,$46.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101364,84133,HC POTASSIUM URINE-90,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$4.73 ,$52.90 ,$4.73 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$4.73 ,$4.73 ,$69.00 ,$65.32 ,$65.32 ,$4.73 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$11.83 ,$78.20 ,$4.73 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$9.93 ,$78.20 ,$82.80 ,$4.73 ,$76.36 ,$73.14 ,$73.14 ,$4.73 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101366,84140,HC PREGNENOLONE-90,301,1 ,$119.00 ,$77.35 ,$16.85 ,$119.00 ,$101.15 ,$71.04 ,$20.67 ,$68.43 ,$20.67 ,$81.99 ,$101.15 ,$101.15 ,$101.15 ,$97.58 ,$80.92 ,$20.67 ,$20.67 ,$89.25 ,$84.49 ,$84.49 ,$20.67 ,$84.49 ,$98.77 ,$98.77 ,$98.77 , N/A ,$51.68 ,$101.15 ,$20.67 ,$119.00 ,$16.85 ,$16.85 ,$101.15 ,$43.41 ,$101.15 ,$107.10 ,$20.67 ,$98.77 ,$94.61 ,$94.61 ,$20.67 ,$77.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101368,84144,HC PROGESTERONE-90,301,1 ,$153.00 ,$99.45 ,$9.69 ,$153.00 ,$130.05 ,$91.34 ,$20.86 ,$87.98 ,$20.86 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$20.86 ,$20.86 ,$114.75 ,$108.63 ,$108.63 ,$20.86 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$52.15 ,$130.05 ,$20.86 ,$153.00 ,$9.69 ,$9.69 ,$130.05 ,$43.81 ,$130.05 ,$137.70 ,$20.86 ,$126.99 ,$121.64 ,$121.64 ,$20.86 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101370,84153,HC PSA TOTAL-90,301,1 ,$191.00 ,$124.15 ,$7.20 ,$191.00 ,$162.35 ,$114.03 ,$18.39 ,$109.83 ,$18.39 ,$131.60 ,$162.35 ,$162.35 ,$162.35 ,$156.62 ,$129.88 ,$18.39 ,$18.39 ,$143.25 ,$135.61 ,$135.61 ,$18.39 ,$135.61 ,$158.53 ,$158.53 ,$158.53 , N/A ,$45.98 ,$162.35 ,$18.39 ,$191.00 ,$7.20 ,$7.20 ,$162.35 ,$38.62 ,$162.35 ,$171.90 ,$18.39 ,$158.53 ,$151.85 ,$151.85 ,$18.39 ,$124.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101372,84155,HC PROTEIN TOTAL-90,301,1 ,$58.00 ,$37.70 ,$3.20 ,$58.00 ,$49.30 ,$34.63 ,$3.67 ,$33.35 ,$3.67 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$3.67 ,$3.67 ,$43.50 ,$41.18 ,$41.18 ,$3.67 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$9.18 ,$49.30 ,$3.67 ,$58.00 ,$3.20 ,$3.20 ,$49.30 ,$7.71 ,$49.30 ,$52.20 ,$3.67 ,$48.14 ,$46.11 ,$46.11 ,$3.67 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101373,84156,HC PROTEIN TOTAL URINE-90,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$3.67 ,$52.90 ,$3.67 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$3.67 ,$3.67 ,$69.00 ,$65.32 ,$65.32 ,$3.67 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$9.18 ,$78.20 ,$3.67 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$7.71 ,$78.20 ,$82.80 ,$3.67 ,$76.36 ,$73.14 ,$73.14 ,$3.67 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101375,84165,HC PROTEIN ELECTROPHORESIS-90,301,1 ,$62.00 ,$40.30 ,$7.20 ,$62.00 ,$52.70 ,$37.01 ,$10.74 ,$35.65 ,$10.74 ,$42.72 ,$52.70 ,$52.70 ,$52.70 ,$50.84 ,$42.16 ,$10.74 ,$10.74 ,$46.50 ,$44.02 ,$44.02 ,$10.74 ,$44.02 ,$51.46 ,$51.46 ,$51.46 , N/A ,$26.85 ,$52.70 ,$10.74 ,$62.00 ,$7.20 ,$7.20 ,$52.70 ,$22.55 ,$52.70 ,$55.80 ,$10.74 ,$51.46 ,$49.29 ,$49.29 ,$10.74 ,$40.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101377,84166,HC PROTEIN EP OTH FLUID-90,301,1 ,$114.00 ,$74.10 ,$7.20 ,$114.00 ,$96.90 ,$68.06 ,$17.83 ,$65.55 ,$17.83 ,$78.55 ,$96.90 ,$96.90 ,$96.90 ,$93.48 ,$77.52 ,$17.83 ,$17.83 ,$85.50 ,$80.94 ,$80.94 ,$17.83 ,$80.94 ,$94.62 ,$94.62 ,$94.62 , N/A ,$44.58 ,$96.90 ,$17.83 ,$114.00 ,$7.20 ,$7.20 ,$96.90 ,$37.44 ,$96.90 ,$102.60 ,$17.83 ,$94.62 ,$90.63 ,$90.63 ,$17.83 ,$74.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101379,84181,HC PROTEIN WESTERN BLOT-90,301,1 ,$133.00 ,$86.45 ,$6.45 ,$133.00 ,$113.05 ,$79.40 ,$17.03 ,$76.48 ,$17.03 ,$91.64 ,$113.05 ,$113.05 ,$113.05 ,$109.06 ,$90.44 ,$17.03 ,$17.03 ,$99.75 ,$94.43 ,$94.43 ,$17.03 ,$94.43 ,$110.39 ,$110.39 ,$110.39 , N/A ,$42.58 ,$113.05 ,$17.03 ,$133.00 ,$6.45 ,$6.45 ,$113.05 ,$35.76 ,$113.05 ,$119.70 ,$17.03 ,$110.39 ,$105.74 ,$105.74 ,$17.03 ,$86.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101380,84182,HC PROTEIN WEST BLOT BAND ID-90,301,1 ,$105.00 ,$68.25 ,$11.11 ,$105.00 ,$89.25 ,$62.69 ,$29.21 ,$60.38 ,$29.21 ,$72.35 ,$89.25 ,$89.25 ,$89.25 ,$86.10 ,$71.40 ,$29.21 ,$29.21 ,$78.75 ,$74.55 ,$74.55 ,$29.21 ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A ,$73.03 ,$89.25 ,$29.21 ,$105.00 ,$11.11 ,$11.11 ,$89.25 ,$61.34 ,$89.25 ,$94.50 ,$29.21 ,$87.15 ,$83.48 ,$83.48 ,$29.21 ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101381,84202,HC PROTOPORPHYRIN-90,301,1 ,$68.00 ,$44.20 ,$7.20 ,$68.00 ,$57.80 ,$40.60 ,$14.35 ,$39.10 ,$14.35 ,$46.85 ,$57.80 ,$57.80 ,$57.80 ,$55.76 ,$46.24 ,$14.35 ,$14.35 ,$51.00 ,$48.28 ,$48.28 ,$14.35 ,$48.28 ,$56.44 ,$56.44 ,$56.44 , N/A ,$35.88 ,$57.80 ,$14.35 ,$68.00 ,$7.20 ,$7.20 ,$57.80 ,$30.14 ,$57.80 ,$61.20 ,$14.35 ,$56.44 ,$54.06 ,$54.06 ,$14.35 ,$44.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101382,84206,HC PROINSULIN-90,301,1 ,$99.00 ,$64.35 ,$16.85 ,$99.00 ,$84.15 ,$59.10 ,$26.69 ,$56.93 ,$26.69 ,$68.21 ,$84.15 ,$84.15 ,$84.15 ,$81.18 ,$67.32 ,$26.69 ,$26.69 ,$74.25 ,$70.29 ,$70.29 ,$26.69 ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A ,$66.73 ,$84.15 ,$26.69 ,$99.00 ,$16.85 ,$16.85 ,$84.15 ,$56.05 ,$84.15 ,$89.10 ,$26.69 ,$82.17 ,$78.71 ,$78.71 ,$26.69 ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101383,84207,HC VITAMIN B6-90,301,1 ,$114.00 ,$74.10 ,$7.20 ,$114.00 ,$96.90 ,$68.06 ,$28.10 ,$65.55 ,$28.10 ,$78.55 ,$96.90 ,$96.90 ,$96.90 ,$93.48 ,$77.52 ,$28.10 ,$28.10 ,$85.50 ,$80.94 ,$80.94 ,$28.10 ,$80.94 ,$94.62 ,$94.62 ,$94.62 , N/A ,$70.25 ,$96.90 ,$28.10 ,$114.00 ,$7.20 ,$7.20 ,$96.90 ,$59.01 ,$96.90 ,$102.60 ,$28.10 ,$94.62 ,$90.63 ,$90.63 ,$28.10 ,$74.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101386,84238,HC RECEPTOR ASSAY NON ENDO-90,301,1 ,$290.00 ,$188.50 ,$19.38 ,$290.00 ,$246.50 ,$173.13 ,$36.57 ,$166.75 ,$36.57 ,$199.81 ,$246.50 ,$246.50 ,$246.50 ,$237.80 ,$197.20 ,$36.57 ,$36.57 ,$217.50 ,$205.90 ,$205.90 ,$36.57 ,$205.90 ,$240.70 ,$240.70 ,$240.70 , N/A ,$91.43 ,$246.50 ,$36.57 ,$290.00 ,$19.38 ,$19.38 ,$246.50 ,$76.80 ,$246.50 ,$261.00 ,$36.57 ,$240.70 ,$230.55 ,$230.55 ,$36.57 ,$188.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101387,84244,HC RENIN-90,301,1 ,$96.00 ,$62.40 ,$16.85 ,$96.00 ,$81.60 ,$57.31 ,$21.99 ,$55.20 ,$21.99 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$21.99 ,$21.99 ,$72.00 ,$68.16 ,$68.16 ,$21.99 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$54.98 ,$81.60 ,$21.99 ,$96.00 ,$16.85 ,$16.85 ,$81.60 ,$46.18 ,$81.60 ,$86.40 ,$21.99 ,$79.68 ,$76.32 ,$76.32 ,$21.99 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101388,84255,HC SELENIUM-90,301,1 ,$149.00 ,$96.85 ,$7.20 ,$149.00 ,$126.65 ,$88.95 ,$25.53 ,$85.68 ,$25.53 ,$102.66 ,$126.65 ,$126.65 ,$126.65 ,$122.18 ,$101.32 ,$25.53 ,$25.53 ,$111.75 ,$105.79 ,$105.79 ,$25.53 ,$105.79 ,$123.67 ,$123.67 ,$123.67 , N/A ,$63.83 ,$126.65 ,$25.53 ,$149.00 ,$7.20 ,$7.20 ,$126.65 ,$53.61 ,$126.65 ,$134.10 ,$25.53 ,$123.67 ,$118.46 ,$118.46 ,$25.53 ,$96.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101389,84252,HC VITAMIN B-2 (RIBOFLAVIN)-90,301,1 ,$86.00 ,$55.90 ,$7.20 ,$86.00 ,$73.10 ,$51.34 ,$20.24 ,$49.45 ,$20.24 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$20.24 ,$20.24 ,$64.50 ,$61.06 ,$61.06 ,$20.24 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$50.60 ,$73.10 ,$20.24 ,$86.00 ,$7.20 ,$7.20 ,$73.10 ,$42.50 ,$73.10 ,$77.40 ,$20.24 ,$71.38 ,$68.37 ,$68.37 ,$20.24 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101390,84270,HC SEX HORMONE BIND GLOB-90,301,1 ,$110.00 ,$71.50 ,$7.20 ,$110.00 ,$93.50 ,$65.67 ,$21.73 ,$63.25 ,$21.73 ,$75.79 ,$93.50 ,$93.50 ,$93.50 ,$90.20 ,$74.80 ,$21.73 ,$21.73 ,$82.50 ,$78.10 ,$78.10 ,$21.73 ,$78.10 ,$91.30 ,$91.30 ,$91.30 , N/A ,$54.33 ,$93.50 ,$21.73 ,$110.00 ,$7.20 ,$7.20 ,$93.50 ,$45.63 ,$93.50 ,$99.00 ,$21.73 ,$91.30 ,$87.45 ,$87.45 ,$21.73 ,$71.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101392,84260,HC SEROTONIN-90,301,1 ,$71.00 ,$46.15 ,$16.85 ,$71.00 ,$60.35 ,$42.39 ,$30.98 ,$40.83 ,$30.98 ,$48.92 ,$60.35 ,$60.35 ,$60.35 ,$58.22 ,$48.28 ,$30.98 ,$30.98 ,$53.25 ,$50.41 ,$50.41 ,$30.98 ,$50.41 ,$58.93 ,$58.93 ,$58.93 , N/A ,$71.00 ,$60.35 ,$30.98 ,$71.00 ,$16.85 ,$16.85 ,$60.35 ,$65.06 ,$60.35 ,$63.90 ,$30.98 ,$58.93 ,$56.45 ,$56.45 ,$30.98 ,$46.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101394,84300,HC SODIUM URINE-90,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$5.06 ,$52.90 ,$5.06 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$5.06 ,$5.06 ,$69.00 ,$65.32 ,$65.32 ,$5.06 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$12.65 ,$78.20 ,$5.06 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$10.63 ,$78.20 ,$82.80 ,$5.06 ,$76.36 ,$73.14 ,$73.14 ,$5.06 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101395,84302,HC SODIUM OTHER FLUID-90,301,1 ,$16.00 ,$10.40 ,$3.20 ,$16.00 ,$13.60 ,$9.55 ,$4.86 ,$9.20 ,$4.86 ,$11.02 ,$13.60 ,$13.60 ,$13.60 ,$13.12 ,$10.88 ,$4.86 ,$4.86 ,$12.00 ,$11.36 ,$11.36 ,$4.86 ,$11.36 ,$13.28 ,$13.28 ,$13.28 , N/A ,$12.15 ,$13.60 ,$4.86 ,$16.00 ,$3.20 ,$3.20 ,$13.60 ,$10.21 ,$13.60 ,$14.40 ,$4.86 ,$13.28 ,$12.72 ,$12.72 ,$4.86 ,$10.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101396,84305,HC SOMATOMEDIN-90,301,1 ,$139.00 ,$90.35 ,$16.85 ,$139.00 ,$118.15 ,$82.98 ,$21.26 ,$79.93 ,$21.26 ,$95.77 ,$118.15 ,$118.15 ,$118.15 ,$113.98 ,$94.52 ,$21.26 ,$21.26 ,$104.25 ,$98.69 ,$98.69 ,$21.26 ,$98.69 ,$115.37 ,$115.37 ,$115.37 , N/A ,$53.15 ,$118.15 ,$21.26 ,$139.00 ,$16.85 ,$16.85 ,$118.15 ,$44.65 ,$118.15 ,$125.10 ,$21.26 ,$115.37 ,$110.51 ,$110.51 ,$21.26 ,$90.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101398,84311,HC SPECTROPHOTOMETRY-90,301,1 ,$77.00 ,$50.05 ,$7.20 ,$77.00 ,$65.45 ,$45.97 ,$8.10 ,$44.28 ,$8.10 ,$53.05 ,$65.45 ,$65.45 ,$65.45 ,$63.14 ,$52.36 ,$8.10 ,$8.10 ,$57.75 ,$54.67 ,$54.67 ,$8.10 ,$54.67 ,$63.91 ,$63.91 ,$63.91 , N/A ,$20.25 ,$65.45 ,$8.10 ,$77.00 ,$7.20 ,$7.20 ,$65.45 ,$17.01 ,$65.45 ,$69.30 ,$8.10 ,$63.91 ,$61.22 ,$61.22 ,$8.10 ,$50.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101405,84392,HC SULFATE URINE-90,301,1 ,$153.00 ,$99.45 ,$2.57 ,$153.00 ,$130.05 ,$91.34 ,$5.49 ,$87.98 ,$5.49 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$5.49 ,$5.49 ,$114.75 ,$108.63 ,$108.63 ,$5.49 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$13.73 ,$130.05 ,$5.49 ,$153.00 ,$2.57 ,$2.57 ,$130.05 ,$11.53 ,$130.05 ,$137.70 ,$5.49 ,$126.99 ,$121.64 ,$121.64 ,$5.49 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101406,84402,HC TESTOSTERONE FREE-90,301,1 ,$58.00 ,$37.70 ,$16.85 ,$58.00 ,$49.30 ,$34.63 ,$25.47 ,$33.35 ,$25.47 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$25.47 ,$25.47 ,$43.50 ,$41.18 ,$41.18 ,$25.47 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$58.00 ,$49.30 ,$25.47 ,$58.00 ,$16.85 ,$16.85 ,$49.30 ,$53.49 ,$49.30 ,$52.20 ,$25.47 ,$48.14 ,$46.11 ,$46.11 ,$25.47 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101407,84403,HC TESTOSTERONE TOTAL-90,301,1 ,$172.00 ,$111.80 ,$16.85 ,$172.00 ,$146.20 ,$102.68 ,$25.81 ,$98.90 ,$25.81 ,$118.51 ,$146.20 ,$146.20 ,$146.20 ,$141.04 ,$116.96 ,$25.81 ,$25.81 ,$129.00 ,$122.12 ,$122.12 ,$25.81 ,$122.12 ,$142.76 ,$142.76 ,$142.76 , N/A ,$64.53 ,$146.20 ,$25.81 ,$172.00 ,$16.85 ,$16.85 ,$146.20 ,$54.20 ,$146.20 ,$154.80 ,$25.81 ,$142.76 ,$136.74 ,$136.74 ,$25.81 ,$111.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101408,84425,HC VITAMIN B1-90,301,1 ,$106.00 ,$68.90 ,$7.20 ,$106.00 ,$90.10 ,$63.28 ,$21.23 ,$60.95 ,$21.23 ,$73.03 ,$90.10 ,$90.10 ,$90.10 ,$86.92 ,$72.08 ,$21.23 ,$21.23 ,$79.50 ,$75.26 ,$75.26 ,$21.23 ,$75.26 ,$87.98 ,$87.98 ,$87.98 , N/A ,$53.08 ,$90.10 ,$21.23 ,$106.00 ,$7.20 ,$7.20 ,$90.10 ,$44.58 ,$90.10 ,$95.40 ,$21.23 ,$87.98 ,$84.27 ,$84.27 ,$21.23 ,$68.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101410,84432,HC THYROGLOBULIN-90,301,1 ,$57.00 ,$37.05 ,$16.06 ,$57.00 ,$48.45 ,$34.03 ,$16.06 ,$32.78 ,$16.06 ,$39.27 ,$48.45 ,$48.45 ,$48.45 ,$46.74 ,$38.76 ,$16.06 ,$16.06 ,$42.75 ,$40.47 ,$40.47 ,$16.06 ,$40.47 ,$47.31 ,$47.31 ,$47.31 , N/A ,$40.15 ,$48.45 ,$16.06 ,$57.00 ,$16.85 ,$16.85 ,$48.45 ,$33.73 ,$48.45 ,$51.30 ,$16.06 ,$47.31 ,$45.32 ,$45.32 ,$16.06 ,$37.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101413,84439,HC T4 FREE-90,301,1 ,$23.10 ,$15.02 ,$9.02 ,$23.10 ,$19.64 ,$13.79 ,$9.02 ,$13.28 ,$9.02 ,$15.92 ,$19.64 ,$19.64 ,$19.64 ,$18.94 ,$15.71 ,$9.02 ,$9.02 ,$17.33 ,$16.40 ,$16.40 ,$9.02 ,$16.40 ,$19.17 ,$19.17 ,$19.17 , N/A ,$22.55 ,$19.64 ,$9.02 ,$23.10 ,$9.69 ,$9.69 ,$19.64 ,$18.94 ,$19.64 ,$20.79 ,$9.02 ,$19.17 ,$18.36 ,$18.36 ,$9.02 ,$15.02 
ST. JOSEPH'S HOSPITAL - BREESE,30101415,84442,HC THYROXINE BIND GLOB-90,301,1 ,$61.00 ,$39.65 ,$9.69 ,$61.00 ,$51.85 ,$36.42 ,$14.78 ,$35.08 ,$14.78 ,$42.03 ,$51.85 ,$51.85 ,$51.85 ,$50.02 ,$41.48 ,$14.78 ,$14.78 ,$45.75 ,$43.31 ,$43.31 ,$14.78 ,$43.31 ,$50.63 ,$50.63 ,$50.63 , N/A ,$36.95 ,$51.85 ,$14.78 ,$61.00 ,$9.69 ,$9.69 ,$51.85 ,$31.04 ,$51.85 ,$54.90 ,$14.78 ,$50.63 ,$48.50 ,$48.50 ,$14.78 ,$39.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101417,84445,HC THYROID STIM IMMUNO GLOB-90,301,1 ,$116.00 ,$75.40 ,$16.85 ,$116.00 ,$98.60 ,$69.25 ,$50.86 ,$66.70 ,$50.86 ,$79.92 ,$98.60 ,$98.60 ,$98.60 ,$95.12 ,$78.88 ,$50.86 ,$50.86 ,$87.00 ,$82.36 ,$82.36 ,$50.86 ,$82.36 ,$96.28 ,$96.28 ,$96.28 , N/A ,$116.00 ,$98.60 ,$50.86 ,$116.00 ,$16.85 ,$16.85 ,$98.60 ,$106.81 ,$98.60 ,$104.40 ,$50.86 ,$96.28 ,$92.22 ,$92.22 ,$50.86 ,$75.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101418,84446,HC VITAMIN E-90,301,1 ,$57.00 ,$37.05 ,$7.20 ,$57.00 ,$48.45 ,$34.03 ,$14.18 ,$32.78 ,$14.18 ,$39.27 ,$48.45 ,$48.45 ,$48.45 ,$46.74 ,$38.76 ,$14.18 ,$14.18 ,$42.75 ,$40.47 ,$40.47 ,$14.18 ,$40.47 ,$47.31 ,$47.31 ,$47.31 , N/A ,$35.45 ,$48.45 ,$14.18 ,$57.00 ,$7.20 ,$7.20 ,$48.45 ,$29.78 ,$48.45 ,$51.30 ,$14.18 ,$47.31 ,$45.32 ,$45.32 ,$14.18 ,$37.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101422,84479,HC T3 UPTAKE-90,301,1 ,$72.00 ,$46.80 ,$6.47 ,$72.00 ,$61.20 ,$42.98 ,$6.47 ,$41.40 ,$6.47 ,$49.61 ,$61.20 ,$61.20 ,$61.20 ,$59.04 ,$48.96 ,$6.47 ,$6.47 ,$54.00 ,$51.12 ,$51.12 ,$6.47 ,$51.12 ,$59.76 ,$59.76 ,$59.76 , N/A ,$16.18 ,$61.20 ,$6.47 ,$72.00 ,$9.69 ,$9.69 ,$61.20 ,$13.59 ,$61.20 ,$64.80 ,$6.47 ,$59.76 ,$57.24 ,$57.24 ,$6.47 ,$46.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101423,84480,HC T3 TOTAL-90,301,1 ,$133.00 ,$86.45 ,$9.69 ,$133.00 ,$113.05 ,$79.40 ,$14.18 ,$76.48 ,$14.18 ,$91.64 ,$113.05 ,$113.05 ,$113.05 ,$109.06 ,$90.44 ,$14.18 ,$14.18 ,$99.75 ,$94.43 ,$94.43 ,$14.18 ,$94.43 ,$110.39 ,$110.39 ,$110.39 , N/A ,$35.45 ,$113.05 ,$14.18 ,$133.00 ,$9.69 ,$9.69 ,$113.05 ,$29.78 ,$113.05 ,$119.70 ,$14.18 ,$110.39 ,$105.74 ,$105.74 ,$14.18 ,$86.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101425,84482,HC T3 REVERSE-90,301,1 ,$81.00 ,$52.65 ,$9.69 ,$81.00 ,$68.85 ,$48.36 ,$15.76 ,$46.58 ,$15.76 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$15.76 ,$15.76 ,$60.75 ,$57.51 ,$57.51 ,$15.76 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$39.40 ,$68.85 ,$15.76 ,$81.00 ,$9.69 ,$9.69 ,$68.85 ,$33.10 ,$68.85 ,$72.90 ,$15.76 ,$67.23 ,$64.40 ,$64.40 ,$15.76 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101434,84560,HC URIC ACID OTH SRC-90,301,1 ,$52.00 ,$33.80 ,$3.20 ,$52.00 ,$44.20 ,$31.04 ,$5.08 ,$29.90 ,$5.08 ,$35.83 ,$44.20 ,$44.20 ,$44.20 ,$42.64 ,$35.36 ,$5.08 ,$5.08 ,$39.00 ,$36.92 ,$36.92 ,$5.08 ,$36.92 ,$43.16 ,$43.16 ,$43.16 , N/A ,$12.70 ,$44.20 ,$5.08 ,$52.00 ,$3.20 ,$3.20 ,$44.20 ,$10.67 ,$44.20 ,$46.80 ,$5.08 ,$43.16 ,$41.34 ,$41.34 ,$5.08 ,$33.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101435,84585,HC VANILLYLMAND AC (VMA)-90,301,1 ,$97.00 ,$63.05 ,$15.50 ,$97.00 ,$82.45 ,$57.91 ,$15.50 ,$55.78 ,$15.50 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$15.50 ,$15.50 ,$72.75 ,$68.87 ,$68.87 ,$15.50 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$38.75 ,$82.45 ,$15.50 ,$97.00 ,$16.85 ,$16.85 ,$82.45 ,$32.55 ,$82.45 ,$87.30 ,$15.50 ,$80.51 ,$77.12 ,$77.12 ,$15.50 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101436,84586,HC VASOACTIVE INTEST PEPTIDE-90,301,1 ,$157.00 ,$102.05 ,$16.85 ,$157.00 ,$133.45 ,$93.73 ,$35.33 ,$90.28 ,$35.33 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$35.33 ,$35.33 ,$117.75 ,$111.47 ,$111.47 ,$35.33 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$88.33 ,$133.45 ,$35.33 ,$157.00 ,$16.85 ,$16.85 ,$133.45 ,$74.19 ,$133.45 ,$141.30 ,$35.33 ,$130.31 ,$124.82 ,$124.82 ,$35.33 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101437,84588,HC VASOPRESSIN (ADH)-90,301,1 ,$151.00 ,$98.15 ,$16.85 ,$151.00 ,$128.35 ,$90.15 ,$33.94 ,$86.83 ,$33.94 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$33.94 ,$33.94 ,$113.25 ,$107.21 ,$107.21 ,$33.94 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$84.85 ,$128.35 ,$33.94 ,$151.00 ,$16.85 ,$16.85 ,$128.35 ,$71.27 ,$128.35 ,$135.90 ,$33.94 ,$125.33 ,$120.05 ,$120.05 ,$33.94 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101438,84590,HC VITAMIN A-90,301,1 ,$67.00 ,$43.55 ,$7.20 ,$67.00 ,$56.95 ,$40.00 ,$11.61 ,$38.53 ,$11.61 ,$46.16 ,$56.95 ,$56.95 ,$56.95 ,$54.94 ,$45.56 ,$11.61 ,$11.61 ,$50.25 ,$47.57 ,$47.57 ,$11.61 ,$47.57 ,$55.61 ,$55.61 ,$55.61 , N/A ,$29.03 ,$56.95 ,$11.61 ,$67.00 ,$7.20 ,$7.20 ,$56.95 ,$24.38 ,$56.95 ,$60.30 ,$11.61 ,$55.61 ,$53.27 ,$53.27 ,$11.61 ,$43.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101440,84597,HC VITAMIN K-90,301,1 ,$106.00 ,$68.90 ,$7.20 ,$106.00 ,$90.10 ,$63.28 ,$13.72 ,$60.95 ,$13.72 ,$73.03 ,$90.10 ,$90.10 ,$90.10 ,$86.92 ,$72.08 ,$13.72 ,$13.72 ,$79.50 ,$75.26 ,$75.26 ,$13.72 ,$75.26 ,$87.98 ,$87.98 ,$87.98 , N/A ,$34.30 ,$90.10 ,$13.72 ,$106.00 ,$7.20 ,$7.20 ,$90.10 ,$28.81 ,$90.10 ,$95.40 ,$13.72 ,$87.98 ,$84.27 ,$84.27 ,$13.72 ,$68.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101441,84600,HC VOLATILES-90,301,1 ,$58.00 ,$37.70 ,$7.20 ,$58.00 ,$49.30 ,$34.63 ,$17.11 ,$33.35 ,$17.11 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$17.11 ,$17.11 ,$43.50 ,$41.18 ,$41.18 ,$17.11 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$42.78 ,$49.30 ,$17.11 ,$58.00 ,$7.20 ,$7.20 ,$49.30 ,$35.93 ,$49.30 ,$52.20 ,$17.11 ,$48.14 ,$46.11 ,$46.11 ,$17.11 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101442,84630,HC ZINC-90,301,1 ,$81.00 ,$52.65 ,$8.78 ,$81.00 ,$68.85 ,$48.36 ,$11.39 ,$46.58 ,$11.39 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$11.39 ,$11.39 ,$60.75 ,$57.51 ,$57.51 ,$11.39 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$28.48 ,$68.85 ,$11.39 ,$81.00 ,$8.78 ,$8.78 ,$68.85 ,$23.92 ,$68.85 ,$72.90 ,$11.39 ,$67.23 ,$64.40 ,$64.40 ,$11.39 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101443,84681,HC C PEPTIDE-90,301,1 ,$91.00 ,$59.15 ,$7.20 ,$91.00 ,$77.35 ,$54.33 ,$20.81 ,$52.33 ,$20.81 ,$62.70 ,$77.35 ,$77.35 ,$77.35 ,$74.62 ,$61.88 ,$20.81 ,$20.81 ,$68.25 ,$64.61 ,$64.61 ,$20.81 ,$64.61 ,$75.53 ,$75.53 ,$75.53 , N/A ,$52.03 ,$77.35 ,$20.81 ,$91.00 ,$7.20 ,$7.20 ,$77.35 ,$43.70 ,$77.35 ,$81.90 ,$20.81 ,$75.53 ,$72.35 ,$72.35 ,$20.81 ,$59.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101444,84702,HC HCG QN-90,301,1 ,$192.00 ,$124.80 ,$9.69 ,$192.00 ,$163.20 ,$114.62 ,$15.05 ,$110.40 ,$15.05 ,$132.29 ,$163.20 ,$163.20 ,$163.20 ,$157.44 ,$130.56 ,$15.05 ,$15.05 ,$144.00 ,$136.32 ,$136.32 ,$15.05 ,$136.32 ,$159.36 ,$159.36 ,$159.36 , N/A ,$37.63 ,$163.20 ,$15.05 ,$192.00 ,$9.69 ,$9.69 ,$163.20 ,$31.61 ,$163.20 ,$172.80 ,$15.05 ,$159.36 ,$152.64 ,$152.64 ,$15.05 ,$124.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101455,G0480,HC DRUG SCRN DEFNT 1-7 CLS T1-90,301,1 ,$56.00 ,$36.40 ,$19.38 ,$117.60 ,$47.60 ,$33.43 ,$56.00 ,$32.20 ,$56.00 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$56.00 ,$56.00 ,$42.00 ,$39.76 ,$39.76 ,$56.00 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$56.00 ,$47.60 ,$56.00 ,$56.00 ,$19.38 ,$19.38 ,$47.60 ,$117.60 ,$47.60 ,$50.40 ,$56.00 ,$46.48 ,$44.52 ,$44.52 ,$56.00 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101456,G0480,HC DRUG SCRN DEFNT 1-7 CLS T2-90,301,1 ,$137.00 ,$89.05 ,$19.38 ,$240.30 ,$116.45 ,$81.79 ,$114.43 ,$78.78 ,$114.43 ,$94.39 ,$116.45 ,$116.45 ,$116.45 ,$112.34 ,$93.16 ,$114.43 ,$114.43 ,$102.75 ,$97.27 ,$97.27 ,$114.43 ,$97.27 ,$113.71 ,$113.71 ,$113.71 , N/A ,$137.00 ,$116.45 ,$114.43 ,$137.00 ,$19.38 ,$19.38 ,$116.45 ,$240.30 ,$116.45 ,$123.30 ,$114.43 ,$113.71 ,$108.92 ,$108.92 ,$114.43 ,$89.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101457,G0480,HC DRUG SCRN DEFNT 1-7 CLS T3-90,301,1 ,$220.00 ,$143.00 ,$19.38 ,$240.30 ,$187.00 ,$131.34 ,$114.43 ,$126.50 ,$114.43 ,$151.58 ,$187.00 ,$187.00 ,$187.00 ,$180.40 ,$149.60 ,$114.43 ,$114.43 ,$165.00 ,$156.20 ,$156.20 ,$114.43 ,$156.20 ,$182.60 ,$182.60 ,$182.60 , N/A ,$220.00 ,$187.00 ,$114.43 ,$220.00 ,$19.38 ,$19.38 ,$187.00 ,$240.30 ,$187.00 ,$198.00 ,$114.43 ,$182.60 ,$174.90 ,$174.90 ,$114.43 ,$143.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101463,G0483,HC DRUG SCRN DEFINT 22+ CLASS-90,301,1 ,$244.00 ,$158.60 ,$19.38 ,$512.40 ,$207.40 ,$145.67 ,$244.00 ,$140.30 ,$244.00 ,$168.12 ,$207.40 ,$207.40 ,$207.40 ,$200.08 ,$165.92 ,$244.00 ,$244.00 ,$183.00 ,$173.24 ,$173.24 ,$244.00 ,$173.24 ,$202.52 ,$202.52 ,$202.52 , N/A ,$244.00 ,$207.40 ,$244.00 ,$244.00 ,$19.38 ,$19.38 ,$207.40 ,$512.40 ,$207.40 ,$219.60 ,$244.00 ,$202.52 ,$193.98 ,$193.98 ,$244.00 ,$158.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101464,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$46.00 ,$29.90 ,$3.20 ,$46.00 ,$39.10 ,$27.46 ,$4.23 ,$26.45 ,$4.23 ,$31.69 ,$39.10 ,$39.10 ,$39.10 ,$37.72 ,$31.28 ,$4.23 ,$4.23 ,$34.50 ,$32.66 ,$32.66 ,$4.23 ,$32.66 ,$38.18 ,$38.18 ,$38.18 , N/A ,$10.58 ,$39.10 ,$4.23 ,$46.00 ,$3.20 ,$3.20 ,$39.10 ,$8.88 ,$39.10 ,$41.40 ,$4.23 ,$38.18 ,$36.57 ,$36.57 ,$4.23 ,$29.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101465,83921,HC ORGANIC ACIDS QN SINGLE-90,301,1 ,$182.00 ,$118.30 ,$7.20 ,$182.00 ,$154.70 ,$108.65 ,$21.21 ,$104.65 ,$21.21 ,$125.40 ,$154.70 ,$154.70 ,$154.70 ,$149.24 ,$123.76 ,$21.21 ,$21.21 ,$136.50 ,$129.22 ,$129.22 ,$21.21 ,$129.22 ,$151.06 ,$151.06 ,$151.06 , N/A ,$53.03 ,$154.70 ,$21.21 ,$182.00 ,$7.20 ,$7.20 ,$154.70 ,$44.54 ,$154.70 ,$163.80 ,$21.21 ,$151.06 ,$144.69 ,$144.69 ,$21.21 ,$118.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101473,80339,HC ANTIEPILIPTICS NOS 1-3 -90,301,1 ,$75.00 ,$48.75 ,$19.38 ,$75.00 ,$63.75 ,$44.78 , N/A ,$43.13 , N/A ,$51.68 ,$63.75 ,$63.75 ,$63.75 ,$61.50 ,$51.00 , N/A , N/A ,$56.25 ,$53.25 ,$53.25 , N/A ,$53.25 ,$62.25 ,$62.25 ,$62.25 , N/A , N/A ,$63.75 , N/A ,$75.00 ,$19.38 ,$19.38 ,$63.75 , N/A ,$63.75 ,$67.50 , N/A ,$62.25 ,$59.63 ,$59.63 , N/A ,$48.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101476,82610,HC CYSTATIN C -90,301,1 ,$140.40 ,$91.26 ,$7.20 ,$140.40 ,$119.34 ,$83.82 ,$18.52 ,$80.73 ,$18.52 ,$96.74 ,$119.34 ,$119.34 ,$119.34 ,$115.13 ,$95.47 ,$18.52 ,$18.52 ,$105.30 ,$99.68 ,$99.68 ,$18.52 ,$99.68 ,$116.53 ,$116.53 ,$116.53 , N/A ,$46.30 ,$119.34 ,$18.52 ,$140.40 ,$7.20 ,$7.20 ,$119.34 ,$38.89 ,$119.34 ,$126.36 ,$18.52 ,$116.53 ,$111.62 ,$111.62 ,$18.52 ,$91.26 
ST. JOSEPH'S HOSPITAL - BREESE,30101477,83519,HC QN RIA MUSK-90,301,1 ,"$1,906.00 ","$1,238.90 ",$6.45 ,"$1,906.00 ","$1,620.10 ","$1,137.88 ",$18.40 ,"$1,095.95 ",$18.40 ,"$1,313.23 ","$1,620.10 ","$1,620.10 ","$1,620.10 ","$1,562.92 ","$1,296.08 ",$18.40 ,$18.40 ,"$1,429.50 ","$1,353.26 ","$1,353.26 ",$18.40 ,"$1,353.26 ","$1,581.98 ","$1,581.98 ","$1,581.98 ", N/A ,$46.00 ,"$1,620.10 ",$18.40 ,"$1,906.00 ",$6.45 ,$6.45 ,"$1,620.10 ",$38.64 ,"$1,620.10 ","$1,715.40 ",$18.40 ,"$1,581.98 ","$1,515.27 ","$1,515.27 ",$18.40 ,"$1,238.90 "
ST. JOSEPH'S HOSPITAL - BREESE,30101478,82800,HC BLOOD GAS PH,301,1 ,$215.00 ,$139.75 ,$7.20 ,$215.00 ,$182.75 ,$128.36 ,$11.00 ,$123.63 ,$11.00 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$11.00 ,$11.00 ,$161.25 ,$152.65 ,$152.65 ,$11.00 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$27.50 ,$182.75 ,$11.00 ,$215.00 ,$7.20 ,$7.20 ,$182.75 ,$23.10 ,$182.75 ,$193.50 ,$11.00 ,$178.45 ,$170.93 ,$170.93 ,$11.00 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101479,82803,HC BLOOD GAS PH PO2  AND /OR PCO2,301,1 ,$221.00 ,$143.65 ,$7.20 ,$221.00 ,$187.85 ,$131.94 ,$26.07 ,$127.08 ,$26.07 ,$152.27 ,$187.85 ,$187.85 ,$187.85 ,$181.22 ,$150.28 ,$26.07 ,$26.07 ,$165.75 ,$156.91 ,$156.91 ,$26.07 ,$156.91 ,$183.43 ,$183.43 ,$183.43 , N/A ,$65.18 ,$187.85 ,$26.07 ,$221.00 ,$7.20 ,$7.20 ,$187.85 ,$54.75 ,$187.85 ,$198.90 ,$26.07 ,$183.43 ,$175.70 ,$175.70 ,$26.07 ,$143.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101480,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$428.00 ,$278.20 ,$7.20 ,$428.00 ,$363.80 ,$255.52 ,$78.77 ,$246.10 ,$78.77 ,$294.89 ,$363.80 ,$363.80 ,$363.80 ,$350.96 ,$291.04 ,$78.77 ,$78.77 ,$321.00 ,$303.88 ,$303.88 ,$78.77 ,$303.88 ,$355.24 ,$355.24 ,$355.24 , N/A ,$196.93 ,$363.80 ,$78.77 ,$428.00 ,$7.20 ,$7.20 ,$363.80 ,$165.42 ,$363.80 ,$385.20 ,$78.77 ,$355.24 ,$340.26 ,$340.26 ,$78.77 ,$278.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101486,82375,HC CARBON MONOXIDE QN,301,1 ,$221.00 ,$143.65 ,$7.20 ,$221.00 ,$187.85 ,$131.94 ,$12.32 ,$127.08 ,$12.32 ,$152.27 ,$187.85 ,$187.85 ,$187.85 ,$181.22 ,$150.28 ,$12.32 ,$12.32 ,$165.75 ,$156.91 ,$156.91 ,$12.32 ,$156.91 ,$183.43 ,$183.43 ,$183.43 , N/A ,$30.80 ,$187.85 ,$12.32 ,$221.00 ,$7.20 ,$7.20 ,$187.85 ,$25.87 ,$187.85 ,$198.90 ,$12.32 ,$183.43 ,$175.70 ,$175.70 ,$12.32 ,$143.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101509,82330,HC CALCIUM IONIZED STAT -90,301,1 ,$94.00 ,$61.10 ,$7.20 ,$94.00 ,$79.90 ,$56.12 ,$13.68 ,$54.05 ,$13.68 ,$64.77 ,$79.90 ,$79.90 ,$79.90 ,$77.08 ,$63.92 ,$13.68 ,$13.68 ,$70.50 ,$66.74 ,$66.74 ,$13.68 ,$66.74 ,$78.02 ,$78.02 ,$78.02 , N/A ,$34.20 ,$79.90 ,$13.68 ,$94.00 ,$7.20 ,$7.20 ,$79.90 ,$28.73 ,$79.90 ,$84.60 ,$13.68 ,$78.02 ,$74.73 ,$74.73 ,$13.68 ,$61.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101511,80345,HC BARBITURATE -90,301,1 ,$44.00 ,$28.60 ,$7.20 ,$44.00 ,$37.40 ,$26.27 , N/A ,$25.30 , N/A ,$30.32 ,$37.40 ,$37.40 ,$37.40 ,$36.08 ,$29.92 , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.52 ,$36.52 ,$36.52 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$7.20 ,$7.20 ,$37.40 , N/A ,$37.40 ,$39.60 , N/A ,$36.52 ,$34.98 ,$34.98 , N/A ,$28.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101512,80324,HC AMPHETAMINE 1-2 -90,301,1 ,$44.00 ,$28.60 ,$19.38 ,$44.00 ,$37.40 ,$26.27 , N/A ,$25.30 , N/A ,$30.32 ,$37.40 ,$37.40 ,$37.40 ,$36.08 ,$29.92 , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.52 ,$36.52 ,$36.52 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$19.38 ,$19.38 ,$37.40 , N/A ,$37.40 ,$39.60 , N/A ,$36.52 ,$34.98 ,$34.98 , N/A ,$28.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101529,82725,HC FATTY ACIDS NONESTERIFIED-90,301,1 ,$146.00 ,$94.90 ,$7.20 ,$146.00 ,$124.10 ,$87.16 ,$18.77 ,$83.95 ,$18.77 ,$100.59 ,$124.10 ,$124.10 ,$124.10 ,$119.72 ,$99.28 ,$18.77 ,$18.77 ,$109.50 ,$103.66 ,$103.66 ,$18.77 ,$103.66 ,$121.18 ,$121.18 ,$121.18 , N/A ,$46.93 ,$124.10 ,$18.77 ,$146.00 ,$7.20 ,$7.20 ,$124.10 ,$39.42 ,$124.10 ,$131.40 ,$18.77 ,$121.18 ,$116.07 ,$116.07 ,$18.77 ,$94.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101538,83491,HC CORTICOSTEROIDS 17D -90,301,1 ,$65.00 ,$42.25 ,$16.85 ,$65.00 ,$55.25 ,$38.81 ,$17.90 ,$37.38 ,$17.90 ,$44.79 ,$55.25 ,$55.25 ,$55.25 ,$53.30 ,$44.20 ,$17.90 ,$17.90 ,$48.75 ,$46.15 ,$46.15 ,$17.90 ,$46.15 ,$53.95 ,$53.95 ,$53.95 , N/A ,$44.75 ,$55.25 ,$17.90 ,$65.00 ,$16.85 ,$16.85 ,$55.25 ,$37.59 ,$55.25 ,$58.50 ,$17.90 ,$53.95 ,$51.68 ,$51.68 ,$17.90 ,$42.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101540,84163,HC PLASMA PROTEIN-A PREGNANCY ASSOCIATED-90,301,1 ,$163.00 ,$105.95 ,$7.20 ,$163.00 ,$138.55 ,$97.31 ,$15.05 ,$93.73 ,$15.05 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$15.05 ,$15.05 ,$122.25 ,$115.73 ,$115.73 ,$15.05 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$37.63 ,$138.55 ,$15.05 ,$163.00 ,$7.20 ,$7.20 ,$138.55 ,$31.61 ,$138.55 ,$146.70 ,$15.05 ,$135.29 ,$129.59 ,$129.59 ,$15.05 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101543,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$619.00 ,$402.35 ,$6.56 ,$619.00 ,$526.15 ,$369.54 ,$47.63 ,$355.93 ,$47.63 ,$426.49 ,$526.15 ,$526.15 ,$526.15 ,$507.58 ,$420.92 ,$47.63 ,$47.63 ,$464.25 ,$439.49 ,$439.49 ,$47.63 ,$439.49 ,$513.77 ,$513.77 ,$513.77 , N/A ,$119.08 ,$526.15 ,$47.63 ,$619.00 ,$6.56 ,$6.56 ,$526.15 ,$100.02 ,$526.15 ,$557.10 ,$47.63 ,$513.77 ,$492.11 ,$492.11 ,$47.63 ,$402.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101545,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$148.00 ,$96.20 ,$8.26 ,$148.00 ,$125.80 ,$88.36 ,$14.57 ,$85.10 ,$14.57 ,$101.97 ,$125.80 ,$125.80 ,$125.80 ,$121.36 ,$100.64 ,$14.57 ,$14.57 ,$111.00 ,$105.08 ,$105.08 ,$14.57 ,$105.08 ,$122.84 ,$122.84 ,$122.84 , N/A ,$36.43 ,$125.80 ,$14.57 ,$148.00 ,$8.26 ,$8.26 ,$125.80 ,$30.60 ,$125.80 ,$133.20 ,$14.57 ,$122.84 ,$117.66 ,$117.66 ,$14.57 ,$96.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101546,80164,HC VALPROCIC ACID,301,1 ,$147.00 ,$95.55 ,$8.26 ,$147.00 ,$124.95 ,$87.76 ,$13.54 ,$84.53 ,$13.54 ,$101.28 ,$124.95 ,$124.95 ,$124.95 ,$120.54 ,$99.96 ,$13.54 ,$13.54 ,$110.25 ,$104.37 ,$104.37 ,$13.54 ,$104.37 ,$122.01 ,$122.01 ,$122.01 , N/A ,$33.85 ,$124.95 ,$13.54 ,$147.00 ,$8.26 ,$8.26 ,$124.95 ,$28.43 ,$124.95 ,$132.30 ,$13.54 ,$122.01 ,$116.87 ,$116.87 ,$13.54 ,$95.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101548,80178,HC LITHIUM,301,1 ,$99.00 ,$64.35 ,$6.61 ,$99.00 ,$84.15 ,$59.10 ,$6.61 ,$56.93 ,$6.61 ,$68.21 ,$84.15 ,$84.15 ,$84.15 ,$81.18 ,$67.32 ,$6.61 ,$6.61 ,$74.25 ,$70.29 ,$70.29 ,$6.61 ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A ,$16.53 ,$84.15 ,$6.61 ,$99.00 ,$8.26 ,$8.26 ,$84.15 ,$13.88 ,$84.15 ,$89.10 ,$6.61 ,$82.17 ,$78.71 ,$78.71 ,$6.61 ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101549,80184,HC PHENOBARBITAL,301,1 ,$143.00 ,$92.95 ,$8.26 ,$143.00 ,$121.55 ,$85.37 ,$15.30 ,$82.23 ,$15.30 ,$98.53 ,$121.55 ,$121.55 ,$121.55 ,$117.26 ,$97.24 ,$15.30 ,$15.30 ,$107.25 ,$101.53 ,$101.53 ,$15.30 ,$101.53 ,$118.69 ,$118.69 ,$118.69 , N/A ,$38.25 ,$121.55 ,$15.30 ,$143.00 ,$8.26 ,$8.26 ,$121.55 ,$32.13 ,$121.55 ,$128.70 ,$15.30 ,$118.69 ,$113.69 ,$113.69 ,$15.30 ,$92.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101551,80198,HC THEOPHYLLINE,301,1 ,$135.00 ,$87.75 ,$8.26 ,$135.00 ,$114.75 ,$80.60 ,$14.14 ,$77.63 ,$14.14 ,$93.02 ,$114.75 ,$114.75 ,$114.75 ,$110.70 ,$91.80 ,$14.14 ,$14.14 ,$101.25 ,$95.85 ,$95.85 ,$14.14 ,$95.85 ,$112.05 ,$112.05 ,$112.05 , N/A ,$35.35 ,$114.75 ,$14.14 ,$135.00 ,$8.26 ,$8.26 ,$114.75 ,$29.69 ,$114.75 ,$121.50 ,$14.14 ,$112.05 ,$107.33 ,$107.33 ,$14.14 ,$87.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101552,80200,HC TOBRAMYCIN,301,1 ,$134.00 ,$87.10 ,$8.26 ,$134.00 ,$113.90 ,$80.00 ,$16.13 ,$77.05 ,$16.13 ,$92.33 ,$113.90 ,$113.90 ,$113.90 ,$109.88 ,$91.12 ,$16.13 ,$16.13 ,$100.50 ,$95.14 ,$95.14 ,$16.13 ,$95.14 ,$111.22 ,$111.22 ,$111.22 , N/A ,$40.33 ,$113.90 ,$16.13 ,$134.00 ,$8.26 ,$8.26 ,$113.90 ,$33.87 ,$113.90 ,$120.60 ,$16.13 ,$111.22 ,$106.53 ,$106.53 ,$16.13 ,$87.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101555,81479,HC IDH GENE MUTATION ASSAY - 90,301,1 ,$550.00 ,$357.50 ,$25.54 ,$550.00 ,$467.50 ,$328.35 ,$165.00 ,$316.25 , N/A ,$378.95 ,$467.50 ,$467.50 ,$467.50 ,$451.00 ,$374.00 , N/A , N/A ,$412.50 ,$390.50 ,$390.50 , N/A ,$390.50 ,$456.50 ,$456.50 ,$456.50 , N/A , N/A ,$467.50 , N/A ,$550.00 ,$25.54 ,$25.54 ,$467.50 ,$330.00 ,$467.50 ,$495.00 , N/A ,$456.50 ,$437.25 ,$437.25 , N/A ,$357.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101556,82042,HC ALBUMIN OTHER SOURCE,301,1 ,$35.00 ,$22.75 ,$3.20 ,$35.00 ,$29.75 ,$20.90 ,$7.78 ,$20.13 ,$7.78 ,$24.12 ,$29.75 ,$29.75 ,$29.75 ,$28.70 ,$23.80 ,$7.78 ,$7.78 ,$26.25 ,$24.85 ,$24.85 ,$7.78 ,$24.85 ,$29.05 ,$29.05 ,$29.05 , N/A ,$19.45 ,$29.75 ,$7.78 ,$35.00 ,$3.20 ,$3.20 ,$29.75 ,$16.34 ,$29.75 ,$31.50 ,$7.78 ,$29.05 ,$27.83 ,$27.83 ,$7.78 ,$22.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101558,82105,HC ALPHA FETOPROTEIN SERUM,301,1 ,$82.00 ,$53.30 ,$7.20 ,$82.00 ,$69.70 ,$48.95 ,$16.77 ,$47.15 ,$16.77 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$16.77 ,$16.77 ,$61.50 ,$58.22 ,$58.22 ,$16.77 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$41.93 ,$69.70 ,$16.77 ,$82.00 ,$7.20 ,$7.20 ,$69.70 ,$35.22 ,$69.70 ,$73.80 ,$16.77 ,$68.06 ,$65.19 ,$65.19 ,$16.77 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101559,82150,HC AMYLASE,301,1 ,$109.00 ,$70.85 ,$6.48 ,$109.00 ,$92.65 ,$65.07 ,$6.48 ,$62.68 ,$6.48 ,$75.10 ,$92.65 ,$92.65 ,$92.65 ,$89.38 ,$74.12 ,$6.48 ,$6.48 ,$81.75 ,$77.39 ,$77.39 ,$6.48 ,$77.39 ,$90.47 ,$90.47 ,$90.47 , N/A ,$16.20 ,$92.65 ,$6.48 ,$109.00 ,$7.20 ,$7.20 ,$92.65 ,$13.61 ,$92.65 ,$98.10 ,$6.48 ,$90.47 ,$86.66 ,$86.66 ,$6.48 ,$70.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101561,82247,HC BILIRUBIN TOTAL,301,1 ,$51.00 ,$33.15 ,$3.20 ,$51.00 ,$43.35 ,$30.45 ,$5.02 ,$29.33 ,$5.02 ,$35.14 ,$43.35 ,$43.35 ,$43.35 ,$41.82 ,$34.68 ,$5.02 ,$5.02 ,$38.25 ,$36.21 ,$36.21 ,$5.02 ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A ,$12.55 ,$43.35 ,$5.02 ,$51.00 ,$3.20 ,$3.20 ,$43.35 ,$10.54 ,$43.35 ,$45.90 ,$5.02 ,$42.33 ,$40.55 ,$40.55 ,$5.02 ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101562,82248,HC BILIRUBIN DIRECT T1,301,1 ,$69.00 ,$44.85 ,$3.20 ,$69.00 ,$58.65 ,$41.19 ,$5.02 ,$39.68 ,$5.02 ,$47.54 ,$58.65 ,$58.65 ,$58.65 ,$56.58 ,$46.92 ,$5.02 ,$5.02 ,$51.75 ,$48.99 ,$48.99 ,$5.02 ,$48.99 ,$57.27 ,$57.27 ,$57.27 , N/A ,$12.55 ,$58.65 ,$5.02 ,$69.00 ,$3.20 ,$3.20 ,$58.65 ,$10.54 ,$58.65 ,$62.10 ,$5.02 ,$57.27 ,$54.86 ,$54.86 ,$5.02 ,$44.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101565,82310,HC CALCIUM,301,1 ,$70.00 ,$45.50 ,$3.20 ,$70.00 ,$59.50 ,$41.79 ,$5.16 ,$40.25 ,$5.16 ,$48.23 ,$59.50 ,$59.50 ,$59.50 ,$57.40 ,$47.60 ,$5.16 ,$5.16 ,$52.50 ,$49.70 ,$49.70 ,$5.16 ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A ,$12.90 ,$59.50 ,$5.16 ,$70.00 ,$3.20 ,$3.20 ,$59.50 ,$10.84 ,$59.50 ,$63.00 ,$5.16 ,$58.10 ,$55.65 ,$55.65 ,$5.16 ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101566,82340,HC CALCIUM URINE QN TIMED,301,1 ,$153.00 ,$99.45 ,$6.03 ,$153.00 ,$130.05 ,$91.34 ,$6.03 ,$87.98 ,$6.03 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$6.03 ,$6.03 ,$114.75 ,$108.63 ,$108.63 ,$6.03 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$15.08 ,$130.05 ,$6.03 ,$153.00 ,$7.20 ,$7.20 ,$130.05 ,$12.66 ,$130.05 ,$137.70 ,$6.03 ,$126.99 ,$121.64 ,$121.64 ,$6.03 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101568,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$76.00 ,$49.40 ,$7.20 ,$76.00 ,$64.60 ,$45.37 ,$18.96 ,$43.70 ,$18.96 ,$52.36 ,$64.60 ,$64.60 ,$64.60 ,$62.32 ,$51.68 ,$18.96 ,$18.96 ,$57.00 ,$53.96 ,$53.96 ,$18.96 ,$53.96 ,$63.08 ,$63.08 ,$63.08 , N/A ,$47.40 ,$64.60 ,$18.96 ,$76.00 ,$7.20 ,$7.20 ,$64.60 ,$39.82 ,$64.60 ,$68.40 ,$18.96 ,$63.08 ,$60.42 ,$60.42 ,$18.96 ,$49.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101569,82436,HC CHLORIDE URINE,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$5.75 ,$52.90 ,$5.75 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$5.75 ,$5.75 ,$69.00 ,$65.32 ,$65.32 ,$5.75 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$14.38 ,$78.20 ,$5.75 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$12.08 ,$78.20 ,$82.80 ,$5.75 ,$76.36 ,$73.14 ,$73.14 ,$5.75 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101570,82465,HC CHOLESTEROL,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$4.35 ,$52.90 ,$4.35 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$4.35 ,$4.35 ,$69.00 ,$65.32 ,$65.32 ,$4.35 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$10.88 ,$78.20 ,$4.35 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$9.14 ,$78.20 ,$82.80 ,$4.35 ,$76.36 ,$73.14 ,$73.14 ,$4.35 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101571,82533,HC CORTISOL TOTAL,301,1 ,$91.00 ,$59.15 ,$16.30 ,$91.00 ,$77.35 ,$54.33 ,$16.30 ,$52.33 ,$16.30 ,$62.70 ,$77.35 ,$77.35 ,$77.35 ,$74.62 ,$61.88 ,$16.30 ,$16.30 ,$68.25 ,$64.61 ,$64.61 ,$16.30 ,$64.61 ,$75.53 ,$75.53 ,$75.53 , N/A ,$40.75 ,$77.35 ,$16.30 ,$91.00 ,$16.85 ,$16.85 ,$77.35 ,$34.23 ,$77.35 ,$81.90 ,$16.30 ,$75.53 ,$72.35 ,$72.35 ,$16.30 ,$59.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101572,82570,HC CREATININE OTH SOURCE,301,1 ,$84.00 ,$54.60 ,$3.20 ,$84.00 ,$71.40 ,$50.15 ,$5.18 ,$48.30 ,$5.18 ,$57.88 ,$71.40 ,$71.40 ,$71.40 ,$68.88 ,$57.12 ,$5.18 ,$5.18 ,$63.00 ,$59.64 ,$59.64 ,$5.18 ,$59.64 ,$69.72 ,$69.72 ,$69.72 , N/A ,$12.95 ,$71.40 ,$5.18 ,$84.00 ,$3.20 ,$3.20 ,$71.40 ,$10.88 ,$71.40 ,$75.60 ,$5.18 ,$69.72 ,$66.78 ,$66.78 ,$5.18 ,$54.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101573,82607,HC VITAMIN B12,301,1 ,$110.00 ,$71.50 ,$9.69 ,$110.00 ,$93.50 ,$65.67 ,$15.08 ,$63.25 ,$15.08 ,$75.79 ,$93.50 ,$93.50 ,$93.50 ,$90.20 ,$74.80 ,$15.08 ,$15.08 ,$82.50 ,$78.10 ,$78.10 ,$15.08 ,$78.10 ,$91.30 ,$91.30 ,$91.30 , N/A ,$37.70 ,$93.50 ,$15.08 ,$110.00 ,$9.69 ,$9.69 ,$93.50 ,$31.67 ,$93.50 ,$99.00 ,$15.08 ,$91.30 ,$87.45 ,$87.45 ,$15.08 ,$71.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101575,82728,HC FERRITIN,301,1 ,$126.00 ,$81.90 ,$7.20 ,$126.00 ,$107.10 ,$75.22 ,$13.63 ,$72.45 ,$13.63 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$103.32 ,$85.68 ,$13.63 ,$13.63 ,$94.50 ,$89.46 ,$89.46 ,$13.63 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$34.08 ,$107.10 ,$13.63 ,$126.00 ,$7.20 ,$7.20 ,$107.10 ,$28.62 ,$107.10 ,$113.40 ,$13.63 ,$104.58 ,$100.17 ,$100.17 ,$13.63 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101577,82746,HC FOLIC ACID SERUM,301,1 ,$126.00 ,$81.90 ,$7.20 ,$126.00 ,$107.10 ,$75.22 ,$14.70 ,$72.45 ,$14.70 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$103.32 ,$85.68 ,$14.70 ,$14.70 ,$94.50 ,$89.46 ,$89.46 ,$14.70 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$36.75 ,$107.10 ,$14.70 ,$126.00 ,$7.20 ,$7.20 ,$107.10 ,$30.87 ,$107.10 ,$113.40 ,$14.70 ,$104.58 ,$100.17 ,$100.17 ,$14.70 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101581,82945,HC GLUCOSE BODY FLUID,301,1 ,$74.00 ,$48.10 ,$3.20 ,$74.00 ,$62.90 ,$44.18 ,$3.93 ,$42.55 ,$3.93 ,$50.99 ,$62.90 ,$62.90 ,$62.90 ,$60.68 ,$50.32 ,$3.93 ,$3.93 ,$55.50 ,$52.54 ,$52.54 ,$3.93 ,$52.54 ,$61.42 ,$61.42 ,$61.42 , N/A ,$9.83 ,$62.90 ,$3.93 ,$74.00 ,$3.20 ,$3.20 ,$62.90 ,$8.25 ,$62.90 ,$66.60 ,$3.93 ,$61.42 ,$58.83 ,$58.83 ,$3.93 ,$48.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101584,82977,HC GGT / GGTP,301,1 ,$114.00 ,$74.10 ,$3.20 ,$114.00 ,$96.90 ,$68.06 ,$7.20 ,$65.55 ,$7.20 ,$78.55 ,$96.90 ,$96.90 ,$96.90 ,$93.48 ,$77.52 ,$7.20 ,$7.20 ,$85.50 ,$80.94 ,$80.94 ,$7.20 ,$80.94 ,$94.62 ,$94.62 ,$94.62 , N/A ,$18.00 ,$96.90 ,$7.20 ,$114.00 ,$3.20 ,$3.20 ,$96.90 ,$15.12 ,$96.90 ,$102.60 ,$7.20 ,$94.62 ,$90.63 ,$90.63 ,$7.20 ,$74.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101585,83001,HC FSH,301,1 ,$138.00 ,$89.70 ,$16.85 ,$138.00 ,$117.30 ,$82.39 ,$18.58 ,$79.35 ,$18.58 ,$95.08 ,$117.30 ,$117.30 ,$117.30 ,$113.16 ,$93.84 ,$18.58 ,$18.58 ,$103.50 ,$97.98 ,$97.98 ,$18.58 ,$97.98 ,$114.54 ,$114.54 ,$114.54 , N/A ,$46.45 ,$117.30 ,$18.58 ,$138.00 ,$16.85 ,$16.85 ,$117.30 ,$39.02 ,$117.30 ,$124.20 ,$18.58 ,$114.54 ,$109.71 ,$109.71 ,$18.58 ,$89.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101586,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$138.00 ,$89.70 ,$16.85 ,$138.00 ,$117.30 ,$82.39 ,$18.52 ,$79.35 ,$18.52 ,$95.08 ,$117.30 ,$117.30 ,$117.30 ,$113.16 ,$93.84 ,$18.52 ,$18.52 ,$103.50 ,$97.98 ,$97.98 ,$18.52 ,$97.98 ,$114.54 ,$114.54 ,$114.54 , N/A ,$46.30 ,$117.30 ,$18.52 ,$138.00 ,$16.85 ,$16.85 ,$117.30 ,$38.89 ,$117.30 ,$124.20 ,$18.52 ,$114.54 ,$109.71 ,$109.71 ,$18.52 ,$89.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101587,83010,HC HAPTOGLOBIN,301,1 ,$81.00 ,$52.65 ,$7.20 ,$81.00 ,$68.85 ,$48.36 ,$12.58 ,$46.58 ,$12.58 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$12.58 ,$12.58 ,$60.75 ,$57.51 ,$57.51 ,$12.58 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$31.45 ,$68.85 ,$12.58 ,$81.00 ,$7.20 ,$7.20 ,$68.85 ,$26.42 ,$68.85 ,$72.90 ,$12.58 ,$67.23 ,$64.40 ,$64.40 ,$12.58 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30101590,83036,HC GLYCOSYLATED HGB,301,1 ,$123.00 ,$79.95 ,$7.20 ,$123.00 ,$104.55 ,$73.43 ,$9.71 ,$70.73 ,$9.71 ,$84.75 ,$104.55 ,$104.55 ,$104.55 ,$100.86 ,$83.64 ,$9.71 ,$9.71 ,$92.25 ,$87.33 ,$87.33 ,$9.71 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$24.28 ,$104.55 ,$9.71 ,$123.00 ,$7.20 ,$7.20 ,$104.55 ,$20.39 ,$104.55 ,$110.70 ,$9.71 ,$102.09 ,$97.79 ,$97.79 ,$9.71 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,30101592,83540,HC IRON TOTAL,301,1 ,$104.00 ,$67.60 ,$3.20 ,$104.00 ,$88.40 ,$62.09 ,$6.47 ,$59.80 ,$6.47 ,$71.66 ,$88.40 ,$88.40 ,$88.40 ,$85.28 ,$70.72 ,$6.47 ,$6.47 ,$78.00 ,$73.84 ,$73.84 ,$6.47 ,$73.84 ,$86.32 ,$86.32 ,$86.32 , N/A ,$16.18 ,$88.40 ,$6.47 ,$104.00 ,$3.20 ,$3.20 ,$88.40 ,$13.59 ,$88.40 ,$93.60 ,$6.47 ,$86.32 ,$82.68 ,$82.68 ,$6.47 ,$67.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101593,83550,HC IRON BINDING CAPACITY,301,1 ,$138.00 ,$89.70 ,$7.20 ,$138.00 ,$117.30 ,$82.39 ,$8.74 ,$79.35 ,$8.74 ,$95.08 ,$117.30 ,$117.30 ,$117.30 ,$113.16 ,$93.84 ,$8.74 ,$8.74 ,$103.50 ,$97.98 ,$97.98 ,$8.74 ,$97.98 ,$114.54 ,$114.54 ,$114.54 , N/A ,$21.85 ,$117.30 ,$8.74 ,$138.00 ,$7.20 ,$7.20 ,$117.30 ,$18.35 ,$117.30 ,$124.20 ,$8.74 ,$114.54 ,$109.71 ,$109.71 ,$8.74 ,$89.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$88.00 ,$57.20 ,$3.20 ,$88.00 ,$74.80 ,$52.54 ,$6.04 ,$50.60 ,$6.04 ,$60.63 ,$74.80 ,$74.80 ,$74.80 ,$72.16 ,$59.84 ,$6.04 ,$6.04 ,$66.00 ,$62.48 ,$62.48 ,$6.04 ,$62.48 ,$73.04 ,$73.04 ,$73.04 , N/A ,$15.10 ,$74.80 ,$6.04 ,$88.00 ,$3.20 ,$3.20 ,$74.80 ,$12.68 ,$74.80 ,$79.20 ,$6.04 ,$73.04 ,$69.96 ,$69.96 ,$6.04 ,$57.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101595,83690,HC LIPASE,301,1 ,$102.00 ,$66.30 ,$3.20 ,$102.00 ,$86.70 ,$60.89 ,$6.89 ,$58.65 ,$6.89 ,$70.28 ,$86.70 ,$86.70 ,$86.70 ,$83.64 ,$69.36 ,$6.89 ,$6.89 ,$76.50 ,$72.42 ,$72.42 ,$6.89 ,$72.42 ,$84.66 ,$84.66 ,$84.66 , N/A ,$17.23 ,$86.70 ,$6.89 ,$102.00 ,$3.20 ,$3.20 ,$86.70 ,$14.47 ,$86.70 ,$91.80 ,$6.89 ,$84.66 ,$81.09 ,$81.09 ,$6.89 ,$66.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101598,83930,HC OSMOLALITY BLOOD,301,1 ,$56.00 ,$36.40 ,$3.20 ,$56.00 ,$47.60 ,$33.43 ,$6.61 ,$32.20 ,$6.61 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$6.61 ,$6.61 ,$42.00 ,$39.76 ,$39.76 ,$6.61 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$16.53 ,$47.60 ,$6.61 ,$56.00 ,$3.20 ,$3.20 ,$47.60 ,$13.88 ,$47.60 ,$50.40 ,$6.61 ,$46.48 ,$44.52 ,$44.52 ,$6.61 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101599,83935,HC OSMOLALITY URINE,301,1 ,$73.00 ,$47.45 ,$3.20 ,$73.00 ,$62.05 ,$43.58 ,$6.82 ,$41.98 ,$6.82 ,$50.30 ,$62.05 ,$62.05 ,$62.05 ,$59.86 ,$49.64 ,$6.82 ,$6.82 ,$54.75 ,$51.83 ,$51.83 ,$6.82 ,$51.83 ,$60.59 ,$60.59 ,$60.59 , N/A ,$17.05 ,$62.05 ,$6.82 ,$73.00 ,$3.20 ,$3.20 ,$62.05 ,$14.32 ,$62.05 ,$65.70 ,$6.82 ,$60.59 ,$58.04 ,$58.04 ,$6.82 ,$47.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101600,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$92.00 ,$59.80 ,$16.85 ,$92.00 ,$78.20 ,$54.92 ,$41.28 ,$52.90 ,$41.28 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$41.28 ,$41.28 ,$69.00 ,$65.32 ,$65.32 ,$41.28 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$92.00 ,$78.20 ,$41.28 ,$92.00 ,$16.85 ,$16.85 ,$78.20 ,$86.69 ,$78.20 ,$82.80 ,$41.28 ,$76.36 ,$73.14 ,$73.14 ,$41.28 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101601,84075,HC ALKALINE PHOSPHATASE,301,1 ,$51.00 ,$33.15 ,$3.20 ,$51.00 ,$43.35 ,$30.45 ,$5.18 ,$29.33 ,$5.18 ,$35.14 ,$43.35 ,$43.35 ,$43.35 ,$41.82 ,$34.68 ,$5.18 ,$5.18 ,$38.25 ,$36.21 ,$36.21 ,$5.18 ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A ,$12.95 ,$43.35 ,$5.18 ,$51.00 ,$3.20 ,$3.20 ,$43.35 ,$10.88 ,$43.35 ,$45.90 ,$5.18 ,$42.33 ,$40.55 ,$40.55 ,$5.18 ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101602,84105,HC PHOSPHORUS UR,301,1 ,$153.00 ,$99.45 ,$3.20 ,$153.00 ,$130.05 ,$91.34 ,$5.78 ,$87.98 ,$5.78 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$5.78 ,$5.78 ,$114.75 ,$108.63 ,$108.63 ,$5.78 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$14.45 ,$130.05 ,$5.78 ,$153.00 ,$3.20 ,$3.20 ,$130.05 ,$12.14 ,$130.05 ,$137.70 ,$5.78 ,$126.99 ,$121.64 ,$121.64 ,$5.78 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101603,84112,HC EVAL C/V AMNIOTIC FLD QL EA,301,1 ,$213.00 ,$138.45 ,$19.38 ,$213.00 ,$181.05 ,$127.16 ,$98.11 ,$122.48 ,$98.11 ,$146.76 ,$181.05 ,$181.05 ,$181.05 ,$174.66 ,$144.84 ,$98.11 ,$98.11 ,$159.75 ,$151.23 ,$151.23 ,$98.11 ,$151.23 ,$176.79 ,$176.79 ,$176.79 , N/A ,$213.00 ,$181.05 ,$98.11 ,$213.00 ,$19.38 ,$19.38 ,$181.05 ,$206.03 ,$181.05 ,$191.70 ,$98.11 ,$176.79 ,$169.34 ,$169.34 ,$98.11 ,$138.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101604,84133,HC POTASSIUM UR,301,1 ,$80.00 ,$52.00 ,$3.20 ,$80.00 ,$68.00 ,$47.76 ,$4.73 ,$46.00 ,$4.73 ,$55.12 ,$68.00 ,$68.00 ,$68.00 ,$65.60 ,$54.40 ,$4.73 ,$4.73 ,$60.00 ,$56.80 ,$56.80 ,$4.73 ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A ,$11.83 ,$68.00 ,$4.73 ,$80.00 ,$3.20 ,$3.20 ,$68.00 ,$9.93 ,$68.00 ,$72.00 ,$4.73 ,$66.40 ,$63.60 ,$63.60 ,$4.73 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101605,84134,HC PREALBUMIN,301,1 ,$153.00 ,$99.45 ,$7.20 ,$153.00 ,$130.05 ,$91.34 ,$14.59 ,$87.98 ,$14.59 ,$105.42 ,$130.05 ,$130.05 ,$130.05 ,$125.46 ,$104.04 ,$14.59 ,$14.59 ,$114.75 ,$108.63 ,$108.63 ,$14.59 ,$108.63 ,$126.99 ,$126.99 ,$126.99 , N/A ,$36.48 ,$130.05 ,$14.59 ,$153.00 ,$7.20 ,$7.20 ,$130.05 ,$30.64 ,$130.05 ,$137.70 ,$14.59 ,$126.99 ,$121.64 ,$121.64 ,$14.59 ,$99.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101607,84145,HC PROCALCITONIN (PCT),301,1 ,$87.00 ,$56.55 ,$16.85 ,$87.00 ,$73.95 ,$51.94 ,$27.22 ,$50.03 ,$27.22 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$27.22 ,$27.22 ,$65.25 ,$61.77 ,$61.77 ,$27.22 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$68.05 ,$73.95 ,$27.22 ,$87.00 ,$16.85 ,$16.85 ,$73.95 ,$57.16 ,$73.95 ,$78.30 ,$27.22 ,$72.21 ,$69.17 ,$69.17 ,$27.22 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101608,84146,HC PROLACTIN,301,1 ,$86.00 ,$55.90 ,$16.85 ,$86.00 ,$73.10 ,$51.34 ,$19.38 ,$49.45 ,$19.38 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$19.38 ,$19.38 ,$64.50 ,$61.06 ,$61.06 ,$19.38 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$48.45 ,$73.10 ,$19.38 ,$86.00 ,$16.85 ,$16.85 ,$73.10 ,$40.70 ,$73.10 ,$77.40 ,$19.38 ,$71.38 ,$68.37 ,$68.37 ,$19.38 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30101609,84153,HC PSA TOTAL,301,1 ,$191.00 ,$124.15 ,$7.20 ,$191.00 ,$162.35 ,$114.03 ,$18.39 ,$109.83 ,$18.39 ,$131.60 ,$162.35 ,$162.35 ,$162.35 ,$156.62 ,$129.88 ,$18.39 ,$18.39 ,$143.25 ,$135.61 ,$135.61 ,$18.39 ,$135.61 ,$158.53 ,$158.53 ,$158.53 , N/A ,$45.98 ,$162.35 ,$18.39 ,$191.00 ,$7.20 ,$7.20 ,$162.35 ,$38.62 ,$162.35 ,$171.90 ,$18.39 ,$158.53 ,$151.85 ,$151.85 ,$18.39 ,$124.15 
ST. JOSEPH'S HOSPITAL - BREESE,30101610,84154,HC PSA FREE,301,1 ,$125.00 ,$81.25 ,$7.20 ,$125.00 ,$106.25 ,$74.63 ,$18.39 ,$71.88 ,$18.39 ,$86.13 ,$106.25 ,$106.25 ,$106.25 ,$102.50 ,$85.00 ,$18.39 ,$18.39 ,$93.75 ,$88.75 ,$88.75 ,$18.39 ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A ,$45.98 ,$106.25 ,$18.39 ,$125.00 ,$7.20 ,$7.20 ,$106.25 ,$38.62 ,$106.25 ,$112.50 ,$18.39 ,$103.75 ,$99.38 ,$99.38 ,$18.39 ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101613,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$80.00 ,$52.00 ,$3.20 ,$80.00 ,$68.00 ,$47.76 ,$4.00 ,$46.00 ,$4.00 ,$55.12 ,$68.00 ,$68.00 ,$68.00 ,$65.60 ,$54.40 ,$4.00 ,$4.00 ,$60.00 ,$56.80 ,$56.80 ,$4.00 ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A ,$10.00 ,$68.00 ,$4.00 ,$80.00 ,$3.20 ,$3.20 ,$68.00 ,$8.40 ,$68.00 ,$72.00 ,$4.00 ,$66.40 ,$63.60 ,$63.60 ,$4.00 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101617,84300,HC SODIUM URINE,301,1 ,$92.00 ,$59.80 ,$3.20 ,$92.00 ,$78.20 ,$54.92 ,$5.06 ,$52.90 ,$5.06 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$5.06 ,$5.06 ,$69.00 ,$65.32 ,$65.32 ,$5.06 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$12.65 ,$78.20 ,$5.06 ,$92.00 ,$3.20 ,$3.20 ,$78.20 ,$10.63 ,$78.20 ,$82.80 ,$5.06 ,$76.36 ,$73.14 ,$73.14 ,$5.06 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101618,84302,HC SODIUM OTHER FLUID,301,1 ,$14.00 ,$9.10 ,$3.20 ,$14.00 ,$11.90 ,$8.36 ,$4.86 ,$8.05 ,$4.86 ,$9.65 ,$11.90 ,$11.90 ,$11.90 ,$11.48 ,$9.52 ,$4.86 ,$4.86 ,$10.50 ,$9.94 ,$9.94 ,$4.86 ,$9.94 ,$11.62 ,$11.62 ,$11.62 , N/A ,$12.15 ,$11.90 ,$4.86 ,$14.00 ,$3.20 ,$3.20 ,$11.90 ,$10.21 ,$11.90 ,$12.60 ,$4.86 ,$11.62 ,$11.13 ,$11.13 ,$4.86 ,$9.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101620,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$97.00 ,$63.05 ,$6.87 ,$97.00 ,$82.45 ,$57.91 ,$6.87 ,$55.78 ,$6.87 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$6.87 ,$6.87 ,$72.75 ,$68.87 ,$68.87 ,$6.87 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$17.18 ,$82.45 ,$6.87 ,$97.00 ,$9.69 ,$9.69 ,$82.45 ,$14.43 ,$82.45 ,$87.30 ,$6.87 ,$80.51 ,$77.12 ,$77.12 ,$6.87 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101621,84450,HC AST,301,1 ,$82.00 ,$53.30 ,$3.20 ,$82.00 ,$69.70 ,$48.95 ,$5.18 ,$47.15 ,$5.18 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$5.18 ,$5.18 ,$61.50 ,$58.22 ,$58.22 ,$5.18 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$12.95 ,$69.70 ,$5.18 ,$82.00 ,$3.20 ,$3.20 ,$69.70 ,$10.88 ,$69.70 ,$73.80 ,$5.18 ,$68.06 ,$65.19 ,$65.19 ,$5.18 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101622,84466,HC TRANSFERRIN,301,1 ,$87.00 ,$56.55 ,$7.20 ,$87.00 ,$73.95 ,$51.94 ,$12.76 ,$50.03 ,$12.76 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$12.76 ,$12.76 ,$65.25 ,$61.77 ,$61.77 ,$12.76 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$31.90 ,$73.95 ,$12.76 ,$87.00 ,$7.20 ,$7.20 ,$73.95 ,$26.80 ,$73.95 ,$78.30 ,$12.76 ,$72.21 ,$69.17 ,$69.17 ,$12.76 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101623,84478,HC TRIGLYCERIDES,301,1 ,$77.00 ,$50.05 ,$3.20 ,$77.00 ,$65.45 ,$45.97 ,$5.74 ,$44.28 ,$5.74 ,$53.05 ,$65.45 ,$65.45 ,$65.45 ,$63.14 ,$52.36 ,$5.74 ,$5.74 ,$57.75 ,$54.67 ,$54.67 ,$5.74 ,$54.67 ,$63.91 ,$63.91 ,$63.91 , N/A ,$14.35 ,$65.45 ,$5.74 ,$77.00 ,$3.20 ,$3.20 ,$65.45 ,$12.05 ,$65.45 ,$69.30 ,$5.74 ,$63.91 ,$61.22 ,$61.22 ,$5.74 ,$50.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101626,84520,HC BUN,301,1 ,$56.00 ,$36.40 ,$3.20 ,$56.00 ,$47.60 ,$33.43 ,$3.95 ,$32.20 ,$3.95 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$3.95 ,$3.95 ,$42.00 ,$39.76 ,$39.76 ,$3.95 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$9.88 ,$47.60 ,$3.95 ,$3.95 ,$3.20 ,$3.20 ,$47.60 ,$8.30 ,$47.60 ,$50.40 ,$3.95 ,$46.48 ,$44.52 ,$44.52 ,$3.95 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101627,84540,HC UREA URINE,301,1 ,$102.00 ,$66.30 ,$3.20 ,$102.00 ,$86.70 ,$60.89 ,$5.56 ,$58.65 ,$5.56 ,$70.28 ,$86.70 ,$86.70 ,$86.70 ,$83.64 ,$69.36 ,$5.56 ,$5.56 ,$76.50 ,$72.42 ,$72.42 ,$5.56 ,$72.42 ,$84.66 ,$84.66 ,$84.66 , N/A ,$13.90 ,$86.70 ,$5.56 ,$102.00 ,$3.20 ,$3.20 ,$86.70 ,$11.68 ,$86.70 ,$91.80 ,$5.56 ,$84.66 ,$81.09 ,$81.09 ,$5.56 ,$66.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101628,84560,HC URIC ACID OTH SRC,301,1 ,$52.00 ,$33.80 ,$3.20 ,$52.00 ,$44.20 ,$31.04 ,$5.08 ,$29.90 ,$5.08 ,$35.83 ,$44.20 ,$44.20 ,$44.20 ,$42.64 ,$35.36 ,$5.08 ,$5.08 ,$39.00 ,$36.92 ,$36.92 ,$5.08 ,$36.92 ,$43.16 ,$43.16 ,$43.16 , N/A ,$12.70 ,$44.20 ,$5.08 ,$52.00 ,$3.20 ,$3.20 ,$44.20 ,$10.67 ,$44.20 ,$46.80 ,$5.08 ,$43.16 ,$41.34 ,$41.34 ,$5.08 ,$33.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101630,84702,HC HCG QN,301,1 ,$167.00 ,$108.55 ,$9.69 ,$167.00 ,$141.95 ,$99.70 ,$15.05 ,$96.03 ,$15.05 ,$115.06 ,$141.95 ,$141.95 ,$141.95 ,$136.94 ,$113.56 ,$15.05 ,$15.05 ,$125.25 ,$118.57 ,$118.57 ,$15.05 ,$118.57 ,$138.61 ,$138.61 ,$138.61 , N/A ,$37.63 ,$141.95 ,$15.05 ,$167.00 ,$9.69 ,$9.69 ,$141.95 ,$31.61 ,$141.95 ,$150.30 ,$15.05 ,$138.61 ,$132.77 ,$132.77 ,$15.05 ,$108.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101636,83735,HC MAGNESIUM,301,1 ,$79.00 ,$51.35 ,$3.20 ,$79.00 ,$67.15 ,$47.16 ,$6.70 ,$45.43 ,$6.70 ,$54.43 ,$67.15 ,$67.15 ,$67.15 ,$64.78 ,$53.72 ,$6.70 ,$6.70 ,$59.25 ,$56.09 ,$56.09 ,$6.70 ,$56.09 ,$65.57 ,$65.57 ,$65.57 , N/A ,$16.75 ,$67.15 ,$6.70 ,$79.00 ,$3.20 ,$3.20 ,$67.15 ,$14.07 ,$67.15 ,$71.10 ,$6.70 ,$65.57 ,$62.81 ,$62.81 ,$6.70 ,$51.35 
ST. JOSEPH'S HOSPITAL - BREESE,30101638,84100,HC PHOSPHORUS,301,1 ,$97.00 ,$63.05 ,$3.20 ,$97.00 ,$82.45 ,$57.91 ,$4.74 ,$55.78 ,$4.74 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$4.74 ,$4.74 ,$72.75 ,$68.87 ,$68.87 ,$4.74 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$11.85 ,$82.45 ,$4.74 ,$97.00 ,$3.20 ,$3.20 ,$82.45 ,$9.95 ,$82.45 ,$87.30 ,$4.74 ,$80.51 ,$77.12 ,$77.12 ,$4.74 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,30101643,81596,HC CHRONIC HEP C VIRUS ASSAYS-90,301,1 ,$532.00 ,$345.80 ,$25.54 ,$532.00 ,$452.20 ,$317.60 ,$72.19 ,$305.90 ,$72.19 ,$366.55 ,$452.20 ,$452.20 ,$452.20 ,$436.24 ,$361.76 ,$72.19 ,$72.19 ,$399.00 ,$377.72 ,$377.72 ,$72.19 ,$377.72 ,$441.56 ,$441.56 ,$441.56 , N/A ,$180.48 ,$452.20 ,$72.19 ,$532.00 ,$25.54 ,$25.54 ,$452.20 ,$151.60 ,$452.20 ,$478.80 ,$72.19 ,$441.56 ,$422.94 ,$422.94 ,$72.19 ,$345.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101648,83664,HC LAMELLAR BODY CT,301,1 ,$29.00 ,$18.85 ,$16.68 ,$40.57 ,$24.65 ,$17.31 ,$19.32 ,$16.68 ,$19.32 ,$19.98 ,$24.65 ,$24.65 ,$24.65 ,$23.78 ,$19.72 ,$19.32 ,$19.32 ,$21.75 ,$20.59 ,$20.59 ,$19.32 ,$20.59 ,$24.07 ,$24.07 ,$24.07 , N/A ,$29.00 ,$24.65 ,$19.32 ,$29.00 ,$20.56 ,$20.56 ,$24.65 ,$40.57 ,$24.65 ,$26.10 ,$19.32 ,$24.07 ,$23.06 ,$23.06 ,$19.32 ,$18.85 
ST. JOSEPH'S HOSPITAL - BREESE,30101653,82642,HC DIHYDROTESTOSTERONE-90,301,1 ,$336.00 ,$218.40 ,$9.69 ,$336.00 ,$285.60 ,$200.59 ,$29.28 ,$193.20 ,$29.28 ,$231.50 ,$285.60 ,$285.60 ,$285.60 ,$275.52 ,$228.48 ,$29.28 ,$29.28 ,$252.00 ,$238.56 ,$238.56 ,$29.28 ,$238.56 ,$278.88 ,$278.88 ,$278.88 , N/A ,$73.20 ,$285.60 ,$29.28 ,$336.00 ,$9.69 ,$9.69 ,$285.60 ,$61.49 ,$285.60 ,$302.40 ,$29.28 ,$278.88 ,$267.12 ,$267.12 ,$29.28 ,$218.40 
ST. JOSEPH'S HOSPITAL - BREESE,30101656,N/A,HC HEALTH FAIR HEMOGLOBIN A1C,301,1 ,$10.00 ,$6.50 ,$5.75 ,$10.00 ,$8.50 ,$5.97 , N/A ,$5.75 , N/A ,$6.89 ,$8.50 ,$8.50 ,$8.50 , N/A ,$6.80 , N/A , N/A ,$7.50 ,$7.10 ,$7.10 , N/A ,$7.10 ,$8.30 ,$8.30 ,$8.30 , N/A , N/A ,$8.50 , N/A ,$10.00 , N/A , N/A ,$8.50 , N/A ,$8.50 ,$9.00 , N/A ,$8.30 ,$7.95 ,$7.95 , N/A ,$6.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101657,N/A,HC HEALTH FAIR TOTAL PSA SCREEN,301,1 ,$15.00 ,$9.75 ,$8.63 ,$15.00 ,$12.75 ,$8.96 , N/A ,$8.63 , N/A ,$10.34 ,$12.75 ,$12.75 ,$12.75 , N/A ,$10.20 , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.45 ,$12.45 ,$12.45 , N/A , N/A ,$12.75 , N/A ,$15.00 , N/A , N/A ,$12.75 , N/A ,$12.75 ,$13.50 , N/A ,$12.45 ,$11.93 ,$11.93 , N/A ,$9.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101658,N/A,HC HEALTH FAIR VITAMIN D 25-OH,301,1 ,$15.00 ,$9.75 ,$8.63 ,$15.00 ,$12.75 ,$8.96 , N/A ,$8.63 , N/A ,$10.34 ,$12.75 ,$12.75 ,$12.75 , N/A ,$10.20 , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.45 ,$12.45 ,$12.45 , N/A , N/A ,$12.75 , N/A ,$15.00 , N/A , N/A ,$12.75 , N/A ,$12.75 ,$13.50 , N/A ,$12.45 ,$11.93 ,$11.93 , N/A ,$9.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101660,N/A,HC HEALTH FAIR LAB PANEL,301,1 ,$45.00 ,$29.25 ,$25.88 ,$45.00 ,$38.25 ,$26.87 , N/A ,$25.88 , N/A ,$31.01 ,$38.25 ,$38.25 ,$38.25 , N/A ,$30.60 , N/A , N/A ,$33.75 ,$31.95 ,$31.95 , N/A ,$31.95 ,$37.35 ,$37.35 ,$37.35 , N/A , N/A ,$38.25 , N/A ,$45.00 , N/A , N/A ,$38.25 , N/A ,$38.25 ,$40.50 , N/A ,$37.35 ,$35.78 ,$35.78 , N/A ,$29.25 
ST. JOSEPH'S HOSPITAL - BREESE,30101661,N/A,HC HEALTH FAIR LIPID W/CALC LDL,301,1 ,$15.00 ,$9.75 ,$8.63 ,$15.00 ,$12.75 ,$8.96 , N/A ,$8.63 , N/A ,$10.34 ,$12.75 ,$12.75 ,$12.75 , N/A ,$10.20 , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.45 ,$12.45 ,$12.45 , N/A , N/A ,$12.75 , N/A ,$15.00 , N/A , N/A ,$12.75 , N/A ,$12.75 ,$13.50 , N/A ,$12.45 ,$11.93 ,$11.93 , N/A ,$9.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101662,N/A,HC HEALTH FAIR OCCULT BLOOD FECAL SCREEN,301,1 ,$15.00 ,$9.75 ,$8.63 ,$15.00 ,$12.75 ,$8.96 , N/A ,$8.63 , N/A ,$10.34 ,$12.75 ,$12.75 ,$12.75 , N/A ,$10.20 , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.45 ,$12.45 ,$12.45 , N/A , N/A ,$12.75 , N/A ,$15.00 , N/A , N/A ,$12.75 , N/A ,$12.75 ,$13.50 , N/A ,$12.45 ,$11.93 ,$11.93 , N/A ,$9.75 
ST. JOSEPH'S HOSPITAL - BREESE,30101674,82978,HC GLUTATHIONE-90,301,1 ,$92.00 ,$59.80 ,$7.20 ,$92.00 ,$78.20 ,$54.92 ,$15.45 ,$52.90 ,$15.45 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$15.45 ,$15.45 ,$69.00 ,$65.32 ,$65.32 ,$15.45 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$38.63 ,$78.20 ,$15.45 ,$92.00 ,$7.20 ,$7.20 ,$78.20 ,$32.45 ,$78.20 ,$82.80 ,$15.45 ,$76.36 ,$73.14 ,$73.14 ,$15.45 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101678,83516,HC FLUOR AB SCR AQUAPORIN 4-90,301,1 ,$880.00 ,$572.00 ,$6.45 ,$880.00 ,$748.00 ,$525.36 ,$11.53 ,$506.00 ,$11.53 ,$606.32 ,$748.00 ,$748.00 ,$748.00 ,$721.60 ,$598.40 ,$11.53 ,$11.53 ,$660.00 ,$624.80 ,$624.80 ,$11.53 ,$624.80 ,$730.40 ,$730.40 ,$730.40 , N/A ,$28.83 ,$748.00 ,$11.53 ,$880.00 ,$6.45 ,$6.45 ,$748.00 ,$24.21 ,$748.00 ,$792.00 ,$11.53 ,$730.40 ,$699.60 ,$699.60 ,$11.53 ,$572.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101685,80235,HC LACOSAMIDE -90,301,1 ,$147.00 ,$95.55 ,$8.26 ,$147.00 ,$124.95 ,$87.76 ,$27.11 ,$84.53 ,$27.11 ,$101.28 ,$124.95 ,$124.95 ,$124.95 ,$120.54 ,$99.96 ,$27.11 ,$27.11 ,$110.25 ,$104.37 ,$104.37 ,$27.11 ,$104.37 ,$122.01 ,$122.01 ,$122.01 , N/A ,$67.78 ,$124.95 ,$27.11 ,$147.00 ,$8.26 ,$8.26 ,$124.95 ,$56.93 ,$124.95 ,$132.30 ,$27.11 ,$122.01 ,$116.87 ,$116.87 ,$27.11 ,$95.55 
ST. JOSEPH'S HOSPITAL - BREESE,30101692,80366,HC DRUG SCREEN PREGABALIN-90,301,1 ,$204.00 ,$132.60 ,$7.20 ,$204.00 ,$173.40 ,$121.79 , N/A ,$117.30 , N/A ,$140.56 ,$173.40 ,$173.40 ,$173.40 ,$167.28 ,$138.72 , N/A , N/A ,$153.00 ,$144.84 ,$144.84 , N/A ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A , N/A ,$173.40 , N/A ,$204.00 ,$7.20 ,$7.20 ,$173.40 , N/A ,$173.40 ,$183.60 , N/A ,$169.32 ,$162.18 ,$162.18 , N/A ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,30101703,80299,HC HYPOGLYCEMIC PANEL-90,301,1 ,$393.00 ,$255.45 ,$8.26 ,$393.00 ,$334.05 ,$234.62 ,$18.64 ,$225.98 ,$18.64 ,$270.78 ,$334.05 ,$334.05 ,$334.05 ,$322.26 ,$267.24 ,$18.64 ,$18.64 ,$294.75 ,$279.03 ,$279.03 ,$18.64 ,$279.03 ,$326.19 ,$326.19 ,$326.19 , N/A ,$46.60 ,$334.05 ,$18.64 ,$393.00 ,$8.26 ,$8.26 ,$334.05 ,$39.14 ,$334.05 ,$353.70 ,$18.64 ,$326.19 ,$312.44 ,$312.44 ,$18.64 ,$255.45 
ST. JOSEPH'S HOSPITAL - BREESE,30101706,80230,HC DRUG ASSAY INFLIXIMAB-90,301,1 ,$366.66 ,$238.33 ,$8.26 ,$366.66 ,$311.66 ,$218.90 ,$38.57 ,$210.83 ,$38.57 ,$252.63 ,$311.66 ,$311.66 ,$311.66 ,$300.66 ,$249.33 ,$38.57 ,$38.57 ,$275.00 ,$260.33 ,$260.33 ,$38.57 ,$260.33 ,$304.33 ,$304.33 ,$304.33 , N/A ,$96.43 ,$311.66 ,$38.57 ,$366.66 ,$8.26 ,$8.26 ,$311.66 ,$81.00 ,$311.66 ,$329.99 ,$38.57 ,$304.33 ,$291.49 ,$291.49 ,$38.57 ,$238.33 
ST. JOSEPH'S HOSPITAL - BREESE,30101735,84146,HC PROLACTIN-90,301,1 ,$210.00 ,$136.50 ,$16.85 ,$210.00 ,$178.50 ,$125.37 ,$19.38 ,$120.75 ,$19.38 ,$144.69 ,$178.50 ,$178.50 ,$178.50 ,$172.20 ,$142.80 ,$19.38 ,$19.38 ,$157.50 ,$149.10 ,$149.10 ,$19.38 ,$149.10 ,$174.30 ,$174.30 ,$174.30 , N/A ,$48.45 ,$178.50 ,$19.38 ,$210.00 ,$16.85 ,$16.85 ,$178.50 ,$40.70 ,$178.50 ,$189.00 ,$19.38 ,$174.30 ,$166.95 ,$166.95 ,$19.38 ,$136.50 
ST. JOSEPH'S HOSPITAL - BREESE,30200121,86060,HC ASO,302,1 ,$184.00 ,$119.60 ,$6.45 ,$184.00 ,$156.40 ,$109.85 ,$7.30 ,$105.80 ,$7.30 ,$126.78 ,$156.40 ,$156.40 ,$156.40 ,$150.88 ,$125.12 ,$7.30 ,$7.30 ,$138.00 ,$130.64 ,$130.64 ,$7.30 ,$130.64 ,$152.72 ,$152.72 ,$152.72 , N/A ,$18.25 ,$156.40 ,$7.30 ,$184.00 ,$6.45 ,$6.45 ,$156.40 ,$15.33 ,$156.40 ,$165.60 ,$7.30 ,$152.72 ,$146.28 ,$146.28 ,$7.30 ,$119.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$144.00 ,$93.60 ,$5.18 ,$144.00 ,$122.40 ,$85.97 ,$5.18 ,$82.80 ,$5.18 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$5.18 ,$5.18 ,$108.00 ,$102.24 ,$102.24 ,$5.18 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$12.95 ,$122.40 ,$5.18 ,$144.00 ,$6.45 ,$6.45 ,$122.40 ,$10.88 ,$122.40 ,$129.60 ,$5.18 ,$119.52 ,$114.48 ,$114.48 ,$5.18 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$185.00 ,$120.25 ,$5.18 ,$185.00 ,$157.25 ,$110.45 ,$5.18 ,$106.38 ,$5.18 ,$127.47 ,$157.25 ,$157.25 ,$157.25 ,$151.70 ,$125.80 ,$5.18 ,$5.18 ,$138.75 ,$131.35 ,$131.35 ,$5.18 ,$131.35 ,$153.55 ,$153.55 ,$153.55 , N/A ,$12.95 ,$157.25 ,$5.18 ,$185.00 ,$6.45 ,$6.45 ,$157.25 ,$10.88 ,$157.25 ,$166.50 ,$5.18 ,$153.55 ,$147.08 ,$147.08 ,$5.18 ,$120.25 
ST. JOSEPH'S HOSPITAL - BREESE,30200197,86430,HC RHEUMATOID FACTOR,302,1 ,$144.00 ,$93.60 ,$6.14 ,$144.00 ,$122.40 ,$85.97 ,$6.14 ,$82.80 ,$6.14 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$6.14 ,$6.14 ,$108.00 ,$102.24 ,$102.24 ,$6.14 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$15.35 ,$122.40 ,$6.14 ,$144.00 ,$6.45 ,$6.45 ,$122.40 ,$12.89 ,$122.40 ,$129.60 ,$6.14 ,$119.52 ,$114.48 ,$114.48 ,$6.14 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200200,86580,HC SKIN TEST TB INTRADERMAL,302,1 ,$56.00 ,$36.40 ,$6.45 ,$56.00 ,$47.60 ,$33.43 ,$21.97 ,$32.20 ,$21.97 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$21.97 ,$21.97 ,$42.00 ,$39.76 ,$39.76 ,$21.97 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$54.92 ,$47.60 ,$21.97 ,$56.00 ,$6.45 ,$6.45 ,$47.60 ,$46.14 ,$47.60 ,$50.40 ,$21.97 ,$46.48 ,$44.52 ,$44.52 ,$21.97 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200270,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$147.00 ,$95.55 ,$6.45 ,$147.00 ,$124.95 ,$87.76 ,$13.71 ,$84.53 ,$13.71 ,$101.28 ,$124.95 ,$124.95 ,$124.95 ,$120.54 ,$99.96 ,$13.71 ,$13.71 ,$110.25 ,$104.37 ,$104.37 ,$13.71 ,$104.37 ,$122.01 ,$122.01 ,$122.01 , N/A ,$34.28 ,$124.95 ,$13.71 ,$147.00 ,$6.45 ,$6.45 ,$124.95 ,$28.79 ,$124.95 ,$132.30 ,$13.71 ,$122.01 ,$116.87 ,$116.87 ,$13.71 ,$95.55 
ST. JOSEPH'S HOSPITAL - BREESE,30200561,86870,HC RBC AB ID PANEL,302,1 ,$226.00 ,$146.90 ,$6.45 ,$568.74 ,$192.10 ,$134.92 ,$270.83 ,$129.95 ,$270.83 ,$155.71 ,$192.10 ,$192.10 ,$192.10 ,$185.32 ,$153.68 ,$270.83 ,$270.83 ,$169.50 ,$160.46 ,$160.46 ,$270.83 ,$160.46 ,$187.58 ,$187.58 ,$187.58 , N/A ,$226.00 ,$192.10 ,$270.83 ,$226.00 ,$6.45 ,$6.45 ,$192.10 ,$568.74 ,$192.10 ,$203.40 ,$270.83 ,$187.58 ,$179.67 ,$179.67 ,$270.83 ,$146.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200562,86880,HC COOMBS DIRECT,302,1 ,$82.00 ,$53.30 ,$6.45 ,$82.00 ,$69.70 ,$48.95 ,$31.95 ,$47.15 ,$31.95 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$31.95 ,$31.95 ,$61.50 ,$58.22 ,$58.22 ,$31.95 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$79.86 ,$69.70 ,$31.95 ,$82.00 ,$6.45 ,$6.45 ,$69.70 ,$67.09 ,$69.70 ,$73.80 ,$31.95 ,$68.06 ,$65.19 ,$65.19 ,$31.95 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30200563,86885,HC INDIRECT COOMBS,302,1 ,$82.00 ,$53.30 ,$6.45 ,$287.97 ,$69.70 ,$48.95 ,$137.13 ,$47.15 ,$137.13 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$137.13 ,$137.13 ,$61.50 ,$58.22 ,$58.22 ,$137.13 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$82.00 ,$69.70 ,$137.13 ,$82.00 ,$6.45 ,$6.45 ,$69.70 ,$287.97 ,$69.70 ,$73.80 ,$137.13 ,$68.06 ,$65.19 ,$65.19 ,$137.13 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30200564,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,"$1,280.00 ",$832.00 ,$26.02 ,"$1,280.00 ","$1,088.00 ",$764.16 ,$137.13 ,$736.00 ,$137.13 ,$881.92 ,"$1,088.00 ","$1,088.00 ","$1,088.00 ","$1,049.60 ",$870.40 ,$137.13 ,$137.13 ,$960.00 ,$908.80 ,$908.80 ,$137.13 ,$908.80 ,"$1,062.40 ","$1,062.40 ","$1,062.40 ", N/A ,$342.82 ,"$1,088.00 ",$137.13 ,"$1,280.00 ",$26.02 ,$26.02 ,"$1,088.00 ",$287.97 ,"$1,088.00 ","$1,152.00 ",$137.13 ,"$1,062.40 ","$1,017.60 ","$1,017.60 ",$137.13 ,$832.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200565,86900,HC BLOOD TYPING ABO,302,1 ,$62.00 ,$40.30 ,$4.00 ,$218.80 ,$52.70 ,$37.01 ,$104.19 ,$35.65 ,$104.19 ,$42.72 ,$52.70 ,$52.70 ,$52.70 ,$50.84 ,$42.16 ,$104.19 ,$104.19 ,$46.50 ,$44.02 ,$44.02 ,$104.19 ,$44.02 ,$51.46 ,$51.46 ,$51.46 , N/A ,$62.00 ,$52.70 ,$104.19 ,$62.00 ,$4.00 ,$4.00 ,$52.70 ,$218.80 ,$52.70 ,$55.80 ,$104.19 ,$51.46 ,$49.29 ,$49.29 ,$104.19 ,$40.30 
ST. JOSEPH'S HOSPITAL - BREESE,30200566,86901,HC BLOOD TYPING RH,302,1 ,$58.00 ,$37.70 ,$4.00 ,$67.09 ,$49.30 ,$34.63 ,$31.95 ,$33.35 ,$31.95 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$31.95 ,$31.95 ,$43.50 ,$41.18 ,$41.18 ,$31.95 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$58.00 ,$49.30 ,$31.95 ,$58.00 ,$4.00 ,$4.00 ,$49.30 ,$67.09 ,$49.30 ,$52.20 ,$31.95 ,$48.14 ,$46.11 ,$46.11 ,$31.95 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30200567,86902,HC RBC AG SCR RGT SERUM,302,1 ,$96.00 ,$62.40 ,$4.00 ,$568.74 ,$81.60 ,$57.31 ,$270.83 ,$55.20 ,$270.83 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$270.83 ,$270.83 ,$72.00 ,$68.16 ,$68.16 ,$270.83 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$96.00 ,$81.60 ,$270.83 ,$96.00 ,$4.00 ,$4.00 ,$81.60 ,$568.74 ,$81.60 ,$86.40 ,$270.83 ,$79.68 ,$76.32 ,$76.32 ,$270.83 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200569,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$139.00 ,$90.35 ,$4.00 ,$287.97 ,$118.15 ,$82.98 ,$137.13 ,$79.93 ,$137.13 ,$95.77 ,$118.15 ,$118.15 ,$118.15 ,$113.98 ,$94.52 ,$137.13 ,$137.13 ,$104.25 ,$98.69 ,$98.69 ,$137.13 ,$98.69 ,$115.37 ,$115.37 ,$115.37 , N/A ,$139.00 ,$118.15 ,$137.13 ,$139.00 ,$4.00 ,$4.00 ,$118.15 ,$287.97 ,$118.15 ,$125.10 ,$137.13 ,$115.37 ,$110.51 ,$110.51 ,$137.13 ,$90.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200571,86922,HC CROSSMATCH AHG,302,1 ,$119.00 ,$77.35 ,$26.02 ,$287.97 ,$101.15 ,$71.04 ,$137.13 ,$68.43 ,$137.13 ,$81.99 ,$101.15 ,$101.15 ,$101.15 ,$97.58 ,$80.92 ,$137.13 ,$137.13 ,$89.25 ,$84.49 ,$84.49 ,$137.13 ,$84.49 ,$98.77 ,$98.77 ,$98.77 , N/A ,$119.00 ,$101.15 ,$137.13 ,$119.00 ,$26.02 ,$26.02 ,$101.15 ,$287.97 ,$101.15 ,$107.10 ,$137.13 ,$98.77 ,$94.61 ,$94.61 ,$137.13 ,$77.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200844,86001,HC RAST ALLERGEN IGG QN SQ EA-90,302,1 ,$67.32 ,$43.76 ,$6.45 ,$67.32 ,$57.22 ,$40.19 ,$7.82 ,$38.71 ,$7.82 ,$46.38 ,$57.22 ,$57.22 ,$57.22 ,$55.20 ,$45.78 ,$7.82 ,$7.82 ,$50.49 ,$47.80 ,$47.80 ,$7.82 ,$47.80 ,$55.88 ,$55.88 ,$55.88 , N/A ,$19.55 ,$57.22 ,$7.82 ,$67.32 ,$6.45 ,$6.45 ,$57.22 ,$16.42 ,$57.22 ,$60.59 ,$7.82 ,$55.88 ,$53.52 ,$53.52 ,$7.82 ,$43.76 
ST. JOSEPH'S HOSPITAL - BREESE,30200845,86003,HC RAST ALLERGEN IGE QN SQ EA-90,302,1 ,$68.00 ,$44.20 ,$5.22 ,$68.00 ,$57.80 ,$40.60 ,$5.22 ,$39.10 ,$5.22 ,$46.85 ,$57.80 ,$57.80 ,$57.80 ,$55.76 ,$46.24 ,$5.22 ,$5.22 ,$51.00 ,$48.28 ,$48.28 ,$5.22 ,$48.28 ,$56.44 ,$56.44 ,$56.44 , N/A ,$13.05 ,$57.80 ,$5.22 ,$68.00 ,$6.45 ,$6.45 ,$57.80 ,$10.96 ,$57.80 ,$61.20 ,$5.22 ,$56.44 ,$54.06 ,$54.06 ,$5.22 ,$44.20 
ST. JOSEPH'S HOSPITAL - BREESE,30200847,86021,HC LEUKO AB ID-90,302,1 ,$223.00 ,$144.95 ,$6.45 ,$223.00 ,$189.55 ,$133.13 ,$15.05 ,$128.23 ,$15.05 ,$153.65 ,$189.55 ,$189.55 ,$189.55 ,$182.86 ,$151.64 ,$15.05 ,$15.05 ,$167.25 ,$158.33 ,$158.33 ,$15.05 ,$158.33 ,$185.09 ,$185.09 ,$185.09 , N/A ,$37.63 ,$189.55 ,$15.05 ,$223.00 ,$6.45 ,$6.45 ,$189.55 ,$31.61 ,$189.55 ,$200.70 ,$15.05 ,$185.09 ,$177.29 ,$177.29 ,$15.05 ,$144.95 
ST. JOSEPH'S HOSPITAL - BREESE,30200851,86022,HC PLATELET AB ID-90,302,1 ,$174.00 ,$113.10 ,$6.45 ,$174.00 ,$147.90 ,$103.88 ,$18.37 ,$100.05 ,$18.37 ,$119.89 ,$147.90 ,$147.90 ,$147.90 ,$142.68 ,$118.32 ,$18.37 ,$18.37 ,$130.50 ,$123.54 ,$123.54 ,$18.37 ,$123.54 ,$144.42 ,$144.42 ,$144.42 , N/A ,$45.93 ,$147.90 ,$18.37 ,$174.00 ,$6.45 ,$6.45 ,$147.90 ,$38.58 ,$147.90 ,$156.60 ,$18.37 ,$144.42 ,$138.33 ,$138.33 ,$18.37 ,$113.10 
ST. JOSEPH'S HOSPITAL - BREESE,30200857,86023,HC PLATELET ASSOC AB ID IGG-90,302,1 ,$126.00 ,$81.90 ,$6.45 ,$126.00 ,$107.10 ,$75.22 ,$12.46 ,$72.45 ,$12.46 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$103.32 ,$85.68 ,$12.46 ,$12.46 ,$94.50 ,$89.46 ,$89.46 ,$12.46 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$31.15 ,$107.10 ,$12.46 ,$126.00 ,$6.45 ,$6.45 ,$107.10 ,$26.17 ,$107.10 ,$113.40 ,$12.46 ,$104.58 ,$100.17 ,$100.17 ,$12.46 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200858,86038,HC ANA SCREEN-90,302,1 ,$131.00 ,$85.15 ,$6.45 ,$131.00 ,$111.35 ,$78.21 ,$12.09 ,$75.33 ,$12.09 ,$90.26 ,$111.35 ,$111.35 ,$111.35 ,$107.42 ,$89.08 ,$12.09 ,$12.09 ,$98.25 ,$93.01 ,$93.01 ,$12.09 ,$93.01 ,$108.73 ,$108.73 ,$108.73 , N/A ,$30.23 ,$111.35 ,$12.09 ,$131.00 ,$6.45 ,$6.45 ,$111.35 ,$25.39 ,$111.35 ,$117.90 ,$12.09 ,$108.73 ,$104.15 ,$104.15 ,$12.09 ,$85.15 
ST. JOSEPH'S HOSPITAL - BREESE,30200859,86039,HC ANA TITER-90,302,1 ,$117.00 ,$76.05 ,$6.45 ,$117.00 ,$99.45 ,$69.85 ,$11.16 ,$67.28 ,$11.16 ,$80.61 ,$99.45 ,$99.45 ,$99.45 ,$95.94 ,$79.56 ,$11.16 ,$11.16 ,$87.75 ,$83.07 ,$83.07 ,$11.16 ,$83.07 ,$97.11 ,$97.11 ,$97.11 , N/A ,$27.90 ,$99.45 ,$11.16 ,$117.00 ,$6.45 ,$6.45 ,$99.45 ,$23.44 ,$99.45 ,$105.30 ,$11.16 ,$97.11 ,$93.02 ,$93.02 ,$11.16 ,$76.05 
ST. JOSEPH'S HOSPITAL - BREESE,30200863,86141,HC C-REACTIVE PROTEIN (HS)-90,302,1 ,$176.00 ,$114.40 ,$6.45 ,$176.00 ,$149.60 ,$105.07 ,$12.95 ,$101.20 ,$12.95 ,$121.26 ,$149.60 ,$149.60 ,$149.60 ,$144.32 ,$119.68 ,$12.95 ,$12.95 ,$132.00 ,$124.96 ,$124.96 ,$12.95 ,$124.96 ,$146.08 ,$146.08 ,$146.08 , N/A ,$32.38 ,$149.60 ,$12.95 ,$176.00 ,$6.45 ,$6.45 ,$149.60 ,$27.20 ,$149.60 ,$158.40 ,$12.95 ,$146.08 ,$139.92 ,$139.92 ,$12.95 ,$114.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200864,86146,HC BETA 2 GLYCO AB-90,302,1 ,$94.00 ,$61.10 ,$7.20 ,$94.00 ,$79.90 ,$56.12 ,$25.45 ,$54.05 ,$25.45 ,$64.77 ,$79.90 ,$79.90 ,$79.90 ,$77.08 ,$63.92 ,$25.45 ,$25.45 ,$70.50 ,$66.74 ,$66.74 ,$25.45 ,$66.74 ,$78.02 ,$78.02 ,$78.02 , N/A ,$63.63 ,$79.90 ,$25.45 ,$94.00 ,$7.20 ,$7.20 ,$79.90 ,$53.45 ,$79.90 ,$84.60 ,$25.45 ,$78.02 ,$74.73 ,$74.73 ,$25.45 ,$61.10 
ST. JOSEPH'S HOSPITAL - BREESE,30200865,86147,HC CARDIOLIPIN AB EA-90,302,1 ,$156.00 ,$101.40 ,$11.11 ,$156.00 ,$132.60 ,$93.13 ,$25.45 ,$89.70 ,$25.45 ,$107.48 ,$132.60 ,$132.60 ,$132.60 ,$127.92 ,$106.08 ,$25.45 ,$25.45 ,$117.00 ,$110.76 ,$110.76 ,$25.45 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$63.63 ,$132.60 ,$25.45 ,$156.00 ,$11.11 ,$11.11 ,$132.60 ,$53.45 ,$132.60 ,$140.40 ,$25.45 ,$129.48 ,$124.02 ,$124.02 ,$25.45 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200866,86148,HC ANTI-PHOSPHATIDYLSERINE AB-90,302,1 ,$60.00 ,$39.00 ,$7.20 ,$60.00 ,$51.00 ,$35.82 ,$16.07 ,$34.50 ,$16.07 ,$41.34 ,$51.00 ,$51.00 ,$51.00 ,$49.20 ,$40.80 ,$16.07 ,$16.07 ,$45.00 ,$42.60 ,$42.60 ,$16.07 ,$42.60 ,$49.80 ,$49.80 ,$49.80 , N/A ,$40.18 ,$51.00 ,$16.07 ,$60.00 ,$7.20 ,$7.20 ,$51.00 ,$33.75 ,$51.00 ,$54.00 ,$16.07 ,$49.80 ,$47.70 ,$47.70 ,$16.07 ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200868,86157,HC COLD AGGLUTININ TITER-90,302,1 ,$221.00 ,$143.65 ,$6.45 ,$221.00 ,$187.85 ,$131.94 ,$8.06 ,$127.08 ,$8.06 ,$152.27 ,$187.85 ,$187.85 ,$187.85 ,$181.22 ,$150.28 ,$8.06 ,$8.06 ,$165.75 ,$156.91 ,$156.91 ,$8.06 ,$156.91 ,$183.43 ,$183.43 ,$183.43 , N/A ,$20.15 ,$187.85 ,$8.06 ,$221.00 ,$6.45 ,$6.45 ,$187.85 ,$16.93 ,$187.85 ,$198.90 ,$8.06 ,$183.43 ,$175.70 ,$175.70 ,$8.06 ,$143.65 
ST. JOSEPH'S HOSPITAL - BREESE,30200869,86160,HC COMPLEMENT AG EA-90,302,1 ,$162.00 ,$105.30 ,$6.45 ,$162.00 ,$137.70 ,$96.71 ,$12.00 ,$93.15 ,$12.00 ,$111.62 ,$137.70 ,$137.70 ,$137.70 ,$132.84 ,$110.16 ,$12.00 ,$12.00 ,$121.50 ,$115.02 ,$115.02 ,$12.00 ,$115.02 ,$134.46 ,$134.46 ,$134.46 , N/A ,$30.00 ,$137.70 ,$12.00 ,$162.00 ,$6.45 ,$6.45 ,$137.70 ,$25.20 ,$137.70 ,$145.80 ,$12.00 ,$134.46 ,$128.79 ,$128.79 ,$12.00 ,$105.30 
ST. JOSEPH'S HOSPITAL - BREESE,30200870,86161,HC C1 ESTERASE INHIBITOR-90,302,1 ,$112.00 ,$72.80 ,$6.45 ,$112.00 ,$95.20 ,$66.86 ,$12.00 ,$64.40 ,$12.00 ,$77.17 ,$95.20 ,$95.20 ,$95.20 ,$91.84 ,$76.16 ,$12.00 ,$12.00 ,$84.00 ,$79.52 ,$79.52 ,$12.00 ,$79.52 ,$92.96 ,$92.96 ,$92.96 , N/A ,$30.00 ,$95.20 ,$12.00 ,$112.00 ,$6.45 ,$6.45 ,$95.20 ,$25.20 ,$95.20 ,$100.80 ,$12.00 ,$92.96 ,$89.04 ,$89.04 ,$12.00 ,$72.80 
ST. JOSEPH'S HOSPITAL - BREESE,30200871,86162,HC COMPLEMENT TOTAL-90,302,1 ,$159.00 ,$103.35 ,$6.45 ,$159.00 ,$135.15 ,$94.92 ,$20.32 ,$91.43 ,$20.32 ,$109.55 ,$135.15 ,$135.15 ,$135.15 ,$130.38 ,$108.12 ,$20.32 ,$20.32 ,$119.25 ,$112.89 ,$112.89 ,$20.32 ,$112.89 ,$131.97 ,$131.97 ,$131.97 , N/A ,$50.80 ,$135.15 ,$20.32 ,$159.00 ,$6.45 ,$6.45 ,$135.15 ,$42.67 ,$135.15 ,$143.10 ,$20.32 ,$131.97 ,$126.41 ,$126.41 ,$20.32 ,$103.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200873,86200,HC CCP AB-90,302,1 ,$216.00 ,$140.40 ,$6.45 ,$216.00 ,$183.60 ,$128.95 ,$12.95 ,$124.20 ,$12.95 ,$148.82 ,$183.60 ,$183.60 ,$183.60 ,$177.12 ,$146.88 ,$12.95 ,$12.95 ,$162.00 ,$153.36 ,$153.36 ,$12.95 ,$153.36 ,$179.28 ,$179.28 ,$179.28 , N/A ,$32.38 ,$183.60 ,$12.95 ,$216.00 ,$6.45 ,$6.45 ,$183.60 ,$27.20 ,$183.60 ,$194.40 ,$12.95 ,$179.28 ,$171.72 ,$171.72 ,$12.95 ,$140.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200874,86215,HC DEOXYRIBONUCLEASE AB-90,302,1 ,$139.00 ,$90.35 ,$6.45 ,$139.00 ,$118.15 ,$82.98 ,$13.25 ,$79.93 ,$13.25 ,$95.77 ,$118.15 ,$118.15 ,$118.15 ,$113.98 ,$94.52 ,$13.25 ,$13.25 ,$104.25 ,$98.69 ,$98.69 ,$13.25 ,$98.69 ,$115.37 ,$115.37 ,$115.37 , N/A ,$33.13 ,$118.15 ,$13.25 ,$139.00 ,$6.45 ,$6.45 ,$118.15 ,$27.83 ,$118.15 ,$125.10 ,$13.25 ,$115.37 ,$110.51 ,$110.51 ,$13.25 ,$90.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200875,86225,HC DNA DOUBLE STRAND AB-90,302,1 ,$145.00 ,$94.25 ,$6.45 ,$145.00 ,$123.25 ,$86.57 ,$13.74 ,$83.38 ,$13.74 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$13.74 ,$13.74 ,$108.75 ,$102.95 ,$102.95 ,$13.74 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$34.35 ,$123.25 ,$13.74 ,$145.00 ,$6.45 ,$6.45 ,$123.25 ,$28.85 ,$123.25 ,$130.50 ,$13.74 ,$120.35 ,$115.28 ,$115.28 ,$13.74 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,30200877,86235,HC ENA AB-90,302,1 ,$154.00 ,$100.10 ,$11.11 ,$154.00 ,$130.90 ,$91.94 ,$17.93 ,$88.55 ,$17.93 ,$106.11 ,$130.90 ,$130.90 ,$130.90 ,$126.28 ,$104.72 ,$17.93 ,$17.93 ,$115.50 ,$109.34 ,$109.34 ,$17.93 ,$109.34 ,$127.82 ,$127.82 ,$127.82 , N/A ,$44.83 ,$130.90 ,$17.93 ,$154.00 ,$11.11 ,$11.11 ,$130.90 ,$37.65 ,$130.90 ,$138.60 ,$17.93 ,$127.82 ,$122.43 ,$122.43 ,$17.93 ,$100.10 
ST. JOSEPH'S HOSPITAL - BREESE,30200878,86255,HC FLUOR AB SCR-90,302,1 ,$184.00 ,$119.60 ,$11.11 ,$184.00 ,$156.40 ,$109.85 ,$12.05 ,$105.80 ,$12.05 ,$126.78 ,$156.40 ,$156.40 ,$156.40 ,$150.88 ,$125.12 ,$12.05 ,$12.05 ,$138.00 ,$130.64 ,$130.64 ,$12.05 ,$130.64 ,$152.72 ,$152.72 ,$152.72 , N/A ,$30.13 ,$156.40 ,$12.05 ,$184.00 ,$11.11 ,$11.11 ,$156.40 ,$25.31 ,$156.40 ,$165.60 ,$12.05 ,$152.72 ,$146.28 ,$146.28 ,$12.05 ,$119.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200879,86256,HC FLUOR AB TITER-90,302,1 ,$56.00 ,$36.40 ,$11.11 ,$56.00 ,$47.60 ,$33.43 ,$12.05 ,$32.20 ,$12.05 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$12.05 ,$12.05 ,$42.00 ,$39.76 ,$39.76 ,$12.05 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$30.13 ,$47.60 ,$12.05 ,$56.00 ,$11.11 ,$11.11 ,$47.60 ,$25.31 ,$47.60 ,$50.40 ,$12.05 ,$46.48 ,$44.52 ,$44.52 ,$12.05 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200880,86300,HC TUMOR AG CA 15-3 (27.29)-90,302,1 ,$179.00 ,$116.35 ,$17.08 ,$179.00 ,$152.15 ,$106.86 ,$20.81 ,$102.93 ,$20.81 ,$123.33 ,$152.15 ,$152.15 ,$152.15 ,$146.78 ,$121.72 ,$20.81 ,$20.81 ,$134.25 ,$127.09 ,$127.09 ,$20.81 ,$127.09 ,$148.57 ,$148.57 ,$148.57 , N/A ,$52.03 ,$152.15 ,$20.81 ,$179.00 ,$17.08 ,$17.08 ,$152.15 ,$43.70 ,$152.15 ,$161.10 ,$20.81 ,$148.57 ,$142.31 ,$142.31 ,$20.81 ,$116.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200881,86301,HC TUMOR AG CA 19-9  -90,302,1 ,$174.00 ,$113.10 ,$17.08 ,$174.00 ,$147.90 ,$103.88 ,$20.81 ,$100.05 ,$20.81 ,$119.89 ,$147.90 ,$147.90 ,$147.90 ,$142.68 ,$118.32 ,$20.81 ,$20.81 ,$130.50 ,$123.54 ,$123.54 ,$20.81 ,$123.54 ,$144.42 ,$144.42 ,$144.42 , N/A ,$52.03 ,$147.90 ,$20.81 ,$174.00 ,$17.08 ,$17.08 ,$147.90 ,$43.70 ,$147.90 ,$156.60 ,$20.81 ,$144.42 ,$138.33 ,$138.33 ,$20.81 ,$113.10 
ST. JOSEPH'S HOSPITAL - BREESE,30200882,86304,HC TUMOR AG CA 125 -90,302,1 ,$55.00 ,$35.75 ,$17.08 ,$55.00 ,$46.75 ,$32.84 ,$20.81 ,$31.63 ,$20.81 ,$37.90 ,$46.75 ,$46.75 ,$46.75 ,$45.10 ,$37.40 ,$20.81 ,$20.81 ,$41.25 ,$39.05 ,$39.05 ,$20.81 ,$39.05 ,$45.65 ,$45.65 ,$45.65 , N/A ,$52.03 ,$46.75 ,$20.81 ,$55.00 ,$17.08 ,$17.08 ,$46.75 ,$43.70 ,$46.75 ,$49.50 ,$20.81 ,$45.65 ,$43.73 ,$43.73 ,$20.81 ,$35.75 
ST. JOSEPH'S HOSPITAL - BREESE,30200883,86305,HC HE4 OVARIAN CANCER-90,302,1 ,$591.00 ,$384.15 ,$17.08 ,$591.00 ,$502.35 ,$352.83 ,$20.81 ,$339.83 ,$20.81 ,$407.20 ,$502.35 ,$502.35 ,$502.35 ,$484.62 ,$401.88 ,$20.81 ,$20.81 ,$443.25 ,$419.61 ,$419.61 ,$20.81 ,$419.61 ,$490.53 ,$490.53 ,$490.53 , N/A ,$52.03 ,$502.35 ,$20.81 ,$591.00 ,$17.08 ,$17.08 ,$502.35 ,$43.70 ,$502.35 ,$531.90 ,$20.81 ,$490.53 ,$469.85 ,$469.85 ,$20.81 ,$384.15 
ST. JOSEPH'S HOSPITAL - BREESE,30200886,86632,HC CHLAMYDIA AB IGM-90,302,1 ,$161.00 ,$104.65 ,$5.14 ,$161.00 ,$136.85 ,$96.12 ,$12.68 ,$92.58 ,$12.68 ,$110.93 ,$136.85 ,$136.85 ,$136.85 ,$132.02 ,$109.48 ,$12.68 ,$12.68 ,$120.75 ,$114.31 ,$114.31 ,$12.68 ,$114.31 ,$133.63 ,$133.63 ,$133.63 , N/A ,$31.70 ,$136.85 ,$12.68 ,$161.00 ,$5.14 ,$5.14 ,$136.85 ,$26.63 ,$136.85 ,$144.90 ,$12.68 ,$133.63 ,$128.00 ,$128.00 ,$12.68 ,$104.65 
ST. JOSEPH'S HOSPITAL - BREESE,30200887,86635,HC COCCIDIOIDES AB-90,302,1 ,$131.00 ,$85.15 ,$11.11 ,$131.00 ,$111.35 ,$78.21 ,$11.47 ,$75.33 ,$11.47 ,$90.26 ,$111.35 ,$111.35 ,$111.35 ,$107.42 ,$89.08 ,$11.47 ,$11.47 ,$98.25 ,$93.01 ,$93.01 ,$11.47 ,$93.01 ,$108.73 ,$108.73 ,$108.73 , N/A ,$28.68 ,$111.35 ,$11.47 ,$131.00 ,$11.11 ,$11.11 ,$111.35 ,$24.09 ,$111.35 ,$117.90 ,$11.47 ,$108.73 ,$104.15 ,$104.15 ,$11.47 ,$85.15 
ST. JOSEPH'S HOSPITAL - BREESE,30200890,86644,HC CMV AB-90,302,1 ,$156.00 ,$101.40 ,$11.11 ,$156.00 ,$132.60 ,$93.13 ,$14.39 ,$89.70 ,$14.39 ,$107.48 ,$132.60 ,$132.60 ,$132.60 ,$127.92 ,$106.08 ,$14.39 ,$14.39 ,$117.00 ,$110.76 ,$110.76 ,$14.39 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$35.98 ,$132.60 ,$14.39 ,$156.00 ,$11.11 ,$11.11 ,$132.60 ,$30.22 ,$132.60 ,$140.40 ,$14.39 ,$129.48 ,$124.02 ,$124.02 ,$14.39 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200891,86645,HC CMV AB IGM-90,302,1 ,$110.00 ,$71.50 ,$11.11 ,$110.00 ,$93.50 ,$65.67 ,$16.85 ,$63.25 ,$16.85 ,$75.79 ,$93.50 ,$93.50 ,$93.50 ,$90.20 ,$74.80 ,$16.85 ,$16.85 ,$82.50 ,$78.10 ,$78.10 ,$16.85 ,$78.10 ,$91.30 ,$91.30 ,$91.30 , N/A ,$42.13 ,$93.50 ,$16.85 ,$110.00 ,$11.11 ,$11.11 ,$93.50 ,$35.39 ,$93.50 ,$99.00 ,$16.85 ,$91.30 ,$87.45 ,$87.45 ,$16.85 ,$71.50 
ST. JOSEPH'S HOSPITAL - BREESE,30200892,86648,HC DIPTHERIA-90,302,1 ,$183.00 ,$118.95 ,$11.11 ,$183.00 ,$155.55 ,$109.25 ,$15.21 ,$105.23 ,$15.21 ,$126.09 ,$155.55 ,$155.55 ,$155.55 ,$150.06 ,$124.44 ,$15.21 ,$15.21 ,$137.25 ,$129.93 ,$129.93 ,$15.21 ,$129.93 ,$151.89 ,$151.89 ,$151.89 , N/A ,$38.03 ,$155.55 ,$15.21 ,$183.00 ,$11.11 ,$11.11 ,$155.55 ,$31.94 ,$155.55 ,$164.70 ,$15.21 ,$151.89 ,$145.49 ,$145.49 ,$15.21 ,$118.95 
ST. JOSEPH'S HOSPITAL - BREESE,30200897,86658,HC ENTEROVIRUS AB-90,302,1 ,$31.00 ,$20.15 ,$11.11 ,$31.00 ,$26.35 ,$18.51 ,$13.03 ,$17.83 ,$13.03 ,$21.36 ,$26.35 ,$26.35 ,$26.35 ,$25.42 ,$21.08 ,$13.03 ,$13.03 ,$23.25 ,$22.01 ,$22.01 ,$13.03 ,$22.01 ,$25.73 ,$25.73 ,$25.73 , N/A ,$31.00 ,$26.35 ,$13.03 ,$31.00 ,$11.11 ,$11.11 ,$26.35 ,$27.36 ,$26.35 ,$27.90 ,$13.03 ,$25.73 ,$24.65 ,$24.65 ,$13.03 ,$20.15 
ST. JOSEPH'S HOSPITAL - BREESE,30200898,86663,HC EBV EARLY AG-90,302,1 ,$94.00 ,$61.10 ,$11.11 ,$94.00 ,$79.90 ,$56.12 ,$13.12 ,$54.05 ,$13.12 ,$64.77 ,$79.90 ,$79.90 ,$79.90 ,$77.08 ,$63.92 ,$13.12 ,$13.12 ,$70.50 ,$66.74 ,$66.74 ,$13.12 ,$66.74 ,$78.02 ,$78.02 ,$78.02 , N/A ,$32.80 ,$79.90 ,$13.12 ,$94.00 ,$11.11 ,$11.11 ,$79.90 ,$27.55 ,$79.90 ,$84.60 ,$13.12 ,$78.02 ,$74.73 ,$74.73 ,$13.12 ,$61.10 
ST. JOSEPH'S HOSPITAL - BREESE,30200899,86664,HC EBV NUCLEAR AG-90,302,1 ,$64.00 ,$41.60 ,$11.11 ,$64.00 ,$54.40 ,$38.21 ,$15.29 ,$36.80 ,$15.29 ,$44.10 ,$54.40 ,$54.40 ,$54.40 ,$52.48 ,$43.52 ,$15.29 ,$15.29 ,$48.00 ,$45.44 ,$45.44 ,$15.29 ,$45.44 ,$53.12 ,$53.12 ,$53.12 , N/A ,$38.23 ,$54.40 ,$15.29 ,$64.00 ,$11.11 ,$11.11 ,$54.40 ,$32.11 ,$54.40 ,$57.60 ,$15.29 ,$53.12 ,$50.88 ,$50.88 ,$15.29 ,$41.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200900,86665,HC EBV VIRAL CAP-90,302,1 ,$79.00 ,$51.35 ,$11.11 ,$79.00 ,$67.15 ,$47.16 ,$18.14 ,$45.43 ,$18.14 ,$54.43 ,$67.15 ,$67.15 ,$67.15 ,$64.78 ,$53.72 ,$18.14 ,$18.14 ,$59.25 ,$56.09 ,$56.09 ,$18.14 ,$56.09 ,$65.57 ,$65.57 ,$65.57 , N/A ,$45.35 ,$67.15 ,$18.14 ,$79.00 ,$11.11 ,$11.11 ,$67.15 ,$38.09 ,$67.15 ,$71.10 ,$18.14 ,$65.57 ,$62.81 ,$62.81 ,$18.14 ,$51.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200901,86666,HC EHRLICHIA AB-90,302,1 ,$151.00 ,$98.15 ,$10.18 ,$151.00 ,$128.35 ,$90.15 ,$10.18 ,$86.83 ,$10.18 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$10.18 ,$10.18 ,$113.25 ,$107.21 ,$107.21 ,$10.18 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$25.45 ,$128.35 ,$10.18 ,$151.00 ,$11.11 ,$11.11 ,$128.35 ,$21.38 ,$128.35 ,$135.90 ,$10.18 ,$125.33 ,$120.05 ,$120.05 ,$10.18 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30200902,86668,HC FRANCISELLA AB-90,302,1 ,$184.00 ,$119.60 ,$11.11 ,$184.00 ,$156.40 ,$109.85 ,$14.16 ,$105.80 ,$14.16 ,$126.78 ,$156.40 ,$156.40 ,$156.40 ,$150.88 ,$125.12 ,$14.16 ,$14.16 ,$138.00 ,$130.64 ,$130.64 ,$14.16 ,$130.64 ,$152.72 ,$152.72 ,$152.72 , N/A ,$35.40 ,$156.40 ,$14.16 ,$184.00 ,$11.11 ,$11.11 ,$156.40 ,$29.74 ,$156.40 ,$165.60 ,$14.16 ,$152.72 ,$146.28 ,$146.28 ,$14.16 ,$119.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200903,86671,HC FUNGUS AB NOS-90,302,1 ,$156.00 ,$101.40 ,$6.45 ,$156.00 ,$132.60 ,$93.13 ,$12.25 ,$89.70 ,$12.25 ,$107.48 ,$132.60 ,$132.60 ,$132.60 ,$127.92 ,$106.08 ,$12.25 ,$12.25 ,$117.00 ,$110.76 ,$110.76 ,$12.25 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$30.63 ,$132.60 ,$12.25 ,$156.00 ,$6.45 ,$6.45 ,$132.60 ,$25.73 ,$132.60 ,$140.40 ,$12.25 ,$129.48 ,$124.02 ,$124.02 ,$12.25 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,30200907,86684,HC HAEMOPHILUS INFLUENZA AB-90,302,1 ,$183.00 ,$118.95 ,$6.45 ,$183.00 ,$155.55 ,$109.25 ,$15.84 ,$105.23 ,$15.84 ,$126.09 ,$155.55 ,$155.55 ,$155.55 ,$150.06 ,$124.44 ,$15.84 ,$15.84 ,$137.25 ,$129.93 ,$129.93 ,$15.84 ,$129.93 ,$151.89 ,$151.89 ,$151.89 , N/A ,$39.60 ,$155.55 ,$15.84 ,$183.00 ,$6.45 ,$6.45 ,$155.55 ,$33.26 ,$155.55 ,$164.70 ,$15.84 ,$151.89 ,$145.49 ,$145.49 ,$15.84 ,$118.95 
ST. JOSEPH'S HOSPITAL - BREESE,30200909,86689,HC HTLV OR HIV AB CONF-90,302,1 ,$124.00 ,$80.60 ,$11.11 ,$124.00 ,$105.40 ,$74.03 ,$19.35 ,$71.30 ,$19.35 ,$85.44 ,$105.40 ,$105.40 ,$105.40 ,$101.68 ,$84.32 ,$19.35 ,$19.35 ,$93.00 ,$88.04 ,$88.04 ,$19.35 ,$88.04 ,$102.92 ,$102.92 ,$102.92 , N/A ,$48.38 ,$105.40 ,$19.35 ,$124.00 ,$11.11 ,$11.11 ,$105.40 ,$40.64 ,$105.40 ,$111.60 ,$19.35 ,$102.92 ,$98.58 ,$98.58 ,$19.35 ,$80.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200912,86695,HC HERPES SIMPLEX AB I-90,302,1 ,$87.00 ,$56.55 ,$11.11 ,$87.00 ,$73.95 ,$51.94 ,$13.19 ,$50.03 ,$13.19 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$13.19 ,$13.19 ,$65.25 ,$61.77 ,$61.77 ,$13.19 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$32.98 ,$73.95 ,$13.19 ,$87.00 ,$11.11 ,$11.11 ,$73.95 ,$27.70 ,$73.95 ,$78.30 ,$13.19 ,$72.21 ,$69.17 ,$69.17 ,$13.19 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30200913,86696,HC HERPES SIMPLEX AB II-90,302,1 ,$118.00 ,$76.70 ,$6.45 ,$118.00 ,$100.30 ,$70.45 ,$19.35 ,$67.85 ,$19.35 ,$81.30 ,$100.30 ,$100.30 ,$100.30 ,$96.76 ,$80.24 ,$19.35 ,$19.35 ,$88.50 ,$83.78 ,$83.78 ,$19.35 ,$83.78 ,$97.94 ,$97.94 ,$97.94 , N/A ,$48.38 ,$100.30 ,$19.35 ,$118.00 ,$6.45 ,$6.45 ,$100.30 ,$40.64 ,$100.30 ,$106.20 ,$19.35 ,$97.94 ,$93.81 ,$93.81 ,$19.35 ,$76.70 
ST. JOSEPH'S HOSPITAL - BREESE,30200914,86698,HC HISTOPLASMA AB-90,302,1 ,$124.00 ,$80.60 ,$11.11 ,$124.00 ,$105.40 ,$74.03 ,$13.79 ,$71.30 ,$13.79 ,$85.44 ,$105.40 ,$105.40 ,$105.40 ,$101.68 ,$84.32 ,$13.79 ,$13.79 ,$93.00 ,$88.04 ,$88.04 ,$13.79 ,$88.04 ,$102.92 ,$102.92 ,$102.92 , N/A ,$34.48 ,$105.40 ,$13.79 ,$124.00 ,$11.11 ,$11.11 ,$105.40 ,$28.96 ,$105.40 ,$111.60 ,$13.79 ,$102.92 ,$98.58 ,$98.58 ,$13.79 ,$80.60 
ST. JOSEPH'S HOSPITAL - BREESE,30200923,86707,HC HEP B E AB-90,302,1 ,$78.00 ,$50.70 ,$6.45 ,$78.00 ,$66.30 ,$46.57 ,$11.57 ,$44.85 ,$11.57 ,$53.74 ,$66.30 ,$66.30 ,$66.30 ,$63.96 ,$53.04 ,$11.57 ,$11.57 ,$58.50 ,$55.38 ,$55.38 ,$11.57 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$28.93 ,$66.30 ,$11.57 ,$78.00 ,$6.45 ,$6.45 ,$66.30 ,$24.30 ,$66.30 ,$70.20 ,$11.57 ,$64.74 ,$62.01 ,$62.01 ,$11.57 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,30200924,86708,HC HEP A AB TOTAL-90,302,1 ,$205.00 ,$133.25 ,$6.45 ,$205.00 ,$174.25 ,$122.39 ,$12.39 ,$117.88 ,$12.39 ,$141.25 ,$174.25 ,$174.25 ,$174.25 ,$168.10 ,$139.40 ,$12.39 ,$12.39 ,$153.75 ,$145.55 ,$145.55 ,$12.39 ,$145.55 ,$170.15 ,$170.15 ,$170.15 , N/A ,$30.98 ,$174.25 ,$12.39 ,$205.00 ,$6.45 ,$6.45 ,$174.25 ,$26.02 ,$174.25 ,$184.50 ,$12.39 ,$170.15 ,$162.98 ,$162.98 ,$12.39 ,$133.25 
ST. JOSEPH'S HOSPITAL - BREESE,30200926,86710,HC INFLUENZA AB-90,302,1 ,$145.00 ,$94.25 ,$6.45 ,$145.00 ,$123.25 ,$86.57 ,$13.55 ,$83.38 ,$13.55 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$13.55 ,$13.55 ,$108.75 ,$102.95 ,$102.95 ,$13.55 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$33.88 ,$123.25 ,$13.55 ,$145.00 ,$6.45 ,$6.45 ,$123.25 ,$28.46 ,$123.25 ,$130.50 ,$13.55 ,$120.35 ,$115.28 ,$115.28 ,$13.55 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,30200927,86713,HC LEGIONELLA AB-90,302,1 ,$86.00 ,$55.90 ,$11.11 ,$86.00 ,$73.10 ,$51.34 ,$15.30 ,$49.45 ,$15.30 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$15.30 ,$15.30 ,$64.50 ,$61.06 ,$61.06 ,$15.30 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$38.25 ,$73.10 ,$15.30 ,$86.00 ,$11.11 ,$11.11 ,$73.10 ,$32.13 ,$73.10 ,$77.40 ,$15.30 ,$71.38 ,$68.37 ,$68.37 ,$15.30 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200931,86735,HC MUMPS AB-90,302,1 ,$126.00 ,$81.90 ,$6.45 ,$126.00 ,$107.10 ,$75.22 ,$13.05 ,$72.45 ,$13.05 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$103.32 ,$85.68 ,$13.05 ,$13.05 ,$94.50 ,$89.46 ,$89.46 ,$13.05 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$32.63 ,$107.10 ,$13.05 ,$126.00 ,$6.45 ,$6.45 ,$107.10 ,$27.41 ,$107.10 ,$113.40 ,$13.05 ,$104.58 ,$100.17 ,$100.17 ,$13.05 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200932,86738,HC MYCOPLASMA AB-90,302,1 ,$126.00 ,$81.90 ,$11.11 ,$126.00 ,$107.10 ,$75.22 ,$13.24 ,$72.45 ,$13.24 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$103.32 ,$85.68 ,$13.24 ,$13.24 ,$94.50 ,$89.46 ,$89.46 ,$13.24 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$33.10 ,$107.10 ,$13.24 ,$126.00 ,$11.11 ,$11.11 ,$107.10 ,$27.80 ,$107.10 ,$113.40 ,$13.24 ,$104.58 ,$100.17 ,$100.17 ,$13.24 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200935,86747,HC PARVOVIRUS AB-90,302,1 ,$139.00 ,$90.35 ,$11.11 ,$139.00 ,$118.15 ,$82.98 ,$15.03 ,$79.93 ,$15.03 ,$95.77 ,$118.15 ,$118.15 ,$118.15 ,$113.98 ,$94.52 ,$15.03 ,$15.03 ,$104.25 ,$98.69 ,$98.69 ,$15.03 ,$98.69 ,$115.37 ,$115.37 ,$115.37 , N/A ,$37.58 ,$118.15 ,$15.03 ,$139.00 ,$11.11 ,$11.11 ,$118.15 ,$31.56 ,$118.15 ,$125.10 ,$15.03 ,$115.37 ,$110.51 ,$110.51 ,$15.03 ,$90.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200939,86757,HC RICKETTSIA AB-90,302,1 ,$59.00 ,$38.35 ,$11.11 ,$59.00 ,$50.15 ,$35.22 ,$19.35 ,$33.93 ,$19.35 ,$40.65 ,$50.15 ,$50.15 ,$50.15 ,$48.38 ,$40.12 ,$19.35 ,$19.35 ,$44.25 ,$41.89 ,$41.89 ,$19.35 ,$41.89 ,$48.97 ,$48.97 ,$48.97 , N/A ,$48.38 ,$50.15 ,$19.35 ,$59.00 ,$11.11 ,$11.11 ,$50.15 ,$40.64 ,$50.15 ,$53.10 ,$19.35 ,$48.97 ,$46.91 ,$46.91 ,$19.35 ,$38.35 
ST. JOSEPH'S HOSPITAL - BREESE,30200941,86765,HC RUBEOLA AB-90,302,1 ,$122.00 ,$79.30 ,$6.45 ,$122.00 ,$103.70 ,$72.83 ,$12.88 ,$70.15 ,$12.88 ,$84.06 ,$103.70 ,$103.70 ,$103.70 ,$100.04 ,$82.96 ,$12.88 ,$12.88 ,$91.50 ,$86.62 ,$86.62 ,$12.88 ,$86.62 ,$101.26 ,$101.26 ,$101.26 , N/A ,$32.20 ,$103.70 ,$12.88 ,$122.00 ,$6.45 ,$6.45 ,$103.70 ,$27.05 ,$103.70 ,$109.80 ,$12.88 ,$101.26 ,$96.99 ,$96.99 ,$12.88 ,$79.30 
ST. JOSEPH'S HOSPITAL - BREESE,30200943,86774,HC TETANUS AB-90,302,1 ,$132.00 ,$85.80 ,$11.11 ,$132.00 ,$112.20 ,$78.80 ,$14.80 ,$75.90 ,$14.80 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$14.80 ,$14.80 ,$99.00 ,$93.72 ,$93.72 ,$14.80 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$37.00 ,$112.20 ,$14.80 ,$132.00 ,$11.11 ,$11.11 ,$112.20 ,$31.08 ,$112.20 ,$118.80 ,$14.80 ,$109.56 ,$104.94 ,$104.94 ,$14.80 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,30200944,86777,HC TOXOPLASMA AB-90,302,1 ,$115.00 ,$74.75 ,$11.11 ,$115.00 ,$97.75 ,$68.66 ,$14.39 ,$66.13 ,$14.39 ,$79.24 ,$97.75 ,$97.75 ,$97.75 ,$94.30 ,$78.20 ,$14.39 ,$14.39 ,$86.25 ,$81.65 ,$81.65 ,$14.39 ,$81.65 ,$95.45 ,$95.45 ,$95.45 , N/A ,$35.98 ,$97.75 ,$14.39 ,$115.00 ,$11.11 ,$11.11 ,$97.75 ,$30.22 ,$97.75 ,$103.50 ,$14.39 ,$95.45 ,$91.43 ,$91.43 ,$14.39 ,$74.75 
ST. JOSEPH'S HOSPITAL - BREESE,30200945,86778,HC TOXOPLASMA AB IGM-90,302,1 ,$115.00 ,$74.75 ,$11.11 ,$115.00 ,$97.75 ,$68.66 ,$14.41 ,$66.13 ,$14.41 ,$79.24 ,$97.75 ,$97.75 ,$97.75 ,$94.30 ,$78.20 ,$14.41 ,$14.41 ,$86.25 ,$81.65 ,$81.65 ,$14.41 ,$81.65 ,$95.45 ,$95.45 ,$95.45 , N/A ,$36.03 ,$97.75 ,$14.41 ,$115.00 ,$11.11 ,$11.11 ,$97.75 ,$30.26 ,$97.75 ,$103.50 ,$14.41 ,$95.45 ,$91.43 ,$91.43 ,$14.41 ,$74.75 
ST. JOSEPH'S HOSPITAL - BREESE,30200946,86780,HC TREPONEMA P AB CONFIRM-90,302,1 ,$95.00 ,$61.75 ,$11.11 ,$95.00 ,$80.75 ,$56.72 ,$13.24 ,$54.63 ,$13.24 ,$65.46 ,$80.75 ,$80.75 ,$80.75 ,$77.90 ,$64.60 ,$13.24 ,$13.24 ,$71.25 ,$67.45 ,$67.45 ,$13.24 ,$67.45 ,$78.85 ,$78.85 ,$78.85 , N/A ,$33.10 ,$80.75 ,$13.24 ,$95.00 ,$11.11 ,$11.11 ,$80.75 ,$27.80 ,$80.75 ,$85.50 ,$13.24 ,$78.85 ,$75.53 ,$75.53 ,$13.24 ,$61.75 
ST. JOSEPH'S HOSPITAL - BREESE,30200948,86787,HC VARICELLA ZOSTER AB-90,302,1 ,$146.00 ,$94.90 ,$6.45 ,$146.00 ,$124.10 ,$87.16 ,$12.88 ,$83.95 ,$12.88 ,$100.59 ,$124.10 ,$124.10 ,$124.10 ,$119.72 ,$99.28 ,$12.88 ,$12.88 ,$109.50 ,$103.66 ,$103.66 ,$12.88 ,$103.66 ,$121.18 ,$121.18 ,$121.18 , N/A ,$32.20 ,$124.10 ,$12.88 ,$146.00 ,$6.45 ,$6.45 ,$124.10 ,$27.05 ,$124.10 ,$131.40 ,$12.88 ,$121.18 ,$116.07 ,$116.07 ,$12.88 ,$94.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200951,86790,HC VIRUS AB NOT SPECIFIED-90,302,1 ,$118.00 ,$76.70 ,$6.45 ,$118.00 ,$100.30 ,$70.45 ,$12.88 ,$67.85 ,$12.88 ,$81.30 ,$100.30 ,$100.30 ,$100.30 ,$96.76 ,$80.24 ,$12.88 ,$12.88 ,$88.50 ,$83.78 ,$83.78 ,$12.88 ,$83.78 ,$97.94 ,$97.94 ,$97.94 , N/A ,$32.20 ,$100.30 ,$12.88 ,$118.00 ,$6.45 ,$6.45 ,$100.30 ,$27.05 ,$100.30 ,$106.20 ,$12.88 ,$97.94 ,$93.81 ,$93.81 ,$12.88 ,$76.70 
ST. JOSEPH'S HOSPITAL - BREESE,30200953,86800,HC THYROGLOBULIN AB-90,302,1 ,$151.00 ,$98.15 ,$15.91 ,$151.00 ,$128.35 ,$90.15 ,$15.91 ,$86.83 ,$15.91 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$15.91 ,$15.91 ,$113.25 ,$107.21 ,$107.21 ,$15.91 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$39.78 ,$128.35 ,$15.91 ,$151.00 ,$16.85 ,$16.85 ,$128.35 ,$33.41 ,$128.35 ,$135.90 ,$15.91 ,$125.33 ,$120.05 ,$120.05 ,$15.91 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30200954,86803,HC HEP C AB-90,302,1 ,$10.00 ,$6.50 ,$5.75 ,$21.00 ,$8.50 ,$5.97 ,$10.00 ,$5.75 ,$10.00 ,$6.89 ,$8.50 ,$8.50 ,$8.50 ,$8.20 ,$6.80 ,$10.00 ,$10.00 ,$7.50 ,$7.10 ,$7.10 ,$10.00 ,$7.10 ,$8.30 ,$8.30 ,$8.30 , N/A ,$10.00 ,$8.50 ,$10.00 ,$10.00 ,$11.11 ,$9.65 ,$8.50 ,$21.00 ,$8.50 ,$9.00 ,$10.00 ,$8.30 ,$7.95 ,$7.95 ,$10.00 ,$6.50 
ST. JOSEPH'S HOSPITAL - BREESE,30200960,86812,HC HLA TYPING SINGLE A/B/C-90,302,1 ,$189.00 ,$122.85 ,$25.81 ,$189.00 ,$160.65 ,$112.83 ,$25.81 ,$108.68 ,$25.81 ,$130.22 ,$160.65 ,$160.65 ,$160.65 ,$154.98 ,$128.52 ,$25.81 ,$25.81 ,$141.75 ,$134.19 ,$134.19 ,$25.81 ,$134.19 ,$156.87 ,$156.87 ,$156.87 , N/A ,$64.53 ,$160.65 ,$25.81 ,$189.00 ,$26.02 ,$26.02 ,$160.65 ,$54.20 ,$160.65 ,$170.10 ,$25.81 ,$156.87 ,$150.26 ,$150.26 ,$25.81 ,$122.85 
ST. JOSEPH'S HOSPITAL - BREESE,30200966,86850,HC AB SCREEN-90,302,1 ,$86.00 ,$55.90 ,$6.45 ,$99.27 ,$73.10 ,$51.34 ,$47.27 ,$49.45 ,$47.27 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$47.27 ,$47.27 ,$64.50 ,$61.06 ,$61.06 ,$47.27 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$86.00 ,$73.10 ,$47.27 ,$86.00 ,$6.45 ,$6.45 ,$73.10 ,$99.27 ,$73.10 ,$77.40 ,$47.27 ,$71.38 ,$68.37 ,$68.37 ,$47.27 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200970,86860,HC ELUTION-90,302,1 ,$52.00 ,$33.80 ,$6.45 ,$287.97 ,$44.20 ,$31.04 ,$137.13 ,$29.90 ,$137.13 ,$35.83 ,$44.20 ,$44.20 ,$44.20 ,$42.64 ,$35.36 ,$137.13 ,$137.13 ,$39.00 ,$36.92 ,$36.92 ,$137.13 ,$36.92 ,$43.16 ,$43.16 ,$43.16 , N/A ,$52.00 ,$44.20 ,$137.13 ,$52.00 ,$6.45 ,$6.45 ,$44.20 ,$287.97 ,$44.20 ,$46.80 ,$137.13 ,$43.16 ,$41.34 ,$41.34 ,$137.13 ,$33.80 
ST. JOSEPH'S HOSPITAL - BREESE,30200974,86870,HC RBC AB ID PANEL-90,302,1 ,$226.00 ,$146.90 ,$6.45 ,$568.74 ,$192.10 ,$134.92 ,$270.83 ,$129.95 ,$270.83 ,$155.71 ,$192.10 ,$192.10 ,$192.10 ,$185.32 ,$153.68 ,$270.83 ,$270.83 ,$169.50 ,$160.46 ,$160.46 ,$270.83 ,$160.46 ,$187.58 ,$187.58 ,$187.58 , N/A ,$226.00 ,$192.10 ,$270.83 ,$226.00 ,$6.45 ,$6.45 ,$192.10 ,$568.74 ,$192.10 ,$203.40 ,$270.83 ,$187.58 ,$179.67 ,$179.67 ,$270.83 ,$146.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200976,86880,HC COOMBS DIRECT-90,302,1 ,$82.00 ,$53.30 ,$6.45 ,$82.00 ,$69.70 ,$48.95 ,$31.95 ,$47.15 ,$31.95 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$31.95 ,$31.95 ,$61.50 ,$58.22 ,$58.22 ,$31.95 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$79.86 ,$69.70 ,$31.95 ,$82.00 ,$6.45 ,$6.45 ,$69.70 ,$67.09 ,$69.70 ,$73.80 ,$31.95 ,$68.06 ,$65.19 ,$65.19 ,$31.95 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30200978,86886,HC INDIRECT TITER-90,302,1 ,$86.00 ,$55.90 ,$6.45 ,$287.97 ,$73.10 ,$51.34 ,$137.13 ,$49.45 ,$137.13 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$137.13 ,$137.13 ,$64.50 ,$61.06 ,$61.06 ,$137.13 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$86.00 ,$73.10 ,$137.13 ,$86.00 ,$6.45 ,$6.45 ,$73.10 ,$287.97 ,$73.10 ,$77.40 ,$137.13 ,$71.38 ,$68.37 ,$68.37 ,$137.13 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30200981,86900,HC BLOOD TYPING ABO-90,302,1 ,$62.00 ,$40.30 ,$4.00 ,$218.80 ,$52.70 ,$37.01 ,$104.19 ,$35.65 ,$104.19 ,$42.72 ,$52.70 ,$52.70 ,$52.70 ,$50.84 ,$42.16 ,$104.19 ,$104.19 ,$46.50 ,$44.02 ,$44.02 ,$104.19 ,$44.02 ,$51.46 ,$51.46 ,$51.46 , N/A ,$62.00 ,$52.70 ,$104.19 ,$62.00 ,$4.00 ,$4.00 ,$52.70 ,$218.80 ,$52.70 ,$55.80 ,$104.19 ,$51.46 ,$49.29 ,$49.29 ,$104.19 ,$40.30 
ST. JOSEPH'S HOSPITAL - BREESE,30200983,86901,HC BLOOD TYPING RH-90,302,1 ,$58.00 ,$37.70 ,$4.00 ,$67.09 ,$49.30 ,$34.63 ,$31.95 ,$33.35 ,$31.95 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$31.95 ,$31.95 ,$43.50 ,$41.18 ,$41.18 ,$31.95 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$58.00 ,$49.30 ,$31.95 ,$58.00 ,$4.00 ,$4.00 ,$49.30 ,$67.09 ,$49.30 ,$52.20 ,$31.95 ,$48.14 ,$46.11 ,$46.11 ,$31.95 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30200989,86902,HC RBC AG SCR RGT SERUM-90,302,1 ,$263.00 ,$170.95 ,$4.00 ,$568.74 ,$223.55 ,$157.01 ,$270.83 ,$151.23 ,$270.83 ,$181.21 ,$223.55 ,$223.55 ,$223.55 ,$215.66 ,$178.84 ,$270.83 ,$270.83 ,$197.25 ,$186.73 ,$186.73 ,$270.83 ,$186.73 ,$218.29 ,$218.29 ,$218.29 , N/A ,$263.00 ,$223.55 ,$270.83 ,$263.00 ,$4.00 ,$4.00 ,$223.55 ,$568.74 ,$223.55 ,$236.70 ,$270.83 ,$218.29 ,$209.09 ,$209.09 ,$270.83 ,$170.95 
ST. JOSEPH'S HOSPITAL - BREESE,30200990,86904,HC RBC AG SCR PAT SERUM-90,302,1 ,$67.00 ,$43.55 ,$4.00 ,$67.09 ,$56.95 ,$40.00 ,$31.95 ,$38.53 ,$31.95 ,$46.16 ,$56.95 ,$56.95 ,$56.95 ,$54.94 ,$45.56 ,$31.95 ,$31.95 ,$50.25 ,$47.57 ,$47.57 ,$31.95 ,$47.57 ,$55.61 ,$55.61 ,$55.61 , N/A ,$67.00 ,$56.95 ,$31.95 ,$67.00 ,$4.00 ,$4.00 ,$56.95 ,$67.09 ,$56.95 ,$60.30 ,$31.95 ,$55.61 ,$53.27 ,$53.27 ,$31.95 ,$43.55 
ST. JOSEPH'S HOSPITAL - BREESE,30200997,86905,HC RBC AG TYPING NON ABO/RH-90,302,1 ,$72.00 ,$46.80 ,$4.00 ,$568.74 ,$61.20 ,$42.98 ,$270.83 ,$41.40 ,$270.83 ,$49.61 ,$61.20 ,$61.20 ,$61.20 ,$59.04 ,$48.96 ,$270.83 ,$270.83 ,$54.00 ,$51.12 ,$51.12 ,$270.83 ,$51.12 ,$59.76 ,$59.76 ,$59.76 , N/A ,$72.00 ,$61.20 ,$270.83 ,$72.00 ,$4.00 ,$4.00 ,$61.20 ,$568.74 ,$61.20 ,$64.80 ,$270.83 ,$59.76 ,$57.24 ,$57.24 ,$270.83 ,$46.80 
ST. JOSEPH'S HOSPITAL - BREESE,30200998,86906,HC RH PHENOTYPE COMPLETE-90,302,1 ,$92.00 ,$59.80 ,$4.00 ,$92.00 ,$78.20 ,$54.92 ,$31.95 ,$52.90 ,$31.95 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$31.95 ,$31.95 ,$69.00 ,$65.32 ,$65.32 ,$31.95 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$79.86 ,$78.20 ,$31.95 ,$92.00 ,$4.00 ,$4.00 ,$78.20 ,$67.09 ,$78.20 ,$82.80 ,$31.95 ,$76.36 ,$73.14 ,$73.14 ,$31.95 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201003,86970,HC RBC PRETREAT CHEM-90,302,1 ,$92.00 ,$59.80 ,$26.02 ,$92.00 ,$78.20 ,$54.92 ,$31.95 ,$52.90 ,$31.95 ,$63.39 ,$78.20 ,$78.20 ,$78.20 ,$75.44 ,$62.56 ,$31.95 ,$31.95 ,$69.00 ,$65.32 ,$65.32 ,$31.95 ,$65.32 ,$76.36 ,$76.36 ,$76.36 , N/A ,$79.86 ,$78.20 ,$31.95 ,$92.00 ,$26.02 ,$26.02 ,$78.20 ,$67.09 ,$78.20 ,$82.80 ,$31.95 ,$76.36 ,$73.14 ,$73.14 ,$31.95 ,$59.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201005,86971,HC RBC PRETREAT ENZYME-90,302,1 ,$82.00 ,$53.30 ,$26.02 ,$568.74 ,$69.70 ,$48.95 ,$270.83 ,$47.15 ,$270.83 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$270.83 ,$270.83 ,$61.50 ,$58.22 ,$58.22 ,$270.83 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$82.00 ,$69.70 ,$270.83 ,$82.00 ,$26.02 ,$26.02 ,$69.70 ,$568.74 ,$69.70 ,$73.80 ,$270.83 ,$68.06 ,$65.19 ,$65.19 ,$270.83 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30201007,86972,HC RBC PRETREAT DENSITY SEP-90,302,1 ,$95.00 ,$61.75 ,$26.02 ,$287.97 ,$80.75 ,$56.72 ,$137.13 ,$54.63 ,$137.13 ,$65.46 ,$80.75 ,$80.75 ,$80.75 ,$77.90 ,$64.60 ,$137.13 ,$137.13 ,$71.25 ,$67.45 ,$67.45 ,$137.13 ,$67.45 ,$78.85 ,$78.85 ,$78.85 , N/A ,$95.00 ,$80.75 ,$137.13 ,$95.00 ,$26.02 ,$26.02 ,$80.75 ,$287.97 ,$80.75 ,$85.50 ,$137.13 ,$78.85 ,$75.53 ,$75.53 ,$137.13 ,$61.75 
ST. JOSEPH'S HOSPITAL - BREESE,30201009,86975,HC INCUBATION OF SERUM W/DRUG-90,302,1 ,$138.00 ,$89.70 ,$26.02 ,$218.80 ,$117.30 ,$82.39 ,$104.19 ,$79.35 ,$104.19 ,$95.08 ,$117.30 ,$117.30 ,$117.30 ,$113.16 ,$93.84 ,$104.19 ,$104.19 ,$103.50 ,$97.98 ,$97.98 ,$104.19 ,$97.98 ,$114.54 ,$114.54 ,$114.54 , N/A ,$138.00 ,$117.30 ,$104.19 ,$138.00 ,$26.02 ,$26.02 ,$117.30 ,$218.80 ,$117.30 ,$124.20 ,$104.19 ,$114.54 ,$109.71 ,$109.71 ,$104.19 ,$89.70 
ST. JOSEPH'S HOSPITAL - BREESE,30201011,86976,HC RBC PRETREAT SERUM DIL-90,302,1 ,$33.00 ,$21.45 ,$18.98 ,$46.14 ,$28.05 ,$19.70 ,$21.97 ,$18.98 ,$21.97 ,$22.74 ,$28.05 ,$28.05 ,$28.05 ,$27.06 ,$22.44 ,$21.97 ,$21.97 ,$24.75 ,$23.43 ,$23.43 ,$21.97 ,$23.43 ,$27.39 ,$27.39 ,$27.39 , N/A ,$33.00 ,$28.05 ,$21.97 ,$33.00 ,$26.02 ,$26.02 ,$28.05 ,$46.14 ,$28.05 ,$29.70 ,$21.97 ,$27.39 ,$26.24 ,$26.24 ,$21.97 ,$21.45 
ST. JOSEPH'S HOSPITAL - BREESE,30201016,86977,HC RBC PRETREAT NEUTRAL SERUM INHIBIT-90,302,1 ,$75.00 ,$48.75 ,$26.02 ,$287.97 ,$63.75 ,$44.78 ,$137.13 ,$43.13 ,$137.13 ,$51.68 ,$63.75 ,$63.75 ,$63.75 ,$61.50 ,$51.00 ,$137.13 ,$137.13 ,$56.25 ,$53.25 ,$53.25 ,$137.13 ,$53.25 ,$62.25 ,$62.25 ,$62.25 , N/A ,$75.00 ,$63.75 ,$137.13 ,$75.00 ,$26.02 ,$26.02 ,$63.75 ,$287.97 ,$63.75 ,$67.50 ,$137.13 ,$62.25 ,$59.63 ,$59.63 ,$137.13 ,$48.75 
ST. JOSEPH'S HOSPITAL - BREESE,30201020,86978,HC RBC PRETREAT ABSOR-90,302,1 ,$181.00 ,$117.65 ,$4.00 ,$181.00 ,$153.85 ,$108.06 ,$31.95 ,$104.08 ,$31.95 ,$124.71 ,$153.85 ,$153.85 ,$153.85 ,$148.42 ,$123.08 ,$31.95 ,$31.95 ,$135.75 ,$128.51 ,$128.51 ,$31.95 ,$128.51 ,$150.23 ,$150.23 ,$150.23 , N/A ,$79.86 ,$153.85 ,$31.95 ,$181.00 ,$4.00 ,$4.00 ,$153.85 ,$67.09 ,$153.85 ,$162.90 ,$31.95 ,$150.23 ,$143.90 ,$143.90 ,$31.95 ,$117.65 
ST. JOSEPH'S HOSPITAL - BREESE,30201022,87801,HC INFECT MLT  ORG AMP-90,302,1 ,$165.00 ,$107.25 ,$5.14 ,$165.00 ,$140.25 ,$98.51 ,$70.20 ,$94.88 ,$70.20 ,$113.69 ,$140.25 ,$140.25 ,$140.25 ,$135.30 ,$112.20 ,$70.20 ,$70.20 ,$123.75 ,$117.15 ,$117.15 ,$70.20 ,$117.15 ,$136.95 ,$136.95 ,$136.95 , N/A ,$165.00 ,$140.25 ,$70.20 ,$165.00 ,$5.14 ,$5.14 ,$140.25 ,$147.42 ,$140.25 ,$148.50 ,$70.20 ,$136.95 ,$131.18 ,$131.18 ,$70.20 ,$107.25 
ST. JOSEPH'S HOSPITAL - BREESE,30201025,86316,HC TUMOR AG OTHER AG QN-90,302,1 ,$323.00 ,$209.95 ,$7.20 ,$323.00 ,$274.55 ,$192.83 ,$20.81 ,$185.73 ,$20.81 ,$222.55 ,$274.55 ,$274.55 ,$274.55 ,$264.86 ,$219.64 ,$20.81 ,$20.81 ,$242.25 ,$229.33 ,$229.33 ,$20.81 ,$229.33 ,$268.09 ,$268.09 ,$268.09 , N/A ,$52.03 ,$274.55 ,$20.81 ,$323.00 ,$7.20 ,$7.20 ,$274.55 ,$43.70 ,$274.55 ,$290.70 ,$20.81 ,$268.09 ,$256.79 ,$256.79 ,$20.81 ,$209.95 
ST. JOSEPH'S HOSPITAL - BREESE,30201026,86317,HC INFECTIOUS AB QN-90,302,1 ,$35.65 ,$23.17 ,$11.11 ,$35.65 ,$30.30 ,$21.28 ,$14.99 ,$20.50 ,$14.99 ,$24.56 ,$30.30 ,$30.30 ,$30.30 ,$29.23 ,$24.24 ,$14.99 ,$14.99 ,$26.74 ,$25.31 ,$25.31 ,$14.99 ,$25.31 ,$29.59 ,$29.59 ,$29.59 , N/A ,$35.65 ,$30.30 ,$14.99 ,$35.65 ,$11.11 ,$11.11 ,$30.30 ,$31.48 ,$30.30 ,$32.09 ,$14.99 ,$29.59 ,$28.34 ,$28.34 ,$14.99 ,$23.17 
ST. JOSEPH'S HOSPITAL - BREESE,30201029,86331,HC IMMUNODIFF EL EA AG AB QL-90,302,1 ,$40.00 ,$26.00 ,$11.11 ,$40.00 ,$34.00 ,$23.88 ,$11.98 ,$23.00 ,$11.98 ,$27.56 ,$34.00 ,$34.00 ,$34.00 ,$32.80 ,$27.20 ,$11.98 ,$11.98 ,$30.00 ,$28.40 ,$28.40 ,$11.98 ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A ,$29.95 ,$34.00 ,$11.98 ,$40.00 ,$11.11 ,$11.11 ,$34.00 ,$25.16 ,$34.00 ,$36.00 ,$11.98 ,$33.20 ,$31.80 ,$31.80 ,$11.98 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201030,86332,HC IMMUNE COMPLEX ASSAY-90,302,1 ,$52.00 ,$33.80 ,$11.11 ,$52.00 ,$44.20 ,$31.04 ,$24.37 ,$29.90 ,$24.37 ,$35.83 ,$44.20 ,$44.20 ,$44.20 ,$42.64 ,$35.36 ,$24.37 ,$24.37 ,$39.00 ,$36.92 ,$36.92 ,$24.37 ,$36.92 ,$43.16 ,$43.16 ,$43.16 , N/A ,$52.00 ,$44.20 ,$24.37 ,$52.00 ,$11.11 ,$11.11 ,$44.20 ,$51.18 ,$44.20 ,$46.80 ,$24.37 ,$43.16 ,$41.34 ,$41.34 ,$24.37 ,$33.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201031,86334,HC IMMUNOFIX ELECTRO SERUM -90,302,1 ,$145.00 ,$94.25 ,$11.11 ,$145.00 ,$123.25 ,$86.57 ,$22.34 ,$83.38 ,$22.34 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$22.34 ,$22.34 ,$108.75 ,$102.95 ,$102.95 ,$22.34 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$55.85 ,$123.25 ,$22.34 ,$145.00 ,$11.11 ,$11.11 ,$123.25 ,$46.91 ,$123.25 ,$130.50 ,$22.34 ,$120.35 ,$115.28 ,$115.28 ,$22.34 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,30201032,86335,HC IMMUNOFIX ELECTRO OTH-90,302,1 ,$137.00 ,$89.05 ,$11.11 ,$137.00 ,$116.45 ,$81.79 ,$29.35 ,$78.78 ,$29.35 ,$94.39 ,$116.45 ,$116.45 ,$116.45 ,$112.34 ,$93.16 ,$29.35 ,$29.35 ,$102.75 ,$97.27 ,$97.27 ,$29.35 ,$97.27 ,$113.71 ,$113.71 ,$113.71 , N/A ,$73.38 ,$116.45 ,$29.35 ,$137.00 ,$11.11 ,$11.11 ,$116.45 ,$61.64 ,$116.45 ,$123.30 ,$29.35 ,$113.71 ,$108.92 ,$108.92 ,$29.35 ,$89.05 
ST. JOSEPH'S HOSPITAL - BREESE,30201033,86336,HC INHIBIN A-90,302,1 ,$156.00 ,$101.40 ,$7.20 ,$156.00 ,$132.60 ,$93.13 ,$15.59 ,$89.70 ,$15.59 ,$107.48 ,$132.60 ,$132.60 ,$132.60 ,$127.92 ,$106.08 ,$15.59 ,$15.59 ,$117.00 ,$110.76 ,$110.76 ,$15.59 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$38.98 ,$132.60 ,$15.59 ,$156.00 ,$7.20 ,$7.20 ,$132.60 ,$32.74 ,$132.60 ,$140.40 ,$15.59 ,$129.48 ,$124.02 ,$124.02 ,$15.59 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,30201034,86337,HC INSULIN AB-90,302,1 ,$154.00 ,$100.10 ,$16.85 ,$154.00 ,$130.90 ,$91.94 ,$21.41 ,$88.55 ,$21.41 ,$106.11 ,$130.90 ,$130.90 ,$130.90 ,$126.28 ,$104.72 ,$21.41 ,$21.41 ,$115.50 ,$109.34 ,$109.34 ,$21.41 ,$109.34 ,$127.82 ,$127.82 ,$127.82 , N/A ,$53.53 ,$130.90 ,$21.41 ,$154.00 ,$16.85 ,$16.85 ,$130.90 ,$44.96 ,$130.90 ,$138.60 ,$21.41 ,$127.82 ,$122.43 ,$122.43 ,$21.41 ,$100.10 
ST. JOSEPH'S HOSPITAL - BREESE,30201035,86340,HC INTRINSIC FACTOR AB-90,302,1 ,$97.00 ,$63.05 ,$15.08 ,$97.00 ,$82.45 ,$57.91 ,$15.08 ,$55.78 ,$15.08 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$15.08 ,$15.08 ,$72.75 ,$68.87 ,$68.87 ,$15.08 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$37.70 ,$82.45 ,$15.08 ,$97.00 ,$16.85 ,$16.85 ,$82.45 ,$31.67 ,$82.45 ,$87.30 ,$15.08 ,$80.51 ,$77.12 ,$77.12 ,$15.08 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,30201036,86341,HC ISLET CELL AB-90,302,1 ,$213.00 ,$138.45 ,$11.11 ,$213.00 ,$181.05 ,$127.16 ,$23.57 ,$122.48 ,$23.57 ,$146.76 ,$181.05 ,$181.05 ,$181.05 ,$174.66 ,$144.84 ,$23.57 ,$23.57 ,$159.75 ,$151.23 ,$151.23 ,$23.57 ,$151.23 ,$176.79 ,$176.79 ,$176.79 , N/A ,$58.93 ,$181.05 ,$23.57 ,$213.00 ,$11.11 ,$11.11 ,$181.05 ,$49.50 ,$181.05 ,$191.70 ,$23.57 ,$176.79 ,$169.34 ,$169.34 ,$23.57 ,$138.45 
ST. JOSEPH'S HOSPITAL - BREESE,30201037,86343,HC LEUKOCYTE HISTAMINE RELEASE-90,302,1 ,$304.00 ,$197.60 ,$11.11 ,$304.00 ,$258.40 ,$181.49 ,$12.46 ,$174.80 ,$12.46 ,$209.46 ,$258.40 ,$258.40 ,$258.40 ,$249.28 ,$206.72 ,$12.46 ,$12.46 ,$228.00 ,$215.84 ,$215.84 ,$12.46 ,$215.84 ,$252.32 ,$252.32 ,$252.32 , N/A ,$31.15 ,$258.40 ,$12.46 ,$304.00 ,$11.11 ,$11.11 ,$258.40 ,$26.17 ,$258.40 ,$273.60 ,$12.46 ,$252.32 ,$241.68 ,$241.68 ,$12.46 ,$197.60 
ST. JOSEPH'S HOSPITAL - BREESE,30201040,86355,HC B CELLS TOTAL COUNT-90,302,1 ,$206.00 ,$133.90 ,$11.11 ,$206.00 ,$175.10 ,$122.98 ,$37.73 ,$118.45 ,$37.73 ,$141.93 ,$175.10 ,$175.10 ,$175.10 ,$168.92 ,$140.08 ,$37.73 ,$37.73 ,$154.50 ,$146.26 ,$146.26 ,$37.73 ,$146.26 ,$170.98 ,$170.98 ,$170.98 , N/A ,$94.33 ,$175.10 ,$37.73 ,$206.00 ,$11.11 ,$11.11 ,$175.10 ,$79.23 ,$175.10 ,$185.40 ,$37.73 ,$170.98 ,$163.77 ,$163.77 ,$37.73 ,$133.90 
ST. JOSEPH'S HOSPITAL - BREESE,30201042,86357,HC CD8 TOTAL COUNT-90,302,1 ,$201.00 ,$130.65 ,$11.11 ,$201.00 ,$170.85 ,$120.00 ,$37.73 ,$115.58 ,$37.73 ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$164.82 ,$136.68 ,$37.73 ,$37.73 ,$150.75 ,$142.71 ,$142.71 ,$37.73 ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A ,$94.33 ,$170.85 ,$37.73 ,$201.00 ,$11.11 ,$11.11 ,$170.85 ,$79.23 ,$170.85 ,$180.90 ,$37.73 ,$166.83 ,$159.80 ,$159.80 ,$37.73 ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,30201043,86359,HC T CELLS TOTAL COUNT-90,302,1 ,$201.00 ,$130.65 ,$11.11 ,$201.00 ,$170.85 ,$120.00 ,$37.73 ,$115.58 ,$37.73 ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$164.82 ,$136.68 ,$37.73 ,$37.73 ,$150.75 ,$142.71 ,$142.71 ,$37.73 ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A ,$94.33 ,$170.85 ,$37.73 ,$201.00 ,$11.11 ,$11.11 ,$170.85 ,$79.23 ,$170.85 ,$180.90 ,$37.73 ,$166.83 ,$159.80 ,$159.80 ,$37.73 ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,30201045,86360,HC ABS T CELLS CD4 CD8 RATIO-90,302,1 ,$212.00 ,$137.80 ,$11.11 ,$212.00 ,$180.20 ,$126.56 ,$46.98 ,$121.90 ,$46.98 ,$146.07 ,$180.20 ,$180.20 ,$180.20 ,$173.84 ,$144.16 ,$46.98 ,$46.98 ,$159.00 ,$150.52 ,$150.52 ,$46.98 ,$150.52 ,$175.96 ,$175.96 ,$175.96 , N/A ,$117.45 ,$180.20 ,$46.98 ,$212.00 ,$11.11 ,$11.11 ,$180.20 ,$98.66 ,$180.20 ,$190.80 ,$46.98 ,$175.96 ,$168.54 ,$168.54 ,$46.98 ,$137.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201047,86376,HC MICROSOMAL AB-90,302,1 ,$152.00 ,$98.80 ,$14.55 ,$152.00 ,$129.20 ,$90.74 ,$14.55 ,$87.40 ,$14.55 ,$104.73 ,$129.20 ,$129.20 ,$129.20 ,$124.64 ,$103.36 ,$14.55 ,$14.55 ,$114.00 ,$107.92 ,$107.92 ,$14.55 ,$107.92 ,$126.16 ,$126.16 ,$126.16 , N/A ,$36.38 ,$129.20 ,$14.55 ,$152.00 ,$16.85 ,$16.85 ,$129.20 ,$30.56 ,$129.20 ,$136.80 ,$14.55 ,$126.16 ,$120.84 ,$120.84 ,$14.55 ,$98.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201048,86382,HC NEUTRALIZATION TEST VIRAL-90,302,1 ,$216.00 ,$140.40 ,$11.11 ,$216.00 ,$183.60 ,$128.95 ,$16.91 ,$124.20 ,$16.91 ,$148.82 ,$183.60 ,$183.60 ,$183.60 ,$177.12 ,$146.88 ,$16.91 ,$16.91 ,$162.00 ,$153.36 ,$153.36 ,$16.91 ,$153.36 ,$179.28 ,$179.28 ,$179.28 , N/A ,$42.28 ,$183.60 ,$16.91 ,$216.00 ,$11.11 ,$11.11 ,$183.60 ,$35.51 ,$183.60 ,$194.40 ,$16.91 ,$179.28 ,$171.72 ,$171.72 ,$16.91 ,$140.40 
ST. JOSEPH'S HOSPITAL - BREESE,30201053,86480,HC TB QUANTIFERON GOLD-90,302,1 ,$373.00 ,$242.45 ,$11.11 ,$373.00 ,$317.05 ,$222.68 ,$61.98 ,$214.48 ,$61.98 ,$257.00 ,$317.05 ,$317.05 ,$317.05 ,$305.86 ,$253.64 ,$61.98 ,$61.98 ,$279.75 ,$264.83 ,$264.83 ,$61.98 ,$264.83 ,$309.59 ,$309.59 ,$309.59 , N/A ,$154.95 ,$317.05 ,$61.98 ,$373.00 ,$11.11 ,$11.11 ,$317.05 ,$130.16 ,$317.05 ,$335.70 ,$61.98 ,$309.59 ,$296.54 ,$296.54 ,$61.98 ,$242.45 
ST. JOSEPH'S HOSPITAL - BREESE,30201054,86592,HC SYPHILIS VDRL RPR QL-90,302,1 ,$140.00 ,$91.00 ,$4.27 ,$140.00 ,$119.00 ,$83.58 ,$4.27 ,$80.50 ,$4.27 ,$96.46 ,$119.00 ,$119.00 ,$119.00 ,$114.80 ,$95.20 ,$4.27 ,$4.27 ,$105.00 ,$99.40 ,$99.40 ,$4.27 ,$99.40 ,$116.20 ,$116.20 ,$116.20 , N/A ,$10.68 ,$119.00 ,$4.27 ,$140.00 ,$6.45 ,$6.45 ,$119.00 ,$8.97 ,$119.00 ,$126.00 ,$4.27 ,$116.20 ,$111.30 ,$111.30 ,$4.27 ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201055,86603,HC ADENOVIRUS AB-90,302,1 ,$97.00 ,$63.05 ,$11.11 ,$97.00 ,$82.45 ,$57.91 ,$12.87 ,$55.78 ,$12.87 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$12.87 ,$12.87 ,$72.75 ,$68.87 ,$68.87 ,$12.87 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$32.18 ,$82.45 ,$12.87 ,$97.00 ,$11.11 ,$11.11 ,$82.45 ,$27.03 ,$82.45 ,$87.30 ,$12.87 ,$80.51 ,$77.12 ,$77.12 ,$12.87 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,30201056,86606,HC ASPERGILLUS AB-90,302,1 ,$112.00 ,$72.80 ,$11.11 ,$112.00 ,$95.20 ,$66.86 ,$15.05 ,$64.40 ,$15.05 ,$77.17 ,$95.20 ,$95.20 ,$95.20 ,$91.84 ,$76.16 ,$15.05 ,$15.05 ,$84.00 ,$79.52 ,$79.52 ,$15.05 ,$79.52 ,$92.96 ,$92.96 ,$92.96 , N/A ,$37.63 ,$95.20 ,$15.05 ,$112.00 ,$11.11 ,$11.11 ,$95.20 ,$31.61 ,$95.20 ,$100.80 ,$15.05 ,$92.96 ,$89.04 ,$89.04 ,$15.05 ,$72.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201057,86609,HC BACTERIUM AB NOS-90,302,1 ,$90.00 ,$58.50 ,$12.88 ,$90.00 ,$76.50 ,$53.73 ,$12.88 ,$51.75 ,$12.88 ,$62.01 ,$76.50 ,$76.50 ,$76.50 ,$73.80 ,$61.20 ,$12.88 ,$12.88 ,$67.50 ,$63.90 ,$63.90 ,$12.88 ,$63.90 ,$74.70 ,$74.70 ,$74.70 , N/A ,$32.20 ,$76.50 ,$12.88 ,$90.00 ,$17.08 ,$17.08 ,$76.50 ,$27.05 ,$76.50 ,$81.00 ,$12.88 ,$74.70 ,$71.55 ,$71.55 ,$12.88 ,$58.50 
ST. JOSEPH'S HOSPITAL - BREESE,30201058,86611,HC BARTONELLA SCREEN AB-90,302,1 ,$76.00 ,$49.40 ,$10.18 ,$76.00 ,$64.60 ,$45.37 ,$10.18 ,$43.70 ,$10.18 ,$52.36 ,$64.60 ,$64.60 ,$64.60 ,$62.32 ,$51.68 ,$10.18 ,$10.18 ,$57.00 ,$53.96 ,$53.96 ,$10.18 ,$53.96 ,$63.08 ,$63.08 ,$63.08 , N/A ,$25.45 ,$64.60 ,$10.18 ,$76.00 ,$11.11 ,$11.11 ,$64.60 ,$21.38 ,$64.60 ,$68.40 ,$10.18 ,$63.08 ,$60.42 ,$60.42 ,$10.18 ,$49.40 
ST. JOSEPH'S HOSPITAL - BREESE,30201060,86612,HC BLASTOMYCES AB-90,302,1 ,$71.00 ,$46.15 ,$11.11 ,$71.00 ,$60.35 ,$42.39 ,$12.90 ,$40.83 ,$12.90 ,$48.92 ,$60.35 ,$60.35 ,$60.35 ,$58.22 ,$48.28 ,$12.90 ,$12.90 ,$53.25 ,$50.41 ,$50.41 ,$12.90 ,$50.41 ,$58.93 ,$58.93 ,$58.93 , N/A ,$32.25 ,$60.35 ,$12.90 ,$71.00 ,$11.11 ,$11.11 ,$60.35 ,$27.09 ,$60.35 ,$63.90 ,$12.90 ,$58.93 ,$56.45 ,$56.45 ,$12.90 ,$46.15 
ST. JOSEPH'S HOSPITAL - BREESE,30201061,86615,HC BORDETELLA AB-90,302,1 ,$107.00 ,$69.55 ,$11.11 ,$107.00 ,$90.95 ,$63.88 ,$13.19 ,$61.53 ,$13.19 ,$73.72 ,$90.95 ,$90.95 ,$90.95 ,$87.74 ,$72.76 ,$13.19 ,$13.19 ,$80.25 ,$75.97 ,$75.97 ,$13.19 ,$75.97 ,$88.81 ,$88.81 ,$88.81 , N/A ,$32.98 ,$90.95 ,$13.19 ,$107.00 ,$11.11 ,$11.11 ,$90.95 ,$27.70 ,$90.95 ,$96.30 ,$13.19 ,$88.81 ,$85.07 ,$85.07 ,$13.19 ,$69.55 
ST. JOSEPH'S HOSPITAL - BREESE,30201062,86617,HC LYME DISEASE AB CONFIRM-90,302,1 ,$131.00 ,$85.15 ,$11.11 ,$131.00 ,$111.35 ,$78.21 ,$15.49 ,$75.33 ,$15.49 ,$90.26 ,$111.35 ,$111.35 ,$111.35 ,$107.42 ,$89.08 ,$15.49 ,$15.49 ,$98.25 ,$93.01 ,$93.01 ,$15.49 ,$93.01 ,$108.73 ,$108.73 ,$108.73 , N/A ,$38.73 ,$111.35 ,$15.49 ,$131.00 ,$11.11 ,$11.11 ,$111.35 ,$32.53 ,$111.35 ,$117.90 ,$15.49 ,$108.73 ,$104.15 ,$104.15 ,$15.49 ,$85.15 
ST. JOSEPH'S HOSPITAL - BREESE,30201063,86618,HC LYME AB-90,302,1 ,$146.00 ,$94.90 ,$11.11 ,$146.00 ,$124.10 ,$87.16 ,$17.03 ,$83.95 ,$17.03 ,$100.59 ,$124.10 ,$124.10 ,$124.10 ,$119.72 ,$99.28 ,$17.03 ,$17.03 ,$109.50 ,$103.66 ,$103.66 ,$17.03 ,$103.66 ,$121.18 ,$121.18 ,$121.18 , N/A ,$42.58 ,$124.10 ,$17.03 ,$146.00 ,$11.11 ,$11.11 ,$124.10 ,$35.76 ,$124.10 ,$131.40 ,$17.03 ,$121.18 ,$116.07 ,$116.07 ,$17.03 ,$94.90 
ST. JOSEPH'S HOSPITAL - BREESE,30201065,86622,HC BRUCELLA AB-90,302,1 ,$94.00 ,$61.10 ,$8.93 ,$94.00 ,$79.90 ,$56.12 ,$8.93 ,$54.05 ,$8.93 ,$64.77 ,$79.90 ,$79.90 ,$79.90 ,$77.08 ,$63.92 ,$8.93 ,$8.93 ,$70.50 ,$66.74 ,$66.74 ,$8.93 ,$66.74 ,$78.02 ,$78.02 ,$78.02 , N/A ,$22.33 ,$79.90 ,$8.93 ,$94.00 ,$11.11 ,$11.11 ,$79.90 ,$18.75 ,$79.90 ,$84.60 ,$8.93 ,$78.02 ,$74.73 ,$74.73 ,$8.93 ,$61.10 
ST. JOSEPH'S HOSPITAL - BREESE,30201067,86631,HC CHLAMYDIA AB-90,302,1 ,$102.00 ,$66.30 ,$5.14 ,$102.00 ,$86.70 ,$60.89 ,$11.82 ,$58.65 ,$11.82 ,$70.28 ,$86.70 ,$86.70 ,$86.70 ,$83.64 ,$69.36 ,$11.82 ,$11.82 ,$76.50 ,$72.42 ,$72.42 ,$11.82 ,$72.42 ,$84.66 ,$84.66 ,$84.66 , N/A ,$29.55 ,$86.70 ,$11.82 ,$102.00 ,$5.14 ,$5.14 ,$86.70 ,$24.82 ,$86.70 ,$91.80 ,$11.82 ,$84.66 ,$81.09 ,$81.09 ,$11.82 ,$66.30 
ST. JOSEPH'S HOSPITAL - BREESE,30201079,86711,HC AB JOHN CUNNINGHAM VIRUS-90,302,1 ,"$2,726.00 ","$1,771.90 ",$6.45 ,"$2,726.00 ","$2,317.10 ","$1,627.42 ",$16.89 ,"$1,567.45 ",$16.89 ,"$1,878.21 ","$2,317.10 ","$2,317.10 ","$2,317.10 ","$2,235.32 ","$1,853.68 ",$16.89 ,$16.89 ,"$2,044.50 ","$1,935.46 ","$1,935.46 ",$16.89 ,"$1,935.46 ","$2,262.58 ","$2,262.58 ","$2,262.58 ", N/A ,$42.23 ,"$2,317.10 ",$16.89 ,"$2,726.00 ",$6.45 ,$6.45 ,"$2,317.10 ",$35.47 ,"$2,317.10 ","$2,453.40 ",$16.89 ,"$2,262.58 ","$2,167.17 ","$2,167.17 ",$16.89 ,"$1,771.90 "
ST. JOSEPH'S HOSPITAL - BREESE,30201088,86008,HC ALLERGEN IGE QN/SEMI-QN RECOMB/COMP EA-90,302,1 ,$10.00 ,$6.50 ,$5.75 ,$21.00 ,$8.50 ,$5.97 ,$10.00 ,$5.75 ,$10.00 ,$6.89 ,$8.50 ,$8.50 ,$8.50 ,$8.20 ,$6.80 ,$10.00 ,$10.00 ,$7.50 ,$7.10 ,$7.10 ,$10.00 ,$7.10 ,$8.30 ,$8.30 ,$8.30 , N/A ,$10.00 ,$8.50 ,$10.00 ,$10.00 ,$6.45 ,$6.45 ,$8.50 ,$21.00 ,$8.50 ,$9.00 ,$10.00 ,$8.30 ,$7.95 ,$7.95 ,$10.00 ,$6.50 
ST. JOSEPH'S HOSPITAL - BREESE,30201092,86593,HC SYPHILIS VDRL RPR QN-90,302,1 ,$2.62 ,$1.70 ,$1.51 ,$6.45 ,$2.23 ,$1.56 ,$2.62 ,$1.51 ,$2.62 ,$1.81 ,$2.23 ,$2.23 ,$2.23 ,$2.15 ,$1.78 ,$2.62 ,$2.62 ,$1.97 ,$1.86 ,$1.86 ,$2.62 ,$1.86 ,$2.17 ,$2.17 ,$2.17 , N/A ,$2.62 ,$2.23 ,$2.62 ,$2.62 ,$6.45 ,$2.53 ,$2.23 ,$5.50 ,$2.23 ,$2.36 ,$2.62 ,$2.17 ,$2.08 ,$2.08 ,$2.62 ,$1.70 
ST. JOSEPH'S HOSPITAL - BREESE,30201096,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$176.00 ,$114.40 ,$6.45 ,$176.00 ,$149.60 ,$105.07 ,$12.95 ,$101.20 ,$12.95 ,$121.26 ,$149.60 ,$149.60 ,$149.60 ,$144.32 ,$119.68 ,$12.95 ,$12.95 ,$132.00 ,$124.96 ,$124.96 ,$12.95 ,$124.96 ,$146.08 ,$146.08 ,$146.08 , N/A ,$32.38 ,$149.60 ,$12.95 ,$176.00 ,$6.45 ,$6.45 ,$149.60 ,$27.20 ,$149.60 ,$158.40 ,$12.95 ,$146.08 ,$139.92 ,$139.92 ,$12.95 ,$114.40 
ST. JOSEPH'S HOSPITAL - BREESE,30201107,86403,HC PARTICLE AGG SCREEN,302,1 ,$124.00 ,$80.60 ,$6.45 ,$124.00 ,$105.40 ,$74.03 ,$11.54 ,$71.30 ,$11.54 ,$85.44 ,$105.40 ,$105.40 ,$105.40 ,$101.68 ,$84.32 ,$11.54 ,$11.54 ,$93.00 ,$88.04 ,$88.04 ,$11.54 ,$88.04 ,$102.92 ,$102.92 ,$102.92 , N/A ,$28.85 ,$105.40 ,$11.54 ,$124.00 ,$6.45 ,$6.45 ,$105.40 ,$24.23 ,$105.40 ,$111.60 ,$11.54 ,$102.92 ,$98.58 ,$98.58 ,$11.54 ,$80.60 
ST. JOSEPH'S HOSPITAL - BREESE,30201108,86431,HC RHEUMATOID FACTOR QN,302,1 ,$85.00 ,$55.25 ,$5.67 ,$85.00 ,$72.25 ,$50.75 ,$5.67 ,$48.88 ,$5.67 ,$58.57 ,$72.25 ,$72.25 ,$72.25 ,$69.70 ,$57.80 ,$5.67 ,$5.67 ,$63.75 ,$60.35 ,$60.35 ,$5.67 ,$60.35 ,$70.55 ,$70.55 ,$70.55 , N/A ,$14.18 ,$72.25 ,$5.67 ,$85.00 ,$6.45 ,$6.45 ,$72.25 ,$11.91 ,$72.25 ,$76.50 ,$5.67 ,$70.55 ,$67.58 ,$67.58 ,$5.67 ,$55.25 
ST. JOSEPH'S HOSPITAL - BREESE,30201110,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$140.00 ,$91.00 ,$4.27 ,$140.00 ,$119.00 ,$83.58 ,$4.27 ,$80.50 ,$4.27 ,$96.46 ,$119.00 ,$119.00 ,$119.00 ,$114.80 ,$95.20 ,$4.27 ,$4.27 ,$105.00 ,$99.40 ,$99.40 ,$4.27 ,$99.40 ,$116.20 ,$116.20 ,$116.20 , N/A ,$10.68 ,$119.00 ,$4.27 ,$140.00 ,$6.45 ,$6.45 ,$119.00 ,$8.97 ,$119.00 ,$126.00 ,$4.27 ,$116.20 ,$111.30 ,$111.30 ,$4.27 ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201121,86704,HC HEP CORE AB,302,1 ,$192.00 ,$124.80 ,$6.45 ,$192.00 ,$163.20 ,$114.62 ,$12.05 ,$110.40 ,$12.05 ,$132.29 ,$163.20 ,$163.20 ,$163.20 ,$157.44 ,$130.56 ,$12.05 ,$12.05 ,$144.00 ,$136.32 ,$136.32 ,$12.05 ,$136.32 ,$159.36 ,$159.36 ,$159.36 , N/A ,$30.13 ,$163.20 ,$12.05 ,$192.00 ,$6.45 ,$6.45 ,$163.20 ,$25.31 ,$163.20 ,$172.80 ,$12.05 ,$159.36 ,$152.64 ,$152.64 ,$12.05 ,$124.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201122,86705,HC HEP B CORE IGM,302,1 ,$185.00 ,$120.25 ,$6.45 ,$185.00 ,$157.25 ,$110.45 ,$11.77 ,$106.38 ,$11.77 ,$127.47 ,$157.25 ,$157.25 ,$157.25 ,$151.70 ,$125.80 ,$11.77 ,$11.77 ,$138.75 ,$131.35 ,$131.35 ,$11.77 ,$131.35 ,$153.55 ,$153.55 ,$153.55 , N/A ,$29.43 ,$157.25 ,$11.77 ,$185.00 ,$6.45 ,$6.45 ,$157.25 ,$24.72 ,$157.25 ,$166.50 ,$11.77 ,$153.55 ,$147.08 ,$147.08 ,$11.77 ,$120.25 
ST. JOSEPH'S HOSPITAL - BREESE,30201123,86706,HC HEP B SURFACE AB,302,1 ,$177.00 ,$115.05 ,$6.45 ,$177.00 ,$150.45 ,$105.67 ,$10.74 ,$101.78 ,$10.74 ,$121.95 ,$150.45 ,$150.45 ,$150.45 ,$145.14 ,$120.36 ,$10.74 ,$10.74 ,$132.75 ,$125.67 ,$125.67 ,$10.74 ,$125.67 ,$146.91 ,$146.91 ,$146.91 , N/A ,$26.85 ,$150.45 ,$10.74 ,$177.00 ,$6.45 ,$6.45 ,$150.45 ,$22.55 ,$150.45 ,$159.30 ,$10.74 ,$146.91 ,$140.72 ,$140.72 ,$10.74 ,$115.05 
ST. JOSEPH'S HOSPITAL - BREESE,30201125,86709,HC HEP A AB (HAAB) IGM,302,1 ,$192.00 ,$124.80 ,$6.45 ,$192.00 ,$163.20 ,$114.62 ,$11.26 ,$110.40 ,$11.26 ,$132.29 ,$163.20 ,$163.20 ,$163.20 ,$157.44 ,$130.56 ,$11.26 ,$11.26 ,$144.00 ,$136.32 ,$136.32 ,$11.26 ,$136.32 ,$159.36 ,$159.36 ,$159.36 , N/A ,$28.15 ,$163.20 ,$11.26 ,$192.00 ,$6.45 ,$6.45 ,$163.20 ,$23.65 ,$163.20 ,$172.80 ,$11.26 ,$159.36 ,$152.64 ,$152.64 ,$11.26 ,$124.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201127,86762,HC RUBELLA AB,302,1 ,$83.00 ,$53.95 ,$6.45 ,$83.00 ,$70.55 ,$49.55 ,$14.39 ,$47.73 ,$14.39 ,$57.19 ,$70.55 ,$70.55 ,$70.55 ,$68.06 ,$56.44 ,$14.39 ,$14.39 ,$62.25 ,$58.93 ,$58.93 ,$14.39 ,$58.93 ,$68.89 ,$68.89 ,$68.89 , N/A ,$35.98 ,$70.55 ,$14.39 ,$83.00 ,$6.45 ,$6.45 ,$70.55 ,$30.22 ,$70.55 ,$74.70 ,$14.39 ,$68.89 ,$65.99 ,$65.99 ,$14.39 ,$53.95 
ST. JOSEPH'S HOSPITAL - BREESE,30201132,86803,HC HEP C AB,302,1 ,$201.00 ,$130.65 ,$11.11 ,$201.00 ,$170.85 ,$120.00 ,$14.27 ,$115.58 ,$14.27 ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$164.82 ,$136.68 ,$14.27 ,$14.27 ,$150.75 ,$142.71 ,$142.71 ,$14.27 ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A ,$35.68 ,$170.85 ,$14.27 ,$201.00 ,$11.11 ,$11.11 ,$170.85 ,$29.97 ,$170.85 ,$180.90 ,$14.27 ,$166.83 ,$159.80 ,$159.80 ,$14.27 ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,30201133,86885,HC INDIRECT COOMBS-90,302,1 ,$82.00 ,$53.30 ,$6.45 ,$287.97 ,$69.70 ,$48.95 ,$137.13 ,$47.15 ,$137.13 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$137.13 ,$137.13 ,$61.50 ,$58.22 ,$58.22 ,$137.13 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$82.00 ,$69.70 ,$137.13 ,$82.00 ,$6.45 ,$6.45 ,$69.70 ,$287.97 ,$69.70 ,$73.80 ,$137.13 ,$68.06 ,$65.19 ,$65.19 ,$137.13 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30201135,86902,HC RBC AG SCR RGT SERUM T2-90,302,1 ,$148.00 ,$96.20 ,$4.00 ,$568.74 ,$125.80 ,$88.36 ,$270.83 ,$85.10 ,$270.83 ,$101.97 ,$125.80 ,$125.80 ,$125.80 ,$121.36 ,$100.64 ,$270.83 ,$270.83 ,$111.00 ,$105.08 ,$105.08 ,$270.83 ,$105.08 ,$122.84 ,$122.84 ,$122.84 , N/A ,$148.00 ,$125.80 ,$270.83 ,$148.00 ,$4.00 ,$4.00 ,$125.80 ,$568.74 ,$125.80 ,$133.20 ,$270.83 ,$122.84 ,$117.66 ,$117.66 ,$270.83 ,$96.20 
ST. JOSEPH'S HOSPITAL - BREESE,30201136,86902,HC RBC AG SCR RGT SERUM T3-90,302,1 ,$190.00 ,$123.50 ,$4.00 ,$568.74 ,$161.50 ,$113.43 ,$270.83 ,$109.25 ,$270.83 ,$130.91 ,$161.50 ,$161.50 ,$161.50 ,$155.80 ,$129.20 ,$270.83 ,$270.83 ,$142.50 ,$134.90 ,$134.90 ,$270.83 ,$134.90 ,$157.70 ,$157.70 ,$157.70 , N/A ,$190.00 ,$161.50 ,$270.83 ,$190.00 ,$4.00 ,$4.00 ,$161.50 ,$568.74 ,$161.50 ,$171.00 ,$270.83 ,$157.70 ,$151.05 ,$151.05 ,$270.83 ,$123.50 
ST. JOSEPH'S HOSPITAL - BREESE,30201137,86902,HC RBC AG SCR RGT SERUM T4-90,302,1 ,$234.00 ,$152.10 ,$4.00 ,$568.74 ,$198.90 ,$139.70 ,$270.83 ,$134.55 ,$270.83 ,$161.23 ,$198.90 ,$198.90 ,$198.90 ,$191.88 ,$159.12 ,$270.83 ,$270.83 ,$175.50 ,$166.14 ,$166.14 ,$270.83 ,$166.14 ,$194.22 ,$194.22 ,$194.22 , N/A ,$234.00 ,$198.90 ,$270.83 ,$234.00 ,$4.00 ,$4.00 ,$198.90 ,$568.74 ,$198.90 ,$210.60 ,$270.83 ,$194.22 ,$186.03 ,$186.03 ,$270.83 ,$152.10 
ST. JOSEPH'S HOSPITAL - BREESE,30201139,86905,HC RBC AG TYPING NON ABO/RH T2-90,302,1 ,$148.00 ,$96.20 ,$4.00 ,$568.74 ,$125.80 ,$88.36 ,$270.83 ,$85.10 ,$270.83 ,$101.97 ,$125.80 ,$125.80 ,$125.80 ,$121.36 ,$100.64 ,$270.83 ,$270.83 ,$111.00 ,$105.08 ,$105.08 ,$270.83 ,$105.08 ,$122.84 ,$122.84 ,$122.84 , N/A ,$148.00 ,$125.80 ,$270.83 ,$148.00 ,$4.00 ,$4.00 ,$125.80 ,$568.74 ,$125.80 ,$133.20 ,$270.83 ,$122.84 ,$117.66 ,$117.66 ,$270.83 ,$96.20 
ST. JOSEPH'S HOSPITAL - BREESE,30201140,86905,HC RBC AG TYPING NON ABO/RH T3-90,302,1 ,$190.00 ,$123.50 ,$4.00 ,$568.74 ,$161.50 ,$113.43 ,$270.83 ,$109.25 ,$270.83 ,$130.91 ,$161.50 ,$161.50 ,$161.50 ,$155.80 ,$129.20 ,$270.83 ,$270.83 ,$142.50 ,$134.90 ,$134.90 ,$270.83 ,$134.90 ,$157.70 ,$157.70 ,$157.70 , N/A ,$190.00 ,$161.50 ,$270.83 ,$190.00 ,$4.00 ,$4.00 ,$161.50 ,$568.74 ,$161.50 ,$171.00 ,$270.83 ,$157.70 ,$151.05 ,$151.05 ,$270.83 ,$123.50 
ST. JOSEPH'S HOSPITAL - BREESE,30201141,86905,HC RBC AG TYPING NON ABO/RH T4-90,302,1 ,$234.00 ,$152.10 ,$4.00 ,$568.74 ,$198.90 ,$139.70 ,$270.83 ,$134.55 ,$270.83 ,$161.23 ,$198.90 ,$198.90 ,$198.90 ,$191.88 ,$159.12 ,$270.83 ,$270.83 ,$175.50 ,$166.14 ,$166.14 ,$270.83 ,$166.14 ,$194.22 ,$194.22 ,$194.22 , N/A ,$234.00 ,$198.90 ,$270.83 ,$234.00 ,$4.00 ,$4.00 ,$198.90 ,$568.74 ,$198.90 ,$210.60 ,$270.83 ,$194.22 ,$186.03 ,$186.03 ,$270.83 ,$152.10 
ST. JOSEPH'S HOSPITAL - BREESE,30201148,83986,HC PH BODY FLUID,302,1 ,$89.00 ,$57.85 ,$3.20 ,$89.00 ,$75.65 ,$53.13 ,$3.58 ,$51.18 ,$3.58 ,$61.32 ,$75.65 ,$75.65 ,$75.65 ,$72.98 ,$60.52 ,$3.58 ,$3.58 ,$66.75 ,$63.19 ,$63.19 ,$3.58 ,$63.19 ,$73.87 ,$73.87 ,$73.87 , N/A ,$8.95 ,$75.65 ,$3.58 ,$89.00 ,$3.20 ,$3.20 ,$75.65 ,$7.52 ,$75.65 ,$80.10 ,$3.58 ,$73.87 ,$70.76 ,$70.76 ,$3.58 ,$57.85 
ST. JOSEPH'S HOSPITAL - BREESE,30201152,86255,HC FLUOR AB SCR AQUAPORIN-90,302,1 ,$973.50 ,$632.78 ,$11.11 ,$973.50 ,$827.48 ,$581.18 ,$12.05 ,$559.76 ,$12.05 ,$670.74 ,$827.48 ,$827.48 ,$827.48 ,$798.27 ,$661.98 ,$12.05 ,$12.05 ,$730.13 ,$691.19 ,$691.19 ,$12.05 ,$691.19 ,$808.01 ,$808.01 ,$808.01 , N/A ,$30.13 ,$827.48 ,$12.05 ,$973.50 ,$11.11 ,$11.11 ,$827.48 ,$25.31 ,$827.48 ,$876.15 ,$12.05 ,$808.01 ,$773.93 ,$773.93 ,$12.05 ,$632.78 
ST. JOSEPH'S HOSPITAL - BREESE,30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$57.00 ,$37.05 ,$3.80 ,$57.00 ,$48.45 ,$34.03 ,$3.80 ,$32.78 ,$3.80 ,$39.27 ,$48.45 ,$48.45 ,$48.45 ,$46.74 ,$38.76 ,$3.80 ,$3.80 ,$42.75 ,$40.47 ,$40.47 ,$3.80 ,$40.47 ,$47.31 ,$47.31 ,$47.31 , N/A ,$9.50 ,$48.45 ,$3.80 ,$57.00 ,$4.47 ,$4.47 ,$48.45 ,$7.98 ,$48.45 ,$51.30 ,$3.80 ,$47.31 ,$45.32 ,$45.32 ,$3.80 ,$37.05 
ST. JOSEPH'S HOSPITAL - BREESE,30500104,85014,HC HEMATOCRIT,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$32.30 ,$22.69 ,$2.37 ,$21.85 ,$2.37 ,$26.18 ,$32.30 ,$32.30 ,$32.30 ,$31.16 ,$25.84 ,$2.37 ,$2.37 ,$28.50 ,$26.98 ,$26.98 ,$2.37 ,$26.98 ,$31.54 ,$31.54 ,$31.54 , N/A ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$4.47 ,$4.47 ,$32.30 ,$4.98 ,$32.30 ,$34.20 ,$2.37 ,$31.54 ,$30.21 ,$30.21 ,$2.37 ,$24.70 
ST. JOSEPH'S HOSPITAL - BREESE,30500106,85018,HC HGB,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$32.30 ,$22.69 ,$2.37 ,$21.85 ,$2.37 ,$26.18 ,$32.30 ,$32.30 ,$32.30 ,$31.16 ,$25.84 ,$2.37 ,$2.37 ,$28.50 ,$26.98 ,$26.98 ,$2.37 ,$26.98 ,$31.54 ,$31.54 ,$31.54 , N/A ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$4.47 ,$4.47 ,$32.30 ,$4.98 ,$32.30 ,$34.20 ,$2.37 ,$31.54 ,$30.21 ,$30.21 ,$2.37 ,$24.70 
ST. JOSEPH'S HOSPITAL - BREESE,30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$109.00 ,$70.85 ,$4.47 ,$109.00 ,$92.65 ,$65.07 ,$7.77 ,$62.68 ,$7.77 ,$75.10 ,$92.65 ,$92.65 ,$92.65 ,$89.38 ,$74.12 ,$7.77 ,$7.77 ,$81.75 ,$77.39 ,$77.39 ,$7.77 ,$77.39 ,$90.47 ,$90.47 ,$90.47 , N/A ,$19.43 ,$92.65 ,$7.77 ,$7.77 ,$4.47 ,$4.47 ,$92.65 ,$16.32 ,$92.65 ,$98.10 ,$7.77 ,$90.47 ,$86.66 ,$86.66 ,$7.77 ,$70.85 
ST. JOSEPH'S HOSPITAL - BREESE,30500108,85027,HC CBC W/O DIFF,305,1 ,$82.00 ,$53.30 ,$4.47 ,$82.00 ,$69.70 ,$48.95 ,$6.47 ,$47.15 ,$6.47 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$6.47 ,$6.47 ,$61.50 ,$58.22 ,$58.22 ,$6.47 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$16.18 ,$69.70 ,$6.47 ,$6.47 ,$4.47 ,$4.47 ,$69.70 ,$13.59 ,$69.70 ,$73.80 ,$6.47 ,$68.06 ,$65.19 ,$65.19 ,$6.47 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30500111,85045,HC RETIC COUNT AUTO,305,1 ,$61.00 ,$39.65 ,$3.99 ,$61.00 ,$51.85 ,$36.42 ,$3.99 ,$35.08 ,$3.99 ,$42.03 ,$51.85 ,$51.85 ,$51.85 ,$50.02 ,$41.48 ,$3.99 ,$3.99 ,$45.75 ,$43.31 ,$43.31 ,$3.99 ,$43.31 ,$50.63 ,$50.63 ,$50.63 , N/A ,$9.98 ,$51.85 ,$3.99 ,$61.00 ,$4.47 ,$4.47 ,$51.85 ,$8.38 ,$51.85 ,$54.90 ,$3.99 ,$50.63 ,$48.50 ,$48.50 ,$3.99 ,$39.65 
ST. JOSEPH'S HOSPITAL - BREESE,30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$38.00 ,$24.70 ,$2.54 ,$38.00 ,$32.30 ,$22.69 ,$2.54 ,$21.85 ,$2.54 ,$26.18 ,$32.30 ,$32.30 ,$32.30 ,$31.16 ,$25.84 ,$2.54 ,$2.54 ,$28.50 ,$26.98 ,$26.98 ,$2.54 ,$26.98 ,$31.54 ,$31.54 ,$31.54 , N/A ,$6.35 ,$32.30 ,$2.54 ,$38.00 ,$4.47 ,$4.47 ,$32.30 ,$5.33 ,$32.30 ,$34.20 ,$2.54 ,$31.54 ,$30.21 ,$30.21 ,$2.54 ,$24.70 
ST. JOSEPH'S HOSPITAL - BREESE,30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$43.00 ,$27.95 ,$4.47 ,$43.00 ,$36.55 ,$25.67 ,$4.48 ,$24.73 ,$4.48 ,$29.63 ,$36.55 ,$36.55 ,$36.55 ,$35.26 ,$29.24 ,$4.48 ,$4.48 ,$32.25 ,$30.53 ,$30.53 ,$4.48 ,$30.53 ,$35.69 ,$35.69 ,$35.69 , N/A ,$11.20 ,$36.55 ,$4.48 ,$43.00 ,$4.47 ,$4.47 ,$36.55 ,$9.41 ,$36.55 ,$38.70 ,$4.48 ,$35.69 ,$34.19 ,$34.19 ,$4.48 ,$27.95 
ST. JOSEPH'S HOSPITAL - BREESE,30500175,85379,HC D DIMER QN,305,1 ,$210.00 ,$136.50 ,$7.75 ,$210.00 ,$178.50 ,$125.37 ,$10.18 ,$120.75 ,$10.18 ,$144.69 ,$178.50 ,$178.50 ,$178.50 ,$172.20 ,$142.80 ,$10.18 ,$10.18 ,$157.50 ,$149.10 ,$149.10 ,$10.18 ,$149.10 ,$174.30 ,$174.30 ,$174.30 , N/A ,$25.45 ,$178.50 ,$10.18 ,$210.00 ,$7.75 ,$7.75 ,$178.50 ,$21.38 ,$178.50 ,$189.00 ,$10.18 ,$174.30 ,$166.95 ,$166.95 ,$10.18 ,$136.50 
ST. JOSEPH'S HOSPITAL - BREESE,30500179,85385,HC FIBRINOGEN AG,305,1 ,$142.00 ,$92.30 ,$2.61 ,$142.00 ,$120.70 ,$84.77 ,$14.46 ,$81.65 ,$14.46 ,$97.84 ,$120.70 ,$120.70 ,$120.70 ,$116.44 ,$96.56 ,$14.46 ,$14.46 ,$106.50 ,$100.82 ,$100.82 ,$14.46 ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A ,$36.15 ,$120.70 ,$14.46 ,$142.00 ,$2.61 ,$2.61 ,$120.70 ,$30.37 ,$120.70 ,$127.80 ,$14.46 ,$117.86 ,$112.89 ,$112.89 ,$14.46 ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,30500187,85520,HC HEPARIN ASSAY,305,1 ,$191.00 ,$124.15 ,$7.75 ,$191.00 ,$162.35 ,$114.03 ,$13.09 ,$109.83 ,$13.09 ,$131.60 ,$162.35 ,$162.35 ,$162.35 ,$156.62 ,$129.88 ,$13.09 ,$13.09 ,$143.25 ,$135.61 ,$135.61 ,$13.09 ,$135.61 ,$158.53 ,$158.53 ,$158.53 , N/A ,$32.73 ,$162.35 ,$13.09 ,$191.00 ,$7.75 ,$7.75 ,$162.35 ,$27.49 ,$162.35 ,$171.90 ,$13.09 ,$158.53 ,$151.85 ,$151.85 ,$13.09 ,$124.15 
ST. JOSEPH'S HOSPITAL - BREESE,30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$74.00 ,$48.10 ,$2.61 ,$74.00 ,$62.90 ,$44.18 ,$4.29 ,$42.55 ,$4.29 ,$50.99 ,$62.90 ,$62.90 ,$62.90 ,$60.68 ,$50.32 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$61.42 ,$61.42 ,$61.42 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$2.61 ,$2.61 ,$62.90 ,$9.01 ,$62.90 ,$66.60 ,$4.29 ,$61.42 ,$58.83 ,$58.83 ,$4.29 ,$48.10 
ST. JOSEPH'S HOSPITAL - BREESE,30500205,85652,HC SED RATE AUTO,305,1 ,$80.00 ,$52.00 ,$2.70 ,$80.00 ,$68.00 ,$47.76 ,$2.70 ,$46.00 ,$2.70 ,$55.12 ,$68.00 ,$68.00 ,$68.00 ,$65.60 ,$54.40 ,$2.70 ,$2.70 ,$60.00 ,$56.80 ,$56.80 ,$2.70 ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A ,$6.75 ,$68.00 ,$2.70 ,$80.00 ,$4.47 ,$4.47 ,$68.00 ,$5.67 ,$68.00 ,$72.00 ,$2.70 ,$66.40 ,$63.60 ,$63.60 ,$2.70 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500211,85730,HC PTT,305,1 ,$105.00 ,$68.25 ,$2.61 ,$105.00 ,$89.25 ,$62.69 ,$6.01 ,$60.38 ,$6.01 ,$72.35 ,$89.25 ,$89.25 ,$89.25 ,$86.10 ,$71.40 ,$6.01 ,$6.01 ,$78.75 ,$74.55 ,$74.55 ,$6.01 ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A ,$15.03 ,$89.25 ,$6.01 ,$105.00 ,$2.61 ,$2.61 ,$89.25 ,$12.62 ,$89.25 ,$94.50 ,$6.01 ,$87.15 ,$83.48 ,$83.48 ,$6.01 ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,30500217,85810,HC VISCOSITY,305,1 ,$58.00 ,$37.70 ,$6.80 ,$58.00 ,$49.30 ,$34.63 ,$11.67 ,$33.35 ,$11.67 ,$39.96 ,$49.30 ,$49.30 ,$49.30 ,$47.56 ,$39.44 ,$11.67 ,$11.67 ,$43.50 ,$41.18 ,$41.18 ,$11.67 ,$41.18 ,$48.14 ,$48.14 ,$48.14 , N/A ,$29.18 ,$49.30 ,$11.67 ,$58.00 ,$6.80 ,$6.80 ,$49.30 ,$24.51 ,$49.30 ,$52.20 ,$11.67 ,$48.14 ,$46.11 ,$46.11 ,$11.67 ,$37.70 
ST. JOSEPH'S HOSPITAL - BREESE,30500234,85014,HC HEMATOCRIT-90,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$32.30 ,$22.69 ,$2.37 ,$21.85 ,$2.37 ,$26.18 ,$32.30 ,$32.30 ,$32.30 ,$31.16 ,$25.84 ,$2.37 ,$2.37 ,$28.50 ,$26.98 ,$26.98 ,$2.37 ,$26.98 ,$31.54 ,$31.54 ,$31.54 , N/A ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$4.47 ,$4.47 ,$32.30 ,$4.98 ,$32.30 ,$34.20 ,$2.37 ,$31.54 ,$30.21 ,$30.21 ,$2.37 ,$24.70 
ST. JOSEPH'S HOSPITAL - BREESE,30500238,85018,HC HGB-90,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$32.30 ,$22.69 ,$2.37 ,$21.85 ,$2.37 ,$26.18 ,$32.30 ,$32.30 ,$32.30 ,$31.16 ,$25.84 ,$2.37 ,$2.37 ,$28.50 ,$26.98 ,$26.98 ,$2.37 ,$26.98 ,$31.54 ,$31.54 ,$31.54 , N/A ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$4.47 ,$4.47 ,$32.30 ,$4.98 ,$32.30 ,$34.20 ,$2.37 ,$31.54 ,$30.21 ,$30.21 ,$2.37 ,$24.70 
ST. JOSEPH'S HOSPITAL - BREESE,30500244,85041,HC BLOOD COUNT RBC AUTO-90,305,1 ,$29.00 ,$18.85 ,$3.02 ,$29.00 ,$24.65 ,$17.31 ,$3.02 ,$16.68 ,$3.02 ,$19.98 ,$24.65 ,$24.65 ,$24.65 ,$23.78 ,$19.72 ,$3.02 ,$3.02 ,$21.75 ,$20.59 ,$20.59 ,$3.02 ,$20.59 ,$24.07 ,$24.07 ,$24.07 , N/A ,$7.55 ,$24.65 ,$3.02 ,$29.00 ,$4.47 ,$4.47 ,$24.65 ,$6.34 ,$24.65 ,$26.10 ,$3.02 ,$24.07 ,$23.06 ,$23.06 ,$3.02 ,$18.85 
ST. JOSEPH'S HOSPITAL - BREESE,30500247,85097,HC BONE MARROW SMEAR INTERP,305,1 ,$73.00 ,$47.45 ,$20.56 ,"$1,260.65 ",$62.05 ,$43.58 ,$600.31 ,$41.98 ,$600.31 ,$50.30 ,$62.05 ,$62.05 ,$62.05 ,$59.86 ,$49.64 ,$600.31 ,$600.31 ,$54.75 ,$51.83 ,$51.83 ,$600.31 ,$51.83 ,$60.59 ,$60.59 ,$60.59 , N/A ,$73.00 ,$62.05 ,$600.31 ,$73.00 ,$20.56 ,$20.56 ,$62.05 ,"$1,260.65 ",$62.05 ,$65.70 ,$600.31 ,$60.59 ,$58.04 ,$58.04 ,$600.31 ,$47.45 
ST. JOSEPH'S HOSPITAL - BREESE,30500249,85210,HC FACTOR II-90,305,1 ,$151.00 ,$98.15 ,$2.61 ,$151.00 ,$128.35 ,$90.15 ,$12.98 ,$86.83 ,$12.98 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$12.98 ,$12.98 ,$113.25 ,$107.21 ,$107.21 ,$12.98 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$32.45 ,$128.35 ,$12.98 ,$151.00 ,$2.61 ,$2.61 ,$128.35 ,$27.26 ,$128.35 ,$135.90 ,$12.98 ,$125.33 ,$120.05 ,$120.05 ,$12.98 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30500250,85220,HC FACTOR V-90,305,1 ,$151.00 ,$98.15 ,$7.75 ,$151.00 ,$128.35 ,$90.15 ,$17.65 ,$86.83 ,$17.65 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$17.65 ,$17.65 ,$113.25 ,$107.21 ,$107.21 ,$17.65 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$44.13 ,$128.35 ,$17.65 ,$151.00 ,$7.75 ,$7.75 ,$128.35 ,$37.07 ,$128.35 ,$135.90 ,$17.65 ,$125.33 ,$120.05 ,$120.05 ,$17.65 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30500251,85230,HC FACTOR VII-90,305,1 ,$145.00 ,$94.25 ,$7.75 ,$145.00 ,$123.25 ,$86.57 ,$17.90 ,$83.38 ,$17.90 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$17.90 ,$17.90 ,$108.75 ,$102.95 ,$102.95 ,$17.90 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$44.75 ,$123.25 ,$17.90 ,$145.00 ,$7.75 ,$7.75 ,$123.25 ,$37.59 ,$123.25 ,$130.50 ,$17.90 ,$120.35 ,$115.28 ,$115.28 ,$17.90 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,30500252,85240,HC FACTOR VIII AHG-90,305,1 ,$167.00 ,$108.55 ,$7.75 ,$167.00 ,$141.95 ,$99.70 ,$17.90 ,$96.03 ,$17.90 ,$115.06 ,$141.95 ,$141.95 ,$141.95 ,$136.94 ,$113.56 ,$17.90 ,$17.90 ,$125.25 ,$118.57 ,$118.57 ,$17.90 ,$118.57 ,$138.61 ,$138.61 ,$138.61 , N/A ,$44.75 ,$141.95 ,$17.90 ,$167.00 ,$7.75 ,$7.75 ,$141.95 ,$37.59 ,$141.95 ,$150.30 ,$17.90 ,$138.61 ,$132.77 ,$132.77 ,$17.90 ,$108.55 
ST. JOSEPH'S HOSPITAL - BREESE,30500253,85245,HC FACTOR VIII VW RISTO-90,305,1 ,$81.00 ,$52.65 ,$7.75 ,$81.00 ,$68.85 ,$48.36 ,$22.94 ,$46.58 ,$22.94 ,$55.81 ,$68.85 ,$68.85 ,$68.85 ,$66.42 ,$55.08 ,$22.94 ,$22.94 ,$60.75 ,$57.51 ,$57.51 ,$22.94 ,$57.51 ,$67.23 ,$67.23 ,$67.23 , N/A ,$57.35 ,$68.85 ,$22.94 ,$81.00 ,$7.75 ,$7.75 ,$68.85 ,$48.17 ,$68.85 ,$72.90 ,$22.94 ,$67.23 ,$64.40 ,$64.40 ,$22.94 ,$52.65 
ST. JOSEPH'S HOSPITAL - BREESE,30500254,85246,HC FACTOR VIII VW AG-90,305,1 ,$152.00 ,$98.80 ,$7.75 ,$152.00 ,$129.20 ,$90.74 ,$22.94 ,$87.40 ,$22.94 ,$104.73 ,$129.20 ,$129.20 ,$129.20 ,$124.64 ,$103.36 ,$22.94 ,$22.94 ,$114.00 ,$107.92 ,$107.92 ,$22.94 ,$107.92 ,$126.16 ,$126.16 ,$126.16 , N/A ,$57.35 ,$129.20 ,$22.94 ,$152.00 ,$7.75 ,$7.75 ,$129.20 ,$48.17 ,$129.20 ,$136.80 ,$22.94 ,$126.16 ,$120.84 ,$120.84 ,$22.94 ,$98.80 
ST. JOSEPH'S HOSPITAL - BREESE,30500255,85247,HC FACTOR VW MULTIM ANALY-90,305,1 ,$122.00 ,$79.30 ,$7.75 ,$122.00 ,$103.70 ,$72.83 ,$22.94 ,$70.15 ,$22.94 ,$84.06 ,$103.70 ,$103.70 ,$103.70 ,$100.04 ,$82.96 ,$22.94 ,$22.94 ,$91.50 ,$86.62 ,$86.62 ,$22.94 ,$86.62 ,$101.26 ,$101.26 ,$101.26 , N/A ,$57.35 ,$103.70 ,$22.94 ,$122.00 ,$7.75 ,$7.75 ,$103.70 ,$48.17 ,$103.70 ,$109.80 ,$22.94 ,$101.26 ,$96.99 ,$96.99 ,$22.94 ,$79.30 
ST. JOSEPH'S HOSPITAL - BREESE,30500256,85250,HC FACTOR IX-90,305,1 ,$133.00 ,$86.45 ,$7.75 ,$133.00 ,$113.05 ,$79.40 ,$19.04 ,$76.48 ,$19.04 ,$91.64 ,$113.05 ,$113.05 ,$113.05 ,$109.06 ,$90.44 ,$19.04 ,$19.04 ,$99.75 ,$94.43 ,$94.43 ,$19.04 ,$94.43 ,$110.39 ,$110.39 ,$110.39 , N/A ,$47.60 ,$113.05 ,$19.04 ,$133.00 ,$7.75 ,$7.75 ,$113.05 ,$39.98 ,$113.05 ,$119.70 ,$19.04 ,$110.39 ,$105.74 ,$105.74 ,$19.04 ,$86.45 
ST. JOSEPH'S HOSPITAL - BREESE,30500257,85260,HC FACTOR X-90,305,1 ,$151.00 ,$98.15 ,$7.75 ,$151.00 ,$128.35 ,$90.15 ,$17.90 ,$86.83 ,$17.90 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$17.90 ,$17.90 ,$113.25 ,$107.21 ,$107.21 ,$17.90 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$44.75 ,$128.35 ,$17.90 ,$151.00 ,$7.75 ,$7.75 ,$128.35 ,$37.59 ,$128.35 ,$135.90 ,$17.90 ,$125.33 ,$120.05 ,$120.05 ,$17.90 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,30500261,85300,HC ANTITHROMBIN III ACT-90,305,1 ,$177.00 ,$115.05 ,$7.75 ,$177.00 ,$150.45 ,$105.67 ,$11.85 ,$101.78 ,$11.85 ,$121.95 ,$150.45 ,$150.45 ,$150.45 ,$145.14 ,$120.36 ,$11.85 ,$11.85 ,$132.75 ,$125.67 ,$125.67 ,$11.85 ,$125.67 ,$146.91 ,$146.91 ,$146.91 , N/A ,$29.63 ,$150.45 ,$11.85 ,$177.00 ,$7.75 ,$7.75 ,$150.45 ,$24.89 ,$150.45 ,$159.30 ,$11.85 ,$146.91 ,$140.72 ,$140.72 ,$11.85 ,$115.05 
ST. JOSEPH'S HOSPITAL - BREESE,30500262,85301,HC ANTITHROMBIN III AG-90,305,1 ,$53.00 ,$34.45 ,$7.75 ,$53.00 ,$45.05 ,$31.64 ,$10.81 ,$30.48 ,$10.81 ,$36.52 ,$45.05 ,$45.05 ,$45.05 ,$43.46 ,$36.04 ,$10.81 ,$10.81 ,$39.75 ,$37.63 ,$37.63 ,$10.81 ,$37.63 ,$43.99 ,$43.99 ,$43.99 , N/A ,$27.03 ,$45.05 ,$10.81 ,$53.00 ,$7.75 ,$7.75 ,$45.05 ,$22.70 ,$45.05 ,$47.70 ,$10.81 ,$43.99 ,$42.14 ,$42.14 ,$10.81 ,$34.45 
ST. JOSEPH'S HOSPITAL - BREESE,30500263,85302,HC PROTEIN C AG-90,305,1 ,$130.00 ,$84.50 ,$7.75 ,$130.00 ,$110.50 ,$77.61 ,$12.01 ,$74.75 ,$12.01 ,$89.57 ,$110.50 ,$110.50 ,$110.50 ,$106.60 ,$88.40 ,$12.01 ,$12.01 ,$97.50 ,$92.30 ,$92.30 ,$12.01 ,$92.30 ,$107.90 ,$107.90 ,$107.90 , N/A ,$30.03 ,$110.50 ,$12.01 ,$130.00 ,$7.75 ,$7.75 ,$110.50 ,$25.22 ,$110.50 ,$117.00 ,$12.01 ,$107.90 ,$103.35 ,$103.35 ,$12.01 ,$84.50 
ST. JOSEPH'S HOSPITAL - BREESE,30500264,85303,HC PROTEIN C ACTIVITY-90,305,1 ,$215.00 ,$139.75 ,$7.75 ,$215.00 ,$182.75 ,$128.36 ,$13.84 ,$123.63 ,$13.84 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$13.84 ,$13.84 ,$161.25 ,$152.65 ,$152.65 ,$13.84 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$34.60 ,$182.75 ,$13.84 ,$215.00 ,$7.75 ,$7.75 ,$182.75 ,$29.06 ,$182.75 ,$193.50 ,$13.84 ,$178.45 ,$170.93 ,$170.93 ,$13.84 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,30500265,85305,HC PROTEIN S TOTAL-90,305,1 ,$37.00 ,$24.05 ,$7.75 ,$37.00 ,$31.45 ,$22.09 ,$11.61 ,$21.28 ,$11.61 ,$25.49 ,$31.45 ,$31.45 ,$31.45 ,$30.34 ,$25.16 ,$11.61 ,$11.61 ,$27.75 ,$26.27 ,$26.27 ,$11.61 ,$26.27 ,$30.71 ,$30.71 ,$30.71 , N/A ,$29.03 ,$31.45 ,$11.61 ,$37.00 ,$7.75 ,$7.75 ,$31.45 ,$24.38 ,$31.45 ,$33.30 ,$11.61 ,$30.71 ,$29.42 ,$29.42 ,$11.61 ,$24.05 
ST. JOSEPH'S HOSPITAL - BREESE,30500266,85306,HC PROTEIN S FREE-90,305,1 ,$201.00 ,$130.65 ,$7.75 ,$201.00 ,$170.85 ,$120.00 ,$15.32 ,$115.58 ,$15.32 ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$164.82 ,$136.68 ,$15.32 ,$15.32 ,$150.75 ,$142.71 ,$142.71 ,$15.32 ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A ,$38.30 ,$170.85 ,$15.32 ,$201.00 ,$7.75 ,$7.75 ,$170.85 ,$32.17 ,$170.85 ,$180.90 ,$15.32 ,$166.83 ,$159.80 ,$159.80 ,$15.32 ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,30500267,85307,HC ACTIVATED PROTEIN C RESIST-90,305,1 ,$139.00 ,$90.35 ,$7.20 ,$139.00 ,$118.15 ,$82.98 ,$15.32 ,$79.93 ,$15.32 ,$95.77 ,$118.15 ,$118.15 ,$118.15 ,$113.98 ,$94.52 ,$15.32 ,$15.32 ,$104.25 ,$98.69 ,$98.69 ,$15.32 ,$98.69 ,$115.37 ,$115.37 ,$115.37 , N/A ,$38.30 ,$118.15 ,$15.32 ,$139.00 ,$7.20 ,$7.20 ,$118.15 ,$32.17 ,$118.15 ,$125.10 ,$15.32 ,$115.37 ,$110.51 ,$110.51 ,$15.32 ,$90.35 
ST. JOSEPH'S HOSPITAL - BREESE,30500287,85549,HC MURAMIDASE-90,305,1 ,$70.00 ,$45.50 ,$7.20 ,$70.00 ,$59.50 ,$41.79 ,$18.75 ,$40.25 ,$18.75 ,$48.23 ,$59.50 ,$59.50 ,$59.50 ,$57.40 ,$47.60 ,$18.75 ,$18.75 ,$52.50 ,$49.70 ,$49.70 ,$18.75 ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A ,$46.88 ,$59.50 ,$18.75 ,$70.00 ,$7.20 ,$7.20 ,$59.50 ,$39.38 ,$59.50 ,$63.00 ,$18.75 ,$58.10 ,$55.65 ,$55.65 ,$18.75 ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,30500289,85597,HC PLATELET NEUTRALIZATION-90,305,1 ,$40.00 ,$26.00 ,$7.75 ,$40.00 ,$34.00 ,$23.88 ,$17.98 ,$23.00 ,$17.98 ,$27.56 ,$34.00 ,$34.00 ,$34.00 ,$32.80 ,$27.20 ,$17.98 ,$17.98 ,$30.00 ,$28.40 ,$28.40 ,$17.98 ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A ,$40.00 ,$34.00 ,$17.98 ,$40.00 ,$7.75 ,$7.75 ,$34.00 ,$37.76 ,$34.00 ,$36.00 ,$17.98 ,$33.20 ,$31.80 ,$31.80 ,$17.98 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500297,85613,HC RUSSELL VIPER VENOM SCR T1-90,305,1 ,$66.00 ,$42.90 ,$7.75 ,$66.00 ,$56.10 ,$39.40 ,$9.58 ,$37.95 ,$9.58 ,$45.47 ,$56.10 ,$56.10 ,$56.10 ,$54.12 ,$44.88 ,$9.58 ,$9.58 ,$49.50 ,$46.86 ,$46.86 ,$9.58 ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A ,$23.95 ,$56.10 ,$9.58 ,$66.00 ,$7.75 ,$7.75 ,$56.10 ,$20.12 ,$56.10 ,$59.40 ,$9.58 ,$54.78 ,$52.47 ,$52.47 ,$9.58 ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,30500304,85670,HC THROMBIN TIME PLASMA-90,305,1 ,$54.00 ,$35.10 ,$2.61 ,$54.00 ,$45.90 ,$32.24 ,$5.77 ,$31.05 ,$5.77 ,$37.21 ,$45.90 ,$45.90 ,$45.90 ,$44.28 ,$36.72 ,$5.77 ,$5.77 ,$40.50 ,$38.34 ,$38.34 ,$5.77 ,$38.34 ,$44.82 ,$44.82 ,$44.82 , N/A ,$14.43 ,$45.90 ,$5.77 ,$54.00 ,$2.61 ,$2.61 ,$45.90 ,$12.12 ,$45.90 ,$48.60 ,$5.77 ,$44.82 ,$42.93 ,$42.93 ,$5.77 ,$35.10 
ST. JOSEPH'S HOSPITAL - BREESE,30500305,85730,HC PTT-90,305,1 ,$105.00 ,$68.25 ,$2.61 ,$105.00 ,$89.25 ,$62.69 ,$6.01 ,$60.38 ,$6.01 ,$72.35 ,$89.25 ,$89.25 ,$89.25 ,$86.10 ,$71.40 ,$6.01 ,$6.01 ,$78.75 ,$74.55 ,$74.55 ,$6.01 ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A ,$15.03 ,$89.25 ,$6.01 ,$105.00 ,$2.61 ,$2.61 ,$89.25 ,$12.62 ,$89.25 ,$94.50 ,$6.01 ,$87.15 ,$83.48 ,$83.48 ,$6.01 ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,30500310,85810,HC VISCOSITY-90,305,1 ,$51.00 ,$33.15 ,$6.80 ,$51.00 ,$43.35 ,$30.45 ,$11.67 ,$29.33 ,$11.67 ,$35.14 ,$43.35 ,$43.35 ,$43.35 ,$41.82 ,$34.68 ,$11.67 ,$11.67 ,$38.25 ,$36.21 ,$36.21 ,$11.67 ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A ,$29.18 ,$43.35 ,$11.67 ,$51.00 ,$6.80 ,$6.80 ,$43.35 ,$24.51 ,$43.35 ,$45.90 ,$11.67 ,$42.33 ,$40.55 ,$40.55 ,$11.67 ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,30500324,85009,HC BLOOD COUNT MAN DIFF WBC BUFFY COAT,305,1 ,$77.00 ,$50.05 ,$4.47 ,$77.00 ,$65.45 ,$45.97 ,$5.07 ,$44.28 ,$5.07 ,$53.05 ,$65.45 ,$65.45 ,$65.45 ,$63.14 ,$52.36 ,$5.07 ,$5.07 ,$57.75 ,$54.67 ,$54.67 ,$5.07 ,$54.67 ,$63.91 ,$63.91 ,$63.91 , N/A ,$12.68 ,$65.45 ,$5.07 ,$77.00 ,$4.47 ,$4.47 ,$65.45 ,$10.65 ,$65.45 ,$69.30 ,$5.07 ,$63.91 ,$61.22 ,$61.22 ,$5.07 ,$50.05 
ST. JOSEPH'S HOSPITAL - BREESE,30500327,85041,HC BLOOD COUNT RBS AUTO,305,1 ,$29.00 ,$18.85 ,$3.02 ,$29.00 ,$24.65 ,$17.31 ,$3.02 ,$16.68 ,$3.02 ,$19.98 ,$24.65 ,$24.65 ,$24.65 ,$23.78 ,$19.72 ,$3.02 ,$3.02 ,$21.75 ,$20.59 ,$20.59 ,$3.02 ,$20.59 ,$24.07 ,$24.07 ,$24.07 , N/A ,$7.55 ,$24.65 ,$3.02 ,$29.00 ,$4.47 ,$4.47 ,$24.65 ,$6.34 ,$24.65 ,$26.10 ,$3.02 ,$24.07 ,$23.06 ,$23.06 ,$3.02 ,$18.85 
ST. JOSEPH'S HOSPITAL - BREESE,30500345,85610,HC PROTHROMBIN TIME (PT)-QW,305,1 ,$74.00 ,$48.10 ,$2.61 ,$74.00 ,$62.90 ,$44.18 ,$4.29 ,$42.55 ,$4.29 ,$50.99 ,$62.90 ,$62.90 ,$62.90 ,$60.68 ,$50.32 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$61.42 ,$61.42 ,$61.42 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$2.61 ,$2.61 ,$62.90 ,$9.01 ,$62.90 ,$66.60 ,$4.29 ,$61.42 ,$58.83 ,$58.83 ,$4.29 ,$48.10 
ST. JOSEPH'S HOSPITAL - BREESE,30500831,85384,HC FIBRINOGEN,305,1 ,$158.00 ,$102.70 ,$2.61 ,$158.00 ,$134.30 ,$94.33 ,$9.72 ,$90.85 ,$9.72 ,$108.86 ,$134.30 ,$134.30 ,$134.30 ,$129.56 ,$107.44 ,$9.72 ,$9.72 ,$118.50 ,$112.18 ,$112.18 ,$9.72 ,$112.18 ,$131.14 ,$131.14 ,$131.14 , N/A ,$24.30 ,$134.30 ,$9.72 ,$158.00 ,$2.61 ,$2.61 ,$134.30 ,$20.41 ,$134.30 ,$142.20 ,$9.72 ,$131.14 ,$125.61 ,$125.61 ,$9.72 ,$102.70 
ST. JOSEPH'S HOSPITAL - BREESE,30500832,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$242.00 ,$157.30 ,$6.80 ,$242.00 ,$205.70 ,$144.47 ,$7.73 ,$139.15 ,$7.73 ,$166.74 ,$205.70 ,$205.70 ,$205.70 ,$198.44 ,$164.56 ,$7.73 ,$7.73 ,$181.50 ,$171.82 ,$171.82 ,$7.73 ,$171.82 ,$200.86 ,$200.86 ,$200.86 , N/A ,$19.33 ,$205.70 ,$7.73 ,$242.00 ,$6.80 ,$6.80 ,$205.70 ,$16.23 ,$205.70 ,$217.80 ,$7.73 ,$200.86 ,$192.39 ,$192.39 ,$7.73 ,$157.30 
ST. JOSEPH'S HOSPITAL - BREESE,30500833,85520,HC HEPARIN ASSAY,305,1 ,$166.00 ,$107.90 ,$7.75 ,$166.00 ,$141.10 ,$99.10 ,$13.09 ,$95.45 ,$13.09 ,$114.37 ,$141.10 ,$141.10 ,$141.10 ,$136.12 ,$112.88 ,$13.09 ,$13.09 ,$124.50 ,$117.86 ,$117.86 ,$13.09 ,$117.86 ,$137.78 ,$137.78 ,$137.78 , N/A ,$32.73 ,$141.10 ,$13.09 ,$166.00 ,$7.75 ,$7.75 ,$141.10 ,$27.49 ,$141.10 ,$149.40 ,$13.09 ,$137.78 ,$131.97 ,$131.97 ,$13.09 ,$107.90 
ST. JOSEPH'S HOSPITAL - BREESE,30500835,85576,HC PLATELET AGGREGATION EA-90,305,1 ,$87.00 ,$56.55 ,$7.75 ,$87.00 ,$73.95 ,$51.94 ,$24.91 ,$50.03 ,$24.91 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$24.91 ,$24.91 ,$65.25 ,$61.77 ,$61.77 ,$24.91 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$62.28 ,$73.95 ,$24.91 ,$87.00 ,$7.75 ,$7.75 ,$73.95 ,$52.31 ,$73.95 ,$78.30 ,$24.91 ,$72.21 ,$69.17 ,$69.17 ,$24.91 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,30500836,85610,HC PROTHROMBIN TIME (PT),305,1 ,$74.00 ,$48.10 ,$2.61 ,$74.00 ,$62.90 ,$44.18 ,$4.29 ,$42.55 ,$4.29 ,$50.99 ,$62.90 ,$62.90 ,$62.90 ,$60.68 ,$50.32 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$61.42 ,$61.42 ,$61.42 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$2.61 ,$2.61 ,$62.90 ,$9.01 ,$62.90 ,$66.60 ,$4.29 ,$61.42 ,$58.83 ,$58.83 ,$4.29 ,$48.10 
ST. JOSEPH'S HOSPITAL - BREESE,30500837,85610,HC PROTHROMBIN TIME (PT)-QW,305,1 ,$74.00 ,$48.10 ,$2.61 ,$74.00 ,$62.90 ,$44.18 ,$4.29 ,$42.55 ,$4.29 ,$50.99 ,$62.90 ,$62.90 ,$62.90 ,$60.68 ,$50.32 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$61.42 ,$61.42 ,$61.42 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$2.61 ,$2.61 ,$62.90 ,$9.01 ,$62.90 ,$66.60 ,$4.29 ,$61.42 ,$58.83 ,$58.83 ,$4.29 ,$48.10 
ST. JOSEPH'S HOSPITAL - BREESE,30500838,85730,HC PARTIAL THROMBO TIME (PTT),305,1 ,$91.00 ,$59.15 ,$2.61 ,$91.00 ,$77.35 ,$54.33 ,$6.01 ,$52.33 ,$6.01 ,$62.70 ,$77.35 ,$77.35 ,$77.35 ,$74.62 ,$61.88 ,$6.01 ,$6.01 ,$68.25 ,$64.61 ,$64.61 ,$6.01 ,$64.61 ,$75.53 ,$75.53 ,$75.53 , N/A ,$15.03 ,$77.35 ,$6.01 ,$91.00 ,$2.61 ,$2.61 ,$77.35 ,$12.62 ,$77.35 ,$81.90 ,$6.01 ,$75.53 ,$72.35 ,$72.35 ,$6.01 ,$59.15 
ST. JOSEPH'S HOSPITAL - BREESE,30500842,85660,HC SICKLE CELL RBC,305,1 ,$56.00 ,$36.40 ,$4.47 ,$56.00 ,$47.60 ,$33.43 ,$5.51 ,$32.20 ,$5.51 ,$38.58 ,$47.60 ,$47.60 ,$47.60 ,$45.92 ,$38.08 ,$5.51 ,$5.51 ,$42.00 ,$39.76 ,$39.76 ,$5.51 ,$39.76 ,$46.48 ,$46.48 ,$46.48 , N/A ,$13.78 ,$47.60 ,$5.51 ,$56.00 ,$4.47 ,$4.47 ,$47.60 ,$11.57 ,$47.60 ,$50.40 ,$5.51 ,$46.48 ,$44.52 ,$44.52 ,$5.51 ,$36.40 
ST. JOSEPH'S HOSPITAL - BREESE,30500846,85610,HC PROTHROMBIN TIME (PT)-QW,305,1 ,$74.00 ,$48.10 ,$2.61 ,$74.00 ,$62.90 ,$44.18 ,$4.29 ,$42.55 ,$4.29 ,$50.99 ,$62.90 ,$62.90 ,$62.90 ,$60.68 ,$50.32 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$61.42 ,$61.42 ,$61.42 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$2.61 ,$2.61 ,$62.90 ,$9.01 ,$62.90 ,$66.60 ,$4.29 ,$61.42 ,$58.83 ,$58.83 ,$4.29 ,$48.10 
ST. JOSEPH'S HOSPITAL - BREESE,30600102,87040,HC BLOOD CULTURE,306,1 ,$315.00 ,$204.75 ,$10.32 ,$315.00 ,$267.75 ,$188.06 ,$10.32 ,$181.13 ,$10.32 ,$217.04 ,$267.75 ,$267.75 ,$267.75 ,$258.30 ,$214.20 ,$10.32 ,$10.32 ,$236.25 ,$223.65 ,$223.65 ,$10.32 ,$223.65 ,$261.45 ,$261.45 ,$261.45 , N/A ,$25.80 ,$267.75 ,$10.32 ,$315.00 ,$17.08 ,$17.08 ,$267.75 ,$21.67 ,$267.75 ,$283.50 ,$10.32 ,$261.45 ,$250.43 ,$250.43 ,$10.32 ,$204.75 
ST. JOSEPH'S HOSPITAL - BREESE,30600163,87172,HC PINWORM EXAM,306,1 ,$96.00 ,$62.40 ,$4.27 ,$96.00 ,$81.60 ,$57.31 ,$4.27 ,$55.20 ,$4.27 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$4.27 ,$4.27 ,$72.00 ,$68.16 ,$68.16 ,$4.27 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$10.68 ,$81.60 ,$4.27 ,$96.00 ,$5.14 ,$5.14 ,$81.60 ,$8.97 ,$81.60 ,$86.40 ,$4.27 ,$79.68 ,$76.32 ,$76.32 ,$4.27 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$113.00 ,$73.45 ,$4.27 ,$113.00 ,$96.05 ,$67.46 ,$4.27 ,$64.98 ,$4.27 ,$77.86 ,$96.05 ,$96.05 ,$96.05 ,$92.66 ,$76.84 ,$4.27 ,$4.27 ,$84.75 ,$80.23 ,$80.23 ,$4.27 ,$80.23 ,$93.79 ,$93.79 ,$93.79 , N/A ,$10.68 ,$96.05 ,$4.27 ,$113.00 ,$5.14 ,$5.14 ,$96.05 ,$8.97 ,$96.05 ,$101.70 ,$4.27 ,$93.79 ,$89.84 ,$89.84 ,$4.27 ,$73.45 
ST. JOSEPH'S HOSPITAL - BREESE,30600183,87210,HC SMEAR WET MOUNT,306,1 ,$119.00 ,$77.35 ,$5.14 ,$119.00 ,$101.15 ,$71.04 ,$5.82 ,$68.43 ,$5.82 ,$81.99 ,$101.15 ,$101.15 ,$101.15 ,$97.58 ,$80.92 ,$5.82 ,$5.82 ,$89.25 ,$84.49 ,$84.49 ,$5.82 ,$84.49 ,$98.77 ,$98.77 ,$98.77 , N/A ,$14.55 ,$101.15 ,$5.82 ,$119.00 ,$5.14 ,$5.14 ,$101.15 ,$12.22 ,$101.15 ,$107.10 ,$5.82 ,$98.77 ,$94.61 ,$94.61 ,$5.82 ,$77.35 
ST. JOSEPH'S HOSPITAL - BREESE,30600185,87220,HC TISSUE KOH PREP,306,1 ,$106.00 ,$68.90 ,$4.27 ,$106.00 ,$90.10 ,$63.28 ,$4.27 ,$60.95 ,$4.27 ,$73.03 ,$90.10 ,$90.10 ,$90.10 ,$86.92 ,$72.08 ,$4.27 ,$4.27 ,$79.50 ,$75.26 ,$75.26 ,$4.27 ,$75.26 ,$87.98 ,$87.98 ,$87.98 , N/A ,$10.68 ,$90.10 ,$4.27 ,$106.00 ,$5.14 ,$5.14 ,$90.10 ,$8.97 ,$90.10 ,$95.40 ,$4.27 ,$87.98 ,$84.27 ,$84.27 ,$4.27 ,$68.90 
ST. JOSEPH'S HOSPITAL - BREESE,30600269,87807,HC QL RSV,306,1 ,$148.00 ,$96.20 ,$5.14 ,$148.00 ,$125.80 ,$88.36 ,$13.10 ,$85.10 ,$13.10 ,$101.97 ,$125.80 ,$125.80 ,$125.80 ,$121.36 ,$100.64 ,$13.10 ,$13.10 ,$111.00 ,$105.08 ,$105.08 ,$13.10 ,$105.08 ,$122.84 ,$122.84 ,$122.84 , N/A ,$32.75 ,$125.80 ,$13.10 ,$148.00 ,$5.14 ,$5.14 ,$125.80 ,$27.51 ,$125.80 ,$133.20 ,$13.10 ,$122.84 ,$117.66 ,$117.66 ,$13.10 ,$96.20 
ST. JOSEPH'S HOSPITAL - BREESE,30600270,87880,HC OPTICAL STREP,306,1 ,$104.00 ,$67.60 ,$5.14 ,$104.00 ,$88.40 ,$62.09 ,$16.53 ,$59.80 ,$16.53 ,$71.66 ,$88.40 ,$88.40 ,$88.40 ,$85.28 ,$70.72 ,$16.53 ,$16.53 ,$78.00 ,$73.84 ,$73.84 ,$16.53 ,$73.84 ,$86.32 ,$86.32 ,$86.32 , N/A ,$41.33 ,$88.40 ,$16.53 ,$104.00 ,$5.14 ,$5.14 ,$88.40 ,$34.71 ,$88.40 ,$93.60 ,$16.53 ,$86.32 ,$82.68 ,$82.68 ,$16.53 ,$67.60 
ST. JOSEPH'S HOSPITAL - BREESE,30600271,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$377.00 ,$245.05 ,$5.14 ,$377.00 ,$320.45 ,$225.07 ,$16.07 ,$216.78 ,$16.07 ,$259.75 ,$320.45 ,$320.45 ,$320.45 ,$309.14 ,$256.36 ,$16.07 ,$16.07 ,$282.75 ,$267.67 ,$267.67 ,$16.07 ,$267.67 ,$312.91 ,$312.91 ,$312.91 , N/A ,$40.18 ,$320.45 ,$16.07 ,$377.00 ,$5.14 ,$5.14 ,$320.45 ,$33.75 ,$320.45 ,$339.30 ,$16.07 ,$312.91 ,$299.72 ,$299.72 ,$16.07 ,$245.05 
ST. JOSEPH'S HOSPITAL - BREESE,30600283,87804,HC QL INFLUENZA A/B,306,1 ,$192.00 ,$124.80 ,$5.14 ,$192.00 ,$163.20 ,$114.62 ,$16.55 ,$110.40 ,$16.55 ,$132.29 ,$163.20 ,$163.20 ,$163.20 ,$157.44 ,$130.56 ,$16.55 ,$16.55 ,$144.00 ,$136.32 ,$136.32 ,$16.55 ,$136.32 ,$159.36 ,$159.36 ,$159.36 , N/A ,$41.38 ,$163.20 ,$16.55 ,$192.00 ,$5.14 ,$5.14 ,$163.20 ,$34.76 ,$163.20 ,$172.80 ,$16.55 ,$159.36 ,$152.64 ,$152.64 ,$16.55 ,$124.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600353,87015,HC CONCENTRATION INFECTIOUS AGENT-90,306,1 ,$61.00 ,$39.65 ,$5.14 ,$61.00 ,$51.85 ,$36.42 ,$6.68 ,$35.08 ,$6.68 ,$42.03 ,$51.85 ,$51.85 ,$51.85 ,$50.02 ,$41.48 ,$6.68 ,$6.68 ,$45.75 ,$43.31 ,$43.31 ,$6.68 ,$43.31 ,$50.63 ,$50.63 ,$50.63 , N/A ,$16.70 ,$51.85 ,$6.68 ,$61.00 ,$5.14 ,$5.14 ,$51.85 ,$14.03 ,$51.85 ,$54.90 ,$6.68 ,$50.63 ,$48.50 ,$48.50 ,$6.68 ,$39.65 
ST. JOSEPH'S HOSPITAL - BREESE,30600359,87081,HC CULTURE SCR PRESUMP PATHOGENS-90,306,1 ,$163.00 ,$105.95 ,$5.14 ,$163.00 ,$138.55 ,$97.31 ,$6.63 ,$93.73 ,$6.63 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$6.63 ,$6.63 ,$122.25 ,$115.73 ,$115.73 ,$6.63 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$16.58 ,$138.55 ,$6.63 ,$163.00 ,$5.14 ,$5.14 ,$138.55 ,$13.92 ,$138.55 ,$146.70 ,$6.63 ,$135.29 ,$129.59 ,$129.59 ,$6.63 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,30600361,87081,HC CULTURE SCR PRESUMP PATHOGENS T2,306,1 ,$163.00 ,$105.95 ,$5.14 ,$163.00 ,$138.55 ,$97.31 ,$6.63 ,$93.73 ,$6.63 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$6.63 ,$6.63 ,$122.25 ,$115.73 ,$115.73 ,$6.63 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$16.58 ,$138.55 ,$6.63 ,$163.00 ,$5.14 ,$5.14 ,$138.55 ,$13.92 ,$138.55 ,$146.70 ,$6.63 ,$135.29 ,$129.59 ,$129.59 ,$6.63 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,30600363,87103,HC CULTURE FUNGUS BLOOD-90,306,1 ,$19.00 ,$12.35 ,$10.93 ,$39.90 ,$16.15 ,$11.34 ,$19.00 ,$10.93 ,$19.00 ,$13.09 ,$16.15 ,$16.15 ,$16.15 ,$15.58 ,$12.92 ,$19.00 ,$19.00 ,$14.25 ,$13.49 ,$13.49 ,$19.00 ,$13.49 ,$15.77 ,$15.77 ,$15.77 , N/A ,$19.00 ,$16.15 ,$19.00 ,$19.00 ,$17.08 ,$17.08 ,$16.15 ,$39.90 ,$16.15 ,$17.10 ,$19.00 ,$15.77 ,$15.11 ,$15.11 ,$19.00 ,$12.35 
ST. JOSEPH'S HOSPITAL - BREESE,30600364,87106,HC CULTURE FUNGUS ID YEAST-90,306,1 ,$86.00 ,$55.90 ,$5.14 ,$86.00 ,$73.10 ,$51.34 ,$10.32 ,$49.45 ,$10.32 ,$59.25 ,$73.10 ,$73.10 ,$73.10 ,$70.52 ,$58.48 ,$10.32 ,$10.32 ,$64.50 ,$61.06 ,$61.06 ,$10.32 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$25.80 ,$73.10 ,$10.32 ,$86.00 ,$5.14 ,$5.14 ,$73.10 ,$21.67 ,$73.10 ,$77.40 ,$10.32 ,$71.38 ,$68.37 ,$68.37 ,$10.32 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,30600366,87109,HC CULTURE MYCOPLASMA-90,306,1 ,$142.00 ,$92.30 ,$15.39 ,$142.00 ,$120.70 ,$84.77 ,$15.39 ,$81.65 ,$15.39 ,$97.84 ,$120.70 ,$120.70 ,$120.70 ,$116.44 ,$96.56 ,$15.39 ,$15.39 ,$106.50 ,$100.82 ,$100.82 ,$15.39 ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A ,$38.48 ,$120.70 ,$15.39 ,$142.00 ,$17.08 ,$17.08 ,$120.70 ,$32.32 ,$120.70 ,$127.80 ,$15.39 ,$117.86 ,$112.89 ,$112.89 ,$15.39 ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600367,87110,HC CULTURE CHLAMYDIA-90,306,1 ,$129.00 ,$83.85 ,$5.14 ,$129.00 ,$109.65 ,$77.01 ,$19.60 ,$74.18 ,$19.60 ,$88.88 ,$109.65 ,$109.65 ,$109.65 ,$105.78 ,$87.72 ,$19.60 ,$19.60 ,$96.75 ,$91.59 ,$91.59 ,$19.60 ,$91.59 ,$107.07 ,$107.07 ,$107.07 , N/A ,$49.00 ,$109.65 ,$19.60 ,$129.00 ,$5.14 ,$5.14 ,$109.65 ,$41.16 ,$109.65 ,$116.10 ,$19.60 ,$107.07 ,$102.56 ,$102.56 ,$19.60 ,$83.85 
ST. JOSEPH'S HOSPITAL - BREESE,30600368,87116,HC CULTURE AFB/TB/MYCOBACT-90,306,1 ,$96.00 ,$62.40 ,$10.80 ,$96.00 ,$81.60 ,$57.31 ,$10.80 ,$55.20 ,$10.80 ,$66.14 ,$81.60 ,$81.60 ,$81.60 ,$78.72 ,$65.28 ,$10.80 ,$10.80 ,$72.00 ,$68.16 ,$68.16 ,$10.80 ,$68.16 ,$79.68 ,$79.68 ,$79.68 , N/A ,$27.00 ,$81.60 ,$10.80 ,$96.00 ,$17.08 ,$17.08 ,$81.60 ,$22.68 ,$81.60 ,$86.40 ,$10.80 ,$79.68 ,$76.32 ,$76.32 ,$10.80 ,$62.40 
ST. JOSEPH'S HOSPITAL - BREESE,30600369,87118,HC CULTURE MYCOBACTERIA ID-90,306,1 ,$105.00 ,$68.25 ,$14.61 ,$105.00 ,$89.25 ,$62.69 ,$14.61 ,$60.38 ,$14.61 ,$72.35 ,$89.25 ,$89.25 ,$89.25 ,$86.10 ,$71.40 ,$14.61 ,$14.61 ,$78.75 ,$74.55 ,$74.55 ,$14.61 ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A ,$36.53 ,$89.25 ,$14.61 ,$105.00 ,$17.08 ,$17.08 ,$89.25 ,$30.68 ,$89.25 ,$94.50 ,$14.61 ,$87.15 ,$83.48 ,$83.48 ,$14.61 ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,30600370,87140,HC CULTURE TYPE IF EA ANTISERUM-90,306,1 ,$46.00 ,$29.90 ,$5.57 ,$46.00 ,$39.10 ,$27.46 ,$5.57 ,$26.45 ,$5.57 ,$31.69 ,$39.10 ,$39.10 ,$39.10 ,$37.72 ,$31.28 ,$5.57 ,$5.57 ,$34.50 ,$32.66 ,$32.66 ,$5.57 ,$32.66 ,$38.18 ,$38.18 ,$38.18 , N/A ,$13.93 ,$39.10 ,$5.57 ,$46.00 ,$17.08 ,$17.08 ,$39.10 ,$11.70 ,$39.10 ,$41.40 ,$5.57 ,$38.18 ,$36.57 ,$36.57 ,$5.57 ,$29.90 
ST. JOSEPH'S HOSPITAL - BREESE,30600375,87149,HC CULTURE TYPING ID NUCLEIC ACID-90,306,1 ,$100.00 ,$65.00 ,$5.14 ,$100.00 ,$85.00 ,$59.70 ,$20.05 ,$57.50 ,$20.05 ,$68.90 ,$85.00 ,$85.00 ,$85.00 ,$82.00 ,$68.00 ,$20.05 ,$20.05 ,$75.00 ,$71.00 ,$71.00 ,$20.05 ,$71.00 ,$83.00 ,$83.00 ,$83.00 , N/A ,$50.13 ,$85.00 ,$20.05 ,$100.00 ,$5.14 ,$5.14 ,$85.00 ,$42.11 ,$85.00 ,$90.00 ,$20.05 ,$83.00 ,$79.50 ,$79.50 ,$20.05 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600380,87177,HC SMEAR OVA PARASITE CONC/ID-90,306,1 ,$197.00 ,$128.05 ,$5.14 ,$197.00 ,$167.45 ,$117.61 ,$8.90 ,$113.28 ,$8.90 ,$135.73 ,$167.45 ,$167.45 ,$167.45 ,$161.54 ,$133.96 ,$8.90 ,$8.90 ,$147.75 ,$139.87 ,$139.87 ,$8.90 ,$139.87 ,$163.51 ,$163.51 ,$163.51 , N/A ,$22.25 ,$167.45 ,$8.90 ,$197.00 ,$5.14 ,$5.14 ,$167.45 ,$18.69 ,$167.45 ,$177.30 ,$8.90 ,$163.51 ,$156.62 ,$156.62 ,$8.90 ,$128.05 
ST. JOSEPH'S HOSPITAL - BREESE,30600388,87186,HC SENSITIVITY MIC INIT PLATE-90,306,1 ,$280.00 ,$182.00 ,$5.14 ,$280.00 ,$238.00 ,$167.16 ,$8.65 ,$161.00 ,$8.65 ,$192.92 ,$238.00 ,$238.00 ,$238.00 ,$229.60 ,$190.40 ,$8.65 ,$8.65 ,$210.00 ,$198.80 ,$198.80 ,$8.65 ,$198.80 ,$232.40 ,$232.40 ,$232.40 , N/A ,$21.63 ,$238.00 ,$8.65 ,$280.00 ,$5.14 ,$5.14 ,$238.00 ,$18.17 ,$238.00 ,$252.00 ,$8.65 ,$232.40 ,$222.60 ,$222.60 ,$8.65 ,$182.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600395,87206,HC SMEAR ACID FAST/FLUOR-90,306,1 ,$97.00 ,$63.05 ,$5.14 ,$97.00 ,$82.45 ,$57.91 ,$5.39 ,$55.78 ,$5.39 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$5.39 ,$5.39 ,$72.75 ,$68.87 ,$68.87 ,$5.39 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$13.48 ,$82.45 ,$5.39 ,$97.00 ,$5.14 ,$5.14 ,$82.45 ,$11.32 ,$82.45 ,$87.30 ,$5.39 ,$80.51 ,$77.12 ,$77.12 ,$5.39 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,30600397,87207,HC SPECIAL STAIN INCL BODIES/PARASITES-90,306,1 ,$101.00 ,$65.65 ,$5.14 ,$101.00 ,$85.85 ,$60.30 ,$5.99 ,$58.08 ,$5.99 ,$69.59 ,$85.85 ,$85.85 ,$85.85 ,$82.82 ,$68.68 ,$5.99 ,$5.99 ,$75.75 ,$71.71 ,$71.71 ,$5.99 ,$71.71 ,$83.83 ,$83.83 ,$83.83 , N/A ,$14.98 ,$85.85 ,$5.99 ,$101.00 ,$5.14 ,$5.14 ,$85.85 ,$12.58 ,$85.85 ,$90.90 ,$5.99 ,$83.83 ,$80.30 ,$80.30 ,$5.99 ,$65.65 
ST. JOSEPH'S HOSPITAL - BREESE,30600399,87209,HC OVA  AND  PARASITE W/STAIN-90,306,1 ,$126.00 ,$81.90 ,$17.08 ,$126.00 ,$107.10 ,$75.22 ,$17.98 ,$72.45 ,$17.98 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$103.32 ,$85.68 ,$17.98 ,$17.98 ,$94.50 ,$89.46 ,$89.46 ,$17.98 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$44.95 ,$107.10 ,$17.98 ,$126.00 ,$17.08 ,$17.08 ,$107.10 ,$37.76 ,$107.10 ,$113.40 ,$17.98 ,$104.58 ,$100.17 ,$100.17 ,$17.98 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,30600402,87252,HC CULTURE VIRUS ID TISSUE-90,306,1 ,$163.00 ,$105.95 ,$17.08 ,$163.00 ,$138.55 ,$97.31 ,$26.07 ,$93.73 ,$26.07 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$26.07 ,$26.07 ,$122.25 ,$115.73 ,$115.73 ,$26.07 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$65.18 ,$138.55 ,$26.07 ,$163.00 ,$17.08 ,$17.08 ,$138.55 ,$54.75 ,$138.55 ,$146.70 ,$26.07 ,$135.29 ,$129.59 ,$129.59 ,$26.07 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,30600405,87254,HC VIRUS ISOL SHELL ID-90,306,1 ,$113.00 ,$73.45 ,$17.08 ,$113.00 ,$96.05 ,$67.46 ,$19.56 ,$64.98 ,$19.56 ,$77.86 ,$96.05 ,$96.05 ,$96.05 ,$92.66 ,$76.84 ,$19.56 ,$19.56 ,$84.75 ,$80.23 ,$80.23 ,$19.56 ,$80.23 ,$93.79 ,$93.79 ,$93.79 , N/A ,$48.90 ,$96.05 ,$19.56 ,$113.00 ,$17.08 ,$17.08 ,$96.05 ,$41.08 ,$96.05 ,$101.70 ,$19.56 ,$93.79 ,$89.84 ,$89.84 ,$19.56 ,$73.45 
ST. JOSEPH'S HOSPITAL - BREESE,30600407,87260,HC IF ADENOVIRUS AG-90,306,1 ,$207.00 ,$134.55 ,$6.45 ,$207.00 ,$175.95 ,$123.58 ,$14.43 ,$119.03 ,$14.43 ,$142.62 ,$175.95 ,$175.95 ,$175.95 ,$169.74 ,$140.76 ,$14.43 ,$14.43 ,$155.25 ,$146.97 ,$146.97 ,$14.43 ,$146.97 ,$171.81 ,$171.81 ,$171.81 , N/A ,$36.08 ,$175.95 ,$14.43 ,$207.00 ,$6.45 ,$6.45 ,$175.95 ,$30.30 ,$175.95 ,$186.30 ,$14.43 ,$171.81 ,$164.57 ,$164.57 ,$14.43 ,$134.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600419,87338,HC EIA QL H PYLORI AG STOOL-90,306,1 ,$288.00 ,$187.20 ,$6.45 ,$288.00 ,$244.80 ,$171.94 ,$14.38 ,$165.60 ,$14.38 ,$198.43 ,$244.80 ,$244.80 ,$244.80 ,$236.16 ,$195.84 ,$14.38 ,$14.38 ,$216.00 ,$204.48 ,$204.48 ,$14.38 ,$204.48 ,$239.04 ,$239.04 ,$239.04 , N/A ,$35.95 ,$244.80 ,$14.38 ,$288.00 ,$6.45 ,$6.45 ,$244.80 ,$30.20 ,$244.80 ,$259.20 ,$14.38 ,$239.04 ,$228.96 ,$228.96 ,$14.38 ,$187.20 
ST. JOSEPH'S HOSPITAL - BREESE,30600424,87350,HC HEPATITIS BE AG QL-90,306,1 ,$121.00 ,$78.65 ,$6.45 ,$121.00 ,$102.85 ,$72.24 ,$11.53 ,$69.58 ,$11.53 ,$83.37 ,$102.85 ,$102.85 ,$102.85 ,$99.22 ,$82.28 ,$11.53 ,$11.53 ,$90.75 ,$85.91 ,$85.91 ,$11.53 ,$85.91 ,$100.43 ,$100.43 ,$100.43 , N/A ,$28.83 ,$102.85 ,$11.53 ,$121.00 ,$6.45 ,$6.45 ,$102.85 ,$24.21 ,$102.85 ,$108.90 ,$11.53 ,$100.43 ,$96.20 ,$96.20 ,$11.53 ,$78.65 
ST. JOSEPH'S HOSPITAL - BREESE,30600426,87385,HC EIA QL HISTOPLASMA AG-90,306,1 ,$355.00 ,$230.75 ,$6.45 ,$355.00 ,$301.75 ,$211.94 ,$13.25 ,$204.13 ,$13.25 ,$244.60 ,$301.75 ,$301.75 ,$301.75 ,$291.10 ,$241.40 ,$13.25 ,$13.25 ,$266.25 ,$252.05 ,$252.05 ,$13.25 ,$252.05 ,$294.65 ,$294.65 ,$294.65 , N/A ,$33.13 ,$301.75 ,$13.25 ,$355.00 ,$6.45 ,$6.45 ,$301.75 ,$27.83 ,$301.75 ,$319.50 ,$13.25 ,$294.65 ,$282.23 ,$282.23 ,$13.25 ,$230.75 
ST. JOSEPH'S HOSPITAL - BREESE,30600432,87449,HC EIA QL MLT AG INF-90,306,1 ,$358.00 ,$232.70 ,$6.45 ,$358.00 ,$304.30 ,$213.73 ,$11.98 ,$205.85 ,$11.98 ,$246.66 ,$304.30 ,$304.30 ,$304.30 ,$293.56 ,$243.44 ,$11.98 ,$11.98 ,$268.50 ,$254.18 ,$254.18 ,$11.98 ,$254.18 ,$297.14 ,$297.14 ,$297.14 , N/A ,$29.95 ,$304.30 ,$11.98 ,$358.00 ,$6.45 ,$6.45 ,$304.30 ,$25.16 ,$304.30 ,$322.20 ,$11.98 ,$297.14 ,$284.61 ,$284.61 ,$11.98 ,$232.70 
ST. JOSEPH'S HOSPITAL - BREESE,30600438,87491,HC CHLAMYDIA TRACH AMP-90,306,1 ,$262.00 ,$170.30 ,$6.45 ,$262.00 ,$222.70 ,$156.41 ,$35.09 ,$150.65 ,$35.09 ,$180.52 ,$222.70 ,$222.70 ,$222.70 ,$214.84 ,$178.16 ,$35.09 ,$35.09 ,$196.50 ,$186.02 ,$186.02 ,$35.09 ,$186.02 ,$217.46 ,$217.46 ,$217.46 , N/A ,$87.73 ,$222.70 ,$35.09 ,$262.00 ,$6.45 ,$6.45 ,$222.70 ,$73.69 ,$222.70 ,$235.80 ,$35.09 ,$217.46 ,$208.29 ,$208.29 ,$35.09 ,$170.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600439,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$132.00 ,$85.80 ,$6.45 ,$132.00 ,$112.20 ,$78.80 ,$35.09 ,$75.90 ,$35.09 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$35.09 ,$35.09 ,$99.00 ,$93.72 ,$93.72 ,$35.09 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$87.73 ,$112.20 ,$35.09 ,$132.00 ,$6.45 ,$6.45 ,$112.20 ,$73.69 ,$112.20 ,$118.80 ,$35.09 ,$109.56 ,$104.94 ,$104.94 ,$35.09 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600441,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$233.00 ,$151.45 ,$6.45 ,$233.00 ,$198.05 ,$139.10 ,$37.27 ,$133.98 ,$37.27 ,$160.54 ,$198.05 ,$198.05 ,$198.05 ,$191.06 ,$158.44 ,$37.27 ,$37.27 ,$174.75 ,$165.43 ,$165.43 ,$37.27 ,$165.43 ,$193.39 ,$193.39 ,$193.39 , N/A ,$93.18 ,$198.05 ,$37.27 ,$233.00 ,$6.45 ,$6.45 ,$198.05 ,$78.27 ,$198.05 ,$209.70 ,$37.27 ,$193.39 ,$185.24 ,$185.24 ,$37.27 ,$151.45 
ST. JOSEPH'S HOSPITAL - BREESE,30600442,87496,HC INFECT AMP (CMV) MENI-90,306,1 ,$640.00 ,$416.00 ,$17.08 ,$640.00 ,$544.00 ,$382.08 ,$35.09 ,$368.00 ,$35.09 ,$440.96 ,$544.00 ,$544.00 ,$544.00 ,$524.80 ,$435.20 ,$35.09 ,$35.09 ,$480.00 ,$454.40 ,$454.40 ,$35.09 ,$454.40 ,$531.20 ,$531.20 ,$531.20 , N/A ,$87.73 ,$544.00 ,$35.09 ,$640.00 ,$17.08 ,$17.08 ,$544.00 ,$73.69 ,$544.00 ,$576.00 ,$35.09 ,$531.20 ,$508.80 ,$508.80 ,$35.09 ,$416.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600443,87497,HC CMV QN-90,306,1 ,$471.00 ,$306.15 ,$17.08 ,$471.00 ,$400.35 ,$281.19 ,$42.84 ,$270.83 ,$42.84 ,$324.52 ,$400.35 ,$400.35 ,$400.35 ,$386.22 ,$320.28 ,$42.84 ,$42.84 ,$353.25 ,$334.41 ,$334.41 ,$42.84 ,$334.41 ,$390.93 ,$390.93 ,$390.93 , N/A ,$107.10 ,$400.35 ,$42.84 ,$471.00 ,$17.08 ,$17.08 ,$400.35 ,$89.96 ,$400.35 ,$423.90 ,$42.84 ,$390.93 ,$374.45 ,$374.45 ,$42.84 ,$306.15 
ST. JOSEPH'S HOSPITAL - BREESE,30600446,87502,HC INFLUENZA VIRUS MULTIPLE DNA/RNA-90,306,1 ,$497.00 ,$323.05 ,$11.11 ,$497.00 ,$422.45 ,$296.71 ,$95.80 ,$285.78 ,$95.80 ,$342.43 ,$422.45 ,$422.45 ,$422.45 ,$407.54 ,$337.96 ,$95.80 ,$95.80 ,$372.75 ,$352.87 ,$352.87 ,$95.80 ,$352.87 ,$412.51 ,$412.51 ,$412.51 , N/A ,$239.50 ,$422.45 ,$95.80 ,$497.00 ,$11.11 ,$11.11 ,$422.45 ,$201.18 ,$422.45 ,$447.30 ,$95.80 ,$412.51 ,$395.12 ,$395.12 ,$95.80 ,$323.05 
ST. JOSEPH'S HOSPITAL - BREESE,30600448,87517,HC HEPATITIS B QN-90,306,1 ,$355.00 ,$230.75 ,$17.08 ,$355.00 ,$301.75 ,$211.94 ,$42.84 ,$204.13 ,$42.84 ,$244.60 ,$301.75 ,$301.75 ,$301.75 ,$291.10 ,$241.40 ,$42.84 ,$42.84 ,$266.25 ,$252.05 ,$252.05 ,$42.84 ,$252.05 ,$294.65 ,$294.65 ,$294.65 , N/A ,$107.10 ,$301.75 ,$42.84 ,$355.00 ,$17.08 ,$17.08 ,$301.75 ,$89.96 ,$301.75 ,$319.50 ,$42.84 ,$294.65 ,$282.23 ,$282.23 ,$42.84 ,$230.75 
ST. JOSEPH'S HOSPITAL - BREESE,30600451,87522,HC HEPATITIS C QN-90,306,1 ,$634.00 ,$412.10 ,$17.08 ,$634.00 ,$538.90 ,$378.50 ,$42.84 ,$364.55 ,$42.84 ,$436.83 ,$538.90 ,$538.90 ,$538.90 ,$519.88 ,$431.12 ,$42.84 ,$42.84 ,$475.50 ,$450.14 ,$450.14 ,$42.84 ,$450.14 ,$526.22 ,$526.22 ,$526.22 , N/A ,$107.10 ,$538.90 ,$42.84 ,$634.00 ,$17.08 ,$17.08 ,$538.90 ,$89.96 ,$538.90 ,$570.60 ,$42.84 ,$526.22 ,$504.03 ,$504.03 ,$42.84 ,$412.10 
ST. JOSEPH'S HOSPITAL - BREESE,30600453,87529,HC HERPES SIMPLEX AMP-90,306,1 ,$612.00 ,$397.80 ,$17.08 ,$612.00 ,$520.20 ,$365.36 ,$35.09 ,$351.90 ,$35.09 ,$421.67 ,$520.20 ,$520.20 ,$520.20 ,$501.84 ,$416.16 ,$35.09 ,$35.09 ,$459.00 ,$434.52 ,$434.52 ,$35.09 ,$434.52 ,$507.96 ,$507.96 ,$507.96 , N/A ,$87.73 ,$520.20 ,$35.09 ,$612.00 ,$17.08 ,$17.08 ,$520.20 ,$73.69 ,$520.20 ,$550.80 ,$35.09 ,$507.96 ,$486.54 ,$486.54 ,$35.09 ,$397.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600454,87530,HC HSV QUANT-90,306,1 ,$330.00 ,$214.50 ,$17.08 ,$330.00 ,$280.50 ,$197.01 ,$42.84 ,$189.75 ,$42.84 ,$227.37 ,$280.50 ,$280.50 ,$280.50 ,$270.60 ,$224.40 ,$42.84 ,$42.84 ,$247.50 ,$234.30 ,$234.30 ,$42.84 ,$234.30 ,$273.90 ,$273.90 ,$273.90 , N/A ,$107.10 ,$280.50 ,$42.84 ,$330.00 ,$17.08 ,$17.08 ,$280.50 ,$89.96 ,$280.50 ,$297.00 ,$42.84 ,$273.90 ,$262.35 ,$262.35 ,$42.84 ,$214.50 
ST. JOSEPH'S HOSPITAL - BREESE,30600458,87536,HC HIV-1 QN-90,306,1 ,$331.00 ,$215.15 ,$17.08 ,$331.00 ,$281.35 ,$197.61 ,$85.10 ,$190.33 ,$85.10 ,$228.06 ,$281.35 ,$281.35 ,$281.35 ,$271.42 ,$225.08 ,$85.10 ,$85.10 ,$248.25 ,$235.01 ,$235.01 ,$85.10 ,$235.01 ,$274.73 ,$274.73 ,$274.73 , N/A ,$212.75 ,$281.35 ,$85.10 ,$331.00 ,$17.08 ,$17.08 ,$281.35 ,$178.71 ,$281.35 ,$297.90 ,$85.10 ,$274.73 ,$263.15 ,$263.15 ,$85.10 ,$215.15 
ST. JOSEPH'S HOSPITAL - BREESE,30600460,87591,HC NEISSERIA AMP-90,306,1 ,$218.00 ,$141.70 ,$17.08 ,$218.00 ,$185.30 ,$130.15 ,$35.09 ,$125.35 ,$35.09 ,$150.20 ,$185.30 ,$185.30 ,$185.30 ,$178.76 ,$148.24 ,$35.09 ,$35.09 ,$163.50 ,$154.78 ,$154.78 ,$35.09 ,$154.78 ,$180.94 ,$180.94 ,$180.94 , N/A ,$87.73 ,$185.30 ,$35.09 ,$218.00 ,$17.08 ,$17.08 ,$185.30 ,$73.69 ,$185.30 ,$196.20 ,$35.09 ,$180.94 ,$173.31 ,$173.31 ,$35.09 ,$141.70 
ST. JOSEPH'S HOSPITAL - BREESE,30600462,87624,HC HPV AMP HIGH RISK ALL OTHERS-90,306,1 ,$247.00 ,$160.55 ,$17.08 ,$247.00 ,$209.95 ,$147.46 ,$35.09 ,$142.03 ,$35.09 ,$170.18 ,$209.95 ,$209.95 ,$209.95 ,$202.54 ,$167.96 ,$35.09 ,$35.09 ,$185.25 ,$175.37 ,$175.37 ,$35.09 ,$175.37 ,$205.01 ,$205.01 ,$205.01 , N/A ,$87.73 ,$209.95 ,$35.09 ,$35.09 ,$17.08 ,$17.08 ,$209.95 ,$73.69 ,$209.95 ,$222.30 ,$35.09 ,$205.01 ,$196.37 ,$196.37 ,$35.09 ,$160.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600463,87625,HC HPV GENOTYPE 16 18/45-90,306,1 ,$224.00 ,$145.60 ,$17.08 ,$224.00 ,$190.40 ,$133.73 ,$40.55 ,$128.80 ,$40.55 ,$154.34 ,$190.40 ,$190.40 ,$190.40 ,$183.68 ,$152.32 ,$40.55 ,$40.55 ,$168.00 ,$159.04 ,$159.04 ,$40.55 ,$159.04 ,$185.92 ,$185.92 ,$185.92 , N/A ,$101.38 ,$190.40 ,$40.55 ,$40.55 ,$17.08 ,$17.08 ,$190.40 ,$85.16 ,$190.40 ,$201.60 ,$40.55 ,$185.92 ,$178.08 ,$178.08 ,$40.55 ,$145.60 
ST. JOSEPH'S HOSPITAL - BREESE,30600467,87651,HC INFECT AMP (GRP A STREP),306,1 ,$200.00 ,$130.00 ,$17.08 ,$200.00 ,$170.00 ,$119.40 ,$35.09 ,$115.00 ,$35.09 ,$137.80 ,$170.00 ,$170.00 ,$170.00 ,$164.00 ,$136.00 ,$35.09 ,$35.09 ,$150.00 ,$142.00 ,$142.00 ,$35.09 ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A ,$87.73 ,$170.00 ,$35.09 ,$200.00 ,$17.08 ,$17.08 ,$170.00 ,$73.69 ,$170.00 ,$180.00 ,$35.09 ,$166.00 ,$159.00 ,$159.00 ,$35.09 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600468,87653,HC INFECT AMP (GRP B STREP),306,1 ,$200.00 ,$130.00 ,$17.08 ,$200.00 ,$170.00 ,$119.40 ,$35.09 ,$115.00 ,$35.09 ,$137.80 ,$170.00 ,$170.00 ,$170.00 ,$164.00 ,$136.00 ,$35.09 ,$35.09 ,$150.00 ,$142.00 ,$142.00 ,$35.09 ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A ,$87.73 ,$170.00 ,$35.09 ,$200.00 ,$17.08 ,$17.08 ,$170.00 ,$73.69 ,$170.00 ,$180.00 ,$35.09 ,$166.00 ,$159.00 ,$159.00 ,$35.09 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600469,87661,HC TRICHOMONAS VAG AMP PROBE-90,306,1 ,$219.00 ,$142.35 ,$17.08 ,$219.00 ,$186.15 ,$130.74 ,$35.09 ,$125.93 ,$35.09 ,$150.89 ,$186.15 ,$186.15 ,$186.15 ,$179.58 ,$148.92 ,$35.09 ,$35.09 ,$164.25 ,$155.49 ,$155.49 ,$35.09 ,$155.49 ,$181.77 ,$181.77 ,$181.77 , N/A ,$87.73 ,$186.15 ,$35.09 ,$219.00 ,$17.08 ,$17.08 ,$186.15 ,$73.69 ,$186.15 ,$197.10 ,$35.09 ,$181.77 ,$174.11 ,$174.11 ,$35.09 ,$142.35 
ST. JOSEPH'S HOSPITAL - BREESE,30600471,87798,HC INFECT AMP-90,306,1 ,$509.00 ,$330.85 ,$17.08 ,$509.00 ,$432.65 ,$303.87 ,$35.09 ,$292.68 ,$35.09 ,$350.70 ,$432.65 ,$432.65 ,$432.65 ,$417.38 ,$346.12 ,$35.09 ,$35.09 ,$381.75 ,$361.39 ,$361.39 ,$35.09 ,$361.39 ,$422.47 ,$422.47 ,$422.47 , N/A ,$87.73 ,$432.65 ,$35.09 ,$509.00 ,$17.08 ,$17.08 ,$432.65 ,$73.69 ,$432.65 ,$458.10 ,$35.09 ,$422.47 ,$404.66 ,$404.66 ,$35.09 ,$330.85 
ST. JOSEPH'S HOSPITAL - BREESE,30600478,87799,HC INFECT AGENT QN-90,306,1 ,$407.00 ,$264.55 ,$17.08 ,$407.00 ,$345.95 ,$242.98 ,$42.84 ,$234.03 ,$42.84 ,$280.42 ,$345.95 ,$345.95 ,$345.95 ,$333.74 ,$276.76 ,$42.84 ,$42.84 ,$305.25 ,$288.97 ,$288.97 ,$42.84 ,$288.97 ,$337.81 ,$337.81 ,$337.81 , N/A ,$107.10 ,$345.95 ,$42.84 ,$407.00 ,$17.08 ,$17.08 ,$345.95 ,$89.96 ,$345.95 ,$366.30 ,$42.84 ,$337.81 ,$323.57 ,$323.57 ,$42.84 ,$264.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600483,87902,HC GENTOYPE HEP C-90,306,1 ,$626.00 ,$406.90 ,$17.08 ,$626.00 ,$532.10 ,$373.72 ,$257.45 ,$359.95 ,$257.45 ,$431.31 ,$532.10 ,$532.10 ,$532.10 ,$513.32 ,$425.68 ,$257.45 ,$257.45 ,$469.50 ,$444.46 ,$444.46 ,$257.45 ,$444.46 ,$519.58 ,$519.58 ,$519.58 , N/A ,$626.00 ,$532.10 ,$257.45 ,$626.00 ,$17.08 ,$17.08 ,$532.10 ,$540.65 ,$532.10 ,$563.40 ,$257.45 ,$519.58 ,$497.67 ,$497.67 ,$257.45 ,$406.90 
ST. JOSEPH'S HOSPITAL - BREESE,30600503,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB-90,306,1 ,$40.00 ,$26.00 ,$6.45 ,$50.57 ,$34.00 ,$23.88 ,$24.08 ,$23.00 ,$24.08 ,$27.56 ,$34.00 ,$34.00 ,$34.00 ,$32.80 ,$27.20 ,$24.08 ,$24.08 ,$30.00 ,$28.40 ,$28.40 ,$24.08 ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A ,$40.00 ,$34.00 ,$24.08 ,$40.00 ,$6.45 ,$6.45 ,$34.00 ,$50.57 ,$34.00 ,$36.00 ,$24.08 ,$33.20 ,$31.80 ,$31.80 ,$24.08 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600516,87040,HC BACTERIA BLOOD CULTURE T1,306,1 ,$315.00 ,$204.75 ,$10.32 ,$315.00 ,$267.75 ,$188.06 ,$10.32 ,$181.13 ,$10.32 ,$217.04 ,$267.75 ,$267.75 ,$267.75 ,$258.30 ,$214.20 ,$10.32 ,$10.32 ,$236.25 ,$223.65 ,$223.65 ,$10.32 ,$223.65 ,$261.45 ,$261.45 ,$261.45 , N/A ,$25.80 ,$267.75 ,$10.32 ,$315.00 ,$17.08 ,$17.08 ,$267.75 ,$21.67 ,$267.75 ,$283.50 ,$10.32 ,$261.45 ,$250.43 ,$250.43 ,$10.32 ,$204.75 
ST. JOSEPH'S HOSPITAL - BREESE,30600517,87045,HC STOOL CULTURE,306,1 ,$144.00 ,$93.60 ,$5.14 ,$144.00 ,$122.40 ,$85.97 ,$9.44 ,$82.80 ,$9.44 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$9.44 ,$9.44 ,$108.00 ,$102.24 ,$102.24 ,$9.44 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$23.60 ,$122.40 ,$9.44 ,$144.00 ,$5.14 ,$5.14 ,$122.40 ,$19.82 ,$122.40 ,$129.60 ,$9.44 ,$119.52 ,$114.48 ,$114.48 ,$9.44 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,30600518,87046,HC STOOL CULTURE OTH SRC,306,1 ,$113.00 ,$73.45 ,$5.14 ,$113.00 ,$96.05 ,$67.46 ,$9.44 ,$64.98 ,$9.44 ,$77.86 ,$96.05 ,$96.05 ,$96.05 ,$92.66 ,$76.84 ,$9.44 ,$9.44 ,$84.75 ,$80.23 ,$80.23 ,$9.44 ,$80.23 ,$93.79 ,$93.79 ,$93.79 , N/A ,$23.60 ,$96.05 ,$9.44 ,$113.00 ,$5.14 ,$5.14 ,$96.05 ,$19.82 ,$96.05 ,$101.70 ,$9.44 ,$93.79 ,$89.84 ,$89.84 ,$9.44 ,$73.45 
ST. JOSEPH'S HOSPITAL - BREESE,30600519,87070,HC BODY FLUID CULTURE,306,1 ,$36.00 ,$23.40 ,$5.14 ,$36.00 ,$30.60 ,$21.49 ,$8.62 ,$20.70 ,$8.62 ,$24.80 ,$30.60 ,$30.60 ,$30.60 ,$29.52 ,$24.48 ,$8.62 ,$8.62 ,$27.00 ,$25.56 ,$25.56 ,$8.62 ,$25.56 ,$29.88 ,$29.88 ,$29.88 , N/A ,$21.55 ,$30.60 ,$8.62 ,$36.00 ,$5.14 ,$5.14 ,$30.60 ,$18.10 ,$30.60 ,$32.40 ,$8.62 ,$29.88 ,$28.62 ,$28.62 ,$8.62 ,$23.40 
ST. JOSEPH'S HOSPITAL - BREESE,30600520,87071,HC CULTURE AEROBIC OTH QN,306,1 ,$190.00 ,$123.50 ,$5.14 ,$190.00 ,$161.50 ,$113.43 ,$9.89 ,$109.25 ,$9.89 ,$130.91 ,$161.50 ,$161.50 ,$161.50 ,$155.80 ,$129.20 ,$9.89 ,$9.89 ,$142.50 ,$134.90 ,$134.90 ,$9.89 ,$134.90 ,$157.70 ,$157.70 ,$157.70 , N/A ,$24.73 ,$161.50 ,$9.89 ,$190.00 ,$5.14 ,$5.14 ,$161.50 ,$20.77 ,$161.50 ,$171.00 ,$9.89 ,$157.70 ,$151.05 ,$151.05 ,$9.89 ,$123.50 
ST. JOSEPH'S HOSPITAL - BREESE,30600521,87073,HC CULTURE ANAEROBIC OTHER SOURCE QN,306,1 ,$214.00 ,$139.10 ,$9.66 ,$214.00 ,$181.90 ,$127.76 ,$9.66 ,$123.05 ,$9.66 ,$147.45 ,$181.90 ,$181.90 ,$181.90 ,$175.48 ,$145.52 ,$9.66 ,$9.66 ,$160.50 ,$151.94 ,$151.94 ,$9.66 ,$151.94 ,$177.62 ,$177.62 ,$177.62 , N/A ,$24.15 ,$181.90 ,$9.66 ,$214.00 ,$17.08 ,$17.08 ,$181.90 ,$20.29 ,$181.90 ,$192.60 ,$9.66 ,$177.62 ,$170.13 ,$170.13 ,$9.66 ,$139.10 
ST. JOSEPH'S HOSPITAL - BREESE,30600522,87075,HC CULTURE ANAEROBIC,306,1 ,$212.00 ,$137.80 ,$5.14 ,$212.00 ,$180.20 ,$126.56 ,$9.47 ,$121.90 ,$9.47 ,$146.07 ,$180.20 ,$180.20 ,$180.20 ,$173.84 ,$144.16 ,$9.47 ,$9.47 ,$159.00 ,$150.52 ,$150.52 ,$9.47 ,$150.52 ,$175.96 ,$175.96 ,$175.96 , N/A ,$23.68 ,$180.20 ,$9.47 ,$212.00 ,$5.14 ,$5.14 ,$180.20 ,$19.89 ,$180.20 ,$190.80 ,$9.47 ,$175.96 ,$168.54 ,$168.54 ,$9.47 ,$137.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600523,87076,HC CULTURE ANAEROBIC ID,306,1 ,$167.00 ,$108.55 ,$5.14 ,$167.00 ,$141.95 ,$99.70 ,$8.08 ,$96.03 ,$8.08 ,$115.06 ,$141.95 ,$141.95 ,$141.95 ,$136.94 ,$113.56 ,$8.08 ,$8.08 ,$125.25 ,$118.57 ,$118.57 ,$8.08 ,$118.57 ,$138.61 ,$138.61 ,$138.61 , N/A ,$20.20 ,$141.95 ,$8.08 ,$167.00 ,$5.14 ,$5.14 ,$141.95 ,$16.97 ,$141.95 ,$150.30 ,$8.08 ,$138.61 ,$132.77 ,$132.77 ,$8.08 ,$108.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600524,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$147.00 ,$95.55 ,$5.14 ,$147.00 ,$124.95 ,$87.76 ,$8.08 ,$84.53 ,$8.08 ,$101.28 ,$124.95 ,$124.95 ,$124.95 ,$120.54 ,$99.96 ,$8.08 ,$8.08 ,$110.25 ,$104.37 ,$104.37 ,$8.08 ,$104.37 ,$122.01 ,$122.01 ,$122.01 , N/A ,$20.20 ,$124.95 ,$8.08 ,$147.00 ,$5.14 ,$5.14 ,$124.95 ,$16.97 ,$124.95 ,$132.30 ,$8.08 ,$122.01 ,$116.87 ,$116.87 ,$8.08 ,$95.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600525,87081,HC CULTURE SCR PRESUMP PATHOGENS,306,1 ,$163.00 ,$105.95 ,$5.14 ,$163.00 ,$138.55 ,$97.31 ,$6.63 ,$93.73 ,$6.63 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$6.63 ,$6.63 ,$122.25 ,$115.73 ,$115.73 ,$6.63 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$16.58 ,$138.55 ,$6.63 ,$163.00 ,$5.14 ,$5.14 ,$138.55 ,$13.92 ,$138.55 ,$146.70 ,$6.63 ,$135.29 ,$129.59 ,$129.59 ,$6.63 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,30600526,87081,HC CULTURE SCR PRESUMP PATHOGENS,306,1 ,$163.00 ,$105.95 ,$5.14 ,$163.00 ,$138.55 ,$97.31 ,$6.63 ,$93.73 ,$6.63 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$6.63 ,$6.63 ,$122.25 ,$115.73 ,$115.73 ,$6.63 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$16.58 ,$138.55 ,$6.63 ,$163.00 ,$5.14 ,$5.14 ,$138.55 ,$13.92 ,$138.55 ,$146.70 ,$6.63 ,$135.29 ,$129.59 ,$129.59 ,$6.63 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,30600527,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$186.00 ,$120.90 ,$5.14 ,$186.00 ,$158.10 ,$111.04 ,$8.07 ,$106.95 ,$8.07 ,$128.15 ,$158.10 ,$158.10 ,$158.10 ,$152.52 ,$126.48 ,$8.07 ,$8.07 ,$139.50 ,$132.06 ,$132.06 ,$8.07 ,$132.06 ,$154.38 ,$154.38 ,$154.38 , N/A ,$20.18 ,$158.10 ,$8.07 ,$186.00 ,$5.14 ,$5.14 ,$158.10 ,$16.95 ,$158.10 ,$167.40 ,$8.07 ,$154.38 ,$147.87 ,$147.87 ,$8.07 ,$120.90 
ST. JOSEPH'S HOSPITAL - BREESE,30600528,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$105.00 ,$68.25 ,$5.14 ,$105.00 ,$89.25 ,$62.69 ,$8.09 ,$60.38 ,$8.09 ,$72.35 ,$89.25 ,$89.25 ,$89.25 ,$86.10 ,$71.40 ,$8.09 ,$8.09 ,$78.75 ,$74.55 ,$74.55 ,$8.09 ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A ,$20.23 ,$89.25 ,$8.09 ,$105.00 ,$5.14 ,$5.14 ,$89.25 ,$16.99 ,$89.25 ,$94.50 ,$8.09 ,$87.15 ,$83.48 ,$83.48 ,$8.09 ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,30600529,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL -90,306,1 ,$72.00 ,$46.80 ,$5.14 ,$72.00 ,$61.20 ,$42.98 ,$7.71 ,$41.40 ,$7.71 ,$49.61 ,$61.20 ,$61.20 ,$61.20 ,$59.04 ,$48.96 ,$7.71 ,$7.71 ,$54.00 ,$51.12 ,$51.12 ,$7.71 ,$51.12 ,$59.76 ,$59.76 ,$59.76 , N/A ,$19.28 ,$61.20 ,$7.71 ,$72.00 ,$5.14 ,$5.14 ,$61.20 ,$16.19 ,$61.20 ,$64.80 ,$7.71 ,$59.76 ,$57.24 ,$57.24 ,$7.71 ,$46.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600531,87102,HC CULTURE FUNGUS OTHER,306,1 ,$224.00 ,$145.60 ,$5.14 ,$224.00 ,$190.40 ,$133.73 ,$8.41 ,$128.80 ,$8.41 ,$154.34 ,$190.40 ,$190.40 ,$190.40 ,$183.68 ,$152.32 ,$8.41 ,$8.41 ,$168.00 ,$159.04 ,$159.04 ,$8.41 ,$159.04 ,$185.92 ,$185.92 ,$185.92 , N/A ,$21.03 ,$190.40 ,$8.41 ,$224.00 ,$5.14 ,$5.14 ,$190.40 ,$17.66 ,$190.40 ,$201.60 ,$8.41 ,$185.92 ,$178.08 ,$178.08 ,$8.41 ,$145.60 
ST. JOSEPH'S HOSPITAL - BREESE,30600533,87106,HC CULTURE FUNGUS ID YEAST,306,1 ,$175.00 ,$113.75 ,$5.14 ,$175.00 ,$148.75 ,$104.48 ,$10.32 ,$100.63 ,$10.32 ,$120.58 ,$148.75 ,$148.75 ,$148.75 ,$143.50 ,$119.00 ,$10.32 ,$10.32 ,$131.25 ,$124.25 ,$124.25 ,$10.32 ,$124.25 ,$145.25 ,$145.25 ,$145.25 , N/A ,$25.80 ,$148.75 ,$10.32 ,$175.00 ,$5.14 ,$5.14 ,$148.75 ,$21.67 ,$148.75 ,$157.50 ,$10.32 ,$145.25 ,$139.13 ,$139.13 ,$10.32 ,$113.75 
ST. JOSEPH'S HOSPITAL - BREESE,30600536,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$187.00 ,$121.55 ,$5.14 ,$187.00 ,$158.95 ,$111.64 ,$5.18 ,$107.53 ,$5.18 ,$128.84 ,$158.95 ,$158.95 ,$158.95 ,$153.34 ,$127.16 ,$5.18 ,$5.18 ,$140.25 ,$132.77 ,$132.77 ,$5.18 ,$132.77 ,$155.21 ,$155.21 ,$155.21 , N/A ,$12.95 ,$158.95 ,$5.18 ,$187.00 ,$5.14 ,$5.14 ,$158.95 ,$10.88 ,$158.95 ,$168.30 ,$5.18 ,$155.21 ,$148.67 ,$148.67 ,$5.18 ,$121.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600537,87149,HC CULTURE TYPING ID NUCLEIC ACID,306,1 ,$82.00 ,$53.30 ,$5.14 ,$82.00 ,$69.70 ,$48.95 ,$20.05 ,$47.15 ,$20.05 ,$56.50 ,$69.70 ,$69.70 ,$69.70 ,$67.24 ,$55.76 ,$20.05 ,$20.05 ,$61.50 ,$58.22 ,$58.22 ,$20.05 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$50.13 ,$69.70 ,$20.05 ,$82.00 ,$5.14 ,$5.14 ,$69.70 ,$42.11 ,$69.70 ,$73.80 ,$20.05 ,$68.06 ,$65.19 ,$65.19 ,$20.05 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600541,87172,HC PINWORM EXAM,306,1 ,$70.00 ,$45.50 ,$4.27 ,$70.00 ,$59.50 ,$41.79 ,$4.27 ,$40.25 ,$4.27 ,$48.23 ,$59.50 ,$59.50 ,$59.50 ,$57.40 ,$47.60 ,$4.27 ,$4.27 ,$52.50 ,$49.70 ,$49.70 ,$4.27 ,$49.70 ,$58.10 ,$58.10 ,$58.10 , N/A ,$10.68 ,$59.50 ,$4.27 ,$70.00 ,$5.14 ,$5.14 ,$59.50 ,$8.97 ,$59.50 ,$63.00 ,$4.27 ,$58.10 ,$55.65 ,$55.65 ,$4.27 ,$45.50 
ST. JOSEPH'S HOSPITAL - BREESE,30600542,87176,HC HOMOGENIZATION TISSUE,306,1 ,$80.00 ,$52.00 ,$5.14 ,$80.00 ,$68.00 ,$47.76 ,$5.88 ,$46.00 ,$5.88 ,$55.12 ,$68.00 ,$68.00 ,$68.00 ,$65.60 ,$54.40 ,$5.88 ,$5.88 ,$60.00 ,$56.80 ,$56.80 ,$5.88 ,$56.80 ,$66.40 ,$66.40 ,$66.40 , N/A ,$14.70 ,$68.00 ,$5.88 ,$80.00 ,$5.14 ,$5.14 ,$68.00 ,$12.35 ,$68.00 ,$72.00 ,$5.88 ,$66.40 ,$63.60 ,$63.60 ,$5.88 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600544,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$29.00 ,$18.85 ,$4.75 ,$29.00 ,$24.65 ,$17.31 ,$4.75 ,$16.68 ,$4.75 ,$19.98 ,$24.65 ,$24.65 ,$24.65 ,$23.78 ,$19.72 ,$4.75 ,$4.75 ,$21.75 ,$20.59 ,$20.59 ,$4.75 ,$20.59 ,$24.07 ,$24.07 ,$24.07 , N/A ,$11.88 ,$24.65 ,$4.75 ,$29.00 ,$5.14 ,$5.14 ,$24.65 ,$9.98 ,$24.65 ,$26.10 ,$4.75 ,$24.07 ,$23.06 ,$23.06 ,$4.75 ,$18.85 
ST. JOSEPH'S HOSPITAL - BREESE,30600545,87184,HC SENSITIVITY DISK KB,306,1 ,$102.00 ,$66.30 ,$5.14 ,$102.00 ,$86.70 ,$60.89 ,$7.48 ,$58.65 ,$7.48 ,$70.28 ,$86.70 ,$86.70 ,$86.70 ,$83.64 ,$69.36 ,$7.48 ,$7.48 ,$76.50 ,$72.42 ,$72.42 ,$7.48 ,$72.42 ,$84.66 ,$84.66 ,$84.66 , N/A ,$18.70 ,$86.70 ,$7.48 ,$102.00 ,$5.14 ,$5.14 ,$86.70 ,$15.71 ,$86.70 ,$91.80 ,$7.48 ,$84.66 ,$81.09 ,$81.09 ,$7.48 ,$66.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600546,87185,HC BETA LACTAMASE,306,1 ,$20.00 ,$13.00 ,$4.75 ,$20.00 ,$17.00 ,$11.94 ,$4.75 ,$11.50 ,$4.75 ,$13.78 ,$17.00 ,$17.00 ,$17.00 ,$16.40 ,$13.60 ,$4.75 ,$4.75 ,$15.00 ,$14.20 ,$14.20 ,$4.75 ,$14.20 ,$16.60 ,$16.60 ,$16.60 , N/A ,$11.88 ,$17.00 ,$4.75 ,$20.00 ,$5.14 ,$5.14 ,$17.00 ,$9.98 ,$17.00 ,$18.00 ,$4.75 ,$16.60 ,$15.90 ,$15.90 ,$4.75 ,$13.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600547,87186,HC SENSITIVITY MIC,306,1 ,$207.00 ,$134.55 ,$5.14 ,$207.00 ,$175.95 ,$123.58 ,$8.65 ,$119.03 ,$8.65 ,$142.62 ,$175.95 ,$175.95 ,$175.95 ,$169.74 ,$140.76 ,$8.65 ,$8.65 ,$155.25 ,$146.97 ,$146.97 ,$8.65 ,$146.97 ,$171.81 ,$171.81 ,$171.81 , N/A ,$21.63 ,$175.95 ,$8.65 ,$207.00 ,$5.14 ,$5.14 ,$175.95 ,$18.17 ,$175.95 ,$186.30 ,$8.65 ,$171.81 ,$164.57 ,$164.57 ,$8.65 ,$134.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600551,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$98.00 ,$63.70 ,$4.27 ,$98.00 ,$83.30 ,$58.51 ,$4.27 ,$56.35 ,$4.27 ,$67.52 ,$83.30 ,$83.30 ,$83.30 ,$80.36 ,$66.64 ,$4.27 ,$4.27 ,$73.50 ,$69.58 ,$69.58 ,$4.27 ,$69.58 ,$81.34 ,$81.34 ,$81.34 , N/A ,$10.68 ,$83.30 ,$4.27 ,$98.00 ,$5.14 ,$5.14 ,$83.30 ,$8.97 ,$83.30 ,$88.20 ,$4.27 ,$81.34 ,$77.91 ,$77.91 ,$4.27 ,$63.70 
ST. JOSEPH'S HOSPITAL - BREESE,30600552,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$85.00 ,$55.25 ,$5.14 ,$85.00 ,$72.25 ,$50.75 ,$5.39 ,$48.88 ,$5.39 ,$58.57 ,$72.25 ,$72.25 ,$72.25 ,$69.70 ,$57.80 ,$5.39 ,$5.39 ,$63.75 ,$60.35 ,$60.35 ,$5.39 ,$60.35 ,$70.55 ,$70.55 ,$70.55 , N/A ,$13.48 ,$72.25 ,$5.39 ,$85.00 ,$5.14 ,$5.14 ,$72.25 ,$11.32 ,$72.25 ,$76.50 ,$5.39 ,$70.55 ,$67.58 ,$67.58 ,$5.39 ,$55.25 
ST. JOSEPH'S HOSPITAL - BREESE,30600555,87255,HC VIRUS ID NON-IMMUNOLOGIC OTHER THAN CYTOPATHIC-90,306,1 ,$157.00 ,$102.05 ,$17.08 ,$157.00 ,$133.45 ,$93.73 ,$33.86 ,$90.28 ,$33.86 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$33.86 ,$33.86 ,$117.75 ,$111.47 ,$111.47 ,$33.86 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$84.65 ,$133.45 ,$33.86 ,$157.00 ,$17.08 ,$17.08 ,$133.45 ,$71.11 ,$133.45 ,$141.30 ,$33.86 ,$130.31 ,$124.82 ,$124.82 ,$33.86 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,30600556,87327,HC EIA QL CRYPTOCOCCUS AG,306,1 ,$125.00 ,$81.25 ,$6.45 ,$125.00 ,$106.25 ,$74.63 ,$13.42 ,$71.88 ,$13.42 ,$86.13 ,$106.25 ,$106.25 ,$106.25 ,$102.50 ,$85.00 ,$13.42 ,$13.42 ,$93.75 ,$88.75 ,$88.75 ,$13.42 ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A ,$33.55 ,$106.25 ,$13.42 ,$125.00 ,$6.45 ,$6.45 ,$106.25 ,$28.18 ,$106.25 ,$112.50 ,$13.42 ,$103.75 ,$99.38 ,$99.38 ,$13.42 ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,30600557,87329,HC EIA QL GIARDIA AG,306,1 ,$144.00 ,$93.60 ,$6.45 ,$144.00 ,$122.40 ,$85.97 ,$11.98 ,$82.80 ,$11.98 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$11.98 ,$11.98 ,$108.00 ,$102.24 ,$102.24 ,$11.98 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$29.95 ,$122.40 ,$11.98 ,$144.00 ,$6.45 ,$6.45 ,$122.40 ,$25.16 ,$122.40 ,$129.60 ,$11.98 ,$119.52 ,$114.48 ,$114.48 ,$11.98 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,30600559,87340,HC EIA QL HEPATITIS B AG,306,1 ,$197.00 ,$128.05 ,$6.45 ,$197.00 ,$167.45 ,$117.61 ,$10.33 ,$113.28 ,$10.33 ,$135.73 ,$167.45 ,$167.45 ,$167.45 ,$161.54 ,$133.96 ,$10.33 ,$10.33 ,$147.75 ,$139.87 ,$139.87 ,$10.33 ,$139.87 ,$163.51 ,$163.51 ,$163.51 , N/A ,$25.83 ,$167.45 ,$10.33 ,$197.00 ,$6.45 ,$6.45 ,$167.45 ,$21.69 ,$167.45 ,$177.30 ,$10.33 ,$163.51 ,$156.62 ,$156.62 ,$10.33 ,$128.05 
ST. JOSEPH'S HOSPITAL - BREESE,30600560,87341,HC EIA QL HEPATITIS B AG NEUT,306,1 ,$185.00 ,$120.25 ,$6.45 ,$185.00 ,$157.25 ,$110.45 ,$10.33 ,$106.38 ,$10.33 ,$127.47 ,$157.25 ,$157.25 ,$157.25 ,$151.70 ,$125.80 ,$10.33 ,$10.33 ,$138.75 ,$131.35 ,$131.35 ,$10.33 ,$131.35 ,$153.55 ,$153.55 ,$153.55 , N/A ,$25.83 ,$157.25 ,$10.33 ,$185.00 ,$6.45 ,$6.45 ,$157.25 ,$21.69 ,$157.25 ,$166.50 ,$10.33 ,$153.55 ,$147.08 ,$147.08 ,$10.33 ,$120.25 
ST. JOSEPH'S HOSPITAL - BREESE,30600561,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$202.00 ,$131.30 ,$6.45 ,$202.00 ,$171.70 ,$120.59 ,$24.08 ,$116.15 ,$24.08 ,$139.18 ,$171.70 ,$171.70 ,$171.70 ,$165.64 ,$137.36 ,$24.08 ,$24.08 ,$151.50 ,$143.42 ,$143.42 ,$24.08 ,$143.42 ,$167.66 ,$167.66 ,$167.66 , N/A ,$60.20 ,$171.70 ,$24.08 ,$202.00 ,$6.45 ,$6.45 ,$171.70 ,$50.57 ,$171.70 ,$181.80 ,$24.08 ,$167.66 ,$160.59 ,$160.59 ,$24.08 ,$131.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600562,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$323.00 ,$209.95 ,$6.45 ,$323.00 ,$274.55 ,$192.83 ,$11.98 ,$185.73 ,$11.98 ,$222.55 ,$274.55 ,$274.55 ,$274.55 ,$264.86 ,$219.64 ,$11.98 ,$11.98 ,$242.25 ,$229.33 ,$229.33 ,$11.98 ,$229.33 ,$268.09 ,$268.09 ,$268.09 , N/A ,$29.95 ,$274.55 ,$11.98 ,$323.00 ,$6.45 ,$6.45 ,$274.55 ,$25.16 ,$274.55 ,$290.70 ,$11.98 ,$268.09 ,$256.79 ,$256.79 ,$11.98 ,$209.95 
ST. JOSEPH'S HOSPITAL - BREESE,30600563,87427,HC SHIGELLA LIKE TOXIN AG,306,1 ,$152.00 ,$98.80 ,$6.45 ,$152.00 ,$129.20 ,$90.74 ,$11.98 ,$87.40 ,$11.98 ,$104.73 ,$129.20 ,$129.20 ,$129.20 ,$124.64 ,$103.36 ,$11.98 ,$11.98 ,$114.00 ,$107.92 ,$107.92 ,$11.98 ,$107.92 ,$126.16 ,$126.16 ,$126.16 , N/A ,$29.95 ,$129.20 ,$11.98 ,$152.00 ,$6.45 ,$6.45 ,$129.20 ,$25.16 ,$129.20 ,$136.80 ,$11.98 ,$126.16 ,$120.84 ,$120.84 ,$11.98 ,$98.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600568,87486,HC CHLAMYDIA PNEUM AMP PROBE,306,1 ,$105.00 ,$68.25 ,$17.08 ,$105.00 ,$89.25 ,$62.69 ,$35.09 ,$60.38 ,$35.09 ,$72.35 ,$89.25 ,$89.25 ,$89.25 ,$86.10 ,$71.40 ,$35.09 ,$35.09 ,$78.75 ,$74.55 ,$74.55 ,$35.09 ,$74.55 ,$87.15 ,$87.15 ,$87.15 , N/A ,$87.73 ,$89.25 ,$35.09 ,$105.00 ,$17.08 ,$17.08 ,$89.25 ,$73.69 ,$89.25 ,$94.50 ,$35.09 ,$87.15 ,$83.48 ,$83.48 ,$35.09 ,$68.25 
ST. JOSEPH'S HOSPITAL - BREESE,30600570,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$132.00 ,$85.80 ,$6.45 ,$132.00 ,$112.20 ,$78.80 ,$35.09 ,$75.90 ,$35.09 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$35.09 ,$35.09 ,$99.00 ,$93.72 ,$93.72 ,$35.09 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$87.73 ,$112.20 ,$35.09 ,$132.00 ,$6.45 ,$6.45 ,$112.20 ,$73.69 ,$112.20 ,$118.80 ,$35.09 ,$109.56 ,$104.94 ,$104.94 ,$35.09 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600573,87581,HC IF AG PROBE MYCOPLASMA PNEUMONIAE,306,1 ,$462.00 ,$300.30 ,$17.08 ,$462.00 ,$392.70 ,$275.81 ,$35.09 ,$265.65 ,$35.09 ,$318.32 ,$392.70 ,$392.70 ,$392.70 ,$378.84 ,$314.16 ,$35.09 ,$35.09 ,$346.50 ,$328.02 ,$328.02 ,$35.09 ,$328.02 ,$383.46 ,$383.46 ,$383.46 , N/A ,$87.73 ,$392.70 ,$35.09 ,$462.00 ,$17.08 ,$17.08 ,$392.70 ,$73.69 ,$392.70 ,$415.80 ,$35.09 ,$383.46 ,$367.29 ,$367.29 ,$35.09 ,$300.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600575,87591,HC NEISSERIA AMP,306,1 ,$132.00 ,$85.80 ,$17.08 ,$132.00 ,$112.20 ,$78.80 ,$35.09 ,$75.90 ,$35.09 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$35.09 ,$35.09 ,$99.00 ,$93.72 ,$93.72 ,$35.09 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$87.73 ,$112.20 ,$35.09 ,$132.00 ,$17.08 ,$17.08 ,$112.20 ,$73.69 ,$112.20 ,$118.80 ,$35.09 ,$109.56 ,$104.94 ,$104.94 ,$35.09 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,30600577,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,"$1,250.00 ",$812.50 ,$17.08 ,"$1,250.00 ","$1,062.50 ",$746.25 ,$416.78 ,$718.75 ,$416.78 ,$861.25 ,"$1,062.50 ","$1,062.50 ","$1,062.50 ","$1,025.00 ",$850.00 ,$416.78 ,$416.78 ,$937.50 ,$887.50 ,$887.50 ,$416.78 ,$887.50 ,"$1,037.50 ","$1,037.50 ","$1,037.50 ", N/A ,"$1,041.95 ","$1,062.50 ",$416.78 ,"$1,250.00 ",$17.08 ,$17.08 ,"$1,062.50 ",$875.24 ,"$1,062.50 ","$1,125.00 ",$416.78 ,"$1,037.50 ",$993.75 ,$993.75 ,$416.78 ,$812.50 
ST. JOSEPH'S HOSPITAL - BREESE,30600581,87798,HC INFECT AMP,306,1 ,$442.00 ,$287.30 ,$17.08 ,$442.00 ,$375.70 ,$263.87 ,$35.09 ,$254.15 ,$35.09 ,$304.54 ,$375.70 ,$375.70 ,$375.70 ,$362.44 ,$300.56 ,$35.09 ,$35.09 ,$331.50 ,$313.82 ,$313.82 ,$35.09 ,$313.82 ,$366.86 ,$366.86 ,$366.86 , N/A ,$87.73 ,$375.70 ,$35.09 ,$442.00 ,$17.08 ,$17.08 ,$375.70 ,$73.69 ,$375.70 ,$397.80 ,$35.09 ,$366.86 ,$351.39 ,$351.39 ,$35.09 ,$287.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600583,87808,HC TRICHOMONAS VAGINITIS OPTICAL,306,1 ,$167.00 ,$108.55 ,$5.14 ,$167.00 ,$141.95 ,$99.70 ,$15.29 ,$96.03 ,$15.29 ,$115.06 ,$141.95 ,$141.95 ,$141.95 ,$136.94 ,$113.56 ,$15.29 ,$15.29 ,$125.25 ,$118.57 ,$118.57 ,$15.29 ,$118.57 ,$138.61 ,$138.61 ,$138.61 , N/A ,$38.23 ,$141.95 ,$15.29 ,$167.00 ,$5.14 ,$5.14 ,$141.95 ,$32.11 ,$141.95 ,$150.30 ,$15.29 ,$138.61 ,$132.77 ,$132.77 ,$15.29 ,$108.55 
ST. JOSEPH'S HOSPITAL - BREESE,30600590,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$122.00 ,$79.30 ,$6.45 ,$122.00 ,$103.70 ,$72.83 ,$13.82 ,$70.15 ,$13.82 ,$84.06 ,$103.70 ,$103.70 ,$103.70 ,$100.04 ,$82.96 ,$13.82 ,$13.82 ,$91.50 ,$86.62 ,$86.62 ,$13.82 ,$86.62 ,$101.26 ,$101.26 ,$101.26 , N/A ,$34.55 ,$103.70 ,$13.82 ,$122.00 ,$6.45 ,$6.45 ,$103.70 ,$29.02 ,$103.70 ,$109.80 ,$13.82 ,$101.26 ,$96.99 ,$96.99 ,$13.82 ,$79.30 
ST. JOSEPH'S HOSPITAL - BREESE,30600593,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$377.00 ,$245.05 ,$5.14 ,$377.00 ,$320.45 ,$225.07 ,$16.07 ,$216.78 ,$16.07 ,$259.75 ,$320.45 ,$320.45 ,$320.45 ,$309.14 ,$256.36 ,$16.07 ,$16.07 ,$282.75 ,$267.67 ,$267.67 ,$16.07 ,$267.67 ,$312.91 ,$312.91 ,$312.91 , N/A ,$40.18 ,$320.45 ,$16.07 ,$377.00 ,$5.14 ,$5.14 ,$320.45 ,$33.75 ,$320.45 ,$339.30 ,$16.07 ,$312.91 ,$299.72 ,$299.72 ,$16.07 ,$245.05 
ST. JOSEPH'S HOSPITAL - BREESE,30600607,87661,HC TRICHOMONAS BAG AMP PROBE,306,1 ,$28.88 ,$18.77 ,$16.61 ,$60.65 ,$24.55 ,$17.24 ,$28.88 ,$16.61 ,$28.88 ,$19.90 ,$24.55 ,$24.55 ,$24.55 ,$23.68 ,$19.64 ,$28.88 ,$28.88 ,$21.66 ,$20.50 ,$20.50 ,$28.88 ,$20.50 ,$23.97 ,$23.97 ,$23.97 , N/A ,$28.88 ,$24.55 ,$28.88 ,$28.88 ,$17.08 ,$17.08 ,$24.55 ,$60.65 ,$24.55 ,$25.99 ,$28.88 ,$23.97 ,$22.96 ,$22.96 ,$28.88 ,$18.77 
ST. JOSEPH'S HOSPITAL - BREESE,30600610,87632,HC RESP VIRUS AMP 6-11 TARGETS-90,306,1 ,"$2,011.00 ","$1,307.15 ",$17.08 ,"$2,011.00 ","$1,709.35 ","$1,200.57 ",$218.06 ,"$1,156.33 ",$218.06 ,"$1,385.58 ","$1,709.35 ","$1,709.35 ","$1,709.35 ","$1,649.02 ","$1,367.48 ",$218.06 ,$218.06 ,"$1,508.25 ","$1,427.81 ","$1,427.81 ",$218.06 ,"$1,427.81 ","$1,669.13 ","$1,669.13 ","$1,669.13 ", N/A ,$545.15 ,"$1,709.35 ",$218.06 ,"$2,011.00 ",$17.08 ,$17.08 ,"$1,709.35 ",$457.93 ,"$1,709.35 ","$1,809.90 ",$218.06 ,"$1,669.13 ","$1,598.75 ","$1,598.75 ",$218.06 ,"$1,307.15 "
ST. JOSEPH'S HOSPITAL - BREESE,30600611,87512,HC G VAGINALIS DNA SCREEN QN-90,306,1 ,$484.00 ,$314.60 ,$17.08 ,$484.00 ,$411.40 ,$288.95 ,$41.76 ,$278.30 ,$41.76 ,$333.48 ,$411.40 ,$411.40 ,$411.40 ,$396.88 ,$329.12 ,$41.76 ,$41.76 ,$363.00 ,$343.64 ,$343.64 ,$41.76 ,$343.64 ,$401.72 ,$401.72 ,$401.72 , N/A ,$104.40 ,$411.40 ,$41.76 ,$484.00 ,$17.08 ,$17.08 ,$411.40 ,$87.70 ,$411.40 ,$435.60 ,$41.76 ,$401.72 ,$384.78 ,$384.78 ,$41.76 ,$314.60 
ST. JOSEPH'S HOSPITAL - BREESE,30600614,87220,HC TISSUE KOH PREP,306,1 ,$61.00 ,$39.65 ,$4.27 ,$61.00 ,$51.85 ,$36.42 ,$4.27 ,$35.08 ,$4.27 ,$42.03 ,$51.85 ,$51.85 ,$51.85 ,$50.02 ,$41.48 ,$4.27 ,$4.27 ,$45.75 ,$43.31 ,$43.31 ,$4.27 ,$43.31 ,$50.63 ,$50.63 ,$50.63 , N/A ,$10.68 ,$51.85 ,$4.27 ,$61.00 ,$5.14 ,$5.14 ,$51.85 ,$8.97 ,$51.85 ,$54.90 ,$4.27 ,$50.63 ,$48.50 ,$48.50 ,$4.27 ,$39.65 
ST. JOSEPH'S HOSPITAL - BREESE,30600619,87481,HC CANDIDA SPECIES DNA/RNA AMP PROBE TECH-90,306,1 ,$220.00 ,$143.00 ,$6.45 ,$220.00 ,$187.00 ,$131.34 ,$35.09 ,$126.50 ,$35.09 ,$151.58 ,$187.00 ,$187.00 ,$187.00 ,$180.40 ,$149.60 ,$35.09 ,$35.09 ,$165.00 ,$156.20 ,$156.20 ,$35.09 ,$156.20 ,$182.60 ,$182.60 ,$182.60 , N/A ,$87.73 ,$187.00 ,$35.09 ,$220.00 ,$6.45 ,$6.45 ,$187.00 ,$73.69 ,$187.00 ,$198.00 ,$35.09 ,$182.60 ,$174.90 ,$174.90 ,$35.09 ,$143.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600623,87635,HC COVID-19 LAB TEST CDC-90,306,1 ,$398.00 ,$258.70 ,$17.08 ,$398.00 ,$338.30 ,$237.61 ,$51.31 ,$228.85 ,$51.31 ,$274.22 ,$338.30 ,$338.30 ,$338.30 ,$326.36 ,$270.64 ,$51.31 ,$51.31 ,$298.50 ,$282.58 ,$282.58 ,$51.31 ,$282.58 ,$330.34 ,$330.34 ,$330.34 , N/A ,$128.28 ,$338.30 ,$51.31 ,$398.00 ,$17.08 ,$17.08 ,$338.30 ,$107.75 ,$338.30 ,$358.20 ,$51.31 ,$330.34 ,$316.41 ,$316.41 ,$51.31 ,$258.70 
ST. JOSEPH'S HOSPITAL - BREESE,30682010,87635,HC COVID-19 LAB TEST NON-CDC-90,306,1 ,$398.00 ,$258.70 ,$17.08 ,$398.00 ,$338.30 ,$237.61 ,$51.31 ,$228.85 ,$51.31 ,$274.22 ,$338.30 ,$338.30 ,$338.30 ,$326.36 ,$270.64 ,$51.31 ,$51.31 ,$298.50 ,$282.58 ,$282.58 ,$51.31 ,$282.58 ,$330.34 ,$330.34 ,$330.34 , N/A ,$128.28 ,$338.30 ,$51.31 ,$398.00 ,$17.08 ,$17.08 ,$338.30 ,$107.75 ,$338.30 ,$358.20 ,$51.31 ,$330.34 ,$316.41 ,$316.41 ,$51.31 ,$258.70 
ST. JOSEPH'S HOSPITAL - BREESE,30682012,87635,HC COVID-19 LAB TEST,306,1 ,$398.00 ,$258.70 ,$17.08 ,$398.00 ,$338.30 ,$237.61 ,$51.31 ,$228.85 ,$51.31 ,$274.22 ,$338.30 ,$338.30 ,$338.30 ,$326.36 ,$270.64 ,$51.31 ,$51.31 ,$298.50 ,$282.58 ,$282.58 ,$51.31 ,$282.58 ,$330.34 ,$330.34 ,$330.34 , N/A ,$128.28 ,$338.30 ,$51.31 ,$398.00 ,$17.08 ,$17.08 ,$338.30 ,$107.75 ,$338.30 ,$358.20 ,$51.31 ,$330.34 ,$316.41 ,$316.41 ,$51.31 ,$258.70 
ST. JOSEPH'S HOSPITAL - BREESE,30682015,86769,HC SARS-COV-2 COVID-19 ANTIBODY-90,306,1 ,$130.00 ,$84.50 ,$6.45 ,$130.00 ,$110.50 ,$77.61 ,$42.13 ,$74.75 ,$42.13 ,$89.57 ,$110.50 ,$110.50 ,$110.50 ,$106.60 ,$88.40 ,$42.13 ,$42.13 ,$97.50 ,$92.30 ,$92.30 ,$42.13 ,$92.30 ,$107.90 ,$107.90 ,$107.90 , N/A ,$105.33 ,$110.50 ,$42.13 ,$130.00 ,$6.45 ,$6.45 ,$110.50 ,$88.47 ,$110.50 ,$117.00 ,$42.13 ,$107.90 ,$103.35 ,$103.35 ,$42.13 ,$84.50 
ST. JOSEPH'S HOSPITAL - BREESE,30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$133.00 ,$86.45 ,$2.57 ,$133.00 ,$113.05 ,$79.40 ,$3.17 ,$76.48 ,$3.17 ,$91.64 ,$113.05 ,$113.05 ,$113.05 ,$109.06 ,$90.44 ,$3.17 ,$3.17 ,$99.75 ,$94.43 ,$94.43 ,$3.17 ,$94.43 ,$110.39 ,$110.39 ,$110.39 , N/A ,$7.93 ,$113.05 ,$3.17 ,$3.17 ,$2.57 ,$2.57 ,$113.05 ,$6.66 ,$113.05 ,$119.70 ,$3.17 ,$110.39 ,$105.74 ,$105.74 ,$3.17 ,$86.45 
ST. JOSEPH'S HOSPITAL - BREESE,30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$61.00 ,$39.65 ,$1.62 ,$61.00 ,$51.85 ,$36.42 ,$2.25 ,$35.08 ,$2.25 ,$42.03 ,$51.85 ,$51.85 ,$51.85 ,$50.02 ,$41.48 ,$2.25 ,$2.25 ,$45.75 ,$43.31 ,$43.31 ,$2.25 ,$43.31 ,$50.63 ,$50.63 ,$50.63 , N/A ,$5.63 ,$51.85 ,$2.25 ,$61.00 ,$1.62 ,$1.62 ,$51.85 ,$4.73 ,$51.85 ,$54.90 ,$2.25 ,$50.63 ,$48.50 ,$48.50 ,$2.25 ,$39.65 
ST. JOSEPH'S HOSPITAL - BREESE,30700115,81015,HC URINALYSIS MICRO ONLY,307,1 ,$46.00 ,$29.90 ,$2.57 ,$46.00 ,$39.10 ,$27.46 ,$3.05 ,$26.45 ,$3.05 ,$31.69 ,$39.10 ,$39.10 ,$39.10 ,$37.72 ,$31.28 ,$3.05 ,$3.05 ,$34.50 ,$32.66 ,$32.66 ,$3.05 ,$32.66 ,$38.18 ,$38.18 ,$38.18 , N/A ,$7.63 ,$39.10 ,$3.05 ,$46.00 ,$2.57 ,$2.57 ,$39.10 ,$6.41 ,$39.10 ,$41.40 ,$3.05 ,$38.18 ,$36.57 ,$36.57 ,$3.05 ,$29.90 
ST. JOSEPH'S HOSPITAL - BREESE,30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$122.00 ,$79.30 ,$2.57 ,$122.00 ,$103.70 ,$72.83 ,$8.61 ,$70.15 ,$8.61 ,$84.06 ,$103.70 ,$103.70 ,$103.70 ,$100.04 ,$82.96 ,$8.61 ,$8.61 ,$91.50 ,$86.62 ,$86.62 ,$8.61 ,$86.62 ,$101.26 ,$101.26 ,$101.26 , N/A ,$21.53 ,$103.70 ,$8.61 ,$8.61 ,$2.57 ,$2.57 ,$103.70 ,$18.08 ,$103.70 ,$109.80 ,$8.61 ,$101.26 ,$96.99 ,$96.99 ,$8.61 ,$79.30 
ST. JOSEPH'S HOSPITAL - BREESE,30700117,81050,HC VOLUME MEASUREMENT URINE,307,1 ,$34.00 ,$22.10 ,$2.57 ,$34.00 ,$28.90 ,$20.30 ,$3.64 ,$19.55 ,$3.64 ,$23.43 ,$28.90 ,$28.90 ,$28.90 ,$27.88 ,$23.12 ,$3.64 ,$3.64 ,$25.50 ,$24.14 ,$24.14 ,$3.64 ,$24.14 ,$28.22 ,$28.22 ,$28.22 , N/A ,$9.10 ,$28.90 ,$3.64 ,$34.00 ,$2.57 ,$2.57 ,$28.90 ,$7.64 ,$28.90 ,$30.60 ,$3.64 ,$28.22 ,$27.03 ,$27.03 ,$3.64 ,$22.10 
ST. JOSEPH'S HOSPITAL - BREESE,31000128,81162,HC BRCA1  AND  BRCA2 FULL SEQ/DUPE/DEL ANALYSIS -90,310,1 ,"$3,792.60 ","$2,465.19 ",$236.00 ,"$3,832.25 ","$3,223.71 ","$2,264.18 ","$1,824.88 ","$2,180.75 ","$1,824.88 ","$2,613.10 ","$3,223.71 ","$3,223.71 ","$3,223.71 ","$3,109.93 ","$2,578.97 ","$1,824.88 ","$1,824.88 ","$2,844.45 ","$2,692.75 ","$2,692.75 ","$1,824.88 ","$2,692.75 ","$3,147.86 ","$3,147.86 ","$3,147.86 ", N/A ,"$3,792.60 ","$3,223.71 ","$1,824.88 ","$3,792.60 ",$236.00 ,$236.00 ,"$3,223.71 ","$3,832.25 ","$3,223.71 ","$3,413.34 ","$1,824.88 ","$3,147.86 ","$3,015.12 ","$3,015.12 ","$1,824.88 ","$2,465.19 "
ST. JOSEPH'S HOSPITAL - BREESE,31000129,81206,HC BCR/ABL1 GENE MAJOR BP QL/QN DIAG -90,310,1 ,$263.00 ,$170.95 ,$83.16 ,$344.32 ,$223.55 ,$157.01 ,$163.96 ,$151.23 ,$163.96 ,$181.21 ,$223.55 ,$223.55 ,$223.55 ,$215.66 ,$178.84 ,$163.96 ,$163.96 ,$197.25 ,$186.73 ,$186.73 ,$163.96 ,$186.73 ,$218.29 ,$218.29 ,$218.29 , N/A ,$263.00 ,$223.55 ,$163.96 ,$263.00 ,$83.16 ,$83.16 ,$223.55 ,$344.32 ,$223.55 ,$236.70 ,$163.96 ,$218.29 ,$209.09 ,$209.09 ,$163.96 ,$170.95 
ST. JOSEPH'S HOSPITAL - BREESE,31000131,81207,HC BCR/ABL1 GENE MINOR BP DIAG -90,310,1 ,$263.00 ,$170.95 ,$83.16 ,$304.16 ,$223.55 ,$157.01 ,$144.84 ,$151.23 ,$144.84 ,$181.21 ,$223.55 ,$223.55 ,$223.55 ,$215.66 ,$178.84 ,$144.84 ,$144.84 ,$197.25 ,$186.73 ,$186.73 ,$144.84 ,$186.73 ,$218.29 ,$218.29 ,$218.29 , N/A ,$263.00 ,$223.55 ,$144.84 ,$263.00 ,$83.16 ,$83.16 ,$223.55 ,$304.16 ,$223.55 ,$236.70 ,$144.84 ,$218.29 ,$209.09 ,$209.09 ,$144.84 ,$170.95 
ST. JOSEPH'S HOSPITAL - BREESE,31000134,81210,HC BRAF GENE ANALYS V600E VAR-90,310,1 ,$374.00 ,$243.10 ,$83.16 ,$374.00 ,$317.90 ,$223.28 ,$175.40 ,$215.05 ,$175.40 ,$257.69 ,$317.90 ,$317.90 ,$317.90 ,$306.68 ,$254.32 ,$175.40 ,$175.40 ,$280.50 ,$265.54 ,$265.54 ,$175.40 ,$265.54 ,$310.42 ,$310.42 ,$310.42 , N/A ,$374.00 ,$317.90 ,$175.40 ,$374.00 ,$83.16 ,$83.16 ,$317.90 ,$368.34 ,$317.90 ,$336.60 ,$175.40 ,$310.42 ,$297.33 ,$297.33 ,$175.40 ,$243.10 
ST. JOSEPH'S HOSPITAL - BREESE,31000137,81220,HC CYSTIC FIBROSIS GENE COMMON VARIANTS -90,310,1 ,$296.00 ,$192.40 ,$25.54 ,$621.60 ,$251.60 ,$176.71 ,$296.00 ,$170.20 ,$296.00 ,$203.94 ,$251.60 ,$251.60 ,$251.60 ,$242.72 ,$201.28 ,$296.00 ,$296.00 ,$222.00 ,$210.16 ,$210.16 ,$296.00 ,$210.16 ,$245.68 ,$245.68 ,$245.68 , N/A ,$296.00 ,$251.60 ,$296.00 ,$296.00 ,$25.54 ,$25.54 ,$251.60 ,$621.60 ,$251.60 ,$266.40 ,$296.00 ,$245.68 ,$235.32 ,$235.32 ,$296.00 ,$192.40 
ST. JOSEPH'S HOSPITAL - BREESE,31000139,81229,HC CYTOGENOMIC MICROARRY ASSAY-90,310,1 ,"$1,090.00 ",$708.50 ,$236.00 ,"$2,289.00 ",$926.50 ,$650.73 ,"$1,090.00 ",$626.75 ,"$1,090.00 ",$751.01 ,$926.50 ,$926.50 ,$926.50 ,$893.80 ,$741.20 ,"$1,090.00 ","$1,090.00 ",$817.50 ,$773.90 ,$773.90 ,"$1,090.00 ",$773.90 ,$904.70 ,$904.70 ,$904.70 , N/A ,"$1,090.00 ",$926.50 ,"$1,090.00 ","$1,090.00 ",$236.00 ,$236.00 ,$926.50 ,"$2,289.00 ",$926.50 ,$981.00 ,"$1,090.00 ",$904.70 ,$866.55 ,$866.55 ,"$1,090.00 ",$708.50 
ST. JOSEPH'S HOSPITAL - BREESE,31000143,81240,HC F2 GENE ANAL 20210G A VAR -90,310,1 ,$430.00 ,$279.50 ,$25.54 ,$430.00 ,$365.50 ,$256.71 ,$65.69 ,$247.25 ,$65.69 ,$296.27 ,$365.50 ,$365.50 ,$365.50 ,$352.60 ,$292.40 ,$65.69 ,$65.69 ,$322.50 ,$305.30 ,$305.30 ,$65.69 ,$305.30 ,$356.90 ,$356.90 ,$356.90 , N/A ,$164.23 ,$365.50 ,$65.69 ,$430.00 ,$25.54 ,$25.54 ,$365.50 ,$137.95 ,$365.50 ,$387.00 ,$65.69 ,$356.90 ,$341.85 ,$341.85 ,$65.69 ,$279.50 
ST. JOSEPH'S HOSPITAL - BREESE,31000145,81241,HC F5 GENE ANAL LEIDEN VAR -90,310,1 ,$147.00 ,$95.55 ,$25.54 ,$154.08 ,$124.95 ,$87.76 ,$73.37 ,$84.53 ,$73.37 ,$101.28 ,$124.95 ,$124.95 ,$124.95 ,$120.54 ,$99.96 ,$73.37 ,$73.37 ,$110.25 ,$104.37 ,$104.37 ,$73.37 ,$104.37 ,$122.01 ,$122.01 ,$122.01 , N/A ,$147.00 ,$124.95 ,$73.37 ,$147.00 ,$25.54 ,$25.54 ,$124.95 ,$154.08 ,$124.95 ,$132.30 ,$73.37 ,$122.01 ,$116.87 ,$116.87 ,$73.37 ,$95.55 
ST. JOSEPH'S HOSPITAL - BREESE,31000146,81243,HC FMR1 GENE DETECTION -90,310,1 ,$377.00 ,$245.05 ,$25.54 ,$377.00 ,$320.45 ,$225.07 ,$113.10 ,$216.78 , N/A ,$259.75 ,$320.45 ,$320.45 ,$320.45 ,$309.14 ,$256.36 , N/A , N/A ,$282.75 ,$267.67 ,$267.67 , N/A ,$267.67 ,$312.91 ,$312.91 ,$312.91 , N/A , N/A ,$320.45 , N/A ,$377.00 ,$25.54 ,$25.54 ,$320.45 ,$226.20 ,$320.45 ,$339.30 , N/A ,$312.91 ,$299.72 ,$299.72 , N/A ,$245.05 
ST. JOSEPH'S HOSPITAL - BREESE,31000147,81244,HC FMR1 GENE CHARACTERIZATION - 90,310,1 ,$197.00 ,$128.05 ,$25.54 ,$197.00 ,$167.45 ,$117.61 ,$44.89 ,$113.28 ,$44.89 ,$135.73 ,$167.45 ,$167.45 ,$167.45 ,$161.54 ,$133.96 ,$44.89 ,$44.89 ,$147.75 ,$139.87 ,$139.87 ,$44.89 ,$139.87 ,$163.51 ,$163.51 ,$163.51 , N/A ,$112.23 ,$167.45 ,$44.89 ,$197.00 ,$25.54 ,$25.54 ,$167.45 ,$94.27 ,$167.45 ,$177.30 ,$44.89 ,$163.51 ,$156.62 ,$156.62 ,$44.89 ,$128.05 
ST. JOSEPH'S HOSPITAL - BREESE,31000149,81256,HC HFE GENE ANALYSIS -90,310,1 ,$377.00 ,$245.05 ,$25.54 ,$377.00 ,$320.45 ,$225.07 ,$65.36 ,$216.78 ,$65.36 ,$259.75 ,$320.45 ,$320.45 ,$320.45 ,$309.14 ,$256.36 ,$65.36 ,$65.36 ,$282.75 ,$267.67 ,$267.67 ,$65.36 ,$267.67 ,$312.91 ,$312.91 ,$312.91 , N/A ,$163.40 ,$320.45 ,$65.36 ,$377.00 ,$25.54 ,$25.54 ,$320.45 ,$137.26 ,$320.45 ,$339.30 ,$65.36 ,$312.91 ,$299.72 ,$299.72 ,$65.36 ,$245.05 
ST. JOSEPH'S HOSPITAL - BREESE,31000154,81270,HC JAK2 GENE ANALYSIS-90,310,1 ,$360.00 ,$234.00 ,$25.54 ,$360.00 ,$306.00 ,$214.92 ,$91.66 ,$207.00 ,$91.66 ,$248.04 ,$306.00 ,$306.00 ,$306.00 ,$295.20 ,$244.80 ,$91.66 ,$91.66 ,$270.00 ,$255.60 ,$255.60 ,$91.66 ,$255.60 ,$298.80 ,$298.80 ,$298.80 , N/A ,$229.15 ,$306.00 ,$91.66 ,$360.00 ,$25.54 ,$25.54 ,$306.00 ,$192.49 ,$306.00 ,$324.00 ,$91.66 ,$298.80 ,$286.20 ,$286.20 ,$91.66 ,$234.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000157,81291,HC MTHFR GENE ANALYSIS-90,310,1 ,$331.00 ,$215.15 ,$25.54 ,$331.00 ,$281.35 ,$197.61 ,$65.34 ,$190.33 ,$65.34 ,$228.06 ,$281.35 ,$281.35 ,$281.35 ,$271.42 ,$225.08 ,$65.34 ,$65.34 ,$248.25 ,$235.01 ,$235.01 ,$65.34 ,$235.01 ,$274.73 ,$274.73 ,$274.73 , N/A ,$163.35 ,$281.35 ,$65.34 ,$331.00 ,$25.54 ,$25.54 ,$281.35 ,$137.21 ,$281.35 ,$297.90 ,$65.34 ,$274.73 ,$263.15 ,$263.15 ,$65.34 ,$215.15 
ST. JOSEPH'S HOSPITAL - BREESE,31000163,81301,HC MICROSATELLITE INSTAB ANALYSIS-90,310,1 ,$912.00 ,$592.80 ,$83.16 ,$912.00 ,$775.20 ,$544.46 ,$348.56 ,$524.40 ,$348.56 ,$628.37 ,$775.20 ,$775.20 ,$775.20 ,$747.84 ,$620.16 ,$348.56 ,$348.56 ,$684.00 ,$647.52 ,$647.52 ,$348.56 ,$647.52 ,$756.96 ,$756.96 ,$756.96 , N/A ,$871.40 ,$775.20 ,$348.56 ,$912.00 ,$83.16 ,$83.16 ,$775.20 ,$731.98 ,$775.20 ,$820.80 ,$348.56 ,$756.96 ,$725.04 ,$725.04 ,$348.56 ,$592.80 
ST. JOSEPH'S HOSPITAL - BREESE,31000172,81340,HC TRB GENE ANALYSIS-90,310,1 ,"$1,047.00 ",$680.55 ,$83.16 ,"$1,047.00 ",$889.95 ,$625.06 ,$208.92 ,$602.03 ,$208.92 ,$721.38 ,$889.95 ,$889.95 ,$889.95 ,$858.54 ,$711.96 ,$208.92 ,$208.92 ,$785.25 ,$743.37 ,$743.37 ,$208.92 ,$743.37 ,$869.01 ,$869.01 ,$869.01 , N/A ,$522.30 ,$889.95 ,$208.92 ,"$1,047.00 ",$83.16 ,$83.16 ,$889.95 ,$438.73 ,$889.95 ,$942.30 ,$208.92 ,$869.01 ,$832.37 ,$832.37 ,$208.92 ,$680.55 
ST. JOSEPH'S HOSPITAL - BREESE,31000173,81342,HC TRB GENE ANALYSIS DIRECT PROBE-90,310,1 ,$561.00 ,$364.65 ,$83.16 ,$561.00 ,$476.85 ,$334.92 ,$201.50 ,$322.58 ,$201.50 ,$386.53 ,$476.85 ,$476.85 ,$476.85 ,$460.02 ,$381.48 ,$201.50 ,$201.50 ,$420.75 ,$398.31 ,$398.31 ,$201.50 ,$398.31 ,$465.63 ,$465.63 ,$465.63 , N/A ,$503.75 ,$476.85 ,$201.50 ,$561.00 ,$83.16 ,$83.16 ,$476.85 ,$423.15 ,$476.85 ,$504.90 ,$201.50 ,$465.63 ,$446.00 ,$446.00 ,$201.50 ,$364.65 
ST. JOSEPH'S HOSPITAL - BREESE,31000174,81372,HC CLASS 1 TYPING COMPLETE LOW RESOLUTION-90,310,1 ,$658.00 ,$427.70 ,$83.16 ,$847.54 ,$559.30 ,$392.83 ,$403.59 ,$378.35 ,$403.59 ,$453.36 ,$559.30 ,$559.30 ,$559.30 ,$539.56 ,$447.44 ,$403.59 ,$403.59 ,$493.50 ,$467.18 ,$467.18 ,$403.59 ,$467.18 ,$546.14 ,$546.14 ,$546.14 , N/A ,$658.00 ,$559.30 ,$403.59 ,$658.00 ,$83.16 ,$83.16 ,$559.30 ,$847.54 ,$559.30 ,$592.20 ,$403.59 ,$546.14 ,$523.11 ,$523.11 ,$403.59 ,$427.70 
ST. JOSEPH'S HOSPITAL - BREESE,31000178,81377,HC HLA CLASS 2 TYPE 1 AG EQV LR-90,310,1 ,$784.00 ,$509.60 ,$25.54 ,$784.00 ,$666.40 ,$468.05 ,$94.74 ,$450.80 ,$94.74 ,$540.18 ,$666.40 ,$666.40 ,$666.40 ,$642.88 ,$533.12 ,$94.74 ,$94.74 ,$588.00 ,$556.64 ,$556.64 ,$94.74 ,$556.64 ,$650.72 ,$650.72 ,$650.72 , N/A ,$236.85 ,$666.40 ,$94.74 ,$784.00 ,$25.54 ,$25.54 ,$666.40 ,$198.95 ,$666.40 ,$705.60 ,$94.74 ,$650.72 ,$623.28 ,$623.28 ,$94.74 ,$509.60 
ST. JOSEPH'S HOSPITAL - BREESE,31000180,81383,HC HLA 2 TYPE 1 ALLELE HIGH RESOLUTION -90,310,1 ,$784.00 ,$509.60 ,$25.54 ,$784.00 ,$666.40 ,$468.05 ,$109.13 ,$450.80 ,$109.13 ,$540.18 ,$666.40 ,$666.40 ,$666.40 ,$642.88 ,$533.12 ,$109.13 ,$109.13 ,$588.00 ,$556.64 ,$556.64 ,$109.13 ,$556.64 ,$650.72 ,$650.72 ,$650.72 , N/A ,$272.83 ,$666.40 ,$109.13 ,$784.00 ,$25.54 ,$25.54 ,$666.40 ,$229.17 ,$666.40 ,$705.60 ,$109.13 ,$650.72 ,$623.28 ,$623.28 ,$109.13 ,$509.60 
ST. JOSEPH'S HOSPITAL - BREESE,31000181,81400,HC MOLECULAR PATH PROC LEVEL 1-90,310,1 ,$430.00 ,$279.50 ,$25.54 ,$430.00 ,$365.50 ,$256.71 ,$63.96 ,$247.25 ,$63.96 ,$296.27 ,$365.50 ,$365.50 ,$365.50 ,$352.60 ,$292.40 ,$63.96 ,$63.96 ,$322.50 ,$305.30 ,$305.30 ,$63.96 ,$305.30 ,$356.90 ,$356.90 ,$356.90 , N/A ,$159.90 ,$365.50 ,$63.96 ,$430.00 ,$25.54 ,$25.54 ,$365.50 ,$134.32 ,$365.50 ,$387.00 ,$63.96 ,$356.90 ,$341.85 ,$341.85 ,$63.96 ,$279.50 
ST. JOSEPH'S HOSPITAL - BREESE,31000183,81401,HC MOLECULAR PATH PROC LEVEL 2-90,310,1 ,$754.00 ,$490.10 ,$25.54 ,$754.00 ,$640.90 ,$450.14 ,$226.20 ,$433.55 , N/A ,$519.51 ,$640.90 ,$640.90 ,$640.90 ,$618.28 ,$512.72 , N/A , N/A ,$565.50 ,$535.34 ,$535.34 , N/A ,$535.34 ,$625.82 ,$625.82 ,$625.82 , N/A , N/A ,$640.90 , N/A ,$754.00 ,$25.54 ,$25.54 ,$640.90 ,$452.40 ,$640.90 ,$678.60 , N/A ,$625.82 ,$599.43 ,$599.43 , N/A ,$490.10 
ST. JOSEPH'S HOSPITAL - BREESE,31000184,81403,HC MOLECULAR PATH PROC LEVEL 4-90,310,1 ,$978.00 ,$635.70 ,$25.54 ,$978.00 ,$831.30 ,$583.87 ,$293.40 ,$562.35 , N/A ,$673.84 ,$831.30 ,$831.30 ,$831.30 ,$801.96 ,$665.04 , N/A , N/A ,$733.50 ,$694.38 ,$694.38 , N/A ,$694.38 ,$811.74 ,$811.74 ,$811.74 , N/A , N/A ,$831.30 , N/A ,$978.00 ,$25.54 ,$25.54 ,$831.30 ,$586.80 ,$831.30 ,$880.20 , N/A ,$811.74 ,$777.51 ,$777.51 , N/A ,$635.70 
ST. JOSEPH'S HOSPITAL - BREESE,31000205,81219,HC CALR GENE ANALYSIS EXON 9-90,310,1 ,$937.00 ,$609.05 ,$83.16 ,$937.00 ,$796.45 ,$559.39 ,$121.63 ,$538.78 ,$121.63 ,$645.59 ,$796.45 ,$796.45 ,$796.45 ,$768.34 ,$637.16 ,$121.63 ,$121.63 ,$702.75 ,$665.27 ,$665.27 ,$121.63 ,$665.27 ,$777.71 ,$777.71 ,$777.71 , N/A ,$304.08 ,$796.45 ,$121.63 ,$937.00 ,$83.16 ,$83.16 ,$796.45 ,$255.42 ,$796.45 ,$843.30 ,$121.63 ,$777.71 ,$744.92 ,$744.92 ,$121.63 ,$609.05 
ST. JOSEPH'S HOSPITAL - BREESE,31000208,81402,HC MOLECULAR PATHOLOGY PROC LEVEL 3-90,310,1 ,$490.00 ,$318.50 ,$25.54 ,$490.00 ,$416.50 ,$292.53 ,$147.00 ,$281.75 , N/A ,$337.61 ,$416.50 ,$416.50 ,$416.50 ,$401.80 ,$333.20 , N/A , N/A ,$367.50 ,$347.90 ,$347.90 , N/A ,$347.90 ,$406.70 ,$406.70 ,$406.70 , N/A , N/A ,$416.50 , N/A ,$490.00 ,$25.54 ,$25.54 ,$416.50 ,$294.00 ,$416.50 ,$441.00 , N/A ,$406.70 ,$389.55 ,$389.55 , N/A ,$318.50 
ST. JOSEPH'S HOSPITAL - BREESE,31000214,88285,HC CHROMOSOME ADDL CELLS COUNTED EA STUDY-90,310,1 ,$66.00 ,$42.90 ,$25.54 ,$66.00 ,$56.10 ,$39.40 ,$26.91 ,$37.95 ,$26.91 ,$45.47 ,$56.10 ,$56.10 ,$56.10 ,$54.12 ,$44.88 ,$26.91 ,$26.91 ,$49.50 ,$46.86 ,$46.86 ,$26.91 ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A ,$66.00 ,$56.10 ,$26.91 ,$66.00 ,$25.54 ,$25.54 ,$56.10 ,$56.51 ,$56.10 ,$59.40 ,$26.91 ,$54.78 ,$52.47 ,$52.47 ,$26.91 ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,31000224,81335,HC TPMT GENE ANALYSIS COMMON VARIANTS-90,310,1 ,$360.00 ,$234.00 ,$83.16 ,$367.10 ,$306.00 ,$214.92 ,$174.81 ,$207.00 ,$174.81 ,$248.04 ,$306.00 ,$306.00 ,$306.00 ,$295.20 ,$244.80 ,$174.81 ,$174.81 ,$270.00 ,$255.60 ,$255.60 ,$174.81 ,$255.60 ,$298.80 ,$298.80 ,$298.80 , N/A ,$360.00 ,$306.00 ,$174.81 ,$360.00 ,$83.16 ,$83.16 ,$306.00 ,$367.10 ,$306.00 ,$324.00 ,$174.81 ,$298.80 ,$286.20 ,$286.20 ,$174.81 ,$234.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000226,81450,HC TARGET GENOMIC SEQ ANALYSIS HEMATOLYMPHOID 5-50 GENES-90,310,1 ,"$5,200.00 ","$3,380.00 ",$83.16 ,"$5,200.00 ","$4,420.00 ","$3,104.40 ",$759.53 ,"$2,990.00 ",$759.53 ,"$3,582.80 ","$4,420.00 ","$4,420.00 ","$4,420.00 ","$4,264.00 ","$3,536.00 ",$759.53 ,$759.53 ,"$3,900.00 ","$3,692.00 ","$3,692.00 ",$759.53 ,"$3,692.00 ","$4,316.00 ","$4,316.00 ","$4,316.00 ", N/A ,"$1,898.83 ","$4,420.00 ",$759.53 ,"$5,200.00 ",$83.16 ,$83.16 ,"$4,420.00 ","$1,595.01 ","$4,420.00 ","$4,680.00 ",$759.53 ,"$4,316.00 ","$4,134.00 ","$4,134.00 ",$759.53 ,"$3,380.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$133.00 ,$86.45 ,$20.56 ,$133.00 ,$113.05 ,$79.40 ,$31.95 ,$76.48 ,$31.95 ,$91.64 ,$113.05 ,$113.05 ,$113.05 ,$109.06 ,$90.44 ,$31.95 ,$31.95 ,$99.75 ,$94.43 ,$94.43 ,$31.95 ,$94.43 ,$110.39 ,$110.39 ,$110.39 , N/A ,$79.86 ,$113.05 ,$31.95 ,$133.00 ,$20.56 ,$20.56 ,$113.05 ,$67.09 ,$113.05 ,$119.70 ,$31.95 ,$110.39 ,$105.74 ,$105.74 ,$31.95 ,$86.45 
ST. JOSEPH'S HOSPITAL - BREESE,31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$142.00 ,$92.30 ,$22.62 ,$142.00 ,$120.70 ,$84.77 ,$47.27 ,$81.65 ,$47.27 ,$97.84 ,$120.70 ,$120.70 ,$120.70 ,$116.44 ,$96.56 ,$47.27 ,$47.27 ,$106.50 ,$100.82 ,$100.82 ,$47.27 ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A ,$118.18 ,$120.70 ,$47.27 ,$142.00 ,$22.62 ,$22.62 ,$120.70 ,$99.27 ,$120.70 ,$127.80 ,$47.27 ,$117.86 ,$112.89 ,$112.89 ,$47.27 ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,31100107,88142,HC THINPREP PAP,311,1 ,$174.00 ,$113.10 ,$14.91 ,$174.00 ,$147.90 ,$103.88 ,$20.26 ,$100.05 ,$20.26 ,$119.89 ,$147.90 ,$147.90 ,$147.90 ,$142.68 ,$118.32 ,$20.26 ,$20.26 ,$130.50 ,$123.54 ,$123.54 ,$20.26 ,$123.54 ,$144.42 ,$144.42 ,$144.42 , N/A ,$50.65 ,$147.90 ,$20.26 ,$20.26 ,$14.91 ,$14.91 ,$147.90 ,$42.55 ,$147.90 ,$156.60 ,$20.26 ,$144.42 ,$138.33 ,$138.33 ,$20.26 ,$113.10 
ST. JOSEPH'S HOSPITAL - BREESE,31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$114.00 ,$74.10 ,$20.56 ,$114.00 ,$96.90 ,$68.06 ,$21.97 ,$65.55 ,$21.97 ,$78.55 ,$96.90 ,$96.90 ,$96.90 ,$93.48 ,$77.52 ,$21.97 ,$21.97 ,$85.50 ,$80.94 ,$80.94 ,$21.97 ,$80.94 ,$94.62 ,$94.62 ,$94.62 , N/A ,$54.92 ,$96.90 ,$21.97 ,$114.00 ,$20.56 ,$20.56 ,$96.90 ,$46.14 ,$96.90 ,$102.60 ,$21.97 ,$94.62 ,$90.63 ,$90.63 ,$21.97 ,$74.10 
ST. JOSEPH'S HOSPITAL - BREESE,31100113,88164,HC CYTOPATH SCR BETHESDA,311,1 ,$159.00 ,$103.35 ,$14.91 ,$159.00 ,$135.15 ,$94.92 ,$15.12 ,$91.43 ,$15.12 ,$109.55 ,$135.15 ,$135.15 ,$135.15 ,$130.38 ,$108.12 ,$15.12 ,$15.12 ,$119.25 ,$112.89 ,$112.89 ,$15.12 ,$112.89 ,$131.97 ,$131.97 ,$131.97 , N/A ,$37.80 ,$135.15 ,$15.12 ,$15.12 ,$14.91 ,$14.91 ,$135.15 ,$31.75 ,$135.15 ,$143.10 ,$15.12 ,$131.97 ,$126.41 ,$126.41 ,$15.12 ,$103.35 
ST. JOSEPH'S HOSPITAL - BREESE,31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$236.00 ,$153.40 ,$20.56 ,$236.00 ,$200.60 ,$140.89 ,$47.27 ,$135.70 ,$47.27 ,$162.60 ,$200.60 ,$200.60 ,$200.60 ,$193.52 ,$160.48 ,$47.27 ,$47.27 ,$177.00 ,$167.56 ,$167.56 ,$47.27 ,$167.56 ,$195.88 ,$195.88 ,$195.88 , N/A ,$118.18 ,$200.60 ,$47.27 ,$87.24 ,$20.56 ,$20.56 ,$200.60 ,$99.27 ,$200.60 ,$212.40 ,$47.27 ,$195.88 ,$187.62 ,$187.62 ,$47.27 ,$153.40 
ST. JOSEPH'S HOSPITAL - BREESE,31100240,88161,HC CYTOPATH SMEAR OTHER SOURCE W/PREP,311,1 ,$151.00 ,$98.15 ,$20.56 ,$151.00 ,$128.35 ,$90.15 ,$21.97 ,$86.83 ,$21.97 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$21.97 ,$21.97 ,$113.25 ,$107.21 ,$107.21 ,$21.97 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$54.92 ,$128.35 ,$21.97 ,$151.00 ,$20.56 ,$20.56 ,$128.35 ,$46.14 ,$128.35 ,$135.90 ,$21.97 ,$125.33 ,$120.05 ,$120.05 ,$21.97 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,31100244,88184,HC FLOW CYTO 1ST MARKER-90,311,1 ,$197.00 ,$128.05 ,$22.62 ,$568.74 ,$167.45 ,$117.61 ,$270.83 ,$113.28 ,$270.83 ,$135.73 ,$167.45 ,$167.45 ,$167.45 ,$161.54 ,$133.96 ,$270.83 ,$270.83 ,$147.75 ,$139.87 ,$139.87 ,$270.83 ,$139.87 ,$163.51 ,$163.51 ,$163.51 , N/A ,$197.00 ,$167.45 ,$270.83 ,$197.00 ,$22.62 ,$22.62 ,$167.45 ,$568.74 ,$167.45 ,$177.30 ,$270.83 ,$163.51 ,$156.62 ,$156.62 ,$270.83 ,$128.05 
ST. JOSEPH'S HOSPITAL - BREESE,31100246,88185,HC FLOW CYTO EA ADD MARKER-90,311,1 ,$740.00 ,$481.00 ,$22.62 ,$740.00 ,$629.00 ,$441.78 , N/A ,$425.50 , N/A ,$509.86 ,$629.00 ,$629.00 ,$629.00 ,$606.80 ,$503.20 , N/A , N/A ,$555.00 ,$525.40 ,$525.40 , N/A ,$525.40 ,$614.20 ,$614.20 ,$614.20 , N/A , N/A ,$629.00 , N/A ,$740.00 ,$22.62 ,$22.62 ,$629.00 , N/A ,$629.00 ,$666.00 , N/A ,$614.20 ,$588.30 ,$588.30 , N/A ,$481.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100251,88230,HC TISSUE CULT NONNEO LYMPHOCYTE-90,311,1 ,$422.00 ,$274.30 ,$22.62 ,$422.00 ,$358.70 ,$251.93 ,$116.49 ,$242.65 ,$116.49 ,$290.76 ,$358.70 ,$358.70 ,$358.70 ,$346.04 ,$286.96 ,$116.49 ,$116.49 ,$316.50 ,$299.62 ,$299.62 ,$116.49 ,$299.62 ,$350.26 ,$350.26 ,$350.26 , N/A ,$291.23 ,$358.70 ,$116.49 ,$422.00 ,$22.62 ,$22.62 ,$358.70 ,$244.63 ,$358.70 ,$379.80 ,$116.49 ,$350.26 ,$335.49 ,$335.49 ,$116.49 ,$274.30 
ST. JOSEPH'S HOSPITAL - BREESE,31100252,88233,HC TISSUE CULT SKIN/OTH SOLID-90,311,1 ,$740.00 ,$481.00 ,$22.62 ,$740.00 ,$629.00 ,$441.78 ,$140.73 ,$425.50 ,$140.73 ,$509.86 ,$629.00 ,$629.00 ,$629.00 ,$606.80 ,$503.20 ,$140.73 ,$140.73 ,$555.00 ,$525.40 ,$525.40 ,$140.73 ,$525.40 ,$614.20 ,$614.20 ,$614.20 , N/A ,$351.83 ,$629.00 ,$140.73 ,$740.00 ,$22.62 ,$22.62 ,$629.00 ,$295.53 ,$629.00 ,$666.00 ,$140.73 ,$614.20 ,$588.30 ,$588.30 ,$140.73 ,$481.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100255,88237,HC TISSUE CULT BONE/BLD-90,311,1 ,$740.00 ,$481.00 ,$22.62 ,$740.00 ,$629.00 ,$441.78 ,$143.75 ,$425.50 ,$143.75 ,$509.86 ,$629.00 ,$629.00 ,$629.00 ,$606.80 ,$503.20 ,$143.75 ,$143.75 ,$555.00 ,$525.40 ,$525.40 ,$143.75 ,$525.40 ,$614.20 ,$614.20 ,$614.20 , N/A ,$359.38 ,$629.00 ,$143.75 ,$740.00 ,$22.62 ,$22.62 ,$629.00 ,$301.88 ,$629.00 ,$666.00 ,$143.75 ,$614.20 ,$588.30 ,$588.30 ,$143.75 ,$481.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100257,88262,HC CHROM COUNT 15-20/2-90,311,1 ,$558.00 ,$362.70 ,$25.54 ,$558.00 ,$474.30 ,$333.13 ,$125.49 ,$320.85 ,$125.49 ,$384.46 ,$474.30 ,$474.30 ,$474.30 ,$457.56 ,$379.44 ,$125.49 ,$125.49 ,$418.50 ,$396.18 ,$396.18 ,$125.49 ,$396.18 ,$463.14 ,$463.14 ,$463.14 , N/A ,$313.73 ,$474.30 ,$125.49 ,$558.00 ,$25.54 ,$25.54 ,$474.30 ,$263.53 ,$474.30 ,$502.20 ,$125.49 ,$463.14 ,$443.61 ,$443.61 ,$125.49 ,$362.70 
ST. JOSEPH'S HOSPITAL - BREESE,31100258,88264,HC CHROM ANLYS ANALYZE 20-90,311,1 ,$330.00 ,$214.50 ,$25.54 ,$330.00 ,$280.50 ,$197.01 ,$144.61 ,$189.75 ,$144.61 ,$227.37 ,$280.50 ,$280.50 ,$280.50 ,$270.60 ,$224.40 ,$144.61 ,$144.61 ,$247.50 ,$234.30 ,$234.30 ,$144.61 ,$234.30 ,$273.90 ,$273.90 ,$273.90 , N/A ,$330.00 ,$280.50 ,$144.61 ,$330.00 ,$25.54 ,$25.54 ,$280.50 ,$303.68 ,$280.50 ,$297.00 ,$144.61 ,$273.90 ,$262.35 ,$262.35 ,$144.61 ,$214.50 
ST. JOSEPH'S HOSPITAL - BREESE,31100261,88271,HC MCG DNA PROBE(FISH)-90,311,1 ,$146.00 ,$94.90 ,$21.42 ,$146.00 ,$124.10 ,$87.16 ,$21.42 ,$83.95 ,$21.42 ,$100.59 ,$124.10 ,$124.10 ,$124.10 ,$119.72 ,$99.28 ,$21.42 ,$21.42 ,$109.50 ,$103.66 ,$103.66 ,$21.42 ,$103.66 ,$121.18 ,$121.18 ,$121.18 , N/A ,$53.55 ,$124.10 ,$21.42 ,$146.00 ,$25.54 ,$25.54 ,$124.10 ,$44.98 ,$124.10 ,$131.40 ,$21.42 ,$121.18 ,$116.07 ,$116.07 ,$21.42 ,$94.90 
ST. JOSEPH'S HOSPITAL - BREESE,31100269,88275,HC MCG INTERPH INSITU 100 -90,311,1 ,$219.00 ,$142.35 ,$25.54 ,$219.00 ,$186.15 ,$130.74 ,$51.19 ,$125.93 ,$51.19 ,$150.89 ,$186.15 ,$186.15 ,$186.15 ,$179.58 ,$148.92 ,$51.19 ,$51.19 ,$164.25 ,$155.49 ,$155.49 ,$51.19 ,$155.49 ,$181.77 ,$181.77 ,$181.77 , N/A ,$127.98 ,$186.15 ,$51.19 ,$219.00 ,$25.54 ,$25.54 ,$186.15 ,$107.50 ,$186.15 ,$197.10 ,$51.19 ,$181.77 ,$174.11 ,$174.11 ,$51.19 ,$142.35 
ST. JOSEPH'S HOSPITAL - BREESE,31100270,88275,HC MCG INTERPH INSITU FISH 100-90,311,1 ,$219.00 ,$142.35 ,$25.54 ,$219.00 ,$186.15 ,$130.74 ,$51.19 ,$125.93 ,$51.19 ,$150.89 ,$186.15 ,$186.15 ,$186.15 ,$179.58 ,$148.92 ,$51.19 ,$51.19 ,$164.25 ,$155.49 ,$155.49 ,$51.19 ,$155.49 ,$181.77 ,$181.77 ,$181.77 , N/A ,$127.98 ,$186.15 ,$51.19 ,$219.00 ,$25.54 ,$25.54 ,$186.15 ,$107.50 ,$186.15 ,$197.10 ,$51.19 ,$181.77 ,$174.11 ,$174.11 ,$51.19 ,$142.35 
ST. JOSEPH'S HOSPITAL - BREESE,31100273,88280,HC CHROM ADDL KARYO-90,311,1 ,$90.00 ,$58.50 ,$25.54 ,$90.00 ,$76.50 ,$53.73 ,$33.47 ,$51.75 ,$33.47 ,$62.01 ,$76.50 ,$76.50 ,$76.50 ,$73.80 ,$61.20 ,$33.47 ,$33.47 ,$67.50 ,$63.90 ,$63.90 ,$33.47 ,$63.90 ,$74.70 ,$74.70 ,$74.70 , N/A ,$83.68 ,$76.50 ,$33.47 ,$90.00 ,$25.54 ,$25.54 ,$76.50 ,$70.29 ,$76.50 ,$81.00 ,$33.47 ,$74.70 ,$71.55 ,$71.55 ,$33.47 ,$58.50 
ST. JOSEPH'S HOSPITAL - BREESE,31100274,88289,HC CHROM ADDL HIGH RES-90,311,1 ,$120.00 ,$78.00 ,$25.54 ,$120.00 ,$102.00 ,$71.64 ,$34.43 ,$69.00 ,$34.43 ,$82.68 ,$102.00 ,$102.00 ,$102.00 ,$98.40 ,$81.60 ,$34.43 ,$34.43 ,$90.00 ,$85.20 ,$85.20 ,$34.43 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$86.08 ,$102.00 ,$34.43 ,$120.00 ,$25.54 ,$25.54 ,$102.00 ,$72.30 ,$102.00 ,$108.00 ,$34.43 ,$99.60 ,$95.40 ,$95.40 ,$34.43 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100275,88291,HC INTERPRETATION-90,311,1 ,$60.00 ,$39.00 ,$25.54 ,$60.00 ,$51.00 ,$35.82 , N/A ,$34.50 , N/A ,$41.34 ,$51.00 ,$51.00 ,$51.00 ,$49.20 ,$40.80 , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.80 ,$49.80 ,$49.80 , N/A , N/A ,$51.00 , N/A ,$60.00 ,$25.54 ,$25.54 ,$51.00 , N/A ,$51.00 ,$54.00 , N/A ,$49.80 ,$47.70 ,$47.70 , N/A ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100283,88120,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC-90,311,1 ,$422.00 ,$274.30 ,$22.62 ,$422.00 ,$358.70 ,$251.93 ,$137.13 ,$242.65 ,$137.13 ,$290.76 ,$358.70 ,$358.70 ,$358.70 ,$346.04 ,$286.96 ,$137.13 ,$137.13 ,$316.50 ,$299.62 ,$299.62 ,$137.13 ,$299.62 ,$350.26 ,$350.26 ,$350.26 , N/A ,$342.82 ,$358.70 ,$137.13 ,$422.00 ,$22.62 ,$22.62 ,$358.70 ,$287.97 ,$358.70 ,$379.80 ,$137.13 ,$350.26 ,$335.49 ,$335.49 ,$137.13 ,$274.30 
ST. JOSEPH'S HOSPITAL - BREESE,31100310,88121,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC COMP ASSIST-90,311,1 ,$400.00 ,$260.00 ,$22.62 ,$568.74 ,$340.00 ,$238.80 ,$270.83 ,$230.00 ,$270.83 ,$275.60 ,$340.00 ,$340.00 ,$340.00 ,$328.00 ,$272.00 ,$270.83 ,$270.83 ,$300.00 ,$284.00 ,$284.00 ,$270.83 ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A ,$400.00 ,$340.00 ,$270.83 ,$400.00 ,$22.62 ,$22.62 ,$340.00 ,$568.74 ,$340.00 ,$360.00 ,$270.83 ,$332.00 ,$318.00 ,$318.00 ,$270.83 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100311,88182,HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS -90,311,1 ,$622.00 ,$404.30 ,$22.62 ,$622.00 ,$528.70 ,$371.33 ,$47.27 ,$357.65 ,$47.27 ,$428.56 ,$528.70 ,$528.70 ,$528.70 ,$510.04 ,$422.96 ,$47.27 ,$47.27 ,$466.50 ,$441.62 ,$441.62 ,$47.27 ,$441.62 ,$516.26 ,$516.26 ,$516.26 , N/A ,$118.18 ,$528.70 ,$47.27 ,$622.00 ,$22.62 ,$22.62 ,$528.70 ,$99.27 ,$528.70 ,$559.80 ,$47.27 ,$516.26 ,$494.49 ,$494.49 ,$47.27 ,$404.30 
ST. JOSEPH'S HOSPITAL - BREESE,31100318,88185,HC FLOW CYTO EA ADD MARKER OVER 24 - 90,311,1 ,$200.00 ,$130.00 ,$22.62 ,$200.00 ,$170.00 ,$119.40 , N/A ,$115.00 , N/A ,$137.80 ,$170.00 ,$170.00 ,$170.00 ,$164.00 ,$136.00 , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$22.62 ,$22.62 ,$170.00 , N/A ,$170.00 ,$180.00 , N/A ,$166.00 ,$159.00 ,$159.00 , N/A ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$156.00 ,$101.40 ,$20.56 ,$156.00 ,$132.60 ,$93.13 ,$21.97 ,$89.70 ,$21.97 ,$107.48 ,$132.60 ,$132.60 ,$132.60 ,$127.92 ,$106.08 ,$21.97 ,$21.97 ,$117.00 ,$110.76 ,$110.76 ,$21.97 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$54.92 ,$132.60 ,$21.97 ,$156.00 ,$20.56 ,$20.56 ,$132.60 ,$46.14 ,$132.60 ,$140.40 ,$21.97 ,$129.48 ,$124.02 ,$124.02 ,$21.97 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$297.00 ,$193.05 ,$20.56 ,$297.00 ,$252.45 ,$177.31 ,$21.97 ,$170.78 ,$21.97 ,$204.63 ,$252.45 ,$252.45 ,$252.45 ,$243.54 ,$201.96 ,$21.97 ,$21.97 ,$222.75 ,$210.87 ,$210.87 ,$21.97 ,$210.87 ,$246.51 ,$246.51 ,$246.51 , N/A ,$54.92 ,$252.45 ,$21.97 ,$297.00 ,$20.56 ,$20.56 ,$252.45 ,$46.14 ,$252.45 ,$267.30 ,$21.97 ,$246.51 ,$236.12 ,$236.12 ,$21.97 ,$193.05 
ST. JOSEPH'S HOSPITAL - BREESE,31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$369.00 ,$239.85 ,$20.56 ,$369.00 ,$313.65 ,$220.29 ,$47.27 ,$212.18 ,$47.27 ,$254.24 ,$313.65 ,$313.65 ,$313.65 ,$302.58 ,$250.92 ,$47.27 ,$47.27 ,$276.75 ,$261.99 ,$261.99 ,$47.27 ,$261.99 ,$306.27 ,$306.27 ,$306.27 , N/A ,$118.18 ,$313.65 ,$47.27 ,$369.00 ,$20.56 ,$20.56 ,$313.65 ,$99.27 ,$313.65 ,$332.10 ,$47.27 ,$306.27 ,$293.36 ,$293.36 ,$47.27 ,$239.85 
ST. JOSEPH'S HOSPITAL - BREESE,31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$468.00 ,$304.20 ,$20.56 ,$468.00 ,$397.80 ,$279.40 ,$47.27 ,$269.10 ,$47.27 ,$322.45 ,$397.80 ,$397.80 ,$397.80 ,$383.76 ,$318.24 ,$47.27 ,$47.27 ,$351.00 ,$332.28 ,$332.28 ,$47.27 ,$332.28 ,$388.44 ,$388.44 ,$388.44 , N/A ,$118.18 ,$397.80 ,$47.27 ,$33.68 ,$20.56 ,$20.56 ,$397.80 ,$99.27 ,$397.80 ,$421.20 ,$47.27 ,$388.44 ,$372.06 ,$372.06 ,$47.27 ,$304.20 
ST. JOSEPH'S HOSPITAL - BREESE,31200110,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,$851.00 ,$553.15 ,$22.62 ,$851.00 ,$723.35 ,$508.05 ,$270.83 ,$489.33 ,$270.83 ,$586.34 ,$723.35 ,$723.35 ,$723.35 ,$697.82 ,$578.68 ,$270.83 ,$270.83 ,$638.25 ,$604.21 ,$604.21 ,$270.83 ,$604.21 ,$706.33 ,$706.33 ,$706.33 , N/A ,$677.07 ,$723.35 ,$270.83 ,$203.41 ,$22.62 ,$22.62 ,$723.35 ,$568.74 ,$723.35 ,$765.90 ,$270.83 ,$706.33 ,$676.55 ,$676.55 ,$270.83 ,$553.15 
ST. JOSEPH'S HOSPITAL - BREESE,31200113,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,"$1,050.00 ",$682.50 ,$22.62 ,"$1,260.65 ",$892.50 ,$626.85 ,$600.31 ,$603.75 ,$600.31 ,$723.45 ,$892.50 ,$892.50 ,$892.50 ,$861.00 ,$714.00 ,$600.31 ,$600.31 ,$787.50 ,$745.50 ,$745.50 ,$600.31 ,$745.50 ,$871.50 ,$871.50 ,$871.50 , N/A ,"$1,050.00 ",$892.50 ,$600.31 ,"$1,050.00 ",$22.62 ,$22.62 ,$892.50 ,"$1,260.65 ",$892.50 ,$945.00 ,$600.31 ,$871.50 ,$834.75 ,$834.75 ,$600.31 ,$682.50 
ST. JOSEPH'S HOSPITAL - BREESE,31200116,88311,HC DECALCIFICATION,312,1 ,$63.00 ,$40.95 ,$20.56 ,$63.00 ,$53.55 ,$37.61 , N/A ,$36.23 , N/A ,$43.41 ,$53.55 ,$53.55 ,$53.55 ,$51.66 ,$42.84 , N/A , N/A ,$47.25 ,$44.73 ,$44.73 , N/A ,$44.73 ,$52.29 ,$52.29 ,$52.29 , N/A , N/A ,$53.55 , N/A ,$63.00 ,$20.56 ,$20.56 ,$53.55 , N/A ,$53.55 ,$56.70 , N/A ,$52.29 ,$50.09 ,$50.09 , N/A ,$40.95 
ST. JOSEPH'S HOSPITAL - BREESE,31200123,88312,HC SPECIAL STAIN I,312,1 ,$163.00 ,$105.95 ,$20.56 ,$163.00 ,$138.55 ,$97.31 ,$47.27 ,$93.73 ,$47.27 ,$112.31 ,$138.55 ,$138.55 ,$138.55 ,$133.66 ,$110.84 ,$47.27 ,$47.27 ,$122.25 ,$115.73 ,$115.73 ,$47.27 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$118.18 ,$138.55 ,$47.27 ,$163.00 ,$20.56 ,$20.56 ,$138.55 ,$99.27 ,$138.55 ,$146.70 ,$47.27 ,$135.29 ,$129.59 ,$129.59 ,$47.27 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,31200125,88313,HC SPECIAL STAIN II,312,1 ,$282.00 ,$183.30 ,$20.56 ,$282.00 ,$239.70 ,$168.35 ,$31.95 ,$162.15 ,$31.95 ,$194.30 ,$239.70 ,$239.70 ,$239.70 ,$231.24 ,$191.76 ,$31.95 ,$31.95 ,$211.50 ,$200.22 ,$200.22 ,$31.95 ,$200.22 ,$234.06 ,$234.06 ,$234.06 , N/A ,$79.86 ,$239.70 ,$31.95 ,$282.00 ,$20.56 ,$20.56 ,$239.70 ,$67.09 ,$239.70 ,$253.80 ,$31.95 ,$234.06 ,$224.19 ,$224.19 ,$31.95 ,$183.30 
ST. JOSEPH'S HOSPITAL - BREESE,31200159,88321,HC CONSULT REFERRED SLIDES,312,1 ,$98.00 ,$63.70 ,$20.56 ,$98.00 ,$83.30 ,$58.51 ,$31.95 ,$56.35 ,$31.95 ,$67.52 ,$83.30 ,$83.30 ,$83.30 ,$80.36 ,$66.64 ,$31.95 ,$31.95 ,$73.50 ,$69.58 ,$69.58 ,$31.95 ,$69.58 ,$81.34 ,$81.34 ,$81.34 , N/A ,$79.86 ,$83.30 ,$31.95 ,$98.00 ,$20.56 ,$20.56 ,$83.30 ,$67.09 ,$83.30 ,$88.20 ,$31.95 ,$81.34 ,$77.91 ,$77.91 ,$31.95 ,$63.70 
ST. JOSEPH'S HOSPITAL - BREESE,31200171,88325,HC CONSULT PATH REV/REP,312,1 ,$98.00 ,$63.70 ,$20.56 ,$99.27 ,$83.30 ,$58.51 ,$47.27 ,$56.35 ,$47.27 ,$67.52 ,$83.30 ,$83.30 ,$83.30 ,$80.36 ,$66.64 ,$47.27 ,$47.27 ,$73.50 ,$69.58 ,$69.58 ,$47.27 ,$69.58 ,$81.34 ,$81.34 ,$81.34 , N/A ,$98.00 ,$83.30 ,$47.27 ,$98.00 ,$20.56 ,$20.56 ,$83.30 ,$99.27 ,$83.30 ,$88.20 ,$47.27 ,$81.34 ,$77.91 ,$77.91 ,$47.27 ,$63.70 
ST. JOSEPH'S HOSPITAL - BREESE,31200172,88329,HC CONSULT PATH SURGERY,312,1 ,$87.00 ,$56.55 ,$20.56 ,$87.00 ,$73.95 ,$51.94 ,$31.95 ,$50.03 ,$31.95 ,$59.94 ,$73.95 ,$73.95 ,$73.95 ,$71.34 ,$59.16 ,$31.95 ,$31.95 ,$65.25 ,$61.77 ,$61.77 ,$31.95 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$79.86 ,$73.95 ,$31.95 ,$87.00 ,$20.56 ,$20.56 ,$73.95 ,$67.09 ,$73.95 ,$78.30 ,$31.95 ,$72.21 ,$69.17 ,$69.17 ,$31.95 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$243.00 ,$157.95 ,$20.56 ,$287.97 ,$206.55 ,$145.07 ,$137.13 ,$139.73 ,$137.13 ,$167.43 ,$206.55 ,$206.55 ,$206.55 ,$199.26 ,$165.24 ,$137.13 ,$137.13 ,$182.25 ,$172.53 ,$172.53 ,$137.13 ,$172.53 ,$201.69 ,$201.69 ,$201.69 , N/A ,$243.00 ,$206.55 ,$137.13 ,$36.68 ,$20.56 ,$20.56 ,$206.55 ,$287.97 ,$206.55 ,$218.70 ,$137.13 ,$201.69 ,$193.19 ,$193.19 ,$137.13 ,$157.95 
ST. JOSEPH'S HOSPITAL - BREESE,31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$164.00 ,$106.60 ,$20.56 ,$164.00 ,$139.40 ,$97.91 , N/A ,$94.30 , N/A ,$113.00 ,$139.40 ,$139.40 ,$139.40 ,$134.48 ,$111.52 , N/A , N/A ,$123.00 ,$116.44 ,$116.44 , N/A ,$116.44 ,$136.12 ,$136.12 ,$136.12 , N/A , N/A ,$139.40 , N/A ,$24.31 ,$20.56 ,$20.56 ,$139.40 , N/A ,$139.40 ,$147.60 , N/A ,$136.12 ,$130.38 ,$130.38 , N/A ,$106.60 
ST. JOSEPH'S HOSPITAL - BREESE,31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$408.00 ,$265.20 ,$22.62 ,$408.00 ,$346.80 ,$243.58 ,$137.13 ,$234.60 ,$137.13 ,$281.11 ,$346.80 ,$346.80 ,$346.80 ,$334.56 ,$277.44 ,$137.13 ,$137.13 ,$306.00 ,$289.68 ,$289.68 ,$137.13 ,$289.68 ,$338.64 ,$338.64 ,$338.64 , N/A ,$342.82 ,$346.80 ,$137.13 ,$86.93 ,$22.62 ,$22.62 ,$346.80 ,$287.97 ,$346.80 ,$367.20 ,$137.13 ,$338.64 ,$324.36 ,$324.36 ,$137.13 ,$265.20 
ST. JOSEPH'S HOSPITAL - BREESE,31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$349.00 ,$226.85 ,$20.56 ,$349.00 ,$296.65 ,$208.35 ,$137.13 ,$200.68 ,$137.13 ,$240.46 ,$296.65 ,$296.65 ,$296.65 ,$286.18 ,$237.32 ,$137.13 ,$137.13 ,$261.75 ,$247.79 ,$247.79 ,$137.13 ,$247.79 ,$289.67 ,$289.67 ,$289.67 , N/A ,$342.82 ,$296.65 ,$137.13 ,$73.43 ,$20.56 ,$20.56 ,$296.65 ,$287.97 ,$296.65 ,$314.10 ,$137.13 ,$289.67 ,$277.46 ,$277.46 ,$137.13 ,$226.85 
ST. JOSEPH'S HOSPITAL - BREESE,31200249,88344,HC IMMUNOHISTOCHEM EA AB STAIN,312,1 ,$701.00 ,$455.65 ,$20.56 ,$701.00 ,$595.85 ,$418.50 ,$270.83 ,$403.08 ,$270.83 ,$482.99 ,$595.85 ,$595.85 ,$595.85 ,$574.82 ,$476.68 ,$270.83 ,$270.83 ,$525.75 ,$497.71 ,$497.71 ,$270.83 ,$497.71 ,$581.83 ,$581.83 ,$581.83 , N/A ,$677.07 ,$595.85 ,$270.83 ,$701.00 ,$20.56 ,$20.56 ,$595.85 ,$568.74 ,$595.85 ,$630.90 ,$270.83 ,$581.83 ,$557.30 ,$557.30 ,$270.83 ,$455.65 
ST. JOSEPH'S HOSPITAL - BREESE,31200261,88321,HC CONSULT REFERRED SLIDES-90,312,1 ,$400.00 ,$260.00 ,$20.56 ,$400.00 ,$340.00 ,$238.80 ,$31.95 ,$230.00 ,$31.95 ,$275.60 ,$340.00 ,$340.00 ,$340.00 ,$328.00 ,$272.00 ,$31.95 ,$31.95 ,$300.00 ,$284.00 ,$284.00 ,$31.95 ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A ,$79.86 ,$340.00 ,$31.95 ,$400.00 ,$20.56 ,$20.56 ,$340.00 ,$67.09 ,$340.00 ,$360.00 ,$31.95 ,$332.00 ,$318.00 ,$318.00 ,$31.95 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200265,88341,HC IMMUNOHISOCHEM EA AD SGL STN-90,312,1 ,$100.00 ,$65.00 ,$20.56 ,$100.00 ,$85.00 ,$59.70 , N/A ,$57.50 , N/A ,$68.90 ,$85.00 ,$85.00 ,$85.00 ,$82.00 ,$68.00 , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$83.00 ,$83.00 ,$83.00 , N/A , N/A ,$85.00 , N/A ,$67.12 ,$20.56 ,$20.56 ,$85.00 , N/A ,$85.00 ,$90.00 , N/A ,$83.00 ,$79.50 ,$79.50 , N/A ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200266,88341,HC IMMUNOHISOCHEMIS EA AD SGL STN,312,1 ,$334.00 ,$217.10 ,$20.56 ,$334.00 ,$283.90 ,$199.40 , N/A ,$192.05 , N/A ,$230.13 ,$283.90 ,$283.90 ,$283.90 ,$273.88 ,$227.12 , N/A , N/A ,$250.50 ,$237.14 ,$237.14 , N/A ,$237.14 ,$277.22 ,$277.22 ,$277.22 , N/A , N/A ,$283.90 , N/A ,$67.12 ,$20.56 ,$20.56 ,$283.90 , N/A ,$283.90 ,$300.60 , N/A ,$277.22 ,$265.53 ,$265.53 , N/A ,$217.10 
ST. JOSEPH'S HOSPITAL - BREESE,31200269,88342,HC IMMUNOHISOCHEMISTR EA AB INIT-90,312,1 ,$100.00 ,$65.00 ,$20.56 ,$287.97 ,$85.00 ,$59.70 ,$137.13 ,$57.50 ,$137.13 ,$68.90 ,$85.00 ,$85.00 ,$85.00 ,$82.00 ,$68.00 ,$137.13 ,$137.13 ,$75.00 ,$71.00 ,$71.00 ,$137.13 ,$71.00 ,$83.00 ,$83.00 ,$83.00 , N/A ,$100.00 ,$85.00 ,$137.13 ,$73.43 ,$20.56 ,$20.56 ,$85.00 ,$287.97 ,$85.00 ,$90.00 ,$137.13 ,$83.00 ,$79.50 ,$79.50 ,$137.13 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200275,88360,HC MORPHO ANLYS TUMOR MAN-90,312,1 ,$566.00 ,$367.90 ,$22.62 ,$566.00 ,$481.10 ,$337.90 ,$137.13 ,$325.45 ,$137.13 ,$389.97 ,$481.10 ,$481.10 ,$481.10 ,$464.12 ,$384.88 ,$137.13 ,$137.13 ,$424.50 ,$401.86 ,$401.86 ,$137.13 ,$401.86 ,$469.78 ,$469.78 ,$469.78 , N/A ,$342.82 ,$481.10 ,$137.13 ,$86.93 ,$22.62 ,$22.62 ,$481.10 ,$287.97 ,$481.10 ,$509.40 ,$137.13 ,$469.78 ,$449.97 ,$449.97 ,$137.13 ,$367.90 
ST. JOSEPH'S HOSPITAL - BREESE,31200276,88361,HC MORPHO ANLYS COMP ASSIST-90,312,1 ,$398.00 ,$258.70 ,$22.62 ,$568.74 ,$338.30 ,$237.61 ,$270.83 ,$228.85 ,$270.83 ,$274.22 ,$338.30 ,$338.30 ,$338.30 ,$326.36 ,$270.64 ,$270.83 ,$270.83 ,$298.50 ,$282.58 ,$282.58 ,$270.83 ,$282.58 ,$330.34 ,$330.34 ,$330.34 , N/A ,$398.00 ,$338.30 ,$270.83 ,$86.18 ,$22.62 ,$22.62 ,$338.30 ,$568.74 ,$338.30 ,$358.20 ,$270.83 ,$330.34 ,$316.41 ,$316.41 ,$270.83 ,$258.70 
ST. JOSEPH'S HOSPITAL - BREESE,31200278,88364,HC IN SITU HYBRID(FISH) EA ADL-90,312,1 ,$380.00 ,$247.00 ,$20.56 ,$380.00 ,$323.00 ,$226.86 , N/A ,$218.50 , N/A ,$261.82 ,$323.00 ,$323.00 ,$323.00 ,$311.60 ,$258.40 , N/A , N/A ,$285.00 ,$269.80 ,$269.80 , N/A ,$269.80 ,$315.40 ,$315.40 ,$315.40 , N/A , N/A ,$323.00 , N/A ,$380.00 ,$20.56 ,$20.56 ,$323.00 , N/A ,$323.00 ,$342.00 , N/A ,$315.40 ,$302.10 ,$302.10 , N/A ,$247.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200279,88365,HC IN SITU HYBRID (FISH)-90,312,1 ,$723.00 ,$469.95 ,$20.56 ,$723.00 ,$614.55 ,$431.63 ,$137.13 ,$415.73 ,$137.13 ,$498.15 ,$614.55 ,$614.55 ,$614.55 ,$592.86 ,$491.64 ,$137.13 ,$137.13 ,$542.25 ,$513.33 ,$513.33 ,$137.13 ,$513.33 ,$600.09 ,$600.09 ,$600.09 , N/A ,$342.82 ,$614.55 ,$137.13 ,$723.00 ,$20.56 ,$20.56 ,$614.55 ,$287.97 ,$614.55 ,$650.70 ,$137.13 ,$600.09 ,$574.79 ,$574.79 ,$137.13 ,$469.95 
ST. JOSEPH'S HOSPITAL - BREESE,31200280,88367,HC FISH HER-2NEU-90,312,1 ,$480.00 ,$312.00 ,$22.62 ,$568.74 ,$408.00 ,$286.56 ,$270.83 ,$276.00 ,$270.83 ,$330.72 ,$408.00 ,$408.00 ,$408.00 ,$393.60 ,$326.40 ,$270.83 ,$270.83 ,$360.00 ,$340.80 ,$340.80 ,$270.83 ,$340.80 ,$398.40 ,$398.40 ,$398.40 , N/A ,$480.00 ,$408.00 ,$270.83 ,$480.00 ,$22.62 ,$22.62 ,$408.00 ,$568.74 ,$408.00 ,$432.00 ,$270.83 ,$398.40 ,$381.60 ,$381.60 ,$270.83 ,$312.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200282,88373,HC MORPH ANLY AUTO EA ADDL-90,312,1 ,$503.00 ,$326.95 ,$22.62 ,$503.00 ,$427.55 ,$300.29 , N/A ,$289.23 , N/A ,$346.57 ,$427.55 ,$427.55 ,$427.55 ,$412.46 ,$342.04 , N/A , N/A ,$377.25 ,$357.13 ,$357.13 , N/A ,$357.13 ,$417.49 ,$417.49 ,$417.49 , N/A , N/A ,$427.55 , N/A ,$503.00 ,$22.62 ,$22.62 ,$427.55 , N/A ,$427.55 ,$452.70 , N/A ,$417.49 ,$399.89 ,$399.89 , N/A ,$326.95 
ST. JOSEPH'S HOSPITAL - BREESE,31200283,88374,HC MORPH ANLY AUTO EA MULTIPLX-90,312,1 ,$503.00 ,$326.95 ,$22.62 ,$503.00 ,$427.55 ,$300.29 ,$137.13 ,$289.23 ,$137.13 ,$346.57 ,$427.55 ,$427.55 ,$427.55 ,$412.46 ,$342.04 ,$137.13 ,$137.13 ,$377.25 ,$357.13 ,$357.13 ,$137.13 ,$357.13 ,$417.49 ,$417.49 ,$417.49 , N/A ,$342.82 ,$427.55 ,$137.13 ,$503.00 ,$22.62 ,$22.62 ,$427.55 ,$287.97 ,$427.55 ,$452.70 ,$137.13 ,$417.49 ,$399.89 ,$399.89 ,$137.13 ,$326.95 
ST. JOSEPH'S HOSPITAL - BREESE,31200284,88377,HC MORPH ANLZ INST HYB EA MTPL-90,312,1 ,$730.00 ,$474.50 ,$22.62 ,$730.00 ,$620.50 ,$435.81 ,$137.13 ,$419.75 ,$137.13 ,$502.97 ,$620.50 ,$620.50 ,$620.50 ,$598.60 ,$496.40 ,$137.13 ,$137.13 ,$547.50 ,$518.30 ,$518.30 ,$137.13 ,$518.30 ,$605.90 ,$605.90 ,$605.90 , N/A ,$342.82 ,$620.50 ,$137.13 ,$730.00 ,$22.62 ,$22.62 ,$620.50 ,$287.97 ,$620.50 ,$657.00 ,$137.13 ,$605.90 ,$580.35 ,$580.35 ,$137.13 ,$474.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000005,22512,HC VERTEBROPLASTY INJ PERC ADDL,320,1 ,"$8,427.69 ","$5,478.00 ","$3,132.02 ","$8,427.69 ","$5,213.00 ","$5,031.33 ", N/A ,"$4,845.92 ", N/A ,"$5,806.68 ","$7,163.54 ","$7,163.54 ","$7,163.54 ","$4,769.00 ","$5,730.83 ", N/A , N/A ,"$6,320.77 ","$5,983.66 ","$5,983.66 ", N/A ,"$5,983.66 ","$6,994.98 ","$6,994.98 ","$6,994.98 ", N/A , N/A ,"$7,163.54 ", N/A ,"$8,427.69 ","$3,132.02 ","$3,132.02 ","$7,163.54 ", N/A ,"$7,163.54 ","$7,584.92 ", N/A ,"$6,994.98 ","$6,700.01 ","$6,700.01 ", N/A ,"$5,478.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$244.00 ,$158.60 ,$140.30 ,$244.00 ,$207.40 ,$145.67 , N/A ,$140.30 , N/A ,$168.12 ,$207.40 ,$207.40 ,$207.40 ,$200.08 ,$165.92 , N/A , N/A ,$183.00 ,$173.24 ,$173.24 , N/A ,$173.24 ,$202.52 ,$202.52 ,$202.52 , N/A , N/A ,$207.40 , N/A ,$244.00 , N/A , N/A ,$207.40 , N/A ,$207.40 ,$219.60 , N/A ,$202.52 ,$193.98 ,$193.98 , N/A ,$158.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$367.00 ,$238.55 ,$211.03 ,$367.00 ,$311.95 ,$219.10 , N/A ,$211.03 , N/A ,$252.86 ,$311.95 ,$311.95 ,$311.95 ,$300.94 ,$249.56 , N/A , N/A ,$275.25 ,$260.57 ,$260.57 , N/A ,$260.57 ,$304.61 ,$304.61 ,$304.61 , N/A , N/A ,$311.95 , N/A ,$367.00 , N/A , N/A ,$311.95 , N/A ,$311.95 ,$330.30 , N/A ,$304.61 ,$291.77 ,$291.77 , N/A ,$238.55 
ST. JOSEPH'S HOSPITAL - BREESE,32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$259.00 ,$168.35 ,$148.93 ,$259.00 ,$220.15 ,$154.62 , N/A ,$148.93 , N/A ,$178.45 ,$220.15 ,$220.15 ,$220.15 ,$212.38 ,$176.12 , N/A , N/A ,$194.25 ,$183.89 ,$183.89 , N/A ,$183.89 ,$214.97 ,$214.97 ,$214.97 , N/A , N/A ,$220.15 , N/A ,$259.00 , N/A , N/A ,$220.15 , N/A ,$220.15 ,$233.10 , N/A ,$214.97 ,$205.91 ,$205.91 , N/A ,$168.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$279.00 ,$181.35 ,$160.43 ,$279.00 ,$237.15 ,$166.56 , N/A ,$160.43 , N/A ,$192.23 ,$237.15 ,$237.15 ,$237.15 ,$228.78 ,$189.72 , N/A , N/A ,$209.25 ,$198.09 ,$198.09 , N/A ,$198.09 ,$231.57 ,$231.57 ,$231.57 , N/A , N/A ,$237.15 , N/A ,$279.00 ,$221.76 ,$221.76 ,$237.15 , N/A ,$237.15 ,$251.10 , N/A ,$231.57 ,$221.81 ,$221.81 , N/A ,$181.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$419.00 ,$272.35 ,$221.76 ,$419.00 ,$356.15 ,$250.14 , N/A ,$240.93 , N/A ,$288.69 ,$356.15 ,$356.15 ,$356.15 ,$343.58 ,$284.92 , N/A , N/A ,$314.25 ,$297.49 ,$297.49 , N/A ,$297.49 ,$347.77 ,$347.77 ,$347.77 , N/A , N/A ,$356.15 , N/A ,$419.00 ,$221.76 ,$221.76 ,$356.15 , N/A ,$356.15 ,$377.10 , N/A ,$347.77 ,$333.11 ,$333.11 , N/A ,$272.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$328.00 ,$213.20 ,$188.60 ,$328.00 ,$278.80 ,$195.82 , N/A ,$188.60 , N/A ,$225.99 ,$278.80 ,$278.80 ,$278.80 ,$268.96 ,$223.04 , N/A , N/A ,$246.00 ,$232.88 ,$232.88 , N/A ,$232.88 ,$272.24 ,$272.24 ,$272.24 , N/A , N/A ,$278.80 , N/A ,$328.00 ,$221.76 ,$221.76 ,$278.80 , N/A ,$278.80 ,$295.20 , N/A ,$272.24 ,$260.76 ,$260.76 , N/A ,$213.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$201.00 ,$130.65 ,$115.58 ,$201.00 ,$170.85 ,$120.00 , N/A ,$115.58 , N/A ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$164.82 ,$136.68 , N/A , N/A ,$150.75 ,$142.71 ,$142.71 , N/A ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A , N/A ,$170.85 , N/A ,$201.00 , N/A , N/A ,$170.85 , N/A ,$170.85 ,$180.90 , N/A ,$166.83 ,$159.80 ,$159.80 , N/A ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$229.00 ,$148.85 ,$131.68 ,$229.00 ,$194.65 ,$136.71 , N/A ,$131.68 , N/A ,$157.78 ,$194.65 ,$194.65 ,$194.65 ,$187.78 ,$155.72 , N/A , N/A ,$171.75 ,$162.59 ,$162.59 , N/A ,$162.59 ,$190.07 ,$190.07 ,$190.07 , N/A , N/A ,$194.65 , N/A ,$229.00 ,$221.76 ,$220.99 ,$194.65 , N/A ,$194.65 ,$206.10 , N/A ,$190.07 ,$182.06 ,$182.06 , N/A ,$148.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,725.00 ","$1,121.25 ",$441.90 ,"$3,273.29 ","$1,466.25 ","$1,029.83 ","$1,558.71 ",$991.88 ,"$1,558.71 ","$1,188.53 ","$1,466.25 ","$1,466.25 ","$1,466.25 ","$1,414.50 ","$1,173.00 ","$1,558.71 ","$1,558.71 ","$1,293.75 ","$1,224.75 ","$1,224.75 ","$1,558.71 ","$1,224.75 ","$1,431.75 ","$1,431.75 ","$1,431.75 ", N/A ,"$1,725.00 ","$1,466.25 ","$1,558.71 ","$1,725.00 ",$441.90 ,$441.90 ,"$1,466.25 ","$3,273.29 ","$1,466.25 ","$1,552.50 ","$1,558.71 ","$1,431.75 ","$1,371.38 ","$1,371.38 ","$1,558.71 ","$1,121.25 "
ST. JOSEPH'S HOSPITAL - BREESE,32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$526.74 ,$342.38 ,$175.58 ,"$1,087.29 ",$447.73 ,$314.46 ,$175.58 ,$302.88 ,$175.58 ,$362.92 ,$447.73 ,$447.73 ,$447.73 ,$431.93 ,$358.18 ,$175.58 ,$175.58 ,$395.06 ,$373.99 ,$373.99 ,$175.58 ,$373.99 ,$437.19 ,$437.19 ,$437.19 , N/A ,$438.95 ,$447.73 ,$175.58 ,$526.74 ,"$1,087.29 ",$508.30 ,$447.73 ,$368.72 ,$447.73 ,$474.07 ,$175.58 ,$437.19 ,$418.76 ,$418.76 ,$175.58 ,$342.38 
ST. JOSEPH'S HOSPITAL - BREESE,32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,$293.00 ,$190.45 ,$168.48 ,$293.00 ,$249.05 ,$174.92 , N/A ,$168.48 , N/A ,$201.88 ,$249.05 ,$249.05 ,$249.05 ,$240.26 ,$199.24 , N/A , N/A ,$219.75 ,$208.03 ,$208.03 , N/A ,$208.03 ,$243.19 ,$243.19 ,$243.19 , N/A , N/A ,$249.05 , N/A ,$293.00 ,$221.76 ,$221.76 ,$249.05 , N/A ,$249.05 ,$263.70 , N/A ,$243.19 ,$232.94 ,$232.94 , N/A ,$190.45 
ST. JOSEPH'S HOSPITAL - BREESE,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$424.00 ,$275.60 ,$35.55 ,$424.00 ,$360.40 ,$253.13 ,$76.27 ,$243.80 ,$76.27 ,$292.14 ,$360.40 ,$360.40 ,$360.40 ,$347.68 ,$288.32 ,$76.27 ,$76.27 ,$318.00 ,$301.04 ,$301.04 ,$76.27 ,$301.04 ,$351.92 ,$351.92 ,$351.92 , N/A ,$190.67 ,$360.40 ,$76.27 ,$424.00 ,$35.55 ,$35.55 ,$360.40 ,$160.16 ,$360.40 ,$381.60 ,$76.27 ,$351.92 ,$337.08 ,$337.08 ,$76.27 ,$275.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$635.00 ,$412.75 ,$35.55 ,$635.00 ,$539.75 ,$379.10 ,$76.27 ,$365.13 ,$76.27 ,$437.52 ,$539.75 ,$539.75 ,$539.75 ,$520.70 ,$431.80 ,$76.27 ,$76.27 ,$476.25 ,$450.85 ,$450.85 ,$76.27 ,$450.85 ,$527.05 ,$527.05 ,$527.05 , N/A ,$190.67 ,$539.75 ,$76.27 ,$635.00 ,$35.55 ,$35.55 ,$539.75 ,$160.16 ,$539.75 ,$571.50 ,$76.27 ,$527.05 ,$504.83 ,$504.83 ,$76.27 ,$412.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$598.00 ,$388.70 ,$35.55 ,$598.00 ,$508.30 ,$357.01 ,$107.10 ,$343.85 ,$107.10 ,$412.02 ,$508.30 ,$508.30 ,$508.30 ,$490.36 ,$406.64 ,$107.10 ,$107.10 ,$448.50 ,$424.58 ,$424.58 ,$107.10 ,$424.58 ,$496.34 ,$496.34 ,$496.34 , N/A ,$267.76 ,$508.30 ,$107.10 ,$598.00 ,$35.55 ,$35.55 ,$508.30 ,$224.92 ,$508.30 ,$538.20 ,$107.10 ,$496.34 ,$475.41 ,$475.41 ,$107.10 ,$388.70 
ST. JOSEPH'S HOSPITAL - BREESE,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$642.00 ,$417.30 ,$35.55 ,$642.00 ,$545.70 ,$383.27 ,$107.10 ,$369.15 ,$107.10 ,$442.34 ,$545.70 ,$545.70 ,$545.70 ,$526.44 ,$436.56 ,$107.10 ,$107.10 ,$481.50 ,$455.82 ,$455.82 ,$107.10 ,$455.82 ,$532.86 ,$532.86 ,$532.86 , N/A ,$267.76 ,$545.70 ,$107.10 ,$642.00 ,$35.55 ,$35.55 ,$545.70 ,$224.92 ,$545.70 ,$577.80 ,$107.10 ,$532.86 ,$510.39 ,$510.39 ,$107.10 ,$417.30 
ST. JOSEPH'S HOSPITAL - BREESE,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$964.00 ,$626.60 ,$35.55 ,$964.00 ,$819.40 ,$575.51 ,$107.10 ,$554.30 ,$107.10 ,$664.20 ,$819.40 ,$819.40 ,$819.40 ,$790.48 ,$655.52 ,$107.10 ,$107.10 ,$723.00 ,$684.44 ,$684.44 ,$107.10 ,$684.44 ,$800.12 ,$800.12 ,$800.12 , N/A ,$267.76 ,$819.40 ,$107.10 ,$964.00 ,$35.55 ,$35.55 ,$819.40 ,$224.92 ,$819.40 ,$867.60 ,$107.10 ,$800.12 ,$766.38 ,$766.38 ,$107.10 ,$626.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$675.00 ,$438.75 ,$35.55 ,$675.00 ,$573.75 ,$402.98 ,$107.10 ,$388.13 ,$107.10 ,$465.08 ,$573.75 ,$573.75 ,$573.75 ,$553.50 ,$459.00 ,$107.10 ,$107.10 ,$506.25 ,$479.25 ,$479.25 ,$107.10 ,$479.25 ,$560.25 ,$560.25 ,$560.25 , N/A ,$267.76 ,$573.75 ,$107.10 ,$675.00 ,$35.55 ,$35.55 ,$573.75 ,$224.92 ,$573.75 ,$607.50 ,$107.10 ,$560.25 ,$536.63 ,$536.63 ,$107.10 ,$438.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$495.00 ,$321.75 ,$35.55 ,$495.00 ,$420.75 ,$295.52 ,$76.27 ,$284.63 ,$76.27 ,$341.06 ,$420.75 ,$420.75 ,$420.75 ,$405.90 ,$336.60 ,$76.27 ,$76.27 ,$371.25 ,$351.45 ,$351.45 ,$76.27 ,$351.45 ,$410.85 ,$410.85 ,$410.85 , N/A ,$190.67 ,$420.75 ,$76.27 ,$495.00 ,$35.55 ,$35.55 ,$420.75 ,$160.16 ,$420.75 ,$445.50 ,$76.27 ,$410.85 ,$393.53 ,$393.53 ,$76.27 ,$321.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$546.00 ,$354.90 ,$35.55 ,$546.00 ,$464.10 ,$325.96 ,$107.10 ,$313.95 ,$107.10 ,$376.19 ,$464.10 ,$464.10 ,$464.10 ,$447.72 ,$371.28 ,$107.10 ,$107.10 ,$409.50 ,$387.66 ,$387.66 ,$107.10 ,$387.66 ,$453.18 ,$453.18 ,$453.18 , N/A ,$267.76 ,$464.10 ,$107.10 ,$546.00 ,$35.55 ,$35.55 ,$464.10 ,$224.92 ,$464.10 ,$491.40 ,$107.10 ,$453.18 ,$434.07 ,$434.07 ,$107.10 ,$354.90 
ST. JOSEPH'S HOSPITAL - BREESE,32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$715.00 ,$464.75 ,$35.55 ,$715.00 ,$607.75 ,$426.86 ,$76.27 ,$411.13 ,$76.27 ,$492.64 ,$607.75 ,$607.75 ,$607.75 ,$586.30 ,$486.20 ,$76.27 ,$76.27 ,$536.25 ,$507.65 ,$507.65 ,$76.27 ,$507.65 ,$593.45 ,$593.45 ,$593.45 , N/A ,$190.67 ,$607.75 ,$76.27 ,$715.00 ,$35.55 ,$35.55 ,$607.75 ,$160.16 ,$607.75 ,$643.50 ,$76.27 ,$593.45 ,$568.43 ,$568.43 ,$76.27 ,$464.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$551.00 ,$358.15 ,$35.55 ,$551.00 ,$468.35 ,$328.95 ,$107.10 ,$316.83 ,$107.10 ,$379.64 ,$468.35 ,$468.35 ,$468.35 ,$451.82 ,$374.68 ,$107.10 ,$107.10 ,$413.25 ,$391.21 ,$391.21 ,$107.10 ,$391.21 ,$457.33 ,$457.33 ,$457.33 , N/A ,$267.76 ,$468.35 ,$107.10 ,$551.00 ,$35.55 ,$35.55 ,$468.35 ,$224.92 ,$468.35 ,$495.90 ,$107.10 ,$457.33 ,$438.05 ,$438.05 ,$107.10 ,$358.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$810.00 ,$526.50 ,$35.55 ,$810.00 ,$688.50 ,$483.57 ,$107.10 ,$465.75 ,$107.10 ,$558.09 ,$688.50 ,$688.50 ,$688.50 ,$664.20 ,$550.80 ,$107.10 ,$107.10 ,$607.50 ,$575.10 ,$575.10 ,$107.10 ,$575.10 ,$672.30 ,$672.30 ,$672.30 , N/A ,$267.76 ,$688.50 ,$107.10 ,$810.00 ,$35.55 ,$35.55 ,$688.50 ,$224.92 ,$688.50 ,$729.00 ,$107.10 ,$672.30 ,$643.95 ,$643.95 ,$107.10 ,$526.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$377.00 ,$245.05 ,$35.55 ,$377.00 ,$320.45 ,$225.07 ,$76.27 ,$216.78 ,$76.27 ,$259.75 ,$320.45 ,$320.45 ,$320.45 ,$309.14 ,$256.36 ,$76.27 ,$76.27 ,$282.75 ,$267.67 ,$267.67 ,$76.27 ,$267.67 ,$312.91 ,$312.91 ,$312.91 , N/A ,$190.67 ,$320.45 ,$76.27 ,$377.00 ,$35.55 ,$35.55 ,$320.45 ,$160.16 ,$320.45 ,$339.30 ,$76.27 ,$312.91 ,$299.72 ,$299.72 ,$76.27 ,$245.05 
ST. JOSEPH'S HOSPITAL - BREESE,32000114,70336,HC MRI TMJ,320,1 ,"$2,860.00 ","$1,859.00 ",$149.35 ,"$2,860.00 ","$2,431.00 ","$1,707.42 ",$222.69 ,"$1,644.50 ",$222.69 ,"$1,970.54 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,345.20 ","$1,944.80 ",$222.69 ,$222.69 ,"$2,145.00 ","$2,030.60 ","$2,030.60 ",$222.69 ,"$2,030.60 ","$2,373.80 ","$2,373.80 ","$2,373.80 ", N/A ,$556.73 ,"$2,431.00 ",$222.69 ,"$2,860.00 ",$149.35 ,$149.35 ,"$2,431.00 ",$467.66 ,"$2,431.00 ","$2,574.00 ",$222.69 ,"$2,373.80 ","$2,273.70 ","$2,273.70 ",$222.69 ,"$1,859.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$379.00 ,$246.35 ,$35.55 ,$379.00 ,$322.15 ,$226.26 ,$76.27 ,$217.93 ,$76.27 ,$261.13 ,$322.15 ,$322.15 ,$322.15 ,$310.78 ,$257.72 ,$76.27 ,$76.27 ,$284.25 ,$269.09 ,$269.09 ,$76.27 ,$269.09 ,$314.57 ,$314.57 ,$314.57 , N/A ,$190.67 ,$322.15 ,$76.27 ,$379.00 ,$35.55 ,$35.55 ,$322.15 ,$160.16 ,$322.15 ,$341.10 ,$76.27 ,$314.57 ,$301.31 ,$301.31 ,$76.27 ,$246.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000121,71045,HC XR CHEST 1V,320,1 ,$375.00 ,$243.75 ,$17.56 ,$375.00 ,$318.75 ,$223.88 ,$76.27 ,$215.63 ,$76.27 ,$258.38 ,$318.75 ,$318.75 ,$318.75 ,$307.50 ,$255.00 ,$76.27 ,$76.27 ,$281.25 ,$266.25 ,$266.25 ,$76.27 ,$266.25 ,$311.25 ,$311.25 ,$311.25 , N/A ,$190.67 ,$318.75 ,$76.27 ,$17.56 ,$35.55 ,$35.55 ,$318.75 ,$160.16 ,$318.75 ,$337.50 ,$76.27 ,$311.25 ,$298.13 ,$298.13 ,$76.27 ,$243.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000127,71046,HC XR CHEST 2V,320,1 ,$515.00 ,$334.75 ,$23.18 ,$515.00 ,$437.75 ,$307.46 ,$76.27 ,$296.13 ,$76.27 ,$354.84 ,$437.75 ,$437.75 ,$437.75 ,$422.30 ,$350.20 ,$76.27 ,$76.27 ,$386.25 ,$365.65 ,$365.65 ,$76.27 ,$365.65 ,$427.45 ,$427.45 ,$427.45 , N/A ,$190.67 ,$437.75 ,$76.27 ,$23.18 ,$35.55 ,$35.55 ,$437.75 ,$160.16 ,$437.75 ,$463.50 ,$76.27 ,$427.45 ,$409.43 ,$409.43 ,$76.27 ,$334.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$570.00 ,$370.50 ,$35.55 ,$570.00 ,$484.50 ,$340.29 ,$76.27 ,$327.75 ,$76.27 ,$392.73 ,$484.50 ,$484.50 ,$484.50 ,$467.40 ,$387.60 ,$76.27 ,$76.27 ,$427.50 ,$404.70 ,$404.70 ,$76.27 ,$404.70 ,$473.10 ,$473.10 ,$473.10 , N/A ,$190.67 ,$484.50 ,$76.27 ,$570.00 ,$35.55 ,$35.55 ,$484.50 ,$160.16 ,$484.50 ,$513.00 ,$76.27 ,$473.10 ,$453.15 ,$453.15 ,$76.27 ,$370.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000131,71048,HC XR CHEST PA/LAT W/OBLIQUES,320,1 ,$570.00 ,$370.50 ,$35.55 ,$570.00 ,$484.50 ,$340.29 ,$107.10 ,$327.75 ,$107.10 ,$392.73 ,$484.50 ,$484.50 ,$484.50 ,$467.40 ,$387.60 ,$107.10 ,$107.10 ,$427.50 ,$404.70 ,$404.70 ,$107.10 ,$404.70 ,$473.10 ,$473.10 ,$473.10 , N/A ,$267.76 ,$484.50 ,$107.10 ,$570.00 ,$35.55 ,$35.55 ,$484.50 ,$224.92 ,$484.50 ,$513.00 ,$107.10 ,$473.10 ,$453.15 ,$453.15 ,$107.10 ,$370.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000133,71048,HC XR CHEST 4+V,320,1 ,$570.00 ,$370.50 ,$35.55 ,$570.00 ,$484.50 ,$340.29 ,$107.10 ,$327.75 ,$107.10 ,$392.73 ,$484.50 ,$484.50 ,$484.50 ,$467.40 ,$387.60 ,$107.10 ,$107.10 ,$427.50 ,$404.70 ,$404.70 ,$107.10 ,$404.70 ,$473.10 ,$473.10 ,$473.10 , N/A ,$267.76 ,$484.50 ,$107.10 ,$570.00 ,$35.55 ,$35.55 ,$484.50 ,$224.92 ,$484.50 ,$513.00 ,$107.10 ,$473.10 ,$453.15 ,$453.15 ,$107.10 ,$370.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$515.00 ,$334.75 ,$23.18 ,$515.00 ,$437.75 ,$307.46 ,$76.27 ,$296.13 ,$76.27 ,$354.84 ,$437.75 ,$437.75 ,$437.75 ,$422.30 ,$350.20 ,$76.27 ,$76.27 ,$386.25 ,$365.65 ,$365.65 ,$76.27 ,$365.65 ,$427.45 ,$427.45 ,$427.45 , N/A ,$190.67 ,$437.75 ,$76.27 ,$23.18 ,$35.55 ,$35.55 ,$437.75 ,$160.16 ,$437.75 ,$463.50 ,$76.27 ,$427.45 ,$409.43 ,$409.43 ,$76.27 ,$334.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000137,71100,HC XR RIBS 2V UNI,320,1 ,$495.00 ,$321.75 ,$35.55 ,$495.00 ,$420.75 ,$295.52 ,$76.27 ,$284.63 ,$76.27 ,$341.06 ,$420.75 ,$420.75 ,$420.75 ,$405.90 ,$336.60 ,$76.27 ,$76.27 ,$371.25 ,$351.45 ,$351.45 ,$76.27 ,$351.45 ,$410.85 ,$410.85 ,$410.85 , N/A ,$190.67 ,$420.75 ,$76.27 ,$495.00 ,$35.55 ,$35.55 ,$420.75 ,$160.16 ,$420.75 ,$445.50 ,$76.27 ,$410.85 ,$393.53 ,$393.53 ,$76.27 ,$321.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$331.00 ,$215.15 ,$35.55 ,$331.00 ,$281.35 ,$197.61 ,$107.10 ,$190.33 ,$107.10 ,$228.06 ,$281.35 ,$281.35 ,$281.35 ,$271.42 ,$225.08 ,$107.10 ,$107.10 ,$248.25 ,$235.01 ,$235.01 ,$107.10 ,$235.01 ,$274.73 ,$274.73 ,$274.73 , N/A ,$267.76 ,$281.35 ,$107.10 ,$331.00 ,$35.55 ,$35.55 ,$281.35 ,$224.92 ,$281.35 ,$297.90 ,$107.10 ,$274.73 ,$263.15 ,$263.15 ,$107.10 ,$215.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$764.00 ,$496.60 ,$35.55 ,$764.00 ,$649.40 ,$456.11 ,$107.10 ,$439.30 ,$107.10 ,$526.40 ,$649.40 ,$649.40 ,$649.40 ,$626.48 ,$519.52 ,$107.10 ,$107.10 ,$573.00 ,$542.44 ,$542.44 ,$107.10 ,$542.44 ,$634.12 ,$634.12 ,$634.12 , N/A ,$267.76 ,$649.40 ,$107.10 ,$764.00 ,$35.55 ,$35.55 ,$649.40 ,$224.92 ,$649.40 ,$687.60 ,$107.10 ,$634.12 ,$607.38 ,$607.38 ,$107.10 ,$496.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$332.00 ,$215.80 ,$35.55 ,$332.00 ,$282.20 ,$198.20 ,$107.10 ,$190.90 ,$107.10 ,$228.75 ,$282.20 ,$282.20 ,$282.20 ,$272.24 ,$225.76 ,$107.10 ,$107.10 ,$249.00 ,$235.72 ,$235.72 ,$107.10 ,$235.72 ,$275.56 ,$275.56 ,$275.56 , N/A ,$267.76 ,$282.20 ,$107.10 ,$332.00 ,$35.55 ,$35.55 ,$282.20 ,$224.92 ,$282.20 ,$298.80 ,$107.10 ,$275.56 ,$263.94 ,$263.94 ,$107.10 ,$215.80 
ST. JOSEPH'S HOSPITAL - BREESE,32000141,71120,HC XR STERNUM 2+V,320,1 ,$524.00 ,$340.60 ,$35.55 ,$524.00 ,$445.40 ,$312.83 ,$76.27 ,$301.30 ,$76.27 ,$361.04 ,$445.40 ,$445.40 ,$445.40 ,$429.68 ,$356.32 ,$76.27 ,$76.27 ,$393.00 ,$372.04 ,$372.04 ,$76.27 ,$372.04 ,$434.92 ,$434.92 ,$434.92 , N/A ,$190.67 ,$445.40 ,$76.27 ,$524.00 ,$35.55 ,$35.55 ,$445.40 ,$160.16 ,$445.40 ,$471.60 ,$76.27 ,$434.92 ,$416.58 ,$416.58 ,$76.27 ,$340.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$314.00 ,$204.10 ,$35.55 ,$314.00 ,$266.90 ,$187.46 ,$76.27 ,$180.55 ,$76.27 ,$216.35 ,$266.90 ,$266.90 ,$266.90 ,$257.48 ,$213.52 ,$76.27 ,$76.27 ,$235.50 ,$222.94 ,$222.94 ,$76.27 ,$222.94 ,$260.62 ,$260.62 ,$260.62 , N/A ,$190.67 ,$266.90 ,$76.27 ,$314.00 ,$35.55 ,$35.55 ,$266.90 ,$160.16 ,$266.90 ,$282.60 ,$76.27 ,$260.62 ,$249.63 ,$249.63 ,$76.27 ,$204.10 
ST. JOSEPH'S HOSPITAL - BREESE,32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$3,098.00 ","$2,013.70 ",$88.69 ,"$3,098.00 ","$2,633.30 ","$1,849.51 ",$107.10 ,"$1,781.35 ",$107.10 ,"$2,134.52 ","$2,633.30 ","$2,633.30 ","$2,633.30 ","$2,540.36 ","$2,106.64 ",$107.10 ,$107.10 ,"$2,323.50 ","$2,199.58 ","$2,199.58 ",$107.10 ,"$2,199.58 ","$2,571.34 ","$2,571.34 ","$2,571.34 ", N/A ,$267.76 ,"$2,633.30 ",$107.10 ,"$3,098.00 ",$88.69 ,$88.69 ,"$2,633.30 ",$224.92 ,"$2,633.30 ","$2,788.20 ",$107.10 ,"$2,571.34 ","$2,462.91 ","$2,462.91 ",$107.10 ,"$2,013.70 "
ST. JOSEPH'S HOSPITAL - BREESE,32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$3,845.00 ","$2,499.25 ",$88.69 ,"$3,845.00 ","$3,268.25 ","$2,295.47 ",$174.13 ,"$2,210.88 ",$174.13 ,"$2,649.21 ","$3,268.25 ","$3,268.25 ","$3,268.25 ","$3,152.90 ","$2,614.60 ",$174.13 ,$174.13 ,"$2,883.75 ","$2,729.95 ","$2,729.95 ",$174.13 ,"$2,729.95 ","$3,191.35 ","$3,191.35 ","$3,191.35 ", N/A ,$435.32 ,"$3,268.25 ",$174.13 ,"$3,845.00 ",$88.69 ,$88.69 ,"$3,268.25 ",$365.67 ,"$3,268.25 ","$3,460.50 ",$174.13 ,"$3,191.35 ","$3,056.78 ","$3,056.78 ",$174.13 ,"$2,499.25 "
ST. JOSEPH'S HOSPITAL - BREESE,32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$4,103.00 ","$2,666.95 ",$88.69 ,"$4,103.00 ","$3,487.55 ","$2,449.49 ",$174.13 ,"$2,359.23 ",$174.13 ,"$2,826.97 ","$3,487.55 ","$3,487.55 ","$3,487.55 ","$3,364.46 ","$2,790.04 ",$174.13 ,$174.13 ,"$3,077.25 ","$2,913.13 ","$2,913.13 ",$174.13 ,"$2,913.13 ","$3,405.49 ","$3,405.49 ","$3,405.49 ", N/A ,$435.32 ,"$3,487.55 ",$174.13 ,"$4,103.00 ",$88.69 ,$88.69 ,"$3,487.55 ",$365.67 ,"$3,487.55 ","$3,692.70 ",$174.13 ,"$3,405.49 ","$3,261.89 ","$3,261.89 ",$174.13 ,"$2,666.95 "
ST. JOSEPH'S HOSPITAL - BREESE,32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$3,317.00 ","$2,156.05 ",$174.13 ,"$3,317.00 ","$2,819.45 ","$1,980.25 ",$174.13 ,"$1,907.28 ",$174.13 ,"$2,285.41 ","$2,819.45 ","$2,819.45 ","$2,819.45 ","$2,719.94 ","$2,255.56 ",$174.13 ,$174.13 ,"$2,487.75 ","$2,355.07 ","$2,355.07 ",$174.13 ,"$2,355.07 ","$2,753.11 ","$2,753.11 ","$2,753.11 ", N/A ,$435.32 ,"$2,819.45 ",$174.13 ,"$3,317.00 ",$200.45 ,$200.45 ,"$2,819.45 ",$365.67 ,"$2,819.45 ","$2,985.30 ",$174.13 ,"$2,753.11 ","$2,637.02 ","$2,637.02 ",$174.13 ,"$2,156.05 "
ST. JOSEPH'S HOSPITAL - BREESE,32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,204.00 ","$2,082.60 ",$222.69 ,"$3,204.00 ","$2,723.40 ","$1,912.79 ",$222.69 ,"$1,842.30 ",$222.69 ,"$2,207.56 ","$2,723.40 ","$2,723.40 ","$2,723.40 ","$2,627.28 ","$2,178.72 ",$222.69 ,$222.69 ,"$2,403.00 ","$2,274.84 ","$2,274.84 ",$222.69 ,"$2,274.84 ","$2,659.32 ","$2,659.32 ","$2,659.32 ", N/A ,$556.73 ,"$2,723.40 ",$222.69 ,"$3,204.00 ",$304.21 ,$304.21 ,"$2,723.40 ",$467.66 ,"$2,723.40 ","$2,883.60 ",$222.69 ,"$2,659.32 ","$2,547.18 ","$2,547.18 ",$222.69 ,"$2,082.60 "
ST. JOSEPH'S HOSPITAL - BREESE,32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,685.00 ","$2,395.25 ",$304.21 ,"$3,685.00 ","$3,132.25 ","$2,199.95 ",$650.59 ,"$2,118.88 ",$650.59 ,"$2,538.97 ","$3,132.25 ","$3,132.25 ","$3,132.25 ","$3,021.70 ","$2,505.80 ",$650.59 ,$650.59 ,"$2,763.75 ","$2,616.35 ","$2,616.35 ",$650.59 ,"$2,616.35 ","$3,058.55 ","$3,058.55 ","$3,058.55 ", N/A ,"$1,626.48 ","$3,132.25 ",$650.59 ,"$3,685.00 ",$304.21 ,$304.21 ,"$3,132.25 ","$1,366.24 ","$3,132.25 ","$3,316.50 ",$650.59 ,"$3,058.55 ","$2,929.58 ","$2,929.58 ",$650.59 ,"$2,395.25 "
ST. JOSEPH'S HOSPITAL - BREESE,32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$492.00 ,$319.80 ,$35.55 ,$492.00 ,$418.20 ,$293.72 ,$76.27 ,$282.90 ,$76.27 ,$338.99 ,$418.20 ,$418.20 ,$418.20 ,$403.44 ,$334.56 ,$76.27 ,$76.27 ,$369.00 ,$349.32 ,$349.32 ,$76.27 ,$349.32 ,$408.36 ,$408.36 ,$408.36 , N/A ,$190.67 ,$418.20 ,$76.27 ,$492.00 ,$35.55 ,$35.55 ,$418.20 ,$160.16 ,$418.20 ,$442.80 ,$76.27 ,$408.36 ,$391.14 ,$391.14 ,$76.27 ,$319.80 
ST. JOSEPH'S HOSPITAL - BREESE,32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$598.00 ,$388.70 ,$35.55 ,$598.00 ,$508.30 ,$357.01 ,$76.27 ,$343.85 ,$76.27 ,$412.02 ,$508.30 ,$508.30 ,$508.30 ,$490.36 ,$406.64 ,$76.27 ,$76.27 ,$448.50 ,$424.58 ,$424.58 ,$76.27 ,$424.58 ,$496.34 ,$496.34 ,$496.34 , N/A ,$190.67 ,$508.30 ,$76.27 ,$598.00 ,$35.55 ,$35.55 ,$508.30 ,$160.16 ,$508.30 ,$538.20 ,$76.27 ,$496.34 ,$475.41 ,$475.41 ,$76.27 ,$388.70 
ST. JOSEPH'S HOSPITAL - BREESE,32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$747.00 ,$485.55 ,$35.55 ,$747.00 ,$634.95 ,$445.96 ,$107.10 ,$429.53 ,$107.10 ,$514.68 ,$634.95 ,$634.95 ,$634.95 ,$612.54 ,$507.96 ,$107.10 ,$107.10 ,$560.25 ,$530.37 ,$530.37 ,$107.10 ,$530.37 ,$620.01 ,$620.01 ,$620.01 , N/A ,$267.76 ,$634.95 ,$107.10 ,$747.00 ,$35.55 ,$35.55 ,$634.95 ,$224.92 ,$634.95 ,$672.30 ,$107.10 ,$620.01 ,$593.87 ,$593.87 ,$107.10 ,$485.55 
ST. JOSEPH'S HOSPITAL - BREESE,32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,"$1,122.00 ",$729.30 ,$35.55 ,"$1,122.00 ",$953.70 ,$669.83 ,$107.10 ,$645.15 ,$107.10 ,$773.06 ,$953.70 ,$953.70 ,$953.70 ,$920.04 ,$762.96 ,$107.10 ,$107.10 ,$841.50 ,$796.62 ,$796.62 ,$107.10 ,$796.62 ,$931.26 ,$931.26 ,$931.26 , N/A ,$267.76 ,$953.70 ,$107.10 ,"$1,122.00 ",$35.55 ,$35.55 ,$953.70 ,$224.92 ,$953.70 ,"$1,009.80 ",$107.10 ,$931.26 ,$891.99 ,$891.99 ,$107.10 ,$729.30 
ST. JOSEPH'S HOSPITAL - BREESE,32000172,72070,HC XR T-SPINE 2V,320,1 ,$374.00 ,$243.10 ,$35.55 ,$374.00 ,$317.90 ,$223.28 ,$107.10 ,$215.05 ,$107.10 ,$257.69 ,$317.90 ,$317.90 ,$317.90 ,$306.68 ,$254.32 ,$107.10 ,$107.10 ,$280.50 ,$265.54 ,$265.54 ,$107.10 ,$265.54 ,$310.42 ,$310.42 ,$310.42 , N/A ,$267.76 ,$317.90 ,$107.10 ,$374.00 ,$35.55 ,$35.55 ,$317.90 ,$224.92 ,$317.90 ,$336.60 ,$107.10 ,$310.42 ,$297.33 ,$297.33 ,$107.10 ,$243.10 
ST. JOSEPH'S HOSPITAL - BREESE,32000174,72072,HC XR T-SPINE 3V,320,1 ,$686.00 ,$445.90 ,$35.55 ,$686.00 ,$583.10 ,$409.54 ,$107.10 ,$394.45 ,$107.10 ,$472.65 ,$583.10 ,$583.10 ,$583.10 ,$562.52 ,$466.48 ,$107.10 ,$107.10 ,$514.50 ,$487.06 ,$487.06 ,$107.10 ,$487.06 ,$569.38 ,$569.38 ,$569.38 , N/A ,$267.76 ,$583.10 ,$107.10 ,$686.00 ,$35.55 ,$35.55 ,$583.10 ,$224.92 ,$583.10 ,$617.40 ,$107.10 ,$569.38 ,$545.37 ,$545.37 ,$107.10 ,$445.90 
ST. JOSEPH'S HOSPITAL - BREESE,32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$729.00 ,$473.85 ,$35.55 ,$729.00 ,$619.65 ,$435.21 ,$107.10 ,$419.18 ,$107.10 ,$502.28 ,$619.65 ,$619.65 ,$619.65 ,$597.78 ,$495.72 ,$107.10 ,$107.10 ,$546.75 ,$517.59 ,$517.59 ,$107.10 ,$517.59 ,$605.07 ,$605.07 ,$605.07 , N/A ,$267.76 ,$619.65 ,$107.10 ,$729.00 ,$35.55 ,$35.55 ,$619.65 ,$224.92 ,$619.65 ,$656.10 ,$107.10 ,$605.07 ,$579.56 ,$579.56 ,$107.10 ,$473.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000181,72110,HC XR L-SPINE 4+V,320,1 ,$979.00 ,$636.35 ,$35.55 ,$979.00 ,$832.15 ,$584.46 ,$107.10 ,$562.93 ,$107.10 ,$674.53 ,$832.15 ,$832.15 ,$832.15 ,$802.78 ,$665.72 ,$107.10 ,$107.10 ,$734.25 ,$695.09 ,$695.09 ,$107.10 ,$695.09 ,$812.57 ,$812.57 ,$812.57 , N/A ,$267.76 ,$832.15 ,$107.10 ,$979.00 ,$35.55 ,$35.55 ,$832.15 ,$224.92 ,$832.15 ,$881.10 ,$107.10 ,$812.57 ,$778.31 ,$778.31 ,$107.10 ,$636.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000183,72120,HC XR L-SPINE BENDING ONLY MIN 4V,320,1 ,$411.00 ,$267.15 ,$35.55 ,$411.00 ,$349.35 ,$245.37 ,$107.10 ,$236.33 ,$107.10 ,$283.18 ,$349.35 ,$349.35 ,$349.35 ,$337.02 ,$279.48 ,$107.10 ,$107.10 ,$308.25 ,$291.81 ,$291.81 ,$107.10 ,$291.81 ,$341.13 ,$341.13 ,$341.13 , N/A ,$267.76 ,$349.35 ,$107.10 ,$411.00 ,$35.55 ,$35.55 ,$349.35 ,$224.92 ,$349.35 ,$369.90 ,$107.10 ,$341.13 ,$326.75 ,$326.75 ,$107.10 ,$267.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,"$1,169.00 ",$759.85 ,$35.55 ,"$1,169.00 ",$993.65 ,$697.89 ,$107.10 ,$672.18 ,$107.10 ,$805.44 ,$993.65 ,$993.65 ,$993.65 ,$958.58 ,$794.92 ,$107.10 ,$107.10 ,$876.75 ,$829.99 ,$829.99 ,$107.10 ,$829.99 ,$970.27 ,$970.27 ,$970.27 , N/A ,$267.76 ,$993.65 ,$107.10 ,"$1,169.00 ",$35.55 ,$35.55 ,$993.65 ,$224.92 ,$993.65 ,"$1,052.10 ",$107.10 ,$970.27 ,$929.36 ,$929.36 ,$107.10 ,$759.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000186,72170,HC XR PELVIS 1-2V,320,1 ,$487.00 ,$316.55 ,$35.55 ,$487.00 ,$413.95 ,$290.74 ,$107.10 ,$280.03 ,$107.10 ,$335.54 ,$413.95 ,$413.95 ,$413.95 ,$399.34 ,$331.16 ,$107.10 ,$107.10 ,$365.25 ,$345.77 ,$345.77 ,$107.10 ,$345.77 ,$404.21 ,$404.21 ,$404.21 , N/A ,$267.76 ,$413.95 ,$107.10 ,$487.00 ,$35.55 ,$35.55 ,$413.95 ,$224.92 ,$413.95 ,$438.30 ,$107.10 ,$404.21 ,$387.17 ,$387.17 ,$107.10 ,$316.55 
ST. JOSEPH'S HOSPITAL - BREESE,32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$531.00 ,$345.15 ,$35.55 ,$531.00 ,$451.35 ,$317.01 ,$107.10 ,$305.33 ,$107.10 ,$365.86 ,$451.35 ,$451.35 ,$451.35 ,$435.42 ,$361.08 ,$107.10 ,$107.10 ,$398.25 ,$377.01 ,$377.01 ,$107.10 ,$377.01 ,$440.73 ,$440.73 ,$440.73 , N/A ,$267.76 ,$451.35 ,$107.10 ,$531.00 ,$35.55 ,$35.55 ,$451.35 ,$224.92 ,$451.35 ,$477.90 ,$107.10 ,$440.73 ,$422.15 ,$422.15 ,$107.10 ,$345.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$524.00 ,$340.60 ,$35.55 ,$524.00 ,$445.40 ,$312.83 ,$76.27 ,$301.30 ,$76.27 ,$361.04 ,$445.40 ,$445.40 ,$445.40 ,$429.68 ,$356.32 ,$76.27 ,$76.27 ,$393.00 ,$372.04 ,$372.04 ,$76.27 ,$372.04 ,$434.92 ,$434.92 ,$434.92 , N/A ,$190.67 ,$445.40 ,$76.27 ,$524.00 ,$35.55 ,$35.55 ,$445.40 ,$160.16 ,$445.40 ,$471.60 ,$76.27 ,$434.92 ,$416.58 ,$416.58 ,$76.27 ,$340.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000201,73000,HC XRAY CLAVICLE,320,1 ,$397.00 ,$258.05 ,$35.55 ,$397.00 ,$337.45 ,$237.01 ,$76.27 ,$228.28 ,$76.27 ,$273.53 ,$337.45 ,$337.45 ,$337.45 ,$325.54 ,$269.96 ,$76.27 ,$76.27 ,$297.75 ,$281.87 ,$281.87 ,$76.27 ,$281.87 ,$329.51 ,$329.51 ,$329.51 , N/A ,$190.67 ,$337.45 ,$76.27 ,$397.00 ,$35.55 ,$35.55 ,$337.45 ,$160.16 ,$337.45 ,$357.30 ,$76.27 ,$329.51 ,$315.62 ,$315.62 ,$76.27 ,$258.05 
ST. JOSEPH'S HOSPITAL - BREESE,32000204,73010,HC XRAY SCAPULA,320,1 ,$397.00 ,$258.05 ,$35.55 ,$397.00 ,$337.45 ,$237.01 ,$107.10 ,$228.28 ,$107.10 ,$273.53 ,$337.45 ,$337.45 ,$337.45 ,$325.54 ,$269.96 ,$107.10 ,$107.10 ,$297.75 ,$281.87 ,$281.87 ,$107.10 ,$281.87 ,$329.51 ,$329.51 ,$329.51 , N/A ,$267.76 ,$337.45 ,$107.10 ,$397.00 ,$35.55 ,$35.55 ,$337.45 ,$224.92 ,$337.45 ,$357.30 ,$107.10 ,$329.51 ,$315.62 ,$315.62 ,$107.10 ,$258.05 
ST. JOSEPH'S HOSPITAL - BREESE,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$388.00 ,$252.20 ,$35.55 ,$388.00 ,$329.80 ,$231.64 ,$76.27 ,$223.10 ,$76.27 ,$267.33 ,$329.80 ,$329.80 ,$329.80 ,$318.16 ,$263.84 ,$76.27 ,$76.27 ,$291.00 ,$275.48 ,$275.48 ,$76.27 ,$275.48 ,$322.04 ,$322.04 ,$322.04 , N/A ,$190.67 ,$329.80 ,$76.27 ,$388.00 ,$35.55 ,$35.55 ,$329.80 ,$160.16 ,$329.80 ,$349.20 ,$76.27 ,$322.04 ,$308.46 ,$308.46 ,$76.27 ,$252.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$546.00 ,$354.90 ,$35.55 ,$546.00 ,$464.10 ,$325.96 ,$76.27 ,$313.95 ,$76.27 ,$376.19 ,$464.10 ,$464.10 ,$464.10 ,$447.72 ,$371.28 ,$76.27 ,$76.27 ,$409.50 ,$387.66 ,$387.66 ,$76.27 ,$387.66 ,$453.18 ,$453.18 ,$453.18 , N/A ,$190.67 ,$464.10 ,$76.27 ,$546.00 ,$35.55 ,$35.55 ,$464.10 ,$160.16 ,$464.10 ,$491.40 ,$76.27 ,$453.18 ,$434.07 ,$434.07 ,$76.27 ,$354.90 
ST. JOSEPH'S HOSPITAL - BREESE,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,687.00 ","$1,096.55 ",$202.58 ,"$1,687.00 ","$1,433.95 ","$1,007.14 ",$364.90 ,$970.03 ,$364.90 ,"$1,162.34 ","$1,433.95 ","$1,433.95 ","$1,433.95 ","$1,383.34 ","$1,147.16 ",$364.90 ,$364.90 ,"$1,265.25 ","$1,197.77 ","$1,197.77 ",$364.90 ,"$1,197.77 ","$1,400.21 ","$1,400.21 ","$1,400.21 ", N/A ,$912.24 ,"$1,433.95 ",$364.90 ,"$1,687.00 ",$202.58 ,$202.58 ,"$1,433.95 ",$766.28 ,"$1,433.95 ","$1,518.30 ",$364.90 ,"$1,400.21 ","$1,341.17 ","$1,341.17 ",$364.90 ,"$1,096.55 "
ST. JOSEPH'S HOSPITAL - BREESE,32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$346.00 ,$224.90 ,$35.55 ,$346.00 ,$294.10 ,$206.56 ,$76.27 ,$198.95 ,$76.27 ,$238.39 ,$294.10 ,$294.10 ,$294.10 ,$283.72 ,$235.28 ,$76.27 ,$76.27 ,$259.50 ,$245.66 ,$245.66 ,$76.27 ,$245.66 ,$287.18 ,$287.18 ,$287.18 , N/A ,$190.67 ,$294.10 ,$76.27 ,$346.00 ,$35.55 ,$35.55 ,$294.10 ,$160.16 ,$294.10 ,$311.40 ,$76.27 ,$287.18 ,$275.07 ,$275.07 ,$76.27 ,$224.90 
ST. JOSEPH'S HOSPITAL - BREESE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$480.00 ,$312.00 ,$35.55 ,$480.00 ,$408.00 ,$286.56 ,$76.27 ,$276.00 ,$76.27 ,$330.72 ,$408.00 ,$408.00 ,$408.00 ,$393.60 ,$326.40 ,$76.27 ,$76.27 ,$360.00 ,$340.80 ,$340.80 ,$76.27 ,$340.80 ,$398.40 ,$398.40 ,$398.40 , N/A ,$190.67 ,$408.00 ,$76.27 ,$480.00 ,$35.55 ,$35.55 ,$408.00 ,$160.16 ,$408.00 ,$432.00 ,$76.27 ,$398.40 ,$381.60 ,$381.60 ,$76.27 ,$312.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$409.00 ,$265.85 ,$35.55 ,$409.00 ,$347.65 ,$244.17 ,$76.27 ,$235.18 ,$76.27 ,$281.80 ,$347.65 ,$347.65 ,$347.65 ,$335.38 ,$278.12 ,$76.27 ,$76.27 ,$306.75 ,$290.39 ,$290.39 ,$76.27 ,$290.39 ,$339.47 ,$339.47 ,$339.47 , N/A ,$190.67 ,$347.65 ,$76.27 ,$409.00 ,$35.55 ,$35.55 ,$347.65 ,$160.16 ,$347.65 ,$368.10 ,$76.27 ,$339.47 ,$325.16 ,$325.16 ,$76.27 ,$265.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$509.00 ,$330.85 ,$35.55 ,$509.00 ,$432.65 ,$303.87 ,$76.27 ,$292.68 ,$76.27 ,$350.70 ,$432.65 ,$432.65 ,$432.65 ,$417.38 ,$346.12 ,$76.27 ,$76.27 ,$381.75 ,$361.39 ,$361.39 ,$76.27 ,$361.39 ,$422.47 ,$422.47 ,$422.47 , N/A ,$190.67 ,$432.65 ,$76.27 ,$509.00 ,$35.55 ,$35.55 ,$432.65 ,$160.16 ,$432.65 ,$458.10 ,$76.27 ,$422.47 ,$404.66 ,$404.66 ,$76.27 ,$330.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,"$1,414.00 ",$919.10 ,$202.58 ,"$1,414.00 ","$1,201.90 ",$844.16 ,$364.90 ,$813.05 ,$364.90 ,$974.25 ,"$1,201.90 ","$1,201.90 ","$1,201.90 ","$1,159.48 ",$961.52 ,$364.90 ,$364.90 ,"$1,060.50 ","$1,003.94 ","$1,003.94 ",$364.90 ,"$1,003.94 ","$1,173.62 ","$1,173.62 ","$1,173.62 ", N/A ,$912.24 ,"$1,201.90 ",$364.90 ,"$1,414.00 ",$202.58 ,$202.58 ,"$1,201.90 ",$766.28 ,"$1,201.90 ","$1,272.60 ",$364.90 ,"$1,173.62 ","$1,124.13 ","$1,124.13 ",$364.90 ,$919.10 
ST. JOSEPH'S HOSPITAL - BREESE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$449.00 ,$291.85 ,$35.55 ,$449.00 ,$381.65 ,$268.05 ,$76.27 ,$258.18 ,$76.27 ,$309.36 ,$381.65 ,$381.65 ,$381.65 ,$368.18 ,$305.32 ,$76.27 ,$76.27 ,$336.75 ,$318.79 ,$318.79 ,$76.27 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$190.67 ,$381.65 ,$76.27 ,$449.00 ,$35.55 ,$35.55 ,$381.65 ,$160.16 ,$381.65 ,$404.10 ,$76.27 ,$372.67 ,$356.96 ,$356.96 ,$76.27 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$424.00 ,$275.60 ,$35.55 ,$424.00 ,$360.40 ,$253.13 ,$107.10 ,$243.80 ,$107.10 ,$292.14 ,$360.40 ,$360.40 ,$360.40 ,$347.68 ,$288.32 ,$107.10 ,$107.10 ,$318.00 ,$301.04 ,$301.04 ,$107.10 ,$301.04 ,$351.92 ,$351.92 ,$351.92 , N/A ,$267.76 ,$360.40 ,$107.10 ,$424.00 ,$35.55 ,$35.55 ,$360.40 ,$224.92 ,$360.40 ,$381.60 ,$107.10 ,$351.92 ,$337.08 ,$337.08 ,$107.10 ,$275.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$397.00 ,$258.05 ,$35.55 ,$397.00 ,$337.45 ,$237.01 ,$76.27 ,$228.28 ,$76.27 ,$273.53 ,$337.45 ,$337.45 ,$337.45 ,$325.54 ,$269.96 ,$76.27 ,$76.27 ,$297.75 ,$281.87 ,$281.87 ,$76.27 ,$281.87 ,$329.51 ,$329.51 ,$329.51 , N/A ,$190.67 ,$337.45 ,$76.27 ,$397.00 ,$35.55 ,$35.55 ,$337.45 ,$160.16 ,$337.45 ,$357.30 ,$76.27 ,$329.51 ,$315.62 ,$315.62 ,$76.27 ,$258.05 
ST. JOSEPH'S HOSPITAL - BREESE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$491.00 ,$319.15 ,$35.55 ,$491.00 ,$417.35 ,$293.13 ,$76.27 ,$282.33 ,$76.27 ,$338.30 ,$417.35 ,$417.35 ,$417.35 ,$402.62 ,$333.88 ,$76.27 ,$76.27 ,$368.25 ,$348.61 ,$348.61 ,$76.27 ,$348.61 ,$407.53 ,$407.53 ,$407.53 , N/A ,$190.67 ,$417.35 ,$76.27 ,$491.00 ,$35.55 ,$35.55 ,$417.35 ,$160.16 ,$417.35 ,$441.90 ,$76.27 ,$407.53 ,$390.35 ,$390.35 ,$76.27 ,$319.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,"$1,413.00 ",$918.45 ,$202.58 ,"$1,413.00 ","$1,201.05 ",$843.56 ,$364.90 ,$812.48 ,$364.90 ,$973.56 ,"$1,201.05 ","$1,201.05 ","$1,201.05 ","$1,158.66 ",$960.84 ,$364.90 ,$364.90 ,"$1,059.75 ","$1,003.23 ","$1,003.23 ",$364.90 ,"$1,003.23 ","$1,172.79 ","$1,172.79 ","$1,172.79 ", N/A ,$912.24 ,"$1,201.05 ",$364.90 ,"$1,413.00 ",$202.58 ,$202.58 ,"$1,201.05 ",$766.28 ,"$1,201.05 ","$1,271.70 ",$364.90 ,"$1,172.79 ","$1,123.34 ","$1,123.34 ",$364.90 ,$918.45 
ST. JOSEPH'S HOSPITAL - BREESE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$459.00 ,$298.35 ,$35.55 ,$459.00 ,$390.15 ,$274.02 ,$107.10 ,$263.93 ,$107.10 ,$316.25 ,$390.15 ,$390.15 ,$390.15 ,$376.38 ,$312.12 ,$107.10 ,$107.10 ,$344.25 ,$325.89 ,$325.89 ,$107.10 ,$325.89 ,$380.97 ,$380.97 ,$380.97 , N/A ,$267.76 ,$390.15 ,$107.10 ,$459.00 ,$35.55 ,$35.55 ,$390.15 ,$224.92 ,$390.15 ,$413.10 ,$107.10 ,$380.97 ,$364.91 ,$364.91 ,$107.10 ,$298.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$473.00 ,$307.45 ,$35.55 ,$473.00 ,$402.05 ,$282.38 ,$76.27 ,$271.98 ,$76.27 ,$325.90 ,$402.05 ,$402.05 ,$402.05 ,$387.86 ,$321.64 ,$76.27 ,$76.27 ,$354.75 ,$335.83 ,$335.83 ,$76.27 ,$335.83 ,$392.59 ,$392.59 ,$392.59 , N/A ,$190.67 ,$402.05 ,$76.27 ,$473.00 ,$35.55 ,$35.55 ,$402.05 ,$160.16 ,$402.05 ,$425.70 ,$76.27 ,$392.59 ,$376.04 ,$376.04 ,$76.27 ,$307.45 
ST. JOSEPH'S HOSPITAL - BREESE,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$615.00 ,$399.75 ,$35.55 ,$615.00 ,$522.75 ,$367.16 ,$76.27 ,$353.63 ,$76.27 ,$423.74 ,$522.75 ,$522.75 ,$522.75 ,$504.30 ,$418.20 ,$76.27 ,$76.27 ,$461.25 ,$436.65 ,$436.65 ,$76.27 ,$436.65 ,$510.45 ,$510.45 ,$510.45 , N/A ,$190.67 ,$522.75 ,$76.27 ,$615.00 ,$35.55 ,$35.55 ,$522.75 ,$160.16 ,$522.75 ,$553.50 ,$76.27 ,$510.45 ,$488.93 ,$488.93 ,$76.27 ,$399.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$922.00 ,$599.30 ,$35.55 ,$922.00 ,$783.70 ,$550.43 ,$76.27 ,$530.15 ,$76.27 ,$635.26 ,$783.70 ,$783.70 ,$783.70 ,$756.04 ,$626.96 ,$76.27 ,$76.27 ,$691.50 ,$654.62 ,$654.62 ,$76.27 ,$654.62 ,$765.26 ,$765.26 ,$765.26 , N/A ,$190.67 ,$783.70 ,$76.27 ,$922.00 ,$35.55 ,$35.55 ,$783.70 ,$160.16 ,$783.70 ,$829.80 ,$76.27 ,$765.26 ,$732.99 ,$732.99 ,$76.27 ,$599.30 
ST. JOSEPH'S HOSPITAL - BREESE,32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,485.00 ",$965.25 ,$202.58 ,"$1,485.00 ","$1,262.25 ",$886.55 ,$364.90 ,$853.88 ,$364.90 ,"$1,023.17 ","$1,262.25 ","$1,262.25 ","$1,262.25 ","$1,217.70 ","$1,009.80 ",$364.90 ,$364.90 ,"$1,113.75 ","$1,054.35 ","$1,054.35 ",$364.90 ,"$1,054.35 ","$1,232.55 ","$1,232.55 ","$1,232.55 ", N/A ,$912.24 ,"$1,262.25 ",$364.90 ,"$1,485.00 ",$202.58 ,$202.58 ,"$1,262.25 ",$766.28 ,"$1,262.25 ","$1,336.50 ",$364.90 ,"$1,232.55 ","$1,180.58 ","$1,180.58 ",$364.90 ,$965.25 
ST. JOSEPH'S HOSPITAL - BREESE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$480.00 ,$312.00 ,$35.55 ,$480.00 ,$408.00 ,$286.56 ,$76.27 ,$276.00 ,$76.27 ,$330.72 ,$408.00 ,$408.00 ,$408.00 ,$393.60 ,$326.40 ,$76.27 ,$76.27 ,$360.00 ,$340.80 ,$340.80 ,$76.27 ,$340.80 ,$398.40 ,$398.40 ,$398.40 , N/A ,$190.67 ,$408.00 ,$76.27 ,$480.00 ,$35.55 ,$35.55 ,$408.00 ,$160.16 ,$408.00 ,$432.00 ,$76.27 ,$398.40 ,$381.60 ,$381.60 ,$76.27 ,$312.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$581.00 ,$377.65 ,$35.55 ,$581.00 ,$493.85 ,$346.86 ,$76.27 ,$334.08 ,$76.27 ,$400.31 ,$493.85 ,$493.85 ,$493.85 ,$476.42 ,$395.08 ,$76.27 ,$76.27 ,$435.75 ,$412.51 ,$412.51 ,$76.27 ,$412.51 ,$482.23 ,$482.23 ,$482.23 , N/A ,$190.67 ,$493.85 ,$76.27 ,$581.00 ,$35.55 ,$35.55 ,$493.85 ,$160.16 ,$493.85 ,$522.90 ,$76.27 ,$482.23 ,$461.90 ,$461.90 ,$76.27 ,$377.65 
ST. JOSEPH'S HOSPITAL - BREESE,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$602.00 ,$391.30 ,$35.55 ,$602.00 ,$511.70 ,$359.39 ,$107.10 ,$346.15 ,$107.10 ,$414.78 ,$511.70 ,$511.70 ,$511.70 ,$493.64 ,$409.36 ,$107.10 ,$107.10 ,$451.50 ,$427.42 ,$427.42 ,$107.10 ,$427.42 ,$499.66 ,$499.66 ,$499.66 , N/A ,$267.76 ,$511.70 ,$107.10 ,$602.00 ,$35.55 ,$35.55 ,$511.70 ,$224.92 ,$511.70 ,$541.80 ,$107.10 ,$499.66 ,$478.59 ,$478.59 ,$107.10 ,$391.30 
ST. JOSEPH'S HOSPITAL - BREESE,32000267,73565,HC XR KNEE STAND,320,1 ,$821.00 ,$533.65 ,$35.55 ,$821.00 ,$697.85 ,$490.14 ,$76.27 ,$472.08 ,$76.27 ,$565.67 ,$697.85 ,$697.85 ,$697.85 ,$673.22 ,$558.28 ,$76.27 ,$76.27 ,$615.75 ,$582.91 ,$582.91 ,$76.27 ,$582.91 ,$681.43 ,$681.43 ,$681.43 , N/A ,$190.67 ,$697.85 ,$76.27 ,$821.00 ,$35.55 ,$35.55 ,$697.85 ,$160.16 ,$697.85 ,$738.90 ,$76.27 ,$681.43 ,$652.70 ,$652.70 ,$76.27 ,$533.65 
ST. JOSEPH'S HOSPITAL - BREESE,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,413.00 ",$918.45 ,$202.58 ,"$1,413.00 ","$1,201.05 ",$843.56 ,$364.90 ,$812.48 ,$364.90 ,$973.56 ,"$1,201.05 ","$1,201.05 ","$1,201.05 ","$1,158.66 ",$960.84 ,$364.90 ,$364.90 ,"$1,059.75 ","$1,003.23 ","$1,003.23 ",$364.90 ,"$1,003.23 ","$1,172.79 ","$1,172.79 ","$1,172.79 ", N/A ,$912.24 ,"$1,201.05 ",$364.90 ,"$1,413.00 ",$202.58 ,$202.58 ,"$1,201.05 ",$766.28 ,"$1,201.05 ","$1,271.70 ",$364.90 ,"$1,172.79 ","$1,123.34 ","$1,123.34 ",$364.90 ,$918.45 
ST. JOSEPH'S HOSPITAL - BREESE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$519.00 ,$337.35 ,$35.55 ,$519.00 ,$441.15 ,$309.84 ,$76.27 ,$298.43 ,$76.27 ,$357.59 ,$441.15 ,$441.15 ,$441.15 ,$425.58 ,$352.92 ,$76.27 ,$76.27 ,$389.25 ,$368.49 ,$368.49 ,$76.27 ,$368.49 ,$430.77 ,$430.77 ,$430.77 , N/A ,$190.67 ,$441.15 ,$76.27 ,$519.00 ,$35.55 ,$35.55 ,$441.15 ,$160.16 ,$441.15 ,$467.10 ,$76.27 ,$430.77 ,$412.61 ,$412.61 ,$76.27 ,$337.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$390.00 ,$253.50 ,$35.55 ,$390.00 ,$331.50 ,$232.83 ,$76.27 ,$224.25 ,$76.27 ,$268.71 ,$331.50 ,$331.50 ,$331.50 ,$319.80 ,$265.20 ,$76.27 ,$76.27 ,$292.50 ,$276.90 ,$276.90 ,$76.27 ,$276.90 ,$323.70 ,$323.70 ,$323.70 , N/A ,$190.67 ,$331.50 ,$76.27 ,$390.00 ,$35.55 ,$35.55 ,$331.50 ,$160.16 ,$331.50 ,$351.00 ,$76.27 ,$323.70 ,$310.05 ,$310.05 ,$76.27 ,$253.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$409.00 ,$265.85 ,$35.55 ,$409.00 ,$347.65 ,$244.17 ,$76.27 ,$235.18 ,$76.27 ,$281.80 ,$347.65 ,$347.65 ,$347.65 ,$335.38 ,$278.12 ,$76.27 ,$76.27 ,$306.75 ,$290.39 ,$290.39 ,$76.27 ,$290.39 ,$339.47 ,$339.47 ,$339.47 , N/A ,$190.67 ,$347.65 ,$76.27 ,$409.00 ,$35.55 ,$35.55 ,$347.65 ,$160.16 ,$347.65 ,$368.10 ,$76.27 ,$339.47 ,$325.16 ,$325.16 ,$76.27 ,$265.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$546.00 ,$354.90 ,$35.55 ,$546.00 ,$464.10 ,$325.96 ,$76.27 ,$313.95 ,$76.27 ,$376.19 ,$464.10 ,$464.10 ,$464.10 ,$447.72 ,$371.28 ,$76.27 ,$76.27 ,$409.50 ,$387.66 ,$387.66 ,$76.27 ,$387.66 ,$453.18 ,$453.18 ,$453.18 , N/A ,$190.67 ,$464.10 ,$76.27 ,$546.00 ,$35.55 ,$35.55 ,$464.10 ,$160.16 ,$464.10 ,$491.40 ,$76.27 ,$453.18 ,$434.07 ,$434.07 ,$76.27 ,$354.90 
ST. JOSEPH'S HOSPITAL - BREESE,32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,342.00 ",$872.30 ,$202.58 ,"$1,342.00 ","$1,140.70 ",$801.17 ,$364.90 ,$771.65 ,$364.90 ,$924.64 ,"$1,140.70 ","$1,140.70 ","$1,140.70 ","$1,100.44 ",$912.56 ,$364.90 ,$364.90 ,"$1,006.50 ",$952.82 ,$952.82 ,$364.90 ,$952.82 ,"$1,113.86 ","$1,113.86 ","$1,113.86 ", N/A ,$912.24 ,"$1,140.70 ",$364.90 ,"$1,342.00 ",$202.58 ,$202.58 ,"$1,140.70 ",$766.28 ,"$1,140.70 ","$1,207.80 ",$364.90 ,"$1,113.86 ","$1,066.89 ","$1,066.89 ",$364.90 ,$872.30 
ST. JOSEPH'S HOSPITAL - BREESE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$409.00 ,$265.85 ,$35.55 ,$409.00 ,$347.65 ,$244.17 ,$76.27 ,$235.18 ,$76.27 ,$281.80 ,$347.65 ,$347.65 ,$347.65 ,$335.38 ,$278.12 ,$76.27 ,$76.27 ,$306.75 ,$290.39 ,$290.39 ,$76.27 ,$290.39 ,$339.47 ,$339.47 ,$339.47 , N/A ,$190.67 ,$347.65 ,$76.27 ,$409.00 ,$35.55 ,$35.55 ,$347.65 ,$160.16 ,$347.65 ,$368.10 ,$76.27 ,$339.47 ,$325.16 ,$325.16 ,$76.27 ,$265.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$519.00 ,$337.35 ,$35.55 ,$519.00 ,$441.15 ,$309.84 ,$76.27 ,$298.43 ,$76.27 ,$357.59 ,$441.15 ,$441.15 ,$441.15 ,$425.58 ,$352.92 ,$76.27 ,$76.27 ,$389.25 ,$368.49 ,$368.49 ,$76.27 ,$368.49 ,$430.77 ,$430.77 ,$430.77 , N/A ,$190.67 ,$441.15 ,$76.27 ,$519.00 ,$35.55 ,$35.55 ,$441.15 ,$160.16 ,$441.15 ,$467.10 ,$76.27 ,$430.77 ,$412.61 ,$412.61 ,$76.27 ,$337.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$397.00 ,$258.05 ,$35.55 ,$397.00 ,$337.45 ,$237.01 ,$76.27 ,$228.28 ,$76.27 ,$273.53 ,$337.45 ,$337.45 ,$337.45 ,$325.54 ,$269.96 ,$76.27 ,$76.27 ,$297.75 ,$281.87 ,$281.87 ,$76.27 ,$281.87 ,$329.51 ,$329.51 ,$329.51 , N/A ,$190.67 ,$337.45 ,$76.27 ,$397.00 ,$35.55 ,$35.55 ,$337.45 ,$160.16 ,$337.45 ,$357.30 ,$76.27 ,$329.51 ,$315.62 ,$315.62 ,$76.27 ,$258.05 
ST. JOSEPH'S HOSPITAL - BREESE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$341.00 ,$221.65 ,$35.55 ,$341.00 ,$289.85 ,$203.58 ,$76.27 ,$196.08 ,$76.27 ,$234.95 ,$289.85 ,$289.85 ,$289.85 ,$279.62 ,$231.88 ,$76.27 ,$76.27 ,$255.75 ,$242.11 ,$242.11 ,$76.27 ,$242.11 ,$283.03 ,$283.03 ,$283.03 , N/A ,$190.67 ,$289.85 ,$76.27 ,$341.00 ,$35.55 ,$35.55 ,$289.85 ,$160.16 ,$289.85 ,$306.90 ,$76.27 ,$283.03 ,$271.10 ,$271.10 ,$76.27 ,$221.65 
ST. JOSEPH'S HOSPITAL - BREESE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$515.00 ,$334.75 ,$35.55 ,$515.00 ,$437.75 ,$307.46 ,$76.27 ,$296.13 ,$76.27 ,$354.84 ,$437.75 ,$437.75 ,$437.75 ,$422.30 ,$350.20 ,$76.27 ,$76.27 ,$386.25 ,$365.65 ,$365.65 ,$76.27 ,$365.65 ,$427.45 ,$427.45 ,$427.45 , N/A ,$190.67 ,$437.75 ,$76.27 ,$515.00 ,$35.55 ,$35.55 ,$437.75 ,$160.16 ,$437.75 ,$463.50 ,$76.27 ,$427.45 ,$409.43 ,$409.43 ,$76.27 ,$334.75 
ST. JOSEPH'S HOSPITAL - BREESE,32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$461.00 ,$299.65 ,$35.55 ,$461.00 ,$391.85 ,$275.22 ,$76.27 ,$265.08 ,$76.27 ,$317.63 ,$391.85 ,$391.85 ,$391.85 ,$378.02 ,$313.48 ,$76.27 ,$76.27 ,$345.75 ,$327.31 ,$327.31 ,$76.27 ,$327.31 ,$382.63 ,$382.63 ,$382.63 , N/A ,$190.67 ,$391.85 ,$76.27 ,$461.00 ,$35.55 ,$35.55 ,$391.85 ,$160.16 ,$391.85 ,$414.90 ,$76.27 ,$382.63 ,$366.50 ,$366.50 ,$76.27 ,$299.65 
ST. JOSEPH'S HOSPITAL - BREESE,32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$671.00 ,$436.15 ,$35.55 ,$671.00 ,$570.35 ,$400.59 ,$107.10 ,$385.83 ,$107.10 ,$462.32 ,$570.35 ,$570.35 ,$570.35 ,$550.22 ,$456.28 ,$107.10 ,$107.10 ,$503.25 ,$476.41 ,$476.41 ,$107.10 ,$476.41 ,$556.93 ,$556.93 ,$556.93 , N/A ,$267.76 ,$570.35 ,$107.10 ,$671.00 ,$35.55 ,$35.55 ,$570.35 ,$224.92 ,$570.35 ,$603.90 ,$107.10 ,$556.93 ,$533.45 ,$533.45 ,$107.10 ,$436.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,"$1,100.00 ",$715.00 ,$35.55 ,"$1,100.00 ",$935.00 ,$656.70 ,$107.10 ,$632.50 ,$107.10 ,$757.90 ,$935.00 ,$935.00 ,$935.00 ,$902.00 ,$748.00 ,$107.10 ,$107.10 ,$825.00 ,$781.00 ,$781.00 ,$107.10 ,$781.00 ,$913.00 ,$913.00 ,$913.00 , N/A ,$267.76 ,$935.00 ,$107.10 ,"$1,100.00 ",$35.55 ,$35.55 ,$935.00 ,$224.92 ,$935.00 ,$990.00 ,$107.10 ,$913.00 ,$874.50 ,$874.50 ,$107.10 ,$715.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$683.00 ,$443.95 ,$35.55 ,$683.00 ,$580.55 ,$407.75 ,$174.13 ,$392.73 ,$174.13 ,$470.59 ,$580.55 ,$580.55 ,$580.55 ,$560.06 ,$464.44 ,$174.13 ,$174.13 ,$512.25 ,$484.93 ,$484.93 ,$174.13 ,$484.93 ,$566.89 ,$566.89 ,$566.89 , N/A ,$435.32 ,$580.55 ,$174.13 ,$683.00 ,$35.55 ,$35.55 ,$580.55 ,$365.67 ,$580.55 ,$614.70 ,$174.13 ,$566.89 ,$542.99 ,$542.99 ,$174.13 ,$443.95 
ST. JOSEPH'S HOSPITAL - BREESE,32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$756.00 ,$491.40 ,$78.17 ,$756.00 ,$642.60 ,$451.33 ,$174.13 ,$434.70 ,$174.13 ,$520.88 ,$642.60 ,$642.60 ,$642.60 ,$619.92 ,$514.08 ,$174.13 ,$174.13 ,$567.00 ,$536.76 ,$536.76 ,$174.13 ,$536.76 ,$627.48 ,$627.48 ,$627.48 , N/A ,$435.32 ,$642.60 ,$174.13 ,$756.00 ,$78.17 ,$78.17 ,$642.60 ,$365.67 ,$642.60 ,$680.40 ,$174.13 ,$627.48 ,$601.02 ,$601.02 ,$174.13 ,$491.40 
ST. JOSEPH'S HOSPITAL - BREESE,32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,"$1,208.00 ",$785.20 ,$78.17 ,"$1,208.00 ","$1,026.80 ",$721.18 ,$174.13 ,$694.60 ,$174.13 ,$832.31 ,"$1,026.80 ","$1,026.80 ","$1,026.80 ",$990.56 ,$821.44 ,$174.13 ,$174.13 ,$906.00 ,$857.68 ,$857.68 ,$174.13 ,$857.68 ,"$1,002.64 ","$1,002.64 ","$1,002.64 ", N/A ,$435.32 ,"$1,026.80 ",$174.13 ,"$1,208.00 ",$78.17 ,$78.17 ,"$1,026.80 ",$365.67 ,"$1,026.80 ","$1,087.20 ",$174.13 ,"$1,002.64 ",$960.36 ,$960.36 ,$174.13 ,$785.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000303,74241,HC SINGLE CONTRAST UPPER GI W/KUB,320,1 ,"$1,369.00 ",$889.85 ,$787.18 ,"$1,369.00 ","$1,163.65 ",$817.29 , N/A ,$787.18 , N/A ,$943.24 ,"$1,163.65 ","$1,163.65 ","$1,163.65 ","$1,122.58 ",$930.92 , N/A , N/A ,"$1,026.75 ",$971.99 ,$971.99 , N/A ,$971.99 ,"$1,136.27 ","$1,136.27 ","$1,136.27 ", N/A , N/A ,"$1,163.65 ", N/A ,"$1,369.00 ", N/A , N/A ,"$1,163.65 ", N/A ,"$1,163.65 ","$1,232.10 ", N/A ,"$1,136.27 ","$1,088.36 ","$1,088.36 ", N/A ,$889.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000304,74245,HC UPPER GI\SMALL BOWEL SGL,320,1 ,"$1,657.00 ","$1,077.05 ",$952.78 ,"$1,657.00 ","$1,408.45 ",$989.23 , N/A ,$952.78 , N/A ,"$1,141.67 ","$1,408.45 ","$1,408.45 ","$1,408.45 ","$1,358.74 ","$1,126.76 ", N/A , N/A ,"$1,242.75 ","$1,176.47 ","$1,176.47 ", N/A ,"$1,176.47 ","$1,375.31 ","$1,375.31 ","$1,375.31 ", N/A , N/A ,"$1,408.45 ", N/A ,"$1,657.00 ", N/A , N/A ,"$1,408.45 ", N/A ,"$1,408.45 ","$1,491.30 ", N/A ,"$1,375.31 ","$1,317.32 ","$1,317.32 ", N/A ,"$1,077.05 "
ST. JOSEPH'S HOSPITAL - BREESE,32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,"$1,348.00 ",$876.20 ,$78.17 ,"$1,348.00 ","$1,145.80 ",$804.76 ,$174.13 ,$775.10 ,$174.13 ,$928.77 ,"$1,145.80 ","$1,145.80 ","$1,145.80 ","$1,105.36 ",$916.64 ,$174.13 ,$174.13 ,"$1,011.00 ",$957.08 ,$957.08 ,$174.13 ,$957.08 ,"$1,118.84 ","$1,118.84 ","$1,118.84 ", N/A ,$435.32 ,"$1,145.80 ",$174.13 ,"$1,348.00 ",$78.17 ,$78.17 ,"$1,145.80 ",$365.67 ,"$1,145.80 ","$1,213.20 ",$174.13 ,"$1,118.84 ","$1,071.66 ","$1,071.66 ",$174.13 ,$876.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,"$1,348.00 ",$876.20 ,$78.17 ,"$1,348.00 ","$1,145.80 ",$804.76 ,$174.13 ,$775.10 ,$174.13 ,$928.77 ,"$1,145.80 ","$1,145.80 ","$1,145.80 ","$1,105.36 ",$916.64 ,$174.13 ,$174.13 ,"$1,011.00 ",$957.08 ,$957.08 ,$174.13 ,$957.08 ,"$1,118.84 ","$1,118.84 ","$1,118.84 ", N/A ,$435.32 ,"$1,145.80 ",$174.13 ,"$1,348.00 ",$78.17 ,$78.17 ,"$1,145.80 ",$365.67 ,"$1,145.80 ","$1,213.20 ",$174.13 ,"$1,118.84 ","$1,071.66 ","$1,071.66 ",$174.13 ,$876.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000308,74247,HC UPPER GI W/KUB DBL CONTRAST,320,1 ,"$1,653.00 ","$1,074.45 ",$950.48 ,"$1,653.00 ","$1,405.05 ",$986.84 , N/A ,$950.48 , N/A ,"$1,138.92 ","$1,405.05 ","$1,405.05 ","$1,405.05 ","$1,355.46 ","$1,124.04 ", N/A , N/A ,"$1,239.75 ","$1,173.63 ","$1,173.63 ", N/A ,"$1,173.63 ","$1,371.99 ","$1,371.99 ","$1,371.99 ", N/A , N/A ,"$1,405.05 ", N/A ,"$1,653.00 ", N/A , N/A ,"$1,405.05 ", N/A ,"$1,405.05 ","$1,487.70 ", N/A ,"$1,371.99 ","$1,314.14 ","$1,314.14 ", N/A ,"$1,074.45 "
ST. JOSEPH'S HOSPITAL - BREESE,32000309,74249,HC UGI/SM BOWEL W AIR CONT,320,1 ,"$1,959.00 ","$1,273.35 ","$1,126.43 ","$1,959.00 ","$1,665.15 ","$1,169.52 ", N/A ,"$1,126.43 ", N/A ,"$1,349.75 ","$1,665.15 ","$1,665.15 ","$1,665.15 ","$1,606.38 ","$1,332.12 ", N/A , N/A ,"$1,469.25 ","$1,390.89 ","$1,390.89 ", N/A ,"$1,390.89 ","$1,625.97 ","$1,625.97 ","$1,625.97 ", N/A , N/A ,"$1,665.15 ", N/A ,"$1,959.00 ", N/A , N/A ,"$1,665.15 ", N/A ,"$1,665.15 ","$1,763.10 ", N/A ,"$1,625.97 ","$1,557.41 ","$1,557.41 ", N/A ,"$1,273.35 "
ST. JOSEPH'S HOSPITAL - BREESE,32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$756.00 ,$491.40 ,$78.17 ,$756.00 ,$642.60 ,$451.33 ,$174.13 ,$434.70 ,$174.13 ,$520.88 ,$642.60 ,$642.60 ,$642.60 ,$619.92 ,$514.08 ,$174.13 ,$174.13 ,$567.00 ,$536.76 ,$536.76 ,$174.13 ,$536.76 ,$627.48 ,$627.48 ,$627.48 , N/A ,$435.32 ,$642.60 ,$174.13 ,$756.00 ,$78.17 ,$78.17 ,$642.60 ,$365.67 ,$642.60 ,$680.40 ,$174.13 ,$627.48 ,$601.02 ,$601.02 ,$174.13 ,$491.40 
ST. JOSEPH'S HOSPITAL - BREESE,32000315,74270,HC XRAY COLON BARIUM,320,1 ,"$1,383.00 ",$898.95 ,$78.17 ,"$1,383.00 ","$1,175.55 ",$825.65 ,$174.13 ,$795.23 ,$174.13 ,$952.89 ,"$1,175.55 ","$1,175.55 ","$1,175.55 ","$1,134.06 ",$940.44 ,$174.13 ,$174.13 ,"$1,037.25 ",$981.93 ,$981.93 ,$174.13 ,$981.93 ,"$1,147.89 ","$1,147.89 ","$1,147.89 ", N/A ,$435.32 ,"$1,175.55 ",$174.13 ,"$1,383.00 ",$78.17 ,$78.17 ,"$1,175.55 ",$365.67 ,"$1,175.55 ","$1,244.70 ",$174.13 ,"$1,147.89 ","$1,099.49 ","$1,099.49 ",$174.13 ,$898.95 
ST. JOSEPH'S HOSPITAL - BREESE,32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,"$1,383.00 ",$898.95 ,$78.17 ,"$1,383.00 ","$1,175.55 ",$825.65 ,$174.13 ,$795.23 ,$174.13 ,$952.89 ,"$1,175.55 ","$1,175.55 ","$1,175.55 ","$1,134.06 ",$940.44 ,$174.13 ,$174.13 ,"$1,037.25 ",$981.93 ,$981.93 ,$174.13 ,$981.93 ,"$1,147.89 ","$1,147.89 ","$1,147.89 ", N/A ,$435.32 ,"$1,175.55 ",$174.13 ,"$1,383.00 ",$78.17 ,$78.17 ,"$1,175.55 ",$365.67 ,"$1,175.55 ","$1,244.70 ",$174.13 ,"$1,147.89 ","$1,099.49 ","$1,099.49 ",$174.13 ,$898.95 
ST. JOSEPH'S HOSPITAL - BREESE,32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,"$1,383.00 ",$898.95 ,$78.17 ,"$1,383.00 ","$1,175.55 ",$825.65 ,$174.13 ,$795.23 ,$174.13 ,$952.89 ,"$1,175.55 ","$1,175.55 ","$1,175.55 ","$1,134.06 ",$940.44 ,$174.13 ,$174.13 ,"$1,037.25 ",$981.93 ,$981.93 ,$174.13 ,$981.93 ,"$1,147.89 ","$1,147.89 ","$1,147.89 ", N/A ,$435.32 ,"$1,175.55 ",$174.13 ,"$1,383.00 ",$78.17 ,$78.17 ,"$1,175.55 ",$365.67 ,"$1,175.55 ","$1,244.70 ",$174.13 ,"$1,147.89 ","$1,099.49 ","$1,099.49 ",$174.13 ,$898.95 
ST. JOSEPH'S HOSPITAL - BREESE,32000320,74280,HC XRAY COLON BARIUM AIR CONTRAST,320,1 ,"$1,563.00 ","$1,015.95 ",$78.17 ,"$1,563.00 ","$1,328.55 ",$933.11 ,$174.13 ,$898.73 ,$174.13 ,"$1,076.91 ","$1,328.55 ","$1,328.55 ","$1,328.55 ","$1,281.66 ","$1,062.84 ",$174.13 ,$174.13 ,"$1,172.25 ","$1,109.73 ","$1,109.73 ",$174.13 ,"$1,109.73 ","$1,297.29 ","$1,297.29 ","$1,297.29 ", N/A ,$435.32 ,"$1,328.55 ",$174.13 ,"$1,563.00 ",$78.17 ,$78.17 ,"$1,328.55 ",$365.67 ,"$1,328.55 ","$1,406.70 ",$174.13 ,"$1,297.29 ","$1,242.59 ","$1,242.59 ",$174.13 ,"$1,015.95 "
ST. JOSEPH'S HOSPITAL - BREESE,32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$904.00 ,$587.60 ,$202.58 ,$904.00 ,$768.40 ,$539.69 , N/A ,$519.80 , N/A ,$622.86 ,$768.40 ,$768.40 ,$768.40 ,$741.28 ,$614.72 , N/A , N/A ,$678.00 ,$641.84 ,$641.84 , N/A ,$641.84 ,$750.32 ,$750.32 ,$750.32 , N/A , N/A ,$768.40 , N/A ,$904.00 ,$202.58 ,$202.58 ,$768.40 , N/A ,$768.40 ,$813.60 , N/A ,$750.32 ,$718.68 ,$718.68 , N/A ,$587.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000324,74301,HC CHOLANGIOGRAPHY OPERATIVE ADDL,320,1 ,$302.00 ,$196.30 ,$173.65 ,$302.00 ,$256.70 ,$180.29 , N/A ,$173.65 , N/A ,$208.08 ,$256.70 ,$256.70 ,$256.70 ,$247.64 ,$205.36 , N/A , N/A ,$226.50 ,$214.42 ,$214.42 , N/A ,$214.42 ,$250.66 ,$250.66 ,$250.66 , N/A , N/A ,$256.70 , N/A ,$302.00 ,$202.58 ,$202.58 ,$256.70 , N/A ,$256.70 ,$271.80 , N/A ,$250.66 ,$240.09 ,$240.09 , N/A ,$196.30 
ST. JOSEPH'S HOSPITAL - BREESE,32000325,47531,HC XRAY CHOLANGIOGRAM THRU CATH,320,1 ,"$1,486.00 ",$965.90 ,$78.17 ,"$6,239.70 ","$1,263.10 ",$887.14 ,"$2,971.29 ",$854.45 ,"$2,971.29 ","$1,023.85 ","$1,263.10 ","$1,263.10 ","$1,263.10 ","$1,218.52 ","$1,010.48 ","$2,971.29 ","$2,971.29 ","$1,114.50 ","$1,055.06 ","$1,055.06 ","$2,971.29 ","$1,055.06 ","$1,233.38 ","$1,233.38 ","$1,233.38 ", N/A ,"$1,486.00 ","$1,263.10 ","$2,971.29 ","$1,486.00 ",$78.17 ,$78.17 ,"$1,263.10 ","$6,239.70 ","$1,263.10 ","$1,337.40 ","$2,971.29 ","$1,233.38 ","$1,181.37 ","$1,181.37 ","$2,971.29 ",$965.90 
ST. JOSEPH'S HOSPITAL - BREESE,32000335,74400,HC XRAY IVP W OR W/O TOMO,320,1 ,"$1,436.00 ",$933.40 ,$174.13 ,"$1,436.00 ","$1,220.60 ",$857.29 ,$174.13 ,$825.70 ,$174.13 ,$989.40 ,"$1,220.60 ","$1,220.60 ","$1,220.60 ","$1,177.52 ",$976.48 ,$174.13 ,$174.13 ,"$1,077.00 ","$1,019.56 ","$1,019.56 ",$174.13 ,"$1,019.56 ","$1,191.88 ","$1,191.88 ","$1,191.88 ", N/A ,$435.32 ,"$1,220.60 ",$174.13 ,"$1,436.00 ",$221.76 ,$221.76 ,"$1,220.60 ",$365.67 ,"$1,220.60 ","$1,292.40 ",$174.13 ,"$1,191.88 ","$1,141.62 ","$1,141.62 ",$174.13 ,$933.40 
ST. JOSEPH'S HOSPITAL - BREESE,32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,$903.00 ,$586.95 ,$202.58 ,$903.00 ,$767.55 ,$539.09 ,$364.90 ,$519.23 ,$364.90 ,$622.17 ,$767.55 ,$767.55 ,$767.55 ,$740.46 ,$614.04 ,$364.90 ,$364.90 ,$677.25 ,$641.13 ,$641.13 ,$364.90 ,$641.13 ,$749.49 ,$749.49 ,$749.49 , N/A ,$903.00 ,$767.55 ,$364.90 ,$903.00 ,$202.58 ,$202.58 ,$767.55 ,$766.28 ,$767.55 ,$812.70 ,$364.90 ,$749.49 ,$717.89 ,$717.89 ,$364.90 ,$586.95 
ST. JOSEPH'S HOSPITAL - BREESE,32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,"$1,270.00 ",$825.50 ,$202.58 ,"$1,270.00 ","$1,079.50 ",$758.19 ,$222.69 ,$730.25 ,$222.69 ,$875.03 ,"$1,079.50 ","$1,079.50 ","$1,079.50 ","$1,041.40 ",$863.60 ,$222.69 ,$222.69 ,$952.50 ,$901.70 ,$901.70 ,$222.69 ,$901.70 ,"$1,054.10 ","$1,054.10 ","$1,054.10 ", N/A ,$556.73 ,"$1,079.50 ",$222.69 ,"$1,270.00 ",$202.58 ,$202.58 ,"$1,079.50 ",$467.66 ,"$1,079.50 ","$1,143.00 ",$222.69 ,"$1,054.10 ","$1,009.65 ","$1,009.65 ",$222.69 ,$825.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$856.00 ,$556.40 ,$202.58 ,$856.00 ,$727.60 ,$511.03 ,$222.69 ,$492.20 ,$222.69 ,$589.78 ,$727.60 ,$727.60 ,$727.60 ,$701.92 ,$582.08 ,$222.69 ,$222.69 ,$642.00 ,$607.76 ,$607.76 ,$222.69 ,$607.76 ,$710.48 ,$710.48 ,$710.48 , N/A ,$556.73 ,$727.60 ,$222.69 ,$856.00 ,$202.58 ,$202.58 ,$727.60 ,$467.66 ,$727.60 ,$770.40 ,$222.69 ,$710.48 ,$680.52 ,$680.52 ,$222.69 ,$556.40 
ST. JOSEPH'S HOSPITAL - BREESE,32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$1,591.00 ","$1,034.15 ",$202.58 ,"$1,591.00 ","$1,352.35 ",$949.83 , N/A ,$914.83 , N/A ,"$1,096.20 ","$1,352.35 ","$1,352.35 ","$1,352.35 ","$1,304.62 ","$1,081.88 ", N/A , N/A ,"$1,193.25 ","$1,129.61 ","$1,129.61 ", N/A ,"$1,129.61 ","$1,320.53 ","$1,320.53 ","$1,320.53 ", N/A , N/A ,"$1,352.35 ", N/A ,"$1,591.00 ",$202.58 ,$202.58 ,"$1,352.35 ", N/A ,"$1,352.35 ","$1,431.90 ", N/A ,"$1,320.53 ","$1,264.85 ","$1,264.85 ", N/A ,"$1,034.15 "
ST. JOSEPH'S HOSPITAL - BREESE,32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$665.00 ,$432.25 ,$35.55 ,$665.00 ,$565.25 ,$397.01 ,$222.69 ,$382.38 ,$222.69 ,$458.19 ,$565.25 ,$565.25 ,$565.25 ,$545.30 ,$452.20 ,$222.69 ,$222.69 ,$498.75 ,$472.15 ,$472.15 ,$222.69 ,$472.15 ,$551.95 ,$551.95 ,$551.95 , N/A ,$556.73 ,$565.25 ,$222.69 ,$665.00 ,$35.55 ,$35.55 ,$565.25 ,$467.66 ,$565.25 ,$598.50 ,$222.69 ,$551.95 ,$528.68 ,$528.68 ,$222.69 ,$432.25 
ST. JOSEPH'S HOSPITAL - BREESE,32000464,76010,HC BABYGRAM,320,1 ,$444.00 ,$288.60 ,$35.55 ,$444.00 ,$377.40 ,$265.07 ,$76.27 ,$255.30 ,$76.27 ,$305.92 ,$377.40 ,$377.40 ,$377.40 ,$364.08 ,$301.92 ,$76.27 ,$76.27 ,$333.00 ,$315.24 ,$315.24 ,$76.27 ,$315.24 ,$368.52 ,$368.52 ,$368.52 , N/A ,$190.67 ,$377.40 ,$76.27 ,$444.00 ,$35.55 ,$35.55 ,$377.40 ,$160.16 ,$377.40 ,$399.60 ,$76.27 ,$368.52 ,$352.98 ,$352.98 ,$76.27 ,$288.60 
ST. JOSEPH'S HOSPITAL - BREESE,32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$407.00 ,$264.55 ,$28.81 ,$966.42 ,$345.95 ,$242.98 ,$460.20 ,$234.03 ,$460.20 ,$280.42 ,$345.95 ,$345.95 ,$345.95 ,$333.74 ,$276.76 ,$460.20 ,$460.20 ,$305.25 ,$288.97 ,$288.97 ,$460.20 ,$288.97 ,$337.81 ,$337.81 ,$337.81 , N/A ,$407.00 ,$345.95 ,$460.20 ,$28.81 ,$35.55 ,$35.55 ,$345.95 ,$966.42 ,$345.95 ,$366.30 ,$460.20 ,$337.81 ,$323.57 ,$323.57 ,$460.20 ,$264.55 
ST. JOSEPH'S HOSPITAL - BREESE,32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,"$1,271.00 ",$826.15 ,$202.58 ,"$1,271.00 ","$1,080.35 ",$758.79 , N/A ,$730.83 , N/A ,$875.72 ,"$1,080.35 ","$1,080.35 ","$1,080.35 ","$1,042.22 ",$864.28 , N/A , N/A ,$953.25 ,$902.41 ,$902.41 , N/A ,$902.41 ,"$1,054.93 ","$1,054.93 ","$1,054.93 ", N/A , N/A ,"$1,080.35 ", N/A ,"$1,271.00 ",$202.58 ,$202.58 ,"$1,080.35 ", N/A ,"$1,080.35 ","$1,143.90 ", N/A ,"$1,054.93 ","$1,010.45 ","$1,010.45 ", N/A ,$826.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$799.00 ,$519.35 ,$202.58 ,$799.00 ,$679.15 ,$477.00 , N/A ,$459.43 , N/A ,$550.51 ,$679.15 ,$679.15 ,$679.15 ,$655.18 ,$543.32 , N/A , N/A ,$599.25 ,$567.29 ,$567.29 , N/A ,$567.29 ,$663.17 ,$663.17 ,$663.17 , N/A , N/A ,$679.15 , N/A ,$799.00 ,$202.58 ,$202.58 ,$679.15 , N/A ,$679.15 ,$719.10 , N/A ,$663.17 ,$635.21 ,$635.21 , N/A ,$519.35 
ST. JOSEPH'S HOSPITAL - BREESE,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$4,975.00 ","$3,233.75 ",$656.56 ,"$4,975.00 ","$4,228.75 ","$2,970.08 ","$1,311.66 ","$2,860.63 ","$1,311.66 ","$3,427.78 ","$4,228.75 ","$4,228.75 ","$4,228.75 ","$4,079.50 ","$3,383.00 ","$1,311.66 ","$1,311.66 ","$3,731.25 ","$3,532.25 ","$3,532.25 ","$1,311.66 ","$3,532.25 ","$4,129.25 ","$4,129.25 ","$4,129.25 ", N/A ,"$3,279.14 ","$4,228.75 ","$1,311.66 ",$656.56 ,$787.43 ,$787.43 ,"$4,228.75 ","$2,754.48 ","$4,228.75 ","$4,477.50 ","$1,311.66 ","$4,129.25 ","$3,955.13 ","$3,955.13 ","$1,311.66 ","$3,233.75 "
ST. JOSEPH'S HOSPITAL - BREESE,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,"$1,736.00 ","$1,128.40 ",$76.28 ,"$1,736.00 ","$1,475.60 ","$1,036.39 ",$582.93 ,$998.20 ,$582.93 ,"$1,196.10 ","$1,475.60 ","$1,475.60 ","$1,475.60 ","$1,423.52 ","$1,180.48 ",$582.93 ,$582.93 ,"$1,302.00 ","$1,232.56 ","$1,232.56 ",$582.93 ,"$1,232.56 ","$1,440.88 ","$1,440.88 ","$1,440.88 ", N/A ,"$1,457.31 ","$1,475.60 ",$582.93 ,$264.15 ,$76.28 ,$76.28 ,"$1,475.60 ","$1,224.14 ","$1,475.60 ","$1,562.40 ",$582.93 ,"$1,440.88 ","$1,380.12 ","$1,380.12 ",$582.93 ,"$1,128.40 "
ST. JOSEPH'S HOSPITAL - BREESE,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,"$2,603.00 ","$1,691.95 ",$76.28 ,"$2,603.00 ","$2,212.55 ","$1,553.99 ",$582.93 ,"$1,496.73 ",$582.93 ,"$1,793.47 ","$2,212.55 ","$2,212.55 ","$2,212.55 ","$2,134.46 ","$1,770.04 ",$582.93 ,$582.93 ,"$1,952.25 ","$1,848.13 ","$1,848.13 ",$582.93 ,"$1,848.13 ","$2,160.49 ","$2,160.49 ","$2,160.49 ", N/A ,"$1,457.31 ","$2,212.55 ",$582.93 ,$264.15 ,$76.28 ,$76.28 ,"$2,212.55 ","$1,224.14 ","$2,212.55 ","$2,342.70 ",$582.93 ,"$2,160.49 ","$2,069.39 ","$2,069.39 ",$582.93 ,"$1,691.95 "
ST. JOSEPH'S HOSPITAL - BREESE,32000490,77053,HC GALACTOGRAM SINGLE DUCT,320,1 ,$588.00 ,$382.20 ,$41.18 ,$588.00 ,$499.80 ,$351.04 ,$222.69 ,$338.10 ,$222.69 ,$405.13 ,$499.80 ,$499.80 ,$499.80 ,$482.16 ,$399.84 ,$222.69 ,$222.69 ,$441.00 ,$417.48 ,$417.48 ,$222.69 ,$417.48 ,$488.04 ,$488.04 ,$488.04 , N/A ,$556.73 ,$499.80 ,$222.69 ,$41.18 ,$202.58 ,$202.58 ,$499.80 ,$467.66 ,$499.80 ,$529.20 ,$222.69 ,$488.04 ,$467.46 ,$467.46 ,$222.69 ,$382.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$773.00 ,$502.45 ,$35.55 ,$773.00 ,$657.05 ,$461.48 ,$107.10 ,$444.48 ,$107.10 ,$532.60 ,$657.05 ,$657.05 ,$657.05 ,$633.86 ,$525.64 ,$107.10 ,$107.10 ,$579.75 ,$548.83 ,$548.83 ,$107.10 ,$548.83 ,$641.59 ,$641.59 ,$641.59 , N/A ,$267.76 ,$657.05 ,$107.10 ,$773.00 ,$35.55 ,$35.55 ,$657.05 ,$224.92 ,$657.05 ,$695.70 ,$107.10 ,$641.59 ,$614.54 ,$614.54 ,$107.10 ,$502.45 
ST. JOSEPH'S HOSPITAL - BREESE,32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,"$1,041.00 ",$676.65 ,$35.55 ,"$1,041.00 ",$884.85 ,$621.48 ,$107.10 ,$598.58 ,$107.10 ,$717.25 ,$884.85 ,$884.85 ,$884.85 ,$853.62 ,$707.88 ,$107.10 ,$107.10 ,$780.75 ,$739.11 ,$739.11 ,$107.10 ,$739.11 ,$864.03 ,$864.03 ,$864.03 , N/A ,$267.76 ,$884.85 ,$107.10 ,"$1,041.00 ",$35.55 ,$35.55 ,$884.85 ,$224.92 ,$884.85 ,$936.90 ,$107.10 ,$864.03 ,$827.60 ,$827.60 ,$107.10 ,$676.65 
ST. JOSEPH'S HOSPITAL - BREESE,32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$831.00 ,$540.15 ,$35.55 ,$831.00 ,$706.35 ,$496.11 ,$107.10 ,$477.83 ,$107.10 ,$572.56 ,$706.35 ,$706.35 ,$706.35 ,$681.42 ,$565.08 ,$107.10 ,$107.10 ,$623.25 ,$590.01 ,$590.01 ,$107.10 ,$590.01 ,$689.73 ,$689.73 ,$689.73 , N/A ,$267.76 ,$706.35 ,$107.10 ,$831.00 ,$35.55 ,$35.55 ,$706.35 ,$224.92 ,$706.35 ,$747.90 ,$107.10 ,$689.73 ,$660.65 ,$660.65 ,$107.10 ,$540.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000496,77080,HC BONE DENSITY DXA,320,1 ,$492.00 ,$319.80 ,$56.15 ,$492.00 ,$418.20 ,$293.72 ,$107.10 ,$282.90 ,$107.10 ,$338.99 ,$418.20 ,$418.20 ,$418.20 ,$403.44 ,$334.56 ,$107.10 ,$107.10 ,$369.00 ,$349.32 ,$349.32 ,$107.10 ,$349.32 ,$408.36 ,$408.36 ,$408.36 , N/A ,$267.76 ,$418.20 ,$107.10 ,$492.00 ,$56.15 ,$56.15 ,$418.20 ,$224.92 ,$418.20 ,$442.80 ,$107.10 ,$408.36 ,$391.14 ,$391.14 ,$107.10 ,$319.80 
ST. JOSEPH'S HOSPITAL - BREESE,32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$411.00 ,$267.15 ,$56.15 ,$411.00 ,$349.35 ,$245.37 ,$76.27 ,$236.33 ,$76.27 ,$283.18 ,$349.35 ,$349.35 ,$349.35 ,$337.02 ,$279.48 ,$76.27 ,$76.27 ,$308.25 ,$291.81 ,$291.81 ,$76.27 ,$291.81 ,$341.13 ,$341.13 ,$341.13 , N/A ,$190.67 ,$349.35 ,$76.27 ,$411.00 ,$56.15 ,$56.15 ,$349.35 ,$160.16 ,$349.35 ,$369.90 ,$76.27 ,$341.13 ,$326.75 ,$326.75 ,$76.27 ,$267.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000498,77086,HC BONE DENSITY VERTEB FX ASSEMT,320,1 ,$327.00 ,$212.55 ,$56.15 ,$327.00 ,$277.95 ,$195.22 ,$76.27 ,$188.03 ,$76.27 ,$225.30 ,$277.95 ,$277.95 ,$277.95 ,$268.14 ,$222.36 ,$76.27 ,$76.27 ,$245.25 ,$232.17 ,$232.17 ,$76.27 ,$232.17 ,$271.41 ,$271.41 ,$271.41 , N/A ,$190.67 ,$277.95 ,$76.27 ,$327.00 ,$56.15 ,$56.15 ,$277.95 ,$160.16 ,$277.95 ,$294.30 ,$76.27 ,$271.41 ,$259.97 ,$259.97 ,$76.27 ,$212.55 
ST. JOSEPH'S HOSPITAL - BREESE,32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$665.00 ,$432.25 ,$35.55 ,$665.00 ,$565.25 ,$397.01 ,$222.69 ,$382.38 ,$222.69 ,$458.19 ,$565.25 ,$565.25 ,$565.25 ,$545.30 ,$452.20 ,$222.69 ,$222.69 ,$498.75 ,$472.15 ,$472.15 ,$222.69 ,$472.15 ,$551.95 ,$551.95 ,$551.95 , N/A ,$556.73 ,$565.25 ,$222.69 ,$665.00 ,$35.55 ,$35.55 ,$565.25 ,$467.66 ,$565.25 ,$598.50 ,$222.69 ,$551.95 ,$528.68 ,$528.68 ,$222.69 ,$432.25 
ST. JOSEPH'S HOSPITAL - BREESE,32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$750.45 ,$487.79 ,$206.77 ,$750.45 ,$637.88 ,$448.02 ,$250.15 ,$431.51 ,$250.15 ,$517.06 ,$637.88 ,$637.88 ,$637.88 ,$615.37 ,$510.31 ,$250.15 ,$250.15 ,$562.84 ,$532.82 ,$532.82 ,$250.15 ,$532.82 ,$622.87 ,$622.87 ,$622.87 , N/A ,$625.37 ,$637.88 ,$250.15 ,$750.45 ,$206.77 ,$206.77 ,$637.88 ,$525.31 ,$637.88 ,$675.41 ,$250.15 ,$622.87 ,$596.61 ,$596.61 ,$250.15 ,$487.79 
ST. JOSEPH'S HOSPITAL - BREESE,32000509,77072,HC BONE AGE STUDIES,320,1 ,$491.00 ,$319.15 ,$35.55 ,$491.00 ,$417.35 ,$293.13 ,$107.10 ,$282.33 ,$107.10 ,$338.30 ,$417.35 ,$417.35 ,$417.35 ,$402.62 ,$333.88 ,$107.10 ,$107.10 ,$368.25 ,$348.61 ,$348.61 ,$107.10 ,$348.61 ,$407.53 ,$407.53 ,$407.53 , N/A ,$267.76 ,$417.35 ,$107.10 ,$491.00 ,$35.55 ,$35.55 ,$417.35 ,$224.92 ,$417.35 ,$441.90 ,$107.10 ,$407.53 ,$390.35 ,$390.35 ,$107.10 ,$319.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,$728.00 ,$473.20 ,$418.60 ,"$1,265.28 ",$618.80 ,$434.62 ,$602.52 ,$418.60 ,$602.52 ,$501.59 ,$618.80 ,$618.80 ,$618.80 ,$596.96 ,$495.04 ,$602.52 ,$602.52 ,$546.00 ,$516.88 ,$516.88 ,$602.52 ,$516.88 ,$604.24 ,$604.24 ,$604.24 , N/A ,$728.00 ,$618.80 ,$602.52 ,$728.00 ,$441.90 ,$441.90 ,$618.80 ,"$1,265.28 ",$618.80 ,$655.20 ,$602.52 ,$604.24 ,$578.76 ,$578.76 ,$602.52 ,$473.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,$831.00 ,$540.15 ,$441.90 ,"$1,265.28 ",$706.35 ,$496.11 ,$602.52 ,$477.83 ,$602.52 ,$572.56 ,$706.35 ,$706.35 ,$706.35 ,$681.42 ,$565.08 ,$602.52 ,$602.52 ,$623.25 ,$590.01 ,$590.01 ,$602.52 ,$590.01 ,$689.73 ,$689.73 ,$689.73 , N/A ,$831.00 ,$706.35 ,$602.52 ,$831.00 ,$441.90 ,$441.90 ,$706.35 ,"$1,265.28 ",$706.35 ,$747.90 ,$602.52 ,$689.73 ,$660.65 ,$660.65 ,$602.52 ,$540.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000543,72074,HC XR T-SPINE 4 + VIEWS,320,1 ,$800.00 ,$520.00 ,$35.55 ,$800.00 ,$680.00 ,$477.60 ,$107.10 ,$460.00 ,$107.10 ,$551.20 ,$680.00 ,$680.00 ,$680.00 ,$656.00 ,$544.00 ,$107.10 ,$107.10 ,$600.00 ,$568.00 ,$568.00 ,$107.10 ,$568.00 ,$664.00 ,$664.00 ,$664.00 , N/A ,$267.76 ,$680.00 ,$107.10 ,$800.00 ,$35.55 ,$35.55 ,$680.00 ,$224.92 ,$680.00 ,$720.00 ,$107.10 ,$664.00 ,$636.00 ,$636.00 ,$107.10 ,$520.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$250.00 ,$162.50 ,$35.55 ,$250.00 ,$212.50 ,$149.25 ,$76.27 ,$143.75 ,$76.27 ,$172.25 ,$212.50 ,$212.50 ,$212.50 ,$205.00 ,$170.00 ,$76.27 ,$76.27 ,$187.50 ,$177.50 ,$177.50 ,$76.27 ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A ,$190.67 ,$212.50 ,$76.27 ,$250.00 ,$35.55 ,$35.55 ,$212.50 ,$160.16 ,$212.50 ,$225.00 ,$76.27 ,$207.50 ,$198.75 ,$198.75 ,$76.27 ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$250.00 ,$162.50 ,$35.55 ,$250.00 ,$212.50 ,$149.25 ,$107.10 ,$143.75 ,$107.10 ,$172.25 ,$212.50 ,$212.50 ,$212.50 ,$205.00 ,$170.00 ,$107.10 ,$107.10 ,$187.50 ,$177.50 ,$177.50 ,$107.10 ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A ,$250.00 ,$212.50 ,$107.10 ,$250.00 ,$35.55 ,$35.55 ,$212.50 ,$224.92 ,$212.50 ,$225.00 ,$107.10 ,$207.50 ,$198.75 ,$198.75 ,$107.10 ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$250.00 ,$162.50 ,$35.55 ,$250.00 ,$212.50 ,$149.25 ,$76.27 ,$143.75 ,$76.27 ,$172.25 ,$212.50 ,$212.50 ,$212.50 ,$205.00 ,$170.00 ,$76.27 ,$76.27 ,$187.50 ,$177.50 ,$177.50 ,$76.27 ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A ,$190.67 ,$212.50 ,$76.27 ,$250.00 ,$35.55 ,$35.55 ,$212.50 ,$160.16 ,$212.50 ,$225.00 ,$76.27 ,$207.50 ,$198.75 ,$198.75 ,$76.27 ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$250.00 ,$162.50 ,$35.55 ,$250.00 ,$212.50 ,$149.25 ,$76.27 ,$143.75 ,$76.27 ,$172.25 ,$212.50 ,$212.50 ,$212.50 ,$205.00 ,$170.00 ,$76.27 ,$76.27 ,$187.50 ,$177.50 ,$177.50 ,$76.27 ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A ,$190.67 ,$212.50 ,$76.27 ,$250.00 ,$35.55 ,$35.55 ,$212.50 ,$160.16 ,$212.50 ,$225.00 ,$76.27 ,$207.50 ,$198.75 ,$198.75 ,$76.27 ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$321.30 ,$208.85 ,$35.55 ,$321.30 ,$273.11 ,$191.82 ,$107.10 ,$184.75 ,$107.10 ,$221.38 ,$273.11 ,$273.11 ,$273.11 ,$263.47 ,$218.48 ,$107.10 ,$107.10 ,$240.98 ,$228.12 ,$228.12 ,$107.10 ,$228.12 ,$266.68 ,$266.68 ,$266.68 , N/A ,$267.76 ,$273.11 ,$107.10 ,$321.30 ,$35.55 ,$35.55 ,$273.11 ,$224.92 ,$273.11 ,$289.17 ,$107.10 ,$266.68 ,$255.43 ,$255.43 ,$107.10 ,$208.85 
ST. JOSEPH'S HOSPITAL - BREESE,32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$338.00 ,$219.70 ,$35.55 ,$338.00 ,$287.30 ,$201.79 ,$107.10 ,$194.35 ,$107.10 ,$232.88 ,$287.30 ,$287.30 ,$287.30 ,$277.16 ,$229.84 ,$107.10 ,$107.10 ,$253.50 ,$239.98 ,$239.98 ,$107.10 ,$239.98 ,$280.54 ,$280.54 ,$280.54 , N/A ,$267.76 ,$287.30 ,$107.10 ,$338.00 ,$35.55 ,$35.55 ,$287.30 ,$224.92 ,$287.30 ,$304.20 ,$107.10 ,$280.54 ,$268.71 ,$268.71 ,$107.10 ,$219.70 
ST. JOSEPH'S HOSPITAL - BREESE,32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$332.00 ,$215.80 ,$35.55 ,$332.00 ,$282.20 ,$198.20 ,$107.10 ,$190.90 ,$107.10 ,$228.75 ,$282.20 ,$282.20 ,$282.20 ,$272.24 ,$225.76 ,$107.10 ,$107.10 ,$249.00 ,$235.72 ,$235.72 ,$107.10 ,$235.72 ,$275.56 ,$275.56 ,$275.56 , N/A ,$267.76 ,$282.20 ,$107.10 ,$332.00 ,$35.55 ,$35.55 ,$282.20 ,$224.92 ,$282.20 ,$298.80 ,$107.10 ,$275.56 ,$263.94 ,$263.94 ,$107.10 ,$215.80 
ST. JOSEPH'S HOSPITAL - BREESE,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$180.00 ,$117.00 ,$35.55 ,$180.00 ,$153.00 ,$107.46 ,$76.27 ,$103.50 ,$76.27 ,$124.02 ,$153.00 ,$153.00 ,$153.00 ,$147.60 ,$122.40 ,$76.27 ,$76.27 ,$135.00 ,$127.80 ,$127.80 ,$76.27 ,$127.80 ,$149.40 ,$149.40 ,$149.40 , N/A ,$180.00 ,$153.00 ,$76.27 ,$180.00 ,$35.55 ,$35.55 ,$153.00 ,$160.16 ,$153.00 ,$162.00 ,$76.27 ,$149.40 ,$143.10 ,$143.10 ,$76.27 ,$117.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$272.00 ,$176.80 ,$35.55 ,$272.00 ,$231.20 ,$162.38 ,$76.27 ,$156.40 ,$76.27 ,$187.41 ,$231.20 ,$231.20 ,$231.20 ,$223.04 ,$184.96 ,$76.27 ,$76.27 ,$204.00 ,$193.12 ,$193.12 ,$76.27 ,$193.12 ,$225.76 ,$225.76 ,$225.76 , N/A ,$190.67 ,$231.20 ,$76.27 ,$272.00 ,$35.55 ,$35.55 ,$231.20 ,$160.16 ,$231.20 ,$244.80 ,$76.27 ,$225.76 ,$216.24 ,$216.24 ,$76.27 ,$176.80 
ST. JOSEPH'S HOSPITAL - BREESE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$250.00 ,$162.50 ,$35.55 ,$250.00 ,$212.50 ,$149.25 ,$76.27 ,$143.75 ,$76.27 ,$172.25 ,$212.50 ,$212.50 ,$212.50 ,$205.00 ,$170.00 ,$76.27 ,$76.27 ,$187.50 ,$177.50 ,$177.50 ,$76.27 ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A ,$190.67 ,$212.50 ,$76.27 ,$250.00 ,$35.55 ,$35.55 ,$212.50 ,$160.16 ,$212.50 ,$225.00 ,$76.27 ,$207.50 ,$198.75 ,$198.75 ,$76.27 ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,32000583,72200,HC XR SACROILIC JOINT <3VIEWS,320,1 ,$281.00 ,$182.65 ,$35.55 ,$281.00 ,$238.85 ,$167.76 ,$107.10 ,$161.58 ,$107.10 ,$193.61 ,$238.85 ,$238.85 ,$238.85 ,$230.42 ,$191.08 ,$107.10 ,$107.10 ,$210.75 ,$199.51 ,$199.51 ,$107.10 ,$199.51 ,$233.23 ,$233.23 ,$233.23 , N/A ,$267.76 ,$238.85 ,$107.10 ,$281.00 ,$35.55 ,$35.55 ,$238.85 ,$224.92 ,$238.85 ,$252.90 ,$107.10 ,$233.23 ,$223.40 ,$223.40 ,$107.10 ,$182.65 
ST. JOSEPH'S HOSPITAL - BREESE,32000589,74019,HC XR ABDOMEN 2V,320,1 ,$671.00 ,$436.15 ,$35.55 ,$671.00 ,$570.35 ,$400.59 ,$107.10 ,$385.83 ,$107.10 ,$462.32 ,$570.35 ,$570.35 ,$570.35 ,$550.22 ,$456.28 ,$107.10 ,$107.10 ,$503.25 ,$476.41 ,$476.41 ,$107.10 ,$476.41 ,$556.93 ,$556.93 ,$556.93 , N/A ,$267.76 ,$570.35 ,$107.10 ,$671.00 ,$35.55 ,$35.55 ,$570.35 ,$224.92 ,$570.35 ,$603.90 ,$107.10 ,$556.93 ,$533.45 ,$533.45 ,$107.10 ,$436.15 
ST. JOSEPH'S HOSPITAL - BREESE,32000595,76000,HC FLUOROSCOPY >1HR,320,1 ,$665.00 ,$432.25 ,$35.55 ,$665.00 ,$565.25 ,$397.01 ,$222.69 ,$382.38 ,$222.69 ,$458.19 ,$565.25 ,$565.25 ,$565.25 ,$545.30 ,$452.20 ,$222.69 ,$222.69 ,$498.75 ,$472.15 ,$472.15 ,$222.69 ,$472.15 ,$551.95 ,$551.95 ,$551.95 , N/A ,$556.73 ,$565.25 ,$222.69 ,$665.00 ,$35.55 ,$35.55 ,$565.25 ,$467.66 ,$565.25 ,$598.50 ,$222.69 ,$551.95 ,$528.68 ,$528.68 ,$222.69 ,$432.25 
ST. JOSEPH'S HOSPITAL - BREESE,32000610,N/A,HC HEALTH FAIR BONE DENSITY,320,1 ,$5.00 ,$3.25 ,$2.88 ,$5.00 ,$4.25 ,$2.99 , N/A ,$2.88 , N/A ,$3.45 ,$4.25 ,$4.25 ,$4.25 , N/A ,$3.40 , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.15 ,$4.15 ,$4.15 , N/A , N/A ,$4.25 , N/A ,$5.00 , N/A , N/A ,$4.25 , N/A ,$4.25 ,$4.50 , N/A ,$4.15 ,$3.98 ,$3.98 , N/A ,$3.25 
ST. JOSEPH'S HOSPITAL - BREESE,32000611,G1004,HC RAD AUC CDSM NATL DECISION SUPPORT COMPANY,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,"$1,208.00 ",$785.20 ,$35.55 ,"$1,208.00 ","$1,026.80 ",$721.18 , N/A ,$694.60 , N/A ,$832.31 ,"$1,026.80 ","$1,026.80 ","$1,026.80 ",$990.56 ,$821.44 , N/A , N/A ,$906.00 ,$857.68 ,$857.68 , N/A ,$857.68 ,"$1,002.64 ","$1,002.64 ","$1,002.64 ", N/A , N/A ,"$1,026.80 ", N/A ,"$1,208.00 ",$35.55 ,$35.55 ,"$1,026.80 ", N/A ,"$1,026.80 ","$1,087.20 ", N/A ,"$1,002.64 ",$960.36 ,$960.36 , N/A ,$785.20 
ST. JOSEPH'S HOSPITAL - BREESE,32000613,G1002,HC RAD AUC CDSM MEDCURRENT,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000614,G1003,HC RAD AUC CDSM MEDICALIS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000615,G1005,HC RAD AUC CDSM NATIONAL IMAGING ASSOCIATES,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000616,G1006,HC RAD AUC CDSM TEST APPROPRIATE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000617,G1007,HC RAD AUC CDSM AIM SPECIALTY HEALTH,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000618,G1008,HC RAD AUC CDSM CRANBERRY PEAK,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000619,G1009,HC RAD AUC CDSM SAGE HEALTH MGMT SOLUTIONS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000620,G1010,HC RAD AUC CDSM STANSON,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000621,G1011,HC RAD AUC CDSM QUALIFIED TOOL NOS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000622,G1000,HC RAD AUC CDSM APPLIED PATHWAYS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000623,G1001,HC RAD AUC CDSM EVICORE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,33500002,96401,HC CHEMO SQ/IM NON ANTI-NEOPLAST,335,1 ,$201.00 ,$130.65 ,$57.79 ,$201.00 ,$170.85 ,$120.00 ,$57.79 ,$115.58 ,$57.79 ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$154.77 ,$136.68 ,$57.79 ,$57.79 ,$150.75 ,$142.71 ,$142.71 ,$57.79 ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A ,$144.46 ,$170.85 ,$57.79 ,$201.00 , N/A , N/A ,$170.85 ,$121.35 ,$170.85 ,$180.90 ,$57.79 ,$166.83 ,$159.80 ,$159.80 ,$57.79 ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$531.00 ,$345.15 ,$175.58 ,$531.00 ,$451.35 ,$317.01 ,$175.58 ,$305.33 ,$175.58 ,$365.86 ,$451.35 ,$451.35 ,$451.35 ,$408.87 ,$361.08 ,$175.58 ,$175.58 ,$398.25 ,$377.01 ,$377.01 ,$175.58 ,$377.01 ,$440.73 ,$440.73 ,$440.73 , N/A ,$438.95 ,$451.35 ,$175.58 ,$531.00 , N/A , N/A ,$451.35 ,$368.72 ,$451.35 ,$477.90 ,$175.58 ,$440.73 ,$422.15 ,$422.15 ,$175.58 ,$345.15 
ST. JOSEPH'S HOSPITAL - BREESE,33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$348.00 ,$226.20 ,$199.85 ,$621.29 ,$295.80 ,$207.76 ,$295.85 ,$200.10 ,$295.85 ,$239.77 ,$295.80 ,$295.80 ,$295.80 ,$267.96 ,$236.64 ,$295.85 ,$295.85 ,$261.00 ,$247.08 ,$247.08 ,$295.85 ,$247.08 ,$288.84 ,$288.84 ,$288.84 , N/A ,$348.00 ,$295.80 ,$295.85 ,$348.00 ,$199.85 ,$199.85 ,$295.80 ,$621.29 ,$295.80 ,$313.20 ,$295.85 ,$288.84 ,$276.66 ,$276.66 ,$295.85 ,$226.20 
ST. JOSEPH'S HOSPITAL - BREESE,33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$126.00 ,$81.90 ,$57.79 ,$312.44 ,$107.10 ,$75.22 ,$57.79 ,$72.45 ,$57.79 ,$86.81 ,$107.10 ,$107.10 ,$107.10 ,$97.02 ,$85.68 ,$57.79 ,$57.79 ,$94.50 ,$89.46 ,$89.46 ,$57.79 ,$89.46 ,$104.58 ,$104.58 ,$104.58 , N/A ,$126.00 ,$107.10 ,$57.79 ,$126.00 ,$312.44 ,$121.59 ,$107.10 ,$121.35 ,$107.10 ,$113.40 ,$57.79 ,$104.58 ,$100.17 ,$100.17 ,$57.79 ,$81.90 
ST. JOSEPH'S HOSPITAL - BREESE,33500013,96402,HC CHEMOTHERAPY INJECTION-HORMONAL ANTI-NEO,335,1 ,$170.00 ,$110.50 ,$57.79 ,$170.00 ,$144.50 ,$101.49 ,$57.79 ,$97.75 ,$57.79 ,$117.13 ,$144.50 ,$144.50 ,$144.50 ,$130.90 ,$115.60 ,$57.79 ,$57.79 ,$127.50 ,$120.70 ,$120.70 ,$57.79 ,$120.70 ,$141.10 ,$141.10 ,$141.10 , N/A ,$144.46 ,$144.50 ,$57.79 ,$170.00 , N/A , N/A ,$144.50 ,$121.35 ,$144.50 ,$153.00 ,$57.79 ,$141.10 ,$135.15 ,$135.15 ,$57.79 ,$110.50 
ST. JOSEPH'S HOSPITAL - BREESE,34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$861.00 ,$559.65 ,$268.82 ,$861.00 ,$731.85 ,$514.02 ,$351.79 ,$495.08 ,$351.79 ,$593.23 ,$731.85 ,$731.85 ,$731.85 ,$706.02 ,$585.48 ,$351.79 ,$351.79 ,$645.75 ,$611.31 ,$611.31 ,$351.79 ,$611.31 ,$714.63 ,$714.63 ,$714.63 , N/A ,$861.00 ,$731.85 ,$351.79 ,$861.00 ,$268.82 ,$268.82 ,$731.85 ,$738.75 ,$731.85 ,$774.90 ,$351.79 ,$714.63 ,$684.50 ,$684.50 ,$351.79 ,$559.65 
ST. JOSEPH'S HOSPITAL - BREESE,34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,408.00 ",$915.20 ,$268.82 ,"$1,408.00 ","$1,196.80 ",$840.58 ,$351.79 ,$809.60 ,$351.79 ,$970.11 ,"$1,196.80 ","$1,196.80 ","$1,196.80 ","$1,154.56 ",$957.44 ,$351.79 ,$351.79 ,"$1,056.00 ",$999.68 ,$999.68 ,$351.79 ,$999.68 ,"$1,168.64 ","$1,168.64 ","$1,168.64 ", N/A ,$879.46 ,"$1,196.80 ",$351.79 ,"$1,408.00 ",$268.82 ,$268.82 ,"$1,196.80 ",$738.75 ,"$1,196.80 ","$1,267.20 ",$351.79 ,"$1,168.64 ","$1,119.36 ","$1,119.36 ",$351.79 ,$915.20 
ST. JOSEPH'S HOSPITAL - BREESE,34000006,78013,HC NM THYROID SCAN,340,1 ,$677.00 ,$440.05 ,$268.82 ,$738.75 ,$575.45 ,$404.17 ,$351.79 ,$389.28 ,$351.79 ,$466.45 ,$575.45 ,$575.45 ,$575.45 ,$555.14 ,$460.36 ,$351.79 ,$351.79 ,$507.75 ,$480.67 ,$480.67 ,$351.79 ,$480.67 ,$561.91 ,$561.91 ,$561.91 , N/A ,$677.00 ,$575.45 ,$351.79 ,$677.00 ,$268.82 ,$268.82 ,$575.45 ,$738.75 ,$575.45 ,$609.30 ,$351.79 ,$561.91 ,$538.22 ,$538.22 ,$351.79 ,$440.05 
ST. JOSEPH'S HOSPITAL - BREESE,34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,870.00 ","$1,215.50 ",$239.91 ,"$1,870.00 ","$1,589.50 ","$1,116.39 ",$351.79 ,"$1,075.25 ",$351.79 ,"$1,288.43 ","$1,589.50 ","$1,589.50 ","$1,589.50 ","$1,533.40 ","$1,271.60 ",$351.79 ,$351.79 ,"$1,402.50 ","$1,327.70 ","$1,327.70 ",$351.79 ,"$1,327.70 ","$1,552.10 ","$1,552.10 ","$1,552.10 ", N/A ,$879.46 ,"$1,589.50 ",$351.79 ,"$1,870.00 ",$239.91 ,$239.91 ,"$1,589.50 ",$738.75 ,"$1,589.50 ","$1,683.00 ",$351.79 ,"$1,552.10 ","$1,486.65 ","$1,486.65 ",$351.79 ,"$1,215.50 "
ST. JOSEPH'S HOSPITAL - BREESE,34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$3,338.00 ","$2,169.70 ",$268.82 ,"$3,338.00 ","$2,837.30 ","$1,992.79 ",$451.02 ,"$1,919.35 ",$451.02 ,"$2,299.88 ","$2,837.30 ","$2,837.30 ","$2,837.30 ","$2,737.16 ","$2,269.84 ",$451.02 ,$451.02 ,"$2,503.50 ","$2,369.98 ","$2,369.98 ",$451.02 ,"$2,369.98 ","$2,770.54 ","$2,770.54 ","$2,770.54 ", N/A ,"$1,127.56 ","$2,837.30 ",$451.02 ,"$3,338.00 ",$268.82 ,$268.82 ,"$2,837.30 ",$947.15 ,"$2,837.30 ","$3,004.20 ",$451.02 ,"$2,770.54 ","$2,653.71 ","$2,653.71 ",$451.02 ,"$2,169.70 "
ST. JOSEPH'S HOSPITAL - BREESE,34000018,78206,HC LIVER IMAGING SPECT FLOW,340,1 ,"$2,444.00 ","$1,588.60 ","$1,405.30 ","$2,444.00 ","$2,077.40 ","$1,459.07 ", N/A ,"$1,405.30 ", N/A ,"$1,683.92 ","$2,077.40 ","$2,077.40 ","$2,077.40 ","$2,004.08 ","$1,661.92 ", N/A , N/A ,"$1,833.00 ","$1,735.24 ","$1,735.24 ", N/A ,"$1,735.24 ","$2,028.52 ","$2,028.52 ","$2,028.52 ", N/A , N/A ,"$2,077.40 ", N/A ,"$2,444.00 ", N/A , N/A ,"$2,077.40 ", N/A ,"$2,077.40 ","$2,199.60 ", N/A ,"$2,028.52 ","$1,942.98 ","$1,942.98 ", N/A ,"$1,588.60 "
ST. JOSEPH'S HOSPITAL - BREESE,34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,498.00 ",$973.70 ,$239.91 ,"$1,498.00 ","$1,273.30 ",$894.31 ,$351.79 ,$861.35 ,$351.79 ,"$1,032.12 ","$1,273.30 ","$1,273.30 ","$1,273.30 ","$1,228.36 ","$1,018.64 ",$351.79 ,$351.79 ,"$1,123.50 ","$1,063.58 ","$1,063.58 ",$351.79 ,"$1,063.58 ","$1,243.34 ","$1,243.34 ","$1,243.34 ", N/A ,$879.46 ,"$1,273.30 ",$351.79 ,"$1,498.00 ",$239.91 ,$239.91 ,"$1,273.30 ",$738.75 ,"$1,273.30 ","$1,348.20 ",$351.79 ,"$1,243.34 ","$1,190.91 ","$1,190.91 ",$351.79 ,$973.70 
ST. JOSEPH'S HOSPITAL - BREESE,34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$2,577.00 ","$1,675.05 ",$268.82 ,"$2,577.00 ","$2,190.45 ","$1,538.47 ",$351.79 ,"$1,481.78 ",$351.79 ,"$1,775.55 ","$2,190.45 ","$2,190.45 ","$2,190.45 ","$2,113.14 ","$1,752.36 ",$351.79 ,$351.79 ,"$1,932.75 ","$1,829.67 ","$1,829.67 ",$351.79 ,"$1,829.67 ","$2,138.91 ","$2,138.91 ","$2,138.91 ", N/A ,$879.46 ,"$2,190.45 ",$351.79 ,"$2,577.00 ",$268.82 ,$268.82 ,"$2,190.45 ",$738.75 ,"$2,190.45 ","$2,319.30 ",$351.79 ,"$2,138.91 ","$2,048.72 ","$2,048.72 ",$351.79 ,"$1,675.05 "
ST. JOSEPH'S HOSPITAL - BREESE,34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$2,263.00 ","$1,470.95 ",$268.82 ,"$2,263.00 ","$1,923.55 ","$1,351.01 ",$351.79 ,"$1,301.23 ",$351.79 ,"$1,559.21 ","$1,923.55 ","$1,923.55 ","$1,923.55 ","$1,855.66 ","$1,538.84 ",$351.79 ,$351.79 ,"$1,697.25 ","$1,606.73 ","$1,606.73 ",$351.79 ,"$1,606.73 ","$1,878.29 ","$1,878.29 ","$1,878.29 ", N/A ,$879.46 ,"$1,923.55 ",$351.79 ,"$2,263.00 ",$268.82 ,$268.82 ,"$1,923.55 ",$738.75 ,"$1,923.55 ","$2,036.70 ",$351.79 ,"$1,878.29 ","$1,799.09 ","$1,799.09 ",$351.79 ,"$1,470.95 "
ST. JOSEPH'S HOSPITAL - BREESE,34000027,78278,HC GI BLEED SCAN,340,1 ,"$1,588.00 ","$1,032.20 ",$268.82 ,"$1,588.00 ","$1,349.80 ",$948.04 ,$351.79 ,$913.10 ,$351.79 ,"$1,094.13 ","$1,349.80 ","$1,349.80 ","$1,349.80 ","$1,302.16 ","$1,079.84 ",$351.79 ,$351.79 ,"$1,191.00 ","$1,127.48 ","$1,127.48 ",$351.79 ,"$1,127.48 ","$1,318.04 ","$1,318.04 ","$1,318.04 ", N/A ,$879.46 ,"$1,349.80 ",$351.79 ,"$1,588.00 ",$268.82 ,$268.82 ,"$1,349.80 ",$738.75 ,"$1,349.80 ","$1,429.20 ",$351.79 ,"$1,318.04 ","$1,262.46 ","$1,262.46 ",$351.79 ,"$1,032.20 "
ST. JOSEPH'S HOSPITAL - BREESE,34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,615.00 ","$1,049.75 ",$239.91 ,"$1,615.00 ","$1,372.75 ",$964.16 ,$351.79 ,$928.63 ,$351.79 ,"$1,112.74 ","$1,372.75 ","$1,372.75 ","$1,372.75 ","$1,324.30 ","$1,098.20 ",$351.79 ,$351.79 ,"$1,211.25 ","$1,146.65 ","$1,146.65 ",$351.79 ,"$1,146.65 ","$1,340.45 ","$1,340.45 ","$1,340.45 ", N/A ,$879.46 ,"$1,372.75 ",$351.79 ,"$1,615.00 ",$239.91 ,$239.91 ,"$1,372.75 ",$738.75 ,"$1,372.75 ","$1,453.50 ",$351.79 ,"$1,340.45 ","$1,283.93 ","$1,283.93 ",$351.79 ,"$1,049.75 "
ST. JOSEPH'S HOSPITAL - BREESE,34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,703.00 ","$1,106.95 ",$239.91 ,"$1,703.00 ","$1,447.55 ","$1,016.69 ",$351.79 ,$979.23 ,$351.79 ,"$1,173.37 ","$1,447.55 ","$1,447.55 ","$1,447.55 ","$1,396.46 ","$1,158.04 ",$351.79 ,$351.79 ,"$1,277.25 ","$1,209.13 ","$1,209.13 ",$351.79 ,"$1,209.13 ","$1,413.49 ","$1,413.49 ","$1,413.49 ", N/A ,$879.46 ,"$1,447.55 ",$351.79 ,"$1,703.00 ",$239.91 ,$239.91 ,"$1,447.55 ",$738.75 ,"$1,447.55 ","$1,532.70 ",$351.79 ,"$1,413.49 ","$1,353.89 ","$1,353.89 ",$351.79 ,"$1,106.95 "
ST. JOSEPH'S HOSPITAL - BREESE,34000030,78305,HC BONE SCAN MULTIPLE,340,1 ,"$1,104.00 ",$717.60 ,$239.91 ,"$1,104.00 ",$938.40 ,$659.09 ,$351.79 ,$634.80 ,$351.79 ,$760.66 ,$938.40 ,$938.40 ,$938.40 ,$905.28 ,$750.72 ,$351.79 ,$351.79 ,$828.00 ,$783.84 ,$783.84 ,$351.79 ,$783.84 ,$916.32 ,$916.32 ,$916.32 , N/A ,$879.46 ,$938.40 ,$351.79 ,"$1,104.00 ",$239.91 ,$239.91 ,$938.40 ,$738.75 ,$938.40 ,$993.60 ,$351.79 ,$916.32 ,$877.68 ,$877.68 ,$351.79 ,$717.60 
ST. JOSEPH'S HOSPITAL - BREESE,34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$2,646.00 ","$1,719.90 ",$239.91 ,"$2,646.00 ","$2,249.10 ","$1,579.66 ",$351.79 ,"$1,521.45 ",$351.79 ,"$1,823.09 ","$2,249.10 ","$2,249.10 ","$2,249.10 ","$2,169.72 ","$1,799.28 ",$351.79 ,$351.79 ,"$1,984.50 ","$1,878.66 ","$1,878.66 ",$351.79 ,"$1,878.66 ","$2,196.18 ","$2,196.18 ","$2,196.18 ", N/A ,$879.46 ,"$2,249.10 ",$351.79 ,"$2,646.00 ",$239.91 ,$239.91 ,"$2,249.10 ",$738.75 ,"$2,249.10 ","$2,381.40 ",$351.79 ,"$2,196.18 ","$2,103.57 ","$2,103.57 ",$351.79 ,"$1,719.90 "
ST. JOSEPH'S HOSPITAL - BREESE,34000032,78315,HC BONE SCAN FLOW WHOLE BODY STATICS,340,1 ,"$2,779.00 ","$1,806.35 ",$239.91 ,"$2,779.00 ","$2,362.15 ","$1,659.06 ",$351.79 ,"$1,597.93 ",$351.79 ,"$1,914.73 ","$2,362.15 ","$2,362.15 ","$2,362.15 ","$2,278.78 ","$1,889.72 ",$351.79 ,$351.79 ,"$2,084.25 ","$1,973.09 ","$1,973.09 ",$351.79 ,"$1,973.09 ","$2,306.57 ","$2,306.57 ","$2,306.57 ", N/A ,$879.46 ,"$2,362.15 ",$351.79 ,"$2,779.00 ",$239.91 ,$239.91 ,"$2,362.15 ",$738.75 ,"$2,362.15 ","$2,501.10 ",$351.79 ,"$2,306.57 ","$2,209.31 ","$2,209.31 ",$351.79 ,"$1,806.35 "
ST. JOSEPH'S HOSPITAL - BREESE,34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$2,779.00 ","$1,806.35 ",$239.91 ,"$2,779.00 ","$2,362.15 ","$1,659.06 ",$351.79 ,"$1,597.93 ",$351.79 ,"$1,914.73 ","$2,362.15 ","$2,362.15 ","$2,362.15 ","$2,278.78 ","$1,889.72 ",$351.79 ,$351.79 ,"$2,084.25 ","$1,973.09 ","$1,973.09 ",$351.79 ,"$1,973.09 ","$2,306.57 ","$2,306.57 ","$2,306.57 ", N/A ,$879.46 ,"$2,362.15 ",$351.79 ,"$2,779.00 ",$239.91 ,$239.91 ,"$2,362.15 ",$738.75 ,"$2,362.15 ","$2,501.10 ",$351.79 ,"$2,306.57 ","$2,209.31 ","$2,209.31 ",$351.79 ,"$1,806.35 "
ST. JOSEPH'S HOSPITAL - BREESE,34000034,78320,HC BONE SPECT,340,1 ,"$2,918.00 ","$1,896.70 ","$1,677.85 ","$2,918.00 ","$2,480.30 ","$1,742.05 ", N/A ,"$1,677.85 ", N/A ,"$2,010.50 ","$2,480.30 ","$2,480.30 ","$2,480.30 ","$2,392.76 ","$1,984.24 ", N/A , N/A ,"$2,188.50 ","$2,071.78 ","$2,071.78 ", N/A ,"$2,071.78 ","$2,421.94 ","$2,421.94 ","$2,421.94 ", N/A , N/A ,"$2,480.30 ", N/A ,"$2,918.00 ", N/A , N/A ,"$2,480.30 ", N/A ,"$2,480.30 ","$2,626.20 ", N/A ,"$2,421.94 ","$2,319.81 ","$2,319.81 ", N/A ,"$1,896.70 "
ST. JOSEPH'S HOSPITAL - BREESE,34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$1,464.00 ",$951.60 ,$268.82 ,"$2,552.98 ","$1,244.40 ",$874.01 ,"$1,215.70 ",$841.80 ,"$1,215.70 ","$1,008.70 ","$1,244.40 ","$1,244.40 ","$1,244.40 ","$1,200.48 ",$995.52 ,"$1,215.70 ","$1,215.70 ","$1,098.00 ","$1,039.44 ","$1,039.44 ","$1,215.70 ","$1,039.44 ","$1,215.12 ","$1,215.12 ","$1,215.12 ", N/A ,"$1,464.00 ","$1,244.40 ","$1,215.70 ","$1,464.00 ",$268.82 ,$268.82 ,"$1,244.40 ","$2,552.98 ","$1,244.40 ","$1,317.60 ","$1,215.70 ","$1,215.12 ","$1,163.88 ","$1,163.88 ","$1,215.70 ",$951.60 
ST. JOSEPH'S HOSPITAL - BREESE,34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$4,460.00 ","$2,899.00 ",$588.57 ,"$4,460.00 ","$3,791.00 ","$2,662.62 ","$1,215.70 ","$2,564.50 ","$1,215.70 ","$3,072.94 ","$3,791.00 ","$3,791.00 ","$3,791.00 ","$3,657.20 ","$3,032.80 ","$1,215.70 ","$1,215.70 ","$3,345.00 ","$3,166.60 ","$3,166.60 ","$1,215.70 ","$3,166.60 ","$3,701.80 ","$3,701.80 ","$3,701.80 ", N/A ,"$3,039.26 ","$3,791.00 ","$1,215.70 ","$4,460.00 ",$588.57 ,$588.57 ,"$3,791.00 ","$2,552.98 ","$3,791.00 ","$4,014.00 ","$1,215.70 ","$3,701.80 ","$3,545.70 ","$3,545.70 ","$1,215.70 ","$2,899.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000044,78472,HC MUGA RESTING SGL,340,1 ,"$2,197.00 ","$1,428.05 ",$239.91 ,"$2,197.00 ","$1,867.45 ","$1,311.61 ",$351.79 ,"$1,263.28 ",$351.79 ,"$1,513.73 ","$1,867.45 ","$1,867.45 ","$1,867.45 ","$1,801.54 ","$1,493.96 ",$351.79 ,$351.79 ,"$1,647.75 ","$1,559.87 ","$1,559.87 ",$351.79 ,"$1,559.87 ","$1,823.51 ","$1,823.51 ","$1,823.51 ", N/A ,$879.46 ,"$1,867.45 ",$351.79 ,"$2,197.00 ",$239.91 ,$239.91 ,"$1,867.45 ",$738.75 ,"$1,867.45 ","$1,977.30 ",$351.79 ,"$1,823.51 ","$1,746.62 ","$1,746.62 ",$351.79 ,"$1,428.05 "
ST. JOSEPH'S HOSPITAL - BREESE,34000047,78580,HC LUNG PERFUS,340,1 ,"$2,354.00 ","$1,530.10 ",$268.82 ,"$2,354.00 ","$2,000.90 ","$1,405.34 ",$351.79 ,"$1,353.55 ",$351.79 ,"$1,621.91 ","$2,000.90 ","$2,000.90 ","$2,000.90 ","$1,930.28 ","$1,600.72 ",$351.79 ,$351.79 ,"$1,765.50 ","$1,671.34 ","$1,671.34 ",$351.79 ,"$1,671.34 ","$1,953.82 ","$1,953.82 ","$1,953.82 ", N/A ,$879.46 ,"$2,000.90 ",$351.79 ,"$2,354.00 ",$268.82 ,$268.82 ,"$2,000.90 ",$738.75 ,"$2,000.90 ","$2,118.60 ",$351.79 ,"$1,953.82 ","$1,871.43 ","$1,871.43 ",$351.79 ,"$1,530.10 "
ST. JOSEPH'S HOSPITAL - BREESE,34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$3,431.00 ","$2,230.15 ",$268.82 ,"$3,431.00 ","$2,916.35 ","$2,048.31 ",$451.02 ,"$1,972.83 ",$451.02 ,"$2,363.96 ","$2,916.35 ","$2,916.35 ","$2,916.35 ","$2,813.42 ","$2,333.08 ",$451.02 ,$451.02 ,"$2,573.25 ","$2,436.01 ","$2,436.01 ",$451.02 ,"$2,436.01 ","$2,847.73 ","$2,847.73 ","$2,847.73 ", N/A ,"$1,127.56 ","$2,916.35 ",$451.02 ,"$3,431.00 ",$268.82 ,$268.82 ,"$2,916.35 ",$947.15 ,"$2,916.35 ","$3,087.90 ",$451.02 ,"$2,847.73 ","$2,727.65 ","$2,727.65 ",$451.02 ,"$2,230.15 "
ST. JOSEPH'S HOSPITAL - BREESE,34000061,78701,HC KIDNEY SCAN W/FLOW,340,1 ,$629.00 ,$408.85 ,$239.91 ,$738.75 ,$534.65 ,$375.51 ,$351.79 ,$361.68 ,$351.79 ,$433.38 ,$534.65 ,$534.65 ,$534.65 ,$515.78 ,$427.72 ,$351.79 ,$351.79 ,$471.75 ,$446.59 ,$446.59 ,$351.79 ,$446.59 ,$522.07 ,$522.07 ,$522.07 , N/A ,$629.00 ,$534.65 ,$351.79 ,$629.00 ,$239.91 ,$239.91 ,$534.65 ,$738.75 ,$534.65 ,$566.10 ,$351.79 ,$522.07 ,$500.06 ,$500.06 ,$351.79 ,$408.85 
ST. JOSEPH'S HOSPITAL - BREESE,34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$1,066.00 ",$692.90 ,$239.91 ,"$1,066.00 ",$906.10 ,$636.40 ,$451.02 ,$612.95 ,$451.02 ,$734.47 ,$906.10 ,$906.10 ,$906.10 ,$874.12 ,$724.88 ,$451.02 ,$451.02 ,$799.50 ,$756.86 ,$756.86 ,$451.02 ,$756.86 ,$884.78 ,$884.78 ,$884.78 , N/A ,"$1,066.00 ",$906.10 ,$451.02 ,"$1,066.00 ",$239.91 ,$239.91 ,$906.10 ,$947.15 ,$906.10 ,$959.40 ,$451.02 ,$884.78 ,$847.47 ,$847.47 ,$451.02 ,$692.90 
ST. JOSEPH'S HOSPITAL - BREESE,34000065,78709,HC KIDNEY W AND W/O PHARM INTERVEN,340,1 ,"$1,353.06 ",$879.49 ,$239.91 ,"$1,353.06 ","$1,150.10 ",$807.78 ,$451.02 ,$778.01 ,$451.02 ,$932.26 ,"$1,150.10 ","$1,150.10 ","$1,150.10 ","$1,109.51 ",$920.08 ,$451.02 ,$451.02 ,"$1,014.80 ",$960.67 ,$960.67 ,$451.02 ,$960.67 ,"$1,123.04 ","$1,123.04 ","$1,123.04 ", N/A ,"$1,127.56 ","$1,150.10 ",$451.02 ,"$1,353.06 ",$239.91 ,$239.91 ,"$1,150.10 ",$947.15 ,"$1,150.10 ","$1,217.75 ",$451.02 ,"$1,123.04 ","$1,075.68 ","$1,075.68 ",$451.02 ,$879.49 
ST. JOSEPH'S HOSPITAL - BREESE,34000068,78800,HC TUMOR LOCAL LIMITED,340,1 ,"$1,104.00 ",$717.60 ,$268.82 ,"$1,104.00 ",$938.40 ,$659.09 ,$351.79 ,$634.80 ,$351.79 ,$760.66 ,$938.40 ,$938.40 ,$938.40 ,$905.28 ,$750.72 ,$351.79 ,$351.79 ,$828.00 ,$783.84 ,$783.84 ,$351.79 ,$783.84 ,$916.32 ,$916.32 ,$916.32 , N/A ,$879.46 ,$938.40 ,$351.79 ,"$1,104.00 ",$268.82 ,$268.82 ,$938.40 ,$738.75 ,$938.40 ,$993.60 ,$351.79 ,$916.32 ,$877.68 ,$877.68 ,$351.79 ,$717.60 
ST. JOSEPH'S HOSPITAL - BREESE,34000069,78801,HC TUMOR LOCAL MULTIPLE,340,1 ,"$1,104.00 ",$717.60 ,$268.82 ,"$1,104.00 ",$938.40 ,$659.09 ,$351.79 ,$634.80 ,$351.79 ,$760.66 ,$938.40 ,$938.40 ,$938.40 ,$905.28 ,$750.72 ,$351.79 ,$351.79 ,$828.00 ,$783.84 ,$783.84 ,$351.79 ,$783.84 ,$916.32 ,$916.32 ,$916.32 , N/A ,$879.46 ,$938.40 ,$351.79 ,"$1,104.00 ",$268.82 ,$268.82 ,$938.40 ,$738.75 ,$938.40 ,$993.60 ,$351.79 ,$916.32 ,$877.68 ,$877.68 ,$351.79 ,$717.60 
ST. JOSEPH'S HOSPITAL - BREESE,34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$3,840.00 ","$2,496.00 ",$588.57 ,"$3,840.00 ","$3,264.00 ","$2,292.48 ","$1,215.70 ","$2,208.00 ","$1,215.70 ","$2,645.76 ","$3,264.00 ","$3,264.00 ","$3,264.00 ","$3,148.80 ","$2,611.20 ","$1,215.70 ","$1,215.70 ","$2,880.00 ","$2,726.40 ","$2,726.40 ","$1,215.70 ","$2,726.40 ","$3,187.20 ","$3,187.20 ","$3,187.20 ", N/A ,"$3,039.26 ","$3,264.00 ","$1,215.70 ","$3,840.00 ",$588.57 ,$588.57 ,"$3,264.00 ","$2,552.98 ","$3,264.00 ","$3,456.00 ","$1,215.70 ","$3,187.20 ","$3,052.80 ","$3,052.80 ","$1,215.70 ","$2,496.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$1,423.00 ",$924.95 ,$588.57 ,"$2,552.98 ","$1,209.55 ",$849.53 ,"$1,215.70 ",$818.23 ,"$1,215.70 ",$980.45 ,"$1,209.55 ","$1,209.55 ","$1,209.55 ","$1,166.86 ",$967.64 ,"$1,215.70 ","$1,215.70 ","$1,067.25 ","$1,010.33 ","$1,010.33 ","$1,215.70 ","$1,010.33 ","$1,181.09 ","$1,181.09 ","$1,181.09 ", N/A ,"$1,423.00 ","$1,209.55 ","$1,215.70 ","$1,423.00 ",$588.57 ,$588.57 ,"$1,209.55 ","$2,552.98 ","$1,209.55 ","$1,280.70 ","$1,215.70 ","$1,181.09 ","$1,131.29 ","$1,131.29 ","$1,215.70 ",$924.95 
ST. JOSEPH'S HOSPITAL - BREESE,34000072,78803,HC TUMOR IMAGING (SPECT) MIBG,340,1 ,"$1,423.00 ",$924.95 ,$588.57 ,"$2,552.98 ","$1,209.55 ",$849.53 ,"$1,215.70 ",$818.23 ,"$1,215.70 ",$980.45 ,"$1,209.55 ","$1,209.55 ","$1,209.55 ","$1,166.86 ",$967.64 ,"$1,215.70 ","$1,215.70 ","$1,067.25 ","$1,010.33 ","$1,010.33 ","$1,215.70 ","$1,010.33 ","$1,181.09 ","$1,181.09 ","$1,181.09 ", N/A ,"$1,423.00 ","$1,209.55 ","$1,215.70 ","$1,423.00 ",$588.57 ,$588.57 ,"$1,209.55 ","$2,552.98 ","$1,209.55 ","$1,280.70 ","$1,215.70 ","$1,181.09 ","$1,131.29 ","$1,131.29 ","$1,215.70 ",$924.95 
ST. JOSEPH'S HOSPITAL - BREESE,34000073,78803,HC TUMOR IMAGING (SPECT) GALLIUM,340,1 ,"$1,423.00 ",$924.95 ,$588.57 ,"$2,552.98 ","$1,209.55 ",$849.53 ,"$1,215.70 ",$818.23 ,"$1,215.70 ",$980.45 ,"$1,209.55 ","$1,209.55 ","$1,209.55 ","$1,166.86 ",$967.64 ,"$1,215.70 ","$1,215.70 ","$1,067.25 ","$1,010.33 ","$1,010.33 ","$1,215.70 ","$1,010.33 ","$1,181.09 ","$1,181.09 ","$1,181.09 ", N/A ,"$1,423.00 ","$1,209.55 ","$1,215.70 ","$1,423.00 ",$588.57 ,$588.57 ,"$1,209.55 ","$2,552.98 ","$1,209.55 ","$1,280.70 ","$1,215.70 ","$1,181.09 ","$1,131.29 ","$1,131.29 ","$1,215.70 ",$924.95 
ST. JOSEPH'S HOSPITAL - BREESE,34000074,78803,HC TUMOR IMAGING (SPECT) NON GATED,340,1 ,"$1,423.00 ",$924.95 ,$588.57 ,"$2,552.98 ","$1,209.55 ",$849.53 ,"$1,215.70 ",$818.23 ,"$1,215.70 ",$980.45 ,"$1,209.55 ","$1,209.55 ","$1,209.55 ","$1,166.86 ",$967.64 ,"$1,215.70 ","$1,215.70 ","$1,067.25 ","$1,010.33 ","$1,010.33 ","$1,215.70 ","$1,010.33 ","$1,181.09 ","$1,181.09 ","$1,181.09 ", N/A ,"$1,423.00 ","$1,209.55 ","$1,215.70 ","$1,423.00 ",$588.57 ,$588.57 ,"$1,209.55 ","$2,552.98 ","$1,209.55 ","$1,280.70 ","$1,215.70 ","$1,181.09 ","$1,131.29 ","$1,131.29 ","$1,215.70 ",$924.95 
ST. JOSEPH'S HOSPITAL - BREESE,34000075,78803,HC TUMOR IMAGING (SPECT) OCTREO,340,1 ,"$1,423.00 ",$924.95 ,$588.57 ,"$2,552.98 ","$1,209.55 ",$849.53 ,"$1,215.70 ",$818.23 ,"$1,215.70 ",$980.45 ,"$1,209.55 ","$1,209.55 ","$1,209.55 ","$1,166.86 ",$967.64 ,"$1,215.70 ","$1,215.70 ","$1,067.25 ","$1,010.33 ","$1,010.33 ","$1,215.70 ","$1,010.33 ","$1,181.09 ","$1,181.09 ","$1,181.09 ", N/A ,"$1,423.00 ","$1,209.55 ","$1,215.70 ","$1,423.00 ",$588.57 ,$588.57 ,"$1,209.55 ","$2,552.98 ","$1,209.55 ","$1,280.70 ","$1,215.70 ","$1,181.09 ","$1,131.29 ","$1,131.29 ","$1,215.70 ",$924.95 
ST. JOSEPH'S HOSPITAL - BREESE,34000076,78803,HC TUMOR IMAGING (SPECT) PARATHYROID,340,1 ,"$1,423.00 ",$924.95 ,$588.57 ,"$2,552.98 ","$1,209.55 ",$849.53 ,"$1,215.70 ",$818.23 ,"$1,215.70 ",$980.45 ,"$1,209.55 ","$1,209.55 ","$1,209.55 ","$1,166.86 ",$967.64 ,"$1,215.70 ","$1,215.70 ","$1,067.25 ","$1,010.33 ","$1,010.33 ","$1,215.70 ","$1,010.33 ","$1,181.09 ","$1,181.09 ","$1,181.09 ", N/A ,"$1,423.00 ","$1,209.55 ","$1,215.70 ","$1,423.00 ",$588.57 ,$588.57 ,"$1,209.55 ","$2,552.98 ","$1,209.55 ","$1,280.70 ","$1,215.70 ","$1,181.09 ","$1,131.29 ","$1,131.29 ","$1,215.70 ",$924.95 
ST. JOSEPH'S HOSPITAL - BREESE,34000079,78805,HC WBC LIMITED,340,1 ,"$3,355.00 ","$2,180.75 ","$1,929.13 ","$3,355.00 ","$2,851.75 ","$2,002.94 ", N/A ,"$1,929.13 ", N/A ,"$2,311.60 ","$2,851.75 ","$2,851.75 ","$2,851.75 ","$2,751.10 ","$2,281.40 ", N/A , N/A ,"$2,516.25 ","$2,382.05 ","$2,382.05 ", N/A ,"$2,382.05 ","$2,784.65 ","$2,784.65 ","$2,784.65 ", N/A , N/A ,"$2,851.75 ", N/A ,"$3,355.00 ", N/A , N/A ,"$2,851.75 ", N/A ,"$2,851.75 ","$3,019.50 ", N/A ,"$2,784.65 ","$2,667.23 ","$2,667.23 ", N/A ,"$2,180.75 "
ST. JOSEPH'S HOSPITAL - BREESE,34000080,78806,HC WBC WHOLE BODY,340,1 ,"$3,399.00 ","$2,209.35 ","$1,954.43 ","$3,399.00 ","$2,889.15 ","$2,029.20 ", N/A ,"$1,954.43 ", N/A ,"$2,341.91 ","$2,889.15 ","$2,889.15 ","$2,889.15 ","$2,787.18 ","$2,311.32 ", N/A , N/A ,"$2,549.25 ","$2,413.29 ","$2,413.29 ", N/A ,"$2,413.29 ","$2,821.17 ","$2,821.17 ","$2,821.17 ", N/A , N/A ,"$2,889.15 ", N/A ,"$3,399.00 ", N/A , N/A ,"$2,889.15 ", N/A ,"$2,889.15 ","$3,059.10 ", N/A ,"$2,821.17 ","$2,702.21 ","$2,702.21 ", N/A ,"$2,209.35 "
ST. JOSEPH'S HOSPITAL - BREESE,34000090,78597,HC PULM PERF DIFF W/IMG,340,1 ,"$1,727.00 ","$1,122.55 ",$268.82 ,"$1,727.00 ","$1,467.95 ","$1,031.02 ",$351.79 ,$993.03 ,$351.79 ,"$1,189.90 ","$1,467.95 ","$1,467.95 ","$1,467.95 ","$1,416.14 ","$1,174.36 ",$351.79 ,$351.79 ,"$1,295.25 ","$1,226.17 ","$1,226.17 ",$351.79 ,"$1,226.17 ","$1,433.41 ","$1,433.41 ","$1,433.41 ", N/A ,$879.46 ,"$1,467.95 ",$351.79 ,"$1,727.00 ",$268.82 ,$268.82 ,"$1,467.95 ",$738.75 ,"$1,467.95 ","$1,554.30 ",$351.79 ,"$1,433.41 ","$1,372.97 ","$1,372.97 ",$351.79 ,"$1,122.55 "
ST. JOSEPH'S HOSPITAL - BREESE,34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$2,739.00 ","$1,780.35 ",$268.82 ,"$2,739.00 ","$2,328.15 ","$1,635.18 ",$451.02 ,"$1,574.93 ",$451.02 ,"$1,887.17 ","$2,328.15 ","$2,328.15 ","$2,328.15 ","$2,245.98 ","$1,862.52 ",$451.02 ,$451.02 ,"$2,054.25 ","$1,944.69 ","$1,944.69 ",$451.02 ,"$1,944.69 ","$2,273.37 ","$2,273.37 ","$2,273.37 ", N/A ,"$1,127.56 ","$2,328.15 ",$451.02 ,"$2,739.00 ",$268.82 ,$268.82 ,"$2,328.15 ",$947.15 ,"$2,328.15 ","$2,465.10 ",$451.02 ,"$2,273.37 ","$2,177.51 ","$2,177.51 ",$451.02 ,"$1,780.35 "
ST. JOSEPH'S HOSPITAL - BREESE,34100007,A9538,HC NM PYROPHOSPHATE 99M VIAL,341,1 ,$152.00 ,$98.80 ,$87.40 ,$152.00 , N/A ,$90.74 , N/A ,$87.40 , N/A ,$104.73 ,$129.20 ,$129.20 ,$129.20 , N/A ,$103.36 , N/A , N/A ,$114.00 ,$107.92 ,$107.92 , N/A ,$107.92 ,$126.16 ,$126.16 ,$126.16 , N/A , N/A ,$129.20 , N/A ,$152.00 , N/A , N/A ,$129.20 , N/A ,$129.20 ,$136.80 , N/A ,$126.16 ,$120.84 ,$120.84 , N/A ,$98.80 
ST. JOSEPH'S HOSPITAL - BREESE,34100033,78831,HC TUMOR LOCAL SPECT MULT AREA 1 DAY OR SGL AREA W/MULT DAYS,341,1 ,"$3,840.00 ","$2,496.00 ",$588.57 ,"$3,840.00 ","$3,264.00 ","$2,292.48 ","$1,215.70 ","$2,208.00 ","$1,215.70 ","$2,645.76 ","$3,264.00 ","$3,264.00 ","$3,264.00 ","$3,148.80 ","$2,611.20 ","$1,215.70 ","$1,215.70 ","$2,880.00 ","$2,726.40 ","$2,726.40 ","$1,215.70 ","$2,726.40 ","$3,187.20 ","$3,187.20 ","$3,187.20 ", N/A ,"$3,039.26 ","$3,264.00 ","$1,215.70 ","$3,840.00 ",$588.57 ,$588.57 ,"$3,264.00 ","$2,552.98 ","$3,264.00 ","$3,456.00 ","$1,215.70 ","$3,187.20 ","$3,052.80 ","$3,052.80 ","$1,215.70 ","$2,496.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34100034,78830,HC TUMOR IMAGING SPECT W/CT SGL AREA 1 DAY,341,1 ,"$3,840.00 ","$2,496.00 ",$588.57 ,"$3,840.00 ","$3,264.00 ","$2,292.48 ","$1,215.70 ","$2,208.00 ","$1,215.70 ","$2,645.76 ","$3,264.00 ","$3,264.00 ","$3,264.00 ","$3,148.80 ","$2,611.20 ","$1,215.70 ","$1,215.70 ","$2,880.00 ","$2,726.40 ","$2,726.40 ","$1,215.70 ","$2,726.40 ","$3,187.20 ","$3,187.20 ","$3,187.20 ", N/A ,"$3,039.26 ","$3,264.00 ","$1,215.70 ","$3,840.00 ",$588.57 ,$588.57 ,"$3,264.00 ","$2,552.98 ","$3,264.00 ","$3,456.00 ","$1,215.70 ","$3,187.20 ","$3,052.80 ","$3,052.80 ","$1,215.70 ","$2,496.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$375.00 ,$243.75 ,$215.63 ,$375.00 , N/A ,$223.88 , N/A ,$215.63 , N/A ,$258.38 ,$318.75 ,$318.75 ,$318.75 , N/A ,$255.00 , N/A , N/A ,$281.25 ,$266.25 ,$266.25 , N/A ,$266.25 ,$311.25 ,$311.25 ,$311.25 , N/A , N/A ,$318.75 , N/A ,$375.00 , N/A , N/A ,$318.75 , N/A ,$318.75 ,$337.50 , N/A ,$311.25 , N/A , N/A , N/A ,$243.75 
ST. JOSEPH'S HOSPITAL - BREESE,34300006,A9505,HC DIAGNUCLIDE THALL 201 PER MCI,343,1 ,$87.00 ,$56.55 ,$50.03 ,$87.00 , N/A ,$51.94 , N/A ,$50.03 , N/A ,$59.94 ,$73.95 ,$73.95 ,$73.95 , N/A ,$59.16 , N/A , N/A ,$65.25 ,$61.77 ,$61.77 , N/A ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A , N/A ,$73.95 , N/A ,$87.00 , N/A , N/A ,$73.95 , N/A ,$73.95 ,$78.30 , N/A ,$72.21 , N/A , N/A , N/A ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,34300009,A9512,HC TECHNETIUM TC99 PERTECH PER MCI,343,1 ,$100.00 ,$65.00 ,$57.50 ,$100.00 , N/A ,$59.70 , N/A ,$57.50 , N/A ,$68.90 ,$85.00 ,$85.00 ,$85.00 , N/A ,$68.00 , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$83.00 ,$83.00 ,$83.00 , N/A , N/A ,$85.00 , N/A ,$100.00 , N/A , N/A ,$85.00 , N/A ,$85.00 ,$90.00 , N/A ,$83.00 , N/A , N/A , N/A ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$212.00 ,$137.80 ,$121.90 ,$212.00 , N/A ,$126.56 , N/A ,$121.90 , N/A ,$146.07 ,$180.20 ,$180.20 ,$180.20 , N/A ,$144.16 , N/A , N/A ,$159.00 ,$150.52 ,$150.52 , N/A ,$150.52 ,$175.96 ,$175.96 ,$175.96 , N/A , N/A ,$180.20 , N/A ,$212.00 , N/A , N/A ,$180.20 , N/A ,$180.20 ,$190.80 , N/A ,$175.96 , N/A , N/A , N/A ,$137.80 
ST. JOSEPH'S HOSPITAL - BREESE,34300012,A9521,HC DIAGNUCLIDE CERETEC,343,1 ,"$2,742.00 ","$1,782.30 ","$1,576.65 ","$2,742.00 ", N/A ,"$1,636.97 ", N/A ,"$1,576.65 ", N/A ,"$1,889.24 ","$2,330.70 ","$2,330.70 ","$2,330.70 ", N/A ,"$1,864.56 ", N/A , N/A ,"$2,056.50 ","$1,946.82 ","$1,946.82 ", N/A ,"$1,946.82 ","$2,275.86 ","$2,275.86 ","$2,275.86 ", N/A , N/A ,"$2,330.70 ", N/A ,"$2,742.00 ", N/A , N/A ,"$2,330.70 ", N/A ,"$2,330.70 ","$2,467.80 ", N/A ,"$2,275.86 ", N/A , N/A , N/A ,"$1,782.30 "
ST. JOSEPH'S HOSPITAL - BREESE,34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$161.00 ,$104.65 ,$92.58 ,$161.00 , N/A ,$96.12 , N/A ,$92.58 , N/A ,$110.93 ,$136.85 ,$136.85 ,$136.85 , N/A ,$109.48 , N/A , N/A ,$120.75 ,$114.31 ,$114.31 , N/A ,$114.31 ,$133.63 ,$133.63 ,$133.63 , N/A , N/A ,$136.85 , N/A ,$161.00 , N/A , N/A ,$136.85 , N/A ,$136.85 ,$144.90 , N/A ,$133.63 , N/A , N/A , N/A ,$104.65 
ST. JOSEPH'S HOSPITAL - BREESE,34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$292.00 ,$189.80 ,$167.90 ,$292.00 , N/A ,$174.32 , N/A ,$167.90 , N/A ,$201.19 ,$248.20 ,$248.20 ,$248.20 , N/A ,$198.56 , N/A , N/A ,$219.00 ,$207.32 ,$207.32 , N/A ,$207.32 ,$242.36 ,$242.36 ,$242.36 , N/A , N/A ,$248.20 , N/A ,$292.00 , N/A , N/A ,$248.20 , N/A ,$248.20 ,$262.80 , N/A ,$242.36 , N/A , N/A , N/A ,$189.80 
ST. JOSEPH'S HOSPITAL - BREESE,34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$125.00 ,$81.25 ,$71.88 ,$125.00 , N/A ,$74.63 , N/A ,$71.88 , N/A ,$86.13 ,$106.25 ,$106.25 ,$106.25 , N/A ,$85.00 , N/A , N/A ,$93.75 ,$88.75 ,$88.75 , N/A ,$88.75 ,$103.75 ,$103.75 ,$103.75 , N/A , N/A ,$106.25 , N/A ,$125.00 , N/A , N/A ,$106.25 , N/A ,$106.25 ,$112.50 , N/A ,$103.75 , N/A , N/A , N/A ,$81.25 
ST. JOSEPH'S HOSPITAL - BREESE,34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$161.00 ,$104.65 ,$92.58 ,$161.00 , N/A ,$96.12 , N/A ,$92.58 , N/A ,$110.93 ,$136.85 ,$136.85 ,$136.85 , N/A ,$109.48 , N/A , N/A ,$120.75 ,$114.31 ,$114.31 , N/A ,$114.31 ,$133.63 ,$133.63 ,$133.63 , N/A , N/A ,$136.85 , N/A ,$161.00 , N/A , N/A ,$136.85 , N/A ,$136.85 ,$144.90 , N/A ,$133.63 , N/A , N/A , N/A ,$104.65 
ST. JOSEPH'S HOSPITAL - BREESE,34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$1,287.00 ",$836.55 ,$740.03 ,"$1,287.00 ", N/A ,$768.34 , N/A ,$740.03 , N/A ,$886.74 ,"$1,093.95 ","$1,093.95 ","$1,093.95 ", N/A ,$875.16 , N/A , N/A ,$965.25 ,$913.77 ,$913.77 , N/A ,$913.77 ,"$1,068.21 ","$1,068.21 ","$1,068.21 ", N/A , N/A ,"$1,093.95 ", N/A ,"$1,287.00 ", N/A , N/A ,"$1,093.95 ", N/A ,"$1,093.95 ","$1,158.30 ", N/A ,"$1,068.21 ", N/A , N/A , N/A ,$836.55 
ST. JOSEPH'S HOSPITAL - BREESE,34300031,A9556,HC DIAGNUCLIDE GA67 PER MCI,343,1 ,$252.00 ,$163.80 ,$144.90 ,$252.00 , N/A ,$150.44 , N/A ,$144.90 , N/A ,$173.63 ,$214.20 ,$214.20 ,$214.20 , N/A ,$171.36 , N/A , N/A ,$189.00 ,$178.92 ,$178.92 , N/A ,$178.92 ,$209.16 ,$209.16 ,$209.16 , N/A , N/A ,$214.20 , N/A ,$252.00 , N/A , N/A ,$214.20 , N/A ,$214.20 ,$226.80 , N/A ,$209.16 , N/A , N/A , N/A ,$163.80 
ST. JOSEPH'S HOSPITAL - BREESE,34300033,A9558,HC DIAGNUCLIDE XE133 10 MCI,343,1 ,$142.00 ,$92.30 ,$81.65 ,$142.00 , N/A ,$84.77 , N/A ,$81.65 , N/A ,$97.84 ,$120.70 ,$120.70 ,$120.70 , N/A ,$96.56 , N/A , N/A ,$106.50 ,$100.82 ,$100.82 , N/A ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A , N/A ,$120.70 , N/A ,$142.00 , N/A , N/A ,$120.70 , N/A ,$120.70 ,$127.80 , N/A ,$117.86 , N/A , N/A , N/A ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$372.00 ,$241.80 ,$213.90 ,$372.00 , N/A ,$222.08 , N/A ,$213.90 , N/A ,$256.31 ,$316.20 ,$316.20 ,$316.20 , N/A ,$252.96 , N/A , N/A ,$279.00 ,$264.12 ,$264.12 , N/A ,$264.12 ,$308.76 ,$308.76 ,$308.76 , N/A , N/A ,$316.20 , N/A ,$372.00 , N/A , N/A ,$316.20 , N/A ,$316.20 ,$334.80 , N/A ,$308.76 , N/A , N/A , N/A ,$241.80 
ST. JOSEPH'S HOSPITAL - BREESE,34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,$740.00 ,$481.00 ,$425.50 ,$740.00 , N/A ,$441.78 , N/A ,$425.50 , N/A ,$509.86 ,$629.00 ,$629.00 ,$629.00 , N/A ,$503.20 , N/A , N/A ,$555.00 ,$525.40 ,$525.40 , N/A ,$525.40 ,$614.20 ,$614.20 ,$614.20 , N/A , N/A ,$629.00 , N/A ,$740.00 , N/A , N/A ,$629.00 , N/A ,$629.00 ,$666.00 , N/A ,$614.20 , N/A , N/A , N/A ,$481.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$312.00 ,$202.80 ,$87.20 ,$312.00 , N/A ,$186.26 , N/A ,$179.40 , N/A ,$214.97 ,$265.20 ,$265.20 ,$265.20 , N/A ,$212.16 , N/A , N/A ,$234.00 ,$221.52 ,$221.52 , N/A ,$221.52 ,$258.96 ,$258.96 ,$258.96 , N/A , N/A ,$265.20 , N/A ,$312.00 ,$87.20 ,$87.20 ,$265.20 , N/A ,$265.20 ,$280.80 , N/A ,$258.96 , N/A , N/A , N/A ,$202.80 
ST. JOSEPH'S HOSPITAL - BREESE,34300057,A9569,HC TC99M EXAMETAZIME CERETEC DX PER DOSE,343,1 ,"$2,449.00 ","$1,591.85 ","$1,408.18 ","$2,449.00 ", N/A ,"$1,462.05 ", N/A ,"$1,408.18 ", N/A ,"$1,687.36 ","$2,081.65 ","$2,081.65 ","$2,081.65 ", N/A ,"$1,665.32 ", N/A , N/A ,"$1,836.75 ","$1,738.79 ","$1,738.79 ", N/A ,"$1,738.79 ","$2,032.67 ","$2,032.67 ","$2,032.67 ", N/A , N/A ,"$2,081.65 ", N/A ,"$2,449.00 ", N/A , N/A ,"$2,081.65 ", N/A ,"$2,081.65 ","$2,204.10 ", N/A ,"$2,032.67 ", N/A , N/A , N/A ,"$1,591.85 "
ST. JOSEPH'S HOSPITAL - BREESE,34300060,A9520,HC DIAGNUCLIDE TC-99 TILMANOCEPT DIAG UP TO 0.5 MCI,343,1 ,$411.00 ,$267.15 ,$236.33 ,$411.00 , N/A ,$245.37 , N/A ,$236.33 , N/A ,$283.18 ,$349.35 ,$349.35 ,$349.35 , N/A ,$279.48 , N/A , N/A ,$308.25 ,$291.81 ,$291.81 , N/A ,$291.81 ,$341.13 ,$341.13 ,$341.13 , N/A , N/A ,$349.35 , N/A ,$411.00 , N/A , N/A ,$349.35 , N/A ,$349.35 ,$369.90 , N/A ,$341.13 , N/A , N/A , N/A ,$267.15 
ST. JOSEPH'S HOSPITAL - BREESE,34300067,A9561,HC DIAGNUCLIDE TC-99 OXIDRONATE PER STUDY UP TO 30MCI,343,1 ,$97.00 ,$63.05 ,$55.78 ,$97.00 , N/A ,$57.91 , N/A ,$55.78 , N/A ,$66.83 ,$82.45 ,$82.45 ,$82.45 , N/A ,$65.96 , N/A , N/A ,$72.75 ,$68.87 ,$68.87 , N/A ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A , N/A ,$82.45 , N/A ,$97.00 , N/A , N/A ,$82.45 , N/A ,$82.45 ,$87.30 , N/A ,$80.51 , N/A , N/A , N/A ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,35000006,21550,HC BX TISSUE NECK/THORAX,350,1 ,"$3,900.00 ","$2,535.00 ",$411.65 ,"$3,900.00 ","$3,315.00 ","$2,328.30 ","$1,311.66 ","$2,242.50 ","$1,311.66 ","$2,687.10 ","$3,315.00 ","$3,315.00 ","$3,315.00 ","$3,198.00 ","$2,652.00 ","$1,311.66 ","$1,311.66 ","$2,925.00 ","$2,769.00 ","$2,769.00 ","$1,311.66 ","$2,769.00 ","$3,237.00 ","$3,237.00 ","$3,237.00 ", N/A ,"$3,279.14 ","$3,315.00 ","$1,311.66 ","$3,900.00 ",$411.65 ,$411.65 ,"$3,315.00 ","$2,754.48 ","$3,315.00 ","$3,510.00 ","$1,311.66 ","$3,237.00 ","$3,100.50 ","$3,100.50 ","$1,311.66 ","$2,535.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,"$1,644.00 ","$1,068.60 ",$388.56 ,"$1,644.00 ","$1,397.40 ",$981.47 ,$582.93 ,$945.30 ,$582.93 ,"$1,132.72 ","$1,397.40 ","$1,397.40 ","$1,397.40 ","$1,348.08 ","$1,117.92 ",$582.93 ,$582.93 ,"$1,233.00 ","$1,167.24 ","$1,167.24 ",$582.93 ,"$1,167.24 ","$1,364.52 ","$1,364.52 ","$1,364.52 ", N/A ,"$1,457.31 ","$1,397.40 ",$582.93 ,"$1,644.00 ",$388.56 ,$388.56 ,"$1,397.40 ","$1,224.14 ","$1,397.40 ","$1,479.60 ",$582.93 ,"$1,364.52 ","$1,306.98 ","$1,306.98 ",$582.93 ,"$1,068.60 "
ST. JOSEPH'S HOSPITAL - BREESE,35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$2,159.00 ","$1,403.35 ",$107.10 ,"$2,159.00 ","$1,835.15 ","$1,288.92 ",$107.10 ,"$1,241.43 ",$107.10 ,"$1,487.55 ","$1,835.15 ","$1,835.15 ","$1,835.15 ","$1,770.38 ","$1,468.12 ",$107.10 ,$107.10 ,"$1,619.25 ","$1,532.89 ","$1,532.89 ",$107.10 ,"$1,532.89 ","$1,791.97 ","$1,791.97 ","$1,791.97 ", N/A ,$267.76 ,"$1,835.15 ",$107.10 ,"$2,159.00 ",$182.53 ,$182.53 ,"$1,835.15 ",$224.92 ,"$1,835.15 ","$1,943.10 ",$107.10 ,"$1,791.97 ","$1,716.41 ","$1,716.41 ",$107.10 ,"$1,403.35 "
ST. JOSEPH'S HOSPITAL - BREESE,35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,609.00 ","$1,695.85 ",$174.13 ,"$2,609.00 ","$2,217.65 ","$1,557.57 ",$174.13 ,"$1,500.18 ",$174.13 ,"$1,797.60 ","$2,217.65 ","$2,217.65 ","$2,217.65 ","$2,139.38 ","$1,774.12 ",$174.13 ,$174.13 ,"$1,956.75 ","$1,852.39 ","$1,852.39 ",$174.13 ,"$1,852.39 ","$2,165.47 ","$2,165.47 ","$2,165.47 ", N/A ,$435.32 ,"$2,217.65 ",$174.13 ,"$2,609.00 ",$182.53 ,$182.53 ,"$2,217.65 ",$365.67 ,"$2,217.65 ","$2,348.10 ",$174.13 ,"$2,165.47 ","$2,074.16 ","$2,074.16 ",$174.13 ,"$1,695.85 "
ST. JOSEPH'S HOSPITAL - BREESE,35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$3,154.00 ","$2,050.10 ",$174.13 ,"$3,154.00 ","$2,680.90 ","$1,882.94 ",$174.13 ,"$1,813.55 ",$174.13 ,"$2,173.11 ","$2,680.90 ","$2,680.90 ","$2,680.90 ","$2,586.28 ","$2,144.72 ",$174.13 ,$174.13 ,"$2,365.50 ","$2,239.34 ","$2,239.34 ",$174.13 ,"$2,239.34 ","$2,617.82 ","$2,617.82 ","$2,617.82 ", N/A ,$435.32 ,"$2,680.90 ",$174.13 ,"$3,154.00 ",$182.53 ,$182.53 ,"$2,680.90 ",$365.67 ,"$2,680.90 ","$2,838.60 ",$174.13 ,"$2,617.82 ","$2,507.43 ","$2,507.43 ",$174.13 ,"$2,050.10 "
ST. JOSEPH'S HOSPITAL - BREESE,35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$1,997.00 ","$1,298.05 ",$88.69 ,"$1,997.00 ","$1,697.45 ","$1,192.21 ",$107.10 ,"$1,148.28 ",$107.10 ,"$1,375.93 ","$1,697.45 ","$1,697.45 ","$1,697.45 ","$1,637.54 ","$1,357.96 ",$107.10 ,$107.10 ,"$1,497.75 ","$1,417.87 ","$1,417.87 ",$107.10 ,"$1,417.87 ","$1,657.51 ","$1,657.51 ","$1,657.51 ", N/A ,$267.76 ,"$1,697.45 ",$107.10 ,"$1,997.00 ",$88.69 ,$88.69 ,"$1,697.45 ",$224.92 ,"$1,697.45 ","$1,797.30 ",$107.10 ,"$1,657.51 ","$1,587.62 ","$1,587.62 ",$107.10 ,"$1,298.05 "
ST. JOSEPH'S HOSPITAL - BREESE,35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,243.00 ","$1,457.95 ",$88.69 ,"$2,243.00 ","$1,906.55 ","$1,339.07 ",$174.13 ,"$1,289.73 ",$174.13 ,"$1,545.43 ","$1,906.55 ","$1,906.55 ","$1,906.55 ","$1,839.26 ","$1,525.24 ",$174.13 ,$174.13 ,"$1,682.25 ","$1,592.53 ","$1,592.53 ",$174.13 ,"$1,592.53 ","$1,861.69 ","$1,861.69 ","$1,861.69 ", N/A ,$435.32 ,"$1,906.55 ",$174.13 ,"$2,243.00 ",$88.69 ,$88.69 ,"$1,906.55 ",$365.67 ,"$1,906.55 ","$2,018.70 ",$174.13 ,"$1,861.69 ","$1,783.19 ","$1,783.19 ",$174.13 ,"$1,457.95 "
ST. JOSEPH'S HOSPITAL - BREESE,35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$2,489.00 ","$1,617.85 ",$88.69 ,"$2,489.00 ","$2,115.65 ","$1,485.93 ",$174.13 ,"$1,431.18 ",$174.13 ,"$1,714.92 ","$2,115.65 ","$2,115.65 ","$2,115.65 ","$2,040.98 ","$1,692.52 ",$174.13 ,$174.13 ,"$1,866.75 ","$1,767.19 ","$1,767.19 ",$174.13 ,"$1,767.19 ","$2,065.87 ","$2,065.87 ","$2,065.87 ", N/A ,$435.32 ,"$2,115.65 ",$174.13 ,"$2,489.00 ",$88.69 ,$88.69 ,"$2,115.65 ",$365.67 ,"$2,115.65 ","$2,240.10 ",$174.13 ,"$2,065.87 ","$1,978.76 ","$1,978.76 ",$174.13 ,"$1,617.85 "
ST. JOSEPH'S HOSPITAL - BREESE,35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$2,188.00 ","$1,422.20 ",$88.69 ,"$2,188.00 ","$1,859.80 ","$1,306.24 ",$107.10 ,"$1,258.10 ",$107.10 ,"$1,507.53 ","$1,859.80 ","$1,859.80 ","$1,859.80 ","$1,794.16 ","$1,487.84 ",$107.10 ,$107.10 ,"$1,641.00 ","$1,553.48 ","$1,553.48 ",$107.10 ,"$1,553.48 ","$1,816.04 ","$1,816.04 ","$1,816.04 ", N/A ,$267.76 ,"$1,859.80 ",$107.10 ,"$2,188.00 ",$88.69 ,$88.69 ,"$1,859.80 ",$224.92 ,"$1,859.80 ","$1,969.20 ",$107.10 ,"$1,816.04 ","$1,739.46 ","$1,739.46 ",$107.10 ,"$1,422.20 "
ST. JOSEPH'S HOSPITAL - BREESE,35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,434.00 ","$1,582.10 ",$88.69 ,"$2,434.00 ","$2,068.90 ","$1,453.10 ",$174.13 ,"$1,399.55 ",$174.13 ,"$1,677.03 ","$2,068.90 ","$2,068.90 ","$2,068.90 ","$1,995.88 ","$1,655.12 ",$174.13 ,$174.13 ,"$1,825.50 ","$1,728.14 ","$1,728.14 ",$174.13 ,"$1,728.14 ","$2,020.22 ","$2,020.22 ","$2,020.22 ", N/A ,$435.32 ,"$2,068.90 ",$174.13 ,"$2,434.00 ",$88.69 ,$88.69 ,"$2,068.90 ",$365.67 ,"$2,068.90 ","$2,190.60 ",$174.13 ,"$2,020.22 ","$1,935.03 ","$1,935.03 ",$174.13 ,"$1,582.10 "
ST. JOSEPH'S HOSPITAL - BREESE,35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,680.00 ","$1,742.00 ",$88.69 ,"$2,680.00 ","$2,278.00 ","$1,599.96 ",$174.13 ,"$1,541.00 ",$174.13 ,"$1,846.52 ","$2,278.00 ","$2,278.00 ","$2,278.00 ","$2,197.60 ","$1,822.40 ",$174.13 ,$174.13 ,"$2,010.00 ","$1,902.80 ","$1,902.80 ",$174.13 ,"$1,902.80 ","$2,224.40 ","$2,224.40 ","$2,224.40 ", N/A ,$435.32 ,"$2,278.00 ",$174.13 ,"$2,680.00 ",$88.69 ,$88.69 ,"$2,278.00 ",$365.67 ,"$2,278.00 ","$2,412.00 ",$174.13 ,"$2,224.40 ","$2,130.60 ","$2,130.60 ",$174.13 ,"$1,742.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$2,075.00 ","$1,348.75 ",$88.69 ,"$2,075.00 ","$1,763.75 ","$1,238.78 ",$107.10 ,"$1,193.13 ",$107.10 ,"$1,429.68 ","$1,763.75 ","$1,763.75 ","$1,763.75 ","$1,701.50 ","$1,411.00 ",$107.10 ,$107.10 ,"$1,556.25 ","$1,473.25 ","$1,473.25 ",$107.10 ,"$1,473.25 ","$1,722.25 ","$1,722.25 ","$1,722.25 ", N/A ,$267.76 ,"$1,763.75 ",$107.10 ,"$2,075.00 ",$88.69 ,$88.69 ,"$1,763.75 ",$224.92 ,"$1,763.75 ","$1,867.50 ",$107.10 ,"$1,722.25 ","$1,649.63 ","$1,649.63 ",$107.10 ,"$1,348.75 "
ST. JOSEPH'S HOSPITAL - BREESE,35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,564.00 ","$1,666.60 ",$88.69 ,"$2,564.00 ","$2,179.40 ","$1,530.71 ",$174.13 ,"$1,474.30 ",$174.13 ,"$1,766.60 ","$2,179.40 ","$2,179.40 ","$2,179.40 ","$2,102.48 ","$1,743.52 ",$174.13 ,$174.13 ,"$1,923.00 ","$1,820.44 ","$1,820.44 ",$174.13 ,"$1,820.44 ","$2,128.12 ","$2,128.12 ","$2,128.12 ", N/A ,$435.32 ,"$2,179.40 ",$174.13 ,"$2,564.00 ",$88.69 ,$88.69 ,"$2,179.40 ",$365.67 ,"$2,179.40 ","$2,307.60 ",$174.13 ,"$2,128.12 ","$2,038.38 ","$2,038.38 ",$174.13 ,"$1,666.60 "
ST. JOSEPH'S HOSPITAL - BREESE,35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$2,891.00 ","$1,879.15 ",$88.69 ,"$2,891.00 ","$2,457.35 ","$1,725.93 ",$174.13 ,"$1,662.33 ",$174.13 ,"$1,991.90 ","$2,457.35 ","$2,457.35 ","$2,457.35 ","$2,370.62 ","$1,965.88 ",$174.13 ,$174.13 ,"$2,168.25 ","$2,052.61 ","$2,052.61 ",$174.13 ,"$2,052.61 ","$2,399.53 ","$2,399.53 ","$2,399.53 ", N/A ,$435.32 ,"$2,457.35 ",$174.13 ,"$2,891.00 ",$88.69 ,$88.69 ,"$2,457.35 ",$365.67 ,"$2,457.35 ","$2,601.90 ",$174.13 ,"$2,399.53 ","$2,298.35 ","$2,298.35 ",$174.13 ,"$1,879.15 "
ST. JOSEPH'S HOSPITAL - BREESE,35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$2,609.00 ","$1,695.85 ",$174.13 ,"$2,609.00 ","$2,217.65 ","$1,557.57 ",$174.13 ,"$1,500.18 ",$174.13 ,"$1,797.60 ","$2,217.65 ","$2,217.65 ","$2,217.65 ","$2,139.38 ","$1,774.12 ",$174.13 ,$174.13 ,"$1,956.75 ","$1,852.39 ","$1,852.39 ",$174.13 ,"$1,852.39 ","$2,165.47 ","$2,165.47 ","$2,165.47 ", N/A ,$435.32 ,"$2,217.65 ",$174.13 ,"$2,609.00 ",$233.78 ,$233.78 ,"$2,217.65 ",$365.67 ,"$2,217.65 ","$2,348.10 ",$174.13 ,"$2,165.47 ","$2,074.16 ","$2,074.16 ",$174.13 ,"$1,695.85 "
ST. JOSEPH'S HOSPITAL - BREESE,35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$2,891.00 ","$1,879.15 ",$88.69 ,"$2,891.00 ","$2,457.35 ","$1,725.93 ",$174.13 ,"$1,662.33 ",$174.13 ,"$1,991.90 ","$2,457.35 ","$2,457.35 ","$2,457.35 ","$2,370.62 ","$1,965.88 ",$174.13 ,$174.13 ,"$2,168.25 ","$2,052.61 ","$2,052.61 ",$174.13 ,"$2,052.61 ","$2,399.53 ","$2,399.53 ","$2,399.53 ", N/A ,$435.32 ,"$2,457.35 ",$174.13 ,"$2,891.00 ",$88.69 ,$88.69 ,"$2,457.35 ",$365.67 ,"$2,457.35 ","$2,601.90 ",$174.13 ,"$2,399.53 ","$2,298.35 ","$2,298.35 ",$174.13 ,"$1,879.15 "
ST. JOSEPH'S HOSPITAL - BREESE,35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,370.00 ","$2,190.50 ",$221.28 ,"$3,370.00 ","$2,864.50 ","$2,011.89 ",$222.69 ,"$1,937.75 ",$222.69 ,"$2,321.93 ","$2,864.50 ","$2,864.50 ","$2,864.50 ","$2,763.40 ","$2,291.60 ",$222.69 ,$222.69 ,"$2,527.50 ","$2,392.70 ","$2,392.70 ",$222.69 ,"$2,392.70 ","$2,797.10 ","$2,797.10 ","$2,797.10 ", N/A ,$556.73 ,"$2,864.50 ",$222.69 ,"$3,370.00 ",$221.28 ,$221.28 ,"$2,864.50 ",$467.66 ,"$2,864.50 ","$3,033.00 ",$222.69 ,"$2,797.10 ","$2,679.15 ","$2,679.15 ",$222.69 ,"$2,190.50 "
ST. JOSEPH'S HOSPITAL - BREESE,35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$3,642.00 ","$2,367.30 ",$100.68 ,"$3,642.00 ","$3,095.70 ","$2,174.27 ",$107.10 ,"$2,094.15 ",$107.10 ,"$2,509.34 ","$3,095.70 ","$3,095.70 ","$3,095.70 ","$2,986.44 ","$2,476.56 ",$107.10 ,$107.10 ,"$2,731.50 ","$2,585.82 ","$2,585.82 ",$107.10 ,"$2,585.82 ","$3,022.86 ","$3,022.86 ","$3,022.86 ", N/A ,$267.76 ,"$3,095.70 ",$107.10 ,"$3,642.00 ",$100.68 ,$100.68 ,"$3,095.70 ",$224.92 ,"$3,095.70 ","$3,277.80 ",$107.10 ,"$3,022.86 ","$2,895.39 ","$2,895.39 ",$107.10 ,"$2,367.30 "
ST. JOSEPH'S HOSPITAL - BREESE,35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$1,128.00 ",$733.20 ,$100.68 ,"$1,128.00 ",$958.80 ,$673.42 ,$364.90 ,$648.60 ,$364.90 ,$777.19 ,$958.80 ,$958.80 ,$958.80 ,$924.96 ,$767.04 ,$364.90 ,$364.90 ,$846.00 ,$800.88 ,$800.88 ,$364.90 ,$800.88 ,$936.24 ,$936.24 ,$936.24 , N/A ,$912.24 ,$958.80 ,$364.90 ,"$1,128.00 ",$100.68 ,$100.68 ,$958.80 ,$766.28 ,$958.80 ,"$1,015.20 ",$364.90 ,$936.24 ,$896.76 ,$896.76 ,$364.90 ,$733.20 
ST. JOSEPH'S HOSPITAL - BREESE,35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$3,543.00 ","$2,302.95 ",$100.68 ,"$3,543.00 ","$3,011.55 ","$2,115.17 ",$107.10 ,"$2,037.23 ",$107.10 ,"$2,441.13 ","$3,011.55 ","$3,011.55 ","$3,011.55 ","$2,905.26 ","$2,409.24 ",$107.10 ,$107.10 ,"$2,657.25 ","$2,515.53 ","$2,515.53 ",$107.10 ,"$2,515.53 ","$2,940.69 ","$2,940.69 ","$2,940.69 ", N/A ,$267.76 ,"$3,011.55 ",$107.10 ,"$3,543.00 ",$100.68 ,$100.68 ,"$3,011.55 ",$224.92 ,"$3,011.55 ","$3,188.70 ",$107.10 ,"$2,940.69 ","$2,816.69 ","$2,816.69 ",$107.10 ,"$2,302.95 "
ST. JOSEPH'S HOSPITAL - BREESE,35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$4,071.00 ","$2,646.15 ",$100.68 ,"$4,071.00 ","$3,460.35 ","$2,430.39 ",$174.13 ,"$2,340.83 ",$174.13 ,"$2,804.92 ","$3,460.35 ","$3,460.35 ","$3,460.35 ","$3,338.22 ","$2,768.28 ",$174.13 ,$174.13 ,"$3,053.25 ","$2,890.41 ","$2,890.41 ",$174.13 ,"$2,890.41 ","$3,378.93 ","$3,378.93 ","$3,378.93 ", N/A ,$435.32 ,"$3,460.35 ",$174.13 ,"$4,071.00 ",$100.68 ,$100.68 ,"$3,460.35 ",$365.67 ,"$3,460.35 ","$3,663.90 ",$174.13 ,"$3,378.93 ","$3,236.45 ","$3,236.45 ",$174.13 ,"$2,646.15 "
ST. JOSEPH'S HOSPITAL - BREESE,35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$4,426.00 ","$2,876.90 ",$100.68 ,"$4,426.00 ","$3,762.10 ","$2,642.32 ",$174.13 ,"$2,544.95 ",$174.13 ,"$3,049.51 ","$3,762.10 ","$3,762.10 ","$3,762.10 ","$3,629.32 ","$3,009.68 ",$174.13 ,$174.13 ,"$3,319.50 ","$3,142.46 ","$3,142.46 ",$174.13 ,"$3,142.46 ","$3,673.58 ","$3,673.58 ","$3,673.58 ", N/A ,$435.32 ,"$3,762.10 ",$174.13 ,"$4,426.00 ",$100.68 ,$100.68 ,"$3,762.10 ",$365.67 ,"$3,762.10 ","$3,983.40 ",$174.13 ,"$3,673.58 ","$3,518.67 ","$3,518.67 ",$174.13 ,"$2,876.90 "
ST. JOSEPH'S HOSPITAL - BREESE,35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$3,608.00 ","$2,345.20 ",$100.68 ,"$3,608.00 ","$3,066.80 ","$2,153.98 ",$107.10 ,"$2,074.60 ",$107.10 ,"$2,485.91 ","$3,066.80 ","$3,066.80 ","$3,066.80 ","$2,958.56 ","$2,453.44 ",$107.10 ,$107.10 ,"$2,706.00 ","$2,561.68 ","$2,561.68 ",$107.10 ,"$2,561.68 ","$2,994.64 ","$2,994.64 ","$2,994.64 ", N/A ,$267.76 ,"$3,066.80 ",$107.10 ,"$3,608.00 ",$100.68 ,$100.68 ,"$3,066.80 ",$224.92 ,"$3,066.80 ","$3,247.20 ",$107.10 ,"$2,994.64 ","$2,868.36 ","$2,868.36 ",$107.10 ,"$2,345.20 "
ST. JOSEPH'S HOSPITAL - BREESE,35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$4,071.00 ","$2,646.15 ",$100.68 ,"$4,071.00 ","$3,460.35 ","$2,430.39 ",$364.90 ,"$2,340.83 ",$364.90 ,"$2,804.92 ","$3,460.35 ","$3,460.35 ","$3,460.35 ","$3,338.22 ","$2,768.28 ",$364.90 ,$364.90 ,"$3,053.25 ","$2,890.41 ","$2,890.41 ",$364.90 ,"$2,890.41 ","$3,378.93 ","$3,378.93 ","$3,378.93 ", N/A ,$912.24 ,"$3,460.35 ",$364.90 ,"$4,071.00 ",$100.68 ,$100.68 ,"$3,460.35 ",$766.28 ,"$3,460.35 ","$3,663.90 ",$364.90 ,"$3,378.93 ","$3,236.45 ","$3,236.45 ",$364.90 ,"$2,646.15 "
ST. JOSEPH'S HOSPITAL - BREESE,35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$4,232.00 ","$2,750.80 ",$100.68 ,"$4,232.00 ","$3,597.20 ","$2,526.50 ",$174.13 ,"$2,433.40 ",$174.13 ,"$2,915.85 ","$3,597.20 ","$3,597.20 ","$3,597.20 ","$3,470.24 ","$2,877.76 ",$174.13 ,$174.13 ,"$3,174.00 ","$3,004.72 ","$3,004.72 ",$174.13 ,"$3,004.72 ","$3,512.56 ","$3,512.56 ","$3,512.56 ", N/A ,$435.32 ,"$3,597.20 ",$174.13 ,"$4,232.00 ",$100.68 ,$100.68 ,"$3,597.20 ",$365.67 ,"$3,597.20 ","$3,808.80 ",$174.13 ,"$3,512.56 ","$3,364.44 ","$3,364.44 ",$174.13 ,"$2,750.80 "
ST. JOSEPH'S HOSPITAL - BREESE,35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$3,438.00 ","$2,234.70 ",$174.13 ,"$3,438.00 ","$2,922.30 ","$2,052.49 ",$174.13 ,"$1,976.85 ",$174.13 ,"$2,368.78 ","$2,922.30 ","$2,922.30 ","$2,922.30 ","$2,819.16 ","$2,337.84 ",$174.13 ,$174.13 ,"$2,578.50 ","$2,440.98 ","$2,440.98 ",$174.13 ,"$2,440.98 ","$2,853.54 ","$2,853.54 ","$2,853.54 ", N/A ,$435.32 ,"$2,922.30 ",$174.13 ,"$3,438.00 ",$200.45 ,$200.45 ,"$2,922.30 ",$365.67 ,"$2,922.30 ","$3,094.20 ",$174.13 ,"$2,853.54 ","$2,733.21 ","$2,733.21 ",$174.13 ,"$2,234.70 "
ST. JOSEPH'S HOSPITAL - BREESE,35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$2,882.00 ","$1,873.30 ",$107.10 ,"$2,882.00 ","$2,449.70 ","$1,720.55 ",$107.10 ,"$1,657.15 ",$107.10 ,"$1,985.70 ","$2,449.70 ","$2,449.70 ","$2,449.70 ","$2,363.24 ","$1,959.76 ",$107.10 ,$107.10 ,"$2,161.50 ","$2,046.22 ","$2,046.22 ",$107.10 ,"$2,046.22 ","$2,392.06 ","$2,392.06 ","$2,392.06 ", N/A ,$267.76 ,"$2,449.70 ",$107.10 ,"$2,882.00 ",$200.64 ,$200.64 ,"$2,449.70 ",$224.92 ,"$2,449.70 ","$2,593.80 ",$107.10 ,"$2,392.06 ","$2,291.19 ","$2,291.19 ",$107.10 ,"$1,873.30 "
ST. JOSEPH'S HOSPITAL - BREESE,35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$3,161.00 ","$2,054.65 ",$174.13 ,"$3,161.00 ","$2,686.85 ","$1,887.12 ",$174.13 ,"$1,817.58 ",$174.13 ,"$2,177.93 ","$2,686.85 ","$2,686.85 ","$2,686.85 ","$2,592.02 ","$2,149.48 ",$174.13 ,$174.13 ,"$2,370.75 ","$2,244.31 ","$2,244.31 ",$174.13 ,"$2,244.31 ","$2,623.63 ","$2,623.63 ","$2,623.63 ", N/A ,$435.32 ,"$2,686.85 ",$174.13 ,"$3,161.00 ",$200.64 ,$200.64 ,"$2,686.85 ",$365.67 ,"$2,686.85 ","$2,844.90 ",$174.13 ,"$2,623.63 ","$2,513.00 ","$2,513.00 ",$174.13 ,"$2,054.65 "
ST. JOSEPH'S HOSPITAL - BREESE,35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$3,438.00 ","$2,234.70 ",$174.13 ,"$3,438.00 ","$2,922.30 ","$2,052.49 ",$174.13 ,"$1,976.85 ",$174.13 ,"$2,368.78 ","$2,922.30 ","$2,922.30 ","$2,922.30 ","$2,819.16 ","$2,337.84 ",$174.13 ,$174.13 ,"$2,578.50 ","$2,440.98 ","$2,440.98 ",$174.13 ,"$2,440.98 ","$2,853.54 ","$2,853.54 ","$2,853.54 ", N/A ,$435.32 ,"$2,922.30 ",$174.13 ,"$3,438.00 ",$200.64 ,$200.64 ,"$2,922.30 ",$365.67 ,"$2,922.30 ","$3,094.20 ",$174.13 ,"$2,853.54 ","$2,733.21 ","$2,733.21 ",$174.13 ,"$2,234.70 "
ST. JOSEPH'S HOSPITAL - BREESE,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$2,439.00 ","$1,585.35 ",$88.69 ,"$2,439.00 ","$2,073.15 ","$1,456.08 ",$107.10 ,"$1,402.43 ",$107.10 ,"$1,680.47 ","$2,073.15 ","$2,073.15 ","$2,073.15 ","$1,999.98 ","$1,658.52 ",$107.10 ,$107.10 ,"$1,829.25 ","$1,731.69 ","$1,731.69 ",$107.10 ,"$1,731.69 ","$2,024.37 ","$2,024.37 ","$2,024.37 ", N/A ,$267.76 ,"$2,073.15 ",$107.10 ,"$2,439.00 ",$88.69 ,$88.69 ,"$2,073.15 ",$224.92 ,"$2,073.15 ","$2,195.10 ",$107.10 ,"$2,024.37 ","$1,939.01 ","$1,939.01 ",$107.10 ,"$1,585.35 "
ST. JOSEPH'S HOSPITAL - BREESE,35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,565.00 ","$1,667.25 ",$88.69 ,"$2,565.00 ","$2,180.25 ","$1,531.31 ",$364.90 ,"$1,474.88 ",$364.90 ,"$1,767.29 ","$2,180.25 ","$2,180.25 ","$2,180.25 ","$2,103.30 ","$1,744.20 ",$364.90 ,$364.90 ,"$1,923.75 ","$1,821.15 ","$1,821.15 ",$364.90 ,"$1,821.15 ","$2,128.95 ","$2,128.95 ","$2,128.95 ", N/A ,$912.24 ,"$2,180.25 ",$364.90 ,"$2,565.00 ",$88.69 ,$88.69 ,"$2,180.25 ",$766.28 ,"$2,180.25 ","$2,308.50 ",$364.90 ,"$2,128.95 ","$2,039.18 ","$2,039.18 ",$364.90 ,"$1,667.25 "
ST. JOSEPH'S HOSPITAL - BREESE,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$3,100.00 ","$2,015.00 ",$88.69 ,"$3,100.00 ","$2,635.00 ","$1,850.70 ",$174.13 ,"$1,782.50 ",$174.13 ,"$2,135.90 ","$2,635.00 ","$2,635.00 ","$2,635.00 ","$2,542.00 ","$2,108.00 ",$174.13 ,$174.13 ,"$2,325.00 ","$2,201.00 ","$2,201.00 ",$174.13 ,"$2,201.00 ","$2,573.00 ","$2,573.00 ","$2,573.00 ", N/A ,$435.32 ,"$2,635.00 ",$174.13 ,"$3,100.00 ",$88.69 ,$88.69 ,"$2,635.00 ",$365.67 ,"$2,635.00 ","$2,790.00 ",$174.13 ,"$2,573.00 ","$2,464.50 ","$2,464.50 ",$174.13 ,"$2,015.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$3,100.00 ","$2,015.00 ",$174.13 ,"$3,100.00 ","$2,635.00 ","$1,850.70 ",$174.13 ,"$1,782.50 ",$174.13 ,"$2,135.90 ","$2,635.00 ","$2,635.00 ","$2,635.00 ","$2,542.00 ","$2,108.00 ",$174.13 ,$174.13 ,"$2,325.00 ","$2,201.00 ","$2,201.00 ",$174.13 ,"$2,201.00 ","$2,573.00 ","$2,573.00 ","$2,573.00 ", N/A ,$435.32 ,"$2,635.00 ",$174.13 ,"$3,100.00 ",$200.45 ,$200.45 ,"$2,635.00 ",$365.67 ,"$2,635.00 ","$2,790.00 ",$174.13 ,"$2,573.00 ","$2,464.50 ","$2,464.50 ",$174.13 ,"$2,015.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$2,439.00 ","$1,585.35 ",$88.69 ,"$2,439.00 ","$2,073.15 ","$1,456.08 ",$107.10 ,"$1,402.43 ",$107.10 ,"$1,680.47 ","$2,073.15 ","$2,073.15 ","$2,073.15 ","$1,999.98 ","$1,658.52 ",$107.10 ,$107.10 ,"$1,829.25 ","$1,731.69 ","$1,731.69 ",$107.10 ,"$1,731.69 ","$2,024.37 ","$2,024.37 ","$2,024.37 ", N/A ,$267.76 ,"$2,073.15 ",$107.10 ,"$2,439.00 ",$88.69 ,$88.69 ,"$2,073.15 ",$224.92 ,"$2,073.15 ","$2,195.10 ",$107.10 ,"$2,024.37 ","$1,939.01 ","$1,939.01 ",$107.10 ,"$1,585.35 "
ST. JOSEPH'S HOSPITAL - BREESE,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,565.00 ","$1,667.25 ",$88.69 ,"$2,565.00 ","$2,180.25 ","$1,531.31 ",$174.13 ,"$1,474.88 ",$174.13 ,"$1,767.29 ","$2,180.25 ","$2,180.25 ","$2,180.25 ","$2,103.30 ","$1,744.20 ",$174.13 ,$174.13 ,"$1,923.75 ","$1,821.15 ","$1,821.15 ",$174.13 ,"$1,821.15 ","$2,128.95 ","$2,128.95 ","$2,128.95 ", N/A ,$435.32 ,"$2,180.25 ",$174.13 ,"$2,565.00 ",$88.69 ,$88.69 ,"$2,180.25 ",$365.67 ,"$2,180.25 ","$2,308.50 ",$174.13 ,"$2,128.95 ","$2,039.18 ","$2,039.18 ",$174.13 ,"$1,667.25 "
ST. JOSEPH'S HOSPITAL - BREESE,35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,997.00 ","$1,948.05 ",$88.69 ,"$2,997.00 ","$2,547.45 ","$1,789.21 ",$174.13 ,"$1,723.28 ",$174.13 ,"$2,064.93 ","$2,547.45 ","$2,547.45 ","$2,547.45 ","$2,457.54 ","$2,037.96 ",$174.13 ,$174.13 ,"$2,247.75 ","$2,127.87 ","$2,127.87 ",$174.13 ,"$2,127.87 ","$2,487.51 ","$2,487.51 ","$2,487.51 ", N/A ,$435.32 ,"$2,547.45 ",$174.13 ,"$2,997.00 ",$88.69 ,$88.69 ,"$2,547.45 ",$365.67 ,"$2,547.45 ","$2,697.30 ",$174.13 ,"$2,487.51 ","$2,382.62 ","$2,382.62 ",$174.13 ,"$1,948.05 "
ST. JOSEPH'S HOSPITAL - BREESE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$3,064.00 ","$1,991.60 ",$174.13 ,"$3,064.00 ","$2,604.40 ","$1,829.21 ",$174.13 ,"$1,761.80 ",$174.13 ,"$2,111.10 ","$2,604.40 ","$2,604.40 ","$2,604.40 ","$2,512.48 ","$2,083.52 ",$174.13 ,$174.13 ,"$2,298.00 ","$2,175.44 ","$2,175.44 ",$174.13 ,"$2,175.44 ","$2,543.12 ","$2,543.12 ","$2,543.12 ", N/A ,$435.32 ,"$2,604.40 ",$174.13 ,"$3,064.00 ",$200.45 ,$200.45 ,"$2,604.40 ",$365.67 ,"$2,604.40 ","$2,757.60 ",$174.13 ,"$2,543.12 ","$2,435.88 ","$2,435.88 ",$174.13 ,"$1,991.60 "
ST. JOSEPH'S HOSPITAL - BREESE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$4,596.00 ","$2,987.40 ",$174.13 ,"$4,596.00 ","$3,906.60 ","$2,743.81 ",$174.13 ,"$2,642.70 ",$174.13 ,"$3,166.64 ","$3,906.60 ","$3,906.60 ","$3,906.60 ","$3,768.72 ","$3,125.28 ",$174.13 ,$174.13 ,"$3,447.00 ","$3,263.16 ","$3,263.16 ",$174.13 ,"$3,263.16 ","$3,814.68 ","$3,814.68 ","$3,814.68 ", N/A ,$435.32 ,"$3,906.60 ",$174.13 ,"$4,596.00 ",$200.45 ,$200.45 ,"$3,906.60 ",$365.67 ,"$3,906.60 ","$4,136.40 ",$174.13 ,"$3,814.68 ","$3,653.82 ","$3,653.82 ",$174.13 ,"$2,987.40 "
ST. JOSEPH'S HOSPITAL - BREESE,35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$3,249.00 ","$2,111.85 ",$107.10 ,"$3,249.00 ","$2,761.65 ","$1,939.65 ",$107.10 ,"$1,868.18 ",$107.10 ,"$2,238.56 ","$2,761.65 ","$2,761.65 ","$2,761.65 ","$2,664.18 ","$2,209.32 ",$107.10 ,$107.10 ,"$2,436.75 ","$2,306.79 ","$2,306.79 ",$107.10 ,"$2,306.79 ","$2,696.67 ","$2,696.67 ","$2,696.67 ", N/A ,$267.76 ,"$2,761.65 ",$107.10 ,"$3,249.00 ",$200.64 ,$200.64 ,"$2,761.65 ",$224.92 ,"$2,761.65 ","$2,924.10 ",$107.10 ,"$2,696.67 ","$2,582.96 ","$2,582.96 ",$107.10 ,"$2,111.85 "
ST. JOSEPH'S HOSPITAL - BREESE,35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$3,673.00 ","$2,387.45 ",$174.13 ,"$3,673.00 ","$3,122.05 ","$2,192.78 ",$174.13 ,"$2,111.98 ",$174.13 ,"$2,530.70 ","$3,122.05 ","$3,122.05 ","$3,122.05 ","$3,011.86 ","$2,497.64 ",$174.13 ,$174.13 ,"$2,754.75 ","$2,607.83 ","$2,607.83 ",$174.13 ,"$2,607.83 ","$3,048.59 ","$3,048.59 ","$3,048.59 ", N/A ,$435.32 ,"$3,122.05 ",$174.13 ,"$3,673.00 ",$200.64 ,$200.64 ,"$3,122.05 ",$365.67 ,"$3,122.05 ","$3,305.70 ",$174.13 ,"$3,048.59 ","$2,920.04 ","$2,920.04 ",$174.13 ,"$2,387.45 "
ST. JOSEPH'S HOSPITAL - BREESE,35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$4,492.00 ","$2,919.80 ",$174.13 ,"$4,492.00 ","$3,818.20 ","$2,681.72 ",$174.13 ,"$2,582.90 ",$174.13 ,"$3,094.99 ","$3,818.20 ","$3,818.20 ","$3,818.20 ","$3,683.44 ","$3,054.56 ",$174.13 ,$174.13 ,"$3,369.00 ","$3,189.32 ","$3,189.32 ",$174.13 ,"$3,189.32 ","$3,728.36 ","$3,728.36 ","$3,728.36 ", N/A ,$435.32 ,"$3,818.20 ",$174.13 ,"$4,492.00 ",$200.64 ,$200.64 ,"$3,818.20 ",$365.67 ,"$3,818.20 ","$4,042.80 ",$174.13 ,"$3,728.36 ","$3,571.14 ","$3,571.14 ",$174.13 ,"$2,919.80 "
ST. JOSEPH'S HOSPITAL - BREESE,35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,242.00 ","$2,107.30 ",$174.13 ,"$3,242.00 ","$2,755.70 ","$1,935.47 ",$174.13 ,"$1,864.15 ",$174.13 ,"$2,233.74 ","$2,755.70 ","$2,755.70 ","$2,755.70 ","$2,658.44 ","$2,204.56 ",$174.13 ,$174.13 ,"$2,431.50 ","$2,301.82 ","$2,301.82 ",$174.13 ,"$2,301.82 ","$2,690.86 ","$2,690.86 ","$2,690.86 ", N/A ,$435.32 ,"$2,755.70 ",$174.13 ,"$3,242.00 ",$200.45 ,$200.45 ,"$2,755.70 ",$365.67 ,"$2,755.70 ","$2,917.80 ",$174.13 ,"$2,690.86 ","$2,577.39 ","$2,577.39 ",$174.13 ,"$2,107.30 "
ST. JOSEPH'S HOSPITAL - BREESE,35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$5,045.00 ","$3,279.25 ",$200.64 ,"$5,045.00 ","$4,288.25 ","$3,011.87 ",$222.69 ,"$2,900.88 ",$222.69 ,"$3,476.01 ","$4,288.25 ","$4,288.25 ","$4,288.25 ","$4,136.90 ","$3,430.60 ",$222.69 ,$222.69 ,"$3,783.75 ","$3,581.95 ","$3,581.95 ",$222.69 ,"$3,581.95 ","$4,187.35 ","$4,187.35 ","$4,187.35 ", N/A ,$556.73 ,"$4,288.25 ",$222.69 ,"$5,045.00 ",$200.64 ,$200.64 ,"$4,288.25 ",$467.66 ,"$4,288.25 ","$4,540.50 ",$222.69 ,"$4,187.35 ","$4,010.78 ","$4,010.78 ",$222.69 ,"$3,279.25 "
ST. JOSEPH'S HOSPITAL - BREESE,35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$5,200.00 ","$3,380.00 ",$200.64 ,"$5,200.00 ","$4,420.00 ","$3,104.40 ",$364.90 ,"$2,990.00 ",$364.90 ,"$3,582.80 ","$4,420.00 ","$4,420.00 ","$4,420.00 ","$4,264.00 ","$3,536.00 ",$364.90 ,$364.90 ,"$3,900.00 ","$3,692.00 ","$3,692.00 ",$364.90 ,"$3,692.00 ","$4,316.00 ","$4,316.00 ","$4,316.00 ", N/A ,$912.24 ,"$4,420.00 ",$364.90 ,"$5,200.00 ",$200.64 ,$200.64 ,"$4,420.00 ",$766.28 ,"$4,420.00 ","$4,680.00 ",$364.90 ,"$4,316.00 ","$4,134.00 ","$4,134.00 ",$364.90 ,"$3,380.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$6,239.00 ","$4,055.35 ",$200.64 ,"$6,239.00 ","$5,303.15 ","$3,724.68 ",$364.90 ,"$3,587.43 ",$364.90 ,"$4,298.67 ","$5,303.15 ","$5,303.15 ","$5,303.15 ","$5,115.98 ","$4,242.52 ",$364.90 ,$364.90 ,"$4,679.25 ","$4,429.69 ","$4,429.69 ",$364.90 ,"$4,429.69 ","$5,178.37 ","$5,178.37 ","$5,178.37 ", N/A ,$912.24 ,"$5,303.15 ",$364.90 ,"$6,239.00 ",$200.64 ,$200.64 ,"$5,303.15 ",$766.28 ,"$5,303.15 ","$5,615.10 ",$364.90 ,"$5,178.37 ","$4,960.01 ","$4,960.01 ",$364.90 ,"$4,055.35 "
ST. JOSEPH'S HOSPITAL - BREESE,35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,$103.00 ,$66.95 ,$59.23 ,$221.76 ,$87.55 ,$61.49 ,$76.27 ,$59.23 ,$76.27 ,$70.97 ,$87.55 ,$87.55 ,$87.55 ,$84.46 ,$70.04 ,$76.27 ,$76.27 ,$77.25 ,$73.13 ,$73.13 ,$76.27 ,$73.13 ,$85.49 ,$85.49 ,$85.49 , N/A ,$103.00 ,$87.55 ,$76.27 ,$103.00 ,$221.76 ,$99.40 ,$87.55 ,$160.16 ,$87.55 ,$92.70 ,$76.27 ,$85.49 ,$81.89 ,$81.89 ,$76.27 ,$66.95 
ST. JOSEPH'S HOSPITAL - BREESE,35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$2,959.00 ","$1,923.35 ",$174.13 ,"$2,959.00 ","$2,515.15 ","$1,766.52 ",$174.13 ,"$1,701.43 ",$174.13 ,"$2,038.75 ","$2,515.15 ","$2,515.15 ","$2,515.15 ","$2,426.38 ","$2,012.12 ",$174.13 ,$174.13 ,"$2,219.25 ","$2,100.89 ","$2,100.89 ",$174.13 ,"$2,100.89 ","$2,455.97 ","$2,455.97 ","$2,455.97 ", N/A ,$435.32 ,"$2,515.15 ",$174.13 ,"$2,959.00 ",$200.45 ,$200.45 ,"$2,515.15 ",$365.67 ,"$2,515.15 ","$2,663.10 ",$174.13 ,"$2,455.97 ","$2,352.41 ","$2,352.41 ",$174.13 ,"$1,923.35 "
ST. JOSEPH'S HOSPITAL - BREESE,35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,"$2,627.00 ","$1,707.55 ",$76.27 ,"$2,627.00 ","$2,232.95 ","$1,568.32 ",$76.27 ,"$1,510.53 ",$76.27 ,"$1,810.00 ","$2,232.95 ","$2,232.95 ","$2,232.95 ","$2,154.14 ","$1,786.36 ",$76.27 ,$76.27 ,"$1,970.25 ","$1,865.17 ","$1,865.17 ",$76.27 ,"$1,865.17 ","$2,180.41 ","$2,180.41 ","$2,180.41 ", N/A ,$190.67 ,"$2,232.95 ",$76.27 ,"$2,627.00 ",$88.69 ,$88.69 ,"$2,232.95 ",$160.16 ,"$2,232.95 ","$2,364.30 ",$76.27 ,"$2,180.41 ","$2,088.47 ","$2,088.47 ",$76.27 ,"$1,707.55 "
ST. JOSEPH'S HOSPITAL - BREESE,35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$5,469.00 ","$3,554.85 ",$200.64 ,"$5,469.00 ","$4,648.65 ","$3,264.99 ",$364.90 ,"$3,144.68 ",$364.90 ,"$3,768.14 ","$4,648.65 ","$4,648.65 ","$4,648.65 ","$4,484.58 ","$3,718.92 ",$364.90 ,$364.90 ,"$4,101.75 ","$3,882.99 ","$3,882.99 ",$364.90 ,"$3,882.99 ","$4,539.27 ","$4,539.27 ","$4,539.27 ", N/A ,$912.24 ,"$4,648.65 ",$364.90 ,"$5,469.00 ",$200.64 ,$200.64 ,"$4,648.65 ",$766.28 ,"$4,648.65 ","$4,922.10 ",$364.90 ,"$4,539.27 ","$4,347.86 ","$4,347.86 ",$364.90 ,"$3,554.85 "
ST. JOSEPH'S HOSPITAL - BREESE,35000135,22513,HC VERTEBROPLASTY INJ PERC THOR  KYPHOPLASTY,350,1 ,"$17,149.05 ","$11,146.88 ","$4,769.00 ","$17,149.05 ","$5,213.00 ","$10,237.98 ","$5,716.35 ","$9,860.70 ","$5,716.35 ","$11,815.70 ","$14,576.69 ","$14,576.69 ","$14,576.69 ","$4,769.00 ","$11,661.35 ","$5,716.35 ","$5,716.35 ","$12,861.79 ","$12,175.83 ","$12,175.83 ","$5,716.35 ","$12,175.83 ","$14,233.71 ","$14,233.71 ","$14,233.71 ", N/A ,"$14,290.88 ","$14,576.69 ","$5,716.35 ","$17,149.05 ","$7,951.94 ","$7,951.94 ","$14,576.69 ","$12,004.34 ","$14,576.69 ","$15,434.15 ","$5,716.35 ","$14,233.71 ","$13,633.49 ","$13,633.49 ","$5,716.35 ","$11,146.88 "
ST. JOSEPH'S HOSPITAL - BREESE,35000136,22514,HC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,350,1 ,"$17,149.05 ","$11,146.88 ","$4,769.00 ","$17,149.05 ","$5,213.00 ","$10,237.98 ","$5,716.35 ","$9,860.70 ","$5,716.35 ","$11,815.70 ","$14,576.69 ","$14,576.69 ","$14,576.69 ","$4,769.00 ","$11,661.35 ","$5,716.35 ","$5,716.35 ","$12,861.79 ","$12,175.83 ","$12,175.83 ","$5,716.35 ","$12,175.83 ","$14,233.71 ","$14,233.71 ","$14,233.71 ", N/A ,"$14,290.88 ","$14,576.69 ","$5,716.35 ","$17,149.05 ","$7,951.94 ","$7,951.94 ","$14,576.69 ","$12,004.34 ","$14,576.69 ","$15,434.15 ","$5,716.35 ","$14,233.71 ","$13,633.49 ","$13,633.49 ","$5,716.35 ","$11,146.88 "
ST. JOSEPH'S HOSPITAL - BREESE,35000137,22515,HC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,350,1 ,"$14,044.55 ","$9,128.96 ","$4,769.00 ","$14,044.55 ","$5,213.00 ","$8,384.60 ", N/A ,"$8,075.62 ", N/A ,"$9,676.70 ","$11,937.87 ","$11,937.87 ","$11,937.87 ","$4,769.00 ","$9,550.29 ", N/A , N/A ,"$10,533.41 ","$9,971.63 ","$9,971.63 ", N/A ,"$9,971.63 ","$11,656.98 ","$11,656.98 ","$11,656.98 ", N/A , N/A ,"$11,937.87 ", N/A ,"$14,044.55 ","$7,951.94 ","$7,951.94 ","$11,937.87 ", N/A ,"$11,937.87 ","$12,640.10 ", N/A ,"$11,656.98 ","$11,165.42 ","$11,165.42 ", N/A ,"$9,128.96 "
ST. JOSEPH'S HOSPITAL - BREESE,35000150,G0297,HC CT LUNG SCREENING,350,1 ,$240.00 ,$156.00 ,$76.27 ,$240.00 ,$204.00 ,$143.28 ,$76.27 ,$138.00 ,$76.27 ,$165.36 ,$204.00 ,$204.00 ,$204.00 ,$196.80 ,$163.20 ,$76.27 ,$76.27 ,$180.00 ,$170.40 ,$170.40 ,$76.27 ,$170.40 ,$199.20 ,$199.20 ,$199.20 , N/A ,$190.67 ,$204.00 ,$76.27 ,$240.00 ,$88.69 ,$88.69 ,$204.00 ,$160.16 ,$204.00 ,$216.00 ,$76.27 ,$199.20 ,$190.80 ,$190.80 ,$76.27 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$420.00 ,$273.00 ,$166.97 ,$420.00 ,$357.00 ,$250.74 ,$166.97 ,$241.50 ,$166.97 ,$289.38 ,$357.00 ,$357.00 ,$357.00 ,$344.40 ,$285.60 ,$166.97 ,$166.97 ,$315.00 ,$298.20 ,$298.20 ,$166.97 ,$298.20 ,$348.60 ,$348.60 ,$348.60 , N/A ,$417.43 ,$357.00 ,$166.97 ,$420.00 ,$191.95 ,$191.95 ,$357.00 ,$350.64 ,$357.00 ,$378.00 ,$166.97 ,$348.60 ,$333.90 ,$333.90 ,$166.97 ,$273.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$816.00 ,$530.40 ,$191.95 ,$816.00 ,$693.60 ,$487.15 ,$305.32 ,$469.20 ,$305.32 ,$562.22 ,$693.60 ,$693.60 ,$693.60 ,$669.12 ,$554.88 ,$305.32 ,$305.32 ,$612.00 ,$579.36 ,$579.36 ,$305.32 ,$579.36 ,$677.28 ,$677.28 ,$677.28 , N/A ,$763.31 ,$693.60 ,$305.32 ,$816.00 ,$191.95 ,$191.95 ,$693.60 ,$641.18 ,$693.60 ,$734.40 ,$305.32 ,$677.28 ,$648.72 ,$648.72 ,$305.32 ,$530.40 
ST. JOSEPH'S HOSPITAL - BREESE,36000078,19000,HC ASP CYST BREAST,360,1 ,$813.00 ,$528.45 ,$119.12 ,"$1,224.14 ",$691.05 ,$485.36 ,$582.93 ,$467.48 ,$582.93 ,$560.16 ,$691.05 ,$691.05 ,$691.05 ,$666.66 ,$552.84 ,$582.93 ,$582.93 ,$609.75 ,$577.23 ,$577.23 ,$582.93 ,$577.23 ,$674.79 ,$674.79 ,$674.79 , N/A ,$813.00 ,$691.05 ,$582.93 ,$119.12 ,$388.56 ,$388.56 ,$691.05 ,"$1,224.14 ",$691.05 ,$731.70 ,$582.93 ,$674.79 ,$646.34 ,$646.34 ,$582.93 ,$528.45 
ST. JOSEPH'S HOSPITAL - BREESE,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$398.00 ,$258.70 ,$228.85 ,$398.00 ,$338.30 ,$237.61 , N/A ,$228.85 , N/A ,$274.22 ,$338.30 ,$338.30 ,$338.30 ,$326.36 ,$270.64 , N/A , N/A ,$298.50 ,$282.58 ,$282.58 , N/A ,$282.58 ,$330.34 ,$330.34 ,$330.34 , N/A , N/A ,$338.30 , N/A ,$398.00 , N/A , N/A ,$338.30 , N/A ,$338.30 ,$358.20 , N/A ,$330.34 ,$316.41 ,$316.41 , N/A ,$258.70 
ST. JOSEPH'S HOSPITAL - BREESE,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$597.00 ,$388.05 ,$343.28 ,$597.00 ,$507.45 ,$356.41 , N/A ,$343.28 , N/A ,$411.33 ,$507.45 ,$507.45 ,$507.45 ,$489.54 ,$405.96 , N/A , N/A ,$447.75 ,$423.87 ,$423.87 , N/A ,$423.87 ,$495.51 ,$495.51 ,$495.51 , N/A , N/A ,$507.45 , N/A ,$597.00 , N/A , N/A ,$507.45 , N/A ,$507.45 ,$537.30 , N/A ,$495.51 ,$474.62 ,$474.62 , N/A ,$388.05 
ST. JOSEPH'S HOSPITAL - BREESE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$3,828.00 ","$2,488.20 ",$650.01 ,"$3,828.00 ","$3,253.80 ","$2,285.32 ","$1,311.66 ","$2,201.10 ","$1,311.66 ","$2,637.49 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$3,138.96 ","$2,603.04 ","$1,311.66 ","$1,311.66 ","$2,871.00 ","$2,717.88 ","$2,717.88 ","$1,311.66 ","$2,717.88 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,279.14 ","$3,253.80 ","$1,311.66 ",$650.01 ,$787.43 ,$787.43 ,"$3,253.80 ","$2,754.48 ","$1,935.00 ","$3,445.20 ","$1,311.66 ","$2,921.00 ","$3,043.26 ","$3,043.26 ","$1,311.66 ","$2,488.20 "
ST. JOSEPH'S HOSPITAL - BREESE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$5,742.00 ","$3,732.30 ",$650.01 ,"$5,742.00 ","$4,880.70 ","$3,427.97 ","$1,311.66 ","$3,301.65 ","$1,311.66 ","$3,956.24 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,708.44 ","$3,904.56 ","$1,311.66 ","$1,311.66 ","$4,306.50 ","$4,076.82 ","$4,076.82 ","$1,311.66 ","$4,076.82 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,279.14 ","$4,880.70 ","$1,311.66 ",$650.01 ,$787.43 ,$787.43 ,"$4,880.70 ","$2,754.48 ","$1,935.00 ","$5,167.80 ","$1,311.66 ","$2,921.00 ","$4,564.89 ","$4,564.89 ","$1,311.66 ","$3,732.30 "
ST. JOSEPH'S HOSPITAL - BREESE,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,736.00 ","$1,128.40 ",$76.28 ,"$1,736.00 ","$1,475.60 ","$1,036.39 ",$582.93 ,$998.20 ,$582.93 ,"$1,196.10 ","$1,475.60 ","$1,475.60 ","$1,475.60 ","$1,423.52 ","$1,180.48 ",$582.93 ,$582.93 ,"$1,302.00 ","$1,232.56 ","$1,232.56 ",$582.93 ,"$1,232.56 ","$1,440.88 ","$1,440.88 ","$1,440.88 ", N/A ,"$1,457.31 ","$1,475.60 ",$582.93 ,$489.83 ,$76.28 ,$76.28 ,"$1,475.60 ","$1,224.14 ","$1,475.60 ","$1,562.40 ",$582.93 ,"$1,440.88 ","$1,380.12 ","$1,380.12 ",$582.93 ,"$1,128.40 "
ST. JOSEPH'S HOSPITAL - BREESE,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$2,603.00 ","$1,691.95 ",$76.28 ,"$2,603.00 ","$2,212.55 ","$1,553.99 ",$582.93 ,"$1,496.73 ",$582.93 ,"$1,793.47 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,134.46 ","$1,770.04 ",$582.93 ,$582.93 ,"$1,952.25 ","$1,848.13 ","$1,848.13 ",$582.93 ,"$1,848.13 ","$2,160.49 ","$2,160.49 ","$2,160.49 ", N/A ,"$1,457.31 ","$2,212.55 ",$582.93 ,$489.83 ,$76.28 ,$76.28 ,"$2,212.55 ","$1,224.14 ","$1,935.00 ","$2,342.70 ",$582.93 ,"$2,160.49 ","$2,069.39 ","$2,069.39 ",$582.93 ,"$1,691.95 "
ST. JOSEPH'S HOSPITAL - BREESE,36000101,29085,HC CAST APPL; HAND AND FOREARM,360,1 ,$283.00 ,$183.95 ,$127.80 ,$283.00 ,$240.55 ,$168.95 ,$127.80 ,$162.73 ,$127.80 ,$194.99 ,$240.55 ,$240.55 ,$240.55 , N/A ,$192.44 ,$127.80 ,$127.80 ,$212.25 ,$200.93 ,$200.93 ,$127.80 ,$200.93 ,$234.89 ,$234.89 ,$234.89 , N/A ,$283.00 ,$240.55 ,$127.80 ,$283.00 ,$207.69 ,$207.69 ,$240.55 ,$268.38 ,$240.55 ,$254.70 ,$127.80 ,$234.89 ,$224.99 ,$224.99 ,$127.80 ,$183.95 
ST. JOSEPH'S HOSPITAL - BREESE,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,"$1,986.00 ","$1,290.90 ",$527.38 ,"$1,986.00 ","$1,688.10 ","$1,185.64 ", N/A ,"$1,141.95 ", N/A ,"$1,368.35 ","$1,688.10 ","$1,688.10 ","$1,688.10 ","$1,628.52 ","$1,350.48 ", N/A , N/A ,"$1,489.50 ","$1,410.06 ","$1,410.06 ", N/A ,"$1,410.06 ","$1,648.38 ","$1,648.38 ","$1,648.38 ", N/A , N/A ,"$1,688.10 ", N/A ,$527.38 ,$787.43 ,$787.43 ,"$1,688.10 ", N/A ,"$1,688.10 ","$1,787.40 ", N/A ,"$1,648.38 ","$1,578.87 ","$1,578.87 ", N/A ,"$1,290.90 "
ST. JOSEPH'S HOSPITAL - BREESE,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,"$2,979.00 ","$1,936.35 ",$527.38 ,"$2,979.00 ","$2,532.15 ","$1,778.46 ", N/A ,"$1,712.93 ", N/A ,"$2,052.53 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,442.78 ","$2,025.72 ", N/A , N/A ,"$2,234.25 ","$2,115.09 ","$2,115.09 ", N/A ,"$2,115.09 ","$2,472.57 ","$2,472.57 ","$2,472.57 ", N/A , N/A ,"$2,532.15 ", N/A ,$527.38 ,$787.43 ,$787.43 ,"$2,532.15 ", N/A ,"$1,935.00 ","$2,681.10 ", N/A ,"$2,472.57 ","$2,368.31 ","$2,368.31 ", N/A ,"$1,936.35 "
ST. JOSEPH'S HOSPITAL - BREESE,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,"$1,413.00 ",$918.45 ,$512.31 ,"$1,413.00 ","$1,201.05 ",$843.56 , N/A ,$812.48 , N/A ,$973.56 ,"$1,201.05 ","$1,201.05 ","$1,201.05 ","$1,158.66 ",$960.84 , N/A , N/A ,"$1,059.75 ","$1,003.23 ","$1,003.23 ", N/A ,"$1,003.23 ","$1,172.79 ","$1,172.79 ","$1,172.79 ", N/A , N/A ,"$1,201.05 ", N/A ,$512.31 ,$787.43 ,$787.43 ,"$1,201.05 ", N/A ,"$1,201.05 ","$1,271.70 ", N/A ,"$1,172.79 ","$1,123.34 ","$1,123.34 ", N/A ,$918.45 
ST. JOSEPH'S HOSPITAL - BREESE,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,"$2,120.00 ","$1,378.00 ",$512.31 ,"$2,120.00 ","$1,802.00 ","$1,265.64 ", N/A ,"$1,219.00 ", N/A ,"$1,460.68 ","$1,802.00 ","$1,802.00 ","$1,802.00 ","$1,738.40 ","$1,441.60 ", N/A , N/A ,"$1,590.00 ","$1,505.20 ","$1,505.20 ", N/A ,"$1,505.20 ","$1,759.60 ","$1,759.60 ","$1,759.60 ", N/A , N/A ,"$1,802.00 ", N/A ,$512.31 ,$787.43 ,$787.43 ,"$1,802.00 ", N/A ,"$1,802.00 ","$1,908.00 ", N/A ,"$1,759.60 ","$1,685.40 ","$1,685.40 ", N/A ,"$1,378.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$611.00 ,$397.15 ,$76.28 ,$611.00 ,$519.35 ,$364.77 , N/A ,$351.33 , N/A ,$420.98 ,$519.35 ,$519.35 ,$519.35 ,$501.02 ,$415.48 , N/A , N/A ,$458.25 ,$433.81 ,$433.81 , N/A ,$433.81 ,$507.13 ,$507.13 ,$507.13 , N/A , N/A ,$519.35 , N/A ,$186.19 ,$76.28 ,$76.28 ,$519.35 , N/A ,$519.35 ,$549.90 , N/A ,$507.13 ,$485.75 ,$485.75 , N/A ,$397.15 
ST. JOSEPH'S HOSPITAL - BREESE,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$917.00 ,$596.05 ,$76.28 ,$917.00 ,$779.45 ,$547.45 , N/A ,$527.28 , N/A ,$631.81 ,$779.45 ,$779.45 ,$779.45 ,$751.94 ,$623.56 , N/A , N/A ,$687.75 ,$651.07 ,$651.07 , N/A ,$651.07 ,$761.11 ,$761.11 ,$761.11 , N/A , N/A ,$779.45 , N/A ,$186.19 ,$76.28 ,$76.28 ,$779.45 , N/A ,$779.45 ,$825.30 , N/A ,$761.11 ,$729.02 ,$729.02 , N/A ,$596.05 
ST. JOSEPH'S HOSPITAL - BREESE,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,$611.00 ,$397.15 ,$76.28 ,$611.00 ,$519.35 ,$364.77 , N/A ,$351.33 , N/A ,$420.98 ,$519.35 ,$519.35 ,$519.35 ,$501.02 ,$415.48 , N/A , N/A ,$458.25 ,$433.81 ,$433.81 , N/A ,$433.81 ,$507.13 ,$507.13 ,$507.13 , N/A , N/A ,$519.35 , N/A ,$417.34 ,$76.28 ,$76.28 ,$519.35 , N/A ,$519.35 ,$549.90 , N/A ,$507.13 ,$485.75 ,$485.75 , N/A ,$397.15 
ST. JOSEPH'S HOSPITAL - BREESE,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,$917.00 ,$596.05 ,$76.28 ,$917.00 ,$779.45 ,$547.45 , N/A ,$527.28 , N/A ,$631.81 ,$779.45 ,$779.45 ,$779.45 ,$751.94 ,$623.56 , N/A , N/A ,$687.75 ,$651.07 ,$651.07 , N/A ,$651.07 ,$761.11 ,$761.11 ,$761.11 , N/A , N/A ,$779.45 , N/A ,$417.34 ,$76.28 ,$76.28 ,$779.45 , N/A ,$779.45 ,$825.30 , N/A ,$761.11 ,$729.02 ,$729.02 , N/A ,$596.05 
ST. JOSEPH'S HOSPITAL - BREESE,36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$2,176.00 ","$1,414.40 ","$1,087.29 ","$3,273.29 ","$1,849.60 ","$1,299.07 ","$1,558.71 ","$1,251.20 ","$1,558.71 ","$1,499.26 ","$1,849.60 ","$1,849.60 ","$1,849.60 ","$1,784.32 ","$1,479.68 ","$1,558.71 ","$1,558.71 ","$1,632.00 ","$1,544.96 ","$1,544.96 ","$1,558.71 ","$1,544.96 ","$1,806.08 ","$1,806.08 ","$1,806.08 ", N/A ,"$2,176.00 ","$1,849.60 ","$1,558.71 ","$2,176.00 ","$1,087.29 ","$1,087.29 ","$1,849.60 ","$3,273.29 ","$1,849.60 ","$1,958.40 ","$1,558.71 ","$1,806.08 ","$1,729.92 ","$1,729.92 ","$1,558.71 ","$1,414.40 "
ST. JOSEPH'S HOSPITAL - BREESE,36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$2,174.00 ","$1,413.10 ",$316.51 ,"$3,273.29 ","$1,847.90 ","$1,297.88 ","$1,558.71 ","$1,250.05 ","$1,558.71 ","$1,497.89 ","$1,847.90 ","$1,847.90 ","$1,847.90 ","$1,782.68 ","$1,478.32 ","$1,558.71 ","$1,558.71 ","$1,630.50 ","$1,543.54 ","$1,543.54 ","$1,558.71 ","$1,543.54 ","$1,804.42 ","$1,804.42 ","$1,804.42 ", N/A ,"$2,174.00 ","$1,847.90 ","$1,558.71 ","$2,174.00 ",$316.51 ,$316.51 ,"$1,847.90 ","$3,273.29 ","$1,847.90 ","$1,956.60 ","$1,558.71 ","$1,804.42 ","$1,728.33 ","$1,728.33 ","$1,558.71 ","$1,413.10 "
ST. JOSEPH'S HOSPITAL - BREESE,36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,$229.00 ,$148.85 ,$90.59 ,"$1,265.28 ",$194.65 ,$136.71 ,$602.52 ,$131.68 ,$602.52 ,$157.78 ,$194.65 ,$194.65 ,$194.65 ,$187.78 ,$155.72 ,$602.52 ,$602.52 ,$171.75 ,$162.59 ,$162.59 ,$602.52 ,$162.59 ,$190.07 ,$190.07 ,$190.07 , N/A ,$229.00 ,$194.65 ,$602.52 ,$229.00 ,$90.59 ,$90.59 ,$194.65 ,"$1,265.28 ",$194.65 ,$206.10 ,$602.52 ,$190.07 ,$182.06 ,$182.06 ,$602.52 ,$148.85 
ST. JOSEPH'S HOSPITAL - BREESE,36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,"$1,225.84 ",$796.80 ,$704.86 ,"$1,709.28 ","$1,041.96 ",$731.83 , N/A ,$704.86 , N/A ,$844.60 ,"$1,041.96 ","$1,041.96 ","$1,041.96 ","$1,005.19 ",$833.57 , N/A , N/A ,$919.38 ,$870.35 ,$870.35 , N/A ,$870.35 ,"$1,017.45 ","$1,017.45 ","$1,017.45 ", N/A , N/A ,"$1,041.96 ", N/A ,"$1,225.84 ","$1,709.28 ","$1,182.94 ","$1,041.96 ", N/A ,"$1,041.96 ","$1,103.26 ", N/A ,"$1,017.45 ",$974.54 ,$974.54 , N/A ,$796.80 
ST. JOSEPH'S HOSPITAL - BREESE,36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,"$3,901.00 ","$2,535.65 ",$388.56 ,"$3,901.00 ","$3,315.85 ","$2,328.90 ","$1,311.66 ","$2,243.08 ","$1,311.66 ","$2,687.79 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$3,198.82 ","$2,652.68 ","$1,311.66 ","$1,311.66 ","$2,925.75 ","$2,769.71 ","$2,769.71 ","$1,311.66 ","$2,769.71 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,279.14 ","$3,315.85 ","$1,311.66 ","$3,901.00 ",$388.56 ,$388.56 ,"$3,315.85 ","$2,754.48 ","$1,935.00 ","$3,510.90 ","$1,311.66 ","$2,921.00 ","$3,101.30 ","$3,101.30 ","$1,311.66 ","$2,535.65 "
ST. JOSEPH'S HOSPITAL - BREESE,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$3,900.00 ","$2,535.00 ",$411.65 ,"$3,900.00 ","$3,315.00 ","$2,328.30 ","$1,311.66 ","$2,242.50 ","$1,311.66 ","$2,687.10 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$3,198.00 ","$2,652.00 ","$1,311.66 ","$1,311.66 ","$2,925.00 ","$2,769.00 ","$2,769.00 ","$1,311.66 ","$2,769.00 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,279.14 ","$3,315.00 ","$1,311.66 ","$3,900.00 ",$411.65 ,$411.65 ,"$3,315.00 ","$2,754.48 ","$1,935.00 ","$3,510.00 ","$1,311.66 ","$2,921.00 ","$3,100.50 ","$3,100.50 ","$1,311.66 ","$2,535.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000194,62270,HC LUMBAR PUNCTURE,360,1 ,$590.00 ,$383.50 ,$330.03 ,"$1,254.33 ",$501.50 ,$352.23 ,$597.30 ,$339.25 ,$597.30 ,$406.51 ,$501.50 ,$501.50 ,$501.50 ,$483.80 ,$401.20 ,$597.30 ,$597.30 ,$442.50 ,$418.90 ,$418.90 ,$597.30 ,$418.90 ,$489.70 ,$489.70 ,$489.70 , N/A ,$590.00 ,$501.50 ,$597.30 ,$590.00 ,$330.03 ,$330.03 ,$501.50 ,"$1,254.33 ",$501.50 ,$531.00 ,$597.30 ,$489.70 ,$469.05 ,$469.05 ,$597.30 ,$383.50 
ST. JOSEPH'S HOSPITAL - BREESE,36000334,63650,HC IMPLANT NEUROELECTRODES,360,1 ,"$17,737.26 ","$11,529.22 ","$1,935.00 ","$17,737.26 ","$5,213.00 ","$10,589.14 ","$5,912.42 ","$10,198.92 ","$5,912.42 ","$12,220.97 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,769.00 ","$12,061.34 ","$5,912.42 ","$5,912.42 ","$13,302.95 ","$12,593.45 ","$12,593.45 ","$5,912.42 ","$12,593.45 ","$14,721.93 ","$14,721.93 ","$14,721.93 ", N/A ,"$14,781.05 ","$15,076.67 ","$5,912.42 ","$17,737.26 ","$3,132.02 ","$3,132.02 ","$15,076.67 ","$12,416.08 ","$1,935.00 ","$15,963.53 ","$5,912.42 ","$14,721.93 ","$14,101.12 ","$14,101.12 ","$5,912.42 ","$11,529.22 "
ST. JOSEPH'S HOSPITAL - BREESE,36000397,27301,HC I AND D ABSC/BURSA THIGH/KNEE,360,1 ,"$6,647.79 ","$4,321.06 ",$669.48 ,"$6,647.79 ","$5,213.00 ","$3,968.73 ","$2,215.93 ","$3,822.48 ","$2,215.93 ","$4,580.33 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,769.00 ","$4,520.50 ","$2,215.93 ","$2,215.93 ","$4,985.84 ","$4,719.93 ","$4,719.93 ","$2,215.93 ","$4,719.93 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$5,539.83 ","$5,650.62 ","$2,215.93 ","$6,647.79 ",$669.48 ,$669.48 ,"$5,650.62 ","$4,653.46 ","$1,935.00 ","$5,983.01 ","$2,215.93 ","$2,921.00 ","$5,284.99 ","$5,284.99 ","$2,215.93 ","$4,321.06 "
ST. JOSEPH'S HOSPITAL - BREESE,36000420,26735,HC TX FX OPEN SHAFT FINGER/THUMB W/INT FIX EACH,360,1 ,"$7,847.73 ","$5,101.02 ","$1,935.00 ","$7,847.73 ","$5,213.00 ","$4,685.09 ","$2,615.91 ","$4,512.44 ","$2,615.91 ","$5,407.09 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,769.00 ","$5,336.46 ","$2,615.91 ","$2,615.91 ","$5,885.80 ","$5,571.89 ","$5,571.89 ","$2,615.91 ","$5,571.89 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$6,539.77 ","$6,670.57 ","$2,615.91 ","$7,847.73 ","$2,863.13 ","$2,863.13 ","$6,670.57 ","$5,493.41 ","$1,935.00 ","$7,062.96 ","$2,615.91 ","$2,921.00 ","$6,238.95 ","$6,238.95 ","$2,615.91 ","$5,101.02 "
ST. JOSEPH'S HOSPITAL - BREESE,36060014,N/A,HC OR LEVEL 1 ADDL 15MIN,360,1 ,$738.00 ,$479.70 ,$424.35 ,$738.00 ,$627.30 ,$440.59 , N/A ,$424.35 , N/A ,$508.48 ,$627.30 ,$627.30 ,$627.30 , N/A ,$501.84 , N/A , N/A ,$553.50 ,$523.98 ,$523.98 , N/A ,$523.98 ,$612.54 ,$612.54 ,$612.54 , N/A , N/A ,$627.30 , N/A ,$738.00 , N/A , N/A ,$627.30 , N/A ,$627.30 ,$664.20 , N/A ,$612.54 ,$586.71 ,$586.71 , N/A ,$479.70 
ST. JOSEPH'S HOSPITAL - BREESE,36060016,N/A,HC OR LEVEL 2 ADDL 15MIN,360,1 ,$841.00 ,$546.65 ,$483.58 ,$841.00 ,$714.85 ,$502.08 , N/A ,$483.58 , N/A ,$579.45 ,$714.85 ,$714.85 ,$714.85 , N/A ,$571.88 , N/A , N/A ,$630.75 ,$597.11 ,$597.11 , N/A ,$597.11 ,$698.03 ,$698.03 ,$698.03 , N/A , N/A ,$714.85 , N/A ,$841.00 , N/A , N/A ,$714.85 , N/A ,$714.85 ,$756.90 , N/A ,$698.03 ,$668.60 ,$668.60 , N/A ,$546.65 
ST. JOSEPH'S HOSPITAL - BREESE,36060018,N/A,HC OR LEVEL 3 ADDL 15MIN,360,1 ,$980.00 ,$637.00 ,$563.50 ,$980.00 ,$833.00 ,$585.06 , N/A ,$563.50 , N/A ,$675.22 ,$833.00 ,$833.00 ,$833.00 , N/A ,$666.40 , N/A , N/A ,$735.00 ,$695.80 ,$695.80 , N/A ,$695.80 ,$813.40 ,$813.40 ,$813.40 , N/A , N/A ,$833.00 , N/A ,$980.00 , N/A , N/A ,$833.00 , N/A ,$833.00 ,$882.00 , N/A ,$813.40 ,$779.10 ,$779.10 , N/A ,$637.00 
ST. JOSEPH'S HOSPITAL - BREESE,36060020,N/A,HC OR LEVEL 4 ADDL 15MIN,360,1 ,"$1,107.00 ",$719.55 ,$636.53 ,"$1,107.00 ",$940.95 ,$660.88 , N/A ,$636.53 , N/A ,$762.72 ,$940.95 ,$940.95 ,$940.95 , N/A ,$752.76 , N/A , N/A ,$830.25 ,$785.97 ,$785.97 , N/A ,$785.97 ,$918.81 ,$918.81 ,$918.81 , N/A , N/A ,$940.95 , N/A ,"$1,107.00 ", N/A , N/A ,$940.95 , N/A ,$940.95 ,$996.30 , N/A ,$918.81 ,$880.07 ,$880.07 , N/A ,$719.55 
ST. JOSEPH'S HOSPITAL - BREESE,36060022,N/A,HC OR LEVEL 5 ADDL 15MIN,360,1 ,"$1,234.00 ",$802.10 ,$709.55 ,"$1,234.00 ","$1,048.90 ",$736.70 , N/A ,$709.55 , N/A ,$850.23 ,"$1,048.90 ","$1,048.90 ","$1,048.90 ", N/A ,$839.12 , N/A , N/A ,$925.50 ,$876.14 ,$876.14 , N/A ,$876.14 ,"$1,024.22 ","$1,024.22 ","$1,024.22 ", N/A , N/A ,"$1,048.90 ", N/A ,"$1,234.00 ", N/A , N/A ,"$1,048.90 ", N/A ,"$1,048.90 ","$1,110.60 ", N/A ,"$1,024.22 ",$981.03 ,$981.03 , N/A ,$802.10 
ST. JOSEPH'S HOSPITAL - BREESE,36060025,N/A,HC OR LEVEL 1 INITIAL 30MIN,360,1 ,"$2,277.00 ","$1,480.05 ","$1,309.28 ","$2,277.00 ","$1,935.45 ","$1,359.37 ", N/A ,"$1,309.28 ", N/A ,"$1,568.85 ","$1,935.00 ","$1,935.00 ","$1,935.00 ", N/A ,"$1,548.36 ", N/A , N/A ,"$1,707.75 ","$1,616.67 ","$1,616.67 ", N/A ,"$1,616.67 ","$1,889.91 ","$1,889.91 ","$1,889.91 ", N/A , N/A ,"$1,935.45 ", N/A ,"$2,277.00 ", N/A , N/A ,"$1,935.45 ", N/A ,"$1,935.00 ","$2,049.30 ", N/A ,"$1,889.91 ","$1,810.22 ","$1,810.22 ", N/A ,"$1,480.05 "
ST. JOSEPH'S HOSPITAL - BREESE,36060026,N/A,HC OR LEVEL 2 INITIAL 30MIN,360,1 ,"$3,920.00 ","$2,548.00 ","$1,935.00 ","$3,920.00 ","$3,332.00 ","$2,340.24 ", N/A ,"$2,254.00 ", N/A ,"$2,700.88 ","$1,935.00 ","$1,935.00 ","$1,935.00 ", N/A ,"$2,665.60 ", N/A , N/A ,"$2,940.00 ","$2,783.20 ","$2,783.20 ", N/A ,"$2,783.20 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A , N/A ,"$3,332.00 ", N/A ,"$3,920.00 ", N/A , N/A ,"$3,332.00 ", N/A ,"$1,935.00 ","$3,528.00 ", N/A ,"$2,921.00 ","$3,116.40 ","$3,116.40 ", N/A ,"$2,548.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060027,N/A,HC OR LEVEL 3 INITIAL 30MIN,360,1 ,"$5,100.00 ","$3,315.00 ","$1,935.00 ","$5,100.00 ","$4,335.00 ","$3,044.70 ", N/A ,"$2,932.50 ", N/A ,"$3,513.90 ","$1,935.00 ","$1,935.00 ","$1,935.00 ", N/A ,"$3,468.00 ", N/A , N/A ,"$3,825.00 ","$3,621.00 ","$3,621.00 ", N/A ,"$3,621.00 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A , N/A ,"$4,335.00 ", N/A ,"$5,100.00 ", N/A , N/A ,"$4,335.00 ", N/A ,"$1,935.00 ","$4,590.00 ", N/A ,"$2,921.00 ","$4,054.50 ","$4,054.50 ", N/A ,"$3,315.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060028,N/A,HC OR LEVEL 4 INITIAL 30MIN,360,1 ,"$5,336.00 ","$3,468.40 ","$1,935.00 ","$5,336.00 ","$4,535.60 ","$3,185.59 ", N/A ,"$3,068.20 ", N/A ,"$3,676.50 ","$1,935.00 ","$1,935.00 ","$1,935.00 ", N/A ,"$3,628.48 ", N/A , N/A ,"$4,002.00 ","$3,788.56 ","$3,788.56 ", N/A ,"$3,788.56 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A , N/A ,"$4,535.60 ", N/A ,"$5,336.00 ", N/A , N/A ,"$4,535.60 ", N/A ,"$1,935.00 ","$4,802.40 ", N/A ,"$2,921.00 ","$4,242.12 ","$4,242.12 ", N/A ,"$3,468.40 "
ST. JOSEPH'S HOSPITAL - BREESE,36060029,N/A,HC OR LEVEL 5 INITIAL 30MIN,360,1 ,"$5,602.00 ","$3,641.30 ","$1,935.00 ","$5,602.00 ","$4,761.70 ","$3,344.39 ", N/A ,"$3,221.15 ", N/A ,"$3,859.78 ","$1,935.00 ","$1,935.00 ","$1,935.00 ", N/A ,"$3,809.36 ", N/A , N/A ,"$4,201.50 ","$3,977.42 ","$3,977.42 ", N/A ,"$3,977.42 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A , N/A ,"$4,761.70 ", N/A ,"$5,602.00 ", N/A , N/A ,"$4,761.70 ", N/A ,"$1,935.00 ","$5,041.80 ", N/A ,"$2,921.00 ","$4,453.59 ","$4,453.59 ", N/A ,"$3,641.30 "
ST. JOSEPH'S HOSPITAL - BREESE,36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,$703.00 ,$456.95 ,$250.15 ,$703.00 ,$597.55 ,$419.69 ,$250.15 ,$404.23 ,$250.15 ,$484.37 ,$597.55 ,$597.55 ,$597.55 ,$576.46 ,$478.04 ,$250.15 ,$250.15 ,$527.25 ,$499.13 ,$499.13 ,$250.15 ,$499.13 ,$583.49 ,$583.49 ,$583.49 , N/A ,$625.37 ,$597.55 ,$250.15 ,$703.00 ,$280.92 ,$280.92 ,$597.55 ,$525.31 ,$597.55 ,$632.70 ,$250.15 ,$583.49 ,$558.89 ,$558.89 ,$250.15 ,$456.95 
ST. JOSEPH'S HOSPITAL - BREESE,36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,"$2,307.00 ","$1,499.55 ",$280.92 ,"$2,307.00 ","$1,960.95 ","$1,377.28 ",$776.00 ,"$1,326.53 ",$776.00 ,"$1,589.52 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$1,891.74 ","$1,568.76 ",$776.00 ,$776.00 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$776.00 ,"$1,637.97 ","$1,914.81 ","$1,914.81 ","$1,914.81 ", N/A ,"$1,939.99 ","$1,960.95 ",$776.00 ,"$2,307.00 ",$280.92 ,$280.92 ,"$1,960.95 ","$1,629.59 ","$1,935.00 ","$2,076.30 ",$776.00 ,"$1,914.81 ","$1,834.07 ","$1,834.07 ",$776.00 ,"$1,499.55 "
ST. JOSEPH'S HOSPITAL - BREESE,36100015,11010,HC DEBRID/REMOVE FOREIGN BODY SKIN/SUBQ TISSUE,361,1 ,"$1,645.00 ","$1,069.25 ",$582.93 ,"$1,645.00 ","$1,398.25 ",$982.07 ,$582.93 ,$945.88 ,$582.93 ,"$1,133.41 ","$1,398.25 ","$1,398.25 ","$1,398.25 ","$1,348.90 ","$1,118.60 ",$582.93 ,$582.93 ,"$1,233.75 ","$1,167.95 ","$1,167.95 ",$582.93 ,"$1,167.95 ","$1,365.35 ","$1,365.35 ","$1,365.35 ", N/A ,"$1,457.31 ","$1,398.25 ",$582.93 ,"$1,645.00 ",$823.30 ,$823.30 ,"$1,398.25 ","$1,224.14 ","$1,398.25 ","$1,480.50 ",$582.93 ,"$1,365.35 ","$1,307.78 ","$1,307.78 ",$582.93 ,"$1,069.25 "
ST. JOSEPH'S HOSPITAL - BREESE,36100026,36510,HC UMBILICAL CATHETER INSERTION NEWBORN,361,1 ,$713.00 ,$463.45 ,$409.98 ,$713.00 ,$606.05 ,$425.66 , N/A ,$409.98 , N/A ,$491.26 ,$606.05 ,$606.05 ,$606.05 ,$584.66 ,$484.84 , N/A , N/A ,$534.75 ,$506.23 ,$506.23 , N/A ,$506.23 ,$591.79 ,$591.79 ,$591.79 , N/A , N/A ,$606.05 , N/A ,$713.00 , N/A , N/A ,$606.05 , N/A ,$606.05 ,$641.70 , N/A ,$591.79 ,$566.84 ,$566.84 , N/A ,$463.45 
ST. JOSEPH'S HOSPITAL - BREESE,36100034,55876,HC PLACE DEVICE/MARKER PROSTATE,361,1 ,"$3,570.15 ","$2,320.60 ",$934.38 ,"$3,570.15 ","$3,034.63 ","$2,131.38 ","$1,190.05 ","$2,052.84 ","$1,190.05 ","$2,459.83 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,927.52 ","$2,427.70 ","$1,190.05 ","$1,190.05 ","$2,677.61 ","$2,534.81 ","$2,534.81 ","$1,190.05 ","$2,534.81 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$2,975.12 ","$3,034.63 ","$1,190.05 ","$3,570.15 ",$934.38 ,$934.38 ,"$3,034.63 ","$2,499.10 ","$1,935.00 ","$3,213.14 ","$1,190.05 ","$2,921.00 ","$2,838.27 ","$2,838.27 ","$1,190.05 ","$2,320.60 "
ST. JOSEPH'S HOSPITAL - BREESE,36100044,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-BIL,361,1 ,$750.45 ,$487.79 ,$310.16 ,$787.96 ,$637.88 ,$448.02 ,$375.22 ,$431.51 ,$375.22 ,$517.06 ,$637.88 ,$637.88 ,$637.88 ,$615.37 ,$510.31 ,$375.22 ,$375.22 ,$562.84 ,$532.82 ,$532.82 ,$375.22 ,$532.82 ,$622.87 ,$622.87 ,$622.87 , N/A ,$750.45 ,$637.88 ,$375.22 ,$750.45 ,$310.16 ,$310.16 ,$637.88 ,$787.96 ,$637.88 ,$675.41 ,$375.22 ,$622.87 ,$596.61 ,$596.61 ,$375.22 ,$487.79 
ST. JOSEPH'S HOSPITAL - BREESE,36100067,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,361,1 ,$562.00 ,$365.30 ,$206.77 ,$562.00 ,$477.70 ,$335.51 ,$250.15 ,$323.15 ,$250.15 ,$387.22 ,$477.70 ,$477.70 ,$477.70 ,$460.84 ,$382.16 ,$250.15 ,$250.15 ,$421.50 ,$399.02 ,$399.02 ,$250.15 ,$399.02 ,$466.46 ,$466.46 ,$466.46 , N/A ,$562.00 ,$477.70 ,$250.15 ,$562.00 ,$206.77 ,$206.77 ,$477.70 ,$525.31 ,$477.70 ,$505.80 ,$250.15 ,$466.46 ,$446.79 ,$446.79 ,$250.15 ,$365.30 
ST. JOSEPH'S HOSPITAL - BREESE,36100068,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,361,1 ,$562.00 ,$365.30 ,$206.77 ,$562.00 ,$477.70 ,$335.51 ,$250.15 ,$323.15 ,$250.15 ,$387.22 ,$477.70 ,$477.70 ,$477.70 ,$460.84 ,$382.16 ,$250.15 ,$250.15 ,$421.50 ,$399.02 ,$399.02 ,$250.15 ,$399.02 ,$466.46 ,$466.46 ,$466.46 , N/A ,$562.00 ,$477.70 ,$250.15 ,$562.00 ,$206.77 ,$206.77 ,$477.70 ,$525.31 ,$477.70 ,$505.80 ,$250.15 ,$466.46 ,$446.79 ,$446.79 ,$250.15 ,$365.30 
ST. JOSEPH'S HOSPITAL - BREESE,36100093,N/A,HC CENTRAL LINE INSERTION,361,1 ,"$2,496.00 ","$1,622.40 ","$1,435.20 ","$2,496.00 ","$2,121.60 ","$1,490.11 ", N/A ,"$1,435.20 ", N/A ,"$1,719.74 ","$1,935.00 ","$1,935.00 ","$1,935.00 ", N/A ,"$1,697.28 ", N/A , N/A ,"$1,872.00 ","$1,772.16 ","$1,772.16 ", N/A ,"$1,772.16 ","$2,071.68 ","$2,071.68 ","$2,071.68 ", N/A , N/A ,"$2,121.60 ", N/A ,"$2,496.00 ", N/A , N/A ,"$2,121.60 ", N/A ,"$1,935.00 ","$2,246.40 ", N/A ,"$2,071.68 ","$1,984.32 ","$1,984.32 ", N/A ,"$1,622.40 "
ST. JOSEPH'S HOSPITAL - BREESE,36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,725.00 ","$1,121.25 ",$280.92 ,"$1,725.00 ","$1,466.25 ","$1,029.83 ",$597.30 ,$991.88 ,$597.30 ,"$1,188.53 ","$1,466.25 ","$1,466.25 ","$1,466.25 ","$1,414.50 ","$1,173.00 ",$597.30 ,$597.30 ,"$1,293.75 ","$1,224.75 ","$1,224.75 ",$597.30 ,"$1,224.75 ","$1,431.75 ","$1,431.75 ","$1,431.75 ", N/A ,"$1,493.24 ","$1,466.25 ",$597.30 ,"$1,725.00 ",$280.92 ,$280.92 ,"$1,466.25 ","$1,254.33 ","$1,466.25 ","$1,552.50 ",$597.30 ,"$1,431.75 ","$1,371.38 ","$1,371.38 ",$597.30 ,"$1,121.25 "
ST. JOSEPH'S HOSPITAL - BREESE,36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$1,791.90 ","$1,164.74 ",$280.92 ,"$1,791.90 ","$1,523.12 ","$1,069.76 ",$597.30 ,"$1,030.34 ",$597.30 ,"$1,234.62 ","$1,523.12 ","$1,523.12 ","$1,523.12 ","$1,469.36 ","$1,218.49 ",$597.30 ,$597.30 ,"$1,343.93 ","$1,272.25 ","$1,272.25 ",$597.30 ,"$1,272.25 ","$1,487.28 ","$1,487.28 ","$1,487.28 ", N/A ,"$1,493.24 ","$1,523.12 ",$597.30 ,"$1,791.90 ",$280.92 ,$280.92 ,"$1,523.12 ","$1,254.33 ","$1,523.12 ","$1,612.71 ",$597.30 ,"$1,487.28 ","$1,424.56 ","$1,424.56 ",$597.30 ,"$1,164.74 "
ST. JOSEPH'S HOSPITAL - BREESE,36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$1,791.90 ","$1,164.74 ",$280.92 ,"$1,791.90 ","$1,523.12 ","$1,069.76 ",$597.30 ,"$1,030.34 ",$597.30 ,"$1,234.62 ","$1,523.12 ","$1,523.12 ","$1,523.12 ","$1,469.36 ","$1,218.49 ",$597.30 ,$597.30 ,"$1,343.93 ","$1,272.25 ","$1,272.25 ",$597.30 ,"$1,272.25 ","$1,487.28 ","$1,487.28 ","$1,487.28 ", N/A ,"$1,493.24 ","$1,523.12 ",$597.30 ,"$1,791.90 ",$280.92 ,$280.92 ,"$1,523.12 ","$1,254.33 ","$1,523.12 ","$1,612.71 ",$597.30 ,"$1,487.28 ","$1,424.56 ","$1,424.56 ",$597.30 ,"$1,164.74 "
ST. JOSEPH'S HOSPITAL - BREESE,36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$3,244.00 ","$2,108.60 ",$509.48 ,"$3,244.00 ","$2,757.40 ","$1,936.67 ",$776.00 ,"$1,865.30 ",$776.00 ,"$2,235.12 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,660.08 ","$2,205.92 ",$776.00 ,$776.00 ,"$2,433.00 ","$2,303.24 ","$2,303.24 ",$776.00 ,"$2,303.24 ","$2,692.52 ","$2,692.52 ","$2,692.52 ", N/A ,"$1,939.99 ","$2,757.40 ",$776.00 ,"$3,244.00 ",$509.48 ,$509.48 ,"$2,757.40 ","$1,629.59 ","$1,935.00 ","$2,919.60 ",$776.00 ,"$2,692.52 ","$2,578.98 ","$2,578.98 ",$776.00 ,"$2,108.60 "
ST. JOSEPH'S HOSPITAL - BREESE,36100119,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-BIL,361,1 ,"$3,172.92 ","$2,062.40 ",$764.22 ,"$3,172.92 ","$2,696.98 ","$1,894.23 ", N/A ,"$1,824.43 ", N/A ,"$2,186.14 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,601.79 ","$2,157.59 ", N/A , N/A ,"$2,379.69 ","$2,252.77 ","$2,252.77 ", N/A ,"$2,252.77 ","$2,633.52 ","$2,633.52 ","$2,633.52 ", N/A , N/A ,"$2,696.98 ", N/A ,"$3,172.92 ",$764.22 ,$764.22 ,"$2,696.98 ", N/A ,"$1,935.00 ","$2,855.63 ", N/A ,"$2,633.52 ","$2,522.47 ","$2,522.47 ", N/A ,"$2,062.40 "
ST. JOSEPH'S HOSPITAL - BREESE,36100120,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-LT,361,1 ,"$3,172.92 ","$2,062.40 ",$509.48 ,"$3,172.92 ","$2,696.98 ","$1,894.23 ", N/A ,"$1,824.43 ", N/A ,"$2,186.14 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,601.79 ","$2,157.59 ", N/A , N/A ,"$2,379.69 ","$2,252.77 ","$2,252.77 ", N/A ,"$2,252.77 ","$2,633.52 ","$2,633.52 ","$2,633.52 ", N/A , N/A ,"$2,696.98 ", N/A ,"$3,172.92 ",$509.48 ,$509.48 ,"$2,696.98 ", N/A ,"$1,935.00 ","$2,855.63 ", N/A ,"$2,633.52 ","$2,522.47 ","$2,522.47 ", N/A ,"$2,062.40 "
ST. JOSEPH'S HOSPITAL - BREESE,36100121,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-RT,361,1 ,"$3,172.92 ","$2,062.40 ",$509.48 ,"$3,172.92 ","$2,696.98 ","$1,894.23 ", N/A ,"$1,824.43 ", N/A ,"$2,186.14 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,601.79 ","$2,157.59 ", N/A , N/A ,"$2,379.69 ","$2,252.77 ","$2,252.77 ", N/A ,"$2,252.77 ","$2,633.52 ","$2,633.52 ","$2,633.52 ", N/A , N/A ,"$2,696.98 ", N/A ,"$3,172.92 ",$509.48 ,$509.48 ,"$2,696.98 ", N/A ,"$1,935.00 ","$2,855.63 ", N/A ,"$2,633.52 ","$2,522.47 ","$2,522.47 ", N/A ,"$2,062.40 "
ST. JOSEPH'S HOSPITAL - BREESE,36100122,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-BIL,361,1 ,"$4,929.03 ","$3,203.87 ",$764.22 ,"$4,929.03 ","$4,189.68 ","$2,942.63 ","$1,643.01 ","$2,834.19 ","$1,643.01 ","$3,396.10 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,041.80 ","$3,351.74 ","$1,643.01 ","$1,643.01 ","$3,696.77 ","$3,499.61 ","$3,499.61 ","$1,643.01 ","$3,499.61 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,107.53 ","$4,189.68 ","$1,643.01 ","$4,929.03 ",$764.22 ,$764.22 ,"$4,189.68 ","$3,450.32 ","$1,935.00 ","$4,436.13 ","$1,643.01 ","$2,921.00 ","$3,918.58 ","$3,918.58 ","$1,643.01 ","$3,203.87 "
ST. JOSEPH'S HOSPITAL - BREESE,36100123,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-LT,361,1 ,"$4,929.03 ","$3,203.87 ",$509.48 ,"$4,929.03 ","$4,189.68 ","$2,942.63 ","$1,643.01 ","$2,834.19 ","$1,643.01 ","$3,396.10 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,041.80 ","$3,351.74 ","$1,643.01 ","$1,643.01 ","$3,696.77 ","$3,499.61 ","$3,499.61 ","$1,643.01 ","$3,499.61 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,107.53 ","$4,189.68 ","$1,643.01 ","$4,929.03 ",$509.48 ,$509.48 ,"$4,189.68 ","$3,450.32 ","$1,935.00 ","$4,436.13 ","$1,643.01 ","$2,921.00 ","$3,918.58 ","$3,918.58 ","$1,643.01 ","$3,203.87 "
ST. JOSEPH'S HOSPITAL - BREESE,36100124,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-RT,361,1 ,"$4,929.03 ","$3,203.87 ",$509.48 ,"$4,929.03 ","$4,189.68 ","$2,942.63 ","$1,643.01 ","$2,834.19 ","$1,643.01 ","$3,396.10 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,041.80 ","$3,351.74 ","$1,643.01 ","$1,643.01 ","$3,696.77 ","$3,499.61 ","$3,499.61 ","$1,643.01 ","$3,499.61 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,107.53 ","$4,189.68 ","$1,643.01 ","$4,929.03 ",$509.48 ,$509.48 ,"$4,189.68 ","$3,450.32 ","$1,935.00 ","$4,436.13 ","$1,643.01 ","$2,921.00 ","$3,918.58 ","$3,918.58 ","$1,643.01 ","$3,203.87 "
ST. JOSEPH'S HOSPITAL - BREESE,36100125,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-BIL,361,1 ,"$3,331.46 ","$2,165.45 ",$764.22 ,"$3,331.46 ","$2,831.74 ","$1,988.88 ", N/A ,"$1,915.59 ", N/A ,"$2,295.38 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,731.80 ","$2,265.39 ", N/A , N/A ,"$2,498.60 ","$2,365.34 ","$2,365.34 ", N/A ,"$2,365.34 ","$2,765.11 ","$2,765.11 ","$2,765.11 ", N/A , N/A ,"$2,831.74 ", N/A ,"$3,331.46 ",$764.22 ,$764.22 ,"$2,831.74 ", N/A ,"$1,935.00 ","$2,998.31 ", N/A ,"$2,765.11 ","$2,648.51 ","$2,648.51 ", N/A ,"$2,165.45 "
ST. JOSEPH'S HOSPITAL - BREESE,36100126,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-LT,361,1 ,"$3,331.46 ","$2,165.45 ",$509.48 ,"$3,331.46 ","$2,831.74 ","$1,988.88 ", N/A ,"$1,915.59 ", N/A ,"$2,295.38 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,731.80 ","$2,265.39 ", N/A , N/A ,"$2,498.60 ","$2,365.34 ","$2,365.34 ", N/A ,"$2,365.34 ","$2,765.11 ","$2,765.11 ","$2,765.11 ", N/A , N/A ,"$2,831.74 ", N/A ,"$3,331.46 ",$509.48 ,$509.48 ,"$2,831.74 ", N/A ,"$1,935.00 ","$2,998.31 ", N/A ,"$2,765.11 ","$2,648.51 ","$2,648.51 ", N/A ,"$2,165.45 "
ST. JOSEPH'S HOSPITAL - BREESE,36100127,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-RT,361,1 ,"$3,331.46 ","$2,165.45 ",$509.48 ,"$3,331.46 ","$2,831.74 ","$1,988.88 ", N/A ,"$1,915.59 ", N/A ,"$2,295.38 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,731.80 ","$2,265.39 ", N/A , N/A ,"$2,498.60 ","$2,365.34 ","$2,365.34 ", N/A ,"$2,365.34 ","$2,765.11 ","$2,765.11 ","$2,765.11 ", N/A , N/A ,"$2,831.74 ", N/A ,"$3,331.46 ",$509.48 ,$509.48 ,"$2,831.74 ", N/A ,"$1,935.00 ","$2,998.31 ", N/A ,"$2,765.11 ","$2,648.51 ","$2,648.51 ", N/A ,"$2,165.45 "
ST. JOSEPH'S HOSPITAL - BREESE,36100128,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-BIL,361,1 ,"$4,929.03 ","$3,203.87 ",$764.22 ,"$4,929.03 ","$4,189.68 ","$2,942.63 ","$1,643.01 ","$2,834.19 ","$1,643.01 ","$3,396.10 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,041.80 ","$3,351.74 ","$1,643.01 ","$1,643.01 ","$3,696.77 ","$3,499.61 ","$3,499.61 ","$1,643.01 ","$3,499.61 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,107.53 ","$4,189.68 ","$1,643.01 ","$4,929.03 ",$764.22 ,$764.22 ,"$4,189.68 ","$3,450.32 ","$1,935.00 ","$4,436.13 ","$1,643.01 ","$2,921.00 ","$3,918.58 ","$3,918.58 ","$1,643.01 ","$3,203.87 "
ST. JOSEPH'S HOSPITAL - BREESE,36100129,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-LT,361,1 ,"$4,929.03 ","$3,203.87 ",$509.48 ,"$4,929.03 ","$4,189.68 ","$2,942.63 ","$1,643.01 ","$2,834.19 ","$1,643.01 ","$3,396.10 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,041.80 ","$3,351.74 ","$1,643.01 ","$1,643.01 ","$3,696.77 ","$3,499.61 ","$3,499.61 ","$1,643.01 ","$3,499.61 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,107.53 ","$4,189.68 ","$1,643.01 ","$4,929.03 ",$509.48 ,$509.48 ,"$4,189.68 ","$3,450.32 ","$1,935.00 ","$4,436.13 ","$1,643.01 ","$2,921.00 ","$3,918.58 ","$3,918.58 ","$1,643.01 ","$3,203.87 "
ST. JOSEPH'S HOSPITAL - BREESE,36100130,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-RT,361,1 ,"$4,929.03 ","$3,203.87 ",$509.48 ,"$4,929.03 ","$4,189.68 ","$2,942.63 ","$1,643.01 ","$2,834.19 ","$1,643.01 ","$3,396.10 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,041.80 ","$3,351.74 ","$1,643.01 ","$1,643.01 ","$3,696.77 ","$3,499.61 ","$3,499.61 ","$1,643.01 ","$3,499.61 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,107.53 ","$4,189.68 ","$1,643.01 ","$4,929.03 ",$509.48 ,$509.48 ,"$4,189.68 ","$3,450.32 ","$1,935.00 ","$4,436.13 ","$1,643.01 ","$2,921.00 ","$3,918.58 ","$3,918.58 ","$1,643.01 ","$3,203.87 "
ST. JOSEPH'S HOSPITAL - BREESE,36100131,64640,HC DESTROY NERVE PERIPHERAL-BIL,361,1 ,"$2,328.00 ","$1,513.20 ",$764.22 ,"$2,444.38 ","$1,978.80 ","$1,389.82 ","$1,163.99 ","$1,338.60 ","$1,163.99 ","$1,603.99 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$1,908.96 ","$1,583.04 ","$1,163.99 ","$1,163.99 ","$1,746.00 ","$1,652.88 ","$1,652.88 ","$1,163.99 ","$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$2,328.00 ","$1,978.80 ","$1,163.99 ","$2,328.00 ",$764.22 ,$764.22 ,"$1,978.80 ","$2,444.38 ","$1,935.00 ","$2,095.20 ","$1,163.99 ","$1,932.24 ","$1,850.76 ","$1,850.76 ","$1,163.99 ","$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,36100132,64640,HC DESTROY NERVE PERIPHERAL-LT,361,1 ,"$2,328.00 ","$1,513.20 ",$509.48 ,"$2,328.00 ","$1,978.80 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$1,908.96 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,935.00 ","$2,095.20 ",$776.00 ,"$1,932.24 ","$1,850.76 ","$1,850.76 ",$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,36100133,64640,HC DESTROY NERVE PERIPHERAL-RT,361,1 ,"$2,328.00 ","$1,513.20 ",$509.48 ,"$2,328.00 ","$1,978.80 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$1,908.96 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,935.00 ","$2,095.20 ",$776.00 ,"$1,932.24 ","$1,850.76 ","$1,850.76 ",$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,36100156,38222,HC BONE MARROW ASPIRATION (BX/ASP SAME SITE),361,1 ,"$3,901.00 ","$2,535.65 ",$388.56 ,"$4,653.46 ","$3,315.85 ","$2,328.90 ","$2,215.93 ","$2,243.08 ","$2,215.93 ","$2,687.79 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$3,198.82 ","$2,652.68 ","$2,215.93 ","$2,215.93 ","$2,925.75 ","$2,769.71 ","$2,769.71 ","$2,215.93 ","$2,769.71 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,901.00 ","$3,315.85 ","$2,215.93 ","$3,901.00 ",$388.56 ,$388.56 ,"$3,315.85 ","$4,653.46 ","$1,935.00 ","$3,510.90 ","$2,215.93 ","$2,921.00 ","$3,101.30 ","$3,101.30 ","$2,215.93 ","$2,535.65 "
ST. JOSEPH'S HOSPITAL - BREESE,36100189,64415,HC INTRASCALENE BLOCK SINGLE,361,1 ,"$3,244.00 ","$2,108.60 ",$280.92 ,"$3,244.00 ","$2,757.40 ","$1,936.67 ",$776.00 ,"$1,865.30 ",$776.00 ,"$2,235.12 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,660.08 ","$2,205.92 ",$776.00 ,$776.00 ,"$2,433.00 ","$2,303.24 ","$2,303.24 ",$776.00 ,"$2,303.24 ","$2,692.52 ","$2,692.52 ","$2,692.52 ", N/A ,"$1,939.99 ","$2,757.40 ",$776.00 ,"$3,244.00 ",$280.92 ,$280.92 ,"$2,757.40 ","$1,629.59 ","$1,935.00 ","$2,919.60 ",$776.00 ,"$2,692.52 ","$2,578.98 ","$2,578.98 ",$776.00 ,"$2,108.60 "
ST. JOSEPH'S HOSPITAL - BREESE,36100197,64450,HC INJ ANES NERVE PERIPHERAL,361,1 ,"$1,797.00 ","$1,168.05 ",$280.92 ,"$1,797.00 ","$1,527.45 ","$1,072.81 ",$597.30 ,"$1,033.28 ",$597.30 ,"$1,238.13 ","$1,527.45 ","$1,527.45 ","$1,527.45 ","$1,473.54 ","$1,221.96 ",$597.30 ,$597.30 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$597.30 ,"$1,275.87 ","$1,491.51 ","$1,491.51 ","$1,491.51 ", N/A ,"$1,493.24 ","$1,527.45 ",$597.30 ,"$1,797.00 ",$280.92 ,$280.92 ,"$1,527.45 ","$1,254.33 ","$1,527.45 ","$1,617.30 ",$597.30 ,"$1,491.51 ","$1,428.62 ","$1,428.62 ",$597.30 ,"$1,168.05 "
ST. JOSEPH'S HOSPITAL - BREESE,36100198,64480,HC INJ TRANSF CERV/THORACIC ADDL-LT,361,1 ,"$2,471.36 ","$1,606.38 ",$509.48 ,"$2,471.36 ","$2,100.66 ","$1,475.40 ", N/A ,"$1,421.03 ", N/A ,"$1,702.77 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,026.52 ","$1,680.52 ", N/A , N/A ,"$1,853.52 ","$1,754.67 ","$1,754.67 ", N/A ,"$1,754.67 ","$2,051.23 ","$2,051.23 ","$2,051.23 ", N/A , N/A ,"$2,100.66 ", N/A ,"$2,471.36 ",$509.48 ,$509.48 ,"$2,100.66 ", N/A ,"$1,935.00 ","$2,224.22 ", N/A ,"$2,051.23 ","$1,964.73 ","$1,964.73 ", N/A ,"$1,606.38 "
ST. JOSEPH'S HOSPITAL - BREESE,36100199,64480,HC INJ TRANSF CERV/THORACIC ADDL-RT,361,1 ,"$2,471.36 ","$1,606.38 ",$509.48 ,"$2,471.36 ","$2,100.66 ","$1,475.40 ", N/A ,"$1,421.03 ", N/A ,"$1,702.77 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,026.52 ","$1,680.52 ", N/A , N/A ,"$1,853.52 ","$1,754.67 ","$1,754.67 ", N/A ,"$1,754.67 ","$2,051.23 ","$2,051.23 ","$2,051.23 ", N/A , N/A ,"$2,100.66 ", N/A ,"$2,471.36 ",$509.48 ,$509.48 ,"$2,100.66 ", N/A ,"$1,935.00 ","$2,224.22 ", N/A ,"$2,051.23 ","$1,964.73 ","$1,964.73 ", N/A ,"$1,606.38 "
ST. JOSEPH'S HOSPITAL - BREESE,36100200,64480,HC INJ TRANSF CERV/THORACIC ADDL,361,1 ,"$2,471.36 ","$1,606.38 ",$509.48 ,"$2,471.36 ","$2,100.66 ","$1,475.40 ", N/A ,"$1,421.03 ", N/A ,"$1,702.77 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,026.52 ","$1,680.52 ", N/A , N/A ,"$1,853.52 ","$1,754.67 ","$1,754.67 ", N/A ,"$1,754.67 ","$2,051.23 ","$2,051.23 ","$2,051.23 ", N/A , N/A ,"$2,100.66 ", N/A ,"$2,471.36 ",$509.48 ,$509.48 ,"$2,100.66 ", N/A ,"$1,935.00 ","$2,224.22 ", N/A ,"$2,051.23 ","$1,964.73 ","$1,964.73 ", N/A ,"$1,606.38 "
ST. JOSEPH'S HOSPITAL - BREESE,36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,$371.00 ,$241.15 ,$140.06 ,"$1,224.14 ",$315.35 ,$221.49 ,$582.93 ,$213.33 ,$582.93 ,$255.62 ,$315.35 ,$315.35 ,$315.35 ,$304.22 ,$252.28 ,$582.93 ,$582.93 ,$278.25 ,$263.41 ,$263.41 ,$582.93 ,$263.41 ,$307.93 ,$307.93 ,$307.93 , N/A ,$371.00 ,$315.35 ,$582.93 ,$140.06 ,$388.56 ,$358.02 ,$315.35 ,"$1,224.14 ",$315.35 ,$333.90 ,$582.93 ,$307.93 ,$294.95 ,$294.95 ,$582.93 ,$241.15 
ST. JOSEPH'S HOSPITAL - BREESE,36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$371.00 ,$241.15 ,$65.45 ,$388.56 ,$315.35 ,$221.49 , N/A ,$213.33 , N/A ,$255.62 ,$315.35 ,$315.35 ,$315.35 ,$304.22 ,$252.28 , N/A , N/A ,$278.25 ,$263.41 ,$263.41 , N/A ,$263.41 ,$307.93 ,$307.93 ,$307.93 , N/A , N/A ,$315.35 , N/A ,$65.45 ,$388.56 ,$358.02 ,$315.35 , N/A ,$315.35 ,$333.90 , N/A ,$307.93 ,$294.95 ,$294.95 , N/A ,$241.15 
ST. JOSEPH'S HOSPITAL - BREESE,36100268,11004,HC DEBRIDEMENT GENITALIA  AND  PERINEUM,361,1 ,"$1,792.00 ","$1,164.80 ",$764.86 ,"$1,792.00 ","$1,523.20 ","$1,069.82 ", N/A ,"$1,030.40 ", N/A ,"$1,234.69 ","$1,523.20 ","$1,523.20 ","$1,523.20 ","$1,469.44 ","$1,218.56 ", N/A , N/A ,"$1,344.00 ","$1,272.32 ","$1,272.32 ", N/A ,"$1,272.32 ","$1,487.36 ","$1,487.36 ","$1,487.36 ", N/A , N/A ,"$1,523.20 ", N/A ,"$1,792.00 ",$764.86 ,$764.86 ,"$1,523.20 ", N/A ,"$1,523.20 ","$1,612.80 ", N/A ,"$1,487.36 ","$1,424.64 ","$1,424.64 ", N/A ,"$1,164.80 "
ST. JOSEPH'S HOSPITAL - BREESE,36100269,11005,HC DEBRIDEMENT NSTI ABDOMINAL WALL,361,1 ,"$2,500.00 ","$1,625.00 ",$764.86 ,"$2,500.00 ","$2,125.00 ","$1,492.50 ", N/A ,"$1,437.50 ", N/A ,"$1,722.50 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$2,050.00 ","$1,700.00 ", N/A , N/A ,"$1,875.00 ","$1,775.00 ","$1,775.00 ", N/A ,"$1,775.00 ","$2,075.00 ","$2,075.00 ","$2,075.00 ", N/A , N/A ,"$2,125.00 ", N/A ,"$2,500.00 ",$764.86 ,$764.86 ,"$2,125.00 ", N/A ,"$1,935.00 ","$2,250.00 ", N/A ,"$2,075.00 ","$1,987.50 ","$1,987.50 ", N/A ,"$1,625.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100274,64624,HC DESTRUST NEUROLYTIC AGENT GENICULAR NERVE W/IMG GUID,361,1 ,"$4,929.00 ","$3,203.85 ",$509.48 ,"$4,929.00 ","$4,189.65 ","$2,942.61 ","$1,643.01 ","$2,834.18 ","$1,643.01 ","$3,396.08 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$4,041.78 ","$3,351.72 ","$1,643.01 ","$1,643.01 ","$3,696.75 ","$3,499.59 ","$3,499.59 ","$1,643.01 ","$3,499.59 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,107.53 ","$4,189.65 ","$1,643.01 ","$4,929.00 ",$509.48 ,$509.48 ,"$4,189.65 ","$3,450.32 ","$1,935.00 ","$4,436.10 ","$1,643.01 ","$2,921.00 ","$3,918.56 ","$3,918.56 ","$1,643.01 ","$3,203.85 "
ST. JOSEPH'S HOSPITAL - BREESE,37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,$514.00 ,$334.10 ,$194.60 ,$514.00 ,$436.90 ,$306.86 ,$194.60 ,$295.55 ,$194.60 ,$354.15 ,$436.90 ,$436.90 ,$436.90 ,$421.48 ,$349.52 ,$194.60 ,$194.60 ,$385.50 ,$364.94 ,$364.94 ,$194.60 ,$364.94 ,$426.62 ,$426.62 ,$426.62 , N/A ,$486.50 ,$436.90 ,$194.60 ,$514.00 ,$431.46 ,$431.46 ,$436.90 ,$408.66 ,$436.90 ,$462.60 ,$194.60 ,$426.62 ,$408.63 ,$408.63 ,$194.60 ,$334.10 
ST. JOSEPH'S HOSPITAL - BREESE,37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$223.00 ,$144.95 ,$15.06 ,$223.00 ,$189.55 ,$133.13 , N/A ,$128.23 , N/A ,$153.65 ,$189.55 ,$189.55 ,$189.55 , N/A ,$151.64 , N/A , N/A ,$167.25 ,$158.33 ,$158.33 , N/A ,$158.33 ,$185.09 ,$185.09 ,$185.09 , N/A , N/A ,$189.55 , N/A ,$223.00 ,$15.06 ,$15.06 ,$189.55 , N/A ,$189.55 ,$200.70 , N/A ,$185.09 ,$177.29 ,$177.29 , N/A ,$144.95 
ST. JOSEPH'S HOSPITAL - BREESE,37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$197.00 ,$128.05 ,$15.06 ,$197.00 ,$167.45 ,$117.61 , N/A ,$113.28 , N/A ,$135.73 ,$167.45 ,$167.45 ,$167.45 , N/A ,$133.96 , N/A , N/A ,$147.75 ,$139.87 ,$139.87 , N/A ,$139.87 ,$163.51 ,$163.51 ,$163.51 , N/A , N/A ,$167.45 , N/A ,$197.00 ,$15.06 ,$15.06 ,$167.45 , N/A ,$167.45 ,$177.30 , N/A ,$163.51 ,$156.62 ,$156.62 , N/A ,$128.05 
ST. JOSEPH'S HOSPITAL - BREESE,37000061,N/A,HC ANESTHESIA GENERAL INITIAL 15MIN,370,1 ,$422.00 ,$274.30 ,$242.65 ,$422.00 ,$358.70 ,$251.93 , N/A ,$242.65 , N/A ,$290.76 ,$358.70 ,$358.70 ,$358.70 , N/A ,$286.96 , N/A , N/A ,$316.50 ,$299.62 ,$299.62 , N/A ,$299.62 ,$350.26 ,$350.26 ,$350.26 , N/A , N/A ,$358.70 , N/A ,$422.00 , N/A , N/A ,$358.70 , N/A ,$358.70 ,$379.80 , N/A ,$350.26 ,$335.49 ,$335.49 , N/A ,$274.30 
ST. JOSEPH'S HOSPITAL - BREESE,37000062,N/A,HC ANESTHESIA GENERAL ADDL 15MIN,370,1 ,$265.00 ,$172.25 ,$152.38 ,$265.00 ,$225.25 ,$158.21 , N/A ,$152.38 , N/A ,$182.59 ,$225.25 ,$225.25 ,$225.25 , N/A ,$180.20 , N/A , N/A ,$198.75 ,$188.15 ,$188.15 , N/A ,$188.15 ,$219.95 ,$219.95 ,$219.95 , N/A , N/A ,$225.25 , N/A ,$265.00 , N/A , N/A ,$225.25 , N/A ,$225.25 ,$238.50 , N/A ,$219.95 ,$210.68 ,$210.68 , N/A ,$172.25 
ST. JOSEPH'S HOSPITAL - BREESE,37000063,N/A,HC ANESTHESIA REGIONAL BLOCK INITIAL 15MIN,370,1 ,$443.00 ,$287.95 ,$254.73 ,$443.00 ,$376.55 ,$264.47 , N/A ,$254.73 , N/A ,$305.23 ,$376.55 ,$376.55 ,$376.55 , N/A ,$301.24 , N/A , N/A ,$332.25 ,$314.53 ,$314.53 , N/A ,$314.53 ,$367.69 ,$367.69 ,$367.69 , N/A , N/A ,$376.55 , N/A ,$443.00 , N/A , N/A ,$376.55 , N/A ,$376.55 ,$398.70 , N/A ,$367.69 ,$352.19 ,$352.19 , N/A ,$287.95 
ST. JOSEPH'S HOSPITAL - BREESE,37000064,N/A,HC ANESTHESIA REGIONAL BLOCK ADDL 15MIN,370,1 ,$253.00 ,$164.45 ,$145.48 ,$253.00 ,$215.05 ,$151.04 , N/A ,$145.48 , N/A ,$174.32 ,$215.05 ,$215.05 ,$215.05 , N/A ,$172.04 , N/A , N/A ,$189.75 ,$179.63 ,$179.63 , N/A ,$179.63 ,$209.99 ,$209.99 ,$209.99 , N/A , N/A ,$215.05 , N/A ,$253.00 , N/A , N/A ,$215.05 , N/A ,$215.05 ,$227.70 , N/A ,$209.99 ,$201.14 ,$201.14 , N/A ,$164.45 
ST. JOSEPH'S HOSPITAL - BREESE,37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$842.00 ,$547.30 ,$15.06 ,$842.00 ,$715.70 ,$502.67 , N/A ,$484.15 , N/A ,$580.14 ,$715.70 ,$715.70 ,$715.70 , N/A ,$572.56 , N/A , N/A ,$631.50 ,$597.82 ,$597.82 , N/A ,$597.82 ,$698.86 ,$698.86 ,$698.86 , N/A , N/A ,$715.70 , N/A ,$842.00 ,$15.06 ,$15.06 ,$715.70 , N/A ,$715.70 ,$757.80 , N/A ,$698.86 ,$669.39 ,$669.39 , N/A ,$547.30 
ST. JOSEPH'S HOSPITAL - BREESE,37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$842.00 ,$547.30 ,$15.06 ,$842.00 ,$715.70 ,$502.67 , N/A ,$484.15 , N/A ,$580.14 ,$715.70 ,$715.70 ,$715.70 , N/A ,$572.56 , N/A , N/A ,$631.50 ,$597.82 ,$597.82 , N/A ,$597.82 ,$698.86 ,$698.86 ,$698.86 , N/A , N/A ,$715.70 , N/A ,$842.00 ,$15.06 ,$15.06 ,$715.70 , N/A ,$715.70 ,$757.80 , N/A ,$698.86 ,$669.39 ,$669.39 , N/A ,$547.30 
ST. JOSEPH'S HOSPITAL - BREESE,37000074,99155,HC MODERATE SEDATION DIFF PHY <5YR 1ST 15MIN,370,1 ,$868.00 ,$564.20 ,$15.06 ,$868.00 ,$737.80 ,$518.20 , N/A ,$499.10 , N/A ,$598.05 ,$737.80 ,$737.80 ,$737.80 , N/A ,$590.24 , N/A , N/A ,$651.00 ,$616.28 ,$616.28 , N/A ,$616.28 ,$720.44 ,$720.44 ,$720.44 , N/A , N/A ,$737.80 , N/A ,$868.00 ,$15.06 ,$15.06 ,$737.80 , N/A ,$737.80 ,$781.20 , N/A ,$720.44 ,$690.06 ,$690.06 , N/A ,$564.20 
ST. JOSEPH'S HOSPITAL - BREESE,37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,$868.00 ,$564.20 ,$15.06 ,$868.00 ,$737.80 ,$518.20 , N/A ,$499.10 , N/A ,$598.05 ,$737.80 ,$737.80 ,$737.80 , N/A ,$590.24 , N/A , N/A ,$651.00 ,$616.28 ,$616.28 , N/A ,$616.28 ,$720.44 ,$720.44 ,$720.44 , N/A , N/A ,$737.80 , N/A ,$200.00 ,$15.06 ,$15.06 ,$737.80 , N/A ,$737.80 ,$781.20 , N/A ,$720.44 ,$690.06 ,$690.06 , N/A ,$564.20 
ST. JOSEPH'S HOSPITAL - BREESE,37000076,N/A,HC MONITORED ANESTHESIA INITIAL 15 MINS,370,1 ,$421.00 ,$273.65 ,$242.08 ,$421.00 ,$357.85 ,$251.34 , N/A ,$242.08 , N/A ,$290.07 ,$357.85 ,$357.85 ,$357.85 , N/A ,$286.28 , N/A , N/A ,$315.75 ,$298.91 ,$298.91 , N/A ,$298.91 ,$349.43 ,$349.43 ,$349.43 , N/A , N/A ,$357.85 , N/A ,$421.00 , N/A , N/A ,$357.85 , N/A ,$357.85 ,$378.90 , N/A ,$349.43 ,$334.70 ,$334.70 , N/A ,$273.65 
ST. JOSEPH'S HOSPITAL - BREESE,37000077,N/A,HC MONITORED ANESTHESIA ADDL 15 MINS,370,1 ,$240.00 ,$156.00 ,$138.00 ,$240.00 ,$204.00 ,$143.28 , N/A ,$138.00 , N/A ,$165.36 ,$204.00 ,$204.00 ,$204.00 , N/A ,$163.20 , N/A , N/A ,$180.00 ,$170.40 ,$170.40 , N/A ,$170.40 ,$199.20 ,$199.20 ,$199.20 , N/A , N/A ,$204.00 , N/A ,$240.00 , N/A , N/A ,$204.00 , N/A ,$204.00 ,$216.00 , N/A ,$199.20 ,$190.80 ,$190.80 , N/A ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,37080000,64447,HC FEMORAL NERVE BLOCK SINGLE,360,1 ,"$2,307.00 ","$1,499.55 ",$280.92 ,"$2,307.00 ","$1,960.95 ","$1,377.28 ",$597.30 ,"$1,326.53 ",$597.30 ,"$1,589.52 ","$1,935.00 ","$1,935.00 ","$1,935.00 ","$1,891.74 ","$1,568.76 ",$597.30 ,$597.30 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$597.30 ,"$1,637.97 ","$1,914.81 ","$1,914.81 ","$1,914.81 ", N/A ,"$1,493.24 ","$1,960.95 ",$597.30 ,"$2,307.00 ",$280.92 ,$280.92 ,"$1,960.95 ","$1,254.33 ","$1,935.00 ","$2,076.30 ",$597.30 ,"$1,914.81 ","$1,834.07 ","$1,834.07 ",$597.30 ,"$1,499.55 "
ST. JOSEPH'S HOSPITAL - BREESE,39000148,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$162.00 ,$105.30 ,$83.75 ,$424.03 ,$137.70 ,$96.71 ,$83.75 ,$93.15 ,$83.75 ,$111.62 ,$137.70 ,$137.70 ,$137.70 , N/A ,$110.16 ,$83.75 ,$83.75 ,$121.50 ,$115.02 ,$115.02 ,$83.75 ,$115.02 ,$134.46 ,$134.46 ,$134.46 , N/A ,$162.00 ,$137.70 ,$83.75 ,$162.00 ,$424.03 ,$156.33 ,$137.70 ,$175.88 ,$137.70 ,$145.80 ,$83.75 ,$134.46 ,$128.79 ,$128.79 ,$83.75 ,$105.30 
ST. JOSEPH'S HOSPITAL - BREESE,39000151,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,$992.45 ,$645.09 ,$126.35 ,$992.45 ,$843.58 ,$592.49 ,$126.35 ,$570.66 ,$126.35 ,$683.80 ,$843.58 ,$843.58 ,$843.58 , N/A ,$674.87 ,$126.35 ,$126.35 ,$744.34 ,$704.64 ,$704.64 ,$126.35 ,$704.64 ,$823.73 ,$823.73 ,$823.73 , N/A ,$315.88 ,$843.58 ,$126.35 ,$992.45 ,$424.03 ,$424.03 ,$843.58 ,$265.34 ,$843.58 ,$893.21 ,$126.35 ,$823.73 ,$789.00 ,$789.00 ,$126.35 ,$645.09 
ST. JOSEPH'S HOSPITAL - BREESE,39000152,P9033,HC PLATELETS L/R IRR EA,390,1 ,$905.05 ,$588.28 ,$217.12 ,$905.05 ,$769.29 ,$540.31 ,$217.12 ,$520.40 ,$217.12 ,$623.58 ,$769.29 ,$769.29 ,$769.29 , N/A ,$615.43 ,$217.12 ,$217.12 ,$678.79 ,$642.59 ,$642.59 ,$217.12 ,$642.59 ,$751.19 ,$751.19 ,$751.19 , N/A ,$542.80 ,$769.29 ,$217.12 ,$905.05 ,$424.03 ,$424.03 ,$769.29 ,$455.95 ,$769.29 ,$814.55 ,$217.12 ,$751.19 ,$719.51 ,$719.51 ,$217.12 ,$588.28 
ST. JOSEPH'S HOSPITAL - BREESE,39000162,P9012,HC CRYOPRECIPITATE EA UNIT T1,390,1 ,$163.00 ,$105.95 ,$50.44 ,$424.03 ,$138.55 ,$97.31 ,$50.44 ,$93.73 ,$50.44 ,$112.31 ,$138.55 ,$138.55 ,$138.55 , N/A ,$110.84 ,$50.44 ,$50.44 ,$122.25 ,$115.73 ,$115.73 ,$50.44 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$126.10 ,$138.55 ,$50.44 ,$163.00 ,$424.03 ,$157.30 ,$138.55 ,$105.92 ,$138.55 ,$146.70 ,$50.44 ,$135.29 ,$129.59 ,$129.59 ,$50.44 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,39000164,P9016,HC RED CELLS L/R EA T1,390,1 ,$565.00 ,$367.25 ,$188.35 ,$565.00 ,$480.25 ,$337.31 ,$188.35 ,$324.88 ,$188.35 ,$389.29 ,$480.25 ,$480.25 ,$480.25 , N/A ,$384.20 ,$188.35 ,$188.35 ,$423.75 ,$401.15 ,$401.15 ,$188.35 ,$401.15 ,$468.95 ,$468.95 ,$468.95 , N/A ,$470.88 ,$480.25 ,$188.35 ,$565.00 ,$424.03 ,$424.03 ,$480.25 ,$395.54 ,$480.25 ,$508.50 ,$188.35 ,$468.95 ,$449.18 ,$449.18 ,$188.35 ,$367.25 
ST. JOSEPH'S HOSPITAL - BREESE,39000173,P9035,HC PLATELETS PHER L/R EA T1,390,1 ,"$1,092.00 ",$709.80 ,$424.03 ,"$1,092.00 ",$928.20 ,$651.92 ,$499.61 ,$627.90 ,$499.61 ,$752.39 ,$928.20 ,$928.20 ,$928.20 , N/A ,$742.56 ,$499.61 ,$499.61 ,$819.00 ,$775.32 ,$775.32 ,$499.61 ,$775.32 ,$906.36 ,$906.36 ,$906.36 , N/A ,"$1,092.00 ",$928.20 ,$499.61 ,"$1,092.00 ",$424.03 ,$424.03 ,$928.20 ,"$1,049.18 ",$928.20 ,$982.80 ,$499.61 ,$906.36 ,$868.14 ,$868.14 ,$499.61 ,$709.80 
ST. JOSEPH'S HOSPITAL - BREESE,39000179,P9037,HC PLATELETS PHER L/R IRR EA T1,390,1 ,$996.00 ,$647.40 ,$424.03 ,"$1,332.85 ",$846.60 ,$594.61 ,$634.69 ,$572.70 ,$634.69 ,$686.24 ,$846.60 ,$846.60 ,$846.60 , N/A ,$677.28 ,$634.69 ,$634.69 ,$747.00 ,$707.16 ,$707.16 ,$634.69 ,$707.16 ,$826.68 ,$826.68 ,$826.68 , N/A ,$996.00 ,$846.60 ,$634.69 ,$996.00 ,$424.03 ,$424.03 ,$846.60 ,"$1,332.85 ",$846.60 ,$896.40 ,$634.69 ,$826.68 ,$791.82 ,$791.82 ,$634.69 ,$647.40 
ST. JOSEPH'S HOSPITAL - BREESE,39000187,P9040,HC RED CELLS L/R IRR EA T1,390,1 ,$616.00 ,$400.40 ,$262.76 ,$616.00 ,$523.60 ,$367.75 ,$262.76 ,$354.20 ,$262.76 ,$424.42 ,$523.60 ,$523.60 ,$523.60 , N/A ,$418.88 ,$262.76 ,$262.76 ,$462.00 ,$437.36 ,$437.36 ,$262.76 ,$437.36 ,$511.28 ,$511.28 ,$511.28 , N/A ,$616.00 ,$523.60 ,$262.76 ,$616.00 ,$424.03 ,$424.03 ,$523.60 ,$551.80 ,$523.60 ,$554.40 ,$262.76 ,$511.28 ,$489.72 ,$489.72 ,$262.76 ,$400.40 
ST. JOSEPH'S HOSPITAL - BREESE,39100001,36430,HC BLOOD PROD ADMIN,391,1 ,$876.00 ,$569.40 ,$370.81 ,$876.00 ,$744.60 ,$522.97 ,$370.81 ,$503.70 ,$370.81 ,$603.56 ,$744.60 ,$744.60 ,$744.60 ,$718.32 ,$595.68 ,$370.81 ,$370.81 ,$657.00 ,$621.96 ,$621.96 ,$370.81 ,$621.96 ,$727.08 ,$727.08 ,$727.08 , N/A ,$876.00 ,$744.60 ,$370.81 ,$876.00 ,$424.03 ,$424.03 ,$744.60 ,$778.70 ,$744.60 ,$788.40 ,$370.81 ,$727.08 ,$696.42 ,$696.42 ,$370.81 ,$569.40 
ST. JOSEPH'S HOSPITAL - BREESE,40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$514.00 ,$334.10 ,$44.13 ,$514.00 ,$436.90 ,$306.86 ,$113.47 ,$295.55 ,$113.47 ,$354.15 ,$436.90 ,$436.90 ,$436.90 ,$421.48 ,$349.52 ,$113.47 ,$113.47 ,$385.50 ,$364.94 ,$364.94 ,$113.47 ,$364.94 ,$426.62 ,$426.62 ,$426.62 , N/A ,$283.68 ,$436.90 ,$113.47 ,$125.55 ,$44.13 ,$44.13 ,$436.90 ,$238.29 ,$436.90 ,$462.60 ,$113.47 ,$426.62 ,$408.63 ,$408.63 ,$113.47 ,$334.10 
ST. JOSEPH'S HOSPITAL - BREESE,40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$514.00 ,$334.10 ,$44.13 ,$514.00 ,$436.90 ,$306.86 ,$113.47 ,$295.55 ,$113.47 ,$354.15 ,$436.90 ,$436.90 ,$436.90 ,$421.48 ,$349.52 ,$113.47 ,$113.47 ,$385.50 ,$364.94 ,$364.94 ,$113.47 ,$364.94 ,$426.62 ,$426.62 ,$426.62 , N/A ,$283.68 ,$436.90 ,$113.47 ,$125.55 ,$44.13 ,$44.13 ,$436.90 ,$238.29 ,$436.90 ,$462.60 ,$113.47 ,$426.62 ,$408.63 ,$408.63 ,$113.47 ,$334.10 
ST. JOSEPH'S HOSPITAL - BREESE,40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$514.00 ,$334.10 ,$44.13 ,$514.00 ,$436.90 ,$306.86 ,$113.47 ,$295.55 ,$113.47 ,$354.15 ,$436.90 ,$436.90 ,$436.90 ,$421.48 ,$349.52 ,$113.47 ,$113.47 ,$385.50 ,$364.94 ,$364.94 ,$113.47 ,$364.94 ,$426.62 ,$426.62 ,$426.62 , N/A ,$283.68 ,$436.90 ,$113.47 ,$125.55 ,$44.13 ,$44.13 ,$436.90 ,$238.29 ,$436.90 ,$462.60 ,$113.47 ,$426.62 ,$408.63 ,$408.63 ,$113.47 ,$334.10 
ST. JOSEPH'S HOSPITAL - BREESE,40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$292.00 ,$189.80 ,$44.13 ,$292.00 ,$248.20 ,$174.32 ,$89.07 ,$167.90 ,$89.07 ,$201.19 ,$248.20 ,$248.20 ,$248.20 ,$239.44 ,$198.56 ,$89.07 ,$89.07 ,$219.00 ,$207.32 ,$207.32 ,$89.07 ,$207.32 ,$242.36 ,$242.36 ,$242.36 , N/A ,$222.68 ,$248.20 ,$89.07 ,$98.55 ,$44.13 ,$44.13 ,$248.20 ,$187.05 ,$248.20 ,$262.80 ,$89.07 ,$242.36 ,$232.14 ,$232.14 ,$89.07 ,$189.80 
ST. JOSEPH'S HOSPITAL - BREESE,40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$292.00 ,$189.80 ,$44.13 ,$292.00 ,$248.20 ,$174.32 ,$89.07 ,$167.90 ,$89.07 ,$201.19 ,$248.20 ,$248.20 ,$248.20 ,$239.44 ,$198.56 ,$89.07 ,$89.07 ,$219.00 ,$207.32 ,$207.32 ,$89.07 ,$207.32 ,$242.36 ,$242.36 ,$242.36 , N/A ,$222.68 ,$248.20 ,$89.07 ,$98.55 ,$44.13 ,$44.13 ,$248.20 ,$187.05 ,$248.20 ,$262.80 ,$89.07 ,$242.36 ,$232.14 ,$232.14 ,$89.07 ,$189.80 
ST. JOSEPH'S HOSPITAL - BREESE,40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$292.00 ,$189.80 ,$44.13 ,$292.00 ,$248.20 ,$174.32 ,$89.07 ,$167.90 ,$89.07 ,$201.19 ,$248.20 ,$248.20 ,$248.20 ,$239.44 ,$198.56 ,$89.07 ,$89.07 ,$219.00 ,$207.32 ,$207.32 ,$89.07 ,$207.32 ,$242.36 ,$242.36 ,$242.36 , N/A ,$222.68 ,$248.20 ,$89.07 ,$98.55 ,$44.13 ,$44.13 ,$248.20 ,$187.05 ,$248.20 ,$262.80 ,$89.07 ,$242.36 ,$232.14 ,$232.14 ,$89.07 ,$189.80 
ST. JOSEPH'S HOSPITAL - BREESE,40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$103.00 ,$66.95 ,$23.72 ,$103.00 ,$87.55 ,$61.49 ,$23.72 ,$59.23 ,$23.72 ,$70.97 ,$87.55 ,$87.55 ,$87.55 ,$84.46 ,$70.04 ,$23.72 ,$23.72 ,$77.25 ,$73.13 ,$73.13 ,$23.72 ,$73.13 ,$85.49 ,$85.49 ,$85.49 , N/A ,$59.30 ,$87.55 ,$23.72 ,$26.25 ,$44.13 ,$44.13 ,$87.55 ,$49.81 ,$87.55 ,$92.70 ,$23.72 ,$85.49 ,$81.89 ,$81.89 ,$23.72 ,$66.95 
ST. JOSEPH'S HOSPITAL - BREESE,40200007,51798,HC US BLADDER SCAN,402,1 ,$177.00 ,$115.05 ,$52.57 ,$177.00 ,$150.45 ,$105.67 ,$52.57 ,$101.78 ,$52.57 ,$121.95 ,$150.45 ,$150.45 ,$150.45 , N/A ,$120.36 ,$52.57 ,$52.57 ,$132.75 ,$125.67 ,$125.67 ,$52.57 ,$125.67 ,$146.91 ,$146.91 ,$146.91 , N/A ,$131.42 ,$150.45 ,$52.57 ,$177.00 ,$76.28 ,$76.28 ,$150.45 ,$110.39 ,$150.45 ,$159.30 ,$52.57 ,$146.91 ,$140.72 ,$140.72 ,$52.57 ,$115.05 
ST. JOSEPH'S HOSPITAL - BREESE,40200010,59000,HC AMNIOCENTESIS DIAGNOSTIC,402,1 ,$582.00 ,$378.30 ,$156.36 ,"$1,281.24 ",$494.70 ,$347.45 ,$610.11 ,$334.65 ,$610.11 ,$401.00 ,$494.70 ,$494.70 ,$494.70 ,$477.24 ,$395.76 ,$610.11 ,$610.11 ,$436.50 ,$413.22 ,$413.22 ,$610.11 ,$413.22 ,$483.06 ,$483.06 ,$483.06 , N/A ,$582.00 ,$494.70 ,$610.11 ,$582.00 ,$156.36 ,$156.36 ,$494.70 ,"$1,281.24 ",$494.70 ,$523.80 ,$610.11 ,$483.06 ,$462.69 ,$462.69 ,$610.11 ,$378.30 
ST. JOSEPH'S HOSPITAL - BREESE,40200012,76506,HC US ENCEPHALOGRAM,402,1 ,$714.00 ,$464.10 ,$97.16 ,$714.00 ,$606.90 ,$426.26 ,$107.10 ,$410.55 ,$107.10 ,$491.95 ,$606.90 ,$606.90 ,$606.90 ,$585.48 ,$485.52 ,$107.10 ,$107.10 ,$535.50 ,$506.94 ,$506.94 ,$107.10 ,$506.94 ,$592.62 ,$592.62 ,$592.62 , N/A ,$267.76 ,$606.90 ,$107.10 ,$714.00 ,$97.16 ,$97.16 ,$606.90 ,$224.92 ,$606.90 ,$642.60 ,$107.10 ,$592.62 ,$567.63 ,$567.63 ,$107.10 ,$464.10 
ST. JOSEPH'S HOSPITAL - BREESE,40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,"$1,142.00 ",$742.30 ,$97.16 ,"$1,142.00 ",$970.70 ,$681.77 ,$107.10 ,$656.65 ,$107.10 ,$786.84 ,$970.70 ,$970.70 ,$970.70 ,$936.44 ,$776.56 ,$107.10 ,$107.10 ,$856.50 ,$810.82 ,$810.82 ,$107.10 ,$810.82 ,$947.86 ,$947.86 ,$947.86 , N/A ,$267.76 ,$970.70 ,$107.10 ,"$1,142.00 ",$97.16 ,$97.16 ,$970.70 ,$224.92 ,$970.70 ,"$1,027.80 ",$107.10 ,$947.86 ,$907.89 ,$907.89 ,$107.10 ,$742.30 
ST. JOSEPH'S HOSPITAL - BREESE,40200014,76604,HC US CHEST,402,1 ,$642.00 ,$417.30 ,$97.16 ,$642.00 ,$545.70 ,$383.27 ,$107.10 ,$369.15 ,$107.10 ,$442.34 ,$545.70 ,$545.70 ,$545.70 ,$526.44 ,$436.56 ,$107.10 ,$107.10 ,$481.50 ,$455.82 ,$455.82 ,$107.10 ,$455.82 ,$532.86 ,$532.86 ,$532.86 , N/A ,$267.76 ,$545.70 ,$107.10 ,$642.00 ,$97.16 ,$97.16 ,$545.70 ,$224.92 ,$545.70 ,$577.80 ,$107.10 ,$532.86 ,$510.39 ,$510.39 ,$107.10 ,$417.30 
ST. JOSEPH'S HOSPITAL - BREESE,40200015,76641,HC US BREAST COMPLETE,402,1 ,"$1,397.00 ",$908.05 ,$74.93 ,"$1,397.00 ","$1,187.45 ",$834.01 ,$107.10 ,$803.28 ,$107.10 ,$962.53 ,"$1,187.45 ","$1,187.45 ","$1,187.45 ","$1,145.54 ",$949.96 ,$107.10 ,$107.10 ,"$1,047.75 ",$991.87 ,$991.87 ,$107.10 ,$991.87 ,"$1,159.51 ","$1,159.51 ","$1,159.51 ", N/A ,$267.76 ,"$1,187.45 ",$107.10 ,$74.93 ,$97.16 ,$97.16 ,"$1,187.45 ",$224.92 ,"$1,187.45 ","$1,257.30 ",$107.10 ,"$1,159.51 ","$1,110.62 ","$1,110.62 ",$107.10 ,$908.05 
ST. JOSEPH'S HOSPITAL - BREESE,40200015,76641,HC US BREAST COMPLETE,402,1 ,$931.00 ,$605.15 ,$74.93 ,$931.00 ,$791.35 ,$555.81 ,$107.10 ,$535.33 ,$107.10 ,$641.46 ,$791.35 ,$791.35 ,$791.35 ,$763.42 ,$633.08 ,$107.10 ,$107.10 ,$698.25 ,$661.01 ,$661.01 ,$107.10 ,$661.01 ,$772.73 ,$772.73 ,$772.73 , N/A ,$267.76 ,$791.35 ,$107.10 ,$74.93 ,$97.16 ,$97.16 ,$791.35 ,$224.92 ,$791.35 ,$837.90 ,$107.10 ,$772.73 ,$740.15 ,$740.15 ,$107.10 ,$605.15 
ST. JOSEPH'S HOSPITAL - BREESE,40200016,76642,HC US BREAST LIMITED,402,1 ,$466.00 ,$302.90 ,$56.93 ,$466.00 ,$396.10 ,$278.20 ,$76.27 ,$267.95 ,$76.27 ,$321.07 ,$396.10 ,$396.10 ,$396.10 ,$382.12 ,$316.88 ,$76.27 ,$76.27 ,$349.50 ,$330.86 ,$330.86 ,$76.27 ,$330.86 ,$386.78 ,$386.78 ,$386.78 , N/A ,$190.67 ,$396.10 ,$76.27 ,$56.93 ,$97.16 ,$97.16 ,$396.10 ,$160.16 ,$396.10 ,$419.40 ,$76.27 ,$386.78 ,$370.47 ,$370.47 ,$76.27 ,$302.90 
ST. JOSEPH'S HOSPITAL - BREESE,40200016,76642,HC US BREAST LIMITED,402,1 ,$698.00 ,$453.70 ,$56.93 ,$698.00 ,$593.30 ,$416.71 ,$76.27 ,$401.35 ,$76.27 ,$480.92 ,$593.30 ,$593.30 ,$593.30 ,$572.36 ,$474.64 ,$76.27 ,$76.27 ,$523.50 ,$495.58 ,$495.58 ,$76.27 ,$495.58 ,$579.34 ,$579.34 ,$579.34 , N/A ,$190.67 ,$593.30 ,$76.27 ,$56.93 ,$97.16 ,$97.16 ,$593.30 ,$160.16 ,$593.30 ,$628.20 ,$76.27 ,$579.34 ,$554.91 ,$554.91 ,$76.27 ,$453.70 
ST. JOSEPH'S HOSPITAL - BREESE,40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,515.00 ",$984.75 ,$97.16 ,"$1,515.00 ","$1,287.75 ",$904.46 ,$107.10 ,$871.13 ,$107.10 ,"$1,043.84 ","$1,287.75 ","$1,287.75 ","$1,287.75 ","$1,242.30 ","$1,030.20 ",$107.10 ,$107.10 ,"$1,136.25 ","$1,075.65 ","$1,075.65 ",$107.10 ,"$1,075.65 ","$1,257.45 ","$1,257.45 ","$1,257.45 ", N/A ,$267.76 ,"$1,287.75 ",$107.10 ,"$1,515.00 ",$97.16 ,$97.16 ,"$1,287.75 ",$224.92 ,"$1,287.75 ","$1,363.50 ",$107.10 ,"$1,257.45 ","$1,204.43 ","$1,204.43 ",$107.10 ,$984.75 
ST. JOSEPH'S HOSPITAL - BREESE,40200018,76705,HC US ABDOMEN LTD,402,1 ,"$1,262.00 ",$820.30 ,$97.16 ,"$1,262.00 ","$1,072.70 ",$753.41 ,$107.10 ,$725.65 ,$107.10 ,$869.52 ,"$1,072.70 ","$1,072.70 ","$1,072.70 ","$1,034.84 ",$858.16 ,$107.10 ,$107.10 ,$946.50 ,$896.02 ,$896.02 ,$107.10 ,$896.02 ,"$1,047.46 ","$1,047.46 ","$1,047.46 ", N/A ,$267.76 ,"$1,072.70 ",$107.10 ,"$1,262.00 ",$97.16 ,$97.16 ,"$1,072.70 ",$224.92 ,"$1,072.70 ","$1,135.80 ",$107.10 ,"$1,047.46 ","$1,003.29 ","$1,003.29 ",$107.10 ,$820.30 
ST. JOSEPH'S HOSPITAL - BREESE,40200019,76770,HC US RETROPERITIONEAL,402,1 ,"$1,044.00 ",$678.60 ,$97.16 ,"$1,044.00 ",$887.40 ,$623.27 ,$107.10 ,$600.30 ,$107.10 ,$719.32 ,$887.40 ,$887.40 ,$887.40 ,$856.08 ,$709.92 ,$107.10 ,$107.10 ,$783.00 ,$741.24 ,$741.24 ,$107.10 ,$741.24 ,$866.52 ,$866.52 ,$866.52 , N/A ,$267.76 ,$887.40 ,$107.10 ,"$1,044.00 ",$97.16 ,$97.16 ,$887.40 ,$224.92 ,$887.40 ,$939.60 ,$107.10 ,$866.52 ,$829.98 ,$829.98 ,$107.10 ,$678.60 
ST. JOSEPH'S HOSPITAL - BREESE,40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$946.00 ,$614.90 ,$97.16 ,$946.00 ,$804.10 ,$564.76 ,$107.10 ,$543.95 ,$107.10 ,$651.79 ,$804.10 ,$804.10 ,$804.10 ,$775.72 ,$643.28 ,$107.10 ,$107.10 ,$709.50 ,$671.66 ,$671.66 ,$107.10 ,$671.66 ,$785.18 ,$785.18 ,$785.18 , N/A ,$267.76 ,$804.10 ,$107.10 ,$946.00 ,$97.16 ,$97.16 ,$804.10 ,$224.92 ,$804.10 ,$851.40 ,$107.10 ,$785.18 ,$752.07 ,$752.07 ,$107.10 ,$614.90 
ST. JOSEPH'S HOSPITAL - BREESE,40200022,76800,HC US SPINAL CANAL  AND  CONTENTS,402,1 ,$324.00 ,$210.60 ,$97.16 ,$324.00 ,$275.40 ,$193.43 ,$107.10 ,$186.30 ,$107.10 ,$223.24 ,$275.40 ,$275.40 ,$275.40 ,$265.68 ,$220.32 ,$107.10 ,$107.10 ,$243.00 ,$230.04 ,$230.04 ,$107.10 ,$230.04 ,$268.92 ,$268.92 ,$268.92 , N/A ,$267.76 ,$275.40 ,$107.10 ,$324.00 ,$97.16 ,$97.16 ,$275.40 ,$224.92 ,$275.40 ,$291.60 ,$107.10 ,$268.92 ,$257.58 ,$257.58 ,$107.10 ,$210.60 
ST. JOSEPH'S HOSPITAL - BREESE,40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,"$1,127.00 ",$732.55 ,$62.88 ,"$1,127.00 ",$957.95 ,$672.82 ,$107.10 ,$648.03 ,$107.10 ,$776.50 ,$957.95 ,$957.95 ,$957.95 ,$924.14 ,$766.36 ,$107.10 ,$107.10 ,$845.25 ,$800.17 ,$800.17 ,$107.10 ,$800.17 ,$935.41 ,$935.41 ,$935.41 , N/A ,$267.76 ,$957.95 ,$107.10 ,"$1,127.00 ",$62.88 ,$62.88 ,$957.95 ,$224.92 ,$957.95 ,"$1,014.30 ",$107.10 ,$935.41 ,$895.97 ,$895.97 ,$107.10 ,$732.55 
ST. JOSEPH'S HOSPITAL - BREESE,40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$517.00 ,$336.05 ,$62.88 ,$517.00 ,$439.45 ,$308.65 , N/A ,$297.28 , N/A ,$356.21 ,$439.45 ,$439.45 ,$439.45 ,$423.94 ,$351.56 , N/A , N/A ,$387.75 ,$367.07 ,$367.07 , N/A ,$367.07 ,$429.11 ,$429.11 ,$429.11 , N/A , N/A ,$439.45 , N/A ,$517.00 ,$62.88 ,$62.88 ,$439.45 , N/A ,$439.45 ,$465.30 , N/A ,$429.11 ,$411.02 ,$411.02 , N/A ,$336.05 
ST. JOSEPH'S HOSPITAL - BREESE,40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,"$1,214.00 ",$789.10 ,$62.88 ,"$1,214.00 ","$1,031.90 ",$724.76 ,$107.10 ,$698.05 ,$107.10 ,$836.45 ,"$1,031.90 ","$1,031.90 ","$1,031.90 ",$995.48 ,$825.52 ,$107.10 ,$107.10 ,$910.50 ,$861.94 ,$861.94 ,$107.10 ,$861.94 ,"$1,007.62 ","$1,007.62 ","$1,007.62 ", N/A ,$267.76 ,"$1,031.90 ",$107.10 ,"$1,214.00 ",$62.88 ,$62.88 ,"$1,031.90 ",$224.92 ,"$1,031.90 ","$1,092.60 ",$107.10 ,"$1,007.62 ",$965.13 ,$965.13 ,$107.10 ,$789.10 
ST. JOSEPH'S HOSPITAL - BREESE,40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,"$1,032.00 ",$670.80 ,$62.88 ,"$1,032.00 ",$877.20 ,$616.10 , N/A ,$593.40 , N/A ,$711.05 ,$877.20 ,$877.20 ,$877.20 ,$846.24 ,$701.76 , N/A , N/A ,$774.00 ,$732.72 ,$732.72 , N/A ,$732.72 ,$856.56 ,$856.56 ,$856.56 , N/A , N/A ,$877.20 , N/A ,"$1,032.00 ",$62.88 ,$62.88 ,$877.20 , N/A ,$877.20 ,$928.80 , N/A ,$856.56 ,$820.44 ,$820.44 , N/A ,$670.80 
ST. JOSEPH'S HOSPITAL - BREESE,40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,"$1,370.00 ",$890.50 ,$62.88 ,"$1,370.00 ","$1,164.50 ",$817.89 ,$222.69 ,$787.75 ,$222.69 ,$943.93 ,"$1,164.50 ","$1,164.50 ","$1,164.50 ","$1,123.40 ",$931.60 ,$222.69 ,$222.69 ,"$1,027.50 ",$972.70 ,$972.70 ,$222.69 ,$972.70 ,"$1,137.10 ","$1,137.10 ","$1,137.10 ", N/A ,$556.73 ,"$1,164.50 ",$222.69 ,"$1,370.00 ",$62.88 ,$62.88 ,"$1,164.50 ",$467.66 ,"$1,164.50 ","$1,233.00 ",$222.69 ,"$1,137.10 ","$1,089.15 ","$1,089.15 ",$222.69 ,$890.50 
ST. JOSEPH'S HOSPITAL - BREESE,40200029,76812,HC US PREGNANCY DETAILED ADDL,402,1 ,$630.00 ,$409.50 ,$62.88 ,$630.00 ,$535.50 ,$376.11 , N/A ,$362.25 , N/A ,$434.07 ,$535.50 ,$535.50 ,$535.50 ,$516.60 ,$428.40 , N/A , N/A ,$472.50 ,$447.30 ,$447.30 , N/A ,$447.30 ,$522.90 ,$522.90 ,$522.90 , N/A , N/A ,$535.50 , N/A ,$630.00 ,$62.88 ,$62.88 ,$535.50 , N/A ,$535.50 ,$567.00 , N/A ,$522.90 ,$500.85 ,$500.85 , N/A ,$409.50 
ST. JOSEPH'S HOSPITAL - BREESE,40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,"$1,062.00 ",$690.30 ,$62.88 ,"$1,062.00 ",$902.70 ,$634.01 ,$107.10 ,$610.65 ,$107.10 ,$731.72 ,$902.70 ,$902.70 ,$902.70 ,$870.84 ,$722.16 ,$107.10 ,$107.10 ,$796.50 ,$754.02 ,$754.02 ,$107.10 ,$754.02 ,$881.46 ,$881.46 ,$881.46 , N/A ,$267.76 ,$902.70 ,$107.10 ,"$1,062.00 ",$62.88 ,$62.88 ,$902.70 ,$224.92 ,$902.70 ,$955.80 ,$107.10 ,$881.46 ,$844.29 ,$844.29 ,$107.10 ,$690.30 
ST. JOSEPH'S HOSPITAL - BREESE,40200031,76815,HC US FETAL HEART BEAT,402,1 ,"$1,000.00 ",$650.00 ,$62.88 ,"$1,000.00 ",$850.00 ,$597.00 ,$107.10 ,$575.00 ,$107.10 ,$689.00 ,$850.00 ,$850.00 ,$850.00 ,$820.00 ,$680.00 ,$107.10 ,$107.10 ,$750.00 ,$710.00 ,$710.00 ,$107.10 ,$710.00 ,$830.00 ,$830.00 ,$830.00 , N/A ,$267.76 ,$850.00 ,$107.10 ,"$1,000.00 ",$62.88 ,$62.88 ,$850.00 ,$224.92 ,$850.00 ,$900.00 ,$107.10 ,$830.00 ,$795.00 ,$795.00 ,$107.10 ,$650.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,"$1,021.00 ",$663.65 ,$62.88 ,"$1,021.00 ",$867.85 ,$609.54 ,$107.10 ,$587.08 ,$107.10 ,$703.47 ,$867.85 ,$867.85 ,$867.85 ,$837.22 ,$694.28 ,$107.10 ,$107.10 ,$765.75 ,$724.91 ,$724.91 ,$107.10 ,$724.91 ,$847.43 ,$847.43 ,$847.43 , N/A ,$267.76 ,$867.85 ,$107.10 ,"$1,021.00 ",$62.88 ,$62.88 ,$867.85 ,$224.92 ,$867.85 ,$918.90 ,$107.10 ,$847.43 ,$811.70 ,$811.70 ,$107.10 ,$663.65 
ST. JOSEPH'S HOSPITAL - BREESE,40200033,76818,HC US FETAL BIO PROFILE W/NST,402,1 ,"$1,721.00 ","$1,118.65 ",$62.88 ,"$1,721.00 ","$1,462.85 ","$1,027.44 ",$107.10 ,$989.58 ,$107.10 ,"$1,185.77 ","$1,462.85 ","$1,462.85 ","$1,462.85 ","$1,411.22 ","$1,170.28 ",$107.10 ,$107.10 ,"$1,290.75 ","$1,221.91 ","$1,221.91 ",$107.10 ,"$1,221.91 ","$1,428.43 ","$1,428.43 ","$1,428.43 ", N/A ,$267.76 ,"$1,462.85 ",$107.10 ,"$1,721.00 ",$62.88 ,$62.88 ,"$1,462.85 ",$224.92 ,"$1,462.85 ","$1,548.90 ",$107.10 ,"$1,428.43 ","$1,368.20 ","$1,368.20 ",$107.10 ,"$1,118.65 "
ST. JOSEPH'S HOSPITAL - BREESE,40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,"$1,319.00 ",$857.35 ,$62.88 ,"$1,319.00 ","$1,121.15 ",$787.44 ,$107.10 ,$758.43 ,$107.10 ,$908.79 ,"$1,121.15 ","$1,121.15 ","$1,121.15 ","$1,081.58 ",$896.92 ,$107.10 ,$107.10 ,$989.25 ,$936.49 ,$936.49 ,$107.10 ,$936.49 ,"$1,094.77 ","$1,094.77 ","$1,094.77 ", N/A ,$267.76 ,"$1,121.15 ",$107.10 ,"$1,319.00 ",$62.88 ,$62.88 ,"$1,121.15 ",$224.92 ,"$1,121.15 ","$1,187.10 ",$107.10 ,"$1,094.77 ","$1,048.61 ","$1,048.61 ",$107.10 ,$857.35 
ST. JOSEPH'S HOSPITAL - BREESE,40200036,76820,HC US FETAL DOPLR VELO UMB,402,1 ,$586.00 ,$380.90 ,$62.88 ,$586.00 ,$498.10 ,$349.84 ,$107.10 ,$336.95 ,$107.10 ,$403.75 ,$498.10 ,$498.10 ,$498.10 ,$480.52 ,$398.48 ,$107.10 ,$107.10 ,$439.50 ,$416.06 ,$416.06 ,$107.10 ,$416.06 ,$486.38 ,$486.38 ,$486.38 , N/A ,$267.76 ,$498.10 ,$107.10 ,$586.00 ,$62.88 ,$62.88 ,$498.10 ,$224.92 ,$498.10 ,$527.40 ,$107.10 ,$486.38 ,$465.87 ,$465.87 ,$107.10 ,$380.90 
ST. JOSEPH'S HOSPITAL - BREESE,40200038,76830,HC US TRANSVAGINAL,402,1 ,$902.00 ,$586.30 ,$97.16 ,$902.00 ,$766.70 ,$538.49 ,$107.10 ,$518.65 ,$107.10 ,$621.48 ,$766.70 ,$766.70 ,$766.70 ,$739.64 ,$613.36 ,$107.10 ,$107.10 ,$676.50 ,$640.42 ,$640.42 ,$107.10 ,$640.42 ,$748.66 ,$748.66 ,$748.66 , N/A ,$267.76 ,$766.70 ,$107.10 ,$902.00 ,$97.16 ,$97.16 ,$766.70 ,$224.92 ,$766.70 ,$811.80 ,$107.10 ,$748.66 ,$717.09 ,$717.09 ,$107.10 ,$586.30 
ST. JOSEPH'S HOSPITAL - BREESE,40200039,76831,HC US HYSTEROSONOGRAM,402,1 ,"$1,063.00 ",$690.95 ,$221.76 ,"$1,063.00 ",$903.55 ,$634.61 ,$222.69 ,$611.23 ,$222.69 ,$732.41 ,$903.55 ,$903.55 ,$903.55 ,$871.66 ,$722.84 ,$222.69 ,$222.69 ,$797.25 ,$754.73 ,$754.73 ,$222.69 ,$754.73 ,$882.29 ,$882.29 ,$882.29 , N/A ,$556.73 ,$903.55 ,$222.69 ,"$1,063.00 ",$221.76 ,$221.76 ,$903.55 ,$467.66 ,$903.55 ,$956.70 ,$222.69 ,$882.29 ,$845.09 ,$845.09 ,$222.69 ,$690.95 
ST. JOSEPH'S HOSPITAL - BREESE,40200040,76856,HC US PELVIS NON OB,402,1 ,"$1,329.00 ",$863.85 ,$79.80 ,"$1,329.00 ","$1,129.65 ",$793.41 ,$107.10 ,$764.18 ,$107.10 ,$915.68 ,"$1,129.65 ","$1,129.65 ","$1,129.65 ","$1,089.78 ",$903.72 ,$107.10 ,$107.10 ,$996.75 ,$943.59 ,$943.59 ,$107.10 ,$943.59 ,"$1,103.07 ","$1,103.07 ","$1,103.07 ", N/A ,$267.76 ,"$1,129.65 ",$107.10 ,$79.80 ,$97.16 ,$97.16 ,"$1,129.65 ",$224.92 ,"$1,129.65 ","$1,196.10 ",$107.10 ,"$1,103.07 ","$1,056.56 ","$1,056.56 ",$107.10 ,$863.85 
ST. JOSEPH'S HOSPITAL - BREESE,40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$605.00 ,$393.25 ,$97.16 ,$605.00 ,$514.25 ,$361.19 ,$107.10 ,$347.88 ,$107.10 ,$416.85 ,$514.25 ,$514.25 ,$514.25 ,$496.10 ,$411.40 ,$107.10 ,$107.10 ,$453.75 ,$429.55 ,$429.55 ,$107.10 ,$429.55 ,$502.15 ,$502.15 ,$502.15 , N/A ,$267.76 ,$514.25 ,$107.10 ,$605.00 ,$97.16 ,$97.16 ,$514.25 ,$224.92 ,$514.25 ,$544.50 ,$107.10 ,$502.15 ,$480.98 ,$480.98 ,$107.10 ,$393.25 
ST. JOSEPH'S HOSPITAL - BREESE,40200042,76870,HC US SCROTUM,402,1 ,"$1,062.00 ",$690.30 ,$97.16 ,"$1,062.00 ",$902.70 ,$634.01 ,$107.10 ,$610.65 ,$107.10 ,$731.72 ,$902.70 ,$902.70 ,$902.70 ,$870.84 ,$722.16 ,$107.10 ,$107.10 ,$796.50 ,$754.02 ,$754.02 ,$107.10 ,$754.02 ,$881.46 ,$881.46 ,$881.46 , N/A ,$267.76 ,$902.70 ,$107.10 ,"$1,062.00 ",$97.16 ,$97.16 ,$902.70 ,$224.92 ,$902.70 ,$955.80 ,$107.10 ,$881.46 ,$844.29 ,$844.29 ,$107.10 ,$690.30 
ST. JOSEPH'S HOSPITAL - BREESE,40200043,76872,HC ULTRA BX PROS,402,1 ,$932.00 ,$605.80 ,$97.16 ,$932.00 ,$792.20 ,$556.40 ,$107.10 ,$535.90 ,$107.10 ,$642.15 ,$792.20 ,$792.20 ,$792.20 ,$764.24 ,$633.76 ,$107.10 ,$107.10 ,$699.00 ,$661.72 ,$661.72 ,$107.10 ,$661.72 ,$773.56 ,$773.56 ,$773.56 , N/A ,$267.76 ,$792.20 ,$107.10 ,$932.00 ,$97.16 ,$97.16 ,$792.20 ,$224.92 ,$792.20 ,$838.80 ,$107.10 ,$773.56 ,$740.94 ,$740.94 ,$107.10 ,$605.80 
ST. JOSEPH'S HOSPITAL - BREESE,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$781.00 ,$507.65 ,$97.16 ,$781.00 ,$663.85 ,$466.26 ,$107.10 ,$449.08 ,$107.10 ,$538.11 ,$663.85 ,$663.85 ,$663.85 ,$640.42 ,$531.08 ,$107.10 ,$107.10 ,$585.75 ,$554.51 ,$554.51 ,$107.10 ,$554.51 ,$648.23 ,$648.23 ,$648.23 , N/A ,$267.76 ,$663.85 ,$107.10 ,$781.00 ,$97.16 ,$97.16 ,$663.85 ,$224.92 ,$663.85 ,$702.90 ,$107.10 ,$648.23 ,$620.90 ,$620.90 ,$107.10 ,$507.65 
ST. JOSEPH'S HOSPITAL - BREESE,40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$665.00 ,$432.25 ,$97.16 ,$665.00 ,$565.25 ,$397.01 ,$107.10 ,$382.38 ,$107.10 ,$458.19 ,$565.25 ,$565.25 ,$565.25 ,$545.30 ,$452.20 ,$107.10 ,$107.10 ,$498.75 ,$472.15 ,$472.15 ,$107.10 ,$472.15 ,$551.95 ,$551.95 ,$551.95 , N/A ,$267.76 ,$565.25 ,$107.10 ,$665.00 ,$97.16 ,$97.16 ,$565.25 ,$224.92 ,$565.25 ,$598.50 ,$107.10 ,$551.95 ,$528.68 ,$528.68 ,$107.10 ,$432.25 
ST. JOSEPH'S HOSPITAL - BREESE,40200048,76885,HC US HIPS INFANT DYNAMIC,402,1 ,$513.00 ,$333.45 ,$76.27 ,$513.00 ,$436.05 ,$306.26 ,$76.27 ,$294.98 ,$76.27 ,$353.46 ,$436.05 ,$436.05 ,$436.05 ,$420.66 ,$348.84 ,$76.27 ,$76.27 ,$384.75 ,$364.23 ,$364.23 ,$76.27 ,$364.23 ,$425.79 ,$425.79 ,$425.79 , N/A ,$190.67 ,$436.05 ,$76.27 ,$513.00 ,$97.16 ,$97.16 ,$436.05 ,$160.16 ,$436.05 ,$461.70 ,$76.27 ,$425.79 ,$407.84 ,$407.84 ,$76.27 ,$333.45 
ST. JOSEPH'S HOSPITAL - BREESE,40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$702.23 ,$456.45 ,$70.90 ,$702.23 ,$596.90 ,$419.23 , N/A ,$403.78 , N/A ,$483.84 ,$596.90 ,$596.90 ,$596.90 ,$575.83 ,$477.52 , N/A , N/A ,$526.67 ,$498.58 ,$498.58 , N/A ,$498.58 ,$582.85 ,$582.85 ,$582.85 , N/A , N/A ,$596.90 , N/A ,$702.23 ,$70.90 ,$70.90 ,$596.90 , N/A ,$596.90 ,$632.01 , N/A ,$582.85 ,$558.27 ,$558.27 , N/A ,$456.45 
ST. JOSEPH'S HOSPITAL - BREESE,40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,231.00 ",$800.15 ,$27.31 ,"$1,231.00 ","$1,046.35 ",$734.91 , N/A ,$707.83 , N/A ,$848.16 ,"$1,046.35 ","$1,046.35 ","$1,046.35 ","$1,009.42 ",$837.08 , N/A , N/A ,$923.25 ,$874.01 ,$874.01 , N/A ,$874.01 ,"$1,021.73 ","$1,021.73 ","$1,021.73 ", N/A , N/A ,"$1,046.35 ", N/A ,$27.31 ,$70.90 ,$70.90 ,"$1,046.35 ", N/A ,"$1,046.35 ","$1,107.90 ", N/A ,"$1,021.73 ",$978.65 ,$978.65 , N/A ,$800.15 
ST. JOSEPH'S HOSPITAL - BREESE,40200059,76946,HC US GUIDED AMNIOCENTESIS,402,1 ,$561.00 ,$364.65 ,$70.90 ,$561.00 ,$476.85 ,$334.92 , N/A ,$322.58 , N/A ,$386.53 ,$476.85 ,$476.85 ,$476.85 ,$460.02 ,$381.48 , N/A , N/A ,$420.75 ,$398.31 ,$398.31 , N/A ,$398.31 ,$465.63 ,$465.63 ,$465.63 , N/A , N/A ,$476.85 , N/A ,$561.00 ,$70.90 ,$70.90 ,$476.85 , N/A ,$476.85 ,$504.90 , N/A ,$465.63 ,$446.00 ,$446.00 , N/A ,$364.65 
ST. JOSEPH'S HOSPITAL - BREESE,40200062,76998,HC US INTRAOPERATIVE,402,1 ,$820.00 ,$533.00 ,$70.90 ,$820.00 ,$697.00 ,$489.54 , N/A ,$471.50 , N/A ,$564.98 ,$697.00 ,$697.00 ,$697.00 ,$672.40 ,$557.60 , N/A , N/A ,$615.00 ,$582.20 ,$582.20 , N/A ,$582.20 ,$680.60 ,$680.60 ,$680.60 , N/A , N/A ,$697.00 , N/A ,$820.00 ,$70.90 ,$70.90 ,$697.00 , N/A ,$697.00 ,$738.00 , N/A ,$680.60 ,$651.90 ,$651.90 , N/A ,$533.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,$666.00 ,$432.90 ,$97.16 ,$666.00 ,$566.10 ,$397.60 ,$222.69 ,$382.95 ,$222.69 ,$458.87 ,$566.10 ,$566.10 ,$566.10 ,$546.12 ,$452.88 ,$222.69 ,$222.69 ,$499.50 ,$472.86 ,$472.86 ,$222.69 ,$472.86 ,$552.78 ,$552.78 ,$552.78 , N/A ,$556.73 ,$566.10 ,$222.69 ,$666.00 ,$97.16 ,$97.16 ,$566.10 ,$467.66 ,$566.10 ,$599.40 ,$222.69 ,$552.78 ,$529.47 ,$529.47 ,$222.69 ,$432.90 
ST. JOSEPH'S HOSPITAL - BREESE,40200068,93976,HC DUPLEX ABD/PEL/RETRO LTD,402,1 ,$928.00 ,$603.20 ,$97.16 ,$928.00 ,$788.80 ,$554.02 ,$107.10 ,$533.60 ,$107.10 ,$639.39 ,$788.80 ,$788.80 ,$788.80 ,$760.96 ,$631.04 ,$107.10 ,$107.10 ,$696.00 ,$658.88 ,$658.88 ,$107.10 ,$658.88 ,$770.24 ,$770.24 ,$770.24 , N/A ,$267.76 ,$788.80 ,$107.10 ,$928.00 ,$97.16 ,$97.16 ,$788.80 ,$224.92 ,$788.80 ,$835.20 ,$107.10 ,$770.24 ,$737.76 ,$737.76 ,$107.10 ,$603.20 
ST. JOSEPH'S HOSPITAL - BREESE,40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,$928.00 ,$603.20 ,$97.16 ,$928.00 ,$788.80 ,$554.02 ,$107.10 ,$533.60 ,$107.10 ,$639.39 ,$788.80 ,$788.80 ,$788.80 ,$760.96 ,$631.04 ,$107.10 ,$107.10 ,$696.00 ,$658.88 ,$658.88 ,$107.10 ,$658.88 ,$770.24 ,$770.24 ,$770.24 , N/A ,$267.76 ,$788.80 ,$107.10 ,$928.00 ,$97.16 ,$97.16 ,$788.80 ,$224.92 ,$788.80 ,$835.20 ,$107.10 ,$770.24 ,$737.76 ,$737.76 ,$107.10 ,$603.20 
ST. JOSEPH'S HOSPITAL - BREESE,40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,402,1 ,"$1,358.00 ",$882.70 ,$97.16 ,"$1,358.00 ","$1,154.30 ",$810.73 ,$222.69 ,$780.85 ,$222.69 ,$935.66 ,"$1,154.30 ","$1,154.30 ","$1,154.30 ","$1,113.56 ",$923.44 ,$222.69 ,$222.69 ,"$1,018.50 ",$964.18 ,$964.18 ,$222.69 ,$964.18 ,"$1,127.14 ","$1,127.14 ","$1,127.14 ", N/A ,$556.73 ,"$1,154.30 ",$222.69 ,"$1,358.00 ",$97.16 ,$97.16 ,"$1,154.30 ",$467.66 ,"$1,154.30 ","$1,222.20 ",$222.69 ,"$1,127.14 ","$1,079.61 ","$1,079.61 ",$222.69 ,$882.70 
ST. JOSEPH'S HOSPITAL - BREESE,40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,$321.30 ,$208.85 ,$97.16 ,$321.30 ,$273.11 ,$191.82 ,$107.10 ,$184.75 ,$107.10 ,$221.38 ,$273.11 ,$273.11 ,$273.11 ,$263.47 ,$218.48 ,$107.10 ,$107.10 ,$240.98 ,$228.12 ,$228.12 ,$107.10 ,$228.12 ,$266.68 ,$266.68 ,$266.68 , N/A ,$267.76 ,$273.11 ,$107.10 ,$321.30 ,$97.16 ,$97.16 ,$273.11 ,$224.92 ,$273.11 ,$289.17 ,$107.10 ,$266.68 ,$255.43 ,$255.43 ,$107.10 ,$208.85 
ST. JOSEPH'S HOSPITAL - BREESE,40200075,76706,HC US AORTA (SCREENING),402,1 ,$878.00 ,$570.70 ,$97.16 ,$878.00 ,$746.30 ,$524.17 ,$107.10 ,$504.85 ,$107.10 ,$604.94 ,$746.30 ,$746.30 ,$746.30 ,$719.96 ,$597.04 ,$107.10 ,$107.10 ,$658.50 ,$623.38 ,$623.38 ,$107.10 ,$623.38 ,$728.74 ,$728.74 ,$728.74 , N/A ,$267.76 ,$746.30 ,$107.10 ,$878.00 ,$97.16 ,$97.16 ,$746.30 ,$224.92 ,$746.30 ,$790.20 ,$107.10 ,$728.74 ,$698.01 ,$698.01 ,$107.10 ,$570.70 
ST. JOSEPH'S HOSPITAL - BREESE,40200091,76886,HC US HIPS INFANT STATIC,402,1 ,$456.00 ,$296.40 ,$76.27 ,$456.00 ,$387.60 ,$272.23 ,$76.27 ,$262.20 ,$76.27 ,$314.18 ,$387.60 ,$387.60 ,$387.60 ,$373.92 ,$310.08 ,$76.27 ,$76.27 ,$342.00 ,$323.76 ,$323.76 ,$76.27 ,$323.76 ,$378.48 ,$378.48 ,$378.48 , N/A ,$190.67 ,$387.60 ,$76.27 ,$456.00 ,$97.16 ,$97.16 ,$387.60 ,$160.16 ,$387.60 ,$410.40 ,$76.27 ,$378.48 ,$362.52 ,$362.52 ,$76.27 ,$296.40 
ST. JOSEPH'S HOSPITAL - BREESE,40200092,76813,HC US FETAL NUCHAL TRANSLUCENCY SNG,402,1 ,$672.00 ,$436.80 ,$62.88 ,$672.00 ,$571.20 ,$401.18 ,$107.10 ,$386.40 ,$107.10 ,$463.01 ,$571.20 ,$571.20 ,$571.20 ,$551.04 ,$456.96 ,$107.10 ,$107.10 ,$504.00 ,$477.12 ,$477.12 ,$107.10 ,$477.12 ,$557.76 ,$557.76 ,$557.76 , N/A ,$267.76 ,$571.20 ,$107.10 ,$672.00 ,$62.88 ,$62.88 ,$571.20 ,$224.92 ,$571.20 ,$604.80 ,$107.10 ,$557.76 ,$534.24 ,$534.24 ,$107.10 ,$436.80 
ST. JOSEPH'S HOSPITAL - BREESE,40200093,76814,HC US FETAL NUCHAL TRANSLUCENCY ADDL,402,1 ,$304.00 ,$197.60 ,$62.88 ,$304.00 ,$258.40 ,$181.49 , N/A ,$174.80 , N/A ,$209.46 ,$258.40 ,$258.40 ,$258.40 ,$249.28 ,$206.72 , N/A , N/A ,$228.00 ,$215.84 ,$215.84 , N/A ,$215.84 ,$252.32 ,$252.32 ,$252.32 , N/A , N/A ,$258.40 , N/A ,$304.00 ,$62.88 ,$62.88 ,$258.40 , N/A ,$258.40 ,$273.60 , N/A ,$252.32 ,$241.68 ,$241.68 , N/A ,$197.60 
ST. JOSEPH'S HOSPITAL - BREESE,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$420.00 ,$273.00 ,$44.13 ,$420.00 ,$357.00 ,$250.74 ,$94.15 ,$241.50 ,$94.15 ,$289.38 ,$357.00 ,$357.00 ,$357.00 ,$344.40 ,$285.60 ,$94.15 ,$94.15 ,$315.00 ,$298.20 ,$298.20 ,$94.15 ,$298.20 ,$348.60 ,$348.60 ,$348.60 , N/A ,$235.38 ,$357.00 ,$94.15 ,$104.18 ,$44.13 ,$44.13 ,$357.00 ,$197.72 ,$357.00 ,$378.00 ,$94.15 ,$348.60 ,$333.90 ,$333.90 ,$94.15 ,$273.00 
ST. JOSEPH'S HOSPITAL - BREESE,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$420.00 ,$273.00 ,$44.13 ,$420.00 ,$357.00 ,$250.74 ,$94.15 ,$241.50 ,$94.15 ,$289.38 ,$357.00 ,$357.00 ,$357.00 ,$344.40 ,$285.60 ,$94.15 ,$94.15 ,$315.00 ,$298.20 ,$298.20 ,$94.15 ,$298.20 ,$348.60 ,$348.60 ,$348.60 , N/A ,$235.38 ,$357.00 ,$94.15 ,$104.18 ,$44.13 ,$44.13 ,$357.00 ,$197.72 ,$357.00 ,$378.00 ,$94.15 ,$348.60 ,$333.90 ,$333.90 ,$94.15 ,$273.00 
ST. JOSEPH'S HOSPITAL - BREESE,40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$103.00 ,$66.95 ,$23.72 ,$103.00 ,$87.55 ,$61.49 ,$23.72 ,$59.23 ,$23.72 ,$70.97 ,$87.55 ,$87.55 ,$87.55 ,$84.46 ,$70.04 ,$23.72 ,$23.72 ,$77.25 ,$73.13 ,$73.13 ,$23.72 ,$73.13 ,$85.49 ,$85.49 ,$85.49 , N/A ,$59.30 ,$87.55 ,$23.72 ,$26.25 ,$44.13 ,$44.13 ,$87.55 ,$49.81 ,$87.55 ,$92.70 ,$23.72 ,$85.49 ,$81.89 ,$81.89 ,$23.72 ,$66.95 
ST. JOSEPH'S HOSPITAL - BREESE,40300007,77063,HC SCREEN DIG BREAST TOMO BIL-52,403,1 ,$103.00 ,$66.95 ,$22.07 ,$103.00 ,$87.55 ,$61.49 ,$23.72 ,$59.23 ,$23.72 ,$70.97 ,$87.55 ,$87.55 ,$87.55 ,$84.46 ,$70.04 ,$23.72 ,$23.72 ,$77.25 ,$73.13 ,$73.13 ,$23.72 ,$73.13 ,$85.49 ,$85.49 ,$85.49 , N/A ,$59.30 ,$87.55 ,$23.72 ,$26.25 ,$22.07 ,$22.07 ,$87.55 ,$49.81 ,$87.55 ,$92.70 ,$23.72 ,$85.49 ,$81.89 ,$81.89 ,$23.72 ,$66.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000005,92950,HC CPR,480,1 ,$849.00 ,$551.85 ,$241.86 ,$849.00 ,$721.65 ,$506.85 ,$241.86 ,$488.18 ,$241.86 ,$584.96 ,$721.65 ,$721.65 ,$721.65 , N/A ,$577.32 ,$241.86 ,$241.86 ,$636.75 ,$602.79 ,$602.79 ,$241.86 ,$602.79 ,$704.67 ,$704.67 ,$704.67 , N/A ,$604.66 ,$721.65 ,$241.86 ,$849.00 ,$431.46 ,$431.46 ,$721.65 ,$507.91 ,$721.65 ,$764.10 ,$241.86 ,$704.67 ,$674.96 ,$674.96 ,$241.86 ,$551.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,"$1,023.00 ",$664.95 ,$443.90 ,"$1,023.00 ",$869.55 ,$610.73 ,$443.90 ,$588.23 ,$443.90 ,$704.85 ,$869.55 ,$869.55 ,$869.55 , N/A ,$695.64 ,$443.90 ,$443.90 ,$767.25 ,$726.33 ,$726.33 ,$443.90 ,$726.33 ,$849.09 ,$849.09 ,$849.09 , N/A ,"$1,023.00 ",$869.55 ,$443.90 ,"$1,023.00 ",$467.80 ,$467.80 ,$869.55 ,$932.20 ,$869.55 ,$920.70 ,$443.90 ,$849.09 ,$813.29 ,$813.29 ,$443.90 ,$664.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000015,94002,HC VENT NEONATAL INTL DAY,410,1 ,"$1,023.00 ",$664.95 ,$443.90 ,"$1,023.00 ",$869.55 ,$610.73 ,$443.90 ,$588.23 ,$443.90 ,$704.85 ,$869.55 ,$869.55 ,$869.55 , N/A ,$695.64 ,$443.90 ,$443.90 ,$767.25 ,$726.33 ,$726.33 ,$443.90 ,$726.33 ,$849.09 ,$849.09 ,$849.09 , N/A ,"$1,023.00 ",$869.55 ,$443.90 ,"$1,023.00 ",$467.80 ,$467.80 ,$869.55 ,$932.20 ,$869.55 ,$920.70 ,$443.90 ,$849.09 ,$813.29 ,$813.29 ,$443.90 ,$664.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000016,94660,HC VENT NONINVAS NEO INTL DAY,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$865.00 ,$562.25 ,$443.90 ,$932.20 ,$735.25 ,$516.41 ,$443.90 ,$497.38 ,$443.90 ,$595.99 ,$735.25 ,$735.25 ,$735.25 , N/A ,$588.20 ,$443.90 ,$443.90 ,$648.75 ,$614.15 ,$614.15 ,$443.90 ,$614.15 ,$717.95 ,$717.95 ,$717.95 , N/A ,$865.00 ,$735.25 ,$443.90 ,$865.00 ,$467.80 ,$467.80 ,$735.25 ,$932.20 ,$735.25 ,$778.50 ,$443.90 ,$717.95 ,$687.68 ,$687.68 ,$443.90 ,$562.25 
ST. JOSEPH'S HOSPITAL - BREESE,41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000033,94660,HC VENT NONINVAS PEDS SUBQ DAY,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$123.00 ,$79.95 ,$70.73 ,$369.16 ,$104.55 ,$73.43 ,$175.79 ,$70.73 ,$175.79 ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 ,$175.79 ,$175.79 ,$92.25 ,$87.33 ,$87.33 ,$175.79 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$123.00 ,$104.55 ,$175.79 ,$123.00 ,$154.93 ,$118.70 ,$104.55 ,$369.16 ,$104.55 ,$110.70 ,$175.79 ,$102.09 ,$97.79 ,$97.79 ,$175.79 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000037,94640,HC INCENTIVE SPIROMETER TRT,410,1 ,$123.00 ,$79.95 ,$70.73 ,$369.16 ,$104.55 ,$73.43 ,$175.79 ,$70.73 ,$175.79 ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 ,$175.79 ,$175.79 ,$92.25 ,$87.33 ,$87.33 ,$175.79 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$123.00 ,$104.55 ,$175.79 ,$123.00 ,$154.93 ,$118.70 ,$104.55 ,$369.16 ,$104.55 ,$110.70 ,$175.79 ,$102.09 ,$97.79 ,$97.79 ,$175.79 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$123.00 ,$79.95 ,$70.73 ,$369.16 ,$104.55 ,$73.43 ,$175.79 ,$70.73 ,$175.79 ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 ,$175.79 ,$175.79 ,$92.25 ,$87.33 ,$87.33 ,$175.79 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$123.00 ,$104.55 ,$175.79 ,$123.00 ,$154.93 ,$118.70 ,$104.55 ,$369.16 ,$104.55 ,$110.70 ,$175.79 ,$102.09 ,$97.79 ,$97.79 ,$175.79 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$123.00 ,$79.95 ,$70.73 ,$369.16 ,$104.55 ,$73.43 ,$175.79 ,$70.73 ,$175.79 ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 ,$175.79 ,$175.79 ,$92.25 ,$87.33 ,$87.33 ,$175.79 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$123.00 ,$104.55 ,$175.79 ,$123.00 ,$154.93 ,$118.70 ,$104.55 ,$369.16 ,$104.55 ,$110.70 ,$175.79 ,$102.09 ,$97.79 ,$97.79 ,$175.79 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$322.00 ,$209.30 ,$47.77 ,$322.00 ,$273.70 ,$192.23 ,$104.19 ,$185.15 ,$104.19 ,$221.86 ,$273.70 ,$273.70 ,$273.70 , N/A ,$218.96 ,$104.19 ,$104.19 ,$241.50 ,$228.62 ,$228.62 ,$104.19 ,$228.62 ,$267.26 ,$267.26 ,$267.26 , N/A ,$260.47 ,$273.70 ,$104.19 ,$322.00 ,$47.77 ,$47.77 ,$273.70 ,$218.80 ,$273.70 ,$289.80 ,$104.19 ,$267.26 ,$255.99 ,$255.99 ,$104.19 ,$209.30 
ST. JOSEPH'S HOSPITAL - BREESE,41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$308.00 ,$200.20 ,$47.77 ,$308.00 ,$261.80 ,$183.88 , N/A ,$177.10 , N/A ,$212.21 ,$261.80 ,$261.80 ,$261.80 , N/A ,$209.44 , N/A , N/A ,$231.00 ,$218.68 ,$218.68 , N/A ,$218.68 ,$255.64 ,$255.64 ,$255.64 , N/A , N/A ,$261.80 , N/A ,$308.00 ,$47.77 ,$47.77 ,$261.80 , N/A ,$261.80 ,$277.20 , N/A ,$255.64 ,$244.86 ,$244.86 , N/A ,$200.20 
ST. JOSEPH'S HOSPITAL - BREESE,41000052,94660,HC CPAP,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000053,94660,HC CPAP DAILY EST PT,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$39.00 ,$25.35 ,$22.43 ,$369.16 ,$33.15 ,$23.28 ,$175.79 ,$22.43 ,$175.79 ,$26.87 ,$33.15 ,$33.15 ,$33.15 , N/A ,$26.52 ,$175.79 ,$175.79 ,$29.25 ,$27.69 ,$27.69 ,$175.79 ,$27.69 ,$32.37 ,$32.37 ,$32.37 , N/A ,$39.00 ,$33.15 ,$175.79 ,$39.00 ,$23.05 ,$23.05 ,$33.15 ,$369.16 ,$33.15 ,$35.10 ,$175.79 ,$32.37 ,$31.01 ,$31.01 ,$175.79 ,$25.35 
ST. JOSEPH'S HOSPITAL - BREESE,41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$78.00 ,$50.70 ,$44.85 ,$218.80 ,$66.30 ,$46.57 ,$104.19 ,$44.85 ,$104.19 ,$53.74 ,$66.30 ,$66.30 ,$66.30 , N/A ,$53.04 ,$104.19 ,$104.19 ,$58.50 ,$55.38 ,$55.38 ,$104.19 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$78.00 ,$66.30 ,$104.19 ,$78.00 ,$154.93 ,$75.27 ,$66.30 ,$218.80 ,$66.30 ,$70.20 ,$104.19 ,$64.74 ,$62.01 ,$62.01 ,$104.19 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$78.00 ,$50.70 ,$44.85 ,$218.80 ,$66.30 ,$46.57 ,$104.19 ,$44.85 ,$104.19 ,$53.74 ,$66.30 ,$66.30 ,$66.30 , N/A ,$53.04 ,$104.19 ,$104.19 ,$58.50 ,$55.38 ,$55.38 ,$104.19 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$78.00 ,$66.30 ,$104.19 ,$78.00 ,$154.93 ,$75.27 ,$66.30 ,$218.80 ,$66.30 ,$70.20 ,$104.19 ,$64.74 ,$62.01 ,$62.01 ,$104.19 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$66.00 ,$42.90 ,$37.95 ,$218.80 ,$56.10 ,$39.40 ,$104.19 ,$37.95 ,$104.19 ,$45.47 ,$56.10 ,$56.10 ,$56.10 , N/A ,$44.88 ,$104.19 ,$104.19 ,$49.50 ,$46.86 ,$46.86 ,$104.19 ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A ,$66.00 ,$56.10 ,$104.19 ,$66.00 ,$154.93 ,$63.69 ,$56.10 ,$218.80 ,$56.10 ,$59.40 ,$104.19 ,$54.78 ,$52.47 ,$52.47 ,$104.19 ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$66.00 ,$42.90 ,$37.95 ,$218.80 ,$56.10 ,$39.40 ,$104.19 ,$37.95 ,$104.19 ,$45.47 ,$56.10 ,$56.10 ,$56.10 , N/A ,$44.88 ,$104.19 ,$104.19 ,$49.50 ,$46.86 ,$46.86 ,$104.19 ,$46.86 ,$54.78 ,$54.78 ,$54.78 , N/A ,$66.00 ,$56.10 ,$104.19 ,$66.00 ,$154.93 ,$63.69 ,$56.10 ,$218.80 ,$56.10 ,$59.40 ,$104.19 ,$54.78 ,$52.47 ,$52.47 ,$104.19 ,$42.90 
ST. JOSEPH'S HOSPITAL - BREESE,41000068,G0237,HC RESP STRENGTH/ENDURANCE 15 MIN,410,1 ,$65.91 ,$42.84 ,$21.97 ,$154.93 ,$56.02 ,$39.35 ,$21.97 ,$37.90 ,$21.97 ,$45.41 ,$56.02 ,$56.02 ,$56.02 , N/A ,$44.82 ,$21.97 ,$21.97 ,$49.43 ,$46.80 ,$46.80 ,$21.97 ,$46.80 ,$54.71 ,$54.71 ,$54.71 , N/A ,$54.92 ,$56.02 ,$21.97 ,$65.91 ,$154.93 ,$63.60 ,$56.02 ,$46.14 ,$56.02 ,$59.32 ,$21.97 ,$54.71 ,$52.40 ,$52.40 ,$21.97 ,$42.84 
ST. JOSEPH'S HOSPITAL - BREESE,41000069,G0238,HC RESP THRP FUNCTION 15 MIN,410,1 ,$74.00 ,$48.10 ,$21.97 ,$154.93 ,$62.90 ,$44.18 ,$21.97 ,$42.55 ,$21.97 ,$50.99 ,$62.90 ,$62.90 ,$62.90 , N/A ,$50.32 ,$21.97 ,$21.97 ,$55.50 ,$52.54 ,$52.54 ,$21.97 ,$52.54 ,$61.42 ,$61.42 ,$61.42 , N/A ,$54.92 ,$62.90 ,$21.97 ,$74.00 ,$154.93 ,$71.41 ,$62.90 ,$46.14 ,$62.90 ,$66.60 ,$21.97 ,$61.42 ,$58.83 ,$58.83 ,$21.97 ,$48.10 
ST. JOSEPH'S HOSPITAL - BREESE,41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$95.85 ,$62.30 ,$1.51 ,$95.85 ,$81.47 ,$57.22 ,$31.95 ,$55.11 ,$31.95 ,$66.04 ,$81.47 ,$81.47 ,$81.47 , N/A ,$65.18 ,$31.95 ,$31.95 ,$71.89 ,$68.05 ,$68.05 ,$31.95 ,$68.05 ,$79.56 ,$79.56 ,$79.56 , N/A ,$79.86 ,$81.47 ,$31.95 ,$95.85 ,$1.51 ,$1.51 ,$81.47 ,$67.09 ,$81.47 ,$86.27 ,$31.95 ,$79.56 ,$76.20 ,$76.20 ,$31.95 ,$62.30 
ST. JOSEPH'S HOSPITAL - BREESE,41000073,94660,HC VENT NONINVAS NEON SUBQ DAY,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000076,94640,HC NEBULIZER SUBSQ,410,1 ,$123.00 ,$79.95 ,$70.73 ,$369.16 ,$104.55 ,$73.43 ,$175.79 ,$70.73 ,$175.79 ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 ,$175.79 ,$175.79 ,$92.25 ,$87.33 ,$87.33 ,$175.79 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$123.00 ,$104.55 ,$175.79 ,$123.00 ,$154.93 ,$118.70 ,$104.55 ,$369.16 ,$104.55 ,$110.70 ,$175.79 ,$102.09 ,$97.79 ,$97.79 ,$175.79 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000077,94762,HC PULSE OX PER DAY,410,1 ,$602.00 ,$391.30 ,$47.77 ,$602.00 ,$511.70 ,$359.39 ,$132.21 ,$346.15 ,$132.21 ,$414.78 ,$511.70 ,$511.70 ,$511.70 , N/A ,$409.36 ,$132.21 ,$132.21 ,$451.50 ,$427.42 ,$427.42 ,$132.21 ,$427.42 ,$499.66 ,$499.66 ,$499.66 , N/A ,$330.52 ,$511.70 ,$132.21 ,$602.00 ,$47.77 ,$47.77 ,$511.70 ,$277.64 ,$511.70 ,$541.80 ,$132.21 ,$499.66 ,$478.59 ,$478.59 ,$132.21 ,$391.30 
ST. JOSEPH'S HOSPITAL - BREESE,41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$449.00 ,$291.85 ,$175.79 ,$467.80 ,$381.65 ,$268.05 ,$175.79 ,$258.18 ,$175.79 ,$309.36 ,$381.65 ,$381.65 ,$381.65 , N/A ,$305.32 ,$175.79 ,$175.79 ,$336.75 ,$318.79 ,$318.79 ,$175.79 ,$318.79 ,$372.67 ,$372.67 ,$372.67 , N/A ,$439.48 ,$381.65 ,$175.79 ,$449.00 ,$467.80 ,$433.29 ,$381.65 ,$369.16 ,$381.65 ,$404.10 ,$175.79 ,$372.67 ,$356.96 ,$356.96 ,$175.79 ,$291.85 
ST. JOSEPH'S HOSPITAL - BREESE,41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$123.00 ,$79.95 ,$70.73 ,$369.16 ,$104.55 ,$73.43 ,$175.79 ,$70.73 ,$175.79 ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 ,$175.79 ,$175.79 ,$92.25 ,$87.33 ,$87.33 ,$175.79 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$123.00 ,$104.55 ,$175.79 ,$123.00 ,$154.93 ,$118.70 ,$104.55 ,$369.16 ,$104.55 ,$110.70 ,$175.79 ,$102.09 ,$97.79 ,$97.79 ,$175.79 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,41000092,94640,HC AEROSOL INHALATION SUBSQ,410,1 ,$123.00 ,$79.95 ,$70.73 ,$369.16 ,$104.55 ,$73.43 ,$175.79 ,$70.73 ,$175.79 ,$84.75 ,$104.55 ,$104.55 ,$104.55 , N/A ,$83.64 ,$175.79 ,$175.79 ,$92.25 ,$87.33 ,$87.33 ,$175.79 ,$87.33 ,$102.09 ,$102.09 ,$102.09 , N/A ,$123.00 ,$104.55 ,$175.79 ,$123.00 ,$154.93 ,$118.70 ,$104.55 ,$369.16 ,$104.55 ,$110.70 ,$175.79 ,$102.09 ,$97.79 ,$97.79 ,$175.79 ,$79.95 
ST. JOSEPH'S HOSPITAL - BREESE,42000006,G0283,HC APPL NEUROSTIMULATOR TRANSCUT,420,1 ,$116.00 ,$75.40 ,$13.90 ,$116.00 ,$98.60 ,$69.25 ,$13.90 ,$66.70 ,$13.90 ,$79.92 ,$98.60 ,$98.60 ,$98.60 ,$95.12 ,$78.88 ,$13.90 ,$13.90 ,$87.00 ,$82.36 ,$82.36 ,$13.90 ,$82.36 ,$96.28 ,$96.28 ,$96.28 , N/A ,$34.75 ,$98.60 ,$13.90 ,$116.00 ,$17.64 ,$17.64 ,$98.60 ,$29.19 ,$98.60 ,$104.40 ,$13.90 ,$96.28 ,$92.22 ,$92.22 ,$13.90 ,$75.40 
ST. JOSEPH'S HOSPITAL - BREESE,42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$176.00 ,$114.40 ,$15.07 ,$215.87 ,$149.60 ,$105.07 ,$15.07 ,$101.20 ,$15.07 ,$121.26 ,$149.60 ,$149.60 ,$149.60 ,$144.32 ,$119.68 ,$15.07 ,$15.07 ,$132.00 ,$124.96 ,$124.96 ,$15.07 ,$124.96 ,$146.08 ,$146.08 ,$146.08 , N/A ,$37.68 ,$149.60 ,$15.07 ,$176.00 ,$215.87 ,$169.84 ,$149.60 ,$31.65 ,$149.60 ,$158.40 ,$15.07 ,$146.08 ,$139.92 ,$139.92 ,$15.07 ,$114.40 
ST. JOSEPH'S HOSPITAL - BREESE,42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$245.00 ,$159.25 ,$20.85 ,$245.00 ,$208.25 ,$146.27 ,$20.85 ,$140.88 ,$20.85 ,$168.81 ,$208.25 ,$208.25 ,$208.25 ,$200.90 ,$166.60 ,$20.85 ,$20.85 ,$183.75 ,$173.95 ,$173.95 ,$20.85 ,$173.95 ,$203.35 ,$203.35 ,$203.35 , N/A ,$52.13 ,$208.25 ,$20.85 ,$245.00 ,$215.87 ,$215.87 ,$208.25 ,$43.79 ,$208.25 ,$220.50 ,$20.85 ,$203.35 ,$194.78 ,$194.78 ,$20.85 ,$159.25 
ST. JOSEPH'S HOSPITAL - BREESE,42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$176.00 ,$114.40 ,$14.64 ,$215.87 ,$149.60 ,$105.07 ,$14.64 ,$101.20 ,$14.64 ,$121.26 ,$149.60 ,$149.60 ,$149.60 ,$144.32 ,$119.68 ,$14.64 ,$14.64 ,$132.00 ,$124.96 ,$124.96 ,$14.64 ,$124.96 ,$146.08 ,$146.08 ,$146.08 , N/A ,$36.60 ,$149.60 ,$14.64 ,$176.00 ,$215.87 ,$169.84 ,$149.60 ,$30.74 ,$149.60 ,$158.40 ,$14.64 ,$146.08 ,$139.92 ,$139.92 ,$14.64 ,$114.40 
ST. JOSEPH'S HOSPITAL - BREESE,42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$142.00 ,$92.30 ,$31.04 ,$215.87 ,$120.70 ,$84.77 ,$31.04 ,$81.65 ,$31.04 ,$97.84 ,$120.70 ,$120.70 ,$120.70 ,$116.44 ,$96.56 ,$31.04 ,$31.04 ,$106.50 ,$100.82 ,$100.82 ,$31.04 ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A ,$77.60 ,$120.70 ,$31.04 ,$142.00 ,$215.87 ,$137.03 ,$120.70 ,$65.18 ,$120.70 ,$127.80 ,$31.04 ,$117.86 ,$112.89 ,$112.89 ,$31.04 ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$159.00 ,$103.35 ,$35.55 ,$215.87 ,$135.15 ,$94.92 ,$35.55 ,$91.43 ,$35.55 ,$109.55 ,$135.15 ,$135.15 ,$135.15 ,$130.38 ,$108.12 ,$35.55 ,$35.55 ,$119.25 ,$112.89 ,$112.89 ,$35.55 ,$112.89 ,$131.97 ,$131.97 ,$131.97 , N/A ,$88.88 ,$135.15 ,$35.55 ,$159.00 ,$215.87 ,$153.44 ,$135.15 ,$74.66 ,$135.15 ,$143.10 ,$35.55 ,$131.97 ,$126.41 ,$126.41 ,$35.55 ,$103.35 
ST. JOSEPH'S HOSPITAL - BREESE,42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$144.00 ,$93.60 ,$30.70 ,$215.87 ,$122.40 ,$85.97 ,$30.70 ,$82.80 ,$30.70 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$30.70 ,$30.70 ,$108.00 ,$102.24 ,$102.24 ,$30.70 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$76.75 ,$122.40 ,$30.70 ,$144.00 ,$215.87 ,$138.96 ,$122.40 ,$64.47 ,$122.40 ,$129.60 ,$30.70 ,$119.52 ,$114.48 ,$114.48 ,$30.70 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$157.00 ,$102.05 ,$29.18 ,$215.87 ,$133.45 ,$93.73 ,$29.18 ,$90.28 ,$29.18 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$29.18 ,$29.18 ,$117.75 ,$111.47 ,$111.47 ,$29.18 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$72.95 ,$133.45 ,$29.18 ,$157.00 ,$215.87 ,$151.51 ,$133.45 ,$61.28 ,$133.45 ,$141.30 ,$29.18 ,$130.31 ,$124.82 ,$124.82 ,$29.18 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$142.00 ,$92.30 ,$28.62 ,$215.87 ,$120.70 ,$84.77 ,$28.62 ,$81.65 ,$28.62 ,$97.84 ,$120.70 ,$120.70 ,$120.70 ,$116.44 ,$96.56 ,$28.62 ,$28.62 ,$106.50 ,$100.82 ,$100.82 ,$28.62 ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A ,$71.55 ,$120.70 ,$28.62 ,$142.00 ,$215.87 ,$137.03 ,$120.70 ,$60.10 ,$120.70 ,$127.80 ,$28.62 ,$117.86 ,$112.89 ,$112.89 ,$28.62 ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$130.00 ,$84.50 ,$39.49 ,$215.87 ,$110.50 ,$77.61 ,$39.49 ,$74.75 ,$39.49 ,$89.57 ,$110.50 ,$110.50 ,$110.50 ,$106.60 ,$88.40 ,$39.49 ,$39.49 ,$97.50 ,$92.30 ,$92.30 ,$39.49 ,$92.30 ,$107.90 ,$107.90 ,$107.90 , N/A ,$98.73 ,$110.50 ,$39.49 ,$130.00 ,$215.87 ,$125.45 ,$110.50 ,$82.93 ,$110.50 ,$117.00 ,$39.49 ,$107.90 ,$103.35 ,$103.35 ,$39.49 ,$84.50 
ST. JOSEPH'S HOSPITAL - BREESE,42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$148.00 ,$96.20 ,$35.11 ,$215.87 ,$125.80 ,$88.36 ,$35.11 ,$85.10 ,$35.11 ,$101.97 ,$125.80 ,$125.80 ,$125.80 ,$121.36 ,$100.64 ,$35.11 ,$35.11 ,$111.00 ,$105.08 ,$105.08 ,$35.11 ,$105.08 ,$122.84 ,$122.84 ,$122.84 , N/A ,$87.78 ,$125.80 ,$35.11 ,$148.00 ,$215.87 ,$142.82 ,$125.80 ,$73.73 ,$125.80 ,$133.20 ,$35.11 ,$122.84 ,$117.66 ,$117.66 ,$35.11 ,$96.20 
ST. JOSEPH'S HOSPITAL - BREESE,42000094,97761,HC PROSTHETIC TRAINING EA 15 MIN,420,1 ,$151.00 ,$98.15 ,$41.99 ,$215.87 ,$128.35 ,$90.15 ,$41.99 ,$86.83 ,$41.99 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$41.99 ,$41.99 ,$113.25 ,$107.21 ,$107.21 ,$41.99 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$104.98 ,$128.35 ,$41.99 ,$151.00 ,$215.87 ,$145.72 ,$128.35 ,$88.18 ,$128.35 ,$135.90 ,$41.99 ,$125.33 ,$120.05 ,$120.05 ,$41.99 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,42000160,97113,HC THERAPEUTIC ACT W/AQUA,420,1 ,$187.00 ,$121.55 ,$38.90 ,$215.87 ,$158.95 ,$111.64 ,$38.90 ,$107.53 ,$38.90 ,$128.84 ,$158.95 ,$158.95 ,$158.95 ,$153.34 ,$127.16 ,$38.90 ,$38.90 ,$140.25 ,$132.77 ,$132.77 ,$38.90 ,$132.77 ,$155.21 ,$155.21 ,$155.21 , N/A ,$97.25 ,$158.95 ,$38.90 ,$187.00 ,$215.87 ,$180.46 ,$158.95 ,$81.69 ,$158.95 ,$168.30 ,$38.90 ,$155.21 ,$148.67 ,$148.67 ,$38.90 ,$121.55 
ST. JOSEPH'S HOSPITAL - BREESE,42000161,97024,HC DIATHERMY,420,1 ,$134.00 ,$87.10 ,$7.19 ,$134.00 ,$113.90 ,$80.00 ,$7.19 ,$77.05 ,$7.19 ,$92.33 ,$113.90 ,$113.90 ,$113.90 ,$109.88 ,$91.12 ,$7.19 ,$7.19 ,$100.50 ,$95.14 ,$95.14 ,$7.19 ,$95.14 ,$111.22 ,$111.22 ,$111.22 , N/A ,$17.98 ,$113.90 ,$7.19 ,$134.00 ,$17.64 ,$17.64 ,$113.90 ,$15.10 ,$113.90 ,$120.60 ,$7.19 ,$111.22 ,$106.53 ,$106.53 ,$7.19 ,$87.10 
ST. JOSEPH'S HOSPITAL - BREESE,42000163,95831,HC MUSCLE TEST; EXT TRUNK,420,1 ,$53.00 ,$34.45 ,$30.48 ,$53.00 ,$45.05 ,$31.64 , N/A ,$30.48 , N/A ,$36.52 ,$45.05 ,$45.05 ,$45.05 ,$43.46 ,$36.04 , N/A , N/A ,$39.75 ,$37.63 ,$37.63 , N/A ,$37.63 ,$43.99 ,$43.99 ,$43.99 , N/A , N/A ,$45.05 , N/A ,$53.00 , N/A , N/A ,$45.05 , N/A ,$45.05 ,$47.70 , N/A ,$43.99 ,$42.14 ,$42.14 , N/A ,$34.45 
ST. JOSEPH'S HOSPITAL - BREESE,42000164,95832,HC MUSCLE TEST; HAND,420,1 ,$53.00 ,$34.45 ,$30.48 ,$53.00 ,$45.05 ,$31.64 , N/A ,$30.48 , N/A ,$36.52 ,$45.05 ,$45.05 ,$45.05 ,$43.46 ,$36.04 , N/A , N/A ,$39.75 ,$37.63 ,$37.63 , N/A ,$37.63 ,$43.99 ,$43.99 ,$43.99 , N/A , N/A ,$45.05 , N/A ,$53.00 , N/A , N/A ,$45.05 , N/A ,$45.05 ,$47.70 , N/A ,$43.99 ,$42.14 ,$42.14 , N/A ,$34.45 
ST. JOSEPH'S HOSPITAL - BREESE,42000206,G0283,HC ELECT STIM (UNATTEND) OTHER 15MIN,420,1 ,$116.00 ,$75.40 ,$13.90 ,$116.00 ,$98.60 ,$69.25 ,$13.90 ,$66.70 ,$13.90 ,$79.92 ,$98.60 ,$98.60 ,$98.60 ,$95.12 ,$78.88 ,$13.90 ,$13.90 ,$87.00 ,$82.36 ,$82.36 ,$13.90 ,$82.36 ,$96.28 ,$96.28 ,$96.28 , N/A ,$34.75 ,$98.60 ,$13.90 ,$116.00 ,$17.64 ,$17.64 ,$98.60 ,$29.19 ,$98.60 ,$104.40 ,$13.90 ,$96.28 ,$92.22 ,$92.22 ,$13.90 ,$75.40 
ST. JOSEPH'S HOSPITAL - BREESE,42000207,G0283,HC ELECT STIM (UNATTEND) OTHER 30MIN,420,1 ,$116.00 ,$75.40 ,$13.90 ,$116.00 ,$98.60 ,$69.25 ,$13.90 ,$66.70 ,$13.90 ,$79.92 ,$98.60 ,$98.60 ,$98.60 ,$95.12 ,$78.88 ,$13.90 ,$13.90 ,$87.00 ,$82.36 ,$82.36 ,$13.90 ,$82.36 ,$96.28 ,$96.28 ,$96.28 , N/A ,$34.75 ,$98.60 ,$13.90 ,$116.00 ,$17.64 ,$17.64 ,$98.60 ,$29.19 ,$98.60 ,$104.40 ,$13.90 ,$96.28 ,$92.22 ,$92.22 ,$13.90 ,$75.40 
ST. JOSEPH'S HOSPITAL - BREESE,42000208,G0283,HC ELECT STIM (UNATTEND) OTHER 45MIN,420,1 ,$116.00 ,$75.40 ,$13.90 ,$116.00 ,$98.60 ,$69.25 ,$13.90 ,$66.70 ,$13.90 ,$79.92 ,$98.60 ,$98.60 ,$98.60 ,$95.12 ,$78.88 ,$13.90 ,$13.90 ,$87.00 ,$82.36 ,$82.36 ,$13.90 ,$82.36 ,$96.28 ,$96.28 ,$96.28 , N/A ,$34.75 ,$98.60 ,$13.90 ,$116.00 ,$17.64 ,$17.64 ,$98.60 ,$29.19 ,$98.60 ,$104.40 ,$13.90 ,$96.28 ,$92.22 ,$92.22 ,$13.90 ,$75.40 
ST. JOSEPH'S HOSPITAL - BREESE,42000209,G0283,HC ELECT STIM (UNATTEND) OTHER 60MIN,420,1 ,$116.00 ,$75.40 ,$13.90 ,$116.00 ,$98.60 ,$69.25 ,$13.90 ,$66.70 ,$13.90 ,$79.92 ,$98.60 ,$98.60 ,$98.60 ,$95.12 ,$78.88 ,$13.90 ,$13.90 ,$87.00 ,$82.36 ,$82.36 ,$13.90 ,$82.36 ,$96.28 ,$96.28 ,$96.28 , N/A ,$34.75 ,$98.60 ,$13.90 ,$116.00 ,$17.64 ,$17.64 ,$98.60 ,$29.19 ,$98.60 ,$104.40 ,$13.90 ,$96.28 ,$92.22 ,$92.22 ,$13.90 ,$75.40 
ST. JOSEPH'S HOSPITAL - BREESE,42000210,97016,HC APPLY VASOPNEUMATIC DEVICE 15MIN,420,1 ,$157.00 ,$102.05 ,$12.54 ,$157.00 ,$133.45 ,$93.73 ,$12.54 ,$90.28 ,$12.54 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$12.54 ,$12.54 ,$117.75 ,$111.47 ,$111.47 ,$12.54 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$31.35 ,$133.45 ,$12.54 ,$157.00 ,$17.64 ,$17.64 ,$133.45 ,$26.33 ,$133.45 ,$141.30 ,$12.54 ,$130.31 ,$124.82 ,$124.82 ,$12.54 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,42000211,97016,HC APPLY VASOPNEUMATIC DEVICE 30MIN,420,1 ,$157.00 ,$102.05 ,$12.54 ,$157.00 ,$133.45 ,$93.73 ,$12.54 ,$90.28 ,$12.54 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$12.54 ,$12.54 ,$117.75 ,$111.47 ,$111.47 ,$12.54 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$31.35 ,$133.45 ,$12.54 ,$157.00 ,$17.64 ,$17.64 ,$133.45 ,$26.33 ,$133.45 ,$141.30 ,$12.54 ,$130.31 ,$124.82 ,$124.82 ,$12.54 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,42000212,97016,HC APPLY VASOPNEUMATIC DEVICE 45MIN,420,1 ,$157.00 ,$102.05 ,$12.54 ,$157.00 ,$133.45 ,$93.73 ,$12.54 ,$90.28 ,$12.54 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$12.54 ,$12.54 ,$117.75 ,$111.47 ,$111.47 ,$12.54 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$31.35 ,$133.45 ,$12.54 ,$157.00 ,$17.64 ,$17.64 ,$133.45 ,$26.33 ,$133.45 ,$141.30 ,$12.54 ,$130.31 ,$124.82 ,$124.82 ,$12.54 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,42000213,97016,HC APPLY VASOPNEUMATIC DEVICE 60MIN,420,1 ,$157.00 ,$102.05 ,$12.54 ,$157.00 ,$133.45 ,$93.73 ,$12.54 ,$90.28 ,$12.54 ,$108.17 ,$133.45 ,$133.45 ,$133.45 ,$128.74 ,$106.76 ,$12.54 ,$12.54 ,$117.75 ,$111.47 ,$111.47 ,$12.54 ,$111.47 ,$130.31 ,$130.31 ,$130.31 , N/A ,$31.35 ,$133.45 ,$12.54 ,$157.00 ,$17.64 ,$17.64 ,$133.45 ,$26.33 ,$133.45 ,$141.30 ,$12.54 ,$130.31 ,$124.82 ,$124.82 ,$12.54 ,$102.05 
ST. JOSEPH'S HOSPITAL - BREESE,42000214,97012,HC TRACTION MECHANICAL APPL 15 MIN,420,1 ,$150.00 ,$97.50 ,$15.41 ,$150.00 ,$127.50 ,$89.55 ,$15.41 ,$86.25 ,$15.41 ,$103.35 ,$127.50 ,$127.50 ,$127.50 ,$123.00 ,$102.00 ,$15.41 ,$15.41 ,$112.50 ,$106.50 ,$106.50 ,$15.41 ,$106.50 ,$124.50 ,$124.50 ,$124.50 , N/A ,$38.53 ,$127.50 ,$15.41 ,$150.00 ,$17.64 ,$17.64 ,$127.50 ,$32.36 ,$127.50 ,$135.00 ,$15.41 ,$124.50 ,$119.25 ,$119.25 ,$15.41 ,$97.50 
ST. JOSEPH'S HOSPITAL - BREESE,42000215,97012,HC TRACTION MECHANICAL APPL 30 MIN,420,1 ,$150.00 ,$97.50 ,$15.41 ,$150.00 ,$127.50 ,$89.55 ,$15.41 ,$86.25 ,$15.41 ,$103.35 ,$127.50 ,$127.50 ,$127.50 ,$123.00 ,$102.00 ,$15.41 ,$15.41 ,$112.50 ,$106.50 ,$106.50 ,$15.41 ,$106.50 ,$124.50 ,$124.50 ,$124.50 , N/A ,$38.53 ,$127.50 ,$15.41 ,$150.00 ,$17.64 ,$17.64 ,$127.50 ,$32.36 ,$127.50 ,$135.00 ,$15.41 ,$124.50 ,$119.25 ,$119.25 ,$15.41 ,$97.50 
ST. JOSEPH'S HOSPITAL - BREESE,42000267,N/A,HC DORSAVI TESTING AMI  AND  RUNNING,420,1 ,$120.00 ,$78.00 ,$69.00 ,$120.00 ,$102.00 ,$71.64 , N/A ,$69.00 , N/A ,$82.68 ,$102.00 ,$102.00 ,$102.00 ,$98.40 ,$81.60 , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A , N/A ,$102.00 , N/A ,$120.00 , N/A , N/A ,$102.00 , N/A ,$102.00 ,$108.00 , N/A ,$99.60 ,$95.40 ,$95.40 , N/A ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000268,N/A,HC DORSAVI TESTING AMI ONLY,420,1 ,$75.00 ,$48.75 ,$43.13 ,$75.00 ,$63.75 ,$44.78 , N/A ,$43.13 , N/A ,$51.68 ,$63.75 ,$63.75 ,$63.75 ,$61.50 ,$51.00 , N/A , N/A ,$56.25 ,$53.25 ,$53.25 , N/A ,$53.25 ,$62.25 ,$62.25 ,$62.25 , N/A , N/A ,$63.75 , N/A ,$75.00 , N/A , N/A ,$63.75 , N/A ,$63.75 ,$67.50 , N/A ,$62.25 ,$59.63 ,$59.63 , N/A ,$48.75 
ST. JOSEPH'S HOSPITAL - BREESE,42000269,N/A,HC DORSAVI TESTING RUNNING ONLY,420,1 ,$50.00 ,$32.50 ,$28.75 ,$50.00 ,$42.50 ,$29.85 , N/A ,$28.75 , N/A ,$34.45 ,$42.50 ,$42.50 ,$42.50 ,$41.00 ,$34.00 , N/A , N/A ,$37.50 ,$35.50 ,$35.50 , N/A ,$35.50 ,$41.50 ,$41.50 ,$41.50 , N/A , N/A ,$42.50 , N/A ,$50.00 , N/A , N/A ,$42.50 , N/A ,$42.50 ,$45.00 , N/A ,$41.50 ,$39.75 ,$39.75 , N/A ,$32.50 
ST. JOSEPH'S HOSPITAL - BREESE,42010001,G8978,HC MOBILITY CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010002,G8979,HC MOBILITY GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010003,G8980,HC MOBILITY DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010004,G8981,HC BODY POSITION CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010005,G8982,HC BODY POSITION GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010006,G8983,HC BODY POSITION DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010007,G8984,HC CARRY CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010008,G8985,HC CARRY GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010009,G8986,HC CARRY DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010010,G8987,HC SELF CARE CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010011,G8988,HC SELF CARE GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010012,G8989,HC SELF CARE DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010013,G8990,HC OTHER PT/OT CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010014,G8991,HC OTHER PT/OT GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010015,G8992,HC OTHER PT/OT DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010016,G8993,HC SUBSEQUENT LIMITATION CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010017,G8994,HC SUBSEQUENT LIMITATION GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42010018,G8995,HC SUBSEQUENT LIMITIATION DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400047,97161,HC PT EVAL LOW COMPLEXITY 75MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400048,97161,HC PT EVAL LOW COMPLEXITY 90MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400049,97161,HC PT EVAL LOW COMPLEXITY 105MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400050,97161,HC PT EVAL LOW COMPLEXITY 120MIN,424,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400059,97162,HC PT EVAL MOD COMPLEXITY 75MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400060,97162,HC PT EVAL MOD COMPLEXITY 90MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400061,97162,HC PT EVAL MOD COMPLEXITY 105MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400062,97162,HC PT EVAL MOD COMPLEXITY 120MIN,424,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 ,$195.98 ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400071,97163,HC PT EVAL HIGH COMPLEXITY 75MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400072,97163,HC PT EVAL HIGH COMPLEXITY 90MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400073,97163,HC PT EVAL HIGH COMPLEXITY 105MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400074,97163,HC PT EVAL HIGH COMPLEXITY 120MIN,424,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$145.00 ,$94.25 ,$59.09 ,$215.87 ,$123.25 ,$86.57 ,$59.09 ,$83.38 ,$59.09 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$59.09 ,$59.09 ,$108.75 ,$102.95 ,$102.95 ,$59.09 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$59.09 ,$145.00 ,$215.87 ,$139.93 ,$123.25 ,$124.09 ,$123.25 ,$130.50 ,$59.09 ,$120.35 ,$115.28 ,$115.28 ,$59.09 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$145.00 ,$94.25 ,$59.09 ,$215.87 ,$123.25 ,$86.57 ,$59.09 ,$83.38 ,$59.09 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$59.09 ,$59.09 ,$108.75 ,$102.95 ,$102.95 ,$59.09 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$59.09 ,$145.00 ,$215.87 ,$139.93 ,$123.25 ,$124.09 ,$123.25 ,$130.50 ,$59.09 ,$120.35 ,$115.28 ,$115.28 ,$59.09 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$145.00 ,$94.25 ,$59.09 ,$215.87 ,$123.25 ,$86.57 ,$59.09 ,$83.38 ,$59.09 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$59.09 ,$59.09 ,$108.75 ,$102.95 ,$102.95 ,$59.09 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$59.09 ,$145.00 ,$215.87 ,$139.93 ,$123.25 ,$124.09 ,$123.25 ,$130.50 ,$59.09 ,$120.35 ,$115.28 ,$115.28 ,$59.09 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$145.00 ,$94.25 ,$59.09 ,$215.87 ,$123.25 ,$86.57 ,$59.09 ,$83.38 ,$59.09 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$59.09 ,$59.09 ,$108.75 ,$102.95 ,$102.95 ,$59.09 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$59.09 ,$145.00 ,$215.87 ,$139.93 ,$123.25 ,$124.09 ,$123.25 ,$130.50 ,$59.09 ,$120.35 ,$115.28 ,$115.28 ,$59.09 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,43000015,97533,HC PERCEPTUAL ACTIVITY EA 15 MIN,430,1 ,$107.00 ,$69.55 ,$51.44 ,$343.40 ,$90.95 ,$63.88 ,$51.44 ,$61.53 ,$51.44 ,$73.72 ,$90.95 ,$90.95 ,$90.95 ,$87.74 ,$72.76 ,$51.44 ,$51.44 ,$80.25 ,$75.97 ,$75.97 ,$51.44 ,$75.97 ,$88.81 ,$88.81 ,$88.81 , N/A ,$107.00 ,$90.95 ,$51.44 ,$107.00 ,$343.40 ,$103.26 ,$90.95 ,$108.02 ,$90.95 ,$96.30 ,$51.44 ,$88.81 ,$85.07 ,$85.07 ,$51.44 ,$69.55 
ST. JOSEPH'S HOSPITAL - BREESE,43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$97.00 ,$63.05 ,$34.43 ,$343.40 ,$82.45 ,$57.91 ,$34.43 ,$55.78 ,$34.43 ,$66.83 ,$82.45 ,$82.45 ,$82.45 ,$79.54 ,$65.96 ,$34.43 ,$34.43 ,$72.75 ,$68.87 ,$68.87 ,$34.43 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$86.08 ,$82.45 ,$34.43 ,$97.00 ,$343.40 ,$93.61 ,$82.45 ,$72.30 ,$82.45 ,$87.30 ,$34.43 ,$80.51 ,$77.12 ,$77.12 ,$34.43 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$151.00 ,$98.15 ,$49.11 ,$215.87 ,$128.35 ,$90.15 ,$49.11 ,$86.83 ,$49.11 ,$104.04 ,$128.35 ,$128.35 ,$128.35 ,$123.82 ,$102.68 ,$49.11 ,$49.11 ,$113.25 ,$107.21 ,$107.21 ,$49.11 ,$107.21 ,$125.33 ,$125.33 ,$125.33 , N/A ,$122.78 ,$128.35 ,$49.11 ,$151.00 ,$215.87 ,$145.72 ,$128.35 ,$103.13 ,$128.35 ,$135.90 ,$49.11 ,$125.33 ,$120.05 ,$120.05 ,$49.11 ,$98.15 
ST. JOSEPH'S HOSPITAL - BREESE,43000035,97545,HC WORK HARDENING/CONDITIONING FIRST 2 HRS,430,1 ,$428.00 ,$278.20 ,$215.87 ,$428.00 ,$363.80 ,$255.52 , N/A ,$246.10 , N/A ,$294.89 ,$363.80 ,$363.80 ,$363.80 ,$350.96 ,$291.04 , N/A , N/A ,$321.00 ,$303.88 ,$303.88 , N/A ,$303.88 ,$355.24 ,$355.24 ,$355.24 , N/A , N/A ,$363.80 , N/A ,$428.00 ,$215.87 ,$215.87 ,$363.80 , N/A ,$363.80 ,$385.20 , N/A ,$355.24 ,$340.26 ,$340.26 , N/A ,$278.20 
ST. JOSEPH'S HOSPITAL - BREESE,43000036,97546,HC WORK HARDENING/CONDITIONINS ADD 1 HOUR,430,1 ,$131.00 ,$85.15 ,$75.33 ,$215.87 ,$111.35 ,$78.21 , N/A ,$75.33 , N/A ,$90.26 ,$111.35 ,$111.35 ,$111.35 ,$107.42 ,$89.08 , N/A , N/A ,$98.25 ,$93.01 ,$93.01 , N/A ,$93.01 ,$108.73 ,$108.73 ,$108.73 , N/A , N/A ,$111.35 , N/A ,$131.00 ,$215.87 ,$126.42 ,$111.35 , N/A ,$111.35 ,$117.90 , N/A ,$108.73 ,$104.15 ,$104.15 , N/A ,$85.15 
ST. JOSEPH'S HOSPITAL - BREESE,43000038,97018,HC PARAFFIN BATH THERAPY 15MIN,430,1 ,$121.00 ,$78.65 ,$6.18 ,$121.00 ,$102.85 ,$72.24 ,$6.18 ,$69.58 ,$6.18 ,$83.37 ,$102.85 ,$102.85 ,$102.85 ,$99.22 ,$82.28 ,$6.18 ,$6.18 ,$90.75 ,$85.91 ,$85.91 ,$6.18 ,$85.91 ,$100.43 ,$100.43 ,$100.43 , N/A ,$15.45 ,$102.85 ,$6.18 ,$121.00 ,$17.64 ,$17.64 ,$102.85 ,$12.98 ,$102.85 ,$108.90 ,$6.18 ,$100.43 ,$96.20 ,$96.20 ,$6.18 ,$78.65 
ST. JOSEPH'S HOSPITAL - BREESE,43000039,97018,HC PARAFFIN BATH THERAPY 30MIN,430,1 ,$121.00 ,$78.65 ,$6.18 ,$121.00 ,$102.85 ,$72.24 ,$6.18 ,$69.58 ,$6.18 ,$83.37 ,$102.85 ,$102.85 ,$102.85 ,$99.22 ,$82.28 ,$6.18 ,$6.18 ,$90.75 ,$85.91 ,$85.91 ,$6.18 ,$85.91 ,$100.43 ,$100.43 ,$100.43 , N/A ,$15.45 ,$102.85 ,$6.18 ,$121.00 ,$17.64 ,$17.64 ,$102.85 ,$12.98 ,$102.85 ,$108.90 ,$6.18 ,$100.43 ,$96.20 ,$96.20 ,$6.18 ,$78.65 
ST. JOSEPH'S HOSPITAL - BREESE,43000049,95852,HC RANGE OF MOTION TESTING HAND,430,1 ,$40.00 ,$26.00 ,$18.82 ,$40.00 ,$34.00 ,$23.88 ,$18.82 ,$23.00 ,$18.82 ,$27.56 ,$34.00 ,$34.00 ,$34.00 ,$32.80 ,$27.20 ,$18.82 ,$18.82 ,$30.00 ,$28.40 ,$28.40 ,$18.82 ,$28.40 ,$33.20 ,$33.20 ,$33.20 , N/A ,$40.00 ,$34.00 ,$18.82 ,$40.00 , N/A , N/A ,$34.00 ,$39.52 ,$34.00 ,$36.00 ,$18.82 ,$33.20 ,$31.80 ,$31.80 ,$18.82 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400038,97165,HC OT EVAL LOW COMPLEXITY 75MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400039,97165,HC OT EVAL LOW COMPLEXITY 90MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400040,97165,HC OT EVAL LOW COMPLEXITY 105MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400041,97165,HC OT EVAL LOW COMPLEXITY 120MIN,434,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 ,$176.30 ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400050,97166,HC OT EVAL MOD COMPLEXITY 75MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400051,97166,HC OT EVAL MOD COMPLEXITY 90MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400052,97166,HC OT EVAL MOD COMPLEXITY 105MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400053,97166,HC OT EVAL MOD COMPLEXITY 120MIN,434,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 ,$216.48 ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400062,97167,HC OT EVAL HIGH COMPLEXITY 75MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400063,97167,HC OT EVAL HIGH COMPLEXITY 90MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400064,97167,HC OT EVAL HIGH COMPLEXITY 105MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400065,97167,HC OT EVAL HIGH COMPLEXITY 120MIN,434,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 ,$410.00 ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$145.00 ,$94.25 ,$62.82 ,$343.40 ,$123.25 ,$86.57 ,$62.82 ,$83.38 ,$62.82 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$62.82 ,$62.82 ,$108.75 ,$102.95 ,$102.95 ,$62.82 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$62.82 ,$145.00 ,$343.40 ,$139.93 ,$123.25 ,$131.92 ,$123.25 ,$130.50 ,$62.82 ,$120.35 ,$115.28 ,$115.28 ,$62.82 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$145.00 ,$94.25 ,$62.82 ,$343.40 ,$123.25 ,$86.57 ,$62.82 ,$83.38 ,$62.82 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$62.82 ,$62.82 ,$108.75 ,$102.95 ,$102.95 ,$62.82 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$62.82 ,$145.00 ,$343.40 ,$139.93 ,$123.25 ,$131.92 ,$123.25 ,$130.50 ,$62.82 ,$120.35 ,$115.28 ,$115.28 ,$62.82 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$145.00 ,$94.25 ,$62.82 ,$343.40 ,$123.25 ,$86.57 ,$62.82 ,$83.38 ,$62.82 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$62.82 ,$62.82 ,$108.75 ,$102.95 ,$102.95 ,$62.82 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$62.82 ,$145.00 ,$343.40 ,$139.93 ,$123.25 ,$131.92 ,$123.25 ,$130.50 ,$62.82 ,$120.35 ,$115.28 ,$115.28 ,$62.82 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$145.00 ,$94.25 ,$62.82 ,$343.40 ,$123.25 ,$86.57 ,$62.82 ,$83.38 ,$62.82 ,$99.91 ,$123.25 ,$123.25 ,$123.25 ,$118.90 ,$98.60 ,$62.82 ,$62.82 ,$108.75 ,$102.95 ,$102.95 ,$62.82 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$62.82 ,$145.00 ,$343.40 ,$139.93 ,$123.25 ,$131.92 ,$123.25 ,$130.50 ,$62.82 ,$120.35 ,$115.28 ,$115.28 ,$62.82 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 ,$108.24 ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$144.00 ,$93.60 ,$82.80 ,$185.66 ,$122.40 ,$85.97 ,$88.41 ,$82.80 ,$88.41 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$88.41 ,$88.41 ,$108.00 ,$102.24 ,$102.24 ,$88.41 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$144.00 ,$122.40 ,$88.41 ,$144.00 ,$159.56 ,$138.96 ,$122.40 ,$185.66 ,$122.40 ,$129.60 ,$88.41 ,$119.52 ,$114.48 ,$114.48 ,$88.41 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$144.00 ,$93.60 ,$82.80 ,$185.66 ,$122.40 ,$85.97 ,$88.41 ,$82.80 ,$88.41 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$88.41 ,$88.41 ,$108.00 ,$102.24 ,$102.24 ,$88.41 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$144.00 ,$122.40 ,$88.41 ,$144.00 ,$159.56 ,$138.96 ,$122.40 ,$185.66 ,$122.40 ,$129.60 ,$88.41 ,$119.52 ,$114.48 ,$114.48 ,$88.41 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$144.00 ,$93.60 ,$82.80 ,$185.66 ,$122.40 ,$85.97 ,$88.41 ,$82.80 ,$88.41 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$88.41 ,$88.41 ,$108.00 ,$102.24 ,$102.24 ,$88.41 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$144.00 ,$122.40 ,$88.41 ,$144.00 ,$159.56 ,$138.96 ,$122.40 ,$185.66 ,$122.40 ,$129.60 ,$88.41 ,$119.52 ,$114.48 ,$114.48 ,$88.41 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$144.00 ,$93.60 ,$82.80 ,$185.66 ,$122.40 ,$85.97 ,$88.41 ,$82.80 ,$88.41 ,$99.22 ,$122.40 ,$122.40 ,$122.40 ,$118.08 ,$97.92 ,$88.41 ,$88.41 ,$108.00 ,$102.24 ,$102.24 ,$88.41 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$144.00 ,$122.40 ,$88.41 ,$144.00 ,$159.56 ,$138.96 ,$122.40 ,$185.66 ,$122.40 ,$129.60 ,$88.41 ,$119.52 ,$114.48 ,$114.48 ,$88.41 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,44010001,G8996,HC SWALLOW CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010002,G8997,HC SWALLOW GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010003,G8998,HC SWALLOW DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010004,G8999,HC MOTOR SPEECH CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010005,G9186,HC MOTOR SPEECH GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010006,G9158,HC MOTOR SPEECH DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010007,G9159,HC LANG COMP CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010008,G9160,HC LANG COMP GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010009,G9161,HC LANG COMP DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010010,G9162,HC LANG EXPRESS CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010011,G9163,HC LANG EXPRESS GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010012,G9164,HC LANG EXPRESS DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010013,G9165,HC ATTENTION CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010014,G9166,HC ATTENTION GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010015,G9167,HC ATTENTION DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010016,G9168,HC MEMORY CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010017,G9169,HC MEMORY GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010018,G9170,HC MEMORY DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010019,G9171,HC VOICE CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010020,G9172,HC VOICE GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010021,G9173,HC VOICE DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010022,G9174,HC OTHER SPEECH LANG CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010023,G9175,HC OTHER SPEECH LANG GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44010024,G9176,HC OTHER SPEECH LANG DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$260.00 ,$169.00 ,$88.26 ,$260.00 ,$221.00 ,$155.22 ,$88.26 ,$149.50 ,$88.26 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$88.26 ,$88.26 ,$195.00 ,$184.60 ,$184.60 ,$88.26 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$220.65 ,$221.00 ,$88.26 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$185.35 ,$221.00 ,$234.00 ,$88.26 ,$215.80 ,$206.70 ,$206.70 ,$88.26 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$260.00 ,$169.00 ,$88.26 ,$260.00 ,$221.00 ,$155.22 ,$88.26 ,$149.50 ,$88.26 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$88.26 ,$88.26 ,$195.00 ,$184.60 ,$184.60 ,$88.26 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$220.65 ,$221.00 ,$88.26 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$185.35 ,$221.00 ,$234.00 ,$88.26 ,$215.80 ,$206.70 ,$206.70 ,$88.26 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$260.00 ,$169.00 ,$88.26 ,$260.00 ,$221.00 ,$155.22 ,$88.26 ,$149.50 ,$88.26 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$88.26 ,$88.26 ,$195.00 ,$184.60 ,$184.60 ,$88.26 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$220.65 ,$221.00 ,$88.26 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$185.35 ,$221.00 ,$234.00 ,$88.26 ,$215.80 ,$206.70 ,$206.70 ,$88.26 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$260.00 ,$169.00 ,$88.26 ,$260.00 ,$221.00 ,$155.22 ,$88.26 ,$149.50 ,$88.26 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$88.26 ,$88.26 ,$195.00 ,$184.60 ,$184.60 ,$88.26 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$220.65 ,$221.00 ,$88.26 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$185.35 ,$221.00 ,$234.00 ,$88.26 ,$215.80 ,$206.70 ,$206.70 ,$88.26 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$489.00 ,$317.85 ,$35.55 ,$489.00 ,$415.65 ,$291.93 ,$94.28 ,$281.18 ,$94.28 ,$336.92 ,$415.65 ,$415.65 ,$415.65 ,$400.98 ,$332.52 ,$94.28 ,$94.28 ,$366.75 ,$347.19 ,$347.19 ,$94.28 ,$347.19 ,$405.87 ,$405.87 ,$405.87 , N/A ,$235.70 ,$415.65 ,$94.28 ,$489.00 ,$35.55 ,$35.55 ,$415.65 ,$197.99 ,$415.65 ,$440.10 ,$94.28 ,$405.87 ,$388.76 ,$388.76 ,$94.28 ,$317.85 
ST. JOSEPH'S HOSPITAL - BREESE,44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$260.00 ,$169.00 ,$149.50 ,$411.81 ,$221.00 ,$155.22 ,$196.10 ,$149.50 ,$196.10 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$196.10 ,$196.10 ,$195.00 ,$184.60 ,$184.60 ,$196.10 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$196.10 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$411.81 ,$221.00 ,$234.00 ,$196.10 ,$215.80 ,$206.70 ,$206.70 ,$196.10 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400043,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 15MIN,444,1 ,$260.00 ,$169.00 ,$92.32 ,$260.00 ,$221.00 ,$155.22 ,$92.32 ,$149.50 ,$92.32 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$92.32 ,$92.32 ,$195.00 ,$184.60 ,$184.60 ,$92.32 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$230.80 ,$221.00 ,$92.32 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$193.87 ,$221.00 ,$234.00 ,$92.32 ,$215.80 ,$206.70 ,$206.70 ,$92.32 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$256.00 ,$166.40 ,$114.90 ,$256.00 ,$217.60 ,$152.83 ,$114.90 ,$147.20 ,$114.90 ,$176.38 ,$217.60 ,$217.60 ,$217.60 ,$209.92 ,$174.08 ,$114.90 ,$114.90 ,$192.00 ,$181.76 ,$181.76 ,$114.90 ,$181.76 ,$212.48 ,$212.48 ,$212.48 , N/A ,$256.00 ,$217.60 ,$114.90 ,$256.00 ,$159.56 ,$159.56 ,$217.60 ,$241.29 ,$217.60 ,$230.40 ,$114.90 ,$212.48 ,$203.52 ,$203.52 ,$114.90 ,$166.40 
ST. JOSEPH'S HOSPITAL - BREESE,44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$256.00 ,$166.40 ,$114.90 ,$256.00 ,$217.60 ,$152.83 ,$114.90 ,$147.20 ,$114.90 ,$176.38 ,$217.60 ,$217.60 ,$217.60 ,$209.92 ,$174.08 ,$114.90 ,$114.90 ,$192.00 ,$181.76 ,$181.76 ,$114.90 ,$181.76 ,$212.48 ,$212.48 ,$212.48 , N/A ,$256.00 ,$217.60 ,$114.90 ,$256.00 ,$159.56 ,$159.56 ,$217.60 ,$241.29 ,$217.60 ,$230.40 ,$114.90 ,$212.48 ,$203.52 ,$203.52 ,$114.90 ,$166.40 
ST. JOSEPH'S HOSPITAL - BREESE,44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$260.00 ,$169.00 ,$149.50 ,$411.81 ,$221.00 ,$155.22 ,$196.10 ,$149.50 ,$196.10 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$196.10 ,$196.10 ,$195.00 ,$184.60 ,$184.60 ,$196.10 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$196.10 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$411.81 ,$221.00 ,$234.00 ,$196.10 ,$215.80 ,$206.70 ,$206.70 ,$196.10 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$260.00 ,$169.00 ,$149.50 ,$411.81 ,$221.00 ,$155.22 ,$196.10 ,$149.50 ,$196.10 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$196.10 ,$196.10 ,$195.00 ,$184.60 ,$184.60 ,$196.10 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$196.10 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$411.81 ,$221.00 ,$234.00 ,$196.10 ,$215.80 ,$206.70 ,$206.70 ,$196.10 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$260.00 ,$169.00 ,$149.50 ,$411.81 ,$221.00 ,$155.22 ,$196.10 ,$149.50 ,$196.10 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$196.10 ,$196.10 ,$195.00 ,$184.60 ,$184.60 ,$196.10 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$196.10 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$411.81 ,$221.00 ,$234.00 ,$196.10 ,$215.80 ,$206.70 ,$206.70 ,$196.10 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$260.00 ,$169.00 ,$92.32 ,$260.00 ,$221.00 ,$155.22 ,$92.32 ,$149.50 ,$92.32 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$92.32 ,$92.32 ,$195.00 ,$184.60 ,$184.60 ,$92.32 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$230.80 ,$221.00 ,$92.32 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$193.87 ,$221.00 ,$234.00 ,$92.32 ,$215.80 ,$206.70 ,$206.70 ,$92.32 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$260.00 ,$169.00 ,$92.32 ,$260.00 ,$221.00 ,$155.22 ,$92.32 ,$149.50 ,$92.32 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$92.32 ,$92.32 ,$195.00 ,$184.60 ,$184.60 ,$92.32 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$230.80 ,$221.00 ,$92.32 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$193.87 ,$221.00 ,$234.00 ,$92.32 ,$215.80 ,$206.70 ,$206.70 ,$92.32 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$260.00 ,$169.00 ,$92.32 ,$260.00 ,$221.00 ,$155.22 ,$92.32 ,$149.50 ,$92.32 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$92.32 ,$92.32 ,$195.00 ,$184.60 ,$184.60 ,$92.32 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$230.80 ,$221.00 ,$92.32 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$193.87 ,$221.00 ,$234.00 ,$92.32 ,$215.80 ,$206.70 ,$206.70 ,$92.32 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$816.00 ,$530.40 ,$305.32 ,$816.00 ,$693.60 ,$487.15 ,$305.32 ,$469.20 ,$305.32 ,$562.22 ,$693.60 ,$693.60 ,$693.60 ,$669.12 ,$554.88 ,$305.32 ,$305.32 ,$612.00 ,$579.36 ,$579.36 ,$305.32 ,$579.36 ,$677.28 ,$677.28 ,$677.28 , N/A ,$763.31 ,$693.60 ,$305.32 ,$816.00 , N/A , N/A ,$693.60 ,$641.18 ,$693.60 ,$734.40 ,$305.32 ,$677.28 ,$648.72 ,$648.72 ,$305.32 ,$530.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$816.00 ,$530.40 ,$469.20 ,"$1,224.14 ",$693.60 ,$487.15 ,$582.93 ,$469.20 ,$582.93 ,$562.22 ,$693.60 ,$693.60 ,$693.60 ,$669.12 ,$554.88 ,$582.93 ,$582.93 ,$612.00 ,$579.36 ,$579.36 ,$582.93 ,$579.36 ,$677.28 ,$677.28 ,$677.28 , N/A ,$816.00 ,$693.60 ,$582.93 ,$816.00 , N/A , N/A ,$693.60 ,"$1,224.14 ",$693.60 ,$734.40 ,$582.93 ,$677.28 ,$648.72 ,$648.72 ,$582.93 ,$530.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000004,10081,HC I AND D CYST PILONIDAL CPLX,450,1 ,"$1,748.79 ","$1,136.71 ",$582.93 ,"$1,748.79 ","$1,486.47 ","$1,044.03 ",$582.93 ,"$1,005.55 ",$582.93 ,"$1,204.92 ","$1,486.47 ","$1,486.47 ","$1,486.47 ","$1,434.01 ","$1,189.18 ",$582.93 ,$582.93 ,"$1,311.59 ","$1,241.64 ","$1,241.64 ",$582.93 ,"$1,241.64 ","$1,451.50 ","$1,451.50 ","$1,451.50 ", N/A ,"$1,457.31 ","$1,486.47 ",$582.93 ,"$1,748.79 ", N/A , N/A ,"$1,486.47 ","$1,224.14 ","$1,486.47 ","$1,573.91 ",$582.93 ,"$1,451.50 ","$1,390.29 ","$1,390.29 ",$582.93 ,"$1,136.71 "
ST. JOSEPH'S HOSPITAL - BREESE,45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$806.00 ,$523.90 ,$305.32 ,$806.00 ,$685.10 ,$481.18 ,$305.32 ,$463.45 ,$305.32 ,$555.33 ,$685.10 ,$685.10 ,$685.10 ,$660.92 ,$548.08 ,$305.32 ,$305.32 ,$604.50 ,$572.26 ,$572.26 ,$305.32 ,$572.26 ,$668.98 ,$668.98 ,$668.98 , N/A ,$763.31 ,$685.10 ,$305.32 ,$806.00 , N/A , N/A ,$685.10 ,$641.18 ,$685.10 ,$725.40 ,$305.32 ,$668.98 ,$640.77 ,$640.77 ,$305.32 ,$523.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$422.00 ,$274.30 ,$166.97 ,$422.00 ,$358.70 ,$251.93 ,$166.97 ,$242.65 ,$166.97 ,$290.76 ,$358.70 ,$358.70 ,$358.70 ,$346.04 ,$286.96 ,$166.97 ,$166.97 ,$316.50 ,$299.62 ,$299.62 ,$166.97 ,$299.62 ,$350.26 ,$350.26 ,$350.26 , N/A ,$417.43 ,$358.70 ,$166.97 ,$422.00 , N/A , N/A ,$358.70 ,$350.64 ,$358.70 ,$379.80 ,$166.97 ,$350.26 ,$335.49 ,$335.49 ,$166.97 ,$274.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000010,11732,HC AVULSION NAIL PL PT/CO EA ADDL FAC,450,1 ,$182.00 ,$118.30 ,$104.65 ,$182.00 ,$154.70 ,$108.65 , N/A ,$104.65 , N/A ,$125.40 ,$154.70 ,$154.70 ,$154.70 ,$149.24 ,$123.76 , N/A , N/A ,$136.50 ,$129.22 ,$129.22 , N/A ,$129.22 ,$151.06 ,$151.06 ,$151.06 , N/A , N/A ,$154.70 , N/A ,$182.00 , N/A , N/A ,$154.70 , N/A ,$154.70 ,$163.80 , N/A ,$151.06 ,$144.69 ,$144.69 , N/A ,$118.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$187.00 ,$121.55 ,$104.19 ,$218.80 ,$158.95 ,$111.64 ,$104.19 ,$107.53 ,$104.19 ,$128.84 ,$158.95 ,$158.95 ,$158.95 ,$153.34 ,$127.16 ,$104.19 ,$104.19 ,$140.25 ,$132.77 ,$132.77 ,$104.19 ,$132.77 ,$155.21 ,$155.21 ,$155.21 , N/A ,$187.00 ,$158.95 ,$104.19 ,$187.00 , N/A , N/A ,$158.95 ,$218.80 ,$158.95 ,$168.30 ,$104.19 ,$155.21 ,$148.67 ,$148.67 ,$104.19 ,$121.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000012,11760,HC REPAIR NAIL BED,450,1 ,"$1,440.00 ",$936.00 ,$474.95 ,"$1,440.00 ","$1,224.00 ",$859.68 ,$474.95 ,$828.00 ,$474.95 ,$992.16 ,"$1,224.00 ","$1,224.00 ","$1,224.00 ","$1,180.80 ",$979.20 ,$474.95 ,$474.95 ,"$1,080.00 ","$1,022.40 ","$1,022.40 ",$474.95 ,"$1,022.40 ","$1,195.20 ","$1,195.20 ","$1,195.20 ", N/A ,"$1,187.38 ","$1,224.00 ",$474.95 ,"$1,440.00 ", N/A , N/A ,"$1,224.00 ",$997.40 ,"$1,224.00 ","$1,296.00 ",$474.95 ,"$1,195.20 ","$1,144.80 ","$1,144.80 ",$474.95 ,$936.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,$304.00 ,$197.60 ,$174.80 ,$641.18 ,$258.40 ,$181.49 ,$305.32 ,$174.80 ,$305.32 ,$209.46 ,$258.40 ,$258.40 ,$258.40 ,$249.28 ,$206.72 ,$305.32 ,$305.32 ,$228.00 ,$215.84 ,$215.84 ,$305.32 ,$215.84 ,$252.32 ,$252.32 ,$252.32 , N/A ,$304.00 ,$258.40 ,$305.32 ,$304.00 , N/A , N/A ,$258.40 ,$641.18 ,$258.40 ,$273.60 ,$305.32 ,$252.32 ,$241.68 ,$241.68 ,$305.32 ,$197.60 
ST. JOSEPH'S HOSPITAL - BREESE,45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$306.00 ,$198.90 ,$166.97 ,$350.64 ,$260.10 ,$182.68 ,$166.97 ,$175.95 ,$166.97 ,$210.83 ,$260.10 ,$260.10 ,$260.10 ,$250.92 ,$208.08 ,$166.97 ,$166.97 ,$229.50 ,$217.26 ,$217.26 ,$166.97 ,$217.26 ,$253.98 ,$253.98 ,$253.98 , N/A ,$306.00 ,$260.10 ,$166.97 ,$306.00 , N/A , N/A ,$260.10 ,$350.64 ,$260.10 ,$275.40 ,$166.97 ,$253.98 ,$243.27 ,$243.27 ,$166.97 ,$198.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$313.00 ,$203.45 ,$166.97 ,$350.64 ,$266.05 ,$186.86 ,$166.97 ,$179.98 ,$166.97 ,$215.66 ,$266.05 ,$266.05 ,$266.05 ,$256.66 ,$212.84 ,$166.97 ,$166.97 ,$234.75 ,$222.23 ,$222.23 ,$166.97 ,$222.23 ,$259.79 ,$259.79 ,$259.79 , N/A ,$313.00 ,$266.05 ,$166.97 ,$313.00 , N/A , N/A ,$266.05 ,$350.64 ,$266.05 ,$281.70 ,$166.97 ,$259.79 ,$248.84 ,$248.84 ,$166.97 ,$203.45 
ST. JOSEPH'S HOSPITAL - BREESE,45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$317.00 ,$206.05 ,$166.97 ,$350.64 ,$269.45 ,$189.25 ,$166.97 ,$182.28 ,$166.97 ,$218.41 ,$269.45 ,$269.45 ,$269.45 ,$259.94 ,$215.56 ,$166.97 ,$166.97 ,$237.75 ,$225.07 ,$225.07 ,$166.97 ,$225.07 ,$263.11 ,$263.11 ,$263.11 , N/A ,$317.00 ,$269.45 ,$166.97 ,$317.00 , N/A , N/A ,$269.45 ,$350.64 ,$269.45 ,$285.30 ,$166.97 ,$263.11 ,$252.02 ,$252.02 ,$166.97 ,$206.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$324.00 ,$210.60 ,$186.30 ,$641.18 ,$275.40 ,$193.43 ,$305.32 ,$186.30 ,$305.32 ,$223.24 ,$275.40 ,$275.40 ,$275.40 ,$265.68 ,$220.32 ,$305.32 ,$305.32 ,$243.00 ,$230.04 ,$230.04 ,$305.32 ,$230.04 ,$268.92 ,$268.92 ,$268.92 , N/A ,$324.00 ,$275.40 ,$305.32 ,$324.00 , N/A , N/A ,$275.40 ,$641.18 ,$275.40 ,$291.60 ,$305.32 ,$268.92 ,$257.58 ,$257.58 ,$305.32 ,$210.60 
ST. JOSEPH'S HOSPITAL - BREESE,45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$329.00 ,$213.85 ,$189.18 ,$641.18 ,$279.65 ,$196.41 ,$305.32 ,$189.18 ,$305.32 ,$226.68 ,$279.65 ,$279.65 ,$279.65 ,$269.78 ,$223.72 ,$305.32 ,$305.32 ,$246.75 ,$233.59 ,$233.59 ,$305.32 ,$233.59 ,$273.07 ,$273.07 ,$273.07 , N/A ,$329.00 ,$279.65 ,$305.32 ,$329.00 , N/A , N/A ,$279.65 ,$641.18 ,$279.65 ,$296.10 ,$305.32 ,$273.07 ,$261.56 ,$261.56 ,$305.32 ,$213.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$335.00 ,$217.75 ,$166.97 ,$350.64 ,$284.75 ,$200.00 ,$166.97 ,$192.63 ,$166.97 ,$230.82 ,$284.75 ,$284.75 ,$284.75 ,$274.70 ,$227.80 ,$166.97 ,$166.97 ,$251.25 ,$237.85 ,$237.85 ,$166.97 ,$237.85 ,$278.05 ,$278.05 ,$278.05 , N/A ,$335.00 ,$284.75 ,$166.97 ,$335.00 , N/A , N/A ,$284.75 ,$350.64 ,$284.75 ,$301.50 ,$166.97 ,$278.05 ,$266.33 ,$266.33 ,$166.97 ,$217.75 
ST. JOSEPH'S HOSPITAL - BREESE,45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$306.00 ,$198.90 ,$166.97 ,$350.64 ,$260.10 ,$182.68 ,$166.97 ,$175.95 ,$166.97 ,$210.83 ,$260.10 ,$260.10 ,$260.10 ,$250.92 ,$208.08 ,$166.97 ,$166.97 ,$229.50 ,$217.26 ,$217.26 ,$166.97 ,$217.26 ,$253.98 ,$253.98 ,$253.98 , N/A ,$306.00 ,$260.10 ,$166.97 ,$306.00 , N/A , N/A ,$260.10 ,$350.64 ,$260.10 ,$275.40 ,$166.97 ,$253.98 ,$243.27 ,$243.27 ,$166.97 ,$198.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$313.00 ,$203.45 ,$166.97 ,$350.64 ,$266.05 ,$186.86 ,$166.97 ,$179.98 ,$166.97 ,$215.66 ,$266.05 ,$266.05 ,$266.05 ,$256.66 ,$212.84 ,$166.97 ,$166.97 ,$234.75 ,$222.23 ,$222.23 ,$166.97 ,$222.23 ,$259.79 ,$259.79 ,$259.79 , N/A ,$313.00 ,$266.05 ,$166.97 ,$313.00 , N/A , N/A ,$266.05 ,$350.64 ,$266.05 ,$281.70 ,$166.97 ,$259.79 ,$248.84 ,$248.84 ,$166.97 ,$203.45 
ST. JOSEPH'S HOSPITAL - BREESE,45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$317.00 ,$206.05 ,$166.97 ,$350.64 ,$269.45 ,$189.25 ,$166.97 ,$182.28 ,$166.97 ,$218.41 ,$269.45 ,$269.45 ,$269.45 ,$259.94 ,$215.56 ,$166.97 ,$166.97 ,$237.75 ,$225.07 ,$225.07 ,$166.97 ,$225.07 ,$263.11 ,$263.11 ,$263.11 , N/A ,$317.00 ,$269.45 ,$166.97 ,$317.00 , N/A , N/A ,$269.45 ,$350.64 ,$269.45 ,$285.30 ,$166.97 ,$263.11 ,$252.02 ,$252.02 ,$166.97 ,$206.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$324.00 ,$210.60 ,$166.97 ,$350.64 ,$275.40 ,$193.43 ,$166.97 ,$186.30 ,$166.97 ,$223.24 ,$275.40 ,$275.40 ,$275.40 ,$265.68 ,$220.32 ,$166.97 ,$166.97 ,$243.00 ,$230.04 ,$230.04 ,$166.97 ,$230.04 ,$268.92 ,$268.92 ,$268.92 , N/A ,$324.00 ,$275.40 ,$166.97 ,$324.00 , N/A , N/A ,$275.40 ,$350.64 ,$275.40 ,$291.60 ,$166.97 ,$268.92 ,$257.58 ,$257.58 ,$166.97 ,$210.60 
ST. JOSEPH'S HOSPITAL - BREESE,45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$329.00 ,$213.85 ,$189.18 ,$641.18 ,$279.65 ,$196.41 ,$305.32 ,$189.18 ,$305.32 ,$226.68 ,$279.65 ,$279.65 ,$279.65 ,$269.78 ,$223.72 ,$305.32 ,$305.32 ,$246.75 ,$233.59 ,$233.59 ,$305.32 ,$233.59 ,$273.07 ,$273.07 ,$273.07 , N/A ,$329.00 ,$279.65 ,$305.32 ,$329.00 , N/A , N/A ,$279.65 ,$641.18 ,$279.65 ,$296.10 ,$305.32 ,$273.07 ,$261.56 ,$261.56 ,$305.32 ,$213.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000025,12017,HC SIMP F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$335.00 ,$217.75 ,$192.63 ,$641.18 ,$284.75 ,$200.00 ,$305.32 ,$192.63 ,$305.32 ,$230.82 ,$284.75 ,$284.75 ,$284.75 ,$274.70 ,$227.80 ,$305.32 ,$305.32 ,$251.25 ,$237.85 ,$237.85 ,$305.32 ,$237.85 ,$278.05 ,$278.05 ,$278.05 , N/A ,$335.00 ,$284.75 ,$305.32 ,$335.00 , N/A , N/A ,$284.75 ,$641.18 ,$284.75 ,$301.50 ,$305.32 ,$278.05 ,$266.33 ,$266.33 ,$305.32 ,$217.75 
ST. JOSEPH'S HOSPITAL - BREESE,45000026,12018,HC SIMP F/E/E/N/L/MM OVER 30CM,450,1 ,$340.00 ,$221.00 ,$166.97 ,$350.64 ,$289.00 ,$202.98 ,$166.97 ,$195.50 ,$166.97 ,$234.26 ,$289.00 ,$289.00 ,$289.00 ,$278.80 ,$231.20 ,$166.97 ,$166.97 ,$255.00 ,$241.40 ,$241.40 ,$166.97 ,$241.40 ,$282.20 ,$282.20 ,$282.20 , N/A ,$340.00 ,$289.00 ,$166.97 ,$340.00 , N/A , N/A ,$289.00 ,$350.64 ,$289.00 ,$306.00 ,$166.97 ,$282.20 ,$270.30 ,$270.30 ,$166.97 ,$221.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$383.00 ,$248.95 ,$220.23 ,$641.18 ,$325.55 ,$228.65 ,$305.32 ,$220.23 ,$305.32 ,$263.89 ,$325.55 ,$325.55 ,$325.55 ,$314.06 ,$260.44 ,$305.32 ,$305.32 ,$287.25 ,$271.93 ,$271.93 ,$305.32 ,$271.93 ,$317.89 ,$317.89 ,$317.89 , N/A ,$383.00 ,$325.55 ,$305.32 ,$383.00 , N/A , N/A ,$325.55 ,$641.18 ,$325.55 ,$344.70 ,$305.32 ,$317.89 ,$304.49 ,$304.49 ,$305.32 ,$248.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$388.00 ,$252.20 ,$223.10 ,$641.18 ,$329.80 ,$231.64 ,$305.32 ,$223.10 ,$305.32 ,$267.33 ,$329.80 ,$329.80 ,$329.80 ,$318.16 ,$263.84 ,$305.32 ,$305.32 ,$291.00 ,$275.48 ,$275.48 ,$305.32 ,$275.48 ,$322.04 ,$322.04 ,$322.04 , N/A ,$388.00 ,$329.80 ,$305.32 ,$388.00 , N/A , N/A ,$329.80 ,$641.18 ,$329.80 ,$349.20 ,$305.32 ,$322.04 ,$308.46 ,$308.46 ,$305.32 ,$252.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$394.00 ,$256.10 ,$226.55 ,$641.18 ,$334.90 ,$235.22 ,$305.32 ,$226.55 ,$305.32 ,$271.47 ,$334.90 ,$334.90 ,$334.90 ,$323.08 ,$267.92 ,$305.32 ,$305.32 ,$295.50 ,$279.74 ,$279.74 ,$305.32 ,$279.74 ,$327.02 ,$327.02 ,$327.02 , N/A ,$394.00 ,$334.90 ,$305.32 ,$394.00 , N/A , N/A ,$334.90 ,$641.18 ,$334.90 ,$354.60 ,$305.32 ,$327.02 ,$313.23 ,$313.23 ,$305.32 ,$256.10 
ST. JOSEPH'S HOSPITAL - BREESE,45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,$399.00 ,$259.35 ,$229.43 ,$641.18 ,$339.15 ,$238.20 ,$305.32 ,$229.43 ,$305.32 ,$274.91 ,$339.15 ,$339.15 ,$339.15 ,$327.18 ,$271.32 ,$305.32 ,$305.32 ,$299.25 ,$283.29 ,$283.29 ,$305.32 ,$283.29 ,$331.17 ,$331.17 ,$331.17 , N/A ,$399.00 ,$339.15 ,$305.32 ,$399.00 , N/A , N/A ,$339.15 ,$641.18 ,$339.15 ,$359.10 ,$305.32 ,$331.17 ,$317.21 ,$317.21 ,$305.32 ,$259.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,$405.00 ,$263.25 ,$232.88 ,$997.40 ,$344.25 ,$241.79 ,$474.95 ,$232.88 ,$474.95 ,$279.05 ,$344.25 ,$344.25 ,$344.25 ,$332.10 ,$275.40 ,$474.95 ,$474.95 ,$303.75 ,$287.55 ,$287.55 ,$474.95 ,$287.55 ,$336.15 ,$336.15 ,$336.15 , N/A ,$405.00 ,$344.25 ,$474.95 ,$405.00 , N/A , N/A ,$344.25 ,$997.40 ,$344.25 ,$364.50 ,$474.95 ,$336.15 ,$321.98 ,$321.98 ,$474.95 ,$263.25 
ST. JOSEPH'S HOSPITAL - BREESE,45000034,12037,HC INTRM S/A/T/EXT OVER 30CM,450,1 ,$411.00 ,$267.15 ,$236.33 ,"$3,256.45 ",$349.35 ,$245.37 ,"$1,550.69 ",$236.33 ,"$1,550.69 ",$283.18 ,$349.35 ,$349.35 ,$349.35 ,$337.02 ,$279.48 ,"$1,550.69 ","$1,550.69 ",$308.25 ,$291.81 ,$291.81 ,"$1,550.69 ",$291.81 ,$341.13 ,$341.13 ,$341.13 , N/A ,$411.00 ,$349.35 ,"$1,550.69 ",$411.00 , N/A , N/A ,$349.35 ,"$3,256.45 ",$349.35 ,$369.90 ,"$1,550.69 ",$341.13 ,$326.75 ,$326.75 ,"$1,550.69 ",$267.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$383.00 ,$248.95 ,$220.23 ,$641.18 ,$325.55 ,$228.65 ,$305.32 ,$220.23 ,$305.32 ,$263.89 ,$325.55 ,$325.55 ,$325.55 ,$314.06 ,$260.44 ,$305.32 ,$305.32 ,$287.25 ,$271.93 ,$271.93 ,$305.32 ,$271.93 ,$317.89 ,$317.89 ,$317.89 , N/A ,$383.00 ,$325.55 ,$305.32 ,$383.00 , N/A , N/A ,$325.55 ,$641.18 ,$325.55 ,$344.70 ,$305.32 ,$317.89 ,$304.49 ,$304.49 ,$305.32 ,$248.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$388.00 ,$252.20 ,$223.10 ,$641.18 ,$329.80 ,$231.64 ,$305.32 ,$223.10 ,$305.32 ,$267.33 ,$329.80 ,$329.80 ,$329.80 ,$318.16 ,$263.84 ,$305.32 ,$305.32 ,$291.00 ,$275.48 ,$275.48 ,$305.32 ,$275.48 ,$322.04 ,$322.04 ,$322.04 , N/A ,$388.00 ,$329.80 ,$305.32 ,$388.00 , N/A , N/A ,$329.80 ,$641.18 ,$329.80 ,$349.20 ,$305.32 ,$322.04 ,$308.46 ,$308.46 ,$305.32 ,$252.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$394.00 ,$256.10 ,$226.55 ,$997.40 ,$334.90 ,$235.22 ,$474.95 ,$226.55 ,$474.95 ,$271.47 ,$334.90 ,$334.90 ,$334.90 ,$323.08 ,$267.92 ,$474.95 ,$474.95 ,$295.50 ,$279.74 ,$279.74 ,$474.95 ,$279.74 ,$327.02 ,$327.02 ,$327.02 , N/A ,$394.00 ,$334.90 ,$474.95 ,$394.00 , N/A , N/A ,$334.90 ,$997.40 ,$334.90 ,$354.60 ,$474.95 ,$327.02 ,$313.23 ,$313.23 ,$474.95 ,$256.10 
ST. JOSEPH'S HOSPITAL - BREESE,45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,$399.00 ,$259.35 ,$229.43 ,$997.40 ,$339.15 ,$238.20 ,$474.95 ,$229.43 ,$474.95 ,$274.91 ,$339.15 ,$339.15 ,$339.15 ,$327.18 ,$271.32 ,$474.95 ,$474.95 ,$299.25 ,$283.29 ,$283.29 ,$474.95 ,$283.29 ,$331.17 ,$331.17 ,$331.17 , N/A ,$399.00 ,$339.15 ,$474.95 ,$399.00 , N/A , N/A ,$339.15 ,$997.40 ,$339.15 ,$359.10 ,$474.95 ,$331.17 ,$317.21 ,$317.21 ,$474.95 ,$259.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,$405.00 ,$263.25 ,$232.88 ,$641.18 ,$344.25 ,$241.79 ,$305.32 ,$232.88 ,$305.32 ,$279.05 ,$344.25 ,$344.25 ,$344.25 ,$332.10 ,$275.40 ,$305.32 ,$305.32 ,$303.75 ,$287.55 ,$287.55 ,$305.32 ,$287.55 ,$336.15 ,$336.15 ,$336.15 , N/A ,$405.00 ,$344.25 ,$305.32 ,$405.00 , N/A , N/A ,$344.25 ,$641.18 ,$344.25 ,$364.50 ,$305.32 ,$336.15 ,$321.98 ,$321.98 ,$305.32 ,$263.25 
ST. JOSEPH'S HOSPITAL - BREESE,45000040,12047,HC INTRM N/H/F/GEN OVER 30CM,450,1 ,$411.00 ,$267.15 ,$236.33 ,"$3,256.45 ",$349.35 ,$245.37 ,"$1,550.69 ",$236.33 ,"$1,550.69 ",$283.18 ,$349.35 ,$349.35 ,$349.35 ,$337.02 ,$279.48 ,"$1,550.69 ","$1,550.69 ",$308.25 ,$291.81 ,$291.81 ,"$1,550.69 ",$291.81 ,$341.13 ,$341.13 ,$341.13 , N/A ,$411.00 ,$349.35 ,"$1,550.69 ",$411.00 , N/A , N/A ,$349.35 ,"$3,256.45 ",$349.35 ,$369.90 ,"$1,550.69 ",$341.13 ,$326.75 ,$326.75 ,"$1,550.69 ",$267.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$420.00 ,$273.00 ,$241.50 ,$641.18 ,$357.00 ,$250.74 ,$305.32 ,$241.50 ,$305.32 ,$289.38 ,$357.00 ,$357.00 ,$357.00 ,$344.40 ,$285.60 ,$305.32 ,$305.32 ,$315.00 ,$298.20 ,$298.20 ,$305.32 ,$298.20 ,$348.60 ,$348.60 ,$348.60 , N/A ,$420.00 ,$357.00 ,$305.32 ,$420.00 , N/A , N/A ,$357.00 ,$641.18 ,$357.00 ,$378.00 ,$305.32 ,$348.60 ,$333.90 ,$333.90 ,$305.32 ,$273.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$423.00 ,$274.95 ,$243.23 ,$641.18 ,$359.55 ,$252.53 ,$305.32 ,$243.23 ,$305.32 ,$291.45 ,$359.55 ,$359.55 ,$359.55 ,$346.86 ,$287.64 ,$305.32 ,$305.32 ,$317.25 ,$300.33 ,$300.33 ,$305.32 ,$300.33 ,$351.09 ,$351.09 ,$351.09 , N/A ,$423.00 ,$359.55 ,$305.32 ,$423.00 , N/A , N/A ,$359.55 ,$641.18 ,$359.55 ,$380.70 ,$305.32 ,$351.09 ,$336.29 ,$336.29 ,$305.32 ,$274.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$444.00 ,$288.60 ,$255.30 ,$641.18 ,$377.40 ,$265.07 ,$305.32 ,$255.30 ,$305.32 ,$305.92 ,$377.40 ,$377.40 ,$377.40 ,$364.08 ,$301.92 ,$305.32 ,$305.32 ,$333.00 ,$315.24 ,$315.24 ,$305.32 ,$315.24 ,$368.52 ,$368.52 ,$368.52 , N/A ,$444.00 ,$377.40 ,$305.32 ,$444.00 , N/A , N/A ,$377.40 ,$641.18 ,$377.40 ,$399.60 ,$305.32 ,$368.52 ,$352.98 ,$352.98 ,$305.32 ,$288.60 
ST. JOSEPH'S HOSPITAL - BREESE,45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,$466.00 ,$302.90 ,$267.95 ,$641.18 ,$396.10 ,$278.20 ,$305.32 ,$267.95 ,$305.32 ,$321.07 ,$396.10 ,$396.10 ,$396.10 ,$382.12 ,$316.88 ,$305.32 ,$305.32 ,$349.50 ,$330.86 ,$330.86 ,$305.32 ,$330.86 ,$386.78 ,$386.78 ,$386.78 , N/A ,$466.00 ,$396.10 ,$305.32 ,$466.00 , N/A , N/A ,$396.10 ,$641.18 ,$396.10 ,$419.40 ,$305.32 ,$386.78 ,$370.47 ,$370.47 ,$305.32 ,$302.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000045,12055,HC INTRM F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$489.00 ,$317.85 ,$281.18 ,$641.18 ,$415.65 ,$291.93 ,$305.32 ,$281.18 ,$305.32 ,$336.92 ,$415.65 ,$415.65 ,$415.65 ,$400.98 ,$332.52 ,$305.32 ,$305.32 ,$366.75 ,$347.19 ,$347.19 ,$305.32 ,$347.19 ,$405.87 ,$405.87 ,$405.87 , N/A ,$489.00 ,$415.65 ,$305.32 ,$489.00 , N/A , N/A ,$415.65 ,$641.18 ,$415.65 ,$440.10 ,$305.32 ,$405.87 ,$388.76 ,$388.76 ,$305.32 ,$317.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000046,12056,HC INTRM F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$513.00 ,$333.45 ,$294.98 ,$641.18 ,$436.05 ,$306.26 ,$305.32 ,$294.98 ,$305.32 ,$353.46 ,$436.05 ,$436.05 ,$436.05 ,$420.66 ,$348.84 ,$305.32 ,$305.32 ,$384.75 ,$364.23 ,$364.23 ,$305.32 ,$364.23 ,$425.79 ,$425.79 ,$425.79 , N/A ,$513.00 ,$436.05 ,$305.32 ,$513.00 , N/A , N/A ,$436.05 ,$641.18 ,$436.05 ,$461.70 ,$305.32 ,$425.79 ,$407.84 ,$407.84 ,$305.32 ,$333.45 
ST. JOSEPH'S HOSPITAL - BREESE,45000047,12057,HC INTRM F/E/E/N/L/MM OVER 30.0CM,450,1 ,$538.00 ,$349.70 ,$305.32 ,$641.18 ,$457.30 ,$321.19 ,$305.32 ,$309.35 ,$305.32 ,$370.68 ,$457.30 ,$457.30 ,$457.30 ,$441.16 ,$365.84 ,$305.32 ,$305.32 ,$403.50 ,$381.98 ,$381.98 ,$305.32 ,$381.98 ,$446.54 ,$446.54 ,$446.54 , N/A ,$538.00 ,$457.30 ,$305.32 ,$538.00 , N/A , N/A ,$457.30 ,$641.18 ,$457.30 ,$484.20 ,$305.32 ,$446.54 ,$427.71 ,$427.71 ,$305.32 ,$349.70 
ST. JOSEPH'S HOSPITAL - BREESE,45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,$466.00 ,$302.90 ,$267.95 ,$997.40 ,$396.10 ,$278.20 ,$474.95 ,$267.95 ,$474.95 ,$321.07 ,$396.10 ,$396.10 ,$396.10 ,$382.12 ,$316.88 ,$474.95 ,$474.95 ,$349.50 ,$330.86 ,$330.86 ,$474.95 ,$330.86 ,$386.78 ,$386.78 ,$386.78 , N/A ,$466.00 ,$396.10 ,$474.95 ,$466.00 , N/A , N/A ,$396.10 ,$997.40 ,$396.10 ,$419.40 ,$474.95 ,$386.78 ,$370.47 ,$370.47 ,$474.95 ,$302.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,$511.00 ,$332.15 ,$293.83 ,$997.40 ,$434.35 ,$305.07 ,$474.95 ,$293.83 ,$474.95 ,$352.08 ,$434.35 ,$434.35 ,$434.35 ,$419.02 ,$347.48 ,$474.95 ,$474.95 ,$383.25 ,$362.81 ,$362.81 ,$474.95 ,$362.81 ,$424.13 ,$424.13 ,$424.13 , N/A ,$511.00 ,$434.35 ,$474.95 ,$511.00 , N/A , N/A ,$434.35 ,$997.40 ,$434.35 ,$459.90 ,$474.95 ,$424.13 ,$406.25 ,$406.25 ,$474.95 ,$332.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000050,13102,HC CMPLX TRUNK EA ADDL 5 CM OR LESS,450,1 ,$466.00 ,$302.90 ,$267.95 ,$466.00 ,$396.10 ,$278.20 , N/A ,$267.95 , N/A ,$321.07 ,$396.10 ,$396.10 ,$396.10 ,$382.12 ,$316.88 , N/A , N/A ,$349.50 ,$330.86 ,$330.86 , N/A ,$330.86 ,$386.78 ,$386.78 ,$386.78 , N/A , N/A ,$396.10 , N/A ,$466.00 , N/A , N/A ,$396.10 , N/A ,$396.10 ,$419.40 , N/A ,$386.78 ,$370.47 ,$370.47 , N/A ,$302.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,$385.00 ,$250.25 ,$221.38 ,$997.40 ,$327.25 ,$229.85 ,$474.95 ,$221.38 ,$474.95 ,$265.27 ,$327.25 ,$327.25 ,$327.25 ,$315.70 ,$261.80 ,$474.95 ,$474.95 ,$288.75 ,$273.35 ,$273.35 ,$474.95 ,$273.35 ,$319.55 ,$319.55 ,$319.55 , N/A ,$385.00 ,$327.25 ,$474.95 ,$385.00 , N/A , N/A ,$327.25 ,$997.40 ,$327.25 ,$346.50 ,$474.95 ,$319.55 ,$306.08 ,$306.08 ,$474.95 ,$250.25 
ST. JOSEPH'S HOSPITAL - BREESE,45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,$423.00 ,$274.95 ,$243.23 ,$997.40 ,$359.55 ,$252.53 ,$474.95 ,$243.23 ,$474.95 ,$291.45 ,$359.55 ,$359.55 ,$359.55 ,$346.86 ,$287.64 ,$474.95 ,$474.95 ,$317.25 ,$300.33 ,$300.33 ,$474.95 ,$300.33 ,$351.09 ,$351.09 ,$351.09 , N/A ,$423.00 ,$359.55 ,$474.95 ,$423.00 , N/A , N/A ,$359.55 ,$997.40 ,$359.55 ,$380.70 ,$474.95 ,$351.09 ,$336.29 ,$336.29 ,$474.95 ,$274.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000053,13122,HC CMPLX S/A/L EA ADDL 5 CM OR LESS,450,1 ,$385.00 ,$250.25 ,$221.38 ,$385.00 ,$327.25 ,$229.85 , N/A ,$221.38 , N/A ,$265.27 ,$327.25 ,$327.25 ,$327.25 ,$315.70 ,$261.80 , N/A , N/A ,$288.75 ,$273.35 ,$273.35 , N/A ,$273.35 ,$319.55 ,$319.55 ,$319.55 , N/A , N/A ,$327.25 , N/A ,$385.00 , N/A , N/A ,$327.25 , N/A ,$327.25 ,$346.50 , N/A ,$319.55 ,$306.08 ,$306.08 , N/A ,$250.25 
ST. JOSEPH'S HOSPITAL - BREESE,45000054,13131,HC CMPLX F/C/C/M/N/A/G/H/F 1.1-2.5 CM,450,1 ,$509.00 ,$330.85 ,$292.68 ,$641.18 ,$432.65 ,$303.87 ,$305.32 ,$292.68 ,$305.32 ,$350.70 ,$432.65 ,$432.65 ,$432.65 ,$417.38 ,$346.12 ,$305.32 ,$305.32 ,$381.75 ,$361.39 ,$361.39 ,$305.32 ,$361.39 ,$422.47 ,$422.47 ,$422.47 , N/A ,$509.00 ,$432.65 ,$305.32 ,$509.00 , N/A , N/A ,$432.65 ,$641.18 ,$432.65 ,$458.10 ,$305.32 ,$422.47 ,$404.66 ,$404.66 ,$305.32 ,$330.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000055,13132,HC CMPLX F/C/C/M/N/A/G/H/F 2.6-7.5 CM,450,1 ,$560.00 ,$364.00 ,$322.00 ,$997.40 ,$476.00 ,$334.32 ,$474.95 ,$322.00 ,$474.95 ,$385.84 ,$476.00 ,$476.00 ,$476.00 ,$459.20 ,$380.80 ,$474.95 ,$474.95 ,$420.00 ,$397.60 ,$397.60 ,$474.95 ,$397.60 ,$464.80 ,$464.80 ,$464.80 , N/A ,$560.00 ,$476.00 ,$474.95 ,$560.00 , N/A , N/A ,$476.00 ,$997.40 ,$476.00 ,$504.00 ,$474.95 ,$464.80 ,$445.20 ,$445.20 ,$474.95 ,$364.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000056,13133,HC CMPLX F/C/C/M/N/A/G/H/F EA ADDL 5 CM OR LESS,450,1 ,$466.00 ,$302.90 ,$267.95 ,$466.00 ,$396.10 ,$278.20 , N/A ,$267.95 , N/A ,$321.07 ,$396.10 ,$396.10 ,$396.10 ,$382.12 ,$316.88 , N/A , N/A ,$349.50 ,$330.86 ,$330.86 , N/A ,$330.86 ,$386.78 ,$386.78 ,$386.78 , N/A , N/A ,$396.10 , N/A ,$466.00 , N/A , N/A ,$396.10 , N/A ,$396.10 ,$419.40 , N/A ,$386.78 ,$370.47 ,$370.47 , N/A ,$302.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,$511.00 ,$332.15 ,$293.83 ,$997.40 ,$434.35 ,$305.07 ,$474.95 ,$293.83 ,$474.95 ,$352.08 ,$434.35 ,$434.35 ,$434.35 ,$419.02 ,$347.48 ,$474.95 ,$474.95 ,$383.25 ,$362.81 ,$362.81 ,$474.95 ,$362.81 ,$424.13 ,$424.13 ,$424.13 , N/A ,$511.00 ,$434.35 ,$474.95 ,$511.00 , N/A , N/A ,$434.35 ,$997.40 ,$434.35 ,$459.90 ,$474.95 ,$424.13 ,$406.25 ,$406.25 ,$474.95 ,$332.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,$511.00 ,$332.15 ,$293.83 ,$997.40 ,$434.35 ,$305.07 ,$474.95 ,$293.83 ,$474.95 ,$352.08 ,$434.35 ,$434.35 ,$434.35 ,$419.02 ,$347.48 ,$474.95 ,$474.95 ,$383.25 ,$362.81 ,$362.81 ,$474.95 ,$362.81 ,$424.13 ,$424.13 ,$424.13 , N/A ,$511.00 ,$434.35 ,$474.95 ,$511.00 , N/A , N/A ,$434.35 ,$997.40 ,$434.35 ,$459.90 ,$474.95 ,$424.13 ,$406.25 ,$406.25 ,$474.95 ,$332.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000060,13153,HC CMPLX E/N/E/L EA ADDL 5 CM OR LESS,450,1 ,$466.00 ,$302.90 ,$267.95 ,$466.00 ,$396.10 ,$278.20 , N/A ,$267.95 , N/A ,$321.07 ,$396.10 ,$396.10 ,$396.10 ,$382.12 ,$316.88 , N/A , N/A ,$349.50 ,$330.86 ,$330.86 , N/A ,$330.86 ,$386.78 ,$386.78 ,$386.78 , N/A , N/A ,$396.10 , N/A ,$466.00 , N/A , N/A ,$396.10 , N/A ,$396.10 ,$419.40 , N/A ,$386.78 ,$370.47 ,$370.47 , N/A ,$302.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$386.00 ,$250.90 ,$166.97 ,$386.00 ,$328.10 ,$230.44 ,$166.97 ,$221.95 ,$166.97 ,$265.95 ,$328.10 ,$328.10 ,$328.10 ,$316.52 ,$262.48 ,$166.97 ,$166.97 ,$289.50 ,$274.06 ,$274.06 ,$166.97 ,$274.06 ,$320.38 ,$320.38 ,$320.38 , N/A ,$386.00 ,$328.10 ,$166.97 ,$386.00 , N/A , N/A ,$328.10 ,$350.64 ,$328.10 ,$347.40 ,$166.97 ,$320.38 ,$306.87 ,$306.87 ,$166.97 ,$250.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$386.00 ,$250.90 ,$166.97 ,$386.00 ,$328.10 ,$230.44 ,$166.97 ,$221.95 ,$166.97 ,$265.95 ,$328.10 ,$328.10 ,$328.10 ,$316.52 ,$262.48 ,$166.97 ,$166.97 ,$289.50 ,$274.06 ,$274.06 ,$166.97 ,$274.06 ,$320.38 ,$320.38 ,$320.38 , N/A ,$386.00 ,$328.10 ,$166.97 ,$386.00 , N/A , N/A ,$328.10 ,$350.64 ,$328.10 ,$347.40 ,$166.97 ,$320.38 ,$306.87 ,$306.87 ,$166.97 ,$250.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$406.00 ,$263.90 ,$166.97 ,$406.00 ,$345.10 ,$242.38 ,$166.97 ,$233.45 ,$166.97 ,$279.73 ,$345.10 ,$345.10 ,$345.10 ,$332.92 ,$276.08 ,$166.97 ,$166.97 ,$304.50 ,$288.26 ,$288.26 ,$166.97 ,$288.26 ,$336.98 ,$336.98 ,$336.98 , N/A ,$406.00 ,$345.10 ,$166.97 ,$406.00 , N/A , N/A ,$345.10 ,$350.64 ,$345.10 ,$365.40 ,$166.97 ,$336.98 ,$322.77 ,$322.77 ,$166.97 ,$263.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$427.00 ,$277.55 ,$245.53 ,$641.18 ,$362.95 ,$254.92 ,$305.32 ,$245.53 ,$305.32 ,$294.20 ,$362.95 ,$362.95 ,$362.95 ,$350.14 ,$290.36 ,$305.32 ,$305.32 ,$320.25 ,$303.17 ,$303.17 ,$305.32 ,$303.17 ,$354.41 ,$354.41 ,$354.41 , N/A ,$427.00 ,$362.95 ,$305.32 ,$427.00 , N/A , N/A ,$362.95 ,$641.18 ,$362.95 ,$384.30 ,$305.32 ,$354.41 ,$339.47 ,$339.47 ,$305.32 ,$277.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,$501.00 ,$325.65 ,$166.97 ,$501.00 ,$425.85 ,$299.10 ,$166.97 ,$288.08 ,$166.97 ,$345.19 ,$425.85 ,$425.85 ,$425.85 ,$410.82 ,$340.68 ,$166.97 ,$166.97 ,$375.75 ,$355.71 ,$355.71 ,$166.97 ,$355.71 ,$415.83 ,$415.83 ,$415.83 , N/A ,$417.43 ,$425.85 ,$166.97 ,$501.00 , N/A , N/A ,$425.85 ,$350.64 ,$425.85 ,$450.90 ,$166.97 ,$415.83 ,$398.30 ,$398.30 ,$166.97 ,$325.65 
ST. JOSEPH'S HOSPITAL - BREESE,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$340.00 ,$221.00 ,$195.50 ,$525.31 ,$289.00 ,$202.98 ,$250.15 ,$195.50 ,$250.15 ,$234.26 ,$289.00 ,$289.00 ,$289.00 ,$278.80 ,$231.20 ,$250.15 ,$250.15 ,$255.00 ,$241.40 ,$241.40 ,$250.15 ,$241.40 ,$282.20 ,$282.20 ,$282.20 , N/A ,$340.00 ,$289.00 ,$250.15 ,$340.00 , N/A , N/A ,$289.00 ,$525.31 ,$289.00 ,$306.00 ,$250.15 ,$282.20 ,$270.30 ,$270.30 ,$250.15 ,$221.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$511.00 ,$332.15 ,$250.15 ,$525.31 ,$434.35 ,$305.07 ,$250.15 ,$293.83 ,$250.15 ,$352.08 ,$434.35 ,$434.35 ,$434.35 ,$419.02 ,$347.48 ,$250.15 ,$250.15 ,$383.25 ,$362.81 ,$362.81 ,$250.15 ,$362.81 ,$424.13 ,$424.13 ,$424.13 , N/A ,$511.00 ,$434.35 ,$250.15 ,$511.00 , N/A , N/A ,$434.35 ,$525.31 ,$434.35 ,$459.90 ,$250.15 ,$424.13 ,$406.25 ,$406.25 ,$250.15 ,$332.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$394.00 ,$256.10 ,$226.55 ,$525.31 ,$334.90 ,$235.22 ,$250.15 ,$226.55 ,$250.15 ,$271.47 ,$334.90 ,$334.90 ,$334.90 ,$323.08 ,$267.92 ,$250.15 ,$250.15 ,$295.50 ,$279.74 ,$279.74 ,$250.15 ,$279.74 ,$327.02 ,$327.02 ,$327.02 , N/A ,$394.00 ,$334.90 ,$250.15 ,$394.00 , N/A , N/A ,$334.90 ,$525.31 ,$334.90 ,$354.60 ,$250.15 ,$327.02 ,$313.23 ,$313.23 ,$250.15 ,$256.10 
ST. JOSEPH'S HOSPITAL - BREESE,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$591.00 ,$384.15 ,$250.15 ,$591.00 ,$502.35 ,$352.83 ,$250.15 ,$339.83 ,$250.15 ,$407.20 ,$502.35 ,$502.35 ,$502.35 ,$484.62 ,$401.88 ,$250.15 ,$250.15 ,$443.25 ,$419.61 ,$419.61 ,$250.15 ,$419.61 ,$490.53 ,$490.53 ,$490.53 , N/A ,$591.00 ,$502.35 ,$250.15 ,$591.00 , N/A , N/A ,$502.35 ,$525.31 ,$502.35 ,$531.90 ,$250.15 ,$490.53 ,$469.85 ,$469.85 ,$250.15 ,$384.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$562.00 ,$365.30 ,$250.15 ,$562.00 ,$477.70 ,$335.51 ,$250.15 ,$323.15 ,$250.15 ,$387.22 ,$477.70 ,$477.70 ,$477.70 ,$460.84 ,$382.16 ,$250.15 ,$250.15 ,$421.50 ,$399.02 ,$399.02 ,$250.15 ,$399.02 ,$466.46 ,$466.46 ,$466.46 , N/A ,$562.00 ,$477.70 ,$250.15 ,$562.00 , N/A , N/A ,$477.70 ,$525.31 ,$477.70 ,$505.80 ,$250.15 ,$466.46 ,$446.79 ,$446.79 ,$250.15 ,$365.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$844.00 ,$548.60 ,$250.15 ,$844.00 ,$717.40 ,$503.87 ,$250.15 ,$485.30 ,$250.15 ,$581.52 ,$717.40 ,$717.40 ,$717.40 ,$692.08 ,$573.92 ,$250.15 ,$250.15 ,$633.00 ,$599.24 ,$599.24 ,$250.15 ,$599.24 ,$700.52 ,$700.52 ,$700.52 , N/A ,$625.37 ,$717.40 ,$250.15 ,$844.00 , N/A , N/A ,$717.40 ,$525.31 ,$717.40 ,$759.60 ,$250.15 ,$700.52 ,$670.98 ,$670.98 ,$250.15 ,$548.60 
ST. JOSEPH'S HOSPITAL - BREESE,45000073,20950,HC MONT INTST FLD PRS COMP SYNDR,450,1 ,$208.00 ,$135.20 ,$119.60 ,"$1,224.14 ",$176.80 ,$124.18 ,$582.93 ,$119.60 ,$582.93 ,$143.31 ,$176.80 ,$176.80 ,$176.80 ,$170.56 ,$141.44 ,$582.93 ,$582.93 ,$156.00 ,$147.68 ,$147.68 ,$582.93 ,$147.68 ,$172.64 ,$172.64 ,$172.64 , N/A ,$208.00 ,$176.80 ,$582.93 ,$208.00 , N/A , N/A ,$176.80 ,"$1,224.14 ",$176.80 ,$187.20 ,$582.93 ,$172.64 ,$165.36 ,$165.36 ,$582.93 ,$135.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,$330.00 ,$214.50 ,$189.75 ,$432.74 ,$280.50 ,$197.01 ,$206.07 ,$189.75 ,$206.07 ,$227.37 ,$280.50 ,$280.50 ,$280.50 ,$270.60 ,$224.40 ,$206.07 ,$206.07 ,$247.50 ,$234.30 ,$234.30 ,$206.07 ,$234.30 ,$273.90 ,$273.90 ,$273.90 , N/A ,$330.00 ,$280.50 ,$206.07 ,$330.00 , N/A , N/A ,$280.50 ,$432.74 ,$280.50 ,$297.00 ,$206.07 ,$273.90 ,$262.35 ,$262.35 ,$206.07 ,$214.50 
ST. JOSEPH'S HOSPITAL - BREESE,45000075,23655,HC TX DISL SHLDR W/MAN/ANES CLS,450,1 ,"$1,297.00 ",$843.05 ,$745.78 ,"$2,719.94 ","$1,102.45 ",$774.31 ,"$1,295.21 ",$745.78 ,"$1,295.21 ",$893.63 ,"$1,102.45 ","$1,102.45 ","$1,102.45 ","$1,063.54 ",$881.96 ,"$1,295.21 ","$1,295.21 ",$972.75 ,$920.87 ,$920.87 ,"$1,295.21 ",$920.87 ,"$1,076.51 ","$1,076.51 ","$1,076.51 ", N/A ,"$1,297.00 ","$1,102.45 ","$1,295.21 ","$1,297.00 ", N/A , N/A ,"$1,102.45 ","$2,719.94 ","$1,102.45 ","$1,167.30 ","$1,295.21 ","$1,076.51 ","$1,031.12 ","$1,031.12 ","$1,295.21 ",$843.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$491.00 ,$319.15 ,$206.07 ,$491.00 ,$417.35 ,$293.13 ,$206.07 ,$282.33 ,$206.07 ,$338.30 ,$417.35 ,$417.35 ,$417.35 ,$402.62 ,$333.88 ,$206.07 ,$206.07 ,$368.25 ,$348.61 ,$348.61 ,$206.07 ,$348.61 ,$407.53 ,$407.53 ,$407.53 , N/A ,$491.00 ,$417.35 ,$206.07 ,$491.00 , N/A , N/A ,$417.35 ,$432.74 ,$417.35 ,$441.90 ,$206.07 ,$407.53 ,$390.35 ,$390.35 ,$206.07 ,$319.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$737.00 ,$479.05 ,$206.07 ,$737.00 ,$626.45 ,$439.99 ,$206.07 ,$423.78 ,$206.07 ,$507.79 ,$626.45 ,$626.45 ,$626.45 ,$604.34 ,$501.16 ,$206.07 ,$206.07 ,$552.75 ,$523.27 ,$523.27 ,$206.07 ,$523.27 ,$611.71 ,$611.71 ,$611.71 , N/A ,$515.16 ,$626.45 ,$206.07 ,$737.00 , N/A , N/A ,$626.45 ,$432.74 ,$626.45 ,$663.30 ,$206.07 ,$611.71 ,$585.92 ,$585.92 ,$206.07 ,$479.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$276.00 ,$179.40 ,$158.70 ,$432.74 ,$234.60 ,$164.77 ,$206.07 ,$158.70 ,$206.07 ,$190.16 ,$234.60 ,$234.60 ,$234.60 ,$226.32 ,$187.68 ,$206.07 ,$206.07 ,$207.00 ,$195.96 ,$195.96 ,$206.07 ,$195.96 ,$229.08 ,$229.08 ,$229.08 , N/A ,$276.00 ,$234.60 ,$206.07 ,$276.00 , N/A , N/A ,$234.60 ,$432.74 ,$234.60 ,$248.40 ,$206.07 ,$229.08 ,$219.42 ,$219.42 ,$206.07 ,$179.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$414.00 ,$269.10 ,$206.07 ,$432.74 ,$351.90 ,$247.16 ,$206.07 ,$238.05 ,$206.07 ,$285.25 ,$351.90 ,$351.90 ,$351.90 ,$339.48 ,$281.52 ,$206.07 ,$206.07 ,$310.50 ,$293.94 ,$293.94 ,$206.07 ,$293.94 ,$343.62 ,$343.62 ,$343.62 , N/A ,$414.00 ,$351.90 ,$206.07 ,$414.00 , N/A , N/A ,$351.90 ,$432.74 ,$351.90 ,$372.60 ,$206.07 ,$343.62 ,$329.13 ,$329.13 ,$206.07 ,$269.10 
ST. JOSEPH'S HOSPITAL - BREESE,45000081,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP,450,1 ,"$3,918.00 ","$2,546.70 ","$1,295.21 ","$3,918.00 ","$3,330.30 ","$2,339.05 ","$1,295.21 ","$2,252.85 ","$1,295.21 ","$2,699.50 ","$3,330.30 ","$3,330.30 ","$3,330.30 ","$3,212.76 ","$2,664.24 ","$1,295.21 ","$1,295.21 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,295.21 ","$2,781.78 ","$3,251.94 ","$3,251.94 ","$3,251.94 ", N/A ,"$3,238.03 ","$3,330.30 ","$1,295.21 ","$3,918.00 ", N/A , N/A ,"$3,330.30 ","$2,719.94 ","$3,330.30 ","$3,526.20 ","$1,295.21 ","$3,251.94 ","$3,114.81 ","$3,114.81 ","$1,295.21 ","$2,546.70 "
ST. JOSEPH'S HOSPITAL - BREESE,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$553.00 ,$359.45 ,$317.98 ,"$2,719.94 ",$470.05 ,$330.14 ,"$1,295.21 ",$317.98 ,"$1,295.21 ",$381.02 ,$470.05 ,$470.05 ,$470.05 ,$453.46 ,$376.04 ,"$1,295.21 ","$1,295.21 ",$414.75 ,$392.63 ,$392.63 ,"$1,295.21 ",$392.63 ,$458.99 ,$458.99 ,$458.99 , N/A ,$553.00 ,$470.05 ,"$1,295.21 ",$553.00 , N/A , N/A ,$470.05 ,"$2,719.94 ",$470.05 ,$497.70 ,"$1,295.21 ",$458.99 ,$439.64 ,$439.64 ,"$1,295.21 ",$359.45 
ST. JOSEPH'S HOSPITAL - BREESE,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$829.00 ,$538.85 ,$476.68 ,"$2,719.94 ",$704.65 ,$494.91 ,"$1,295.21 ",$476.68 ,"$1,295.21 ",$571.18 ,$704.65 ,$704.65 ,$704.65 ,$679.78 ,$563.72 ,"$1,295.21 ","$1,295.21 ",$621.75 ,$588.59 ,$588.59 ,"$1,295.21 ",$588.59 ,$688.07 ,$688.07 ,$688.07 , N/A ,$829.00 ,$704.65 ,"$1,295.21 ",$829.00 , N/A , N/A ,$704.65 ,"$2,719.94 ",$704.65 ,$746.10 ,"$1,295.21 ",$688.07 ,$659.06 ,$659.06 ,"$1,295.21 ",$538.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000087,26725,HC TX FX PHALANX PROX W/MAN CLS,450,1 ,$848.00 ,$551.20 ,$206.07 ,$848.00 ,$720.80 ,$506.26 ,$206.07 ,$487.60 ,$206.07 ,$584.27 ,$720.80 ,$720.80 ,$720.80 ,$695.36 ,$576.64 ,$206.07 ,$206.07 ,$636.00 ,$602.08 ,$602.08 ,$206.07 ,$602.08 ,$703.84 ,$703.84 ,$703.84 , N/A ,$515.16 ,$720.80 ,$206.07 ,$848.00 , N/A , N/A ,$720.80 ,$432.74 ,$720.80 ,$763.20 ,$206.07 ,$703.84 ,$674.16 ,$674.16 ,$206.07 ,$551.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000088,26742,HC TX FX (M-P)(I-P) JT W/MAN,450,1 ,"$3,918.00 ","$2,546.70 ","$1,295.21 ","$3,918.00 ","$3,330.30 ","$2,339.05 ","$1,295.21 ","$2,252.85 ","$1,295.21 ","$2,699.50 ","$3,330.30 ","$3,330.30 ","$3,330.30 ","$3,212.76 ","$2,664.24 ","$1,295.21 ","$1,295.21 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,295.21 ","$2,781.78 ","$3,251.94 ","$3,251.94 ","$3,251.94 ", N/A ,"$3,238.03 ","$3,330.30 ","$1,295.21 ","$3,918.00 ", N/A , N/A ,"$3,330.30 ","$2,719.94 ","$3,330.30 ","$3,526.20 ","$1,295.21 ","$3,251.94 ","$3,114.81 ","$3,114.81 ","$1,295.21 ","$2,546.70 "
ST. JOSEPH'S HOSPITAL - BREESE,45000089,26755,HC TX FX PHALANX DIST W/MAN CLS,450,1 ,$848.00 ,$551.20 ,$206.07 ,$848.00 ,$720.80 ,$506.26 ,$206.07 ,$487.60 ,$206.07 ,$584.27 ,$720.80 ,$720.80 ,$720.80 ,$695.36 ,$576.64 ,$206.07 ,$206.07 ,$636.00 ,$602.08 ,$602.08 ,$206.07 ,$602.08 ,$703.84 ,$703.84 ,$703.84 , N/A ,$515.16 ,$720.80 ,$206.07 ,$848.00 , N/A , N/A ,$720.80 ,$432.74 ,$720.80 ,$763.20 ,$206.07 ,$703.84 ,$674.16 ,$674.16 ,$206.07 ,$551.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$649.00 ,$421.85 ,$206.07 ,$649.00 ,$551.65 ,$387.45 ,$206.07 ,$373.18 ,$206.07 ,$447.16 ,$551.65 ,$551.65 ,$551.65 ,$532.18 ,$441.32 ,$206.07 ,$206.07 ,$486.75 ,$460.79 ,$460.79 ,$206.07 ,$460.79 ,$538.67 ,$538.67 ,$538.67 , N/A ,$515.16 ,$551.65 ,$206.07 ,$649.00 , N/A , N/A ,$551.65 ,$432.74 ,$551.65 ,$584.10 ,$206.07 ,$538.67 ,$515.96 ,$515.96 ,$206.07 ,$421.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$7,847.73 ","$5,101.02 ","$2,615.91 ","$7,847.73 ","$5,213.00 ","$4,685.09 ","$2,615.91 ","$4,512.44 ","$2,615.91 ","$5,407.09 ","$6,670.57 ","$6,670.57 ","$6,670.57 ","$4,769.00 ","$5,336.46 ","$2,615.91 ","$2,615.91 ","$5,885.80 ","$5,571.89 ","$5,571.89 ","$2,615.91 ","$5,571.89 ","$6,513.62 ","$6,513.62 ","$6,513.62 ", N/A ,"$6,539.77 ","$6,670.57 ","$2,615.91 ","$7,847.73 ", N/A , N/A ,"$6,670.57 ","$5,493.41 ","$6,670.57 ","$7,062.96 ","$2,615.91 ","$6,513.62 ","$6,238.95 ","$6,238.95 ","$2,615.91 ","$5,101.02 "
ST. JOSEPH'S HOSPITAL - BREESE,45000092,27250,HC TX DISCL HIP CLOSED W/O ANES,450,1 ,$616.00 ,$400.40 ,$206.07 ,$616.00 ,$523.60 ,$367.75 ,$206.07 ,$354.20 ,$206.07 ,$424.42 ,$523.60 ,$523.60 ,$523.60 ,$505.12 ,$418.88 ,$206.07 ,$206.07 ,$462.00 ,$437.36 ,$437.36 ,$206.07 ,$437.36 ,$511.28 ,$511.28 ,$511.28 , N/A ,$515.16 ,$523.60 ,$206.07 ,$616.00 , N/A , N/A ,$523.60 ,$432.74 ,$523.60 ,$554.40 ,$206.07 ,$511.28 ,$489.72 ,$489.72 ,$206.07 ,$400.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$941.00 ,$611.65 ,$206.07 ,$941.00 ,$799.85 ,$561.78 ,$206.07 ,$541.08 ,$206.07 ,$648.35 ,$799.85 ,$799.85 ,$799.85 ,$771.62 ,$639.88 ,$206.07 ,$206.07 ,$705.75 ,$668.11 ,$668.11 ,$206.07 ,$668.11 ,$781.03 ,$781.03 ,$781.03 , N/A ,$515.16 ,$799.85 ,$206.07 ,$941.00 , N/A , N/A ,$799.85 ,$432.74 ,$799.85 ,$846.90 ,$206.07 ,$781.03 ,$748.10 ,$748.10 ,$206.07 ,$611.65 
ST. JOSEPH'S HOSPITAL - BREESE,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$356.00 ,$231.40 ,$204.70 ,$432.74 ,$302.60 ,$212.53 ,$206.07 ,$204.70 ,$206.07 ,$245.28 ,$302.60 ,$302.60 ,$302.60 ,$291.92 ,$242.08 ,$206.07 ,$206.07 ,$267.00 ,$252.76 ,$252.76 ,$206.07 ,$252.76 ,$295.48 ,$295.48 ,$295.48 , N/A ,$356.00 ,$302.60 ,$206.07 ,$356.00 , N/A , N/A ,$302.60 ,$432.74 ,$302.60 ,$320.40 ,$206.07 ,$295.48 ,$283.02 ,$283.02 ,$206.07 ,$231.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$536.00 ,$348.40 ,$206.07 ,$536.00 ,$455.60 ,$319.99 ,$206.07 ,$308.20 ,$206.07 ,$369.30 ,$455.60 ,$455.60 ,$455.60 ,$439.52 ,$364.48 ,$206.07 ,$206.07 ,$402.00 ,$380.56 ,$380.56 ,$206.07 ,$380.56 ,$444.88 ,$444.88 ,$444.88 , N/A ,$515.16 ,$455.60 ,$206.07 ,$536.00 , N/A , N/A ,$455.60 ,$432.74 ,$455.60 ,$482.40 ,$206.07 ,$444.88 ,$426.12 ,$426.12 ,$206.07 ,$348.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000098,29065,HC APPL CAST ARM LONG,450,1 ,$743.00 ,$482.95 ,$219.62 ,$743.00 ,$631.55 ,$443.57 ,$219.62 ,$427.23 ,$219.62 ,$511.93 ,$631.55 ,$631.55 ,$631.55 ,$609.26 ,$505.24 ,$219.62 ,$219.62 ,$557.25 ,$527.53 ,$527.53 ,$219.62 ,$527.53 ,$616.69 ,$616.69 ,$616.69 , N/A ,$549.04 ,$631.55 ,$219.62 ,$743.00 , N/A , N/A ,$631.55 ,$461.19 ,$631.55 ,$668.70 ,$219.62 ,$616.69 ,$590.69 ,$590.69 ,$219.62 ,$482.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,$743.00 ,$482.95 ,$219.62 ,$743.00 ,$631.55 ,$443.57 ,$219.62 ,$427.23 ,$219.62 ,$511.93 ,$631.55 ,$631.55 ,$631.55 ,$609.26 ,$505.24 ,$219.62 ,$219.62 ,$557.25 ,$527.53 ,$527.53 ,$219.62 ,$527.53 ,$616.69 ,$616.69 ,$616.69 , N/A ,$549.04 ,$631.55 ,$219.62 ,$743.00 , N/A , N/A ,$631.55 ,$461.19 ,$631.55 ,$668.70 ,$219.62 ,$616.69 ,$590.69 ,$590.69 ,$219.62 ,$482.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$427.00 ,$277.55 ,$127.80 ,$427.00 ,$362.95 ,$254.92 ,$127.80 ,$245.53 ,$127.80 ,$294.20 ,$362.95 ,$362.95 ,$362.95 ,$350.14 ,$290.36 ,$127.80 ,$127.80 ,$320.25 ,$303.17 ,$303.17 ,$127.80 ,$303.17 ,$354.41 ,$354.41 ,$354.41 , N/A ,$319.50 ,$362.95 ,$127.80 ,$427.00 , N/A , N/A ,$362.95 ,$268.38 ,$362.95 ,$384.30 ,$127.80 ,$354.41 ,$339.47 ,$339.47 ,$127.80 ,$277.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$327.00 ,$212.55 ,$104.19 ,$327.00 ,$277.95 ,$195.22 ,$104.19 ,$188.03 ,$104.19 ,$225.30 ,$277.95 ,$277.95 ,$277.95 ,$268.14 ,$222.36 ,$104.19 ,$104.19 ,$245.25 ,$232.17 ,$232.17 ,$104.19 ,$232.17 ,$271.41 ,$271.41 ,$271.41 , N/A ,$260.47 ,$277.95 ,$104.19 ,$327.00 , N/A , N/A ,$277.95 ,$218.80 ,$277.95 ,$294.30 ,$104.19 ,$271.41 ,$259.97 ,$259.97 ,$104.19 ,$212.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$189.00 ,$122.85 ,$104.19 ,$218.80 ,$160.65 ,$112.83 ,$104.19 ,$108.68 ,$104.19 ,$130.22 ,$160.65 ,$160.65 ,$160.65 ,$154.98 ,$128.52 ,$104.19 ,$104.19 ,$141.75 ,$134.19 ,$134.19 ,$104.19 ,$134.19 ,$156.87 ,$156.87 ,$156.87 , N/A ,$189.00 ,$160.65 ,$104.19 ,$189.00 , N/A , N/A ,$160.65 ,$218.80 ,$160.65 ,$170.10 ,$104.19 ,$156.87 ,$150.26 ,$150.26 ,$104.19 ,$122.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$200.00 ,$130.00 ,$52.57 ,$200.00 ,$170.00 ,$119.40 ,$52.57 ,$115.00 ,$52.57 ,$137.80 ,$170.00 ,$170.00 ,$170.00 ,$164.00 ,$136.00 ,$52.57 ,$52.57 ,$150.00 ,$142.00 ,$142.00 ,$52.57 ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A ,$131.42 ,$170.00 ,$52.57 ,$200.00 , N/A , N/A ,$170.00 ,$110.39 ,$170.00 ,$180.00 ,$52.57 ,$166.00 ,$159.00 ,$159.00 ,$52.57 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000105,29240,HC STRAPPING SHLDR,450,1 ,$200.00 ,$130.00 ,$104.19 ,$218.80 ,$170.00 ,$119.40 ,$104.19 ,$115.00 ,$104.19 ,$137.80 ,$170.00 ,$170.00 ,$170.00 ,$164.00 ,$136.00 ,$104.19 ,$104.19 ,$150.00 ,$142.00 ,$142.00 ,$104.19 ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A ,$200.00 ,$170.00 ,$104.19 ,$200.00 , N/A , N/A ,$170.00 ,$218.80 ,$170.00 ,$180.00 ,$104.19 ,$166.00 ,$159.00 ,$159.00 ,$104.19 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$743.00 ,$482.95 ,$219.62 ,$743.00 ,$631.55 ,$443.57 ,$219.62 ,$427.23 ,$219.62 ,$511.93 ,$631.55 ,$631.55 ,$631.55 ,$609.26 ,$505.24 ,$219.62 ,$219.62 ,$557.25 ,$527.53 ,$527.53 ,$219.62 ,$527.53 ,$616.69 ,$616.69 ,$616.69 , N/A ,$549.04 ,$631.55 ,$219.62 ,$743.00 , N/A , N/A ,$631.55 ,$461.19 ,$631.55 ,$668.70 ,$219.62 ,$616.69 ,$590.69 ,$590.69 ,$219.62 ,$482.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$427.00 ,$277.55 ,$127.80 ,$427.00 ,$362.95 ,$254.92 ,$127.80 ,$245.53 ,$127.80 ,$294.20 ,$362.95 ,$362.95 ,$362.95 ,$350.14 ,$290.36 ,$127.80 ,$127.80 ,$320.25 ,$303.17 ,$303.17 ,$127.80 ,$303.17 ,$354.41 ,$354.41 ,$354.41 , N/A ,$319.50 ,$362.95 ,$127.80 ,$427.00 , N/A , N/A ,$362.95 ,$268.38 ,$362.95 ,$384.30 ,$127.80 ,$354.41 ,$339.47 ,$339.47 ,$127.80 ,$277.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$427.00 ,$277.55 ,$127.80 ,$427.00 ,$362.95 ,$254.92 ,$127.80 ,$245.53 ,$127.80 ,$294.20 ,$362.95 ,$362.95 ,$362.95 ,$350.14 ,$290.36 ,$127.80 ,$127.80 ,$320.25 ,$303.17 ,$303.17 ,$127.80 ,$303.17 ,$354.41 ,$354.41 ,$354.41 , N/A ,$319.50 ,$362.95 ,$127.80 ,$427.00 , N/A , N/A ,$362.95 ,$268.38 ,$362.95 ,$384.30 ,$127.80 ,$354.41 ,$339.47 ,$339.47 ,$127.80 ,$277.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000110,30300,HC REM FB INTRANASAL,450,1 ,$327.00 ,$212.55 ,$104.19 ,$327.00 ,$277.95 ,$195.22 ,$104.19 ,$188.03 ,$104.19 ,$225.30 ,$277.95 ,$277.95 ,$277.95 ,$268.14 ,$222.36 ,$104.19 ,$104.19 ,$245.25 ,$232.17 ,$232.17 ,$104.19 ,$232.17 ,$271.41 ,$271.41 ,$271.41 , N/A ,$260.47 ,$277.95 ,$104.19 ,$327.00 , N/A , N/A ,$277.95 ,$218.80 ,$277.95 ,$294.30 ,$104.19 ,$271.41 ,$259.97 ,$259.97 ,$104.19 ,$212.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$327.00 ,$212.55 ,$104.19 ,$327.00 ,$277.95 ,$195.22 ,$104.19 ,$188.03 ,$104.19 ,$225.30 ,$277.95 ,$277.95 ,$277.95 ,$268.14 ,$222.36 ,$104.19 ,$104.19 ,$245.25 ,$232.17 ,$232.17 ,$104.19 ,$232.17 ,$271.41 ,$271.41 ,$271.41 , N/A ,$260.47 ,$277.95 ,$104.19 ,$327.00 , N/A , N/A ,$277.95 ,$218.80 ,$277.95 ,$294.30 ,$104.19 ,$271.41 ,$259.97 ,$259.97 ,$104.19 ,$212.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$490.00 ,$318.50 ,$104.19 ,$490.00 ,$416.50 ,$292.53 ,$104.19 ,$281.75 ,$104.19 ,$337.61 ,$416.50 ,$416.50 ,$416.50 ,$401.80 ,$333.20 ,$104.19 ,$104.19 ,$367.50 ,$347.90 ,$347.90 ,$104.19 ,$347.90 ,$406.70 ,$406.70 ,$406.70 , N/A ,$260.47 ,$416.50 ,$104.19 ,$490.00 , N/A , N/A ,$416.50 ,$218.80 ,$416.50 ,$441.00 ,$104.19 ,$406.70 ,$389.55 ,$389.55 ,$104.19 ,$318.50 
ST. JOSEPH'S HOSPITAL - BREESE,45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$462.00 ,$300.30 ,$104.19 ,$462.00 ,$392.70 ,$275.81 ,$104.19 ,$265.65 ,$104.19 ,$318.32 ,$392.70 ,$392.70 ,$392.70 ,$378.84 ,$314.16 ,$104.19 ,$104.19 ,$346.50 ,$328.02 ,$328.02 ,$104.19 ,$328.02 ,$383.46 ,$383.46 ,$383.46 , N/A ,$260.47 ,$392.70 ,$104.19 ,$462.00 , N/A , N/A ,$392.70 ,$218.80 ,$392.70 ,$415.80 ,$104.19 ,$383.46 ,$367.29 ,$367.29 ,$104.19 ,$300.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000136,40800,HC DRAINAGE MOUTH LESION,450,1 ,"$1,748.79 ","$1,136.71 ",$582.93 ,"$1,748.79 ","$1,486.47 ","$1,044.03 ",$582.93 ,"$1,005.55 ",$582.93 ,"$1,204.92 ","$1,486.47 ","$1,486.47 ","$1,486.47 ","$1,434.01 ","$1,189.18 ",$582.93 ,$582.93 ,"$1,311.59 ","$1,241.64 ","$1,241.64 ",$582.93 ,"$1,241.64 ","$1,451.50 ","$1,451.50 ","$1,451.50 ", N/A ,"$1,457.31 ","$1,486.47 ",$582.93 ,"$1,748.79 ", N/A , N/A ,"$1,486.47 ","$1,224.14 ","$1,486.47 ","$1,573.91 ",$582.93 ,"$1,451.50 ","$1,390.29 ","$1,390.29 ",$582.93 ,"$1,136.71 "
ST. JOSEPH'S HOSPITAL - BREESE,45000137,40830,HC LAC REPAIR VESTIBULE MOUTH 2.5 CM OR LESS,450,1 ,$583.80 ,$379.47 ,$194.60 ,$583.80 ,$496.23 ,$348.53 ,$194.60 ,$335.69 ,$194.60 ,$402.24 ,$496.23 ,$496.23 ,$496.23 ,$478.72 ,$396.98 ,$194.60 ,$194.60 ,$437.85 ,$414.50 ,$414.50 ,$194.60 ,$414.50 ,$484.55 ,$484.55 ,$484.55 , N/A ,$486.50 ,$496.23 ,$194.60 ,$583.80 , N/A , N/A ,$496.23 ,$408.66 ,$496.23 ,$525.42 ,$194.60 ,$484.55 ,$464.12 ,$464.12 ,$194.60 ,$379.47 
ST. JOSEPH'S HOSPITAL - BREESE,45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$283.00 ,$183.95 ,$104.19 ,$283.00 ,$240.55 ,$168.95 ,$104.19 ,$162.73 ,$104.19 ,$194.99 ,$240.55 ,$240.55 ,$240.55 ,$232.06 ,$192.44 ,$104.19 ,$104.19 ,$212.25 ,$200.93 ,$200.93 ,$104.19 ,$200.93 ,$234.89 ,$234.89 ,$234.89 , N/A ,$260.47 ,$240.55 ,$104.19 ,$283.00 , N/A , N/A ,$240.55 ,$218.80 ,$240.55 ,$254.70 ,$104.19 ,$234.89 ,$224.99 ,$224.99 ,$104.19 ,$183.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$319.00 ,$207.35 ,$104.19 ,$319.00 ,$271.15 ,$190.44 ,$104.19 ,$183.43 ,$104.19 ,$219.79 ,$271.15 ,$271.15 ,$271.15 ,$261.58 ,$216.92 ,$104.19 ,$104.19 ,$239.25 ,$226.49 ,$226.49 ,$104.19 ,$226.49 ,$264.77 ,$264.77 ,$264.77 , N/A ,$260.47 ,$271.15 ,$104.19 ,$319.00 , N/A , N/A ,$271.15 ,$218.80 ,$271.15 ,$287.10 ,$104.19 ,$264.77 ,$253.61 ,$253.61 ,$104.19 ,$207.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$2,115.00 ","$1,374.75 ",$729.96 ,"$2,115.00 ","$1,797.75 ","$1,262.66 ",$729.96 ,"$1,216.13 ",$729.96 ,"$1,457.24 ","$1,797.75 ","$1,797.75 ","$1,797.75 ","$1,734.30 ","$1,438.20 ",$729.96 ,$729.96 ,"$1,586.25 ","$1,501.65 ","$1,501.65 ",$729.96 ,"$1,501.65 ","$1,755.45 ","$1,755.45 ","$1,755.45 ", N/A ,"$1,824.91 ","$1,797.75 ",$729.96 ,"$2,115.00 ", N/A , N/A ,"$1,797.75 ","$1,532.92 ","$1,797.75 ","$1,903.50 ",$729.96 ,"$1,755.45 ","$1,681.43 ","$1,681.43 ",$729.96 ,"$1,374.75 "
ST. JOSEPH'S HOSPITAL - BREESE,45000149,46320,HC EXCISION THROMBOSED HEMORRHOID; EXTERNAL,450,1 ,"$5,584.00 ","$3,629.60 ",$959.63 ,"$5,584.00 ","$4,746.40 ","$3,333.65 ",$959.63 ,"$3,210.80 ",$959.63 ,"$3,847.38 ","$4,746.40 ","$4,746.40 ","$4,746.40 ","$4,578.88 ","$3,797.12 ",$959.63 ,$959.63 ,"$4,188.00 ","$3,964.64 ","$3,964.64 ",$959.63 ,"$3,964.64 ","$4,634.72 ","$4,634.72 ","$4,634.72 ", N/A ,"$2,399.08 ","$4,746.40 ",$959.63 ,"$5,584.00 ", N/A , N/A ,"$4,746.40 ","$2,015.23 ","$4,746.40 ","$5,025.60 ",$959.63 ,"$4,634.72 ","$4,439.28 ","$4,439.28 ",$959.63 ,"$3,629.60 "
ST. JOSEPH'S HOSPITAL - BREESE,45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$430.00 ,$279.50 ,$224.47 ,$471.39 ,$365.50 ,$256.71 ,$224.47 ,$247.25 ,$224.47 ,$296.27 ,$365.50 ,$365.50 ,$365.50 ,$352.60 ,$292.40 ,$224.47 ,$224.47 ,$322.50 ,$305.30 ,$305.30 ,$224.47 ,$305.30 ,$356.90 ,$356.90 ,$356.90 , N/A ,$430.00 ,$365.50 ,$224.47 ,$430.00 , N/A , N/A ,$365.50 ,$471.39 ,$365.50 ,$387.00 ,$224.47 ,$356.90 ,$341.85 ,$341.85 ,$224.47 ,$279.50 
ST. JOSEPH'S HOSPITAL - BREESE,45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,$657.00 ,$427.05 ,$224.47 ,$657.00 ,$558.45 ,$392.23 ,$224.47 ,$377.78 ,$224.47 ,$452.67 ,$558.45 ,$558.45 ,$558.45 ,$538.74 ,$446.76 ,$224.47 ,$224.47 ,$492.75 ,$466.47 ,$466.47 ,$224.47 ,$466.47 ,$545.31 ,$545.31 ,$545.31 , N/A ,$561.18 ,$558.45 ,$224.47 ,$657.00 , N/A , N/A ,$558.45 ,$471.39 ,$558.45 ,$591.30 ,$224.47 ,$545.31 ,$522.32 ,$522.32 ,$224.47 ,$427.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000161,54700,HC I AND D EPIDIDYMIS TESTIS OR SCROTAL SPACE,450,1 ,"$5,078.67 ","$3,301.14 ","$1,692.89 ","$5,078.67 ","$4,316.87 ","$3,031.97 ","$1,692.89 ","$2,920.24 ","$1,692.89 ","$3,499.20 ","$4,316.87 ","$4,316.87 ","$4,316.87 ","$4,164.51 ","$3,453.50 ","$1,692.89 ","$1,692.89 ","$3,809.00 ","$3,605.86 ","$3,605.86 ","$1,692.89 ","$3,605.86 ","$4,215.30 ","$4,215.30 ","$4,215.30 ", N/A ,"$4,232.23 ","$4,316.87 ","$1,692.89 ","$5,078.67 ", N/A , N/A ,"$4,316.87 ","$3,555.08 ","$4,316.87 ","$4,570.80 ","$1,692.89 ","$4,215.30 ","$4,037.54 ","$4,037.54 ","$1,692.89 ","$3,301.14 "
ST. JOSEPH'S HOSPITAL - BREESE,45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$146.00 ,$94.90 ,$83.95 ,$543.27 ,$124.10 ,$87.16 ,$258.70 ,$83.95 ,$258.70 ,$100.59 ,$124.10 ,$124.10 ,$124.10 ,$119.72 ,$99.28 ,$258.70 ,$258.70 ,$109.50 ,$103.66 ,$103.66 ,$258.70 ,$103.66 ,$121.18 ,$121.18 ,$121.18 , N/A ,$146.00 ,$124.10 ,$258.70 ,$146.00 , N/A , N/A ,$124.10 ,$543.27 ,$124.10 ,$131.40 ,$258.70 ,$121.18 ,$116.07 ,$116.07 ,$258.70 ,$94.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$393.00 ,$255.45 ,$158.68 ,$393.00 ,$334.05 ,$234.62 ,$158.68 ,$225.98 ,$158.68 ,$270.78 ,$334.05 ,$334.05 ,$334.05 ,$322.26 ,$267.24 ,$158.68 ,$158.68 ,$294.75 ,$279.03 ,$279.03 ,$158.68 ,$279.03 ,$326.19 ,$326.19 ,$326.19 , N/A ,$393.00 ,$334.05 ,$158.68 ,$393.00 , N/A , N/A ,$334.05 ,$333.22 ,$334.05 ,$353.70 ,$158.68 ,$326.19 ,$312.44 ,$312.44 ,$158.68 ,$255.45 
ST. JOSEPH'S HOSPITAL - BREESE,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$327.00 ,$212.55 ,$188.03 ,$525.31 ,$277.95 ,$195.22 ,$250.15 ,$188.03 ,$250.15 ,$225.30 ,$277.95 ,$277.95 ,$277.95 ,$268.14 ,$222.36 ,$250.15 ,$250.15 ,$245.25 ,$232.17 ,$232.17 ,$250.15 ,$232.17 ,$271.41 ,$271.41 ,$271.41 , N/A ,$327.00 ,$277.95 ,$250.15 ,$327.00 , N/A , N/A ,$277.95 ,$525.31 ,$277.95 ,$294.30 ,$250.15 ,$271.41 ,$259.97 ,$259.97 ,$250.15 ,$212.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,"$1,797.00 ","$1,168.05 ",$597.30 ,"$1,797.00 ","$1,527.45 ","$1,072.81 ",$597.30 ,"$1,033.28 ",$597.30 ,"$1,238.13 ","$1,527.45 ","$1,527.45 ","$1,527.45 ","$1,473.54 ","$1,221.96 ",$597.30 ,$597.30 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$597.30 ,"$1,275.87 ","$1,491.51 ","$1,491.51 ","$1,491.51 ", N/A ,"$1,493.24 ","$1,527.45 ",$597.30 ,"$1,797.00 ", N/A , N/A ,"$1,527.45 ","$1,254.33 ","$1,527.45 ","$1,617.30 ",$597.30 ,"$1,491.51 ","$1,428.62 ","$1,428.62 ",$597.30 ,"$1,168.05 "
ST. JOSEPH'S HOSPITAL - BREESE,45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$329.00 ,$213.85 ,$104.19 ,$329.00 ,$279.65 ,$196.41 ,$104.19 ,$189.18 ,$104.19 ,$226.68 ,$279.65 ,$279.65 ,$279.65 ,$269.78 ,$223.72 ,$104.19 ,$104.19 ,$246.75 ,$233.59 ,$233.59 ,$104.19 ,$233.59 ,$273.07 ,$273.07 ,$273.07 , N/A ,$260.47 ,$279.65 ,$104.19 ,$329.00 , N/A , N/A ,$279.65 ,$218.80 ,$279.65 ,$296.10 ,$104.19 ,$273.07 ,$261.56 ,$261.56 ,$104.19 ,$213.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$329.00 ,$213.85 ,$189.18 ,$729.64 ,$279.65 ,$196.41 ,$347.45 ,$189.18 ,$347.45 ,$226.68 ,$279.65 ,$279.65 ,$279.65 ,$269.78 ,$223.72 ,$347.45 ,$347.45 ,$246.75 ,$233.59 ,$233.59 ,$347.45 ,$233.59 ,$273.07 ,$273.07 ,$273.07 , N/A ,$329.00 ,$279.65 ,$347.45 ,$329.00 , N/A , N/A ,$279.65 ,$729.64 ,$279.65 ,$296.10 ,$347.45 ,$273.07 ,$261.56 ,$261.56 ,$347.45 ,$213.85 
ST. JOSEPH'S HOSPITAL - BREESE,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$432.00 ,$280.80 ,$248.40 ,$542.81 ,$367.20 ,$257.90 ,$258.48 ,$248.40 ,$258.48 ,$297.65 ,$367.20 ,$367.20 ,$367.20 ,$354.24 ,$293.76 ,$258.48 ,$258.48 ,$324.00 ,$306.72 ,$306.72 ,$258.48 ,$306.72 ,$358.56 ,$358.56 ,$358.56 , N/A ,$432.00 ,$367.20 ,$258.48 ,$432.00 , N/A , N/A ,$367.20 ,$542.81 ,$367.20 ,$388.80 ,$258.48 ,$358.56 ,$343.44 ,$343.44 ,$258.48 ,$280.80 
ST. JOSEPH'S HOSPITAL - BREESE,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$647.00 ,$420.55 ,$258.48 ,$647.00 ,$549.95 ,$386.26 ,$258.48 ,$372.03 ,$258.48 ,$445.78 ,$549.95 ,$549.95 ,$549.95 ,$530.54 ,$439.96 ,$258.48 ,$258.48 ,$485.25 ,$459.37 ,$459.37 ,$258.48 ,$459.37 ,$537.01 ,$537.01 ,$537.01 , N/A ,$646.20 ,$549.95 ,$258.48 ,$647.00 , N/A , N/A ,$549.95 ,$542.81 ,$549.95 ,$582.30 ,$258.48 ,$537.01 ,$514.37 ,$514.37 ,$258.48 ,$420.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,$939.00 ,$610.35 ,$258.48 ,$939.00 ,$798.15 ,$560.58 ,$258.48 ,$539.93 ,$258.48 ,$646.97 ,$798.15 ,$798.15 ,$798.15 ,$769.98 ,$638.52 ,$258.48 ,$258.48 ,$704.25 ,$666.69 ,$666.69 ,$258.48 ,$666.69 ,$779.37 ,$779.37 ,$779.37 , N/A ,$646.20 ,$798.15 ,$258.48 ,$939.00 , N/A , N/A ,$798.15 ,$542.81 ,$798.15 ,$845.10 ,$258.48 ,$779.37 ,$746.51 ,$746.51 ,$258.48 ,$610.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000179,69000,HC DRAIN ABSC/HEMA EAR EXT SMP,450,1 ,"$1,748.79 ","$1,136.71 ",$582.93 ,"$1,748.79 ","$1,486.47 ","$1,044.03 ",$582.93 ,"$1,005.55 ",$582.93 ,"$1,204.92 ","$1,486.47 ","$1,486.47 ","$1,486.47 ","$1,434.01 ","$1,189.18 ",$582.93 ,$582.93 ,"$1,311.59 ","$1,241.64 ","$1,241.64 ",$582.93 ,"$1,241.64 ","$1,451.50 ","$1,451.50 ","$1,451.50 ", N/A ,"$1,457.31 ","$1,486.47 ",$582.93 ,"$1,748.79 ", N/A , N/A ,"$1,486.47 ","$1,224.14 ","$1,486.47 ","$1,573.91 ",$582.93 ,"$1,451.50 ","$1,390.29 ","$1,390.29 ",$582.93 ,"$1,136.71 "
ST. JOSEPH'S HOSPITAL - BREESE,45000181,69200,HC FB REMOVAL EAR,450,1 ,$216.00 ,$140.40 ,$104.19 ,$218.80 ,$183.60 ,$128.95 ,$104.19 ,$124.20 ,$104.19 ,$148.82 ,$183.60 ,$183.60 ,$183.60 ,$177.12 ,$146.88 ,$104.19 ,$104.19 ,$162.00 ,$153.36 ,$153.36 ,$104.19 ,$153.36 ,$179.28 ,$179.28 ,$179.28 , N/A ,$216.00 ,$183.60 ,$104.19 ,$216.00 , N/A , N/A ,$183.60 ,$218.80 ,$183.60 ,$194.40 ,$104.19 ,$179.28 ,$171.72 ,$171.72 ,$104.19 ,$140.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000181,69200,HC FB REMOVAL EAR,450,1 ,$324.00 ,$210.60 ,$104.19 ,$324.00 ,$275.40 ,$193.43 ,$104.19 ,$186.30 ,$104.19 ,$223.24 ,$275.40 ,$275.40 ,$275.40 ,$265.68 ,$220.32 ,$104.19 ,$104.19 ,$243.00 ,$230.04 ,$230.04 ,$104.19 ,$230.04 ,$268.92 ,$268.92 ,$268.92 , N/A ,$260.47 ,$275.40 ,$104.19 ,$324.00 , N/A , N/A ,$275.40 ,$218.80 ,$275.40 ,$291.60 ,$104.19 ,$268.92 ,$257.58 ,$257.58 ,$104.19 ,$210.60 
ST. JOSEPH'S HOSPITAL - BREESE,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$222.00 ,$144.30 ,$52.57 ,$222.00 ,$188.70 ,$132.53 ,$52.57 ,$127.65 ,$52.57 ,$152.96 ,$188.70 ,$188.70 ,$188.70 ,$182.04 ,$150.96 ,$52.57 ,$52.57 ,$166.50 ,$157.62 ,$157.62 ,$52.57 ,$157.62 ,$184.26 ,$184.26 ,$184.26 , N/A ,$131.42 ,$188.70 ,$52.57 ,$222.00 , N/A , N/A ,$188.70 ,$110.39 ,$188.70 ,$199.80 ,$52.57 ,$184.26 ,$176.49 ,$176.49 ,$52.57 ,$144.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000188,99281,HC ER LEVEL 1,450,1 ,$319.00 ,$207.35 ,$66.53 ,$319.00 ,$271.15 ,$190.44 ,$66.53 ,$183.43 ,$66.53 ,$219.79 ,$271.15 ,$271.15 ,$271.15 ,$261.58 ,$216.92 ,$66.53 ,$66.53 ,$239.25 ,$226.49 ,$226.49 ,$66.53 ,$226.49 ,$264.77 ,$264.77 ,$264.77 , N/A ,$166.32 ,$271.15 ,$66.53 ,$319.00 , N/A , N/A ,$271.15 ,$139.71 ,$271.15 ,$287.10 ,$66.53 ,$264.77 ,$253.61 ,$253.61 ,$66.53 ,$207.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000189,99282,HC ER LEVEL 2,450,1 ,$476.00 ,$309.40 ,$122.28 ,$476.00 ,$404.60 ,$284.17 ,$122.28 ,$273.70 ,$122.28 ,$327.96 ,$404.60 ,$404.60 ,$404.60 ,$390.32 ,$323.68 ,$122.28 ,$122.28 ,$357.00 ,$337.96 ,$337.96 ,$122.28 ,$337.96 ,$395.08 ,$395.08 ,$395.08 , N/A ,$305.70 ,$404.60 ,$122.28 ,$476.00 , N/A , N/A ,$404.60 ,$256.79 ,$404.60 ,$428.40 ,$122.28 ,$395.08 ,$378.42 ,$378.42 ,$122.28 ,$309.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000190,99283,HC ER LEVEL 3,450,1 ,$697.00 ,$453.05 ,$213.42 ,$697.00 ,$592.45 ,$416.11 ,$213.42 ,$400.78 ,$213.42 ,$480.23 ,$592.45 ,$592.45 ,$592.45 ,$571.54 ,$473.96 ,$213.42 ,$213.42 ,$522.75 ,$494.87 ,$494.87 ,$213.42 ,$494.87 ,$578.51 ,$578.51 ,$578.51 , N/A ,$533.56 ,$592.45 ,$213.42 ,$697.00 , N/A , N/A ,$592.45 ,$448.19 ,$592.45 ,$627.30 ,$213.42 ,$578.51 ,$554.12 ,$554.12 ,$213.42 ,$453.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000191,99284,HC ER LEVEL 4,450,1 ,"$1,066.00 ",$692.90 ,$89.80 ,"$1,066.00 ",$906.10 ,$636.40 ,$336.17 ,$612.95 ,$336.17 ,$734.47 ,$906.10 ,$906.10 ,$906.10 ,$874.12 ,$724.88 ,$336.17 ,$336.17 ,$799.50 ,$756.86 ,$756.86 ,$336.17 ,$756.86 ,$884.78 ,$884.78 ,$884.78 , N/A ,$840.43 ,$906.10 ,$336.17 ,"$1,066.00 ",$89.80 ,$89.80 ,$906.10 ,$705.96 ,$906.10 ,$959.40 ,$336.17 ,$884.78 ,$847.47 ,$847.47 ,$336.17 ,$692.90 
ST. JOSEPH'S HOSPITAL - BREESE,45000192,99285,HC ER LEVEL 5,450,1 ,"$1,538.00 ",$999.70 ,$89.80 ,"$1,538.00 ","$1,307.30 ",$918.19 ,$482.11 ,$884.35 ,$482.11 ,"$1,059.68 ","$1,307.30 ","$1,307.30 ","$1,307.30 ","$1,261.16 ","$1,045.84 ",$482.11 ,$482.11 ,"$1,153.50 ","$1,091.98 ","$1,091.98 ",$482.11 ,"$1,091.98 ","$1,276.54 ","$1,276.54 ","$1,276.54 ", N/A ,"$1,205.27 ","$1,307.30 ",$482.11 ,"$1,538.00 ",$89.80 ,$89.80 ,"$1,307.30 ","$1,012.43 ","$1,307.30 ","$1,384.20 ",$482.11 ,"$1,276.54 ","$1,222.71 ","$1,222.71 ",$482.11 ,$999.70 
ST. JOSEPH'S HOSPITAL - BREESE,45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$1,956.00 ","$1,271.40 ",$89.80 ,"$1,956.00 ","$1,662.60 ","$1,167.73 ",$637.06 ,"$1,124.70 ",$637.06 ,"$1,347.68 ","$1,662.60 ","$1,662.60 ","$1,662.60 ","$1,603.92 ","$1,330.08 ",$637.06 ,$637.06 ,"$1,467.00 ","$1,388.76 ","$1,388.76 ",$637.06 ,"$1,388.76 ","$1,623.48 ","$1,623.48 ","$1,623.48 ", N/A ,"$1,592.65 ","$1,662.60 ",$637.06 ,"$1,956.00 ",$89.80 ,$89.80 ,"$1,662.60 ","$1,337.83 ","$1,662.60 ","$1,760.40 ",$637.06 ,"$1,623.48 ","$1,555.02 ","$1,555.02 ",$637.06 ,"$1,271.40 "
ST. JOSEPH'S HOSPITAL - BREESE,45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$799.00 ,$519.35 ,$459.43 ,$799.00 ,$679.15 ,$477.00 , N/A ,$459.43 , N/A ,$550.51 ,$679.15 ,$679.15 ,$679.15 ,$655.18 ,$543.32 , N/A , N/A ,$599.25 ,$567.29 ,$567.29 , N/A ,$567.29 ,$663.17 ,$663.17 ,$663.17 , N/A , N/A ,$679.15 , N/A ,$799.00 , N/A , N/A ,$679.15 , N/A ,$679.15 ,$719.10 , N/A ,$663.17 ,$635.21 ,$635.21 , N/A ,$519.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,"$3,885.63 ","$2,525.66 ","$1,295.21 ","$3,885.63 ","$3,302.79 ","$2,319.72 ","$1,295.21 ","$2,234.24 ","$1,295.21 ","$2,677.20 ","$3,302.79 ","$3,302.79 ","$3,302.79 ","$3,186.22 ","$2,642.23 ","$1,295.21 ","$1,295.21 ","$2,914.22 ","$2,758.80 ","$2,758.80 ","$1,295.21 ","$2,758.80 ","$3,225.07 ","$3,225.07 ","$3,225.07 ", N/A ,"$3,238.03 ","$3,302.79 ","$1,295.21 ","$3,885.63 ", N/A , N/A ,"$3,302.79 ","$2,719.94 ","$3,302.79 ","$3,497.07 ","$1,295.21 ","$3,225.07 ","$3,089.08 ","$3,089.08 ","$1,295.21 ","$2,525.66 "
ST. JOSEPH'S HOSPITAL - BREESE,45000197,26700,HC TX DISL (M-P) W/O ANES CLS,450,1 ,$848.00 ,$551.20 ,$206.07 ,$848.00 ,$720.80 ,$506.26 ,$206.07 ,$487.60 ,$206.07 ,$584.27 ,$720.80 ,$720.80 ,$720.80 ,$695.36 ,$576.64 ,$206.07 ,$206.07 ,$636.00 ,$602.08 ,$602.08 ,$206.07 ,$602.08 ,$703.84 ,$703.84 ,$703.84 , N/A ,$515.16 ,$720.80 ,$206.07 ,$848.00 , N/A , N/A ,$720.80 ,$432.74 ,$720.80 ,$763.20 ,$206.07 ,$703.84 ,$674.16 ,$674.16 ,$206.07 ,$551.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$422.00 ,$274.30 ,$206.07 ,$432.74 ,$358.70 ,$251.93 ,$206.07 ,$242.65 ,$206.07 ,$290.76 ,$358.70 ,$358.70 ,$358.70 ,$346.04 ,$286.96 ,$206.07 ,$206.07 ,$316.50 ,$299.62 ,$299.62 ,$206.07 ,$299.62 ,$350.26 ,$350.26 ,$350.26 , N/A ,$422.00 ,$358.70 ,$206.07 ,$422.00 , N/A , N/A ,$358.70 ,$432.74 ,$358.70 ,$379.80 ,$206.07 ,$350.26 ,$335.49 ,$335.49 ,$206.07 ,$274.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$634.00 ,$412.10 ,$206.07 ,$634.00 ,$538.90 ,$378.50 ,$206.07 ,$364.55 ,$206.07 ,$436.83 ,$538.90 ,$538.90 ,$538.90 ,$519.88 ,$431.12 ,$206.07 ,$206.07 ,$475.50 ,$450.14 ,$450.14 ,$206.07 ,$450.14 ,$526.22 ,$526.22 ,$526.22 , N/A ,$515.16 ,$538.90 ,$206.07 ,$634.00 , N/A , N/A ,$538.90 ,$432.74 ,$538.90 ,$570.60 ,$206.07 ,$526.22 ,$504.03 ,$504.03 ,$206.07 ,$412.10 
ST. JOSEPH'S HOSPITAL - BREESE,45000200,35206,HC RPR VESSEL EXTREM UPR,450,1 ,"$6,250.00 ","$4,062.50 ","$2,648.24 ","$6,250.00 ","$5,213.00 ","$3,731.25 ","$2,648.24 ","$3,593.75 ","$2,648.24 ","$4,306.25 ","$5,312.50 ","$5,312.50 ","$5,312.50 ","$4,769.00 ","$4,250.00 ","$2,648.24 ","$2,648.24 ","$4,687.50 ","$4,437.50 ","$4,437.50 ","$2,648.24 ","$4,437.50 ","$5,187.50 ","$5,187.50 ","$5,187.50 ", N/A ,"$6,250.00 ","$5,312.50 ","$2,648.24 ","$6,250.00 ", N/A , N/A ,"$5,312.50 ","$5,561.29 ","$5,312.50 ","$5,625.00 ","$2,648.24 ","$5,187.50 ","$4,968.75 ","$4,968.75 ","$2,648.24 ","$4,062.50 "
ST. JOSEPH'S HOSPITAL - BREESE,45000203,27840,HC TX DISL ANKE W/O ANES CLS,450,1 ,$451.00 ,$293.15 ,$206.07 ,$451.00 ,$383.35 ,$269.25 ,$206.07 ,$259.33 ,$206.07 ,$310.74 ,$383.35 ,$383.35 ,$383.35 ,$369.82 ,$306.68 ,$206.07 ,$206.07 ,$338.25 ,$320.21 ,$320.21 ,$206.07 ,$320.21 ,$374.33 ,$374.33 ,$374.33 , N/A ,$451.00 ,$383.35 ,$206.07 ,$451.00 , N/A , N/A ,$383.35 ,$432.74 ,$383.35 ,$405.90 ,$206.07 ,$374.33 ,$358.55 ,$358.55 ,$206.07 ,$293.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000207,49084,HC PERITONEAL LAVAGE,450,1 ,$260.00 ,$169.00 ,$149.50 ,"$1,577.15 ",$221.00 ,$155.22 ,$751.03 ,$149.50 ,$751.03 ,$179.14 ,$221.00 ,$221.00 ,$221.00 ,$213.20 ,$176.80 ,$751.03 ,$751.03 ,$195.00 ,$184.60 ,$184.60 ,$751.03 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$751.03 ,$260.00 , N/A , N/A ,$221.00 ,"$1,577.15 ",$221.00 ,$234.00 ,$751.03 ,$215.80 ,$206.70 ,$206.70 ,$751.03 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$841.00 ,$546.65 ,$295.85 ,$841.00 ,$714.85 ,$502.08 ,$295.85 ,$483.58 ,$295.85 ,$579.45 ,$714.85 ,$714.85 ,$714.85 ,$689.62 ,$571.88 ,$295.85 ,$295.85 ,$630.75 ,$597.11 ,$597.11 ,$295.85 ,$597.11 ,$698.03 ,$698.03 ,$698.03 , N/A ,$739.63 ,$714.85 ,$295.85 ,$841.00 , N/A , N/A ,$714.85 ,$621.29 ,$714.85 ,$756.90 ,$295.85 ,$698.03 ,$668.60 ,$668.60 ,$295.85 ,$546.65 
ST. JOSEPH'S HOSPITAL - BREESE,45000215,27786,HC DIST FIB FX W/O MANIP,450,1 ,$358.00 ,$232.70 ,$205.85 ,$432.74 ,$304.30 ,$213.73 ,$206.07 ,$205.85 ,$206.07 ,$246.66 ,$304.30 ,$304.30 ,$304.30 ,$293.56 ,$243.44 ,$206.07 ,$206.07 ,$268.50 ,$254.18 ,$254.18 ,$206.07 ,$254.18 ,$297.14 ,$297.14 ,$297.14 , N/A ,$358.00 ,$304.30 ,$206.07 ,$358.00 , N/A , N/A ,$304.30 ,$432.74 ,$304.30 ,$322.20 ,$206.07 ,$297.14 ,$284.61 ,$284.61 ,$206.07 ,$232.70 
ST. JOSEPH'S HOSPITAL - BREESE,45000215,27786,HC DIST FIB FX W/O MANIP,450,1 ,$537.00 ,$349.05 ,$206.07 ,$537.00 ,$456.45 ,$320.59 ,$206.07 ,$308.78 ,$206.07 ,$369.99 ,$456.45 ,$456.45 ,$456.45 ,$440.34 ,$365.16 ,$206.07 ,$206.07 ,$402.75 ,$381.27 ,$381.27 ,$206.07 ,$381.27 ,$445.71 ,$445.71 ,$445.71 , N/A ,$515.16 ,$456.45 ,$206.07 ,$537.00 , N/A , N/A ,$456.45 ,$432.74 ,$456.45 ,$483.30 ,$206.07 ,$445.71 ,$426.92 ,$426.92 ,$206.07 ,$349.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000216,41899,HC DENTOALVEOLAR STRUCT PROC,450,1 ,$644.00 ,$418.60 ,$194.60 ,$644.00 ,$547.40 ,$384.47 ,$194.60 ,$370.30 ,$194.60 ,$443.72 ,$547.40 ,$547.40 ,$547.40 ,$528.08 ,$437.92 ,$194.60 ,$194.60 ,$483.00 ,$457.24 ,$457.24 ,$194.60 ,$457.24 ,$534.52 ,$534.52 ,$534.52 , N/A ,$486.50 ,$547.40 ,$194.60 ,$644.00 , N/A , N/A ,$547.40 ,$408.66 ,$547.40 ,$579.60 ,$194.60 ,$534.52 ,$511.98 ,$511.98 ,$194.60 ,$418.60 
ST. JOSEPH'S HOSPITAL - BREESE,45000221,10121,HC RM FB SUBQ W/INC COMPL,450,1 ,"$5,054.00 ","$3,285.10 ","$1,311.66 ","$5,054.00 ","$4,295.90 ","$3,017.24 ","$1,311.66 ","$2,906.05 ","$1,311.66 ","$3,482.21 ","$4,295.90 ","$4,295.90 ","$4,295.90 ","$4,144.28 ","$3,436.72 ","$1,311.66 ","$1,311.66 ","$3,790.50 ","$3,588.34 ","$3,588.34 ","$1,311.66 ","$3,588.34 ","$4,194.82 ","$4,194.82 ","$4,194.82 ", N/A ,"$3,279.14 ","$4,295.90 ","$1,311.66 ","$5,054.00 ", N/A , N/A ,"$4,295.90 ","$2,754.48 ","$4,295.90 ","$4,548.60 ","$1,311.66 ","$4,194.82 ","$4,017.93 ","$4,017.93 ","$1,311.66 ","$3,285.10 "
ST. JOSEPH'S HOSPITAL - BREESE,45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$848.00 ,$551.20 ,$206.07 ,$848.00 ,$720.80 ,$506.26 ,$206.07 ,$487.60 ,$206.07 ,$584.27 ,$720.80 ,$720.80 ,$720.80 ,$695.36 ,$576.64 ,$206.07 ,$206.07 ,$636.00 ,$602.08 ,$602.08 ,$206.07 ,$602.08 ,$703.84 ,$703.84 ,$703.84 , N/A ,$515.16 ,$720.80 ,$206.07 ,$848.00 , N/A , N/A ,$720.80 ,$432.74 ,$720.80 ,$763.20 ,$206.07 ,$703.84 ,$674.16 ,$674.16 ,$206.07 ,$551.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000231,25505,HC RADIUS FX W MANIP,450,1 ,"$3,683.00 ","$2,393.95 ","$1,295.21 ","$3,683.00 ","$3,130.55 ","$2,198.75 ","$1,295.21 ","$2,117.73 ","$1,295.21 ","$2,537.59 ","$3,130.55 ","$3,130.55 ","$3,130.55 ","$3,020.06 ","$2,504.44 ","$1,295.21 ","$1,295.21 ","$2,762.25 ","$2,614.93 ","$2,614.93 ","$1,295.21 ","$2,614.93 ","$3,056.89 ","$3,056.89 ","$3,056.89 ", N/A ,"$3,238.03 ","$3,130.55 ","$1,295.21 ","$3,683.00 ", N/A , N/A ,"$3,130.55 ","$2,719.94 ","$3,130.55 ","$3,314.70 ","$1,295.21 ","$3,056.89 ","$2,927.99 ","$2,927.99 ","$1,295.21 ","$2,393.95 "
ST. JOSEPH'S HOSPITAL - BREESE,45000235,28470,HC CLSD METATARSAL W/O MANIP,450,1 ,$331.00 ,$215.15 ,$190.33 ,$432.74 ,$281.35 ,$197.61 ,$206.07 ,$190.33 ,$206.07 ,$228.06 ,$281.35 ,$281.35 ,$281.35 ,$271.42 ,$225.08 ,$206.07 ,$206.07 ,$248.25 ,$235.01 ,$235.01 ,$206.07 ,$235.01 ,$274.73 ,$274.73 ,$274.73 , N/A ,$331.00 ,$281.35 ,$206.07 ,$331.00 , N/A , N/A ,$281.35 ,$432.74 ,$281.35 ,$297.90 ,$206.07 ,$274.73 ,$263.15 ,$263.15 ,$206.07 ,$215.15 
ST. JOSEPH'S HOSPITAL - BREESE,45000246,24505,HC HUMERAL CLOSED RED FX,450,1 ,$642.00 ,$417.30 ,$369.15 ,"$2,719.94 ",$545.70 ,$383.27 ,"$1,295.21 ",$369.15 ,"$1,295.21 ",$442.34 ,$545.70 ,$545.70 ,$545.70 ,$526.44 ,$436.56 ,"$1,295.21 ","$1,295.21 ",$481.50 ,$455.82 ,$455.82 ,"$1,295.21 ",$455.82 ,$532.86 ,$532.86 ,$532.86 , N/A ,$642.00 ,$545.70 ,"$1,295.21 ",$642.00 , N/A , N/A ,$545.70 ,"$2,719.94 ",$545.70 ,$577.80 ,"$1,295.21 ",$532.86 ,$510.39 ,$510.39 ,"$1,295.21 ",$417.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$347.00 ,$225.55 ,$199.53 ,$432.74 ,$294.95 ,$207.16 ,$206.07 ,$199.53 ,$206.07 ,$239.08 ,$294.95 ,$294.95 ,$294.95 ,$284.54 ,$235.96 ,$206.07 ,$206.07 ,$260.25 ,$246.37 ,$246.37 ,$206.07 ,$246.37 ,$288.01 ,$288.01 ,$288.01 , N/A ,$347.00 ,$294.95 ,$206.07 ,$347.00 , N/A , N/A ,$294.95 ,$432.74 ,$294.95 ,$312.30 ,$206.07 ,$288.01 ,$275.87 ,$275.87 ,$206.07 ,$225.55 
ST. JOSEPH'S HOSPITAL - BREESE,45000249,28515,HC TOE FX W/MANIP,450,1 ,$639.00 ,$415.35 ,$206.07 ,$639.00 ,$543.15 ,$381.48 ,$206.07 ,$367.43 ,$206.07 ,$440.27 ,$543.15 ,$543.15 ,$543.15 ,$523.98 ,$434.52 ,$206.07 ,$206.07 ,$479.25 ,$453.69 ,$453.69 ,$206.07 ,$453.69 ,$530.37 ,$530.37 ,$530.37 , N/A ,$515.16 ,$543.15 ,$206.07 ,$639.00 , N/A , N/A ,$543.15 ,$432.74 ,$543.15 ,$575.10 ,$206.07 ,$530.37 ,$508.01 ,$508.01 ,$206.07 ,$415.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000258,29345,HC LONG LEG CAST,450,1 ,$743.00 ,$482.95 ,$219.62 ,$743.00 ,$631.55 ,$443.57 ,$219.62 ,$427.23 ,$219.62 ,$511.93 ,$631.55 ,$631.55 ,$631.55 ,$609.26 ,$505.24 ,$219.62 ,$219.62 ,$557.25 ,$527.53 ,$527.53 ,$219.62 ,$527.53 ,$616.69 ,$616.69 ,$616.69 , N/A ,$549.04 ,$631.55 ,$219.62 ,$743.00 , N/A , N/A ,$631.55 ,$461.19 ,$631.55 ,$668.70 ,$219.62 ,$616.69 ,$590.69 ,$590.69 ,$219.62 ,$482.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,$639.00 ,$415.35 ,$206.07 ,$639.00 ,$543.15 ,$381.48 ,$206.07 ,$367.43 ,$206.07 ,$440.27 ,$543.15 ,$543.15 ,$543.15 ,$523.98 ,$434.52 ,$206.07 ,$206.07 ,$479.25 ,$453.69 ,$453.69 ,$206.07 ,$453.69 ,$530.37 ,$530.37 ,$530.37 , N/A ,$515.16 ,$543.15 ,$206.07 ,$639.00 , N/A , N/A ,$543.15 ,$432.74 ,$543.15 ,$575.10 ,$206.07 ,$530.37 ,$508.01 ,$508.01 ,$206.07 ,$415.35 
ST. JOSEPH'S HOSPITAL - BREESE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$156.00 ,$101.40 ,$52.57 ,$156.00 ,$132.60 ,$93.13 ,$52.57 ,$89.70 ,$52.57 ,$107.48 ,$132.60 ,$132.60 ,$132.60 ,$127.92 ,$106.08 ,$52.57 ,$52.57 ,$117.00 ,$110.76 ,$110.76 ,$52.57 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$131.42 ,$132.60 ,$52.57 ,$156.00 , N/A , N/A ,$132.60 ,$110.39 ,$132.60 ,$140.40 ,$52.57 ,$129.48 ,$124.02 ,$124.02 ,$52.57 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$234.00 ,$152.10 ,$52.57 ,$234.00 ,$198.90 ,$139.70 ,$52.57 ,$134.55 ,$52.57 ,$161.23 ,$198.90 ,$198.90 ,$198.90 ,$191.88 ,$159.12 ,$52.57 ,$52.57 ,$175.50 ,$166.14 ,$166.14 ,$52.57 ,$166.14 ,$194.22 ,$194.22 ,$194.22 , N/A ,$131.42 ,$198.90 ,$52.57 ,$234.00 , N/A , N/A ,$198.90 ,$110.39 ,$198.90 ,$210.60 ,$52.57 ,$194.22 ,$186.03 ,$186.03 ,$52.57 ,$152.10 
ST. JOSEPH'S HOSPITAL - BREESE,45000293,11440,HC EXCISION LESION BENIGN FACE/EAR<0.5CM,450,1 ,"$1,644.00 ","$1,068.60 ",$582.93 ,"$1,644.00 ","$1,397.40 ",$981.47 ,$582.93 ,$945.30 ,$582.93 ,"$1,132.72 ","$1,397.40 ","$1,397.40 ","$1,397.40 ","$1,348.08 ","$1,117.92 ",$582.93 ,$582.93 ,"$1,233.00 ","$1,167.24 ","$1,167.24 ",$582.93 ,"$1,167.24 ","$1,364.52 ","$1,364.52 ","$1,364.52 ", N/A ,"$1,457.31 ","$1,397.40 ",$582.93 ,"$1,644.00 ", N/A , N/A ,"$1,397.40 ","$1,224.14 ","$1,397.40 ","$1,479.60 ",$582.93 ,"$1,364.52 ","$1,306.98 ","$1,306.98 ",$582.93 ,"$1,068.60 "
ST. JOSEPH'S HOSPITAL - BREESE,45000301,24200,HC REMOVE FOREIGN BODY UPPER ARM/ELBOW SUBQ,450,1 ,"$1,717.00 ","$1,116.05 ",$987.28 ,"$2,754.48 ","$1,459.45 ","$1,025.05 ","$1,311.66 ",$987.28 ,"$1,311.66 ","$1,183.01 ","$1,459.45 ","$1,459.45 ","$1,459.45 ","$1,407.94 ","$1,167.56 ","$1,311.66 ","$1,311.66 ","$1,287.75 ","$1,219.07 ","$1,219.07 ","$1,311.66 ","$1,219.07 ","$1,425.11 ","$1,425.11 ","$1,425.11 ", N/A ,"$1,717.00 ","$1,459.45 ","$1,311.66 ","$1,717.00 ", N/A , N/A ,"$1,459.45 ","$2,754.48 ","$1,459.45 ","$1,545.30 ","$1,311.66 ","$1,425.11 ","$1,365.02 ","$1,365.02 ","$1,311.66 ","$1,116.05 "
ST. JOSEPH'S HOSPITAL - BREESE,45000302,24565,HC CLOSED TX HUMERUS EPICONDYLR FX W/MANIP,450,1 ,$417.00 ,$271.05 ,$239.78 ,"$2,719.94 ",$354.45 ,$248.95 ,"$1,295.21 ",$239.78 ,"$1,295.21 ",$287.31 ,$354.45 ,$354.45 ,$354.45 ,$341.94 ,$283.56 ,"$1,295.21 ","$1,295.21 ",$312.75 ,$296.07 ,$296.07 ,"$1,295.21 ",$296.07 ,$346.11 ,$346.11 ,$346.11 , N/A ,$417.00 ,$354.45 ,"$1,295.21 ",$417.00 , N/A , N/A ,$354.45 ,"$2,719.94 ",$354.45 ,$375.30 ,"$1,295.21 ",$346.11 ,$331.52 ,$331.52 ,"$1,295.21 ",$271.05 
ST. JOSEPH'S HOSPITAL - BREESE,45000325,24655,HC CLOSED TX FX RADIAL HEAD/NECK W/MANIP,450,1 ,"$3,918.00 ","$2,546.70 ","$1,295.21 ","$3,918.00 ","$3,330.30 ","$2,339.05 ","$1,295.21 ","$2,252.85 ","$1,295.21 ","$2,699.50 ","$3,330.30 ","$3,330.30 ","$3,330.30 ","$3,212.76 ","$2,664.24 ","$1,295.21 ","$1,295.21 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,295.21 ","$2,781.78 ","$3,251.94 ","$3,251.94 ","$3,251.94 ", N/A ,"$3,238.03 ","$3,330.30 ","$1,295.21 ","$3,918.00 ", N/A , N/A ,"$3,330.30 ","$2,719.94 ","$3,330.30 ","$3,526.20 ","$1,295.21 ","$3,251.94 ","$3,114.81 ","$3,114.81 ","$1,295.21 ","$2,546.70 "
ST. JOSEPH'S HOSPITAL - BREESE,45000327,26765,HC TX FX OPEN FINGER/THUMB W/INT FIX EACH,450,1 ,"$5,200.00 ","$3,380.00 ","$2,615.91 ","$5,493.41 ","$4,420.00 ","$3,104.40 ","$2,615.91 ","$2,990.00 ","$2,615.91 ","$3,582.80 ","$4,420.00 ","$4,420.00 ","$4,420.00 ","$4,264.00 ","$3,536.00 ","$2,615.91 ","$2,615.91 ","$3,900.00 ","$3,692.00 ","$3,692.00 ","$2,615.91 ","$3,692.00 ","$4,316.00 ","$4,316.00 ","$4,316.00 ", N/A ,"$5,200.00 ","$4,420.00 ","$2,615.91 ","$5,200.00 ", N/A , N/A ,"$4,420.00 ","$5,493.41 ","$4,420.00 ","$4,680.00 ","$2,615.91 ","$4,316.00 ","$4,134.00 ","$4,134.00 ","$2,615.91 ","$3,380.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,$848.00 ,$551.20 ,$206.07 ,$848.00 ,$720.80 ,$506.26 ,$206.07 ,$487.60 ,$206.07 ,$584.27 ,$720.80 ,$720.80 ,$720.80 ,$695.36 ,$576.64 ,$206.07 ,$206.07 ,$636.00 ,$602.08 ,$602.08 ,$206.07 ,$602.08 ,$703.84 ,$703.84 ,$703.84 , N/A ,$515.16 ,$720.80 ,$206.07 ,$848.00 , N/A , N/A ,$720.80 ,$432.74 ,$720.80 ,$763.20 ,$206.07 ,$703.84 ,$674.16 ,$674.16 ,$206.07 ,$551.20 
ST. JOSEPH'S HOSPITAL - BREESE,45000329,27752,HC CLSD TX FX TIBIAL SHAFT W/MANIP,450,1 ,"$4,066.17 ","$2,643.01 ","$1,295.21 ","$4,066.17 ","$3,456.24 ","$2,427.50 ","$1,295.21 ","$2,338.05 ","$1,295.21 ","$2,801.59 ","$3,456.24 ","$3,456.24 ","$3,456.24 ","$3,334.26 ","$2,765.00 ","$1,295.21 ","$1,295.21 ","$3,049.63 ","$2,886.98 ","$2,886.98 ","$1,295.21 ","$2,886.98 ","$3,374.92 ","$3,374.92 ","$3,374.92 ", N/A ,"$3,238.03 ","$3,456.24 ","$1,295.21 ","$4,066.17 ", N/A , N/A ,"$3,456.24 ","$2,719.94 ","$3,456.24 ","$3,659.55 ","$1,295.21 ","$3,374.92 ","$3,232.61 ","$3,232.61 ","$1,295.21 ","$2,643.01 "
ST. JOSEPH'S HOSPITAL - BREESE,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$581.00 ,$377.65 ,$206.07 ,$581.00 ,$493.85 ,$346.86 ,$206.07 ,$334.08 ,$206.07 ,$400.31 ,$493.85 ,$493.85 ,$493.85 ,$476.42 ,$395.08 ,$206.07 ,$206.07 ,$435.75 ,$412.51 ,$412.51 ,$206.07 ,$412.51 ,$482.23 ,$482.23 ,$482.23 , N/A ,$515.16 ,$493.85 ,$206.07 ,$581.00 , N/A , N/A ,$493.85 ,$432.74 ,$493.85 ,$522.90 ,$206.07 ,$482.23 ,$461.90 ,$461.90 ,$206.07 ,$377.65 
ST. JOSEPH'S HOSPITAL - BREESE,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$872.00 ,$566.80 ,$206.07 ,$872.00 ,$741.20 ,$520.58 ,$206.07 ,$501.40 ,$206.07 ,$600.81 ,$741.20 ,$741.20 ,$741.20 ,$715.04 ,$592.96 ,$206.07 ,$206.07 ,$654.00 ,$619.12 ,$619.12 ,$206.07 ,$619.12 ,$723.76 ,$723.76 ,$723.76 , N/A ,$515.16 ,$741.20 ,$206.07 ,$872.00 , N/A , N/A ,$741.20 ,$432.74 ,$741.20 ,$784.80 ,$206.07 ,$723.76 ,$693.24 ,$693.24 ,$206.07 ,$566.80 
ST. JOSEPH'S HOSPITAL - BREESE,45000335,29530,HC STRAPPING KNEE,450,1 ,$200.00 ,$130.00 ,$104.19 ,$218.80 ,$170.00 ,$119.40 ,$104.19 ,$115.00 ,$104.19 ,$137.80 ,$170.00 ,$170.00 ,$170.00 ,$164.00 ,$136.00 ,$104.19 ,$104.19 ,$150.00 ,$142.00 ,$142.00 ,$104.19 ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A ,$200.00 ,$170.00 ,$104.19 ,$200.00 , N/A , N/A ,$170.00 ,$218.80 ,$170.00 ,$180.00 ,$104.19 ,$166.00 ,$159.00 ,$159.00 ,$104.19 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000439,64450,HC INJ ANES OTHER THAN PERIPHERAL-LT,450,1 ,"$1,797.00 ","$1,168.05 ",$597.30 ,"$1,797.00 ","$1,527.45 ","$1,072.81 ",$597.30 ,"$1,033.28 ",$597.30 ,"$1,238.13 ","$1,527.45 ","$1,527.45 ","$1,527.45 ","$1,473.54 ","$1,221.96 ",$597.30 ,$597.30 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$597.30 ,"$1,275.87 ","$1,491.51 ","$1,491.51 ","$1,491.51 ", N/A ,"$1,493.24 ","$1,527.45 ",$597.30 ,"$1,797.00 ", N/A , N/A ,"$1,527.45 ","$1,254.33 ","$1,527.45 ","$1,617.30 ",$597.30 ,"$1,491.51 ","$1,428.62 ","$1,428.62 ",$597.30 ,"$1,168.05 "
ST. JOSEPH'S HOSPITAL - BREESE,45000440,64450,HC INJ ANES OTHER THAN PERIPHERAL-RT,450,1 ,"$1,797.00 ","$1,168.05 ",$597.30 ,"$1,797.00 ","$1,527.45 ","$1,072.81 ",$597.30 ,"$1,033.28 ",$597.30 ,"$1,238.13 ","$1,527.45 ","$1,527.45 ","$1,527.45 ","$1,473.54 ","$1,221.96 ",$597.30 ,$597.30 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$597.30 ,"$1,275.87 ","$1,491.51 ","$1,491.51 ","$1,491.51 ", N/A ,"$1,493.24 ","$1,527.45 ",$597.30 ,"$1,797.00 ", N/A , N/A ,"$1,527.45 ","$1,254.33 ","$1,527.45 ","$1,617.30 ",$597.30 ,"$1,491.51 ","$1,428.62 ","$1,428.62 ",$597.30 ,"$1,168.05 "
ST. JOSEPH'S HOSPITAL - BREESE,45000451,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-LT,450,1 ,"$1,748.79 ","$1,136.71 ",$582.93 ,"$1,748.79 ","$1,486.47 ","$1,044.03 ",$582.93 ,"$1,005.55 ",$582.93 ,"$1,204.92 ","$1,486.47 ","$1,486.47 ","$1,486.47 ","$1,434.01 ","$1,189.18 ",$582.93 ,$582.93 ,"$1,311.59 ","$1,241.64 ","$1,241.64 ",$582.93 ,"$1,241.64 ","$1,451.50 ","$1,451.50 ","$1,451.50 ", N/A ,"$1,457.31 ","$1,486.47 ",$582.93 ,"$1,748.79 ", N/A , N/A ,"$1,486.47 ","$1,224.14 ","$1,486.47 ","$1,573.91 ",$582.93 ,"$1,451.50 ","$1,390.29 ","$1,390.29 ",$582.93 ,"$1,136.71 "
ST. JOSEPH'S HOSPITAL - BREESE,45000452,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-RT,450,1 ,"$1,748.79 ","$1,136.71 ",$582.93 ,"$1,748.79 ","$1,486.47 ","$1,044.03 ",$582.93 ,"$1,005.55 ",$582.93 ,"$1,204.92 ","$1,486.47 ","$1,486.47 ","$1,486.47 ","$1,434.01 ","$1,189.18 ",$582.93 ,$582.93 ,"$1,311.59 ","$1,241.64 ","$1,241.64 ",$582.93 ,"$1,241.64 ","$1,451.50 ","$1,451.50 ","$1,451.50 ", N/A ,"$1,457.31 ","$1,486.47 ",$582.93 ,"$1,748.79 ", N/A , N/A ,"$1,486.47 ","$1,224.14 ","$1,486.47 ","$1,573.91 ",$582.93 ,"$1,451.50 ","$1,390.29 ","$1,390.29 ",$582.93 ,"$1,136.71 "
ST. JOSEPH'S HOSPITAL - BREESE,45000467,27842,HC CLOSED TX ANKLE DISLOC W/ANESTH W/W/O FIXATION,450,1 ,"$1,282.00 ",$833.30 ,$737.15 ,"$2,719.94 ","$1,089.70 ",$765.35 ,"$1,295.21 ",$737.15 ,"$1,295.21 ",$883.30 ,"$1,089.70 ","$1,089.70 ","$1,089.70 ","$1,051.24 ",$871.76 ,"$1,295.21 ","$1,295.21 ",$961.50 ,$910.22 ,$910.22 ,"$1,295.21 ",$910.22 ,"$1,064.06 ","$1,064.06 ","$1,064.06 ", N/A ,"$1,282.00 ","$1,089.70 ","$1,295.21 ","$1,282.00 ", N/A , N/A ,"$1,089.70 ","$2,719.94 ","$1,089.70 ","$1,153.80 ","$1,295.21 ","$1,064.06 ","$1,019.19 ","$1,019.19 ","$1,295.21 ",$833.30 
ST. JOSEPH'S HOSPITAL - BREESE,45000493,36600,HC ARTERIAL PUNCTURE,450,1 ,$312.57 ,$203.17 ,$104.19 ,$312.57 ,$265.68 ,$186.60 ,$104.19 ,$179.73 ,$104.19 ,$215.36 ,$265.68 ,$265.68 ,$265.68 ,$256.31 ,$212.55 ,$104.19 ,$104.19 ,$234.43 ,$221.92 ,$221.92 ,$104.19 ,$221.92 ,$259.43 ,$259.43 ,$259.43 , N/A ,$260.47 ,$265.68 ,$104.19 ,$312.57 , N/A , N/A ,$265.68 ,$218.80 ,$265.68 ,$281.31 ,$104.19 ,$259.43 ,$248.49 ,$248.49 ,$104.19 ,$203.17 
ST. JOSEPH'S HOSPITAL - BREESE,45000497,27086,HC REMOVE FB PELVIS/HIP SUBQ TISSUE,450,1 ,"$5,054.00 ","$3,285.10 ","$2,215.93 ","$5,054.00 ","$4,295.90 ","$3,017.24 ","$2,215.93 ","$2,906.05 ","$2,215.93 ","$3,482.21 ","$4,295.90 ","$4,295.90 ","$4,295.90 ","$4,144.28 ","$3,436.72 ","$2,215.93 ","$2,215.93 ","$3,790.50 ","$3,588.34 ","$3,588.34 ","$2,215.93 ","$3,588.34 ","$4,194.82 ","$4,194.82 ","$4,194.82 ", N/A ,"$5,054.00 ","$4,295.90 ","$2,215.93 ","$5,054.00 ", N/A , N/A ,"$4,295.90 ","$4,653.46 ","$4,295.90 ","$4,548.60 ","$2,215.93 ","$4,194.82 ","$4,017.93 ","$4,017.93 ","$2,215.93 ","$3,285.10 "
ST. JOSEPH'S HOSPITAL - BREESE,45000516,26775,HC TX DISLOC I-P JOINT W/ANES/MAN,450,1 ,$743.00 ,$482.95 ,$219.62 ,$743.00 ,$631.55 ,$443.57 ,$219.62 ,$427.23 ,$219.62 ,$511.93 ,$631.55 ,$631.55 ,$631.55 ,$609.26 ,$505.24 ,$219.62 ,$219.62 ,$557.25 ,$527.53 ,$527.53 ,$219.62 ,$527.53 ,$616.69 ,$616.69 ,$616.69 , N/A ,$549.04 ,$631.55 ,$219.62 ,$743.00 , N/A , N/A ,$631.55 ,$461.19 ,$631.55 ,$668.70 ,$219.62 ,$616.69 ,$590.69 ,$590.69 ,$219.62 ,$482.95 
ST. JOSEPH'S HOSPITAL - BREESE,45000518,27200,HC TX FX COCCYGEAL CLOSED,450,1 ,$616.00 ,$400.40 ,$206.07 ,$616.00 ,$523.60 ,$367.75 ,$206.07 ,$354.20 ,$206.07 ,$424.42 ,$523.60 ,$523.60 ,$523.60 ,$505.12 ,$418.88 ,$206.07 ,$206.07 ,$462.00 ,$437.36 ,$437.36 ,$206.07 ,$437.36 ,$511.28 ,$511.28 ,$511.28 , N/A ,$515.16 ,$523.60 ,$206.07 ,$616.00 , N/A , N/A ,$523.60 ,$432.74 ,$523.60 ,$554.40 ,$206.07 ,$511.28 ,$489.72 ,$489.72 ,$206.07 ,$400.40 
ST. JOSEPH'S HOSPITAL - BREESE,45000548,29425,HC APPLY SHORT LEG CAST WALKING,450,1 ,$743.00 ,$482.95 ,$219.62 ,$743.00 ,$631.55 ,$443.57 ,$219.62 ,$427.23 ,$219.62 ,$511.93 ,$631.55 ,$631.55 ,$631.55 ,$609.26 ,$505.24 ,$219.62 ,$219.62 ,$557.25 ,$527.53 ,$527.53 ,$219.62 ,$527.53 ,$616.69 ,$616.69 ,$616.69 , N/A ,$549.04 ,$631.55 ,$219.62 ,$743.00 , N/A , N/A ,$631.55 ,$461.19 ,$631.55 ,$668.70 ,$219.62 ,$616.69 ,$590.69 ,$590.69 ,$219.62 ,$482.95 
ST. JOSEPH'S HOSPITAL - BREESE,45001273,23675,HC TX FX DISLOC SHOULDER W/PROX HUM W/MANIP,450,1 ,"$3,885.63 ","$2,525.66 ","$1,295.21 ","$3,885.63 ","$3,302.79 ","$2,319.72 ","$1,295.21 ","$2,234.24 ","$1,295.21 ","$2,677.20 ","$3,302.79 ","$3,302.79 ","$3,302.79 ","$3,186.22 ","$2,642.23 ","$1,295.21 ","$1,295.21 ","$2,914.22 ","$2,758.80 ","$2,758.80 ","$1,295.21 ","$2,758.80 ","$3,225.07 ","$3,225.07 ","$3,225.07 ", N/A ,"$3,238.03 ","$3,302.79 ","$1,295.21 ","$3,885.63 ", N/A , N/A ,"$3,302.79 ","$2,719.94 ","$3,302.79 ","$3,497.07 ","$1,295.21 ","$3,225.07 ","$3,089.08 ","$3,089.08 ","$1,295.21 ","$2,525.66 "
ST. JOSEPH'S HOSPITAL - BREESE,45001278,24675,HC TX FX CLOSED ULNA PROXIMAL W/MANIP,450,1 ,"$3,918.00 ","$2,546.70 ","$1,295.21 ","$3,918.00 ","$3,330.30 ","$2,339.05 ","$1,295.21 ","$2,252.85 ","$1,295.21 ","$2,699.50 ","$3,330.30 ","$3,330.30 ","$3,330.30 ","$3,212.76 ","$2,664.24 ","$1,295.21 ","$1,295.21 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,295.21 ","$2,781.78 ","$3,251.94 ","$3,251.94 ","$3,251.94 ", N/A ,"$3,238.03 ","$3,330.30 ","$1,295.21 ","$3,918.00 ", N/A , N/A ,"$3,330.30 ","$2,719.94 ","$3,330.30 ","$3,526.20 ","$1,295.21 ","$3,251.94 ","$3,114.81 ","$3,114.81 ","$1,295.21 ","$2,546.70 "
ST. JOSEPH'S HOSPITAL - BREESE,45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$4,090.00 ","$2,658.50 ","$1,295.21 ","$4,090.00 ","$3,476.50 ","$2,441.73 ","$1,295.21 ","$2,351.75 ","$1,295.21 ","$2,818.01 ","$3,476.50 ","$3,476.50 ","$3,476.50 ","$3,353.80 ","$2,781.20 ","$1,295.21 ","$1,295.21 ","$3,067.50 ","$2,903.90 ","$2,903.90 ","$1,295.21 ","$2,903.90 ","$3,394.70 ","$3,394.70 ","$3,394.70 ", N/A ,"$3,238.03 ","$3,476.50 ","$1,295.21 ","$4,090.00 ", N/A , N/A ,"$3,476.50 ","$2,719.94 ","$3,476.50 ","$3,681.00 ","$1,295.21 ","$3,394.70 ","$3,251.55 ","$3,251.55 ","$1,295.21 ","$2,658.50 "
ST. JOSEPH'S HOSPITAL - BREESE,45001291,27502,HC TX FX FEMUR W/MAN W/W/O TRACTION,450,1 ,"$3,885.63 ","$2,525.66 ","$1,295.21 ","$3,885.63 ","$3,302.79 ","$2,319.72 ","$1,295.21 ","$2,234.24 ","$1,295.21 ","$2,677.20 ","$3,302.79 ","$3,302.79 ","$3,302.79 ","$3,186.22 ","$2,642.23 ","$1,295.21 ","$1,295.21 ","$2,914.22 ","$2,758.80 ","$2,758.80 ","$1,295.21 ","$2,758.80 ","$3,225.07 ","$3,225.07 ","$3,225.07 ", N/A ,"$3,238.03 ","$3,302.79 ","$1,295.21 ","$3,885.63 ", N/A , N/A ,"$3,302.79 ","$2,719.94 ","$3,302.79 ","$3,497.07 ","$1,295.21 ","$3,225.07 ","$3,089.08 ","$3,089.08 ","$1,295.21 ","$2,525.66 "
ST. JOSEPH'S HOSPITAL - BREESE,45001317,67935,HC REPAIR EYELID WOUND FULL THICKNESS,450,1 ,"$5,547.84 ","$3,606.10 ","$1,849.28 ","$5,547.84 ","$4,715.66 ","$3,312.06 ","$1,849.28 ","$3,190.01 ","$1,849.28 ","$3,822.46 ","$4,715.66 ","$4,715.66 ","$4,715.66 ","$4,549.23 ","$3,772.53 ","$1,849.28 ","$1,849.28 ","$4,160.88 ","$3,938.97 ","$3,938.97 ","$1,849.28 ","$3,938.97 ","$4,604.71 ","$4,604.71 ","$4,604.71 ", N/A ,"$4,623.19 ","$4,715.66 ","$1,849.28 ","$5,547.84 ", N/A , N/A ,"$4,715.66 ","$3,883.48 ","$4,715.66 ","$4,993.06 ","$1,849.28 ","$4,604.71 ","$4,410.53 ","$4,410.53 ","$1,849.28 ","$3,606.10 "
ST. JOSEPH'S HOSPITAL - BREESE,45001329,41005,HC I AND D INTRAORAL LESION,450,1 ,$387.00 ,$251.55 ,$194.60 ,$408.66 ,$328.95 ,$231.04 ,$194.60 ,$222.53 ,$194.60 ,$266.64 ,$328.95 ,$328.95 ,$328.95 ,$317.34 ,$263.16 ,$194.60 ,$194.60 ,$290.25 ,$274.77 ,$274.77 ,$194.60 ,$274.77 ,$321.21 ,$321.21 ,$321.21 , N/A ,$387.00 ,$328.95 ,$194.60 ,$387.00 , N/A , N/A ,$328.95 ,$408.66 ,$328.95 ,$348.30 ,$194.60 ,$321.21 ,$307.67 ,$307.67 ,$194.60 ,$251.55 
ST. JOSEPH'S HOSPITAL - BREESE,45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$657.00 ,$427.05 ,$224.47 ,$657.00 ,$558.45 ,$392.23 ,$224.47 ,$377.78 ,$224.47 ,$452.67 ,$558.45 ,$558.45 ,$558.45 ,$538.74 ,$446.76 ,$224.47 ,$224.47 ,$492.75 ,$466.47 ,$466.47 ,$224.47 ,$466.47 ,$545.31 ,$545.31 ,$545.31 , N/A ,$561.18 ,$558.45 ,$224.47 ,$657.00 , N/A , N/A ,$558.45 ,$471.39 ,$558.45 ,$591.30 ,$224.47 ,$545.31 ,$522.32 ,$522.32 ,$224.47 ,$427.05 
ST. JOSEPH'S HOSPITAL - BREESE,45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,$657.00 ,$427.05 ,$224.47 ,$657.00 ,$558.45 ,$392.23 ,$224.47 ,$377.78 ,$224.47 ,$452.67 ,$558.45 ,$558.45 ,$558.45 ,$538.74 ,$446.76 ,$224.47 ,$224.47 ,$492.75 ,$466.47 ,$466.47 ,$224.47 ,$466.47 ,$545.31 ,$545.31 ,$545.31 , N/A ,$561.18 ,$558.45 ,$224.47 ,$657.00 , N/A , N/A ,$558.45 ,$471.39 ,$558.45 ,$591.30 ,$224.47 ,$545.31 ,$522.32 ,$522.32 ,$224.47 ,$427.05 
ST. JOSEPH'S HOSPITAL - BREESE,45001347,27503,HC CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,450,1 ,"$3,885.63 ","$2,525.66 ","$1,295.21 ","$3,885.63 ","$3,302.79 ","$2,319.72 ","$1,295.21 ","$2,234.24 ","$1,295.21 ","$2,677.20 ","$3,302.79 ","$3,302.79 ","$3,302.79 ","$3,186.22 ","$2,642.23 ","$1,295.21 ","$1,295.21 ","$2,914.22 ","$2,758.80 ","$2,758.80 ","$1,295.21 ","$2,758.80 ","$3,225.07 ","$3,225.07 ","$3,225.07 ", N/A ,"$3,238.03 ","$3,302.79 ","$1,295.21 ","$3,885.63 ", N/A , N/A ,"$3,302.79 ","$2,719.94 ","$3,302.79 ","$3,497.07 ","$1,295.21 ","$3,225.07 ","$3,089.08 ","$3,089.08 ","$1,295.21 ","$2,525.66 "
ST. JOSEPH'S HOSPITAL - BREESE,45001350,P9612,HC STRAIGHT CATH FOR URINE SPECIMEN,450,1 ,$201.00 ,$130.65 ,$3.00 ,$201.00 ,$170.85 ,$120.00 ,$3.00 ,$115.58 ,$3.00 ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$164.82 ,$136.68 ,$3.00 ,$3.00 ,$150.75 ,$142.71 ,$142.71 ,$3.00 ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A ,$7.50 ,$170.85 ,$3.00 ,$201.00 , N/A , N/A ,$170.85 ,$6.30 ,$170.85 ,$180.90 ,$3.00 ,$166.83 ,$159.80 ,$159.80 ,$3.00 ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,45001352,26545,HC RECONSTRUCT FINGER JOINT,450,1 ,"$7,847.37 ","$5,100.79 ","$2,615.91 ","$7,847.37 ","$5,213.00 ","$4,684.88 ","$2,615.91 ","$4,512.24 ","$2,615.91 ","$5,406.84 ","$6,670.26 ","$6,670.26 ","$6,670.26 ","$4,769.00 ","$5,336.21 ","$2,615.91 ","$2,615.91 ","$5,885.53 ","$5,571.63 ","$5,571.63 ","$2,615.91 ","$5,571.63 ","$6,513.32 ","$6,513.32 ","$6,513.32 ", N/A ,"$6,539.77 ","$6,670.26 ","$2,615.91 ","$7,847.37 ", N/A , N/A ,"$6,670.26 ","$5,493.41 ","$6,670.26 ","$7,062.63 ","$2,615.91 ","$6,513.32 ","$6,238.66 ","$6,238.66 ","$2,615.91 ","$5,100.79 "
ST. JOSEPH'S HOSPITAL - BREESE,46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$326.00 ,$211.90 ,$47.77 ,$326.00 ,$277.10 ,$194.62 ,$132.21 ,$187.45 ,$132.21 ,$224.61 ,$277.10 ,$277.10 ,$277.10 , N/A ,$221.68 ,$132.21 ,$132.21 ,$244.50 ,$231.46 ,$231.46 ,$132.21 ,$231.46 ,$270.58 ,$270.58 ,$270.58 , N/A ,$326.00 ,$277.10 ,$132.21 ,$326.00 ,$47.77 ,$47.77 ,$277.10 ,$277.64 ,$277.10 ,$293.40 ,$132.21 ,$270.58 ,$259.17 ,$259.17 ,$132.21 ,$211.90 
ST. JOSEPH'S HOSPITAL - BREESE,46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$702.00 ,$456.30 ,$47.77 ,$702.00 ,$596.70 ,$419.09 ,$241.86 ,$403.65 ,$241.86 ,$483.68 ,$596.70 ,$596.70 ,$596.70 , N/A ,$477.36 ,$241.86 ,$241.86 ,$526.50 ,$498.42 ,$498.42 ,$241.86 ,$498.42 ,$582.66 ,$582.66 ,$582.66 , N/A ,$604.66 ,$596.70 ,$241.86 ,$702.00 ,$47.77 ,$47.77 ,$596.70 ,$507.91 ,$596.70 ,$631.80 ,$241.86 ,$582.66 ,$558.09 ,$558.09 ,$241.86 ,$456.30 
ST. JOSEPH'S HOSPITAL - BREESE,46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,$553.00 ,$359.45 ,$145.96 ,$553.00 ,$470.05 ,$330.14 ,$241.86 ,$317.98 ,$241.86 ,$381.02 ,$470.05 ,$470.05 ,$470.05 , N/A ,$376.04 ,$241.86 ,$241.86 ,$414.75 ,$392.63 ,$392.63 ,$241.86 ,$392.63 ,$458.99 ,$458.99 ,$458.99 , N/A ,$553.00 ,$470.05 ,$241.86 ,$553.00 ,$145.96 ,$145.96 ,$470.05 ,$507.91 ,$470.05 ,$497.70 ,$241.86 ,$458.99 ,$439.64 ,$439.64 ,$241.86 ,$359.45 
ST. JOSEPH'S HOSPITAL - BREESE,46000007,94150,HC VITAL CAPACITY TOTAL,460,1 ,$85.00 ,$55.25 ,$47.77 ,$277.64 ,$72.25 ,$50.75 ,$132.21 ,$48.88 ,$132.21 ,$58.57 ,$72.25 ,$72.25 ,$72.25 , N/A ,$57.80 ,$132.21 ,$132.21 ,$63.75 ,$60.35 ,$60.35 ,$132.21 ,$60.35 ,$70.55 ,$70.55 ,$70.55 , N/A ,$85.00 ,$72.25 ,$132.21 ,$85.00 ,$47.77 ,$47.77 ,$72.25 ,$277.64 ,$72.25 ,$76.50 ,$132.21 ,$70.55 ,$67.58 ,$67.58 ,$132.21 ,$55.25 
ST. JOSEPH'S HOSPITAL - BREESE,46000012,94728,HC AIRFLOW RESISTANCE,460,1 ,$328.00 ,$213.20 ,$47.77 ,$507.91 ,$278.80 ,$195.82 ,$241.86 ,$188.60 ,$241.86 ,$225.99 ,$278.80 ,$278.80 ,$278.80 , N/A ,$223.04 ,$241.86 ,$241.86 ,$246.00 ,$232.88 ,$232.88 ,$241.86 ,$232.88 ,$272.24 ,$272.24 ,$272.24 , N/A ,$328.00 ,$278.80 ,$241.86 ,$328.00 ,$47.77 ,$47.77 ,$278.80 ,$507.91 ,$278.80 ,$295.20 ,$241.86 ,$272.24 ,$260.76 ,$260.76 ,$241.86 ,$213.20 
ST. JOSEPH'S HOSPITAL - BREESE,46000013,94726,HC PLETHYSMOGRAPHY,460,1 ,$821.00 ,$533.65 ,$47.77 ,$821.00 ,$697.85 ,$490.14 ,$241.86 ,$472.08 ,$241.86 ,$565.67 ,$697.85 ,$697.85 ,$697.85 , N/A ,$558.28 ,$241.86 ,$241.86 ,$615.75 ,$582.91 ,$582.91 ,$241.86 ,$582.91 ,$681.43 ,$681.43 ,$681.43 , N/A ,$604.66 ,$697.85 ,$241.86 ,$821.00 ,$47.77 ,$47.77 ,$697.85 ,$507.91 ,$697.85 ,$738.90 ,$241.86 ,$681.43 ,$652.70 ,$652.70 ,$241.86 ,$533.65 
ST. JOSEPH'S HOSPITAL - BREESE,46000014,94618,HC WALK TEST 6 MIN,460,1 ,$323.00 ,$209.95 ,$104.19 ,$323.00 ,$274.55 ,$192.83 ,$104.19 ,$185.73 ,$104.19 ,$222.55 ,$274.55 ,$274.55 ,$274.55 , N/A ,$219.64 ,$104.19 ,$104.19 ,$242.25 ,$229.33 ,$229.33 ,$104.19 ,$229.33 ,$268.09 ,$268.09 ,$268.09 , N/A ,$260.47 ,$274.55 ,$104.19 ,$323.00 ,$145.96 ,$145.96 ,$274.55 ,$218.80 ,$274.55 ,$290.70 ,$104.19 ,$268.09 ,$256.79 ,$256.79 ,$104.19 ,$209.95 
ST. JOSEPH'S HOSPITAL - BREESE,46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$363.00 ,$235.95 ,$47.77 ,$363.00 ,$308.55 ,$216.71 , N/A ,$208.73 , N/A ,$250.11 ,$308.55 ,$308.55 ,$308.55 , N/A ,$246.84 , N/A , N/A ,$272.25 ,$257.73 ,$257.73 , N/A ,$257.73 ,$301.29 ,$301.29 ,$301.29 , N/A , N/A ,$308.55 , N/A ,$363.00 ,$47.77 ,$47.77 ,$308.55 , N/A ,$308.55 ,$326.70 , N/A ,$301.29 ,$288.59 ,$288.59 , N/A ,$235.95 
ST. JOSEPH'S HOSPITAL - BREESE,46000021,94760,HC PULSE OX SINGLE,460,1 ,$83.00 ,$53.95 ,$47.73 ,$83.00 ,$70.55 ,$49.55 , N/A ,$47.73 , N/A ,$57.19 ,$70.55 ,$70.55 ,$70.55 , N/A ,$56.44 , N/A , N/A ,$62.25 ,$58.93 ,$58.93 , N/A ,$58.93 ,$68.89 ,$68.89 ,$68.89 , N/A , N/A ,$70.55 , N/A ,$83.00 , N/A , N/A ,$70.55 , N/A ,$70.55 ,$74.70 , N/A ,$68.89 ,$65.99 ,$65.99 , N/A ,$53.95 
ST. JOSEPH'S HOSPITAL - BREESE,46000022,94200,HC MAXIMAL VOL VENTILATION,942,1 ,$177.00 ,$115.05 ,$52.57 ,$177.00 ,$150.45 ,$105.67 ,$52.57 ,$101.78 ,$52.57 ,$121.95 ,$150.45 ,$150.45 ,$150.45 , N/A ,$120.36 ,$52.57 ,$52.57 ,$132.75 ,$125.67 ,$125.67 ,$52.57 ,$125.67 ,$146.91 ,$146.91 ,$146.91 , N/A ,$131.42 ,$150.45 ,$52.57 ,$177.00 , N/A , N/A ,$150.45 ,$110.39 ,$150.45 ,$159.30 ,$52.57 ,$146.91 ,$140.72 ,$140.72 ,$52.57 ,$115.05 
ST. JOSEPH'S HOSPITAL - BREESE,47000001,92587,HC DISTORTION EVOKED POTENT LTD,470,1 ,$277.00 ,$180.05 ,$139.32 ,$507.91 ,$235.45 ,$165.37 ,$241.86 ,$159.28 ,$241.86 ,$190.85 ,$235.45 ,$235.45 ,$235.45 , N/A ,$188.36 ,$241.86 ,$241.86 ,$207.75 ,$196.67 ,$196.67 ,$241.86 ,$196.67 ,$229.91 ,$229.91 ,$229.91 , N/A ,$277.00 ,$235.45 ,$241.86 ,$277.00 ,$139.32 ,$139.32 ,$235.45 ,$507.91 ,$235.45 ,$249.30 ,$241.86 ,$229.91 ,$220.22 ,$220.22 ,$241.86 ,$180.05 
ST. JOSEPH'S HOSPITAL - BREESE,47000003,92586,HC NEWBORN HEARING SCREENING,470,1 ,$120.00 ,$78.00 ,$69.00 ,$277.64 ,$102.00 ,$71.64 ,$132.21 ,$69.00 ,$132.21 ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 ,$132.21 ,$132.21 ,$90.00 ,$85.20 ,$85.20 ,$132.21 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$120.00 ,$102.00 ,$132.21 ,$120.00 ,$209.74 ,$115.80 ,$102.00 ,$277.64 ,$102.00 ,$108.00 ,$132.21 ,$99.60 ,$95.40 ,$95.40 ,$132.21 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000014,V5014,HC REPROGRAM HEARING AID W/O WARRANTY,470,1 ,$72.00 ,$46.80 ,$41.40 ,$88.18 ,$61.20 ,$42.98 , N/A ,$41.40 , N/A ,$49.61 ,$61.20 ,$61.20 ,$61.20 , N/A ,$48.96 , N/A , N/A ,$54.00 ,$51.12 ,$51.12 , N/A ,$51.12 ,$59.76 ,$59.76 ,$59.76 , N/A , N/A ,$61.20 , N/A ,$72.00 ,$88.18 ,$69.48 ,$61.20 , N/A ,$61.20 ,$64.80 , N/A ,$59.76 ,$57.24 ,$57.24 , N/A ,$46.80 
ST. JOSEPH'S HOSPITAL - BREESE,47000015,V5014,HC REPAIR HEARING AID T1,470,1 ,$6.00 ,$3.90 ,$3.45 ,$88.18 ,$5.10 ,$3.58 , N/A ,$3.45 , N/A ,$4.13 ,$5.10 ,$5.10 ,$5.10 , N/A ,$4.08 , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.98 ,$4.98 ,$4.98 , N/A , N/A ,$5.10 , N/A ,$6.00 ,$88.18 ,$5.79 ,$5.10 , N/A ,$5.10 ,$5.40 , N/A ,$4.98 ,$4.77 ,$4.77 , N/A ,$3.90 
ST. JOSEPH'S HOSPITAL - BREESE,47000016,V5014,HC REPAIR HEARING AID T2,470,1 ,$11.00 ,$7.15 ,$6.33 ,$88.18 ,$9.35 ,$6.57 , N/A ,$6.33 , N/A ,$7.58 ,$9.35 ,$9.35 ,$9.35 , N/A ,$7.48 , N/A , N/A ,$8.25 ,$7.81 ,$7.81 , N/A ,$7.81 ,$9.13 ,$9.13 ,$9.13 , N/A , N/A ,$9.35 , N/A ,$11.00 ,$88.18 ,$10.62 ,$9.35 , N/A ,$9.35 ,$9.90 , N/A ,$9.13 ,$8.75 ,$8.75 , N/A ,$7.15 
ST. JOSEPH'S HOSPITAL - BREESE,47000017,V5014,HC REPAIR HEARING AID T3,470,1 ,$22.00 ,$14.30 ,$12.65 ,$88.18 ,$18.70 ,$13.13 , N/A ,$12.65 , N/A ,$15.16 ,$18.70 ,$18.70 ,$18.70 , N/A ,$14.96 , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.26 ,$18.26 ,$18.26 , N/A , N/A ,$18.70 , N/A ,$22.00 ,$88.18 ,$21.23 ,$18.70 , N/A ,$18.70 ,$19.80 , N/A ,$18.26 ,$17.49 ,$17.49 , N/A ,$14.30 
ST. JOSEPH'S HOSPITAL - BREESE,47000018,V5014,HC REPAIR HEARING AID T4,470,1 ,$28.00 ,$18.20 ,$16.10 ,$88.18 ,$23.80 ,$16.72 , N/A ,$16.10 , N/A ,$19.29 ,$23.80 ,$23.80 ,$23.80 , N/A ,$19.04 , N/A , N/A ,$21.00 ,$19.88 ,$19.88 , N/A ,$19.88 ,$23.24 ,$23.24 ,$23.24 , N/A , N/A ,$23.80 , N/A ,$28.00 ,$88.18 ,$27.02 ,$23.80 , N/A ,$23.80 ,$25.20 , N/A ,$23.24 ,$22.26 ,$22.26 , N/A ,$18.20 
ST. JOSEPH'S HOSPITAL - BREESE,47000019,V5014,HC REPAIR HEARING AID T5,470,1 ,$55.00 ,$35.75 ,$31.63 ,$88.18 ,$46.75 ,$32.84 , N/A ,$31.63 , N/A ,$37.90 ,$46.75 ,$46.75 ,$46.75 , N/A ,$37.40 , N/A , N/A ,$41.25 ,$39.05 ,$39.05 , N/A ,$39.05 ,$45.65 ,$45.65 ,$45.65 , N/A , N/A ,$46.75 , N/A ,$55.00 ,$88.18 ,$53.08 ,$46.75 , N/A ,$46.75 ,$49.50 , N/A ,$45.65 ,$43.73 ,$43.73 , N/A ,$35.75 
ST. JOSEPH'S HOSPITAL - BREESE,47000020,V5014,HC REPAIR HEARING AID T6,470,1 ,$72.00 ,$46.80 ,$41.40 ,$88.18 ,$61.20 ,$42.98 , N/A ,$41.40 , N/A ,$49.61 ,$61.20 ,$61.20 ,$61.20 , N/A ,$48.96 , N/A , N/A ,$54.00 ,$51.12 ,$51.12 , N/A ,$51.12 ,$59.76 ,$59.76 ,$59.76 , N/A , N/A ,$61.20 , N/A ,$72.00 ,$88.18 ,$69.48 ,$61.20 , N/A ,$61.20 ,$64.80 , N/A ,$59.76 ,$57.24 ,$57.24 , N/A ,$46.80 
ST. JOSEPH'S HOSPITAL - BREESE,47000021,V5014,HC REPAIR HEARING AID T7,470,1 ,$82.00 ,$53.30 ,$47.15 ,$88.18 ,$69.70 ,$48.95 , N/A ,$47.15 , N/A ,$56.50 ,$69.70 ,$69.70 ,$69.70 , N/A ,$55.76 , N/A , N/A ,$61.50 ,$58.22 ,$58.22 , N/A ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A , N/A ,$69.70 , N/A ,$82.00 ,$88.18 ,$79.13 ,$69.70 , N/A ,$69.70 ,$73.80 , N/A ,$68.06 ,$65.19 ,$65.19 , N/A ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,47000022,V5014,HC REPAIR HEARING AID T8,470,1 ,$110.00 ,$71.50 ,$63.25 ,$110.00 ,$93.50 ,$65.67 , N/A ,$63.25 , N/A ,$75.79 ,$93.50 ,$93.50 ,$93.50 , N/A ,$74.80 , N/A , N/A ,$82.50 ,$78.10 ,$78.10 , N/A ,$78.10 ,$91.30 ,$91.30 ,$91.30 , N/A , N/A ,$93.50 , N/A ,$110.00 ,$88.18 ,$88.18 ,$93.50 , N/A ,$93.50 ,$99.00 , N/A ,$91.30 ,$87.45 ,$87.45 , N/A ,$71.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000023,V5014,HC REPAIR HEARING AID T9,470,1 ,$242.00 ,$157.30 ,$88.18 ,$242.00 ,$205.70 ,$144.47 , N/A ,$139.15 , N/A ,$166.74 ,$205.70 ,$205.70 ,$205.70 , N/A ,$164.56 , N/A , N/A ,$181.50 ,$171.82 ,$171.82 , N/A ,$171.82 ,$200.86 ,$200.86 ,$200.86 , N/A , N/A ,$205.70 , N/A ,$242.00 ,$88.18 ,$88.18 ,$205.70 , N/A ,$205.70 ,$217.80 , N/A ,$200.86 ,$192.39 ,$192.39 , N/A ,$157.30 
ST. JOSEPH'S HOSPITAL - BREESE,47000024,V5014,HC REPAIR HEARING AID T10,470,1 ,$286.00 ,$185.90 ,$88.18 ,$286.00 ,$243.10 ,$170.74 , N/A ,$164.45 , N/A ,$197.05 ,$243.10 ,$243.10 ,$243.10 , N/A ,$194.48 , N/A , N/A ,$214.50 ,$203.06 ,$203.06 , N/A ,$203.06 ,$237.38 ,$237.38 ,$237.38 , N/A , N/A ,$243.10 , N/A ,$286.00 ,$88.18 ,$88.18 ,$243.10 , N/A ,$243.10 ,$257.40 , N/A ,$237.38 ,$227.37 ,$227.37 , N/A ,$185.90 
ST. JOSEPH'S HOSPITAL - BREESE,47000025,V5014,HC REPAIR HEARING AID T11,470,1 ,$308.00 ,$200.20 ,$88.18 ,$308.00 ,$261.80 ,$183.88 , N/A ,$177.10 , N/A ,$212.21 ,$261.80 ,$261.80 ,$261.80 , N/A ,$209.44 , N/A , N/A ,$231.00 ,$218.68 ,$218.68 , N/A ,$218.68 ,$255.64 ,$255.64 ,$255.64 , N/A , N/A ,$261.80 , N/A ,$308.00 ,$88.18 ,$88.18 ,$261.80 , N/A ,$261.80 ,$277.20 , N/A ,$255.64 ,$244.86 ,$244.86 , N/A ,$200.20 
ST. JOSEPH'S HOSPITAL - BREESE,47000026,V5014,HC REPAIR HEARING AID T12,470,1 ,$330.00 ,$214.50 ,$88.18 ,$330.00 ,$280.50 ,$197.01 , N/A ,$189.75 , N/A ,$227.37 ,$280.50 ,$280.50 ,$280.50 , N/A ,$224.40 , N/A , N/A ,$247.50 ,$234.30 ,$234.30 , N/A ,$234.30 ,$273.90 ,$273.90 ,$273.90 , N/A , N/A ,$280.50 , N/A ,$330.00 ,$88.18 ,$88.18 ,$280.50 , N/A ,$280.50 ,$297.00 , N/A ,$273.90 ,$262.35 ,$262.35 , N/A ,$214.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000027,V5014,HC REPAIR HEARING AID T13,470,1 ,$385.00 ,$250.25 ,$88.18 ,$385.00 ,$327.25 ,$229.85 , N/A ,$221.38 , N/A ,$265.27 ,$327.25 ,$327.25 ,$327.25 , N/A ,$261.80 , N/A , N/A ,$288.75 ,$273.35 ,$273.35 , N/A ,$273.35 ,$319.55 ,$319.55 ,$319.55 , N/A , N/A ,$327.25 , N/A ,$385.00 ,$88.18 ,$88.18 ,$327.25 , N/A ,$327.25 ,$346.50 , N/A ,$319.55 ,$306.08 ,$306.08 , N/A ,$250.25 
ST. JOSEPH'S HOSPITAL - BREESE,47000028,V5010,HC HEARING AID ASSESSMENT,470,1 ,$214.00 ,$139.10 ,$88.18 ,$214.00 ,$181.90 ,$127.76 , N/A ,$123.05 , N/A ,$147.45 ,$181.90 ,$181.90 ,$181.90 , N/A ,$145.52 , N/A , N/A ,$160.50 ,$151.94 ,$151.94 , N/A ,$151.94 ,$177.62 ,$177.62 ,$177.62 , N/A , N/A ,$181.90 , N/A ,$214.00 ,$88.18 ,$88.18 ,$181.90 , N/A ,$181.90 ,$192.60 , N/A ,$177.62 ,$170.13 ,$170.13 , N/A ,$139.10 
ST. JOSEPH'S HOSPITAL - BREESE,47000029,V5011,HC HEARING AID FITTING/CHECK,470,1 ,$1.10 ,$0.72 ,$0.63 ,$88.18 ,$0.94 ,$0.66 , N/A ,$0.63 , N/A ,$0.76 ,$0.94 ,$0.94 ,$0.94 , N/A ,$0.75 , N/A , N/A ,$0.83 ,$0.78 ,$0.78 , N/A ,$0.78 ,$0.91 ,$0.91 ,$0.91 , N/A , N/A ,$0.94 , N/A ,$1.10 ,$88.18 ,$1.06 ,$0.94 , N/A ,$0.94 ,$0.99 , N/A ,$0.91 ,$0.87 ,$0.87 , N/A ,$0.72 
ST. JOSEPH'S HOSPITAL - BREESE,47000030,V5020,HC CONFORMITY EVAL,470,1 ,$72.00 ,$46.80 ,$41.40 ,$88.18 ,$61.20 ,$42.98 , N/A ,$41.40 , N/A ,$49.61 ,$61.20 ,$61.20 ,$61.20 , N/A ,$48.96 , N/A , N/A ,$54.00 ,$51.12 ,$51.12 , N/A ,$51.12 ,$59.76 ,$59.76 ,$59.76 , N/A , N/A ,$61.20 , N/A ,$72.00 ,$88.18 ,$69.48 ,$61.20 , N/A ,$61.20 ,$64.80 , N/A ,$59.76 ,$57.24 ,$57.24 , N/A ,$46.80 
ST. JOSEPH'S HOSPITAL - BREESE,47000031,V5299,HC WARRANTY REPAIR/LOSS DELUXE,470,1 ,$241.00 ,$156.65 ,$138.58 ,$241.00 ,$204.85 ,$143.88 , N/A ,$138.58 , N/A ,$166.05 ,$204.85 ,$204.85 ,$204.85 , N/A ,$163.88 , N/A , N/A ,$180.75 ,$171.11 ,$171.11 , N/A ,$171.11 ,$200.03 ,$200.03 ,$200.03 , N/A , N/A ,$204.85 , N/A ,$241.00 , N/A , N/A ,$204.85 , N/A ,$204.85 ,$216.90 , N/A ,$200.03 ,$191.60 ,$191.60 , N/A ,$156.65 
ST. JOSEPH'S HOSPITAL - BREESE,47000032,V5299,HC WARRANTY REPAIR/LOSS,470,1 ,$202.00 ,$131.30 ,$116.15 ,$202.00 ,$171.70 ,$120.59 , N/A ,$116.15 , N/A ,$139.18 ,$171.70 ,$171.70 ,$171.70 , N/A ,$137.36 , N/A , N/A ,$151.50 ,$143.42 ,$143.42 , N/A ,$143.42 ,$167.66 ,$167.66 ,$167.66 , N/A , N/A ,$171.70 , N/A ,$202.00 , N/A , N/A ,$171.70 , N/A ,$171.70 ,$181.80 , N/A ,$167.66 ,$160.59 ,$160.59 , N/A ,$131.30 
ST. JOSEPH'S HOSPITAL - BREESE,47000033,V5299,HC WARRANTY SERVICE 1 YEAR,470,1 ,$448.00 ,$291.20 ,$257.60 ,$448.00 ,$380.80 ,$267.46 , N/A ,$257.60 , N/A ,$308.67 ,$380.80 ,$380.80 ,$380.80 , N/A ,$304.64 , N/A , N/A ,$336.00 ,$318.08 ,$318.08 , N/A ,$318.08 ,$371.84 ,$371.84 ,$371.84 , N/A , N/A ,$380.80 , N/A ,$448.00 , N/A , N/A ,$380.80 , N/A ,$380.80 ,$403.20 , N/A ,$371.84 ,$356.16 ,$356.16 , N/A ,$291.20 
ST. JOSEPH'S HOSPITAL - BREESE,47000034,V5299,HC WARRANTY EXTENDED PHONAK,470,1 ,$253.00 ,$164.45 ,$145.48 ,$253.00 ,$215.05 ,$151.04 , N/A ,$145.48 , N/A ,$174.32 ,$215.05 ,$215.05 ,$215.05 , N/A ,$172.04 , N/A , N/A ,$189.75 ,$179.63 ,$179.63 , N/A ,$179.63 ,$209.99 ,$209.99 ,$209.99 , N/A , N/A ,$215.05 , N/A ,$253.00 , N/A , N/A ,$215.05 , N/A ,$215.05 ,$227.70 , N/A ,$209.99 ,$201.14 ,$201.14 , N/A ,$164.45 
ST. JOSEPH'S HOSPITAL - BREESE,47000035,V5299,HC WARRANTY EXTENDED SIGNIA,470,1 ,$99.00 ,$64.35 ,$56.93 ,$99.00 ,$84.15 ,$59.10 , N/A ,$56.93 , N/A ,$68.21 ,$84.15 ,$84.15 ,$84.15 , N/A ,$67.32 , N/A , N/A ,$74.25 ,$70.29 ,$70.29 , N/A ,$70.29 ,$82.17 ,$82.17 ,$82.17 , N/A , N/A ,$84.15 , N/A ,$99.00 , N/A , N/A ,$84.15 , N/A ,$84.15 ,$89.10 , N/A ,$82.17 ,$78.71 ,$78.71 , N/A ,$64.35 
ST. JOSEPH'S HOSPITAL - BREESE,47000036,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 500-600,470,1 ,$292.00 ,$189.80 ,$167.90 ,$292.00 ,$248.20 ,$174.32 , N/A ,$167.90 , N/A ,$201.19 ,$248.20 ,$248.20 ,$248.20 , N/A ,$198.56 , N/A , N/A ,$219.00 ,$207.32 ,$207.32 , N/A ,$207.32 ,$242.36 ,$242.36 ,$242.36 , N/A , N/A ,$248.20 , N/A ,$292.00 , N/A , N/A ,$248.20 , N/A ,$248.20 ,$262.80 , N/A ,$242.36 ,$232.14 ,$232.14 , N/A ,$189.80 
ST. JOSEPH'S HOSPITAL - BREESE,47000037,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 600-700,470,1 ,$341.00 ,$221.65 ,$196.08 ,$341.00 ,$289.85 ,$203.58 , N/A ,$196.08 , N/A ,$234.95 ,$289.85 ,$289.85 ,$289.85 , N/A ,$231.88 , N/A , N/A ,$255.75 ,$242.11 ,$242.11 , N/A ,$242.11 ,$283.03 ,$283.03 ,$283.03 , N/A , N/A ,$289.85 , N/A ,$341.00 , N/A , N/A ,$289.85 , N/A ,$289.85 ,$306.90 , N/A ,$283.03 ,$271.10 ,$271.10 , N/A ,$221.65 
ST. JOSEPH'S HOSPITAL - BREESE,47000038,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 700-800,470,1 ,$385.00 ,$250.25 ,$221.38 ,$385.00 ,$327.25 ,$229.85 , N/A ,$221.38 , N/A ,$265.27 ,$327.25 ,$327.25 ,$327.25 , N/A ,$261.80 , N/A , N/A ,$288.75 ,$273.35 ,$273.35 , N/A ,$273.35 ,$319.55 ,$319.55 ,$319.55 , N/A , N/A ,$327.25 , N/A ,$385.00 , N/A , N/A ,$327.25 , N/A ,$327.25 ,$346.50 , N/A ,$319.55 ,$306.08 ,$306.08 , N/A ,$250.25 
ST. JOSEPH'S HOSPITAL - BREESE,47000039,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 800-PRO,470,1 ,$770.00 ,$500.50 ,$442.75 ,$770.00 ,$654.50 ,$459.69 , N/A ,$442.75 , N/A ,$530.53 ,$654.50 ,$654.50 ,$654.50 , N/A ,$523.60 , N/A , N/A ,$577.50 ,$546.70 ,$546.70 , N/A ,$546.70 ,$639.10 ,$639.10 ,$639.10 , N/A , N/A ,$654.50 , N/A ,$770.00 , N/A , N/A ,$654.50 , N/A ,$654.50 ,$693.00 , N/A ,$639.10 ,$612.15 ,$612.15 , N/A ,$500.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000040,V5299,HC WARRANTY DEDUCTIBLE T1,470,1 ,$198.00 ,$128.70 ,$113.85 ,$198.00 ,$168.30 ,$118.21 , N/A ,$113.85 , N/A ,$136.42 ,$168.30 ,$168.30 ,$168.30 , N/A ,$134.64 , N/A , N/A ,$148.50 ,$140.58 ,$140.58 , N/A ,$140.58 ,$164.34 ,$164.34 ,$164.34 , N/A , N/A ,$168.30 , N/A ,$198.00 , N/A , N/A ,$168.30 , N/A ,$168.30 ,$178.20 , N/A ,$164.34 ,$157.41 ,$157.41 , N/A ,$128.70 
ST. JOSEPH'S HOSPITAL - BREESE,47000041,V5299,HC WARRANTY DEDUCTIBLE T2,470,1 ,$209.00 ,$135.85 ,$120.18 ,$209.00 ,$177.65 ,$124.77 , N/A ,$120.18 , N/A ,$144.00 ,$177.65 ,$177.65 ,$177.65 , N/A ,$142.12 , N/A , N/A ,$156.75 ,$148.39 ,$148.39 , N/A ,$148.39 ,$173.47 ,$173.47 ,$173.47 , N/A , N/A ,$177.65 , N/A ,$209.00 , N/A , N/A ,$177.65 , N/A ,$177.65 ,$188.10 , N/A ,$173.47 ,$166.16 ,$166.16 , N/A ,$135.85 
ST. JOSEPH'S HOSPITAL - BREESE,47000042,V5299,HC WARRANTY DEDUCTIBLE T3,470,1 ,$220.00 ,$143.00 ,$126.50 ,$220.00 ,$187.00 ,$131.34 , N/A ,$126.50 , N/A ,$151.58 ,$187.00 ,$187.00 ,$187.00 , N/A ,$149.60 , N/A , N/A ,$165.00 ,$156.20 ,$156.20 , N/A ,$156.20 ,$182.60 ,$182.60 ,$182.60 , N/A , N/A ,$187.00 , N/A ,$220.00 , N/A , N/A ,$187.00 , N/A ,$187.00 ,$198.00 , N/A ,$182.60 ,$174.90 ,$174.90 , N/A ,$143.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000043,V5299,HC WARRANTY DEDUCTIBLE T4,470,1 ,$358.00 ,$232.70 ,$205.85 ,$358.00 ,$304.30 ,$213.73 , N/A ,$205.85 , N/A ,$246.66 ,$304.30 ,$304.30 ,$304.30 , N/A ,$243.44 , N/A , N/A ,$268.50 ,$254.18 ,$254.18 , N/A ,$254.18 ,$297.14 ,$297.14 ,$297.14 , N/A , N/A ,$304.30 , N/A ,$358.00 , N/A , N/A ,$304.30 , N/A ,$304.30 ,$322.20 , N/A ,$297.14 ,$284.61 ,$284.61 , N/A ,$232.70 
ST. JOSEPH'S HOSPITAL - BREESE,47000044,V5299,HC WARRANTY DEDUCTIBLE T5,470,1 ,$385.00 ,$250.25 ,$221.38 ,$385.00 ,$327.25 ,$229.85 , N/A ,$221.38 , N/A ,$265.27 ,$327.25 ,$327.25 ,$327.25 , N/A ,$261.80 , N/A , N/A ,$288.75 ,$273.35 ,$273.35 , N/A ,$273.35 ,$319.55 ,$319.55 ,$319.55 , N/A , N/A ,$327.25 , N/A ,$385.00 , N/A , N/A ,$327.25 , N/A ,$327.25 ,$346.50 , N/A ,$319.55 ,$306.08 ,$306.08 , N/A ,$250.25 
ST. JOSEPH'S HOSPITAL - BREESE,47000045,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - STARKEY (2017  AND  EARLIER),470,1 ,$185.00 ,$120.25 ,$106.38 ,$185.00 ,$157.25 ,$110.45 , N/A ,$106.38 , N/A ,$127.47 ,$157.25 ,$157.25 ,$157.25 , N/A ,$125.80 , N/A , N/A ,$138.75 ,$131.35 ,$131.35 , N/A ,$131.35 ,$153.55 ,$153.55 ,$153.55 , N/A , N/A ,$157.25 , N/A ,$185.00 , N/A , N/A ,$157.25 , N/A ,$157.25 ,$166.50 , N/A ,$153.55 ,$147.08 ,$147.08 , N/A ,$120.25 
ST. JOSEPH'S HOSPITAL - BREESE,47000046,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - SIGNIA TIER 1,470,1 ,$210.00 ,$136.50 ,$120.75 ,$210.00 ,$178.50 ,$125.37 , N/A ,$120.75 , N/A ,$144.69 ,$178.50 ,$178.50 ,$178.50 , N/A ,$142.80 , N/A , N/A ,$157.50 ,$149.10 ,$149.10 , N/A ,$149.10 ,$174.30 ,$174.30 ,$174.30 , N/A , N/A ,$178.50 , N/A ,$210.00 , N/A , N/A ,$178.50 , N/A ,$178.50 ,$189.00 , N/A ,$174.30 ,$166.95 ,$166.95 , N/A ,$136.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000047,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - PHONAK,470,1 ,$245.00 ,$159.25 ,$140.88 ,$245.00 ,$208.25 ,$146.27 , N/A ,$140.88 , N/A ,$168.81 ,$208.25 ,$208.25 ,$208.25 , N/A ,$166.60 , N/A , N/A ,$183.75 ,$173.95 ,$173.95 , N/A ,$173.95 ,$203.35 ,$203.35 ,$203.35 , N/A , N/A ,$208.25 , N/A ,$245.00 , N/A , N/A ,$208.25 , N/A ,$208.25 ,$220.50 , N/A ,$203.35 ,$194.78 ,$194.78 , N/A ,$159.25 
ST. JOSEPH'S HOSPITAL - BREESE,47000048,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - UNITRON,470,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000049,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - WIDEX,470,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000050,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - SIGNIA TIER 2,470,1 ,$260.00 ,$169.00 ,$149.50 ,$260.00 ,$221.00 ,$155.22 , N/A ,$149.50 , N/A ,$179.14 ,$221.00 ,$221.00 ,$221.00 , N/A ,$176.80 , N/A , N/A ,$195.00 ,$184.60 ,$184.60 , N/A ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A , N/A ,$221.00 , N/A ,$260.00 , N/A , N/A ,$221.00 , N/A ,$221.00 ,$234.00 , N/A ,$215.80 ,$206.70 ,$206.70 , N/A ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000051,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - STARKEY (2018  AND  LATER),470,1 ,$270.00 ,$175.50 ,$155.25 ,$270.00 ,$229.50 ,$161.19 , N/A ,$155.25 , N/A ,$186.03 ,$229.50 ,$229.50 ,$229.50 , N/A ,$183.60 , N/A , N/A ,$202.50 ,$191.70 ,$191.70 , N/A ,$191.70 ,$224.10 ,$224.10 ,$224.10 , N/A , N/A ,$229.50 , N/A ,$270.00 , N/A , N/A ,$229.50 , N/A ,$229.50 ,$243.00 , N/A ,$224.10 ,$214.65 ,$214.65 , N/A ,$175.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000052,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - OTICON,470,1 ,$275.00 ,$178.75 ,$158.13 ,$275.00 ,$233.75 ,$164.18 , N/A ,$158.13 , N/A ,$189.48 ,$233.75 ,$233.75 ,$233.75 , N/A ,$187.00 , N/A , N/A ,$206.25 ,$195.25 ,$195.25 , N/A ,$195.25 ,$228.25 ,$228.25 ,$228.25 , N/A , N/A ,$233.75 , N/A ,$275.00 , N/A , N/A ,$233.75 , N/A ,$233.75 ,$247.50 , N/A ,$228.25 ,$218.63 ,$218.63 , N/A ,$178.75 
ST. JOSEPH'S HOSPITAL - BREESE,47000053,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - RESOUND,470,1 ,$285.00 ,$185.25 ,$163.88 ,$285.00 ,$242.25 ,$170.15 , N/A ,$163.88 , N/A ,$196.37 ,$242.25 ,$242.25 ,$242.25 , N/A ,$193.80 , N/A , N/A ,$213.75 ,$202.35 ,$202.35 , N/A ,$202.35 ,$236.55 ,$236.55 ,$236.55 , N/A , N/A ,$242.25 , N/A ,$285.00 , N/A , N/A ,$242.25 , N/A ,$242.25 ,$256.50 , N/A ,$236.55 ,$226.58 ,$226.58 , N/A ,$185.25 
ST. JOSEPH'S HOSPITAL - BREESE,47000055,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - REXTON,470,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000056,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - SIGNIA TIER 3,470,1 ,$320.00 ,$208.00 ,$184.00 ,$320.00 ,$272.00 ,$191.04 , N/A ,$184.00 , N/A ,$220.48 ,$272.00 ,$272.00 ,$272.00 , N/A ,$217.60 , N/A , N/A ,$240.00 ,$227.20 ,$227.20 , N/A ,$227.20 ,$265.60 ,$265.60 ,$265.60 , N/A , N/A ,$272.00 , N/A ,$320.00 , N/A , N/A ,$272.00 , N/A ,$272.00 ,$288.00 , N/A ,$265.60 ,$254.40 ,$254.40 , N/A ,$208.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000057,N/A,HC AMPLIFON HEARING AIDS - BASIC,470,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000058,N/A,HC AMPLIFON HEARING AIDS - WC BASIC,470,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000059,N/A,HC AMPLIFON HEARING AIDS - PLUS,470,1 ,$275.00 ,$178.75 ,$158.13 ,$275.00 ,$233.75 ,$164.18 , N/A ,$158.13 , N/A ,$189.48 ,$233.75 ,$233.75 ,$233.75 , N/A ,$187.00 , N/A , N/A ,$206.25 ,$195.25 ,$195.25 , N/A ,$195.25 ,$228.25 ,$228.25 ,$228.25 , N/A , N/A ,$233.75 , N/A ,$275.00 , N/A , N/A ,$233.75 , N/A ,$233.75 ,$247.50 , N/A ,$228.25 ,$218.63 ,$218.63 , N/A ,$178.75 
ST. JOSEPH'S HOSPITAL - BREESE,47000060,N/A,HC AMPLIFON HEARING AIDS - WC CROS,470,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000061,N/A,HC AMPLIFON HEARING AIDS - CROS,470,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000062,N/A,HC AMPLIFON HEARING AIDS - WC PLUS,470,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000063,N/A,HC AMPLIFON HEARING AIDS - ADVANTAGE,470,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000064,N/A,HC AMPLIFON HEARING AIDS - PREMIER,470,1 ,$750.00 ,$487.50 ,$431.25 ,$750.00 ,$637.50 ,$447.75 , N/A ,$431.25 , N/A ,$516.75 ,$637.50 ,$637.50 ,$637.50 , N/A ,$510.00 , N/A , N/A ,$562.50 ,$532.50 ,$532.50 , N/A ,$532.50 ,$622.50 ,$622.50 ,$622.50 , N/A , N/A ,$637.50 , N/A ,$750.00 , N/A , N/A ,$637.50 , N/A ,$637.50 ,$675.00 , N/A ,$622.50 ,$596.25 ,$596.25 , N/A ,$487.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000065,N/A,HC AMPLIFON HEARING AIDS - SIGNATURE,470,1 ,$600.00 ,$390.00 ,$345.00 ,$600.00 ,$510.00 ,$358.20 , N/A ,$345.00 , N/A ,$413.40 ,$510.00 ,$510.00 ,$510.00 , N/A ,$408.00 , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$498.00 ,$498.00 ,$498.00 , N/A , N/A ,$510.00 , N/A ,$600.00 , N/A , N/A ,$510.00 , N/A ,$510.00 ,$540.00 , N/A ,$498.00 ,$477.00 ,$477.00 , N/A ,$390.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000066,N/A,HC AMPLIFON HEARING AIDS - WC PREMIER,470,1 ,$600.00 ,$390.00 ,$345.00 ,$600.00 ,$510.00 ,$358.20 , N/A ,$345.00 , N/A ,$413.40 ,$510.00 ,$510.00 ,$510.00 , N/A ,$408.00 , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$498.00 ,$498.00 ,$498.00 , N/A , N/A ,$510.00 , N/A ,$600.00 , N/A , N/A ,$510.00 , N/A ,$510.00 ,$540.00 , N/A ,$498.00 ,$477.00 ,$477.00 , N/A ,$390.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000067,N/A,HC AMPLIFON HEARING AIDS - WC SIGNATURE,470,1 ,$600.00 ,$390.00 ,$345.00 ,$600.00 ,$510.00 ,$358.20 , N/A ,$345.00 , N/A ,$413.40 ,$510.00 ,$510.00 ,$510.00 , N/A ,$408.00 , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$498.00 ,$498.00 ,$498.00 , N/A , N/A ,$510.00 , N/A ,$600.00 , N/A , N/A ,$510.00 , N/A ,$510.00 ,$540.00 , N/A ,$498.00 ,$477.00 ,$477.00 , N/A ,$390.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000068,N/A,HC AMPLIFON HEARING AIDS - WC ADVANTAGE,470,1 ,$600.00 ,$390.00 ,$345.00 ,$600.00 ,$510.00 ,$358.20 , N/A ,$345.00 , N/A ,$413.40 ,$510.00 ,$510.00 ,$510.00 , N/A ,$408.00 , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$498.00 ,$498.00 ,$498.00 , N/A , N/A ,$510.00 , N/A ,$600.00 , N/A , N/A ,$510.00 , N/A ,$510.00 ,$540.00 , N/A ,$498.00 ,$477.00 ,$477.00 , N/A ,$390.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000069,N/A,HC UHC RETURN UNRESPONSIVE PATIENT,470,1 ,$150.00 ,$97.50 ,$86.25 ,$150.00 ,$127.50 ,$89.55 , N/A ,$86.25 , N/A ,$103.35 ,$127.50 ,$127.50 ,$127.50 , N/A ,$102.00 , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$124.50 ,$124.50 ,$124.50 , N/A , N/A ,$127.50 , N/A ,$150.00 , N/A , N/A ,$127.50 , N/A ,$127.50 ,$135.00 , N/A ,$124.50 ,$119.25 ,$119.25 , N/A ,$97.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000070,N/A,HC UHC LOSS  AND  DAMAGE 3 YR WARRANTY,470,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000071,N/A,HC UHC LOSS  AND  DAMAGE FITTING FEE,470,1 ,$200.00 ,$130.00 ,$115.00 ,$200.00 ,$170.00 ,$119.40 , N/A ,$115.00 , N/A ,$137.80 ,$170.00 ,$170.00 ,$170.00 , N/A ,$136.00 , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A , N/A ,$170.00 , N/A ,$200.00 , N/A , N/A ,$170.00 , N/A ,$170.00 ,$180.00 , N/A ,$166.00 ,$159.00 ,$159.00 , N/A ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000072,N/A,HC UHC PRO FEE - EARMOLDS W/O HA PURCHASE,470,1 ,$10.00 ,$6.50 ,$5.75 ,$10.00 ,$8.50 ,$5.97 , N/A ,$5.75 , N/A ,$6.89 ,$8.50 ,$8.50 ,$8.50 , N/A ,$6.80 , N/A , N/A ,$7.50 ,$7.10 ,$7.10 , N/A ,$7.10 ,$8.30 ,$8.30 ,$8.30 , N/A , N/A ,$8.50 , N/A ,$10.00 , N/A , N/A ,$8.50 , N/A ,$8.50 ,$9.00 , N/A ,$8.30 ,$7.95 ,$7.95 , N/A ,$6.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000073,N/A,HC UHC PRO FEE - FM RECEIVERS,470,1 ,$75.00 ,$48.75 ,$43.13 ,$75.00 ,$63.75 ,$44.78 , N/A ,$43.13 , N/A ,$51.68 ,$63.75 ,$63.75 ,$63.75 , N/A ,$51.00 , N/A , N/A ,$56.25 ,$53.25 ,$53.25 , N/A ,$53.25 ,$62.25 ,$62.25 ,$62.25 , N/A , N/A ,$63.75 , N/A ,$75.00 , N/A , N/A ,$63.75 , N/A ,$63.75 ,$67.50 , N/A ,$62.25 ,$59.63 ,$59.63 , N/A ,$48.75 
ST. JOSEPH'S HOSPITAL - BREESE,47000074,N/A,HC UHC PRO FEE - FM TRANSMITTERS,470,1 ,$100.00 ,$65.00 ,$57.50 ,$100.00 ,$85.00 ,$59.70 , N/A ,$57.50 , N/A ,$68.90 ,$85.00 ,$85.00 ,$85.00 , N/A ,$68.00 , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$83.00 ,$83.00 ,$83.00 , N/A , N/A ,$85.00 , N/A ,$100.00 , N/A , N/A ,$85.00 , N/A ,$85.00 ,$90.00 , N/A ,$83.00 ,$79.50 ,$79.50 , N/A ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000075,N/A,HC UHCPRO FEE - RETURN/CREDIT W/O REORDER,470,1 ,$150.00 ,$97.50 ,$86.25 ,$150.00 ,$127.50 ,$89.55 , N/A ,$86.25 , N/A ,$103.35 ,$127.50 ,$127.50 ,$127.50 , N/A ,$102.00 , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$124.50 ,$124.50 ,$124.50 , N/A , N/A ,$127.50 , N/A ,$150.00 , N/A , N/A ,$127.50 , N/A ,$127.50 ,$135.00 , N/A ,$124.50 ,$119.25 ,$119.25 , N/A ,$97.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000076,N/A,HC UHC PRO FEE - CROS,470,1 ,$200.00 ,$130.00 ,$115.00 ,$200.00 ,$170.00 ,$119.40 , N/A ,$115.00 , N/A ,$137.80 ,$170.00 ,$170.00 ,$170.00 , N/A ,$136.00 , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A , N/A ,$170.00 , N/A ,$200.00 , N/A , N/A ,$170.00 , N/A ,$170.00 ,$180.00 , N/A ,$166.00 ,$159.00 ,$159.00 , N/A ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000077,N/A,HC UHC PRO FEE - LOSS  AND  DAMANGE,470,1 ,$200.00 ,$130.00 ,$115.00 ,$200.00 ,$170.00 ,$119.40 , N/A ,$115.00 , N/A ,$137.80 ,$170.00 ,$170.00 ,$170.00 , N/A ,$136.00 , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A , N/A ,$170.00 , N/A ,$200.00 , N/A , N/A ,$170.00 , N/A ,$170.00 ,$180.00 , N/A ,$166.00 ,$159.00 ,$159.00 , N/A ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000078,N/A,HC UHC PRO FEE - ENTRY,470,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000079,N/A,HC UHC PRO FEE - AMPLIFY VISTA 610,470,1 ,$300.00 ,$195.00 ,$172.50 ,$300.00 ,$255.00 ,$179.10 , N/A ,$172.50 , N/A ,$206.70 ,$255.00 ,$255.00 ,$255.00 , N/A ,$204.00 , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$249.00 ,$249.00 ,$249.00 , N/A , N/A ,$255.00 , N/A ,$300.00 , N/A , N/A ,$255.00 , N/A ,$255.00 ,$270.00 , N/A ,$249.00 ,$238.50 ,$238.50 , N/A ,$195.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000080,N/A,HC UHC PRO FEE - ESSENTIAL,470,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000081,N/A,HC UHC PRO FEE - AMPLIFY VISTA 810,470,1 ,$400.00 ,$260.00 ,$230.00 ,$400.00 ,$340.00 ,$238.80 , N/A ,$230.00 , N/A ,$275.60 ,$340.00 ,$340.00 ,$340.00 , N/A ,$272.00 , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$332.00 ,$332.00 ,$332.00 , N/A , N/A ,$340.00 , N/A ,$400.00 , N/A , N/A ,$340.00 , N/A ,$340.00 ,$360.00 , N/A ,$332.00 ,$318.00 ,$318.00 , N/A ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000082,N/A,HC UHC PRO FEE - STANDARD,470,1 ,$500.00 ,$325.00 ,$287.50 ,$500.00 ,$425.00 ,$298.50 , N/A ,$287.50 , N/A ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 , N/A , N/A ,$375.00 ,$355.00 ,$355.00 , N/A ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A , N/A ,$425.00 , N/A ,$500.00 , N/A , N/A ,$425.00 , N/A ,$425.00 ,$450.00 , N/A ,$415.00 ,$397.50 ,$397.50 , N/A ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000083,N/A,HC UHC PRO FEE - ADVANCED,470,1 ,$600.00 ,$390.00 ,$345.00 ,$600.00 ,$510.00 ,$358.20 , N/A ,$345.00 , N/A ,$413.40 ,$510.00 ,$510.00 ,$510.00 , N/A ,$408.00 , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$498.00 ,$498.00 ,$498.00 , N/A , N/A ,$510.00 , N/A ,$600.00 , N/A , N/A ,$510.00 , N/A ,$510.00 ,$540.00 , N/A ,$498.00 ,$477.00 ,$477.00 , N/A ,$390.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000084,N/A,HC UHC PRO FEE - LYRIC (PER YEAR),470,1 ,$600.00 ,$390.00 ,$345.00 ,$600.00 ,$510.00 ,$358.20 , N/A ,$345.00 , N/A ,$413.40 ,$510.00 ,$510.00 ,$510.00 , N/A ,$408.00 , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$498.00 ,$498.00 ,$498.00 , N/A , N/A ,$510.00 , N/A ,$600.00 , N/A , N/A ,$510.00 , N/A ,$510.00 ,$540.00 , N/A ,$498.00 ,$477.00 ,$477.00 , N/A ,$390.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000085,N/A,HC UHC PRO FEE - PREMIER,470,1 ,$700.00 ,$455.00 ,$402.50 ,$700.00 ,$595.00 ,$417.90 , N/A ,$402.50 , N/A ,$482.30 ,$595.00 ,$595.00 ,$595.00 , N/A ,$476.00 , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$581.00 ,$581.00 ,$581.00 , N/A , N/A ,$595.00 , N/A ,$700.00 , N/A , N/A ,$595.00 , N/A ,$595.00 ,$630.00 , N/A ,$581.00 ,$556.50 ,$556.50 , N/A ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000086,N/A,HC UHC AUDIENT PROGRAM - ENTRY (MONAURAL  AND  BINAURAL),470,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000087,N/A,HC UHC AUDIENT PROGRAM - ALL OTHERS (BINAURAL),470,1 ,$350.00 ,$227.50 ,$201.25 ,$350.00 ,$297.50 ,$208.95 , N/A ,$201.25 , N/A ,$241.15 ,$297.50 ,$297.50 ,$297.50 , N/A ,$238.00 , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$290.50 ,$290.50 ,$290.50 , N/A , N/A ,$297.50 , N/A ,$350.00 , N/A , N/A ,$297.50 , N/A ,$297.50 ,$315.00 , N/A ,$290.50 ,$278.25 ,$278.25 , N/A ,$227.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000088,N/A,HC UHC AUDIENT PROGRAM - ALL OTHERS (MONAURAL),470,1 ,$250.00 ,$162.50 ,$143.75 ,$250.00 ,$212.50 ,$149.25 , N/A ,$143.75 , N/A ,$172.25 ,$212.50 ,$212.50 ,$212.50 , N/A ,$170.00 , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$207.50 ,$207.50 ,$207.50 , N/A , N/A ,$212.50 , N/A ,$250.00 , N/A , N/A ,$212.50 , N/A ,$212.50 ,$225.00 , N/A ,$207.50 ,$198.75 ,$198.75 , N/A ,$162.50 
ST. JOSEPH'S HOSPITAL - BREESE,47000089,N/A,HC UHC TESTING  AND  EVAL - PURETONE THRESHOLD W/O HA PURCHASE,470,1 ,$20.00 ,$13.00 ,$11.50 ,$20.00 ,$17.00 ,$11.94 , N/A ,$11.50 , N/A ,$13.78 ,$17.00 ,$17.00 ,$17.00 , N/A ,$13.60 , N/A , N/A ,$15.00 ,$14.20 ,$14.20 , N/A ,$14.20 ,$16.60 ,$16.60 ,$16.60 , N/A , N/A ,$17.00 , N/A ,$20.00 , N/A , N/A ,$17.00 , N/A ,$17.00 ,$18.00 , N/A ,$16.60 ,$15.90 ,$15.90 , N/A ,$13.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100001,92550,HC AUD TYMPAN/REFLEX THRESHOLD MEASURE,471,1 ,$134.00 ,$87.10 ,$77.05 ,$277.64 ,$113.90 ,$80.00 ,$132.21 ,$77.05 ,$132.21 ,$92.33 ,$113.90 ,$113.90 ,$113.90 , N/A ,$91.12 ,$132.21 ,$132.21 ,$100.50 ,$95.14 ,$95.14 ,$132.21 ,$95.14 ,$111.22 ,$111.22 ,$111.22 , N/A ,$134.00 ,$113.90 ,$132.21 ,$134.00 ,$139.32 ,$129.31 ,$113.90 ,$277.64 ,$113.90 ,$120.60 ,$132.21 ,$111.22 ,$106.53 ,$106.53 ,$132.21 ,$87.10 
ST. JOSEPH'S HOSPITAL - BREESE,47100003,92567,HC TYMPANOMETRY IMPED TEST,471,1 ,$156.00 ,$101.40 ,$31.95 ,$156.00 ,$132.60 ,$93.13 ,$31.95 ,$89.70 ,$31.95 ,$107.48 ,$132.60 ,$132.60 ,$132.60 , N/A ,$106.08 ,$31.95 ,$31.95 ,$117.00 ,$110.76 ,$110.76 ,$31.95 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$79.86 ,$132.60 ,$31.95 ,$156.00 ,$88.18 ,$88.18 ,$132.60 ,$67.09 ,$132.60 ,$140.40 ,$31.95 ,$129.48 ,$124.02 ,$124.02 ,$31.95 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,47100006,92557,HC AUD COMPREHENSIVE AUDIO,471,1 ,$375.00 ,$243.75 ,$88.18 ,$375.00 ,$318.75 ,$223.88 ,$132.21 ,$215.63 ,$132.21 ,$258.38 ,$318.75 ,$318.75 ,$318.75 , N/A ,$255.00 ,$132.21 ,$132.21 ,$281.25 ,$266.25 ,$266.25 ,$132.21 ,$266.25 ,$311.25 ,$311.25 ,$311.25 , N/A ,$330.52 ,$318.75 ,$132.21 ,$375.00 ,$88.18 ,$88.18 ,$318.75 ,$277.64 ,$318.75 ,$337.50 ,$132.21 ,$311.25 ,$298.13 ,$298.13 ,$132.21 ,$243.75 
ST. JOSEPH'S HOSPITAL - BREESE,47100007,92582,HC AUD CONDITION PLAY AUDIOMETRY,471,1 ,$185.00 ,$120.25 ,$76.28 ,$277.64 ,$157.25 ,$110.45 ,$132.21 ,$106.38 ,$132.21 ,$127.47 ,$157.25 ,$157.25 ,$157.25 , N/A ,$125.80 ,$132.21 ,$132.21 ,$138.75 ,$131.35 ,$131.35 ,$132.21 ,$131.35 ,$153.55 ,$153.55 ,$153.55 , N/A ,$185.00 ,$157.25 ,$132.21 ,$185.00 ,$76.28 ,$76.28 ,$157.25 ,$277.64 ,$157.25 ,$166.50 ,$132.21 ,$153.55 ,$147.08 ,$147.08 ,$132.21 ,$120.25 
ST. JOSEPH'S HOSPITAL - BREESE,47100008,92588,HC AUD EVOKED OTOACOUS EMISSIONS COMP EVAL,471,1 ,$120.00 ,$78.00 ,$69.00 ,$507.91 ,$102.00 ,$71.64 ,$241.86 ,$69.00 ,$241.86 ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 ,$241.86 ,$241.86 ,$90.00 ,$85.20 ,$85.20 ,$241.86 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$120.00 ,$102.00 ,$241.86 ,$120.00 ,$139.32 ,$115.80 ,$102.00 ,$507.91 ,$102.00 ,$108.00 ,$241.86 ,$99.60 ,$95.40 ,$95.40 ,$241.86 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100009,92558,HC AUD EVOKED OTOACOUS EMISSIONS SCREENING,471,1 ,$120.00 ,$78.00 ,$69.00 ,$120.00 ,$102.00 ,$71.64 , N/A ,$69.00 , N/A ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$88.18 ,$88.18 ,$102.00 , N/A ,$102.00 ,$108.00 , N/A ,$99.60 ,$95.40 ,$95.40 , N/A ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100011,92553,HC AUD PURE TONE AIR  AND  BONE,471,1 ,$305.00 ,$198.25 ,$88.18 ,$305.00 ,$259.25 ,$182.09 ,$132.21 ,$175.38 ,$132.21 ,$210.15 ,$259.25 ,$259.25 ,$259.25 , N/A ,$207.40 ,$132.21 ,$132.21 ,$228.75 ,$216.55 ,$216.55 ,$132.21 ,$216.55 ,$253.15 ,$253.15 ,$253.15 , N/A ,$305.00 ,$259.25 ,$132.21 ,$305.00 ,$88.18 ,$88.18 ,$259.25 ,$277.64 ,$259.25 ,$274.50 ,$132.21 ,$253.15 ,$242.48 ,$242.48 ,$132.21 ,$198.25 
ST. JOSEPH'S HOSPITAL - BREESE,47100012,92553,HC AUD PURE TONE AIR  AND  BONE -52,471,1 ,$305.00 ,$198.25 ,$44.09 ,$305.00 ,$259.25 ,$182.09 ,$66.10 ,$175.38 ,$66.10 ,$210.15 ,$259.25 ,$259.25 ,$259.25 , N/A ,$207.40 ,$66.10 ,$66.10 ,$228.75 ,$216.55 ,$216.55 ,$66.10 ,$216.55 ,$253.15 ,$253.15 ,$253.15 , N/A ,$165.26 ,$259.25 ,$66.10 ,$305.00 ,$44.09 ,$44.09 ,$259.25 ,$138.82 ,$259.25 ,$274.50 ,$66.10 ,$253.15 ,$242.48 ,$242.48 ,$66.10 ,$198.25 
ST. JOSEPH'S HOSPITAL - BREESE,47100013,92552,HC AUD PURE TONE AIR ONLY,471,1 ,$88.00 ,$57.20 ,$50.60 ,$218.80 ,$74.80 ,$52.54 ,$104.19 ,$50.60 ,$104.19 ,$60.63 ,$74.80 ,$74.80 ,$74.80 , N/A ,$59.84 ,$104.19 ,$104.19 ,$66.00 ,$62.48 ,$62.48 ,$104.19 ,$62.48 ,$73.04 ,$73.04 ,$73.04 , N/A ,$88.00 ,$74.80 ,$104.19 ,$88.00 ,$88.18 ,$84.92 ,$74.80 ,$218.80 ,$74.80 ,$79.20 ,$104.19 ,$73.04 ,$69.96 ,$69.96 ,$104.19 ,$57.20 
ST. JOSEPH'S HOSPITAL - BREESE,47100014,92583,HC AUD SELECT PICTURE AUDIOMETRY,471,1 ,$119.00 ,$77.35 ,$31.95 ,$119.00 ,$101.15 ,$71.04 ,$31.95 ,$68.43 ,$31.95 ,$81.99 ,$101.15 ,$101.15 ,$101.15 , N/A ,$80.92 ,$31.95 ,$31.95 ,$89.25 ,$84.49 ,$84.49 ,$31.95 ,$84.49 ,$98.77 ,$98.77 ,$98.77 , N/A ,$79.86 ,$101.15 ,$31.95 ,$119.00 ,$76.28 ,$76.28 ,$101.15 ,$67.09 ,$101.15 ,$107.10 ,$31.95 ,$98.77 ,$94.61 ,$94.61 ,$31.95 ,$77.35 
ST. JOSEPH'S HOSPITAL - BREESE,47100015,92555,HC AUD SPEECH THRESHOLD,471,1 ,$87.00 ,$56.55 ,$31.95 ,$88.18 ,$73.95 ,$51.94 ,$31.95 ,$50.03 ,$31.95 ,$59.94 ,$73.95 ,$73.95 ,$73.95 , N/A ,$59.16 ,$31.95 ,$31.95 ,$65.25 ,$61.77 ,$61.77 ,$31.95 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$79.86 ,$73.95 ,$31.95 ,$87.00 ,$88.18 ,$83.96 ,$73.95 ,$67.09 ,$73.95 ,$78.30 ,$31.95 ,$72.21 ,$69.17 ,$69.17 ,$31.95 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,47100016,92556,HC AUD SPEECH THRESHOLD W/SPEECH RECOGNITION,471,1 ,$156.00 ,$101.40 ,$31.95 ,$156.00 ,$132.60 ,$93.13 ,$31.95 ,$89.70 ,$31.95 ,$107.48 ,$132.60 ,$132.60 ,$132.60 , N/A ,$106.08 ,$31.95 ,$31.95 ,$117.00 ,$110.76 ,$110.76 ,$31.95 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$79.86 ,$132.60 ,$31.95 ,$156.00 ,$88.18 ,$88.18 ,$132.60 ,$67.09 ,$132.60 ,$140.40 ,$31.95 ,$129.48 ,$124.02 ,$124.02 ,$31.95 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,47100017,92579,HC AUD VISUAL REINFORCEMENT AUDIOMETRY,471,1 ,$204.00 ,$132.60 ,$88.18 ,$277.64 ,$173.40 ,$121.79 ,$132.21 ,$117.30 ,$132.21 ,$140.56 ,$173.40 ,$173.40 ,$173.40 , N/A ,$138.72 ,$132.21 ,$132.21 ,$153.00 ,$144.84 ,$144.84 ,$132.21 ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A ,$204.00 ,$173.40 ,$132.21 ,$204.00 ,$88.18 ,$88.18 ,$173.40 ,$277.64 ,$173.40 ,$183.60 ,$132.21 ,$169.32 ,$162.18 ,$162.18 ,$132.21 ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,47100019,92537,HC CALORIC VESTIBULAR TEST W/REC BILAT BITHERMAL,471,1 ,$561.00 ,$364.65 ,$132.21 ,$561.00 ,$476.85 ,$334.92 ,$132.21 ,$322.58 ,$132.21 ,$386.53 ,$476.85 ,$476.85 ,$476.85 , N/A ,$381.48 ,$132.21 ,$132.21 ,$420.75 ,$398.31 ,$398.31 ,$132.21 ,$398.31 ,$465.63 ,$465.63 ,$465.63 , N/A ,$330.52 ,$476.85 ,$132.21 ,$561.00 ,$139.32 ,$139.32 ,$476.85 ,$277.64 ,$476.85 ,$504.90 ,$132.21 ,$465.63 ,$446.00 ,$446.00 ,$132.21 ,$364.65 
ST. JOSEPH'S HOSPITAL - BREESE,47100020,92538,HC CALORIC VESTIBULAR TEST W/REC BILAT MONOTHERMAL,471,1 ,$561.00 ,$364.65 ,$132.21 ,$561.00 ,$476.85 ,$334.92 ,$132.21 ,$322.58 ,$132.21 ,$386.53 ,$476.85 ,$476.85 ,$476.85 , N/A ,$381.48 ,$132.21 ,$132.21 ,$420.75 ,$398.31 ,$398.31 ,$132.21 ,$398.31 ,$465.63 ,$465.63 ,$465.63 , N/A ,$330.52 ,$476.85 ,$132.21 ,$561.00 ,$139.32 ,$139.32 ,$476.85 ,$277.64 ,$476.85 ,$504.90 ,$132.21 ,$465.63 ,$446.00 ,$446.00 ,$132.21 ,$364.65 
ST. JOSEPH'S HOSPITAL - BREESE,47100021,92540,HC BASIC VESTIBULAR EVAL,471,1 ,$828.00 ,$538.20 ,$132.21 ,$828.00 ,$703.80 ,$494.32 ,$132.21 ,$476.10 ,$132.21 ,$570.49 ,$703.80 ,$703.80 ,$703.80 , N/A ,$563.04 ,$132.21 ,$132.21 ,$621.00 ,$587.88 ,$587.88 ,$132.21 ,$587.88 ,$687.24 ,$687.24 ,$687.24 , N/A ,$330.52 ,$703.80 ,$132.21 ,$828.00 ,$139.32 ,$139.32 ,$703.80 ,$277.64 ,$703.80 ,$745.20 ,$132.21 ,$687.24 ,$658.26 ,$658.26 ,$132.21 ,$538.20 
ST. JOSEPH'S HOSPITAL - BREESE,47100023,92542,HC POSITIONAL NYSTAGMUS TEST W/RECORDING,471,1 ,$311.00 ,$202.15 ,$76.28 ,$311.00 ,$264.35 ,$185.67 ,$104.19 ,$178.83 ,$104.19 ,$214.28 ,$264.35 ,$264.35 ,$264.35 , N/A ,$211.48 ,$104.19 ,$104.19 ,$233.25 ,$220.81 ,$220.81 ,$104.19 ,$220.81 ,$258.13 ,$258.13 ,$258.13 , N/A ,$260.47 ,$264.35 ,$104.19 ,$311.00 ,$76.28 ,$76.28 ,$264.35 ,$218.80 ,$264.35 ,$279.90 ,$104.19 ,$258.13 ,$247.25 ,$247.25 ,$104.19 ,$202.15 
ST. JOSEPH'S HOSPITAL - BREESE,47100038,92592,HC HEARING AID CHECK MONAURAL,471,1 ,$68.00 ,$44.20 ,$39.10 ,$88.18 ,$57.80 ,$40.60 , N/A ,$39.10 , N/A ,$46.85 ,$57.80 ,$57.80 ,$57.80 , N/A ,$46.24 , N/A , N/A ,$51.00 ,$48.28 ,$48.28 , N/A ,$48.28 ,$56.44 ,$56.44 ,$56.44 , N/A , N/A ,$57.80 , N/A ,$68.00 ,$88.18 ,$65.62 ,$57.80 , N/A ,$57.80 ,$61.20 , N/A ,$56.44 ,$54.06 ,$54.06 , N/A ,$44.20 
ST. JOSEPH'S HOSPITAL - BREESE,47100039,92591,HC HEARING AID EXAM BINAURAL,471,1 ,$195.00 ,$126.75 ,$88.18 ,$195.00 ,$165.75 ,$116.42 , N/A ,$112.13 , N/A ,$134.36 ,$165.75 ,$165.75 ,$165.75 , N/A ,$132.60 , N/A , N/A ,$146.25 ,$138.45 ,$138.45 , N/A ,$138.45 ,$161.85 ,$161.85 ,$161.85 , N/A , N/A ,$165.75 , N/A ,$195.00 ,$88.18 ,$88.18 ,$165.75 , N/A ,$165.75 ,$175.50 , N/A ,$161.85 ,$155.03 ,$155.03 , N/A ,$126.75 
ST. JOSEPH'S HOSPITAL - BREESE,47100040,92590,HC HEARING AID EXAM MONAURAL,471,1 ,$185.00 ,$120.25 ,$88.18 ,$185.00 ,$157.25 ,$110.45 , N/A ,$106.38 , N/A ,$127.47 ,$157.25 ,$157.25 ,$157.25 , N/A ,$125.80 , N/A , N/A ,$138.75 ,$131.35 ,$131.35 , N/A ,$131.35 ,$153.55 ,$153.55 ,$153.55 , N/A , N/A ,$157.25 , N/A ,$185.00 ,$88.18 ,$88.18 ,$157.25 , N/A ,$157.25 ,$166.50 , N/A ,$153.55 ,$147.08 ,$147.08 , N/A ,$120.25 
ST. JOSEPH'S HOSPITAL - BREESE,47100041,92555,HC AUD SPEECH THRESHOLD -52,471,1 ,$87.00 ,$56.55 ,$15.97 ,$87.00 ,$73.95 ,$51.94 ,$15.97 ,$50.03 ,$15.97 ,$59.94 ,$73.95 ,$73.95 ,$73.95 , N/A ,$59.16 ,$15.97 ,$15.97 ,$65.25 ,$61.77 ,$61.77 ,$15.97 ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A ,$39.93 ,$73.95 ,$15.97 ,$87.00 ,$44.09 ,$44.09 ,$73.95 ,$33.54 ,$73.95 ,$78.30 ,$15.97 ,$72.21 ,$69.17 ,$69.17 ,$15.97 ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,47100042,92567,HC TYMPANOMETRY IMPED TEST -52,471,1 ,$156.00 ,$101.40 ,$15.97 ,$156.00 ,$132.60 ,$93.13 ,$15.97 ,$89.70 ,$15.97 ,$107.48 ,$132.60 ,$132.60 ,$132.60 , N/A ,$106.08 ,$15.97 ,$15.97 ,$117.00 ,$110.76 ,$110.76 ,$15.97 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$39.93 ,$132.60 ,$15.97 ,$156.00 ,$44.09 ,$44.09 ,$132.60 ,$33.54 ,$132.60 ,$140.40 ,$15.97 ,$129.48 ,$124.02 ,$124.02 ,$15.97 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,47100043,92552,HC AUD PURE TONE AIR ONLY -52,471,1 ,$88.00 ,$57.20 ,$44.09 ,$109.40 ,$74.80 ,$52.54 ,$52.09 ,$50.60 ,$52.09 ,$60.63 ,$74.80 ,$74.80 ,$74.80 , N/A ,$59.84 ,$52.09 ,$52.09 ,$66.00 ,$62.48 ,$62.48 ,$52.09 ,$62.48 ,$73.04 ,$73.04 ,$73.04 , N/A ,$88.00 ,$74.80 ,$52.09 ,$88.00 ,$44.09 ,$44.09 ,$74.80 ,$109.40 ,$74.80 ,$79.20 ,$52.09 ,$73.04 ,$69.96 ,$69.96 ,$52.09 ,$57.20 
ST. JOSEPH'S HOSPITAL - BREESE,47100044,92556,HC AUD SPEECH THRESHOLD W/SPEECH RECOGNITION -52,471,1 ,$156.00 ,$101.40 ,$15.97 ,$156.00 ,$132.60 ,$93.13 ,$15.97 ,$89.70 ,$15.97 ,$107.48 ,$132.60 ,$132.60 ,$132.60 , N/A ,$106.08 ,$15.97 ,$15.97 ,$117.00 ,$110.76 ,$110.76 ,$15.97 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$39.93 ,$132.60 ,$15.97 ,$156.00 ,$44.09 ,$44.09 ,$132.60 ,$33.54 ,$132.60 ,$140.40 ,$15.97 ,$129.48 ,$124.02 ,$124.02 ,$15.97 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,47100046,92540,HC BASIC VESTIBULAR EVAL -52,471,1 ,$828.00 ,$538.20 ,$66.10 ,$828.00 ,$703.80 ,$494.32 ,$66.10 ,$476.10 ,$66.10 ,$570.49 ,$703.80 ,$703.80 ,$703.80 , N/A ,$563.04 ,$66.10 ,$66.10 ,$621.00 ,$587.88 ,$587.88 ,$66.10 ,$587.88 ,$687.24 ,$687.24 ,$687.24 , N/A ,$165.26 ,$703.80 ,$66.10 ,$828.00 ,$69.65 ,$69.65 ,$703.80 ,$138.82 ,$703.80 ,$745.20 ,$66.10 ,$687.24 ,$658.26 ,$658.26 ,$66.10 ,$538.20 
ST. JOSEPH'S HOSPITAL - BREESE,47100047,V5008,HC HEARING SCREENING,471,1 ,$62.00 ,$40.30 ,$35.65 ,$88.18 ,$52.70 ,$37.01 , N/A ,$35.65 , N/A ,$42.72 ,$52.70 ,$52.70 ,$52.70 , N/A ,$42.16 , N/A , N/A ,$46.50 ,$44.02 ,$44.02 , N/A ,$44.02 ,$51.46 ,$51.46 ,$51.46 , N/A , N/A ,$52.70 , N/A ,$62.00 ,$88.18 ,$59.83 ,$52.70 , N/A ,$52.70 ,$55.80 , N/A ,$51.46 ,$49.29 ,$49.29 , N/A ,$40.30 
ST. JOSEPH'S HOSPITAL - BREESE,47100048,92587,HC DISTORTION AUDITORY EVOKED POTENT LTD-52,471,1 ,$277.00 ,$180.05 ,$69.65 ,$277.00 ,$235.45 ,$165.37 ,$120.93 ,$159.28 ,$120.93 ,$190.85 ,$235.45 ,$235.45 ,$235.45 , N/A ,$188.36 ,$120.93 ,$120.93 ,$207.75 ,$196.67 ,$196.67 ,$120.93 ,$196.67 ,$229.91 ,$229.91 ,$229.91 , N/A ,$277.00 ,$235.45 ,$120.93 ,$277.00 ,$69.65 ,$69.65 ,$235.45 ,$253.96 ,$235.45 ,$249.30 ,$120.93 ,$229.91 ,$220.22 ,$220.22 ,$120.93 ,$180.05 
ST. JOSEPH'S HOSPITAL - BREESE,47100049,92588,HC AUD EVOKED OTOACOUS EMISSIONS COMP EVAL-52,471,1 ,$120.00 ,$78.00 ,$69.00 ,$253.96 ,$102.00 ,$71.64 ,$120.93 ,$69.00 ,$120.93 ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 ,$120.93 ,$120.93 ,$90.00 ,$85.20 ,$85.20 ,$120.93 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$120.00 ,$102.00 ,$120.93 ,$120.00 ,$69.65 ,$69.65 ,$102.00 ,$253.96 ,$102.00 ,$108.00 ,$120.93 ,$99.60 ,$95.40 ,$95.40 ,$120.93 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100050,92557,HC AUD COMPREHENSIVE AUDIO-52,471,1 ,$375.00 ,$243.75 ,$44.09 ,$375.00 ,$318.75 ,$223.88 ,$66.10 ,$215.63 ,$66.10 ,$258.38 ,$318.75 ,$318.75 ,$318.75 , N/A ,$255.00 ,$66.10 ,$66.10 ,$281.25 ,$266.25 ,$266.25 ,$66.10 ,$266.25 ,$311.25 ,$311.25 ,$311.25 , N/A ,$165.26 ,$318.75 ,$66.10 ,$375.00 ,$44.09 ,$44.09 ,$318.75 ,$138.82 ,$318.75 ,$337.50 ,$66.10 ,$311.25 ,$298.13 ,$298.13 ,$66.10 ,$243.75 
ST. JOSEPH'S HOSPITAL - BREESE,47100051,92570,HC AUD ACOUSTIC REFLEX DECAY-52,471,1 ,$46.00 ,$29.90 ,$26.45 ,$138.82 ,$39.10 ,$27.46 ,$66.10 ,$26.45 ,$66.10 ,$31.69 ,$39.10 ,$39.10 ,$39.10 , N/A ,$31.28 ,$66.10 ,$66.10 ,$34.50 ,$32.66 ,$32.66 ,$66.10 ,$32.66 ,$38.18 ,$38.18 ,$38.18 , N/A ,$46.00 ,$39.10 ,$66.10 ,$46.00 ,$38.14 ,$38.14 ,$39.10 ,$138.82 ,$39.10 ,$41.40 ,$66.10 ,$38.18 ,$36.57 ,$36.57 ,$66.10 ,$29.90 
ST. JOSEPH'S HOSPITAL - BREESE,48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,$981.00 ,$637.65 ,$389.19 ,"$1,076.55 ",$833.85 ,$585.66 ,$512.64 ,$564.08 ,$512.64 ,$675.91 ,$833.85 ,$833.85 ,$833.85 , N/A ,$667.08 ,$512.64 ,$512.64 ,$735.75 ,$696.51 ,$696.51 ,$512.64 ,$696.51 ,$814.23 ,$814.23 ,$814.23 , N/A ,$981.00 ,$833.85 ,$512.64 ,$981.00 ,$389.19 ,$389.19 ,$833.85 ,"$1,076.55 ",$833.85 ,$882.90 ,$512.64 ,$814.23 ,$779.90 ,$779.90 ,$512.64 ,$637.65 
ST. JOSEPH'S HOSPITAL - BREESE,48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,219.00 ",$792.35 ,$194.99 ,"$1,219.00 ","$1,036.15 ",$727.74 ,$241.86 ,$700.93 ,$241.86 ,$839.89 ,"$1,036.15 ","$1,036.15 ","$1,036.15 ",$999.58 ,$828.92 ,$241.86 ,$241.86 ,$914.25 ,$865.49 ,$865.49 ,$241.86 ,$865.49 ,"$1,011.77 ","$1,011.77 ","$1,011.77 ", N/A ,$604.66 ,"$1,036.15 ",$241.86 ,"$1,219.00 ",$194.99 ,$194.99 ,"$1,036.15 ",$507.91 ,"$1,036.15 ","$1,097.10 ",$241.86 ,"$1,011.77 ",$969.11 ,$969.11 ,$241.86 ,$792.35 
ST. JOSEPH'S HOSPITAL - BREESE,48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$1,664.00 ","$1,081.60 ",$309.90 ,"$1,664.00 ","$1,414.40 ",$993.41 ,$460.20 ,$956.80 ,$460.20 ,"$1,146.50 ","$1,414.40 ","$1,414.40 ","$1,414.40 ","$1,364.48 ","$1,131.52 ",$460.20 ,$460.20 ,"$1,248.00 ","$1,181.44 ","$1,181.44 ",$460.20 ,"$1,181.44 ","$1,381.12 ","$1,381.12 ","$1,381.12 ", N/A ,"$1,150.49 ","$1,414.40 ",$460.20 ,"$1,664.00 ",$309.90 ,$309.90 ,"$1,414.40 ",$966.42 ,"$1,414.40 ","$1,497.60 ",$460.20 ,"$1,381.12 ","$1,322.88 ","$1,322.88 ",$460.20 ,"$1,081.60 "
ST. JOSEPH'S HOSPITAL - BREESE,48300001,93307,HC ECHOCARDIOGRAM 2D W/O DOP,483,1 ,$605.00 ,$393.25 ,$222.69 ,$605.00 ,$514.25 ,$361.19 ,$222.69 ,$347.88 ,$222.69 ,$416.85 ,$514.25 ,$514.25 ,$514.25 ,$496.10 ,$411.40 ,$222.69 ,$222.69 ,$453.75 ,$429.55 ,$429.55 ,$222.69 ,$429.55 ,$502.15 ,$502.15 ,$502.15 , N/A ,$556.73 ,$514.25 ,$222.69 ,$605.00 ,$309.90 ,$309.90 ,$514.25 ,$467.66 ,$514.25 ,$544.50 ,$222.69 ,$502.15 ,$480.98 ,$480.98 ,$222.69 ,$393.25 
ST. JOSEPH'S HOSPITAL - BREESE,48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$452.00 ,$293.80 ,$222.69 ,$467.66 ,$384.20 ,$269.84 ,$222.69 ,$259.90 ,$222.69 ,$311.43 ,$384.20 ,$384.20 ,$384.20 ,$370.64 ,$307.36 ,$222.69 ,$222.69 ,$339.00 ,$320.92 ,$320.92 ,$222.69 ,$320.92 ,$375.16 ,$375.16 ,$375.16 , N/A ,$452.00 ,$384.20 ,$222.69 ,$452.00 ,$309.90 ,$309.90 ,$384.20 ,$467.66 ,$384.20 ,$406.80 ,$222.69 ,$375.16 ,$359.34 ,$359.34 ,$222.69 ,$293.80 
ST. JOSEPH'S HOSPITAL - BREESE,48300005,93320,HC ECHO DOPPLER,483,1 ,$442.00 ,$287.30 ,$254.15 ,$442.00 ,$375.70 ,$263.87 , N/A ,$254.15 , N/A ,$304.54 ,$375.70 ,$375.70 ,$375.70 ,$362.44 ,$300.56 , N/A , N/A ,$331.50 ,$313.82 ,$313.82 , N/A ,$313.82 ,$366.86 ,$366.86 ,$366.86 , N/A , N/A ,$375.70 , N/A ,$442.00 ,$309.90 ,$309.90 ,$375.70 , N/A ,$375.70 ,$397.80 , N/A ,$366.86 ,$351.39 ,$351.39 , N/A ,$287.30 
ST. JOSEPH'S HOSPITAL - BREESE,48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$263.00 ,$170.95 ,$151.23 ,$309.90 ,$223.55 ,$157.01 , N/A ,$151.23 , N/A ,$181.21 ,$223.55 ,$223.55 ,$223.55 ,$215.66 ,$178.84 , N/A , N/A ,$197.25 ,$186.73 ,$186.73 , N/A ,$186.73 ,$218.29 ,$218.29 ,$218.29 , N/A , N/A ,$223.55 , N/A ,$263.00 ,$309.90 ,$253.80 ,$223.55 , N/A ,$223.55 ,$236.70 , N/A ,$218.29 ,$209.09 ,$209.09 , N/A ,$170.95 
ST. JOSEPH'S HOSPITAL - BREESE,48300007,93350,HC ECHO REST  AND  STRESS W/PF,483,1 ,"$1,958.00 ","$1,272.70 ",$309.90 ,"$1,958.00 ","$1,664.30 ","$1,168.93 ",$460.20 ,"$1,125.85 ",$460.20 ,"$1,349.06 ","$1,664.30 ","$1,664.30 ","$1,664.30 ","$1,605.56 ","$1,331.44 ",$460.20 ,$460.20 ,"$1,468.50 ","$1,390.18 ","$1,390.18 ",$460.20 ,"$1,390.18 ","$1,625.14 ","$1,625.14 ","$1,625.14 ", N/A ,"$1,150.49 ","$1,664.30 ",$460.20 ,"$1,958.00 ",$309.90 ,$309.90 ,"$1,664.30 ",$966.42 ,"$1,664.30 ","$1,762.20 ",$460.20 ,"$1,625.14 ","$1,556.61 ","$1,556.61 ",$460.20 ,"$1,272.70 "
ST. JOSEPH'S HOSPITAL - BREESE,48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$253.00 ,$164.45 ,$145.48 ,$309.90 ,$215.05 ,$151.04 , N/A ,$145.48 , N/A ,$174.32 ,$215.05 ,$215.05 ,$215.05 ,$207.46 ,$172.04 , N/A , N/A ,$189.75 ,$179.63 ,$179.63 , N/A ,$179.63 ,$209.99 ,$209.99 ,$209.99 , N/A , N/A ,$215.05 , N/A ,$253.00 ,$309.90 ,$244.15 ,$215.05 , N/A ,$215.05 ,$227.70 , N/A ,$209.99 ,$201.14 ,$201.14 , N/A ,$164.45 
ST. JOSEPH'S HOSPITAL - BREESE,48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$1,095.00 ",$711.75 ,$309.90 ,"$1,095.00 ",$930.75 ,$653.72 ,$364.90 ,$629.63 ,$364.90 ,$754.46 ,$930.75 ,$930.75 ,$930.75 , N/A ,$744.60 ,$364.90 ,$364.90 ,$821.25 ,$777.45 ,$777.45 ,$364.90 ,$777.45 ,$908.85 ,$908.85 ,$908.85 , N/A ,$912.24 ,$930.75 ,$364.90 ,"$1,095.00 ",$309.90 ,$309.90 ,$930.75 ,$766.28 ,$930.75 ,$985.50 ,$364.90 ,$908.85 ,$870.53 ,$870.53 ,$364.90 ,$711.75 
ST. JOSEPH'S HOSPITAL - BREESE,48300018,C8928,HC ECHO TTE 2D STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$1,965.00 ","$1,277.25 ",$309.90 ,"$1,965.00 ","$1,670.25 ","$1,173.11 ",$650.59 ,"$1,129.88 ",$650.59 ,"$1,353.89 ","$1,670.25 ","$1,670.25 ","$1,670.25 ", N/A ,"$1,336.20 ",$650.59 ,$650.59 ,"$1,473.75 ","$1,395.15 ","$1,395.15 ",$650.59 ,"$1,395.15 ","$1,630.95 ","$1,630.95 ","$1,630.95 ", N/A ,"$1,626.48 ","$1,670.25 ",$650.59 ,"$1,965.00 ",$309.90 ,$309.90 ,"$1,670.25 ","$1,366.24 ","$1,670.25 ","$1,768.50 ",$650.59 ,"$1,630.95 ","$1,562.18 ","$1,562.18 ",$650.59 ,"$1,277.25 "
ST. JOSEPH'S HOSPITAL - BREESE,48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$2,103.00 ","$1,366.95 ",$309.90 ,"$2,103.00 ","$1,787.55 ","$1,255.49 ",$650.59 ,"$1,209.23 ",$650.59 ,"$1,448.97 ","$1,787.55 ","$1,787.55 ","$1,787.55 ", N/A ,"$1,430.04 ",$650.59 ,$650.59 ,"$1,577.25 ","$1,493.13 ","$1,493.13 ",$650.59 ,"$1,493.13 ","$1,745.49 ","$1,745.49 ","$1,745.49 ", N/A ,"$1,626.48 ","$1,787.55 ",$650.59 ,"$2,103.00 ",$309.90 ,$309.90 ,"$1,787.55 ","$1,366.24 ","$1,787.55 ","$1,892.70 ",$650.59 ,"$1,745.49 ","$1,671.89 ","$1,671.89 ",$650.59 ,"$1,366.95 "
ST. JOSEPH'S HOSPITAL - BREESE,48300020,C8930,HC ECHO TTE 2D REST/STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$1,965.00 ","$1,277.25 ",$309.90 ,"$1,965.00 ","$1,670.25 ","$1,173.11 ",$650.59 ,"$1,129.88 ",$650.59 ,"$1,353.89 ","$1,670.25 ","$1,670.25 ","$1,670.25 ", N/A ,"$1,336.20 ",$650.59 ,$650.59 ,"$1,473.75 ","$1,395.15 ","$1,395.15 ",$650.59 ,"$1,395.15 ","$1,630.95 ","$1,630.95 ","$1,630.95 ", N/A ,"$1,626.48 ","$1,670.25 ",$650.59 ,"$1,965.00 ",$309.90 ,$309.90 ,"$1,670.25 ","$1,366.24 ","$1,670.25 ","$1,768.50 ",$650.59 ,"$1,630.95 ","$1,562.18 ","$1,562.18 ",$650.59 ,"$1,277.25 "
ST. JOSEPH'S HOSPITAL - BREESE,51000002,95117,HC ALLERGY SHOTS 2 OR MORE,510,1 ,$82.00 ,$53.30 ,$15.70 ,$82.00 ,$69.70 ,$48.95 ,$36.42 ,$47.15 ,$36.42 ,$56.50 ,$69.70 ,$69.70 ,$69.70 , N/A ,$55.76 ,$36.42 ,$36.42 ,$61.50 ,$58.22 ,$58.22 ,$36.42 ,$58.22 ,$68.06 ,$68.06 ,$68.06 , N/A ,$82.00 ,$69.70 ,$36.42 ,$82.00 ,$15.70 ,$15.70 ,$69.70 ,$76.48 ,$69.70 ,$73.80 ,$36.42 ,$68.06 ,$82.00 ,$82.00 ,$36.42 ,$53.30 
ST. JOSEPH'S HOSPITAL - BREESE,51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,$806.00 ,$523.90 ,$119.00 ,$806.00 ,$685.10 ,$481.18 ,$305.32 ,$463.45 ,$305.32 ,$555.33 ,$685.10 ,$685.10 ,$685.10 ,$660.92 ,$548.08 ,$305.32 ,$305.32 ,$604.50 ,$572.26 ,$572.26 ,$305.32 ,$572.26 ,$668.98 ,$668.98 ,$668.98 , N/A ,$763.31 ,$685.10 ,$305.32 ,$806.00 ,$195.86 ,$195.86 ,$685.10 ,$641.18 ,$685.10 ,$725.40 ,$305.32 ,$668.98 ,$119.00 ,$119.00 ,$305.32 ,$523.90 
ST. JOSEPH'S HOSPITAL - BREESE,51000023,11720,HC DEBR NAIL(S) UP TO 5,510,1 ,$200.00 ,$130.00 ,$52.40 ,$200.00 ,$170.00 ,$119.40 ,$52.57 ,$115.00 ,$52.57 ,$137.80 ,$170.00 ,$170.00 ,$170.00 ,$164.00 ,$136.00 ,$52.57 ,$52.57 ,$150.00 ,$142.00 ,$142.00 ,$52.57 ,$142.00 ,$166.00 ,$166.00 ,$166.00 , N/A ,$131.42 ,$170.00 ,$52.57 ,$200.00 ,$52.40 ,$52.40 ,$170.00 ,$110.39 ,$170.00 ,$180.00 ,$52.57 ,$166.00 ,$119.00 ,$119.00 ,$52.57 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000024,11721,HC DEBR NAIL(S) 6 OR MORE,510,1 ,$327.00 ,$212.55 ,$52.40 ,$327.00 ,$277.95 ,$195.22 ,$52.57 ,$188.03 ,$52.57 ,$225.30 ,$277.95 ,$277.95 ,$277.95 ,$268.14 ,$222.36 ,$52.57 ,$52.57 ,$245.25 ,$232.17 ,$232.17 ,$52.57 ,$232.17 ,$271.41 ,$271.41 ,$271.41 , N/A ,$131.42 ,$277.95 ,$52.57 ,$327.00 ,$52.40 ,$52.40 ,$277.95 ,$110.39 ,$277.95 ,$294.30 ,$52.57 ,$271.41 ,$119.00 ,$119.00 ,$52.57 ,$212.55 
ST. JOSEPH'S HOSPITAL - BREESE,51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,$846.00 ,$549.90 ,$119.00 ,$846.00 ,$719.10 ,$505.06 ,$305.32 ,$486.45 ,$305.32 ,$582.89 ,$719.10 ,$719.10 ,$719.10 ,$693.72 ,$575.28 ,$305.32 ,$305.32 ,$634.50 ,$600.66 ,$600.66 ,$305.32 ,$600.66 ,$702.18 ,$702.18 ,$702.18 , N/A ,$763.31 ,$719.10 ,$305.32 ,$846.00 ,$411.65 ,$411.65 ,$719.10 ,$641.18 ,$719.10 ,$761.40 ,$305.32 ,$702.18 ,$119.00 ,$119.00 ,$305.32 ,$549.90 
ST. JOSEPH'S HOSPITAL - BREESE,51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$330.00 ,$214.50 ,$76.28 ,$621.29 ,$280.50 ,$197.01 ,$295.85 ,$189.75 ,$295.85 ,$227.37 ,$280.50 ,$280.50 ,$280.50 ,$270.60 ,$224.40 ,$295.85 ,$295.85 ,$247.50 ,$234.30 ,$234.30 ,$295.85 ,$234.30 ,$273.90 ,$273.90 ,$273.90 , N/A ,$330.00 ,$280.50 ,$295.85 ,$330.00 ,$76.28 ,$76.28 ,$280.50 ,$621.29 ,$280.50 ,$297.00 ,$295.85 ,$273.90 ,$119.00 ,$119.00 ,$295.85 ,$214.50 
ST. JOSEPH'S HOSPITAL - BREESE,51000053,29580,HC APPLY UNNA BOOT,510,1 ,$427.00 ,$277.55 ,$119.00 ,$427.00 ,$362.95 ,$254.92 ,$127.80 ,$245.53 ,$127.80 ,$294.20 ,$362.95 ,$362.95 ,$362.95 , N/A ,$290.36 ,$127.80 ,$127.80 ,$320.25 ,$303.17 ,$303.17 ,$127.80 ,$303.17 ,$354.41 ,$354.41 ,$354.41 , N/A ,$319.50 ,$362.95 ,$127.80 ,$427.00 ,$160.98 ,$160.98 ,$362.95 ,$268.38 ,$362.95 ,$384.30 ,$127.80 ,$354.41 ,$119.00 ,$119.00 ,$127.80 ,$277.55 
ST. JOSEPH'S HOSPITAL - BREESE,51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$55.00 ,$35.75 ,$31.63 ,$121.35 ,$46.75 ,$32.84 ,$57.79 ,$31.63 ,$57.79 ,$37.90 ,$46.75 ,$46.75 ,$46.75 , N/A ,$37.40 ,$57.79 ,$57.79 ,$41.25 ,$39.05 ,$39.05 ,$57.79 ,$39.05 ,$45.65 ,$45.65 ,$45.65 , N/A ,$55.00 ,$46.75 ,$57.79 ,$55.00 , N/A , N/A ,$46.75 ,$121.35 ,$46.75 ,$49.50 ,$57.79 ,$45.65 ,$43.73 ,$43.73 ,$57.79 ,$35.75 
ST. JOSEPH'S HOSPITAL - BREESE,51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$156.00 ,$101.40 ,$89.70 ,$368.72 ,$132.60 ,$93.13 ,$175.58 ,$89.70 ,$175.58 ,$107.48 ,$132.60 ,$132.60 ,$132.60 , N/A ,$106.08 ,$175.58 ,$175.58 ,$117.00 ,$110.76 ,$110.76 ,$175.58 ,$110.76 ,$129.48 ,$129.48 ,$129.48 , N/A ,$156.00 ,$132.60 ,$175.58 ,$156.00 , N/A , N/A ,$132.60 ,$368.72 ,$132.60 ,$140.40 ,$175.58 ,$129.48 ,$124.02 ,$124.02 ,$175.58 ,$101.40 
ST. JOSEPH'S HOSPITAL - BREESE,51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$86.00 ,$55.90 ,$36.42 ,$86.00 ,$73.10 ,$51.34 ,$36.42 ,$49.45 ,$36.42 ,$59.25 ,$73.10 ,$73.10 ,$73.10 , N/A ,$58.48 ,$36.42 ,$36.42 ,$64.50 ,$61.06 ,$61.06 ,$36.42 ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A ,$86.00 ,$73.10 ,$36.42 ,$86.00 , N/A , N/A ,$73.10 ,$76.48 ,$73.10 ,$77.40 ,$36.42 ,$71.38 ,$68.37 ,$68.37 ,$36.42 ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$86.00 ,$55.90 ,$49.45 ,$86.00 ,$73.10 ,$51.34 , N/A ,$49.45 , N/A ,$59.25 ,$73.10 ,$73.10 ,$73.10 , N/A ,$58.48 , N/A , N/A ,$64.50 ,$61.06 ,$61.06 , N/A ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A , N/A ,$73.10 , N/A ,$86.00 , N/A , N/A ,$73.10 , N/A ,$73.10 ,$77.40 , N/A ,$71.38 ,$68.37 ,$68.37 , N/A ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$152.00 ,$98.80 ,$52.57 ,$152.00 ,$129.20 ,$90.74 ,$52.57 ,$87.40 ,$52.57 ,$104.73 ,$129.20 ,$129.20 ,$129.20 ,$117.04 ,$103.36 ,$52.57 ,$52.57 ,$114.00 ,$107.92 ,$107.92 ,$52.57 ,$107.92 ,$126.16 ,$126.16 ,$126.16 , N/A ,$131.42 ,$129.20 ,$52.57 ,$152.00 ,$76.28 ,$76.28 ,$129.20 ,$110.39 ,$129.20 ,$136.80 ,$52.57 ,$126.16 ,$119.00 ,$119.00 ,$52.57 ,$98.80 
ST. JOSEPH'S HOSPITAL - BREESE,51000099,99201,HC CLINIC VISIT BRIEF NEW,510,1 ,$202.00 ,$131.30 ,$49.40 ,$202.00 ,$171.70 ,$120.59 , N/A ,$116.15 , N/A ,$139.18 ,$171.70 ,$171.70 ,$171.70 , N/A ,$137.36 , N/A , N/A ,$151.50 ,$143.42 ,$143.42 , N/A ,$143.42 ,$167.66 ,$167.66 ,$167.66 , N/A , N/A ,$171.70 , N/A ,$49.40 ,$89.80 ,$89.80 ,$171.70 , N/A ,$171.70 ,$181.80 , N/A ,$167.66 ,$119.00 ,$119.00 , N/A ,$131.30 
ST. JOSEPH'S HOSPITAL - BREESE,51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$144.00 ,$93.60 ,$82.03 ,$144.00 ,$122.40 ,$85.97 , N/A ,$82.80 , N/A ,$99.22 ,$122.40 ,$122.40 ,$122.40 , N/A ,$97.92 , N/A , N/A ,$108.00 ,$102.24 ,$102.24 , N/A ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A , N/A ,$122.40 , N/A ,$82.03 ,$89.80 ,$89.80 ,$122.40 , N/A ,$122.40 ,$129.60 , N/A ,$119.52 ,$119.00 ,$119.00 , N/A ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$337.00 ,$219.05 ,$89.80 ,$337.00 ,$286.45 ,$201.19 , N/A ,$193.78 , N/A ,$232.19 ,$286.45 ,$286.45 ,$286.45 , N/A ,$229.16 , N/A , N/A ,$252.75 ,$239.27 ,$239.27 , N/A ,$239.27 ,$279.71 ,$279.71 ,$279.71 , N/A , N/A ,$286.45 , N/A ,$116.11 ,$89.80 ,$89.80 ,$286.45 , N/A ,$286.45 ,$303.30 , N/A ,$279.71 ,$119.00 ,$119.00 , N/A ,$219.05 
ST. JOSEPH'S HOSPITAL - BREESE,51000109,99204,HC CLINIC VISIT COMPLEX NEW,510,1 ,$210.00 ,$136.50 ,$89.80 ,$210.00 ,$178.50 ,$125.37 , N/A ,$120.75 , N/A ,$144.69 ,$178.50 ,$178.50 ,$178.50 , N/A ,$142.80 , N/A , N/A ,$157.50 ,$149.10 ,$149.10 , N/A ,$149.10 ,$174.30 ,$174.30 ,$174.30 , N/A , N/A ,$178.50 , N/A ,$177.80 ,$89.80 ,$89.80 ,$178.50 , N/A ,$178.50 ,$189.00 , N/A ,$174.30 ,$119.00 ,$119.00 , N/A ,$136.50 
ST. JOSEPH'S HOSPITAL - BREESE,51000113,99205,HC CLINIC VISIT COMPREH NEW,510,1 ,$541.00 ,$351.65 ,$89.80 ,$541.00 ,$459.85 ,$322.98 , N/A ,$311.08 , N/A ,$372.75 ,$459.85 ,$459.85 ,$459.85 , N/A ,$367.88 , N/A , N/A ,$405.75 ,$384.11 ,$384.11 , N/A ,$384.11 ,$449.03 ,$449.03 ,$449.03 , N/A , N/A ,$459.85 , N/A ,$224.61 ,$89.80 ,$89.80 ,$459.85 , N/A ,$459.85 ,$486.90 , N/A ,$449.03 ,$119.00 ,$119.00 , N/A ,$351.65 
ST. JOSEPH'S HOSPITAL - BREESE,51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$188.00 ,$122.20 ,$89.80 ,$188.00 ,$159.80 ,$112.24 , N/A ,$108.10 , N/A ,$129.53 ,$159.80 ,$159.80 ,$159.80 , N/A ,$127.84 , N/A , N/A ,$141.00 ,$133.48 ,$133.48 , N/A ,$133.48 ,$156.04 ,$156.04 ,$156.04 , N/A , N/A ,$159.80 , N/A ,$188.00 ,$89.80 ,$89.80 ,$159.80 , N/A ,$159.80 ,$169.20 , N/A ,$156.04 ,$119.00 ,$119.00 , N/A ,$122.20 
ST. JOSEPH'S HOSPITAL - BREESE,51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$213.00 ,$138.45 ,$49.03 ,$213.00 ,$181.05 ,$127.16 , N/A ,$122.48 , N/A ,$146.76 ,$181.05 ,$181.05 ,$181.05 , N/A ,$144.84 , N/A , N/A ,$159.75 ,$151.23 ,$151.23 , N/A ,$151.23 ,$176.79 ,$176.79 ,$176.79 , N/A , N/A ,$181.05 , N/A ,$49.03 ,$89.80 ,$89.80 ,$181.05 , N/A ,$181.05 ,$191.70 , N/A ,$176.79 ,$119.00 ,$119.00 , N/A ,$138.45 
ST. JOSEPH'S HOSPITAL - BREESE,51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$239.00 ,$155.35 ,$80.55 ,$239.00 ,$203.15 ,$142.68 , N/A ,$137.43 , N/A ,$164.67 ,$203.15 ,$203.15 ,$203.15 , N/A ,$162.52 , N/A , N/A ,$179.25 ,$169.69 ,$169.69 , N/A ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A , N/A ,$203.15 , N/A ,$80.55 ,$89.80 ,$89.80 ,$203.15 , N/A ,$203.15 ,$215.10 , N/A ,$198.37 ,$119.00 ,$119.00 , N/A ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$304.00 ,$197.60 ,$89.80 ,$304.00 ,$258.40 ,$181.49 , N/A ,$174.80 , N/A ,$209.46 ,$258.40 ,$258.40 ,$258.40 , N/A ,$206.72 , N/A , N/A ,$228.00 ,$215.84 ,$215.84 , N/A ,$215.84 ,$252.32 ,$252.32 ,$252.32 , N/A , N/A ,$258.40 , N/A ,$304.00 ,$89.80 ,$89.80 ,$258.40 , N/A ,$258.40 ,$273.60 , N/A ,$252.32 ,$119.00 ,$119.00 , N/A ,$197.60 
ST. JOSEPH'S HOSPITAL - BREESE,51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$380.00 ,$247.00 ,$89.80 ,$380.00 ,$323.00 ,$226.86 , N/A ,$218.50 , N/A ,$261.82 ,$323.00 ,$323.00 ,$323.00 , N/A ,$258.40 , N/A , N/A ,$285.00 ,$269.80 ,$269.80 , N/A ,$269.80 ,$315.40 ,$315.40 ,$315.40 , N/A , N/A ,$323.00 , N/A ,$380.00 ,$89.80 ,$89.80 ,$323.00 , N/A ,$323.00 ,$342.00 , N/A ,$315.40 ,$119.00 ,$119.00 , N/A ,$247.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$201.00 ,$130.65 ,$3.00 ,$201.00 ,$170.85 ,$120.00 ,$3.00 ,$115.58 ,$3.00 ,$138.49 ,$170.85 ,$170.85 ,$170.85 ,$164.82 ,$136.68 ,$3.00 ,$3.00 ,$150.75 ,$142.71 ,$142.71 ,$3.00 ,$142.71 ,$166.83 ,$166.83 ,$166.83 , N/A ,$7.50 ,$170.85 ,$3.00 ,$201.00 , N/A , N/A ,$170.85 ,$6.30 ,$170.85 ,$180.90 ,$3.00 ,$166.83 ,$159.80 ,$159.80 ,$3.00 ,$130.65 
ST. JOSEPH'S HOSPITAL - BREESE,51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$196.00 ,$127.40 ,$76.28 ,$218.80 ,$166.60 ,$117.01 ,$104.19 ,$112.70 ,$104.19 ,$135.04 ,$166.60 ,$166.60 ,$166.60 ,$160.72 ,$133.28 ,$104.19 ,$104.19 ,$147.00 ,$139.16 ,$139.16 ,$104.19 ,$139.16 ,$162.68 ,$162.68 ,$162.68 , N/A ,$196.00 ,$166.60 ,$104.19 ,$196.00 ,$76.28 ,$76.28 ,$166.60 ,$218.80 ,$166.60 ,$176.40 ,$104.19 ,$162.68 ,$119.00 ,$119.00 ,$104.19 ,$127.40 
ST. JOSEPH'S HOSPITAL - BREESE,51000172,51702,HC CATH BLADDER SMP,510,1 ,$214.00 ,$139.10 ,$76.28 ,$218.80 ,$181.90 ,$127.76 ,$104.19 ,$123.05 ,$104.19 ,$147.45 ,$181.90 ,$181.90 ,$181.90 ,$175.48 ,$145.52 ,$104.19 ,$104.19 ,$160.50 ,$151.94 ,$151.94 ,$104.19 ,$151.94 ,$177.62 ,$177.62 ,$177.62 , N/A ,$214.00 ,$181.90 ,$104.19 ,$214.00 ,$76.28 ,$76.28 ,$181.90 ,$218.80 ,$181.90 ,$192.60 ,$104.19 ,$177.62 ,$119.00 ,$119.00 ,$104.19 ,$139.10 
ST. JOSEPH'S HOSPITAL - BREESE,51000173,51703,HC CATH BLADDER CPLX,510,1 ,$396.63 ,$257.81 ,$76.28 ,$396.63 ,$337.14 ,$236.79 ,$132.21 ,$228.06 ,$132.21 ,$273.28 ,$337.14 ,$337.14 ,$337.14 ,$325.24 ,$269.71 ,$132.21 ,$132.21 ,$297.47 ,$281.61 ,$281.61 ,$132.21 ,$281.61 ,$329.20 ,$329.20 ,$329.20 , N/A ,$330.52 ,$337.14 ,$132.21 ,$396.63 ,$76.28 ,$76.28 ,$337.14 ,$277.64 ,$337.14 ,$356.97 ,$132.21 ,$329.20 ,$119.00 ,$119.00 ,$132.21 ,$257.81 
ST. JOSEPH'S HOSPITAL - BREESE,51000175,94780,HC CARSEAT ANALYSIS FIRST 60MIN,510,1 ,$134.00 ,$87.10 ,$31.95 ,$134.00 ,$113.90 ,$80.00 ,$31.95 ,$77.05 ,$31.95 ,$92.33 ,$113.90 ,$113.90 ,$113.90 , N/A ,$91.12 ,$31.95 ,$31.95 ,$100.50 ,$95.14 ,$95.14 ,$31.95 ,$95.14 ,$111.22 ,$111.22 ,$111.22 , N/A ,$79.86 ,$113.90 ,$31.95 ,$134.00 ,$47.77 ,$47.77 ,$113.90 ,$67.09 ,$113.90 ,$120.60 ,$31.95 ,$111.22 ,$119.00 ,$119.00 ,$31.95 ,$87.10 
ST. JOSEPH'S HOSPITAL - BREESE,51000320,94781,HC CARSEAT ANALYSIS  EA ADDN 30MIN,510,1 ,$78.00 ,$50.70 ,$44.85 ,$78.00 ,$66.30 ,$46.57 , N/A ,$44.85 , N/A ,$53.74 ,$66.30 ,$66.30 ,$66.30 , N/A ,$53.04 , N/A , N/A ,$58.50 ,$55.38 ,$55.38 , N/A ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A , N/A ,$66.30 , N/A ,$78.00 ,$47.77 ,$47.77 ,$66.30 , N/A ,$66.30 ,$70.20 , N/A ,$64.74 ,$78.00 ,$78.00 , N/A ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,51001010,99215,HC CLINIC VISIT - MEMORY INITIAL,510,1 ,$380.00 ,$247.00 ,$89.80 ,$380.00 ,$323.00 ,$226.86 , N/A ,$218.50 , N/A ,$261.82 ,$323.00 ,$323.00 ,$323.00 , N/A ,$258.40 , N/A , N/A ,$285.00 ,$269.80 ,$269.80 , N/A ,$269.80 ,$315.40 ,$315.40 ,$315.40 , N/A , N/A ,$323.00 , N/A ,$380.00 ,$89.80 ,$89.80 ,$323.00 , N/A ,$323.00 ,$342.00 , N/A ,$315.40 ,$119.00 ,$119.00 , N/A ,$247.00 
ST. JOSEPH'S HOSPITAL - BREESE,51001012,95115,HC ALLERGY SHOTS ONE INJECTION,510,1 ,$54.00 ,$35.10 ,$15.70 ,$76.48 ,$45.90 ,$32.24 ,$36.42 ,$31.05 ,$36.42 ,$37.21 ,$45.90 ,$45.90 ,$45.90 , N/A ,$36.72 ,$36.42 ,$36.42 ,$40.50 ,$38.34 ,$38.34 ,$36.42 ,$38.34 ,$44.82 ,$44.82 ,$44.82 , N/A ,$54.00 ,$45.90 ,$36.42 ,$54.00 ,$15.70 ,$15.70 ,$45.90 ,$76.48 ,$45.90 ,$48.60 ,$36.42 ,$44.82 ,$54.00 ,$54.00 ,$36.42 ,$35.10 
ST. JOSEPH'S HOSPITAL - BREESE,51070001,98960,HC EDUCATION SELF MGNT NON PHY HLTCARE PROF,510,1 ,$91.00 ,$59.15 ,$23.05 ,$91.00 ,$77.35 ,$54.33 , N/A ,$52.33 , N/A ,$62.70 ,$77.35 ,$77.35 ,$77.35 , N/A ,$61.88 , N/A , N/A ,$68.25 ,$64.61 ,$64.61 , N/A ,$64.61 ,$75.53 ,$75.53 ,$75.53 , N/A , N/A ,$77.35 , N/A ,$91.00 ,$23.05 ,$23.05 ,$77.35 , N/A ,$77.35 ,$81.90 , N/A ,$75.53 ,$91.00 ,$91.00 , N/A ,$59.15 
ST. JOSEPH'S HOSPITAL - BREESE,61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$5,062.00 ","$3,290.30 ",$221.28 ,"$5,062.00 ","$4,302.70 ","$3,022.01 ",$364.90 ,"$2,910.65 ",$364.90 ,"$3,487.72 ","$4,302.70 ","$4,302.70 ","$4,302.70 ","$4,150.84 ","$3,442.16 ",$364.90 ,$364.90 ,"$3,796.50 ","$3,594.02 ","$3,594.02 ",$364.90 ,"$3,594.02 ","$4,201.46 ","$4,201.46 ","$4,201.46 ", N/A ,$912.24 ,"$4,302.70 ",$364.90 ,"$5,062.00 ",$221.28 ,$221.28 ,"$4,302.70 ",$766.28 ,"$4,302.70 ","$4,555.80 ",$364.90 ,"$4,201.46 ","$4,024.29 ","$4,024.29 ",$364.90 ,"$3,290.30 "
ST. JOSEPH'S HOSPITAL - BREESE,61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,456.00 ","$2,246.40 ",$222.69 ,"$3,456.00 ","$2,937.60 ","$2,063.23 ",$222.69 ,"$1,987.20 ",$222.69 ,"$2,381.18 ","$2,937.60 ","$2,937.60 ","$2,937.60 ","$2,833.92 ","$2,350.08 ",$222.69 ,$222.69 ,"$2,592.00 ","$2,453.76 ","$2,453.76 ",$222.69 ,"$2,453.76 ","$2,868.48 ","$2,868.48 ","$2,868.48 ", N/A ,$556.73 ,"$2,937.60 ",$222.69 ,"$3,456.00 ",$270.91 ,$270.91 ,"$2,937.60 ",$467.66 ,"$2,937.60 ","$3,110.40 ",$222.69 ,"$2,868.48 ","$2,747.52 ","$2,747.52 ",$222.69 ,"$2,246.40 "
ST. JOSEPH'S HOSPITAL - BREESE,61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$3,631.00 ","$2,360.15 ",$270.91 ,"$3,631.00 ","$3,086.35 ","$2,167.71 ",$364.90 ,"$2,087.83 ",$364.90 ,"$2,501.76 ","$3,086.35 ","$3,086.35 ","$3,086.35 ","$2,977.42 ","$2,469.08 ",$364.90 ,$364.90 ,"$2,723.25 ","$2,578.01 ","$2,578.01 ",$364.90 ,"$2,578.01 ","$3,013.73 ","$3,013.73 ","$3,013.73 ", N/A ,$912.24 ,"$3,086.35 ",$364.90 ,"$3,631.00 ",$270.91 ,$270.91 ,"$3,086.35 ",$766.28 ,"$3,086.35 ","$3,267.90 ",$364.90 ,"$3,013.73 ","$2,886.65 ","$2,886.65 ",$364.90 ,"$2,360.15 "
ST. JOSEPH'S HOSPITAL - BREESE,61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$3,576.00 ","$2,324.40 ",$270.91 ,"$3,576.00 ","$3,039.60 ","$2,134.87 ",$364.90 ,"$2,056.20 ",$364.90 ,"$2,463.86 ","$3,039.60 ","$3,039.60 ","$3,039.60 ","$2,932.32 ","$2,431.68 ",$364.90 ,$364.90 ,"$2,682.00 ","$2,538.96 ","$2,538.96 ",$364.90 ,"$2,538.96 ","$2,968.08 ","$2,968.08 ","$2,968.08 ", N/A ,$912.24 ,"$3,039.60 ",$364.90 ,"$3,576.00 ",$270.91 ,$270.91 ,"$3,039.60 ",$766.28 ,"$3,039.60 ","$3,218.40 ",$364.90 ,"$2,968.08 ","$2,842.92 ","$2,842.92 ",$364.90 ,"$2,324.40 "
ST. JOSEPH'S HOSPITAL - BREESE,61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$3,628.00 ","$2,358.20 ",$222.69 ,"$3,628.00 ","$3,083.80 ","$2,165.92 ",$222.69 ,"$2,086.10 ",$222.69 ,"$2,499.69 ","$3,083.80 ","$3,083.80 ","$3,083.80 ","$2,974.96 ","$2,467.04 ",$222.69 ,$222.69 ,"$2,721.00 ","$2,575.88 ","$2,575.88 ",$222.69 ,"$2,575.88 ","$3,011.24 ","$3,011.24 ","$3,011.24 ", N/A ,$556.73 ,"$3,083.80 ",$222.69 ,"$3,628.00 ",$270.91 ,$270.91 ,"$3,083.80 ",$467.66 ,"$3,083.80 ","$3,265.20 ",$222.69 ,"$3,011.24 ","$2,884.26 ","$2,884.26 ",$222.69 ,"$2,358.20 "
ST. JOSEPH'S HOSPITAL - BREESE,61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$3,873.00 ","$2,517.45 ",$270.91 ,"$3,873.00 ","$3,292.05 ","$2,312.18 ",$364.90 ,"$2,226.98 ",$364.90 ,"$2,668.50 ","$3,292.05 ","$3,292.05 ","$3,292.05 ","$3,175.86 ","$2,633.64 ",$364.90 ,$364.90 ,"$2,904.75 ","$2,749.83 ","$2,749.83 ",$364.90 ,"$2,749.83 ","$3,214.59 ","$3,214.59 ","$3,214.59 ", N/A ,$912.24 ,"$3,292.05 ",$364.90 ,"$3,873.00 ",$270.91 ,$270.91 ,"$3,292.05 ",$766.28 ,"$3,292.05 ","$3,485.70 ",$364.90 ,"$3,214.59 ","$3,079.04 ","$3,079.04 ",$364.90 ,"$2,517.45 "
ST. JOSEPH'S HOSPITAL - BREESE,61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$4,117.00 ","$2,676.05 ",$270.91 ,"$4,117.00 ","$3,499.45 ","$2,457.85 ",$364.90 ,"$2,367.28 ",$364.90 ,"$2,836.61 ","$3,499.45 ","$3,499.45 ","$3,499.45 ","$3,375.94 ","$2,799.56 ",$364.90 ,$364.90 ,"$3,087.75 ","$2,923.07 ","$2,923.07 ",$364.90 ,"$2,923.07 ","$3,417.11 ","$3,417.11 ","$3,417.11 ", N/A ,$912.24 ,"$3,499.45 ",$364.90 ,"$4,117.00 ",$270.91 ,$270.91 ,"$3,499.45 ",$766.28 ,"$3,499.45 ","$3,705.30 ",$364.90 ,"$3,417.11 ","$3,273.02 ","$3,273.02 ",$364.90 ,"$2,676.05 "
ST. JOSEPH'S HOSPITAL - BREESE,61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,716.00 ","$2,415.40 ",$222.69 ,"$3,716.00 ","$3,158.60 ","$2,218.45 ",$222.69 ,"$2,136.70 ",$222.69 ,"$2,560.32 ","$3,158.60 ","$3,158.60 ","$3,158.60 ","$3,047.12 ","$2,526.88 ",$222.69 ,$222.69 ,"$2,787.00 ","$2,638.36 ","$2,638.36 ",$222.69 ,"$2,638.36 ","$3,084.28 ","$3,084.28 ","$3,084.28 ", N/A ,$556.73 ,"$3,158.60 ",$222.69 ,"$3,716.00 ",$247.94 ,$247.94 ,"$3,158.60 ",$467.66 ,"$3,158.60 ","$3,344.40 ",$222.69 ,"$3,084.28 ","$2,954.22 ","$2,954.22 ",$222.69 ,"$2,415.40 "
ST. JOSEPH'S HOSPITAL - BREESE,61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$4,322.00 ","$2,809.30 ",$247.94 ,"$4,322.00 ","$3,673.70 ","$2,580.23 ",$364.90 ,"$2,485.15 ",$364.90 ,"$2,977.86 ","$3,673.70 ","$3,673.70 ","$3,673.70 ","$3,544.04 ","$2,938.96 ",$364.90 ,$364.90 ,"$3,241.50 ","$3,068.62 ","$3,068.62 ",$364.90 ,"$3,068.62 ","$3,587.26 ","$3,587.26 ","$3,587.26 ", N/A ,$912.24 ,"$3,673.70 ",$364.90 ,"$4,322.00 ",$247.94 ,$247.94 ,"$3,673.70 ",$766.28 ,"$3,673.70 ","$3,889.80 ",$364.90 ,"$3,587.26 ","$3,435.99 ","$3,435.99 ",$364.90 ,"$2,809.30 "
ST. JOSEPH'S HOSPITAL - BREESE,61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$4,945.00 ","$3,214.25 ",$247.94 ,"$4,945.00 ","$4,203.25 ","$2,952.17 ",$364.90 ,"$2,843.38 ",$364.90 ,"$3,407.11 ","$4,203.25 ","$4,203.25 ","$4,203.25 ","$4,054.90 ","$3,362.60 ",$364.90 ,$364.90 ,"$3,708.75 ","$3,510.95 ","$3,510.95 ",$364.90 ,"$3,510.95 ","$4,104.35 ","$4,104.35 ","$4,104.35 ", N/A ,$912.24 ,"$4,203.25 ",$364.90 ,"$4,945.00 ",$247.94 ,$247.94 ,"$4,203.25 ",$766.28 ,"$4,203.25 ","$4,450.50 ",$364.90 ,"$4,104.35 ","$3,931.28 ","$3,931.28 ",$364.90 ,"$3,214.25 "
ST. JOSEPH'S HOSPITAL - BREESE,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$3,633.00 ","$2,361.45 ",$178.81 ,"$3,633.00 ","$3,088.05 ","$2,168.90 ",$222.69 ,"$2,088.98 ",$222.69 ,"$2,503.14 ","$3,088.05 ","$3,088.05 ","$3,088.05 ","$2,979.06 ","$2,470.44 ",$222.69 ,$222.69 ,"$2,724.75 ","$2,579.43 ","$2,579.43 ",$222.69 ,"$2,579.43 ","$3,015.39 ","$3,015.39 ","$3,015.39 ", N/A ,$556.73 ,"$3,088.05 ",$222.69 ,"$3,633.00 ",$178.81 ,$178.81 ,"$3,088.05 ",$467.66 ,"$3,088.05 ","$3,269.70 ",$222.69 ,"$3,015.39 ","$2,888.24 ","$2,888.24 ",$222.69 ,"$2,361.45 "
ST. JOSEPH'S HOSPITAL - BREESE,61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$4,330.00 ","$2,814.50 ",$178.81 ,"$4,330.00 ","$3,680.50 ","$2,585.01 ",$364.90 ,"$2,489.75 ",$364.90 ,"$2,983.37 ","$3,680.50 ","$3,680.50 ","$3,680.50 ","$3,550.60 ","$2,944.40 ",$364.90 ,$364.90 ,"$3,247.50 ","$3,074.30 ","$3,074.30 ",$364.90 ,"$3,074.30 ","$3,593.90 ","$3,593.90 ","$3,593.90 ", N/A ,$912.24 ,"$3,680.50 ",$364.90 ,"$4,330.00 ",$178.81 ,$178.81 ,"$3,680.50 ",$766.28 ,"$3,680.50 ","$3,897.00 ",$364.90 ,"$3,593.90 ","$3,442.35 ","$3,442.35 ",$364.90 ,"$2,814.50 "
ST. JOSEPH'S HOSPITAL - BREESE,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$3,391.00 ","$2,204.15 ",$178.81 ,"$3,391.00 ","$2,882.35 ","$2,024.43 ",$222.69 ,"$1,949.83 ",$222.69 ,"$2,336.40 ","$2,882.35 ","$2,882.35 ","$2,882.35 ","$2,780.62 ","$2,305.88 ",$222.69 ,$222.69 ,"$2,543.25 ","$2,407.61 ","$2,407.61 ",$222.69 ,"$2,407.61 ","$2,814.53 ","$2,814.53 ","$2,814.53 ", N/A ,$556.73 ,"$2,882.35 ",$222.69 ,"$3,391.00 ",$178.81 ,$178.81 ,"$2,882.35 ",$467.66 ,"$2,882.35 ","$3,051.90 ",$222.69 ,"$2,814.53 ","$2,695.85 ","$2,695.85 ",$222.69 ,"$2,204.15 "
ST. JOSEPH'S HOSPITAL - BREESE,61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$3,821.00 ","$2,483.65 ",$178.81 ,"$3,821.00 ","$3,247.85 ","$2,281.14 ",$364.90 ,"$2,197.08 ",$364.90 ,"$2,632.67 ","$3,247.85 ","$3,247.85 ","$3,247.85 ","$3,133.22 ","$2,598.28 ",$364.90 ,$364.90 ,"$2,865.75 ","$2,712.91 ","$2,712.91 ",$364.90 ,"$2,712.91 ","$3,171.43 ","$3,171.43 ","$3,171.43 ", N/A ,$912.24 ,"$3,247.85 ",$364.90 ,"$3,821.00 ",$178.81 ,$178.81 ,"$3,247.85 ",$766.28 ,"$3,247.85 ","$3,438.90 ",$364.90 ,"$3,171.43 ","$3,037.70 ","$3,037.70 ",$364.90 ,"$2,483.65 "
ST. JOSEPH'S HOSPITAL - BREESE,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$3,416.00 ","$2,220.40 ",$178.81 ,"$3,416.00 ","$2,903.60 ","$2,039.35 ",$222.69 ,"$1,964.20 ",$222.69 ,"$2,353.62 ","$2,903.60 ","$2,903.60 ","$2,903.60 ","$2,801.12 ","$2,322.88 ",$222.69 ,$222.69 ,"$2,562.00 ","$2,425.36 ","$2,425.36 ",$222.69 ,"$2,425.36 ","$2,835.28 ","$2,835.28 ","$2,835.28 ", N/A ,$556.73 ,"$2,903.60 ",$222.69 ,"$3,416.00 ",$178.81 ,$178.81 ,"$2,903.60 ",$467.66 ,"$2,903.60 ","$3,074.40 ",$222.69 ,"$2,835.28 ","$2,715.72 ","$2,715.72 ",$222.69 ,"$2,220.40 "
ST. JOSEPH'S HOSPITAL - BREESE,61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$3,848.00 ","$2,501.20 ",$178.81 ,"$3,848.00 ","$3,270.80 ","$2,297.26 ",$364.90 ,"$2,212.60 ",$364.90 ,"$2,651.27 ","$3,270.80 ","$3,270.80 ","$3,270.80 ","$3,155.36 ","$2,616.64 ",$364.90 ,$364.90 ,"$2,886.00 ","$2,732.08 ","$2,732.08 ",$364.90 ,"$2,732.08 ","$3,193.84 ","$3,193.84 ","$3,193.84 ", N/A ,$912.24 ,"$3,270.80 ",$364.90 ,"$3,848.00 ",$178.81 ,$178.81 ,"$3,270.80 ",$766.28 ,"$3,270.80 ","$3,463.20 ",$364.90 ,"$3,193.84 ","$3,059.16 ","$3,059.16 ",$364.90 ,"$2,501.20 "
ST. JOSEPH'S HOSPITAL - BREESE,61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$4,858.00 ","$3,157.70 ",$178.81 ,"$4,858.00 ","$4,129.30 ","$2,900.23 ",$364.90 ,"$2,793.35 ",$364.90 ,"$3,347.16 ","$4,129.30 ","$4,129.30 ","$4,129.30 ","$3,983.56 ","$3,303.44 ",$364.90 ,$364.90 ,"$3,643.50 ","$3,449.18 ","$3,449.18 ",$364.90 ,"$3,449.18 ","$4,032.14 ","$4,032.14 ","$4,032.14 ", N/A ,$912.24 ,"$4,129.30 ",$364.90 ,"$4,858.00 ",$178.81 ,$178.81 ,"$4,129.30 ",$766.28 ,"$4,129.30 ","$4,372.20 ",$364.90 ,"$4,032.14 ","$3,862.11 ","$3,862.11 ",$364.90 ,"$3,157.70 "
ST. JOSEPH'S HOSPITAL - BREESE,61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$4,681.00 ","$3,042.65 ",$178.81 ,"$4,681.00 ","$3,978.85 ","$2,794.56 ",$364.90 ,"$2,691.58 ",$364.90 ,"$3,225.21 ","$3,978.85 ","$3,978.85 ","$3,978.85 ","$3,838.42 ","$3,183.08 ",$364.90 ,$364.90 ,"$3,510.75 ","$3,323.51 ","$3,323.51 ",$364.90 ,"$3,323.51 ","$3,885.23 ","$3,885.23 ","$3,885.23 ", N/A ,$912.24 ,"$3,978.85 ",$364.90 ,"$4,681.00 ",$178.81 ,$178.81 ,"$3,978.85 ",$766.28 ,"$3,978.85 ","$4,212.90 ",$364.90 ,"$3,885.23 ","$3,721.40 ","$3,721.40 ",$364.90 ,"$3,042.65 "
ST. JOSEPH'S HOSPITAL - BREESE,61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$4,640.00 ","$3,016.00 ",$178.81 ,"$4,640.00 ","$3,944.00 ","$2,770.08 ",$364.90 ,"$2,668.00 ",$364.90 ,"$3,196.96 ","$3,944.00 ","$3,944.00 ","$3,944.00 ","$3,804.80 ","$3,155.20 ",$364.90 ,$364.90 ,"$3,480.00 ","$3,294.40 ","$3,294.40 ",$364.90 ,"$3,294.40 ","$3,851.20 ","$3,851.20 ","$3,851.20 ", N/A ,$912.24 ,"$3,944.00 ",$364.90 ,"$4,640.00 ",$178.81 ,$178.81 ,"$3,944.00 ",$766.28 ,"$3,944.00 ","$4,176.00 ",$364.90 ,"$3,851.20 ","$3,688.80 ","$3,688.80 ",$364.90 ,"$3,016.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$3,219.00 ","$2,092.35 ",$221.28 ,"$3,219.00 ","$2,736.15 ","$1,921.74 ",$222.69 ,"$1,850.93 ",$222.69 ,"$2,217.89 ","$2,736.15 ","$2,736.15 ","$2,736.15 ","$2,639.58 ","$2,188.92 ",$222.69 ,$222.69 ,"$2,414.25 ","$2,285.49 ","$2,285.49 ",$222.69 ,"$2,285.49 ","$2,671.77 ","$2,671.77 ","$2,671.77 ", N/A ,$556.73 ,"$2,736.15 ",$222.69 ,"$3,219.00 ",$221.28 ,$221.28 ,"$2,736.15 ",$467.66 ,"$2,736.15 ","$2,897.10 ",$222.69 ,"$2,671.77 ","$2,559.11 ","$2,559.11 ",$222.69 ,"$2,092.35 "
ST. JOSEPH'S HOSPITAL - BREESE,61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$3,758.00 ","$2,442.70 ",$221.28 ,"$3,758.00 ","$3,194.30 ","$2,243.53 ",$364.90 ,"$2,160.85 ",$364.90 ,"$2,589.26 ","$3,194.30 ","$3,194.30 ","$3,194.30 ","$3,081.56 ","$2,555.44 ",$364.90 ,$364.90 ,"$2,818.50 ","$2,668.18 ","$2,668.18 ",$364.90 ,"$2,668.18 ","$3,119.14 ","$3,119.14 ","$3,119.14 ", N/A ,$912.24 ,"$3,194.30 ",$364.90 ,"$3,758.00 ",$221.28 ,$221.28 ,"$3,194.30 ",$766.28 ,"$3,194.30 ","$3,382.20 ",$364.90 ,"$3,119.14 ","$2,987.61 ","$2,987.61 ",$364.90 ,"$2,442.70 "
ST. JOSEPH'S HOSPITAL - BREESE,61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$4,423.00 ","$2,874.95 ",$221.28 ,"$4,423.00 ","$3,759.55 ","$2,640.53 ",$364.90 ,"$2,543.23 ",$364.90 ,"$3,047.45 ","$3,759.55 ","$3,759.55 ","$3,759.55 ","$3,626.86 ","$3,007.64 ",$364.90 ,$364.90 ,"$3,317.25 ","$3,140.33 ","$3,140.33 ",$364.90 ,"$3,140.33 ","$3,671.09 ","$3,671.09 ","$3,671.09 ", N/A ,$912.24 ,"$3,759.55 ",$364.90 ,"$4,423.00 ",$221.28 ,$221.28 ,"$3,759.55 ",$766.28 ,"$3,759.55 ","$3,980.70 ",$364.90 ,"$3,671.09 ","$3,516.29 ","$3,516.29 ",$364.90 ,"$2,874.95 "
ST. JOSEPH'S HOSPITAL - BREESE,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$3,492.00 ","$2,269.80 ",$221.28 ,"$3,492.00 ","$2,968.20 ","$2,084.72 ",$222.69 ,"$2,007.90 ",$222.69 ,"$2,405.99 ","$2,968.20 ","$2,968.20 ","$2,968.20 ","$2,863.44 ","$2,374.56 ",$222.69 ,$222.69 ,"$2,619.00 ","$2,479.32 ","$2,479.32 ",$222.69 ,"$2,479.32 ","$2,898.36 ","$2,898.36 ","$2,898.36 ", N/A ,$556.73 ,"$2,968.20 ",$222.69 ,"$3,492.00 ",$221.28 ,$221.28 ,"$2,968.20 ",$467.66 ,"$2,968.20 ","$3,142.80 ",$222.69 ,"$2,898.36 ","$2,776.14 ","$2,776.14 ",$222.69 ,"$2,269.80 "
ST. JOSEPH'S HOSPITAL - BREESE,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$3,827.00 ","$2,487.55 ",$221.28 ,"$3,827.00 ","$3,252.95 ","$2,284.72 ",$364.90 ,"$2,200.53 ",$364.90 ,"$2,636.80 ","$3,252.95 ","$3,252.95 ","$3,252.95 ","$3,138.14 ","$2,602.36 ",$364.90 ,$364.90 ,"$2,870.25 ","$2,717.17 ","$2,717.17 ",$364.90 ,"$2,717.17 ","$3,176.41 ","$3,176.41 ","$3,176.41 ", N/A ,$912.24 ,"$3,252.95 ",$364.90 ,"$3,827.00 ",$221.28 ,$221.28 ,"$3,252.95 ",$766.28 ,"$3,252.95 ","$3,444.30 ",$364.90 ,"$3,176.41 ","$3,042.47 ","$3,042.47 ",$364.90 ,"$2,487.55 "
ST. JOSEPH'S HOSPITAL - BREESE,61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$4,470.00 ","$2,905.50 ",$221.28 ,"$4,470.00 ","$3,799.50 ","$2,668.59 ",$364.90 ,"$2,570.25 ",$364.90 ,"$3,079.83 ","$3,799.50 ","$3,799.50 ","$3,799.50 ","$3,665.40 ","$3,039.60 ",$364.90 ,$364.90 ,"$3,352.50 ","$3,173.70 ","$3,173.70 ",$364.90 ,"$3,173.70 ","$3,710.10 ","$3,710.10 ","$3,710.10 ", N/A ,$912.24 ,"$3,799.50 ",$364.90 ,"$4,470.00 ",$221.28 ,$221.28 ,"$3,799.50 ",$766.28 ,"$3,799.50 ","$4,023.00 ",$364.90 ,"$3,710.10 ","$3,553.65 ","$3,553.65 ",$364.90 ,"$2,905.50 "
ST. JOSEPH'S HOSPITAL - BREESE,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$3,492.00 ","$2,269.80 ",$149.35 ,"$3,492.00 ","$2,968.20 ","$2,084.72 ",$222.69 ,"$2,007.90 ",$222.69 ,"$2,405.99 ","$2,968.20 ","$2,968.20 ","$2,968.20 ","$2,863.44 ","$2,374.56 ",$222.69 ,$222.69 ,"$2,619.00 ","$2,479.32 ","$2,479.32 ",$222.69 ,"$2,479.32 ","$2,898.36 ","$2,898.36 ","$2,898.36 ", N/A ,$556.73 ,"$2,968.20 ",$222.69 ,"$3,492.00 ",$149.35 ,$149.35 ,"$2,968.20 ",$467.66 ,"$2,968.20 ","$3,142.80 ",$222.69 ,"$2,898.36 ","$2,776.14 ","$2,776.14 ",$222.69 ,"$2,269.80 "
ST. JOSEPH'S HOSPITAL - BREESE,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$3,924.00 ","$2,550.60 ",$149.35 ,"$3,924.00 ","$3,335.40 ","$2,342.63 ",$650.59 ,"$2,256.30 ",$650.59 ,"$2,703.64 ","$3,335.40 ","$3,335.40 ","$3,335.40 ","$3,217.68 ","$2,668.32 ",$650.59 ,$650.59 ,"$2,943.00 ","$2,786.04 ","$2,786.04 ",$650.59 ,"$2,786.04 ","$3,256.92 ","$3,256.92 ","$3,256.92 ", N/A ,"$1,626.48 ","$3,335.40 ",$650.59 ,"$3,924.00 ",$149.35 ,$149.35 ,"$3,335.40 ","$1,366.24 ","$3,335.40 ","$3,531.60 ",$650.59 ,"$3,256.92 ","$3,119.58 ","$3,119.58 ",$650.59 ,"$2,550.60 "
ST. JOSEPH'S HOSPITAL - BREESE,61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,470.00 ","$2,905.50 ",$149.35 ,"$4,470.00 ","$3,799.50 ","$2,668.59 ",$364.90 ,"$2,570.25 ",$364.90 ,"$3,079.83 ","$3,799.50 ","$3,799.50 ","$3,799.50 ","$3,665.40 ","$3,039.60 ",$364.90 ,$364.90 ,"$3,352.50 ","$3,173.70 ","$3,173.70 ",$364.90 ,"$3,173.70 ","$3,710.10 ","$3,710.10 ","$3,710.10 ", N/A ,$912.24 ,"$3,799.50 ",$364.90 ,"$4,470.00 ",$149.35 ,$149.35 ,"$3,799.50 ",$766.28 ,"$3,799.50 ","$4,023.00 ",$364.90 ,"$3,710.10 ","$3,553.65 ","$3,553.65 ",$364.90 ,"$2,905.50 "
ST. JOSEPH'S HOSPITAL - BREESE,61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$3,492.00 ","$2,269.80 ",$221.28 ,"$3,492.00 ","$2,968.20 ","$2,084.72 ",$222.69 ,"$2,007.90 ",$222.69 ,"$2,405.99 ","$2,968.20 ","$2,968.20 ","$2,968.20 ","$2,863.44 ","$2,374.56 ",$222.69 ,$222.69 ,"$2,619.00 ","$2,479.32 ","$2,479.32 ",$222.69 ,"$2,479.32 ","$2,898.36 ","$2,898.36 ","$2,898.36 ", N/A ,$556.73 ,"$2,968.20 ",$222.69 ,"$3,492.00 ",$221.28 ,$221.28 ,"$2,968.20 ",$467.66 ,"$2,968.20 ","$3,142.80 ",$222.69 ,"$2,898.36 ","$2,776.14 ","$2,776.14 ",$222.69 ,"$2,269.80 "
ST. JOSEPH'S HOSPITAL - BREESE,61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$3,816.00 ","$2,480.40 ",$221.28 ,"$3,816.00 ","$3,243.60 ","$2,278.15 ",$364.90 ,"$2,194.20 ",$364.90 ,"$2,629.22 ","$3,243.60 ","$3,243.60 ","$3,243.60 ","$3,129.12 ","$2,594.88 ",$364.90 ,$364.90 ,"$2,862.00 ","$2,709.36 ","$2,709.36 ",$364.90 ,"$2,709.36 ","$3,167.28 ","$3,167.28 ","$3,167.28 ", N/A ,$912.24 ,"$3,243.60 ",$364.90 ,"$3,816.00 ",$221.28 ,$221.28 ,"$3,243.60 ",$766.28 ,"$3,243.60 ","$3,434.40 ",$364.90 ,"$3,167.28 ","$3,033.72 ","$3,033.72 ",$364.90 ,"$2,480.40 "
ST. JOSEPH'S HOSPITAL - BREESE,61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$4,470.00 ","$2,905.50 ",$221.28 ,"$4,470.00 ","$3,799.50 ","$2,668.59 ",$364.90 ,"$2,570.25 ",$364.90 ,"$3,079.83 ","$3,799.50 ","$3,799.50 ","$3,799.50 ","$3,665.40 ","$3,039.60 ",$364.90 ,$364.90 ,"$3,352.50 ","$3,173.70 ","$3,173.70 ",$364.90 ,"$3,173.70 ","$3,710.10 ","$3,710.10 ","$3,710.10 ", N/A ,$912.24 ,"$3,799.50 ",$364.90 ,"$4,470.00 ",$221.28 ,$221.28 ,"$3,799.50 ",$766.28 ,"$3,799.50 ","$4,023.00 ",$364.90 ,"$3,710.10 ","$3,553.65 ","$3,553.65 ",$364.90 ,"$2,905.50 "
ST. JOSEPH'S HOSPITAL - BREESE,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$3,492.00 ","$2,269.80 ",$149.35 ,"$3,492.00 ","$2,968.20 ","$2,084.72 ",$222.69 ,"$2,007.90 ",$222.69 ,"$2,405.99 ","$2,968.20 ","$2,968.20 ","$2,968.20 ","$2,863.44 ","$2,374.56 ",$222.69 ,$222.69 ,"$2,619.00 ","$2,479.32 ","$2,479.32 ",$222.69 ,"$2,479.32 ","$2,898.36 ","$2,898.36 ","$2,898.36 ", N/A ,$556.73 ,"$2,968.20 ",$222.69 ,"$3,492.00 ",$149.35 ,$149.35 ,"$2,968.20 ",$467.66 ,"$2,968.20 ","$3,142.80 ",$222.69 ,"$2,898.36 ","$2,776.14 ","$2,776.14 ",$222.69 ,"$2,269.80 "
ST. JOSEPH'S HOSPITAL - BREESE,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$3,816.00 ","$2,480.40 ",$149.35 ,"$3,816.00 ","$3,243.60 ","$2,278.15 ",$650.59 ,"$2,194.20 ",$650.59 ,"$2,629.22 ","$3,243.60 ","$3,243.60 ","$3,243.60 ","$3,129.12 ","$2,594.88 ",$650.59 ,$650.59 ,"$2,862.00 ","$2,709.36 ","$2,709.36 ",$650.59 ,"$2,709.36 ","$3,167.28 ","$3,167.28 ","$3,167.28 ", N/A ,"$1,626.48 ","$3,243.60 ",$650.59 ,"$3,816.00 ",$149.35 ,$149.35 ,"$3,243.60 ","$1,366.24 ","$3,243.60 ","$3,434.40 ",$650.59 ,"$3,167.28 ","$3,033.72 ","$3,033.72 ",$650.59 ,"$2,480.40 "
ST. JOSEPH'S HOSPITAL - BREESE,61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,470.00 ","$2,905.50 ",$149.35 ,"$4,470.00 ","$3,799.50 ","$2,668.59 ",$364.90 ,"$2,570.25 ",$364.90 ,"$3,079.83 ","$3,799.50 ","$3,799.50 ","$3,799.50 ","$3,665.40 ","$3,039.60 ",$364.90 ,$364.90 ,"$3,352.50 ","$3,173.70 ","$3,173.70 ",$364.90 ,"$3,173.70 ","$3,710.10 ","$3,710.10 ","$3,710.10 ", N/A ,$912.24 ,"$3,799.50 ",$364.90 ,"$4,470.00 ",$149.35 ,$149.35 ,"$3,799.50 ",$766.28 ,"$3,799.50 ","$4,023.00 ",$364.90 ,"$3,710.10 ","$3,553.65 ","$3,553.65 ",$364.90 ,"$2,905.50 "
ST. JOSEPH'S HOSPITAL - BREESE,61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,424.00 ","$2,225.60 ",$222.69 ,"$3,424.00 ","$2,910.40 ","$2,044.13 ",$222.69 ,"$1,968.80 ",$222.69 ,"$2,359.14 ","$2,910.40 ","$2,910.40 ","$2,910.40 ","$2,807.68 ","$2,328.32 ",$222.69 ,$222.69 ,"$2,568.00 ","$2,431.04 ","$2,431.04 ",$222.69 ,"$2,431.04 ","$2,841.92 ","$2,841.92 ","$2,841.92 ", N/A ,$556.73 ,"$2,910.40 ",$222.69 ,"$3,424.00 ",$265.22 ,$265.22 ,"$2,910.40 ",$467.66 ,"$2,910.40 ","$3,081.60 ",$222.69 ,"$2,841.92 ","$2,722.08 ","$2,722.08 ",$222.69 ,"$2,225.60 "
ST. JOSEPH'S HOSPITAL - BREESE,61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$3,855.00 ","$2,505.75 ",$265.22 ,"$3,855.00 ","$3,276.75 ","$2,301.44 ",$364.90 ,"$2,216.63 ",$364.90 ,"$2,656.10 ","$3,276.75 ","$3,276.75 ","$3,276.75 ","$3,161.10 ","$2,621.40 ",$364.90 ,$364.90 ,"$2,891.25 ","$2,737.05 ","$2,737.05 ",$364.90 ,"$2,737.05 ","$3,199.65 ","$3,199.65 ","$3,199.65 ", N/A ,$912.24 ,"$3,276.75 ",$364.90 ,"$3,855.00 ",$265.22 ,$265.22 ,"$3,276.75 ",$766.28 ,"$3,276.75 ","$3,469.50 ",$364.90 ,"$3,199.65 ","$3,064.73 ","$3,064.73 ",$364.90 ,"$2,505.75 "
ST. JOSEPH'S HOSPITAL - BREESE,61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$4,435.00 ","$2,882.75 ",$265.22 ,"$4,435.00 ","$3,769.75 ","$2,647.70 ",$364.90 ,"$2,550.13 ",$364.90 ,"$3,055.72 ","$3,769.75 ","$3,769.75 ","$3,769.75 ","$3,636.70 ","$3,015.80 ",$364.90 ,$364.90 ,"$3,326.25 ","$3,148.85 ","$3,148.85 ",$364.90 ,"$3,148.85 ","$3,681.05 ","$3,681.05 ","$3,681.05 ", N/A ,$912.24 ,"$3,769.75 ",$364.90 ,"$4,435.00 ",$265.22 ,$265.22 ,"$3,769.75 ",$766.28 ,"$3,769.75 ","$3,991.50 ",$364.90 ,"$3,681.05 ","$3,525.83 ","$3,525.83 ",$364.90 ,"$2,882.75 "
ST. JOSEPH'S HOSPITAL - BREESE,61000050,C8937,HC MRI BREAST CAD,610,1 ,$140.00 ,$91.00 ,$80.50 ,$140.00 ,$119.00 ,$83.58 , N/A ,$80.50 , N/A ,$96.46 ,$119.00 ,$119.00 ,$119.00 ,$114.80 ,$95.20 , N/A , N/A ,$105.00 ,$99.40 ,$99.40 , N/A ,$99.40 ,$116.20 ,$116.20 ,$116.20 , N/A , N/A ,$119.00 , N/A ,$140.00 , N/A , N/A ,$119.00 , N/A ,$119.00 ,$126.00 , N/A ,$116.20 ,$111.30 ,$111.30 , N/A ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,411.00 ","$2,217.15 ",$286.14 ,"$3,411.00 ","$2,899.35 ","$2,036.37 ",$364.90 ,"$1,961.33 ",$364.90 ,"$2,350.18 ","$2,899.35 ","$2,899.35 ","$2,899.35 ","$2,797.02 ","$2,319.48 ",$364.90 ,$364.90 ,"$2,558.25 ","$2,421.81 ","$2,421.81 ",$364.90 ,"$2,421.81 ","$2,831.13 ","$2,831.13 ","$2,831.13 ", N/A ,$912.24 ,"$2,899.35 ",$364.90 ,"$3,411.00 ",$286.14 ,$286.14 ,"$2,899.35 ",$766.28 ,"$2,899.35 ","$3,069.90 ",$364.90 ,"$2,831.13 ","$2,711.75 ","$2,711.75 ",$364.90 ,"$2,217.15 "
ST. JOSEPH'S HOSPITAL - BREESE,61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$3,204.00 ","$2,082.60 ",$222.69 ,"$3,204.00 ","$2,723.40 ","$1,912.79 ",$222.69 ,"$1,842.30 ",$222.69 ,"$2,207.56 ","$2,723.40 ","$2,723.40 ","$2,723.40 ","$2,627.28 ","$2,178.72 ",$222.69 ,$222.69 ,"$2,403.00 ","$2,274.84 ","$2,274.84 ",$222.69 ,"$2,274.84 ","$2,659.32 ","$2,659.32 ","$2,659.32 ", N/A ,$556.73 ,"$2,723.40 ",$222.69 ,"$3,204.00 ",$286.14 ,$286.14 ,"$2,723.40 ",$467.66 ,"$2,723.40 ","$2,883.60 ",$222.69 ,"$2,659.32 ","$2,547.18 ","$2,547.18 ",$222.69 ,"$2,082.60 "
ST. JOSEPH'S HOSPITAL - BREESE,61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$3,619.00 ","$2,352.35 ",$286.14 ,"$3,619.00 ","$3,076.15 ","$2,160.54 ",$364.90 ,"$2,080.93 ",$364.90 ,"$2,493.49 ","$3,076.15 ","$3,076.15 ","$3,076.15 ","$2,967.58 ","$2,460.92 ",$364.90 ,$364.90 ,"$2,714.25 ","$2,569.49 ","$2,569.49 ",$364.90 ,"$2,569.49 ","$3,003.77 ","$3,003.77 ","$3,003.77 ", N/A ,$912.24 ,"$3,076.15 ",$364.90 ,"$3,619.00 ",$286.14 ,$286.14 ,"$3,076.15 ",$766.28 ,"$3,076.15 ","$3,257.10 ",$364.90 ,"$3,003.77 ","$2,877.11 ","$2,877.11 ",$364.90 ,"$2,352.35 "
ST. JOSEPH'S HOSPITAL - BREESE,61000054,C8903,HC MRI BREAST UNI W/CONTRAST,610,1 ,"$2,860.00 ","$1,859.00 ",$174.13 ,"$2,860.00 ","$2,431.00 ","$1,707.42 ",$174.13 ,"$1,644.50 ",$174.13 ,"$1,970.54 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,345.20 ","$1,944.80 ",$174.13 ,$174.13 ,"$2,145.00 ","$2,030.60 ","$2,030.60 ",$174.13 ,"$2,030.60 ","$2,373.80 ","$2,373.80 ","$2,373.80 ", N/A ,$435.32 ,"$2,431.00 ",$174.13 ,"$2,860.00 ",$221.28 ,$221.28 ,"$2,431.00 ",$365.67 ,"$2,431.00 ","$2,574.00 ",$174.13 ,"$2,373.80 ","$2,273.70 ","$2,273.70 ",$174.13 ,"$1,859.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$4,101.00 ","$2,665.65 ",$221.28 ,"$4,101.00 ","$3,485.85 ","$2,448.30 ",$364.90 ,"$2,358.08 ",$364.90 ,"$2,825.59 ","$3,485.85 ","$3,485.85 ","$3,485.85 ","$3,362.82 ","$2,788.68 ",$364.90 ,$364.90 ,"$3,075.75 ","$2,911.71 ","$2,911.71 ",$364.90 ,"$2,911.71 ","$3,403.83 ","$3,403.83 ","$3,403.83 ", N/A ,$912.24 ,"$3,485.85 ",$364.90 ,"$4,101.00 ",$221.28 ,$221.28 ,"$3,485.85 ",$766.28 ,"$3,485.85 ","$3,690.90 ",$364.90 ,"$3,403.83 ","$3,260.30 ","$3,260.30 ",$364.90 ,"$2,665.65 "
ST. JOSEPH'S HOSPITAL - BREESE,61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$3,529.00 ","$2,293.85 ",$251.69 ,"$3,529.00 ","$2,999.65 ","$2,106.81 ",$364.90 ,"$2,029.18 ",$364.90 ,"$2,431.48 ","$2,999.65 ","$2,999.65 ","$2,999.65 ","$2,893.78 ","$2,399.72 ",$364.90 ,$364.90 ,"$2,646.75 ","$2,505.59 ","$2,505.59 ",$364.90 ,"$2,505.59 ","$2,929.07 ","$2,929.07 ","$2,929.07 ", N/A ,$912.24 ,"$2,999.65 ",$364.90 ,"$3,529.00 ",$251.69 ,$251.69 ,"$2,999.65 ",$766.28 ,"$2,999.65 ","$3,176.10 ",$364.90 ,"$2,929.07 ","$2,805.56 ","$2,805.56 ",$364.90 ,"$2,293.85 "
ST. JOSEPH'S HOSPITAL - BREESE,61000061,C8910,HC MRA CHEST W/O CONTRAST,610,1 ,"$3,204.00 ","$2,082.60 ",$222.69 ,"$3,204.00 ","$2,723.40 ","$1,912.79 ",$222.69 ,"$1,842.30 ",$222.69 ,"$2,207.56 ","$2,723.40 ","$2,723.40 ","$2,723.40 ","$2,627.28 ","$2,178.72 ",$222.69 ,$222.69 ,"$2,403.00 ","$2,274.84 ","$2,274.84 ",$222.69 ,"$2,274.84 ","$2,659.32 ","$2,659.32 ","$2,659.32 ", N/A ,$556.73 ,"$2,723.40 ",$222.69 ,"$3,204.00 ",$251.69 ,$251.69 ,"$2,723.40 ",$467.66 ,"$2,723.40 ","$2,883.60 ",$222.69 ,"$2,659.32 ","$2,547.18 ","$2,547.18 ",$222.69 ,"$2,082.60 "
ST. JOSEPH'S HOSPITAL - BREESE,61000062,C8911,HC MRA CHEST W AND W/O CONTRAST,610,1 ,"$3,906.00 ","$2,538.90 ",$251.69 ,"$3,906.00 ","$3,320.10 ","$2,331.88 ",$364.90 ,"$2,245.95 ",$364.90 ,"$2,691.23 ","$3,320.10 ","$3,320.10 ","$3,320.10 ","$3,202.92 ","$2,656.08 ",$364.90 ,$364.90 ,"$2,929.50 ","$2,773.26 ","$2,773.26 ",$364.90 ,"$2,773.26 ","$3,241.98 ","$3,241.98 ","$3,241.98 ", N/A ,$912.24 ,"$3,320.10 ",$364.90 ,"$3,906.00 ",$251.69 ,$251.69 ,"$3,320.10 ",$766.28 ,"$3,320.10 ","$3,515.40 ",$364.90 ,"$3,241.98 ","$3,105.27 ","$3,105.27 ",$364.90 ,"$2,538.90 "
ST. JOSEPH'S HOSPITAL - BREESE,61000064,C8913,HC MRA LWR EXT W/O CON,610,1 ,"$3,204.00 ","$2,082.60 ",$222.69 ,"$3,204.00 ","$2,723.40 ","$1,912.79 ",$222.69 ,"$1,842.30 ",$222.69 ,"$2,207.56 ","$2,723.40 ","$2,723.40 ","$2,723.40 ","$2,627.28 ","$2,178.72 ",$222.69 ,$222.69 ,"$2,403.00 ","$2,274.84 ","$2,274.84 ",$222.69 ,"$2,274.84 ","$2,659.32 ","$2,659.32 ","$2,659.32 ", N/A ,$556.73 ,"$2,723.40 ",$222.69 ,"$3,204.00 ",$286.14 ,$286.14 ,"$2,723.40 ",$467.66 ,"$2,723.40 ","$2,883.60 ",$222.69 ,"$2,659.32 ","$2,547.18 ","$2,547.18 ",$222.69 ,"$2,082.60 "
ST. JOSEPH'S HOSPITAL - BREESE,61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$3,636.00 ","$2,363.40 ",$286.14 ,"$3,636.00 ","$3,090.60 ","$2,170.69 ",$364.90 ,"$2,090.70 ",$364.90 ,"$2,505.20 ","$3,090.60 ","$3,090.60 ","$3,090.60 ","$2,981.52 ","$2,472.48 ",$364.90 ,$364.90 ,"$2,727.00 ","$2,581.56 ","$2,581.56 ",$364.90 ,"$2,581.56 ","$3,017.88 ","$3,017.88 ","$3,017.88 ", N/A ,$912.24 ,"$3,090.60 ",$364.90 ,"$3,636.00 ",$286.14 ,$286.14 ,"$3,090.60 ",$766.28 ,"$3,090.60 ","$3,272.40 ",$364.90 ,"$3,017.88 ","$2,890.62 ","$2,890.62 ",$364.90 ,"$2,363.40 "
ST. JOSEPH'S HOSPITAL - BREESE,61000070,C8920,HC MRA PELVIS W AND W/O CONTRAST,610,1 ,"$4,101.00 ","$2,665.65 ",$286.14 ,"$4,101.00 ","$3,485.85 ","$2,448.30 ",$364.90 ,"$2,358.08 ",$364.90 ,"$2,825.59 ","$3,485.85 ","$3,485.85 ","$3,485.85 ","$3,362.82 ","$2,788.68 ",$364.90 ,$364.90 ,"$3,075.75 ","$2,911.71 ","$2,911.71 ",$364.90 ,"$2,911.71 ","$3,403.83 ","$3,403.83 ","$3,403.83 ", N/A ,$912.24 ,"$3,485.85 ",$364.90 ,"$4,101.00 ",$286.14 ,$286.14 ,"$3,485.85 ",$766.28 ,"$3,485.85 ","$3,690.90 ",$364.90 ,"$3,403.83 ","$3,260.30 ","$3,260.30 ",$364.90 ,"$2,665.65 "
ST. JOSEPH'S HOSPITAL - BREESE,61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$4,945.00 ","$3,214.25 ",$247.94 ,"$4,945.00 ","$4,203.25 ","$2,952.17 ",$364.90 ,"$2,843.38 ",$364.90 ,"$3,407.11 ","$4,203.25 ","$4,203.25 ","$4,203.25 ","$4,054.90 ","$3,362.60 ",$364.90 ,$364.90 ,"$3,708.75 ","$3,510.95 ","$3,510.95 ",$364.90 ,"$3,510.95 ","$4,104.35 ","$4,104.35 ","$4,104.35 ", N/A ,$912.24 ,"$4,203.25 ",$364.90 ,"$4,945.00 ",$247.94 ,$247.94 ,"$4,203.25 ",$766.28 ,"$4,203.25 ","$4,450.50 ",$364.90 ,"$4,104.35 ","$3,931.28 ","$3,931.28 ",$364.90 ,"$3,214.25 "
ST. JOSEPH'S HOSPITAL - BREESE,61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$3,956.00 ","$2,571.40 ",$221.28 ,"$3,956.00 ","$3,362.60 ","$2,361.73 ",$364.90 ,"$2,274.70 ",$364.90 ,"$2,725.68 ","$3,362.60 ","$3,362.60 ","$3,362.60 ","$3,243.92 ","$2,690.08 ",$364.90 ,$364.90 ,"$2,967.00 ","$2,808.76 ","$2,808.76 ",$364.90 ,"$2,808.76 ","$3,283.48 ","$3,283.48 ","$3,283.48 ", N/A ,$912.24 ,"$3,362.60 ",$364.90 ,"$3,956.00 ",$221.28 ,$221.28 ,"$3,362.60 ",$766.28 ,"$3,362.60 ","$3,560.40 ",$364.90 ,"$3,283.48 ","$3,145.02 ","$3,145.02 ",$364.90 ,"$2,571.40 "
ST. JOSEPH'S HOSPITAL - BREESE,71000221,N/A,HC C-SECTION RECOVERY 30 MIN,710,1 ,"$1,274.00 ",$828.10 ,$732.55 ,"$1,274.00 ","$1,082.90 ",$760.58 , N/A ,$732.55 , N/A ,$877.79 ,"$1,082.90 ","$1,082.90 ","$1,082.90 ", N/A ,$866.32 , N/A , N/A ,$955.50 ,$904.54 ,$904.54 , N/A ,$904.54 ,"$1,057.42 ","$1,057.42 ","$1,057.42 ", N/A , N/A ,"$1,082.90 ", N/A ,"$1,274.00 ", N/A , N/A ,"$1,082.90 ", N/A ,"$1,082.90 ","$1,146.60 ", N/A ,"$1,057.42 ","$1,012.83 ","$1,012.83 ", N/A ,$828.10 
ST. JOSEPH'S HOSPITAL - BREESE,71000230,N/A,HC PHASE II RECOVERY 15 MIN,710,1 ,$155.00 ,$100.75 ,$89.13 ,$155.00 ,$131.75 ,$92.54 , N/A ,$89.13 , N/A ,$106.80 ,$131.75 ,$131.75 ,$131.75 , N/A ,$105.40 , N/A , N/A ,$116.25 ,$110.05 ,$110.05 , N/A ,$110.05 ,$128.65 ,$128.65 ,$128.65 , N/A , N/A ,$131.75 , N/A ,$155.00 , N/A , N/A ,$131.75 , N/A ,$131.75 ,$139.50 , N/A ,$128.65 ,$123.23 ,$123.23 , N/A ,$100.75 
ST. JOSEPH'S HOSPITAL - BREESE,71000231,N/A,HC RECOVERY <75 MIN,710,1 ,$828.32 ,$538.41 ,$476.28 ,$828.32 ,$704.07 ,$494.51 , N/A ,$476.28 , N/A ,$570.71 ,$704.07 ,$704.07 ,$704.07 , N/A ,$563.26 , N/A , N/A ,$621.24 ,$588.11 ,$588.11 , N/A ,$588.11 ,$687.51 ,$687.51 ,$687.51 , N/A , N/A ,$704.07 , N/A ,$828.32 , N/A , N/A ,$704.07 , N/A ,$704.07 ,$745.49 , N/A ,$687.51 ,$658.51 ,$658.51 , N/A ,$538.41 
ST. JOSEPH'S HOSPITAL - BREESE,71000232,N/A,HC RECOVERY >75 MIN,710,1 ,$161.94 ,$105.26 ,$93.12 ,$161.94 ,$137.65 ,$96.68 , N/A ,$93.12 , N/A ,$111.58 ,$137.65 ,$137.65 ,$137.65 , N/A ,$110.12 , N/A , N/A ,$121.46 ,$114.98 ,$114.98 , N/A ,$114.98 ,$134.41 ,$134.41 ,$134.41 , N/A , N/A ,$137.65 , N/A ,$161.94 , N/A , N/A ,$137.65 , N/A ,$137.65 ,$145.75 , N/A ,$134.41 ,$128.74 ,$128.74 , N/A ,$105.26 
ST. JOSEPH'S HOSPITAL - BREESE,71000233,N/A,HC PHASE I RECOVERY 30 MIN,710,1 ,"$1,184.00 ",$769.60 ,$680.80 ,"$1,184.00 ","$1,006.40 ",$706.85 , N/A ,$680.80 , N/A ,$815.78 ,"$1,006.40 ","$1,006.40 ","$1,006.40 ", N/A ,$805.12 , N/A , N/A ,$888.00 ,$840.64 ,$840.64 , N/A ,$840.64 ,$982.72 ,$982.72 ,$982.72 , N/A , N/A ,"$1,006.40 ", N/A ,"$1,184.00 ", N/A , N/A ,"$1,006.40 ", N/A ,"$1,006.40 ","$1,065.60 ", N/A ,$982.72 ,$941.28 ,$941.28 , N/A ,$769.60 
ST. JOSEPH'S HOSPITAL - BREESE,71000234,N/A,HC PHASE I RECOVERY 15 MIN,710,1 ,$229.00 ,$148.85 ,$131.68 ,$229.00 ,$194.65 ,$136.71 , N/A ,$131.68 , N/A ,$157.78 ,$194.65 ,$194.65 ,$194.65 , N/A ,$155.72 , N/A , N/A ,$171.75 ,$162.59 ,$162.59 , N/A ,$162.59 ,$190.07 ,$190.07 ,$190.07 , N/A , N/A ,$194.65 , N/A ,$229.00 , N/A , N/A ,$194.65 , N/A ,$194.65 ,$206.10 , N/A ,$190.07 ,$182.06 ,$182.06 , N/A ,$148.85 
ST. JOSEPH'S HOSPITAL - BREESE,71000252,N/A,HC RECOVERY EXTENDED INIT HR,710,1 ,$39.00 ,$25.35 ,$22.43 ,$39.00 ,$33.15 ,$23.28 , N/A ,$22.43 , N/A ,$26.87 ,$33.15 ,$33.15 ,$33.15 , N/A ,$26.52 , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$32.37 ,$32.37 ,$32.37 , N/A , N/A ,$33.15 , N/A ,$39.00 , N/A , N/A ,$33.15 , N/A ,$33.15 ,$35.10 , N/A ,$32.37 ,$31.01 ,$31.01 , N/A ,$25.35 
ST. JOSEPH'S HOSPITAL - BREESE,71000253,N/A,HC RECOVERY EXTENDED ADDL HR,710,1 ,$35.00 ,$22.75 ,$20.13 ,$35.00 ,$29.75 ,$20.90 , N/A ,$20.13 , N/A ,$24.12 ,$29.75 ,$29.75 ,$29.75 , N/A ,$23.80 , N/A , N/A ,$26.25 ,$24.85 ,$24.85 , N/A ,$24.85 ,$29.05 ,$29.05 ,$29.05 , N/A , N/A ,$29.75 , N/A ,$35.00 , N/A , N/A ,$29.75 , N/A ,$29.75 ,$31.50 , N/A ,$29.05 ,$27.83 ,$27.83 , N/A ,$22.75 
ST. JOSEPH'S HOSPITAL - BREESE,71000256,N/A,HC C-SECTION RECOVERY ADDL 15MIN,710,1 ,$243.00 ,$157.95 ,$139.73 ,$243.00 ,$206.55 ,$145.07 , N/A ,$139.73 , N/A ,$167.43 ,$206.55 ,$206.55 ,$206.55 , N/A ,$165.24 , N/A , N/A ,$182.25 ,$172.53 ,$172.53 , N/A ,$172.53 ,$201.69 ,$201.69 ,$201.69 , N/A , N/A ,$206.55 , N/A ,$243.00 , N/A , N/A ,$206.55 , N/A ,$206.55 ,$218.70 , N/A ,$201.69 ,$193.19 ,$193.19 , N/A ,$157.95 
ST. JOSEPH'S HOSPITAL - BREESE,72000008,59412,HC EXTERNAL CEPHALIC VERSION,720,1 ,$701.00 ,$455.65 ,$1.51 ,"$5,013.09 ",$595.85 ,$418.50 ,"$2,387.18 ",$403.08 ,"$2,387.18 ",$482.99 ,$595.85 ,$595.85 ,$595.85 , N/A ,$476.68 ,"$2,387.18 ","$2,387.18 ",$525.75 ,$497.71 ,$497.71 ,"$2,387.18 ",$497.71 ,$581.83 ,$581.83 ,$581.83 , N/A ,$701.00 ,$595.85 ,"$2,387.18 ",$701.00 ,$1.51 ,$1.51 ,$595.85 ,"$5,013.09 ",$595.85 ,$630.90 ,"$2,387.18 ",$581.83 ,$557.30 ,$557.30 ,"$2,387.18 ",$455.65 
ST. JOSEPH'S HOSPITAL - BREESE,72000013,N/A,HC DELIVERY COMPLICATED,720,1 ,"$3,193.00 ","$2,075.45 ","$1,835.98 ","$3,193.00 ","$2,714.05 ","$1,906.22 ", N/A ,"$1,835.98 ", N/A ,"$2,199.98 ","$2,714.05 ","$2,714.05 ","$2,714.05 ", N/A ,"$2,171.24 ", N/A , N/A ,"$2,394.75 ","$2,267.03 ","$2,267.03 ", N/A ,"$2,267.03 ","$2,650.19 ","$2,650.19 ","$2,650.19 ", N/A , N/A ,"$2,714.05 ", N/A ,"$3,193.00 ", N/A , N/A ,"$2,714.05 ", N/A ,"$2,714.05 ","$2,873.70 ", N/A ,"$2,650.19 ","$2,538.44 ","$2,538.44 ", N/A ,"$2,075.45 "
ST. JOSEPH'S HOSPITAL - BREESE,72100005,N/A,HC LABOR PER HR,721,1 ,$121.00 ,$78.65 ,$69.58 ,$121.00 ,$102.85 ,$72.24 , N/A ,$69.58 , N/A ,$83.37 ,$102.85 ,$102.85 ,$102.85 , N/A ,$82.28 , N/A , N/A ,$90.75 ,$85.91 ,$85.91 , N/A ,$85.91 ,$100.43 ,$100.43 ,$100.43 , N/A , N/A ,$102.85 , N/A ,$121.00 , N/A , N/A ,$102.85 , N/A ,$102.85 ,$108.90 , N/A ,$100.43 ,$96.20 ,$96.20 , N/A ,$78.65 
ST. JOSEPH'S HOSPITAL - BREESE,72200009,N/A,HC DELIVERY,722,1 ,"$2,875.00 ","$1,868.75 ","$1,653.13 ","$2,875.00 ","$2,443.75 ","$1,716.38 ", N/A ,"$1,653.13 ", N/A ,"$1,980.88 ","$2,443.75 ","$2,443.75 ","$2,443.75 ", N/A ,"$1,955.00 ", N/A , N/A ,"$2,156.25 ","$2,041.25 ","$2,041.25 ", N/A ,"$2,041.25 ","$2,386.25 ","$2,386.25 ","$2,386.25 ", N/A , N/A ,"$2,443.75 ", N/A ,"$2,875.00 ", N/A , N/A ,"$2,443.75 ", N/A ,"$2,443.75 ","$2,587.50 ", N/A ,"$2,386.25 ","$2,285.63 ","$2,285.63 ", N/A ,"$1,868.75 "
ST. JOSEPH'S HOSPITAL - BREESE,72200014,N/A,HC C-SECTION,722,1 ,"$7,479.00 ","$4,861.35 ","$4,300.43 ","$7,479.00 ","$6,357.15 ","$4,464.96 ", N/A ,"$4,300.43 ", N/A ,"$5,153.03 ","$6,357.15 ","$6,357.15 ","$6,357.15 ", N/A ,"$5,085.72 ", N/A , N/A ,"$5,609.25 ","$5,310.09 ","$5,310.09 ", N/A ,"$5,310.09 ","$6,207.57 ","$6,207.57 ","$6,207.57 ", N/A , N/A ,"$6,357.15 ", N/A ,"$7,479.00 ", N/A , N/A ,"$6,357.15 ", N/A ,"$6,357.15 ","$6,731.10 ", N/A ,"$6,207.57 ","$5,945.81 ","$5,945.81 ", N/A ,"$4,861.35 "
ST. JOSEPH'S HOSPITAL - BREESE,72200015,N/A,HC C-SECTION COMPLICATED,722,1 ,"$8,130.00 ","$5,284.50 ","$4,674.75 ","$8,130.00 ","$6,910.50 ","$4,853.61 ", N/A ,"$4,674.75 ", N/A ,"$5,601.57 ","$6,910.50 ","$6,910.50 ","$6,910.50 ", N/A ,"$5,528.40 ", N/A , N/A ,"$6,097.50 ","$5,772.30 ","$5,772.30 ", N/A ,"$5,772.30 ","$6,747.90 ","$6,747.90 ","$6,747.90 ", N/A , N/A ,"$6,910.50 ", N/A ,"$8,130.00 ", N/A , N/A ,"$6,910.50 ", N/A ,"$6,910.50 ","$7,317.00 ", N/A ,"$6,747.90 ","$6,463.35 ","$6,463.35 ", N/A ,"$5,284.50 "
ST. JOSEPH'S HOSPITAL - BREESE,72300002,54160,HC CIRCUMCISION,723,1 ,$467.00 ,$303.55 ,$268.53 ,"$1,116.82 ",$396.95 ,$278.80 ,$531.82 ,$268.53 ,$531.82 ,$321.76 ,$396.95 ,$396.95 ,$396.95 ,$382.94 ,$317.56 ,$531.82 ,$531.82 ,$350.25 ,$331.57 ,$331.57 ,$531.82 ,$331.57 ,$387.61 ,$387.61 ,$387.61 , N/A ,$467.00 ,$396.95 ,$531.82 ,$467.00 ,$957.51 ,$450.66 ,$396.95 ,"$1,116.82 ",$396.95 ,$420.30 ,$531.82 ,$387.61 ,$371.27 ,$371.27 ,$531.82 ,$303.55 
ST. JOSEPH'S HOSPITAL - BREESE,73000002,93005,HC EKG,730,1 ,$308.00 ,$200.20 ,$16.45 ,$308.00 ,$261.80 ,$183.88 ,$52.57 ,$177.10 ,$52.57 ,$212.21 ,$261.80 ,$261.80 ,$261.80 ,$252.56 ,$209.44 ,$52.57 ,$52.57 ,$231.00 ,$218.68 ,$218.68 ,$52.57 ,$218.68 ,$255.64 ,$255.64 ,$255.64 , N/A ,$131.42 ,$261.80 ,$52.57 ,$308.00 ,$16.45 ,$16.45 ,$261.80 ,$110.39 ,$261.80 ,$277.20 ,$52.57 ,$255.64 ,$244.86 ,$244.86 ,$52.57 ,$200.20 
ST. JOSEPH'S HOSPITAL - BREESE,73000003,93041,HC EKG RHYTHM STRIP TRACING,730,1 ,$237.00 ,$154.05 ,$16.45 ,$237.00 ,$201.45 ,$141.49 ,$52.57 ,$136.28 ,$52.57 ,$163.29 ,$201.45 ,$201.45 ,$201.45 ,$194.34 ,$161.16 ,$52.57 ,$52.57 ,$177.75 ,$168.27 ,$168.27 ,$52.57 ,$168.27 ,$196.71 ,$196.71 ,$196.71 , N/A ,$131.42 ,$201.45 ,$52.57 ,$237.00 ,$16.45 ,$16.45 ,$201.45 ,$110.39 ,$201.45 ,$213.30 ,$52.57 ,$196.71 ,$188.42 ,$188.42 ,$52.57 ,$154.05 
ST. JOSEPH'S HOSPITAL - BREESE,73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$659.00 ,$428.35 ,$44.13 ,$659.00 ,$560.15 ,$393.42 ,$104.19 ,$378.93 ,$104.19 ,$454.05 ,$560.15 ,$560.15 ,$560.15 ,$540.38 ,$448.12 ,$104.19 ,$104.19 ,$494.25 ,$467.89 ,$467.89 ,$104.19 ,$467.89 ,$546.97 ,$546.97 ,$546.97 , N/A ,$260.47 ,$560.15 ,$104.19 ,$659.00 ,$44.13 ,$44.13 ,$560.15 ,$218.80 ,$560.15 ,$593.10 ,$104.19 ,$546.97 ,$523.91 ,$523.91 ,$104.19 ,$428.35 
ST. JOSEPH'S HOSPITAL - BREESE,73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,$612.00 ,$397.80 ,$44.13 ,$612.00 ,$520.20 ,$365.36 ,$104.19 ,$351.90 ,$104.19 ,$421.67 ,$520.20 ,$520.20 ,$520.20 ,$501.84 ,$416.16 ,$104.19 ,$104.19 ,$459.00 ,$434.52 ,$434.52 ,$104.19 ,$434.52 ,$507.96 ,$507.96 ,$507.96 , N/A ,$260.47 ,$520.20 ,$104.19 ,$612.00 ,$44.13 ,$44.13 ,$520.20 ,$218.80 ,$520.20 ,$550.80 ,$104.19 ,$507.96 ,$486.54 ,$486.54 ,$104.19 ,$397.80 
ST. JOSEPH'S HOSPITAL - BREESE,73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$499.00 ,$324.35 ,$34.64 ,$499.00 ,$424.15 ,$297.90 ,$34.64 ,$286.93 ,$34.64 ,$343.81 ,$424.15 ,$424.15 ,$424.15 ,$409.18 ,$339.32 ,$34.64 ,$34.64 ,$374.25 ,$354.29 ,$354.29 ,$34.64 ,$354.29 ,$414.17 ,$414.17 ,$414.17 , N/A ,$86.60 ,$424.15 ,$34.64 ,$499.00 ,$44.13 ,$44.13 ,$424.15 ,$72.75 ,$424.15 ,$449.10 ,$34.64 ,$414.17 ,$396.71 ,$396.71 ,$34.64 ,$324.35 
ST. JOSEPH'S HOSPITAL - BREESE,73100005,93271,HC CARDIAC EVENT MONITOR,731,1 ,$588.00 ,$382.20 ,$90.59 ,$588.00 ,$499.80 ,$351.04 ,$108.39 ,$338.10 ,$108.39 ,$405.13 ,$499.80 ,$499.80 ,$499.80 ,$482.16 ,$399.84 ,$108.39 ,$108.39 ,$441.00 ,$417.48 ,$417.48 ,$108.39 ,$417.48 ,$488.04 ,$488.04 ,$488.04 , N/A ,$270.98 ,$499.80 ,$108.39 ,$588.00 ,$90.59 ,$90.59 ,$499.80 ,$227.63 ,$499.80 ,$529.20 ,$108.39 ,$488.04 ,$467.46 ,$467.46 ,$108.39 ,$382.20 
ST. JOSEPH'S HOSPITAL - BREESE,74000003,95806,HC SLEEP STUDY UNATTENDED,740,1 ,"$1,065.00 ",$692.25 ,$132.21 ,"$1,065.00 ",$905.25 ,$635.81 ,$132.21 ,$612.38 ,$132.21 ,$733.79 ,$905.25 ,$905.25 ,$905.25 ,$873.30 ,$724.20 ,$132.21 ,$132.21 ,$798.75 ,$756.15 ,$756.15 ,$132.21 ,$756.15 ,$883.95 ,$883.95 ,$883.95 , N/A ,$330.52 ,$905.25 ,$132.21 ,"$1,065.00 ",$490.14 ,$490.14 ,$905.25 ,$277.64 ,$905.25 ,$958.50 ,$132.21 ,$883.95 ,$846.68 ,$846.68 ,$132.21 ,$692.25 
ST. JOSEPH'S HOSPITAL - BREESE,74000006,95810,HC SLEEP STUDY,740,1 ,"$4,558.00 ","$2,962.70 ",$490.14 ,"$4,558.00 ","$3,874.30 ","$2,721.13 ",$868.59 ,"$2,620.85 ",$868.59 ,"$3,140.46 ","$3,874.30 ","$3,874.30 ","$3,874.30 ","$3,737.56 ","$3,099.44 ",$868.59 ,$868.59 ,"$3,418.50 ","$3,236.18 ","$3,236.18 ",$868.59 ,"$3,236.18 ","$3,783.14 ","$3,783.14 ","$3,783.14 ", N/A ,"$2,171.48 ","$3,874.30 ",$868.59 ,"$4,558.00 ",$490.14 ,$490.14 ,"$3,874.30 ","$1,824.04 ","$3,874.30 ","$4,102.20 ",$868.59 ,"$3,783.14 ","$3,623.61 ","$3,623.61 ",$868.59 ,"$2,962.70 "
ST. JOSEPH'S HOSPITAL - BREESE,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$5,157.00 ","$3,352.05 ",$490.14 ,"$5,157.00 ","$4,383.45 ","$3,078.73 ",$868.59 ,"$2,965.28 ",$868.59 ,"$3,553.17 ","$4,383.45 ","$4,383.45 ","$4,383.45 ","$4,228.74 ","$3,506.76 ",$868.59 ,$868.59 ,"$3,867.75 ","$3,661.47 ","$3,661.47 ",$868.59 ,"$3,661.47 ","$4,280.31 ","$4,280.31 ","$4,280.31 ", N/A ,"$2,171.48 ","$4,383.45 ",$868.59 ,"$5,157.00 ",$490.14 ,$490.14 ,"$4,383.45 ","$1,824.04 ","$4,383.45 ","$4,641.30 ",$868.59 ,"$4,280.31 ","$4,099.82 ","$4,099.82 ",$868.59 ,"$3,352.05 "
ST. JOSEPH'S HOSPITAL - BREESE,75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$1,055.00 ",$685.75 ,$441.90 ,"$1,577.15 ",$896.75 ,$629.84 ,$751.03 ,$606.63 ,$751.03 ,$726.90 ,$896.75 ,$896.75 ,$896.75 ,$865.10 ,$717.40 ,$751.03 ,$751.03 ,$791.25 ,$749.05 ,$749.05 ,$751.03 ,$749.05 ,$875.65 ,$875.65 ,$875.65 , N/A ,"$1,055.00 ",$896.75 ,$751.03 ,"$1,055.00 ",$441.90 ,$441.90 ,$896.75 ,"$1,577.15 ",$896.75 ,$949.50 ,$751.03 ,$875.65 ,$838.73 ,$838.73 ,$751.03 ,$685.75 
ST. JOSEPH'S HOSPITAL - BREESE,75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,$568.00 ,$369.20 ,$326.60 ,"$1,577.15 ",$482.80 ,$339.10 ,$751.03 ,$326.60 ,$751.03 ,$391.35 ,$482.80 ,$482.80 ,$482.80 ,$465.76 ,$386.24 ,$751.03 ,$751.03 ,$426.00 ,$403.28 ,$403.28 ,$751.03 ,$403.28 ,$471.44 ,$471.44 ,$471.44 , N/A ,$568.00 ,$482.80 ,$751.03 ,$568.00 ,$441.90 ,$441.90 ,$482.80 ,"$1,577.15 ",$482.80 ,$511.20 ,$751.03 ,$471.44 ,$451.56 ,$451.56 ,$751.03 ,$369.20 
ST. JOSEPH'S HOSPITAL - BREESE,75001071,43233,HC EGD W/BALLOON DILAT >30MM - 43233,750,1 ,"$4,497.00 ","$2,923.05 ",$690.08 ,"$4,497.00 ","$3,822.45 ","$2,684.71 ","$1,488.25 ","$2,585.78 ","$1,488.25 ","$3,098.43 ","$3,822.45 ","$3,822.45 ","$3,822.45 ","$3,687.54 ","$3,057.96 ","$1,488.25 ","$1,488.25 ","$3,372.75 ","$3,192.87 ","$3,192.87 ","$1,488.25 ","$3,192.87 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,720.63 ","$3,822.45 ","$1,488.25 ","$4,497.00 ",$690.08 ,$690.08 ,"$3,822.45 ","$3,125.33 ","$3,822.45 ","$4,047.30 ","$1,488.25 ","$2,921.00 ","$3,575.12 ","$3,575.12 ","$1,488.25 ","$2,923.05 "
ST. JOSEPH'S HOSPITAL - BREESE,75001072,43235,HC EGD W/BRUSH/WASH - 43235,750,1 ,"$2,780.00 ","$1,807.00 ",$499.95 ,"$2,780.00 ","$2,363.00 ","$1,659.66 ",$751.03 ,"$1,598.50 ",$751.03 ,"$1,915.42 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,279.60 ","$1,890.40 ",$751.03 ,$751.03 ,"$2,085.00 ","$1,973.80 ","$1,973.80 ",$751.03 ,"$1,973.80 ","$2,307.40 ","$2,307.40 ","$2,307.40 ", N/A ,"$1,877.56 ","$2,363.00 ",$751.03 ,"$2,780.00 ",$499.95 ,$499.95 ,"$2,363.00 ","$1,577.15 ","$2,363.00 ","$2,502.00 ",$751.03 ,"$2,307.40 ","$2,210.10 ","$2,210.10 ",$751.03 ,"$1,807.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001076,43239,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$2,032.00 ","$1,320.80 ",$499.95 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$751.03 ,"$1,168.40 ",$751.03 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$751.03 ,$751.03 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$751.03 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$1,877.56 ","$1,727.20 ",$751.03 ,"$2,032.00 ",$499.95 ,$499.95 ,"$1,727.20 ","$1,577.15 ","$1,727.20 ","$1,828.80 ",$751.03 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$751.03 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001081,43245,HC EGD W/DILAT STRICTURE - 43245,750,1 ,"$4,429.00 ","$2,878.85 ",$690.08 ,"$4,429.00 ","$3,764.65 ","$2,644.11 ","$1,488.25 ","$2,546.68 ","$1,488.25 ","$3,051.58 ","$3,764.65 ","$3,764.65 ","$3,764.65 ","$3,631.78 ","$3,011.72 ","$1,488.25 ","$1,488.25 ","$3,321.75 ","$3,144.59 ","$3,144.59 ","$1,488.25 ","$3,144.59 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,720.63 ","$3,764.65 ","$1,488.25 ","$4,429.00 ",$690.08 ,$690.08 ,"$3,764.65 ","$3,125.33 ","$3,764.65 ","$3,986.10 ","$1,488.25 ","$2,921.00 ","$3,521.06 ","$3,521.06 ","$1,488.25 ","$2,878.85 "
ST. JOSEPH'S HOSPITAL - BREESE,75001082,43246,HC EGD W/PLACEMENT G-TUBE - 43246,750,1 ,"$4,497.00 ","$2,923.05 ",$690.08 ,"$4,497.00 ","$3,822.45 ","$2,684.71 ","$1,488.25 ","$2,585.78 ","$1,488.25 ","$3,098.43 ","$3,822.45 ","$3,822.45 ","$3,822.45 ","$3,687.54 ","$3,057.96 ","$1,488.25 ","$1,488.25 ","$3,372.75 ","$3,192.87 ","$3,192.87 ","$1,488.25 ","$3,192.87 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,720.63 ","$3,822.45 ","$1,488.25 ","$4,497.00 ",$690.08 ,$690.08 ,"$3,822.45 ","$3,125.33 ","$3,822.45 ","$4,047.30 ","$1,488.25 ","$2,921.00 ","$3,575.12 ","$3,575.12 ","$1,488.25 ","$2,923.05 "
ST. JOSEPH'S HOSPITAL - BREESE,75001083,43247,HC EGD W/FB REMOVAL - 43247,750,1 ,"$2,032.00 ","$1,320.80 ",$690.08 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$751.03 ,"$1,168.40 ",$751.03 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$751.03 ,$751.03 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$751.03 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$1,877.56 ","$1,727.20 ",$751.03 ,"$2,032.00 ",$690.08 ,$690.08 ,"$1,727.20 ","$1,577.15 ","$1,727.20 ","$1,828.80 ",$751.03 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$751.03 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001084,43248,HC EGD W/INSERT GUIDEWIRE - 43248,750,1 ,"$2,032.00 ","$1,320.80 ",$690.08 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$751.03 ,"$1,168.40 ",$751.03 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$751.03 ,$751.03 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$751.03 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$1,877.56 ","$1,727.20 ",$751.03 ,"$2,032.00 ",$690.08 ,$690.08 ,"$1,727.20 ","$1,577.15 ","$1,727.20 ","$1,828.80 ",$751.03 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$751.03 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001085,43249,HC EGD W/BALLOON DILAT <30MM - 43249,750,1 ,"$2,032.00 ","$1,320.80 ",$690.08 ,"$3,125.33 ","$1,727.20 ","$1,213.10 ","$1,488.25 ","$1,168.40 ","$1,488.25 ","$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ","$1,488.25 ","$1,488.25 ","$1,524.00 ","$1,442.72 ","$1,442.72 ","$1,488.25 ","$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$2,032.00 ","$1,727.20 ","$1,488.25 ","$2,032.00 ",$690.08 ,$690.08 ,"$1,727.20 ","$3,125.33 ","$1,727.20 ","$1,828.80 ","$1,488.25 ","$1,686.56 ","$1,615.44 ","$1,615.44 ","$1,488.25 ","$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001086,43250,HC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY - 43250,750,1 ,"$4,717.00 ","$3,066.05 ",$690.08 ,"$4,717.00 ","$4,009.45 ","$2,816.05 ","$1,488.25 ","$2,712.28 ","$1,488.25 ","$3,250.01 ","$4,009.45 ","$4,009.45 ","$4,009.45 ","$3,867.94 ","$3,207.56 ","$1,488.25 ","$1,488.25 ","$3,537.75 ","$3,349.07 ","$3,349.07 ","$1,488.25 ","$3,349.07 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,720.63 ","$4,009.45 ","$1,488.25 ","$4,717.00 ",$690.08 ,$690.08 ,"$4,009.45 ","$3,125.33 ","$4,009.45 ","$4,245.30 ","$1,488.25 ","$2,921.00 ","$3,750.02 ","$3,750.02 ","$1,488.25 ","$3,066.05 "
ST. JOSEPH'S HOSPITAL - BREESE,75001087,43251,HC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH - 43251,750,1 ,"$4,717.00 ","$3,066.05 ",$690.08 ,"$4,717.00 ","$4,009.45 ","$2,816.05 ","$1,488.25 ","$2,712.28 ","$1,488.25 ","$3,250.01 ","$4,009.45 ","$4,009.45 ","$4,009.45 ","$3,867.94 ","$3,207.56 ","$1,488.25 ","$1,488.25 ","$3,537.75 ","$3,349.07 ","$3,349.07 ","$1,488.25 ","$3,349.07 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,720.63 ","$4,009.45 ","$1,488.25 ","$4,717.00 ",$690.08 ,$690.08 ,"$4,009.45 ","$3,125.33 ","$4,009.45 ","$4,245.30 ","$1,488.25 ","$2,921.00 ","$3,750.02 ","$3,750.02 ","$1,488.25 ","$3,066.05 "
ST. JOSEPH'S HOSPITAL - BREESE,75001090,43255,HC EGD W/CONTROL BLEEDING - 43255,750,1 ,"$4,633.00 ","$3,011.45 ",$690.08 ,"$4,633.00 ","$3,938.05 ","$2,765.90 ","$1,488.25 ","$2,663.98 ","$1,488.25 ","$3,192.14 ","$3,938.05 ","$3,938.05 ","$3,938.05 ","$3,799.06 ","$3,150.44 ","$1,488.25 ","$1,488.25 ","$3,474.75 ","$3,289.43 ","$3,289.43 ","$1,488.25 ","$3,289.43 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$3,720.63 ","$3,938.05 ","$1,488.25 ","$4,633.00 ",$690.08 ,$690.08 ,"$3,938.05 ","$3,125.33 ","$3,938.05 ","$4,169.70 ","$1,488.25 ","$2,921.00 ","$3,683.24 ","$3,683.24 ","$1,488.25 ","$3,011.45 "
ST. JOSEPH'S HOSPITAL - BREESE,75001097,43263,HC ERCP W/SPHINCTER PRESSURE MEASUREMENT - 43263,750,1 ,"$4,884.00 ","$3,174.60 ","$1,459.28 ","$6,018.43 ","$4,151.40 ","$2,915.75 ","$2,865.92 ","$2,808.30 ","$2,865.92 ","$3,365.08 ","$4,151.40 ","$4,151.40 ","$4,151.40 ","$4,004.88 ","$3,321.12 ","$2,865.92 ","$2,865.92 ","$3,663.00 ","$3,467.64 ","$3,467.64 ","$2,865.92 ","$3,467.64 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,884.00 ","$4,151.40 ","$2,865.92 ","$4,884.00 ","$1,459.28 ","$1,459.28 ","$4,151.40 ","$6,018.43 ","$4,151.40 ","$4,395.60 ","$2,865.92 ","$2,921.00 ","$3,882.78 ","$3,882.78 ","$2,865.92 ","$3,174.60 "
ST. JOSEPH'S HOSPITAL - BREESE,75001098,43264,HC ERCP W/STONE REMOVAL DUCT - 43264,750,1 ,"$8,821.00 ","$5,733.65 ","$1,459.28 ","$8,821.00 ","$5,213.00 ","$5,266.14 ","$2,865.92 ","$5,072.08 ","$2,865.92 ","$6,077.67 ","$7,497.85 ","$7,497.85 ","$7,497.85 ","$4,769.00 ","$5,998.28 ","$2,865.92 ","$2,865.92 ","$6,615.75 ","$6,262.91 ","$6,262.91 ","$2,865.92 ","$6,262.91 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$7,164.80 ","$7,497.85 ","$2,865.92 ","$8,821.00 ","$1,459.28 ","$1,459.28 ","$7,497.85 ","$6,018.43 ","$7,497.85 ","$7,938.90 ","$2,865.92 ","$2,921.00 ","$7,012.70 ","$7,012.70 ","$2,865.92 ","$5,733.65 "
ST. JOSEPH'S HOSPITAL - BREESE,75001099,43265,HC ERCP W/LITHOTRIPSY - 43265,750,1 ,"$14,042.00 ","$9,127.30 ","$1,459.28 ","$14,042.00 ","$5,213.00 ","$8,383.07 ","$4,568.56 ","$8,074.15 ","$4,568.56 ","$9,674.94 ","$11,935.70 ","$11,935.70 ","$11,935.70 ","$4,769.00 ","$9,548.56 ","$4,568.56 ","$4,568.56 ","$10,531.50 ","$9,969.82 ","$9,969.82 ","$4,568.56 ","$9,969.82 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$11,421.40 ","$11,935.70 ","$4,568.56 ","$14,042.00 ","$1,459.28 ","$1,459.28 ","$11,935.70 ","$9,593.98 ","$11,935.70 ","$12,637.80 ","$4,568.56 ","$2,921.00 ","$11,163.39 ","$11,163.39 ","$4,568.56 ","$9,127.30 "
ST. JOSEPH'S HOSPITAL - BREESE,75001100,43274,HC ERCP W/STENT PLACEMENT DUCT - 43274,750,1 ,"$14,042.00 ","$9,127.30 ","$1,459.28 ","$14,042.00 ","$5,213.00 ","$8,383.07 ","$4,568.56 ","$8,074.15 ","$4,568.56 ","$9,674.94 ","$11,935.70 ","$11,935.70 ","$11,935.70 ","$4,769.00 ","$9,548.56 ","$4,568.56 ","$4,568.56 ","$10,531.50 ","$9,969.82 ","$9,969.82 ","$4,568.56 ","$9,969.82 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$11,421.40 ","$11,935.70 ","$4,568.56 ","$14,042.00 ","$1,459.28 ","$1,459.28 ","$11,935.70 ","$9,593.98 ","$11,935.70 ","$12,637.80 ","$4,568.56 ","$2,921.00 ","$11,163.39 ","$11,163.39 ","$4,568.56 ","$9,127.30 "
ST. JOSEPH'S HOSPITAL - BREESE,75001101,43275,HC ERCP W/FB OR STENT REMOVAL DUCT - 43275,750,1 ,"$8,821.00 ","$5,733.65 ","$1,459.28 ","$8,821.00 ","$5,213.00 ","$5,266.14 ","$2,865.92 ","$5,072.08 ","$2,865.92 ","$6,077.67 ","$7,497.85 ","$7,497.85 ","$7,497.85 ","$4,769.00 ","$5,998.28 ","$2,865.92 ","$2,865.92 ","$6,615.75 ","$6,262.91 ","$6,262.91 ","$2,865.92 ","$6,262.91 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$7,164.80 ","$7,497.85 ","$2,865.92 ","$8,821.00 ","$1,459.28 ","$1,459.28 ","$7,497.85 ","$6,018.43 ","$7,497.85 ","$7,938.90 ","$2,865.92 ","$2,921.00 ","$7,012.70 ","$7,012.70 ","$2,865.92 ","$5,733.65 "
ST. JOSEPH'S HOSPITAL - BREESE,75001102,43276,HC ERCP W/REM/EXCHG STENT W/DILAT  AND  WIRE EA - 43276,750,1 ,"$14,042.00 ","$9,127.30 ","$1,459.28 ","$14,042.00 ","$5,213.00 ","$8,383.07 ","$4,568.56 ","$8,074.15 ","$4,568.56 ","$9,674.94 ","$11,935.70 ","$11,935.70 ","$11,935.70 ","$4,769.00 ","$9,548.56 ","$4,568.56 ","$4,568.56 ","$10,531.50 ","$9,969.82 ","$9,969.82 ","$4,568.56 ","$9,969.82 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$11,421.40 ","$11,935.70 ","$4,568.56 ","$14,042.00 ","$1,459.28 ","$1,459.28 ","$11,935.70 ","$9,593.98 ","$11,935.70 ","$12,637.80 ","$4,568.56 ","$2,921.00 ","$11,163.39 ","$11,163.39 ","$4,568.56 ","$9,127.30 "
ST. JOSEPH'S HOSPITAL - BREESE,75001103,43277,HC ERCP W/BALL DILAT DUCT/AMPULLA EA -43277,750,1 ,"$8,821.00 ","$5,733.65 ","$1,459.28 ","$8,821.00 ","$5,213.00 ","$5,266.14 ","$2,865.92 ","$5,072.08 ","$2,865.92 ","$6,077.67 ","$7,497.85 ","$7,497.85 ","$7,497.85 ","$4,769.00 ","$5,998.28 ","$2,865.92 ","$2,865.92 ","$6,615.75 ","$6,262.91 ","$6,262.91 ","$2,865.92 ","$6,262.91 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$7,164.80 ","$7,497.85 ","$2,865.92 ","$8,821.00 ","$1,459.28 ","$1,459.28 ","$7,497.85 ","$6,018.43 ","$7,497.85 ","$7,938.90 ","$2,865.92 ","$2,921.00 ","$7,012.70 ","$7,012.70 ","$2,865.92 ","$5,733.65 "
ST. JOSEPH'S HOSPITAL - BREESE,75001106,43450,HC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS - 43450,750,1 ,"$2,032.00 ","$1,320.80 ",$441.47 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$751.03 ,"$1,168.40 ",$751.03 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$751.03 ,$751.03 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$751.03 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$1,877.56 ","$1,727.20 ",$751.03 ,"$2,032.00 ",$441.47 ,$441.47 ,"$1,727.20 ","$1,577.15 ","$1,727.20 ","$1,828.80 ",$751.03 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$751.03 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001125,44388,HC COLONOSCOPY STOMA DX W/BRUSH/WASH - 44388,750,1 ,"$2,032.00 ","$1,320.80 ",$479.27 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$729.96 ,"$1,168.40 ",$729.96 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$729.96 ,$729.96 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$729.96 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$1,824.91 ","$1,727.20 ",$729.96 ,"$2,032.00 ",$479.27 ,$479.27 ,"$1,727.20 ","$1,532.92 ","$1,727.20 ","$1,828.80 ",$729.96 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$729.96 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001129,44392,HC COLONOSCOPY STOMA W/REM TUMOR HOT BX - 44392,750,1 ,"$2,032.00 ","$1,320.80 ",$533.37 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$959.63 ,"$1,168.40 ",$959.63 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$959.63 ,$959.63 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$959.63 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$2,032.00 ","$1,727.20 ",$959.63 ,"$2,032.00 ",$533.37 ,$533.37 ,"$1,727.20 ","$2,015.23 ","$1,727.20 ","$1,828.80 ",$959.63 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$959.63 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001139,45300,HC PROCTOSIGMOIDOSCOPY RIGID DX W/W/O SPECIMEN - 45300,750,1 ,"$2,291.64 ","$1,489.57 ",$419.00 ,"$2,291.64 ","$1,947.89 ","$1,368.11 ",$729.96 ,"$1,317.69 ",$729.96 ,"$1,578.94 ","$1,947.89 ","$1,947.89 ","$1,947.89 ","$1,879.14 ","$1,558.32 ",$729.96 ,$729.96 ,"$1,718.73 ","$1,627.06 ","$1,627.06 ",$729.96 ,"$1,627.06 ","$1,902.06 ","$1,902.06 ","$1,902.06 ", N/A ,"$1,824.91 ","$1,947.89 ",$729.96 ,"$2,291.64 ",$419.00 ,$419.00 ,"$1,947.89 ","$1,532.92 ","$1,947.89 ","$2,062.48 ",$729.96 ,"$1,902.06 ","$1,821.85 ","$1,821.85 ",$729.96 ,"$1,489.57 "
ST. JOSEPH'S HOSPITAL - BREESE,75001142,45330,HC SIGMOIDOSCOPY DX W/BRUSH/WASH - 45330,750,1 ,"$2,032.00 ","$1,320.80 ",$419.00 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$729.96 ,"$1,168.40 ",$729.96 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$729.96 ,$729.96 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$729.96 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$1,824.91 ","$1,727.20 ",$729.96 ,"$2,032.00 ",$419.00 ,$419.00 ,"$1,727.20 ","$1,532.92 ","$1,727.20 ","$1,828.80 ",$729.96 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$729.96 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001143,45331,HC SIGMOIDOSCOPY W/BIOPSY SGL/MULT -45331,750,1 ,"$2,032.00 ","$1,320.80 ",$508.29 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$729.96 ,"$1,168.40 ",$729.96 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$729.96 ,$729.96 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$729.96 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,"$1,824.91 ","$1,727.20 ",$729.96 ,"$2,032.00 ",$508.29 ,$508.29 ,"$1,727.20 ","$1,532.92 ","$1,727.20 ","$1,828.80 ",$729.96 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$729.96 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001147,45335,HC SIGMOIDOSCOPY W/SUBMUCOSAL INJ - 45335,750,1 ,"$2,183.88 ","$1,419.52 ",$508.29 ,"$2,183.88 ","$1,856.30 ","$1,303.78 ",$729.96 ,"$1,255.73 ",$729.96 ,"$1,504.69 ","$1,856.30 ","$1,856.30 ","$1,856.30 ","$1,790.78 ","$1,485.04 ",$729.96 ,$729.96 ,"$1,637.91 ","$1,550.55 ","$1,550.55 ",$729.96 ,"$1,550.55 ","$1,812.62 ","$1,812.62 ","$1,812.62 ", N/A ,"$1,824.91 ","$1,856.30 ",$729.96 ,"$2,183.88 ",$508.29 ,$508.29 ,"$1,856.30 ","$1,532.92 ","$1,856.30 ","$1,965.49 ",$729.96 ,"$1,812.62 ","$1,736.18 ","$1,736.18 ",$729.96 ,"$1,419.52 "
ST. JOSEPH'S HOSPITAL - BREESE,75001149,45338,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45338,750,1 ,"$2,878.89 ","$1,871.28 ",$508.29 ,"$2,878.89 ","$2,447.06 ","$1,718.70 ",$959.63 ,"$1,655.36 ",$959.63 ,"$1,983.56 ","$2,447.06 ","$2,447.06 ","$2,447.06 ","$2,360.69 ","$1,957.65 ",$959.63 ,$959.63 ,"$2,159.17 ","$2,044.01 ","$2,044.01 ",$959.63 ,"$2,044.01 ","$2,389.48 ","$2,389.48 ","$2,389.48 ", N/A ,"$2,399.08 ","$2,447.06 ",$959.63 ,"$2,878.89 ",$508.29 ,$508.29 ,"$2,447.06 ","$2,015.23 ","$2,447.06 ","$2,591.00 ",$959.63 ,"$2,389.48 ","$2,288.72 ","$2,288.72 ",$959.63 ,"$1,871.28 "
ST. JOSEPH'S HOSPITAL - BREESE,75001155,45349,HC SIGMOIDOSCOPY W/ENDO MUCOSAL RESECTION - 45349,750,1 ,"$6,720.30 ","$4,368.20 ",$508.29 ,"$6,720.30 ","$5,213.00 ","$4,012.02 ","$2,240.10 ","$3,864.17 ","$2,240.10 ","$4,630.29 ","$5,712.26 ","$5,712.26 ","$5,712.26 ","$4,769.00 ","$4,569.80 ","$2,240.10 ","$2,240.10 ","$5,040.23 ","$4,771.41 ","$4,771.41 ","$2,240.10 ","$4,771.41 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$5,600.25 ","$5,712.26 ","$2,240.10 ","$6,720.30 ",$508.29 ,$508.29 ,"$5,712.26 ","$4,704.21 ","$5,712.26 ","$6,048.27 ","$2,240.10 ","$2,921.00 ","$5,342.64 ","$5,342.64 ","$2,240.10 ","$4,368.20 "
ST. JOSEPH'S HOSPITAL - BREESE,75001156,45350,HC SIGMOIDOSCOPY W/BAND LIGATION - 45350,750,1 ,"$3,059.00 ","$1,988.35 ",$508.29 ,"$3,059.00 ","$2,600.15 ","$1,826.22 ",$959.63 ,"$1,758.93 ",$959.63 ,"$2,107.65 ","$2,600.15 ","$2,600.15 ","$2,600.15 ","$2,508.38 ","$2,080.12 ",$959.63 ,$959.63 ,"$2,294.25 ","$2,171.89 ","$2,171.89 ",$959.63 ,"$2,171.89 ","$2,538.97 ","$2,538.97 ","$2,538.97 ", N/A ,"$2,399.08 ","$2,600.15 ",$959.63 ,"$3,059.00 ",$508.29 ,$508.29 ,"$2,600.15 ","$2,015.23 ","$2,600.15 ","$2,753.10 ",$959.63 ,"$2,538.97 ","$2,431.91 ","$2,431.91 ",$959.63 ,"$1,988.35 "
ST. JOSEPH'S HOSPITAL - BREESE,75001157,45378,HC COLONOSCOPY DX W/SPECIMEN BRUSH/WASH - 45378,750,1 ,"$2,780.00 ","$1,807.00 ",$433.52 ,"$2,780.00 ","$2,363.00 ","$1,659.66 ",$729.96 ,"$1,598.50 ",$729.96 ,"$1,915.42 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,279.60 ","$1,890.40 ",$729.96 ,$729.96 ,"$2,085.00 ","$1,973.80 ","$1,973.80 ",$729.96 ,"$1,973.80 ","$2,307.40 ","$2,307.40 ","$2,307.40 ", N/A ,"$1,824.91 ","$2,363.00 ",$729.96 ,"$2,780.00 ",$433.52 ,$433.52 ,"$2,363.00 ","$1,532.92 ","$2,363.00 ","$2,502.00 ",$729.96 ,"$2,307.40 ","$2,210.10 ","$2,210.10 ",$729.96 ,"$1,807.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001159,45380,HC COLONOSCOPY W/BIOPSY SGL/MULT - 45380,750,1 ,"$3,086.00 ","$2,005.90 ",$433.52 ,"$3,086.00 ","$2,623.10 ","$1,842.34 ",$959.63 ,"$1,774.45 ",$959.63 ,"$2,126.25 ","$2,623.10 ","$2,623.10 ","$2,623.10 ","$2,530.52 ","$2,098.48 ",$959.63 ,$959.63 ,"$2,314.50 ","$2,191.06 ","$2,191.06 ",$959.63 ,"$2,191.06 ","$2,561.38 ","$2,561.38 ","$2,561.38 ", N/A ,"$2,399.08 ","$2,623.10 ",$959.63 ,"$3,086.00 ",$433.52 ,$433.52 ,"$2,623.10 ","$2,015.23 ","$2,623.10 ","$2,777.40 ",$959.63 ,"$2,561.38 ","$2,453.37 ","$2,453.37 ",$959.63 ,"$2,005.90 "
ST. JOSEPH'S HOSPITAL - BREESE,75001160,45381,HC COLONOSCOPY W/SUBMUCOSAL INJ - 45381,750,1 ,"$3,086.00 ","$2,005.90 ",$533.37 ,"$3,086.00 ","$2,623.10 ","$1,842.34 ",$959.63 ,"$1,774.45 ",$959.63 ,"$2,126.25 ","$2,623.10 ","$2,623.10 ","$2,623.10 ","$2,530.52 ","$2,098.48 ",$959.63 ,$959.63 ,"$2,314.50 ","$2,191.06 ","$2,191.06 ",$959.63 ,"$2,191.06 ","$2,561.38 ","$2,561.38 ","$2,561.38 ", N/A ,"$2,399.08 ","$2,623.10 ",$959.63 ,"$3,086.00 ",$533.37 ,$533.37 ,"$2,623.10 ","$2,015.23 ","$2,623.10 ","$2,777.40 ",$959.63 ,"$2,561.38 ","$2,453.37 ","$2,453.37 ",$959.63 ,"$2,005.90 "
ST. JOSEPH'S HOSPITAL - BREESE,75001161,45382,HC COLONOSCOPY W/CONTROL BLEEDING - 45382,750,1 ,"$3,086.00 ","$2,005.90 ",$533.37 ,"$3,086.00 ","$2,623.10 ","$1,842.34 ",$959.63 ,"$1,774.45 ",$959.63 ,"$2,126.25 ","$2,623.10 ","$2,623.10 ","$2,623.10 ","$2,530.52 ","$2,098.48 ",$959.63 ,$959.63 ,"$2,314.50 ","$2,191.06 ","$2,191.06 ",$959.63 ,"$2,191.06 ","$2,561.38 ","$2,561.38 ","$2,561.38 ", N/A ,"$2,399.08 ","$2,623.10 ",$959.63 ,"$3,086.00 ",$533.37 ,$533.37 ,"$2,623.10 ","$2,015.23 ","$2,623.10 ","$2,777.40 ",$959.63 ,"$2,561.38 ","$2,453.37 ","$2,453.37 ",$959.63 ,"$2,005.90 "
ST. JOSEPH'S HOSPITAL - BREESE,75001162,45384,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 45384,750,1 ,"$3,086.00 ","$2,005.90 ",$533.37 ,"$3,086.00 ","$2,623.10 ","$1,842.34 ",$959.63 ,"$1,774.45 ",$959.63 ,"$2,126.25 ","$2,623.10 ","$2,623.10 ","$2,623.10 ","$2,530.52 ","$2,098.48 ",$959.63 ,$959.63 ,"$2,314.50 ","$2,191.06 ","$2,191.06 ",$959.63 ,"$2,191.06 ","$2,561.38 ","$2,561.38 ","$2,561.38 ", N/A ,"$2,399.08 ","$2,623.10 ",$959.63 ,"$3,086.00 ",$533.37 ,$533.37 ,"$2,623.10 ","$2,015.23 ","$2,623.10 ","$2,777.40 ",$959.63 ,"$2,561.38 ","$2,453.37 ","$2,453.37 ",$959.63 ,"$2,005.90 "
ST. JOSEPH'S HOSPITAL - BREESE,75001163,45385,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45385,750,1 ,"$3,086.00 ","$2,005.90 ",$533.37 ,"$3,086.00 ","$2,623.10 ","$1,842.34 ",$959.63 ,"$1,774.45 ",$959.63 ,"$2,126.25 ","$2,623.10 ","$2,623.10 ","$2,623.10 ","$2,530.52 ","$2,098.48 ",$959.63 ,$959.63 ,"$2,314.50 ","$2,191.06 ","$2,191.06 ",$959.63 ,"$2,191.06 ","$2,561.38 ","$2,561.38 ","$2,561.38 ", N/A ,"$2,399.08 ","$2,623.10 ",$959.63 ,"$3,086.00 ",$533.37 ,$533.37 ,"$2,623.10 ","$2,015.23 ","$2,623.10 ","$2,777.40 ",$959.63 ,"$2,561.38 ","$2,453.37 ","$2,453.37 ",$959.63 ,"$2,005.90 "
ST. JOSEPH'S HOSPITAL - BREESE,75001164,45386,HC COLONOSCOPY W/BALLOON DILATION - 45386,750,1 ,"$3,086.00 ","$2,005.90 ",$533.37 ,"$3,086.00 ","$2,623.10 ","$1,842.34 ",$959.63 ,"$1,774.45 ",$959.63 ,"$2,126.25 ","$2,623.10 ","$2,623.10 ","$2,623.10 ","$2,530.52 ","$2,098.48 ",$959.63 ,$959.63 ,"$2,314.50 ","$2,191.06 ","$2,191.06 ",$959.63 ,"$2,191.06 ","$2,561.38 ","$2,561.38 ","$2,561.38 ", N/A ,"$2,399.08 ","$2,623.10 ",$959.63 ,"$3,086.00 ",$533.37 ,$533.37 ,"$2,623.10 ","$2,015.23 ","$2,623.10 ","$2,777.40 ",$959.63 ,"$2,561.38 ","$2,453.37 ","$2,453.37 ",$959.63 ,"$2,005.90 "
ST. JOSEPH'S HOSPITAL - BREESE,75001165,45388,HC COLONOSCOPY W/ABLATION TUMOR - 45388,750,1 ,"$2,879.00 ","$1,871.35 ",$533.37 ,"$2,879.00 ","$2,447.15 ","$1,718.76 ",$959.63 ,"$1,655.43 ",$959.63 ,"$1,983.63 ","$2,447.15 ","$2,447.15 ","$2,447.15 ","$2,360.78 ","$1,957.72 ",$959.63 ,$959.63 ,"$2,159.25 ","$2,044.09 ","$2,044.09 ",$959.63 ,"$2,044.09 ","$2,389.57 ","$2,389.57 ","$2,389.57 ", N/A ,"$2,399.08 ","$2,447.15 ",$959.63 ,"$2,879.00 ",$533.37 ,$533.37 ,"$2,447.15 ","$2,015.23 ","$2,447.15 ","$2,591.10 ",$959.63 ,"$2,389.57 ","$2,288.81 ","$2,288.81 ",$959.63 ,"$1,871.35 "
ST. JOSEPH'S HOSPITAL - BREESE,75001167,45390,HC COLONOSCOPY W/MUCOSAL RESECTION - 45390,750,1 ,"$6,720.30 ","$4,368.20 ",$533.37 ,"$6,720.30 ","$5,213.00 ","$4,012.02 ","$2,240.10 ","$3,864.17 ","$2,240.10 ","$4,630.29 ","$5,712.26 ","$5,712.26 ","$5,712.26 ","$4,769.00 ","$4,569.80 ","$2,240.10 ","$2,240.10 ","$5,040.23 ","$4,771.41 ","$4,771.41 ","$2,240.10 ","$4,771.41 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$5,600.25 ","$5,712.26 ","$2,240.10 ","$6,720.30 ",$533.37 ,$533.37 ,"$5,712.26 ","$4,704.21 ","$5,712.26 ","$6,048.27 ","$2,240.10 ","$2,921.00 ","$5,342.64 ","$5,342.64 ","$2,240.10 ","$4,368.20 "
ST. JOSEPH'S HOSPITAL - BREESE,75001171,45398,HC COLONOSCOPY W/BAND LIGATION - 45398,750,1 ,"$3,086.00 ","$2,005.90 ",$533.37 ,"$3,086.00 ","$2,623.10 ","$1,842.34 ",$959.63 ,"$1,774.45 ",$959.63 ,"$2,126.25 ","$2,623.10 ","$2,623.10 ","$2,623.10 ","$2,530.52 ","$2,098.48 ",$959.63 ,$959.63 ,"$2,314.50 ","$2,191.06 ","$2,191.06 ",$959.63 ,"$2,191.06 ","$2,561.38 ","$2,561.38 ","$2,561.38 ", N/A ,"$2,399.08 ","$2,623.10 ",$959.63 ,"$3,086.00 ",$533.37 ,$533.37 ,"$2,623.10 ","$2,015.23 ","$2,623.10 ","$2,777.40 ",$959.63 ,"$2,561.38 ","$2,453.37 ","$2,453.37 ",$959.63 ,"$2,005.90 "
ST. JOSEPH'S HOSPITAL - BREESE,75001173,46221,HC HERMORRHOIDECTOMY INTERNAL W/LIGATION - 46221,750,1 ,"$1,980.00 ","$1,287.00 ",$411.65 ,"$1,980.00 ","$1,683.00 ","$1,182.06 ",$729.96 ,"$1,138.50 ",$729.96 ,"$1,364.22 ","$1,683.00 ","$1,683.00 ","$1,683.00 ","$1,623.60 ","$1,346.40 ",$729.96 ,$729.96 ,"$1,485.00 ","$1,405.80 ","$1,405.80 ",$729.96 ,"$1,405.80 ","$1,643.40 ","$1,643.40 ","$1,643.40 ", N/A ,"$1,824.91 ","$1,683.00 ",$729.96 ,"$1,980.00 ",$411.65 ,$411.65 ,"$1,683.00 ","$1,532.92 ","$1,683.00 ","$1,782.00 ",$729.96 ,"$1,643.40 ","$1,574.10 ","$1,574.10 ",$729.96 ,"$1,287.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001174,46600,HC ANOSCOPY DX W/SPECIMEN -46600,750,1 ,"$2,032.00 ","$1,320.80 ",$104.19 ,"$2,032.00 ","$1,727.20 ","$1,213.10 ",$104.19 ,"$1,168.40 ",$104.19 ,"$1,400.05 ","$1,727.20 ","$1,727.20 ","$1,727.20 ","$1,666.24 ","$1,381.76 ",$104.19 ,$104.19 ,"$1,524.00 ","$1,442.72 ","$1,442.72 ",$104.19 ,"$1,442.72 ","$1,686.56 ","$1,686.56 ","$1,686.56 ", N/A ,$260.47 ,"$1,727.20 ",$104.19 ,"$2,032.00 ", N/A , N/A ,"$1,727.20 ",$218.80 ,"$1,727.20 ","$1,828.80 ",$104.19 ,"$1,686.56 ","$1,615.44 ","$1,615.44 ",$104.19 ,"$1,320.80 "
ST. JOSEPH'S HOSPITAL - BREESE,75001177,46610,HC ANOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 46610,750,1 ,"$6,720.30 ","$4,368.20 ",$419.00 ,"$6,720.30 ","$5,213.00 ","$4,012.02 ","$2,240.10 ","$3,864.17 ","$2,240.10 ","$4,630.29 ","$5,712.26 ","$5,712.26 ","$5,712.26 ","$4,769.00 ","$4,569.80 ","$2,240.10 ","$2,240.10 ","$5,040.23 ","$4,771.41 ","$4,771.41 ","$2,240.10 ","$4,771.41 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$5,600.25 ","$5,712.26 ","$2,240.10 ","$6,720.30 ",$419.00 ,$419.00 ,"$5,712.26 ","$4,704.21 ","$5,712.26 ","$6,048.27 ","$2,240.10 ","$2,921.00 ","$5,342.64 ","$5,342.64 ","$2,240.10 ","$4,368.20 "
ST. JOSEPH'S HOSPITAL - BREESE,75001178,46922,HC EXCISION ANAL LESIONS SIMPLE - 46922,750,1 ,"$4,497.00 ","$2,923.05 ",$532.85 ,"$4,704.21 ","$3,822.45 ","$2,684.71 ","$2,240.10 ","$2,585.78 ","$2,240.10 ","$3,098.43 ","$3,822.45 ","$3,822.45 ","$3,822.45 ","$3,687.54 ","$3,057.96 ","$2,240.10 ","$2,240.10 ","$3,372.75 ","$3,192.87 ","$3,192.87 ","$2,240.10 ","$3,192.87 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$4,497.00 ","$3,822.45 ","$2,240.10 ","$4,497.00 ",$532.85 ,$532.85 ,"$3,822.45 ","$4,704.21 ","$3,822.45 ","$4,047.30 ","$2,240.10 ","$2,921.00 ","$3,575.12 ","$3,575.12 ","$2,240.10 ","$2,923.05 "
ST. JOSEPH'S HOSPITAL - BREESE,75001179,47563,HC LAP CHOLECYSTECTOMY W/CHOLANG - 47563,750,1 ,"$13,933.00 ","$9,056.45 ","$2,921.00 ","$13,933.00 ","$5,213.00 ","$8,318.00 ","$4,619.09 ","$8,011.48 ","$4,619.09 ","$9,599.84 ","$11,843.05 ","$11,843.05 ","$11,843.05 ","$4,769.00 ","$9,474.44 ","$4,619.09 ","$4,619.09 ","$10,449.75 ","$9,892.43 ","$9,892.43 ","$4,619.09 ","$9,892.43 ","$2,921.00 ","$2,921.00 ","$2,921.00 ", N/A ,"$11,547.73 ","$11,843.05 ","$4,619.09 ","$13,933.00 ","$2,955.30 ","$2,955.30 ","$11,843.05 ","$9,700.10 ","$11,843.05 ","$12,539.70 ","$4,619.09 ","$2,921.00 ","$11,076.74 ","$11,076.74 ","$4,619.09 ","$9,056.45 "
ST. JOSEPH'S HOSPITAL - BREESE,75001202,43762,HC REPLACE GASTRO TUBE PERC - 43762,750,1 ,$723.00 ,$469.95 ,$133.50 ,$723.00 ,$614.55 ,$431.63 ,$224.47 ,$415.73 ,$224.47 ,$498.15 ,$614.55 ,$614.55 ,$614.55 ,$592.86 ,$491.64 ,$224.47 ,$224.47 ,$542.25 ,$513.33 ,$513.33 ,$224.47 ,$513.33 ,$600.09 ,$600.09 ,$600.09 , N/A ,$561.18 ,$614.55 ,$224.47 ,$723.00 ,$133.50 ,$133.50 ,$614.55 ,$471.39 ,$614.55 ,$650.70 ,$224.47 ,$600.09 ,$574.79 ,$574.79 ,$224.47 ,$469.95 
ST. JOSEPH'S HOSPITAL - BREESE,75001203,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT - 43763,750,1 ,$723.00 ,$469.95 ,$133.50 ,$723.00 ,$614.55 ,$431.63 ,$224.47 ,$415.73 ,$224.47 ,$498.15 ,$614.55 ,$614.55 ,$614.55 ,$592.86 ,$491.64 ,$224.47 ,$224.47 ,$542.25 ,$513.33 ,$513.33 ,$224.47 ,$513.33 ,$600.09 ,$600.09 ,$600.09 , N/A ,$561.18 ,$614.55 ,$224.47 ,$723.00 ,$133.50 ,$133.50 ,$614.55 ,$471.39 ,$614.55 ,$650.70 ,$224.47 ,$600.09 ,$574.79 ,$574.79 ,$224.47 ,$469.95 
ST. JOSEPH'S HOSPITAL - BREESE,75001204,43999,HC REMOVE G TUBE W/ANESTHESIA - 43999,750,1 ,"$2,378.00 ","$1,545.70 ",$751.03 ,"$2,378.00 ","$2,021.30 ","$1,419.67 ",$751.03 ,"$1,367.35 ",$751.03 ,"$1,638.44 ","$2,021.30 ","$2,021.30 ","$2,021.30 ","$1,949.96 ","$1,617.04 ",$751.03 ,$751.03 ,"$1,783.50 ","$1,688.38 ","$1,688.38 ",$751.03 ,"$1,688.38 ","$1,973.74 ","$1,973.74 ","$1,973.74 ", N/A ,"$1,877.56 ","$2,021.30 ",$751.03 ,"$2,378.00 ","$1,075.40 ","$1,075.40 ","$2,021.30 ","$1,577.15 ","$2,021.30 ","$2,140.20 ",$751.03 ,"$1,973.74 ","$1,890.51 ","$1,890.51 ",$751.03 ,"$1,545.70 "
ST. JOSEPH'S HOSPITAL - BREESE,76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,$973.00 ,$632.45 ,$509.48 ,"$1,254.33 ",$827.05 ,$580.88 ,$597.30 ,$559.48 ,$597.30 ,$670.40 ,$827.05 ,$827.05 ,$827.05 ,$797.86 ,$661.64 ,$597.30 ,$597.30 ,$729.75 ,$690.83 ,$690.83 ,$597.30 ,$690.83 ,$807.59 ,$807.59 ,$807.59 , N/A ,$973.00 ,$827.05 ,$597.30 ,$973.00 ,$509.48 ,$509.48 ,$827.05 ,"$1,254.33 ",$827.05 ,$875.70 ,$597.30 ,$807.59 ,$773.54 ,$773.54 ,$597.30 ,$632.45 
ST. JOSEPH'S HOSPITAL - BREESE,76100006,64447,HC INJ ANES NERVE FEMORAL SINGLE-BI,761,1 ,"$3,460.00 ","$2,249.00 ",$186.00 ,"$3,460.00 ","$1,810.00 ","$2,065.62 ",$895.95 ,"$1,989.50 ",$895.95 ,"$2,383.94 ","$2,941.00 ","$2,941.00 ","$2,941.00 ","$1,707.00 ","$2,352.80 ",$895.95 ,$895.95 ,"$2,595.00 ","$2,456.60 ","$2,456.60 ",$895.95 ,"$2,456.60 ","$2,871.80 ","$2,871.80 ","$2,871.80 ", N/A ,"$2,239.87 ","$2,941.00 ",$895.95 ,"$3,460.00 ",$421.38 ,$421.38 ,"$2,941.00 ","$1,881.49 ","$2,941.00 ","$3,114.00 ",$895.95 ,"$2,871.80 ",$186.00 ,$186.00 ,$895.95 ,"$2,249.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100007,64447,HC INJ ANES NERVE FEMORAL SINGLE-LT,761,1 ,"$2,307.00 ","$1,499.55 ",$186.00 ,"$2,307.00 ","$1,614.90 ","$1,377.28 ",$597.30 ,"$1,326.53 ",$597.30 ,"$1,589.52 ","$1,960.95 ","$1,960.95 ","$1,960.95 ","$1,568.76 ","$1,568.76 ",$597.30 ,$597.30 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$597.30 ,"$1,637.97 ","$1,914.81 ","$1,914.81 ","$1,914.81 ", N/A ,"$1,493.24 ","$1,960.95 ",$597.30 ,"$2,307.00 ",$280.92 ,$280.92 ,"$1,960.95 ","$1,254.33 ","$1,960.95 ","$2,076.30 ",$597.30 ,"$1,914.81 ",$186.00 ,$186.00 ,$597.30 ,"$1,499.55 "
ST. JOSEPH'S HOSPITAL - BREESE,76100008,64447,HC INJ ANES NERVE FEMORAL SINGLE-RT,761,1 ,"$2,307.00 ","$1,499.55 ",$186.00 ,"$2,307.00 ","$1,614.90 ","$1,377.28 ",$597.30 ,"$1,326.53 ",$597.30 ,"$1,589.52 ","$1,960.95 ","$1,960.95 ","$1,960.95 ","$1,568.76 ","$1,568.76 ",$597.30 ,$597.30 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$597.30 ,"$1,637.97 ","$1,914.81 ","$1,914.81 ","$1,914.81 ", N/A ,"$1,493.24 ","$1,960.95 ",$597.30 ,"$2,307.00 ",$280.92 ,$280.92 ,"$1,960.95 ","$1,254.33 ","$1,960.95 ","$2,076.30 ",$597.30 ,"$1,914.81 ",$186.00 ,$186.00 ,$597.30 ,"$1,499.55 "
ST. JOSEPH'S HOSPITAL - BREESE,76100021,64484,HC INJ EPID LUMBAR/SACRAL ADDL,761,1 ,"$2,392.05 ","$1,554.83 ",$186.00 ,"$2,392.05 ","$1,674.44 ","$1,428.05 ", N/A ,"$1,375.43 ", N/A ,"$1,648.12 ","$2,033.24 ","$2,033.24 ","$2,033.24 ","$1,626.59 ","$1,626.59 ", N/A , N/A ,"$1,794.04 ","$1,698.36 ","$1,698.36 ", N/A ,"$1,698.36 ","$1,985.40 ","$1,985.40 ","$1,985.40 ", N/A , N/A ,"$2,033.24 ", N/A ,"$2,392.05 ",$509.48 ,$509.48 ,"$2,033.24 ", N/A ,"$2,033.24 ","$2,152.85 ", N/A ,"$1,985.40 ",$186.00 ,$186.00 , N/A ,"$1,554.83 "
ST. JOSEPH'S HOSPITAL - BREESE,76100024,64483,HC INJ EPID LUMBAR/SACRAL SGL-BI,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,444.38 ","$1,629.60 ","$1,389.82 ","$1,163.99 ","$1,338.60 ","$1,163.99 ","$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ","$1,163.99 ","$1,163.99 ","$1,746.00 ","$1,652.88 ","$1,652.88 ","$1,163.99 ","$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$2,328.00 ","$1,978.80 ","$1,163.99 ","$2,328.00 ",$764.22 ,$764.22 ,"$1,978.80 ","$2,444.38 ","$1,978.80 ","$2,095.20 ","$1,163.99 ","$1,932.24 ",$186.00 ,$186.00 ,"$1,163.99 ","$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100025,64483,HC INJ EPID LUMBAR/SACRAL SGL-LT,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,328.00 ","$1,629.60 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,978.80 ","$2,095.20 ",$776.00 ,"$1,932.24 ",$186.00 ,$186.00 ,$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100026,64483,HC INJ EPID LUMBAR/SACRAL SGL-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,328.00 ","$1,629.60 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,978.80 ","$2,095.20 ",$776.00 ,"$1,932.24 ",$186.00 ,$186.00 ,$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100027,64479,HC INJ EPIDURAL CREV/THOR SGL-BI,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,444.38 ","$1,629.60 ","$1,389.82 ","$1,163.99 ","$1,338.60 ","$1,163.99 ","$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ","$1,163.99 ","$1,163.99 ","$1,746.00 ","$1,652.88 ","$1,652.88 ","$1,163.99 ","$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$2,328.00 ","$1,978.80 ","$1,163.99 ","$2,328.00 ",$764.22 ,$764.22 ,"$1,978.80 ","$2,444.38 ","$1,978.80 ","$2,095.20 ","$1,163.99 ","$1,932.24 ",$186.00 ,$186.00 ,"$1,163.99 ","$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100028,64479,HC INJ EPIDURAL CREV/THOR SGL-LT,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,328.00 ","$1,629.60 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,978.80 ","$2,095.20 ",$776.00 ,"$1,932.24 ",$186.00 ,$186.00 ,$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100029,64479,HC INJ EPIDURAL CREV/THOR SGL-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,328.00 ","$1,629.60 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,978.80 ","$2,095.20 ",$776.00 ,"$1,932.24 ",$186.00 ,$186.00 ,$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100032,64490,HC INJ PARAVERT F JNT C/T 1 LV-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,328.00 ","$1,629.60 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,978.80 ","$2,095.20 ",$776.00 ,"$1,932.24 ",$186.00 ,$186.00 ,$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100033,64491,HC INJ PARAVERT F JNT C/T 2 LV,761,1 ,"$2,036.14 ","$1,323.49 ",$186.00 ,"$2,036.14 ","$1,425.30 ","$1,215.58 ", N/A ,"$1,170.78 ", N/A ,"$1,402.90 ","$1,730.72 ","$1,730.72 ","$1,730.72 ","$1,384.58 ","$1,384.58 ", N/A , N/A ,"$1,527.11 ","$1,445.66 ","$1,445.66 ", N/A ,"$1,445.66 ","$1,690.00 ","$1,690.00 ","$1,690.00 ", N/A , N/A ,"$1,730.72 ", N/A ,"$2,036.14 ",$509.48 ,$509.48 ,"$1,730.72 ", N/A ,"$1,730.72 ","$1,832.53 ", N/A ,"$1,690.00 ",$186.00 ,$186.00 , N/A ,"$1,323.49 "
ST. JOSEPH'S HOSPITAL - BREESE,76100034,64491,HC INJ PARAVERT F JNT C/T 2 LV-LT,761,1 ,"$2,036.14 ","$1,323.49 ",$186.00 ,"$2,036.14 ","$1,425.30 ","$1,215.58 ", N/A ,"$1,170.78 ", N/A ,"$1,402.90 ","$1,730.72 ","$1,730.72 ","$1,730.72 ","$1,384.58 ","$1,384.58 ", N/A , N/A ,"$1,527.11 ","$1,445.66 ","$1,445.66 ", N/A ,"$1,445.66 ","$1,690.00 ","$1,690.00 ","$1,690.00 ", N/A , N/A ,"$1,730.72 ", N/A ,"$2,036.14 ",$509.48 ,$509.48 ,"$1,730.72 ", N/A ,"$1,730.72 ","$1,832.53 ", N/A ,"$1,690.00 ",$186.00 ,$186.00 , N/A ,"$1,323.49 "
ST. JOSEPH'S HOSPITAL - BREESE,76100035,64491,HC INJ PARAVERT F JNT C/T 2 LV-RT,761,1 ,"$2,036.14 ","$1,323.49 ",$186.00 ,"$2,036.14 ","$1,425.30 ","$1,215.58 ", N/A ,"$1,170.78 ", N/A ,"$1,402.90 ","$1,730.72 ","$1,730.72 ","$1,730.72 ","$1,384.58 ","$1,384.58 ", N/A , N/A ,"$1,527.11 ","$1,445.66 ","$1,445.66 ", N/A ,"$1,445.66 ","$1,690.00 ","$1,690.00 ","$1,690.00 ", N/A , N/A ,"$1,730.72 ", N/A ,"$2,036.14 ",$509.48 ,$509.48 ,"$1,730.72 ", N/A ,"$1,730.72 ","$1,832.53 ", N/A ,"$1,690.00 ",$186.00 ,$186.00 , N/A ,"$1,323.49 "
ST. JOSEPH'S HOSPITAL - BREESE,76100036,64492,HC INJ PARAVERT F JNT C/T 3 LV,761,1 ,"$1,936.26 ","$1,258.57 ",$186.00 ,"$1,936.26 ","$1,355.38 ","$1,155.95 ", N/A ,"$1,113.35 ", N/A ,"$1,334.08 ","$1,645.82 ","$1,645.82 ","$1,645.82 ","$1,316.66 ","$1,316.66 ", N/A , N/A ,"$1,452.20 ","$1,374.74 ","$1,374.74 ", N/A ,"$1,374.74 ","$1,607.10 ","$1,607.10 ","$1,607.10 ", N/A , N/A ,"$1,645.82 ", N/A ,"$1,936.26 ",$509.48 ,$509.48 ,"$1,645.82 ", N/A ,"$1,645.82 ","$1,742.63 ", N/A ,"$1,607.10 ",$186.00 ,$186.00 , N/A ,"$1,258.57 "
ST. JOSEPH'S HOSPITAL - BREESE,76100037,64492,HC INJ PARAVERT F JNT C/T 3 LV-LT,761,1 ,"$1,936.26 ","$1,258.57 ",$186.00 ,"$1,936.26 ","$1,355.38 ","$1,155.95 ", N/A ,"$1,113.35 ", N/A ,"$1,334.08 ","$1,645.82 ","$1,645.82 ","$1,645.82 ","$1,316.66 ","$1,316.66 ", N/A , N/A ,"$1,452.20 ","$1,374.74 ","$1,374.74 ", N/A ,"$1,374.74 ","$1,607.10 ","$1,607.10 ","$1,607.10 ", N/A , N/A ,"$1,645.82 ", N/A ,"$1,936.26 ",$509.48 ,$509.48 ,"$1,645.82 ", N/A ,"$1,645.82 ","$1,742.63 ", N/A ,"$1,607.10 ",$186.00 ,$186.00 , N/A ,"$1,258.57 "
ST. JOSEPH'S HOSPITAL - BREESE,76100038,64492,HC INJ PARAVERT F JNT C/T 3 LV-RT,761,1 ,"$1,936.26 ","$1,258.57 ",$186.00 ,"$1,936.26 ","$1,355.38 ","$1,155.95 ", N/A ,"$1,113.35 ", N/A ,"$1,334.08 ","$1,645.82 ","$1,645.82 ","$1,645.82 ","$1,316.66 ","$1,316.66 ", N/A , N/A ,"$1,452.20 ","$1,374.74 ","$1,374.74 ", N/A ,"$1,374.74 ","$1,607.10 ","$1,607.10 ","$1,607.10 ", N/A , N/A ,"$1,645.82 ", N/A ,"$1,936.26 ",$509.48 ,$509.48 ,"$1,645.82 ", N/A ,"$1,645.82 ","$1,742.63 ", N/A ,"$1,607.10 ",$186.00 ,$186.00 , N/A ,"$1,258.57 "
ST. JOSEPH'S HOSPITAL - BREESE,76100039,64493,HC INJ PARAVERT F JNT L/S 1 LV-BI,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,444.38 ","$1,629.60 ","$1,389.82 ","$1,163.99 ","$1,338.60 ","$1,163.99 ","$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ","$1,163.99 ","$1,163.99 ","$1,746.00 ","$1,652.88 ","$1,652.88 ","$1,163.99 ","$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$2,328.00 ","$1,978.80 ","$1,163.99 ","$2,328.00 ",$764.22 ,$764.22 ,"$1,978.80 ","$2,444.38 ","$1,978.80 ","$2,095.20 ","$1,163.99 ","$1,932.24 ",$186.00 ,$186.00 ,"$1,163.99 ","$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100040,64493,HC INJ PARAVERT F JNT L/S 1 LV-LT,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,328.00 ","$1,629.60 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,978.80 ","$2,095.20 ",$776.00 ,"$1,932.24 ",$186.00 ,$186.00 ,$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100041,64493,HC INJ PARAVERT F JNT L/S 1 LV-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$186.00 ,"$2,328.00 ","$1,629.60 ","$1,389.82 ",$776.00 ,"$1,338.60 ",$776.00 ,"$1,603.99 ","$1,978.80 ","$1,978.80 ","$1,978.80 ","$1,583.04 ","$1,583.04 ",$776.00 ,$776.00 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$776.00 ,"$1,652.88 ","$1,932.24 ","$1,932.24 ","$1,932.24 ", N/A ,"$1,939.99 ","$1,978.80 ",$776.00 ,"$2,328.00 ",$509.48 ,$509.48 ,"$1,978.80 ","$1,629.59 ","$1,978.80 ","$2,095.20 ",$776.00 ,"$1,932.24 ",$186.00 ,$186.00 ,$776.00 ,"$1,513.20 "
ST. JOSEPH'S HOSPITAL - BREESE,76100042,64494,HC INJ PARAVERT F JNT L/S 2 LV,761,1 ,"$2,016.45 ","$1,310.69 ",$186.00 ,"$2,016.45 ","$1,411.52 ","$1,203.82 ", N/A ,"$1,159.46 ", N/A ,"$1,389.33 ","$1,713.98 ","$1,713.98 ","$1,713.98 ","$1,371.19 ","$1,371.19 ", N/A , N/A ,"$1,512.34 ","$1,431.68 ","$1,431.68 ", N/A ,"$1,431.68 ","$1,673.65 ","$1,673.65 ","$1,673.65 ", N/A , N/A ,"$1,713.98 ", N/A ,"$2,016.45 ",$509.48 ,$509.48 ,"$1,713.98 ", N/A ,"$1,713.98 ","$1,814.81 ", N/A ,"$1,673.65 ",$186.00 ,$186.00 , N/A ,"$1,310.69 "
ST. JOSEPH'S HOSPITAL - BREESE,76100043,64494,HC INJ PARAVERT F JNT L/S 2 LV-LT,761,1 ,"$2,016.45 ","$1,310.69 ",$186.00 ,"$2,016.45 ","$1,411.52 ","$1,203.82 ", N/A ,"$1,159.46 ", N/A ,"$1,389.33 ","$1,713.98 ","$1,713.98 ","$1,713.98 ","$1,371.19 ","$1,371.19 ", N/A , N/A ,"$1,512.34 ","$1,431.68 ","$1,431.68 ", N/A ,"$1,431.68 ","$1,673.65 ","$1,673.65 ","$1,673.65 ", N/A , N/A ,"$1,713.98 ", N/A ,"$2,016.45 ",$509.48 ,$509.48 ,"$1,713.98 ", N/A ,"$1,713.98 ","$1,814.81 ", N/A ,"$1,673.65 ",$186.00 ,$186.00 , N/A ,"$1,310.69 "
ST. JOSEPH'S HOSPITAL - BREESE,76100044,64494,HC INJ PARAVERT F JNT L/S 2 LV-RT,761,1 ,"$2,016.45 ","$1,310.69 ",$186.00 ,"$2,016.45 ","$1,411.52 ","$1,203.82 ", N/A ,"$1,159.46 ", N/A ,"$1,389.33 ","$1,713.98 ","$1,713.98 ","$1,713.98 ","$1,371.19 ","$1,371.19 ", N/A , N/A ,"$1,512.34 ","$1,431.68 ","$1,431.68 ", N/A ,"$1,431.68 ","$1,673.65 ","$1,673.65 ","$1,673.65 ", N/A , N/A ,"$1,713.98 ", N/A ,"$2,016.45 ",$509.48 ,$509.48 ,"$1,713.98 ", N/A ,"$1,713.98 ","$1,814.81 ", N/A ,"$1,673.65 ",$186.00 ,$186.00 , N/A ,"$1,310.69 "
ST. JOSEPH'S HOSPITAL - BREESE,76100045,64495,HC INJ PARAVRT F JNT L/S 3+ LV,761,1 ,"$1,878.24 ","$1,220.86 ",$186.00 ,"$1,878.24 ","$1,314.77 ","$1,121.31 ", N/A ,"$1,079.99 ", N/A ,"$1,294.11 ","$1,596.50 ","$1,596.50 ","$1,596.50 ","$1,277.20 ","$1,277.20 ", N/A , N/A ,"$1,408.68 ","$1,333.55 ","$1,333.55 ", N/A ,"$1,333.55 ","$1,558.94 ","$1,558.94 ","$1,558.94 ", N/A , N/A ,"$1,596.50 ", N/A ,"$1,878.24 ",$509.48 ,$509.48 ,"$1,596.50 ", N/A ,"$1,596.50 ","$1,690.42 ", N/A ,"$1,558.94 ",$186.00 ,$186.00 , N/A ,"$1,220.86 "
ST. JOSEPH'S HOSPITAL - BREESE,76100046,64495,HC INJ PARAVRT F JNT L/S 3+ LV-LT,761,1 ,"$1,878.24 ","$1,220.86 ",$186.00 ,"$1,878.24 ","$1,314.77 ","$1,121.31 ", N/A ,"$1,079.99 ", N/A ,"$1,294.11 ","$1,596.50 ","$1,596.50 ","$1,596.50 ","$1,277.20 ","$1,277.20 ", N/A , N/A ,"$1,408.68 ","$1,333.55 ","$1,333.55 ", N/A ,"$1,333.55 ","$1,558.94 ","$1,558.94 ","$1,558.94 ", N/A , N/A ,"$1,596.50 ", N/A ,"$1,878.24 ",$509.48 ,$509.48 ,"$1,596.50 ", N/A ,"$1,596.50 ","$1,690.42 ", N/A ,"$1,558.94 ",$186.00 ,$186.00 , N/A ,"$1,220.86 "
ST. JOSEPH'S HOSPITAL - BREESE,76100047,64495,HC INJ PARAVRT F JNT L/S 3+ LV-RT,761,1 ,"$1,878.24 ","$1,220.86 ",$186.00 ,"$1,878.24 ","$1,314.77 ","$1,121.31 ", N/A ,"$1,079.99 ", N/A ,"$1,294.11 ","$1,596.50 ","$1,596.50 ","$1,596.50 ","$1,277.20 ","$1,277.20 ", N/A , N/A ,"$1,408.68 ","$1,333.55 ","$1,333.55 ", N/A ,"$1,333.55 ","$1,558.94 ","$1,558.94 ","$1,558.94 ", N/A , N/A ,"$1,596.50 ", N/A ,"$1,878.24 ",$509.48 ,$509.48 ,"$1,596.50 ", N/A ,"$1,596.50 ","$1,690.42 ", N/A ,"$1,558.94 ",$186.00 ,$186.00 , N/A ,"$1,220.86 "
ST. JOSEPH'S HOSPITAL - BREESE,76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$142.00 ,$92.30 ,$81.65 ,$142.00 ,$99.40 ,$84.77 , N/A ,$81.65 , N/A ,$97.84 ,$120.70 ,$120.70 ,$120.70 ,$96.56 ,$96.56 , N/A , N/A ,$106.50 ,$100.82 ,$100.82 , N/A ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A , N/A ,$120.70 , N/A ,$142.00 , N/A , N/A ,$120.70 , N/A ,$120.70 ,$127.80 , N/A ,$117.86 ,$112.89 ,$112.89 , N/A ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,76200009,G0378,HC OBSERVATION HOURLY,762,1 ,$63.00 ,$40.95 ,$36.23 ,$63.00 ,$44.10 ,$37.61 , N/A ,$36.23 , N/A ,$43.41 ,$53.55 ,$53.55 ,$53.55 ,$42.84 ,$42.84 , N/A , N/A ,$47.25 ,$44.73 ,$44.73 , N/A ,$44.73 ,$52.29 ,$52.29 ,$52.29 , N/A , N/A ,$53.55 , N/A ,$63.00 , N/A , N/A ,$53.55 , N/A ,$53.55 ,$56.70 , N/A ,$52.29 ,$50.09 ,$50.09 , N/A ,$40.95 
ST. JOSEPH'S HOSPITAL - BREESE,77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$51.00 ,$33.15 ,$29.33 ,$121.35 ,$43.35 ,$30.45 ,$57.79 ,$29.33 ,$57.79 ,$35.14 ,$43.35 ,$43.35 ,$43.35 , N/A ,$34.68 ,$57.79 ,$57.79 ,$38.25 ,$36.21 ,$36.21 ,$57.79 ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A ,$51.00 ,$43.35 ,$57.79 ,$51.00 , N/A , N/A ,$43.35 ,$121.35 ,$43.35 ,$45.90 ,$57.79 ,$42.33 ,$40.55 ,$40.55 ,$57.79 ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$69.00 ,$44.85 ,$39.68 ,$69.00 ,$58.65 ,$41.19 , N/A ,$39.68 , N/A ,$47.54 ,$58.65 ,$58.65 ,$58.65 , N/A ,$46.92 , N/A , N/A ,$51.75 ,$48.99 ,$48.99 , N/A ,$48.99 ,$57.27 ,$57.27 ,$57.27 , N/A , N/A ,$58.65 , N/A ,$69.00 , N/A , N/A ,$58.65 , N/A ,$58.65 ,$62.10 , N/A ,$57.27 ,$54.86 ,$54.86 , N/A ,$44.85 
ST. JOSEPH'S HOSPITAL - BREESE,77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$48.00 ,$31.20 ,$27.60 ,$76.48 ,$40.80 ,$28.66 ,$36.42 ,$27.60 ,$36.42 ,$33.07 ,$40.80 ,$40.80 ,$40.80 , N/A ,$32.64 ,$36.42 ,$36.42 ,$36.00 ,$34.08 ,$34.08 ,$36.42 ,$34.08 ,$39.84 ,$39.84 ,$39.84 , N/A ,$48.00 ,$40.80 ,$36.42 ,$48.00 , N/A , N/A ,$40.80 ,$76.48 ,$40.80 ,$43.20 ,$36.42 ,$39.84 ,$38.16 ,$38.16 ,$36.42 ,$31.20 
ST. JOSEPH'S HOSPITAL - BREESE,77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$48.00 ,$31.20 ,$27.60 ,$76.48 ,$40.80 ,$28.66 ,$36.42 ,$27.60 ,$36.42 ,$33.07 ,$40.80 ,$40.80 ,$40.80 , N/A ,$32.64 ,$36.42 ,$36.42 ,$36.00 ,$34.08 ,$34.08 ,$36.42 ,$34.08 ,$39.84 ,$39.84 ,$39.84 , N/A ,$48.00 ,$40.80 ,$36.42 ,$48.00 , N/A , N/A ,$40.80 ,$76.48 ,$40.80 ,$43.20 ,$36.42 ,$39.84 ,$38.16 ,$38.16 ,$36.42 ,$31.20 
ST. JOSEPH'S HOSPITAL - BREESE,77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$48.00 ,$31.20 ,$27.60 ,$76.48 ,$40.80 ,$28.66 ,$36.42 ,$27.60 ,$36.42 ,$33.07 ,$40.80 ,$40.80 ,$40.80 , N/A ,$32.64 ,$36.42 ,$36.42 ,$36.00 ,$34.08 ,$34.08 ,$36.42 ,$34.08 ,$39.84 ,$39.84 ,$39.84 , N/A ,$48.00 ,$40.80 ,$36.42 ,$48.00 , N/A , N/A ,$40.80 ,$76.48 ,$40.80 ,$43.20 ,$36.42 ,$39.84 ,$38.16 ,$38.16 ,$36.42 ,$31.20 
ST. JOSEPH'S HOSPITAL - BREESE,77100008,N/A,HC HEALTH FAIR INFLUENZA VACCINE,771,1 ,$20.00 ,$13.00 ,$11.50 ,$20.00 ,$17.00 ,$11.94 , N/A ,$11.50 , N/A ,$13.78 ,$17.00 ,$17.00 ,$17.00 , N/A ,$13.60 , N/A , N/A ,$15.00 ,$14.20 ,$14.20 , N/A ,$14.20 ,$16.60 ,$16.60 ,$16.60 , N/A , N/A ,$17.00 , N/A ,$20.00 , N/A , N/A ,$17.00 , N/A ,$17.00 ,$18.00 , N/A ,$16.60 ,$15.90 ,$15.90 , N/A ,$13.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$85.00 ,$55.25 ,$9.33 ,$85.00 ,$72.25 ,$50.75 ,$26.65 ,$48.88 ,$26.65 ,$58.57 ,$72.25 ,$72.25 ,$72.25 , N/A ,$57.80 ,$26.65 ,$26.65 ,$63.75 ,$60.35 ,$60.35 ,$26.65 ,$60.35 ,$70.55 ,$70.55 ,$70.55 , N/A ,$66.63 ,$72.25 ,$26.65 ,$85.00 ,$9.33 ,$9.33 ,$72.25 ,$55.97 ,$72.25 ,$76.50 ,$26.65 ,$70.55 ,$67.58 ,$67.58 ,$26.65 ,$55.25 
ST. JOSEPH'S HOSPITAL - BREESE,78000003,97110,HC THERA EXER; EA 15 MIN - 95,780,1 ,$142.00 ,$92.30 ,$31.04 ,$215.87 ,$120.70 ,$84.77 ,$31.04 ,$81.65 ,$31.04 ,$97.84 ,$120.70 ,$120.70 ,$120.70 , N/A ,$96.56 ,$31.04 ,$31.04 ,$106.50 ,$100.82 ,$100.82 ,$31.04 ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A ,$77.60 ,$120.70 ,$31.04 ,$142.00 ,$215.87 ,$137.03 ,$120.70 ,$65.18 ,$120.70 ,$127.80 ,$31.04 ,$117.86 ,$112.89 ,$112.89 ,$31.04 ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,78000004,97112,HC NEUROMUSCULAR RE ED EA 15 MIN - 95,780,1 ,$159.00 ,$103.35 ,$35.55 ,$215.87 ,$135.15 ,$94.92 ,$35.55 ,$91.43 ,$35.55 ,$109.55 ,$135.15 ,$135.15 ,$135.15 , N/A ,$108.12 ,$35.55 ,$35.55 ,$119.25 ,$112.89 ,$112.89 ,$35.55 ,$112.89 ,$131.97 ,$131.97 ,$131.97 , N/A ,$88.88 ,$135.15 ,$35.55 ,$159.00 ,$215.87 ,$153.44 ,$135.15 ,$74.66 ,$135.15 ,$143.10 ,$35.55 ,$131.97 ,$126.41 ,$126.41 ,$35.55 ,$103.35 
ST. JOSEPH'S HOSPITAL - BREESE,78000005,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN - 95,780,1 ,$130.00 ,$84.50 ,$39.49 ,$215.87 ,$110.50 ,$77.61 ,$39.49 ,$74.75 ,$39.49 ,$89.57 ,$110.50 ,$110.50 ,$110.50 , N/A ,$88.40 ,$39.49 ,$39.49 ,$97.50 ,$92.30 ,$92.30 ,$39.49 ,$92.30 ,$107.90 ,$107.90 ,$107.90 , N/A ,$98.73 ,$110.50 ,$39.49 ,$130.00 ,$215.87 ,$125.45 ,$110.50 ,$82.93 ,$110.50 ,$117.00 ,$39.49 ,$107.90 ,$103.35 ,$103.35 ,$39.49 ,$84.50 
ST. JOSEPH'S HOSPITAL - BREESE,78000006,97535,HC SELF CARE ADL TRAINING EA 15 MIN - 95,780,1 ,$97.00 ,$63.05 ,$34.43 ,$343.40 ,$82.45 ,$57.91 ,$34.43 ,$55.78 ,$34.43 ,$66.83 ,$82.45 ,$82.45 ,$82.45 , N/A ,$65.96 ,$34.43 ,$34.43 ,$72.75 ,$68.87 ,$68.87 ,$34.43 ,$68.87 ,$80.51 ,$80.51 ,$80.51 , N/A ,$86.08 ,$82.45 ,$34.43 ,$97.00 ,$343.40 ,$93.61 ,$82.45 ,$72.30 ,$82.45 ,$87.30 ,$34.43 ,$80.51 ,$77.12 ,$77.12 ,$34.43 ,$63.05 
ST. JOSEPH'S HOSPITAL - BREESE,78000007,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN - 95,780,1 ,$78.00 ,$50.70 ,$17.64 ,$78.00 ,$66.30 ,$46.57 ,$24.71 ,$44.85 ,$24.71 ,$53.74 ,$66.30 ,$66.30 ,$66.30 , N/A ,$53.04 ,$24.71 ,$24.71 ,$58.50 ,$55.38 ,$55.38 ,$24.71 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$61.78 ,$66.30 ,$24.71 ,$78.00 ,$17.64 ,$17.64 ,$66.30 ,$51.89 ,$66.30 ,$70.20 ,$24.71 ,$64.74 ,$62.01 ,$62.01 ,$24.71 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,78000008,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN - 95,780,1 ,$78.00 ,$50.70 ,$17.64 ,$78.00 ,$66.30 ,$46.57 ,$23.65 ,$44.85 ,$23.65 ,$53.74 ,$66.30 ,$66.30 ,$66.30 , N/A ,$53.04 ,$23.65 ,$23.65 ,$58.50 ,$55.38 ,$55.38 ,$23.65 ,$55.38 ,$64.74 ,$64.74 ,$64.74 , N/A ,$59.13 ,$66.30 ,$23.65 ,$78.00 ,$17.64 ,$17.64 ,$66.30 ,$49.67 ,$66.30 ,$70.20 ,$23.65 ,$64.74 ,$62.01 ,$62.01 ,$23.65 ,$50.70 
ST. JOSEPH'S HOSPITAL - BREESE,78000009,97161,HC PT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$215.00 ,$139.75 ,$86.40 ,$215.87 ,$182.75 ,$128.36 ,$86.40 ,$123.63 ,$86.40 ,$148.14 ,$182.75 ,$182.75 ,$182.75 , N/A ,$146.20 ,$86.40 ,$86.40 ,$161.25 ,$152.65 ,$152.65 ,$86.40 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$86.40 ,$215.00 ,$215.87 ,$207.48 ,$182.75 ,$181.44 ,$182.75 ,$193.50 ,$86.40 ,$178.45 ,$170.93 ,$170.93 ,$86.40 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,78000010,97162,HC PT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$239.00 ,$155.35 ,$86.40 ,$239.00 ,$203.15 ,$142.68 ,$86.40 ,$137.43 ,$86.40 ,$164.67 ,$203.15 ,$203.15 ,$203.15 , N/A ,$162.52 ,$86.40 ,$86.40 ,$179.25 ,$169.69 ,$169.69 ,$86.40 ,$169.69 ,$198.37 ,$198.37 ,$198.37 , N/A ,$216.00 ,$203.15 ,$86.40 ,$239.00 ,$215.87 ,$215.87 ,$203.15 ,$181.44 ,$203.15 ,$215.10 ,$86.40 ,$198.37 ,$190.01 ,$190.01 ,$86.40 ,$155.35 
ST. JOSEPH'S HOSPITAL - BREESE,78000011,97163,HC PT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$500.00 ,$325.00 ,$86.40 ,$500.00 ,$425.00 ,$298.50 ,$86.40 ,$287.50 ,$86.40 ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 ,$86.40 ,$86.40 ,$375.00 ,$355.00 ,$355.00 ,$86.40 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$216.00 ,$425.00 ,$86.40 ,$500.00 ,$215.87 ,$215.87 ,$425.00 ,$181.44 ,$425.00 ,$450.00 ,$86.40 ,$415.00 ,$397.50 ,$397.50 ,$86.40 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000012,97164,HC PT RE-EVAL 15 MIN - 95,780,1 ,$145.00 ,$94.25 ,$59.09 ,$215.87 ,$123.25 ,$86.57 ,$59.09 ,$83.38 ,$59.09 ,$99.91 ,$123.25 ,$123.25 ,$123.25 , N/A ,$98.60 ,$59.09 ,$59.09 ,$108.75 ,$102.95 ,$102.95 ,$59.09 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$59.09 ,$145.00 ,$215.87 ,$139.93 ,$123.25 ,$124.09 ,$123.25 ,$130.50 ,$59.09 ,$120.35 ,$115.28 ,$115.28 ,$59.09 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,78000013,97165,HC OT EVAL LOW COMPLEXITY 30 MIN - 95,780,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 , N/A ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,78000014,97116,HC AMBULATION GAIT TRAIN EA 15 MIN - 95,780,1 ,$144.00 ,$93.60 ,$30.70 ,$215.87 ,$122.40 ,$85.97 ,$30.70 ,$82.80 ,$30.70 ,$99.22 ,$122.40 ,$122.40 ,$122.40 , N/A ,$97.92 ,$30.70 ,$30.70 ,$108.00 ,$102.24 ,$102.24 ,$30.70 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$76.75 ,$122.40 ,$30.70 ,$144.00 ,$215.87 ,$138.96 ,$122.40 ,$64.47 ,$122.40 ,$129.60 ,$30.70 ,$119.52 ,$114.48 ,$114.48 ,$30.70 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000015,97167,HC OT EVAL HIGH COMPLEXITY 60 MIN - 95,780,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000016,97168,HC OT RE-EVAL 30 MIN - 95,780,1 ,$145.00 ,$94.25 ,$62.82 ,$343.40 ,$123.25 ,$86.57 ,$62.82 ,$83.38 ,$62.82 ,$99.91 ,$123.25 ,$123.25 ,$123.25 , N/A ,$98.60 ,$62.82 ,$62.82 ,$108.75 ,$102.95 ,$102.95 ,$62.82 ,$102.95 ,$120.35 ,$120.35 ,$120.35 , N/A ,$145.00 ,$123.25 ,$62.82 ,$145.00 ,$343.40 ,$139.93 ,$123.25 ,$131.92 ,$123.25 ,$130.50 ,$62.82 ,$120.35 ,$115.28 ,$115.28 ,$62.82 ,$94.25 
ST. JOSEPH'S HOSPITAL - BREESE,78000017,92507,HC SPEECH THERAPY TREATMENT 15 MIN - 95,780,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 , N/A ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,78000018,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN - 95,780,1 ,$256.00 ,$166.40 ,$114.90 ,$256.00 ,$217.60 ,$152.83 ,$114.90 ,$147.20 ,$114.90 ,$176.38 ,$217.60 ,$217.60 ,$217.60 , N/A ,$174.08 ,$114.90 ,$114.90 ,$192.00 ,$181.76 ,$181.76 ,$114.90 ,$181.76 ,$212.48 ,$212.48 ,$212.48 , N/A ,$256.00 ,$217.60 ,$114.90 ,$256.00 ,$159.56 ,$159.56 ,$217.60 ,$241.29 ,$217.60 ,$230.40 ,$114.90 ,$212.48 ,$203.52 ,$203.52 ,$114.90 ,$166.40 
ST. JOSEPH'S HOSPITAL - BREESE,78000019,92526,HC DYSPHAGIA TREATMENT 15 MIN - 95,780,1 ,$144.00 ,$93.60 ,$82.80 ,$185.66 ,$122.40 ,$85.97 ,$88.41 ,$82.80 ,$88.41 ,$99.22 ,$122.40 ,$122.40 ,$122.40 , N/A ,$97.92 ,$88.41 ,$88.41 ,$108.00 ,$102.24 ,$102.24 ,$88.41 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$144.00 ,$122.40 ,$88.41 ,$144.00 ,$159.56 ,$138.96 ,$122.40 ,$185.66 ,$122.40 ,$129.60 ,$88.41 ,$119.52 ,$114.48 ,$114.48 ,$88.41 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000024,90832,PC THERAPY INDIVIDUAL PSYCH 30 MIN - 95,961,1 ,$120.00 ,$78.00 ,$69.00 ,$263.61 ,$102.00 ,$71.64 ,$125.53 ,$69.00 ,$125.53 ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 ,$125.53 ,$125.53 ,$90.00 ,$85.20 ,$85.20 ,$125.53 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$120.00 ,$102.00 ,$125.53 ,$120.00 ,$94.55 ,$94.55 ,$102.00 ,$263.61 ,$102.00 ,$108.00 ,$125.53 ,$99.60 , N/A , N/A ,$125.53 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000026,90834,PC THERAPY INDIVIDUAL PSYCH 45 MIN - 95,961,1 ,$181.00 ,$117.65 ,$94.71 ,$263.61 ,$153.85 ,$108.06 ,$125.53 ,$104.08 ,$125.53 ,$124.71 ,$153.85 ,$153.85 ,$153.85 , N/A ,$123.08 ,$125.53 ,$125.53 ,$135.75 ,$128.51 ,$128.51 ,$125.53 ,$128.51 ,$150.23 ,$150.23 ,$150.23 , N/A ,$181.00 ,$153.85 ,$125.53 ,$181.00 ,$94.71 ,$94.71 ,$153.85 ,$263.61 ,$153.85 ,$162.90 ,$125.53 ,$150.23 , N/A , N/A ,$125.53 ,$117.65 
ST. JOSEPH'S HOSPITAL - BREESE,78000028,90837,PC THERAPY INDIVIDUAL PSYCH 60 MIN - 95,961,1 ,$204.00 ,$132.60 ,$94.71 ,$263.61 ,$173.40 ,$121.79 ,$125.53 ,$117.30 ,$125.53 ,$140.56 ,$173.40 ,$173.40 ,$173.40 , N/A ,$138.72 ,$125.53 ,$125.53 ,$153.00 ,$144.84 ,$144.84 ,$125.53 ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A ,$204.00 ,$173.40 ,$125.53 ,$204.00 ,$94.71 ,$94.71 ,$173.40 ,$263.61 ,$173.40 ,$183.60 ,$125.53 ,$169.32 , N/A , N/A ,$125.53 ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000198,92526,PC DYSPHAGIA TREATMENT 30 MIN - 95,961,1 ,$144.00 ,$93.60 ,$82.80 ,$185.66 ,$122.40 ,$85.97 ,$88.41 ,$82.80 ,$88.41 ,$99.22 ,$122.40 ,$122.40 ,$122.40 , N/A ,$97.92 ,$88.41 ,$88.41 ,$108.00 ,$102.24 ,$102.24 ,$88.41 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$144.00 ,$122.40 ,$88.41 ,$144.00 ,$159.56 ,$138.96 ,$122.40 ,$185.66 ,$122.40 ,$129.60 ,$88.41 ,$119.52 , N/A , N/A ,$88.41 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000199,92526,PC DYSPHAGIA TREATMENT 45 MIN - 95,780,1 ,$144.00 ,$93.60 ,$82.80 ,$185.66 ,$122.40 ,$85.97 ,$88.41 ,$82.80 ,$88.41 ,$99.22 ,$122.40 ,$122.40 ,$122.40 , N/A ,$97.92 ,$88.41 ,$88.41 ,$108.00 ,$102.24 ,$102.24 ,$88.41 ,$102.24 ,$119.52 ,$119.52 ,$119.52 , N/A ,$144.00 ,$122.40 ,$88.41 ,$144.00 ,$159.56 ,$138.96 ,$122.40 ,$185.66 ,$122.40 ,$129.60 ,$88.41 ,$119.52 ,$114.48 ,$114.48 ,$88.41 ,$93.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000201,92507,HC SPEECH THERAPY TREATMENT 30 MIN - 95,780,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 , N/A ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,78000202,92507,PC SPEECH THERAPY TREATMENT 45 MIN - 95,780,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 , N/A ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,78000203,92507,PC SPEECH THERAPY TREATMENT 60 MIN - 95,780,1 ,$132.00 ,$85.80 ,$75.90 ,$169.09 ,$112.20 ,$78.80 ,$80.52 ,$75.90 ,$80.52 ,$90.95 ,$112.20 ,$112.20 ,$112.20 , N/A ,$89.76 ,$80.52 ,$80.52 ,$99.00 ,$93.72 ,$93.72 ,$80.52 ,$93.72 ,$109.56 ,$109.56 ,$109.56 , N/A ,$132.00 ,$112.20 ,$80.52 ,$132.00 ,$159.56 ,$127.38 ,$112.20 ,$169.09 ,$112.20 ,$118.80 ,$80.52 ,$109.56 ,$104.94 ,$104.94 ,$80.52 ,$85.80 
ST. JOSEPH'S HOSPITAL - BREESE,78000204,92521,PC EVALUATION OF SPEECH FLUENCY 30 MIN - 95,780,1 ,$256.00 ,$166.40 ,$114.90 ,$256.00 ,$217.60 ,$152.83 ,$114.90 ,$147.20 ,$114.90 ,$176.38 ,$217.60 ,$217.60 ,$217.60 , N/A ,$174.08 ,$114.90 ,$114.90 ,$192.00 ,$181.76 ,$181.76 ,$114.90 ,$181.76 ,$212.48 ,$212.48 ,$212.48 , N/A ,$256.00 ,$217.60 ,$114.90 ,$256.00 ,$159.56 ,$159.56 ,$217.60 ,$241.29 ,$217.60 ,$230.40 ,$114.90 ,$212.48 ,$203.52 ,$203.52 ,$114.90 ,$166.40 
ST. JOSEPH'S HOSPITAL - BREESE,78000205,92521,PC EVALUATION OF SPEECH FLUENCY 45 MIN - 95,780,1 ,$256.00 ,$166.40 ,$114.90 ,$256.00 ,$217.60 ,$152.83 ,$114.90 ,$147.20 ,$114.90 ,$176.38 ,$217.60 ,$217.60 ,$217.60 , N/A ,$174.08 ,$114.90 ,$114.90 ,$192.00 ,$181.76 ,$181.76 ,$114.90 ,$181.76 ,$212.48 ,$212.48 ,$212.48 , N/A ,$256.00 ,$217.60 ,$114.90 ,$256.00 ,$159.56 ,$159.56 ,$217.60 ,$241.29 ,$217.60 ,$230.40 ,$114.90 ,$212.48 ,$203.52 ,$203.52 ,$114.90 ,$166.40 
ST. JOSEPH'S HOSPITAL - BREESE,78000206,92521,PC EVALUATION OF SPEECH FLUENCY 60 MIN - 95,780,1 ,$256.00 ,$166.40 ,$114.90 ,$256.00 ,$217.60 ,$152.83 ,$114.90 ,$147.20 ,$114.90 ,$176.38 ,$217.60 ,$217.60 ,$217.60 , N/A ,$174.08 ,$114.90 ,$114.90 ,$192.00 ,$181.76 ,$181.76 ,$114.90 ,$181.76 ,$212.48 ,$212.48 ,$212.48 , N/A ,$256.00 ,$217.60 ,$114.90 ,$256.00 ,$159.56 ,$159.56 ,$217.60 ,$241.29 ,$217.60 ,$230.40 ,$114.90 ,$212.48 ,$203.52 ,$203.52 ,$114.90 ,$166.40 
ST. JOSEPH'S HOSPITAL - BREESE,78000207,97165,PC OT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 , N/A ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,78000208,97165,PC OT EVAL LOW COMPLEXITY 45 MIN - 95,780,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 , N/A ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,78000209,97165,PC OT EVAL LOW COMPLEXITY 60 MIN - 95,780,1 ,$215.00 ,$139.75 ,$91.49 ,$343.40 ,$182.75 ,$128.36 ,$91.49 ,$123.63 ,$91.49 ,$148.14 ,$182.75 ,$182.75 ,$182.75 , N/A ,$146.20 ,$91.49 ,$91.49 ,$161.25 ,$152.65 ,$152.65 ,$91.49 ,$152.65 ,$178.45 ,$178.45 ,$178.45 , N/A ,$215.00 ,$182.75 ,$91.49 ,$215.00 ,$343.40 ,$207.48 ,$182.75 ,$192.13 ,$182.75 ,$193.50 ,$91.49 ,$178.45 ,$170.93 ,$170.93 ,$91.49 ,$139.75 
ST. JOSEPH'S HOSPITAL - BREESE,78000210,97166,PC OT EVAL MOD COMPLEXITY 15 MIN - 95,780,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 , N/A ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000211,97166,HC OT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 , N/A ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000212,97166,PC OT EVAL MOD COMPLEXITY 60 MIN - 95,780,1 ,$264.00 ,$171.60 ,$91.15 ,$343.40 ,$224.40 ,$157.61 ,$91.15 ,$151.80 ,$91.15 ,$181.90 ,$224.40 ,$224.40 ,$224.40 , N/A ,$179.52 ,$91.15 ,$91.15 ,$198.00 ,$187.44 ,$187.44 ,$91.15 ,$187.44 ,$219.12 ,$219.12 ,$219.12 , N/A ,$227.88 ,$224.40 ,$91.15 ,$264.00 ,$343.40 ,$254.76 ,$224.40 ,$191.42 ,$224.40 ,$237.60 ,$91.15 ,$219.12 ,$209.88 ,$209.88 ,$91.15 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,78000213,97167,PC OT EVAL HIGH COMPLEXITY 15 MIN - 95,780,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000214,97167,PC OT EVAL HIGH COMPLEXITY 30 MIN - 95,961,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 , N/A , N/A ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000215,97167,PC OT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$500.00 ,$325.00 ,$91.15 ,$500.00 ,$425.00 ,$298.50 ,$91.15 ,$287.50 ,$91.15 ,$344.50 ,$425.00 ,$425.00 ,$425.00 , N/A ,$340.00 ,$91.15 ,$91.15 ,$375.00 ,$355.00 ,$355.00 ,$91.15 ,$355.00 ,$415.00 ,$415.00 ,$415.00 , N/A ,$227.88 ,$425.00 ,$91.15 ,$500.00 ,$343.40 ,$343.40 ,$425.00 ,$191.42 ,$425.00 ,$450.00 ,$91.15 ,$415.00 ,$397.50 ,$397.50 ,$91.15 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000216,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 30 MIN - 95,780,1 ,$260.00 ,$169.00 ,$149.50 ,$411.81 ,$221.00 ,$155.22 ,$196.10 ,$149.50 ,$196.10 ,$179.14 ,$221.00 ,$221.00 ,$221.00 , N/A ,$176.80 ,$196.10 ,$196.10 ,$195.00 ,$184.60 ,$184.60 ,$196.10 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$196.10 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$411.81 ,$221.00 ,$234.00 ,$196.10 ,$215.80 ,$206.70 ,$206.70 ,$196.10 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000217,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 45 MIN - 95,780,1 ,$260.00 ,$169.00 ,$149.50 ,$411.81 ,$221.00 ,$155.22 ,$196.10 ,$149.50 ,$196.10 ,$179.14 ,$221.00 ,$221.00 ,$221.00 , N/A ,$176.80 ,$196.10 ,$196.10 ,$195.00 ,$184.60 ,$184.60 ,$196.10 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$196.10 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$411.81 ,$221.00 ,$234.00 ,$196.10 ,$215.80 ,$206.70 ,$206.70 ,$196.10 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000218,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60 MIN - 95,780,1 ,$260.00 ,$169.00 ,$149.50 ,$411.81 ,$221.00 ,$155.22 ,$196.10 ,$149.50 ,$196.10 ,$179.14 ,$221.00 ,$221.00 ,$221.00 , N/A ,$176.80 ,$196.10 ,$196.10 ,$195.00 ,$184.60 ,$184.60 ,$196.10 ,$184.60 ,$215.80 ,$215.80 ,$215.80 , N/A ,$260.00 ,$221.00 ,$196.10 ,$260.00 ,$159.56 ,$159.56 ,$221.00 ,$411.81 ,$221.00 ,$234.00 ,$196.10 ,$215.80 ,$206.70 ,$206.70 ,$196.10 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000221,90832,HC THERAPY INDIVIDUAL PSYCH 30 MIN-95,780,1 ,$120.00 ,$78.00 ,$69.00 ,$263.61 ,$102.00 ,$71.64 ,$125.53 ,$69.00 ,$125.53 ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 ,$125.53 ,$125.53 ,$90.00 ,$85.20 ,$85.20 ,$125.53 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$120.00 ,$102.00 ,$125.53 ,$120.00 ,$94.55 ,$94.55 ,$102.00 ,$263.61 ,$102.00 ,$108.00 ,$125.53 ,$99.60 ,$95.40 ,$95.40 ,$125.53 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000222,90834,HC THERAPY INDIVIDUAL PSYCH 45 MIN-95,780,1 ,$181.00 ,$117.65 ,$94.71 ,$263.61 ,$153.85 ,$108.06 ,$125.53 ,$104.08 ,$125.53 ,$124.71 ,$153.85 ,$153.85 ,$153.85 , N/A ,$123.08 ,$125.53 ,$125.53 ,$135.75 ,$128.51 ,$128.51 ,$125.53 ,$128.51 ,$150.23 ,$150.23 ,$150.23 , N/A ,$181.00 ,$153.85 ,$125.53 ,$181.00 ,$94.71 ,$94.71 ,$153.85 ,$263.61 ,$153.85 ,$162.90 ,$125.53 ,$150.23 ,$143.90 ,$143.90 ,$125.53 ,$117.65 
ST. JOSEPH'S HOSPITAL - BREESE,78000223,90837,HC THERAPY INDIVIDUAL PSYCH 45 MIN-95,780,1 ,$204.00 ,$132.60 ,$94.71 ,$263.61 ,$173.40 ,$121.79 ,$125.53 ,$117.30 ,$125.53 ,$140.56 ,$173.40 ,$173.40 ,$173.40 , N/A ,$138.72 ,$125.53 ,$125.53 ,$153.00 ,$144.84 ,$144.84 ,$125.53 ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A ,$204.00 ,$173.40 ,$125.53 ,$204.00 ,$94.71 ,$94.71 ,$173.40 ,$263.61 ,$173.40 ,$183.60 ,$125.53 ,$169.32 ,$162.18 ,$162.18 ,$125.53 ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,91400004,90832,HC THERAPY INDIVIDUAL PSYCH 30MIN,914,1 ,$120.00 ,$78.00 ,$69.00 ,$263.61 ,$102.00 ,$71.64 ,$125.53 ,$69.00 ,$125.53 ,$82.68 ,$102.00 ,$102.00 ,$102.00 , N/A ,$81.60 ,$125.53 ,$125.53 ,$90.00 ,$85.20 ,$85.20 ,$125.53 ,$85.20 ,$99.60 ,$99.60 ,$99.60 , N/A ,$120.00 ,$102.00 ,$125.53 ,$120.00 ,$94.55 ,$94.55 ,$102.00 ,$263.61 ,$102.00 ,$108.00 ,$125.53 ,$99.60 , N/A , N/A ,$125.53 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,91400007,90834,HC THERAPY INDIVIDUAL PSYCH 45MIN,914,1 ,$181.00 ,$117.65 ,$94.71 ,$263.61 ,$153.85 ,$108.06 ,$125.53 ,$104.08 ,$125.53 ,$124.71 ,$153.85 ,$153.85 ,$153.85 , N/A ,$123.08 ,$125.53 ,$125.53 ,$135.75 ,$128.51 ,$128.51 ,$125.53 ,$128.51 ,$150.23 ,$150.23 ,$150.23 , N/A ,$181.00 ,$153.85 ,$125.53 ,$181.00 ,$94.71 ,$94.71 ,$153.85 ,$263.61 ,$153.85 ,$162.90 ,$125.53 ,$150.23 , N/A , N/A ,$125.53 ,$117.65 
ST. JOSEPH'S HOSPITAL - BREESE,91400012,90837,HC THERAPY INDIVIDUAL PSYCH 60MIN,914,1 ,$204.00 ,$132.60 ,$94.71 ,$263.61 ,$173.40 ,$121.79 ,$125.53 ,$117.30 ,$125.53 ,$140.56 ,$173.40 ,$173.40 ,$173.40 , N/A ,$138.72 ,$125.53 ,$125.53 ,$153.00 ,$144.84 ,$144.84 ,$125.53 ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A ,$204.00 ,$173.40 ,$125.53 ,$204.00 ,$94.71 ,$94.71 ,$173.40 ,$263.61 ,$173.40 ,$183.60 ,$125.53 ,$169.32 , N/A , N/A ,$125.53 ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,91600005,90846,HC THERAPY FAMILY PSYCH W/O PATIENT 50 MIN,916,1 ,$204.00 ,$132.60 ,$99.85 ,$263.61 ,$173.40 ,$121.79 ,$125.53 ,$117.30 ,$125.53 ,$140.56 ,$173.40 ,$173.40 ,$173.40 , N/A ,$138.72 ,$125.53 ,$125.53 ,$153.00 ,$144.84 ,$144.84 ,$125.53 ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A ,$204.00 ,$173.40 ,$125.53 ,$204.00 ,$99.85 ,$99.85 ,$173.40 ,$263.61 ,$173.40 ,$183.60 ,$125.53 ,$169.32 , N/A , N/A ,$125.53 ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,91600006,90847,HC THERAPY FAMILY PSYCH W/PATIENT 50 MIN,916,1 ,$181.00 ,$117.65 ,$99.85 ,$263.61 ,$153.85 ,$108.06 ,$125.53 ,$104.08 ,$125.53 ,$124.71 ,$153.85 ,$153.85 ,$153.85 , N/A ,$123.08 ,$125.53 ,$125.53 ,$135.75 ,$128.51 ,$128.51 ,$125.53 ,$128.51 ,$150.23 ,$150.23 ,$150.23 , N/A ,$181.00 ,$153.85 ,$125.53 ,$181.00 ,$99.85 ,$99.85 ,$153.85 ,$263.61 ,$153.85 ,$162.90 ,$125.53 ,$150.23 , N/A , N/A ,$125.53 ,$117.65 
ST. JOSEPH'S HOSPITAL - BREESE,91600007,90853,HC THERAPY GROUP PSYCH,916,1 ,$181.00 ,$117.65 ,$75.05 ,$181.00 ,$153.85 ,$108.06 ,$75.05 ,$104.08 ,$75.05 ,$124.71 ,$153.85 ,$153.85 ,$153.85 , N/A ,$123.08 ,$75.05 ,$75.05 ,$135.75 ,$128.51 ,$128.51 ,$75.05 ,$128.51 ,$150.23 ,$150.23 ,$150.23 , N/A ,$181.00 ,$153.85 ,$75.05 ,$181.00 ,$134.29 ,$134.29 ,$153.85 ,$157.61 ,$153.85 ,$162.90 ,$75.05 ,$150.23 , N/A , N/A ,$75.05 ,$117.65 
ST. JOSEPH'S HOSPITAL - BREESE,91800006,96116,HC NEUROPSYCH STATUS EXAM MD/QHCP INIT HOUR,918,1 ,$399.00 ,$259.35 ,$228.06 ,$513.27 ,$339.15 ,$238.20 ,$228.06 ,$229.43 ,$228.06 ,$274.91 ,$339.15 ,$339.15 ,$339.15 , N/A ,$271.32 ,$228.06 ,$228.06 ,$299.25 ,$283.29 ,$283.29 ,$228.06 ,$283.29 ,$331.17 ,$331.17 ,$331.17 , N/A ,$399.00 ,$339.15 ,$228.06 ,$399.00 ,$513.27 ,$385.04 ,$339.15 ,$478.93 ,$339.15 ,$359.10 ,$228.06 ,$331.17 ,$317.21 ,$317.21 ,$228.06 ,$259.35 
ST. JOSEPH'S HOSPITAL - BREESE,91800007,96121,HC NEUROPSYCH STATUS EXAM MD/QHCP ADDL HOUR,918,1 ,$399.00 ,$259.35 ,$229.43 ,$513.27 ,$339.15 ,$238.20 , N/A ,$229.43 , N/A ,$274.91 ,$339.15 ,$339.15 ,$339.15 , N/A ,$271.32 , N/A , N/A ,$299.25 ,$283.29 ,$283.29 , N/A ,$283.29 ,$331.17 ,$331.17 ,$331.17 , N/A , N/A ,$339.15 , N/A ,$399.00 ,$513.27 ,$385.04 ,$339.15 , N/A ,$339.15 ,$359.10 , N/A ,$331.17 ,$317.21 ,$317.21 , N/A ,$259.35 
ST. JOSEPH'S HOSPITAL - BREESE,92000001,59020,HC TEST STRESS FETAL,920,1 ,$374.00 ,$243.10 ,$156.36 ,$374.00 ,$317.90 ,$223.28 ,$158.68 ,$215.05 ,$158.68 ,$257.69 ,$317.90 ,$317.90 ,$317.90 , N/A ,$254.32 ,$158.68 ,$158.68 ,$280.50 ,$265.54 ,$265.54 ,$158.68 ,$265.54 ,$310.42 ,$310.42 ,$310.42 , N/A ,$374.00 ,$317.90 ,$158.68 ,$374.00 ,$156.36 ,$156.36 ,$317.90 ,$333.22 ,$317.90 ,$336.60 ,$158.68 ,$310.42 ,$297.33 ,$297.33 ,$158.68 ,$243.10 
ST. JOSEPH'S HOSPITAL - BREESE,92000002,59025,HC TEST NON STRESS FETAL,920,1 ,$492.00 ,$319.80 ,$156.36 ,$492.00 ,$418.20 ,$293.72 ,$158.68 ,$282.90 ,$158.68 ,$338.99 ,$418.20 ,$418.20 ,$418.20 , N/A ,$334.56 ,$158.68 ,$158.68 ,$369.00 ,$349.32 ,$349.32 ,$158.68 ,$349.32 ,$408.36 ,$408.36 ,$408.36 , N/A ,$396.69 ,$418.20 ,$158.68 ,$492.00 ,$156.36 ,$156.36 ,$418.20 ,$333.22 ,$418.20 ,$442.80 ,$158.68 ,$408.36 ,$391.14 ,$391.14 ,$158.68 ,$319.80 
ST. JOSEPH'S HOSPITAL - BREESE,92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$1,354.00 ",$880.10 ,$97.16 ,"$1,354.00 ","$1,150.90 ",$808.34 ,$222.69 ,$778.55 ,$222.69 ,$932.91 ,"$1,150.90 ","$1,150.90 ","$1,150.90 ","$1,110.28 ",$920.72 ,$222.69 ,$222.69 ,"$1,015.50 ",$961.34 ,$961.34 ,$222.69 ,$961.34 ,"$1,123.82 ","$1,123.82 ","$1,123.82 ", N/A ,$556.73 ,"$1,150.90 ",$222.69 ,"$1,354.00 ",$97.16 ,$97.16 ,"$1,150.90 ",$467.66 ,"$1,150.90 ","$1,218.60 ",$222.69 ,"$1,123.82 ","$1,076.43 ","$1,076.43 ",$222.69 ,$880.10 
ST. JOSEPH'S HOSPITAL - BREESE,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$606.00 ,$393.90 ,$90.59 ,$606.00 ,$515.10 ,$361.78 ,$104.19 ,$348.45 ,$104.19 ,$417.53 ,$515.10 ,$515.10 ,$515.10 ,$496.92 ,$412.08 ,$104.19 ,$104.19 ,$454.50 ,$430.26 ,$430.26 ,$104.19 ,$430.26 ,$502.98 ,$502.98 ,$502.98 , N/A ,$260.47 ,$515.10 ,$104.19 ,$606.00 ,$90.59 ,$90.59 ,$515.10 ,$218.80 ,$515.10 ,$545.40 ,$104.19 ,$502.98 ,$481.77 ,$481.77 ,$104.19 ,$393.90 
ST. JOSEPH'S HOSPITAL - BREESE,92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,560.00 ","$1,014.00 ",$90.59 ,"$1,560.00 ","$1,326.00 ",$931.32 ,$132.21 ,$897.00 ,$132.21 ,"$1,074.84 ","$1,326.00 ","$1,326.00 ","$1,326.00 ","$1,279.20 ","$1,060.80 ",$132.21 ,$132.21 ,"$1,170.00 ","$1,107.60 ","$1,107.60 ",$132.21 ,"$1,107.60 ","$1,294.80 ","$1,294.80 ","$1,294.80 ", N/A ,$330.52 ,"$1,326.00 ",$132.21 ,"$1,560.00 ",$90.59 ,$90.59 ,"$1,326.00 ",$277.64 ,"$1,326.00 ","$1,404.00 ",$132.21 ,"$1,294.80 ","$1,240.20 ","$1,240.20 ",$132.21 ,"$1,014.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$1,096.00 ",$712.40 ,$90.59 ,"$1,096.00 ",$931.60 ,$654.31 ,$132.21 ,$630.20 ,$132.21 ,$755.14 ,$931.60 ,$931.60 ,$931.60 ,$898.72 ,$745.28 ,$132.21 ,$132.21 ,$822.00 ,$778.16 ,$778.16 ,$132.21 ,$778.16 ,$909.68 ,$909.68 ,$909.68 , N/A ,$330.52 ,$931.60 ,$132.21 ,"$1,096.00 ",$90.59 ,$90.59 ,$931.60 ,$277.64 ,$931.60 ,$986.40 ,$132.21 ,$909.68 ,$871.32 ,$871.32 ,$132.21 ,$712.40 
ST. JOSEPH'S HOSPITAL - BREESE,92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$2,287.00 ","$1,486.55 ",$127.88 ,"$2,287.00 ","$1,943.95 ","$1,365.34 ",$222.69 ,"$1,315.03 ",$222.69 ,"$1,575.74 ","$1,943.95 ","$1,943.95 ","$1,943.95 ","$1,875.34 ","$1,555.16 ",$222.69 ,$222.69 ,"$1,715.25 ","$1,623.77 ","$1,623.77 ",$222.69 ,"$1,623.77 ","$1,898.21 ","$1,898.21 ","$1,898.21 ", N/A ,$556.73 ,"$1,943.95 ",$222.69 ,"$2,287.00 ",$127.88 ,$127.88 ,"$1,943.95 ",$467.66 ,"$1,943.95 ","$2,058.30 ",$222.69 ,"$1,898.21 ","$1,818.17 ","$1,818.17 ",$222.69 ,"$1,486.55 "
ST. JOSEPH'S HOSPITAL - BREESE,92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,"$1,661.00 ","$1,079.65 ",$107.10 ,"$1,661.00 ","$1,411.85 ",$991.62 ,$107.10 ,$955.08 ,$107.10 ,"$1,144.43 ","$1,411.85 ","$1,411.85 ","$1,411.85 ","$1,362.02 ","$1,129.48 ",$107.10 ,$107.10 ,"$1,245.75 ","$1,179.31 ","$1,179.31 ",$107.10 ,"$1,179.31 ","$1,378.63 ","$1,378.63 ","$1,378.63 ", N/A ,$267.76 ,"$1,411.85 ",$107.10 ,"$1,661.00 ",$127.88 ,$127.88 ,"$1,411.85 ",$224.92 ,"$1,411.85 ","$1,494.90 ",$107.10 ,"$1,378.63 ","$1,320.50 ","$1,320.50 ",$107.10 ,"$1,079.65 "
ST. JOSEPH'S HOSPITAL - BREESE,92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$2,591.00 ","$1,684.15 ",$97.16 ,"$2,591.00 ","$2,202.35 ","$1,546.83 ",$222.69 ,"$1,489.83 ",$222.69 ,"$1,785.20 ","$2,202.35 ","$2,202.35 ","$2,202.35 ","$2,124.62 ","$1,761.88 ",$222.69 ,$222.69 ,"$1,943.25 ","$1,839.61 ","$1,839.61 ",$222.69 ,"$1,839.61 ","$2,150.53 ","$2,150.53 ","$2,150.53 ", N/A ,$556.73 ,"$2,202.35 ",$222.69 ,"$2,591.00 ",$97.16 ,$97.16 ,"$2,202.35 ",$467.66 ,"$2,202.35 ","$2,331.90 ",$222.69 ,"$2,150.53 ","$2,059.85 ","$2,059.85 ",$222.69 ,"$1,684.15 "
ST. JOSEPH'S HOSPITAL - BREESE,92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,"$1,346.00 ",$874.90 ,$97.16 ,"$1,346.00 ","$1,144.10 ",$803.56 ,$107.10 ,$773.95 ,$107.10 ,$927.39 ,"$1,144.10 ","$1,144.10 ","$1,144.10 ","$1,103.72 ",$915.28 ,$107.10 ,$107.10 ,"$1,009.50 ",$955.66 ,$955.66 ,$107.10 ,$955.66 ,"$1,117.18 ","$1,117.18 ","$1,117.18 ", N/A ,$267.76 ,"$1,144.10 ",$107.10 ,"$1,346.00 ",$97.16 ,$97.16 ,"$1,144.10 ",$224.92 ,"$1,144.10 ","$1,211.40 ",$107.10 ,"$1,117.18 ","$1,070.07 ","$1,070.07 ",$107.10 ,$874.90 
ST. JOSEPH'S HOSPITAL - BREESE,92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$2,287.00 ","$1,486.55 ",$127.88 ,"$2,287.00 ","$1,943.95 ","$1,365.34 ",$222.69 ,"$1,315.03 ",$222.69 ,"$1,575.74 ","$1,943.95 ","$1,943.95 ","$1,943.95 ","$1,875.34 ","$1,555.16 ",$222.69 ,$222.69 ,"$1,715.25 ","$1,623.77 ","$1,623.77 ",$222.69 ,"$1,623.77 ","$1,898.21 ","$1,898.21 ","$1,898.21 ", N/A ,$556.73 ,"$1,943.95 ",$222.69 ,"$2,287.00 ",$127.88 ,$127.88 ,"$1,943.95 ",$467.66 ,"$1,943.95 ","$2,058.30 ",$222.69 ,"$1,898.21 ","$1,818.17 ","$1,818.17 ",$222.69 ,"$1,486.55 "
ST. JOSEPH'S HOSPITAL - BREESE,92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,"$1,383.00 ",$898.95 ,$107.10 ,"$1,383.00 ","$1,175.55 ",$825.65 ,$107.10 ,$795.23 ,$107.10 ,$952.89 ,"$1,175.55 ","$1,175.55 ","$1,175.55 ","$1,134.06 ",$940.44 ,$107.10 ,$107.10 ,"$1,037.25 ",$981.93 ,$981.93 ,$107.10 ,$981.93 ,"$1,147.89 ","$1,147.89 ","$1,147.89 ", N/A ,$267.76 ,"$1,175.55 ",$107.10 ,"$1,383.00 ",$127.88 ,$127.88 ,"$1,175.55 ",$224.92 ,"$1,175.55 ","$1,244.70 ",$107.10 ,"$1,147.89 ","$1,099.49 ","$1,099.49 ",$107.10 ,$898.95 
ST. JOSEPH'S HOSPITAL - BREESE,92100049,93923,HC RESTING ARTERIAL EXTREMITY COMP -52,921,1 ,"$1,560.00 ","$1,014.00 ",$45.30 ,"$1,560.00 ","$1,326.00 ",$931.32 ,$66.10 ,$897.00 ,$66.10 ,"$1,074.84 ","$1,326.00 ","$1,326.00 ","$1,326.00 ","$1,279.20 ","$1,060.80 ",$66.10 ,$66.10 ,"$1,170.00 ","$1,107.60 ","$1,107.60 ",$66.10 ,"$1,107.60 ","$1,294.80 ","$1,294.80 ","$1,294.80 ", N/A ,$165.26 ,"$1,326.00 ",$66.10 ,"$1,560.00 ",$45.30 ,$45.30 ,"$1,326.00 ",$138.82 ,"$1,326.00 ","$1,404.00 ",$66.10 ,"$1,294.80 ","$1,240.20 ","$1,240.20 ",$66.10 ,"$1,014.00 "
ST. JOSEPH'S HOSPITAL - BREESE,94000110,99195,HC THERAPEUTIC PHLEBOTOMY,940,1 ,$158.00 ,$102.70 ,$56.59 ,$218.80 ,$134.30 ,$94.33 ,$104.19 ,$90.85 ,$104.19 ,$108.86 ,$134.30 ,$134.30 ,$134.30 ,$129.56 ,$107.44 ,$104.19 ,$104.19 ,$118.50 ,$112.18 ,$112.18 ,$104.19 ,$112.18 ,$131.14 ,$131.14 ,$131.14 , N/A ,$158.00 ,$134.30 ,$104.19 ,$158.00 ,$56.59 ,$56.59 ,$134.30 ,$218.80 ,$134.30 ,$142.20 ,$104.19 ,$131.14 ,$125.61 ,$125.61 ,$104.19 ,$102.70 
ST. JOSEPH'S HOSPITAL - BREESE,94000114,20560,HC NEEDLE INSERTION W/O INJECTION 1-2 MUSCLES,940,1 ,$129.00 ,$83.85 ,$17.64 ,$129.00 ,$109.65 ,$77.01 ,$21.97 ,$74.18 ,$21.97 ,$88.88 ,$109.65 ,$109.65 ,$109.65 ,$105.78 ,$87.72 ,$21.97 ,$21.97 ,$96.75 ,$91.59 ,$91.59 ,$21.97 ,$91.59 ,$107.07 ,$107.07 ,$107.07 , N/A ,$54.92 ,$109.65 ,$21.97 ,$129.00 ,$17.64 ,$17.64 ,$109.65 ,$46.14 ,$109.65 ,$116.10 ,$21.97 ,$107.07 ,$102.56 ,$102.56 ,$21.97 ,$83.85 
ST. JOSEPH'S HOSPITAL - BREESE,94000115,20561,HC NEEDLE INSERTION W/O INJECTION 3+ MUSCLES,940,1 ,$129.00 ,$83.85 ,$17.64 ,$129.00 ,$109.65 ,$77.01 ,$21.97 ,$74.18 ,$21.97 ,$88.88 ,$109.65 ,$109.65 ,$109.65 ,$105.78 ,$87.72 ,$21.97 ,$21.97 ,$96.75 ,$91.59 ,$91.59 ,$21.97 ,$91.59 ,$107.07 ,$107.07 ,$107.07 , N/A ,$54.92 ,$109.65 ,$21.97 ,$129.00 ,$17.64 ,$17.64 ,$109.65 ,$46.14 ,$109.65 ,$116.10 ,$21.97 ,$107.07 ,$102.56 ,$102.56 ,$21.97 ,$83.85 
ST. JOSEPH'S HOSPITAL - BREESE,94200005,97802,HC NUTRITION THRPY EVAL 15 MIN,942,1 ,$25.00 ,$16.25 ,$14.38 ,$79.07 ,$21.25 ,$14.93 ,$37.65 ,$14.38 ,$37.65 ,$17.23 ,$21.25 ,$21.25 ,$21.25 , N/A ,$17.00 ,$37.65 ,$37.65 ,$18.75 ,$17.75 ,$17.75 ,$37.65 ,$17.75 ,$20.75 ,$20.75 ,$20.75 , N/A ,$25.00 ,$21.25 ,$37.65 ,$25.00 , N/A , N/A ,$21.25 ,$79.07 ,$21.25 ,$22.50 ,$37.65 ,$20.75 ,$19.88 ,$19.88 ,$37.65 ,$16.25 
ST. JOSEPH'S HOSPITAL - BREESE,94200006,97803,HC NUTRITION THRPY RE-EVAL 15 MIN,942,1 ,$25.00 ,$16.25 ,$14.38 ,$68.73 ,$21.25 ,$14.93 ,$32.73 ,$14.38 ,$32.73 ,$17.23 ,$21.25 ,$21.25 ,$21.25 , N/A ,$17.00 ,$32.73 ,$32.73 ,$18.75 ,$17.75 ,$17.75 ,$32.73 ,$17.75 ,$20.75 ,$20.75 ,$20.75 , N/A ,$25.00 ,$21.25 ,$32.73 ,$25.00 , N/A , N/A ,$21.25 ,$68.73 ,$21.25 ,$22.50 ,$32.73 ,$20.75 ,$19.88 ,$19.88 ,$32.73 ,$16.25 
ST. JOSEPH'S HOSPITAL - BREESE,94200007,97804,HC MNT GROUP INIT 30 MIN,942,1 ,$53.00 ,$34.45 ,$14.54 ,$53.00 ,$45.05 ,$31.64 ,$17.10 ,$30.48 ,$17.10 ,$36.52 ,$45.05 ,$45.05 ,$45.05 , N/A ,$36.04 ,$17.10 ,$17.10 ,$39.75 ,$37.63 ,$37.63 ,$17.10 ,$37.63 ,$43.99 ,$43.99 ,$43.99 , N/A ,$14.54 ,$45.05 ,$17.10 ,$53.00 , N/A , N/A ,$45.05 ,$35.91 ,$45.05 ,$47.70 ,$17.10 ,$43.99 ,$42.14 ,$42.14 ,$17.10 ,$34.45 
ST. JOSEPH'S HOSPITAL - BREESE,94200011,G0108,HC DIABETES SELF MGT ED 30 MIN,942,1 ,$67.00 ,$43.55 ,$38.53 ,$119.57 ,$56.95 ,$40.00 ,$56.94 ,$38.53 ,$56.94 ,$46.16 ,$56.95 ,$56.95 ,$56.95 , N/A ,$45.56 ,$56.94 ,$56.94 ,$50.25 ,$47.57 ,$47.57 ,$56.94 ,$47.57 ,$55.61 ,$55.61 ,$55.61 , N/A ,$67.00 ,$56.95 ,$56.94 ,$67.00 , N/A , N/A ,$56.95 ,$119.57 ,$56.95 ,$60.30 ,$56.94 ,$55.61 ,$53.27 ,$53.27 ,$56.94 ,$43.55 
ST. JOSEPH'S HOSPITAL - BREESE,94200013,G0109,HC DIABETES SELF MGT GROUP 30MIN,942,1 ,$91.00 ,$59.15 ,$15.74 ,$91.00 ,$77.35 ,$54.33 ,$15.74 ,$52.33 ,$15.74 ,$62.70 ,$77.35 ,$77.35 ,$77.35 , N/A ,$61.88 ,$15.74 ,$15.74 ,$68.25 ,$64.61 ,$64.61 ,$15.74 ,$64.61 ,$75.53 ,$75.53 ,$75.53 , N/A ,$39.35 ,$77.35 ,$15.74 ,$91.00 , N/A , N/A ,$77.35 ,$33.05 ,$77.35 ,$81.90 ,$15.74 ,$75.53 ,$72.35 ,$72.35 ,$15.74 ,$59.15 
ST. JOSEPH'S HOSPITAL - BREESE,94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$188.00 ,$122.20 ,$105.14 ,$220.80 ,$159.80 ,$112.24 ,$105.14 ,$108.10 ,$105.14 ,$129.53 ,$159.80 ,$159.80 ,$159.80 , N/A ,$127.84 ,$105.14 ,$105.14 ,$141.00 ,$133.48 ,$133.48 ,$105.14 ,$133.48 ,$156.04 ,$156.04 ,$156.04 , N/A ,$188.00 ,$159.80 ,$105.14 ,$188.00 , N/A , N/A ,$159.80 ,$220.80 ,$159.80 ,$169.20 ,$105.14 ,$156.04 ,$149.46 ,$149.46 ,$105.14 ,$122.20 
ST. JOSEPH'S HOSPITAL - BREESE,94300008,G0424,HC PULMONARY REHAB PER HOUR,948,1 ,$142.00 ,$92.30 ,$52.57 ,$142.00 ,$120.70 ,$84.77 ,$52.57 ,$81.65 ,$52.57 ,$97.84 ,$120.70 ,$120.70 ,$120.70 , N/A ,$96.56 ,$52.57 ,$52.57 ,$106.50 ,$100.82 ,$100.82 ,$52.57 ,$100.82 ,$117.86 ,$117.86 ,$117.86 , N/A ,$131.42 ,$120.70 ,$52.57 ,$142.00 , N/A , N/A ,$120.70 ,$110.39 ,$120.70 ,$127.80 ,$52.57 ,$117.86 ,$112.89 ,$112.89 ,$52.57 ,$92.30 
ST. JOSEPH'S HOSPITAL - BREESE,94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$163.00 ,$105.95 ,$93.73 ,$220.80 ,$138.55 ,$97.31 ,$105.14 ,$93.73 ,$105.14 ,$112.31 ,$138.55 ,$138.55 ,$138.55 , N/A ,$110.84 ,$105.14 ,$105.14 ,$122.25 ,$115.73 ,$115.73 ,$105.14 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$163.00 ,$138.55 ,$105.14 ,$163.00 , N/A , N/A ,$138.55 ,$220.80 ,$138.55 ,$146.70 ,$105.14 ,$135.29 ,$129.59 ,$129.59 ,$105.14 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$163.00 ,$105.95 ,$93.73 ,$220.80 ,$138.55 ,$97.31 ,$105.14 ,$93.73 ,$105.14 ,$112.31 ,$138.55 ,$138.55 ,$138.55 , N/A ,$110.84 ,$105.14 ,$105.14 ,$122.25 ,$115.73 ,$115.73 ,$105.14 ,$115.73 ,$135.29 ,$135.29 ,$135.29 , N/A ,$163.00 ,$138.55 ,$105.14 ,$163.00 , N/A , N/A ,$138.55 ,$220.80 ,$138.55 ,$146.70 ,$105.14 ,$135.29 ,$129.59 ,$129.59 ,$105.14 ,$105.95 
ST. JOSEPH'S HOSPITAL - BREESE,94300019,N/A,HC CARDIAC REHAB PHASE 3 FULL MONTH,943,1 ,$32.00 ,$20.80 ,$18.40 ,$32.00 ,$27.20 ,$19.10 , N/A ,$18.40 , N/A ,$22.05 ,$27.20 ,$27.20 ,$27.20 , N/A ,$21.76 , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.56 ,$26.56 ,$26.56 , N/A , N/A ,$27.20 , N/A ,$32.00 , N/A , N/A ,$27.20 , N/A ,$27.20 ,$28.80 , N/A ,$26.56 ,$25.44 ,$25.44 , N/A ,$20.80 
ST. JOSEPH'S HOSPITAL - BREESE,94300022,N/A,HC CARDIAC REHAB 4 EXERCISE MONTHLY,943,1 ,$87.00 ,$56.55 ,$50.03 ,$87.00 ,$73.95 ,$51.94 , N/A ,$50.03 , N/A ,$59.94 ,$73.95 ,$73.95 ,$73.95 , N/A ,$59.16 , N/A , N/A ,$65.25 ,$61.77 ,$61.77 , N/A ,$61.77 ,$72.21 ,$72.21 ,$72.21 , N/A , N/A ,$73.95 , N/A ,$87.00 , N/A , N/A ,$73.95 , N/A ,$73.95 ,$78.30 , N/A ,$72.21 ,$69.17 ,$69.17 , N/A ,$56.55 
ST. JOSEPH'S HOSPITAL - BREESE,96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$37.47 ,$24.36 ,$12.36 ,$89.80 ,$31.85 ,$22.37 ,$12.36 ,$21.55 ,$12.36 ,$25.82 ,$31.85 ,$31.85 ,$31.85 , N/A ,$25.48 ,$12.36 ,$12.36 ,$28.10 ,$26.60 ,$26.60 ,$12.36 ,$26.60 ,$31.10 ,$31.10 ,$31.10 , N/A ,$30.90 ,$31.85 ,$12.36 ,$37.47 ,$89.80 ,$36.16 ,$31.85 ,$25.96 ,$31.85 ,$33.72 ,$12.36 ,$31.10 , N/A , N/A ,$12.36 ,$24.36 
ST. JOSEPH'S HOSPITAL - BREESE,96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$66.27 ,$43.08 ,$21.87 ,$89.80 ,$56.33 ,$39.56 ,$21.87 ,$38.11 ,$21.87 ,$45.66 ,$56.33 ,$56.33 ,$56.33 , N/A ,$45.06 ,$21.87 ,$21.87 ,$49.70 ,$47.05 ,$47.05 ,$21.87 ,$47.05 ,$55.00 ,$55.00 ,$55.00 , N/A ,$54.68 ,$56.33 ,$21.87 ,$66.27 ,$89.80 ,$63.95 ,$56.33 ,$45.93 ,$56.33 ,$59.64 ,$21.87 ,$55.00 , N/A , N/A ,$21.87 ,$43.08 
ST. JOSEPH'S HOSPITAL - BREESE,96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$103.74 ,$67.43 ,$34.22 ,$103.74 ,$88.18 ,$61.93 ,$34.22 ,$59.65 ,$34.22 ,$71.48 ,$88.18 ,$88.18 ,$88.18 , N/A ,$70.54 ,$34.22 ,$34.22 ,$77.81 ,$73.66 ,$73.66 ,$34.22 ,$73.66 ,$86.10 ,$86.10 ,$86.10 , N/A ,$85.55 ,$88.18 ,$34.22 ,$103.74 ,$89.80 ,$89.80 ,$88.18 ,$71.86 ,$88.18 ,$93.37 ,$34.22 ,$86.10 , N/A , N/A ,$34.22 ,$67.43 
ST. JOSEPH'S HOSPITAL - BREESE,97500073,43239,PC EGD W/BIOPSY SGL/MULT,975,1 ,$456.00 ,$296.40 ,$262.20 ,"$1,577.15 ",$387.60 ,$272.23 ,$751.03 ,$262.20 ,$751.03 ,$314.18 ,$387.60 ,$387.60 ,$387.60 ,$373.92 ,$310.08 ,$751.03 ,$751.03 ,$342.00 ,$323.76 ,$323.76 ,$751.03 ,$323.76 ,$378.48 ,$378.48 ,$378.48 , N/A ,$456.00 ,$387.60 ,$751.03 ,$456.00 ,$499.95 ,$440.04 ,$387.60 ,"$1,577.15 ",$387.60 ,$410.40 ,$751.03 ,$378.48 , N/A , N/A ,$751.03 ,$296.40 
ST. JOSEPH'S HOSPITAL - BREESE,97500074,45380,PC COLONOSCOPY W/BIOPSY SGL/MULT,975,1 ,$666.00 ,$432.90 ,$382.95 ,"$2,015.23 ",$566.10 ,$397.60 ,$959.63 ,$382.95 ,$959.63 ,$458.87 ,$566.10 ,$566.10 ,$566.10 ,$546.12 ,$452.88 ,$959.63 ,$959.63 ,$499.50 ,$472.86 ,$472.86 ,$959.63 ,$472.86 ,$552.78 ,$552.78 ,$552.78 , N/A ,$666.00 ,$566.10 ,$959.63 ,$666.00 ,$433.52 ,$433.52 ,$566.10 ,"$2,015.23 ",$566.10 ,$599.40 ,$959.63 ,$552.78 , N/A , N/A ,$959.63 ,$432.90 
ST. JOSEPH'S HOSPITAL - BREESE,97500075,43450,PC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS,975,1 ,$261.00 ,$169.65 ,$150.08 ,"$1,577.15 ",$221.85 ,$155.82 ,$751.03 ,$150.08 ,$751.03 ,$179.83 ,$221.85 ,$221.85 ,$221.85 ,$214.02 ,$177.48 ,$751.03 ,$751.03 ,$195.75 ,$185.31 ,$185.31 ,$751.03 ,$185.31 ,$216.63 ,$216.63 ,$216.63 , N/A ,$261.00 ,$221.85 ,$751.03 ,$261.00 ,$441.47 ,$251.87 ,$221.85 ,"$1,577.15 ",$221.85 ,$234.90 ,$751.03 ,$216.63 , N/A , N/A ,$751.03 ,$169.65 
ST. JOSEPH'S HOSPITAL - BREESE,97500076,45378,PC COLONSCOPY DX W/SPECIMEN BRUSH/WASH,975,1 ,$205.00 ,$133.25 ,$117.88 ,"$1,532.92 ",$174.25 ,$122.39 ,$729.96 ,$117.88 ,$729.96 ,$141.25 ,$174.25 ,$174.25 ,$174.25 ,$168.10 ,$139.40 ,$729.96 ,$729.96 ,$153.75 ,$145.55 ,$145.55 ,$729.96 ,$145.55 ,$170.15 ,$170.15 ,$170.15 , N/A ,$205.00 ,$174.25 ,$729.96 ,$205.00 ,$433.52 ,$197.83 ,$174.25 ,"$1,532.92 ",$174.25 ,$184.50 ,$729.96 ,$170.15 , N/A , N/A ,$729.96 ,$133.25 
ST. JOSEPH'S HOSPITAL - BREESE,97500077,45385,PC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH,975,1 ,$843.00 ,$547.95 ,$484.73 ,"$2,015.23 ",$716.55 ,$503.27 ,$959.63 ,$484.73 ,$959.63 ,$580.83 ,$716.55 ,$716.55 ,$716.55 ,$691.26 ,$573.24 ,$959.63 ,$959.63 ,$632.25 ,$598.53 ,$598.53 ,$959.63 ,$598.53 ,$699.69 ,$699.69 ,$699.69 , N/A ,$843.00 ,$716.55 ,$959.63 ,$843.00 ,$533.37 ,$533.37 ,$716.55 ,"$2,015.23 ",$716.55 ,$758.70 ,$959.63 ,$699.69 , N/A , N/A ,$959.63 ,$547.95 
ST. JOSEPH'S HOSPITAL - BREESE,97500078,G0105,PC COLONSCOPY CANCER SCREENING HIGH RISK,975,1 ,$204.00 ,$132.60 ,$117.30 ,"$1,532.92 ",$173.40 ,$121.79 ,$729.96 ,$117.30 ,$729.96 ,$140.56 ,$173.40 ,$173.40 ,$173.40 ,$167.28 ,$138.72 ,$729.96 ,$729.96 ,$153.00 ,$144.84 ,$144.84 ,$729.96 ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A ,$204.00 ,$173.40 ,$729.96 ,$204.00 ,$433.52 ,$196.86 ,$173.40 ,"$1,532.92 ",$173.40 ,$183.60 ,$729.96 ,$169.32 , N/A , N/A ,$729.96 ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,97500079,G0121,PC COLONSCOPY CANCER SCREENING NOT HIGH RISK,975,1 ,$183.00 ,$118.95 ,$105.23 ,"$1,532.92 ",$155.55 ,$109.25 ,$729.96 ,$105.23 ,$729.96 ,$126.09 ,$155.55 ,$155.55 ,$155.55 ,$150.06 ,$124.44 ,$729.96 ,$729.96 ,$137.25 ,$129.93 ,$129.93 ,$729.96 ,$129.93 ,$151.89 ,$151.89 ,$151.89 , N/A ,$183.00 ,$155.55 ,$729.96 ,$183.00 ,$433.52 ,$176.60 ,$155.55 ,"$1,532.92 ",$155.55 ,$164.70 ,$729.96 ,$151.89 , N/A , N/A ,$729.96 ,$118.95 
ST. JOSEPH'S HOSPITAL - BREESE,97500080,43249,PC EGD W/BALLOON DILAT <30MM,975,1 ,$504.00 ,$327.60 ,$289.80 ,"$3,125.33 ",$428.40 ,$300.89 ,"$1,488.25 ",$289.80 ,"$1,488.25 ",$347.26 ,$428.40 ,$428.40 ,$428.40 ,$413.28 ,$342.72 ,"$1,488.25 ","$1,488.25 ",$378.00 ,$357.84 ,$357.84 ,"$1,488.25 ",$357.84 ,$418.32 ,$418.32 ,$418.32 , N/A ,$504.00 ,$428.40 ,"$1,488.25 ",$504.00 ,$690.08 ,$486.36 ,$428.40 ,"$3,125.33 ",$428.40 ,$453.60 ,"$1,488.25 ",$418.32 , N/A , N/A ,"$1,488.25 ",$327.60 
ST. JOSEPH'S HOSPITAL - BREESE,97500081,43235,PC EGD W/BRUSH/WASH,975,1 ,$468.00 ,$304.20 ,$269.10 ,"$1,577.15 ",$397.80 ,$279.40 ,$751.03 ,$269.10 ,$751.03 ,$322.45 ,$397.80 ,$397.80 ,$397.80 ,$383.76 ,$318.24 ,$751.03 ,$751.03 ,$351.00 ,$332.28 ,$332.28 ,$751.03 ,$332.28 ,$388.44 ,$388.44 ,$388.44 , N/A ,$468.00 ,$397.80 ,$751.03 ,$468.00 ,$499.95 ,$451.62 ,$397.80 ,"$1,577.15 ",$397.80 ,$421.20 ,$751.03 ,$388.44 , N/A , N/A ,$751.03 ,$304.20 
ST. JOSEPH'S HOSPITAL - BREESE,97500082,43251,PC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH,975,1 ,$651.00 ,$423.15 ,$374.33 ,"$3,125.33 ",$553.35 ,$388.65 ,"$1,488.25 ",$374.33 ,"$1,488.25 ",$448.54 ,$553.35 ,$553.35 ,$553.35 ,$533.82 ,$442.68 ,"$1,488.25 ","$1,488.25 ",$488.25 ,$462.21 ,$462.21 ,"$1,488.25 ",$462.21 ,$540.33 ,$540.33 ,$540.33 , N/A ,$651.00 ,$553.35 ,"$1,488.25 ",$651.00 ,$690.08 ,$628.22 ,$553.35 ,"$3,125.33 ",$553.35 ,$585.90 ,"$1,488.25 ",$540.33 , N/A , N/A ,"$1,488.25 ",$423.15 
ST. JOSEPH'S HOSPITAL - BREESE,97500083,43250,PC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY,975,1 ,$570.00 ,$370.50 ,$327.75 ,"$3,125.33 ",$484.50 ,$340.29 ,"$1,488.25 ",$327.75 ,"$1,488.25 ",$392.73 ,$484.50 ,$484.50 ,$484.50 ,$467.40 ,$387.60 ,"$1,488.25 ","$1,488.25 ",$427.50 ,$404.70 ,$404.70 ,"$1,488.25 ",$404.70 ,$473.10 ,$473.10 ,$473.10 , N/A ,$570.00 ,$484.50 ,"$1,488.25 ",$570.00 ,$690.08 ,$550.05 ,$484.50 ,"$3,125.33 ",$484.50 ,$513.00 ,"$1,488.25 ",$473.10 , N/A , N/A ,"$1,488.25 ",$370.50 
ST. JOSEPH'S HOSPITAL - BREESE,97500084,45386,PC COLONOSCOPY W/BALLOON DILATION,975,1 ,$702.00 ,$456.30 ,$403.65 ,"$2,015.23 ",$596.70 ,$419.09 ,$959.63 ,$403.65 ,$959.63 ,$483.68 ,$596.70 ,$596.70 ,$596.70 ,$575.64 ,$477.36 ,$959.63 ,$959.63 ,$526.50 ,$498.42 ,$498.42 ,$959.63 ,$498.42 ,$582.66 ,$582.66 ,$582.66 , N/A ,$702.00 ,$596.70 ,$959.63 ,$702.00 ,$533.37 ,$533.37 ,$596.70 ,"$2,015.23 ",$596.70 ,$631.80 ,$959.63 ,$582.66 , N/A , N/A ,$959.63 ,$456.30 
ST. JOSEPH'S HOSPITAL - BREESE,97500085,45381,PC COLONSCOPY W/SUBMUCOSAL INJ,975,1 ,$666.00 ,$432.90 ,$382.95 ,"$2,015.23 ",$566.10 ,$397.60 ,$959.63 ,$382.95 ,$959.63 ,$458.87 ,$566.10 ,$566.10 ,$566.10 ,$546.12 ,$452.88 ,$959.63 ,$959.63 ,$499.50 ,$472.86 ,$472.86 ,$959.63 ,$472.86 ,$552.78 ,$552.78 ,$552.78 , N/A ,$666.00 ,$566.10 ,$959.63 ,$666.00 ,$533.37 ,$533.37 ,$566.10 ,"$2,015.23 ",$566.10 ,$599.40 ,$959.63 ,$552.78 , N/A , N/A ,$959.63 ,$432.90 
ST. JOSEPH'S HOSPITAL - BREESE,97500086,45382,PC COLONSCOPY W/CONTROL BLEEDING,975,1 ,$858.00 ,$557.70 ,$493.35 ,"$2,015.23 ",$729.30 ,$512.23 ,$959.63 ,$493.35 ,$959.63 ,$591.16 ,$729.30 ,$729.30 ,$729.30 ,$703.56 ,$583.44 ,$959.63 ,$959.63 ,$643.50 ,$609.18 ,$609.18 ,$959.63 ,$609.18 ,$712.14 ,$712.14 ,$712.14 , N/A ,$858.00 ,$729.30 ,$959.63 ,$858.00 ,$533.37 ,$533.37 ,$729.30 ,"$2,015.23 ",$729.30 ,$772.20 ,$959.63 ,$712.14 , N/A , N/A ,$959.63 ,$557.70 
ST. JOSEPH'S HOSPITAL - BREESE,97500087,43233,PC EGD W/BALLOON DILAT >30MM,975,1 ,$762.00 ,$495.30 ,$438.15 ,"$3,125.33 ",$647.70 ,$454.91 ,"$1,488.25 ",$438.15 ,"$1,488.25 ",$525.02 ,$647.70 ,$647.70 ,$647.70 ,$624.84 ,$518.16 ,"$1,488.25 ","$1,488.25 ",$571.50 ,$541.02 ,$541.02 ,"$1,488.25 ",$541.02 ,$632.46 ,$632.46 ,$632.46 , N/A ,$762.00 ,$647.70 ,"$1,488.25 ",$762.00 ,$690.08 ,$690.08 ,$647.70 ,"$3,125.33 ",$647.70 ,$685.80 ,"$1,488.25 ",$632.46 , N/A , N/A ,"$1,488.25 ",$495.30 
ST. JOSEPH'S HOSPITAL - BREESE,97500088,45398,PC COLONOSCOPY W/BAND LIGATION,975,1 ,"$1,296.00 ",$842.40 ,$533.37 ,"$2,015.23 ","$1,101.60 ",$773.71 ,$959.63 ,$745.20 ,$959.63 ,$892.94 ,"$1,101.60 ","$1,101.60 ","$1,101.60 ","$1,062.72 ",$881.28 ,$959.63 ,$959.63 ,$972.00 ,$920.16 ,$920.16 ,$959.63 ,$920.16 ,"$1,075.68 ","$1,075.68 ","$1,075.68 ", N/A ,"$1,296.00 ","$1,101.60 ",$959.63 ,"$1,296.00 ",$533.37 ,$533.37 ,"$1,101.60 ","$2,015.23 ","$1,101.60 ","$1,166.40 ",$959.63 ,"$1,075.68 ", N/A , N/A ,$959.63 ,$842.40 
ST. JOSEPH'S HOSPITAL - BREESE,97500089,43247,PC EGD W/FB REMOVAL,975,1 ,$718.00 ,$466.70 ,$412.85 ,"$1,577.15 ",$610.30 ,$428.65 ,$751.03 ,$412.85 ,$751.03 ,$494.70 ,$610.30 ,$610.30 ,$610.30 ,$588.76 ,$488.24 ,$751.03 ,$751.03 ,$538.50 ,$509.78 ,$509.78 ,$751.03 ,$509.78 ,$595.94 ,$595.94 ,$595.94 , N/A ,$718.00 ,$610.30 ,$751.03 ,$718.00 ,$690.08 ,$690.08 ,$610.30 ,"$1,577.15 ",$610.30 ,$646.20 ,$751.03 ,$595.94 , N/A , N/A ,$751.03 ,$466.70 
ST. JOSEPH'S HOSPITAL - BREESE,97500090,43236,PC EGD W/SUBMUCOSAL INJ,975,1 ,"$1,253.00 ",$814.45 ,$690.08 ,"$1,577.15 ","$1,065.05 ",$748.04 ,$751.03 ,$720.48 ,$751.03 ,$863.32 ,"$1,065.05 ","$1,065.05 ","$1,065.05 ","$1,027.46 ",$852.04 ,$751.03 ,$751.03 ,$939.75 ,$889.63 ,$889.63 ,$751.03 ,$889.63 ,"$1,039.99 ","$1,039.99 ","$1,039.99 ", N/A ,"$1,253.00 ","$1,065.05 ",$751.03 ,"$1,253.00 ",$690.08 ,$690.08 ,"$1,065.05 ","$1,577.15 ","$1,065.05 ","$1,127.70 ",$751.03 ,"$1,039.99 ", N/A , N/A ,$751.03 ,$814.45 
ST. JOSEPH'S HOSPITAL - BREESE,97500091,43248,PC EGD W/DILAT ESOPH GD WIRE,975,1 ,$480.00 ,$312.00 ,$276.00 ,"$1,577.15 ",$408.00 ,$286.56 ,$751.03 ,$276.00 ,$751.03 ,$330.72 ,$408.00 ,$408.00 ,$408.00 ,$393.60 ,$326.40 ,$751.03 ,$751.03 ,$360.00 ,$340.80 ,$340.80 ,$751.03 ,$340.80 ,$398.40 ,$398.40 ,$398.40 , N/A ,$480.00 ,$408.00 ,$751.03 ,$480.00 ,$690.08 ,$463.20 ,$408.00 ,"$1,577.15 ",$408.00 ,$432.00 ,$751.03 ,$398.40 , N/A , N/A ,$751.03 ,$312.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500092,43220,PC ESOPHAGOSC W/BALLOON,975,1 ,$387.00 ,$251.55 ,$222.53 ,"$3,125.33 ",$328.95 ,$231.04 ,"$1,488.25 ",$222.53 ,"$1,488.25 ",$266.64 ,$328.95 ,$328.95 ,$328.95 ,$317.34 ,$263.16 ,"$1,488.25 ","$1,488.25 ",$290.25 ,$274.77 ,$274.77 ,"$1,488.25 ",$274.77 ,$321.21 ,$321.21 ,$321.21 , N/A ,$387.00 ,$328.95 ,"$1,488.25 ",$387.00 ,$690.08 ,$373.46 ,$328.95 ,"$3,125.33 ",$328.95 ,$348.30 ,"$1,488.25 ",$321.21 , N/A , N/A ,"$1,488.25 ",$251.55 
ST. JOSEPH'S HOSPITAL - BREESE,97500093,43264,PC ERCP W/REMOVE CALCULUS,975,1 ,"$1,843.00 ","$1,197.95 ","$1,059.73 ","$6,018.43 ","$1,566.55 ","$1,100.27 ","$2,865.92 ","$1,059.73 ","$2,865.92 ","$1,269.83 ","$1,566.55 ","$1,566.55 ","$1,566.55 ","$1,511.26 ","$1,253.24 ","$2,865.92 ","$2,865.92 ","$1,382.25 ","$1,308.53 ","$1,308.53 ","$2,865.92 ","$1,308.53 ","$1,529.69 ","$1,529.69 ","$1,529.69 ", N/A ,"$1,843.00 ","$1,566.55 ","$2,865.92 ","$1,843.00 ","$1,459.28 ","$1,459.28 ","$1,566.55 ","$6,018.43 ","$1,566.55 ","$1,658.70 ","$2,865.92 ","$1,529.69 ", N/A , N/A ,"$2,865.92 ","$1,197.95 "
ST. JOSEPH'S HOSPITAL - BREESE,97500094,43275,PC ERCP W/REM FB STENT DUCT,975,1 ,"$1,455.00 ",$945.75 ,$836.63 ,"$6,018.43 ","$1,236.75 ",$868.64 ,"$2,865.92 ",$836.63 ,"$2,865.92 ","$1,002.50 ","$1,236.75 ","$1,236.75 ","$1,236.75 ","$1,193.10 ",$989.40 ,"$2,865.92 ","$2,865.92 ","$1,091.25 ","$1,033.05 ","$1,033.05 ","$2,865.92 ","$1,033.05 ","$1,207.65 ","$1,207.65 ","$1,207.65 ", N/A ,"$1,455.00 ","$1,236.75 ","$2,865.92 ","$1,455.00 ","$1,459.28 ","$1,404.08 ","$1,236.75 ","$6,018.43 ","$1,236.75 ","$1,309.50 ","$2,865.92 ","$1,207.65 ", N/A , N/A ,"$2,865.92 ",$945.75 
ST. JOSEPH'S HOSPITAL - BREESE,97500096,43274,PC ERCP W/STENT PLACEMENT DUCT,975,1 ,"$1,764.00 ","$1,146.60 ","$1,014.30 ","$9,593.98 ","$1,499.40 ","$1,053.11 ","$4,568.56 ","$1,014.30 ","$4,568.56 ","$1,215.40 ","$1,499.40 ","$1,499.40 ","$1,499.40 ","$1,446.48 ","$1,199.52 ","$4,568.56 ","$4,568.56 ","$1,323.00 ","$1,252.44 ","$1,252.44 ","$4,568.56 ","$1,252.44 ","$1,464.12 ","$1,464.12 ","$1,464.12 ", N/A ,"$1,764.00 ","$1,499.40 ","$4,568.56 ","$1,764.00 ","$1,459.28 ","$1,459.28 ","$1,499.40 ","$9,593.98 ","$1,499.40 ","$1,587.60 ","$4,568.56 ","$1,464.12 ", N/A , N/A ,"$4,568.56 ","$1,146.60 "
ST. JOSEPH'S HOSPITAL - BREESE,97500097,43276,PC ERCP W/REM/EXCHG STENT W/DILAT  AND  WIRE EA,975,1 ,"$1,835.00 ","$1,192.75 ","$1,055.13 ","$9,593.98 ","$1,559.75 ","$1,095.50 ","$4,568.56 ","$1,055.13 ","$4,568.56 ","$1,264.32 ","$1,559.75 ","$1,559.75 ","$1,559.75 ","$1,504.70 ","$1,247.80 ","$4,568.56 ","$4,568.56 ","$1,376.25 ","$1,302.85 ","$1,302.85 ","$4,568.56 ","$1,302.85 ","$1,523.05 ","$1,523.05 ","$1,523.05 ", N/A ,"$1,835.00 ","$1,559.75 ","$4,568.56 ","$1,835.00 ","$1,459.28 ","$1,459.28 ","$1,559.75 ","$9,593.98 ","$1,559.75 ","$1,651.50 ","$4,568.56 ","$1,523.05 ", N/A , N/A ,"$4,568.56 ","$1,192.75 "
ST. JOSEPH'S HOSPITAL - BREESE,97500098,43275,PC ERCP W/FB OR STENT REMOVAL DUCT,975,1 ,"$1,455.00 ",$945.75 ,$836.63 ,"$6,018.43 ","$1,236.75 ",$868.64 ,"$2,865.92 ",$836.63 ,"$2,865.92 ","$1,002.50 ","$1,236.75 ","$1,236.75 ","$1,236.75 ","$1,193.10 ",$989.40 ,"$2,865.92 ","$2,865.92 ","$1,091.25 ","$1,033.05 ","$1,033.05 ","$2,865.92 ","$1,033.05 ","$1,207.65 ","$1,207.65 ","$1,207.65 ", N/A ,"$1,455.00 ","$1,236.75 ","$2,865.92 ","$1,455.00 ","$1,459.28 ","$1,404.08 ","$1,236.75 ","$6,018.43 ","$1,236.75 ","$1,309.50 ","$2,865.92 ","$1,207.65 ", N/A , N/A ,"$2,865.92 ",$945.75 
ST. JOSEPH'S HOSPITAL - BREESE,97500099,43265,PC ERCP W/LITHOTRIPSY,975,1 ,"$1,933.00 ","$1,256.45 ","$1,111.48 ","$9,593.98 ","$1,643.05 ","$1,154.00 ","$4,568.56 ","$1,111.48 ","$4,568.56 ","$1,331.84 ","$1,643.05 ","$1,643.05 ","$1,643.05 ","$1,585.06 ","$1,314.44 ","$4,568.56 ","$4,568.56 ","$1,449.75 ","$1,372.43 ","$1,372.43 ","$4,568.56 ","$1,372.43 ","$1,604.39 ","$1,604.39 ","$1,604.39 ", N/A ,"$1,933.00 ","$1,643.05 ","$4,568.56 ","$1,933.00 ","$1,459.28 ","$1,459.28 ","$1,643.05 ","$9,593.98 ","$1,643.05 ","$1,739.70 ","$4,568.56 ","$1,604.39 ", N/A , N/A ,"$4,568.56 ","$1,256.45 "
ST. JOSEPH'S HOSPITAL - BREESE,97500100,43263,PC ERCP W/SPHINCTER PRESSURE MEASUREMENT,975,1 ,"$1,414.00 ",$919.10 ,$813.05 ,"$6,018.43 ","$1,201.90 ",$844.16 ,"$2,865.92 ",$813.05 ,"$2,865.92 ",$974.25 ,"$1,201.90 ","$1,201.90 ","$1,201.90 ","$1,159.48 ",$961.52 ,"$2,865.92 ","$2,865.92 ","$1,060.50 ","$1,003.94 ","$1,003.94 ","$2,865.92 ","$1,003.94 ","$1,173.62 ","$1,173.62 ","$1,173.62 ", N/A ,"$1,414.00 ","$1,201.90 ","$2,865.92 ","$1,414.00 ","$1,459.28 ","$1,364.51 ","$1,201.90 ","$6,018.43 ","$1,201.90 ","$1,272.60 ","$2,865.92 ","$1,173.62 ", N/A , N/A ,"$2,865.92 ",$919.10 
ST. JOSEPH'S HOSPITAL - BREESE,97500101,43277,PC ERCP W/BALL DILAT DUCT/AMPULLA EA,975,1 ,"$1,463.00 ",$950.95 ,$841.23 ,"$6,018.43 ","$1,243.55 ",$873.41 ,"$2,865.92 ",$841.23 ,"$2,865.92 ","$1,008.01 ","$1,243.55 ","$1,243.55 ","$1,243.55 ","$1,199.66 ",$994.84 ,"$2,865.92 ","$2,865.92 ","$1,097.25 ","$1,038.73 ","$1,038.73 ","$2,865.92 ","$1,038.73 ","$1,214.29 ","$1,214.29 ","$1,214.29 ", N/A ,"$1,463.00 ","$1,243.55 ","$2,865.92 ","$1,463.00 ","$1,459.28 ","$1,411.80 ","$1,243.55 ","$6,018.43 ","$1,243.55 ","$1,316.70 ","$2,865.92 ","$1,214.29 ", N/A , N/A ,"$2,865.92 ",$950.95 
ST. JOSEPH'S HOSPITAL - BREESE,97500102,43245,PC EGD DILATE STRICTURE,975,1 ,$544.14 ,$353.69 ,$312.88 ,"$3,125.33 ",$462.52 ,$324.85 ,"$1,488.25 ",$312.88 ,"$1,488.25 ",$374.91 ,$462.52 ,$462.52 ,$462.52 ,$446.19 ,$370.02 ,"$1,488.25 ","$1,488.25 ",$408.11 ,$386.34 ,$386.34 ,"$1,488.25 ",$386.34 ,$451.64 ,$451.64 ,$451.64 , N/A ,$544.14 ,$462.52 ,"$1,488.25 ",$544.14 ,$690.08 ,$525.10 ,$462.52 ,"$3,125.33 ",$462.52 ,$489.73 ,"$1,488.25 ",$451.64 , N/A , N/A ,"$1,488.25 ",$353.69 
ST. JOSEPH'S HOSPITAL - BREESE,98180092,20600,PC DRAIN/INJECT SMALL JOINT/BURSA,981,1 ,$117.24 ,$76.21 ,$67.41 ,$525.31 ,$99.65 ,$69.99 ,$250.15 ,$67.41 ,$250.15 ,$80.78 ,$99.65 ,$99.65 ,$99.65 ,$96.14 ,$79.72 ,$250.15 ,$250.15 ,$87.93 ,$83.24 ,$83.24 ,$250.15 ,$83.24 ,$97.31 ,$97.31 ,$97.31 , N/A ,$117.24 ,$99.65 ,$250.15 ,$117.24 ,$206.77 ,$113.14 ,$99.65 ,$525.31 ,$99.65 ,$105.52 ,$250.15 ,$97.31 , N/A , N/A ,$250.15 ,$76.21 
ST. JOSEPH'S HOSPITAL - BREESE,98180093,20605,PC DRAIN/INJECT MEDIUM JOINT/BURSA,981,1 ,$121.41 ,$78.92 ,$69.81 ,$525.31 ,$103.20 ,$72.48 ,$250.15 ,$69.81 ,$250.15 ,$83.65 ,$103.20 ,$103.20 ,$103.20 ,$99.56 ,$82.56 ,$250.15 ,$250.15 ,$91.06 ,$86.20 ,$86.20 ,$250.15 ,$86.20 ,$100.77 ,$100.77 ,$100.77 , N/A ,$121.41 ,$103.20 ,$250.15 ,$121.41 ,$206.77 ,$117.16 ,$103.20 ,$525.31 ,$103.20 ,$109.27 ,$250.15 ,$100.77 , N/A , N/A ,$250.15 ,$78.92 
ST. JOSEPH'S HOSPITAL - BREESE,98180094,20610,PC DRAIN/INJECT LARGE JOINT/BURSA,981,1 ,$149.01 ,$96.86 ,$85.68 ,$525.31 ,$126.66 ,$88.96 ,$250.15 ,$85.68 ,$250.15 ,$102.67 ,$126.66 ,$126.66 ,$126.66 ,$122.19 ,$101.33 ,$250.15 ,$250.15 ,$111.76 ,$105.80 ,$105.80 ,$250.15 ,$105.80 ,$123.68 ,$123.68 ,$123.68 , N/A ,$149.01 ,$126.66 ,$250.15 ,$149.01 ,$206.77 ,$143.79 ,$126.66 ,$525.31 ,$126.66 ,$134.11 ,$250.15 ,$123.68 , N/A , N/A ,$250.15 ,$96.86 
ST. JOSEPH'S HOSPITAL - BREESE,98180506,20550,PC INJ SINGLE TENDON/LIGAMENT,981,1 ,$126.90 ,$82.49 ,$72.97 ,$525.31 ,$107.87 ,$75.76 ,$250.15 ,$72.97 ,$250.15 ,$87.43 ,$107.87 ,$107.87 ,$107.87 ,$104.06 ,$86.29 ,$250.15 ,$250.15 ,$95.18 ,$90.10 ,$90.10 ,$250.15 ,$90.10 ,$105.33 ,$105.33 ,$105.33 , N/A ,$126.90 ,$107.87 ,$250.15 ,$126.90 ,$206.77 ,$122.46 ,$107.87 ,$525.31 ,$107.87 ,$114.21 ,$250.15 ,$105.33 , N/A , N/A ,$250.15 ,$82.49 
ST. JOSEPH'S HOSPITAL - BREESE,98180507,20552,PC INJ TRIGGER PT 1-2 MUSCLE,981,1 ,$124.35 ,$80.83 ,$71.50 ,$525.31 ,$105.70 ,$74.24 ,$250.15 ,$71.50 ,$250.15 ,$85.68 ,$105.70 ,$105.70 ,$105.70 ,$101.97 ,$84.56 ,$250.15 ,$250.15 ,$93.26 ,$88.29 ,$88.29 ,$250.15 ,$88.29 ,$103.21 ,$103.21 ,$103.21 , N/A ,$124.35 ,$105.70 ,$250.15 ,$124.35 ,$206.77 ,$120.00 ,$105.70 ,$525.31 ,$105.70 ,$111.92 ,$250.15 ,$103.21 , N/A , N/A ,$250.15 ,$80.83 
ST. JOSEPH'S HOSPITAL - BREESE,98180508,20553,PC INJ TRIGGER PT 3+ MUSCLE,981,1 ,$139.11 ,$90.42 ,$79.99 ,$525.31 ,$118.24 ,$83.05 ,$250.15 ,$79.99 ,$250.15 ,$95.85 ,$118.24 ,$118.24 ,$118.24 ,$114.07 ,$94.59 ,$250.15 ,$250.15 ,$104.33 ,$98.77 ,$98.77 ,$250.15 ,$98.77 ,$115.46 ,$115.46 ,$115.46 , N/A ,$139.11 ,$118.24 ,$250.15 ,$139.11 ,$206.77 ,$134.24 ,$118.24 ,$525.31 ,$118.24 ,$125.20 ,$250.15 ,$115.46 , N/A , N/A ,$250.15 ,$90.42 
ST. JOSEPH'S HOSPITAL - BREESE,98180552,45330,PC SIGMOIDOSCOPY FLEXIBLE DIAG,981,1 ,$174.00 ,$113.10 ,$100.05 ,"$1,532.92 ",$147.90 ,$103.88 ,$729.96 ,$100.05 ,$729.96 ,$119.89 ,$147.90 ,$147.90 ,$147.90 ,$142.68 ,$118.32 ,$729.96 ,$729.96 ,$130.50 ,$123.54 ,$123.54 ,$729.96 ,$123.54 ,$144.42 ,$144.42 ,$144.42 , N/A ,$174.00 ,$147.90 ,$729.96 ,$174.00 ,$419.00 ,$167.91 ,$147.90 ,"$1,532.92 ",$147.90 ,$156.60 ,$729.96 ,$144.42 , N/A , N/A ,$729.96 ,$113.10 
ST. JOSEPH'S HOSPITAL - BREESE,98180592,64405,PC INJ ANES NERVE OCCIPITAL,981,1 ,$180.90 ,$117.59 ,$104.02 ,$525.31 ,$153.77 ,$108.00 ,$250.15 ,$104.02 ,$250.15 ,$124.64 ,$153.77 ,$153.77 ,$153.77 ,$148.34 ,$123.01 ,$250.15 ,$250.15 ,$135.68 ,$128.44 ,$128.44 ,$250.15 ,$128.44 ,$150.15 ,$150.15 ,$150.15 , N/A ,$180.90 ,$153.77 ,$250.15 ,$180.90 ,$280.92 ,$174.57 ,$153.77 ,$525.31 ,$153.77 ,$162.81 ,$250.15 ,$150.15 , N/A , N/A ,$250.15 ,$117.59 
ST. JOSEPH'S HOSPITAL - BREESE,98180621,20600,PC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-LT,981,1 ,$117.24 ,$76.21 ,$67.41 ,$525.31 ,$99.65 ,$69.99 ,$250.15 ,$67.41 ,$250.15 ,$80.78 ,$99.65 ,$99.65 ,$99.65 ,$96.14 ,$79.72 ,$250.15 ,$250.15 ,$87.93 ,$83.24 ,$83.24 ,$250.15 ,$83.24 ,$97.31 ,$97.31 ,$97.31 , N/A ,$117.24 ,$99.65 ,$250.15 ,$117.24 ,$206.77 ,$113.14 ,$99.65 ,$525.31 ,$99.65 ,$105.52 ,$250.15 ,$97.31 , N/A , N/A ,$250.15 ,$76.21 
ST. JOSEPH'S HOSPITAL - BREESE,98180622,20600,PC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-RT,981,1 ,$117.24 ,$76.21 ,$67.41 ,$525.31 ,$99.65 ,$69.99 ,$250.15 ,$67.41 ,$250.15 ,$80.78 ,$99.65 ,$99.65 ,$99.65 ,$96.14 ,$79.72 ,$250.15 ,$250.15 ,$87.93 ,$83.24 ,$83.24 ,$250.15 ,$83.24 ,$97.31 ,$97.31 ,$97.31 , N/A ,$117.24 ,$99.65 ,$250.15 ,$117.24 ,$206.77 ,$113.14 ,$99.65 ,$525.31 ,$99.65 ,$105.52 ,$250.15 ,$97.31 , N/A , N/A ,$250.15 ,$76.21 
ST. JOSEPH'S HOSPITAL - BREESE,98180623,20605,PC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-LT,981,1 ,$121.41 ,$78.92 ,$69.81 ,$525.31 ,$103.20 ,$72.48 ,$250.15 ,$69.81 ,$250.15 ,$83.65 ,$103.20 ,$103.20 ,$103.20 ,$99.56 ,$82.56 ,$250.15 ,$250.15 ,$91.06 ,$86.20 ,$86.20 ,$250.15 ,$86.20 ,$100.77 ,$100.77 ,$100.77 , N/A ,$121.41 ,$103.20 ,$250.15 ,$121.41 ,$206.77 ,$117.16 ,$103.20 ,$525.31 ,$103.20 ,$109.27 ,$250.15 ,$100.77 , N/A , N/A ,$250.15 ,$78.92 
ST. JOSEPH'S HOSPITAL - BREESE,98180624,20605,PC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-RT,981,1 ,$121.41 ,$78.92 ,$69.81 ,$525.31 ,$103.20 ,$72.48 ,$250.15 ,$69.81 ,$250.15 ,$83.65 ,$103.20 ,$103.20 ,$103.20 ,$99.56 ,$82.56 ,$250.15 ,$250.15 ,$91.06 ,$86.20 ,$86.20 ,$250.15 ,$86.20 ,$100.77 ,$100.77 ,$100.77 , N/A ,$121.41 ,$103.20 ,$250.15 ,$121.41 ,$206.77 ,$117.16 ,$103.20 ,$525.31 ,$103.20 ,$109.27 ,$250.15 ,$100.77 , N/A , N/A ,$250.15 ,$78.92 
ST. JOSEPH'S HOSPITAL - BREESE,98180625,20610,PC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,981,1 ,$149.01 ,$96.86 ,$85.68 ,$525.31 ,$126.66 ,$88.96 ,$250.15 ,$85.68 ,$250.15 ,$102.67 ,$126.66 ,$126.66 ,$126.66 ,$122.19 ,$101.33 ,$250.15 ,$250.15 ,$111.76 ,$105.80 ,$105.80 ,$250.15 ,$105.80 ,$123.68 ,$123.68 ,$123.68 , N/A ,$149.01 ,$126.66 ,$250.15 ,$149.01 ,$206.77 ,$143.79 ,$126.66 ,$525.31 ,$126.66 ,$134.11 ,$250.15 ,$123.68 , N/A , N/A ,$250.15 ,$96.86 
ST. JOSEPH'S HOSPITAL - BREESE,98180626,20610,PC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,981,1 ,$149.01 ,$96.86 ,$85.68 ,$525.31 ,$126.66 ,$88.96 ,$250.15 ,$85.68 ,$250.15 ,$102.67 ,$126.66 ,$126.66 ,$126.66 ,$122.19 ,$101.33 ,$250.15 ,$250.15 ,$111.76 ,$105.80 ,$105.80 ,$250.15 ,$105.80 ,$123.68 ,$123.68 ,$123.68 , N/A ,$149.01 ,$126.66 ,$250.15 ,$149.01 ,$206.77 ,$143.79 ,$126.66 ,$525.31 ,$126.66 ,$134.11 ,$250.15 ,$123.68 , N/A , N/A ,$250.15 ,$96.86 
ST. JOSEPH'S HOSPITAL - BREESE,98180665,64450,PC INJ ANES OTHER THAN PERIPHERAL-LT,981,1 ,$137.07 ,$89.10 ,$78.82 ,"$1,254.33 ",$116.51 ,$81.83 ,$597.30 ,$78.82 ,$597.30 ,$94.44 ,$116.51 ,$116.51 ,$116.51 ,$112.40 ,$93.21 ,$597.30 ,$597.30 ,$102.80 ,$97.32 ,$97.32 ,$597.30 ,$97.32 ,$113.77 ,$113.77 ,$113.77 , N/A ,$137.07 ,$116.51 ,$597.30 ,$137.07 ,$280.92 ,$132.27 ,$116.51 ,"$1,254.33 ",$116.51 ,$123.36 ,$597.30 ,$113.77 , N/A , N/A ,$597.30 ,$89.10 
ST. JOSEPH'S HOSPITAL - BREESE,98180666,64450,PC INJ ANES OTHER THAN PERIPHERAL-RT,981,1 ,$137.07 ,$89.10 ,$78.82 ,"$1,254.33 ",$116.51 ,$81.83 ,$597.30 ,$78.82 ,$597.30 ,$94.44 ,$116.51 ,$116.51 ,$116.51 ,$112.40 ,$93.21 ,$597.30 ,$597.30 ,$102.80 ,$97.32 ,$97.32 ,$597.30 ,$97.32 ,$113.77 ,$113.77 ,$113.77 , N/A ,$137.07 ,$116.51 ,$597.30 ,$137.07 ,$280.92 ,$132.27 ,$116.51 ,"$1,254.33 ",$116.51 ,$123.36 ,$597.30 ,$113.77 , N/A , N/A ,$597.30 ,$89.10 
ST. JOSEPH'S HOSPITAL - BREESE,98180871,62323,PC INJ INTRLAMNR LUM/SAC W/GUIDE,981,1 ,$316.59 ,$205.78 ,$182.04 ,"$1,254.33 ",$269.10 ,$189.00 ,$597.30 ,$182.04 ,$597.30 ,$218.13 ,$269.10 ,$269.10 ,$269.10 ,$259.60 ,$215.28 ,$597.30 ,$597.30 ,$237.44 ,$224.78 ,$224.78 ,$597.30 ,$224.78 ,$262.77 ,$262.77 ,$262.77 , N/A ,$316.59 ,$269.10 ,$597.30 ,$316.59 ,$280.92 ,$280.92 ,$269.10 ,"$1,254.33 ",$269.10 ,$284.93 ,$597.30 ,$262.77 , N/A , N/A ,$597.30 ,$205.78 
ST. JOSEPH'S HOSPITAL - BREESE,98180975,20551,PC INJECTION SINGLE TENDON ORIGIN/INSERTION,981,1 ,$138.12 ,$89.78 ,$79.42 ,$525.31 ,$117.40 ,$82.46 ,$250.15 ,$79.42 ,$250.15 ,$95.16 ,$117.40 ,$117.40 ,$117.40 ,$113.26 ,$93.92 ,$250.15 ,$250.15 ,$103.59 ,$98.07 ,$98.07 ,$250.15 ,$98.07 ,$114.64 ,$114.64 ,$114.64 , N/A ,$138.12 ,$117.40 ,$250.15 ,$138.12 ,$206.77 ,$133.29 ,$117.40 ,$525.31 ,$117.40 ,$124.31 ,$250.15 ,$114.64 , N/A , N/A ,$250.15 ,$89.78 
ST. JOSEPH'S HOSPITAL - BREESE,98180976,20606,PC ARTHROCENTESIS ASPIR AND /INJ INTERM JT/BURS W/US,981,1 ,$169.71 ,$110.31 ,$97.58 ,"$1,254.33 ",$144.25 ,$101.32 ,$597.30 ,$97.58 ,$597.30 ,$116.93 ,$144.25 ,$144.25 ,$144.25 ,$139.16 ,$115.40 ,$597.30 ,$597.30 ,$127.28 ,$120.49 ,$120.49 ,$597.30 ,$120.49 ,$140.86 ,$140.86 ,$140.86 , N/A ,$169.71 ,$144.25 ,$597.30 ,$169.71 ,$206.77 ,$163.77 ,$144.25 ,"$1,254.33 ",$144.25 ,$152.74 ,$597.30 ,$140.86 , N/A , N/A ,$597.30 ,$110.31 
ST. JOSEPH'S HOSPITAL - BREESE,98180977,20611,PC ARTHROCENTESIS ASPIR AND /INJ MAJOR JT/BURSA W/US,981,1 ,$193.35 ,$125.68 ,$111.18 ,$525.31 ,$164.35 ,$115.43 ,$250.15 ,$111.18 ,$250.15 ,$133.22 ,$164.35 ,$164.35 ,$164.35 ,$158.55 ,$131.48 ,$250.15 ,$250.15 ,$145.01 ,$137.28 ,$137.28 ,$250.15 ,$137.28 ,$160.48 ,$160.48 ,$160.48 , N/A ,$193.35 ,$164.35 ,$250.15 ,$193.35 ,$206.77 ,$186.58 ,$164.35 ,$525.31 ,$164.35 ,$174.02 ,$250.15 ,$160.48 , N/A , N/A ,$250.15 ,$125.68 
ST. JOSEPH'S HOSPITAL - BREESE,98200001,99201,PC CLINIC VISIT BRIEF NEW PRO,982,1 ,$83.31 ,$54.15 ,$47.90 ,$89.80 ,$70.81 ,$49.74 , N/A ,$47.90 , N/A ,$57.40 ,$70.81 ,$70.81 ,$70.81 , N/A ,$56.65 , N/A , N/A ,$62.48 ,$59.15 ,$59.15 , N/A ,$59.15 ,$69.15 ,$69.15 ,$69.15 , N/A , N/A ,$70.81 , N/A ,$49.40 ,$89.80 ,$80.39 ,$70.81 , N/A ,$70.81 ,$74.98 , N/A ,$69.15 , N/A , N/A , N/A ,$54.15 
ST. JOSEPH'S HOSPITAL - BREESE,98200002,99202,PC CLINIC VISIT LIMITED NEW PRO,982,1 ,$158.46 ,$103.00 ,$82.03 ,$158.46 ,$134.69 ,$94.60 , N/A ,$91.11 , N/A ,$109.18 ,$134.69 ,$134.69 ,$134.69 , N/A ,$107.75 , N/A , N/A ,$118.85 ,$112.51 ,$112.51 , N/A ,$112.51 ,$131.52 ,$131.52 ,$131.52 , N/A , N/A ,$134.69 , N/A ,$82.03 ,$89.80 ,$89.80 ,$134.69 , N/A ,$134.69 ,$142.61 , N/A ,$131.52 , N/A , N/A , N/A ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,98200003,99203,PC CLINIC VISIT INTERM NEW PRO,982,1 ,$236.91 ,$153.99 ,$89.80 ,$236.91 ,$201.37 ,$141.44 , N/A ,$136.22 , N/A ,$163.23 ,$201.37 ,$201.37 ,$201.37 , N/A ,$161.10 , N/A , N/A ,$177.68 ,$168.21 ,$168.21 , N/A ,$168.21 ,$196.64 ,$196.64 ,$196.64 , N/A , N/A ,$201.37 , N/A ,$116.11 ,$89.80 ,$89.80 ,$201.37 , N/A ,$201.37 ,$213.22 , N/A ,$196.64 , N/A , N/A , N/A ,$153.99 
ST. JOSEPH'S HOSPITAL - BREESE,98200004,99204,PC CLINIC VISIT COMPLEX NEW PRO,982,1 ,$405.00 ,$263.25 ,$89.80 ,$405.00 ,$344.25 ,$241.79 , N/A ,$232.88 , N/A ,$279.05 ,$344.25 ,$344.25 ,$344.25 , N/A ,$275.40 , N/A , N/A ,$303.75 ,$287.55 ,$287.55 , N/A ,$287.55 ,$336.15 ,$336.15 ,$336.15 , N/A , N/A ,$344.25 , N/A ,$177.80 ,$89.80 ,$89.80 ,$344.25 , N/A ,$344.25 ,$364.50 , N/A ,$336.15 , N/A , N/A , N/A ,$263.25 
ST. JOSEPH'S HOSPITAL - BREESE,98200005,99205,PC CLINIC VISIT COMPREH NEW PRO,982,1 ,$528.30 ,$343.40 ,$89.80 ,$528.30 ,$449.06 ,$315.40 , N/A ,$303.77 , N/A ,$364.00 ,$449.06 ,$449.06 ,$449.06 , N/A ,$359.24 , N/A , N/A ,$396.23 ,$375.09 ,$375.09 , N/A ,$375.09 ,$438.49 ,$438.49 ,$438.49 , N/A , N/A ,$449.06 , N/A ,$224.61 ,$89.80 ,$89.80 ,$449.06 , N/A ,$449.06 ,$475.47 , N/A ,$438.49 , N/A , N/A , N/A ,$343.40 
ST. JOSEPH'S HOSPITAL - BREESE,98200006,99211,PC CLINIC VISIT BRIEF EST PRO,982,1 ,$28.35 ,$18.43 ,$16.30 ,$89.80 ,$24.10 ,$16.93 , N/A ,$16.30 , N/A ,$19.53 ,$24.10 ,$24.10 ,$24.10 , N/A ,$19.28 , N/A , N/A ,$21.26 ,$20.13 ,$20.13 , N/A ,$20.13 ,$23.53 ,$23.53 ,$23.53 , N/A , N/A ,$24.10 , N/A ,$28.35 ,$89.80 ,$27.36 ,$24.10 , N/A ,$24.10 ,$25.52 , N/A ,$23.53 , N/A , N/A , N/A ,$18.43 
ST. JOSEPH'S HOSPITAL - BREESE,98200007,99212,PC CLINIC VISIT LIMIT EST PRO,982,1 ,$81.27 ,$52.83 ,$46.73 ,$89.80 ,$69.08 ,$48.52 , N/A ,$46.73 , N/A ,$56.00 ,$69.08 ,$69.08 ,$69.08 , N/A ,$55.26 , N/A , N/A ,$60.95 ,$57.70 ,$57.70 , N/A ,$57.70 ,$67.45 ,$67.45 ,$67.45 , N/A , N/A ,$69.08 , N/A ,$49.03 ,$89.80 ,$78.43 ,$69.08 , N/A ,$69.08 ,$73.14 , N/A ,$67.45 , N/A , N/A , N/A ,$52.83 
ST. JOSEPH'S HOSPITAL - BREESE,98200008,99213,PC CLINIC VISIT INTERM EST PRO,982,1 ,$157.17 ,$102.16 ,$80.55 ,$157.17 ,$133.59 ,$93.83 , N/A ,$90.37 , N/A ,$108.29 ,$133.59 ,$133.59 ,$133.59 , N/A ,$106.88 , N/A , N/A ,$117.88 ,$111.59 ,$111.59 , N/A ,$111.59 ,$130.45 ,$130.45 ,$130.45 , N/A , N/A ,$133.59 , N/A ,$80.55 ,$89.80 ,$89.80 ,$133.59 , N/A ,$133.59 ,$141.45 , N/A ,$130.45 , N/A , N/A , N/A ,$102.16 
ST. JOSEPH'S HOSPITAL - BREESE,98200009,99214,PC CLINIC VISIT COMPLX EST PRO,982,1 ,$244.83 ,$159.14 ,$89.80 ,$244.83 ,$208.11 ,$146.16 , N/A ,$140.78 , N/A ,$168.69 ,$208.11 ,$208.11 ,$208.11 , N/A ,$166.48 , N/A , N/A ,$183.62 ,$173.83 ,$173.83 , N/A ,$173.83 ,$203.21 ,$203.21 ,$203.21 , N/A , N/A ,$208.11 , N/A ,$244.83 ,$89.80 ,$89.80 ,$208.11 , N/A ,$208.11 ,$220.35 , N/A ,$203.21 , N/A , N/A , N/A ,$159.14 
ST. JOSEPH'S HOSPITAL - BREESE,98200010,99215,PC CLINIC VISIT COMPRH EST PRO,982,1 ,$345.33 ,$224.46 ,$89.80 ,$345.33 ,$293.53 ,$206.16 , N/A ,$198.56 , N/A ,$237.93 ,$293.53 ,$293.53 ,$293.53 , N/A ,$234.82 , N/A , N/A ,$259.00 ,$245.18 ,$245.18 , N/A ,$245.18 ,$286.62 ,$286.62 ,$286.62 , N/A , N/A ,$293.53 , N/A ,$345.33 ,$89.80 ,$89.80 ,$293.53 , N/A ,$293.53 ,$310.80 , N/A ,$286.62 , N/A , N/A , N/A ,$224.46 
ST. JOSEPH'S HOSPITAL - BREESE,98200028,22512,PC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL,982,1 ,$675.18 ,$438.87 ,$388.23 ,"$3,132.02 ",$573.90 ,$403.08 , N/A ,$388.23 , N/A ,$465.20 ,$573.90 ,$573.90 ,$573.90 ,$553.65 ,$459.12 , N/A , N/A ,$506.39 ,$479.38 ,$479.38 , N/A ,$479.38 ,$560.40 ,$560.40 ,$560.40 , N/A , N/A ,$573.90 , N/A ,$675.18 ,"$3,132.02 ",$651.55 ,$573.90 , N/A ,$573.90 ,$607.66 , N/A ,$560.40 , N/A , N/A , N/A ,$438.87 
ST. JOSEPH'S HOSPITAL - BREESE,98200029,22513,PC VERTEBROPLASTY INJ PERC THOR KYPHOPLASTY,982,1 ,"$1,683.99 ","$1,094.59 ",$968.29 ,"$12,004.34 ","$1,431.39 ","$1,005.34 ","$5,716.35 ",$968.29 ,"$5,716.35 ","$1,160.27 ","$1,431.39 ","$1,431.39 ","$1,431.39 ","$1,380.87 ","$1,145.11 ","$5,716.35 ","$5,716.35 ","$1,262.99 ","$1,195.63 ","$1,195.63 ","$5,716.35 ","$1,195.63 ","$1,397.71 ","$1,397.71 ","$1,397.71 ", N/A ,"$1,683.99 ","$1,431.39 ","$5,716.35 ","$1,683.99 ","$7,951.94 ","$1,625.05 ","$1,431.39 ","$12,004.34 ","$1,431.39 ","$1,515.59 ","$5,716.35 ","$1,397.71 ", N/A , N/A ,"$5,716.35 ","$1,094.59 "
ST. JOSEPH'S HOSPITAL - BREESE,98200030,22514,PC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,982,1 ,"$1,569.96 ","$1,020.47 ",$902.73 ,"$12,004.34 ","$1,334.47 ",$937.27 ,"$5,716.35 ",$902.73 ,"$5,716.35 ","$1,081.70 ","$1,334.47 ","$1,334.47 ","$1,334.47 ","$1,287.37 ","$1,067.57 ","$5,716.35 ","$5,716.35 ","$1,177.47 ","$1,114.67 ","$1,114.67 ","$5,716.35 ","$1,114.67 ","$1,303.07 ","$1,303.07 ","$1,303.07 ", N/A ,"$1,569.96 ","$1,334.47 ","$5,716.35 ","$1,569.96 ","$7,951.94 ","$1,515.01 ","$1,334.47 ","$12,004.34 ","$1,334.47 ","$1,412.96 ","$5,716.35 ","$1,303.07 ", N/A , N/A ,"$5,716.35 ","$1,020.47 "
ST. JOSEPH'S HOSPITAL - BREESE,98200031,22515,PC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,982,1 ,$735.03 ,$477.77 ,$422.64 ,"$7,951.94 ",$624.78 ,$438.81 , N/A ,$422.64 , N/A ,$506.44 ,$624.78 ,$624.78 ,$624.78 ,$602.72 ,$499.82 , N/A , N/A ,$551.27 ,$521.87 ,$521.87 , N/A ,$521.87 ,$610.07 ,$610.07 ,$610.07 , N/A , N/A ,$624.78 , N/A ,$735.03 ,"$7,951.94 ",$709.30 ,$624.78 , N/A ,$624.78 ,$661.53 , N/A ,$610.07 , N/A , N/A , N/A ,$477.77 
ST. JOSEPH'S HOSPITAL - BREESE,98200032,63650,PC IMPLANT NEUROELECTRODES,982,1 ,"$1,320.09 ",$858.06 ,$759.05 ,"$12,416.08 ","$1,122.08 ",$788.09 ,"$5,912.42 ",$759.05 ,"$5,912.42 ",$909.54 ,"$1,122.08 ","$1,122.08 ","$1,122.08 ","$1,082.47 ",$897.66 ,"$5,912.42 ","$5,912.42 ",$990.07 ,$937.26 ,$937.26 ,"$5,912.42 ",$937.26 ,"$1,095.67 ","$1,095.67 ","$1,095.67 ", N/A ,"$1,320.09 ","$1,122.08 ","$5,912.42 ","$1,320.09 ","$3,132.02 ","$1,273.89 ","$1,122.08 ","$12,416.08 ","$1,122.08 ","$1,188.08 ","$5,912.42 ","$1,095.67 ", N/A , N/A ,"$5,912.42 ",$858.06 
ST. JOSEPH'S HOSPITAL - BREESE,98200033,64479,PC INJ EPIDURAL CREV/THOR SGL-BI,982,1 ,$415.35 ,$269.98 ,$238.83 ,"$1,629.59 ",$353.05 ,$247.96 ,$776.00 ,$238.83 ,$776.00 ,$286.18 ,$353.05 ,$353.05 ,$353.05 ,$340.59 ,$282.44 ,$776.00 ,$776.00 ,$311.51 ,$294.90 ,$294.90 ,$776.00 ,$294.90 ,$344.74 ,$344.74 ,$344.74 , N/A ,$415.35 ,$353.05 ,$776.00 ,$415.35 ,$509.48 ,$400.81 ,$353.05 ,"$1,629.59 ",$353.05 ,$373.82 ,$776.00 ,$344.74 , N/A , N/A ,$776.00 ,$269.98 
ST. JOSEPH'S HOSPITAL - BREESE,98200034,64479,PC INJ EPIDURAL CREV/THOR SGL-LT,982,1 ,$415.35 ,$269.98 ,$238.83 ,"$1,629.59 ",$353.05 ,$247.96 ,$776.00 ,$238.83 ,$776.00 ,$286.18 ,$353.05 ,$353.05 ,$353.05 ,$340.59 ,$282.44 ,$776.00 ,$776.00 ,$311.51 ,$294.90 ,$294.90 ,$776.00 ,$294.90 ,$344.74 ,$344.74 ,$344.74 , N/A ,$415.35 ,$353.05 ,$776.00 ,$415.35 ,$509.48 ,$400.81 ,$353.05 ,"$1,629.59 ",$353.05 ,$373.82 ,$776.00 ,$344.74 , N/A , N/A ,$776.00 ,$269.98 
ST. JOSEPH'S HOSPITAL - BREESE,98200035,64479,PC INJ EPIDURAL CREV/THOR SGL-RT,982,1 ,$415.35 ,$269.98 ,$238.83 ,"$1,629.59 ",$353.05 ,$247.96 ,$776.00 ,$238.83 ,$776.00 ,$286.18 ,$353.05 ,$353.05 ,$353.05 ,$340.59 ,$282.44 ,$776.00 ,$776.00 ,$311.51 ,$294.90 ,$294.90 ,$776.00 ,$294.90 ,$344.74 ,$344.74 ,$344.74 , N/A ,$415.35 ,$353.05 ,$776.00 ,$415.35 ,$509.48 ,$400.81 ,$353.05 ,"$1,629.59 ",$353.05 ,$373.82 ,$776.00 ,$344.74 , N/A , N/A ,$776.00 ,$269.98 
ST. JOSEPH'S HOSPITAL - BREESE,98200036,64480,PC INJ TRANSF CERV/THORACIC ADDL-LT,982,1 ,$200.22 ,$130.14 ,$115.13 ,$509.48 ,$170.19 ,$119.53 , N/A ,$115.13 , N/A ,$137.95 ,$170.19 ,$170.19 ,$170.19 ,$164.18 ,$136.15 , N/A , N/A ,$150.17 ,$142.16 ,$142.16 , N/A ,$142.16 ,$166.18 ,$166.18 ,$166.18 , N/A , N/A ,$170.19 , N/A ,$200.22 ,$509.48 ,$193.21 ,$170.19 , N/A ,$170.19 ,$180.20 , N/A ,$166.18 , N/A , N/A , N/A ,$130.14 
ST. JOSEPH'S HOSPITAL - BREESE,98200037,64480,PC INJ TRANSF CERV/THORACIC ADDL-RT,982,1 ,$200.22 ,$130.14 ,$115.13 ,$509.48 ,$170.19 ,$119.53 , N/A ,$115.13 , N/A ,$137.95 ,$170.19 ,$170.19 ,$170.19 ,$164.18 ,$136.15 , N/A , N/A ,$150.17 ,$142.16 ,$142.16 , N/A ,$142.16 ,$166.18 ,$166.18 ,$166.18 , N/A , N/A ,$170.19 , N/A ,$200.22 ,$509.48 ,$193.21 ,$170.19 , N/A ,$170.19 ,$180.20 , N/A ,$166.18 , N/A , N/A , N/A ,$130.14 
ST. JOSEPH'S HOSPITAL - BREESE,98200038,64483,PC INJ EPID LUMBAR/SACRAL SGL-BI,982,1 ,$352.74 ,$229.28 ,$202.83 ,"$1,629.59 ",$299.83 ,$210.59 ,$776.00 ,$202.83 ,$776.00 ,$243.04 ,$299.83 ,$299.83 ,$299.83 ,$289.25 ,$239.86 ,$776.00 ,$776.00 ,$264.56 ,$250.45 ,$250.45 ,$776.00 ,$250.45 ,$292.77 ,$292.77 ,$292.77 , N/A ,$352.74 ,$299.83 ,$776.00 ,$352.74 ,$509.48 ,$340.39 ,$299.83 ,"$1,629.59 ",$299.83 ,$317.47 ,$776.00 ,$292.77 , N/A , N/A ,$776.00 ,$229.28 
ST. JOSEPH'S HOSPITAL - BREESE,98200039,64483,PC INJ EPID LUMBAR/SACRAL SGL-LT,982,1 ,$352.74 ,$229.28 ,$202.83 ,"$1,629.59 ",$299.83 ,$210.59 ,$776.00 ,$202.83 ,$776.00 ,$243.04 ,$299.83 ,$299.83 ,$299.83 ,$289.25 ,$239.86 ,$776.00 ,$776.00 ,$264.56 ,$250.45 ,$250.45 ,$776.00 ,$250.45 ,$292.77 ,$292.77 ,$292.77 , N/A ,$352.74 ,$299.83 ,$776.00 ,$352.74 ,$509.48 ,$340.39 ,$299.83 ,"$1,629.59 ",$299.83 ,$317.47 ,$776.00 ,$292.77 , N/A , N/A ,$776.00 ,$229.28 
ST. JOSEPH'S HOSPITAL - BREESE,98200040,64483,PC INJ EPID LUMBAR/SACRAL SGL-RT,982,1 ,$352.74 ,$229.28 ,$202.83 ,"$1,629.59 ",$299.83 ,$210.59 ,$776.00 ,$202.83 ,$776.00 ,$243.04 ,$299.83 ,$299.83 ,$299.83 ,$289.25 ,$239.86 ,$776.00 ,$776.00 ,$264.56 ,$250.45 ,$250.45 ,$776.00 ,$250.45 ,$292.77 ,$292.77 ,$292.77 , N/A ,$352.74 ,$299.83 ,$776.00 ,$352.74 ,$509.48 ,$340.39 ,$299.83 ,"$1,629.59 ",$299.83 ,$317.47 ,$776.00 ,$292.77 , N/A , N/A ,$776.00 ,$229.28 
ST. JOSEPH'S HOSPITAL - BREESE,98200041,64484,PC INJ EPID LUMBAR/SACRAL ADDL-LT,982,1 ,$165.99 ,$107.89 ,$95.44 ,$509.48 ,$141.09 ,$99.10 , N/A ,$95.44 , N/A ,$114.37 ,$141.09 ,$141.09 ,$141.09 ,$136.11 ,$112.87 , N/A , N/A ,$124.49 ,$117.85 ,$117.85 , N/A ,$117.85 ,$137.77 ,$137.77 ,$137.77 , N/A , N/A ,$141.09 , N/A ,$165.99 ,$509.48 ,$160.18 ,$141.09 , N/A ,$141.09 ,$149.39 , N/A ,$137.77 , N/A , N/A , N/A ,$107.89 
ST. JOSEPH'S HOSPITAL - BREESE,98200042,64484,PC INJ EPID LUMBAR/SACRAL ADDL-RT,982,1 ,$165.99 ,$107.89 ,$95.44 ,$509.48 ,$141.09 ,$99.10 , N/A ,$95.44 , N/A ,$114.37 ,$141.09 ,$141.09 ,$141.09 ,$136.11 ,$112.87 , N/A , N/A ,$124.49 ,$117.85 ,$117.85 , N/A ,$117.85 ,$137.77 ,$137.77 ,$137.77 , N/A , N/A ,$141.09 , N/A ,$165.99 ,$509.48 ,$160.18 ,$141.09 , N/A ,$141.09 ,$149.39 , N/A ,$137.77 , N/A , N/A , N/A ,$107.89 
ST. JOSEPH'S HOSPITAL - BREESE,98200043,64490,PC INJ PARAVERT F JNT C/T 1 LV-BI,982,1 ,$335.01 ,$217.76 ,$192.63 ,"$1,629.59 ",$284.76 ,$200.00 ,$776.00 ,$192.63 ,$776.00 ,$230.82 ,$284.76 ,$284.76 ,$284.76 ,$274.71 ,$227.81 ,$776.00 ,$776.00 ,$251.26 ,$237.86 ,$237.86 ,$776.00 ,$237.86 ,$278.06 ,$278.06 ,$278.06 , N/A ,$335.01 ,$284.76 ,$776.00 ,$335.01 ,$509.48 ,$323.28 ,$284.76 ,"$1,629.59 ",$284.76 ,$301.51 ,$776.00 ,$278.06 , N/A , N/A ,$776.00 ,$217.76 
ST. JOSEPH'S HOSPITAL - BREESE,98200044,64490,PC INJ PARAVERT F JNT C/T 1 LV-RT,982,1 ,$335.01 ,$217.76 ,$192.63 ,"$1,629.59 ",$284.76 ,$200.00 ,$776.00 ,$192.63 ,$776.00 ,$230.82 ,$284.76 ,$284.76 ,$284.76 ,$274.71 ,$227.81 ,$776.00 ,$776.00 ,$251.26 ,$237.86 ,$237.86 ,$776.00 ,$237.86 ,$278.06 ,$278.06 ,$278.06 , N/A ,$335.01 ,$284.76 ,$776.00 ,$335.01 ,$509.48 ,$323.28 ,$284.76 ,"$1,629.59 ",$284.76 ,$301.51 ,$776.00 ,$278.06 , N/A , N/A ,$776.00 ,$217.76 
ST. JOSEPH'S HOSPITAL - BREESE,98200045,64490,PC INJ PARAVERT F JNT C/T 1 LV-LT,982,1 ,$335.01 ,$217.76 ,$192.63 ,"$1,629.59 ",$284.76 ,$200.00 ,$776.00 ,$192.63 ,$776.00 ,$230.82 ,$284.76 ,$284.76 ,$284.76 ,$274.71 ,$227.81 ,$776.00 ,$776.00 ,$251.26 ,$237.86 ,$237.86 ,$776.00 ,$237.86 ,$278.06 ,$278.06 ,$278.06 , N/A ,$335.01 ,$284.76 ,$776.00 ,$335.01 ,$509.48 ,$323.28 ,$284.76 ,"$1,629.59 ",$284.76 ,$301.51 ,$776.00 ,$278.06 , N/A , N/A ,$776.00 ,$217.76 
ST. JOSEPH'S HOSPITAL - BREESE,98200046,64491,PC INJ PARAVERT F JNT C/T 2 LV-LT,982,1 ,$192.00 ,$124.80 ,$110.40 ,$509.48 ,$163.20 ,$114.62 , N/A ,$110.40 , N/A ,$132.29 ,$163.20 ,$163.20 ,$163.20 ,$157.44 ,$130.56 , N/A , N/A ,$144.00 ,$136.32 ,$136.32 , N/A ,$136.32 ,$159.36 ,$159.36 ,$159.36 , N/A , N/A ,$163.20 , N/A ,$192.00 ,$509.48 ,$185.28 ,$163.20 , N/A ,$163.20 ,$172.80 , N/A ,$159.36 , N/A , N/A , N/A ,$124.80 
ST. JOSEPH'S HOSPITAL - BREESE,98200047,64491,PC INJ PARAVERT F JNT C/T 2 LV-RT,982,1 ,$192.00 ,$124.80 ,$110.40 ,$509.48 ,$163.20 ,$114.62 , N/A ,$110.40 , N/A ,$132.29 ,$163.20 ,$163.20 ,$163.20 ,$157.44 ,$130.56 , N/A , N/A ,$144.00 ,$136.32 ,$136.32 , N/A ,$136.32 ,$159.36 ,$159.36 ,$159.36 , N/A , N/A ,$163.20 , N/A ,$192.00 ,$509.48 ,$185.28 ,$163.20 , N/A ,$163.20 ,$172.80 , N/A ,$159.36 , N/A , N/A , N/A ,$124.80 
ST. JOSEPH'S HOSPITAL - BREESE,98200048,64492,PC INJ PARAVERT F JNT C/T 3 LV-LT,982,1 ,$194.04 ,$126.13 ,$111.57 ,$509.48 ,$164.93 ,$115.84 , N/A ,$111.57 , N/A ,$133.69 ,$164.93 ,$164.93 ,$164.93 ,$159.11 ,$131.95 , N/A , N/A ,$145.53 ,$137.77 ,$137.77 , N/A ,$137.77 ,$161.05 ,$161.05 ,$161.05 , N/A , N/A ,$164.93 , N/A ,$194.04 ,$509.48 ,$187.25 ,$164.93 , N/A ,$164.93 ,$174.64 , N/A ,$161.05 , N/A , N/A , N/A ,$126.13 
ST. JOSEPH'S HOSPITAL - BREESE,98200049,64492,PC INJ PARAVERT F JNT C/T 3 LV-RT,982,1 ,$194.04 ,$126.13 ,$111.57 ,$509.48 ,$164.93 ,$115.84 , N/A ,$111.57 , N/A ,$133.69 ,$164.93 ,$164.93 ,$164.93 ,$159.11 ,$131.95 , N/A , N/A ,$145.53 ,$137.77 ,$137.77 , N/A ,$137.77 ,$161.05 ,$161.05 ,$161.05 , N/A , N/A ,$164.93 , N/A ,$194.04 ,$509.48 ,$187.25 ,$164.93 , N/A ,$164.93 ,$174.64 , N/A ,$161.05 , N/A , N/A , N/A ,$126.13 
ST. JOSEPH'S HOSPITAL - BREESE,98200050,64493,PC INJ PARAVERT F JNT L/S 1 LV-BI,982,1 ,$282.24 ,$183.46 ,$162.29 ,"$1,629.59 ",$239.90 ,$168.50 ,$776.00 ,$162.29 ,$776.00 ,$194.46 ,$239.90 ,$239.90 ,$239.90 ,$231.44 ,$191.92 ,$776.00 ,$776.00 ,$211.68 ,$200.39 ,$200.39 ,$776.00 ,$200.39 ,$234.26 ,$234.26 ,$234.26 , N/A ,$282.24 ,$239.90 ,$776.00 ,$282.24 ,$509.48 ,$272.36 ,$239.90 ,"$1,629.59 ",$239.90 ,$254.02 ,$776.00 ,$234.26 , N/A , N/A ,$776.00 ,$183.46 
ST. JOSEPH'S HOSPITAL - BREESE,98200051,64493,PC INJ PARAVERT F JNT L/S 1 LV-LT,982,1 ,$282.24 ,$183.46 ,$162.29 ,"$1,629.59 ",$239.90 ,$168.50 ,$776.00 ,$162.29 ,$776.00 ,$194.46 ,$239.90 ,$239.90 ,$239.90 ,$231.44 ,$191.92 ,$776.00 ,$776.00 ,$211.68 ,$200.39 ,$200.39 ,$776.00 ,$200.39 ,$234.26 ,$234.26 ,$234.26 , N/A ,$282.24 ,$239.90 ,$776.00 ,$282.24 ,$509.48 ,$272.36 ,$239.90 ,"$1,629.59 ",$239.90 ,$254.02 ,$776.00 ,$234.26 , N/A , N/A ,$776.00 ,$183.46 
ST. JOSEPH'S HOSPITAL - BREESE,98200052,64493,PC INJ PARAVERT F JNT L/S 1 LV-RT,982,1 ,$282.24 ,$183.46 ,$162.29 ,"$1,629.59 ",$239.90 ,$168.50 ,$776.00 ,$162.29 ,$776.00 ,$194.46 ,$239.90 ,$239.90 ,$239.90 ,$231.44 ,$191.92 ,$776.00 ,$776.00 ,$211.68 ,$200.39 ,$200.39 ,$776.00 ,$200.39 ,$234.26 ,$234.26 ,$234.26 , N/A ,$282.24 ,$239.90 ,$776.00 ,$282.24 ,$509.48 ,$272.36 ,$239.90 ,"$1,629.59 ",$239.90 ,$254.02 ,$776.00 ,$234.26 , N/A , N/A ,$776.00 ,$183.46 
ST. JOSEPH'S HOSPITAL - BREESE,98200053,64494,PC INJ PARAVERT F JNT L/S 2 LV-LT,982,1 ,$164.97 ,$107.23 ,$94.86 ,$509.48 ,$140.22 ,$98.49 , N/A ,$94.86 , N/A ,$113.66 ,$140.22 ,$140.22 ,$140.22 ,$135.28 ,$112.18 , N/A , N/A ,$123.73 ,$117.13 ,$117.13 , N/A ,$117.13 ,$136.93 ,$136.93 ,$136.93 , N/A , N/A ,$140.22 , N/A ,$164.97 ,$509.48 ,$159.20 ,$140.22 , N/A ,$140.22 ,$148.47 , N/A ,$136.93 , N/A , N/A , N/A ,$107.23 
ST. JOSEPH'S HOSPITAL - BREESE,98200054,64494,PC INJ PARAVERT F JNT L/S 2 LV-RT,982,1 ,$164.97 ,$107.23 ,$94.86 ,$509.48 ,$140.22 ,$98.49 , N/A ,$94.86 , N/A ,$113.66 ,$140.22 ,$140.22 ,$140.22 ,$135.28 ,$112.18 , N/A , N/A ,$123.73 ,$117.13 ,$117.13 , N/A ,$117.13 ,$136.93 ,$136.93 ,$136.93 , N/A , N/A ,$140.22 , N/A ,$164.97 ,$509.48 ,$159.20 ,$140.22 , N/A ,$140.22 ,$148.47 , N/A ,$136.93 , N/A , N/A , N/A ,$107.23 
ST. JOSEPH'S HOSPITAL - BREESE,98200055,64495,PC INJ PARAVRT F JNT L/S 3+ LV-LT,982,1 ,$167.00 ,$108.55 ,$96.03 ,$509.48 ,$141.95 ,$99.70 , N/A ,$96.03 , N/A ,$115.06 ,$141.95 ,$141.95 ,$141.95 ,$136.94 ,$113.56 , N/A , N/A ,$125.25 ,$118.57 ,$118.57 , N/A ,$118.57 ,$138.61 ,$138.61 ,$138.61 , N/A , N/A ,$141.95 , N/A ,$167.00 ,$509.48 ,$161.16 ,$141.95 , N/A ,$141.95 ,$150.30 , N/A ,$138.61 , N/A , N/A , N/A ,$108.55 
ST. JOSEPH'S HOSPITAL - BREESE,98200056,64495,PC INJ PARAVRT F JNT L/S 3+ LV-RT,982,1 ,$167.00 ,$108.55 ,$96.03 ,$509.48 ,$141.95 ,$99.70 , N/A ,$96.03 , N/A ,$115.06 ,$141.95 ,$141.95 ,$141.95 ,$136.94 ,$113.56 , N/A , N/A ,$125.25 ,$118.57 ,$118.57 , N/A ,$118.57 ,$138.61 ,$138.61 ,$138.61 , N/A , N/A ,$141.95 , N/A ,$167.00 ,$509.48 ,$161.16 ,$141.95 , N/A ,$141.95 ,$150.30 , N/A ,$138.61 , N/A , N/A , N/A ,$108.55 
ST. JOSEPH'S HOSPITAL - BREESE,98200057,64633,PC DESTROY NERVE CERVICAL/THORACIC SGL-BIL,982,1 ,$710.64 ,$461.92 ,$408.62 ,"$3,450.32 ",$604.04 ,$424.25 ,"$1,643.01 ",$408.62 ,"$1,643.01 ",$489.63 ,$604.04 ,$604.04 ,$604.04 ,$582.72 ,$483.24 ,"$1,643.01 ","$1,643.01 ",$532.98 ,$504.55 ,$504.55 ,"$1,643.01 ",$504.55 ,$589.83 ,$589.83 ,$589.83 , N/A ,$710.64 ,$604.04 ,"$1,643.01 ",$710.64 ,$509.48 ,$509.48 ,$604.04 ,"$3,450.32 ",$604.04 ,$639.58 ,"$1,643.01 ",$589.83 , N/A , N/A ,"$1,643.01 ",$461.92 
ST. JOSEPH'S HOSPITAL - BREESE,98200058,64633,PC DESTROY NERVE CERVICAL/THORACIC SGL-LT,982,1 ,$710.64 ,$461.92 ,$408.62 ,"$3,450.32 ",$604.04 ,$424.25 ,"$1,643.01 ",$408.62 ,"$1,643.01 ",$489.63 ,$604.04 ,$604.04 ,$604.04 ,$582.72 ,$483.24 ,"$1,643.01 ","$1,643.01 ",$532.98 ,$504.55 ,$504.55 ,"$1,643.01 ",$504.55 ,$589.83 ,$589.83 ,$589.83 , N/A ,$710.64 ,$604.04 ,"$1,643.01 ",$710.64 ,$509.48 ,$509.48 ,$604.04 ,"$3,450.32 ",$604.04 ,$639.58 ,"$1,643.01 ",$589.83 , N/A , N/A ,"$1,643.01 ",$461.92 
ST. JOSEPH'S HOSPITAL - BREESE,98200059,64633,PC DESTROY NERVE CERVICAL/THORACIC SGL-RT,982,1 ,$710.64 ,$461.92 ,$408.62 ,"$3,450.32 ",$604.04 ,$424.25 ,"$1,643.01 ",$408.62 ,"$1,643.01 ",$489.63 ,$604.04 ,$604.04 ,$604.04 ,$582.72 ,$483.24 ,"$1,643.01 ","$1,643.01 ",$532.98 ,$504.55 ,$504.55 ,"$1,643.01 ",$504.55 ,$589.83 ,$589.83 ,$589.83 , N/A ,$710.64 ,$604.04 ,"$1,643.01 ",$710.64 ,$509.48 ,$509.48 ,$604.04 ,"$3,450.32 ",$604.04 ,$639.58 ,"$1,643.01 ",$589.83 , N/A , N/A ,"$1,643.01 ",$461.92 
ST. JOSEPH'S HOSPITAL - BREESE,98200060,64634,PC DESTROY NERVE CERVICAL/THORACIC EA ADDL-BIL,982,1 ,$217.17 ,$141.16 ,$124.87 ,$509.48 ,$184.59 ,$129.65 , N/A ,$124.87 , N/A ,$149.63 ,$184.59 ,$184.59 ,$184.59 ,$178.08 ,$147.68 , N/A , N/A ,$162.88 ,$154.19 ,$154.19 , N/A ,$154.19 ,$180.25 ,$180.25 ,$180.25 , N/A , N/A ,$184.59 , N/A ,$217.17 ,$509.48 ,$209.57 ,$184.59 , N/A ,$184.59 ,$195.45 , N/A ,$180.25 , N/A , N/A , N/A ,$141.16 
ST. JOSEPH'S HOSPITAL - BREESE,98200061,64634,PC DESTROY NERVE CERVICAL/THORACIC EA ADDL-LT,982,1 ,$217.17 ,$141.16 ,$124.87 ,$509.48 ,$184.59 ,$129.65 , N/A ,$124.87 , N/A ,$149.63 ,$184.59 ,$184.59 ,$184.59 ,$178.08 ,$147.68 , N/A , N/A ,$162.88 ,$154.19 ,$154.19 , N/A ,$154.19 ,$180.25 ,$180.25 ,$180.25 , N/A , N/A ,$184.59 , N/A ,$217.17 ,$509.48 ,$209.57 ,$184.59 , N/A ,$184.59 ,$195.45 , N/A ,$180.25 , N/A , N/A , N/A ,$141.16 
ST. JOSEPH'S HOSPITAL - BREESE,98200062,64634,PC DESTROY NERVE CERVICAL/THORACIC EA ADDL-RT,982,1 ,$217.17 ,$141.16 ,$124.87 ,$509.48 ,$184.59 ,$129.65 , N/A ,$124.87 , N/A ,$149.63 ,$184.59 ,$184.59 ,$184.59 ,$178.08 ,$147.68 , N/A , N/A ,$162.88 ,$154.19 ,$154.19 , N/A ,$154.19 ,$180.25 ,$180.25 ,$180.25 , N/A , N/A ,$184.59 , N/A ,$217.17 ,$509.48 ,$209.57 ,$184.59 , N/A ,$184.59 ,$195.45 , N/A ,$180.25 , N/A , N/A , N/A ,$141.16 
ST. JOSEPH'S HOSPITAL - BREESE,98200063,64635,PC DESTROY NERVE LUMBAR/SACRAL SGL-BIL,982,1 ,$699.45 ,$454.64 ,$402.18 ,"$3,450.32 ",$594.53 ,$417.57 ,"$1,643.01 ",$402.18 ,"$1,643.01 ",$481.92 ,$594.53 ,$594.53 ,$594.53 ,$573.55 ,$475.63 ,"$1,643.01 ","$1,643.01 ",$524.59 ,$496.61 ,$496.61 ,"$1,643.01 ",$496.61 ,$580.54 ,$580.54 ,$580.54 , N/A ,$699.45 ,$594.53 ,"$1,643.01 ",$699.45 ,$509.48 ,$509.48 ,$594.53 ,"$3,450.32 ",$594.53 ,$629.51 ,"$1,643.01 ",$580.54 , N/A , N/A ,"$1,643.01 ",$454.64 
ST. JOSEPH'S HOSPITAL - BREESE,98200064,64635,PC DESTROY NERVE LUMBAR/SACRAL SGL-LT,982,1 ,$699.45 ,$454.64 ,$402.18 ,"$3,450.32 ",$594.53 ,$417.57 ,"$1,643.01 ",$402.18 ,"$1,643.01 ",$481.92 ,$594.53 ,$594.53 ,$594.53 ,$573.55 ,$475.63 ,"$1,643.01 ","$1,643.01 ",$524.59 ,$496.61 ,$496.61 ,"$1,643.01 ",$496.61 ,$580.54 ,$580.54 ,$580.54 , N/A ,$699.45 ,$594.53 ,"$1,643.01 ",$699.45 ,$509.48 ,$509.48 ,$594.53 ,"$3,450.32 ",$594.53 ,$629.51 ,"$1,643.01 ",$580.54 , N/A , N/A ,"$1,643.01 ",$454.64 
ST. JOSEPH'S HOSPITAL - BREESE,98200065,64635,PC DESTROY NERVE LUMBAR/SACRAL SGL-RT,982,1 ,$699.45 ,$454.64 ,$402.18 ,"$3,450.32 ",$594.53 ,$417.57 ,"$1,643.01 ",$402.18 ,"$1,643.01 ",$481.92 ,$594.53 ,$594.53 ,$594.53 ,$573.55 ,$475.63 ,"$1,643.01 ","$1,643.01 ",$524.59 ,$496.61 ,$496.61 ,"$1,643.01 ",$496.61 ,$580.54 ,$580.54 ,$580.54 , N/A ,$699.45 ,$594.53 ,"$1,643.01 ",$699.45 ,$509.48 ,$509.48 ,$594.53 ,"$3,450.32 ",$594.53 ,$629.51 ,"$1,643.01 ",$580.54 , N/A , N/A ,"$1,643.01 ",$454.64 
ST. JOSEPH'S HOSPITAL - BREESE,98200066,64636,PC DESTROY NERVE LUMBAR/SACRAL EA ADDL-BIL,982,1 ,$190.98 ,$124.14 ,$109.81 ,$509.48 ,$162.33 ,$114.02 , N/A ,$109.81 , N/A ,$131.59 ,$162.33 ,$162.33 ,$162.33 ,$156.60 ,$129.87 , N/A , N/A ,$143.24 ,$135.60 ,$135.60 , N/A ,$135.60 ,$158.51 ,$158.51 ,$158.51 , N/A , N/A ,$162.33 , N/A ,$190.98 ,$509.48 ,$184.30 ,$162.33 , N/A ,$162.33 ,$171.88 , N/A ,$158.51 , N/A , N/A , N/A ,$124.14 
ST. JOSEPH'S HOSPITAL - BREESE,98200067,64636,PC DESTROY NERVE LUMBAR/SACRAL EA ADDL-LT,982,1 ,$190.98 ,$124.14 ,$109.81 ,$509.48 ,$162.33 ,$114.02 , N/A ,$109.81 , N/A ,$131.59 ,$162.33 ,$162.33 ,$162.33 ,$156.60 ,$129.87 , N/A , N/A ,$143.24 ,$135.60 ,$135.60 , N/A ,$135.60 ,$158.51 ,$158.51 ,$158.51 , N/A , N/A ,$162.33 , N/A ,$190.98 ,$509.48 ,$184.30 ,$162.33 , N/A ,$162.33 ,$171.88 , N/A ,$158.51 , N/A , N/A , N/A ,$124.14 
ST. JOSEPH'S HOSPITAL - BREESE,98200068,64636,PC DESTROY NERVE LUMBAR/SACRAL EA ADDL-RT,982,1 ,$190.98 ,$124.14 ,$109.81 ,$509.48 ,$162.33 ,$114.02 , N/A ,$109.81 , N/A ,$131.59 ,$162.33 ,$162.33 ,$162.33 ,$156.60 ,$129.87 , N/A , N/A ,$143.24 ,$135.60 ,$135.60 , N/A ,$135.60 ,$158.51 ,$158.51 ,$158.51 , N/A , N/A ,$162.33 , N/A ,$190.98 ,$509.48 ,$184.30 ,$162.33 , N/A ,$162.33 ,$171.88 , N/A ,$158.51 , N/A , N/A , N/A ,$124.14 
ST. JOSEPH'S HOSPITAL - BREESE,98200069,64640,PC DESTROY NERVE PERIPHERAL-BIL,982,1 ,$370.50 ,$240.83 ,$213.04 ,"$1,629.59 ",$314.93 ,$221.19 ,$776.00 ,$213.04 ,$776.00 ,$255.27 ,$314.93 ,$314.93 ,$314.93 ,$303.81 ,$251.94 ,$776.00 ,$776.00 ,$277.88 ,$263.06 ,$263.06 ,$776.00 ,$263.06 ,$307.52 ,$307.52 ,$307.52 , N/A ,$370.50 ,$314.93 ,$776.00 ,$370.50 ,$509.48 ,$357.53 ,$314.93 ,"$1,629.59 ",$314.93 ,$333.45 ,$776.00 ,$307.52 , N/A , N/A ,$776.00 ,$240.83 
ST. JOSEPH'S HOSPITAL - BREESE,98200070,64640,PC DESTROY NERVE PERIPHERAL-LT,982,1 ,$370.50 ,$240.83 ,$213.04 ,"$1,629.59 ",$314.93 ,$221.19 ,$776.00 ,$213.04 ,$776.00 ,$255.27 ,$314.93 ,$314.93 ,$314.93 ,$303.81 ,$251.94 ,$776.00 ,$776.00 ,$277.88 ,$263.06 ,$263.06 ,$776.00 ,$263.06 ,$307.52 ,$307.52 ,$307.52 , N/A ,$370.50 ,$314.93 ,$776.00 ,$370.50 ,$509.48 ,$357.53 ,$314.93 ,"$1,629.59 ",$314.93 ,$333.45 ,$776.00 ,$307.52 , N/A , N/A ,$776.00 ,$240.83 
ST. JOSEPH'S HOSPITAL - BREESE,98200071,64640,PC DESTROY NERVE PERIPHERAL-RT,982,1 ,$370.50 ,$240.83 ,$213.04 ,"$1,629.59 ",$314.93 ,$221.19 ,$776.00 ,$213.04 ,$776.00 ,$255.27 ,$314.93 ,$314.93 ,$314.93 ,$303.81 ,$251.94 ,$776.00 ,$776.00 ,$277.88 ,$263.06 ,$263.06 ,$776.00 ,$263.06 ,$307.52 ,$307.52 ,$307.52 , N/A ,$370.50 ,$314.93 ,$776.00 ,$370.50 ,$509.48 ,$357.53 ,$314.93 ,"$1,629.59 ",$314.93 ,$333.45 ,$776.00 ,$307.52 , N/A , N/A ,$776.00 ,$240.83 
ST. JOSEPH'S HOSPITAL - BREESE,98500000,93010,PC EKG INTER AND REPORT PRO,985,1 ,$51.00 ,$33.15 ,$16.45 ,$51.00 ,$43.35 ,$30.45 , N/A ,$29.33 , N/A ,$35.14 ,$43.35 ,$43.35 ,$43.35 ,$41.82 ,$34.68 , N/A , N/A ,$38.25 ,$36.21 ,$36.21 , N/A ,$36.21 ,$42.33 ,$42.33 ,$42.33 , N/A , N/A ,$43.35 , N/A ,$51.00 ,$16.45 ,$16.45 ,$43.35 , N/A ,$43.35 ,$45.90 , N/A ,$42.33 , N/A , N/A , N/A ,$33.15 
ST. JOSEPH'S HOSPITAL - BREESE,98880000,99251,PC INPATIENT CONSULTATION 1 LIMITED 20MIN,988,1 ,$86.00 ,$55.90 ,$49.45 ,$86.00 ,$73.10 ,$51.34 , N/A ,$49.45 , N/A ,$59.25 ,$73.10 ,$73.10 ,$73.10 , N/A ,$58.48 , N/A , N/A ,$64.50 ,$61.06 ,$61.06 , N/A ,$61.06 ,$71.38 ,$71.38 ,$71.38 , N/A , N/A ,$73.10 , N/A ,$86.00 , N/A , N/A ,$73.10 , N/A ,$73.10 ,$77.40 , N/A ,$71.38 , N/A , N/A , N/A ,$55.90 
ST. JOSEPH'S HOSPITAL - BREESE,98880001,99252,PC INPATIENT CONSULTATION 2 LOW 40MIN,988,1 ,$152.00 ,$98.80 ,$87.40 ,$152.00 ,$129.20 ,$90.74 , N/A ,$87.40 , N/A ,$104.73 ,$129.20 ,$129.20 ,$129.20 , N/A ,$103.36 , N/A , N/A ,$114.00 ,$107.92 ,$107.92 , N/A ,$107.92 ,$126.16 ,$126.16 ,$126.16 , N/A , N/A ,$129.20 , N/A ,$152.00 , N/A , N/A ,$129.20 , N/A ,$129.20 ,$136.80 , N/A ,$126.16 , N/A , N/A , N/A ,$98.80 
ST. JOSEPH'S HOSPITAL - BREESE,98880002,99253,PC INPATIENT CONSULTATION 3 MOD 55MIN,988,1 ,$204.00 ,$132.60 ,$117.30 ,$204.00 ,$173.40 ,$121.79 , N/A ,$117.30 , N/A ,$140.56 ,$173.40 ,$173.40 ,$173.40 , N/A ,$138.72 , N/A , N/A ,$153.00 ,$144.84 ,$144.84 , N/A ,$144.84 ,$169.32 ,$169.32 ,$169.32 , N/A , N/A ,$173.40 , N/A ,$204.00 , N/A , N/A ,$173.40 , N/A ,$173.40 ,$183.60 , N/A ,$169.32 , N/A , N/A , N/A ,$132.60 
ST. JOSEPH'S HOSPITAL - BREESE,98880003,99254,PC INPATIENT CONSULTATION 4 MOD-HIGH 80MIN,988,1 ,$298.00 ,$193.70 ,$171.35 ,$298.00 ,$253.30 ,$177.91 , N/A ,$171.35 , N/A ,$205.32 ,$253.30 ,$253.30 ,$253.30 , N/A ,$202.64 , N/A , N/A ,$223.50 ,$211.58 ,$211.58 , N/A ,$211.58 ,$247.34 ,$247.34 ,$247.34 , N/A , N/A ,$253.30 , N/A ,$298.00 , N/A , N/A ,$253.30 , N/A ,$253.30 ,$268.20 , N/A ,$247.34 , N/A , N/A , N/A ,$193.70 
ST. JOSEPH'S HOSPITAL - BREESE,98880004,99255,PC INPATIENT CONSULTATION 5 HIGH 110MIN,988,1 ,$345.00 ,$224.25 ,$198.38 ,$345.00 ,$293.25 ,$205.97 , N/A ,$198.38 , N/A ,$237.71 ,$293.25 ,$293.25 ,$293.25 , N/A ,$234.60 , N/A , N/A ,$258.75 ,$244.95 ,$244.95 , N/A ,$244.95 ,$286.35 ,$286.35 ,$286.35 , N/A , N/A ,$293.25 , N/A ,$345.00 , N/A , N/A ,$293.25 , N/A ,$293.25 ,$310.50 , N/A ,$286.35 , N/A , N/A , N/A ,$224.25