ST. FRANCIS HOSPITAL - 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 ," 6 DEGREES HEALTH, INC ", AETNA , AETNA HSHS , AETNA MEDICARE , AMISH COMMUNITY DISCOUNT , BC EXCHANGE , BC MEDICARE , BCBS OF ILLINOIS PPO , BLUE CROSS BLUE SHEILD OF ILLINOIS DUAL , BLUE CROSS BLUE SHIELD  IL HMO , BLUE CROSS BLUE SHIELD IPA IL , BLUE CROSS BLUE SHIELD OF ILLINOIS MEDICARE ADV , BLUE CROSS SIHCA , CELTIC INSURANCE COMPANY , CIGNA , CLAIM DOC , CLEAR SPRING HEALTH MEDICARE ADV , CONSOCIATE GROUP , CURRENT HEALTH SOLUTIONS ," 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 , HEALTHSCOPE , HFN , HOPETRUST , HUMANA , HUMANA MEDICARE , ILLINOIS BREAST AND CERVICAL CANCER PROGRAM , LIVE360 HSHS HEALTHY PLAN , LIVE360 MEDICARE COST PLAN , LIVE360 NON HSHS HEALTHY PLAN , MERIDIAN HMO MCD , MOLINA MEDICAID , MOLINA MEDICARE , MULTIPLAN , PHYSICIANS HEALTH ASSOCIATION OF IL BCBS HMO , PLAIN CHURCH MEDICAL GROUP , PROVIDER NETWORK OF AMERICA , ST CLAIR COUNTY HOUSING AUTHORITY , UHC CATERPILLAR , UNITED HEALTH ALL PAYOR , UNITED HEALTH CARE MEDICARE , WELLFIRST 
ST. FRANCIS HOSPITAL - ACUTE,N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$39,336.51 ","$2,402.55 ","$80,625.38 ","$80,625.38 ","$43,572.74 ","$32,921.63 ","$36,031.76 ","$16,944.96 ","$49,428.30 ","$36,031.76 ","$56,803.20 ","$36,031.76 ","$56,803.20 ","$56,803.20 ","$36,031.76 ","$56,803.20 ","$68,460.34 ","$50,834.87 ", Inpatient Medicare +250% ,"$36,031.76 ","$51,440.05 ","$45,388.28 ","$36,031.76 ","$45,388.28 ","$45,388.28 ","$45,388.28 ","$36,031.76 ","$45,388.28 ",$984.00 ,$984.00 ,$984.00 ,"$60,517.70 ","$54,465.93 ","$80,625.38 ","$60,517.70 ","$36,031.76 ", N/A ,"$32,921.63 ","$36,031.76 ","$25,175.36 ","$2,516.95 ","$2,402.55 ","$37,833.35 ","$51,440.05 ","$56,803.20 ","$16,944.96 ","$54,465.93 ",$984.00 ,"$48,414.16 ","$48,414.16 ","$36,031.76 ","$39,336.51 "
ST. FRANCIS HOSPITAL - ACUTE,N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$9,948.71 ","$2,324.00 ","$15,305.70 ","$10,750.05 ","$11,020.10 ","$8,326.30 ","$4,902.28 ","$4,285.60 ","$3,295.22 ","$4,902.28 ","$3,786.88 ","$4,902.28 ","$3,786.88 ","$3,786.88 ","$4,902.28 ","$3,786.88 ","$9,314.33 ","$12,856.79 ", Inpatient Medicare +250% ,"$4,902.28 ","$13,009.85 ","$11,479.28 ","$4,902.28 ","$11,479.28 ","$2,324.00 ","$2,324.00 ","$4,902.28 ","$2,324.00 ",$984.00 ,$984.00 ,$984.00 ,"$15,305.70 ","$13,775.13 ","$10,750.05 ","$15,305.70 ","$4,902.28 ", N/A ,"$8,326.30 ","$4,902.28 ","$6,367.17 ","$2,516.95 ","$2,402.55 ","$5,147.39 ","$13,009.85 ","$3,786.88 ","$4,285.60 ","$13,775.13 ",$984.00 ,"$12,244.56 ","$12,244.56 ","$4,902.28 ","$9,948.71 "
ST. FRANCIS HOSPITAL - ACUTE,N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$7,445.85 ","$2,324.00 ","$11,455.16 ","$10,750.05 ","$8,247.72 ","$6,231.61 ","$4,902.28 ","$3,207.44 ","$3,295.22 ","$4,902.28 ","$3,786.88 ","$4,902.28 ","$3,786.88 ","$3,786.88 ","$4,902.28 ","$3,786.88 ","$9,314.33 ","$9,622.33 ", Inpatient Medicare +250% ,"$4,902.28 ","$9,736.89 ","$8,591.37 ","$4,902.28 ","$8,591.37 ","$2,324.00 ","$2,324.00 ","$4,902.28 ","$2,324.00 ",$984.00 ,$984.00 ,$984.00 ,"$11,455.16 ","$10,309.64 ","$10,750.05 ","$11,455.16 ","$4,902.28 ", N/A ,"$6,231.61 ","$4,902.28 ","$4,765.35 ","$2,516.95 ","$2,402.55 ","$5,147.39 ","$9,736.89 ","$3,786.88 ","$3,207.44 ","$10,309.64 ",$984.00 ,"$9,164.13 ","$9,164.13 ","$4,902.28 ","$7,445.85 "
ST. FRANCIS HOSPITAL - ACUTE,N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$15,401.47 ","$2,402.55 ","$23,694.57 ","$16,125.08 ","$17,060.09 ","$12,889.85 ","$7,206.35 ","$6,634.48 ","$4,942.83 ","$7,206.35 ","$5,680.32 ","$7,206.35 ","$5,680.32 ","$5,680.32 ","$7,206.35 ","$5,680.32 ","$13,692.07 ","$19,903.44 ", Inpatient Medicare +250% ,"$7,206.35 ","$20,140.38 ","$17,770.93 ","$7,206.35 ","$17,770.93 ","$3,486.00 ","$3,486.00 ","$7,206.35 ","$3,486.00 ",$984.00 ,$984.00 ,$984.00 ,"$23,694.57 ","$21,325.11 ","$16,125.08 ","$23,694.57 ","$7,206.35 ", N/A ,"$12,889.85 ","$7,206.35 ","$9,856.94 ","$2,516.95 ","$2,402.55 ","$7,566.67 ","$20,140.38 ","$5,680.32 ","$6,634.48 ","$21,325.11 ",$984.00 ,"$18,955.66 ","$18,955.66 ","$7,206.35 ","$15,401.47 "
ST. FRANCIS HOSPITAL - ACUTE,N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$4,438.60 ","$1,912.01 ","$10,750.05 ","$10,750.05 ","$4,916.60 ","$3,714.76 ","$4,902.28 ","$1,912.01 ","$3,295.22 ","$4,902.28 ","$3,786.88 ","$4,902.28 ","$3,786.88 ","$3,786.88 ","$4,902.28 ","$3,786.88 ","$9,314.33 ","$5,736.03 ", Inpatient Medicare +250% ,"$4,902.28 ","$5,804.32 ","$5,121.46 ","$4,902.28 ","$5,121.46 ","$2,324.00 ","$2,324.00 ","$4,902.28 ","$2,324.00 ",$984.00 ,$984.00 ,$984.00 ,"$6,828.61 ","$6,145.75 ","$10,750.05 ","$6,828.61 ","$4,902.28 ", N/A ,"$3,714.76 ","$4,902.28 ","$2,840.70 ","$2,516.95 ","$2,402.55 ","$5,147.39 ","$5,804.32 ","$3,786.88 ","$1,912.01 ","$6,145.75 ",$984.00 ,"$5,462.89 ","$5,462.89 ","$4,902.28 ","$4,438.60 "
ST. FRANCIS HOSPITAL - ACUTE,12000001,N/A,HC DAILY SERVICE GENERAL,120,1 ,"$1,188.00 ",$772.20 ,$332.64 ,"$1,188.00 ", Inpatient Medicare +150% ,$855.36 ,$646.27 ,"$2,451.14 ",$332.64 ,"$1,647.61 ","$2,451.14 ","$1,893.44 ","$2,451.14 ","$1,893.44 ","$1,893.44 ","$2,451.14 ","$1,893.44 ", Inpatient Medicare +90% ,$997.92 , Inpatient Medicare +250% ,"$2,451.14 ","$1,009.80 ",$891.00 ,"$2,451.14 ",$891.00 ,"$1,162.00 ","$1,162.00 ","$2,451.14 ","$1,162.00 ",$984.00 ,$984.00 ,$984.00 ,"$1,188.00 ","$1,069.20 ", Inpatient Medicare +150% ,"$1,188.00 ","$2,451.14 ", N/A ,$646.27 ,"$2,451.14 ",$494.21 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,009.80 ","$1,893.44 ",$332.64 ,"$1,069.20 ",$984.00 ,$950.40 ,$950.40 ,"$2,451.14 ",$772.20 
ST. FRANCIS HOSPITAL - ACUTE,12000002,N/A,HC DAILY SERVICE SWING BED,120,1 ,$369.00 ,$239.85 ,$103.32 ,$369.00 , Inpatient Medicare +150% ,$265.68 ,$200.74 ,"$2,451.14 ",$103.32 ,"$1,647.61 ","$2,451.14 ","$1,893.44 ","$2,451.14 ","$1,893.44 ","$1,893.44 ","$2,451.14 ","$1,893.44 ", Inpatient Medicare +90% ,$309.96 , Inpatient Medicare +250% ,"$2,451.14 ",$313.65 ,$276.75 ,"$2,451.14 ",$276.75 ,"$1,162.00 ","$1,162.00 ","$2,451.14 ","$1,162.00 ",$984.00 ,$984.00 ,$984.00 ,$369.00 ,$332.10 , Inpatient Medicare +150% ,$369.00 ,"$2,451.14 ", N/A ,$200.74 ,"$2,451.14 ",$153.50 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,$313.65 ,"$1,893.44 ",$103.32 ,$332.10 ,$984.00 ,$295.20 ,$295.20 ,"$2,451.14 ",$239.85 
ST. FRANCIS HOSPITAL - ACUTE,12000006,N/A,HC DAILY SERVICE W/TELEMETRY,120,1 ,"$1,622.00 ","$1,054.30 ",$454.16 ,"$1,622.00 ", Inpatient Medicare +150% ,"$1,167.84 ",$882.37 ,"$2,451.14 ",$454.16 ,"$1,647.61 ","$2,451.14 ","$1,893.44 ","$2,451.14 ","$1,893.44 ","$1,893.44 ","$2,451.14 ","$1,893.44 ", Inpatient Medicare +90% ,"$1,362.48 ", Inpatient Medicare +250% ,"$2,451.14 ","$1,378.70 ","$1,216.50 ","$2,451.14 ","$1,216.50 ","$1,162.00 ","$1,162.00 ","$2,451.14 ","$1,162.00 ",$984.00 ,$984.00 ,$984.00 ,"$1,622.00 ","$1,459.80 ", Inpatient Medicare +150% ,"$1,622.00 ","$2,451.14 ", N/A ,$882.37 ,"$2,451.14 ",$674.75 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,378.70 ","$1,893.44 ",$454.16 ,"$1,459.80 ",$984.00 ,"$1,297.60 ","$1,297.60 ","$2,451.14 ","$1,054.30 "
ST. FRANCIS HOSPITAL - ACUTE,12200001,N/A,HC DAILY SERVICE OBSTETRICS,122,1 ,"$1,188.00 ",$772.20 ,$332.64 ,"$1,188.00 ", Inpatient Medicare +150% ,$855.36 ,$646.27 ,"$2,451.14 ",$332.64 ,"$1,647.61 ","$2,451.14 ","$1,893.44 ","$2,451.14 ","$1,893.44 ","$1,893.44 ","$2,451.14 ","$1,893.44 ", Inpatient Medicare +90% ,$997.92 , Inpatient Medicare +250% ,"$2,451.14 ","$1,009.80 ",$891.00 ,"$2,451.14 ",$891.00 ,"$1,162.00 ","$1,162.00 ","$2,451.14 ","$1,162.00 ",$984.00 ,$984.00 ,$984.00 ,"$1,188.00 ","$1,069.20 ", Inpatient Medicare +150% ,"$1,188.00 ","$2,451.14 ", N/A ,$646.27 ,"$2,451.14 ",$494.21 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,009.80 ","$1,893.44 ",$332.64 ,"$1,069.20 ",$984.00 ,$950.40 ,$950.40 ,"$2,451.14 ",$772.20 
ST. FRANCIS HOSPITAL - ACUTE,12500001,N/A,HC DAILY HOSPICE ACUTE CARE,125,1 ,$900.00 ,$585.00 ,$252.00 ,$900.00 , Inpatient Medicare +150% ,$648.00 ,$489.60 ,"$2,451.14 ",$252.00 ,"$1,647.61 ","$2,451.14 ","$1,893.44 ","$2,451.14 ","$1,893.44 ","$1,893.44 ","$2,451.14 ","$1,893.44 ", Inpatient Medicare +90% ,$756.00 , Inpatient Medicare +250% ,"$2,451.14 ",$765.00 ,$675.00 ,"$2,451.14 ",$675.00 ,"$1,162.00 ","$1,162.00 ","$2,451.14 ","$1,162.00 ",$984.00 ,$984.00 ,$984.00 ,$900.00 ,$810.00 , Inpatient Medicare +150% ,$900.00 ,"$2,451.14 ", N/A ,$489.60 ,"$2,451.14 ",$374.40 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,$765.00 ,"$1,893.44 ",$252.00 ,$810.00 ,$984.00 ,$720.00 ,$720.00 ,"$2,451.14 ",$585.00 
ST. FRANCIS HOSPITAL - ACUTE,17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,$583.00 ,$378.95 ,$163.24 ,$583.00 , Inpatient Medicare +150% ,$419.76 ,$317.15 ,"$2,451.14 ",$163.24 ,"$1,647.61 ","$2,451.14 ","$1,893.44 ","$2,451.14 ","$1,893.44 ","$1,893.44 ","$2,451.14 ","$1,893.44 ", Inpatient Medicare +90% ,$489.72 , Inpatient Medicare +250% ,"$2,451.14 ",$495.55 ,$437.25 ,"$2,451.14 ",$437.25 , N/A , N/A ,"$2,451.14 ", N/A ,$290.00 ,$290.00 ,$290.00 ,$583.00 ,$524.70 , Inpatient Medicare +150% ,$583.00 ,"$2,451.14 ", N/A ,$317.15 ,"$2,451.14 ",$242.53 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,$495.55 ,"$1,893.44 ",$163.24 ,$524.70 ,$290.00 ,$466.40 ,$466.40 ,"$2,451.14 ",$378.95 
ST. FRANCIS HOSPITAL - ACUTE,20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$2,493.00 ","$1,620.45 ",$698.04 ,"$2,493.00 ", Inpatient Medicare +150% ,"$1,794.96 ","$1,356.19 ","$2,451.14 ",$698.04 ,"$1,647.61 ","$2,451.14 ","$1,893.44 ","$2,451.14 ","$1,893.44 ","$1,893.44 ","$2,451.14 ","$1,893.44 ", Inpatient Medicare +90% ,"$2,094.12 ", Inpatient Medicare +250% ,"$2,451.14 ","$2,119.05 ","$1,869.75 ","$2,451.14 ","$1,869.75 ","$1,162.00 ","$1,162.00 ","$2,451.14 ","$1,162.00 ","$1,910.00 ","$1,910.00 ","$1,910.00 ","$2,493.00 ","$2,243.70 ", Inpatient Medicare +150% ,"$2,493.00 ","$2,451.14 ", N/A ,"$1,356.19 ","$2,451.14 ","$1,037.09 ", Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$2,119.05 ","$1,893.44 ",$698.04 ,"$2,243.70 ","$1,910.00 ","$1,994.40 ","$1,994.40 ","$2,451.14 ","$1,620.45 "
ST. FRANCIS HOSPITAL - ACUTE,23100003,N/A,HC ADVANCED NURSING CARE,231,1 ,$260.00 ,$169.00 ,$57.20 ,$260.00 ,$149.50 ,$187.20 ,$141.44 ,$57.20 ,$72.80 ,$145.86 ,$57.20 ,$169.52 ,$65.00 ,$169.52 ,$169.52 ,$65.00 ,$169.52 ,$108.68 ,$218.40 , N/A ,$57.20 ,$221.00 ,$218.40 ,$57.20 ,$195.00 ,$208.00 ,$208.00 ,$57.20 ,$208.00 ,$218.40 ,$218.40 ,$218.40 ,$260.00 ,$234.00 ,$149.50 ,$260.00 ,$57.20 ,$260.00 ,$141.44 ,$57.20 ,$108.16 , N/A , N/A ,$60.06 ,$221.00 ,$169.52 ,$72.80 ,$234.00 ,$218.40 ,$208.00 ,$208.00 ,$57.20 ,$169.00 
ST. FRANCIS HOSPITAL - ACUTE,26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$429.00 ,$278.85 ,$94.38 ,$522.33 ,$246.68 ,$308.88 ,$233.38 ,$94.38 ,$120.12 ,$252.25 ,$94.38 ,$294.72 ,$107.25 ,$294.72 ,$294.72 ,$107.25 ,$294.72 ,$179.32 ,$360.36 ,$522.33 ,$94.38 ,$364.65 ,$360.36 ,$94.38 ,$321.75 ,$343.20 ,$343.20 ,$94.38 ,$343.20 ,$360.36 ,$360.36 ,$360.36 ,$429.00 ,$386.10 ,$246.68 ,$429.00 ,$94.38 ,$429.00 ,$233.38 ,$94.38 ,$178.46 ,$330.08 ,$315.07 ,$99.10 ,$364.65 ,$294.72 ,$120.12 ,$386.10 ,$360.36 ,$343.20 ,$343.20 ,$94.38 ,$278.85 
ST. FRANCIS HOSPITAL - ACUTE,26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$283.00 ,$183.95 ,$62.26 ,$516.01 ,$162.73 ,$203.76 ,$153.95 ,$62.26 ,$79.24 ,$166.40 ,$62.26 ,$194.42 ,$70.75 ,$194.42 ,$194.42 ,$70.75 ,$194.42 ,$118.29 ,$237.72 ,$102.18 ,$62.26 ,$240.55 ,$237.72 ,$62.26 ,$212.25 ,$226.40 ,$226.40 ,$62.26 ,$226.40 ,$237.72 ,$237.72 ,$237.72 ,$283.00 ,$254.70 ,$162.73 ,$283.00 ,$62.26 ,$283.00 ,$153.95 ,$62.26 ,$117.73 ,$516.01 ,$492.56 ,$65.37 ,$240.55 ,$194.42 ,$79.24 ,$254.70 ,$237.72 ,$226.40 ,$226.40 ,$62.26 ,$183.95 
ST. FRANCIS HOSPITAL - ACUTE,26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$429.00 ,$278.85 ,$94.38 ,$522.33 ,$246.68 ,$308.88 ,$233.38 ,$94.38 ,$120.12 ,$252.25 ,$94.38 ,$294.72 ,$107.25 ,$294.72 ,$294.72 ,$107.25 ,$294.72 ,$179.32 ,$360.36 ,$522.33 ,$94.38 ,$364.65 ,$360.36 ,$94.38 ,$321.75 ,$343.20 ,$343.20 ,$94.38 ,$343.20 ,$360.36 ,$360.36 ,$360.36 ,$429.00 ,$386.10 ,$246.68 ,$429.00 ,$94.38 ,$429.00 ,$233.38 ,$94.38 ,$178.46 ,$330.08 ,$315.07 ,$99.10 ,$364.65 ,$294.72 ,$120.12 ,$386.10 ,$360.36 ,$343.20 ,$343.20 ,$94.38 ,$278.85 
ST. FRANCIS HOSPITAL - ACUTE,26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$283.00 ,$183.95 ,$62.26 ,$516.01 ,$162.73 ,$203.76 ,$153.95 ,$62.26 ,$79.24 ,$166.40 ,$62.26 ,$194.42 ,$70.75 ,$194.42 ,$194.42 ,$70.75 ,$194.42 ,$118.29 ,$237.72 ,$102.18 ,$62.26 ,$240.55 ,$237.72 ,$62.26 ,$212.25 ,$226.40 ,$226.40 ,$62.26 ,$226.40 ,$237.72 ,$237.72 ,$237.72 ,$283.00 ,$254.70 ,$162.73 ,$283.00 ,$62.26 ,$283.00 ,$153.95 ,$62.26 ,$117.73 ,$516.01 ,$492.56 ,$65.37 ,$240.55 ,$194.42 ,$79.24 ,$254.70 ,$237.72 ,$226.40 ,$226.40 ,$62.26 ,$183.95 
ST. FRANCIS HOSPITAL - ACUTE,26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$283.00 ,$183.95 ,$62.26 ,$330.08 ,$162.73 ,$203.76 ,$153.95 ,$62.26 ,$79.24 ,$166.40 ,$62.26 ,$194.42 ,$70.75 ,$194.42 ,$194.42 ,$70.75 ,$194.42 ,$118.29 ,$237.72 ,$158.30 ,$62.26 ,$240.55 ,$237.72 ,$62.26 ,$212.25 ,$226.40 ,$226.40 ,$62.26 ,$226.40 ,$237.72 ,$237.72 ,$237.72 ,$283.00 ,$254.70 ,$162.73 ,$283.00 ,$62.26 ,$283.00 ,$153.95 ,$62.26 ,$117.73 ,$330.08 ,$315.07 ,$65.37 ,$240.55 ,$194.42 ,$79.24 ,$254.70 ,$237.72 ,$226.40 ,$226.40 ,$62.26 ,$183.95 
ST. FRANCIS HOSPITAL - ACUTE,26000005,96368,HC INFUS CONCURRENT,260,1 ,$283.00 ,$183.95 ,$62.26 ,$330.08 ,$162.73 ,$203.76 ,$153.95 ,$62.26 ,$79.24 ,$166.40 ,$62.26 ,$194.42 ,$70.75 ,$194.42 ,$194.42 ,$70.75 ,$194.42 ,$118.29 ,$237.72 , N/A ,$62.26 ,$240.55 ,$237.72 ,$62.26 ,$212.25 ,$226.40 ,$226.40 ,$62.26 ,$226.40 ,$237.72 ,$237.72 ,$237.72 ,$283.00 ,$254.70 ,$162.73 ,$283.00 ,$62.26 ,$283.00 ,$153.95 ,$62.26 ,$117.73 ,$330.08 ,$315.07 ,$65.37 ,$240.55 ,$194.42 ,$79.24 ,$254.70 ,$237.72 ,$226.40 ,$226.40 ,$62.26 ,$183.95 
ST. FRANCIS HOSPITAL - ACUTE,26000010,96370,HC IV INFUSION THERPAY/PROPH SUBQ EA ADDL HR,260,1 ,$202.00 ,$131.30 ,$44.44 ,$516.01 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$118.78 ,$44.44 ,$138.77 ,$50.50 ,$138.77 ,$138.77 ,$50.50 ,$138.77 ,$84.44 ,$169.68 ,$102.18 ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$202.00 ,$109.89 ,$44.44 ,$84.03 ,$516.01 ,$492.56 ,$46.66 ,$171.70 ,$138.77 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,26000011,96371,HC IV INFUSION THERPAY/PROPH SUBQ SECOND LOCATION,260,1 ,$256.00 ,$166.40 ,$56.32 ,$330.08 ,$147.20 ,$184.32 ,$139.26 ,$56.32 ,$71.68 ,$150.53 ,$56.32 ,$175.87 ,$64.00 ,$175.87 ,$175.87 ,$64.00 ,$175.87 ,$107.01 ,$215.04 ,$158.30 ,$56.32 ,$217.60 ,$215.04 ,$56.32 ,$192.00 ,$204.80 ,$204.80 ,$56.32 ,$204.80 ,$215.04 ,$215.04 ,$215.04 ,$256.00 ,$230.40 ,$147.20 ,$256.00 ,$56.32 ,$256.00 ,$139.26 ,$56.32 ,$106.50 ,$330.08 ,$315.07 ,$59.14 ,$217.60 ,$175.87 ,$71.68 ,$230.40 ,$215.04 ,$204.80 ,$204.80 ,$56.32 ,$166.40 
ST. FRANCIS HOSPITAL - ACUTE,26000012,96369,HC INFUSION THERAPY/PROPHLAXIS INIT <1HR,260,1 ,$471.00 ,$306.15 ,$103.62 ,$522.33 ,$270.83 ,$339.12 ,$256.22 ,$103.62 ,$131.88 ,$276.95 ,$103.62 ,$323.58 ,$117.75 ,$323.58 ,$323.58 ,$117.75 ,$323.58 ,$196.88 ,$395.64 ,$522.33 ,$103.62 ,$400.35 ,$395.64 ,$103.62 ,$353.25 ,$376.80 ,$376.80 ,$103.62 ,$376.80 ,$395.64 ,$395.64 ,$395.64 ,$471.00 ,$423.90 ,$270.83 ,$471.00 ,$103.62 ,$471.00 ,$256.22 ,$103.62 ,$195.94 ,$330.08 ,$315.07 ,$108.80 ,$400.35 ,$323.58 ,$131.88 ,$423.90 ,$395.64 ,$376.80 ,$376.80 ,$103.62 ,$306.15 
ST. FRANCIS HOSPITAL - ACUTE,26000014,M0239,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB",260,1 ,"$1,045.00 ",$679.25 ,$229.90 ,"$1,045.00 ",$600.88 ,$752.40 ,$568.48 ,$229.90 ,$292.60 ,$586.25 ,$229.90 ,$681.34 ,$261.25 ,$681.34 ,$681.34 ,$261.25 ,$681.34 ,$436.81 ,$309.60 , N/A ,$229.90 ,$888.25 ,$877.80 ,$229.90 ,$783.75 ,$836.00 ,$836.00 ,$229.90 ,$836.00 ,$877.80 ,$877.80 ,$877.80 ,"$1,045.00 ",$940.50 ,$600.88 ,"$1,045.00 ",$229.90 ,"$1,045.00 ",$568.48 ,$229.90 ,$434.72 , N/A , N/A ,$241.40 ,$888.25 ,$681.34 ,$292.60 ,$940.50 ,$877.80 ,$836.00 ,$836.00 ,$229.90 ,$679.25 
ST. FRANCIS HOSPITAL - ACUTE,26000015,M0243,"HC INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB ADMINISTRATION",260,1 ,$930.00 ,$604.50 ,$204.60 ,"$1,126.25 ",$534.75 ,$669.60 ,$505.92 ,$204.60 ,$260.40 ,$521.73 ,$204.60 ,$606.36 ,$232.50 ,$606.36 ,$606.36 ,$232.50 ,$606.36 ,$388.74 ,$450.00 ,"$1,126.25 ",$204.60 ,$790.50 ,$781.20 ,$204.60 ,$697.50 ,$744.00 ,$744.00 ,$204.60 ,$744.00 ,$781.20 ,$781.20 ,$781.20 ,$930.00 ,$837.00 ,$534.75 ,$930.00 ,$204.60 ,$930.00 ,$505.92 ,$204.60 ,$386.88 ,$330.08 ,$315.07 ,$214.83 ,$790.50 ,$606.36 ,$260.40 ,$837.00 ,$781.20 ,$744.00 ,$744.00 ,$204.60 ,$604.50 
ST. FRANCIS HOSPITAL - ACUTE,27000008,N/A,HC CONTAINER DRAINAGE,270,1 ,$36.00 ,$23.40 ,$7.92 ,$36.00 ,$20.70 ,$25.92 ,$19.58 ,$7.92 ,$10.08 ,$20.20 ,$7.92 ,$23.47 ,$9.00 ,$23.47 ,$23.47 ,$9.00 ,$23.47 ,$15.05 ,$30.24 , N/A ,$7.92 ,$30.60 ,$30.24 ,$7.92 ,$27.00 ,$28.80 ,$28.80 ,$7.92 ,$28.80 ,$30.24 ,$30.24 ,$30.24 ,$36.00 ,$32.40 ,$20.70 ,$36.00 ,$7.92 ,$36.00 ,$19.58 ,$7.92 ,$14.98 , N/A , N/A ,$8.32 ,$30.60 ,$23.47 ,$10.08 ,$32.40 ,$30.24 ,$28.80 ,$28.80 ,$7.92 ,$23.40 
ST. FRANCIS HOSPITAL - ACUTE,27000027,N/A,HC TRAY AMNIOCENTESIS,270,1 ,$128.00 ,$83.20 ,$28.16 ,$128.00 ,$73.60 ,$92.16 ,$69.63 ,$28.16 ,$35.84 ,$71.81 ,$28.16 ,$83.46 ,$32.00 ,$83.46 ,$83.46 ,$32.00 ,$83.46 ,$53.50 ,$107.52 , N/A ,$28.16 ,$108.80 ,$107.52 ,$28.16 ,$96.00 ,$102.40 ,$102.40 ,$28.16 ,$102.40 ,$107.52 ,$107.52 ,$107.52 ,$128.00 ,$115.20 ,$73.60 ,$128.00 ,$28.16 ,$128.00 ,$69.63 ,$28.16 ,$53.25 , N/A , N/A ,$29.57 ,$108.80 ,$83.46 ,$35.84 ,$115.20 ,$107.52 ,$102.40 ,$102.40 ,$28.16 ,$83.20 
ST. FRANCIS HOSPITAL - ACUTE,27000052,N/A,HC KIT CPM MACHINE,270,1 ,$53.00 ,$34.45 ,$11.66 ,$53.00 ,$30.48 ,$38.16 ,$28.83 ,$11.66 ,$14.84 ,$29.73 ,$11.66 ,$34.56 ,$13.25 ,$34.56 ,$34.56 ,$13.25 ,$34.56 ,$22.15 ,$44.52 , N/A ,$11.66 ,$45.05 ,$44.52 ,$11.66 ,$39.75 ,$42.40 ,$42.40 ,$11.66 ,$42.40 ,$44.52 ,$44.52 ,$44.52 ,$53.00 ,$47.70 ,$30.48 ,$53.00 ,$11.66 ,$53.00 ,$28.83 ,$11.66 ,$22.05 , N/A , N/A ,$12.24 ,$45.05 ,$34.56 ,$14.84 ,$47.70 ,$44.52 ,$42.40 ,$42.40 ,$11.66 ,$34.45 
ST. FRANCIS HOSPITAL - ACUTE,27100038,N/A,HC CPAP MASK,271,1 ,$76.00 ,$49.40 ,$16.72 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$42.64 ,$16.72 ,$49.55 ,$19.00 ,$49.55 ,$49.55 ,$19.00 ,$49.55 ,$31.77 ,$63.84 , N/A ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 , N/A , N/A ,$17.56 ,$64.60 ,$49.55 ,$21.28 ,$68.40 ,$63.84 ,$60.80 ,$60.80 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,27100075,N/A,HC IPPB CIRCUITS,271,1 ,$44.00 ,$28.60 ,$9.68 ,$44.00 ,$25.30 ,$31.68 ,$23.94 ,$9.68 ,$12.32 ,$24.68 ,$9.68 ,$28.69 ,$11.00 ,$28.69 ,$28.69 ,$11.00 ,$28.69 ,$18.39 ,$36.96 , N/A ,$9.68 ,$37.40 ,$36.96 ,$9.68 ,$33.00 ,$35.20 ,$35.20 ,$9.68 ,$35.20 ,$36.96 ,$36.96 ,$36.96 ,$44.00 ,$39.60 ,$25.30 ,$44.00 ,$9.68 ,$44.00 ,$23.94 ,$9.68 ,$18.30 , N/A , N/A ,$10.16 ,$37.40 ,$28.69 ,$12.32 ,$39.60 ,$36.96 ,$35.20 ,$35.20 ,$9.68 ,$28.60 
ST. FRANCIS HOSPITAL - ACUTE,27100080,N/A,HC LARYNGEAL MASK AIRWAY,272,1 ,$91.00 ,$59.15 ,$20.02 ,$91.00 ,$52.33 ,$65.52 ,$49.50 ,$20.02 ,$25.48 ,$51.05 ,$20.02 ,$59.33 ,$22.75 ,$59.33 ,$59.33 ,$22.75 ,$59.33 ,$38.04 ,$76.44 , N/A ,$20.02 ,$77.35 ,$76.44 ,$20.02 ,$68.25 ,$72.80 ,$72.80 ,$20.02 ,$72.80 ,$76.44 ,$76.44 ,$76.44 ,$91.00 ,$81.90 ,$52.33 ,$91.00 ,$20.02 ,$91.00 ,$49.50 ,$20.02 ,$37.86 , N/A , N/A ,$21.02 ,$77.35 ,$59.33 ,$25.48 ,$81.90 ,$76.44 ,$72.80 ,$72.80 ,$20.02 ,$59.15 
ST. FRANCIS HOSPITAL - ACUTE,27100106,N/A,HC OXYGEN DAILY,271,1 ,$189.00 ,$122.85 ,$41.58 ,$189.00 ,$108.68 ,$136.08 ,$102.82 ,$41.58 ,$52.92 ,$106.03 ,$41.58 ,$123.23 ,$47.25 ,$123.23 ,$123.23 ,$47.25 ,$123.23 ,$79.00 ,$158.76 , N/A ,$41.58 ,$160.65 ,$158.76 ,$41.58 ,$141.75 ,$151.20 ,$151.20 ,$41.58 ,$151.20 ,$158.76 ,$158.76 ,$158.76 ,$189.00 ,$170.10 ,$108.68 ,$189.00 ,$41.58 ,$189.00 ,$102.82 ,$41.58 ,$78.62 , N/A , N/A ,$43.66 ,$160.65 ,$123.23 ,$52.92 ,$170.10 ,$158.76 ,$151.20 ,$151.20 ,$41.58 ,$122.85 
ST. FRANCIS HOSPITAL - ACUTE,27100107,N/A,HC OXYGEN HOURLY,271,1 ,$24.00 ,$15.60 ,$5.28 ,$24.00 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$13.46 ,$5.28 ,$15.65 ,$6.00 ,$15.65 ,$15.65 ,$6.00 ,$15.65 ,$10.03 ,$20.16 , N/A ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 , N/A , N/A ,$5.54 ,$20.40 ,$15.65 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,27100108,N/A,HC OXYGEN HOOD DAILY,271,1 ,$100.00 ,$65.00 ,$22.00 ,$100.00 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$56.10 ,$22.00 ,$65.20 ,$25.00 ,$65.20 ,$65.20 ,$25.00 ,$65.20 ,$41.80 ,$84.00 , N/A ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 , N/A , N/A ,$23.10 ,$85.00 ,$65.20 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,27100110,N/A,HC OXYGEN/AEROSAL MASK,271,1 ,$47.00 ,$30.55 ,$10.34 ,$47.00 ,$27.03 ,$33.84 ,$25.57 ,$10.34 ,$13.16 ,$26.37 ,$10.34 ,$30.64 ,$11.75 ,$30.64 ,$30.64 ,$11.75 ,$30.64 ,$19.65 ,$39.48 , N/A ,$10.34 ,$39.95 ,$39.48 ,$10.34 ,$35.25 ,$37.60 ,$37.60 ,$10.34 ,$37.60 ,$39.48 ,$39.48 ,$39.48 ,$47.00 ,$42.30 ,$27.03 ,$47.00 ,$10.34 ,$47.00 ,$25.57 ,$10.34 ,$19.55 , N/A , N/A ,$10.86 ,$39.95 ,$30.64 ,$13.16 ,$42.30 ,$39.48 ,$37.60 ,$37.60 ,$10.34 ,$30.55 
ST. FRANCIS HOSPITAL - ACUTE,27100114,N/A,HC PEAK FLOWMETER,271,1 ,$29.00 ,$18.85 ,$6.38 ,$29.00 ,$16.68 ,$20.88 ,$15.78 ,$6.38 ,$8.12 ,$16.27 ,$6.38 ,$18.91 ,$7.25 ,$18.91 ,$18.91 ,$7.25 ,$18.91 ,$12.12 ,$24.36 , N/A ,$6.38 ,$24.65 ,$24.36 ,$6.38 ,$21.75 ,$23.20 ,$23.20 ,$6.38 ,$23.20 ,$24.36 ,$24.36 ,$24.36 ,$29.00 ,$26.10 ,$16.68 ,$29.00 ,$6.38 ,$29.00 ,$15.78 ,$6.38 ,$12.06 , N/A , N/A ,$6.70 ,$24.65 ,$18.91 ,$8.12 ,$26.10 ,$24.36 ,$23.20 ,$23.20 ,$6.38 ,$18.85 
ST. FRANCIS HOSPITAL - ACUTE,27100120,N/A,HC CAST SHOE,271,1 ,$41.00 ,$26.65 ,$9.02 ,$41.00 ,$23.58 ,$29.52 ,$22.30 ,$9.02 ,$11.48 ,$23.00 ,$9.02 ,$26.73 ,$10.25 ,$26.73 ,$26.73 ,$10.25 ,$26.73 ,$17.14 ,$34.44 , N/A ,$9.02 ,$34.85 ,$34.44 ,$9.02 ,$30.75 ,$32.80 ,$32.80 ,$9.02 ,$32.80 ,$34.44 ,$34.44 ,$34.44 ,$41.00 ,$36.90 ,$23.58 ,$41.00 ,$9.02 ,$41.00 ,$22.30 ,$9.02 ,$17.06 , N/A , N/A ,$9.47 ,$34.85 ,$26.73 ,$11.48 ,$36.90 ,$34.44 ,$32.80 ,$32.80 ,$9.02 ,$26.65 
ST. FRANCIS HOSPITAL - ACUTE,27100136,N/A,HC FINGER SPLINT,271,1 ,$13.00 ,$8.45 ,$2.86 ,$13.00 ,$7.48 ,$9.36 ,$7.07 ,$2.86 ,$3.64 ,$7.29 ,$2.86 ,$8.48 ,$3.25 ,$8.48 ,$8.48 ,$3.25 ,$8.48 ,$5.43 ,$10.92 , N/A ,$2.86 ,$11.05 ,$10.92 ,$2.86 ,$9.75 ,$10.40 ,$10.40 ,$2.86 ,$10.40 ,$10.92 ,$10.92 ,$10.92 ,$13.00 ,$11.70 ,$7.48 ,$13.00 ,$2.86 ,$13.00 ,$7.07 ,$2.86 ,$5.41 , N/A , N/A ,$3.00 ,$11.05 ,$8.48 ,$3.64 ,$11.70 ,$10.92 ,$10.40 ,$10.40 ,$2.86 ,$8.45 
ST. FRANCIS HOSPITAL - ACUTE,27100159,N/A,HC TUBE GAUZE,271,1 ,$37.00 ,$24.05 ,$8.14 ,$37.00 ,$21.28 ,$26.64 ,$20.13 ,$8.14 ,$10.36 ,$20.76 ,$8.14 ,$24.12 ,$9.25 ,$24.12 ,$24.12 ,$9.25 ,$24.12 ,$15.47 ,$31.08 , N/A ,$8.14 ,$31.45 ,$31.08 ,$8.14 ,$27.75 ,$29.60 ,$29.60 ,$8.14 ,$29.60 ,$31.08 ,$31.08 ,$31.08 ,$37.00 ,$33.30 ,$21.28 ,$37.00 ,$8.14 ,$37.00 ,$20.13 ,$8.14 ,$15.39 , N/A , N/A ,$8.55 ,$31.45 ,$24.12 ,$10.36 ,$33.30 ,$31.08 ,$29.60 ,$29.60 ,$8.14 ,$24.05 
ST. FRANCIS HOSPITAL - ACUTE,27100182,N/A,HC HAND SPLINT,271,1 ,$76.00 ,$49.40 ,$16.72 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$42.64 ,$16.72 ,$49.55 ,$19.00 ,$49.55 ,$49.55 ,$19.00 ,$49.55 ,$31.77 ,$63.84 , N/A ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 , N/A , N/A ,$17.56 ,$64.60 ,$49.55 ,$21.28 ,$68.40 ,$63.84 ,$60.80 ,$60.80 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,27100187,N/A,HC BAG DRAINAGE,271,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27100188,N/A,HC SLING ARM,271,1 ,$96.00 ,$62.40 ,$21.12 ,$96.00 ,$55.20 ,$69.12 ,$52.22 ,$21.12 ,$26.88 ,$53.86 ,$21.12 ,$62.59 ,$24.00 ,$62.59 ,$62.59 ,$24.00 ,$62.59 ,$40.13 ,$80.64 , N/A ,$21.12 ,$81.60 ,$80.64 ,$21.12 ,$72.00 ,$76.80 ,$76.80 ,$21.12 ,$76.80 ,$80.64 ,$80.64 ,$80.64 ,$96.00 ,$86.40 ,$55.20 ,$96.00 ,$21.12 ,$96.00 ,$52.22 ,$21.12 ,$39.94 , N/A , N/A ,$22.18 ,$81.60 ,$62.59 ,$26.88 ,$86.40 ,$80.64 ,$76.80 ,$76.80 ,$21.12 ,$62.40 
ST. FRANCIS HOSPITAL - ACUTE,27100204,N/A,HC CIRCUIT BREATHING,271,1 ,$44.00 ,$28.60 ,$9.68 ,$44.00 ,$25.30 ,$31.68 ,$23.94 ,$9.68 ,$12.32 ,$24.68 ,$9.68 ,$28.69 ,$11.00 ,$28.69 ,$28.69 ,$11.00 ,$28.69 ,$18.39 ,$36.96 , N/A ,$9.68 ,$37.40 ,$36.96 ,$9.68 ,$33.00 ,$35.20 ,$35.20 ,$9.68 ,$35.20 ,$36.96 ,$36.96 ,$36.96 ,$44.00 ,$39.60 ,$25.30 ,$44.00 ,$9.68 ,$44.00 ,$23.94 ,$9.68 ,$18.30 , N/A , N/A ,$10.16 ,$37.40 ,$28.69 ,$12.32 ,$39.60 ,$36.96 ,$35.20 ,$35.20 ,$9.68 ,$28.60 
ST. FRANCIS HOSPITAL - ACUTE,27100207,N/A,HC DRESSING BANDAGE ELASTIC,271,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27100209,N/A,HC ENEMA BAG,271,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27100211,N/A,HC PAD DEFIBRILLATOR,271,1 ,$54.00 ,$35.10 ,$11.88 ,$54.00 ,$31.05 ,$38.88 ,$29.38 ,$11.88 ,$15.12 ,$30.29 ,$11.88 ,$35.21 ,$13.50 ,$35.21 ,$35.21 ,$13.50 ,$35.21 ,$22.57 ,$45.36 , N/A ,$11.88 ,$45.90 ,$45.36 ,$11.88 ,$40.50 ,$43.20 ,$43.20 ,$11.88 ,$43.20 ,$45.36 ,$45.36 ,$45.36 ,$54.00 ,$48.60 ,$31.05 ,$54.00 ,$11.88 ,$54.00 ,$29.38 ,$11.88 ,$22.46 , N/A , N/A ,$12.47 ,$45.90 ,$35.21 ,$15.12 ,$48.60 ,$45.36 ,$43.20 ,$43.20 ,$11.88 ,$35.10 
ST. FRANCIS HOSPITAL - ACUTE,27100215,N/A,HC RESTRAINT ANY TYPE,271,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27100218,N/A,HC SET IV BLOOD ADMINISTRATION,271,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27100221,N/A,HC SET IV PCA,271,1 ,$165.00 ,$107.25 ,$36.30 ,$165.00 ,$94.88 ,$118.80 ,$89.76 ,$36.30 ,$46.20 ,$92.57 ,$36.30 ,$107.58 ,$41.25 ,$107.58 ,$107.58 ,$41.25 ,$107.58 ,$68.97 ,$138.60 , N/A ,$36.30 ,$140.25 ,$138.60 ,$36.30 ,$123.75 ,$132.00 ,$132.00 ,$36.30 ,$132.00 ,$138.60 ,$138.60 ,$138.60 ,$165.00 ,$148.50 ,$94.88 ,$165.00 ,$36.30 ,$165.00 ,$89.76 ,$36.30 ,$68.64 , N/A , N/A ,$38.12 ,$140.25 ,$107.58 ,$46.20 ,$148.50 ,$138.60 ,$132.00 ,$132.00 ,$36.30 ,$107.25 
ST. FRANCIS HOSPITAL - ACUTE,27100222,N/A,HC SET OSTOMY IRRIGATION,271,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27100223,N/A,HC SHELL/SHIELD BREAST,271,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27100225,N/A,HC SPLINT KNEE,271,1 ,$148.00 ,$96.20 ,$32.56 ,$148.00 ,$85.10 ,$106.56 ,$80.51 ,$32.56 ,$41.44 ,$83.03 ,$32.56 ,$96.50 ,$37.00 ,$96.50 ,$96.50 ,$37.00 ,$96.50 ,$61.86 ,$124.32 , N/A ,$32.56 ,$125.80 ,$124.32 ,$32.56 ,$111.00 ,$118.40 ,$118.40 ,$32.56 ,$118.40 ,$124.32 ,$124.32 ,$124.32 ,$148.00 ,$133.20 ,$85.10 ,$148.00 ,$32.56 ,$148.00 ,$80.51 ,$32.56 ,$61.57 , N/A , N/A ,$34.19 ,$125.80 ,$96.50 ,$41.44 ,$133.20 ,$124.32 ,$118.40 ,$118.40 ,$32.56 ,$96.20 
ST. FRANCIS HOSPITAL - ACUTE,27100231,N/A,HC TUBING DRAINAGE,271,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27100234,N/A,HC MASK BIPAP,271,1 ,$152.00 ,$98.80 ,$33.44 ,$152.00 ,$87.40 ,$109.44 ,$82.69 ,$33.44 ,$42.56 ,$85.27 ,$33.44 ,$99.10 ,$38.00 ,$99.10 ,$99.10 ,$38.00 ,$99.10 ,$63.54 ,$127.68 , N/A ,$33.44 ,$129.20 ,$127.68 ,$33.44 ,$114.00 ,$121.60 ,$121.60 ,$33.44 ,$121.60 ,$127.68 ,$127.68 ,$127.68 ,$152.00 ,$136.80 ,$87.40 ,$152.00 ,$33.44 ,$152.00 ,$82.69 ,$33.44 ,$63.23 , N/A , N/A ,$35.11 ,$129.20 ,$99.10 ,$42.56 ,$136.80 ,$127.68 ,$121.60 ,$121.60 ,$33.44 ,$98.80 
ST. FRANCIS HOSPITAL - ACUTE,27100239,N/A,HC TUBING OXYGEN,271,1 ,$41.00 ,$26.65 ,$9.02 ,$41.00 ,$23.58 ,$29.52 ,$22.30 ,$9.02 ,$11.48 ,$23.00 ,$9.02 ,$26.73 ,$10.25 ,$26.73 ,$26.73 ,$10.25 ,$26.73 ,$17.14 ,$34.44 , N/A ,$9.02 ,$34.85 ,$34.44 ,$9.02 ,$30.75 ,$32.80 ,$32.80 ,$9.02 ,$32.80 ,$34.44 ,$34.44 ,$34.44 ,$41.00 ,$36.90 ,$23.58 ,$41.00 ,$9.02 ,$41.00 ,$22.30 ,$9.02 ,$17.06 , N/A , N/A ,$9.47 ,$34.85 ,$26.73 ,$11.48 ,$36.90 ,$34.44 ,$32.80 ,$32.80 ,$9.02 ,$26.65 
ST. FRANCIS HOSPITAL - ACUTE,27100256,N/A,HC ELECTRODE FETAL SCALP,271,1 ,$209.00 ,$135.85 ,$45.98 ,$209.00 ,$120.18 ,$150.48 ,$113.70 ,$45.98 ,$58.52 ,$117.25 ,$45.98 ,$136.27 ,$52.25 ,$136.27 ,$136.27 ,$52.25 ,$136.27 ,$87.36 ,$175.56 , N/A ,$45.98 ,$177.65 ,$175.56 ,$45.98 ,$156.75 ,$167.20 ,$167.20 ,$45.98 ,$167.20 ,$175.56 ,$175.56 ,$175.56 ,$209.00 ,$188.10 ,$120.18 ,$209.00 ,$45.98 ,$209.00 ,$113.70 ,$45.98 ,$86.94 , N/A , N/A ,$48.28 ,$177.65 ,$136.27 ,$58.52 ,$188.10 ,$175.56 ,$167.20 ,$167.20 ,$45.98 ,$135.85 
ST. FRANCIS HOSPITAL - ACUTE,27100261,N/A,HC PAD K PAD,271,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27100273,N/A,HC SPLINT OCL CUSTOM,271,1 ,$51.00 ,$33.15 ,$11.22 ,$51.00 ,$29.33 ,$36.72 ,$27.74 ,$11.22 ,$14.28 ,$28.61 ,$11.22 ,$33.25 ,$12.75 ,$33.25 ,$33.25 ,$12.75 ,$33.25 ,$21.32 ,$42.84 , N/A ,$11.22 ,$43.35 ,$42.84 ,$11.22 ,$38.25 ,$40.80 ,$40.80 ,$11.22 ,$40.80 ,$42.84 ,$42.84 ,$42.84 ,$51.00 ,$45.90 ,$29.33 ,$51.00 ,$11.22 ,$51.00 ,$27.74 ,$11.22 ,$21.22 , N/A , N/A ,$11.78 ,$43.35 ,$33.25 ,$14.28 ,$45.90 ,$42.84 ,$40.80 ,$40.80 ,$11.22 ,$33.15 
ST. FRANCIS HOSPITAL - ACUTE,27100282,N/A,HC PACK HOT/ COLD SMALL,271,1 ,$13.00 ,$8.45 ,$2.86 ,$13.00 ,$7.48 ,$9.36 ,$7.07 ,$2.86 ,$3.64 ,$7.29 ,$2.86 ,$8.48 ,$3.25 ,$8.48 ,$8.48 ,$3.25 ,$8.48 ,$5.43 ,$10.92 , N/A ,$2.86 ,$11.05 ,$10.92 ,$2.86 ,$9.75 ,$10.40 ,$10.40 ,$2.86 ,$10.40 ,$10.92 ,$10.92 ,$10.92 ,$13.00 ,$11.70 ,$7.48 ,$13.00 ,$2.86 ,$13.00 ,$7.07 ,$2.86 ,$5.41 , N/A , N/A ,$3.00 ,$11.05 ,$8.48 ,$3.64 ,$11.70 ,$10.92 ,$10.40 ,$10.40 ,$2.86 ,$8.45 
ST. FRANCIS HOSPITAL - ACUTE,27100290,A4467,HC GARMENT ELASTIC,271,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27100291,L3650,HC IMMOBILIZER SHOULDER ADB RESTR,271,1 ,$60.00 ,$39.00 ,$13.20 ,$168.38 ,$34.50 ,$43.20 ,$32.64 ,$13.20 ,$16.80 ,$35.28 ,$13.20 ,$41.22 ,$15.00 ,$41.22 ,$41.22 ,$15.00 ,$41.22 ,$25.08 ,$50.40 ,$168.38 ,$13.20 ,$51.00 ,$50.40 ,$13.20 ,$45.00 ,$48.00 ,$48.00 ,$13.20 ,$48.00 ,$50.40 ,$50.40 ,$50.40 ,$60.00 ,$54.00 ,$34.50 ,$60.00 ,$13.20 ,$60.00 ,$32.64 ,$13.20 ,$24.96 , N/A , N/A ,$13.86 ,$51.00 ,$41.22 ,$16.80 ,$54.00 ,$50.40 ,$48.00 ,$48.00 ,$13.20 ,$39.00 
ST. FRANCIS HOSPITAL - ACUTE,27100325,N/A,HC SPACER MDI,271,1 ,$16.00 ,$10.40 ,$3.52 ,$16.00 ,$9.20 ,$11.52 ,$8.70 ,$3.52 ,$4.48 ,$8.98 ,$3.52 ,$10.43 ,$4.00 ,$10.43 ,$10.43 ,$4.00 ,$10.43 ,$6.69 ,$13.44 , N/A ,$3.52 ,$13.60 ,$13.44 ,$3.52 ,$12.00 ,$12.80 ,$12.80 ,$3.52 ,$12.80 ,$13.44 ,$13.44 ,$13.44 ,$16.00 ,$14.40 ,$9.20 ,$16.00 ,$3.52 ,$16.00 ,$8.70 ,$3.52 ,$6.66 , N/A , N/A ,$3.70 ,$13.60 ,$10.43 ,$4.48 ,$14.40 ,$13.44 ,$12.80 ,$12.80 ,$3.52 ,$10.40 
ST. FRANCIS HOSPITAL - ACUTE,27100326,N/A,HC STOCKING ANTIEMBOLISM,271,1 ,$75.00 ,$48.75 ,$16.50 ,$75.00 ,$43.13 ,$54.00 ,$40.80 ,$16.50 ,$21.00 ,$42.08 ,$16.50 ,$48.90 ,$18.75 ,$48.90 ,$48.90 ,$18.75 ,$48.90 ,$31.35 ,$63.00 , N/A ,$16.50 ,$63.75 ,$63.00 ,$16.50 ,$56.25 ,$60.00 ,$60.00 ,$16.50 ,$60.00 ,$63.00 ,$63.00 ,$63.00 ,$75.00 ,$67.50 ,$43.13 ,$75.00 ,$16.50 ,$75.00 ,$40.80 ,$16.50 ,$31.20 , N/A , N/A ,$17.33 ,$63.75 ,$48.90 ,$21.00 ,$67.50 ,$63.00 ,$60.00 ,$60.00 ,$16.50 ,$48.75 
ST. FRANCIS HOSPITAL - ACUTE,27100483,N/A,HC BOTTLE HUMIDITY,271,1 ,$17.00 ,$11.05 ,$3.74 ,$17.00 ,$9.78 ,$12.24 ,$9.25 ,$3.74 ,$4.76 ,$9.54 ,$3.74 ,$11.08 ,$4.25 ,$11.08 ,$11.08 ,$4.25 ,$11.08 ,$7.11 ,$14.28 , N/A ,$3.74 ,$14.45 ,$14.28 ,$3.74 ,$12.75 ,$13.60 ,$13.60 ,$3.74 ,$13.60 ,$14.28 ,$14.28 ,$14.28 ,$17.00 ,$15.30 ,$9.78 ,$17.00 ,$3.74 ,$17.00 ,$9.25 ,$3.74 ,$7.07 , N/A , N/A ,$3.93 ,$14.45 ,$11.08 ,$4.76 ,$15.30 ,$14.28 ,$13.60 ,$13.60 ,$3.74 ,$11.05 
ST. FRANCIS HOSPITAL - ACUTE,27100484,N/A,HC ROLL CAST FIBERGLASS,271,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27100485,N/A,HC ROLL CAST PLASTER,271,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27100491,N/A,HC PROTECTANT SKIN,271,1 ,$10.00 ,$6.50 ,$2.20 ,$10.00 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.61 ,$2.20 ,$6.52 ,$2.50 ,$6.52 ,$6.52 ,$2.50 ,$6.52 ,$4.18 ,$8.40 , N/A ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$10.00 ,$5.44 ,$2.20 ,$4.16 , N/A , N/A ,$2.31 ,$8.50 ,$6.52 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,27100493,N/A,HC PAD SENSOR,271,1 ,$41.00 ,$26.65 ,$9.02 ,$41.00 ,$23.58 ,$29.52 ,$22.30 ,$9.02 ,$11.48 ,$23.00 ,$9.02 ,$26.73 ,$10.25 ,$26.73 ,$26.73 ,$10.25 ,$26.73 ,$17.14 ,$34.44 , N/A ,$9.02 ,$34.85 ,$34.44 ,$9.02 ,$30.75 ,$32.80 ,$32.80 ,$9.02 ,$32.80 ,$34.44 ,$34.44 ,$34.44 ,$41.00 ,$36.90 ,$23.58 ,$41.00 ,$9.02 ,$41.00 ,$22.30 ,$9.02 ,$17.06 , N/A , N/A ,$9.47 ,$34.85 ,$26.73 ,$11.48 ,$36.90 ,$34.44 ,$32.80 ,$32.80 ,$9.02 ,$26.65 
ST. FRANCIS HOSPITAL - ACUTE,27100495,N/A,HC SPLITTER PILL,271,1 ,$34.00 ,$22.10 ,$7.48 ,$34.00 ,$19.55 ,$24.48 ,$18.50 ,$7.48 ,$9.52 ,$19.07 ,$7.48 ,$22.17 ,$8.50 ,$22.17 ,$22.17 ,$8.50 ,$22.17 ,$14.21 ,$28.56 , N/A ,$7.48 ,$28.90 ,$28.56 ,$7.48 ,$25.50 ,$27.20 ,$27.20 ,$7.48 ,$27.20 ,$28.56 ,$28.56 ,$28.56 ,$34.00 ,$30.60 ,$19.55 ,$34.00 ,$7.48 ,$34.00 ,$18.50 ,$7.48 ,$14.14 , N/A , N/A ,$7.85 ,$28.90 ,$22.17 ,$9.52 ,$30.60 ,$28.56 ,$27.20 ,$27.20 ,$7.48 ,$22.10 
ST. FRANCIS HOSPITAL - ACUTE,27100497,N/A,HC STRAP CATHETER,271,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27200035,C1729,HC CATHETER DRAINAGE PLEUREX,272,1 ,$221.00 ,$143.65 ,$48.62 ,$221.00 ,$127.08 ,$159.12 ,$120.22 ,$48.62 ,$61.88 ,$123.98 ,$48.62 ,$144.09 ,$55.25 ,$144.09 ,$144.09 ,$55.25 ,$144.09 ,$92.38 ,$185.64 , N/A ,$48.62 ,$187.85 ,$185.64 ,$48.62 ,$165.75 ,$176.80 ,$176.80 ,$48.62 ,$176.80 ,$185.64 ,$185.64 ,$185.64 ,$221.00 ,$198.90 ,$127.08 ,$221.00 ,$48.62 ,$221.00 ,$120.22 ,$48.62 ,$91.94 , N/A , N/A ,$51.05 ,$187.85 ,$144.09 ,$61.88 ,$198.90 ,$185.64 ,$176.80 ,$176.80 ,$48.62 ,$143.65 
ST. FRANCIS HOSPITAL - ACUTE,27200075,C1758,HC CATHETER URETERAL,272,1 ,$91.00 ,$59.15 ,$20.02 ,$91.00 ,$52.33 ,$65.52 ,$49.50 ,$20.02 ,$25.48 ,$51.05 ,$20.02 ,$59.33 ,$22.75 ,$59.33 ,$59.33 ,$22.75 ,$59.33 ,$38.04 ,$76.44 , N/A ,$20.02 ,$77.35 ,$76.44 ,$20.02 ,$68.25 ,$72.80 ,$72.80 ,$20.02 ,$72.80 ,$76.44 ,$76.44 ,$76.44 ,$91.00 ,$81.90 ,$52.33 ,$91.00 ,$20.02 ,$91.00 ,$49.50 ,$20.02 ,$37.86 , N/A , N/A ,$21.02 ,$77.35 ,$59.33 ,$25.48 ,$81.90 ,$76.44 ,$72.80 ,$72.80 ,$20.02 ,$59.15 
ST. FRANCIS HOSPITAL - ACUTE,27200200,N/A,HC ABDOMINAL BINDERS,272,1 ,$55.00 ,$35.75 ,$12.10 ,$55.00 ,$31.63 ,$39.60 ,$29.92 ,$12.10 ,$15.40 ,$30.86 ,$12.10 ,$35.86 ,$13.75 ,$35.86 ,$35.86 ,$13.75 ,$35.86 ,$22.99 ,$46.20 , N/A ,$12.10 ,$46.75 ,$46.20 ,$12.10 ,$41.25 ,$44.00 ,$44.00 ,$12.10 ,$44.00 ,$46.20 ,$46.20 ,$46.20 ,$55.00 ,$49.50 ,$31.63 ,$55.00 ,$12.10 ,$55.00 ,$29.92 ,$12.10 ,$22.88 , N/A , N/A ,$12.71 ,$46.75 ,$35.86 ,$15.40 ,$49.50 ,$46.20 ,$44.00 ,$44.00 ,$12.10 ,$35.75 
ST. FRANCIS HOSPITAL - ACUTE,27200226,N/A,HC ADHESIVE DERMABOND,272,1 ,$69.00 ,$44.85 ,$15.18 ,$69.00 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$38.71 ,$15.18 ,$44.99 ,$17.25 ,$44.99 ,$44.99 ,$17.25 ,$44.99 ,$28.84 ,$57.96 , N/A ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 , N/A , N/A ,$15.94 ,$58.65 ,$44.99 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,27200236,N/A,HC AIRWAY NASO-PHARYNGEAL,272,1 ,$47.00 ,$30.55 ,$10.34 ,$47.00 ,$27.03 ,$33.84 ,$25.57 ,$10.34 ,$13.16 ,$26.37 ,$10.34 ,$30.64 ,$11.75 ,$30.64 ,$30.64 ,$11.75 ,$30.64 ,$19.65 ,$39.48 , N/A ,$10.34 ,$39.95 ,$39.48 ,$10.34 ,$35.25 ,$37.60 ,$37.60 ,$10.34 ,$37.60 ,$39.48 ,$39.48 ,$39.48 ,$47.00 ,$42.30 ,$27.03 ,$47.00 ,$10.34 ,$47.00 ,$25.57 ,$10.34 ,$19.55 , N/A , N/A ,$10.86 ,$39.95 ,$30.64 ,$13.16 ,$42.30 ,$39.48 ,$37.60 ,$37.60 ,$10.34 ,$30.55 
ST. FRANCIS HOSPITAL - ACUTE,27200290,N/A,HC BAG BILE,272,1 ,$43.00 ,$27.95 ,$9.46 ,$43.00 ,$24.73 ,$30.96 ,$23.39 ,$9.46 ,$12.04 ,$24.12 ,$9.46 ,$28.04 ,$10.75 ,$28.04 ,$28.04 ,$10.75 ,$28.04 ,$17.97 ,$36.12 , N/A ,$9.46 ,$36.55 ,$36.12 ,$9.46 ,$32.25 ,$34.40 ,$34.40 ,$9.46 ,$34.40 ,$36.12 ,$36.12 ,$36.12 ,$43.00 ,$38.70 ,$24.73 ,$43.00 ,$9.46 ,$43.00 ,$23.39 ,$9.46 ,$17.89 , N/A , N/A ,$9.93 ,$36.55 ,$28.04 ,$12.04 ,$38.70 ,$36.12 ,$34.40 ,$34.40 ,$9.46 ,$27.95 
ST. FRANCIS HOSPITAL - ACUTE,27200502,N/A,HC BLADE SAW,272,1 ,$25.00 ,$16.25 ,$5.50 ,$25.00 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.03 ,$5.50 ,$16.30 ,$6.25 ,$16.30 ,$16.30 ,$6.25 ,$16.30 ,$10.45 ,$21.00 , N/A ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 , N/A , N/A ,$5.78 ,$21.25 ,$16.30 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,27200571,N/A,HC BREAST PUMP KIT,272,1 ,$51.00 ,$33.15 ,$11.22 ,$51.00 ,$29.33 ,$36.72 ,$27.74 ,$11.22 ,$14.28 ,$28.61 ,$11.22 ,$33.25 ,$12.75 ,$33.25 ,$33.25 ,$12.75 ,$33.25 ,$21.32 ,$42.84 , N/A ,$11.22 ,$43.35 ,$42.84 ,$11.22 ,$38.25 ,$40.80 ,$40.80 ,$11.22 ,$40.80 ,$42.84 ,$42.84 ,$42.84 ,$51.00 ,$45.90 ,$29.33 ,$51.00 ,$11.22 ,$51.00 ,$27.74 ,$11.22 ,$21.22 , N/A , N/A ,$11.78 ,$43.35 ,$33.25 ,$14.28 ,$45.90 ,$42.84 ,$40.80 ,$40.80 ,$11.22 ,$33.15 
ST. FRANCIS HOSPITAL - ACUTE,27200832,N/A,HC CATH TRAY WITH FOLEY,272,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27200849,N/A,HC CATHETER - FOLEY,272,1 ,$234.00 ,$152.10 ,$51.48 ,$234.00 ,$134.55 ,$168.48 ,$127.30 ,$51.48 ,$65.52 ,$131.27 ,$51.48 ,$152.57 ,$58.50 ,$152.57 ,$152.57 ,$58.50 ,$152.57 ,$97.81 ,$196.56 , N/A ,$51.48 ,$198.90 ,$196.56 ,$51.48 ,$175.50 ,$187.20 ,$187.20 ,$51.48 ,$187.20 ,$196.56 ,$196.56 ,$196.56 ,$234.00 ,$210.60 ,$134.55 ,$234.00 ,$51.48 ,$234.00 ,$127.30 ,$51.48 ,$97.34 , N/A , N/A ,$54.05 ,$198.90 ,$152.57 ,$65.52 ,$210.60 ,$196.56 ,$187.20 ,$187.20 ,$51.48 ,$152.10 
ST. FRANCIS HOSPITAL - ACUTE,27201077,N/A,HC DIS INCENTIVE SPIROMETER,272,1 ,$114.00 ,$74.10 ,$25.08 ,$114.00 ,$65.55 ,$82.08 ,$62.02 ,$25.08 ,$31.92 ,$63.95 ,$25.08 ,$74.33 ,$28.50 ,$74.33 ,$74.33 ,$28.50 ,$74.33 ,$47.65 ,$95.76 , N/A ,$25.08 ,$96.90 ,$95.76 ,$25.08 ,$85.50 ,$91.20 ,$91.20 ,$25.08 ,$91.20 ,$95.76 ,$95.76 ,$95.76 ,$114.00 ,$102.60 ,$65.55 ,$114.00 ,$25.08 ,$114.00 ,$62.02 ,$25.08 ,$47.42 , N/A , N/A ,$26.33 ,$96.90 ,$74.33 ,$31.92 ,$102.60 ,$95.76 ,$91.20 ,$91.20 ,$25.08 ,$74.10 
ST. FRANCIS HOSPITAL - ACUTE,27201157,N/A,HC DRSG ADAPTIC 3X3 PK,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27201252,N/A,HC EPIDURAL TRAY,272,1 ,$230.00 ,$149.50 ,$50.60 ,$230.00 ,$132.25 ,$165.60 ,$125.12 ,$50.60 ,$64.40 ,$129.03 ,$50.60 ,$149.96 ,$57.50 ,$149.96 ,$149.96 ,$57.50 ,$149.96 ,$96.14 ,$193.20 , N/A ,$50.60 ,$195.50 ,$193.20 ,$50.60 ,$172.50 ,$184.00 ,$184.00 ,$50.60 ,$184.00 ,$193.20 ,$193.20 ,$193.20 ,$230.00 ,$207.00 ,$132.25 ,$230.00 ,$50.60 ,$230.00 ,$125.12 ,$50.60 ,$95.68 , N/A , N/A ,$53.13 ,$195.50 ,$149.96 ,$64.40 ,$207.00 ,$193.20 ,$184.00 ,$184.00 ,$50.60 ,$149.50 
ST. FRANCIS HOSPITAL - ACUTE,27201282,N/A,HC FEEDING TUBE,272,1 ,$53.00 ,$34.45 ,$11.66 ,$53.00 ,$30.48 ,$38.16 ,$28.83 ,$11.66 ,$14.84 ,$29.73 ,$11.66 ,$34.56 ,$13.25 ,$34.56 ,$34.56 ,$13.25 ,$34.56 ,$22.15 ,$44.52 , N/A ,$11.66 ,$45.05 ,$44.52 ,$11.66 ,$39.75 ,$42.40 ,$42.40 ,$11.66 ,$42.40 ,$44.52 ,$44.52 ,$44.52 ,$53.00 ,$47.70 ,$30.48 ,$53.00 ,$11.66 ,$53.00 ,$28.83 ,$11.66 ,$22.05 , N/A , N/A ,$12.24 ,$45.05 ,$34.56 ,$14.84 ,$47.70 ,$44.52 ,$42.40 ,$42.40 ,$11.66 ,$34.45 
ST. FRANCIS HOSPITAL - ACUTE,27201315,N/A,HC FLUTTER VALVE EQUIPMENT,272,1 ,$115.00 ,$74.75 ,$25.30 ,$115.00 ,$66.13 ,$82.80 ,$62.56 ,$25.30 ,$32.20 ,$64.52 ,$25.30 ,$74.98 ,$28.75 ,$74.98 ,$74.98 ,$28.75 ,$74.98 ,$48.07 ,$96.60 , N/A ,$25.30 ,$97.75 ,$96.60 ,$25.30 ,$86.25 ,$92.00 ,$92.00 ,$25.30 ,$92.00 ,$96.60 ,$96.60 ,$96.60 ,$115.00 ,$103.50 ,$66.13 ,$115.00 ,$25.30 ,$115.00 ,$62.56 ,$25.30 ,$47.84 , N/A , N/A ,$26.57 ,$97.75 ,$74.98 ,$32.20 ,$103.50 ,$96.60 ,$92.00 ,$92.00 ,$25.30 ,$74.75 
ST. FRANCIS HOSPITAL - ACUTE,27201319,N/A,HC FOLEY CATH W/URINE METER,272,1 ,$51.00 ,$33.15 ,$11.22 ,$51.00 ,$29.33 ,$36.72 ,$27.74 ,$11.22 ,$14.28 ,$28.61 ,$11.22 ,$33.25 ,$12.75 ,$33.25 ,$33.25 ,$12.75 ,$33.25 ,$21.32 ,$42.84 , N/A ,$11.22 ,$43.35 ,$42.84 ,$11.22 ,$38.25 ,$40.80 ,$40.80 ,$11.22 ,$40.80 ,$42.84 ,$42.84 ,$42.84 ,$51.00 ,$45.90 ,$29.33 ,$51.00 ,$11.22 ,$51.00 ,$27.74 ,$11.22 ,$21.22 , N/A , N/A ,$11.78 ,$43.35 ,$33.25 ,$14.28 ,$45.90 ,$42.84 ,$40.80 ,$40.80 ,$11.22 ,$33.15 
ST. FRANCIS HOSPITAL - ACUTE,27201502,N/A,HC KIT DRAINAGE,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27201713,N/A,HC NEEDLE SPINAL,272,1 ,$60.00 ,$39.00 ,$13.20 ,$60.00 ,$34.50 ,$43.20 ,$32.64 ,$13.20 ,$16.80 ,$33.66 ,$13.20 ,$39.12 ,$15.00 ,$39.12 ,$39.12 ,$15.00 ,$39.12 ,$25.08 ,$50.40 , N/A ,$13.20 ,$51.00 ,$50.40 ,$13.20 ,$45.00 ,$48.00 ,$48.00 ,$13.20 ,$48.00 ,$50.40 ,$50.40 ,$50.40 ,$60.00 ,$54.00 ,$34.50 ,$60.00 ,$13.20 ,$60.00 ,$32.64 ,$13.20 ,$24.96 , N/A , N/A ,$13.86 ,$51.00 ,$39.12 ,$16.80 ,$54.00 ,$50.40 ,$48.00 ,$48.00 ,$13.20 ,$39.00 
ST. FRANCIS HOSPITAL - ACUTE,27201799,N/A,HC PACKING - WOUND,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27201938,N/A,HC PULSE OXIMETER PROBE DISP,272,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27202018,N/A,HC SENSOR ADULT ADHESIVE,272,1 ,$108.00 ,$70.20 ,$23.76 ,$108.00 ,$62.10 ,$77.76 ,$58.75 ,$23.76 ,$30.24 ,$60.59 ,$23.76 ,$70.42 ,$27.00 ,$70.42 ,$70.42 ,$27.00 ,$70.42 ,$45.14 ,$90.72 , N/A ,$23.76 ,$91.80 ,$90.72 ,$23.76 ,$81.00 ,$86.40 ,$86.40 ,$23.76 ,$86.40 ,$90.72 ,$90.72 ,$90.72 ,$108.00 ,$97.20 ,$62.10 ,$108.00 ,$23.76 ,$108.00 ,$58.75 ,$23.76 ,$44.93 , N/A , N/A ,$24.95 ,$91.80 ,$70.42 ,$30.24 ,$97.20 ,$90.72 ,$86.40 ,$86.40 ,$23.76 ,$70.20 
ST. FRANCIS HOSPITAL - ACUTE,27202033,N/A,HC SET IV SECONDARY,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27202120,N/A,HC STAPLER SKIN,272,1 ,$107.00 ,$69.55 ,$23.54 ,$107.00 ,$61.53 ,$77.04 ,$58.21 ,$23.54 ,$29.96 ,$60.03 ,$23.54 ,$69.76 ,$26.75 ,$69.76 ,$69.76 ,$26.75 ,$69.76 ,$44.73 ,$89.88 , N/A ,$23.54 ,$90.95 ,$89.88 ,$23.54 ,$80.25 ,$85.60 ,$85.60 ,$23.54 ,$85.60 ,$89.88 ,$89.88 ,$89.88 ,$107.00 ,$96.30 ,$61.53 ,$107.00 ,$23.54 ,$107.00 ,$58.21 ,$23.54 ,$44.51 , N/A , N/A ,$24.72 ,$90.95 ,$69.76 ,$29.96 ,$96.30 ,$89.88 ,$85.60 ,$85.60 ,$23.54 ,$69.55 
ST. FRANCIS HOSPITAL - ACUTE,27202600,N/A,HC SUTURE,272,1 ,$155.00 ,$100.75 ,$34.10 ,$155.00 ,$89.13 ,$111.60 ,$84.32 ,$34.10 ,$43.40 ,$86.96 ,$34.10 ,$101.06 ,$38.75 ,$101.06 ,$101.06 ,$38.75 ,$101.06 ,$64.79 ,$130.20 , N/A ,$34.10 ,$131.75 ,$130.20 ,$34.10 ,$116.25 ,$124.00 ,$124.00 ,$34.10 ,$124.00 ,$130.20 ,$130.20 ,$130.20 ,$155.00 ,$139.50 ,$89.13 ,$155.00 ,$34.10 ,$155.00 ,$84.32 ,$34.10 ,$64.48 , N/A , N/A ,$35.81 ,$131.75 ,$101.06 ,$43.40 ,$139.50 ,$130.20 ,$124.00 ,$124.00 ,$34.10 ,$100.75 
ST. FRANCIS HOSPITAL - ACUTE,27202743,N/A,HC TRAY CATH,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27202786,N/A,HC TRAY PERI-CERV BLOCK,272,1 ,$250.00 ,$162.50 ,$55.00 ,$250.00 ,$143.75 ,$180.00 ,$136.00 ,$55.00 ,$70.00 ,$140.25 ,$55.00 ,$163.00 ,$62.50 ,$163.00 ,$163.00 ,$62.50 ,$163.00 ,$104.50 ,$210.00 , N/A ,$55.00 ,$212.50 ,$210.00 ,$55.00 ,$187.50 ,$200.00 ,$200.00 ,$55.00 ,$200.00 ,$210.00 ,$210.00 ,$210.00 ,$250.00 ,$225.00 ,$143.75 ,$250.00 ,$55.00 ,$250.00 ,$136.00 ,$55.00 ,$104.00 , N/A , N/A ,$57.75 ,$212.50 ,$163.00 ,$70.00 ,$225.00 ,$210.00 ,$200.00 ,$200.00 ,$55.00 ,$162.50 
ST. FRANCIS HOSPITAL - ACUTE,27203103,N/A,HC DRSG PRIMAPORE,272,1 ,$12.00 ,$7.80 ,$2.64 ,$12.00 ,$6.90 ,$8.64 ,$6.53 ,$2.64 ,$3.36 ,$6.73 ,$2.64 ,$7.82 ,$3.00 ,$7.82 ,$7.82 ,$3.00 ,$7.82 ,$5.02 ,$10.08 , N/A ,$2.64 ,$10.20 ,$10.08 ,$2.64 ,$9.00 ,$9.60 ,$9.60 ,$2.64 ,$9.60 ,$10.08 ,$10.08 ,$10.08 ,$12.00 ,$10.80 ,$6.90 ,$12.00 ,$2.64 ,$12.00 ,$6.53 ,$2.64 ,$4.99 , N/A , N/A ,$2.77 ,$10.20 ,$7.82 ,$3.36 ,$10.80 ,$10.08 ,$9.60 ,$9.60 ,$2.64 ,$7.80 
ST. FRANCIS HOSPITAL - ACUTE,27203503,N/A,HC CANNULA NASAL HEATED HI FLOW,272,1 ,$185.00 ,$120.25 ,$40.70 ,$185.00 ,$106.38 ,$133.20 ,$100.64 ,$40.70 ,$51.80 ,$103.79 ,$40.70 ,$120.62 ,$46.25 ,$120.62 ,$120.62 ,$46.25 ,$120.62 ,$77.33 ,$155.40 , N/A ,$40.70 ,$157.25 ,$155.40 ,$40.70 ,$138.75 ,$148.00 ,$148.00 ,$40.70 ,$148.00 ,$155.40 ,$155.40 ,$155.40 ,$185.00 ,$166.50 ,$106.38 ,$185.00 ,$40.70 ,$185.00 ,$100.64 ,$40.70 ,$76.96 , N/A , N/A ,$42.74 ,$157.25 ,$120.62 ,$51.80 ,$166.50 ,$155.40 ,$148.00 ,$148.00 ,$40.70 ,$120.25 
ST. FRANCIS HOSPITAL - ACUTE,27203509,N/A,HC CATHETER FOLEY 3W,272,1 ,$245.00 ,$159.25 ,$53.90 ,$245.00 ,$140.88 ,$176.40 ,$133.28 ,$53.90 ,$68.60 ,$137.45 ,$53.90 ,$159.74 ,$61.25 ,$159.74 ,$159.74 ,$61.25 ,$159.74 ,$102.41 ,$205.80 , N/A ,$53.90 ,$208.25 ,$205.80 ,$53.90 ,$183.75 ,$196.00 ,$196.00 ,$53.90 ,$196.00 ,$205.80 ,$205.80 ,$205.80 ,$245.00 ,$220.50 ,$140.88 ,$245.00 ,$53.90 ,$245.00 ,$133.28 ,$53.90 ,$101.92 , N/A , N/A ,$56.60 ,$208.25 ,$159.74 ,$68.60 ,$220.50 ,$205.80 ,$196.00 ,$196.00 ,$53.90 ,$159.25 
ST. FRANCIS HOSPITAL - ACUTE,27203511,N/A,HC BAG LEG URINARY,272,1 ,$22.00 ,$14.30 ,$4.84 ,$22.00 ,$12.65 ,$15.84 ,$11.97 ,$4.84 ,$6.16 ,$12.34 ,$4.84 ,$14.34 ,$5.50 ,$14.34 ,$14.34 ,$5.50 ,$14.34 ,$9.20 ,$18.48 , N/A ,$4.84 ,$18.70 ,$18.48 ,$4.84 ,$16.50 ,$17.60 ,$17.60 ,$4.84 ,$17.60 ,$18.48 ,$18.48 ,$18.48 ,$22.00 ,$19.80 ,$12.65 ,$22.00 ,$4.84 ,$22.00 ,$11.97 ,$4.84 ,$9.15 , N/A , N/A ,$5.08 ,$18.70 ,$14.34 ,$6.16 ,$19.80 ,$18.48 ,$17.60 ,$17.60 ,$4.84 ,$14.30 
ST. FRANCIS HOSPITAL - ACUTE,27203519,A6223,HC DRESSING XEROFORM,272,1 ,$270.00 ,$175.50 ,$27.14 ,$270.00 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$27.14 ,$59.40 ,$27.14 ,$67.50 ,$27.14 ,$27.14 ,$67.50 ,$27.14 ,$112.86 ,$226.80 , N/A ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 , N/A , N/A ,$62.37 ,$229.50 ,$27.14 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,27203521,A6234,HC DRESSING DUODERM <16 SQ CM,272,1 ,$270.00 ,$175.50 ,$59.40 ,$270.00 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$73.33 ,$59.40 ,$73.33 ,$67.50 ,$73.33 ,$73.33 ,$67.50 ,$73.33 ,$112.86 ,$226.80 , N/A ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 , N/A , N/A ,$62.37 ,$229.50 ,$73.33 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,27203526,A6266,HC PACKING GAUZE IODOFORM,272,1 ,$13.00 ,$8.45 ,$2.86 ,$13.00 ,$7.48 ,$9.36 ,$7.07 ,$2.86 ,$3.64 ,$7.64 ,$2.86 ,$8.93 ,$3.25 ,$8.93 ,$8.93 ,$3.25 ,$8.93 ,$5.43 ,$10.92 , N/A ,$2.86 ,$11.05 ,$10.92 ,$2.86 ,$9.75 ,$10.40 ,$10.40 ,$2.86 ,$10.40 ,$10.92 ,$10.92 ,$10.92 ,$13.00 ,$11.70 ,$7.48 ,$13.00 ,$2.86 ,$13.00 ,$7.07 ,$2.86 ,$5.41 , N/A , N/A ,$3.00 ,$11.05 ,$8.93 ,$3.64 ,$11.70 ,$10.92 ,$10.40 ,$10.40 ,$2.86 ,$8.45 
ST. FRANCIS HOSPITAL - ACUTE,27203528,A6403,HC DRESSING KERLIX SPONGE >16  AND  <48 SQ CM,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$6.23 ,$5.72 ,$6.23 ,$6.50 ,$6.23 ,$6.23 ,$6.50 ,$6.23 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$6.23 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27203531,C1751,HC CATHETER CV TRIPLE-LUMEN,272,1 ,$302.00 ,$196.30 ,$66.44 ,$302.00 ,$173.65 ,$217.44 ,$164.29 ,$66.44 ,$84.56 ,$169.42 ,$66.44 ,$196.90 ,$75.50 ,$196.90 ,$196.90 ,$75.50 ,$196.90 ,$126.24 ,$253.68 , N/A ,$66.44 ,$256.70 ,$253.68 ,$66.44 ,$226.50 ,$241.60 ,$241.60 ,$66.44 ,$241.60 ,$253.68 ,$253.68 ,$253.68 ,$302.00 ,$271.80 ,$173.65 ,$302.00 ,$66.44 ,$302.00 ,$164.29 ,$66.44 ,$125.63 , N/A , N/A ,$69.76 ,$256.70 ,$196.90 ,$84.56 ,$271.80 ,$253.68 ,$241.60 ,$241.60 ,$66.44 ,$196.30 
ST. FRANCIS HOSPITAL - ACUTE,27203535,N/A,HC TRAY LUMBAR PUNCTURE,272,1 ,$263.00 ,$170.95 ,$57.86 ,$263.00 ,$151.23 ,$189.36 ,$143.07 ,$57.86 ,$73.64 ,$147.54 ,$57.86 ,$171.48 ,$65.75 ,$171.48 ,$171.48 ,$65.75 ,$171.48 ,$109.93 ,$220.92 , N/A ,$57.86 ,$223.55 ,$220.92 ,$57.86 ,$197.25 ,$210.40 ,$210.40 ,$57.86 ,$210.40 ,$220.92 ,$220.92 ,$220.92 ,$263.00 ,$236.70 ,$151.23 ,$263.00 ,$57.86 ,$263.00 ,$143.07 ,$57.86 ,$109.41 , N/A , N/A ,$60.75 ,$223.55 ,$171.48 ,$73.64 ,$236.70 ,$220.92 ,$210.40 ,$210.40 ,$57.86 ,$170.95 
ST. FRANCIS HOSPITAL - ACUTE,27203538,N/A,HC KIT ARTERIAL LINE,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27203557,N/A,HC CATHETER INTRAUTERINE,272,1 ,$346.00 ,$224.90 ,$76.12 ,$346.00 ,$198.95 ,$249.12 ,$188.22 ,$76.12 ,$96.88 ,$194.11 ,$76.12 ,$225.59 ,$86.50 ,$225.59 ,$225.59 ,$86.50 ,$225.59 ,$144.63 ,$290.64 , N/A ,$76.12 ,$294.10 ,$290.64 ,$76.12 ,$259.50 ,$276.80 ,$276.80 ,$76.12 ,$276.80 ,$290.64 ,$290.64 ,$290.64 ,$346.00 ,$311.40 ,$198.95 ,$346.00 ,$76.12 ,$346.00 ,$188.22 ,$76.12 ,$143.94 , N/A , N/A ,$79.93 ,$294.10 ,$225.59 ,$96.88 ,$311.40 ,$290.64 ,$276.80 ,$276.80 ,$76.12 ,$224.90 
ST. FRANCIS HOSPITAL - ACUTE,27203558,N/A,HC EXTRACTOR,272,1 ,$225.00 ,$146.25 ,$49.50 ,$225.00 ,$129.38 ,$162.00 ,$122.40 ,$49.50 ,$63.00 ,$126.23 ,$49.50 ,$146.70 ,$56.25 ,$146.70 ,$146.70 ,$56.25 ,$146.70 ,$94.05 ,$189.00 , N/A ,$49.50 ,$191.25 ,$189.00 ,$49.50 ,$168.75 ,$180.00 ,$180.00 ,$49.50 ,$180.00 ,$189.00 ,$189.00 ,$189.00 ,$225.00 ,$202.50 ,$129.38 ,$225.00 ,$49.50 ,$225.00 ,$122.40 ,$49.50 ,$93.60 , N/A , N/A ,$51.98 ,$191.25 ,$146.70 ,$63.00 ,$202.50 ,$189.00 ,$180.00 ,$180.00 ,$49.50 ,$146.25 
ST. FRANCIS HOSPITAL - ACUTE,27203560,N/A,HC CATHETER IV,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27203562,N/A,HC CATHETER SUCTION,272,1 ,$134.00 ,$87.10 ,$29.48 ,$134.00 ,$77.05 ,$96.48 ,$72.90 ,$29.48 ,$37.52 ,$75.17 ,$29.48 ,$87.37 ,$33.50 ,$87.37 ,$87.37 ,$33.50 ,$87.37 ,$56.01 ,$112.56 , N/A ,$29.48 ,$113.90 ,$112.56 ,$29.48 ,$100.50 ,$107.20 ,$107.20 ,$29.48 ,$107.20 ,$112.56 ,$112.56 ,$112.56 ,$134.00 ,$120.60 ,$77.05 ,$134.00 ,$29.48 ,$134.00 ,$72.90 ,$29.48 ,$55.74 , N/A , N/A ,$30.95 ,$113.90 ,$87.37 ,$37.52 ,$120.60 ,$112.56 ,$107.20 ,$107.20 ,$29.48 ,$87.10 
ST. FRANCIS HOSPITAL - ACUTE,27203575,N/A,HC DRESSING TELFA,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27203576,N/A,HC DRESSING V.A.C.,272,1 ,$78.00 ,$50.70 ,$17.16 ,$78.00 ,$44.85 ,$56.16 ,$42.43 ,$17.16 ,$21.84 ,$43.76 ,$17.16 ,$50.86 ,$19.50 ,$50.86 ,$50.86 ,$19.50 ,$50.86 ,$32.60 ,$65.52 , N/A ,$17.16 ,$66.30 ,$65.52 ,$17.16 ,$58.50 ,$62.40 ,$62.40 ,$17.16 ,$62.40 ,$65.52 ,$65.52 ,$65.52 ,$78.00 ,$70.20 ,$44.85 ,$78.00 ,$17.16 ,$78.00 ,$42.43 ,$17.16 ,$32.45 , N/A , N/A ,$18.02 ,$66.30 ,$50.86 ,$21.84 ,$70.20 ,$65.52 ,$62.40 ,$62.40 ,$17.16 ,$50.70 
ST. FRANCIS HOSPITAL - ACUTE,27203586,N/A,HC SALEM SUMP,272,1 ,$62.00 ,$40.30 ,$13.64 ,$62.00 ,$35.65 ,$44.64 ,$33.73 ,$13.64 ,$17.36 ,$34.78 ,$13.64 ,$40.42 ,$15.50 ,$40.42 ,$40.42 ,$15.50 ,$40.42 ,$25.92 ,$52.08 , N/A ,$13.64 ,$52.70 ,$52.08 ,$13.64 ,$46.50 ,$49.60 ,$49.60 ,$13.64 ,$49.60 ,$52.08 ,$52.08 ,$52.08 ,$62.00 ,$55.80 ,$35.65 ,$62.00 ,$13.64 ,$62.00 ,$33.73 ,$13.64 ,$25.79 , N/A , N/A ,$14.32 ,$52.70 ,$40.42 ,$17.36 ,$55.80 ,$52.08 ,$49.60 ,$49.60 ,$13.64 ,$40.30 
ST. FRANCIS HOSPITAL - ACUTE,27203591,N/A,HC TRAP SPECIMEN,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27203597,N/A,HC TUBING ANY,272,1 ,$57.00 ,$37.05 ,$12.54 ,$57.00 ,$32.78 ,$41.04 ,$31.01 ,$12.54 ,$15.96 ,$31.98 ,$12.54 ,$37.16 ,$14.25 ,$37.16 ,$37.16 ,$14.25 ,$37.16 ,$23.83 ,$47.88 , N/A ,$12.54 ,$48.45 ,$47.88 ,$12.54 ,$42.75 ,$45.60 ,$45.60 ,$12.54 ,$45.60 ,$47.88 ,$47.88 ,$47.88 ,$57.00 ,$51.30 ,$32.78 ,$57.00 ,$12.54 ,$57.00 ,$31.01 ,$12.54 ,$23.71 , N/A , N/A ,$13.17 ,$48.45 ,$37.16 ,$15.96 ,$51.30 ,$47.88 ,$45.60 ,$45.60 ,$12.54 ,$37.05 
ST. FRANCIS HOSPITAL - ACUTE,27203612,N/A,HC KIT TRACHEOSTOMY CARE,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27203626,N/A,HC TUBE ENDOTRACH,272,1 ,$89.00 ,$57.85 ,$19.58 ,$89.00 ,$51.18 ,$64.08 ,$48.42 ,$19.58 ,$24.92 ,$49.93 ,$19.58 ,$58.03 ,$22.25 ,$58.03 ,$58.03 ,$22.25 ,$58.03 ,$37.20 ,$74.76 , N/A ,$19.58 ,$75.65 ,$74.76 ,$19.58 ,$66.75 ,$71.20 ,$71.20 ,$19.58 ,$71.20 ,$74.76 ,$74.76 ,$74.76 ,$89.00 ,$80.10 ,$51.18 ,$89.00 ,$19.58 ,$89.00 ,$48.42 ,$19.58 ,$37.02 , N/A , N/A ,$20.56 ,$75.65 ,$58.03 ,$24.92 ,$80.10 ,$74.76 ,$71.20 ,$71.20 ,$19.58 ,$57.85 
ST. FRANCIS HOSPITAL - ACUTE,27203703,C1751,HC CATHETER PICC,272,1 ,$420.00 ,$273.00 ,$92.40 ,$420.00 ,$241.50 ,$302.40 ,$228.48 ,$92.40 ,$117.60 ,$235.62 ,$92.40 ,$273.84 ,$105.00 ,$273.84 ,$273.84 ,$105.00 ,$273.84 ,$175.56 ,$352.80 , N/A ,$92.40 ,$357.00 ,$352.80 ,$92.40 ,$315.00 ,$336.00 ,$336.00 ,$92.40 ,$336.00 ,$352.80 ,$352.80 ,$352.80 ,$420.00 ,$378.00 ,$241.50 ,$420.00 ,$92.40 ,$420.00 ,$228.48 ,$92.40 ,$174.72 , N/A , N/A ,$97.02 ,$357.00 ,$273.84 ,$117.60 ,$378.00 ,$352.80 ,$336.00 ,$336.00 ,$92.40 ,$273.00 
ST. FRANCIS HOSPITAL - ACUTE,27203827,C1894,HC INTRODUCER/SHEATH/CATH,272,1 ,$90.00 ,$58.50 ,$19.80 ,$90.00 ,$51.75 ,$64.80 ,$48.96 ,$19.80 ,$25.20 ,$50.49 ,$19.80 ,$58.68 ,$22.50 ,$58.68 ,$58.68 ,$22.50 ,$58.68 ,$37.62 ,$75.60 , N/A ,$19.80 ,$76.50 ,$75.60 ,$19.80 ,$67.50 ,$72.00 ,$72.00 ,$19.80 ,$72.00 ,$75.60 ,$75.60 ,$75.60 ,$90.00 ,$81.00 ,$51.75 ,$90.00 ,$19.80 ,$90.00 ,$48.96 ,$19.80 ,$37.44 , N/A , N/A ,$20.79 ,$76.50 ,$58.68 ,$25.20 ,$81.00 ,$75.60 ,$72.00 ,$72.00 ,$19.80 ,$58.50 
ST. FRANCIS HOSPITAL - ACUTE,27203841,N/A,HC BALLOON DILATOR CERVICAL,272,1 ,$126.00 ,$81.90 ,$27.72 ,$126.00 ,$72.45 ,$90.72 ,$68.54 ,$27.72 ,$35.28 ,$70.69 ,$27.72 ,$82.15 ,$31.50 ,$82.15 ,$82.15 ,$31.50 ,$82.15 ,$52.67 ,$105.84 , N/A ,$27.72 ,$107.10 ,$105.84 ,$27.72 ,$94.50 ,$100.80 ,$100.80 ,$27.72 ,$100.80 ,$105.84 ,$105.84 ,$105.84 ,$126.00 ,$113.40 ,$72.45 ,$126.00 ,$27.72 ,$126.00 ,$68.54 ,$27.72 ,$52.42 , N/A , N/A ,$29.11 ,$107.10 ,$82.15 ,$35.28 ,$113.40 ,$105.84 ,$100.80 ,$100.80 ,$27.72 ,$81.90 
ST. FRANCIS HOSPITAL - ACUTE,27203847,N/A,HC NEEDLE INTRAOSSEOUS,272,1 ,$133.00 ,$86.45 ,$29.26 ,$133.00 ,$76.48 ,$95.76 ,$72.35 ,$29.26 ,$37.24 ,$74.61 ,$29.26 ,$86.72 ,$33.25 ,$86.72 ,$86.72 ,$33.25 ,$86.72 ,$55.59 ,$111.72 , N/A ,$29.26 ,$113.05 ,$111.72 ,$29.26 ,$99.75 ,$106.40 ,$106.40 ,$29.26 ,$106.40 ,$111.72 ,$111.72 ,$111.72 ,$133.00 ,$119.70 ,$76.48 ,$133.00 ,$29.26 ,$133.00 ,$72.35 ,$29.26 ,$55.33 , N/A , N/A ,$30.72 ,$113.05 ,$86.72 ,$37.24 ,$119.70 ,$111.72 ,$106.40 ,$106.40 ,$29.26 ,$86.45 
ST. FRANCIS HOSPITAL - ACUTE,27203871,N/A,HC NASAL RHINO ROCKET,272,1 ,$151.00 ,$98.15 ,$33.22 ,$151.00 ,$86.83 ,$108.72 ,$82.14 ,$33.22 ,$42.28 ,$84.71 ,$33.22 ,$98.45 ,$37.75 ,$98.45 ,$98.45 ,$37.75 ,$98.45 ,$63.12 ,$126.84 , N/A ,$33.22 ,$128.35 ,$126.84 ,$33.22 ,$113.25 ,$120.80 ,$120.80 ,$33.22 ,$120.80 ,$126.84 ,$126.84 ,$126.84 ,$151.00 ,$135.90 ,$86.83 ,$151.00 ,$33.22 ,$151.00 ,$82.14 ,$33.22 ,$62.82 , N/A , N/A ,$34.88 ,$128.35 ,$98.45 ,$42.28 ,$135.90 ,$126.84 ,$120.80 ,$120.80 ,$33.22 ,$98.15 
ST. FRANCIS HOSPITAL - ACUTE,27204594,N/A,HC SPONGE GELFOAM,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27204596,N/A,HC SUCTION TIP,272,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27204603,N/A,HC TRAY UMBILICAL CATH,272,1 ,$165.00 ,$107.25 ,$36.30 ,$165.00 ,$94.88 ,$118.80 ,$89.76 ,$36.30 ,$46.20 ,$92.57 ,$36.30 ,$107.58 ,$41.25 ,$107.58 ,$107.58 ,$41.25 ,$107.58 ,$68.97 ,$138.60 , N/A ,$36.30 ,$140.25 ,$138.60 ,$36.30 ,$123.75 ,$132.00 ,$132.00 ,$36.30 ,$132.00 ,$138.60 ,$138.60 ,$138.60 ,$165.00 ,$148.50 ,$94.88 ,$165.00 ,$36.30 ,$165.00 ,$89.76 ,$36.30 ,$68.64 , N/A , N/A ,$38.12 ,$140.25 ,$107.58 ,$46.20 ,$148.50 ,$138.60 ,$132.00 ,$132.00 ,$36.30 ,$107.25 
ST. FRANCIS HOSPITAL - ACUTE,27204607,N/A,HC TUBE NASOGASTRIC,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27204612,N/A,HC TUBING EXTENSION,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27204615,N/A,HC TUBING Y,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27204622,N/A,HC MARKER BIOPSY SITE,272,1 ,$211.00 ,$137.15 ,$46.42 ,$211.00 ,$121.33 ,$151.92 ,$114.78 ,$46.42 ,$59.08 ,$118.37 ,$46.42 ,$137.57 ,$52.75 ,$137.57 ,$137.57 ,$52.75 ,$137.57 ,$88.20 ,$177.24 , N/A ,$46.42 ,$179.35 ,$177.24 ,$46.42 ,$158.25 ,$168.80 ,$168.80 ,$46.42 ,$168.80 ,$177.24 ,$177.24 ,$177.24 ,$211.00 ,$189.90 ,$121.33 ,$211.00 ,$46.42 ,$211.00 ,$114.78 ,$46.42 ,$87.78 , N/A , N/A ,$48.74 ,$179.35 ,$137.57 ,$59.08 ,$189.90 ,$177.24 ,$168.80 ,$168.80 ,$46.42 ,$137.15 
ST. FRANCIS HOSPITAL - ACUTE,27204654,N/A,HC BAG RESUSCITATE INFANT,272,1 ,$53.00 ,$34.45 ,$11.66 ,$53.00 ,$30.48 ,$38.16 ,$28.83 ,$11.66 ,$14.84 ,$29.73 ,$11.66 ,$34.56 ,$13.25 ,$34.56 ,$34.56 ,$13.25 ,$34.56 ,$22.15 ,$44.52 , N/A ,$11.66 ,$45.05 ,$44.52 ,$11.66 ,$39.75 ,$42.40 ,$42.40 ,$11.66 ,$42.40 ,$44.52 ,$44.52 ,$44.52 ,$53.00 ,$47.70 ,$30.48 ,$53.00 ,$11.66 ,$53.00 ,$28.83 ,$11.66 ,$22.05 , N/A , N/A ,$12.24 ,$45.05 ,$34.56 ,$14.84 ,$47.70 ,$44.52 ,$42.40 ,$42.40 ,$11.66 ,$34.45 
ST. FRANCIS HOSPITAL - ACUTE,27204655,N/A,HC BAG RESUSCITATE PEDIATRIC,272,1 ,$53.00 ,$34.45 ,$11.66 ,$53.00 ,$30.48 ,$38.16 ,$28.83 ,$11.66 ,$14.84 ,$29.73 ,$11.66 ,$34.56 ,$13.25 ,$34.56 ,$34.56 ,$13.25 ,$34.56 ,$22.15 ,$44.52 , N/A ,$11.66 ,$45.05 ,$44.52 ,$11.66 ,$39.75 ,$42.40 ,$42.40 ,$11.66 ,$42.40 ,$44.52 ,$44.52 ,$44.52 ,$53.00 ,$47.70 ,$30.48 ,$53.00 ,$11.66 ,$53.00 ,$28.83 ,$11.66 ,$22.05 , N/A , N/A ,$12.24 ,$45.05 ,$34.56 ,$14.84 ,$47.70 ,$44.52 ,$42.40 ,$42.40 ,$11.66 ,$34.45 
ST. FRANCIS HOSPITAL - ACUTE,27204656,N/A,HC BAG RESUSCITOR,272,1 ,$52.00 ,$33.80 ,$11.44 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$29.17 ,$11.44 ,$33.90 ,$13.00 ,$33.90 ,$33.90 ,$13.00 ,$33.90 ,$21.74 ,$43.68 , N/A ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 , N/A , N/A ,$12.01 ,$44.20 ,$33.90 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,27204657,N/A,HC CANISTER V.A.C.,272,1 ,$65.00 ,$42.25 ,$14.30 ,$65.00 ,$37.38 ,$46.80 ,$35.36 ,$14.30 ,$18.20 ,$36.47 ,$14.30 ,$42.38 ,$16.25 ,$42.38 ,$42.38 ,$16.25 ,$42.38 ,$27.17 ,$54.60 , N/A ,$14.30 ,$55.25 ,$54.60 ,$14.30 ,$48.75 ,$52.00 ,$52.00 ,$14.30 ,$52.00 ,$54.60 ,$54.60 ,$54.60 ,$65.00 ,$58.50 ,$37.38 ,$65.00 ,$14.30 ,$65.00 ,$35.36 ,$14.30 ,$27.04 , N/A , N/A ,$15.02 ,$55.25 ,$42.38 ,$18.20 ,$58.50 ,$54.60 ,$52.00 ,$52.00 ,$14.30 ,$42.25 
ST. FRANCIS HOSPITAL - ACUTE,27204692,N/A,HC MASK NON-REBREATHER ADULT,272,1 ,$13.00 ,$8.45 ,$2.86 ,$13.00 ,$7.48 ,$9.36 ,$7.07 ,$2.86 ,$3.64 ,$7.29 ,$2.86 ,$8.48 ,$3.25 ,$8.48 ,$8.48 ,$3.25 ,$8.48 ,$5.43 ,$10.92 , N/A ,$2.86 ,$11.05 ,$10.92 ,$2.86 ,$9.75 ,$10.40 ,$10.40 ,$2.86 ,$10.40 ,$10.92 ,$10.92 ,$10.92 ,$13.00 ,$11.70 ,$7.48 ,$13.00 ,$2.86 ,$13.00 ,$7.07 ,$2.86 ,$5.41 , N/A , N/A ,$3.00 ,$11.05 ,$8.48 ,$3.64 ,$11.70 ,$10.92 ,$10.40 ,$10.40 ,$2.86 ,$8.45 
ST. FRANCIS HOSPITAL - ACUTE,27204771,N/A,HC BLADE LARYNGOSCOPE,272,1 ,$39.00 ,$25.35 ,$8.58 ,$39.00 ,$22.43 ,$28.08 ,$21.22 ,$8.58 ,$10.92 ,$21.88 ,$8.58 ,$25.43 ,$9.75 ,$25.43 ,$25.43 ,$9.75 ,$25.43 ,$16.30 ,$32.76 , N/A ,$8.58 ,$33.15 ,$32.76 ,$8.58 ,$29.25 ,$31.20 ,$31.20 ,$8.58 ,$31.20 ,$32.76 ,$32.76 ,$32.76 ,$39.00 ,$35.10 ,$22.43 ,$39.00 ,$8.58 ,$39.00 ,$21.22 ,$8.58 ,$16.22 , N/A , N/A ,$9.01 ,$33.15 ,$25.43 ,$10.92 ,$35.10 ,$32.76 ,$31.20 ,$31.20 ,$8.58 ,$25.35 
ST. FRANCIS HOSPITAL - ACUTE,27204869,N/A,HC IV ANGIOCATH,272,1 ,$59.00 ,$38.35 ,$12.98 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$33.10 ,$12.98 ,$38.47 ,$14.75 ,$38.47 ,$38.47 ,$14.75 ,$38.47 ,$24.66 ,$49.56 , N/A ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 , N/A , N/A ,$13.63 ,$50.15 ,$38.47 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,27204901,N/A,HC KIT IRRIGATION PISTON SYRINGE,272,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$28.05 ,$11.00 ,$32.60 ,$12.50 ,$32.60 ,$32.60 ,$12.50 ,$32.60 ,$20.90 ,$42.00 , N/A ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 , N/A , N/A ,$11.55 ,$42.50 ,$32.60 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,27204937,N/A,HC NEEDLE NERVE BLOCK STIMULATING,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27204957,N/A,HC BARRIER PROTECTANT SENSI-CARE,272,1 ,$34.00 ,$22.10 ,$7.48 ,$34.00 ,$19.55 ,$24.48 ,$18.50 ,$7.48 ,$9.52 ,$19.07 ,$7.48 ,$22.17 ,$8.50 ,$22.17 ,$22.17 ,$8.50 ,$22.17 ,$14.21 ,$28.56 , N/A ,$7.48 ,$28.90 ,$28.56 ,$7.48 ,$25.50 ,$27.20 ,$27.20 ,$7.48 ,$27.20 ,$28.56 ,$28.56 ,$28.56 ,$34.00 ,$30.60 ,$19.55 ,$34.00 ,$7.48 ,$34.00 ,$18.50 ,$7.48 ,$14.14 , N/A , N/A ,$7.85 ,$28.90 ,$22.17 ,$9.52 ,$30.60 ,$28.56 ,$27.20 ,$27.20 ,$7.48 ,$22.10 
ST. FRANCIS HOSPITAL - ACUTE,27204966,N/A,HC OSTOMY POUCH,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27204968,N/A,HC OSTOMY PASTE,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27204969,N/A,HC OSTOMY STOMAHESIVE POWDER,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27205010,N/A,HC VALVE ANTI-REFLUX SALEM,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205028,N/A,HC STAPLE REMOVER SKIN,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205029,N/A,HC STATLOCK DEVICE FOLEY,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205033,N/A,HC STOPCOCK 4 WAY,272,1 ,$22.00 ,$14.30 ,$4.84 ,$22.00 ,$12.65 ,$15.84 ,$11.97 ,$4.84 ,$6.16 ,$12.34 ,$4.84 ,$14.34 ,$5.50 ,$14.34 ,$14.34 ,$5.50 ,$14.34 ,$9.20 ,$18.48 , N/A ,$4.84 ,$18.70 ,$18.48 ,$4.84 ,$16.50 ,$17.60 ,$17.60 ,$4.84 ,$17.60 ,$18.48 ,$18.48 ,$18.48 ,$22.00 ,$19.80 ,$12.65 ,$22.00 ,$4.84 ,$22.00 ,$11.97 ,$4.84 ,$9.15 , N/A , N/A ,$5.08 ,$18.70 ,$14.34 ,$6.16 ,$19.80 ,$18.48 ,$17.60 ,$17.60 ,$4.84 ,$14.30 
ST. FRANCIS HOSPITAL - ACUTE,27205049,N/A,HC TAPE MEDIPORE,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27205058,N/A,HC TRAY FOLEY,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205063,N/A,HC TRAY SUTURE REMOVAL,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205083,N/A,HC TUBING BLOOD WARMING,272,1 ,$15.00 ,$9.75 ,$3.30 ,$15.00 ,$8.63 ,$10.80 ,$8.16 ,$3.30 ,$4.20 ,$8.42 ,$3.30 ,$9.78 ,$3.75 ,$9.78 ,$9.78 ,$3.75 ,$9.78 ,$6.27 ,$12.60 , N/A ,$3.30 ,$12.75 ,$12.60 ,$3.30 ,$11.25 ,$12.00 ,$12.00 ,$3.30 ,$12.00 ,$12.60 ,$12.60 ,$12.60 ,$15.00 ,$13.50 ,$8.63 ,$15.00 ,$3.30 ,$15.00 ,$8.16 ,$3.30 ,$6.24 , N/A , N/A ,$3.47 ,$12.75 ,$9.78 ,$4.20 ,$13.50 ,$12.60 ,$12.00 ,$12.00 ,$3.30 ,$9.75 
ST. FRANCIS HOSPITAL - ACUTE,27205084,N/A,HC TUBING FEEDING KANGAROO,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205095,N/A,HC WEDGE WAFFLE,272,1 ,$44.00 ,$28.60 ,$9.68 ,$44.00 ,$25.30 ,$31.68 ,$23.94 ,$9.68 ,$12.32 ,$24.68 ,$9.68 ,$28.69 ,$11.00 ,$28.69 ,$28.69 ,$11.00 ,$28.69 ,$18.39 ,$36.96 , N/A ,$9.68 ,$37.40 ,$36.96 ,$9.68 ,$33.00 ,$35.20 ,$35.20 ,$9.68 ,$35.20 ,$36.96 ,$36.96 ,$36.96 ,$44.00 ,$39.60 ,$25.30 ,$44.00 ,$9.68 ,$44.00 ,$23.94 ,$9.68 ,$18.30 , N/A , N/A ,$10.16 ,$37.40 ,$28.69 ,$12.32 ,$39.60 ,$36.96 ,$35.20 ,$35.20 ,$9.68 ,$28.60 
ST. FRANCIS HOSPITAL - ACUTE,27205105,N/A,HC DRESSING NASAL RHINO ROCKET RAPID,272,1 ,$86.00 ,$55.90 ,$18.92 ,$86.00 ,$49.45 ,$61.92 ,$46.78 ,$18.92 ,$24.08 ,$48.25 ,$18.92 ,$56.07 ,$21.50 ,$56.07 ,$56.07 ,$21.50 ,$56.07 ,$35.95 ,$72.24 , N/A ,$18.92 ,$73.10 ,$72.24 ,$18.92 ,$64.50 ,$68.80 ,$68.80 ,$18.92 ,$68.80 ,$72.24 ,$72.24 ,$72.24 ,$86.00 ,$77.40 ,$49.45 ,$86.00 ,$18.92 ,$86.00 ,$46.78 ,$18.92 ,$35.78 , N/A , N/A ,$19.87 ,$73.10 ,$56.07 ,$24.08 ,$77.40 ,$72.24 ,$68.80 ,$68.80 ,$18.92 ,$55.90 
ST. FRANCIS HOSPITAL - ACUTE,27205115,N/A,HC DRESSING AQUACEL AG,272,1 ,$22.00 ,$14.30 ,$4.84 ,$22.00 ,$12.65 ,$15.84 ,$11.97 ,$4.84 ,$6.16 ,$12.34 ,$4.84 ,$14.34 ,$5.50 ,$14.34 ,$14.34 ,$5.50 ,$14.34 ,$9.20 ,$18.48 , N/A ,$4.84 ,$18.70 ,$18.48 ,$4.84 ,$16.50 ,$17.60 ,$17.60 ,$4.84 ,$17.60 ,$18.48 ,$18.48 ,$18.48 ,$22.00 ,$19.80 ,$12.65 ,$22.00 ,$4.84 ,$22.00 ,$11.97 ,$4.84 ,$9.15 , N/A , N/A ,$5.08 ,$18.70 ,$14.34 ,$6.16 ,$19.80 ,$18.48 ,$17.60 ,$17.60 ,$4.84 ,$14.30 
ST. FRANCIS HOSPITAL - ACUTE,27205125,N/A,HC CATHETER NASAL,272,1 ,$177.00 ,$115.05 ,$38.94 ,$177.00 ,$101.78 ,$127.44 ,$96.29 ,$38.94 ,$49.56 ,$99.30 ,$38.94 ,$115.40 ,$44.25 ,$115.40 ,$115.40 ,$44.25 ,$115.40 ,$73.99 ,$148.68 , N/A ,$38.94 ,$150.45 ,$148.68 ,$38.94 ,$132.75 ,$141.60 ,$141.60 ,$38.94 ,$141.60 ,$148.68 ,$148.68 ,$148.68 ,$177.00 ,$159.30 ,$101.78 ,$177.00 ,$38.94 ,$177.00 ,$96.29 ,$38.94 ,$73.63 , N/A , N/A ,$40.89 ,$150.45 ,$115.40 ,$49.56 ,$159.30 ,$148.68 ,$141.60 ,$141.60 ,$38.94 ,$115.05 
ST. FRANCIS HOSPITAL - ACUTE,27205181,N/A,HC STRYKER AIR 2 MATTRESS OVERLAY,272,1 ,$85.00 ,$55.25 ,$18.70 ,$85.00 ,$48.88 ,$61.20 ,$46.24 ,$18.70 ,$23.80 ,$47.69 ,$18.70 ,$55.42 ,$21.25 ,$55.42 ,$55.42 ,$21.25 ,$55.42 ,$35.53 ,$71.40 , N/A ,$18.70 ,$72.25 ,$71.40 ,$18.70 ,$63.75 ,$68.00 ,$68.00 ,$18.70 ,$68.00 ,$71.40 ,$71.40 ,$71.40 ,$85.00 ,$76.50 ,$48.88 ,$85.00 ,$18.70 ,$85.00 ,$46.24 ,$18.70 ,$35.36 , N/A , N/A ,$19.64 ,$72.25 ,$55.42 ,$23.80 ,$76.50 ,$71.40 ,$68.00 ,$68.00 ,$18.70 ,$55.25 
ST. FRANCIS HOSPITAL - ACUTE,27205275,N/A,HC ADAPTER CPAP,272,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 , N/A ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 , N/A , N/A ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,27205283,N/A,HC AIRWAY ORAL NASAL,272,1 ,$10.00 ,$6.50 ,$2.20 ,$10.00 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.61 ,$2.20 ,$6.52 ,$2.50 ,$6.52 ,$6.52 ,$2.50 ,$6.52 ,$4.18 ,$8.40 , N/A ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$10.00 ,$5.44 ,$2.20 ,$4.16 , N/A , N/A ,$2.31 ,$8.50 ,$6.52 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,27205287,N/A,HC BAG TUBING,272,1 ,$146.00 ,$94.90 ,$32.12 ,$146.00 ,$83.95 ,$105.12 ,$79.42 ,$32.12 ,$40.88 ,$81.91 ,$32.12 ,$95.19 ,$36.50 ,$95.19 ,$95.19 ,$36.50 ,$95.19 ,$61.03 ,$122.64 , N/A ,$32.12 ,$124.10 ,$122.64 ,$32.12 ,$109.50 ,$116.80 ,$116.80 ,$32.12 ,$116.80 ,$122.64 ,$122.64 ,$122.64 ,$146.00 ,$131.40 ,$83.95 ,$146.00 ,$32.12 ,$146.00 ,$79.42 ,$32.12 ,$60.74 , N/A , N/A ,$33.73 ,$124.10 ,$95.19 ,$40.88 ,$131.40 ,$122.64 ,$116.80 ,$116.80 ,$32.12 ,$94.90 
ST. FRANCIS HOSPITAL - ACUTE,27205288,N/A,HC BANDAGE ADHESIVE,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205291,N/A,HC BARRIER OSTOMY OINTMENT,270,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205294,N/A,HC SWAB BETADINE,270,1 ,$3.00 ,$1.95 ,$0.66 ,$3.00 ,$1.73 ,$2.16 ,$1.63 ,$0.66 ,$0.84 ,$1.68 ,$0.66 ,$1.96 ,$0.75 ,$1.96 ,$1.96 ,$0.75 ,$1.96 ,$1.25 ,$2.52 , N/A ,$0.66 ,$2.55 ,$2.52 ,$0.66 ,$2.25 ,$2.40 ,$2.40 ,$0.66 ,$2.40 ,$2.52 ,$2.52 ,$2.52 ,$3.00 ,$2.70 ,$1.73 ,$3.00 ,$0.66 ,$3.00 ,$1.63 ,$0.66 ,$1.25 , N/A , N/A ,$0.69 ,$2.55 ,$1.96 ,$0.84 ,$2.70 ,$2.52 ,$2.40 ,$2.40 ,$0.66 ,$1.95 
ST. FRANCIS HOSPITAL - ACUTE,27205298,N/A,HC CATHETER FOLEY COUDE,272,1 ,$241.00 ,$156.65 ,$53.02 ,$241.00 ,$138.58 ,$173.52 ,$131.10 ,$53.02 ,$67.48 ,$135.20 ,$53.02 ,$157.13 ,$60.25 ,$157.13 ,$157.13 ,$60.25 ,$157.13 ,$100.74 ,$202.44 , N/A ,$53.02 ,$204.85 ,$202.44 ,$53.02 ,$180.75 ,$192.80 ,$192.80 ,$53.02 ,$192.80 ,$202.44 ,$202.44 ,$202.44 ,$241.00 ,$216.90 ,$138.58 ,$241.00 ,$53.02 ,$241.00 ,$131.10 ,$53.02 ,$100.26 , N/A , N/A ,$55.67 ,$204.85 ,$157.13 ,$67.48 ,$216.90 ,$202.44 ,$192.80 ,$192.80 ,$53.02 ,$156.65 
ST. FRANCIS HOSPITAL - ACUTE,27205300,N/A,HC CAUTERY PEN LOW TEMP,272,1 ,$39.00 ,$25.35 ,$8.58 ,$39.00 ,$22.43 ,$28.08 ,$21.22 ,$8.58 ,$10.92 ,$21.88 ,$8.58 ,$25.43 ,$9.75 ,$25.43 ,$25.43 ,$9.75 ,$25.43 ,$16.30 ,$32.76 , N/A ,$8.58 ,$33.15 ,$32.76 ,$8.58 ,$29.25 ,$31.20 ,$31.20 ,$8.58 ,$31.20 ,$32.76 ,$32.76 ,$32.76 ,$39.00 ,$35.10 ,$22.43 ,$39.00 ,$8.58 ,$39.00 ,$21.22 ,$8.58 ,$16.22 , N/A , N/A ,$9.01 ,$33.15 ,$25.43 ,$10.92 ,$35.10 ,$32.76 ,$31.20 ,$31.20 ,$8.58 ,$25.35 
ST. FRANCIS HOSPITAL - ACUTE,27205301,N/A,HC CLEANSER WOUND,272,1 ,$51.00 ,$33.15 ,$11.22 ,$51.00 ,$29.33 ,$36.72 ,$27.74 ,$11.22 ,$14.28 ,$28.61 ,$11.22 ,$33.25 ,$12.75 ,$33.25 ,$33.25 ,$12.75 ,$33.25 ,$21.32 ,$42.84 , N/A ,$11.22 ,$43.35 ,$42.84 ,$11.22 ,$38.25 ,$40.80 ,$40.80 ,$11.22 ,$40.80 ,$42.84 ,$42.84 ,$42.84 ,$51.00 ,$45.90 ,$29.33 ,$51.00 ,$11.22 ,$51.00 ,$27.74 ,$11.22 ,$21.22 , N/A , N/A ,$11.78 ,$43.35 ,$33.25 ,$14.28 ,$45.90 ,$42.84 ,$40.80 ,$40.80 ,$11.22 ,$33.15 
ST. FRANCIS HOSPITAL - ACUTE,27205306,N/A,HC ELECTRODE NONINVASIVE PACING PAD,272,1 ,$70.00 ,$45.50 ,$15.40 ,$70.00 ,$40.25 ,$50.40 ,$38.08 ,$15.40 ,$19.60 ,$39.27 ,$15.40 ,$45.64 ,$17.50 ,$45.64 ,$45.64 ,$17.50 ,$45.64 ,$29.26 ,$58.80 , N/A ,$15.40 ,$59.50 ,$58.80 ,$15.40 ,$52.50 ,$56.00 ,$56.00 ,$15.40 ,$56.00 ,$58.80 ,$58.80 ,$58.80 ,$70.00 ,$63.00 ,$40.25 ,$70.00 ,$15.40 ,$70.00 ,$38.08 ,$15.40 ,$29.12 , N/A , N/A ,$16.17 ,$59.50 ,$45.64 ,$19.60 ,$63.00 ,$58.80 ,$56.00 ,$56.00 ,$15.40 ,$45.50 
ST. FRANCIS HOSPITAL - ACUTE,27205310,N/A,HC KIT ENEMA,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205317,N/A,HC NEEDLE NON-CORING,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205318,N/A,HC NEEDLE ANGLED,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205324,N/A,HC PAD ABDOMNINAL,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205334,N/A,HC TRAY ENT,272,1 ,$64.00 ,$41.60 ,$14.08 ,$64.00 ,$36.80 ,$46.08 ,$34.82 ,$14.08 ,$17.92 ,$35.90 ,$14.08 ,$41.73 ,$16.00 ,$41.73 ,$41.73 ,$16.00 ,$41.73 ,$26.75 ,$53.76 , N/A ,$14.08 ,$54.40 ,$53.76 ,$14.08 ,$48.00 ,$51.20 ,$51.20 ,$14.08 ,$51.20 ,$53.76 ,$53.76 ,$53.76 ,$64.00 ,$57.60 ,$36.80 ,$64.00 ,$14.08 ,$64.00 ,$34.82 ,$14.08 ,$26.62 , N/A , N/A ,$14.78 ,$54.40 ,$41.73 ,$17.92 ,$57.60 ,$53.76 ,$51.20 ,$51.20 ,$14.08 ,$41.60 
ST. FRANCIS HOSPITAL - ACUTE,27205335,N/A,HC TRAY EPISIOTOMY,272,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$26.93 ,$10.56 ,$31.30 ,$12.00 ,$31.30 ,$31.30 ,$12.00 ,$31.30 ,$20.06 ,$40.32 , N/A ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 , N/A , N/A ,$11.09 ,$40.80 ,$31.30 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,27205339,N/A,HC KIT DRESSING,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205341,N/A,HC DRESSING BANDAGE ACE DOUBLE,272,1 ,$43.00 ,$27.95 ,$9.46 ,$43.00 ,$24.73 ,$30.96 ,$23.39 ,$9.46 ,$12.04 ,$24.12 ,$9.46 ,$28.04 ,$10.75 ,$28.04 ,$28.04 ,$10.75 ,$28.04 ,$17.97 ,$36.12 , N/A ,$9.46 ,$36.55 ,$36.12 ,$9.46 ,$32.25 ,$34.40 ,$34.40 ,$9.46 ,$34.40 ,$36.12 ,$36.12 ,$36.12 ,$43.00 ,$38.70 ,$24.73 ,$43.00 ,$9.46 ,$43.00 ,$23.39 ,$9.46 ,$17.89 , N/A , N/A ,$9.93 ,$36.55 ,$28.04 ,$12.04 ,$38.70 ,$36.12 ,$34.40 ,$34.40 ,$9.46 ,$27.95 
ST. FRANCIS HOSPITAL - ACUTE,27205342,N/A,HC DRESSING TEGADERM,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205345,N/A,HC DRESSING GAUZE STRETCH,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205387,N/A,HC IRRIGATION SOL W/WATER/SODIUM CHLORIDE,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27205391,N/A,HC DRESSING AQUACEL FOAM/FLAT,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27260409,N/A,HC CONNECTOR T-TUBE,272,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$14.59 ,$5.72 ,$16.95 ,$6.50 ,$16.95 ,$16.95 ,$6.50 ,$16.95 ,$10.87 ,$21.84 , N/A ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 , N/A , N/A ,$6.01 ,$22.10 ,$16.95 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,27400006,L0150,HC PHILADELPHA COLLAR,274,1 ,$136.00 ,$88.40 ,$29.92 ,$293.86 ,$78.20 ,$97.92 ,$73.98 ,$29.92 ,$38.08 ,$79.97 ,$29.92 ,$93.43 ,$34.00 ,$93.43 ,$93.43 ,$34.00 ,$93.43 ,$56.85 ,$114.24 ,$293.86 ,$29.92 ,$115.60 ,$114.24 ,$29.92 ,$102.00 ,$108.80 ,$108.80 ,$29.92 ,$108.80 ,$114.24 ,$114.24 ,$114.24 ,$136.00 ,$122.40 ,$78.20 ,$136.00 ,$29.92 ,$136.00 ,$73.98 ,$29.92 ,$56.58 , N/A , N/A ,$31.42 ,$115.60 ,$93.43 ,$38.08 ,$122.40 ,$114.24 ,$108.80 ,$108.80 ,$29.92 ,$88.40 
ST. FRANCIS HOSPITAL - ACUTE,27400044,L3908,HC COCK UP WRIST SPLINT/FIT  AND  ADJ,274,1 ,$78.00 ,$50.70 ,$17.16 ,$179.80 ,$44.85 ,$56.16 ,$42.43 ,$17.16 ,$21.84 ,$45.86 ,$17.16 ,$53.59 ,$19.50 ,$53.59 ,$53.59 ,$19.50 ,$53.59 ,$32.60 ,$65.52 ,$179.80 ,$17.16 ,$66.30 ,$65.52 ,$17.16 ,$58.50 ,$62.40 ,$62.40 ,$17.16 ,$62.40 ,$65.52 ,$65.52 ,$65.52 ,$78.00 ,$70.20 ,$44.85 ,$78.00 ,$17.16 ,$78.00 ,$42.43 ,$17.16 ,$32.45 , N/A , N/A ,$18.02 ,$66.30 ,$53.59 ,$21.84 ,$70.20 ,$65.52 ,$62.40 ,$62.40 ,$17.16 ,$50.70 
ST. FRANCIS HOSPITAL - ACUTE,27400128,L1930,HC AFO ANKLE BRACE CUSTOM,274,1 ,$187.00 ,$121.55 ,$41.14 ,$625.08 ,$107.53 ,$134.64 ,$101.73 ,$41.14 ,$52.36 ,$109.96 ,$41.14 ,$128.47 ,$46.75 ,$128.47 ,$128.47 ,$46.75 ,$128.47 ,$78.17 ,$157.08 ,$625.08 ,$41.14 ,$158.95 ,$157.08 ,$41.14 ,$140.25 ,$149.60 ,$149.60 ,$41.14 ,$149.60 ,$157.08 ,$157.08 ,$157.08 ,$187.00 ,$168.30 ,$107.53 ,$187.00 ,$41.14 ,$187.00 ,$101.73 ,$41.14 ,$77.79 , N/A , N/A ,$43.20 ,$158.95 ,$128.47 ,$52.36 ,$168.30 ,$157.08 ,$149.60 ,$149.60 ,$41.14 ,$121.55 
ST. FRANCIS HOSPITAL - ACUTE,27800553,A4648,HC TISSUE MARKER IMPLANTABLE,278,1 ,$238.00 ,$154.70 ,$52.36 ,$238.00 ,$136.85 ,$171.36 ,$129.47 ,$52.36 ,$66.64 ,$133.52 ,$52.36 ,$155.18 ,$59.50 ,$155.18 ,$155.18 ,$59.50 ,$155.18 ,$99.48 ,$199.92 , N/A ,$52.36 ,$202.30 ,$199.92 ,$52.36 ,$178.50 ,$190.40 ,$190.40 ,$52.36 ,$190.40 ,$199.92 ,$199.92 ,$199.92 ,$238.00 ,$214.20 ,$136.85 ,$238.00 ,$52.36 ,$238.00 ,$129.47 ,$52.36 ,$99.01 , N/A , N/A ,$54.98 ,$202.30 ,$155.18 ,$66.64 ,$214.20 ,$199.92 ,$190.40 ,$190.40 ,$52.36 ,$154.70 
ST. FRANCIS HOSPITAL - ACUTE,28000001,G0498,HC CHEMO IV W/PUMP EXTENDED,280,1 ,$814.00 ,$529.10 ,$179.08 ,$814.10 ,$468.05 ,$586.08 ,$442.82 ,$179.08 ,$227.92 ,$456.65 ,$179.08 ,$530.73 ,$203.50 ,$530.73 ,$530.73 ,$203.50 ,$530.73 ,$340.25 ,$683.76 ,$814.10 ,$179.08 ,$691.90 ,$683.76 ,$179.08 ,$610.50 ,$651.20 ,$651.20 ,$179.08 ,$651.20 ,$683.76 ,$683.76 ,$683.76 ,$814.00 ,$732.60 ,$468.05 ,$814.00 ,$179.08 ,$814.00 ,$442.82 ,$179.08 ,$338.62 ,$516.01 ,$492.56 ,$188.03 ,$691.90 ,$530.73 ,$227.92 ,$732.60 ,$683.76 ,$651.20 ,$651.20 ,$179.08 ,$529.10 
ST. FRANCIS HOSPITAL - ACUTE,30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$33.00 ,$21.45 ,$7.26 ,$33.00 ,$18.98 ,$23.76 ,$17.95 ,$7.26 ,$9.24 ,$18.51 ,$7.26 ,$21.52 ,$8.25 ,$21.52 ,$21.52 ,$8.25 ,$21.52 ,$13.79 ,$27.72 , N/A ,$7.26 ,$28.05 ,$27.72 ,$7.26 ,$24.75 ,$26.40 ,$26.40 ,$7.26 ,$26.40 ,$27.72 ,$27.72 ,$27.72 ,$33.00 ,$29.70 ,$18.98 ,$33.00 ,$7.26 ,$33.00 ,$17.95 ,$7.26 ,$13.73 , N/A , N/A ,$7.62 ,$28.05 ,$21.52 ,$9.24 ,$29.70 ,$27.72 ,$26.40 ,$26.40 ,$7.26 ,$21.45 
ST. FRANCIS HOSPITAL - ACUTE,30000010,36415,HC VENIPUNCTURE,300,1 ,$27.00 ,$17.55 ,$2.37 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.15 ,$5.94 ,$17.60 ,$6.75 ,$17.60 ,$17.60 ,$6.75 ,$17.60 ,$11.29 ,$22.68 ,$7.50 ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 , N/A , N/A ,$5.94 , N/A ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$3.00 ,$14.69 ,$5.94 ,$11.23 ,$2.49 ,$2.37 ,$6.24 ,$22.95 ,$17.60 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,30000015,36600,HC ARTERIAL PUNCTURE,300,1 ,$78.00 ,$50.70 ,$17.16 ,$287.90 ,$44.85 ,$56.16 ,$42.43 ,$17.16 ,$21.84 ,$43.76 ,$17.16 ,$50.86 ,$19.50 ,$50.86 ,$50.86 ,$19.50 ,$50.86 ,$32.60 ,$65.52 ,$287.90 ,$17.16 ,$66.30 ,$65.52 ,$17.16 ,$58.50 ,$62.40 ,$62.40 ,$17.16 ,$62.40 ,$65.52 ,$65.52 ,$65.52 ,$78.00 ,$70.20 ,$44.85 ,$78.00 ,$17.16 ,$78.00 ,$42.43 ,$17.16 ,$32.45 ,$51.14 ,$48.81 ,$18.02 ,$66.30 ,$50.86 ,$21.84 ,$70.20 ,$65.52 ,$62.40 ,$62.40 ,$17.16 ,$50.70 
ST. FRANCIS HOSPITAL - ACUTE,30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$159.00 ,$103.35 ,$34.98 ,$287.90 ,$91.43 ,$114.48 ,$86.50 ,$34.98 ,$44.52 ,$89.20 ,$34.98 ,$103.67 ,$39.75 ,$103.67 ,$103.67 ,$39.75 ,$103.67 ,$66.46 ,$133.56 ,$287.90 ,$34.98 ,$135.15 ,$133.56 ,$34.98 ,$119.25 ,$127.20 ,$127.20 ,$34.98 ,$127.20 ,$133.56 ,$133.56 ,$133.56 ,$159.00 ,$143.10 ,$91.43 ,$159.00 ,$34.98 ,$159.00 ,$86.50 ,$34.98 ,$66.14 ,$51.14 ,$48.81 ,$36.73 ,$135.15 ,$103.67 ,$44.52 ,$143.10 ,$133.56 ,$127.20 ,$127.20 ,$34.98 ,$103.35 
ST. FRANCIS HOSPITAL - ACUTE,30000206,80307,HC DRUG SCREEN PANEL 9,300,1 ,$115.00 ,$74.75 ,$25.30 ,$155.35 ,$66.13 ,$82.80 ,$62.56 ,$25.30 ,$32.20 ,$67.62 ,$25.30 ,$79.01 ,$28.75 ,$79.01 ,$79.01 ,$28.75 ,$79.01 ,$48.07 ,$96.60 ,$155.35 ,$25.30 ,$97.75 ,$96.60 ,$25.30 ,$86.25 ,$92.00 ,$92.00 ,$25.30 ,$92.00 ,$96.60 ,$96.60 ,$96.60 ,$115.00 ,$103.50 ,$66.13 ,$115.00 ,$25.30 ,$115.00 ,$62.56 ,$25.30 ,$47.84 ,$32.00 ,$30.54 ,$26.57 ,$97.75 ,$79.01 ,$32.20 ,$103.50 ,$96.60 ,$92.00 ,$92.00 ,$25.30 ,$74.75 
ST. FRANCIS HOSPITAL - ACUTE,30000213,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$188.00 ,$122.20 ,$41.36 ,$287.90 ,$108.10 ,$135.36 ,$102.27 ,$41.36 ,$52.64 ,$105.47 ,$41.36 ,$122.58 ,$47.00 ,$122.58 ,$122.58 ,$47.00 ,$122.58 ,$78.58 ,$157.92 ,$287.90 ,$41.36 ,$159.80 ,$157.92 ,$41.36 ,$141.00 ,$150.40 ,$150.40 ,$41.36 ,$150.40 ,$157.92 ,$157.92 ,$157.92 ,$188.00 ,$169.20 ,$108.10 ,$188.00 ,$41.36 ,$188.00 ,$102.27 ,$41.36 ,$78.21 ,$51.14 ,$48.81 ,$43.43 ,$159.80 ,$122.58 ,$52.64 ,$169.20 ,$157.92 ,$150.40 ,$150.40 ,$41.36 ,$122.20 
ST. FRANCIS HOSPITAL - ACUTE,30000218,86927,HC FFP THAWING EACH UNIT,300,1 ,$91.00 ,$59.15 ,$20.02 ,$380.80 ,$52.33 ,$65.52 ,$49.50 ,$20.02 ,$25.48 ,$53.51 ,$20.02 ,$62.52 ,$22.75 ,$62.52 ,$62.52 ,$22.75 ,$62.52 ,$38.04 ,$76.44 ,$380.80 ,$20.02 ,$77.35 ,$76.44 ,$20.02 ,$68.25 ,$72.80 ,$72.80 ,$20.02 ,$72.80 ,$76.44 ,$76.44 ,$76.44 ,$91.00 ,$81.90 ,$52.33 ,$91.00 ,$20.02 ,$91.00 ,$49.50 ,$20.02 ,$37.86 ,$42.98 ,$41.02 ,$21.02 ,$77.35 ,$62.52 ,$25.48 ,$81.90 ,$76.44 ,$72.80 ,$72.80 ,$20.02 ,$59.15 
ST. FRANCIS HOSPITAL - ACUTE,30000219,86970,HC RBC PRETREAT CHEM,300,1 ,$137.00 ,$89.05 ,$30.14 ,$137.00 ,$78.78 ,$98.64 ,$74.53 ,$30.14 ,$38.36 ,$80.56 ,$30.14 ,$94.12 ,$34.25 ,$94.12 ,$94.12 ,$34.25 ,$94.12 ,$57.27 ,$115.08 ,$86.43 ,$30.14 ,$116.45 ,$115.08 ,$30.14 ,$102.75 ,$109.60 ,$109.60 ,$30.14 ,$109.60 ,$115.08 ,$115.08 ,$115.08 ,$137.00 ,$123.30 ,$78.78 ,$137.00 ,$30.14 ,$137.00 ,$74.53 ,$30.14 ,$56.99 ,$42.98 ,$41.02 ,$31.65 ,$116.45 ,$94.12 ,$38.36 ,$123.30 ,$115.08 ,$109.60 ,$109.60 ,$30.14 ,$89.05 
ST. FRANCIS HOSPITAL - ACUTE,30000221,86999,HC TRANSFUSION UNLISTED PROCEDURE,300,1 ,$93.00 ,$60.45 ,$20.46 ,$93.00 ,$53.48 ,$66.96 ,$50.59 ,$20.46 ,$26.04 ,$52.17 ,$20.46 ,$60.64 ,$23.25 ,$60.64 ,$60.64 ,$23.25 ,$60.64 ,$38.87 ,$78.12 ,$63.08 ,$20.46 ,$79.05 ,$78.12 ,$20.46 ,$69.75 ,$74.40 ,$74.40 ,$20.46 ,$74.40 ,$78.12 ,$78.12 ,$78.12 ,$93.00 ,$83.70 ,$53.48 ,$93.00 ,$20.46 ,$93.00 ,$50.59 ,$20.46 ,$38.69 ,$42.98 ,$41.02 ,$21.48 ,$79.05 ,$60.64 ,$26.04 ,$83.70 ,$78.12 ,$74.40 ,$74.40 ,$20.46 ,$60.45 
ST. FRANCIS HOSPITAL - ACUTE,30000223,89051,HC CELL CT BODY FLUID W/DIFF,300,1 ,$260.00 ,$169.00 ,$14.00 ,$260.00 ,$149.50 ,$187.20 ,$141.44 ,$57.20 ,$72.80 ,$68.23 ,$57.20 ,$86.89 ,$65.00 ,$86.89 ,$86.89 ,$65.00 ,$86.89 ,$108.68 ,$218.40 ,$14.00 ,$57.20 ,$221.00 ,$218.40 ,$57.20 ,$195.00 ,$208.00 ,$208.00 ,$57.20 ,$208.00 ,$218.40 ,$218.40 ,$218.40 ,$260.00 ,$234.00 ,$149.50 ,$260.00 ,$57.20 ,$260.00 ,$141.44 ,$57.20 ,$108.16 ,$33.96 ,$32.41 ,$60.06 ,$221.00 ,$86.89 ,$72.80 ,$234.00 ,$218.40 ,$208.00 ,$208.00 ,$57.20 ,$169.00 
ST. FRANCIS HOSPITAL - ACUTE,30000242,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$188.00 ,$122.20 ,$41.36 ,$287.90 ,$108.10 ,$135.36 ,$102.27 ,$41.36 ,$52.64 ,$105.47 ,$41.36 ,$122.58 ,$47.00 ,$122.58 ,$122.58 ,$47.00 ,$122.58 ,$78.58 ,$157.92 ,$287.90 ,$41.36 ,$159.80 ,$157.92 ,$41.36 ,$141.00 ,$150.40 ,$150.40 ,$41.36 ,$150.40 ,$157.92 ,$157.92 ,$157.92 ,$188.00 ,$169.20 ,$108.10 ,$188.00 ,$41.36 ,$188.00 ,$102.27 ,$41.36 ,$78.21 ,$51.14 ,$48.81 ,$43.43 ,$159.80 ,$122.58 ,$52.64 ,$169.20 ,$157.92 ,$150.40 ,$150.40 ,$41.36 ,$122.20 
ST. FRANCIS HOSPITAL - ACUTE,30002013,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$159.00 ,$103.35 ,$34.98 ,$287.90 ,$91.43 ,$114.48 ,$86.50 ,$34.98 ,$44.52 ,$89.20 ,$34.98 ,$103.67 ,$39.75 ,$103.67 ,$103.67 ,$39.75 ,$103.67 ,$66.46 ,$133.56 ,$287.90 ,$34.98 ,$135.15 ,$133.56 ,$34.98 ,$119.25 ,$127.20 ,$127.20 ,$34.98 ,$127.20 ,$133.56 ,$133.56 ,$133.56 ,$159.00 ,$143.10 ,$91.43 ,$159.00 ,$34.98 ,$159.00 ,$86.50 ,$34.98 ,$66.14 ,$51.14 ,$48.81 ,$36.73 ,$135.15 ,$103.67 ,$44.52 ,$143.10 ,$133.56 ,$127.20 ,$127.20 ,$34.98 ,$103.35 
ST. FRANCIS HOSPITAL - ACUTE,30002017,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$44.00 ,$28.60 ,$7.05 ,$44.00 ,$25.30 ,$31.68 ,$23.94 ,$9.68 ,$12.32 ,$25.87 ,$9.68 ,$30.23 ,$11.00 ,$30.23 ,$30.23 ,$11.00 ,$30.23 ,$18.39 ,$36.96 ,$10.68 ,$9.68 ,$37.40 ,$36.96 ,$9.68 ,$33.00 ,$35.20 ,$35.20 ,$9.68 ,$35.20 ,$36.96 ,$36.96 ,$36.96 ,$44.00 ,$39.60 ,$25.30 ,$44.00 ,$9.68 ,$44.00 ,$23.94 ,$9.68 ,$18.30 ,$7.38 ,$7.05 ,$10.16 ,$37.40 ,$30.23 ,$12.32 ,$39.60 ,$36.96 ,$35.20 ,$35.20 ,$9.68 ,$28.60 
ST. FRANCIS HOSPITAL - ACUTE,30002018,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$81.00 ,$52.65 ,$17.82 ,$81.00 ,$46.58 ,$58.32 ,$44.06 ,$17.82 ,$22.68 ,$47.63 ,$17.82 ,$55.65 ,$20.25 ,$55.65 ,$55.65 ,$20.25 ,$55.65 ,$33.86 ,$68.04 ,$18.33 ,$17.82 ,$68.85 ,$68.04 ,$17.82 ,$60.75 ,$64.80 ,$64.80 ,$17.82 ,$64.80 ,$68.04 ,$68.04 ,$68.04 ,$81.00 ,$72.90 ,$46.58 ,$81.00 ,$17.82 ,$81.00 ,$44.06 ,$17.82 ,$33.70 ,$33.96 ,$32.41 ,$18.71 ,$68.85 ,$55.65 ,$22.68 ,$72.90 ,$68.04 ,$64.80 ,$64.80 ,$17.82 ,$52.65 
ST. FRANCIS HOSPITAL - ACUTE,30002022,80306,HC DRUG SCREEN SGL CLASS PRESUMPTIVE INSTRMNT,300,1 ,$321.00 ,$208.65 ,$11.35 ,$321.00 ,$184.58 ,$231.12 ,$174.62 ,$70.62 ,$89.88 ,$133.15 ,$70.62 ,$169.57 ,$80.25 ,$169.57 ,$169.57 ,$80.25 ,$169.57 ,$134.18 ,$269.64 ,$42.85 ,$70.62 ,$272.85 ,$269.64 ,$70.62 ,$240.75 ,$256.80 ,$256.80 ,$70.62 ,$256.80 ,$269.64 ,$269.64 ,$269.64 ,$321.00 ,$288.90 ,$184.58 ,$321.00 ,$70.62 ,$321.00 ,$174.62 ,$70.62 ,$133.54 ,$11.89 ,$11.35 ,$74.15 ,$272.85 ,$169.57 ,$89.88 ,$288.90 ,$269.64 ,$256.80 ,$256.80 ,$70.62 ,$208.65 
ST. FRANCIS HOSPITAL - ACUTE,30002023,G0483,HC TOX SCREEN CHAIN OF CUSTODY URINE,300,1 ,$29.00 ,$18.85 ,$6.38 ,$72.50 ,$16.68 ,$20.88 ,$15.78 ,$6.38 ,$8.12 ,$17.05 ,$6.38 ,$19.92 ,$7.25 ,$19.92 ,$19.92 ,$7.25 ,$19.92 ,$12.12 ,$24.36 ,$72.50 ,$6.38 ,$24.65 ,$24.36 ,$6.38 ,$21.75 ,$23.20 ,$23.20 ,$6.38 ,$23.20 ,$24.36 ,$24.36 ,$24.36 ,$29.00 ,$26.10 ,$16.68 ,$29.00 ,$6.38 ,$29.00 ,$15.78 ,$6.38 ,$12.06 ,$32.00 ,$30.54 ,$6.70 ,$24.65 ,$19.92 ,$8.12 ,$26.10 ,$24.36 ,$23.20 ,$23.20 ,$6.38 ,$18.85 
ST. FRANCIS HOSPITAL - ACUTE,30002024,80307,HC TOX SCREEN CHAIN OF CUSTODY ALCOHOL-90,300,1 ,$47.00 ,$30.55 ,$10.34 ,$117.50 ,$27.03 ,$33.84 ,$25.57 ,$10.34 ,$13.16 ,$27.64 ,$10.34 ,$32.29 ,$11.75 ,$32.29 ,$32.29 ,$11.75 ,$32.29 ,$19.65 ,$39.48 ,$117.50 ,$10.34 ,$39.95 ,$39.48 ,$10.34 ,$35.25 ,$37.60 ,$37.60 ,$10.34 ,$37.60 ,$39.48 ,$39.48 ,$39.48 ,$47.00 ,$42.30 ,$27.03 ,$47.00 ,$10.34 ,$47.00 ,$25.57 ,$10.34 ,$19.55 ,$32.00 ,$30.54 ,$10.86 ,$39.95 ,$32.29 ,$13.16 ,$42.30 ,$39.48 ,$37.60 ,$37.60 ,$10.34 ,$30.55 
ST. FRANCIS HOSPITAL - ACUTE,30040115,99001,HC SPECIMEN HAND/CONVEY OTHER,300,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 , N/A ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 , N/A , N/A ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30100101,80048,HC BASIC METABOLIC PANEL,301,1 ,$238.00 ,$154.70 ,$8.46 ,$238.00 ,$136.85 ,$171.36 ,$129.47 ,$52.36 ,$66.64 ,$114.42 ,$52.36 ,$114.42 ,$59.50 ,$114.42 ,$114.42 ,$59.50 ,$114.42 ,$99.48 ,$199.92 ,$21.15 ,$52.36 ,$202.30 ,$199.92 ,$52.36 ,$178.50 ,$190.40 ,$190.40 ,$52.36 ,$190.40 ,$199.92 ,$199.92 ,$199.92 ,$238.00 ,$214.20 ,$136.85 ,$238.00 ,$52.36 ,$8.46 ,$129.47 ,$52.36 ,$99.01 ,$10.85 ,$10.35 ,$54.98 ,$202.30 ,$114.42 ,$66.64 ,$214.20 ,$199.92 ,$190.40 ,$190.40 ,$52.36 ,$154.70 
ST. FRANCIS HOSPITAL - ACUTE,30100103,80051,HC ELECTROLYTE PANEL,301,1 ,$184.00 ,$119.60 ,$10.35 ,$184.00 ,$105.80 ,$132.48 ,$100.10 ,$40.48 ,$51.52 ,$94.87 ,$40.48 ,$94.87 ,$46.00 ,$94.87 ,$94.87 ,$46.00 ,$94.87 ,$76.91 ,$154.56 ,$17.53 ,$40.48 ,$156.40 ,$154.56 ,$40.48 ,$138.00 ,$147.20 ,$147.20 ,$40.48 ,$147.20 ,$154.56 ,$154.56 ,$154.56 ,$184.00 ,$165.60 ,$105.80 ,$184.00 ,$40.48 ,$184.00 ,$100.10 ,$40.48 ,$76.54 ,$10.85 ,$10.35 ,$42.50 ,$156.40 ,$94.87 ,$51.52 ,$165.60 ,$154.56 ,$147.20 ,$147.20 ,$40.48 ,$119.60 
ST. FRANCIS HOSPITAL - ACUTE,30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$288.00 ,$187.20 ,$10.35 ,$288.00 ,$165.60 ,$207.36 ,$156.67 ,$63.36 ,$80.64 ,$142.93 ,$63.36 ,$142.93 ,$72.00 ,$142.93 ,$142.93 ,$72.00 ,$142.93 ,$120.38 ,$241.92 ,$26.40 ,$63.36 ,$244.80 ,$241.92 ,$63.36 ,$216.00 ,$230.40 ,$230.40 ,$63.36 ,$230.40 ,$241.92 ,$241.92 ,$241.92 ,$288.00 ,$259.20 ,$165.60 ,$288.00 ,$63.36 ,$10.56 ,$156.67 ,$63.36 ,$119.81 ,$10.85 ,$10.35 ,$66.53 ,$244.80 ,$142.93 ,$80.64 ,$259.20 ,$241.92 ,$230.40 ,$230.40 ,$63.36 ,$187.20 
ST. FRANCIS HOSPITAL - ACUTE,30100107,80061,HC LIPID PANEL,301,1 ,$135.00 ,$87.75 ,$10.35 ,$135.00 ,$77.63 ,$97.20 ,$73.44 ,$29.70 ,$37.80 ,$79.38 ,$29.70 ,$92.75 ,$33.75 ,$92.75 ,$92.75 ,$33.75 ,$92.75 ,$56.43 ,$113.40 ,$33.48 ,$29.70 ,$114.75 ,$113.40 ,$29.70 ,$101.25 ,$108.00 ,$108.00 ,$29.70 ,$108.00 ,$113.40 ,$113.40 ,$113.40 ,$135.00 ,$121.50 ,$77.63 ,$135.00 ,$29.70 ,$135.00 ,$73.44 ,$29.70 ,$56.16 ,$10.85 ,$10.35 ,$31.19 ,$114.75 ,$92.75 ,$37.80 ,$121.50 ,$113.40 ,$108.00 ,$108.00 ,$29.70 ,$87.75 
ST. FRANCIS HOSPITAL - ACUTE,30100108,80069,HC RENAL PANEL,301,1 ,$248.00 ,$161.20 ,$10.35 ,$248.00 ,$142.60 ,$178.56 ,$134.91 ,$54.56 ,$69.44 ,$107.60 ,$54.56 ,$137.02 ,$62.00 ,$137.02 ,$137.02 ,$62.00 ,$137.02 ,$103.66 ,$208.32 ,$21.70 ,$54.56 ,$210.80 ,$208.32 ,$54.56 ,$186.00 ,$198.40 ,$198.40 ,$54.56 ,$198.40 ,$208.32 ,$208.32 ,$208.32 ,$248.00 ,$223.20 ,$142.60 ,$248.00 ,$54.56 ,$248.00 ,$134.91 ,$54.56 ,$103.17 ,$10.85 ,$10.35 ,$57.29 ,$210.80 ,$137.02 ,$69.44 ,$223.20 ,$208.32 ,$198.40 ,$198.40 ,$54.56 ,$161.20 
ST. FRANCIS HOSPITAL - ACUTE,30100110,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$218.00 ,$141.70 ,$10.35 ,$218.00 ,$125.35 ,$156.96 ,$118.59 ,$47.96 ,$61.04 ,$74.85 ,$47.96 ,$95.32 ,$54.50 ,$95.32 ,$95.32 ,$54.50 ,$95.32 ,$91.12 ,$183.12 ,$20.43 ,$47.96 ,$185.30 ,$183.12 ,$47.96 ,$163.50 ,$174.40 ,$174.40 ,$47.96 ,$174.40 ,$183.12 ,$183.12 ,$183.12 ,$218.00 ,$196.20 ,$125.35 ,$218.00 ,$47.96 ,$218.00 ,$118.59 ,$47.96 ,$90.69 ,$10.85 ,$10.35 ,$50.36 ,$185.30 ,$95.32 ,$61.04 ,$196.20 ,$183.12 ,$174.40 ,$174.40 ,$47.96 ,$141.70 
ST. FRANCIS HOSPITAL - ACUTE,30100116,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$202.00 ,$131.30 ,$13.03 ,$202.00 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$118.78 ,$44.44 ,$138.77 ,$50.50 ,$138.77 ,$138.77 ,$50.50 ,$138.77 ,$84.44 ,$169.68 ,$36.43 ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$202.00 ,$109.89 ,$44.44 ,$84.03 ,$13.65 ,$13.03 ,$46.66 ,$171.70 ,$138.77 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,30100120,80162,HC DIGOXIN LEVELS,301,1 ,$202.00 ,$131.30 ,$13.03 ,$202.00 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$118.78 ,$44.44 ,$138.77 ,$50.50 ,$138.77 ,$138.77 ,$50.50 ,$138.77 ,$84.44 ,$169.68 ,$33.20 ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$202.00 ,$109.89 ,$44.44 ,$84.03 ,$13.65 ,$13.03 ,$46.66 ,$171.70 ,$138.77 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,30100121,80164,HC VALPROIC ACID,301,1 ,$172.00 ,$111.80 ,$13.03 ,$172.00 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$101.14 ,$37.84 ,$118.16 ,$43.00 ,$118.16 ,$118.16 ,$43.00 ,$118.16 ,$71.90 ,$144.48 ,$33.85 ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 ,$13.65 ,$13.03 ,$39.73 ,$146.20 ,$118.16 ,$48.16 ,$154.80 ,$144.48 ,$137.60 ,$137.60 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,30100124,80170,HC GENTAMICIN,301,1 ,$202.00 ,$131.30 ,$13.03 ,$202.00 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$118.78 ,$44.44 ,$138.77 ,$50.50 ,$138.77 ,$138.77 ,$50.50 ,$138.77 ,$84.44 ,$169.68 ,$40.95 ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$202.00 ,$109.89 ,$44.44 ,$84.03 ,$13.65 ,$13.03 ,$46.66 ,$171.70 ,$138.77 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,30100127,80178,HC LITHIUM,301,1 ,$202.00 ,$131.30 ,$13.03 ,$202.00 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$81.92 ,$44.44 ,$104.33 ,$50.50 ,$104.33 ,$104.33 ,$50.50 ,$104.33 ,$84.44 ,$169.68 ,$16.53 ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$202.00 ,$109.89 ,$44.44 ,$84.03 ,$13.65 ,$13.03 ,$46.66 ,$171.70 ,$104.33 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,30100130,80185,HC PHENYTOIN TOTAL,301,1 ,$202.00 ,$131.30 ,$13.03 ,$202.00 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$118.78 ,$44.44 ,$138.77 ,$50.50 ,$138.77 ,$138.77 ,$50.50 ,$138.77 ,$84.44 ,$169.68 ,$33.13 ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$202.00 ,$109.89 ,$44.44 ,$84.03 ,$13.65 ,$13.03 ,$46.66 ,$171.70 ,$138.77 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,30100138,80198,HC THEOPHYLLINE,301,1 ,$202.00 ,$131.30 ,$13.03 ,$202.00 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$118.78 ,$44.44 ,$138.77 ,$50.50 ,$138.77 ,$138.77 ,$50.50 ,$138.77 ,$84.44 ,$169.68 ,$35.35 ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$202.00 ,$109.89 ,$44.44 ,$84.03 ,$13.65 ,$13.03 ,$46.66 ,$171.70 ,$138.77 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,30100141,80202,HC VANCOMYCIN,301,1 ,$239.00 ,$155.35 ,$13.03 ,$239.00 ,$137.43 ,$172.08 ,$130.02 ,$52.58 ,$66.92 ,$124.03 ,$52.58 ,$157.94 ,$59.75 ,$157.94 ,$157.94 ,$59.75 ,$157.94 ,$99.90 ,$200.76 ,$33.85 ,$52.58 ,$203.15 ,$200.76 ,$52.58 ,$179.25 ,$191.20 ,$191.20 ,$52.58 ,$191.20 ,$200.76 ,$200.76 ,$200.76 ,$239.00 ,$215.10 ,$137.43 ,$239.00 ,$52.58 ,$239.00 ,$130.02 ,$52.58 ,$99.42 ,$13.65 ,$13.03 ,$55.21 ,$203.15 ,$157.94 ,$66.92 ,$215.10 ,$200.76 ,$191.20 ,$191.20 ,$52.58 ,$155.35 
ST. FRANCIS HOSPITAL - ACUTE,30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$54.00 ,$35.10 ,$11.35 ,$54.00 ,$31.05 ,$38.88 ,$29.38 ,$11.88 ,$15.12 ,$31.75 ,$11.88 ,$37.10 ,$13.50 ,$37.10 ,$37.10 ,$13.50 ,$37.10 ,$22.57 ,$45.36 ,$20.43 ,$11.88 ,$45.90 ,$45.36 ,$11.88 ,$40.50 ,$43.20 ,$43.20 ,$11.88 ,$43.20 ,$45.36 ,$45.36 ,$45.36 ,$54.00 ,$48.60 ,$31.05 ,$54.00 ,$11.88 ,$54.00 ,$29.38 ,$11.88 ,$22.46 ,$11.89 ,$11.35 ,$12.47 ,$45.90 ,$37.10 ,$15.12 ,$48.60 ,$45.36 ,$43.20 ,$43.20 ,$11.88 ,$35.10 
ST. FRANCIS HOSPITAL - ACUTE,30100165,82040,HC ALBUMIN SERUM,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$61.39 ,$26.62 ,$78.17 ,$30.25 ,$78.17 ,$78.17 ,$30.25 ,$78.17 ,$50.58 ,$101.64 ,$12.38 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$78.17 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$135.00 ,$87.75 ,$4.05 ,$135.00 ,$77.63 ,$97.20 ,$73.44 ,$29.70 ,$37.80 ,$71.65 ,$29.70 ,$91.25 ,$33.75 ,$91.25 ,$91.25 ,$33.75 ,$91.25 ,$56.43 ,$113.40 ,$14.45 ,$29.70 ,$114.75 ,$113.40 ,$29.70 ,$101.25 ,$108.00 ,$108.00 ,$29.70 ,$108.00 ,$113.40 ,$113.40 ,$113.40 ,$135.00 ,$121.50 ,$77.63 ,$135.00 ,$29.70 ,$135.00 ,$73.44 ,$29.70 ,$56.16 ,$4.25 ,$4.05 ,$31.19 ,$114.75 ,$91.25 ,$37.80 ,$121.50 ,$113.40 ,$108.00 ,$108.00 ,$29.70 ,$87.75 
ST. FRANCIS HOSPITAL - ACUTE,30100186,82140,HC AMMONIA,301,1 ,$222.00 ,$144.30 ,$11.35 ,$222.00 ,$127.65 ,$159.84 ,$120.77 ,$48.84 ,$62.16 ,$130.54 ,$48.84 ,$152.51 ,$55.50 ,$152.51 ,$152.51 ,$55.50 ,$152.51 ,$92.80 ,$186.48 ,$36.43 ,$48.84 ,$188.70 ,$186.48 ,$48.84 ,$166.50 ,$177.60 ,$177.60 ,$48.84 ,$177.60 ,$186.48 ,$186.48 ,$186.48 ,$222.00 ,$199.80 ,$127.65 ,$222.00 ,$48.84 ,$222.00 ,$120.77 ,$48.84 ,$92.35 ,$11.89 ,$11.35 ,$51.28 ,$188.70 ,$152.51 ,$62.16 ,$199.80 ,$186.48 ,$177.60 ,$177.60 ,$48.84 ,$144.30 
ST. FRANCIS HOSPITAL - ACUTE,30100188,82150,HC AMYLASE,301,1 ,$158.00 ,$102.70 ,$11.35 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$80.33 ,$34.76 ,$102.29 ,$39.50 ,$102.29 ,$102.29 ,$39.50 ,$102.29 ,$66.04 ,$132.72 ,$16.20 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$11.89 ,$11.35 ,$36.50 ,$134.30 ,$102.29 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$108.00 ,$70.20 ,$5.05 ,$108.00 ,$62.10 ,$77.76 ,$58.75 ,$23.76 ,$30.24 ,$62.18 ,$23.76 ,$74.20 ,$27.00 ,$74.20 ,$74.20 ,$27.00 ,$74.20 ,$45.14 ,$90.72 ,$12.55 ,$23.76 ,$91.80 ,$90.72 ,$23.76 ,$81.00 ,$86.40 ,$86.40 ,$23.76 ,$86.40 ,$90.72 ,$90.72 ,$90.72 ,$108.00 ,$97.20 ,$62.10 ,$108.00 ,$23.76 ,$108.00 ,$58.75 ,$23.76 ,$44.93 ,$5.29 ,$5.05 ,$24.95 ,$91.80 ,$74.20 ,$30.24 ,$97.20 ,$90.72 ,$86.40 ,$86.40 ,$23.76 ,$70.20 
ST. FRANCIS HOSPITAL - ACUTE,30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$90.00 ,$58.50 ,$5.05 ,$90.00 ,$51.75 ,$64.80 ,$48.96 ,$19.80 ,$25.20 ,$52.92 ,$19.80 ,$61.83 ,$22.50 ,$61.83 ,$61.83 ,$22.50 ,$61.83 ,$37.62 ,$75.60 ,$12.55 ,$19.80 ,$76.50 ,$75.60 ,$19.80 ,$67.50 ,$72.00 ,$72.00 ,$19.80 ,$72.00 ,$75.60 ,$75.60 ,$75.60 ,$90.00 ,$81.00 ,$51.75 ,$90.00 ,$19.80 ,$90.00 ,$48.96 ,$19.80 ,$37.44 ,$5.29 ,$5.05 ,$20.79 ,$76.50 ,$61.83 ,$25.20 ,$81.00 ,$75.60 ,$72.00 ,$72.00 ,$19.80 ,$58.50 
ST. FRANCIS HOSPITAL - ACUTE,30100214,82310,HC CALCIUM,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$64.01 ,$26.62 ,$81.51 ,$30.25 ,$81.51 ,$81.51 ,$30.25 ,$81.51 ,$50.58 ,$101.64 ,$12.90 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$81.51 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$158.00 ,$102.70 ,$11.35 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$55.22 ,$34.76 ,$70.33 ,$39.50 ,$70.33 ,$70.33 ,$39.50 ,$70.33 ,$66.04 ,$132.72 ,$15.08 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$11.89 ,$11.35 ,$36.50 ,$134.30 ,$70.33 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100222,82374,HC BICARBONATE,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$60.59 ,$26.62 ,$77.15 ,$30.25 ,$77.15 ,$77.15 ,$30.25 ,$77.15 ,$50.58 ,$101.64 ,$12.20 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$77.15 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100225,82375,HC CARBOXYHEMOGLOBIN,301,1 ,$222.00 ,$144.30 ,$11.35 ,$222.00 ,$127.65 ,$159.84 ,$120.77 ,$48.84 ,$62.16 ,$112.84 ,$48.84 ,$143.70 ,$55.50 ,$143.70 ,$143.70 ,$55.50 ,$143.70 ,$92.80 ,$186.48 ,$30.80 ,$48.84 ,$188.70 ,$186.48 ,$48.84 ,$166.50 ,$177.60 ,$177.60 ,$48.84 ,$177.60 ,$186.48 ,$186.48 ,$186.48 ,$222.00 ,$199.80 ,$127.65 ,$222.00 ,$48.84 ,$222.00 ,$120.77 ,$48.84 ,$92.35 ,$11.89 ,$11.35 ,$51.28 ,$188.70 ,$143.70 ,$62.16 ,$199.80 ,$186.48 ,$177.60 ,$177.60 ,$48.84 ,$144.30 
ST. FRANCIS HOSPITAL - ACUTE,30100237,82435,HC CHLORIDE,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$57.05 ,$26.62 ,$72.65 ,$30.25 ,$72.65 ,$72.65 ,$30.25 ,$72.65 ,$50.58 ,$101.64 ,$11.50 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$72.65 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100238,82436,HC CHLORIDE URINE,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$46.10 ,$34.76 ,$58.70 ,$39.50 ,$58.70 ,$58.70 ,$39.50 ,$58.70 ,$66.04 ,$132.72 ,$14.38 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$58.70 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100241,82465,HC CHOLESTEROL,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$53.97 ,$26.62 ,$68.73 ,$30.25 ,$68.73 ,$68.73 ,$30.25 ,$68.73 ,$50.58 ,$101.64 ,$10.88 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$68.73 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$185.00 ,$120.25 ,$5.05 ,$185.00 ,$106.38 ,$133.20 ,$100.64 ,$40.70 ,$51.80 ,$80.78 ,$40.70 ,$102.87 ,$46.25 ,$102.87 ,$102.87 ,$46.25 ,$102.87 ,$77.33 ,$155.40 ,$16.28 ,$40.70 ,$157.25 ,$155.40 ,$40.70 ,$138.75 ,$148.00 ,$148.00 ,$40.70 ,$148.00 ,$155.40 ,$155.40 ,$155.40 ,$185.00 ,$166.50 ,$106.38 ,$185.00 ,$40.70 ,$185.00 ,$100.64 ,$40.70 ,$76.96 ,$5.29 ,$5.05 ,$42.74 ,$157.25 ,$102.87 ,$51.80 ,$166.50 ,$155.40 ,$148.00 ,$148.00 ,$40.70 ,$120.25 
ST. FRANCIS HOSPITAL - ACUTE,30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$258.00 ,$167.70 ,$11.35 ,$258.00 ,$148.35 ,$185.76 ,$140.35 ,$56.76 ,$72.24 ,$105.77 ,$56.76 ,$134.69 ,$64.50 ,$134.69 ,$134.69 ,$64.50 ,$134.69 ,$107.84 ,$216.72 ,$28.88 ,$56.76 ,$219.30 ,$216.72 ,$56.76 ,$193.50 ,$206.40 ,$206.40 ,$56.76 ,$206.40 ,$216.72 ,$216.72 ,$216.72 ,$258.00 ,$232.20 ,$148.35 ,$258.00 ,$56.76 ,$258.00 ,$140.35 ,$56.76 ,$107.33 ,$11.89 ,$11.35 ,$59.60 ,$219.30 ,$134.69 ,$72.24 ,$232.20 ,$216.72 ,$206.40 ,$206.40 ,$56.76 ,$167.70 
ST. FRANCIS HOSPITAL - ACUTE,30100262,82565,HC CREATININE,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$63.55 ,$26.62 ,$80.93 ,$30.25 ,$80.93 ,$80.93 ,$30.25 ,$80.93 ,$50.58 ,$101.64 ,$12.80 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$5.12 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$80.93 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$64.12 ,$34.76 ,$81.66 ,$39.50 ,$81.66 ,$81.66 ,$39.50 ,$81.66 ,$66.04 ,$132.72 ,$12.95 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$81.66 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100266,82575,HC CREATININE CLEARANCE,301,1 ,$266.00 ,$172.90 ,$11.35 ,$266.00 ,$152.95 ,$191.52 ,$144.70 ,$58.52 ,$74.48 ,$86.60 ,$58.52 ,$110.28 ,$66.50 ,$110.28 ,$110.28 ,$66.50 ,$110.28 ,$111.19 ,$223.44 ,$23.65 ,$58.52 ,$226.10 ,$223.44 ,$58.52 ,$199.50 ,$212.80 ,$212.80 ,$58.52 ,$212.80 ,$223.44 ,$223.44 ,$223.44 ,$266.00 ,$239.40 ,$152.95 ,$266.00 ,$58.52 ,$266.00 ,$144.70 ,$58.52 ,$110.66 ,$11.89 ,$11.35 ,$61.45 ,$226.10 ,$110.28 ,$74.48 ,$239.40 ,$223.44 ,$212.80 ,$212.80 ,$58.52 ,$172.90 
ST. FRANCIS HOSPITAL - ACUTE,30100290,82728,HC FERRITIN,301,1 ,$186.00 ,$120.90 ,$11.35 ,$186.00 ,$106.95 ,$133.92 ,$101.18 ,$40.92 ,$52.08 ,$109.37 ,$40.92 ,$127.78 ,$46.50 ,$127.78 ,$127.78 ,$46.50 ,$127.78 ,$77.75 ,$156.24 ,$34.08 ,$40.92 ,$158.10 ,$156.24 ,$40.92 ,$139.50 ,$148.80 ,$148.80 ,$40.92 ,$148.80 ,$156.24 ,$156.24 ,$156.24 ,$186.00 ,$167.40 ,$106.95 ,$186.00 ,$40.92 ,$186.00 ,$101.18 ,$40.92 ,$77.38 ,$11.89 ,$11.35 ,$42.97 ,$158.10 ,$127.78 ,$52.08 ,$167.40 ,$156.24 ,$148.80 ,$148.80 ,$40.92 ,$120.90 
ST. FRANCIS HOSPITAL - ACUTE,30100305,82800,HC BLOOD GAS PH,301,1 ,$154.00 ,$100.10 ,$11.35 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$90.55 ,$33.88 ,$105.80 ,$38.50 ,$105.80 ,$105.80 ,$38.50 ,$105.80 ,$64.37 ,$129.36 ,$27.50 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$11.89 ,$11.35 ,$35.57 ,$130.90 ,$105.80 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100307,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$294.00 ,$191.10 ,$11.35 ,$294.00 ,$169.05 ,$211.68 ,$159.94 ,$64.68 ,$82.32 ,$172.87 ,$64.68 ,$201.98 ,$73.50 ,$201.98 ,$201.98 ,$73.50 ,$201.98 ,$122.89 ,$246.96 ,$196.93 ,$64.68 ,$249.90 ,$246.96 ,$64.68 ,$220.50 ,$235.20 ,$235.20 ,$64.68 ,$235.20 ,$246.96 ,$246.96 ,$246.96 ,$294.00 ,$264.60 ,$169.05 ,$294.00 ,$64.68 ,$294.00 ,$159.94 ,$64.68 ,$122.30 ,$11.89 ,$11.35 ,$67.91 ,$249.90 ,$201.98 ,$82.32 ,$264.60 ,$246.96 ,$235.20 ,$235.20 ,$64.68 ,$191.10 
ST. FRANCIS HOSPITAL - ACUTE,30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$90.00 ,$58.50 ,$5.05 ,$90.00 ,$51.75 ,$64.80 ,$48.96 ,$19.80 ,$25.20 ,$48.72 ,$19.80 ,$61.83 ,$22.50 ,$61.83 ,$61.83 ,$22.50 ,$61.83 ,$37.62 ,$75.60 ,$9.83 ,$19.80 ,$76.50 ,$75.60 ,$19.80 ,$67.50 ,$72.00 ,$72.00 ,$19.80 ,$72.00 ,$75.60 ,$75.60 ,$75.60 ,$90.00 ,$81.00 ,$51.75 ,$90.00 ,$19.80 ,$90.00 ,$48.96 ,$19.80 ,$37.44 ,$5.29 ,$5.05 ,$20.79 ,$76.50 ,$61.83 ,$25.20 ,$81.00 ,$75.60 ,$72.00 ,$72.00 ,$19.80 ,$58.50 
ST. FRANCIS HOSPITAL - ACUTE,30100312,82947,HC GLUCOSE,301,1 ,$90.00 ,$58.50 ,$5.05 ,$90.00 ,$51.75 ,$64.80 ,$48.96 ,$19.80 ,$25.20 ,$48.72 ,$19.80 ,$61.83 ,$22.50 ,$61.83 ,$61.83 ,$22.50 ,$61.83 ,$37.62 ,$75.60 ,$9.83 ,$19.80 ,$76.50 ,$75.60 ,$19.80 ,$67.50 ,$72.00 ,$72.00 ,$19.80 ,$72.00 ,$75.60 ,$75.60 ,$75.60 ,$90.00 ,$81.00 ,$51.75 ,$90.00 ,$19.80 ,$90.00 ,$48.96 ,$19.80 ,$37.44 ,$5.29 ,$5.05 ,$20.79 ,$76.50 ,$61.83 ,$25.20 ,$81.00 ,$75.60 ,$72.00 ,$72.00 ,$19.80 ,$58.50 
ST. FRANCIS HOSPITAL - ACUTE,30100313,82950,HC GLUCOSE SCREEN,301,1 ,$117.00 ,$76.05 ,$5.05 ,$117.00 ,$67.28 ,$84.24 ,$63.65 ,$25.74 ,$32.76 ,$58.88 ,$25.74 ,$74.97 ,$29.25 ,$74.97 ,$74.97 ,$29.25 ,$74.97 ,$48.91 ,$98.28 ,$11.88 ,$25.74 ,$99.45 ,$98.28 ,$25.74 ,$87.75 ,$93.60 ,$93.60 ,$25.74 ,$93.60 ,$98.28 ,$98.28 ,$98.28 ,$117.00 ,$105.30 ,$67.28 ,$117.00 ,$25.74 ,$117.00 ,$63.65 ,$25.74 ,$48.67 ,$5.29 ,$5.05 ,$27.03 ,$99.45 ,$74.97 ,$32.76 ,$105.30 ,$98.28 ,$93.60 ,$93.60 ,$25.74 ,$76.05 
ST. FRANCIS HOSPITAL - ACUTE,30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$182.00 ,$118.30 ,$11.35 ,$182.00 ,$104.65 ,$131.04 ,$99.01 ,$40.04 ,$50.96 ,$107.02 ,$40.04 ,$125.03 ,$45.50 ,$125.03 ,$125.03 ,$45.50 ,$125.03 ,$76.08 ,$152.88 ,$32.18 ,$40.04 ,$154.70 ,$152.88 ,$40.04 ,$136.50 ,$145.60 ,$145.60 ,$40.04 ,$145.60 ,$152.88 ,$152.88 ,$152.88 ,$182.00 ,$163.80 ,$104.65 ,$182.00 ,$40.04 ,$182.00 ,$99.01 ,$40.04 ,$75.71 ,$11.89 ,$11.35 ,$42.04 ,$154.70 ,$125.03 ,$50.96 ,$163.80 ,$152.88 ,$145.60 ,$145.60 ,$40.04 ,$118.30 
ST. FRANCIS HOSPITAL - ACUTE,30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$66.00 ,$42.90 ,$9.80 ,$66.00 ,$37.95 ,$47.52 ,$35.90 ,$14.52 ,$18.48 ,$38.81 ,$14.52 ,$45.34 ,$16.50 ,$45.34 ,$45.34 ,$16.50 ,$45.34 ,$27.59 ,$55.44 ,$9.80 ,$14.52 ,$56.10 ,$55.44 ,$14.52 ,$49.50 ,$52.80 ,$52.80 ,$14.52 ,$52.80 ,$55.44 ,$55.44 ,$55.44 ,$66.00 ,$59.40 ,$37.95 ,$66.00 ,$14.52 ,$66.00 ,$35.90 ,$14.52 ,$27.46 ,$11.89 ,$11.35 ,$15.25 ,$56.10 ,$45.34 ,$18.48 ,$59.40 ,$55.44 ,$52.80 ,$52.80 ,$14.52 ,$42.90 
ST. FRANCIS HOSPITAL - ACUTE,30100319,82977,HC GGT/GGTP,301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$89.23 ,$33.88 ,$105.80 ,$38.50 ,$105.80 ,$105.80 ,$38.50 ,$105.80 ,$64.37 ,$129.36 ,$18.00 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$105.80 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$203.00 ,$131.95 ,$11.35 ,$203.00 ,$116.73 ,$146.16 ,$110.43 ,$44.66 ,$56.84 ,$119.36 ,$44.66 ,$139.46 ,$50.75 ,$139.46 ,$139.46 ,$50.75 ,$139.46 ,$84.85 ,$170.52 ,$24.28 ,$44.66 ,$172.55 ,$170.52 ,$44.66 ,$152.25 ,$162.40 ,$162.40 ,$44.66 ,$162.40 ,$170.52 ,$170.52 ,$170.52 ,$203.00 ,$182.70 ,$116.73 ,$203.00 ,$44.66 ,$203.00 ,$110.43 ,$44.66 ,$84.45 ,$11.89 ,$11.35 ,$46.89 ,$172.55 ,$139.46 ,$56.84 ,$182.70 ,$170.52 ,$162.40 ,$162.40 ,$44.66 ,$131.95 
ST. FRANCIS HOSPITAL - ACUTE,30100338,83050,HC METHEMOGLOBIN,301,1 ,$222.00 ,$144.30 ,$11.35 ,$222.00 ,$127.65 ,$159.84 ,$120.77 ,$48.84 ,$62.16 ,$67.09 ,$48.84 ,$85.44 ,$55.50 ,$85.44 ,$85.44 ,$55.50 ,$85.44 ,$92.80 ,$186.48 ,$20.50 ,$48.84 ,$188.70 ,$186.48 ,$48.84 ,$166.50 ,$177.60 ,$177.60 ,$48.84 ,$177.60 ,$186.48 ,$186.48 ,$186.48 ,$222.00 ,$199.80 ,$127.65 ,$222.00 ,$48.84 ,$222.00 ,$120.77 ,$48.84 ,$92.35 ,$11.89 ,$11.35 ,$51.28 ,$188.70 ,$85.44 ,$62.16 ,$199.80 ,$186.48 ,$177.60 ,$177.60 ,$48.84 ,$144.30 
ST. FRANCIS HOSPITAL - ACUTE,30100393,83540,HC IRON TOTAL,301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$59.22 ,$33.88 ,$75.41 ,$38.50 ,$75.41 ,$75.41 ,$38.50 ,$75.41 ,$64.37 ,$129.36 ,$16.18 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$75.41 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$311.00 ,$202.15 ,$11.35 ,$311.00 ,$178.83 ,$223.92 ,$169.18 ,$68.42 ,$87.08 ,$79.98 ,$68.42 ,$101.86 ,$77.75 ,$101.86 ,$101.86 ,$77.75 ,$101.86 ,$130.00 ,$261.24 ,$21.85 ,$68.42 ,$264.35 ,$261.24 ,$68.42 ,$233.25 ,$248.80 ,$248.80 ,$68.42 ,$248.80 ,$261.24 ,$261.24 ,$261.24 ,$311.00 ,$279.90 ,$178.83 ,$311.00 ,$68.42 ,$311.00 ,$169.18 ,$68.42 ,$129.38 ,$11.89 ,$11.35 ,$71.84 ,$264.35 ,$101.86 ,$87.08 ,$279.90 ,$261.24 ,$248.80 ,$248.80 ,$68.42 ,$202.15 
ST. FRANCIS HOSPITAL - ACUTE,30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$228.00 ,$148.20 ,$11.35 ,$228.00 ,$131.10 ,$164.16 ,$124.03 ,$50.16 ,$63.84 ,$132.47 ,$50.16 ,$156.64 ,$57.00 ,$156.64 ,$156.64 ,$57.00 ,$156.64 ,$95.30 ,$191.52 ,$28.93 ,$50.16 ,$193.80 ,$191.52 ,$50.16 ,$171.00 ,$182.40 ,$182.40 ,$50.16 ,$182.40 ,$191.52 ,$191.52 ,$191.52 ,$228.00 ,$205.20 ,$131.10 ,$228.00 ,$50.16 ,$228.00 ,$124.03 ,$50.16 ,$94.85 ,$11.89 ,$11.35 ,$52.67 ,$193.80 ,$156.64 ,$63.84 ,$205.20 ,$191.52 ,$182.40 ,$182.40 ,$50.16 ,$148.20 
ST. FRANCIS HOSPITAL - ACUTE,30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$55.22 ,$33.88 ,$70.33 ,$38.50 ,$70.33 ,$70.33 ,$38.50 ,$70.33 ,$64.37 ,$129.36 ,$15.10 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$70.33 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100409,83690,HC LIPASE,301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$63.10 ,$33.88 ,$80.35 ,$38.50 ,$80.35 ,$80.35 ,$38.50 ,$80.35 ,$64.37 ,$129.36 ,$17.23 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$80.35 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100415,83718,HC CHOLESTEROL HDL,301,1 ,$120.00 ,$78.00 ,$11.35 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$70.56 ,$26.40 ,$82.44 ,$30.00 ,$82.44 ,$82.44 ,$30.00 ,$82.44 ,$50.16 ,$100.80 ,$20.48 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 ,$11.89 ,$11.35 ,$27.72 ,$102.00 ,$82.44 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,30100416,83721,HC CHOLESTEROL LDL,301,1 ,$120.00 ,$78.00 ,$11.35 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$70.56 ,$26.40 ,$82.44 ,$30.00 ,$82.44 ,$82.44 ,$30.00 ,$82.44 ,$50.16 ,$100.80 ,$26.25 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 ,$11.89 ,$11.35 ,$27.72 ,$102.00 ,$82.44 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,30100417,83735,HC MAGNESIUM,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$71.15 ,$26.62 ,$83.13 ,$30.25 ,$83.13 ,$83.13 ,$30.25 ,$83.13 ,$50.58 ,$101.64 ,$16.75 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$83.13 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$284.00 ,$184.60 ,$30.54 ,$284.00 ,$163.30 ,$204.48 ,$154.50 ,$62.48 ,$79.52 ,$166.99 ,$62.48 ,$195.11 ,$71.00 ,$195.11 ,$195.11 ,$71.00 ,$195.11 ,$118.71 ,$238.56 ,$98.15 ,$62.48 ,$241.40 ,$238.56 ,$62.48 ,$213.00 ,$227.20 ,$227.20 ,$62.48 ,$227.20 ,$238.56 ,$238.56 ,$238.56 ,$284.00 ,$255.60 ,$163.30 ,$284.00 ,$62.48 ,$284.00 ,$154.50 ,$62.48 ,$118.14 ,$32.00 ,$30.54 ,$65.60 ,$241.40 ,$195.11 ,$79.52 ,$255.60 ,$238.56 ,$227.20 ,$227.20 ,$62.48 ,$184.60 
ST. FRANCIS HOSPITAL - ACUTE,30100673,83986,HC PH BODY FLUID,301,1 ,$10.00 ,$6.50 ,$2.20 ,$10.00 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.88 ,$2.20 ,$6.87 ,$2.50 ,$6.87 ,$6.87 ,$2.50 ,$6.87 ,$4.18 ,$8.40 ,$8.95 ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$10.00 ,$5.44 ,$2.20 ,$4.16 ,$5.29 ,$5.05 ,$2.31 ,$8.50 ,$6.87 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$64.12 ,$33.88 ,$81.66 ,$38.50 ,$81.66 ,$81.66 ,$38.50 ,$81.66 ,$64.37 ,$129.36 ,$12.95 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$81.66 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100684,84100,HC PHOSPHORUS,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$43.36 ,$26.62 ,$55.21 ,$30.25 ,$55.21 ,$55.21 ,$30.25 ,$55.21 ,$50.58 ,$101.64 ,$11.85 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$55.21 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100685,84105,HC PHOSPHORUS URINE,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$47.35 ,$34.76 ,$60.30 ,$39.50 ,$60.30 ,$60.30 ,$39.50 ,$60.30 ,$66.04 ,$132.72 ,$14.45 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$60.30 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100688,84112,HC PLACENTAL ALPHA MICROGLOBULIN,301,1 ,$244.00 ,$158.60 ,$30.54 ,$245.28 ,$140.30 ,$175.68 ,$132.74 ,$53.68 ,$68.32 ,$143.47 ,$53.68 ,$167.63 ,$61.00 ,$167.63 ,$167.63 ,$61.00 ,$167.63 ,$101.99 ,$204.96 ,$245.28 ,$53.68 ,$207.40 ,$204.96 ,$53.68 ,$183.00 ,$195.20 ,$195.20 ,$53.68 ,$195.20 ,$204.96 ,$204.96 ,$204.96 ,$244.00 ,$219.60 ,$140.30 ,$244.00 ,$53.68 ,$244.00 ,$132.74 ,$53.68 ,$101.50 ,$32.00 ,$30.54 ,$56.36 ,$207.40 ,$167.63 ,$68.32 ,$219.60 ,$204.96 ,$195.20 ,$195.20 ,$53.68 ,$158.60 
ST. FRANCIS HOSPITAL - ACUTE,30100691,84132,HC POTASSIUM,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$57.05 ,$26.62 ,$72.65 ,$30.25 ,$72.65 ,$72.65 ,$30.25 ,$72.65 ,$50.58 ,$101.64 ,$11.90 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$72.65 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100694,84133,HC POTASSIUM URINE,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$39.48 ,$34.76 ,$50.27 ,$39.50 ,$50.27 ,$50.27 ,$39.50 ,$50.27 ,$66.04 ,$132.72 ,$11.83 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$50.27 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100698,84153,HC PSA TOTAL,301,1 ,$168.00 ,$109.20 ,$11.35 ,$168.00 ,$96.60 ,$120.96 ,$91.39 ,$36.96 ,$47.04 ,$98.78 ,$36.96 ,$115.42 ,$42.00 ,$115.42 ,$115.42 ,$42.00 ,$115.42 ,$70.22 ,$141.12 ,$45.98 ,$36.96 ,$142.80 ,$141.12 ,$36.96 ,$126.00 ,$134.40 ,$134.40 ,$36.96 ,$134.40 ,$141.12 ,$141.12 ,$141.12 ,$168.00 ,$151.20 ,$96.60 ,$168.00 ,$36.96 ,$168.00 ,$91.39 ,$36.96 ,$69.89 ,$11.89 ,$11.35 ,$38.81 ,$142.80 ,$115.42 ,$47.04 ,$151.20 ,$141.12 ,$134.40 ,$134.40 ,$36.96 ,$109.20 
ST. FRANCIS HOSPITAL - ACUTE,30100700,84155,HC PROTEIN TOTAL,301,1 ,$26.00 ,$16.90 ,$5.05 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$15.29 ,$5.72 ,$17.86 ,$6.50 ,$17.86 ,$17.86 ,$6.50 ,$17.86 ,$10.87 ,$21.84 ,$9.18 ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 ,$5.29 ,$5.05 ,$6.01 ,$22.10 ,$17.86 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$33.55 ,$34.76 ,$42.72 ,$39.50 ,$42.72 ,$42.72 ,$39.50 ,$42.72 ,$66.04 ,$132.72 ,$9.18 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$42.72 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$128.00 ,$83.20 ,$5.05 ,$128.00 ,$73.60 ,$92.16 ,$69.63 ,$28.16 ,$35.84 ,$45.53 ,$28.16 ,$57.97 ,$32.00 ,$57.97 ,$57.97 ,$32.00 ,$57.97 ,$53.50 ,$107.52 ,$10.00 ,$28.16 ,$108.80 ,$107.52 ,$28.16 ,$96.00 ,$102.40 ,$102.40 ,$28.16 ,$102.40 ,$107.52 ,$107.52 ,$107.52 ,$128.00 ,$115.20 ,$73.60 ,$128.00 ,$28.16 ,$128.00 ,$69.63 ,$28.16 ,$53.25 ,$5.29 ,$5.05 ,$29.57 ,$108.80 ,$57.97 ,$35.84 ,$115.20 ,$107.52 ,$102.40 ,$102.40 ,$28.16 ,$83.20 
ST. FRANCIS HOSPITAL - ACUTE,30100721,84295,HC SODIUM,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$59.67 ,$26.62 ,$75.99 ,$30.25 ,$75.99 ,$75.99 ,$30.25 ,$75.99 ,$50.58 ,$101.64 ,$12.03 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$75.99 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100724,84300,HC SODIUM URINE,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$44.50 ,$34.76 ,$56.67 ,$39.50 ,$56.67 ,$56.67 ,$39.50 ,$56.67 ,$66.04 ,$132.72 ,$12.65 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$56.67 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100730,84315,HC SPEC GRAVITY NON UR,301,1 ,$37.00 ,$24.05 ,$5.05 ,$37.00 ,$21.28 ,$26.64 ,$20.13 ,$8.14 ,$10.36 ,$21.76 ,$8.14 ,$25.42 ,$9.25 ,$25.42 ,$25.42 ,$9.25 ,$25.42 ,$15.47 ,$31.08 ,$8.20 ,$8.14 ,$31.45 ,$31.08 ,$8.14 ,$27.75 ,$29.60 ,$29.60 ,$8.14 ,$29.60 ,$31.08 ,$31.08 ,$31.08 ,$37.00 ,$33.30 ,$21.28 ,$37.00 ,$8.14 ,$37.00 ,$20.13 ,$8.14 ,$15.39 ,$5.29 ,$5.05 ,$8.55 ,$31.45 ,$25.42 ,$10.36 ,$33.30 ,$31.08 ,$29.60 ,$29.60 ,$8.14 ,$24.05 
ST. FRANCIS HOSPITAL - ACUTE,30100740,84439,HC T4 FREE,301,1 ,$128.00 ,$83.20 ,$15.28 ,$128.00 ,$73.60 ,$92.16 ,$69.63 ,$28.16 ,$35.84 ,$75.26 ,$28.16 ,$87.94 ,$32.00 ,$87.94 ,$87.94 ,$32.00 ,$87.94 ,$53.50 ,$107.52 ,$22.55 ,$28.16 ,$108.80 ,$107.52 ,$28.16 ,$96.00 ,$102.40 ,$102.40 ,$28.16 ,$102.40 ,$107.52 ,$107.52 ,$107.52 ,$128.00 ,$115.20 ,$73.60 ,$128.00 ,$28.16 ,$128.00 ,$69.63 ,$28.16 ,$53.25 ,$16.01 ,$15.28 ,$29.57 ,$108.80 ,$87.94 ,$35.84 ,$115.20 ,$107.52 ,$102.40 ,$102.40 ,$28.16 ,$83.20 
ST. FRANCIS HOSPITAL - ACUTE,30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$158.00 ,$102.70 ,$15.28 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$92.90 ,$34.76 ,$108.55 ,$39.50 ,$108.55 ,$108.55 ,$39.50 ,$108.55 ,$66.04 ,$132.72 ,$42.00 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$16.01 ,$15.28 ,$36.50 ,$134.30 ,$108.55 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100746,84450,HC AST,301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$64.12 ,$33.88 ,$81.66 ,$38.50 ,$81.66 ,$81.66 ,$38.50 ,$81.66 ,$64.37 ,$129.36 ,$12.95 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$81.66 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100747,84460,HC ALT,301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$65.72 ,$33.88 ,$83.69 ,$38.50 ,$83.69 ,$83.69 ,$38.50 ,$83.69 ,$64.37 ,$129.36 ,$13.25 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$83.69 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100750,84478,HC TRIGLYCERIDES,301,1 ,$121.00 ,$78.65 ,$5.05 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$71.15 ,$26.62 ,$83.13 ,$30.25 ,$83.13 ,$83.13 ,$30.25 ,$83.13 ,$50.58 ,$101.64 ,$14.35 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$121.00 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$83.13 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100758,84484,HC TROPONIN QN,301,1 ,$276.00 ,$179.40 ,$11.35 ,$276.00 ,$158.70 ,$198.72 ,$150.14 ,$60.72 ,$77.28 ,$92.54 ,$60.72 ,$117.84 ,$69.00 ,$117.84 ,$117.84 ,$69.00 ,$117.84 ,$115.37 ,$231.84 ,$31.18 ,$60.72 ,$234.60 ,$231.84 ,$60.72 ,$207.00 ,$220.80 ,$220.80 ,$60.72 ,$220.80 ,$231.84 ,$231.84 ,$231.84 ,$276.00 ,$248.40 ,$158.70 ,$276.00 ,$60.72 ,$276.00 ,$150.14 ,$60.72 ,$114.82 ,$11.89 ,$11.35 ,$63.76 ,$234.60 ,$117.84 ,$77.28 ,$248.40 ,$231.84 ,$220.80 ,$220.80 ,$60.72 ,$179.40 
ST. FRANCIS HOSPITAL - ACUTE,30100761,84520,HC BUN,301,1 ,$121.00 ,$78.65 ,$3.95 ,$121.00 ,$69.58 ,$87.12 ,$65.82 ,$26.62 ,$33.88 ,$48.95 ,$26.62 ,$62.33 ,$30.25 ,$62.33 ,$62.33 ,$30.25 ,$62.33 ,$50.58 ,$101.64 ,$9.88 ,$26.62 ,$102.85 ,$101.64 ,$26.62 ,$90.75 ,$96.80 ,$96.80 ,$26.62 ,$96.80 ,$101.64 ,$101.64 ,$101.64 ,$121.00 ,$108.90 ,$69.58 ,$121.00 ,$26.62 ,$3.95 ,$65.82 ,$26.62 ,$50.34 ,$5.29 ,$5.05 ,$27.95 ,$102.85 ,$62.33 ,$33.88 ,$108.90 ,$101.64 ,$96.80 ,$96.80 ,$26.62 ,$78.65 
ST. FRANCIS HOSPITAL - ACUTE,30100764,84540,HC UREA URINE,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$43.47 ,$34.76 ,$55.36 ,$39.50 ,$55.36 ,$55.36 ,$39.50 ,$55.36 ,$66.04 ,$132.72 ,$13.90 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$55.36 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100765,84550,HC URIC ACID,301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$56.02 ,$33.88 ,$71.34 ,$38.50 ,$71.34 ,$71.34 ,$38.50 ,$71.34 ,$64.37 ,$129.36 ,$11.30 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$71.34 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30100766,84560,HC URIC ACID OTH SRC,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$43.47 ,$34.76 ,$55.36 ,$39.50 ,$55.36 ,$55.36 ,$39.50 ,$55.36 ,$66.04 ,$132.72 ,$12.70 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$55.36 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30100767,84578,HC UROBILINOGEN,301,1 ,$35.00 ,$22.75 ,$2.55 ,$35.00 ,$20.13 ,$25.20 ,$19.04 ,$7.70 ,$9.80 ,$20.58 ,$7.70 ,$24.05 ,$8.75 ,$24.05 ,$24.05 ,$8.75 ,$24.05 ,$14.63 ,$29.40 ,$11.18 ,$7.70 ,$29.75 ,$29.40 ,$7.70 ,$26.25 ,$28.00 ,$28.00 ,$7.70 ,$28.00 ,$29.40 ,$29.40 ,$29.40 ,$35.00 ,$31.50 ,$20.13 ,$35.00 ,$7.70 ,$35.00 ,$19.04 ,$7.70 ,$14.56 ,$2.67 ,$2.55 ,$8.09 ,$29.75 ,$24.05 ,$9.80 ,$31.50 ,$29.40 ,$28.00 ,$28.00 ,$7.70 ,$22.75 
ST. FRANCIS HOSPITAL - ACUTE,30100802,84702,HC HCG QN,301,1 ,$241.00 ,$156.65 ,$15.28 ,$241.00 ,$138.58 ,$173.52 ,$131.10 ,$53.02 ,$67.48 ,$141.71 ,$53.02 ,$165.57 ,$60.25 ,$165.57 ,$165.57 ,$60.25 ,$165.57 ,$100.74 ,$202.44 ,$37.63 ,$53.02 ,$204.85 ,$202.44 ,$53.02 ,$180.75 ,$192.80 ,$192.80 ,$53.02 ,$192.80 ,$202.44 ,$202.44 ,$202.44 ,$241.00 ,$216.90 ,$138.58 ,$241.00 ,$53.02 ,$241.00 ,$131.10 ,$53.02 ,$100.26 ,$16.01 ,$15.28 ,$55.67 ,$204.85 ,$165.57 ,$67.48 ,$216.90 ,$202.44 ,$192.80 ,$192.80 ,$53.02 ,$156.65 
ST. FRANCIS HOSPITAL - ACUTE,30100810,88720,HC BILICHECK TEST,301,1 ,$51.00 ,$33.15 ,$5.05 ,$51.00 ,$29.33 ,$36.72 ,$27.74 ,$11.22 ,$14.28 ,$29.99 ,$11.22 ,$35.04 ,$12.75 ,$35.04 ,$35.04 ,$12.75 ,$35.04 ,$21.32 ,$42.84 ,$12.55 ,$11.22 ,$43.35 ,$42.84 ,$11.22 ,$38.25 ,$40.80 ,$40.80 ,$11.22 ,$40.80 ,$42.84 ,$42.84 ,$42.84 ,$51.00 ,$45.90 ,$29.33 ,$51.00 ,$11.22 ,$51.00 ,$27.74 ,$11.22 ,$21.22 ,$5.29 ,$5.05 ,$11.78 ,$43.35 ,$35.04 ,$14.28 ,$45.90 ,$42.84 ,$40.80 ,$40.80 ,$11.22 ,$33.15 
ST. FRANCIS HOSPITAL - ACUTE,30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$255.00 ,$165.75 ,$11.35 ,$255.00 ,$146.63 ,$183.60 ,$138.72 ,$56.10 ,$71.40 ,$149.94 ,$56.10 ,$175.19 ,$63.75 ,$175.19 ,$175.19 ,$63.75 ,$175.19 ,$106.59 ,$214.20 ,$48.28 ,$56.10 ,$216.75 ,$214.20 ,$56.10 ,$191.25 ,$204.00 ,$204.00 ,$56.10 ,$204.00 ,$214.20 ,$214.20 ,$214.20 ,$255.00 ,$229.50 ,$146.63 ,$255.00 ,$56.10 ,$255.00 ,$138.72 ,$56.10 ,$106.08 ,$11.89 ,$11.35 ,$58.91 ,$216.75 ,$175.19 ,$71.40 ,$229.50 ,$214.20 ,$204.00 ,$204.00 ,$56.10 ,$165.75 
ST. FRANCIS HOSPITAL - ACUTE,30101089,80150,HC AMIKACIN - 90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$37.70 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$13.65 ,$13.03 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101094,80158,HC CYCLOSPORINE - 90,301,1 ,$82.00 ,$53.30 ,$13.03 ,$82.00 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$48.22 ,$18.04 ,$56.33 ,$20.50 ,$56.33 ,$56.33 ,$20.50 ,$56.33 ,$34.28 ,$68.88 ,$45.13 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 ,$13.65 ,$13.03 ,$18.94 ,$69.70 ,$56.33 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,30101095,80159,HC CLOZAPINE - 90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$50.38 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$50.38 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$13.65 ,$13.03 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101099,80168,HC ETHOSUXIMIDE - 90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$40.85 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$13.65 ,$13.03 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101100,80169,HC EVEROLIMUS - 90,301,1 ,$95.00 ,$61.75 ,$13.03 ,$95.00 ,$54.63 ,$68.40 ,$51.68 ,$20.90 ,$26.60 ,$55.86 ,$20.90 ,$65.27 ,$23.75 ,$65.27 ,$65.27 ,$23.75 ,$65.27 ,$39.71 ,$79.80 ,$34.33 ,$20.90 ,$80.75 ,$79.80 ,$20.90 ,$71.25 ,$76.00 ,$76.00 ,$20.90 ,$76.00 ,$79.80 ,$79.80 ,$79.80 ,$95.00 ,$85.50 ,$54.63 ,$95.00 ,$20.90 ,$95.00 ,$51.68 ,$20.90 ,$39.52 ,$13.65 ,$13.03 ,$21.95 ,$80.75 ,$65.27 ,$26.60 ,$85.50 ,$79.80 ,$76.00 ,$76.00 ,$20.90 ,$61.75 
ST. FRANCIS HOSPITAL - ACUTE,30101102,80171,HC GABAPENTIN PLASMA - 90,301,1 ,$66.00 ,$42.90 ,$13.03 ,$66.00 ,$37.95 ,$47.52 ,$35.90 ,$14.52 ,$18.48 ,$38.81 ,$14.52 ,$45.34 ,$16.50 ,$45.34 ,$45.34 ,$16.50 ,$45.34 ,$27.59 ,$55.44 ,$54.18 ,$14.52 ,$56.10 ,$55.44 ,$14.52 ,$49.50 ,$52.80 ,$52.80 ,$14.52 ,$52.80 ,$55.44 ,$55.44 ,$55.44 ,$66.00 ,$59.40 ,$37.95 ,$66.00 ,$14.52 ,$66.00 ,$35.90 ,$14.52 ,$27.46 ,$13.65 ,$13.03 ,$15.25 ,$56.10 ,$45.34 ,$18.48 ,$59.40 ,$55.44 ,$52.80 ,$52.80 ,$14.52 ,$42.90 
ST. FRANCIS HOSPITAL - ACUTE,30101104,80175,HC LAMOTRIGINE - 90,301,1 ,$66.00 ,$42.90 ,$13.03 ,$66.00 ,$37.95 ,$47.52 ,$35.90 ,$14.52 ,$18.48 ,$38.81 ,$14.52 ,$45.34 ,$16.50 ,$45.34 ,$45.34 ,$16.50 ,$45.34 ,$27.59 ,$55.44 ,$33.13 ,$14.52 ,$56.10 ,$55.44 ,$14.52 ,$49.50 ,$52.80 ,$52.80 ,$14.52 ,$52.80 ,$55.44 ,$55.44 ,$55.44 ,$66.00 ,$59.40 ,$37.95 ,$66.00 ,$14.52 ,$66.00 ,$35.90 ,$14.52 ,$27.46 ,$13.65 ,$13.03 ,$15.25 ,$56.10 ,$45.34 ,$18.48 ,$59.40 ,$55.44 ,$52.80 ,$52.80 ,$14.52 ,$42.90 
ST. FRANCIS HOSPITAL - ACUTE,30101106,80177,HC LEVETIRACETAM - 90,301,1 ,$74.00 ,$48.10 ,$13.03 ,$74.00 ,$42.55 ,$53.28 ,$40.26 ,$16.28 ,$20.72 ,$43.51 ,$16.28 ,$50.84 ,$18.50 ,$50.84 ,$50.84 ,$18.50 ,$50.84 ,$30.93 ,$62.16 ,$33.13 ,$16.28 ,$62.90 ,$62.16 ,$16.28 ,$55.50 ,$59.20 ,$59.20 ,$16.28 ,$59.20 ,$62.16 ,$62.16 ,$62.16 ,$74.00 ,$66.60 ,$42.55 ,$74.00 ,$16.28 ,$74.00 ,$40.26 ,$16.28 ,$30.78 ,$13.65 ,$13.03 ,$17.09 ,$62.90 ,$50.84 ,$20.72 ,$66.60 ,$62.16 ,$59.20 ,$59.20 ,$16.28 ,$48.10 
ST. FRANCIS HOSPITAL - ACUTE,30101108,80180,HC MYCOPHENOLATE/MYCOPHENOLIC ACID - 90,301,1 ,$213.00 ,$138.45 ,$13.03 ,$213.00 ,$122.48 ,$153.36 ,$115.87 ,$46.86 ,$59.64 ,$125.24 ,$46.86 ,$146.33 ,$53.25 ,$146.33 ,$146.33 ,$53.25 ,$146.33 ,$89.03 ,$178.92 ,$45.13 ,$46.86 ,$181.05 ,$178.92 ,$46.86 ,$159.75 ,$170.40 ,$170.40 ,$46.86 ,$170.40 ,$178.92 ,$178.92 ,$178.92 ,$213.00 ,$191.70 ,$122.48 ,$213.00 ,$46.86 ,$213.00 ,$115.87 ,$46.86 ,$88.61 ,$13.65 ,$13.03 ,$49.20 ,$181.05 ,$146.33 ,$59.64 ,$191.70 ,$178.92 ,$170.40 ,$170.40 ,$46.86 ,$138.45 
ST. FRANCIS HOSPITAL - ACUTE,30101109,80183,HC OXCARBAZEPINE - 90,301,1 ,$84.00 ,$54.60 ,$13.03 ,$84.00 ,$48.30 ,$60.48 ,$45.70 ,$18.48 ,$23.52 ,$49.39 ,$18.48 ,$57.71 ,$21.00 ,$57.71 ,$57.71 ,$21.00 ,$57.71 ,$35.11 ,$70.56 ,$33.13 ,$18.48 ,$71.40 ,$70.56 ,$18.48 ,$63.00 ,$67.20 ,$67.20 ,$18.48 ,$67.20 ,$70.56 ,$70.56 ,$70.56 ,$84.00 ,$75.60 ,$48.30 ,$84.00 ,$18.48 ,$84.00 ,$45.70 ,$18.48 ,$34.94 ,$13.65 ,$13.03 ,$19.40 ,$71.40 ,$57.71 ,$23.52 ,$75.60 ,$70.56 ,$67.20 ,$67.20 ,$18.48 ,$54.60 
ST. FRANCIS HOSPITAL - ACUTE,30101110,80184,HC PHENOBARBITAL - 90,301,1 ,$23.00 ,$14.95 ,$5.06 ,$38.25 ,$13.23 ,$16.56 ,$12.51 ,$5.06 ,$6.44 ,$13.52 ,$5.06 ,$15.80 ,$5.75 ,$15.80 ,$15.80 ,$5.75 ,$15.80 ,$9.61 ,$19.32 ,$38.25 ,$5.06 ,$19.55 ,$19.32 ,$5.06 ,$17.25 ,$18.40 ,$18.40 ,$5.06 ,$18.40 ,$19.32 ,$19.32 ,$19.32 ,$23.00 ,$20.70 ,$13.23 ,$23.00 ,$5.06 ,$23.00 ,$12.51 ,$5.06 ,$9.57 ,$13.65 ,$13.03 ,$5.31 ,$19.55 ,$15.80 ,$6.44 ,$20.70 ,$19.32 ,$18.40 ,$18.40 ,$5.06 ,$14.95 
ST. FRANCIS HOSPITAL - ACUTE,30101114,80186,HC PHENYTOIN FREE - 90,301,1 ,$155.00 ,$100.75 ,$13.03 ,$155.00 ,$89.13 ,$111.60 ,$84.32 ,$34.10 ,$43.40 ,$91.14 ,$34.10 ,$106.49 ,$38.75 ,$106.49 ,$106.49 ,$38.75 ,$106.49 ,$64.79 ,$130.20 ,$34.40 ,$34.10 ,$131.75 ,$130.20 ,$34.10 ,$116.25 ,$124.00 ,$124.00 ,$34.10 ,$124.00 ,$130.20 ,$130.20 ,$130.20 ,$155.00 ,$139.50 ,$89.13 ,$155.00 ,$34.10 ,$155.00 ,$84.32 ,$34.10 ,$64.48 ,$13.65 ,$13.03 ,$35.81 ,$131.75 ,$106.49 ,$43.40 ,$139.50 ,$130.20 ,$124.00 ,$124.00 ,$34.10 ,$100.75 
ST. FRANCIS HOSPITAL - ACUTE,30101115,80188,HC PRIMIDONE - 90,301,1 ,$23.00 ,$14.95 ,$5.06 ,$41.48 ,$13.23 ,$16.56 ,$12.51 ,$5.06 ,$6.44 ,$13.52 ,$5.06 ,$15.80 ,$5.75 ,$15.80 ,$15.80 ,$5.75 ,$15.80 ,$9.61 ,$19.32 ,$41.48 ,$5.06 ,$19.55 ,$19.32 ,$5.06 ,$17.25 ,$18.40 ,$18.40 ,$5.06 ,$18.40 ,$19.32 ,$19.32 ,$19.32 ,$23.00 ,$20.70 ,$13.23 ,$23.00 ,$5.06 ,$23.00 ,$12.51 ,$5.06 ,$9.57 ,$13.65 ,$13.03 ,$5.31 ,$19.55 ,$15.80 ,$6.44 ,$20.70 ,$19.32 ,$18.40 ,$18.40 ,$5.06 ,$14.95 
ST. FRANCIS HOSPITAL - ACUTE,30101116,80192,HC PROCAINEAMIDE - 90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$41.88 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$13.65 ,$13.03 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101117,80194,HC QUINIDINE - 90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$36.50 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$13.65 ,$13.03 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101118,80195,HC RAPAMYCIN (SIROLIMUS) - 90,301,1 ,$76.00 ,$49.40 ,$13.03 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$44.69 ,$16.72 ,$52.21 ,$19.00 ,$52.21 ,$52.21 ,$19.00 ,$52.21 ,$31.77 ,$63.84 ,$34.33 ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 ,$13.65 ,$13.03 ,$17.56 ,$64.60 ,$52.21 ,$21.28 ,$68.40 ,$63.84 ,$60.80 ,$60.80 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,30101119,80197,HC TACROLIMUS - 90,301,1 ,$198.00 ,$128.70 ,$13.03 ,$198.00 ,$113.85 ,$142.56 ,$107.71 ,$43.56 ,$55.44 ,$116.42 ,$43.56 ,$136.03 ,$49.50 ,$136.03 ,$136.03 ,$49.50 ,$136.03 ,$82.76 ,$166.32 ,$34.33 ,$43.56 ,$168.30 ,$166.32 ,$43.56 ,$148.50 ,$158.40 ,$158.40 ,$43.56 ,$158.40 ,$166.32 ,$166.32 ,$166.32 ,$198.00 ,$178.20 ,$113.85 ,$198.00 ,$43.56 ,$198.00 ,$107.71 ,$43.56 ,$82.37 ,$13.65 ,$13.03 ,$45.74 ,$168.30 ,$136.03 ,$55.44 ,$178.20 ,$166.32 ,$158.40 ,$158.40 ,$43.56 ,$128.70 
ST. FRANCIS HOSPITAL - ACUTE,30101124,80201,HC TOPIRAMATE - 90,301,1 ,$55.00 ,$35.75 ,$12.10 ,$55.00 ,$31.63 ,$39.60 ,$29.92 ,$12.10 ,$15.40 ,$32.34 ,$12.10 ,$37.79 ,$13.75 ,$37.79 ,$37.79 ,$13.75 ,$37.79 ,$22.99 ,$46.20 ,$29.80 ,$12.10 ,$46.75 ,$46.20 ,$12.10 ,$41.25 ,$44.00 ,$44.00 ,$12.10 ,$44.00 ,$46.20 ,$46.20 ,$46.20 ,$55.00 ,$49.50 ,$31.63 ,$55.00 ,$12.10 ,$55.00 ,$29.92 ,$12.10 ,$22.88 ,$13.65 ,$13.03 ,$12.71 ,$46.75 ,$37.79 ,$15.40 ,$49.50 ,$46.20 ,$44.00 ,$44.00 ,$12.10 ,$35.75 
ST. FRANCIS HOSPITAL - ACUTE,30101131,80299,HC THERAPEUTIC DRUG OTHER - 90,301,1 ,$76.00 ,$49.40 ,$13.03 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$44.69 ,$16.72 ,$52.21 ,$19.00 ,$52.21 ,$52.21 ,$19.00 ,$52.21 ,$31.77 ,$63.84 ,$46.60 ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 ,$13.65 ,$13.03 ,$17.56 ,$64.60 ,$52.21 ,$21.28 ,$68.40 ,$63.84 ,$60.80 ,$60.80 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,30101134,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T1,301,1 ,$174.00 ,$113.10 ,$30.54 ,$174.00 ,$100.05 ,$125.28 ,$94.66 ,$38.28 ,$48.72 ,$102.31 ,$38.28 ,$119.54 ,$43.50 ,$119.54 ,$119.54 ,$43.50 ,$119.54 ,$72.73 ,$146.16 ,$155.35 ,$38.28 ,$147.90 ,$146.16 ,$38.28 ,$130.50 ,$139.20 ,$139.20 ,$38.28 ,$139.20 ,$146.16 ,$146.16 ,$146.16 ,$174.00 ,$156.60 ,$100.05 ,$174.00 ,$38.28 ,$174.00 ,$94.66 ,$38.28 ,$72.38 ,$32.00 ,$30.54 ,$40.19 ,$147.90 ,$119.54 ,$48.72 ,$156.60 ,$146.16 ,$139.20 ,$139.20 ,$38.28 ,$113.10 
ST. FRANCIS HOSPITAL - ACUTE,30101135,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T2,301,1 ,$231.00 ,$150.15 ,$30.54 ,$231.00 ,$132.83 ,$166.32 ,$125.66 ,$50.82 ,$64.68 ,$135.83 ,$50.82 ,$158.70 ,$57.75 ,$158.70 ,$158.70 ,$57.75 ,$158.70 ,$96.56 ,$194.04 ,$155.35 ,$50.82 ,$196.35 ,$194.04 ,$50.82 ,$173.25 ,$184.80 ,$184.80 ,$50.82 ,$184.80 ,$194.04 ,$194.04 ,$194.04 ,$231.00 ,$207.90 ,$132.83 ,$231.00 ,$50.82 ,$231.00 ,$125.66 ,$50.82 ,$96.10 ,$32.00 ,$30.54 ,$53.36 ,$196.35 ,$158.70 ,$64.68 ,$207.90 ,$194.04 ,$184.80 ,$184.80 ,$50.82 ,$150.15 
ST. FRANCIS HOSPITAL - ACUTE,30101136,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T3,301,1 ,$337.00 ,$219.05 ,$30.54 ,$337.00 ,$193.78 ,$242.64 ,$183.33 ,$74.14 ,$94.36 ,$198.16 ,$74.14 ,$231.52 ,$84.25 ,$231.52 ,$231.52 ,$84.25 ,$231.52 ,$140.87 ,$283.08 ,$155.35 ,$74.14 ,$286.45 ,$283.08 ,$74.14 ,$252.75 ,$269.60 ,$269.60 ,$74.14 ,$269.60 ,$283.08 ,$283.08 ,$283.08 ,$337.00 ,$303.30 ,$193.78 ,$337.00 ,$74.14 ,$337.00 ,$183.33 ,$74.14 ,$140.19 ,$32.00 ,$30.54 ,$77.85 ,$286.45 ,$231.52 ,$94.36 ,$303.30 ,$283.08 ,$269.60 ,$269.60 ,$74.14 ,$219.05 
ST. FRANCIS HOSPITAL - ACUTE,30101140,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T1-90,301,1 ,$174.00 ,$113.10 ,$30.54 ,$174.00 ,$100.05 ,$125.28 ,$94.66 ,$38.28 ,$48.72 ,$102.31 ,$38.28 ,$119.54 ,$43.50 ,$119.54 ,$119.54 ,$43.50 ,$119.54 ,$72.73 ,$146.16 ,$155.35 ,$38.28 ,$147.90 ,$146.16 ,$38.28 ,$130.50 ,$139.20 ,$139.20 ,$38.28 ,$139.20 ,$146.16 ,$146.16 ,$146.16 ,$174.00 ,$156.60 ,$100.05 ,$174.00 ,$38.28 ,$174.00 ,$94.66 ,$38.28 ,$72.38 ,$32.00 ,$30.54 ,$40.19 ,$147.90 ,$119.54 ,$48.72 ,$156.60 ,$146.16 ,$139.20 ,$139.20 ,$38.28 ,$113.10 
ST. FRANCIS HOSPITAL - ACUTE,30101141,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T2-90,301,1 ,$59.00 ,$38.35 ,$12.98 ,$147.50 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$147.50 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$32.00 ,$30.54 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101146,80323,HC NICOTINE - 90,301,1 ,$57.00 ,$37.05 ,$12.54 ,$57.00 ,$32.78 ,$41.04 ,$31.01 ,$12.54 ,$15.96 , N/A ,$12.54 , N/A ,$14.25 , N/A , N/A ,$14.25 , N/A ,$23.83 ,$47.88 , N/A ,$12.54 ,$48.45 ,$47.88 ,$12.54 ,$42.75 ,$45.60 ,$45.60 ,$12.54 ,$45.60 ,$47.88 ,$47.88 ,$47.88 ,$57.00 ,$51.30 ,$32.78 ,$57.00 ,$12.54 ,$57.00 ,$31.01 ,$12.54 ,$23.71 ,$32.00 ,$30.54 ,$13.17 ,$48.45 , N/A ,$15.96 ,$51.30 ,$47.88 ,$45.60 ,$45.60 ,$12.54 ,$37.05 
ST. FRANCIS HOSPITAL - ACUTE,30101148,80327,HC ANABOLIC STERIODS 1-2  - 90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 , N/A ,$10.78 , N/A ,$12.25 , N/A , N/A ,$12.25 , N/A ,$20.48 ,$41.16 , N/A ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$32.00 ,$30.54 ,$11.32 ,$41.65 , N/A ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101150,80346,HC BENZODIAZEPINES 1-12  -90,301,1 ,$114.00 ,$74.10 ,$25.08 ,$114.00 ,$65.55 ,$82.08 ,$62.02 ,$25.08 ,$31.92 , N/A ,$25.08 , N/A ,$28.50 , N/A , N/A ,$28.50 , N/A ,$47.65 ,$95.76 , N/A ,$25.08 ,$96.90 ,$95.76 ,$25.08 ,$85.50 ,$91.20 ,$91.20 ,$25.08 ,$91.20 ,$95.76 ,$95.76 ,$95.76 ,$114.00 ,$102.60 ,$65.55 ,$114.00 ,$25.08 ,$114.00 ,$62.02 ,$25.08 ,$47.42 ,$32.00 ,$30.54 ,$26.33 ,$96.90 , N/A ,$31.92 ,$102.60 ,$95.76 ,$91.20 ,$91.20 ,$25.08 ,$74.10 
ST. FRANCIS HOSPITAL - ACUTE,30101151,80349,HC CANNABINOIDS NATURAL -90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 , N/A ,$10.78 , N/A ,$12.25 , N/A , N/A ,$12.25 , N/A ,$20.48 ,$41.16 , N/A ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$11.89 ,$11.35 ,$11.32 ,$41.65 , N/A ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101153,80359,HC METHYLENEDIOXYAMPHETAMINES MDA MDEA MDMA -90,301,1 ,$142.00 ,$92.30 ,$11.35 ,$142.00 ,$81.65 ,$102.24 ,$77.25 ,$31.24 ,$39.76 , N/A ,$31.24 , N/A ,$35.50 , N/A , N/A ,$35.50 , N/A ,$59.36 ,$119.28 , N/A ,$31.24 ,$120.70 ,$119.28 ,$31.24 ,$106.50 ,$113.60 ,$113.60 ,$31.24 ,$113.60 ,$119.28 ,$119.28 ,$119.28 ,$142.00 ,$127.80 ,$81.65 ,$142.00 ,$31.24 ,$142.00 ,$77.25 ,$31.24 ,$59.07 ,$11.89 ,$11.35 ,$32.80 ,$120.70 , N/A ,$39.76 ,$127.80 ,$119.28 ,$113.60 ,$113.60 ,$31.24 ,$92.30 
ST. FRANCIS HOSPITAL - ACUTE,30101157,82017,HC ACYLCARNITINES QN EA SPEC-90,301,1 ,$163.00 ,$105.95 ,$11.35 ,$163.00 ,$93.73 ,$117.36 ,$88.67 ,$35.86 ,$45.64 ,$95.84 ,$35.86 ,$111.98 ,$40.75 ,$111.98 ,$111.98 ,$40.75 ,$111.98 ,$68.13 ,$136.92 ,$42.18 ,$35.86 ,$138.55 ,$136.92 ,$35.86 ,$122.25 ,$130.40 ,$130.40 ,$35.86 ,$130.40 ,$136.92 ,$136.92 ,$136.92 ,$163.00 ,$146.70 ,$93.73 ,$163.00 ,$35.86 ,$163.00 ,$88.67 ,$35.86 ,$67.81 ,$11.89 ,$11.35 ,$37.65 ,$138.55 ,$111.98 ,$45.64 ,$146.70 ,$136.92 ,$130.40 ,$130.40 ,$35.86 ,$105.95 
ST. FRANCIS HOSPITAL - ACUTE,30101158,82024,HC ACTH -90,301,1 ,$229.00 ,$148.85 ,$26.55 ,$229.00 ,$131.68 ,$164.88 ,$124.58 ,$50.38 ,$64.12 ,$134.65 ,$50.38 ,$157.32 ,$57.25 ,$157.32 ,$157.32 ,$57.25 ,$157.32 ,$95.72 ,$192.36 ,$96.55 ,$50.38 ,$194.65 ,$192.36 ,$50.38 ,$171.75 ,$183.20 ,$183.20 ,$50.38 ,$183.20 ,$192.36 ,$192.36 ,$192.36 ,$229.00 ,$206.10 ,$131.68 ,$229.00 ,$50.38 ,$229.00 ,$124.58 ,$50.38 ,$95.26 ,$27.82 ,$26.55 ,$52.90 ,$194.65 ,$157.32 ,$64.12 ,$206.10 ,$192.36 ,$183.20 ,$183.20 ,$50.38 ,$148.85 
ST. FRANCIS HOSPITAL - ACUTE,30101162,82085,HC ALDOLASE-90,301,1 ,$63.00 ,$40.95 ,$11.35 ,$63.00 ,$36.23 ,$45.36 ,$34.27 ,$13.86 ,$17.64 ,$37.04 ,$13.86 ,$43.28 ,$15.75 ,$43.28 ,$43.28 ,$15.75 ,$43.28 ,$26.33 ,$52.92 ,$24.28 ,$13.86 ,$53.55 ,$52.92 ,$13.86 ,$47.25 ,$50.40 ,$50.40 ,$13.86 ,$50.40 ,$52.92 ,$52.92 ,$52.92 ,$63.00 ,$56.70 ,$36.23 ,$63.00 ,$13.86 ,$63.00 ,$34.27 ,$13.86 ,$26.21 ,$11.89 ,$11.35 ,$14.55 ,$53.55 ,$43.28 ,$17.64 ,$56.70 ,$52.92 ,$50.40 ,$50.40 ,$13.86 ,$40.95 
ST. FRANCIS HOSPITAL - ACUTE,30101163,82088,HC ALDOSTERONE-90,301,1 ,$245.00 ,$159.25 ,$26.55 ,$245.00 ,$140.88 ,$176.40 ,$133.28 ,$53.90 ,$68.60 ,$144.06 ,$53.90 ,$168.32 ,$61.25 ,$168.32 ,$168.32 ,$61.25 ,$168.32 ,$102.41 ,$205.80 ,$101.88 ,$53.90 ,$208.25 ,$205.80 ,$53.90 ,$183.75 ,$196.00 ,$196.00 ,$53.90 ,$196.00 ,$205.80 ,$205.80 ,$205.80 ,$245.00 ,$220.50 ,$140.88 ,$245.00 ,$53.90 ,$245.00 ,$133.28 ,$53.90 ,$101.92 ,$27.82 ,$26.55 ,$56.60 ,$208.25 ,$168.32 ,$68.60 ,$220.50 ,$205.80 ,$196.00 ,$196.00 ,$53.90 ,$159.25 
ST. FRANCIS HOSPITAL - ACUTE,30101164,82103,HC ALPHA-1 ANTITRYPSIN TOTAL-90,301,1 ,$94.00 ,$61.10 ,$11.35 ,$94.00 ,$54.05 ,$67.68 ,$51.14 ,$20.68 ,$26.32 ,$55.27 ,$20.68 ,$64.58 ,$23.50 ,$64.58 ,$64.58 ,$23.50 ,$64.58 ,$39.29 ,$78.96 ,$33.60 ,$20.68 ,$79.90 ,$78.96 ,$20.68 ,$70.50 ,$75.20 ,$75.20 ,$20.68 ,$75.20 ,$78.96 ,$78.96 ,$78.96 ,$94.00 ,$84.60 ,$54.05 ,$94.00 ,$20.68 ,$94.00 ,$51.14 ,$20.68 ,$39.10 ,$11.89 ,$11.35 ,$21.71 ,$79.90 ,$64.58 ,$26.32 ,$84.60 ,$78.96 ,$75.20 ,$75.20 ,$20.68 ,$61.10 
ST. FRANCIS HOSPITAL - ACUTE,30101165,82104,HC ALPHA-1 ANTITRYPSIN PHENO-90,301,1 ,$178.00 ,$115.70 ,$11.35 ,$178.00 ,$102.35 ,$128.16 ,$96.83 ,$39.16 ,$49.84 ,$104.66 ,$39.16 ,$122.29 ,$44.50 ,$122.29 ,$122.29 ,$44.50 ,$122.29 ,$74.40 ,$149.52 ,$36.15 ,$39.16 ,$151.30 ,$149.52 ,$39.16 ,$133.50 ,$142.40 ,$142.40 ,$39.16 ,$142.40 ,$149.52 ,$149.52 ,$149.52 ,$178.00 ,$160.20 ,$102.35 ,$178.00 ,$39.16 ,$178.00 ,$96.83 ,$39.16 ,$74.05 ,$11.89 ,$11.35 ,$41.12 ,$151.30 ,$122.29 ,$49.84 ,$160.20 ,$149.52 ,$142.40 ,$142.40 ,$39.16 ,$115.70 
ST. FRANCIS HOSPITAL - ACUTE,30101166,82105,HC ALPHA FETOPROTEIN SERUM-90,301,1 ,$99.00 ,$64.35 ,$11.35 ,$99.00 ,$56.93 ,$71.28 ,$53.86 ,$21.78 ,$27.72 ,$58.21 ,$21.78 ,$68.01 ,$24.75 ,$68.01 ,$68.01 ,$24.75 ,$68.01 ,$41.38 ,$83.16 ,$41.93 ,$21.78 ,$84.15 ,$83.16 ,$21.78 ,$74.25 ,$79.20 ,$79.20 ,$21.78 ,$79.20 ,$83.16 ,$83.16 ,$83.16 ,$99.00 ,$89.10 ,$56.93 ,$99.00 ,$21.78 ,$99.00 ,$53.86 ,$21.78 ,$41.18 ,$11.89 ,$11.35 ,$22.87 ,$84.15 ,$68.01 ,$27.72 ,$89.10 ,$83.16 ,$79.20 ,$79.20 ,$21.78 ,$64.35 
ST. FRANCIS HOSPITAL - ACUTE,30101169,82108,HC ALUMINUM-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$63.70 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$63.70 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$14.50 ,$13.84 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101172,82131,HC AMINO ACID QN SINGLE-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$57.45 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$57.45 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$11.89 ,$11.35 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101175,82139,HC AMINO ACIDS 6+ QN CSF-90,301,1 ,$131.00 ,$85.15 ,$11.35 ,$131.00 ,$75.33 ,$94.32 ,$71.26 ,$28.82 ,$36.68 ,$77.03 ,$28.82 ,$90.00 ,$32.75 ,$90.00 ,$90.00 ,$32.75 ,$90.00 ,$54.76 ,$110.04 ,$42.18 ,$28.82 ,$111.35 ,$110.04 ,$28.82 ,$98.25 ,$104.80 ,$104.80 ,$28.82 ,$104.80 ,$110.04 ,$110.04 ,$110.04 ,$131.00 ,$117.90 ,$75.33 ,$131.00 ,$28.82 ,$131.00 ,$71.26 ,$28.82 ,$54.50 ,$11.89 ,$11.35 ,$30.26 ,$111.35 ,$90.00 ,$36.68 ,$117.90 ,$110.04 ,$104.80 ,$104.80 ,$28.82 ,$85.15 
ST. FRANCIS HOSPITAL - ACUTE,30101176,82140,HC AMMONIA-90,301,1 ,$59.00 ,$38.35 ,$11.35 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$36.43 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$11.89 ,$11.35 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101178,82157,HC ANDROSTENEDIONE-90,301,1 ,$110.00 ,$71.50 ,$24.20 ,$110.00 ,$63.25 ,$79.20 ,$59.84 ,$24.20 ,$30.80 ,$64.68 ,$24.20 ,$75.57 ,$27.50 ,$75.57 ,$75.57 ,$27.50 ,$75.57 ,$45.98 ,$92.40 ,$73.20 ,$24.20 ,$93.50 ,$92.40 ,$24.20 ,$82.50 ,$88.00 ,$88.00 ,$24.20 ,$88.00 ,$92.40 ,$92.40 ,$92.40 ,$110.00 ,$99.00 ,$63.25 ,$110.00 ,$24.20 ,$110.00 ,$59.84 ,$24.20 ,$45.76 ,$27.82 ,$26.55 ,$25.41 ,$93.50 ,$75.57 ,$30.80 ,$99.00 ,$92.40 ,$88.00 ,$88.00 ,$24.20 ,$71.50 
ST. FRANCIS HOSPITAL - ACUTE,30101179,82164,HC ANGIOTENSIN 1 ENZYME (ACE)-90,301,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$36.50 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$11.89 ,$11.35 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30101180,82172,HC APOLIPOPROTEIN SERUM-90,301,1 ,$40.00 ,$26.00 ,$8.80 ,$52.73 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$52.73 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$11.89 ,$11.35 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101181,82175,HC ARSENIC-90,301,1 ,$24.00 ,$15.60 ,$5.28 ,$47.43 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$47.43 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$14.50 ,$13.84 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101182,82180,HC VITAMIN C (ASCORBIC ACID)-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$24.73 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$11.89 ,$11.35 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101184,82232,HC BETA 2 MICROGLOBULIN-90,301,1 ,$67.00 ,$43.55 ,$14.74 ,$67.00 ,$38.53 ,$48.24 ,$36.45 ,$14.74 ,$18.76 ,$39.40 ,$14.74 ,$46.03 ,$16.75 ,$46.03 ,$46.03 ,$16.75 ,$46.03 ,$28.01 ,$56.28 ,$40.45 ,$14.74 ,$56.95 ,$56.28 ,$14.74 ,$50.25 ,$53.60 ,$53.60 ,$14.74 ,$53.60 ,$56.28 ,$56.28 ,$56.28 ,$67.00 ,$60.30 ,$38.53 ,$67.00 ,$14.74 ,$67.00 ,$36.45 ,$14.74 ,$27.87 ,$27.82 ,$26.55 ,$15.48 ,$56.95 ,$46.03 ,$18.76 ,$60.30 ,$56.28 ,$53.60 ,$53.60 ,$14.74 ,$43.55 
ST. FRANCIS HOSPITAL - ACUTE,30101185,82239,HC BILE ACID TOTAL-90,301,1 ,$43.00 ,$27.95 ,$9.46 ,$43.00 ,$24.73 ,$30.96 ,$23.39 ,$9.46 ,$12.04 ,$25.28 ,$9.46 ,$29.54 ,$10.75 ,$29.54 ,$29.54 ,$10.75 ,$29.54 ,$17.97 ,$36.12 ,$42.80 ,$9.46 ,$36.55 ,$36.12 ,$9.46 ,$32.25 ,$34.40 ,$34.40 ,$9.46 ,$34.40 ,$36.12 ,$36.12 ,$36.12 ,$43.00 ,$38.70 ,$24.73 ,$43.00 ,$9.46 ,$43.00 ,$23.39 ,$9.46 ,$17.89 ,$11.89 ,$11.35 ,$9.93 ,$36.55 ,$29.54 ,$12.04 ,$38.70 ,$36.12 ,$34.40 ,$34.40 ,$9.46 ,$27.95 
ST. FRANCIS HOSPITAL - ACUTE,30101186,82247,HC BILIRUBIN TOTAL-90,301,1 ,$40.00 ,$26.00 ,$5.05 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$12.55 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$5.29 ,$5.05 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101188,82270,HC OCCULT BLOOD FECAL SCRN,301,1 ,$66.00 ,$42.90 ,$5.05 ,$66.00 ,$37.95 ,$47.52 ,$35.90 ,$14.52 ,$18.48 ,$38.81 ,$14.52 ,$45.34 ,$16.50 ,$45.34 ,$45.34 ,$16.50 ,$45.34 ,$27.59 ,$55.44 ,$10.95 ,$14.52 ,$56.10 ,$55.44 ,$14.52 ,$49.50 ,$52.80 ,$52.80 ,$14.52 ,$52.80 ,$55.44 ,$55.44 ,$55.44 ,$66.00 ,$59.40 ,$37.95 ,$66.00 ,$14.52 ,$66.00 ,$35.90 ,$14.52 ,$27.46 ,$5.29 ,$5.05 ,$15.25 ,$56.10 ,$45.34 ,$18.48 ,$59.40 ,$55.44 ,$52.80 ,$52.80 ,$14.52 ,$42.90 
ST. FRANCIS HOSPITAL - ACUTE,30101191,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$54.00 ,$35.10 ,$5.05 ,$54.00 ,$31.05 ,$38.88 ,$29.38 ,$11.88 ,$15.12 ,$31.75 ,$11.88 ,$37.10 ,$13.50 ,$37.10 ,$37.10 ,$13.50 ,$37.10 ,$22.57 ,$45.36 ,$13.30 ,$11.88 ,$45.90 ,$45.36 ,$11.88 ,$40.50 ,$43.20 ,$43.20 ,$11.88 ,$43.20 ,$45.36 ,$45.36 ,$45.36 ,$54.00 ,$48.60 ,$31.05 ,$54.00 ,$11.88 ,$54.00 ,$29.38 ,$11.88 ,$22.46 ,$5.29 ,$5.05 ,$12.47 ,$45.90 ,$37.10 ,$15.12 ,$48.60 ,$45.36 ,$43.20 ,$43.20 ,$11.88 ,$35.10 
ST. FRANCIS HOSPITAL - ACUTE,30101196,82300,HC CADMIUM-90,301,1 ,$24.00 ,$15.60 ,$5.28 ,$59.10 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$59.10 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$14.50 ,$13.84 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101197,82306,HC VITAMIN D 25 OH-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$74.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$74.00 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$32.00 ,$30.54 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101199,82308,HC CALCITONIN-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$66.98 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$66.98 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$27.82 ,$26.55 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101203,82340,HC CALCIUM URINE QN TIMED-90,301,1 ,$59.00 ,$38.35 ,$11.35 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$15.08 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$11.89 ,$11.35 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101205,82365,HC CALCULUS ANLYS INFRARED-90,301,1 ,$95.00 ,$61.75 ,$11.35 ,$95.00 ,$54.63 ,$68.40 ,$51.68 ,$20.90 ,$26.60 ,$55.86 ,$20.90 ,$65.27 ,$23.75 ,$65.27 ,$65.27 ,$23.75 ,$65.27 ,$39.71 ,$79.80 ,$32.25 ,$20.90 ,$80.75 ,$79.80 ,$20.90 ,$71.25 ,$76.00 ,$76.00 ,$20.90 ,$76.00 ,$79.80 ,$79.80 ,$79.80 ,$95.00 ,$85.50 ,$54.63 ,$95.00 ,$20.90 ,$95.00 ,$51.68 ,$20.90 ,$39.52 ,$11.89 ,$11.35 ,$21.95 ,$80.75 ,$65.27 ,$26.60 ,$85.50 ,$79.80 ,$76.00 ,$76.00 ,$20.90 ,$61.75 
ST. FRANCIS HOSPITAL - ACUTE,30101207,82373,HC CARBOHY DEFICIENT TRANSFER CONGENTIAL-90,301,1 ,$134.00 ,$87.10 ,$11.35 ,$134.00 ,$77.05 ,$96.48 ,$72.90 ,$29.48 ,$37.52 ,$78.79 ,$29.48 ,$92.06 ,$33.50 ,$92.06 ,$92.06 ,$33.50 ,$92.06 ,$56.01 ,$112.56 ,$45.15 ,$29.48 ,$113.90 ,$112.56 ,$29.48 ,$100.50 ,$107.20 ,$107.20 ,$29.48 ,$107.20 ,$112.56 ,$112.56 ,$112.56 ,$134.00 ,$120.60 ,$77.05 ,$134.00 ,$29.48 ,$134.00 ,$72.90 ,$29.48 ,$55.74 ,$11.89 ,$11.35 ,$30.95 ,$113.90 ,$92.06 ,$37.52 ,$120.60 ,$112.56 ,$107.20 ,$107.20 ,$29.48 ,$87.10 
ST. FRANCIS HOSPITAL - ACUTE,30101209,82379,HC CARNITINE TOTAL AND FREE QN-90,301,1 ,$172.00 ,$111.80 ,$11.35 ,$172.00 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$101.14 ,$37.84 ,$118.16 ,$43.00 ,$118.16 ,$118.16 ,$43.00 ,$118.16 ,$71.90 ,$144.48 ,$42.18 ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 ,$11.89 ,$11.35 ,$39.73 ,$146.20 ,$118.16 ,$48.16 ,$154.80 ,$144.48 ,$137.60 ,$137.60 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,30101210,82380,HC CAROTENE-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$23.05 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$11.89 ,$11.35 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101211,82384,HC CATECHOLAMINE FRACTION-90,301,1 ,$72.00 ,$46.80 ,$15.84 ,$72.00 ,$41.40 ,$51.84 ,$39.17 ,$15.84 ,$20.16 ,$42.34 ,$15.84 ,$49.46 ,$18.00 ,$49.46 ,$49.46 ,$18.00 ,$49.46 ,$30.10 ,$60.48 ,$63.13 ,$15.84 ,$61.20 ,$60.48 ,$15.84 ,$54.00 ,$57.60 ,$57.60 ,$15.84 ,$57.60 ,$60.48 ,$60.48 ,$60.48 ,$72.00 ,$64.80 ,$41.40 ,$72.00 ,$15.84 ,$72.00 ,$39.17 ,$15.84 ,$29.95 ,$27.82 ,$26.55 ,$16.63 ,$61.20 ,$49.46 ,$20.16 ,$64.80 ,$60.48 ,$57.60 ,$57.60 ,$15.84 ,$46.80 
ST. FRANCIS HOSPITAL - ACUTE,30101212,82390,HC CERULOPLASMIN-90,301,1 ,$91.00 ,$59.15 ,$11.35 ,$91.00 ,$52.33 ,$65.52 ,$49.50 ,$20.02 ,$25.48 ,$53.51 ,$20.02 ,$62.52 ,$22.75 ,$62.52 ,$62.52 ,$22.75 ,$62.52 ,$38.04 ,$76.44 ,$26.85 ,$20.02 ,$77.35 ,$76.44 ,$20.02 ,$68.25 ,$72.80 ,$72.80 ,$20.02 ,$72.80 ,$76.44 ,$76.44 ,$76.44 ,$91.00 ,$81.90 ,$52.33 ,$91.00 ,$20.02 ,$91.00 ,$49.50 ,$20.02 ,$37.86 ,$11.89 ,$11.35 ,$21.02 ,$77.35 ,$62.52 ,$25.48 ,$81.90 ,$76.44 ,$72.80 ,$72.80 ,$20.02 ,$59.15 
ST. FRANCIS HOSPITAL - ACUTE,30101213,82397,HC CHEMILUMINESCENT ASSAY-90,301,1 ,$37.00 ,$24.05 ,$8.14 ,$37.00 ,$21.28 ,$26.64 ,$20.13 ,$8.14 ,$10.36 ,$21.76 ,$8.14 ,$25.42 ,$9.25 ,$25.42 ,$25.42 ,$9.25 ,$25.42 ,$15.47 ,$31.08 ,$35.30 ,$8.14 ,$31.45 ,$31.08 ,$8.14 ,$27.75 ,$29.60 ,$29.60 ,$8.14 ,$29.60 ,$31.08 ,$31.08 ,$31.08 ,$37.00 ,$33.30 ,$21.28 ,$37.00 ,$8.14 ,$37.00 ,$20.13 ,$8.14 ,$15.39 ,$11.89 ,$11.35 ,$8.55 ,$31.45 ,$25.42 ,$10.36 ,$33.30 ,$31.08 ,$29.60 ,$29.60 ,$8.14 ,$24.05 
ST. FRANCIS HOSPITAL - ACUTE,30101218,82495,HC CHROMIUM SERUM-90,301,1 ,$94.00 ,$61.10 ,$13.84 ,$94.00 ,$54.05 ,$67.68 ,$51.14 ,$20.68 ,$26.32 ,$55.27 ,$20.68 ,$64.58 ,$23.50 ,$64.58 ,$64.58 ,$23.50 ,$64.58 ,$39.29 ,$78.96 ,$50.70 ,$20.68 ,$79.90 ,$78.96 ,$20.68 ,$70.50 ,$75.20 ,$75.20 ,$20.68 ,$75.20 ,$78.96 ,$78.96 ,$78.96 ,$94.00 ,$84.60 ,$54.05 ,$94.00 ,$20.68 ,$94.00 ,$51.14 ,$20.68 ,$39.10 ,$14.50 ,$13.84 ,$21.71 ,$79.90 ,$64.58 ,$26.32 ,$84.60 ,$78.96 ,$75.20 ,$75.20 ,$20.68 ,$61.10 
ST. FRANCIS HOSPITAL - ACUTE,30101219,82507,HC CITRATE-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$69.50 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$69.50 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$11.89 ,$11.35 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101220,82523,HC COLLAGEN CROSS LINKS ANY METHOD-90,301,1 ,$207.00 ,$134.55 ,$17.51 ,$207.00 ,$119.03 ,$149.04 ,$112.61 ,$45.54 ,$57.96 ,$121.72 ,$45.54 ,$142.21 ,$51.75 ,$142.21 ,$142.21 ,$51.75 ,$142.21 ,$86.53 ,$173.88 ,$46.70 ,$45.54 ,$175.95 ,$173.88 ,$45.54 ,$155.25 ,$165.60 ,$165.60 ,$45.54 ,$165.60 ,$173.88 ,$173.88 ,$173.88 ,$207.00 ,$186.30 ,$119.03 ,$207.00 ,$45.54 ,$207.00 ,$112.61 ,$45.54 ,$86.11 ,$18.35 ,$17.51 ,$47.82 ,$175.95 ,$142.21 ,$57.96 ,$186.30 ,$173.88 ,$165.60 ,$165.60 ,$45.54 ,$134.55 
ST. FRANCIS HOSPITAL - ACUTE,30101221,82525,HC COPPER-90,301,1 ,$77.00 ,$50.05 ,$13.84 ,$77.00 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$31.03 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$14.50 ,$13.84 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,30101222,82530,HC CORTISOL FREE-90,301,1 ,$154.00 ,$100.10 ,$11.35 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$90.55 ,$33.88 ,$105.80 ,$38.50 ,$105.80 ,$105.80 ,$38.50 ,$105.80 ,$64.37 ,$129.36 ,$41.78 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$11.89 ,$11.35 ,$35.57 ,$130.90 ,$105.80 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30101223,82533,HC CORTISOL TOTAL-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$40.75 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$27.82 ,$26.55 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101224,82542,HC CHROMO SPECTROMETRY -90,301,1 ,$119.00 ,$77.35 ,$11.35 ,$119.00 ,$68.43 ,$85.68 ,$64.74 ,$26.18 ,$33.32 ,$69.97 ,$26.18 ,$81.75 ,$29.75 ,$81.75 ,$81.75 ,$29.75 ,$81.75 ,$49.74 ,$99.96 ,$60.23 ,$26.18 ,$101.15 ,$99.96 ,$26.18 ,$89.25 ,$95.20 ,$95.20 ,$26.18 ,$95.20 ,$99.96 ,$99.96 ,$99.96 ,$119.00 ,$107.10 ,$68.43 ,$119.00 ,$26.18 ,$119.00 ,$64.74 ,$26.18 ,$49.50 ,$11.89 ,$11.35 ,$27.49 ,$101.15 ,$81.75 ,$33.32 ,$107.10 ,$99.96 ,$95.20 ,$95.20 ,$26.18 ,$77.35 
ST. FRANCIS HOSPITAL - ACUTE,30101225,82550,HC CREATINE KINASE (CPK) TOTAL-90,301,1 ,$185.00 ,$120.25 ,$5.05 ,$185.00 ,$106.38 ,$133.20 ,$100.64 ,$40.70 ,$51.80 ,$80.78 ,$40.70 ,$102.87 ,$46.25 ,$102.87 ,$102.87 ,$46.25 ,$102.87 ,$77.33 ,$155.40 ,$16.28 ,$40.70 ,$157.25 ,$155.40 ,$40.70 ,$138.75 ,$148.00 ,$148.00 ,$40.70 ,$148.00 ,$155.40 ,$155.40 ,$155.40 ,$185.00 ,$166.50 ,$106.38 ,$185.00 ,$40.70 ,$185.00 ,$100.64 ,$40.70 ,$76.96 ,$5.29 ,$5.05 ,$42.74 ,$157.25 ,$102.87 ,$51.80 ,$166.50 ,$155.40 ,$148.00 ,$148.00 ,$40.70 ,$120.25 
ST. FRANCIS HOSPITAL - ACUTE,30101226,82552,HC CREATINE KINASE (CPK) ISO-90,301,1 ,$56.00 ,$36.40 ,$11.35 ,$56.00 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$33.48 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$11.89 ,$11.35 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30101231,82570,HC CREATININE OTH SOURCE-90,301,1 ,$158.00 ,$102.70 ,$5.05 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$64.12 ,$34.76 ,$81.66 ,$39.50 ,$81.66 ,$81.66 ,$39.50 ,$81.66 ,$66.04 ,$132.72 ,$12.95 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$5.29 ,$5.05 ,$36.50 ,$134.30 ,$81.66 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30101233,82595,HC CRYOGLOBULIN QL OR SQN-90,301,1 ,$95.00 ,$61.75 ,$11.35 ,$95.00 ,$54.63 ,$68.40 ,$51.68 ,$20.90 ,$26.60 ,$55.86 ,$20.90 ,$65.27 ,$23.75 ,$65.27 ,$65.27 ,$23.75 ,$65.27 ,$39.71 ,$79.80 ,$16.18 ,$20.90 ,$80.75 ,$79.80 ,$20.90 ,$71.25 ,$76.00 ,$76.00 ,$20.90 ,$76.00 ,$79.80 ,$79.80 ,$79.80 ,$95.00 ,$85.50 ,$54.63 ,$95.00 ,$20.90 ,$95.00 ,$51.68 ,$20.90 ,$39.52 ,$11.89 ,$11.35 ,$21.95 ,$80.75 ,$65.27 ,$26.60 ,$85.50 ,$79.80 ,$76.00 ,$76.00 ,$20.90 ,$61.75 
ST. FRANCIS HOSPITAL - ACUTE,30101238,82627,HC DHEA SULFATE-90,301,1 ,$169.00 ,$109.85 ,$26.55 ,$169.00 ,$97.18 ,$121.68 ,$91.94 ,$37.18 ,$47.32 ,$99.37 ,$37.18 ,$116.10 ,$42.25 ,$116.10 ,$116.10 ,$42.25 ,$116.10 ,$70.64 ,$141.96 ,$55.58 ,$37.18 ,$143.65 ,$141.96 ,$37.18 ,$126.75 ,$135.20 ,$135.20 ,$37.18 ,$135.20 ,$141.96 ,$141.96 ,$141.96 ,$169.00 ,$152.10 ,$97.18 ,$169.00 ,$37.18 ,$169.00 ,$91.94 ,$37.18 ,$70.30 ,$27.82 ,$26.55 ,$39.04 ,$143.65 ,$116.10 ,$47.32 ,$152.10 ,$141.96 ,$135.20 ,$135.20 ,$37.18 ,$109.85 
ST. FRANCIS HOSPITAL - ACUTE,30101240,82652,HC VITAMIN D (1 25 DIHYDROXY)-90,301,1 ,$276.00 ,$179.40 ,$30.54 ,$276.00 ,$158.70 ,$198.72 ,$150.14 ,$60.72 ,$77.28 ,$162.29 ,$60.72 ,$189.61 ,$69.00 ,$189.61 ,$189.61 ,$69.00 ,$189.61 ,$115.37 ,$231.84 ,$96.25 ,$60.72 ,$234.60 ,$231.84 ,$60.72 ,$207.00 ,$220.80 ,$220.80 ,$60.72 ,$220.80 ,$231.84 ,$231.84 ,$231.84 ,$276.00 ,$248.40 ,$158.70 ,$276.00 ,$60.72 ,$276.00 ,$150.14 ,$60.72 ,$114.82 ,$32.00 ,$30.54 ,$63.76 ,$234.60 ,$189.61 ,$77.28 ,$248.40 ,$231.84 ,$220.80 ,$220.80 ,$60.72 ,$179.40 
ST. FRANCIS HOSPITAL - ACUTE,30101241,82656,HC ELASTASE PANCREATIC EL1 FECAL QL OR SQN-90,301,1 ,$72.00 ,$46.80 ,$11.35 ,$72.00 ,$41.40 ,$51.84 ,$39.17 ,$15.84 ,$20.16 ,$42.34 ,$15.84 ,$49.46 ,$18.00 ,$49.46 ,$49.46 ,$18.00 ,$49.46 ,$30.10 ,$60.48 ,$28.83 ,$15.84 ,$61.20 ,$60.48 ,$15.84 ,$54.00 ,$57.60 ,$57.60 ,$15.84 ,$57.60 ,$60.48 ,$60.48 ,$60.48 ,$72.00 ,$64.80 ,$41.40 ,$72.00 ,$15.84 ,$72.00 ,$39.17 ,$15.84 ,$29.95 ,$11.89 ,$11.35 ,$16.63 ,$61.20 ,$49.46 ,$20.16 ,$64.80 ,$60.48 ,$57.60 ,$57.60 ,$15.84 ,$46.80 
ST. FRANCIS HOSPITAL - ACUTE,30101242,82657,HC ENZYME ACT NONRAD SUBS-90,301,1 ,$85.00 ,$55.25 ,$11.35 ,$85.00 ,$48.88 ,$61.20 ,$46.24 ,$18.70 ,$23.80 ,$49.98 ,$18.70 ,$58.40 ,$21.25 ,$58.40 ,$58.40 ,$21.25 ,$58.40 ,$35.53 ,$71.40 ,$55.43 ,$18.70 ,$72.25 ,$71.40 ,$18.70 ,$63.75 ,$68.00 ,$68.00 ,$18.70 ,$68.00 ,$71.40 ,$71.40 ,$71.40 ,$85.00 ,$76.50 ,$48.88 ,$85.00 ,$18.70 ,$85.00 ,$46.24 ,$18.70 ,$35.36 ,$11.89 ,$11.35 ,$19.64 ,$72.25 ,$58.40 ,$23.80 ,$76.50 ,$71.40 ,$68.00 ,$68.00 ,$18.70 ,$55.25 
ST. FRANCIS HOSPITAL - ACUTE,30101245,82668,HC ERYTHROPOIETIN-90,301,1 ,$224.00 ,$145.60 ,$11.35 ,$224.00 ,$128.80 ,$161.28 ,$121.86 ,$49.28 ,$62.72 ,$131.71 ,$49.28 ,$153.89 ,$56.00 ,$153.89 ,$153.89 ,$56.00 ,$153.89 ,$93.63 ,$188.16 ,$46.98 ,$49.28 ,$190.40 ,$188.16 ,$49.28 ,$168.00 ,$179.20 ,$179.20 ,$49.28 ,$179.20 ,$188.16 ,$188.16 ,$188.16 ,$224.00 ,$201.60 ,$128.80 ,$224.00 ,$49.28 ,$224.00 ,$121.86 ,$49.28 ,$93.18 ,$11.89 ,$11.35 ,$51.74 ,$190.40 ,$153.89 ,$62.72 ,$201.60 ,$188.16 ,$179.20 ,$179.20 ,$49.28 ,$145.60 
ST. FRANCIS HOSPITAL - ACUTE,30101246,82670,HC ESTRADIOL-90,301,1 ,$130.00 ,$84.50 ,$26.55 ,$130.00 ,$74.75 ,$93.60 ,$70.72 ,$28.60 ,$36.40 ,$76.44 ,$28.60 ,$89.31 ,$32.50 ,$89.31 ,$89.31 ,$32.50 ,$89.31 ,$54.34 ,$109.20 ,$69.85 ,$28.60 ,$110.50 ,$109.20 ,$28.60 ,$97.50 ,$104.00 ,$104.00 ,$28.60 ,$104.00 ,$109.20 ,$109.20 ,$109.20 ,$130.00 ,$117.00 ,$74.75 ,$130.00 ,$28.60 ,$130.00 ,$70.72 ,$28.60 ,$54.08 ,$27.82 ,$26.55 ,$30.03 ,$110.50 ,$89.31 ,$36.40 ,$117.00 ,$109.20 ,$104.00 ,$104.00 ,$28.60 ,$84.50 
ST. FRANCIS HOSPITAL - ACUTE,30101247,82670,HC ESTRADIOL FREE-90,301,1 ,$94.00 ,$61.10 ,$20.68 ,$94.00 ,$54.05 ,$67.68 ,$51.14 ,$20.68 ,$26.32 ,$55.27 ,$20.68 ,$64.58 ,$23.50 ,$64.58 ,$64.58 ,$23.50 ,$64.58 ,$39.29 ,$78.96 ,$69.85 ,$20.68 ,$79.90 ,$78.96 ,$20.68 ,$70.50 ,$75.20 ,$75.20 ,$20.68 ,$75.20 ,$78.96 ,$78.96 ,$78.96 ,$94.00 ,$84.60 ,$54.05 ,$94.00 ,$20.68 ,$94.00 ,$51.14 ,$20.68 ,$39.10 ,$27.82 ,$26.55 ,$21.71 ,$79.90 ,$64.58 ,$26.32 ,$84.60 ,$78.96 ,$75.20 ,$75.20 ,$20.68 ,$61.10 
ST. FRANCIS HOSPITAL - ACUTE,30101249,82672,HC ESTROGEN TOTAL-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$54.25 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$54.25 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$27.82 ,$26.55 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101250,82677,HC ESTRIOL-90,301,1 ,$56.00 ,$36.40 ,$12.32 ,$60.45 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$60.45 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$27.82 ,$26.55 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30101251,82679,HC ESTRONE-90,301,1 ,$107.00 ,$69.55 ,$23.54 ,$107.00 ,$61.53 ,$77.04 ,$58.21 ,$23.54 ,$29.96 ,$62.92 ,$23.54 ,$73.51 ,$26.75 ,$73.51 ,$73.51 ,$26.75 ,$73.51 ,$44.73 ,$89.88 ,$62.38 ,$23.54 ,$90.95 ,$89.88 ,$23.54 ,$80.25 ,$85.60 ,$85.60 ,$23.54 ,$85.60 ,$89.88 ,$89.88 ,$89.88 ,$107.00 ,$96.30 ,$61.53 ,$107.00 ,$23.54 ,$107.00 ,$58.21 ,$23.54 ,$44.51 ,$27.82 ,$26.55 ,$24.72 ,$90.95 ,$73.51 ,$29.96 ,$96.30 ,$89.88 ,$85.60 ,$85.60 ,$23.54 ,$69.55 
ST. FRANCIS HOSPITAL - ACUTE,30101253,82705,HC FECAL FAT QUALITATIVE-90,301,1 ,$26.00 ,$16.90 ,$5.05 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$15.29 ,$5.72 ,$17.86 ,$6.50 ,$17.86 ,$17.86 ,$6.50 ,$17.86 ,$10.87 ,$21.84 ,$12.75 ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 ,$5.29 ,$5.05 ,$6.01 ,$22.10 ,$17.86 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,30101254,82710,HC FECAL FAT QN-90,301,1 ,$133.00 ,$86.45 ,$11.35 ,$133.00 ,$76.48 ,$95.76 ,$72.35 ,$29.26 ,$37.24 ,$78.20 ,$29.26 ,$91.37 ,$33.25 ,$91.37 ,$91.37 ,$33.25 ,$91.37 ,$55.59 ,$111.72 ,$42.00 ,$29.26 ,$113.05 ,$111.72 ,$29.26 ,$99.75 ,$106.40 ,$106.40 ,$29.26 ,$106.40 ,$111.72 ,$111.72 ,$111.72 ,$133.00 ,$119.70 ,$76.48 ,$133.00 ,$29.26 ,$133.00 ,$72.35 ,$29.26 ,$55.33 ,$11.89 ,$11.35 ,$30.72 ,$113.05 ,$91.37 ,$37.24 ,$119.70 ,$111.72 ,$106.40 ,$106.40 ,$29.26 ,$86.45 
ST. FRANCIS HOSPITAL - ACUTE,30101256,82728,HC FERRITIN-90,301,1 ,$12.00 ,$7.80 ,$2.64 ,$30.00 ,$6.90 ,$8.64 ,$6.53 ,$2.64 ,$3.36 ,$7.06 ,$2.64 ,$8.24 ,$3.00 ,$8.24 ,$8.24 ,$3.00 ,$8.24 ,$5.02 ,$10.08 ,$30.00 ,$2.64 ,$10.20 ,$10.08 ,$2.64 ,$9.00 ,$9.60 ,$9.60 ,$2.64 ,$9.60 ,$10.08 ,$10.08 ,$10.08 ,$12.00 ,$10.80 ,$6.90 ,$12.00 ,$2.64 ,$12.00 ,$6.53 ,$2.64 ,$4.99 ,$11.89 ,$11.35 ,$2.77 ,$10.20 ,$8.24 ,$3.36 ,$10.80 ,$10.08 ,$9.60 ,$9.60 ,$2.64 ,$7.80 
ST. FRANCIS HOSPITAL - ACUTE,30101259,82747,HC FOLIC ACID RBC-90,301,1 ,$138.00 ,$89.70 ,$7.05 ,$138.00 ,$79.35 ,$99.36 ,$75.07 ,$30.36 ,$38.64 ,$81.14 ,$30.36 ,$94.81 ,$34.50 ,$94.81 ,$94.81 ,$34.50 ,$94.81 ,$57.68 ,$115.92 ,$44.13 ,$30.36 ,$117.30 ,$115.92 ,$30.36 ,$103.50 ,$110.40 ,$110.40 ,$30.36 ,$110.40 ,$115.92 ,$115.92 ,$115.92 ,$138.00 ,$124.20 ,$79.35 ,$138.00 ,$30.36 ,$138.00 ,$75.07 ,$30.36 ,$57.41 ,$7.38 ,$7.05 ,$31.88 ,$117.30 ,$94.81 ,$38.64 ,$124.20 ,$115.92 ,$110.40 ,$110.40 ,$30.36 ,$89.70 
ST. FRANCIS HOSPITAL - ACUTE,30101262,82784,HC GAMMAGLOBULIN-90,301,1 ,$55.00 ,$35.75 ,$11.35 ,$55.00 ,$31.63 ,$39.60 ,$29.92 ,$12.10 ,$15.40 ,$32.34 ,$12.10 ,$37.79 ,$13.75 ,$37.79 ,$37.79 ,$13.75 ,$37.79 ,$22.99 ,$46.20 ,$23.25 ,$12.10 ,$46.75 ,$46.20 ,$12.10 ,$41.25 ,$44.00 ,$44.00 ,$12.10 ,$44.00 ,$46.20 ,$46.20 ,$46.20 ,$55.00 ,$49.50 ,$31.63 ,$55.00 ,$12.10 ,$55.00 ,$29.92 ,$12.10 ,$22.88 ,$11.89 ,$11.35 ,$12.71 ,$46.75 ,$37.79 ,$15.40 ,$49.50 ,$46.20 ,$44.00 ,$44.00 ,$12.10 ,$35.75 
ST. FRANCIS HOSPITAL - ACUTE,30101265,82787,HC IMMUNOGLOBULIN SUBCLASSES-90,301,1 ,$24.00 ,$15.60 ,$5.28 ,$24.00 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$20.05 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$18.35 ,$17.51 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101268,82941,HC GASTRIN-90,301,1 ,$117.00 ,$76.05 ,$25.74 ,$117.00 ,$67.28 ,$84.24 ,$63.65 ,$25.74 ,$32.76 ,$68.80 ,$25.74 ,$80.38 ,$29.25 ,$80.38 ,$80.38 ,$29.25 ,$80.38 ,$48.91 ,$98.28 ,$44.08 ,$25.74 ,$99.45 ,$98.28 ,$25.74 ,$87.75 ,$93.60 ,$93.60 ,$25.74 ,$93.60 ,$98.28 ,$98.28 ,$98.28 ,$117.00 ,$105.30 ,$67.28 ,$117.00 ,$25.74 ,$117.00 ,$63.65 ,$25.74 ,$48.67 ,$27.82 ,$26.55 ,$27.03 ,$99.45 ,$80.38 ,$32.76 ,$105.30 ,$98.28 ,$93.60 ,$93.60 ,$25.74 ,$76.05 
ST. FRANCIS HOSPITAL - ACUTE,30101273,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$45.00 ,$29.25 ,$2.55 ,$45.00 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$12.60 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$2.67 ,$2.55 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30101274,82955,HC G6PD ENZYME QN-90,301,1 ,$56.00 ,$36.40 ,$11.35 ,$56.00 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$24.25 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$11.89 ,$11.35 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30101275,82977,HC GGT/GGTP-90,301,1 ,$40.00 ,$26.00 ,$5.05 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$18.00 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$5.29 ,$5.05 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101276,82985,HC FRUCTOSAMINE-90,301,1 ,$24.00 ,$15.60 ,$5.28 ,$41.90 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$41.90 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$11.89 ,$11.35 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101279,83003,HC GROWTH HORMONE (HGH)-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$41.68 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$27.82 ,$26.55 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101281,83010,HC HAPTOGLOBIN-90,301,1 ,$77.00 ,$50.05 ,$11.35 ,$77.00 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$31.45 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$11.89 ,$11.35 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,30101282,83013,HC H PYLORI BREATH TEST-90,301,1 ,$175.00 ,$113.75 ,$30.54 ,$175.00 ,$100.63 ,$126.00 ,$95.20 ,$38.50 ,$49.00 ,$102.90 ,$38.50 ,$120.23 ,$43.75 ,$120.23 ,$120.23 ,$43.75 ,$120.23 ,$73.15 ,$147.00 ,$168.40 ,$38.50 ,$148.75 ,$147.00 ,$38.50 ,$131.25 ,$140.00 ,$140.00 ,$38.50 ,$140.00 ,$147.00 ,$147.00 ,$147.00 ,$175.00 ,$157.50 ,$100.63 ,$175.00 ,$38.50 ,$175.00 ,$95.20 ,$38.50 ,$72.80 ,$32.00 ,$30.54 ,$40.43 ,$148.75 ,$120.23 ,$49.00 ,$157.50 ,$147.00 ,$140.00 ,$140.00 ,$38.50 ,$113.75 
ST. FRANCIS HOSPITAL - ACUTE,30101283,83018,HC HEAVY METAL QN EACH-90,301,1 ,$68.00 ,$44.20 ,$13.84 ,$68.00 ,$39.10 ,$48.96 ,$36.99 ,$14.96 ,$19.04 ,$39.98 ,$14.96 ,$46.72 ,$17.00 ,$46.72 ,$46.72 ,$17.00 ,$46.72 ,$28.42 ,$57.12 ,$54.90 ,$14.96 ,$57.80 ,$57.12 ,$14.96 ,$51.00 ,$54.40 ,$54.40 ,$14.96 ,$54.40 ,$57.12 ,$57.12 ,$57.12 ,$68.00 ,$61.20 ,$39.10 ,$68.00 ,$14.96 ,$68.00 ,$36.99 ,$14.96 ,$28.29 ,$14.50 ,$13.84 ,$15.71 ,$57.80 ,$46.72 ,$19.04 ,$61.20 ,$57.12 ,$54.40 ,$54.40 ,$14.96 ,$44.20 
ST. FRANCIS HOSPITAL - ACUTE,30101285,83021,HC HEMOGLOBIN FRACT QN-90,301,1 ,$12.00 ,$7.80 ,$2.64 ,$30.00 ,$6.90 ,$8.64 ,$6.53 ,$2.64 ,$3.36 ,$7.06 ,$2.64 ,$8.24 ,$3.00 ,$8.24 ,$8.24 ,$3.00 ,$8.24 ,$5.02 ,$10.08 ,$30.00 ,$2.64 ,$10.20 ,$10.08 ,$2.64 ,$9.00 ,$9.60 ,$9.60 ,$2.64 ,$9.60 ,$10.08 ,$10.08 ,$10.08 ,$12.00 ,$10.80 ,$6.90 ,$12.00 ,$2.64 ,$12.00 ,$6.53 ,$2.64 ,$4.99 ,$11.23 ,$10.72 ,$2.77 ,$10.20 ,$8.24 ,$3.36 ,$10.80 ,$10.08 ,$9.60 ,$9.60 ,$2.64 ,$7.80 
ST. FRANCIS HOSPITAL - ACUTE,30101294,83497,HC HYDROXYINDOLACET 5 (HIAA)-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$32.25 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$16.01 ,$15.28 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101295,83498,HC HYDROXYPROGESTERONE 17D-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$67.93 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$67.93 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$27.82 ,$26.55 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101297,83516,HC MLT NON INFECT QL/SQ-90,301,1 ,$98.00 ,$63.70 ,$10.16 ,$98.00 ,$56.35 ,$70.56 ,$53.31 ,$21.56 ,$27.44 ,$57.62 ,$21.56 ,$67.33 ,$24.50 ,$67.33 ,$67.33 ,$24.50 ,$67.33 ,$40.96 ,$82.32 ,$28.83 ,$21.56 ,$83.30 ,$82.32 ,$21.56 ,$73.50 ,$78.40 ,$78.40 ,$21.56 ,$78.40 ,$82.32 ,$82.32 ,$82.32 ,$98.00 ,$88.20 ,$56.35 ,$98.00 ,$21.56 ,$98.00 ,$53.31 ,$21.56 ,$40.77 ,$10.65 ,$10.16 ,$22.64 ,$83.30 ,$67.33 ,$27.44 ,$88.20 ,$82.32 ,$78.40 ,$78.40 ,$21.56 ,$63.70 
ST. FRANCIS HOSPITAL - ACUTE,30101300,83516,HC MLT NON INFECT QL/SQ TTG-90,301,1 ,$48.00 ,$31.20 ,$10.16 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$28.83 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$10.65 ,$10.16 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101302,83519,HC QN RIA-90,301,1 ,$150.00 ,$97.50 ,$10.16 ,$150.00 ,$86.25 ,$108.00 ,$81.60 ,$33.00 ,$42.00 ,$88.20 ,$33.00 ,$103.05 ,$37.50 ,$103.05 ,$103.05 ,$37.50 ,$103.05 ,$62.70 ,$126.00 ,$46.00 ,$33.00 ,$127.50 ,$126.00 ,$33.00 ,$112.50 ,$120.00 ,$120.00 ,$33.00 ,$120.00 ,$126.00 ,$126.00 ,$126.00 ,$150.00 ,$135.00 ,$86.25 ,$150.00 ,$33.00 ,$150.00 ,$81.60 ,$33.00 ,$62.40 ,$10.65 ,$10.16 ,$34.65 ,$127.50 ,$103.05 ,$42.00 ,$135.00 ,$126.00 ,$120.00 ,$120.00 ,$33.00 ,$97.50 
ST. FRANCIS HOSPITAL - ACUTE,30101303,83520,HC IMMUNOASSAY QN OTHER-90,301,1 ,$36.00 ,$23.40 ,$7.92 ,$43.18 ,$20.70 ,$25.92 ,$19.58 ,$7.92 ,$10.08 ,$21.17 ,$7.92 ,$24.73 ,$9.00 ,$24.73 ,$24.73 ,$9.00 ,$24.73 ,$15.05 ,$30.24 ,$43.18 ,$7.92 ,$30.60 ,$30.24 ,$7.92 ,$27.00 ,$28.80 ,$28.80 ,$7.92 ,$28.80 ,$30.24 ,$30.24 ,$30.24 ,$36.00 ,$32.40 ,$20.70 ,$36.00 ,$7.92 ,$36.00 ,$19.58 ,$7.92 ,$14.98 ,$10.65 ,$10.16 ,$8.32 ,$30.60 ,$24.73 ,$10.08 ,$32.40 ,$30.24 ,$28.80 ,$28.80 ,$7.92 ,$23.40 
ST. FRANCIS HOSPITAL - ACUTE,30101306,83520,HC IMMUNOASSAY QN ENZYME-90,301,1 ,$297.00 ,$193.05 ,$10.16 ,$297.00 ,$170.78 ,$213.84 ,$161.57 ,$65.34 ,$83.16 ,$173.43 ,$65.34 ,$204.04 ,$74.25 ,$204.04 ,$204.04 ,$74.25 ,$204.04 ,$124.15 ,$249.48 ,$43.18 ,$65.34 ,$252.45 ,$249.48 ,$65.34 ,$222.75 ,$237.60 ,$237.60 ,$65.34 ,$237.60 ,$249.48 ,$249.48 ,$249.48 ,$297.00 ,$267.30 ,$170.78 ,$297.00 ,$65.34 ,$297.00 ,$161.57 ,$65.34 ,$123.55 ,$10.65 ,$10.16 ,$68.61 ,$252.45 ,$204.04 ,$83.16 ,$267.30 ,$249.48 ,$237.60 ,$237.60 ,$65.34 ,$193.05 
ST. FRANCIS HOSPITAL - ACUTE,30101307,83525,HC INSULIN TOTAL-90,301,1 ,$68.00 ,$44.20 ,$14.96 ,$68.00 ,$39.10 ,$48.96 ,$36.99 ,$14.96 ,$19.04 ,$39.98 ,$14.96 ,$46.72 ,$17.00 ,$46.72 ,$46.72 ,$17.00 ,$46.72 ,$28.42 ,$57.12 ,$28.58 ,$14.96 ,$57.80 ,$57.12 ,$14.96 ,$51.00 ,$54.40 ,$54.40 ,$14.96 ,$54.40 ,$57.12 ,$57.12 ,$57.12 ,$68.00 ,$61.20 ,$39.10 ,$68.00 ,$14.96 ,$68.00 ,$36.99 ,$14.96 ,$28.29 ,$16.01 ,$15.28 ,$15.71 ,$57.80 ,$46.72 ,$19.04 ,$61.20 ,$57.12 ,$54.40 ,$54.40 ,$14.96 ,$44.20 
ST. FRANCIS HOSPITAL - ACUTE,30101310,83586,HC KETOSTEROIDS (17-KS)-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$32.00 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$16.01 ,$15.28 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101312,83615,HC LACTATE DEHYDRO (LDH)-90,301,1 ,$24.00 ,$15.60 ,$5.05 ,$24.00 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$15.10 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$5.29 ,$5.05 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101313,83625,HC LDH ISOENZYMES-90,301,1 ,$24.00 ,$15.60 ,$5.28 ,$31.98 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$31.98 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$11.89 ,$11.35 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101314,83630,HC LACTOGEN FECAL QL-90,301,1 ,$158.00 ,$102.70 ,$11.35 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$92.90 ,$34.76 ,$108.55 ,$39.50 ,$108.55 ,$108.55 ,$39.50 ,$108.55 ,$66.04 ,$132.72 ,$49.25 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$11.89 ,$11.35 ,$36.50 ,$134.30 ,$108.55 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30101316,83655,HC LEAD-90,301,1 ,$24.00 ,$15.60 ,$5.28 ,$30.28 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$30.28 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$14.50 ,$13.84 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101325,80335,HC ANTIDEPRESSANTS TRYCLIC 1-2  -90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 , N/A ,$10.78 , N/A ,$12.25 , N/A , N/A ,$12.25 , N/A ,$20.48 ,$41.16 , N/A ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$32.00 ,$30.54 ,$11.32 ,$41.65 , N/A ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101326,83735,HC MAGNESIUM-90,301,1 ,$59.00 ,$38.35 ,$5.05 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$16.75 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$5.29 ,$5.05 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101327,83785,HC MANGANESE-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$66.63 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$66.63 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$14.50 ,$13.84 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101329,83825,HC MERCURY-90,301,1 ,$56.00 ,$36.40 ,$12.32 ,$56.00 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$40.65 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$14.50 ,$13.84 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30101330,83835,HC METANEPHRINES-90,301,1 ,$107.00 ,$69.55 ,$23.54 ,$107.00 ,$61.53 ,$77.04 ,$58.21 ,$23.54 ,$29.96 ,$62.92 ,$23.54 ,$73.51 ,$26.75 ,$73.51 ,$73.51 ,$26.75 ,$73.51 ,$44.73 ,$89.88 ,$42.35 ,$23.54 ,$90.95 ,$89.88 ,$23.54 ,$80.25 ,$85.60 ,$85.60 ,$23.54 ,$85.60 ,$89.88 ,$89.88 ,$89.88 ,$107.00 ,$96.30 ,$61.53 ,$107.00 ,$23.54 ,$107.00 ,$58.21 ,$23.54 ,$44.51 ,$27.82 ,$26.55 ,$24.72 ,$90.95 ,$73.51 ,$29.96 ,$96.30 ,$89.88 ,$85.60 ,$85.60 ,$23.54 ,$69.55 
ST. FRANCIS HOSPITAL - ACUTE,30101334,83874,HC MYOGLOBIN-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$32.30 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$11.89 ,$11.35 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101337,83883,HC NEPHELOMETRY EA ANALYTE-90,301,1 ,$125.00 ,$81.25 ,$17.51 ,$125.00 ,$71.88 ,$90.00 ,$68.00 ,$27.50 ,$35.00 ,$73.50 ,$27.50 ,$85.88 ,$31.25 ,$85.88 ,$85.88 ,$31.25 ,$85.88 ,$52.25 ,$105.00 ,$34.00 ,$27.50 ,$106.25 ,$105.00 ,$27.50 ,$93.75 ,$100.00 ,$100.00 ,$27.50 ,$100.00 ,$105.00 ,$105.00 ,$105.00 ,$125.00 ,$112.50 ,$71.88 ,$125.00 ,$27.50 ,$125.00 ,$68.00 ,$27.50 ,$52.00 ,$18.35 ,$17.51 ,$28.88 ,$106.25 ,$85.88 ,$35.00 ,$112.50 ,$105.00 ,$100.00 ,$100.00 ,$27.50 ,$81.25 
ST. FRANCIS HOSPITAL - ACUTE,30101339,83915,HC NUCLEOTIDASE 5 -90,301,1 ,$70.00 ,$45.50 ,$11.35 ,$70.00 ,$40.25 ,$50.40 ,$38.08 ,$15.40 ,$19.60 ,$41.16 ,$15.40 ,$48.09 ,$17.50 ,$48.09 ,$48.09 ,$17.50 ,$48.09 ,$29.26 ,$58.80 ,$27.88 ,$15.40 ,$59.50 ,$58.80 ,$15.40 ,$52.50 ,$56.00 ,$56.00 ,$15.40 ,$56.00 ,$58.80 ,$58.80 ,$58.80 ,$70.00 ,$63.00 ,$40.25 ,$70.00 ,$15.40 ,$70.00 ,$38.08 ,$15.40 ,$29.12 ,$11.89 ,$11.35 ,$16.17 ,$59.50 ,$48.09 ,$19.60 ,$63.00 ,$58.80 ,$56.00 ,$56.00 ,$15.40 ,$45.50 
ST. FRANCIS HOSPITAL - ACUTE,30101341,83918,HC ORGANIC ACIDS QN-90,301,1 ,$158.00 ,$102.70 ,$13.84 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$92.90 ,$34.76 ,$108.55 ,$39.50 ,$108.55 ,$108.55 ,$39.50 ,$108.55 ,$66.04 ,$132.72 ,$59.00 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$14.50 ,$13.84 ,$36.50 ,$134.30 ,$108.55 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30101345,83945,HC OXALATE-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$36.13 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$11.89 ,$11.35 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101348,83986,HC PH BODY FLUID NOT BLOOD-90,301,1 ,$10.00 ,$6.50 ,$2.20 ,$10.00 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.88 ,$2.20 ,$6.87 ,$2.50 ,$6.87 ,$6.87 ,$2.50 ,$6.87 ,$4.18 ,$8.40 ,$8.95 ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$10.00 ,$5.44 ,$2.20 ,$4.16 ,$5.29 ,$5.05 ,$2.31 ,$8.50 ,$6.87 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,30101351,83993,HC CALPROTECTIN STOOL-90,301,1 ,$117.00 ,$76.05 ,$11.35 ,$117.00 ,$67.28 ,$84.24 ,$63.65 ,$25.74 ,$32.76 ,$68.80 ,$25.74 ,$80.38 ,$29.25 ,$80.38 ,$80.38 ,$29.25 ,$80.38 ,$48.91 ,$98.28 ,$49.08 ,$25.74 ,$99.45 ,$98.28 ,$25.74 ,$87.75 ,$93.60 ,$93.60 ,$25.74 ,$93.60 ,$98.28 ,$98.28 ,$98.28 ,$117.00 ,$105.30 ,$67.28 ,$117.00 ,$25.74 ,$117.00 ,$63.65 ,$25.74 ,$48.67 ,$11.89 ,$11.35 ,$27.03 ,$99.45 ,$80.38 ,$32.76 ,$105.30 ,$98.28 ,$93.60 ,$93.60 ,$25.74 ,$76.05 
ST. FRANCIS HOSPITAL - ACUTE,30101352,84030,HC NEWBORN SCREEN PKU-90,301,1 ,$169.00 ,$109.85 ,$5.05 ,$169.00 ,$97.18 ,$121.68 ,$91.94 ,$37.18 ,$47.32 ,$68.23 ,$37.18 ,$86.89 ,$42.25 ,$86.89 ,$86.89 ,$42.25 ,$86.89 ,$70.64 ,$141.96 ,$13.75 ,$37.18 ,$143.65 ,$141.96 ,$37.18 ,$126.75 ,$135.20 ,$135.20 ,$37.18 ,$135.20 ,$141.96 ,$141.96 ,$141.96 ,$169.00 ,$152.10 ,$97.18 ,$169.00 ,$37.18 ,$169.00 ,$91.94 ,$37.18 ,$70.30 ,$5.29 ,$5.05 ,$39.04 ,$143.65 ,$86.89 ,$47.32 ,$152.10 ,$141.96 ,$135.20 ,$135.20 ,$37.18 ,$109.85 
ST. FRANCIS HOSPITAL - ACUTE,30101353,84066,HC PHOSPHATASE ACID PROSTATIC-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$24.15 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$11.89 ,$11.35 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101354,84075,HC ALKALINE PHOSPHATASE-90,301,1 ,$27.00 ,$17.55 ,$5.05 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.88 ,$5.94 ,$18.55 ,$6.75 ,$18.55 ,$18.55 ,$6.75 ,$18.55 ,$11.29 ,$22.68 ,$12.95 ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 ,$5.29 ,$5.05 ,$6.24 ,$22.95 ,$18.55 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,30101356,84080,HC ALK PHOS ISOENZ-90,301,1 ,$106.00 ,$68.90 ,$11.35 ,$106.00 ,$60.95 ,$76.32 ,$57.66 ,$23.32 ,$29.68 ,$62.33 ,$23.32 ,$72.82 ,$26.50 ,$72.82 ,$72.82 ,$26.50 ,$72.82 ,$44.31 ,$89.04 ,$36.95 ,$23.32 ,$90.10 ,$89.04 ,$23.32 ,$79.50 ,$84.80 ,$84.80 ,$23.32 ,$84.80 ,$89.04 ,$89.04 ,$89.04 ,$106.00 ,$95.40 ,$60.95 ,$106.00 ,$23.32 ,$106.00 ,$57.66 ,$23.32 ,$44.10 ,$11.89 ,$11.35 ,$24.49 ,$90.10 ,$72.82 ,$29.68 ,$95.40 ,$89.04 ,$84.80 ,$84.80 ,$23.32 ,$68.90 
ST. FRANCIS HOSPITAL - ACUTE,30101358,84105,HC PHOSPHORUS URINE-90,301,1 ,$59.00 ,$38.35 ,$5.05 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$14.45 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$5.29 ,$5.05 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101364,84133,HC POTASSIUM URINE-90,301,1 ,$59.00 ,$38.35 ,$5.05 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$11.83 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$5.29 ,$5.05 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101369,84145,HC PROCALCITONIN (PCT)-90,301,1 ,$133.00 ,$86.45 ,$26.55 ,$133.00 ,$76.48 ,$95.76 ,$72.35 ,$29.26 ,$37.24 ,$78.20 ,$29.26 ,$91.37 ,$33.25 ,$91.37 ,$91.37 ,$33.25 ,$91.37 ,$55.59 ,$111.72 ,$68.05 ,$29.26 ,$113.05 ,$111.72 ,$29.26 ,$99.75 ,$106.40 ,$106.40 ,$29.26 ,$106.40 ,$111.72 ,$111.72 ,$111.72 ,$133.00 ,$119.70 ,$76.48 ,$133.00 ,$29.26 ,$133.00 ,$72.35 ,$29.26 ,$55.33 ,$27.82 ,$26.55 ,$30.72 ,$113.05 ,$91.37 ,$37.24 ,$119.70 ,$111.72 ,$106.40 ,$106.40 ,$29.26 ,$86.45 
ST. FRANCIS HOSPITAL - ACUTE,30101370,84153,HC PSA TOTAL-90,301,1 ,$55.00 ,$35.75 ,$11.35 ,$55.00 ,$31.63 ,$39.60 ,$29.92 ,$12.10 ,$15.40 ,$32.34 ,$12.10 ,$37.79 ,$13.75 ,$37.79 ,$37.79 ,$13.75 ,$37.79 ,$22.99 ,$46.20 ,$45.98 ,$12.10 ,$46.75 ,$46.20 ,$12.10 ,$41.25 ,$44.00 ,$44.00 ,$12.10 ,$44.00 ,$46.20 ,$46.20 ,$46.20 ,$55.00 ,$49.50 ,$31.63 ,$55.00 ,$12.10 ,$55.00 ,$29.92 ,$12.10 ,$22.88 ,$11.89 ,$11.35 ,$12.71 ,$46.75 ,$37.79 ,$15.40 ,$49.50 ,$46.20 ,$44.00 ,$44.00 ,$12.10 ,$35.75 
ST. FRANCIS HOSPITAL - ACUTE,30101371,84154,HC PSA FREE-90,301,1 ,$135.00 ,$87.75 ,$11.35 ,$135.00 ,$77.63 ,$97.20 ,$73.44 ,$29.70 ,$37.80 ,$79.38 ,$29.70 ,$92.75 ,$33.75 ,$92.75 ,$92.75 ,$33.75 ,$92.75 ,$56.43 ,$113.40 ,$45.98 ,$29.70 ,$114.75 ,$113.40 ,$29.70 ,$101.25 ,$108.00 ,$108.00 ,$29.70 ,$108.00 ,$113.40 ,$113.40 ,$113.40 ,$135.00 ,$121.50 ,$77.63 ,$135.00 ,$29.70 ,$135.00 ,$73.44 ,$29.70 ,$56.16 ,$11.89 ,$11.35 ,$31.19 ,$114.75 ,$92.75 ,$37.80 ,$121.50 ,$113.40 ,$108.00 ,$108.00 ,$29.70 ,$87.75 
ST. FRANCIS HOSPITAL - ACUTE,30101382,84206,HC PROINSULIN-90,301,1 ,$169.00 ,$109.85 ,$26.55 ,$169.00 ,$97.18 ,$121.68 ,$91.94 ,$37.18 ,$47.32 ,$99.37 ,$37.18 ,$116.10 ,$42.25 ,$116.10 ,$116.10 ,$42.25 ,$116.10 ,$70.64 ,$141.96 ,$66.73 ,$37.18 ,$143.65 ,$141.96 ,$37.18 ,$126.75 ,$135.20 ,$135.20 ,$37.18 ,$135.20 ,$141.96 ,$141.96 ,$141.96 ,$169.00 ,$152.10 ,$97.18 ,$169.00 ,$37.18 ,$169.00 ,$91.94 ,$37.18 ,$70.30 ,$27.82 ,$26.55 ,$39.04 ,$143.65 ,$116.10 ,$47.32 ,$152.10 ,$141.96 ,$135.20 ,$135.20 ,$37.18 ,$109.85 
ST. FRANCIS HOSPITAL - ACUTE,30101383,84207,HC VITAMIN B6-90,301,1 ,$127.00 ,$82.55 ,$11.35 ,$127.00 ,$73.03 ,$91.44 ,$69.09 ,$27.94 ,$35.56 ,$74.68 ,$27.94 ,$87.25 ,$31.75 ,$87.25 ,$87.25 ,$31.75 ,$87.25 ,$53.09 ,$106.68 ,$70.25 ,$27.94 ,$107.95 ,$106.68 ,$27.94 ,$95.25 ,$101.60 ,$101.60 ,$27.94 ,$101.60 ,$106.68 ,$106.68 ,$106.68 ,$127.00 ,$114.30 ,$73.03 ,$127.00 ,$27.94 ,$127.00 ,$69.09 ,$27.94 ,$52.83 ,$11.89 ,$11.35 ,$29.34 ,$107.95 ,$87.25 ,$35.56 ,$114.30 ,$106.68 ,$101.60 ,$101.60 ,$27.94 ,$82.55 
ST. FRANCIS HOSPITAL - ACUTE,30101387,84244,HC RENIN-90,301,1 ,$146.00 ,$94.90 ,$26.55 ,$146.00 ,$83.95 ,$105.12 ,$79.42 ,$32.12 ,$40.88 ,$85.85 ,$32.12 ,$100.30 ,$36.50 ,$100.30 ,$100.30 ,$36.50 ,$100.30 ,$61.03 ,$122.64 ,$54.98 ,$32.12 ,$124.10 ,$122.64 ,$32.12 ,$109.50 ,$116.80 ,$116.80 ,$32.12 ,$116.80 ,$122.64 ,$122.64 ,$122.64 ,$146.00 ,$131.40 ,$83.95 ,$146.00 ,$32.12 ,$146.00 ,$79.42 ,$32.12 ,$60.74 ,$27.82 ,$26.55 ,$33.73 ,$124.10 ,$100.30 ,$40.88 ,$131.40 ,$122.64 ,$116.80 ,$116.80 ,$32.12 ,$94.90 
ST. FRANCIS HOSPITAL - ACUTE,30101388,84255,HC SELENIUM-90,301,1 ,$56.00 ,$36.40 ,$11.35 ,$63.83 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$63.83 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$11.89 ,$11.35 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30101390,84270,HC SEX HORMONE BIND GLOB-90,301,1 ,$56.00 ,$36.40 ,$11.35 ,$56.00 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$54.33 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$11.89 ,$11.35 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30101392,84260,HC SEROTONIN-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$77.45 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$77.45 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$27.82 ,$26.55 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101394,84300,HC SODIUM URINE-90,301,1 ,$59.00 ,$38.35 ,$5.05 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$12.65 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$5.29 ,$5.05 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101395,84302,HC SODIUM OTHER FLUID-90,301,1 ,$48.00 ,$31.20 ,$5.05 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$12.15 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$5.29 ,$5.05 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101396,84305,HC SOMATOMEDIN-90,301,1 ,$123.00 ,$79.95 ,$26.55 ,$123.00 ,$70.73 ,$88.56 ,$66.91 ,$27.06 ,$34.44 ,$72.32 ,$27.06 ,$84.50 ,$30.75 ,$84.50 ,$84.50 ,$30.75 ,$84.50 ,$51.41 ,$103.32 ,$53.15 ,$27.06 ,$104.55 ,$103.32 ,$27.06 ,$92.25 ,$98.40 ,$98.40 ,$27.06 ,$98.40 ,$103.32 ,$103.32 ,$103.32 ,$123.00 ,$110.70 ,$70.73 ,$123.00 ,$27.06 ,$123.00 ,$66.91 ,$27.06 ,$51.17 ,$27.82 ,$26.55 ,$28.41 ,$104.55 ,$84.50 ,$34.44 ,$110.70 ,$103.32 ,$98.40 ,$98.40 ,$27.06 ,$79.95 
ST. FRANCIS HOSPITAL - ACUTE,30101398,84311,HC SPECTROPHOTOMETRY-90,301,1 ,$10.00 ,$6.50 ,$2.20 ,$20.25 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.88 ,$2.20 ,$6.87 ,$2.50 ,$6.87 ,$6.87 ,$2.50 ,$6.87 ,$4.18 ,$8.40 ,$20.25 ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$10.00 ,$5.44 ,$2.20 ,$4.16 ,$11.89 ,$11.35 ,$2.31 ,$8.50 ,$6.87 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,30101399,84311,HC SPECTROPHOTOMETRY FECAL-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$20.25 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$11.89 ,$11.35 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101402,84376,HC SUGARS SINGLE QL-90,301,1 ,$24.00 ,$15.60 ,$5.05 ,$24.00 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$13.75 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$5.29 ,$5.05 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101405,84392,HC SULFATE URINE-90,301,1 ,$59.00 ,$38.35 ,$4.05 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$13.73 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$4.25 ,$4.05 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101406,84402,HC TESTOSTERONE FREE-90,301,1 ,$78.00 ,$50.70 ,$17.16 ,$78.00 ,$44.85 ,$56.16 ,$42.43 ,$17.16 ,$21.84 ,$45.86 ,$17.16 ,$53.59 ,$19.50 ,$53.59 ,$53.59 ,$19.50 ,$53.59 ,$32.60 ,$65.52 ,$63.68 ,$17.16 ,$66.30 ,$65.52 ,$17.16 ,$58.50 ,$62.40 ,$62.40 ,$17.16 ,$62.40 ,$65.52 ,$65.52 ,$65.52 ,$78.00 ,$70.20 ,$44.85 ,$78.00 ,$17.16 ,$78.00 ,$42.43 ,$17.16 ,$32.45 ,$27.82 ,$26.55 ,$18.02 ,$66.30 ,$53.59 ,$21.84 ,$70.20 ,$65.52 ,$62.40 ,$62.40 ,$17.16 ,$50.70 
ST. FRANCIS HOSPITAL - ACUTE,30101407,84403,HC TESTOSTERONE TOTAL-90,301,1 ,$109.00 ,$70.85 ,$23.98 ,$109.00 ,$62.68 ,$78.48 ,$59.30 ,$23.98 ,$30.52 ,$64.09 ,$23.98 ,$74.88 ,$27.25 ,$74.88 ,$74.88 ,$27.25 ,$74.88 ,$45.56 ,$91.56 ,$64.53 ,$23.98 ,$92.65 ,$91.56 ,$23.98 ,$81.75 ,$87.20 ,$87.20 ,$23.98 ,$87.20 ,$91.56 ,$91.56 ,$91.56 ,$109.00 ,$98.10 ,$62.68 ,$109.00 ,$23.98 ,$109.00 ,$59.30 ,$23.98 ,$45.34 ,$27.82 ,$26.55 ,$25.18 ,$92.65 ,$74.88 ,$30.52 ,$98.10 ,$91.56 ,$87.20 ,$87.20 ,$23.98 ,$70.85 
ST. FRANCIS HOSPITAL - ACUTE,30101408,84425,HC VITAMIN B1-90,301,1 ,$99.00 ,$64.35 ,$11.35 ,$99.00 ,$56.93 ,$71.28 ,$53.86 ,$21.78 ,$27.72 ,$58.21 ,$21.78 ,$68.01 ,$24.75 ,$68.01 ,$68.01 ,$24.75 ,$68.01 ,$41.38 ,$83.16 ,$53.08 ,$21.78 ,$84.15 ,$83.16 ,$21.78 ,$74.25 ,$79.20 ,$79.20 ,$21.78 ,$79.20 ,$83.16 ,$83.16 ,$83.16 ,$99.00 ,$89.10 ,$56.93 ,$99.00 ,$21.78 ,$99.00 ,$53.86 ,$21.78 ,$41.18 ,$11.89 ,$11.35 ,$22.87 ,$84.15 ,$68.01 ,$27.72 ,$89.10 ,$83.16 ,$79.20 ,$79.20 ,$21.78 ,$64.35 
ST. FRANCIS HOSPITAL - ACUTE,30101410,84432,HC THYROGLOBULIN-90,301,1 ,$92.00 ,$59.80 ,$20.24 ,$92.00 ,$52.90 ,$66.24 ,$50.05 ,$20.24 ,$25.76 ,$54.10 ,$20.24 ,$63.20 ,$23.00 ,$63.20 ,$63.20 ,$23.00 ,$63.20 ,$38.46 ,$77.28 ,$40.15 ,$20.24 ,$78.20 ,$77.28 ,$20.24 ,$69.00 ,$73.60 ,$73.60 ,$20.24 ,$73.60 ,$77.28 ,$77.28 ,$77.28 ,$92.00 ,$82.80 ,$52.90 ,$92.00 ,$20.24 ,$92.00 ,$50.05 ,$20.24 ,$38.27 ,$27.82 ,$26.55 ,$21.25 ,$78.20 ,$63.20 ,$25.76 ,$82.80 ,$77.28 ,$73.60 ,$73.60 ,$20.24 ,$59.80 
ST. FRANCIS HOSPITAL - ACUTE,30101415,84442,HC THYROXINE BIND GLOB-90,301,1 ,$43.00 ,$27.95 ,$9.46 ,$43.00 ,$24.73 ,$30.96 ,$23.39 ,$9.46 ,$12.04 ,$25.28 ,$9.46 ,$29.54 ,$10.75 ,$29.54 ,$29.54 ,$10.75 ,$29.54 ,$17.97 ,$36.12 ,$36.95 ,$9.46 ,$36.55 ,$36.12 ,$9.46 ,$32.25 ,$34.40 ,$34.40 ,$9.46 ,$34.40 ,$36.12 ,$36.12 ,$36.12 ,$43.00 ,$38.70 ,$24.73 ,$43.00 ,$9.46 ,$43.00 ,$23.39 ,$9.46 ,$17.89 ,$16.01 ,$15.28 ,$9.93 ,$36.55 ,$29.54 ,$12.04 ,$38.70 ,$36.12 ,$34.40 ,$34.40 ,$9.46 ,$27.95 
ST. FRANCIS HOSPITAL - ACUTE,30101417,84445,HC THYROID STIM IMMUNO GLOB-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$120.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$120.00 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$27.82 ,$26.55 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101418,84446,HC VITAMIN E-90,301,1 ,$84.00 ,$54.60 ,$11.35 ,$84.00 ,$48.30 ,$60.48 ,$45.70 ,$18.48 ,$23.52 ,$49.39 ,$18.48 ,$57.71 ,$21.00 ,$57.71 ,$57.71 ,$21.00 ,$57.71 ,$35.11 ,$70.56 ,$35.45 ,$18.48 ,$71.40 ,$70.56 ,$18.48 ,$63.00 ,$67.20 ,$67.20 ,$18.48 ,$67.20 ,$70.56 ,$70.56 ,$70.56 ,$84.00 ,$75.60 ,$48.30 ,$84.00 ,$18.48 ,$84.00 ,$45.70 ,$18.48 ,$34.94 ,$11.89 ,$11.35 ,$19.40 ,$71.40 ,$57.71 ,$23.52 ,$75.60 ,$70.56 ,$67.20 ,$67.20 ,$18.48 ,$54.60 
ST. FRANCIS HOSPITAL - ACUTE,30101419,84460,HC ALT-90,301,1 ,$40.00 ,$26.00 ,$5.05 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$13.25 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$5.29 ,$5.05 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101422,84479,HC T3 UPTAKE-90,301,1 ,$40.00 ,$26.00 ,$8.80 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$16.18 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$16.01 ,$15.28 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101423,84480,HC T3 TOTAL-90,301,1 ,$24.00 ,$15.60 ,$5.28 ,$35.45 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$35.45 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$16.01 ,$15.28 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101425,84482,HC T3 REVERSE-90,301,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 ,$39.40 ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$16.01 ,$15.28 ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,30101434,84560,HC URIC ACID OTH SRC-90,301,1 ,$24.00 ,$15.60 ,$5.05 ,$24.00 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$12.70 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$5.29 ,$5.05 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101435,84585,HC VANILLYLMAND AC (VMA)-90,301,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$38.75 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$27.82 ,$26.55 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101436,84586,HC VASOACTIVE INTEST PEPTIDE-90,301,1 ,$339.00 ,$220.35 ,$26.55 ,$339.00 ,$194.93 ,$244.08 ,$184.42 ,$74.58 ,$94.92 ,$199.33 ,$74.58 ,$232.89 ,$84.75 ,$232.89 ,$232.89 ,$84.75 ,$232.89 ,$141.70 ,$284.76 ,$88.33 ,$74.58 ,$288.15 ,$284.76 ,$74.58 ,$254.25 ,$271.20 ,$271.20 ,$74.58 ,$271.20 ,$284.76 ,$284.76 ,$284.76 ,$339.00 ,$305.10 ,$194.93 ,$339.00 ,$74.58 ,$339.00 ,$184.42 ,$74.58 ,$141.02 ,$27.82 ,$26.55 ,$78.31 ,$288.15 ,$232.89 ,$94.92 ,$305.10 ,$284.76 ,$271.20 ,$271.20 ,$74.58 ,$220.35 
ST. FRANCIS HOSPITAL - ACUTE,30101437,84588,HC VASOPRESSIN (ADH)-90,301,1 ,$150.00 ,$97.50 ,$26.55 ,$150.00 ,$86.25 ,$108.00 ,$81.60 ,$33.00 ,$42.00 ,$88.20 ,$33.00 ,$103.05 ,$37.50 ,$103.05 ,$103.05 ,$37.50 ,$103.05 ,$62.70 ,$126.00 ,$84.85 ,$33.00 ,$127.50 ,$126.00 ,$33.00 ,$112.50 ,$120.00 ,$120.00 ,$33.00 ,$120.00 ,$126.00 ,$126.00 ,$126.00 ,$150.00 ,$135.00 ,$86.25 ,$150.00 ,$33.00 ,$150.00 ,$81.60 ,$33.00 ,$62.40 ,$27.82 ,$26.55 ,$34.65 ,$127.50 ,$103.05 ,$42.00 ,$135.00 ,$126.00 ,$120.00 ,$120.00 ,$33.00 ,$97.50 
ST. FRANCIS HOSPITAL - ACUTE,30101438,84590,HC VITAMIN A-90,301,1 ,$89.00 ,$57.85 ,$11.35 ,$89.00 ,$51.18 ,$64.08 ,$48.42 ,$19.58 ,$24.92 ,$52.33 ,$19.58 ,$61.14 ,$22.25 ,$61.14 ,$61.14 ,$22.25 ,$61.14 ,$37.20 ,$74.76 ,$29.03 ,$19.58 ,$75.65 ,$74.76 ,$19.58 ,$66.75 ,$71.20 ,$71.20 ,$19.58 ,$71.20 ,$74.76 ,$74.76 ,$74.76 ,$89.00 ,$80.10 ,$51.18 ,$89.00 ,$19.58 ,$89.00 ,$48.42 ,$19.58 ,$37.02 ,$11.89 ,$11.35 ,$20.56 ,$75.65 ,$61.14 ,$24.92 ,$80.10 ,$74.76 ,$71.20 ,$71.20 ,$19.58 ,$57.85 
ST. FRANCIS HOSPITAL - ACUTE,30101440,84597,HC VITAMIN K-90,301,1 ,$59.00 ,$38.35 ,$11.35 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$34.30 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$11.89 ,$11.35 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30101442,84630,HC ZINC-90,301,1 ,$72.00 ,$46.80 ,$13.84 ,$72.00 ,$41.40 ,$51.84 ,$39.17 ,$15.84 ,$20.16 ,$42.34 ,$15.84 ,$49.46 ,$18.00 ,$49.46 ,$49.46 ,$18.00 ,$49.46 ,$30.10 ,$60.48 ,$28.48 ,$15.84 ,$61.20 ,$60.48 ,$15.84 ,$54.00 ,$57.60 ,$57.60 ,$15.84 ,$57.60 ,$60.48 ,$60.48 ,$60.48 ,$72.00 ,$64.80 ,$41.40 ,$72.00 ,$15.84 ,$72.00 ,$39.17 ,$15.84 ,$29.95 ,$14.50 ,$13.84 ,$16.63 ,$61.20 ,$49.46 ,$20.16 ,$64.80 ,$60.48 ,$57.60 ,$57.60 ,$15.84 ,$46.80 
ST. FRANCIS HOSPITAL - ACUTE,30101443,84681,HC C PEPTIDE-90,301,1 ,$78.00 ,$50.70 ,$11.35 ,$78.00 ,$44.85 ,$56.16 ,$42.43 ,$17.16 ,$21.84 ,$45.86 ,$17.16 ,$53.59 ,$19.50 ,$53.59 ,$53.59 ,$19.50 ,$53.59 ,$32.60 ,$65.52 ,$52.03 ,$17.16 ,$66.30 ,$65.52 ,$17.16 ,$58.50 ,$62.40 ,$62.40 ,$17.16 ,$62.40 ,$65.52 ,$65.52 ,$65.52 ,$78.00 ,$70.20 ,$44.85 ,$78.00 ,$17.16 ,$78.00 ,$42.43 ,$17.16 ,$32.45 ,$11.89 ,$11.35 ,$18.02 ,$66.30 ,$53.59 ,$21.84 ,$70.20 ,$65.52 ,$62.40 ,$62.40 ,$17.16 ,$50.70 
ST. FRANCIS HOSPITAL - ACUTE,30101444,84702,HC HCG QN-90,301,1 ,$104.00 ,$67.60 ,$15.28 ,$104.00 ,$59.80 ,$74.88 ,$56.58 ,$22.88 ,$29.12 ,$61.15 ,$22.88 ,$71.45 ,$26.00 ,$71.45 ,$71.45 ,$26.00 ,$71.45 ,$43.47 ,$87.36 ,$37.63 ,$22.88 ,$88.40 ,$87.36 ,$22.88 ,$78.00 ,$83.20 ,$83.20 ,$22.88 ,$83.20 ,$87.36 ,$87.36 ,$87.36 ,$104.00 ,$93.60 ,$59.80 ,$104.00 ,$22.88 ,$104.00 ,$56.58 ,$22.88 ,$43.26 ,$16.01 ,$15.28 ,$24.02 ,$88.40 ,$71.45 ,$29.12 ,$93.60 ,$87.36 ,$83.20 ,$83.20 ,$22.88 ,$67.60 
ST. FRANCIS HOSPITAL - ACUTE,30101457,G0480,HC DRUG SCRN DEFNT 1-7 CLS T3-90,301,1 ,$165.00 ,$107.25 ,$30.54 ,$286.08 ,$94.88 ,$118.80 ,$89.76 ,$36.30 ,$46.20 ,$39.94 ,$36.30 ,$50.86 ,$41.25 ,$50.86 ,$50.86 ,$41.25 ,$50.86 ,$68.97 ,$138.60 ,$286.08 ,$36.30 ,$140.25 ,$138.60 ,$36.30 ,$123.75 ,$132.00 ,$132.00 ,$36.30 ,$132.00 ,$138.60 ,$138.60 ,$138.60 ,$165.00 ,$148.50 ,$94.88 ,$165.00 ,$36.30 ,$165.00 ,$89.76 ,$36.30 ,$68.64 ,$32.00 ,$30.54 ,$38.12 ,$140.25 ,$50.86 ,$46.20 ,$148.50 ,$138.60 ,$132.00 ,$132.00 ,$36.30 ,$107.25 
ST. FRANCIS HOSPITAL - ACUTE,30101464,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$54.00 ,$35.10 ,$5.05 ,$54.00 ,$31.05 ,$38.88 ,$29.38 ,$11.88 ,$15.12 ,$31.75 ,$11.88 ,$37.10 ,$13.50 ,$37.10 ,$37.10 ,$13.50 ,$37.10 ,$22.57 ,$45.36 ,$10.58 ,$11.88 ,$45.90 ,$45.36 ,$11.88 ,$40.50 ,$43.20 ,$43.20 ,$11.88 ,$43.20 ,$45.36 ,$45.36 ,$45.36 ,$54.00 ,$48.60 ,$31.05 ,$54.00 ,$11.88 ,$54.00 ,$29.38 ,$11.88 ,$22.46 ,$5.29 ,$5.05 ,$12.47 ,$45.90 ,$37.10 ,$15.12 ,$48.60 ,$45.36 ,$43.20 ,$43.20 ,$11.88 ,$35.10 
ST. FRANCIS HOSPITAL - ACUTE,30101465,83921,HC ORGANIC ACIDS QN SINGLE-90,301,1 ,$237.00 ,$154.05 ,$11.35 ,$237.00 ,$136.28 ,$170.64 ,$128.93 ,$52.14 ,$66.36 ,$139.36 ,$52.14 ,$162.82 ,$59.25 ,$162.82 ,$162.82 ,$59.25 ,$162.82 ,$99.07 ,$199.08 ,$53.03 ,$52.14 ,$201.45 ,$199.08 ,$52.14 ,$177.75 ,$189.60 ,$189.60 ,$52.14 ,$189.60 ,$199.08 ,$199.08 ,$199.08 ,$237.00 ,$213.30 ,$136.28 ,$237.00 ,$52.14 ,$237.00 ,$128.93 ,$52.14 ,$98.59 ,$11.89 ,$11.35 ,$54.75 ,$201.45 ,$162.82 ,$66.36 ,$213.30 ,$199.08 ,$189.60 ,$189.60 ,$52.14 ,$154.05 
ST. FRANCIS HOSPITAL - ACUTE,30101476,82610,HC CYSTATIN C -90,301,1 ,$93.00 ,$60.45 ,$11.35 ,$93.00 ,$53.48 ,$66.96 ,$50.59 ,$20.46 ,$26.04 ,$54.68 ,$20.46 ,$63.89 ,$23.25 ,$63.89 ,$63.89 ,$23.25 ,$63.89 ,$38.87 ,$78.12 ,$46.30 ,$20.46 ,$79.05 ,$78.12 ,$20.46 ,$69.75 ,$74.40 ,$74.40 ,$20.46 ,$74.40 ,$78.12 ,$78.12 ,$78.12 ,$93.00 ,$83.70 ,$53.48 ,$93.00 ,$20.46 ,$93.00 ,$50.59 ,$20.46 ,$38.69 ,$11.89 ,$11.35 ,$21.48 ,$79.05 ,$63.89 ,$26.04 ,$83.70 ,$78.12 ,$74.40 ,$74.40 ,$20.46 ,$60.45 
ST. FRANCIS HOSPITAL - ACUTE,30101509,82330,HC CALCIUM IONIZED STAT -90,301,1 ,$107.00 ,$69.55 ,$11.35 ,$107.00 ,$61.53 ,$77.04 ,$58.21 ,$23.54 ,$29.96 ,$62.92 ,$23.54 ,$73.51 ,$26.75 ,$73.51 ,$73.51 ,$26.75 ,$73.51 ,$44.73 ,$89.88 ,$34.20 ,$23.54 ,$90.95 ,$89.88 ,$23.54 ,$80.25 ,$85.60 ,$85.60 ,$23.54 ,$85.60 ,$89.88 ,$89.88 ,$89.88 ,$107.00 ,$96.30 ,$61.53 ,$107.00 ,$23.54 ,$107.00 ,$58.21 ,$23.54 ,$44.51 ,$11.89 ,$11.35 ,$24.72 ,$90.95 ,$73.51 ,$29.96 ,$96.30 ,$89.88 ,$85.60 ,$85.60 ,$23.54 ,$69.55 
ST. FRANCIS HOSPITAL - ACUTE,30101524,83721,HC CHOLESTEROL LDL,301,1 ,$120.00 ,$78.00 ,$11.35 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$70.56 ,$26.40 ,$82.44 ,$30.00 ,$82.44 ,$82.44 ,$30.00 ,$82.44 ,$50.16 ,$100.80 ,$26.25 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 ,$11.89 ,$11.35 ,$27.72 ,$102.00 ,$82.44 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,30101525,82465,HC CHOLESTEROL -90,301,1 ,$40.00 ,$26.00 ,$5.05 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$10.88 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$5.29 ,$5.05 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101526,82947,HC GLUCOSE -90,301,1 ,$40.00 ,$26.00 ,$5.05 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$9.83 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$5.29 ,$5.05 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101527,84450,HC AST -90,301,1 ,$40.00 ,$26.00 ,$5.05 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$12.95 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$5.29 ,$5.05 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30101543,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$222.00 ,$144.30 ,$10.35 ,$222.00 ,$127.65 ,$159.84 ,$120.77 ,$48.84 ,$62.16 ,$130.54 ,$48.84 ,$152.51 ,$55.50 ,$152.51 ,$152.51 ,$55.50 ,$152.51 ,$92.80 ,$186.48 ,$119.08 ,$48.84 ,$188.70 ,$186.48 ,$48.84 ,$166.50 ,$177.60 ,$177.60 ,$48.84 ,$177.60 ,$186.48 ,$186.48 ,$186.48 ,$222.00 ,$199.80 ,$127.65 ,$222.00 ,$48.84 ,$222.00 ,$120.77 ,$48.84 ,$92.35 ,$10.85 ,$10.35 ,$51.28 ,$188.70 ,$152.51 ,$62.16 ,$199.80 ,$186.48 ,$177.60 ,$177.60 ,$48.84 ,$144.30 
ST. FRANCIS HOSPITAL - ACUTE,30101549,80184,HC PHENOBARBITAL,301,1 ,$70.00 ,$45.50 ,$13.03 ,$70.00 ,$40.25 ,$50.40 ,$38.08 ,$15.40 ,$19.60 ,$41.16 ,$15.40 ,$48.09 ,$17.50 ,$48.09 ,$48.09 ,$17.50 ,$48.09 ,$29.26 ,$58.80 ,$38.25 ,$15.40 ,$59.50 ,$58.80 ,$15.40 ,$52.50 ,$56.00 ,$56.00 ,$15.40 ,$56.00 ,$58.80 ,$58.80 ,$58.80 ,$70.00 ,$63.00 ,$40.25 ,$70.00 ,$15.40 ,$70.00 ,$38.08 ,$15.40 ,$29.12 ,$13.65 ,$13.03 ,$16.17 ,$59.50 ,$48.09 ,$19.60 ,$63.00 ,$58.80 ,$56.00 ,$56.00 ,$15.40 ,$45.50 
ST. FRANCIS HOSPITAL - ACUTE,30101552,80200,HC TOBRAMYCIN,301,1 ,$122.00 ,$79.30 ,$13.03 ,$122.00 ,$70.15 ,$87.84 ,$66.37 ,$26.84 ,$34.16 ,$71.74 ,$26.84 ,$83.81 ,$30.50 ,$83.81 ,$83.81 ,$30.50 ,$83.81 ,$51.00 ,$102.48 ,$40.33 ,$26.84 ,$103.70 ,$102.48 ,$26.84 ,$91.50 ,$97.60 ,$97.60 ,$26.84 ,$97.60 ,$102.48 ,$102.48 ,$102.48 ,$122.00 ,$109.80 ,$70.15 ,$122.00 ,$26.84 ,$122.00 ,$66.37 ,$26.84 ,$50.75 ,$13.65 ,$13.03 ,$28.18 ,$103.70 ,$83.81 ,$34.16 ,$109.80 ,$102.48 ,$97.60 ,$97.60 ,$26.84 ,$79.30 
ST. FRANCIS HOSPITAL - ACUTE,30101553,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$144.00 ,$93.60 ,$13.03 ,$144.00 ,$82.80 ,$103.68 ,$78.34 ,$31.68 ,$40.32 ,$84.67 ,$31.68 ,$98.93 ,$36.00 ,$98.93 ,$98.93 ,$36.00 ,$98.93 ,$60.19 ,$120.96 ,$46.60 ,$31.68 ,$122.40 ,$120.96 ,$31.68 ,$108.00 ,$115.20 ,$115.20 ,$31.68 ,$115.20 ,$120.96 ,$120.96 ,$120.96 ,$144.00 ,$129.60 ,$82.80 ,$144.00 ,$31.68 ,$144.00 ,$78.34 ,$31.68 ,$59.90 ,$13.65 ,$13.03 ,$33.26 ,$122.40 ,$98.93 ,$40.32 ,$129.60 ,$120.96 ,$115.20 ,$115.20 ,$31.68 ,$93.60 
ST. FRANCIS HOSPITAL - ACUTE,30101555,81479,HC IDH GENE MUTATION ASSAY - 90,301,1 ,$28.00 ,$18.20 ,$7.84 ,$42.19 , N/A ,$20.16 ,$15.23 , N/A ,$7.84 ,$16.46 , N/A ,$19.24 , N/A ,$19.24 ,$19.24 , N/A ,$19.24 , N/A ,$23.52 ,$19.60 , N/A ,$23.80 ,$23.52 , N/A ,$21.00 ,$22.40 ,$22.40 , N/A ,$22.40 ,$23.52 ,$23.52 ,$23.52 ,$28.00 ,$25.20 , N/A ,$28.00 , N/A ,$28.00 ,$15.23 , N/A ,$11.65 ,$42.19 ,$40.27 , N/A ,$23.80 ,$19.24 ,$7.84 ,$25.20 ,$23.52 ,$22.40 ,$22.40 , N/A ,$18.20 
ST. FRANCIS HOSPITAL - ACUTE,30101556,82042,HC ALBUMIN OTHER SOURCE,301,1 ,$49.00 ,$31.85 ,$5.05 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$19.45 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$5.29 ,$5.05 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30101559,82150,HC AMYLASE,301,1 ,$158.00 ,$102.70 ,$11.35 ,$158.00 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$80.33 ,$34.76 ,$102.29 ,$39.50 ,$102.29 ,$102.29 ,$39.50 ,$102.29 ,$66.04 ,$132.72 ,$16.20 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$11.89 ,$11.35 ,$36.50 ,$134.30 ,$102.29 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,30101564,82306,HC VITAMIN D 25 OH,301,1 ,$268.00 ,$174.20 ,$30.54 ,$268.00 ,$154.10 ,$192.96 ,$145.79 ,$58.96 ,$75.04 ,$157.58 ,$58.96 ,$184.12 ,$67.00 ,$184.12 ,$184.12 ,$67.00 ,$184.12 ,$112.02 ,$225.12 ,$74.00 ,$58.96 ,$227.80 ,$225.12 ,$58.96 ,$201.00 ,$214.40 ,$214.40 ,$58.96 ,$214.40 ,$225.12 ,$225.12 ,$225.12 ,$268.00 ,$241.20 ,$154.10 ,$268.00 ,$58.96 ,$268.00 ,$145.79 ,$58.96 ,$111.49 ,$32.00 ,$30.54 ,$61.91 ,$227.80 ,$184.12 ,$75.04 ,$241.20 ,$225.12 ,$214.40 ,$214.40 ,$58.96 ,$174.20 
ST. FRANCIS HOSPITAL - ACUTE,30101568,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$91.00 ,$59.15 ,$11.35 ,$91.00 ,$52.33 ,$65.52 ,$49.50 ,$20.02 ,$25.48 ,$53.51 ,$20.02 ,$62.52 ,$22.75 ,$62.52 ,$62.52 ,$22.75 ,$62.52 ,$38.04 ,$76.44 ,$47.40 ,$20.02 ,$77.35 ,$76.44 ,$20.02 ,$68.25 ,$72.80 ,$72.80 ,$20.02 ,$72.80 ,$76.44 ,$76.44 ,$76.44 ,$91.00 ,$81.90 ,$52.33 ,$91.00 ,$20.02 ,$91.00 ,$49.50 ,$20.02 ,$37.86 ,$11.89 ,$11.35 ,$21.02 ,$77.35 ,$62.52 ,$25.48 ,$81.90 ,$76.44 ,$72.80 ,$72.80 ,$20.02 ,$59.15 
ST. FRANCIS HOSPITAL - ACUTE,30101571,82533,HC CORTISOL TOTAL,301,1 ,$112.00 ,$72.80 ,$24.64 ,$112.00 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$65.86 ,$24.64 ,$76.94 ,$28.00 ,$76.94 ,$76.94 ,$28.00 ,$76.94 ,$46.82 ,$94.08 ,$40.75 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$27.82 ,$26.55 ,$25.87 ,$95.20 ,$76.94 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30101573,82607,HC VITAMIN B12,301,1 ,$77.00 ,$50.05 ,$15.28 ,$77.00 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$37.70 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$16.01 ,$15.28 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,30101574,82670,HC ESTRADIOL,301,1 ,$130.00 ,$84.50 ,$26.55 ,$130.00 ,$74.75 ,$93.60 ,$70.72 ,$28.60 ,$36.40 ,$76.44 ,$28.60 ,$89.31 ,$32.50 ,$89.31 ,$89.31 ,$32.50 ,$89.31 ,$54.34 ,$109.20 ,$69.85 ,$28.60 ,$110.50 ,$109.20 ,$28.60 ,$97.50 ,$104.00 ,$104.00 ,$28.60 ,$104.00 ,$109.20 ,$109.20 ,$109.20 ,$130.00 ,$117.00 ,$74.75 ,$130.00 ,$28.60 ,$130.00 ,$70.72 ,$28.60 ,$54.08 ,$27.82 ,$26.55 ,$30.03 ,$110.50 ,$89.31 ,$36.40 ,$117.00 ,$109.20 ,$104.00 ,$104.00 ,$28.60 ,$84.50 
ST. FRANCIS HOSPITAL - ACUTE,30101576,82731,HC FETAL FIBRONECTIN,301,1 ,$407.00 ,$264.55 ,$30.54 ,$407.00 ,$234.03 ,$293.04 ,$221.41 ,$89.54 ,$113.96 ,$239.32 ,$89.54 ,$279.61 ,$101.75 ,$279.61 ,$279.61 ,$101.75 ,$279.61 ,$170.13 ,$341.88 ,$161.03 ,$89.54 ,$345.95 ,$341.88 ,$89.54 ,$305.25 ,$325.60 ,$325.60 ,$89.54 ,$325.60 ,$341.88 ,$341.88 ,$341.88 ,$407.00 ,$366.30 ,$234.03 ,$407.00 ,$89.54 ,$407.00 ,$221.41 ,$89.54 ,$169.31 ,$32.00 ,$30.54 ,$94.02 ,$345.95 ,$279.61 ,$113.96 ,$366.30 ,$341.88 ,$325.60 ,$325.60 ,$89.54 ,$264.55 
ST. FRANCIS HOSPITAL - ACUTE,30101577,82746,HC FOLIC ACID SERUM,301,1 ,$81.00 ,$52.65 ,$11.35 ,$81.00 ,$46.58 ,$58.32 ,$44.06 ,$17.82 ,$22.68 ,$47.63 ,$17.82 ,$55.65 ,$20.25 ,$55.65 ,$55.65 ,$20.25 ,$55.65 ,$33.86 ,$68.04 ,$36.75 ,$17.82 ,$68.85 ,$68.04 ,$17.82 ,$60.75 ,$64.80 ,$64.80 ,$17.82 ,$64.80 ,$68.04 ,$68.04 ,$68.04 ,$81.00 ,$72.90 ,$46.58 ,$81.00 ,$17.82 ,$81.00 ,$44.06 ,$17.82 ,$33.70 ,$11.89 ,$11.35 ,$18.71 ,$68.85 ,$55.65 ,$22.68 ,$72.90 ,$68.04 ,$64.80 ,$64.80 ,$17.82 ,$52.65 
ST. FRANCIS HOSPITAL - ACUTE,30101579,82784,HC GAMMAGLOBULIN,301,1 ,$55.00 ,$35.75 ,$11.35 ,$55.00 ,$31.63 ,$39.60 ,$29.92 ,$12.10 ,$15.40 ,$32.34 ,$12.10 ,$37.79 ,$13.75 ,$37.79 ,$37.79 ,$13.75 ,$37.79 ,$22.99 ,$46.20 ,$23.25 ,$12.10 ,$46.75 ,$46.20 ,$12.10 ,$41.25 ,$44.00 ,$44.00 ,$12.10 ,$44.00 ,$46.20 ,$46.20 ,$46.20 ,$55.00 ,$49.50 ,$31.63 ,$55.00 ,$12.10 ,$55.00 ,$29.92 ,$12.10 ,$22.88 ,$11.89 ,$11.35 ,$12.71 ,$46.75 ,$37.79 ,$15.40 ,$49.50 ,$46.20 ,$44.00 ,$44.00 ,$12.10 ,$35.75 
ST. FRANCIS HOSPITAL - ACUTE,30101580,82785,HC GAMMAGLOBULIN IGE,301,1 ,$116.00 ,$75.40 ,$11.35 ,$116.00 ,$66.70 ,$83.52 ,$63.10 ,$25.52 ,$32.48 ,$68.21 ,$25.52 ,$79.69 ,$29.00 ,$79.69 ,$79.69 ,$29.00 ,$79.69 ,$48.49 ,$97.44 ,$41.15 ,$25.52 ,$98.60 ,$97.44 ,$25.52 ,$87.00 ,$92.80 ,$92.80 ,$25.52 ,$92.80 ,$97.44 ,$97.44 ,$97.44 ,$116.00 ,$104.40 ,$66.70 ,$116.00 ,$25.52 ,$116.00 ,$63.10 ,$25.52 ,$48.26 ,$11.89 ,$11.35 ,$26.80 ,$98.60 ,$79.69 ,$32.48 ,$104.40 ,$97.44 ,$92.80 ,$92.80 ,$25.52 ,$75.40 
ST. FRANCIS HOSPITAL - ACUTE,30101581,82945,HC GLUCOSE BODY FLUID,301,1 ,$90.00 ,$58.50 ,$5.05 ,$90.00 ,$51.75 ,$64.80 ,$48.96 ,$19.80 ,$25.20 ,$48.72 ,$19.80 ,$61.83 ,$22.50 ,$61.83 ,$61.83 ,$22.50 ,$61.83 ,$37.62 ,$75.60 ,$9.83 ,$19.80 ,$76.50 ,$75.60 ,$19.80 ,$67.50 ,$72.00 ,$72.00 ,$19.80 ,$72.00 ,$75.60 ,$75.60 ,$75.60 ,$90.00 ,$81.00 ,$51.75 ,$90.00 ,$19.80 ,$90.00 ,$48.96 ,$19.80 ,$37.44 ,$5.29 ,$5.05 ,$20.79 ,$76.50 ,$61.83 ,$25.20 ,$81.00 ,$75.60 ,$72.00 ,$72.00 ,$19.80 ,$58.50 
ST. FRANCIS HOSPITAL - ACUTE,30101585,83001,HC FSH,301,1 ,$122.00 ,$79.30 ,$26.55 ,$122.00 ,$70.15 ,$87.84 ,$66.37 ,$26.84 ,$34.16 ,$71.74 ,$26.84 ,$83.81 ,$30.50 ,$83.81 ,$83.81 ,$30.50 ,$83.81 ,$51.00 ,$102.48 ,$46.45 ,$26.84 ,$103.70 ,$102.48 ,$26.84 ,$91.50 ,$97.60 ,$97.60 ,$26.84 ,$97.60 ,$102.48 ,$102.48 ,$102.48 ,$122.00 ,$109.80 ,$70.15 ,$122.00 ,$26.84 ,$122.00 ,$66.37 ,$26.84 ,$50.75 ,$27.82 ,$26.55 ,$28.18 ,$103.70 ,$83.81 ,$34.16 ,$109.80 ,$102.48 ,$97.60 ,$97.60 ,$26.84 ,$79.30 
ST. FRANCIS HOSPITAL - ACUTE,30101586,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$132.00 ,$85.80 ,$26.55 ,$132.00 ,$75.90 ,$95.04 ,$71.81 ,$29.04 ,$36.96 ,$77.62 ,$29.04 ,$90.68 ,$33.00 ,$90.68 ,$90.68 ,$33.00 ,$90.68 ,$55.18 ,$110.88 ,$46.30 ,$29.04 ,$112.20 ,$110.88 ,$29.04 ,$99.00 ,$105.60 ,$105.60 ,$29.04 ,$105.60 ,$110.88 ,$110.88 ,$110.88 ,$132.00 ,$118.80 ,$75.90 ,$132.00 ,$29.04 ,$132.00 ,$71.81 ,$29.04 ,$54.91 ,$27.82 ,$26.55 ,$30.49 ,$112.20 ,$90.68 ,$36.96 ,$118.80 ,$110.88 ,$105.60 ,$105.60 ,$29.04 ,$85.80 
ST. FRANCIS HOSPITAL - ACUTE,30101591,83090,HC HOMOCYSTEINE,301,1 ,$129.00 ,$83.85 ,$26.55 ,$129.00 ,$74.18 ,$92.88 ,$70.18 ,$28.38 ,$36.12 ,$75.85 ,$28.38 ,$88.62 ,$32.25 ,$88.62 ,$88.62 ,$32.25 ,$88.62 ,$53.92 ,$108.36 ,$44.80 ,$28.38 ,$109.65 ,$108.36 ,$28.38 ,$96.75 ,$103.20 ,$103.20 ,$28.38 ,$103.20 ,$108.36 ,$108.36 ,$108.36 ,$129.00 ,$116.10 ,$74.18 ,$129.00 ,$28.38 ,$129.00 ,$70.18 ,$28.38 ,$53.66 ,$27.82 ,$26.55 ,$29.80 ,$109.65 ,$88.62 ,$36.12 ,$116.10 ,$108.36 ,$103.20 ,$103.20 ,$28.38 ,$83.85 
ST. FRANCIS HOSPITAL - ACUTE,30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$154.00 ,$100.10 ,$5.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$55.22 ,$33.88 ,$70.33 ,$38.50 ,$70.33 ,$70.33 ,$38.50 ,$70.33 ,$64.37 ,$129.36 ,$15.10 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$5.29 ,$5.05 ,$35.57 ,$130.90 ,$70.33 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30101597,83874,HC MYOGLOBIN,301,1 ,$127.00 ,$82.55 ,$11.35 ,$127.00 ,$73.03 ,$91.44 ,$69.09 ,$27.94 ,$35.56 ,$74.68 ,$27.94 ,$87.25 ,$31.75 ,$87.25 ,$87.25 ,$31.75 ,$87.25 ,$53.09 ,$106.68 ,$32.30 ,$27.94 ,$107.95 ,$106.68 ,$27.94 ,$95.25 ,$101.60 ,$101.60 ,$27.94 ,$101.60 ,$106.68 ,$106.68 ,$106.68 ,$127.00 ,$114.30 ,$73.03 ,$127.00 ,$27.94 ,$127.00 ,$69.09 ,$27.94 ,$52.83 ,$11.89 ,$11.35 ,$29.34 ,$107.95 ,$87.25 ,$35.56 ,$114.30 ,$106.68 ,$101.60 ,$101.60 ,$27.94 ,$82.55 
ST. FRANCIS HOSPITAL - ACUTE,30101598,83930,HC OSMOLALITY BLOOD,301,1 ,$85.00 ,$55.25 ,$5.05 ,$85.00 ,$48.88 ,$61.20 ,$46.24 ,$18.70 ,$23.80 ,$49.98 ,$18.70 ,$58.40 ,$21.25 ,$58.40 ,$58.40 ,$21.25 ,$58.40 ,$35.53 ,$71.40 ,$16.53 ,$18.70 ,$72.25 ,$71.40 ,$18.70 ,$63.75 ,$68.00 ,$68.00 ,$18.70 ,$68.00 ,$71.40 ,$71.40 ,$71.40 ,$85.00 ,$76.50 ,$48.88 ,$85.00 ,$18.70 ,$85.00 ,$46.24 ,$18.70 ,$35.36 ,$5.29 ,$5.05 ,$19.64 ,$72.25 ,$58.40 ,$23.80 ,$76.50 ,$71.40 ,$68.00 ,$68.00 ,$18.70 ,$55.25 
ST. FRANCIS HOSPITAL - ACUTE,30101599,83935,HC OSMOLALITY URINE,301,1 ,$98.00 ,$63.70 ,$5.05 ,$98.00 ,$56.35 ,$70.56 ,$53.31 ,$21.56 ,$27.44 ,$57.62 ,$21.56 ,$67.33 ,$24.50 ,$67.33 ,$67.33 ,$24.50 ,$67.33 ,$40.96 ,$82.32 ,$17.05 ,$21.56 ,$83.30 ,$82.32 ,$21.56 ,$73.50 ,$78.40 ,$78.40 ,$21.56 ,$78.40 ,$82.32 ,$82.32 ,$82.32 ,$98.00 ,$88.20 ,$56.35 ,$98.00 ,$21.56 ,$98.00 ,$53.31 ,$21.56 ,$40.77 ,$5.29 ,$5.05 ,$22.64 ,$83.30 ,$67.33 ,$27.44 ,$88.20 ,$82.32 ,$78.40 ,$78.40 ,$21.56 ,$63.70 
ST. FRANCIS HOSPITAL - ACUTE,30101600,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$88.00 ,$57.20 ,$19.36 ,$103.20 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$51.74 ,$19.36 ,$60.46 ,$22.00 ,$60.46 ,$60.46 ,$22.00 ,$60.46 ,$36.78 ,$73.92 ,$103.20 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$88.00 ,$47.87 ,$19.36 ,$36.61 ,$27.82 ,$26.55 ,$20.33 ,$74.80 ,$60.46 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,30101605,84134,HC PREALBUMIN,301,1 ,$77.00 ,$50.05 ,$11.35 ,$77.00 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$36.48 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$11.89 ,$11.35 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,30101606,84144,HC PROGESTERONE,301,1 ,$117.00 ,$76.05 ,$15.28 ,$117.00 ,$67.28 ,$84.24 ,$63.65 ,$25.74 ,$32.76 ,$68.80 ,$25.74 ,$80.38 ,$29.25 ,$80.38 ,$80.38 ,$29.25 ,$80.38 ,$48.91 ,$98.28 ,$52.15 ,$25.74 ,$99.45 ,$98.28 ,$25.74 ,$87.75 ,$93.60 ,$93.60 ,$25.74 ,$93.60 ,$98.28 ,$98.28 ,$98.28 ,$117.00 ,$105.30 ,$67.28 ,$117.00 ,$25.74 ,$117.00 ,$63.65 ,$25.74 ,$48.67 ,$16.01 ,$15.28 ,$27.03 ,$99.45 ,$80.38 ,$32.76 ,$105.30 ,$98.28 ,$93.60 ,$93.60 ,$25.74 ,$76.05 
ST. FRANCIS HOSPITAL - ACUTE,30101608,84146,HC PROLACTIN,301,1 ,$142.00 ,$92.30 ,$26.55 ,$142.00 ,$81.65 ,$102.24 ,$77.25 ,$31.24 ,$39.76 ,$83.50 ,$31.24 ,$97.55 ,$35.50 ,$97.55 ,$97.55 ,$35.50 ,$97.55 ,$59.36 ,$119.28 ,$48.45 ,$31.24 ,$120.70 ,$119.28 ,$31.24 ,$106.50 ,$113.60 ,$113.60 ,$31.24 ,$113.60 ,$119.28 ,$119.28 ,$119.28 ,$142.00 ,$127.80 ,$81.65 ,$142.00 ,$31.24 ,$142.00 ,$77.25 ,$31.24 ,$59.07 ,$27.82 ,$26.55 ,$32.80 ,$120.70 ,$97.55 ,$39.76 ,$127.80 ,$119.28 ,$113.60 ,$113.60 ,$31.24 ,$92.30 
ST. FRANCIS HOSPITAL - ACUTE,30101611,84155,HC PROTEIN TOTAL,301,1 ,$26.00 ,$16.90 ,$5.05 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$15.29 ,$5.72 ,$17.86 ,$6.50 ,$17.86 ,$17.86 ,$6.50 ,$17.86 ,$10.87 ,$21.84 ,$9.18 ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 ,$5.29 ,$5.05 ,$6.01 ,$22.10 ,$17.86 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,30101612,84156,HC PROTEIN TOTAL URINE,301,1 ,$25.00 ,$16.25 ,$5.05 ,$25.00 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$9.18 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$5.29 ,$5.05 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30101613,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$128.00 ,$83.20 ,$5.05 ,$128.00 ,$73.60 ,$92.16 ,$69.63 ,$28.16 ,$35.84 ,$45.53 ,$28.16 ,$57.97 ,$32.00 ,$57.97 ,$57.97 ,$32.00 ,$57.97 ,$53.50 ,$107.52 ,$10.00 ,$28.16 ,$108.80 ,$107.52 ,$28.16 ,$96.00 ,$102.40 ,$102.40 ,$28.16 ,$102.40 ,$107.52 ,$107.52 ,$107.52 ,$128.00 ,$115.20 ,$73.60 ,$128.00 ,$28.16 ,$128.00 ,$69.63 ,$28.16 ,$53.25 ,$5.29 ,$5.05 ,$29.57 ,$108.80 ,$57.97 ,$35.84 ,$115.20 ,$107.52 ,$102.40 ,$102.40 ,$28.16 ,$83.20 
ST. FRANCIS HOSPITAL - ACUTE,30101614,84165,HC PROTEIN ELECTROPHORESIS,301,1 ,$75.00 ,$48.75 ,$11.35 ,$75.00 ,$43.13 ,$54.00 ,$40.80 ,$16.50 ,$21.00 ,$44.10 ,$16.50 ,$51.53 ,$18.75 ,$51.53 ,$51.53 ,$18.75 ,$51.53 ,$31.35 ,$63.00 ,$26.85 ,$16.50 ,$63.75 ,$63.00 ,$16.50 ,$56.25 ,$60.00 ,$60.00 ,$16.50 ,$60.00 ,$63.00 ,$63.00 ,$63.00 ,$75.00 ,$67.50 ,$43.13 ,$75.00 ,$16.50 ,$75.00 ,$40.80 ,$16.50 ,$31.20 ,$11.89 ,$11.35 ,$17.33 ,$63.75 ,$51.53 ,$21.00 ,$67.50 ,$63.00 ,$60.00 ,$60.00 ,$16.50 ,$48.75 
ST. FRANCIS HOSPITAL - ACUTE,30101615,84166,HC PROTEIN EP OTH FLUID,301,1 ,$91.00 ,$59.15 ,$11.35 ,$91.00 ,$52.33 ,$65.52 ,$49.50 ,$20.02 ,$25.48 ,$53.51 ,$20.02 ,$62.52 ,$22.75 ,$62.52 ,$62.52 ,$22.75 ,$62.52 ,$38.04 ,$76.44 ,$44.58 ,$20.02 ,$77.35 ,$76.44 ,$20.02 ,$68.25 ,$72.80 ,$72.80 ,$20.02 ,$72.80 ,$76.44 ,$76.44 ,$76.44 ,$91.00 ,$81.90 ,$52.33 ,$91.00 ,$20.02 ,$91.00 ,$49.50 ,$20.02 ,$37.86 ,$11.89 ,$11.35 ,$21.02 ,$77.35 ,$62.52 ,$25.48 ,$81.90 ,$76.44 ,$72.80 ,$72.80 ,$20.02 ,$59.15 
ST. FRANCIS HOSPITAL - ACUTE,30101620,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$99.00 ,$64.35 ,$15.28 ,$99.00 ,$56.93 ,$71.28 ,$53.86 ,$21.78 ,$27.72 ,$58.21 ,$21.78 ,$68.01 ,$24.75 ,$68.01 ,$68.01 ,$24.75 ,$68.01 ,$41.38 ,$83.16 ,$17.18 ,$21.78 ,$84.15 ,$83.16 ,$21.78 ,$74.25 ,$79.20 ,$79.20 ,$21.78 ,$79.20 ,$83.16 ,$83.16 ,$83.16 ,$99.00 ,$89.10 ,$56.93 ,$99.00 ,$21.78 ,$99.00 ,$53.86 ,$21.78 ,$41.18 ,$16.01 ,$15.28 ,$22.87 ,$84.15 ,$68.01 ,$27.72 ,$89.10 ,$83.16 ,$79.20 ,$79.20 ,$21.78 ,$64.35 
ST. FRANCIS HOSPITAL - ACUTE,30101622,84466,HC TRANSFERRIN,301,1 ,$154.00 ,$100.10 ,$11.35 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$90.55 ,$33.88 ,$105.80 ,$38.50 ,$105.80 ,$105.80 ,$38.50 ,$105.80 ,$64.37 ,$129.36 ,$31.90 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$154.00 ,$83.78 ,$33.88 ,$64.06 ,$11.89 ,$11.35 ,$35.57 ,$130.90 ,$105.80 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30101624,84480,HC T3 TOTAL,301,1 ,$102.00 ,$66.30 ,$15.28 ,$102.00 ,$58.65 ,$73.44 ,$55.49 ,$22.44 ,$28.56 ,$59.98 ,$22.44 ,$70.07 ,$25.50 ,$70.07 ,$70.07 ,$25.50 ,$70.07 ,$42.64 ,$85.68 ,$35.45 ,$22.44 ,$86.70 ,$85.68 ,$22.44 ,$76.50 ,$81.60 ,$81.60 ,$22.44 ,$81.60 ,$85.68 ,$85.68 ,$85.68 ,$102.00 ,$91.80 ,$58.65 ,$102.00 ,$22.44 ,$102.00 ,$55.49 ,$22.44 ,$42.43 ,$16.01 ,$15.28 ,$23.56 ,$86.70 ,$70.07 ,$28.56 ,$91.80 ,$85.68 ,$81.60 ,$81.60 ,$22.44 ,$66.30 
ST. FRANCIS HOSPITAL - ACUTE,30101625,84481,HC T3 FREE,301,1 ,$102.00 ,$66.30 ,$15.28 ,$102.00 ,$58.65 ,$73.44 ,$55.49 ,$22.44 ,$28.56 ,$59.98 ,$22.44 ,$70.07 ,$25.50 ,$70.07 ,$70.07 ,$25.50 ,$70.07 ,$42.64 ,$85.68 ,$42.35 ,$22.44 ,$86.70 ,$85.68 ,$22.44 ,$76.50 ,$81.60 ,$81.60 ,$22.44 ,$81.60 ,$85.68 ,$85.68 ,$85.68 ,$102.00 ,$91.80 ,$58.65 ,$102.00 ,$22.44 ,$102.00 ,$55.49 ,$22.44 ,$42.43 ,$16.01 ,$15.28 ,$23.56 ,$86.70 ,$70.07 ,$28.56 ,$91.80 ,$85.68 ,$81.60 ,$81.60 ,$22.44 ,$66.30 
ST. FRANCIS HOSPITAL - ACUTE,30101642,84999,HC OSMOLALITY FECAL-90,301,1 ,$24.00 ,$15.60 ,$6.72 ,$24.00 , N/A ,$17.28 ,$13.06 , N/A ,$6.72 ,$13.46 , N/A ,$15.65 , N/A ,$15.65 ,$15.65 , N/A ,$15.65 , N/A ,$20.16 ,$16.80 , N/A ,$20.40 ,$20.16 , N/A ,$18.00 ,$19.20 ,$19.20 , N/A ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 , N/A ,$24.00 , N/A ,$24.00 ,$13.06 , N/A ,$9.98 ,$11.89 ,$11.35 , N/A ,$20.40 ,$15.65 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 , N/A ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30101643,81596,HC CHRONIC HEP C VIRUS ASSAYS-90,301,1 ,$343.00 ,$222.95 ,$40.27 ,$343.00 ,$197.23 ,$246.96 ,$186.59 ,$75.46 ,$96.04 ,$192.42 ,$75.46 ,$223.64 ,$85.75 ,$223.64 ,$223.64 ,$85.75 ,$223.64 ,$143.37 ,$288.12 ,$180.48 ,$75.46 ,$291.55 ,$288.12 ,$75.46 ,$257.25 ,$274.40 ,$274.40 ,$75.46 ,$274.40 ,$288.12 ,$288.12 ,$288.12 ,$343.00 ,$308.70 ,$197.23 ,$343.00 ,$75.46 ,$343.00 ,$186.59 ,$75.46 ,$142.69 ,$42.19 ,$40.27 ,$79.23 ,$291.55 ,$223.64 ,$96.04 ,$308.70 ,$288.12 ,$274.40 ,$274.40 ,$75.46 ,$222.95 
ST. FRANCIS HOSPITAL - ACUTE,30101664,80307,HC DRUG SCREEN UMBILICAL CORD-90,301,1 ,$26.00 ,$16.90 ,$5.72 ,$65.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$15.29 ,$5.72 ,$17.86 ,$6.50 ,$17.86 ,$17.86 ,$6.50 ,$17.86 ,$10.87 ,$21.84 ,$65.00 ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 ,$32.00 ,$30.54 ,$6.01 ,$22.10 ,$17.86 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,30101665,80307,HC DRUG SCREEN MECONIUM-90,301,1 ,$16.00 ,$10.40 ,$3.52 ,$40.00 ,$9.20 ,$11.52 ,$8.70 ,$3.52 ,$4.48 ,$9.41 ,$3.52 ,$10.99 ,$4.00 ,$10.99 ,$10.99 ,$4.00 ,$10.99 ,$6.69 ,$13.44 ,$40.00 ,$3.52 ,$13.60 ,$13.44 ,$3.52 ,$12.00 ,$12.80 ,$12.80 ,$3.52 ,$12.80 ,$13.44 ,$13.44 ,$13.44 ,$16.00 ,$14.40 ,$9.20 ,$16.00 ,$3.52 ,$16.00 ,$8.70 ,$3.52 ,$6.66 ,$32.00 ,$30.54 ,$3.70 ,$13.60 ,$10.99 ,$4.48 ,$14.40 ,$13.44 ,$12.80 ,$12.80 ,$3.52 ,$10.40 
ST. FRANCIS HOSPITAL - ACUTE,30101668,83550,HC IRON BINDING CAPACITY -90,301,1 ,$119.00 ,$77.35 ,$11.35 ,$119.00 ,$68.43 ,$85.68 ,$64.74 ,$26.18 ,$33.32 ,$69.97 ,$26.18 ,$81.75 ,$29.75 ,$81.75 ,$81.75 ,$29.75 ,$81.75 ,$49.74 ,$99.96 ,$21.85 ,$26.18 ,$101.15 ,$99.96 ,$26.18 ,$89.25 ,$95.20 ,$95.20 ,$26.18 ,$95.20 ,$99.96 ,$99.96 ,$99.96 ,$119.00 ,$107.10 ,$68.43 ,$119.00 ,$26.18 ,$119.00 ,$64.74 ,$26.18 ,$49.50 ,$11.89 ,$11.35 ,$27.49 ,$101.15 ,$81.75 ,$33.32 ,$107.10 ,$99.96 ,$95.20 ,$95.20 ,$26.18 ,$77.35 
ST. FRANCIS HOSPITAL - ACUTE,30101702,81479,HC MUTATION ANALYSIS MYD88-90,301,1 ,$519.00 ,$337.35 ,$39.94 ,$519.00 , N/A ,$373.68 ,$282.34 , N/A ,$145.32 ,$39.94 , N/A ,$50.86 , N/A ,$50.86 ,$50.86 , N/A ,$50.86 , N/A ,$435.96 ,$363.30 , N/A ,$441.15 ,$435.96 , N/A ,$389.25 ,$415.20 ,$415.20 , N/A ,$415.20 ,$435.96 ,$435.96 ,$435.96 ,$519.00 ,$467.10 , N/A ,$519.00 , N/A ,$519.00 ,$282.34 , N/A ,$215.90 ,$42.19 ,$40.27 , N/A ,$441.15 ,$50.86 ,$145.32 ,$467.10 ,$435.96 ,$415.20 ,$415.20 , N/A ,$337.35 
ST. FRANCIS HOSPITAL - ACUTE,30101770,83521,HC IMMUNOGLOBULIN LIGHT CHAINS- 90,301,1 ,$210.00 ,$136.50 ,$11.35 ,$210.00 ,$120.75 ,$151.20 ,$114.24 ,$46.20 ,$58.80 ,$117.81 ,$46.20 ,$136.92 ,$52.50 ,$136.92 ,$136.92 ,$52.50 ,$136.92 ,$87.78 ,$176.40 ,$43.18 ,$46.20 ,$178.50 ,$176.40 ,$46.20 ,$157.50 ,$168.00 ,$168.00 ,$46.20 ,$168.00 ,$176.40 ,$176.40 ,$176.40 ,$210.00 ,$189.00 ,$120.75 ,$210.00 ,$46.20 ,$210.00 ,$114.24 ,$46.20 ,$87.36 ,$11.89 ,$11.35 ,$48.51 ,$178.50 ,$136.92 ,$58.80 ,$189.00 ,$176.40 ,$168.00 ,$168.00 ,$46.20 ,$136.50 
ST. FRANCIS HOSPITAL - ACUTE,30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$297.00 ,$193.05 ,$10.16 ,$297.00 ,$170.78 ,$213.84 ,$161.57 ,$65.34 ,$83.16 ,$64.12 ,$65.34 ,$81.66 ,$74.25 ,$81.66 ,$81.66 ,$74.25 ,$81.66 ,$124.15 ,$249.48 ,$12.95 ,$65.34 ,$252.45 ,$249.48 ,$65.34 ,$222.75 ,$237.60 ,$237.60 ,$65.34 ,$237.60 ,$249.48 ,$249.48 ,$249.48 ,$297.00 ,$267.30 ,$170.78 ,$297.00 ,$65.34 ,$297.00 ,$161.57 ,$65.34 ,$123.55 ,$10.65 ,$10.16 ,$68.61 ,$252.45 ,$81.66 ,$83.16 ,$267.30 ,$249.48 ,$237.60 ,$237.60 ,$65.34 ,$193.05 
ST. FRANCIS HOSPITAL - ACUTE,30200542,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$385.00 ,$250.25 ,$10.16 ,$385.00 ,$221.38 ,$277.20 ,$209.44 ,$84.70 ,$107.80 ,$169.89 ,$84.70 ,$216.35 ,$96.25 ,$216.35 ,$216.35 ,$96.25 ,$216.35 ,$160.93 ,$323.40 ,$34.28 ,$84.70 ,$327.25 ,$323.40 ,$84.70 ,$288.75 ,$308.00 ,$308.00 ,$84.70 ,$308.00 ,$323.40 ,$323.40 ,$323.40 ,$385.00 ,$346.50 ,$221.38 ,$385.00 ,$84.70 ,$385.00 ,$209.44 ,$84.70 ,$160.16 ,$10.65 ,$10.16 ,$88.94 ,$327.25 ,$216.35 ,$107.80 ,$346.50 ,$323.40 ,$308.00 ,$308.00 ,$84.70 ,$250.25 
ST. FRANCIS HOSPITAL - ACUTE,30200562,86880,HC COOMBS DIRECT,302,1 ,$131.00 ,$85.15 ,$10.16 ,$142.13 ,$75.33 ,$94.32 ,$71.26 ,$28.82 ,$36.68 ,$49.29 ,$28.82 ,$62.77 ,$32.75 ,$62.77 ,$62.77 ,$32.75 ,$62.77 ,$54.76 ,$110.04 ,$142.13 ,$28.82 ,$111.35 ,$110.04 ,$28.82 ,$98.25 ,$104.80 ,$104.80 ,$28.82 ,$104.80 ,$110.04 ,$110.04 ,$110.04 ,$131.00 ,$117.90 ,$75.33 ,$131.00 ,$28.82 ,$131.00 ,$71.26 ,$28.82 ,$54.50 ,$10.65 ,$10.16 ,$30.26 ,$111.35 ,$62.77 ,$36.68 ,$117.90 ,$110.04 ,$104.80 ,$104.80 ,$28.82 ,$85.15 
ST. FRANCIS HOSPITAL - ACUTE,30200563,86885,HC INDIRECT COOMBS,302,1 ,$201.00 ,$130.65 ,$10.16 ,$380.80 ,$115.58 ,$144.72 ,$109.34 ,$44.22 ,$56.28 ,$52.49 ,$44.22 ,$66.84 ,$50.25 ,$66.84 ,$66.84 ,$50.25 ,$66.84 ,$84.02 ,$168.84 ,$380.80 ,$44.22 ,$170.85 ,$168.84 ,$44.22 ,$150.75 ,$160.80 ,$160.80 ,$44.22 ,$160.80 ,$168.84 ,$168.84 ,$168.84 ,$201.00 ,$180.90 ,$115.58 ,$201.00 ,$44.22 ,$201.00 ,$109.34 ,$44.22 ,$83.62 ,$10.65 ,$10.16 ,$46.43 ,$170.85 ,$66.84 ,$56.28 ,$180.90 ,$168.84 ,$160.80 ,$160.80 ,$44.22 ,$130.65 
ST. FRANCIS HOSPITAL - ACUTE,30200564,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,$135.00 ,$87.75 ,$29.70 ,$380.80 ,$77.63 ,$97.20 ,$73.44 ,$29.70 ,$37.80 ,$79.38 ,$29.70 ,$92.75 ,$33.75 ,$92.75 ,$92.75 ,$33.75 ,$92.75 ,$56.43 ,$113.40 ,$380.80 ,$29.70 ,$114.75 ,$113.40 ,$29.70 ,$101.25 ,$108.00 ,$108.00 ,$29.70 ,$108.00 ,$113.40 ,$113.40 ,$113.40 ,$135.00 ,$121.50 ,$77.63 ,$135.00 ,$29.70 ,$135.00 ,$73.44 ,$29.70 ,$56.16 ,$42.98 ,$41.02 ,$31.19 ,$114.75 ,$92.75 ,$37.80 ,$121.50 ,$113.40 ,$108.00 ,$108.00 ,$29.70 ,$87.75 
ST. FRANCIS HOSPITAL - ACUTE,30200565,86900,HC BLOOD TYPING ABO,302,1 ,$69.00 ,$44.85 ,$6.30 ,$287.90 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$27.38 ,$15.18 ,$34.87 ,$17.25 ,$34.87 ,$34.87 ,$17.25 ,$34.87 ,$28.84 ,$57.96 ,$287.90 ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 ,$6.60 ,$6.30 ,$15.94 ,$58.65 ,$34.87 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,30200566,86901,HC BLOOD TYPING RH,302,1 ,$99.00 ,$64.35 ,$6.30 ,$99.00 ,$56.93 ,$71.28 ,$53.86 ,$21.78 ,$27.72 ,$27.38 ,$21.78 ,$34.87 ,$24.75 ,$34.87 ,$34.87 ,$24.75 ,$34.87 ,$41.38 ,$83.16 ,$86.43 ,$21.78 ,$84.15 ,$83.16 ,$21.78 ,$74.25 ,$79.20 ,$79.20 ,$21.78 ,$79.20 ,$83.16 ,$83.16 ,$83.16 ,$99.00 ,$89.10 ,$56.93 ,$99.00 ,$21.78 ,$99.00 ,$53.86 ,$21.78 ,$41.18 ,$6.60 ,$6.30 ,$22.87 ,$84.15 ,$34.87 ,$27.72 ,$89.10 ,$83.16 ,$79.20 ,$79.20 ,$21.78 ,$64.35 
ST. FRANCIS HOSPITAL - ACUTE,30200568,86905,HC RBC ANTIGEN OTHER THAN ABO OR RH(D) EACH,302,1 ,$112.00 ,$72.80 ,$6.30 ,$743.63 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$35.03 ,$24.64 ,$44.61 ,$28.00 ,$44.61 ,$44.61 ,$28.00 ,$44.61 ,$46.82 ,$94.08 ,$743.63 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$6.60 ,$6.30 ,$25.87 ,$95.20 ,$44.61 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30200569,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$169.00 ,$109.85 ,$6.30 ,$380.80 ,$97.18 ,$121.68 ,$91.94 ,$37.18 ,$47.32 ,$99.37 ,$37.18 ,$116.10 ,$42.25 ,$116.10 ,$116.10 ,$42.25 ,$116.10 ,$70.64 ,$141.96 ,$380.80 ,$37.18 ,$143.65 ,$141.96 ,$37.18 ,$126.75 ,$135.20 ,$135.20 ,$37.18 ,$135.20 ,$141.96 ,$141.96 ,$141.96 ,$169.00 ,$152.10 ,$97.18 ,$169.00 ,$37.18 ,$169.00 ,$91.94 ,$37.18 ,$70.30 ,$6.60 ,$6.30 ,$39.04 ,$143.65 ,$116.10 ,$47.32 ,$152.10 ,$141.96 ,$135.20 ,$135.20 ,$37.18 ,$109.85 
ST. FRANCIS HOSPITAL - ACUTE,30200571,86922,HC CROSSMATCH AHG,302,1 ,$32.00 ,$20.80 ,$7.04 ,$380.80 ,$18.40 ,$23.04 ,$17.41 ,$7.04 ,$8.96 ,$18.82 ,$7.04 ,$21.98 ,$8.00 ,$21.98 ,$21.98 ,$8.00 ,$21.98 ,$13.38 ,$26.88 ,$380.80 ,$7.04 ,$27.20 ,$26.88 ,$7.04 ,$24.00 ,$25.60 ,$25.60 ,$7.04 ,$25.60 ,$26.88 ,$26.88 ,$26.88 ,$32.00 ,$28.80 ,$18.40 ,$32.00 ,$7.04 ,$32.00 ,$17.41 ,$7.04 ,$13.31 ,$42.98 ,$41.02 ,$7.39 ,$27.20 ,$21.98 ,$8.96 ,$28.80 ,$26.88 ,$25.60 ,$25.60 ,$7.04 ,$20.80 
ST. FRANCIS HOSPITAL - ACUTE,30200844,86001,HC RAST ALLERGEN IGG QN SQ EA-90,302,1 ,$45.00 ,$29.25 ,$9.90 ,$45.00 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$19.55 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$10.65 ,$10.16 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30200845,86003,HC RAST ALLERGEN IGE QN SQ EA-90,302,1 ,$22.00 ,$14.30 ,$4.84 ,$22.00 ,$12.65 ,$15.84 ,$11.97 ,$4.84 ,$6.16 ,$12.94 ,$4.84 ,$15.11 ,$5.50 ,$15.11 ,$15.11 ,$5.50 ,$15.11 ,$9.20 ,$18.48 ,$13.05 ,$4.84 ,$18.70 ,$18.48 ,$4.84 ,$16.50 ,$17.60 ,$17.60 ,$4.84 ,$17.60 ,$18.48 ,$18.48 ,$18.48 ,$22.00 ,$19.80 ,$12.65 ,$22.00 ,$4.84 ,$22.00 ,$11.97 ,$4.84 ,$9.15 ,$10.65 ,$10.16 ,$5.08 ,$18.70 ,$15.11 ,$6.16 ,$19.80 ,$18.48 ,$17.60 ,$17.60 ,$4.84 ,$14.30 
ST. FRANCIS HOSPITAL - ACUTE,30200847,86021,HC LEUKO AB ID-90,302,1 ,$100.00 ,$65.00 ,$10.16 ,$100.00 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$58.80 ,$22.00 ,$68.70 ,$25.00 ,$68.70 ,$68.70 ,$25.00 ,$68.70 ,$41.80 ,$84.00 ,$37.63 ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 ,$10.65 ,$10.16 ,$23.10 ,$85.00 ,$68.70 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,30200851,86022,HC PLATELET AB ID-90,302,1 ,$69.00 ,$44.85 ,$10.16 ,$69.00 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$40.57 ,$15.18 ,$47.40 ,$17.25 ,$47.40 ,$47.40 ,$17.25 ,$47.40 ,$28.84 ,$57.96 ,$45.93 ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 ,$10.65 ,$10.16 ,$15.94 ,$58.65 ,$47.40 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,30200859,86039,HC ANA TITER-90,302,1 ,$66.00 ,$42.90 ,$10.16 ,$66.00 ,$37.95 ,$47.52 ,$35.90 ,$14.52 ,$18.48 ,$38.81 ,$14.52 ,$45.34 ,$16.50 ,$45.34 ,$45.34 ,$16.50 ,$45.34 ,$27.59 ,$55.44 ,$27.90 ,$14.52 ,$56.10 ,$55.44 ,$14.52 ,$49.50 ,$52.80 ,$52.80 ,$14.52 ,$52.80 ,$55.44 ,$55.44 ,$55.44 ,$66.00 ,$59.40 ,$37.95 ,$66.00 ,$14.52 ,$66.00 ,$35.90 ,$14.52 ,$27.46 ,$10.65 ,$10.16 ,$15.25 ,$56.10 ,$45.34 ,$18.48 ,$59.40 ,$55.44 ,$52.80 ,$52.80 ,$14.52 ,$42.90 
ST. FRANCIS HOSPITAL - ACUTE,30200861,86140,HC C-REACTIVE PROTEIN-90,302,1 ,$165.00 ,$107.25 ,$10.16 ,$165.00 ,$94.88 ,$118.80 ,$89.76 ,$36.30 ,$46.20 ,$47.35 ,$36.30 ,$60.30 ,$41.25 ,$60.30 ,$60.30 ,$41.25 ,$60.30 ,$68.97 ,$138.60 ,$12.95 ,$36.30 ,$140.25 ,$138.60 ,$36.30 ,$123.75 ,$132.00 ,$132.00 ,$36.30 ,$132.00 ,$138.60 ,$138.60 ,$138.60 ,$165.00 ,$148.50 ,$94.88 ,$165.00 ,$36.30 ,$165.00 ,$89.76 ,$36.30 ,$68.64 ,$10.65 ,$10.16 ,$38.12 ,$140.25 ,$60.30 ,$46.20 ,$148.50 ,$138.60 ,$132.00 ,$132.00 ,$36.30 ,$107.25 
ST. FRANCIS HOSPITAL - ACUTE,30200862,86140,HC C-REACTIVE PROTEIN,302,1 ,$165.00 ,$107.25 ,$10.16 ,$165.00 ,$94.88 ,$118.80 ,$89.76 ,$36.30 ,$46.20 ,$47.35 ,$36.30 ,$60.30 ,$41.25 ,$60.30 ,$60.30 ,$41.25 ,$60.30 ,$68.97 ,$138.60 ,$12.95 ,$36.30 ,$140.25 ,$138.60 ,$36.30 ,$123.75 ,$132.00 ,$132.00 ,$36.30 ,$132.00 ,$138.60 ,$138.60 ,$138.60 ,$165.00 ,$148.50 ,$94.88 ,$165.00 ,$36.30 ,$165.00 ,$89.76 ,$36.30 ,$68.64 ,$10.65 ,$10.16 ,$38.12 ,$140.25 ,$60.30 ,$46.20 ,$148.50 ,$138.60 ,$132.00 ,$132.00 ,$36.30 ,$107.25 
ST. FRANCIS HOSPITAL - ACUTE,30200863,86141,HC C-REACTIVE PROTEIN (HS)-90,302,1 ,$112.00 ,$72.80 ,$10.16 ,$112.00 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$65.86 ,$24.64 ,$76.94 ,$28.00 ,$76.94 ,$76.94 ,$28.00 ,$76.94 ,$46.82 ,$94.08 ,$32.38 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$10.65 ,$10.16 ,$25.87 ,$95.20 ,$76.94 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30200864,86146,HC BETA 2 GLYCO AB-90,302,1 ,$100.00 ,$65.00 ,$11.35 ,$100.00 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$58.80 ,$22.00 ,$68.70 ,$25.00 ,$68.70 ,$68.70 ,$25.00 ,$68.70 ,$41.80 ,$84.00 ,$63.63 ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 ,$11.89 ,$11.35 ,$23.10 ,$85.00 ,$68.70 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,30200865,86147,HC CARDIOLIPIN AB EA-90,302,1 ,$25.00 ,$16.25 ,$5.50 ,$62.50 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$62.50 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$18.35 ,$17.51 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30200866,86148,HC ANTI-PHOSPHATIDYLSERINE AB-90,302,1 ,$62.00 ,$40.30 ,$11.35 ,$62.00 ,$35.65 ,$44.64 ,$33.73 ,$13.64 ,$17.36 ,$36.46 ,$13.64 ,$42.59 ,$15.50 ,$42.59 ,$42.59 ,$15.50 ,$42.59 ,$25.92 ,$52.08 ,$40.18 ,$13.64 ,$52.70 ,$52.08 ,$13.64 ,$46.50 ,$49.60 ,$49.60 ,$13.64 ,$49.60 ,$52.08 ,$52.08 ,$52.08 ,$62.00 ,$55.80 ,$35.65 ,$62.00 ,$13.64 ,$62.00 ,$33.73 ,$13.64 ,$25.79 ,$11.89 ,$11.35 ,$14.32 ,$52.70 ,$42.59 ,$17.36 ,$55.80 ,$52.08 ,$49.60 ,$49.60 ,$13.64 ,$40.30 
ST. FRANCIS HOSPITAL - ACUTE,30200868,86157,HC COLD AGGLUTININ TITER-90,302,1 ,$73.00 ,$47.45 ,$10.16 ,$73.00 ,$41.98 ,$52.56 ,$39.71 ,$16.06 ,$20.44 ,$42.92 ,$16.06 ,$50.15 ,$18.25 ,$50.15 ,$50.15 ,$18.25 ,$50.15 ,$30.51 ,$61.32 ,$20.15 ,$16.06 ,$62.05 ,$61.32 ,$16.06 ,$54.75 ,$58.40 ,$58.40 ,$16.06 ,$58.40 ,$61.32 ,$61.32 ,$61.32 ,$73.00 ,$65.70 ,$41.98 ,$73.00 ,$16.06 ,$73.00 ,$39.71 ,$16.06 ,$30.37 ,$10.65 ,$10.16 ,$16.86 ,$62.05 ,$50.15 ,$20.44 ,$65.70 ,$61.32 ,$58.40 ,$58.40 ,$16.06 ,$47.45 
ST. FRANCIS HOSPITAL - ACUTE,30200869,86160,HC COMPLEMENT AG EA-90,302,1 ,$50.00 ,$32.50 ,$10.16 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$30.00 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$10.65 ,$10.16 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30200871,86162,HC COMPLEMENT TOTAL-90,302,1 ,$292.00 ,$189.80 ,$10.16 ,$292.00 ,$167.90 ,$210.24 ,$158.85 ,$64.24 ,$81.76 ,$171.70 ,$64.24 ,$200.60 ,$73.00 ,$200.60 ,$200.60 ,$73.00 ,$200.60 ,$122.06 ,$245.28 ,$50.80 ,$64.24 ,$248.20 ,$245.28 ,$64.24 ,$219.00 ,$233.60 ,$233.60 ,$64.24 ,$233.60 ,$245.28 ,$245.28 ,$245.28 ,$292.00 ,$262.80 ,$167.90 ,$292.00 ,$64.24 ,$292.00 ,$158.85 ,$64.24 ,$121.47 ,$10.65 ,$10.16 ,$67.45 ,$248.20 ,$200.60 ,$81.76 ,$262.80 ,$245.28 ,$233.60 ,$233.60 ,$64.24 ,$189.80 
ST. FRANCIS HOSPITAL - ACUTE,30200873,86200,HC CCP AB-90,302,1 ,$155.00 ,$100.75 ,$10.16 ,$155.00 ,$89.13 ,$111.60 ,$84.32 ,$34.10 ,$43.40 ,$91.14 ,$34.10 ,$106.49 ,$38.75 ,$106.49 ,$106.49 ,$38.75 ,$106.49 ,$64.79 ,$130.20 ,$32.38 ,$34.10 ,$131.75 ,$130.20 ,$34.10 ,$116.25 ,$124.00 ,$124.00 ,$34.10 ,$124.00 ,$130.20 ,$130.20 ,$130.20 ,$155.00 ,$139.50 ,$89.13 ,$155.00 ,$34.10 ,$155.00 ,$84.32 ,$34.10 ,$64.48 ,$10.65 ,$10.16 ,$35.81 ,$131.75 ,$106.49 ,$43.40 ,$139.50 ,$130.20 ,$124.00 ,$124.00 ,$34.10 ,$100.75 
ST. FRANCIS HOSPITAL - ACUTE,30200878,86255,HC FLUOR AB SCR-90,302,1 ,$205.00 ,$133.25 ,$17.51 ,$205.00 ,$117.88 ,$147.60 ,$111.52 ,$45.10 ,$57.40 ,$110.33 ,$45.10 ,$140.51 ,$51.25 ,$140.51 ,$140.51 ,$51.25 ,$140.51 ,$85.69 ,$172.20 ,$30.13 ,$45.10 ,$174.25 ,$172.20 ,$45.10 ,$153.75 ,$164.00 ,$164.00 ,$45.10 ,$164.00 ,$172.20 ,$172.20 ,$172.20 ,$205.00 ,$184.50 ,$117.88 ,$205.00 ,$45.10 ,$205.00 ,$111.52 ,$45.10 ,$85.28 ,$18.35 ,$17.51 ,$47.36 ,$174.25 ,$140.51 ,$57.40 ,$184.50 ,$172.20 ,$164.00 ,$164.00 ,$45.10 ,$133.25 
ST. FRANCIS HOSPITAL - ACUTE,30200879,86256,HC FLUOR AB TITER-90,302,1 ,$262.00 ,$170.30 ,$17.51 ,$262.00 ,$150.65 ,$188.64 ,$142.53 ,$57.64 ,$73.36 ,$110.33 ,$57.64 ,$140.51 ,$65.50 ,$140.51 ,$140.51 ,$65.50 ,$140.51 ,$109.52 ,$220.08 ,$30.13 ,$57.64 ,$222.70 ,$220.08 ,$57.64 ,$196.50 ,$209.60 ,$209.60 ,$57.64 ,$209.60 ,$220.08 ,$220.08 ,$220.08 ,$262.00 ,$235.80 ,$150.65 ,$262.00 ,$57.64 ,$262.00 ,$142.53 ,$57.64 ,$108.99 ,$18.35 ,$17.51 ,$60.52 ,$222.70 ,$140.51 ,$73.36 ,$235.80 ,$220.08 ,$209.60 ,$209.60 ,$57.64 ,$170.30 
ST. FRANCIS HOSPITAL - ACUTE,30200880,86300,HC TUMOR AG CA 15-3 (27.29)-90,302,1 ,$271.00 ,$176.15 ,$26.93 ,$271.00 ,$155.83 ,$195.12 ,$147.42 ,$59.62 ,$75.88 ,$159.35 ,$59.62 ,$186.18 ,$67.75 ,$186.18 ,$186.18 ,$67.75 ,$186.18 ,$113.28 ,$227.64 ,$52.03 ,$59.62 ,$230.35 ,$227.64 ,$59.62 ,$203.25 ,$216.80 ,$216.80 ,$59.62 ,$216.80 ,$227.64 ,$227.64 ,$227.64 ,$271.00 ,$243.90 ,$155.83 ,$271.00 ,$59.62 ,$271.00 ,$147.42 ,$59.62 ,$112.74 ,$28.22 ,$26.93 ,$62.60 ,$230.35 ,$186.18 ,$75.88 ,$243.90 ,$227.64 ,$216.80 ,$216.80 ,$59.62 ,$176.15 
ST. FRANCIS HOSPITAL - ACUTE,30200881,86301,HC TUMOR AG CA 19-9  -90,302,1 ,$334.00 ,$217.10 ,$26.93 ,$334.00 ,$192.05 ,$240.48 ,$181.70 ,$73.48 ,$93.52 ,$190.66 ,$73.48 ,$229.46 ,$83.50 ,$229.46 ,$229.46 ,$83.50 ,$229.46 ,$139.61 ,$280.56 ,$52.03 ,$73.48 ,$283.90 ,$280.56 ,$73.48 ,$250.50 ,$267.20 ,$267.20 ,$73.48 ,$267.20 ,$280.56 ,$280.56 ,$280.56 ,$334.00 ,$300.60 ,$192.05 ,$334.00 ,$73.48 ,$334.00 ,$181.70 ,$73.48 ,$138.94 ,$28.22 ,$26.93 ,$77.15 ,$283.90 ,$229.46 ,$93.52 ,$300.60 ,$280.56 ,$267.20 ,$267.20 ,$73.48 ,$217.10 
ST. FRANCIS HOSPITAL - ACUTE,30200883,86305,HC HE4 OVARIAN CANCER-90,302,1 ,$500.00 ,$325.00 ,$26.93 ,$500.00 ,$287.50 ,$360.00 ,$272.00 ,$110.00 ,$140.00 ,$190.66 ,$110.00 ,$242.80 ,$125.00 ,$242.80 ,$242.80 ,$125.00 ,$242.80 ,$209.00 ,$420.00 ,$52.03 ,$110.00 ,$425.00 ,$420.00 ,$110.00 ,$375.00 ,$400.00 ,$400.00 ,$110.00 ,$400.00 ,$420.00 ,$420.00 ,$420.00 ,$500.00 ,$450.00 ,$287.50 ,$500.00 ,$110.00 ,$500.00 ,$272.00 ,$110.00 ,$208.00 ,$28.22 ,$26.93 ,$115.50 ,$425.00 ,$242.80 ,$140.00 ,$450.00 ,$420.00 ,$400.00 ,$400.00 ,$110.00 ,$325.00 
ST. FRANCIS HOSPITAL - ACUTE,30200887,86635,HC COCCIDIOIDES AB-90,302,1 ,$25.00 ,$16.25 ,$5.50 ,$28.68 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$28.68 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$18.35 ,$17.51 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30200888,86638,HC Q FEVER AB-90,302,1 ,$59.00 ,$38.35 ,$12.98 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$30.30 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$18.35 ,$17.51 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30200890,86644,HC CMV AB-90,302,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$35.98 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$18.35 ,$17.51 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30200892,86648,HC DIPTHERIA-90,302,1 ,$60.00 ,$39.00 ,$13.20 ,$60.00 ,$34.50 ,$43.20 ,$32.64 ,$13.20 ,$16.80 ,$35.28 ,$13.20 ,$41.22 ,$15.00 ,$41.22 ,$41.22 ,$15.00 ,$41.22 ,$25.08 ,$50.40 ,$38.03 ,$13.20 ,$51.00 ,$50.40 ,$13.20 ,$45.00 ,$48.00 ,$48.00 ,$13.20 ,$48.00 ,$50.40 ,$50.40 ,$50.40 ,$60.00 ,$54.00 ,$34.50 ,$60.00 ,$13.20 ,$60.00 ,$32.64 ,$13.20 ,$24.96 ,$18.35 ,$17.51 ,$13.86 ,$51.00 ,$41.22 ,$16.80 ,$54.00 ,$50.40 ,$48.00 ,$48.00 ,$13.20 ,$39.00 
ST. FRANCIS HOSPITAL - ACUTE,30200897,86658,HC ENTEROVIRUS AB-90,302,1 ,$81.00 ,$52.65 ,$17.51 ,$81.00 ,$46.58 ,$58.32 ,$44.06 ,$17.82 ,$22.68 ,$47.63 ,$17.82 ,$55.65 ,$20.25 ,$55.65 ,$55.65 ,$20.25 ,$55.65 ,$33.86 ,$68.04 ,$32.58 ,$17.82 ,$68.85 ,$68.04 ,$17.82 ,$60.75 ,$64.80 ,$64.80 ,$17.82 ,$64.80 ,$68.04 ,$68.04 ,$68.04 ,$81.00 ,$72.90 ,$46.58 ,$81.00 ,$17.82 ,$81.00 ,$44.06 ,$17.82 ,$33.70 ,$18.35 ,$17.51 ,$18.71 ,$68.85 ,$55.65 ,$22.68 ,$72.90 ,$68.04 ,$64.80 ,$64.80 ,$17.82 ,$52.65 
ST. FRANCIS HOSPITAL - ACUTE,30200899,86664,HC EBV NUCLEAR AG-90,302,1 ,$93.00 ,$60.45 ,$17.51 ,$93.00 ,$53.48 ,$66.96 ,$50.59 ,$20.46 ,$26.04 ,$54.68 ,$20.46 ,$63.89 ,$23.25 ,$63.89 ,$63.89 ,$23.25 ,$63.89 ,$38.87 ,$78.12 ,$38.23 ,$20.46 ,$79.05 ,$78.12 ,$20.46 ,$69.75 ,$74.40 ,$74.40 ,$20.46 ,$74.40 ,$78.12 ,$78.12 ,$78.12 ,$93.00 ,$83.70 ,$53.48 ,$93.00 ,$20.46 ,$93.00 ,$50.59 ,$20.46 ,$38.69 ,$18.35 ,$17.51 ,$21.48 ,$79.05 ,$63.89 ,$26.04 ,$83.70 ,$78.12 ,$74.40 ,$74.40 ,$20.46 ,$60.45 
ST. FRANCIS HOSPITAL - ACUTE,30200900,86665,HC EBV VIRAL CAP-90,302,1 ,$93.00 ,$60.45 ,$17.51 ,$93.00 ,$53.48 ,$66.96 ,$50.59 ,$20.46 ,$26.04 ,$54.68 ,$20.46 ,$63.89 ,$23.25 ,$63.89 ,$63.89 ,$23.25 ,$63.89 ,$38.87 ,$78.12 ,$45.35 ,$20.46 ,$79.05 ,$78.12 ,$20.46 ,$69.75 ,$74.40 ,$74.40 ,$20.46 ,$74.40 ,$78.12 ,$78.12 ,$78.12 ,$93.00 ,$83.70 ,$53.48 ,$93.00 ,$20.46 ,$93.00 ,$50.59 ,$20.46 ,$38.69 ,$18.35 ,$17.51 ,$21.48 ,$79.05 ,$63.89 ,$26.04 ,$83.70 ,$78.12 ,$74.40 ,$74.40 ,$20.46 ,$60.45 
ST. FRANCIS HOSPITAL - ACUTE,30200901,86666,HC EHRLICHIA AB-90,302,1 ,$45.00 ,$29.25 ,$9.90 ,$45.00 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$25.45 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$18.35 ,$17.51 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30200903,86671,HC FUNGUS AB NOS-90,302,1 ,$199.00 ,$129.35 ,$10.16 ,$199.00 ,$114.43 ,$143.28 ,$108.26 ,$43.78 ,$55.72 ,$112.16 ,$43.78 ,$136.71 ,$49.75 ,$136.71 ,$136.71 ,$49.75 ,$136.71 ,$83.18 ,$167.16 ,$30.63 ,$43.78 ,$169.15 ,$167.16 ,$43.78 ,$149.25 ,$159.20 ,$159.20 ,$43.78 ,$159.20 ,$167.16 ,$167.16 ,$167.16 ,$199.00 ,$179.10 ,$114.43 ,$199.00 ,$43.78 ,$199.00 ,$108.26 ,$43.78 ,$82.78 ,$10.65 ,$10.16 ,$45.97 ,$169.15 ,$136.71 ,$55.72 ,$179.10 ,$167.16 ,$159.20 ,$159.20 ,$43.78 ,$129.35 
ST. FRANCIS HOSPITAL - ACUTE,30200912,86695,HC HERPES SIMPLEX AB I-90,302,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$32.98 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$18.35 ,$17.51 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30200913,86696,HC HERPES SIMPLEX AB II-90,302,1 ,$50.00 ,$32.50 ,$10.16 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$48.38 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$10.65 ,$10.16 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30200914,86698,HC HISTOPLASMA AB-90,302,1 ,$108.00 ,$70.20 ,$17.51 ,$108.00 ,$62.10 ,$77.76 ,$58.75 ,$23.76 ,$30.24 ,$63.50 ,$23.76 ,$74.20 ,$27.00 ,$74.20 ,$74.20 ,$27.00 ,$74.20 ,$45.14 ,$90.72 ,$34.48 ,$23.76 ,$91.80 ,$90.72 ,$23.76 ,$81.00 ,$86.40 ,$86.40 ,$23.76 ,$86.40 ,$90.72 ,$90.72 ,$90.72 ,$108.00 ,$97.20 ,$62.10 ,$108.00 ,$23.76 ,$108.00 ,$58.75 ,$23.76 ,$44.93 ,$18.35 ,$17.51 ,$24.95 ,$91.80 ,$74.20 ,$30.24 ,$97.20 ,$90.72 ,$86.40 ,$86.40 ,$23.76 ,$70.20 
ST. FRANCIS HOSPITAL - ACUTE,30200923,86707,HC HEP B E AB-90,302,1 ,$50.00 ,$32.50 ,$10.16 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$28.93 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$10.65 ,$10.16 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30200924,86708,HC HEP A AB TOTAL-90,302,1 ,$106.00 ,$68.90 ,$10.16 ,$106.00 ,$60.95 ,$76.32 ,$57.66 ,$23.32 ,$29.68 ,$62.33 ,$23.32 ,$72.82 ,$26.50 ,$72.82 ,$72.82 ,$26.50 ,$72.82 ,$44.31 ,$89.04 ,$30.98 ,$23.32 ,$90.10 ,$89.04 ,$23.32 ,$79.50 ,$84.80 ,$84.80 ,$23.32 ,$84.80 ,$89.04 ,$89.04 ,$89.04 ,$106.00 ,$95.40 ,$60.95 ,$106.00 ,$23.32 ,$106.00 ,$57.66 ,$23.32 ,$44.10 ,$10.65 ,$10.16 ,$24.49 ,$90.10 ,$72.82 ,$29.68 ,$95.40 ,$89.04 ,$84.80 ,$84.80 ,$23.32 ,$68.90 
ST. FRANCIS HOSPITAL - ACUTE,30200925,86709,HC HEP A AB IGM-90,302,1 ,$100.00 ,$65.00 ,$10.16 ,$100.00 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$58.80 ,$22.00 ,$68.70 ,$25.00 ,$68.70 ,$68.70 ,$25.00 ,$68.70 ,$41.80 ,$84.00 ,$28.15 ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 ,$10.65 ,$10.16 ,$23.10 ,$85.00 ,$68.70 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,30200926,86710,HC INFLUENZA AB-90,302,1 ,$46.00 ,$29.90 ,$10.12 ,$46.00 ,$26.45 ,$33.12 ,$25.02 ,$10.12 ,$12.88 ,$27.05 ,$10.12 ,$31.60 ,$11.50 ,$31.60 ,$31.60 ,$11.50 ,$31.60 ,$19.23 ,$38.64 ,$33.88 ,$10.12 ,$39.10 ,$38.64 ,$10.12 ,$34.50 ,$36.80 ,$36.80 ,$10.12 ,$36.80 ,$38.64 ,$38.64 ,$38.64 ,$46.00 ,$41.40 ,$26.45 ,$46.00 ,$10.12 ,$46.00 ,$25.02 ,$10.12 ,$19.14 ,$10.65 ,$10.16 ,$10.63 ,$39.10 ,$31.60 ,$12.88 ,$41.40 ,$38.64 ,$36.80 ,$36.80 ,$10.12 ,$29.90 
ST. FRANCIS HOSPITAL - ACUTE,30200932,86738,HC MYCOPLASMA AB-90,302,1 ,$25.00 ,$16.25 ,$5.50 ,$33.10 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$33.10 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$18.35 ,$17.51 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30200935,86747,HC PARVOVIRUS AB-90,302,1 ,$25.00 ,$16.25 ,$5.50 ,$37.58 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$37.58 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$18.35 ,$17.51 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30200943,86774,HC TETANUS AB-90,302,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$37.00 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$18.35 ,$17.51 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30200944,86777,HC TOXOPLASMA AB-90,302,1 ,$112.00 ,$72.80 ,$17.51 ,$112.00 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$65.86 ,$24.64 ,$76.94 ,$28.00 ,$76.94 ,$76.94 ,$28.00 ,$76.94 ,$46.82 ,$94.08 ,$35.98 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$18.35 ,$17.51 ,$25.87 ,$95.20 ,$76.94 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30200945,86778,HC TOXOPLASMA AB IGM-90,302,1 ,$112.00 ,$72.80 ,$17.51 ,$112.00 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$65.86 ,$24.64 ,$76.94 ,$28.00 ,$76.94 ,$76.94 ,$28.00 ,$76.94 ,$46.82 ,$94.08 ,$36.03 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$18.35 ,$17.51 ,$25.87 ,$95.20 ,$76.94 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30200946,86780,HC TREPONEMA P AB CONFIRM-90,302,1 ,$73.00 ,$47.45 ,$16.06 ,$73.00 ,$41.98 ,$52.56 ,$39.71 ,$16.06 ,$20.44 ,$42.92 ,$16.06 ,$50.15 ,$18.25 ,$50.15 ,$50.15 ,$18.25 ,$50.15 ,$30.51 ,$61.32 ,$33.10 ,$16.06 ,$62.05 ,$61.32 ,$16.06 ,$54.75 ,$58.40 ,$58.40 ,$16.06 ,$58.40 ,$61.32 ,$61.32 ,$61.32 ,$73.00 ,$65.70 ,$41.98 ,$73.00 ,$16.06 ,$73.00 ,$39.71 ,$16.06 ,$30.37 ,$18.35 ,$17.51 ,$16.86 ,$62.05 ,$50.15 ,$20.44 ,$65.70 ,$61.32 ,$58.40 ,$58.40 ,$16.06 ,$47.45 
ST. FRANCIS HOSPITAL - ACUTE,30200948,86787,HC VARICELLA ZOSTER AB-90,302,1 ,$50.00 ,$32.50 ,$10.16 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$32.20 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$10.65 ,$10.16 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30200949,86788,HC WEST NILE VIRUS AB IGM-90,302,1 ,$43.00 ,$27.95 ,$9.46 ,$43.00 ,$24.73 ,$30.96 ,$23.39 ,$9.46 ,$12.04 ,$25.28 ,$9.46 ,$29.54 ,$10.75 ,$29.54 ,$29.54 ,$10.75 ,$29.54 ,$17.97 ,$36.12 ,$42.13 ,$9.46 ,$36.55 ,$36.12 ,$9.46 ,$32.25 ,$34.40 ,$34.40 ,$9.46 ,$34.40 ,$36.12 ,$36.12 ,$36.12 ,$43.00 ,$38.70 ,$24.73 ,$43.00 ,$9.46 ,$43.00 ,$23.39 ,$9.46 ,$17.89 ,$18.35 ,$17.51 ,$9.93 ,$36.55 ,$29.54 ,$12.04 ,$38.70 ,$36.12 ,$34.40 ,$34.40 ,$9.46 ,$27.95 
ST. FRANCIS HOSPITAL - ACUTE,30200950,86789,HC WEST NILE AB-90,302,1 ,$43.00 ,$27.95 ,$9.46 ,$43.00 ,$24.73 ,$30.96 ,$23.39 ,$9.46 ,$12.04 ,$25.28 ,$9.46 ,$29.54 ,$10.75 ,$29.54 ,$29.54 ,$10.75 ,$29.54 ,$17.97 ,$36.12 ,$35.98 ,$9.46 ,$36.55 ,$36.12 ,$9.46 ,$32.25 ,$34.40 ,$34.40 ,$9.46 ,$34.40 ,$36.12 ,$36.12 ,$36.12 ,$43.00 ,$38.70 ,$24.73 ,$43.00 ,$9.46 ,$43.00 ,$23.39 ,$9.46 ,$17.89 ,$18.35 ,$17.51 ,$9.93 ,$36.55 ,$29.54 ,$12.04 ,$38.70 ,$36.12 ,$34.40 ,$34.40 ,$9.46 ,$27.95 
ST. FRANCIS HOSPITAL - ACUTE,30200953,86800,HC THYROGLOBULIN AB-90,302,1 ,$25.00 ,$16.25 ,$5.50 ,$39.78 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$39.78 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$27.82 ,$26.55 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30200960,86812,HC HLA TYPING SINGLE A/B/C-90,302,1 ,$308.00 ,$200.20 ,$41.02 ,$308.00 ,$177.10 ,$221.76 ,$167.55 ,$67.76 ,$86.24 ,$181.10 ,$67.76 ,$211.60 ,$77.00 ,$211.60 ,$211.60 ,$77.00 ,$211.60 ,$128.74 ,$258.72 ,$64.53 ,$67.76 ,$261.80 ,$258.72 ,$67.76 ,$231.00 ,$246.40 ,$246.40 ,$67.76 ,$246.40 ,$258.72 ,$258.72 ,$258.72 ,$308.00 ,$277.20 ,$177.10 ,$308.00 ,$67.76 ,$308.00 ,$167.55 ,$67.76 ,$128.13 ,$42.98 ,$41.02 ,$71.15 ,$261.80 ,$211.60 ,$86.24 ,$277.20 ,$258.72 ,$246.40 ,$246.40 ,$67.76 ,$200.20 
ST. FRANCIS HOSPITAL - ACUTE,30200966,86850,HC AB SCREEN-90,302,1 ,$99.00 ,$64.35 ,$10.16 ,$126.88 ,$56.93 ,$71.28 ,$53.86 ,$21.78 ,$27.72 ,$58.21 ,$21.78 ,$68.01 ,$24.75 ,$68.01 ,$68.01 ,$24.75 ,$68.01 ,$41.38 ,$83.16 ,$126.88 ,$21.78 ,$84.15 ,$83.16 ,$21.78 ,$74.25 ,$79.20 ,$79.20 ,$21.78 ,$79.20 ,$83.16 ,$83.16 ,$83.16 ,$99.00 ,$89.10 ,$56.93 ,$99.00 ,$21.78 ,$99.00 ,$53.86 ,$21.78 ,$41.18 ,$10.65 ,$10.16 ,$22.87 ,$84.15 ,$68.01 ,$27.72 ,$89.10 ,$83.16 ,$79.20 ,$79.20 ,$21.78 ,$64.35 
ST. FRANCIS HOSPITAL - ACUTE,30200970,86860,HC ELUTION-90,302,1 ,$224.00 ,$145.60 ,$10.16 ,$380.80 ,$128.80 ,$161.28 ,$121.86 ,$49.28 ,$62.72 ,$131.71 ,$49.28 ,$153.89 ,$56.00 ,$153.89 ,$153.89 ,$56.00 ,$153.89 ,$93.63 ,$188.16 ,$380.80 ,$49.28 ,$190.40 ,$188.16 ,$49.28 ,$168.00 ,$179.20 ,$179.20 ,$49.28 ,$179.20 ,$188.16 ,$188.16 ,$188.16 ,$224.00 ,$201.60 ,$128.80 ,$224.00 ,$49.28 ,$224.00 ,$121.86 ,$49.28 ,$93.18 ,$10.65 ,$10.16 ,$51.74 ,$190.40 ,$153.89 ,$62.72 ,$201.60 ,$188.16 ,$179.20 ,$179.20 ,$49.28 ,$145.60 
ST. FRANCIS HOSPITAL - ACUTE,30200974,86870,HC RBC AB ID PANEL-90,302,1 ,$175.00 ,$113.75 ,$10.16 ,$743.63 ,$100.63 ,$126.00 ,$95.20 ,$38.50 ,$49.00 ,$102.90 ,$38.50 ,$120.23 ,$43.75 ,$120.23 ,$120.23 ,$43.75 ,$120.23 ,$73.15 ,$147.00 ,$743.63 ,$38.50 ,$148.75 ,$147.00 ,$38.50 ,$131.25 ,$140.00 ,$140.00 ,$38.50 ,$140.00 ,$147.00 ,$147.00 ,$147.00 ,$175.00 ,$157.50 ,$100.63 ,$175.00 ,$38.50 ,$175.00 ,$95.20 ,$38.50 ,$72.80 ,$10.65 ,$10.16 ,$40.43 ,$148.75 ,$120.23 ,$49.00 ,$157.50 ,$147.00 ,$140.00 ,$140.00 ,$38.50 ,$113.75 
ST. FRANCIS HOSPITAL - ACUTE,30200976,86880,HC COOMBS DIRECT-90,302,1 ,$131.00 ,$85.15 ,$10.16 ,$142.13 ,$75.33 ,$94.32 ,$71.26 ,$28.82 ,$36.68 ,$49.29 ,$28.82 ,$62.77 ,$32.75 ,$62.77 ,$62.77 ,$32.75 ,$62.77 ,$54.76 ,$110.04 ,$142.13 ,$28.82 ,$111.35 ,$110.04 ,$28.82 ,$98.25 ,$104.80 ,$104.80 ,$28.82 ,$104.80 ,$110.04 ,$110.04 ,$110.04 ,$131.00 ,$117.90 ,$75.33 ,$131.00 ,$28.82 ,$131.00 ,$71.26 ,$28.82 ,$54.50 ,$10.65 ,$10.16 ,$30.26 ,$111.35 ,$62.77 ,$36.68 ,$117.90 ,$110.04 ,$104.80 ,$104.80 ,$28.82 ,$85.15 
ST. FRANCIS HOSPITAL - ACUTE,30200978,86886,HC INDIRECT TITER-90,302,1 ,$162.00 ,$105.30 ,$10.16 ,$380.80 ,$93.15 ,$116.64 ,$88.13 ,$35.64 ,$45.36 ,$47.35 ,$35.64 ,$60.30 ,$40.50 ,$60.30 ,$60.30 ,$40.50 ,$60.30 ,$67.72 ,$136.08 ,$380.80 ,$35.64 ,$137.70 ,$136.08 ,$35.64 ,$121.50 ,$129.60 ,$129.60 ,$35.64 ,$129.60 ,$136.08 ,$136.08 ,$136.08 ,$162.00 ,$145.80 ,$93.15 ,$162.00 ,$35.64 ,$162.00 ,$88.13 ,$35.64 ,$67.39 ,$10.65 ,$10.16 ,$37.42 ,$137.70 ,$60.30 ,$45.36 ,$145.80 ,$136.08 ,$129.60 ,$129.60 ,$35.64 ,$105.30 
ST. FRANCIS HOSPITAL - ACUTE,30200981,86900,HC BLOOD TYPING ABO-90,302,1 ,$69.00 ,$44.85 ,$6.30 ,$287.90 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$27.38 ,$15.18 ,$34.87 ,$17.25 ,$34.87 ,$34.87 ,$17.25 ,$34.87 ,$28.84 ,$57.96 ,$287.90 ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 ,$6.60 ,$6.30 ,$15.94 ,$58.65 ,$34.87 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,30200983,86901,HC BLOOD TYPING RH-90,302,1 ,$99.00 ,$64.35 ,$6.30 ,$99.00 ,$56.93 ,$71.28 ,$53.86 ,$21.78 ,$27.72 ,$27.38 ,$21.78 ,$34.87 ,$24.75 ,$34.87 ,$34.87 ,$24.75 ,$34.87 ,$41.38 ,$83.16 ,$86.43 ,$21.78 ,$84.15 ,$83.16 ,$21.78 ,$74.25 ,$79.20 ,$79.20 ,$21.78 ,$79.20 ,$83.16 ,$83.16 ,$83.16 ,$99.00 ,$89.10 ,$56.93 ,$99.00 ,$21.78 ,$99.00 ,$53.86 ,$21.78 ,$41.18 ,$6.60 ,$6.30 ,$22.87 ,$84.15 ,$34.87 ,$27.72 ,$89.10 ,$83.16 ,$79.20 ,$79.20 ,$21.78 ,$64.35 
ST. FRANCIS HOSPITAL - ACUTE,30200998,86906,HC RH PHENOTYPE COMPLETE-90,302,1 ,$112.00 ,$72.80 ,$6.30 ,$112.00 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$65.86 ,$24.64 ,$76.94 ,$28.00 ,$76.94 ,$76.94 ,$28.00 ,$76.94 ,$46.82 ,$94.08 ,$86.43 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$6.60 ,$6.30 ,$25.87 ,$95.20 ,$76.94 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30201001,86940,HC HEOLYSIN AGG AUTO SCREEN-90,302,1 ,$114.00 ,$74.10 ,$17.51 ,$114.00 ,$65.55 ,$82.08 ,$62.02 ,$25.08 ,$31.92 ,$67.03 ,$25.08 ,$78.32 ,$28.50 ,$78.32 ,$78.32 ,$28.50 ,$78.32 ,$47.65 ,$95.76 ,$21.93 ,$25.08 ,$96.90 ,$95.76 ,$25.08 ,$85.50 ,$91.20 ,$91.20 ,$25.08 ,$91.20 ,$95.76 ,$95.76 ,$95.76 ,$114.00 ,$102.60 ,$65.55 ,$114.00 ,$25.08 ,$114.00 ,$62.02 ,$25.08 ,$47.42 ,$18.35 ,$17.51 ,$26.33 ,$96.90 ,$78.32 ,$31.92 ,$102.60 ,$95.76 ,$91.20 ,$91.20 ,$25.08 ,$74.10 
ST. FRANCIS HOSPITAL - ACUTE,30201003,86970,HC RBC PRETREAT CHEM-90,302,1 ,$137.00 ,$89.05 ,$30.14 ,$137.00 ,$78.78 ,$98.64 ,$74.53 ,$30.14 ,$38.36 ,$80.56 ,$30.14 ,$94.12 ,$34.25 ,$94.12 ,$94.12 ,$34.25 ,$94.12 ,$57.27 ,$115.08 ,$86.43 ,$30.14 ,$116.45 ,$115.08 ,$30.14 ,$102.75 ,$109.60 ,$109.60 ,$30.14 ,$109.60 ,$115.08 ,$115.08 ,$115.08 ,$137.00 ,$123.30 ,$78.78 ,$137.00 ,$30.14 ,$137.00 ,$74.53 ,$30.14 ,$56.99 ,$42.98 ,$41.02 ,$31.65 ,$116.45 ,$94.12 ,$38.36 ,$123.30 ,$115.08 ,$109.60 ,$109.60 ,$30.14 ,$89.05 
ST. FRANCIS HOSPITAL - ACUTE,30201005,86971,HC RBC PRETREAT ENZYME-90,302,1 ,$61.00 ,$39.65 ,$13.42 ,$743.63 ,$35.08 ,$43.92 ,$33.18 ,$13.42 ,$17.08 ,$35.87 ,$13.42 ,$41.91 ,$15.25 ,$41.91 ,$41.91 ,$15.25 ,$41.91 ,$25.50 ,$51.24 ,$743.63 ,$13.42 ,$51.85 ,$51.24 ,$13.42 ,$45.75 ,$48.80 ,$48.80 ,$13.42 ,$48.80 ,$51.24 ,$51.24 ,$51.24 ,$61.00 ,$54.90 ,$35.08 ,$61.00 ,$13.42 ,$61.00 ,$33.18 ,$13.42 ,$25.38 ,$42.98 ,$41.02 ,$14.09 ,$51.85 ,$41.91 ,$17.08 ,$54.90 ,$51.24 ,$48.80 ,$48.80 ,$13.42 ,$39.65 
ST. FRANCIS HOSPITAL - ACUTE,30201007,86972,HC RBC PRETREAT DENSITY SEP-90,302,1 ,$144.00 ,$93.60 ,$31.68 ,$380.80 ,$82.80 ,$103.68 ,$78.34 ,$31.68 ,$40.32 ,$84.67 ,$31.68 ,$98.93 ,$36.00 ,$98.93 ,$98.93 ,$36.00 ,$98.93 ,$60.19 ,$120.96 ,$380.80 ,$31.68 ,$122.40 ,$120.96 ,$31.68 ,$108.00 ,$115.20 ,$115.20 ,$31.68 ,$115.20 ,$120.96 ,$120.96 ,$120.96 ,$144.00 ,$129.60 ,$82.80 ,$144.00 ,$31.68 ,$144.00 ,$78.34 ,$31.68 ,$59.90 ,$42.98 ,$41.02 ,$33.26 ,$122.40 ,$98.93 ,$40.32 ,$129.60 ,$120.96 ,$115.20 ,$115.20 ,$31.68 ,$93.60 
ST. FRANCIS HOSPITAL - ACUTE,30201016,86977,HC RBC PRETREAT NEUTRAL SERUM INHIBIT-90,302,1 ,$137.00 ,$89.05 ,$30.14 ,$380.80 ,$78.78 ,$98.64 ,$74.53 ,$30.14 ,$38.36 ,$80.56 ,$30.14 ,$94.12 ,$34.25 ,$94.12 ,$94.12 ,$34.25 ,$94.12 ,$57.27 ,$115.08 ,$380.80 ,$30.14 ,$116.45 ,$115.08 ,$30.14 ,$102.75 ,$109.60 ,$109.60 ,$30.14 ,$109.60 ,$115.08 ,$115.08 ,$115.08 ,$137.00 ,$123.30 ,$78.78 ,$137.00 ,$30.14 ,$137.00 ,$74.53 ,$30.14 ,$56.99 ,$42.98 ,$41.02 ,$31.65 ,$116.45 ,$94.12 ,$38.36 ,$123.30 ,$115.08 ,$109.60 ,$109.60 ,$30.14 ,$89.05 
ST. FRANCIS HOSPITAL - ACUTE,30201020,86978,HC RBC PRETREAT ABSOR-90,302,1 ,$112.00 ,$72.80 ,$6.30 ,$112.00 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$65.86 ,$24.64 ,$76.94 ,$28.00 ,$76.94 ,$76.94 ,$28.00 ,$76.94 ,$46.82 ,$94.08 ,$86.43 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$6.60 ,$6.30 ,$25.87 ,$95.20 ,$76.94 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30201022,87801,HC INFECT MLT  ORG AMP-90,302,1 ,$274.00 ,$178.10 ,$8.11 ,$274.00 ,$157.55 ,$197.28 ,$149.06 ,$60.28 ,$76.72 ,$161.11 ,$60.28 ,$188.24 ,$68.50 ,$188.24 ,$188.24 ,$68.50 ,$188.24 ,$114.53 ,$230.16 ,$175.50 ,$60.28 ,$232.90 ,$230.16 ,$60.28 ,$205.50 ,$219.20 ,$219.20 ,$60.28 ,$219.20 ,$230.16 ,$230.16 ,$230.16 ,$274.00 ,$246.60 ,$157.55 ,$274.00 ,$60.28 ,$274.00 ,$149.06 ,$60.28 ,$113.98 ,$8.49 ,$8.11 ,$63.29 ,$232.90 ,$188.24 ,$76.72 ,$246.60 ,$230.16 ,$219.20 ,$219.20 ,$60.28 ,$178.10 
ST. FRANCIS HOSPITAL - ACUTE,30201025,86316,HC TUMOR AG OTHER AG QN-90,302,1 ,$50.00 ,$32.50 ,$11.00 ,$52.03 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$52.03 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$11.89 ,$11.35 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30201026,86317,HC INFECTIOUS AB QN-90,302,1 ,$8.00 ,$5.20 ,$1.76 ,$20.00 ,$4.60 ,$5.76 ,$4.35 ,$1.76 ,$2.24 ,$4.70 ,$1.76 ,$5.50 ,$2.00 ,$5.50 ,$5.50 ,$2.00 ,$5.50 ,$3.34 ,$6.72 ,$20.00 ,$1.76 ,$6.80 ,$6.72 ,$1.76 ,$6.00 ,$6.40 ,$6.40 ,$1.76 ,$6.40 ,$6.72 ,$6.72 ,$6.72 ,$8.00 ,$7.20 ,$4.60 ,$8.00 ,$1.76 ,$8.00 ,$4.35 ,$1.76 ,$3.33 ,$18.35 ,$17.51 ,$1.85 ,$6.80 ,$5.50 ,$2.24 ,$7.20 ,$6.72 ,$6.40 ,$6.40 ,$1.76 ,$5.20 
ST. FRANCIS HOSPITAL - ACUTE,30201028,86329,HC IMMUNODIFFUSION NOS-90,302,1 ,$110.00 ,$71.50 ,$17.51 ,$110.00 ,$63.25 ,$79.20 ,$59.84 ,$24.20 ,$30.80 ,$64.68 ,$24.20 ,$75.57 ,$27.50 ,$75.57 ,$75.57 ,$27.50 ,$75.57 ,$45.98 ,$92.40 ,$35.13 ,$24.20 ,$93.50 ,$92.40 ,$24.20 ,$82.50 ,$88.00 ,$88.00 ,$24.20 ,$88.00 ,$92.40 ,$92.40 ,$92.40 ,$110.00 ,$99.00 ,$63.25 ,$110.00 ,$24.20 ,$110.00 ,$59.84 ,$24.20 ,$45.76 ,$18.35 ,$17.51 ,$25.41 ,$93.50 ,$75.57 ,$30.80 ,$99.00 ,$92.40 ,$88.00 ,$88.00 ,$24.20 ,$71.50 
ST. FRANCIS HOSPITAL - ACUTE,30201031,86334,HC IMMUNOFIX ELECTRO SERUM -90,302,1 ,$254.00 ,$165.10 ,$17.51 ,$254.00 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$149.35 ,$55.88 ,$174.50 ,$63.50 ,$174.50 ,$174.50 ,$63.50 ,$174.50 ,$106.17 ,$213.36 ,$55.85 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 ,$18.35 ,$17.51 ,$58.67 ,$215.90 ,$174.50 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,30201033,86336,HC INHIBIN A-90,302,1 ,$73.00 ,$47.45 ,$11.35 ,$73.00 ,$41.98 ,$52.56 ,$39.71 ,$16.06 ,$20.44 ,$42.92 ,$16.06 ,$50.15 ,$18.25 ,$50.15 ,$50.15 ,$18.25 ,$50.15 ,$30.51 ,$61.32 ,$38.98 ,$16.06 ,$62.05 ,$61.32 ,$16.06 ,$54.75 ,$58.40 ,$58.40 ,$16.06 ,$58.40 ,$61.32 ,$61.32 ,$61.32 ,$73.00 ,$65.70 ,$41.98 ,$73.00 ,$16.06 ,$73.00 ,$39.71 ,$16.06 ,$30.37 ,$11.89 ,$11.35 ,$16.86 ,$62.05 ,$50.15 ,$20.44 ,$65.70 ,$61.32 ,$58.40 ,$58.40 ,$16.06 ,$47.45 
ST. FRANCIS HOSPITAL - ACUTE,30201034,86337,HC INSULIN AB-90,302,1 ,$203.00 ,$131.95 ,$26.55 ,$203.00 ,$116.73 ,$146.16 ,$110.43 ,$44.66 ,$56.84 ,$119.36 ,$44.66 ,$139.46 ,$50.75 ,$139.46 ,$139.46 ,$50.75 ,$139.46 ,$84.85 ,$170.52 ,$53.53 ,$44.66 ,$172.55 ,$170.52 ,$44.66 ,$152.25 ,$162.40 ,$162.40 ,$44.66 ,$162.40 ,$170.52 ,$170.52 ,$170.52 ,$203.00 ,$182.70 ,$116.73 ,$203.00 ,$44.66 ,$203.00 ,$110.43 ,$44.66 ,$84.45 ,$27.82 ,$26.55 ,$46.89 ,$172.55 ,$139.46 ,$56.84 ,$182.70 ,$170.52 ,$162.40 ,$162.40 ,$44.66 ,$131.95 
ST. FRANCIS HOSPITAL - ACUTE,30201035,86340,HC INTRINSIC FACTOR AB-90,302,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$37.70 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$27.82 ,$26.55 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30201036,86341,HC ISLET CELL AB-90,302,1 ,$50.00 ,$32.50 ,$11.00 ,$58.93 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$58.93 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$18.35 ,$17.51 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30201041,86356,HC MOL ANTIGEN QN EA-90,302,1 ,$383.00 ,$248.95 ,$17.51 ,$383.00 ,$220.23 ,$275.76 ,$208.35 ,$84.26 ,$107.24 ,$225.20 ,$84.26 ,$263.12 ,$95.75 ,$263.12 ,$263.12 ,$95.75 ,$263.12 ,$160.09 ,$321.72 ,$66.95 ,$84.26 ,$325.55 ,$321.72 ,$84.26 ,$287.25 ,$306.40 ,$306.40 ,$84.26 ,$306.40 ,$321.72 ,$321.72 ,$321.72 ,$383.00 ,$344.70 ,$220.23 ,$383.00 ,$84.26 ,$383.00 ,$208.35 ,$84.26 ,$159.33 ,$18.35 ,$17.51 ,$88.47 ,$325.55 ,$263.12 ,$107.24 ,$344.70 ,$321.72 ,$306.40 ,$306.40 ,$84.26 ,$248.95 
ST. FRANCIS HOSPITAL - ACUTE,30201043,86359,HC T CELLS TOTAL COUNT-90,302,1 ,$45.00 ,$29.25 ,$9.90 ,$94.33 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$94.33 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$18.35 ,$17.51 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30201045,86360,HC ABS T CELLS CD4 CD8 RATIO-90,302,1 ,$49.00 ,$31.85 ,$10.78 ,$117.45 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$117.45 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$18.35 ,$17.51 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30201047,86376,HC MICROSOMAL AB-90,302,1 ,$49.00 ,$31.85 ,$10.78 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$36.38 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$27.82 ,$26.55 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30201052,86431,HC RHEUMATOID FACTOR QN-90,302,1 ,$270.00 ,$175.50 ,$10.16 ,$270.00 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$51.92 ,$59.40 ,$66.11 ,$67.50 ,$66.11 ,$66.11 ,$67.50 ,$66.11 ,$112.86 ,$226.80 ,$14.18 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 ,$10.65 ,$10.16 ,$62.37 ,$229.50 ,$66.11 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,30201055,86603,HC ADENOVIRUS AB-90,302,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$32.18 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$18.35 ,$17.51 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30201056,86606,HC ASPERGILLUS AB-90,302,1 ,$45.00 ,$29.25 ,$9.90 ,$45.00 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$37.63 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$18.35 ,$17.51 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30201058,86611,HC BARTONELLA SCREEN AB-90,302,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$25.45 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$18.35 ,$17.51 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30201060,86612,HC BLASTOMYCES AB-90,302,1 ,$25.00 ,$16.25 ,$5.50 ,$32.25 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$32.25 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$18.35 ,$17.51 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30201062,86617,HC LYME DISEASE AB CONFIRM-90,302,1 ,$129.00 ,$83.85 ,$17.51 ,$129.00 ,$74.18 ,$92.88 ,$70.18 ,$28.38 ,$36.12 ,$75.85 ,$28.38 ,$88.62 ,$32.25 ,$88.62 ,$88.62 ,$32.25 ,$88.62 ,$53.92 ,$108.36 ,$38.73 ,$28.38 ,$109.65 ,$108.36 ,$28.38 ,$96.75 ,$103.20 ,$103.20 ,$28.38 ,$103.20 ,$108.36 ,$108.36 ,$108.36 ,$129.00 ,$116.10 ,$74.18 ,$129.00 ,$28.38 ,$129.00 ,$70.18 ,$28.38 ,$53.66 ,$18.35 ,$17.51 ,$29.80 ,$109.65 ,$88.62 ,$36.12 ,$116.10 ,$108.36 ,$103.20 ,$103.20 ,$28.38 ,$83.85 
ST. FRANCIS HOSPITAL - ACUTE,30201063,86618,HC LYME AB-90,302,1 ,$131.00 ,$85.15 ,$17.51 ,$131.00 ,$75.33 ,$94.32 ,$71.26 ,$28.82 ,$36.68 ,$77.03 ,$28.82 ,$90.00 ,$32.75 ,$90.00 ,$90.00 ,$32.75 ,$90.00 ,$54.76 ,$110.04 ,$42.58 ,$28.82 ,$111.35 ,$110.04 ,$28.82 ,$98.25 ,$104.80 ,$104.80 ,$28.82 ,$104.80 ,$110.04 ,$110.04 ,$110.04 ,$131.00 ,$117.90 ,$75.33 ,$131.00 ,$28.82 ,$131.00 ,$71.26 ,$28.82 ,$54.50 ,$18.35 ,$17.51 ,$30.26 ,$111.35 ,$90.00 ,$36.68 ,$117.90 ,$110.04 ,$104.80 ,$104.80 ,$28.82 ,$85.15 
ST. FRANCIS HOSPITAL - ACUTE,30201088,86008,HC ALLERGEN IGE QN/SEMI-QN RECOMB/COMP EA-90,302,1 ,$7.00 ,$4.55 ,$1.54 ,$17.50 ,$4.03 ,$5.04 ,$3.81 ,$1.54 ,$1.96 ,$4.12 ,$1.54 ,$4.81 ,$1.75 ,$4.81 ,$4.81 ,$1.75 ,$4.81 ,$2.93 ,$5.88 ,$17.50 ,$1.54 ,$5.95 ,$5.88 ,$1.54 ,$5.25 ,$5.60 ,$5.60 ,$1.54 ,$5.60 ,$5.88 ,$5.88 ,$5.88 ,$7.00 ,$6.30 ,$4.03 ,$7.00 ,$1.54 ,$7.00 ,$3.81 ,$1.54 ,$2.91 ,$10.65 ,$10.16 ,$1.62 ,$5.95 ,$4.81 ,$1.96 ,$6.30 ,$5.88 ,$5.60 ,$5.60 ,$1.54 ,$4.55 
ST. FRANCIS HOSPITAL - ACUTE,30201093,86003,HC ALLERGEN IGE QN EA,302,1 ,$34.00 ,$22.10 ,$7.48 ,$34.00 ,$19.55 ,$24.48 ,$18.50 ,$7.48 ,$9.52 ,$19.99 ,$7.48 ,$23.36 ,$8.50 ,$23.36 ,$23.36 ,$8.50 ,$23.36 ,$14.21 ,$28.56 ,$13.05 ,$7.48 ,$28.90 ,$28.56 ,$7.48 ,$25.50 ,$27.20 ,$27.20 ,$7.48 ,$27.20 ,$28.56 ,$28.56 ,$28.56 ,$34.00 ,$30.60 ,$19.55 ,$34.00 ,$7.48 ,$34.00 ,$18.50 ,$7.48 ,$14.14 ,$10.65 ,$10.16 ,$7.85 ,$28.90 ,$23.36 ,$9.52 ,$30.60 ,$28.56 ,$27.20 ,$27.20 ,$7.48 ,$22.10 
ST. FRANCIS HOSPITAL - ACUTE,30201094,86038,HC ANA SCREEN,302,1 ,$207.00 ,$134.55 ,$10.16 ,$207.00 ,$119.03 ,$149.04 ,$112.61 ,$45.54 ,$57.96 ,$110.68 ,$45.54 ,$140.94 ,$51.75 ,$140.94 ,$140.94 ,$51.75 ,$140.94 ,$86.53 ,$173.88 ,$30.23 ,$45.54 ,$175.95 ,$173.88 ,$45.54 ,$155.25 ,$165.60 ,$165.60 ,$45.54 ,$165.60 ,$173.88 ,$173.88 ,$173.88 ,$207.00 ,$186.30 ,$119.03 ,$207.00 ,$45.54 ,$207.00 ,$112.61 ,$45.54 ,$86.11 ,$10.65 ,$10.16 ,$47.82 ,$175.95 ,$140.94 ,$57.96 ,$186.30 ,$173.88 ,$165.60 ,$165.60 ,$45.54 ,$134.55 
ST. FRANCIS HOSPITAL - ACUTE,30201095,86060,HC ASO,302,1 ,$165.00 ,$107.25 ,$10.16 ,$165.00 ,$94.88 ,$118.80 ,$89.76 ,$36.30 ,$46.20 ,$66.86 ,$36.30 ,$85.15 ,$41.25 ,$85.15 ,$85.15 ,$41.25 ,$85.15 ,$68.97 ,$138.60 ,$18.25 ,$36.30 ,$140.25 ,$138.60 ,$36.30 ,$123.75 ,$132.00 ,$132.00 ,$36.30 ,$132.00 ,$138.60 ,$138.60 ,$138.60 ,$165.00 ,$148.50 ,$94.88 ,$165.00 ,$36.30 ,$165.00 ,$89.76 ,$36.30 ,$68.64 ,$10.65 ,$10.16 ,$38.12 ,$140.25 ,$85.15 ,$46.20 ,$148.50 ,$138.60 ,$132.00 ,$132.00 ,$36.30 ,$107.25 
ST. FRANCIS HOSPITAL - ACUTE,30201096,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$73.00 ,$47.45 ,$10.16 ,$73.00 ,$41.98 ,$52.56 ,$39.71 ,$16.06 ,$20.44 ,$42.92 ,$16.06 ,$50.15 ,$18.25 ,$50.15 ,$50.15 ,$18.25 ,$50.15 ,$30.51 ,$61.32 ,$32.38 ,$16.06 ,$62.05 ,$61.32 ,$16.06 ,$54.75 ,$58.40 ,$58.40 ,$16.06 ,$58.40 ,$61.32 ,$61.32 ,$61.32 ,$73.00 ,$65.70 ,$41.98 ,$73.00 ,$16.06 ,$73.00 ,$39.71 ,$16.06 ,$30.37 ,$10.65 ,$10.16 ,$16.86 ,$62.05 ,$50.15 ,$20.44 ,$65.70 ,$61.32 ,$58.40 ,$58.40 ,$16.06 ,$47.45 
ST. FRANCIS HOSPITAL - ACUTE,30201097,86147,HC CARDIOLIPIN AB EA,302,1 ,$141.00 ,$91.65 ,$17.51 ,$141.00 ,$81.08 ,$101.52 ,$76.70 ,$31.02 ,$39.48 ,$82.91 ,$31.02 ,$96.87 ,$35.25 ,$96.87 ,$96.87 ,$35.25 ,$96.87 ,$58.94 ,$118.44 ,$63.63 ,$31.02 ,$119.85 ,$118.44 ,$31.02 ,$105.75 ,$112.80 ,$112.80 ,$31.02 ,$112.80 ,$118.44 ,$118.44 ,$118.44 ,$141.00 ,$126.90 ,$81.08 ,$141.00 ,$31.02 ,$141.00 ,$76.70 ,$31.02 ,$58.66 ,$18.35 ,$17.51 ,$32.57 ,$119.85 ,$96.87 ,$39.48 ,$126.90 ,$118.44 ,$112.80 ,$112.80 ,$31.02 ,$91.65 
ST. FRANCIS HOSPITAL - ACUTE,30201098,86225,HC DNA DOUBLE STRAND AB,302,1 ,$334.00 ,$217.10 ,$10.16 ,$334.00 ,$192.05 ,$240.48 ,$181.70 ,$73.48 ,$93.52 ,$125.85 ,$73.48 ,$160.27 ,$83.50 ,$160.27 ,$160.27 ,$83.50 ,$160.27 ,$139.61 ,$280.56 ,$34.35 ,$73.48 ,$283.90 ,$280.56 ,$73.48 ,$250.50 ,$267.20 ,$267.20 ,$73.48 ,$267.20 ,$280.56 ,$280.56 ,$280.56 ,$334.00 ,$300.60 ,$192.05 ,$334.00 ,$73.48 ,$334.00 ,$181.70 ,$73.48 ,$138.94 ,$10.65 ,$10.16 ,$77.15 ,$283.90 ,$160.27 ,$93.52 ,$300.60 ,$280.56 ,$267.20 ,$267.20 ,$73.48 ,$217.10 
ST. FRANCIS HOSPITAL - ACUTE,30201099,86235,HC ENA AB,302,1 ,$120.00 ,$78.00 ,$17.51 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$70.56 ,$26.40 ,$82.44 ,$30.00 ,$82.44 ,$82.44 ,$30.00 ,$82.44 ,$50.16 ,$100.80 ,$44.83 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 ,$18.35 ,$17.51 ,$27.72 ,$102.00 ,$82.44 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,30201101,86304,HC TUMOR AG CA 125,302,1 ,$334.00 ,$217.10 ,$26.93 ,$334.00 ,$192.05 ,$240.48 ,$181.70 ,$73.48 ,$93.52 ,$190.66 ,$73.48 ,$229.46 ,$83.50 ,$229.46 ,$229.46 ,$83.50 ,$229.46 ,$139.61 ,$280.56 ,$52.03 ,$73.48 ,$283.90 ,$280.56 ,$73.48 ,$250.50 ,$267.20 ,$267.20 ,$73.48 ,$267.20 ,$280.56 ,$280.56 ,$280.56 ,$334.00 ,$300.60 ,$192.05 ,$334.00 ,$73.48 ,$334.00 ,$181.70 ,$73.48 ,$138.94 ,$28.22 ,$26.93 ,$77.15 ,$283.90 ,$229.46 ,$93.52 ,$300.60 ,$280.56 ,$267.20 ,$267.20 ,$73.48 ,$217.10 
ST. FRANCIS HOSPITAL - ACUTE,30201102,86334,HC IMMUNOFIX ELECTRO SERUM,302,1 ,$254.00 ,$165.10 ,$17.51 ,$254.00 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$149.35 ,$55.88 ,$174.50 ,$63.50 ,$174.50 ,$174.50 ,$63.50 ,$174.50 ,$106.17 ,$213.36 ,$55.85 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 ,$18.35 ,$17.51 ,$58.67 ,$215.90 ,$174.50 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,30201103,86335,HC IMMUNOFIX ELECTRO OTH,302,1 ,$254.00 ,$165.10 ,$17.51 ,$254.00 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$149.35 ,$55.88 ,$174.50 ,$63.50 ,$174.50 ,$174.50 ,$63.50 ,$174.50 ,$106.17 ,$213.36 ,$73.38 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 ,$18.35 ,$17.51 ,$58.67 ,$215.90 ,$174.50 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,30201104,86359,HC T CELLS TOTAL COUNT,302,1 ,$84.00 ,$54.60 ,$17.51 ,$94.33 ,$48.30 ,$60.48 ,$45.70 ,$18.48 ,$23.52 ,$49.39 ,$18.48 ,$57.71 ,$21.00 ,$57.71 ,$57.71 ,$21.00 ,$57.71 ,$35.11 ,$70.56 ,$94.33 ,$18.48 ,$71.40 ,$70.56 ,$18.48 ,$63.00 ,$67.20 ,$67.20 ,$18.48 ,$67.20 ,$70.56 ,$70.56 ,$70.56 ,$84.00 ,$75.60 ,$48.30 ,$84.00 ,$18.48 ,$84.00 ,$45.70 ,$18.48 ,$34.94 ,$18.35 ,$17.51 ,$19.40 ,$71.40 ,$57.71 ,$23.52 ,$75.60 ,$70.56 ,$67.20 ,$67.20 ,$18.48 ,$54.60 
ST. FRANCIS HOSPITAL - ACUTE,30201105,86360,HC ABS T CELLS CD4 CD8 RATIO,302,1 ,$160.00 ,$104.00 ,$17.51 ,$160.00 ,$92.00 ,$115.20 ,$87.04 ,$35.20 ,$44.80 ,$94.08 ,$35.20 ,$109.92 ,$40.00 ,$109.92 ,$109.92 ,$40.00 ,$109.92 ,$66.88 ,$134.40 ,$117.45 ,$35.20 ,$136.00 ,$134.40 ,$35.20 ,$120.00 ,$128.00 ,$128.00 ,$35.20 ,$128.00 ,$134.40 ,$134.40 ,$134.40 ,$160.00 ,$144.00 ,$92.00 ,$160.00 ,$35.20 ,$160.00 ,$87.04 ,$35.20 ,$66.56 ,$18.35 ,$17.51 ,$36.96 ,$136.00 ,$109.92 ,$44.80 ,$144.00 ,$134.40 ,$128.00 ,$128.00 ,$35.20 ,$104.00 
ST. FRANCIS HOSPITAL - ACUTE,30201106,86376,HC MICROSOMAL AB,302,1 ,$357.00 ,$232.05 ,$26.55 ,$357.00 ,$205.28 ,$257.04 ,$194.21 ,$78.54 ,$99.96 ,$133.15 ,$78.54 ,$169.57 ,$89.25 ,$169.57 ,$169.57 ,$89.25 ,$169.57 ,$149.23 ,$299.88 ,$36.38 ,$78.54 ,$303.45 ,$299.88 ,$78.54 ,$267.75 ,$285.60 ,$285.60 ,$78.54 ,$285.60 ,$299.88 ,$299.88 ,$299.88 ,$357.00 ,$321.30 ,$205.28 ,$357.00 ,$78.54 ,$357.00 ,$194.21 ,$78.54 ,$148.51 ,$27.82 ,$26.55 ,$82.47 ,$303.45 ,$169.57 ,$99.96 ,$321.30 ,$299.88 ,$285.60 ,$285.60 ,$78.54 ,$232.05 
ST. FRANCIS HOSPITAL - ACUTE,30201108,86431,HC RHEUMATOID FACTOR QN,302,1 ,$270.00 ,$175.50 ,$10.16 ,$270.00 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$51.92 ,$59.40 ,$66.11 ,$67.50 ,$66.11 ,$66.11 ,$67.50 ,$66.11 ,$112.86 ,$226.80 ,$14.18 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 ,$10.65 ,$10.16 ,$62.37 ,$229.50 ,$66.11 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,30201109,86480,HC TB QUANTIFERON GOLD,302,1 ,$298.00 ,$193.70 ,$17.51 ,$298.00 ,$171.35 ,$214.56 ,$162.11 ,$65.56 ,$83.44 ,$175.22 ,$65.56 ,$204.73 ,$74.50 ,$204.73 ,$204.73 ,$74.50 ,$204.73 ,$124.56 ,$250.32 ,$154.95 ,$65.56 ,$253.30 ,$250.32 ,$65.56 ,$223.50 ,$238.40 ,$238.40 ,$65.56 ,$238.40 ,$250.32 ,$250.32 ,$250.32 ,$298.00 ,$268.20 ,$171.35 ,$298.00 ,$65.56 ,$298.00 ,$162.11 ,$65.56 ,$123.97 ,$18.35 ,$17.51 ,$68.84 ,$253.30 ,$204.73 ,$83.44 ,$268.20 ,$250.32 ,$238.40 ,$238.40 ,$65.56 ,$193.70 
ST. FRANCIS HOSPITAL - ACUTE,30201110,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$162.00 ,$105.30 ,$10.16 ,$162.00 ,$93.15 ,$116.64 ,$88.13 ,$35.64 ,$45.36 ,$39.14 ,$35.64 ,$49.84 ,$40.50 ,$49.84 ,$49.84 ,$40.50 ,$49.84 ,$67.72 ,$136.08 ,$10.68 ,$35.64 ,$137.70 ,$136.08 ,$35.64 ,$121.50 ,$129.60 ,$129.60 ,$35.64 ,$129.60 ,$136.08 ,$136.08 ,$136.08 ,$162.00 ,$145.80 ,$93.15 ,$162.00 ,$35.64 ,$162.00 ,$88.13 ,$35.64 ,$67.39 ,$10.65 ,$10.16 ,$37.42 ,$137.70 ,$49.84 ,$45.36 ,$145.80 ,$136.08 ,$129.60 ,$129.60 ,$35.64 ,$105.30 
ST. FRANCIS HOSPITAL - ACUTE,30201111,86593,HC SYPHILIS VDRL RPR QN,302,1 ,$59.00 ,$38.35 ,$10.16 ,$59.00 ,$33.93 ,$42.48 ,$32.10 ,$12.98 ,$16.52 ,$34.69 ,$12.98 ,$40.53 ,$14.75 ,$40.53 ,$40.53 ,$14.75 ,$40.53 ,$24.66 ,$49.56 ,$11.00 ,$12.98 ,$50.15 ,$49.56 ,$12.98 ,$44.25 ,$47.20 ,$47.20 ,$12.98 ,$47.20 ,$49.56 ,$49.56 ,$49.56 ,$59.00 ,$53.10 ,$33.93 ,$59.00 ,$12.98 ,$59.00 ,$32.10 ,$12.98 ,$24.54 ,$10.65 ,$10.16 ,$13.63 ,$50.15 ,$40.53 ,$16.52 ,$53.10 ,$49.56 ,$47.20 ,$47.20 ,$12.98 ,$38.35 
ST. FRANCIS HOSPITAL - ACUTE,30201112,86606,HC ASPERGILLUS AB,302,1 ,$76.00 ,$49.40 ,$16.72 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$44.69 ,$16.72 ,$52.21 ,$19.00 ,$52.21 ,$52.21 ,$19.00 ,$52.21 ,$31.77 ,$63.84 ,$37.63 ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 ,$18.35 ,$17.51 ,$17.56 ,$64.60 ,$52.21 ,$21.28 ,$68.40 ,$63.84 ,$60.80 ,$60.80 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,30201113,86612,HC BLASTOMYCES AB,302,1 ,$76.00 ,$49.40 ,$16.72 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$44.69 ,$16.72 ,$52.21 ,$19.00 ,$52.21 ,$52.21 ,$19.00 ,$52.21 ,$31.77 ,$63.84 ,$32.25 ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 ,$18.35 ,$17.51 ,$17.56 ,$64.60 ,$52.21 ,$21.28 ,$68.40 ,$63.84 ,$60.80 ,$60.80 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,30201115,86635,HC COCCIDIOIDES AB,302,1 ,$76.00 ,$49.40 ,$16.72 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$44.69 ,$16.72 ,$52.21 ,$19.00 ,$52.21 ,$52.21 ,$19.00 ,$52.21 ,$31.77 ,$63.84 ,$28.68 ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 ,$18.35 ,$17.51 ,$17.56 ,$64.60 ,$52.21 ,$21.28 ,$68.40 ,$63.84 ,$60.80 ,$60.80 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,30201116,86641,HC CRYPTOCOCCAL AB,302,1 ,$249.00 ,$161.85 ,$17.51 ,$249.00 ,$143.18 ,$179.28 ,$135.46 ,$54.78 ,$69.72 ,$131.90 ,$54.78 ,$167.97 ,$62.25 ,$167.97 ,$167.97 ,$62.25 ,$167.97 ,$104.08 ,$209.16 ,$36.03 ,$54.78 ,$211.65 ,$209.16 ,$54.78 ,$186.75 ,$199.20 ,$199.20 ,$54.78 ,$199.20 ,$209.16 ,$209.16 ,$209.16 ,$249.00 ,$224.10 ,$143.18 ,$249.00 ,$54.78 ,$249.00 ,$135.46 ,$54.78 ,$103.58 ,$18.35 ,$17.51 ,$57.52 ,$211.65 ,$167.97 ,$69.72 ,$224.10 ,$209.16 ,$199.20 ,$199.20 ,$54.78 ,$161.85 
ST. FRANCIS HOSPITAL - ACUTE,30201117,86644,HC CMV AB,302,1 ,$148.00 ,$96.20 ,$17.51 ,$148.00 ,$85.10 ,$106.56 ,$80.51 ,$32.56 ,$41.44 ,$87.02 ,$32.56 ,$101.68 ,$37.00 ,$101.68 ,$101.68 ,$37.00 ,$101.68 ,$61.86 ,$124.32 ,$35.98 ,$32.56 ,$125.80 ,$124.32 ,$32.56 ,$111.00 ,$118.40 ,$118.40 ,$32.56 ,$118.40 ,$124.32 ,$124.32 ,$124.32 ,$148.00 ,$133.20 ,$85.10 ,$148.00 ,$32.56 ,$148.00 ,$80.51 ,$32.56 ,$61.57 ,$18.35 ,$17.51 ,$34.19 ,$125.80 ,$101.68 ,$41.44 ,$133.20 ,$124.32 ,$118.40 ,$118.40 ,$32.56 ,$96.20 
ST. FRANCIS HOSPITAL - ACUTE,30201118,86645,HC CMV AB IGM,302,1 ,$148.00 ,$96.20 ,$17.51 ,$148.00 ,$85.10 ,$106.56 ,$80.51 ,$32.56 ,$41.44 ,$87.02 ,$32.56 ,$101.68 ,$37.00 ,$101.68 ,$101.68 ,$37.00 ,$101.68 ,$61.86 ,$124.32 ,$42.13 ,$32.56 ,$125.80 ,$124.32 ,$32.56 ,$111.00 ,$118.40 ,$118.40 ,$32.56 ,$118.40 ,$124.32 ,$124.32 ,$124.32 ,$148.00 ,$133.20 ,$85.10 ,$148.00 ,$32.56 ,$148.00 ,$80.51 ,$32.56 ,$61.57 ,$18.35 ,$17.51 ,$34.19 ,$125.80 ,$101.68 ,$41.44 ,$133.20 ,$124.32 ,$118.40 ,$118.40 ,$32.56 ,$96.20 
ST. FRANCIS HOSPITAL - ACUTE,30201119,86677,HC H PYLORI AB,302,1 ,$379.00 ,$246.35 ,$17.51 ,$379.00 ,$217.93 ,$272.88 ,$206.18 ,$83.38 ,$106.12 ,$132.81 ,$83.38 ,$169.13 ,$94.75 ,$169.13 ,$169.13 ,$94.75 ,$169.13 ,$158.42 ,$318.36 ,$42.13 ,$83.38 ,$322.15 ,$318.36 ,$83.38 ,$284.25 ,$303.20 ,$303.20 ,$83.38 ,$303.20 ,$318.36 ,$318.36 ,$318.36 ,$379.00 ,$341.10 ,$217.93 ,$379.00 ,$83.38 ,$379.00 ,$206.18 ,$83.38 ,$157.66 ,$18.35 ,$17.51 ,$87.55 ,$322.15 ,$169.13 ,$106.12 ,$341.10 ,$318.36 ,$303.20 ,$303.20 ,$83.38 ,$246.35 
ST. FRANCIS HOSPITAL - ACUTE,30201120,86698,HC HISTOPLASMA AB,302,1 ,$108.00 ,$70.20 ,$17.51 ,$108.00 ,$62.10 ,$77.76 ,$58.75 ,$23.76 ,$30.24 ,$63.50 ,$23.76 ,$74.20 ,$27.00 ,$74.20 ,$74.20 ,$27.00 ,$74.20 ,$45.14 ,$90.72 ,$34.48 ,$23.76 ,$91.80 ,$90.72 ,$23.76 ,$81.00 ,$86.40 ,$86.40 ,$23.76 ,$86.40 ,$90.72 ,$90.72 ,$90.72 ,$108.00 ,$97.20 ,$62.10 ,$108.00 ,$23.76 ,$108.00 ,$58.75 ,$23.76 ,$44.93 ,$18.35 ,$17.51 ,$24.95 ,$91.80 ,$74.20 ,$30.24 ,$97.20 ,$90.72 ,$86.40 ,$86.40 ,$23.76 ,$70.20 
ST. FRANCIS HOSPITAL - ACUTE,30201121,86704,HC HEP CORE AB,302,1 ,$58.00 ,$37.70 ,$10.16 ,$58.00 ,$33.35 ,$41.76 ,$31.55 ,$12.76 ,$16.24 ,$34.10 ,$12.76 ,$39.85 ,$14.50 ,$39.85 ,$39.85 ,$14.50 ,$39.85 ,$24.24 ,$48.72 ,$30.13 ,$12.76 ,$49.30 ,$48.72 ,$12.76 ,$43.50 ,$46.40 ,$46.40 ,$12.76 ,$46.40 ,$48.72 ,$48.72 ,$48.72 ,$58.00 ,$52.20 ,$33.35 ,$58.00 ,$12.76 ,$58.00 ,$31.55 ,$12.76 ,$24.13 ,$10.65 ,$10.16 ,$13.40 ,$49.30 ,$39.85 ,$16.24 ,$52.20 ,$48.72 ,$46.40 ,$46.40 ,$12.76 ,$37.70 
ST. FRANCIS HOSPITAL - ACUTE,30201122,86705,HC HEP B CORE IGM,302,1 ,$212.00 ,$137.80 ,$10.16 ,$212.00 ,$121.90 ,$152.64 ,$115.33 ,$46.64 ,$59.36 ,$107.82 ,$46.64 ,$137.31 ,$53.00 ,$137.31 ,$137.31 ,$53.00 ,$137.31 ,$88.62 ,$178.08 ,$29.43 ,$46.64 ,$180.20 ,$178.08 ,$46.64 ,$159.00 ,$169.60 ,$169.60 ,$46.64 ,$169.60 ,$178.08 ,$178.08 ,$178.08 ,$212.00 ,$190.80 ,$121.90 ,$212.00 ,$46.64 ,$212.00 ,$115.33 ,$46.64 ,$88.19 ,$10.65 ,$10.16 ,$48.97 ,$180.20 ,$137.31 ,$59.36 ,$190.80 ,$178.08 ,$169.60 ,$169.60 ,$46.64 ,$137.80 
ST. FRANCIS HOSPITAL - ACUTE,30201123,86706,HC HEP B SURFACE AB,302,1 ,$267.00 ,$173.55 ,$10.16 ,$267.00 ,$153.53 ,$192.24 ,$145.25 ,$58.74 ,$74.76 ,$98.35 ,$58.74 ,$125.25 ,$66.75 ,$125.25 ,$125.25 ,$66.75 ,$125.25 ,$111.61 ,$224.28 ,$26.85 ,$58.74 ,$226.95 ,$224.28 ,$58.74 ,$200.25 ,$213.60 ,$213.60 ,$58.74 ,$213.60 ,$224.28 ,$224.28 ,$224.28 ,$267.00 ,$240.30 ,$153.53 ,$267.00 ,$58.74 ,$267.00 ,$145.25 ,$58.74 ,$111.07 ,$10.65 ,$10.16 ,$61.68 ,$226.95 ,$125.25 ,$74.76 ,$240.30 ,$224.28 ,$213.60 ,$213.60 ,$58.74 ,$173.55 
ST. FRANCIS HOSPITAL - ACUTE,30201126,86735,HC MUMPS AB,302,1 ,$161.00 ,$104.65 ,$10.16 ,$161.00 ,$92.58 ,$115.92 ,$87.58 ,$35.42 ,$45.08 ,$94.67 ,$35.42 ,$110.61 ,$40.25 ,$110.61 ,$110.61 ,$40.25 ,$110.61 ,$67.30 ,$135.24 ,$32.63 ,$35.42 ,$136.85 ,$135.24 ,$35.42 ,$120.75 ,$128.80 ,$128.80 ,$35.42 ,$128.80 ,$135.24 ,$135.24 ,$135.24 ,$161.00 ,$144.90 ,$92.58 ,$161.00 ,$35.42 ,$161.00 ,$87.58 ,$35.42 ,$66.98 ,$10.65 ,$10.16 ,$37.19 ,$136.85 ,$110.61 ,$45.08 ,$144.90 ,$135.24 ,$128.80 ,$128.80 ,$35.42 ,$104.65 
ST. FRANCIS HOSPITAL - ACUTE,30201127,86762,HC RUBELLA AB,302,1 ,$166.00 ,$107.90 ,$10.16 ,$166.00 ,$95.45 ,$119.52 ,$90.30 ,$36.52 ,$46.48 ,$97.61 ,$36.52 ,$114.04 ,$41.50 ,$114.04 ,$114.04 ,$41.50 ,$114.04 ,$69.39 ,$139.44 ,$35.98 ,$36.52 ,$141.10 ,$139.44 ,$36.52 ,$124.50 ,$132.80 ,$132.80 ,$36.52 ,$132.80 ,$139.44 ,$139.44 ,$139.44 ,$166.00 ,$149.40 ,$95.45 ,$166.00 ,$36.52 ,$166.00 ,$90.30 ,$36.52 ,$69.06 ,$10.65 ,$10.16 ,$38.35 ,$141.10 ,$114.04 ,$46.48 ,$149.40 ,$139.44 ,$132.80 ,$132.80 ,$36.52 ,$107.90 
ST. FRANCIS HOSPITAL - ACUTE,30201128,86765,HC RUBEOLA AB,302,1 ,$155.00 ,$100.75 ,$10.16 ,$155.00 ,$89.13 ,$111.60 ,$84.32 ,$34.10 ,$43.40 ,$91.14 ,$34.10 ,$106.49 ,$38.75 ,$106.49 ,$106.49 ,$38.75 ,$106.49 ,$64.79 ,$130.20 ,$32.20 ,$34.10 ,$131.75 ,$130.20 ,$34.10 ,$116.25 ,$124.00 ,$124.00 ,$34.10 ,$124.00 ,$130.20 ,$130.20 ,$130.20 ,$155.00 ,$139.50 ,$89.13 ,$155.00 ,$34.10 ,$155.00 ,$84.32 ,$34.10 ,$64.48 ,$10.65 ,$10.16 ,$35.81 ,$131.75 ,$106.49 ,$43.40 ,$139.50 ,$130.20 ,$124.00 ,$124.00 ,$34.10 ,$100.75 
ST. FRANCIS HOSPITAL - ACUTE,30201130,86787,HC VARICELLA ZOSTER AB,302,1 ,$125.00 ,$81.25 ,$10.16 ,$125.00 ,$71.88 ,$90.00 ,$68.00 ,$27.50 ,$35.00 ,$73.50 ,$27.50 ,$85.88 ,$31.25 ,$85.88 ,$85.88 ,$31.25 ,$85.88 ,$52.25 ,$105.00 ,$32.20 ,$27.50 ,$106.25 ,$105.00 ,$27.50 ,$93.75 ,$100.00 ,$100.00 ,$27.50 ,$100.00 ,$105.00 ,$105.00 ,$105.00 ,$125.00 ,$112.50 ,$71.88 ,$125.00 ,$27.50 ,$125.00 ,$68.00 ,$27.50 ,$52.00 ,$10.65 ,$10.16 ,$28.88 ,$106.25 ,$85.88 ,$35.00 ,$112.50 ,$105.00 ,$100.00 ,$100.00 ,$27.50 ,$81.25 
ST. FRANCIS HOSPITAL - ACUTE,30201131,86800,HC THYROGLOBULIN AB,302,1 ,$100.00 ,$65.00 ,$22.00 ,$100.00 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$58.80 ,$22.00 ,$68.70 ,$25.00 ,$68.70 ,$68.70 ,$25.00 ,$68.70 ,$41.80 ,$84.00 ,$39.78 ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 ,$27.82 ,$26.55 ,$23.10 ,$85.00 ,$68.70 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,30201132,86803,HC HEP C AB,302,1 ,$212.00 ,$137.80 ,$17.51 ,$212.00 ,$121.90 ,$152.64 ,$115.33 ,$46.64 ,$59.36 ,$124.66 ,$46.64 ,$145.64 ,$53.00 ,$145.64 ,$145.64 ,$53.00 ,$145.64 ,$88.62 ,$178.08 ,$35.68 ,$46.64 ,$180.20 ,$178.08 ,$46.64 ,$159.00 ,$169.60 ,$169.60 ,$46.64 ,$169.60 ,$178.08 ,$178.08 ,$178.08 ,$212.00 ,$190.80 ,$121.90 ,$212.00 ,$46.64 ,$212.00 ,$115.33 ,$46.64 ,$88.19 ,$18.35 ,$17.51 ,$48.97 ,$180.20 ,$145.64 ,$59.36 ,$190.80 ,$178.08 ,$169.60 ,$169.60 ,$46.64 ,$137.80 
ST. FRANCIS HOSPITAL - ACUTE,30201134,86902,HC RBC AG SCR RGT SERUM T1-90,302,1 ,$112.00 ,$72.80 ,$6.30 ,$743.63 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$47.12 ,$24.64 ,$60.01 ,$28.00 ,$60.01 ,$60.01 ,$28.00 ,$60.01 ,$46.82 ,$94.08 ,$743.63 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$6.60 ,$6.30 ,$25.87 ,$95.20 ,$60.01 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30201135,86902,HC RBC AG SCR RGT SERUM T2-90,302,1 ,$175.00 ,$113.75 ,$6.30 ,$743.63 ,$100.63 ,$126.00 ,$95.20 ,$38.50 ,$49.00 ,$47.12 ,$38.50 ,$60.01 ,$43.75 ,$60.01 ,$60.01 ,$43.75 ,$60.01 ,$73.15 ,$147.00 ,$743.63 ,$38.50 ,$148.75 ,$147.00 ,$38.50 ,$131.25 ,$140.00 ,$140.00 ,$38.50 ,$140.00 ,$147.00 ,$147.00 ,$147.00 ,$175.00 ,$157.50 ,$100.63 ,$175.00 ,$38.50 ,$175.00 ,$95.20 ,$38.50 ,$72.80 ,$6.60 ,$6.30 ,$40.43 ,$148.75 ,$60.01 ,$49.00 ,$157.50 ,$147.00 ,$140.00 ,$140.00 ,$38.50 ,$113.75 
ST. FRANCIS HOSPITAL - ACUTE,30201136,86902,HC RBC AG SCR RGT SERUM T3-90,302,1 ,$249.00 ,$161.85 ,$6.30 ,$743.63 ,$143.18 ,$179.28 ,$135.46 ,$54.78 ,$69.72 ,$47.12 ,$54.78 ,$60.01 ,$62.25 ,$60.01 ,$60.01 ,$62.25 ,$60.01 ,$104.08 ,$209.16 ,$743.63 ,$54.78 ,$211.65 ,$209.16 ,$54.78 ,$186.75 ,$199.20 ,$199.20 ,$54.78 ,$199.20 ,$209.16 ,$209.16 ,$209.16 ,$249.00 ,$224.10 ,$143.18 ,$249.00 ,$54.78 ,$249.00 ,$135.46 ,$54.78 ,$103.58 ,$6.60 ,$6.30 ,$57.52 ,$211.65 ,$60.01 ,$69.72 ,$224.10 ,$209.16 ,$199.20 ,$199.20 ,$54.78 ,$161.85 
ST. FRANCIS HOSPITAL - ACUTE,30201137,86902,HC RBC AG SCR RGT SERUM T4-90,302,1 ,$373.00 ,$242.45 ,$6.30 ,$743.63 ,$214.48 ,$268.56 ,$202.91 ,$82.06 ,$104.44 ,$47.12 ,$82.06 ,$60.01 ,$93.25 ,$60.01 ,$60.01 ,$93.25 ,$60.01 ,$155.91 ,$313.32 ,$743.63 ,$82.06 ,$317.05 ,$313.32 ,$82.06 ,$279.75 ,$298.40 ,$298.40 ,$82.06 ,$298.40 ,$313.32 ,$313.32 ,$313.32 ,$373.00 ,$335.70 ,$214.48 ,$373.00 ,$82.06 ,$373.00 ,$202.91 ,$82.06 ,$155.17 ,$6.60 ,$6.30 ,$86.16 ,$317.05 ,$60.01 ,$104.44 ,$335.70 ,$313.32 ,$298.40 ,$298.40 ,$82.06 ,$242.45 
ST. FRANCIS HOSPITAL - ACUTE,30201138,86905,HC RBC AG TYPING NON ABO/RH T1-90,302,1 ,$112.00 ,$72.80 ,$6.30 ,$743.63 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$35.03 ,$24.64 ,$44.61 ,$28.00 ,$44.61 ,$44.61 ,$28.00 ,$44.61 ,$46.82 ,$94.08 ,$743.63 ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$6.60 ,$6.30 ,$25.87 ,$95.20 ,$44.61 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,30201139,86905,HC RBC AG TYPING NON ABO/RH T2-90,302,1 ,$175.00 ,$113.75 ,$6.30 ,$743.63 ,$100.63 ,$126.00 ,$95.20 ,$38.50 ,$49.00 ,$35.03 ,$38.50 ,$44.61 ,$43.75 ,$44.61 ,$44.61 ,$43.75 ,$44.61 ,$73.15 ,$147.00 ,$743.63 ,$38.50 ,$148.75 ,$147.00 ,$38.50 ,$131.25 ,$140.00 ,$140.00 ,$38.50 ,$140.00 ,$147.00 ,$147.00 ,$147.00 ,$175.00 ,$157.50 ,$100.63 ,$175.00 ,$38.50 ,$175.00 ,$95.20 ,$38.50 ,$72.80 ,$6.60 ,$6.30 ,$40.43 ,$148.75 ,$44.61 ,$49.00 ,$157.50 ,$147.00 ,$140.00 ,$140.00 ,$38.50 ,$113.75 
ST. FRANCIS HOSPITAL - ACUTE,30201140,86905,HC RBC AG TYPING NON ABO/RH T3-90,302,1 ,$249.00 ,$161.85 ,$6.30 ,$743.63 ,$143.18 ,$179.28 ,$135.46 ,$54.78 ,$69.72 ,$35.03 ,$54.78 ,$44.61 ,$62.25 ,$44.61 ,$44.61 ,$62.25 ,$44.61 ,$104.08 ,$209.16 ,$743.63 ,$54.78 ,$211.65 ,$209.16 ,$54.78 ,$186.75 ,$199.20 ,$199.20 ,$54.78 ,$199.20 ,$209.16 ,$209.16 ,$209.16 ,$249.00 ,$224.10 ,$143.18 ,$249.00 ,$54.78 ,$249.00 ,$135.46 ,$54.78 ,$103.58 ,$6.60 ,$6.30 ,$57.52 ,$211.65 ,$44.61 ,$69.72 ,$224.10 ,$209.16 ,$199.20 ,$199.20 ,$54.78 ,$161.85 
ST. FRANCIS HOSPITAL - ACUTE,30201141,86905,HC RBC AG TYPING NON ABO/RH T4-90,302,1 ,$373.00 ,$242.45 ,$6.30 ,$743.63 ,$214.48 ,$268.56 ,$202.91 ,$82.06 ,$104.44 ,$35.03 ,$82.06 ,$44.61 ,$93.25 ,$44.61 ,$44.61 ,$93.25 ,$44.61 ,$155.91 ,$313.32 ,$743.63 ,$82.06 ,$317.05 ,$313.32 ,$82.06 ,$279.75 ,$298.40 ,$298.40 ,$82.06 ,$298.40 ,$313.32 ,$313.32 ,$313.32 ,$373.00 ,$335.70 ,$214.48 ,$373.00 ,$82.06 ,$373.00 ,$202.91 ,$82.06 ,$155.17 ,$6.60 ,$6.30 ,$86.16 ,$317.05 ,$44.61 ,$104.44 ,$335.70 ,$313.32 ,$298.40 ,$298.40 ,$82.06 ,$242.45 
ST. FRANCIS HOSPITAL - ACUTE,30201147,86870,HC RBC AB ID PANEL SERUM-90,302,1 ,$44.00 ,$28.60 ,$9.68 ,$743.63 ,$25.30 ,$31.68 ,$23.94 ,$9.68 ,$12.32 ,$25.87 ,$9.68 ,$30.23 ,$11.00 ,$30.23 ,$30.23 ,$11.00 ,$30.23 ,$18.39 ,$36.96 ,$743.63 ,$9.68 ,$37.40 ,$36.96 ,$9.68 ,$33.00 ,$35.20 ,$35.20 ,$9.68 ,$35.20 ,$36.96 ,$36.96 ,$36.96 ,$44.00 ,$39.60 ,$25.30 ,$44.00 ,$9.68 ,$44.00 ,$23.94 ,$9.68 ,$18.30 ,$10.65 ,$10.16 ,$10.16 ,$37.40 ,$30.23 ,$12.32 ,$39.60 ,$36.96 ,$35.20 ,$35.20 ,$9.68 ,$28.60 
ST. FRANCIS HOSPITAL - ACUTE,30201163,87427,HC SHIGA-LIKE TOXIN -90,302,1 ,$40.00 ,$26.00 ,$8.80 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$29.95 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$10.65 ,$10.16 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30201189,86015,HC ACTIN SMOOTH MUSC ANTIBODY- 90,302,1 ,$23.00 ,$14.95 ,$5.06 ,$28.83 ,$13.23 ,$16.56 ,$12.51 ,$5.06 ,$6.44 ,$12.90 ,$5.06 ,$15.00 ,$5.75 ,$15.00 ,$15.00 ,$5.75 ,$15.00 ,$9.61 ,$19.32 ,$28.83 ,$5.06 ,$19.55 ,$19.32 ,$5.06 ,$17.25 ,$18.40 ,$18.40 ,$5.06 ,$18.40 ,$19.32 ,$19.32 ,$19.32 ,$23.00 ,$20.70 ,$13.23 ,$23.00 ,$5.06 ,$23.00 ,$12.51 ,$5.06 ,$9.57 ,$10.65 ,$10.16 ,$5.31 ,$19.55 ,$15.00 ,$6.44 ,$20.70 ,$19.32 ,$18.40 ,$18.40 ,$5.06 ,$14.95 
ST. FRANCIS HOSPITAL - ACUTE,30201190,86036,HC ANTINEUTROPHIL CYTO ANTB SCREEN- 90,302,1 ,$105.00 ,$68.25 ,$10.16 ,$105.00 ,$60.38 ,$75.60 ,$57.12 ,$23.10 ,$29.40 ,$58.91 ,$23.10 ,$68.46 ,$26.25 ,$68.46 ,$68.46 ,$26.25 ,$68.46 ,$43.89 ,$88.20 ,$30.13 ,$23.10 ,$89.25 ,$88.20 ,$23.10 ,$78.75 ,$84.00 ,$84.00 ,$23.10 ,$84.00 ,$88.20 ,$88.20 ,$88.20 ,$105.00 ,$94.50 ,$60.38 ,$105.00 ,$23.10 ,$105.00 ,$57.12 ,$23.10 ,$43.68 ,$10.65 ,$10.16 ,$24.26 ,$89.25 ,$68.46 ,$29.40 ,$94.50 ,$88.20 ,$84.00 ,$84.00 ,$23.10 ,$68.25 
ST. FRANCIS HOSPITAL - ACUTE,30201191,86037,HC ANTINEUTROPHIL CYTOPLASMIC ANTIBODY TITER- 90,302,1 ,$105.00 ,$68.25 ,$10.16 ,$105.00 ,$60.38 ,$75.60 ,$57.12 ,$23.10 ,$29.40 ,$58.91 ,$23.10 ,$68.46 ,$26.25 ,$68.46 ,$68.46 ,$26.25 ,$68.46 ,$43.89 ,$88.20 ,$30.13 ,$23.10 ,$89.25 ,$88.20 ,$23.10 ,$78.75 ,$84.00 ,$84.00 ,$23.10 ,$84.00 ,$88.20 ,$88.20 ,$88.20 ,$105.00 ,$94.50 ,$60.38 ,$105.00 ,$23.10 ,$105.00 ,$57.12 ,$23.10 ,$43.68 ,$10.65 ,$10.16 ,$24.26 ,$89.25 ,$68.46 ,$29.40 ,$94.50 ,$88.20 ,$84.00 ,$84.00 ,$23.10 ,$68.25 
ST. FRANCIS HOSPITAL - ACUTE,30201192,86364,HC TISS TRANSGLUTAMINASE EA IMMUNO- 90,302,1 ,$75.00 ,$48.75 ,$10.16 ,$75.00 ,$43.13 ,$54.00 ,$40.80 ,$16.50 ,$21.00 ,$42.08 ,$16.50 ,$48.90 ,$18.75 ,$48.90 ,$48.90 ,$18.75 ,$48.90 ,$31.35 ,$63.00 ,$28.83 ,$16.50 ,$63.75 ,$63.00 ,$16.50 ,$56.25 ,$60.00 ,$60.00 ,$16.50 ,$60.00 ,$63.00 ,$63.00 ,$63.00 ,$75.00 ,$67.50 ,$43.13 ,$75.00 ,$16.50 ,$75.00 ,$40.80 ,$16.50 ,$31.20 ,$10.65 ,$10.16 ,$17.33 ,$63.75 ,$48.90 ,$21.00 ,$67.50 ,$63.00 ,$60.00 ,$60.00 ,$16.50 ,$48.75 
ST. FRANCIS HOSPITAL - ACUTE,30201193,86231,HC EMA EACH IG CLASS- 90,302,1 ,$36.00 ,$23.40 ,$7.92 ,$36.00 ,$20.70 ,$25.92 ,$19.58 ,$7.92 ,$10.08 ,$20.20 ,$7.92 ,$23.47 ,$9.00 ,$23.47 ,$23.47 ,$9.00 ,$23.47 ,$15.05 ,$30.24 ,$30.23 ,$7.92 ,$30.60 ,$30.24 ,$7.92 ,$27.00 ,$28.80 ,$28.80 ,$7.92 ,$28.80 ,$30.24 ,$30.24 ,$30.24 ,$36.00 ,$32.40 ,$20.70 ,$36.00 ,$7.92 ,$36.00 ,$19.58 ,$7.92 ,$14.98 ,$10.65 ,$10.16 ,$8.32 ,$30.60 ,$23.47 ,$10.08 ,$32.40 ,$30.24 ,$28.80 ,$28.80 ,$7.92 ,$23.40 
ST. FRANCIS HOSPITAL - ACUTE,30201194,86258,HC GLIADIN ANTIBODY EA- 90,302,1 ,$24.00 ,$15.60 ,$5.28 ,$28.83 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$13.46 ,$5.28 ,$15.65 ,$6.00 ,$15.65 ,$15.65 ,$6.00 ,$15.65 ,$10.03 ,$20.16 ,$28.83 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$10.65 ,$10.16 ,$5.54 ,$20.40 ,$15.65 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30201195,86381,HC MITOCHONDRIAL ANTIBODY- 90,302,1 ,$22.00 ,$14.30 ,$4.84 ,$55.00 ,$12.65 ,$15.84 ,$11.97 ,$4.84 ,$6.16 ,$12.34 ,$4.84 ,$14.34 ,$5.50 ,$14.34 ,$14.34 ,$5.50 ,$14.34 ,$9.20 ,$18.48 ,$55.00 ,$4.84 ,$18.70 ,$18.48 ,$4.84 ,$16.50 ,$17.60 ,$17.60 ,$4.84 ,$17.60 ,$18.48 ,$18.48 ,$18.48 ,$22.00 ,$19.80 ,$12.65 ,$22.00 ,$4.84 ,$22.00 ,$11.97 ,$4.84 ,$9.15 ,$10.65 ,$10.16 ,$5.08 ,$18.70 ,$14.34 ,$6.16 ,$19.80 ,$18.48 ,$17.60 ,$17.60 ,$4.84 ,$14.30 
ST. FRANCIS HOSPITAL - ACUTE,30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$42.00 ,$27.30 ,$7.05 ,$42.00 ,$24.15 ,$30.24 ,$22.85 ,$9.24 ,$11.76 ,$24.70 ,$9.24 ,$28.85 ,$10.50 ,$28.85 ,$28.85 ,$10.50 ,$28.85 ,$17.56 ,$35.28 ,$9.50 ,$9.24 ,$35.70 ,$35.28 ,$9.24 ,$31.50 ,$33.60 ,$33.60 ,$9.24 ,$33.60 ,$35.28 ,$35.28 ,$35.28 ,$42.00 ,$37.80 ,$24.15 ,$42.00 ,$9.24 ,$42.00 ,$22.85 ,$9.24 ,$17.47 ,$7.38 ,$7.05 ,$9.70 ,$35.70 ,$28.85 ,$11.76 ,$37.80 ,$35.28 ,$33.60 ,$33.60 ,$9.24 ,$27.30 
ST. FRANCIS HOSPITAL - ACUTE,30500104,85014,HC HEMATOCRIT,305,1 ,$32.00 ,$20.80 ,$2.37 ,$32.00 ,$18.40 ,$23.04 ,$17.41 ,$7.04 ,$8.96 ,$18.82 ,$7.04 ,$21.98 ,$8.00 ,$21.98 ,$21.98 ,$8.00 ,$21.98 ,$13.38 ,$26.88 ,$5.93 ,$7.04 ,$27.20 ,$26.88 ,$7.04 ,$24.00 ,$25.60 ,$25.60 ,$7.04 ,$25.60 ,$26.88 ,$26.88 ,$26.88 ,$32.00 ,$28.80 ,$18.40 ,$32.00 ,$7.04 ,$2.37 ,$17.41 ,$7.04 ,$13.31 ,$7.38 ,$7.05 ,$7.39 ,$27.20 ,$21.98 ,$8.96 ,$28.80 ,$26.88 ,$25.60 ,$25.60 ,$7.04 ,$20.80 
ST. FRANCIS HOSPITAL - ACUTE,30500106,85018,HC HGB,305,1 ,$32.00 ,$20.80 ,$2.37 ,$32.00 ,$18.40 ,$23.04 ,$17.41 ,$7.04 ,$8.96 ,$18.82 ,$7.04 ,$21.98 ,$8.00 ,$21.98 ,$21.98 ,$8.00 ,$21.98 ,$13.38 ,$26.88 ,$5.93 ,$7.04 ,$27.20 ,$26.88 ,$7.04 ,$24.00 ,$25.60 ,$25.60 ,$7.04 ,$25.60 ,$26.88 ,$26.88 ,$26.88 ,$32.00 ,$28.80 ,$18.40 ,$32.00 ,$7.04 ,$2.37 ,$17.41 ,$7.04 ,$13.31 ,$7.38 ,$7.05 ,$7.39 ,$27.20 ,$21.98 ,$8.96 ,$28.80 ,$26.88 ,$25.60 ,$25.60 ,$7.04 ,$20.80 
ST. FRANCIS HOSPITAL - ACUTE,30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$154.00 ,$100.10 ,$7.05 ,$154.00 ,$88.55 ,$110.88 ,$83.78 ,$33.88 ,$43.12 ,$90.55 ,$33.88 ,$105.80 ,$38.50 ,$105.80 ,$105.80 ,$38.50 ,$105.80 ,$64.37 ,$129.36 ,$19.43 ,$33.88 ,$130.90 ,$129.36 ,$33.88 ,$115.50 ,$123.20 ,$123.20 ,$33.88 ,$123.20 ,$129.36 ,$129.36 ,$129.36 ,$154.00 ,$138.60 ,$88.55 ,$154.00 ,$33.88 ,$7.77 ,$83.78 ,$33.88 ,$64.06 ,$7.38 ,$7.05 ,$35.57 ,$130.90 ,$105.80 ,$43.12 ,$138.60 ,$129.36 ,$123.20 ,$123.20 ,$33.88 ,$100.10 
ST. FRANCIS HOSPITAL - ACUTE,30500108,85027,HC CBC W/O DIFF,305,1 ,$124.00 ,$80.60 ,$6.47 ,$124.00 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$16.18 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$6.47 ,$67.46 ,$27.28 ,$51.58 ,$7.38 ,$7.05 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$32.00 ,$20.80 ,$6.35 ,$32.00 ,$18.40 ,$23.04 ,$17.41 ,$7.04 ,$8.96 ,$18.82 ,$7.04 ,$21.98 ,$8.00 ,$21.98 ,$21.98 ,$8.00 ,$21.98 ,$13.38 ,$26.88 ,$6.35 ,$7.04 ,$27.20 ,$26.88 ,$7.04 ,$24.00 ,$25.60 ,$25.60 ,$7.04 ,$25.60 ,$26.88 ,$26.88 ,$26.88 ,$32.00 ,$28.80 ,$18.40 ,$32.00 ,$7.04 ,$32.00 ,$17.41 ,$7.04 ,$13.31 ,$7.38 ,$7.05 ,$7.39 ,$27.20 ,$21.98 ,$8.96 ,$28.80 ,$26.88 ,$25.60 ,$25.60 ,$7.04 ,$20.80 
ST. FRANCIS HOSPITAL - ACUTE,30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$70.00 ,$45.50 ,$7.05 ,$70.00 ,$40.25 ,$50.40 ,$38.08 ,$15.40 ,$19.60 ,$41.16 ,$15.40 ,$48.09 ,$17.50 ,$48.09 ,$48.09 ,$17.50 ,$48.09 ,$29.26 ,$58.80 ,$11.20 ,$15.40 ,$59.50 ,$58.80 ,$15.40 ,$52.50 ,$56.00 ,$56.00 ,$15.40 ,$56.00 ,$58.80 ,$58.80 ,$58.80 ,$70.00 ,$63.00 ,$40.25 ,$70.00 ,$15.40 ,$70.00 ,$38.08 ,$15.40 ,$29.12 ,$7.38 ,$7.05 ,$16.17 ,$59.50 ,$48.09 ,$19.60 ,$63.00 ,$58.80 ,$56.00 ,$56.00 ,$15.40 ,$45.50 
ST. FRANCIS HOSPITAL - ACUTE,30500175,85379,HC D DIMER QN,305,1 ,$135.00 ,$87.75 ,$12.22 ,$135.00 ,$77.63 ,$97.20 ,$73.44 ,$29.70 ,$37.80 ,$79.38 ,$29.70 ,$92.75 ,$33.75 ,$92.75 ,$92.75 ,$33.75 ,$92.75 ,$56.43 ,$113.40 ,$25.45 ,$29.70 ,$114.75 ,$113.40 ,$29.70 ,$101.25 ,$108.00 ,$108.00 ,$29.70 ,$108.00 ,$113.40 ,$113.40 ,$113.40 ,$135.00 ,$121.50 ,$77.63 ,$135.00 ,$29.70 ,$135.00 ,$73.44 ,$29.70 ,$56.16 ,$12.80 ,$12.22 ,$31.19 ,$114.75 ,$92.75 ,$37.80 ,$121.50 ,$113.40 ,$108.00 ,$108.00 ,$29.70 ,$87.75 
ST. FRANCIS HOSPITAL - ACUTE,30500176,85384,HC FIBRINOGEN,305,1 ,$204.00 ,$132.60 ,$4.12 ,$204.00 ,$117.30 ,$146.88 ,$110.98 ,$44.88 ,$57.12 ,$77.82 ,$44.88 ,$99.09 ,$51.00 ,$99.09 ,$99.09 ,$51.00 ,$99.09 ,$85.27 ,$171.36 ,$24.30 ,$44.88 ,$173.40 ,$171.36 ,$44.88 ,$153.00 ,$163.20 ,$163.20 ,$44.88 ,$163.20 ,$171.36 ,$171.36 ,$171.36 ,$204.00 ,$183.60 ,$117.30 ,$204.00 ,$44.88 ,$204.00 ,$110.98 ,$44.88 ,$84.86 ,$4.31 ,$4.12 ,$47.12 ,$173.40 ,$99.09 ,$57.12 ,$183.60 ,$171.36 ,$163.20 ,$163.20 ,$44.88 ,$132.60 
ST. FRANCIS HOSPITAL - ACUTE,30500187,85520,HC HEPARIN ASSAY,305,1 ,$155.00 ,$100.75 ,$12.22 ,$155.00 ,$89.13 ,$111.60 ,$84.32 ,$34.10 ,$43.40 ,$91.14 ,$34.10 ,$106.49 ,$38.75 ,$106.49 ,$106.49 ,$38.75 ,$106.49 ,$64.79 ,$130.20 ,$32.73 ,$34.10 ,$131.75 ,$130.20 ,$34.10 ,$116.25 ,$124.00 ,$124.00 ,$34.10 ,$124.00 ,$130.20 ,$130.20 ,$130.20 ,$155.00 ,$139.50 ,$89.13 ,$155.00 ,$34.10 ,$155.00 ,$84.32 ,$34.10 ,$64.48 ,$12.80 ,$12.22 ,$35.81 ,$131.75 ,$106.49 ,$43.40 ,$139.50 ,$130.20 ,$124.00 ,$124.00 ,$34.10 ,$100.75 
ST. FRANCIS HOSPITAL - ACUTE,30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$70.00 ,$45.50 ,$4.12 ,$70.00 ,$40.25 ,$50.40 ,$38.08 ,$15.40 ,$19.60 ,$41.16 ,$15.40 ,$48.09 ,$17.50 ,$48.09 ,$48.09 ,$17.50 ,$48.09 ,$29.26 ,$58.80 ,$10.73 ,$15.40 ,$59.50 ,$58.80 ,$15.40 ,$52.50 ,$56.00 ,$56.00 ,$15.40 ,$56.00 ,$58.80 ,$58.80 ,$58.80 ,$70.00 ,$63.00 ,$40.25 ,$70.00 ,$15.40 ,$70.00 ,$38.08 ,$15.40 ,$29.12 ,$4.31 ,$4.12 ,$16.17 ,$59.50 ,$48.09 ,$19.60 ,$63.00 ,$58.80 ,$56.00 ,$56.00 ,$15.40 ,$45.50 
ST. FRANCIS HOSPITAL - ACUTE,30500205,85652,HC SED RATE AUTO,305,1 ,$75.00 ,$48.75 ,$6.75 ,$75.00 ,$43.13 ,$54.00 ,$40.80 ,$16.50 ,$21.00 ,$33.43 ,$16.50 ,$42.57 ,$18.75 ,$42.57 ,$42.57 ,$18.75 ,$42.57 ,$31.35 ,$63.00 ,$6.75 ,$16.50 ,$63.75 ,$63.00 ,$16.50 ,$56.25 ,$60.00 ,$60.00 ,$16.50 ,$60.00 ,$63.00 ,$63.00 ,$63.00 ,$75.00 ,$67.50 ,$43.13 ,$75.00 ,$16.50 ,$75.00 ,$40.80 ,$16.50 ,$31.20 ,$7.38 ,$7.05 ,$17.33 ,$63.75 ,$42.57 ,$21.00 ,$67.50 ,$63.00 ,$60.00 ,$60.00 ,$16.50 ,$48.75 
ST. FRANCIS HOSPITAL - ACUTE,30500211,85730,HC PTT,305,1 ,$116.00 ,$75.40 ,$4.12 ,$116.00 ,$66.70 ,$83.52 ,$63.10 ,$25.52 ,$32.48 ,$68.21 ,$25.52 ,$79.69 ,$29.00 ,$79.69 ,$79.69 ,$29.00 ,$79.69 ,$48.49 ,$97.44 ,$15.03 ,$25.52 ,$98.60 ,$97.44 ,$25.52 ,$87.00 ,$92.80 ,$92.80 ,$25.52 ,$92.80 ,$97.44 ,$97.44 ,$97.44 ,$116.00 ,$104.40 ,$66.70 ,$116.00 ,$25.52 ,$116.00 ,$63.10 ,$25.52 ,$48.26 ,$4.31 ,$4.12 ,$26.80 ,$98.60 ,$79.69 ,$32.48 ,$104.40 ,$97.44 ,$92.80 ,$92.80 ,$25.52 ,$75.40 
ST. FRANCIS HOSPITAL - ACUTE,30500234,85014,HC HEMATOCRIT-90,305,1 ,$10.00 ,$6.50 ,$2.20 ,$10.00 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.88 ,$2.20 ,$6.87 ,$2.50 ,$6.87 ,$6.87 ,$2.50 ,$6.87 ,$4.18 ,$8.40 ,$5.93 ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$2.37 ,$5.44 ,$2.20 ,$4.16 ,$7.38 ,$7.05 ,$2.31 ,$8.50 ,$6.87 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,30500238,85018,HC HGB-90,305,1 ,$10.00 ,$6.50 ,$2.20 ,$10.00 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.88 ,$2.20 ,$6.87 ,$2.50 ,$6.87 ,$6.87 ,$2.50 ,$6.87 ,$4.18 ,$8.40 ,$5.93 ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$2.37 ,$5.44 ,$2.20 ,$4.16 ,$7.38 ,$7.05 ,$2.31 ,$8.50 ,$6.87 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,30500244,85041,HC BLOOD COUNT RBC AUTO-90,305,1 ,$10.00 ,$6.50 ,$2.20 ,$10.00 ,$5.75 ,$7.20 ,$5.44 ,$2.20 ,$2.80 ,$5.88 ,$2.20 ,$6.87 ,$2.50 ,$6.87 ,$6.87 ,$2.50 ,$6.87 ,$4.18 ,$8.40 ,$7.55 ,$2.20 ,$8.50 ,$8.40 ,$2.20 ,$7.50 ,$8.00 ,$8.00 ,$2.20 ,$8.00 ,$8.40 ,$8.40 ,$8.40 ,$10.00 ,$9.00 ,$5.75 ,$10.00 ,$2.20 ,$10.00 ,$5.44 ,$2.20 ,$4.16 ,$7.38 ,$7.05 ,$2.31 ,$8.50 ,$6.87 ,$2.80 ,$9.00 ,$8.40 ,$8.00 ,$8.00 ,$2.20 ,$6.50 
ST. FRANCIS HOSPITAL - ACUTE,30500249,85210,HC FACTOR II-90,305,1 ,$88.00 ,$57.20 ,$4.12 ,$88.00 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$51.74 ,$19.36 ,$60.46 ,$22.00 ,$60.46 ,$60.46 ,$22.00 ,$60.46 ,$36.78 ,$73.92 ,$32.45 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$88.00 ,$47.87 ,$19.36 ,$36.61 ,$4.31 ,$4.12 ,$20.33 ,$74.80 ,$60.46 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,30500250,85220,HC FACTOR V-90,305,1 ,$88.00 ,$57.20 ,$12.22 ,$88.00 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$51.74 ,$19.36 ,$60.46 ,$22.00 ,$60.46 ,$60.46 ,$22.00 ,$60.46 ,$36.78 ,$73.92 ,$44.13 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$88.00 ,$47.87 ,$19.36 ,$36.61 ,$12.80 ,$12.22 ,$20.33 ,$74.80 ,$60.46 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,30500251,85230,HC FACTOR VII-90,305,1 ,$82.00 ,$53.30 ,$12.22 ,$82.00 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$48.22 ,$18.04 ,$56.33 ,$20.50 ,$56.33 ,$56.33 ,$20.50 ,$56.33 ,$34.28 ,$68.88 ,$44.75 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 ,$12.80 ,$12.22 ,$18.94 ,$69.70 ,$56.33 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,30500252,85240,HC FACTOR VIII AHG-90,305,1 ,$222.00 ,$144.30 ,$12.22 ,$222.00 ,$127.65 ,$159.84 ,$120.77 ,$48.84 ,$62.16 ,$130.54 ,$48.84 ,$152.51 ,$55.50 ,$152.51 ,$152.51 ,$55.50 ,$152.51 ,$92.80 ,$186.48 ,$44.75 ,$48.84 ,$188.70 ,$186.48 ,$48.84 ,$166.50 ,$177.60 ,$177.60 ,$48.84 ,$177.60 ,$186.48 ,$186.48 ,$186.48 ,$222.00 ,$199.80 ,$127.65 ,$222.00 ,$48.84 ,$222.00 ,$120.77 ,$48.84 ,$92.35 ,$12.80 ,$12.22 ,$51.28 ,$188.70 ,$152.51 ,$62.16 ,$199.80 ,$186.48 ,$177.60 ,$177.60 ,$48.84 ,$144.30 
ST. FRANCIS HOSPITAL - ACUTE,30500253,85245,HC FACTOR VIII VW RISTO-90,305,1 ,$57.00 ,$37.05 ,$12.22 ,$57.35 ,$32.78 ,$41.04 ,$31.01 ,$12.54 ,$15.96 ,$33.52 ,$12.54 ,$39.16 ,$14.25 ,$39.16 ,$39.16 ,$14.25 ,$39.16 ,$23.83 ,$47.88 ,$57.35 ,$12.54 ,$48.45 ,$47.88 ,$12.54 ,$42.75 ,$45.60 ,$45.60 ,$12.54 ,$45.60 ,$47.88 ,$47.88 ,$47.88 ,$57.00 ,$51.30 ,$32.78 ,$57.00 ,$12.54 ,$57.00 ,$31.01 ,$12.54 ,$23.71 ,$12.80 ,$12.22 ,$13.17 ,$48.45 ,$39.16 ,$15.96 ,$51.30 ,$47.88 ,$45.60 ,$45.60 ,$12.54 ,$37.05 
ST. FRANCIS HOSPITAL - ACUTE,30500254,85246,HC FACTOR VIII VW AG-90,305,1 ,$80.00 ,$52.00 ,$12.22 ,$80.00 ,$46.00 ,$57.60 ,$43.52 ,$17.60 ,$22.40 ,$47.04 ,$17.60 ,$54.96 ,$20.00 ,$54.96 ,$54.96 ,$20.00 ,$54.96 ,$33.44 ,$67.20 ,$57.35 ,$17.60 ,$68.00 ,$67.20 ,$17.60 ,$60.00 ,$64.00 ,$64.00 ,$17.60 ,$64.00 ,$67.20 ,$67.20 ,$67.20 ,$80.00 ,$72.00 ,$46.00 ,$80.00 ,$17.60 ,$80.00 ,$43.52 ,$17.60 ,$33.28 ,$12.80 ,$12.22 ,$18.48 ,$68.00 ,$54.96 ,$22.40 ,$72.00 ,$67.20 ,$64.00 ,$64.00 ,$17.60 ,$52.00 
ST. FRANCIS HOSPITAL - ACUTE,30500256,85250,HC FACTOR IX-90,305,1 ,$72.00 ,$46.80 ,$12.22 ,$72.00 ,$41.40 ,$51.84 ,$39.17 ,$15.84 ,$20.16 ,$42.34 ,$15.84 ,$49.46 ,$18.00 ,$49.46 ,$49.46 ,$18.00 ,$49.46 ,$30.10 ,$60.48 ,$47.60 ,$15.84 ,$61.20 ,$60.48 ,$15.84 ,$54.00 ,$57.60 ,$57.60 ,$15.84 ,$57.60 ,$60.48 ,$60.48 ,$60.48 ,$72.00 ,$64.80 ,$41.40 ,$72.00 ,$15.84 ,$72.00 ,$39.17 ,$15.84 ,$29.95 ,$12.80 ,$12.22 ,$16.63 ,$61.20 ,$49.46 ,$20.16 ,$64.80 ,$60.48 ,$57.60 ,$57.60 ,$15.84 ,$46.80 
ST. FRANCIS HOSPITAL - ACUTE,30500257,85260,HC FACTOR X-90,305,1 ,$88.00 ,$57.20 ,$12.22 ,$88.00 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$51.74 ,$19.36 ,$60.46 ,$22.00 ,$60.46 ,$60.46 ,$22.00 ,$60.46 ,$36.78 ,$73.92 ,$44.75 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$88.00 ,$47.87 ,$19.36 ,$36.61 ,$12.80 ,$12.22 ,$20.33 ,$74.80 ,$60.46 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,30500258,85270,HC FACTOR XI-90,305,1 ,$40.00 ,$26.00 ,$8.80 ,$44.75 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$44.75 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$12.80 ,$12.22 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30500260,85291,HC FACTOR XII-90,305,1 ,$40.00 ,$26.00 ,$8.80 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$22.78 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$12.80 ,$12.22 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30500261,85300,HC ANTITHROMBIN III ACT-90,305,1 ,$78.00 ,$50.70 ,$12.22 ,$78.00 ,$44.85 ,$56.16 ,$42.43 ,$17.16 ,$21.84 ,$45.86 ,$17.16 ,$53.59 ,$19.50 ,$53.59 ,$53.59 ,$19.50 ,$53.59 ,$32.60 ,$65.52 ,$29.63 ,$17.16 ,$66.30 ,$65.52 ,$17.16 ,$58.50 ,$62.40 ,$62.40 ,$17.16 ,$62.40 ,$65.52 ,$65.52 ,$65.52 ,$78.00 ,$70.20 ,$44.85 ,$78.00 ,$17.16 ,$78.00 ,$42.43 ,$17.16 ,$32.45 ,$12.80 ,$12.22 ,$18.02 ,$66.30 ,$53.59 ,$21.84 ,$70.20 ,$65.52 ,$62.40 ,$62.40 ,$17.16 ,$50.70 
ST. FRANCIS HOSPITAL - ACUTE,30500262,85301,HC ANTITHROMBIN III AG-90,305,1 ,$40.00 ,$26.00 ,$8.80 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$27.03 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$12.80 ,$12.22 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30500263,85302,HC PROTEIN C AG-90,305,1 ,$80.00 ,$52.00 ,$12.22 ,$80.00 ,$46.00 ,$57.60 ,$43.52 ,$17.60 ,$22.40 ,$47.04 ,$17.60 ,$54.96 ,$20.00 ,$54.96 ,$54.96 ,$20.00 ,$54.96 ,$33.44 ,$67.20 ,$30.03 ,$17.60 ,$68.00 ,$67.20 ,$17.60 ,$60.00 ,$64.00 ,$64.00 ,$17.60 ,$64.00 ,$67.20 ,$67.20 ,$67.20 ,$80.00 ,$72.00 ,$46.00 ,$80.00 ,$17.60 ,$80.00 ,$43.52 ,$17.60 ,$33.28 ,$12.80 ,$12.22 ,$18.48 ,$68.00 ,$54.96 ,$22.40 ,$72.00 ,$67.20 ,$64.00 ,$64.00 ,$17.60 ,$52.00 
ST. FRANCIS HOSPITAL - ACUTE,30500264,85303,HC PROTEIN C ACTIVITY-90,305,1 ,$130.00 ,$84.50 ,$12.22 ,$130.00 ,$74.75 ,$93.60 ,$70.72 ,$28.60 ,$36.40 ,$76.44 ,$28.60 ,$89.31 ,$32.50 ,$89.31 ,$89.31 ,$32.50 ,$89.31 ,$54.34 ,$109.20 ,$34.60 ,$28.60 ,$110.50 ,$109.20 ,$28.60 ,$97.50 ,$104.00 ,$104.00 ,$28.60 ,$104.00 ,$109.20 ,$109.20 ,$109.20 ,$130.00 ,$117.00 ,$74.75 ,$130.00 ,$28.60 ,$130.00 ,$70.72 ,$28.60 ,$54.08 ,$12.80 ,$12.22 ,$30.03 ,$110.50 ,$89.31 ,$36.40 ,$117.00 ,$109.20 ,$104.00 ,$104.00 ,$28.60 ,$84.50 
ST. FRANCIS HOSPITAL - ACUTE,30500265,85305,HC PROTEIN S TOTAL-90,305,1 ,$77.00 ,$50.05 ,$12.22 ,$77.00 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$29.03 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$12.80 ,$12.22 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,30500266,85306,HC PROTEIN S FREE-90,305,1 ,$75.00 ,$48.75 ,$12.22 ,$75.00 ,$43.13 ,$54.00 ,$40.80 ,$16.50 ,$21.00 ,$44.10 ,$16.50 ,$51.53 ,$18.75 ,$51.53 ,$51.53 ,$18.75 ,$51.53 ,$31.35 ,$63.00 ,$38.30 ,$16.50 ,$63.75 ,$63.00 ,$16.50 ,$56.25 ,$60.00 ,$60.00 ,$16.50 ,$60.00 ,$63.00 ,$63.00 ,$63.00 ,$75.00 ,$67.50 ,$43.13 ,$75.00 ,$16.50 ,$75.00 ,$40.80 ,$16.50 ,$31.20 ,$12.80 ,$12.22 ,$17.33 ,$63.75 ,$51.53 ,$21.00 ,$67.50 ,$63.00 ,$60.00 ,$60.00 ,$16.50 ,$48.75 
ST. FRANCIS HOSPITAL - ACUTE,30500267,85307,HC ACTIVATED PROTEIN C RESIST-90,305,1 ,$50.00 ,$32.50 ,$11.00 ,$50.00 ,$28.75 ,$36.00 ,$27.20 ,$11.00 ,$14.00 ,$29.40 ,$11.00 ,$34.35 ,$12.50 ,$34.35 ,$34.35 ,$12.50 ,$34.35 ,$20.90 ,$42.00 ,$38.30 ,$11.00 ,$42.50 ,$42.00 ,$11.00 ,$37.50 ,$40.00 ,$40.00 ,$11.00 ,$40.00 ,$42.00 ,$42.00 ,$42.00 ,$50.00 ,$45.00 ,$28.75 ,$50.00 ,$11.00 ,$50.00 ,$27.20 ,$11.00 ,$20.80 ,$11.89 ,$11.35 ,$11.55 ,$42.50 ,$34.35 ,$14.00 ,$45.00 ,$42.00 ,$40.00 ,$40.00 ,$11.00 ,$32.50 
ST. FRANCIS HOSPITAL - ACUTE,30500276,85397,HC COAGUL/FIBRINOLYSIS CLOT ACT-90,305,1 ,$212.00 ,$137.80 ,$12.22 ,$212.00 ,$121.90 ,$152.64 ,$115.33 ,$46.64 ,$59.36 ,$124.66 ,$46.64 ,$145.64 ,$53.00 ,$145.64 ,$145.64 ,$53.00 ,$145.64 ,$88.62 ,$178.08 ,$77.15 ,$46.64 ,$180.20 ,$178.08 ,$46.64 ,$159.00 ,$169.60 ,$169.60 ,$46.64 ,$169.60 ,$178.08 ,$178.08 ,$178.08 ,$212.00 ,$190.80 ,$121.90 ,$212.00 ,$46.64 ,$212.00 ,$115.33 ,$46.64 ,$88.19 ,$12.80 ,$12.22 ,$48.97 ,$180.20 ,$145.64 ,$59.36 ,$190.80 ,$178.08 ,$169.60 ,$169.60 ,$46.64 ,$137.80 
ST. FRANCIS HOSPITAL - ACUTE,30500289,85597,HC PLATELET NEUTRALIZATION-90,305,1 ,$124.00 ,$80.60 ,$12.22 ,$124.00 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$44.95 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$12.80 ,$12.22 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,30500290,85598,HC HEXAGN NEUTRALIZATION PHOSPH-90,305,1 ,$44.00 ,$28.60 ,$9.68 ,$44.95 ,$25.30 ,$31.68 ,$23.94 ,$9.68 ,$12.32 ,$25.87 ,$9.68 ,$30.23 ,$11.00 ,$30.23 ,$30.23 ,$11.00 ,$30.23 ,$18.39 ,$36.96 ,$44.95 ,$9.68 ,$37.40 ,$36.96 ,$9.68 ,$33.00 ,$35.20 ,$35.20 ,$9.68 ,$35.20 ,$36.96 ,$36.96 ,$36.96 ,$44.00 ,$39.60 ,$25.30 ,$44.00 ,$9.68 ,$44.00 ,$23.94 ,$9.68 ,$18.30 ,$12.80 ,$12.22 ,$10.16 ,$37.40 ,$30.23 ,$12.32 ,$39.60 ,$36.96 ,$35.20 ,$35.20 ,$9.68 ,$28.60 
ST. FRANCIS HOSPITAL - ACUTE,30500297,85613,HC RUSSELL VIPER VENOM SCR T1-90,305,1 ,$60.00 ,$39.00 ,$12.22 ,$60.00 ,$34.50 ,$43.20 ,$32.64 ,$13.20 ,$16.80 ,$35.28 ,$13.20 ,$41.22 ,$15.00 ,$41.22 ,$41.22 ,$15.00 ,$41.22 ,$25.08 ,$50.40 ,$23.95 ,$13.20 ,$51.00 ,$50.40 ,$13.20 ,$45.00 ,$48.00 ,$48.00 ,$13.20 ,$48.00 ,$50.40 ,$50.40 ,$50.40 ,$60.00 ,$54.00 ,$34.50 ,$60.00 ,$13.20 ,$60.00 ,$32.64 ,$13.20 ,$24.96 ,$12.80 ,$12.22 ,$13.86 ,$51.00 ,$41.22 ,$16.80 ,$54.00 ,$50.40 ,$48.00 ,$48.00 ,$13.20 ,$39.00 
ST. FRANCIS HOSPITAL - ACUTE,30500304,85670,HC THROMBIN TIME PLASMA-90,305,1 ,$44.00 ,$28.60 ,$4.12 ,$44.00 ,$25.30 ,$31.68 ,$23.94 ,$9.68 ,$12.32 ,$25.87 ,$9.68 ,$30.23 ,$11.00 ,$30.23 ,$30.23 ,$11.00 ,$30.23 ,$18.39 ,$36.96 ,$14.43 ,$9.68 ,$37.40 ,$36.96 ,$9.68 ,$33.00 ,$35.20 ,$35.20 ,$9.68 ,$35.20 ,$36.96 ,$36.96 ,$36.96 ,$44.00 ,$39.60 ,$25.30 ,$44.00 ,$9.68 ,$44.00 ,$23.94 ,$9.68 ,$18.30 ,$4.31 ,$4.12 ,$10.16 ,$37.40 ,$30.23 ,$12.32 ,$39.60 ,$36.96 ,$35.20 ,$35.20 ,$9.68 ,$28.60 
ST. FRANCIS HOSPITAL - ACUTE,30500305,85730,HC PTT-90,305,1 ,$49.00 ,$31.85 ,$4.12 ,$49.00 ,$28.18 ,$35.28 ,$26.66 ,$10.78 ,$13.72 ,$28.81 ,$10.78 ,$33.66 ,$12.25 ,$33.66 ,$33.66 ,$12.25 ,$33.66 ,$20.48 ,$41.16 ,$15.03 ,$10.78 ,$41.65 ,$41.16 ,$10.78 ,$36.75 ,$39.20 ,$39.20 ,$10.78 ,$39.20 ,$41.16 ,$41.16 ,$41.16 ,$49.00 ,$44.10 ,$28.18 ,$49.00 ,$10.78 ,$49.00 ,$26.66 ,$10.78 ,$20.38 ,$4.31 ,$4.12 ,$11.32 ,$41.65 ,$33.66 ,$13.72 ,$44.10 ,$41.16 ,$39.20 ,$39.20 ,$10.78 ,$31.85 
ST. FRANCIS HOSPITAL - ACUTE,30500310,85810,HC VISCOSITY-90,305,1 ,$40.00 ,$26.00 ,$8.80 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$29.18 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$11.23 ,$10.72 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30500341,85046,HC BLOOD COUNT RETICULOCYTES AUTO,305,1 ,$85.00 ,$55.25 ,$7.05 ,$85.00 ,$48.88 ,$61.20 ,$46.24 ,$18.70 ,$23.80 ,$49.98 ,$18.70 ,$58.40 ,$21.25 ,$58.40 ,$58.40 ,$21.25 ,$58.40 ,$35.53 ,$71.40 ,$13.93 ,$18.70 ,$72.25 ,$71.40 ,$18.70 ,$63.75 ,$68.00 ,$68.00 ,$18.70 ,$68.00 ,$71.40 ,$71.40 ,$71.40 ,$85.00 ,$76.50 ,$48.88 ,$85.00 ,$18.70 ,$85.00 ,$46.24 ,$18.70 ,$35.36 ,$7.38 ,$7.05 ,$19.64 ,$72.25 ,$58.40 ,$23.80 ,$76.50 ,$71.40 ,$68.00 ,$68.00 ,$18.70 ,$55.25 
ST. FRANCIS HOSPITAL - ACUTE,30500829,85300,HC ANTITHROMBIN III ACT,305,1 ,$102.00 ,$66.30 ,$12.22 ,$102.00 ,$58.65 ,$73.44 ,$55.49 ,$22.44 ,$28.56 ,$59.98 ,$22.44 ,$70.07 ,$25.50 ,$70.07 ,$70.07 ,$25.50 ,$70.07 ,$42.64 ,$85.68 ,$29.63 ,$22.44 ,$86.70 ,$85.68 ,$22.44 ,$76.50 ,$81.60 ,$81.60 ,$22.44 ,$81.60 ,$85.68 ,$85.68 ,$85.68 ,$102.00 ,$91.80 ,$58.65 ,$102.00 ,$22.44 ,$102.00 ,$55.49 ,$22.44 ,$42.43 ,$12.80 ,$12.22 ,$23.56 ,$86.70 ,$70.07 ,$28.56 ,$91.80 ,$85.68 ,$81.60 ,$81.60 ,$22.44 ,$66.30 
ST. FRANCIS HOSPITAL - ACUTE,30500832,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$210.00 ,$136.50 ,$10.72 ,$210.00 ,$120.75 ,$151.20 ,$114.24 ,$46.20 ,$58.80 ,$70.86 ,$46.20 ,$90.23 ,$52.50 ,$90.23 ,$90.23 ,$52.50 ,$90.23 ,$87.78 ,$176.40 ,$19.33 ,$46.20 ,$178.50 ,$176.40 ,$46.20 ,$157.50 ,$168.00 ,$168.00 ,$46.20 ,$168.00 ,$176.40 ,$176.40 ,$176.40 ,$210.00 ,$189.00 ,$120.75 ,$210.00 ,$46.20 ,$210.00 ,$114.24 ,$46.20 ,$87.36 ,$11.23 ,$10.72 ,$48.51 ,$178.50 ,$90.23 ,$58.80 ,$189.00 ,$176.40 ,$168.00 ,$168.00 ,$46.20 ,$136.50 
ST. FRANCIS HOSPITAL - ACUTE,30500833,85520,HC HEPARIN ASSAY,305,1 ,$75.00 ,$48.75 ,$12.22 ,$75.00 ,$43.13 ,$54.00 ,$40.80 ,$16.50 ,$21.00 ,$44.10 ,$16.50 ,$51.53 ,$18.75 ,$51.53 ,$51.53 ,$18.75 ,$51.53 ,$31.35 ,$63.00 ,$32.73 ,$16.50 ,$63.75 ,$63.00 ,$16.50 ,$56.25 ,$60.00 ,$60.00 ,$16.50 ,$60.00 ,$63.00 ,$63.00 ,$63.00 ,$75.00 ,$67.50 ,$43.13 ,$75.00 ,$16.50 ,$75.00 ,$40.80 ,$16.50 ,$31.20 ,$12.80 ,$12.22 ,$17.33 ,$63.75 ,$51.53 ,$21.00 ,$67.50 ,$63.00 ,$60.00 ,$60.00 ,$16.50 ,$48.75 
ST. FRANCIS HOSPITAL - ACUTE,30500835,85576,HC PLATELET AGGREGATION EA-90,305,1 ,$45.00 ,$29.25 ,$9.90 ,$62.28 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$62.28 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$12.80 ,$12.22 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30530180,85999,HC URINE EOSINOPHIL COUNT- 90,305,1 ,$68.00 ,$44.20 ,$7.05 ,$68.00 , N/A ,$48.96 ,$36.99 , N/A ,$19.04 ,$38.15 , N/A ,$44.34 , N/A ,$44.34 ,$44.34 , N/A ,$44.34 , N/A ,$57.12 ,$47.60 , N/A ,$57.80 ,$57.12 , N/A ,$51.00 ,$54.40 ,$54.40 , N/A ,$54.40 ,$57.12 ,$57.12 ,$57.12 ,$68.00 ,$61.20 , N/A ,$68.00 , N/A ,$68.00 ,$36.99 , N/A ,$28.29 ,$7.38 ,$7.05 , N/A ,$57.80 ,$44.34 ,$19.04 ,$61.20 ,$57.12 ,$54.40 ,$54.40 , N/A ,$44.20 
ST. FRANCIS HOSPITAL - ACUTE,30600102,87040,HC BLOOD CULTURE,306,1 ,$436.00 ,$283.40 ,$25.80 ,$436.00 ,$250.70 ,$313.92 ,$237.18 ,$95.92 ,$122.08 ,$94.47 ,$95.92 ,$120.31 ,$109.00 ,$120.31 ,$120.31 ,$109.00 ,$120.31 ,$182.25 ,$366.24 ,$25.80 ,$95.92 ,$370.60 ,$366.24 ,$95.92 ,$327.00 ,$348.80 ,$348.80 ,$95.92 ,$348.80 ,$366.24 ,$366.24 ,$366.24 ,$436.00 ,$392.40 ,$250.70 ,$436.00 ,$95.92 ,$436.00 ,$237.18 ,$95.92 ,$181.38 ,$28.22 ,$26.93 ,$100.72 ,$370.60 ,$120.31 ,$122.08 ,$392.40 ,$366.24 ,$348.80 ,$348.80 ,$95.92 ,$283.40 
ST. FRANCIS HOSPITAL - ACUTE,30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$136.00 ,$88.40 ,$8.11 ,$136.00 ,$78.20 ,$97.92 ,$73.98 ,$29.92 ,$38.08 ,$52.94 ,$29.92 ,$67.42 ,$34.00 ,$67.42 ,$67.42 ,$34.00 ,$67.42 ,$56.85 ,$114.24 ,$10.68 ,$29.92 ,$115.60 ,$114.24 ,$29.92 ,$102.00 ,$108.80 ,$108.80 ,$29.92 ,$108.80 ,$114.24 ,$114.24 ,$114.24 ,$136.00 ,$122.40 ,$78.20 ,$136.00 ,$29.92 ,$136.00 ,$73.98 ,$29.92 ,$56.58 ,$8.49 ,$8.11 ,$31.42 ,$115.60 ,$67.42 ,$38.08 ,$122.40 ,$114.24 ,$108.80 ,$108.80 ,$29.92 ,$88.40 
ST. FRANCIS HOSPITAL - ACUTE,30600176,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$123.00 ,$79.95 ,$8.11 ,$123.00 ,$70.73 ,$88.56 ,$66.91 ,$27.06 ,$34.44 ,$66.75 ,$27.06 ,$84.50 ,$30.75 ,$84.50 ,$84.50 ,$30.75 ,$84.50 ,$51.41 ,$103.32 ,$13.48 ,$27.06 ,$104.55 ,$103.32 ,$27.06 ,$92.25 ,$98.40 ,$98.40 ,$27.06 ,$98.40 ,$103.32 ,$103.32 ,$103.32 ,$123.00 ,$110.70 ,$70.73 ,$123.00 ,$27.06 ,$123.00 ,$66.91 ,$27.06 ,$51.17 ,$8.49 ,$8.11 ,$28.41 ,$104.55 ,$84.50 ,$34.44 ,$110.70 ,$103.32 ,$98.40 ,$98.40 ,$27.06 ,$79.95 
ST. FRANCIS HOSPITAL - ACUTE,30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$129.00 ,$83.85 ,$10.16 ,$129.00 ,$74.18 ,$92.88 ,$70.18 ,$28.38 ,$36.12 ,$75.85 ,$28.38 ,$88.62 ,$32.25 ,$88.62 ,$88.62 ,$32.25 ,$88.62 ,$53.92 ,$108.36 ,$29.95 ,$28.38 ,$109.65 ,$108.36 ,$28.38 ,$96.75 ,$103.20 ,$103.20 ,$28.38 ,$103.20 ,$108.36 ,$108.36 ,$108.36 ,$129.00 ,$116.10 ,$74.18 ,$129.00 ,$28.38 ,$129.00 ,$70.18 ,$28.38 ,$53.66 ,$10.65 ,$10.16 ,$29.80 ,$109.65 ,$88.62 ,$36.12 ,$116.10 ,$108.36 ,$103.20 ,$103.20 ,$28.38 ,$83.85 
ST. FRANCIS HOSPITAL - ACUTE,30600225,87400,HC EIA QL INFLUENZA A/B AG,306,1 ,$163.00 ,$105.95 ,$17.51 ,$163.00 ,$93.73 ,$117.36 ,$88.67 ,$35.86 ,$45.64 ,$95.84 ,$35.86 ,$111.98 ,$40.75 ,$111.98 ,$111.98 ,$40.75 ,$111.98 ,$68.13 ,$136.92 ,$35.33 ,$35.86 ,$138.55 ,$136.92 ,$35.86 ,$122.25 ,$130.40 ,$130.40 ,$35.86 ,$130.40 ,$136.92 ,$136.92 ,$136.92 ,$163.00 ,$146.70 ,$93.73 ,$163.00 ,$35.86 ,$163.00 ,$88.67 ,$35.86 ,$67.81 ,$18.35 ,$17.51 ,$37.65 ,$138.55 ,$111.98 ,$45.64 ,$146.70 ,$136.92 ,$130.40 ,$130.40 ,$35.86 ,$105.95 
ST. FRANCIS HOSPITAL - ACUTE,30600226,87420,HC RSV AG QL,306,1 ,$483.00 ,$313.95 ,$26.93 ,$483.00 ,$277.73 ,$347.76 ,$262.75 ,$106.26 ,$135.24 ,$109.76 ,$106.26 ,$139.78 ,$120.75 ,$139.78 ,$139.78 ,$120.75 ,$139.78 ,$201.89 ,$405.72 ,$34.78 ,$106.26 ,$410.55 ,$405.72 ,$106.26 ,$362.25 ,$386.40 ,$386.40 ,$106.26 ,$386.40 ,$405.72 ,$405.72 ,$405.72 ,$483.00 ,$434.70 ,$277.73 ,$483.00 ,$106.26 ,$483.00 ,$262.75 ,$106.26 ,$200.93 ,$28.22 ,$26.93 ,$111.57 ,$410.55 ,$139.78 ,$135.24 ,$434.70 ,$405.72 ,$386.40 ,$386.40 ,$106.26 ,$313.95 
ST. FRANCIS HOSPITAL - ACUTE,30600237,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$589.00 ,$382.85 ,$10.16 ,$589.00 ,$338.68 ,$424.08 ,$320.42 ,$129.58 ,$164.92 ,$321.31 ,$129.58 ,$404.64 ,$147.25 ,$404.64 ,$404.64 ,$147.25 ,$404.64 ,$246.20 ,$494.76 ,$93.18 ,$129.58 ,$500.65 ,$494.76 ,$129.58 ,$441.75 ,$471.20 ,$471.20 ,$129.58 ,$471.20 ,$494.76 ,$494.76 ,$494.76 ,$589.00 ,$530.10 ,$338.68 ,$589.00 ,$129.58 ,$589.00 ,$320.42 ,$129.58 ,$245.02 ,$10.65 ,$10.16 ,$136.06 ,$500.65 ,$404.64 ,$164.92 ,$530.10 ,$494.76 ,$471.20 ,$471.20 ,$129.58 ,$382.85 
ST. FRANCIS HOSPITAL - ACUTE,30600269,87807,HC QL RSV,306,1 ,$541.00 ,$351.65 ,$8.11 ,$541.00 ,$311.08 ,$389.52 ,$294.30 ,$119.02 ,$151.48 ,$148.56 ,$119.02 ,$189.18 ,$135.25 ,$189.18 ,$189.18 ,$135.25 ,$189.18 ,$226.14 ,$454.44 ,$32.75 ,$119.02 ,$459.85 ,$454.44 ,$119.02 ,$405.75 ,$432.80 ,$432.80 ,$119.02 ,$432.80 ,$454.44 ,$454.44 ,$454.44 ,$541.00 ,$486.90 ,$311.08 ,$541.00 ,$119.02 ,$541.00 ,$294.30 ,$119.02 ,$225.06 ,$8.49 ,$8.11 ,$124.97 ,$459.85 ,$189.18 ,$151.48 ,$486.90 ,$454.44 ,$432.80 ,$432.80 ,$119.02 ,$351.65 
ST. FRANCIS HOSPITAL - ACUTE,30600270,87880,HC OPTICAL STREP,306,1 ,$284.00 ,$184.60 ,$8.11 ,$284.00 ,$163.30 ,$204.48 ,$154.50 ,$62.48 ,$79.52 ,$166.02 ,$62.48 ,$195.11 ,$71.00 ,$195.11 ,$195.11 ,$71.00 ,$195.11 ,$118.71 ,$238.56 ,$41.33 ,$62.48 ,$241.40 ,$238.56 ,$62.48 ,$213.00 ,$227.20 ,$227.20 ,$62.48 ,$227.20 ,$238.56 ,$238.56 ,$238.56 ,$284.00 ,$255.60 ,$163.30 ,$284.00 ,$62.48 ,$284.00 ,$154.50 ,$62.48 ,$118.14 ,$8.49 ,$8.11 ,$65.60 ,$241.40 ,$195.11 ,$79.52 ,$255.60 ,$238.56 ,$227.20 ,$227.20 ,$62.48 ,$184.60 
ST. FRANCIS HOSPITAL - ACUTE,30600283,87804,HC QL INFLUENZA A/B,306,1 ,$364.00 ,$236.60 ,$8.11 ,$364.00 ,$209.30 ,$262.08 ,$198.02 ,$80.08 ,$101.92 ,$166.13 ,$80.08 ,$211.56 ,$91.00 ,$211.56 ,$211.56 ,$91.00 ,$211.56 ,$152.15 ,$305.76 ,$41.38 ,$80.08 ,$309.40 ,$305.76 ,$80.08 ,$273.00 ,$291.20 ,$291.20 ,$80.08 ,$291.20 ,$305.76 ,$305.76 ,$305.76 ,$364.00 ,$327.60 ,$209.30 ,$364.00 ,$80.08 ,$364.00 ,$198.02 ,$80.08 ,$151.42 ,$8.49 ,$8.11 ,$84.08 ,$309.40 ,$211.56 ,$101.92 ,$327.60 ,$305.76 ,$291.20 ,$291.20 ,$80.08 ,$236.60 
ST. FRANCIS HOSPITAL - ACUTE,30600303,87176,HC HOMOGENIZATION TISSUE,306,1 ,$90.00 ,$58.50 ,$8.11 ,$90.00 ,$51.75 ,$64.80 ,$48.96 ,$19.80 ,$25.20 ,$52.92 ,$19.80 ,$61.83 ,$22.50 ,$61.83 ,$61.83 ,$22.50 ,$61.83 ,$37.62 ,$75.60 ,$14.70 ,$19.80 ,$76.50 ,$75.60 ,$19.80 ,$67.50 ,$72.00 ,$72.00 ,$19.80 ,$72.00 ,$75.60 ,$75.60 ,$75.60 ,$90.00 ,$81.00 ,$51.75 ,$90.00 ,$19.80 ,$90.00 ,$48.96 ,$19.80 ,$37.44 ,$8.49 ,$8.11 ,$20.79 ,$76.50 ,$61.83 ,$25.20 ,$81.00 ,$75.60 ,$72.00 ,$72.00 ,$19.80 ,$58.50 
ST. FRANCIS HOSPITAL - ACUTE,30600318,87449,HC EIA QL MLT AG INF,306,1 ,$137.00 ,$89.05 ,$10.16 ,$137.00 ,$78.78 ,$98.64 ,$74.53 ,$30.14 ,$38.36 ,$80.56 ,$30.14 ,$94.12 ,$34.25 ,$94.12 ,$94.12 ,$34.25 ,$94.12 ,$57.27 ,$115.08 ,$29.95 ,$30.14 ,$116.45 ,$115.08 ,$30.14 ,$102.75 ,$109.60 ,$109.60 ,$30.14 ,$109.60 ,$115.08 ,$115.08 ,$115.08 ,$137.00 ,$123.30 ,$78.78 ,$137.00 ,$30.14 ,$137.00 ,$74.53 ,$30.14 ,$56.99 ,$10.65 ,$10.16 ,$31.65 ,$116.45 ,$94.12 ,$38.36 ,$123.30 ,$115.08 ,$109.60 ,$109.60 ,$30.14 ,$89.05 
ST. FRANCIS HOSPITAL - ACUTE,30600332,87651,HC INFECT AMP (GRP A STREP),306,1 ,$111.00 ,$72.15 ,$24.42 ,$111.00 ,$63.83 ,$79.92 ,$60.38 ,$24.42 ,$31.08 ,$65.27 ,$24.42 ,$76.26 ,$27.75 ,$76.26 ,$76.26 ,$27.75 ,$76.26 ,$46.40 ,$93.24 ,$87.73 ,$24.42 ,$94.35 ,$93.24 ,$24.42 ,$83.25 ,$88.80 ,$88.80 ,$24.42 ,$88.80 ,$93.24 ,$93.24 ,$93.24 ,$111.00 ,$99.90 ,$63.83 ,$111.00 ,$24.42 ,$111.00 ,$60.38 ,$24.42 ,$46.18 ,$28.22 ,$26.93 ,$25.64 ,$94.35 ,$76.26 ,$31.08 ,$99.90 ,$93.24 ,$88.80 ,$88.80 ,$24.42 ,$72.15 
ST. FRANCIS HOSPITAL - ACUTE,30600333,87808,HC TRICHOMONAS VAGINITIS OPTICAL,306,1 ,$185.00 ,$120.25 ,$8.11 ,$185.00 ,$106.38 ,$133.20 ,$100.64 ,$40.70 ,$51.80 ,$108.78 ,$40.70 ,$127.10 ,$46.25 ,$127.10 ,$127.10 ,$46.25 ,$127.10 ,$77.33 ,$155.40 ,$38.23 ,$40.70 ,$157.25 ,$155.40 ,$40.70 ,$138.75 ,$148.00 ,$148.00 ,$40.70 ,$148.00 ,$155.40 ,$155.40 ,$155.40 ,$185.00 ,$166.50 ,$106.38 ,$185.00 ,$40.70 ,$185.00 ,$100.64 ,$40.70 ,$76.96 ,$8.49 ,$8.11 ,$42.74 ,$157.25 ,$127.10 ,$51.80 ,$166.50 ,$155.40 ,$148.00 ,$148.00 ,$40.70 ,$120.25 
ST. FRANCIS HOSPITAL - ACUTE,30600353,87015,HC CONCENTRATION INFECTIOUS AGENT-90,306,1 ,$26.00 ,$16.90 ,$5.72 ,$26.00 ,$14.95 ,$18.72 ,$14.14 ,$5.72 ,$7.28 ,$15.29 ,$5.72 ,$17.86 ,$6.50 ,$17.86 ,$17.86 ,$6.50 ,$17.86 ,$10.87 ,$21.84 ,$16.70 ,$5.72 ,$22.10 ,$21.84 ,$5.72 ,$19.50 ,$20.80 ,$20.80 ,$5.72 ,$20.80 ,$21.84 ,$21.84 ,$21.84 ,$26.00 ,$23.40 ,$14.95 ,$26.00 ,$5.72 ,$26.00 ,$14.14 ,$5.72 ,$10.82 ,$8.49 ,$8.11 ,$6.01 ,$22.10 ,$17.86 ,$7.28 ,$23.40 ,$21.84 ,$20.80 ,$20.80 ,$5.72 ,$16.90 
ST. FRANCIS HOSPITAL - ACUTE,30600360,87081,HC CULTURE SCR PRESUMP PATHOGENS T1,306,1 ,$270.00 ,$175.50 ,$8.11 ,$270.00 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$82.15 ,$59.40 ,$104.62 ,$67.50 ,$104.62 ,$104.62 ,$67.50 ,$104.62 ,$112.86 ,$226.80 ,$16.58 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 ,$8.49 ,$8.11 ,$62.37 ,$229.50 ,$104.62 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,30600366,87109,HC CULTURE MYCOPLASMA-90,306,1 ,$73.00 ,$47.45 ,$16.06 ,$73.00 ,$41.98 ,$52.56 ,$39.71 ,$16.06 ,$20.44 ,$42.92 ,$16.06 ,$50.15 ,$18.25 ,$50.15 ,$50.15 ,$18.25 ,$50.15 ,$30.51 ,$61.32 ,$38.48 ,$16.06 ,$62.05 ,$61.32 ,$16.06 ,$54.75 ,$58.40 ,$58.40 ,$16.06 ,$58.40 ,$61.32 ,$61.32 ,$61.32 ,$73.00 ,$65.70 ,$41.98 ,$73.00 ,$16.06 ,$73.00 ,$39.71 ,$16.06 ,$30.37 ,$28.22 ,$26.93 ,$16.86 ,$62.05 ,$50.15 ,$20.44 ,$65.70 ,$61.32 ,$58.40 ,$58.40 ,$16.06 ,$47.45 
ST. FRANCIS HOSPITAL - ACUTE,30600367,87110,HC CULTURE CHLAMYDIA-90,306,1 ,$175.00 ,$113.75 ,$8.11 ,$175.00 ,$100.63 ,$126.00 ,$95.20 ,$38.50 ,$49.00 ,$102.90 ,$38.50 ,$120.23 ,$43.75 ,$120.23 ,$120.23 ,$43.75 ,$120.23 ,$73.15 ,$147.00 ,$49.00 ,$38.50 ,$148.75 ,$147.00 ,$38.50 ,$131.25 ,$140.00 ,$140.00 ,$38.50 ,$140.00 ,$147.00 ,$147.00 ,$147.00 ,$175.00 ,$157.50 ,$100.63 ,$175.00 ,$38.50 ,$175.00 ,$95.20 ,$38.50 ,$72.80 ,$8.49 ,$8.11 ,$40.43 ,$148.75 ,$120.23 ,$49.00 ,$157.50 ,$147.00 ,$140.00 ,$140.00 ,$38.50 ,$113.75 
ST. FRANCIS HOSPITAL - ACUTE,30600368,87116,HC CULTURE AFB/TB/MYCOBACT-90,306,1 ,$165.00 ,$107.25 ,$26.93 ,$165.00 ,$94.88 ,$118.80 ,$89.76 ,$36.30 ,$46.20 ,$97.02 ,$36.30 ,$113.36 ,$41.25 ,$113.36 ,$113.36 ,$41.25 ,$113.36 ,$68.97 ,$138.60 ,$27.00 ,$36.30 ,$140.25 ,$138.60 ,$36.30 ,$123.75 ,$132.00 ,$132.00 ,$36.30 ,$132.00 ,$138.60 ,$138.60 ,$138.60 ,$165.00 ,$148.50 ,$94.88 ,$165.00 ,$36.30 ,$165.00 ,$89.76 ,$36.30 ,$68.64 ,$28.22 ,$26.93 ,$38.12 ,$140.25 ,$113.36 ,$46.20 ,$148.50 ,$138.60 ,$132.00 ,$132.00 ,$36.30 ,$107.25 
ST. FRANCIS HOSPITAL - ACUTE,30600370,87140,HC CULTURE TYPE IF EA ANTISERUM-90,306,1 ,$94.00 ,$61.10 ,$13.93 ,$94.00 ,$54.05 ,$67.68 ,$51.14 ,$20.68 ,$26.32 ,$51.00 ,$20.68 ,$64.58 ,$23.50 ,$64.58 ,$64.58 ,$23.50 ,$64.58 ,$39.29 ,$78.96 ,$13.93 ,$20.68 ,$79.90 ,$78.96 ,$20.68 ,$70.50 ,$75.20 ,$75.20 ,$20.68 ,$75.20 ,$78.96 ,$78.96 ,$78.96 ,$94.00 ,$84.60 ,$54.05 ,$94.00 ,$20.68 ,$94.00 ,$51.14 ,$20.68 ,$39.10 ,$28.22 ,$26.93 ,$21.71 ,$79.90 ,$64.58 ,$26.32 ,$84.60 ,$78.96 ,$75.20 ,$75.20 ,$20.68 ,$61.10 
ST. FRANCIS HOSPITAL - ACUTE,30600380,87177,HC SMEAR OVA PARASITE CONC/ID-90,306,1 ,$81.00 ,$52.65 ,$8.11 ,$81.00 ,$46.58 ,$58.32 ,$44.06 ,$17.82 ,$22.68 ,$47.63 ,$17.82 ,$55.65 ,$20.25 ,$55.65 ,$55.65 ,$20.25 ,$55.65 ,$33.86 ,$68.04 ,$22.25 ,$17.82 ,$68.85 ,$68.04 ,$17.82 ,$60.75 ,$64.80 ,$64.80 ,$17.82 ,$64.80 ,$68.04 ,$68.04 ,$68.04 ,$81.00 ,$72.90 ,$46.58 ,$81.00 ,$17.82 ,$81.00 ,$44.06 ,$17.82 ,$33.70 ,$8.49 ,$8.11 ,$18.71 ,$68.85 ,$55.65 ,$22.68 ,$72.90 ,$68.04 ,$64.80 ,$64.80 ,$17.82 ,$52.65 
ST. FRANCIS HOSPITAL - ACUTE,30600395,87206,HC SMEAR ACID FAST/FLUOR-90,306,1 ,$82.00 ,$53.30 ,$8.11 ,$82.00 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$48.22 ,$18.04 ,$56.33 ,$20.50 ,$56.33 ,$56.33 ,$20.50 ,$56.33 ,$34.28 ,$68.88 ,$13.48 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 ,$8.49 ,$8.11 ,$18.94 ,$69.70 ,$56.33 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,30600397,87207,HC SPECIAL STAIN INCL BODIES/PARASITES-90,306,1 ,$25.00 ,$16.25 ,$5.50 ,$25.00 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$14.98 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$8.49 ,$8.11 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30600399,87209,HC OVA  AND  PARASITE W/STAIN-90,306,1 ,$81.00 ,$52.65 ,$17.82 ,$81.00 ,$46.58 ,$58.32 ,$44.06 ,$17.82 ,$22.68 ,$47.63 ,$17.82 ,$55.65 ,$20.25 ,$55.65 ,$55.65 ,$20.25 ,$55.65 ,$33.86 ,$68.04 ,$44.95 ,$17.82 ,$68.85 ,$68.04 ,$17.82 ,$60.75 ,$64.80 ,$64.80 ,$17.82 ,$64.80 ,$68.04 ,$68.04 ,$68.04 ,$81.00 ,$72.90 ,$46.58 ,$81.00 ,$17.82 ,$81.00 ,$44.06 ,$17.82 ,$33.70 ,$28.22 ,$26.93 ,$18.71 ,$68.85 ,$55.65 ,$22.68 ,$72.90 ,$68.04 ,$64.80 ,$64.80 ,$17.82 ,$52.65 
ST. FRANCIS HOSPITAL - ACUTE,30600405,87254,HC VIRUS ISOL SHELL ID-90,306,1 ,$185.00 ,$120.25 ,$26.93 ,$185.00 ,$106.38 ,$133.20 ,$100.64 ,$40.70 ,$51.80 ,$108.78 ,$40.70 ,$127.10 ,$46.25 ,$127.10 ,$127.10 ,$46.25 ,$127.10 ,$77.33 ,$155.40 ,$48.90 ,$40.70 ,$157.25 ,$155.40 ,$40.70 ,$138.75 ,$148.00 ,$148.00 ,$40.70 ,$148.00 ,$155.40 ,$155.40 ,$155.40 ,$185.00 ,$166.50 ,$106.38 ,$185.00 ,$40.70 ,$185.00 ,$100.64 ,$40.70 ,$76.96 ,$28.22 ,$26.93 ,$42.74 ,$157.25 ,$127.10 ,$51.80 ,$166.50 ,$155.40 ,$148.00 ,$148.00 ,$40.70 ,$120.25 
ST. FRANCIS HOSPITAL - ACUTE,30600413,87290,HC IF VARICELLA ZOETER AG-90,306,1 ,$56.00 ,$36.40 ,$10.16 ,$56.00 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$33.55 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$10.65 ,$10.16 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30600414,87299,HC ANTIBODY DETECT IF NOS-90,306,1 ,$56.00 ,$36.40 ,$10.16 ,$56.00 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$40.25 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 ,$10.65 ,$10.16 ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,30600423,87341,HC EIA QL HEPATITIS B AG NEUT-90,306,1 ,$45.00 ,$29.25 ,$9.90 ,$45.00 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$25.83 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$10.65 ,$10.16 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30600424,87350,HC HEPATITIS BE AG QL-90,306,1 ,$81.00 ,$52.65 ,$10.16 ,$81.00 ,$46.58 ,$58.32 ,$44.06 ,$17.82 ,$22.68 ,$47.63 ,$17.82 ,$55.65 ,$20.25 ,$55.65 ,$55.65 ,$20.25 ,$55.65 ,$33.86 ,$68.04 ,$28.83 ,$17.82 ,$68.85 ,$68.04 ,$17.82 ,$60.75 ,$64.80 ,$64.80 ,$17.82 ,$64.80 ,$68.04 ,$68.04 ,$68.04 ,$81.00 ,$72.90 ,$46.58 ,$81.00 ,$17.82 ,$81.00 ,$44.06 ,$17.82 ,$33.70 ,$10.65 ,$10.16 ,$18.71 ,$68.85 ,$55.65 ,$22.68 ,$72.90 ,$68.04 ,$64.80 ,$64.80 ,$17.82 ,$52.65 
ST. FRANCIS HOSPITAL - ACUTE,30600426,87385,HC EIA QL HISTOPLASMA AG-90,306,1 ,$67.00 ,$43.55 ,$10.16 ,$67.00 ,$38.53 ,$48.24 ,$36.45 ,$14.74 ,$18.76 ,$39.40 ,$14.74 ,$46.03 ,$16.75 ,$46.03 ,$46.03 ,$16.75 ,$46.03 ,$28.01 ,$56.28 ,$33.13 ,$14.74 ,$56.95 ,$56.28 ,$14.74 ,$50.25 ,$53.60 ,$53.60 ,$14.74 ,$53.60 ,$56.28 ,$56.28 ,$56.28 ,$67.00 ,$60.30 ,$38.53 ,$67.00 ,$14.74 ,$67.00 ,$36.45 ,$14.74 ,$27.87 ,$10.65 ,$10.16 ,$15.48 ,$56.95 ,$46.03 ,$18.76 ,$60.30 ,$56.28 ,$53.60 ,$53.60 ,$14.74 ,$43.55 
ST. FRANCIS HOSPITAL - ACUTE,30600438,87491,HC CHLAMYDIA TRACH AMP-90,306,1 ,$123.00 ,$79.95 ,$10.16 ,$123.00 ,$70.73 ,$88.56 ,$66.91 ,$27.06 ,$34.44 ,$72.32 ,$27.06 ,$84.50 ,$30.75 ,$84.50 ,$84.50 ,$30.75 ,$84.50 ,$51.41 ,$103.32 ,$87.73 ,$27.06 ,$104.55 ,$103.32 ,$27.06 ,$92.25 ,$98.40 ,$98.40 ,$27.06 ,$98.40 ,$103.32 ,$103.32 ,$103.32 ,$123.00 ,$110.70 ,$70.73 ,$123.00 ,$27.06 ,$123.00 ,$66.91 ,$27.06 ,$51.17 ,$10.65 ,$10.16 ,$28.41 ,$104.55 ,$84.50 ,$34.44 ,$110.70 ,$103.32 ,$98.40 ,$98.40 ,$27.06 ,$79.95 
ST. FRANCIS HOSPITAL - ACUTE,30600442,87496,HC INFECT AMP (CMV) MENI-90,306,1 ,$123.00 ,$79.95 ,$26.93 ,$123.00 ,$70.73 ,$88.56 ,$66.91 ,$27.06 ,$34.44 ,$72.32 ,$27.06 ,$84.50 ,$30.75 ,$84.50 ,$84.50 ,$30.75 ,$84.50 ,$51.41 ,$103.32 ,$87.73 ,$27.06 ,$104.55 ,$103.32 ,$27.06 ,$92.25 ,$98.40 ,$98.40 ,$27.06 ,$98.40 ,$103.32 ,$103.32 ,$103.32 ,$123.00 ,$110.70 ,$70.73 ,$123.00 ,$27.06 ,$123.00 ,$66.91 ,$27.06 ,$51.17 ,$28.22 ,$26.93 ,$28.41 ,$104.55 ,$84.50 ,$34.44 ,$110.70 ,$103.32 ,$98.40 ,$98.40 ,$27.06 ,$79.95 
ST. FRANCIS HOSPITAL - ACUTE,30600443,87497,HC CMV QN-90,306,1 ,$137.00 ,$89.05 ,$26.93 ,$137.00 ,$78.78 ,$98.64 ,$74.53 ,$30.14 ,$38.36 ,$80.56 ,$30.14 ,$94.12 ,$34.25 ,$94.12 ,$94.12 ,$34.25 ,$94.12 ,$57.27 ,$115.08 ,$107.10 ,$30.14 ,$116.45 ,$115.08 ,$30.14 ,$102.75 ,$109.60 ,$109.60 ,$30.14 ,$109.60 ,$115.08 ,$115.08 ,$115.08 ,$137.00 ,$123.30 ,$78.78 ,$137.00 ,$30.14 ,$137.00 ,$74.53 ,$30.14 ,$56.99 ,$28.22 ,$26.93 ,$31.65 ,$116.45 ,$94.12 ,$38.36 ,$123.30 ,$115.08 ,$109.60 ,$109.60 ,$30.14 ,$89.05 
ST. FRANCIS HOSPITAL - ACUTE,30600448,87517,HC HEPATITIS B QN-90,306,1 ,$95.00 ,$61.75 ,$20.90 ,$107.10 ,$54.63 ,$68.40 ,$51.68 ,$20.90 ,$26.60 ,$55.86 ,$20.90 ,$65.27 ,$23.75 ,$65.27 ,$65.27 ,$23.75 ,$65.27 ,$39.71 ,$79.80 ,$107.10 ,$20.90 ,$80.75 ,$79.80 ,$20.90 ,$71.25 ,$76.00 ,$76.00 ,$20.90 ,$76.00 ,$79.80 ,$79.80 ,$79.80 ,$95.00 ,$85.50 ,$54.63 ,$95.00 ,$20.90 ,$95.00 ,$51.68 ,$20.90 ,$39.52 ,$28.22 ,$26.93 ,$21.95 ,$80.75 ,$65.27 ,$26.60 ,$85.50 ,$79.80 ,$76.00 ,$76.00 ,$20.90 ,$61.75 
ST. FRANCIS HOSPITAL - ACUTE,30600451,87522,HC HEPATITIS C QN-90,306,1 ,$389.00 ,$252.85 ,$26.93 ,$389.00 ,$223.68 ,$280.08 ,$211.62 ,$85.58 ,$108.92 ,$228.73 ,$85.58 ,$267.24 ,$97.25 ,$267.24 ,$267.24 ,$97.25 ,$267.24 ,$162.60 ,$326.76 ,$107.10 ,$85.58 ,$330.65 ,$326.76 ,$85.58 ,$291.75 ,$311.20 ,$311.20 ,$85.58 ,$311.20 ,$326.76 ,$326.76 ,$326.76 ,$389.00 ,$350.10 ,$223.68 ,$389.00 ,$85.58 ,$389.00 ,$211.62 ,$85.58 ,$161.82 ,$28.22 ,$26.93 ,$89.86 ,$330.65 ,$267.24 ,$108.92 ,$350.10 ,$326.76 ,$311.20 ,$311.20 ,$85.58 ,$252.85 
ST. FRANCIS HOSPITAL - ACUTE,30600453,87529,HC HERPES SIMPLEX AMP-90,306,1 ,$267.00 ,$173.55 ,$26.93 ,$267.00 ,$153.53 ,$192.24 ,$145.25 ,$58.74 ,$74.76 ,$157.00 ,$58.74 ,$183.43 ,$66.75 ,$183.43 ,$183.43 ,$66.75 ,$183.43 ,$111.61 ,$224.28 ,$87.73 ,$58.74 ,$226.95 ,$224.28 ,$58.74 ,$200.25 ,$213.60 ,$213.60 ,$58.74 ,$213.60 ,$224.28 ,$224.28 ,$224.28 ,$267.00 ,$240.30 ,$153.53 ,$267.00 ,$58.74 ,$267.00 ,$145.25 ,$58.74 ,$111.07 ,$28.22 ,$26.93 ,$61.68 ,$226.95 ,$183.43 ,$74.76 ,$240.30 ,$224.28 ,$213.60 ,$213.60 ,$58.74 ,$173.55 
ST. FRANCIS HOSPITAL - ACUTE,30600458,87536,HC HIV-1 QN-90,306,1 ,$814.00 ,$529.10 ,$26.93 ,$814.00 ,$468.05 ,$586.08 ,$442.82 ,$179.08 ,$227.92 ,$478.63 ,$179.08 ,$559.22 ,$203.50 ,$559.22 ,$559.22 ,$203.50 ,$559.22 ,$340.25 ,$683.76 ,$212.75 ,$179.08 ,$691.90 ,$683.76 ,$179.08 ,$610.50 ,$651.20 ,$651.20 ,$179.08 ,$651.20 ,$683.76 ,$683.76 ,$683.76 ,$814.00 ,$732.60 ,$468.05 ,$814.00 ,$179.08 ,$814.00 ,$442.82 ,$179.08 ,$338.62 ,$28.22 ,$26.93 ,$188.03 ,$691.90 ,$559.22 ,$227.92 ,$732.60 ,$683.76 ,$651.20 ,$651.20 ,$179.08 ,$529.10 
ST. FRANCIS HOSPITAL - ACUTE,30600460,87591,HC NEISSERIA AMP-90,306,1 ,$122.00 ,$79.30 ,$26.84 ,$122.00 ,$70.15 ,$87.84 ,$66.37 ,$26.84 ,$34.16 ,$71.74 ,$26.84 ,$83.81 ,$30.50 ,$83.81 ,$83.81 ,$30.50 ,$83.81 ,$51.00 ,$102.48 ,$87.73 ,$26.84 ,$103.70 ,$102.48 ,$26.84 ,$91.50 ,$97.60 ,$97.60 ,$26.84 ,$97.60 ,$102.48 ,$102.48 ,$102.48 ,$122.00 ,$109.80 ,$70.15 ,$122.00 ,$26.84 ,$122.00 ,$66.37 ,$26.84 ,$50.75 ,$28.22 ,$26.93 ,$28.18 ,$103.70 ,$83.81 ,$34.16 ,$109.80 ,$102.48 ,$97.60 ,$97.60 ,$26.84 ,$79.30 
ST. FRANCIS HOSPITAL - ACUTE,30600469,87661,HC TRICHOMONAS VAG AMP PROBE-90,306,1 ,$122.00 ,$79.30 ,$26.84 ,$122.00 ,$70.15 ,$87.84 ,$66.37 ,$26.84 ,$34.16 ,$71.74 ,$26.84 ,$83.81 ,$30.50 ,$83.81 ,$83.81 ,$30.50 ,$83.81 ,$51.00 ,$102.48 ,$87.73 ,$26.84 ,$103.70 ,$102.48 ,$26.84 ,$91.50 ,$97.60 ,$97.60 ,$26.84 ,$97.60 ,$102.48 ,$102.48 ,$102.48 ,$122.00 ,$109.80 ,$70.15 ,$122.00 ,$26.84 ,$122.00 ,$66.37 ,$26.84 ,$50.75 ,$28.22 ,$26.93 ,$28.18 ,$103.70 ,$83.81 ,$34.16 ,$109.80 ,$102.48 ,$97.60 ,$97.60 ,$26.84 ,$79.30 
ST. FRANCIS HOSPITAL - ACUTE,30600471,87798,HC INFECT AMP-90,306,1 ,$246.00 ,$159.90 ,$26.93 ,$246.00 ,$141.45 ,$177.12 ,$133.82 ,$54.12 ,$68.88 ,$144.65 ,$54.12 ,$169.00 ,$61.50 ,$169.00 ,$169.00 ,$61.50 ,$169.00 ,$102.83 ,$206.64 ,$87.73 ,$54.12 ,$209.10 ,$206.64 ,$54.12 ,$184.50 ,$196.80 ,$196.80 ,$54.12 ,$196.80 ,$206.64 ,$206.64 ,$206.64 ,$246.00 ,$221.40 ,$141.45 ,$246.00 ,$54.12 ,$246.00 ,$133.82 ,$54.12 ,$102.34 ,$28.22 ,$26.93 ,$56.83 ,$209.10 ,$169.00 ,$68.88 ,$221.40 ,$206.64 ,$196.80 ,$196.80 ,$54.12 ,$159.90 
ST. FRANCIS HOSPITAL - ACUTE,30600478,87799,HC INFECT AGENT QN-90,306,1 ,$438.00 ,$284.70 ,$26.93 ,$438.00 ,$251.85 ,$315.36 ,$238.27 ,$96.36 ,$122.64 ,$257.54 ,$96.36 ,$300.91 ,$109.50 ,$300.91 ,$300.91 ,$109.50 ,$300.91 ,$183.08 ,$367.92 ,$107.10 ,$96.36 ,$372.30 ,$367.92 ,$96.36 ,$328.50 ,$350.40 ,$350.40 ,$96.36 ,$350.40 ,$367.92 ,$367.92 ,$367.92 ,$438.00 ,$394.20 ,$251.85 ,$438.00 ,$96.36 ,$438.00 ,$238.27 ,$96.36 ,$182.21 ,$28.22 ,$26.93 ,$101.18 ,$372.30 ,$300.91 ,$122.64 ,$394.20 ,$367.92 ,$350.40 ,$350.40 ,$96.36 ,$284.70 
ST. FRANCIS HOSPITAL - ACUTE,30600481,87900,HC PHENOTYPE INFCT AGT DRG SUS-90,306,1 ,$160.00 ,$104.00 ,$26.93 ,$325.88 ,$92.00 ,$115.20 ,$87.04 ,$35.20 ,$44.80 ,$94.08 ,$35.20 ,$109.92 ,$40.00 ,$109.92 ,$109.92 ,$40.00 ,$109.92 ,$66.88 ,$134.40 ,$325.88 ,$35.20 ,$136.00 ,$134.40 ,$35.20 ,$120.00 ,$128.00 ,$128.00 ,$35.20 ,$128.00 ,$134.40 ,$134.40 ,$134.40 ,$160.00 ,$144.00 ,$92.00 ,$160.00 ,$35.20 ,$160.00 ,$87.04 ,$35.20 ,$66.56 ,$28.22 ,$26.93 ,$36.96 ,$136.00 ,$109.92 ,$44.80 ,$144.00 ,$134.40 ,$128.00 ,$128.00 ,$35.20 ,$104.00 
ST. FRANCIS HOSPITAL - ACUTE,30600482,87901,HC GENOTYPE HIV 1-90,306,1 ,$533.00 ,$346.45 ,$26.93 ,$643.63 ,$306.48 ,$383.76 ,$289.95 ,$117.26 ,$149.24 ,$313.40 ,$117.26 ,$366.17 ,$133.25 ,$366.17 ,$366.17 ,$133.25 ,$366.17 ,$222.79 ,$447.72 ,$643.63 ,$117.26 ,$453.05 ,$447.72 ,$117.26 ,$399.75 ,$426.40 ,$426.40 ,$117.26 ,$426.40 ,$447.72 ,$447.72 ,$447.72 ,$533.00 ,$479.70 ,$306.48 ,$533.00 ,$117.26 ,$533.00 ,$289.95 ,$117.26 ,$221.73 ,$28.22 ,$26.93 ,$123.12 ,$453.05 ,$366.17 ,$149.24 ,$479.70 ,$447.72 ,$426.40 ,$426.40 ,$117.26 ,$346.45 
ST. FRANCIS HOSPITAL - ACUTE,30600483,87902,HC GENTOYPE HEP C-90,306,1 ,$304.00 ,$197.60 ,$26.93 ,$643.63 ,$174.80 ,$218.88 ,$165.38 ,$66.88 ,$85.12 ,$178.75 ,$66.88 ,$208.85 ,$76.00 ,$208.85 ,$208.85 ,$76.00 ,$208.85 ,$127.07 ,$255.36 ,$643.63 ,$66.88 ,$258.40 ,$255.36 ,$66.88 ,$228.00 ,$243.20 ,$243.20 ,$66.88 ,$243.20 ,$255.36 ,$255.36 ,$255.36 ,$304.00 ,$273.60 ,$174.80 ,$304.00 ,$66.88 ,$304.00 ,$165.38 ,$66.88 ,$126.46 ,$28.22 ,$26.93 ,$70.22 ,$258.40 ,$208.85 ,$85.12 ,$273.60 ,$255.36 ,$243.20 ,$243.20 ,$66.88 ,$197.60 
ST. FRANCIS HOSPITAL - ACUTE,30600490,87272,HC IF CRYPTOSPORIDIUM AG-90,306,1 ,$40.00 ,$26.00 ,$8.80 ,$40.00 ,$23.00 ,$28.80 ,$21.76 ,$8.80 ,$11.20 ,$23.52 ,$8.80 ,$27.48 ,$10.00 ,$27.48 ,$27.48 ,$10.00 ,$27.48 ,$16.72 ,$33.60 ,$29.95 ,$8.80 ,$34.00 ,$33.60 ,$8.80 ,$30.00 ,$32.00 ,$32.00 ,$8.80 ,$32.00 ,$33.60 ,$33.60 ,$33.60 ,$40.00 ,$36.00 ,$23.00 ,$40.00 ,$8.80 ,$40.00 ,$21.76 ,$8.80 ,$16.64 ,$10.65 ,$10.16 ,$9.24 ,$34.00 ,$27.48 ,$11.20 ,$36.00 ,$33.60 ,$32.00 ,$32.00 ,$8.80 ,$26.00 
ST. FRANCIS HOSPITAL - ACUTE,30600504,87046,HC STOOL CULTURE ADD ISO-90,306,1 ,$29.00 ,$18.85 ,$6.38 ,$29.00 ,$16.68 ,$20.88 ,$15.78 ,$6.38 ,$8.12 ,$17.05 ,$6.38 ,$19.92 ,$7.25 ,$19.92 ,$19.92 ,$7.25 ,$19.92 ,$12.12 ,$24.36 ,$23.60 ,$6.38 ,$24.65 ,$24.36 ,$6.38 ,$21.75 ,$23.20 ,$23.20 ,$6.38 ,$23.20 ,$24.36 ,$24.36 ,$24.36 ,$29.00 ,$26.10 ,$16.68 ,$29.00 ,$6.38 ,$29.00 ,$15.78 ,$6.38 ,$12.06 ,$8.49 ,$8.11 ,$6.70 ,$24.65 ,$19.92 ,$8.12 ,$26.10 ,$24.36 ,$23.20 ,$23.20 ,$6.38 ,$18.85 
ST. FRANCIS HOSPITAL - ACUTE,30600505,87329,HC EIA QL GIARDIA AG-90,306,1 ,$45.00 ,$29.25 ,$9.90 ,$45.00 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$29.95 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$10.65 ,$10.16 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30600507,87541,HC INFECT AGT LEGIONELLA PNEUMOPHILA PROBE-90,306,1 ,$109.00 ,$70.85 ,$23.98 ,$109.00 ,$62.68 ,$78.48 ,$59.30 ,$23.98 ,$30.52 ,$64.09 ,$23.98 ,$74.88 ,$27.25 ,$74.88 ,$74.88 ,$27.25 ,$74.88 ,$45.56 ,$91.56 ,$87.73 ,$23.98 ,$92.65 ,$91.56 ,$23.98 ,$81.75 ,$87.20 ,$87.20 ,$23.98 ,$87.20 ,$91.56 ,$91.56 ,$91.56 ,$109.00 ,$98.10 ,$62.68 ,$109.00 ,$23.98 ,$109.00 ,$59.30 ,$23.98 ,$45.34 ,$28.22 ,$26.93 ,$25.18 ,$92.65 ,$74.88 ,$30.52 ,$98.10 ,$91.56 ,$87.20 ,$87.20 ,$23.98 ,$70.85 
ST. FRANCIS HOSPITAL - ACUTE,30600519,87070,HC BODY FLUID CULTURE,306,1 ,$436.00 ,$283.40 ,$8.11 ,$436.00 ,$250.70 ,$313.92 ,$237.18 ,$95.92 ,$122.08 ,$106.80 ,$95.92 ,$136.00 ,$109.00 ,$136.00 ,$136.00 ,$109.00 ,$136.00 ,$182.25 ,$366.24 ,$21.55 ,$95.92 ,$370.60 ,$366.24 ,$95.92 ,$327.00 ,$348.80 ,$348.80 ,$95.92 ,$348.80 ,$366.24 ,$366.24 ,$366.24 ,$436.00 ,$392.40 ,$250.70 ,$436.00 ,$95.92 ,$436.00 ,$237.18 ,$95.92 ,$181.38 ,$8.49 ,$8.11 ,$100.72 ,$370.60 ,$136.00 ,$122.08 ,$392.40 ,$366.24 ,$348.80 ,$348.80 ,$95.92 ,$283.40 
ST. FRANCIS HOSPITAL - ACUTE,30600522,87075,HC CULTURE ANAEROBIC,306,1 ,$539.00 ,$350.35 ,$8.11 ,$539.00 ,$309.93 ,$388.08 ,$293.22 ,$118.58 ,$150.92 ,$86.72 ,$118.58 ,$110.43 ,$134.75 ,$110.43 ,$110.43 ,$134.75 ,$110.43 ,$225.30 ,$452.76 ,$23.68 ,$118.58 ,$458.15 ,$452.76 ,$118.58 ,$404.25 ,$431.20 ,$431.20 ,$118.58 ,$431.20 ,$452.76 ,$452.76 ,$452.76 ,$539.00 ,$485.10 ,$309.93 ,$539.00 ,$118.58 ,$539.00 ,$293.22 ,$118.58 ,$224.22 ,$8.49 ,$8.11 ,$124.51 ,$458.15 ,$110.43 ,$150.92 ,$485.10 ,$452.76 ,$431.20 ,$431.20 ,$118.58 ,$350.35 
ST. FRANCIS HOSPITAL - ACUTE,30600523,87076,HC CULTURE ANAEROBIC ID,306,1 ,$53.00 ,$34.45 ,$8.11 ,$53.00 ,$30.48 ,$38.16 ,$28.83 ,$11.66 ,$14.84 ,$31.16 ,$11.66 ,$36.41 ,$13.25 ,$36.41 ,$36.41 ,$13.25 ,$36.41 ,$22.15 ,$44.52 ,$20.20 ,$11.66 ,$45.05 ,$44.52 ,$11.66 ,$39.75 ,$42.40 ,$42.40 ,$11.66 ,$42.40 ,$44.52 ,$44.52 ,$44.52 ,$53.00 ,$47.70 ,$30.48 ,$53.00 ,$11.66 ,$53.00 ,$28.83 ,$11.66 ,$22.05 ,$8.49 ,$8.11 ,$12.24 ,$45.05 ,$36.41 ,$14.84 ,$47.70 ,$44.52 ,$42.40 ,$42.40 ,$11.66 ,$34.45 
ST. FRANCIS HOSPITAL - ACUTE,30600524,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$53.00 ,$34.45 ,$8.11 ,$53.00 ,$30.48 ,$38.16 ,$28.83 ,$11.66 ,$14.84 ,$31.16 ,$11.66 ,$36.41 ,$13.25 ,$36.41 ,$36.41 ,$13.25 ,$36.41 ,$22.15 ,$44.52 ,$20.20 ,$11.66 ,$45.05 ,$44.52 ,$11.66 ,$39.75 ,$42.40 ,$42.40 ,$11.66 ,$42.40 ,$44.52 ,$44.52 ,$44.52 ,$53.00 ,$47.70 ,$30.48 ,$53.00 ,$11.66 ,$53.00 ,$28.83 ,$11.66 ,$22.05 ,$8.49 ,$8.11 ,$12.24 ,$45.05 ,$36.41 ,$14.84 ,$47.70 ,$44.52 ,$42.40 ,$42.40 ,$11.66 ,$34.45 
ST. FRANCIS HOSPITAL - ACUTE,30600526,87081,HC CULTURE SCR PRESUMP PATHOGENS,306,1 ,$270.00 ,$175.50 ,$8.11 ,$270.00 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$82.15 ,$59.40 ,$104.62 ,$67.50 ,$104.62 ,$104.62 ,$67.50 ,$104.62 ,$112.86 ,$226.80 ,$16.58 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 ,$8.49 ,$8.11 ,$62.37 ,$229.50 ,$104.62 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,30600527,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$114.00 ,$74.10 ,$8.11 ,$114.00 ,$65.55 ,$82.08 ,$62.02 ,$25.08 ,$31.92 ,$67.03 ,$25.08 ,$78.32 ,$28.50 ,$78.32 ,$78.32 ,$28.50 ,$78.32 ,$47.65 ,$95.76 ,$20.18 ,$25.08 ,$96.90 ,$95.76 ,$25.08 ,$85.50 ,$91.20 ,$91.20 ,$25.08 ,$91.20 ,$95.76 ,$95.76 ,$95.76 ,$114.00 ,$102.60 ,$65.55 ,$114.00 ,$25.08 ,$114.00 ,$62.02 ,$25.08 ,$47.42 ,$8.49 ,$8.11 ,$26.33 ,$96.90 ,$78.32 ,$31.92 ,$102.60 ,$95.76 ,$91.20 ,$91.20 ,$25.08 ,$74.10 
ST. FRANCIS HOSPITAL - ACUTE,30600528,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$71.00 ,$46.15 ,$8.11 ,$71.00 ,$40.83 ,$51.12 ,$38.62 ,$15.62 ,$19.88 ,$41.75 ,$15.62 ,$48.78 ,$17.75 ,$48.78 ,$48.78 ,$17.75 ,$48.78 ,$29.68 ,$59.64 ,$20.23 ,$15.62 ,$60.35 ,$59.64 ,$15.62 ,$53.25 ,$56.80 ,$56.80 ,$15.62 ,$56.80 ,$59.64 ,$59.64 ,$59.64 ,$71.00 ,$63.90 ,$40.83 ,$71.00 ,$15.62 ,$71.00 ,$38.62 ,$15.62 ,$29.54 ,$8.49 ,$8.11 ,$16.40 ,$60.35 ,$48.78 ,$19.88 ,$63.90 ,$59.64 ,$56.80 ,$56.80 ,$15.62 ,$46.15 
ST. FRANCIS HOSPITAL - ACUTE,30600529,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL -90,306,1 ,$191.00 ,$124.15 ,$8.11 ,$191.00 ,$109.83 ,$137.52 ,$103.90 ,$42.02 ,$53.48 ,$70.51 ,$42.02 ,$89.80 ,$47.75 ,$89.80 ,$89.80 ,$47.75 ,$89.80 ,$79.84 ,$160.44 ,$19.28 ,$42.02 ,$162.35 ,$160.44 ,$42.02 ,$143.25 ,$152.80 ,$152.80 ,$42.02 ,$152.80 ,$160.44 ,$160.44 ,$160.44 ,$191.00 ,$171.90 ,$109.83 ,$191.00 ,$42.02 ,$191.00 ,$103.90 ,$42.02 ,$79.46 ,$8.49 ,$8.11 ,$44.12 ,$162.35 ,$89.80 ,$53.48 ,$171.90 ,$160.44 ,$152.80 ,$152.80 ,$42.02 ,$124.15 
ST. FRANCIS HOSPITAL - ACUTE,30600530,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL,306,1 ,$214.00 ,$139.10 ,$8.11 ,$214.00 ,$123.05 ,$154.08 ,$116.42 ,$47.08 ,$59.92 ,$70.51 ,$47.08 ,$89.80 ,$53.50 ,$89.80 ,$89.80 ,$53.50 ,$89.80 ,$89.45 ,$179.76 ,$19.28 ,$47.08 ,$181.90 ,$179.76 ,$47.08 ,$160.50 ,$171.20 ,$171.20 ,$47.08 ,$171.20 ,$179.76 ,$179.76 ,$179.76 ,$214.00 ,$192.60 ,$123.05 ,$214.00 ,$47.08 ,$214.00 ,$116.42 ,$47.08 ,$89.02 ,$8.49 ,$8.11 ,$49.43 ,$181.90 ,$89.80 ,$59.92 ,$192.60 ,$179.76 ,$171.20 ,$171.20 ,$47.08 ,$139.10 
ST. FRANCIS HOSPITAL - ACUTE,30600531,87102,HC CULTURE FUNGUS OTHER,306,1 ,$214.00 ,$139.10 ,$8.11 ,$214.00 ,$123.05 ,$154.08 ,$116.42 ,$47.08 ,$59.92 ,$77.02 ,$47.08 ,$98.08 ,$53.50 ,$98.08 ,$98.08 ,$53.50 ,$98.08 ,$89.45 ,$179.76 ,$21.03 ,$47.08 ,$181.90 ,$179.76 ,$47.08 ,$160.50 ,$171.20 ,$171.20 ,$47.08 ,$171.20 ,$179.76 ,$179.76 ,$179.76 ,$214.00 ,$192.60 ,$123.05 ,$214.00 ,$47.08 ,$214.00 ,$116.42 ,$47.08 ,$89.02 ,$8.49 ,$8.11 ,$49.43 ,$181.90 ,$98.08 ,$59.92 ,$192.60 ,$179.76 ,$171.20 ,$171.20 ,$47.08 ,$139.10 
ST. FRANCIS HOSPITAL - ACUTE,30600533,87106,HC CULTURE FUNGUS ID YEAST,306,1 ,$75.00 ,$48.75 ,$8.11 ,$75.00 ,$43.13 ,$54.00 ,$40.80 ,$16.50 ,$21.00 ,$44.10 ,$16.50 ,$51.53 ,$18.75 ,$51.53 ,$51.53 ,$18.75 ,$51.53 ,$31.35 ,$63.00 ,$25.80 ,$16.50 ,$63.75 ,$63.00 ,$16.50 ,$56.25 ,$60.00 ,$60.00 ,$16.50 ,$60.00 ,$63.00 ,$63.00 ,$63.00 ,$75.00 ,$67.50 ,$43.13 ,$75.00 ,$16.50 ,$75.00 ,$40.80 ,$16.50 ,$31.20 ,$8.49 ,$8.11 ,$17.33 ,$63.75 ,$51.53 ,$21.00 ,$67.50 ,$63.00 ,$60.00 ,$60.00 ,$16.50 ,$48.75 
ST. FRANCIS HOSPITAL - ACUTE,30600534,87107,HC CULTURE FUNGUS ID MOLD,306,1 ,$111.00 ,$72.15 ,$24.42 ,$111.00 ,$63.83 ,$79.92 ,$60.38 ,$24.42 ,$31.08 ,$65.27 ,$24.42 ,$76.26 ,$27.75 ,$76.26 ,$76.26 ,$27.75 ,$76.26 ,$46.40 ,$93.24 ,$25.80 ,$24.42 ,$94.35 ,$93.24 ,$24.42 ,$83.25 ,$88.80 ,$88.80 ,$24.42 ,$88.80 ,$93.24 ,$93.24 ,$93.24 ,$111.00 ,$99.90 ,$63.83 ,$111.00 ,$24.42 ,$111.00 ,$60.38 ,$24.42 ,$46.18 ,$28.22 ,$26.93 ,$25.64 ,$94.35 ,$76.26 ,$31.08 ,$99.90 ,$93.24 ,$88.80 ,$88.80 ,$24.42 ,$72.15 
ST. FRANCIS HOSPITAL - ACUTE,30600535,87116,HC CULTURE AFB/TB/MYCOBACT,306,1 ,$184.00 ,$119.60 ,$26.93 ,$184.00 ,$105.80 ,$132.48 ,$100.10 ,$40.48 ,$51.52 ,$98.92 ,$40.48 ,$125.98 ,$46.00 ,$125.98 ,$125.98 ,$46.00 ,$125.98 ,$76.91 ,$154.56 ,$27.00 ,$40.48 ,$156.40 ,$154.56 ,$40.48 ,$138.00 ,$147.20 ,$147.20 ,$40.48 ,$147.20 ,$154.56 ,$154.56 ,$154.56 ,$184.00 ,$165.60 ,$105.80 ,$184.00 ,$40.48 ,$184.00 ,$100.10 ,$40.48 ,$76.54 ,$28.22 ,$26.93 ,$42.50 ,$156.40 ,$125.98 ,$51.52 ,$165.60 ,$154.56 ,$147.20 ,$147.20 ,$40.48 ,$119.60 
ST. FRANCIS HOSPITAL - ACUTE,30600536,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$41.00 ,$26.65 ,$8.11 ,$41.00 ,$23.58 ,$29.52 ,$22.30 ,$9.02 ,$11.48 ,$24.11 ,$9.02 ,$28.17 ,$10.25 ,$28.17 ,$28.17 ,$10.25 ,$28.17 ,$17.14 ,$34.44 ,$12.95 ,$9.02 ,$34.85 ,$34.44 ,$9.02 ,$30.75 ,$32.80 ,$32.80 ,$9.02 ,$32.80 ,$34.44 ,$34.44 ,$34.44 ,$41.00 ,$36.90 ,$23.58 ,$41.00 ,$9.02 ,$41.00 ,$22.30 ,$9.02 ,$17.06 ,$8.49 ,$8.11 ,$9.47 ,$34.85 ,$28.17 ,$11.48 ,$36.90 ,$34.44 ,$32.80 ,$32.80 ,$9.02 ,$26.65 
ST. FRANCIS HOSPITAL - ACUTE,30600537,87149,HC CULTURE TYPING ID NUCLEIC ACID,306,1 ,$375.00 ,$243.75 ,$8.11 ,$375.00 ,$215.63 ,$270.00 ,$204.00 ,$82.50 ,$105.00 ,$183.59 ,$82.50 ,$233.79 ,$93.75 ,$233.79 ,$233.79 ,$93.75 ,$233.79 ,$156.75 ,$315.00 ,$50.13 ,$82.50 ,$318.75 ,$315.00 ,$82.50 ,$281.25 ,$300.00 ,$300.00 ,$82.50 ,$300.00 ,$315.00 ,$315.00 ,$315.00 ,$375.00 ,$337.50 ,$215.63 ,$375.00 ,$82.50 ,$375.00 ,$204.00 ,$82.50 ,$156.00 ,$8.49 ,$8.11 ,$86.63 ,$318.75 ,$233.79 ,$105.00 ,$337.50 ,$315.00 ,$300.00 ,$300.00 ,$82.50 ,$243.75 
ST. FRANCIS HOSPITAL - ACUTE,30600538,87153,HC ID NUCLEAR ACID SEQ METH PROF,306,1 ,$240.00 ,$156.00 ,$26.93 ,$288.40 ,$138.00 ,$172.80 ,$130.56 ,$52.80 ,$67.20 ,$141.12 ,$52.80 ,$164.88 ,$60.00 ,$164.88 ,$164.88 ,$60.00 ,$164.88 ,$100.32 ,$201.60 ,$288.40 ,$52.80 ,$204.00 ,$201.60 ,$52.80 ,$180.00 ,$192.00 ,$192.00 ,$52.80 ,$192.00 ,$201.60 ,$201.60 ,$201.60 ,$240.00 ,$216.00 ,$138.00 ,$240.00 ,$52.80 ,$240.00 ,$130.56 ,$52.80 ,$99.84 ,$28.22 ,$26.93 ,$55.44 ,$204.00 ,$164.88 ,$67.20 ,$216.00 ,$201.60 ,$192.00 ,$192.00 ,$52.80 ,$156.00 
ST. FRANCIS HOSPITAL - ACUTE,30600539,87153,HC ID NUCLEAR ACID SEQ METH ID,306,1 ,$702.00 ,$456.30 ,$26.93 ,$702.00 ,$403.65 ,$505.44 ,$381.89 ,$154.44 ,$196.56 ,$412.78 ,$154.44 ,$482.27 ,$175.50 ,$482.27 ,$482.27 ,$175.50 ,$482.27 ,$293.44 ,$589.68 ,$288.40 ,$154.44 ,$596.70 ,$589.68 ,$154.44 ,$526.50 ,$561.60 ,$561.60 ,$154.44 ,$561.60 ,$589.68 ,$589.68 ,$589.68 ,$702.00 ,$631.80 ,$403.65 ,$702.00 ,$154.44 ,$702.00 ,$381.89 ,$154.44 ,$292.03 ,$28.22 ,$26.93 ,$162.16 ,$596.70 ,$482.27 ,$196.56 ,$631.80 ,$589.68 ,$561.60 ,$561.60 ,$154.44 ,$456.30 
ST. FRANCIS HOSPITAL - ACUTE,30600541,87172,HC PINWORM EXAM,306,1 ,$69.00 ,$44.85 ,$8.11 ,$69.00 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$40.57 ,$15.18 ,$47.40 ,$17.25 ,$47.40 ,$47.40 ,$17.25 ,$47.40 ,$28.84 ,$57.96 ,$10.68 ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 ,$8.49 ,$8.11 ,$15.94 ,$58.65 ,$47.40 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,30600544,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$65.00 ,$42.25 ,$8.11 ,$65.00 ,$37.38 ,$46.80 ,$35.36 ,$14.30 ,$18.20 ,$38.22 ,$14.30 ,$44.66 ,$16.25 ,$44.66 ,$44.66 ,$16.25 ,$44.66 ,$27.17 ,$54.60 ,$11.88 ,$14.30 ,$55.25 ,$54.60 ,$14.30 ,$48.75 ,$52.00 ,$52.00 ,$14.30 ,$52.00 ,$54.60 ,$54.60 ,$54.60 ,$65.00 ,$58.50 ,$37.38 ,$65.00 ,$14.30 ,$65.00 ,$35.36 ,$14.30 ,$27.04 ,$8.49 ,$8.11 ,$15.02 ,$55.25 ,$44.66 ,$18.20 ,$58.50 ,$54.60 ,$52.00 ,$52.00 ,$14.30 ,$42.25 
ST. FRANCIS HOSPITAL - ACUTE,30600545,87184,HC SENSITIVITY DISK KB,306,1 ,$352.00 ,$228.80 ,$8.11 ,$352.00 ,$202.40 ,$253.44 ,$191.49 ,$77.44 ,$98.56 ,$85.46 ,$77.44 ,$108.83 ,$88.00 ,$108.83 ,$108.83 ,$88.00 ,$108.83 ,$147.14 ,$295.68 ,$18.70 ,$77.44 ,$299.20 ,$295.68 ,$77.44 ,$264.00 ,$281.60 ,$281.60 ,$77.44 ,$281.60 ,$295.68 ,$295.68 ,$295.68 ,$352.00 ,$316.80 ,$202.40 ,$352.00 ,$77.44 ,$352.00 ,$191.49 ,$77.44 ,$146.43 ,$8.49 ,$8.11 ,$81.31 ,$299.20 ,$108.83 ,$98.56 ,$316.80 ,$295.68 ,$281.60 ,$281.60 ,$77.44 ,$228.80 
ST. FRANCIS HOSPITAL - ACUTE,30600546,87185,HC BETA LACTAMASE,306,1 ,$47.00 ,$30.55 ,$8.11 ,$47.00 ,$27.03 ,$33.84 ,$25.57 ,$10.34 ,$13.16 ,$27.64 ,$10.34 ,$32.29 ,$11.75 ,$32.29 ,$32.29 ,$11.75 ,$32.29 ,$19.65 ,$39.48 ,$11.88 ,$10.34 ,$39.95 ,$39.48 ,$10.34 ,$35.25 ,$37.60 ,$37.60 ,$10.34 ,$37.60 ,$39.48 ,$39.48 ,$39.48 ,$47.00 ,$42.30 ,$27.03 ,$47.00 ,$10.34 ,$47.00 ,$25.57 ,$10.34 ,$19.55 ,$8.49 ,$8.11 ,$10.86 ,$39.95 ,$32.29 ,$13.16 ,$42.30 ,$39.48 ,$37.60 ,$37.60 ,$10.34 ,$30.55 
ST. FRANCIS HOSPITAL - ACUTE,30600547,87186,HC SENSITIVITY MIC,306,1 ,$315.00 ,$204.75 ,$8.11 ,$315.00 ,$181.13 ,$226.80 ,$171.36 ,$69.30 ,$88.20 ,$79.19 ,$69.30 ,$100.84 ,$78.75 ,$100.84 ,$100.84 ,$78.75 ,$100.84 ,$131.67 ,$264.60 ,$21.63 ,$69.30 ,$267.75 ,$264.60 ,$69.30 ,$236.25 ,$252.00 ,$252.00 ,$69.30 ,$252.00 ,$264.60 ,$264.60 ,$264.60 ,$315.00 ,$283.50 ,$181.13 ,$315.00 ,$69.30 ,$315.00 ,$171.36 ,$69.30 ,$131.04 ,$8.49 ,$8.11 ,$72.77 ,$267.75 ,$100.84 ,$88.20 ,$283.50 ,$264.60 ,$252.00 ,$252.00 ,$69.30 ,$204.75 
ST. FRANCIS HOSPITAL - ACUTE,30600548,87188,HC MACROTUBE DIL METH 4DRG PNL,306,1 ,$66.00 ,$42.90 ,$8.11 ,$66.00 ,$37.95 ,$47.52 ,$35.90 ,$14.52 ,$18.48 ,$38.81 ,$14.52 ,$45.34 ,$16.50 ,$45.34 ,$45.34 ,$16.50 ,$45.34 ,$27.59 ,$55.44 ,$16.60 ,$14.52 ,$56.10 ,$55.44 ,$14.52 ,$49.50 ,$52.80 ,$52.80 ,$14.52 ,$52.80 ,$55.44 ,$55.44 ,$55.44 ,$66.00 ,$59.40 ,$37.95 ,$66.00 ,$14.52 ,$66.00 ,$35.90 ,$14.52 ,$27.46 ,$8.49 ,$8.11 ,$15.25 ,$56.10 ,$45.34 ,$18.48 ,$59.40 ,$55.44 ,$52.80 ,$52.80 ,$14.52 ,$42.90 
ST. FRANCIS HOSPITAL - ACUTE,30600549,87188,HC MACROTUBE DIL METH EA AGNT,306,1 ,$131.00 ,$85.15 ,$8.11 ,$131.00 ,$75.33 ,$94.32 ,$71.26 ,$28.82 ,$36.68 ,$60.82 ,$28.82 ,$77.44 ,$32.75 ,$77.44 ,$77.44 ,$32.75 ,$77.44 ,$54.76 ,$110.04 ,$16.60 ,$28.82 ,$111.35 ,$110.04 ,$28.82 ,$98.25 ,$104.80 ,$104.80 ,$28.82 ,$104.80 ,$110.04 ,$110.04 ,$110.04 ,$131.00 ,$117.90 ,$75.33 ,$131.00 ,$28.82 ,$131.00 ,$71.26 ,$28.82 ,$54.50 ,$8.49 ,$8.11 ,$30.26 ,$111.35 ,$77.44 ,$36.68 ,$117.90 ,$110.04 ,$104.80 ,$104.80 ,$28.82 ,$85.15 
ST. FRANCIS HOSPITAL - ACUTE,30600550,87190,HC SENSITIVITY AFB,306,1 ,$27.00 ,$17.55 ,$5.94 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.88 ,$5.94 ,$18.55 ,$6.75 ,$18.55 ,$18.55 ,$6.75 ,$18.55 ,$11.29 ,$22.68 ,$18.28 ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 ,$8.49 ,$8.11 ,$6.24 ,$22.95 ,$18.55 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,30600552,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$92.00 ,$59.80 ,$8.11 ,$92.00 ,$52.90 ,$66.24 ,$50.05 ,$20.24 ,$25.76 ,$54.10 ,$20.24 ,$63.20 ,$23.00 ,$63.20 ,$63.20 ,$23.00 ,$63.20 ,$38.46 ,$77.28 ,$13.48 ,$20.24 ,$78.20 ,$77.28 ,$20.24 ,$69.00 ,$73.60 ,$73.60 ,$20.24 ,$73.60 ,$77.28 ,$77.28 ,$77.28 ,$92.00 ,$82.80 ,$52.90 ,$92.00 ,$20.24 ,$92.00 ,$50.05 ,$20.24 ,$38.27 ,$8.49 ,$8.11 ,$21.25 ,$78.20 ,$63.20 ,$25.76 ,$82.80 ,$77.28 ,$73.60 ,$73.60 ,$20.24 ,$59.80 
ST. FRANCIS HOSPITAL - ACUTE,30600555,87255,HC VIRUS ID NON-IMMUNOLOGIC OTHER THAN CYTOPATHIC-90,306,1 ,$8.00 ,$5.20 ,$1.76 ,$28.22 ,$4.60 ,$5.76 ,$4.35 ,$1.76 ,$2.24 ,$4.70 ,$1.76 ,$5.50 ,$2.00 ,$5.50 ,$5.50 ,$2.00 ,$5.50 ,$3.34 ,$6.72 ,$20.00 ,$1.76 ,$6.80 ,$6.72 ,$1.76 ,$6.00 ,$6.40 ,$6.40 ,$1.76 ,$6.40 ,$6.72 ,$6.72 ,$6.72 ,$8.00 ,$7.20 ,$4.60 ,$8.00 ,$1.76 ,$8.00 ,$4.35 ,$1.76 ,$3.33 ,$28.22 ,$26.93 ,$1.85 ,$6.80 ,$5.50 ,$2.24 ,$7.20 ,$6.72 ,$6.40 ,$6.40 ,$1.76 ,$5.20 
ST. FRANCIS HOSPITAL - ACUTE,30600558,87338,HC EIA QL H PYLORI AG STOOL,306,1 ,$329.00 ,$213.85 ,$10.16 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$178.34 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$35.95 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$10.65 ,$10.16 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,30600559,87340,HC EIA QL HEPATITIS B AG,306,1 ,$185.00 ,$120.25 ,$10.16 ,$185.00 ,$106.38 ,$133.20 ,$100.64 ,$40.70 ,$51.80 ,$94.59 ,$40.70 ,$120.45 ,$46.25 ,$120.45 ,$120.45 ,$46.25 ,$120.45 ,$77.33 ,$155.40 ,$25.83 ,$40.70 ,$157.25 ,$155.40 ,$40.70 ,$138.75 ,$148.00 ,$148.00 ,$40.70 ,$148.00 ,$155.40 ,$155.40 ,$155.40 ,$185.00 ,$166.50 ,$106.38 ,$185.00 ,$40.70 ,$185.00 ,$100.64 ,$40.70 ,$76.96 ,$10.65 ,$10.16 ,$42.74 ,$157.25 ,$120.45 ,$51.80 ,$166.50 ,$155.40 ,$148.00 ,$148.00 ,$40.70 ,$120.25 
ST. FRANCIS HOSPITAL - ACUTE,30600561,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$292.00 ,$189.80 ,$10.16 ,$292.00 ,$167.90 ,$210.24 ,$158.85 ,$64.24 ,$81.76 ,$171.70 ,$64.24 ,$200.60 ,$73.00 ,$200.60 ,$200.60 ,$73.00 ,$200.60 ,$122.06 ,$245.28 ,$60.20 ,$64.24 ,$248.20 ,$245.28 ,$64.24 ,$219.00 ,$233.60 ,$233.60 ,$64.24 ,$233.60 ,$245.28 ,$245.28 ,$245.28 ,$292.00 ,$262.80 ,$167.90 ,$292.00 ,$64.24 ,$292.00 ,$158.85 ,$64.24 ,$121.47 ,$10.65 ,$10.16 ,$67.45 ,$248.20 ,$200.60 ,$81.76 ,$262.80 ,$245.28 ,$233.60 ,$233.60 ,$64.24 ,$189.80 
ST. FRANCIS HOSPITAL - ACUTE,30600565,87450,HC EIA QL SGL AG,306,1 ,$69.00 ,$44.85 ,$15.18 ,$69.00 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$40.57 ,$15.18 ,$47.40 ,$17.25 ,$47.40 ,$47.40 ,$17.25 ,$47.40 ,$28.84 ,$57.96 , N/A ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 , N/A , N/A ,$15.94 ,$58.65 ,$47.40 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,30600566,87480,HC CANDIDA SPECIES DNA SCREEN,306,1 ,$46.00 ,$29.90 ,$10.12 ,$50.13 ,$26.45 ,$33.12 ,$25.02 ,$10.12 ,$12.88 ,$27.05 ,$10.12 ,$31.60 ,$11.50 ,$31.60 ,$31.60 ,$11.50 ,$31.60 ,$19.23 ,$38.64 ,$50.13 ,$10.12 ,$39.10 ,$38.64 ,$10.12 ,$34.50 ,$36.80 ,$36.80 ,$10.12 ,$36.80 ,$38.64 ,$38.64 ,$38.64 ,$46.00 ,$41.40 ,$26.45 ,$46.00 ,$10.12 ,$46.00 ,$25.02 ,$10.12 ,$19.14 ,$10.65 ,$10.16 ,$10.63 ,$39.10 ,$31.60 ,$12.88 ,$41.40 ,$38.64 ,$36.80 ,$36.80 ,$10.12 ,$29.90 
ST. FRANCIS HOSPITAL - ACUTE,30600567,87483,HC INFECT AMP CNS DNA/RNA 14 TARGETS,306,1 ,$396.00 ,$257.40 ,$26.93 ,$990.00 ,$227.70 ,$285.12 ,$215.42 ,$87.12 ,$110.88 ,$232.85 ,$87.12 ,$272.05 ,$99.00 ,$272.05 ,$272.05 ,$99.00 ,$272.05 ,$165.53 ,$332.64 ,$990.00 ,$87.12 ,$336.60 ,$332.64 ,$87.12 ,$297.00 ,$316.80 ,$316.80 ,$87.12 ,$316.80 ,$332.64 ,$332.64 ,$332.64 ,$396.00 ,$356.40 ,$227.70 ,$396.00 ,$87.12 ,$396.00 ,$215.42 ,$87.12 ,$164.74 ,$28.22 ,$26.93 ,$91.48 ,$336.60 ,$272.05 ,$110.88 ,$356.40 ,$332.64 ,$316.80 ,$316.80 ,$87.12 ,$257.40 
ST. FRANCIS HOSPITAL - ACUTE,30600568,87486,HC CHLAMYDIA PNEUM AMP PROBE,306,1 ,$166.00 ,$107.90 ,$26.93 ,$166.00 ,$95.45 ,$119.52 ,$90.30 ,$36.52 ,$46.48 ,$97.61 ,$36.52 ,$114.04 ,$41.50 ,$114.04 ,$114.04 ,$41.50 ,$114.04 ,$69.39 ,$139.44 ,$87.73 ,$36.52 ,$141.10 ,$139.44 ,$36.52 ,$124.50 ,$132.80 ,$132.80 ,$36.52 ,$132.80 ,$139.44 ,$139.44 ,$139.44 ,$166.00 ,$149.40 ,$95.45 ,$166.00 ,$36.52 ,$166.00 ,$90.30 ,$36.52 ,$69.06 ,$28.22 ,$26.93 ,$38.35 ,$141.10 ,$114.04 ,$46.48 ,$149.40 ,$139.44 ,$132.80 ,$132.80 ,$36.52 ,$107.90 
ST. FRANCIS HOSPITAL - ACUTE,30600570,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$133.00 ,$86.45 ,$10.16 ,$133.00 ,$76.48 ,$95.76 ,$72.35 ,$29.26 ,$37.24 ,$78.20 ,$29.26 ,$91.37 ,$33.25 ,$91.37 ,$91.37 ,$33.25 ,$91.37 ,$55.59 ,$111.72 ,$87.73 ,$29.26 ,$113.05 ,$111.72 ,$29.26 ,$99.75 ,$106.40 ,$106.40 ,$29.26 ,$106.40 ,$111.72 ,$111.72 ,$111.72 ,$133.00 ,$119.70 ,$76.48 ,$133.00 ,$29.26 ,$133.00 ,$72.35 ,$29.26 ,$55.33 ,$10.65 ,$10.16 ,$30.72 ,$113.05 ,$91.37 ,$37.24 ,$119.70 ,$111.72 ,$106.40 ,$106.40 ,$29.26 ,$86.45 
ST. FRANCIS HOSPITAL - ACUTE,30600571,87507,HC IF AG DNA/RNA PROBE TQ 12-25 TARGETS,306,1 ,$791.00 ,$514.15 ,$26.93 ,"$1,041.95 ",$454.83 ,$569.52 ,$430.30 ,$174.02 ,$221.48 ,$465.11 ,$174.02 ,$543.42 ,$197.75 ,$543.42 ,$543.42 ,$197.75 ,$543.42 ,$330.64 ,$664.44 ,"$1,041.95 ",$174.02 ,$672.35 ,$664.44 ,$174.02 ,$593.25 ,$632.80 ,$632.80 ,$174.02 ,$632.80 ,$664.44 ,$664.44 ,$664.44 ,$791.00 ,$711.90 ,$454.83 ,$791.00 ,$174.02 ,$791.00 ,$430.30 ,$174.02 ,$329.06 ,$28.22 ,$26.93 ,$182.72 ,$672.35 ,$543.42 ,$221.48 ,$711.90 ,$664.44 ,$632.80 ,$632.80 ,$174.02 ,$514.15 
ST. FRANCIS HOSPITAL - ACUTE,30600572,87510,HC G VAGINALIS DNA SCREEN,306,1 ,$46.00 ,$29.90 ,$10.12 ,$50.13 ,$26.45 ,$33.12 ,$25.02 ,$10.12 ,$12.88 ,$27.05 ,$10.12 ,$31.60 ,$11.50 ,$31.60 ,$31.60 ,$11.50 ,$31.60 ,$19.23 ,$38.64 ,$50.13 ,$10.12 ,$39.10 ,$38.64 ,$10.12 ,$34.50 ,$36.80 ,$36.80 ,$10.12 ,$36.80 ,$38.64 ,$38.64 ,$38.64 ,$46.00 ,$41.40 ,$26.45 ,$46.00 ,$10.12 ,$46.00 ,$25.02 ,$10.12 ,$19.14 ,$28.22 ,$26.93 ,$10.63 ,$39.10 ,$31.60 ,$12.88 ,$41.40 ,$38.64 ,$36.80 ,$36.80 ,$10.12 ,$29.90 
ST. FRANCIS HOSPITAL - ACUTE,30600573,87581,HC IF AG PROBE MYCOPLASMA PNEUMONIAE,306,1 ,$166.00 ,$107.90 ,$26.93 ,$166.00 ,$95.45 ,$119.52 ,$90.30 ,$36.52 ,$46.48 ,$97.61 ,$36.52 ,$114.04 ,$41.50 ,$114.04 ,$114.04 ,$41.50 ,$114.04 ,$69.39 ,$139.44 ,$87.73 ,$36.52 ,$141.10 ,$139.44 ,$36.52 ,$124.50 ,$132.80 ,$132.80 ,$36.52 ,$132.80 ,$139.44 ,$139.44 ,$139.44 ,$166.00 ,$149.40 ,$95.45 ,$166.00 ,$36.52 ,$166.00 ,$90.30 ,$36.52 ,$69.06 ,$28.22 ,$26.93 ,$38.35 ,$141.10 ,$114.04 ,$46.48 ,$149.40 ,$139.44 ,$132.80 ,$132.80 ,$36.52 ,$107.90 
ST. FRANCIS HOSPITAL - ACUTE,30600575,87591,HC NEISSERIA AMP,306,1 ,$133.00 ,$86.45 ,$26.93 ,$133.00 ,$76.48 ,$95.76 ,$72.35 ,$29.26 ,$37.24 ,$78.20 ,$29.26 ,$91.37 ,$33.25 ,$91.37 ,$91.37 ,$33.25 ,$91.37 ,$55.59 ,$111.72 ,$87.73 ,$29.26 ,$113.05 ,$111.72 ,$29.26 ,$99.75 ,$106.40 ,$106.40 ,$29.26 ,$106.40 ,$111.72 ,$111.72 ,$111.72 ,$133.00 ,$119.70 ,$76.48 ,$133.00 ,$29.26 ,$133.00 ,$72.35 ,$29.26 ,$55.33 ,$28.22 ,$26.93 ,$30.72 ,$113.05 ,$91.37 ,$37.24 ,$119.70 ,$111.72 ,$106.40 ,$106.40 ,$29.26 ,$86.45 
ST. FRANCIS HOSPITAL - ACUTE,30600576,87624,HC HPV HIGH RISK ALL OTHERS,306,1 ,$347.00 ,$225.55 ,$26.93 ,$347.00 ,$199.53 ,$249.84 ,$188.77 ,$76.34 ,$97.16 ,$204.04 ,$76.34 ,$238.39 ,$86.75 ,$238.39 ,$238.39 ,$86.75 ,$238.39 ,$145.05 ,$291.48 ,$87.73 ,$76.34 ,$294.95 ,$291.48 ,$76.34 ,$260.25 ,$277.60 ,$277.60 ,$76.34 ,$277.60 ,$291.48 ,$291.48 ,$291.48 ,$347.00 ,$312.30 ,$199.53 ,$347.00 ,$76.34 ,$35.09 ,$188.77 ,$76.34 ,$144.35 ,$28.22 ,$26.93 ,$80.16 ,$294.95 ,$238.39 ,$97.16 ,$312.30 ,$291.48 ,$277.60 ,$277.60 ,$76.34 ,$225.55 
ST. FRANCIS HOSPITAL - ACUTE,30600577,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,"$1,959.00 ","$1,273.35 ",$26.93 ,"$1,959.00 ","$1,126.43 ","$1,410.48 ","$1,065.70 ",$430.98 ,$548.52 ,"$1,151.89 ",$430.98 ,"$1,345.83 ",$489.75 ,"$1,345.83 ","$1,345.83 ",$489.75 ,"$1,345.83 ",$818.86 ,"$1,645.56 ","$1,041.95 ",$430.98 ,"$1,665.15 ","$1,645.56 ",$430.98 ,"$1,469.25 ","$1,567.20 ","$1,567.20 ",$430.98 ,"$1,567.20 ","$1,645.56 ","$1,645.56 ","$1,645.56 ","$1,959.00 ","$1,763.10 ","$1,126.43 ","$1,959.00 ",$430.98 ,"$1,959.00 ","$1,065.70 ",$430.98 ,$814.94 ,$28.22 ,$26.93 ,$452.53 ,"$1,665.15 ","$1,345.83 ",$548.52 ,"$1,763.10 ","$1,645.56 ","$1,567.20 ","$1,567.20 ",$430.98 ,"$1,273.35 "
ST. FRANCIS HOSPITAL - ACUTE,30600578,87641,HC MRSA AMP,306,1 ,$485.00 ,$315.25 ,$26.93 ,$485.00 ,$278.88 ,$349.20 ,$263.84 ,$106.70 ,$135.80 ,$285.18 ,$106.70 ,$333.20 ,$121.25 ,$333.20 ,$333.20 ,$121.25 ,$333.20 ,$202.73 ,$407.40 ,$87.73 ,$106.70 ,$412.25 ,$407.40 ,$106.70 ,$363.75 ,$388.00 ,$388.00 ,$106.70 ,$388.00 ,$407.40 ,$407.40 ,$407.40 ,$485.00 ,$436.50 ,$278.88 ,$485.00 ,$106.70 ,$485.00 ,$263.84 ,$106.70 ,$201.76 ,$28.22 ,$26.93 ,$112.04 ,$412.25 ,$333.20 ,$135.80 ,$436.50 ,$407.40 ,$388.00 ,$388.00 ,$106.70 ,$315.25 
ST. FRANCIS HOSPITAL - ACUTE,30600579,87653,HC INFECT AMP (GRP B STREP),306,1 ,$541.00 ,$351.65 ,$26.93 ,$541.00 ,$311.08 ,$389.52 ,$294.30 ,$119.02 ,$151.48 ,$318.11 ,$119.02 ,$371.67 ,$135.25 ,$371.67 ,$371.67 ,$135.25 ,$371.67 ,$226.14 ,$454.44 ,$87.73 ,$119.02 ,$459.85 ,$454.44 ,$119.02 ,$405.75 ,$432.80 ,$432.80 ,$119.02 ,$432.80 ,$454.44 ,$454.44 ,$454.44 ,$541.00 ,$486.90 ,$311.08 ,$541.00 ,$119.02 ,$541.00 ,$294.30 ,$119.02 ,$225.06 ,$28.22 ,$26.93 ,$124.97 ,$459.85 ,$371.67 ,$151.48 ,$486.90 ,$454.44 ,$432.80 ,$432.80 ,$119.02 ,$351.65 
ST. FRANCIS HOSPITAL - ACUTE,30600580,87660,HC TRICHOMONAS DNA SCREEN,306,1 ,$46.00 ,$29.90 ,$10.12 ,$50.13 ,$26.45 ,$33.12 ,$25.02 ,$10.12 ,$12.88 ,$27.05 ,$10.12 ,$31.60 ,$11.50 ,$31.60 ,$31.60 ,$11.50 ,$31.60 ,$19.23 ,$38.64 ,$50.13 ,$10.12 ,$39.10 ,$38.64 ,$10.12 ,$34.50 ,$36.80 ,$36.80 ,$10.12 ,$36.80 ,$38.64 ,$38.64 ,$38.64 ,$46.00 ,$41.40 ,$26.45 ,$46.00 ,$10.12 ,$46.00 ,$25.02 ,$10.12 ,$19.14 ,$28.22 ,$26.93 ,$10.63 ,$39.10 ,$31.60 ,$12.88 ,$41.40 ,$38.64 ,$36.80 ,$36.80 ,$10.12 ,$29.90 
ST. FRANCIS HOSPITAL - ACUTE,30600581,87798,HC INFECT AMP,306,1 ,$246.00 ,$159.90 ,$26.93 ,$246.00 ,$141.45 ,$177.12 ,$133.82 ,$54.12 ,$68.88 ,$144.65 ,$54.12 ,$169.00 ,$61.50 ,$169.00 ,$169.00 ,$61.50 ,$169.00 ,$102.83 ,$206.64 ,$87.73 ,$54.12 ,$209.10 ,$206.64 ,$54.12 ,$184.50 ,$196.80 ,$196.80 ,$54.12 ,$196.80 ,$206.64 ,$206.64 ,$206.64 ,$246.00 ,$221.40 ,$141.45 ,$246.00 ,$54.12 ,$246.00 ,$133.82 ,$54.12 ,$102.34 ,$28.22 ,$26.93 ,$56.83 ,$209.10 ,$169.00 ,$68.88 ,$221.40 ,$206.64 ,$196.80 ,$196.80 ,$54.12 ,$159.90 
ST. FRANCIS HOSPITAL - ACUTE,30600582,87798,HC INFECT AMP DRUG RESIST TB,306,1 ,$246.00 ,$159.90 ,$26.93 ,$246.00 ,$141.45 ,$177.12 ,$133.82 ,$54.12 ,$68.88 ,$144.65 ,$54.12 ,$169.00 ,$61.50 ,$169.00 ,$169.00 ,$61.50 ,$169.00 ,$102.83 ,$206.64 ,$87.73 ,$54.12 ,$209.10 ,$206.64 ,$54.12 ,$184.50 ,$196.80 ,$196.80 ,$54.12 ,$196.80 ,$206.64 ,$206.64 ,$206.64 ,$246.00 ,$221.40 ,$141.45 ,$246.00 ,$54.12 ,$246.00 ,$133.82 ,$54.12 ,$102.34 ,$28.22 ,$26.93 ,$56.83 ,$209.10 ,$169.00 ,$68.88 ,$221.40 ,$206.64 ,$196.80 ,$196.80 ,$54.12 ,$159.90 
ST. FRANCIS HOSPITAL - ACUTE,30600585,87181,HC SENSITIVITY STUDY AGAR ACID FAST,306,1 ,$278.00 ,$180.70 ,$8.11 ,$278.00 ,$159.85 ,$200.16 ,$151.23 ,$61.16 ,$77.84 ,$58.88 ,$61.16 ,$74.97 ,$69.50 ,$74.97 ,$74.97 ,$69.50 ,$74.97 ,$116.20 ,$233.52 ,$11.88 ,$61.16 ,$236.30 ,$233.52 ,$61.16 ,$208.50 ,$222.40 ,$222.40 ,$61.16 ,$222.40 ,$233.52 ,$233.52 ,$233.52 ,$278.00 ,$250.20 ,$159.85 ,$278.00 ,$61.16 ,$278.00 ,$151.23 ,$61.16 ,$115.65 ,$8.49 ,$8.11 ,$64.22 ,$236.30 ,$74.97 ,$77.84 ,$250.20 ,$233.52 ,$222.40 ,$222.40 ,$61.16 ,$180.70 
ST. FRANCIS HOSPITAL - ACUTE,30600586,87147,HC CULTURE TYPE SEROLOGIC-91,306,1 ,$46.00 ,$29.90 ,$8.11 ,$46.00 ,$26.45 ,$33.12 ,$25.02 ,$10.12 ,$12.88 ,$27.05 ,$10.12 ,$31.60 ,$11.50 ,$31.60 ,$31.60 ,$11.50 ,$31.60 ,$19.23 ,$38.64 ,$12.95 ,$10.12 ,$39.10 ,$38.64 ,$10.12 ,$34.50 ,$36.80 ,$36.80 ,$10.12 ,$36.80 ,$38.64 ,$38.64 ,$38.64 ,$46.00 ,$41.40 ,$26.45 ,$46.00 ,$10.12 ,$46.00 ,$25.02 ,$10.12 ,$19.14 ,$8.49 ,$8.11 ,$10.63 ,$39.10 ,$31.60 ,$12.88 ,$41.40 ,$38.64 ,$36.80 ,$36.80 ,$10.12 ,$29.90 
ST. FRANCIS HOSPITAL - ACUTE,30600587,87186,HC SENSITIVITY MIC MYCOBACTERIA,306,1 ,$899.00 ,$584.35 ,$8.11 ,$899.00 ,$516.93 ,$647.28 ,$489.06 ,$197.78 ,$251.72 ,$79.19 ,$197.78 ,$100.84 ,$224.75 ,$100.84 ,$100.84 ,$224.75 ,$100.84 ,$375.78 ,$755.16 ,$21.63 ,$197.78 ,$764.15 ,$755.16 ,$197.78 ,$674.25 ,$719.20 ,$719.20 ,$197.78 ,$719.20 ,$755.16 ,$755.16 ,$755.16 ,$899.00 ,$809.10 ,$516.93 ,$899.00 ,$197.78 ,$899.00 ,$489.06 ,$197.78 ,$373.98 ,$8.49 ,$8.11 ,$207.67 ,$764.15 ,$100.84 ,$251.72 ,$809.10 ,$755.16 ,$719.20 ,$719.20 ,$197.78 ,$584.35 
ST. FRANCIS HOSPITAL - ACUTE,30600593,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$69.00 ,$44.85 ,$8.11 ,$69.00 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$40.57 ,$15.18 ,$47.40 ,$17.25 ,$47.40 ,$47.40 ,$17.25 ,$47.40 ,$28.84 ,$57.96 ,$40.18 ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 ,$8.49 ,$8.11 ,$15.94 ,$58.65 ,$47.40 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,30600607,87661,HC TRICHOMONAS BAG AMP PROBE,306,1 ,$24.00 ,$15.60 ,$5.28 ,$60.00 ,$13.80 ,$17.28 ,$13.06 ,$5.28 ,$6.72 ,$14.11 ,$5.28 ,$16.49 ,$6.00 ,$16.49 ,$16.49 ,$6.00 ,$16.49 ,$10.03 ,$20.16 ,$60.00 ,$5.28 ,$20.40 ,$20.16 ,$5.28 ,$18.00 ,$19.20 ,$19.20 ,$5.28 ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 ,$13.80 ,$24.00 ,$5.28 ,$24.00 ,$13.06 ,$5.28 ,$9.98 ,$28.22 ,$26.93 ,$5.54 ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 ,$5.28 ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,30600608,87045,HC STOOL CULTURE -90,306,1 ,$52.00 ,$33.80 ,$8.11 ,$52.00 ,$29.90 ,$37.44 ,$28.29 ,$11.44 ,$14.56 ,$30.58 ,$11.44 ,$35.72 ,$13.00 ,$35.72 ,$35.72 ,$13.00 ,$35.72 ,$21.74 ,$43.68 ,$23.60 ,$11.44 ,$44.20 ,$43.68 ,$11.44 ,$39.00 ,$41.60 ,$41.60 ,$11.44 ,$41.60 ,$43.68 ,$43.68 ,$43.68 ,$52.00 ,$46.80 ,$29.90 ,$52.00 ,$11.44 ,$52.00 ,$28.29 ,$11.44 ,$21.63 ,$8.49 ,$8.11 ,$12.01 ,$44.20 ,$35.72 ,$14.56 ,$46.80 ,$43.68 ,$41.60 ,$41.60 ,$11.44 ,$33.80 
ST. FRANCIS HOSPITAL - ACUTE,30600613,87205,HC URINE FOR EOSINOPHILS-90,306,1 ,$25.00 ,$16.25 ,$5.50 ,$25.00 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$10.68 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$8.49 ,$8.11 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,30600623,87635,HC COVID-19 LAB TEST CDC-90,306,1 ,$466.00 ,$302.90 ,$26.93 ,$466.00 ,$267.95 ,$335.52 ,$253.50 ,$102.52 ,$130.48 ,$261.43 ,$102.52 ,$303.83 ,$116.50 ,$303.83 ,$303.83 ,$116.50 ,$303.83 ,$194.79 ,$51.31 ,$128.28 ,$102.52 ,$396.10 ,$391.44 ,$102.52 ,$349.50 ,$372.80 ,$372.80 ,$102.52 ,$372.80 ,$391.44 ,$391.44 ,$391.44 ,$466.00 ,$419.40 ,$267.95 ,$466.00 ,$102.52 ,$51.31 ,$253.50 ,$102.52 ,$193.86 ,$28.22 ,$26.93 ,$107.65 ,$396.10 ,$303.83 ,$130.48 ,$419.40 ,$391.44 ,$372.80 ,$372.80 ,$102.52 ,$302.90 
ST. FRANCIS HOSPITAL - ACUTE,30600626,87220,HC SCABIES- 90,306,1 ,$45.00 ,$29.25 ,$8.11 ,$45.00 ,$25.88 ,$32.40 ,$24.48 ,$9.90 ,$12.60 ,$26.46 ,$9.90 ,$30.92 ,$11.25 ,$30.92 ,$30.92 ,$11.25 ,$30.92 ,$18.81 ,$37.80 ,$10.68 ,$9.90 ,$38.25 ,$37.80 ,$9.90 ,$33.75 ,$36.00 ,$36.00 ,$9.90 ,$36.00 ,$37.80 ,$37.80 ,$37.80 ,$45.00 ,$40.50 ,$25.88 ,$45.00 ,$9.90 ,$45.00 ,$24.48 ,$9.90 ,$18.72 ,$8.49 ,$8.11 ,$10.40 ,$38.25 ,$30.92 ,$12.60 ,$40.50 ,$37.80 ,$36.00 ,$36.00 ,$9.90 ,$29.25 
ST. FRANCIS HOSPITAL - ACUTE,30600630,87481,HC IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ,306,1 ,$21.00 ,$13.65 ,$4.62 ,$52.50 ,$12.08 ,$15.12 ,$11.42 ,$4.62 ,$5.88 ,$12.35 ,$4.62 ,$14.43 ,$5.25 ,$14.43 ,$14.43 ,$5.25 ,$14.43 ,$8.78 ,$17.64 ,$52.50 ,$4.62 ,$17.85 ,$17.64 ,$4.62 ,$15.75 ,$16.80 ,$16.80 ,$4.62 ,$16.80 ,$17.64 ,$17.64 ,$17.64 ,$21.00 ,$18.90 ,$12.08 ,$21.00 ,$4.62 ,$21.00 ,$11.42 ,$4.62 ,$8.74 ,$10.65 ,$10.16 ,$4.85 ,$17.85 ,$14.43 ,$5.88 ,$18.90 ,$17.64 ,$16.80 ,$16.80 ,$4.62 ,$13.65 
ST. FRANCIS HOSPITAL - ACUTE,30600631,87563,HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH,306,1 ,$41.00 ,$26.65 ,$9.02 ,$87.73 ,$23.58 ,$29.52 ,$22.30 ,$9.02 ,$11.48 ,$23.00 ,$9.02 ,$26.73 ,$10.25 ,$26.73 ,$26.73 ,$10.25 ,$26.73 ,$17.14 ,$34.44 ,$87.73 ,$9.02 ,$34.85 ,$34.44 ,$9.02 ,$30.75 ,$32.80 ,$32.80 ,$9.02 ,$32.80 ,$34.44 ,$34.44 ,$34.44 ,$41.00 ,$36.90 ,$23.58 ,$41.00 ,$9.02 ,$41.00 ,$22.30 ,$9.02 ,$17.06 ,$28.22 ,$26.93 ,$9.47 ,$34.85 ,$26.73 ,$11.48 ,$36.90 ,$34.44 ,$32.80 ,$32.80 ,$9.02 ,$26.65 
ST. FRANCIS HOSPITAL - ACUTE,30600632,87801,HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ,306,1 ,$30.00 ,$19.50 ,$6.60 ,$75.00 ,$17.25 ,$21.60 ,$16.32 ,$6.60 ,$8.40 ,$17.64 ,$6.60 ,$20.61 ,$7.50 ,$20.61 ,$20.61 ,$7.50 ,$20.61 ,$12.54 ,$25.20 ,$75.00 ,$6.60 ,$25.50 ,$25.20 ,$6.60 ,$22.50 ,$24.00 ,$24.00 ,$6.60 ,$24.00 ,$25.20 ,$25.20 ,$25.20 ,$30.00 ,$27.00 ,$17.25 ,$30.00 ,$6.60 ,$30.00 ,$16.32 ,$6.60 ,$12.48 ,$8.49 ,$8.11 ,$6.93 ,$25.50 ,$20.61 ,$8.40 ,$27.00 ,$25.20 ,$24.00 ,$24.00 ,$6.60 ,$19.50 
ST. FRANCIS HOSPITAL - ACUTE,30600636,87811,HC COVID ANTIGEN TEST,306,1 ,$125.00 ,$81.25 ,$8.11 ,$125.00 ,$71.88 ,$90.00 ,$68.00 ,$27.50 ,$35.00 ,$70.13 ,$27.50 ,$81.50 ,$31.25 ,$81.50 ,$81.50 ,$31.25 ,$81.50 ,$52.25 ,$41.38 ,$103.45 ,$27.50 ,$106.25 ,$105.00 ,$27.50 ,$93.75 ,$100.00 ,$100.00 ,$27.50 ,$100.00 ,$105.00 ,$105.00 ,$105.00 ,$125.00 ,$112.50 ,$71.88 ,$125.00 ,$27.50 ,$125.00 ,$68.00 ,$27.50 ,$52.00 ,$8.49 ,$8.11 ,$28.88 ,$106.25 ,$81.50 ,$35.00 ,$112.50 ,$105.00 ,$100.00 ,$100.00 ,$27.50 ,$81.25 
ST. FRANCIS HOSPITAL - ACUTE,30600637,87635,HC COVID-19 LAB PCR TEST,306,1 ,$466.00 ,$302.90 ,$26.93 ,$466.00 ,$267.95 ,$335.52 ,$253.50 ,$102.52 ,$130.48 ,$261.43 ,$102.52 ,$303.83 ,$116.50 ,$303.83 ,$303.83 ,$116.50 ,$303.83 ,$194.79 ,$51.31 ,$128.28 ,$102.52 ,$396.10 ,$391.44 ,$102.52 ,$349.50 ,$372.80 ,$372.80 ,$102.52 ,$372.80 ,$391.44 ,$391.44 ,$391.44 ,$466.00 ,$419.40 ,$267.95 ,$466.00 ,$102.52 ,$51.31 ,$253.50 ,$102.52 ,$193.86 ,$28.22 ,$26.93 ,$107.65 ,$396.10 ,$303.83 ,$130.48 ,$419.40 ,$391.44 ,$372.80 ,$372.80 ,$102.52 ,$302.90 
ST. FRANCIS HOSPITAL - ACUTE,30600638,87635,HC COVID-19 LAB TEST - 2 DAY COMPLETION - 90,306,1 ,$88.00 ,$57.20 ,$19.36 ,$128.28 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$49.37 ,$19.36 ,$57.38 ,$22.00 ,$57.38 ,$57.38 ,$22.00 ,$57.38 ,$36.78 ,$51.31 ,$128.28 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$51.31 ,$47.87 ,$19.36 ,$36.61 ,$28.22 ,$26.93 ,$20.33 ,$74.80 ,$57.38 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,30682004,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$15.00 ,$9.75 ,$3.30 ,$37.50 ,$8.63 ,$10.80 ,$8.16 ,$3.30 ,$4.20 ,$8.82 ,$3.30 ,$10.31 ,$3.75 ,$10.31 ,$10.31 ,$3.75 ,$10.31 ,$6.27 ,$12.60 ,$37.50 ,$3.30 ,$12.75 ,$12.60 ,$3.30 ,$11.25 ,$12.00 ,$12.00 ,$3.30 ,$12.00 ,$12.60 ,$12.60 ,$12.60 ,$15.00 ,$13.50 ,$8.63 ,$15.00 ,$3.30 ,$15.00 ,$8.16 ,$3.30 ,$6.24 ,$10.65 ,$10.16 ,$3.47 ,$12.75 ,$10.31 ,$4.20 ,$13.50 ,$12.60 ,$12.00 ,$12.00 ,$3.30 ,$9.75 
ST. FRANCIS HOSPITAL - ACUTE,30682010,87635,HC COVID-19 LAB TEST NON-CDC-90,306,1 ,$466.00 ,$302.90 ,$26.93 ,$466.00 ,$267.95 ,$335.52 ,$253.50 ,$102.52 ,$130.48 ,$261.43 ,$102.52 ,$303.83 ,$116.50 ,$303.83 ,$303.83 ,$116.50 ,$303.83 ,$194.79 ,$51.31 ,$128.28 ,$102.52 ,$396.10 ,$391.44 ,$102.52 ,$349.50 ,$372.80 ,$372.80 ,$102.52 ,$372.80 ,$391.44 ,$391.44 ,$391.44 ,$466.00 ,$419.40 ,$267.95 ,$466.00 ,$102.52 ,$51.31 ,$253.50 ,$102.52 ,$193.86 ,$28.22 ,$26.93 ,$107.65 ,$396.10 ,$303.83 ,$130.48 ,$419.40 ,$391.44 ,$372.80 ,$372.80 ,$102.52 ,$302.90 
ST. FRANCIS HOSPITAL - ACUTE,30682012,87635,HC COVID-19 LAB TEST,306,1 ,$466.00 ,$302.90 ,$26.93 ,$466.00 ,$267.95 ,$335.52 ,$253.50 ,$102.52 ,$130.48 ,$261.43 ,$102.52 ,$303.83 ,$116.50 ,$303.83 ,$303.83 ,$116.50 ,$303.83 ,$194.79 ,$51.31 ,$128.28 ,$102.52 ,$396.10 ,$391.44 ,$102.52 ,$349.50 ,$372.80 ,$372.80 ,$102.52 ,$372.80 ,$391.44 ,$391.44 ,$391.44 ,$466.00 ,$419.40 ,$267.95 ,$466.00 ,$102.52 ,$51.31 ,$253.50 ,$102.52 ,$193.86 ,$28.22 ,$26.93 ,$107.65 ,$396.10 ,$303.83 ,$130.48 ,$419.40 ,$391.44 ,$372.80 ,$372.80 ,$102.52 ,$302.90 
ST. FRANCIS HOSPITAL - ACUTE,30682015,86769,HC SARS-COV-2 COVID-19 ANTIBODY-90,306,1 ,$146.00 ,$94.90 ,$10.16 ,$146.00 ,$83.95 ,$105.12 ,$79.42 ,$32.12 ,$40.88 ,$81.91 ,$32.12 ,$95.19 ,$36.50 ,$95.19 ,$95.19 ,$36.50 ,$95.19 ,$61.03 ,$42.13 ,$105.33 ,$32.12 ,$124.10 ,$122.64 ,$32.12 ,$109.50 ,$116.80 ,$116.80 ,$32.12 ,$116.80 ,$122.64 ,$122.64 ,$122.64 ,$146.00 ,$131.40 ,$83.95 ,$146.00 ,$32.12 ,$146.00 ,$79.42 ,$32.12 ,$60.74 ,$10.65 ,$10.16 ,$33.73 ,$124.10 ,$95.19 ,$40.88 ,$131.40 ,$122.64 ,$116.80 ,$116.80 ,$32.12 ,$94.90 
ST. FRANCIS HOSPITAL - ACUTE,30682022,87102,HC CULTURE FUNGUS OTHER-90,306,1 ,$191.00 ,$124.15 ,$8.11 ,$191.00 ,$109.83 ,$137.52 ,$103.90 ,$42.02 ,$53.48 ,$77.02 ,$42.02 ,$98.08 ,$47.75 ,$98.08 ,$98.08 ,$47.75 ,$98.08 ,$79.84 ,$160.44 ,$21.03 ,$42.02 ,$162.35 ,$160.44 ,$42.02 ,$143.25 ,$152.80 ,$152.80 ,$42.02 ,$152.80 ,$160.44 ,$160.44 ,$160.44 ,$191.00 ,$171.90 ,$109.83 ,$191.00 ,$42.02 ,$191.00 ,$103.90 ,$42.02 ,$79.46 ,$8.49 ,$8.11 ,$44.12 ,$162.35 ,$98.08 ,$53.48 ,$171.90 ,$160.44 ,$152.80 ,$152.80 ,$42.02 ,$124.15 
ST. FRANCIS HOSPITAL - ACUTE,30682023,87426,HC SARS COVID ANTIGEN TEST,306,1 ,$84.00 ,$54.60 ,$8.11 ,$88.33 ,$48.30 ,$60.48 ,$45.70 ,$18.48 ,$23.52 ,$47.12 ,$18.48 ,$54.77 ,$21.00 ,$54.77 ,$54.77 ,$21.00 ,$54.77 ,$35.11 ,$45.23 ,$88.33 ,$18.48 ,$71.40 ,$70.56 ,$18.48 ,$63.00 ,$67.20 ,$67.20 ,$18.48 ,$67.20 ,$70.56 ,$70.56 ,$70.56 ,$84.00 ,$75.60 ,$48.30 ,$84.00 ,$18.48 ,$37.79 ,$45.70 ,$18.48 ,$34.94 ,$8.49 ,$8.11 ,$19.40 ,$71.40 ,$54.77 ,$23.52 ,$75.60 ,$70.56 ,$67.20 ,$67.20 ,$18.48 ,$54.60 
ST. FRANCIS HOSPITAL - ACUTE,30682024,87635,HC SARS-COV-2 COVID-19 TEST,306,1 ,$88.00 ,$57.20 ,$19.36 ,$128.28 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$49.37 ,$19.36 ,$57.38 ,$22.00 ,$57.38 ,$57.38 ,$22.00 ,$57.38 ,$36.78 ,$51.31 ,$128.28 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$51.31 ,$47.87 ,$19.36 ,$36.61 ,$28.22 ,$26.93 ,$20.33 ,$74.80 ,$57.38 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,30682025,87635,HC COVID-19 LAB TEST - 2 DAY COMPLETION,306,1 ,$88.00 ,$57.20 ,$19.36 ,$128.28 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$49.37 ,$19.36 ,$57.38 ,$22.00 ,$57.38 ,$57.38 ,$22.00 ,$57.38 ,$36.78 ,$51.31 ,$128.28 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$51.31 ,$47.87 ,$19.36 ,$36.61 ,$28.22 ,$26.93 ,$20.33 ,$74.80 ,$57.38 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,30700121,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$98.00 ,$63.70 ,$3.17 ,$98.00 ,$56.35 ,$70.56 ,$53.31 ,$21.56 ,$27.44 ,$39.36 ,$21.56 ,$50.13 ,$24.50 ,$50.13 ,$50.13 ,$24.50 ,$50.13 ,$40.96 ,$82.32 ,$7.93 ,$21.56 ,$83.30 ,$82.32 ,$21.56 ,$73.50 ,$78.40 ,$78.40 ,$21.56 ,$78.40 ,$82.32 ,$82.32 ,$82.32 ,$98.00 ,$88.20 ,$56.35 ,$98.00 ,$21.56 ,$3.17 ,$53.31 ,$21.56 ,$40.77 ,$4.25 ,$4.05 ,$22.64 ,$83.30 ,$50.13 ,$27.44 ,$88.20 ,$82.32 ,$78.40 ,$78.40 ,$21.56 ,$63.70 
ST. FRANCIS HOSPITAL - ACUTE,30700125,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$37.00 ,$24.05 ,$2.55 ,$37.00 ,$21.28 ,$26.64 ,$20.13 ,$8.14 ,$10.36 ,$21.76 ,$8.14 ,$25.42 ,$9.25 ,$25.42 ,$25.42 ,$9.25 ,$25.42 ,$15.47 ,$31.08 ,$5.63 ,$8.14 ,$31.45 ,$31.08 ,$8.14 ,$27.75 ,$29.60 ,$29.60 ,$8.14 ,$29.60 ,$31.08 ,$31.08 ,$31.08 ,$37.00 ,$33.30 ,$21.28 ,$37.00 ,$8.14 ,$37.00 ,$20.13 ,$8.14 ,$15.39 ,$2.67 ,$2.55 ,$8.55 ,$31.45 ,$25.42 ,$10.36 ,$33.30 ,$31.08 ,$29.60 ,$29.60 ,$8.14 ,$24.05 
ST. FRANCIS HOSPITAL - ACUTE,30700127,81005,HC URINALYSIS QL/SEMI QN -90,307,1 ,$47.00 ,$30.55 ,$4.05 ,$47.00 ,$27.03 ,$33.84 ,$25.57 ,$10.34 ,$13.16 ,$26.81 ,$10.34 ,$32.29 ,$11.75 ,$32.29 ,$32.29 ,$11.75 ,$32.29 ,$19.65 ,$39.48 ,$5.43 ,$10.34 ,$39.95 ,$39.48 ,$10.34 ,$35.25 ,$37.60 ,$37.60 ,$10.34 ,$37.60 ,$39.48 ,$39.48 ,$39.48 ,$47.00 ,$42.30 ,$27.03 ,$47.00 ,$10.34 ,$47.00 ,$25.57 ,$10.34 ,$19.55 ,$4.25 ,$4.05 ,$10.86 ,$39.95 ,$32.29 ,$13.16 ,$42.30 ,$39.48 ,$37.60 ,$37.60 ,$10.34 ,$30.55 
ST. FRANCIS HOSPITAL - ACUTE,30700128,81025,HC URINE PREGNANCY TEST,307,1 ,$149.00 ,$96.85 ,$4.05 ,$149.00 ,$85.68 ,$107.28 ,$81.06 ,$32.78 ,$41.72 ,$86.49 ,$32.78 ,$102.36 ,$37.25 ,$102.36 ,$102.36 ,$37.25 ,$102.36 ,$62.28 ,$125.16 ,$21.53 ,$32.78 ,$126.65 ,$125.16 ,$32.78 ,$111.75 ,$119.20 ,$119.20 ,$32.78 ,$119.20 ,$125.16 ,$125.16 ,$125.16 ,$149.00 ,$134.10 ,$85.68 ,$149.00 ,$32.78 ,$8.61 ,$81.06 ,$32.78 ,$61.98 ,$4.25 ,$4.05 ,$34.42 ,$126.65 ,$102.36 ,$41.72 ,$134.10 ,$125.16 ,$119.20 ,$119.20 ,$32.78 ,$96.85 
ST. FRANCIS HOSPITAL - ACUTE,30700131,81050,HC VOLUME MEASUREMENT URINE,307,1 ,$27.00 ,$17.55 ,$4.05 ,$27.00 ,$15.53 ,$19.44 ,$14.69 ,$5.94 ,$7.56 ,$15.88 ,$5.94 ,$18.55 ,$6.75 ,$18.55 ,$18.55 ,$6.75 ,$18.55 ,$11.29 ,$22.68 ,$9.10 ,$5.94 ,$22.95 ,$22.68 ,$5.94 ,$20.25 ,$21.60 ,$21.60 ,$5.94 ,$21.60 ,$22.68 ,$22.68 ,$22.68 ,$27.00 ,$24.30 ,$15.53 ,$27.00 ,$5.94 ,$27.00 ,$14.69 ,$5.94 ,$11.23 ,$4.25 ,$4.05 ,$6.24 ,$22.95 ,$18.55 ,$7.56 ,$24.30 ,$22.68 ,$21.60 ,$21.60 ,$5.94 ,$17.55 
ST. FRANCIS HOSPITAL - ACUTE,31000129,81206,HC BCR/ABL1 GENE MAJOR BP QL/QN DIAG -90,310,1 ,$134.00 ,$87.10 ,$29.48 ,$335.00 ,$77.05 ,$96.48 ,$72.90 ,$29.48 ,$37.52 ,$78.79 ,$29.48 ,$92.06 ,$33.50 ,$92.06 ,$92.06 ,$33.50 ,$92.06 ,$56.01 ,$112.56 ,$335.00 ,$29.48 ,$113.90 ,$112.56 ,$29.48 ,$100.50 ,$107.20 ,$107.20 ,$29.48 ,$107.20 ,$112.56 ,$112.56 ,$112.56 ,$134.00 ,$120.60 ,$77.05 ,$134.00 ,$29.48 ,$134.00 ,$72.90 ,$29.48 ,$55.74 ,$137.35 ,$131.10 ,$30.95 ,$113.90 ,$92.06 ,$37.52 ,$120.60 ,$112.56 ,$107.20 ,$107.20 ,$29.48 ,$87.10 
ST. FRANCIS HOSPITAL - ACUTE,31000131,81207,HC BCR/ABL1 GENE MINOR BP DIAG -90,310,1 ,$119.00 ,$77.35 ,$26.18 ,$297.50 ,$68.43 ,$85.68 ,$64.74 ,$26.18 ,$33.32 ,$69.97 ,$26.18 ,$81.75 ,$29.75 ,$81.75 ,$81.75 ,$29.75 ,$81.75 ,$49.74 ,$99.96 ,$297.50 ,$26.18 ,$101.15 ,$99.96 ,$26.18 ,$89.25 ,$95.20 ,$95.20 ,$26.18 ,$95.20 ,$99.96 ,$99.96 ,$99.96 ,$119.00 ,$107.10 ,$68.43 ,$119.00 ,$26.18 ,$119.00 ,$64.74 ,$26.18 ,$49.50 ,$137.35 ,$131.10 ,$27.49 ,$101.15 ,$81.75 ,$33.32 ,$107.10 ,$99.96 ,$95.20 ,$95.20 ,$26.18 ,$77.35 
ST. FRANCIS HOSPITAL - ACUTE,31000137,81220,HC CYSTIC FIBROSIS GENE COMMON VARIANTS -90,310,1 ,$88.00 ,$57.20 ,$19.36 ,$220.00 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$51.74 ,$19.36 ,$60.46 ,$22.00 ,$60.46 ,$60.46 ,$22.00 ,$60.46 ,$36.78 ,$73.92 ,$220.00 ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$88.00 ,$47.87 ,$19.36 ,$36.61 ,$42.19 ,$40.27 ,$20.33 ,$74.80 ,$60.46 ,$24.64 ,$79.20 ,$73.92 ,$70.40 ,$70.40 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,31000143,81240,HC F2 GENE ANAL 20210G A VAR -90,310,1 ,$505.00 ,$328.25 ,$40.27 ,$505.00 ,$290.38 ,$363.60 ,$274.72 ,$111.10 ,$141.40 ,$296.94 ,$111.10 ,$346.94 ,$126.25 ,$346.94 ,$346.94 ,$126.25 ,$346.94 ,$211.09 ,$424.20 ,$164.23 ,$111.10 ,$429.25 ,$424.20 ,$111.10 ,$378.75 ,$404.00 ,$404.00 ,$111.10 ,$404.00 ,$424.20 ,$424.20 ,$424.20 ,$505.00 ,$454.50 ,$290.38 ,$505.00 ,$111.10 ,$505.00 ,$274.72 ,$111.10 ,$210.08 ,$42.19 ,$40.27 ,$116.66 ,$429.25 ,$346.94 ,$141.40 ,$454.50 ,$424.20 ,$404.00 ,$404.00 ,$111.10 ,$328.25 
ST. FRANCIS HOSPITAL - ACUTE,31000145,81241,HC F5 GENE ANAL LEIDEN VAR -90,310,1 ,$505.00 ,$328.25 ,$40.27 ,$505.00 ,$290.38 ,$363.60 ,$274.72 ,$111.10 ,$141.40 ,$296.94 ,$111.10 ,$346.94 ,$126.25 ,$346.94 ,$346.94 ,$126.25 ,$346.94 ,$211.09 ,$424.20 ,$183.43 ,$111.10 ,$429.25 ,$424.20 ,$111.10 ,$378.75 ,$404.00 ,$404.00 ,$111.10 ,$404.00 ,$424.20 ,$424.20 ,$424.20 ,$505.00 ,$454.50 ,$290.38 ,$505.00 ,$111.10 ,$505.00 ,$274.72 ,$111.10 ,$210.08 ,$42.19 ,$40.27 ,$116.66 ,$429.25 ,$346.94 ,$141.40 ,$454.50 ,$424.20 ,$404.00 ,$404.00 ,$111.10 ,$328.25 
ST. FRANCIS HOSPITAL - ACUTE,31000149,81256,HC HFE GENE ANALYSIS -90,310,1 ,$279.00 ,$181.35 ,$40.27 ,$279.00 ,$160.43 ,$200.88 ,$151.78 ,$61.38 ,$78.12 ,$164.05 ,$61.38 ,$191.67 ,$69.75 ,$191.67 ,$191.67 ,$69.75 ,$191.67 ,$116.62 ,$234.36 ,$163.40 ,$61.38 ,$237.15 ,$234.36 ,$61.38 ,$209.25 ,$223.20 ,$223.20 ,$61.38 ,$223.20 ,$234.36 ,$234.36 ,$234.36 ,$279.00 ,$251.10 ,$160.43 ,$279.00 ,$61.38 ,$279.00 ,$151.78 ,$61.38 ,$116.06 ,$42.19 ,$40.27 ,$64.45 ,$237.15 ,$191.67 ,$78.12 ,$251.10 ,$234.36 ,$223.20 ,$223.20 ,$61.38 ,$181.35 
ST. FRANCIS HOSPITAL - ACUTE,31000154,81270,HC JAK2 GENE ANALYSIS-90,310,1 ,$286.00 ,$185.90 ,$40.27 ,$286.00 ,$164.45 ,$205.92 ,$155.58 ,$62.92 ,$80.08 ,$168.17 ,$62.92 ,$196.48 ,$71.50 ,$196.48 ,$196.48 ,$71.50 ,$196.48 ,$119.55 ,$240.24 ,$229.15 ,$62.92 ,$243.10 ,$240.24 ,$62.92 ,$214.50 ,$228.80 ,$228.80 ,$62.92 ,$228.80 ,$240.24 ,$240.24 ,$240.24 ,$286.00 ,$257.40 ,$164.45 ,$286.00 ,$62.92 ,$286.00 ,$155.58 ,$62.92 ,$118.98 ,$42.19 ,$40.27 ,$66.07 ,$243.10 ,$196.48 ,$80.08 ,$257.40 ,$240.24 ,$228.80 ,$228.80 ,$62.92 ,$185.90 
ST. FRANCIS HOSPITAL - ACUTE,31000157,81291,HC MTHFR GENE ANALYSIS-90,310,1 ,$93.00 ,$60.45 ,$20.46 ,$163.35 ,$53.48 ,$66.96 ,$50.59 ,$20.46 ,$26.04 ,$54.68 ,$20.46 ,$63.89 ,$23.25 ,$63.89 ,$63.89 ,$23.25 ,$63.89 ,$38.87 ,$78.12 ,$163.35 ,$20.46 ,$79.05 ,$78.12 ,$20.46 ,$69.75 ,$74.40 ,$74.40 ,$20.46 ,$74.40 ,$78.12 ,$78.12 ,$78.12 ,$93.00 ,$83.70 ,$53.48 ,$93.00 ,$20.46 ,$93.00 ,$50.59 ,$20.46 ,$38.69 ,$42.19 ,$40.27 ,$21.48 ,$79.05 ,$63.89 ,$26.04 ,$83.70 ,$78.12 ,$74.40 ,$74.40 ,$20.46 ,$60.45 
ST. FRANCIS HOSPITAL - ACUTE,31000171,81332,HC SERPINA 1 GENE ANALYSIS-90,310,1 ,$561.00 ,$364.65 ,$40.27 ,$561.00 ,$322.58 ,$403.92 ,$305.18 ,$123.42 ,$157.08 ,$329.87 ,$123.42 ,$385.41 ,$140.25 ,$385.41 ,$385.41 ,$140.25 ,$385.41 ,$234.50 ,$471.24 ,$109.13 ,$123.42 ,$476.85 ,$471.24 ,$123.42 ,$420.75 ,$448.80 ,$448.80 ,$123.42 ,$448.80 ,$471.24 ,$471.24 ,$471.24 ,$561.00 ,$504.90 ,$322.58 ,$561.00 ,$123.42 ,$561.00 ,$305.18 ,$123.42 ,$233.38 ,$42.19 ,$40.27 ,$129.59 ,$476.85 ,$385.41 ,$157.08 ,$504.90 ,$471.24 ,$448.80 ,$448.80 ,$123.42 ,$364.65 
ST. FRANCIS HOSPITAL - ACUTE,31000183,81401,HC MOLECULAR PATH PROC LEVEL 2-90,310,1 ,$811.00 ,$527.15 ,$40.27 ,$811.00 , N/A ,$583.92 ,$441.18 , N/A ,$227.08 ,$476.87 , N/A ,$557.16 , N/A ,$557.16 ,$557.16 , N/A ,$557.16 , N/A ,$681.24 ,$567.70 , N/A ,$689.35 ,$681.24 , N/A ,$608.25 ,$648.80 ,$648.80 , N/A ,$648.80 ,$681.24 ,$681.24 ,$681.24 ,$811.00 ,$729.90 , N/A ,$811.00 , N/A ,$811.00 ,$441.18 , N/A ,$337.38 ,$42.19 ,$40.27 , N/A ,$689.35 ,$557.16 ,$227.08 ,$729.90 ,$681.24 ,$648.80 ,$648.80 , N/A ,$527.15 
ST. FRANCIS HOSPITAL - ACUTE,31000184,81403,HC MOLECULAR PATH PROC LEVEL 4-90,310,1 ,$319.00 ,$207.35 ,$40.27 ,$319.00 , N/A ,$229.68 ,$173.54 , N/A ,$89.32 ,$187.57 , N/A ,$219.15 , N/A ,$219.15 ,$219.15 , N/A ,$219.15 , N/A ,$267.96 ,$223.30 , N/A ,$271.15 ,$267.96 , N/A ,$239.25 ,$255.20 ,$255.20 , N/A ,$255.20 ,$267.96 ,$267.96 ,$267.96 ,$319.00 ,$287.10 , N/A ,$319.00 , N/A ,$319.00 ,$173.54 , N/A ,$132.70 ,$42.19 ,$40.27 , N/A ,$271.15 ,$219.15 ,$89.32 ,$287.10 ,$267.96 ,$255.20 ,$255.20 , N/A ,$207.35 
ST. FRANCIS HOSPITAL - ACUTE,31000191,81479,HC IBD CELIAC UNLISTED MOLECULAR PATH-90,310,1 ,$24.00 ,$15.60 ,$6.72 ,$42.19 , N/A ,$17.28 ,$13.06 , N/A ,$6.72 ,$14.11 , N/A ,$16.49 , N/A ,$16.49 ,$16.49 , N/A ,$16.49 , N/A ,$20.16 ,$16.80 , N/A ,$20.40 ,$20.16 , N/A ,$18.00 ,$19.20 ,$19.20 , N/A ,$19.20 ,$20.16 ,$20.16 ,$20.16 ,$24.00 ,$21.60 , N/A ,$24.00 , N/A ,$24.00 ,$13.06 , N/A ,$9.98 ,$42.19 ,$40.27 , N/A ,$20.40 ,$16.49 ,$6.72 ,$21.60 ,$20.16 ,$19.20 ,$19.20 , N/A ,$15.60 
ST. FRANCIS HOSPITAL - ACUTE,31000200,0001U,HC RBC DNA HUMAN GENE ANLYS 35 AG 11 BLOOD GRP-90,310,1 ,$724.00 ,$470.60 ,$40.27 ,"$1,800.00 ",$416.30 ,$521.28 ,$393.86 ,$159.28 ,$202.72 ,$406.16 ,$159.28 ,$472.05 ,$181.00 ,$472.05 ,$472.05 ,$181.00 ,$472.05 ,$302.63 ,$608.16 ,"$1,800.00 ",$159.28 ,$615.40 ,$608.16 ,$159.28 ,$543.00 ,$579.20 ,$579.20 ,$159.28 ,$579.20 ,$608.16 ,$608.16 ,$608.16 ,$724.00 ,$651.60 ,$416.30 ,$724.00 ,$159.28 ,$724.00 ,$393.86 ,$159.28 ,$301.18 ,$42.19 ,$40.27 ,$167.24 ,$615.40 ,$472.05 ,$202.72 ,$651.60 ,$608.16 ,$579.20 ,$579.20 ,$159.28 ,$470.60 
ST. FRANCIS HOSPITAL - ACUTE,31000205,81219,HC CALR GENE ANALYSIS EXON 9-90,310,1 ,$356.00 ,$231.40 ,$78.32 ,$356.00 ,$204.70 ,$256.32 ,$193.66 ,$78.32 ,$99.68 ,$209.33 ,$78.32 ,$244.57 ,$89.00 ,$244.57 ,$244.57 ,$89.00 ,$244.57 ,$148.81 ,$299.04 ,$304.08 ,$78.32 ,$302.60 ,$299.04 ,$78.32 ,$267.00 ,$284.80 ,$284.80 ,$78.32 ,$284.80 ,$299.04 ,$299.04 ,$299.04 ,$356.00 ,$320.40 ,$204.70 ,$356.00 ,$78.32 ,$356.00 ,$193.66 ,$78.32 ,$148.10 ,$137.35 ,$131.10 ,$82.24 ,$302.60 ,$244.57 ,$99.68 ,$320.40 ,$299.04 ,$284.80 ,$284.80 ,$78.32 ,$231.40 
ST. FRANCIS HOSPITAL - ACUTE,31000208,81402,HC MOLECULAR PATHOLOGY PROC LEVEL 3-90,310,1 ,$254.00 ,$165.10 ,$40.27 ,$254.00 , N/A ,$182.88 ,$138.18 , N/A ,$71.12 ,$149.35 , N/A ,$174.50 , N/A ,$174.50 ,$174.50 , N/A ,$174.50 , N/A ,$213.36 ,$177.80 , N/A ,$215.90 ,$213.36 , N/A ,$190.50 ,$203.20 ,$203.20 , N/A ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 , N/A ,$254.00 , N/A ,$254.00 ,$138.18 , N/A ,$105.66 ,$42.19 ,$40.27 , N/A ,$215.90 ,$174.50 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 , N/A ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,31000228,81350,HC UGT1A1 GENE ANALYSIS COM VARIANTS-90,310,1 ,$396.00 ,$257.40 ,$40.27 ,$585.00 ,$227.70 ,$285.12 ,$215.42 ,$87.12 ,$110.88 ,$232.85 ,$87.12 ,$272.05 ,$99.00 ,$272.05 ,$272.05 ,$99.00 ,$272.05 ,$165.53 ,$332.64 ,$585.00 ,$87.12 ,$336.60 ,$332.64 ,$87.12 ,$297.00 ,$316.80 ,$316.80 ,$87.12 ,$316.80 ,$332.64 ,$332.64 ,$332.64 ,$396.00 ,$356.40 ,$227.70 ,$396.00 ,$87.12 ,$396.00 ,$215.42 ,$87.12 ,$164.74 ,$42.19 ,$40.27 ,$91.48 ,$336.60 ,$272.05 ,$110.88 ,$356.40 ,$332.64 ,$316.80 ,$316.80 ,$87.12 ,$257.40 
ST. FRANCIS HOSPITAL - ACUTE,31000250,81479,HC MUTATION ANALYSIS CSF3R -90,310,1 ,$204.00 ,$132.60 ,$39.94 ,$204.00 , N/A ,$146.88 ,$110.98 , N/A ,$57.12 ,$39.94 , N/A ,$50.86 , N/A ,$50.86 ,$50.86 , N/A ,$50.86 , N/A ,$171.36 ,$142.80 , N/A ,$173.40 ,$171.36 , N/A ,$153.00 ,$163.20 ,$163.20 , N/A ,$163.20 ,$171.36 ,$171.36 ,$171.36 ,$204.00 ,$183.60 , N/A ,$204.00 , N/A ,$204.00 ,$110.98 , N/A ,$84.86 ,$42.19 ,$40.27 , N/A ,$173.40 ,$50.86 ,$57.12 ,$183.60 ,$171.36 ,$163.20 ,$163.20 , N/A ,$132.60 
ST. FRANCIS HOSPITAL - ACUTE,31000254,81212,HC BRCA 1 AND S BREAST/OVARIAN CANCER GENE ANALYSIS-90,310,1 ,$521.00 ,$338.65 ,$114.62 ,"$1,100.00 ",$299.58 ,$375.12 ,$283.42 ,$114.62 ,$145.88 ,$306.35 ,$114.62 ,$357.93 ,$130.25 ,$357.93 ,$357.93 ,$130.25 ,$357.93 ,$217.78 ,$437.64 ,"$1,100.00 ",$114.62 ,$442.85 ,$437.64 ,$114.62 ,$390.75 ,$416.80 ,$416.80 ,$114.62 ,$416.80 ,$437.64 ,$437.64 ,$437.64 ,$521.00 ,$468.90 ,$299.58 ,$521.00 ,$114.62 ,$521.00 ,$283.42 ,$114.62 ,$216.74 ,$137.35 ,$131.10 ,$120.35 ,$442.85 ,$357.93 ,$145.88 ,$468.90 ,$437.64 ,$416.80 ,$416.80 ,$114.62 ,$338.65 
ST. FRANCIS HOSPITAL - ACUTE,31000260,89257,HC SPERM IDENTIFICATION FROM ASPIRATION-90,310,1 ,$131.00 ,$85.15 ,$28.82 ,$131.00 ,$75.33 ,$94.32 ,$71.26 ,$28.82 ,$36.68 ,$73.49 ,$28.82 ,$85.41 ,$32.75 ,$85.41 ,$85.41 ,$32.75 ,$85.41 ,$54.76 ,$110.04 ,$126.88 ,$28.82 ,$111.35 ,$110.04 ,$28.82 ,$98.25 ,$104.80 ,$104.80 ,$28.82 ,$104.80 ,$110.04 ,$110.04 ,$110.04 ,$131.00 ,$117.90 ,$75.33 ,$131.00 ,$28.82 ,$131.00 ,$71.26 ,$28.82 ,$54.50 ,$33.96 ,$32.41 ,$30.26 ,$111.35 ,$85.41 ,$36.68 ,$117.90 ,$110.04 ,$104.80 ,$104.80 ,$28.82 ,$85.15 
ST. FRANCIS HOSPITAL - ACUTE,31000272,81263,HC IGH VAR REG SOMATIC MUTATION ANALYSIS- 90,310,1 ,$438.00 ,$284.70 ,$96.36 ,$736.30 ,$251.85 ,$315.36 ,$238.27 ,$96.36 ,$122.64 ,$257.54 ,$96.36 ,$300.91 ,$109.50 ,$300.91 ,$300.91 ,$109.50 ,$300.91 ,$183.08 ,$367.92 ,$736.30 ,$96.36 ,$372.30 ,$367.92 ,$96.36 ,$328.50 ,$350.40 ,$350.40 ,$96.36 ,$350.40 ,$367.92 ,$367.92 ,$367.92 ,$438.00 ,$394.20 ,$251.85 ,$438.00 ,$96.36 ,$438.00 ,$238.27 ,$96.36 ,$182.21 ,$389.76 ,$372.05 ,$101.18 ,$372.30 ,$300.91 ,$122.64 ,$394.20 ,$367.92 ,$350.40 ,$350.40 ,$96.36 ,$284.70 
ST. FRANCIS HOSPITAL - ACUTE,31000276,81479,HC T CELL RECEPTOR EXCISION CIRCLES - 90,310,1 ,"$1,066.00 ",$692.90 ,$39.94 ,"$1,066.00 ", N/A ,$767.52 ,$579.90 , N/A ,$298.48 ,$39.94 , N/A ,$50.86 , N/A ,$50.86 ,$50.86 , N/A ,$50.86 , N/A ,$895.44 ,$746.20 , N/A ,$906.10 ,$895.44 , N/A ,$799.50 ,$852.80 ,$852.80 , N/A ,$852.80 ,$895.44 ,$895.44 ,$895.44 ,"$1,066.00 ",$959.40 , N/A ,"$1,066.00 ", N/A ,"$1,066.00 ",$579.90 , N/A ,$443.46 ,$42.19 ,$40.27 , N/A ,$906.10 ,$50.86 ,$298.48 ,$959.40 ,$895.44 ,$852.80 ,$852.80 , N/A ,$692.90 
ST. FRANCIS HOSPITAL - ACUTE,31000288,81164,HC BRCA 1 AND 2 GEN FUL DUP/DEL ANALYS- 90,310,1 ,$578.00 ,$375.70 ,$127.16 ,"$1,445.00 ",$332.35 ,$416.16 ,$314.43 ,$127.16 ,$161.84 ,$324.26 ,$127.16 ,$376.86 ,$144.50 ,$376.86 ,$376.86 ,$144.50 ,$376.86 ,$241.60 ,$485.52 ,"$1,445.00 ",$127.16 ,$491.30 ,$485.52 ,$127.16 ,$433.50 ,$462.40 ,$462.40 ,$127.16 ,$462.40 ,$485.52 ,$485.52 ,$485.52 ,$578.00 ,$520.20 ,$332.35 ,$578.00 ,$127.16 ,$578.00 ,$314.43 ,$127.16 ,$240.45 ,$389.76 ,$372.05 ,$133.52 ,$491.30 ,$376.86 ,$161.84 ,$520.20 ,$485.52 ,$462.40 ,$462.40 ,$127.16 ,$375.70 
ST. FRANCIS HOSPITAL - ACUTE,31100244,88184,HC FLOW CYTO 1ST MARKER-90,311,1 ,$117.00 ,$76.05 ,$25.74 ,$743.63 ,$67.28 ,$84.24 ,$63.65 ,$25.74 ,$32.76 ,$68.80 ,$25.74 ,$80.38 ,$29.25 ,$80.38 ,$80.38 ,$29.25 ,$80.38 ,$48.91 ,$98.28 ,$743.63 ,$25.74 ,$99.45 ,$98.28 ,$25.74 ,$87.75 ,$93.60 ,$93.60 ,$25.74 ,$93.60 ,$98.28 ,$98.28 ,$98.28 ,$117.00 ,$105.30 ,$67.28 ,$117.00 ,$25.74 ,$117.00 ,$63.65 ,$25.74 ,$48.67 ,$37.36 ,$35.66 ,$27.03 ,$99.45 ,$80.38 ,$32.76 ,$105.30 ,$98.28 ,$93.60 ,$93.60 ,$25.74 ,$76.05 
ST. FRANCIS HOSPITAL - ACUTE,31100246,88185,HC FLOW CYTO EA ADD MARKER-90,311,1 ,$118.00 ,$76.70 ,$25.96 ,$118.00 ,$67.85 ,$84.96 ,$64.19 ,$25.96 ,$33.04 ,$69.38 ,$25.96 ,$81.07 ,$29.50 ,$81.07 ,$81.07 ,$29.50 ,$81.07 ,$49.32 ,$99.12 , N/A ,$25.96 ,$100.30 ,$99.12 ,$25.96 ,$88.50 ,$94.40 ,$94.40 ,$25.96 ,$94.40 ,$99.12 ,$99.12 ,$99.12 ,$118.00 ,$106.20 ,$67.85 ,$118.00 ,$25.96 ,$118.00 ,$64.19 ,$25.96 ,$49.09 ,$37.36 ,$35.66 ,$27.26 ,$100.30 ,$81.07 ,$33.04 ,$106.20 ,$99.12 ,$94.40 ,$94.40 ,$25.96 ,$76.70 
ST. FRANCIS HOSPITAL - ACUTE,31100249,88188,HC FLOW CYTO INT 9-15 MARKERS-90,311,1 ,$118.00 ,$76.70 ,$25.96 ,$118.00 ,$67.85 ,$84.96 ,$64.19 ,$25.96 ,$33.04 ,$69.38 ,$25.96 ,$81.07 ,$29.50 ,$81.07 ,$81.07 ,$29.50 ,$81.07 ,$49.32 ,$99.12 , N/A ,$25.96 ,$100.30 ,$99.12 ,$25.96 ,$88.50 ,$94.40 ,$94.40 ,$25.96 ,$94.40 ,$99.12 ,$99.12 ,$99.12 ,$118.00 ,$106.20 ,$67.85 ,$118.00 ,$25.96 ,$118.00 ,$64.19 ,$25.96 ,$49.09 ,$33.96 ,$32.41 ,$27.26 ,$100.30 ,$81.07 ,$33.04 ,$106.20 ,$99.12 ,$94.40 ,$94.40 ,$25.96 ,$76.70 
ST. FRANCIS HOSPITAL - ACUTE,31100262,88271,HC MCG DNA PROBE(BCR/ABL)-90,311,1 ,$87.00 ,$56.55 ,$19.14 ,$87.00 ,$50.03 ,$62.64 ,$47.33 ,$19.14 ,$24.36 ,$51.16 ,$19.14 ,$59.77 ,$21.75 ,$59.77 ,$59.77 ,$21.75 ,$59.77 ,$36.37 ,$73.08 ,$53.55 ,$19.14 ,$73.95 ,$73.08 ,$19.14 ,$65.25 ,$69.60 ,$69.60 ,$19.14 ,$69.60 ,$73.08 ,$73.08 ,$73.08 ,$87.00 ,$78.30 ,$50.03 ,$87.00 ,$19.14 ,$87.00 ,$47.33 ,$19.14 ,$36.19 ,$42.19 ,$40.27 ,$20.10 ,$73.95 ,$59.77 ,$24.36 ,$78.30 ,$73.08 ,$69.60 ,$69.60 ,$19.14 ,$56.55 
ST. FRANCIS HOSPITAL - ACUTE,31100271,88275,HC MCG INTER INSIT BCR/ABL 100-90,311,1 ,$164.00 ,$106.60 ,$36.08 ,$164.00 ,$94.30 ,$118.08 ,$89.22 ,$36.08 ,$45.92 ,$96.43 ,$36.08 ,$112.67 ,$41.00 ,$112.67 ,$112.67 ,$41.00 ,$112.67 ,$68.55 ,$137.76 ,$127.98 ,$36.08 ,$139.40 ,$137.76 ,$36.08 ,$123.00 ,$131.20 ,$131.20 ,$36.08 ,$131.20 ,$137.76 ,$137.76 ,$137.76 ,$164.00 ,$147.60 ,$94.30 ,$164.00 ,$36.08 ,$164.00 ,$89.22 ,$36.08 ,$68.22 ,$42.19 ,$40.27 ,$37.88 ,$139.40 ,$112.67 ,$45.92 ,$147.60 ,$137.76 ,$131.20 ,$131.20 ,$36.08 ,$106.60 
ST. FRANCIS HOSPITAL - ACUTE,31100283,88120,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC-90,311,1 ,$407.00 ,$264.55 ,$35.66 ,$407.00 ,$234.03 ,$293.04 ,$221.41 ,$89.54 ,$113.96 ,$239.32 ,$89.54 ,$279.61 ,$101.75 ,$279.61 ,$279.61 ,$101.75 ,$279.61 ,$170.13 ,$341.88 ,$380.80 ,$89.54 ,$345.95 ,$341.88 ,$89.54 ,$305.25 ,$325.60 ,$325.60 ,$89.54 ,$325.60 ,$341.88 ,$341.88 ,$341.88 ,$407.00 ,$366.30 ,$234.03 ,$407.00 ,$89.54 ,$407.00 ,$221.41 ,$89.54 ,$169.31 ,$37.36 ,$35.66 ,$94.02 ,$345.95 ,$279.61 ,$113.96 ,$366.30 ,$341.88 ,$325.60 ,$325.60 ,$89.54 ,$264.55 
ST. FRANCIS HOSPITAL - ACUTE,31100291,88125,HC CYTOPATH FORENSIC,311,1 ,$110.00 ,$71.50 ,$24.20 ,$126.88 ,$63.25 ,$79.20 ,$59.84 ,$24.20 ,$30.80 ,$64.68 ,$24.20 ,$75.57 ,$27.50 ,$75.57 ,$75.57 ,$27.50 ,$75.57 ,$45.98 ,$92.40 ,$126.88 ,$24.20 ,$93.50 ,$92.40 ,$24.20 ,$82.50 ,$88.00 ,$88.00 ,$24.20 ,$88.00 ,$92.40 ,$92.40 ,$92.40 ,$110.00 ,$99.00 ,$63.25 ,$110.00 ,$24.20 ,$110.00 ,$59.84 ,$24.20 ,$45.76 ,$33.96 ,$32.41 ,$25.41 ,$93.50 ,$75.57 ,$30.80 ,$99.00 ,$92.40 ,$88.00 ,$88.00 ,$24.20 ,$71.50 
ST. FRANCIS HOSPITAL - ACUTE,31100293,88175,HC CYTOPATH PAP DIAG INIT/REDO,311,1 ,$167.00 ,$108.55 ,$20.26 ,$167.00 ,$96.03 ,$120.24 ,$90.85 ,$36.74 ,$46.76 ,$98.20 ,$36.74 ,$114.73 ,$41.75 ,$114.73 ,$114.73 ,$41.75 ,$114.73 ,$69.81 ,$140.28 ,$66.53 ,$36.74 ,$141.95 ,$140.28 ,$36.74 ,$125.25 ,$133.60 ,$133.60 ,$36.74 ,$133.60 ,$140.28 ,$140.28 ,$140.28 ,$167.00 ,$150.30 ,$96.03 ,$167.00 ,$36.74 ,$20.26 ,$90.85 ,$36.74 ,$69.47 ,$24.62 ,$23.50 ,$38.58 ,$141.95 ,$114.73 ,$46.76 ,$150.30 ,$140.28 ,$133.60 ,$133.60 ,$36.74 ,$108.55 
ST. FRANCIS HOSPITAL - ACUTE,31100294,88184,HC FLOW CYTO 1ST MARKER,311,1 ,$117.00 ,$76.05 ,$25.74 ,$743.63 ,$67.28 ,$84.24 ,$63.65 ,$25.74 ,$32.76 ,$68.80 ,$25.74 ,$80.38 ,$29.25 ,$80.38 ,$80.38 ,$29.25 ,$80.38 ,$48.91 ,$98.28 ,$743.63 ,$25.74 ,$99.45 ,$98.28 ,$25.74 ,$87.75 ,$93.60 ,$93.60 ,$25.74 ,$93.60 ,$98.28 ,$98.28 ,$98.28 ,$117.00 ,$105.30 ,$67.28 ,$117.00 ,$25.74 ,$117.00 ,$63.65 ,$25.74 ,$48.67 ,$37.36 ,$35.66 ,$27.03 ,$99.45 ,$80.38 ,$32.76 ,$105.30 ,$98.28 ,$93.60 ,$93.60 ,$25.74 ,$76.05 
ST. FRANCIS HOSPITAL - ACUTE,31100295,88185,HC FLOW CYTO EA ADD MARKER,311,1 ,$101.00 ,$65.65 ,$22.22 ,$101.00 ,$58.08 ,$72.72 ,$54.94 ,$22.22 ,$28.28 ,$59.39 ,$22.22 ,$69.39 ,$25.25 ,$69.39 ,$69.39 ,$25.25 ,$69.39 ,$42.22 ,$84.84 , N/A ,$22.22 ,$85.85 ,$84.84 ,$22.22 ,$75.75 ,$80.80 ,$80.80 ,$22.22 ,$80.80 ,$84.84 ,$84.84 ,$84.84 ,$101.00 ,$90.90 ,$58.08 ,$101.00 ,$22.22 ,$101.00 ,$54.94 ,$22.22 ,$42.02 ,$37.36 ,$35.66 ,$23.33 ,$85.85 ,$69.39 ,$28.28 ,$90.90 ,$84.84 ,$80.80 ,$80.80 ,$22.22 ,$65.65 
ST. FRANCIS HOSPITAL - ACUTE,31100299,88104,HC CYTOPATH FLD SMEAR,311,1 ,$99.00 ,$64.35 ,$21.78 ,$99.00 ,$56.93 ,$71.28 ,$53.86 ,$21.78 ,$27.72 ,$58.21 ,$21.78 ,$68.01 ,$24.75 ,$68.01 ,$68.01 ,$24.75 ,$68.01 ,$41.38 ,$83.16 ,$86.43 ,$21.78 ,$84.15 ,$83.16 ,$21.78 ,$74.25 ,$79.20 ,$79.20 ,$21.78 ,$79.20 ,$83.16 ,$83.16 ,$83.16 ,$99.00 ,$89.10 ,$56.93 ,$99.00 ,$21.78 ,$99.00 ,$53.86 ,$21.78 ,$41.18 ,$33.96 ,$32.41 ,$22.87 ,$84.15 ,$68.01 ,$27.72 ,$89.10 ,$83.16 ,$79.20 ,$79.20 ,$21.78 ,$64.35 
ST. FRANCIS HOSPITAL - ACUTE,31100300,88106,HC CYTOPATH FLUID SIMP FILTER,311,1 ,$92.00 ,$59.80 ,$20.24 ,$92.00 ,$52.90 ,$66.24 ,$50.05 ,$20.24 ,$25.76 ,$54.10 ,$20.24 ,$63.20 ,$23.00 ,$63.20 ,$63.20 ,$23.00 ,$63.20 ,$38.46 ,$77.28 ,$63.08 ,$20.24 ,$78.20 ,$77.28 ,$20.24 ,$69.00 ,$73.60 ,$73.60 ,$20.24 ,$73.60 ,$77.28 ,$77.28 ,$77.28 ,$92.00 ,$82.80 ,$52.90 ,$92.00 ,$20.24 ,$92.00 ,$50.05 ,$20.24 ,$38.27 ,$33.96 ,$32.41 ,$21.25 ,$78.20 ,$63.20 ,$25.76 ,$82.80 ,$77.28 ,$73.60 ,$73.60 ,$20.24 ,$59.80 
ST. FRANCIS HOSPITAL - ACUTE,31100301,88175,HC CYTOPATH PAP SCREEN INIT/REDO,311,1 ,$167.00 ,$108.55 ,$20.26 ,$167.00 ,$96.03 ,$120.24 ,$90.85 ,$36.74 ,$46.76 ,$98.20 ,$36.74 ,$114.73 ,$41.75 ,$114.73 ,$114.73 ,$41.75 ,$114.73 ,$69.81 ,$140.28 ,$66.53 ,$36.74 ,$141.95 ,$140.28 ,$36.74 ,$125.25 ,$133.60 ,$133.60 ,$36.74 ,$133.60 ,$140.28 ,$140.28 ,$140.28 ,$167.00 ,$150.30 ,$96.03 ,$167.00 ,$36.74 ,$20.26 ,$90.85 ,$36.74 ,$69.47 ,$24.62 ,$23.50 ,$38.58 ,$141.95 ,$114.73 ,$46.76 ,$150.30 ,$140.28 ,$133.60 ,$133.60 ,$36.74 ,$108.55 
ST. FRANCIS HOSPITAL - ACUTE,31100310,88121,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC COMP ASSIST-90,311,1 ,$407.00 ,$264.55 ,$35.66 ,$743.63 ,$234.03 ,$293.04 ,$221.41 ,$89.54 ,$113.96 ,$239.32 ,$89.54 ,$279.61 ,$101.75 ,$279.61 ,$279.61 ,$101.75 ,$279.61 ,$170.13 ,$341.88 ,$743.63 ,$89.54 ,$345.95 ,$341.88 ,$89.54 ,$305.25 ,$325.60 ,$325.60 ,$89.54 ,$325.60 ,$341.88 ,$341.88 ,$341.88 ,$407.00 ,$366.30 ,$234.03 ,$407.00 ,$89.54 ,$407.00 ,$221.41 ,$89.54 ,$169.31 ,$37.36 ,$35.66 ,$94.02 ,$345.95 ,$279.61 ,$113.96 ,$366.30 ,$341.88 ,$325.60 ,$325.60 ,$89.54 ,$264.55 
ST. FRANCIS HOSPITAL - ACUTE,31200272,88346,HC IF DIRECT-90,312,1 ,$124.00 ,$80.60 ,$27.28 ,$743.63 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$743.63 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$33.96 ,$32.41 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,31200274,88350,HC IMMUNOFLUOR PER SPEC EA ADDN SINGLE STAIN-90,312,1 ,$124.00 ,$80.60 ,$27.28 ,$124.00 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 , N/A ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$33.96 ,$32.41 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,31200293,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$162.00 ,$105.30 ,$25.42 ,$162.00 ,$93.15 ,$116.64 ,$88.13 ,$35.64 ,$45.36 ,$95.26 ,$35.64 ,$111.29 ,$40.50 ,$111.29 ,$111.29 ,$40.50 ,$111.29 ,$67.72 ,$136.08 , N/A ,$35.64 ,$137.70 ,$136.08 ,$35.64 ,$121.50 ,$129.60 ,$129.60 ,$35.64 ,$129.60 ,$136.08 ,$136.08 ,$136.08 ,$162.00 ,$145.80 ,$93.15 ,$162.00 ,$35.64 ,$25.42 ,$88.13 ,$35.64 ,$67.39 ,$33.96 ,$32.41 ,$37.42 ,$137.70 ,$111.29 ,$45.36 ,$145.80 ,$136.08 ,$129.60 ,$129.60 ,$35.64 ,$105.30 
ST. FRANCIS HOSPITAL - ACUTE,31200294,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$288.00 ,$187.20 ,$32.41 ,$380.80 ,$165.60 ,$207.36 ,$156.67 ,$63.36 ,$80.64 ,$169.34 ,$63.36 ,$197.86 ,$72.00 ,$197.86 ,$197.86 ,$72.00 ,$197.86 ,$120.38 ,$241.92 ,$380.80 ,$63.36 ,$244.80 ,$241.92 ,$63.36 ,$216.00 ,$230.40 ,$230.40 ,$63.36 ,$230.40 ,$241.92 ,$241.92 ,$241.92 ,$288.00 ,$259.20 ,$165.60 ,$288.00 ,$63.36 ,$44.37 ,$156.67 ,$63.36 ,$119.81 ,$33.96 ,$32.41 ,$66.53 ,$244.80 ,$197.86 ,$80.64 ,$259.20 ,$241.92 ,$230.40 ,$230.40 ,$63.36 ,$187.20 
ST. FRANCIS HOSPITAL - ACUTE,31200295,88323,HC CONSULT/SLIDE PREP,312,1 ,$200.00 ,$130.00 ,$32.41 ,$200.00 ,$115.00 ,$144.00 ,$108.80 ,$44.00 ,$56.00 ,$117.60 ,$44.00 ,$137.40 ,$50.00 ,$137.40 ,$137.40 ,$50.00 ,$137.40 ,$83.60 ,$168.00 ,$126.88 ,$44.00 ,$170.00 ,$168.00 ,$44.00 ,$150.00 ,$160.00 ,$160.00 ,$44.00 ,$160.00 ,$168.00 ,$168.00 ,$168.00 ,$200.00 ,$180.00 ,$115.00 ,$200.00 ,$44.00 ,$200.00 ,$108.80 ,$44.00 ,$83.20 ,$33.96 ,$32.41 ,$46.20 ,$170.00 ,$137.40 ,$56.00 ,$180.00 ,$168.00 ,$160.00 ,$160.00 ,$44.00 ,$130.00 
ST. FRANCIS HOSPITAL - ACUTE,31200296,88311,HC DECALCIFICATION,312,1 ,$70.00 ,$45.50 ,$15.40 ,$70.00 ,$40.25 ,$50.40 ,$38.08 ,$15.40 ,$19.60 ,$41.16 ,$15.40 ,$48.09 ,$17.50 ,$48.09 ,$48.09 ,$17.50 ,$48.09 ,$29.26 ,$58.80 , N/A ,$15.40 ,$59.50 ,$58.80 ,$15.40 ,$52.50 ,$56.00 ,$56.00 ,$15.40 ,$56.00 ,$58.80 ,$58.80 ,$58.80 ,$70.00 ,$63.00 ,$40.25 ,$70.00 ,$15.40 ,$70.00 ,$38.08 ,$15.40 ,$29.12 ,$33.96 ,$32.41 ,$16.17 ,$59.50 ,$48.09 ,$19.60 ,$63.00 ,$58.80 ,$56.00 ,$56.00 ,$15.40 ,$45.50 
ST. FRANCIS HOSPITAL - ACUTE,31200297,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$237.00 ,$154.05 ,$32.41 ,$237.00 ,$136.28 ,$170.64 ,$128.93 ,$52.14 ,$66.36 ,$139.36 ,$52.14 ,$162.82 ,$59.25 ,$162.82 ,$162.82 ,$59.25 ,$162.82 ,$99.07 ,$199.08 ,$63.08 ,$52.14 ,$201.45 ,$199.08 ,$52.14 ,$177.75 ,$189.60 ,$189.60 ,$52.14 ,$189.60 ,$199.08 ,$199.08 ,$199.08 ,$237.00 ,$213.30 ,$136.28 ,$237.00 ,$52.14 ,$237.00 ,$128.93 ,$52.14 ,$98.59 ,$33.96 ,$32.41 ,$54.75 ,$201.45 ,$162.82 ,$66.36 ,$213.30 ,$199.08 ,$189.60 ,$189.60 ,$52.14 ,$154.05 
ST. FRANCIS HOSPITAL - ACUTE,31200298,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$289.00 ,$187.85 ,$32.41 ,$289.00 ,$166.18 ,$208.08 ,$157.22 ,$63.58 ,$80.92 ,$169.93 ,$63.58 ,$198.54 ,$72.25 ,$198.54 ,$198.54 ,$72.25 ,$198.54 ,$120.80 ,$242.76 ,$126.88 ,$63.58 ,$245.65 ,$242.76 ,$63.58 ,$216.75 ,$231.20 ,$231.20 ,$63.58 ,$231.20 ,$242.76 ,$242.76 ,$242.76 ,$289.00 ,$260.10 ,$166.18 ,$289.00 ,$63.58 ,$289.00 ,$157.22 ,$63.58 ,$120.22 ,$33.96 ,$32.41 ,$66.76 ,$245.65 ,$198.54 ,$80.92 ,$260.10 ,$242.76 ,$231.20 ,$231.20 ,$63.58 ,$187.85 
ST. FRANCIS HOSPITAL - ACUTE,31200299,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$358.00 ,$232.70 ,$32.41 ,$358.00 ,$205.85 ,$257.76 ,$194.75 ,$78.76 ,$100.24 ,$210.50 ,$78.76 ,$245.95 ,$89.50 ,$245.95 ,$245.95 ,$89.50 ,$245.95 ,$149.64 ,$300.72 ,$126.88 ,$78.76 ,$304.30 ,$300.72 ,$78.76 ,$268.50 ,$286.40 ,$286.40 ,$78.76 ,$286.40 ,$300.72 ,$300.72 ,$300.72 ,$358.00 ,$322.20 ,$205.85 ,$358.00 ,$78.76 ,$35.62 ,$194.75 ,$78.76 ,$148.93 ,$33.96 ,$32.41 ,$82.70 ,$304.30 ,$245.95 ,$100.24 ,$322.20 ,$300.72 ,$286.40 ,$286.40 ,$78.76 ,$232.70 
ST. FRANCIS HOSPITAL - ACUTE,31200300,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,$762.00 ,$495.30 ,$35.66 ,$762.00 ,$438.15 ,$548.64 ,$414.53 ,$167.64 ,$213.36 ,$448.06 ,$167.64 ,$523.49 ,$190.50 ,$523.49 ,$523.49 ,$190.50 ,$523.49 ,$318.52 ,$640.08 ,$743.63 ,$167.64 ,$647.70 ,$640.08 ,$167.64 ,$571.50 ,$609.60 ,$609.60 ,$167.64 ,$609.60 ,$640.08 ,$640.08 ,$640.08 ,$762.00 ,$685.80 ,$438.15 ,$762.00 ,$167.64 ,$217.17 ,$414.53 ,$167.64 ,$316.99 ,$37.36 ,$35.66 ,$176.02 ,$647.70 ,$523.49 ,$213.36 ,$685.80 ,$640.08 ,$609.60 ,$609.60 ,$167.64 ,$495.30 
ST. FRANCIS HOSPITAL - ACUTE,31200301,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,"$1,099.00 ",$714.35 ,$35.66 ,"$1,673.23 ",$631.93 ,$791.28 ,$597.86 ,$241.78 ,$307.72 ,$646.21 ,$241.78 ,$755.01 ,$274.75 ,$755.01 ,$755.01 ,$274.75 ,$755.01 ,$459.38 ,$923.16 ,"$1,673.23 ",$241.78 ,$934.15 ,$923.16 ,$241.78 ,$824.25 ,$879.20 ,$879.20 ,$241.78 ,$879.20 ,$923.16 ,$923.16 ,$923.16 ,"$1,099.00 ",$989.10 ,$631.93 ,"$1,099.00 ",$241.78 ,"$1,099.00 ",$597.86 ,$241.78 ,$457.18 ,$37.36 ,$35.66 ,$253.87 ,$934.15 ,$755.01 ,$307.72 ,$989.10 ,$923.16 ,$879.20 ,$879.20 ,$241.78 ,$714.35 
ST. FRANCIS HOSPITAL - ACUTE,31200302,88300,HC GROSS ONLY LEVEL I,312,1 ,$113.00 ,$73.45 ,$24.86 ,$113.00 ,$64.98 ,$81.36 ,$61.47 ,$24.86 ,$31.64 ,$66.44 ,$24.86 ,$77.63 ,$28.25 ,$77.63 ,$77.63 ,$28.25 ,$77.63 ,$47.23 ,$94.92 ,$63.08 ,$24.86 ,$96.05 ,$94.92 ,$24.86 ,$84.75 ,$90.40 ,$90.40 ,$24.86 ,$90.40 ,$94.92 ,$94.92 ,$94.92 ,$113.00 ,$101.70 ,$64.98 ,$113.00 ,$24.86 ,$113.00 ,$61.47 ,$24.86 ,$47.01 ,$33.96 ,$32.41 ,$26.10 ,$96.05 ,$77.63 ,$31.64 ,$101.70 ,$94.92 ,$90.40 ,$90.40 ,$24.86 ,$73.45 
ST. FRANCIS HOSPITAL - ACUTE,31200303,88312,HC SPECIAL STAIN I,312,1 ,$96.00 ,$62.40 ,$21.12 ,$126.88 ,$55.20 ,$69.12 ,$52.22 ,$21.12 ,$26.88 ,$56.45 ,$21.12 ,$65.95 ,$24.00 ,$65.95 ,$65.95 ,$24.00 ,$65.95 ,$40.13 ,$80.64 ,$126.88 ,$21.12 ,$81.60 ,$80.64 ,$21.12 ,$72.00 ,$76.80 ,$76.80 ,$21.12 ,$76.80 ,$80.64 ,$80.64 ,$80.64 ,$96.00 ,$86.40 ,$55.20 ,$96.00 ,$21.12 ,$96.00 ,$52.22 ,$21.12 ,$39.94 ,$33.96 ,$32.41 ,$22.18 ,$81.60 ,$65.95 ,$26.88 ,$86.40 ,$80.64 ,$76.80 ,$76.80 ,$21.12 ,$62.40 
ST. FRANCIS HOSPITAL - ACUTE,31200304,88313,HC SPECIAL STAIN II,312,1 ,$77.00 ,$50.05 ,$16.94 ,$86.43 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$86.43 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$33.96 ,$32.41 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,31200305,88342,HC IMMUNOHISOCHEMIST EA AB REPEAT,312,1 ,$314.00 ,$204.10 ,$32.41 ,$380.80 ,$180.55 ,$226.08 ,$170.82 ,$69.08 ,$87.92 ,$184.63 ,$69.08 ,$215.72 ,$78.50 ,$215.72 ,$215.72 ,$78.50 ,$215.72 ,$131.25 ,$263.76 ,$380.80 ,$69.08 ,$266.90 ,$263.76 ,$69.08 ,$235.50 ,$251.20 ,$251.20 ,$69.08 ,$251.20 ,$263.76 ,$263.76 ,$263.76 ,$314.00 ,$282.60 ,$180.55 ,$314.00 ,$69.08 ,$74.24 ,$170.82 ,$69.08 ,$130.62 ,$33.96 ,$32.41 ,$72.53 ,$266.90 ,$215.72 ,$87.92 ,$282.60 ,$263.76 ,$251.20 ,$251.20 ,$69.08 ,$204.10 
ST. FRANCIS HOSPITAL - ACUTE,31200306,88344,HC IMMUNOHISTOCHEM EA AB STAIN,312,1 ,$707.00 ,$459.55 ,$32.41 ,$743.63 ,$406.53 ,$509.04 ,$384.61 ,$155.54 ,$197.96 ,$415.72 ,$155.54 ,$485.71 ,$176.75 ,$485.71 ,$485.71 ,$176.75 ,$485.71 ,$295.53 ,$593.88 ,$743.63 ,$155.54 ,$600.95 ,$593.88 ,$155.54 ,$530.25 ,$565.60 ,$565.60 ,$155.54 ,$565.60 ,$593.88 ,$593.88 ,$593.88 ,$707.00 ,$636.30 ,$406.53 ,$707.00 ,$155.54 ,$707.00 ,$384.61 ,$155.54 ,$294.11 ,$33.96 ,$32.41 ,$163.32 ,$600.95 ,$485.71 ,$197.96 ,$636.30 ,$593.88 ,$565.60 ,$565.60 ,$155.54 ,$459.55 
ST. FRANCIS HOSPITAL - ACUTE,31200307,88341,HC IMMUNOHISOCHEMIS EA AD SGL STN,312,1 ,$283.00 ,$183.95 ,$32.41 ,$283.00 ,$162.73 ,$203.76 ,$153.95 ,$62.26 ,$79.24 ,$166.40 ,$62.26 ,$194.42 ,$70.75 ,$194.42 ,$194.42 ,$70.75 ,$194.42 ,$118.29 ,$237.72 , N/A ,$62.26 ,$240.55 ,$237.72 ,$62.26 ,$212.25 ,$226.40 ,$226.40 ,$62.26 ,$226.40 ,$237.72 ,$237.72 ,$237.72 ,$283.00 ,$254.70 ,$162.73 ,$283.00 ,$62.26 ,$68.12 ,$153.95 ,$62.26 ,$117.73 ,$33.96 ,$32.41 ,$65.37 ,$240.55 ,$194.42 ,$79.24 ,$254.70 ,$237.72 ,$226.40 ,$226.40 ,$62.26 ,$183.95 
ST. FRANCIS HOSPITAL - ACUTE,31200308,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$171.00 ,$111.15 ,$35.66 ,$171.00 ,$98.33 ,$123.12 ,$93.02 ,$37.62 ,$47.88 ,$100.55 ,$37.62 ,$117.48 ,$42.75 ,$117.48 ,$117.48 ,$42.75 ,$117.48 ,$71.48 ,$143.64 ,$126.88 ,$37.62 ,$145.35 ,$143.64 ,$37.62 ,$128.25 ,$136.80 ,$136.80 ,$37.62 ,$136.80 ,$143.64 ,$143.64 ,$143.64 ,$171.00 ,$153.90 ,$98.33 ,$171.00 ,$37.62 ,$171.00 ,$93.02 ,$37.62 ,$71.14 ,$37.36 ,$35.66 ,$39.50 ,$145.35 ,$117.48 ,$47.88 ,$153.90 ,$143.64 ,$136.80 ,$136.80 ,$37.62 ,$111.15 
ST. FRANCIS HOSPITAL - ACUTE,31200309,88363,HC EXAM ARCHIVE TISS MOL ANLYS,312,1 ,$25.00 ,$16.25 ,$5.50 ,$63.08 ,$14.38 ,$18.00 ,$13.60 ,$5.50 ,$7.00 ,$14.70 ,$5.50 ,$17.18 ,$6.25 ,$17.18 ,$17.18 ,$6.25 ,$17.18 ,$10.45 ,$21.00 ,$63.08 ,$5.50 ,$21.25 ,$21.00 ,$5.50 ,$18.75 ,$20.00 ,$20.00 ,$5.50 ,$20.00 ,$21.00 ,$21.00 ,$21.00 ,$25.00 ,$22.50 ,$14.38 ,$25.00 ,$5.50 ,$25.00 ,$13.60 ,$5.50 ,$10.40 ,$33.96 ,$32.41 ,$5.78 ,$21.25 ,$17.18 ,$7.00 ,$22.50 ,$21.00 ,$20.00 ,$20.00 ,$5.50 ,$16.25 
ST. FRANCIS HOSPITAL - ACUTE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$172.00 ,$111.80 ,$37.84 ,$172.00 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$96.49 ,$37.84 ,$112.14 ,$43.00 ,$112.14 ,$112.14 ,$43.00 ,$112.14 ,$71.90 ,$144.48 , N/A ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 , N/A , N/A ,$39.73 ,$146.20 ,$112.14 ,$48.16 ,$154.80 ,$144.48 ,$137.60 ,$137.60 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$172.00 ,$111.80 ,$37.84 ,$366.26 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$96.49 ,$37.84 ,$112.14 ,$43.00 ,$112.14 ,$112.14 ,$43.00 ,$112.14 ,$71.90 ,$144.48 , N/A ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 ,$366.26 ,$349.61 ,$39.73 ,$146.20 ,$112.14 ,$48.16 ,$154.80 ,$144.48 ,$137.60 ,$137.60 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$181.00 ,$117.65 ,$39.82 ,$366.26 ,$104.08 ,$130.32 ,$98.46 ,$39.82 ,$50.68 ,$101.54 ,$39.82 ,$118.01 ,$45.25 ,$118.01 ,$118.01 ,$45.25 ,$118.01 ,$75.66 ,$152.04 , N/A ,$39.82 ,$153.85 ,$152.04 ,$39.82 ,$135.75 ,$144.80 ,$144.80 ,$39.82 ,$144.80 ,$152.04 ,$152.04 ,$152.04 ,$181.00 ,$162.90 ,$104.08 ,$181.00 ,$39.82 ,$181.00 ,$98.46 ,$39.82 ,$75.30 ,$366.26 ,$349.61 ,$41.81 ,$153.85 ,$118.01 ,$50.68 ,$162.90 ,$152.04 ,$144.80 ,$144.80 ,$39.82 ,$117.65 
ST. FRANCIS HOSPITAL - ACUTE,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$418.00 ,$271.70 ,$91.96 ,$418.00 ,$240.35 ,$300.96 ,$227.39 ,$91.96 ,$117.04 ,$234.50 ,$91.96 ,$272.54 ,$104.50 ,$272.54 ,$272.54 ,$104.50 ,$272.54 ,$174.72 ,$351.12 , N/A ,$91.96 ,$355.30 ,$351.12 ,$91.96 ,$313.50 ,$334.40 ,$334.40 ,$91.96 ,$334.40 ,$351.12 ,$351.12 ,$351.12 ,$418.00 ,$376.20 ,$240.35 ,$418.00 ,$91.96 ,$418.00 ,$227.39 ,$91.96 ,$173.89 , N/A , N/A ,$96.56 ,$355.30 ,$272.54 ,$117.04 ,$376.20 ,$351.12 ,$334.40 ,$334.40 ,$91.96 ,$271.70 
ST. FRANCIS HOSPITAL - ACUTE,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,$842.00 ,$547.30 ,$185.24 ,"$3,590.40 ",$484.15 ,$606.24 ,$458.05 ,$185.24 ,$235.76 ,$472.36 ,$185.24 ,$548.98 ,$210.50 ,$548.98 ,$548.98 ,$210.50 ,$548.98 ,$351.96 ,$707.28 ,"$3,590.40 ",$185.24 ,$715.70 ,$707.28 ,$185.24 ,$631.50 ,$673.60 ,$673.60 ,$185.24 ,$673.60 ,$707.28 ,$707.28 ,$707.28 ,$842.00 ,$757.80 ,$484.15 ,$842.00 ,$185.24 ,$842.00 ,$458.05 ,$185.24 ,$350.27 ,$729.83 ,$696.65 ,$194.50 ,$715.70 ,$548.98 ,$235.76 ,$757.80 ,$707.28 ,$673.60 ,$673.60 ,$185.24 ,$547.30 
ST. FRANCIS HOSPITAL - ACUTE,32000026,36000,HC IV START > 3YR OLD,320,1 ,$48.00 ,$31.20 ,$10.56 ,$294.28 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$26.93 ,$10.56 ,$31.30 ,$12.00 ,$31.30 ,$31.30 ,$12.00 ,$31.30 ,$20.06 ,$40.32 , N/A ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 ,$294.28 ,$280.91 ,$11.09 ,$40.80 ,$31.30 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,32000029,36410,HC VENIPUNCTURE > AGE 3 REQUIR MD,361,1 ,$274.00 ,$178.10 ,$48.81 ,$274.00 ,$157.55 ,$197.28 ,$149.06 ,$60.28 ,$76.72 ,$153.71 ,$60.28 ,$178.65 ,$68.50 ,$178.65 ,$178.65 ,$68.50 ,$178.65 ,$114.53 ,$230.16 , N/A ,$60.28 ,$232.90 ,$230.16 ,$60.28 ,$205.50 ,$219.20 ,$219.20 ,$60.28 ,$219.20 ,$230.16 ,$230.16 ,$230.16 ,$274.00 ,$246.60 ,$157.55 ,$274.00 ,$60.28 ,$274.00 ,$149.06 ,$60.28 ,$113.98 ,$51.14 ,$48.81 ,$63.29 ,$232.90 ,$178.65 ,$76.72 ,$246.60 ,$230.16 ,$219.20 ,$219.20 ,$60.28 ,$178.10 
ST. FRANCIS HOSPITAL - ACUTE,32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$357.00 ,$232.05 ,$78.54 ,"$1,795.74 ",$205.28 ,$257.04 ,$194.21 ,$78.54 ,$99.96 ,$200.28 ,$78.54 ,$232.76 ,$89.25 ,$232.76 ,$232.76 ,$89.25 ,$232.76 ,$149.23 ,$299.88 ,$522.33 ,$78.54 ,$303.45 ,$299.88 ,$78.54 ,$267.75 ,$285.60 ,$285.60 ,$78.54 ,$285.60 ,$299.88 ,$299.88 ,$299.88 ,$357.00 ,$321.30 ,$205.28 ,$357.00 ,$78.54 ,$357.00 ,$194.21 ,$78.54 ,$148.51 ,"$1,795.74 ","$1,714.11 ",$82.47 ,$303.45 ,$232.76 ,$99.96 ,$321.30 ,$299.88 ,$285.60 ,$285.60 ,$78.54 ,$232.05 
ST. FRANCIS HOSPITAL - ACUTE,32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$175.00 ,$113.75 ,$38.50 ,$692.95 ,$100.63 ,$126.00 ,$95.20 ,$38.50 ,$49.00 ,$98.18 ,$38.50 ,$114.10 ,$43.75 ,$114.10 ,$114.10 ,$43.75 ,$114.10 ,$73.15 ,$147.00 ,$692.95 ,$38.50 ,$148.75 ,$147.00 ,$38.50 ,$131.25 ,$140.00 ,$140.00 ,$38.50 ,$140.00 ,$147.00 ,$147.00 ,$147.00 ,$175.00 ,$157.50 ,$100.63 ,$175.00 ,$38.50 ,$175.00 ,$95.20 ,$38.50 ,$72.80 ,$635.26 ,$606.39 ,$40.43 ,$148.75 ,$114.10 ,$49.00 ,$157.50 ,$147.00 ,$140.00 ,$140.00 ,$38.50 ,$113.75 
ST. FRANCIS HOSPITAL - ACUTE,32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$2,429.00 ","$1,578.85 ",$534.38 ,"$2,429.00 ","$1,396.68 ","$1,748.88 ","$1,321.38 ",$534.38 ,$680.12 ,"$1,362.67 ",$534.38 ,"$1,583.71 ",$607.25 ,"$1,583.71 ","$1,583.71 ",$607.25 ,"$1,583.71 ","$1,015.32 ","$2,040.36 ","$2,065.98 ",$534.38 ,"$2,064.65 ","$2,040.36 ",$534.38 ,"$1,821.75 ","$1,943.20 ","$1,943.20 ",$534.38 ,"$1,943.20 ","$2,040.36 ","$2,040.36 ","$2,040.36 ","$2,429.00 ","$2,186.10 ","$1,396.68 ","$2,429.00 ",$534.38 ,"$2,429.00 ","$1,321.38 ",$534.38 ,"$1,010.46 ",$635.26 ,$606.39 ,$561.10 ,"$2,064.65 ","$1,583.71 ",$680.12 ,"$2,186.10 ","$2,040.36 ","$1,943.20 ","$1,943.20 ",$534.38 ,"$1,578.85 "
ST. FRANCIS HOSPITAL - ACUTE,32000061,49451,HC RPLC DUODEN/JEJUN TB FLUORO,320,1 ,$360.00 ,$234.00 ,$79.20 ,"$2,065.98 ",$207.00 ,$259.20 ,$195.84 ,$79.20 ,$100.80 ,$201.96 ,$79.20 ,$234.72 ,$90.00 ,$234.72 ,$234.72 ,$90.00 ,$234.72 ,$150.48 ,$302.40 ,"$2,065.98 ",$79.20 ,$306.00 ,$302.40 ,$79.20 ,$270.00 ,$288.00 ,$288.00 ,$79.20 ,$288.00 ,$302.40 ,$302.40 ,$302.40 ,$360.00 ,$324.00 ,$207.00 ,$360.00 ,$79.20 ,$360.00 ,$195.84 ,$79.20 ,$149.76 ,$635.26 ,$606.39 ,$83.16 ,$306.00 ,$234.72 ,$100.80 ,$324.00 ,$302.40 ,$288.00 ,$288.00 ,$79.20 ,$234.00 
ST. FRANCIS HOSPITAL - ACUTE,32000062,49452,HC RPLC GASTRO-JEJUN TB FLUORO,361,1 ,$360.00 ,$234.00 ,$79.20 ,"$2,065.98 ",$207.00 ,$259.20 ,$195.84 ,$79.20 ,$100.80 ,$201.96 ,$79.20 ,$234.72 ,$90.00 ,$234.72 ,$234.72 ,$90.00 ,$234.72 ,$150.48 ,$302.40 ,"$2,065.98 ",$79.20 ,$306.00 ,$302.40 ,$79.20 ,$270.00 ,$288.00 ,$288.00 ,$79.20 ,$288.00 ,$302.40 ,$302.40 ,$302.40 ,$360.00 ,$324.00 ,$207.00 ,$360.00 ,$79.20 ,$360.00 ,$195.84 ,$79.20 ,$149.76 ,$635.26 ,$606.39 ,$83.16 ,$306.00 ,$234.72 ,$100.80 ,$324.00 ,$302.40 ,$288.00 ,$288.00 ,$79.20 ,$234.00 
ST. FRANCIS HOSPITAL - ACUTE,32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$419.00 ,$272.35 ,$92.18 ,$587.50 ,$240.93 ,$301.68 ,$227.94 ,$92.18 ,$117.32 ,$235.06 ,$92.18 ,$273.19 ,$104.75 ,$273.19 ,$273.19 ,$104.75 ,$273.19 ,$175.14 ,$351.96 ,$587.50 ,$92.18 ,$356.15 ,$351.96 ,$92.18 ,$314.25 ,$335.20 ,$335.20 ,$92.18 ,$335.20 ,$351.96 ,$351.96 ,$351.96 ,$419.00 ,$377.10 ,$240.93 ,$419.00 ,$92.18 ,$419.00 ,$227.94 ,$92.18 ,$174.30 ,$366.26 ,$349.61 ,$96.79 ,$356.15 ,$273.19 ,$117.32 ,$377.10 ,$351.96 ,$335.20 ,$335.20 ,$92.18 ,$272.35 
ST. FRANCIS HOSPITAL - ACUTE,32000085,51600,HC INJ CYSTOGRAM,320,1 ,$172.00 ,$111.80 ,$37.84 ,$366.26 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$96.49 ,$37.84 ,$112.14 ,$43.00 ,$112.14 ,$112.14 ,$43.00 ,$112.14 ,$71.90 ,$144.48 , N/A ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 ,$366.26 ,$349.61 ,$39.73 ,$146.20 ,$112.14 ,$48.16 ,$154.80 ,$144.48 ,$137.60 ,$137.60 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,32000086,51610,HC INJ URETHROCYSTOGRAM RETRO,320,1 ,$112.00 ,$72.80 ,$24.64 ,$366.26 ,$64.40 ,$80.64 ,$60.93 ,$24.64 ,$31.36 ,$62.83 ,$24.64 ,$73.02 ,$28.00 ,$73.02 ,$73.02 ,$28.00 ,$73.02 ,$46.82 ,$94.08 , N/A ,$24.64 ,$95.20 ,$94.08 ,$24.64 ,$84.00 ,$89.60 ,$89.60 ,$24.64 ,$89.60 ,$94.08 ,$94.08 ,$94.08 ,$112.00 ,$100.80 ,$64.40 ,$112.00 ,$24.64 ,$112.00 ,$60.93 ,$24.64 ,$46.59 ,$366.26 ,$349.61 ,$25.87 ,$95.20 ,$73.02 ,$31.36 ,$100.80 ,$94.08 ,$89.60 ,$89.60 ,$24.64 ,$72.80 
ST. FRANCIS HOSPITAL - ACUTE,32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,$172.00 ,$111.80 ,$37.84 ,$366.26 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$96.49 ,$37.84 ,$112.14 ,$43.00 ,$112.14 ,$112.14 ,$43.00 ,$112.14 ,$71.90 ,$144.48 , N/A ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 ,$366.26 ,$349.61 ,$39.73 ,$146.20 ,$112.14 ,$48.16 ,$154.80 ,$144.48 ,$137.60 ,$137.60 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$686.00 ,$445.90 ,$56.05 ,$686.00 ,$394.45 ,$493.92 ,$373.18 ,$150.92 ,$192.08 ,$351.34 ,$150.92 ,$351.34 ,$171.50 ,$351.34 ,$351.34 ,$171.50 ,$351.34 ,$286.75 ,$576.24 ,$206.53 ,$150.92 ,$583.10 ,$576.24 ,$150.92 ,$514.50 ,$548.80 ,$548.80 ,$150.92 ,$548.80 ,$576.24 ,$576.24 ,$576.24 ,$686.00 ,$617.40 ,$394.45 ,$686.00 ,$150.92 ,$686.00 ,$373.18 ,$150.92 ,$285.38 ,$58.72 ,$56.05 ,$158.47 ,$583.10 ,$351.34 ,$192.08 ,$617.40 ,$576.24 ,$548.80 ,$548.80 ,$150.92 ,$445.90 
ST. FRANCIS HOSPITAL - ACUTE,32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,"$1,082.00 ",$703.30 ,$56.05 ,"$1,082.00 ",$622.15 ,$779.04 ,$588.61 ,$238.04 ,$302.96 ,$451.94 ,$238.04 ,$451.94 ,$270.50 ,$451.94 ,$451.94 ,$270.50 ,$451.94 ,$452.28 ,$908.88 ,$277.98 ,$238.04 ,$919.70 ,$908.88 ,$238.04 ,$811.50 ,$865.60 ,$865.60 ,$238.04 ,$865.60 ,$908.88 ,$908.88 ,$908.88 ,"$1,082.00 ",$973.80 ,$622.15 ,"$1,082.00 ",$238.04 ,"$1,082.00 ",$588.61 ,$238.04 ,$450.11 ,$58.72 ,$56.05 ,$249.94 ,$919.70 ,$451.94 ,$302.96 ,$973.80 ,$908.88 ,$865.60 ,$865.60 ,$238.04 ,$703.30 
ST. FRANCIS HOSPITAL - ACUTE,32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$817.00 ,$531.05 ,$56.05 ,$817.00 ,$469.78 ,$588.24 ,$444.45 ,$179.74 ,$228.76 ,$480.40 ,$179.74 ,$502.23 ,$204.25 ,$502.23 ,$502.23 ,$204.25 ,$502.23 ,$341.51 ,$686.28 ,$277.98 ,$179.74 ,$694.45 ,$686.28 ,$179.74 ,$612.75 ,$653.60 ,$653.60 ,$179.74 ,$653.60 ,$686.28 ,$686.28 ,$686.28 ,$817.00 ,$735.30 ,$469.78 ,$817.00 ,$179.74 ,$817.00 ,$444.45 ,$179.74 ,$339.87 ,$58.72 ,$56.05 ,$188.73 ,$694.45 ,$502.23 ,$228.76 ,$735.30 ,$686.28 ,$653.60 ,$653.60 ,$179.74 ,$531.05 
ST. FRANCIS HOSPITAL - ACUTE,32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$206.53 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$817.00 ,$531.05 ,$56.05 ,$817.00 ,$469.78 ,$588.24 ,$444.45 ,$179.74 ,$228.76 ,$480.40 ,$179.74 ,$502.23 ,$204.25 ,$502.23 ,$502.23 ,$204.25 ,$502.23 ,$341.51 ,$686.28 ,$277.98 ,$179.74 ,$694.45 ,$686.28 ,$179.74 ,$612.75 ,$653.60 ,$653.60 ,$179.74 ,$653.60 ,$686.28 ,$686.28 ,$686.28 ,$817.00 ,$735.30 ,$469.78 ,$817.00 ,$179.74 ,$817.00 ,$444.45 ,$179.74 ,$339.87 ,$58.72 ,$56.05 ,$188.73 ,$694.45 ,$502.23 ,$228.76 ,$735.30 ,$686.28 ,$653.60 ,$653.60 ,$179.74 ,$531.05 
ST. FRANCIS HOSPITAL - ACUTE,32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$293.00 ,$190.45 ,$56.05 ,$293.00 ,$168.48 ,$210.96 ,$159.39 ,$64.46 ,$82.04 ,$172.28 ,$64.46 ,$201.29 ,$73.25 ,$201.29 ,$201.29 ,$73.25 ,$201.29 ,$122.47 ,$246.12 ,$206.53 ,$64.46 ,$249.05 ,$246.12 ,$64.46 ,$219.75 ,$234.40 ,$234.40 ,$64.46 ,$234.40 ,$246.12 ,$246.12 ,$246.12 ,$293.00 ,$263.70 ,$168.48 ,$293.00 ,$64.46 ,$293.00 ,$159.39 ,$64.46 ,$121.89 ,$58.72 ,$56.05 ,$67.68 ,$249.05 ,$201.29 ,$82.04 ,$263.70 ,$246.12 ,$234.40 ,$234.40 ,$64.46 ,$190.45 
ST. FRANCIS HOSPITAL - ACUTE,32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$817.00 ,$531.05 ,$56.05 ,$817.00 ,$469.78 ,$588.24 ,$444.45 ,$179.74 ,$228.76 ,$445.59 ,$179.74 ,$445.59 ,$204.25 ,$445.59 ,$445.59 ,$204.25 ,$445.59 ,$341.51 ,$686.28 ,$206.53 ,$179.74 ,$694.45 ,$686.28 ,$179.74 ,$612.75 ,$653.60 ,$653.60 ,$179.74 ,$653.60 ,$686.28 ,$686.28 ,$686.28 ,$817.00 ,$735.30 ,$469.78 ,$817.00 ,$179.74 ,$817.00 ,$444.45 ,$179.74 ,$339.87 ,$58.72 ,$56.05 ,$188.73 ,$694.45 ,$445.59 ,$228.76 ,$735.30 ,$686.28 ,$653.60 ,$653.60 ,$179.74 ,$531.05 
ST. FRANCIS HOSPITAL - ACUTE,32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$277.98 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$834.00 ,$542.10 ,$56.05 ,$834.00 ,$479.55 ,$600.48 ,$453.70 ,$183.48 ,$233.52 ,$490.39 ,$183.48 ,$502.23 ,$208.50 ,$502.23 ,$502.23 ,$208.50 ,$502.23 ,$348.61 ,$700.56 ,$277.98 ,$183.48 ,$708.90 ,$700.56 ,$183.48 ,$625.50 ,$667.20 ,$667.20 ,$183.48 ,$667.20 ,$700.56 ,$700.56 ,$700.56 ,$834.00 ,$750.60 ,$479.55 ,$834.00 ,$183.48 ,$834.00 ,$453.70 ,$183.48 ,$346.94 ,$58.72 ,$56.05 ,$192.65 ,$708.90 ,$502.23 ,$233.52 ,$750.60 ,$700.56 ,$667.20 ,$667.20 ,$183.48 ,$542.10 
ST. FRANCIS HOSPITAL - ACUTE,32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$817.00 ,$531.05 ,$56.05 ,$817.00 ,$469.78 ,$588.24 ,$444.45 ,$179.74 ,$228.76 ,$480.40 ,$179.74 ,$561.28 ,$204.25 ,$561.28 ,$561.28 ,$204.25 ,$561.28 ,$341.51 ,$686.28 ,$206.53 ,$179.74 ,$694.45 ,$686.28 ,$179.74 ,$612.75 ,$653.60 ,$653.60 ,$179.74 ,$653.60 ,$686.28 ,$686.28 ,$686.28 ,$817.00 ,$735.30 ,$469.78 ,$817.00 ,$179.74 ,$817.00 ,$444.45 ,$179.74 ,$339.87 ,$58.72 ,$56.05 ,$188.73 ,$694.45 ,$561.28 ,$228.76 ,$735.30 ,$686.28 ,$653.60 ,$653.60 ,$179.74 ,$531.05 
ST. FRANCIS HOSPITAL - ACUTE,32000114,70336,HC MRI TMJ,320,1 ,"$3,803.00 ","$2,471.95 ",$235.46 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$246.68 ,$235.46 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$138.00 ,$89.70 ,$30.36 ,$206.53 ,$79.35 ,$99.36 ,$75.07 ,$30.36 ,$38.64 ,$81.14 ,$30.36 ,$94.81 ,$34.50 ,$94.81 ,$94.81 ,$34.50 ,$94.81 ,$57.68 ,$115.92 ,$206.53 ,$30.36 ,$117.30 ,$115.92 ,$30.36 ,$103.50 ,$110.40 ,$110.40 ,$30.36 ,$110.40 ,$115.92 ,$115.92 ,$115.92 ,$138.00 ,$124.20 ,$79.35 ,$138.00 ,$30.36 ,$138.00 ,$75.07 ,$30.36 ,$57.41 ,$58.72 ,$56.05 ,$31.88 ,$117.30 ,$94.81 ,$38.64 ,$124.20 ,$115.92 ,$110.40 ,$110.40 ,$30.36 ,$89.70 
ST. FRANCIS HOSPITAL - ACUTE,32000121,71045,HC XR CHEST 1V,320,1 ,$351.00 ,$228.15 ,$18.14 ,$351.00 ,$201.83 ,$252.72 ,$190.94 ,$77.22 ,$98.28 ,$194.10 ,$77.22 ,$194.10 ,$87.75 ,$194.10 ,$194.10 ,$87.75 ,$194.10 ,$146.72 ,$294.84 ,$206.53 ,$77.22 ,$298.35 ,$294.84 ,$77.22 ,$263.25 ,$280.80 ,$280.80 ,$77.22 ,$280.80 ,$294.84 ,$294.84 ,$294.84 ,$351.00 ,$315.90 ,$201.83 ,$351.00 ,$77.22 ,$18.14 ,$190.94 ,$77.22 ,$146.02 ,$58.72 ,$56.05 ,$81.08 ,$298.35 ,$194.10 ,$98.28 ,$315.90 ,$294.84 ,$280.80 ,$280.80 ,$77.22 ,$228.15 
ST. FRANCIS HOSPITAL - ACUTE,32000127,71046,HC XR CHEST 2V,320,1 ,$441.00 ,$286.65 ,$24.70 ,$441.00 ,$253.58 ,$317.52 ,$239.90 ,$97.02 ,$123.48 ,$259.31 ,$97.02 ,$302.97 ,$110.25 ,$302.97 ,$302.97 ,$110.25 ,$302.97 ,$184.34 ,$370.44 ,$206.53 ,$97.02 ,$374.85 ,$370.44 ,$97.02 ,$330.75 ,$352.80 ,$352.80 ,$97.02 ,$352.80 ,$370.44 ,$370.44 ,$370.44 ,$441.00 ,$396.90 ,$253.58 ,$441.00 ,$97.02 ,$24.70 ,$239.90 ,$97.02 ,$183.46 ,$58.72 ,$56.05 ,$101.87 ,$374.85 ,$302.97 ,$123.48 ,$396.90 ,$370.44 ,$352.80 ,$352.80 ,$97.02 ,$286.65 
ST. FRANCIS HOSPITAL - ACUTE,32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$441.00 ,$286.65 ,$56.05 ,$441.00 ,$253.58 ,$317.52 ,$239.90 ,$97.02 ,$123.48 ,$259.31 ,$97.02 ,$302.97 ,$110.25 ,$302.97 ,$302.97 ,$110.25 ,$302.97 ,$184.34 ,$370.44 ,$206.53 ,$97.02 ,$374.85 ,$370.44 ,$97.02 ,$330.75 ,$352.80 ,$352.80 ,$97.02 ,$352.80 ,$370.44 ,$370.44 ,$370.44 ,$441.00 ,$396.90 ,$253.58 ,$441.00 ,$97.02 ,$441.00 ,$239.90 ,$97.02 ,$183.46 ,$58.72 ,$56.05 ,$101.87 ,$374.85 ,$302.97 ,$123.48 ,$396.90 ,$370.44 ,$352.80 ,$352.80 ,$97.02 ,$286.65 
ST. FRANCIS HOSPITAL - ACUTE,32000133,71048,HC XR CHEST 4+V,320,1 ,$485.00 ,$315.25 ,$56.05 ,$485.00 ,$278.88 ,$349.20 ,$263.84 ,$106.70 ,$135.80 ,$285.18 ,$106.70 ,$333.20 ,$121.25 ,$333.20 ,$333.20 ,$121.25 ,$333.20 ,$202.73 ,$407.40 ,$277.98 ,$106.70 ,$412.25 ,$407.40 ,$106.70 ,$363.75 ,$388.00 ,$388.00 ,$106.70 ,$388.00 ,$407.40 ,$407.40 ,$407.40 ,$485.00 ,$436.50 ,$278.88 ,$485.00 ,$106.70 ,$485.00 ,$263.84 ,$106.70 ,$201.76 ,$58.72 ,$56.05 ,$112.04 ,$412.25 ,$333.20 ,$135.80 ,$436.50 ,$407.40 ,$388.00 ,$388.00 ,$106.70 ,$315.25 
ST. FRANCIS HOSPITAL - ACUTE,32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$441.00 ,$286.65 ,$24.70 ,$441.00 ,$253.58 ,$317.52 ,$239.90 ,$97.02 ,$123.48 ,$259.31 ,$97.02 ,$302.97 ,$110.25 ,$302.97 ,$302.97 ,$110.25 ,$302.97 ,$184.34 ,$370.44 ,$206.53 ,$97.02 ,$374.85 ,$370.44 ,$97.02 ,$330.75 ,$352.80 ,$352.80 ,$97.02 ,$352.80 ,$370.44 ,$370.44 ,$370.44 ,$441.00 ,$396.90 ,$253.58 ,$441.00 ,$97.02 ,$24.70 ,$239.90 ,$97.02 ,$183.46 ,$58.72 ,$56.05 ,$101.87 ,$374.85 ,$302.97 ,$123.48 ,$396.90 ,$370.44 ,$352.80 ,$352.80 ,$97.02 ,$286.65 
ST. FRANCIS HOSPITAL - ACUTE,32000137,71100,HC XR RIBS 2V UNI,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$206.53 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$696.00 ,$452.40 ,$56.05 ,$696.00 ,$400.20 ,$501.12 ,$378.62 ,$153.12 ,$194.88 ,$409.25 ,$153.12 ,$439.36 ,$174.00 ,$439.36 ,$439.36 ,$174.00 ,$439.36 ,$290.93 ,$584.64 ,$277.98 ,$153.12 ,$591.60 ,$584.64 ,$153.12 ,$522.00 ,$556.80 ,$556.80 ,$153.12 ,$556.80 ,$584.64 ,$584.64 ,$584.64 ,$696.00 ,$626.40 ,$400.20 ,$696.00 ,$153.12 ,$696.00 ,$378.62 ,$153.12 ,$289.54 ,$58.72 ,$56.05 ,$160.78 ,$591.60 ,$439.36 ,$194.88 ,$626.40 ,$584.64 ,$556.80 ,$556.80 ,$153.12 ,$452.40 
ST. FRANCIS HOSPITAL - ACUTE,32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$817.00 ,$531.05 ,$56.05 ,$817.00 ,$469.78 ,$588.24 ,$444.45 ,$179.74 ,$228.76 ,$451.94 ,$179.74 ,$451.94 ,$204.25 ,$451.94 ,$451.94 ,$204.25 ,$451.94 ,$341.51 ,$686.28 ,$277.98 ,$179.74 ,$694.45 ,$686.28 ,$179.74 ,$612.75 ,$653.60 ,$653.60 ,$179.74 ,$653.60 ,$686.28 ,$686.28 ,$686.28 ,$817.00 ,$735.30 ,$469.78 ,$817.00 ,$179.74 ,$817.00 ,$444.45 ,$179.74 ,$339.87 ,$58.72 ,$56.05 ,$188.73 ,$694.45 ,$451.94 ,$228.76 ,$735.30 ,$686.28 ,$653.60 ,$653.60 ,$179.74 ,$531.05 
ST. FRANCIS HOSPITAL - ACUTE,32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$817.00 ,$531.05 ,$56.05 ,$817.00 ,$469.78 ,$588.24 ,$444.45 ,$179.74 ,$228.76 ,$480.40 ,$179.74 ,$546.18 ,$204.25 ,$546.18 ,$546.18 ,$204.25 ,$546.18 ,$341.51 ,$686.28 ,$277.98 ,$179.74 ,$694.45 ,$686.28 ,$179.74 ,$612.75 ,$653.60 ,$653.60 ,$179.74 ,$653.60 ,$686.28 ,$686.28 ,$686.28 ,$817.00 ,$735.30 ,$469.78 ,$817.00 ,$179.74 ,$817.00 ,$444.45 ,$179.74 ,$339.87 ,$58.72 ,$56.05 ,$188.73 ,$694.45 ,$546.18 ,$228.76 ,$735.30 ,$686.28 ,$653.60 ,$653.60 ,$179.74 ,$531.05 
ST. FRANCIS HOSPITAL - ACUTE,32000141,71120,HC XR STERNUM 2+V,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$206.53 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$664.00 ,$431.60 ,$56.05 ,$664.00 ,$381.80 ,$478.08 ,$361.22 ,$146.08 ,$185.92 ,$390.43 ,$146.08 ,$445.59 ,$166.00 ,$445.59 ,$445.59 ,$166.00 ,$445.59 ,$277.55 ,$557.76 ,$206.53 ,$146.08 ,$564.40 ,$557.76 ,$146.08 ,$498.00 ,$531.20 ,$531.20 ,$146.08 ,$531.20 ,$557.76 ,$557.76 ,$557.76 ,$664.00 ,$597.60 ,$381.80 ,$664.00 ,$146.08 ,$664.00 ,$361.22 ,$146.08 ,$276.22 ,$58.72 ,$56.05 ,$153.38 ,$564.40 ,$445.59 ,$185.92 ,$597.60 ,$557.76 ,$531.20 ,$531.20 ,$146.08 ,$431.60 
ST. FRANCIS HOSPITAL - ACUTE,32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$2,513.00 ","$1,633.45 ",$139.83 ,"$2,513.00 ","$1,444.98 ","$1,809.36 ","$1,367.07 ",$552.86 ,$703.64 ,"$1,477.64 ",$552.86 ,"$1,726.43 ",$628.25 ,"$1,726.43 ","$1,726.43 ",$628.25 ,"$1,726.43 ","$1,050.43 ","$2,110.92 ",$277.98 ,$552.86 ,"$2,136.05 ","$2,110.92 ",$552.86 ,"$1,884.75 ","$2,010.40 ","$2,010.40 ",$552.86 ,"$2,010.40 ","$2,110.92 ","$2,110.92 ","$2,110.92 ","$2,513.00 ","$2,261.70 ","$1,444.98 ","$2,513.00 ",$552.86 ,"$2,513.00 ","$1,367.07 ",$552.86 ,"$1,045.41 ",$146.49 ,$139.83 ,$580.50 ,"$2,136.05 ","$1,726.43 ",$703.64 ,"$2,261.70 ","$2,110.92 ","$2,010.40 ","$2,010.40 ",$552.86 ,"$1,633.45 "
ST. FRANCIS HOSPITAL - ACUTE,32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$3,031.00 ","$1,970.15 ",$139.83 ,"$3,031.00 ","$1,742.83 ","$2,182.32 ","$1,648.86 ",$666.82 ,$848.68 ,"$1,782.23 ",$666.82 ,"$2,082.30 ",$757.75 ,"$2,082.30 ","$2,082.30 ",$757.75 ,"$2,082.30 ","$1,266.96 ","$2,546.04 ",$456.08 ,$666.82 ,"$2,576.35 ","$2,546.04 ",$666.82 ,"$2,273.25 ","$2,424.80 ","$2,424.80 ",$666.82 ,"$2,424.80 ","$2,546.04 ","$2,546.04 ","$2,546.04 ","$3,031.00 ","$2,727.90 ","$1,742.83 ","$3,031.00 ",$666.82 ,"$3,031.00 ","$1,648.86 ",$666.82 ,"$1,260.90 ",$146.49 ,$139.83 ,$700.16 ,"$2,576.35 ","$2,082.30 ",$848.68 ,"$2,727.90 ","$2,546.04 ","$2,424.80 ","$2,424.80 ",$666.82 ,"$1,970.15 "
ST. FRANCIS HOSPITAL - ACUTE,32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$3,333.00 ","$2,166.45 ",$139.83 ,"$3,333.00 ","$1,916.48 ","$2,399.76 ","$1,813.15 ",$733.26 ,$933.24 ,"$1,959.80 ",$733.26 ,"$2,289.77 ",$833.25 ,"$2,289.77 ","$2,289.77 ",$833.25 ,"$2,289.77 ","$1,393.19 ","$2,799.72 ",$456.08 ,$733.26 ,"$2,833.05 ","$2,799.72 ",$733.26 ,"$2,499.75 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,666.40 ","$2,799.72 ","$2,799.72 ","$2,799.72 ","$3,333.00 ","$2,999.70 ","$1,916.48 ","$3,333.00 ",$733.26 ,"$3,333.00 ","$1,813.15 ",$733.26 ,"$1,386.53 ",$146.49 ,$139.83 ,$769.92 ,"$2,833.05 ","$2,289.77 ",$933.24 ,"$2,999.70 ","$2,799.72 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,166.45 "
ST. FRANCIS HOSPITAL - ACUTE,32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$3,820.00 ","$2,483.00 ",$316.01 ,"$3,820.00 ","$2,196.50 ","$2,750.40 ","$2,078.08 ",$840.40 ,"$1,069.60 ","$2,246.16 ",$840.40 ,"$2,624.34 ",$955.00 ,"$2,624.34 ","$2,624.34 ",$955.00 ,"$2,624.34 ","$1,596.76 ","$3,208.80 ",$456.08 ,$840.40 ,"$3,247.00 ","$3,208.80 ",$840.40 ,"$2,865.00 ","$3,056.00 ","$3,056.00 ",$840.40 ,"$3,056.00 ","$3,208.80 ","$3,208.80 ","$3,208.80 ","$3,820.00 ","$3,438.00 ","$2,196.50 ","$3,820.00 ",$840.40 ,"$3,820.00 ","$2,078.08 ",$840.40 ,"$1,589.12 ",$331.06 ,$316.01 ,$882.42 ,"$3,247.00 ","$2,624.34 ","$1,069.60 ","$3,438.00 ","$3,208.80 ","$3,056.00 ","$3,056.00 ",$840.40 ,"$2,483.00 "
ST. FRANCIS HOSPITAL - ACUTE,32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,803.00 ","$2,471.95 ",$479.59 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$502.43 ,$479.59 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$4,053.00 ","$2,634.45 ",$479.59 ,"$4,053.00 ","$2,330.48 ","$2,918.16 ","$2,204.83 ",$891.66 ,"$1,134.84 ","$2,383.16 ",$891.66 ,"$2,784.41 ","$1,013.25 ","$2,784.41 ","$2,784.41 ","$1,013.25 ","$2,784.41 ","$1,694.15 ","$3,404.52 ","$1,826.68 ",$891.66 ,"$3,445.05 ","$3,404.52 ",$891.66 ,"$3,039.75 ","$3,242.40 ","$3,242.40 ",$891.66 ,"$3,242.40 ","$3,404.52 ","$3,404.52 ","$3,404.52 ","$4,053.00 ","$3,647.70 ","$2,330.48 ","$4,053.00 ",$891.66 ,"$4,053.00 ","$2,204.83 ",$891.66 ,"$1,686.05 ",$502.43 ,$479.59 ,$936.24 ,"$3,445.05 ","$2,784.41 ","$1,134.84 ","$3,647.70 ","$3,404.52 ","$3,242.40 ","$3,242.40 ",$891.66 ,"$2,634.45 "
ST. FRANCIS HOSPITAL - ACUTE,32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$4,325.00 ","$2,811.25 ",$479.59 ,"$4,325.00 ","$2,486.88 ","$3,114.00 ","$2,352.80 ",$951.50 ,"$1,211.00 ","$2,543.10 ",$951.50 ,"$2,971.28 ","$1,081.25 ","$2,971.28 ","$2,971.28 ","$1,081.25 ","$2,971.28 ","$1,807.85 ","$3,633.00 ",$940.23 ,$951.50 ,"$3,676.25 ","$3,633.00 ",$951.50 ,"$3,243.75 ","$3,460.00 ","$3,460.00 ",$951.50 ,"$3,460.00 ","$3,633.00 ","$3,633.00 ","$3,633.00 ","$4,325.00 ","$3,892.50 ","$2,486.88 ","$4,325.00 ",$951.50 ,"$4,325.00 ","$2,352.80 ",$951.50 ,"$1,799.20 ",$502.43 ,$479.59 ,$999.08 ,"$3,676.25 ","$2,971.28 ","$1,211.00 ","$3,892.50 ","$3,633.00 ","$3,460.00 ","$3,460.00 ",$951.50 ,"$2,811.25 "
ST. FRANCIS HOSPITAL - ACUTE,32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$187.00 ,$121.55 ,$41.14 ,$206.53 ,$107.53 ,$134.64 ,$101.73 ,$41.14 ,$52.36 ,$109.96 ,$41.14 ,$128.47 ,$46.75 ,$128.47 ,$128.47 ,$46.75 ,$128.47 ,$78.17 ,$157.08 ,$206.53 ,$41.14 ,$158.95 ,$157.08 ,$41.14 ,$140.25 ,$149.60 ,$149.60 ,$41.14 ,$149.60 ,$157.08 ,$157.08 ,$157.08 ,$187.00 ,$168.30 ,$107.53 ,$187.00 ,$41.14 ,$187.00 ,$101.73 ,$41.14 ,$77.79 ,$58.72 ,$56.05 ,$43.20 ,$158.95 ,$128.47 ,$52.36 ,$168.30 ,$157.08 ,$149.60 ,$149.60 ,$41.14 ,$121.55 
ST. FRANCIS HOSPITAL - ACUTE,32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$510.00 ,$331.50 ,$56.05 ,$510.00 ,$293.25 ,$367.20 ,$277.44 ,$112.20 ,$142.80 ,$299.88 ,$112.20 ,$350.37 ,$127.50 ,$350.37 ,$350.37 ,$127.50 ,$350.37 ,$213.18 ,$428.40 ,$206.53 ,$112.20 ,$433.50 ,$428.40 ,$112.20 ,$382.50 ,$408.00 ,$408.00 ,$112.20 ,$408.00 ,$428.40 ,$428.40 ,$428.40 ,$510.00 ,$459.00 ,$293.25 ,$510.00 ,$112.20 ,$510.00 ,$277.44 ,$112.20 ,$212.16 ,$58.72 ,$56.05 ,$117.81 ,$433.50 ,$350.37 ,$142.80 ,$459.00 ,$428.40 ,$408.00 ,$408.00 ,$112.20 ,$331.50 
ST. FRANCIS HOSPITAL - ACUTE,32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$817.00 ,$531.05 ,$56.05 ,$817.00 ,$469.78 ,$588.24 ,$444.45 ,$179.74 ,$228.76 ,$480.40 ,$179.74 ,$561.28 ,$204.25 ,$561.28 ,$561.28 ,$204.25 ,$561.28 ,$341.51 ,$686.28 ,$277.98 ,$179.74 ,$694.45 ,$686.28 ,$179.74 ,$612.75 ,$653.60 ,$653.60 ,$179.74 ,$653.60 ,$686.28 ,$686.28 ,$686.28 ,$817.00 ,$735.30 ,$469.78 ,$817.00 ,$179.74 ,$817.00 ,$444.45 ,$179.74 ,$339.87 ,$58.72 ,$56.05 ,$188.73 ,$694.45 ,$561.28 ,$228.76 ,$735.30 ,$686.28 ,$653.60 ,$653.60 ,$179.74 ,$531.05 
ST. FRANCIS HOSPITAL - ACUTE,32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,"$1,145.00 ",$744.25 ,$56.05 ,"$1,145.00 ",$658.38 ,$824.40 ,$622.88 ,$251.90 ,$320.60 ,$672.05 ,$251.90 ,$672.05 ,$286.25 ,$672.05 ,$672.05 ,$286.25 ,$672.05 ,$478.61 ,$961.80 ,$277.98 ,$251.90 ,$973.25 ,$961.80 ,$251.90 ,$858.75 ,$916.00 ,$916.00 ,$251.90 ,$916.00 ,$961.80 ,$961.80 ,$961.80 ,"$1,145.00 ","$1,030.50 ",$658.38 ,"$1,145.00 ",$251.90 ,"$1,145.00 ",$622.88 ,$251.90 ,$476.32 ,$58.72 ,$56.05 ,$264.50 ,$973.25 ,$672.05 ,$320.60 ,"$1,030.50 ",$961.80 ,$916.00 ,$916.00 ,$251.90 ,$744.25 
ST. FRANCIS HOSPITAL - ACUTE,32000172,72070,HC XR T-SPINE 2V,320,1 ,$440.00 ,$286.00 ,$56.05 ,$440.00 ,$253.00 ,$316.80 ,$239.36 ,$96.80 ,$123.20 ,$258.72 ,$96.80 ,$302.28 ,$110.00 ,$302.28 ,$302.28 ,$110.00 ,$302.28 ,$183.92 ,$369.60 ,$277.98 ,$96.80 ,$374.00 ,$369.60 ,$96.80 ,$330.00 ,$352.00 ,$352.00 ,$96.80 ,$352.00 ,$369.60 ,$369.60 ,$369.60 ,$440.00 ,$396.00 ,$253.00 ,$440.00 ,$96.80 ,$440.00 ,$239.36 ,$96.80 ,$183.04 ,$58.72 ,$56.05 ,$101.64 ,$374.00 ,$302.28 ,$123.20 ,$396.00 ,$369.60 ,$352.00 ,$352.00 ,$96.80 ,$286.00 
ST. FRANCIS HOSPITAL - ACUTE,32000174,72072,HC XR T-SPINE 3V,320,1 ,$492.00 ,$319.80 ,$56.05 ,$492.00 ,$282.90 ,$354.24 ,$267.65 ,$108.24 ,$137.76 ,$289.30 ,$108.24 ,$338.00 ,$123.00 ,$338.00 ,$338.00 ,$123.00 ,$338.00 ,$205.66 ,$413.28 ,$277.98 ,$108.24 ,$418.20 ,$413.28 ,$108.24 ,$369.00 ,$393.60 ,$393.60 ,$108.24 ,$393.60 ,$413.28 ,$413.28 ,$413.28 ,$492.00 ,$442.80 ,$282.90 ,$492.00 ,$108.24 ,$492.00 ,$267.65 ,$108.24 ,$204.67 ,$58.72 ,$56.05 ,$113.65 ,$418.20 ,$338.00 ,$137.76 ,$442.80 ,$413.28 ,$393.60 ,$393.60 ,$108.24 ,$319.80 
ST. FRANCIS HOSPITAL - ACUTE,32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$510.00 ,$331.50 ,$56.05 ,$510.00 ,$293.25 ,$367.20 ,$277.44 ,$112.20 ,$142.80 ,$299.88 ,$112.20 ,$350.37 ,$127.50 ,$350.37 ,$350.37 ,$127.50 ,$350.37 ,$213.18 ,$428.40 ,$277.98 ,$112.20 ,$433.50 ,$428.40 ,$112.20 ,$382.50 ,$408.00 ,$408.00 ,$112.20 ,$408.00 ,$428.40 ,$428.40 ,$428.40 ,$510.00 ,$459.00 ,$293.25 ,$510.00 ,$112.20 ,$510.00 ,$277.44 ,$112.20 ,$212.16 ,$58.72 ,$56.05 ,$117.81 ,$433.50 ,$350.37 ,$142.80 ,$459.00 ,$428.40 ,$408.00 ,$408.00 ,$112.20 ,$331.50 
ST. FRANCIS HOSPITAL - ACUTE,32000181,72110,HC XR L-SPINE 4+V,320,1 ,"$1,042.00 ",$677.30 ,$56.05 ,"$1,042.00 ",$599.15 ,$750.24 ,$566.85 ,$229.24 ,$291.76 ,$612.70 ,$229.24 ,$715.85 ,$260.50 ,$715.85 ,$715.85 ,$260.50 ,$715.85 ,$435.56 ,$875.28 ,$277.98 ,$229.24 ,$885.70 ,$875.28 ,$229.24 ,$781.50 ,$833.60 ,$833.60 ,$229.24 ,$833.60 ,$875.28 ,$875.28 ,$875.28 ,"$1,042.00 ",$937.80 ,$599.15 ,"$1,042.00 ",$229.24 ,"$1,042.00 ",$566.85 ,$229.24 ,$433.47 ,$58.72 ,$56.05 ,$240.70 ,$885.70 ,$715.85 ,$291.76 ,$937.80 ,$875.28 ,$833.60 ,$833.60 ,$229.24 ,$677.30 
ST. FRANCIS HOSPITAL - ACUTE,32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,"$1,295.00 ",$841.75 ,$56.05 ,"$1,295.00 ",$744.63 ,$932.40 ,$704.48 ,$284.90 ,$362.60 ,$761.46 ,$284.90 ,$804.02 ,$323.75 ,$804.02 ,$804.02 ,$323.75 ,$804.02 ,$541.31 ,"$1,087.80 ",$277.98 ,$284.90 ,"$1,100.75 ","$1,087.80 ",$284.90 ,$971.25 ,"$1,036.00 ","$1,036.00 ",$284.90 ,"$1,036.00 ","$1,087.80 ","$1,087.80 ","$1,087.80 ","$1,295.00 ","$1,165.50 ",$744.63 ,"$1,295.00 ",$284.90 ,"$1,295.00 ",$704.48 ,$284.90 ,$538.72 ,$58.72 ,$56.05 ,$299.15 ,"$1,100.75 ",$804.02 ,$362.60 ,"$1,165.50 ","$1,087.80 ","$1,036.00 ","$1,036.00 ",$284.90 ,$841.75 
ST. FRANCIS HOSPITAL - ACUTE,32000186,72170,HC XR PELVIS 1-2V,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$277.98 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$896.00 ,$582.40 ,$56.05 ,$896.00 ,$515.20 ,$645.12 ,$487.42 ,$197.12 ,$250.88 ,$483.31 ,$197.12 ,$483.31 ,$224.00 ,$483.31 ,$483.31 ,$224.00 ,$483.31 ,$374.53 ,$752.64 ,$277.98 ,$197.12 ,$761.60 ,$752.64 ,$197.12 ,$672.00 ,$716.80 ,$716.80 ,$197.12 ,$716.80 ,$752.64 ,$752.64 ,$752.64 ,$896.00 ,$806.40 ,$515.20 ,$896.00 ,$197.12 ,$896.00 ,$487.42 ,$197.12 ,$372.74 ,$58.72 ,$56.05 ,$206.98 ,$761.60 ,$483.31 ,$250.88 ,$806.40 ,$752.64 ,$716.80 ,$716.80 ,$197.12 ,$582.40 
ST. FRANCIS HOSPITAL - ACUTE,32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$664.00 ,$431.60 ,$56.05 ,$664.00 ,$381.80 ,$478.08 ,$361.22 ,$146.08 ,$185.92 ,$390.43 ,$146.08 ,$420.44 ,$166.00 ,$420.44 ,$420.44 ,$166.00 ,$420.44 ,$277.55 ,$557.76 ,$277.98 ,$146.08 ,$564.40 ,$557.76 ,$146.08 ,$498.00 ,$531.20 ,$531.20 ,$146.08 ,$531.20 ,$557.76 ,$557.76 ,$557.76 ,$664.00 ,$597.60 ,$381.80 ,$664.00 ,$146.08 ,$664.00 ,$361.22 ,$146.08 ,$276.22 ,$58.72 ,$56.05 ,$153.38 ,$564.40 ,$420.44 ,$185.92 ,$597.60 ,$557.76 ,$531.20 ,$531.20 ,$146.08 ,$431.60 
ST. FRANCIS HOSPITAL - ACUTE,32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$206.53 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000201,73000,HC XRAY CLAVICLE,320,1 ,$482.00 ,$313.30 ,$56.05 ,$482.00 ,$277.15 ,$347.04 ,$262.21 ,$106.04 ,$134.96 ,$283.42 ,$106.04 ,$331.13 ,$120.50 ,$331.13 ,$331.13 ,$120.50 ,$331.13 ,$201.48 ,$404.88 ,$206.53 ,$106.04 ,$409.70 ,$404.88 ,$106.04 ,$361.50 ,$385.60 ,$385.60 ,$106.04 ,$385.60 ,$404.88 ,$404.88 ,$404.88 ,$482.00 ,$433.80 ,$277.15 ,$482.00 ,$106.04 ,$482.00 ,$262.21 ,$106.04 ,$200.51 ,$58.72 ,$56.05 ,$111.34 ,$409.70 ,$331.13 ,$134.96 ,$433.80 ,$404.88 ,$385.60 ,$385.60 ,$106.04 ,$313.30 
ST. FRANCIS HOSPITAL - ACUTE,32000201,73000,HC XRAY CLAVICLE,320,1 ,$953.00 ,$619.45 ,$84.06 ,$953.00 ,$547.98 ,$686.16 ,$518.43 ,$209.66 ,$266.84 ,$351.34 ,$209.66 ,$351.34 ,$238.25 ,$351.34 ,$351.34 ,$238.25 ,$351.34 ,$398.35 ,$800.52 ,$206.53 ,$209.66 ,$810.05 ,$800.52 ,$209.66 ,$714.75 ,$762.40 ,$762.40 ,$209.66 ,$762.40 ,$800.52 ,$800.52 ,$800.52 ,$953.00 ,$857.70 ,$547.98 ,$953.00 ,$209.66 ,$953.00 ,$518.43 ,$209.66 ,$396.45 ,$88.07 ,$84.06 ,$220.14 ,$810.05 ,$351.34 ,$266.84 ,$857.70 ,$800.52 ,$762.40 ,$762.40 ,$209.66 ,$619.45 
ST. FRANCIS HOSPITAL - ACUTE,32000204,73010,HC XRAY SCAPULA,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$277.98 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$329.00 ,$213.85 ,$56.05 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$193.45 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$206.53 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$58.72 ,$56.05 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$564.00 ,$366.60 ,$56.05 ,$564.00 ,$324.30 ,$406.08 ,$306.82 ,$124.08 ,$157.92 ,$331.63 ,$124.08 ,$387.47 ,$141.00 ,$387.47 ,$387.47 ,$141.00 ,$387.47 ,$235.75 ,$473.76 ,$206.53 ,$124.08 ,$479.40 ,$473.76 ,$124.08 ,$423.00 ,$451.20 ,$451.20 ,$124.08 ,$451.20 ,$473.76 ,$473.76 ,$473.76 ,$564.00 ,$507.60 ,$324.30 ,$564.00 ,$124.08 ,$564.00 ,$306.82 ,$124.08 ,$234.62 ,$58.72 ,$56.05 ,$130.28 ,$479.40 ,$387.47 ,$157.92 ,$507.60 ,$473.76 ,$451.20 ,$451.20 ,$124.08 ,$366.60 
ST. FRANCIS HOSPITAL - ACUTE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$991.00 ,$644.15 ,$84.06 ,$991.00 ,$569.83 ,$713.52 ,$539.10 ,$218.02 ,$277.48 ,$452.93 ,$218.02 ,$452.93 ,$247.75 ,$452.93 ,$452.93 ,$247.75 ,$452.93 ,$414.24 ,$832.44 ,$206.53 ,$218.02 ,$842.35 ,$832.44 ,$218.02 ,$743.25 ,$792.80 ,$792.80 ,$218.02 ,$792.80 ,$832.44 ,$832.44 ,$832.44 ,$991.00 ,$891.90 ,$569.83 ,$991.00 ,$218.02 ,$991.00 ,$539.10 ,$218.02 ,$412.26 ,$88.07 ,$84.06 ,$228.92 ,$842.35 ,$452.93 ,$277.48 ,$891.90 ,$832.44 ,$792.80 ,$792.80 ,$218.02 ,$644.15 
ST. FRANCIS HOSPITAL - ACUTE,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,018.00 ",$661.70 ,$223.96 ,"$1,018.00 ",$585.35 ,$732.96 ,$553.79 ,$223.96 ,$285.04 ,$598.58 ,$223.96 ,$699.37 ,$254.50 ,$699.37 ,$699.37 ,$254.50 ,$699.37 ,$425.52 ,$855.12 ,$940.23 ,$223.96 ,$865.30 ,$855.12 ,$223.96 ,$763.50 ,$814.40 ,$814.40 ,$223.96 ,$814.40 ,$855.12 ,$855.12 ,$855.12 ,"$1,018.00 ",$916.20 ,$585.35 ,"$1,018.00 ",$223.96 ,"$1,018.00 ",$553.79 ,$223.96 ,$423.49 ,$334.58 ,$319.37 ,$235.16 ,$865.30 ,$699.37 ,$285.04 ,$916.20 ,$855.12 ,$814.40 ,$814.40 ,$223.96 ,$661.70 
ST. FRANCIS HOSPITAL - ACUTE,32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$664.00 ,$431.60 ,$56.05 ,$664.00 ,$381.80 ,$478.08 ,$361.22 ,$146.08 ,$185.92 ,$390.43 ,$146.08 ,$451.94 ,$166.00 ,$451.94 ,$451.94 ,$166.00 ,$451.94 ,$277.55 ,$557.76 ,$206.53 ,$146.08 ,$564.40 ,$557.76 ,$146.08 ,$498.00 ,$531.20 ,$531.20 ,$146.08 ,$531.20 ,$557.76 ,$557.76 ,$557.76 ,$664.00 ,$597.60 ,$381.80 ,$664.00 ,$146.08 ,$664.00 ,$361.22 ,$146.08 ,$276.22 ,$58.72 ,$56.05 ,$153.38 ,$564.40 ,$451.94 ,$185.92 ,$597.60 ,$557.76 ,$531.20 ,$531.20 ,$146.08 ,$431.60 
ST. FRANCIS HOSPITAL - ACUTE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$506.00 ,$328.90 ,$56.05 ,$506.00 ,$290.95 ,$364.32 ,$275.26 ,$111.32 ,$141.68 ,$297.53 ,$111.32 ,$347.62 ,$126.50 ,$347.62 ,$347.62 ,$126.50 ,$347.62 ,$211.51 ,$425.04 ,$206.53 ,$111.32 ,$430.10 ,$425.04 ,$111.32 ,$379.50 ,$404.80 ,$404.80 ,$111.32 ,$404.80 ,$425.04 ,$425.04 ,$425.04 ,$506.00 ,$455.40 ,$290.95 ,$506.00 ,$111.32 ,$506.00 ,$275.26 ,$111.32 ,$210.50 ,$58.72 ,$56.05 ,$116.89 ,$430.10 ,$347.62 ,$141.68 ,$455.40 ,$425.04 ,$404.80 ,$404.80 ,$111.32 ,$328.90 
ST. FRANCIS HOSPITAL - ACUTE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$902.00 ,$586.30 ,$56.05 ,$902.00 ,$518.65 ,$649.44 ,$490.69 ,$198.44 ,$252.56 ,$370.14 ,$198.44 ,$370.14 ,$225.50 ,$370.14 ,$370.14 ,$225.50 ,$370.14 ,$377.04 ,$757.68 ,$206.53 ,$198.44 ,$766.70 ,$757.68 ,$198.44 ,$676.50 ,$721.60 ,$721.60 ,$198.44 ,$721.60 ,$757.68 ,$757.68 ,$757.68 ,$902.00 ,$811.80 ,$518.65 ,$902.00 ,$198.44 ,$902.00 ,$490.69 ,$198.44 ,$375.23 ,$58.72 ,$56.05 ,$208.36 ,$766.70 ,$370.14 ,$252.56 ,$811.80 ,$757.68 ,$721.60 ,$721.60 ,$198.44 ,$586.30 
ST. FRANCIS HOSPITAL - ACUTE,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$329.00 ,$213.85 ,$56.05 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$193.45 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$206.53 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$58.72 ,$56.05 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$507.00 ,$329.55 ,$56.05 ,$507.00 ,$291.53 ,$365.04 ,$275.81 ,$111.54 ,$141.96 ,$298.12 ,$111.54 ,$348.31 ,$126.75 ,$348.31 ,$348.31 ,$126.75 ,$348.31 ,$211.93 ,$425.88 ,$206.53 ,$111.54 ,$430.95 ,$425.88 ,$111.54 ,$380.25 ,$405.60 ,$405.60 ,$111.54 ,$405.60 ,$425.88 ,$425.88 ,$425.88 ,$507.00 ,$456.30 ,$291.53 ,$507.00 ,$111.54 ,$507.00 ,$275.81 ,$111.54 ,$210.91 ,$58.72 ,$56.05 ,$117.12 ,$430.95 ,$348.31 ,$141.96 ,$456.30 ,$425.88 ,$405.60 ,$405.60 ,$111.54 ,$329.55 
ST. FRANCIS HOSPITAL - ACUTE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,"$1,002.00 ",$651.30 ,$84.06 ,"$1,002.00 ",$576.15 ,$721.44 ,$545.09 ,$220.44 ,$280.56 ,$407.86 ,$220.44 ,$407.86 ,$250.50 ,$407.86 ,$407.86 ,$250.50 ,$407.86 ,$418.84 ,$841.68 ,$206.53 ,$220.44 ,$851.70 ,$841.68 ,$220.44 ,$751.50 ,$801.60 ,$801.60 ,$220.44 ,$801.60 ,$841.68 ,$841.68 ,$841.68 ,"$1,002.00 ",$901.80 ,$576.15 ,"$1,002.00 ",$220.44 ,"$1,002.00 ",$545.09 ,$220.44 ,$416.83 ,$88.07 ,$84.06 ,$231.46 ,$851.70 ,$407.86 ,$280.56 ,$901.80 ,$841.68 ,$801.60 ,$801.60 ,$220.44 ,$651.30 
ST. FRANCIS HOSPITAL - ACUTE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$657.00 ,$427.05 ,$84.06 ,$657.00 ,$377.78 ,$473.04 ,$357.41 ,$144.54 ,$183.96 ,$313.62 ,$144.54 ,$313.62 ,$164.25 ,$313.62 ,$313.62 ,$164.25 ,$313.62 ,$274.63 ,$551.88 ,$206.53 ,$144.54 ,$558.45 ,$551.88 ,$144.54 ,$492.75 ,$525.60 ,$525.60 ,$144.54 ,$525.60 ,$551.88 ,$551.88 ,$551.88 ,$657.00 ,$591.30 ,$377.78 ,$657.00 ,$144.54 ,$657.00 ,$357.41 ,$144.54 ,$273.31 ,$88.07 ,$84.06 ,$151.77 ,$558.45 ,$313.62 ,$183.96 ,$591.30 ,$551.88 ,$525.60 ,$525.60 ,$144.54 ,$427.05 
ST. FRANCIS HOSPITAL - ACUTE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$329.00 ,$213.85 ,$56.05 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$193.45 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$206.53 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$58.72 ,$56.05 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$477.00 ,$310.05 ,$56.05 ,$477.00 ,$274.28 ,$343.44 ,$259.49 ,$104.94 ,$133.56 ,$280.48 ,$104.94 ,$327.70 ,$119.25 ,$327.70 ,$327.70 ,$119.25 ,$327.70 ,$199.39 ,$400.68 ,$277.98 ,$104.94 ,$405.45 ,$400.68 ,$104.94 ,$357.75 ,$381.60 ,$381.60 ,$104.94 ,$381.60 ,$400.68 ,$400.68 ,$400.68 ,$477.00 ,$429.30 ,$274.28 ,$477.00 ,$104.94 ,$477.00 ,$259.49 ,$104.94 ,$198.43 ,$58.72 ,$56.05 ,$110.19 ,$405.45 ,$327.70 ,$133.56 ,$429.30 ,$400.68 ,$381.60 ,$381.60 ,$104.94 ,$310.05 
ST. FRANCIS HOSPITAL - ACUTE,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$329.00 ,$213.85 ,$56.05 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$193.45 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$206.53 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$58.72 ,$56.05 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$991.00 ,$644.15 ,$84.06 ,$991.00 ,$569.83 ,$713.52 ,$539.10 ,$218.02 ,$277.48 ,$470.73 ,$218.02 ,$470.73 ,$247.75 ,$470.73 ,$470.73 ,$247.75 ,$470.73 ,$414.24 ,$832.44 ,$206.53 ,$218.02 ,$842.35 ,$832.44 ,$218.02 ,$743.25 ,$792.80 ,$792.80 ,$218.02 ,$792.80 ,$832.44 ,$832.44 ,$832.44 ,$991.00 ,$891.90 ,$569.83 ,$991.00 ,$218.02 ,$991.00 ,$539.10 ,$218.02 ,$412.26 ,$88.07 ,$84.06 ,$228.92 ,$842.35 ,$470.73 ,$277.48 ,$891.90 ,$832.44 ,$792.80 ,$792.80 ,$218.02 ,$644.15 
ST. FRANCIS HOSPITAL - ACUTE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$496.00 ,$322.40 ,$56.05 ,$496.00 ,$285.20 ,$357.12 ,$269.82 ,$109.12 ,$138.88 ,$291.65 ,$109.12 ,$340.75 ,$124.00 ,$340.75 ,$340.75 ,$124.00 ,$340.75 ,$207.33 ,$416.64 ,$206.53 ,$109.12 ,$421.60 ,$416.64 ,$109.12 ,$372.00 ,$396.80 ,$396.80 ,$109.12 ,$396.80 ,$416.64 ,$416.64 ,$416.64 ,$496.00 ,$446.40 ,$285.20 ,$496.00 ,$109.12 ,$496.00 ,$269.82 ,$109.12 ,$206.34 ,$58.72 ,$56.05 ,$114.58 ,$421.60 ,$340.75 ,$138.88 ,$446.40 ,$416.64 ,$396.80 ,$396.80 ,$109.12 ,$322.40 
ST. FRANCIS HOSPITAL - ACUTE,32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,"$1,065.00 ",$692.25 ,$234.30 ,"$1,065.00 ",$612.38 ,$766.80 ,$579.36 ,$234.30 ,$298.20 ,$626.22 ,$234.30 ,$731.66 ,$266.25 ,$731.66 ,$731.66 ,$266.25 ,$731.66 ,$445.17 ,$894.60 ,$940.23 ,$234.30 ,$905.25 ,$894.60 ,$234.30 ,$798.75 ,$852.00 ,$852.00 ,$234.30 ,$852.00 ,$894.60 ,$894.60 ,$894.60 ,"$1,065.00 ",$958.50 ,$612.38 ,"$1,065.00 ",$234.30 ,"$1,065.00 ",$579.36 ,$234.30 ,$443.04 ,$334.58 ,$319.37 ,$246.02 ,$905.25 ,$731.66 ,$298.20 ,$958.50 ,$894.60 ,$852.00 ,$852.00 ,$234.30 ,$692.25 
ST. FRANCIS HOSPITAL - ACUTE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$335.00 ,$217.75 ,$56.05 ,$335.00 ,$192.63 ,$241.20 ,$182.24 ,$73.70 ,$93.80 ,$196.98 ,$73.70 ,$230.15 ,$83.75 ,$230.15 ,$230.15 ,$83.75 ,$230.15 ,$140.03 ,$281.40 ,$277.98 ,$73.70 ,$284.75 ,$281.40 ,$73.70 ,$251.25 ,$268.00 ,$268.00 ,$73.70 ,$268.00 ,$281.40 ,$281.40 ,$281.40 ,$335.00 ,$301.50 ,$192.63 ,$335.00 ,$73.70 ,$335.00 ,$182.24 ,$73.70 ,$139.36 ,$58.72 ,$56.05 ,$77.39 ,$284.75 ,$230.15 ,$93.80 ,$301.50 ,$281.40 ,$268.00 ,$268.00 ,$73.70 ,$217.75 
ST. FRANCIS HOSPITAL - ACUTE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$509.00 ,$330.85 ,$84.06 ,$509.00 ,$292.68 ,$366.48 ,$276.90 ,$111.98 ,$142.52 ,$299.29 ,$111.98 ,$349.68 ,$127.25 ,$349.68 ,$349.68 ,$127.25 ,$349.68 ,$212.76 ,$427.56 ,$277.98 ,$111.98 ,$432.65 ,$427.56 ,$111.98 ,$381.75 ,$407.20 ,$407.20 ,$111.98 ,$407.20 ,$427.56 ,$427.56 ,$427.56 ,$509.00 ,$458.10 ,$292.68 ,$509.00 ,$111.98 ,$509.00 ,$276.90 ,$111.98 ,$211.74 ,$88.07 ,$84.06 ,$117.58 ,$432.65 ,$349.68 ,$142.52 ,$458.10 ,$427.56 ,$407.20 ,$407.20 ,$111.98 ,$330.85 
ST. FRANCIS HOSPITAL - ACUTE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$713.00 ,$463.45 ,$84.06 ,$713.00 ,$409.98 ,$513.36 ,$387.87 ,$156.86 ,$199.64 ,$414.21 ,$156.86 ,$414.21 ,$178.25 ,$414.21 ,$414.21 ,$178.25 ,$414.21 ,$298.03 ,$598.92 ,$206.53 ,$156.86 ,$606.05 ,$598.92 ,$156.86 ,$534.75 ,$570.40 ,$570.40 ,$156.86 ,$570.40 ,$598.92 ,$598.92 ,$598.92 ,$713.00 ,$641.70 ,$409.98 ,$713.00 ,$156.86 ,$713.00 ,$387.87 ,$156.86 ,$296.61 ,$88.07 ,$84.06 ,$164.70 ,$606.05 ,$414.21 ,$199.64 ,$641.70 ,$598.92 ,$570.40 ,$570.40 ,$156.86 ,$463.45 
ST. FRANCIS HOSPITAL - ACUTE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$361.00 ,$234.65 ,$56.05 ,$361.00 ,$207.58 ,$259.92 ,$196.38 ,$79.42 ,$101.08 ,$212.27 ,$79.42 ,$248.01 ,$90.25 ,$248.01 ,$248.01 ,$90.25 ,$248.01 ,$150.90 ,$303.24 ,$206.53 ,$79.42 ,$306.85 ,$303.24 ,$79.42 ,$270.75 ,$288.80 ,$288.80 ,$79.42 ,$288.80 ,$303.24 ,$303.24 ,$303.24 ,$361.00 ,$324.90 ,$207.58 ,$361.00 ,$79.42 ,$361.00 ,$196.38 ,$79.42 ,$150.18 ,$58.72 ,$56.05 ,$83.39 ,$306.85 ,$248.01 ,$101.08 ,$324.90 ,$303.24 ,$288.80 ,$288.80 ,$79.42 ,$234.65 
ST. FRANCIS HOSPITAL - ACUTE,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$329.00 ,$213.85 ,$56.05 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$193.45 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$206.53 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$58.72 ,$56.05 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,018.00 ",$661.70 ,$223.96 ,"$1,018.00 ",$585.35 ,$732.96 ,$553.79 ,$223.96 ,$285.04 ,$598.58 ,$223.96 ,$699.37 ,$254.50 ,$699.37 ,$699.37 ,$254.50 ,$699.37 ,$425.52 ,$855.12 ,$940.23 ,$223.96 ,$865.30 ,$855.12 ,$223.96 ,$763.50 ,$814.40 ,$814.40 ,$223.96 ,$814.40 ,$855.12 ,$855.12 ,$855.12 ,"$1,018.00 ",$916.20 ,$585.35 ,"$1,018.00 ",$223.96 ,"$1,018.00 ",$553.79 ,$223.96 ,$423.49 ,$334.58 ,$319.37 ,$235.16 ,$865.30 ,$699.37 ,$285.04 ,$916.20 ,$855.12 ,$814.40 ,$814.40 ,$223.96 ,$661.70 
ST. FRANCIS HOSPITAL - ACUTE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$657.00 ,$427.05 ,$84.06 ,$657.00 ,$377.78 ,$473.04 ,$357.41 ,$144.54 ,$183.96 ,$386.32 ,$144.54 ,$410.73 ,$164.25 ,$410.73 ,$410.73 ,$164.25 ,$410.73 ,$274.63 ,$551.88 ,$206.53 ,$144.54 ,$558.45 ,$551.88 ,$144.54 ,$492.75 ,$525.60 ,$525.60 ,$144.54 ,$525.60 ,$551.88 ,$551.88 ,$551.88 ,$657.00 ,$591.30 ,$377.78 ,$657.00 ,$144.54 ,$657.00 ,$357.41 ,$144.54 ,$273.31 ,$88.07 ,$84.06 ,$151.77 ,$558.45 ,$410.73 ,$183.96 ,$591.30 ,$551.88 ,$525.60 ,$525.60 ,$144.54 ,$427.05 
ST. FRANCIS HOSPITAL - ACUTE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$333.00 ,$216.45 ,$56.05 ,$333.00 ,$191.48 ,$239.76 ,$181.15 ,$73.26 ,$93.24 ,$195.80 ,$73.26 ,$228.77 ,$83.25 ,$228.77 ,$228.77 ,$83.25 ,$228.77 ,$139.19 ,$279.72 ,$206.53 ,$73.26 ,$283.05 ,$279.72 ,$73.26 ,$249.75 ,$266.40 ,$266.40 ,$73.26 ,$266.40 ,$279.72 ,$279.72 ,$279.72 ,$333.00 ,$299.70 ,$191.48 ,$333.00 ,$73.26 ,$333.00 ,$181.15 ,$73.26 ,$138.53 ,$58.72 ,$56.05 ,$76.92 ,$283.05 ,$228.77 ,$93.24 ,$299.70 ,$279.72 ,$266.40 ,$266.40 ,$73.26 ,$216.45 
ST. FRANCIS HOSPITAL - ACUTE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$853.00 ,$554.45 ,$84.06 ,$853.00 ,$490.48 ,$614.16 ,$464.03 ,$187.66 ,$238.84 ,$501.56 ,$187.66 ,$586.01 ,$213.25 ,$586.01 ,$586.01 ,$213.25 ,$586.01 ,$356.55 ,$716.52 ,$206.53 ,$187.66 ,$725.05 ,$716.52 ,$187.66 ,$639.75 ,$682.40 ,$682.40 ,$187.66 ,$682.40 ,$716.52 ,$716.52 ,$716.52 ,$853.00 ,$767.70 ,$490.48 ,$853.00 ,$187.66 ,$853.00 ,$464.03 ,$187.66 ,$354.85 ,$88.07 ,$84.06 ,$197.04 ,$725.05 ,$586.01 ,$238.84 ,$767.70 ,$716.52 ,$682.40 ,$682.40 ,$187.66 ,$554.45 
ST. FRANCIS HOSPITAL - ACUTE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$504.00 ,$327.60 ,$56.05 ,$504.00 ,$289.80 ,$362.88 ,$274.18 ,$110.88 ,$141.12 ,$296.35 ,$110.88 ,$346.25 ,$126.00 ,$346.25 ,$346.25 ,$126.00 ,$346.25 ,$210.67 ,$423.36 ,$206.53 ,$110.88 ,$428.40 ,$423.36 ,$110.88 ,$378.00 ,$403.20 ,$403.20 ,$110.88 ,$403.20 ,$423.36 ,$423.36 ,$423.36 ,$504.00 ,$453.60 ,$289.80 ,$504.00 ,$110.88 ,$504.00 ,$274.18 ,$110.88 ,$209.66 ,$58.72 ,$56.05 ,$116.42 ,$428.40 ,$346.25 ,$141.12 ,$453.60 ,$423.36 ,$403.20 ,$403.20 ,$110.88 ,$327.60 
ST. FRANCIS HOSPITAL - ACUTE,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$683.00 ,$443.95 ,$56.05 ,$683.00 ,$392.73 ,$491.76 ,$371.55 ,$150.26 ,$191.24 ,$401.60 ,$150.26 ,$469.22 ,$170.75 ,$469.22 ,$469.22 ,$170.75 ,$469.22 ,$285.49 ,$573.72 ,$277.98 ,$150.26 ,$580.55 ,$573.72 ,$150.26 ,$512.25 ,$546.40 ,$546.40 ,$150.26 ,$546.40 ,$573.72 ,$573.72 ,$573.72 ,$683.00 ,$614.70 ,$392.73 ,$683.00 ,$150.26 ,$683.00 ,$371.55 ,$150.26 ,$284.13 ,$58.72 ,$56.05 ,$157.77 ,$580.55 ,$469.22 ,$191.24 ,$614.70 ,$573.72 ,$546.40 ,$546.40 ,$150.26 ,$443.95 
ST. FRANCIS HOSPITAL - ACUTE,32000267,73565,HC XR KNEE STAND,320,1 ,$221.00 ,$143.65 ,$48.62 ,$221.00 ,$127.08 ,$159.12 ,$120.22 ,$48.62 ,$61.88 ,$129.95 ,$48.62 ,$151.83 ,$55.25 ,$151.83 ,$151.83 ,$55.25 ,$151.83 ,$92.38 ,$185.64 ,$206.53 ,$48.62 ,$187.85 ,$185.64 ,$48.62 ,$165.75 ,$176.80 ,$176.80 ,$48.62 ,$176.80 ,$185.64 ,$185.64 ,$185.64 ,$221.00 ,$198.90 ,$127.08 ,$221.00 ,$48.62 ,$221.00 ,$120.22 ,$48.62 ,$91.94 ,$58.72 ,$56.05 ,$51.05 ,$187.85 ,$151.83 ,$61.88 ,$198.90 ,$185.64 ,$176.80 ,$176.80 ,$48.62 ,$143.65 
ST. FRANCIS HOSPITAL - ACUTE,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,$927.00 ,$602.55 ,$203.94 ,$940.23 ,$533.03 ,$667.44 ,$504.29 ,$203.94 ,$259.56 ,$545.08 ,$203.94 ,$636.85 ,$231.75 ,$636.85 ,$636.85 ,$231.75 ,$636.85 ,$387.49 ,$778.68 ,$940.23 ,$203.94 ,$787.95 ,$778.68 ,$203.94 ,$695.25 ,$741.60 ,$741.60 ,$203.94 ,$741.60 ,$778.68 ,$778.68 ,$778.68 ,$927.00 ,$834.30 ,$533.03 ,$927.00 ,$203.94 ,$927.00 ,$504.29 ,$203.94 ,$385.63 ,$334.58 ,$319.37 ,$214.14 ,$787.95 ,$636.85 ,$259.56 ,$834.30 ,$778.68 ,$741.60 ,$741.60 ,$203.94 ,$602.55 
ST. FRANCIS HOSPITAL - ACUTE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$353.00 ,$229.45 ,$56.05 ,$353.00 ,$202.98 ,$254.16 ,$192.03 ,$77.66 ,$98.84 ,$207.56 ,$77.66 ,$242.51 ,$88.25 ,$242.51 ,$242.51 ,$88.25 ,$242.51 ,$147.55 ,$296.52 ,$206.53 ,$77.66 ,$300.05 ,$296.52 ,$77.66 ,$264.75 ,$282.40 ,$282.40 ,$77.66 ,$282.40 ,$296.52 ,$296.52 ,$296.52 ,$353.00 ,$317.70 ,$202.98 ,$353.00 ,$77.66 ,$353.00 ,$192.03 ,$77.66 ,$146.85 ,$58.72 ,$56.05 ,$81.54 ,$300.05 ,$242.51 ,$98.84 ,$317.70 ,$296.52 ,$282.40 ,$282.40 ,$77.66 ,$229.45 
ST. FRANCIS HOSPITAL - ACUTE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$705.00 ,$458.25 ,$84.06 ,$705.00 ,$405.38 ,$507.60 ,$383.52 ,$155.10 ,$197.40 ,$366.40 ,$155.10 ,$366.40 ,$176.25 ,$366.40 ,$366.40 ,$176.25 ,$366.40 ,$294.69 ,$592.20 ,$206.53 ,$155.10 ,$599.25 ,$592.20 ,$155.10 ,$528.75 ,$564.00 ,$564.00 ,$155.10 ,$564.00 ,$592.20 ,$592.20 ,$592.20 ,$705.00 ,$634.50 ,$405.38 ,$705.00 ,$155.10 ,$705.00 ,$383.52 ,$155.10 ,$293.28 ,$88.07 ,$84.06 ,$162.86 ,$599.25 ,$366.40 ,$197.40 ,$634.50 ,$592.20 ,$564.00 ,$564.00 ,$155.10 ,$458.25 
ST. FRANCIS HOSPITAL - ACUTE,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$206.53 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$329.00 ,$213.85 ,$56.05 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$193.45 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$206.53 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$58.72 ,$56.05 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$507.00 ,$329.55 ,$56.05 ,$507.00 ,$291.53 ,$365.04 ,$275.81 ,$111.54 ,$141.96 ,$298.12 ,$111.54 ,$348.31 ,$126.75 ,$348.31 ,$348.31 ,$126.75 ,$348.31 ,$211.93 ,$425.88 ,$206.53 ,$111.54 ,$430.95 ,$425.88 ,$111.54 ,$380.25 ,$405.60 ,$405.60 ,$111.54 ,$405.60 ,$425.88 ,$425.88 ,$425.88 ,$507.00 ,$456.30 ,$291.53 ,$507.00 ,$111.54 ,$507.00 ,$275.81 ,$111.54 ,$210.91 ,$58.72 ,$56.05 ,$117.12 ,$430.95 ,$348.31 ,$141.96 ,$456.30 ,$425.88 ,$405.60 ,$405.60 ,$111.54 ,$329.55 
ST. FRANCIS HOSPITAL - ACUTE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,"$1,002.00 ",$651.30 ,$84.06 ,"$1,002.00 ",$576.15 ,$721.44 ,$545.09 ,$220.44 ,$280.56 ,$410.73 ,$220.44 ,$410.73 ,$250.50 ,$410.73 ,$410.73 ,$250.50 ,$410.73 ,$418.84 ,$841.68 ,$206.53 ,$220.44 ,$851.70 ,$841.68 ,$220.44 ,$751.50 ,$801.60 ,$801.60 ,$220.44 ,$801.60 ,$841.68 ,$841.68 ,$841.68 ,"$1,002.00 ",$901.80 ,$576.15 ,"$1,002.00 ",$220.44 ,"$1,002.00 ",$545.09 ,$220.44 ,$416.83 ,$88.07 ,$84.06 ,$231.46 ,$851.70 ,$410.73 ,$280.56 ,$901.80 ,$841.68 ,$801.60 ,$801.60 ,$220.44 ,$651.30 
ST. FRANCIS HOSPITAL - ACUTE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$333.00 ,$216.45 ,$56.05 ,$333.00 ,$191.48 ,$239.76 ,$181.15 ,$73.26 ,$93.24 ,$195.80 ,$73.26 ,$228.77 ,$83.25 ,$228.77 ,$228.77 ,$83.25 ,$228.77 ,$139.19 ,$279.72 ,$206.53 ,$73.26 ,$283.05 ,$279.72 ,$73.26 ,$249.75 ,$266.40 ,$266.40 ,$73.26 ,$266.40 ,$279.72 ,$279.72 ,$279.72 ,$333.00 ,$299.70 ,$191.48 ,$333.00 ,$73.26 ,$333.00 ,$181.15 ,$73.26 ,$138.53 ,$58.72 ,$56.05 ,$76.92 ,$283.05 ,$228.77 ,$93.24 ,$299.70 ,$279.72 ,$266.40 ,$266.40 ,$73.26 ,$216.45 
ST. FRANCIS HOSPITAL - ACUTE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$657.00 ,$427.05 ,$84.06 ,$657.00 ,$377.78 ,$473.04 ,$357.41 ,$144.54 ,$183.96 ,$334.78 ,$144.54 ,$334.78 ,$164.25 ,$334.78 ,$334.78 ,$164.25 ,$334.78 ,$274.63 ,$551.88 ,$206.53 ,$144.54 ,$558.45 ,$551.88 ,$144.54 ,$492.75 ,$525.60 ,$525.60 ,$144.54 ,$525.60 ,$551.88 ,$551.88 ,$551.88 ,$657.00 ,$591.30 ,$377.78 ,$657.00 ,$144.54 ,$657.00 ,$357.41 ,$144.54 ,$273.31 ,$88.07 ,$84.06 ,$151.77 ,$558.45 ,$334.78 ,$183.96 ,$591.30 ,$551.88 ,$525.60 ,$525.60 ,$144.54 ,$427.05 
ST. FRANCIS HOSPITAL - ACUTE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$507.00 ,$329.55 ,$56.05 ,$507.00 ,$291.53 ,$365.04 ,$275.81 ,$111.54 ,$141.96 ,$298.12 ,$111.54 ,$348.31 ,$126.75 ,$348.31 ,$348.31 ,$126.75 ,$348.31 ,$211.93 ,$425.88 ,$206.53 ,$111.54 ,$430.95 ,$425.88 ,$111.54 ,$380.25 ,$405.60 ,$405.60 ,$111.54 ,$405.60 ,$425.88 ,$425.88 ,$425.88 ,$507.00 ,$456.30 ,$291.53 ,$507.00 ,$111.54 ,$507.00 ,$275.81 ,$111.54 ,$210.91 ,$58.72 ,$56.05 ,$117.12 ,$430.95 ,$348.31 ,$141.96 ,$456.30 ,$425.88 ,$405.60 ,$405.60 ,$111.54 ,$329.55 
ST. FRANCIS HOSPITAL - ACUTE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,"$1,002.00 ",$651.30 ,$84.06 ,"$1,002.00 ",$576.15 ,$721.44 ,$545.09 ,$220.44 ,$280.56 ,$379.10 ,$220.44 ,$379.10 ,$250.50 ,$379.10 ,$379.10 ,$250.50 ,$379.10 ,$418.84 ,$841.68 ,$206.53 ,$220.44 ,$851.70 ,$841.68 ,$220.44 ,$751.50 ,$801.60 ,$801.60 ,$220.44 ,$801.60 ,$841.68 ,$841.68 ,$841.68 ,"$1,002.00 ",$901.80 ,$576.15 ,"$1,002.00 ",$220.44 ,"$1,002.00 ",$545.09 ,$220.44 ,$416.83 ,$88.07 ,$84.06 ,$231.46 ,$851.70 ,$379.10 ,$280.56 ,$901.80 ,$841.68 ,$801.60 ,$801.60 ,$220.44 ,$651.30 
ST. FRANCIS HOSPITAL - ACUTE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$657.00 ,$427.05 ,$84.06 ,$657.00 ,$377.78 ,$473.04 ,$357.41 ,$144.54 ,$183.96 ,$347.36 ,$144.54 ,$347.36 ,$164.25 ,$347.36 ,$347.36 ,$164.25 ,$347.36 ,$274.63 ,$551.88 ,$206.53 ,$144.54 ,$558.45 ,$551.88 ,$144.54 ,$492.75 ,$525.60 ,$525.60 ,$144.54 ,$525.60 ,$551.88 ,$551.88 ,$551.88 ,$657.00 ,$591.30 ,$377.78 ,$657.00 ,$144.54 ,$657.00 ,$357.41 ,$144.54 ,$273.31 ,$88.07 ,$84.06 ,$151.77 ,$558.45 ,$347.36 ,$183.96 ,$591.30 ,$551.88 ,$525.60 ,$525.60 ,$144.54 ,$427.05 
ST. FRANCIS HOSPITAL - ACUTE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$333.00 ,$216.45 ,$56.05 ,$333.00 ,$191.48 ,$239.76 ,$181.15 ,$73.26 ,$93.24 ,$195.80 ,$73.26 ,$228.77 ,$83.25 ,$228.77 ,$228.77 ,$83.25 ,$228.77 ,$139.19 ,$279.72 ,$206.53 ,$73.26 ,$283.05 ,$279.72 ,$73.26 ,$249.75 ,$266.40 ,$266.40 ,$73.26 ,$266.40 ,$279.72 ,$279.72 ,$279.72 ,$333.00 ,$299.70 ,$191.48 ,$333.00 ,$73.26 ,$333.00 ,$181.15 ,$73.26 ,$138.53 ,$58.72 ,$56.05 ,$76.92 ,$283.05 ,$228.77 ,$93.24 ,$299.70 ,$279.72 ,$266.40 ,$266.40 ,$73.26 ,$216.45 
ST. FRANCIS HOSPITAL - ACUTE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$329.00 ,$213.85 ,$56.05 ,$329.00 ,$189.18 ,$236.88 ,$178.98 ,$72.38 ,$92.12 ,$193.45 ,$72.38 ,$226.02 ,$82.25 ,$226.02 ,$226.02 ,$82.25 ,$226.02 ,$137.52 ,$276.36 ,$206.53 ,$72.38 ,$279.65 ,$276.36 ,$72.38 ,$246.75 ,$263.20 ,$263.20 ,$72.38 ,$263.20 ,$276.36 ,$276.36 ,$276.36 ,$329.00 ,$296.10 ,$189.18 ,$329.00 ,$72.38 ,$329.00 ,$178.98 ,$72.38 ,$136.86 ,$58.72 ,$56.05 ,$76.00 ,$279.65 ,$226.02 ,$92.12 ,$296.10 ,$276.36 ,$263.20 ,$263.20 ,$72.38 ,$213.85 
ST. FRANCIS HOSPITAL - ACUTE,32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$414.00 ,$269.10 ,$56.05 ,$414.00 ,$238.05 ,$298.08 ,$225.22 ,$91.08 ,$115.92 ,$243.43 ,$91.08 ,$284.42 ,$103.50 ,$284.42 ,$284.42 ,$103.50 ,$284.42 ,$173.05 ,$347.76 ,$206.53 ,$91.08 ,$351.90 ,$347.76 ,$91.08 ,$310.50 ,$331.20 ,$331.20 ,$91.08 ,$331.20 ,$347.76 ,$347.76 ,$347.76 ,$414.00 ,$372.60 ,$238.05 ,$414.00 ,$91.08 ,$414.00 ,$225.22 ,$91.08 ,$172.22 ,$58.72 ,$56.05 ,$95.63 ,$351.90 ,$284.42 ,$115.92 ,$372.60 ,$347.76 ,$331.20 ,$331.20 ,$91.08 ,$269.10 
ST. FRANCIS HOSPITAL - ACUTE,32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$549.00 ,$356.85 ,$56.05 ,$549.00 ,$315.68 ,$395.28 ,$298.66 ,$120.78 ,$153.72 ,$322.81 ,$120.78 ,$377.16 ,$137.25 ,$377.16 ,$377.16 ,$137.25 ,$377.16 ,$229.48 ,$461.16 ,$277.98 ,$120.78 ,$466.65 ,$461.16 ,$120.78 ,$411.75 ,$439.20 ,$439.20 ,$120.78 ,$439.20 ,$461.16 ,$461.16 ,$461.16 ,$549.00 ,$494.10 ,$315.68 ,$549.00 ,$120.78 ,$549.00 ,$298.66 ,$120.78 ,$228.38 ,$58.72 ,$56.05 ,$126.82 ,$466.65 ,$377.16 ,$153.72 ,$494.10 ,$461.16 ,$439.20 ,$439.20 ,$120.78 ,$356.85 
ST. FRANCIS HOSPITAL - ACUTE,32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,$527.00 ,$342.55 ,$56.05 ,$527.00 ,$303.03 ,$379.44 ,$286.69 ,$115.94 ,$147.56 ,$309.88 ,$115.94 ,$362.05 ,$131.75 ,$362.05 ,$362.05 ,$131.75 ,$362.05 ,$220.29 ,$442.68 ,$277.98 ,$115.94 ,$447.95 ,$442.68 ,$115.94 ,$395.25 ,$421.60 ,$421.60 ,$115.94 ,$421.60 ,$442.68 ,$442.68 ,$442.68 ,$527.00 ,$474.30 ,$303.03 ,$527.00 ,$115.94 ,$527.00 ,$286.69 ,$115.94 ,$219.23 ,$58.72 ,$56.05 ,$121.74 ,$447.95 ,$362.05 ,$147.56 ,$474.30 ,$442.68 ,$421.60 ,$421.60 ,$115.94 ,$342.55 
ST. FRANCIS HOSPITAL - ACUTE,32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$810.00 ,$526.50 ,$56.05 ,$810.00 ,$465.75 ,$583.20 ,$440.64 ,$178.20 ,$226.80 ,$476.28 ,$178.20 ,$556.47 ,$202.50 ,$556.47 ,$556.47 ,$202.50 ,$556.47 ,$338.58 ,$680.40 ,$456.08 ,$178.20 ,$688.50 ,$680.40 ,$178.20 ,$607.50 ,$648.00 ,$648.00 ,$178.20 ,$648.00 ,$680.40 ,$680.40 ,$680.40 ,$810.00 ,$729.00 ,$465.75 ,$810.00 ,$178.20 ,$810.00 ,$440.64 ,$178.20 ,$336.96 ,$58.72 ,$56.05 ,$187.11 ,$688.50 ,$556.47 ,$226.80 ,$729.00 ,$680.40 ,$648.00 ,$648.00 ,$178.20 ,$526.50 
ST. FRANCIS HOSPITAL - ACUTE,32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$810.00 ,$526.50 ,$123.25 ,$810.00 ,$465.75 ,$583.20 ,$440.64 ,$178.20 ,$226.80 ,$476.28 ,$178.20 ,$556.47 ,$202.50 ,$556.47 ,$556.47 ,$202.50 ,$556.47 ,$338.58 ,$680.40 ,$456.08 ,$178.20 ,$688.50 ,$680.40 ,$178.20 ,$607.50 ,$648.00 ,$648.00 ,$178.20 ,$648.00 ,$680.40 ,$680.40 ,$680.40 ,$810.00 ,$729.00 ,$465.75 ,$810.00 ,$178.20 ,$810.00 ,$440.64 ,$178.20 ,$336.96 ,$129.12 ,$123.25 ,$187.11 ,$688.50 ,$556.47 ,$226.80 ,$729.00 ,$680.40 ,$648.00 ,$648.00 ,$178.20 ,$526.50 
ST. FRANCIS HOSPITAL - ACUTE,32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,$987.00 ,$641.55 ,$123.25 ,$987.00 ,$567.53 ,$710.64 ,$536.93 ,$217.14 ,$276.36 ,$580.36 ,$217.14 ,$678.07 ,$246.75 ,$678.07 ,$678.07 ,$246.75 ,$678.07 ,$412.57 ,$829.08 ,$456.08 ,$217.14 ,$838.95 ,$829.08 ,$217.14 ,$740.25 ,$789.60 ,$789.60 ,$217.14 ,$789.60 ,$829.08 ,$829.08 ,$829.08 ,$987.00 ,$888.30 ,$567.53 ,$987.00 ,$217.14 ,$987.00 ,$536.93 ,$217.14 ,$410.59 ,$129.12 ,$123.25 ,$228.00 ,$838.95 ,$678.07 ,$276.36 ,$888.30 ,$829.08 ,$789.60 ,$789.60 ,$217.14 ,$641.55 
ST. FRANCIS HOSPITAL - ACUTE,32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,$906.00 ,$588.90 ,$123.25 ,$906.00 ,$520.95 ,$652.32 ,$492.86 ,$199.32 ,$253.68 ,$532.73 ,$199.32 ,$622.42 ,$226.50 ,$622.42 ,$622.42 ,$226.50 ,$622.42 ,$378.71 ,$761.04 ,$456.08 ,$199.32 ,$770.10 ,$761.04 ,$199.32 ,$679.50 ,$724.80 ,$724.80 ,$199.32 ,$724.80 ,$761.04 ,$761.04 ,$761.04 ,$906.00 ,$815.40 ,$520.95 ,$906.00 ,$199.32 ,$906.00 ,$492.86 ,$199.32 ,$376.90 ,$129.12 ,$123.25 ,$209.29 ,$770.10 ,$622.42 ,$253.68 ,$815.40 ,$761.04 ,$724.80 ,$724.80 ,$199.32 ,$588.90 
ST. FRANCIS HOSPITAL - ACUTE,32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$810.00 ,$526.50 ,$123.25 ,$810.00 ,$465.75 ,$583.20 ,$440.64 ,$178.20 ,$226.80 ,$476.28 ,$178.20 ,$556.47 ,$202.50 ,$556.47 ,$556.47 ,$202.50 ,$556.47 ,$338.58 ,$680.40 ,$456.08 ,$178.20 ,$688.50 ,$680.40 ,$178.20 ,$607.50 ,$648.00 ,$648.00 ,$178.20 ,$648.00 ,$680.40 ,$680.40 ,$680.40 ,$810.00 ,$729.00 ,$465.75 ,$810.00 ,$178.20 ,$810.00 ,$440.64 ,$178.20 ,$336.96 ,$129.12 ,$123.25 ,$187.11 ,$688.50 ,$556.47 ,$226.80 ,$729.00 ,$680.40 ,$648.00 ,$648.00 ,$178.20 ,$526.50 
ST. FRANCIS HOSPITAL - ACUTE,32000315,74270,HC XRAY COLON BARIUM,320,1 ,$994.00 ,$646.10 ,$123.25 ,$994.00 ,$571.55 ,$715.68 ,$540.74 ,$218.68 ,$278.32 ,$584.47 ,$218.68 ,$682.88 ,$248.50 ,$682.88 ,$682.88 ,$248.50 ,$682.88 ,$415.49 ,$834.96 ,$456.08 ,$218.68 ,$844.90 ,$834.96 ,$218.68 ,$745.50 ,$795.20 ,$795.20 ,$218.68 ,$795.20 ,$834.96 ,$834.96 ,$834.96 ,$994.00 ,$894.60 ,$571.55 ,$994.00 ,$218.68 ,$994.00 ,$540.74 ,$218.68 ,$413.50 ,$129.12 ,$123.25 ,$229.61 ,$844.90 ,$682.88 ,$278.32 ,$894.60 ,$834.96 ,$795.20 ,$795.20 ,$218.68 ,$646.10 
ST. FRANCIS HOSPITAL - ACUTE,32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,$994.00 ,$646.10 ,$123.25 ,$994.00 ,$571.55 ,$715.68 ,$540.74 ,$218.68 ,$278.32 ,$584.47 ,$218.68 ,$682.88 ,$248.50 ,$682.88 ,$682.88 ,$248.50 ,$682.88 ,$415.49 ,$834.96 ,$456.08 ,$218.68 ,$844.90 ,$834.96 ,$218.68 ,$745.50 ,$795.20 ,$795.20 ,$218.68 ,$795.20 ,$834.96 ,$834.96 ,$834.96 ,$994.00 ,$894.60 ,$571.55 ,$994.00 ,$218.68 ,$994.00 ,$540.74 ,$218.68 ,$413.50 ,$129.12 ,$123.25 ,$229.61 ,$844.90 ,$682.88 ,$278.32 ,$894.60 ,$834.96 ,$795.20 ,$795.20 ,$218.68 ,$646.10 
ST. FRANCIS HOSPITAL - ACUTE,32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,$994.00 ,$646.10 ,$123.25 ,$994.00 ,$571.55 ,$715.68 ,$540.74 ,$218.68 ,$278.32 ,$584.47 ,$218.68 ,$682.88 ,$248.50 ,$682.88 ,$682.88 ,$248.50 ,$682.88 ,$415.49 ,$834.96 ,$456.08 ,$218.68 ,$844.90 ,$834.96 ,$218.68 ,$745.50 ,$795.20 ,$795.20 ,$218.68 ,$795.20 ,$834.96 ,$834.96 ,$834.96 ,$994.00 ,$894.60 ,$571.55 ,$994.00 ,$218.68 ,$994.00 ,$540.74 ,$218.68 ,$413.50 ,$129.12 ,$123.25 ,$229.61 ,$844.90 ,$682.88 ,$278.32 ,$894.60 ,$834.96 ,$795.20 ,$795.20 ,$218.68 ,$646.10 
ST. FRANCIS HOSPITAL - ACUTE,32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,"$1,207.00 ",$784.55 ,$265.54 ,"$1,207.00 ",$694.03 ,$869.04 ,$656.61 ,$265.54 ,$337.96 ,$641.55 ,$265.54 ,$641.55 ,$301.75 ,$641.55 ,$641.55 ,$301.75 ,$641.55 ,$504.53 ,"$1,013.88 ", N/A ,$265.54 ,"$1,025.95 ","$1,013.88 ",$265.54 ,$905.25 ,$965.60 ,$965.60 ,$265.54 ,$965.60 ,"$1,013.88 ","$1,013.88 ","$1,013.88 ","$1,207.00 ","$1,086.30 ",$694.03 ,"$1,207.00 ",$265.54 ,"$1,207.00 ",$656.61 ,$265.54 ,$502.11 ,$334.58 ,$319.37 ,$278.82 ,"$1,025.95 ",$641.55 ,$337.96 ,"$1,086.30 ","$1,013.88 ",$965.60 ,$965.60 ,$265.54 ,$784.55 
ST. FRANCIS HOSPITAL - ACUTE,32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,$676.00 ,$439.40 ,$148.72 ,$940.23 ,$388.70 ,$486.72 ,$367.74 ,$148.72 ,$189.28 ,$397.49 ,$148.72 ,$464.41 ,$169.00 ,$464.41 ,$464.41 ,$169.00 ,$464.41 ,$282.57 ,$567.84 ,$940.23 ,$148.72 ,$574.60 ,$567.84 ,$148.72 ,$507.00 ,$540.80 ,$540.80 ,$148.72 ,$540.80 ,$567.84 ,$567.84 ,$567.84 ,$676.00 ,$608.40 ,$388.70 ,$676.00 ,$148.72 ,$676.00 ,$367.74 ,$148.72 ,$281.22 ,$366.26 ,$349.61 ,$156.16 ,$574.60 ,$464.41 ,$189.28 ,$608.40 ,$567.84 ,$540.80 ,$540.80 ,$148.72 ,$439.40 
ST. FRANCIS HOSPITAL - ACUTE,32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,$733.00 ,$476.45 ,$161.26 ,$940.23 ,$421.48 ,$527.76 ,$398.75 ,$161.26 ,$205.24 ,$398.03 ,$161.26 ,$398.03 ,$183.25 ,$398.03 ,$398.03 ,$183.25 ,$398.03 ,$306.39 ,$615.72 ,$940.23 ,$161.26 ,$623.05 ,$615.72 ,$161.26 ,$549.75 ,$586.40 ,$586.40 ,$161.26 ,$586.40 ,$615.72 ,$615.72 ,$615.72 ,$733.00 ,$659.70 ,$421.48 ,$733.00 ,$161.26 ,$733.00 ,$398.75 ,$161.26 ,$304.93 ,$334.58 ,$319.37 ,$169.32 ,$623.05 ,$398.03 ,$205.24 ,$659.70 ,$615.72 ,$586.40 ,$586.40 ,$161.26 ,$476.45 
ST. FRANCIS HOSPITAL - ACUTE,32000344,74450,HC CYSTOURETHROGRAM RETROGRADE,320,1 ,$676.00 ,$439.40 ,$148.72 ,$676.00 ,$388.70 ,$486.72 ,$367.74 ,$148.72 ,$189.28 ,$397.49 ,$148.72 ,$464.41 ,$169.00 ,$464.41 ,$464.41 ,$169.00 ,$464.41 ,$282.57 ,$567.84 ,$587.50 ,$148.72 ,$574.60 ,$567.84 ,$148.72 ,$507.00 ,$540.80 ,$540.80 ,$148.72 ,$540.80 ,$567.84 ,$567.84 ,$567.84 ,$676.00 ,$608.40 ,$388.70 ,$676.00 ,$148.72 ,$676.00 ,$367.74 ,$148.72 ,$281.22 ,$334.58 ,$319.37 ,$156.16 ,$574.60 ,$464.41 ,$189.28 ,$608.40 ,$567.84 ,$540.80 ,$540.80 ,$148.72 ,$439.40 
ST. FRANCIS HOSPITAL - ACUTE,32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,$919.00 ,$597.35 ,$202.18 ,$919.00 ,$528.43 ,$661.68 ,$499.94 ,$202.18 ,$257.32 ,$540.37 ,$202.18 ,$631.35 ,$229.75 ,$631.35 ,$631.35 ,$229.75 ,$631.35 ,$384.14 ,$771.96 ,$587.50 ,$202.18 ,$781.15 ,$771.96 ,$202.18 ,$689.25 ,$735.20 ,$735.20 ,$202.18 ,$735.20 ,$771.96 ,$771.96 ,$771.96 ,$919.00 ,$827.10 ,$528.43 ,$919.00 ,$202.18 ,$919.00 ,$499.94 ,$202.18 ,$382.30 ,$334.58 ,$319.37 ,$212.29 ,$781.15 ,$631.35 ,$257.32 ,$827.10 ,$771.96 ,$735.20 ,$735.20 ,$202.18 ,$597.35 
ST. FRANCIS HOSPITAL - ACUTE,32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,"$1,023.00 ",$664.95 ,$225.06 ,"$1,023.00 ",$588.23 ,$736.56 ,$556.51 ,$225.06 ,$286.44 ,$601.52 ,$225.06 ,$702.80 ,$255.75 ,$702.80 ,$702.80 ,$255.75 ,$702.80 ,$427.61 ,$859.32 ,$587.50 ,$225.06 ,$869.55 ,$859.32 ,$225.06 ,$767.25 ,$818.40 ,$818.40 ,$225.06 ,$818.40 ,$859.32 ,$859.32 ,$859.32 ,"$1,023.00 ",$920.70 ,$588.23 ,"$1,023.00 ",$225.06 ,"$1,023.00 ",$556.51 ,$225.06 ,$425.57 ,$334.58 ,$319.37 ,$236.31 ,$869.55 ,$702.80 ,$286.44 ,$920.70 ,$859.32 ,$818.40 ,$818.40 ,$225.06 ,$664.95 
ST. FRANCIS HOSPITAL - ACUTE,32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$2,160.00 ","$1,404.00 ",$319.37 ,"$2,160.00 ","$1,242.00 ","$1,555.20 ","$1,175.04 ",$475.20 ,$604.80 ,"$1,132.58 ",$475.20 ,"$1,132.58 ",$540.00 ,"$1,132.58 ","$1,132.58 ",$540.00 ,"$1,132.58 ",$902.88 ,"$1,814.40 ", N/A ,$475.20 ,"$1,836.00 ","$1,814.40 ",$475.20 ,"$1,620.00 ","$1,728.00 ","$1,728.00 ",$475.20 ,"$1,728.00 ","$1,814.40 ","$1,814.40 ","$1,814.40 ","$2,160.00 ","$1,944.00 ","$1,242.00 ","$2,160.00 ",$475.20 ,"$2,160.00 ","$1,175.04 ",$475.20 ,$898.56 ,$334.58 ,$319.37 ,$498.96 ,"$1,836.00 ","$1,132.58 ",$604.80 ,"$1,944.00 ","$1,814.40 ","$1,728.00 ","$1,728.00 ",$475.20 ,"$1,404.00 "
ST. FRANCIS HOSPITAL - ACUTE,32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,"$1,098.00 ",$713.70 ,$56.05 ,"$1,098.00 ",$631.35 ,$790.56 ,$597.31 ,$241.56 ,$307.44 ,$645.62 ,$241.56 ,$702.06 ,$274.50 ,$702.06 ,$702.06 ,$274.50 ,$702.06 ,$458.96 ,$922.32 ,$587.50 ,$241.56 ,$933.30 ,$922.32 ,$241.56 ,$823.50 ,$878.40 ,$878.40 ,$241.56 ,$878.40 ,$922.32 ,$922.32 ,$922.32 ,"$1,098.00 ",$988.20 ,$631.35 ,"$1,098.00 ",$241.56 ,"$1,098.00 ",$597.31 ,$241.56 ,$456.77 ,$58.72 ,$56.05 ,$253.64 ,$933.30 ,$702.06 ,$307.44 ,$988.20 ,$922.32 ,$878.40 ,$878.40 ,$241.56 ,$713.70 
ST. FRANCIS HOSPITAL - ACUTE,32000464,76010,HC BABYGRAM,320,1 ,$395.00 ,$256.75 ,$56.05 ,$395.00 ,$227.13 ,$284.40 ,$214.88 ,$86.90 ,$110.60 ,$232.26 ,$86.90 ,$271.37 ,$98.75 ,$271.37 ,$271.37 ,$98.75 ,$271.37 ,$165.11 ,$331.80 ,$206.53 ,$86.90 ,$335.75 ,$331.80 ,$86.90 ,$296.25 ,$316.00 ,$316.00 ,$86.90 ,$316.00 ,$331.80 ,$331.80 ,$331.80 ,$395.00 ,$355.50 ,$227.13 ,$395.00 ,$86.90 ,$395.00 ,$214.88 ,$86.90 ,$164.32 ,$58.72 ,$56.05 ,$91.25 ,$335.75 ,$271.37 ,$110.60 ,$355.50 ,$331.80 ,$316.00 ,$316.00 ,$86.90 ,$256.75 
ST. FRANCIS HOSPITAL - ACUTE,32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$146.00 ,$94.90 ,$28.70 ,"$1,233.70 ",$83.95 ,$105.12 ,$79.42 ,$32.12 ,$40.88 ,$85.85 ,$32.12 ,$100.30 ,$36.50 ,$100.30 ,$100.30 ,$36.50 ,$100.30 ,$61.03 ,$122.64 ,"$1,233.70 ",$32.12 ,$124.10 ,$122.64 ,$32.12 ,$109.50 ,$116.80 ,$116.80 ,$32.12 ,$116.80 ,$122.64 ,$122.64 ,$122.64 ,$146.00 ,$131.40 ,$83.95 ,$146.00 ,$32.12 ,$28.70 ,$79.42 ,$32.12 ,$60.74 ,$58.72 ,$56.05 ,$33.73 ,$124.10 ,$100.30 ,$40.88 ,$131.40 ,$122.64 ,$116.80 ,$116.80 ,$32.12 ,$94.90 
ST. FRANCIS HOSPITAL - ACUTE,32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$460.00 ,$299.00 ,$101.20 ,$460.00 ,$264.50 ,$331.20 ,$250.24 ,$101.20 ,$128.80 ,$270.48 ,$101.20 ,$316.02 ,$115.00 ,$316.02 ,$316.02 ,$115.00 ,$316.02 ,$192.28 ,$386.40 , N/A ,$101.20 ,$391.00 ,$386.40 ,$101.20 ,$345.00 ,$368.00 ,$368.00 ,$101.20 ,$368.00 ,$386.40 ,$386.40 ,$386.40 ,$460.00 ,$414.00 ,$264.50 ,$460.00 ,$101.20 ,$460.00 ,$250.24 ,$101.20 ,$191.36 ,$334.58 ,$319.37 ,$106.26 ,$391.00 ,$316.02 ,$128.80 ,$414.00 ,$386.40 ,$368.00 ,$368.00 ,$101.20 ,$299.00 
ST. FRANCIS HOSPITAL - ACUTE,32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$523.00 ,$339.95 ,$115.06 ,$523.00 ,$300.73 ,$376.56 ,$284.51 ,$115.06 ,$146.44 ,$307.52 ,$115.06 ,$359.30 ,$130.75 ,$359.30 ,$359.30 ,$130.75 ,$359.30 ,$218.61 ,$439.32 , N/A ,$115.06 ,$444.55 ,$439.32 ,$115.06 ,$392.25 ,$418.40 ,$418.40 ,$115.06 ,$418.40 ,$439.32 ,$439.32 ,$439.32 ,$523.00 ,$470.70 ,$300.73 ,$523.00 ,$115.06 ,$523.00 ,$284.51 ,$115.06 ,$217.57 ,$334.58 ,$319.37 ,$120.81 ,$444.55 ,$359.30 ,$146.44 ,$470.70 ,$439.32 ,$418.40 ,$418.40 ,$115.06 ,$339.95 
ST. FRANCIS HOSPITAL - ACUTE,32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,$460.00 ,$299.00 ,$101.20 ,$460.00 ,$264.50 ,$331.20 ,$250.24 ,$101.20 ,$128.80 ,$270.48 ,$101.20 ,$316.02 ,$115.00 ,$316.02 ,$316.02 ,$115.00 ,$316.02 ,$192.28 ,$386.40 , N/A ,$101.20 ,$391.00 ,$386.40 ,$101.20 ,$345.00 ,$368.00 ,$368.00 ,$101.20 ,$368.00 ,$386.40 ,$386.40 ,$386.40 ,$460.00 ,$414.00 ,$264.50 ,$460.00 ,$101.20 ,$460.00 ,$250.24 ,$101.20 ,$191.36 ,$334.58 ,$319.37 ,$106.26 ,$391.00 ,$316.02 ,$128.80 ,$414.00 ,$386.40 ,$368.00 ,$368.00 ,$101.20 ,$299.00 
ST. FRANCIS HOSPITAL - ACUTE,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,"$1,503.00 ",$976.95 ,$120.26 ,"$1,588.85 ",$864.23 ,"$1,082.16 ",$817.63 ,$330.66 ,$420.84 ,$843.18 ,$330.66 ,$979.96 ,$375.75 ,$979.96 ,$979.96 ,$375.75 ,$979.96 ,$628.25 ,"$1,262.52 ","$1,588.85 ",$330.66 ,"$1,277.55 ","$1,262.52 ",$330.66 ,"$1,127.25 ","$1,202.40 ","$1,202.40 ",$330.66 ,"$1,202.40 ","$1,262.52 ","$1,262.52 ","$1,262.52 ","$1,503.00 ","$1,352.70 ",$864.23 ,"$1,503.00 ",$330.66 ,$266.06 ,$817.63 ,$330.66 ,$625.25 ,$125.98 ,$120.26 ,$347.19 ,"$1,277.55 ",$979.96 ,$420.84 ,"$1,352.70 ","$1,262.52 ","$1,202.40 ","$1,202.40 ",$330.66 ,$976.95 
ST. FRANCIS HOSPITAL - ACUTE,32000490,77053,HC GALACTOGRAM SINGLE DUCT,320,1 ,"$1,096.00 ",$712.40 ,$40.72 ,"$1,096.00 ",$630.20 ,$789.12 ,$596.22 ,$241.12 ,$306.88 ,$644.45 ,$241.12 ,$727.33 ,$274.00 ,$727.33 ,$727.33 ,$274.00 ,$727.33 ,$458.13 ,$920.64 ,$587.50 ,$241.12 ,$931.60 ,$920.64 ,$241.12 ,$822.00 ,$876.80 ,$876.80 ,$241.12 ,$876.80 ,$920.64 ,$920.64 ,$920.64 ,"$1,096.00 ",$986.40 ,$630.20 ,"$1,096.00 ",$241.12 ,$40.72 ,$596.22 ,$241.12 ,$455.94 ,$334.58 ,$319.37 ,$253.18 ,$931.60 ,$727.33 ,$306.88 ,$986.40 ,$920.64 ,$876.80 ,$876.80 ,$241.12 ,$712.40 
ST. FRANCIS HOSPITAL - ACUTE,32000491,77054,HC GALACTOGRAM MULTI DUCT,320,1 ,"$1,096.00 ",$712.40 ,$241.12 ,"$1,096.00 ",$630.20 ,$789.12 ,$596.22 ,$241.12 ,$306.88 ,$644.45 ,$241.12 ,$752.95 ,$274.00 ,$752.95 ,$752.95 ,$274.00 ,$752.95 ,$458.13 ,$920.64 ,$587.50 ,$241.12 ,$931.60 ,$920.64 ,$241.12 ,$822.00 ,$876.80 ,$876.80 ,$241.12 ,$876.80 ,$920.64 ,$920.64 ,$920.64 ,"$1,096.00 ",$986.40 ,$630.20 ,"$1,096.00 ",$241.12 ,"$1,096.00 ",$596.22 ,$241.12 ,$455.94 ,$334.58 ,$319.37 ,$253.18 ,$931.60 ,$752.95 ,$306.88 ,$986.40 ,$920.64 ,$876.80 ,$876.80 ,$241.12 ,$712.40 
ST. FRANCIS HOSPITAL - ACUTE,32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$473.00 ,$307.45 ,$56.05 ,$473.00 ,$271.98 ,$340.56 ,$257.31 ,$104.06 ,$132.44 ,$278.12 ,$104.06 ,$324.95 ,$118.25 ,$324.95 ,$324.95 ,$118.25 ,$324.95 ,$197.71 ,$397.32 ,$277.98 ,$104.06 ,$402.05 ,$397.32 ,$104.06 ,$354.75 ,$378.40 ,$378.40 ,$104.06 ,$378.40 ,$397.32 ,$397.32 ,$397.32 ,$473.00 ,$425.70 ,$271.98 ,$473.00 ,$104.06 ,$473.00 ,$257.31 ,$104.06 ,$196.77 ,$58.72 ,$56.05 ,$109.26 ,$402.05 ,$324.95 ,$132.44 ,$425.70 ,$397.32 ,$378.40 ,$378.40 ,$104.06 ,$307.45 
ST. FRANCIS HOSPITAL - ACUTE,32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,"$1,478.00 ",$960.70 ,$56.05 ,"$1,478.00 ",$849.85 ,"$1,064.16 ",$804.03 ,$325.16 ,$413.84 ,$869.06 ,$325.16 ,"$1,015.39 ",$369.50 ,"$1,015.39 ","$1,015.39 ",$369.50 ,"$1,015.39 ",$617.80 ,"$1,241.52 ",$277.98 ,$325.16 ,"$1,256.30 ","$1,241.52 ",$325.16 ,"$1,108.50 ","$1,182.40 ","$1,182.40 ",$325.16 ,"$1,182.40 ","$1,241.52 ","$1,241.52 ","$1,241.52 ","$1,478.00 ","$1,330.20 ",$849.85 ,"$1,478.00 ",$325.16 ,"$1,478.00 ",$804.03 ,$325.16 ,$614.85 ,$58.72 ,$56.05 ,$341.42 ,"$1,256.30 ","$1,015.39 ",$413.84 ,"$1,330.20 ","$1,241.52 ","$1,182.40 ","$1,182.40 ",$325.16 ,$960.70 
ST. FRANCIS HOSPITAL - ACUTE,32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$425.00 ,$276.25 ,$56.05 ,$425.00 ,$244.38 ,$306.00 ,$231.20 ,$93.50 ,$119.00 ,$249.90 ,$93.50 ,$291.98 ,$106.25 ,$291.98 ,$291.98 ,$106.25 ,$291.98 ,$177.65 ,$357.00 ,$277.98 ,$93.50 ,$361.25 ,$357.00 ,$93.50 ,$318.75 ,$340.00 ,$340.00 ,$93.50 ,$340.00 ,$357.00 ,$357.00 ,$357.00 ,$425.00 ,$382.50 ,$244.38 ,$425.00 ,$93.50 ,$425.00 ,$231.20 ,$93.50 ,$176.80 ,$58.72 ,$56.05 ,$98.18 ,$361.25 ,$291.98 ,$119.00 ,$382.50 ,$357.00 ,$340.00 ,$340.00 ,$93.50 ,$276.25 
ST. FRANCIS HOSPITAL - ACUTE,32000496,77080,HC BONE DENSITY DXA,320,1 ,$327.00 ,$212.55 ,$71.94 ,$327.00 ,$188.03 ,$235.44 ,$177.89 ,$71.94 ,$91.56 ,$192.28 ,$71.94 ,$224.65 ,$81.75 ,$224.65 ,$224.65 ,$81.75 ,$224.65 ,$136.69 ,$274.68 ,$277.98 ,$71.94 ,$277.95 ,$274.68 ,$71.94 ,$245.25 ,$261.60 ,$261.60 ,$71.94 ,$261.60 ,$274.68 ,$274.68 ,$274.68 ,$327.00 ,$294.30 ,$188.03 ,$327.00 ,$71.94 ,$327.00 ,$177.89 ,$71.94 ,$136.03 ,$92.74 ,$88.53 ,$75.54 ,$277.95 ,$224.65 ,$91.56 ,$294.30 ,$274.68 ,$261.60 ,$261.60 ,$71.94 ,$212.55 
ST. FRANCIS HOSPITAL - ACUTE,32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,"$1,098.00 ",$713.70 ,$56.05 ,"$1,098.00 ",$631.35 ,$790.56 ,$597.31 ,$241.56 ,$307.44 ,$645.62 ,$241.56 ,$702.06 ,$274.50 ,$702.06 ,$702.06 ,$274.50 ,$702.06 ,$458.96 ,$922.32 ,$587.50 ,$241.56 ,$933.30 ,$922.32 ,$241.56 ,$823.50 ,$878.40 ,$878.40 ,$241.56 ,$878.40 ,$922.32 ,$922.32 ,$922.32 ,"$1,098.00 ",$988.20 ,$631.35 ,"$1,098.00 ",$241.56 ,"$1,098.00 ",$597.31 ,$241.56 ,$456.77 ,$58.72 ,$56.05 ,$253.64 ,$933.30 ,$702.06 ,$307.44 ,$988.20 ,$922.32 ,$878.40 ,$878.40 ,$241.56 ,$713.70 
ST. FRANCIS HOSPITAL - ACUTE,32000504,20550,HC INJ SINGLE TENDON/LIGAMENT,320,1 ,"$1,051.00 ",$683.15 ,$231.22 ,"$1,051.00 ",$604.33 ,$756.72 ,$571.74 ,$231.22 ,$294.28 ,$589.61 ,$231.22 ,$685.25 ,$262.75 ,$685.25 ,$685.25 ,$262.75 ,$685.25 ,$439.32 ,$882.84 ,"$1,000.61 ",$231.22 ,$893.35 ,$882.84 ,$231.22 ,$788.25 ,$840.80 ,$840.80 ,$231.22 ,$840.80 ,$882.84 ,$882.84 ,$882.84 ,"$1,051.00 ",$945.90 ,$604.33 ,"$1,051.00 ",$231.22 ,"$1,051.00 ",$571.74 ,$231.22 ,$437.22 ,$512.25 ,$488.96 ,$242.78 ,$893.35 ,$685.25 ,$294.28 ,$945.90 ,$882.84 ,$840.80 ,$840.80 ,$231.22 ,$683.15 
ST. FRANCIS HOSPITAL - ACUTE,32000504,20550,HC INJ SINGLE TENDON/LIGAMENT,320,1 ,$701.00 ,$455.65 ,$154.22 ,$701.00 ,$403.08 ,$504.72 ,$381.34 ,$154.22 ,$196.28 ,$393.26 ,$154.22 ,$457.05 ,$175.25 ,$457.05 ,$457.05 ,$175.25 ,$457.05 ,$293.02 ,$588.84 ,$667.08 ,$154.22 ,$595.85 ,$588.84 ,$154.22 ,$525.75 ,$560.80 ,$560.80 ,$154.22 ,$560.80 ,$588.84 ,$588.84 ,$588.84 ,$701.00 ,$630.90 ,$403.08 ,$701.00 ,$154.22 ,$701.00 ,$381.34 ,$154.22 ,$291.62 ,$341.51 ,$325.98 ,$161.93 ,$595.85 ,$457.05 ,$196.28 ,$630.90 ,$588.84 ,$560.80 ,$560.80 ,$154.22 ,$455.65 
ST. FRANCIS HOSPITAL - ACUTE,32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$615.00 ,$399.75 ,$135.30 ,$667.08 ,$353.63 ,$442.80 ,$334.56 ,$135.30 ,$172.20 ,$345.02 ,$135.30 ,$400.98 ,$153.75 ,$400.98 ,$400.98 ,$153.75 ,$400.98 ,$257.07 ,$516.60 ,$667.08 ,$135.30 ,$522.75 ,$516.60 ,$135.30 ,$461.25 ,$492.00 ,$492.00 ,$135.30 ,$492.00 ,$516.60 ,$516.60 ,$516.60 ,$615.00 ,$553.50 ,$353.63 ,$615.00 ,$135.30 ,$615.00 ,$334.56 ,$135.30 ,$255.84 ,$341.51 ,$325.98 ,$142.07 ,$522.75 ,$400.98 ,$172.20 ,$553.50 ,$516.60 ,$492.00 ,$492.00 ,$135.30 ,$399.75 
ST. FRANCIS HOSPITAL - ACUTE,32000509,77072,HC BONE AGE STUDIES,320,1 ,$221.00 ,$143.65 ,$48.62 ,$277.98 ,$127.08 ,$159.12 ,$120.22 ,$48.62 ,$61.88 ,$129.95 ,$48.62 ,$151.83 ,$55.25 ,$151.83 ,$151.83 ,$55.25 ,$151.83 ,$92.38 ,$185.64 ,$277.98 ,$48.62 ,$187.85 ,$185.64 ,$48.62 ,$165.75 ,$176.80 ,$176.80 ,$48.62 ,$176.80 ,$185.64 ,$185.64 ,$185.64 ,$221.00 ,$198.90 ,$127.08 ,$221.00 ,$48.62 ,$221.00 ,$120.22 ,$48.62 ,$91.94 ,$58.72 ,$56.05 ,$51.05 ,$187.85 ,$151.83 ,$61.88 ,$198.90 ,$185.64 ,$176.80 ,$176.80 ,$48.62 ,$143.65 
ST. FRANCIS HOSPITAL - ACUTE,32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,$842.00 ,$547.30 ,$185.24 ,"$1,380.10 ",$484.15 ,$606.24 ,$458.05 ,$185.24 ,$235.76 ,$472.36 ,$185.24 ,$548.98 ,$210.50 ,$548.98 ,$548.98 ,$210.50 ,$548.98 ,$351.96 ,$707.28 ,"$1,380.10 ",$185.24 ,$715.70 ,$707.28 ,$185.24 ,$631.50 ,$673.60 ,$673.60 ,$185.24 ,$673.60 ,$707.28 ,$707.28 ,$707.28 ,$842.00 ,$757.80 ,$484.15 ,$842.00 ,$185.24 ,$842.00 ,$458.05 ,$185.24 ,$350.27 ,$729.83 ,$696.65 ,$194.50 ,$715.70 ,$548.98 ,$235.76 ,$757.80 ,$707.28 ,$673.60 ,$673.60 ,$185.24 ,$547.30 
ST. FRANCIS HOSPITAL - ACUTE,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,$926.00 ,$601.90 ,$203.72 ,"$1,380.10 ",$532.45 ,$666.72 ,$503.74 ,$203.72 ,$259.28 ,$519.49 ,$203.72 ,$603.75 ,$231.50 ,$603.75 ,$603.75 ,$231.50 ,$603.75 ,$387.07 ,$777.84 ,"$1,380.10 ",$203.72 ,$787.10 ,$777.84 ,$203.72 ,$694.50 ,$740.80 ,$740.80 ,$203.72 ,$740.80 ,$777.84 ,$777.84 ,$777.84 ,$926.00 ,$833.40 ,$532.45 ,$926.00 ,$203.72 ,$926.00 ,$503.74 ,$203.72 ,$385.22 ,$729.83 ,$696.65 ,$213.91 ,$787.10 ,$603.75 ,$259.28 ,$833.40 ,$777.84 ,$740.80 ,$740.80 ,$203.72 ,$601.90 
ST. FRANCIS HOSPITAL - ACUTE,32000542,20551,HC INJ TENDON ORIGIN,320,1 ,$701.00 ,$455.65 ,$154.22 ,$701.00 ,$403.08 ,$504.72 ,$381.34 ,$154.22 ,$196.28 ,$393.26 ,$154.22 ,$457.05 ,$175.25 ,$457.05 ,$457.05 ,$175.25 ,$457.05 ,$293.02 ,$588.84 ,$667.08 ,$154.22 ,$595.85 ,$588.84 ,$154.22 ,$525.75 ,$560.80 ,$560.80 ,$154.22 ,$560.80 ,$588.84 ,$588.84 ,$588.84 ,$701.00 ,$630.90 ,$403.08 ,$701.00 ,$154.22 ,$701.00 ,$381.34 ,$154.22 ,$291.62 ,$341.51 ,$325.98 ,$161.93 ,$595.85 ,$457.05 ,$196.28 ,$630.90 ,$588.84 ,$560.80 ,$560.80 ,$154.22 ,$455.65 
ST. FRANCIS HOSPITAL - ACUTE,32000543,72074,HC XR T-SPINE 4 + VIEWS,320,1 ,$895.00 ,$581.75 ,$56.05 ,$895.00 ,$514.63 ,$644.40 ,$486.88 ,$196.90 ,$250.60 ,$502.23 ,$196.90 ,$502.23 ,$223.75 ,$502.23 ,$502.23 ,$223.75 ,$502.23 ,$374.11 ,$751.80 ,$277.98 ,$196.90 ,$760.75 ,$751.80 ,$196.90 ,$671.25 ,$716.00 ,$716.00 ,$196.90 ,$716.00 ,$751.80 ,$751.80 ,$751.80 ,$895.00 ,$805.50 ,$514.63 ,$895.00 ,$196.90 ,$895.00 ,$486.88 ,$196.90 ,$372.32 ,$58.72 ,$56.05 ,$206.75 ,$760.75 ,$502.23 ,$250.60 ,$805.50 ,$751.80 ,$716.00 ,$716.00 ,$196.90 ,$581.75 
ST. FRANCIS HOSPITAL - ACUTE,32000556,77071,HC XR JOINT STRESS BY PHYS,320,1 ,$435.00 ,$282.75 ,$95.70 ,$435.00 ,$250.13 ,$313.20 ,$236.64 ,$95.70 ,$121.80 ,$255.78 ,$95.70 ,$298.85 ,$108.75 ,$298.85 ,$298.85 ,$108.75 ,$298.85 ,$181.83 ,$365.40 ,$206.53 ,$95.70 ,$369.75 ,$365.40 ,$95.70 ,$326.25 ,$348.00 ,$348.00 ,$95.70 ,$348.00 ,$365.40 ,$365.40 ,$365.40 ,$435.00 ,$391.50 ,$250.13 ,$435.00 ,$95.70 ,$435.00 ,$236.64 ,$95.70 ,$180.96 , N/A , N/A ,$100.49 ,$369.75 ,$298.85 ,$121.80 ,$391.50 ,$365.40 ,$348.00 ,$348.00 ,$95.70 ,$282.75 
ST. FRANCIS HOSPITAL - ACUTE,32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$781.00 ,$507.65 ,$56.05 ,$781.00 ,$449.08 ,$562.32 ,$424.86 ,$171.82 ,$218.68 ,$426.79 ,$171.82 ,$426.79 ,$195.25 ,$426.79 ,$426.79 ,$195.25 ,$426.79 ,$326.46 ,$656.04 ,$206.53 ,$171.82 ,$663.85 ,$656.04 ,$171.82 ,$585.75 ,$624.80 ,$624.80 ,$171.82 ,$624.80 ,$656.04 ,$656.04 ,$656.04 ,$781.00 ,$702.90 ,$449.08 ,$781.00 ,$171.82 ,$781.00 ,$424.86 ,$171.82 ,$324.90 ,$58.72 ,$56.05 ,$180.41 ,$663.85 ,$426.79 ,$218.68 ,$702.90 ,$656.04 ,$624.80 ,$624.80 ,$171.82 ,$507.65 
ST. FRANCIS HOSPITAL - ACUTE,32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$501.00 ,$325.65 ,$56.05 ,$501.00 ,$288.08 ,$360.72 ,$272.54 ,$110.22 ,$140.28 ,$294.59 ,$110.22 ,$344.19 ,$125.25 ,$344.19 ,$344.19 ,$125.25 ,$344.19 ,$209.42 ,$420.84 ,$206.53 ,$110.22 ,$425.85 ,$420.84 ,$110.22 ,$375.75 ,$400.80 ,$400.80 ,$110.22 ,$400.80 ,$420.84 ,$420.84 ,$420.84 ,$501.00 ,$450.90 ,$288.08 ,$501.00 ,$110.22 ,$501.00 ,$272.54 ,$110.22 ,$208.42 ,$58.72 ,$56.05 ,$115.73 ,$425.85 ,$344.19 ,$140.28 ,$450.90 ,$420.84 ,$400.80 ,$400.80 ,$110.22 ,$325.65 
ST. FRANCIS HOSPITAL - ACUTE,32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$552.00 ,$358.80 ,$56.05 ,$552.00 ,$317.40 ,$397.44 ,$300.29 ,$121.44 ,$154.56 ,$324.58 ,$121.44 ,$379.22 ,$138.00 ,$379.22 ,$379.22 ,$138.00 ,$379.22 ,$230.74 ,$463.68 ,$277.98 ,$121.44 ,$469.20 ,$463.68 ,$121.44 ,$414.00 ,$441.60 ,$441.60 ,$121.44 ,$441.60 ,$463.68 ,$463.68 ,$463.68 ,$552.00 ,$496.80 ,$317.40 ,$552.00 ,$121.44 ,$552.00 ,$300.29 ,$121.44 ,$229.63 ,$58.72 ,$56.05 ,$127.51 ,$469.20 ,$379.22 ,$154.56 ,$496.80 ,$463.68 ,$441.60 ,$441.60 ,$121.44 ,$358.80 
ST. FRANCIS HOSPITAL - ACUTE,32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$390.00 ,$253.50 ,$56.05 ,$390.00 ,$224.25 ,$280.80 ,$212.16 ,$85.80 ,$109.20 ,$229.32 ,$85.80 ,$267.93 ,$97.50 ,$267.93 ,$267.93 ,$97.50 ,$267.93 ,$163.02 ,$327.60 ,$206.53 ,$85.80 ,$331.50 ,$327.60 ,$85.80 ,$292.50 ,$312.00 ,$312.00 ,$85.80 ,$312.00 ,$327.60 ,$327.60 ,$327.60 ,$390.00 ,$351.00 ,$224.25 ,$390.00 ,$85.80 ,$390.00 ,$212.16 ,$85.80 ,$162.24 ,$58.72 ,$56.05 ,$90.09 ,$331.50 ,$267.93 ,$109.20 ,$351.00 ,$327.60 ,$312.00 ,$312.00 ,$85.80 ,$253.50 
ST. FRANCIS HOSPITAL - ACUTE,32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$664.00 ,$431.60 ,$56.05 ,$664.00 ,$381.80 ,$478.08 ,$361.22 ,$146.08 ,$185.92 ,$390.43 ,$146.08 ,$456.17 ,$166.00 ,$456.17 ,$456.17 ,$166.00 ,$456.17 ,$277.55 ,$557.76 ,$206.53 ,$146.08 ,$564.40 ,$557.76 ,$146.08 ,$498.00 ,$531.20 ,$531.20 ,$146.08 ,$531.20 ,$557.76 ,$557.76 ,$557.76 ,$664.00 ,$597.60 ,$381.80 ,$664.00 ,$146.08 ,$664.00 ,$361.22 ,$146.08 ,$276.22 ,$58.72 ,$56.05 ,$153.38 ,$564.40 ,$456.17 ,$185.92 ,$597.60 ,$557.76 ,$531.20 ,$531.20 ,$146.08 ,$431.60 
ST. FRANCIS HOSPITAL - ACUTE,32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$445.00 ,$289.25 ,$56.05 ,$445.00 ,$255.88 ,$320.40 ,$242.08 ,$97.90 ,$124.60 ,$261.66 ,$97.90 ,$305.72 ,$111.25 ,$305.72 ,$305.72 ,$111.25 ,$305.72 ,$186.01 ,$373.80 ,$277.98 ,$97.90 ,$378.25 ,$373.80 ,$97.90 ,$333.75 ,$356.00 ,$356.00 ,$97.90 ,$356.00 ,$373.80 ,$373.80 ,$373.80 ,$445.00 ,$400.50 ,$255.88 ,$445.00 ,$97.90 ,$445.00 ,$242.08 ,$97.90 ,$185.12 ,$58.72 ,$56.05 ,$102.80 ,$378.25 ,$305.72 ,$124.60 ,$400.50 ,$373.80 ,$356.00 ,$356.00 ,$97.90 ,$289.25 
ST. FRANCIS HOSPITAL - ACUTE,32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$994.00 ,$646.10 ,$56.05 ,$994.00 ,$571.55 ,$715.68 ,$540.74 ,$218.68 ,$278.32 ,$584.47 ,$218.68 ,$607.06 ,$248.50 ,$607.06 ,$607.06 ,$248.50 ,$607.06 ,$415.49 ,$834.96 ,$277.98 ,$218.68 ,$844.90 ,$834.96 ,$218.68 ,$745.50 ,$795.20 ,$795.20 ,$218.68 ,$795.20 ,$834.96 ,$834.96 ,$834.96 ,$994.00 ,$894.60 ,$571.55 ,$994.00 ,$218.68 ,$994.00 ,$540.74 ,$218.68 ,$413.50 ,$58.72 ,$56.05 ,$229.61 ,$844.90 ,$607.06 ,$278.32 ,$894.60 ,$834.96 ,$795.20 ,$795.20 ,$218.68 ,$646.10 
ST. FRANCIS HOSPITAL - ACUTE,32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,"$1,216.00 ",$790.40 ,$56.05 ,"$1,216.00 ",$699.20 ,$875.52 ,$661.50 ,$267.52 ,$340.48 ,$715.01 ,$267.52 ,$727.33 ,$304.00 ,$727.33 ,$727.33 ,$304.00 ,$727.33 ,$508.29 ,"$1,021.44 ",$277.98 ,$267.52 ,"$1,033.60 ","$1,021.44 ",$267.52 ,$912.00 ,$972.80 ,$972.80 ,$267.52 ,$972.80 ,"$1,021.44 ","$1,021.44 ","$1,021.44 ","$1,216.00 ","$1,094.40 ",$699.20 ,"$1,216.00 ",$267.52 ,"$1,216.00 ",$661.50 ,$267.52 ,$505.86 ,$58.72 ,$56.05 ,$280.90 ,"$1,033.60 ",$727.33 ,$340.48 ,"$1,094.40 ","$1,021.44 ",$972.80 ,$972.80 ,$267.52 ,$790.40 
ST. FRANCIS HOSPITAL - ACUTE,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$245.00 ,$159.25 ,$53.90 ,$245.00 ,$140.88 ,$176.40 ,$133.28 ,$53.90 ,$68.60 ,$144.06 ,$53.90 ,$168.32 ,$61.25 ,$168.32 ,$168.32 ,$61.25 ,$168.32 ,$102.41 ,$205.80 ,$206.53 ,$53.90 ,$208.25 ,$205.80 ,$53.90 ,$183.75 ,$196.00 ,$196.00 ,$53.90 ,$196.00 ,$205.80 ,$205.80 ,$205.80 ,$245.00 ,$220.50 ,$140.88 ,$245.00 ,$53.90 ,$245.00 ,$133.28 ,$53.90 ,$101.92 ,$58.72 ,$56.05 ,$56.60 ,$208.25 ,$168.32 ,$68.60 ,$220.50 ,$205.80 ,$196.00 ,$196.00 ,$53.90 ,$159.25 
ST. FRANCIS HOSPITAL - ACUTE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$525.00 ,$341.25 ,$56.05 ,$525.00 ,$301.88 ,$378.00 ,$285.60 ,$115.50 ,$147.00 ,$308.70 ,$115.50 ,$360.68 ,$131.25 ,$360.68 ,$360.68 ,$131.25 ,$360.68 ,$219.45 ,$441.00 ,$206.53 ,$115.50 ,$446.25 ,$441.00 ,$115.50 ,$393.75 ,$420.00 ,$420.00 ,$115.50 ,$420.00 ,$441.00 ,$441.00 ,$441.00 ,$525.00 ,$472.50 ,$301.88 ,$525.00 ,$115.50 ,$525.00 ,$285.60 ,$115.50 ,$218.40 ,$58.72 ,$56.05 ,$121.28 ,$446.25 ,$360.68 ,$147.00 ,$472.50 ,$441.00 ,$420.00 ,$420.00 ,$115.50 ,$341.25 
ST. FRANCIS HOSPITAL - ACUTE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,"$1,041.00 ",$676.65 ,$84.06 ,"$1,041.00 ",$598.58 ,$749.52 ,$566.30 ,$229.02 ,$291.48 ,$423.42 ,$229.02 ,$423.42 ,$260.25 ,$423.42 ,$423.42 ,$260.25 ,$423.42 ,$435.14 ,$874.44 ,$206.53 ,$229.02 ,$884.85 ,$874.44 ,$229.02 ,$780.75 ,$832.80 ,$832.80 ,$229.02 ,$832.80 ,$874.44 ,$874.44 ,$874.44 ,"$1,041.00 ",$936.90 ,$598.58 ,"$1,041.00 ",$229.02 ,"$1,041.00 ",$566.30 ,$229.02 ,$433.06 ,$88.07 ,$84.06 ,$240.47 ,$884.85 ,$423.42 ,$291.48 ,$936.90 ,$874.44 ,$832.80 ,$832.80 ,$229.02 ,$676.65 
ST. FRANCIS HOSPITAL - ACUTE,32000589,74019,HC XR ABDOMEN 2V,320,1 ,$522.00 ,$339.30 ,$56.05 ,$522.00 ,$300.15 ,$375.84 ,$283.97 ,$114.84 ,$146.16 ,$306.94 ,$114.84 ,$358.61 ,$130.50 ,$358.61 ,$358.61 ,$130.50 ,$358.61 ,$218.20 ,$438.48 ,$277.98 ,$114.84 ,$443.70 ,$438.48 ,$114.84 ,$391.50 ,$417.60 ,$417.60 ,$114.84 ,$417.60 ,$438.48 ,$438.48 ,$438.48 ,$522.00 ,$469.80 ,$300.15 ,$522.00 ,$114.84 ,$522.00 ,$283.97 ,$114.84 ,$217.15 ,$58.72 ,$56.05 ,$120.58 ,$443.70 ,$358.61 ,$146.16 ,$469.80 ,$438.48 ,$417.60 ,$417.60 ,$114.84 ,$339.30 
ST. FRANCIS HOSPITAL - ACUTE,32000595,76000,HC FLUOROSCOPY >1HR,320,1 ,"$1,098.00 ",$713.70 ,$56.05 ,"$1,098.00 ",$631.35 ,$790.56 ,$597.31 ,$241.56 ,$307.44 ,$645.62 ,$241.56 ,$702.06 ,$274.50 ,$702.06 ,$702.06 ,$274.50 ,$702.06 ,$458.96 ,$922.32 ,$587.50 ,$241.56 ,$933.30 ,$922.32 ,$241.56 ,$823.50 ,$878.40 ,$878.40 ,$241.56 ,$878.40 ,$922.32 ,$922.32 ,$922.32 ,"$1,098.00 ",$988.20 ,$631.35 ,"$1,098.00 ",$241.56 ,"$1,098.00 ",$597.31 ,$241.56 ,$456.77 ,$58.72 ,$56.05 ,$253.64 ,$933.30 ,$702.06 ,$307.44 ,$988.20 ,$922.32 ,$878.40 ,$878.40 ,$241.56 ,$713.70 
ST. FRANCIS HOSPITAL - ACUTE,32000605,71045,HC XR CHEST 1V W/PICC INS,320,1 ,$371.00 ,$241.15 ,$18.14 ,$371.00 ,$213.33 ,$267.12 ,$201.82 ,$81.62 ,$103.88 ,$194.10 ,$81.62 ,$194.10 ,$92.75 ,$194.10 ,$194.10 ,$92.75 ,$194.10 ,$155.08 ,$311.64 ,$206.53 ,$81.62 ,$315.35 ,$311.64 ,$81.62 ,$278.25 ,$296.80 ,$296.80 ,$81.62 ,$296.80 ,$311.64 ,$311.64 ,$311.64 ,$371.00 ,$333.90 ,$213.33 ,$371.00 ,$81.62 ,$18.14 ,$201.82 ,$81.62 ,$154.34 ,$58.72 ,$56.05 ,$85.70 ,$315.35 ,$194.10 ,$103.88 ,$333.90 ,$311.64 ,$296.80 ,$296.80 ,$81.62 ,$241.15 
ST. FRANCIS HOSPITAL - ACUTE,32000611,G1004,HC RAD AUC CDSM NATL DECISION SUPPORT COMPANY,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,"$1,230.00 ",$799.50 ,$56.05 ,"$1,230.00 ",$707.25 ,$885.60 ,$669.12 ,$270.60 ,$344.40 ,$690.03 ,$270.60 ,$801.96 ,$307.50 ,$801.96 ,$801.96 ,$307.50 ,$801.96 ,$514.14 ,"$1,033.20 ", N/A ,$270.60 ,"$1,045.50 ","$1,033.20 ",$270.60 ,$922.50 ,$984.00 ,$984.00 ,$270.60 ,$984.00 ,"$1,033.20 ","$1,033.20 ","$1,033.20 ","$1,230.00 ","$1,107.00 ",$707.25 ,"$1,230.00 ",$270.60 ,"$1,230.00 ",$669.12 ,$270.60 ,$511.68 ,$58.72 ,$56.05 ,$284.13 ,"$1,045.50 ",$801.96 ,$344.40 ,"$1,107.00 ","$1,033.20 ",$984.00 ,$984.00 ,$270.60 ,$799.50 
ST. FRANCIS HOSPITAL - ACUTE,32000613,G1002,HC RAD AUC CDSM MEDCURRENT,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000614,G1003,HC RAD AUC CDSM MEDICALIS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000615,G1005,HC RAD AUC CDSM NATIONAL IMAGING ASSOCIATES,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000616,G1006,HC RAD AUC CDSM TEST APPROPRIATE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000617,G1007,HC RAD AUC CDSM AIM SPECIALTY HEALTH,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000618,G1008,HC RAD AUC CDSM CRANBERRY PEAK,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000619,G1009,HC RAD AUC CDSM SAGE HEALTH MGMT SOLUTIONS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000620,G1010,HC RAD AUC CDSM STANSON,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000621,G1011,HC RAD AUC CDSM QUALIFIED TOOL NOS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,32000623,G1001,HC RAD AUC CDSM EVICORE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 
ST. FRANCIS HOSPITAL - ACUTE,33100001,96405,HC CHEMO IV INTRALESION UP TO 7 LESIONS,331,1 ,$536.00 ,$348.40 ,$117.92 ,$536.00 ,$308.20 ,$385.92 ,$291.58 ,$117.92 ,$150.08 ,$315.17 ,$117.92 ,$368.23 ,$134.00 ,$368.23 ,$368.23 ,$134.00 ,$368.23 ,$224.05 ,$450.24 ,$158.30 ,$117.92 ,$455.60 ,$450.24 ,$117.92 ,$402.00 ,$428.80 ,$428.80 ,$117.92 ,$428.80 ,$450.24 ,$450.24 ,$450.24 ,$536.00 ,$482.40 ,$308.20 ,$536.00 ,$117.92 ,$536.00 ,$291.58 ,$117.92 ,$222.98 ,$323.48 ,$308.77 ,$123.82 ,$455.60 ,$368.23 ,$150.08 ,$482.40 ,$450.24 ,$428.80 ,$428.80 ,$117.92 ,$348.40 
ST. FRANCIS HOSPITAL - ACUTE,33100002,96406,HC CHEMO IV INTRALESION >7 LESIONS,331,1 ,$499.00 ,$324.35 ,$109.78 ,$522.33 ,$286.93 ,$359.28 ,$271.46 ,$109.78 ,$139.72 ,$293.41 ,$109.78 ,$342.81 ,$124.75 ,$342.81 ,$342.81 ,$124.75 ,$342.81 ,$208.58 ,$419.16 ,$522.33 ,$109.78 ,$424.15 ,$419.16 ,$109.78 ,$374.25 ,$399.20 ,$399.20 ,$109.78 ,$399.20 ,$419.16 ,$419.16 ,$419.16 ,$499.00 ,$449.10 ,$286.93 ,$499.00 ,$109.78 ,$499.00 ,$271.46 ,$109.78 ,$207.58 ,$323.48 ,$308.77 ,$115.27 ,$424.15 ,$342.81 ,$139.72 ,$449.10 ,$419.16 ,$399.20 ,$399.20 ,$109.78 ,$324.35 
ST. FRANCIS HOSPITAL - ACUTE,33100003,96420,HC CHEMO IV INTRA ART PUSH TECH,331,1 ,$328.00 ,$213.20 ,$72.16 ,$814.10 ,$188.60 ,$236.16 ,$178.43 ,$72.16 ,$91.84 ,$192.86 ,$72.16 ,$225.34 ,$82.00 ,$225.34 ,$225.34 ,$82.00 ,$225.34 ,$137.10 ,$275.52 ,$814.10 ,$72.16 ,$278.80 ,$275.52 ,$72.16 ,$246.00 ,$262.40 ,$262.40 ,$72.16 ,$262.40 ,$275.52 ,$275.52 ,$275.52 ,$328.00 ,$295.20 ,$188.60 ,$328.00 ,$72.16 ,$328.00 ,$178.43 ,$72.16 ,$136.45 , N/A , N/A ,$75.77 ,$278.80 ,$225.34 ,$91.84 ,$295.20 ,$275.52 ,$262.40 ,$262.40 ,$72.16 ,$213.20 
ST. FRANCIS HOSPITAL - ACUTE,33500002,96401,HC CHEMO SQ/IM NON ANTI-NEOPLAST,335,1 ,$259.00 ,$168.35 ,$56.98 ,$259.00 ,$148.93 ,$186.48 ,$140.90 ,$56.98 ,$72.52 ,$152.29 ,$56.98 ,$177.93 ,$64.75 ,$177.93 ,$177.93 ,$64.75 ,$177.93 ,$108.26 ,$217.56 ,$158.30 ,$56.98 ,$220.15 ,$217.56 ,$56.98 ,$194.25 ,$207.20 ,$207.20 ,$56.98 ,$207.20 ,$217.56 ,$217.56 ,$217.56 ,$259.00 ,$233.10 ,$148.93 ,$259.00 ,$56.98 ,$259.00 ,$140.90 ,$56.98 ,$107.74 , N/A , N/A ,$59.83 ,$220.15 ,$177.93 ,$72.52 ,$233.10 ,$217.56 ,$207.20 ,$207.20 ,$56.98 ,$168.35 
ST. FRANCIS HOSPITAL - ACUTE,33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$371.00 ,$241.15 ,$81.62 ,$522.33 ,$213.33 ,$267.12 ,$201.82 ,$81.62 ,$103.88 ,$218.15 ,$81.62 ,$254.88 ,$92.75 ,$254.88 ,$254.88 ,$92.75 ,$254.88 ,$155.08 ,$311.64 ,$522.33 ,$81.62 ,$315.35 ,$311.64 ,$81.62 ,$278.25 ,$296.80 ,$296.80 ,$81.62 ,$296.80 ,$311.64 ,$311.64 ,$311.64 ,$371.00 ,$333.90 ,$213.33 ,$371.00 ,$81.62 ,$371.00 ,$201.82 ,$81.62 ,$154.34 , N/A , N/A ,$85.70 ,$315.35 ,$254.88 ,$103.88 ,$333.90 ,$311.64 ,$296.80 ,$296.80 ,$81.62 ,$241.15 
ST. FRANCIS HOSPITAL - ACUTE,33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$328.00 ,$213.20 ,$72.16 ,$328.00 ,$188.60 ,$236.16 ,$178.43 ,$72.16 ,$91.84 ,$192.86 ,$72.16 ,$225.34 ,$82.00 ,$225.34 ,$225.34 ,$82.00 ,$225.34 ,$137.10 ,$275.52 ,$158.30 ,$72.16 ,$278.80 ,$275.52 ,$72.16 ,$246.00 ,$262.40 ,$262.40 ,$72.16 ,$262.40 ,$275.52 ,$275.52 ,$275.52 ,$328.00 ,$295.20 ,$188.60 ,$328.00 ,$72.16 ,$328.00 ,$178.43 ,$72.16 ,$136.45 , N/A , N/A ,$75.77 ,$278.80 ,$225.34 ,$91.84 ,$295.20 ,$275.52 ,$262.40 ,$262.40 ,$72.16 ,$213.20 
ST. FRANCIS HOSPITAL - ACUTE,33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$483.00 ,$313.95 ,$106.26 ,$814.10 ,$277.73 ,$347.76 ,$262.75 ,$106.26 ,$135.24 ,$284.00 ,$106.26 ,$331.82 ,$120.75 ,$331.82 ,$331.82 ,$120.75 ,$331.82 ,$201.89 ,$405.72 ,$814.10 ,$106.26 ,$410.55 ,$405.72 ,$106.26 ,$362.25 ,$386.40 ,$386.40 ,$106.26 ,$386.40 ,$405.72 ,$405.72 ,$405.72 ,$483.00 ,$434.70 ,$277.73 ,$483.00 ,$106.26 ,$483.00 ,$262.75 ,$106.26 ,$200.93 ,$330.08 ,$315.07 ,$111.57 ,$410.55 ,$331.82 ,$135.24 ,$434.70 ,$405.72 ,$386.40 ,$386.40 ,$106.26 ,$313.95 
ST. FRANCIS HOSPITAL - ACUTE,33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$333.00 ,$216.45 ,$73.26 ,$516.01 ,$191.48 ,$239.76 ,$181.15 ,$73.26 ,$93.24 ,$195.80 ,$73.26 ,$228.77 ,$83.25 ,$228.77 ,$228.77 ,$83.25 ,$228.77 ,$139.19 ,$279.72 ,$158.30 ,$73.26 ,$283.05 ,$279.72 ,$73.26 ,$249.75 ,$266.40 ,$266.40 ,$73.26 ,$266.40 ,$279.72 ,$279.72 ,$279.72 ,$333.00 ,$299.70 ,$191.48 ,$333.00 ,$73.26 ,$333.00 ,$181.15 ,$73.26 ,$138.53 ,$516.01 ,$492.56 ,$76.92 ,$283.05 ,$228.77 ,$93.24 ,$299.70 ,$279.72 ,$266.40 ,$266.40 ,$73.26 ,$216.45 
ST. FRANCIS HOSPITAL - ACUTE,33500007,96416,HC CHEMO ADMIN INTRAV INFUS >8HR,335,1 ,"$2,703.00 ","$1,756.95 ",$492.56 ,"$2,703.00 ","$1,554.23 ","$1,946.16 ","$1,470.43 ",$594.66 ,$756.84 ,"$1,589.36 ",$594.66 ,"$1,856.96 ",$675.75 ,"$1,856.96 ","$1,856.96 ",$675.75 ,"$1,856.96 ","$1,129.85 ","$2,270.52 ",$814.10 ,$594.66 ,"$2,297.55 ","$2,270.52 ",$594.66 ,"$2,027.25 ","$2,162.40 ","$2,162.40 ",$594.66 ,"$2,162.40 ","$2,270.52 ","$2,270.52 ","$2,270.52 ","$2,703.00 ","$2,432.70 ","$1,554.23 ","$2,703.00 ",$594.66 ,"$2,703.00 ","$1,470.43 ",$594.66 ,"$1,124.45 ",$516.01 ,$492.56 ,$624.39 ,"$2,297.55 ","$1,856.96 ",$756.84 ,"$2,432.70 ","$2,270.52 ","$2,162.40 ","$2,162.40 ",$594.66 ,"$1,756.95 "
ST. FRANCIS HOSPITAL - ACUTE,33500008,96417,HC CHEMO IV INFUSION EA ADDL <1H,335,1 ,$333.00 ,$216.45 ,$73.26 ,$333.00 ,$191.48 ,$239.76 ,$181.15 ,$73.26 ,$93.24 ,$195.80 ,$73.26 ,$228.77 ,$83.25 ,$228.77 ,$228.77 ,$83.25 ,$228.77 ,$139.19 ,$279.72 ,$158.30 ,$73.26 ,$283.05 ,$279.72 ,$73.26 ,$249.75 ,$266.40 ,$266.40 ,$73.26 ,$266.40 ,$279.72 ,$279.72 ,$279.72 ,$333.00 ,$299.70 ,$191.48 ,$333.00 ,$73.26 ,$333.00 ,$181.15 ,$73.26 ,$138.53 ,$330.08 ,$315.07 ,$76.92 ,$283.05 ,$228.77 ,$93.24 ,$299.70 ,$279.72 ,$266.40 ,$266.40 ,$73.26 ,$216.45 
ST. FRANCIS HOSPITAL - ACUTE,33500009,96422,HC CHEMO ADMIN INTRA-ARTR INFUS<1HR,335,1 ,$483.00 ,$313.95 ,$106.26 ,$522.33 ,$277.73 ,$347.76 ,$262.75 ,$106.26 ,$135.24 ,$284.00 ,$106.26 ,$331.82 ,$120.75 ,$331.82 ,$331.82 ,$120.75 ,$331.82 ,$201.89 ,$405.72 ,$522.33 ,$106.26 ,$410.55 ,$405.72 ,$106.26 ,$362.25 ,$386.40 ,$386.40 ,$106.26 ,$386.40 ,$405.72 ,$405.72 ,$405.72 ,$483.00 ,$434.70 ,$277.73 ,$483.00 ,$106.26 ,$483.00 ,$262.75 ,$106.26 ,$200.93 ,$330.08 ,$315.07 ,$111.57 ,$410.55 ,$331.82 ,$135.24 ,$434.70 ,$405.72 ,$386.40 ,$386.40 ,$106.26 ,$313.95 
ST. FRANCIS HOSPITAL - ACUTE,33500010,96423,HC CHEMO ADMN INTR-ARTR EA ADD HR,335,1 ,$333.00 ,$216.45 ,$73.26 ,$516.01 ,$191.48 ,$239.76 ,$181.15 ,$73.26 ,$93.24 ,$195.80 ,$73.26 ,$228.77 ,$83.25 ,$228.77 ,$228.77 ,$83.25 ,$228.77 ,$139.19 ,$279.72 ,$102.18 ,$73.26 ,$283.05 ,$279.72 ,$73.26 ,$249.75 ,$266.40 ,$266.40 ,$73.26 ,$266.40 ,$279.72 ,$279.72 ,$279.72 ,$333.00 ,$299.70 ,$191.48 ,$333.00 ,$73.26 ,$333.00 ,$181.15 ,$73.26 ,$138.53 ,$516.01 ,$492.56 ,$76.92 ,$283.05 ,$228.77 ,$93.24 ,$299.70 ,$279.72 ,$266.40 ,$266.40 ,$73.26 ,$216.45 
ST. FRANCIS HOSPITAL - ACUTE,33500011,96446,HC CHEMO PERITONEAL CAVITY,335,1 ,$499.00 ,$324.35 ,$109.78 ,$814.10 ,$286.93 ,$359.28 ,$271.46 ,$109.78 ,$139.72 ,$279.94 ,$109.78 ,$325.35 ,$124.75 ,$325.35 ,$325.35 ,$124.75 ,$325.35 ,$208.58 ,$419.16 ,$814.10 ,$109.78 ,$424.15 ,$419.16 ,$109.78 ,$374.25 ,$399.20 ,$399.20 ,$109.78 ,$399.20 ,$419.16 ,$419.16 ,$419.16 ,$499.00 ,$449.10 ,$286.93 ,$499.00 ,$109.78 ,$499.00 ,$271.46 ,$109.78 ,$207.58 ,$330.08 ,$315.07 ,$115.27 ,$424.15 ,$325.35 ,$139.72 ,$449.10 ,$419.16 ,$399.20 ,$399.20 ,$109.78 ,$324.35 
ST. FRANCIS HOSPITAL - ACUTE,33500012,96450,HC CHEMO CNS,335,1 ,"$1,092.00 ",$709.80 ,$240.24 ,"$1,092.00 ",$627.90 ,$786.24 ,$594.05 ,$240.24 ,$305.76 ,$642.10 ,$240.24 ,$750.20 ,$273.00 ,$750.20 ,$750.20 ,$273.00 ,$750.20 ,$456.46 ,$917.28 ,$814.10 ,$240.24 ,$928.20 ,$917.28 ,$240.24 ,$819.00 ,$873.60 ,$873.60 ,$240.24 ,$873.60 ,$917.28 ,$917.28 ,$917.28 ,"$1,092.00 ",$982.80 ,$627.90 ,"$1,092.00 ",$240.24 ,"$1,092.00 ",$594.05 ,$240.24 ,$454.27 ,$516.01 ,$492.56 ,$252.25 ,$928.20 ,$750.20 ,$305.76 ,$982.80 ,$917.28 ,$873.60 ,$873.60 ,$240.24 ,$709.80 
ST. FRANCIS HOSPITAL - ACUTE,33500013,96402,HC CHEMOTHERAPY INJECTION-HORMONAL ANTI-NEO,335,1 ,$259.00 ,$168.35 ,$56.98 ,$259.00 ,$148.93 ,$186.48 ,$140.90 ,$56.98 ,$72.52 ,$152.29 ,$56.98 ,$177.93 ,$64.75 ,$177.93 ,$177.93 ,$64.75 ,$177.93 ,$108.26 ,$217.56 ,$158.30 ,$56.98 ,$220.15 ,$217.56 ,$56.98 ,$194.25 ,$207.20 ,$207.20 ,$56.98 ,$207.20 ,$217.56 ,$217.56 ,$217.56 ,$259.00 ,$233.10 ,$148.93 ,$259.00 ,$56.98 ,$259.00 ,$140.90 ,$56.98 ,$107.74 , N/A , N/A ,$59.83 ,$220.15 ,$177.93 ,$72.52 ,$233.10 ,$217.56 ,$207.20 ,$207.20 ,$56.98 ,$168.35 
ST. FRANCIS HOSPITAL - ACUTE,33500014,96521,HC REFILLING/MAINTENANCE PORTABLE PUMP,335,1 ,$573.00 ,$372.45 ,$120.26 ,$573.00 ,$329.48 ,$412.56 ,$311.71 ,$126.06 ,$160.44 ,$336.92 ,$126.06 ,$393.65 ,$143.25 ,$393.65 ,$393.65 ,$143.25 ,$393.65 ,$239.51 ,$481.32 ,$522.33 ,$126.06 ,$487.05 ,$481.32 ,$126.06 ,$429.75 ,$458.40 ,$458.40 ,$126.06 ,$458.40 ,$481.32 ,$481.32 ,$481.32 ,$573.00 ,$515.70 ,$329.48 ,$573.00 ,$126.06 ,$573.00 ,$311.71 ,$126.06 ,$238.37 ,$125.98 ,$120.26 ,$132.36 ,$487.05 ,$393.65 ,$160.44 ,$515.70 ,$481.32 ,$458.40 ,$458.40 ,$126.06 ,$372.45 
ST. FRANCIS HOSPITAL - ACUTE,33500027,96425,HC CHEMO INTRA-ART PROLONGED INFUSION W/PUMP,335,1 ,"$1,009.00 ",$655.85 ,$221.98 ,"$1,009.00 ",$580.18 ,$726.48 ,$548.90 ,$221.98 ,$282.52 ,$593.29 ,$221.98 ,$693.18 ,$252.25 ,$693.18 ,$693.18 ,$252.25 ,$693.18 ,$421.76 ,$847.56 ,$814.10 ,$221.98 ,$857.65 ,$847.56 ,$221.98 ,$756.75 ,$807.20 ,$807.20 ,$221.98 ,$807.20 ,$847.56 ,$847.56 ,$847.56 ,"$1,009.00 ",$908.10 ,$580.18 ,"$1,009.00 ",$221.98 ,"$1,009.00 ",$548.90 ,$221.98 ,$419.74 ,$516.01 ,$492.56 ,$233.08 ,$857.65 ,$693.18 ,$282.52 ,$908.10 ,$847.56 ,$807.20 ,$807.20 ,$221.98 ,$655.85 
ST. FRANCIS HOSPITAL - ACUTE,33500028,96440,HC CHEMO ADMIN PLEURAL CAVITY W/THORACENTESIS,335,1 ,$536.00 ,$348.40 ,$117.92 ,$814.10 ,$308.20 ,$385.92 ,$291.58 ,$117.92 ,$150.08 ,$315.17 ,$117.92 ,$368.23 ,$134.00 ,$368.23 ,$368.23 ,$134.00 ,$368.23 ,$224.05 ,$450.24 ,$814.10 ,$117.92 ,$455.60 ,$450.24 ,$117.92 ,$402.00 ,$428.80 ,$428.80 ,$117.92 ,$428.80 ,$450.24 ,$450.24 ,$450.24 ,$536.00 ,$482.40 ,$308.20 ,$536.00 ,$117.92 ,$536.00 ,$291.58 ,$117.92 ,$222.98 ,$729.83 ,$696.65 ,$123.82 ,$455.60 ,$368.23 ,$150.08 ,$482.40 ,$450.24 ,$428.80 ,$428.80 ,$117.92 ,$348.40 
ST. FRANCIS HOSPITAL - ACUTE,33500029,96522,HC PUMP MAINT SYSTEMIC,335,1 ,$573.00 ,$372.45 ,$120.26 ,$573.00 ,$329.48 ,$412.56 ,$311.71 ,$126.06 ,$160.44 ,$336.92 ,$126.06 ,$393.65 ,$143.25 ,$393.65 ,$393.65 ,$143.25 ,$393.65 ,$239.51 ,$481.32 ,$522.33 ,$126.06 ,$487.05 ,$481.32 ,$126.06 ,$429.75 ,$458.40 ,$458.40 ,$126.06 ,$458.40 ,$481.32 ,$481.32 ,$481.32 ,$573.00 ,$515.70 ,$329.48 ,$573.00 ,$126.06 ,$573.00 ,$311.71 ,$126.06 ,$238.37 ,$125.98 ,$120.26 ,$132.36 ,$487.05 ,$393.65 ,$160.44 ,$515.70 ,$481.32 ,$458.40 ,$458.40 ,$126.06 ,$372.45 
ST. FRANCIS HOSPITAL - ACUTE,34000006,78013,HC NM THYROID SCAN,340,1 ,$564.00 ,$366.60 ,$124.08 ,$962.48 ,$324.30 ,$406.08 ,$306.82 ,$124.08 ,$157.92 ,$331.63 ,$124.08 ,$387.47 ,$141.00 ,$387.47 ,$387.47 ,$141.00 ,$387.47 ,$235.75 ,$473.76 ,$962.48 ,$124.08 ,$479.40 ,$473.76 ,$124.08 ,$423.00 ,$451.20 ,$451.20 ,$124.08 ,$451.20 ,$473.76 ,$473.76 ,$473.76 ,$564.00 ,$507.60 ,$324.30 ,$564.00 ,$124.08 ,$564.00 ,$306.82 ,$124.08 ,$234.62 ,$443.97 ,$423.79 ,$130.28 ,$479.40 ,$387.47 ,$157.92 ,$507.60 ,$473.76 ,$451.20 ,$451.20 ,$124.08 ,$366.60 
ST. FRANCIS HOSPITAL - ACUTE,34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,219.00 ",$792.35 ,$268.18 ,"$1,219.00 ",$700.93 ,$877.68 ,$663.14 ,$268.18 ,$341.32 ,$716.77 ,$268.18 ,$837.45 ,$304.75 ,$837.45 ,$837.45 ,$304.75 ,$837.45 ,$509.54 ,"$1,023.96 ",$962.48 ,$268.18 ,"$1,036.15 ","$1,023.96 ",$268.18 ,$914.25 ,$975.20 ,$975.20 ,$268.18 ,$975.20 ,"$1,023.96 ","$1,023.96 ","$1,023.96 ","$1,219.00 ","$1,097.10 ",$700.93 ,"$1,219.00 ",$268.18 ,"$1,219.00 ",$663.14 ,$268.18 ,$507.10 ,$396.23 ,$378.22 ,$281.59 ,"$1,036.15 ",$837.45 ,$341.32 ,"$1,097.10 ","$1,023.96 ",$975.20 ,$975.20 ,$268.18 ,$792.35 
ST. FRANCIS HOSPITAL - ACUTE,34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$2,205.00 ","$1,433.25 ",$423.79 ,"$2,205.00 ","$1,267.88 ","$1,587.60 ","$1,199.52 ",$485.10 ,$617.40 ,"$1,296.54 ",$485.10 ,"$1,514.84 ",$551.25 ,"$1,514.84 ","$1,514.84 ",$551.25 ,"$1,514.84 ",$921.69 ,"$1,852.20 ","$1,249.45 ",$485.10 ,"$1,874.25 ","$1,852.20 ",$485.10 ,"$1,653.75 ","$1,764.00 ","$1,764.00 ",$485.10 ,"$1,764.00 ","$1,852.20 ","$1,852.20 ","$1,852.20 ","$2,205.00 ","$1,984.50 ","$1,267.88 ","$2,205.00 ",$485.10 ,"$2,205.00 ","$1,199.52 ",$485.10 ,$917.28 ,$443.97 ,$423.79 ,$509.36 ,"$1,874.25 ","$1,514.84 ",$617.40 ,"$1,984.50 ","$1,852.20 ","$1,764.00 ","$1,764.00 ",$485.10 ,"$1,433.25 "
ST. FRANCIS HOSPITAL - ACUTE,34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,405.00 ",$913.25 ,$309.10 ,"$1,405.00 ",$807.88 ,"$1,011.60 ",$764.32 ,$309.10 ,$393.40 ,$826.14 ,$309.10 ,$965.24 ,$351.25 ,$965.24 ,$965.24 ,$351.25 ,$965.24 ,$587.29 ,"$1,180.20 ",$962.48 ,$309.10 ,"$1,194.25 ","$1,180.20 ",$309.10 ,"$1,053.75 ","$1,124.00 ","$1,124.00 ",$309.10 ,"$1,124.00 ","$1,180.20 ","$1,180.20 ","$1,180.20 ","$1,405.00 ","$1,264.50 ",$807.88 ,"$1,405.00 ",$309.10 ,"$1,405.00 ",$764.32 ,$309.10 ,$584.48 ,$396.23 ,$378.22 ,$324.56 ,"$1,194.25 ",$965.24 ,$393.40 ,"$1,264.50 ","$1,180.20 ","$1,124.00 ","$1,124.00 ",$309.10 ,$913.25 
ST. FRANCIS HOSPITAL - ACUTE,34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$1,424.00 ",$925.60 ,$313.28 ,"$1,424.00 ",$818.80 ,"$1,025.28 ",$774.66 ,$313.28 ,$398.72 ,$837.31 ,$313.28 ,$978.29 ,$356.00 ,$978.29 ,$978.29 ,$356.00 ,$978.29 ,$595.23 ,"$1,196.16 ",$962.48 ,$313.28 ,"$1,210.40 ","$1,196.16 ",$313.28 ,"$1,068.00 ","$1,139.20 ","$1,139.20 ",$313.28 ,"$1,139.20 ","$1,196.16 ","$1,196.16 ","$1,196.16 ","$1,424.00 ","$1,281.60 ",$818.80 ,"$1,424.00 ",$313.28 ,"$1,424.00 ",$774.66 ,$313.28 ,$592.38 ,$443.97 ,$423.79 ,$328.94 ,"$1,210.40 ",$978.29 ,$398.72 ,"$1,281.60 ","$1,196.16 ","$1,139.20 ","$1,139.20 ",$313.28 ,$925.60 
ST. FRANCIS HOSPITAL - ACUTE,34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$1,026.00 ",$666.90 ,$225.72 ,"$1,026.00 ",$589.95 ,$738.72 ,$558.14 ,$225.72 ,$287.28 ,$603.29 ,$225.72 ,$704.86 ,$256.50 ,$704.86 ,$704.86 ,$256.50 ,$704.86 ,$428.87 ,$861.84 ,$962.48 ,$225.72 ,$872.10 ,$861.84 ,$225.72 ,$769.50 ,$820.80 ,$820.80 ,$225.72 ,$820.80 ,$861.84 ,$861.84 ,$861.84 ,"$1,026.00 ",$923.40 ,$589.95 ,"$1,026.00 ",$225.72 ,"$1,026.00 ",$558.14 ,$225.72 ,$426.82 ,$443.97 ,$423.79 ,$237.01 ,$872.10 ,$704.86 ,$287.28 ,$923.40 ,$861.84 ,$820.80 ,$820.80 ,$225.72 ,$666.90 
ST. FRANCIS HOSPITAL - ACUTE,34000027,78278,HC GI BLEED SCAN,340,1 ,"$1,258.00 ",$817.70 ,$276.76 ,"$1,258.00 ",$723.35 ,$905.76 ,$684.35 ,$276.76 ,$352.24 ,$739.70 ,$276.76 ,$864.25 ,$314.50 ,$864.25 ,$864.25 ,$314.50 ,$864.25 ,$525.84 ,"$1,056.72 ",$962.48 ,$276.76 ,"$1,069.30 ","$1,056.72 ",$276.76 ,$943.50 ,"$1,006.40 ","$1,006.40 ",$276.76 ,"$1,006.40 ","$1,056.72 ","$1,056.72 ","$1,056.72 ","$1,258.00 ","$1,132.20 ",$723.35 ,"$1,258.00 ",$276.76 ,"$1,258.00 ",$684.35 ,$276.76 ,$523.33 ,$443.97 ,$423.79 ,$290.60 ,"$1,069.30 ",$864.25 ,$352.24 ,"$1,132.20 ","$1,056.72 ","$1,006.40 ","$1,006.40 ",$276.76 ,$817.70 
ST. FRANCIS HOSPITAL - ACUTE,34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,040.00 ",$676.00 ,$228.80 ,"$1,040.00 ",$598.00 ,$748.80 ,$565.76 ,$228.80 ,$291.20 ,$611.52 ,$228.80 ,$714.48 ,$260.00 ,$714.48 ,$714.48 ,$260.00 ,$714.48 ,$434.72 ,$873.60 ,$962.48 ,$228.80 ,$884.00 ,$873.60 ,$228.80 ,$780.00 ,$832.00 ,$832.00 ,$228.80 ,$832.00 ,$873.60 ,$873.60 ,$873.60 ,"$1,040.00 ",$936.00 ,$598.00 ,"$1,040.00 ",$228.80 ,"$1,040.00 ",$565.76 ,$228.80 ,$432.64 ,$396.23 ,$378.22 ,$240.24 ,$884.00 ,$714.48 ,$291.20 ,$936.00 ,$873.60 ,$832.00 ,$832.00 ,$228.80 ,$676.00 
ST. FRANCIS HOSPITAL - ACUTE,34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,444.00 ",$938.60 ,$317.68 ,"$1,444.00 ",$830.30 ,"$1,039.68 ",$785.54 ,$317.68 ,$404.32 ,$849.07 ,$317.68 ,$992.03 ,$361.00 ,$992.03 ,$992.03 ,$361.00 ,$992.03 ,$603.59 ,"$1,212.96 ",$962.48 ,$317.68 ,"$1,227.40 ","$1,212.96 ",$317.68 ,"$1,083.00 ","$1,155.20 ","$1,155.20 ",$317.68 ,"$1,155.20 ","$1,212.96 ","$1,212.96 ","$1,212.96 ","$1,444.00 ","$1,299.60 ",$830.30 ,"$1,444.00 ",$317.68 ,"$1,444.00 ",$785.54 ,$317.68 ,$600.70 ,$396.23 ,$378.22 ,$333.56 ,"$1,227.40 ",$992.03 ,$404.32 ,"$1,299.60 ","$1,212.96 ","$1,155.20 ","$1,155.20 ",$317.68 ,$938.60 
ST. FRANCIS HOSPITAL - ACUTE,34000030,78305,HC BONE SCAN MULTIPLE,340,1 ,"$1,444.00 ",$938.60 ,$317.68 ,"$1,444.00 ",$830.30 ,"$1,039.68 ",$785.54 ,$317.68 ,$404.32 ,$849.07 ,$317.68 ,$992.03 ,$361.00 ,$992.03 ,$992.03 ,$361.00 ,$992.03 ,$603.59 ,"$1,212.96 ",$962.48 ,$317.68 ,"$1,227.40 ","$1,212.96 ",$317.68 ,"$1,083.00 ","$1,155.20 ","$1,155.20 ",$317.68 ,"$1,155.20 ","$1,212.96 ","$1,212.96 ","$1,212.96 ","$1,444.00 ","$1,299.60 ",$830.30 ,"$1,444.00 ",$317.68 ,"$1,444.00 ",$785.54 ,$317.68 ,$600.70 ,$396.23 ,$378.22 ,$333.56 ,"$1,227.40 ",$992.03 ,$404.32 ,"$1,299.60 ","$1,212.96 ","$1,155.20 ","$1,155.20 ",$317.68 ,$938.60 
ST. FRANCIS HOSPITAL - ACUTE,34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$1,444.00 ",$938.60 ,$317.68 ,"$1,444.00 ",$830.30 ,"$1,039.68 ",$785.54 ,$317.68 ,$404.32 ,$849.07 ,$317.68 ,$992.03 ,$361.00 ,$992.03 ,$992.03 ,$361.00 ,$992.03 ,$603.59 ,"$1,212.96 ",$962.48 ,$317.68 ,"$1,227.40 ","$1,212.96 ",$317.68 ,"$1,083.00 ","$1,155.20 ","$1,155.20 ",$317.68 ,"$1,155.20 ","$1,212.96 ","$1,212.96 ","$1,212.96 ","$1,444.00 ","$1,299.60 ",$830.30 ,"$1,444.00 ",$317.68 ,"$1,444.00 ",$785.54 ,$317.68 ,$600.70 ,$396.23 ,$378.22 ,$333.56 ,"$1,227.40 ",$992.03 ,$404.32 ,"$1,299.60 ","$1,212.96 ","$1,155.20 ","$1,155.20 ",$317.68 ,$938.60 
ST. FRANCIS HOSPITAL - ACUTE,34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$1,444.00 ",$938.60 ,$317.68 ,"$1,444.00 ",$830.30 ,"$1,039.68 ",$785.54 ,$317.68 ,$404.32 ,$849.07 ,$317.68 ,$992.03 ,$361.00 ,$992.03 ,$992.03 ,$361.00 ,$992.03 ,$603.59 ,"$1,212.96 ",$962.48 ,$317.68 ,"$1,227.40 ","$1,212.96 ",$317.68 ,"$1,083.00 ","$1,155.20 ","$1,155.20 ",$317.68 ,"$1,155.20 ","$1,212.96 ","$1,212.96 ","$1,212.96 ","$1,444.00 ","$1,299.60 ",$830.30 ,"$1,444.00 ",$317.68 ,"$1,444.00 ",$785.54 ,$317.68 ,$600.70 ,$396.23 ,$378.22 ,$333.56 ,"$1,227.40 ",$992.03 ,$404.32 ,"$1,299.60 ","$1,212.96 ","$1,155.20 ","$1,155.20 ",$317.68 ,$938.60 
ST. FRANCIS HOSPITAL - ACUTE,34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$3,976.00 ","$2,584.40 ",$423.79 ,"$3,976.00 ","$2,286.20 ","$2,862.72 ","$2,162.94 ",$874.72 ,"$1,113.28 ","$2,337.89 ",$874.72 ,"$2,731.51 ",$994.00 ,"$2,731.51 ","$2,731.51 ",$994.00 ,"$2,731.51 ","$1,661.97 ","$3,339.84 ","$3,336.55 ",$874.72 ,"$3,379.60 ","$3,339.84 ",$874.72 ,"$2,982.00 ","$3,180.80 ","$3,180.80 ",$874.72 ,"$3,180.80 ","$3,339.84 ","$3,339.84 ","$3,339.84 ","$3,976.00 ","$3,578.40 ","$2,286.20 ","$3,976.00 ",$874.72 ,"$3,976.00 ","$2,162.94 ",$874.72 ,"$1,654.02 ",$443.97 ,$423.79 ,$918.46 ,"$3,379.60 ","$2,731.51 ","$1,113.28 ","$3,578.40 ","$3,339.84 ","$3,180.80 ","$3,180.80 ",$874.72 ,"$2,584.40 "
ST. FRANCIS HOSPITAL - ACUTE,34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$5,055.00 ","$3,285.75 ",$927.87 ,"$5,055.00 ","$2,906.63 ","$3,639.60 ","$2,749.92 ","$1,112.10 ","$1,415.40 ","$2,972.34 ","$1,112.10 ","$3,472.79 ","$1,263.75 ","$3,472.79 ","$3,472.79 ","$1,263.75 ","$3,472.79 ","$2,112.99 ","$4,246.20 ","$3,336.55 ","$1,112.10 ","$4,296.75 ","$4,246.20 ","$1,112.10 ","$3,791.25 ","$4,044.00 ","$4,044.00 ","$1,112.10 ","$4,044.00 ","$4,246.20 ","$4,246.20 ","$4,246.20 ","$5,055.00 ","$4,549.50 ","$2,906.63 ","$5,055.00 ","$1,112.10 ","$5,055.00 ","$2,749.92 ","$1,112.10 ","$2,102.88 ",$972.06 ,$927.87 ,"$1,167.71 ","$4,296.75 ","$3,472.79 ","$1,415.40 ","$4,549.50 ","$4,246.20 ","$4,044.00 ","$4,044.00 ","$1,112.10 ","$3,285.75 "
ST. FRANCIS HOSPITAL - ACUTE,34000044,78472,HC MUGA RESTING SGL,340,1 ,"$1,258.00 ",$817.70 ,$276.76 ,"$1,258.00 ",$723.35 ,$905.76 ,$684.35 ,$276.76 ,$352.24 ,$739.70 ,$276.76 ,$864.25 ,$314.50 ,$864.25 ,$864.25 ,$314.50 ,$864.25 ,$525.84 ,"$1,056.72 ",$962.48 ,$276.76 ,"$1,069.30 ","$1,056.72 ",$276.76 ,$943.50 ,"$1,006.40 ","$1,006.40 ",$276.76 ,"$1,006.40 ","$1,056.72 ","$1,056.72 ","$1,056.72 ","$1,258.00 ","$1,132.20 ",$723.35 ,"$1,258.00 ",$276.76 ,"$1,258.00 ",$684.35 ,$276.76 ,$523.33 ,$396.23 ,$378.22 ,$290.60 ,"$1,069.30 ",$864.25 ,$352.24 ,"$1,132.20 ","$1,056.72 ","$1,006.40 ","$1,006.40 ",$276.76 ,$817.70 
ST. FRANCIS HOSPITAL - ACUTE,34000047,78580,HC LUNG PERFUS,340,1 ,"$2,110.00 ","$1,371.50 ",$423.79 ,"$2,110.00 ","$1,213.25 ","$1,519.20 ","$1,147.84 ",$464.20 ,$590.80 ,"$1,240.68 ",$464.20 ,"$1,449.57 ",$527.50 ,"$1,449.57 ","$1,449.57 ",$527.50 ,"$1,449.57 ",$881.98 ,"$1,772.40 ",$962.48 ,$464.20 ,"$1,793.50 ","$1,772.40 ",$464.20 ,"$1,582.50 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,688.00 ","$1,772.40 ","$1,772.40 ","$1,772.40 ","$2,110.00 ","$1,899.00 ","$1,213.25 ","$2,110.00 ",$464.20 ,"$2,110.00 ","$1,147.84 ",$464.20 ,$877.76 ,$443.97 ,$423.79 ,$487.41 ,"$1,793.50 ","$1,449.57 ",$590.80 ,"$1,899.00 ","$1,772.40 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,371.50 "
ST. FRANCIS HOSPITAL - ACUTE,34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$3,193.00 ","$2,075.45 ",$423.79 ,"$3,193.00 ","$1,835.98 ","$2,298.96 ","$1,736.99 ",$702.46 ,$894.04 ,"$1,877.48 ",$702.46 ,"$2,193.59 ",$798.25 ,"$2,193.59 ","$2,193.59 ",$798.25 ,"$2,193.59 ","$1,334.67 ","$2,682.12 ","$1,249.45 ",$702.46 ,"$2,714.05 ","$2,682.12 ",$702.46 ,"$2,394.75 ","$2,554.40 ","$2,554.40 ",$702.46 ,"$2,554.40 ","$2,682.12 ","$2,682.12 ","$2,682.12 ","$3,193.00 ","$2,873.70 ","$1,835.98 ","$3,193.00 ",$702.46 ,"$3,193.00 ","$1,736.99 ",$702.46 ,"$1,328.29 ",$443.97 ,$423.79 ,$737.58 ,"$2,714.05 ","$2,193.59 ",$894.04 ,"$2,873.70 ","$2,682.12 ","$2,554.40 ","$2,554.40 ",$702.46 ,"$2,075.45 "
ST. FRANCIS HOSPITAL - ACUTE,34000060,78700,HC KIDNEY SCAN,340,1 ,$955.00 ,$620.75 ,$210.10 ,$962.48 ,$549.13 ,$687.60 ,$519.52 ,$210.10 ,$267.40 ,$561.54 ,$210.10 ,$656.09 ,$238.75 ,$656.09 ,$656.09 ,$238.75 ,$656.09 ,$399.19 ,$802.20 ,$962.48 ,$210.10 ,$811.75 ,$802.20 ,$210.10 ,$716.25 ,$764.00 ,$764.00 ,$210.10 ,$764.00 ,$802.20 ,$802.20 ,$802.20 ,$955.00 ,$859.50 ,$549.13 ,$955.00 ,$210.10 ,$955.00 ,$519.52 ,$210.10 ,$397.28 ,$396.23 ,$378.22 ,$220.61 ,$811.75 ,$656.09 ,$267.40 ,$859.50 ,$802.20 ,$764.00 ,$764.00 ,$210.10 ,$620.75 
ST. FRANCIS HOSPITAL - ACUTE,34000061,78701,HC KIDNEY SCAN W/FLOW,340,1 ,"$1,461.00 ",$949.65 ,$321.42 ,"$1,461.00 ",$840.08 ,"$1,051.92 ",$794.78 ,$321.42 ,$409.08 ,$859.07 ,$321.42 ,"$1,003.71 ",$365.25 ,"$1,003.71 ","$1,003.71 ",$365.25 ,"$1,003.71 ",$610.70 ,"$1,227.24 ",$962.48 ,$321.42 ,"$1,241.85 ","$1,227.24 ",$321.42 ,"$1,095.75 ","$1,168.80 ","$1,168.80 ",$321.42 ,"$1,168.80 ","$1,227.24 ","$1,227.24 ","$1,227.24 ","$1,461.00 ","$1,314.90 ",$840.08 ,"$1,461.00 ",$321.42 ,"$1,461.00 ",$794.78 ,$321.42 ,$607.78 ,$396.23 ,$378.22 ,$337.49 ,"$1,241.85 ","$1,003.71 ",$409.08 ,"$1,314.90 ","$1,227.24 ","$1,168.80 ","$1,168.80 ",$321.42 ,$949.65 
ST. FRANCIS HOSPITAL - ACUTE,34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$1,461.00 ",$949.65 ,$321.42 ,"$1,461.00 ",$840.08 ,"$1,051.92 ",$794.78 ,$321.42 ,$409.08 ,$859.07 ,$321.42 ,"$1,003.71 ",$365.25 ,"$1,003.71 ","$1,003.71 ",$365.25 ,"$1,003.71 ",$610.70 ,"$1,227.24 ","$1,249.45 ",$321.42 ,"$1,241.85 ","$1,227.24 ",$321.42 ,"$1,095.75 ","$1,168.80 ","$1,168.80 ",$321.42 ,"$1,168.80 ","$1,227.24 ","$1,227.24 ","$1,227.24 ","$1,461.00 ","$1,314.90 ",$840.08 ,"$1,461.00 ",$321.42 ,"$1,461.00 ",$794.78 ,$321.42 ,$607.78 ,$396.23 ,$378.22 ,$337.49 ,"$1,241.85 ","$1,003.71 ",$409.08 ,"$1,314.90 ","$1,227.24 ","$1,168.80 ","$1,168.80 ",$321.42 ,$949.65 
ST. FRANCIS HOSPITAL - ACUTE,34000065,78709,HC KIDNEY W AND W/O PHARM INTERVEN,340,1 ,"$2,107.00 ","$1,369.55 ",$378.22 ,"$2,107.00 ","$1,211.53 ","$1,517.04 ","$1,146.21 ",$463.54 ,$589.96 ,"$1,238.92 ",$463.54 ,"$1,447.51 ",$526.75 ,"$1,447.51 ","$1,447.51 ",$526.75 ,"$1,447.51 ",$880.73 ,"$1,769.88 ","$1,249.45 ",$463.54 ,"$1,790.95 ","$1,769.88 ",$463.54 ,"$1,580.25 ","$1,685.60 ","$1,685.60 ",$463.54 ,"$1,685.60 ","$1,769.88 ","$1,769.88 ","$1,769.88 ","$2,107.00 ","$1,896.30 ","$1,211.53 ","$2,107.00 ",$463.54 ,"$2,107.00 ","$1,146.21 ",$463.54 ,$876.51 ,$396.23 ,$378.22 ,$486.72 ,"$1,790.95 ","$1,447.51 ",$589.96 ,"$1,896.30 ","$1,769.88 ","$1,685.60 ","$1,685.60 ",$463.54 ,"$1,369.55 "
ST. FRANCIS HOSPITAL - ACUTE,34000068,78800,HC TUMOR LOCAL LIMITED,340,1 ,"$2,547.00 ","$1,655.55 ",$423.79 ,"$2,547.00 ","$1,464.53 ","$1,833.84 ","$1,385.57 ",$560.34 ,$713.16 ,"$1,497.64 ",$560.34 ,"$1,749.79 ",$636.75 ,"$1,749.79 ","$1,749.79 ",$636.75 ,"$1,749.79 ","$1,064.65 ","$2,139.48 ",$962.48 ,$560.34 ,"$2,164.95 ","$2,139.48 ",$560.34 ,"$1,910.25 ","$2,037.60 ","$2,037.60 ",$560.34 ,"$2,037.60 ","$2,139.48 ","$2,139.48 ","$2,139.48 ","$2,547.00 ","$2,292.30 ","$1,464.53 ","$2,547.00 ",$560.34 ,"$2,547.00 ","$1,385.57 ",$560.34 ,"$1,059.55 ",$443.97 ,$423.79 ,$588.36 ,"$2,164.95 ","$1,749.79 ",$713.16 ,"$2,292.30 ","$2,139.48 ","$2,037.60 ","$2,037.60 ",$560.34 ,"$1,655.55 "
ST. FRANCIS HOSPITAL - ACUTE,34000069,78801,HC TUMOR LOCAL MULTIPLE,340,1 ,"$2,852.00 ","$1,853.80 ",$423.79 ,"$2,852.00 ","$1,639.90 ","$2,053.44 ","$1,551.49 ",$627.44 ,$798.56 ,"$1,676.98 ",$627.44 ,"$1,959.32 ",$713.00 ,"$1,959.32 ","$1,959.32 ",$713.00 ,"$1,959.32 ","$1,192.14 ","$2,395.68 ",$962.48 ,$627.44 ,"$2,424.20 ","$2,395.68 ",$627.44 ,"$2,139.00 ","$2,281.60 ","$2,281.60 ",$627.44 ,"$2,281.60 ","$2,395.68 ","$2,395.68 ","$2,395.68 ","$2,852.00 ","$2,566.80 ","$1,639.90 ","$2,852.00 ",$627.44 ,"$2,852.00 ","$1,551.49 ",$627.44 ,"$1,186.43 ",$443.97 ,$423.79 ,$658.81 ,"$2,424.20 ","$1,959.32 ",$798.56 ,"$2,566.80 ","$2,395.68 ","$2,281.60 ","$2,281.60 ",$627.44 ,"$1,853.80 "
ST. FRANCIS HOSPITAL - ACUTE,34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$3,606.00 ","$2,343.90 ",$793.32 ,"$3,606.00 ","$2,073.45 ","$2,596.32 ","$1,961.66 ",$793.32 ,"$1,009.68 ","$2,120.33 ",$793.32 ,"$2,477.32 ",$901.50 ,"$2,477.32 ","$2,477.32 ",$901.50 ,"$2,477.32 ","$1,507.31 ","$3,029.04 ","$3,336.55 ",$793.32 ,"$3,065.10 ","$3,029.04 ",$793.32 ,"$2,704.50 ","$2,884.80 ","$2,884.80 ",$793.32 ,"$2,884.80 ","$3,029.04 ","$3,029.04 ","$3,029.04 ","$3,606.00 ","$3,245.40 ","$2,073.45 ","$3,606.00 ",$793.32 ,"$3,606.00 ","$1,961.66 ",$793.32 ,"$1,500.10 ",$972.06 ,$927.87 ,$832.99 ,"$3,065.10 ","$2,477.32 ","$1,009.68 ","$3,245.40 ","$3,029.04 ","$2,884.80 ","$2,884.80 ",$793.32 ,"$2,343.90 "
ST. FRANCIS HOSPITAL - ACUTE,34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$3,606.00 ","$2,343.90 ",$793.32 ,"$3,606.00 ","$2,073.45 ","$2,596.32 ","$1,961.66 ",$793.32 ,"$1,009.68 ","$2,120.33 ",$793.32 ,"$2,477.32 ",$901.50 ,"$2,477.32 ","$2,477.32 ",$901.50 ,"$2,477.32 ","$1,507.31 ","$3,029.04 ","$3,336.55 ",$793.32 ,"$3,065.10 ","$3,029.04 ",$793.32 ,"$2,704.50 ","$2,884.80 ","$2,884.80 ",$793.32 ,"$2,884.80 ","$3,029.04 ","$3,029.04 ","$3,029.04 ","$3,606.00 ","$3,245.40 ","$2,073.45 ","$3,606.00 ",$793.32 ,"$3,606.00 ","$1,961.66 ",$793.32 ,"$1,500.10 ",$972.06 ,$927.87 ,$832.99 ,"$3,065.10 ","$2,477.32 ","$1,009.68 ","$3,245.40 ","$3,029.04 ","$2,884.80 ","$2,884.80 ",$793.32 ,"$2,343.90 "
ST. FRANCIS HOSPITAL - ACUTE,34000077,78804,HC TUMOR/INF-WHOLE BODY-MULT DAY,340,1 ,"$3,606.00 ","$2,343.90 ",$793.32 ,"$3,606.00 ","$2,073.45 ","$2,596.32 ","$1,961.66 ",$793.32 ,"$1,009.68 ","$2,120.33 ",$793.32 ,"$2,477.32 ",$901.50 ,"$2,477.32 ","$2,477.32 ",$901.50 ,"$2,477.32 ","$1,507.31 ","$3,029.04 ","$3,336.55 ",$793.32 ,"$3,065.10 ","$3,029.04 ",$793.32 ,"$2,704.50 ","$2,884.80 ","$2,884.80 ",$793.32 ,"$2,884.80 ","$3,029.04 ","$3,029.04 ","$3,029.04 ","$3,606.00 ","$3,245.40 ","$2,073.45 ","$3,606.00 ",$793.32 ,"$3,606.00 ","$1,961.66 ",$793.32 ,"$1,500.10 ",$972.06 ,$927.87 ,$832.99 ,"$3,065.10 ","$2,477.32 ","$1,009.68 ","$3,245.40 ","$3,029.04 ","$2,884.80 ","$2,884.80 ",$793.32 ,"$2,343.90 "
ST. FRANCIS HOSPITAL - ACUTE,34000090,78597,HC PULM PERF DIFF W/IMG,340,1 ,"$3,149.00 ","$2,046.85 ",$423.79 ,"$3,149.00 ","$1,810.68 ","$2,267.28 ","$1,713.06 ",$692.78 ,$881.72 ,"$1,851.61 ",$692.78 ,"$2,163.36 ",$787.25 ,"$2,163.36 ","$2,163.36 ",$787.25 ,"$2,163.36 ","$1,316.28 ","$2,645.16 ",$962.48 ,$692.78 ,"$2,676.65 ","$2,645.16 ",$692.78 ,"$2,361.75 ","$2,519.20 ","$2,519.20 ",$692.78 ,"$2,519.20 ","$2,645.16 ","$2,645.16 ","$2,645.16 ","$3,149.00 ","$2,834.10 ","$1,810.68 ","$3,149.00 ",$692.78 ,"$3,149.00 ","$1,713.06 ",$692.78 ,"$1,309.98 ",$443.97 ,$423.79 ,$727.42 ,"$2,676.65 ","$2,163.36 ",$881.72 ,"$2,834.10 ","$2,645.16 ","$2,519.20 ","$2,519.20 ",$692.78 ,"$2,046.85 "
ST. FRANCIS HOSPITAL - ACUTE,34000091,78598,HC NM PULM VENT AND PERF DIFF W/IMG,340,1 ,"$2,110.00 ","$1,371.50 ",$423.79 ,"$2,110.00 ","$1,213.25 ","$1,519.20 ","$1,147.84 ",$464.20 ,$590.80 ,"$1,240.68 ",$464.20 ,"$1,449.57 ",$527.50 ,"$1,449.57 ","$1,449.57 ",$527.50 ,"$1,449.57 ",$881.98 ,"$1,772.40 ","$1,249.45 ",$464.20 ,"$1,793.50 ","$1,772.40 ",$464.20 ,"$1,582.50 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,688.00 ","$1,772.40 ","$1,772.40 ","$1,772.40 ","$2,110.00 ","$1,899.00 ","$1,213.25 ","$2,110.00 ",$464.20 ,"$2,110.00 ","$1,147.84 ",$464.20 ,$877.76 ,$443.97 ,$423.79 ,$487.41 ,"$1,793.50 ","$1,449.57 ",$590.80 ,"$1,899.00 ","$1,772.40 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,371.50 "
ST. FRANCIS HOSPITAL - ACUTE,34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$2,310.00 ","$1,501.50 ",$423.79 ,"$2,310.00 ","$1,328.25 ","$1,663.20 ","$1,256.64 ",$508.20 ,$646.80 ,"$1,358.28 ",$508.20 ,"$1,586.97 ",$577.50 ,"$1,586.97 ","$1,586.97 ",$577.50 ,"$1,586.97 ",$965.58 ,"$1,940.40 ","$1,249.45 ",$508.20 ,"$1,963.50 ","$1,940.40 ",$508.20 ,"$1,732.50 ","$1,848.00 ","$1,848.00 ",$508.20 ,"$1,848.00 ","$1,940.40 ","$1,940.40 ","$1,940.40 ","$2,310.00 ","$2,079.00 ","$1,328.25 ","$2,310.00 ",$508.20 ,"$2,310.00 ","$1,256.64 ",$508.20 ,$960.96 ,$443.97 ,$423.79 ,$533.61 ,"$1,963.50 ","$1,586.97 ",$646.80 ,"$2,079.00 ","$1,940.40 ","$1,848.00 ","$1,848.00 ",$508.20 ,"$1,501.50 "
ST. FRANCIS HOSPITAL - ACUTE,34000093,78071,HC PARATHYROID IMG W/SPECT 78071,340,1 ,"$1,341.00 ",$871.65 ,$295.02 ,"$1,341.00 ",$771.08 ,$965.52 ,$729.50 ,$295.02 ,$375.48 ,$788.51 ,$295.02 ,$921.27 ,$335.25 ,$921.27 ,$921.27 ,$335.25 ,$921.27 ,$560.54 ,"$1,126.44 ",$962.48 ,$295.02 ,"$1,139.85 ","$1,126.44 ",$295.02 ,"$1,005.75 ","$1,072.80 ","$1,072.80 ",$295.02 ,"$1,072.80 ","$1,126.44 ","$1,126.44 ","$1,126.44 ","$1,341.00 ","$1,206.90 ",$771.08 ,"$1,341.00 ",$295.02 ,"$1,341.00 ",$729.50 ,$295.02 ,$557.86 ,$396.23 ,$378.22 ,$309.77 ,"$1,139.85 ",$921.27 ,$375.48 ,"$1,206.90 ","$1,126.44 ","$1,072.80 ","$1,072.80 ",$295.02 ,$871.65 
ST. FRANCIS HOSPITAL - ACUTE,34100032,78494,HC MUGA RESTING W/SPECT,341,1 ,"$1,241.00 ",$806.65 ,$273.02 ,"$1,241.00 ",$713.58 ,$893.52 ,$675.10 ,$273.02 ,$347.48 ,$729.71 ,$273.02 ,$852.57 ,$310.25 ,$852.57 ,$852.57 ,$310.25 ,$852.57 ,$518.74 ,"$1,042.44 ",$962.48 ,$273.02 ,"$1,054.85 ","$1,042.44 ",$273.02 ,$930.75 ,$992.80 ,$992.80 ,$273.02 ,$992.80 ,"$1,042.44 ","$1,042.44 ","$1,042.44 ","$1,241.00 ","$1,116.90 ",$713.58 ,"$1,241.00 ",$273.02 ,"$1,241.00 ",$675.10 ,$273.02 ,$516.26 ,$972.06 ,$927.87 ,$286.67 ,"$1,054.85 ",$852.57 ,$347.48 ,"$1,116.90 ","$1,042.44 ",$992.80 ,$992.80 ,$273.02 ,$806.65 
ST. FRANCIS HOSPITAL - ACUTE,34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$398.00 ,$258.70 ,$87.56 ,$398.00 ,$228.85 ,$286.56 ,$216.51 ,$87.56 ,$111.44 ,$234.02 ,$87.56 ,$273.43 ,$99.50 ,$273.43 ,$273.43 ,$99.50 ,$273.43 ,$166.36 ,$334.32 , N/A ,$87.56 ,$338.30 ,$334.32 ,$87.56 ,$298.50 ,$318.40 ,$318.40 ,$87.56 ,$318.40 ,$334.32 ,$334.32 ,$334.32 ,$398.00 ,$358.20 ,$228.85 ,$398.00 ,$87.56 ,$398.00 ,$216.51 ,$87.56 ,$165.57 , N/A , N/A ,$91.94 ,$338.30 ,$273.43 ,$111.44 ,$358.20 ,$334.32 ,$398.00 ,$398.00 ,$87.56 ,$258.70 
ST. FRANCIS HOSPITAL - ACUTE,34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$88.00 ,$57.20 ,$19.36 ,$88.00 ,$50.60 ,$63.36 ,$47.87 ,$19.36 ,$24.64 ,$51.74 ,$19.36 ,$60.46 ,$22.00 ,$60.46 ,$60.46 ,$22.00 ,$60.46 ,$36.78 ,$73.92 , N/A ,$19.36 ,$74.80 ,$73.92 ,$19.36 ,$66.00 ,$70.40 ,$70.40 ,$19.36 ,$70.40 ,$73.92 ,$73.92 ,$73.92 ,$88.00 ,$79.20 ,$50.60 ,$88.00 ,$19.36 ,$88.00 ,$47.87 ,$19.36 ,$36.61 , N/A , N/A ,$20.33 ,$74.80 ,$60.46 ,$24.64 ,$79.20 ,$73.92 ,$26.83 ,$26.83 ,$19.36 ,$57.20 
ST. FRANCIS HOSPITAL - ACUTE,34300006,A9505,HC DIAGNUCLIDE THALL 201 PER MCI,343,1 ,$440.00 ,$286.00 ,$96.80 ,$440.00 ,$253.00 ,$316.80 ,$239.36 ,$96.80 ,$123.20 ,$258.72 ,$96.80 ,$302.28 ,$110.00 ,$302.28 ,$302.28 ,$110.00 ,$302.28 ,$183.92 ,$369.60 , N/A ,$96.80 ,$374.00 ,$369.60 ,$96.80 ,$330.00 ,$352.00 ,$352.00 ,$96.80 ,$352.00 ,$369.60 ,$369.60 ,$369.60 ,$440.00 ,$396.00 ,$253.00 ,$440.00 ,$96.80 ,$440.00 ,$239.36 ,$96.80 ,$183.04 , N/A , N/A ,$101.64 ,$374.00 ,$302.28 ,$123.20 ,$396.00 ,$369.60 ,$203.28 ,$203.28 ,$96.80 ,$286.00 
ST. FRANCIS HOSPITAL - ACUTE,34300009,A9512,HC TECHNETIUM TC99 PERTECH PER MCI,343,1 ,$2.50 ,$1.63 ,$0.55 ,$2.50 ,$1.45 ,$1.80 ,$1.36 ,$0.55 ,$0.70 ,$1.40 ,$0.55 ,$1.63 ,$0.63 ,$1.63 ,$1.63 ,$0.63 ,$1.63 ,$1.05 ,$2.10 , N/A ,$0.55 ,$2.13 ,$2.10 ,$0.55 ,$1.88 ,$2.00 ,$2.00 ,$0.55 ,$2.00 ,$2.10 ,$2.10 ,$2.10 ,$2.50 ,$2.25 ,$1.45 ,$2.50 ,$0.55 ,$2.50 ,$1.36 ,$0.55 ,$1.04 , N/A , N/A ,$0.58 ,$2.13 ,$1.63 ,$0.70 ,$2.25 ,$2.10 ,$2.50 ,$2.50 ,$0.55 ,$1.63 
ST. FRANCIS HOSPITAL - ACUTE,34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$125.00 ,$81.25 ,$27.50 ,$125.00 ,$71.88 ,$90.00 ,$68.00 ,$27.50 ,$35.00 ,$73.50 ,$27.50 ,$85.88 ,$31.25 ,$85.88 ,$85.88 ,$31.25 ,$85.88 ,$52.25 ,$105.00 , N/A ,$27.50 ,$106.25 ,$105.00 ,$27.50 ,$93.75 ,$100.00 ,$100.00 ,$27.50 ,$100.00 ,$105.00 ,$105.00 ,$105.00 ,$125.00 ,$112.50 ,$71.88 ,$125.00 ,$27.50 ,$125.00 ,$68.00 ,$27.50 ,$52.00 , N/A , N/A ,$28.88 ,$106.25 ,$85.88 ,$35.00 ,$112.50 ,$105.00 ,$125.00 ,$125.00 ,$27.50 ,$81.25 
ST. FRANCIS HOSPITAL - ACUTE,34300014,A9528,HC DIAGNUCLIDE I131 NECK/CHST,343,1 ,$76.00 ,$49.40 ,$16.72 ,$76.00 ,$43.70 ,$54.72 ,$41.34 ,$16.72 ,$21.28 ,$42.64 ,$16.72 ,$49.55 ,$19.00 ,$49.55 ,$49.55 ,$19.00 ,$49.55 ,$31.77 ,$63.84 , N/A ,$16.72 ,$64.60 ,$63.84 ,$16.72 ,$57.00 ,$60.80 ,$60.80 ,$16.72 ,$60.80 ,$63.84 ,$63.84 ,$63.84 ,$76.00 ,$68.40 ,$43.70 ,$76.00 ,$16.72 ,$76.00 ,$41.34 ,$16.72 ,$31.62 , N/A , N/A ,$17.56 ,$64.60 ,$49.55 ,$21.28 ,$68.40 ,$63.84 ,$76.00 ,$76.00 ,$16.72 ,$49.40 
ST. FRANCIS HOSPITAL - ACUTE,34300015,A9530,HC THERAPEUTIC ISOTOPE SOLUTION PER MCI,343,1 ,$43.00 ,$27.95 ,$9.46 ,$336.93 ,$24.73 ,$30.96 ,$23.39 ,$9.46 ,$12.04 ,$24.12 ,$9.46 ,$28.04 ,$10.75 ,$28.04 ,$28.04 ,$10.75 ,$28.04 ,$17.97 ,$36.12 ,$33.35 ,$9.46 ,$36.55 ,$36.12 ,$9.46 ,$32.25 ,$34.40 ,$34.40 ,$9.46 ,$34.40 ,$36.12 ,$36.12 ,$36.12 ,$43.00 ,$38.70 ,$24.73 ,$43.00 ,$9.46 ,$43.00 ,$23.39 ,$9.46 ,$17.89 ,$336.93 ,$321.62 ,$9.93 ,$36.55 ,$28.04 ,$12.04 ,$38.70 ,$36.12 ,$22.01 ,$22.01 ,$9.46 ,$27.95 
ST. FRANCIS HOSPITAL - ACUTE,34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$138.00 ,$89.70 ,$30.36 ,$138.00 ,$79.35 ,$99.36 ,$75.07 ,$30.36 ,$38.64 ,$81.14 ,$30.36 ,$94.81 ,$34.50 ,$94.81 ,$94.81 ,$34.50 ,$94.81 ,$57.68 ,$115.92 , N/A ,$30.36 ,$117.30 ,$115.92 ,$30.36 ,$103.50 ,$110.40 ,$110.40 ,$30.36 ,$110.40 ,$115.92 ,$115.92 ,$115.92 ,$138.00 ,$124.20 ,$79.35 ,$138.00 ,$30.36 ,$138.00 ,$75.07 ,$30.36 ,$57.41 , N/A , N/A ,$31.88 ,$117.30 ,$94.81 ,$38.64 ,$124.20 ,$115.92 ,$138.00 ,$138.00 ,$30.36 ,$89.70 
ST. FRANCIS HOSPITAL - ACUTE,34300018,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$626.00 ,$406.90 ,$55.95 ,$626.00 ,$359.95 ,$450.72 ,$340.54 ,$137.72 ,$175.28 ,$368.09 ,$137.72 ,$430.06 ,$156.50 ,$430.06 ,$430.06 ,$156.50 ,$430.06 ,$261.67 ,$525.84 , N/A ,$137.72 ,$532.10 ,$525.84 ,$137.72 ,$469.50 ,$500.80 ,$500.80 ,$137.72 ,$500.80 ,$525.84 ,$525.84 ,$525.84 ,$626.00 ,$563.40 ,$359.95 ,$626.00 ,$137.72 ,$626.00 ,$340.54 ,$137.72 ,$260.42 , N/A , N/A ,$144.61 ,$532.10 ,$430.06 ,$175.28 ,$563.40 ,$525.84 ,$55.95 ,$55.95 ,$137.72 ,$406.90 
ST. FRANCIS HOSPITAL - ACUTE,34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$626.00 ,$406.90 ,$55.95 ,$626.00 ,$359.95 ,$450.72 ,$340.54 ,$137.72 ,$175.28 ,$368.09 ,$137.72 ,$430.06 ,$156.50 ,$430.06 ,$430.06 ,$156.50 ,$430.06 ,$261.67 ,$525.84 , N/A ,$137.72 ,$532.10 ,$525.84 ,$137.72 ,$469.50 ,$500.80 ,$500.80 ,$137.72 ,$500.80 ,$525.84 ,$525.84 ,$525.84 ,$626.00 ,$563.40 ,$359.95 ,$626.00 ,$137.72 ,$626.00 ,$340.54 ,$137.72 ,$260.42 , N/A , N/A ,$144.61 ,$532.10 ,$430.06 ,$175.28 ,$563.40 ,$525.84 ,$55.95 ,$55.95 ,$137.72 ,$406.90 
ST. FRANCIS HOSPITAL - ACUTE,34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,"$1,037.00 ",$674.05 ,$228.14 ,"$1,037.00 ",$596.28 ,$746.64 ,$564.13 ,$228.14 ,$290.36 ,$609.76 ,$228.14 ,$712.42 ,$259.25 ,$712.42 ,$712.42 ,$259.25 ,$712.42 ,$433.47 ,$871.08 , N/A ,$228.14 ,$881.45 ,$871.08 ,$228.14 ,$777.75 ,$829.60 ,$829.60 ,$228.14 ,$829.60 ,$871.08 ,$871.08 ,$871.08 ,"$1,037.00 ",$933.30 ,$596.28 ,"$1,037.00 ",$228.14 ,"$1,037.00 ",$564.13 ,$228.14 ,$431.39 , N/A , N/A ,$239.55 ,$881.45 ,$712.42 ,$290.36 ,$933.30 ,$871.08 ,$408.26 ,$408.26 ,$228.14 ,$674.05 
ST. FRANCIS HOSPITAL - ACUTE,34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$1,188.00 ",$772.20 ,$261.36 ,"$1,188.00 ",$683.10 ,$855.36 ,$646.27 ,$261.36 ,$332.64 ,$698.54 ,$261.36 ,$816.16 ,$297.00 ,$816.16 ,$816.16 ,$297.00 ,$816.16 ,$496.58 ,$997.92 , N/A ,$261.36 ,"$1,009.80 ",$997.92 ,$261.36 ,$891.00 ,$950.40 ,$950.40 ,$261.36 ,$950.40 ,$997.92 ,$997.92 ,$997.92 ,"$1,188.00 ","$1,069.20 ",$683.10 ,"$1,188.00 ",$261.36 ,"$1,188.00 ",$646.27 ,$261.36 ,$494.21 , N/A , N/A ,$274.43 ,"$1,009.80 ",$816.16 ,$332.64 ,"$1,069.20 ",$997.92 ,$521.90 ,$521.90 ,$261.36 ,$772.20 
ST. FRANCIS HOSPITAL - ACUTE,34300028,A9551,HC DIAGNUCLIDE DMSA,343,1 ,"$2,004.00 ","$1,302.60 ",$440.88 ,"$2,004.00 ","$1,152.30 ","$1,442.88 ","$1,090.18 ",$440.88 ,$561.12 ,"$1,178.35 ",$440.88 ,"$1,376.75 ",$501.00 ,"$1,376.75 ","$1,376.75 ",$501.00 ,"$1,376.75 ",$837.67 ,"$1,683.36 ", N/A ,$440.88 ,"$1,703.40 ","$1,683.36 ",$440.88 ,"$1,503.00 ","$1,603.20 ","$1,603.20 ",$440.88 ,"$1,603.20 ","$1,683.36 ","$1,683.36 ","$1,683.36 ","$2,004.00 ","$1,803.60 ","$1,152.30 ","$2,004.00 ",$440.88 ,"$2,004.00 ","$1,090.18 ",$440.88 ,$833.66 , N/A , N/A ,$462.92 ,"$1,703.40 ","$1,376.75 ",$561.12 ,"$1,803.60 ","$1,683.36 ","$1,084.33 ","$1,084.33 ",$440.88 ,"$1,302.60 "
ST. FRANCIS HOSPITAL - ACUTE,34300029,A9552,HC DIAGNUCLIDE 18FDG,343,1 ,"$1,064.00 ",$691.60 ,$234.08 ,"$1,064.00 ",$611.80 ,$766.08 ,$578.82 ,$234.08 ,$297.92 ,$625.63 ,$234.08 ,$730.97 ,$266.00 ,$730.97 ,$730.97 ,$266.00 ,$730.97 ,$444.75 ,$893.76 , N/A ,$234.08 ,$904.40 ,$893.76 ,$234.08 ,$798.00 ,$851.20 ,$851.20 ,$234.08 ,$851.20 ,$893.76 ,$893.76 ,$893.76 ,"$1,064.00 ",$957.60 ,$611.80 ,"$1,064.00 ",$234.08 ,"$1,064.00 ",$578.82 ,$234.08 ,$442.62 , N/A , N/A ,$245.78 ,$904.40 ,$730.97 ,$297.92 ,$957.60 ,$893.76 ,$491.06 ,$491.06 ,$234.08 ,$691.60 
ST. FRANCIS HOSPITAL - ACUTE,34300033,A9558,HC DIAGNUCLIDE XE133 10 MCI,343,1 ,$727.00 ,$472.55 ,$159.94 ,$727.00 ,$418.03 ,$523.44 ,$395.49 ,$159.94 ,$203.56 ,$427.48 ,$159.94 ,$499.45 ,$181.75 ,$499.45 ,$499.45 ,$181.75 ,$499.45 ,$303.89 ,$610.68 , N/A ,$159.94 ,$617.95 ,$610.68 ,$159.94 ,$545.25 ,$581.60 ,$581.60 ,$159.94 ,$581.60 ,$610.68 ,$610.68 ,$610.68 ,$727.00 ,$654.30 ,$418.03 ,$727.00 ,$159.94 ,$727.00 ,$395.49 ,$159.94 ,$302.43 , N/A , N/A ,$167.94 ,$617.95 ,$499.45 ,$203.56 ,$654.30 ,$610.68 ,$358.02 ,$358.02 ,$159.94 ,$472.55 
ST. FRANCIS HOSPITAL - ACUTE,34300035,A9560,HC TC99M GI BLD MUGA UP TO 30MCI,343,1 ,$860.00 ,$559.00 ,$165.59 ,$860.00 ,$494.50 ,$619.20 ,$467.84 ,$189.20 ,$240.80 ,$505.68 ,$189.20 ,$590.82 ,$215.00 ,$590.82 ,$590.82 ,$215.00 ,$590.82 ,$359.48 ,$722.40 , N/A ,$189.20 ,$731.00 ,$722.40 ,$189.20 ,$645.00 ,$688.00 ,$688.00 ,$189.20 ,$688.00 ,$722.40 ,$722.40 ,$722.40 ,$860.00 ,$774.00 ,$494.50 ,$860.00 ,$189.20 ,$860.00 ,$467.84 ,$189.20 ,$357.76 , N/A , N/A ,$198.66 ,$731.00 ,$590.82 ,$240.80 ,$774.00 ,$722.40 ,$165.59 ,$165.59 ,$189.20 ,$559.00 
ST. FRANCIS HOSPITAL - ACUTE,34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$860.00 ,$559.00 ,$165.59 ,$860.00 ,$494.50 ,$619.20 ,$467.84 ,$189.20 ,$240.80 ,$505.68 ,$189.20 ,$590.82 ,$215.00 ,$590.82 ,$590.82 ,$215.00 ,$590.82 ,$359.48 ,$722.40 , N/A ,$189.20 ,$731.00 ,$722.40 ,$189.20 ,$645.00 ,$688.00 ,$688.00 ,$189.20 ,$688.00 ,$722.40 ,$722.40 ,$722.40 ,$860.00 ,$774.00 ,$494.50 ,$860.00 ,$189.20 ,$860.00 ,$467.84 ,$189.20 ,$357.76 , N/A , N/A ,$198.66 ,$731.00 ,$590.82 ,$240.80 ,$774.00 ,$722.40 ,$165.59 ,$165.59 ,$189.20 ,$559.00 
ST. FRANCIS HOSPITAL - ACUTE,34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,$976.00 ,$634.40 ,$214.72 ,$976.00 ,$561.20 ,$702.72 ,$530.94 ,$214.72 ,$273.28 ,$573.89 ,$214.72 ,$670.51 ,$244.00 ,$670.51 ,$670.51 ,$244.00 ,$670.51 ,$407.97 ,$819.84 , N/A ,$214.72 ,$829.60 ,$819.84 ,$214.72 ,$732.00 ,$780.80 ,$780.80 ,$214.72 ,$780.80 ,$819.84 ,$819.84 ,$819.84 ,$976.00 ,$878.40 ,$561.20 ,$976.00 ,$214.72 ,$976.00 ,$530.94 ,$214.72 ,$406.02 , N/A , N/A ,$225.46 ,$829.60 ,$670.51 ,$273.28 ,$878.40 ,$819.84 ,$976.00 ,$976.00 ,$214.72 ,$634.40 
ST. FRANCIS HOSPITAL - ACUTE,34300038,A9572,HC DIAGNUCLIDE OCTREOTIDE PER DOSE UP TO 6MCI,343,1 ,"$14,998.00 ","$9,748.70 ","$3,299.56 ","$14,998.00 ","$8,623.85 ","$10,798.56 ","$8,158.91 ","$3,299.56 ","$4,199.44 ","$8,818.82 ","$3,299.56 ","$10,303.63 ","$3,749.50 ","$10,303.63 ","$10,303.63 ","$3,749.50 ","$10,303.63 ","$6,269.16 ","$12,598.32 ", N/A ,"$3,299.56 ","$12,748.30 ","$12,598.32 ","$3,299.56 ","$11,248.50 ","$11,998.40 ","$11,998.40 ","$3,299.56 ","$11,998.40 ","$12,598.32 ","$12,598.32 ","$12,598.32 ","$14,998.00 ","$13,498.20 ","$8,623.85 ","$14,998.00 ","$3,299.56 ","$14,998.00 ","$8,158.91 ","$3,299.56 ","$6,239.17 ", N/A , N/A ,"$3,464.54 ","$12,748.30 ","$10,303.63 ","$4,199.44 ","$13,498.20 ","$12,598.32 ","$10,241.50 ","$10,241.50 ","$3,299.56 ","$9,748.70 "
ST. FRANCIS HOSPITAL - ACUTE,34300039,A9582,HC DIAGNUCLIDE I 123 MIBG,343,1 ,"$15,624.00 ","$10,155.60 ","$3,437.28 ","$15,624.00 ","$8,983.80 ","$11,249.28 ","$8,499.46 ","$3,437.28 ","$4,374.72 ","$9,186.91 ","$3,437.28 ","$10,733.69 ","$3,906.00 ","$10,733.69 ","$10,733.69 ","$3,906.00 ","$10,733.69 ","$6,530.83 ","$13,124.16 ", N/A ,"$3,437.28 ","$13,280.40 ","$13,124.16 ","$3,437.28 ","$11,718.00 ","$12,499.20 ","$12,499.20 ","$3,437.28 ","$12,499.20 ","$13,124.16 ","$13,124.16 ","$13,124.16 ","$15,624.00 ","$14,061.60 ","$8,983.80 ","$15,624.00 ","$3,437.28 ","$15,624.00 ","$8,499.46 ","$3,437.28 ","$6,499.58 ", N/A , N/A ,"$3,609.14 ","$13,280.40 ","$10,733.69 ","$4,374.72 ","$14,061.60 ","$13,124.16 ","$3,825.15 ","$3,825.15 ","$3,437.28 ","$10,155.60 "
ST. FRANCIS HOSPITAL - ACUTE,34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$233.00 ,$151.45 ,$51.26 ,$233.00 ,$133.98 ,$167.76 ,$126.75 ,$51.26 ,$65.24 ,$137.00 ,$51.26 ,$160.07 ,$58.25 ,$160.07 ,$160.07 ,$58.25 ,$160.07 ,$97.39 ,$195.72 , N/A ,$51.26 ,$198.05 ,$195.72 ,$51.26 ,$174.75 ,$186.40 ,$186.40 ,$51.26 ,$186.40 ,$195.72 ,$195.72 ,$195.72 ,$233.00 ,$209.70 ,$133.98 ,$233.00 ,$51.26 ,$233.00 ,$126.75 ,$51.26 ,$96.93 ,$144.01 ,$137.47 ,$53.82 ,$198.05 ,$160.07 ,$65.24 ,$209.70 ,$195.72 ,$190.82 ,$190.82 ,$51.26 ,$151.45 
ST. FRANCIS HOSPITAL - ACUTE,34300049,A9509,HC DIAGNUCLIDE I123 CAP PER MILLICURIE,343,1 ,$394.00 ,$256.10 ,$86.68 ,$394.00 ,$226.55 ,$283.68 ,$214.34 ,$86.68 ,$110.32 ,$231.67 ,$86.68 ,$270.68 ,$98.50 ,$270.68 ,$270.68 ,$98.50 ,$270.68 ,$164.69 ,$330.96 , N/A ,$86.68 ,$334.90 ,$330.96 ,$86.68 ,$295.50 ,$315.20 ,$315.20 ,$86.68 ,$315.20 ,$330.96 ,$330.96 ,$330.96 ,$394.00 ,$354.60 ,$226.55 ,$394.00 ,$86.68 ,$394.00 ,$214.34 ,$86.68 ,$163.90 , N/A , N/A ,$91.01 ,$334.90 ,$270.68 ,$110.32 ,$354.60 ,$330.96 ,$394.00 ,$394.00 ,$86.68 ,$256.10 
ST. FRANCIS HOSPITAL - ACUTE,34300052,A9539,HC DIAGNUCLIDE DTPA AEROSOL,343,1 ,$338.00 ,$219.70 ,$51.96 ,$338.00 ,$194.35 ,$243.36 ,$183.87 ,$74.36 ,$94.64 ,$198.74 ,$74.36 ,$232.21 ,$84.50 ,$232.21 ,$232.21 ,$84.50 ,$232.21 ,$141.28 ,$283.92 , N/A ,$74.36 ,$287.30 ,$283.92 ,$74.36 ,$253.50 ,$270.40 ,$270.40 ,$74.36 ,$270.40 ,$283.92 ,$283.92 ,$283.92 ,$338.00 ,$304.20 ,$194.35 ,$338.00 ,$74.36 ,$338.00 ,$183.87 ,$74.36 ,$140.61 , N/A , N/A ,$78.08 ,$287.30 ,$232.21 ,$94.64 ,$304.20 ,$283.92 ,$51.96 ,$51.96 ,$74.36 ,$219.70 
ST. FRANCIS HOSPITAL - ACUTE,34300058,A9500,HC SESTAMIBI PER STUDY DOSE,343,1 ,$172.00 ,$111.80 ,$37.84 ,$172.00 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$101.14 ,$37.84 ,$118.16 ,$43.00 ,$118.16 ,$118.16 ,$43.00 ,$118.16 ,$71.90 ,$144.48 , N/A ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 , N/A , N/A ,$39.73 ,$146.20 ,$118.16 ,$48.16 ,$154.80 ,$144.48 ,$172.00 ,$172.00 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,34300060,A9520,HC DIAGNUCLIDE TC-99 TILMANOCEPT DIAG UP TO 0.5 MCI,343,1 ,"$2,204.00 ","$1,432.60 ",$484.88 ,"$2,204.00 ","$1,267.30 ","$1,586.88 ","$1,198.98 ",$484.88 ,$617.12 ,"$1,295.95 ",$484.88 ,"$1,514.15 ",$551.00 ,"$1,514.15 ","$1,514.15 ",$551.00 ,"$1,514.15 ",$921.27 ,"$1,851.36 ", N/A ,$484.88 ,"$1,873.40 ","$1,851.36 ",$484.88 ,"$1,653.00 ","$1,763.20 ","$1,763.20 ",$484.88 ,"$1,763.20 ","$1,851.36 ","$1,851.36 ","$1,851.36 ","$2,204.00 ","$1,983.60 ","$1,267.30 ","$2,204.00 ",$484.88 ,"$2,204.00 ","$1,198.98 ",$484.88 ,$916.86 , N/A , N/A ,$509.12 ,"$1,873.40 ","$1,514.15 ",$617.12 ,"$1,983.60 ","$1,851.36 ", N/A , N/A ,$484.88 ,"$1,432.60 "
ST. FRANCIS HOSPITAL - ACUTE,34300061,A9557,HC DIAGNUCLIDE TC-99 BICISATE PER STUDY UP TO 25MCI,343,1 ,"$3,167.00 ","$2,058.55 ",$663.50 ,"$3,167.00 ","$1,821.03 ","$2,280.24 ","$1,722.85 ",$696.74 ,$886.76 ,"$1,862.20 ",$696.74 ,"$2,175.73 ",$791.75 ,"$2,175.73 ","$2,175.73 ",$791.75 ,"$2,175.73 ","$1,323.81 ","$2,660.28 ", N/A ,$696.74 ,"$2,691.95 ","$2,660.28 ",$696.74 ,"$2,375.25 ","$2,533.60 ","$2,533.60 ",$696.74 ,"$2,533.60 ","$2,660.28 ","$2,660.28 ","$2,660.28 ","$3,167.00 ","$2,850.30 ","$1,821.03 ","$3,167.00 ",$696.74 ,"$3,167.00 ","$1,722.85 ",$696.74 ,"$1,317.47 ", N/A , N/A ,$731.58 ,"$2,691.95 ","$2,175.73 ",$886.76 ,"$2,850.30 ","$2,660.28 ",$663.50 ,$663.50 ,$696.74 ,"$2,058.55 "
ST. FRANCIS HOSPITAL - ACUTE,34300062,A9562,HC DIAGNUCLIDE TC-99 MERTIATIDE PER STUDY UP TO 15MCI,343,1 ,"$1,281.00 ",$832.65 ,$281.82 ,"$1,281.00 ",$736.58 ,$922.32 ,$696.86 ,$281.82 ,$358.68 ,$753.23 ,$281.82 ,$880.05 ,$320.25 ,$880.05 ,$880.05 ,$320.25 ,$880.05 ,$535.46 ,"$1,076.04 ", N/A ,$281.82 ,"$1,088.85 ","$1,076.04 ",$281.82 ,$960.75 ,"$1,024.80 ","$1,024.80 ",$281.82 ,"$1,024.80 ","$1,076.04 ","$1,076.04 ","$1,076.04 ","$1,281.00 ","$1,152.90 ",$736.58 ,"$1,281.00 ",$281.82 ,"$1,281.00 ",$696.86 ,$281.82 ,$532.90 , N/A , N/A ,$295.91 ,"$1,088.85 ",$880.05 ,$358.68 ,"$1,152.90 ","$1,076.04 ","$1,279.05 ","$1,279.05 ",$281.82 ,$832.65 
ST. FRANCIS HOSPITAL - ACUTE,35000018,47000,HC BX LIVER NEEDLE PERC,350,1 ,"$2,165.00 ","$1,407.25 ",$476.30 ,"$3,592.48 ","$1,244.88 ","$1,558.80 ","$1,177.76 ",$476.30 ,$606.20 ,"$1,214.57 ",$476.30 ,"$1,411.58 ",$541.25 ,"$1,411.58 ","$1,411.58 ",$541.25 ,"$1,411.58 ",$904.97 ,"$1,818.60 ","$3,592.48 ",$476.30 ,"$1,840.25 ","$1,818.60 ",$476.30 ,"$1,623.75 ","$1,732.00 ","$1,732.00 ",$476.30 ,"$1,732.00 ","$1,818.60 ","$1,818.60 ","$1,818.60 ","$2,165.00 ","$1,948.50 ","$1,244.88 ","$2,165.00 ",$476.30 ,"$2,165.00 ","$1,177.76 ",$476.30 ,$900.64 ,$729.83 ,$696.65 ,$500.12 ,"$1,840.25 ","$1,411.58 ",$606.20 ,"$1,948.50 ","$1,818.60 ","$1,732.00 ","$1,732.00 ",$476.30 ,"$1,407.25 "
ST. FRANCIS HOSPITAL - ACUTE,35000032,64430,HC INJ ANEST AGENT PUDENDAL NERVE,350,1 ,"$2,468.00 ","$1,604.20 ",$442.87 ,"$2,468.00 ","$1,419.10 ","$1,776.96 ","$1,342.59 ",$542.96 ,$691.04 ,"$1,384.55 ",$542.96 ,"$1,609.14 ",$617.00 ,"$1,609.14 ","$1,609.14 ",$617.00 ,"$1,609.14 ","$1,031.62 ","$2,073.12 ","$2,101.83 ",$542.96 ,"$2,097.80 ","$2,073.12 ",$542.96 ,"$1,851.00 ","$1,974.40 ","$1,974.40 ",$542.96 ,"$1,974.40 ","$2,073.12 ","$2,073.12 ","$2,073.12 ","$2,468.00 ","$2,221.20 ","$1,419.10 ","$2,468.00 ",$542.96 ,"$2,468.00 ","$1,342.59 ",$542.96 ,"$1,026.69 ",$463.96 ,$442.87 ,$570.11 ,"$2,097.80 ","$1,609.14 ",$691.04 ,"$2,221.20 ","$2,073.12 ","$1,974.40 ","$1,974.40 ",$542.96 ,"$1,604.20 "
ST. FRANCIS HOSPITAL - ACUTE,35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$2,389.00 ","$1,552.85 ",$277.98 ,"$2,389.00 ","$1,373.68 ","$1,720.08 ","$1,299.62 ",$525.58 ,$668.92 ,"$1,307.13 ",$525.58 ,"$1,307.13 ",$597.25 ,"$1,307.13 ","$1,307.13 ",$597.25 ,"$1,307.13 ",$998.60 ,"$2,006.76 ",$277.98 ,$525.58 ,"$2,030.65 ","$2,006.76 ",$525.58 ,"$1,791.75 ","$1,911.20 ","$1,911.20 ",$525.58 ,"$1,911.20 ","$2,006.76 ","$2,006.76 ","$2,006.76 ","$2,389.00 ","$2,150.10 ","$1,373.68 ","$2,389.00 ",$525.58 ,"$2,389.00 ","$1,299.62 ",$525.58 ,$993.82 ,$301.47 ,$287.76 ,$551.86 ,"$2,030.65 ","$1,307.13 ",$668.92 ,"$2,150.10 ","$2,006.76 ","$1,911.20 ","$1,911.20 ",$525.58 ,"$1,552.85 "
ST. FRANCIS HOSPITAL - ACUTE,35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$3,026.00 ","$1,966.90 ",$287.76 ,"$3,026.00 ","$1,739.95 ","$2,178.72 ","$1,646.14 ",$665.72 ,$847.28 ,"$1,779.29 ",$665.72 ,"$1,892.03 ",$756.50 ,"$1,892.03 ","$1,892.03 ",$756.50 ,"$1,892.03 ","$1,264.87 ","$2,541.84 ",$456.08 ,$665.72 ,"$2,572.10 ","$2,541.84 ",$665.72 ,"$2,269.50 ","$2,420.80 ","$2,420.80 ",$665.72 ,"$2,420.80 ","$2,541.84 ","$2,541.84 ","$2,541.84 ","$3,026.00 ","$2,723.40 ","$1,739.95 ","$3,026.00 ",$665.72 ,"$3,026.00 ","$1,646.14 ",$665.72 ,"$1,258.82 ",$301.47 ,$287.76 ,$699.01 ,"$2,572.10 ","$1,892.03 ",$847.28 ,"$2,723.40 ","$2,541.84 ","$2,420.80 ","$2,420.80 ",$665.72 ,"$1,966.90 "
ST. FRANCIS HOSPITAL - ACUTE,35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$3,329.00 ","$2,163.85 ",$287.76 ,"$3,329.00 ","$1,914.18 ","$2,396.88 ","$1,810.98 ",$732.38 ,$932.12 ,"$1,957.45 ",$732.38 ,"$2,275.61 ",$832.25 ,"$2,275.61 ","$2,275.61 ",$832.25 ,"$2,275.61 ","$1,391.52 ","$2,796.36 ",$456.08 ,$732.38 ,"$2,829.65 ","$2,796.36 ",$732.38 ,"$2,496.75 ","$2,663.20 ","$2,663.20 ",$732.38 ,"$2,663.20 ","$2,796.36 ","$2,796.36 ","$2,796.36 ","$3,329.00 ","$2,996.10 ","$1,914.18 ","$3,329.00 ",$732.38 ,"$3,329.00 ","$1,810.98 ",$732.38 ,"$1,384.86 ",$301.47 ,$287.76 ,$769.00 ,"$2,829.65 ","$2,275.61 ",$932.12 ,"$2,996.10 ","$2,796.36 ","$2,663.20 ","$2,663.20 ",$732.38 ,"$2,163.85 "
ST. FRANCIS HOSPITAL - ACUTE,35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$2,389.00 ","$1,552.85 ",$139.83 ,"$2,389.00 ","$1,373.68 ","$1,720.08 ","$1,299.62 ",$525.58 ,$668.92 ,"$1,404.73 ",$525.58 ,"$1,641.24 ",$597.25 ,"$1,641.24 ","$1,641.24 ",$597.25 ,"$1,641.24 ",$998.60 ,"$2,006.76 ",$277.98 ,$525.58 ,"$2,030.65 ","$2,006.76 ",$525.58 ,"$1,791.75 ","$1,911.20 ","$1,911.20 ",$525.58 ,"$1,911.20 ","$2,006.76 ","$2,006.76 ","$2,006.76 ","$2,389.00 ","$2,150.10 ","$1,373.68 ","$2,389.00 ",$525.58 ,"$2,389.00 ","$1,299.62 ",$525.58 ,$993.82 ,$146.49 ,$139.83 ,$551.86 ,"$2,030.65 ","$1,641.24 ",$668.92 ,"$2,150.10 ","$2,006.76 ","$1,911.20 ","$1,911.20 ",$525.58 ,"$1,552.85 "
ST. FRANCIS HOSPITAL - ACUTE,35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$3,026.00 ","$1,966.90 ",$139.83 ,"$3,026.00 ","$1,739.95 ","$2,178.72 ","$1,646.14 ",$665.72 ,$847.28 ,"$1,779.29 ",$665.72 ,"$2,078.86 ",$756.50 ,"$2,078.86 ","$2,078.86 ",$756.50 ,"$2,078.86 ","$1,264.87 ","$2,541.84 ",$456.08 ,$665.72 ,"$2,572.10 ","$2,541.84 ",$665.72 ,"$2,269.50 ","$2,420.80 ","$2,420.80 ",$665.72 ,"$2,420.80 ","$2,541.84 ","$2,541.84 ","$2,541.84 ","$3,026.00 ","$2,723.40 ","$1,739.95 ","$3,026.00 ",$665.72 ,"$3,026.00 ","$1,646.14 ",$665.72 ,"$1,258.82 ",$146.49 ,$139.83 ,$699.01 ,"$2,572.10 ","$2,078.86 ",$847.28 ,"$2,723.40 ","$2,541.84 ","$2,420.80 ","$2,420.80 ",$665.72 ,"$1,966.90 "
ST. FRANCIS HOSPITAL - ACUTE,35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$3,026.00 ","$1,966.90 ",$139.83 ,"$3,026.00 ","$1,739.95 ","$2,178.72 ","$1,646.14 ",$665.72 ,$847.28 ,"$1,779.29 ",$665.72 ,"$2,078.86 ",$756.50 ,"$2,078.86 ","$2,078.86 ",$756.50 ,"$2,078.86 ","$1,264.87 ","$2,541.84 ",$456.08 ,$665.72 ,"$2,572.10 ","$2,541.84 ",$665.72 ,"$2,269.50 ","$2,420.80 ","$2,420.80 ",$665.72 ,"$2,420.80 ","$2,541.84 ","$2,541.84 ","$2,541.84 ","$3,026.00 ","$2,723.40 ","$1,739.95 ","$3,026.00 ",$665.72 ,"$3,026.00 ","$1,646.14 ",$665.72 ,"$1,258.82 ",$146.49 ,$139.83 ,$699.01 ,"$2,572.10 ","$2,078.86 ",$847.28 ,"$2,723.40 ","$2,541.84 ","$2,420.80 ","$2,420.80 ",$665.72 ,"$1,966.90 "
ST. FRANCIS HOSPITAL - ACUTE,35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$2,004.00 ","$1,302.60 ",$139.83 ,"$2,004.00 ","$1,152.30 ","$1,442.88 ","$1,090.18 ",$440.88 ,$561.12 ,"$1,178.35 ",$440.88 ,"$1,376.75 ",$501.00 ,"$1,376.75 ","$1,376.75 ",$501.00 ,"$1,376.75 ",$837.67 ,"$1,683.36 ",$277.98 ,$440.88 ,"$1,703.40 ","$1,683.36 ",$440.88 ,"$1,503.00 ","$1,603.20 ","$1,603.20 ",$440.88 ,"$1,603.20 ","$1,683.36 ","$1,683.36 ","$1,683.36 ","$2,004.00 ","$1,803.60 ","$1,152.30 ","$2,004.00 ",$440.88 ,"$2,004.00 ","$1,090.18 ",$440.88 ,$833.66 ,$146.49 ,$139.83 ,$462.92 ,"$1,703.40 ","$1,376.75 ",$561.12 ,"$1,803.60 ","$1,683.36 ","$1,603.20 ","$1,603.20 ",$440.88 ,"$1,302.60 "
ST. FRANCIS HOSPITAL - ACUTE,35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,204.00 ","$1,432.60 ",$139.83 ,"$2,204.00 ","$1,267.30 ","$1,586.88 ","$1,198.98 ",$484.88 ,$617.12 ,"$1,295.95 ",$484.88 ,"$1,514.15 ",$551.00 ,"$1,514.15 ","$1,514.15 ",$551.00 ,"$1,514.15 ",$921.27 ,"$1,851.36 ",$456.08 ,$484.88 ,"$1,873.40 ","$1,851.36 ",$484.88 ,"$1,653.00 ","$1,763.20 ","$1,763.20 ",$484.88 ,"$1,763.20 ","$1,851.36 ","$1,851.36 ","$1,851.36 ","$2,204.00 ","$1,983.60 ","$1,267.30 ","$2,204.00 ",$484.88 ,"$2,204.00 ","$1,198.98 ",$484.88 ,$916.86 ,$146.49 ,$139.83 ,$509.12 ,"$1,873.40 ","$1,514.15 ",$617.12 ,"$1,983.60 ","$1,851.36 ","$1,763.20 ","$1,763.20 ",$484.88 ,"$1,432.60 "
ST. FRANCIS HOSPITAL - ACUTE,35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,204.00 ","$1,432.60 ",$139.83 ,"$2,204.00 ","$1,267.30 ","$1,586.88 ","$1,198.98 ",$484.88 ,$617.12 ,"$1,295.95 ",$484.88 ,"$1,514.15 ",$551.00 ,"$1,514.15 ","$1,514.15 ",$551.00 ,"$1,514.15 ",$921.27 ,"$1,851.36 ",$456.08 ,$484.88 ,"$1,873.40 ","$1,851.36 ",$484.88 ,"$1,653.00 ","$1,763.20 ","$1,763.20 ",$484.88 ,"$1,763.20 ","$1,851.36 ","$1,851.36 ","$1,851.36 ","$2,204.00 ","$1,983.60 ","$1,267.30 ","$2,204.00 ",$484.88 ,"$2,204.00 ","$1,198.98 ",$484.88 ,$916.86 ,$146.49 ,$139.83 ,$509.12 ,"$1,873.40 ","$1,514.15 ",$617.12 ,"$1,983.60 ","$1,851.36 ","$1,763.20 ","$1,763.20 ",$484.88 ,"$1,432.60 "
ST. FRANCIS HOSPITAL - ACUTE,35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$2,649.00 ","$1,721.85 ",$139.83 ,"$2,649.00 ","$1,523.18 ","$1,907.28 ","$1,441.06 ",$582.78 ,$741.72 ,"$1,557.61 ",$582.78 ,"$1,819.86 ",$662.25 ,"$1,819.86 ","$1,819.86 ",$662.25 ,"$1,819.86 ","$1,107.28 ","$2,225.16 ",$277.98 ,$582.78 ,"$2,251.65 ","$2,225.16 ",$582.78 ,"$1,986.75 ","$2,119.20 ","$2,119.20 ",$582.78 ,"$2,119.20 ","$2,225.16 ","$2,225.16 ","$2,225.16 ","$2,649.00 ","$2,384.10 ","$1,523.18 ","$2,649.00 ",$582.78 ,"$2,649.00 ","$1,441.06 ",$582.78 ,"$1,101.98 ",$146.49 ,$139.83 ,$611.92 ,"$2,251.65 ","$1,819.86 ",$741.72 ,"$2,384.10 ","$2,225.16 ","$2,119.20 ","$2,119.20 ",$582.78 ,"$1,721.85 "
ST. FRANCIS HOSPITAL - ACUTE,35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$3,208.00 ","$2,085.20 ",$139.83 ,"$3,208.00 ","$1,844.60 ","$2,309.76 ","$1,745.15 ",$705.76 ,$898.24 ,"$1,886.30 ",$705.76 ,"$2,203.90 ",$802.00 ,"$2,203.90 ","$2,203.90 ",$802.00 ,"$2,203.90 ","$1,340.94 ","$2,694.72 ",$456.08 ,$705.76 ,"$2,726.80 ","$2,694.72 ",$705.76 ,"$2,406.00 ","$2,566.40 ","$2,566.40 ",$705.76 ,"$2,566.40 ","$2,694.72 ","$2,694.72 ","$2,694.72 ","$3,208.00 ","$2,887.20 ","$1,844.60 ","$3,208.00 ",$705.76 ,"$3,208.00 ","$1,745.15 ",$705.76 ,"$1,334.53 ",$146.49 ,$139.83 ,$741.05 ,"$2,726.80 ","$2,203.90 ",$898.24 ,"$2,887.20 ","$2,694.72 ","$2,566.40 ","$2,566.40 ",$705.76 ,"$2,085.20 "
ST. FRANCIS HOSPITAL - ACUTE,35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$4,164.00 ","$2,706.60 ",$139.83 ,"$4,164.00 ","$2,394.30 ","$2,998.08 ","$2,265.22 ",$916.08 ,"$1,165.92 ","$2,448.43 ",$916.08 ,"$2,860.67 ","$1,041.00 ","$2,860.67 ","$2,860.67 ","$1,041.00 ","$2,860.67 ","$1,740.55 ","$3,497.76 ",$456.08 ,$916.08 ,"$3,539.40 ","$3,497.76 ",$916.08 ,"$3,123.00 ","$3,331.20 ","$3,331.20 ",$916.08 ,"$3,331.20 ","$3,497.76 ","$3,497.76 ","$3,497.76 ","$4,164.00 ","$3,747.60 ","$2,394.30 ","$4,164.00 ",$916.08 ,"$4,164.00 ","$2,265.22 ",$916.08 ,"$1,732.22 ",$146.49 ,$139.83 ,$961.88 ,"$3,539.40 ","$2,860.67 ","$1,165.92 ","$3,747.60 ","$3,497.76 ","$3,331.20 ","$3,331.20 ",$916.08 ,"$2,706.60 "
ST. FRANCIS HOSPITAL - ACUTE,35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$3,097.00 ","$2,013.05 ",$368.56 ,"$3,097.00 ","$1,780.78 ","$2,229.84 ","$1,684.77 ",$681.34 ,$867.16 ,"$1,821.04 ",$681.34 ,"$2,127.64 ",$774.25 ,"$2,127.64 ","$2,127.64 ",$774.25 ,"$2,127.64 ","$1,294.55 ","$2,601.48 ",$456.08 ,$681.34 ,"$2,632.45 ","$2,601.48 ",$681.34 ,"$2,322.75 ","$2,477.60 ","$2,477.60 ",$681.34 ,"$2,477.60 ","$2,601.48 ","$2,601.48 ","$2,601.48 ","$3,097.00 ","$2,787.30 ","$1,780.78 ","$3,097.00 ",$681.34 ,"$3,097.00 ","$1,684.77 ",$681.34 ,"$1,288.35 ",$386.11 ,$368.56 ,$715.41 ,"$2,632.45 ","$2,127.64 ",$867.16 ,"$2,787.30 ","$2,601.48 ","$2,477.60 ","$2,477.60 ",$681.34 ,"$2,013.05 "
ST. FRANCIS HOSPITAL - ACUTE,35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$3,353.00 ","$2,179.45 ",$139.83 ,"$3,353.00 ","$1,927.98 ","$2,414.16 ","$1,824.03 ",$737.66 ,$938.84 ,"$1,971.56 ",$737.66 ,"$2,303.51 ",$838.25 ,"$2,303.51 ","$2,303.51 ",$838.25 ,"$2,303.51 ","$1,401.55 ","$2,816.52 ",$456.08 ,$737.66 ,"$2,850.05 ","$2,816.52 ",$737.66 ,"$2,514.75 ","$2,682.40 ","$2,682.40 ",$737.66 ,"$2,682.40 ","$2,816.52 ","$2,816.52 ","$2,816.52 ","$3,353.00 ","$3,017.70 ","$1,927.98 ","$3,353.00 ",$737.66 ,"$3,353.00 ","$1,824.03 ",$737.66 ,"$1,394.85 ",$146.49 ,$139.83 ,$774.54 ,"$2,850.05 ","$2,303.51 ",$938.84 ,"$3,017.70 ","$2,816.52 ","$2,682.40 ","$2,682.40 ",$737.66 ,"$2,179.45 "
ST. FRANCIS HOSPITAL - ACUTE,35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,617.00 ","$2,351.05 ",$348.86 ,"$3,617.00 ","$2,079.78 ","$2,604.24 ","$1,967.65 ",$795.74 ,"$1,012.76 ","$2,126.80 ",$795.74 ,"$2,484.88 ",$904.25 ,"$2,484.88 ","$2,484.88 ",$904.25 ,"$2,484.88 ","$1,511.91 ","$3,038.28 ",$587.50 ,$795.74 ,"$3,074.45 ","$3,038.28 ",$795.74 ,"$2,712.75 ","$2,893.60 ","$2,893.60 ",$795.74 ,"$2,893.60 ","$3,038.28 ","$3,038.28 ","$3,038.28 ","$3,617.00 ","$3,255.30 ","$2,079.78 ","$3,617.00 ",$795.74 ,"$3,617.00 ","$1,967.65 ",$795.74 ,"$1,504.67 ",$365.48 ,$348.86 ,$835.53 ,"$3,074.45 ","$2,484.88 ","$1,012.76 ","$3,255.30 ","$3,038.28 ","$2,893.60 ","$2,893.60 ",$795.74 ,"$2,351.05 "
ST. FRANCIS HOSPITAL - ACUTE,35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$2,919.00 ","$1,897.35 ",$158.72 ,"$2,919.00 ","$1,678.43 ","$2,101.68 ","$1,587.94 ",$642.18 ,$817.32 ,"$1,716.37 ",$642.18 ,"$2,005.35 ",$729.75 ,"$2,005.35 ","$2,005.35 ",$729.75 ,"$2,005.35 ","$1,220.14 ","$2,451.96 ",$277.98 ,$642.18 ,"$2,481.15 ","$2,451.96 ",$642.18 ,"$2,189.25 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$2,335.20 ","$2,451.96 ","$2,451.96 ","$2,451.96 ","$2,919.00 ","$2,627.10 ","$1,678.43 ","$2,919.00 ",$642.18 ,"$2,919.00 ","$1,587.94 ",$642.18 ,"$1,214.30 ",$166.28 ,$158.72 ,$674.29 ,"$2,481.15 ","$2,005.35 ",$817.32 ,"$2,627.10 ","$2,451.96 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$1,897.35 "
ST. FRANCIS HOSPITAL - ACUTE,35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$3,593.00 ","$2,335.45 ",$158.72 ,"$3,593.00 ","$2,065.98 ","$2,586.96 ","$1,954.59 ",$790.46 ,"$1,006.04 ","$2,112.68 ",$790.46 ,"$2,468.39 ",$898.25 ,"$2,468.39 ","$2,468.39 ",$898.25 ,"$2,468.39 ","$1,501.87 ","$3,018.12 ",$940.23 ,$790.46 ,"$3,054.05 ","$3,018.12 ",$790.46 ,"$2,694.75 ","$2,874.40 ","$2,874.40 ",$790.46 ,"$2,874.40 ","$3,018.12 ","$3,018.12 ","$3,018.12 ","$3,593.00 ","$3,233.70 ","$2,065.98 ","$3,593.00 ",$790.46 ,"$3,593.00 ","$1,954.59 ",$790.46 ,"$1,494.69 ",$166.28 ,$158.72 ,$829.98 ,"$3,054.05 ","$2,468.39 ","$1,006.04 ","$3,233.70 ","$3,018.12 ","$2,874.40 ","$2,874.40 ",$790.46 ,"$2,335.45 "
ST. FRANCIS HOSPITAL - ACUTE,35000056,72127,HC CT C-SPINE W AND W/O CONTRAST,350,1 ,"$3,820.00 ","$2,483.00 ",$158.72 ,"$3,820.00 ","$2,196.50 ","$2,750.40 ","$2,078.08 ",$840.40 ,"$1,069.60 ","$2,246.16 ",$840.40 ,"$2,624.34 ",$955.00 ,"$2,624.34 ","$2,624.34 ",$955.00 ,"$2,624.34 ","$1,596.76 ","$3,208.80 ",$456.08 ,$840.40 ,"$3,247.00 ","$3,208.80 ",$840.40 ,"$2,865.00 ","$3,056.00 ","$3,056.00 ",$840.40 ,"$3,056.00 ","$3,208.80 ","$3,208.80 ","$3,208.80 ","$3,820.00 ","$3,438.00 ","$2,196.50 ","$3,820.00 ",$840.40 ,"$3,820.00 ","$2,078.08 ",$840.40 ,"$1,589.12 ",$166.28 ,$158.72 ,$882.42 ,"$3,247.00 ","$2,624.34 ","$1,069.60 ","$3,438.00 ","$3,208.80 ","$3,056.00 ","$3,056.00 ",$840.40 ,"$2,483.00 "
ST. FRANCIS HOSPITAL - ACUTE,35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$2,110.00 ","$1,371.50 ",$158.72 ,"$2,110.00 ","$1,213.25 ","$1,519.20 ","$1,147.84 ",$464.20 ,$590.80 ,"$1,240.68 ",$464.20 ,"$1,449.57 ",$527.50 ,"$1,449.57 ","$1,449.57 ",$527.50 ,"$1,449.57 ",$881.98 ,"$1,772.40 ",$277.98 ,$464.20 ,"$1,793.50 ","$1,772.40 ",$464.20 ,"$1,582.50 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,688.00 ","$1,772.40 ","$1,772.40 ","$1,772.40 ","$2,110.00 ","$1,899.00 ","$1,213.25 ","$2,110.00 ",$464.20 ,"$2,110.00 ","$1,147.84 ",$464.20 ,$877.76 ,$166.28 ,$158.72 ,$487.41 ,"$1,793.50 ","$1,449.57 ",$590.80 ,"$1,899.00 ","$1,772.40 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,371.50 "
ST. FRANCIS HOSPITAL - ACUTE,35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$2,891.00 ","$1,879.15 ",$158.72 ,"$2,891.00 ","$1,662.33 ","$2,081.52 ","$1,572.70 ",$636.02 ,$809.48 ,"$1,699.91 ",$636.02 ,"$1,986.12 ",$722.75 ,"$1,986.12 ","$1,986.12 ",$722.75 ,"$1,986.12 ","$1,208.44 ","$2,428.44 ",$456.08 ,$636.02 ,"$2,457.35 ","$2,428.44 ",$636.02 ,"$2,168.25 ","$2,312.80 ","$2,312.80 ",$636.02 ,"$2,312.80 ","$2,428.44 ","$2,428.44 ","$2,428.44 ","$2,891.00 ","$2,601.90 ","$1,662.33 ","$2,891.00 ",$636.02 ,"$2,891.00 ","$1,572.70 ",$636.02 ,"$1,202.66 ",$166.28 ,$158.72 ,$667.82 ,"$2,457.35 ","$1,986.12 ",$809.48 ,"$2,601.90 ","$2,428.44 ","$2,312.80 ","$2,312.80 ",$636.02 ,"$1,879.15 "
ST. FRANCIS HOSPITAL - ACUTE,35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$3,313.00 ","$2,153.45 ",$158.72 ,"$3,313.00 ","$1,904.98 ","$2,385.36 ","$1,802.27 ",$728.86 ,$927.64 ,"$1,948.04 ",$728.86 ,"$2,276.03 ",$828.25 ,"$2,276.03 ","$2,276.03 ",$828.25 ,"$2,276.03 ","$1,384.83 ","$2,782.92 ",$456.08 ,$728.86 ,"$2,816.05 ","$2,782.92 ",$728.86 ,"$2,484.75 ","$2,650.40 ","$2,650.40 ",$728.86 ,"$2,650.40 ","$2,782.92 ","$2,782.92 ","$2,782.92 ","$3,313.00 ","$2,981.70 ","$1,904.98 ","$3,313.00 ",$728.86 ,"$3,313.00 ","$1,802.27 ",$728.86 ,"$1,378.21 ",$166.28 ,$158.72 ,$765.30 ,"$2,816.05 ","$2,276.03 ",$927.64 ,"$2,981.70 ","$2,782.92 ","$2,650.40 ","$2,650.40 ",$728.86 ,"$2,153.45 "
ST. FRANCIS HOSPITAL - ACUTE,35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$2,110.00 ","$1,371.50 ",$158.72 ,"$2,110.00 ","$1,213.25 ","$1,519.20 ","$1,147.84 ",$464.20 ,$590.80 ,"$1,240.68 ",$464.20 ,"$1,449.57 ",$527.50 ,"$1,449.57 ","$1,449.57 ",$527.50 ,"$1,449.57 ",$881.98 ,"$1,772.40 ",$277.98 ,$464.20 ,"$1,793.50 ","$1,772.40 ",$464.20 ,"$1,582.50 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,688.00 ","$1,772.40 ","$1,772.40 ","$1,772.40 ","$2,110.00 ","$1,899.00 ","$1,213.25 ","$2,110.00 ",$464.20 ,"$2,110.00 ","$1,147.84 ",$464.20 ,$877.76 ,$166.28 ,$158.72 ,$487.41 ,"$1,793.50 ","$1,449.57 ",$590.80 ,"$1,899.00 ","$1,772.40 ","$1,688.00 ","$1,688.00 ",$464.20 ,"$1,371.50 "
ST. FRANCIS HOSPITAL - ACUTE,35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$2,235.00 ","$1,452.75 ",$158.72 ,"$2,235.00 ","$1,285.13 ","$1,609.20 ","$1,215.84 ",$491.70 ,$625.80 ,"$1,314.18 ",$491.70 ,"$1,535.45 ",$558.75 ,"$1,535.45 ","$1,535.45 ",$558.75 ,"$1,535.45 ",$934.23 ,"$1,877.40 ",$940.23 ,$491.70 ,"$1,899.75 ","$1,877.40 ",$491.70 ,"$1,676.25 ","$1,788.00 ","$1,788.00 ",$491.70 ,"$1,788.00 ","$1,877.40 ","$1,877.40 ","$1,877.40 ","$2,235.00 ","$2,011.50 ","$1,285.13 ","$2,235.00 ",$491.70 ,"$2,235.00 ","$1,215.84 ",$491.70 ,$929.76 ,$166.28 ,$158.72 ,$516.29 ,"$1,899.75 ","$1,535.45 ",$625.80 ,"$2,011.50 ","$1,877.40 ","$1,788.00 ","$1,788.00 ",$491.70 ,"$1,452.75 "
ST. FRANCIS HOSPITAL - ACUTE,35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$2,435.00 ","$1,582.75 ",$158.72 ,"$2,435.00 ","$1,400.13 ","$1,753.20 ","$1,324.64 ",$535.70 ,$681.80 ,"$1,431.78 ",$535.70 ,"$1,672.85 ",$608.75 ,"$1,672.85 ","$1,672.85 ",$608.75 ,"$1,672.85 ","$1,017.83 ","$2,045.40 ",$456.08 ,$535.70 ,"$2,069.75 ","$2,045.40 ",$535.70 ,"$1,826.25 ","$1,948.00 ","$1,948.00 ",$535.70 ,"$1,948.00 ","$2,045.40 ","$2,045.40 ","$2,045.40 ","$2,435.00 ","$2,191.50 ","$1,400.13 ","$2,435.00 ",$535.70 ,"$2,435.00 ","$1,324.64 ",$535.70 ,"$1,012.96 ",$166.28 ,$158.72 ,$562.49 ,"$2,069.75 ","$1,672.85 ",$681.80 ,"$2,191.50 ","$2,045.40 ","$1,948.00 ","$1,948.00 ",$535.70 ,"$1,582.75 "
ST. FRANCIS HOSPITAL - ACUTE,35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$3,299.00 ","$2,144.35 ",$316.01 ,"$3,299.00 ","$1,896.93 ","$2,375.28 ","$1,794.66 ",$725.78 ,$923.72 ,"$1,939.81 ",$725.78 ,"$2,266.41 ",$824.75 ,"$2,266.41 ","$2,266.41 ",$824.75 ,"$2,266.41 ","$1,378.98 ","$2,771.16 ",$456.08 ,$725.78 ,"$2,804.15 ","$2,771.16 ",$725.78 ,"$2,474.25 ","$2,639.20 ","$2,639.20 ",$725.78 ,"$2,639.20 ","$2,771.16 ","$2,771.16 ","$2,771.16 ","$3,299.00 ","$2,969.10 ","$1,896.93 ","$3,299.00 ",$725.78 ,"$3,299.00 ","$1,794.66 ",$725.78 ,"$1,372.38 ",$331.06 ,$316.01 ,$762.07 ,"$2,804.15 ","$2,266.41 ",$923.72 ,"$2,969.10 ","$2,771.16 ","$2,639.20 ","$2,639.20 ",$725.78 ,"$2,144.35 "
ST. FRANCIS HOSPITAL - ACUTE,35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$2,479.00 ","$1,611.35 ",$277.98 ,"$2,479.00 ","$1,425.43 ","$1,784.88 ","$1,348.58 ",$545.38 ,$694.12 ,"$1,457.65 ",$545.38 ,"$1,703.07 ",$619.75 ,"$1,703.07 ","$1,703.07 ",$619.75 ,"$1,703.07 ","$1,036.22 ","$2,082.36 ",$277.98 ,$545.38 ,"$2,107.15 ","$2,082.36 ",$545.38 ,"$1,859.25 ","$1,983.20 ","$1,983.20 ",$545.38 ,"$1,983.20 ","$2,082.36 ","$2,082.36 ","$2,082.36 ","$2,479.00 ","$2,231.10 ","$1,425.43 ","$2,479.00 ",$545.38 ,"$2,479.00 ","$1,348.58 ",$545.38 ,"$1,031.26 ",$331.38 ,$316.31 ,$572.65 ,"$2,107.15 ","$1,703.07 ",$694.12 ,"$2,231.10 ","$2,082.36 ","$1,983.20 ","$1,983.20 ",$545.38 ,"$1,611.35 "
ST. FRANCIS HOSPITAL - ACUTE,35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,706.00 ","$1,758.90 ",$316.31 ,"$2,706.00 ","$1,555.95 ","$1,948.32 ","$1,472.06 ",$595.32 ,$757.68 ,"$1,591.13 ",$595.32 ,"$1,859.02 ",$676.50 ,"$1,859.02 ","$1,859.02 ",$676.50 ,"$1,859.02 ","$1,131.11 ","$2,273.04 ",$456.08 ,$595.32 ,"$2,300.10 ","$2,273.04 ",$595.32 ,"$2,029.50 ","$2,164.80 ","$2,164.80 ",$595.32 ,"$2,164.80 ","$2,273.04 ","$2,273.04 ","$2,273.04 ","$2,706.00 ","$2,435.40 ","$1,555.95 ","$2,706.00 ",$595.32 ,"$2,706.00 ","$1,472.06 ",$595.32 ,"$1,125.70 ",$331.38 ,$316.31 ,$625.09 ,"$2,300.10 ","$1,859.02 ",$757.68 ,"$2,435.40 ","$2,273.04 ","$2,164.80 ","$2,164.80 ",$595.32 ,"$1,758.90 "
ST. FRANCIS HOSPITAL - ACUTE,35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$3,204.00 ","$2,082.60 ",$316.31 ,"$3,204.00 ","$1,842.30 ","$2,306.88 ","$1,742.98 ",$704.88 ,$897.12 ,"$1,883.95 ",$704.88 ,"$2,201.15 ",$801.00 ,"$2,201.15 ","$2,201.15 ",$801.00 ,"$2,201.15 ","$1,339.27 ","$2,691.36 ",$456.08 ,$704.88 ,"$2,723.40 ","$2,691.36 ",$704.88 ,"$2,403.00 ","$2,563.20 ","$2,563.20 ",$704.88 ,"$2,563.20 ","$2,691.36 ","$2,691.36 ","$2,691.36 ","$3,204.00 ","$2,883.60 ","$1,842.30 ","$3,204.00 ",$704.88 ,"$3,204.00 ","$1,742.98 ",$704.88 ,"$1,332.86 ",$331.38 ,$316.31 ,$740.12 ,"$2,723.40 ","$2,201.15 ",$897.12 ,"$2,883.60 ","$2,691.36 ","$2,563.20 ","$2,563.20 ",$704.88 ,"$2,082.60 "
ST. FRANCIS HOSPITAL - ACUTE,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$2,175.00 ","$1,413.75 ",$139.83 ,"$2,175.00 ","$1,250.63 ","$1,566.00 ","$1,183.20 ",$478.50 ,$609.00 ,"$1,278.90 ",$478.50 ,"$1,494.23 ",$543.75 ,"$1,494.23 ","$1,494.23 ",$543.75 ,"$1,494.23 ",$909.15 ,"$1,827.00 ",$277.98 ,$478.50 ,"$1,848.75 ","$1,827.00 ",$478.50 ,"$1,631.25 ","$1,740.00 ","$1,740.00 ",$478.50 ,"$1,740.00 ","$1,827.00 ","$1,827.00 ","$1,827.00 ","$2,175.00 ","$1,957.50 ","$1,250.63 ","$2,175.00 ",$478.50 ,"$2,175.00 ","$1,183.20 ",$478.50 ,$904.80 ,$146.49 ,$139.83 ,$502.43 ,"$1,848.75 ","$1,494.23 ",$609.00 ,"$1,957.50 ","$1,827.00 ","$1,740.00 ","$1,740.00 ",$478.50 ,"$1,413.75 "
ST. FRANCIS HOSPITAL - ACUTE,35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$3,051.00 ","$1,983.15 ",$139.83 ,"$3,051.00 ","$1,754.33 ","$2,196.72 ","$1,659.74 ",$671.22 ,$854.28 ,"$1,793.99 ",$671.22 ,"$2,096.04 ",$762.75 ,"$2,096.04 ","$2,096.04 ",$762.75 ,"$2,096.04 ","$1,275.32 ","$2,562.84 ",$940.23 ,$671.22 ,"$2,593.35 ","$2,562.84 ",$671.22 ,"$2,288.25 ","$2,440.80 ","$2,440.80 ",$671.22 ,"$2,440.80 ","$2,562.84 ","$2,562.84 ","$2,562.84 ","$3,051.00 ","$2,745.90 ","$1,754.33 ","$3,051.00 ",$671.22 ,"$3,051.00 ","$1,659.74 ",$671.22 ,"$1,269.22 ",$146.49 ,$139.83 ,$704.78 ,"$2,593.35 ","$2,096.04 ",$854.28 ,"$2,745.90 ","$2,562.84 ","$2,440.80 ","$2,440.80 ",$671.22 ,"$1,983.15 "
ST. FRANCIS HOSPITAL - ACUTE,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$3,051.00 ","$1,983.15 ",$139.83 ,"$3,051.00 ","$1,754.33 ","$2,196.72 ","$1,659.74 ",$671.22 ,$854.28 ,"$1,793.99 ",$671.22 ,"$2,096.04 ",$762.75 ,"$2,096.04 ","$2,096.04 ",$762.75 ,"$2,096.04 ","$1,275.32 ","$2,562.84 ",$456.08 ,$671.22 ,"$2,593.35 ","$2,562.84 ",$671.22 ,"$2,288.25 ","$2,440.80 ","$2,440.80 ",$671.22 ,"$2,440.80 ","$2,562.84 ","$2,562.84 ","$2,562.84 ","$3,051.00 ","$2,745.90 ","$1,754.33 ","$3,051.00 ",$671.22 ,"$3,051.00 ","$1,659.74 ",$671.22 ,"$1,269.22 ",$146.49 ,$139.83 ,$704.78 ,"$2,593.35 ","$2,096.04 ",$854.28 ,"$2,745.90 ","$2,562.84 ","$2,440.80 ","$2,440.80 ",$671.22 ,"$1,983.15 "
ST. FRANCIS HOSPITAL - ACUTE,35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$3,051.00 ","$1,983.15 ",$316.01 ,"$3,051.00 ","$1,754.33 ","$2,196.72 ","$1,659.74 ",$671.22 ,$854.28 ,"$1,793.99 ",$671.22 ,"$2,096.04 ",$762.75 ,"$2,096.04 ","$2,096.04 ",$762.75 ,"$2,096.04 ","$1,275.32 ","$2,562.84 ",$456.08 ,$671.22 ,"$2,593.35 ","$2,562.84 ",$671.22 ,"$2,288.25 ","$2,440.80 ","$2,440.80 ",$671.22 ,"$2,440.80 ","$2,562.84 ","$2,562.84 ","$2,562.84 ","$3,051.00 ","$2,745.90 ","$1,754.33 ","$3,051.00 ",$671.22 ,"$3,051.00 ","$1,659.74 ",$671.22 ,"$1,269.22 ",$331.06 ,$316.01 ,$704.78 ,"$2,593.35 ","$2,096.04 ",$854.28 ,"$2,745.90 ","$2,562.84 ","$2,440.80 ","$2,440.80 ",$671.22 ,"$1,983.15 "
ST. FRANCIS HOSPITAL - ACUTE,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$2,364.00 ","$1,536.60 ",$139.83 ,"$2,364.00 ","$1,359.30 ","$1,702.08 ","$1,286.02 ",$520.08 ,$661.92 ,"$1,390.03 ",$520.08 ,"$1,624.07 ",$591.00 ,"$1,624.07 ","$1,624.07 ",$591.00 ,"$1,624.07 ",$988.15 ,"$1,985.76 ",$277.98 ,$520.08 ,"$2,009.40 ","$1,985.76 ",$520.08 ,"$1,773.00 ","$1,891.20 ","$1,891.20 ",$520.08 ,"$1,891.20 ","$1,985.76 ","$1,985.76 ","$1,985.76 ","$2,364.00 ","$2,127.60 ","$1,359.30 ","$2,364.00 ",$520.08 ,"$2,364.00 ","$1,286.02 ",$520.08 ,$983.42 ,$146.49 ,$139.83 ,$546.08 ,"$2,009.40 ","$1,624.07 ",$661.92 ,"$2,127.60 ","$1,985.76 ","$1,891.20 ","$1,891.20 ",$520.08 ,"$1,536.60 "
ST. FRANCIS HOSPITAL - ACUTE,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,709.00 ","$1,760.85 ",$139.83 ,"$2,709.00 ","$1,557.68 ","$1,950.48 ","$1,473.70 ",$595.98 ,$758.52 ,"$1,592.89 ",$595.98 ,"$1,861.08 ",$677.25 ,"$1,861.08 ","$1,861.08 ",$677.25 ,"$1,861.08 ","$1,132.36 ","$2,275.56 ",$456.08 ,$595.98 ,"$2,302.65 ","$2,275.56 ",$595.98 ,"$2,031.75 ","$2,167.20 ","$2,167.20 ",$595.98 ,"$2,167.20 ","$2,275.56 ","$2,275.56 ","$2,275.56 ","$2,709.00 ","$2,438.10 ","$1,557.68 ","$2,709.00 ",$595.98 ,"$2,709.00 ","$1,473.70 ",$595.98 ,"$1,126.94 ",$146.49 ,$139.83 ,$625.78 ,"$2,302.65 ","$1,861.08 ",$758.52 ,"$2,438.10 ","$2,275.56 ","$2,167.20 ","$2,167.20 ",$595.98 ,"$1,760.85 "
ST. FRANCIS HOSPITAL - ACUTE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$2,239.00 ","$1,455.35 ",$474.01 ,"$2,239.00 ","$1,287.43 ","$1,612.08 ","$1,218.02 ",$492.58 ,$626.92 ,"$1,316.53 ",$492.58 ,"$1,538.19 ",$559.75 ,"$1,538.19 ","$1,538.19 ",$559.75 ,"$1,538.19 ",$935.90 ,"$1,880.76 ","$1,111.40 ",$492.58 ,"$1,903.15 ","$1,880.76 ",$492.58 ,"$1,679.25 ","$1,791.20 ","$1,791.20 ",$492.58 ,"$1,791.20 ","$1,880.76 ","$1,880.76 ","$1,880.76 ","$2,239.00 ","$2,015.10 ","$1,287.43 ","$2,239.00 ",$492.58 ,"$2,239.00 ","$1,218.02 ",$492.58 ,$931.42 ,$496.58 ,$474.01 ,$517.21 ,"$1,903.15 ","$1,538.19 ",$626.92 ,"$2,015.10 ","$1,880.76 ","$1,791.20 ","$1,791.20 ",$492.58 ,"$1,455.35 "
ST. FRANCIS HOSPITAL - ACUTE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$2,039.00 ","$1,325.35 ",$316.01 ,"$2,039.00 ","$1,172.43 ","$1,468.08 ","$1,109.22 ",$448.58 ,$570.92 ,"$1,198.93 ",$448.58 ,"$1,400.79 ",$509.75 ,"$1,400.79 ","$1,400.79 ",$509.75 ,"$1,400.79 ",$852.30 ,"$1,712.76 ",$456.08 ,$448.58 ,"$1,733.15 ","$1,712.76 ",$448.58 ,"$1,529.25 ","$1,631.20 ","$1,631.20 ",$448.58 ,"$1,631.20 ","$1,712.76 ","$1,712.76 ","$1,712.76 ","$2,039.00 ","$1,835.10 ","$1,172.43 ","$2,039.00 ",$448.58 ,"$2,039.00 ","$1,109.22 ",$448.58 ,$848.22 ,$331.06 ,$316.01 ,$471.01 ,"$1,733.15 ","$1,400.79 ",$570.92 ,"$1,835.10 ","$1,712.76 ","$1,631.20 ","$1,631.20 ",$448.58 ,"$1,325.35 "
ST. FRANCIS HOSPITAL - ACUTE,35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$2,393.00 ","$1,555.45 ",$277.98 ,"$2,393.00 ","$1,375.98 ","$1,722.96 ","$1,301.79 ",$526.46 ,$670.04 ,"$1,407.08 ",$526.46 ,"$1,643.99 ",$598.25 ,"$1,643.99 ","$1,643.99 ",$598.25 ,"$1,643.99 ","$1,000.27 ","$2,010.12 ",$277.98 ,$526.46 ,"$2,034.05 ","$2,010.12 ",$526.46 ,"$1,794.75 ","$1,914.40 ","$1,914.40 ",$526.46 ,"$1,914.40 ","$2,010.12 ","$2,010.12 ","$2,010.12 ","$2,393.00 ","$2,153.70 ","$1,375.98 ","$2,393.00 ",$526.46 ,"$2,393.00 ","$1,301.79 ",$526.46 ,$995.49 ,$331.38 ,$316.31 ,$552.78 ,"$2,034.05 ","$1,643.99 ",$670.04 ,"$2,153.70 ","$2,010.12 ","$1,914.40 ","$1,914.40 ",$526.46 ,"$1,555.45 "
ST. FRANCIS HOSPITAL - ACUTE,35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$3,227.00 ","$2,097.55 ",$316.31 ,"$3,227.00 ","$1,855.53 ","$2,323.44 ","$1,755.49 ",$709.94 ,$903.56 ,"$1,897.48 ",$709.94 ,"$2,216.95 ",$806.75 ,"$2,216.95 ","$2,216.95 ",$806.75 ,"$2,216.95 ","$1,348.89 ","$2,710.68 ",$456.08 ,$709.94 ,"$2,742.95 ","$2,710.68 ",$709.94 ,"$2,420.25 ","$2,581.60 ","$2,581.60 ",$709.94 ,"$2,581.60 ","$2,710.68 ","$2,710.68 ","$2,710.68 ","$3,227.00 ","$2,904.30 ","$1,855.53 ","$3,227.00 ",$709.94 ,"$3,227.00 ","$1,755.49 ",$709.94 ,"$1,342.43 ",$331.38 ,$316.31 ,$745.44 ,"$2,742.95 ","$2,216.95 ",$903.56 ,"$2,904.30 ","$2,710.68 ","$2,581.60 ","$2,581.60 ",$709.94 ,"$2,097.55 "
ST. FRANCIS HOSPITAL - ACUTE,35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,528.00 ","$2,293.20 ",$316.31 ,"$3,528.00 ","$2,028.60 ","$2,540.16 ","$1,919.23 ",$776.16 ,$987.84 ,"$2,074.46 ",$776.16 ,"$2,423.74 ",$882.00 ,"$2,423.74 ","$2,423.74 ",$882.00 ,"$2,423.74 ","$1,474.70 ","$2,963.52 ",$456.08 ,$776.16 ,"$2,998.80 ","$2,963.52 ",$776.16 ,"$2,646.00 ","$2,822.40 ","$2,822.40 ",$776.16 ,"$2,822.40 ","$2,963.52 ","$2,963.52 ","$2,963.52 ","$3,528.00 ","$3,175.20 ","$2,028.60 ","$3,528.00 ",$776.16 ,"$3,528.00 ","$1,919.23 ",$776.16 ,"$1,467.65 ",$331.38 ,$316.31 ,$814.97 ,"$2,998.80 ","$2,423.74 ",$987.84 ,"$3,175.20 ","$2,963.52 ","$2,822.40 ","$2,822.40 ",$776.16 ,"$2,293.20 "
ST. FRANCIS HOSPITAL - ACUTE,35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,499.00 ","$2,274.35 ",$316.01 ,"$3,499.00 ","$2,011.93 ","$2,519.28 ","$1,903.46 ",$769.78 ,$979.72 ,"$2,057.41 ",$769.78 ,"$2,403.81 ",$874.75 ,"$2,403.81 ","$2,403.81 ",$874.75 ,"$2,403.81 ","$1,462.58 ","$2,939.16 ",$456.08 ,$769.78 ,"$2,974.15 ","$2,939.16 ",$769.78 ,"$2,624.25 ","$2,799.20 ","$2,799.20 ",$769.78 ,"$2,799.20 ","$2,939.16 ","$2,939.16 ","$2,939.16 ","$3,499.00 ","$3,149.10 ","$2,011.93 ","$3,499.00 ",$769.78 ,"$3,499.00 ","$1,903.46 ",$769.78 ,"$1,455.58 ",$331.06 ,$316.01 ,$808.27 ,"$2,974.15 ","$2,403.81 ",$979.72 ,"$3,149.10 ","$2,939.16 ","$2,799.20 ","$2,799.20 ",$769.78 ,"$2,274.35 "
ST. FRANCIS HOSPITAL - ACUTE,35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$4,871.00 ","$3,166.15 ",$316.31 ,"$4,871.00 ","$2,800.83 ","$3,507.12 ","$2,649.82 ","$1,071.62 ","$1,363.88 ","$2,555.61 ","$1,071.62 ","$2,555.61 ","$1,217.75 ","$2,555.61 ","$2,555.61 ","$1,217.75 ","$2,555.61 ","$2,036.08 ","$4,091.64 ",$587.50 ,"$1,071.62 ","$4,140.35 ","$4,091.64 ","$1,071.62 ","$3,653.25 ","$3,896.80 ","$3,896.80 ","$1,071.62 ","$3,896.80 ","$4,091.64 ","$4,091.64 ","$4,091.64 ","$4,871.00 ","$4,383.90 ","$2,800.83 ","$4,871.00 ","$1,071.62 ","$4,871.00 ","$2,649.82 ","$1,071.62 ","$2,026.34 ",$331.38 ,$316.31 ,"$1,125.20 ","$4,140.35 ","$2,555.61 ","$1,363.88 ","$4,383.90 ","$4,091.64 ","$3,896.80 ","$3,896.80 ","$1,071.62 ","$3,166.15 "
ST. FRANCIS HOSPITAL - ACUTE,35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$5,932.00 ","$3,855.80 ",$316.31 ,"$5,932.00 ","$3,410.90 ","$4,271.04 ","$3,227.01 ","$1,305.04 ","$1,660.96 ","$3,488.02 ","$1,305.04 ","$4,075.28 ","$1,483.00 ","$4,075.28 ","$4,075.28 ","$1,483.00 ","$4,075.28 ","$2,479.58 ","$4,982.88 ",$940.23 ,"$1,305.04 ","$5,042.20 ","$4,982.88 ","$1,305.04 ","$4,449.00 ","$4,745.60 ","$4,745.60 ","$1,305.04 ","$4,745.60 ","$4,982.88 ","$4,982.88 ","$4,982.88 ","$5,932.00 ","$5,338.80 ","$3,410.90 ","$5,932.00 ","$1,305.04 ","$5,932.00 ","$3,227.01 ","$1,305.04 ","$2,467.71 ",$331.38 ,$316.31 ,"$1,370.29 ","$5,042.20 ","$4,075.28 ","$1,660.96 ","$5,338.80 ","$4,982.88 ","$4,745.60 ","$4,745.60 ","$1,305.04 ","$3,855.80 "
ST. FRANCIS HOSPITAL - ACUTE,35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$6,301.00 ","$4,095.65 ",$316.31 ,"$6,301.00 ","$3,623.08 ","$4,536.72 ","$3,427.74 ","$1,386.22 ","$1,764.28 ","$3,704.99 ","$1,386.22 ","$4,328.79 ","$1,575.25 ","$4,328.79 ","$4,328.79 ","$1,575.25 ","$4,328.79 ","$2,633.82 ","$5,292.84 ",$940.23 ,"$1,386.22 ","$5,355.85 ","$5,292.84 ","$1,386.22 ","$4,725.75 ","$5,040.80 ","$5,040.80 ","$1,386.22 ","$5,040.80 ","$5,292.84 ","$5,292.84 ","$5,292.84 ","$6,301.00 ","$5,670.90 ","$3,623.08 ","$6,301.00 ","$1,386.22 ","$6,301.00 ","$3,427.74 ","$1,386.22 ","$2,621.22 ",$331.38 ,$316.31 ,"$1,455.53 ","$5,355.85 ","$4,328.79 ","$1,764.28 ","$5,670.90 ","$5,292.84 ","$5,040.80 ","$5,040.80 ","$1,386.22 ","$4,095.65 "
ST. FRANCIS HOSPITAL - ACUTE,35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$3,856.00 ","$2,506.40 ",$316.01 ,"$3,856.00 ","$2,217.20 ","$2,776.32 ","$2,097.66 ",$848.32 ,"$1,079.68 ","$2,267.33 ",$848.32 ,"$2,649.07 ",$964.00 ,"$2,649.07 ","$2,649.07 ",$964.00 ,"$2,649.07 ","$1,611.81 ","$3,239.04 ",$456.08 ,$848.32 ,"$3,277.60 ","$3,239.04 ",$848.32 ,"$2,892.00 ","$3,084.80 ","$3,084.80 ",$848.32 ,"$3,084.80 ","$3,239.04 ","$3,239.04 ","$3,239.04 ","$3,856.00 ","$3,470.40 ","$2,217.20 ","$3,856.00 ",$848.32 ,"$3,856.00 ","$2,097.66 ",$848.32 ,"$1,604.10 ",$331.06 ,$316.01 ,$890.74 ,"$3,277.60 ","$2,649.07 ","$1,079.68 ","$3,470.40 ","$3,239.04 ","$3,084.80 ","$3,084.80 ",$848.32 ,"$2,506.40 "
ST. FRANCIS HOSPITAL - ACUTE,35000099,76376,HC 3D RENDER CT NOT REQUIRE INDEP,350,1 ,"$1,162.00 ",$755.30 ,$255.64 ,"$1,162.00 ",$668.15 ,$836.64 ,$632.13 ,$255.64 ,$325.36 ,$309.51 ,$255.64 ,$309.51 ,$290.50 ,$309.51 ,$309.51 ,$290.50 ,$309.51 ,$485.72 ,$976.08 , N/A ,$255.64 ,$987.70 ,$976.08 ,$255.64 ,$871.50 ,$929.60 ,$929.60 ,$255.64 ,$929.60 ,$976.08 ,$976.08 ,$976.08 ,"$1,162.00 ","$1,045.80 ",$668.15 ,"$1,162.00 ",$255.64 ,"$1,162.00 ",$632.13 ,$255.64 ,$483.39 , N/A , N/A ,$268.42 ,$987.70 ,$309.51 ,$325.36 ,"$1,045.80 ",$976.08 ,$929.60 ,$929.60 ,$255.64 ,$755.30 
ST. FRANCIS HOSPITAL - ACUTE,35000100,76377,HC 3D RENDER CT REQUIRES INDEPENDENT,350,1 ,$605.00 ,$393.25 ,$133.10 ,$605.00 ,$347.88 ,$435.60 ,$329.12 ,$133.10 ,$169.40 ,$355.74 ,$133.10 ,$415.64 ,$151.25 ,$415.64 ,$415.64 ,$151.25 ,$415.64 ,$252.89 ,$508.20 , N/A ,$133.10 ,$514.25 ,$508.20 ,$133.10 ,$453.75 ,$484.00 ,$484.00 ,$133.10 ,$484.00 ,$508.20 ,$508.20 ,$508.20 ,$605.00 ,$544.50 ,$347.88 ,$605.00 ,$133.10 ,$605.00 ,$329.12 ,$133.10 ,$251.68 , N/A , N/A ,$139.76 ,$514.25 ,$415.64 ,$169.40 ,$544.50 ,$508.20 ,$484.00 ,$484.00 ,$133.10 ,$393.25 
ST. FRANCIS HOSPITAL - ACUTE,35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$2,341.00 ","$1,521.65 ",$107.85 ,"$2,341.00 ","$1,346.08 ","$1,685.52 ","$1,273.50 ",$515.02 ,$655.48 ,"$1,376.51 ",$515.02 ,"$1,520.15 ",$585.25 ,"$1,520.15 ","$1,520.15 ",$585.25 ,"$1,520.15 ",$978.54 ,"$1,966.44 ", N/A ,$515.02 ,"$1,989.85 ","$1,966.44 ",$515.02 ,"$1,755.75 ","$1,872.80 ","$1,872.80 ",$515.02 ,"$1,872.80 ","$1,966.44 ","$1,966.44 ","$1,966.44 ","$2,341.00 ","$2,106.90 ","$1,346.08 ","$2,341.00 ",$515.02 ,"$2,341.00 ","$1,273.50 ",$515.02 ,$973.86 ,$112.98 ,$107.85 ,$540.77 ,"$1,989.85 ","$1,520.15 ",$655.48 ,"$2,106.90 ","$1,966.44 ","$1,872.80 ","$1,872.80 ",$515.02 ,"$1,521.65 "
ST. FRANCIS HOSPITAL - ACUTE,35000111,77014,HC CT GUIDED THRPY PLACEMENT UNENHAN,350,1 ,$490.00 ,$318.50 ,$107.80 ,$490.00 ,$281.75 ,$352.80 ,$266.56 ,$107.80 ,$137.20 ,$288.12 ,$107.80 ,$336.63 ,$122.50 ,$336.63 ,$336.63 ,$122.50 ,$336.63 ,$204.82 ,$411.60 , N/A ,$107.80 ,$416.50 ,$411.60 ,$107.80 ,$367.50 ,$392.00 ,$392.00 ,$107.80 ,$392.00 ,$411.60 ,$411.60 ,$411.60 ,$490.00 ,$441.00 ,$281.75 ,$490.00 ,$107.80 ,$490.00 ,$266.56 ,$107.80 ,$203.84 ,$112.98 ,$107.85 ,$113.19 ,$416.50 ,$336.63 ,$137.20 ,$441.00 ,$411.60 ,$392.00 ,$392.00 ,$107.80 ,$318.50 
ST. FRANCIS HOSPITAL - ACUTE,35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$6,301.00 ","$4,095.65 ",$316.31 ,"$6,301.00 ","$3,623.08 ","$4,536.72 ","$3,427.74 ","$1,386.22 ","$1,764.28 ","$3,704.99 ","$1,386.22 ","$4,328.79 ","$1,575.25 ","$4,328.79 ","$4,328.79 ","$1,575.25 ","$4,328.79 ","$2,633.82 ","$5,292.84 ",$940.23 ,"$1,386.22 ","$5,355.85 ","$5,292.84 ","$1,386.22 ","$4,725.75 ","$5,040.80 ","$5,040.80 ","$1,386.22 ","$5,040.80 ","$5,292.84 ","$5,292.84 ","$5,292.84 ","$6,301.00 ","$5,670.90 ","$3,623.08 ","$6,301.00 ","$1,386.22 ","$6,301.00 ","$3,427.74 ","$1,386.22 ","$2,621.22 ",$331.38 ,$316.31 ,"$1,455.53 ","$5,355.85 ","$4,328.79 ","$1,764.28 ","$5,670.90 ","$5,292.84 ","$5,040.80 ","$5,040.80 ","$1,386.22 ","$4,095.65 "
ST. FRANCIS HOSPITAL - ACUTE,35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,$419.00 ,$272.35 ,$92.18 ,$419.00 ,$240.93 ,$301.68 ,$227.94 ,$92.18 ,$117.32 ,$235.06 ,$92.18 ,$273.19 ,$104.75 ,$273.19 ,$273.19 ,$104.75 ,$273.19 ,$175.14 ,$351.96 ,$277.98 ,$92.18 ,$356.15 ,$351.96 ,$92.18 ,$314.25 ,$335.20 ,$335.20 ,$92.18 ,$335.20 ,$351.96 ,$351.96 ,$351.96 ,$419.00 ,$377.10 ,$240.93 ,$419.00 ,$92.18 ,$419.00 ,$227.94 ,$92.18 ,$174.30 ,$146.49 ,$139.83 ,$96.79 ,$356.15 ,$273.19 ,$117.32 ,$377.10 ,$351.96 ,$335.20 ,$335.20 ,$92.18 ,$272.35 
ST. FRANCIS HOSPITAL - ACUTE,36000025,10021,HC ASP FINE NDL W/O IMAGING GUIDE,360,1 ,$324.00 ,$210.60 ,$71.28 ,$882.50 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$882.50 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$112.87 ,$176.26 ,$71.28 ,$134.78 ,$641.73 ,$612.56 ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$324.00 ,$210.60 ,$71.28 ,$458.50 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$458.50 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 ,$317.01 ,$302.60 ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,$371.00 ,$241.15 ,$81.62 ,"$3,592.48 ",$213.33 ,$267.12 ,$201.82 ,$81.62 ,$103.88 ,$208.13 ,$81.62 ,$241.89 ,$92.75 ,$241.89 ,$241.89 ,$92.75 ,$241.89 ,$155.08 ,$311.64 ,"$3,592.48 ",$81.62 ,$315.35 ,$311.64 ,$81.62 ,$278.25 ,$296.80 ,$296.80 ,$81.62 ,$296.80 ,$311.64 ,$311.64 ,$311.64 ,$371.00 ,$333.90 ,$213.33 ,$371.00 ,$81.62 ,$371.00 ,$201.82 ,$81.62 ,$154.34 ,"$1,105.69 ","$1,055.43 ",$85.70 ,$315.35 ,$241.89 ,$103.88 ,$333.90 ,$311.64 ,$296.80 ,$296.80 ,$81.62 ,$241.15 
ST. FRANCIS HOSPITAL - ACUTE,36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$281.00 ,$182.65 ,$61.82 ,$882.50 ,$161.58 ,$202.32 ,$152.86 ,$61.82 ,$78.68 ,$157.64 ,$61.82 ,$183.21 ,$70.25 ,$183.21 ,$183.21 ,$70.25 ,$183.21 ,$117.46 ,$236.04 ,$882.50 ,$61.82 ,$238.85 ,$236.04 ,$61.82 ,$210.75 ,$224.80 ,$224.80 ,$61.82 ,$224.80 ,$236.04 ,$236.04 ,$236.04 ,$281.00 ,$252.90 ,$161.58 ,$281.00 ,$61.82 ,$281.00 ,$152.86 ,$61.82 ,$116.90 ,$317.01 ,$302.60 ,$64.91 ,$238.85 ,$183.21 ,$78.68 ,$252.90 ,$236.04 ,$224.80 ,$224.80 ,$61.82 ,$182.65 
ST. FRANCIS HOSPITAL - ACUTE,36000078,19000,HC ASP CYST BREAST,360,1 ,"$1,465.00 ",$952.25 ,$177.68 ,"$1,588.85 ",$842.38 ,"$1,054.80 ",$796.96 ,$322.30 ,$410.20 ,$821.87 ,$322.30 ,$955.18 ,$366.25 ,$955.18 ,$955.18 ,$366.25 ,$955.18 ,$612.37 ,"$1,230.60 ","$1,588.85 ",$322.30 ,"$1,245.25 ","$1,230.60 ",$322.30 ,"$1,098.75 ","$1,172.00 ","$1,172.00 ",$322.30 ,"$1,172.00 ","$1,230.60 ","$1,230.60 ","$1,230.60 ","$1,465.00 ","$1,318.50 ",$842.38 ,"$1,465.00 ",$322.30 ,$177.68 ,$796.96 ,$322.30 ,$609.44 ,$641.73 ,$612.56 ,$338.42 ,"$1,245.25 ",$955.18 ,$410.20 ,"$1,318.50 ","$1,230.60 ","$1,172.00 ","$1,172.00 ",$322.30 ,$952.25 
ST. FRANCIS HOSPITAL - ACUTE,36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$732.00 ,$475.80 ,$29.74 ,$732.00 ,$420.90 ,$527.04 ,$398.21 ,$161.04 ,$204.96 ,$410.65 ,$161.04 ,$477.26 ,$183.00 ,$477.26 ,$477.26 ,$183.00 ,$477.26 ,$305.98 ,$614.88 , N/A ,$161.04 ,$622.20 ,$614.88 ,$161.04 ,$549.00 ,$585.60 ,$585.60 ,$161.04 ,$585.60 ,$614.88 ,$614.88 ,$614.88 ,$732.00 ,$658.80 ,$420.90 ,$732.00 ,$161.04 ,$29.74 ,$398.21 ,$161.04 ,$304.51 ,$641.73 ,$612.56 ,$169.09 ,$622.20 ,$477.26 ,$204.96 ,$658.80 ,$614.88 ,$585.60 ,$585.60 ,$161.04 ,$475.80 
ST. FRANCIS HOSPITAL - ACUTE,36000080,19020,HC BREAST ABSCESS DRAINAGE,360,1 ,"$3,924.00 ","$2,550.60 ",$863.28 ,"$3,924.00 ","$2,256.30 ","$2,825.28 ","$2,134.66 ",$863.28 ,"$1,098.72 ","$2,201.36 ",$863.28 ,"$2,558.45 ",$981.00 ,"$2,558.45 ","$2,558.45 ",$981.00 ,"$2,558.45 ","$1,640.23 ","$3,296.16 ","$3,592.48 ",$863.28 ,"$3,335.40 ","$3,296.16 ",$863.28 ,"$2,943.00 ","$3,139.20 ","$3,139.20 ",$863.28 ,"$3,139.20 ","$3,296.16 ","$3,296.16 ","$3,296.16 ","$3,924.00 ","$3,531.60 ","$2,256.30 ","$3,924.00 ",$863.28 ,"$3,924.00 ","$2,134.66 ",$863.28 ,"$1,632.38 ","$1,105.69 ","$1,055.43 ",$906.44 ,"$3,335.40 ","$2,558.45 ","$1,098.72 ","$3,531.60 ","$3,296.16 ","$3,139.20 ","$3,139.20 ",$863.28 ,"$2,550.60 "
ST. FRANCIS HOSPITAL - ACUTE,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,"$1,267.00 ",$823.55 ,$278.74 ,"$1,267.00 ",$728.53 ,$912.24 ,$689.25 ,$278.74 ,$354.76 ,$710.79 ,$278.74 ,$826.08 ,$316.75 ,$826.08 ,$826.08 ,$316.75 ,$826.08 ,$529.61 ,"$1,064.28 ", N/A ,$278.74 ,"$1,076.95 ","$1,064.28 ",$278.74 ,$950.25 ,"$1,013.60 ","$1,013.60 ",$278.74 ,"$1,013.60 ","$1,064.28 ","$1,064.28 ","$1,064.28 ","$1,267.00 ","$1,140.30 ",$728.53 ,"$1,267.00 ",$278.74 ,"$1,267.00 ",$689.25 ,$278.74 ,$527.07 , N/A , N/A ,$292.68 ,"$1,076.95 ",$826.08 ,$354.76 ,"$1,140.30 ","$1,064.28 ","$1,013.60 ","$1,013.60 ",$278.74 ,$823.55 
ST. FRANCIS HOSPITAL - ACUTE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$3,143.00 ","$2,042.95 ",$620.94 ,"$3,592.48 ","$1,807.23 ","$2,262.96 ","$1,709.79 ",$691.46 ,$880.04 ,"$1,763.22 ",$691.46 ,"$2,049.24 ",$785.75 ,"$2,049.24 ","$2,049.24 ",$785.75 ,"$2,049.24 ","$1,313.77 ","$2,640.12 ","$3,592.48 ",$691.46 ,"$2,671.55 ","$2,640.12 ",$691.46 ,"$2,357.25 ","$2,514.40 ","$2,514.40 ",$691.46 ,"$2,514.40 ","$2,640.12 ","$2,640.12 ","$2,640.12 ","$3,143.00 ","$2,828.70 ","$1,807.23 ","$3,143.00 ",$691.46 ,$620.94 ,"$1,709.79 ",$691.46 ,"$1,307.49 ","$1,300.50 ","$1,241.38 ",$726.03 ,"$2,671.55 ","$2,049.24 ",$880.04 ,"$2,828.70 ","$2,640.12 ","$2,514.40 ","$2,514.40 ",$691.46 ,"$2,042.95 "
ST. FRANCIS HOSPITAL - ACUTE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$3,474.00 ","$2,258.10 ",$620.94 ,"$6,053.88 ","$1,997.55 ","$2,501.28 ","$1,889.86 ",$764.28 ,$972.72 ,"$1,948.91 ",$764.28 ,"$2,265.05 ",$868.50 ,"$2,265.05 ","$2,265.05 ",$868.50 ,"$2,265.05 ","$1,452.13 ","$2,918.16 ","$6,053.88 ",$764.28 ,"$2,952.90 ","$2,918.16 ",$764.28 ,"$2,605.50 ","$2,779.20 ","$2,779.20 ",$764.28 ,"$2,779.20 ","$2,918.16 ","$2,918.16 ","$2,918.16 ","$3,474.00 ","$3,126.60 ","$1,997.55 ","$3,474.00 ",$764.28 ,$620.94 ,"$1,889.86 ",$764.28 ,"$1,445.18 ","$1,950.75 ","$1,862.08 ",$802.49 ,"$2,952.90 ","$2,265.05 ",$972.72 ,"$3,126.60 ","$2,918.16 ","$2,779.20 ","$2,779.20 ",$764.28 ,"$2,258.10 "
ST. FRANCIS HOSPITAL - ACUTE,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$2,733.00 ","$1,776.45 ",$120.26 ,"$2,733.00 ","$1,571.48 ","$1,967.76 ","$1,486.75 ",$601.26 ,$765.24 ,"$1,533.21 ",$601.26 ,"$1,781.92 ",$683.25 ,"$1,781.92 ","$1,781.92 ",$683.25 ,"$1,781.92 ","$1,142.39 ","$2,295.72 ","$1,588.85 ",$601.26 ,"$2,323.05 ","$2,295.72 ",$601.26 ,"$2,049.75 ","$2,186.40 ","$2,186.40 ",$601.26 ,"$2,186.40 ","$2,295.72 ","$2,295.72 ","$2,295.72 ","$2,733.00 ","$2,459.70 ","$1,571.48 ","$2,733.00 ",$601.26 ,$464.28 ,"$1,486.75 ",$601.26 ,"$1,136.93 ",$125.98 ,$120.26 ,$631.32 ,"$2,323.05 ","$1,781.92 ",$765.24 ,"$2,459.70 ","$2,295.72 ","$2,186.40 ","$2,186.40 ",$601.26 ,"$1,776.45 "
ST. FRANCIS HOSPITAL - ACUTE,36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$1,587.00 ","$1,031.55 ",$349.14 ,"$3,592.48 ",$912.53 ,"$1,142.64 ",$863.33 ,$349.14 ,$444.36 ,$890.31 ,$349.14 ,"$1,034.72 ",$396.75 ,"$1,034.72 ","$1,034.72 ",$396.75 ,"$1,034.72 ",$663.37 ,"$1,333.08 ","$3,592.48 ",$349.14 ,"$1,348.95 ","$1,333.08 ",$349.14 ,"$1,190.25 ","$1,269.60 ","$1,269.60 ",$349.14 ,"$1,269.60 ","$1,333.08 ","$1,333.08 ","$1,333.08 ","$1,587.00 ","$1,428.30 ",$912.53 ,"$1,587.00 ",$349.14 ,"$1,587.00 ",$863.33 ,$349.14 ,$660.19 ,$641.73 ,$612.56 ,$366.60 ,"$1,348.95 ","$1,034.72 ",$444.36 ,"$1,428.30 ","$1,333.08 ","$1,269.60 ","$1,269.60 ",$349.14 ,"$1,031.55 "
ST. FRANCIS HOSPITAL - ACUTE,36000101,29085,HC CAST APPL; HAND AND FOREARM,360,1 ,$421.00 ,$273.65 ,$92.62 ,$421.00 ,$242.08 ,$303.12 ,$229.02 ,$92.62 ,$117.88 ,$236.18 ,$92.62 ,$274.49 ,$105.25 ,$274.49 ,$274.49 ,$105.25 ,$274.49 ,$175.98 ,$353.64 ,$360.73 ,$92.62 ,$357.85 ,$353.64 ,$92.62 ,$315.75 ,$336.80 ,$336.80 ,$92.62 ,$336.80 ,$353.64 ,$353.64 ,$353.64 ,$421.00 ,$378.90 ,$242.08 ,$421.00 ,$92.62 ,$421.00 ,$229.02 ,$92.62 ,$175.14 ,$343.00 ,$327.41 ,$97.25 ,$357.85 ,$274.49 ,$117.88 ,$378.90 ,$353.64 ,$336.80 ,$336.80 ,$92.62 ,$273.65 
ST. FRANCIS HOSPITAL - ACUTE,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,$773.00 ,$502.45 ,$170.06 ,"$1,300.50 ",$444.48 ,$556.56 ,$420.51 ,$170.06 ,$216.44 ,$433.65 ,$170.06 ,$504.00 ,$193.25 ,$504.00 ,$504.00 ,$193.25 ,$504.00 ,$323.11 ,$649.32 , N/A ,$170.06 ,$657.05 ,$649.32 ,$170.06 ,$579.75 ,$618.40 ,$618.40 ,$170.06 ,$618.40 ,$649.32 ,$649.32 ,$649.32 ,$773.00 ,$695.70 ,$444.48 ,$773.00 ,$170.06 ,$485.95 ,$420.51 ,$170.06 ,$321.57 ,"$1,300.50 ","$1,241.38 ",$178.56 ,$657.05 ,$504.00 ,$216.44 ,$695.70 ,$649.32 ,$618.40 ,$618.40 ,$170.06 ,$502.45 
ST. FRANCIS HOSPITAL - ACUTE,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$963.00 ,$625.95 ,$120.26 ,$963.00 ,$553.73 ,$693.36 ,$523.87 ,$211.86 ,$269.64 ,$540.24 ,$211.86 ,$627.88 ,$240.75 ,$627.88 ,$627.88 ,$240.75 ,$627.88 ,$402.53 ,$808.92 , N/A ,$211.86 ,$818.55 ,$808.92 ,$211.86 ,$722.25 ,$770.40 ,$770.40 ,$211.86 ,$770.40 ,$808.92 ,$808.92 ,$808.92 ,$963.00 ,$866.70 ,$553.73 ,$963.00 ,$211.86 ,$189.78 ,$523.87 ,$211.86 ,$400.61 ,$125.98 ,$120.26 ,$222.45 ,$818.55 ,$627.88 ,$269.64 ,$866.70 ,$808.92 ,$770.40 ,$770.40 ,$211.86 ,$625.95 
ST. FRANCIS HOSPITAL - ACUTE,36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,$693.00 ,$450.45 ,$152.46 ,"$7,309.08 ",$398.48 ,$498.96 ,$376.99 ,$152.46 ,$194.04 ,$388.77 ,$152.46 ,$451.84 ,$173.25 ,$451.84 ,$451.84 ,$173.25 ,$451.84 ,$289.67 ,$582.12 ,"$7,309.08 ",$152.46 ,$589.05 ,$582.12 ,$152.46 ,$519.75 ,$554.40 ,$554.40 ,$152.46 ,$554.40 ,$582.12 ,$582.12 ,$582.12 ,$693.00 ,$623.70 ,$398.48 ,$693.00 ,$152.46 ,$693.00 ,$376.99 ,$152.46 ,$288.29 ,"$1,795.74 ","$1,714.11 ",$160.08 ,$589.05 ,$451.84 ,$194.04 ,$623.70 ,$582.12 ,$554.40 ,$554.40 ,$152.46 ,$450.45 
ST. FRANCIS HOSPITAL - ACUTE,36000131,36568,HC INS CATH PERIPH CV W/O PORT <5,360,1 ,$981.00 ,$637.65 ,$215.82 ,"$3,590.40 ",$564.08 ,$706.32 ,$533.66 ,$215.82 ,$274.68 ,$550.34 ,$215.82 ,$639.61 ,$245.25 ,$639.61 ,$639.61 ,$245.25 ,$639.61 ,$410.06 ,$824.04 ,"$3,590.40 ",$215.82 ,$833.85 ,$824.04 ,$215.82 ,$735.75 ,$784.80 ,$784.80 ,$215.82 ,$784.80 ,$824.04 ,$824.04 ,$824.04 ,$981.00 ,$882.90 ,$564.08 ,$981.00 ,$215.82 ,$981.00 ,$533.66 ,$215.82 ,$408.10 , N/A , N/A ,$226.61 ,$833.85 ,$639.61 ,$274.68 ,$882.90 ,$824.04 ,$784.80 ,$784.80 ,$215.82 ,$637.65 
ST. FRANCIS HOSPITAL - ACUTE,36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,$810.00 ,$526.50 ,$178.20 ,"$3,590.40 ",$465.75 ,$583.20 ,$440.64 ,$178.20 ,$226.80 ,$454.41 ,$178.20 ,$528.12 ,$202.50 ,$528.12 ,$528.12 ,$202.50 ,$528.12 ,$338.58 ,$680.40 ,"$3,590.40 ",$178.20 ,$688.50 ,$680.40 ,$178.20 ,$607.50 ,$648.00 ,$648.00 ,$178.20 ,$648.00 ,$680.40 ,$680.40 ,$680.40 ,$810.00 ,$729.00 ,$465.75 ,$810.00 ,$178.20 ,$810.00 ,$440.64 ,$178.20 ,$336.96 ,$522.73 ,$498.97 ,$187.11 ,$688.50 ,$528.12 ,$226.80 ,$729.00 ,$680.40 ,$648.00 ,$648.00 ,$178.20 ,$526.50 
ST. FRANCIS HOSPITAL - ACUTE,36000139,36584,HC REPL PICC W/O PORT/PUMP,360,1 ,"$3,381.00 ","$2,197.65 ",$142.82 ,"$3,590.40 ","$1,944.08 ","$2,434.32 ","$1,839.26 ",$743.82 ,$946.68 ,"$1,896.74 ",$743.82 ,"$2,204.41 ",$845.25 ,"$2,204.41 ","$2,204.41 ",$845.25 ,"$2,204.41 ","$1,413.26 ","$2,840.04 ","$3,590.40 ",$743.82 ,"$2,873.85 ","$2,840.04 ",$743.82 ,"$2,535.75 ","$2,704.80 ","$2,704.80 ",$743.82 ,"$2,704.80 ","$2,840.04 ","$2,840.04 ","$2,840.04 ","$3,381.00 ","$3,042.90 ","$1,944.08 ","$3,381.00 ",$743.82 ,"$3,381.00 ","$1,839.26 ",$743.82 ,"$1,406.50 ",$149.62 ,$142.82 ,$781.01 ,"$2,873.85 ","$2,204.41 ",$946.68 ,"$3,042.90 ","$2,840.04 ","$2,704.80 ","$2,704.80 ",$743.82 ,"$2,197.65 "
ST. FRANCIS HOSPITAL - ACUTE,36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,$803.00 ,$521.95 ,$176.66 ,"$3,592.48 ",$461.73 ,$578.16 ,$436.83 ,$176.66 ,$224.84 ,$450.48 ,$176.66 ,$523.56 ,$200.75 ,$523.56 ,$523.56 ,$200.75 ,$523.56 ,$335.65 ,$674.52 ,"$3,592.48 ",$176.66 ,$682.55 ,$674.52 ,$176.66 ,$602.25 ,$642.40 ,$642.40 ,$176.66 ,$642.40 ,$674.52 ,$674.52 ,$674.52 ,$803.00 ,$722.70 ,$461.73 ,$803.00 ,$176.66 ,$803.00 ,$436.83 ,$176.66 ,$334.05 ,$641.73 ,$612.56 ,$185.49 ,$682.55 ,$523.56 ,$224.84 ,$722.70 ,$674.52 ,$642.40 ,$642.40 ,$176.66 ,$521.95 
ST. FRANCIS HOSPITAL - ACUTE,36000158,38221,HC BX BONE MARROW ONLY,360,1 ,$905.00 ,$588.25 ,$199.10 ,"$3,592.48 ",$520.38 ,$651.60 ,$492.32 ,$199.10 ,$253.40 ,$507.71 ,$199.10 ,$590.06 ,$226.25 ,$590.06 ,$590.06 ,$226.25 ,$590.06 ,$378.29 ,$760.20 ,"$3,592.48 ",$199.10 ,$769.25 ,$760.20 ,$199.10 ,$678.75 ,$724.00 ,$724.00 ,$199.10 ,$724.00 ,$760.20 ,$760.20 ,$760.20 ,$905.00 ,$814.50 ,$520.38 ,$905.00 ,$199.10 ,$905.00 ,$492.32 ,$199.10 ,$376.48 ,$641.73 ,$612.56 ,$209.06 ,$769.25 ,$590.06 ,$253.40 ,$814.50 ,$760.20 ,$724.00 ,$724.00 ,$199.10 ,$588.25 
ST. FRANCIS HOSPITAL - ACUTE,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$3,105.00 ","$2,018.25 ",$648.96 ,"$3,592.48 ","$1,785.38 ","$2,235.60 ","$1,689.12 ",$683.10 ,$869.40 ,"$1,741.91 ",$683.10 ,"$2,024.46 ",$776.25 ,"$2,024.46 ","$2,024.46 ",$776.25 ,"$2,024.46 ","$1,297.89 ","$2,608.20 ","$3,592.48 ",$683.10 ,"$2,639.25 ","$2,608.20 ",$683.10 ,"$2,328.75 ","$2,484.00 ","$2,484.00 ",$683.10 ,"$2,484.00 ","$2,608.20 ","$2,608.20 ","$2,608.20 ","$3,105.00 ","$2,794.50 ","$1,785.38 ","$3,105.00 ",$683.10 ,"$3,105.00 ","$1,689.12 ",$683.10 ,"$1,291.68 ",$679.87 ,$648.96 ,$717.26 ,"$2,639.25 ","$2,024.46 ",$869.40 ,"$2,794.50 ","$2,608.20 ","$2,484.00 ","$2,484.00 ",$683.10 ,"$2,018.25 "
ST. FRANCIS HOSPITAL - ACUTE,36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,"$2,184.00 ","$1,419.60 ",$480.48 ,"$2,184.00 ","$1,255.80 ","$1,572.48 ","$1,188.10 ",$480.48 ,$611.52 ,"$1,225.22 ",$480.48 ,"$1,423.97 ",$546.00 ,"$1,423.97 ","$1,423.97 ",$546.00 ,"$1,423.97 ",$912.91 ,"$1,834.56 ",$962.48 ,$480.48 ,"$1,856.40 ","$1,834.56 ",$480.48 ,"$1,638.00 ","$1,747.20 ","$1,747.20 ",$480.48 ,"$1,747.20 ","$1,834.56 ","$1,834.56 ","$1,834.56 ","$2,184.00 ","$1,965.60 ","$1,255.80 ","$2,184.00 ",$480.48 ,"$2,184.00 ","$1,188.10 ",$480.48 ,$908.54 , N/A , N/A ,$504.50 ,"$1,856.40 ","$1,423.97 ",$611.52 ,"$1,965.60 ","$1,834.56 ","$1,747.20 ","$1,747.20 ",$480.48 ,"$1,419.60 "
ST. FRANCIS HOSPITAL - ACUTE,36000187,54150,HC CIRCUMCISION OP,360,1 ,$852.00 ,$553.80 ,$187.44 ,"$4,571.63 ",$489.90 ,$613.44 ,$463.49 ,$187.44 ,$238.56 ,$477.97 ,$187.44 ,$555.50 ,$213.00 ,$555.50 ,$555.50 ,$213.00 ,$555.50 ,$356.14 ,$715.68 ,"$4,571.63 ",$187.44 ,$724.20 ,$715.68 ,$187.44 ,$639.00 ,$681.60 ,$681.60 ,$187.44 ,$681.60 ,$715.68 ,$715.68 ,$715.68 ,$852.00 ,$766.80 ,$489.90 ,$852.00 ,$187.44 ,$852.00 ,$463.49 ,$187.44 ,$354.43 ,"$1,581.39 ","$1,509.51 ",$196.81 ,$724.20 ,$555.50 ,$238.56 ,$766.80 ,$715.68 ,$681.60 ,$681.60 ,$187.44 ,$553.80 
ST. FRANCIS HOSPITAL - ACUTE,36000188,55700,HC BX PROSTATE NEEDLE/PUNCH,360,1 ,$346.00 ,$224.90 ,$76.12 ,"$4,571.63 ",$198.95 ,$249.12 ,$188.22 ,$76.12 ,$96.88 ,$194.11 ,$76.12 ,$225.59 ,$86.50 ,$225.59 ,$225.59 ,$86.50 ,$225.59 ,$144.63 ,$290.64 ,"$4,571.63 ",$76.12 ,$294.10 ,$290.64 ,$76.12 ,$259.50 ,$276.80 ,$276.80 ,$76.12 ,$276.80 ,$290.64 ,$290.64 ,$290.64 ,$346.00 ,$311.40 ,$198.95 ,$346.00 ,$76.12 ,$346.00 ,$188.22 ,$76.12 ,$143.94 ,"$1,218.22 ","$1,162.84 ",$79.93 ,$294.10 ,$225.59 ,$96.88 ,$311.40 ,$290.64 ,$276.80 ,$276.80 ,$76.12 ,$224.90 
ST. FRANCIS HOSPITAL - ACUTE,36000194,62270,HC LUMBAR PUNCTURE,360,1 ,$979.00 ,$636.35 ,$215.38 ,"$1,621.30 ",$562.93 ,$704.88 ,$532.58 ,$215.38 ,$274.12 ,$549.22 ,$215.38 ,$638.31 ,$244.75 ,$638.31 ,$638.31 ,$244.75 ,$638.31 ,$409.22 ,$822.36 ,"$1,621.30 ",$215.38 ,$832.15 ,$822.36 ,$215.38 ,$734.25 ,$783.20 ,$783.20 ,$215.38 ,$783.20 ,$822.36 ,$822.36 ,$822.36 ,$979.00 ,$881.10 ,$562.93 ,$979.00 ,$215.38 ,$979.00 ,$532.58 ,$215.38 ,$407.26 ,$545.07 ,$520.30 ,$226.15 ,$832.15 ,$638.31 ,$274.12 ,$881.10 ,$822.36 ,$783.20 ,$783.20 ,$215.38 ,$636.35 
ST. FRANCIS HOSPITAL - ACUTE,36000319,20526,HC INJECTION;CARPAL TUNNEL,360,1 ,$260.00 ,$169.00 ,$57.20 ,$667.08 ,$149.50 ,$187.20 ,$141.44 ,$57.20 ,$72.80 ,$145.86 ,$57.20 ,$169.52 ,$65.00 ,$169.52 ,$169.52 ,$65.00 ,$169.52 ,$108.68 ,$218.40 ,$667.08 ,$57.20 ,$221.00 ,$218.40 ,$57.20 ,$195.00 ,$208.00 ,$208.00 ,$57.20 ,$208.00 ,$218.40 ,$218.40 ,$218.40 ,$260.00 ,$234.00 ,$149.50 ,$260.00 ,$57.20 ,$260.00 ,$141.44 ,$57.20 ,$108.16 ,$341.51 ,$325.98 ,$60.06 ,$221.00 ,$169.52 ,$72.80 ,$234.00 ,$218.40 ,$208.00 ,$208.00 ,$57.20 ,$169.00 
ST. FRANCIS HOSPITAL - ACUTE,36000326,64405,HC NERVE BLOCK; OCCIPITAL,360,1 ,$176.00 ,$114.40 ,$38.72 ,$667.08 ,$101.20 ,$126.72 ,$95.74 ,$38.72 ,$49.28 ,$98.74 ,$38.72 ,$114.75 ,$44.00 ,$114.75 ,$114.75 ,$44.00 ,$114.75 ,$73.57 ,$147.84 ,$667.08 ,$38.72 ,$149.60 ,$147.84 ,$38.72 ,$132.00 ,$140.80 ,$140.80 ,$38.72 ,$140.80 ,$147.84 ,$147.84 ,$147.84 ,$176.00 ,$158.40 ,$101.20 ,$176.00 ,$38.72 ,$176.00 ,$95.74 ,$38.72 ,$73.22 ,$463.96 ,$442.87 ,$40.66 ,$149.60 ,$114.75 ,$49.28 ,$158.40 ,$147.84 ,$140.80 ,$140.80 ,$38.72 ,$114.40 
ST. FRANCIS HOSPITAL - ACUTE,36000327,64445,HC NERVE BLOCK;SCIATIC SINGLE,360,1 ,"$1,975.00 ","$1,283.75 ",$434.50 ,"$1,975.00 ","$1,135.63 ","$1,422.00 ","$1,074.40 ",$434.50 ,$553.00 ,"$1,107.98 ",$434.50 ,"$1,287.70 ",$493.75 ,"$1,287.70 ","$1,287.70 ",$493.75 ,"$1,287.70 ",$825.55 ,"$1,659.00 ","$1,621.30 ",$434.50 ,"$1,678.75 ","$1,659.00 ",$434.50 ,"$1,481.25 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,580.00 ","$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,975.00 ","$1,777.50 ","$1,135.63 ","$1,975.00 ",$434.50 ,"$1,975.00 ","$1,074.40 ",$434.50 ,$821.60 ,$463.96 ,$442.87 ,$456.23 ,"$1,678.75 ","$1,287.70 ",$553.00 ,"$1,777.50 ","$1,659.00 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,283.75 "
ST. FRANCIS HOSPITAL - ACUTE,36000420,26735,HC TX FX OPEN SHAFT FINGER/THUMB W/INT FIX EACH,360,1 ,"$9,199.00 ","$5,979.35 ","$2,023.78 ","$9,199.00 ","$5,289.43 ","$6,623.28 ","$5,004.26 ","$2,023.78 ","$2,575.72 ","$4,857.07 ","$2,023.78 ","$5,583.79 ","$2,299.75 ","$5,583.79 ","$5,583.79 ","$2,299.75 ","$5,583.79 ","$3,845.18 ","$7,727.16 ","$7,230.70 ","$2,023.78 ","$7,819.15 ","$7,727.16 ","$2,023.78 ","$6,899.25 ","$7,359.20 ","$7,359.20 ","$2,023.78 ","$7,359.20 ","$7,222.00 ","$7,222.00 ","$7,222.00 ","$9,199.00 ","$8,279.10 ","$5,289.43 ","$9,199.00 ","$2,023.78 ","$9,199.00 ","$5,004.26 ","$2,023.78 ","$3,826.78 ","$4,728.65 ","$4,513.71 ","$2,124.97 ","$7,819.15 ","$5,583.79 ","$2,575.72 ","$8,279.10 ","$7,222.00 ","$7,359.20 ","$7,359.20 ","$2,023.78 ","$5,979.35 "
ST. FRANCIS HOSPITAL - ACUTE,36000441,37618,HC LIGATION ARTERY EXTREMITY,360,1 ,"$1,478.00 ",$960.70 ,$325.16 ,"$2,173.36 ",$849.85 ,"$1,064.16 ",$804.03 ,$325.16 ,$413.84 ,$829.16 ,$325.16 ,$963.66 ,$369.50 ,$963.66 ,$963.66 ,$369.50 ,$963.66 ,$617.80 ,"$1,241.52 ", N/A ,$325.16 ,"$1,256.30 ","$1,241.52 ",$325.16 ,"$1,108.50 ","$1,182.40 ","$1,182.40 ",$325.16 ,"$1,182.40 ","$1,241.52 ","$1,241.52 ","$1,241.52 ","$1,478.00 ","$1,330.20 ",$849.85 ,"$1,478.00 ",$325.16 ,"$1,478.00 ",$804.03 ,$325.16 ,$614.85 ,"$2,173.36 ","$2,074.57 ",$341.42 ,"$1,256.30 ",$963.66 ,$413.84 ,"$1,330.20 ","$1,241.52 ","$1,182.40 ","$1,182.40 ",$325.16 ,$960.70 
ST. FRANCIS HOSPITAL - ACUTE,36000546,11750,HC REMOVE NAIL BED,360,1 ,"$1,411.00 ",$917.15 ,$310.42 ,"$1,411.00 ",$811.33 ,"$1,015.92 ",$767.58 ,$310.42 ,$395.08 ,$791.57 ,$310.42 ,$919.97 ,$352.75 ,$919.97 ,$919.97 ,$352.75 ,$919.97 ,$589.80 ,"$1,185.24 ",$882.50 ,$310.42 ,"$1,199.35 ","$1,185.24 ",$310.42 ,"$1,058.25 ","$1,128.80 ","$1,128.80 ",$310.42 ,"$1,128.80 ","$1,185.24 ","$1,185.24 ","$1,185.24 ","$1,411.00 ","$1,269.90 ",$811.33 ,"$1,411.00 ",$310.42 ,"$1,411.00 ",$767.58 ,$310.42 ,$586.98 ,$679.87 ,$648.96 ,$325.94 ,"$1,199.35 ",$919.97 ,$395.08 ,"$1,269.90 ","$1,185.24 ","$1,128.80 ","$1,128.80 ",$310.42 ,$917.15 
ST. FRANCIS HOSPITAL - ACUTE,36060013,N/A,HC OR LEVEL 1 INITIAL 15MIN,360,1 ,$808.00 ,$525.20 ,$177.76 ,$808.00 ,$464.60 ,$581.76 ,$439.55 ,$177.76 ,$226.24 ,$453.29 ,$177.76 ,$526.82 ,$202.00 ,$526.82 ,$526.82 ,$202.00 ,$526.82 ,$337.74 ,$678.72 , N/A ,$177.76 ,$686.80 ,$678.72 ,$177.76 ,$606.00 ,$646.40 ,$646.40 ,$177.76 ,$646.40 ,$678.72 ,$678.72 ,$678.72 ,$808.00 ,$727.20 ,$464.60 ,$808.00 ,$177.76 ,$808.00 ,$439.55 ,$177.76 ,$336.13 , N/A , N/A ,$186.65 ,$686.80 ,$526.82 ,$226.24 ,$727.20 ,$678.72 ,$646.40 ,$646.40 ,$177.76 ,$525.20 
ST. FRANCIS HOSPITAL - ACUTE,36060014,N/A,HC OR LEVEL 1 ADDL 15MIN,360,1 ,$401.00 ,$260.65 ,$88.22 ,$401.00 ,$230.58 ,$288.72 ,$218.14 ,$88.22 ,$112.28 ,$224.96 ,$88.22 ,$261.45 ,$100.25 ,$261.45 ,$261.45 ,$100.25 ,$261.45 ,$167.62 ,$336.84 , N/A ,$88.22 ,$340.85 ,$336.84 ,$88.22 ,$300.75 ,$320.80 ,$320.80 ,$88.22 ,$320.80 ,$336.84 ,$336.84 ,$336.84 ,$401.00 ,$360.90 ,$230.58 ,$401.00 ,$88.22 ,$401.00 ,$218.14 ,$88.22 ,$166.82 , N/A , N/A ,$92.63 ,$340.85 ,$261.45 ,$112.28 ,$360.90 ,$336.84 ,$320.80 ,$320.80 ,$88.22 ,$260.65 
ST. FRANCIS HOSPITAL - ACUTE,36060015,N/A,HC OR LEVEL 2 INITIAL 15MIN,360,1 ,"$2,846.00 ","$1,849.90 ",$626.12 ,"$2,846.00 ","$1,636.45 ","$2,049.12 ","$1,548.22 ",$626.12 ,$796.88 ,"$1,596.61 ",$626.12 ,"$1,855.59 ",$711.50 ,"$1,855.59 ","$1,855.59 ",$711.50 ,"$1,855.59 ","$1,189.63 ","$2,390.64 ", N/A ,$626.12 ,"$2,419.10 ","$2,390.64 ",$626.12 ,"$2,134.50 ","$2,276.80 ","$2,276.80 ",$626.12 ,"$2,276.80 ","$2,390.64 ","$2,390.64 ","$2,390.64 ","$2,846.00 ","$2,561.40 ","$1,636.45 ","$2,846.00 ",$626.12 ,"$2,846.00 ","$1,548.22 ",$626.12 ,"$1,183.94 ", N/A , N/A ,$657.43 ,"$2,419.10 ","$1,855.59 ",$796.88 ,"$2,561.40 ","$2,390.64 ","$2,276.80 ","$2,276.80 ",$626.12 ,"$1,849.90 "
ST. FRANCIS HOSPITAL - ACUTE,36060016,N/A,HC OR LEVEL 2 ADDL 15MIN,360,1 ,$712.00 ,$462.80 ,$156.64 ,$712.00 ,$409.40 ,$512.64 ,$387.33 ,$156.64 ,$199.36 ,$399.43 ,$156.64 ,$464.22 ,$178.00 ,$464.22 ,$464.22 ,$178.00 ,$464.22 ,$297.62 ,$598.08 , N/A ,$156.64 ,$605.20 ,$598.08 ,$156.64 ,$534.00 ,$569.60 ,$569.60 ,$156.64 ,$569.60 ,$598.08 ,$598.08 ,$598.08 ,$712.00 ,$640.80 ,$409.40 ,$712.00 ,$156.64 ,$712.00 ,$387.33 ,$156.64 ,$296.19 , N/A , N/A ,$164.47 ,$605.20 ,$464.22 ,$199.36 ,$640.80 ,$598.08 ,$569.60 ,$569.60 ,$156.64 ,$462.80 
ST. FRANCIS HOSPITAL - ACUTE,36060017,N/A,HC OR LEVEL 3 INITIAL 15MIN,360,1 ,"$3,137.00 ","$2,039.05 ",$690.14 ,"$3,137.00 ","$1,803.78 ","$2,258.64 ","$1,706.53 ",$690.14 ,$878.36 ,"$1,759.86 ",$690.14 ,"$2,045.32 ",$784.25 ,"$2,045.32 ","$2,045.32 ",$784.25 ,"$2,045.32 ","$1,311.27 ","$2,635.08 ", N/A ,$690.14 ,"$2,666.45 ","$2,635.08 ",$690.14 ,"$2,352.75 ","$2,509.60 ","$2,509.60 ",$690.14 ,"$2,509.60 ","$2,635.08 ","$2,635.08 ","$2,635.08 ","$3,137.00 ","$2,823.30 ","$1,803.78 ","$3,137.00 ",$690.14 ,"$3,137.00 ","$1,706.53 ",$690.14 ,"$1,304.99 ", N/A , N/A ,$724.65 ,"$2,666.45 ","$2,045.32 ",$878.36 ,"$2,823.30 ","$2,635.08 ","$2,509.60 ","$2,509.60 ",$690.14 ,"$2,039.05 "
ST. FRANCIS HOSPITAL - ACUTE,36060018,N/A,HC OR LEVEL 3 ADDL 15MIN,360,1 ,$784.00 ,$509.60 ,$172.48 ,$784.00 ,$450.80 ,$564.48 ,$426.50 ,$172.48 ,$219.52 ,$439.82 ,$172.48 ,$511.17 ,$196.00 ,$511.17 ,$511.17 ,$196.00 ,$511.17 ,$327.71 ,$658.56 , N/A ,$172.48 ,$666.40 ,$658.56 ,$172.48 ,$588.00 ,$627.20 ,$627.20 ,$172.48 ,$627.20 ,$658.56 ,$658.56 ,$658.56 ,$784.00 ,$705.60 ,$450.80 ,$784.00 ,$172.48 ,$784.00 ,$426.50 ,$172.48 ,$326.14 , N/A , N/A ,$181.10 ,$666.40 ,$511.17 ,$219.52 ,$705.60 ,$658.56 ,$627.20 ,$627.20 ,$172.48 ,$509.60 
ST. FRANCIS HOSPITAL - ACUTE,36060019,N/A,HC OR LEVEL 4 INITIAL 15MIN,360,1 ,"$3,428.00 ","$2,228.20 ",$754.16 ,"$3,428.00 ","$1,971.10 ","$2,468.16 ","$1,864.83 ",$754.16 ,$959.84 ,"$1,923.11 ",$754.16 ,"$2,235.06 ",$857.00 ,"$2,235.06 ","$2,235.06 ",$857.00 ,"$2,235.06 ","$1,432.90 ","$2,879.52 ", N/A ,$754.16 ,"$2,913.80 ","$2,879.52 ",$754.16 ,"$2,571.00 ","$2,742.40 ","$2,742.40 ",$754.16 ,"$2,742.40 ","$2,879.52 ","$2,879.52 ","$2,879.52 ","$3,428.00 ","$3,085.20 ","$1,971.10 ","$3,428.00 ",$754.16 ,"$3,428.00 ","$1,864.83 ",$754.16 ,"$1,426.05 ", N/A , N/A ,$791.87 ,"$2,913.80 ","$2,235.06 ",$959.84 ,"$3,085.20 ","$2,879.52 ","$2,742.40 ","$2,742.40 ",$754.16 ,"$2,228.20 "
ST. FRANCIS HOSPITAL - ACUTE,36060020,N/A,HC OR LEVEL 4 ADDL 15MIN,360,1 ,$857.00 ,$557.05 ,$188.54 ,$857.00 ,$492.78 ,$617.04 ,$466.21 ,$188.54 ,$239.96 ,$480.78 ,$188.54 ,$558.76 ,$214.25 ,$558.76 ,$558.76 ,$214.25 ,$558.76 ,$358.23 ,$719.88 , N/A ,$188.54 ,$728.45 ,$719.88 ,$188.54 ,$642.75 ,$685.60 ,$685.60 ,$188.54 ,$685.60 ,$719.88 ,$719.88 ,$719.88 ,$857.00 ,$771.30 ,$492.78 ,$857.00 ,$188.54 ,$857.00 ,$466.21 ,$188.54 ,$356.51 , N/A , N/A ,$197.97 ,$728.45 ,$558.76 ,$239.96 ,$771.30 ,$719.88 ,$685.60 ,$685.60 ,$188.54 ,$557.05 
ST. FRANCIS HOSPITAL - ACUTE,36060021,N/A,HC OR LEVEL 5 INITIAL 15MIN,360,1 ,"$3,719.00 ","$2,417.35 ",$818.18 ,"$3,719.00 ","$2,138.43 ","$2,677.68 ","$2,023.14 ",$818.18 ,"$1,041.32 ","$2,086.36 ",$818.18 ,"$2,424.79 ",$929.75 ,"$2,424.79 ","$2,424.79 ",$929.75 ,"$2,424.79 ","$1,554.54 ","$3,123.96 ", N/A ,$818.18 ,"$3,161.15 ","$3,123.96 ",$818.18 ,"$2,789.25 ","$2,975.20 ","$2,975.20 ",$818.18 ,"$2,975.20 ","$3,123.96 ","$3,123.96 ","$3,123.96 ","$3,719.00 ","$3,347.10 ","$2,138.43 ","$3,719.00 ",$818.18 ,"$3,719.00 ","$2,023.14 ",$818.18 ,"$1,547.10 ", N/A , N/A ,$859.09 ,"$3,161.15 ","$2,424.79 ","$1,041.32 ","$3,347.10 ","$3,123.96 ","$2,975.20 ","$2,975.20 ",$818.18 ,"$2,417.35 "
ST. FRANCIS HOSPITAL - ACUTE,36060022,N/A,HC OR LEVEL 5 ADDL 15MIN,360,1 ,$930.00 ,$604.50 ,$204.60 ,$930.00 ,$534.75 ,$669.60 ,$505.92 ,$204.60 ,$260.40 ,$521.73 ,$204.60 ,$606.36 ,$232.50 ,$606.36 ,$606.36 ,$232.50 ,$606.36 ,$388.74 ,$781.20 , N/A ,$204.60 ,$790.50 ,$781.20 ,$204.60 ,$697.50 ,$744.00 ,$744.00 ,$204.60 ,$744.00 ,$781.20 ,$781.20 ,$781.20 ,$930.00 ,$837.00 ,$534.75 ,$930.00 ,$204.60 ,$930.00 ,$505.92 ,$204.60 ,$386.88 , N/A , N/A ,$214.83 ,$790.50 ,$606.36 ,$260.40 ,$837.00 ,$781.20 ,$744.00 ,$744.00 ,$204.60 ,$604.50 
ST. FRANCIS HOSPITAL - ACUTE,36060023,N/A,HC OR LEVEL 6 INITIAL 15MIN,360,1 ,"$4,010.00 ","$2,606.50 ",$882.20 ,"$4,010.00 ","$2,305.75 ","$2,887.20 ","$2,181.44 ",$882.20 ,"$1,122.80 ","$2,249.61 ",$882.20 ,"$2,614.52 ","$1,002.50 ","$2,614.52 ","$2,614.52 ","$1,002.50 ","$2,614.52 ","$1,676.18 ","$3,368.40 ", N/A ,$882.20 ,"$3,408.50 ","$3,368.40 ",$882.20 ,"$3,007.50 ","$3,208.00 ","$3,208.00 ",$882.20 ,"$3,208.00 ","$3,368.40 ","$3,368.40 ","$3,368.40 ","$4,010.00 ","$3,609.00 ","$2,305.75 ","$4,010.00 ",$882.20 ,"$4,010.00 ","$2,181.44 ",$882.20 ,"$1,668.16 ", N/A , N/A ,$926.31 ,"$3,408.50 ","$2,614.52 ","$1,122.80 ","$3,609.00 ","$3,368.40 ","$3,208.00 ","$3,208.00 ",$882.20 ,"$2,606.50 "
ST. FRANCIS HOSPITAL - ACUTE,36060024,N/A,HC OR LEVEL 6 ADDL 15MIN,360,1 ,"$1,003.00 ",$651.95 ,$220.66 ,"$1,003.00 ",$576.73 ,$722.16 ,$545.63 ,$220.66 ,$280.84 ,$562.68 ,$220.66 ,$653.96 ,$250.75 ,$653.96 ,$653.96 ,$250.75 ,$653.96 ,$419.25 ,$842.52 , N/A ,$220.66 ,$852.55 ,$842.52 ,$220.66 ,$752.25 ,$802.40 ,$802.40 ,$220.66 ,$802.40 ,$842.52 ,$842.52 ,$842.52 ,"$1,003.00 ",$902.70 ,$576.73 ,"$1,003.00 ",$220.66 ,"$1,003.00 ",$545.63 ,$220.66 ,$417.25 , N/A , N/A ,$231.69 ,$852.55 ,$653.96 ,$280.84 ,$902.70 ,$842.52 ,$802.40 ,$802.40 ,$220.66 ,$651.95 
ST. FRANCIS HOSPITAL - ACUTE,36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,$784.00 ,$509.60 ,$172.48 ,$784.00 ,$450.80 ,$564.48 ,$426.50 ,$172.48 ,$219.52 ,$439.82 ,$172.48 ,$511.17 ,$196.00 ,$511.17 ,$511.17 ,$196.00 ,$511.17 ,$327.71 ,$658.56 ,$667.08 ,$172.48 ,$666.40 ,$658.56 ,$172.48 ,$588.00 ,$627.20 ,$627.20 ,$172.48 ,$627.20 ,$658.56 ,$658.56 ,$658.56 ,$784.00 ,$705.60 ,$450.80 ,$784.00 ,$172.48 ,$784.00 ,$426.50 ,$172.48 ,$326.14 ,$463.96 ,$442.87 ,$181.10 ,$666.40 ,$511.17 ,$219.52 ,$705.60 ,$658.56 ,$627.20 ,$627.20 ,$172.48 ,$509.60 
ST. FRANCIS HOSPITAL - ACUTE,36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,"$1,975.00 ","$1,283.75 ",$434.50 ,"$2,101.83 ","$1,135.63 ","$1,422.00 ","$1,074.40 ",$434.50 ,$553.00 ,"$1,107.98 ",$434.50 ,"$1,287.70 ",$493.75 ,"$1,287.70 ","$1,287.70 ",$493.75 ,"$1,287.70 ",$825.55 ,"$1,659.00 ","$2,101.83 ",$434.50 ,"$1,678.75 ","$1,659.00 ",$434.50 ,"$1,481.25 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,580.00 ","$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,975.00 ","$1,777.50 ","$1,135.63 ","$1,975.00 ",$434.50 ,"$1,975.00 ","$1,074.40 ",$434.50 ,$821.60 ,$463.96 ,$442.87 ,$456.23 ,"$1,678.75 ","$1,287.70 ",$553.00 ,"$1,777.50 ","$1,659.00 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,283.75 "
ST. FRANCIS HOSPITAL - ACUTE,36080010,64455,HC INJ ANES AGENT DIGITAL NERVES,360,1 ,"$1,975.00 ","$1,283.75 ",$434.50 ,"$1,975.00 ","$1,135.63 ","$1,422.00 ","$1,074.40 ",$434.50 ,$553.00 ,"$1,107.98 ",$434.50 ,"$1,287.70 ",$493.75 ,"$1,287.70 ","$1,287.70 ",$493.75 ,"$1,287.70 ",$825.55 ,"$1,659.00 ",$667.08 ,$434.50 ,"$1,678.75 ","$1,659.00 ",$434.50 ,"$1,481.25 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,580.00 ","$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,975.00 ","$1,777.50 ","$1,135.63 ","$1,975.00 ",$434.50 ,"$1,975.00 ","$1,074.40 ",$434.50 ,$821.60 ,$463.96 ,$442.87 ,$456.23 ,"$1,678.75 ","$1,287.70 ",$553.00 ,"$1,777.50 ","$1,659.00 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,283.75 "
ST. FRANCIS HOSPITAL - ACUTE,36100042,20600,HC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-BIL,361,1 ,"$1,141.00 ",$741.65 ,$251.02 ,"$1,141.00 ",$656.08 ,$821.52 ,$620.70 ,$251.02 ,$319.48 ,$640.10 ,$251.02 ,$743.93 ,$285.25 ,$743.93 ,$743.93 ,$285.25 ,$743.93 ,$476.94 ,$958.44 ,"$1,000.61 ",$251.02 ,$969.85 ,$958.44 ,$251.02 ,$855.75 ,$912.80 ,$912.80 ,$251.02 ,$912.80 ,$958.44 ,$958.44 ,$958.44 ,"$1,141.00 ","$1,026.90 ",$656.08 ,"$1,141.00 ",$251.02 ,"$1,141.00 ",$620.70 ,$251.02 ,$474.66 ,$512.25 ,$488.96 ,$263.57 ,$969.85 ,$743.93 ,$319.48 ,"$1,026.90 ",$958.44 ,$912.80 ,$912.80 ,$251.02 ,$741.65 
ST. FRANCIS HOSPITAL - ACUTE,36100043,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-BIL,361,1 ,"$1,285.00 ",$835.25 ,$282.70 ,"$1,285.00 ",$738.88 ,$925.20 ,$699.04 ,$282.70 ,$359.80 ,$720.89 ,$282.70 ,$837.82 ,$321.25 ,$837.82 ,$837.82 ,$321.25 ,$837.82 ,$537.13 ,"$1,079.40 ","$1,000.61 ",$282.70 ,"$1,092.25 ","$1,079.40 ",$282.70 ,$963.75 ,"$1,028.00 ","$1,028.00 ",$282.70 ,"$1,028.00 ","$1,079.40 ","$1,079.40 ","$1,079.40 ","$1,285.00 ","$1,156.50 ",$738.88 ,"$1,285.00 ",$282.70 ,"$1,285.00 ",$699.04 ,$282.70 ,$534.56 ,$512.25 ,$488.96 ,$296.84 ,"$1,092.25 ",$837.82 ,$359.80 ,"$1,156.50 ","$1,079.40 ","$1,028.00 ","$1,028.00 ",$282.70 ,$835.25 
ST. FRANCIS HOSPITAL - ACUTE,36100044,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-BIL,361,1 ,"$1,603.00 ","$1,041.95 ",$352.66 ,"$1,603.00 ",$921.73 ,"$1,154.16 ",$872.03 ,$352.66 ,$448.84 ,$899.28 ,$352.66 ,"$1,045.16 ",$400.75 ,"$1,045.16 ","$1,045.16 ",$400.75 ,"$1,045.16 ",$670.05 ,"$1,346.52 ","$1,000.61 ",$352.66 ,"$1,362.55 ","$1,346.52 ",$352.66 ,"$1,202.25 ","$1,282.40 ","$1,282.40 ",$352.66 ,"$1,282.40 ","$1,346.52 ","$1,346.52 ","$1,346.52 ","$1,603.00 ","$1,442.70 ",$921.73 ,"$1,603.00 ",$352.66 ,"$1,603.00 ",$872.03 ,$352.66 ,$666.85 ,$512.25 ,$488.96 ,$370.29 ,"$1,362.55 ","$1,045.16 ",$448.84 ,"$1,442.70 ","$1,346.52 ","$1,282.40 ","$1,282.40 ",$352.66 ,"$1,041.95 "
ST. FRANCIS HOSPITAL - ACUTE,36100063,20600,HC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-LT,361,1 ,$760.00 ,$494.00 ,$167.20 ,$760.00 ,$437.00 ,$547.20 ,$413.44 ,$167.20 ,$212.80 ,$426.36 ,$167.20 ,$495.52 ,$190.00 ,$495.52 ,$495.52 ,$190.00 ,$495.52 ,$317.68 ,$638.40 ,$667.08 ,$167.20 ,$646.00 ,$638.40 ,$167.20 ,$570.00 ,$608.00 ,$608.00 ,$167.20 ,$608.00 ,$638.40 ,$638.40 ,$638.40 ,$760.00 ,$684.00 ,$437.00 ,$760.00 ,$167.20 ,$760.00 ,$413.44 ,$167.20 ,$316.16 ,$341.51 ,$325.98 ,$175.56 ,$646.00 ,$495.52 ,$212.80 ,$684.00 ,$638.40 ,$608.00 ,$608.00 ,$167.20 ,$494.00 
ST. FRANCIS HOSPITAL - ACUTE,36100064,20600,HC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-RT,361,1 ,$760.00 ,$494.00 ,$167.20 ,$760.00 ,$437.00 ,$547.20 ,$413.44 ,$167.20 ,$212.80 ,$426.36 ,$167.20 ,$495.52 ,$190.00 ,$495.52 ,$495.52 ,$190.00 ,$495.52 ,$317.68 ,$638.40 ,$667.08 ,$167.20 ,$646.00 ,$638.40 ,$167.20 ,$570.00 ,$608.00 ,$608.00 ,$167.20 ,$608.00 ,$638.40 ,$638.40 ,$638.40 ,$760.00 ,$684.00 ,$437.00 ,$760.00 ,$167.20 ,$760.00 ,$413.44 ,$167.20 ,$316.16 ,$341.51 ,$325.98 ,$175.56 ,$646.00 ,$495.52 ,$212.80 ,$684.00 ,$638.40 ,$608.00 ,$608.00 ,$167.20 ,$494.00 
ST. FRANCIS HOSPITAL - ACUTE,36100065,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-LT,361,1 ,$857.00 ,$557.05 ,$188.54 ,$857.00 ,$492.78 ,$617.04 ,$466.21 ,$188.54 ,$239.96 ,$480.78 ,$188.54 ,$558.76 ,$214.25 ,$558.76 ,$558.76 ,$214.25 ,$558.76 ,$358.23 ,$719.88 ,$667.08 ,$188.54 ,$728.45 ,$719.88 ,$188.54 ,$642.75 ,$685.60 ,$685.60 ,$188.54 ,$685.60 ,$719.88 ,$719.88 ,$719.88 ,$857.00 ,$771.30 ,$492.78 ,$857.00 ,$188.54 ,$857.00 ,$466.21 ,$188.54 ,$356.51 ,$341.51 ,$325.98 ,$197.97 ,$728.45 ,$558.76 ,$239.96 ,$771.30 ,$719.88 ,$685.60 ,$685.60 ,$188.54 ,$557.05 
ST. FRANCIS HOSPITAL - ACUTE,36100066,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-RT,361,1 ,$857.00 ,$557.05 ,$188.54 ,$857.00 ,$492.78 ,$617.04 ,$466.21 ,$188.54 ,$239.96 ,$480.78 ,$188.54 ,$558.76 ,$214.25 ,$558.76 ,$558.76 ,$214.25 ,$558.76 ,$358.23 ,$719.88 ,$667.08 ,$188.54 ,$728.45 ,$719.88 ,$188.54 ,$642.75 ,$685.60 ,$685.60 ,$188.54 ,$685.60 ,$719.88 ,$719.88 ,$719.88 ,$857.00 ,$771.30 ,$492.78 ,$857.00 ,$188.54 ,$857.00 ,$466.21 ,$188.54 ,$356.51 ,$341.51 ,$325.98 ,$197.97 ,$728.45 ,$558.76 ,$239.96 ,$771.30 ,$719.88 ,$685.60 ,$685.60 ,$188.54 ,$557.05 
ST. FRANCIS HOSPITAL - ACUTE,36100067,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,361,1 ,"$1,070.00 ",$695.50 ,$235.40 ,"$1,070.00 ",$615.25 ,$770.40 ,$582.08 ,$235.40 ,$299.60 ,$600.27 ,$235.40 ,$697.64 ,$267.50 ,$697.64 ,$697.64 ,$267.50 ,$697.64 ,$447.26 ,$898.80 ,$667.08 ,$235.40 ,$909.50 ,$898.80 ,$235.40 ,$802.50 ,$856.00 ,$856.00 ,$235.40 ,$856.00 ,$898.80 ,$898.80 ,$898.80 ,"$1,070.00 ",$963.00 ,$615.25 ,"$1,070.00 ",$235.40 ,"$1,070.00 ",$582.08 ,$235.40 ,$445.12 ,$341.51 ,$325.98 ,$247.17 ,$909.50 ,$697.64 ,$299.60 ,$963.00 ,$898.80 ,$856.00 ,$856.00 ,$235.40 ,$695.50 
ST. FRANCIS HOSPITAL - ACUTE,36100068,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,361,1 ,"$1,070.00 ",$695.50 ,$235.40 ,"$1,070.00 ",$615.25 ,$770.40 ,$582.08 ,$235.40 ,$299.60 ,$600.27 ,$235.40 ,$697.64 ,$267.50 ,$697.64 ,$697.64 ,$267.50 ,$697.64 ,$447.26 ,$898.80 ,$667.08 ,$235.40 ,$909.50 ,$898.80 ,$235.40 ,$802.50 ,$856.00 ,$856.00 ,$235.40 ,$856.00 ,$898.80 ,$898.80 ,$898.80 ,"$1,070.00 ",$963.00 ,$615.25 ,"$1,070.00 ",$235.40 ,"$1,070.00 ",$582.08 ,$235.40 ,$445.12 ,$341.51 ,$325.98 ,$247.17 ,$909.50 ,$697.64 ,$299.60 ,$963.00 ,$898.80 ,$856.00 ,$856.00 ,$235.40 ,$695.50 
ST. FRANCIS HOSPITAL - ACUTE,36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$1,880.00 ","$1,222.00 ",$413.60 ,"$2,101.83 ","$1,081.00 ","$1,353.60 ","$1,022.72 ",$413.60 ,$526.40 ,"$1,054.68 ",$413.60 ,"$1,225.76 ",$470.00 ,"$1,225.76 ","$1,225.76 ",$470.00 ,"$1,225.76 ",$785.84 ,"$1,579.20 ","$2,101.83 ",$413.60 ,"$1,598.00 ","$1,579.20 ",$413.60 ,"$1,410.00 ","$1,504.00 ","$1,504.00 ",$413.60 ,"$1,504.00 ","$1,579.20 ","$1,579.20 ","$1,579.20 ","$1,880.00 ","$1,692.00 ","$1,081.00 ","$1,880.00 ",$413.60 ,"$1,880.00 ","$1,022.72 ",$413.60 ,$782.08 ,$841.45 ,$803.20 ,$434.28 ,"$1,598.00 ","$1,225.76 ",$526.40 ,"$1,692.00 ","$1,579.20 ","$1,504.00 ","$1,504.00 ",$413.60 ,"$1,222.00 "
ST. FRANCIS HOSPITAL - ACUTE,36100146,51720,HC INSTILL ANTICARCINOG BLADDER,361,1 ,$599.00 ,$389.35 ,$131.78 ,"$1,145.13 ",$344.43 ,$431.28 ,$325.86 ,$131.78 ,$167.72 ,$336.04 ,$131.78 ,$390.55 ,$149.75 ,$390.55 ,$390.55 ,$149.75 ,$390.55 ,$250.38 ,$503.16 ,$679.43 ,$131.78 ,$509.15 ,$503.16 ,$131.78 ,$449.25 ,$479.20 ,$479.20 ,$131.78 ,$479.20 ,$503.16 ,$503.16 ,$503.16 ,$599.00 ,$539.10 ,$344.43 ,$599.00 ,$131.78 ,$599.00 ,$325.86 ,$131.78 ,$249.18 ,"$1,145.13 ","$1,093.08 ",$138.37 ,$509.15 ,$390.55 ,$167.72 ,$539.10 ,$503.16 ,$479.20 ,$479.20 ,$131.78 ,$389.35 
ST. FRANCIS HOSPITAL - ACUTE,36100235,11102,HC BIOPSY SKIN TANGENTIAL INIT LESN,361,1 ,"$2,352.00 ","$1,528.80 ",$458.50 ,"$2,352.00 ","$1,352.40 ","$1,693.44 ","$1,279.49 ",$517.44 ,$658.56 ,"$1,319.47 ",$517.44 ,"$1,533.50 ",$588.00 ,"$1,533.50 ","$1,533.50 ",$588.00 ,"$1,533.50 ",$983.14 ,"$1,975.68 ",$458.50 ,$517.44 ,"$1,999.20 ","$1,975.68 ",$517.44 ,"$1,764.00 ","$1,881.60 ","$1,881.60 ",$517.44 ,"$1,881.60 ","$1,975.68 ","$1,975.68 ","$1,975.68 ","$2,352.00 ","$2,116.80 ","$1,352.40 ","$2,352.00 ",$517.44 ,"$2,352.00 ","$1,279.49 ",$517.44 ,$978.43 ,$679.87 ,$648.96 ,$543.31 ,"$1,999.20 ","$1,533.50 ",$658.56 ,"$2,116.80 ","$1,975.68 ","$1,881.60 ","$1,881.60 ",$517.44 ,"$1,528.80 "
ST. FRANCIS HOSPITAL - ACUTE,36100236,11104,HC BIOPSY SKIN PUNCH INIT LESN,361,1 ,"$2,352.00 ","$1,528.80 ",$517.44 ,"$2,352.00 ","$1,352.40 ","$1,693.44 ","$1,279.49 ",$517.44 ,$658.56 ,"$1,319.47 ",$517.44 ,"$1,533.50 ",$588.00 ,"$1,533.50 ","$1,533.50 ",$588.00 ,"$1,533.50 ",$983.14 ,"$1,975.68 ",$882.50 ,$517.44 ,"$1,999.20 ","$1,975.68 ",$517.44 ,"$1,764.00 ","$1,881.60 ","$1,881.60 ",$517.44 ,"$1,881.60 ","$1,975.68 ","$1,975.68 ","$1,975.68 ","$2,352.00 ","$2,116.80 ","$1,352.40 ","$2,352.00 ",$517.44 ,"$2,352.00 ","$1,279.49 ",$517.44 ,$978.43 ,$679.87 ,$648.96 ,$543.31 ,"$1,999.20 ","$1,533.50 ",$658.56 ,"$2,116.80 ","$1,975.68 ","$1,881.60 ","$1,881.60 ",$517.44 ,"$1,528.80 "
ST. FRANCIS HOSPITAL - ACUTE,36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,"$2,352.00 ","$1,528.80 ",$517.44 ,"$2,352.00 ","$1,352.40 ","$1,693.44 ","$1,279.49 ",$517.44 ,$658.56 ,"$1,319.47 ",$517.44 ,"$1,533.50 ",$588.00 ,"$1,533.50 ","$1,533.50 ",$588.00 ,"$1,533.50 ",$983.14 ,"$1,975.68 ","$1,337.23 ",$517.44 ,"$1,999.20 ","$1,975.68 ",$517.44 ,"$1,764.00 ","$1,881.60 ","$1,881.60 ",$517.44 ,"$1,881.60 ","$1,975.68 ","$1,975.68 ","$1,975.68 ","$2,352.00 ","$2,116.80 ","$1,352.40 ","$2,352.00 ",$517.44 ,"$2,352.00 ","$1,279.49 ",$517.44 ,$978.43 ,$679.87 ,$648.96 ,$543.31 ,"$1,999.20 ","$1,533.50 ",$658.56 ,"$2,116.80 ","$1,975.68 ","$1,881.60 ","$1,881.60 ",$517.44 ,"$1,528.80 "
ST. FRANCIS HOSPITAL - ACUTE,36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,"$4,716.00 ","$3,065.40 ",$498.97 ,"$4,716.00 ","$2,711.70 ","$3,395.52 ","$2,565.50 ","$1,037.52 ","$1,320.48 ","$2,645.68 ","$1,037.52 ","$3,074.83 ","$1,179.00 ","$3,074.83 ","$3,074.83 ","$1,179.00 ","$3,074.83 ","$1,971.29 ","$3,961.44 ","$3,590.40 ","$1,037.52 ","$4,008.60 ","$3,961.44 ","$1,037.52 ","$3,537.00 ","$3,772.80 ","$3,772.80 ","$1,037.52 ","$3,772.80 ","$3,961.44 ","$3,961.44 ","$3,961.44 ","$4,716.00 ","$4,244.40 ","$2,711.70 ","$4,716.00 ","$1,037.52 ","$4,716.00 ","$2,565.50 ","$1,037.52 ","$1,961.86 ",$522.73 ,$498.97 ,"$1,089.40 ","$4,008.60 ","$3,074.83 ","$1,320.48 ","$4,244.40 ","$3,961.44 ","$3,772.80 ","$3,772.80 ","$1,037.52 ","$3,065.40 "
ST. FRANCIS HOSPITAL - ACUTE,36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,"$5,379.00 ","$3,496.35 ","$1,183.38 ","$5,379.00 ","$3,092.93 ","$3,872.88 ","$2,926.18 ","$1,183.38 ","$1,506.12 ","$3,017.62 ","$1,183.38 ","$3,507.11 ","$1,344.75 ","$3,507.11 ","$3,507.11 ","$1,344.75 ","$3,507.11 ","$2,248.42 ","$4,518.36 ","$4,571.63 ","$1,183.38 ","$4,572.15 ","$4,518.36 ","$1,183.38 ","$4,034.25 ","$4,303.20 ","$4,303.20 ","$1,183.38 ","$4,303.20 ","$4,518.36 ","$4,518.36 ","$4,518.36 ","$5,379.00 ","$4,841.10 ","$3,092.93 ","$5,379.00 ","$1,183.38 ","$5,379.00 ","$2,926.18 ","$1,183.38 ","$2,237.66 ", N/A , N/A ,"$1,242.55 ","$4,572.15 ","$3,507.11 ","$1,506.12 ","$4,841.10 ","$4,518.36 ","$4,303.20 ","$4,303.20 ","$1,183.38 ","$3,496.35 "
ST. FRANCIS HOSPITAL - ACUTE,37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,$595.00 ,$386.75 ,$130.90 ,$712.59 ,$342.13 ,$428.40 ,$323.68 ,$130.90 ,$166.60 ,$333.80 ,$130.90 ,$387.94 ,$148.75 ,$387.94 ,$387.94 ,$148.75 ,$387.94 ,$248.71 ,$499.80 ,$540.18 ,$130.90 ,$505.75 ,$499.80 ,$130.90 ,$446.25 ,$476.00 ,$476.00 ,$130.90 ,$476.00 ,$499.80 ,$499.80 ,$499.80 ,$595.00 ,$535.50 ,$342.13 ,$595.00 ,$130.90 ,$595.00 ,$323.68 ,$130.90 ,$247.52 ,$712.59 ,$680.20 ,$137.45 ,$505.75 ,$387.94 ,$166.60 ,$535.50 ,$499.80 ,$476.00 ,$476.00 ,$130.90 ,$386.75 
ST. FRANCIS HOSPITAL - ACUTE,37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,"$1,975.00 ","$1,283.75 ",$434.50 ,"$2,101.83 ","$1,135.63 ","$1,422.00 ","$1,074.40 ",$434.50 ,$553.00 ,"$1,107.98 ",$434.50 ,"$1,287.70 ",$493.75 ,"$1,287.70 ","$1,287.70 ",$493.75 ,"$1,287.70 ",$825.55 ,"$1,659.00 ","$2,101.83 ",$434.50 ,"$1,678.75 ","$1,659.00 ",$434.50 ,"$1,481.25 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,580.00 ","$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,975.00 ","$1,777.50 ","$1,135.63 ","$1,975.00 ",$434.50 ,"$1,975.00 ","$1,074.40 ",$434.50 ,$821.60 ,$463.96 ,$442.87 ,$456.23 ,"$1,678.75 ","$1,287.70 ",$553.00 ,"$1,777.50 ","$1,659.00 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,283.75 "
ST. FRANCIS HOSPITAL - ACUTE,37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$242.00 ,$157.30 ,$23.75 ,$242.00 ,$139.15 ,$174.24 ,$131.65 ,$53.24 ,$67.76 ,$142.30 ,$53.24 ,$147.66 ,$60.50 ,$147.66 ,$147.66 ,$60.50 ,$147.66 ,$101.16 ,$203.28 , N/A ,$53.24 ,$205.70 ,$203.28 ,$53.24 ,$181.50 ,$193.60 ,$193.60 ,$53.24 ,$193.60 ,$203.28 ,$203.28 ,$203.28 ,$242.00 ,$217.80 ,$139.15 ,$242.00 ,$53.24 ,$242.00 ,$131.65 ,$53.24 ,$100.67 ,$24.88 ,$23.75 ,$55.90 ,$205.70 ,$147.66 ,$67.76 ,$217.80 ,$203.28 ,$193.60 ,$193.60 ,$53.24 ,$157.30 
ST. FRANCIS HOSPITAL - ACUTE,37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$214.00 ,$139.10 ,$23.75 ,$214.00 ,$123.05 ,$154.08 ,$116.42 ,$47.08 ,$59.92 ,$125.83 ,$47.08 ,$147.02 ,$53.50 ,$147.02 ,$147.02 ,$53.50 ,$147.02 ,$89.45 ,$179.76 , N/A ,$47.08 ,$181.90 ,$179.76 ,$47.08 ,$160.50 ,$171.20 ,$171.20 ,$47.08 ,$171.20 ,$179.76 ,$179.76 ,$179.76 ,$214.00 ,$192.60 ,$123.05 ,$214.00 ,$47.08 ,$200.00 ,$116.42 ,$47.08 ,$89.02 ,$24.88 ,$23.75 ,$49.43 ,$181.90 ,$147.02 ,$59.92 ,$192.60 ,$179.76 ,$171.20 ,$171.20 ,$47.08 ,$139.10 
ST. FRANCIS HOSPITAL - ACUTE,37000021,64447,HC FEMORAL NERVE BLOCK SINGLE,370,1 ,"$1,975.00 ","$1,283.75 ",$434.50 ,"$1,975.00 ","$1,135.63 ","$1,422.00 ","$1,074.40 ",$434.50 ,$553.00 ,"$1,107.98 ",$434.50 ,"$1,287.70 ",$493.75 ,"$1,287.70 ","$1,287.70 ",$493.75 ,"$1,287.70 ",$825.55 ,"$1,659.00 ","$1,621.30 ",$434.50 ,"$1,678.75 ","$1,659.00 ",$434.50 ,"$1,481.25 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,580.00 ","$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,975.00 ","$1,777.50 ","$1,135.63 ","$1,975.00 ",$434.50 ,"$1,975.00 ","$1,074.40 ",$434.50 ,$821.60 ,$463.96 ,$442.87 ,$456.23 ,"$1,678.75 ","$1,287.70 ",$553.00 ,"$1,777.50 ","$1,659.00 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,283.75 "
ST. FRANCIS HOSPITAL - ACUTE,37000023,64416,HC INTRASCALENE BLOCK CONTINUOUS,370,1 ,"$1,975.00 ","$1,283.75 ",$434.50 ,"$2,101.83 ","$1,135.63 ","$1,422.00 ","$1,074.40 ",$434.50 ,$553.00 ,"$1,107.98 ",$434.50 ,"$1,287.70 ",$493.75 ,"$1,287.70 ","$1,287.70 ",$493.75 ,"$1,287.70 ",$825.55 ,"$1,659.00 ","$2,101.83 ",$434.50 ,"$1,678.75 ","$1,659.00 ",$434.50 ,"$1,481.25 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,580.00 ","$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,975.00 ","$1,777.50 ","$1,135.63 ","$1,975.00 ",$434.50 ,"$1,975.00 ","$1,074.40 ",$434.50 ,$821.60 ,$463.96 ,$442.87 ,$456.23 ,"$1,678.75 ","$1,287.70 ",$553.00 ,"$1,777.50 ","$1,659.00 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,283.75 "
ST. FRANCIS HOSPITAL - ACUTE,37000024,N/A,HC EPIDURAL NERVE BLOCK,370,1 ,"$1,851.00 ","$1,203.15 ",$407.22 ,"$1,851.00 ","$1,064.33 ","$1,332.72 ","$1,006.94 ",$407.22 ,$518.28 ,"$1,038.41 ",$407.22 ,"$1,206.85 ",$462.75 ,"$1,206.85 ","$1,206.85 ",$462.75 ,"$1,206.85 ",$773.72 ,"$1,554.84 ", N/A ,$407.22 ,"$1,573.35 ","$1,554.84 ",$407.22 ,"$1,388.25 ","$1,480.80 ","$1,480.80 ",$407.22 ,"$1,480.80 ","$1,554.84 ","$1,554.84 ","$1,554.84 ","$1,851.00 ","$1,665.90 ","$1,064.33 ","$1,851.00 ",$407.22 ,"$1,851.00 ","$1,006.94 ",$407.22 ,$770.02 , N/A , N/A ,$427.58 ,"$1,573.35 ","$1,206.85 ",$518.28 ,"$1,665.90 ","$1,554.84 ","$1,480.80 ","$1,480.80 ",$407.22 ,"$1,203.15 "
ST. FRANCIS HOSPITAL - ACUTE,37000061,N/A,HC ANESTHESIA GENERAL INITIAL 15MIN,370,1 ,"$3,333.00 ","$2,166.45 ",$733.26 ,"$3,333.00 ","$1,916.48 ","$2,399.76 ","$1,813.15 ",$733.26 ,$933.24 ,"$1,869.81 ",$733.26 ,"$2,173.12 ",$833.25 ,"$2,173.12 ","$2,173.12 ",$833.25 ,"$2,173.12 ","$1,393.19 ","$2,799.72 ", N/A ,$733.26 ,"$2,833.05 ","$2,799.72 ",$733.26 ,"$2,499.75 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,666.40 ","$2,799.72 ","$2,799.72 ","$2,799.72 ","$3,333.00 ","$2,999.70 ","$1,916.48 ","$3,333.00 ",$733.26 ,"$3,333.00 ","$1,813.15 ",$733.26 ,"$1,386.53 ", N/A , N/A ,$769.92 ,"$2,833.05 ","$2,173.12 ",$933.24 ,"$2,999.70 ","$2,799.72 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,166.45 "
ST. FRANCIS HOSPITAL - ACUTE,37000062,N/A,HC ANESTHESIA GENERAL ADDL 15MIN,370,1 ,$258.00 ,$167.70 ,$56.76 ,$258.00 ,$148.35 ,$185.76 ,$140.35 ,$56.76 ,$72.24 ,$144.74 ,$56.76 ,$168.22 ,$64.50 ,$168.22 ,$168.22 ,$64.50 ,$168.22 ,$107.84 ,$216.72 , N/A ,$56.76 ,$219.30 ,$216.72 ,$56.76 ,$193.50 ,$206.40 ,$206.40 ,$56.76 ,$206.40 ,$216.72 ,$216.72 ,$216.72 ,$258.00 ,$232.20 ,$148.35 ,$258.00 ,$56.76 ,$258.00 ,$140.35 ,$56.76 ,$107.33 , N/A , N/A ,$59.60 ,$219.30 ,$168.22 ,$72.24 ,$232.20 ,$216.72 ,$206.40 ,$206.40 ,$56.76 ,$167.70 
ST. FRANCIS HOSPITAL - ACUTE,37000063,N/A,HC ANESTHESIA REGIONAL BLOCK INITIAL 15MIN,370,1 ,"$3,333.00 ","$2,166.45 ",$733.26 ,"$3,333.00 ","$1,916.48 ","$2,399.76 ","$1,813.15 ",$733.26 ,$933.24 ,"$1,869.81 ",$733.26 ,"$2,173.12 ",$833.25 ,"$2,173.12 ","$2,173.12 ",$833.25 ,"$2,173.12 ","$1,393.19 ","$2,799.72 ", N/A ,$733.26 ,"$2,833.05 ","$2,799.72 ",$733.26 ,"$2,499.75 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,666.40 ","$2,799.72 ","$2,799.72 ","$2,799.72 ","$3,333.00 ","$2,999.70 ","$1,916.48 ","$3,333.00 ",$733.26 ,"$3,333.00 ","$1,813.15 ",$733.26 ,"$1,386.53 ", N/A , N/A ,$769.92 ,"$2,833.05 ","$2,173.12 ",$933.24 ,"$2,999.70 ","$2,799.72 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,166.45 "
ST. FRANCIS HOSPITAL - ACUTE,37000064,N/A,HC ANESTHESIA REGIONAL BLOCK ADDL 15MIN,370,1 ,$258.00 ,$167.70 ,$56.76 ,$258.00 ,$148.35 ,$185.76 ,$140.35 ,$56.76 ,$72.24 ,$144.74 ,$56.76 ,$168.22 ,$64.50 ,$168.22 ,$168.22 ,$64.50 ,$168.22 ,$107.84 ,$216.72 , N/A ,$56.76 ,$219.30 ,$216.72 ,$56.76 ,$193.50 ,$206.40 ,$206.40 ,$56.76 ,$206.40 ,$216.72 ,$216.72 ,$216.72 ,$258.00 ,$232.20 ,$148.35 ,$258.00 ,$56.76 ,$258.00 ,$140.35 ,$56.76 ,$107.33 , N/A , N/A ,$59.60 ,$219.30 ,$168.22 ,$72.24 ,$232.20 ,$216.72 ,$206.40 ,$206.40 ,$56.76 ,$167.70 
ST. FRANCIS HOSPITAL - ACUTE,37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$918.00 ,$596.70 ,$23.75 ,$918.00 ,$527.85 ,$660.96 ,$499.39 ,$201.96 ,$257.04 ,$338.52 ,$201.96 ,$338.52 ,$229.50 ,$338.52 ,$338.52 ,$229.50 ,$338.52 ,$383.72 ,$771.12 , N/A ,$201.96 ,$780.30 ,$771.12 ,$201.96 ,$688.50 ,$734.40 ,$734.40 ,$201.96 ,$734.40 ,$771.12 ,$771.12 ,$771.12 ,$918.00 ,$826.20 ,$527.85 ,$918.00 ,$201.96 ,$918.00 ,$499.39 ,$201.96 ,$381.89 ,$24.88 ,$23.75 ,$212.06 ,$780.30 ,$338.52 ,$257.04 ,$826.20 ,$771.12 ,$734.40 ,$734.40 ,$201.96 ,$596.70 
ST. FRANCIS HOSPITAL - ACUTE,37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$918.00 ,$596.70 ,$23.75 ,$918.00 ,$527.85 ,$660.96 ,$499.39 ,$201.96 ,$257.04 ,$175.92 ,$201.96 ,$175.92 ,$229.50 ,$175.92 ,$175.92 ,$229.50 ,$175.92 ,$383.72 ,$771.12 , N/A ,$201.96 ,$780.30 ,$771.12 ,$201.96 ,$688.50 ,$734.40 ,$734.40 ,$201.96 ,$734.40 ,$771.12 ,$771.12 ,$771.12 ,$918.00 ,$826.20 ,$527.85 ,$918.00 ,$201.96 ,$918.00 ,$499.39 ,$201.96 ,$381.89 ,$24.88 ,$23.75 ,$212.06 ,$780.30 ,$175.92 ,$257.04 ,$826.20 ,$771.12 ,$734.40 ,$734.40 ,$201.96 ,$596.70 
ST. FRANCIS HOSPITAL - ACUTE,37000074,99155,HC MODERATE SEDATION DIFF PHY <5YR 1ST 15MIN,370,1 ,$947.00 ,$615.55 ,$23.75 ,$947.00 ,$544.53 ,$681.84 ,$515.17 ,$208.34 ,$265.16 ,$556.84 ,$208.34 ,$650.59 ,$236.75 ,$650.59 ,$650.59 ,$236.75 ,$650.59 ,$395.85 ,$795.48 , N/A ,$208.34 ,$804.95 ,$795.48 ,$208.34 ,$710.25 ,$757.60 ,$757.60 ,$208.34 ,$757.60 ,$795.48 ,$795.48 ,$795.48 ,$947.00 ,$852.30 ,$544.53 ,$947.00 ,$208.34 ,$947.00 ,$515.17 ,$208.34 ,$393.95 ,$24.88 ,$23.75 ,$218.76 ,$804.95 ,$650.59 ,$265.16 ,$852.30 ,$795.48 ,$757.60 ,$757.60 ,$208.34 ,$615.55 
ST. FRANCIS HOSPITAL - ACUTE,37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,$947.00 ,$615.55 ,$23.75 ,$947.00 ,$544.53 ,$681.84 ,$515.17 ,$208.34 ,$265.16 ,$556.84 ,$208.34 ,$650.59 ,$236.75 ,$650.59 ,$650.59 ,$236.75 ,$650.59 ,$395.85 ,$795.48 , N/A ,$208.34 ,$804.95 ,$795.48 ,$208.34 ,$710.25 ,$757.60 ,$757.60 ,$208.34 ,$757.60 ,$795.48 ,$795.48 ,$795.48 ,$947.00 ,$852.30 ,$544.53 ,$947.00 ,$208.34 ,$200.00 ,$515.17 ,$208.34 ,$393.95 ,$24.88 ,$23.75 ,$218.76 ,$804.95 ,$650.59 ,$265.16 ,$852.30 ,$795.48 ,$757.60 ,$757.60 ,$208.34 ,$615.55 
ST. FRANCIS HOSPITAL - ACUTE,37000076,N/A,HC MONITORED ANESTHESIA INITIAL 15 MINS,370,1 ,"$3,333.00 ","$2,166.45 ",$733.26 ,"$3,333.00 ","$1,916.48 ","$2,399.76 ","$1,813.15 ",$733.26 ,$933.24 ,"$1,869.81 ",$733.26 ,"$2,173.12 ",$833.25 ,"$2,173.12 ","$2,173.12 ",$833.25 ,"$2,173.12 ","$1,393.19 ","$2,799.72 ", N/A ,$733.26 ,"$2,833.05 ","$2,799.72 ",$733.26 ,"$2,499.75 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,666.40 ","$2,799.72 ","$2,799.72 ","$2,799.72 ","$3,333.00 ","$2,999.70 ","$1,916.48 ","$3,333.00 ",$733.26 ,"$3,333.00 ","$1,813.15 ",$733.26 ,"$1,386.53 ", N/A , N/A ,$769.92 ,"$2,833.05 ","$2,173.12 ",$933.24 ,"$2,999.70 ","$2,799.72 ","$2,666.40 ","$2,666.40 ",$733.26 ,"$2,166.45 "
ST. FRANCIS HOSPITAL - ACUTE,37000077,N/A,HC MONITORED ANESTHESIA ADDL 15 MINS,370,1 ,$258.00 ,$167.70 ,$56.76 ,$258.00 ,$148.35 ,$185.76 ,$140.35 ,$56.76 ,$72.24 ,$144.74 ,$56.76 ,$168.22 ,$64.50 ,$168.22 ,$168.22 ,$64.50 ,$168.22 ,$107.84 ,$216.72 , N/A ,$56.76 ,$219.30 ,$216.72 ,$56.76 ,$193.50 ,$206.40 ,$206.40 ,$56.76 ,$206.40 ,$216.72 ,$216.72 ,$216.72 ,$258.00 ,$232.20 ,$148.35 ,$258.00 ,$56.76 ,$258.00 ,$140.35 ,$56.76 ,$107.33 , N/A , N/A ,$59.60 ,$219.30 ,$168.22 ,$72.24 ,$232.20 ,$216.72 ,$206.40 ,$206.40 ,$56.76 ,$167.70 
ST. FRANCIS HOSPITAL - ACUTE,37080001,64415,HC INTRASCALENE BLOCK SINGLE,360,1 ,"$1,975.00 ","$1,283.75 ",$434.50 ,"$2,101.83 ","$1,135.63 ","$1,422.00 ","$1,074.40 ",$434.50 ,$553.00 ,"$1,107.98 ",$434.50 ,"$1,287.70 ",$493.75 ,"$1,287.70 ","$1,287.70 ",$493.75 ,"$1,287.70 ",$825.55 ,"$1,659.00 ","$2,101.83 ",$434.50 ,"$1,678.75 ","$1,659.00 ",$434.50 ,"$1,481.25 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,580.00 ","$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,975.00 ","$1,777.50 ","$1,135.63 ","$1,975.00 ",$434.50 ,"$1,975.00 ","$1,074.40 ",$434.50 ,$821.60 ,$463.96 ,$442.87 ,$456.23 ,"$1,678.75 ","$1,287.70 ",$553.00 ,"$1,777.50 ","$1,659.00 ","$1,580.00 ","$1,580.00 ",$434.50 ,"$1,283.75 "
ST. FRANCIS HOSPITAL - ACUTE,39000143,86945,HC BLOOD PRODUCT IRRADIATION,390,1 ,$131.00 ,$85.15 ,$6.30 ,$131.00 ,$75.33 ,$94.32 ,$71.26 ,$28.82 ,$36.68 ,$77.03 ,$28.82 ,$90.00 ,$32.75 ,$90.00 ,$90.00 ,$32.75 ,$90.00 ,$54.76 ,$110.04 ,$86.43 ,$28.82 ,$111.35 ,$110.04 ,$28.82 ,$98.25 ,$104.80 ,$104.80 ,$28.82 ,$104.80 ,$110.04 ,$110.04 ,$110.04 ,$131.00 ,$117.90 ,$75.33 ,$131.00 ,$28.82 ,$131.00 ,$71.26 ,$28.82 ,$54.50 ,$6.60 ,$6.30 ,$30.26 ,$111.35 ,$90.00 ,$36.68 ,$117.90 ,$110.04 ,$104.80 ,$104.80 ,$28.82 ,$85.15 
ST. FRANCIS HOSPITAL - ACUTE,39000148,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$123.00 ,$79.95 ,$27.06 ,$700.32 ,$70.73 ,$88.56 ,$66.91 ,$27.06 ,$34.44 ,$69.00 ,$27.06 ,$80.20 ,$30.75 ,$80.20 ,$80.20 ,$30.75 ,$80.20 ,$51.41 ,$103.32 ,$211.00 ,$27.06 ,$104.55 ,$103.32 ,$27.06 ,$92.25 ,$98.40 ,$98.40 ,$27.06 ,$98.40 ,$103.32 ,$103.32 ,$103.32 ,$123.00 ,$110.70 ,$70.73 ,$123.00 ,$27.06 ,$123.00 ,$66.91 ,$27.06 ,$51.17 ,$700.32 ,$668.48 ,$28.41 ,$104.55 ,$80.20 ,$34.44 ,$110.70 ,$103.32 ,$98.40 ,$98.40 ,$27.06 ,$79.95 
ST. FRANCIS HOSPITAL - ACUTE,39000151,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,$177.00 ,$115.05 ,$38.94 ,$700.32 ,$101.78 ,$127.44 ,$96.29 ,$38.94 ,$49.56 ,$99.30 ,$38.94 ,$115.40 ,$44.25 ,$115.40 ,$115.40 ,$44.25 ,$115.40 ,$73.99 ,$148.68 ,$382.68 ,$38.94 ,$150.45 ,$148.68 ,$38.94 ,$132.75 ,$141.60 ,$141.60 ,$38.94 ,$141.60 ,$148.68 ,$148.68 ,$148.68 ,$177.00 ,$159.30 ,$101.78 ,$177.00 ,$38.94 ,$177.00 ,$96.29 ,$38.94 ,$73.63 ,$700.32 ,$668.48 ,$40.89 ,$150.45 ,$115.40 ,$49.56 ,$159.30 ,$148.68 ,$141.60 ,$141.60 ,$38.94 ,$115.05 
ST. FRANCIS HOSPITAL - ACUTE,39000152,P9033,HC PLATELETS L/R IRR EA,390,1 ,"$1,283.00 ",$833.95 ,$282.26 ,"$1,283.00 ",$737.73 ,$923.76 ,$697.95 ,$282.26 ,$359.24 ,$719.76 ,$282.26 ,$836.52 ,$320.75 ,$836.52 ,$836.52 ,$320.75 ,$836.52 ,$536.29 ,"$1,077.72 ",$544.15 ,$282.26 ,"$1,090.55 ","$1,077.72 ",$282.26 ,$962.25 ,"$1,026.40 ","$1,026.40 ",$282.26 ,"$1,026.40 ","$1,077.72 ","$1,077.72 ","$1,077.72 ","$1,283.00 ","$1,154.70 ",$737.73 ,"$1,283.00 ",$282.26 ,"$1,283.00 ",$697.95 ,$282.26 ,$533.73 ,$700.32 ,$668.48 ,$296.37 ,"$1,090.55 ",$836.52 ,$359.24 ,"$1,154.70 ","$1,077.72 ","$1,026.40 ","$1,026.40 ",$282.26 ,$833.95 
ST. FRANCIS HOSPITAL - ACUTE,39000157,P9052,HC PLT APHER/PHER L/R HLA EA,390,1 ,"$1,421.00 ",$923.65 ,$312.62 ,"$2,055.28 ",$817.08 ,"$1,023.12 ",$773.02 ,$312.62 ,$397.88 ,$797.18 ,$312.62 ,$926.49 ,$355.25 ,$926.49 ,$926.49 ,$355.25 ,$926.49 ,$593.98 ,"$1,193.64 ","$2,055.28 ",$312.62 ,"$1,207.85 ","$1,193.64 ",$312.62 ,"$1,065.75 ","$1,136.80 ","$1,136.80 ",$312.62 ,"$1,136.80 ","$1,193.64 ","$1,193.64 ","$1,193.64 ","$1,421.00 ","$1,278.90 ",$817.08 ,"$1,421.00 ",$312.62 ,"$1,421.00 ",$773.02 ,$312.62 ,$591.14 ,$700.32 ,$668.48 ,$328.25 ,"$1,207.85 ",$926.49 ,$397.88 ,"$1,278.90 ","$1,193.64 ","$1,136.80 ","$1,136.80 ",$312.62 ,$923.65 
ST. FRANCIS HOSPITAL - ACUTE,39000160,P9059,HC PLASMA FROZEN 8-24 HRS EA UNIT,390,1 ,$149.00 ,$96.85 ,$32.78 ,$700.32 ,$85.68 ,$107.28 ,$81.06 ,$32.78 ,$41.72 ,$83.59 ,$32.78 ,$97.15 ,$37.25 ,$97.15 ,$97.15 ,$37.25 ,$97.15 ,$62.28 ,$125.16 ,$181.60 ,$32.78 ,$126.65 ,$125.16 ,$32.78 ,$111.75 ,$119.20 ,$119.20 ,$32.78 ,$119.20 ,$125.16 ,$125.16 ,$125.16 ,$149.00 ,$134.10 ,$85.68 ,$149.00 ,$32.78 ,$149.00 ,$81.06 ,$32.78 ,$61.98 ,$700.32 ,$668.48 ,$34.42 ,$126.65 ,$97.15 ,$41.72 ,$134.10 ,$125.16 ,$119.20 ,$119.20 ,$32.78 ,$96.85 
ST. FRANCIS HOSPITAL - ACUTE,39000162,P9012,HC CRYOPRECIPITATE EA UNIT T1,390,1 ,$133.00 ,$86.45 ,$29.26 ,$700.32 ,$76.48 ,$95.76 ,$72.35 ,$29.26 ,$37.24 ,$74.61 ,$29.26 ,$86.72 ,$33.25 ,$86.72 ,$86.72 ,$33.25 ,$86.72 ,$55.59 ,$111.72 ,$203.83 ,$29.26 ,$113.05 ,$111.72 ,$29.26 ,$99.75 ,$106.40 ,$106.40 ,$29.26 ,$106.40 ,$111.72 ,$111.72 ,$111.72 ,$133.00 ,$119.70 ,$76.48 ,$133.00 ,$29.26 ,$133.00 ,$72.35 ,$29.26 ,$55.33 ,$700.32 ,$668.48 ,$30.72 ,$113.05 ,$86.72 ,$37.24 ,$119.70 ,$111.72 ,$106.40 ,$106.40 ,$29.26 ,$86.45 
ST. FRANCIS HOSPITAL - ACUTE,39000164,P9016,HC RED CELLS L/R EA T1,390,1 ,"$1,261.00 ",$819.65 ,$277.42 ,"$1,261.00 ",$725.08 ,$907.92 ,$685.98 ,$277.42 ,$353.08 ,$707.42 ,$277.42 ,$822.17 ,$315.25 ,$822.17 ,$822.17 ,$315.25 ,$822.17 ,$527.10 ,"$1,059.24 ",$480.98 ,$277.42 ,"$1,071.85 ","$1,059.24 ",$277.42 ,$945.75 ,"$1,008.80 ","$1,008.80 ",$277.42 ,"$1,008.80 ","$1,059.24 ","$1,059.24 ","$1,059.24 ","$1,261.00 ","$1,134.90 ",$725.08 ,"$1,261.00 ",$277.42 ,"$1,261.00 ",$685.98 ,$277.42 ,$524.58 ,$700.32 ,$668.48 ,$291.29 ,"$1,071.85 ",$822.17 ,$353.08 ,"$1,134.90 ","$1,059.24 ","$1,008.80 ","$1,008.80 ",$277.42 ,$819.65 
ST. FRANCIS HOSPITAL - ACUTE,39000173,P9035,HC PLATELETS PHER L/R EA T1,390,1 ,"$1,220.00 ",$793.00 ,$268.40 ,"$1,242.28 ",$701.50 ,$878.40 ,$663.68 ,$268.40 ,$341.60 ,$684.42 ,$268.40 ,$795.44 ,$305.00 ,$795.44 ,$795.44 ,$305.00 ,$795.44 ,$509.96 ,"$1,024.80 ","$1,242.28 ",$268.40 ,"$1,037.00 ","$1,024.80 ",$268.40 ,$915.00 ,$976.00 ,$976.00 ,$268.40 ,$976.00 ,"$1,024.80 ","$1,024.80 ","$1,024.80 ","$1,220.00 ","$1,098.00 ",$701.50 ,"$1,220.00 ",$268.40 ,"$1,220.00 ",$663.68 ,$268.40 ,$507.52 ,$700.32 ,$668.48 ,$281.82 ,"$1,037.00 ",$795.44 ,$341.60 ,"$1,098.00 ","$1,024.80 ",$976.00 ,$976.00 ,$268.40 ,$793.00 
ST. FRANCIS HOSPITAL - ACUTE,39000179,P9037,HC PLATELETS PHER L/R IRR EA T1,390,1 ,"$1,283.00 ",$833.95 ,$282.26 ,"$1,575.80 ",$737.73 ,$923.76 ,$697.95 ,$282.26 ,$359.24 ,$719.76 ,$282.26 ,$836.52 ,$320.75 ,$836.52 ,$836.52 ,$320.75 ,$836.52 ,$536.29 ,"$1,077.72 ","$1,575.80 ",$282.26 ,"$1,090.55 ","$1,077.72 ",$282.26 ,$962.25 ,"$1,026.40 ","$1,026.40 ",$282.26 ,"$1,026.40 ","$1,077.72 ","$1,077.72 ","$1,077.72 ","$1,283.00 ","$1,154.70 ",$737.73 ,"$1,283.00 ",$282.26 ,"$1,283.00 ",$697.95 ,$282.26 ,$533.73 ,$700.32 ,$668.48 ,$296.37 ,"$1,090.55 ",$836.52 ,$359.24 ,"$1,154.70 ","$1,077.72 ","$1,026.40 ","$1,026.40 ",$282.26 ,$833.95 
ST. FRANCIS HOSPITAL - ACUTE,39000187,P9040,HC RED CELLS L/R IRR EA T1,390,1 ,"$1,327.00 ",$862.55 ,$291.94 ,"$1,327.00 ",$763.03 ,$955.44 ,$721.89 ,$291.94 ,$371.56 ,$744.45 ,$291.94 ,$865.20 ,$331.75 ,$865.20 ,$865.20 ,$331.75 ,$865.20 ,$554.69 ,"$1,114.68 ",$665.08 ,$291.94 ,"$1,127.95 ","$1,114.68 ",$291.94 ,$995.25 ,"$1,061.60 ","$1,061.60 ",$291.94 ,"$1,061.60 ","$1,114.68 ","$1,114.68 ","$1,114.68 ","$1,327.00 ","$1,194.30 ",$763.03 ,"$1,327.00 ",$291.94 ,"$1,327.00 ",$721.89 ,$291.94 ,$552.03 ,$700.32 ,$668.48 ,$306.54 ,"$1,127.95 ",$865.20 ,$371.56 ,"$1,194.30 ","$1,114.68 ","$1,061.60 ","$1,061.60 ",$291.94 ,$862.55 
ST. FRANCIS HOSPITAL - ACUTE,39000193,P9054,HC BLOOD L/R DEG WASH EA UN T1,390,1 ,$729.00 ,$473.85 ,$160.38 ,$793.05 ,$419.18 ,$524.88 ,$396.58 ,$160.38 ,$204.12 ,$408.97 ,$160.38 ,$475.31 ,$182.25 ,$475.31 ,$475.31 ,$182.25 ,$475.31 ,$304.72 ,$612.36 ,$793.05 ,$160.38 ,$619.65 ,$612.36 ,$160.38 ,$546.75 ,$583.20 ,$583.20 ,$160.38 ,$583.20 ,$612.36 ,$612.36 ,$612.36 ,$729.00 ,$656.10 ,$419.18 ,$729.00 ,$160.38 ,$729.00 ,$396.58 ,$160.38 ,$303.26 ,$700.32 ,$668.48 ,$168.40 ,$619.65 ,$475.31 ,$204.12 ,$656.10 ,$612.36 ,$583.20 ,$583.20 ,$160.38 ,$473.85 
ST. FRANCIS HOSPITAL - ACUTE,39100001,36430,HC BLOOD PROD ADMIN,391,1 ,"$1,590.00 ","$1,033.50 ",$349.80 ,"$1,590.00 ",$914.25 ,"$1,144.80 ",$864.96 ,$349.80 ,$445.20 ,$891.99 ,$349.80 ,"$1,036.68 ",$397.50 ,"$1,036.68 ","$1,036.68 ",$397.50 ,"$1,036.68 ",$664.62 ,"$1,335.60 ","$1,013.43 ",$349.80 ,"$1,351.50 ","$1,335.60 ",$349.80 ,"$1,192.50 ","$1,272.00 ","$1,272.00 ",$349.80 ,"$1,272.00 ","$1,335.60 ","$1,335.60 ","$1,335.60 ","$1,590.00 ","$1,431.00 ",$914.25 ,"$1,590.00 ",$349.80 ,"$1,590.00 ",$864.96 ,$349.80 ,$661.44 ,$700.32 ,$668.48 ,$367.29 ,"$1,351.50 ","$1,036.68 ",$445.20 ,"$1,431.00 ","$1,335.60 ","$1,272.00 ","$1,272.00 ",$349.80 ,"$1,033.50 "
ST. FRANCIS HOSPITAL - ACUTE,40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$705.00 ,$458.25 ,$69.57 ,$705.00 ,$405.38 ,$507.60 ,$383.52 ,$155.10 ,$197.40 ,$414.54 ,$155.10 ,$484.34 ,$176.25 ,$484.34 ,$484.34 ,$176.25 ,$484.34 ,$294.69 ,$592.20 ,$272.83 ,$155.10 ,$599.25 ,$592.20 ,$155.10 ,$528.75 ,$564.00 ,$564.00 ,$155.10 ,$564.00 ,$592.20 ,$592.20 ,$592.20 ,$705.00 ,$634.50 ,$405.38 ,$705.00 ,$155.10 ,$122.32 ,$383.52 ,$155.10 ,$293.28 ,$72.89 ,$69.57 ,$162.86 ,$599.25 ,$484.34 ,$197.40 ,$634.50 ,$592.20 ,$564.00 ,$564.00 ,$155.10 ,$458.25 
ST. FRANCIS HOSPITAL - ACUTE,40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$705.00 ,$458.25 ,$69.57 ,$705.00 ,$405.38 ,$507.60 ,$383.52 ,$155.10 ,$197.40 ,$414.54 ,$155.10 ,$484.34 ,$176.25 ,$484.34 ,$484.34 ,$176.25 ,$484.34 ,$294.69 ,$592.20 ,$272.83 ,$155.10 ,$599.25 ,$592.20 ,$155.10 ,$528.75 ,$564.00 ,$564.00 ,$155.10 ,$564.00 ,$592.20 ,$592.20 ,$592.20 ,$705.00 ,$634.50 ,$405.38 ,$705.00 ,$155.10 ,$122.32 ,$383.52 ,$155.10 ,$293.28 ,$72.89 ,$69.57 ,$162.86 ,$599.25 ,$484.34 ,$197.40 ,$634.50 ,$592.20 ,$564.00 ,$564.00 ,$155.10 ,$458.25 
ST. FRANCIS HOSPITAL - ACUTE,40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$705.00 ,$458.25 ,$69.57 ,$705.00 ,$405.38 ,$507.60 ,$383.52 ,$155.10 ,$197.40 ,$414.54 ,$155.10 ,$484.34 ,$176.25 ,$484.34 ,$484.34 ,$176.25 ,$484.34 ,$294.69 ,$592.20 ,$272.83 ,$155.10 ,$599.25 ,$592.20 ,$155.10 ,$528.75 ,$564.00 ,$564.00 ,$155.10 ,$564.00 ,$592.20 ,$592.20 ,$592.20 ,$705.00 ,$634.50 ,$405.38 ,$705.00 ,$155.10 ,$122.32 ,$383.52 ,$155.10 ,$293.28 ,$72.89 ,$69.57 ,$162.86 ,$599.25 ,$484.34 ,$197.40 ,$634.50 ,$592.20 ,$564.00 ,$564.00 ,$155.10 ,$458.25 
ST. FRANCIS HOSPITAL - ACUTE,40100006,77066,HC MAMMOGRAM DIAG W/CAD UPGRADE BIL,401,1 ,$705.00 ,$458.25 ,$69.57 ,$705.00 ,$405.38 ,$507.60 ,$383.52 ,$155.10 ,$197.40 ,$414.54 ,$155.10 ,$484.34 ,$176.25 ,$484.34 ,$484.34 ,$176.25 ,$484.34 ,$294.69 ,$592.20 ,$272.83 ,$155.10 ,$599.25 ,$592.20 ,$155.10 ,$528.75 ,$564.00 ,$564.00 ,$155.10 ,$564.00 ,$592.20 ,$592.20 ,$592.20 ,$705.00 ,$634.50 ,$405.38 ,$705.00 ,$155.10 ,$122.32 ,$383.52 ,$155.10 ,$293.28 ,$72.89 ,$69.57 ,$162.86 ,$599.25 ,$484.34 ,$197.40 ,$634.50 ,$592.20 ,$564.00 ,$564.00 ,$155.10 ,$458.25 
ST. FRANCIS HOSPITAL - ACUTE,40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$495.00 ,$321.75 ,$69.57 ,$495.00 ,$284.63 ,$356.40 ,$269.28 ,$108.90 ,$138.60 ,$291.06 ,$108.90 ,$340.07 ,$123.75 ,$340.07 ,$340.07 ,$123.75 ,$340.07 ,$206.91 ,$415.80 ,$214.15 ,$108.90 ,$420.75 ,$415.80 ,$108.90 ,$371.25 ,$396.00 ,$396.00 ,$108.90 ,$396.00 ,$415.80 ,$415.80 ,$415.80 ,$495.00 ,$445.50 ,$284.63 ,$495.00 ,$108.90 ,$95.73 ,$269.28 ,$108.90 ,$205.92 ,$72.89 ,$69.57 ,$114.35 ,$420.75 ,$340.07 ,$138.60 ,$445.50 ,$415.80 ,$396.00 ,$396.00 ,$108.90 ,$321.75 
ST. FRANCIS HOSPITAL - ACUTE,40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$495.00 ,$321.75 ,$69.57 ,$495.00 ,$284.63 ,$356.40 ,$269.28 ,$108.90 ,$138.60 ,$291.06 ,$108.90 ,$340.07 ,$123.75 ,$340.07 ,$340.07 ,$123.75 ,$340.07 ,$206.91 ,$415.80 ,$214.15 ,$108.90 ,$420.75 ,$415.80 ,$108.90 ,$371.25 ,$396.00 ,$396.00 ,$108.90 ,$396.00 ,$415.80 ,$415.80 ,$415.80 ,$495.00 ,$445.50 ,$284.63 ,$495.00 ,$108.90 ,$95.73 ,$269.28 ,$108.90 ,$205.92 ,$72.89 ,$69.57 ,$114.35 ,$420.75 ,$340.07 ,$138.60 ,$445.50 ,$415.80 ,$396.00 ,$396.00 ,$108.90 ,$321.75 
ST. FRANCIS HOSPITAL - ACUTE,40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$495.00 ,$321.75 ,$69.57 ,$495.00 ,$284.63 ,$356.40 ,$269.28 ,$108.90 ,$138.60 ,$291.06 ,$108.90 ,$340.07 ,$123.75 ,$340.07 ,$340.07 ,$123.75 ,$340.07 ,$206.91 ,$415.80 ,$214.15 ,$108.90 ,$420.75 ,$415.80 ,$108.90 ,$371.25 ,$396.00 ,$396.00 ,$108.90 ,$396.00 ,$415.80 ,$415.80 ,$415.80 ,$495.00 ,$445.50 ,$284.63 ,$495.00 ,$108.90 ,$95.73 ,$269.28 ,$108.90 ,$205.92 ,$72.89 ,$69.57 ,$114.35 ,$420.75 ,$340.07 ,$138.60 ,$445.50 ,$415.80 ,$396.00 ,$396.00 ,$108.90 ,$321.75 
ST. FRANCIS HOSPITAL - ACUTE,40100010,77065,HC MAMMOGRAM DIAG UNIL W/CAD UPGRADE,401,1 ,$495.00 ,$321.75 ,$69.57 ,$495.00 ,$284.63 ,$356.40 ,$269.28 ,$108.90 ,$138.60 ,$291.06 ,$108.90 ,$340.07 ,$123.75 ,$340.07 ,$340.07 ,$123.75 ,$340.07 ,$206.91 ,$415.80 ,$214.15 ,$108.90 ,$420.75 ,$415.80 ,$108.90 ,$371.25 ,$396.00 ,$396.00 ,$108.90 ,$396.00 ,$415.80 ,$415.80 ,$415.80 ,$495.00 ,$445.50 ,$284.63 ,$495.00 ,$108.90 ,$95.73 ,$269.28 ,$108.90 ,$205.92 ,$72.89 ,$69.57 ,$114.35 ,$420.75 ,$340.07 ,$138.60 ,$445.50 ,$415.80 ,$396.00 ,$396.00 ,$108.90 ,$321.75 
ST. FRANCIS HOSPITAL - ACUTE,40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$107.00 ,$69.55 ,$23.54 ,$107.00 ,$61.53 ,$77.04 ,$58.21 ,$23.54 ,$29.96 ,$62.92 ,$23.54 ,$73.51 ,$26.75 ,$73.51 ,$73.51 ,$26.75 ,$73.51 ,$44.73 ,$89.88 ,$57.05 ,$23.54 ,$90.95 ,$89.88 ,$23.54 ,$80.25 ,$85.60 ,$85.60 ,$23.54 ,$85.60 ,$89.88 ,$89.88 ,$89.88 ,$107.00 ,$96.30 ,$61.53 ,$107.00 ,$23.54 ,$26.59 ,$58.21 ,$23.54 ,$44.51 ,$72.89 ,$69.57 ,$24.72 ,$90.95 ,$73.51 ,$29.96 ,$96.30 ,$89.88 ,$85.60 ,$85.60 ,$23.54 ,$69.55 
ST. FRANCIS HOSPITAL - ACUTE,40200007,51798,HC US BLADDER SCAN,402,1 ,"$1,124.00 ",$730.60 ,$120.26 ,"$1,124.00 ",$646.30 ,$809.28 ,$611.46 ,$247.28 ,$314.72 ,$630.56 ,$247.28 ,$732.85 ,$281.00 ,$732.85 ,$732.85 ,$281.00 ,$732.85 ,$469.83 ,$944.16 ,$142.13 ,$247.28 ,$955.40 ,$944.16 ,$247.28 ,$843.00 ,$899.20 ,$899.20 ,$247.28 ,$899.20 ,$944.16 ,$944.16 ,$944.16 ,"$1,124.00 ","$1,011.60 ",$646.30 ,"$1,124.00 ",$247.28 ,"$1,124.00 ",$611.46 ,$247.28 ,$467.58 ,$125.98 ,$120.26 ,$259.64 ,$955.40 ,$732.85 ,$314.72 ,"$1,011.60 ",$944.16 ,$899.20 ,$899.20 ,$247.28 ,$730.60 
ST. FRANCIS HOSPITAL - ACUTE,40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,$903.00 ,$586.95 ,$153.17 ,$903.00 ,$519.23 ,$650.16 ,$491.23 ,$198.66 ,$252.84 ,$530.96 ,$198.66 ,$620.36 ,$225.75 ,$620.36 ,$620.36 ,$225.75 ,$620.36 ,$377.45 ,$758.52 ,$277.98 ,$198.66 ,$767.55 ,$758.52 ,$198.66 ,$677.25 ,$722.40 ,$722.40 ,$198.66 ,$722.40 ,$758.52 ,$758.52 ,$758.52 ,$903.00 ,$812.70 ,$519.23 ,$903.00 ,$198.66 ,$903.00 ,$491.23 ,$198.66 ,$375.65 ,$160.47 ,$153.17 ,$208.59 ,$767.55 ,$620.36 ,$252.84 ,$812.70 ,$758.52 ,$722.40 ,$722.40 ,$198.66 ,$586.95 
ST. FRANCIS HOSPITAL - ACUTE,40200014,76604,HC US CHEST,402,1 ,"$1,045.00 ",$679.25 ,$153.17 ,"$1,045.00 ",$600.88 ,$752.40 ,$568.48 ,$229.90 ,$292.60 ,$614.46 ,$229.90 ,$717.92 ,$261.25 ,$717.92 ,$717.92 ,$261.25 ,$717.92 ,$436.81 ,$877.80 ,$277.98 ,$229.90 ,$888.25 ,$877.80 ,$229.90 ,$783.75 ,$836.00 ,$836.00 ,$229.90 ,$836.00 ,$877.80 ,$877.80 ,$877.80 ,"$1,045.00 ",$940.50 ,$600.88 ,"$1,045.00 ",$229.90 ,"$1,045.00 ",$568.48 ,$229.90 ,$434.72 ,$160.47 ,$153.17 ,$241.40 ,$888.25 ,$717.92 ,$292.60 ,$940.50 ,$877.80 ,$836.00 ,$836.00 ,$229.90 ,$679.25 
ST. FRANCIS HOSPITAL - ACUTE,40200015,76641,HC US BREAST COMPLETE,402,1 ,"$1,120.00 ",$728.00 ,$76.42 ,"$1,120.00 ",$644.00 ,$806.40 ,$609.28 ,$246.40 ,$313.60 ,$658.56 ,$246.40 ,$769.44 ,$280.00 ,$769.44 ,$769.44 ,$280.00 ,$769.44 ,$468.16 ,$940.80 ,$277.98 ,$246.40 ,$952.00 ,$940.80 ,$246.40 ,$840.00 ,$896.00 ,$896.00 ,$246.40 ,$896.00 ,$940.80 ,$940.80 ,$940.80 ,"$1,120.00 ","$1,008.00 ",$644.00 ,"$1,120.00 ",$246.40 ,$76.42 ,$609.28 ,$246.40 ,$465.92 ,$160.47 ,$153.17 ,$258.72 ,$952.00 ,$769.44 ,$313.60 ,"$1,008.00 ",$940.80 ,$896.00 ,$896.00 ,$246.40 ,$728.00 
ST. FRANCIS HOSPITAL - ACUTE,40200016,76642,HC US BREAST LIMITED,402,1 ,"$1,024.00 ",$665.60 ,$58.57 ,"$1,024.00 ",$588.80 ,$737.28 ,$557.06 ,$225.28 ,$286.72 ,$602.11 ,$225.28 ,$703.49 ,$256.00 ,$703.49 ,$703.49 ,$256.00 ,$703.49 ,$428.03 ,$860.16 ,$206.53 ,$225.28 ,$870.40 ,$860.16 ,$225.28 ,$768.00 ,$819.20 ,$819.20 ,$225.28 ,$819.20 ,$860.16 ,$860.16 ,$860.16 ,"$1,024.00 ",$921.60 ,$588.80 ,"$1,024.00 ",$225.28 ,$58.57 ,$557.06 ,$225.28 ,$425.98 ,$160.47 ,$153.17 ,$236.54 ,$870.40 ,$703.49 ,$286.72 ,$921.60 ,$860.16 ,$819.20 ,$819.20 ,$225.28 ,$665.60 
ST. FRANCIS HOSPITAL - ACUTE,40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,566.00 ","$1,017.90 ",$153.17 ,"$1,566.00 ",$900.45 ,"$1,127.52 ",$851.90 ,$344.52 ,$438.48 ,$920.81 ,$344.52 ,"$1,075.84 ",$391.50 ,"$1,075.84 ","$1,075.84 ",$391.50 ,"$1,075.84 ",$654.59 ,"$1,315.44 ",$277.98 ,$344.52 ,"$1,331.10 ","$1,315.44 ",$344.52 ,"$1,174.50 ","$1,252.80 ","$1,252.80 ",$344.52 ,"$1,252.80 ","$1,315.44 ","$1,315.44 ","$1,315.44 ","$1,566.00 ","$1,409.40 ",$900.45 ,"$1,566.00 ",$344.52 ,"$1,566.00 ",$851.90 ,$344.52 ,$651.46 ,$160.47 ,$153.17 ,$361.75 ,"$1,331.10 ","$1,075.84 ",$438.48 ,"$1,409.40 ","$1,315.44 ","$1,252.80 ","$1,252.80 ",$344.52 ,"$1,017.90 "
ST. FRANCIS HOSPITAL - ACUTE,40200018,76705,HC US ABDOMEN LTD,402,1 ,"$1,407.00 ",$914.55 ,$153.17 ,"$1,407.00 ",$809.03 ,"$1,013.04 ",$765.41 ,$309.54 ,$393.96 ,$827.32 ,$309.54 ,$966.61 ,$351.75 ,$966.61 ,$966.61 ,$351.75 ,$966.61 ,$588.13 ,"$1,181.88 ",$277.98 ,$309.54 ,"$1,195.95 ","$1,181.88 ",$309.54 ,"$1,055.25 ","$1,125.60 ","$1,125.60 ",$309.54 ,"$1,125.60 ","$1,181.88 ","$1,181.88 ","$1,181.88 ","$1,407.00 ","$1,266.30 ",$809.03 ,"$1,407.00 ",$309.54 ,"$1,407.00 ",$765.41 ,$309.54 ,$585.31 ,$160.47 ,$153.17 ,$325.02 ,"$1,195.95 ",$966.61 ,$393.96 ,"$1,266.30 ","$1,181.88 ","$1,125.60 ","$1,125.60 ",$309.54 ,$914.55 
ST. FRANCIS HOSPITAL - ACUTE,40200019,76770,HC US RETROPERITIONEAL,402,1 ,"$1,424.00 ",$925.60 ,$153.17 ,"$1,424.00 ",$818.80 ,"$1,025.28 ",$774.66 ,$313.28 ,$398.72 ,$837.31 ,$313.28 ,$978.29 ,$356.00 ,$978.29 ,$978.29 ,$356.00 ,$978.29 ,$595.23 ,"$1,196.16 ",$277.98 ,$313.28 ,"$1,210.40 ","$1,196.16 ",$313.28 ,"$1,068.00 ","$1,139.20 ","$1,139.20 ",$313.28 ,"$1,139.20 ","$1,196.16 ","$1,196.16 ","$1,196.16 ","$1,424.00 ","$1,281.60 ",$818.80 ,"$1,424.00 ",$313.28 ,"$1,424.00 ",$774.66 ,$313.28 ,$592.38 ,$160.47 ,$153.17 ,$328.94 ,"$1,210.40 ",$978.29 ,$398.72 ,"$1,281.60 ","$1,196.16 ","$1,139.20 ","$1,139.20 ",$313.28 ,$925.60 
ST. FRANCIS HOSPITAL - ACUTE,40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,"$1,109.00 ",$720.85 ,$153.17 ,"$1,109.00 ",$637.68 ,$798.48 ,$603.30 ,$243.98 ,$310.52 ,$652.09 ,$243.98 ,$667.94 ,$277.25 ,$667.94 ,$667.94 ,$277.25 ,$667.94 ,$463.56 ,$931.56 ,$277.98 ,$243.98 ,$942.65 ,$931.56 ,$243.98 ,$831.75 ,$887.20 ,$887.20 ,$243.98 ,$887.20 ,$931.56 ,$931.56 ,$931.56 ,"$1,109.00 ",$998.10 ,$637.68 ,"$1,109.00 ",$243.98 ,"$1,109.00 ",$603.30 ,$243.98 ,$461.34 ,$160.47 ,$153.17 ,$256.18 ,$942.65 ,$667.94 ,$310.52 ,$998.10 ,$931.56 ,$887.20 ,$887.20 ,$243.98 ,$720.85 
ST. FRANCIS HOSPITAL - ACUTE,40200021,76776,HC US KIDNEY TRANSPLANT W/DOPPLER,402,1 ,"$1,412.00 ",$917.80 ,$153.17 ,"$1,412.00 ",$811.90 ,"$1,016.64 ",$768.13 ,$310.64 ,$395.36 ,$830.26 ,$310.64 ,$970.04 ,$353.00 ,$970.04 ,$970.04 ,$353.00 ,$970.04 ,$590.22 ,"$1,186.08 ",$277.98 ,$310.64 ,"$1,200.20 ","$1,186.08 ",$310.64 ,"$1,059.00 ","$1,129.60 ","$1,129.60 ",$310.64 ,"$1,129.60 ","$1,186.08 ","$1,186.08 ","$1,186.08 ","$1,412.00 ","$1,270.80 ",$811.90 ,"$1,412.00 ",$310.64 ,"$1,412.00 ",$768.13 ,$310.64 ,$587.39 ,$160.47 ,$153.17 ,$326.17 ,"$1,200.20 ",$970.04 ,$395.36 ,"$1,270.80 ","$1,186.08 ","$1,129.60 ","$1,129.60 ",$310.64 ,$917.80 
ST. FRANCIS HOSPITAL - ACUTE,40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,"$1,133.00 ",$736.45 ,$249.26 ,"$1,133.00 ",$651.48 ,$815.76 ,$616.35 ,$249.26 ,$317.24 ,$666.20 ,$249.26 ,$778.37 ,$283.25 ,$778.37 ,$778.37 ,$283.25 ,$778.37 ,$473.59 ,$951.72 ,$277.98 ,$249.26 ,$963.05 ,$951.72 ,$249.26 ,$849.75 ,$906.40 ,$906.40 ,$249.26 ,$906.40 ,$951.72 ,$951.72 ,$951.72 ,"$1,133.00 ","$1,019.70 ",$651.48 ,"$1,133.00 ",$249.26 ,"$1,133.00 ",$616.35 ,$249.26 ,$471.33 , N/A , N/A ,$261.72 ,$963.05 ,$778.37 ,$317.24 ,"$1,019.70 ",$951.72 ,$906.40 ,$906.40 ,$249.26 ,$736.45 
ST. FRANCIS HOSPITAL - ACUTE,40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$435.00 ,$282.75 ,$95.70 ,$435.00 ,$250.13 ,$313.20 ,$236.64 ,$95.70 ,$121.80 ,$255.78 ,$95.70 ,$298.85 ,$108.75 ,$298.85 ,$298.85 ,$108.75 ,$298.85 ,$181.83 ,$365.40 , N/A ,$95.70 ,$369.75 ,$365.40 ,$95.70 ,$326.25 ,$348.00 ,$348.00 ,$95.70 ,$348.00 ,$365.40 ,$365.40 ,$365.40 ,$435.00 ,$391.50 ,$250.13 ,$435.00 ,$95.70 ,$435.00 ,$236.64 ,$95.70 ,$180.96 , N/A , N/A ,$100.49 ,$369.75 ,$298.85 ,$121.80 ,$391.50 ,$365.40 ,$348.00 ,$348.00 ,$95.70 ,$282.75 
ST. FRANCIS HOSPITAL - ACUTE,40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,$989.00 ,$642.85 ,$217.58 ,$989.00 ,$568.68 ,$712.08 ,$538.02 ,$217.58 ,$276.92 ,$581.53 ,$217.58 ,$679.44 ,$247.25 ,$679.44 ,$679.44 ,$247.25 ,$679.44 ,$413.40 ,$830.76 ,$277.98 ,$217.58 ,$840.65 ,$830.76 ,$217.58 ,$741.75 ,$791.20 ,$791.20 ,$217.58 ,$791.20 ,$830.76 ,$830.76 ,$830.76 ,$989.00 ,$890.10 ,$568.68 ,$989.00 ,$217.58 ,$989.00 ,$538.02 ,$217.58 ,$411.42 , N/A , N/A ,$228.46 ,$840.65 ,$679.44 ,$276.92 ,$890.10 ,$830.76 ,$791.20 ,$791.20 ,$217.58 ,$642.85 
ST. FRANCIS HOSPITAL - ACUTE,40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,"$1,509.00 ",$980.85 ,$331.98 ,"$1,509.00 ",$867.68 ,"$1,086.48 ",$820.90 ,$331.98 ,$422.52 ,$778.87 ,$331.98 ,$778.87 ,$377.25 ,$778.87 ,$778.87 ,$377.25 ,$778.87 ,$630.76 ,"$1,267.56 ", N/A ,$331.98 ,"$1,282.65 ","$1,267.56 ",$331.98 ,"$1,131.75 ","$1,207.20 ","$1,207.20 ",$331.98 ,"$1,207.20 ","$1,267.56 ","$1,267.56 ","$1,267.56 ","$1,509.00 ","$1,358.10 ",$867.68 ,"$1,509.00 ",$331.98 ,"$1,509.00 ",$820.90 ,$331.98 ,$627.74 , N/A , N/A ,$348.58 ,"$1,282.65 ",$778.87 ,$422.52 ,"$1,358.10 ","$1,267.56 ","$1,207.20 ","$1,207.20 ",$331.98 ,$980.85 
ST. FRANCIS HOSPITAL - ACUTE,40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,"$1,259.00 ",$818.35 ,$276.98 ,"$1,259.00 ",$723.93 ,$906.48 ,$684.90 ,$276.98 ,$352.52 ,$740.29 ,$276.98 ,$864.93 ,$314.75 ,$864.93 ,$864.93 ,$314.75 ,$864.93 ,$526.26 ,"$1,057.56 ",$587.50 ,$276.98 ,"$1,070.15 ","$1,057.56 ",$276.98 ,$944.25 ,"$1,007.20 ","$1,007.20 ",$276.98 ,"$1,007.20 ","$1,057.56 ","$1,057.56 ","$1,057.56 ","$1,259.00 ","$1,133.10 ",$723.93 ,"$1,259.00 ",$276.98 ,"$1,259.00 ",$684.90 ,$276.98 ,$523.74 , N/A , N/A ,$290.83 ,"$1,070.15 ",$864.93 ,$352.52 ,"$1,133.10 ","$1,057.56 ","$1,007.20 ","$1,007.20 ",$276.98 ,$818.35 
ST. FRANCIS HOSPITAL - ACUTE,40200029,76812,HC US PREGNANCY DETAILED ADDL,402,1 ,$906.00 ,$588.90 ,$199.32 ,$906.00 ,$520.95 ,$652.32 ,$492.86 ,$199.32 ,$253.68 ,$532.73 ,$199.32 ,$622.42 ,$226.50 ,$622.42 ,$622.42 ,$226.50 ,$622.42 ,$378.71 ,$761.04 , N/A ,$199.32 ,$770.10 ,$761.04 ,$199.32 ,$679.50 ,$724.80 ,$724.80 ,$199.32 ,$724.80 ,$761.04 ,$761.04 ,$761.04 ,$906.00 ,$815.40 ,$520.95 ,$906.00 ,$199.32 ,$906.00 ,$492.86 ,$199.32 ,$376.90 , N/A , N/A ,$209.29 ,$770.10 ,$622.42 ,$253.68 ,$815.40 ,$761.04 ,$724.80 ,$724.80 ,$199.32 ,$588.90 
ST. FRANCIS HOSPITAL - ACUTE,40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$719.00 ,$467.35 ,$158.18 ,$719.00 ,$413.43 ,$517.68 ,$391.14 ,$158.18 ,$201.32 ,$422.77 ,$158.18 ,$493.95 ,$179.75 ,$493.95 ,$493.95 ,$179.75 ,$493.95 ,$300.54 ,$603.96 ,$277.98 ,$158.18 ,$611.15 ,$603.96 ,$158.18 ,$539.25 ,$575.20 ,$575.20 ,$158.18 ,$575.20 ,$603.96 ,$603.96 ,$603.96 ,$719.00 ,$647.10 ,$413.43 ,$719.00 ,$158.18 ,$719.00 ,$391.14 ,$158.18 ,$299.10 , N/A , N/A ,$166.09 ,$611.15 ,$493.95 ,$201.32 ,$647.10 ,$603.96 ,$575.20 ,$575.20 ,$158.18 ,$467.35 
ST. FRANCIS HOSPITAL - ACUTE,40200031,76815,HC US FETAL HEART BEAT,402,1 ,$646.00 ,$419.90 ,$142.12 ,$646.00 ,$371.45 ,$465.12 ,$351.42 ,$142.12 ,$180.88 ,$379.85 ,$142.12 ,$443.80 ,$161.50 ,$443.80 ,$443.80 ,$161.50 ,$443.80 ,$270.03 ,$542.64 ,$277.98 ,$142.12 ,$549.10 ,$542.64 ,$142.12 ,$484.50 ,$516.80 ,$516.80 ,$142.12 ,$516.80 ,$542.64 ,$542.64 ,$542.64 ,$646.00 ,$581.40 ,$371.45 ,$646.00 ,$142.12 ,$646.00 ,$351.42 ,$142.12 ,$268.74 , N/A , N/A ,$149.23 ,$549.10 ,$443.80 ,$180.88 ,$581.40 ,$542.64 ,$516.80 ,$516.80 ,$142.12 ,$419.90 
ST. FRANCIS HOSPITAL - ACUTE,40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,$456.00 ,$296.40 ,$100.32 ,$456.00 ,$262.20 ,$328.32 ,$248.06 ,$100.32 ,$127.68 ,$268.13 ,$100.32 ,$313.27 ,$114.00 ,$313.27 ,$313.27 ,$114.00 ,$313.27 ,$190.61 ,$383.04 ,$277.98 ,$100.32 ,$387.60 ,$383.04 ,$100.32 ,$342.00 ,$364.80 ,$364.80 ,$100.32 ,$364.80 ,$383.04 ,$383.04 ,$383.04 ,$456.00 ,$410.40 ,$262.20 ,$456.00 ,$100.32 ,$456.00 ,$248.06 ,$100.32 ,$189.70 , N/A , N/A ,$105.34 ,$387.60 ,$313.27 ,$127.68 ,$410.40 ,$383.04 ,$364.80 ,$364.80 ,$100.32 ,$296.40 
ST. FRANCIS HOSPITAL - ACUTE,40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,"$1,166.00 ",$757.90 ,$256.52 ,"$1,166.00 ",$670.45 ,$839.52 ,$634.30 ,$256.52 ,$326.48 ,$685.61 ,$256.52 ,$801.04 ,$291.50 ,$801.04 ,$801.04 ,$291.50 ,$801.04 ,$487.39 ,$979.44 ,$277.98 ,$256.52 ,$991.10 ,$979.44 ,$256.52 ,$874.50 ,$932.80 ,$932.80 ,$256.52 ,$932.80 ,$979.44 ,$979.44 ,$979.44 ,"$1,166.00 ","$1,049.40 ",$670.45 ,"$1,166.00 ",$256.52 ,"$1,166.00 ",$634.30 ,$256.52 ,$485.06 , N/A , N/A ,$269.35 ,$991.10 ,$801.04 ,$326.48 ,"$1,049.40 ",$979.44 ,$932.80 ,$932.80 ,$256.52 ,$757.90 
ST. FRANCIS HOSPITAL - ACUTE,40200036,76820,HC US FETAL DOPLR VELO UMB,402,1 ,$401.00 ,$260.65 ,$88.22 ,$401.00 ,$230.58 ,$288.72 ,$218.14 ,$88.22 ,$112.28 ,$235.79 ,$88.22 ,$275.49 ,$100.25 ,$275.49 ,$275.49 ,$100.25 ,$275.49 ,$167.62 ,$336.84 ,$277.98 ,$88.22 ,$340.85 ,$336.84 ,$88.22 ,$300.75 ,$320.80 ,$320.80 ,$88.22 ,$320.80 ,$336.84 ,$336.84 ,$336.84 ,$401.00 ,$360.90 ,$230.58 ,$401.00 ,$88.22 ,$401.00 ,$218.14 ,$88.22 ,$166.82 , N/A , N/A ,$92.63 ,$340.85 ,$275.49 ,$112.28 ,$360.90 ,$336.84 ,$320.80 ,$320.80 ,$88.22 ,$260.65 
ST. FRANCIS HOSPITAL - ACUTE,40200038,76830,HC US TRANSVAGINAL,402,1 ,$815.00 ,$529.75 ,$153.17 ,$815.00 ,$468.63 ,$586.80 ,$443.36 ,$179.30 ,$228.20 ,$479.22 ,$179.30 ,$559.91 ,$203.75 ,$559.91 ,$559.91 ,$203.75 ,$559.91 ,$340.67 ,$684.60 ,$277.98 ,$179.30 ,$692.75 ,$684.60 ,$179.30 ,$611.25 ,$652.00 ,$652.00 ,$179.30 ,$652.00 ,$684.60 ,$684.60 ,$684.60 ,$815.00 ,$733.50 ,$468.63 ,$815.00 ,$179.30 ,$815.00 ,$443.36 ,$179.30 ,$339.04 ,$160.47 ,$153.17 ,$188.27 ,$692.75 ,$559.91 ,$228.20 ,$733.50 ,$684.60 ,$652.00 ,$652.00 ,$179.30 ,$529.75 
ST. FRANCIS HOSPITAL - ACUTE,40200039,76831,HC US HYSTEROSONOGRAM,402,1 ,$923.00 ,$599.95 ,$203.06 ,$923.00 ,$530.73 ,$664.56 ,$502.11 ,$203.06 ,$258.44 ,$542.72 ,$203.06 ,$634.10 ,$230.75 ,$634.10 ,$634.10 ,$230.75 ,$634.10 ,$385.81 ,$775.32 ,$587.50 ,$203.06 ,$784.55 ,$775.32 ,$203.06 ,$692.25 ,$738.40 ,$738.40 ,$203.06 ,$738.40 ,$775.32 ,$775.32 ,$775.32 ,$923.00 ,$830.70 ,$530.73 ,$923.00 ,$203.06 ,$923.00 ,$502.11 ,$203.06 ,$383.97 ,$366.26 ,$349.61 ,$213.21 ,$784.55 ,$634.10 ,$258.44 ,$830.70 ,$775.32 ,$738.40 ,$738.40 ,$203.06 ,$599.95 
ST. FRANCIS HOSPITAL - ACUTE,40200040,76856,HC US PELVIS NON OB,402,1 ,"$1,166.00 ",$757.90 ,$81.89 ,"$1,166.00 ",$670.45 ,$839.52 ,$634.30 ,$256.52 ,$326.48 ,$685.61 ,$256.52 ,$801.04 ,$291.50 ,$801.04 ,$801.04 ,$291.50 ,$801.04 ,$487.39 ,$979.44 ,$277.98 ,$256.52 ,$991.10 ,$979.44 ,$256.52 ,$874.50 ,$932.80 ,$932.80 ,$256.52 ,$932.80 ,$979.44 ,$979.44 ,$979.44 ,"$1,166.00 ","$1,049.40 ",$670.45 ,"$1,166.00 ",$256.52 ,$81.89 ,$634.30 ,$256.52 ,$485.06 ,$160.47 ,$153.17 ,$269.35 ,$991.10 ,$801.04 ,$326.48 ,"$1,049.40 ",$979.44 ,$932.80 ,$932.80 ,$256.52 ,$757.90 
ST. FRANCIS HOSPITAL - ACUTE,40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$934.00 ,$607.10 ,$153.17 ,$934.00 ,$537.05 ,$672.48 ,$508.10 ,$205.48 ,$261.52 ,$540.45 ,$205.48 ,$540.45 ,$233.50 ,$540.45 ,$540.45 ,$233.50 ,$540.45 ,$390.41 ,$784.56 ,$277.98 ,$205.48 ,$793.90 ,$784.56 ,$205.48 ,$700.50 ,$747.20 ,$747.20 ,$205.48 ,$747.20 ,$784.56 ,$784.56 ,$784.56 ,$934.00 ,$840.60 ,$537.05 ,$934.00 ,$205.48 ,$934.00 ,$508.10 ,$205.48 ,$388.54 ,$160.47 ,$153.17 ,$215.75 ,$793.90 ,$540.45 ,$261.52 ,$840.60 ,$784.56 ,$747.20 ,$747.20 ,$205.48 ,$607.10 
ST. FRANCIS HOSPITAL - ACUTE,40200042,76870,HC US SCROTUM,402,1 ,"$1,166.00 ",$757.90 ,$153.17 ,"$1,166.00 ",$670.45 ,$839.52 ,$634.30 ,$256.52 ,$326.48 ,$685.61 ,$256.52 ,$801.04 ,$291.50 ,$801.04 ,$801.04 ,$291.50 ,$801.04 ,$487.39 ,$979.44 ,$277.98 ,$256.52 ,$991.10 ,$979.44 ,$256.52 ,$874.50 ,$932.80 ,$932.80 ,$256.52 ,$932.80 ,$979.44 ,$979.44 ,$979.44 ,"$1,166.00 ","$1,049.40 ",$670.45 ,"$1,166.00 ",$256.52 ,"$1,166.00 ",$634.30 ,$256.52 ,$485.06 ,$160.47 ,$153.17 ,$269.35 ,$991.10 ,$801.04 ,$326.48 ,"$1,049.40 ",$979.44 ,$932.80 ,$932.80 ,$256.52 ,$757.90 
ST. FRANCIS HOSPITAL - ACUTE,40200043,76872,HC ULTRA BX PROS,402,1 ,"$1,166.00 ",$757.90 ,$153.17 ,"$1,166.00 ",$670.45 ,$839.52 ,$634.30 ,$256.52 ,$326.48 ,$685.61 ,$256.52 ,$801.04 ,$291.50 ,$801.04 ,$801.04 ,$291.50 ,$801.04 ,$487.39 ,$979.44 ,$277.98 ,$256.52 ,$991.10 ,$979.44 ,$256.52 ,$874.50 ,$932.80 ,$932.80 ,$256.52 ,$932.80 ,$979.44 ,$979.44 ,$979.44 ,"$1,166.00 ","$1,049.40 ",$670.45 ,"$1,166.00 ",$256.52 ,"$1,166.00 ",$634.30 ,$256.52 ,$485.06 ,$160.47 ,$153.17 ,$269.35 ,$991.10 ,$801.04 ,$326.48 ,"$1,049.40 ",$979.44 ,$932.80 ,$932.80 ,$256.52 ,$757.90 
ST. FRANCIS HOSPITAL - ACUTE,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$779.00 ,$506.35 ,$153.17 ,$779.00 ,$447.93 ,$560.88 ,$423.78 ,$171.38 ,$218.12 ,$458.05 ,$171.38 ,$535.17 ,$194.75 ,$535.17 ,$535.17 ,$194.75 ,$535.17 ,$325.62 ,$654.36 ,$277.98 ,$171.38 ,$662.15 ,$654.36 ,$171.38 ,$584.25 ,$623.20 ,$623.20 ,$171.38 ,$623.20 ,$654.36 ,$654.36 ,$654.36 ,$779.00 ,$701.10 ,$447.93 ,$779.00 ,$171.38 ,$779.00 ,$423.78 ,$171.38 ,$324.06 ,$160.47 ,$153.17 ,$179.95 ,$662.15 ,$535.17 ,$218.12 ,$701.10 ,$654.36 ,$623.20 ,$623.20 ,$171.38 ,$506.35 
ST. FRANCIS HOSPITAL - ACUTE,40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$466.00 ,$302.90 ,$102.52 ,$466.00 ,$267.95 ,$335.52 ,$253.50 ,$102.52 ,$130.48 ,$274.01 ,$102.52 ,$320.14 ,$116.50 ,$320.14 ,$320.14 ,$116.50 ,$320.14 ,$194.79 ,$391.44 ,$277.98 ,$102.52 ,$396.10 ,$391.44 ,$102.52 ,$349.50 ,$372.80 ,$372.80 ,$102.52 ,$372.80 ,$391.44 ,$391.44 ,$391.44 ,$466.00 ,$419.40 ,$267.95 ,$466.00 ,$102.52 ,$466.00 ,$253.50 ,$102.52 ,$193.86 ,$160.47 ,$153.17 ,$107.65 ,$396.10 ,$320.14 ,$130.48 ,$419.40 ,$391.44 ,$372.80 ,$372.80 ,$102.52 ,$302.90 
ST. FRANCIS HOSPITAL - ACUTE,40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$147.00 ,$95.55 ,$32.34 ,$147.00 ,$84.53 ,$105.84 ,$79.97 ,$32.34 ,$41.16 ,$86.44 ,$32.34 ,$100.99 ,$36.75 ,$100.99 ,$100.99 ,$36.75 ,$100.99 ,$61.45 ,$123.48 , N/A ,$32.34 ,$124.95 ,$123.48 ,$32.34 ,$110.25 ,$117.60 ,$117.60 ,$32.34 ,$117.60 ,$123.48 ,$123.48 ,$123.48 ,$147.00 ,$132.30 ,$84.53 ,$147.00 ,$32.34 ,$147.00 ,$79.97 ,$32.34 ,$61.15 ,$117.10 ,$111.77 ,$33.96 ,$124.95 ,$100.99 ,$41.16 ,$132.30 ,$123.48 ,$117.60 ,$117.60 ,$32.34 ,$95.55 
ST. FRANCIS HOSPITAL - ACUTE,40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,$202.00 ,$131.30 ,$29.07 ,$202.00 ,$116.15 ,$145.44 ,$109.89 ,$44.44 ,$56.56 ,$118.78 ,$44.44 ,$138.77 ,$50.50 ,$138.77 ,$138.77 ,$50.50 ,$138.77 ,$84.44 ,$169.68 , N/A ,$44.44 ,$171.70 ,$169.68 ,$44.44 ,$151.50 ,$161.60 ,$161.60 ,$44.44 ,$161.60 ,$169.68 ,$169.68 ,$169.68 ,$202.00 ,$181.80 ,$116.15 ,$202.00 ,$44.44 ,$29.07 ,$109.89 ,$44.44 ,$84.03 ,$117.10 ,$111.77 ,$46.66 ,$171.70 ,$138.77 ,$56.56 ,$181.80 ,$169.68 ,$161.60 ,$161.60 ,$44.44 ,$131.30 
ST. FRANCIS HOSPITAL - ACUTE,40200059,76946,HC US GUIDED AMNIOCENTESIS,402,1 ,"$1,536.00 ",$998.40 ,$111.77 ,"$1,536.00 ",$883.20 ,"$1,105.92 ",$835.58 ,$337.92 ,$430.08 ,$239.79 ,$337.92 ,$239.79 ,$384.00 ,$239.79 ,$239.79 ,$384.00 ,$239.79 ,$642.05 ,"$1,290.24 ", N/A ,$337.92 ,"$1,305.60 ","$1,290.24 ",$337.92 ,"$1,152.00 ","$1,228.80 ","$1,228.80 ",$337.92 ,"$1,228.80 ","$1,290.24 ","$1,290.24 ","$1,290.24 ","$1,536.00 ","$1,382.40 ",$883.20 ,"$1,536.00 ",$337.92 ,"$1,536.00 ",$835.58 ,$337.92 ,$638.98 ,$117.10 ,$111.77 ,$354.82 ,"$1,305.60 ",$239.79 ,$430.08 ,"$1,382.40 ","$1,290.24 ","$1,228.80 ","$1,228.80 ",$337.92 ,$998.40 
ST. FRANCIS HOSPITAL - ACUTE,40200062,76998,HC US INTRAOPERATIVE,402,1 ,$646.00 ,$419.90 ,$111.77 ,$646.00 ,$371.45 ,$465.12 ,$351.42 ,$142.12 ,$180.88 ,$379.85 ,$142.12 ,$443.80 ,$161.50 ,$443.80 ,$443.80 ,$161.50 ,$443.80 ,$270.03 ,$542.64 , N/A ,$142.12 ,$549.10 ,$542.64 ,$142.12 ,$484.50 ,$516.80 ,$516.80 ,$142.12 ,$516.80 ,$542.64 ,$542.64 ,$542.64 ,$646.00 ,$581.40 ,$371.45 ,$646.00 ,$142.12 ,$646.00 ,$351.42 ,$142.12 ,$268.74 ,$117.10 ,$111.77 ,$149.23 ,$549.10 ,$443.80 ,$180.88 ,$581.40 ,$542.64 ,$516.80 ,$516.80 ,$142.12 ,$419.90 
ST. FRANCIS HOSPITAL - ACUTE,40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,"$1,716.00 ","$1,115.40 ",$153.17 ,"$1,716.00 ",$986.70 ,"$1,235.52 ",$933.50 ,$377.52 ,$480.48 ,"$1,009.01 ",$377.52 ,"$1,178.89 ",$429.00 ,"$1,178.89 ","$1,178.89 ",$429.00 ,"$1,178.89 ",$717.29 ,"$1,441.44 ",$587.50 ,$377.52 ,"$1,458.60 ","$1,441.44 ",$377.52 ,"$1,287.00 ","$1,372.80 ","$1,372.80 ",$377.52 ,"$1,372.80 ","$1,441.44 ","$1,441.44 ","$1,441.44 ","$1,716.00 ","$1,544.40 ",$986.70 ,"$1,716.00 ",$377.52 ,"$1,716.00 ",$933.50 ,$377.52 ,$713.86 ,$160.47 ,$153.17 ,$396.40 ,"$1,458.60 ","$1,178.89 ",$480.48 ,"$1,544.40 ","$1,441.44 ","$1,372.80 ","$1,372.80 ",$377.52 ,"$1,115.40 "
ST. FRANCIS HOSPITAL - ACUTE,40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,089.00 ",$707.85 ,$153.17 ,"$1,089.00 ",$626.18 ,$784.08 ,$592.42 ,$239.58 ,$304.92 ,$640.33 ,$239.58 ,$748.14 ,$272.25 ,$748.14 ,$748.14 ,$272.25 ,$748.14 ,$455.20 ,$914.76 ,$277.98 ,$239.58 ,$925.65 ,$914.76 ,$239.58 ,$816.75 ,$871.20 ,$871.20 ,$239.58 ,$871.20 ,$914.76 ,$914.76 ,$914.76 ,"$1,089.00 ",$980.10 ,$626.18 ,"$1,089.00 ",$239.58 ,"$1,089.00 ",$592.42 ,$239.58 ,$453.02 ,$160.47 ,$153.17 ,$251.56 ,$925.65 ,$748.14 ,$304.92 ,$980.10 ,$914.76 ,$871.20 ,$871.20 ,$239.58 ,$707.85 
ST. FRANCIS HOSPITAL - ACUTE,40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,921,1 ,"$1,544.00 ","$1,003.60 ",$153.17 ,"$1,544.00 ",$887.80 ,"$1,111.68 ",$839.94 ,$339.68 ,$432.32 ,$907.87 ,$339.68 ,"$1,060.73 ",$386.00 ,"$1,060.73 ","$1,060.73 ",$386.00 ,"$1,060.73 ",$645.39 ,"$1,296.96 ",$587.50 ,$339.68 ,"$1,312.40 ","$1,296.96 ",$339.68 ,"$1,158.00 ","$1,235.20 ","$1,235.20 ",$339.68 ,"$1,235.20 ","$1,296.96 ","$1,296.96 ","$1,296.96 ","$1,544.00 ","$1,389.60 ",$887.80 ,"$1,544.00 ",$339.68 ,"$1,544.00 ",$839.94 ,$339.68 ,$642.30 ,$160.47 ,$153.17 ,$356.66 ,"$1,312.40 ","$1,060.73 ",$432.32 ,"$1,389.60 ","$1,296.96 ","$1,235.20 ","$1,235.20 ",$339.68 ,"$1,003.60 "
ST. FRANCIS HOSPITAL - ACUTE,40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,$327.00 ,$212.55 ,$71.94 ,$327.00 ,$188.03 ,$235.44 ,$177.89 ,$71.94 ,$91.56 ,$192.28 ,$71.94 ,$224.65 ,$81.75 ,$224.65 ,$224.65 ,$81.75 ,$224.65 ,$136.69 ,$274.68 ,$277.98 ,$71.94 ,$277.95 ,$274.68 ,$71.94 ,$245.25 ,$261.60 ,$261.60 ,$71.94 ,$261.60 ,$274.68 ,$274.68 ,$274.68 ,$327.00 ,$294.30 ,$188.03 ,$327.00 ,$71.94 ,$327.00 ,$177.89 ,$71.94 ,$136.03 ,$160.47 ,$153.17 ,$75.54 ,$277.95 ,$224.65 ,$91.56 ,$294.30 ,$274.68 ,$261.60 ,$261.60 ,$71.94 ,$212.55 
ST. FRANCIS HOSPITAL - ACUTE,40200075,76706,HC US AORTA (SCREENING),402,1 ,$998.00 ,$648.70 ,$153.17 ,$998.00 ,$573.85 ,$718.56 ,$542.91 ,$219.56 ,$279.44 ,$586.82 ,$219.56 ,$685.63 ,$249.50 ,$685.63 ,$685.63 ,$249.50 ,$685.63 ,$417.16 ,$838.32 ,$277.98 ,$219.56 ,$848.30 ,$838.32 ,$219.56 ,$748.50 ,$798.40 ,$798.40 ,$219.56 ,$798.40 ,$838.32 ,$838.32 ,$838.32 ,$998.00 ,$898.20 ,$573.85 ,$998.00 ,$219.56 ,$998.00 ,$542.91 ,$219.56 ,$415.17 ,$160.47 ,$153.17 ,$230.54 ,$848.30 ,$685.63 ,$279.44 ,$898.20 ,$838.32 ,$798.40 ,$798.40 ,$219.56 ,$648.70 
ST. FRANCIS HOSPITAL - ACUTE,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$603.00 ,$391.95 ,$69.57 ,$603.00 ,$225.55 ,$434.16 ,$328.03 ,$90.22 ,$168.84 ,$354.56 ,$90.22 ,$414.26 ,$90.22 ,$414.26 ,$414.26 ,$90.22 ,$414.26 ,$171.42 ,$506.52 ,$225.55 ,$90.22 ,$512.55 ,$506.52 ,$90.22 ,$452.25 ,$482.40 ,$482.40 ,$90.22 ,$482.40 ,$506.52 ,$506.52 ,$506.52 ,$603.00 ,$542.70 ,$225.55 ,$603.00 ,$90.22 ,$101.20 ,$328.03 ,$90.22 ,$250.85 ,$72.89 ,$69.57 ,$94.73 ,$512.55 ,$414.26 ,$168.84 ,$542.70 ,$506.52 ,$482.40 ,$482.40 ,$90.22 ,$391.95 
ST. FRANCIS HOSPITAL - ACUTE,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$603.00 ,$391.95 ,$69.57 ,$603.00 ,$225.55 ,$434.16 ,$328.03 ,$90.22 ,$168.84 ,$354.56 ,$90.22 ,$414.26 ,$90.22 ,$414.26 ,$414.26 ,$90.22 ,$414.26 ,$171.42 ,$506.52 ,$225.55 ,$90.22 ,$512.55 ,$506.52 ,$90.22 ,$452.25 ,$482.40 ,$482.40 ,$90.22 ,$482.40 ,$506.52 ,$506.52 ,$506.52 ,$603.00 ,$542.70 ,$225.55 ,$603.00 ,$90.22 ,$101.20 ,$328.03 ,$90.22 ,$250.85 ,$72.89 ,$69.57 ,$94.73 ,$512.55 ,$414.26 ,$168.84 ,$542.70 ,$506.52 ,$482.40 ,$482.40 ,$90.22 ,$391.95 
ST. FRANCIS HOSPITAL - ACUTE,40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$109.00 ,$70.85 ,$22.82 ,$109.00 ,$62.68 ,$78.48 ,$59.30 ,$22.82 ,$30.52 ,$64.09 ,$27.25 ,$74.88 ,$27.25 ,$74.88 ,$74.88 ,$27.25 ,$74.88 ,$51.78 ,$91.56 ,$57.05 ,$27.25 ,$92.65 ,$91.56 ,$27.25 ,$81.75 ,$87.20 ,$87.20 ,$27.25 ,$87.20 ,$91.56 ,$91.56 ,$91.56 ,$109.00 ,$98.10 ,$62.68 ,$109.00 ,$27.25 ,$26.59 ,$59.30 ,$27.25 ,$45.34 ,$72.89 ,$69.57 ,$28.61 ,$92.65 ,$74.88 ,$30.52 ,$98.10 ,$91.56 ,$87.20 ,$87.20 ,$27.25 ,$70.85 
ST. FRANCIS HOSPITAL - ACUTE,40300007,77063,HC SCREEN DIG BREAST TOMO BIL-52,403,1 ,$82.00 ,$53.30 ,$20.50 ,$82.00 ,$47.15 ,$59.04 ,$44.61 ,$22.82 ,$22.96 ,$48.22 ,$20.50 ,$56.33 ,$20.50 ,$56.33 ,$56.33 ,$20.50 ,$56.33 ,$38.95 ,$68.88 ,$57.05 ,$20.50 ,$69.70 ,$68.88 ,$20.50 ,$61.50 ,$65.60 ,$65.60 ,$20.50 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$20.50 ,$26.59 ,$44.61 ,$20.50 ,$34.11 ,$36.44 ,$34.79 ,$21.53 ,$69.70 ,$56.33 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$20.50 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,41000005,92950,HC CPR,480,1 ,"$1,027.00 ",$667.55 ,$225.94 ,"$1,027.00 ",$590.53 ,$739.44 ,$558.69 ,$225.94 ,$287.56 ,$603.88 ,$225.94 ,$705.55 ,$256.75 ,$705.55 ,$705.55 ,$256.75 ,$705.55 ,$429.29 ,$862.68 ,$675.73 ,$225.94 ,$872.95 ,$862.68 ,$225.94 ,$770.25 ,$821.60 ,$821.60 ,$225.94 ,$821.60 ,$862.68 ,$862.68 ,$862.68 ,"$1,027.00 ",$924.30 ,$590.53 ,"$1,027.00 ",$225.94 ,"$1,027.00 ",$558.69 ,$225.94 ,$427.23 ,$712.59 ,$680.20 ,$237.24 ,$872.95 ,$705.55 ,$287.56 ,$924.30 ,$862.68 ,$821.60 ,$821.60 ,$225.94 ,$667.55 
ST. FRANCIS HOSPITAL - ACUTE,41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,"$1,550.00 ","$1,007.50 ",$341.00 ,"$1,550.00 ",$891.25 ,"$1,116.00 ",$843.20 ,$341.00 ,$434.00 ,$911.40 ,$341.00 ,"$1,064.85 ",$387.50 ,"$1,064.85 ","$1,064.85 ",$387.50 ,"$1,064.85 ",$647.90 ,"$1,302.00 ","$1,243.85 ",$341.00 ,"$1,317.50 ","$1,302.00 ",$341.00 ,"$1,162.50 ","$1,240.00 ","$1,240.00 ",$341.00 ,"$1,240.00 ","$1,302.00 ","$1,302.00 ","$1,302.00 ","$1,550.00 ","$1,395.00 ",$891.25 ,"$1,550.00 ",$341.00 ,"$1,550.00 ",$843.20 ,$341.00 ,$644.80 ,$772.61 ,$737.49 ,$358.05 ,"$1,317.50 ","$1,064.85 ",$434.00 ,"$1,395.00 ","$1,302.00 ","$1,240.00 ","$1,240.00 ",$341.00 ,"$1,007.50 "
ST. FRANCIS HOSPITAL - ACUTE,41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$982.00 ,$638.30 ,$216.04 ,$982.00 ,$564.65 ,$707.04 ,$534.21 ,$216.04 ,$274.96 ,$577.42 ,$216.04 ,$674.63 ,$245.50 ,$674.63 ,$674.63 ,$245.50 ,$674.63 ,$410.48 ,$824.88 ,$479.93 ,$216.04 ,$834.70 ,$824.88 ,$216.04 ,$736.50 ,$785.60 ,$785.60 ,$216.04 ,$785.60 ,$824.88 ,$824.88 ,$824.88 ,$982.00 ,$883.80 ,$564.65 ,$982.00 ,$216.04 ,$982.00 ,$534.21 ,$216.04 ,$408.51 ,$772.61 ,$737.49 ,$226.84 ,$834.70 ,$674.63 ,$274.96 ,$883.80 ,$824.88 ,$785.60 ,$785.60 ,$216.04 ,$638.30 
ST. FRANCIS HOSPITAL - ACUTE,41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,"$1,341.00 ",$871.65 ,$295.02 ,"$1,341.00 ",$771.08 ,$965.52 ,$729.50 ,$295.02 ,$375.48 ,$752.30 ,$295.02 ,$874.33 ,$335.25 ,$874.33 ,$874.33 ,$335.25 ,$874.33 ,$560.54 ,"$1,126.44 ","$1,243.85 ",$295.02 ,"$1,139.85 ","$1,126.44 ",$295.02 ,"$1,005.75 ","$1,072.80 ","$1,072.80 ",$295.02 ,"$1,072.80 ","$1,126.44 ","$1,126.44 ","$1,126.44 ","$1,341.00 ","$1,206.90 ",$771.08 ,"$1,341.00 ",$295.02 ,"$1,341.00 ",$729.50 ,$295.02 ,$557.86 ,$772.61 ,$737.49 ,$309.77 ,"$1,139.85 ",$874.33 ,$375.48 ,"$1,206.90 ","$1,126.44 ","$1,072.80 ","$1,072.80 ",$295.02 ,$871.65 
ST. FRANCIS HOSPITAL - ACUTE,41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$414.00 ,$269.10 ,$91.08 ,$772.61 ,$238.05 ,$298.08 ,$225.22 ,$91.08 ,$115.92 ,$243.43 ,$91.08 ,$284.42 ,$103.50 ,$284.42 ,$284.42 ,$103.50 ,$284.42 ,$173.05 ,$347.76 ,$479.93 ,$91.08 ,$351.90 ,$347.76 ,$91.08 ,$310.50 ,$331.20 ,$331.20 ,$91.08 ,$331.20 ,$347.76 ,$347.76 ,$347.76 ,$414.00 ,$372.60 ,$238.05 ,$414.00 ,$91.08 ,$414.00 ,$225.22 ,$91.08 ,$172.22 ,$772.61 ,$737.49 ,$95.63 ,$351.90 ,$284.42 ,$115.92 ,$372.60 ,$347.76 ,$331.20 ,$331.20 ,$91.08 ,$269.10 
ST. FRANCIS HOSPITAL - ACUTE,41000034,94640,HC IPPB,410,1 ,$358.00 ,$232.70 ,$78.76 ,$479.93 ,$205.85 ,$257.76 ,$194.75 ,$78.76 ,$100.24 ,$210.50 ,$78.76 ,$245.95 ,$89.50 ,$245.95 ,$245.95 ,$89.50 ,$245.95 ,$149.64 ,$300.72 ,$479.93 ,$78.76 ,$304.30 ,$300.72 ,$78.76 ,$268.50 ,$286.40 ,$286.40 ,$78.76 ,$286.40 ,$300.72 ,$300.72 ,$300.72 ,$358.00 ,$322.20 ,$205.85 ,$358.00 ,$78.76 ,$358.00 ,$194.75 ,$78.76 ,$148.93 ,$255.88 ,$244.25 ,$82.70 ,$304.30 ,$245.95 ,$100.24 ,$322.20 ,$300.72 ,$286.40 ,$286.40 ,$78.76 ,$232.70 
ST. FRANCIS HOSPITAL - ACUTE,41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$230.00 ,$149.50 ,$50.60 ,$479.93 ,$132.25 ,$165.60 ,$125.12 ,$50.60 ,$64.40 ,$135.24 ,$50.60 ,$158.01 ,$57.50 ,$158.01 ,$158.01 ,$57.50 ,$158.01 ,$96.14 ,$193.20 ,$479.93 ,$50.60 ,$195.50 ,$193.20 ,$50.60 ,$172.50 ,$184.00 ,$184.00 ,$50.60 ,$184.00 ,$193.20 ,$193.20 ,$193.20 ,$230.00 ,$207.00 ,$132.25 ,$230.00 ,$50.60 ,$230.00 ,$125.12 ,$50.60 ,$95.68 ,$255.88 ,$244.25 ,$53.13 ,$195.50 ,$158.01 ,$64.40 ,$207.00 ,$193.20 ,$184.00 ,$184.00 ,$50.60 ,$149.50 
ST. FRANCIS HOSPITAL - ACUTE,41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$239.00 ,$155.35 ,$52.58 ,$479.93 ,$137.43 ,$172.08 ,$130.02 ,$52.58 ,$66.92 ,$140.53 ,$52.58 ,$164.19 ,$59.75 ,$164.19 ,$164.19 ,$59.75 ,$164.19 ,$99.90 ,$200.76 ,$479.93 ,$52.58 ,$203.15 ,$200.76 ,$52.58 ,$179.25 ,$191.20 ,$191.20 ,$52.58 ,$191.20 ,$200.76 ,$200.76 ,$200.76 ,$239.00 ,$215.10 ,$137.43 ,$239.00 ,$52.58 ,$239.00 ,$130.02 ,$52.58 ,$99.42 ,$255.88 ,$244.25 ,$55.21 ,$203.15 ,$164.19 ,$66.92 ,$215.10 ,$200.76 ,$191.20 ,$191.20 ,$52.58 ,$155.35 
ST. FRANCIS HOSPITAL - ACUTE,41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$204.00 ,$132.60 ,$44.88 ,$479.93 ,$117.30 ,$146.88 ,$110.98 ,$44.88 ,$57.12 ,$119.95 ,$44.88 ,$140.15 ,$51.00 ,$140.15 ,$140.15 ,$51.00 ,$140.15 ,$85.27 ,$171.36 ,$479.93 ,$44.88 ,$173.40 ,$171.36 ,$44.88 ,$153.00 ,$163.20 ,$163.20 ,$44.88 ,$163.20 ,$171.36 ,$171.36 ,$171.36 ,$204.00 ,$183.60 ,$117.30 ,$204.00 ,$44.88 ,$204.00 ,$110.98 ,$44.88 ,$84.86 ,$255.88 ,$244.25 ,$47.12 ,$173.40 ,$140.15 ,$57.12 ,$183.60 ,$171.36 ,$163.20 ,$163.20 ,$44.88 ,$132.60 
ST. FRANCIS HOSPITAL - ACUTE,41000046,94640,HC HIGH EFF NEB AERO EACH,410,1 ,$239.00 ,$155.35 ,$52.58 ,$479.93 ,$137.43 ,$172.08 ,$130.02 ,$52.58 ,$66.92 ,$140.53 ,$52.58 ,$164.19 ,$59.75 ,$164.19 ,$164.19 ,$59.75 ,$164.19 ,$99.90 ,$200.76 ,$479.93 ,$52.58 ,$203.15 ,$200.76 ,$52.58 ,$179.25 ,$191.20 ,$191.20 ,$52.58 ,$191.20 ,$200.76 ,$200.76 ,$200.76 ,$239.00 ,$215.10 ,$137.43 ,$239.00 ,$52.58 ,$239.00 ,$130.02 ,$52.58 ,$99.42 ,$255.88 ,$244.25 ,$55.21 ,$203.15 ,$164.19 ,$66.92 ,$215.10 ,$200.76 ,$191.20 ,$191.20 ,$52.58 ,$155.35 
ST. FRANCIS HOSPITAL - ACUTE,41000047,94640,HC HIGH EFF NEB AERO W/INSTR/TEACH DEVICE,410,1 ,$239.00 ,$155.35 ,$52.58 ,$479.93 ,$137.43 ,$172.08 ,$130.02 ,$52.58 ,$66.92 ,$140.53 ,$52.58 ,$164.19 ,$59.75 ,$164.19 ,$164.19 ,$59.75 ,$164.19 ,$99.90 ,$200.76 ,$479.93 ,$52.58 ,$203.15 ,$200.76 ,$52.58 ,$179.25 ,$191.20 ,$191.20 ,$52.58 ,$191.20 ,$200.76 ,$200.76 ,$200.76 ,$239.00 ,$215.10 ,$137.43 ,$239.00 ,$52.58 ,$239.00 ,$130.02 ,$52.58 ,$99.42 ,$255.88 ,$244.25 ,$55.21 ,$203.15 ,$164.19 ,$66.92 ,$215.10 ,$200.76 ,$191.20 ,$191.20 ,$52.58 ,$155.35 
ST. FRANCIS HOSPITAL - ACUTE,41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$789.00 ,$512.85 ,$75.31 ,$789.00 ,$453.68 ,$568.08 ,$429.22 ,$173.58 ,$220.92 ,$463.93 ,$173.58 ,$542.04 ,$197.25 ,$542.04 ,$542.04 ,$197.25 ,$542.04 ,$329.80 ,$662.76 ,$287.90 ,$173.58 ,$670.65 ,$662.76 ,$173.58 ,$591.75 ,$631.20 ,$631.20 ,$173.58 ,$631.20 ,$662.76 ,$662.76 ,$662.76 ,$789.00 ,$710.10 ,$453.68 ,$789.00 ,$173.58 ,$789.00 ,$429.22 ,$173.58 ,$328.22 ,$78.89 ,$75.31 ,$182.26 ,$670.65 ,$542.04 ,$220.92 ,$710.10 ,$662.76 ,$631.20 ,$631.20 ,$173.58 ,$512.85 
ST. FRANCIS HOSPITAL - ACUTE,41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$236.00 ,$153.40 ,$51.92 ,$236.00 ,$135.70 ,$169.92 ,$128.38 ,$51.92 ,$66.08 ,$138.77 ,$51.92 ,$162.13 ,$59.00 ,$162.13 ,$162.13 ,$59.00 ,$162.13 ,$98.65 ,$198.24 , N/A ,$51.92 ,$200.60 ,$198.24 ,$51.92 ,$177.00 ,$188.80 ,$188.80 ,$51.92 ,$188.80 ,$198.24 ,$198.24 ,$198.24 ,$236.00 ,$212.40 ,$135.70 ,$236.00 ,$51.92 ,$236.00 ,$128.38 ,$51.92 ,$98.18 ,$78.89 ,$75.31 ,$54.52 ,$200.60 ,$162.13 ,$66.08 ,$212.40 ,$198.24 ,$188.80 ,$188.80 ,$51.92 ,$153.40 
ST. FRANCIS HOSPITAL - ACUTE,41000052,94660,HC CPAP,410,1 ,$782.00 ,$508.30 ,$172.04 ,$782.00 ,$449.65 ,$563.04 ,$425.41 ,$172.04 ,$218.96 ,$459.82 ,$172.04 ,$537.23 ,$195.50 ,$537.23 ,$537.23 ,$195.50 ,$537.23 ,$326.88 ,$656.88 ,$479.93 ,$172.04 ,$664.70 ,$656.88 ,$172.04 ,$586.50 ,$625.60 ,$625.60 ,$172.04 ,$625.60 ,$656.88 ,$656.88 ,$656.88 ,$782.00 ,$703.80 ,$449.65 ,$782.00 ,$172.04 ,$782.00 ,$425.41 ,$172.04 ,$325.31 ,$772.61 ,$737.49 ,$180.64 ,$664.70 ,$537.23 ,$218.96 ,$703.80 ,$656.88 ,$625.60 ,$625.60 ,$172.04 ,$508.30 
ST. FRANCIS HOSPITAL - ACUTE,41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$269.00 ,$174.85 ,$36.34 ,$479.93 ,$154.68 ,$193.68 ,$146.34 ,$59.18 ,$75.32 ,$158.17 ,$59.18 ,$184.80 ,$67.25 ,$184.80 ,$184.80 ,$67.25 ,$184.80 ,$112.44 ,$225.96 ,$479.93 ,$59.18 ,$228.65 ,$225.96 ,$59.18 ,$201.75 ,$215.20 ,$215.20 ,$59.18 ,$215.20 ,$225.96 ,$225.96 ,$225.96 ,$269.00 ,$242.10 ,$154.68 ,$269.00 ,$59.18 ,$269.00 ,$146.34 ,$59.18 ,$111.90 ,$38.07 ,$36.34 ,$62.14 ,$228.65 ,$184.80 ,$75.32 ,$242.10 ,$225.96 ,$215.20 ,$215.20 ,$59.18 ,$174.85 
ST. FRANCIS HOSPITAL - ACUTE,41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$183.00 ,$118.95 ,$40.26 ,$287.90 ,$105.23 ,$131.76 ,$99.55 ,$40.26 ,$51.24 ,$107.60 ,$40.26 ,$125.72 ,$45.75 ,$125.72 ,$125.72 ,$45.75 ,$125.72 ,$76.49 ,$153.72 ,$287.90 ,$40.26 ,$155.55 ,$153.72 ,$40.26 ,$137.25 ,$146.40 ,$146.40 ,$40.26 ,$146.40 ,$153.72 ,$153.72 ,$153.72 ,$183.00 ,$164.70 ,$105.23 ,$183.00 ,$40.26 ,$183.00 ,$99.55 ,$40.26 ,$76.13 ,$255.88 ,$244.25 ,$42.27 ,$155.55 ,$125.72 ,$51.24 ,$164.70 ,$153.72 ,$146.40 ,$146.40 ,$40.26 ,$118.95 
ST. FRANCIS HOSPITAL - ACUTE,41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$166.00 ,$107.90 ,$36.52 ,$287.90 ,$95.45 ,$119.52 ,$90.30 ,$36.52 ,$46.48 ,$97.61 ,$36.52 ,$114.04 ,$41.50 ,$114.04 ,$114.04 ,$41.50 ,$114.04 ,$69.39 ,$139.44 ,$287.90 ,$36.52 ,$141.10 ,$139.44 ,$36.52 ,$124.50 ,$132.80 ,$132.80 ,$36.52 ,$132.80 ,$139.44 ,$139.44 ,$139.44 ,$166.00 ,$149.40 ,$95.45 ,$166.00 ,$36.52 ,$166.00 ,$90.30 ,$36.52 ,$69.06 ,$255.88 ,$244.25 ,$38.35 ,$141.10 ,$114.04 ,$46.48 ,$149.40 ,$139.44 ,$132.80 ,$132.80 ,$36.52 ,$107.90 
ST. FRANCIS HOSPITAL - ACUTE,41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$168.00 ,$109.20 ,$36.96 ,$287.90 ,$96.60 ,$120.96 ,$91.39 ,$36.96 ,$47.04 ,$94.25 ,$36.96 ,$109.54 ,$42.00 ,$109.54 ,$109.54 ,$42.00 ,$109.54 ,$70.22 ,$141.12 ,$287.90 ,$36.96 ,$142.80 ,$141.12 ,$36.96 ,$126.00 ,$134.40 ,$134.40 ,$36.96 ,$134.40 ,$141.12 ,$141.12 ,$141.12 ,$168.00 ,$151.20 ,$96.60 ,$168.00 ,$36.96 ,$168.00 ,$91.39 ,$36.96 ,$69.89 ,$255.88 ,$244.25 ,$38.81 ,$142.80 ,$109.54 ,$47.04 ,$151.20 ,$141.12 ,$134.40 ,$134.40 ,$36.96 ,$109.20 
ST. FRANCIS HOSPITAL - ACUTE,41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$153.00 ,$99.45 ,$33.66 ,$287.90 ,$87.98 ,$110.16 ,$83.23 ,$33.66 ,$42.84 ,$85.83 ,$33.66 ,$99.76 ,$38.25 ,$99.76 ,$99.76 ,$38.25 ,$99.76 ,$63.95 ,$128.52 ,$287.90 ,$33.66 ,$130.05 ,$128.52 ,$33.66 ,$114.75 ,$122.40 ,$122.40 ,$33.66 ,$122.40 ,$128.52 ,$128.52 ,$128.52 ,$153.00 ,$137.70 ,$87.98 ,$153.00 ,$33.66 ,$153.00 ,$83.23 ,$33.66 ,$63.65 ,$255.88 ,$244.25 ,$35.34 ,$130.05 ,$99.76 ,$42.84 ,$137.70 ,$128.52 ,$122.40 ,$122.40 ,$33.66 ,$99.45 
ST. FRANCIS HOSPITAL - ACUTE,41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$77.00 ,$50.05 ,$16.94 ,$255.88 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$63.08 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$255.88 ,$244.25 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,41000069,G0238,HC RESP THRP FUNCTION,410,1 ,$77.00 ,$50.05 ,$16.94 ,$255.88 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$45.28 ,$16.94 ,$52.90 ,$19.25 ,$52.90 ,$52.90 ,$19.25 ,$52.90 ,$32.19 ,$64.68 ,$63.08 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 ,$255.88 ,$244.25 ,$17.79 ,$65.45 ,$52.90 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$113.00 ,$73.45 ,$2.37 ,$113.00 ,$64.98 ,$81.36 ,$61.47 ,$24.86 ,$31.64 ,$66.44 ,$24.86 ,$77.63 ,$28.25 ,$77.63 ,$77.63 ,$28.25 ,$77.63 ,$47.23 ,$94.92 ,$86.43 ,$24.86 ,$96.05 ,$94.92 ,$24.86 ,$84.75 ,$90.40 ,$90.40 ,$24.86 ,$90.40 ,$94.92 ,$94.92 ,$94.92 ,$113.00 ,$101.70 ,$64.98 ,$113.00 ,$24.86 ,$113.00 ,$61.47 ,$24.86 ,$47.01 ,$2.49 ,$2.37 ,$26.10 ,$96.05 ,$77.63 ,$31.64 ,$101.70 ,$94.92 ,$90.40 ,$90.40 ,$24.86 ,$73.45 
ST. FRANCIS HOSPITAL - ACUTE,41000074,94640,HC IPPB SUBSQ,410,1 ,$318.00 ,$206.70 ,$69.96 ,$479.93 ,$182.85 ,$228.96 ,$172.99 ,$69.96 ,$89.04 ,$186.98 ,$69.96 ,$218.47 ,$79.50 ,$218.47 ,$218.47 ,$79.50 ,$218.47 ,$132.92 ,$267.12 ,$479.93 ,$69.96 ,$270.30 ,$267.12 ,$69.96 ,$238.50 ,$254.40 ,$254.40 ,$69.96 ,$254.40 ,$267.12 ,$267.12 ,$267.12 ,$318.00 ,$286.20 ,$182.85 ,$318.00 ,$69.96 ,$318.00 ,$172.99 ,$69.96 ,$132.29 ,$255.88 ,$244.25 ,$73.46 ,$270.30 ,$218.47 ,$89.04 ,$286.20 ,$267.12 ,$254.40 ,$254.40 ,$69.96 ,$206.70 
ST. FRANCIS HOSPITAL - ACUTE,41000076,94640,HC NEBULIZER SUBSQ,410,1 ,$187.00 ,$121.55 ,$41.14 ,$479.93 ,$107.53 ,$134.64 ,$101.73 ,$41.14 ,$52.36 ,$109.96 ,$41.14 ,$128.47 ,$46.75 ,$128.47 ,$128.47 ,$46.75 ,$128.47 ,$78.17 ,$157.08 ,$479.93 ,$41.14 ,$158.95 ,$157.08 ,$41.14 ,$140.25 ,$149.60 ,$149.60 ,$41.14 ,$149.60 ,$157.08 ,$157.08 ,$157.08 ,$187.00 ,$168.30 ,$107.53 ,$187.00 ,$41.14 ,$187.00 ,$101.73 ,$41.14 ,$77.79 ,$255.88 ,$244.25 ,$43.20 ,$158.95 ,$128.47 ,$52.36 ,$168.30 ,$157.08 ,$149.60 ,$149.60 ,$41.14 ,$121.55 
ST. FRANCIS HOSPITAL - ACUTE,41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$782.00 ,$508.30 ,$172.04 ,$782.00 ,$449.65 ,$563.04 ,$425.41 ,$172.04 ,$218.96 ,$459.82 ,$172.04 ,$537.23 ,$195.50 ,$537.23 ,$537.23 ,$195.50 ,$537.23 ,$326.88 ,$656.88 ,$479.93 ,$172.04 ,$664.70 ,$656.88 ,$172.04 ,$586.50 ,$625.60 ,$625.60 ,$172.04 ,$625.60 ,$656.88 ,$656.88 ,$656.88 ,$782.00 ,$703.80 ,$449.65 ,$782.00 ,$172.04 ,$782.00 ,$425.41 ,$172.04 ,$325.31 ,$772.61 ,$737.49 ,$180.64 ,$664.70 ,$537.23 ,$218.96 ,$703.80 ,$656.88 ,$625.60 ,$625.60 ,$172.04 ,$508.30 
ST. FRANCIS HOSPITAL - ACUTE,41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$204.00 ,$132.60 ,$44.88 ,$479.93 ,$117.30 ,$146.88 ,$110.98 ,$44.88 ,$57.12 ,$119.95 ,$44.88 ,$140.15 ,$51.00 ,$140.15 ,$140.15 ,$51.00 ,$140.15 ,$85.27 ,$171.36 ,$479.93 ,$44.88 ,$173.40 ,$171.36 ,$44.88 ,$153.00 ,$163.20 ,$163.20 ,$44.88 ,$163.20 ,$171.36 ,$171.36 ,$171.36 ,$204.00 ,$183.60 ,$117.30 ,$204.00 ,$44.88 ,$204.00 ,$110.98 ,$44.88 ,$84.86 ,$255.88 ,$244.25 ,$47.12 ,$173.40 ,$140.15 ,$57.12 ,$183.60 ,$171.36 ,$163.20 ,$163.20 ,$44.88 ,$132.60 
ST. FRANCIS HOSPITAL - ACUTE,42000008,95992,HC CANNALITH REPOSITIONING,420,1 ,$204.00 ,$132.60 ,$44.88 ,$356.52 ,$117.30 ,$146.88 ,$110.98 ,$44.88 ,$57.12 ,$114.44 ,$44.88 ,$133.01 ,$51.00 ,$133.01 ,$133.01 ,$51.00 ,$133.01 ,$85.27 ,$171.36 ,$110.58 ,$44.88 ,$173.40 ,$171.36 ,$44.88 ,$153.00 ,$163.20 ,$163.20 ,$44.88 ,$163.20 ,$171.36 ,$171.36 ,$171.36 ,$204.00 ,$183.60 ,$117.30 ,$204.00 ,$44.88 ,$204.00 ,$110.98 ,$44.88 ,$84.86 ,$356.52 ,$340.32 ,$47.12 ,$173.40 ,$133.01 ,$57.12 ,$183.60 ,$171.36 ,$163.20 ,$163.20 ,$44.88 ,$132.60 
ST. FRANCIS HOSPITAL - ACUTE,42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$160.00 ,$104.00 ,$35.20 ,$356.52 ,$92.00 ,$115.20 ,$87.04 ,$35.20 ,$44.80 ,$94.08 ,$35.20 ,$109.92 ,$40.00 ,$109.92 ,$109.92 ,$40.00 ,$109.92 ,$66.88 ,$134.40 ,$36.93 ,$35.20 ,$136.00 ,$134.40 ,$35.20 ,$120.00 ,$128.00 ,$128.00 ,$35.20 ,$128.00 ,$134.40 ,$134.40 ,$134.40 ,$160.00 ,$144.00 ,$92.00 ,$160.00 ,$35.20 ,$160.00 ,$87.04 ,$35.20 ,$66.56 ,$356.52 ,$340.32 ,$36.96 ,$136.00 ,$109.92 ,$44.80 ,$144.00 ,$134.40 ,$128.00 ,$128.00 ,$35.20 ,$104.00 
ST. FRANCIS HOSPITAL - ACUTE,42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$177.00 ,$115.05 ,$38.94 ,$356.52 ,$101.78 ,$127.44 ,$96.29 ,$38.94 ,$49.56 ,$104.08 ,$38.94 ,$121.60 ,$44.25 ,$121.60 ,$121.60 ,$44.25 ,$121.60 ,$73.99 ,$148.68 ,$49.20 ,$38.94 ,$150.45 ,$148.68 ,$38.94 ,$132.75 ,$141.60 ,$141.60 ,$38.94 ,$141.60 ,$148.68 ,$148.68 ,$148.68 ,$177.00 ,$159.30 ,$101.78 ,$177.00 ,$38.94 ,$177.00 ,$96.29 ,$38.94 ,$73.63 ,$356.52 ,$340.32 ,$40.89 ,$150.45 ,$121.60 ,$49.56 ,$159.30 ,$148.68 ,$141.60 ,$141.60 ,$38.94 ,$115.05 
ST. FRANCIS HOSPITAL - ACUTE,42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$200.00 ,$130.00 ,$35.90 ,$356.52 ,$115.00 ,$144.00 ,$108.80 ,$44.00 ,$56.00 ,$117.60 ,$44.00 ,$137.40 ,$50.00 ,$137.40 ,$137.40 ,$50.00 ,$137.40 ,$83.60 ,$168.00 ,$35.90 ,$44.00 ,$170.00 ,$168.00 ,$44.00 ,$150.00 ,$160.00 ,$160.00 ,$44.00 ,$160.00 ,$168.00 ,$168.00 ,$168.00 ,$200.00 ,$180.00 ,$115.00 ,$200.00 ,$44.00 ,$200.00 ,$108.80 ,$44.00 ,$83.20 ,$356.52 ,$340.32 ,$46.20 ,$170.00 ,$137.40 ,$56.00 ,$180.00 ,$168.00 ,$160.00 ,$160.00 ,$44.00 ,$130.00 
ST. FRANCIS HOSPITAL - ACUTE,42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$180.00 ,$117.00 ,$39.60 ,$356.52 ,$103.50 ,$129.60 ,$97.92 ,$39.60 ,$50.40 ,$105.84 ,$39.60 ,$123.66 ,$45.00 ,$123.66 ,$123.66 ,$45.00 ,$123.66 ,$75.24 ,$151.20 ,$74.40 ,$39.60 ,$153.00 ,$151.20 ,$39.60 ,$135.00 ,$144.00 ,$144.00 ,$39.60 ,$144.00 ,$151.20 ,$151.20 ,$151.20 ,$180.00 ,$162.00 ,$103.50 ,$180.00 ,$39.60 ,$180.00 ,$97.92 ,$39.60 ,$74.88 ,$356.52 ,$340.32 ,$41.58 ,$153.00 ,$123.66 ,$50.40 ,$162.00 ,$151.20 ,$144.00 ,$144.00 ,$39.60 ,$117.00 
ST. FRANCIS HOSPITAL - ACUTE,42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$126.00 ,$81.90 ,$27.72 ,$356.52 ,$72.45 ,$90.72 ,$68.54 ,$27.72 ,$35.28 ,$74.09 ,$27.72 ,$86.56 ,$31.50 ,$86.56 ,$86.56 ,$31.50 ,$86.56 ,$52.67 ,$105.84 ,$86.08 ,$27.72 ,$107.10 ,$105.84 ,$27.72 ,$94.50 ,$100.80 ,$100.80 ,$27.72 ,$100.80 ,$105.84 ,$105.84 ,$105.84 ,$126.00 ,$113.40 ,$72.45 ,$126.00 ,$27.72 ,$126.00 ,$68.54 ,$27.72 ,$52.42 ,$356.52 ,$340.32 ,$29.11 ,$107.10 ,$86.56 ,$35.28 ,$113.40 ,$105.84 ,$100.80 ,$100.80 ,$27.72 ,$81.90 
ST. FRANCIS HOSPITAL - ACUTE,42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$124.00 ,$80.60 ,$27.28 ,$356.52 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$74.40 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$356.52 ,$340.32 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$172.00 ,$111.80 ,$37.84 ,$356.52 ,$98.90 ,$123.84 ,$93.57 ,$37.84 ,$48.16 ,$101.14 ,$37.84 ,$118.16 ,$43.00 ,$118.16 ,$118.16 ,$43.00 ,$118.16 ,$71.90 ,$144.48 ,$74.10 ,$37.84 ,$146.20 ,$144.48 ,$37.84 ,$129.00 ,$137.60 ,$137.60 ,$37.84 ,$137.60 ,$144.48 ,$144.48 ,$144.48 ,$172.00 ,$154.80 ,$98.90 ,$172.00 ,$37.84 ,$172.00 ,$93.57 ,$37.84 ,$71.55 ,$356.52 ,$340.32 ,$39.73 ,$146.20 ,$118.16 ,$48.16 ,$154.80 ,$144.48 ,$137.60 ,$137.60 ,$37.84 ,$111.80 
ST. FRANCIS HOSPITAL - ACUTE,42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$181.00 ,$117.65 ,$39.82 ,$356.52 ,$104.08 ,$130.32 ,$98.46 ,$39.82 ,$50.68 ,$106.43 ,$39.82 ,$124.35 ,$45.25 ,$124.35 ,$124.35 ,$45.25 ,$124.35 ,$75.66 ,$152.04 ,$68.60 ,$39.82 ,$153.85 ,$152.04 ,$39.82 ,$135.75 ,$144.80 ,$144.80 ,$39.82 ,$144.80 ,$152.04 ,$152.04 ,$152.04 ,$181.00 ,$162.90 ,$104.08 ,$181.00 ,$39.82 ,$181.00 ,$98.46 ,$39.82 ,$75.30 ,$356.52 ,$340.32 ,$41.81 ,$153.85 ,$124.35 ,$50.68 ,$162.90 ,$152.04 ,$144.80 ,$144.80 ,$39.82 ,$117.65 
ST. FRANCIS HOSPITAL - ACUTE,42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$180.00 ,$117.00 ,$39.60 ,$356.52 ,$103.50 ,$129.60 ,$97.92 ,$39.60 ,$50.40 ,$105.84 ,$39.60 ,$123.66 ,$45.00 ,$123.66 ,$123.66 ,$45.00 ,$123.66 ,$75.24 ,$151.20 ,$93.10 ,$39.60 ,$153.00 ,$151.20 ,$39.60 ,$135.00 ,$144.00 ,$144.00 ,$39.60 ,$144.00 ,$151.20 ,$151.20 ,$151.20 ,$180.00 ,$162.00 ,$103.50 ,$180.00 ,$39.60 ,$180.00 ,$97.92 ,$39.60 ,$74.88 ,$356.52 ,$340.32 ,$41.58 ,$153.00 ,$123.66 ,$50.40 ,$162.00 ,$151.20 ,$144.00 ,$144.00 ,$39.60 ,$117.00 
ST. FRANCIS HOSPITAL - ACUTE,42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$84.00 ,$54.60 ,$18.48 ,$356.52 ,$48.30 ,$60.48 ,$45.70 ,$18.48 ,$23.52 ,$49.39 ,$18.48 ,$57.71 ,$21.00 ,$57.71 ,$57.71 ,$21.00 ,$57.71 ,$35.11 ,$70.56 ,$84.18 ,$18.48 ,$71.40 ,$70.56 ,$18.48 ,$63.00 ,$67.20 ,$67.20 ,$18.48 ,$67.20 ,$70.56 ,$70.56 ,$70.56 ,$84.00 ,$75.60 ,$48.30 ,$84.00 ,$18.48 ,$84.00 ,$45.70 ,$18.48 ,$34.94 ,$356.52 ,$340.32 ,$19.40 ,$71.40 ,$57.71 ,$23.52 ,$75.60 ,$70.56 ,$67.20 ,$67.20 ,$18.48 ,$54.60 
ST. FRANCIS HOSPITAL - ACUTE,42000094,97761,HC PROSTHETIC TRAINING EA 15 MIN,420,1 ,$198.00 ,$128.70 ,$43.56 ,$356.52 ,$113.85 ,$142.56 ,$107.71 ,$43.56 ,$55.44 ,$116.42 ,$43.56 ,$136.03 ,$49.50 ,$136.03 ,$136.03 ,$49.50 ,$136.03 ,$82.76 ,$166.32 ,$104.00 ,$43.56 ,$168.30 ,$166.32 ,$43.56 ,$148.50 ,$158.40 ,$158.40 ,$43.56 ,$158.40 ,$166.32 ,$166.32 ,$166.32 ,$198.00 ,$178.20 ,$113.85 ,$198.00 ,$43.56 ,$198.00 ,$107.71 ,$43.56 ,$82.37 ,$356.52 ,$340.32 ,$45.74 ,$168.30 ,$136.03 ,$55.44 ,$178.20 ,$166.32 ,$158.40 ,$158.40 ,$43.56 ,$128.70 
ST. FRANCIS HOSPITAL - ACUTE,42000204,97010,HC HOT/COLD PACK 15MIN,420,1 ,$135.00 ,$87.75 ,$27.80 ,$135.00 ,$77.63 ,$97.20 ,$73.44 ,$29.70 ,$37.80 ,$37.35 ,$29.70 ,$37.35 ,$33.75 ,$37.35 ,$37.35 ,$33.75 ,$37.35 ,$56.43 ,$113.40 , N/A ,$29.70 ,$114.75 ,$113.40 ,$29.70 ,$101.25 ,$108.00 ,$108.00 ,$29.70 ,$108.00 ,$113.40 ,$113.40 ,$113.40 ,$135.00 ,$121.50 ,$77.63 ,$135.00 ,$29.70 ,$135.00 ,$73.44 ,$29.70 ,$56.16 ,$29.13 ,$27.80 ,$31.19 ,$114.75 ,$37.35 ,$37.80 ,$121.50 ,$113.40 ,$108.00 ,$108.00 ,$29.70 ,$87.75 
ST. FRANCIS HOSPITAL - ACUTE,42000205,97010,HC HOT/COLD PACK 30MIN,420,1 ,$135.00 ,$87.75 ,$27.80 ,$135.00 ,$77.63 ,$97.20 ,$73.44 ,$29.70 ,$37.80 ,$37.35 ,$29.70 ,$37.35 ,$33.75 ,$37.35 ,$37.35 ,$33.75 ,$37.35 ,$56.43 ,$113.40 , N/A ,$29.70 ,$114.75 ,$113.40 ,$29.70 ,$101.25 ,$108.00 ,$108.00 ,$29.70 ,$108.00 ,$113.40 ,$113.40 ,$113.40 ,$135.00 ,$121.50 ,$77.63 ,$135.00 ,$29.70 ,$135.00 ,$73.44 ,$29.70 ,$56.16 ,$29.13 ,$27.80 ,$31.19 ,$114.75 ,$37.35 ,$37.80 ,$121.50 ,$113.40 ,$108.00 ,$108.00 ,$29.70 ,$87.75 
ST. FRANCIS HOSPITAL - ACUTE,42000206,G0283,HC ELECT STIM (UNATTEND) OTHER 15MIN,420,1 ,$194.00 ,$126.10 ,$27.80 ,$194.00 ,$111.55 ,$139.68 ,$105.54 ,$42.68 ,$54.32 ,$114.07 ,$42.68 ,$124.50 ,$48.50 ,$124.50 ,$124.50 ,$48.50 ,$124.50 ,$81.09 ,$162.96 ,$30.88 ,$42.68 ,$164.90 ,$162.96 ,$42.68 ,$145.50 ,$155.20 ,$155.20 ,$42.68 ,$155.20 ,$162.96 ,$162.96 ,$162.96 ,$194.00 ,$174.60 ,$111.55 ,$194.00 ,$42.68 ,$194.00 ,$105.54 ,$42.68 ,$80.70 ,$29.13 ,$27.80 ,$44.81 ,$164.90 ,$124.50 ,$54.32 ,$174.60 ,$162.96 ,$155.20 ,$155.20 ,$42.68 ,$126.10 
ST. FRANCIS HOSPITAL - ACUTE,42000207,G0283,HC ELECT STIM (UNATTEND) OTHER 30MIN,420,1 ,$272.00 ,$176.80 ,$27.80 ,$272.00 ,$156.40 ,$195.84 ,$147.97 ,$59.84 ,$76.16 ,$124.50 ,$59.84 ,$124.50 ,$68.00 ,$124.50 ,$124.50 ,$68.00 ,$124.50 ,$113.70 ,$228.48 ,$30.88 ,$59.84 ,$231.20 ,$228.48 ,$59.84 ,$204.00 ,$217.60 ,$217.60 ,$59.84 ,$217.60 ,$228.48 ,$228.48 ,$228.48 ,$272.00 ,$244.80 ,$156.40 ,$272.00 ,$59.84 ,$272.00 ,$147.97 ,$59.84 ,$113.15 ,$29.13 ,$27.80 ,$62.83 ,$231.20 ,$124.50 ,$76.16 ,$244.80 ,$228.48 ,$217.60 ,$217.60 ,$59.84 ,$176.80 
ST. FRANCIS HOSPITAL - ACUTE,42000208,G0283,HC ELECT STIM (UNATTEND) OTHER 45MIN,420,1 ,$343.00 ,$222.95 ,$27.80 ,$343.00 ,$197.23 ,$246.96 ,$186.59 ,$75.46 ,$96.04 ,$124.50 ,$75.46 ,$124.50 ,$85.75 ,$124.50 ,$124.50 ,$85.75 ,$124.50 ,$143.37 ,$288.12 ,$30.88 ,$75.46 ,$291.55 ,$288.12 ,$75.46 ,$257.25 ,$274.40 ,$274.40 ,$75.46 ,$274.40 ,$288.12 ,$288.12 ,$288.12 ,$343.00 ,$308.70 ,$197.23 ,$343.00 ,$75.46 ,$343.00 ,$186.59 ,$75.46 ,$142.69 ,$29.13 ,$27.80 ,$79.23 ,$291.55 ,$124.50 ,$96.04 ,$308.70 ,$288.12 ,$274.40 ,$274.40 ,$75.46 ,$222.95 
ST. FRANCIS HOSPITAL - ACUTE,42000209,G0283,HC ELECT STIM (UNATTEND) OTHER 60MIN,420,1 ,$414.00 ,$269.10 ,$27.80 ,$414.00 ,$238.05 ,$298.08 ,$225.22 ,$91.08 ,$115.92 ,$124.50 ,$91.08 ,$124.50 ,$103.50 ,$124.50 ,$124.50 ,$103.50 ,$124.50 ,$173.05 ,$347.76 ,$30.88 ,$91.08 ,$351.90 ,$347.76 ,$91.08 ,$310.50 ,$331.20 ,$331.20 ,$91.08 ,$331.20 ,$347.76 ,$347.76 ,$347.76 ,$414.00 ,$372.60 ,$238.05 ,$414.00 ,$91.08 ,$414.00 ,$225.22 ,$91.08 ,$172.22 ,$29.13 ,$27.80 ,$95.63 ,$351.90 ,$124.50 ,$115.92 ,$372.60 ,$347.76 ,$331.20 ,$331.20 ,$91.08 ,$269.10 
ST. FRANCIS HOSPITAL - ACUTE,42000210,97016,HC APPLY VASOPNEUMATIC DEVICE 15MIN,420,1 ,$124.00 ,$80.60 ,$27.28 ,$124.00 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$30.05 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$29.13 ,$27.80 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,42000211,97016,HC APPLY VASOPNEUMATIC DEVICE 30MIN,420,1 ,$124.00 ,$80.60 ,$27.28 ,$124.00 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$30.05 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$29.13 ,$27.80 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,42000212,97016,HC APPLY VASOPNEUMATIC DEVICE 45MIN,420,1 ,$124.00 ,$80.60 ,$27.28 ,$124.00 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$30.05 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$29.13 ,$27.80 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,42000213,97016,HC APPLY VASOPNEUMATIC DEVICE 60MIN,420,1 ,$124.00 ,$80.60 ,$27.28 ,$124.00 ,$71.30 ,$89.28 ,$67.46 ,$27.28 ,$34.72 ,$72.91 ,$27.28 ,$85.19 ,$31.00 ,$85.19 ,$85.19 ,$31.00 ,$85.19 ,$51.83 ,$104.16 ,$30.05 ,$27.28 ,$105.40 ,$104.16 ,$27.28 ,$93.00 ,$99.20 ,$99.20 ,$27.28 ,$99.20 ,$104.16 ,$104.16 ,$104.16 ,$124.00 ,$111.60 ,$71.30 ,$124.00 ,$27.28 ,$124.00 ,$67.46 ,$27.28 ,$51.58 ,$29.13 ,$27.80 ,$28.64 ,$105.40 ,$85.19 ,$34.72 ,$111.60 ,$104.16 ,$99.20 ,$99.20 ,$27.28 ,$80.60 
ST. FRANCIS HOSPITAL - ACUTE,42000214,97012,HC TRACTION MECHANICAL APPL 15 MIN,420,1 ,$134.00 ,$87.10 ,$27.80 ,$134.00 ,$77.05 ,$96.48 ,$72.90 ,$29.48 ,$37.52 ,$78.79 ,$29.48 ,$92.06 ,$33.50 ,$92.06 ,$92.06 ,$33.50 ,$92.06 ,$56.01 ,$112.56 ,$36.10 ,$29.48 ,$113.90 ,$112.56 ,$29.48 ,$100.50 ,$107.20 ,$107.20 ,$29.48 ,$107.20 ,$112.56 ,$112.56 ,$112.56 ,$134.00 ,$120.60 ,$77.05 ,$134.00 ,$29.48 ,$134.00 ,$72.90 ,$29.48 ,$55.74 ,$29.13 ,$27.80 ,$30.95 ,$113.90 ,$92.06 ,$37.52 ,$120.60 ,$112.56 ,$107.20 ,$107.20 ,$29.48 ,$87.10 
ST. FRANCIS HOSPITAL - ACUTE,42000215,97012,HC TRACTION MECHANICAL APPL 30 MIN,420,1 ,$134.00 ,$87.10 ,$27.80 ,$134.00 ,$77.05 ,$96.48 ,$72.90 ,$29.48 ,$37.52 ,$78.79 ,$29.48 ,$92.06 ,$33.50 ,$92.06 ,$92.06 ,$33.50 ,$92.06 ,$56.01 ,$112.56 ,$36.10 ,$29.48 ,$113.90 ,$112.56 ,$29.48 ,$100.50 ,$107.20 ,$107.20 ,$29.48 ,$107.20 ,$112.56 ,$112.56 ,$112.56 ,$134.00 ,$120.60 ,$77.05 ,$134.00 ,$29.48 ,$134.00 ,$72.90 ,$29.48 ,$55.74 ,$29.13 ,$27.80 ,$30.95 ,$113.90 ,$92.06 ,$37.52 ,$120.60 ,$112.56 ,$107.20 ,$107.20 ,$29.48 ,$87.10 
ST. FRANCIS HOSPITAL - ACUTE,42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$234.00 ,$152.10 ,$51.48 ,$356.52 ,$134.55 ,$168.48 ,$127.30 ,$51.48 ,$65.52 ,$137.59 ,$51.48 ,$160.76 ,$58.50 ,$160.76 ,$160.76 ,$58.50 ,$160.76 ,$97.81 ,$196.56 ,$253.33 ,$51.48 ,$198.90 ,$196.56 ,$51.48 ,$175.50 ,$187.20 ,$187.20 ,$51.48 ,$187.20 ,$196.56 ,$196.56 ,$196.56 ,$234.00 ,$210.60 ,$134.55 ,$234.00 ,$51.48 ,$234.00 ,$127.30 ,$51.48 ,$97.34 ,$356.52 ,$340.32 ,$54.05 ,$198.90 ,$160.76 ,$65.52 ,$210.60 ,$196.56 ,$187.20 ,$187.20 ,$51.48 ,$152.10 
ST. FRANCIS HOSPITAL - ACUTE,42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$234.00 ,$152.10 ,$51.48 ,$356.52 ,$134.55 ,$168.48 ,$127.30 ,$51.48 ,$65.52 ,$137.59 ,$51.48 ,$160.76 ,$58.50 ,$160.76 ,$160.76 ,$58.50 ,$160.76 ,$97.81 ,$196.56 ,$253.33 ,$51.48 ,$198.90 ,$196.56 ,$51.48 ,$175.50 ,$187.20 ,$187.20 ,$51.48 ,$187.20 ,$196.56 ,$196.56 ,$196.56 ,$234.00 ,$210.60 ,$134.55 ,$234.00 ,$51.48 ,$234.00 ,$127.30 ,$51.48 ,$97.34 ,$356.52 ,$340.32 ,$54.05 ,$198.90 ,$160.76 ,$65.52 ,$210.60 ,$196.56 ,$187.20 ,$187.20 ,$51.48 ,$152.10 
ST. FRANCIS HOSPITAL - ACUTE,42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$234.00 ,$152.10 ,$51.48 ,$356.52 ,$134.55 ,$168.48 ,$127.30 ,$51.48 ,$65.52 ,$137.59 ,$51.48 ,$160.76 ,$58.50 ,$160.76 ,$160.76 ,$58.50 ,$160.76 ,$97.81 ,$196.56 ,$253.33 ,$51.48 ,$198.90 ,$196.56 ,$51.48 ,$175.50 ,$187.20 ,$187.20 ,$51.48 ,$187.20 ,$196.56 ,$196.56 ,$196.56 ,$234.00 ,$210.60 ,$134.55 ,$234.00 ,$51.48 ,$234.00 ,$127.30 ,$51.48 ,$97.34 ,$356.52 ,$340.32 ,$54.05 ,$198.90 ,$160.76 ,$65.52 ,$210.60 ,$196.56 ,$187.20 ,$187.20 ,$51.48 ,$152.10 
ST. FRANCIS HOSPITAL - ACUTE,42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$234.00 ,$152.10 ,$51.48 ,$356.52 ,$134.55 ,$168.48 ,$127.30 ,$51.48 ,$65.52 ,$137.59 ,$51.48 ,$160.76 ,$58.50 ,$160.76 ,$160.76 ,$58.50 ,$160.76 ,$97.81 ,$196.56 ,$253.33 ,$51.48 ,$198.90 ,$196.56 ,$51.48 ,$175.50 ,$187.20 ,$187.20 ,$51.48 ,$187.20 ,$196.56 ,$196.56 ,$196.56 ,$234.00 ,$210.60 ,$134.55 ,$234.00 ,$51.48 ,$234.00 ,$127.30 ,$51.48 ,$97.34 ,$356.52 ,$340.32 ,$54.05 ,$198.90 ,$160.76 ,$65.52 ,$210.60 ,$196.56 ,$187.20 ,$187.20 ,$51.48 ,$152.10 
ST. FRANCIS HOSPITAL - ACUTE,42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$292.00 ,$189.80 ,$64.24 ,$356.52 ,$167.90 ,$210.24 ,$158.85 ,$64.24 ,$81.76 ,$171.70 ,$64.24 ,$200.60 ,$73.00 ,$200.60 ,$200.60 ,$73.00 ,$200.60 ,$122.06 ,$245.28 ,$253.33 ,$64.24 ,$248.20 ,$245.28 ,$64.24 ,$219.00 ,$233.60 ,$233.60 ,$64.24 ,$233.60 ,$245.28 ,$245.28 ,$245.28 ,$292.00 ,$262.80 ,$167.90 ,$292.00 ,$64.24 ,$292.00 ,$158.85 ,$64.24 ,$121.47 ,$356.52 ,$340.32 ,$67.45 ,$248.20 ,$200.60 ,$81.76 ,$262.80 ,$245.28 ,$233.60 ,$233.60 ,$64.24 ,$189.80 
ST. FRANCIS HOSPITAL - ACUTE,42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$292.00 ,$189.80 ,$64.24 ,$356.52 ,$167.90 ,$210.24 ,$158.85 ,$64.24 ,$81.76 ,$171.70 ,$64.24 ,$200.60 ,$73.00 ,$200.60 ,$200.60 ,$73.00 ,$200.60 ,$122.06 ,$245.28 ,$253.33 ,$64.24 ,$248.20 ,$245.28 ,$64.24 ,$219.00 ,$233.60 ,$233.60 ,$64.24 ,$233.60 ,$245.28 ,$245.28 ,$245.28 ,$292.00 ,$262.80 ,$167.90 ,$292.00 ,$64.24 ,$292.00 ,$158.85 ,$64.24 ,$121.47 ,$356.52 ,$340.32 ,$67.45 ,$248.20 ,$200.60 ,$81.76 ,$262.80 ,$245.28 ,$233.60 ,$233.60 ,$64.24 ,$189.80 
ST. FRANCIS HOSPITAL - ACUTE,42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$292.00 ,$189.80 ,$64.24 ,$356.52 ,$167.90 ,$210.24 ,$158.85 ,$64.24 ,$81.76 ,$171.70 ,$64.24 ,$200.60 ,$73.00 ,$200.60 ,$200.60 ,$73.00 ,$200.60 ,$122.06 ,$245.28 ,$253.33 ,$64.24 ,$248.20 ,$245.28 ,$64.24 ,$219.00 ,$233.60 ,$233.60 ,$64.24 ,$233.60 ,$245.28 ,$245.28 ,$245.28 ,$292.00 ,$262.80 ,$167.90 ,$292.00 ,$64.24 ,$292.00 ,$158.85 ,$64.24 ,$121.47 ,$356.52 ,$340.32 ,$67.45 ,$248.20 ,$200.60 ,$81.76 ,$262.80 ,$245.28 ,$233.60 ,$233.60 ,$64.24 ,$189.80 
ST. FRANCIS HOSPITAL - ACUTE,42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$292.00 ,$189.80 ,$64.24 ,$356.52 ,$167.90 ,$210.24 ,$158.85 ,$64.24 ,$81.76 ,$171.70 ,$64.24 ,$200.60 ,$73.00 ,$200.60 ,$200.60 ,$73.00 ,$200.60 ,$122.06 ,$245.28 ,$253.33 ,$64.24 ,$248.20 ,$245.28 ,$64.24 ,$219.00 ,$233.60 ,$233.60 ,$64.24 ,$233.60 ,$245.28 ,$245.28 ,$245.28 ,$292.00 ,$262.80 ,$167.90 ,$292.00 ,$64.24 ,$292.00 ,$158.85 ,$64.24 ,$121.47 ,$356.52 ,$340.32 ,$67.45 ,$248.20 ,$200.60 ,$81.76 ,$262.80 ,$245.28 ,$233.60 ,$233.60 ,$64.24 ,$189.80 
ST. FRANCIS HOSPITAL - ACUTE,42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$199.00 ,$129.35 ,$43.78 ,$356.52 ,$114.43 ,$143.28 ,$108.26 ,$43.78 ,$55.72 ,$117.01 ,$43.78 ,$136.71 ,$49.75 ,$136.71 ,$136.71 ,$49.75 ,$136.71 ,$83.18 ,$167.16 ,$173.55 ,$43.78 ,$169.15 ,$167.16 ,$43.78 ,$149.25 ,$159.20 ,$159.20 ,$43.78 ,$159.20 ,$167.16 ,$167.16 ,$167.16 ,$199.00 ,$179.10 ,$114.43 ,$199.00 ,$43.78 ,$199.00 ,$108.26 ,$43.78 ,$82.78 ,$356.52 ,$340.32 ,$45.97 ,$169.15 ,$136.71 ,$55.72 ,$179.10 ,$167.16 ,$159.20 ,$159.20 ,$43.78 ,$129.35 
ST. FRANCIS HOSPITAL - ACUTE,42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$199.00 ,$129.35 ,$43.78 ,$356.52 ,$114.43 ,$143.28 ,$108.26 ,$43.78 ,$55.72 ,$117.01 ,$43.78 ,$136.71 ,$49.75 ,$136.71 ,$136.71 ,$49.75 ,$136.71 ,$83.18 ,$167.16 ,$173.55 ,$43.78 ,$169.15 ,$167.16 ,$43.78 ,$149.25 ,$159.20 ,$159.20 ,$43.78 ,$159.20 ,$167.16 ,$167.16 ,$167.16 ,$199.00 ,$179.10 ,$114.43 ,$199.00 ,$43.78 ,$199.00 ,$108.26 ,$43.78 ,$82.78 ,$356.52 ,$340.32 ,$45.97 ,$169.15 ,$136.71 ,$55.72 ,$179.10 ,$167.16 ,$159.20 ,$159.20 ,$43.78 ,$129.35 
ST. FRANCIS HOSPITAL - ACUTE,42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$199.00 ,$129.35 ,$43.78 ,$356.52 ,$114.43 ,$143.28 ,$108.26 ,$43.78 ,$55.72 ,$117.01 ,$43.78 ,$136.71 ,$49.75 ,$136.71 ,$136.71 ,$49.75 ,$136.71 ,$83.18 ,$167.16 ,$173.55 ,$43.78 ,$169.15 ,$167.16 ,$43.78 ,$149.25 ,$159.20 ,$159.20 ,$43.78 ,$159.20 ,$167.16 ,$167.16 ,$167.16 ,$199.00 ,$179.10 ,$114.43 ,$199.00 ,$43.78 ,$199.00 ,$108.26 ,$43.78 ,$82.78 ,$356.52 ,$340.32 ,$45.97 ,$169.15 ,$136.71 ,$55.72 ,$179.10 ,$167.16 ,$159.20 ,$159.20 ,$43.78 ,$129.35 
ST. FRANCIS HOSPITAL - ACUTE,42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$199.00 ,$129.35 ,$43.78 ,$356.52 ,$114.43 ,$143.28 ,$108.26 ,$43.78 ,$55.72 ,$117.01 ,$43.78 ,$136.71 ,$49.75 ,$136.71 ,$136.71 ,$49.75 ,$136.71 ,$83.18 ,$167.16 ,$173.55 ,$43.78 ,$169.15 ,$167.16 ,$43.78 ,$149.25 ,$159.20 ,$159.20 ,$43.78 ,$159.20 ,$167.16 ,$167.16 ,$167.16 ,$199.00 ,$179.10 ,$114.43 ,$199.00 ,$43.78 ,$199.00 ,$108.26 ,$43.78 ,$82.78 ,$356.52 ,$340.32 ,$45.97 ,$169.15 ,$136.71 ,$55.72 ,$179.10 ,$167.16 ,$159.20 ,$159.20 ,$43.78 ,$129.35 
ST. FRANCIS HOSPITAL - ACUTE,43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$158.00 ,$102.70 ,$34.76 ,$567.15 ,$90.85 ,$113.76 ,$85.95 ,$34.76 ,$44.24 ,$92.90 ,$34.76 ,$108.55 ,$39.50 ,$108.55 ,$108.55 ,$39.50 ,$108.55 ,$66.04 ,$132.72 ,$82.55 ,$34.76 ,$134.30 ,$132.72 ,$34.76 ,$118.50 ,$126.40 ,$126.40 ,$34.76 ,$126.40 ,$132.72 ,$132.72 ,$132.72 ,$158.00 ,$142.20 ,$90.85 ,$158.00 ,$34.76 ,$158.00 ,$85.95 ,$34.76 ,$65.73 ,$567.15 ,$541.37 ,$36.50 ,$134.30 ,$108.55 ,$44.24 ,$142.20 ,$132.72 ,$126.40 ,$126.40 ,$34.76 ,$102.70 
ST. FRANCIS HOSPITAL - ACUTE,43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$173.00 ,$112.45 ,$38.06 ,$356.52 ,$99.48 ,$124.56 ,$94.11 ,$38.06 ,$48.44 ,$101.72 ,$38.06 ,$118.85 ,$43.25 ,$118.85 ,$118.85 ,$43.25 ,$118.85 ,$72.31 ,$145.32 ,$121.10 ,$38.06 ,$147.05 ,$145.32 ,$38.06 ,$129.75 ,$138.40 ,$138.40 ,$38.06 ,$138.40 ,$145.32 ,$145.32 ,$145.32 ,$173.00 ,$155.70 ,$99.48 ,$173.00 ,$38.06 ,$173.00 ,$94.11 ,$38.06 ,$71.97 ,$356.52 ,$340.32 ,$39.96 ,$147.05 ,$118.85 ,$48.44 ,$155.70 ,$145.32 ,$138.40 ,$138.40 ,$38.06 ,$112.45 
ST. FRANCIS HOSPITAL - ACUTE,43000038,97018,HC PARAFFIN BATH THERAPY 15MIN,430,1 ,$103.00 ,$66.95 ,$14.78 ,$103.00 ,$59.23 ,$74.16 ,$56.03 ,$22.66 ,$28.84 ,$57.78 ,$22.66 ,$67.16 ,$25.75 ,$67.16 ,$67.16 ,$25.75 ,$67.16 ,$43.05 ,$86.52 ,$14.78 ,$22.66 ,$87.55 ,$86.52 ,$22.66 ,$77.25 ,$82.40 ,$82.40 ,$22.66 ,$82.40 ,$86.52 ,$86.52 ,$86.52 ,$103.00 ,$92.70 ,$59.23 ,$103.00 ,$22.66 ,$103.00 ,$56.03 ,$22.66 ,$42.85 ,$29.13 ,$27.80 ,$23.79 ,$87.55 ,$67.16 ,$28.84 ,$92.70 ,$86.52 ,$82.40 ,$82.40 ,$22.66 ,$66.95 
ST. FRANCIS HOSPITAL - ACUTE,43000039,97018,HC PARAFFIN BATH THERAPY 30MIN,430,1 ,$103.00 ,$66.95 ,$14.78 ,$103.00 ,$59.23 ,$74.16 ,$56.03 ,$22.66 ,$28.84 ,$57.78 ,$22.66 ,$67.16 ,$25.75 ,$67.16 ,$67.16 ,$25.75 ,$67.16 ,$43.05 ,$86.52 ,$14.78 ,$22.66 ,$87.55 ,$86.52 ,$22.66 ,$77.25 ,$82.40 ,$82.40 ,$22.66 ,$82.40 ,$86.52 ,$86.52 ,$86.52 ,$103.00 ,$92.70 ,$59.23 ,$103.00 ,$22.66 ,$103.00 ,$56.03 ,$22.66 ,$42.85 ,$29.13 ,$27.80 ,$23.79 ,$87.55 ,$67.16 ,$28.84 ,$92.70 ,$86.52 ,$82.40 ,$82.40 ,$22.66 ,$66.95 
ST. FRANCIS HOSPITAL - ACUTE,43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$189.00 ,$122.85 ,$27.80 ,$189.00 ,$108.68 ,$136.08 ,$102.82 ,$41.58 ,$52.92 ,$106.03 ,$41.58 ,$123.23 ,$47.25 ,$123.23 ,$123.23 ,$47.25 ,$123.23 ,$79.00 ,$158.76 ,$58.35 ,$41.58 ,$160.65 ,$158.76 ,$41.58 ,$141.75 ,$151.20 ,$151.20 ,$41.58 ,$151.20 ,$158.76 ,$158.76 ,$158.76 ,$189.00 ,$170.10 ,$108.68 ,$189.00 ,$41.58 ,$189.00 ,$102.82 ,$41.58 ,$78.62 ,$29.13 ,$27.80 ,$43.66 ,$160.65 ,$123.23 ,$52.92 ,$170.10 ,$158.76 ,$151.20 ,$151.20 ,$41.58 ,$122.85 
ST. FRANCIS HOSPITAL - ACUTE,43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$130.00 ,$84.50 ,$27.80 ,$130.00 ,$74.75 ,$93.60 ,$70.72 ,$28.60 ,$36.40 ,$72.93 ,$28.60 ,$84.76 ,$32.50 ,$84.76 ,$84.76 ,$32.50 ,$84.76 ,$54.34 ,$109.20 ,$56.63 ,$28.60 ,$110.50 ,$109.20 ,$28.60 ,$97.50 ,$104.00 ,$104.00 ,$28.60 ,$104.00 ,$109.20 ,$109.20 ,$109.20 ,$130.00 ,$117.00 ,$74.75 ,$130.00 ,$28.60 ,$130.00 ,$70.72 ,$28.60 ,$54.08 ,$29.13 ,$27.80 ,$30.03 ,$110.50 ,$84.76 ,$36.40 ,$117.00 ,$109.20 ,$104.00 ,$104.00 ,$28.60 ,$84.50 
ST. FRANCIS HOSPITAL - ACUTE,43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$271.00 ,$176.15 ,$59.62 ,$567.15 ,$155.83 ,$195.12 ,$147.42 ,$59.62 ,$75.88 ,$159.35 ,$59.62 ,$186.18 ,$67.75 ,$186.18 ,$186.18 ,$67.75 ,$186.18 ,$113.28 ,$227.64 ,$254.95 ,$59.62 ,$230.35 ,$227.64 ,$59.62 ,$203.25 ,$216.80 ,$216.80 ,$59.62 ,$216.80 ,$227.64 ,$227.64 ,$227.64 ,$271.00 ,$243.90 ,$155.83 ,$271.00 ,$59.62 ,$271.00 ,$147.42 ,$59.62 ,$112.74 ,$567.15 ,$541.37 ,$62.60 ,$230.35 ,$186.18 ,$75.88 ,$243.90 ,$227.64 ,$216.80 ,$216.80 ,$59.62 ,$176.15 
ST. FRANCIS HOSPITAL - ACUTE,43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$270.00 ,$175.50 ,$59.40 ,$567.15 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$158.76 ,$59.40 ,$185.49 ,$67.50 ,$185.49 ,$185.49 ,$67.50 ,$185.49 ,$112.86 ,$226.80 ,$254.95 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 ,$567.15 ,$541.37 ,$62.37 ,$229.50 ,$185.49 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$270.00 ,$175.50 ,$59.40 ,$567.15 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$158.76 ,$59.40 ,$185.49 ,$67.50 ,$185.49 ,$185.49 ,$67.50 ,$185.49 ,$112.86 ,$226.80 ,$254.95 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 ,$567.15 ,$541.37 ,$62.37 ,$229.50 ,$185.49 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$270.00 ,$175.50 ,$59.40 ,$567.15 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$158.76 ,$59.40 ,$185.49 ,$67.50 ,$185.49 ,$185.49 ,$67.50 ,$185.49 ,$112.86 ,$226.80 ,$254.95 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 ,$567.15 ,$541.37 ,$62.37 ,$229.50 ,$185.49 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$337.00 ,$219.05 ,$74.14 ,$567.15 ,$193.78 ,$242.64 ,$183.33 ,$74.14 ,$94.36 ,$198.16 ,$74.14 ,$231.52 ,$84.25 ,$231.52 ,$231.52 ,$84.25 ,$231.52 ,$140.87 ,$283.08 ,$254.95 ,$74.14 ,$286.45 ,$283.08 ,$74.14 ,$252.75 ,$269.60 ,$269.60 ,$74.14 ,$269.60 ,$283.08 ,$283.08 ,$283.08 ,$337.00 ,$303.30 ,$193.78 ,$337.00 ,$74.14 ,$337.00 ,$183.33 ,$74.14 ,$140.19 ,$567.15 ,$541.37 ,$77.85 ,$286.45 ,$231.52 ,$94.36 ,$303.30 ,$283.08 ,$269.60 ,$269.60 ,$74.14 ,$219.05 
ST. FRANCIS HOSPITAL - ACUTE,43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$337.00 ,$219.05 ,$74.14 ,$567.15 ,$193.78 ,$242.64 ,$183.33 ,$74.14 ,$94.36 ,$198.16 ,$74.14 ,$231.52 ,$84.25 ,$231.52 ,$231.52 ,$84.25 ,$231.52 ,$140.87 ,$283.08 ,$254.95 ,$74.14 ,$286.45 ,$283.08 ,$74.14 ,$252.75 ,$269.60 ,$269.60 ,$74.14 ,$269.60 ,$283.08 ,$283.08 ,$283.08 ,$337.00 ,$303.30 ,$193.78 ,$337.00 ,$74.14 ,$337.00 ,$183.33 ,$74.14 ,$140.19 ,$567.15 ,$541.37 ,$77.85 ,$286.45 ,$231.52 ,$94.36 ,$303.30 ,$283.08 ,$269.60 ,$269.60 ,$74.14 ,$219.05 
ST. FRANCIS HOSPITAL - ACUTE,43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$337.00 ,$219.05 ,$74.14 ,$567.15 ,$193.78 ,$242.64 ,$183.33 ,$74.14 ,$94.36 ,$198.16 ,$74.14 ,$231.52 ,$84.25 ,$231.52 ,$231.52 ,$84.25 ,$231.52 ,$140.87 ,$283.08 ,$254.95 ,$74.14 ,$286.45 ,$283.08 ,$74.14 ,$252.75 ,$269.60 ,$269.60 ,$74.14 ,$269.60 ,$283.08 ,$283.08 ,$283.08 ,$337.00 ,$303.30 ,$193.78 ,$337.00 ,$74.14 ,$337.00 ,$183.33 ,$74.14 ,$140.19 ,$567.15 ,$541.37 ,$77.85 ,$286.45 ,$231.52 ,$94.36 ,$303.30 ,$283.08 ,$269.60 ,$269.60 ,$74.14 ,$219.05 
ST. FRANCIS HOSPITAL - ACUTE,43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$337.00 ,$219.05 ,$74.14 ,$567.15 ,$193.78 ,$242.64 ,$183.33 ,$74.14 ,$94.36 ,$198.16 ,$74.14 ,$231.52 ,$84.25 ,$231.52 ,$231.52 ,$84.25 ,$231.52 ,$140.87 ,$283.08 ,$254.95 ,$74.14 ,$286.45 ,$283.08 ,$74.14 ,$252.75 ,$269.60 ,$269.60 ,$74.14 ,$269.60 ,$283.08 ,$283.08 ,$283.08 ,$337.00 ,$303.30 ,$193.78 ,$337.00 ,$74.14 ,$337.00 ,$183.33 ,$74.14 ,$140.19 ,$567.15 ,$541.37 ,$77.85 ,$286.45 ,$231.52 ,$94.36 ,$303.30 ,$283.08 ,$269.60 ,$269.60 ,$74.14 ,$219.05 
ST. FRANCIS HOSPITAL - ACUTE,43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$176.00 ,$114.40 ,$38.72 ,$567.15 ,$101.20 ,$126.72 ,$95.74 ,$38.72 ,$49.28 ,$103.49 ,$38.72 ,$120.91 ,$44.00 ,$120.91 ,$120.91 ,$44.00 ,$120.91 ,$73.57 ,$147.84 ,$174.38 ,$38.72 ,$149.60 ,$147.84 ,$38.72 ,$132.00 ,$140.80 ,$140.80 ,$38.72 ,$140.80 ,$147.84 ,$147.84 ,$147.84 ,$176.00 ,$158.40 ,$101.20 ,$176.00 ,$38.72 ,$176.00 ,$95.74 ,$38.72 ,$73.22 ,$567.15 ,$541.37 ,$40.66 ,$149.60 ,$120.91 ,$49.28 ,$158.40 ,$147.84 ,$140.80 ,$140.80 ,$38.72 ,$114.40 
ST. FRANCIS HOSPITAL - ACUTE,43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$176.00 ,$114.40 ,$38.72 ,$567.15 ,$101.20 ,$126.72 ,$95.74 ,$38.72 ,$49.28 ,$103.49 ,$38.72 ,$120.91 ,$44.00 ,$120.91 ,$120.91 ,$44.00 ,$120.91 ,$73.57 ,$147.84 ,$174.38 ,$38.72 ,$149.60 ,$147.84 ,$38.72 ,$132.00 ,$140.80 ,$140.80 ,$38.72 ,$140.80 ,$147.84 ,$147.84 ,$147.84 ,$176.00 ,$158.40 ,$101.20 ,$176.00 ,$38.72 ,$176.00 ,$95.74 ,$38.72 ,$73.22 ,$567.15 ,$541.37 ,$40.66 ,$149.60 ,$120.91 ,$49.28 ,$158.40 ,$147.84 ,$140.80 ,$140.80 ,$38.72 ,$114.40 
ST. FRANCIS HOSPITAL - ACUTE,43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$176.00 ,$114.40 ,$38.72 ,$567.15 ,$101.20 ,$126.72 ,$95.74 ,$38.72 ,$49.28 ,$103.49 ,$38.72 ,$120.91 ,$44.00 ,$120.91 ,$120.91 ,$44.00 ,$120.91 ,$73.57 ,$147.84 ,$174.38 ,$38.72 ,$149.60 ,$147.84 ,$38.72 ,$132.00 ,$140.80 ,$140.80 ,$38.72 ,$140.80 ,$147.84 ,$147.84 ,$147.84 ,$176.00 ,$158.40 ,$101.20 ,$176.00 ,$38.72 ,$176.00 ,$95.74 ,$38.72 ,$73.22 ,$567.15 ,$541.37 ,$40.66 ,$149.60 ,$120.91 ,$49.28 ,$158.40 ,$147.84 ,$140.80 ,$140.80 ,$38.72 ,$114.40 
ST. FRANCIS HOSPITAL - ACUTE,43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$176.00 ,$114.40 ,$38.72 ,$567.15 ,$101.20 ,$126.72 ,$95.74 ,$38.72 ,$49.28 ,$103.49 ,$38.72 ,$120.91 ,$44.00 ,$120.91 ,$120.91 ,$44.00 ,$120.91 ,$73.57 ,$147.84 ,$174.38 ,$38.72 ,$149.60 ,$147.84 ,$38.72 ,$132.00 ,$140.80 ,$140.80 ,$38.72 ,$140.80 ,$147.84 ,$147.84 ,$147.84 ,$176.00 ,$158.40 ,$101.20 ,$176.00 ,$38.72 ,$176.00 ,$95.74 ,$38.72 ,$73.22 ,$567.15 ,$541.37 ,$40.66 ,$149.60 ,$120.91 ,$49.28 ,$158.40 ,$147.84 ,$140.80 ,$140.80 ,$38.72 ,$114.40 
ST. FRANCIS HOSPITAL - ACUTE,44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$284.00 ,$184.60 ,$62.48 ,$284.00 ,$163.30 ,$204.48 ,$154.50 ,$62.48 ,$79.52 ,$166.99 ,$62.48 ,$195.11 ,$71.00 ,$195.11 ,$195.11 ,$71.00 ,$195.11 ,$118.71 ,$238.56 ,$193.83 ,$62.48 ,$241.40 ,$238.56 ,$62.48 ,$213.00 ,$227.20 ,$227.20 ,$62.48 ,$227.20 ,$238.56 ,$238.56 ,$238.56 ,$284.00 ,$255.60 ,$163.30 ,$284.00 ,$62.48 ,$284.00 ,$154.50 ,$62.48 ,$118.14 ,$263.53 ,$251.55 ,$65.60 ,$241.40 ,$195.11 ,$79.52 ,$255.60 ,$238.56 ,$227.20 ,$227.20 ,$62.48 ,$184.60 
ST. FRANCIS HOSPITAL - ACUTE,44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$284.00 ,$184.60 ,$62.48 ,$284.00 ,$163.30 ,$204.48 ,$154.50 ,$62.48 ,$79.52 ,$166.99 ,$62.48 ,$195.11 ,$71.00 ,$195.11 ,$195.11 ,$71.00 ,$195.11 ,$118.71 ,$238.56 ,$193.83 ,$62.48 ,$241.40 ,$238.56 ,$62.48 ,$213.00 ,$227.20 ,$227.20 ,$62.48 ,$227.20 ,$238.56 ,$238.56 ,$238.56 ,$284.00 ,$255.60 ,$163.30 ,$284.00 ,$62.48 ,$284.00 ,$154.50 ,$62.48 ,$118.14 ,$263.53 ,$251.55 ,$65.60 ,$241.40 ,$195.11 ,$79.52 ,$255.60 ,$238.56 ,$227.20 ,$227.20 ,$62.48 ,$184.60 
ST. FRANCIS HOSPITAL - ACUTE,44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$284.00 ,$184.60 ,$62.48 ,$284.00 ,$163.30 ,$204.48 ,$154.50 ,$62.48 ,$79.52 ,$166.99 ,$62.48 ,$195.11 ,$71.00 ,$195.11 ,$195.11 ,$71.00 ,$195.11 ,$118.71 ,$238.56 ,$193.83 ,$62.48 ,$241.40 ,$238.56 ,$62.48 ,$213.00 ,$227.20 ,$227.20 ,$62.48 ,$227.20 ,$238.56 ,$238.56 ,$238.56 ,$284.00 ,$255.60 ,$163.30 ,$284.00 ,$62.48 ,$284.00 ,$154.50 ,$62.48 ,$118.14 ,$263.53 ,$251.55 ,$65.60 ,$241.40 ,$195.11 ,$79.52 ,$255.60 ,$238.56 ,$227.20 ,$227.20 ,$62.48 ,$184.60 
ST. FRANCIS HOSPITAL - ACUTE,44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$284.00 ,$184.60 ,$62.48 ,$284.00 ,$163.30 ,$204.48 ,$154.50 ,$62.48 ,$79.52 ,$166.99 ,$62.48 ,$195.11 ,$71.00 ,$195.11 ,$195.11 ,$71.00 ,$195.11 ,$118.71 ,$238.56 ,$193.83 ,$62.48 ,$241.40 ,$238.56 ,$62.48 ,$213.00 ,$227.20 ,$227.20 ,$62.48 ,$227.20 ,$238.56 ,$238.56 ,$238.56 ,$284.00 ,$255.60 ,$163.30 ,$284.00 ,$62.48 ,$284.00 ,$154.50 ,$62.48 ,$118.14 ,$263.53 ,$251.55 ,$65.60 ,$241.40 ,$195.11 ,$79.52 ,$255.60 ,$238.56 ,$227.20 ,$227.20 ,$62.48 ,$184.60 
ST. FRANCIS HOSPITAL - ACUTE,44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$156.00 ,$101.40 ,$34.32 ,$263.53 ,$89.70 ,$112.32 ,$84.86 ,$34.32 ,$43.68 ,$91.73 ,$34.32 ,$107.17 ,$39.00 ,$107.17 ,$107.17 ,$39.00 ,$107.17 ,$65.21 ,$131.04 ,$214.40 ,$34.32 ,$132.60 ,$131.04 ,$34.32 ,$117.00 ,$124.80 ,$124.80 ,$34.32 ,$124.80 ,$131.04 ,$131.04 ,$131.04 ,$156.00 ,$140.40 ,$89.70 ,$156.00 ,$34.32 ,$156.00 ,$84.86 ,$34.32 ,$64.90 ,$263.53 ,$251.55 ,$36.04 ,$132.60 ,$107.17 ,$43.68 ,$140.40 ,$131.04 ,$124.80 ,$124.80 ,$34.32 ,$101.40 
ST. FRANCIS HOSPITAL - ACUTE,44000037,92526,HC SPEECH THERAPY TREATMENT DYSPHAGIA 90MIN,440,1 ,$938.00 ,$609.70 ,$206.36 ,$938.00 ,$539.35 ,$675.36 ,$510.27 ,$206.36 ,$262.64 ,$551.54 ,$206.36 ,$644.41 ,$234.50 ,$644.41 ,$644.41 ,$234.50 ,$644.41 ,$392.08 ,$787.92 ,$214.40 ,$206.36 ,$797.30 ,$787.92 ,$206.36 ,$703.50 ,$750.40 ,$750.40 ,$206.36 ,$750.40 ,$787.92 ,$787.92 ,$787.92 ,$938.00 ,$844.20 ,$539.35 ,$938.00 ,$206.36 ,$938.00 ,$510.27 ,$206.36 ,$390.21 ,$263.53 ,$251.55 ,$216.68 ,$797.30 ,$644.41 ,$262.64 ,$844.20 ,$787.92 ,$750.40 ,$750.40 ,$206.36 ,$609.70 
ST. FRANCIS HOSPITAL - ACUTE,44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$294.00 ,$191.10 ,$64.68 ,$294.00 ,$169.05 ,$211.68 ,$159.94 ,$64.68 ,$82.32 ,$172.87 ,$64.68 ,$201.98 ,$73.50 ,$201.98 ,$201.98 ,$73.50 ,$201.98 ,$122.89 ,$246.96 ,$216.25 ,$64.68 ,$249.90 ,$246.96 ,$64.68 ,$220.50 ,$235.20 ,$235.20 ,$64.68 ,$235.20 ,$246.96 ,$246.96 ,$246.96 ,$294.00 ,$264.60 ,$169.05 ,$294.00 ,$64.68 ,$294.00 ,$159.94 ,$64.68 ,$122.30 ,$263.53 ,$251.55 ,$67.91 ,$249.90 ,$201.98 ,$82.32 ,$264.60 ,$246.96 ,$235.20 ,$235.20 ,$64.68 ,$191.10 
ST. FRANCIS HOSPITAL - ACUTE,44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$352.00 ,$228.80 ,$77.44 ,$352.00 ,$202.40 ,$253.44 ,$191.49 ,$77.44 ,$98.56 ,$206.98 ,$77.44 ,$241.82 ,$88.00 ,$241.82 ,$241.82 ,$88.00 ,$241.82 ,$147.14 ,$295.68 ,$216.25 ,$77.44 ,$299.20 ,$295.68 ,$77.44 ,$264.00 ,$281.60 ,$281.60 ,$77.44 ,$281.60 ,$295.68 ,$295.68 ,$295.68 ,$352.00 ,$316.80 ,$202.40 ,$352.00 ,$77.44 ,$352.00 ,$191.49 ,$77.44 ,$146.43 ,$263.53 ,$251.55 ,$81.31 ,$299.20 ,$241.82 ,$98.56 ,$316.80 ,$295.68 ,$281.60 ,$281.60 ,$77.44 ,$228.80 
ST. FRANCIS HOSPITAL - ACUTE,44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$423.00 ,$274.95 ,$93.06 ,$423.00 ,$243.23 ,$304.56 ,$230.11 ,$93.06 ,$118.44 ,$248.72 ,$93.06 ,$290.60 ,$105.75 ,$290.60 ,$290.60 ,$105.75 ,$290.60 ,$176.81 ,$355.32 ,$216.25 ,$93.06 ,$359.55 ,$355.32 ,$93.06 ,$317.25 ,$338.40 ,$338.40 ,$93.06 ,$338.40 ,$355.32 ,$355.32 ,$355.32 ,$423.00 ,$380.70 ,$243.23 ,$423.00 ,$93.06 ,$423.00 ,$230.11 ,$93.06 ,$175.97 ,$263.53 ,$251.55 ,$97.71 ,$359.55 ,$290.60 ,$118.44 ,$380.70 ,$355.32 ,$338.40 ,$338.40 ,$93.06 ,$274.95 
ST. FRANCIS HOSPITAL - ACUTE,44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$507.00 ,$329.55 ,$111.54 ,$507.00 ,$291.53 ,$365.04 ,$275.81 ,$111.54 ,$141.96 ,$298.12 ,$111.54 ,$348.31 ,$126.75 ,$348.31 ,$348.31 ,$126.75 ,$348.31 ,$211.93 ,$425.88 ,$216.25 ,$111.54 ,$430.95 ,$425.88 ,$111.54 ,$380.25 ,$405.60 ,$405.60 ,$111.54 ,$405.60 ,$425.88 ,$425.88 ,$425.88 ,$507.00 ,$456.30 ,$291.53 ,$507.00 ,$111.54 ,$507.00 ,$275.81 ,$111.54 ,$210.91 ,$263.53 ,$251.55 ,$117.12 ,$430.95 ,$348.31 ,$141.96 ,$456.30 ,$425.88 ,$405.60 ,$405.60 ,$111.54 ,$329.55 
ST. FRANCIS HOSPITAL - ACUTE,44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$280.00 ,$182.00 ,$56.05 ,$280.00 ,$161.00 ,$201.60 ,$152.32 ,$61.60 ,$78.40 ,$164.64 ,$61.60 ,$192.36 ,$70.00 ,$192.36 ,$192.36 ,$70.00 ,$192.36 ,$117.04 ,$235.20 ,$233.18 ,$61.60 ,$238.00 ,$235.20 ,$61.60 ,$210.00 ,$224.00 ,$224.00 ,$61.60 ,$224.00 ,$235.20 ,$235.20 ,$235.20 ,$280.00 ,$252.00 ,$161.00 ,$280.00 ,$61.60 ,$280.00 ,$152.32 ,$61.60 ,$116.48 ,$58.72 ,$56.05 ,$64.68 ,$238.00 ,$192.36 ,$78.40 ,$252.00 ,$235.20 ,$224.00 ,$224.00 ,$61.60 ,$182.00 
ST. FRANCIS HOSPITAL - ACUTE,44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$465.00 ,$302.25 ,$102.30 ,$571.95 ,$267.38 ,$334.80 ,$252.96 ,$102.30 ,$130.20 ,$273.42 ,$102.30 ,$319.46 ,$116.25 ,$319.46 ,$319.46 ,$116.25 ,$319.46 ,$194.37 ,$390.60 ,$571.95 ,$102.30 ,$395.25 ,$390.60 ,$102.30 ,$348.75 ,$372.00 ,$372.00 ,$102.30 ,$372.00 ,$390.60 ,$390.60 ,$390.60 ,$465.00 ,$418.50 ,$267.38 ,$465.00 ,$102.30 ,$465.00 ,$252.96 ,$102.30 ,$193.44 ,$263.53 ,$251.55 ,$107.42 ,$395.25 ,$319.46 ,$130.20 ,$418.50 ,$390.60 ,$372.00 ,$372.00 ,$102.30 ,$302.25 
ST. FRANCIS HOSPITAL - ACUTE,44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$465.00 ,$302.25 ,$102.30 ,$571.95 ,$267.38 ,$334.80 ,$252.96 ,$102.30 ,$130.20 ,$273.42 ,$102.30 ,$319.46 ,$116.25 ,$319.46 ,$319.46 ,$116.25 ,$319.46 ,$194.37 ,$390.60 ,$571.95 ,$102.30 ,$395.25 ,$390.60 ,$102.30 ,$348.75 ,$372.00 ,$372.00 ,$102.30 ,$372.00 ,$390.60 ,$390.60 ,$390.60 ,$465.00 ,$418.50 ,$267.38 ,$465.00 ,$102.30 ,$465.00 ,$252.96 ,$102.30 ,$193.44 ,$263.53 ,$251.55 ,$107.42 ,$395.25 ,$319.46 ,$130.20 ,$418.50 ,$390.60 ,$372.00 ,$372.00 ,$102.30 ,$302.25 
ST. FRANCIS HOSPITAL - ACUTE,44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$465.00 ,$302.25 ,$102.30 ,$571.95 ,$267.38 ,$334.80 ,$252.96 ,$102.30 ,$130.20 ,$273.42 ,$102.30 ,$319.46 ,$116.25 ,$319.46 ,$319.46 ,$116.25 ,$319.46 ,$194.37 ,$390.60 ,$571.95 ,$102.30 ,$395.25 ,$390.60 ,$102.30 ,$348.75 ,$372.00 ,$372.00 ,$102.30 ,$372.00 ,$390.60 ,$390.60 ,$390.60 ,$465.00 ,$418.50 ,$267.38 ,$465.00 ,$102.30 ,$465.00 ,$252.96 ,$102.30 ,$193.44 ,$263.53 ,$251.55 ,$107.42 ,$395.25 ,$319.46 ,$130.20 ,$418.50 ,$390.60 ,$372.00 ,$372.00 ,$102.30 ,$302.25 
ST. FRANCIS HOSPITAL - ACUTE,44400086,92610,HC DYSPHAGIA EVALUATION 75MIN,444,1 ,$609.00 ,$395.85 ,$133.98 ,$609.00 ,$350.18 ,$438.48 ,$331.30 ,$133.98 ,$170.52 ,$358.09 ,$133.98 ,$418.38 ,$152.25 ,$418.38 ,$418.38 ,$152.25 ,$418.38 ,$254.56 ,$511.56 ,$216.25 ,$133.98 ,$517.65 ,$511.56 ,$133.98 ,$456.75 ,$487.20 ,$487.20 ,$133.98 ,$487.20 ,$511.56 ,$511.56 ,$511.56 ,$609.00 ,$548.10 ,$350.18 ,$609.00 ,$133.98 ,$609.00 ,$331.30 ,$133.98 ,$253.34 ,$263.53 ,$251.55 ,$140.68 ,$517.65 ,$418.38 ,$170.52 ,$548.10 ,$511.56 ,$487.20 ,$487.20 ,$133.98 ,$395.85 
ST. FRANCIS HOSPITAL - ACUTE,44400094,92597,HC VOICE PROST EVAL/FITTING 15MIN,444,1 ,$156.00 ,$101.40 ,$34.32 ,$263.53 ,$89.70 ,$112.32 ,$84.86 ,$34.32 ,$43.68 ,$91.73 ,$34.32 ,$107.17 ,$39.00 ,$107.17 ,$107.17 ,$39.00 ,$107.17 ,$65.21 ,$131.04 ,$184.28 ,$34.32 ,$132.60 ,$131.04 ,$34.32 ,$117.00 ,$124.80 ,$124.80 ,$34.32 ,$124.80 ,$131.04 ,$131.04 ,$131.04 ,$156.00 ,$140.40 ,$89.70 ,$156.00 ,$34.32 ,$156.00 ,$84.86 ,$34.32 ,$64.90 ,$263.53 ,$251.55 ,$36.04 ,$132.60 ,$107.17 ,$43.68 ,$140.40 ,$131.04 ,$124.80 ,$124.80 ,$34.32 ,$101.40 
ST. FRANCIS HOSPITAL - ACUTE,44400095,92597,HC VOICE PROST EVAL/FITTING 30MIN,444,1 ,$156.00 ,$101.40 ,$34.32 ,$263.53 ,$89.70 ,$112.32 ,$84.86 ,$34.32 ,$43.68 ,$91.73 ,$34.32 ,$107.17 ,$39.00 ,$107.17 ,$107.17 ,$39.00 ,$107.17 ,$65.21 ,$131.04 ,$184.28 ,$34.32 ,$132.60 ,$131.04 ,$34.32 ,$117.00 ,$124.80 ,$124.80 ,$34.32 ,$124.80 ,$131.04 ,$131.04 ,$131.04 ,$156.00 ,$140.40 ,$89.70 ,$156.00 ,$34.32 ,$156.00 ,$84.86 ,$34.32 ,$64.90 ,$263.53 ,$251.55 ,$36.04 ,$132.60 ,$107.17 ,$43.68 ,$140.40 ,$131.04 ,$124.80 ,$124.80 ,$34.32 ,$101.40 
ST. FRANCIS HOSPITAL - ACUTE,44400096,92597,HC VOICE PROST EVAL/FITTING 45MIN,444,1 ,$156.00 ,$101.40 ,$34.32 ,$263.53 ,$89.70 ,$112.32 ,$84.86 ,$34.32 ,$43.68 ,$91.73 ,$34.32 ,$107.17 ,$39.00 ,$107.17 ,$107.17 ,$39.00 ,$107.17 ,$65.21 ,$131.04 ,$184.28 ,$34.32 ,$132.60 ,$131.04 ,$34.32 ,$117.00 ,$124.80 ,$124.80 ,$34.32 ,$124.80 ,$131.04 ,$131.04 ,$131.04 ,$156.00 ,$140.40 ,$89.70 ,$156.00 ,$34.32 ,$156.00 ,$84.86 ,$34.32 ,$64.90 ,$263.53 ,$251.55 ,$36.04 ,$132.60 ,$107.17 ,$43.68 ,$140.40 ,$131.04 ,$124.80 ,$124.80 ,$34.32 ,$101.40 
ST. FRANCIS HOSPITAL - ACUTE,44400097,92597,HC VOICE PROST EVAL/FITTING 60MIN,444,1 ,$156.00 ,$101.40 ,$34.32 ,$263.53 ,$89.70 ,$112.32 ,$84.86 ,$34.32 ,$43.68 ,$91.73 ,$34.32 ,$107.17 ,$39.00 ,$107.17 ,$107.17 ,$39.00 ,$107.17 ,$65.21 ,$131.04 ,$184.28 ,$34.32 ,$132.60 ,$131.04 ,$34.32 ,$117.00 ,$124.80 ,$124.80 ,$34.32 ,$124.80 ,$131.04 ,$131.04 ,$131.04 ,$156.00 ,$140.40 ,$89.70 ,$156.00 ,$34.32 ,$156.00 ,$84.86 ,$34.32 ,$64.90 ,$263.53 ,$251.55 ,$36.04 ,$132.60 ,$107.17 ,$43.68 ,$140.40 ,$131.04 ,$124.80 ,$124.80 ,$34.32 ,$101.40 
ST. FRANCIS HOSPITAL - ACUTE,45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$371.00 ,$241.15 ,$81.62 ,$882.50 ,$213.33 ,$267.12 ,$201.82 ,$81.62 ,$103.88 ,$208.13 ,$81.62 ,$241.89 ,$92.75 ,$241.89 ,$241.89 ,$92.75 ,$241.89 ,$155.08 ,$311.64 ,$882.50 ,$81.62 ,$315.35 ,$311.64 ,$81.62 ,$278.25 ,$296.80 ,$296.80 ,$81.62 ,$296.80 ,$311.64 ,$311.64 ,$311.64 ,$371.00 ,$333.90 ,$213.33 ,$371.00 ,$81.62 ,$371.00 ,$201.82 ,$81.62 ,$154.34 , N/A , N/A ,$85.70 ,$315.35 ,$241.89 ,$103.88 ,$333.90 ,$311.64 ,$296.80 ,$296.80 ,$81.62 ,$241.15 
ST. FRANCIS HOSPITAL - ACUTE,45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$324.00 ,$210.60 ,$71.28 ,"$1,588.85 ",$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,"$1,588.85 ",$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000004,10081,HC I AND D CYST PILONIDAL CPLX,450,1 ,"$1,982.00 ","$1,288.30 ",$436.04 ,"$1,982.00 ","$1,139.65 ","$1,427.04 ","$1,078.21 ",$436.04 ,$554.96 ,"$1,111.90 ",$436.04 ,"$1,292.26 ",$495.50 ,"$1,292.26 ","$1,292.26 ",$495.50 ,"$1,292.26 ",$828.48 ,"$1,664.88 ","$1,588.85 ",$436.04 ,"$1,684.70 ","$1,664.88 ",$436.04 ,"$1,486.50 ","$1,585.60 ","$1,585.60 ",$436.04 ,"$1,585.60 ","$1,664.88 ","$1,664.88 ","$1,664.88 ","$1,982.00 ","$1,783.80 ","$1,139.65 ","$1,982.00 ",$436.04 ,"$1,982.00 ","$1,078.21 ",$436.04 ,$824.51 , N/A , N/A ,$457.84 ,"$1,684.70 ","$1,292.26 ",$554.96 ,"$1,783.80 ","$1,664.88 ","$1,585.60 ","$1,585.60 ",$436.04 ,"$1,288.30 "
ST. FRANCIS HOSPITAL - ACUTE,45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$274.00 ,$178.10 ,$60.28 ,$882.50 ,$157.55 ,$197.28 ,$149.06 ,$60.28 ,$76.72 ,$153.71 ,$60.28 ,$178.65 ,$68.50 ,$178.65 ,$178.65 ,$68.50 ,$178.65 ,$114.53 ,$230.16 ,$882.50 ,$60.28 ,$232.90 ,$230.16 ,$60.28 ,$205.50 ,$219.20 ,$219.20 ,$60.28 ,$219.20 ,$230.16 ,$230.16 ,$230.16 ,$274.00 ,$246.60 ,$157.55 ,$274.00 ,$60.28 ,$274.00 ,$149.06 ,$60.28 ,$113.98 , N/A , N/A ,$63.29 ,$232.90 ,$178.65 ,$76.72 ,$246.60 ,$230.16 ,$219.20 ,$219.20 ,$60.28 ,$178.10 
ST. FRANCIS HOSPITAL - ACUTE,45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$415.00 ,$269.75 ,$91.30 ,$458.50 ,$238.63 ,$298.80 ,$225.76 ,$91.30 ,$116.20 ,$232.82 ,$91.30 ,$270.58 ,$103.75 ,$270.58 ,$270.58 ,$103.75 ,$270.58 ,$173.47 ,$348.60 ,$458.50 ,$91.30 ,$352.75 ,$348.60 ,$91.30 ,$311.25 ,$332.00 ,$332.00 ,$91.30 ,$332.00 ,$348.60 ,$348.60 ,$348.60 ,$415.00 ,$373.50 ,$238.63 ,$415.00 ,$91.30 ,$415.00 ,$225.76 ,$91.30 ,$172.64 , N/A , N/A ,$95.87 ,$352.75 ,$270.58 ,$116.20 ,$373.50 ,$348.60 ,$332.00 ,$332.00 ,$91.30 ,$269.75 
ST. FRANCIS HOSPITAL - ACUTE,45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$160.00 ,$104.00 ,$35.20 ,$287.90 ,$92.00 ,$115.20 ,$87.04 ,$35.20 ,$44.80 ,$89.76 ,$35.20 ,$104.32 ,$40.00 ,$104.32 ,$104.32 ,$40.00 ,$104.32 ,$66.88 ,$134.40 ,$287.90 ,$35.20 ,$136.00 ,$134.40 ,$35.20 ,$120.00 ,$128.00 ,$128.00 ,$35.20 ,$128.00 ,$134.40 ,$134.40 ,$134.40 ,$160.00 ,$144.00 ,$92.00 ,$160.00 ,$35.20 ,$160.00 ,$87.04 ,$35.20 ,$66.56 , N/A , N/A ,$36.96 ,$136.00 ,$104.32 ,$44.80 ,$144.00 ,$134.40 ,$128.00 ,$128.00 ,$35.20 ,$104.00 
ST. FRANCIS HOSPITAL - ACUTE,45000012,11760,HC REPAIR NAIL BED,450,1 ,$332.00 ,$215.80 ,$73.04 ,"$1,337.23 ",$190.90 ,$239.04 ,$180.61 ,$73.04 ,$92.96 ,$186.25 ,$73.04 ,$216.46 ,$83.00 ,$216.46 ,$216.46 ,$83.00 ,$216.46 ,$138.78 ,$278.88 ,"$1,337.23 ",$73.04 ,$282.20 ,$278.88 ,$73.04 ,$249.00 ,$265.60 ,$265.60 ,$73.04 ,$265.60 ,$278.88 ,$278.88 ,$278.88 ,$332.00 ,$298.80 ,$190.90 ,$332.00 ,$73.04 ,$332.00 ,$180.61 ,$73.04 ,$138.11 , N/A , N/A ,$76.69 ,$282.20 ,$216.46 ,$92.96 ,$298.80 ,$278.88 ,$265.60 ,$265.60 ,$73.04 ,$215.80 
ST. FRANCIS HOSPITAL - ACUTE,45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$82.00 ,$53.30 ,$18.04 ,$458.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$458.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$82.00 ,$53.30 ,$18.04 ,$458.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$458.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$100.00 ,$65.00 ,$22.00 ,$458.50 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$56.10 ,$22.00 ,$65.20 ,$25.00 ,$65.20 ,$65.20 ,$25.00 ,$65.20 ,$41.80 ,$84.00 ,$458.50 ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 , N/A , N/A ,$23.10 ,$85.00 ,$65.20 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$142.00 ,$92.30 ,$31.24 ,$882.50 ,$81.65 ,$102.24 ,$77.25 ,$31.24 ,$39.76 ,$79.66 ,$31.24 ,$92.58 ,$35.50 ,$92.58 ,$92.58 ,$35.50 ,$92.58 ,$59.36 ,$119.28 ,$882.50 ,$31.24 ,$120.70 ,$119.28 ,$31.24 ,$106.50 ,$113.60 ,$113.60 ,$31.24 ,$113.60 ,$119.28 ,$119.28 ,$119.28 ,$142.00 ,$127.80 ,$81.65 ,$142.00 ,$31.24 ,$142.00 ,$77.25 ,$31.24 ,$59.07 , N/A , N/A ,$32.80 ,$120.70 ,$92.58 ,$39.76 ,$127.80 ,$119.28 ,$113.60 ,$113.60 ,$31.24 ,$92.30 
ST. FRANCIS HOSPITAL - ACUTE,45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$155.00 ,$100.75 ,$34.10 ,$882.50 ,$89.13 ,$111.60 ,$84.32 ,$34.10 ,$43.40 ,$86.96 ,$34.10 ,$101.06 ,$38.75 ,$101.06 ,$101.06 ,$38.75 ,$101.06 ,$64.79 ,$130.20 ,$882.50 ,$34.10 ,$131.75 ,$130.20 ,$34.10 ,$116.25 ,$124.00 ,$124.00 ,$34.10 ,$124.00 ,$130.20 ,$130.20 ,$130.20 ,$155.00 ,$139.50 ,$89.13 ,$155.00 ,$34.10 ,$155.00 ,$84.32 ,$34.10 ,$64.48 , N/A , N/A ,$35.81 ,$131.75 ,$101.06 ,$43.40 ,$139.50 ,$130.20 ,$124.00 ,$124.00 ,$34.10 ,$100.75 
ST. FRANCIS HOSPITAL - ACUTE,45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$510.00 ,$331.50 ,$112.20 ,$510.00 ,$293.25 ,$367.20 ,$277.44 ,$112.20 ,$142.80 ,$286.11 ,$112.20 ,$332.52 ,$127.50 ,$332.52 ,$332.52 ,$127.50 ,$332.52 ,$213.18 ,$428.40 ,$458.50 ,$112.20 ,$433.50 ,$428.40 ,$112.20 ,$382.50 ,$408.00 ,$408.00 ,$112.20 ,$408.00 ,$428.40 ,$428.40 ,$428.40 ,$510.00 ,$459.00 ,$293.25 ,$510.00 ,$112.20 ,$510.00 ,$277.44 ,$112.20 ,$212.16 , N/A , N/A ,$117.81 ,$433.50 ,$332.52 ,$142.80 ,$459.00 ,$428.40 ,$408.00 ,$408.00 ,$112.20 ,$331.50 
ST. FRANCIS HOSPITAL - ACUTE,45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$82.00 ,$53.30 ,$18.04 ,$458.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$458.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$91.00 ,$59.15 ,$20.02 ,$458.50 ,$52.33 ,$65.52 ,$49.50 ,$20.02 ,$25.48 ,$51.05 ,$20.02 ,$59.33 ,$22.75 ,$59.33 ,$59.33 ,$22.75 ,$59.33 ,$38.04 ,$76.44 ,$458.50 ,$20.02 ,$77.35 ,$76.44 ,$20.02 ,$68.25 ,$72.80 ,$72.80 ,$20.02 ,$72.80 ,$76.44 ,$76.44 ,$76.44 ,$91.00 ,$81.90 ,$52.33 ,$91.00 ,$20.02 ,$91.00 ,$49.50 ,$20.02 ,$37.86 , N/A , N/A ,$21.02 ,$77.35 ,$59.33 ,$25.48 ,$81.90 ,$76.44 ,$72.80 ,$72.80 ,$20.02 ,$59.15 
ST. FRANCIS HOSPITAL - ACUTE,45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$100.00 ,$65.00 ,$22.00 ,$458.50 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$56.10 ,$22.00 ,$65.20 ,$25.00 ,$65.20 ,$65.20 ,$25.00 ,$65.20 ,$41.80 ,$84.00 ,$458.50 ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 , N/A , N/A ,$23.10 ,$85.00 ,$65.20 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$109.00 ,$70.85 ,$23.98 ,$458.50 ,$62.68 ,$78.48 ,$59.30 ,$23.98 ,$30.52 ,$61.15 ,$23.98 ,$71.07 ,$27.25 ,$71.07 ,$71.07 ,$27.25 ,$71.07 ,$45.56 ,$91.56 ,$458.50 ,$23.98 ,$92.65 ,$91.56 ,$23.98 ,$81.75 ,$87.20 ,$87.20 ,$23.98 ,$87.20 ,$91.56 ,$91.56 ,$91.56 ,$109.00 ,$98.10 ,$62.68 ,$109.00 ,$23.98 ,$109.00 ,$59.30 ,$23.98 ,$45.34 , N/A , N/A ,$25.18 ,$92.65 ,$71.07 ,$30.52 ,$98.10 ,$91.56 ,$87.20 ,$87.20 ,$23.98 ,$70.85 
ST. FRANCIS HOSPITAL - ACUTE,45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$82.00 ,$53.30 ,$18.04 ,$882.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$882.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$82.00 ,$53.30 ,$18.04 ,$882.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$882.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$100.00 ,$65.00 ,$22.00 ,$882.50 ,$57.50 ,$72.00 ,$54.40 ,$22.00 ,$28.00 ,$56.10 ,$22.00 ,$65.20 ,$25.00 ,$65.20 ,$65.20 ,$25.00 ,$65.20 ,$41.80 ,$84.00 ,$882.50 ,$22.00 ,$85.00 ,$84.00 ,$22.00 ,$75.00 ,$80.00 ,$80.00 ,$22.00 ,$80.00 ,$84.00 ,$84.00 ,$84.00 ,$100.00 ,$90.00 ,$57.50 ,$100.00 ,$22.00 ,$100.00 ,$54.40 ,$22.00 ,$41.60 , N/A , N/A ,$23.10 ,$85.00 ,$65.20 ,$28.00 ,$90.00 ,$84.00 ,$80.00 ,$80.00 ,$22.00 ,$65.00 
ST. FRANCIS HOSPITAL - ACUTE,45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$82.00 ,$53.30 ,$18.04 ,$882.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$882.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$82.00 ,$53.30 ,$18.04 ,$882.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$882.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$92.00 ,$59.80 ,$20.24 ,"$1,337.23 ",$52.90 ,$66.24 ,$50.05 ,$20.24 ,$25.76 ,$51.61 ,$20.24 ,$59.98 ,$23.00 ,$59.98 ,$59.98 ,$23.00 ,$59.98 ,$38.46 ,$77.28 ,"$1,337.23 ",$20.24 ,$78.20 ,$77.28 ,$20.24 ,$69.00 ,$73.60 ,$73.60 ,$20.24 ,$73.60 ,$77.28 ,$77.28 ,$77.28 ,$92.00 ,$82.80 ,$52.90 ,$92.00 ,$20.24 ,$92.00 ,$50.05 ,$20.24 ,$38.27 , N/A , N/A ,$21.25 ,$78.20 ,$59.98 ,$25.76 ,$82.80 ,$77.28 ,$73.60 ,$73.60 ,$20.24 ,$59.80 
ST. FRANCIS HOSPITAL - ACUTE,45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$82.00 ,$53.30 ,$18.04 ,$882.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$882.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$82.00 ,$53.30 ,$18.04 ,$882.50 ,$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,$882.50 ,$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,$82.00 ,$53.30 ,$18.04 ,"$1,337.23 ",$47.15 ,$59.04 ,$44.61 ,$18.04 ,$22.96 ,$46.00 ,$18.04 ,$53.46 ,$20.50 ,$53.46 ,$53.46 ,$20.50 ,$53.46 ,$34.28 ,$68.88 ,"$1,337.23 ",$18.04 ,$69.70 ,$68.88 ,$18.04 ,$61.50 ,$65.60 ,$65.60 ,$18.04 ,$65.60 ,$68.88 ,$68.88 ,$68.88 ,$82.00 ,$73.80 ,$47.15 ,$82.00 ,$18.04 ,$82.00 ,$44.61 ,$18.04 ,$34.11 , N/A , N/A ,$18.94 ,$69.70 ,$53.46 ,$22.96 ,$73.80 ,$68.88 ,$65.60 ,$65.60 ,$18.04 ,$53.30 
ST. FRANCIS HOSPITAL - ACUTE,45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,$86.00 ,$55.90 ,$18.92 ,"$1,337.23 ",$49.45 ,$61.92 ,$46.78 ,$18.92 ,$24.08 ,$48.25 ,$18.92 ,$56.07 ,$21.50 ,$56.07 ,$56.07 ,$21.50 ,$56.07 ,$35.95 ,$72.24 ,"$1,337.23 ",$18.92 ,$73.10 ,$72.24 ,$18.92 ,$64.50 ,$68.80 ,$68.80 ,$18.92 ,$68.80 ,$72.24 ,$72.24 ,$72.24 ,$86.00 ,$77.40 ,$49.45 ,$86.00 ,$18.92 ,$86.00 ,$46.78 ,$18.92 ,$35.78 , N/A , N/A ,$19.87 ,$73.10 ,$56.07 ,$24.08 ,$77.40 ,$72.24 ,$68.80 ,$68.80 ,$18.92 ,$55.90 
ST. FRANCIS HOSPITAL - ACUTE,45000054,13131,HC CMPLX F/C/C/M/N/A/G/H/F 1.1-2.5 CM,450,1 ,$113.00 ,$73.45 ,$24.86 ,$882.50 ,$64.98 ,$81.36 ,$61.47 ,$24.86 ,$31.64 ,$63.39 ,$24.86 ,$73.68 ,$28.25 ,$73.68 ,$73.68 ,$28.25 ,$73.68 ,$47.23 ,$94.92 ,$882.50 ,$24.86 ,$96.05 ,$94.92 ,$24.86 ,$84.75 ,$90.40 ,$90.40 ,$24.86 ,$90.40 ,$94.92 ,$94.92 ,$94.92 ,$113.00 ,$101.70 ,$64.98 ,$113.00 ,$24.86 ,$113.00 ,$61.47 ,$24.86 ,$47.01 , N/A , N/A ,$26.10 ,$96.05 ,$73.68 ,$31.64 ,$101.70 ,$94.92 ,$90.40 ,$90.40 ,$24.86 ,$73.45 
ST. FRANCIS HOSPITAL - ACUTE,45000055,13132,HC CMPLX F/C/C/M/N/A/G/H/F 2.6-7.5 CM,450,1 ,$113.00 ,$73.45 ,$24.86 ,"$1,337.23 ",$64.98 ,$81.36 ,$61.47 ,$24.86 ,$31.64 ,$63.39 ,$24.86 ,$73.68 ,$28.25 ,$73.68 ,$73.68 ,$28.25 ,$73.68 ,$47.23 ,$94.92 ,"$1,337.23 ",$24.86 ,$96.05 ,$94.92 ,$24.86 ,$84.75 ,$90.40 ,$90.40 ,$24.86 ,$90.40 ,$94.92 ,$94.92 ,$94.92 ,$113.00 ,$101.70 ,$64.98 ,$113.00 ,$24.86 ,$113.00 ,$61.47 ,$24.86 ,$47.01 , N/A , N/A ,$26.10 ,$96.05 ,$73.68 ,$31.64 ,$101.70 ,$94.92 ,$90.40 ,$90.40 ,$24.86 ,$73.45 
ST. FRANCIS HOSPITAL - ACUTE,45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,$113.00 ,$73.45 ,$24.86 ,"$1,337.23 ",$64.98 ,$81.36 ,$61.47 ,$24.86 ,$31.64 ,$63.39 ,$24.86 ,$73.68 ,$28.25 ,$73.68 ,$73.68 ,$28.25 ,$73.68 ,$47.23 ,$94.92 ,"$1,337.23 ",$24.86 ,$96.05 ,$94.92 ,$24.86 ,$84.75 ,$90.40 ,$90.40 ,$24.86 ,$90.40 ,$94.92 ,$94.92 ,$94.92 ,$113.00 ,$101.70 ,$64.98 ,$113.00 ,$24.86 ,$113.00 ,$61.47 ,$24.86 ,$47.01 , N/A , N/A ,$26.10 ,$96.05 ,$73.68 ,$31.64 ,$101.70 ,$94.92 ,$90.40 ,$90.40 ,$24.86 ,$73.45 
ST. FRANCIS HOSPITAL - ACUTE,45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,$113.00 ,$73.45 ,$24.86 ,"$1,337.23 ",$64.98 ,$81.36 ,$61.47 ,$24.86 ,$31.64 ,$63.39 ,$24.86 ,$73.68 ,$28.25 ,$73.68 ,$73.68 ,$28.25 ,$73.68 ,$47.23 ,$94.92 ,"$1,337.23 ",$24.86 ,$96.05 ,$94.92 ,$24.86 ,$84.75 ,$90.40 ,$90.40 ,$24.86 ,$90.40 ,$94.92 ,$94.92 ,$94.92 ,$113.00 ,$101.70 ,$64.98 ,$113.00 ,$24.86 ,$113.00 ,$61.47 ,$24.86 ,$47.01 , N/A , N/A ,$26.10 ,$96.05 ,$73.68 ,$31.64 ,$101.70 ,$94.92 ,$90.40 ,$90.40 ,$24.86 ,$73.45 
ST. FRANCIS HOSPITAL - ACUTE,45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$199.00 ,$129.35 ,$43.78 ,$458.50 ,$114.43 ,$143.28 ,$108.26 ,$43.78 ,$55.72 ,$111.64 ,$43.78 ,$129.75 ,$49.75 ,$129.75 ,$129.75 ,$49.75 ,$129.75 ,$83.18 ,$167.16 ,$458.50 ,$43.78 ,$169.15 ,$167.16 ,$43.78 ,$149.25 ,$159.20 ,$159.20 ,$43.78 ,$159.20 ,$167.16 ,$167.16 ,$167.16 ,$199.00 ,$179.10 ,$114.43 ,$199.00 ,$43.78 ,$199.00 ,$108.26 ,$43.78 ,$82.78 , N/A , N/A ,$45.97 ,$169.15 ,$129.75 ,$55.72 ,$179.10 ,$167.16 ,$159.20 ,$159.20 ,$43.78 ,$129.35 
ST. FRANCIS HOSPITAL - ACUTE,45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$147.00 ,$95.55 ,$32.34 ,$458.50 ,$84.53 ,$105.84 ,$79.97 ,$32.34 ,$41.16 ,$82.47 ,$32.34 ,$95.84 ,$36.75 ,$95.84 ,$95.84 ,$36.75 ,$95.84 ,$61.45 ,$123.48 ,$458.50 ,$32.34 ,$124.95 ,$123.48 ,$32.34 ,$110.25 ,$117.60 ,$117.60 ,$32.34 ,$117.60 ,$123.48 ,$123.48 ,$123.48 ,$147.00 ,$132.30 ,$84.53 ,$147.00 ,$32.34 ,$147.00 ,$79.97 ,$32.34 ,$61.15 , N/A , N/A ,$33.96 ,$124.95 ,$95.84 ,$41.16 ,$132.30 ,$123.48 ,$117.60 ,$117.60 ,$32.34 ,$95.55 
ST. FRANCIS HOSPITAL - ACUTE,45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$270.00 ,$175.50 ,$59.40 ,$882.50 ,$155.25 ,$194.40 ,$146.88 ,$59.40 ,$75.60 ,$151.47 ,$59.40 ,$176.04 ,$67.50 ,$176.04 ,$176.04 ,$67.50 ,$176.04 ,$112.86 ,$226.80 ,$882.50 ,$59.40 ,$229.50 ,$226.80 ,$59.40 ,$202.50 ,$216.00 ,$216.00 ,$59.40 ,$216.00 ,$226.80 ,$226.80 ,$226.80 ,$270.00 ,$243.00 ,$155.25 ,$270.00 ,$59.40 ,$270.00 ,$146.88 ,$59.40 ,$112.32 , N/A , N/A ,$62.37 ,$229.50 ,$176.04 ,$75.60 ,$243.00 ,$226.80 ,$216.00 ,$216.00 ,$59.40 ,$175.50 
ST. FRANCIS HOSPITAL - ACUTE,45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,$159.00 ,$103.35 ,$34.98 ,$458.50 ,$91.43 ,$114.48 ,$86.50 ,$34.98 ,$44.52 ,$89.20 ,$34.98 ,$103.67 ,$39.75 ,$103.67 ,$103.67 ,$39.75 ,$103.67 ,$66.46 ,$133.56 ,$458.50 ,$34.98 ,$135.15 ,$133.56 ,$34.98 ,$119.25 ,$127.20 ,$127.20 ,$34.98 ,$127.20 ,$133.56 ,$133.56 ,$133.56 ,$159.00 ,$143.10 ,$91.43 ,$159.00 ,$34.98 ,$159.00 ,$86.50 ,$34.98 ,$66.14 , N/A , N/A ,$36.73 ,$135.15 ,$103.67 ,$44.52 ,$143.10 ,$133.56 ,$127.20 ,$127.20 ,$34.98 ,$103.35 
ST. FRANCIS HOSPITAL - ACUTE,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$760.00 ,$494.00 ,$167.20 ,$760.00 ,$437.00 ,$547.20 ,$413.44 ,$167.20 ,$212.80 ,$426.36 ,$167.20 ,$495.52 ,$190.00 ,$495.52 ,$495.52 ,$190.00 ,$495.52 ,$317.68 ,$638.40 ,$667.08 ,$167.20 ,$646.00 ,$638.40 ,$167.20 ,$570.00 ,$608.00 ,$608.00 ,$167.20 ,$608.00 ,$638.40 ,$638.40 ,$638.40 ,$760.00 ,$684.00 ,$437.00 ,$760.00 ,$167.20 ,$760.00 ,$413.44 ,$167.20 ,$316.16 , N/A , N/A ,$175.56 ,$646.00 ,$495.52 ,$212.80 ,$684.00 ,$638.40 ,$608.00 ,$608.00 ,$167.20 ,$494.00 
ST. FRANCIS HOSPITAL - ACUTE,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,"$1,070.00 ",$695.50 ,$235.40 ,"$1,070.00 ",$615.25 ,$770.40 ,$582.08 ,$235.40 ,$299.60 ,$600.27 ,$235.40 ,$697.64 ,$267.50 ,$697.64 ,$697.64 ,$267.50 ,$697.64 ,$447.26 ,$898.80 ,$667.08 ,$235.40 ,$909.50 ,$898.80 ,$235.40 ,$802.50 ,$856.00 ,$856.00 ,$235.40 ,$856.00 ,$898.80 ,$898.80 ,$898.80 ,"$1,070.00 ",$963.00 ,$615.25 ,"$1,070.00 ",$235.40 ,"$1,070.00 ",$582.08 ,$235.40 ,$445.12 , N/A , N/A ,$247.17 ,$909.50 ,$697.64 ,$299.60 ,$963.00 ,$898.80 ,$856.00 ,$856.00 ,$235.40 ,$695.50 
ST. FRANCIS HOSPITAL - ACUTE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,"$1,603.00 ","$1,041.95 ",$352.66 ,"$1,603.00 ",$921.73 ,"$1,154.16 ",$872.03 ,$352.66 ,$448.84 ,$899.28 ,$352.66 ,"$1,045.16 ",$400.75 ,"$1,045.16 ","$1,045.16 ",$400.75 ,"$1,045.16 ",$670.05 ,"$1,346.52 ","$1,000.61 ",$352.66 ,"$1,362.55 ","$1,346.52 ",$352.66 ,"$1,202.25 ","$1,282.40 ","$1,282.40 ",$352.66 ,"$1,282.40 ","$1,346.52 ","$1,346.52 ","$1,346.52 ","$1,603.00 ","$1,442.70 ",$921.73 ,"$1,603.00 ",$352.66 ,"$1,603.00 ",$872.03 ,$352.66 ,$666.85 , N/A , N/A ,$370.29 ,"$1,362.55 ","$1,045.16 ",$448.84 ,"$1,442.70 ","$1,346.52 ","$1,282.40 ","$1,282.40 ",$352.66 ,"$1,041.95 "
ST. FRANCIS HOSPITAL - ACUTE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,"$1,070.00 ",$695.50 ,$235.40 ,"$1,070.00 ",$615.25 ,$770.40 ,$582.08 ,$235.40 ,$299.60 ,$600.27 ,$235.40 ,$697.64 ,$267.50 ,$697.64 ,$697.64 ,$267.50 ,$697.64 ,$447.26 ,$898.80 ,$667.08 ,$235.40 ,$909.50 ,$898.80 ,$235.40 ,$802.50 ,$856.00 ,$856.00 ,$235.40 ,$856.00 ,$898.80 ,$898.80 ,$898.80 ,"$1,070.00 ",$963.00 ,$615.25 ,"$1,070.00 ",$235.40 ,"$1,070.00 ",$582.08 ,$235.40 ,$445.12 , N/A , N/A ,$247.17 ,$909.50 ,$697.64 ,$299.60 ,$963.00 ,$898.80 ,$856.00 ,$856.00 ,$235.40 ,$695.50 
ST. FRANCIS HOSPITAL - ACUTE,45000072,20612,HC INJ GANGLION CYST,450,1 ,$454.00 ,$295.10 ,$99.88 ,$667.08 ,$261.05 ,$326.88 ,$246.98 ,$99.88 ,$127.12 ,$254.69 ,$99.88 ,$296.01 ,$113.50 ,$296.01 ,$296.01 ,$113.50 ,$296.01 ,$189.77 ,$381.36 ,$667.08 ,$99.88 ,$385.90 ,$381.36 ,$99.88 ,$340.50 ,$363.20 ,$363.20 ,$99.88 ,$363.20 ,$381.36 ,$381.36 ,$381.36 ,$454.00 ,$408.60 ,$261.05 ,$454.00 ,$99.88 ,$454.00 ,$246.98 ,$99.88 ,$188.86 , N/A , N/A ,$104.87 ,$385.90 ,$296.01 ,$127.12 ,$408.60 ,$381.36 ,$363.20 ,$363.20 ,$99.88 ,$295.10 
ST. FRANCIS HOSPITAL - ACUTE,45000072,20612,HC INJ GANGLION CYST,450,1 ,$680.00 ,$442.00 ,$149.60 ,$680.00 ,$391.00 ,$489.60 ,$369.92 ,$149.60 ,$190.40 ,$381.48 ,$149.60 ,$443.36 ,$170.00 ,$443.36 ,$443.36 ,$170.00 ,$443.36 ,$284.24 ,$571.20 ,$667.08 ,$149.60 ,$578.00 ,$571.20 ,$149.60 ,$510.00 ,$544.00 ,$544.00 ,$149.60 ,$544.00 ,$571.20 ,$571.20 ,$571.20 ,$680.00 ,$612.00 ,$391.00 ,$680.00 ,$149.60 ,$680.00 ,$369.92 ,$149.60 ,$282.88 , N/A , N/A ,$157.08 ,$578.00 ,$443.36 ,$190.40 ,$612.00 ,$571.20 ,$544.00 ,$544.00 ,$149.60 ,$442.00 
ST. FRANCIS HOSPITAL - ACUTE,45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,$324.00 ,$210.60 ,$71.28 ,$526.25 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$526.25 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000075,23655,HC TX DISL SHLDR W/MAN/ANES CLS,450,1 ,$738.00 ,$479.70 ,$162.36 ,"$3,556.28 ",$424.35 ,$531.36 ,$401.47 ,$162.36 ,$206.64 ,$414.02 ,$162.36 ,$481.18 ,$184.50 ,$481.18 ,$481.18 ,$184.50 ,$481.18 ,$308.48 ,$619.92 ,"$3,556.28 ",$162.36 ,$627.30 ,$619.92 ,$162.36 ,$553.50 ,$590.40 ,$590.40 ,$162.36 ,$590.40 ,$619.92 ,$619.92 ,$619.92 ,$738.00 ,$664.20 ,$424.35 ,$738.00 ,$162.36 ,$738.00 ,$401.47 ,$162.36 ,$307.01 , N/A , N/A ,$170.48 ,$627.30 ,$481.18 ,$206.64 ,$664.20 ,$619.92 ,$590.40 ,$590.40 ,$162.36 ,$479.70 
ST. FRANCIS HOSPITAL - ACUTE,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$324.00 ,$210.60 ,$71.28 ,$526.25 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$526.25 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$324.00 ,$210.60 ,$71.28 ,$526.25 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$526.25 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,"$3,238.00 ","$2,104.70 ",$712.36 ,"$3,556.28 ","$1,861.85 ","$2,331.36 ","$1,761.47 ",$712.36 ,$906.64 ,"$1,816.52 ",$712.36 ,"$2,111.18 ",$809.50 ,"$2,111.18 ","$2,111.18 ",$809.50 ,"$2,111.18 ","$1,353.48 ","$2,719.92 ","$3,556.28 ",$712.36 ,"$2,752.30 ","$2,719.92 ",$712.36 ,"$2,428.50 ","$2,590.40 ","$2,590.40 ",$712.36 ,"$2,590.40 ","$2,719.92 ","$2,719.92 ","$2,719.92 ","$3,238.00 ","$2,914.20 ","$1,861.85 ","$3,238.00 ",$712.36 ,"$3,238.00 ","$1,761.47 ",$712.36 ,"$1,347.01 ", N/A , N/A ,$747.98 ,"$2,752.30 ","$2,111.18 ",$906.64 ,"$2,914.20 ","$2,719.92 ","$2,590.40 ","$2,590.40 ",$712.36 ,"$2,104.70 "
ST. FRANCIS HOSPITAL - ACUTE,45000084,26011,HC DRAIN ABSC FINGER COMPLCD,450,1 ,"$4,221.00 ","$2,743.65 ",$928.62 ,"$4,221.00 ","$2,427.08 ","$3,039.12 ","$2,296.22 ",$928.62 ,"$1,181.88 ","$2,367.98 ",$928.62 ,"$2,752.09 ","$1,055.25 ","$2,752.09 ","$2,752.09 ","$1,055.25 ","$2,752.09 ","$1,764.38 ","$3,545.64 ","$3,592.48 ",$928.62 ,"$3,587.85 ","$3,545.64 ",$928.62 ,"$3,165.75 ","$3,376.80 ","$3,376.80 ",$928.62 ,"$3,376.80 ","$3,545.64 ","$3,545.64 ","$3,545.64 ","$4,221.00 ","$3,798.90 ","$2,427.08 ","$4,221.00 ",$928.62 ,"$4,221.00 ","$2,296.22 ",$928.62 ,"$1,755.94 ", N/A , N/A ,$975.05 ,"$3,587.85 ","$2,752.09 ","$1,181.88 ","$3,798.90 ","$3,545.64 ","$3,376.80 ","$3,376.80 ",$928.62 ,"$2,743.65 "
ST. FRANCIS HOSPITAL - ACUTE,45000087,26725,HC TX FX PHALANX PROX W/MAN CLS,450,1 ,$324.00 ,$210.60 ,$71.28 ,$526.25 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$526.25 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$324.00 ,$210.60 ,$71.28 ,$526.25 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$526.25 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$5,916.00 ","$3,845.40 ","$1,301.52 ","$7,230.70 ","$3,401.70 ","$4,259.52 ","$3,218.30 ","$1,301.52 ","$1,656.48 ","$3,318.88 ","$1,301.52 ","$3,857.23 ","$1,479.00 ","$3,857.23 ","$3,857.23 ","$1,479.00 ","$3,857.23 ","$2,472.89 ","$4,969.44 ","$7,230.70 ","$1,301.52 ","$5,028.60 ","$4,969.44 ","$1,301.52 ","$4,437.00 ","$4,732.80 ","$4,732.80 ","$1,301.52 ","$4,732.80 ","$4,969.44 ","$4,969.44 ","$4,969.44 ","$5,916.00 ","$5,324.40 ","$3,401.70 ","$5,916.00 ","$1,301.52 ","$5,916.00 ","$3,218.30 ","$1,301.52 ","$2,461.06 ", N/A , N/A ,"$1,366.60 ","$5,028.60 ","$3,857.23 ","$1,656.48 ","$5,324.40 ","$4,969.44 ","$4,732.80 ","$4,732.80 ","$1,301.52 ","$3,845.40 "
ST. FRANCIS HOSPITAL - ACUTE,45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$411.00 ,$267.15 ,$90.42 ,$526.25 ,$236.33 ,$295.92 ,$223.58 ,$90.42 ,$115.08 ,$230.57 ,$90.42 ,$267.97 ,$102.75 ,$267.97 ,$267.97 ,$102.75 ,$267.97 ,$171.80 ,$345.24 ,$526.25 ,$90.42 ,$349.35 ,$345.24 ,$90.42 ,$308.25 ,$328.80 ,$328.80 ,$90.42 ,$328.80 ,$345.24 ,$345.24 ,$345.24 ,$411.00 ,$369.90 ,$236.33 ,$411.00 ,$90.42 ,$411.00 ,$223.58 ,$90.42 ,$170.98 , N/A , N/A ,$94.94 ,$349.35 ,$267.97 ,$115.08 ,$369.90 ,$345.24 ,$328.80 ,$328.80 ,$90.42 ,$267.15 
ST. FRANCIS HOSPITAL - ACUTE,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$299.00 ,$194.35 ,$65.78 ,$526.25 ,$171.93 ,$215.28 ,$162.66 ,$65.78 ,$83.72 ,$167.74 ,$65.78 ,$194.95 ,$74.75 ,$194.95 ,$194.95 ,$74.75 ,$194.95 ,$124.98 ,$251.16 ,$526.25 ,$65.78 ,$254.15 ,$251.16 ,$65.78 ,$224.25 ,$239.20 ,$239.20 ,$65.78 ,$239.20 ,$251.16 ,$251.16 ,$251.16 ,$299.00 ,$269.10 ,$171.93 ,$299.00 ,$65.78 ,$299.00 ,$162.66 ,$65.78 ,$124.38 , N/A , N/A ,$69.07 ,$254.15 ,$194.95 ,$83.72 ,$269.10 ,$251.16 ,$239.20 ,$239.20 ,$65.78 ,$194.35 
ST. FRANCIS HOSPITAL - ACUTE,45000097,28190,HC REM FB FOOT SUBQ,450,1 ,$577.00 ,$375.05 ,$126.94 ,"$2,383.28 ",$331.78 ,$415.44 ,$313.89 ,$126.94 ,$161.56 ,$323.70 ,$126.94 ,$376.20 ,$144.25 ,$376.20 ,$376.20 ,$144.25 ,$376.20 ,$241.19 ,$484.68 ,"$2,383.28 ",$126.94 ,$490.45 ,$484.68 ,$126.94 ,$432.75 ,$461.60 ,$461.60 ,$126.94 ,$461.60 ,$484.68 ,$484.68 ,$484.68 ,$577.00 ,$519.30 ,$331.78 ,$577.00 ,$126.94 ,$577.00 ,$313.89 ,$126.94 ,$240.03 , N/A , N/A ,$133.29 ,$490.45 ,$376.20 ,$161.56 ,$519.30 ,$484.68 ,$461.60 ,$461.60 ,$126.94 ,$375.05 
ST. FRANCIS HOSPITAL - ACUTE,45000097,28190,HC REM FB FOOT SUBQ,450,1 ,$288.00 ,$187.20 ,$63.36 ,"$1,588.85 ",$165.60 ,$207.36 ,$156.67 ,$63.36 ,$80.64 ,$161.57 ,$63.36 ,$187.78 ,$72.00 ,$187.78 ,$187.78 ,$72.00 ,$187.78 ,$120.38 ,$241.92 ,"$1,588.85 ",$63.36 ,$244.80 ,$241.92 ,$63.36 ,$216.00 ,$230.40 ,$230.40 ,$63.36 ,$230.40 ,$241.92 ,$241.92 ,$241.92 ,$288.00 ,$259.20 ,$165.60 ,$288.00 ,$63.36 ,$288.00 ,$156.67 ,$63.36 ,$119.81 , N/A , N/A ,$66.53 ,$244.80 ,$187.78 ,$80.64 ,$259.20 ,$241.92 ,$230.40 ,$230.40 ,$63.36 ,$187.20 
ST. FRANCIS HOSPITAL - ACUTE,45000098,29065,HC APPL CAST ARM LONG,450,1 ,$404.00 ,$262.60 ,$88.88 ,$615.95 ,$232.30 ,$290.88 ,$219.78 ,$88.88 ,$113.12 ,$226.64 ,$88.88 ,$263.41 ,$101.00 ,$263.41 ,$263.41 ,$101.00 ,$263.41 ,$168.87 ,$339.36 ,$615.95 ,$88.88 ,$343.40 ,$339.36 ,$88.88 ,$303.00 ,$323.20 ,$323.20 ,$88.88 ,$323.20 ,$339.36 ,$339.36 ,$339.36 ,$404.00 ,$363.60 ,$232.30 ,$404.00 ,$88.88 ,$404.00 ,$219.78 ,$88.88 ,$168.06 , N/A , N/A ,$93.32 ,$343.40 ,$263.41 ,$113.12 ,$363.60 ,$339.36 ,$323.20 ,$323.20 ,$88.88 ,$262.60 
ST. FRANCIS HOSPITAL - ACUTE,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,$560.00 ,$364.00 ,$123.20 ,$615.95 ,$322.00 ,$403.20 ,$304.64 ,$123.20 ,$156.80 ,$314.16 ,$123.20 ,$365.12 ,$140.00 ,$365.12 ,$365.12 ,$140.00 ,$365.12 ,$234.08 ,$470.40 ,$615.95 ,$123.20 ,$476.00 ,$470.40 ,$123.20 ,$420.00 ,$448.00 ,$448.00 ,$123.20 ,$448.00 ,$470.40 ,$470.40 ,$470.40 ,$560.00 ,$504.00 ,$322.00 ,$560.00 ,$123.20 ,$560.00 ,$304.64 ,$123.20 ,$232.96 , N/A , N/A ,$129.36 ,$476.00 ,$365.12 ,$156.80 ,$504.00 ,$470.40 ,$448.00 ,$448.00 ,$123.20 ,$364.00 
ST. FRANCIS HOSPITAL - ACUTE,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$254.00 ,$165.10 ,$55.88 ,$360.73 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$142.49 ,$55.88 ,$165.61 ,$63.50 ,$165.61 ,$165.61 ,$63.50 ,$165.61 ,$106.17 ,$213.36 ,$360.73 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 , N/A , N/A ,$58.67 ,$215.90 ,$165.61 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$503.00 ,$326.95 ,$110.66 ,$541.09 ,$289.23 ,$362.16 ,$273.63 ,$110.66 ,$140.84 ,$282.18 ,$110.66 ,$327.96 ,$125.75 ,$327.96 ,$327.96 ,$125.75 ,$327.96 ,$210.25 ,$422.52 ,$541.09 ,$110.66 ,$427.55 ,$422.52 ,$110.66 ,$377.25 ,$402.40 ,$402.40 ,$110.66 ,$402.40 ,$422.52 ,$422.52 ,$422.52 ,$503.00 ,$452.70 ,$289.23 ,$503.00 ,$110.66 ,$503.00 ,$273.63 ,$110.66 ,$209.25 , N/A , N/A ,$116.19 ,$427.55 ,$327.96 ,$140.84 ,$452.70 ,$422.52 ,$402.40 ,$402.40 ,$110.66 ,$326.95 
ST. FRANCIS HOSPITAL - ACUTE,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$508.00 ,$330.20 ,$111.76 ,$508.00 ,$292.10 ,$365.76 ,$276.35 ,$111.76 ,$142.24 ,$284.99 ,$111.76 ,$331.22 ,$127.00 ,$331.22 ,$331.22 ,$127.00 ,$331.22 ,$212.34 ,$426.72 ,$287.90 ,$111.76 ,$431.80 ,$426.72 ,$111.76 ,$381.00 ,$406.40 ,$406.40 ,$111.76 ,$406.40 ,$426.72 ,$426.72 ,$426.72 ,$508.00 ,$457.20 ,$292.10 ,$508.00 ,$111.76 ,$508.00 ,$276.35 ,$111.76 ,$211.33 , N/A , N/A ,$117.35 ,$431.80 ,$331.22 ,$142.24 ,$457.20 ,$426.72 ,$406.40 ,$406.40 ,$111.76 ,$330.20 
ST. FRANCIS HOSPITAL - ACUTE,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$254.00 ,$165.10 ,$55.88 ,$287.90 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$142.49 ,$55.88 ,$165.61 ,$63.50 ,$165.61 ,$165.61 ,$63.50 ,$165.61 ,$106.17 ,$213.36 ,$287.90 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 , N/A , N/A ,$58.67 ,$215.90 ,$165.61 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$503.00 ,$326.95 ,$110.66 ,$503.00 ,$289.23 ,$362.16 ,$273.63 ,$110.66 ,$140.84 ,$282.18 ,$110.66 ,$327.96 ,$125.75 ,$327.96 ,$327.96 ,$125.75 ,$327.96 ,$210.25 ,$422.52 ,$287.90 ,$110.66 ,$427.55 ,$422.52 ,$110.66 ,$377.25 ,$402.40 ,$402.40 ,$110.66 ,$402.40 ,$422.52 ,$422.52 ,$422.52 ,$503.00 ,$452.70 ,$289.23 ,$503.00 ,$110.66 ,$503.00 ,$273.63 ,$110.66 ,$209.25 , N/A , N/A ,$116.19 ,$427.55 ,$327.96 ,$140.84 ,$452.70 ,$422.52 ,$402.40 ,$402.40 ,$110.66 ,$326.95 
ST. FRANCIS HOSPITAL - ACUTE,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$508.00 ,$330.20 ,$111.76 ,$508.00 ,$292.10 ,$365.76 ,$276.35 ,$111.76 ,$142.24 ,$284.99 ,$111.76 ,$331.22 ,$127.00 ,$331.22 ,$331.22 ,$127.00 ,$331.22 ,$212.34 ,$426.72 ,$287.90 ,$111.76 ,$431.80 ,$426.72 ,$111.76 ,$381.00 ,$406.40 ,$406.40 ,$111.76 ,$406.40 ,$426.72 ,$426.72 ,$426.72 ,$508.00 ,$457.20 ,$292.10 ,$508.00 ,$111.76 ,$508.00 ,$276.35 ,$111.76 ,$211.33 , N/A , N/A ,$117.35 ,$431.80 ,$331.22 ,$142.24 ,$457.20 ,$426.72 ,$406.40 ,$406.40 ,$111.76 ,$330.20 
ST. FRANCIS HOSPITAL - ACUTE,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$508.00 ,$330.20 ,$111.76 ,$508.00 ,$292.10 ,$365.76 ,$276.35 ,$111.76 ,$142.24 ,$284.99 ,$111.76 ,$331.22 ,$127.00 ,$331.22 ,$331.22 ,$127.00 ,$331.22 ,$212.34 ,$426.72 ,$287.90 ,$111.76 ,$431.80 ,$426.72 ,$111.76 ,$381.00 ,$406.40 ,$406.40 ,$111.76 ,$406.40 ,$426.72 ,$426.72 ,$426.72 ,$508.00 ,$457.20 ,$292.10 ,$508.00 ,$111.76 ,$508.00 ,$276.35 ,$111.76 ,$211.33 , N/A , N/A ,$117.35 ,$431.80 ,$331.22 ,$142.24 ,$457.20 ,$426.72 ,$406.40 ,$406.40 ,$111.76 ,$330.20 
ST. FRANCIS HOSPITAL - ACUTE,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$251.00 ,$163.15 ,$55.22 ,$287.90 ,$144.33 ,$180.72 ,$136.54 ,$55.22 ,$70.28 ,$140.81 ,$55.22 ,$163.65 ,$62.75 ,$163.65 ,$163.65 ,$62.75 ,$163.65 ,$104.92 ,$210.84 ,$287.90 ,$55.22 ,$213.35 ,$210.84 ,$55.22 ,$188.25 ,$200.80 ,$200.80 ,$55.22 ,$200.80 ,$210.84 ,$210.84 ,$210.84 ,$251.00 ,$225.90 ,$144.33 ,$251.00 ,$55.22 ,$251.00 ,$136.54 ,$55.22 ,$104.42 , N/A , N/A ,$57.98 ,$213.35 ,$163.65 ,$70.28 ,$225.90 ,$210.84 ,$200.80 ,$200.80 ,$55.22 ,$163.15 
ST. FRANCIS HOSPITAL - ACUTE,45000104,29131,HC APPL FINGER SPLINT DYNAMIC,450,1 ,$251.00 ,$163.15 ,$55.22 ,$251.00 ,$144.33 ,$180.72 ,$136.54 ,$55.22 ,$70.28 ,$140.81 ,$55.22 ,$163.65 ,$62.75 ,$163.65 ,$163.65 ,$62.75 ,$163.65 ,$104.92 ,$210.84 ,$142.13 ,$55.22 ,$213.35 ,$210.84 ,$55.22 ,$188.25 ,$200.80 ,$200.80 ,$55.22 ,$200.80 ,$210.84 ,$210.84 ,$210.84 ,$251.00 ,$225.90 ,$144.33 ,$251.00 ,$55.22 ,$251.00 ,$136.54 ,$55.22 ,$104.42 , N/A , N/A ,$57.98 ,$213.35 ,$163.65 ,$70.28 ,$225.90 ,$210.84 ,$200.80 ,$200.80 ,$55.22 ,$163.15 
ST. FRANCIS HOSPITAL - ACUTE,45000105,29240,HC STRAPPING SHLDR,450,1 ,$254.00 ,$165.10 ,$55.88 ,$287.90 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$142.49 ,$55.88 ,$165.61 ,$63.50 ,$165.61 ,$165.61 ,$63.50 ,$165.61 ,$106.17 ,$213.36 ,$287.90 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 , N/A , N/A ,$58.67 ,$215.90 ,$165.61 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$589.00 ,$382.85 ,$129.58 ,$615.95 ,$338.68 ,$424.08 ,$320.42 ,$129.58 ,$164.92 ,$330.43 ,$129.58 ,$384.03 ,$147.25 ,$384.03 ,$384.03 ,$147.25 ,$384.03 ,$246.20 ,$494.76 ,$615.95 ,$129.58 ,$500.65 ,$494.76 ,$129.58 ,$441.75 ,$471.20 ,$471.20 ,$129.58 ,$471.20 ,$494.76 ,$494.76 ,$494.76 ,$589.00 ,$530.10 ,$338.68 ,$589.00 ,$129.58 ,$589.00 ,$320.42 ,$129.58 ,$245.02 , N/A , N/A ,$136.06 ,$500.65 ,$384.03 ,$164.92 ,$530.10 ,$494.76 ,$471.20 ,$471.20 ,$129.58 ,$382.85 
ST. FRANCIS HOSPITAL - ACUTE,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$251.00 ,$163.15 ,$55.22 ,$360.73 ,$144.33 ,$180.72 ,$136.54 ,$55.22 ,$70.28 ,$140.81 ,$55.22 ,$163.65 ,$62.75 ,$163.65 ,$163.65 ,$62.75 ,$163.65 ,$104.92 ,$210.84 ,$360.73 ,$55.22 ,$213.35 ,$210.84 ,$55.22 ,$188.25 ,$200.80 ,$200.80 ,$55.22 ,$200.80 ,$210.84 ,$210.84 ,$210.84 ,$251.00 ,$225.90 ,$144.33 ,$251.00 ,$55.22 ,$251.00 ,$136.54 ,$55.22 ,$104.42 , N/A , N/A ,$57.98 ,$213.35 ,$163.65 ,$70.28 ,$225.90 ,$210.84 ,$200.80 ,$200.80 ,$55.22 ,$163.15 
ST. FRANCIS HOSPITAL - ACUTE,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$503.00 ,$326.95 ,$110.66 ,$541.09 ,$289.23 ,$362.16 ,$273.63 ,$110.66 ,$140.84 ,$282.18 ,$110.66 ,$327.96 ,$125.75 ,$327.96 ,$327.96 ,$125.75 ,$327.96 ,$210.25 ,$422.52 ,$541.09 ,$110.66 ,$427.55 ,$422.52 ,$110.66 ,$377.25 ,$402.40 ,$402.40 ,$110.66 ,$402.40 ,$422.52 ,$422.52 ,$422.52 ,$503.00 ,$452.70 ,$289.23 ,$503.00 ,$110.66 ,$503.00 ,$273.63 ,$110.66 ,$209.25 , N/A , N/A ,$116.19 ,$427.55 ,$327.96 ,$140.84 ,$452.70 ,$422.52 ,$402.40 ,$402.40 ,$110.66 ,$326.95 
ST. FRANCIS HOSPITAL - ACUTE,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$503.00 ,$326.95 ,$110.66 ,$541.09 ,$289.23 ,$362.16 ,$273.63 ,$110.66 ,$140.84 ,$282.18 ,$110.66 ,$327.96 ,$125.75 ,$327.96 ,$327.96 ,$125.75 ,$327.96 ,$210.25 ,$422.52 ,$541.09 ,$110.66 ,$427.55 ,$422.52 ,$110.66 ,$377.25 ,$402.40 ,$402.40 ,$110.66 ,$402.40 ,$422.52 ,$422.52 ,$422.52 ,$503.00 ,$452.70 ,$289.23 ,$503.00 ,$110.66 ,$503.00 ,$273.63 ,$110.66 ,$209.25 , N/A , N/A ,$116.19 ,$427.55 ,$327.96 ,$140.84 ,$452.70 ,$422.52 ,$402.40 ,$402.40 ,$110.66 ,$326.95 
ST. FRANCIS HOSPITAL - ACUTE,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$251.00 ,$163.15 ,$55.22 ,$360.73 ,$144.33 ,$180.72 ,$136.54 ,$55.22 ,$70.28 ,$140.81 ,$55.22 ,$163.65 ,$62.75 ,$163.65 ,$163.65 ,$62.75 ,$163.65 ,$104.92 ,$210.84 ,$360.73 ,$55.22 ,$213.35 ,$210.84 ,$55.22 ,$188.25 ,$200.80 ,$200.80 ,$55.22 ,$200.80 ,$210.84 ,$210.84 ,$210.84 ,$251.00 ,$225.90 ,$144.33 ,$251.00 ,$55.22 ,$251.00 ,$136.54 ,$55.22 ,$104.42 , N/A , N/A ,$57.98 ,$213.35 ,$163.65 ,$70.28 ,$225.90 ,$210.84 ,$200.80 ,$200.80 ,$55.22 ,$163.15 
ST. FRANCIS HOSPITAL - ACUTE,45000110,30300,HC REM FB INTRANASAL,450,1 ,$128.00 ,$83.20 ,$28.16 ,$287.90 ,$73.60 ,$92.16 ,$69.63 ,$28.16 ,$35.84 ,$71.81 ,$28.16 ,$83.46 ,$32.00 ,$83.46 ,$83.46 ,$32.00 ,$83.46 ,$53.50 ,$107.52 ,$287.90 ,$28.16 ,$108.80 ,$107.52 ,$28.16 ,$96.00 ,$102.40 ,$102.40 ,$28.16 ,$102.40 ,$107.52 ,$107.52 ,$107.52 ,$128.00 ,$115.20 ,$73.60 ,$128.00 ,$28.16 ,$128.00 ,$69.63 ,$28.16 ,$53.25 , N/A , N/A ,$29.57 ,$108.80 ,$83.46 ,$35.84 ,$115.20 ,$107.52 ,$102.40 ,$102.40 ,$28.16 ,$83.20 
ST. FRANCIS HOSPITAL - ACUTE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$152.00 ,$98.80 ,$33.44 ,$287.90 ,$87.40 ,$109.44 ,$82.69 ,$33.44 ,$42.56 ,$85.27 ,$33.44 ,$99.10 ,$38.00 ,$99.10 ,$99.10 ,$38.00 ,$99.10 ,$63.54 ,$127.68 ,$287.90 ,$33.44 ,$129.20 ,$127.68 ,$33.44 ,$114.00 ,$121.60 ,$121.60 ,$33.44 ,$121.60 ,$127.68 ,$127.68 ,$127.68 ,$152.00 ,$136.80 ,$87.40 ,$152.00 ,$33.44 ,$152.00 ,$82.69 ,$33.44 ,$63.23 , N/A , N/A ,$35.11 ,$129.20 ,$99.10 ,$42.56 ,$136.80 ,$127.68 ,$121.60 ,$121.60 ,$33.44 ,$98.80 
ST. FRANCIS HOSPITAL - ACUTE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$77.00 ,$50.05 ,$16.94 ,$287.90 ,$44.28 ,$55.44 ,$41.89 ,$16.94 ,$21.56 ,$43.20 ,$16.94 ,$50.20 ,$19.25 ,$50.20 ,$50.20 ,$19.25 ,$50.20 ,$32.19 ,$64.68 ,$287.90 ,$16.94 ,$65.45 ,$64.68 ,$16.94 ,$57.75 ,$61.60 ,$61.60 ,$16.94 ,$61.60 ,$64.68 ,$64.68 ,$64.68 ,$77.00 ,$69.30 ,$44.28 ,$77.00 ,$16.94 ,$77.00 ,$41.89 ,$16.94 ,$32.03 , N/A , N/A ,$17.79 ,$65.45 ,$50.20 ,$21.56 ,$69.30 ,$64.68 ,$61.60 ,$61.60 ,$16.94 ,$50.05 
ST. FRANCIS HOSPITAL - ACUTE,45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$187.00 ,$121.55 ,$41.14 ,$287.90 ,$107.53 ,$134.64 ,$101.73 ,$41.14 ,$52.36 ,$104.91 ,$41.14 ,$121.92 ,$46.75 ,$121.92 ,$121.92 ,$46.75 ,$121.92 ,$78.17 ,$157.08 ,$287.90 ,$41.14 ,$158.95 ,$157.08 ,$41.14 ,$140.25 ,$149.60 ,$149.60 ,$41.14 ,$149.60 ,$157.08 ,$157.08 ,$157.08 ,$187.00 ,$168.30 ,$107.53 ,$187.00 ,$41.14 ,$187.00 ,$101.73 ,$41.14 ,$77.79 , N/A , N/A ,$43.20 ,$158.95 ,$121.92 ,$52.36 ,$168.30 ,$157.08 ,$149.60 ,$149.60 ,$41.14 ,$121.55 
ST. FRANCIS HOSPITAL - ACUTE,45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$375.00 ,$243.75 ,$82.50 ,$431.85 ,$215.63 ,$270.00 ,$204.00 ,$82.50 ,$105.00 ,$210.38 ,$82.50 ,$244.50 ,$93.75 ,$244.50 ,$244.50 ,$93.75 ,$244.50 ,$156.75 ,$315.00 ,$431.85 ,$82.50 ,$318.75 ,$315.00 ,$82.50 ,$281.25 ,$300.00 ,$300.00 ,$82.50 ,$300.00 ,$315.00 ,$315.00 ,$315.00 ,$375.00 ,$337.50 ,$215.63 ,$375.00 ,$82.50 ,$375.00 ,$204.00 ,$82.50 ,$156.00 , N/A , N/A ,$86.63 ,$318.75 ,$244.50 ,$105.00 ,$337.50 ,$315.00 ,$300.00 ,$300.00 ,$82.50 ,$243.75 
ST. FRANCIS HOSPITAL - ACUTE,45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$152.00 ,$98.80 ,$33.44 ,$287.90 ,$87.40 ,$109.44 ,$82.69 ,$33.44 ,$42.56 ,$85.27 ,$33.44 ,$99.10 ,$38.00 ,$99.10 ,$99.10 ,$38.00 ,$99.10 ,$63.54 ,$127.68 ,$287.90 ,$33.44 ,$129.20 ,$127.68 ,$33.44 ,$114.00 ,$121.60 ,$121.60 ,$33.44 ,$121.60 ,$127.68 ,$127.68 ,$127.68 ,$152.00 ,$136.80 ,$87.40 ,$152.00 ,$33.44 ,$152.00 ,$82.69 ,$33.44 ,$63.23 , N/A , N/A ,$35.11 ,$129.20 ,$99.10 ,$42.56 ,$136.80 ,$127.68 ,$121.60 ,$121.60 ,$33.44 ,$98.80 
ST. FRANCIS HOSPITAL - ACUTE,45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$319.00 ,$207.35 ,$70.18 ,$692.95 ,$183.43 ,$229.68 ,$173.54 ,$70.18 ,$89.32 ,$178.96 ,$70.18 ,$207.99 ,$79.75 ,$207.99 ,$207.99 ,$79.75 ,$207.99 ,$133.34 ,$267.96 ,$692.95 ,$70.18 ,$271.15 ,$267.96 ,$70.18 ,$239.25 ,$255.20 ,$255.20 ,$70.18 ,$255.20 ,$267.96 ,$267.96 ,$267.96 ,$319.00 ,$287.10 ,$183.43 ,$319.00 ,$70.18 ,$319.00 ,$173.54 ,$70.18 ,$132.70 , N/A , N/A ,$73.69 ,$271.15 ,$207.99 ,$89.32 ,$287.10 ,$267.96 ,$255.20 ,$255.20 ,$70.18 ,$207.35 
ST. FRANCIS HOSPITAL - ACUTE,45000136,40800,HC DRAINAGE MOUTH LESION,450,1 ,$148.00 ,$96.20 ,$32.56 ,"$1,588.85 ",$85.10 ,$106.56 ,$80.51 ,$32.56 ,$41.44 ,$83.03 ,$32.56 ,$96.50 ,$37.00 ,$96.50 ,$96.50 ,$37.00 ,$96.50 ,$61.86 ,$124.32 ,"$1,588.85 ",$32.56 ,$125.80 ,$124.32 ,$32.56 ,$111.00 ,$118.40 ,$118.40 ,$32.56 ,$118.40 ,$124.32 ,$124.32 ,$124.32 ,$148.00 ,$133.20 ,$85.10 ,$148.00 ,$32.56 ,$148.00 ,$80.51 ,$32.56 ,$61.57 , N/A , N/A ,$34.19 ,$125.80 ,$96.50 ,$41.44 ,$133.20 ,$124.32 ,$118.40 ,$118.40 ,$32.56 ,$96.20 
ST. FRANCIS HOSPITAL - ACUTE,45000137,40830,HC LAC REPAIR VESTIBULE MOUTH 2.5 CM OR LESS,450,1 ,$620.00 ,$403.00 ,$136.40 ,$620.00 ,$356.50 ,$446.40 ,$337.28 ,$136.40 ,$173.60 ,$347.82 ,$136.40 ,$404.24 ,$155.00 ,$404.24 ,$404.24 ,$155.00 ,$404.24 ,$259.16 ,$520.80 ,$540.18 ,$136.40 ,$527.00 ,$520.80 ,$136.40 ,$465.00 ,$496.00 ,$496.00 ,$136.40 ,$496.00 ,$520.80 ,$520.80 ,$520.80 ,$620.00 ,$558.00 ,$356.50 ,$620.00 ,$136.40 ,$620.00 ,$337.28 ,$136.40 ,$257.92 , N/A , N/A ,$143.22 ,$527.00 ,$404.24 ,$173.60 ,$558.00 ,$520.80 ,$496.00 ,$496.00 ,$136.40 ,$403.00 
ST. FRANCIS HOSPITAL - ACUTE,45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$304.00 ,$197.60 ,$66.88 ,$692.95 ,$174.80 ,$218.88 ,$165.38 ,$66.88 ,$85.12 ,$170.54 ,$66.88 ,$198.21 ,$76.00 ,$198.21 ,$198.21 ,$76.00 ,$198.21 ,$127.07 ,$255.36 ,$692.95 ,$66.88 ,$258.40 ,$255.36 ,$66.88 ,$228.00 ,$243.20 ,$243.20 ,$66.88 ,$243.20 ,$255.36 ,$255.36 ,$255.36 ,$304.00 ,$273.60 ,$174.80 ,$304.00 ,$66.88 ,$304.00 ,$165.38 ,$66.88 ,$126.46 , N/A , N/A ,$70.22 ,$258.40 ,$198.21 ,$85.12 ,$273.60 ,$255.36 ,$243.20 ,$243.20 ,$66.88 ,$197.60 
ST. FRANCIS HOSPITAL - ACUTE,45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$160.00 ,$104.00 ,$35.20 ,$287.90 ,$92.00 ,$115.20 ,$87.04 ,$35.20 ,$44.80 ,$89.76 ,$35.20 ,$104.32 ,$40.00 ,$104.32 ,$104.32 ,$40.00 ,$104.32 ,$66.88 ,$134.40 ,$287.90 ,$35.20 ,$136.00 ,$134.40 ,$35.20 ,$120.00 ,$128.00 ,$128.00 ,$35.20 ,$128.00 ,$134.40 ,$134.40 ,$134.40 ,$160.00 ,$144.00 ,$92.00 ,$160.00 ,$35.20 ,$160.00 ,$87.04 ,$35.20 ,$66.56 , N/A , N/A ,$36.96 ,$136.00 ,$104.32 ,$44.80 ,$144.00 ,$134.40 ,$128.00 ,$128.00 ,$35.20 ,$104.00 
ST. FRANCIS HOSPITAL - ACUTE,45000143,43753,HC GASTRIC LAVAGE,450,1 ,$794.00 ,$516.10 ,$174.68 ,$794.00 ,$456.55 ,$571.68 ,$431.94 ,$174.68 ,$222.32 ,$445.43 ,$174.68 ,$517.69 ,$198.50 ,$517.69 ,$517.69 ,$198.50 ,$517.69 ,$331.89 ,$666.96 ,$675.73 ,$174.68 ,$674.90 ,$666.96 ,$174.68 ,$595.50 ,$635.20 ,$635.20 ,$174.68 ,$635.20 ,$666.96 ,$666.96 ,$666.96 ,$794.00 ,$714.60 ,$456.55 ,$794.00 ,$174.68 ,$794.00 ,$431.94 ,$174.68 ,$330.30 , N/A , N/A ,$183.41 ,$674.90 ,$517.69 ,$222.32 ,$714.60 ,$666.96 ,$635.20 ,$635.20 ,$174.68 ,$516.10 
ST. FRANCIS HOSPITAL - ACUTE,45000146,46040,HC INCISION RECTAL ABSCESS,450,1 ,"$3,484.00 ","$2,264.60 ",$766.48 ,"$3,484.00 ","$2,003.30 ","$2,508.48 ","$1,895.30 ",$766.48 ,$975.52 ,"$1,954.52 ",$766.48 ,"$2,271.57 ",$871.00 ,"$2,271.57 ","$2,271.57 ",$871.00 ,"$2,271.57 ","$1,456.31 ","$2,926.56 ","$2,647.65 ",$766.48 ,"$2,961.40 ","$2,926.56 ",$766.48 ,"$2,613.00 ","$2,787.20 ","$2,787.20 ",$766.48 ,"$2,787.20 ","$2,926.56 ","$2,926.56 ","$2,926.56 ","$3,484.00 ","$3,135.60 ","$2,003.30 ","$3,484.00 ",$766.48 ,"$3,484.00 ","$1,895.30 ",$766.48 ,"$1,449.34 ", N/A , N/A ,$804.80 ,"$2,961.40 ","$2,271.57 ",$975.52 ,"$3,135.60 ","$2,926.56 ","$2,787.20 ","$2,787.20 ",$766.48 ,"$2,264.60 "
ST. FRANCIS HOSPITAL - ACUTE,45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,$324.00 ,$210.60 ,$71.28 ,"$2,026.20 ",$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,"$2,026.20 ",$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$160.00 ,$104.00 ,$35.20 ,$679.43 ,$92.00 ,$115.20 ,$87.04 ,$35.20 ,$44.80 ,$89.76 ,$35.20 ,$104.32 ,$40.00 ,$104.32 ,$104.32 ,$40.00 ,$104.32 ,$66.88 ,$134.40 ,$679.43 ,$35.20 ,$136.00 ,$134.40 ,$35.20 ,$120.00 ,$128.00 ,$128.00 ,$35.20 ,$128.00 ,$134.40 ,$134.40 ,$134.40 ,$160.00 ,$144.00 ,$92.00 ,$160.00 ,$35.20 ,$160.00 ,$87.04 ,$35.20 ,$66.56 , N/A , N/A ,$36.96 ,$136.00 ,$104.32 ,$44.80 ,$144.00 ,$134.40 ,$128.00 ,$128.00 ,$35.20 ,$104.00 
ST. FRANCIS HOSPITAL - ACUTE,45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$367.00 ,$238.55 ,$80.74 ,$679.43 ,$211.03 ,$264.24 ,$199.65 ,$80.74 ,$102.76 ,$205.89 ,$80.74 ,$239.28 ,$91.75 ,$239.28 ,$239.28 ,$91.75 ,$239.28 ,$153.41 ,$308.28 ,$679.43 ,$80.74 ,$311.95 ,$308.28 ,$80.74 ,$275.25 ,$293.60 ,$293.60 ,$80.74 ,$293.60 ,$308.28 ,$308.28 ,$308.28 ,$367.00 ,$330.30 ,$211.03 ,$367.00 ,$80.74 ,$367.00 ,$199.65 ,$80.74 ,$152.67 , N/A , N/A ,$84.78 ,$311.95 ,$239.28 ,$102.76 ,$330.30 ,$308.28 ,$293.60 ,$293.60 ,$80.74 ,$238.55 
ST. FRANCIS HOSPITAL - ACUTE,45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,$685.00 ,$445.25 ,$150.70 ,$685.00 ,$393.88 ,$493.20 ,$372.64 ,$150.70 ,$191.80 ,$384.29 ,$150.70 ,$446.62 ,$171.25 ,$446.62 ,$446.62 ,$171.25 ,$446.62 ,$286.33 ,$575.40 ,$679.43 ,$150.70 ,$582.25 ,$575.40 ,$150.70 ,$513.75 ,$548.00 ,$548.00 ,$150.70 ,$548.00 ,$575.40 ,$575.40 ,$575.40 ,$685.00 ,$616.50 ,$393.88 ,$685.00 ,$150.70 ,$685.00 ,$372.64 ,$150.70 ,$284.96 , N/A , N/A ,$158.24 ,$582.25 ,$446.62 ,$191.80 ,$616.50 ,$575.40 ,$548.00 ,$548.00 ,$150.70 ,$445.25 
ST. FRANCIS HOSPITAL - ACUTE,45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$371.00 ,$241.15 ,$81.62 ,$720.10 ,$213.33 ,$267.12 ,$201.82 ,$81.62 ,$103.88 ,$208.13 ,$81.62 ,$241.89 ,$92.75 ,$241.89 ,$241.89 ,$92.75 ,$241.89 ,$155.08 ,$311.64 ,$720.10 ,$81.62 ,$315.35 ,$311.64 ,$81.62 ,$278.25 ,$296.80 ,$296.80 ,$81.62 ,$296.80 ,$311.64 ,$311.64 ,$311.64 ,$371.00 ,$333.90 ,$213.33 ,$371.00 ,$81.62 ,$371.00 ,$201.82 ,$81.62 ,$154.34 , N/A , N/A ,$85.70 ,$315.35 ,$241.89 ,$103.88 ,$333.90 ,$311.64 ,$296.80 ,$296.80 ,$81.62 ,$241.15 
ST. FRANCIS HOSPITAL - ACUTE,45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$511.00 ,$332.15 ,$112.42 ,$511.00 ,$293.83 ,$367.92 ,$277.98 ,$112.42 ,$143.08 ,$286.67 ,$112.42 ,$333.17 ,$127.75 ,$333.17 ,$333.17 ,$127.75 ,$333.17 ,$213.60 ,$429.24 ,$434.98 ,$112.42 ,$434.35 ,$429.24 ,$112.42 ,$383.25 ,$408.80 ,$408.80 ,$112.42 ,$408.80 ,$429.24 ,$429.24 ,$429.24 ,$511.00 ,$459.90 ,$293.83 ,$511.00 ,$112.42 ,$511.00 ,$277.98 ,$112.42 ,$212.58 , N/A , N/A ,$118.04 ,$434.35 ,$333.17 ,$143.08 ,$459.90 ,$429.24 ,$408.80 ,$408.80 ,$112.42 ,$332.15 
ST. FRANCIS HOSPITAL - ACUTE,45000165,58301,HC REM DVC INTRAUTERINE,450,1 ,$150.00 ,$97.50 ,$33.00 ,$720.10 ,$86.25 ,$108.00 ,$81.60 ,$33.00 ,$42.00 ,$84.15 ,$33.00 ,$97.80 ,$37.50 ,$97.80 ,$97.80 ,$37.50 ,$97.80 ,$62.70 ,$126.00 ,$720.10 ,$33.00 ,$127.50 ,$126.00 ,$33.00 ,$112.50 ,$120.00 ,$120.00 ,$33.00 ,$120.00 ,$126.00 ,$126.00 ,$126.00 ,$150.00 ,$135.00 ,$86.25 ,$150.00 ,$33.00 ,$150.00 ,$81.60 ,$33.00 ,$62.40 , N/A , N/A ,$34.65 ,$127.50 ,$97.80 ,$42.00 ,$135.00 ,$126.00 ,$120.00 ,$120.00 ,$33.00 ,$97.50 
ST. FRANCIS HOSPITAL - ACUTE,45000168,64400,HC DENTAL BLOCK,450,1 ,"$1,217.00 ",$791.05 ,$267.74 ,"$1,217.00 ",$699.78 ,$876.24 ,$662.05 ,$267.74 ,$340.76 ,$682.74 ,$267.74 ,$793.48 ,$304.25 ,$793.48 ,$793.48 ,$304.25 ,$793.48 ,$508.71 ,"$1,022.28 ","$1,000.61 ",$267.74 ,"$1,034.45 ","$1,022.28 ",$267.74 ,$912.75 ,$973.60 ,$973.60 ,$267.74 ,$973.60 ,"$1,022.28 ","$1,022.28 ","$1,022.28 ","$1,217.00 ","$1,095.30 ",$699.78 ,"$1,217.00 ",$267.74 ,"$1,217.00 ",$662.05 ,$267.74 ,$506.27 , N/A , N/A ,$281.13 ,"$1,034.45 ",$793.48 ,$340.76 ,"$1,095.30 ","$1,022.28 ",$973.60 ,$973.60 ,$267.74 ,$791.05 
ST. FRANCIS HOSPITAL - ACUTE,45000168,64400,HC DENTAL BLOCK,450,1 ,$562.00 ,$365.30 ,$123.64 ,$667.08 ,$323.15 ,$404.64 ,$305.73 ,$123.64 ,$157.36 ,$315.28 ,$123.64 ,$366.42 ,$140.50 ,$366.42 ,$366.42 ,$140.50 ,$366.42 ,$234.92 ,$472.08 ,$667.08 ,$123.64 ,$477.70 ,$472.08 ,$123.64 ,$421.50 ,$449.60 ,$449.60 ,$123.64 ,$449.60 ,$472.08 ,$472.08 ,$472.08 ,$562.00 ,$505.80 ,$323.15 ,$562.00 ,$123.64 ,$562.00 ,$305.73 ,$123.64 ,$233.79 , N/A , N/A ,$129.82 ,$477.70 ,$366.42 ,$157.36 ,$505.80 ,$472.08 ,$449.60 ,$449.60 ,$123.64 ,$365.30 
ST. FRANCIS HOSPITAL - ACUTE,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,"$1,138.00 ",$739.70 ,$250.36 ,"$1,138.00 ",$654.35 ,$819.36 ,$619.07 ,$250.36 ,$318.64 ,$638.42 ,$250.36 ,$741.98 ,$284.50 ,$741.98 ,$741.98 ,$284.50 ,$741.98 ,$475.68 ,$955.92 ,$667.08 ,$250.36 ,$967.30 ,$955.92 ,$250.36 ,$853.50 ,$910.40 ,$910.40 ,$250.36 ,$910.40 ,$955.92 ,$955.92 ,$955.92 ,"$1,138.00 ","$1,024.20 ",$654.35 ,"$1,138.00 ",$250.36 ,"$1,138.00 ",$619.07 ,$250.36 ,$473.41 , N/A , N/A ,$262.88 ,$967.30 ,$741.98 ,$318.64 ,"$1,024.20 ",$955.92 ,$910.40 ,$910.40 ,$250.36 ,$739.70 
ST. FRANCIS HOSPITAL - ACUTE,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$575.00 ,$373.75 ,$126.50 ,$667.08 ,$330.63 ,$414.00 ,$312.80 ,$126.50 ,$161.00 ,$322.58 ,$126.50 ,$374.90 ,$143.75 ,$374.90 ,$374.90 ,$143.75 ,$374.90 ,$240.35 ,$483.00 ,$667.08 ,$126.50 ,$488.75 ,$483.00 ,$126.50 ,$431.25 ,$460.00 ,$460.00 ,$126.50 ,$460.00 ,$483.00 ,$483.00 ,$483.00 ,$575.00 ,$517.50 ,$330.63 ,$575.00 ,$126.50 ,$575.00 ,$312.80 ,$126.50 ,$239.20 , N/A , N/A ,$132.83 ,$488.75 ,$374.90 ,$161.00 ,$517.50 ,$483.00 ,$460.00 ,$460.00 ,$126.50 ,$373.75 
ST. FRANCIS HOSPITAL - ACUTE,45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,"$1,880.00 ","$1,222.00 ",$413.60 ,"$1,880.00 ","$1,081.00 ","$1,353.60 ","$1,022.72 ",$413.60 ,$526.40 ,"$1,054.68 ",$413.60 ,"$1,225.76 ",$470.00 ,"$1,225.76 ","$1,225.76 ",$470.00 ,"$1,225.76 ",$785.84 ,"$1,579.20 ","$1,621.30 ",$413.60 ,"$1,598.00 ","$1,579.20 ",$413.60 ,"$1,410.00 ","$1,504.00 ","$1,504.00 ",$413.60 ,"$1,504.00 ","$1,579.20 ","$1,579.20 ","$1,579.20 ","$1,880.00 ","$1,692.00 ","$1,081.00 ","$1,880.00 ",$413.60 ,"$1,880.00 ","$1,022.72 ",$413.60 ,$782.08 , N/A , N/A ,$434.28 ,"$1,598.00 ","$1,225.76 ",$526.40 ,"$1,692.00 ","$1,579.20 ","$1,504.00 ","$1,504.00 ",$413.60 ,"$1,222.00 "
ST. FRANCIS HOSPITAL - ACUTE,45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$69.00 ,$44.85 ,$15.18 ,$287.90 ,$39.68 ,$49.68 ,$37.54 ,$15.18 ,$19.32 ,$38.71 ,$15.18 ,$44.99 ,$17.25 ,$44.99 ,$44.99 ,$17.25 ,$44.99 ,$28.84 ,$57.96 ,$287.90 ,$15.18 ,$58.65 ,$57.96 ,$15.18 ,$51.75 ,$55.20 ,$55.20 ,$15.18 ,$55.20 ,$57.96 ,$57.96 ,$57.96 ,$69.00 ,$62.10 ,$39.68 ,$69.00 ,$15.18 ,$69.00 ,$37.54 ,$15.18 ,$28.70 , N/A , N/A ,$15.94 ,$58.65 ,$44.99 ,$19.32 ,$62.10 ,$57.96 ,$55.20 ,$55.20 ,$15.18 ,$44.85 
ST. FRANCIS HOSPITAL - ACUTE,45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$269.00 ,$174.85 ,$59.18 ,$692.95 ,$154.68 ,$193.68 ,$146.34 ,$59.18 ,$75.32 ,$150.91 ,$59.18 ,$175.39 ,$67.25 ,$175.39 ,$175.39 ,$67.25 ,$175.39 ,$112.44 ,$225.96 ,$692.95 ,$59.18 ,$228.65 ,$225.96 ,$59.18 ,$201.75 ,$215.20 ,$215.20 ,$59.18 ,$215.20 ,$225.96 ,$225.96 ,$225.96 ,$269.00 ,$242.10 ,$154.68 ,$269.00 ,$59.18 ,$269.00 ,$146.34 ,$59.18 ,$111.90 , N/A , N/A ,$62.14 ,$228.65 ,$175.39 ,$75.32 ,$242.10 ,$225.96 ,$215.20 ,$215.20 ,$59.18 ,$174.85 
ST. FRANCIS HOSPITAL - ACUTE,45000174,65222,HC REM FB CORNL W/ SLIT LA,450,1 ,$279.00 ,$181.35 ,$61.38 ,$287.90 ,$160.43 ,$200.88 ,$151.78 ,$61.38 ,$78.12 ,$156.52 ,$61.38 ,$181.91 ,$69.75 ,$181.91 ,$181.91 ,$69.75 ,$181.91 ,$116.62 ,$234.36 ,$287.90 ,$61.38 ,$237.15 ,$234.36 ,$61.38 ,$209.25 ,$223.20 ,$223.20 ,$61.38 ,$223.20 ,$234.36 ,$234.36 ,$234.36 ,$279.00 ,$251.10 ,$160.43 ,$279.00 ,$61.38 ,$279.00 ,$151.78 ,$61.38 ,$116.06 , N/A , N/A ,$64.45 ,$237.15 ,$181.91 ,$78.12 ,$251.10 ,$234.36 ,$223.20 ,$223.20 ,$61.38 ,$181.35 
ST. FRANCIS HOSPITAL - ACUTE,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$357.00 ,$232.05 ,$78.54 ,$667.90 ,$205.28 ,$257.04 ,$194.21 ,$78.54 ,$99.96 ,$200.28 ,$78.54 ,$232.76 ,$89.25 ,$232.76 ,$232.76 ,$89.25 ,$232.76 ,$149.23 ,$299.88 ,$667.90 ,$78.54 ,$303.45 ,$299.88 ,$78.54 ,$267.75 ,$285.60 ,$285.60 ,$78.54 ,$285.60 ,$299.88 ,$299.88 ,$299.88 ,$357.00 ,$321.30 ,$205.28 ,$357.00 ,$78.54 ,$357.00 ,$194.21 ,$78.54 ,$148.51 , N/A , N/A ,$82.47 ,$303.45 ,$232.76 ,$99.96 ,$321.30 ,$299.88 ,$285.60 ,$285.60 ,$78.54 ,$232.05 
ST. FRANCIS HOSPITAL - ACUTE,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,$155.00 ,$100.75 ,$34.10 ,$667.90 ,$89.13 ,$111.60 ,$84.32 ,$34.10 ,$43.40 ,$86.96 ,$34.10 ,$101.06 ,$38.75 ,$101.06 ,$101.06 ,$38.75 ,$101.06 ,$64.79 ,$130.20 ,$667.90 ,$34.10 ,$131.75 ,$130.20 ,$34.10 ,$116.25 ,$124.00 ,$124.00 ,$34.10 ,$124.00 ,$130.20 ,$130.20 ,$130.20 ,$155.00 ,$139.50 ,$89.13 ,$155.00 ,$34.10 ,$155.00 ,$84.32 ,$34.10 ,$64.48 , N/A , N/A ,$35.81 ,$131.75 ,$101.06 ,$43.40 ,$139.50 ,$130.20 ,$124.00 ,$124.00 ,$34.10 ,$100.75 
ST. FRANCIS HOSPITAL - ACUTE,45000181,69200,HC FB REMOVAL EAR,450,1 ,$363.00 ,$235.95 ,$79.86 ,$363.00 ,$208.73 ,$261.36 ,$197.47 ,$79.86 ,$101.64 ,$203.64 ,$79.86 ,$236.68 ,$90.75 ,$236.68 ,$236.68 ,$90.75 ,$236.68 ,$151.73 ,$304.92 ,$287.90 ,$79.86 ,$308.55 ,$304.92 ,$79.86 ,$272.25 ,$290.40 ,$290.40 ,$79.86 ,$290.40 ,$304.92 ,$304.92 ,$304.92 ,$363.00 ,$326.70 ,$208.73 ,$363.00 ,$79.86 ,$363.00 ,$197.47 ,$79.86 ,$151.01 , N/A , N/A ,$83.85 ,$308.55 ,$236.68 ,$101.64 ,$326.70 ,$304.92 ,$290.40 ,$290.40 ,$79.86 ,$235.95 
ST. FRANCIS HOSPITAL - ACUTE,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$81.00 ,$52.65 ,$17.82 ,$142.13 ,$46.58 ,$58.32 ,$44.06 ,$17.82 ,$22.68 ,$45.44 ,$17.82 ,$52.81 ,$20.25 ,$52.81 ,$52.81 ,$20.25 ,$52.81 ,$33.86 ,$68.04 ,$142.13 ,$17.82 ,$68.85 ,$68.04 ,$17.82 ,$60.75 ,$64.80 ,$64.80 ,$17.82 ,$64.80 ,$68.04 ,$68.04 ,$68.04 ,$81.00 ,$72.90 ,$46.58 ,$81.00 ,$17.82 ,$81.00 ,$44.06 ,$17.82 ,$33.70 , N/A , N/A ,$18.71 ,$68.85 ,$52.81 ,$22.68 ,$72.90 ,$68.04 ,$64.80 ,$64.80 ,$17.82 ,$52.65 
ST. FRANCIS HOSPITAL - ACUTE,45000188,99281,HC ER LEVEL 1,450,1 ,$220.00 ,$143.00 ,$48.40 ,$220.00 ,$126.50 ,$158.40 ,$119.68 ,$48.40 ,$61.60 ,$123.42 ,$48.40 ,$143.44 ,$55.00 ,$143.44 ,$143.44 ,$55.00 ,$143.44 ,$91.96 ,$184.80 ,$185.20 ,$48.40 ,$187.00 ,$184.80 ,$48.40 ,$165.00 ,$176.00 ,$176.00 ,$48.40 ,$176.00 ,$184.80 ,$184.80 ,$184.80 ,$220.00 ,$198.00 ,$126.50 ,$220.00 ,$48.40 ,$220.00 ,$119.68 ,$48.40 ,$91.52 , N/A , N/A ,$50.82 ,$187.00 ,$143.44 ,$61.60 ,$198.00 ,$184.80 ,$176.00 ,$176.00 ,$48.40 ,$143.00 
ST. FRANCIS HOSPITAL - ACUTE,45000189,99282,HC ER LEVEL 2,450,1 ,$436.00 ,$283.40 ,$95.92 ,$436.00 ,$250.70 ,$313.92 ,$237.18 ,$95.92 ,$122.08 ,$244.60 ,$95.92 ,$284.27 ,$109.00 ,$284.27 ,$284.27 ,$109.00 ,$284.27 ,$182.25 ,$366.24 ,$335.38 ,$95.92 ,$370.60 ,$366.24 ,$95.92 ,$327.00 ,$348.80 ,$348.80 ,$95.92 ,$348.80 ,$366.24 ,$366.24 ,$366.24 ,$436.00 ,$392.40 ,$250.70 ,$436.00 ,$95.92 ,$436.00 ,$237.18 ,$95.92 ,$181.38 , N/A , N/A ,$100.72 ,$370.60 ,$284.27 ,$122.08 ,$392.40 ,$366.24 ,$348.80 ,$348.80 ,$95.92 ,$283.40 
ST. FRANCIS HOSPITAL - ACUTE,45000190,99283,HC ER LEVEL 3,450,1 ,$636.00 ,$413.40 ,$139.92 ,$636.00 ,$365.70 ,$457.92 ,$345.98 ,$139.92 ,$178.08 ,$356.80 ,$139.92 ,$414.67 ,$159.00 ,$414.67 ,$414.67 ,$159.00 ,$414.67 ,$265.85 ,$534.24 ,$590.88 ,$139.92 ,$540.60 ,$534.24 ,$139.92 ,$477.00 ,$508.80 ,$508.80 ,$139.92 ,$508.80 ,$534.24 ,$534.24 ,$534.24 ,$636.00 ,$572.40 ,$365.70 ,$636.00 ,$139.92 ,$636.00 ,$345.98 ,$139.92 ,$264.58 , N/A , N/A ,$146.92 ,$540.60 ,$414.67 ,$178.08 ,$572.40 ,$534.24 ,$508.80 ,$508.80 ,$139.92 ,$413.40 
ST. FRANCIS HOSPITAL - ACUTE,45000191,99284,HC ER LEVEL 4,450,1 ,"$1,000.00 ",$650.00 ,$141.57 ,"$1,000.00 ",$575.00 ,$720.00 ,$544.00 ,$220.00 ,$280.00 ,$561.00 ,$220.00 ,$652.00 ,$250.00 ,$652.00 ,$652.00 ,$250.00 ,$652.00 ,$418.00 ,$840.00 ,$928.80 ,$220.00 ,$850.00 ,$840.00 ,$220.00 ,$750.00 ,$800.00 ,$800.00 ,$220.00 ,$800.00 ,$840.00 ,$840.00 ,$840.00 ,"$1,000.00 ",$900.00 ,$575.00 ,"$1,000.00 ",$220.00 ,"$1,000.00 ",$544.00 ,$220.00 ,$416.00 ,$148.31 ,$141.57 ,$231.00 ,$850.00 ,$652.00 ,$280.00 ,$900.00 ,$840.00 ,$800.00 ,$800.00 ,$220.00 ,$650.00 
ST. FRANCIS HOSPITAL - ACUTE,45000192,99285,HC ER LEVEL 5,450,1 ,"$1,764.00 ","$1,146.60 ",$141.57 ,"$1,764.00 ","$1,014.30 ","$1,270.08 ",$959.62 ,$388.08 ,$493.92 ,$989.60 ,$388.08 ,"$1,150.13 ",$441.00 ,"$1,150.13 ","$1,150.13 ",$441.00 ,"$1,150.13 ",$737.35 ,"$1,481.76 ","$1,333.18 ",$388.08 ,"$1,499.40 ","$1,481.76 ",$388.08 ,"$1,323.00 ","$1,411.20 ","$1,411.20 ",$388.08 ,"$1,411.20 ","$1,481.76 ","$1,481.76 ","$1,481.76 ","$1,764.00 ","$1,587.60 ","$1,014.30 ","$1,764.00 ",$388.08 ,"$1,764.00 ",$959.62 ,$388.08 ,$733.82 ,$148.31 ,$141.57 ,$407.48 ,"$1,499.40 ","$1,150.13 ",$493.92 ,"$1,587.60 ","$1,481.76 ","$1,411.20 ","$1,411.20 ",$388.08 ,"$1,146.60 "
ST. FRANCIS HOSPITAL - ACUTE,45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$2,488.00 ","$1,617.20 ",$141.57 ,"$2,488.00 ","$1,430.60 ","$1,791.36 ","$1,353.47 ",$547.36 ,$696.64 ,"$1,395.77 ",$547.36 ,"$1,622.18 ",$622.00 ,"$1,622.18 ","$1,622.18 ",$622.00 ,"$1,622.18 ","$1,039.98 ","$2,089.92 ","$1,901.85 ",$547.36 ,"$2,114.80 ","$2,089.92 ",$547.36 ,"$1,866.00 ","$1,990.40 ","$1,990.40 ",$547.36 ,"$1,990.40 ","$2,089.92 ","$2,089.92 ","$2,089.92 ","$2,488.00 ","$2,239.20 ","$1,430.60 ","$2,488.00 ",$547.36 ,"$2,488.00 ","$1,353.47 ",$547.36 ,"$1,035.01 ",$148.31 ,$141.57 ,$574.73 ,"$2,114.80 ","$1,622.18 ",$696.64 ,"$2,239.20 ","$2,089.92 ","$1,990.40 ","$1,990.40 ",$547.36 ,"$1,617.20 "
ST. FRANCIS HOSPITAL - ACUTE,45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$775.00 ,$503.75 ,$170.50 ,$775.00 ,$445.63 ,$558.00 ,$421.60 ,$170.50 ,$217.00 ,$434.78 ,$170.50 ,$505.30 ,$193.75 ,$505.30 ,$505.30 ,$193.75 ,$505.30 ,$323.95 ,$651.00 , N/A ,$170.50 ,$658.75 ,$651.00 ,$170.50 ,$581.25 ,$620.00 ,$620.00 ,$170.50 ,$620.00 ,$651.00 ,$651.00 ,$651.00 ,$775.00 ,$697.50 ,$445.63 ,$775.00 ,$170.50 ,$775.00 ,$421.60 ,$170.50 ,$322.40 , N/A , N/A ,$179.03 ,$658.75 ,$505.30 ,$217.00 ,$697.50 ,$651.00 ,$620.00 ,$620.00 ,$170.50 ,$503.75 
ST. FRANCIS HOSPITAL - ACUTE,45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,$616.00 ,$400.40 ,$135.52 ,"$3,556.28 ",$354.20 ,$443.52 ,$335.10 ,$135.52 ,$172.48 ,$345.58 ,$135.52 ,$401.63 ,$154.00 ,$401.63 ,$401.63 ,$154.00 ,$401.63 ,$257.49 ,$517.44 ,"$3,556.28 ",$135.52 ,$523.60 ,$517.44 ,$135.52 ,$462.00 ,$492.80 ,$492.80 ,$135.52 ,$492.80 ,$517.44 ,$517.44 ,$517.44 ,$616.00 ,$554.40 ,$354.20 ,$616.00 ,$135.52 ,$616.00 ,$335.10 ,$135.52 ,$256.26 , N/A , N/A ,$142.30 ,$523.60 ,$401.63 ,$172.48 ,$554.40 ,$517.44 ,$492.80 ,$492.80 ,$135.52 ,$400.40 
ST. FRANCIS HOSPITAL - ACUTE,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$324.00 ,$210.60 ,$71.28 ,$526.25 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$526.25 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000200,35206,HC RPR VESSEL EXTREM UPR,450,1 ,"$3,343.00 ","$2,172.95 ",$735.46 ,"$7,309.08 ","$1,922.23 ","$2,406.96 ","$1,818.59 ",$735.46 ,$936.04 ,"$1,875.42 ",$735.46 ,"$2,179.64 ",$835.75 ,"$2,179.64 ","$2,179.64 ",$835.75 ,"$2,179.64 ","$1,397.37 ","$2,808.12 ","$7,309.08 ",$735.46 ,"$2,841.55 ","$2,808.12 ",$735.46 ,"$2,507.25 ","$2,674.40 ","$2,674.40 ",$735.46 ,"$2,674.40 ","$2,808.12 ","$2,808.12 ","$2,808.12 ","$3,343.00 ","$3,008.70 ","$1,922.23 ","$3,343.00 ",$735.46 ,"$3,343.00 ","$1,818.59 ",$735.46 ,"$1,390.69 ", N/A , N/A ,$772.23 ,"$2,841.55 ","$2,179.64 ",$936.04 ,"$3,008.70 ","$2,808.12 ","$2,674.40 ","$2,674.40 ",$735.46 ,"$2,172.95 "
ST. FRANCIS HOSPITAL - ACUTE,45000203,27840,HC TX DISL ANKE W/O ANES CLS,450,1 ,$657.00 ,$427.05 ,$144.54 ,$657.00 ,$377.78 ,$473.04 ,$357.41 ,$144.54 ,$183.96 ,$368.58 ,$144.54 ,$428.36 ,$164.25 ,$428.36 ,$428.36 ,$164.25 ,$428.36 ,$274.63 ,$551.88 ,$526.25 ,$144.54 ,$558.45 ,$551.88 ,$144.54 ,$492.75 ,$525.60 ,$525.60 ,$144.54 ,$525.60 ,$551.88 ,$551.88 ,$551.88 ,$657.00 ,$591.30 ,$377.78 ,$657.00 ,$144.54 ,$657.00 ,$357.41 ,$144.54 ,$273.31 , N/A , N/A ,$151.77 ,$558.45 ,$428.36 ,$183.96 ,$591.30 ,$551.88 ,$525.60 ,$525.60 ,$144.54 ,$427.05 
ST. FRANCIS HOSPITAL - ACUTE,45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,$177.00 ,$115.05 ,$38.94 ,"$3,592.48 ",$101.78 ,$127.44 ,$96.29 ,$38.94 ,$49.56 ,$99.30 ,$38.94 ,$115.40 ,$44.25 ,$115.40 ,$115.40 ,$44.25 ,$115.40 ,$73.99 ,$148.68 ,"$3,592.48 ",$38.94 ,$150.45 ,$148.68 ,$38.94 ,$132.75 ,$141.60 ,$141.60 ,$38.94 ,$141.60 ,$148.68 ,$148.68 ,$148.68 ,$177.00 ,$159.30 ,$101.78 ,$177.00 ,$38.94 ,$177.00 ,$96.29 ,$38.94 ,$73.63 , N/A , N/A ,$40.89 ,$150.45 ,$115.40 ,$49.56 ,$159.30 ,$148.68 ,$141.60 ,$141.60 ,$38.94 ,$115.05 
ST. FRANCIS HOSPITAL - ACUTE,45000210,25680,HC CLSD WRIST FX W/MANIP,450,1 ,$278.00 ,$180.70 ,$61.16 ,$526.25 ,$159.85 ,$200.16 ,$151.23 ,$61.16 ,$77.84 ,$155.96 ,$61.16 ,$181.26 ,$69.50 ,$181.26 ,$181.26 ,$69.50 ,$181.26 ,$116.20 ,$233.52 ,$526.25 ,$61.16 ,$236.30 ,$233.52 ,$61.16 ,$208.50 ,$222.40 ,$222.40 ,$61.16 ,$222.40 ,$233.52 ,$233.52 ,$233.52 ,$278.00 ,$250.20 ,$159.85 ,$278.00 ,$61.16 ,$278.00 ,$151.23 ,$61.16 ,$115.65 , N/A , N/A ,$64.22 ,$236.30 ,$181.26 ,$77.84 ,$250.20 ,$233.52 ,$222.40 ,$222.40 ,$61.16 ,$180.70 
ST. FRANCIS HOSPITAL - ACUTE,45000212,25690,HC CLSD WRIST DISLOC,450,1 ,"$4,178.00 ","$2,715.70 ",$919.16 ,"$4,178.00 ","$2,402.35 ","$3,008.16 ","$2,272.83 ",$919.16 ,"$1,169.84 ","$2,343.86 ",$919.16 ,"$2,724.06 ","$1,044.50 ","$2,724.06 ","$2,724.06 ","$1,044.50 ","$2,724.06 ","$1,746.40 ","$3,509.52 ","$3,556.28 ",$919.16 ,"$3,551.30 ","$3,509.52 ",$919.16 ,"$3,133.50 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$3,342.40 ","$3,509.52 ","$3,509.52 ","$3,509.52 ","$4,178.00 ","$3,760.20 ","$2,402.35 ","$4,178.00 ",$919.16 ,"$4,178.00 ","$2,272.83 ",$919.16 ,"$1,738.05 ", N/A , N/A ,$965.12 ,"$3,551.30 ","$2,724.06 ","$1,169.84 ","$3,760.20 ","$3,509.52 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$2,715.70 "
ST. FRANCIS HOSPITAL - ACUTE,45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$893.00 ,$580.45 ,$196.46 ,$893.00 ,$513.48 ,$642.96 ,$485.79 ,$196.46 ,$250.04 ,$500.97 ,$196.46 ,$582.24 ,$223.25 ,$582.24 ,$582.24 ,$223.25 ,$582.24 ,$373.27 ,$750.12 ,$814.10 ,$196.46 ,$759.05 ,$750.12 ,$196.46 ,$669.75 ,$714.40 ,$714.40 ,$196.46 ,$714.40 ,$750.12 ,$750.12 ,$750.12 ,$893.00 ,$803.70 ,$513.48 ,$893.00 ,$196.46 ,$893.00 ,$485.79 ,$196.46 ,$371.49 , N/A , N/A ,$206.28 ,$759.05 ,$582.24 ,$250.04 ,$803.70 ,$750.12 ,$714.40 ,$714.40 ,$196.46 ,$580.45 
ST. FRANCIS HOSPITAL - ACUTE,45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,$411.00 ,$267.15 ,$90.42 ,"$3,556.28 ",$236.33 ,$295.92 ,$223.58 ,$90.42 ,$115.08 ,$230.57 ,$90.42 ,$267.97 ,$102.75 ,$267.97 ,$267.97 ,$102.75 ,$267.97 ,$171.80 ,$345.24 ,"$3,556.28 ",$90.42 ,$349.35 ,$345.24 ,$90.42 ,$308.25 ,$328.80 ,$328.80 ,$90.42 ,$328.80 ,$345.24 ,$345.24 ,$345.24 ,$411.00 ,$369.90 ,$236.33 ,$411.00 ,$90.42 ,$411.00 ,$223.58 ,$90.42 ,$170.98 , N/A , N/A ,$94.94 ,$349.35 ,$267.97 ,$115.08 ,$369.90 ,$345.24 ,$328.80 ,$328.80 ,$90.42 ,$267.15 
ST. FRANCIS HOSPITAL - ACUTE,45000220,29280,HC STRAPPING HAND/FINGER,450,1 ,$254.00 ,$165.10 ,$55.88 ,$254.00 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$142.49 ,$55.88 ,$165.61 ,$63.50 ,$165.61 ,$165.61 ,$63.50 ,$165.61 ,$106.17 ,$213.36 ,$142.13 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 , N/A , N/A ,$58.67 ,$215.90 ,$165.61 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,45000227,25600,HC CLSD DIS.RADIUS W/O MANIP,450,1 ,$560.00 ,$364.00 ,$123.20 ,$560.00 ,$322.00 ,$403.20 ,$304.64 ,$123.20 ,$156.80 ,$314.16 ,$123.20 ,$365.12 ,$140.00 ,$365.12 ,$365.12 ,$140.00 ,$365.12 ,$234.08 ,$470.40 ,$526.25 ,$123.20 ,$476.00 ,$470.40 ,$123.20 ,$420.00 ,$448.00 ,$448.00 ,$123.20 ,$448.00 ,$470.40 ,$470.40 ,$470.40 ,$560.00 ,$504.00 ,$322.00 ,$560.00 ,$123.20 ,$560.00 ,$304.64 ,$123.20 ,$232.96 , N/A , N/A ,$129.36 ,$476.00 ,$365.12 ,$156.80 ,$504.00 ,$470.40 ,$448.00 ,$448.00 ,$123.20 ,$364.00 
ST. FRANCIS HOSPITAL - ACUTE,45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$324.00 ,$210.60 ,$71.28 ,$526.25 ,$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,$526.25 ,$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000234,25560,HC RADIUS AND ULNA FX W/O MANIP,450,1 ,$684.00 ,$444.60 ,$150.48 ,$684.00 ,$393.30 ,$492.48 ,$372.10 ,$150.48 ,$191.52 ,$383.72 ,$150.48 ,$445.97 ,$171.00 ,$445.97 ,$445.97 ,$171.00 ,$445.97 ,$285.91 ,$574.56 ,$526.25 ,$150.48 ,$581.40 ,$574.56 ,$150.48 ,$513.00 ,$547.20 ,$547.20 ,$150.48 ,$547.20 ,$574.56 ,$574.56 ,$574.56 ,$684.00 ,$615.60 ,$393.30 ,$684.00 ,$150.48 ,$684.00 ,$372.10 ,$150.48 ,$284.54 , N/A , N/A ,$158.00 ,$581.40 ,$445.97 ,$191.52 ,$615.60 ,$574.56 ,$547.20 ,$547.20 ,$150.48 ,$444.60 
ST. FRANCIS HOSPITAL - ACUTE,45000238,26670,HC HAND DISL W/MANIP W/O ANES,450,1 ,$725.00 ,$471.25 ,$159.50 ,$725.00 ,$416.88 ,$522.00 ,$394.40 ,$159.50 ,$203.00 ,$406.73 ,$159.50 ,$472.70 ,$181.25 ,$472.70 ,$472.70 ,$181.25 ,$472.70 ,$303.05 ,$609.00 ,$526.25 ,$159.50 ,$616.25 ,$609.00 ,$159.50 ,$543.75 ,$580.00 ,$580.00 ,$159.50 ,$580.00 ,$609.00 ,$609.00 ,$609.00 ,$725.00 ,$652.50 ,$416.88 ,$725.00 ,$159.50 ,$725.00 ,$394.40 ,$159.50 ,$301.60 , N/A , N/A ,$167.48 ,$616.25 ,$472.70 ,$203.00 ,$652.50 ,$609.00 ,$580.00 ,$580.00 ,$159.50 ,$471.25 
ST. FRANCIS HOSPITAL - ACUTE,45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$619.00 ,$402.35 ,$136.18 ,$619.00 ,$355.93 ,$445.68 ,$336.74 ,$136.18 ,$173.32 ,$347.26 ,$136.18 ,$403.59 ,$154.75 ,$403.59 ,$403.59 ,$154.75 ,$403.59 ,$258.74 ,$519.96 ,$526.25 ,$136.18 ,$526.15 ,$519.96 ,$136.18 ,$464.25 ,$495.20 ,$495.20 ,$136.18 ,$495.20 ,$519.96 ,$519.96 ,$519.96 ,$619.00 ,$557.10 ,$355.93 ,$619.00 ,$136.18 ,$619.00 ,$336.74 ,$136.18 ,$257.50 , N/A , N/A ,$142.99 ,$526.15 ,$403.59 ,$173.32 ,$557.10 ,$519.96 ,$495.20 ,$495.20 ,$136.18 ,$402.35 
ST. FRANCIS HOSPITAL - ACUTE,45000252,20520,HC MUSCLE FB REM W/ INC,450,1 ,$291.00 ,$189.15 ,$64.02 ,"$3,592.48 ",$167.33 ,$209.52 ,$158.30 ,$64.02 ,$81.48 ,$163.25 ,$64.02 ,$189.73 ,$72.75 ,$189.73 ,$189.73 ,$72.75 ,$189.73 ,$121.64 ,$244.44 ,"$3,592.48 ",$64.02 ,$247.35 ,$244.44 ,$64.02 ,$218.25 ,$232.80 ,$232.80 ,$64.02 ,$232.80 ,$244.44 ,$244.44 ,$244.44 ,$291.00 ,$261.90 ,$167.33 ,$291.00 ,$64.02 ,$291.00 ,$158.30 ,$64.02 ,$121.06 , N/A , N/A ,$67.22 ,$247.35 ,$189.73 ,$81.48 ,$261.90 ,$244.44 ,$232.80 ,$232.80 ,$64.02 ,$189.15 
ST. FRANCIS HOSPITAL - ACUTE,45000258,29345,HC LONG LEG CAST,450,1 ,$463.00 ,$300.95 ,$101.86 ,$615.95 ,$266.23 ,$333.36 ,$251.87 ,$101.86 ,$129.64 ,$259.74 ,$101.86 ,$301.88 ,$115.75 ,$301.88 ,$301.88 ,$115.75 ,$301.88 ,$193.53 ,$388.92 ,$615.95 ,$101.86 ,$393.55 ,$388.92 ,$101.86 ,$347.25 ,$370.40 ,$370.40 ,$101.86 ,$370.40 ,$388.92 ,$388.92 ,$388.92 ,$463.00 ,$416.70 ,$266.23 ,$463.00 ,$101.86 ,$463.00 ,$251.87 ,$101.86 ,$192.61 , N/A , N/A ,$106.95 ,$393.55 ,$301.88 ,$129.64 ,$416.70 ,$388.92 ,$370.40 ,$370.40 ,$101.86 ,$300.95 
ST. FRANCIS HOSPITAL - ACUTE,45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,"$1,432.00 ",$930.80 ,$315.04 ,"$1,432.00 ",$823.40 ,"$1,031.04 ",$779.01 ,$315.04 ,$400.96 ,$803.35 ,$315.04 ,$933.66 ,$358.00 ,$933.66 ,$933.66 ,$358.00 ,$933.66 ,$598.58 ,"$1,202.88 ",$667.08 ,$315.04 ,"$1,217.20 ","$1,202.88 ",$315.04 ,"$1,074.00 ","$1,145.60 ","$1,145.60 ",$315.04 ,"$1,145.60 ","$1,202.88 ","$1,202.88 ","$1,202.88 ","$1,432.00 ","$1,288.80 ",$823.40 ,"$1,432.00 ",$315.04 ,"$1,432.00 ",$779.01 ,$315.04 ,$595.71 , N/A , N/A ,$330.79 ,"$1,217.20 ",$933.66 ,$400.96 ,"$1,288.80 ","$1,202.88 ","$1,145.60 ","$1,145.60 ",$315.04 ,$930.80 
ST. FRANCIS HOSPITAL - ACUTE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$127.00 ,$82.55 ,$27.94 ,$142.13 ,$73.03 ,$91.44 ,$69.09 ,$27.94 ,$35.56 ,$71.25 ,$27.94 ,$82.80 ,$31.75 ,$82.80 ,$82.80 ,$31.75 ,$82.80 ,$53.09 ,$106.68 ,$142.13 ,$27.94 ,$107.95 ,$106.68 ,$27.94 ,$95.25 ,$101.60 ,$101.60 ,$27.94 ,$101.60 ,$106.68 ,$106.68 ,$106.68 ,$127.00 ,$114.30 ,$73.03 ,$127.00 ,$27.94 ,$127.00 ,$69.09 ,$27.94 ,$52.83 , N/A , N/A ,$29.34 ,$107.95 ,$82.80 ,$35.56 ,$114.30 ,$106.68 ,$101.60 ,$101.60 ,$27.94 ,$82.55 
ST. FRANCIS HOSPITAL - ACUTE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$250.00 ,$162.50 ,$55.00 ,$250.00 ,$143.75 ,$180.00 ,$136.00 ,$55.00 ,$70.00 ,$140.25 ,$55.00 ,$163.00 ,$62.50 ,$163.00 ,$163.00 ,$62.50 ,$163.00 ,$104.50 ,$210.00 ,$142.13 ,$55.00 ,$212.50 ,$210.00 ,$55.00 ,$187.50 ,$200.00 ,$200.00 ,$55.00 ,$200.00 ,$210.00 ,$210.00 ,$210.00 ,$250.00 ,$225.00 ,$143.75 ,$250.00 ,$55.00 ,$250.00 ,$136.00 ,$55.00 ,$104.00 , N/A , N/A ,$57.75 ,$212.50 ,$163.00 ,$70.00 ,$225.00 ,$210.00 ,$200.00 ,$200.00 ,$55.00 ,$162.50 
ST. FRANCIS HOSPITAL - ACUTE,45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$619.00 ,$402.35 ,$136.18 ,$619.00 ,$355.93 ,$445.68 ,$336.74 ,$136.18 ,$173.32 ,$347.26 ,$136.18 ,$403.59 ,$154.75 ,$403.59 ,$403.59 ,$154.75 ,$403.59 ,$258.74 ,$519.96 ,$526.25 ,$136.18 ,$526.15 ,$519.96 ,$136.18 ,$464.25 ,$495.20 ,$495.20 ,$136.18 ,$495.20 ,$519.96 ,$519.96 ,$519.96 ,$619.00 ,$557.10 ,$355.93 ,$619.00 ,$136.18 ,$619.00 ,$336.74 ,$136.18 ,$257.50 , N/A , N/A ,$142.99 ,$526.15 ,$403.59 ,$173.32 ,$557.10 ,$519.96 ,$495.20 ,$495.20 ,$136.18 ,$402.35 
ST. FRANCIS HOSPITAL - ACUTE,45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$494.00 ,$321.10 ,$108.68 ,$494.00 ,$284.05 ,$355.68 ,$268.74 ,$108.68 ,$138.32 ,$277.13 ,$108.68 ,$322.09 ,$123.50 ,$322.09 ,$322.09 ,$123.50 ,$322.09 ,$206.49 ,$414.96 ,$420.30 ,$108.68 ,$419.90 ,$414.96 ,$108.68 ,$370.50 ,$395.20 ,$395.20 ,$108.68 ,$395.20 ,$414.96 ,$414.96 ,$414.96 ,$494.00 ,$444.60 ,$284.05 ,$494.00 ,$108.68 ,$494.00 ,$268.74 ,$108.68 ,$205.50 , N/A , N/A ,$114.11 ,$419.90 ,$322.09 ,$138.32 ,$444.60 ,$414.96 ,$395.20 ,$395.20 ,$108.68 ,$321.10 
ST. FRANCIS HOSPITAL - ACUTE,45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,$619.00 ,$402.35 ,$136.18 ,$619.00 ,$355.93 ,$445.68 ,$336.74 ,$136.18 ,$173.32 ,$347.26 ,$136.18 ,$403.59 ,$154.75 ,$403.59 ,$403.59 ,$154.75 ,$403.59 ,$258.74 ,$519.96 ,$526.25 ,$136.18 ,$526.15 ,$519.96 ,$136.18 ,$464.25 ,$495.20 ,$495.20 ,$136.18 ,$495.20 ,$519.96 ,$519.96 ,$519.96 ,$619.00 ,$557.10 ,$355.93 ,$619.00 ,$136.18 ,$619.00 ,$336.74 ,$136.18 ,$257.50 , N/A , N/A ,$142.99 ,$526.15 ,$403.59 ,$173.32 ,$557.10 ,$519.96 ,$495.20 ,$495.20 ,$136.18 ,$402.35 
ST. FRANCIS HOSPITAL - ACUTE,45000329,27752,HC CLSD TX FX TIBIAL SHAFT W/MANIP,450,1 ,$411.00 ,$267.15 ,$90.42 ,"$3,556.28 ",$236.33 ,$295.92 ,$223.58 ,$90.42 ,$115.08 ,$230.57 ,$90.42 ,$267.97 ,$102.75 ,$267.97 ,$267.97 ,$102.75 ,$267.97 ,$171.80 ,$345.24 ,"$3,556.28 ",$90.42 ,$349.35 ,$345.24 ,$90.42 ,$308.25 ,$328.80 ,$328.80 ,$90.42 ,$328.80 ,$345.24 ,$345.24 ,$345.24 ,$411.00 ,$369.90 ,$236.33 ,$411.00 ,$90.42 ,$411.00 ,$223.58 ,$90.42 ,$170.98 , N/A , N/A ,$94.94 ,$349.35 ,$267.97 ,$115.08 ,$369.90 ,$345.24 ,$328.80 ,$328.80 ,$90.42 ,$267.15 
ST. FRANCIS HOSPITAL - ACUTE,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$725.00 ,$471.25 ,$159.50 ,$725.00 ,$416.88 ,$522.00 ,$394.40 ,$159.50 ,$203.00 ,$406.73 ,$159.50 ,$472.70 ,$181.25 ,$472.70 ,$472.70 ,$181.25 ,$472.70 ,$303.05 ,$609.00 ,$526.25 ,$159.50 ,$616.25 ,$609.00 ,$159.50 ,$543.75 ,$580.00 ,$580.00 ,$159.50 ,$580.00 ,$609.00 ,$609.00 ,$609.00 ,$725.00 ,$652.50 ,$416.88 ,$725.00 ,$159.50 ,$725.00 ,$394.40 ,$159.50 ,$301.60 , N/A , N/A ,$167.48 ,$616.25 ,$472.70 ,$203.00 ,$652.50 ,$609.00 ,$580.00 ,$580.00 ,$159.50 ,$471.25 
ST. FRANCIS HOSPITAL - ACUTE,45000334,29260,HC STRAPPING ELBOW/WRIST,450,1 ,$254.00 ,$165.10 ,$55.88 ,$254.00 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$142.49 ,$55.88 ,$165.61 ,$63.50 ,$165.61 ,$165.61 ,$63.50 ,$165.61 ,$106.17 ,$213.36 ,$142.13 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 , N/A , N/A ,$58.67 ,$215.90 ,$165.61 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,45000335,29530,HC STRAPPING KNEE,450,1 ,$301.00 ,$195.65 ,$66.22 ,$301.00 ,$173.08 ,$216.72 ,$163.74 ,$66.22 ,$84.28 ,$168.86 ,$66.22 ,$196.25 ,$75.25 ,$196.25 ,$196.25 ,$75.25 ,$196.25 ,$125.82 ,$252.84 ,$287.90 ,$66.22 ,$255.85 ,$252.84 ,$66.22 ,$225.75 ,$240.80 ,$240.80 ,$66.22 ,$240.80 ,$252.84 ,$252.84 ,$252.84 ,$301.00 ,$270.90 ,$173.08 ,$301.00 ,$66.22 ,$301.00 ,$163.74 ,$66.22 ,$125.22 , N/A , N/A ,$69.53 ,$255.85 ,$196.25 ,$84.28 ,$270.90 ,$252.84 ,$240.80 ,$240.80 ,$66.22 ,$195.65 
ST. FRANCIS HOSPITAL - ACUTE,45000336,29550,HC STRAPPING TOES,450,1 ,$254.00 ,$165.10 ,$55.88 ,$254.00 ,$146.05 ,$182.88 ,$138.18 ,$55.88 ,$71.12 ,$142.49 ,$55.88 ,$165.61 ,$63.50 ,$165.61 ,$165.61 ,$63.50 ,$165.61 ,$106.17 ,$213.36 ,$142.13 ,$55.88 ,$215.90 ,$213.36 ,$55.88 ,$190.50 ,$203.20 ,$203.20 ,$55.88 ,$203.20 ,$213.36 ,$213.36 ,$213.36 ,$254.00 ,$228.60 ,$146.05 ,$254.00 ,$55.88 ,$254.00 ,$138.18 ,$55.88 ,$105.66 , N/A , N/A ,$58.67 ,$215.90 ,$165.61 ,$71.12 ,$228.60 ,$213.36 ,$203.20 ,$203.20 ,$55.88 ,$165.10 
ST. FRANCIS HOSPITAL - ACUTE,45000338,30906,HC CONTROL NASAL HEMORRHAGE SUBSQ,450,1 ,$591.00 ,$384.15 ,$130.02 ,$591.00 ,$339.83 ,$425.52 ,$321.50 ,$130.02 ,$165.48 ,$331.55 ,$130.02 ,$385.33 ,$147.75 ,$385.33 ,$385.33 ,$147.75 ,$385.33 ,$247.04 ,$496.44 ,$540.18 ,$130.02 ,$502.35 ,$496.44 ,$130.02 ,$443.25 ,$472.80 ,$472.80 ,$130.02 ,$472.80 ,$496.44 ,$496.44 ,$496.44 ,$591.00 ,$531.90 ,$339.83 ,$591.00 ,$130.02 ,$591.00 ,$321.50 ,$130.02 ,$245.86 , N/A , N/A ,$136.52 ,$502.35 ,$385.33 ,$165.48 ,$531.90 ,$496.44 ,$472.80 ,$472.80 ,$130.02 ,$384.15 
ST. FRANCIS HOSPITAL - ACUTE,45000346,23625,HC CLOSED TX GR TUBER HUM FX W/MANIP,450,1 ,"$4,679.00 ","$3,041.35 ","$1,029.38 ","$4,679.00 ","$2,690.43 ","$3,368.88 ","$2,545.38 ","$1,029.38 ","$1,310.12 ","$2,624.92 ","$1,029.38 ","$3,050.71 ","$1,169.75 ","$3,050.71 ","$3,050.71 ","$1,169.75 ","$3,050.71 ","$1,955.82 ","$3,930.36 ","$3,556.28 ","$1,029.38 ","$3,977.15 ","$3,930.36 ","$1,029.38 ","$3,509.25 ","$3,743.20 ","$3,743.20 ","$1,029.38 ","$3,743.20 ","$3,930.36 ","$3,930.36 ","$3,930.36 ","$4,679.00 ","$4,211.10 ","$2,690.43 ","$4,679.00 ","$1,029.38 ","$4,679.00 ","$2,545.38 ","$1,029.38 ","$1,946.46 ", N/A , N/A ,"$1,080.85 ","$3,977.15 ","$3,050.71 ","$1,310.12 ","$4,211.10 ","$3,930.36 ","$3,743.20 ","$3,743.20 ","$1,029.38 ","$3,041.35 "
ST. FRANCIS HOSPITAL - ACUTE,45000451,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-LT,450,1 ,"$1,392.00 ",$904.80 ,$306.24 ,"$1,588.85 ",$800.40 ,"$1,002.24 ",$757.25 ,$306.24 ,$389.76 ,$780.91 ,$306.24 ,$907.58 ,$348.00 ,$907.58 ,$907.58 ,$348.00 ,$907.58 ,$581.86 ,"$1,169.28 ","$1,588.85 ",$306.24 ,"$1,183.20 ","$1,169.28 ",$306.24 ,"$1,044.00 ","$1,113.60 ","$1,113.60 ",$306.24 ,"$1,113.60 ","$1,169.28 ","$1,169.28 ","$1,169.28 ","$1,392.00 ","$1,252.80 ",$800.40 ,"$1,392.00 ",$306.24 ,"$1,392.00 ",$757.25 ,$306.24 ,$579.07 , N/A , N/A ,$321.55 ,"$1,183.20 ",$907.58 ,$389.76 ,"$1,252.80 ","$1,169.28 ","$1,113.60 ","$1,113.60 ",$306.24 ,$904.80 
ST. FRANCIS HOSPITAL - ACUTE,45000452,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-RT,450,1 ,"$1,392.00 ",$904.80 ,$306.24 ,"$1,588.85 ",$800.40 ,"$1,002.24 ",$757.25 ,$306.24 ,$389.76 ,$780.91 ,$306.24 ,$907.58 ,$348.00 ,$907.58 ,$907.58 ,$348.00 ,$907.58 ,$581.86 ,"$1,169.28 ","$1,588.85 ",$306.24 ,"$1,183.20 ","$1,169.28 ",$306.24 ,"$1,044.00 ","$1,113.60 ","$1,113.60 ",$306.24 ,"$1,113.60 ","$1,169.28 ","$1,169.28 ","$1,169.28 ","$1,392.00 ","$1,252.80 ",$800.40 ,"$1,392.00 ",$306.24 ,"$1,392.00 ",$757.25 ,$306.24 ,$579.07 , N/A , N/A ,$321.55 ,"$1,183.20 ",$907.58 ,$389.76 ,"$1,252.80 ","$1,169.28 ","$1,113.60 ","$1,113.60 ",$306.24 ,$904.80 
ST. FRANCIS HOSPITAL - ACUTE,45000457,29365,HC APPL CAST CYCLINDER THIGH TO ANKLE,450,1 ,$664.00 ,$431.60 ,$146.08 ,$664.00 ,$381.80 ,$478.08 ,$361.22 ,$146.08 ,$185.92 ,$372.50 ,$146.08 ,$432.93 ,$166.00 ,$432.93 ,$432.93 ,$166.00 ,$432.93 ,$277.55 ,$557.76 ,$615.95 ,$146.08 ,$564.40 ,$557.76 ,$146.08 ,$498.00 ,$531.20 ,$531.20 ,$146.08 ,$531.20 ,$557.76 ,$557.76 ,$557.76 ,$664.00 ,$597.60 ,$381.80 ,$664.00 ,$146.08 ,$664.00 ,$361.22 ,$146.08 ,$276.22 , N/A , N/A ,$153.38 ,$564.40 ,$432.93 ,$185.92 ,$597.60 ,$557.76 ,$531.20 ,$531.20 ,$146.08 ,$431.60 
ST. FRANCIS HOSPITAL - ACUTE,45000493,36600,HC ARTERIAL PUNCTURE,450,1 ,$78.00 ,$50.70 ,$17.16 ,$287.90 ,$44.85 ,$56.16 ,$42.43 ,$17.16 ,$21.84 ,$43.76 ,$17.16 ,$50.86 ,$19.50 ,$50.86 ,$50.86 ,$19.50 ,$50.86 ,$32.60 ,$65.52 ,$287.90 ,$17.16 ,$66.30 ,$65.52 ,$17.16 ,$58.50 ,$62.40 ,$62.40 ,$17.16 ,$62.40 ,$65.52 ,$65.52 ,$65.52 ,$78.00 ,$70.20 ,$44.85 ,$78.00 ,$17.16 ,$78.00 ,$42.43 ,$17.16 ,$32.45 , N/A , N/A ,$18.02 ,$66.30 ,$50.86 ,$21.84 ,$70.20 ,$65.52 ,$62.40 ,$62.40 ,$17.16 ,$50.70 
ST. FRANCIS HOSPITAL - ACUTE,45000515,32551,HC TUBE THORACOSTOMY-BIL,450,1 ,$842.00 ,$547.30 ,$185.24 ,"$7,309.08 ",$484.15 ,$606.24 ,$458.05 ,$185.24 ,$235.76 ,$472.36 ,$185.24 ,$548.98 ,$210.50 ,$548.98 ,$548.98 ,$210.50 ,$548.98 ,$351.96 ,$707.28 ,"$7,309.08 ",$185.24 ,$715.70 ,$707.28 ,$185.24 ,$631.50 ,$673.60 ,$673.60 ,$185.24 ,$673.60 ,$707.28 ,$707.28 ,$707.28 ,$842.00 ,$757.80 ,$484.15 ,$842.00 ,$185.24 ,$842.00 ,$458.05 ,$185.24 ,$350.27 , N/A , N/A ,$194.50 ,$715.70 ,$548.98 ,$235.76 ,$757.80 ,$707.28 ,$673.60 ,$673.60 ,$185.24 ,$547.30 
ST. FRANCIS HOSPITAL - ACUTE,45000532,23575,HC TX FX SCAPULA CLOSED W/MANIP W/W/O TRACTION,450,1 ,$324.00 ,$210.60 ,$71.28 ,"$3,556.28 ",$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,"$3,556.28 ",$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45000538,27530,HC TX FX TIBIAL W/O MANIP CLOSED,450,1 ,$782.00 ,$508.30 ,$172.04 ,$782.00 ,$449.65 ,$563.04 ,$425.41 ,$172.04 ,$218.96 ,$438.70 ,$172.04 ,$509.86 ,$195.50 ,$509.86 ,$509.86 ,$195.50 ,$509.86 ,$326.88 ,$656.88 ,$526.25 ,$172.04 ,$664.70 ,$656.88 ,$172.04 ,$586.50 ,$625.60 ,$625.60 ,$172.04 ,$625.60 ,$656.88 ,$656.88 ,$656.88 ,$782.00 ,$703.80 ,$449.65 ,$782.00 ,$172.04 ,$782.00 ,$425.41 ,$172.04 ,$325.31 , N/A , N/A ,$180.64 ,$664.70 ,$509.86 ,$218.96 ,$703.80 ,$656.88 ,$625.60 ,$625.60 ,$172.04 ,$508.30 
ST. FRANCIS HOSPITAL - ACUTE,45000548,29425,HC APPLY SHORT LEG CAST WALKING,450,1 ,$457.00 ,$297.05 ,$100.54 ,$615.95 ,$262.78 ,$329.04 ,$248.61 ,$100.54 ,$127.96 ,$256.38 ,$100.54 ,$297.96 ,$114.25 ,$297.96 ,$297.96 ,$114.25 ,$297.96 ,$191.03 ,$383.88 ,$615.95 ,$100.54 ,$388.45 ,$383.88 ,$100.54 ,$342.75 ,$365.60 ,$365.60 ,$100.54 ,$365.60 ,$383.88 ,$383.88 ,$383.88 ,$457.00 ,$411.30 ,$262.78 ,$457.00 ,$100.54 ,$457.00 ,$248.61 ,$100.54 ,$190.11 , N/A , N/A ,$105.57 ,$388.45 ,$297.96 ,$127.96 ,$411.30 ,$383.88 ,$365.60 ,$365.60 ,$100.54 ,$297.05 
ST. FRANCIS HOSPITAL - ACUTE,45000569,26705,HC TX DISLOC (M-P) W/ANES CLOSED,450,1 ,$417.00 ,$271.05 ,$91.74 ,"$3,556.28 ",$239.78 ,$300.24 ,$226.85 ,$91.74 ,$116.76 ,$233.94 ,$91.74 ,$271.88 ,$104.25 ,$271.88 ,$271.88 ,$104.25 ,$271.88 ,$174.31 ,$350.28 ,"$3,556.28 ",$91.74 ,$354.45 ,$350.28 ,$91.74 ,$312.75 ,$333.60 ,$333.60 ,$91.74 ,$333.60 ,$350.28 ,$350.28 ,$350.28 ,$417.00 ,$375.30 ,$239.78 ,$417.00 ,$91.74 ,$417.00 ,$226.85 ,$91.74 ,$173.47 , N/A , N/A ,$96.33 ,$354.45 ,$271.88 ,$116.76 ,$375.30 ,$350.28 ,$333.60 ,$333.60 ,$91.74 ,$271.05 
ST. FRANCIS HOSPITAL - ACUTE,45000582,25600,HC DISTAL RADIUS W/O MANIP CLOSED - RT,450,1 ,$497.00 ,$323.05 ,$109.34 ,$526.25 ,$285.78 ,$357.84 ,$270.37 ,$109.34 ,$139.16 ,$278.82 ,$109.34 ,$324.04 ,$124.25 ,$324.04 ,$324.04 ,$124.25 ,$324.04 ,$207.75 ,$417.48 ,$526.25 ,$109.34 ,$422.45 ,$417.48 ,$109.34 ,$372.75 ,$397.60 ,$397.60 ,$109.34 ,$397.60 ,$417.48 ,$417.48 ,$417.48 ,$497.00 ,$447.30 ,$285.78 ,$497.00 ,$109.34 ,$497.00 ,$270.37 ,$109.34 ,$206.75 , N/A , N/A ,$114.81 ,$422.45 ,$324.04 ,$139.16 ,$447.30 ,$417.48 ,$397.60 ,$397.60 ,$109.34 ,$323.05 
ST. FRANCIS HOSPITAL - ACUTE,45000791,25680,HC TX FX CLOSED WRIST W/MANIP-LT,450,1 ,$278.00 ,$180.70 ,$61.16 ,$526.25 ,$159.85 ,$200.16 ,$151.23 ,$61.16 ,$77.84 ,$155.96 ,$61.16 ,$181.26 ,$69.50 ,$181.26 ,$181.26 ,$69.50 ,$181.26 ,$116.20 ,$233.52 ,$526.25 ,$61.16 ,$236.30 ,$233.52 ,$61.16 ,$208.50 ,$222.40 ,$222.40 ,$61.16 ,$222.40 ,$233.52 ,$233.52 ,$233.52 ,$278.00 ,$250.20 ,$159.85 ,$278.00 ,$61.16 ,$278.00 ,$151.23 ,$61.16 ,$115.65 , N/A , N/A ,$64.22 ,$236.30 ,$181.26 ,$77.84 ,$250.20 ,$233.52 ,$222.40 ,$222.40 ,$61.16 ,$180.70 
ST. FRANCIS HOSPITAL - ACUTE,45001024,27768,HC CLSD TX POSTERIOR WITH MANIP,450,1 ,"$4,178.00 ","$2,715.70 ",$919.16 ,"$4,178.00 ","$2,402.35 ","$3,008.16 ","$2,272.83 ",$919.16 ,"$1,169.84 ","$2,343.86 ",$919.16 ,"$2,724.06 ","$1,044.50 ","$2,724.06 ","$2,724.06 ","$1,044.50 ","$2,724.06 ","$1,746.40 ","$3,509.52 ","$3,556.28 ",$919.16 ,"$3,551.30 ","$3,509.52 ",$919.16 ,"$3,133.50 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$3,342.40 ","$3,509.52 ","$3,509.52 ","$3,509.52 ","$4,178.00 ","$3,760.20 ","$2,402.35 ","$4,178.00 ",$919.16 ,"$4,178.00 ","$2,272.83 ",$919.16 ,"$1,738.05 ", N/A , N/A ,$965.12 ,"$3,551.30 ","$2,724.06 ","$1,169.84 ","$3,760.20 ","$3,509.52 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$2,715.70 "
ST. FRANCIS HOSPITAL - ACUTE,45001162,43830,HC GASTROSTOMY CONSTRUCT G-TUBE OPEN,450,1 ,"$1,058.00 ",$687.70 ,$232.76 ,"$4,147.03 ",$608.35 ,$761.76 ,$575.55 ,$232.76 ,$296.24 ,$593.54 ,$232.76 ,$689.82 ,$264.50 ,$689.82 ,$689.82 ,$264.50 ,$689.82 ,$442.24 ,$888.72 ,"$4,147.03 ",$232.76 ,$899.30 ,$888.72 ,$232.76 ,$793.50 ,$846.40 ,$846.40 ,$232.76 ,$846.40 ,$888.72 ,$888.72 ,$888.72 ,"$1,058.00 ",$952.20 ,$608.35 ,"$1,058.00 ",$232.76 ,"$1,058.00 ",$575.55 ,$232.76 ,$440.13 , N/A , N/A ,$244.40 ,$899.30 ,$689.82 ,$296.24 ,$952.20 ,$888.72 ,$846.40 ,$846.40 ,$232.76 ,$687.70 
ST. FRANCIS HOSPITAL - ACUTE,45001168,52281,HC CYSTOURETHROSCOPY W/CALIBRATION/DILATION,450,1 ,"$5,379.00 ","$3,496.35 ","$1,183.38 ","$5,379.00 ","$3,092.93 ","$3,872.88 ","$2,926.18 ","$1,183.38 ","$1,506.12 ","$3,017.62 ","$1,183.38 ","$3,507.11 ","$1,344.75 ","$3,507.11 ","$3,507.11 ","$1,344.75 ","$3,507.11 ","$2,248.42 ","$4,518.36 ","$4,571.63 ","$1,183.38 ","$4,572.15 ","$4,518.36 ","$1,183.38 ","$4,034.25 ","$4,303.20 ","$4,303.20 ","$1,183.38 ","$4,303.20 ","$4,518.36 ","$4,518.36 ","$4,518.36 ","$5,379.00 ","$4,841.10 ","$3,092.93 ","$5,379.00 ","$1,183.38 ","$5,379.00 ","$2,926.18 ","$1,183.38 ","$2,237.66 ", N/A , N/A ,"$1,242.55 ","$4,572.15 ","$3,507.11 ","$1,506.12 ","$4,841.10 ","$4,518.36 ","$4,303.20 ","$4,303.20 ","$1,183.38 ","$3,496.35 "
ST. FRANCIS HOSPITAL - ACUTE,45001169,54235,HC INJ PENILE W/RX AGENT,450,1 ,$799.00 ,$519.35 ,$175.78 ,$799.00 ,$459.43 ,$575.28 ,$434.66 ,$175.78 ,$223.72 ,$448.24 ,$175.78 ,$520.95 ,$199.75 ,$520.95 ,$520.95 ,$199.75 ,$520.95 ,$333.98 ,$671.16 ,$679.43 ,$175.78 ,$679.15 ,$671.16 ,$175.78 ,$599.25 ,$639.20 ,$639.20 ,$175.78 ,$639.20 ,$671.16 ,$671.16 ,$671.16 ,$799.00 ,$719.10 ,$459.43 ,$799.00 ,$175.78 ,$799.00 ,$434.66 ,$175.78 ,$332.38 , N/A , N/A ,$184.57 ,$679.15 ,$520.95 ,$223.72 ,$719.10 ,$671.16 ,$639.20 ,$639.20 ,$175.78 ,$519.35 
ST. FRANCIS HOSPITAL - ACUTE,45001265,23545,HC TX ACROMIOCLAVICULAR DISLOC W/MANIP CLOSED,450,1 ,$164.00 ,$106.60 ,$36.08 ,$526.25 ,$94.30 ,$118.08 ,$89.22 ,$36.08 ,$45.92 ,$92.00 ,$36.08 ,$106.93 ,$41.00 ,$106.93 ,$106.93 ,$41.00 ,$106.93 ,$68.55 ,$137.76 ,$526.25 ,$36.08 ,$139.40 ,$137.76 ,$36.08 ,$123.00 ,$131.20 ,$131.20 ,$36.08 ,$131.20 ,$137.76 ,$137.76 ,$137.76 ,$164.00 ,$147.60 ,$94.30 ,$164.00 ,$36.08 ,$164.00 ,$89.22 ,$36.08 ,$68.22 , N/A , N/A ,$37.88 ,$139.40 ,$106.93 ,$45.92 ,$147.60 ,$137.76 ,$131.20 ,$131.20 ,$36.08 ,$106.60 
ST. FRANCIS HOSPITAL - ACUTE,45001272,23665,HC TX FX DISLOC SHOULDER HUMERW/MANIP,450,1 ,$299.00 ,$194.35 ,$65.78 ,"$3,556.28 ",$171.93 ,$215.28 ,$162.66 ,$65.78 ,$83.72 ,$167.74 ,$65.78 ,$194.95 ,$74.75 ,$194.95 ,$194.95 ,$74.75 ,$194.95 ,$124.98 ,$251.16 ,"$3,556.28 ",$65.78 ,$254.15 ,$251.16 ,$65.78 ,$224.25 ,$239.20 ,$239.20 ,$65.78 ,$239.20 ,$251.16 ,$251.16 ,$251.16 ,$299.00 ,$269.10 ,$171.93 ,$299.00 ,$65.78 ,$299.00 ,$162.66 ,$65.78 ,$124.38 , N/A , N/A ,$69.07 ,$254.15 ,$194.95 ,$83.72 ,$269.10 ,$251.16 ,$239.20 ,$239.20 ,$65.78 ,$194.35 
ST. FRANCIS HOSPITAL - ACUTE,45001273,23675,HC TX FX DISLOC SHOULDER W/PROX HUM W/MANIP,450,1 ,$324.00 ,$210.60 ,$71.28 ,"$3,556.28 ",$186.30 ,$233.28 ,$176.26 ,$71.28 ,$90.72 ,$181.76 ,$71.28 ,$211.25 ,$81.00 ,$211.25 ,$211.25 ,$81.00 ,$211.25 ,$135.43 ,$272.16 ,"$3,556.28 ",$71.28 ,$275.40 ,$272.16 ,$71.28 ,$243.00 ,$259.20 ,$259.20 ,$71.28 ,$259.20 ,$272.16 ,$272.16 ,$272.16 ,$324.00 ,$291.60 ,$186.30 ,$324.00 ,$71.28 ,$324.00 ,$176.26 ,$71.28 ,$134.78 , N/A , N/A ,$74.84 ,$275.40 ,$211.25 ,$90.72 ,$291.60 ,$272.16 ,$259.20 ,$259.20 ,$71.28 ,$210.60 
ST. FRANCIS HOSPITAL - ACUTE,45001277,24577,HC TX FX HUMERUS CONDYLAR W/MANIP CLOSED,450,1 ,"$4,178.00 ","$2,715.70 ",$919.16 ,"$4,178.00 ","$2,402.35 ","$3,008.16 ","$2,272.83 ",$919.16 ,"$1,169.84 ","$2,343.86 ",$919.16 ,"$2,724.06 ","$1,044.50 ","$2,724.06 ","$2,724.06 ","$1,044.50 ","$2,724.06 ","$1,746.40 ","$3,509.52 ","$3,556.28 ",$919.16 ,"$3,551.30 ","$3,509.52 ",$919.16 ,"$3,133.50 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$3,342.40 ","$3,509.52 ","$3,509.52 ","$3,509.52 ","$4,178.00 ","$3,760.20 ","$2,402.35 ","$4,178.00 ",$919.16 ,"$4,178.00 ","$2,272.83 ",$919.16 ,"$1,738.05 ", N/A , N/A ,$965.12 ,"$3,551.30 ","$2,724.06 ","$1,169.84 ","$3,760.20 ","$3,509.52 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$2,715.70 "
ST. FRANCIS HOSPITAL - ACUTE,45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$4,178.00 ","$2,715.70 ",$919.16 ,"$4,178.00 ","$2,402.35 ","$3,008.16 ","$2,272.83 ",$919.16 ,"$1,169.84 ","$2,343.86 ",$919.16 ,"$2,724.06 ","$1,044.50 ","$2,724.06 ","$2,724.06 ","$1,044.50 ","$2,724.06 ","$1,746.40 ","$3,509.52 ","$3,556.28 ",$919.16 ,"$3,551.30 ","$3,509.52 ",$919.16 ,"$3,133.50 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$3,342.40 ","$3,509.52 ","$3,509.52 ","$3,509.52 ","$4,178.00 ","$3,760.20 ","$2,402.35 ","$4,178.00 ",$919.16 ,"$4,178.00 ","$2,272.83 ",$919.16 ,"$1,738.05 ", N/A , N/A ,$965.12 ,"$3,551.30 ","$2,724.06 ","$1,169.84 ","$3,760.20 ","$3,509.52 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$2,715.70 "
ST. FRANCIS HOSPITAL - ACUTE,45001282,25535,HC TX FX ULNAR CLOSED W/MANIP,450,1 ,$299.00 ,$194.35 ,$65.78 ,$526.25 ,$171.93 ,$215.28 ,$162.66 ,$65.78 ,$83.72 ,$167.74 ,$65.78 ,$194.95 ,$74.75 ,$194.95 ,$194.95 ,$74.75 ,$194.95 ,$124.98 ,$251.16 ,$526.25 ,$65.78 ,$254.15 ,$251.16 ,$65.78 ,$224.25 ,$239.20 ,$239.20 ,$65.78 ,$239.20 ,$251.16 ,$251.16 ,$251.16 ,$299.00 ,$269.10 ,$171.93 ,$299.00 ,$65.78 ,$299.00 ,$162.66 ,$65.78 ,$124.38 , N/A , N/A ,$69.07 ,$254.15 ,$194.95 ,$83.72 ,$269.10 ,$251.16 ,$239.20 ,$239.20 ,$65.78 ,$194.35 
ST. FRANCIS HOSPITAL - ACUTE,45001296,27762,HC TX FX CLOSED MEDIAL MALLEOLUS W/MANIP,450,1 ,"$4,178.00 ","$2,715.70 ",$919.16 ,"$4,178.00 ","$2,402.35 ","$3,008.16 ","$2,272.83 ",$919.16 ,"$1,169.84 ","$2,343.86 ",$919.16 ,"$2,724.06 ","$1,044.50 ","$2,724.06 ","$2,724.06 ","$1,044.50 ","$2,724.06 ","$1,746.40 ","$3,509.52 ","$3,556.28 ",$919.16 ,"$3,551.30 ","$3,509.52 ",$919.16 ,"$3,133.50 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$3,342.40 ","$3,509.52 ","$3,509.52 ","$3,509.52 ","$4,178.00 ","$3,760.20 ","$2,402.35 ","$4,178.00 ",$919.16 ,"$4,178.00 ","$2,272.83 ",$919.16 ,"$1,738.05 ", N/A , N/A ,$965.12 ,"$3,551.30 ","$2,724.06 ","$1,169.84 ","$3,760.20 ","$3,509.52 ","$3,342.40 ","$3,342.40 ",$919.16 ,"$2,715.70 "
ST. FRANCIS HOSPITAL - ACUTE,45001298,27816,HC TX FX CLOSED TRIMALLEOLAR ANKLE W/O MANIP,450,1 ,$619.00 ,$402.35 ,$136.18 ,$619.00 ,$355.93 ,$445.68 ,$336.74 ,$136.18 ,$173.32 ,$347.26 ,$136.18 ,$403.59 ,$154.75 ,$403.59 ,$403.59 ,$154.75 ,$403.59 ,$258.74 ,$519.96 ,$526.25 ,$136.18 ,$526.15 ,$519.96 ,$136.18 ,$464.25 ,$495.20 ,$495.20 ,$136.18 ,$495.20 ,$519.96 ,$519.96 ,$519.96 ,$619.00 ,$557.10 ,$355.93 ,$619.00 ,$136.18 ,$619.00 ,$336.74 ,$136.18 ,$257.50 , N/A , N/A ,$142.99 ,$526.15 ,$403.59 ,$173.32 ,$557.10 ,$519.96 ,$495.20 ,$495.20 ,$136.18 ,$402.35 
ST. FRANCIS HOSPITAL - ACUTE,45001317,67935,HC REPAIR EYELID WOUND FULL THICKNESS,450,1 ,"$2,944.00 ","$1,913.60 ",$647.68 ,"$5,109.25 ","$1,692.80 ","$2,119.68 ","$1,601.54 ",$647.68 ,$824.32 ,"$1,651.58 ",$647.68 ,"$1,919.49 ",$736.00 ,"$1,919.49 ","$1,919.49 ",$736.00 ,"$1,919.49 ","$1,230.59 ","$2,472.96 ","$5,109.25 ",$647.68 ,"$2,502.40 ","$2,472.96 ",$647.68 ,"$2,208.00 ","$2,355.20 ","$2,355.20 ",$647.68 ,"$2,355.20 ","$2,472.96 ","$2,472.96 ","$2,472.96 ","$2,944.00 ","$2,649.60 ","$1,692.80 ","$2,944.00 ",$647.68 ,"$2,944.00 ","$1,601.54 ",$647.68 ,"$1,224.70 ", N/A , N/A ,$680.06 ,"$2,502.40 ","$1,919.49 ",$824.32 ,"$2,649.60 ","$2,472.96 ","$2,355.20 ","$2,355.20 ",$647.68 ,"$1,913.60 "
ST. FRANCIS HOSPITAL - ACUTE,45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$805.00 ,$523.25 ,$177.10 ,$805.00 ,$462.88 ,$579.60 ,$437.92 ,$177.10 ,$225.40 ,$451.61 ,$177.10 ,$524.86 ,$201.25 ,$524.86 ,$524.86 ,$201.25 ,$524.86 ,$336.49 ,$676.20 ,$679.43 ,$177.10 ,$684.25 ,$676.20 ,$177.10 ,$603.75 ,$644.00 ,$644.00 ,$177.10 ,$644.00 ,$676.20 ,$676.20 ,$676.20 ,$805.00 ,$724.50 ,$462.88 ,$805.00 ,$177.10 ,$805.00 ,$437.92 ,$177.10 ,$334.88 , N/A , N/A ,$185.96 ,$684.25 ,$524.86 ,$225.40 ,$724.50 ,$676.20 ,$644.00 ,$644.00 ,$177.10 ,$523.25 
ST. FRANCIS HOSPITAL - ACUTE,45001341,42720,HC I AND D ABSCESS PHARYNGEAL INTRAORAL APPROACH,450,1 ,"$9,195.00 ","$5,976.75 ","$2,022.90 ","$9,195.00 ","$5,287.13 ","$6,620.40 ","$5,002.08 ","$2,022.90 ","$2,574.60 ","$5,114.88 ","$2,022.90 ","$5,995.14 ","$2,298.75 ","$5,995.14 ","$5,995.14 ","$2,298.75 ","$5,995.14 ","$3,843.51 ","$7,723.80 ","$6,984.95 ","$2,022.90 ","$7,815.75 ","$7,723.80 ","$2,022.90 ","$6,896.25 ","$7,356.00 ","$7,356.00 ","$2,022.90 ","$7,356.00 ","$7,723.80 ","$7,723.80 ","$7,723.80 ","$9,195.00 ","$8,275.50 ","$5,287.13 ","$9,195.00 ","$2,022.90 ","$9,195.00 ","$5,002.08 ","$2,022.90 ","$3,825.12 ", N/A , N/A ,"$2,124.05 ","$7,815.75 ","$5,995.14 ","$2,574.60 ","$8,275.50 ","$7,723.80 ","$7,356.00 ","$7,356.00 ","$2,022.90 ","$5,976.75 "
ST. FRANCIS HOSPITAL - ACUTE,45001352,26545,HC RECONSTRUCT FINGER JOINT,450,1 ,"$9,199.00 ","$5,979.35 ","$2,023.78 ","$9,199.00 ","$5,289.43 ","$6,623.28 ","$5,004.26 ","$2,023.78 ","$2,575.72 ","$5,114.88 ","$2,023.78 ","$5,997.75 ","$2,299.75 ","$5,997.75 ","$5,997.75 ","$2,299.75 ","$5,997.75 ","$3,845.18 ","$7,727.16 ","$7,230.70 ","$2,023.78 ","$7,819.15 ","$7,727.16 ","$2,023.78 ","$6,899.25 ","$7,359.20 ","$7,359.20 ","$2,023.78 ","$7,359.20 ","$7,727.16 ","$7,727.16 ","$7,727.16 ","$9,199.00 ","$8,279.10 ","$5,289.43 ","$9,199.00 ","$2,023.78 ","$9,199.00 ","$5,004.26 ","$2,023.78 ","$3,826.78 ", N/A , N/A ,"$2,124.97 ","$7,819.15 ","$5,997.75 ","$2,575.72 ","$8,279.10 ","$7,727.16 ","$7,359.20 ","$7,359.20 ","$2,023.78 ","$5,979.35 "
ST. FRANCIS HOSPITAL - ACUTE,45001354,42650,HC DILATION OF SALIVARY DUCT,450,1 ,"$4,535.00 ","$2,947.75 ",$997.70 ,"$4,535.00 ","$2,607.63 ","$3,265.20 ","$2,467.04 ",$997.70 ,"$1,269.80 ","$2,544.14 ",$997.70 ,"$2,956.82 ","$1,133.75 ","$2,956.82 ","$2,956.82 ","$1,133.75 ","$2,956.82 ","$1,895.63 ","$3,809.40 ","$3,453.85 ",$997.70 ,"$3,854.75 ","$3,809.40 ",$997.70 ,"$3,401.25 ","$3,628.00 ","$3,628.00 ",$997.70 ,"$3,628.00 ","$3,809.40 ","$3,809.40 ","$3,809.40 ","$4,535.00 ","$4,081.50 ","$2,607.63 ","$4,535.00 ",$997.70 ,"$4,535.00 ","$2,467.04 ",$997.70 ,"$1,886.56 ", N/A , N/A ,"$1,047.59 ","$3,854.75 ","$2,956.82 ","$1,269.80 ","$4,081.50 ","$3,809.40 ","$3,628.00 ","$3,628.00 ",$997.70 ,"$2,947.75 "
ST. FRANCIS HOSPITAL - ACUTE,45001355,25660,HC CLTX RDCRPL/INTERCARPL DISLC 1 >BONES W MAN,450,1 ,$619.00 ,$402.35 ,$136.18 ,$619.00 ,$355.93 ,$445.68 ,$336.74 ,$136.18 ,$173.32 ,$347.26 ,$136.18 ,$403.59 ,$154.75 ,$403.59 ,$403.59 ,$154.75 ,$403.59 ,$258.74 ,$519.96 ,$526.25 ,$136.18 ,$526.15 ,$519.96 ,$136.18 ,$464.25 ,$495.20 ,$495.20 ,$136.18 ,$495.20 ,$519.96 ,$519.96 ,$519.96 ,$619.00 ,$557.10 ,$355.93 ,$619.00 ,$136.18 ,$619.00 ,$336.74 ,$136.18 ,$257.50 , N/A , N/A ,$142.99 ,$526.15 ,$403.59 ,$173.32 ,$557.10 ,$519.96 ,$495.20 ,$495.20 ,$136.18 ,$402.35 
ST. FRANCIS HOSPITAL - ACUTE,45001360,31577,HC LARYNGOSCOPY FLX RMVL FOREIGN BODY(S),450,1 ,"$1,130.00 ",$734.50 ,$248.60 ,"$1,130.00 ",$649.75 ,$813.60 ,$614.72 ,$248.60 ,$316.40 ,$633.93 ,$248.60 ,$736.76 ,$282.50 ,$736.76 ,$736.76 ,$282.50 ,$736.76 ,$472.34 ,$949.20 ,$959.70 ,$248.60 ,$960.50 ,$949.20 ,$248.60 ,$847.50 ,$904.00 ,$904.00 ,$248.60 ,$904.00 ,$949.20 ,$949.20 ,$949.20 ,"$1,130.00 ","$1,017.00 ",$649.75 ,"$1,130.00 ",$248.60 ,"$1,130.00 ",$614.72 ,$248.60 ,$470.08 , N/A , N/A ,$261.03 ,$960.50 ,$736.76 ,$316.40 ,"$1,017.00 ",$949.20 ,$904.00 ,$904.00 ,$248.60 ,$734.50 
ST. FRANCIS HOSPITAL - ACUTE,45001361,27256,HC TX SPONT HIP DISC,450,1 ,$619.00 ,$402.35 ,$136.18 ,$619.00 ,$355.93 ,$445.68 ,$336.74 ,$136.18 ,$173.32 ,$347.26 ,$136.18 ,$403.59 ,$154.75 ,$403.59 ,$403.59 ,$154.75 ,$403.59 ,$258.74 ,$519.96 ,$526.25 ,$136.18 ,$526.15 ,$519.96 ,$136.18 ,$464.25 ,$495.20 ,$495.20 ,$136.18 ,$495.20 ,$519.96 ,$519.96 ,$519.96 ,$619.00 ,$557.10 ,$355.93 ,$619.00 ,$136.18 ,$619.00 ,$336.74 ,$136.18 ,$257.50 , N/A , N/A ,$142.99 ,$526.15 ,$403.59 ,$173.32 ,$557.10 ,$519.96 ,$495.20 ,$495.20 ,$136.18 ,$402.35 
ST. FRANCIS HOSPITAL - ACUTE,45080004,23605,HC CLOSED RX PROX HUMERUS FX MANIP,450,1 ,$299.00 ,$194.35 ,$65.78 ,"$3,556.28 ",$171.93 ,$215.28 ,$162.66 ,$65.78 ,$83.72 ,$167.74 ,$65.78 ,$194.95 ,$74.75 ,$194.95 ,$194.95 ,$74.75 ,$194.95 ,$124.98 ,$251.16 ,"$3,556.28 ",$65.78 ,$254.15 ,$251.16 ,$65.78 ,$224.25 ,$239.20 ,$239.20 ,$65.78 ,$239.20 ,$251.16 ,$251.16 ,$251.16 ,$299.00 ,$269.10 ,$171.93 ,$299.00 ,$65.78 ,$299.00 ,$162.66 ,$65.78 ,$124.38 , N/A , N/A ,$69.07 ,$254.15 ,$194.95 ,$83.72 ,$269.10 ,$251.16 ,$239.20 ,$239.20 ,$65.78 ,$194.35 
ST. FRANCIS HOSPITAL - ACUTE,46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$350.00 ,$227.50 ,$75.31 ,$356.48 ,$201.25 ,$252.00 ,$190.40 ,$77.00 ,$98.00 ,$205.80 ,$77.00 ,$240.45 ,$87.50 ,$240.45 ,$240.45 ,$87.50 ,$240.45 ,$146.30 ,$294.00 ,$356.48 ,$77.00 ,$297.50 ,$294.00 ,$77.00 ,$262.50 ,$280.00 ,$280.00 ,$77.00 ,$280.00 ,$294.00 ,$294.00 ,$294.00 ,$350.00 ,$315.00 ,$201.25 ,$350.00 ,$77.00 ,$350.00 ,$190.40 ,$77.00 ,$145.60 ,$78.89 ,$75.31 ,$80.85 ,$297.50 ,$240.45 ,$98.00 ,$315.00 ,$294.00 ,$280.00 ,$280.00 ,$77.00 ,$227.50 
ST. FRANCIS HOSPITAL - ACUTE,46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,"$1,078.00 ",$700.70 ,$75.31 ,"$1,078.00 ",$619.85 ,$776.16 ,$586.43 ,$237.16 ,$301.84 ,$633.86 ,$237.16 ,$740.59 ,$269.50 ,$740.59 ,$740.59 ,$269.50 ,$740.59 ,$450.60 ,$905.52 ,$675.73 ,$237.16 ,$916.30 ,$905.52 ,$237.16 ,$808.50 ,$862.40 ,$862.40 ,$237.16 ,$862.40 ,$905.52 ,$905.52 ,$905.52 ,"$1,078.00 ",$970.20 ,$619.85 ,"$1,078.00 ",$237.16 ,"$1,078.00 ",$586.43 ,$237.16 ,$448.45 ,$78.89 ,$75.31 ,$249.02 ,$916.30 ,$740.59 ,$301.84 ,$970.20 ,$905.52 ,$862.40 ,$862.40 ,$237.16 ,$700.70 
ST. FRANCIS HOSPITAL - ACUTE,46000013,94726,HC PLETHYSMOGRAPHY,460,1 ,$447.00 ,$290.55 ,$75.31 ,$675.73 ,$257.03 ,$321.84 ,$243.17 ,$98.34 ,$125.16 ,$262.84 ,$98.34 ,$307.09 ,$111.75 ,$307.09 ,$307.09 ,$111.75 ,$307.09 ,$186.85 ,$375.48 ,$675.73 ,$98.34 ,$379.95 ,$375.48 ,$98.34 ,$335.25 ,$357.60 ,$357.60 ,$98.34 ,$357.60 ,$375.48 ,$375.48 ,$375.48 ,$447.00 ,$402.30 ,$257.03 ,$447.00 ,$98.34 ,$447.00 ,$243.17 ,$98.34 ,$185.95 ,$78.89 ,$75.31 ,$103.26 ,$379.95 ,$307.09 ,$125.16 ,$402.30 ,$375.48 ,$357.60 ,$357.60 ,$98.34 ,$290.55 
ST. FRANCIS HOSPITAL - ACUTE,46000014,94618,HC WALK TEST 6 MIN,460,1 ,$628.00 ,$408.20 ,$138.16 ,$628.00 ,$361.10 ,$452.16 ,$341.63 ,$138.16 ,$175.84 ,$217.88 ,$138.16 ,$217.88 ,$157.00 ,$217.88 ,$217.88 ,$157.00 ,$217.88 ,$262.50 ,$527.52 ,$287.90 ,$138.16 ,$533.80 ,$527.52 ,$138.16 ,$471.00 ,$502.40 ,$502.40 ,$138.16 ,$502.40 ,$527.52 ,$527.52 ,$527.52 ,$628.00 ,$565.20 ,$361.10 ,$628.00 ,$138.16 ,$628.00 ,$341.63 ,$138.16 ,$261.25 ,$241.05 ,$230.10 ,$145.07 ,$533.80 ,$217.88 ,$175.84 ,$565.20 ,$527.52 ,$502.40 ,$502.40 ,$138.16 ,$408.20 
ST. FRANCIS HOSPITAL - ACUTE,46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$447.00 ,$290.55 ,$75.31 ,$447.00 ,$257.03 ,$321.84 ,$243.17 ,$98.34 ,$125.16 ,$262.84 ,$98.34 ,$307.09 ,$111.75 ,$307.09 ,$307.09 ,$111.75 ,$307.09 ,$186.85 ,$375.48 , N/A ,$98.34 ,$379.95 ,$375.48 ,$98.34 ,$335.25 ,$357.60 ,$357.60 ,$98.34 ,$357.60 ,$375.48 ,$375.48 ,$375.48 ,$447.00 ,$402.30 ,$257.03 ,$447.00 ,$98.34 ,$447.00 ,$243.17 ,$98.34 ,$185.95 ,$78.89 ,$75.31 ,$103.26 ,$379.95 ,$307.09 ,$125.16 ,$402.30 ,$375.48 ,$357.60 ,$357.60 ,$98.34 ,$290.55 
ST. FRANCIS HOSPITAL - ACUTE,46000021,94760,HC PULSE OX SINGLE,460,1 ,$127.00 ,$82.55 ,$27.94 ,$127.00 ,$73.03 ,$91.44 ,$69.09 ,$27.94 ,$35.56 ,$58.76 ,$27.94 ,$58.76 ,$31.75 ,$58.76 ,$58.76 ,$31.75 ,$58.76 ,$53.09 ,$106.68 , N/A ,$27.94 ,$107.95 ,$106.68 ,$27.94 ,$95.25 ,$101.60 ,$101.60 ,$27.94 ,$101.60 ,$106.68 ,$106.68 ,$106.68 ,$127.00 ,$114.30 ,$73.03 ,$127.00 ,$27.94 ,$127.00 ,$69.09 ,$27.94 ,$52.83 , N/A , N/A ,$29.34 ,$107.95 ,$58.76 ,$35.56 ,$114.30 ,$106.68 ,$101.60 ,$101.60 ,$27.94 ,$82.55 
ST. FRANCIS HOSPITAL - ACUTE,47100009,92558,HC AUD EVOKED OTOACOUS EMISSIONS SCREENING,471,1 ,$168.00 ,$109.20 ,$36.96 ,$168.00 ,$96.60 ,$120.96 ,$91.39 ,$36.96 ,$47.04 ,$94.25 ,$36.96 ,$109.54 ,$42.00 ,$109.54 ,$109.54 ,$42.00 ,$109.54 ,$70.22 ,$141.12 , N/A ,$36.96 ,$142.80 ,$141.12 ,$36.96 ,$126.00 ,$134.40 ,$134.40 ,$36.96 ,$134.40 ,$141.12 ,$141.12 ,$141.12 ,$168.00 ,$151.20 ,$96.60 ,$168.00 ,$36.96 ,$168.00 ,$91.39 ,$36.96 ,$69.89 ,$145.64 ,$139.02 ,$38.81 ,$142.80 ,$109.54 ,$47.04 ,$151.20 ,$141.12 ,$134.40 ,$134.40 ,$36.96 ,$109.20 
ST. FRANCIS HOSPITAL - ACUTE,48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$1,686.00 ","$1,095.90 ",$370.92 ,"$1,686.00 ",$969.45 ,"$1,213.92 ",$917.18 ,$370.92 ,$472.08 ,$991.37 ,$370.92 ,"$1,158.28 ",$421.50 ,"$1,158.28 ","$1,158.28 ",$421.50 ,"$1,158.28 ",$704.75 ,"$1,416.24 ","$1,434.33 ",$370.92 ,"$1,433.10 ","$1,416.24 ",$370.92 ,"$1,264.50 ","$1,348.80 ","$1,348.80 ",$370.92 ,"$1,348.80 ","$1,416.24 ","$1,416.24 ","$1,416.24 ","$1,686.00 ","$1,517.40 ",$969.45 ,"$1,686.00 ",$370.92 ,"$1,686.00 ",$917.18 ,$370.92 ,$701.38 ,$642.77 ,$613.56 ,$389.47 ,"$1,433.10 ","$1,158.28 ",$472.08 ,"$1,517.40 ","$1,416.24 ","$1,348.80 ","$1,348.80 ",$370.92 ,"$1,095.90 "
ST. FRANCIS HOSPITAL - ACUTE,48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,176.00 ",$764.40 ,$258.72 ,"$1,176.00 ",$676.20 ,$846.72 ,$639.74 ,$258.72 ,$329.28 ,$691.49 ,$258.72 ,$724.34 ,$294.00 ,$724.34 ,$724.34 ,$294.00 ,$724.34 ,$491.57 ,$987.84 ,$675.73 ,$258.72 ,$999.60 ,$987.84 ,$258.72 ,$882.00 ,$940.80 ,$940.80 ,$258.72 ,$940.80 ,$987.84 ,$987.84 ,$987.84 ,"$1,176.00 ","$1,058.40 ",$676.20 ,"$1,176.00 ",$258.72 ,"$1,176.00 ",$639.74 ,$258.72 ,$489.22 ,$322.04 ,$307.40 ,$271.66 ,$999.60 ,$724.34 ,$329.28 ,"$1,058.40 ",$987.84 ,$940.80 ,$940.80 ,$258.72 ,$764.40 
ST. FRANCIS HOSPITAL - ACUTE,48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$3,129.00 ","$2,033.85 ",$488.57 ,"$3,129.00 ","$1,799.18 ","$2,252.88 ","$1,702.18 ",$688.38 ,$876.12 ,"$1,839.85 ",$688.38 ,"$2,149.62 ",$782.25 ,"$2,149.62 ","$2,149.62 ",$782.25 ,"$2,149.62 ","$1,307.92 ","$2,628.36 ","$1,233.70 ",$688.38 ,"$2,659.65 ","$2,628.36 ",$688.38 ,"$2,346.75 ","$2,503.20 ","$2,503.20 ",$688.38 ,"$2,503.20 ","$2,628.36 ","$2,628.36 ","$2,628.36 ","$3,129.00 ","$2,816.10 ","$1,799.18 ","$3,129.00 ",$688.38 ,"$3,129.00 ","$1,702.18 ",$688.38 ,"$1,301.66 ",$511.83 ,$488.57 ,$722.80 ,"$2,659.65 ","$2,149.62 ",$876.12 ,"$2,816.10 ","$2,628.36 ","$2,503.20 ","$2,503.20 ",$688.38 ,"$2,033.85 "
ST. FRANCIS HOSPITAL - ACUTE,48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$341.00 ,$221.65 ,$75.02 ,$587.50 ,$196.08 ,$245.52 ,$185.50 ,$75.02 ,$95.48 ,$200.51 ,$75.02 ,$234.27 ,$85.25 ,$234.27 ,$234.27 ,$85.25 ,$234.27 ,$142.54 ,$286.44 ,$587.50 ,$75.02 ,$289.85 ,$286.44 ,$75.02 ,$255.75 ,$272.80 ,$272.80 ,$75.02 ,$272.80 ,$286.44 ,$286.44 ,$286.44 ,$341.00 ,$306.90 ,$196.08 ,$341.00 ,$75.02 ,$341.00 ,$185.50 ,$75.02 ,$141.86 ,$511.83 ,$488.57 ,$78.77 ,$289.85 ,$234.27 ,$95.48 ,$306.90 ,$286.44 ,$272.80 ,$272.80 ,$75.02 ,$221.65 
ST. FRANCIS HOSPITAL - ACUTE,48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$826.00 ,$536.90 ,$181.72 ,$826.00 ,$474.95 ,$594.72 ,$449.34 ,$181.72 ,$231.28 ,$473.72 ,$181.72 ,$473.72 ,$206.50 ,$473.72 ,$473.72 ,$206.50 ,$473.72 ,$345.27 ,$693.84 , N/A ,$181.72 ,$702.10 ,$693.84 ,$181.72 ,$619.50 ,$660.80 ,$660.80 ,$181.72 ,$660.80 ,$693.84 ,$693.84 ,$693.84 ,$826.00 ,$743.40 ,$474.95 ,$826.00 ,$181.72 ,$826.00 ,$449.34 ,$181.72 ,$343.62 ,$511.83 ,$488.57 ,$190.81 ,$702.10 ,$473.72 ,$231.28 ,$743.40 ,$693.84 ,$660.80 ,$660.80 ,$181.72 ,$536.90 
ST. FRANCIS HOSPITAL - ACUTE,48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$249.00 ,$161.85 ,$54.78 ,$511.83 ,$143.18 ,$179.28 ,$135.46 ,$54.78 ,$69.72 ,$146.41 ,$54.78 ,$171.06 ,$62.25 ,$171.06 ,$171.06 ,$62.25 ,$171.06 ,$104.08 ,$209.16 , N/A ,$54.78 ,$211.65 ,$209.16 ,$54.78 ,$186.75 ,$199.20 ,$199.20 ,$54.78 ,$199.20 ,$209.16 ,$209.16 ,$209.16 ,$249.00 ,$224.10 ,$143.18 ,$249.00 ,$54.78 ,$249.00 ,$135.46 ,$54.78 ,$103.58 ,$511.83 ,$488.57 ,$57.52 ,$211.65 ,$171.06 ,$69.72 ,$224.10 ,$209.16 ,$199.20 ,$199.20 ,$54.78 ,$161.85 
ST. FRANCIS HOSPITAL - ACUTE,48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,$457.00 ,$297.05 ,$100.54 ,$940.23 ,$262.78 ,$329.04 ,$248.61 ,$100.54 ,$127.96 ,$256.38 ,$100.54 ,$297.96 ,$114.25 ,$297.96 ,$297.96 ,$114.25 ,$297.96 ,$191.03 ,$383.88 ,$940.23 ,$100.54 ,$388.45 ,$383.88 ,$100.54 ,$342.75 ,$365.60 ,$365.60 ,$100.54 ,$365.60 ,$383.88 ,$383.88 ,$383.88 ,$457.00 ,$411.30 ,$262.78 ,$457.00 ,$100.54 ,$457.00 ,$248.61 ,$100.54 ,$190.11 ,$511.83 ,$488.57 ,$105.57 ,$388.45 ,$297.96 ,$127.96 ,$411.30 ,$383.88 ,$365.60 ,$365.60 ,$100.54 ,$297.05 
ST. FRANCIS HOSPITAL - ACUTE,48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$3,869.00 ","$2,514.85 ",$488.57 ,"$3,869.00 ","$2,224.68 ","$2,785.68 ","$2,104.74 ",$851.18 ,"$1,083.32 ","$2,170.51 ",$851.18 ,"$2,522.59 ",$967.25 ,"$2,522.59 ","$2,522.59 ",$967.25 ,"$2,522.59 ","$1,617.24 ","$3,249.96 ","$1,826.68 ",$851.18 ,"$3,288.65 ","$3,249.96 ",$851.18 ,"$2,901.75 ","$3,095.20 ","$3,095.20 ",$851.18 ,"$3,095.20 ","$3,249.96 ","$3,249.96 ","$3,249.96 ","$3,869.00 ","$3,482.10 ","$2,224.68 ","$3,869.00 ",$851.18 ,"$3,869.00 ","$2,104.74 ",$851.18 ,"$1,609.50 ",$511.83 ,$488.57 ,$893.74 ,"$3,288.65 ","$2,522.59 ","$1,083.32 ","$3,482.10 ","$3,249.96 ","$3,095.20 ","$3,095.20 ",$851.18 ,"$2,514.85 "
ST. FRANCIS HOSPITAL - ACUTE,51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$706.00 ,$458.90 ,$120.26 ,$814.10 ,$405.95 ,$508.32 ,$384.06 ,$155.32 ,$197.68 ,$396.07 ,$155.32 ,$460.31 ,$176.50 ,$460.31 ,$460.31 ,$176.50 ,$460.31 ,$295.11 ,$593.04 ,$814.10 ,$155.32 ,$600.10 ,$593.04 ,$155.32 ,$529.50 ,$564.80 ,$564.80 ,$155.32 ,$564.80 ,$593.04 ,$593.04 ,$593.04 ,$706.00 ,$635.40 ,$405.95 ,$706.00 ,$155.32 ,$706.00 ,$384.06 ,$155.32 ,$293.70 ,$125.98 ,$120.26 ,$163.09 ,$600.10 ,$460.31 ,$197.68 ,$635.40 ,$593.04 ,$564.80 ,$564.80 ,$155.32 ,$458.90 
ST. FRANCIS HOSPITAL - ACUTE,51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$234.00 ,$152.10 ,$51.48 ,$234.00 ,$134.55 ,$168.48 ,$127.30 ,$51.48 ,$65.52 ,$137.59 ,$51.48 ,$160.76 ,$58.50 ,$160.76 ,$160.76 ,$58.50 ,$160.76 ,$97.81 ,$196.56 ,$158.30 ,$51.48 ,$198.90 ,$196.56 ,$51.48 ,$175.50 ,$187.20 ,$187.20 ,$51.48 ,$187.20 ,$196.56 ,$196.56 ,$196.56 ,$234.00 ,$210.60 ,$134.55 ,$234.00 ,$51.48 ,$234.00 ,$127.30 ,$51.48 ,$97.34 , N/A , N/A ,$54.05 ,$198.90 ,$160.76 ,$65.52 ,$210.60 ,$196.56 ,$187.20 ,$187.20 ,$51.48 ,$152.10 
ST. FRANCIS HOSPITAL - ACUTE,51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$245.00 ,$159.25 ,$53.90 ,$522.33 ,$140.88 ,$176.40 ,$133.28 ,$53.90 ,$68.60 ,$144.06 ,$53.90 ,$168.32 ,$61.25 ,$168.32 ,$168.32 ,$61.25 ,$168.32 ,$102.41 ,$205.80 ,$522.33 ,$53.90 ,$208.25 ,$205.80 ,$53.90 ,$183.75 ,$196.00 ,$196.00 ,$53.90 ,$196.00 ,$205.80 ,$205.80 ,$205.80 ,$245.00 ,$220.50 ,$140.88 ,$245.00 ,$53.90 ,$245.00 ,$133.28 ,$53.90 ,$101.92 , N/A , N/A ,$56.60 ,$208.25 ,$168.32 ,$68.60 ,$220.50 ,$205.80 ,$196.00 ,$196.00 ,$53.90 ,$159.25 
ST. FRANCIS HOSPITAL - ACUTE,51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$245.00 ,$159.25 ,$53.90 ,$245.00 ,$140.88 ,$176.40 ,$133.28 ,$53.90 ,$68.60 ,$144.06 ,$53.90 ,$168.32 ,$61.25 ,$168.32 ,$168.32 ,$61.25 ,$168.32 ,$102.41 ,$205.80 ,$102.18 ,$53.90 ,$208.25 ,$205.80 ,$53.90 ,$183.75 ,$196.00 ,$196.00 ,$53.90 ,$196.00 ,$205.80 ,$205.80 ,$205.80 ,$245.00 ,$220.50 ,$140.88 ,$245.00 ,$53.90 ,$245.00 ,$133.28 ,$53.90 ,$101.92 , N/A , N/A ,$56.60 ,$208.25 ,$168.32 ,$68.60 ,$220.50 ,$205.80 ,$196.00 ,$196.00 ,$53.90 ,$159.25 
ST. FRANCIS HOSPITAL - ACUTE,51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$245.00 ,$159.25 ,$53.90 ,$245.00 ,$140.88 ,$176.40 ,$133.28 ,$53.90 ,$68.60 ,$144.06 ,$53.90 ,$168.32 ,$61.25 ,$168.32 ,$168.32 ,$61.25 ,$168.32 ,$102.41 ,$205.80 , N/A ,$53.90 ,$208.25 ,$205.80 ,$53.90 ,$183.75 ,$196.00 ,$196.00 ,$53.90 ,$196.00 ,$205.80 ,$205.80 ,$205.80 ,$245.00 ,$220.50 ,$140.88 ,$245.00 ,$53.90 ,$245.00 ,$133.28 ,$53.90 ,$101.92 , N/A , N/A ,$56.60 ,$208.25 ,$168.32 ,$68.60 ,$220.50 ,$205.80 ,$196.00 ,$196.00 ,$53.90 ,$159.25 
ST. FRANCIS HOSPITAL - ACUTE,51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$197.00 ,$128.05 ,$43.34 ,$197.00 ,$113.28 ,$141.84 ,$107.17 ,$43.34 ,$55.16 ,$115.84 ,$43.34 ,$135.34 ,$49.25 ,$135.34 ,$135.34 ,$49.25 ,$135.34 ,$82.35 ,$165.48 ,$142.13 ,$43.34 ,$167.45 ,$165.48 ,$43.34 ,$147.75 ,$157.60 ,$157.60 ,$43.34 ,$157.60 ,$165.48 ,$165.48 ,$165.48 ,$197.00 ,$177.30 ,$113.28 ,$197.00 ,$43.34 ,$197.00 ,$107.17 ,$43.34 ,$81.95 ,$125.98 ,$120.26 ,$45.51 ,$167.45 ,$135.34 ,$55.16 ,$177.30 ,$165.48 ,$157.60 ,$157.60 ,$43.34 ,$128.05 
ST. FRANCIS HOSPITAL - ACUTE,51000072,97597,HC DEBR SKIN PART THICKNESS <20CM FAC,510,1 ,"$1,927.00 ","$1,252.55 ",$120.26 ,"$1,927.00 ","$1,108.03 ","$1,387.44 ","$1,048.29 ",$423.94 ,$539.56 ,$287.97 ,$423.94 ,$287.97 ,$481.75 ,$287.97 ,$287.97 ,$481.75 ,$287.97 ,$805.49 ,"$1,618.68 ",$458.50 ,$423.94 ,"$1,637.95 ","$1,618.68 ",$423.94 ,"$1,445.25 ","$1,541.60 ","$1,541.60 ",$423.94 ,"$1,541.60 ","$1,618.68 ","$1,618.68 ","$1,618.68 ","$1,927.00 ","$1,734.30 ","$1,108.03 ","$1,927.00 ",$423.94 ,"$1,927.00 ","$1,048.29 ",$423.94 ,$801.63 ,$125.98 ,$120.26 ,$445.14 ,"$1,637.95 ",$287.97 ,$539.56 ,"$1,734.30 ","$1,618.68 ","$1,541.60 ","$1,541.60 ",$423.94 ,"$1,252.55 "
ST. FRANCIS HOSPITAL - ACUTE,51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$440.00 ,$286.00 ,$78.75 ,$440.00 ,$253.00 ,$316.80 ,$239.36 ,$96.80 ,$123.20 ,$258.72 ,$96.80 ,$302.28 ,$110.00 ,$302.28 ,$302.28 ,$110.00 ,$302.28 ,$183.92 ,$369.60 , N/A ,$96.80 ,$374.00 ,$369.60 ,$96.80 ,$330.00 ,$352.00 ,$352.00 ,$96.80 ,$352.00 ,$369.60 ,$369.60 ,$369.60 ,$440.00 ,$396.00 ,$253.00 ,$440.00 ,$96.80 ,$78.75 ,$239.36 ,$96.80 ,$183.04 ,$148.31 ,$141.57 ,$101.64 ,$374.00 ,$302.28 ,$123.20 ,$396.00 ,$369.60 ,$352.00 ,$352.00 ,$96.80 ,$286.00 
ST. FRANCIS HOSPITAL - ACUTE,51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$557.00 ,$362.05 ,$121.24 ,$557.00 ,$320.28 ,$401.04 ,$303.01 ,$122.54 ,$155.96 ,$327.52 ,$122.54 ,$382.66 ,$139.25 ,$382.66 ,$382.66 ,$139.25 ,$382.66 ,$232.83 ,$467.88 , N/A ,$122.54 ,$473.45 ,$467.88 ,$122.54 ,$417.75 ,$445.60 ,$445.60 ,$122.54 ,$445.60 ,$467.88 ,$467.88 ,$467.88 ,$557.00 ,$501.30 ,$320.28 ,$557.00 ,$122.54 ,$121.24 ,$303.01 ,$122.54 ,$231.71 ,$148.31 ,$141.57 ,$128.67 ,$473.45 ,$382.66 ,$155.96 ,$501.30 ,$467.88 ,$445.60 ,$445.60 ,$122.54 ,$362.05 
ST. FRANCIS HOSPITAL - ACUTE,51000107,99211,HC DRESSING CHANGE/ENEMA MINOR,510,1 ,$627.00 ,$407.55 ,$131.72 ,$627.00 ,$360.53 ,$451.44 ,$341.09 ,$137.94 ,$175.56 ,$131.72 ,$137.94 ,$131.72 ,$156.75 ,$131.72 ,$131.72 ,$156.75 ,$131.72 ,$262.09 ,$526.68 , N/A ,$137.94 ,$532.95 ,$526.68 ,$137.94 ,$470.25 ,$501.60 ,$501.60 ,$137.94 ,$501.60 ,$526.68 ,$526.68 ,$526.68 ,$627.00 ,$564.30 ,$360.53 ,$627.00 ,$137.94 ,$627.00 ,$341.09 ,$137.94 ,$260.83 ,$148.31 ,$141.57 ,$144.84 ,$532.95 ,$131.72 ,$175.56 ,$564.30 ,$526.68 ,$501.60 ,$501.60 ,$137.94 ,$407.55 
ST. FRANCIS HOSPITAL - ACUTE,51000109,99204,HC CLINIC VISIT COMPLEX NEW,510,1 ,$744.00 ,$483.60 ,$141.57 ,$744.00 ,$427.80 ,$535.68 ,$404.74 ,$163.68 ,$208.32 ,$437.47 ,$163.68 ,$511.13 ,$186.00 ,$511.13 ,$511.13 ,$186.00 ,$511.13 ,$310.99 ,$624.96 , N/A ,$163.68 ,$632.40 ,$624.96 ,$163.68 ,$558.00 ,$595.20 ,$595.20 ,$163.68 ,$595.20 ,$624.96 ,$624.96 ,$624.96 ,$744.00 ,$669.60 ,$427.80 ,$744.00 ,$163.68 ,$181.05 ,$404.74 ,$163.68 ,$309.50 ,$148.31 ,$141.57 ,$171.86 ,$632.40 ,$511.13 ,$208.32 ,$669.60 ,$624.96 ,$595.20 ,$595.20 ,$163.68 ,$483.60 
ST. FRANCIS HOSPITAL - ACUTE,51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$243.00 ,$157.95 ,$53.46 ,$243.00 ,$139.73 ,$174.96 ,$132.19 ,$53.46 ,$68.04 ,$131.72 ,$53.46 ,$131.72 ,$60.75 ,$131.72 ,$131.72 ,$60.75 ,$131.72 ,$101.57 ,$204.12 , N/A ,$53.46 ,$206.55 ,$204.12 ,$53.46 ,$182.25 ,$194.40 ,$194.40 ,$53.46 ,$194.40 ,$204.12 ,$204.12 ,$204.12 ,$243.00 ,$218.70 ,$139.73 ,$243.00 ,$53.46 ,$243.00 ,$132.19 ,$53.46 ,$101.09 ,$148.31 ,$141.57 ,$56.13 ,$206.55 ,$131.72 ,$68.04 ,$218.70 ,$204.12 ,$194.40 ,$194.40 ,$53.46 ,$157.95 
ST. FRANCIS HOSPITAL - ACUTE,51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$320.00 ,$208.00 ,$60.02 ,$320.00 ,$184.00 ,$230.40 ,$174.08 ,$70.40 ,$89.60 ,$188.16 ,$70.40 ,$219.84 ,$80.00 ,$219.84 ,$219.84 ,$80.00 ,$219.84 ,$133.76 ,$268.80 , N/A ,$70.40 ,$272.00 ,$268.80 ,$70.40 ,$240.00 ,$256.00 ,$256.00 ,$70.40 ,$256.00 ,$268.80 ,$268.80 ,$268.80 ,$320.00 ,$288.00 ,$184.00 ,$320.00 ,$70.40 ,$60.02 ,$174.08 ,$70.40 ,$133.12 ,$148.31 ,$141.57 ,$73.92 ,$272.00 ,$219.84 ,$89.60 ,$288.00 ,$268.80 ,$256.00 ,$256.00 ,$70.40 ,$208.00 
ST. FRANCIS HOSPITAL - ACUTE,51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$375.00 ,$243.75 ,$82.50 ,$375.00 ,$215.63 ,$270.00 ,$204.00 ,$82.50 ,$105.00 ,$220.50 ,$82.50 ,$257.63 ,$93.75 ,$257.63 ,$257.63 ,$93.75 ,$257.63 ,$156.75 ,$315.00 , N/A ,$82.50 ,$318.75 ,$315.00 ,$82.50 ,$281.25 ,$300.00 ,$300.00 ,$82.50 ,$300.00 ,$315.00 ,$315.00 ,$315.00 ,$375.00 ,$337.50 ,$215.63 ,$375.00 ,$82.50 ,$97.92 ,$204.00 ,$82.50 ,$156.00 ,$148.31 ,$141.57 ,$86.63 ,$318.75 ,$257.63 ,$105.00 ,$337.50 ,$315.00 ,$300.00 ,$300.00 ,$82.50 ,$243.75 
ST. FRANCIS HOSPITAL - ACUTE,51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$585.00 ,$380.25 ,$128.70 ,$585.00 ,$336.38 ,$421.20 ,$318.24 ,$128.70 ,$163.80 ,$343.98 ,$128.70 ,$401.90 ,$146.25 ,$401.90 ,$401.90 ,$146.25 ,$401.90 ,$244.53 ,$491.40 , N/A ,$128.70 ,$497.25 ,$491.40 ,$128.70 ,$438.75 ,$468.00 ,$468.00 ,$128.70 ,$468.00 ,$491.40 ,$491.40 ,$491.40 ,$585.00 ,$526.50 ,$336.38 ,$585.00 ,$128.70 ,$585.00 ,$318.24 ,$128.70 ,$243.36 ,$148.31 ,$141.57 ,$135.14 ,$497.25 ,$401.90 ,$163.80 ,$526.50 ,$491.40 ,$468.00 ,$468.00 ,$128.70 ,$380.25 
ST. FRANCIS HOSPITAL - ACUTE,51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$681.00 ,$442.65 ,$141.57 ,$681.00 ,$391.58 ,$490.32 ,$370.46 ,$149.82 ,$190.68 ,$400.43 ,$149.82 ,$467.85 ,$170.25 ,$467.85 ,$467.85 ,$170.25 ,$467.85 ,$284.66 ,$572.04 , N/A ,$149.82 ,$578.85 ,$572.04 ,$149.82 ,$510.75 ,$544.80 ,$544.80 ,$149.82 ,$544.80 ,$572.04 ,$572.04 ,$572.04 ,$681.00 ,$612.90 ,$391.58 ,$681.00 ,$149.82 ,$681.00 ,$370.46 ,$149.82 ,$283.30 ,$148.31 ,$141.57 ,$157.31 ,$578.85 ,$467.85 ,$190.68 ,$612.90 ,$572.04 ,$544.80 ,$544.80 ,$149.82 ,$442.65 
ST. FRANCIS HOSPITAL - ACUTE,51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$115.00 ,$74.75 ,$7.50 ,$115.00 ,$66.13 ,$82.80 ,$62.56 ,$25.30 ,$32.20 ,$22.25 ,$25.30 ,$28.33 ,$28.75 ,$28.33 ,$28.33 ,$28.75 ,$28.33 ,$48.07 ,$96.60 ,$7.50 ,$25.30 ,$97.75 ,$96.60 ,$25.30 ,$86.25 ,$92.00 ,$92.00 ,$25.30 ,$92.00 ,$96.60 ,$96.60 ,$96.60 ,$115.00 ,$103.50 ,$66.13 ,$115.00 ,$25.30 ,$115.00 ,$62.56 ,$25.30 ,$47.84 , N/A , N/A ,$26.57 ,$97.75 ,$28.33 ,$32.20 ,$103.50 ,$96.60 ,$92.00 ,$92.00 ,$25.30 ,$74.75 
ST. FRANCIS HOSPITAL - ACUTE,51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$392.00 ,$254.80 ,$86.24 ,$392.00 ,$225.40 ,$282.24 ,$213.25 ,$86.24 ,$109.76 ,$219.91 ,$86.24 ,$255.58 ,$98.00 ,$255.58 ,$255.58 ,$98.00 ,$255.58 ,$163.86 ,$329.28 ,$287.90 ,$86.24 ,$333.20 ,$329.28 ,$86.24 ,$294.00 ,$313.60 ,$313.60 ,$86.24 ,$313.60 ,$329.28 ,$329.28 ,$329.28 ,$392.00 ,$352.80 ,$225.40 ,$392.00 ,$86.24 ,$392.00 ,$213.25 ,$86.24 ,$163.07 ,$125.98 ,$120.26 ,$90.55 ,$333.20 ,$255.58 ,$109.76 ,$352.80 ,$329.28 ,$313.60 ,$313.60 ,$86.24 ,$254.80 
ST. FRANCIS HOSPITAL - ACUTE,51000172,51702,HC CATH BLADDER SMP,510,1 ,$470.00 ,$305.50 ,$103.40 ,$470.00 ,$270.25 ,$338.40 ,$255.68 ,$103.40 ,$131.60 ,$263.67 ,$103.40 ,$306.44 ,$117.50 ,$306.44 ,$306.44 ,$117.50 ,$306.44 ,$196.46 ,$394.80 ,$287.90 ,$103.40 ,$399.50 ,$394.80 ,$103.40 ,$352.50 ,$376.00 ,$376.00 ,$103.40 ,$376.00 ,$394.80 ,$394.80 ,$394.80 ,$470.00 ,$423.00 ,$270.25 ,$470.00 ,$103.40 ,$470.00 ,$255.68 ,$103.40 ,$195.52 ,$125.98 ,$120.26 ,$108.57 ,$399.50 ,$306.44 ,$131.60 ,$423.00 ,$394.80 ,$376.00 ,$376.00 ,$103.40 ,$305.50 
ST. FRANCIS HOSPITAL - ACUTE,51000173,51703,HC CATH BLADDER CPLX,510,1 ,$517.00 ,$336.05 ,$113.74 ,$517.00 ,$297.28 ,$372.24 ,$281.25 ,$113.74 ,$144.76 ,$290.04 ,$113.74 ,$337.08 ,$129.25 ,$337.08 ,$337.08 ,$129.25 ,$337.08 ,$216.11 ,$434.28 ,$356.48 ,$113.74 ,$439.45 ,$434.28 ,$113.74 ,$387.75 ,$413.60 ,$413.60 ,$113.74 ,$413.60 ,$434.28 ,$434.28 ,$434.28 ,$517.00 ,$465.30 ,$297.28 ,$517.00 ,$113.74 ,$517.00 ,$281.25 ,$113.74 ,$215.07 ,$125.98 ,$120.26 ,$119.43 ,$439.45 ,$337.08 ,$144.76 ,$465.30 ,$434.28 ,$413.60 ,$413.60 ,$113.74 ,$336.05 
ST. FRANCIS HOSPITAL - ACUTE,51000175,94780,HC CARSEAT ANALYSIS FIRST 60MIN,510,1 ,$286.00 ,$185.90 ,$62.92 ,$286.00 ,$164.45 ,$205.92 ,$155.58 ,$62.92 ,$80.08 ,$160.45 ,$62.92 ,$186.47 ,$71.50 ,$186.47 ,$186.47 ,$71.50 ,$186.47 ,$119.55 ,$240.24 ,$86.43 ,$62.92 ,$243.10 ,$240.24 ,$62.92 ,$214.50 ,$228.80 ,$228.80 ,$62.92 ,$228.80 ,$240.24 ,$240.24 ,$240.24 ,$286.00 ,$257.40 ,$164.45 ,$286.00 ,$62.92 ,$286.00 ,$155.58 ,$62.92 ,$118.98 ,$78.89 ,$75.31 ,$66.07 ,$243.10 ,$186.47 ,$80.08 ,$257.40 ,$240.24 ,$228.80 ,$228.80 ,$62.92 ,$185.90 
ST. FRANCIS HOSPITAL - ACUTE,51000201,29799,HC REMOVAL REVISION LEGCAST FACILITY,510,1 ,$179.00 ,$116.35 ,$39.38 ,$360.73 ,$102.93 ,$128.88 ,$97.38 ,$39.38 ,$50.12 ,$100.42 ,$39.38 ,$116.71 ,$44.75 ,$116.71 ,$116.71 ,$44.75 ,$116.71 ,$74.82 ,$150.36 ,$360.73 ,$39.38 ,$152.15 ,$150.36 ,$39.38 ,$134.25 ,$143.20 ,$143.20 ,$39.38 ,$143.20 ,$150.36 ,$150.36 ,$150.36 ,$179.00 ,$161.10 ,$102.93 ,$179.00 ,$39.38 ,$179.00 ,$97.38 ,$39.38 ,$74.46 ,$265.87 ,$253.79 ,$41.35 ,$152.15 ,$116.71 ,$50.12 ,$161.10 ,$150.36 ,$143.20 ,$143.20 ,$39.38 ,$116.35 
ST. FRANCIS HOSPITAL - ACUTE,51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$7,870.00 ","$5,115.50 ","$1,093.08 ","$7,870.00 ","$4,525.25 ","$5,666.40 ","$4,281.28 ","$1,731.40 ","$2,203.60 ","$4,415.07 ","$1,731.40 ","$5,131.24 ","$1,967.50 ","$5,131.24 ","$5,131.24 ","$1,967.50 ","$5,131.24 ","$3,289.66 ","$6,610.80 ","$1,468.90 ","$1,731.40 ","$6,689.50 ","$6,610.80 ","$1,731.40 ","$5,902.50 ","$6,296.00 ","$6,296.00 ","$1,731.40 ","$6,296.00 ","$6,610.80 ","$6,610.80 ","$6,610.80 ","$7,870.00 ","$7,083.00 ","$4,525.25 ","$7,870.00 ","$1,731.40 ","$7,870.00 ","$4,281.28 ","$1,731.40 ","$3,273.92 ","$1,145.13 ","$1,093.08 ","$1,817.97 ","$6,689.50 ","$5,131.24 ","$2,203.60 ","$7,083.00 ","$6,610.80 ","$6,296.00 ","$6,296.00 ","$1,731.40 ","$5,115.50 "
ST. FRANCIS HOSPITAL - ACUTE,51000315,38222,HC BM ASPIRATION (BX/ASP SAME SITE),360,1 ,$905.00 ,$588.25 ,$199.10 ,"$6,053.88 ",$520.38 ,$651.60 ,$492.32 ,$199.10 ,$253.40 ,$507.71 ,$199.10 ,$590.06 ,$226.25 ,$590.06 ,$590.06 ,$226.25 ,$590.06 ,$378.29 ,$760.20 ,"$6,053.88 ",$199.10 ,$769.25 ,$760.20 ,$199.10 ,$678.75 ,$724.00 ,$724.00 ,$199.10 ,$724.00 ,$760.20 ,$760.20 ,$760.20 ,$905.00 ,$814.50 ,$520.38 ,$905.00 ,$199.10 ,$905.00 ,$492.32 ,$199.10 ,$376.48 ,$641.73 ,$612.56 ,$209.06 ,$769.25 ,$590.06 ,$253.40 ,$814.50 ,$760.20 ,$724.00 ,$724.00 ,$199.10 ,$588.25 
ST. FRANCIS HOSPITAL - ACUTE,51000320,94781,HC CARSEAT ANALYSIS  EA ADDN 30MIN,510,1 ,$142.00 ,$92.30 ,$31.24 ,$142.00 ,$81.65 ,$102.24 ,$77.25 ,$31.24 ,$39.76 ,$79.66 ,$31.24 ,$92.58 ,$35.50 ,$92.58 ,$92.58 ,$35.50 ,$92.58 ,$59.36 ,$119.28 , N/A ,$31.24 ,$120.70 ,$119.28 ,$31.24 ,$106.50 ,$113.60 ,$113.60 ,$31.24 ,$113.60 ,$119.28 ,$119.28 ,$119.28 ,$142.00 ,$127.80 ,$81.65 ,$142.00 ,$31.24 ,$142.00 ,$77.25 ,$31.24 ,$59.07 ,$78.89 ,$75.31 ,$32.80 ,$120.70 ,$92.58 ,$39.76 ,$127.80 ,$119.28 ,$113.60 ,$113.60 ,$31.24 ,$92.30 
ST. FRANCIS HOSPITAL - ACUTE,51000464,99202,HC CLINIC VISIT LIMITED NEW -25,510,1 ,$440.00 ,$286.00 ,$78.75 ,$440.00 ,$253.00 ,$316.80 ,$239.36 ,$96.80 ,$123.20 ,$258.72 ,$96.80 ,$302.28 ,$110.00 ,$302.28 ,$302.28 ,$110.00 ,$302.28 ,$183.92 ,$369.60 , N/A ,$96.80 ,$374.00 ,$369.60 ,$96.80 ,$330.00 ,$352.00 ,$352.00 ,$96.80 ,$352.00 ,$369.60 ,$369.60 ,$369.60 ,$440.00 ,$396.00 ,$253.00 ,$440.00 ,$96.80 ,$78.75 ,$239.36 ,$96.80 ,$183.04 ,$148.31 ,$141.57 ,$101.64 ,$374.00 ,$302.28 ,$123.20 ,$396.00 ,$369.60 ,$352.00 ,$352.00 ,$96.80 ,$286.00 
ST. FRANCIS HOSPITAL - ACUTE,51000465,99203,HC CLINIC VISIT INTERM NEW -25,510,1 ,$557.00 ,$362.05 ,$121.24 ,$557.00 ,$320.28 ,$401.04 ,$303.01 ,$122.54 ,$155.96 ,$327.52 ,$122.54 ,$382.66 ,$139.25 ,$382.66 ,$382.66 ,$139.25 ,$382.66 ,$232.83 ,$467.88 , N/A ,$122.54 ,$473.45 ,$467.88 ,$122.54 ,$417.75 ,$445.60 ,$445.60 ,$122.54 ,$445.60 ,$467.88 ,$467.88 ,$467.88 ,$557.00 ,$501.30 ,$320.28 ,$557.00 ,$122.54 ,$121.24 ,$303.01 ,$122.54 ,$231.71 ,$148.31 ,$141.57 ,$128.67 ,$473.45 ,$382.66 ,$155.96 ,$501.30 ,$467.88 ,$445.60 ,$445.60 ,$122.54 ,$362.05 
ST. FRANCIS HOSPITAL - ACUTE,51000466,99204,HC CLINIC VISIT COMPLEX NEW -25,510,1 ,$744.00 ,$483.60 ,$141.57 ,$744.00 ,$427.80 ,$535.68 ,$404.74 ,$163.68 ,$208.32 ,$437.47 ,$163.68 ,$511.13 ,$186.00 ,$511.13 ,$511.13 ,$186.00 ,$511.13 ,$310.99 ,$624.96 , N/A ,$163.68 ,$632.40 ,$624.96 ,$163.68 ,$558.00 ,$595.20 ,$595.20 ,$163.68 ,$595.20 ,$624.96 ,$624.96 ,$624.96 ,$744.00 ,$669.60 ,$427.80 ,$744.00 ,$163.68 ,$181.05 ,$404.74 ,$163.68 ,$309.50 ,$148.31 ,$141.57 ,$171.86 ,$632.40 ,$511.13 ,$208.32 ,$669.60 ,$624.96 ,$595.20 ,$595.20 ,$163.68 ,$483.60 
ST. FRANCIS HOSPITAL - ACUTE,51000468,99211,HC CLINIC VISIT BRIEF ESTAB -25,510,1 ,$277.00 ,$180.05 ,$60.94 ,$277.00 ,$159.28 ,$199.44 ,$150.69 ,$60.94 ,$77.56 ,$131.72 ,$60.94 ,$131.72 ,$69.25 ,$131.72 ,$131.72 ,$69.25 ,$131.72 ,$115.79 ,$232.68 , N/A ,$60.94 ,$235.45 ,$232.68 ,$60.94 ,$207.75 ,$221.60 ,$221.60 ,$60.94 ,$221.60 ,$232.68 ,$232.68 ,$232.68 ,$277.00 ,$249.30 ,$159.28 ,$277.00 ,$60.94 ,$277.00 ,$150.69 ,$60.94 ,$115.23 ,$148.31 ,$141.57 ,$63.99 ,$235.45 ,$131.72 ,$77.56 ,$249.30 ,$232.68 ,$221.60 ,$221.60 ,$60.94 ,$180.05 
ST. FRANCIS HOSPITAL - ACUTE,51000469,99212,HC CLINIC VISIT LIMITED ESTAB -25,510,1 ,$320.00 ,$208.00 ,$60.02 ,$320.00 ,$184.00 ,$230.40 ,$174.08 ,$70.40 ,$89.60 ,$188.16 ,$70.40 ,$219.84 ,$80.00 ,$219.84 ,$219.84 ,$80.00 ,$219.84 ,$133.76 ,$268.80 , N/A ,$70.40 ,$272.00 ,$268.80 ,$70.40 ,$240.00 ,$256.00 ,$256.00 ,$70.40 ,$256.00 ,$268.80 ,$268.80 ,$268.80 ,$320.00 ,$288.00 ,$184.00 ,$320.00 ,$70.40 ,$60.02 ,$174.08 ,$70.40 ,$133.12 ,$148.31 ,$141.57 ,$73.92 ,$272.00 ,$219.84 ,$89.60 ,$288.00 ,$268.80 ,$256.00 ,$256.00 ,$70.40 ,$208.00 
ST. FRANCIS HOSPITAL - ACUTE,51000470,99213,HC CLINIC VISIT INTERM EST -25,510,1 ,$375.00 ,$243.75 ,$82.50 ,$375.00 ,$215.63 ,$270.00 ,$204.00 ,$82.50 ,$105.00 ,$220.50 ,$82.50 ,$257.63 ,$93.75 ,$257.63 ,$257.63 ,$93.75 ,$257.63 ,$156.75 ,$315.00 , N/A ,$82.50 ,$318.75 ,$315.00 ,$82.50 ,$281.25 ,$300.00 ,$300.00 ,$82.50 ,$300.00 ,$315.00 ,$315.00 ,$315.00 ,$375.00 ,$337.50 ,$215.63 ,$375.00 ,$82.50 ,$97.92 ,$204.00 ,$82.50 ,$156.00 ,$148.31 ,$141.57 ,$86.63 ,$318.75 ,$257.63 ,$105.00 ,$337.50 ,$315.00 ,$300.00 ,$300.00 ,$82.50 ,$243.75 
ST. FRANCIS HOSPITAL - ACUTE,51000471,99214,HC CLINIC VISIT COMPLEX EST -25,510,1 ,$585.00 ,$380.25 ,$128.70 ,$585.00 ,$336.38 ,$421.20 ,$318.24 ,$128.70 ,$163.80 ,$343.98 ,$128.70 ,$401.90 ,$146.25 ,$401.90 ,$401.90 ,$146.25 ,$401.90 ,$244.53 ,$491.40 , N/A ,$128.70 ,$497.25 ,$491.40 ,$128.70 ,$438.75 ,$468.00 ,$468.00 ,$128.70 ,$468.00 ,$491.40 ,$491.40 ,$491.40 ,$585.00 ,$526.50 ,$336.38 ,$585.00 ,$128.70 ,$585.00 ,$318.24 ,$128.70 ,$243.36 ,$148.31 ,$141.57 ,$135.14 ,$497.25 ,$401.90 ,$163.80 ,$526.50 ,$491.40 ,$468.00 ,$468.00 ,$128.70 ,$380.25 
ST. FRANCIS HOSPITAL - ACUTE,51000472,99215,HC CLINIC VISIT COMPREH EST -25,510,1 ,$681.00 ,$442.65 ,$141.57 ,$681.00 ,$391.58 ,$490.32 ,$370.46 ,$149.82 ,$190.68 ,$400.43 ,$149.82 ,$467.85 ,$170.25 ,$467.85 ,$467.85 ,$170.25 ,$467.85 ,$284.66 ,$572.04 , N/A ,$149.82 ,$578.85 ,$572.04 ,$149.82 ,$510.75 ,$544.80 ,$544.80 ,$149.82 ,$544.80 ,$572.04 ,$572.04 ,$572.04 ,$681.00 ,$612.90 ,$391.58 ,$681.00 ,$149.82 ,$681.00 ,$370.46 ,$149.82 ,$283.30 ,$148.31 ,$141.57 ,$157.31 ,$578.85 ,$467.85 ,$190.68 ,$612.90 ,$572.04 ,$544.80 ,$544.80 ,$149.82 ,$442.65 
ST. FRANCIS HOSPITAL - ACUTE,51001010,99215,HC CLINIC VISIT - MEMORY INITIAL,510,1 ,$439.00 ,$285.35 ,$96.58 ,$439.00 ,$252.43 ,$316.08 ,$238.82 ,$96.58 ,$122.92 ,$258.13 ,$96.58 ,$301.59 ,$109.75 ,$301.59 ,$301.59 ,$109.75 ,$301.59 ,$183.50 ,$368.76 , N/A ,$96.58 ,$373.15 ,$368.76 ,$96.58 ,$329.25 ,$351.20 ,$351.20 ,$96.58 ,$351.20 ,$368.76 ,$368.76 ,$368.76 ,$439.00 ,$395.10 ,$252.43 ,$439.00 ,$96.58 ,$439.00 ,$238.82 ,$96.58 ,$182.62 ,$148.31 ,$141.57 ,$101.41 ,$373.15 ,$301.59 ,$122.92 ,$395.10 ,$368.76 ,$351.20 ,$351.20 ,$96.58 ,$285.35 
ST. FRANCIS HOSPITAL - ACUTE,61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$4,419.00 ","$2,872.35 ",$348.86 ,"$4,419.00 ","$2,540.93 ","$3,181.68 ","$2,403.94 ",$972.18 ,"$1,237.32 ","$2,598.37 ",$972.18 ,"$3,035.85 ","$1,104.75 ","$3,035.85 ","$3,035.85 ","$1,104.75 ","$3,035.85 ","$1,847.14 ","$3,711.96 ",$940.23 ,$972.18 ,"$3,756.15 ","$3,711.96 ",$972.18 ,"$3,314.25 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$3,535.20 ","$3,711.96 ","$3,711.96 ","$3,711.96 ","$4,419.00 ","$3,977.10 ","$2,540.93 ","$4,419.00 ",$972.18 ,"$4,419.00 ","$2,403.94 ",$972.18 ,"$1,838.30 ",$365.48 ,$348.86 ,"$1,020.79 ","$3,756.15 ","$3,035.85 ","$1,237.32 ","$3,977.10 ","$3,711.96 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$2,872.35 "
ST. FRANCIS HOSPITAL - ACUTE,61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,579.00 ","$2,326.35 ",$427.10 ,"$3,579.00 ","$2,057.93 ","$2,576.88 ","$1,946.98 ",$787.38 ,"$1,002.12 ","$2,104.45 ",$787.38 ,"$2,458.77 ",$894.75 ,"$2,458.77 ","$2,458.77 ",$894.75 ,"$2,458.77 ","$1,496.02 ","$3,006.36 ",$587.50 ,$787.38 ,"$3,042.15 ","$3,006.36 ",$787.38 ,"$2,684.25 ","$2,863.20 ","$2,863.20 ",$787.38 ,"$2,863.20 ","$3,006.36 ","$3,006.36 ","$3,006.36 ","$3,579.00 ","$3,221.10 ","$2,057.93 ","$3,579.00 ",$787.38 ,"$3,579.00 ","$1,946.98 ",$787.38 ,"$1,488.86 ",$447.44 ,$427.10 ,$826.75 ,"$3,042.15 ","$2,458.77 ","$1,002.12 ","$3,221.10 ","$3,006.36 ","$2,863.20 ","$2,863.20 ",$787.38 ,"$2,326.35 "
ST. FRANCIS HOSPITAL - ACUTE,61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$4,235.00 ","$2,752.75 ",$427.10 ,"$4,235.00 ","$2,435.13 ","$3,049.20 ","$2,303.84 ",$931.70 ,"$1,185.80 ","$2,490.18 ",$931.70 ,"$2,909.45 ","$1,058.75 ","$2,909.45 ","$2,909.45 ","$1,058.75 ","$2,909.45 ","$1,770.23 ","$3,557.40 ",$940.23 ,$931.70 ,"$3,599.75 ","$3,557.40 ",$931.70 ,"$3,176.25 ","$3,388.00 ","$3,388.00 ",$931.70 ,"$3,388.00 ","$3,557.40 ","$3,557.40 ","$3,557.40 ","$4,235.00 ","$3,811.50 ","$2,435.13 ","$4,235.00 ",$931.70 ,"$4,235.00 ","$2,303.84 ",$931.70 ,"$1,761.76 ",$447.44 ,$427.10 ,$978.29 ,"$3,599.75 ","$2,909.45 ","$1,185.80 ","$3,811.50 ","$3,557.40 ","$3,388.00 ","$3,388.00 ",$931.70 ,"$2,752.75 "
ST. FRANCIS HOSPITAL - ACUTE,61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$4,235.00 ","$2,752.75 ",$427.10 ,"$4,235.00 ","$2,435.13 ","$3,049.20 ","$2,303.84 ",$931.70 ,"$1,185.80 ","$2,490.18 ",$931.70 ,"$2,909.45 ","$1,058.75 ","$2,909.45 ","$2,909.45 ","$1,058.75 ","$2,909.45 ","$1,770.23 ","$3,557.40 ",$940.23 ,$931.70 ,"$3,599.75 ","$3,557.40 ",$931.70 ,"$3,176.25 ","$3,388.00 ","$3,388.00 ",$931.70 ,"$3,388.00 ","$3,557.40 ","$3,557.40 ","$3,557.40 ","$4,235.00 ","$3,811.50 ","$2,435.13 ","$4,235.00 ",$931.70 ,"$4,235.00 ","$2,303.84 ",$931.70 ,"$1,761.76 ",$447.44 ,$427.10 ,$978.29 ,"$3,599.75 ","$2,909.45 ","$1,185.80 ","$3,811.50 ","$3,557.40 ","$3,388.00 ","$3,388.00 ",$931.70 ,"$2,752.75 "
ST. FRANCIS HOSPITAL - ACUTE,61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$3,579.00 ","$2,326.35 ",$427.10 ,"$3,579.00 ","$2,057.93 ","$2,576.88 ","$1,946.98 ",$787.38 ,"$1,002.12 ","$2,104.45 ",$787.38 ,"$2,458.77 ",$894.75 ,"$2,458.77 ","$2,458.77 ",$894.75 ,"$2,458.77 ","$1,496.02 ","$3,006.36 ",$587.50 ,$787.38 ,"$3,042.15 ","$3,006.36 ",$787.38 ,"$2,684.25 ","$2,863.20 ","$2,863.20 ",$787.38 ,"$2,863.20 ","$3,006.36 ","$3,006.36 ","$3,006.36 ","$3,579.00 ","$3,221.10 ","$2,057.93 ","$3,579.00 ",$787.38 ,"$3,579.00 ","$1,946.98 ",$787.38 ,"$1,488.86 ",$447.44 ,$427.10 ,$826.75 ,"$3,042.15 ","$2,458.77 ","$1,002.12 ","$3,221.10 ","$3,006.36 ","$2,863.20 ","$2,863.20 ",$787.38 ,"$2,326.35 "
ST. FRANCIS HOSPITAL - ACUTE,61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$4,419.00 ","$2,872.35 ",$427.10 ,"$4,419.00 ","$2,540.93 ","$3,181.68 ","$2,403.94 ",$972.18 ,"$1,237.32 ","$2,598.37 ",$972.18 ,"$3,035.85 ","$1,104.75 ","$3,035.85 ","$3,035.85 ","$1,104.75 ","$3,035.85 ","$1,847.14 ","$3,711.96 ",$940.23 ,$972.18 ,"$3,756.15 ","$3,711.96 ",$972.18 ,"$3,314.25 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$3,535.20 ","$3,711.96 ","$3,711.96 ","$3,711.96 ","$4,419.00 ","$3,977.10 ","$2,540.93 ","$4,419.00 ",$972.18 ,"$4,419.00 ","$2,403.94 ",$972.18 ,"$1,838.30 ",$447.44 ,$427.10 ,"$1,020.79 ","$3,756.15 ","$3,035.85 ","$1,237.32 ","$3,977.10 ","$3,711.96 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$2,872.35 "
ST. FRANCIS HOSPITAL - ACUTE,61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,645.00 ","$2,369.25 ",$390.87 ,"$3,645.00 ","$2,095.88 ","$2,624.40 ","$1,982.88 ",$801.90 ,"$1,020.60 ","$2,143.26 ",$801.90 ,"$2,504.12 ",$911.25 ,"$2,504.12 ","$2,504.12 ",$911.25 ,"$2,504.12 ","$1,523.61 ","$3,061.80 ",$587.50 ,$801.90 ,"$3,098.25 ","$3,061.80 ",$801.90 ,"$2,733.75 ","$2,916.00 ","$2,916.00 ",$801.90 ,"$2,916.00 ","$3,061.80 ","$3,061.80 ","$3,061.80 ","$3,645.00 ","$3,280.50 ","$2,095.88 ","$3,645.00 ",$801.90 ,"$3,645.00 ","$1,982.88 ",$801.90 ,"$1,516.32 ",$409.49 ,$390.87 ,$842.00 ,"$3,098.25 ","$2,504.12 ","$1,020.60 ","$3,280.50 ","$3,061.80 ","$2,916.00 ","$2,916.00 ",$801.90 ,"$2,369.25 "
ST. FRANCIS HOSPITAL - ACUTE,61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$4,419.00 ","$2,872.35 ",$390.87 ,"$4,419.00 ","$2,540.93 ","$3,181.68 ","$2,403.94 ",$972.18 ,"$1,237.32 ","$2,598.37 ",$972.18 ,"$3,035.85 ","$1,104.75 ","$3,035.85 ","$3,035.85 ","$1,104.75 ","$3,035.85 ","$1,847.14 ","$3,711.96 ",$940.23 ,$972.18 ,"$3,756.15 ","$3,711.96 ",$972.18 ,"$3,314.25 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$3,535.20 ","$3,711.96 ","$3,711.96 ","$3,711.96 ","$4,419.00 ","$3,977.10 ","$2,540.93 ","$4,419.00 ",$972.18 ,"$4,419.00 ","$2,403.94 ",$972.18 ,"$1,838.30 ",$409.49 ,$390.87 ,"$1,020.79 ","$3,756.15 ","$3,035.85 ","$1,237.32 ","$3,977.10 ","$3,711.96 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$2,872.35 "
ST. FRANCIS HOSPITAL - ACUTE,61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$4,419.00 ","$2,872.35 ",$390.87 ,"$4,419.00 ","$2,540.93 ","$3,181.68 ","$2,403.94 ",$972.18 ,"$1,237.32 ","$2,598.37 ",$972.18 ,"$3,035.85 ","$1,104.75 ","$3,035.85 ","$3,035.85 ","$1,104.75 ","$3,035.85 ","$1,847.14 ","$3,711.96 ",$940.23 ,$972.18 ,"$3,756.15 ","$3,711.96 ",$972.18 ,"$3,314.25 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$3,535.20 ","$3,711.96 ","$3,711.96 ","$3,711.96 ","$4,419.00 ","$3,977.10 ","$2,540.93 ","$4,419.00 ",$972.18 ,"$4,419.00 ","$2,403.94 ",$972.18 ,"$1,838.30 ",$409.49 ,$390.87 ,"$1,020.79 ","$3,756.15 ","$3,035.85 ","$1,237.32 ","$3,977.10 ","$3,711.96 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$2,872.35 "
ST. FRANCIS HOSPITAL - ACUTE,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$3,388.00 ","$2,202.20 ",$281.90 ,"$3,388.00 ","$1,948.10 ","$2,439.36 ","$1,843.07 ",$745.36 ,$948.64 ,"$1,992.14 ",$745.36 ,"$2,327.56 ",$847.00 ,"$2,327.56 ","$2,327.56 ",$847.00 ,"$2,327.56 ","$1,416.18 ","$2,845.92 ",$587.50 ,$745.36 ,"$2,879.80 ","$2,845.92 ",$745.36 ,"$2,541.00 ","$2,710.40 ","$2,710.40 ",$745.36 ,"$2,710.40 ","$2,845.92 ","$2,845.92 ","$2,845.92 ","$3,388.00 ","$3,049.20 ","$1,948.10 ","$3,388.00 ",$745.36 ,"$3,388.00 ","$1,843.07 ",$745.36 ,"$1,409.41 ",$295.33 ,$281.90 ,$782.63 ,"$2,879.80 ","$2,327.56 ",$948.64 ,"$3,049.20 ","$2,845.92 ","$2,710.40 ","$2,710.40 ",$745.36 ,"$2,202.20 "
ST. FRANCIS HOSPITAL - ACUTE,61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$4,138.00 ","$2,689.70 ",$281.90 ,"$4,138.00 ","$2,379.35 ","$2,979.36 ","$2,251.07 ",$910.36 ,"$1,158.64 ","$2,433.14 ",$910.36 ,"$2,842.81 ","$1,034.50 ","$2,842.81 ","$2,842.81 ","$1,034.50 ","$2,842.81 ","$1,729.68 ","$3,475.92 ",$940.23 ,$910.36 ,"$3,517.30 ","$3,475.92 ",$910.36 ,"$3,103.50 ","$3,310.40 ","$3,310.40 ",$910.36 ,"$3,310.40 ","$3,475.92 ","$3,475.92 ","$3,475.92 ","$4,138.00 ","$3,724.20 ","$2,379.35 ","$4,138.00 ",$910.36 ,"$4,138.00 ","$2,251.07 ",$910.36 ,"$1,721.41 ",$295.33 ,$281.90 ,$955.88 ,"$3,517.30 ","$2,842.81 ","$1,158.64 ","$3,724.20 ","$3,475.92 ","$3,310.40 ","$3,310.40 ",$910.36 ,"$2,689.70 "
ST. FRANCIS HOSPITAL - ACUTE,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$3,873.00 ","$2,517.45 ",$281.90 ,"$3,873.00 ","$2,226.98 ","$2,788.56 ","$2,106.91 ",$852.06 ,"$1,084.44 ","$2,277.32 ",$852.06 ,"$2,660.75 ",$968.25 ,"$2,660.75 ","$2,660.75 ",$968.25 ,"$2,660.75 ","$1,618.91 ","$3,253.32 ",$587.50 ,$852.06 ,"$3,292.05 ","$3,253.32 ",$852.06 ,"$2,904.75 ","$3,098.40 ","$3,098.40 ",$852.06 ,"$3,098.40 ","$3,253.32 ","$3,253.32 ","$3,253.32 ","$3,873.00 ","$3,485.70 ","$2,226.98 ","$3,873.00 ",$852.06 ,"$3,873.00 ","$2,106.91 ",$852.06 ,"$1,611.17 ",$295.33 ,$281.90 ,$894.66 ,"$3,292.05 ","$2,660.75 ","$1,084.44 ","$3,485.70 ","$3,253.32 ","$3,098.40 ","$3,098.40 ",$852.06 ,"$2,517.45 "
ST. FRANCIS HOSPITAL - ACUTE,61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$4,646.00 ","$3,019.90 ",$281.90 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$295.33 ,$281.90 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$3,996.00 ","$2,597.40 ",$281.90 ,"$3,996.00 ","$2,297.70 ","$2,877.12 ","$2,173.82 ",$879.12 ,"$1,118.88 ","$2,349.65 ",$879.12 ,"$2,745.25 ",$999.00 ,"$2,745.25 ","$2,745.25 ",$999.00 ,"$2,745.25 ","$1,670.33 ","$3,356.64 ",$587.50 ,$879.12 ,"$3,396.60 ","$3,356.64 ",$879.12 ,"$2,997.00 ","$3,196.80 ","$3,196.80 ",$879.12 ,"$3,196.80 ","$3,356.64 ","$3,356.64 ","$3,356.64 ","$3,996.00 ","$3,596.40 ","$2,297.70 ","$3,996.00 ",$879.12 ,"$3,996.00 ","$2,173.82 ",$879.12 ,"$1,662.34 ",$295.33 ,$281.90 ,$923.08 ,"$3,396.60 ","$2,745.25 ","$1,118.88 ","$3,596.40 ","$3,356.64 ","$3,196.80 ","$3,196.80 ",$879.12 ,"$2,597.40 "
ST. FRANCIS HOSPITAL - ACUTE,61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$4,216.00 ","$2,740.40 ",$281.90 ,"$4,216.00 ","$2,424.20 ","$3,035.52 ","$2,293.50 ",$927.52 ,"$1,180.48 ","$2,479.01 ",$927.52 ,"$2,896.39 ","$1,054.00 ","$2,896.39 ","$2,896.39 ","$1,054.00 ","$2,896.39 ","$1,762.29 ","$3,541.44 ",$940.23 ,$927.52 ,"$3,583.60 ","$3,541.44 ",$927.52 ,"$3,162.00 ","$3,372.80 ","$3,372.80 ",$927.52 ,"$3,372.80 ","$3,541.44 ","$3,541.44 ","$3,541.44 ","$4,216.00 ","$3,794.40 ","$2,424.20 ","$4,216.00 ",$927.52 ,"$4,216.00 ","$2,293.50 ",$927.52 ,"$1,753.86 ",$295.33 ,$281.90 ,$973.90 ,"$3,583.60 ","$2,896.39 ","$1,180.48 ","$3,794.40 ","$3,541.44 ","$3,372.80 ","$3,372.80 ",$927.52 ,"$2,740.40 "
ST. FRANCIS HOSPITAL - ACUTE,61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$4,138.00 ","$2,689.70 ",$281.90 ,"$4,138.00 ","$2,379.35 ","$2,979.36 ","$2,251.07 ",$910.36 ,"$1,158.64 ","$2,433.14 ",$910.36 ,"$2,842.81 ","$1,034.50 ","$2,842.81 ","$2,842.81 ","$1,034.50 ","$2,842.81 ","$1,729.68 ","$3,475.92 ",$940.23 ,$910.36 ,"$3,517.30 ","$3,475.92 ",$910.36 ,"$3,103.50 ","$3,310.40 ","$3,310.40 ",$910.36 ,"$3,310.40 ","$3,475.92 ","$3,475.92 ","$3,475.92 ","$4,138.00 ","$3,724.20 ","$2,379.35 ","$4,138.00 ",$910.36 ,"$4,138.00 ","$2,251.07 ",$910.36 ,"$1,721.41 ",$295.33 ,$281.90 ,$955.88 ,"$3,517.30 ","$2,842.81 ","$1,158.64 ","$3,724.20 ","$3,475.92 ","$3,310.40 ","$3,310.40 ",$910.36 ,"$2,689.70 "
ST. FRANCIS HOSPITAL - ACUTE,61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$4,646.00 ","$3,019.90 ",$281.90 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$295.33 ,$281.90 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$4,646.00 ","$3,019.90 ",$281.90 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$295.33 ,$281.90 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$3,803.00 ","$2,471.95 ",$348.86 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$365.48 ,$348.86 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$4,646.00 ","$3,019.90 ",$348.86 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$365.48 ,$348.86 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$3,803.00 ","$2,471.95 ",$348.86 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$365.48 ,$348.86 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$348.86 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$365.48 ,$348.86 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$3,803.00 ","$2,471.95 ",$235.46 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$246.68 ,$235.46 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$235.46 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ","$1,826.68 ","$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$246.68 ,$235.46 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$235.46 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$246.68 ,$235.46 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$3,803.00 ","$2,471.95 ",$348.86 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$365.48 ,$348.86 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$348.86 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$365.48 ,$348.86 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$348.86 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$365.48 ,$348.86 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$3,803.00 ","$2,471.95 ",$235.46 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$246.68 ,$235.46 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$3,938.00 ","$2,559.70 ",$235.46 ,"$3,938.00 ","$2,264.35 ","$2,835.36 ","$2,142.27 ",$866.36 ,"$1,102.64 ","$2,315.54 ",$866.36 ,"$2,705.41 ",$984.50 ,"$2,705.41 ","$2,705.41 ",$984.50 ,"$2,705.41 ","$1,646.08 ","$3,307.92 ","$1,826.68 ",$866.36 ,"$3,347.30 ","$3,307.92 ",$866.36 ,"$2,953.50 ","$3,150.40 ","$3,150.40 ",$866.36 ,"$3,150.40 ","$3,307.92 ","$3,307.92 ","$3,307.92 ","$3,938.00 ","$3,544.20 ","$2,264.35 ","$3,938.00 ",$866.36 ,"$3,938.00 ","$2,142.27 ",$866.36 ,"$1,638.21 ",$246.68 ,$235.46 ,$909.68 ,"$3,347.30 ","$2,705.41 ","$1,102.64 ","$3,544.20 ","$3,307.92 ","$3,150.40 ","$3,150.40 ",$866.36 ,"$2,559.70 "
ST. FRANCIS HOSPITAL - ACUTE,61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$235.46 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$246.68 ,$235.46 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,803.00 ","$2,471.95 ",$418.12 ,"$3,803.00 ","$2,186.73 ","$2,738.16 ","$2,068.83 ",$836.66 ,"$1,064.84 ","$2,236.16 ",$836.66 ,"$2,612.66 ",$950.75 ,"$2,612.66 ","$2,612.66 ",$950.75 ,"$2,612.66 ","$1,589.65 ","$3,194.52 ",$587.50 ,$836.66 ,"$3,232.55 ","$3,194.52 ",$836.66 ,"$2,852.25 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$3,042.40 ","$3,194.52 ","$3,194.52 ","$3,194.52 ","$3,803.00 ","$3,422.70 ","$2,186.73 ","$3,803.00 ",$836.66 ,"$3,803.00 ","$2,068.83 ",$836.66 ,"$1,582.05 ",$438.03 ,$418.12 ,$878.49 ,"$3,232.55 ","$2,612.66 ","$1,064.84 ","$3,422.70 ","$3,194.52 ","$3,042.40 ","$3,042.40 ",$836.66 ,"$2,471.95 "
ST. FRANCIS HOSPITAL - ACUTE,61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$4,646.00 ","$3,019.90 ",$418.12 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$438.03 ,$418.12 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$4,646.00 ","$3,019.90 ",$418.12 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,731.85 ","$1,022.12 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$3,191.80 ","$1,161.50 ","$3,191.80 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$438.03 ,$418.12 ,"$1,073.23 ","$3,949.10 ","$3,191.80 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000050,C8937,HC MRI BREAST CAD,610,1 ,$84.00 ,$54.60 ,$18.48 ,$84.00 ,$48.30 ,$60.48 ,$45.70 ,$18.48 ,$23.52 ,$47.12 ,$18.48 ,$54.77 ,$21.00 ,$54.77 ,$54.77 ,$21.00 ,$54.77 ,$35.11 ,$70.56 , N/A ,$18.48 ,$71.40 ,$70.56 ,$18.48 ,$63.00 ,$67.20 ,$67.20 ,$18.48 ,$67.20 ,$70.56 ,$70.56 ,$70.56 ,$84.00 ,$75.60 ,$48.30 ,$84.00 ,$18.48 ,$84.00 ,$45.70 ,$18.48 ,$34.94 , N/A , N/A ,$19.40 ,$71.40 ,$54.77 ,$23.52 ,$75.60 ,$70.56 ,$67.20 ,$67.20 ,$18.48 ,$54.60 
ST. FRANCIS HOSPITAL - ACUTE,61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$4,182.00 ","$2,718.30 ",$451.10 ,"$4,182.00 ","$2,404.65 ","$3,011.04 ","$2,275.01 ",$920.04 ,"$1,170.96 ","$2,346.10 ",$920.04 ,"$2,726.66 ","$1,045.50 ","$2,726.66 ","$2,726.66 ","$1,045.50 ","$2,726.66 ","$1,748.08 ","$3,512.88 ",$940.23 ,$920.04 ,"$3,554.70 ","$3,512.88 ",$920.04 ,"$3,136.50 ","$3,345.60 ","$3,345.60 ",$920.04 ,"$3,345.60 ","$3,512.88 ","$3,512.88 ","$3,512.88 ","$4,182.00 ","$3,763.80 ","$2,404.65 ","$4,182.00 ",$920.04 ,"$4,182.00 ","$2,275.01 ",$920.04 ,"$1,739.71 ",$472.58 ,$451.10 ,$966.04 ,"$3,554.70 ","$2,726.66 ","$1,170.96 ","$3,763.80 ","$3,512.88 ","$3,345.60 ","$3,345.60 ",$920.04 ,"$2,718.30 "
ST. FRANCIS HOSPITAL - ACUTE,61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$3,961.00 ","$2,574.65 ",$451.10 ,"$3,961.00 ","$2,277.58 ","$2,851.92 ","$2,154.78 ",$871.42 ,"$1,109.08 ","$2,222.12 ",$871.42 ,"$2,582.57 ",$990.25 ,"$2,582.57 ","$2,582.57 ",$990.25 ,"$2,582.57 ","$1,655.70 ","$3,327.24 ",$587.50 ,$871.42 ,"$3,366.85 ","$3,327.24 ",$871.42 ,"$2,970.75 ","$3,168.80 ","$3,168.80 ",$871.42 ,"$3,168.80 ","$3,327.24 ","$3,327.24 ","$3,327.24 ","$3,961.00 ","$3,564.90 ","$2,277.58 ","$3,961.00 ",$871.42 ,"$3,961.00 ","$2,154.78 ",$871.42 ,"$1,647.78 ",$472.58 ,$451.10 ,$914.99 ,"$3,366.85 ","$2,582.57 ","$1,109.08 ","$3,564.90 ","$3,327.24 ","$3,168.80 ","$3,168.80 ",$871.42 ,"$2,574.65 "
ST. FRANCIS HOSPITAL - ACUTE,61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$4,697.00 ","$3,053.05 ",$451.10 ,"$4,697.00 ","$2,700.78 ","$3,381.84 ","$2,555.17 ","$1,033.34 ","$1,315.16 ","$2,635.02 ","$1,033.34 ","$3,062.44 ","$1,174.25 ","$3,062.44 ","$3,062.44 ","$1,174.25 ","$3,062.44 ","$1,963.35 ","$3,945.48 ",$940.23 ,"$1,033.34 ","$3,992.45 ","$3,945.48 ","$1,033.34 ","$3,522.75 ","$3,757.60 ","$3,757.60 ","$1,033.34 ","$3,757.60 ","$3,945.48 ","$3,945.48 ","$3,945.48 ","$4,697.00 ","$4,227.30 ","$2,700.78 ","$4,697.00 ","$1,033.34 ","$4,697.00 ","$2,555.17 ","$1,033.34 ","$1,953.95 ",$472.58 ,$451.10 ,"$1,085.01 ","$3,992.45 ","$3,062.44 ","$1,315.16 ","$4,227.30 ","$3,945.48 ","$3,757.60 ","$3,757.60 ","$1,033.34 ","$3,053.05 "
ST. FRANCIS HOSPITAL - ACUTE,61000056,C8905,HC MRI BREAST UNI W AND W/O CONTRAST,610,1 ,"$3,385.00 ","$2,200.25 ",$348.86 ,"$3,385.00 ","$1,946.38 ","$2,437.20 ","$1,841.44 ",$744.70 ,$947.80 ,"$1,898.99 ",$744.70 ,"$2,207.02 ",$846.25 ,"$2,207.02 ","$2,207.02 ",$846.25 ,"$2,207.02 ","$1,414.93 ","$2,843.40 ",$940.23 ,$744.70 ,"$2,877.25 ","$2,843.40 ",$744.70 ,"$2,538.75 ","$2,708.00 ","$2,708.00 ",$744.70 ,"$2,708.00 ","$2,843.40 ","$2,843.40 ","$2,843.40 ","$3,385.00 ","$3,046.50 ","$1,946.38 ","$3,385.00 ",$744.70 ,"$3,385.00 ","$1,841.44 ",$744.70 ,"$1,408.16 ",$365.48 ,$348.86 ,$781.94 ,"$2,877.25 ","$2,207.02 ",$947.80 ,"$3,046.50 ","$2,843.40 ","$2,708.00 ","$2,708.00 ",$744.70 ,"$2,200.25 "
ST. FRANCIS HOSPITAL - ACUTE,61000058,77047,HC MRI BREAST BI W/O CON,610,1 ,"$3,385.00 ","$2,200.25 ",$179.80 ,"$3,385.00 ","$1,946.38 ","$2,437.20 ","$1,841.44 ",$744.70 ,$947.80 ,"$1,898.99 ",$744.70 ,"$2,207.02 ",$846.25 ,"$2,207.02 ","$2,207.02 ",$846.25 ,"$2,207.02 ","$1,414.93 ","$2,843.40 ",$587.50 ,$744.70 ,"$2,877.25 ","$2,843.40 ",$744.70 ,"$2,538.75 ","$2,708.00 ","$2,708.00 ",$744.70 ,"$2,708.00 ","$2,843.40 ","$2,843.40 ","$2,843.40 ","$3,385.00 ","$3,046.50 ","$1,946.38 ","$3,385.00 ",$744.70 ,$179.80 ,"$1,841.44 ",$744.70 ,"$1,408.16 ",$365.48 ,$348.86 ,$781.94 ,"$2,877.25 ","$2,207.02 ",$947.80 ,"$3,046.50 ","$2,843.40 ","$2,708.00 ","$2,708.00 ",$744.70 ,"$2,200.25 "
ST. FRANCIS HOSPITAL - ACUTE,61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$4,646.00 ","$3,019.90 ",$348.86 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,606.41 ","$1,022.12 ","$3,029.19 ","$1,161.50 ","$3,029.19 ","$3,029.19 ","$1,161.50 ","$3,029.19 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$365.48 ,$348.86 ,"$1,073.23 ","$3,949.10 ","$3,029.19 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$1,105.00 ",$718.25 ,$243.10 ,"$1,105.00 ",$635.38 ,$795.60 ,$601.12 ,$243.10 ,$309.40 ,$619.91 ,$243.10 ,$720.46 ,$276.25 ,$720.46 ,$720.46 ,$276.25 ,$720.46 ,$461.89 ,$928.20 ,$940.23 ,$243.10 ,$939.25 ,$928.20 ,$243.10 ,$828.75 ,$884.00 ,$884.00 ,$243.10 ,$884.00 ,$928.20 ,$928.20 ,$928.20 ,"$1,105.00 ",$994.50 ,$635.38 ,"$1,105.00 ",$243.10 ,"$1,105.00 ",$601.12 ,$243.10 ,$459.68 ,$472.58 ,$451.10 ,$255.26 ,$939.25 ,$720.46 ,$309.40 ,$994.50 ,$928.20 ,$884.00 ,$884.00 ,$243.10 ,$718.25 
ST. FRANCIS HOSPITAL - ACUTE,61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$4,646.00 ","$3,019.90 ",$451.10 ,"$4,646.00 ","$2,671.45 ","$3,345.12 ","$2,527.42 ","$1,022.12 ","$1,300.88 ","$2,606.41 ","$1,022.12 ","$3,029.19 ","$1,161.50 ","$3,029.19 ","$3,029.19 ","$1,161.50 ","$3,029.19 ","$1,942.03 ","$3,902.64 ",$940.23 ,"$1,022.12 ","$3,949.10 ","$3,902.64 ","$1,022.12 ","$3,484.50 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,716.80 ","$3,902.64 ","$3,902.64 ","$3,902.64 ","$4,646.00 ","$4,181.40 ","$2,671.45 ","$4,646.00 ","$1,022.12 ","$4,646.00 ","$2,527.42 ","$1,022.12 ","$1,932.74 ",$472.58 ,$451.10 ,"$1,073.23 ","$3,949.10 ","$3,029.19 ","$1,300.88 ","$4,181.40 ","$3,902.64 ","$3,716.80 ","$3,716.80 ","$1,022.12 ","$3,019.90 "
ST. FRANCIS HOSPITAL - ACUTE,61000070,C8920,HC MRA PELVIS W AND W/O CONTRAST,610,1 ,"$3,785.00 ","$2,460.25 ",$451.10 ,"$3,785.00 ","$2,176.38 ","$2,725.20 ","$2,059.04 ",$832.70 ,"$1,059.80 ","$2,123.39 ",$832.70 ,"$2,467.82 ",$946.25 ,"$2,467.82 ","$2,467.82 ",$946.25 ,"$2,467.82 ","$1,582.13 ","$3,179.40 ",$940.23 ,$832.70 ,"$3,217.25 ","$3,179.40 ",$832.70 ,"$2,838.75 ","$3,028.00 ","$3,028.00 ",$832.70 ,"$3,028.00 ","$3,179.40 ","$3,179.40 ","$3,179.40 ","$3,785.00 ","$3,406.50 ","$2,176.38 ","$3,785.00 ",$832.70 ,"$3,785.00 ","$2,059.04 ",$832.70 ,"$1,574.56 ",$472.58 ,$451.10 ,$874.34 ,"$3,217.25 ","$2,467.82 ","$1,059.80 ","$3,406.50 ","$3,179.40 ","$3,028.00 ","$3,028.00 ",$832.70 ,"$2,460.25 "
ST. FRANCIS HOSPITAL - ACUTE,61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$4,419.00 ","$2,872.35 ",$390.87 ,"$4,419.00 ","$2,540.93 ","$3,181.68 ","$2,403.94 ",$972.18 ,"$1,237.32 ","$2,598.37 ",$972.18 ,"$3,035.85 ","$1,104.75 ","$3,035.85 ","$3,035.85 ","$1,104.75 ","$3,035.85 ","$1,847.14 ","$3,711.96 ",$940.23 ,$972.18 ,"$3,756.15 ","$3,711.96 ",$972.18 ,"$3,314.25 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$3,535.20 ","$3,711.96 ","$3,711.96 ","$3,711.96 ","$4,419.00 ","$3,977.10 ","$2,540.93 ","$4,419.00 ",$972.18 ,"$4,419.00 ","$2,403.94 ",$972.18 ,"$1,838.30 ",$409.49 ,$390.87 ,"$1,020.79 ","$3,756.15 ","$3,035.85 ","$1,237.32 ","$3,977.10 ","$3,711.96 ","$3,535.20 ","$3,535.20 ",$972.18 ,"$2,872.35 "
ST. FRANCIS HOSPITAL - ACUTE,61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$4,213.00 ","$2,738.45 ",$348.86 ,"$4,213.00 ","$2,422.48 ","$3,033.36 ","$2,291.87 ",$926.86 ,"$1,179.64 ","$2,477.24 ",$926.86 ,"$2,894.33 ","$1,053.25 ","$2,894.33 ","$2,894.33 ","$1,053.25 ","$2,894.33 ","$1,761.03 ","$3,538.92 ",$940.23 ,$926.86 ,"$3,581.05 ","$3,538.92 ",$926.86 ,"$3,159.75 ","$3,370.40 ","$3,370.40 ",$926.86 ,"$3,370.40 ","$3,538.92 ","$3,538.92 ","$3,538.92 ","$4,213.00 ","$3,791.70 ","$2,422.48 ","$4,213.00 ",$926.86 ,"$4,213.00 ","$2,291.87 ",$926.86 ,"$1,752.61 ",$365.48 ,$348.86 ,$973.20 ,"$3,581.05 ","$2,894.33 ","$1,179.64 ","$3,791.70 ","$3,538.92 ","$3,370.40 ","$3,370.40 ",$926.86 ,"$2,738.45 "
ST. FRANCIS HOSPITAL - ACUTE,71000206,N/A,HC PACU RECOVERY INITIAL 15MIN,710,1 ,$386.00 ,$250.90 ,$84.92 ,$386.00 ,$221.95 ,$277.92 ,$209.98 ,$84.92 ,$108.08 ,$216.55 ,$84.92 ,$251.67 ,$96.50 ,$251.67 ,$251.67 ,$96.50 ,$251.67 ,$161.35 ,$324.24 , N/A ,$84.92 ,$328.10 ,$324.24 ,$84.92 ,$289.50 ,$308.80 ,$308.80 ,$84.92 ,$308.80 ,$324.24 ,$324.24 ,$324.24 ,$386.00 ,$347.40 ,$221.95 ,$386.00 ,$84.92 ,$386.00 ,$209.98 ,$84.92 ,$160.58 , N/A , N/A ,$89.17 ,$328.10 ,$251.67 ,$108.08 ,$347.40 ,$324.24 ,$308.80 ,$308.80 ,$84.92 ,$250.90 
ST. FRANCIS HOSPITAL - ACUTE,71000207,N/A,HC PACU RECOVERY ADDL 15MIN,710,1 ,$312.00 ,$202.80 ,$68.64 ,$312.00 ,$179.40 ,$224.64 ,$169.73 ,$68.64 ,$87.36 ,$175.03 ,$68.64 ,$203.42 ,$78.00 ,$203.42 ,$203.42 ,$78.00 ,$203.42 ,$130.42 ,$262.08 , N/A ,$68.64 ,$265.20 ,$262.08 ,$68.64 ,$234.00 ,$249.60 ,$249.60 ,$68.64 ,$249.60 ,$262.08 ,$262.08 ,$262.08 ,$312.00 ,$280.80 ,$179.40 ,$312.00 ,$68.64 ,$312.00 ,$169.73 ,$68.64 ,$129.79 , N/A , N/A ,$72.07 ,$265.20 ,$203.42 ,$87.36 ,$280.80 ,$262.08 ,$249.60 ,$249.60 ,$68.64 ,$202.80 
ST. FRANCIS HOSPITAL - ACUTE,71000250,N/A,HC PHASE II RECOVERY INIT 15MIN,710,1 ,$130.00 ,$84.50 ,$28.60 ,$130.00 ,$74.75 ,$93.60 ,$70.72 ,$28.60 ,$36.40 ,$72.93 ,$28.60 ,$84.76 ,$32.50 ,$84.76 ,$84.76 ,$32.50 ,$84.76 ,$54.34 ,$109.20 , N/A ,$28.60 ,$110.50 ,$109.20 ,$28.60 ,$97.50 ,$104.00 ,$104.00 ,$28.60 ,$104.00 ,$109.20 ,$109.20 ,$109.20 ,$130.00 ,$117.00 ,$74.75 ,$130.00 ,$28.60 ,$130.00 ,$70.72 ,$28.60 ,$54.08 , N/A , N/A ,$30.03 ,$110.50 ,$84.76 ,$36.40 ,$117.00 ,$109.20 ,$104.00 ,$104.00 ,$28.60 ,$84.50 
ST. FRANCIS HOSPITAL - ACUTE,71000251,N/A,HC PHASE II RECOVERY ADDL 15MIN,710,1 ,$66.00 ,$42.90 ,$14.52 ,$66.00 ,$37.95 ,$47.52 ,$35.90 ,$14.52 ,$18.48 ,$37.03 ,$14.52 ,$43.03 ,$16.50 ,$43.03 ,$43.03 ,$16.50 ,$43.03 ,$27.59 ,$55.44 , N/A ,$14.52 ,$56.10 ,$55.44 ,$14.52 ,$49.50 ,$52.80 ,$52.80 ,$14.52 ,$52.80 ,$55.44 ,$55.44 ,$55.44 ,$66.00 ,$59.40 ,$37.95 ,$66.00 ,$14.52 ,$66.00 ,$35.90 ,$14.52 ,$27.46 , N/A , N/A ,$15.25 ,$56.10 ,$43.03 ,$18.48 ,$59.40 ,$55.44 ,$52.80 ,$52.80 ,$14.52 ,$42.90 
ST. FRANCIS HOSPITAL - ACUTE,72000023,59070,HC TRANSABDOMINAL AMNIOINFUSION W/US GUIDANCE,720,1 ,$540.00 ,$351.00 ,$118.80 ,$720.10 ,$310.50 ,$388.80 ,$293.76 ,$118.80 ,$151.20 ,$302.94 ,$118.80 ,$352.08 ,$135.00 ,$352.08 ,$352.08 ,$135.00 ,$352.08 ,$225.72 ,$453.60 ,$720.10 ,$118.80 ,$459.00 ,$453.60 ,$118.80 ,$405.00 ,$432.00 ,$432.00 ,$118.80 ,$432.00 ,$453.60 ,$453.60 ,$453.60 ,$540.00 ,$486.00 ,$310.50 ,$540.00 ,$118.80 ,$540.00 ,$293.76 ,$118.80 ,$224.64 , N/A , N/A ,$124.74 ,$459.00 ,$352.08 ,$151.20 ,$486.00 ,$453.60 ,$432.00 ,$432.00 ,$118.80 ,$351.00 
ST. FRANCIS HOSPITAL - ACUTE,72100005,N/A,HC LABOR PER HR,721,1 ,$94.00 ,$61.10 ,$20.68 ,$94.00 ,$54.05 ,$67.68 ,$51.14 ,$20.68 ,$26.32 ,$52.73 ,$20.68 ,$61.29 ,$23.50 ,$61.29 ,$61.29 ,$23.50 ,$61.29 ,$39.29 ,$78.96 , N/A ,$20.68 ,$79.90 ,$78.96 ,$20.68 ,$70.50 ,$75.20 ,$75.20 ,$20.68 ,$75.20 ,$78.96 ,$78.96 ,$78.96 ,$94.00 ,$84.60 ,$54.05 ,$94.00 ,$20.68 ,$94.00 ,$51.14 ,$20.68 ,$39.10 , N/A , N/A ,$21.71 ,$79.90 ,$61.29 ,$26.32 ,$84.60 ,$78.96 ,$75.20 ,$75.20 ,$20.68 ,$61.10 
ST. FRANCIS HOSPITAL - ACUTE,72200009,N/A,HC DELIVERY,722,1 ,"$2,581.00 ","$1,677.65 ",$567.82 ,"$2,581.00 ","$1,484.08 ","$1,858.32 ","$1,404.06 ",$567.82 ,$722.68 ,"$1,447.94 ",$567.82 ,"$1,682.81 ",$645.25 ,"$1,682.81 ","$1,682.81 ",$645.25 ,"$1,682.81 ","$1,078.86 ","$2,168.04 ", N/A ,$567.82 ,"$2,193.85 ","$2,168.04 ",$567.82 ,"$1,935.75 ","$2,064.80 ","$2,064.80 ",$567.82 ,"$2,064.80 ","$2,168.04 ","$2,168.04 ","$2,168.04 ","$2,581.00 ","$2,322.90 ","$1,484.08 ","$2,581.00 ",$567.82 ,"$2,581.00 ","$1,404.06 ",$567.82 ,"$1,073.70 ", N/A , N/A ,$596.21 ,"$2,193.85 ","$1,682.81 ",$722.68 ,"$2,322.90 ","$2,168.04 ","$2,064.80 ","$2,064.80 ",$567.82 ,"$1,677.65 "
ST. FRANCIS HOSPITAL - ACUTE,72300002,54160,HC CIRCUMCISION,723,1 ,$852.00 ,$553.80 ,$187.44 ,"$1,468.90 ",$489.90 ,$613.44 ,$463.49 ,$187.44 ,$238.56 ,$477.97 ,$187.44 ,$555.50 ,$213.00 ,$555.50 ,$555.50 ,$213.00 ,$555.50 ,$356.14 ,$715.68 ,"$1,468.90 ",$187.44 ,$724.20 ,$715.68 ,$187.44 ,$639.00 ,$681.60 ,$681.60 ,$187.44 ,$681.60 ,$715.68 ,$715.68 ,$715.68 ,$852.00 ,$766.80 ,$489.90 ,$852.00 ,$187.44 ,$852.00 ,$463.49 ,$187.44 ,$354.43 , N/A , N/A ,$196.81 ,$724.20 ,$555.50 ,$238.56 ,$766.80 ,$715.68 ,$681.60 ,$681.60 ,$187.44 ,$553.80 
ST. FRANCIS HOSPITAL - ACUTE,73000002,93005,HC EKG,730,1 ,$309.00 ,$200.85 ,$25.94 ,$309.00 ,$177.68 ,$222.48 ,$168.10 ,$67.98 ,$86.52 ,$181.69 ,$67.98 ,$184.01 ,$77.25 ,$184.01 ,$184.01 ,$77.25 ,$184.01 ,$129.16 ,$259.56 ,$142.13 ,$67.98 ,$262.65 ,$259.56 ,$67.98 ,$231.75 ,$247.20 ,$247.20 ,$67.98 ,$247.20 ,$259.56 ,$259.56 ,$259.56 ,$309.00 ,$278.10 ,$177.68 ,$309.00 ,$67.98 ,$309.00 ,$168.10 ,$67.98 ,$128.54 ,$27.17 ,$25.94 ,$71.38 ,$262.65 ,$184.01 ,$86.52 ,$278.10 ,$259.56 ,$247.20 ,$247.20 ,$67.98 ,$200.85 
ST. FRANCIS HOSPITAL - ACUTE,73000003,93041,HC EKG RHYTHM STRIP TRACING,730,1 ,$55.00 ,$35.75 ,$12.10 ,$142.13 ,$31.63 ,$39.60 ,$29.92 ,$12.10 ,$15.40 ,$30.86 ,$12.10 ,$35.86 ,$13.75 ,$35.86 ,$35.86 ,$13.75 ,$35.86 ,$22.99 ,$46.20 ,$142.13 ,$12.10 ,$46.75 ,$46.20 ,$12.10 ,$41.25 ,$44.00 ,$44.00 ,$12.10 ,$44.00 ,$46.20 ,$46.20 ,$46.20 ,$55.00 ,$49.50 ,$31.63 ,$55.00 ,$12.10 ,$55.00 ,$29.92 ,$12.10 ,$22.88 ,$27.17 ,$25.94 ,$12.71 ,$46.75 ,$35.86 ,$15.40 ,$49.50 ,$46.20 ,$44.00 ,$44.00 ,$12.10 ,$35.75 
ST. FRANCIS HOSPITAL - ACUTE,73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$812.00 ,$527.80 ,$69.57 ,$812.00 ,$466.90 ,$584.64 ,$441.73 ,$178.64 ,$227.36 ,$477.46 ,$178.64 ,$557.84 ,$203.00 ,$557.84 ,$557.84 ,$203.00 ,$557.84 ,$339.42 ,$682.08 ,$287.90 ,$178.64 ,$690.20 ,$682.08 ,$178.64 ,$609.00 ,$649.60 ,$649.60 ,$178.64 ,$649.60 ,$682.08 ,$682.08 ,$682.08 ,$812.00 ,$730.80 ,$466.90 ,$812.00 ,$178.64 ,$812.00 ,$441.73 ,$178.64 ,$337.79 ,$72.89 ,$69.57 ,$187.57 ,$690.20 ,$557.84 ,$227.36 ,$730.80 ,$682.08 ,$649.60 ,$649.60 ,$178.64 ,$527.80 
ST. FRANCIS HOSPITAL - ACUTE,73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,"$1,060.00 ",$689.00 ,$69.57 ,"$1,060.00 ",$609.50 ,$763.20 ,$576.64 ,$233.20 ,$296.80 ,$623.28 ,$233.20 ,$728.22 ,$265.00 ,$728.22 ,$728.22 ,$265.00 ,$728.22 ,$443.08 ,$890.40 ,$287.90 ,$233.20 ,$901.00 ,$890.40 ,$233.20 ,$795.00 ,$848.00 ,$848.00 ,$233.20 ,$848.00 ,$890.40 ,$890.40 ,$890.40 ,"$1,060.00 ",$954.00 ,$609.50 ,"$1,060.00 ",$233.20 ,"$1,060.00 ",$576.64 ,$233.20 ,$440.96 ,$72.89 ,$69.57 ,$244.86 ,$901.00 ,$728.22 ,$296.80 ,$954.00 ,$890.40 ,$848.00 ,$848.00 ,$233.20 ,$689.00 
ST. FRANCIS HOSPITAL - ACUTE,73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$890.00 ,$578.50 ,$69.57 ,$890.00 ,$511.75 ,$640.80 ,$484.16 ,$195.80 ,$249.20 ,$198.83 ,$195.80 ,$198.83 ,$222.50 ,$198.83 ,$198.83 ,$222.50 ,$198.83 ,$372.02 ,$747.60 ,$95.08 ,$195.80 ,$756.50 ,$747.60 ,$195.80 ,$667.50 ,$712.00 ,$712.00 ,$195.80 ,$712.00 ,$747.60 ,$747.60 ,$747.60 ,$890.00 ,$801.00 ,$511.75 ,$890.00 ,$195.80 ,$890.00 ,$484.16 ,$195.80 ,$370.24 ,$72.89 ,$69.57 ,$205.59 ,$756.50 ,$198.83 ,$249.20 ,$801.00 ,$747.60 ,$712.00 ,$712.00 ,$195.80 ,$578.50 
ST. FRANCIS HOSPITAL - ACUTE,74000002,95805,HC MULTIPLE SLEEP LATENCY,740,1 ,"$2,973.00 ","$1,932.45 ",$654.06 ,"$2,973.00 ","$1,709.48 ","$2,140.56 ","$1,617.31 ",$654.06 ,$832.44 ,"$1,748.12 ",$654.06 ,"$2,042.45 ",$743.25 ,"$2,042.45 ","$2,042.45 ",$743.25 ,"$2,042.45 ","$1,242.71 ","$2,497.32 ","$1,246.33 ",$654.06 ,"$2,527.05 ","$2,497.32 ",$654.06 ,"$2,229.75 ","$2,378.40 ","$2,378.40 ",$654.06 ,"$2,378.40 ","$2,497.32 ","$2,497.32 ","$2,497.32 ","$2,973.00 ","$2,675.70 ","$1,709.48 ","$2,973.00 ",$654.06 ,"$2,973.00 ","$1,617.31 ",$654.06 ,"$1,236.77 ",$809.51 ,$772.72 ,$686.76 ,"$2,527.05 ","$2,042.45 ",$832.44 ,"$2,675.70 ","$2,497.32 ","$2,378.40 ","$2,378.40 ",$654.06 ,"$1,932.45 "
ST. FRANCIS HOSPITAL - ACUTE,74000003,95806,HC SLEEP STUDY UNATTENDED,740,1 ,"$1,534.00 ",$997.10 ,$337.48 ,"$1,534.00 ",$882.05 ,"$1,104.48 ",$834.50 ,$337.48 ,$429.52 ,$901.99 ,$337.48 ,"$1,053.86 ",$383.50 ,"$1,053.86 ","$1,053.86 ",$383.50 ,"$1,053.86 ",$641.21 ,"$1,288.56 ",$356.48 ,$337.48 ,"$1,303.90 ","$1,288.56 ",$337.48 ,"$1,150.50 ","$1,227.20 ","$1,227.20 ",$337.48 ,"$1,227.20 ","$1,288.56 ","$1,288.56 ","$1,288.56 ","$1,534.00 ","$1,380.60 ",$882.05 ,"$1,534.00 ",$337.48 ,"$1,534.00 ",$834.50 ,$337.48 ,$638.14 ,$809.51 ,$772.72 ,$354.35 ,"$1,303.90 ","$1,053.86 ",$429.52 ,"$1,380.60 ","$1,288.56 ","$1,227.20 ","$1,227.20 ",$337.48 ,$997.10 
ST. FRANCIS HOSPITAL - ACUTE,74000006,95810,HC SLEEP STUDY,740,1 ,"$4,905.00 ","$3,188.25 ",$772.72 ,"$4,905.00 ","$2,820.38 ","$3,531.60 ","$2,668.32 ","$1,079.10 ","$1,373.40 ","$2,884.14 ","$1,079.10 ","$3,369.74 ","$1,226.25 ","$3,369.74 ","$3,369.74 ","$1,226.25 ","$3,369.74 ","$2,050.29 ","$4,120.20 ","$2,349.03 ","$1,079.10 ","$4,169.25 ","$4,120.20 ","$1,079.10 ","$3,678.75 ","$3,924.00 ","$3,924.00 ","$1,079.10 ","$3,924.00 ","$4,120.20 ","$4,120.20 ","$4,120.20 ","$4,905.00 ","$4,414.50 ","$2,820.38 ","$4,905.00 ","$1,079.10 ","$4,905.00 ","$2,668.32 ","$1,079.10 ","$2,040.48 ",$809.51 ,$772.72 ,"$1,133.06 ","$4,169.25 ","$3,369.74 ","$1,373.40 ","$4,414.50 ","$4,120.20 ","$3,924.00 ","$3,924.00 ","$1,079.10 ","$3,188.25 "
ST. FRANCIS HOSPITAL - ACUTE,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$5,722.00 ","$3,719.30 ",$772.72 ,"$5,722.00 ","$3,290.15 ","$4,119.84 ","$3,112.77 ","$1,258.84 ","$1,602.16 ","$3,364.54 ","$1,258.84 ","$3,931.01 ","$1,430.50 ","$3,931.01 ","$3,931.01 ","$1,430.50 ","$3,931.01 ","$2,391.80 ","$4,806.48 ","$2,349.03 ","$1,258.84 ","$4,863.70 ","$4,806.48 ","$1,258.84 ","$4,291.50 ","$4,577.60 ","$4,577.60 ","$1,258.84 ","$4,577.60 ","$4,806.48 ","$4,806.48 ","$4,806.48 ","$5,722.00 ","$5,149.80 ","$3,290.15 ","$5,722.00 ","$1,258.84 ","$5,722.00 ","$3,112.77 ","$1,258.84 ","$2,380.35 ",$809.51 ,$772.72 ,"$1,321.78 ","$4,863.70 ","$3,931.01 ","$1,602.16 ","$5,149.80 ","$4,806.48 ","$4,577.60 ","$4,577.60 ","$1,258.84 ","$3,719.30 "
ST. FRANCIS HOSPITAL - ACUTE,74000014,95816,HC EEG AWAKE/DROWSY,740,1 ,$835.00 ,$542.75 ,$183.70 ,$835.00 ,$480.13 ,$601.20 ,$454.24 ,$183.70 ,$233.80 ,$490.98 ,$183.70 ,$573.65 ,$208.75 ,$573.65 ,$573.65 ,$208.75 ,$573.65 ,$349.03 ,$701.40 ,$675.73 ,$183.70 ,$709.75 ,$701.40 ,$183.70 ,$626.25 ,$668.00 ,$668.00 ,$183.70 ,$668.00 ,$701.40 ,$701.40 ,$701.40 ,$835.00 ,$751.50 ,$480.13 ,$835.00 ,$183.70 ,$835.00 ,$454.24 ,$183.70 ,$347.36 ,$273.19 ,$260.77 ,$192.89 ,$709.75 ,$573.65 ,$233.80 ,$751.50 ,$701.40 ,$668.00 ,$668.00 ,$183.70 ,$542.75 
ST. FRANCIS HOSPITAL - ACUTE,74000016,95819,HC EEG AWAKE/ASLEEP,740,1 ,$835.00 ,$542.75 ,$183.70 ,$835.00 ,$480.13 ,$601.20 ,$454.24 ,$183.70 ,$233.80 ,$490.98 ,$183.70 ,$573.65 ,$208.75 ,$573.65 ,$573.65 ,$208.75 ,$573.65 ,$349.03 ,$701.40 ,$675.73 ,$183.70 ,$709.75 ,$701.40 ,$183.70 ,$626.25 ,$668.00 ,$668.00 ,$183.70 ,$668.00 ,$701.40 ,$701.40 ,$701.40 ,$835.00 ,$751.50 ,$480.13 ,$835.00 ,$183.70 ,$835.00 ,$454.24 ,$183.70 ,$347.36 ,$273.19 ,$260.77 ,$192.89 ,$709.75 ,$573.65 ,$233.80 ,$751.50 ,$701.40 ,$668.00 ,$668.00 ,$183.70 ,$542.75 
ST. FRANCIS HOSPITAL - ACUTE,74000045,95810,HC SLEEP STUDY PSG 4+ PARAMETERS >6YRS -52,740,1 ,"$4,905.00 ","$3,188.25 ",$386.36 ,"$4,905.00 ","$2,820.38 ","$3,531.60 ","$2,668.32 ","$1,079.10 ","$1,373.40 ","$2,884.14 ","$1,079.10 ","$3,369.74 ","$1,226.25 ","$3,369.74 ","$3,369.74 ","$1,226.25 ","$3,369.74 ","$2,050.29 ","$4,120.20 ","$1,174.51 ","$1,079.10 ","$4,169.25 ","$4,120.20 ","$1,079.10 ","$3,678.75 ","$3,924.00 ","$3,924.00 ","$1,079.10 ","$3,924.00 ","$4,120.20 ","$4,120.20 ","$4,120.20 ","$4,905.00 ","$4,414.50 ","$2,820.38 ","$4,905.00 ","$1,079.10 ","$4,905.00 ","$2,668.32 ","$1,079.10 ","$2,040.48 ",$404.76 ,$386.36 ,"$1,133.06 ","$4,169.25 ","$3,369.74 ","$1,373.40 ","$4,414.50 ","$4,120.20 ","$3,924.00 ","$3,924.00 ","$1,079.10 ","$3,188.25 "
ST. FRANCIS HOSPITAL - ACUTE,75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,$330.00 ,$214.50 ,$72.60 ,"$2,065.98 ",$189.75 ,$237.60 ,$179.52 ,$72.60 ,$92.40 ,$185.13 ,$72.60 ,$215.16 ,$82.50 ,$215.16 ,$215.16 ,$82.50 ,$215.16 ,$137.94 ,$277.20 ,"$2,065.98 ",$72.60 ,$280.50 ,$277.20 ,$72.60 ,$247.50 ,$264.00 ,$264.00 ,$72.60 ,$264.00 ,$277.20 ,$277.20 ,$277.20 ,$330.00 ,$297.00 ,$189.75 ,$330.00 ,$72.60 ,$330.00 ,$179.52 ,$72.60 ,$137.28 ,$729.83 ,$696.65 ,$76.23 ,$280.50 ,$215.16 ,$92.40 ,$297.00 ,$277.20 ,$264.00 ,$264.00 ,$72.60 ,$214.50 
ST. FRANCIS HOSPITAL - ACUTE,75001066,N/A,HC ESOPHAGOSCOPY FLEXIBLE DX W/BRUSH/WASH -43200,750,1 ,"$2,429.00 ","$1,578.85 ",$534.38 ,"$2,429.00 ","$1,396.68 ","$1,748.88 ","$1,321.38 ",$534.38 ,$680.12 ,"$1,362.67 ",$534.38 ,"$1,583.71 ",$607.25 ,"$1,583.71 ","$1,583.71 ",$607.25 ,"$1,583.71 ","$1,015.32 ","$2,040.36 ", N/A ,$534.38 ,"$2,064.65 ","$2,040.36 ",$534.38 ,"$1,821.75 ","$1,943.20 ","$1,943.20 ",$534.38 ,"$1,943.20 ","$2,040.36 ","$2,040.36 ","$2,040.36 ","$2,429.00 ","$2,186.10 ","$1,396.68 ","$2,429.00 ",$534.38 ,"$2,429.00 ","$1,321.38 ",$534.38 ,"$1,010.46 ", N/A , N/A ,$561.10 ,"$2,064.65 ","$1,583.71 ",$680.12 ,"$2,186.10 ","$2,040.36 ","$1,943.20 ","$1,943.20 ",$534.38 ,"$1,578.85 "
ST. FRANCIS HOSPITAL - ACUTE,75001071,N/A,HC EGD W/BALLOON DILAT >30MM - 43233,750,1 ,"$3,301.00 ","$2,145.65 ",$726.22 ,"$3,301.00 ","$1,898.08 ","$2,376.72 ","$1,795.74 ",$726.22 ,$924.28 ,"$1,851.86 ",$726.22 ,"$2,152.25 ",$825.25 ,"$2,152.25 ","$2,152.25 ",$825.25 ,"$2,152.25 ","$1,379.82 ","$2,772.84 ", N/A ,$726.22 ,"$2,805.85 ","$2,772.84 ",$726.22 ,"$2,475.75 ","$2,640.80 ","$2,640.80 ",$726.22 ,"$2,640.80 ","$2,772.84 ","$2,772.84 ","$2,772.84 ","$3,301.00 ","$2,970.90 ","$1,898.08 ","$3,301.00 ",$726.22 ,"$3,301.00 ","$1,795.74 ",$726.22 ,"$1,373.22 ", N/A , N/A ,$762.53 ,"$2,805.85 ","$2,152.25 ",$924.28 ,"$2,970.90 ","$2,772.84 ","$2,640.80 ","$2,640.80 ",$726.22 ,"$2,145.65 "
ST. FRANCIS HOSPITAL - ACUTE,75001072,N/A,HC EGD W/BRUSH/WASH - 43235,750,1 ,"$2,919.00 ","$1,897.35 ",$642.18 ,"$2,919.00 ","$1,678.43 ","$2,101.68 ","$1,587.94 ",$642.18 ,$817.32 ,"$1,637.56 ",$642.18 ,"$1,903.19 ",$729.75 ,"$1,903.19 ","$1,903.19 ",$729.75 ,"$1,903.19 ","$1,220.14 ","$2,451.96 ", N/A ,$642.18 ,"$2,481.15 ","$2,451.96 ",$642.18 ,"$2,189.25 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$2,335.20 ","$2,451.96 ","$2,451.96 ","$2,451.96 ","$2,919.00 ","$2,627.10 ","$1,678.43 ","$2,919.00 ",$642.18 ,"$2,919.00 ","$1,587.94 ",$642.18 ,"$1,214.30 ", N/A , N/A ,$674.29 ,"$2,481.15 ","$1,903.19 ",$817.32 ,"$2,627.10 ","$2,451.96 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$1,897.35 "
ST. FRANCIS HOSPITAL - ACUTE,75001076,N/A,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$2,919.00 ","$1,897.35 ",$642.18 ,"$2,919.00 ","$1,678.43 ","$2,101.68 ","$1,587.94 ",$642.18 ,$817.32 ,"$1,637.56 ",$642.18 ,"$1,903.19 ",$729.75 ,"$1,903.19 ","$1,903.19 ",$729.75 ,"$1,903.19 ","$1,220.14 ","$2,451.96 ", N/A ,$642.18 ,"$2,481.15 ","$2,451.96 ",$642.18 ,"$2,189.25 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$2,335.20 ","$2,451.96 ","$2,451.96 ","$2,451.96 ","$2,919.00 ","$2,627.10 ","$1,678.43 ","$2,919.00 ",$642.18 ,"$2,919.00 ","$1,587.94 ",$642.18 ,"$1,214.30 ", N/A , N/A ,$674.29 ,"$2,481.15 ","$1,903.19 ",$817.32 ,"$2,627.10 ","$2,451.96 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$1,897.35 "
ST. FRANCIS HOSPITAL - ACUTE,75001081,N/A,HC EGD W/DILAT STRICTURE - 43245,750,1 ,"$3,144.00 ","$2,043.60 ",$691.68 ,"$3,144.00 ","$1,807.80 ","$2,263.68 ","$1,710.34 ",$691.68 ,$880.32 ,"$1,763.78 ",$691.68 ,"$2,049.89 ",$786.00 ,"$2,049.89 ","$2,049.89 ",$786.00 ,"$2,049.89 ","$1,314.19 ","$2,640.96 ", N/A ,$691.68 ,"$2,672.40 ","$2,640.96 ",$691.68 ,"$2,358.00 ","$2,515.20 ","$2,515.20 ",$691.68 ,"$2,515.20 ","$2,640.96 ","$2,640.96 ","$2,640.96 ","$3,144.00 ","$2,829.60 ","$1,807.80 ","$3,144.00 ",$691.68 ,"$3,144.00 ","$1,710.34 ",$691.68 ,"$1,307.90 ", N/A , N/A ,$726.26 ,"$2,672.40 ","$2,049.89 ",$880.32 ,"$2,829.60 ","$2,640.96 ","$2,515.20 ","$2,515.20 ",$691.68 ,"$2,043.60 "
ST. FRANCIS HOSPITAL - ACUTE,75001082,N/A,HC EGD W/PLACEMENT G-TUBE - 43246,750,1 ,"$1,870.00 ","$1,215.50 ",$411.40 ,"$1,870.00 ","$1,075.25 ","$1,346.40 ","$1,017.28 ",$411.40 ,$523.60 ,"$1,049.07 ",$411.40 ,"$1,219.24 ",$467.50 ,"$1,219.24 ","$1,219.24 ",$467.50 ,"$1,219.24 ",$781.66 ,"$1,570.80 ", N/A ,$411.40 ,"$1,589.50 ","$1,570.80 ",$411.40 ,"$1,402.50 ","$1,496.00 ","$1,496.00 ",$411.40 ,"$1,496.00 ","$1,570.80 ","$1,570.80 ","$1,570.80 ","$1,870.00 ","$1,683.00 ","$1,075.25 ","$1,870.00 ",$411.40 ,"$1,870.00 ","$1,017.28 ",$411.40 ,$777.92 , N/A , N/A ,$431.97 ,"$1,589.50 ","$1,219.24 ",$523.60 ,"$1,683.00 ","$1,570.80 ","$1,496.00 ","$1,496.00 ",$411.40 ,"$1,215.50 "
ST. FRANCIS HOSPITAL - ACUTE,75001083,N/A,HC EGD W/FB REMOVAL - 43247,750,1 ,"$3,446.00 ","$2,239.90 ",$758.12 ,"$3,446.00 ","$1,981.45 ","$2,481.12 ","$1,874.62 ",$758.12 ,$964.88 ,"$1,933.21 ",$758.12 ,"$2,246.79 ",$861.50 ,"$2,246.79 ","$2,246.79 ",$861.50 ,"$2,246.79 ","$1,440.43 ","$2,894.64 ", N/A ,$758.12 ,"$2,929.10 ","$2,894.64 ",$758.12 ,"$2,584.50 ","$2,756.80 ","$2,756.80 ",$758.12 ,"$2,756.80 ","$2,894.64 ","$2,894.64 ","$2,894.64 ","$3,446.00 ","$3,101.40 ","$1,981.45 ","$3,446.00 ",$758.12 ,"$3,446.00 ","$1,874.62 ",$758.12 ,"$1,433.54 ", N/A , N/A ,$796.03 ,"$2,929.10 ","$2,246.79 ",$964.88 ,"$3,101.40 ","$2,894.64 ","$2,756.80 ","$2,756.80 ",$758.12 ,"$2,239.90 "
ST. FRANCIS HOSPITAL - ACUTE,75001084,N/A,HC EGD W/INSERT GUIDEWIRE - 43248,750,1 ,"$2,937.00 ","$1,909.05 ",$646.14 ,"$2,937.00 ","$1,688.78 ","$2,114.64 ","$1,597.73 ",$646.14 ,$822.36 ,"$1,647.66 ",$646.14 ,"$1,914.92 ",$734.25 ,"$1,914.92 ","$1,914.92 ",$734.25 ,"$1,914.92 ","$1,227.67 ","$2,467.08 ", N/A ,$646.14 ,"$2,496.45 ","$2,467.08 ",$646.14 ,"$2,202.75 ","$2,349.60 ","$2,349.60 ",$646.14 ,"$2,349.60 ","$2,467.08 ","$2,467.08 ","$2,467.08 ","$2,937.00 ","$2,643.30 ","$1,688.78 ","$2,937.00 ",$646.14 ,"$2,937.00 ","$1,597.73 ",$646.14 ,"$1,221.79 ", N/A , N/A ,$678.45 ,"$2,496.45 ","$1,914.92 ",$822.36 ,"$2,643.30 ","$2,467.08 ","$2,349.60 ","$2,349.60 ",$646.14 ,"$1,909.05 "
ST. FRANCIS HOSPITAL - ACUTE,75001085,N/A,HC EGD W/BALLOON DILAT <30MM - 43249,750,1 ,"$3,301.00 ","$2,145.65 ",$726.22 ,"$3,301.00 ","$1,898.08 ","$2,376.72 ","$1,795.74 ",$726.22 ,$924.28 ,"$1,851.86 ",$726.22 ,"$2,152.25 ",$825.25 ,"$2,152.25 ","$2,152.25 ",$825.25 ,"$2,152.25 ","$1,379.82 ","$2,772.84 ", N/A ,$726.22 ,"$2,805.85 ","$2,772.84 ",$726.22 ,"$2,475.75 ","$2,640.80 ","$2,640.80 ",$726.22 ,"$2,640.80 ","$2,772.84 ","$2,772.84 ","$2,772.84 ","$3,301.00 ","$2,970.90 ","$1,898.08 ","$3,301.00 ",$726.22 ,"$3,301.00 ","$1,795.74 ",$726.22 ,"$1,373.22 ", N/A , N/A ,$762.53 ,"$2,805.85 ","$2,152.25 ",$924.28 ,"$2,970.90 ","$2,772.84 ","$2,640.80 ","$2,640.80 ",$726.22 ,"$2,145.65 "
ST. FRANCIS HOSPITAL - ACUTE,75001086,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY - 43250,750,1 ,"$3,301.00 ","$2,145.65 ",$726.22 ,"$3,301.00 ","$1,898.08 ","$2,376.72 ","$1,795.74 ",$726.22 ,$924.28 ,"$1,851.86 ",$726.22 ,"$2,152.25 ",$825.25 ,"$2,152.25 ","$2,152.25 ",$825.25 ,"$2,152.25 ","$1,379.82 ","$2,772.84 ", N/A ,$726.22 ,"$2,805.85 ","$2,772.84 ",$726.22 ,"$2,475.75 ","$2,640.80 ","$2,640.80 ",$726.22 ,"$2,640.80 ","$2,772.84 ","$2,772.84 ","$2,772.84 ","$3,301.00 ","$2,970.90 ","$1,898.08 ","$3,301.00 ",$726.22 ,"$3,301.00 ","$1,795.74 ",$726.22 ,"$1,373.22 ", N/A , N/A ,$762.53 ,"$2,805.85 ","$2,152.25 ",$924.28 ,"$2,970.90 ","$2,772.84 ","$2,640.80 ","$2,640.80 ",$726.22 ,"$2,145.65 "
ST. FRANCIS HOSPITAL - ACUTE,75001087,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH - 43251,750,1 ,"$2,919.00 ","$1,897.35 ",$642.18 ,"$2,919.00 ","$1,678.43 ","$2,101.68 ","$1,587.94 ",$642.18 ,$817.32 ,"$1,637.56 ",$642.18 ,"$1,903.19 ",$729.75 ,"$1,903.19 ","$1,903.19 ",$729.75 ,"$1,903.19 ","$1,220.14 ","$2,451.96 ", N/A ,$642.18 ,"$2,481.15 ","$2,451.96 ",$642.18 ,"$2,189.25 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$2,335.20 ","$2,451.96 ","$2,451.96 ","$2,451.96 ","$2,919.00 ","$2,627.10 ","$1,678.43 ","$2,919.00 ",$642.18 ,"$2,919.00 ","$1,587.94 ",$642.18 ,"$1,214.30 ", N/A , N/A ,$674.29 ,"$2,481.15 ","$1,903.19 ",$817.32 ,"$2,627.10 ","$2,451.96 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$1,897.35 "
ST. FRANCIS HOSPITAL - ACUTE,75001090,N/A,HC EGD W/CONTROL BLEEDING - 43255,750,1 ,"$4,876.00 ","$3,169.40 ","$1,072.72 ","$4,876.00 ","$2,803.70 ","$3,510.72 ","$2,652.54 ","$1,072.72 ","$1,365.28 ","$2,735.44 ","$1,072.72 ","$3,179.15 ","$1,219.00 ","$3,179.15 ","$3,179.15 ","$1,219.00 ","$3,179.15 ","$2,038.17 ","$4,095.84 ", N/A ,"$1,072.72 ","$4,144.60 ","$4,095.84 ","$1,072.72 ","$3,657.00 ","$3,900.80 ","$3,900.80 ","$1,072.72 ","$3,900.80 ","$4,095.84 ","$4,095.84 ","$4,095.84 ","$4,876.00 ","$4,388.40 ","$2,803.70 ","$4,876.00 ","$1,072.72 ","$4,876.00 ","$2,652.54 ","$1,072.72 ","$2,028.42 ", N/A , N/A ,"$1,126.36 ","$4,144.60 ","$3,179.15 ","$1,365.28 ","$4,388.40 ","$4,095.84 ","$3,900.80 ","$3,900.80 ","$1,072.72 ","$3,169.40 "
ST. FRANCIS HOSPITAL - ACUTE,75001106,N/A,HC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS - 43450,750,1 ,"$2,779.00 ","$1,806.35 ",$611.38 ,"$2,779.00 ","$1,597.93 ","$2,000.88 ","$1,511.78 ",$611.38 ,$778.12 ,"$1,559.02 ",$611.38 ,"$1,811.91 ",$694.75 ,"$1,811.91 ","$1,811.91 ",$694.75 ,"$1,811.91 ","$1,161.62 ","$2,334.36 ", N/A ,$611.38 ,"$2,362.15 ","$2,334.36 ",$611.38 ,"$2,084.25 ","$2,223.20 ","$2,223.20 ",$611.38 ,"$2,223.20 ","$2,334.36 ","$2,334.36 ","$2,334.36 ","$2,779.00 ","$2,501.10 ","$1,597.93 ","$2,779.00 ",$611.38 ,"$2,779.00 ","$1,511.78 ",$611.38 ,"$1,156.06 ", N/A , N/A ,$641.95 ,"$2,362.15 ","$1,811.91 ",$778.12 ,"$2,501.10 ","$2,334.36 ","$2,223.20 ","$2,223.20 ",$611.38 ,"$1,806.35 "
ST. FRANCIS HOSPITAL - ACUTE,75001126,N/A,HC COLONOSCOPY STOMA W/BX SGL/MULT - 44389,750,1 ,"$5,074.00 ","$3,298.10 ","$1,116.28 ","$5,074.00 ","$2,917.55 ","$3,653.28 ","$2,760.26 ","$1,116.28 ","$1,420.72 ","$2,846.51 ","$1,116.28 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$2,120.93 ","$4,262.16 ", N/A ,"$1,116.28 ","$4,312.90 ","$4,262.16 ","$1,116.28 ","$3,805.50 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$4,059.20 ","$4,262.16 ","$4,262.16 ","$4,262.16 ","$5,074.00 ","$4,566.60 ","$2,917.55 ","$5,074.00 ","$1,116.28 ","$5,074.00 ","$2,760.26 ","$1,116.28 ","$2,110.78 ", N/A , N/A ,"$1,172.09 ","$4,312.90 ","$3,308.25 ","$1,420.72 ","$4,566.60 ","$4,262.16 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$3,298.10 "
ST. FRANCIS HOSPITAL - ACUTE,75001129,N/A,HC COLONOSCOPY STOMA W/REM TUMOR HOT BX - 44392,750,1 ,"$5,398.00 ","$3,508.70 ","$1,187.56 ","$5,398.00 ","$3,103.85 ","$3,886.56 ","$2,936.51 ","$1,187.56 ","$1,511.44 ","$3,028.28 ","$1,187.56 ","$3,519.50 ","$1,349.50 ","$3,519.50 ","$3,519.50 ","$1,349.50 ","$3,519.50 ","$2,256.36 ","$4,534.32 ", N/A ,"$1,187.56 ","$4,588.30 ","$4,534.32 ","$1,187.56 ","$4,048.50 ","$4,318.40 ","$4,318.40 ","$1,187.56 ","$4,318.40 ","$4,534.32 ","$4,534.32 ","$4,534.32 ","$5,398.00 ","$4,858.20 ","$3,103.85 ","$5,398.00 ","$1,187.56 ","$5,398.00 ","$2,936.51 ","$1,187.56 ","$2,245.57 ", N/A , N/A ,"$1,246.94 ","$4,588.30 ","$3,519.50 ","$1,511.44 ","$4,858.20 ","$4,534.32 ","$4,318.40 ","$4,318.40 ","$1,187.56 ","$3,508.70 "
ST. FRANCIS HOSPITAL - ACUTE,75001130,N/A,HC COLONOSCOPY STOMA W/REM TUMOR SNARE TECH - 44394,750,1 ,"$2,776.00 ","$1,804.40 ",$610.72 ,"$2,776.00 ","$1,596.20 ","$1,998.72 ","$1,510.14 ",$610.72 ,$777.28 ,"$1,557.34 ",$610.72 ,"$1,809.95 ",$694.00 ,"$1,809.95 ","$1,809.95 ",$694.00 ,"$1,809.95 ","$1,160.37 ","$2,331.84 ", N/A ,$610.72 ,"$2,359.60 ","$2,331.84 ",$610.72 ,"$2,082.00 ","$2,220.80 ","$2,220.80 ",$610.72 ,"$2,220.80 ","$2,331.84 ","$2,331.84 ","$2,331.84 ","$2,776.00 ","$2,498.40 ","$1,596.20 ","$2,776.00 ",$610.72 ,"$2,776.00 ","$1,510.14 ",$610.72 ,"$1,154.82 ", N/A , N/A ,$641.26 ,"$2,359.60 ","$1,809.95 ",$777.28 ,"$2,498.40 ","$2,331.84 ","$2,220.80 ","$2,220.80 ",$610.72 ,"$1,804.40 "
ST. FRANCIS HOSPITAL - ACUTE,75001139,N/A,HC PROCTOSIGMOIDOSCOPY RIGID DX W/W/O SPECIMEN - 45300,750,1 ,$791.00 ,$514.15 ,$174.02 ,$791.00 ,$454.83 ,$569.52 ,$430.30 ,$174.02 ,$221.48 ,$443.75 ,$174.02 ,$515.73 ,$197.75 ,$515.73 ,$515.73 ,$197.75 ,$515.73 ,$330.64 ,$664.44 , N/A ,$174.02 ,$672.35 ,$664.44 ,$174.02 ,$593.25 ,$632.80 ,$632.80 ,$174.02 ,$632.80 ,$664.44 ,$664.44 ,$664.44 ,$791.00 ,$711.90 ,$454.83 ,$791.00 ,$174.02 ,$791.00 ,$430.30 ,$174.02 ,$329.06 , N/A , N/A ,$182.72 ,$672.35 ,$515.73 ,$221.48 ,$711.90 ,$664.44 ,$632.80 ,$632.80 ,$174.02 ,$514.15 
ST. FRANCIS HOSPITAL - ACUTE,75001140,N/A,HC PROCTOSIGMOIDOSCOPY RIGID W/FB REMOVAL - 45307,750,1 ,$791.00 ,$514.15 ,$174.02 ,$791.00 ,$454.83 ,$569.52 ,$430.30 ,$174.02 ,$221.48 ,$443.75 ,$174.02 ,$515.73 ,$197.75 ,$515.73 ,$515.73 ,$197.75 ,$515.73 ,$330.64 ,$664.44 , N/A ,$174.02 ,$672.35 ,$664.44 ,$174.02 ,$593.25 ,$632.80 ,$632.80 ,$174.02 ,$632.80 ,$664.44 ,$664.44 ,$664.44 ,$791.00 ,$711.90 ,$454.83 ,$791.00 ,$174.02 ,$791.00 ,$430.30 ,$174.02 ,$329.06 , N/A , N/A ,$182.72 ,$672.35 ,$515.73 ,$221.48 ,$711.90 ,$664.44 ,$632.80 ,$632.80 ,$174.02 ,$514.15 
ST. FRANCIS HOSPITAL - ACUTE,75001143,N/A,HC SIGMOIDOSCOPY W/BIOPSY SGL/MULT -45331,750,1 ,"$2,381.00 ","$1,547.65 ",$523.82 ,"$2,381.00 ","$1,369.08 ","$1,714.32 ","$1,295.26 ",$523.82 ,$666.68 ,"$1,335.74 ",$523.82 ,"$1,552.41 ",$595.25 ,"$1,552.41 ","$1,552.41 ",$595.25 ,"$1,552.41 ",$995.26 ,"$2,000.04 ", N/A ,$523.82 ,"$2,023.85 ","$2,000.04 ",$523.82 ,"$1,785.75 ","$1,904.80 ","$1,904.80 ",$523.82 ,"$1,904.80 ","$2,000.04 ","$2,000.04 ","$2,000.04 ","$2,381.00 ","$2,142.90 ","$1,369.08 ","$2,381.00 ",$523.82 ,"$2,381.00 ","$1,295.26 ",$523.82 ,$990.50 , N/A , N/A ,$550.01 ,"$2,023.85 ","$1,552.41 ",$666.68 ,"$2,142.90 ","$2,000.04 ","$1,904.80 ","$1,904.80 ",$523.82 ,"$1,547.65 "
ST. FRANCIS HOSPITAL - ACUTE,75001145,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN  HOT BIOPSY -45333,750,1 ,"$2,381.00 ","$1,547.65 ",$523.82 ,"$2,381.00 ","$1,369.08 ","$1,714.32 ","$1,295.26 ",$523.82 ,$666.68 ,"$1,335.74 ",$523.82 ,"$1,552.41 ",$595.25 ,"$1,552.41 ","$1,552.41 ",$595.25 ,"$1,552.41 ",$995.26 ,"$2,000.04 ", N/A ,$523.82 ,"$2,023.85 ","$2,000.04 ",$523.82 ,"$1,785.75 ","$1,904.80 ","$1,904.80 ",$523.82 ,"$1,904.80 ","$2,000.04 ","$2,000.04 ","$2,000.04 ","$2,381.00 ","$2,142.90 ","$1,369.08 ","$2,381.00 ",$523.82 ,"$2,381.00 ","$1,295.26 ",$523.82 ,$990.50 , N/A , N/A ,$550.01 ,"$2,023.85 ","$1,552.41 ",$666.68 ,"$2,142.90 ","$2,000.04 ","$1,904.80 ","$1,904.80 ",$523.82 ,"$1,547.65 "
ST. FRANCIS HOSPITAL - ACUTE,75001149,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45338,750,1 ,"$3,111.00 ","$2,022.15 ",$684.42 ,"$3,111.00 ","$1,788.83 ","$2,239.92 ","$1,692.38 ",$684.42 ,$871.08 ,"$1,745.27 ",$684.42 ,"$2,028.37 ",$777.75 ,"$2,028.37 ","$2,028.37 ",$777.75 ,"$2,028.37 ","$1,300.40 ","$2,613.24 ", N/A ,$684.42 ,"$2,644.35 ","$2,613.24 ",$684.42 ,"$2,333.25 ","$2,488.80 ","$2,488.80 ",$684.42 ,"$2,488.80 ","$2,613.24 ","$2,613.24 ","$2,613.24 ","$3,111.00 ","$2,799.90 ","$1,788.83 ","$3,111.00 ",$684.42 ,"$3,111.00 ","$1,692.38 ",$684.42 ,"$1,294.18 ", N/A , N/A ,$718.64 ,"$2,644.35 ","$2,028.37 ",$871.08 ,"$2,799.90 ","$2,613.24 ","$2,488.80 ","$2,488.80 ",$684.42 ,"$2,022.15 "
ST. FRANCIS HOSPITAL - ACUTE,75001157,N/A,HC COLONOSCOPY DX W/SPECIMEN BRUSH/WASH - 45378,750,1 ,"$4,499.00 ","$2,924.35 ",$989.78 ,"$4,499.00 ","$2,586.93 ","$3,239.28 ","$2,447.46 ",$989.78 ,"$1,259.72 ","$2,523.94 ",$989.78 ,"$2,933.35 ","$1,124.75 ","$2,933.35 ","$2,933.35 ","$1,124.75 ","$2,933.35 ","$1,880.58 ","$3,779.16 ", N/A ,$989.78 ,"$3,824.15 ","$3,779.16 ",$989.78 ,"$3,374.25 ","$3,599.20 ","$3,599.20 ",$989.78 ,"$3,599.20 ","$3,779.16 ","$3,779.16 ","$3,779.16 ","$4,499.00 ","$4,049.10 ","$2,586.93 ","$4,499.00 ",$989.78 ,"$4,499.00 ","$2,447.46 ",$989.78 ,"$1,871.58 ", N/A , N/A ,"$1,039.27 ","$3,824.15 ","$2,933.35 ","$1,259.72 ","$4,049.10 ","$3,779.16 ","$3,599.20 ","$3,599.20 ",$989.78 ,"$2,924.35 "
ST. FRANCIS HOSPITAL - ACUTE,75001159,N/A,HC COLONOSCOPY W/BIOPSY SGL/MULT - 45380,750,1 ,"$5,074.00 ","$3,298.10 ","$1,116.28 ","$5,074.00 ","$2,917.55 ","$3,653.28 ","$2,760.26 ","$1,116.28 ","$1,420.72 ","$2,846.51 ","$1,116.28 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$2,120.93 ","$4,262.16 ", N/A ,"$1,116.28 ","$4,312.90 ","$4,262.16 ","$1,116.28 ","$3,805.50 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$4,059.20 ","$4,262.16 ","$4,262.16 ","$4,262.16 ","$5,074.00 ","$4,566.60 ","$2,917.55 ","$5,074.00 ","$1,116.28 ","$5,074.00 ","$2,760.26 ","$1,116.28 ","$2,110.78 ", N/A , N/A ,"$1,172.09 ","$4,312.90 ","$3,308.25 ","$1,420.72 ","$4,566.60 ","$4,262.16 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$3,298.10 "
ST. FRANCIS HOSPITAL - ACUTE,75001160,N/A,HC COLONOSCOPY W/SUBMUCOSAL INJ - 45381,750,1 ,"$5,398.00 ","$3,508.70 ","$1,187.56 ","$5,398.00 ","$3,103.85 ","$3,886.56 ","$2,936.51 ","$1,187.56 ","$1,511.44 ","$3,028.28 ","$1,187.56 ","$3,519.50 ","$1,349.50 ","$3,519.50 ","$3,519.50 ","$1,349.50 ","$3,519.50 ","$2,256.36 ","$4,534.32 ", N/A ,"$1,187.56 ","$4,588.30 ","$4,534.32 ","$1,187.56 ","$4,048.50 ","$4,318.40 ","$4,318.40 ","$1,187.56 ","$4,318.40 ","$4,534.32 ","$4,534.32 ","$4,534.32 ","$5,398.00 ","$4,858.20 ","$3,103.85 ","$5,398.00 ","$1,187.56 ","$5,398.00 ","$2,936.51 ","$1,187.56 ","$2,245.57 ", N/A , N/A ,"$1,246.94 ","$4,588.30 ","$3,519.50 ","$1,511.44 ","$4,858.20 ","$4,534.32 ","$4,318.40 ","$4,318.40 ","$1,187.56 ","$3,508.70 "
ST. FRANCIS HOSPITAL - ACUTE,75001161,N/A,HC COLONOSCOPY W/CONTROL BLEEDING - 45382,750,1 ,"$5,074.00 ","$3,298.10 ","$1,116.28 ","$5,074.00 ","$2,917.55 ","$3,653.28 ","$2,760.26 ","$1,116.28 ","$1,420.72 ","$2,846.51 ","$1,116.28 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$2,120.93 ","$4,262.16 ", N/A ,"$1,116.28 ","$4,312.90 ","$4,262.16 ","$1,116.28 ","$3,805.50 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$4,059.20 ","$4,262.16 ","$4,262.16 ","$4,262.16 ","$5,074.00 ","$4,566.60 ","$2,917.55 ","$5,074.00 ","$1,116.28 ","$5,074.00 ","$2,760.26 ","$1,116.28 ","$2,110.78 ", N/A , N/A ,"$1,172.09 ","$4,312.90 ","$3,308.25 ","$1,420.72 ","$4,566.60 ","$4,262.16 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$3,298.10 "
ST. FRANCIS HOSPITAL - ACUTE,75001162,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 45384,750,1 ,"$5,074.00 ","$3,298.10 ","$1,116.28 ","$5,074.00 ","$2,917.55 ","$3,653.28 ","$2,760.26 ","$1,116.28 ","$1,420.72 ","$2,846.51 ","$1,116.28 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$2,120.93 ","$4,262.16 ", N/A ,"$1,116.28 ","$4,312.90 ","$4,262.16 ","$1,116.28 ","$3,805.50 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$4,059.20 ","$4,262.16 ","$4,262.16 ","$4,262.16 ","$5,074.00 ","$4,566.60 ","$2,917.55 ","$5,074.00 ","$1,116.28 ","$5,074.00 ","$2,760.26 ","$1,116.28 ","$2,110.78 ", N/A , N/A ,"$1,172.09 ","$4,312.90 ","$3,308.25 ","$1,420.72 ","$4,566.60 ","$4,262.16 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$3,298.10 "
ST. FRANCIS HOSPITAL - ACUTE,75001163,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45385,750,1 ,"$5,398.00 ","$3,508.70 ","$1,187.56 ","$5,398.00 ","$3,103.85 ","$3,886.56 ","$2,936.51 ","$1,187.56 ","$1,511.44 ","$3,028.28 ","$1,187.56 ","$3,519.50 ","$1,349.50 ","$3,519.50 ","$3,519.50 ","$1,349.50 ","$3,519.50 ","$2,256.36 ","$4,534.32 ", N/A ,"$1,187.56 ","$4,588.30 ","$4,534.32 ","$1,187.56 ","$4,048.50 ","$4,318.40 ","$4,318.40 ","$1,187.56 ","$4,318.40 ","$4,534.32 ","$4,534.32 ","$4,534.32 ","$5,398.00 ","$4,858.20 ","$3,103.85 ","$5,398.00 ","$1,187.56 ","$5,398.00 ","$2,936.51 ","$1,187.56 ","$2,245.57 ", N/A , N/A ,"$1,246.94 ","$4,588.30 ","$3,519.50 ","$1,511.44 ","$4,858.20 ","$4,534.32 ","$4,318.40 ","$4,318.40 ","$1,187.56 ","$3,508.70 "
ST. FRANCIS HOSPITAL - ACUTE,75001165,N/A,HC COLONOSCOPY W/ABLATION TUMOR - 45388,750,1 ,"$5,074.00 ","$3,298.10 ","$1,116.28 ","$5,074.00 ","$2,917.55 ","$3,653.28 ","$2,760.26 ","$1,116.28 ","$1,420.72 ","$2,846.51 ","$1,116.28 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$3,308.25 ","$1,268.50 ","$3,308.25 ","$2,120.93 ","$4,262.16 ", N/A ,"$1,116.28 ","$4,312.90 ","$4,262.16 ","$1,116.28 ","$3,805.50 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$4,059.20 ","$4,262.16 ","$4,262.16 ","$4,262.16 ","$5,074.00 ","$4,566.60 ","$2,917.55 ","$5,074.00 ","$1,116.28 ","$5,074.00 ","$2,760.26 ","$1,116.28 ","$2,110.78 ", N/A , N/A ,"$1,172.09 ","$4,312.90 ","$3,308.25 ","$1,420.72 ","$4,566.60 ","$4,262.16 ","$4,059.20 ","$4,059.20 ","$1,116.28 ","$3,298.10 "
ST. FRANCIS HOSPITAL - ACUTE,75001167,N/A,HC COLONOSCOPY W/MUCOSAL RESECTION - 45390,750,1 ,"$4,467.00 ","$2,903.55 ",$982.74 ,"$4,467.00 ","$2,568.53 ","$3,216.24 ","$2,430.05 ",$982.74 ,"$1,250.76 ","$2,505.99 ",$982.74 ,"$2,912.48 ","$1,116.75 ","$2,912.48 ","$2,912.48 ","$1,116.75 ","$2,912.48 ","$1,867.21 ","$3,752.28 ", N/A ,$982.74 ,"$3,796.95 ","$3,752.28 ",$982.74 ,"$3,350.25 ","$3,573.60 ","$3,573.60 ",$982.74 ,"$3,573.60 ","$3,752.28 ","$3,752.28 ","$3,752.28 ","$4,467.00 ","$4,020.30 ","$2,568.53 ","$4,467.00 ",$982.74 ,"$4,467.00 ","$2,430.05 ",$982.74 ,"$1,858.27 ", N/A , N/A ,"$1,031.88 ","$3,796.95 ","$2,912.48 ","$1,250.76 ","$4,020.30 ","$3,752.28 ","$3,573.60 ","$3,573.60 ",$982.74 ,"$2,903.55 "
ST. FRANCIS HOSPITAL - ACUTE,75001171,N/A,HC COLONOSCOPY W/BAND LIGATION - 45398,750,1 ,"$4,499.00 ","$2,924.35 ",$989.78 ,"$4,499.00 ","$2,586.93 ","$3,239.28 ","$2,447.46 ",$989.78 ,"$1,259.72 ","$2,523.94 ",$989.78 ,"$2,933.35 ","$1,124.75 ","$2,933.35 ","$2,933.35 ","$1,124.75 ","$2,933.35 ","$1,880.58 ","$3,779.16 ", N/A ,$989.78 ,"$3,824.15 ","$3,779.16 ",$989.78 ,"$3,374.25 ","$3,599.20 ","$3,599.20 ",$989.78 ,"$3,599.20 ","$3,779.16 ","$3,779.16 ","$3,779.16 ","$4,499.00 ","$4,049.10 ","$2,586.93 ","$4,499.00 ",$989.78 ,"$4,499.00 ","$2,447.46 ",$989.78 ,"$1,871.58 ", N/A , N/A ,"$1,039.27 ","$3,824.15 ","$2,933.35 ","$1,259.72 ","$4,049.10 ","$3,779.16 ","$3,599.20 ","$3,599.20 ",$989.78 ,"$2,924.35 "
ST. FRANCIS HOSPITAL - ACUTE,75001173,N/A,HC HERMORRHOIDECTOMY INTERNAL W/LIGATION - 46221,750,1 ,"$2,200.00 ","$1,430.00 ",$484.00 ,"$2,200.00 ","$1,265.00 ","$1,584.00 ","$1,196.80 ",$484.00 ,$616.00 ,"$1,234.20 ",$484.00 ,"$1,434.40 ",$550.00 ,"$1,434.40 ","$1,434.40 ",$550.00 ,"$1,434.40 ",$919.60 ,"$1,848.00 ", N/A ,$484.00 ,"$1,870.00 ","$1,848.00 ",$484.00 ,"$1,650.00 ","$1,760.00 ","$1,760.00 ",$484.00 ,"$1,760.00 ","$1,848.00 ","$1,848.00 ","$1,848.00 ","$2,200.00 ","$1,980.00 ","$1,265.00 ","$2,200.00 ",$484.00 ,"$2,200.00 ","$1,196.80 ",$484.00 ,$915.20 , N/A , N/A ,$508.20 ,"$1,870.00 ","$1,434.40 ",$616.00 ,"$1,980.00 ","$1,848.00 ","$1,760.00 ","$1,760.00 ",$484.00 ,"$1,430.00 "
ST. FRANCIS HOSPITAL - ACUTE,75001181,N/A,HC CYSTOURETHROSCOPY - 52000,750,1 ,"$2,919.00 ","$1,897.35 ",$642.18 ,"$2,919.00 ","$1,678.43 ","$2,101.68 ","$1,587.94 ",$642.18 ,$817.32 ,"$1,637.56 ",$642.18 ,"$1,903.19 ",$729.75 ,"$1,903.19 ","$1,903.19 ",$729.75 ,"$1,903.19 ","$1,220.14 ","$2,451.96 ", N/A ,$642.18 ,"$2,481.15 ","$2,451.96 ",$642.18 ,"$2,189.25 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$2,335.20 ","$2,451.96 ","$2,451.96 ","$2,451.96 ","$2,919.00 ","$2,627.10 ","$1,678.43 ","$2,919.00 ",$642.18 ,"$2,919.00 ","$1,587.94 ",$642.18 ,"$1,214.30 ", N/A , N/A ,$674.29 ,"$2,481.15 ","$1,903.19 ",$817.32 ,"$2,627.10 ","$2,451.96 ","$2,335.20 ","$2,335.20 ",$642.18 ,"$1,897.35 "
ST. FRANCIS HOSPITAL - ACUTE,75001183,N/A,HC CYSTOURETHROSCOPY W/INS URETERAL STENT - 52332,750,1 ,"$3,985.00 ","$2,590.25 ",$876.70 ,"$3,985.00 ","$2,291.38 ","$2,869.20 ","$2,167.84 ",$876.70 ,"$1,115.80 ","$2,235.59 ",$876.70 ,"$2,598.22 ",$996.25 ,"$2,598.22 ","$2,598.22 ",$996.25 ,"$2,598.22 ","$1,665.73 ","$3,347.40 ", N/A ,$876.70 ,"$3,387.25 ","$3,347.40 ",$876.70 ,"$2,988.75 ","$3,188.00 ","$3,188.00 ",$876.70 ,"$3,188.00 ","$3,347.40 ","$3,347.40 ","$3,347.40 ","$3,985.00 ","$3,586.50 ","$2,291.38 ","$3,985.00 ",$876.70 ,"$3,985.00 ","$2,167.84 ",$876.70 ,"$1,657.76 ", N/A , N/A ,$920.54 ,"$3,387.25 ","$2,598.22 ","$1,115.80 ","$3,586.50 ","$3,347.40 ","$3,188.00 ","$3,188.00 ",$876.70 ,"$2,590.25 "
ST. FRANCIS HOSPITAL - ACUTE,75001184,N/A,HC CYSTOURETHROSCOPY W/STONE REMOVAL - 52352,750,1 ,"$4,117.00 ","$2,676.05 ",$905.74 ,"$4,117.00 ","$2,367.28 ","$2,964.24 ","$2,239.65 ",$905.74 ,"$1,152.76 ","$2,309.64 ",$905.74 ,"$2,684.28 ","$1,029.25 ","$2,684.28 ","$2,684.28 ","$1,029.25 ","$2,684.28 ","$1,720.91 ","$3,458.28 ", N/A ,$905.74 ,"$3,499.45 ","$3,458.28 ",$905.74 ,"$3,087.75 ","$3,293.60 ","$3,293.60 ",$905.74 ,"$3,293.60 ","$3,458.28 ","$3,458.28 ","$3,458.28 ","$4,117.00 ","$3,705.30 ","$2,367.28 ","$4,117.00 ",$905.74 ,"$4,117.00 ","$2,239.65 ",$905.74 ,"$1,712.67 ", N/A , N/A ,$951.03 ,"$3,499.45 ","$2,684.28 ","$1,152.76 ","$3,705.30 ","$3,458.28 ","$3,293.60 ","$3,293.60 ",$905.74 ,"$2,676.05 "
ST. FRANCIS HOSPITAL - ACUTE,75001185,N/A,HC CYSTOURETHROSCOPY W/LITHOTRIPSY - 52353,750,1 ,"$4,117.00 ","$2,676.05 ",$905.74 ,"$4,117.00 ","$2,367.28 ","$2,964.24 ","$2,239.65 ",$905.74 ,"$1,152.76 ","$2,309.64 ",$905.74 ,"$2,684.28 ","$1,029.25 ","$2,684.28 ","$2,684.28 ","$1,029.25 ","$2,684.28 ","$1,720.91 ","$3,458.28 ", N/A ,$905.74 ,"$3,499.45 ","$3,458.28 ",$905.74 ,"$3,087.75 ","$3,293.60 ","$3,293.60 ",$905.74 ,"$3,293.60 ","$3,458.28 ","$3,458.28 ","$3,458.28 ","$4,117.00 ","$3,705.30 ","$2,367.28 ","$4,117.00 ",$905.74 ,"$4,117.00 ","$2,239.65 ",$905.74 ,"$1,712.67 ", N/A , N/A ,$951.03 ,"$3,499.45 ","$2,684.28 ","$1,152.76 ","$3,705.30 ","$3,458.28 ","$3,293.60 ","$3,293.60 ",$905.74 ,"$2,676.05 "
ST. FRANCIS HOSPITAL - ACUTE,75001193,91035,HC ACID REFLUX TEST MUCOSAL ELECTRODE- 91035,750,1 ,"$3,534.00 ","$2,297.10 ",$606.39 ,"$3,534.00 ","$2,032.05 ","$2,544.48 ","$1,922.50 ",$777.48 ,$989.52 ,"$2,077.99 ",$777.48 ,"$2,427.86 ",$883.50 ,"$2,427.86 ","$2,427.86 ",$883.50 ,"$2,427.86 ","$1,477.21 ","$2,968.56 ","$1,246.33 ",$777.48 ,"$3,003.90 ","$2,968.56 ",$777.48 ,"$2,650.50 ","$2,827.20 ","$2,827.20 ",$777.48 ,"$2,827.20 ","$2,968.56 ","$2,968.56 ","$2,968.56 ","$3,534.00 ","$3,180.60 ","$2,032.05 ","$3,534.00 ",$777.48 ,"$3,534.00 ","$1,922.50 ",$777.48 ,"$1,470.14 ",$635.26 ,$606.39 ,$816.35 ,"$3,003.90 ","$2,427.86 ",$989.52 ,"$3,180.60 ","$2,968.56 ","$2,827.20 ","$2,827.20 ",$777.48 ,"$2,297.10 "
ST. FRANCIS HOSPITAL - ACUTE,75001200,G0104,HC COLONOSCOPY SCREEN W/FLEX SIGMOID - G0104,750,1 ,"$3,896.00 ","$2,532.40 ",$660.57 ,"$3,896.00 ","$2,240.20 ","$2,805.12 ","$2,119.42 ",$857.12 ,"$1,090.88 ","$1,180.14 ",$857.12 ,"$1,180.14 ",$974.00 ,"$1,180.14 ","$1,180.14 ",$974.00 ,"$1,180.14 ","$1,628.53 ","$3,272.64 ","$2,026.20 ",$857.12 ,"$3,311.60 ","$3,272.64 ",$857.12 ,"$2,922.00 ","$3,116.80 ","$3,116.80 ",$857.12 ,"$3,116.80 ","$3,272.64 ","$3,272.64 ","$3,272.64 ","$3,896.00 ","$3,506.40 ","$2,240.20 ","$3,896.00 ",$857.12 ,"$3,896.00 ","$2,119.42 ",$857.12 ,"$1,620.74 ",$692.02 ,$660.57 ,$899.98 ,"$3,311.60 ","$1,180.14 ","$1,090.88 ","$3,506.40 ","$3,272.64 ","$3,116.80 ","$3,116.80 ",$857.12 ,"$2,532.40 "
ST. FRANCIS HOSPITAL - ACUTE,75001223,N/A,HC SMALL BOWEL ENDOSCOPY- 44378,750,1 ,"$4,876.00 ","$3,169.40 ","$1,072.72 ","$4,876.00 ","$2,803.70 ","$3,510.72 ","$2,652.54 ","$1,072.72 ","$1,365.28 ","$2,735.44 ","$1,072.72 ","$3,179.15 ","$1,219.00 ","$3,179.15 ","$3,179.15 ","$1,219.00 ","$3,179.15 ","$2,038.17 ","$4,095.84 ", N/A ,"$1,072.72 ","$4,144.60 ","$4,095.84 ","$1,072.72 ","$3,657.00 ","$3,900.80 ","$3,900.80 ","$1,072.72 ","$3,900.80 ","$4,095.84 ","$4,095.84 ","$4,095.84 ","$4,876.00 ","$4,388.40 ","$2,803.70 ","$4,876.00 ","$1,072.72 ","$4,876.00 ","$2,652.54 ","$1,072.72 ","$2,028.42 ", N/A , N/A ,"$1,126.36 ","$4,144.60 ","$3,179.15 ","$1,365.28 ","$4,388.40 ","$4,095.84 ","$3,900.80 ","$3,900.80 ","$1,072.72 ","$3,169.40 "
ST. FRANCIS HOSPITAL - ACUTE,76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,$740.00 ,$481.00 ,$162.80 ,"$1,621.30 ",$425.50 ,$532.80 ,$402.56 ,$162.80 ,$207.20 ,$415.14 ,$162.80 ,$482.48 ,$185.00 ,$482.48 ,$482.48 ,$185.00 ,$482.48 ,$309.32 ,$621.60 ,"$1,621.30 ",$162.80 ,$629.00 ,$621.60 ,$162.80 ,$555.00 ,$592.00 ,$592.00 ,$162.80 ,$592.00 ,$621.60 ,$621.60 ,$621.60 ,$740.00 ,$666.00 ,$425.50 ,$740.00 ,$162.80 ,$740.00 ,$402.56 ,$162.80 ,$307.84 ,$841.45 ,$803.20 ,$170.94 ,$629.00 ,$482.48 ,$207.20 ,$666.00 ,$621.60 ,$592.00 ,$592.00 ,$162.80 ,$481.00 
ST. FRANCIS HOSPITAL - ACUTE,76100055,99211,HC EXAM PELVIC STERILE,761,1 ,$449.00 ,$291.85 ,$98.78 ,$449.00 ,$258.18 ,$323.28 ,$244.26 ,$98.78 ,$125.72 ,$131.72 ,$98.78 ,$131.72 ,$112.25 ,$131.72 ,$131.72 ,$112.25 ,$131.72 ,$187.68 ,$377.16 , N/A ,$98.78 ,$381.65 ,$377.16 ,$98.78 ,$336.75 ,$359.20 ,$359.20 ,$98.78 ,$359.20 ,$377.16 ,$377.16 ,$377.16 ,$449.00 ,$404.10 ,$258.18 ,$449.00 ,$98.78 ,$449.00 ,$244.26 ,$98.78 ,$186.78 ,$148.31 ,$141.57 ,$103.72 ,$381.65 ,$131.72 ,$125.72 ,$404.10 ,$377.16 ,$359.20 ,$359.20 ,$98.78 ,$291.85 
ST. FRANCIS HOSPITAL - ACUTE,76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$86.00 ,$55.90 ,$18.92 ,$86.00 ,$49.45 ,$61.92 ,$46.78 ,$18.92 ,$24.08 ,$48.25 ,$18.92 ,$56.07 ,$21.50 ,$56.07 ,$56.07 ,$21.50 ,$56.07 ,$35.95 ,$72.24 , N/A ,$18.92 ,$73.10 ,$72.24 ,$18.92 ,$64.50 ,$68.80 ,$68.80 ,$18.92 ,$68.80 ,$72.24 ,$72.24 ,$72.24 ,$86.00 ,$77.40 ,$49.45 ,$86.00 ,$18.92 ,$86.00 ,$46.78 ,$18.92 ,$35.78 , N/A , N/A ,$19.87 ,$73.10 ,$56.07 ,$24.08 ,$77.40 ,$72.24 ,$68.80 ,$68.80 ,$18.92 ,$55.90 
ST. FRANCIS HOSPITAL - ACUTE,76200009,G0378,HC OBSERVATION HOURLY,762,1 ,$86.00 ,$55.90 ,$18.92 ,$86.00 ,$49.45 ,$61.92 ,$46.78 ,$18.92 ,$24.08 ,$48.25 ,$18.92 ,$56.07 ,$21.50 ,$56.07 ,$56.07 ,$21.50 ,$56.07 ,$35.95 ,$72.24 , N/A ,$18.92 ,$73.10 ,$72.24 ,$18.92 ,$64.50 ,$68.80 ,$68.80 ,$18.92 ,$68.80 ,$72.24 ,$72.24 ,$72.24 ,$86.00 ,$77.40 ,$49.45 ,$86.00 ,$18.92 ,$86.00 ,$46.78 ,$18.92 ,$35.78 , N/A , N/A ,$19.87 ,$73.10 ,$56.07 ,$24.08 ,$77.40 ,$72.24 ,$68.80 ,$68.80 ,$18.92 ,$55.90 
ST. FRANCIS HOSPITAL - ACUTE,76200020,G0378,HC OBSERVATION W/INTENSIVE CARE PER HR,762,1 ,$148.00 ,$96.20 ,$32.56 ,$148.00 ,$85.10 ,$106.56 ,$80.51 ,$32.56 ,$41.44 ,$83.03 ,$32.56 ,$96.50 ,$37.00 ,$96.50 ,$96.50 ,$37.00 ,$96.50 ,$61.86 ,$124.32 , N/A ,$32.56 ,$125.80 ,$124.32 ,$32.56 ,$111.00 ,$118.40 ,$118.40 ,$32.56 ,$118.40 ,$124.32 ,$124.32 ,$124.32 ,$148.00 ,$133.20 ,$85.10 ,$148.00 ,$32.56 ,$148.00 ,$80.51 ,$32.56 ,$61.57 , N/A , N/A ,$34.19 ,$125.80 ,$96.50 ,$41.44 ,$133.20 ,$124.32 ,$118.40 ,$118.40 ,$32.56 ,$96.20 
ST. FRANCIS HOSPITAL - ACUTE,77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$85.00 ,$55.25 ,$18.70 ,$158.30 ,$48.88 ,$61.20 ,$46.24 ,$18.70 ,$23.80 ,$49.98 ,$18.70 ,$58.40 ,$21.25 ,$58.40 ,$58.40 ,$21.25 ,$58.40 ,$35.53 ,$71.40 ,$158.30 ,$18.70 ,$72.25 ,$71.40 ,$18.70 ,$63.75 ,$68.00 ,$68.00 ,$18.70 ,$68.00 ,$71.40 ,$71.40 ,$71.40 ,$85.00 ,$76.50 ,$48.88 ,$85.00 ,$18.70 ,$85.00 ,$46.24 ,$18.70 ,$35.36 , N/A , N/A ,$19.64 ,$72.25 ,$58.40 ,$23.80 ,$76.50 ,$71.40 ,$68.00 ,$68.00 ,$18.70 ,$55.25 
ST. FRANCIS HOSPITAL - ACUTE,77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$48.00 ,$31.20 ,$10.56 ,$48.00 ,$27.60 ,$34.56 ,$26.11 ,$10.56 ,$13.44 ,$28.22 ,$10.56 ,$32.98 ,$12.00 ,$32.98 ,$32.98 ,$12.00 ,$32.98 ,$20.06 ,$40.32 , N/A ,$10.56 ,$40.80 ,$40.32 ,$10.56 ,$36.00 ,$38.40 ,$38.40 ,$10.56 ,$38.40 ,$40.32 ,$40.32 ,$40.32 ,$48.00 ,$43.20 ,$27.60 ,$48.00 ,$10.56 ,$48.00 ,$26.11 ,$10.56 ,$19.97 , N/A , N/A ,$11.09 ,$40.80 ,$32.98 ,$13.44 ,$43.20 ,$40.32 ,$38.40 ,$38.40 ,$10.56 ,$31.20 
ST. FRANCIS HOSPITAL - ACUTE,77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$56.00 ,$36.40 ,$15.68 ,$102.18 , N/A ,$40.32 ,$30.46 , N/A ,$15.68 ,$32.93 , N/A ,$38.47 , N/A ,$38.47 ,$38.47 , N/A ,$38.47 , N/A ,$47.04 ,$102.18 , N/A ,$47.60 ,$47.04 , N/A ,$42.00 ,$44.80 ,$44.80 , N/A ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 , N/A ,$56.00 , N/A ,$56.00 ,$30.46 , N/A ,$23.30 , N/A , N/A , N/A ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 , N/A ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$56.00 ,$36.40 ,$15.68 ,$102.18 , N/A ,$40.32 ,$30.46 , N/A ,$15.68 ,$32.93 , N/A ,$38.47 , N/A ,$38.47 ,$38.47 , N/A ,$38.47 , N/A ,$47.04 ,$102.18 , N/A ,$47.60 ,$47.04 , N/A ,$42.00 ,$44.80 ,$44.80 , N/A ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 , N/A ,$56.00 , N/A ,$56.00 ,$30.46 , N/A ,$23.30 , N/A , N/A , N/A ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 , N/A ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$56.00 ,$36.40 ,$12.32 ,$102.18 ,$32.20 ,$40.32 ,$30.46 ,$12.32 ,$15.68 ,$32.93 ,$12.32 ,$38.47 ,$14.00 ,$38.47 ,$38.47 ,$14.00 ,$38.47 ,$23.41 ,$47.04 ,$102.18 ,$12.32 ,$47.60 ,$47.04 ,$12.32 ,$42.00 ,$44.80 ,$44.80 ,$12.32 ,$44.80 ,$47.04 ,$47.04 ,$47.04 ,$56.00 ,$50.40 ,$32.20 ,$56.00 ,$12.32 ,$56.00 ,$30.46 ,$12.32 ,$23.30 , N/A , N/A ,$12.94 ,$47.60 ,$38.47 ,$15.68 ,$50.40 ,$47.04 ,$44.80 ,$44.80 ,$12.32 ,$36.40 
ST. FRANCIS HOSPITAL - ACUTE,77100009,0001A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$40.00 ,$100.00 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100010,0002A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$40.00 ,$100.00 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100011,0011A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$40.00 ,$100.00 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100012,0012A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5M SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$40.00 ,$100.00 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100013,0021A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$40.00 , N/A ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100014,0022A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$40.00 , N/A ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100015,0031A,HC ADMINISTRATION SARS-COV-2 VACCINE AD26 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$40.00 ,$100.00 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100016,0041A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$100.80 , N/A ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100017,0042A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$100.80 , N/A ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100019,0013A,HC ADM SARSCOV2 100MCG/0.5ML 3RD - MODERNA,771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$100.80 ,$100.00 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,77100025,0064A,"HC ADMIN SARS-COV-2 VACCINE 50MCG/0.25ML, BOOSTER DOSE",771,1 ,$120.00 ,$78.00 ,$26.40 ,$120.00 ,$69.00 ,$86.40 ,$65.28 ,$26.40 ,$33.60 ,$67.32 ,$26.40 ,$78.24 ,$30.00 ,$78.24 ,$78.24 ,$30.00 ,$78.24 ,$50.16 ,$100.80 ,$100.00 ,$26.40 ,$102.00 ,$100.80 ,$26.40 ,$90.00 ,$96.00 ,$96.00 ,$26.40 ,$96.00 ,$100.80 ,$100.80 ,$100.80 ,$120.00 ,$108.00 ,$69.00 ,$120.00 ,$26.40 ,$120.00 ,$65.28 ,$26.40 ,$49.92 , N/A , N/A ,$27.72 ,$102.00 ,$78.24 ,$33.60 ,$108.00 ,$100.80 ,$96.00 ,$96.00 ,$26.40 ,$78.00 
ST. FRANCIS HOSPITAL - ACUTE,78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$108.00 ,$70.20 ,$14.71 ,$108.00 ,$62.10 ,$77.76 ,$58.75 ,$23.76 ,$30.24 ,$60.59 ,$23.76 ,$70.42 ,$27.00 ,$70.42 ,$70.42 ,$27.00 ,$70.42 ,$45.14 ,$90.72 ,$68.98 ,$23.76 ,$91.80 ,$90.72 ,$23.76 ,$81.00 ,$86.40 ,$86.40 ,$23.76 ,$86.40 ,$90.72 ,$90.72 ,$90.72 ,$108.00 ,$97.20 ,$62.10 ,$108.00 ,$23.76 ,$108.00 ,$58.75 ,$23.76 ,$44.93 ,$15.41 ,$14.71 ,$24.95 ,$91.80 ,$70.42 ,$30.24 ,$97.20 ,$90.72 ,$86.40 ,$86.40 ,$23.76 ,$70.20 
ST. FRANCIS HOSPITAL - ACUTE,92000002,59025,HC TEST NON STRESS FETAL,920,1 ,"$1,297.00 ",$843.05 ,$285.34 ,"$1,297.00 ",$745.78 ,$933.84 ,$705.57 ,$285.34 ,$363.16 ,$727.62 ,$285.34 ,$845.64 ,$324.25 ,$845.64 ,$845.64 ,$324.25 ,$845.64 ,$542.15 ,"$1,089.48 ",$434.98 ,$285.34 ,"$1,102.45 ","$1,089.48 ",$285.34 ,$972.75 ,"$1,037.60 ","$1,037.60 ",$285.34 ,"$1,037.60 ","$1,089.48 ","$1,089.48 ","$1,089.48 ","$1,297.00 ","$1,167.30 ",$745.78 ,"$1,297.00 ",$285.34 ,"$1,297.00 ",$705.57 ,$285.34 ,$539.55 , N/A , N/A ,$299.61 ,"$1,102.45 ",$845.64 ,$363.16 ,"$1,167.30 ","$1,089.48 ","$1,037.60 ","$1,037.60 ",$285.34 ,$843.05 
ST. FRANCIS HOSPITAL - ACUTE,92000031,59025,HC TEST NON STRESS FETAL EXTENDED,920,1 ,$467.00 ,$303.55 ,$102.74 ,$467.00 ,$268.53 ,$336.24 ,$254.05 ,$102.74 ,$130.76 ,$261.99 ,$102.74 ,$304.48 ,$116.75 ,$304.48 ,$304.48 ,$116.75 ,$304.48 ,$195.21 ,$392.28 ,$434.98 ,$102.74 ,$396.95 ,$392.28 ,$102.74 ,$350.25 ,$373.60 ,$373.60 ,$102.74 ,$373.60 ,$392.28 ,$392.28 ,$392.28 ,$467.00 ,$420.30 ,$268.53 ,$467.00 ,$102.74 ,$467.00 ,$254.05 ,$102.74 ,$194.27 , N/A , N/A ,$107.88 ,$396.95 ,$304.48 ,$130.76 ,$420.30 ,$392.28 ,$373.60 ,$373.60 ,$102.74 ,$303.55 
ST. FRANCIS HOSPITAL - ACUTE,92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$1,542.00 ","$1,002.30 ",$153.17 ,"$1,542.00 ",$886.65 ,"$1,110.24 ",$838.85 ,$339.24 ,$431.76 ,$906.70 ,$339.24 ,"$1,059.35 ",$385.50 ,"$1,059.35 ","$1,059.35 ",$385.50 ,"$1,059.35 ",$644.56 ,"$1,295.28 ",$587.50 ,$339.24 ,"$1,310.70 ","$1,295.28 ",$339.24 ,"$1,156.50 ","$1,233.60 ","$1,233.60 ",$339.24 ,"$1,233.60 ","$1,295.28 ","$1,295.28 ","$1,295.28 ","$1,542.00 ","$1,387.80 ",$886.65 ,"$1,542.00 ",$339.24 ,"$1,542.00 ",$838.85 ,$339.24 ,$641.47 ,$160.47 ,$153.17 ,$356.20 ,"$1,310.70 ","$1,059.35 ",$431.76 ,"$1,387.80 ","$1,295.28 ","$1,233.60 ","$1,233.60 ",$339.24 ,"$1,002.30 "
ST. FRANCIS HOSPITAL - ACUTE,92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,$771.00 ,$501.15 ,$153.17 ,$771.00 ,$443.33 ,$555.12 ,$419.42 ,$169.62 ,$215.88 ,$453.35 ,$169.62 ,$529.68 ,$192.75 ,$529.68 ,$529.68 ,$192.75 ,$529.68 ,$322.28 ,$647.64 ,$277.98 ,$169.62 ,$655.35 ,$647.64 ,$169.62 ,$578.25 ,$616.80 ,$616.80 ,$169.62 ,$616.80 ,$647.64 ,$647.64 ,$647.64 ,$771.00 ,$693.90 ,$443.33 ,$771.00 ,$169.62 ,$771.00 ,$419.42 ,$169.62 ,$320.74 ,$160.47 ,$153.17 ,$178.10 ,$655.35 ,$529.68 ,$215.88 ,$693.90 ,$647.64 ,$616.80 ,$616.80 ,$169.62 ,$501.15 
ST. FRANCIS HOSPITAL - ACUTE,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$695.00 ,$451.75 ,$142.82 ,$695.00 ,$399.63 ,$500.40 ,$378.08 ,$152.90 ,$194.60 ,$408.66 ,$152.90 ,$477.47 ,$173.75 ,$477.47 ,$477.47 ,$173.75 ,$477.47 ,$290.51 ,$583.80 ,$287.90 ,$152.90 ,$590.75 ,$583.80 ,$152.90 ,$521.25 ,$556.00 ,$556.00 ,$152.90 ,$556.00 ,$583.80 ,$583.80 ,$583.80 ,$695.00 ,$625.50 ,$399.63 ,$695.00 ,$152.90 ,$695.00 ,$378.08 ,$152.90 ,$289.12 ,$149.62 ,$142.82 ,$160.55 ,$590.75 ,$477.47 ,$194.60 ,$625.50 ,$583.80 ,$556.00 ,$556.00 ,$152.90 ,$451.75 
ST. FRANCIS HOSPITAL - ACUTE,92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,594.00 ","$1,036.10 ",$142.82 ,"$1,594.00 ",$916.55 ,"$1,147.68 ",$867.14 ,$350.68 ,$446.32 ,$937.27 ,$350.68 ,"$1,095.08 ",$398.50 ,"$1,095.08 ","$1,095.08 ",$398.50 ,"$1,095.08 ",$666.29 ,"$1,338.96 ",$356.48 ,$350.68 ,"$1,354.90 ","$1,338.96 ",$350.68 ,"$1,195.50 ","$1,275.20 ","$1,275.20 ",$350.68 ,"$1,275.20 ","$1,338.96 ","$1,338.96 ","$1,338.96 ","$1,594.00 ","$1,434.60 ",$916.55 ,"$1,594.00 ",$350.68 ,"$1,594.00 ",$867.14 ,$350.68 ,$663.10 ,$149.62 ,$142.82 ,$368.21 ,"$1,354.90 ","$1,095.08 ",$446.32 ,"$1,434.60 ","$1,338.96 ","$1,275.20 ","$1,275.20 ",$350.68 ,"$1,036.10 "
ST. FRANCIS HOSPITAL - ACUTE,92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$2,081.00 ","$1,352.65 ",$142.82 ,"$2,081.00 ","$1,196.58 ","$1,498.32 ","$1,132.06 ",$457.82 ,$582.68 ,"$1,223.63 ",$457.82 ,"$1,429.65 ",$520.25 ,"$1,429.65 ","$1,429.65 ",$520.25 ,"$1,429.65 ",$869.86 ,"$1,748.04 ",$675.73 ,$457.82 ,"$1,768.85 ","$1,748.04 ",$457.82 ,"$1,560.75 ","$1,664.80 ","$1,664.80 ",$457.82 ,"$1,664.80 ","$1,748.04 ","$1,748.04 ","$1,748.04 ","$2,081.00 ","$1,872.90 ","$1,196.58 ","$2,081.00 ",$457.82 ,"$2,081.00 ","$1,132.06 ",$457.82 ,$865.70 ,$149.62 ,$142.82 ,$480.71 ,"$1,768.85 ","$1,429.65 ",$582.68 ,"$1,872.90 ","$1,748.04 ","$1,664.80 ","$1,664.80 ",$457.82 ,"$1,352.65 "
ST. FRANCIS HOSPITAL - ACUTE,92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$1,476.00 ",$959.40 ,$201.61 ,"$1,476.00 ",$848.70 ,"$1,062.72 ",$802.94 ,$324.72 ,$413.28 ,$867.89 ,$324.72 ,"$1,014.01 ",$369.00 ,"$1,014.01 ","$1,014.01 ",$369.00 ,"$1,014.01 ",$616.97 ,"$1,239.84 ",$587.50 ,$324.72 ,"$1,254.60 ","$1,239.84 ",$324.72 ,"$1,107.00 ","$1,180.80 ","$1,180.80 ",$324.72 ,"$1,180.80 ","$1,239.84 ","$1,239.84 ","$1,239.84 ","$1,476.00 ","$1,328.40 ",$848.70 ,"$1,476.00 ",$324.72 ,"$1,476.00 ",$802.94 ,$324.72 ,$614.02 ,$211.21 ,$201.61 ,$340.96 ,"$1,254.60 ","$1,014.01 ",$413.28 ,"$1,328.40 ","$1,239.84 ","$1,180.80 ","$1,180.80 ",$324.72 ,$959.40 
ST. FRANCIS HOSPITAL - ACUTE,92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,$776.00 ,$504.40 ,$170.72 ,$776.00 ,$446.20 ,$558.72 ,$422.14 ,$170.72 ,$217.28 ,$456.29 ,$170.72 ,$533.11 ,$194.00 ,$533.11 ,$533.11 ,$194.00 ,$533.11 ,$324.37 ,$651.84 ,$277.98 ,$170.72 ,$659.60 ,$651.84 ,$170.72 ,$582.00 ,$620.80 ,$620.80 ,$170.72 ,$620.80 ,$651.84 ,$651.84 ,$651.84 ,$776.00 ,$698.40 ,$446.20 ,$776.00 ,$170.72 ,$776.00 ,$422.14 ,$170.72 ,$322.82 ,$211.21 ,$201.61 ,$179.26 ,$659.60 ,$533.11 ,$217.28 ,$698.40 ,$651.84 ,$620.80 ,$620.80 ,$170.72 ,$504.40 
ST. FRANCIS HOSPITAL - ACUTE,92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$1,301.00 ",$845.65 ,$153.17 ,"$1,301.00 ",$748.08 ,$936.72 ,$707.74 ,$286.22 ,$364.28 ,$764.99 ,$286.22 ,$893.79 ,$325.25 ,$893.79 ,$893.79 ,$325.25 ,$893.79 ,$543.82 ,"$1,092.84 ",$587.50 ,$286.22 ,"$1,105.85 ","$1,092.84 ",$286.22 ,$975.75 ,"$1,040.80 ","$1,040.80 ",$286.22 ,"$1,040.80 ","$1,092.84 ","$1,092.84 ","$1,092.84 ","$1,301.00 ","$1,170.90 ",$748.08 ,"$1,301.00 ",$286.22 ,"$1,301.00 ",$707.74 ,$286.22 ,$541.22 ,$160.47 ,$153.17 ,$300.53 ,"$1,105.85 ",$893.79 ,$364.28 ,"$1,170.90 ","$1,092.84 ","$1,040.80 ","$1,040.80 ",$286.22 ,$845.65 
ST. FRANCIS HOSPITAL - ACUTE,92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,$776.00 ,$504.40 ,$153.17 ,$776.00 ,$446.20 ,$558.72 ,$422.14 ,$170.72 ,$217.28 ,$456.29 ,$170.72 ,$533.11 ,$194.00 ,$533.11 ,$533.11 ,$194.00 ,$533.11 ,$324.37 ,$651.84 ,$277.98 ,$170.72 ,$659.60 ,$651.84 ,$170.72 ,$582.00 ,$620.80 ,$620.80 ,$170.72 ,$620.80 ,$651.84 ,$651.84 ,$651.84 ,$776.00 ,$698.40 ,$446.20 ,$776.00 ,$170.72 ,$776.00 ,$422.14 ,$170.72 ,$322.82 ,$160.47 ,$153.17 ,$179.26 ,$659.60 ,$533.11 ,$217.28 ,$698.40 ,$651.84 ,$620.80 ,$620.80 ,$170.72 ,$504.40 
ST. FRANCIS HOSPITAL - ACUTE,92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$1,856.00 ","$1,206.40 ",$201.61 ,"$1,856.00 ","$1,067.20 ","$1,336.32 ","$1,009.66 ",$408.32 ,$519.68 ,"$1,091.33 ",$408.32 ,"$1,275.07 ",$464.00 ,"$1,275.07 ","$1,275.07 ",$464.00 ,"$1,275.07 ",$775.81 ,"$1,559.04 ",$587.50 ,$408.32 ,"$1,577.60 ","$1,559.04 ",$408.32 ,"$1,392.00 ","$1,484.80 ","$1,484.80 ",$408.32 ,"$1,484.80 ","$1,559.04 ","$1,559.04 ","$1,559.04 ","$1,856.00 ","$1,670.40 ","$1,067.20 ","$1,856.00 ",$408.32 ,"$1,856.00 ","$1,009.66 ",$408.32 ,$772.10 ,$211.21 ,$201.61 ,$428.74 ,"$1,577.60 ","$1,275.07 ",$519.68 ,"$1,670.40 ","$1,559.04 ","$1,484.80 ","$1,484.80 ",$408.32 ,"$1,206.40 "
ST. FRANCIS HOSPITAL - ACUTE,92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,$890.00 ,$578.50 ,$195.80 ,$890.00 ,$511.75 ,$640.80 ,$484.16 ,$195.80 ,$249.20 ,$523.32 ,$195.80 ,$611.43 ,$222.50 ,$611.43 ,$611.43 ,$222.50 ,$611.43 ,$372.02 ,$747.60 ,$277.98 ,$195.80 ,$756.50 ,$747.60 ,$195.80 ,$667.50 ,$712.00 ,$712.00 ,$195.80 ,$712.00 ,$747.60 ,$747.60 ,$747.60 ,$890.00 ,$801.00 ,$511.75 ,$890.00 ,$195.80 ,$890.00 ,$484.16 ,$195.80 ,$370.24 ,$211.21 ,$201.61 ,$205.59 ,$756.50 ,$611.43 ,$249.20 ,$801.00 ,$747.60 ,$712.00 ,$712.00 ,$195.80 ,$578.50 
ST. FRANCIS HOSPITAL - ACUTE,92100049,93923,HC RESTING ARTERIAL EXTREMITY COMP -52,921,1 ,$585.00 ,$380.25 ,$71.41 ,$585.00 ,$336.38 ,$421.20 ,$318.24 ,$128.70 ,$163.80 ,$343.98 ,$128.70 ,$401.90 ,$146.25 ,$401.90 ,$401.90 ,$146.25 ,$401.90 ,$244.53 ,$491.40 ,$178.24 ,$128.70 ,$497.25 ,$491.40 ,$128.70 ,$438.75 ,$468.00 ,$468.00 ,$128.70 ,$468.00 ,$491.40 ,$491.40 ,$491.40 ,$585.00 ,$526.50 ,$336.38 ,$585.00 ,$128.70 ,$585.00 ,$318.24 ,$128.70 ,$243.36 ,$74.81 ,$71.41 ,$135.14 ,$497.25 ,$401.90 ,$163.80 ,$526.50 ,$491.40 ,$468.00 ,$468.00 ,$128.70 ,$380.25 
ST. FRANCIS HOSPITAL - ACUTE,92100051,93701,HC BIOIMPEDANCE DERIVED PHYSIO CV ANALYSIS,921,1 ,$272.00 ,$176.80 ,$2.37 ,$287.90 ,$156.40 ,$195.84 ,$147.97 ,$59.84 ,$76.16 ,$159.94 ,$59.84 ,$186.86 ,$68.00 ,$186.86 ,$186.86 ,$68.00 ,$186.86 ,$113.70 ,$228.48 ,$287.90 ,$59.84 ,$231.20 ,$228.48 ,$59.84 ,$204.00 ,$217.60 ,$217.60 ,$59.84 ,$217.60 ,$228.48 ,$228.48 ,$228.48 ,$272.00 ,$244.80 ,$156.40 ,$272.00 ,$59.84 ,$272.00 ,$147.97 ,$59.84 ,$113.15 ,$2.49 ,$2.37 ,$62.83 ,$231.20 ,$186.86 ,$76.16 ,$244.80 ,$228.48 ,$217.60 ,$217.60 ,$59.84 ,$176.80 
ST. FRANCIS HOSPITAL - ACUTE,94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$251.00 ,$163.15 ,$55.22 ,$287.90 ,$144.33 ,$180.72 ,$136.54 ,$55.22 ,$70.28 ,$147.59 ,$55.22 ,$172.44 ,$62.75 ,$172.44 ,$172.44 ,$62.75 ,$172.44 ,$104.92 ,$210.84 ,$287.90 ,$55.22 ,$213.35 ,$210.84 ,$55.22 ,$188.25 ,$200.80 ,$200.80 ,$55.22 ,$200.80 ,$210.84 ,$210.84 ,$210.84 ,$251.00 ,$225.90 ,$144.33 ,$251.00 ,$55.22 ,$251.00 ,$136.54 ,$55.22 ,$104.42 ,$93.46 ,$89.21 ,$57.98 ,$213.35 ,$172.44 ,$70.28 ,$225.90 ,$210.84 ,$200.80 ,$200.80 ,$55.22 ,$163.15 
ST. FRANCIS HOSPITAL - ACUTE,94000111,96373,HC INJ TX/PROPH/DIAG INTRA-ARTERIAL,940,1 ,$244.00 ,$158.60 ,$53.68 ,$522.33 ,$140.30 ,$175.68 ,$132.74 ,$53.68 ,$68.32 ,$136.88 ,$53.68 ,$159.09 ,$61.00 ,$159.09 ,$159.09 ,$61.00 ,$159.09 ,$101.99 ,$204.96 ,$522.33 ,$53.68 ,$207.40 ,$204.96 ,$53.68 ,$183.00 ,$195.20 ,$195.20 ,$53.68 ,$195.20 ,$204.96 ,$204.96 ,$204.96 ,$244.00 ,$219.60 ,$140.30 ,$244.00 ,$53.68 ,$244.00 ,$132.74 ,$53.68 ,$101.50 , N/A , N/A ,$56.36 ,$207.40 ,$159.09 ,$68.32 ,$219.60 ,$204.96 ,$195.20 ,$195.20 ,$53.68 ,$158.60 
ST. FRANCIS HOSPITAL - ACUTE,94000112,E0202,HC PHOTO THERAPY PER HOUR,940,1 ,$36.00 ,$23.40 ,$7.92 ,$36.00 ,$20.70 ,$25.92 ,$19.58 ,$7.92 ,$10.08 ,$20.20 ,$7.92 ,$23.47 ,$9.00 ,$23.47 ,$23.47 ,$9.00 ,$23.47 ,$15.05 ,$30.24 ,$18.00 ,$7.92 ,$30.60 ,$30.24 ,$7.92 ,$27.00 ,$28.80 ,$28.80 ,$7.92 ,$28.80 ,$30.24 ,$30.24 ,$30.24 ,$36.00 ,$32.40 ,$20.70 ,$36.00 ,$7.92 ,$36.00 ,$19.58 ,$7.92 ,$14.98 , N/A , N/A ,$8.32 ,$30.60 ,$23.47 ,$10.08 ,$32.40 ,$30.24 ,$28.80 ,$28.80 ,$7.92 ,$23.40 
ST. FRANCIS HOSPITAL - ACUTE,94000114,20560,HC NEEDLE INSERTION W/O INJECTION 1-2 MUSCLES,940,1 ,$218.00 ,$141.70 ,$27.80 ,$218.00 ,$125.35 ,$156.96 ,$118.59 ,$47.96 ,$61.04 ,$122.30 ,$47.96 ,$142.14 ,$54.50 ,$142.14 ,$142.14 ,$54.50 ,$142.14 ,$91.12 ,$183.12 ,$63.08 ,$47.96 ,$185.30 ,$183.12 ,$47.96 ,$163.50 ,$174.40 ,$174.40 ,$47.96 ,$174.40 ,$183.12 ,$183.12 ,$183.12 ,$218.00 ,$196.20 ,$125.35 ,$218.00 ,$47.96 ,$218.00 ,$118.59 ,$47.96 ,$90.69 ,$29.13 ,$27.80 ,$50.36 ,$185.30 ,$142.14 ,$61.04 ,$196.20 ,$183.12 ,$174.40 ,$174.40 ,$47.96 ,$141.70 
ST. FRANCIS HOSPITAL - ACUTE,94000115,20561,HC NEEDLE INSERTION W/O INJECTION 3+ MUSCLES,940,1 ,$218.00 ,$141.70 ,$27.80 ,$218.00 ,$125.35 ,$156.96 ,$118.59 ,$47.96 ,$61.04 ,$122.30 ,$47.96 ,$142.14 ,$54.50 ,$142.14 ,$142.14 ,$54.50 ,$142.14 ,$91.12 ,$183.12 ,$63.08 ,$47.96 ,$185.30 ,$183.12 ,$47.96 ,$163.50 ,$174.40 ,$174.40 ,$47.96 ,$174.40 ,$183.12 ,$183.12 ,$183.12 ,$218.00 ,$196.20 ,$125.35 ,$218.00 ,$47.96 ,$218.00 ,$118.59 ,$47.96 ,$90.69 ,$29.13 ,$27.80 ,$50.36 ,$185.30 ,$142.14 ,$61.04 ,$196.20 ,$183.12 ,$174.40 ,$174.40 ,$47.96 ,$141.70 
ST. FRANCIS HOSPITAL - ACUTE,94200005,97802,HC NUTRITION THRPY EVAL 15 MIN,942,1 ,$97.00 ,$63.05 ,$21.34 ,$97.00 ,$55.78 ,$69.84 ,$52.77 ,$21.34 ,$27.16 ,$57.04 ,$21.34 ,$66.64 ,$24.25 ,$66.64 ,$66.64 ,$24.25 ,$66.64 ,$40.55 ,$81.48 ,$91.93 ,$21.34 ,$82.45 ,$81.48 ,$21.34 ,$72.75 ,$77.60 ,$77.60 ,$21.34 ,$77.60 ,$81.48 ,$81.48 ,$81.48 ,$97.00 ,$87.30 ,$55.78 ,$97.00 ,$21.34 ,$97.00 ,$52.77 ,$21.34 ,$40.35 , N/A , N/A ,$22.41 ,$82.45 ,$66.64 ,$27.16 ,$87.30 ,$81.48 ,$77.60 ,$77.60 ,$21.34 ,$63.05 
ST. FRANCIS HOSPITAL - ACUTE,94200019,N/A,HC LACTATION CONSULT 30 MIN,942,1 ,$162.00 ,$105.30 ,$35.64 ,$162.00 ,$93.15 ,$116.64 ,$88.13 ,$35.64 ,$45.36 ,$90.88 ,$35.64 ,$105.62 ,$40.50 ,$105.62 ,$105.62 ,$40.50 ,$105.62 ,$67.72 ,$136.08 , N/A ,$35.64 ,$137.70 ,$136.08 ,$35.64 ,$121.50 ,$129.60 ,$129.60 ,$35.64 ,$129.60 ,$136.08 ,$136.08 ,$136.08 ,$162.00 ,$145.80 ,$93.15 ,$162.00 ,$35.64 ,$162.00 ,$88.13 ,$35.64 ,$67.39 , N/A , N/A ,$37.42 ,$137.70 ,$105.62 ,$45.36 ,$145.80 ,$136.08 ,$129.60 ,$129.60 ,$35.64 ,$105.30 
ST. FRANCIS HOSPITAL - ACUTE,94200020,N/A,HC LACTATION CONSULT 45 MIN,942,1 ,$227.00 ,$147.55 ,$49.94 ,$227.00 ,$130.53 ,$163.44 ,$123.49 ,$49.94 ,$63.56 ,$127.35 ,$49.94 ,$148.00 ,$56.75 ,$148.00 ,$148.00 ,$56.75 ,$148.00 ,$94.89 ,$190.68 , N/A ,$49.94 ,$192.95 ,$190.68 ,$49.94 ,$170.25 ,$181.60 ,$181.60 ,$49.94 ,$181.60 ,$190.68 ,$190.68 ,$190.68 ,$227.00 ,$204.30 ,$130.53 ,$227.00 ,$49.94 ,$227.00 ,$123.49 ,$49.94 ,$94.43 , N/A , N/A ,$52.44 ,$192.95 ,$148.00 ,$63.56 ,$204.30 ,$190.68 ,$181.60 ,$181.60 ,$49.94 ,$147.55 
ST. FRANCIS HOSPITAL - ACUTE,94200021,N/A,HC LACTATION CONSULT 60 MIN,942,1 ,$291.00 ,$189.15 ,$64.02 ,$291.00 ,$167.33 ,$209.52 ,$158.30 ,$64.02 ,$81.48 ,$163.25 ,$64.02 ,$189.73 ,$72.75 ,$189.73 ,$189.73 ,$72.75 ,$189.73 ,$121.64 ,$244.44 , N/A ,$64.02 ,$247.35 ,$244.44 ,$64.02 ,$218.25 ,$232.80 ,$232.80 ,$64.02 ,$232.80 ,$244.44 ,$244.44 ,$244.44 ,$291.00 ,$261.90 ,$167.33 ,$291.00 ,$64.02 ,$291.00 ,$158.30 ,$64.02 ,$121.06 , N/A , N/A ,$67.22 ,$247.35 ,$189.73 ,$81.48 ,$261.90 ,$244.44 ,$232.80 ,$232.80 ,$64.02 ,$189.15 
ST. FRANCIS HOSPITAL - ACUTE,94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$303.00 ,$196.95 ,$66.66 ,$303.00 ,$174.23 ,$218.16 ,$164.83 ,$66.66 ,$84.84 ,$178.16 ,$66.66 ,$201.32 ,$75.75 ,$201.32 ,$201.32 ,$75.75 ,$201.32 ,$126.65 ,$254.52 ,$296.38 ,$66.66 ,$257.55 ,$254.52 ,$66.66 ,$227.25 ,$242.40 ,$242.40 ,$66.66 ,$242.40 ,$254.52 ,$254.52 ,$254.52 ,$303.00 ,$272.70 ,$174.23 ,$303.00 ,$66.66 ,$303.00 ,$164.83 ,$66.66 ,$126.05 , N/A , N/A ,$69.99 ,$257.55 ,$201.32 ,$84.84 ,$272.70 ,$254.52 ,$242.40 ,$242.40 ,$66.66 ,$196.95 
ST. FRANCIS HOSPITAL - ACUTE,94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$303.00 ,$196.95 ,$66.66 ,$303.00 ,$174.23 ,$218.16 ,$164.83 ,$66.66 ,$84.84 ,$178.16 ,$66.66 ,$208.16 ,$75.75 ,$208.16 ,$208.16 ,$75.75 ,$208.16 ,$126.65 ,$254.52 ,$296.38 ,$66.66 ,$257.55 ,$254.52 ,$66.66 ,$227.25 ,$242.40 ,$242.40 ,$66.66 ,$242.40 ,$254.52 ,$254.52 ,$254.52 ,$303.00 ,$272.70 ,$174.23 ,$303.00 ,$66.66 ,$303.00 ,$164.83 ,$66.66 ,$126.05 , N/A , N/A ,$69.99 ,$257.55 ,$208.16 ,$84.84 ,$272.70 ,$254.52 ,$242.40 ,$242.40 ,$66.66 ,$196.95 
ST. FRANCIS HOSPITAL - ACUTE,94300019,N/A,HC CARDIAC REHAB PHASE 3 FULL MONTH,943,1 ,$46.00 ,$29.90 ,$10.12 ,$46.00 ,$26.45 ,$33.12 ,$25.02 ,$10.12 ,$12.88 ,$25.81 ,$10.12 ,$29.99 ,$11.50 ,$29.99 ,$29.99 ,$11.50 ,$29.99 ,$19.23 ,$38.64 , N/A ,$10.12 ,$39.10 ,$38.64 ,$10.12 ,$34.50 ,$36.80 ,$36.80 ,$10.12 ,$36.80 ,$38.64 ,$38.64 ,$38.64 ,$46.00 ,$41.40 ,$26.45 ,$46.00 ,$10.12 ,$46.00 ,$25.02 ,$10.12 ,$19.14 , N/A , N/A ,$10.63 ,$39.10 ,$29.99 ,$12.88 ,$41.40 ,$38.64 ,$36.80 ,$36.80 ,$10.12 ,$29.90 
ST. FRANCIS HOSPITAL - ACUTE,94300021,N/A,HC CARDIAC REHAB EXERCISE PER VISIT,943,1 ,$5.00 ,$3.25 ,$1.10 ,$5.00 ,$2.88 ,$3.60 ,$2.72 ,$1.10 ,$1.40 ,$2.81 ,$1.10 ,$3.26 ,$1.25 ,$3.26 ,$3.26 ,$1.25 ,$3.26 ,$2.09 ,$4.20 , N/A ,$1.10 ,$4.25 ,$4.20 ,$1.10 ,$3.75 ,$4.00 ,$4.00 ,$1.10 ,$4.00 ,$4.20 ,$4.20 ,$4.20 ,$5.00 ,$4.50 ,$2.88 ,$5.00 ,$1.10 ,$5.00 ,$2.72 ,$1.10 ,$2.08 , N/A , N/A ,$1.16 ,$4.25 ,$3.26 ,$1.40 ,$4.50 ,$4.20 ,$4.00 ,$4.00 ,$1.10 ,$3.25 
ST. FRANCIS HOSPITAL - ACUTE,98500000,93010,PC EKG INTER AND REPORT PRO,985,1 ,$73.00 ,$47.45 ,$15.74 ,$73.00 ,$41.98 ,$52.56 ,$39.71 ,$16.06 ,$20.44 ,$42.92 ,$16.06 ,$50.15 ,$18.25 ,$50.15 ,$50.15 ,$18.25 ,$50.15 ,$30.51 ,$61.32 , N/A ,$16.06 ,$62.05 ,$61.32 ,$16.06 ,$54.75 ,$58.40 ,$58.40 ,$16.06 ,$58.40 ,$61.32 ,$61.32 ,$61.32 ,$73.00 ,$65.70 ,$41.98 ,$73.00 ,$16.06 ,$73.00 ,$39.71 ,$16.06 ,$15.74 ,$27.17 ,$25.94 ,$16.86 ,$62.05 ,$50.15 ,$20.44 ,$65.70 ,$61.32 , N/A , N/A ,$16.06 ,$47.45 
ST. FRANCIS HOSPITAL - ACUTE,98500003,93018,PC CARDIOVASCULAR STRESS TEST,985,1 ,$73.00 ,$47.45 ,$16.06 ,$322.04 ,$41.98 ,$52.56 ,$39.71 ,$16.06 ,$20.44 ,$42.92 ,$16.06 ,$50.15 ,$18.25 ,$50.15 ,$50.15 ,$18.25 ,$50.15 ,$30.51 ,$61.32 , N/A ,$16.06 ,$62.05 ,$61.32 ,$16.06 ,$54.75 ,$58.40 ,$58.40 ,$16.06 ,$58.40 ,$61.32 ,$61.32 ,$61.32 ,$73.00 ,$65.70 ,$41.98 ,$73.00 ,$16.06 ,$73.00 ,$39.71 ,$16.06 ,$27.42 ,$322.04 ,$307.40 ,$16.86 ,$62.05 ,$50.15 ,$20.44 ,$65.70 ,$61.32 , N/A , N/A ,$16.06 ,$47.45