ST. ELIZABETH'S 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 , COVENTRY MEDICARE ADVENTRA ," 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 , HEARTLAND HOSPICE , HFN , HOPETRUST , HUMANA , HUMANA MEDICARE , ILLINOIS BREAST AND CERVICAL CANCER PROGRAM , LIVE360 HSHS HEALTHY PLAN , LIVE360 MEDICARE COST PLAN , LIVE360 NON HSHS HEALTHY PLAN , MENTAL HEALTH NETWORK , MERIDIAN HMO MCD , MOLINA MEDICAID , MOLINA MEDICARE , MULTIPLAN , NAPHCARE , PHYSICIANS HEALTH ASSOCIATION OF IL BCBS HMO , PLAIN CHURCH MEDICAL GROUP , PROVIDER NETWORK OF AMERICA , SAE MEMORIAL HOSPICE , ST CLAIR COUNTY HOUSING AUTHORITY , UHC CATERPILLAR , UNITED HEALTH ALL PAYOR , UNITED HEALTH CARE MEDICARE , UNITED HEALTHCARE BEHAVIORAL HEALTH , WELLFIRST , WEXFORD HEALTH SOURCES 
ST. ELIZABETH'S HOSPITAL,N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$39,336.51 ","$2,385.37 ","$168,133.28 ","$168,133.28 ","$60,517.70 ","$33,889.91 ","$63,728.87 ","$16,944.96 ","$60,517.70 ","$63,728.87 ","$60,517.70 ","$59,307.35 ","$35,614.80 ","$35,614.80 ","$59,307.35 ","$35,614.80 ","$59,307.35 ","$60,517.70 ","$60,517.70 ","$64,366.15 ","$59,307.35 ","$59,307.35 ","$45,388.28 ","$27,232.97 ","$27,232.97 ","$63,728.87 ","$27,232.97 ","$60,517.70 ","$60,517.70 ","$60,517.70 ","$60,517.70 ", N/A ,"$51,440.05 ","$60,517.70 ","$60,517.70 ","$63,728.87 ", N/A ,"$33,889.91 ","$63,728.87 ","$15,916.16 ","$14,325.60 ","$2,623.91 ","$2,504.64 ","$66,915.31 ","$48,414.16 ","$60,517.70 ","$35,614.80 ","$16,944.96 ","$54,465.93 ","$63,728.87 ","$60,517.70 ","$60,517.70 ","$60,517.70 ","$59,307.35 ","$60,517.70 ","$29,048.50 ","$2,385.37 "
ST. ELIZABETH'S HOSPITAL,N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$9,948.71 ","$1,910.08 ","$43,207.40 ","$43,207.40 ","$15,305.70 ","$8,571.19 ","$16,720.54 ","$4,285.60 ","$15,305.70 ","$16,720.54 ","$15,305.70 ","$15,305.70 ","$4,748.64 ","$4,748.64 ","$15,305.70 ","$4,748.64 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$16,887.75 ","$15,305.70 ","$15,305.70 ","$11,479.28 ","$6,887.57 ","$6,887.57 ","$16,720.54 ","$6,887.57 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$15,305.70 ", N/A ,"$13,009.85 ","$15,305.70 ","$15,305.70 ","$16,720.54 ", N/A ,"$8,571.19 ","$16,720.54 ","$4,025.40 ","$1,910.08 ","$2,623.91 ","$2,504.64 ","$17,556.57 ","$12,244.56 ","$15,305.70 ","$4,748.64 ","$4,285.60 ","$13,775.13 ","$16,720.54 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$7,346.74 ","$2,385.37 "
ST. ELIZABETH'S HOSPITAL,N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$7,445.85 ","$1,910.08 ","$32,569.13 ","$32,569.13 ","$11,455.16 ","$6,414.89 ","$12,606.71 ","$3,207.44 ","$11,455.16 ","$12,606.71 ","$11,455.16 ","$11,455.16 ","$5,143.37 ","$5,143.37 ","$11,455.16 ","$5,143.37 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$12,732.78 ","$11,455.16 ","$11,455.16 ","$8,591.37 ","$5,154.82 ","$5,154.82 ","$12,606.71 ","$5,154.82 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$11,455.16 ", N/A ,"$9,736.89 ","$11,455.16 ","$11,455.16 ","$12,606.71 ", N/A ,"$6,414.89 ","$12,606.71 ","$3,012.71 ","$1,910.08 ","$2,623.91 ","$2,504.64 ","$13,237.05 ","$9,164.13 ","$11,455.16 ","$5,143.37 ","$3,207.44 ","$10,309.64 ","$12,606.71 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$5,498.48 ","$2,385.37 "
ST. ELIZABETH'S HOSPITAL,N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$15,401.47 ","$2,385.37 ","$66,387.73 ","$66,387.73 ","$23,694.57 ","$13,268.96 ","$25,170.69 ","$6,634.48 ","$23,694.57 ","$25,170.69 ","$23,694.57 ","$23,220.68 ","$10,638.86 ","$10,638.86 ","$23,220.68 ","$10,638.86 ","$23,220.68 ","$23,694.57 ","$23,694.57 ","$25,422.40 ","$23,220.68 ","$23,220.68 ","$17,770.93 ","$10,662.56 ","$10,662.56 ","$25,170.69 ","$10,662.56 ","$23,694.57 ","$23,694.57 ","$23,694.57 ","$23,694.57 ", N/A ,"$20,140.38 ","$23,694.57 ","$23,694.57 ","$25,170.69 ", N/A ,"$13,268.96 ","$25,170.69 ","$6,231.67 ","$2,865.12 ","$2,623.91 ","$2,504.64 ","$26,429.23 ","$18,955.66 ","$23,694.57 ","$10,638.86 ","$6,634.48 ","$21,325.11 ","$25,170.69 ","$23,694.57 ","$23,694.57 ","$23,694.57 ","$23,220.68 ","$23,694.57 ","$11,373.39 ","$2,385.37 "
ST. ELIZABETH'S HOSPITAL,N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$4,438.60 ","$1,795.92 ","$19,785.58 ","$19,785.58 ","$6,828.61 ","$3,824.02 ","$7,663.30 ","$1,912.01 ","$6,828.61 ","$7,663.30 ","$6,828.61 ","$6,828.61 ","$4,748.64 ","$4,748.64 ","$6,828.61 ","$4,748.64 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$7,739.93 ","$6,828.61 ","$6,828.61 ","$5,121.46 ","$3,072.87 ","$3,072.87 ","$7,663.30 ","$3,072.87 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$6,828.61 ", N/A ,"$5,804.32 ","$6,828.61 ","$6,828.61 ","$7,663.30 ", N/A ,"$3,824.02 ","$7,663.30 ","$1,795.92 ","$1,910.08 ","$2,623.91 ","$2,504.64 ","$8,046.47 ","$5,462.89 ","$6,828.61 ","$4,748.64 ","$1,912.01 ","$6,145.75 ","$7,663.30 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$3,277.73 ","$2,385.37 "
ST. ELIZABETH'S HOSPITAL,12000001,N/A,HC DAILY SERVICE GENERAL,120,1 ,"$1,623.00 ","$1,054.95 ",$426.85 ,"$1,623.00 ", Inpatient Medicare +150% ,"$12,350.00 ",$908.88 , Inpatient Medicare ,$454.44 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$2,374.32 ","$2,374.32 ", Inpatient Medicare ,$731.97 , Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$1,217.25 ",$730.35 ,$730.35 , Inpatient Medicare ,$730.35 ,"$12,438.00 ","$12,438.00 ","$12,438.00 ","$1,623.00 ", N/A ,"$1,379.55 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,$908.88 , Inpatient Medicare ,$426.85 ,$955.04 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,298.40 ", Inpatient Medicare +100% ,"$2,374.32 ",$454.44 ,"$1,460.70 ", Inpatient Medicare ,"$11,195.00 ","$10,500.00 ","$10,500.00 ", Inpatient Medicare ,"$10,500.00 ",$779.04 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,12000006,N/A,HC DAILY SERVICE W/TELEMETRY,120,1 ,"$2,614.00 ","$1,699.10 ",$687.48 ,"$2,614.00 ", Inpatient Medicare +150% ,"$12,350.00 ","$1,463.84 ", Inpatient Medicare ,$731.92 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$2,374.32 ","$2,374.32 ", Inpatient Medicare ,"$1,178.91 ", Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$1,960.50 ","$1,176.30 ","$1,176.30 ", Inpatient Medicare ,"$1,176.30 ","$12,438.00 ","$12,438.00 ","$12,438.00 ","$2,614.00 ", N/A ,"$2,221.90 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,"$1,463.84 ", Inpatient Medicare ,$687.48 ,$955.04 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$2,091.20 ", Inpatient Medicare +100% ,"$2,374.32 ",$731.92 ,"$2,352.60 ", Inpatient Medicare ,"$11,195.00 ","$10,500.00 ","$10,500.00 ", Inpatient Medicare ,"$10,500.00 ","$1,254.72 ", Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,12100001,N/A,HC DAILY SERVICE,121,1 ,"$1,623.00 ","$1,054.95 ",$426.85 ,"$1,623.00 ", Inpatient Medicare +150% ,"$12,350.00 ",$908.88 , Inpatient Medicare ,$454.44 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$2,374.32 ","$2,374.32 ", Inpatient Medicare ,$731.97 , Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$1,217.25 ",$730.35 ,$730.35 , Inpatient Medicare ,$730.35 ,"$12,438.00 ","$12,438.00 ","$12,438.00 ","$1,623.00 ", N/A ,"$1,379.55 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,$908.88 , Inpatient Medicare ,$426.85 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,298.40 ", Inpatient Medicare +100% ,"$2,374.32 ",$454.44 ,"$1,460.70 ", Inpatient Medicare ,"$11,195.00 ","$10,500.00 ","$10,500.00 ", Inpatient Medicare ,"$10,500.00 ",$779.04 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,12200001,N/A,HC DAILY SERVICE OBSTETRICS,122,1 ,"$1,623.00 ","$1,054.95 ",$426.85 ,"$1,623.00 ", Inpatient Medicare +150% ,"$12,350.00 ",$908.88 , Inpatient Medicare ,$454.44 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$2,374.32 ","$2,374.32 ", Inpatient Medicare ,$731.97 , Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$1,217.25 ",$730.35 ,$730.35 , Inpatient Medicare ,$730.35 ,"$12,438.00 ","$12,438.00 ","$12,438.00 ","$1,623.00 ", N/A ,"$1,379.55 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,$908.88 , Inpatient Medicare ,$426.85 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,298.40 ", Inpatient Medicare +100% ,"$2,374.32 ",$454.44 ,"$1,460.70 ", Inpatient Medicare ,"$11,195.00 ","$10,500.00 ","$10,500.00 ", Inpatient Medicare ,"$10,500.00 ",$779.04 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,12500001,N/A,HC DAILY HOSPICE ACUTE CARE,125,1 ,"$1,694.00 ","$1,101.10 ",$445.52 ,"$1,694.00 ", Inpatient Medicare +150% ,"$12,350.00 ",$948.64 , Inpatient Medicare ,$474.32 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$2,374.32 ","$2,374.32 ", Inpatient Medicare ,$763.99 , Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$1,270.50 ",$762.30 ,$762.30 , Inpatient Medicare ,$762.30 ,$849.00 ,$849.00 ,$849.00 ,"$1,694.00 ", N/A ,"$1,439.90 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,$948.64 , Inpatient Medicare ,$445.52 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,355.20 ", Inpatient Medicare +100% ,"$2,374.32 ",$474.32 ,"$1,524.60 ", Inpatient Medicare ,$764.00 , N/A , N/A , Inpatient Medicare , N/A ,$813.12 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,12800001,N/A,HC DAILY REHAB SERVICE,128,1 ,"$1,641.00 ","$1,066.65 ",$431.58 ,"$1,641.00 ", Inpatient Medicare +150% ,"$1,260.00 ",$918.96 , Inpatient Medicare ,$459.48 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$1,755.52 ","$1,755.52 ", Inpatient Medicare ,$740.09 , Inpatient Medicare +90% ,"$1,889.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare ,$695.00 ,"$1,230.75 ",$738.45 ,$738.45 , Inpatient Medicare ,$738.45 ,"$12,438.00 ","$12,438.00 ","$12,438.00 ","$1,641.00 ", N/A ,"$1,394.85 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,$918.96 , Inpatient Medicare ,$431.58 ,$955.04 , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,312.80 ", Inpatient Medicare +100% ,"$1,755.52 ",$459.48 ,"$1,476.90 ", Inpatient Medicare ,"$11,195.00 ","$1,858.00 ","$1,858.00 ", Inpatient Medicare ,"$1,858.00 ",$787.68 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,"$1,139.00 ",$740.35 ,$299.56 ,"$1,139.00 ", Inpatient Medicare +150% ,"$12,350.00 ",$637.84 , Inpatient Medicare ,$318.92 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$3,440.32 ","$3,440.32 ", Inpatient Medicare ,$513.69 , Inpatient Medicare +90% ,"$1,181.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,$854.25 ,$512.55 ,$512.55 , Inpatient Medicare ,$512.55 ,$823.00 ,$823.00 ,$823.00 ,"$1,139.00 ", N/A ,$968.15 , Inpatient Medicare +150% ,"$1,029.00 ", Inpatient Medicare , N/A ,$637.84 , Inpatient Medicare ,$299.56 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,$911.20 , Inpatient Medicare +100% ,"$3,440.32 ",$318.92 ,"$1,025.10 ", Inpatient Medicare ,$740.00 ,$600.00 ,$600.00 , Inpatient Medicare ,$600.00 ,$546.72 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,17200002,N/A,HC DAILY INFANT SERVICE LEV 2,172,1 ,"$2,009.00 ","$1,305.85 ",$528.37 ,"$2,009.00 ", Inpatient Medicare +150% ,"$12,350.00 ","$1,125.04 ", Inpatient Medicare ,$562.52 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$3,440.32 ","$3,440.32 ", Inpatient Medicare ,$906.06 , Inpatient Medicare +90% ,"$1,923.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$1,506.75 ",$904.05 ,$904.05 , Inpatient Medicare ,$904.05 ,$823.00 ,$823.00 ,$823.00 ,"$2,009.00 ", N/A ,"$1,707.65 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,"$1,125.04 ", Inpatient Medicare ,$528.37 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,607.20 ", Inpatient Medicare +100% ,"$3,440.32 ",$562.52 ,"$1,808.10 ", Inpatient Medicare ,$740.00 ,$850.00 ,$850.00 , Inpatient Medicare ,$850.00 ,$964.32 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,17300002,N/A,HC DAILY INFANT SERVICE LEV 3,173,1 ,"$3,133.00 ","$2,036.45 ",$823.98 ,"$3,133.00 ", Inpatient Medicare +150% ,"$12,350.00 ","$1,754.48 ", Inpatient Medicare ,$877.24 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$3,440.32 ","$3,440.32 ", Inpatient Medicare ,"$1,412.98 ", Inpatient Medicare +90% ,"$3,572.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$2,349.75 ","$1,409.85 ","$1,409.85 ", Inpatient Medicare ,"$1,409.85 ","$1,647.00 ","$1,647.00 ","$1,647.00 ","$3,133.00 ", N/A ,"$2,663.05 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,"$1,754.48 ", Inpatient Medicare ,$823.98 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$2,506.40 ", Inpatient Medicare +100% ,"$3,440.32 ",$877.24 ,"$2,819.70 ", Inpatient Medicare ,"$1,483.00 ","$1,250.00 ","$1,250.00 ", Inpatient Medicare ,"$1,250.00 ","$1,503.84 ", Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$3,582.00 ","$2,328.30 ",$942.07 ,"$3,582.00 ", Inpatient Medicare +150% ,"$12,350.00 ","$2,005.92 ", Inpatient Medicare ,"$1,002.96 ","$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$3,440.32 ","$3,440.32 ", Inpatient Medicare ,"$1,615.48 ", Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$2,686.50 ","$1,611.90 ","$1,611.90 ", Inpatient Medicare ,"$1,611.90 ","$12,438.00 ","$12,438.00 ","$12,438.00 ","$3,582.00 ", N/A ,"$3,044.70 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,"$2,005.92 ", Inpatient Medicare ,$942.07 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$2,865.60 ", Inpatient Medicare +100% ,"$3,440.32 ","$1,002.96 ","$3,223.80 ", Inpatient Medicare ,"$11,195.00 ","$10,500.00 ","$10,500.00 ", Inpatient Medicare ,"$10,500.00 ","$1,719.36 ", Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,20300001,N/A,HC DAILY PEDIATRIC IMC,203,1 ,"$2,009.00 ","$1,305.85 ",$528.37 ,"$2,009.00 ", Inpatient Medicare +150% ,"$12,350.00 ","$1,125.04 ", Inpatient Medicare ,$562.52 ,"$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$3,440.32 ","$3,440.32 ", Inpatient Medicare ,$906.06 , Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$1,506.75 ",$904.05 ,$904.05 , Inpatient Medicare ,$904.05 ,"$12,438.00 ","$12,438.00 ","$12,438.00 ","$2,009.00 ", N/A ,"$1,707.65 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,"$1,125.04 ", Inpatient Medicare ,$528.37 , N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$1,607.20 ", Inpatient Medicare +100% ,"$3,440.32 ",$562.52 ,"$1,808.10 ", Inpatient Medicare ,"$11,195.00 ","$10,500.00 ","$10,500.00 ", Inpatient Medicare ,"$10,500.00 ",$964.32 , Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,21000002,N/A,HC DAILY CARDIAC CARE,210,1 ,"$4,688.00 ","$3,047.20 ","$1,232.94 ","$4,688.00 ", Inpatient Medicare +150% ,"$12,350.00 ","$2,625.28 ", Inpatient Medicare ,"$1,312.64 ","$8,452.53 ", Inpatient Medicare ,"$9,715.32 ", Inpatient Medicare ,"$3,440.32 ","$3,440.32 ", Inpatient Medicare ,"$2,114.29 ", Inpatient Medicare +90% ,"$8,448.00 ", Inpatient Medicare +150% , Inpatient Medicare +1% , Inpatient Medicare , Inpatient Medicare +2% ,"$3,516.00 ","$2,109.60 ","$2,109.60 ", Inpatient Medicare ,"$2,109.60 ","$12,438.00 ","$12,438.00 ","$12,438.00 ","$4,688.00 ", N/A ,"$3,984.80 ", Inpatient Medicare +150% ,"$12,810.00 ", Inpatient Medicare , N/A ,"$2,625.28 ", Inpatient Medicare ,"$1,232.94 ", N/A , Inpatient Medicaid +10% , Inpatient Medicaid +5% , Inpatient Medicare +5% ,"$3,750.40 ", Inpatient Medicare +100% ,"$3,440.32 ","$1,312.64 ","$4,219.20 ", Inpatient Medicare ,"$11,195.00 ","$10,500.00 ","$10,500.00 ", Inpatient Medicare ,"$10,500.00 ","$2,250.24 ", Inpatient Medicaid 
ST. ELIZABETH'S HOSPITAL,26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$325.00 ,$211.25 ,$42.20 ,$504.21 ,$504.20 ,$149.50 ,$182.00 ,$201.68 ,$91.00 ,$114.73 ,$201.68 ,$133.90 ,$201.68 ,$146.58 ,$146.58 ,$201.68 ,$42.20 ,$325.00 ,$162.50 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$243.75 ,$195.00 ,$195.00 ,$201.68 ,$195.00 ,$247.00 ,$247.00 ,$247.00 ,$325.00 , N/A ,$276.25 ,$325.00 ,$211.25 ,$201.68 ,$325.00 ,$182.00 ,$201.68 ,$85.48 , N/A ,$325.00 ,$314.91 ,$211.76 ,$260.00 ,$453.79 ,$146.58 ,$91.00 ,$292.50 ,$201.68 ,$247.00 ,$211.25 ,$211.25 ,$201.68 ,$211.25 ,$156.00 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$388.00 ,$252.20 ,$16.03 ,$468.85 ,$98.63 ,$178.48 ,$217.28 ,$39.45 ,$108.64 ,$136.96 ,$39.45 ,$159.86 ,$39.45 ,$174.99 ,$174.99 ,$39.45 ,$16.03 ,$74.96 ,$194.00 ,$98.63 ,$39.45 ,$39.45 ,$40.24 ,$291.00 ,$232.80 ,$232.80 ,$39.45 ,$232.80 ,$294.88 ,$294.88 ,$294.88 ,$388.00 , N/A ,$329.80 ,$98.63 ,$252.20 ,$39.45 ,$388.00 ,$217.28 ,$39.45 ,$102.04 , N/A ,$388.00 ,$388.00 ,$41.42 ,$310.40 ,$88.77 ,$174.99 ,$108.64 ,$349.20 ,$39.45 ,$294.88 ,$252.20 ,$252.20 ,$39.45 ,$252.20 ,$186.24 ,$468.85 
ST. ELIZABETH'S HOSPITAL,26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$840.00 ,$546.00 ,$83.26 ,$840.00 ,$504.20 ,$386.40 ,$470.40 ,$201.68 ,$235.20 ,$296.52 ,$201.68 ,$346.08 ,$201.68 ,$378.84 ,$378.84 ,$201.68 ,$83.26 ,$383.20 ,$420.00 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$630.00 ,$504.00 ,$504.00 ,$201.68 ,$504.00 ,$638.40 ,$638.40 ,$638.40 ,$840.00 , N/A ,$714.00 ,$504.21 ,$546.00 ,$201.68 ,$840.00 ,$470.40 ,$201.68 ,$220.92 , N/A ,$329.90 ,$314.91 ,$211.76 ,$672.00 ,$453.79 ,$378.84 ,$235.20 ,$756.00 ,$201.68 ,$638.40 ,$546.00 ,$546.00 ,$201.68 ,$546.00 ,$403.20 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$397.00 ,$258.05 ,$26.03 ,$468.85 ,$98.63 ,$182.62 ,$222.32 ,$39.45 ,$111.16 ,$140.14 ,$39.45 ,$163.56 ,$39.45 ,$179.05 ,$179.05 ,$39.45 ,$26.03 ,$74.96 ,$198.50 ,$98.63 ,$39.45 ,$39.45 ,$40.24 ,$297.75 ,$238.20 ,$238.20 ,$39.45 ,$238.20 ,$301.72 ,$301.72 ,$301.72 ,$397.00 , N/A ,$337.45 ,$98.63 ,$258.05 ,$39.45 ,$397.00 ,$222.32 ,$39.45 ,$104.41 , N/A ,$397.00 ,$397.00 ,$41.42 ,$317.60 ,$88.77 ,$179.05 ,$111.16 ,$357.30 ,$39.45 ,$301.72 ,$258.05 ,$258.05 ,$39.45 ,$258.05 ,$190.56 ,$468.85 
ST. ELIZABETH'S HOSPITAL,26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$397.00 ,$258.05 ,$37.36 ,$397.00 ,$152.80 ,$182.62 ,$222.32 ,$61.12 ,$111.16 ,$140.14 ,$61.12 ,$163.56 ,$61.12 ,$179.05 ,$179.05 ,$61.12 ,$37.36 ,$116.14 ,$198.50 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$297.75 ,$238.20 ,$238.20 ,$61.12 ,$238.20 ,$301.72 ,$301.72 ,$301.72 ,$397.00 , N/A ,$337.45 ,$152.81 ,$258.05 ,$61.12 ,$397.00 ,$222.32 ,$61.12 ,$104.41 , N/A ,$329.90 ,$314.91 ,$64.18 ,$317.60 ,$137.53 ,$179.05 ,$111.16 ,$357.30 ,$61.12 ,$301.72 ,$258.05 ,$258.05 ,$61.12 ,$258.05 ,$190.56 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000005,96368,HC INFUS CONCURRENT,260,1 ,$420.00 ,$273.00 ,$25.19 ,$420.00 , N/A ,$193.20 ,$235.20 , N/A ,$117.60 ,$148.26 , N/A ,$173.04 , N/A ,$189.42 ,$189.42 , N/A ,$25.19 , N/A ,$210.00 , N/A , N/A , N/A , N/A ,$315.00 ,$252.00 ,$252.00 , N/A ,$252.00 ,$319.20 ,$319.20 ,$319.20 ,$420.00 , N/A ,$357.00 , N/A ,$273.00 , N/A ,$420.00 ,$235.20 , N/A ,$110.46 , N/A ,$329.90 ,$314.91 , N/A ,$336.00 , N/A ,$189.42 ,$117.60 ,$378.00 , N/A ,$319.20 ,$273.00 ,$273.00 , N/A ,$273.00 ,$201.60 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000006,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$325.00 ,$211.25 ,$42.20 ,$504.21 ,$504.20 ,$149.50 ,$182.00 ,$201.68 ,$91.00 ,$114.73 ,$201.68 ,$133.90 ,$201.68 ,$146.58 ,$146.58 ,$201.68 ,$42.20 ,$325.00 ,$162.50 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$243.75 ,$195.00 ,$195.00 ,$201.68 ,$195.00 ,$247.00 ,$247.00 ,$247.00 ,$325.00 , N/A ,$276.25 ,$325.00 ,$211.25 ,$201.68 ,$325.00 ,$182.00 ,$201.68 ,$85.48 , N/A ,$325.00 ,$314.91 ,$211.76 ,$260.00 ,$453.79 ,$146.58 ,$91.00 ,$292.50 ,$201.68 ,$247.00 ,$211.25 ,$211.25 ,$201.68 ,$211.25 ,$156.00 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000007,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$840.00 ,$546.00 ,$83.26 ,$840.00 ,$504.20 ,$386.40 ,$470.40 ,$201.68 ,$235.20 ,$296.52 ,$201.68 ,$346.08 ,$201.68 ,$378.84 ,$378.84 ,$201.68 ,$83.26 ,$383.20 ,$420.00 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$630.00 ,$504.00 ,$504.00 ,$201.68 ,$504.00 ,$638.40 ,$638.40 ,$638.40 ,$840.00 , N/A ,$714.00 ,$504.21 ,$546.00 ,$201.68 ,$840.00 ,$470.40 ,$201.68 ,$220.92 , N/A ,$329.90 ,$314.91 ,$211.76 ,$672.00 ,$453.79 ,$378.84 ,$235.20 ,$756.00 ,$201.68 ,$638.40 ,$546.00 ,$546.00 ,$201.68 ,$546.00 ,$403.20 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000008,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$313.00 ,$203.45 ,$19.71 ,$313.00 ,$98.63 ,$143.98 ,$175.28 ,$39.45 ,$87.64 ,$110.49 ,$39.45 ,$128.96 ,$39.45 ,$141.16 ,$141.16 ,$39.45 ,$19.71 ,$74.96 ,$156.50 ,$98.63 ,$39.45 ,$39.45 ,$40.24 ,$234.75 ,$187.80 ,$187.80 ,$39.45 ,$187.80 ,$237.88 ,$237.88 ,$237.88 ,$313.00 , N/A ,$266.05 ,$98.63 ,$203.45 ,$39.45 ,$313.00 ,$175.28 ,$39.45 ,$82.32 , N/A , N/A , N/A ,$41.42 ,$250.40 ,$88.77 ,$141.16 ,$87.64 ,$281.70 ,$39.45 ,$237.88 ,$203.45 ,$203.45 ,$39.45 ,$203.45 ,$150.24 , N/A 
ST. ELIZABETH'S HOSPITAL,26000009,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$348.00 ,$226.20 ,$91.52 ,$348.00 , N/A ,$160.08 ,$194.88 , N/A ,$97.44 ,$122.84 , N/A ,$143.38 , N/A ,$156.95 ,$156.95 , N/A ,$226.20 , N/A ,$174.00 , N/A , N/A , N/A , N/A ,$261.00 ,$208.80 ,$208.80 , N/A ,$208.80 ,$264.48 ,$264.48 ,$264.48 ,$348.00 , N/A ,$295.80 , N/A ,$226.20 , N/A ,$348.00 ,$194.88 , N/A ,$91.52 , N/A , N/A , N/A , N/A ,$278.40 , N/A ,$156.95 ,$97.44 ,$313.20 , N/A ,$264.48 ,$226.20 ,$226.20 , N/A ,$226.20 ,$167.04 , N/A 
ST. ELIZABETH'S HOSPITAL,26000014,M0239,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB",260,1 ,$929.00 ,$603.85 ,$244.33 ,$929.00 , N/A ,$427.34 ,$520.24 , N/A ,$260.12 ,$314.00 , N/A ,$361.38 , N/A ,$418.98 ,$418.98 , N/A ,$603.85 , N/A ,$464.50 , N/A , N/A , N/A , N/A ,$696.75 ,$557.40 ,$557.40 , N/A ,$557.40 ,$706.04 ,$706.04 ,$706.04 ,$929.00 , N/A ,$789.65 , N/A ,$603.85 , N/A ,$929.00 ,$520.24 , N/A ,$244.33 , N/A , N/A , N/A , N/A ,$743.20 , N/A ,$418.98 ,$260.12 ,$836.10 , N/A ,$706.04 ,$603.85 ,$603.85 , N/A ,$603.85 ,$445.92 , N/A 
ST. ELIZABETH'S HOSPITAL,26000015,M0243,"HC INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB ADMINISTRATION",260,1 ,$930.00 ,$604.50 ,$244.59 ,"$1,087.20 ","$1,087.20 ",$427.80 ,$520.80 ,$434.88 ,$260.40 ,$314.34 ,$434.88 ,$361.77 ,$434.88 ,$419.43 ,$419.43 ,$434.88 ,$604.50 ,$826.27 ,$465.00 ,"$1,087.19 ",$434.88 ,$434.88 ,$443.57 ,$697.50 ,$558.00 ,$558.00 ,$434.88 ,$558.00 ,$706.80 ,$706.80 ,$706.80 ,$930.00 , N/A ,$790.50 ,$930.00 ,$604.50 ,$434.88 ,$930.00 ,$520.80 ,$434.88 ,$244.59 , N/A ,$329.90 ,$314.91 ,$456.62 ,$744.00 ,$978.47 ,$419.43 ,$260.40 ,$837.00 ,$434.88 ,$706.80 ,$604.50 ,$604.50 ,$434.88 ,$604.50 ,$446.40 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000016,M0245,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB AND ETESEVIMAB ADMINISTRATION",260,1 ,$932.25 ,$605.96 ,$245.18 ,"$1,087.20 ","$1,087.20 ",$428.84 ,$522.06 ,$434.88 ,$261.03 ,$315.10 ,$434.88 ,$362.65 ,$434.88 ,$420.44 ,$420.44 ,$434.88 ,$605.96 ,$826.27 ,$466.13 ,"$1,087.19 ",$434.88 ,$434.88 ,$443.57 ,$699.19 ,$559.35 ,$559.35 ,$434.88 ,$559.35 ,$708.51 ,$708.51 ,$708.51 ,$932.25 , N/A ,$792.41 ,$932.25 ,$605.96 ,$434.88 ,$932.25 ,$522.06 ,$434.88 ,$245.18 , N/A ,$329.90 ,$314.91 ,$456.62 ,$745.80 ,$978.47 ,$420.44 ,$261.03 ,$839.03 ,$434.88 ,$708.51 ,$605.96 ,$605.96 ,$434.88 ,$605.96 ,$447.48 ,$299.91 
ST. ELIZABETH'S HOSPITAL,26000017,M0247,"HC INTRAVENOUS INFUSION, SOTROVIMAB ADMINISTRATION",260,1 ,"$1,350.00 ",$877.50 ,$299.91 ,"$1,350.00 ","$1,087.20 ",$621.00 ,$756.00 ,$434.88 ,$378.00 ,$456.30 ,$434.88 ,$525.15 ,$434.88 ,$608.85 ,$608.85 ,$434.88 ,$877.50 ,$826.27 ,$675.00 ,"$1,087.19 ",$434.88 ,$434.88 ,$443.57 ,"$1,012.50 ",$810.00 ,$810.00 ,$434.88 ,$810.00 ,"$1,026.00 ","$1,026.00 ","$1,026.00 ","$1,350.00 ", N/A ,"$1,147.50 ","$1,087.19 ",$877.50 ,$434.88 ,"$1,350.00 ",$756.00 ,$434.88 ,$355.05 , N/A ,$329.90 ,$314.91 ,$456.62 ,"$1,080.00 ",$978.47 ,$608.85 ,$378.00 ,"$1,215.00 ",$434.88 ,"$1,026.00 ",$877.50 ,$877.50 ,$434.88 ,$877.50 ,$648.00 ,$299.91 
ST. ELIZABETH'S HOSPITAL,27000017,N/A,HC SYSTEM DRAINAGE,270,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000021,N/A,HC TRAY ARTHROGRAM,270,1 ,$75.00 ,$48.75 ,$19.73 ,$75.00 , N/A ,$34.50 ,$42.00 , N/A ,$21.00 ,$25.35 , N/A ,$29.18 , N/A ,$33.83 ,$33.83 , N/A ,$48.75 , N/A ,$37.50 , N/A , N/A , N/A , N/A ,$56.25 ,$45.00 ,$45.00 , N/A ,$45.00 ,$57.00 ,$57.00 ,$57.00 ,$75.00 , N/A ,$63.75 , N/A ,$48.75 , N/A ,$75.00 ,$42.00 , N/A ,$19.73 , N/A , N/A , N/A , N/A ,$60.00 , N/A ,$33.83 ,$21.00 ,$67.50 , N/A ,$57.00 ,$48.75 ,$48.75 , N/A ,$48.75 ,$36.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000022,N/A,HC TRAY BIOPSY,270,1 ,$41.00 ,$26.65 ,$10.78 ,$41.00 , N/A ,$18.86 ,$22.96 , N/A ,$11.48 ,$13.86 , N/A ,$15.95 , N/A ,$18.49 ,$18.49 , N/A ,$26.65 , N/A ,$20.50 , N/A , N/A , N/A , N/A ,$30.75 ,$24.60 ,$24.60 , N/A ,$24.60 ,$31.16 ,$31.16 ,$31.16 ,$41.00 , N/A ,$34.85 , N/A ,$26.65 , N/A ,$41.00 ,$22.96 , N/A ,$10.78 , N/A , N/A , N/A , N/A ,$32.80 , N/A ,$18.49 ,$11.48 ,$36.90 , N/A ,$31.16 ,$26.65 ,$26.65 , N/A ,$26.65 ,$19.68 , N/A 
ST. ELIZABETH'S HOSPITAL,27000024,N/A,HC TRAY SPINAL ANESTHESIA,272,1 ,$41.00 ,$26.65 ,$10.78 ,$41.00 , N/A ,$18.86 ,$22.96 , N/A ,$11.48 ,$13.86 , N/A ,$15.95 , N/A ,$18.49 ,$18.49 , N/A ,$26.65 , N/A ,$20.50 , N/A , N/A , N/A , N/A ,$30.75 ,$24.60 ,$24.60 , N/A ,$24.60 ,$31.16 ,$31.16 ,$31.16 ,$41.00 , N/A ,$34.85 , N/A ,$26.65 , N/A ,$41.00 ,$22.96 , N/A ,$10.78 , N/A , N/A , N/A , N/A ,$32.80 , N/A ,$18.49 ,$11.48 ,$36.90 , N/A ,$31.16 ,$26.65 ,$26.65 , N/A ,$26.65 ,$19.68 , N/A 
ST. ELIZABETH'S HOSPITAL,27000027,N/A,HC TRAY AMNIOCENTESIS,270,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000037,N/A,HC DEVICE RADIAL COMPRESSION,270,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000042,N/A,HC BINDER ABDOMINAL LARGE,270,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000043,N/A,HC BINDER ABDOMINAL 2-5 XLARGE,270,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000044,N/A,HC TAPE BROSELOW PEDIATRIC,270,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000047,N/A,HC PAD CARDIAC MONITOR,270,1 ,$116.25 ,$75.56 ,$30.57 ,$116.25 , N/A ,$53.48 ,$65.10 , N/A ,$32.55 ,$39.29 , N/A ,$45.22 , N/A ,$52.43 ,$52.43 , N/A ,$75.56 , N/A ,$58.13 , N/A , N/A , N/A , N/A ,$87.19 ,$69.75 ,$69.75 , N/A ,$69.75 ,$88.35 ,$88.35 ,$88.35 ,$116.25 , N/A ,$98.81 , N/A ,$75.56 , N/A ,$116.25 ,$65.10 , N/A ,$30.57 , N/A , N/A , N/A , N/A ,$93.00 , N/A ,$52.43 ,$32.55 ,$104.63 , N/A ,$88.35 ,$75.56 ,$75.56 , N/A ,$75.56 ,$55.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27000048,N/A,HC CARTRIDGE CRRT INITIAL,270,1 ,$701.00 ,$455.65 ,$184.36 ,$701.00 , N/A ,$322.46 ,$392.56 , N/A ,$196.28 ,$236.94 , N/A ,$272.69 , N/A ,$316.15 ,$316.15 , N/A ,$455.65 , N/A ,$350.50 , N/A , N/A , N/A , N/A ,$525.75 ,$420.60 ,$420.60 , N/A ,$420.60 ,$532.76 ,$532.76 ,$532.76 ,$701.00 , N/A ,$595.85 , N/A ,$455.65 , N/A ,$701.00 ,$392.56 , N/A ,$184.36 , N/A , N/A , N/A , N/A ,$560.80 , N/A ,$316.15 ,$196.28 ,$630.90 , N/A ,$532.76 ,$455.65 ,$455.65 , N/A ,$455.65 ,$336.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27000049,N/A,HC CARTRIDGE CRRT ADDL,270,1 ,"$1,070.00 ",$695.50 ,$281.41 ,"$1,070.00 ", N/A ,$492.20 ,$599.20 , N/A ,$299.60 ,$361.66 , N/A ,$416.23 , N/A ,$482.57 ,$482.57 , N/A ,$695.50 , N/A ,$535.00 , N/A , N/A , N/A , N/A ,$802.50 ,$642.00 ,$642.00 , N/A ,$642.00 ,$813.20 ,$813.20 ,$813.20 ,"$1,070.00 ", N/A ,$909.50 , N/A ,$695.50 , N/A ,"$1,070.00 ",$599.20 , N/A ,$281.41 , N/A , N/A , N/A , N/A ,$856.00 , N/A ,$482.57 ,$299.60 ,$963.00 , N/A ,$813.20 ,$695.50 ,$695.50 , N/A ,$695.50 ,$513.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27000050,N/A,HC DEVICE THERAPEP,270,1 ,$117.00 ,$76.05 ,$30.77 ,$117.00 , N/A ,$53.82 ,$65.52 , N/A ,$32.76 ,$39.55 , N/A ,$45.51 , N/A ,$52.77 ,$52.77 , N/A ,$76.05 , N/A ,$58.50 , N/A , N/A , N/A , N/A ,$87.75 ,$70.20 ,$70.20 , N/A ,$70.20 ,$88.92 ,$88.92 ,$88.92 ,$117.00 , N/A ,$99.45 , N/A ,$76.05 , N/A ,$117.00 ,$65.52 , N/A ,$30.77 , N/A , N/A , N/A , N/A ,$93.60 , N/A ,$52.77 ,$32.76 ,$105.30 , N/A ,$88.92 ,$76.05 ,$76.05 , N/A ,$76.05 ,$56.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27000054,N/A,HC KIT BLOOD GLUCOSE,270,1 ,$58.53 ,$38.04 ,$15.39 ,$58.53 , N/A ,$26.92 ,$32.78 , N/A ,$16.39 ,$19.78 , N/A ,$22.77 , N/A ,$26.40 ,$26.40 , N/A ,$38.04 , N/A ,$29.27 , N/A , N/A , N/A , N/A ,$43.90 ,$35.12 ,$35.12 , N/A ,$35.12 ,$44.48 ,$44.48 ,$44.48 ,$58.53 , N/A ,$49.75 , N/A ,$38.04 , N/A ,$58.53 ,$32.78 , N/A ,$15.39 , N/A , N/A , N/A , N/A ,$46.82 , N/A ,$26.40 ,$16.39 ,$52.68 , N/A ,$44.48 ,$38.04 ,$38.04 , N/A ,$38.04 ,$28.09 , N/A 
ST. ELIZABETH'S HOSPITAL,27000058,N/A,HC DEXTROSE STICKS,270,1 ,$12.28 ,$7.98 ,$3.23 ,$12.28 , N/A ,$5.65 ,$6.88 , N/A ,$3.44 ,$4.15 , N/A ,$4.78 , N/A ,$5.54 ,$5.54 , N/A ,$7.98 , N/A ,$6.14 , N/A , N/A , N/A , N/A ,$9.21 ,$7.37 ,$7.37 , N/A ,$7.37 ,$9.33 ,$9.33 ,$9.33 ,$12.28 , N/A ,$10.44 , N/A ,$7.98 , N/A ,$12.28 ,$6.88 , N/A ,$3.23 , N/A , N/A , N/A , N/A ,$9.82 , N/A ,$5.54 ,$3.44 ,$11.05 , N/A ,$9.33 ,$7.98 ,$7.98 , N/A ,$7.98 ,$5.89 , N/A 
ST. ELIZABETH'S HOSPITAL,27000106,N/A,HC SYRING KIT MR INJECTION SYSTEM,270,1 ,$51.00 ,$33.15 ,$13.41 ,$51.00 , N/A ,$23.46 ,$28.56 , N/A ,$14.28 ,$17.24 , N/A ,$19.84 , N/A ,$23.00 ,$23.00 , N/A ,$33.15 , N/A ,$25.50 , N/A , N/A , N/A , N/A ,$38.25 ,$30.60 ,$30.60 , N/A ,$30.60 ,$38.76 ,$38.76 ,$38.76 ,$51.00 , N/A ,$43.35 , N/A ,$33.15 , N/A ,$51.00 ,$28.56 , N/A ,$13.41 , N/A , N/A , N/A , N/A ,$40.80 , N/A ,$23.00 ,$14.28 ,$45.90 , N/A ,$38.76 ,$33.15 ,$33.15 , N/A ,$33.15 ,$24.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27000107,N/A,HC STANDARD (SPIKE) INFUSION SET,270,1 ,$38.34 ,$24.92 ,$10.08 ,$38.34 , N/A ,$17.64 ,$21.47 , N/A ,$10.74 ,$12.96 , N/A ,$14.91 , N/A ,$17.29 ,$17.29 , N/A ,$24.92 , N/A ,$19.17 , N/A , N/A , N/A , N/A ,$28.76 ,$23.00 ,$23.00 , N/A ,$23.00 ,$29.14 ,$29.14 ,$29.14 ,$38.34 , N/A ,$32.59 , N/A ,$24.92 , N/A ,$38.34 ,$21.47 , N/A ,$10.08 , N/A , N/A , N/A , N/A ,$30.67 , N/A ,$17.29 ,$10.74 ,$34.51 , N/A ,$29.14 ,$24.92 ,$24.92 , N/A ,$24.92 ,$18.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27000108,N/A,HC TRANSFER MATTRESS,270,1 ,$309.00 ,$200.85 ,$81.27 ,$309.00 , N/A ,$142.14 ,$173.04 , N/A ,$86.52 ,$104.44 , N/A ,$120.20 , N/A ,$139.36 ,$139.36 , N/A ,$200.85 , N/A ,$154.50 , N/A , N/A , N/A , N/A ,$231.75 ,$185.40 ,$185.40 , N/A ,$185.40 ,$234.84 ,$234.84 ,$234.84 ,$309.00 , N/A ,$262.65 , N/A ,$200.85 , N/A ,$309.00 ,$173.04 , N/A ,$81.27 , N/A , N/A , N/A , N/A ,$247.20 , N/A ,$139.36 ,$86.52 ,$278.10 , N/A ,$234.84 ,$200.85 ,$200.85 , N/A ,$200.85 ,$148.32 , N/A 
ST. ELIZABETH'S HOSPITAL,27000109,N/A,HC TRANSFER MATTRESS DISP,270,1 ,$209.70 ,$136.31 ,$55.15 ,$209.70 , N/A ,$96.46 ,$117.43 , N/A ,$58.72 ,$70.88 , N/A ,$81.57 , N/A ,$94.57 ,$94.57 , N/A ,$136.31 , N/A ,$104.85 , N/A , N/A , N/A , N/A ,$157.28 ,$125.82 ,$125.82 , N/A ,$125.82 ,$159.37 ,$159.37 ,$159.37 ,$209.70 , N/A ,$178.25 , N/A ,$136.31 , N/A ,$209.70 ,$117.43 , N/A ,$55.15 , N/A , N/A , N/A , N/A ,$167.76 , N/A ,$94.57 ,$58.72 ,$188.73 , N/A ,$159.37 ,$136.31 ,$136.31 , N/A ,$136.31 ,$100.66 , N/A 
ST. ELIZABETH'S HOSPITAL,27000111,N/A,HC ROM PLUS RUPTURE OF MEMBRANES TEST,270,1 ,$94.47 ,$61.41 ,$24.85 ,$94.47 , N/A ,$43.46 ,$52.90 , N/A ,$26.45 ,$31.93 , N/A ,$36.75 , N/A ,$42.61 ,$42.61 , N/A ,$61.41 , N/A ,$47.24 , N/A , N/A , N/A , N/A ,$70.85 ,$56.68 ,$56.68 , N/A ,$56.68 ,$71.80 ,$71.80 ,$71.80 ,$94.47 , N/A ,$80.30 , N/A ,$61.41 , N/A ,$94.47 ,$52.90 , N/A ,$24.85 , N/A , N/A , N/A , N/A ,$75.58 , N/A ,$42.61 ,$26.45 ,$85.02 , N/A ,$71.80 ,$61.41 ,$61.41 , N/A ,$61.41 ,$45.35 , N/A 
ST. ELIZABETH'S HOSPITAL,27000112,N/A,HC SENSOR MONITOR,270,1 ,$225.00 ,$146.25 ,$59.18 ,$225.00 , N/A ,$103.50 ,$126.00 , N/A ,$63.00 ,$76.05 , N/A ,$87.53 , N/A ,$101.48 ,$101.48 , N/A ,$146.25 , N/A ,$112.50 , N/A , N/A , N/A , N/A ,$168.75 ,$135.00 ,$135.00 , N/A ,$135.00 ,$171.00 ,$171.00 ,$171.00 ,$225.00 , N/A ,$191.25 , N/A ,$146.25 , N/A ,$225.00 ,$126.00 , N/A ,$59.18 , N/A , N/A , N/A , N/A ,$180.00 , N/A ,$101.48 ,$63.00 ,$202.50 , N/A ,$171.00 ,$146.25 ,$146.25 , N/A ,$146.25 ,$108.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000114,N/A,HC OP3 KIT/BITEBLOCK,270,1 ,$42.30 ,$27.50 ,$11.12 ,$42.30 , N/A ,$19.46 ,$23.69 , N/A ,$11.84 ,$14.30 , N/A ,$16.45 , N/A ,$19.08 ,$19.08 , N/A ,$27.50 , N/A ,$21.15 , N/A , N/A , N/A , N/A ,$31.73 ,$25.38 ,$25.38 , N/A ,$25.38 ,$32.15 ,$32.15 ,$32.15 ,$42.30 , N/A ,$35.96 , N/A ,$27.50 , N/A ,$42.30 ,$23.69 , N/A ,$11.12 , N/A , N/A , N/A , N/A ,$33.84 , N/A ,$19.08 ,$11.84 ,$38.07 , N/A ,$32.15 ,$27.50 ,$27.50 , N/A ,$27.50 ,$20.30 , N/A 
ST. ELIZABETH'S HOSPITAL,27000115,N/A,HC HEARING SCREEN EARPHONES/SENSORS,270,1 ,$32.33 ,$21.01 ,$8.50 ,$32.33 , N/A ,$14.87 ,$18.10 , N/A ,$9.05 ,$10.93 , N/A ,$12.58 , N/A ,$14.58 ,$14.58 , N/A ,$21.01 , N/A ,$16.17 , N/A , N/A , N/A , N/A ,$24.25 ,$19.40 ,$19.40 , N/A ,$19.40 ,$24.57 ,$24.57 ,$24.57 ,$32.33 , N/A ,$27.48 , N/A ,$21.01 , N/A ,$32.33 ,$18.10 , N/A ,$8.50 , N/A , N/A , N/A , N/A ,$25.86 , N/A ,$14.58 ,$9.05 ,$29.10 , N/A ,$24.57 ,$21.01 ,$21.01 , N/A ,$21.01 ,$15.52 , N/A 
ST. ELIZABETH'S HOSPITAL,27000128,N/A,HC C. DIFF QUICK CHECK TEST COMPLETE,270,1 ,"$1,612.50 ","$1,048.13 ",$424.09 ,"$1,612.50 ", N/A ,$741.75 ,$903.00 , N/A ,$451.50 ,$545.03 , N/A ,$627.26 , N/A ,$727.24 ,$727.24 , N/A ,"$1,048.13 ", N/A ,$806.25 , N/A , N/A , N/A , N/A ,"$1,209.38 ",$967.50 ,$967.50 , N/A ,$967.50 ,"$1,225.50 ","$1,225.50 ","$1,225.50 ","$1,612.50 ", N/A ,"$1,370.63 ", N/A ,"$1,048.13 ", N/A ,"$1,612.50 ",$903.00 , N/A ,$424.09 , N/A , N/A , N/A , N/A ,"$1,290.00 ", N/A ,$727.24 ,$451.50 ,"$1,451.25 ", N/A ,"$1,225.50 ","$1,048.13 ","$1,048.13 ", N/A ,"$1,048.13 ",$774.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27000129,N/A,HC STERILIZATION WRAP,270,1 ,$396.34 ,$257.62 ,$104.24 ,$396.34 , N/A ,$182.32 ,$221.95 , N/A ,$110.98 ,$133.96 , N/A ,$154.18 , N/A ,$178.75 ,$178.75 , N/A ,$257.62 , N/A ,$198.17 , N/A , N/A , N/A , N/A ,$297.26 ,$237.80 ,$237.80 , N/A ,$237.80 ,$301.22 ,$301.22 ,$301.22 ,$396.34 , N/A ,$336.89 , N/A ,$257.62 , N/A ,$396.34 ,$221.95 , N/A ,$104.24 , N/A , N/A , N/A , N/A ,$317.07 , N/A ,$178.75 ,$110.98 ,$356.71 , N/A ,$301.22 ,$257.62 ,$257.62 , N/A ,$257.62 ,$190.24 , N/A 
ST. ELIZABETH'S HOSPITAL,27000133,N/A,HC NEURO SENSOR,270,1 ,$67.50 ,$43.88 ,$17.75 ,$67.50 , N/A ,$31.05 ,$37.80 , N/A ,$18.90 ,$22.82 , N/A ,$26.26 , N/A ,$30.44 ,$30.44 , N/A ,$43.88 , N/A ,$33.75 , N/A , N/A , N/A , N/A ,$50.63 ,$40.50 ,$40.50 , N/A ,$40.50 ,$51.30 ,$51.30 ,$51.30 ,$67.50 , N/A ,$57.38 , N/A ,$43.88 , N/A ,$67.50 ,$37.80 , N/A ,$17.75 , N/A , N/A , N/A , N/A ,$54.00 , N/A ,$30.44 ,$18.90 ,$60.75 , N/A ,$51.30 ,$43.88 ,$43.88 , N/A ,$43.88 ,$32.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27000134,N/A,HC ADAPTER AIRWAY CAP,270,1 ,$85.05 ,$55.28 ,$22.37 ,$85.05 , N/A ,$39.12 ,$47.63 , N/A ,$23.81 ,$28.75 , N/A ,$33.08 , N/A ,$38.36 ,$38.36 , N/A ,$55.28 , N/A ,$42.53 , N/A , N/A , N/A , N/A ,$63.79 ,$51.03 ,$51.03 , N/A ,$51.03 ,$64.64 ,$64.64 ,$64.64 ,$85.05 , N/A ,$72.29 , N/A ,$55.28 , N/A ,$85.05 ,$47.63 , N/A ,$22.37 , N/A , N/A , N/A , N/A ,$68.04 , N/A ,$38.36 ,$23.81 ,$76.55 , N/A ,$64.64 ,$55.28 ,$55.28 , N/A ,$55.28 ,$40.82 , N/A 
ST. ELIZABETH'S HOSPITAL,27000135,N/A,HC COLON KIT,270,1 ,$43.65 ,$28.37 ,$11.48 ,$43.65 , N/A ,$20.08 ,$24.44 , N/A ,$12.22 ,$14.75 , N/A ,$16.98 , N/A ,$19.69 ,$19.69 , N/A ,$28.37 , N/A ,$21.83 , N/A , N/A , N/A , N/A ,$32.74 ,$26.19 ,$26.19 , N/A ,$26.19 ,$33.17 ,$33.17 ,$33.17 ,$43.65 , N/A ,$37.10 , N/A ,$28.37 , N/A ,$43.65 ,$24.44 , N/A ,$11.48 , N/A , N/A , N/A , N/A ,$34.92 , N/A ,$19.69 ,$12.22 ,$39.29 , N/A ,$33.17 ,$28.37 ,$28.37 , N/A ,$28.37 ,$20.95 , N/A 
ST. ELIZABETH'S HOSPITAL,27100021,N/A,HC CAST ARM SYNTHETIC,271,1 ,$110.00 ,$71.50 ,$28.93 ,$110.00 , N/A ,$50.60 ,$61.60 , N/A ,$30.80 ,$37.18 , N/A ,$42.79 , N/A ,$49.61 ,$49.61 , N/A ,$71.50 , N/A ,$55.00 , N/A , N/A , N/A , N/A ,$82.50 ,$66.00 ,$66.00 , N/A ,$66.00 ,$83.60 ,$83.60 ,$83.60 ,$110.00 , N/A ,$93.50 , N/A ,$71.50 , N/A ,$110.00 ,$61.60 , N/A ,$28.93 , N/A , N/A , N/A , N/A ,$88.00 , N/A ,$49.61 ,$30.80 ,$99.00 , N/A ,$83.60 ,$71.50 ,$71.50 , N/A ,$71.50 ,$52.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27100024,N/A,HC CAST LEG SYNTHETIC,271,1 ,$165.00 ,$107.25 ,$43.40 ,$165.00 , N/A ,$75.90 ,$92.40 , N/A ,$46.20 ,$55.77 , N/A ,$64.19 , N/A ,$74.42 ,$74.42 , N/A ,$107.25 , N/A ,$82.50 , N/A , N/A , N/A , N/A ,$123.75 ,$99.00 ,$99.00 , N/A ,$99.00 ,$125.40 ,$125.40 ,$125.40 ,$165.00 , N/A ,$140.25 , N/A ,$107.25 , N/A ,$165.00 ,$92.40 , N/A ,$43.40 , N/A , N/A , N/A , N/A ,$132.00 , N/A ,$74.42 ,$46.20 ,$148.50 , N/A ,$125.40 ,$107.25 ,$107.25 , N/A ,$107.25 ,$79.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27100038,N/A,HC CPAP MASK,271,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100054,N/A,HC FOAM BLOCK,271,1 ,$4.57 ,$2.97 ,$1.20 ,$4.57 , N/A ,$2.10 ,$2.56 , N/A ,$1.28 ,$1.54 , N/A ,$1.78 , N/A ,$2.06 ,$2.06 , N/A ,$2.97 , N/A ,$2.29 , N/A , N/A , N/A , N/A ,$3.43 ,$2.74 ,$2.74 , N/A ,$2.74 ,$3.47 ,$3.47 ,$3.47 ,$4.57 , N/A ,$3.88 , N/A ,$2.97 , N/A ,$4.57 ,$2.56 , N/A ,$1.20 , N/A , N/A , N/A , N/A ,$3.66 , N/A ,$2.06 ,$1.28 ,$4.11 , N/A ,$3.47 ,$2.97 ,$2.97 , N/A ,$2.97 ,$2.19 , N/A 
ST. ELIZABETH'S HOSPITAL,27100080,N/A,HC LARYNGEAL MASK AIRWAY,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27100096,N/A,HC NASAL PHANYNGEAL AIRWAY,271,1 ,$9.20 ,$5.98 ,$2.42 ,$9.20 , N/A ,$4.23 ,$5.15 , N/A ,$2.58 ,$3.11 , N/A ,$3.58 , N/A ,$4.15 ,$4.15 , N/A ,$5.98 , N/A ,$4.60 , N/A , N/A , N/A , N/A ,$6.90 ,$5.52 ,$5.52 , N/A ,$5.52 ,$6.99 ,$6.99 ,$6.99 ,$9.20 , N/A ,$7.82 , N/A ,$5.98 , N/A ,$9.20 ,$5.15 , N/A ,$2.42 , N/A , N/A , N/A , N/A ,$7.36 , N/A ,$4.15 ,$2.58 ,$8.28 , N/A ,$6.99 ,$5.98 ,$5.98 , N/A ,$5.98 ,$4.42 , N/A 
ST. ELIZABETH'S HOSPITAL,27100106,N/A,HC OXYGEN DAILY,271,1 ,$54.16 ,$35.20 ,$14.24 ,$54.16 , N/A ,$24.91 ,$30.33 , N/A ,$15.16 ,$18.31 , N/A ,$21.07 , N/A ,$24.43 ,$24.43 , N/A ,$35.20 , N/A ,$27.08 , N/A , N/A , N/A , N/A ,$40.62 ,$32.50 ,$32.50 , N/A ,$32.50 ,$41.16 ,$41.16 ,$41.16 ,$54.16 , N/A ,$46.04 , N/A ,$35.20 , N/A ,$54.16 ,$30.33 , N/A ,$14.24 , N/A , N/A , N/A , N/A ,$43.33 , N/A ,$24.43 ,$15.16 ,$48.74 , N/A ,$41.16 ,$35.20 ,$35.20 , N/A ,$35.20 ,$26.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100107,N/A,HC OXYGEN HOURLY,271,1 ,$16.00 ,$10.40 ,$4.21 ,$16.00 , N/A ,$7.36 ,$8.96 , N/A ,$4.48 ,$5.41 , N/A ,$6.22 , N/A ,$7.22 ,$7.22 , N/A ,$10.40 , N/A ,$8.00 , N/A , N/A , N/A , N/A ,$12.00 ,$9.60 ,$9.60 , N/A ,$9.60 ,$12.16 ,$12.16 ,$12.16 ,$16.00 , N/A ,$13.60 , N/A ,$10.40 , N/A ,$16.00 ,$8.96 , N/A ,$4.21 , N/A , N/A , N/A , N/A ,$12.80 , N/A ,$7.22 ,$4.48 ,$14.40 , N/A ,$12.16 ,$10.40 ,$10.40 , N/A ,$10.40 ,$7.68 , N/A 
ST. ELIZABETH'S HOSPITAL,27100108,N/A,HC OXYGEN HOOD DAILY,271,1 ,$238.50 ,$155.03 ,$62.73 ,$238.50 , N/A ,$109.71 ,$133.56 , N/A ,$66.78 ,$80.61 , N/A ,$92.78 , N/A ,$107.56 ,$107.56 , N/A ,$155.03 , N/A ,$119.25 , N/A , N/A , N/A , N/A ,$178.88 ,$143.10 ,$143.10 , N/A ,$143.10 ,$181.26 ,$181.26 ,$181.26 ,$238.50 , N/A ,$202.73 , N/A ,$155.03 , N/A ,$238.50 ,$133.56 , N/A ,$62.73 , N/A , N/A , N/A , N/A ,$190.80 , N/A ,$107.56 ,$66.78 ,$214.65 , N/A ,$181.26 ,$155.03 ,$155.03 , N/A ,$155.03 ,$114.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27100141,N/A,HC SPLINT ORTHGLSS 4IN/INCH,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100142,N/A,HC SPLINT ORTHGLSS 5IN/INCH,271,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100183,N/A,HC WALKING BRACE LOW TIDE,271,1 ,$117.03 ,$76.07 ,$30.78 ,$117.03 , N/A ,$53.83 ,$65.54 , N/A ,$32.77 ,$39.56 , N/A ,$45.52 , N/A ,$52.78 ,$52.78 , N/A ,$76.07 , N/A ,$58.52 , N/A , N/A , N/A , N/A ,$87.77 ,$70.22 ,$70.22 , N/A ,$70.22 ,$88.94 ,$88.94 ,$88.94 ,$117.03 , N/A ,$99.48 , N/A ,$76.07 , N/A ,$117.03 ,$65.54 , N/A ,$30.78 , N/A , N/A , N/A , N/A ,$93.62 , N/A ,$52.78 ,$32.77 ,$105.33 , N/A ,$88.94 ,$76.07 ,$76.07 , N/A ,$76.07 ,$56.17 , N/A 
ST. ELIZABETH'S HOSPITAL,27100185,N/A,HC CANNULA NASAL OXIMIZER,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100187,N/A,HC BAG DRAINAGE,271,1 ,$142.00 ,$92.30 ,$37.35 ,$142.00 , N/A ,$65.32 ,$79.52 , N/A ,$39.76 ,$48.00 , N/A ,$55.24 , N/A ,$64.04 ,$64.04 , N/A ,$92.30 , N/A ,$71.00 , N/A , N/A , N/A , N/A ,$106.50 ,$85.20 ,$85.20 , N/A ,$85.20 ,$107.92 ,$107.92 ,$107.92 ,$142.00 , N/A ,$120.70 , N/A ,$92.30 , N/A ,$142.00 ,$79.52 , N/A ,$37.35 , N/A , N/A , N/A , N/A ,$113.60 , N/A ,$64.04 ,$39.76 ,$127.80 , N/A ,$107.92 ,$92.30 ,$92.30 , N/A ,$92.30 ,$68.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27100191,E0218,HC COLD THERAPY SYSTEM,271,1 ,$598.18 ,$388.82 ,$119.64 ,$598.18 ,$299.10 ,$275.16 ,$334.98 ,$119.64 ,$167.49 ,$202.18 ,$119.64 ,$232.69 ,$119.64 ,$269.78 ,$269.78 ,$119.64 ,$388.82 ,$227.31 ,$299.09 ,$299.09 ,$119.64 ,$119.64 ,$122.03 ,$448.64 ,$358.91 ,$358.91 ,$119.64 ,$358.91 ,$454.62 ,$454.62 ,$454.62 ,$598.18 , N/A ,$508.45 ,$299.09 ,$388.82 ,$119.64 ,$598.18 ,$334.98 ,$119.64 ,$157.32 , N/A , N/A , N/A ,$125.62 ,$478.54 ,$269.18 ,$269.78 ,$167.49 ,$538.36 ,$119.64 ,$454.62 ,$388.82 ,$388.82 ,$119.64 ,$388.82 ,$287.13 , N/A 
ST. ELIZABETH'S HOSPITAL,27100205,N/A,HC COLLAR CERVICAL ASPEN,271,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100210,N/A,HC KIT CANISTER SUCTION,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100211,N/A,HC PAD DEFIBRILLATOR,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100218,N/A,HC SET IV BLOOD ADMINISTRATION,271,1 ,$25.02 ,$16.26 ,$6.58 ,$25.02 , N/A ,$11.51 ,$14.01 , N/A ,$7.01 ,$8.46 , N/A ,$9.73 , N/A ,$11.28 ,$11.28 , N/A ,$16.26 , N/A ,$12.51 , N/A , N/A , N/A , N/A ,$18.77 ,$15.01 ,$15.01 , N/A ,$15.01 ,$19.02 ,$19.02 ,$19.02 ,$25.02 , N/A ,$21.27 , N/A ,$16.26 , N/A ,$25.02 ,$14.01 , N/A ,$6.58 , N/A , N/A , N/A , N/A ,$20.02 , N/A ,$11.28 ,$7.01 ,$22.52 , N/A ,$19.02 ,$16.26 ,$16.26 , N/A ,$16.26 ,$12.01 , N/A 
ST. ELIZABETH'S HOSPITAL,27100242,N/A,HC CANNULA NASAL W/HEAD STRAP,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100243,N/A,HC CANISTER/GEL WOUND INFOVAC 500ML,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100244,N/A,HC SPLINT ORTHGLSS 2IN/INCH,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100245,N/A,HC SPLINT ORTHGLSS 3IN/INCH,271,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100246,N/A,HC SPLINT ORTHGLSS 6IN/INCH,271,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100247,N/A,HC SLING SHOULDER,271,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100248,N/A,HC SLING SHOULDER W/PILLOW,271,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100249,N/A,HC VEST AIRWAY,271,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100251,N/A,HC BAG URINARY DRAIN,271,1 ,$42.00 ,$27.30 ,$11.05 ,$42.00 , N/A ,$19.32 ,$23.52 , N/A ,$11.76 ,$14.20 , N/A ,$16.34 , N/A ,$18.94 ,$18.94 , N/A ,$27.30 , N/A ,$21.00 , N/A , N/A , N/A , N/A ,$31.50 ,$25.20 ,$25.20 , N/A ,$25.20 ,$31.92 ,$31.92 ,$31.92 ,$42.00 , N/A ,$35.70 , N/A ,$27.30 , N/A ,$42.00 ,$23.52 , N/A ,$11.05 , N/A , N/A , N/A , N/A ,$33.60 , N/A ,$18.94 ,$11.76 ,$37.80 , N/A ,$31.92 ,$27.30 ,$27.30 , N/A ,$27.30 ,$20.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27100254,N/A,HC CUFF BLOOD PRESSURE,271,1 ,$33.00 ,$21.45 ,$8.68 ,$33.00 , N/A ,$15.18 ,$18.48 , N/A ,$9.24 ,$11.15 , N/A ,$12.84 , N/A ,$14.88 ,$14.88 , N/A ,$21.45 , N/A ,$16.50 , N/A , N/A , N/A , N/A ,$24.75 ,$19.80 ,$19.80 , N/A ,$19.80 ,$25.08 ,$25.08 ,$25.08 ,$33.00 , N/A ,$28.05 , N/A ,$21.45 , N/A ,$33.00 ,$18.48 , N/A ,$8.68 , N/A , N/A , N/A , N/A ,$26.40 , N/A ,$14.88 ,$9.24 ,$29.70 , N/A ,$25.08 ,$21.45 ,$21.45 , N/A ,$21.45 ,$15.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27100255,N/A,HC ELECTRODE DEFIB FAST PATCH,271,1 ,$33.00 ,$21.45 ,$8.68 ,$33.00 , N/A ,$15.18 ,$18.48 , N/A ,$9.24 ,$11.15 , N/A ,$12.84 , N/A ,$14.88 ,$14.88 , N/A ,$21.45 , N/A ,$16.50 , N/A , N/A , N/A , N/A ,$24.75 ,$19.80 ,$19.80 , N/A ,$19.80 ,$25.08 ,$25.08 ,$25.08 ,$33.00 , N/A ,$28.05 , N/A ,$21.45 , N/A ,$33.00 ,$18.48 , N/A ,$8.68 , N/A , N/A , N/A , N/A ,$26.40 , N/A ,$14.88 ,$9.24 ,$29.70 , N/A ,$25.08 ,$21.45 ,$21.45 , N/A ,$21.45 ,$15.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27100265,N/A,HC ORTHOSIS HAND RESTING MOLDED,271,1 ,$137.19 ,$89.17 ,$36.08 ,$137.19 , N/A ,$63.11 ,$76.83 , N/A ,$38.41 ,$46.37 , N/A ,$53.37 , N/A ,$61.87 ,$61.87 , N/A ,$89.17 , N/A ,$68.60 , N/A , N/A , N/A , N/A ,$102.89 ,$82.31 ,$82.31 , N/A ,$82.31 ,$104.26 ,$104.26 ,$104.26 ,$137.19 , N/A ,$116.61 , N/A ,$89.17 , N/A ,$137.19 ,$76.83 , N/A ,$36.08 , N/A , N/A , N/A , N/A ,$109.75 , N/A ,$61.87 ,$38.41 ,$123.47 , N/A ,$104.26 ,$89.17 ,$89.17 , N/A ,$89.17 ,$65.85 , N/A 
ST. ELIZABETH'S HOSPITAL,27100268,N/A,HC SLING HEMI ARM,271,1 ,$114.29 ,$74.29 ,$30.06 ,$114.29 , N/A ,$52.57 ,$64.00 , N/A ,$32.00 ,$38.63 , N/A ,$44.46 , N/A ,$51.54 ,$51.54 , N/A ,$74.29 , N/A ,$57.15 , N/A , N/A , N/A , N/A ,$85.72 ,$68.57 ,$68.57 , N/A ,$68.57 ,$86.86 ,$86.86 ,$86.86 ,$114.29 , N/A ,$97.15 , N/A ,$74.29 , N/A ,$114.29 ,$64.00 , N/A ,$30.06 , N/A , N/A , N/A , N/A ,$91.43 , N/A ,$51.54 ,$32.00 ,$102.86 , N/A ,$86.86 ,$74.29 ,$74.29 , N/A ,$74.29 ,$54.86 , N/A 
ST. ELIZABETH'S HOSPITAL,27100270,N/A,HC OXYGEN WATER TRAP W/ANESTHESIA,271,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27100272,N/A,HC OXYGEN WATER TRAP W/RAD PROCS,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27100276,N/A,HC TAPE PAPER/PLASTIC,271,1 ,$5.73 ,$3.72 ,$1.51 ,$5.73 , N/A ,$2.64 ,$3.21 , N/A ,$1.60 ,$1.94 , N/A ,$2.23 , N/A ,$2.58 ,$2.58 , N/A ,$3.72 , N/A ,$2.87 , N/A , N/A , N/A , N/A ,$4.30 ,$3.44 ,$3.44 , N/A ,$3.44 ,$4.35 ,$4.35 ,$4.35 ,$5.73 , N/A ,$4.87 , N/A ,$3.72 , N/A ,$5.73 ,$3.21 , N/A ,$1.51 , N/A , N/A , N/A , N/A ,$4.58 , N/A ,$2.58 ,$1.60 ,$5.16 , N/A ,$4.35 ,$3.72 ,$3.72 , N/A ,$3.72 ,$2.75 , N/A 
ST. ELIZABETH'S HOSPITAL,27100553,N/A,HC HEEL PROTECTOR,271,1 ,$111.39 ,$72.40 ,$29.30 ,$111.39 , N/A ,$51.24 ,$62.38 , N/A ,$31.19 ,$37.65 , N/A ,$43.33 , N/A ,$50.24 ,$50.24 , N/A ,$72.40 , N/A ,$55.70 , N/A , N/A , N/A , N/A ,$83.54 ,$66.83 ,$66.83 , N/A ,$66.83 ,$84.66 ,$84.66 ,$84.66 ,$111.39 , N/A ,$94.68 , N/A ,$72.40 , N/A ,$111.39 ,$62.38 , N/A ,$29.30 , N/A , N/A , N/A , N/A ,$89.11 , N/A ,$50.24 ,$31.19 ,$100.25 , N/A ,$84.66 ,$72.40 ,$72.40 , N/A ,$72.40 ,$53.47 , N/A 
ST. ELIZABETH'S HOSPITAL,27200002,A7041,HC PLEURAL DRAINAGE SYSTEM,272,1 ,$66.06 ,$42.94 ,$17.37 ,$66.06 , N/A ,$30.39 ,$36.99 , N/A ,$18.50 ,$23.32 , N/A ,$27.22 , N/A ,$29.79 ,$29.79 , N/A ,$42.94 , N/A ,$33.03 , N/A , N/A , N/A , N/A ,$49.55 ,$39.64 ,$39.64 , N/A ,$39.64 ,$50.21 ,$50.21 ,$50.21 ,$66.06 , N/A ,$56.15 , N/A ,$42.94 , N/A ,$66.06 ,$36.99 , N/A ,$17.37 , N/A , N/A , N/A , N/A ,$52.85 , N/A ,$29.79 ,$18.50 ,$59.45 , N/A ,$50.21 ,$42.94 ,$42.94 , N/A ,$42.94 ,$31.71 , N/A 
ST. ELIZABETH'S HOSPITAL,27200009,C1724,HC ROTABLATOR BURR,272,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,462.50 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,710.00 ","$1,710.00 ","$1,710.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,710.00 ","$1,462.50 ","$1,462.50 ", N/A ,"$1,462.50 ","$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27200011,C1724,HC ROTALINK PLUS,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27200029,C1726,HC DILATOR BALLOON,272,1 ,"$1,057.00 ",$687.05 ,$277.99 ,"$1,057.00 ", N/A ,$486.22 ,$591.92 , N/A ,$295.96 ,$357.27 , N/A ,$411.17 , N/A ,$476.71 ,$476.71 , N/A ,$687.05 , N/A ,$528.50 , N/A , N/A , N/A , N/A ,$792.75 ,$634.20 ,$634.20 , N/A ,$634.20 ,$803.32 ,$803.32 ,$803.32 ,"$1,057.00 ", N/A ,$898.45 , N/A ,$687.05 , N/A ,"$1,057.00 ",$591.92 , N/A ,$277.99 , N/A , N/A , N/A , N/A ,$845.60 , N/A ,$476.71 ,$295.96 ,$951.30 , N/A ,$803.32 ,$687.05 ,$687.05 , N/A ,$687.05 ,$507.36 , N/A 
ST. ELIZABETH'S HOSPITAL,27200034,C1729,HC CATHETER DRAINAGE,272,1 ,$197.66 ,$128.48 ,$51.98 ,$197.66 , N/A ,$90.92 ,$110.69 , N/A ,$55.34 ,$66.81 , N/A ,$76.89 , N/A ,$89.14 ,$89.14 , N/A ,$128.48 , N/A ,$98.83 , N/A , N/A , N/A , N/A ,$148.25 ,$118.60 ,$118.60 , N/A ,$118.60 ,$150.22 ,$150.22 ,$150.22 ,$197.66 , N/A ,$168.01 , N/A ,$128.48 , N/A ,$197.66 ,$110.69 , N/A ,$51.98 , N/A , N/A , N/A , N/A ,$158.13 , N/A ,$89.14 ,$55.34 ,$177.89 , N/A ,$150.22 ,$128.48 ,$128.48 , N/A ,$128.48 ,$94.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27200035,C1729,HC CATHETER DRAINAGE PLEUREX,272,1 ,$198.19 ,$128.82 ,$52.12 ,$198.19 , N/A ,$91.17 ,$110.99 , N/A ,$55.49 ,$66.99 , N/A ,$77.10 , N/A ,$89.38 ,$89.38 , N/A ,$128.82 , N/A ,$99.10 , N/A , N/A , N/A , N/A ,$148.64 ,$118.91 ,$118.91 , N/A ,$118.91 ,$150.62 ,$150.62 ,$150.62 ,$198.19 , N/A ,$168.46 , N/A ,$128.82 , N/A ,$198.19 ,$110.99 , N/A ,$52.12 , N/A , N/A , N/A , N/A ,$158.55 , N/A ,$89.38 ,$55.49 ,$178.37 , N/A ,$150.62 ,$128.82 ,$128.82 , N/A ,$128.82 ,$95.13 , N/A 
ST. ELIZABETH'S HOSPITAL,27200052,C1730,HC QUADRIPOLAR CATHETER,272,1 ,"$3,750.00 ","$2,437.50 ",$986.25 ,"$3,750.00 ", N/A ,"$1,725.00 ","$2,100.00 ", N/A ,"$1,050.00 ","$1,267.50 ", N/A ,"$1,458.75 ", N/A ,"$1,691.25 ","$1,691.25 ", N/A ,"$2,437.50 ", N/A ,"$1,875.00 ", N/A , N/A , N/A , N/A ,"$2,812.50 ","$2,250.00 ","$2,250.00 ", N/A ,"$2,250.00 ","$2,850.00 ","$2,850.00 ","$2,850.00 ","$3,750.00 ", N/A ,"$3,187.50 ", N/A ,"$2,437.50 ", N/A ,"$3,750.00 ","$2,100.00 ", N/A ,$986.25 , N/A , N/A , N/A , N/A ,"$3,000.00 ", N/A ,"$1,691.25 ","$1,050.00 ","$3,375.00 ", N/A ,"$2,850.00 ","$2,437.50 ","$2,437.50 ", N/A ,"$2,437.50 ","$1,800.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27200054,C1751,HC KIT CATHETER,272,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$55.20 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 ,$78.00 ,$78.00 , N/A ,$78.00 ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27200055,C1751,HC CATH MULTILUMEN CVP,272,1 ,$114.00 ,$74.10 ,$29.98 ,$114.00 , N/A ,$52.44 ,$63.84 , N/A ,$31.92 ,$38.53 , N/A ,$44.35 , N/A ,$51.41 ,$51.41 , N/A ,$74.10 , N/A ,$57.00 , N/A , N/A , N/A , N/A ,$85.50 ,$68.40 ,$68.40 , N/A ,$68.40 ,$86.64 ,$86.64 ,$86.64 ,$114.00 , N/A ,$96.90 , N/A ,$74.10 , N/A ,$114.00 ,$63.84 , N/A ,$29.98 , N/A , N/A , N/A , N/A ,$91.20 , N/A ,$51.41 ,$31.92 ,$102.60 , N/A ,$86.64 ,$74.10 ,$74.10 , N/A ,$74.10 ,$54.72 , N/A 
ST. ELIZABETH'S HOSPITAL,27200059,C1757,HC ANGIOJET ZELANTE CATHETER,272,1 ,"$8,868.00 ","$5,764.20 ","$2,332.28 ","$8,868.00 ", N/A ,"$4,079.28 ","$4,966.08 ", N/A ,"$2,483.04 ","$2,997.38 ", N/A ,"$3,449.65 ", N/A ,"$3,999.47 ","$3,999.47 ", N/A ,"$5,764.20 ", N/A ,"$4,434.00 ", N/A , N/A , N/A , N/A ,"$6,651.00 ","$5,320.80 ","$5,320.80 ", N/A ,"$5,320.80 ","$6,739.68 ","$6,739.68 ","$6,739.68 ","$8,868.00 ", N/A ,"$7,537.80 ", N/A ,"$5,764.20 ", N/A ,"$8,868.00 ","$4,966.08 ", N/A ,"$2,332.28 ", N/A , N/A , N/A , N/A ,"$7,094.40 ", N/A ,"$3,999.47 ","$2,483.04 ","$7,981.20 ", N/A ,"$6,739.68 ","$5,764.20 ","$5,764.20 ", N/A ,"$5,764.20 ","$4,256.64 ", N/A 
ST. ELIZABETH'S HOSPITAL,27200070,C1757,HC CATH THROMBECTOMY,272,1 ,"$1,125.00 ",$731.25 ,$295.88 ,"$1,125.00 ", N/A ,$517.50 ,$630.00 , N/A ,$315.00 ,$380.25 , N/A ,$437.63 , N/A ,$507.38 ,$507.38 , N/A ,$731.25 , N/A ,$562.50 , N/A , N/A , N/A , N/A ,$843.75 ,$675.00 ,$675.00 , N/A ,$675.00 ,$855.00 ,$855.00 ,$855.00 ,"$1,125.00 ", N/A ,$956.25 , N/A ,$731.25 , N/A ,"$1,125.00 ",$630.00 , N/A ,$295.88 , N/A , N/A , N/A , N/A ,$900.00 , N/A ,$507.38 ,$315.00 ,"$1,012.50 ", N/A ,$855.00 ,$731.25 ,$731.25 , N/A ,$731.25 ,$540.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200077,C1764,HC REVEAL LOOP RECORDER,278,1 ,"$14,616.00 ","$9,500.40 ","$3,844.01 ","$14,616.00 ", N/A ,"$6,723.36 ","$8,184.96 ", N/A ,"$4,092.48 ","$4,940.21 ", N/A ,"$5,685.62 ", N/A ,"$6,591.82 ","$6,591.82 ", N/A ,"$6,591.82 ", N/A ,"$7,308.00 ", N/A , N/A , N/A , N/A ,"$10,962.00 ","$8,769.60 ","$8,769.60 ", N/A ,"$8,769.60 ","$7,308.00 ","$7,308.00 ","$7,308.00 ","$14,616.00 ", N/A ,"$12,423.60 ", N/A ,"$9,500.40 ", N/A ,"$14,616.00 ","$8,184.96 ", N/A ,"$3,844.01 ", N/A , N/A , N/A , N/A ,"$11,692.80 ", N/A ,"$6,591.82 ","$4,092.48 ","$13,154.40 ", N/A ,"$7,308.00 ","$5,510.23 ","$5,510.23 ", N/A ,"$5,510.23 ","$7,015.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,27200083,C1769,HC CRICOTHYROTOMY CATH/GUIDEWIRE,272,1 ,$396.38 ,$257.65 ,$104.25 ,$396.38 , N/A ,$182.33 ,$221.97 , N/A ,$110.99 ,$133.98 , N/A ,$154.19 , N/A ,$178.77 ,$178.77 , N/A ,$257.65 , N/A ,$198.19 , N/A , N/A , N/A , N/A ,$297.29 ,$237.83 ,$237.83 , N/A ,$237.83 ,$301.25 ,$301.25 ,$301.25 ,$396.38 , N/A ,$336.92 , N/A ,$257.65 , N/A ,$396.38 ,$221.97 , N/A ,$104.25 , N/A , N/A , N/A , N/A ,$317.10 , N/A ,$178.77 ,$110.99 ,$356.74 , N/A ,$301.25 ,$257.65 ,$257.65 , N/A ,$257.65 ,$190.26 , N/A 
ST. ELIZABETH'S HOSPITAL,27200107,C1769,HC GUIDEWIRE BENTSON,272,1 ,$71.88 ,$46.72 ,$18.90 ,$71.88 , N/A ,$33.06 ,$40.25 , N/A ,$20.13 ,$24.30 , N/A ,$27.96 , N/A ,$32.42 ,$32.42 , N/A ,$46.72 , N/A ,$35.94 , N/A , N/A , N/A , N/A ,$53.91 ,$43.13 ,$43.13 , N/A ,$43.13 ,$54.63 ,$54.63 ,$54.63 ,$71.88 , N/A ,$61.10 , N/A ,$46.72 , N/A ,$71.88 ,$40.25 , N/A ,$18.90 , N/A , N/A , N/A , N/A ,$57.50 , N/A ,$32.42 ,$20.13 ,$64.69 , N/A ,$54.63 ,$46.72 ,$46.72 , N/A ,$46.72 ,$34.50 , N/A 
ST. ELIZABETH'S HOSPITAL,27200138,C1773,HC SNARE RETRIEVAL DEVICE,272,1 ,$687.00 ,$446.55 ,$180.68 ,$687.00 , N/A ,$316.02 ,$384.72 , N/A ,$192.36 ,$232.21 , N/A ,$267.24 , N/A ,$309.84 ,$309.84 , N/A ,$446.55 , N/A ,$343.50 , N/A , N/A , N/A , N/A ,$515.25 ,$412.20 ,$412.20 , N/A ,$412.20 ,$522.12 ,$522.12 ,$522.12 ,$687.00 , N/A ,$583.95 , N/A ,$446.55 , N/A ,$687.00 ,$384.72 , N/A ,$180.68 , N/A , N/A , N/A , N/A ,$549.60 , N/A ,$309.84 ,$192.36 ,$618.30 , N/A ,$522.12 ,$446.55 ,$446.55 , N/A ,$446.55 ,$329.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27200152,C1884,HC EMBOLIZATION PROTECTION SYSTEM,272,1 ,"$3,250.00 ","$2,112.50 ",$854.75 ,"$3,250.00 ", N/A ,"$1,495.00 ","$1,820.00 ", N/A ,$910.00 ,"$1,098.50 ", N/A ,"$1,264.25 ", N/A ,"$1,465.75 ","$1,465.75 ", N/A ,"$2,112.50 ", N/A ,"$1,625.00 ", N/A , N/A , N/A , N/A ,"$2,437.50 ","$1,950.00 ","$1,950.00 ", N/A ,"$1,950.00 ","$2,470.00 ","$2,470.00 ","$2,470.00 ","$3,250.00 ", N/A ,"$2,762.50 ", N/A ,"$2,112.50 ", N/A ,"$3,250.00 ","$1,820.00 ", N/A ,$854.75 , N/A , N/A , N/A , N/A ,"$2,600.00 ", N/A ,"$1,465.75 ",$910.00 ,"$2,925.00 ", N/A ,"$2,470.00 ","$2,112.50 ","$2,112.50 ", N/A ,"$2,112.50 ","$1,560.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27200175,C1894,HC SHEATH SAFE 7FR 8FR 9FR,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200176,C2618,HC CRYO ABLATION SYSTEM,272,1 ,"$4,200.00 ","$2,730.00 ","$1,104.60 ","$4,200.00 ", N/A ,"$1,932.00 ","$2,352.00 ", N/A ,"$1,176.00 ","$1,419.60 ", N/A ,"$1,633.80 ", N/A ,"$1,894.20 ","$1,894.20 ", N/A ,"$2,730.00 ", N/A ,"$2,100.00 ", N/A , N/A , N/A , N/A ,"$3,150.00 ","$2,520.00 ","$2,520.00 ", N/A ,"$2,520.00 ","$3,192.00 ","$3,192.00 ","$3,192.00 ","$4,200.00 ", N/A ,"$3,570.00 ", N/A ,"$2,730.00 ", N/A ,"$4,200.00 ","$2,352.00 ", N/A ,"$1,104.60 ", N/A , N/A , N/A , N/A ,"$3,360.00 ", N/A ,"$1,894.20 ","$1,176.00 ","$3,780.00 ", N/A ,"$3,192.00 ","$2,730.00 ","$2,730.00 ", N/A ,"$2,730.00 ","$2,016.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27200178,C2627,HC CATH SUPRAPUBIC,272,1 ,$97.24 ,$63.21 ,$25.57 ,$97.24 , N/A ,$44.73 ,$54.45 , N/A ,$27.23 ,$32.87 , N/A ,$37.83 , N/A ,$43.86 ,$43.86 , N/A ,$63.21 , N/A ,$48.62 , N/A , N/A , N/A , N/A ,$72.93 ,$58.34 ,$58.34 , N/A ,$58.34 ,$73.90 ,$73.90 ,$73.90 ,$97.24 , N/A ,$82.65 , N/A ,$63.21 , N/A ,$97.24 ,$54.45 , N/A ,$25.57 , N/A , N/A , N/A , N/A ,$77.79 , N/A ,$43.86 ,$27.23 ,$87.52 , N/A ,$73.90 ,$63.21 ,$63.21 , N/A ,$63.21 ,$46.68 , N/A 
ST. ELIZABETH'S HOSPITAL,27200200,N/A,HC ABDOMINAL BINDERS,272,1 ,$23.58 ,$15.33 ,$6.20 ,$23.58 , N/A ,$10.85 ,$13.20 , N/A ,$6.60 ,$7.97 , N/A ,$9.17 , N/A ,$10.63 ,$10.63 , N/A ,$15.33 , N/A ,$11.79 , N/A , N/A , N/A , N/A ,$17.69 ,$14.15 ,$14.15 , N/A ,$14.15 ,$17.92 ,$17.92 ,$17.92 ,$23.58 , N/A ,$20.04 , N/A ,$15.33 , N/A ,$23.58 ,$13.20 , N/A ,$6.20 , N/A , N/A , N/A , N/A ,$18.86 , N/A ,$10.63 ,$6.60 ,$21.22 , N/A ,$17.92 ,$15.33 ,$15.33 , N/A ,$15.33 ,$11.32 , N/A 
ST. ELIZABETH'S HOSPITAL,27200226,N/A,HC ADHESIVE DERMABOND,272,1 ,$70.40 ,$45.76 ,$18.52 ,$70.40 , N/A ,$32.38 ,$39.42 , N/A ,$19.71 ,$23.80 , N/A ,$27.39 , N/A ,$31.75 ,$31.75 , N/A ,$45.76 , N/A ,$35.20 , N/A , N/A , N/A , N/A ,$52.80 ,$42.24 ,$42.24 , N/A ,$42.24 ,$53.50 ,$53.50 ,$53.50 ,$70.40 , N/A ,$59.84 , N/A ,$45.76 , N/A ,$70.40 ,$39.42 , N/A ,$18.52 , N/A , N/A , N/A , N/A ,$56.32 , N/A ,$31.75 ,$19.71 ,$63.36 , N/A ,$53.50 ,$45.76 ,$45.76 , N/A ,$45.76 ,$33.79 , N/A 
ST. ELIZABETH'S HOSPITAL,27200235,N/A,HC AIRWAY EXCHANGE CATHETER,272,1 ,$186.66 ,$121.33 ,$49.09 ,$186.66 , N/A ,$85.86 ,$104.53 , N/A ,$52.26 ,$63.09 , N/A ,$72.61 , N/A ,$84.18 ,$84.18 , N/A ,$121.33 , N/A ,$93.33 , N/A , N/A , N/A , N/A ,$140.00 ,$112.00 ,$112.00 , N/A ,$112.00 ,$141.86 ,$141.86 ,$141.86 ,$186.66 , N/A ,$158.66 , N/A ,$121.33 , N/A ,$186.66 ,$104.53 , N/A ,$49.09 , N/A , N/A , N/A , N/A ,$149.33 , N/A ,$84.18 ,$52.26 ,$167.99 , N/A ,$141.86 ,$121.33 ,$121.33 , N/A ,$121.33 ,$89.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27200257,N/A,HC AQUACEL DRESSINGS,272,1 ,$25.00 ,$16.25 ,$6.58 ,$25.00 , N/A ,$11.50 ,$14.00 , N/A ,$7.00 ,$8.45 , N/A ,$9.73 , N/A ,$11.28 ,$11.28 , N/A ,$16.25 , N/A ,$12.50 , N/A , N/A , N/A , N/A ,$18.75 ,$15.00 ,$15.00 , N/A ,$15.00 ,$19.00 ,$19.00 ,$19.00 ,$25.00 , N/A ,$21.25 , N/A ,$16.25 , N/A ,$25.00 ,$14.00 , N/A ,$6.58 , N/A , N/A , N/A , N/A ,$20.00 , N/A ,$11.28 ,$7.00 ,$22.50 , N/A ,$19.00 ,$16.25 ,$16.25 , N/A ,$16.25 ,$12.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200297,N/A,HC BAG RESUSCITATION DISP,272,1 ,$64.93 ,$42.20 ,$17.08 ,$64.93 , N/A ,$29.87 ,$36.36 , N/A ,$18.18 ,$21.95 , N/A ,$25.26 , N/A ,$29.28 ,$29.28 , N/A ,$42.20 , N/A ,$32.47 , N/A , N/A , N/A , N/A ,$48.70 ,$38.96 ,$38.96 , N/A ,$38.96 ,$49.35 ,$49.35 ,$49.35 ,$64.93 , N/A ,$55.19 , N/A ,$42.20 , N/A ,$64.93 ,$36.36 , N/A ,$17.08 , N/A , N/A , N/A , N/A ,$51.94 , N/A ,$29.28 ,$18.18 ,$58.44 , N/A ,$49.35 ,$42.20 ,$42.20 , N/A ,$42.20 ,$31.17 , N/A 
ST. ELIZABETH'S HOSPITAL,27200338,N/A,HC BIOPSY DEVICE NEEDLE CORE,272,1 ,$187.00 ,$121.55 ,$49.18 ,$187.00 , N/A ,$86.02 ,$104.72 , N/A ,$52.36 ,$63.21 , N/A ,$72.74 , N/A ,$84.34 ,$84.34 , N/A ,$121.55 , N/A ,$93.50 , N/A , N/A , N/A , N/A ,$140.25 ,$112.20 ,$112.20 , N/A ,$112.20 ,$142.12 ,$142.12 ,$142.12 ,$187.00 , N/A ,$158.95 , N/A ,$121.55 , N/A ,$187.00 ,$104.72 , N/A ,$49.18 , N/A , N/A , N/A , N/A ,$149.60 , N/A ,$84.34 ,$52.36 ,$168.30 , N/A ,$142.12 ,$121.55 ,$121.55 , N/A ,$121.55 ,$89.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27200357,N/A,HC BIS MONITOR STRIP,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27200546,N/A,HC BLOOD WARMER UNIT AND TUBING,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200547,N/A,HC BONE BIOPSY DEVICE F07,272,1 ,$269.00 ,$174.85 ,$70.75 ,$269.00 , N/A ,$123.74 ,$150.64 , N/A ,$75.32 ,$90.92 , N/A ,$104.64 , N/A ,$121.32 ,$121.32 , N/A ,$174.85 , N/A ,$134.50 , N/A , N/A , N/A , N/A ,$201.75 ,$161.40 ,$161.40 , N/A ,$161.40 ,$204.44 ,$204.44 ,$204.44 ,$269.00 , N/A ,$228.65 , N/A ,$174.85 , N/A ,$269.00 ,$150.64 , N/A ,$70.75 , N/A , N/A , N/A , N/A ,$215.20 , N/A ,$121.32 ,$75.32 ,$242.10 , N/A ,$204.44 ,$174.85 ,$174.85 , N/A ,$174.85 ,$129.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27200568,N/A,HC BRA SURGICAL,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200571,N/A,HC BREAST PUMP KIT,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200576,N/A,HC BREAST SHIELDS,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200658,N/A,HC C SECTION PACK,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200703,N/A,HC CANNULA HIGHFLOW,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200764,N/A,HC CATH COBRA 2 DIAGNOSTIC,272,1 ,$42.00 ,$27.30 ,$11.05 ,$42.00 , N/A ,$19.32 ,$23.52 , N/A ,$11.76 ,$14.20 , N/A ,$16.34 , N/A ,$18.94 ,$18.94 , N/A ,$27.30 , N/A ,$21.00 , N/A , N/A , N/A , N/A ,$31.50 ,$25.20 ,$25.20 , N/A ,$25.20 ,$31.92 ,$31.92 ,$31.92 ,$42.00 , N/A ,$35.70 , N/A ,$27.30 , N/A ,$42.00 ,$23.52 , N/A ,$11.05 , N/A , N/A , N/A , N/A ,$33.60 , N/A ,$18.94 ,$11.76 ,$37.80 , N/A ,$31.92 ,$27.30 ,$27.30 , N/A ,$27.30 ,$20.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27200781,C1730,HC CATH DECAPOLAR,272,1 ,"$1,125.00 ",$731.25 ,$295.88 ,"$1,125.00 ", N/A ,$517.50 ,$630.00 , N/A ,$315.00 ,$380.25 , N/A ,$437.63 , N/A ,$507.38 ,$507.38 , N/A ,$731.25 , N/A ,$562.50 , N/A , N/A , N/A , N/A ,$843.75 ,$675.00 ,$675.00 , N/A ,$675.00 ,$855.00 ,$855.00 ,$855.00 ,"$1,125.00 ", N/A ,$956.25 , N/A ,$731.25 , N/A ,"$1,125.00 ",$630.00 , N/A ,$295.88 , N/A , N/A , N/A , N/A ,$900.00 , N/A ,$507.38 ,$315.00 ,"$1,012.50 ", N/A ,$855.00 ,$731.25 ,$731.25 , N/A ,$731.25 ,$540.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27200798,N/A,HC CATH INTRODUCER,272,1 ,$512.44 ,$333.09 ,$134.77 ,$512.44 , N/A ,$235.72 ,$286.97 , N/A ,$143.48 ,$173.20 , N/A ,$199.34 , N/A ,$231.11 ,$231.11 , N/A ,$333.09 , N/A ,$256.22 , N/A , N/A , N/A , N/A ,$384.33 ,$307.46 ,$307.46 , N/A ,$307.46 ,$389.45 ,$389.45 ,$389.45 ,$512.44 , N/A ,$435.57 , N/A ,$333.09 , N/A ,$512.44 ,$286.97 , N/A ,$134.77 , N/A , N/A , N/A , N/A ,$409.95 , N/A ,$231.11 ,$143.48 ,$461.20 , N/A ,$389.45 ,$333.09 ,$333.09 , N/A ,$333.09 ,$245.97 , N/A 
ST. ELIZABETH'S HOSPITAL,27200839,N/A,HC CATH URETHRAL RED RUBBER,272,1 ,$21.00 ,$13.65 ,$5.52 ,$21.00 , N/A ,$9.66 ,$11.76 , N/A ,$5.88 ,$7.10 , N/A ,$8.17 , N/A ,$9.47 ,$9.47 , N/A ,$13.65 , N/A ,$10.50 , N/A , N/A , N/A , N/A ,$15.75 ,$12.60 ,$12.60 , N/A ,$12.60 ,$15.96 ,$15.96 ,$15.96 ,$21.00 , N/A ,$17.85 , N/A ,$13.65 , N/A ,$21.00 ,$11.76 , N/A ,$5.52 , N/A , N/A , N/A , N/A ,$16.80 , N/A ,$9.47 ,$5.88 ,$18.90 , N/A ,$15.96 ,$13.65 ,$13.65 , N/A ,$13.65 ,$10.08 , N/A 
ST. ELIZABETH'S HOSPITAL,27200849,N/A,HC CATHETER - FOLEY,272,1 ,$29.00 ,$18.85 ,$7.63 ,$29.00 , N/A ,$13.34 ,$16.24 , N/A ,$8.12 ,$9.80 , N/A ,$11.28 , N/A ,$13.08 ,$13.08 , N/A ,$18.85 , N/A ,$14.50 , N/A , N/A , N/A , N/A ,$21.75 ,$17.40 ,$17.40 , N/A ,$17.40 ,$22.04 ,$22.04 ,$22.04 ,$29.00 , N/A ,$24.65 , N/A ,$18.85 , N/A ,$29.00 ,$16.24 , N/A ,$7.63 , N/A , N/A , N/A , N/A ,$23.20 , N/A ,$13.08 ,$8.12 ,$26.10 , N/A ,$22.04 ,$18.85 ,$18.85 , N/A ,$18.85 ,$13.92 , N/A 
ST. ELIZABETH'S HOSPITAL,27200861,C1750,HC CATH HEMODIALYSIS PERITONEAL,272,1 ,$528.50 ,$343.53 ,$139.00 ,$528.50 , N/A ,$243.11 ,$295.96 , N/A ,$147.98 ,$178.63 , N/A ,$205.59 , N/A ,$238.35 ,$238.35 , N/A ,$343.53 , N/A ,$264.25 , N/A , N/A , N/A , N/A ,$396.38 ,$317.10 ,$317.10 , N/A ,$317.10 ,$401.66 ,$401.66 ,$401.66 ,$528.50 , N/A ,$449.23 , N/A ,$343.53 , N/A ,$528.50 ,$295.96 , N/A ,$139.00 , N/A , N/A , N/A , N/A ,$422.80 , N/A ,$238.35 ,$147.98 ,$475.65 , N/A ,$401.66 ,$343.53 ,$343.53 , N/A ,$343.53 ,$253.68 , N/A 
ST. ELIZABETH'S HOSPITAL,27200889,N/A,HC CHEST DRAIN VALVE PNEUO ATRIUM,272,1 ,$87.96 ,$57.17 ,$23.13 ,$87.96 , N/A ,$40.46 ,$49.26 , N/A ,$24.63 ,$29.73 , N/A ,$34.22 , N/A ,$39.67 ,$39.67 , N/A ,$57.17 , N/A ,$43.98 , N/A , N/A , N/A , N/A ,$65.97 ,$52.78 ,$52.78 , N/A ,$52.78 ,$66.85 ,$66.85 ,$66.85 ,$87.96 , N/A ,$74.77 , N/A ,$57.17 , N/A ,$87.96 ,$49.26 , N/A ,$23.13 , N/A , N/A , N/A , N/A ,$70.37 , N/A ,$39.67 ,$24.63 ,$79.16 , N/A ,$66.85 ,$57.17 ,$57.17 , N/A ,$57.17 ,$42.22 , N/A 
ST. ELIZABETH'S HOSPITAL,27201009,N/A,HC CRICOTHYROTOMY CATH SET,272,1 ,$403.00 ,$261.95 ,$105.99 ,$403.00 , N/A ,$185.38 ,$225.68 , N/A ,$112.84 ,$136.21 , N/A ,$156.77 , N/A ,$181.75 ,$181.75 , N/A ,$261.95 , N/A ,$201.50 , N/A , N/A , N/A , N/A ,$302.25 ,$241.80 ,$241.80 , N/A ,$241.80 ,$306.28 ,$306.28 ,$306.28 ,$403.00 , N/A ,$342.55 , N/A ,$261.95 , N/A ,$403.00 ,$225.68 , N/A ,$105.99 , N/A , N/A , N/A , N/A ,$322.40 , N/A ,$181.75 ,$112.84 ,$362.70 , N/A ,$306.28 ,$261.95 ,$261.95 , N/A ,$261.95 ,$193.44 , N/A 
ST. ELIZABETH'S HOSPITAL,27201012,N/A,HC BONOPTY BX SET,272,1 ,$375.00 ,$243.75 ,$98.63 ,$375.00 , N/A ,$172.50 ,$210.00 , N/A ,$105.00 ,$126.75 , N/A ,$145.88 , N/A ,$169.13 ,$169.13 , N/A ,$243.75 , N/A ,$187.50 , N/A , N/A , N/A , N/A ,$281.25 ,$225.00 ,$225.00 , N/A ,$225.00 ,$285.00 ,$285.00 ,$285.00 ,$375.00 , N/A ,$318.75 , N/A ,$243.75 , N/A ,$375.00 ,$210.00 , N/A ,$98.63 , N/A , N/A , N/A , N/A ,$300.00 , N/A ,$169.13 ,$105.00 ,$337.50 , N/A ,$285.00 ,$243.75 ,$243.75 , N/A ,$243.75 ,$180.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201013,N/A,HC BONOPTY ED DRILL,272,1 ,$270.00 ,$175.50 ,$71.01 ,$270.00 , N/A ,$124.20 ,$151.20 , N/A ,$75.60 ,$91.26 , N/A ,$105.03 , N/A ,$121.77 ,$121.77 , N/A ,$175.50 , N/A ,$135.00 , N/A , N/A , N/A , N/A ,$202.50 ,$162.00 ,$162.00 , N/A ,$162.00 ,$205.20 ,$205.20 ,$205.20 ,$270.00 , N/A ,$229.50 , N/A ,$175.50 , N/A ,$270.00 ,$151.20 , N/A ,$71.01 , N/A , N/A , N/A , N/A ,$216.00 , N/A ,$121.77 ,$75.60 ,$243.00 , N/A ,$205.20 ,$175.50 ,$175.50 , N/A ,$175.50 ,$129.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27201014,N/A,HC BONOPTY PENETRATION SET,272,1 ,$402.00 ,$261.30 ,$105.73 ,$402.00 , N/A ,$184.92 ,$225.12 , N/A ,$112.56 ,$135.88 , N/A ,$156.38 , N/A ,$181.30 ,$181.30 , N/A ,$261.30 , N/A ,$201.00 , N/A , N/A , N/A , N/A ,$301.50 ,$241.20 ,$241.20 , N/A ,$241.20 ,$305.52 ,$305.52 ,$305.52 ,$402.00 , N/A ,$341.70 , N/A ,$261.30 , N/A ,$402.00 ,$225.12 , N/A ,$105.73 , N/A , N/A , N/A , N/A ,$321.60 , N/A ,$181.30 ,$112.56 ,$361.80 , N/A ,$305.52 ,$261.30 ,$261.30 , N/A ,$261.30 ,$192.96 , N/A 
ST. ELIZABETH'S HOSPITAL,27201083,N/A,HC DISP. OXIMETER SENSOR,272,1 ,$312.00 ,$202.80 ,$82.06 ,$312.00 , N/A ,$143.52 ,$174.72 , N/A ,$87.36 ,$105.46 , N/A ,$121.37 , N/A ,$140.71 ,$140.71 , N/A ,$202.80 , N/A ,$156.00 , N/A , N/A , N/A , N/A ,$234.00 ,$187.20 ,$187.20 , N/A ,$187.20 ,$237.12 ,$237.12 ,$237.12 ,$312.00 , N/A ,$265.20 , N/A ,$202.80 , N/A ,$312.00 ,$174.72 , N/A ,$82.06 , N/A , N/A , N/A , N/A ,$249.60 , N/A ,$140.71 ,$87.36 ,$280.80 , N/A ,$237.12 ,$202.80 ,$202.80 , N/A ,$202.80 ,$149.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27201087,N/A,HC TRACH KIT BEDSIDE,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201165,N/A,HC MORGAN LENS,272,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201236,N/A,HC ENDOBRONCHIAL BLOCKER SET,272,1 ,$500.00 ,$325.00 ,$131.50 ,$500.00 , N/A ,$230.00 ,$280.00 , N/A ,$140.00 ,$169.00 , N/A ,$194.50 , N/A ,$225.50 ,$225.50 , N/A ,$325.00 , N/A ,$250.00 , N/A , N/A , N/A , N/A ,$375.00 ,$300.00 ,$300.00 , N/A ,$300.00 ,$380.00 ,$380.00 ,$380.00 ,$500.00 , N/A ,$425.00 , N/A ,$325.00 , N/A ,$500.00 ,$280.00 , N/A ,$131.50 , N/A , N/A , N/A , N/A ,$400.00 , N/A ,$225.50 ,$140.00 ,$450.00 , N/A ,$380.00 ,$325.00 ,$325.00 , N/A ,$325.00 ,$240.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201248,N/A,HC ENDOTRACHEAL TUBE (DUAL LUMEN),272,1 ,$187.00 ,$121.55 ,$49.18 ,$187.00 , N/A ,$86.02 ,$104.72 , N/A ,$52.36 ,$63.21 , N/A ,$72.74 , N/A ,$84.34 ,$84.34 , N/A ,$121.55 , N/A ,$93.50 , N/A , N/A , N/A , N/A ,$140.25 ,$112.20 ,$112.20 , N/A ,$112.20 ,$142.12 ,$142.12 ,$142.12 ,$187.00 , N/A ,$158.95 , N/A ,$121.55 , N/A ,$187.00 ,$104.72 , N/A ,$49.18 , N/A , N/A , N/A , N/A ,$149.60 , N/A ,$84.34 ,$52.36 ,$168.30 , N/A ,$142.12 ,$121.55 ,$121.55 , N/A ,$121.55 ,$89.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27201252,N/A,HC EPIDURAL TRAY,272,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201279,N/A,HC FECAL MANAGEMENT KIT,272,1 ,$276.00 ,$179.40 ,$72.59 ,$276.00 , N/A ,$126.96 ,$154.56 , N/A ,$77.28 ,$93.29 , N/A ,$107.36 , N/A ,$124.48 ,$124.48 , N/A ,$179.40 , N/A ,$138.00 , N/A , N/A , N/A , N/A ,$207.00 ,$165.60 ,$165.60 , N/A ,$165.60 ,$209.76 ,$209.76 ,$209.76 ,$276.00 , N/A ,$234.60 , N/A ,$179.40 , N/A ,$276.00 ,$154.56 , N/A ,$72.59 , N/A , N/A , N/A , N/A ,$220.80 , N/A ,$124.48 ,$77.28 ,$248.40 , N/A ,$209.76 ,$179.40 ,$179.40 , N/A ,$179.40 ,$132.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27201280,N/A,HC FECAL MGT COLLECTION BAGS,272,1 ,$270.00 ,$175.50 ,$71.01 ,$270.00 , N/A ,$124.20 ,$151.20 , N/A ,$75.60 ,$91.26 , N/A ,$105.03 , N/A ,$121.77 ,$121.77 , N/A ,$175.50 , N/A ,$135.00 , N/A , N/A , N/A , N/A ,$202.50 ,$162.00 ,$162.00 , N/A ,$162.00 ,$205.20 ,$205.20 ,$205.20 ,$270.00 , N/A ,$229.50 , N/A ,$175.50 , N/A ,$270.00 ,$151.20 , N/A ,$71.01 , N/A , N/A , N/A , N/A ,$216.00 , N/A ,$121.77 ,$75.60 ,$243.00 , N/A ,$205.20 ,$175.50 ,$175.50 , N/A ,$175.50 ,$129.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27201282,N/A,HC FEEDING TUBE,272,1 ,$552.00 ,$358.80 ,$145.18 ,$552.00 , N/A ,$253.92 ,$309.12 , N/A ,$154.56 ,$186.58 , N/A ,$214.73 , N/A ,$248.95 ,$248.95 , N/A ,$358.80 , N/A ,$276.00 , N/A , N/A , N/A , N/A ,$414.00 ,$331.20 ,$331.20 , N/A ,$331.20 ,$419.52 ,$419.52 ,$419.52 ,$552.00 , N/A ,$469.20 , N/A ,$358.80 , N/A ,$552.00 ,$309.12 , N/A ,$145.18 , N/A , N/A , N/A , N/A ,$441.60 , N/A ,$248.95 ,$154.56 ,$496.80 , N/A ,$419.52 ,$358.80 ,$358.80 , N/A ,$358.80 ,$264.96 , N/A 
ST. ELIZABETH'S HOSPITAL,27201311,N/A,HC FLOW SWITCH,272,1 ,$20.00 ,$13.00 ,$5.26 ,$20.00 , N/A ,$9.20 ,$11.20 , N/A ,$5.60 ,$6.76 , N/A ,$7.78 , N/A ,$9.02 ,$9.02 , N/A ,$13.00 , N/A ,$10.00 , N/A , N/A , N/A , N/A ,$15.00 ,$12.00 ,$12.00 , N/A ,$12.00 ,$15.20 ,$15.20 ,$15.20 ,$20.00 , N/A ,$17.00 , N/A ,$13.00 , N/A ,$20.00 ,$11.20 , N/A ,$5.26 , N/A , N/A , N/A , N/A ,$16.00 , N/A ,$9.02 ,$5.60 ,$18.00 , N/A ,$15.20 ,$13.00 ,$13.00 , N/A ,$13.00 ,$9.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27201391,N/A,HC HEEL PROTECTOR EA,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201423,N/A,HC HYSTEROSALPINGEOGRAM CATH,272,1 ,$187.00 ,$121.55 ,$49.18 ,$187.00 , N/A ,$86.02 ,$104.72 , N/A ,$52.36 ,$63.21 , N/A ,$72.74 , N/A ,$84.34 ,$84.34 , N/A ,$121.55 , N/A ,$93.50 , N/A , N/A , N/A , N/A ,$140.25 ,$112.20 ,$112.20 , N/A ,$112.20 ,$142.12 ,$142.12 ,$142.12 ,$187.00 , N/A ,$158.95 , N/A ,$121.55 , N/A ,$187.00 ,$104.72 , N/A ,$49.18 , N/A , N/A , N/A , N/A ,$149.60 , N/A ,$84.34 ,$52.36 ,$168.30 , N/A ,$142.12 ,$121.55 ,$121.55 , N/A ,$121.55 ,$89.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27201424,N/A,HC IABP BALLOON,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27201450,N/A,HC INTRODUCER KIT,272,1 ,$165.00 ,$107.25 ,$43.40 ,$165.00 , N/A ,$75.90 ,$92.40 , N/A ,$46.20 ,$55.77 , N/A ,$64.19 , N/A ,$74.42 ,$74.42 , N/A ,$107.25 , N/A ,$82.50 , N/A , N/A , N/A , N/A ,$123.75 ,$99.00 ,$99.00 , N/A ,$99.00 ,$125.40 ,$125.40 ,$125.40 ,$165.00 , N/A ,$140.25 , N/A ,$107.25 , N/A ,$165.00 ,$92.40 , N/A ,$43.40 , N/A , N/A , N/A , N/A ,$132.00 , N/A ,$74.42 ,$46.20 ,$148.50 , N/A ,$125.40 ,$107.25 ,$107.25 , N/A ,$107.25 ,$79.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27201486,N/A,HC CHEST TUBE DRAINAGE SYSTEM,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201512,N/A,HC KIT GASTROSTOMY MICKEY,272,1 ,$57.42 ,$37.32 ,$15.10 ,$57.42 , N/A ,$26.41 ,$32.16 , N/A ,$16.08 ,$19.41 , N/A ,$22.34 , N/A ,$25.90 ,$25.90 , N/A ,$37.32 , N/A ,$28.71 , N/A , N/A , N/A , N/A ,$43.07 ,$34.45 ,$34.45 , N/A ,$34.45 ,$43.64 ,$43.64 ,$43.64 ,$57.42 , N/A ,$48.81 , N/A ,$37.32 , N/A ,$57.42 ,$32.16 , N/A ,$15.10 , N/A , N/A , N/A , N/A ,$45.94 , N/A ,$25.90 ,$16.08 ,$51.68 , N/A ,$43.64 ,$37.32 ,$37.32 , N/A ,$37.32 ,$27.56 , N/A 
ST. ELIZABETH'S HOSPITAL,27201521,N/A,HC KIT INTRODUCER,272,1 ,$201.00 ,$130.65 ,$52.86 ,$201.00 , N/A ,$92.46 ,$112.56 , N/A ,$56.28 ,$67.94 , N/A ,$78.19 , N/A ,$90.65 ,$90.65 , N/A ,$130.65 , N/A ,$100.50 , N/A , N/A , N/A , N/A ,$150.75 ,$120.60 ,$120.60 , N/A ,$120.60 ,$152.76 ,$152.76 ,$152.76 ,$201.00 , N/A ,$170.85 , N/A ,$130.65 , N/A ,$201.00 ,$112.56 , N/A ,$52.86 , N/A , N/A , N/A , N/A ,$160.80 , N/A ,$90.65 ,$56.28 ,$180.90 , N/A ,$152.76 ,$130.65 ,$130.65 , N/A ,$130.65 ,$96.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27201596,N/A,HC LASER-FLEX ENDOTRACH TUB,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201721,N/A,HC NEEDLE VERTERBRO INTRO 11/13GA,272,1 ,$132.00 ,$85.80 ,$34.72 ,$132.00 , N/A ,$60.72 ,$73.92 , N/A ,$36.96 ,$44.62 , N/A ,$51.35 , N/A ,$59.53 ,$59.53 , N/A ,$85.80 , N/A ,$66.00 , N/A , N/A , N/A , N/A ,$99.00 ,$79.20 ,$79.20 , N/A ,$79.20 ,$100.32 ,$100.32 ,$100.32 ,$132.00 , N/A ,$112.20 , N/A ,$85.80 , N/A ,$132.00 ,$73.92 , N/A ,$34.72 , N/A , N/A , N/A , N/A ,$105.60 , N/A ,$59.53 ,$36.96 ,$118.80 , N/A ,$100.32 ,$85.80 ,$85.80 , N/A ,$85.80 ,$63.36 , N/A 
ST. ELIZABETH'S HOSPITAL,27201814,N/A,HC PARACENTESIS TRAY,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201877,N/A,HC PNEUMOTHORAX KIT,272,1 ,$400.00 ,$260.00 ,$105.20 ,$400.00 , N/A ,$184.00 ,$224.00 , N/A ,$112.00 ,$135.20 , N/A ,$155.60 , N/A ,$180.40 ,$180.40 , N/A ,$260.00 , N/A ,$200.00 , N/A , N/A , N/A , N/A ,$300.00 ,$240.00 ,$240.00 , N/A ,$240.00 ,$304.00 ,$304.00 ,$304.00 ,$400.00 , N/A ,$340.00 , N/A ,$260.00 , N/A ,$400.00 ,$224.00 , N/A ,$105.20 , N/A , N/A , N/A , N/A ,$320.00 , N/A ,$180.40 ,$112.00 ,$360.00 , N/A ,$304.00 ,$260.00 ,$260.00 , N/A ,$260.00 ,$192.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27201938,N/A,HC PULSE OXIMETER PROBE DISP,272,1 ,$21.18 ,$13.77 ,$5.57 ,$21.18 , N/A ,$9.74 ,$11.86 , N/A ,$5.93 ,$7.16 , N/A ,$8.24 , N/A ,$9.55 ,$9.55 , N/A ,$13.77 , N/A ,$10.59 , N/A , N/A , N/A , N/A ,$15.89 ,$12.71 ,$12.71 , N/A ,$12.71 ,$16.10 ,$16.10 ,$16.10 ,$21.18 , N/A ,$18.00 , N/A ,$13.77 , N/A ,$21.18 ,$11.86 , N/A ,$5.57 , N/A , N/A , N/A , N/A ,$16.94 , N/A ,$9.55 ,$5.93 ,$19.06 , N/A ,$16.10 ,$13.77 ,$13.77 , N/A ,$13.77 ,$10.17 , N/A 
ST. ELIZABETH'S HOSPITAL,27202018,N/A,HC SENSOR ADULT ADHESIVE,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27202120,N/A,HC STAPLER SKIN,272,1 ,$57.00 ,$37.05 ,$14.99 ,$57.00 , N/A ,$26.22 ,$31.92 , N/A ,$15.96 ,$19.27 , N/A ,$22.17 , N/A ,$25.71 ,$25.71 , N/A ,$37.05 , N/A ,$28.50 , N/A , N/A , N/A , N/A ,$42.75 ,$34.20 ,$34.20 , N/A ,$34.20 ,$43.32 ,$43.32 ,$43.32 ,$57.00 , N/A ,$48.45 , N/A ,$37.05 , N/A ,$57.00 ,$31.92 , N/A ,$14.99 , N/A , N/A , N/A , N/A ,$45.60 , N/A ,$25.71 ,$15.96 ,$51.30 , N/A ,$43.32 ,$37.05 ,$37.05 , N/A ,$37.05 ,$27.36 , N/A 
ST. ELIZABETH'S HOSPITAL,27202600,N/A,HC SUTURE,272,1 ,$6.78 ,$4.41 ,$1.78 ,$6.78 , N/A ,$3.12 ,$3.80 , N/A ,$1.90 ,$2.29 , N/A ,$2.64 , N/A ,$3.06 ,$3.06 , N/A ,$4.41 , N/A ,$3.39 , N/A , N/A , N/A , N/A ,$5.09 ,$4.07 ,$4.07 , N/A ,$4.07 ,$5.15 ,$5.15 ,$5.15 ,$6.78 , N/A ,$5.76 , N/A ,$4.41 , N/A ,$6.78 ,$3.80 , N/A ,$1.78 , N/A , N/A , N/A , N/A ,$5.42 , N/A ,$3.06 ,$1.90 ,$6.10 , N/A ,$5.15 ,$4.41 ,$4.41 , N/A ,$4.41 ,$3.25 , N/A 
ST. ELIZABETH'S HOSPITAL,27202731,N/A,HC TRAY 16FOLEY W/URIM-DISP,272,1 ,$75.00 ,$48.75 ,$19.73 ,$75.00 , N/A ,$34.50 ,$42.00 , N/A ,$21.00 ,$25.35 , N/A ,$29.18 , N/A ,$33.83 ,$33.83 , N/A ,$48.75 , N/A ,$37.50 , N/A , N/A , N/A , N/A ,$56.25 ,$45.00 ,$45.00 , N/A ,$45.00 ,$57.00 ,$57.00 ,$57.00 ,$75.00 , N/A ,$63.75 , N/A ,$48.75 , N/A ,$75.00 ,$42.00 , N/A ,$19.73 , N/A , N/A , N/A , N/A ,$60.00 , N/A ,$33.83 ,$21.00 ,$67.50 , N/A ,$57.00 ,$48.75 ,$48.75 , N/A ,$48.75 ,$36.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27202806,N/A,HC TRAY SPECIAL INSTRUMENT,272,1 ,$100.38 ,$65.25 ,$26.40 ,$100.38 , N/A ,$46.17 ,$56.21 , N/A ,$28.11 ,$33.93 , N/A ,$39.05 , N/A ,$45.27 ,$45.27 , N/A ,$65.25 , N/A ,$50.19 , N/A , N/A , N/A , N/A ,$75.29 ,$60.23 ,$60.23 , N/A ,$60.23 ,$76.29 ,$76.29 ,$76.29 ,$100.38 , N/A ,$85.32 , N/A ,$65.25 , N/A ,$100.38 ,$56.21 , N/A ,$26.40 , N/A , N/A , N/A , N/A ,$80.30 , N/A ,$45.27 ,$28.11 ,$90.34 , N/A ,$76.29 ,$65.25 ,$65.25 , N/A ,$65.25 ,$48.18 , N/A 
ST. ELIZABETH'S HOSPITAL,27202807,N/A,HC TRAY SPINAL,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27202900,N/A,HC TUBES FEEDING,272,1 ,$18.45 ,$11.99 ,$4.85 ,$18.45 , N/A ,$8.49 ,$10.33 , N/A ,$5.17 ,$6.24 , N/A ,$7.18 , N/A ,$8.32 ,$8.32 , N/A ,$11.99 , N/A ,$9.23 , N/A , N/A , N/A , N/A ,$13.84 ,$11.07 ,$11.07 , N/A ,$11.07 ,$14.02 ,$14.02 ,$14.02 ,$18.45 , N/A ,$15.68 , N/A ,$11.99 , N/A ,$18.45 ,$10.33 , N/A ,$4.85 , N/A , N/A , N/A , N/A ,$14.76 , N/A ,$8.32 ,$5.17 ,$16.61 , N/A ,$14.02 ,$11.99 ,$11.99 , N/A ,$11.99 ,$8.86 , N/A 
ST. ELIZABETH'S HOSPITAL,27203025,N/A,HC EMBOLIZATION COIL,272,1 ,$210.12 ,$136.58 ,$55.26 ,$210.12 , N/A ,$96.66 ,$117.67 , N/A ,$58.83 ,$71.02 , N/A ,$81.74 , N/A ,$94.76 ,$94.76 , N/A ,$136.58 , N/A ,$105.06 , N/A , N/A , N/A , N/A ,$157.59 ,$126.07 ,$126.07 , N/A ,$126.07 ,$159.69 ,$159.69 ,$159.69 ,$210.12 , N/A ,$178.60 , N/A ,$136.58 , N/A ,$210.12 ,$117.67 , N/A ,$55.26 , N/A , N/A , N/A , N/A ,$168.10 , N/A ,$94.76 ,$58.83 ,$189.11 , N/A ,$159.69 ,$136.58 ,$136.58 , N/A ,$136.58 ,$100.86 , N/A 
ST. ELIZABETH'S HOSPITAL,27203111,C1887,HC FINE CROSS CATHETER,272,1 ,"$1,100.00 ",$715.00 ,$289.30 ,"$1,100.00 ", N/A ,$506.00 ,$616.00 , N/A ,$308.00 ,$371.80 , N/A ,$427.90 , N/A ,$496.10 ,$496.10 , N/A ,$715.00 , N/A ,$550.00 , N/A , N/A , N/A , N/A ,$825.00 ,$660.00 ,$660.00 , N/A ,$660.00 ,$836.00 ,$836.00 ,$836.00 ,"$1,100.00 ", N/A ,$935.00 , N/A ,$715.00 , N/A ,"$1,100.00 ",$616.00 , N/A ,$289.30 , N/A , N/A , N/A , N/A ,$880.00 , N/A ,$496.10 ,$308.00 ,$990.00 , N/A ,$836.00 ,$715.00 ,$715.00 , N/A ,$715.00 ,$528.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203113,C1766,HC EP STEERABLE NON PEEL AWAY SHEATH C1766,272,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,462.50 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,710.00 ","$1,710.00 ","$1,710.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,710.00 ","$1,462.50 ","$1,462.50 ", N/A ,"$1,462.50 ","$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203115,C1731,HC HALO/LASSO CATHETER,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203119,C1894,HC SHEATH RAABE/ANSEL/SHUTTLE/DESTINATION,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203121,C1769,HC MICROPUNCTURE KITS,272,1 ,$52.85 ,$34.35 ,$13.90 ,$52.85 , N/A ,$24.31 ,$29.60 , N/A ,$14.80 ,$17.86 , N/A ,$20.56 , N/A ,$23.84 ,$23.84 , N/A ,$34.35 , N/A ,$26.43 , N/A , N/A , N/A , N/A ,$39.64 ,$31.71 ,$31.71 , N/A ,$31.71 ,$40.17 ,$40.17 ,$40.17 ,$52.85 , N/A ,$44.92 , N/A ,$34.35 , N/A ,$52.85 ,$29.60 , N/A ,$13.90 , N/A , N/A , N/A , N/A ,$42.28 , N/A ,$23.84 ,$14.80 ,$47.57 , N/A ,$40.17 ,$34.35 ,$34.35 , N/A ,$34.35 ,$25.37 , N/A 
ST. ELIZABETH'S HOSPITAL,27203225,N/A,HC MRI BREAST BIOPSY KIT,272,1 ,$349.00 ,$226.85 ,$91.79 ,$349.00 , N/A ,$160.54 ,$195.44 , N/A ,$97.72 ,$117.96 , N/A ,$135.76 , N/A ,$157.40 ,$157.40 , N/A ,$226.85 , N/A ,$174.50 , N/A , N/A , N/A , N/A ,$261.75 ,$209.40 ,$209.40 , N/A ,$209.40 ,$265.24 ,$265.24 ,$265.24 ,$349.00 , N/A ,$296.65 , N/A ,$226.85 , N/A ,$349.00 ,$195.44 , N/A ,$91.79 , N/A , N/A , N/A , N/A ,$279.20 , N/A ,$157.40 ,$97.72 ,$314.10 , N/A ,$265.24 ,$226.85 ,$226.85 , N/A ,$226.85 ,$167.52 , N/A 
ST. ELIZABETH'S HOSPITAL,27203238,N/A,HC EDEMA GLOVE,272,1 ,$25.89 ,$16.83 ,$6.81 ,$25.89 , N/A ,$11.91 ,$14.50 , N/A ,$7.25 ,$8.75 , N/A ,$10.07 , N/A ,$11.68 ,$11.68 , N/A ,$16.83 , N/A ,$12.95 , N/A , N/A , N/A , N/A ,$19.42 ,$15.53 ,$15.53 , N/A ,$15.53 ,$19.68 ,$19.68 ,$19.68 ,$25.89 , N/A ,$22.01 , N/A ,$16.83 , N/A ,$25.89 ,$14.50 , N/A ,$6.81 , N/A , N/A , N/A , N/A ,$20.71 , N/A ,$11.68 ,$7.25 ,$23.30 , N/A ,$19.68 ,$16.83 ,$16.83 , N/A ,$16.83 ,$12.43 , N/A 
ST. ELIZABETH'S HOSPITAL,27203239,N/A,HC PUTTY,272,1 ,$16.86 ,$10.96 ,$4.43 ,$16.86 , N/A ,$7.76 ,$9.44 , N/A ,$4.72 ,$5.70 , N/A ,$6.56 , N/A ,$7.60 ,$7.60 , N/A ,$10.96 , N/A ,$8.43 , N/A , N/A , N/A , N/A ,$12.65 ,$10.12 ,$10.12 , N/A ,$10.12 ,$12.81 ,$12.81 ,$12.81 ,$16.86 , N/A ,$14.33 , N/A ,$10.96 , N/A ,$16.86 ,$9.44 , N/A ,$4.43 , N/A , N/A , N/A , N/A ,$13.49 , N/A ,$7.60 ,$4.72 ,$15.17 , N/A ,$12.81 ,$10.96 ,$10.96 , N/A ,$10.96 ,$8.09 , N/A 
ST. ELIZABETH'S HOSPITAL,27203246,N/A,HC ERGONOMIC HAND EXERCISER,272,1 ,$40.27 ,$26.18 ,$10.59 ,$40.27 , N/A ,$18.52 ,$22.55 , N/A ,$11.28 ,$13.61 , N/A ,$15.67 , N/A ,$18.16 ,$18.16 , N/A ,$26.18 , N/A ,$20.14 , N/A , N/A , N/A , N/A ,$30.20 ,$24.16 ,$24.16 , N/A ,$24.16 ,$30.61 ,$30.61 ,$30.61 ,$40.27 , N/A ,$34.23 , N/A ,$26.18 , N/A ,$40.27 ,$22.55 , N/A ,$10.59 , N/A , N/A , N/A , N/A ,$32.22 , N/A ,$18.16 ,$11.28 ,$36.24 , N/A ,$30.61 ,$26.18 ,$26.18 , N/A ,$26.18 ,$19.33 , N/A 
ST. ELIZABETH'S HOSPITAL,27203255,N/A,HC CPM PADS,272,1 ,$172.33 ,$112.01 ,$45.32 ,$172.33 , N/A ,$79.27 ,$96.50 , N/A ,$48.25 ,$58.25 , N/A ,$67.04 , N/A ,$77.72 ,$77.72 , N/A ,$112.01 , N/A ,$86.17 , N/A , N/A , N/A , N/A ,$129.25 ,$103.40 ,$103.40 , N/A ,$103.40 ,$130.97 ,$130.97 ,$130.97 ,$172.33 , N/A ,$146.48 , N/A ,$112.01 , N/A ,$172.33 ,$96.50 , N/A ,$45.32 , N/A , N/A , N/A , N/A ,$137.86 , N/A ,$77.72 ,$48.25 ,$155.10 , N/A ,$130.97 ,$112.01 ,$112.01 , N/A ,$112.01 ,$82.72 , N/A 
ST. ELIZABETH'S HOSPITAL,27203292,C1732,HC THERMACOOL ABLATION CATH,272,1 ,"$6,250.00 ","$4,062.50 ","$1,643.75 ","$6,250.00 ", N/A ,"$2,875.00 ","$3,500.00 ", N/A ,"$1,750.00 ","$2,112.50 ", N/A ,"$2,431.25 ", N/A ,"$2,818.75 ","$2,818.75 ", N/A ,"$4,062.50 ", N/A ,"$3,125.00 ", N/A , N/A , N/A , N/A ,"$4,687.50 ","$3,750.00 ","$3,750.00 ", N/A ,"$3,750.00 ","$4,750.00 ","$4,750.00 ","$4,750.00 ","$6,250.00 ", N/A ,"$5,312.50 ", N/A ,"$4,062.50 ", N/A ,"$6,250.00 ","$3,500.00 ", N/A ,"$1,643.75 ", N/A , N/A , N/A , N/A ,"$5,000.00 ", N/A ,"$2,818.75 ","$1,750.00 ","$5,625.00 ", N/A ,"$4,750.00 ","$4,062.50 ","$4,062.50 ", N/A ,"$4,062.50 ","$3,000.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203294,C1893,HC EP NON PEEL AWAY SHEATH C1893,272,1 ,$375.00 ,$243.75 ,$98.63 ,$375.00 , N/A ,$172.50 ,$210.00 , N/A ,$105.00 ,$126.75 , N/A ,$145.88 , N/A ,$169.13 ,$169.13 , N/A ,$243.75 , N/A ,$187.50 , N/A , N/A , N/A , N/A ,$281.25 ,$225.00 ,$225.00 , N/A ,$225.00 ,$285.00 ,$285.00 ,$285.00 ,$375.00 , N/A ,$318.75 , N/A ,$243.75 , N/A ,$375.00 ,$210.00 , N/A ,$98.63 , N/A , N/A , N/A , N/A ,$300.00 , N/A ,$169.13 ,$105.00 ,$337.50 , N/A ,$285.00 ,$243.75 ,$243.75 , N/A ,$243.75 ,$180.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203307,N/A,HC ARCTIC SUN PADS,272,1 ,"$1,750.00 ","$1,137.50 ",$460.25 ,"$1,750.00 ", N/A ,$805.00 ,$980.00 , N/A ,$490.00 ,$591.50 , N/A ,$680.75 , N/A ,$789.25 ,$789.25 , N/A ,"$1,137.50 ", N/A ,$875.00 , N/A , N/A , N/A , N/A ,"$1,312.50 ","$1,050.00 ","$1,050.00 ", N/A ,"$1,050.00 ","$1,330.00 ","$1,330.00 ","$1,330.00 ","$1,750.00 ", N/A ,"$1,487.50 ", N/A ,"$1,137.50 ", N/A ,"$1,750.00 ",$980.00 , N/A ,$460.25 , N/A , N/A , N/A , N/A ,"$1,400.00 ", N/A ,$789.25 ,$490.00 ,"$1,575.00 ", N/A ,"$1,330.00 ","$1,137.50 ","$1,137.50 ", N/A ,"$1,137.50 ",$840.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203312,N/A,HC FLOTRAC SENSOR,272,1 ,$625.00 ,$406.25 ,$164.38 ,$625.00 , N/A ,$287.50 ,$350.00 , N/A ,$175.00 ,$211.25 , N/A ,$243.13 , N/A ,$281.88 ,$281.88 , N/A ,$406.25 , N/A ,$312.50 , N/A , N/A , N/A , N/A ,$468.75 ,$375.00 ,$375.00 , N/A ,$375.00 ,$475.00 ,$475.00 ,$475.00 ,$625.00 , N/A ,$531.25 , N/A ,$406.25 , N/A ,$625.00 ,$350.00 , N/A ,$164.38 , N/A , N/A , N/A , N/A ,$500.00 , N/A ,$281.88 ,$175.00 ,$562.50 , N/A ,$475.00 ,$406.25 ,$406.25 , N/A ,$406.25 ,$300.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203503,N/A,HC CANNULA NASAL HEATED HI FLOW,272,1 ,$25.00 ,$16.25 ,$6.58 ,$25.00 , N/A ,$11.50 ,$14.00 , N/A ,$7.00 ,$8.45 , N/A ,$9.73 , N/A ,$11.28 ,$11.28 , N/A ,$16.25 , N/A ,$12.50 , N/A , N/A , N/A , N/A ,$18.75 ,$15.00 ,$15.00 , N/A ,$15.00 ,$19.00 ,$19.00 ,$19.00 ,$25.00 , N/A ,$21.25 , N/A ,$16.25 , N/A ,$25.00 ,$14.00 , N/A ,$6.58 , N/A , N/A , N/A , N/A ,$20.00 , N/A ,$11.28 ,$7.00 ,$22.50 , N/A ,$19.00 ,$16.25 ,$16.25 , N/A ,$16.25 ,$12.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203504,N/A,HC TRAY CATHETER,272,1 ,$126.00 ,$81.90 ,$33.14 ,$126.00 , N/A ,$57.96 ,$70.56 , N/A ,$35.28 ,$42.59 , N/A ,$49.01 , N/A ,$56.83 ,$56.83 , N/A ,$81.90 , N/A ,$63.00 , N/A , N/A , N/A , N/A ,$94.50 ,$75.60 ,$75.60 , N/A ,$75.60 ,$95.76 ,$95.76 ,$95.76 ,$126.00 , N/A ,$107.10 , N/A ,$81.90 , N/A ,$126.00 ,$70.56 , N/A ,$33.14 , N/A , N/A , N/A , N/A ,$100.80 , N/A ,$56.83 ,$35.28 ,$113.40 , N/A ,$95.76 ,$81.90 ,$81.90 , N/A ,$81.90 ,$60.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27203511,N/A,HC BAG LEG URINARY,272,1 ,$14.00 ,$9.10 ,$3.68 ,$14.00 , N/A ,$6.44 ,$7.84 , N/A ,$3.92 ,$4.73 , N/A ,$5.45 , N/A ,$6.31 ,$6.31 , N/A ,$9.10 , N/A ,$7.00 , N/A , N/A , N/A , N/A ,$10.50 ,$8.40 ,$8.40 , N/A ,$8.40 ,$10.64 ,$10.64 ,$10.64 ,$14.00 , N/A ,$11.90 , N/A ,$9.10 , N/A ,$14.00 ,$7.84 , N/A ,$3.68 , N/A , N/A , N/A , N/A ,$11.20 , N/A ,$6.31 ,$3.92 ,$12.60 , N/A ,$10.64 ,$9.10 ,$9.10 , N/A ,$9.10 ,$6.72 , N/A 
ST. ELIZABETH'S HOSPITAL,27203530,C1729,HC NEEDLE CATH CENTESIS YUEH,272,1 ,$42.28 ,$27.48 ,$11.12 ,$42.28 , N/A ,$19.45 ,$23.68 , N/A ,$11.84 ,$14.29 , N/A ,$16.45 , N/A ,$19.07 ,$19.07 , N/A ,$27.48 , N/A ,$21.14 , N/A , N/A , N/A , N/A ,$31.71 ,$25.37 ,$25.37 , N/A ,$25.37 ,$32.13 ,$32.13 ,$32.13 ,$42.28 , N/A ,$35.94 , N/A ,$27.48 , N/A ,$42.28 ,$23.68 , N/A ,$11.12 , N/A , N/A , N/A , N/A ,$33.82 , N/A ,$19.07 ,$11.84 ,$38.05 , N/A ,$32.13 ,$27.48 ,$27.48 , N/A ,$27.48 ,$20.29 , N/A 
ST. ELIZABETH'S HOSPITAL,27203531,C1751,HC CATHETER CV TRIPLE-LUMEN,272,1 ,$598.55 ,$389.06 ,$157.42 ,$598.55 , N/A ,$275.33 ,$335.19 , N/A ,$167.59 ,$202.31 , N/A ,$232.84 , N/A ,$269.95 ,$269.95 , N/A ,$389.06 , N/A ,$299.28 , N/A , N/A , N/A , N/A ,$448.91 ,$359.13 ,$359.13 , N/A ,$359.13 ,$454.90 ,$454.90 ,$454.90 ,$598.55 , N/A ,$508.77 , N/A ,$389.06 , N/A ,$598.55 ,$335.19 , N/A ,$157.42 , N/A , N/A , N/A , N/A ,$478.84 , N/A ,$269.95 ,$167.59 ,$538.70 , N/A ,$454.90 ,$389.06 ,$389.06 , N/A ,$389.06 ,$287.30 , N/A 
ST. ELIZABETH'S HOSPITAL,27203532,C1751,HC CATHETER CV DUAL-LUMEN,272,1 ,$350.00 ,$227.50 ,$92.05 ,$350.00 , N/A ,$161.00 ,$196.00 , N/A ,$98.00 ,$118.30 , N/A ,$136.15 , N/A ,$157.85 ,$157.85 , N/A ,$227.50 , N/A ,$175.00 , N/A , N/A , N/A , N/A ,$262.50 ,$210.00 ,$210.00 , N/A ,$210.00 ,$266.00 ,$266.00 ,$266.00 ,$350.00 , N/A ,$297.50 , N/A ,$227.50 , N/A ,$350.00 ,$196.00 , N/A ,$92.05 , N/A , N/A , N/A , N/A ,$280.00 , N/A ,$157.85 ,$98.00 ,$315.00 , N/A ,$266.00 ,$227.50 ,$227.50 , N/A ,$227.50 ,$168.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203533,C1751,HC CATHETER CV SINGLE-LUMEN,272,1 ,$493.06 ,$320.49 ,$129.67 ,$493.06 , N/A ,$226.81 ,$276.11 , N/A ,$138.06 ,$166.65 , N/A ,$191.80 , N/A ,$222.37 ,$222.37 , N/A ,$320.49 , N/A ,$246.53 , N/A , N/A , N/A , N/A ,$369.80 ,$295.84 ,$295.84 , N/A ,$295.84 ,$374.73 ,$374.73 ,$374.73 ,$493.06 , N/A ,$419.10 , N/A ,$320.49 , N/A ,$493.06 ,$276.11 , N/A ,$129.67 , N/A , N/A , N/A , N/A ,$394.45 , N/A ,$222.37 ,$138.06 ,$443.75 , N/A ,$374.73 ,$320.49 ,$320.49 , N/A ,$320.49 ,$236.67 , N/A 
ST. ELIZABETH'S HOSPITAL,27203537,N/A,HC CATHETER RADIAL ARTERY,272,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203538,N/A,HC KIT ARTERIAL LINE,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203539,N/A,HC TRANSDUCER,272,1 ,$134.32 ,$87.31 ,$35.33 ,$134.32 , N/A ,$61.79 ,$75.22 , N/A ,$37.61 ,$45.40 , N/A ,$52.25 , N/A ,$60.58 ,$60.58 , N/A ,$87.31 , N/A ,$67.16 , N/A , N/A , N/A , N/A ,$100.74 ,$80.59 ,$80.59 , N/A ,$80.59 ,$102.08 ,$102.08 ,$102.08 ,$134.32 , N/A ,$114.17 , N/A ,$87.31 , N/A ,$134.32 ,$75.22 , N/A ,$35.33 , N/A , N/A , N/A , N/A ,$107.46 , N/A ,$60.58 ,$37.61 ,$120.89 , N/A ,$102.08 ,$87.31 ,$87.31 , N/A ,$87.31 ,$64.47 , N/A 
ST. ELIZABETH'S HOSPITAL,27203540,N/A,HC CATHETER FEMOSTOP,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203545,N/A,HC TRAY HEMODIALYSIS CATHETER,272,1 ,$183.00 ,$118.95 ,$48.13 ,$183.00 , N/A ,$84.18 ,$102.48 , N/A ,$51.24 ,$61.85 , N/A ,$71.19 , N/A ,$82.53 ,$82.53 , N/A ,$118.95 , N/A ,$91.50 , N/A , N/A , N/A , N/A ,$137.25 ,$109.80 ,$109.80 , N/A ,$109.80 ,$139.08 ,$139.08 ,$139.08 ,$183.00 , N/A ,$155.55 , N/A ,$118.95 , N/A ,$183.00 ,$102.48 , N/A ,$48.13 , N/A , N/A , N/A , N/A ,$146.40 , N/A ,$82.53 ,$51.24 ,$164.70 , N/A ,$139.08 ,$118.95 ,$118.95 , N/A ,$118.95 ,$87.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27203546,N/A,HC KIT CATHETER COOL LINE,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203554,N/A,HC KIT ICP PRESSURE MONITOR,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203557,N/A,HC CATHETER INTRAUTERINE,272,1 ,$500.00 ,$325.00 ,$131.50 ,$500.00 , N/A ,$230.00 ,$280.00 , N/A ,$140.00 ,$169.00 , N/A ,$194.50 , N/A ,$225.50 ,$225.50 , N/A ,$325.00 , N/A ,$250.00 , N/A , N/A , N/A , N/A ,$375.00 ,$300.00 ,$300.00 , N/A ,$300.00 ,$380.00 ,$380.00 ,$380.00 ,$500.00 , N/A ,$425.00 , N/A ,$325.00 , N/A ,$500.00 ,$280.00 , N/A ,$131.50 , N/A , N/A , N/A , N/A ,$400.00 , N/A ,$225.50 ,$140.00 ,$450.00 , N/A ,$380.00 ,$325.00 ,$325.00 , N/A ,$325.00 ,$240.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203562,N/A,HC CATHETER SUCTION,272,1 ,$4.31 ,$2.80 ,$1.13 ,$4.31 , N/A ,$1.98 ,$2.41 , N/A ,$1.21 ,$1.46 , N/A ,$1.68 , N/A ,$1.94 ,$1.94 , N/A ,$2.80 , N/A ,$2.16 , N/A , N/A , N/A , N/A ,$3.23 ,$2.59 ,$2.59 , N/A ,$2.59 ,$3.28 ,$3.28 ,$3.28 ,$4.31 , N/A ,$3.66 , N/A ,$2.80 , N/A ,$4.31 ,$2.41 , N/A ,$1.13 , N/A , N/A , N/A , N/A ,$3.45 , N/A ,$1.94 ,$1.21 ,$3.88 , N/A ,$3.28 ,$2.80 ,$2.80 , N/A ,$2.80 ,$2.07 , N/A 
ST. ELIZABETH'S HOSPITAL,27203564,N/A,HC CATHETER UMBILICAL ARTERY,272,1 ,$76.57 ,$49.77 ,$20.14 ,$76.57 , N/A ,$35.22 ,$42.88 , N/A ,$21.44 ,$25.88 , N/A ,$29.79 , N/A ,$34.53 ,$34.53 , N/A ,$49.77 , N/A ,$38.29 , N/A , N/A , N/A , N/A ,$57.43 ,$45.94 ,$45.94 , N/A ,$45.94 ,$58.19 ,$58.19 ,$58.19 ,$76.57 , N/A ,$65.08 , N/A ,$49.77 , N/A ,$76.57 ,$42.88 , N/A ,$20.14 , N/A , N/A , N/A , N/A ,$61.26 , N/A ,$34.53 ,$21.44 ,$68.91 , N/A ,$58.19 ,$49.77 ,$49.77 , N/A ,$49.77 ,$36.75 , N/A 
ST. ELIZABETH'S HOSPITAL,27203568,N/A,HC DRAIN CHEST,272,1 ,$40.03 ,$26.02 ,$10.53 ,$40.03 , N/A ,$18.41 ,$22.42 , N/A ,$11.21 ,$13.53 , N/A ,$15.57 , N/A ,$18.05 ,$18.05 , N/A ,$26.02 , N/A ,$20.02 , N/A , N/A , N/A , N/A ,$30.02 ,$24.02 ,$24.02 , N/A ,$24.02 ,$30.42 ,$30.42 ,$30.42 ,$40.03 , N/A ,$34.03 , N/A ,$26.02 , N/A ,$40.03 ,$22.42 , N/A ,$10.53 , N/A , N/A , N/A , N/A ,$32.02 , N/A ,$18.05 ,$11.21 ,$36.03 , N/A ,$30.42 ,$26.02 ,$26.02 , N/A ,$26.02 ,$19.21 , N/A 
ST. ELIZABETH'S HOSPITAL,27203590,N/A,HC SYRINGE PUMP SYRINGE,272,1 ,$31.00 ,$20.15 ,$8.15 ,$31.00 , N/A ,$14.26 ,$17.36 , N/A ,$8.68 ,$10.48 , N/A ,$12.06 , N/A ,$13.98 ,$13.98 , N/A ,$20.15 , N/A ,$15.50 , N/A , N/A , N/A , N/A ,$23.25 ,$18.60 ,$18.60 , N/A ,$18.60 ,$23.56 ,$23.56 ,$23.56 ,$31.00 , N/A ,$26.35 , N/A ,$20.15 , N/A ,$31.00 ,$17.36 , N/A ,$8.15 , N/A , N/A , N/A , N/A ,$24.80 , N/A ,$13.98 ,$8.68 ,$27.90 , N/A ,$23.56 ,$20.15 ,$20.15 , N/A ,$20.15 ,$14.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27203593,N/A,HC TRAY PERICARDIOCENTESIS DISP,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203594,N/A,HC TRAY TRACHEOSTOMY,272,1 ,"$1,431.00 ",$930.15 ,$376.35 ,"$1,431.00 ", N/A ,$658.26 ,$801.36 , N/A ,$400.68 ,$483.68 , N/A ,$556.66 , N/A ,$645.38 ,$645.38 , N/A ,$930.15 , N/A ,$715.50 , N/A , N/A , N/A , N/A ,"$1,073.25 ",$858.60 ,$858.60 , N/A ,$858.60 ,"$1,087.56 ","$1,087.56 ","$1,087.56 ","$1,431.00 ", N/A ,"$1,216.35 ", N/A ,$930.15 , N/A ,"$1,431.00 ",$801.36 , N/A ,$376.35 , N/A , N/A , N/A , N/A ,"$1,144.80 ", N/A ,$645.38 ,$400.68 ,"$1,287.90 ", N/A ,"$1,087.56 ",$930.15 ,$930.15 , N/A ,$930.15 ,$686.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27203595,N/A,HC TUBE TRACH CUFFED,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203599,N/A,HC TUBE TRACH PEDIATRIC,272,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203614,N/A,HC NEEDLE LOCALIZATION,272,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203626,N/A,HC TUBE ENDOTRACH,272,1 ,$200.00 ,$130.00 ,$52.60 ,$200.00 , N/A ,$92.00 ,$112.00 , N/A ,$56.00 ,$67.60 , N/A ,$77.80 , N/A ,$90.20 ,$90.20 , N/A ,$130.00 , N/A ,$100.00 , N/A , N/A , N/A , N/A ,$150.00 ,$120.00 ,$120.00 , N/A ,$120.00 ,$152.00 ,$152.00 ,$152.00 ,$200.00 , N/A ,$170.00 , N/A ,$130.00 , N/A ,$200.00 ,$112.00 , N/A ,$52.60 , N/A , N/A , N/A , N/A ,$160.00 , N/A ,$90.20 ,$56.00 ,$180.00 , N/A ,$152.00 ,$130.00 ,$130.00 , N/A ,$130.00 ,$96.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203636,N/A,HC TRAY MYELOGRAM,272,1 ,$44.00 ,$28.60 ,$11.57 ,$44.00 , N/A ,$20.24 ,$24.64 , N/A ,$12.32 ,$14.87 , N/A ,$17.12 , N/A ,$19.84 ,$19.84 , N/A ,$28.60 , N/A ,$22.00 , N/A , N/A , N/A , N/A ,$33.00 ,$26.40 ,$26.40 , N/A ,$26.40 ,$33.44 ,$33.44 ,$33.44 ,$44.00 , N/A ,$37.40 , N/A ,$28.60 , N/A ,$44.00 ,$24.64 , N/A ,$11.57 , N/A , N/A , N/A , N/A ,$35.20 , N/A ,$19.84 ,$12.32 ,$39.60 , N/A ,$33.44 ,$28.60 ,$28.60 , N/A ,$28.60 ,$21.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27203641,N/A,HC NEEDLE BIOPSY,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203646,C1769,HC GUIDEWIRE FRACTIONAL FLOW RESERVE (FFR),272,1 ,"$1,750.00 ","$1,137.50 ",$460.25 ,"$1,750.00 ", N/A ,$805.00 ,$980.00 , N/A ,$490.00 ,$591.50 , N/A ,$680.75 , N/A ,$789.25 ,$789.25 , N/A ,"$1,137.50 ", N/A ,$875.00 , N/A , N/A , N/A , N/A ,"$1,312.50 ","$1,050.00 ","$1,050.00 ", N/A ,"$1,050.00 ","$1,330.00 ","$1,330.00 ","$1,330.00 ","$1,750.00 ", N/A ,"$1,487.50 ", N/A ,"$1,137.50 ", N/A ,"$1,750.00 ",$980.00 , N/A ,$460.25 , N/A , N/A , N/A , N/A ,"$1,400.00 ", N/A ,$789.25 ,$490.00 ,"$1,575.00 ", N/A ,"$1,330.00 ","$1,137.50 ","$1,137.50 ", N/A ,"$1,137.50 ",$840.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203649,C1725,HC BALLOON CATHETER,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203654,N/A,HC CATHETER SWAN GANZ,272,1 ,$500.00 ,$325.00 ,$131.50 ,$500.00 , N/A ,$230.00 ,$280.00 , N/A ,$140.00 ,$169.00 , N/A ,$194.50 , N/A ,$225.50 ,$225.50 , N/A ,$325.00 , N/A ,$250.00 , N/A , N/A , N/A , N/A ,$375.00 ,$300.00 ,$300.00 , N/A ,$300.00 ,$380.00 ,$380.00 ,$380.00 ,$500.00 , N/A ,$425.00 , N/A ,$325.00 , N/A ,$500.00 ,$280.00 , N/A ,$131.50 , N/A , N/A , N/A , N/A ,$400.00 , N/A ,$225.50 ,$140.00 ,$450.00 , N/A ,$380.00 ,$325.00 ,$325.00 , N/A ,$325.00 ,$240.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203655,N/A,HC CATHETER SWAN GANZ THERMODIULTION,272,1 ,"$1,170.00 ",$760.50 ,$307.71 ,"$1,170.00 ", N/A ,$538.20 ,$655.20 , N/A ,$327.60 ,$395.46 , N/A ,$455.13 , N/A ,$527.67 ,$527.67 , N/A ,$760.50 , N/A ,$585.00 , N/A , N/A , N/A , N/A ,$877.50 ,$702.00 ,$702.00 , N/A ,$702.00 ,$889.20 ,$889.20 ,$889.20 ,"$1,170.00 ", N/A ,$994.50 , N/A ,$760.50 , N/A ,"$1,170.00 ",$655.20 , N/A ,$307.71 , N/A , N/A , N/A , N/A ,$936.00 , N/A ,$527.67 ,$327.60 ,"$1,053.00 ", N/A ,$889.20 ,$760.50 ,$760.50 , N/A ,$760.50 ,$561.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27203657,C1769,HC GUIDEWIRE,272,1 ,$174.00 ,$113.10 ,$45.76 ,$174.00 , N/A ,$80.04 ,$97.44 , N/A ,$48.72 ,$58.81 , N/A ,$67.69 , N/A ,$78.47 ,$78.47 , N/A ,$113.10 , N/A ,$87.00 , N/A , N/A , N/A , N/A ,$130.50 ,$104.40 ,$104.40 , N/A ,$104.40 ,$132.24 ,$132.24 ,$132.24 ,$174.00 , N/A ,$147.90 , N/A ,$113.10 , N/A ,$174.00 ,$97.44 , N/A ,$45.76 , N/A , N/A , N/A , N/A ,$139.20 , N/A ,$78.47 ,$48.72 ,$156.60 , N/A ,$132.24 ,$113.10 ,$113.10 , N/A ,$113.10 ,$83.52 , N/A 
ST. ELIZABETH'S HOSPITAL,27203658,C1769,HC GUIDEWIRE GLIDEWIRE,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203666,C1753,HC CATHETER IVUS,272,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,462.50 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,710.00 ","$1,710.00 ","$1,710.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,710.00 ","$1,462.50 ","$1,462.50 ", N/A ,"$1,462.50 ","$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203667,C1725,HC CATHETER BALLOON CORONARY,272,1 ,$225.00 ,$146.25 ,$59.18 ,$225.00 , N/A ,$103.50 ,$126.00 , N/A ,$63.00 ,$76.05 , N/A ,$87.53 , N/A ,$101.48 ,$101.48 , N/A ,$146.25 , N/A ,$112.50 , N/A , N/A , N/A , N/A ,$168.75 ,$135.00 ,$135.00 , N/A ,$135.00 ,$171.00 ,$171.00 ,$171.00 ,$225.00 , N/A ,$191.25 , N/A ,$146.25 , N/A ,$225.00 ,$126.00 , N/A ,$59.18 , N/A , N/A , N/A , N/A ,$180.00 , N/A ,$101.48 ,$63.00 ,$202.50 , N/A ,$171.00 ,$146.25 ,$146.25 , N/A ,$146.25 ,$108.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203668,C1725,HC CATHETER BALLOON PERIPHERAL,272,1 ,"$3,150.00 ","$2,047.50 ",$828.45 ,"$3,150.00 ", N/A ,"$1,449.00 ","$1,764.00 ", N/A ,$882.00 ,"$1,064.70 ", N/A ,"$1,225.35 ", N/A ,"$1,420.65 ","$1,420.65 ", N/A ,"$2,047.50 ", N/A ,"$1,575.00 ", N/A , N/A , N/A , N/A ,"$2,362.50 ","$1,890.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$2,394.00 ","$2,394.00 ","$2,394.00 ","$3,150.00 ", N/A ,"$2,677.50 ", N/A ,"$2,047.50 ", N/A ,"$3,150.00 ","$1,764.00 ", N/A ,$828.45 , N/A , N/A , N/A , N/A ,"$2,520.00 ", N/A ,"$1,420.65 ",$882.00 ,"$2,835.00 ", N/A ,"$2,394.00 ","$2,047.50 ","$2,047.50 ", N/A ,"$2,047.50 ","$1,512.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203673,C1887,HC CATHETER GUIDELINER,272,1 ,"$1,000.00 ",$650.00 ,$263.00 ,"$1,000.00 ", N/A ,$460.00 ,$560.00 , N/A ,$280.00 ,$338.00 , N/A ,$389.00 , N/A ,$451.00 ,$451.00 , N/A ,$650.00 , N/A ,$500.00 , N/A , N/A , N/A , N/A ,$750.00 ,$600.00 ,$600.00 , N/A ,$600.00 ,$760.00 ,$760.00 ,$760.00 ,"$1,000.00 ", N/A ,$850.00 , N/A ,$650.00 , N/A ,"$1,000.00 ",$560.00 , N/A ,$263.00 , N/A , N/A , N/A , N/A ,$800.00 , N/A ,$451.00 ,$280.00 ,$900.00 , N/A ,$760.00 ,$650.00 ,$650.00 , N/A ,$650.00 ,$480.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203678,N/A,HC TRAY BONE BIOPSY,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203679,C1751,HC CATHETER INFUSION,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203680,N/A,HC SET NEEDLE ACCESS,272,1 ,$330.00 ,$214.50 ,$86.79 ,$330.00 , N/A ,$151.80 ,$184.80 , N/A ,$92.40 ,$111.54 , N/A ,$128.37 , N/A ,$148.83 ,$148.83 , N/A ,$214.50 , N/A ,$165.00 , N/A , N/A , N/A , N/A ,$247.50 ,$198.00 ,$198.00 , N/A ,$198.00 ,$250.80 ,$250.80 ,$250.80 ,$330.00 , N/A ,$280.50 , N/A ,$214.50 , N/A ,$330.00 ,$184.80 , N/A ,$86.79 , N/A , N/A , N/A , N/A ,$264.00 , N/A ,$148.83 ,$92.40 ,$297.00 , N/A ,$250.80 ,$214.50 ,$214.50 , N/A ,$214.50 ,$158.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27203693,C1887,HC MICROCATHETER HI FLO,272,1 ,"$2,034.00 ","$1,322.10 ",$534.94 ,"$2,034.00 ", N/A ,$935.64 ,"$1,139.04 ", N/A ,$569.52 ,$687.49 , N/A ,$791.23 , N/A ,$917.33 ,$917.33 , N/A ,"$1,322.10 ", N/A ,"$1,017.00 ", N/A , N/A , N/A , N/A ,"$1,525.50 ","$1,220.40 ","$1,220.40 ", N/A ,"$1,220.40 ","$1,545.84 ","$1,545.84 ","$1,545.84 ","$2,034.00 ", N/A ,"$1,728.90 ", N/A ,"$1,322.10 ", N/A ,"$2,034.00 ","$1,139.04 ", N/A ,$534.94 , N/A , N/A , N/A , N/A ,"$1,627.20 ", N/A ,$917.33 ,$569.52 ,"$1,830.60 ", N/A ,"$1,545.84 ","$1,322.10 ","$1,322.10 ", N/A ,"$1,322.10 ",$976.32 , N/A 
ST. ELIZABETH'S HOSPITAL,27203695,C1887,HC MICROCATHETER PROGREAT,272,1 ,"$1,100.00 ",$715.00 ,$289.30 ,"$1,100.00 ", N/A ,$506.00 ,$616.00 , N/A ,$308.00 ,$371.80 , N/A ,$427.90 , N/A ,$496.10 ,$496.10 , N/A ,$715.00 , N/A ,$550.00 , N/A , N/A , N/A , N/A ,$825.00 ,$660.00 ,$660.00 , N/A ,$660.00 ,$836.00 ,$836.00 ,$836.00 ,"$1,100.00 ", N/A ,$935.00 , N/A ,$715.00 , N/A ,"$1,100.00 ",$616.00 , N/A ,$289.30 , N/A , N/A , N/A , N/A ,$880.00 , N/A ,$496.10 ,$308.00 ,$990.00 , N/A ,$836.00 ,$715.00 ,$715.00 , N/A ,$715.00 ,$528.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203701,C1729,HC CATHETER NEPHROSTOMY,272,1 ,$264.25 ,$171.76 ,$69.50 ,$264.25 , N/A ,$121.56 ,$147.98 , N/A ,$73.99 ,$89.32 , N/A ,$102.79 , N/A ,$119.18 ,$119.18 , N/A ,$171.76 , N/A ,$132.13 , N/A , N/A , N/A , N/A ,$198.19 ,$158.55 ,$158.55 , N/A ,$158.55 ,$200.83 ,$200.83 ,$200.83 ,$264.25 , N/A ,$224.61 , N/A ,$171.76 , N/A ,$264.25 ,$147.98 , N/A ,$69.50 , N/A , N/A , N/A , N/A ,$211.40 , N/A ,$119.18 ,$73.99 ,$237.83 , N/A ,$200.83 ,$171.76 ,$171.76 , N/A ,$171.76 ,$126.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27203749,C1725,HC CATHETER BALLOON PERIPHERAL CONQUEST,272,1 ,$500.00 ,$325.00 ,$131.50 ,$500.00 , N/A ,$230.00 ,$280.00 , N/A ,$140.00 ,$169.00 , N/A ,$194.50 , N/A ,$225.50 ,$225.50 , N/A ,$325.00 , N/A ,$250.00 , N/A , N/A , N/A , N/A ,$375.00 ,$300.00 ,$300.00 , N/A ,$300.00 ,$380.00 ,$380.00 ,$380.00 ,$500.00 , N/A ,$425.00 , N/A ,$325.00 , N/A ,$500.00 ,$280.00 , N/A ,$131.50 , N/A , N/A , N/A , N/A ,$400.00 , N/A ,$225.50 ,$140.00 ,$450.00 , N/A ,$380.00 ,$325.00 ,$325.00 , N/A ,$325.00 ,$240.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203769,N/A,HC EMBOLIZATION PARTICLES,272,1 ,$465.00 ,$302.25 ,$122.30 ,$465.00 , N/A ,$213.90 ,$260.40 , N/A ,$130.20 ,$157.17 , N/A ,$180.89 , N/A ,$209.72 ,$209.72 , N/A ,$302.25 , N/A ,$232.50 , N/A , N/A , N/A , N/A ,$348.75 ,$279.00 ,$279.00 , N/A ,$279.00 ,$353.40 ,$353.40 ,$353.40 ,$465.00 , N/A ,$395.25 , N/A ,$302.25 , N/A ,$465.00 ,$260.40 , N/A ,$122.30 , N/A , N/A , N/A , N/A ,$372.00 , N/A ,$209.72 ,$130.20 ,$418.50 , N/A ,$353.40 ,$302.25 ,$302.25 , N/A ,$302.25 ,$223.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27203773,C1769,HC GUIDEWIRE ANGIOPLASTY,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203785,C1733,HC ABLATION CATH EP,272,1 ,"$4,750.00 ","$3,087.50 ","$1,249.25 ","$4,750.00 ", N/A ,"$2,185.00 ","$2,660.00 ", N/A ,"$1,330.00 ","$1,605.50 ", N/A ,"$1,847.75 ", N/A ,"$2,142.25 ","$2,142.25 ", N/A ,"$3,087.50 ", N/A ,"$2,375.00 ", N/A , N/A , N/A , N/A ,"$3,562.50 ","$2,850.00 ","$2,850.00 ", N/A ,"$2,850.00 ","$3,610.00 ","$3,610.00 ","$3,610.00 ","$4,750.00 ", N/A ,"$4,037.50 ", N/A ,"$3,087.50 ", N/A ,"$4,750.00 ","$2,660.00 ", N/A ,"$1,249.25 ", N/A , N/A , N/A , N/A ,"$3,800.00 ", N/A ,"$2,142.25 ","$1,330.00 ","$4,275.00 ", N/A ,"$3,610.00 ","$3,087.50 ","$3,087.50 ", N/A ,"$3,087.50 ","$2,280.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203786,C2630,HC ABLATION CATH EP COOL TIP,272,1 ,"$3,750.00 ","$2,437.50 ",$986.25 ,"$3,750.00 ", N/A ,"$1,725.00 ","$2,100.00 ", N/A ,"$1,050.00 ","$1,267.50 ", N/A ,"$1,458.75 ", N/A ,"$1,691.25 ","$1,691.25 ", N/A ,"$2,437.50 ", N/A ,"$1,875.00 ", N/A , N/A , N/A , N/A ,"$2,812.50 ","$2,250.00 ","$2,250.00 ", N/A ,"$2,250.00 ","$2,850.00 ","$2,850.00 ","$2,850.00 ","$3,750.00 ", N/A ,"$3,187.50 ", N/A ,"$2,437.50 ", N/A ,"$3,750.00 ","$2,100.00 ", N/A ,$986.25 , N/A , N/A , N/A , N/A ,"$3,000.00 ", N/A ,"$1,691.25 ","$1,050.00 ","$3,375.00 ", N/A ,"$2,850.00 ","$2,437.50 ","$2,437.50 ", N/A ,"$2,437.50 ","$1,800.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203787,C1732,HC ABLATION CATH MAPPING NAV,272,1 ,"$3,750.00 ","$2,437.50 ",$986.25 ,"$3,750.00 ", N/A ,"$1,725.00 ","$2,100.00 ", N/A ,"$1,050.00 ","$1,267.50 ", N/A ,"$1,458.75 ", N/A ,"$1,691.25 ","$1,691.25 ", N/A ,"$2,437.50 ", N/A ,"$1,875.00 ", N/A , N/A , N/A , N/A ,"$2,812.50 ","$2,250.00 ","$2,250.00 ", N/A ,"$2,250.00 ","$2,850.00 ","$2,850.00 ","$2,850.00 ","$3,750.00 ", N/A ,"$3,187.50 ", N/A ,"$2,437.50 ", N/A ,"$3,750.00 ","$2,100.00 ", N/A ,$986.25 , N/A , N/A , N/A , N/A ,"$3,000.00 ", N/A ,"$1,691.25 ","$1,050.00 ","$3,375.00 ", N/A ,"$2,850.00 ","$2,437.50 ","$2,437.50 ", N/A ,"$2,437.50 ","$1,800.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203788,C1732,HC ABLATION CATH SMART TOUCH NAV,272,1 ,"$8,250.00 ","$5,362.50 ","$2,169.75 ","$8,250.00 ", N/A ,"$3,795.00 ","$4,620.00 ", N/A ,"$2,310.00 ","$2,788.50 ", N/A ,"$3,209.25 ", N/A ,"$3,720.75 ","$3,720.75 ", N/A ,"$5,362.50 ", N/A ,"$4,125.00 ", N/A , N/A , N/A , N/A ,"$6,187.50 ","$4,950.00 ","$4,950.00 ", N/A ,"$4,950.00 ","$6,270.00 ","$6,270.00 ","$6,270.00 ","$8,250.00 ", N/A ,"$7,012.50 ", N/A ,"$5,362.50 ", N/A ,"$8,250.00 ","$4,620.00 ", N/A ,"$2,169.75 ", N/A , N/A , N/A , N/A ,"$6,600.00 ", N/A ,"$3,720.75 ","$2,310.00 ","$7,425.00 ", N/A ,"$6,270.00 ","$5,362.50 ","$5,362.50 ", N/A ,"$5,362.50 ","$3,960.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203789,C1732,HC ABLATION CATH THERMACOOL SMART TOUCH,272,1 ,"$7,250.00 ","$4,712.50 ","$1,906.75 ","$7,250.00 ", N/A ,"$3,335.00 ","$4,060.00 ", N/A ,"$2,030.00 ","$2,450.50 ", N/A ,"$2,820.25 ", N/A ,"$3,269.75 ","$3,269.75 ", N/A ,"$4,712.50 ", N/A ,"$3,625.00 ", N/A , N/A , N/A , N/A ,"$5,437.50 ","$4,350.00 ","$4,350.00 ", N/A ,"$4,350.00 ","$5,510.00 ","$5,510.00 ","$5,510.00 ","$7,250.00 ", N/A ,"$6,162.50 ", N/A ,"$4,712.50 ", N/A ,"$7,250.00 ","$4,060.00 ", N/A ,"$1,906.75 ", N/A , N/A , N/A , N/A ,"$5,800.00 ", N/A ,"$3,269.75 ","$2,030.00 ","$6,525.00 ", N/A ,"$5,510.00 ","$4,712.50 ","$4,712.50 ", N/A ,"$4,712.50 ","$3,480.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203790,N/A,HC BLADE CAUTERY PEAK PLASMA,272,1 ,$750.25 ,$487.66 ,$197.32 ,$750.25 , N/A ,$345.12 ,$420.14 , N/A ,$210.07 ,$253.58 , N/A ,$291.85 , N/A ,$338.36 ,$338.36 , N/A ,$487.66 , N/A ,$375.13 , N/A , N/A , N/A , N/A ,$562.69 ,$450.15 ,$450.15 , N/A ,$450.15 ,$570.19 ,$570.19 ,$570.19 ,$750.25 , N/A ,$637.71 , N/A ,$487.66 , N/A ,$750.25 ,$420.14 , N/A ,$197.32 , N/A , N/A , N/A , N/A ,$600.20 , N/A ,$338.36 ,$210.07 ,$675.23 , N/A ,$570.19 ,$487.66 ,$487.66 , N/A ,$487.66 ,$360.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27203791,C1757,HC CATHETER ANGIOJET DISTA,272,1 ,"$5,250.00 ","$3,412.50 ","$1,380.75 ","$5,250.00 ", N/A ,"$2,415.00 ","$2,940.00 ", N/A ,"$1,470.00 ","$1,774.50 ", N/A ,"$2,042.25 ", N/A ,"$2,367.75 ","$2,367.75 ", N/A ,"$3,412.50 ", N/A ,"$2,625.00 ", N/A , N/A , N/A , N/A ,"$3,937.50 ","$3,150.00 ","$3,150.00 ", N/A ,"$3,150.00 ","$3,990.00 ","$3,990.00 ","$3,990.00 ","$5,250.00 ", N/A ,"$4,462.50 ", N/A ,"$3,412.50 ", N/A ,"$5,250.00 ","$2,940.00 ", N/A ,"$1,380.75 ", N/A , N/A , N/A , N/A ,"$4,200.00 ", N/A ,"$2,367.75 ","$1,470.00 ","$4,725.00 ", N/A ,"$3,990.00 ","$3,412.50 ","$3,412.50 ", N/A ,"$3,412.50 ","$2,520.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203792,C1757,HC CATHETER ANGIOJET OMNI,272,1 ,"$5,250.00 ","$3,412.50 ","$1,380.75 ","$5,250.00 ", N/A ,"$2,415.00 ","$2,940.00 ", N/A ,"$1,470.00 ","$1,774.50 ", N/A ,"$2,042.25 ", N/A ,"$2,367.75 ","$2,367.75 ", N/A ,"$3,412.50 ", N/A ,"$2,625.00 ", N/A , N/A , N/A , N/A ,"$3,937.50 ","$3,150.00 ","$3,150.00 ", N/A ,"$3,150.00 ","$3,990.00 ","$3,990.00 ","$3,990.00 ","$5,250.00 ", N/A ,"$4,462.50 ", N/A ,"$3,412.50 ", N/A ,"$5,250.00 ","$2,940.00 ", N/A ,"$1,380.75 ", N/A , N/A , N/A , N/A ,"$4,200.00 ", N/A ,"$2,367.75 ","$1,470.00 ","$4,725.00 ", N/A ,"$3,990.00 ","$3,412.50 ","$3,412.50 ", N/A ,"$3,412.50 ","$2,520.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203793,C1757,HC CATHETER ANGIOJET PROXI,272,1 ,"$4,250.00 ","$2,762.50 ","$1,117.75 ","$4,250.00 ", N/A ,"$1,955.00 ","$2,380.00 ", N/A ,"$1,190.00 ","$1,436.50 ", N/A ,"$1,653.25 ", N/A ,"$1,916.75 ","$1,916.75 ", N/A ,"$2,762.50 ", N/A ,"$2,125.00 ", N/A , N/A , N/A , N/A ,"$3,187.50 ","$2,550.00 ","$2,550.00 ", N/A ,"$2,550.00 ","$3,230.00 ","$3,230.00 ","$3,230.00 ","$4,250.00 ", N/A ,"$3,612.50 ", N/A ,"$2,762.50 ", N/A ,"$4,250.00 ","$2,380.00 ", N/A ,"$1,117.75 ", N/A , N/A , N/A , N/A ,"$3,400.00 ", N/A ,"$1,916.75 ","$1,190.00 ","$3,825.00 ", N/A ,"$3,230.00 ","$2,762.50 ","$2,762.50 ", N/A ,"$2,762.50 ","$2,040.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203794,C1725,HC CATHETER BALLOON PERIPHERAL ATLAS,272,1 ,$750.00 ,$487.50 ,$197.25 ,$750.00 , N/A ,$345.00 ,$420.00 , N/A ,$210.00 ,$253.50 , N/A ,$291.75 , N/A ,$338.25 ,$338.25 , N/A ,$487.50 , N/A ,$375.00 , N/A , N/A , N/A , N/A ,$562.50 ,$450.00 ,$450.00 , N/A ,$450.00 ,$570.00 ,$570.00 ,$570.00 ,$750.00 , N/A ,$637.50 , N/A ,$487.50 , N/A ,$750.00 ,$420.00 , N/A ,$197.25 , N/A , N/A , N/A , N/A ,$600.00 , N/A ,$338.25 ,$210.00 ,$675.00 , N/A ,$570.00 ,$487.50 ,$487.50 , N/A ,$487.50 ,$360.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203795,C1725,HC CATHETER BALLOON PERIPHERAL NANOCROSS,272,1 ,$625.00 ,$406.25 ,$164.38 ,$625.00 , N/A ,$287.50 ,$350.00 , N/A ,$175.00 ,$211.25 , N/A ,$243.13 , N/A ,$281.88 ,$281.88 , N/A ,$406.25 , N/A ,$312.50 , N/A , N/A , N/A , N/A ,$468.75 ,$375.00 ,$375.00 , N/A ,$375.00 ,$475.00 ,$475.00 ,$475.00 ,$625.00 , N/A ,$531.25 , N/A ,$406.25 , N/A ,$625.00 ,$350.00 , N/A ,$164.38 , N/A , N/A , N/A , N/A ,$500.00 , N/A ,$281.88 ,$175.00 ,$562.50 , N/A ,$475.00 ,$406.25 ,$406.25 , N/A ,$406.25 ,$300.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203796,C1725,HC CATHETER BALLOON PERIPHERAL NANOCROSS LG DIA,272,1 ,$750.00 ,$487.50 ,$197.25 ,$750.00 , N/A ,$345.00 ,$420.00 , N/A ,$210.00 ,$253.50 , N/A ,$291.75 , N/A ,$338.25 ,$338.25 , N/A ,$487.50 , N/A ,$375.00 , N/A , N/A , N/A , N/A ,$562.50 ,$450.00 ,$450.00 , N/A ,$450.00 ,$570.00 ,$570.00 ,$570.00 ,$750.00 , N/A ,$637.50 , N/A ,$487.50 , N/A ,$750.00 ,$420.00 , N/A ,$197.25 , N/A , N/A , N/A , N/A ,$600.00 , N/A ,$338.25 ,$210.00 ,$675.00 , N/A ,$570.00 ,$487.50 ,$487.50 , N/A ,$487.50 ,$360.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203797,C1725,HC CATHETER BALLOON PERIPHERAL ULTRAVERSE,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203798,C1714,HC CATHETER DIAMOND BACK,272,1 ,"$3,750.00 ","$2,437.50 ",$986.25 ,"$3,750.00 ", N/A ,"$1,725.00 ","$2,100.00 ", N/A ,"$1,050.00 ","$1,267.50 ", N/A ,"$1,458.75 ", N/A ,"$1,691.25 ","$1,691.25 ", N/A ,"$2,437.50 ", N/A ,"$1,875.00 ", N/A , N/A , N/A , N/A ,"$2,812.50 ","$2,250.00 ","$2,250.00 ", N/A ,"$2,250.00 ","$2,850.00 ","$2,850.00 ","$2,850.00 ","$3,750.00 ", N/A ,"$3,187.50 ", N/A ,"$2,437.50 ", N/A ,"$3,750.00 ","$2,100.00 ", N/A ,$986.25 , N/A , N/A , N/A , N/A ,"$3,000.00 ", N/A ,"$1,691.25 ","$1,050.00 ","$3,375.00 ", N/A ,"$2,850.00 ","$2,437.50 ","$2,437.50 ", N/A ,"$2,437.50 ","$1,800.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203799,C1887,HC CATHETER DUAL-LUMEN LANGSTON,272,1 ,$310.00 ,$201.50 ,$81.53 ,$310.00 , N/A ,$142.60 ,$173.60 , N/A ,$86.80 ,$104.78 , N/A ,$120.59 , N/A ,$139.81 ,$139.81 , N/A ,$201.50 , N/A ,$155.00 , N/A , N/A , N/A , N/A ,$232.50 ,$186.00 ,$186.00 , N/A ,$186.00 ,$235.60 ,$235.60 ,$235.60 ,$310.00 , N/A ,$263.50 , N/A ,$201.50 , N/A ,$310.00 ,$173.60 , N/A ,$81.53 , N/A , N/A , N/A , N/A ,$248.00 , N/A ,$139.81 ,$86.80 ,$279.00 , N/A ,$235.60 ,$201.50 ,$201.50 , N/A ,$201.50 ,$148.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27203800,C1731,HC CATHETER EP STEERABLE INQUIRY,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203801,C1887,HC CATHETER EXTENSION GUIDEZILLA,272,1 ,"$1,000.00 ",$650.00 ,$263.00 ,"$1,000.00 ", N/A ,$460.00 ,$560.00 , N/A ,$280.00 ,$338.00 , N/A ,$389.00 , N/A ,$451.00 ,$451.00 , N/A ,$650.00 , N/A ,$500.00 , N/A , N/A , N/A , N/A ,$750.00 ,$600.00 ,$600.00 , N/A ,$600.00 ,$760.00 ,$760.00 ,$760.00 ,"$1,000.00 ", N/A ,$850.00 , N/A ,$650.00 , N/A ,"$1,000.00 ",$560.00 , N/A ,$263.00 , N/A , N/A , N/A , N/A ,$800.00 , N/A ,$451.00 ,$280.00 ,$900.00 , N/A ,$760.00 ,$650.00 ,$650.00 , N/A ,$650.00 ,$480.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203802,C1887,HC CATHETER GUIDING IKARI,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203803,C1887,HC CATHETER GUIDING LAUNCHER,272,1 ,$130.34 ,$84.72 ,$34.28 ,$130.34 , N/A ,$59.96 ,$72.99 , N/A ,$36.50 ,$44.05 , N/A ,$50.70 , N/A ,$58.78 ,$58.78 , N/A ,$84.72 , N/A ,$65.17 , N/A , N/A , N/A , N/A ,$97.76 ,$78.20 ,$78.20 , N/A ,$78.20 ,$99.06 ,$99.06 ,$99.06 ,$130.34 , N/A ,$110.79 , N/A ,$84.72 , N/A ,$130.34 ,$72.99 , N/A ,$34.28 , N/A , N/A , N/A , N/A ,$104.27 , N/A ,$58.78 ,$36.50 ,$117.31 , N/A ,$99.06 ,$84.72 ,$84.72 , N/A ,$84.72 ,$62.56 , N/A 
ST. ELIZABETH'S HOSPITAL,27203804,C1759,HC CATHETER INTRACARD EP ACCUNAV,272,1 ,"$5,250.00 ","$3,412.50 ","$1,380.75 ","$5,250.00 ", N/A ,"$2,415.00 ","$2,940.00 ", N/A ,"$1,470.00 ","$1,774.50 ", N/A ,"$2,042.25 ", N/A ,"$2,367.75 ","$2,367.75 ", N/A ,"$3,412.50 ", N/A ,"$2,625.00 ", N/A , N/A , N/A , N/A ,"$3,937.50 ","$3,150.00 ","$3,150.00 ", N/A ,"$3,150.00 ","$3,990.00 ","$3,990.00 ","$3,990.00 ","$5,250.00 ", N/A ,"$4,462.50 ", N/A ,"$3,412.50 ", N/A ,"$5,250.00 ","$2,940.00 ", N/A ,"$1,380.75 ", N/A , N/A , N/A , N/A ,"$4,200.00 ", N/A ,"$2,367.75 ","$1,470.00 ","$4,725.00 ", N/A ,"$3,990.00 ","$3,412.50 ","$3,412.50 ", N/A ,"$3,412.50 ","$2,520.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203805,C1759,HC CATHETER INTRACARD EP ACCUNAV CERT PERF,272,1 ,"$1,750.00 ","$1,137.50 ",$460.25 ,"$1,750.00 ", N/A ,$805.00 ,$980.00 , N/A ,$490.00 ,$591.50 , N/A ,$680.75 , N/A ,$789.25 ,$789.25 , N/A ,"$1,137.50 ", N/A ,$875.00 , N/A , N/A , N/A , N/A ,"$1,312.50 ","$1,050.00 ","$1,050.00 ", N/A ,"$1,050.00 ","$1,330.00 ","$1,330.00 ","$1,330.00 ","$1,750.00 ", N/A ,"$1,487.50 ", N/A ,"$1,137.50 ", N/A ,"$1,750.00 ",$980.00 , N/A ,$460.25 , N/A , N/A , N/A , N/A ,"$1,400.00 ", N/A ,$789.25 ,$490.00 ,"$1,575.00 ", N/A ,"$1,330.00 ","$1,137.50 ","$1,137.50 ", N/A ,"$1,137.50 ",$840.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203806,C1759,HC CATHETER INTRACARD EP SOUND STAR,272,1 ,"$5,250.00 ","$3,412.50 ","$1,380.75 ","$5,250.00 ", N/A ,"$2,415.00 ","$2,940.00 ", N/A ,"$1,470.00 ","$1,774.50 ", N/A ,"$2,042.25 ", N/A ,"$2,367.75 ","$2,367.75 ", N/A ,"$3,412.50 ", N/A ,"$2,625.00 ", N/A , N/A , N/A , N/A ,"$3,937.50 ","$3,150.00 ","$3,150.00 ", N/A ,"$3,150.00 ","$3,990.00 ","$3,990.00 ","$3,990.00 ","$5,250.00 ", N/A ,"$4,462.50 ", N/A ,"$3,412.50 ", N/A ,"$5,250.00 ","$2,940.00 ", N/A ,"$1,380.75 ", N/A , N/A , N/A , N/A ,"$4,200.00 ", N/A ,"$2,367.75 ","$1,470.00 ","$4,725.00 ", N/A ,"$3,990.00 ","$3,412.50 ","$3,412.50 ", N/A ,"$3,412.50 ","$2,520.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203807,C1759,HC CATHETER INTRACARD EP SOUND STAR CERT PERF,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203808,C1714,HC CATHETER JETSTREAM,272,1 ,"$8,250.00 ","$5,362.50 ","$2,169.75 ","$8,250.00 ", N/A ,"$3,795.00 ","$4,620.00 ", N/A ,"$2,310.00 ","$2,788.50 ", N/A ,"$3,209.25 ", N/A ,"$3,720.75 ","$3,720.75 ", N/A ,"$5,362.50 ", N/A ,"$4,125.00 ", N/A , N/A , N/A , N/A ,"$6,187.50 ","$4,950.00 ","$4,950.00 ", N/A ,"$4,950.00 ","$6,270.00 ","$6,270.00 ","$6,270.00 ","$8,250.00 ", N/A ,"$7,012.50 ", N/A ,"$5,362.50 ", N/A ,"$8,250.00 ","$4,620.00 ", N/A ,"$2,169.75 ", N/A , N/A , N/A , N/A ,"$6,600.00 ", N/A ,"$3,720.75 ","$2,310.00 ","$7,425.00 ", N/A ,"$6,270.00 ","$5,362.50 ","$5,362.50 ", N/A ,"$5,362.50 ","$3,960.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203809,C1887,HC CATHETER MICRO GUIDE XP,272,1 ,$625.00 ,$406.25 ,$164.38 ,$625.00 , N/A ,$287.50 ,$350.00 , N/A ,$175.00 ,$211.25 , N/A ,$243.13 , N/A ,$281.88 ,$281.88 , N/A ,$406.25 , N/A ,$312.50 , N/A , N/A , N/A , N/A ,$468.75 ,$375.00 ,$375.00 , N/A ,$375.00 ,$475.00 ,$475.00 ,$475.00 ,$625.00 , N/A ,$531.25 , N/A ,$406.25 , N/A ,$625.00 ,$350.00 , N/A ,$164.38 , N/A , N/A , N/A , N/A ,$500.00 , N/A ,$281.88 ,$175.00 ,$562.50 , N/A ,$475.00 ,$406.25 ,$406.25 , N/A ,$406.25 ,$300.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203810,C1714,HC CATHETER OUTBACK,272,1 ,"$5,250.00 ","$3,412.50 ","$1,380.75 ","$5,250.00 ", N/A ,"$2,415.00 ","$2,940.00 ", N/A ,"$1,470.00 ","$1,774.50 ", N/A ,"$2,042.25 ", N/A ,"$2,367.75 ","$2,367.75 ", N/A ,"$3,412.50 ", N/A ,"$2,625.00 ", N/A , N/A , N/A , N/A ,"$3,937.50 ","$3,150.00 ","$3,150.00 ", N/A ,"$3,150.00 ","$3,990.00 ","$3,990.00 ","$3,990.00 ","$5,250.00 ", N/A ,"$4,462.50 ", N/A ,"$3,412.50 ", N/A ,"$5,250.00 ","$2,940.00 ", N/A ,"$1,380.75 ", N/A , N/A , N/A , N/A ,"$4,200.00 ", N/A ,"$2,367.75 ","$1,470.00 ","$4,725.00 ", N/A ,"$3,990.00 ","$3,412.50 ","$3,412.50 ", N/A ,"$3,412.50 ","$2,520.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203811,C1887,HC CATHETER SUPPORT CXI,272,1 ,$437.50 ,$284.38 ,$115.06 ,$437.50 , N/A ,$201.25 ,$245.00 , N/A ,$122.50 ,$147.88 , N/A ,$170.19 , N/A ,$197.31 ,$197.31 , N/A ,$284.38 , N/A ,$218.75 , N/A , N/A , N/A , N/A ,$328.13 ,$262.50 ,$262.50 , N/A ,$262.50 ,$332.50 ,$332.50 ,$332.50 ,$437.50 , N/A ,$371.88 , N/A ,$284.38 , N/A ,$437.50 ,$245.00 , N/A ,$115.06 , N/A , N/A , N/A , N/A ,$350.00 , N/A ,$197.31 ,$122.50 ,$393.75 , N/A ,$332.50 ,$284.38 ,$284.38 , N/A ,$284.38 ,$210.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203812,C1887,HC CATHETER TRANSIT INFUSION,272,1 ,"$1,125.00 ",$731.25 ,$295.88 ,"$1,125.00 ", N/A ,$517.50 ,$630.00 , N/A ,$315.00 ,$380.25 , N/A ,$437.63 , N/A ,$507.38 ,$507.38 , N/A ,$731.25 , N/A ,$562.50 , N/A , N/A , N/A , N/A ,$843.75 ,$675.00 ,$675.00 , N/A ,$675.00 ,$855.00 ,$855.00 ,$855.00 ,"$1,125.00 ", N/A ,$956.25 , N/A ,$731.25 , N/A ,"$1,125.00 ",$630.00 , N/A ,$295.88 , N/A , N/A , N/A , N/A ,$900.00 , N/A ,$507.38 ,$315.00 ,"$1,012.50 ", N/A ,$855.00 ,$731.25 ,$731.25 , N/A ,$731.25 ,$540.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203813,N/A,HC CURETTE BONE,272,1 ,"$1,250.00 ",$812.50 ,$328.75 ,"$1,250.00 ", N/A ,$575.00 ,$700.00 , N/A ,$350.00 ,$422.50 , N/A ,$486.25 , N/A ,$563.75 ,$563.75 , N/A ,$812.50 , N/A ,$625.00 , N/A , N/A , N/A , N/A ,$937.50 ,$750.00 ,$750.00 , N/A ,$750.00 ,$950.00 ,$950.00 ,$950.00 ,"$1,250.00 ", N/A ,"$1,062.50 ", N/A ,$812.50 , N/A ,"$1,250.00 ",$700.00 , N/A ,$328.75 , N/A , N/A , N/A , N/A ,"$1,000.00 ", N/A ,$563.75 ,$350.00 ,"$1,125.00 ", N/A ,$950.00 ,$812.50 ,$812.50 , N/A ,$812.50 ,$600.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203814,N/A,HC DEVICE INDEFLATOR,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203815,N/A,HC DRILL HAND VERTEBRAL BONE,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203816,C1769,HC GUIDEWIRE ASAHI,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203817,C1769,HC GUIDEWIRE CHOICE,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203818,C1769,HC GUIDEWIRE HI-TORQUE,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203819,C1769,HC GUIDEWIRE PERIPHERAL,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203820,C1769,HC GUIDEWIRE PLATINUM PLUS,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203821,C1769,HC GUIDEWIRE ROTAWIRE,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203822,C1769,HC GUIDEWIRE RUNTHROUGH NS,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203823,C1769,HC GUIDEWIRE SPARTACORE,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203824,C1769,HC GUIDEWIRE STIFF AMPLATZ,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203825,C1769,HC GUIDEWIRE VIPER WIRE,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203826,C1769,HC GUIDEWIRE WHISPER WIRE,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203827,C1894,HC INTRODUCER/SHEATH/CATH,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203828,C1753,HC IVUS CATHETER PLATINUM,272,1 ,"$1,750.00 ","$1,137.50 ",$460.25 ,"$1,750.00 ", N/A ,$805.00 ,$980.00 , N/A ,$490.00 ,$591.50 , N/A ,$680.75 , N/A ,$789.25 ,$789.25 , N/A ,"$1,137.50 ", N/A ,$875.00 , N/A , N/A , N/A , N/A ,"$1,312.50 ","$1,050.00 ","$1,050.00 ", N/A ,"$1,050.00 ","$1,330.00 ","$1,330.00 ","$1,330.00 ","$1,750.00 ", N/A ,"$1,487.50 ", N/A ,"$1,137.50 ", N/A ,"$1,750.00 ",$980.00 , N/A ,$460.25 , N/A , N/A , N/A , N/A ,"$1,400.00 ", N/A ,$789.25 ,$490.00 ,"$1,575.00 ", N/A ,"$1,330.00 ","$1,137.50 ","$1,137.50 ", N/A ,"$1,137.50 ",$840.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203829,N/A,HC KIT KYPHOPLASTY BALLOON,272,1 ,"$1,800.00 ","$1,170.00 ",$473.40 ,"$1,800.00 ", N/A ,$828.00 ,"$1,008.00 ", N/A ,$504.00 ,$608.40 , N/A ,$700.20 , N/A ,$811.80 ,$811.80 , N/A ,"$1,170.00 ", N/A ,$900.00 , N/A , N/A , N/A , N/A ,"$1,350.00 ","$1,080.00 ","$1,080.00 ", N/A ,"$1,080.00 ","$1,368.00 ","$1,368.00 ","$1,368.00 ","$1,800.00 ", N/A ,"$1,530.00 ", N/A ,"$1,170.00 ", N/A ,"$1,800.00 ","$1,008.00 ", N/A ,$473.40 , N/A , N/A , N/A , N/A ,"$1,440.00 ", N/A ,$811.80 ,$504.00 ,"$1,620.00 ", N/A ,"$1,368.00 ","$1,170.00 ","$1,170.00 ", N/A ,"$1,170.00 ",$864.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203830,N/A,HC NEEDLE ARTERIAL SMART,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203831,N/A,HC NEEDLE CURVED,272,1 ,"$1,000.00 ",$650.00 ,$263.00 ,"$1,000.00 ", N/A ,$460.00 ,$560.00 , N/A ,$280.00 ,$338.00 , N/A ,$389.00 , N/A ,$451.00 ,$451.00 , N/A ,$650.00 , N/A ,$500.00 , N/A , N/A , N/A , N/A ,$750.00 ,$600.00 ,$600.00 , N/A ,$600.00 ,$760.00 ,$760.00 ,$760.00 ,"$1,000.00 ", N/A ,$850.00 , N/A ,$650.00 , N/A ,"$1,000.00 ",$560.00 , N/A ,$263.00 , N/A , N/A , N/A , N/A ,$800.00 , N/A ,$451.00 ,$280.00 ,$900.00 , N/A ,$760.00 ,$650.00 ,$650.00 , N/A ,$650.00 ,$480.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203832,N/A,HC NEEDLE BAYLIS,272,1 ,"$1,175.00 ",$763.75 ,$309.03 ,"$1,175.00 ", N/A ,$540.50 ,$658.00 , N/A ,$329.00 ,$397.15 , N/A ,$457.08 , N/A ,$529.93 ,$529.93 , N/A ,$763.75 , N/A ,$587.50 , N/A , N/A , N/A , N/A ,$881.25 ,$705.00 ,$705.00 , N/A ,$705.00 ,$893.00 ,$893.00 ,$893.00 ,"$1,175.00 ", N/A ,$998.75 , N/A ,$763.75 , N/A ,"$1,175.00 ",$658.00 , N/A ,$309.03 , N/A , N/A , N/A , N/A ,$940.00 , N/A ,$529.93 ,$329.00 ,"$1,057.50 ", N/A ,$893.00 ,$763.75 ,$763.75 , N/A ,$763.75 ,$564.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203833,N/A,HC NEEDLE VERSA CROSS W/GUIDEWIRE,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203834,N/A,HC PATCH REFERENCE QWIKPATCH,272,1 ,$750.25 ,$487.66 ,$197.32 ,$750.25 , N/A ,$345.12 ,$420.14 , N/A ,$210.07 ,$253.58 , N/A ,$291.85 , N/A ,$338.36 ,$338.36 , N/A ,$487.66 , N/A ,$375.13 , N/A , N/A , N/A , N/A ,$562.69 ,$450.15 ,$450.15 , N/A ,$450.15 ,$570.19 ,$570.19 ,$570.19 ,$750.25 , N/A ,$637.71 , N/A ,$487.66 , N/A ,$750.25 ,$420.14 , N/A ,$197.32 , N/A , N/A , N/A , N/A ,$600.20 , N/A ,$338.36 ,$210.07 ,$675.23 , N/A ,$570.19 ,$487.66 ,$487.66 , N/A ,$487.66 ,$360.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27203835,C1894,HC ROTOBLATOR ADVANCER,272,1 ,$437.50 ,$284.38 ,$115.06 ,$437.50 , N/A ,$201.25 ,$245.00 , N/A ,$122.50 ,$147.88 , N/A ,$170.19 , N/A ,$197.31 ,$197.31 , N/A ,$284.38 , N/A ,$218.75 , N/A , N/A , N/A , N/A ,$328.13 ,$262.50 ,$262.50 , N/A ,$262.50 ,$332.50 ,$332.50 ,$332.50 ,$437.50 , N/A ,$371.88 , N/A ,$284.38 , N/A ,$437.50 ,$245.00 , N/A ,$115.06 , N/A , N/A , N/A , N/A ,$350.00 , N/A ,$197.31 ,$122.50 ,$393.75 , N/A ,$332.50 ,$284.38 ,$284.38 , N/A ,$284.38 ,$210.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203836,C1892,HC SHEATH EP PEEL AWAY WORLEY,272,1 ,$700.00 ,$455.00 ,$184.10 ,$700.00 , N/A ,$322.00 ,$392.00 , N/A ,$196.00 ,$236.60 , N/A ,$272.30 , N/A ,$315.70 ,$315.70 , N/A ,$455.00 , N/A ,$350.00 , N/A , N/A , N/A , N/A ,$525.00 ,$420.00 ,$420.00 , N/A ,$420.00 ,$532.00 ,$532.00 ,$532.00 ,$700.00 , N/A ,$595.00 , N/A ,$455.00 , N/A ,$700.00 ,$392.00 , N/A ,$184.10 , N/A , N/A , N/A , N/A ,$560.00 , N/A ,$315.70 ,$196.00 ,$630.00 , N/A ,$532.00 ,$455.00 ,$455.00 , N/A ,$455.00 ,$336.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203837,N/A,HC TUBING COOL FLOW,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203838,N/A,HC CANNULA CEMENT VERTEPORT,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203839,N/A,HC ARCTIC SUN PADS LARGE,272,1 ,"$2,175.00 ","$1,413.75 ",$572.03 ,"$2,175.00 ", N/A ,"$1,000.50 ","$1,218.00 ", N/A ,$609.00 ,$735.15 , N/A ,$846.08 , N/A ,$980.93 ,$980.93 , N/A ,"$1,413.75 ", N/A ,"$1,087.50 ", N/A , N/A , N/A , N/A ,"$1,631.25 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ","$1,653.00 ","$1,653.00 ","$1,653.00 ","$2,175.00 ", N/A ,"$1,848.75 ", N/A ,"$1,413.75 ", N/A ,"$2,175.00 ","$1,218.00 ", N/A ,$572.03 , N/A , N/A , N/A , N/A ,"$1,740.00 ", N/A ,$980.93 ,$609.00 ,"$1,957.50 ", N/A ,"$1,653.00 ","$1,413.75 ","$1,413.75 ", N/A ,"$1,413.75 ","$1,044.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203840,N/A,HC ARCTIC SUN PADS MEDIUM,272,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,787.50 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$2,090.00 ","$2,090.00 ","$2,090.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$2,090.00 ","$1,787.50 ","$1,787.50 ", N/A ,"$1,787.50 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27203841,N/A,HC BALLOON DILATOR CERVICAL,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203842,N/A,HC BRA SURGICAL VELCRO,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203843,N/A,HC VEST SURGICAL W/CUPS,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203844,N/A,HC TRAY CHEST TUBE,272,1 ,$375.00 ,$243.75 ,$98.63 ,$375.00 , N/A ,$172.50 ,$210.00 , N/A ,$105.00 ,$126.75 , N/A ,$145.88 , N/A ,$169.13 ,$169.13 , N/A ,$243.75 , N/A ,$187.50 , N/A , N/A , N/A , N/A ,$281.25 ,$225.00 ,$225.00 , N/A ,$225.00 ,$285.00 ,$285.00 ,$285.00 ,$375.00 , N/A ,$318.75 , N/A ,$243.75 , N/A ,$375.00 ,$210.00 , N/A ,$98.63 , N/A , N/A , N/A , N/A ,$300.00 , N/A ,$169.13 ,$105.00 ,$337.50 , N/A ,$285.00 ,$243.75 ,$243.75 , N/A ,$243.75 ,$180.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203845,N/A,HC SYSTEM VACUUM ASSIST PUMP,272,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203846,N/A,HC SYSTEM VACUUM ASSIST MUSHROOM CAP,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203848,N/A,HC PACK GYNE,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203849,N/A,HC DRESSING WOUND PICO,272,1 ,$500.00 ,$325.00 ,$131.50 ,$500.00 , N/A ,$230.00 ,$280.00 , N/A ,$140.00 ,$169.00 , N/A ,$194.50 , N/A ,$225.50 ,$225.50 , N/A ,$325.00 , N/A ,$250.00 , N/A , N/A , N/A , N/A ,$375.00 ,$300.00 ,$300.00 , N/A ,$300.00 ,$380.00 ,$380.00 ,$380.00 ,$500.00 , N/A ,$425.00 , N/A ,$325.00 , N/A ,$500.00 ,$280.00 , N/A ,$131.50 , N/A , N/A , N/A , N/A ,$400.00 , N/A ,$225.50 ,$140.00 ,$450.00 , N/A ,$380.00 ,$325.00 ,$325.00 , N/A ,$325.00 ,$240.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203850,C1729,HC CATHETER DRAINAGE 8FR,272,1 ,$330.31 ,$214.70 ,$86.87 ,$330.31 , N/A ,$151.94 ,$184.97 , N/A ,$92.49 ,$111.64 , N/A ,$128.49 , N/A ,$148.97 ,$148.97 , N/A ,$214.70 , N/A ,$165.16 , N/A , N/A , N/A , N/A ,$247.73 ,$198.19 ,$198.19 , N/A ,$198.19 ,$251.04 ,$251.04 ,$251.04 ,$330.31 , N/A ,$280.76 , N/A ,$214.70 , N/A ,$330.31 ,$184.97 , N/A ,$86.87 , N/A , N/A , N/A , N/A ,$264.25 , N/A ,$148.97 ,$92.49 ,$297.28 , N/A ,$251.04 ,$214.70 ,$214.70 , N/A ,$214.70 ,$158.55 , N/A 
ST. ELIZABETH'S HOSPITAL,27203851,C1729,HC CATHETER DRAINAGE 10FR,272,1 ,$237.83 ,$154.59 ,$62.55 ,$237.83 , N/A ,$109.40 ,$133.18 , N/A ,$66.59 ,$80.39 , N/A ,$92.52 , N/A ,$107.26 ,$107.26 , N/A ,$154.59 , N/A ,$118.92 , N/A , N/A , N/A , N/A ,$178.37 ,$142.70 ,$142.70 , N/A ,$142.70 ,$180.75 ,$180.75 ,$180.75 ,$237.83 , N/A ,$202.16 , N/A ,$154.59 , N/A ,$237.83 ,$133.18 , N/A ,$62.55 , N/A , N/A , N/A , N/A ,$190.26 , N/A ,$107.26 ,$66.59 ,$214.05 , N/A ,$180.75 ,$154.59 ,$154.59 , N/A ,$154.59 ,$114.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27203852,C1729,HC CATHETER DRAINAGE 14FR,272,1 ,$396.38 ,$257.65 ,$104.25 ,$396.38 , N/A ,$182.33 ,$221.97 , N/A ,$110.99 ,$133.98 , N/A ,$154.19 , N/A ,$178.77 ,$178.77 , N/A ,$257.65 , N/A ,$198.19 , N/A , N/A , N/A , N/A ,$297.29 ,$237.83 ,$237.83 , N/A ,$237.83 ,$301.25 ,$301.25 ,$301.25 ,$396.38 , N/A ,$336.92 , N/A ,$257.65 , N/A ,$396.38 ,$221.97 , N/A ,$104.25 , N/A , N/A , N/A , N/A ,$317.10 , N/A ,$178.77 ,$110.99 ,$356.74 , N/A ,$301.25 ,$257.65 ,$257.65 , N/A ,$257.65 ,$190.26 , N/A 
ST. ELIZABETH'S HOSPITAL,27203853,C1725,HC CATHETER BALLOON CUTTING,272,1 ,"$2,062.00 ","$1,340.30 ",$542.31 ,"$2,062.00 ", N/A ,$948.52 ,"$1,154.72 ", N/A ,$577.36 ,$696.96 , N/A ,$802.12 , N/A ,$929.96 ,$929.96 , N/A ,"$1,340.30 ", N/A ,"$1,031.00 ", N/A , N/A , N/A , N/A ,"$1,546.50 ","$1,237.20 ","$1,237.20 ", N/A ,"$1,237.20 ","$1,567.12 ","$1,567.12 ","$1,567.12 ","$2,062.00 ", N/A ,"$1,752.70 ", N/A ,"$1,340.30 ", N/A ,"$2,062.00 ","$1,154.72 ", N/A ,$542.31 , N/A , N/A , N/A , N/A ,"$1,649.60 ", N/A ,$929.96 ,$577.36 ,"$1,855.80 ", N/A ,"$1,567.12 ","$1,340.30 ","$1,340.30 ", N/A ,"$1,340.30 ",$989.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27203855,A6197,HC DRESSING WOUND AQUACEL AG 10 X 3.5IN,623,1 ,$132.13 ,$85.88 ,$34.75 ,$132.13 , N/A ,$60.78 ,$73.99 , N/A ,$37.00 ,$46.64 , N/A ,$54.44 , N/A ,$59.59 ,$59.59 , N/A ,$85.88 , N/A ,$66.07 , N/A , N/A , N/A , N/A ,$99.10 ,$79.28 ,$79.28 , N/A ,$79.28 ,$100.42 ,$100.42 ,$100.42 ,$132.13 , N/A ,$112.31 , N/A ,$85.88 , N/A ,$132.13 ,$73.99 , N/A ,$34.75 , N/A , N/A , N/A , N/A ,$105.70 , N/A ,$59.59 ,$37.00 ,$118.92 , N/A ,$100.42 ,$85.88 ,$85.88 , N/A ,$85.88 ,$63.42 , N/A 
ST. ELIZABETH'S HOSPITAL,27203856,A6197,HC DRESSING WOUND AQUACEL AG 30 X 9CM WATERPROOF,623,1 ,$132.13 ,$85.88 ,$34.75 ,$132.13 , N/A ,$60.78 ,$73.99 , N/A ,$37.00 ,$46.64 , N/A ,$54.44 , N/A ,$59.59 ,$59.59 , N/A ,$85.88 , N/A ,$66.07 , N/A , N/A , N/A , N/A ,$99.10 ,$79.28 ,$79.28 , N/A ,$79.28 ,$100.42 ,$100.42 ,$100.42 ,$132.13 , N/A ,$112.31 , N/A ,$85.88 , N/A ,$132.13 ,$73.99 , N/A ,$34.75 , N/A , N/A , N/A , N/A ,$105.70 , N/A ,$59.59 ,$37.00 ,$118.92 , N/A ,$100.42 ,$85.88 ,$85.88 , N/A ,$85.88 ,$63.42 , N/A 
ST. ELIZABETH'S HOSPITAL,27203857,A6197,HC DRESSING WOUND AQUACEL AG 15 X 9CM ANTIMICROBIAL,623,1 ,$132.13 ,$85.88 ,$34.75 ,$132.13 , N/A ,$60.78 ,$73.99 , N/A ,$37.00 ,$46.64 , N/A ,$54.44 , N/A ,$59.59 ,$59.59 , N/A ,$85.88 , N/A ,$66.07 , N/A , N/A , N/A , N/A ,$99.10 ,$79.28 ,$79.28 , N/A ,$79.28 ,$100.42 ,$100.42 ,$100.42 ,$132.13 , N/A ,$112.31 , N/A ,$85.88 , N/A ,$132.13 ,$73.99 , N/A ,$34.75 , N/A , N/A , N/A , N/A ,$105.70 , N/A ,$59.59 ,$37.00 ,$118.92 , N/A ,$100.42 ,$85.88 ,$85.88 , N/A ,$85.88 ,$63.42 , N/A 
ST. ELIZABETH'S HOSPITAL,27203858,N/A,HC DRESSING WOUND SILVER ANTIMICROBIAL,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203859,N/A,HC KIT DRESSING WOUND VAC WHITEFOAM,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203860,N/A,HC KIT DRESSING WOUND VAC GRANUFOAM SILVER,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203861,N/A,HC KIT DRESSING WOUND VAC SPIRAL GRANUFOAM MED,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203862,N/A,HC HEEL ELEVATOR CUSTOM,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203863,N/A,HC CATHETER DRAIN BARTHOLIN,272,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203864,N/A,HC CATHETER DUAL LUMEN DIALYSIS,272,1 ,$437.50 ,$284.38 ,$115.06 ,$437.50 , N/A ,$201.25 ,$245.00 , N/A ,$122.50 ,$147.88 , N/A ,$170.19 , N/A ,$197.31 ,$197.31 , N/A ,$284.38 , N/A ,$218.75 , N/A , N/A , N/A , N/A ,$328.13 ,$262.50 ,$262.50 , N/A ,$262.50 ,$332.50 ,$332.50 ,$332.50 ,$437.50 , N/A ,$371.88 , N/A ,$284.38 , N/A ,$437.50 ,$245.00 , N/A ,$115.06 , N/A , N/A , N/A , N/A ,$350.00 , N/A ,$197.31 ,$122.50 ,$393.75 , N/A ,$332.50 ,$284.38 ,$284.38 , N/A ,$284.38 ,$210.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203865,N/A,HC CATHETER DUAL LUMEN DIALYSIS MAHURKAR,272,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A ,$86.25 ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$121.88 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$142.50 ,$142.50 ,$142.50 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$142.50 ,$121.88 ,$121.88 , N/A ,$121.88 ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203866,C1729,HC TRAY DRAINAGE W/ GUIDING CATHETER,272,1 ,$396.38 ,$257.65 ,$104.25 ,$396.38 , N/A ,$182.33 ,$221.97 , N/A ,$110.99 ,$133.98 , N/A ,$154.19 , N/A ,$178.77 ,$178.77 , N/A ,$257.65 , N/A ,$198.19 , N/A , N/A , N/A , N/A ,$297.29 ,$237.83 ,$237.83 , N/A ,$237.83 ,$301.25 ,$301.25 ,$301.25 ,$396.38 , N/A ,$336.92 , N/A ,$257.65 , N/A ,$396.38 ,$221.97 , N/A ,$104.25 , N/A , N/A , N/A , N/A ,$317.10 , N/A ,$178.77 ,$110.99 ,$356.74 , N/A ,$301.25 ,$257.65 ,$257.65 , N/A ,$257.65 ,$190.26 , N/A 
ST. ELIZABETH'S HOSPITAL,27203867,N/A,HC CATHETER COOL LINE,272,1 ,$437.50 ,$284.38 ,$115.06 ,$437.50 , N/A ,$201.25 ,$245.00 , N/A ,$122.50 ,$147.88 , N/A ,$170.19 , N/A ,$197.31 ,$197.31 , N/A ,$284.38 , N/A ,$218.75 , N/A , N/A , N/A , N/A ,$328.13 ,$262.50 ,$262.50 , N/A ,$262.50 ,$332.50 ,$332.50 ,$332.50 ,$437.50 , N/A ,$371.88 , N/A ,$284.38 , N/A ,$437.50 ,$245.00 , N/A ,$115.06 , N/A , N/A , N/A , N/A ,$350.00 , N/A ,$197.31 ,$122.50 ,$393.75 , N/A ,$332.50 ,$284.38 ,$284.38 , N/A ,$284.38 ,$210.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203868,C1894,HC INTRODUCER/SHEATH 9-10FR,272,1 ,$198.19 ,$128.82 ,$52.12 ,$198.19 , N/A ,$91.17 ,$110.99 , N/A ,$55.49 ,$66.99 , N/A ,$77.10 , N/A ,$89.38 ,$89.38 , N/A ,$128.82 , N/A ,$99.10 , N/A , N/A , N/A , N/A ,$148.64 ,$118.91 ,$118.91 , N/A ,$118.91 ,$150.62 ,$150.62 ,$150.62 ,$198.19 , N/A ,$168.46 , N/A ,$128.82 , N/A ,$198.19 ,$110.99 , N/A ,$52.12 , N/A , N/A , N/A , N/A ,$158.55 , N/A ,$89.38 ,$55.49 ,$178.37 , N/A ,$150.62 ,$128.82 ,$128.82 , N/A ,$128.82 ,$95.13 , N/A 
ST. ELIZABETH'S HOSPITAL,27203869,N/A,HC TUBE TRACH CUFFED FIXED NECK,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203870,C1729,HC CATHETER DRAINAGE SAFE T,272,1 ,$198.19 ,$128.82 ,$52.12 ,$198.19 , N/A ,$91.17 ,$110.99 , N/A ,$55.49 ,$66.99 , N/A ,$77.10 , N/A ,$89.38 ,$89.38 , N/A ,$128.82 , N/A ,$99.10 , N/A , N/A , N/A , N/A ,$148.64 ,$118.91 ,$118.91 , N/A ,$118.91 ,$150.62 ,$150.62 ,$150.62 ,$198.19 , N/A ,$168.46 , N/A ,$128.82 , N/A ,$198.19 ,$110.99 , N/A ,$52.12 , N/A , N/A , N/A , N/A ,$158.55 , N/A ,$89.38 ,$55.49 ,$178.37 , N/A ,$150.62 ,$128.82 ,$128.82 , N/A ,$128.82 ,$95.13 , N/A 
ST. ELIZABETH'S HOSPITAL,27203871,N/A,HC NASAL RHINO ROCKET,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203872,N/A,HC TUBIING RAPID INFUSER,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203874,N/A,HC KIT DRESSING WOUND VAC GRANUFOAM  LARGE,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203875,N/A,HC SYSTEM DRESSING WOUND VAC THERAPY,272,1 ,"$1,750.00 ","$1,137.50 ",$460.25 ,"$1,750.00 ", N/A ,$805.00 ,$980.00 , N/A ,$490.00 ,$591.50 , N/A ,$680.75 , N/A ,$789.25 ,$789.25 , N/A ,"$1,137.50 ", N/A ,$875.00 , N/A , N/A , N/A , N/A ,"$1,312.50 ","$1,050.00 ","$1,050.00 ", N/A ,"$1,050.00 ","$1,330.00 ","$1,330.00 ","$1,330.00 ","$1,750.00 ", N/A ,"$1,487.50 ", N/A ,"$1,137.50 ", N/A ,"$1,750.00 ",$980.00 , N/A ,$460.25 , N/A , N/A , N/A , N/A ,"$1,400.00 ", N/A ,$789.25 ,$490.00 ,"$1,575.00 ", N/A ,"$1,330.00 ","$1,137.50 ","$1,137.50 ", N/A ,"$1,137.50 ",$840.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27203958,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T16,272,1 ,"$1,350.00 ",$877.50 ,$355.05 ,"$1,350.00 ", N/A ,$621.00 ,$756.00 , N/A ,$378.00 ,$456.30 , N/A ,$525.15 , N/A ,$608.85 ,$608.85 , N/A ,$877.50 , N/A ,$675.00 , N/A , N/A , N/A , N/A ,"$1,012.50 ",$810.00 ,$810.00 , N/A ,$810.00 ,"$1,026.00 ","$1,026.00 ","$1,026.00 ","$1,350.00 ", N/A ,"$1,147.50 ", N/A ,$877.50 , N/A ,"$1,350.00 ",$756.00 , N/A ,$355.05 , N/A , N/A , N/A , N/A ,"$1,080.00 ", N/A ,$608.85 ,$378.00 ,"$1,215.00 ", N/A ,"$1,026.00 ",$877.50 ,$877.50 , N/A ,$877.50 ,$648.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204117,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T17,272,1 ,"$1,500.00 ",$975.00 ,$394.50 ,"$1,500.00 ", N/A ,$690.00 ,$840.00 , N/A ,$420.00 ,$507.00 , N/A ,$583.50 , N/A ,$676.50 ,$676.50 , N/A ,$975.00 , N/A ,$750.00 , N/A , N/A , N/A , N/A ,"$1,125.00 ",$900.00 ,$900.00 , N/A ,$900.00 ,"$1,140.00 ","$1,140.00 ","$1,140.00 ","$1,500.00 ", N/A ,"$1,275.00 ", N/A ,$975.00 , N/A ,"$1,500.00 ",$840.00 , N/A ,$394.50 , N/A , N/A , N/A , N/A ,"$1,200.00 ", N/A ,$676.50 ,$420.00 ,"$1,350.00 ", N/A ,"$1,140.00 ",$975.00 ,$975.00 , N/A ,$975.00 ,$720.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204120,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T20,272,1 ,"$3,300.00 ","$2,145.00 ",$867.90 ,"$3,300.00 ", N/A ,"$1,518.00 ","$1,848.00 ", N/A ,$924.00 ,"$1,115.40 ", N/A ,"$1,283.70 ", N/A ,"$1,488.30 ","$1,488.30 ", N/A ,"$2,145.00 ", N/A ,"$1,650.00 ", N/A , N/A , N/A , N/A ,"$2,475.00 ","$1,980.00 ","$1,980.00 ", N/A ,"$1,980.00 ","$2,508.00 ","$2,508.00 ","$2,508.00 ","$3,300.00 ", N/A ,"$2,805.00 ", N/A ,"$2,145.00 ", N/A ,"$3,300.00 ","$1,848.00 ", N/A ,$867.90 , N/A , N/A , N/A , N/A ,"$2,640.00 ", N/A ,"$1,488.30 ",$924.00 ,"$2,970.00 ", N/A ,"$2,508.00 ","$2,145.00 ","$2,145.00 ", N/A ,"$2,145.00 ","$1,584.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204124,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T24,272,1 ,"$5,700.00 ","$3,705.00 ","$1,499.10 ","$5,700.00 ", N/A ,"$2,622.00 ","$3,192.00 ", N/A ,"$1,596.00 ","$1,926.60 ", N/A ,"$2,217.30 ", N/A ,"$2,570.70 ","$2,570.70 ", N/A ,"$3,705.00 ", N/A ,"$2,850.00 ", N/A , N/A , N/A , N/A ,"$4,275.00 ","$3,420.00 ","$3,420.00 ", N/A ,"$3,420.00 ","$4,332.00 ","$4,332.00 ","$4,332.00 ","$5,700.00 ", N/A ,"$4,845.00 ", N/A ,"$3,705.00 ", N/A ,"$5,700.00 ","$3,192.00 ", N/A ,"$1,499.10 ", N/A , N/A , N/A , N/A ,"$4,560.00 ", N/A ,"$2,570.70 ","$1,596.00 ","$5,130.00 ", N/A ,"$4,332.00 ","$3,705.00 ","$3,705.00 ", N/A ,"$3,705.00 ","$2,736.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204125,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T25,272,1 ,"$6,300.00 ","$4,095.00 ","$1,656.90 ","$6,300.00 ", N/A ,"$2,898.00 ","$3,528.00 ", N/A ,"$1,764.00 ","$2,129.40 ", N/A ,"$2,450.70 ", N/A ,"$2,841.30 ","$2,841.30 ", N/A ,"$4,095.00 ", N/A ,"$3,150.00 ", N/A , N/A , N/A , N/A ,"$4,725.00 ","$3,780.00 ","$3,780.00 ", N/A ,"$3,780.00 ","$4,788.00 ","$4,788.00 ","$4,788.00 ","$6,300.00 ", N/A ,"$5,355.00 ", N/A ,"$4,095.00 ", N/A ,"$6,300.00 ","$3,528.00 ", N/A ,"$1,656.90 ", N/A , N/A , N/A , N/A ,"$5,040.00 ", N/A ,"$2,841.30 ","$1,764.00 ","$5,670.00 ", N/A ,"$4,788.00 ","$4,095.00 ","$4,095.00 ", N/A ,"$4,095.00 ","$3,024.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204127,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T27,272,1 ,"$7,500.00 ","$4,875.00 ","$1,972.50 ","$7,500.00 ", N/A ,"$3,450.00 ","$4,200.00 ", N/A ,"$2,100.00 ","$2,535.00 ", N/A ,"$2,917.50 ", N/A ,"$3,382.50 ","$3,382.50 ", N/A ,"$4,875.00 ", N/A ,"$3,750.00 ", N/A , N/A , N/A , N/A ,"$5,625.00 ","$4,500.00 ","$4,500.00 ", N/A ,"$4,500.00 ","$5,700.00 ","$5,700.00 ","$5,700.00 ","$7,500.00 ", N/A ,"$6,375.00 ", N/A ,"$4,875.00 ", N/A ,"$7,500.00 ","$4,200.00 ", N/A ,"$1,972.50 ", N/A , N/A , N/A , N/A ,"$6,000.00 ", N/A ,"$3,382.50 ","$2,100.00 ","$6,750.00 ", N/A ,"$5,700.00 ","$4,875.00 ","$4,875.00 ", N/A ,"$4,875.00 ","$3,600.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204130,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T30,272,1 ,"$9,300.00 ","$6,045.00 ","$2,445.90 ","$9,300.00 ", N/A ,"$4,278.00 ","$5,208.00 ", N/A ,"$2,604.00 ","$3,143.40 ", N/A ,"$3,617.70 ", N/A ,"$4,194.30 ","$4,194.30 ", N/A ,"$6,045.00 ", N/A ,"$4,650.00 ", N/A , N/A , N/A , N/A ,"$6,975.00 ","$5,580.00 ","$5,580.00 ", N/A ,"$5,580.00 ","$7,068.00 ","$7,068.00 ","$7,068.00 ","$9,300.00 ", N/A ,"$7,905.00 ", N/A ,"$6,045.00 ", N/A ,"$9,300.00 ","$5,208.00 ", N/A ,"$2,445.90 ", N/A , N/A , N/A , N/A ,"$7,440.00 ", N/A ,"$4,194.30 ","$2,604.00 ","$8,370.00 ", N/A ,"$7,068.00 ","$6,045.00 ","$6,045.00 ", N/A ,"$6,045.00 ","$4,464.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204203,C1769,HC GUIDEWIRE GLIDEWIRE T6,272,1 ,$150.00 ,$97.50 ,$39.45 ,$150.00 , N/A ,$69.00 ,$84.00 , N/A ,$42.00 ,$50.70 , N/A ,$58.35 , N/A ,$67.65 ,$67.65 , N/A ,$97.50 , N/A ,$75.00 , N/A , N/A , N/A , N/A ,$112.50 ,$90.00 ,$90.00 , N/A ,$90.00 ,$114.00 ,$114.00 ,$114.00 ,$150.00 , N/A ,$127.50 , N/A ,$97.50 , N/A ,$150.00 ,$84.00 , N/A ,$39.45 , N/A , N/A , N/A , N/A ,$120.00 , N/A ,$67.65 ,$42.00 ,$135.00 , N/A ,$114.00 ,$97.50 ,$97.50 , N/A ,$97.50 ,$72.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204204,C1769,HC GUIDEWIRE GLIDEWIRE T7,272,1 ,$558.00 ,$362.70 ,$146.75 ,$558.00 , N/A ,$256.68 ,$312.48 , N/A ,$156.24 ,$188.60 , N/A ,$217.06 , N/A ,$251.66 ,$251.66 , N/A ,$362.70 , N/A ,$279.00 , N/A , N/A , N/A , N/A ,$418.50 ,$334.80 ,$334.80 , N/A ,$334.80 ,$424.08 ,$424.08 ,$424.08 ,$558.00 , N/A ,$474.30 , N/A ,$362.70 , N/A ,$558.00 ,$312.48 , N/A ,$146.75 , N/A , N/A , N/A , N/A ,$446.40 , N/A ,$251.66 ,$156.24 ,$502.20 , N/A ,$424.08 ,$362.70 ,$362.70 , N/A ,$362.70 ,$267.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27204223,C1769,HC GUIDEWIRE T6,272,1 ,$225.00 ,$146.25 ,$59.18 ,$225.00 , N/A ,$103.50 ,$126.00 , N/A ,$63.00 ,$76.05 , N/A ,$87.53 , N/A ,$101.48 ,$101.48 , N/A ,$146.25 , N/A ,$112.50 , N/A , N/A , N/A , N/A ,$168.75 ,$135.00 ,$135.00 , N/A ,$135.00 ,$171.00 ,$171.00 ,$171.00 ,$225.00 , N/A ,$191.25 , N/A ,$146.25 , N/A ,$225.00 ,$126.00 , N/A ,$59.18 , N/A , N/A , N/A , N/A ,$180.00 , N/A ,$101.48 ,$63.00 ,$202.50 , N/A ,$171.00 ,$146.25 ,$146.25 , N/A ,$146.25 ,$108.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204229,C1769,HC GUIDEWIRE T12,272,1 ,$750.00 ,$487.50 ,$197.25 ,$750.00 , N/A ,$345.00 ,$420.00 , N/A ,$210.00 ,$253.50 , N/A ,$291.75 , N/A ,$338.25 ,$338.25 , N/A ,$487.50 , N/A ,$375.00 , N/A , N/A , N/A , N/A ,$562.50 ,$450.00 ,$450.00 , N/A ,$450.00 ,$570.00 ,$570.00 ,$570.00 ,$750.00 , N/A ,$637.50 , N/A ,$487.50 , N/A ,$750.00 ,$420.00 , N/A ,$197.25 , N/A , N/A , N/A , N/A ,$600.00 , N/A ,$338.25 ,$210.00 ,$675.00 , N/A ,$570.00 ,$487.50 ,$487.50 , N/A ,$487.50 ,$360.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204257,C1773,HC DEVICE RETRIEVAL INSERTABLE T12,272,1 ,$825.00 ,$536.25 ,$216.98 ,$825.00 , N/A ,$379.50 ,$462.00 , N/A ,$231.00 ,$278.85 , N/A ,$320.93 , N/A ,$372.08 ,$372.08 , N/A ,$536.25 , N/A ,$412.50 , N/A , N/A , N/A , N/A ,$618.75 ,$495.00 ,$495.00 , N/A ,$495.00 ,$627.00 ,$627.00 ,$627.00 ,$825.00 , N/A ,$701.25 , N/A ,$536.25 , N/A ,$825.00 ,$462.00 , N/A ,$216.98 , N/A , N/A , N/A , N/A ,$660.00 , N/A ,$372.08 ,$231.00 ,$742.50 , N/A ,$627.00 ,$536.25 ,$536.25 , N/A ,$536.25 ,$396.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204263,C1773,HC DEVICE RETRIEVAL INSERTABLE T18,272,1 ,"$2,100.00 ","$1,365.00 ",$552.30 ,"$2,100.00 ", N/A ,$966.00 ,"$1,176.00 ", N/A ,$588.00 ,$709.80 , N/A ,$816.90 , N/A ,$947.10 ,$947.10 , N/A ,"$1,365.00 ", N/A ,"$1,050.00 ", N/A , N/A , N/A , N/A ,"$1,575.00 ","$1,260.00 ","$1,260.00 ", N/A ,"$1,260.00 ","$1,596.00 ","$1,596.00 ","$1,596.00 ","$2,100.00 ", N/A ,"$1,785.00 ", N/A ,"$1,365.00 ", N/A ,"$2,100.00 ","$1,176.00 ", N/A ,$552.30 , N/A , N/A , N/A , N/A ,"$1,680.00 ", N/A ,$947.10 ,$588.00 ,"$1,890.00 ", N/A ,"$1,596.00 ","$1,365.00 ","$1,365.00 ", N/A ,"$1,365.00 ","$1,008.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204264,C1773,HC DEVICE RETRIEVAL INSERTABLE T19,272,1 ,"$2,700.00 ","$1,755.00 ",$710.10 ,"$2,700.00 ", N/A ,"$1,242.00 ","$1,512.00 ", N/A ,$756.00 ,$912.60 , N/A ,"$1,050.30 ", N/A ,"$1,217.70 ","$1,217.70 ", N/A ,"$1,755.00 ", N/A ,"$1,350.00 ", N/A , N/A , N/A , N/A ,"$2,025.00 ","$1,620.00 ","$1,620.00 ", N/A ,"$1,620.00 ","$2,052.00 ","$2,052.00 ","$2,052.00 ","$2,700.00 ", N/A ,"$2,295.00 ", N/A ,"$1,755.00 ", N/A ,"$2,700.00 ","$1,512.00 ", N/A ,$710.10 , N/A , N/A , N/A , N/A ,"$2,160.00 ", N/A ,"$1,217.70 ",$756.00 ,"$2,430.00 ", N/A ,"$2,052.00 ","$1,755.00 ","$1,755.00 ", N/A ,"$1,755.00 ","$1,296.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204326,C1887,HC CATHETER GUIDING T2,272,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$55.20 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 ,$78.00 ,$78.00 , N/A ,$78.00 ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27204329,C1887,HC CATHETER GUIDING T5,272,1 ,$143.40 ,$93.21 ,$37.71 ,$143.40 , N/A ,$65.96 ,$80.30 , N/A ,$40.15 ,$48.47 , N/A ,$55.78 , N/A ,$64.67 ,$64.67 , N/A ,$93.21 , N/A ,$71.70 , N/A , N/A , N/A , N/A ,$107.55 ,$86.04 ,$86.04 , N/A ,$86.04 ,$108.98 ,$108.98 ,$108.98 ,$143.40 , N/A ,$121.89 , N/A ,$93.21 , N/A ,$143.40 ,$80.30 , N/A ,$37.71 , N/A , N/A , N/A , N/A ,$114.72 , N/A ,$64.67 ,$40.15 ,$129.06 , N/A ,$108.98 ,$93.21 ,$93.21 , N/A ,$93.21 ,$68.83 , N/A 
ST. ELIZABETH'S HOSPITAL,27204333,C1887,HC CATHETER GUIDING T9,272,1 ,$450.00 ,$292.50 ,$118.35 ,$450.00 , N/A ,$207.00 ,$252.00 , N/A ,$126.00 ,$152.10 , N/A ,$175.05 , N/A ,$202.95 ,$202.95 , N/A ,$292.50 , N/A ,$225.00 , N/A , N/A , N/A , N/A ,$337.50 ,$270.00 ,$270.00 , N/A ,$270.00 ,$342.00 ,$342.00 ,$342.00 ,$450.00 , N/A ,$382.50 , N/A ,$292.50 , N/A ,$450.00 ,$252.00 , N/A ,$118.35 , N/A , N/A , N/A , N/A ,$360.00 , N/A ,$202.95 ,$126.00 ,$405.00 , N/A ,$342.00 ,$292.50 ,$292.50 , N/A ,$292.50 ,$216.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204334,C1887,HC CATHETER GUIDING T10,272,1 ,$705.00 ,$458.25 ,$185.42 ,$705.00 , N/A ,$324.30 ,$394.80 , N/A ,$197.40 ,$238.29 , N/A ,$274.25 , N/A ,$317.96 ,$317.96 , N/A ,$458.25 , N/A ,$352.50 , N/A , N/A , N/A , N/A ,$528.75 ,$423.00 ,$423.00 , N/A ,$423.00 ,$535.80 ,$535.80 ,$535.80 ,$705.00 , N/A ,$599.25 , N/A ,$458.25 , N/A ,$705.00 ,$394.80 , N/A ,$185.42 , N/A , N/A , N/A , N/A ,$564.00 , N/A ,$317.96 ,$197.40 ,$634.50 , N/A ,$535.80 ,$458.25 ,$458.25 , N/A ,$458.25 ,$338.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27204339,C1887,HC CATHETER GUIDING T15,272,1 ,"$1,200.00 ",$780.00 ,$315.60 ,"$1,200.00 ", N/A ,$552.00 ,$672.00 , N/A ,$336.00 ,$405.60 , N/A ,$466.80 , N/A ,$541.20 ,$541.20 , N/A ,$780.00 , N/A ,$600.00 , N/A , N/A , N/A , N/A ,$900.00 ,$720.00 ,$720.00 , N/A ,$720.00 ,$912.00 ,$912.00 ,$912.00 ,"$1,200.00 ", N/A ,"$1,020.00 ", N/A ,$780.00 , N/A ,"$1,200.00 ",$672.00 , N/A ,$315.60 , N/A , N/A , N/A , N/A ,$960.00 , N/A ,$541.20 ,$336.00 ,"$1,080.00 ", N/A ,$912.00 ,$780.00 ,$780.00 , N/A ,$780.00 ,$576.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204342,C1887,HC CATHETER GUIDING T18,272,1 ,"$2,100.00 ","$1,365.00 ",$552.30 ,"$2,100.00 ", N/A ,$966.00 ,"$1,176.00 ", N/A ,$588.00 ,$709.80 , N/A ,$816.90 , N/A ,$947.10 ,$947.10 , N/A ,"$1,365.00 ", N/A ,"$1,050.00 ", N/A , N/A , N/A , N/A ,"$1,575.00 ","$1,260.00 ","$1,260.00 ", N/A ,"$1,260.00 ","$1,596.00 ","$1,596.00 ","$1,596.00 ","$2,100.00 ", N/A ,"$1,785.00 ", N/A ,"$1,365.00 ", N/A ,"$2,100.00 ","$1,176.00 ", N/A ,$552.30 , N/A , N/A , N/A , N/A ,"$1,680.00 ", N/A ,$947.10 ,$588.00 ,"$1,890.00 ", N/A ,"$1,596.00 ","$1,365.00 ","$1,365.00 ", N/A ,"$1,365.00 ","$1,008.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204351,C1887,HC CATHETER GUIDING T27,272,1 ,"$7,500.00 ","$4,875.00 ","$1,972.50 ","$7,500.00 ", N/A ,"$3,450.00 ","$4,200.00 ", N/A ,"$2,100.00 ","$2,535.00 ", N/A ,"$2,917.50 ", N/A ,"$3,382.50 ","$3,382.50 ", N/A ,"$4,875.00 ", N/A ,"$3,750.00 ", N/A , N/A , N/A , N/A ,"$5,625.00 ","$4,500.00 ","$4,500.00 ", N/A ,"$4,500.00 ","$5,700.00 ","$5,700.00 ","$5,700.00 ","$7,500.00 ", N/A ,"$6,375.00 ", N/A ,"$4,875.00 ", N/A ,"$7,500.00 ","$4,200.00 ", N/A ,"$1,972.50 ", N/A , N/A , N/A , N/A ,"$6,000.00 ", N/A ,"$3,382.50 ","$2,100.00 ","$6,750.00 ", N/A ,"$5,700.00 ","$4,875.00 ","$4,875.00 ", N/A ,"$4,875.00 ","$3,600.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204355,C1887,HC CATHETER GUIDING T31,272,1 ,"$9,900.00 ","$6,435.00 ","$2,603.70 ","$9,900.00 ", N/A ,"$4,554.00 ","$5,544.00 ", N/A ,"$2,772.00 ","$3,346.20 ", N/A ,"$3,851.10 ", N/A ,"$4,464.90 ","$4,464.90 ", N/A ,"$6,435.00 ", N/A ,"$4,950.00 ", N/A , N/A , N/A , N/A ,"$7,425.00 ","$5,940.00 ","$5,940.00 ", N/A ,"$5,940.00 ","$7,524.00 ","$7,524.00 ","$7,524.00 ","$9,900.00 ", N/A ,"$8,415.00 ", N/A ,"$6,435.00 ", N/A ,"$9,900.00 ","$5,544.00 ", N/A ,"$2,603.70 ", N/A , N/A , N/A , N/A ,"$7,920.00 ", N/A ,"$4,464.90 ","$2,772.00 ","$8,910.00 ", N/A ,"$7,524.00 ","$6,435.00 ","$6,435.00 ", N/A ,"$6,435.00 ","$4,752.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204356,C1887,HC CATHETER GUIDING T32,272,1 ,"$15,150.00 ","$9,847.50 ","$3,984.45 ","$15,150.00 ", N/A ,"$6,969.00 ","$8,484.00 ", N/A ,"$4,242.00 ","$5,120.70 ", N/A ,"$5,893.35 ", N/A ,"$6,832.65 ","$6,832.65 ", N/A ,"$9,847.50 ", N/A ,"$7,575.00 ", N/A , N/A , N/A , N/A ,"$11,362.50 ","$9,090.00 ","$9,090.00 ", N/A ,"$9,090.00 ","$11,514.00 ","$11,514.00 ","$11,514.00 ","$15,150.00 ", N/A ,"$12,877.50 ", N/A ,"$9,847.50 ", N/A ,"$15,150.00 ","$8,484.00 ", N/A ,"$3,984.45 ", N/A , N/A , N/A , N/A ,"$12,120.00 ", N/A ,"$6,832.65 ","$4,242.00 ","$13,635.00 ", N/A ,"$11,514.00 ","$9,847.50 ","$9,847.50 ", N/A ,"$9,847.50 ","$7,272.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204357,C1887,HC CATHETER GUIDING T33,272,1 ,"$16,950.00 ","$11,017.50 ","$4,457.85 ","$16,950.00 ", N/A ,"$7,797.00 ","$9,492.00 ", N/A ,"$4,746.00 ","$5,729.10 ", N/A ,"$6,593.55 ", N/A ,"$7,644.45 ","$7,644.45 ", N/A ,"$11,017.50 ", N/A ,"$8,475.00 ", N/A , N/A , N/A , N/A ,"$12,712.50 ","$10,170.00 ","$10,170.00 ", N/A ,"$10,170.00 ","$12,882.00 ","$12,882.00 ","$12,882.00 ","$16,950.00 ", N/A ,"$14,407.50 ", N/A ,"$11,017.50 ", N/A ,"$16,950.00 ","$9,492.00 ", N/A ,"$4,457.85 ", N/A , N/A , N/A , N/A ,"$13,560.00 ", N/A ,"$7,644.45 ","$4,746.00 ","$15,255.00 ", N/A ,"$12,882.00 ","$11,017.50 ","$11,017.50 ", N/A ,"$11,017.50 ","$8,136.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204359,C1887,HC CATHETER GUIDING T35,272,1 ,"$31,000.00 ","$20,150.00 ","$8,153.00 ","$31,000.00 ", N/A ,"$14,260.00 ","$17,360.00 ", N/A ,"$8,680.00 ","$10,478.00 ", N/A ,"$12,059.00 ", N/A ,"$13,981.00 ","$13,981.00 ", N/A ,"$20,150.00 ", N/A ,"$15,500.00 ", N/A , N/A , N/A , N/A ,"$23,250.00 ","$18,600.00 ","$18,600.00 ", N/A ,"$18,600.00 ","$23,560.00 ","$23,560.00 ","$23,560.00 ","$31,000.00 ", N/A ,"$26,350.00 ", N/A ,"$20,150.00 ", N/A ,"$31,000.00 ","$17,360.00 ", N/A ,"$8,153.00 ", N/A , N/A , N/A , N/A ,"$24,800.00 ", N/A ,"$13,981.00 ","$8,680.00 ","$27,900.00 ", N/A ,"$23,560.00 ","$20,150.00 ","$20,150.00 ", N/A ,"$20,150.00 ","$14,880.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204372,C1892,HC INTRODUCER/SHEATH FIXED PEEL-AWAY T7,272,1 ,$300.00 ,$195.00 ,$78.90 ,$300.00 , N/A ,$138.00 ,$168.00 , N/A ,$84.00 ,$101.40 , N/A ,$116.70 , N/A ,$135.30 ,$135.30 , N/A ,$195.00 , N/A ,$150.00 , N/A , N/A , N/A , N/A ,$225.00 ,$180.00 ,$180.00 , N/A ,$180.00 ,$228.00 ,$228.00 ,$228.00 ,$300.00 , N/A ,$255.00 , N/A ,$195.00 , N/A ,$300.00 ,$168.00 , N/A ,$78.90 , N/A , N/A , N/A , N/A ,$240.00 , N/A ,$135.30 ,$84.00 ,$270.00 , N/A ,$228.00 ,$195.00 ,$195.00 , N/A ,$195.00 ,$144.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204412,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T7,272,1 ,$300.00 ,$195.00 ,$78.90 ,$300.00 , N/A ,$138.00 ,$168.00 , N/A ,$84.00 ,$101.40 , N/A ,$116.70 , N/A ,$135.30 ,$135.30 , N/A ,$195.00 , N/A ,$150.00 , N/A , N/A , N/A , N/A ,$225.00 ,$180.00 ,$180.00 , N/A ,$180.00 ,$228.00 ,$228.00 ,$228.00 ,$300.00 , N/A ,$255.00 , N/A ,$195.00 , N/A ,$300.00 ,$168.00 , N/A ,$78.90 , N/A , N/A , N/A , N/A ,$240.00 , N/A ,$135.30 ,$84.00 ,$270.00 , N/A ,$228.00 ,$195.00 ,$195.00 , N/A ,$195.00 ,$144.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204418,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T13,272,1 ,$825.00 ,$536.25 ,$216.98 ,$825.00 , N/A ,$379.50 ,$462.00 , N/A ,$231.00 ,$278.85 , N/A ,$320.93 , N/A ,$372.08 ,$372.08 , N/A ,$536.25 , N/A ,$412.50 , N/A , N/A , N/A , N/A ,$618.75 ,$495.00 ,$495.00 , N/A ,$495.00 ,$627.00 ,$627.00 ,$627.00 ,$825.00 , N/A ,$701.25 , N/A ,$536.25 , N/A ,$825.00 ,$462.00 , N/A ,$216.98 , N/A , N/A , N/A , N/A ,$660.00 , N/A ,$372.08 ,$231.00 ,$742.50 , N/A ,$627.00 ,$536.25 ,$536.25 , N/A ,$536.25 ,$396.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204453,N/A,HC SURGICAL STERILE SUPPLY T3,272,1 ,$21.00 ,$13.65 ,$5.52 ,$21.00 , N/A ,$9.66 ,$11.76 , N/A ,$5.88 ,$7.10 , N/A ,$8.17 , N/A ,$9.47 ,$9.47 , N/A ,$13.65 , N/A ,$10.50 , N/A , N/A , N/A , N/A ,$15.75 ,$12.60 ,$12.60 , N/A ,$12.60 ,$15.96 ,$15.96 ,$15.96 ,$21.00 , N/A ,$17.85 , N/A ,$13.65 , N/A ,$21.00 ,$11.76 , N/A ,$5.52 , N/A , N/A , N/A , N/A ,$16.80 , N/A ,$9.47 ,$5.88 ,$18.90 , N/A ,$15.96 ,$13.65 ,$13.65 , N/A ,$13.65 ,$10.08 , N/A 
ST. ELIZABETH'S HOSPITAL,27204455,N/A,HC SURGICAL STERILE SUPPLY T5,272,1 ,$150.00 ,$97.50 ,$39.45 ,$150.00 , N/A ,$69.00 ,$84.00 , N/A ,$42.00 ,$50.70 , N/A ,$58.35 , N/A ,$67.65 ,$67.65 , N/A ,$97.50 , N/A ,$75.00 , N/A , N/A , N/A , N/A ,$112.50 ,$90.00 ,$90.00 , N/A ,$90.00 ,$114.00 ,$114.00 ,$114.00 ,$150.00 , N/A ,$127.50 , N/A ,$97.50 , N/A ,$150.00 ,$84.00 , N/A ,$39.45 , N/A , N/A , N/A , N/A ,$120.00 , N/A ,$67.65 ,$42.00 ,$135.00 , N/A ,$114.00 ,$97.50 ,$97.50 , N/A ,$97.50 ,$72.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204462,N/A,HC SURGICAL STERILE SUPPLY T12,272,1 ,$150.00 ,$97.50 ,$39.45 ,$150.00 , N/A ,$69.00 ,$84.00 , N/A ,$42.00 ,$50.70 , N/A ,$58.35 , N/A ,$67.65 ,$67.65 , N/A ,$97.50 , N/A ,$75.00 , N/A , N/A , N/A , N/A ,$112.50 ,$90.00 ,$90.00 , N/A ,$90.00 ,$114.00 ,$114.00 ,$114.00 ,$150.00 , N/A ,$127.50 , N/A ,$97.50 , N/A ,$150.00 ,$84.00 , N/A ,$39.45 , N/A , N/A , N/A , N/A ,$120.00 , N/A ,$67.65 ,$42.00 ,$135.00 , N/A ,$114.00 ,$97.50 ,$97.50 , N/A ,$97.50 ,$72.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204464,N/A,HC SURGICAL STERILE SUPPLY T14,272,1 ,"$1,050.00 ",$682.50 ,$276.15 ,"$1,050.00 ", N/A ,$483.00 ,$588.00 , N/A ,$294.00 ,$354.90 , N/A ,$408.45 , N/A ,$473.55 ,$473.55 , N/A ,$682.50 , N/A ,$525.00 , N/A , N/A , N/A , N/A ,$787.50 ,$630.00 ,$630.00 , N/A ,$630.00 ,$798.00 ,$798.00 ,$798.00 ,"$1,050.00 ", N/A ,$892.50 , N/A ,$682.50 , N/A ,"$1,050.00 ",$588.00 , N/A ,$276.15 , N/A , N/A , N/A , N/A ,$840.00 , N/A ,$473.55 ,$294.00 ,$945.00 , N/A ,$798.00 ,$682.50 ,$682.50 , N/A ,$682.50 ,$504.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204522,C1751,HC CATHETER INFUSION PICC/CV/MIDLINE T23,272,1 ,"$8,100.00 ","$5,265.00 ","$2,130.30 ","$8,100.00 ", N/A ,"$3,726.00 ","$4,536.00 ", N/A ,"$2,268.00 ","$2,737.80 ", N/A ,"$3,150.90 ", N/A ,"$3,653.10 ","$3,653.10 ", N/A ,"$5,265.00 ", N/A ,"$4,050.00 ", N/A , N/A , N/A , N/A ,"$6,075.00 ","$4,860.00 ","$4,860.00 ", N/A ,"$4,860.00 ","$6,156.00 ","$6,156.00 ","$6,156.00 ","$8,100.00 ", N/A ,"$6,885.00 ", N/A ,"$5,265.00 ", N/A ,"$8,100.00 ","$4,536.00 ", N/A ,"$2,130.30 ", N/A , N/A , N/A , N/A ,"$6,480.00 ", N/A ,"$3,653.10 ","$2,268.00 ","$7,290.00 ", N/A ,"$6,156.00 ","$5,265.00 ","$5,265.00 ", N/A ,"$5,265.00 ","$3,888.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204529,C1887,HC SYSTEM THROMBOSIS CATHETER RETRIEVAL,272,1 ,"$17,850.00 ","$11,602.50 ","$4,694.55 ","$17,850.00 ", N/A ,"$8,211.00 ","$9,996.00 ", N/A ,"$4,998.00 ","$6,033.30 ", N/A ,"$6,943.65 ", N/A ,"$8,050.35 ","$8,050.35 ", N/A ,"$11,602.50 ", N/A ,"$8,925.00 ", N/A , N/A , N/A , N/A ,"$13,387.50 ","$10,710.00 ","$10,710.00 ", N/A ,"$10,710.00 ","$13,566.00 ","$13,566.00 ","$13,566.00 ","$17,850.00 ", N/A ,"$15,172.50 ", N/A ,"$11,602.50 ", N/A ,"$17,850.00 ","$9,996.00 ", N/A ,"$4,694.55 ", N/A , N/A , N/A , N/A ,"$14,280.00 ", N/A ,"$8,050.35 ","$4,998.00 ","$16,065.00 ", N/A ,"$13,566.00 ","$11,602.50 ","$11,602.50 ", N/A ,"$11,602.50 ","$8,568.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27204562,C1729,HC CATHETER DRAINAGE T6,272,1 ,$225.00 ,$146.25 ,$59.18 ,$225.00 , N/A ,$103.50 ,$126.00 , N/A ,$63.00 ,$76.05 , N/A ,$87.53 , N/A ,$101.48 ,$101.48 , N/A ,$146.25 , N/A ,$112.50 , N/A , N/A , N/A , N/A ,$168.75 ,$135.00 ,$135.00 , N/A ,$135.00 ,$171.00 ,$171.00 ,$171.00 ,$225.00 , N/A ,$191.25 , N/A ,$146.25 , N/A ,$225.00 ,$126.00 , N/A ,$59.18 , N/A , N/A , N/A , N/A ,$180.00 , N/A ,$101.48 ,$63.00 ,$202.50 , N/A ,$171.00 ,$146.25 ,$146.25 , N/A ,$146.25 ,$108.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204576,N/A,HC CANNULA RADIOFREQUENCY,272,1 ,$90.00 ,$58.50 ,$23.67 ,$90.00 , N/A ,$41.40 ,$50.40 , N/A ,$25.20 ,$30.42 , N/A ,$35.01 , N/A ,$40.59 ,$40.59 , N/A ,$58.50 , N/A ,$45.00 , N/A , N/A , N/A , N/A ,$67.50 ,$54.00 ,$54.00 , N/A ,$54.00 ,$68.40 ,$68.40 ,$68.40 ,$90.00 , N/A ,$76.50 , N/A ,$58.50 , N/A ,$90.00 ,$50.40 , N/A ,$23.67 , N/A , N/A , N/A , N/A ,$72.00 , N/A ,$40.59 ,$25.20 ,$81.00 , N/A ,$68.40 ,$58.50 ,$58.50 , N/A ,$58.50 ,$43.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27204578,N/A,HC CONNECTOR ANESTHESIA SWIVEL,272,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$57.50 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$95.00 ,$95.00 ,$95.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$95.00 ,$81.25 ,$81.25 , N/A ,$81.25 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204579,N/A,HC DIALYZER,272,1 ,$78.00 ,$50.70 ,$20.51 ,$78.00 , N/A ,$35.88 ,$43.68 , N/A ,$21.84 ,$26.36 , N/A ,$30.34 , N/A ,$35.18 ,$35.18 , N/A ,$50.70 , N/A ,$39.00 , N/A , N/A , N/A , N/A ,$58.50 ,$46.80 ,$46.80 , N/A ,$46.80 ,$59.28 ,$59.28 ,$59.28 ,$78.00 , N/A ,$66.30 , N/A ,$50.70 , N/A ,$78.00 ,$43.68 , N/A ,$20.51 , N/A , N/A , N/A , N/A ,$62.40 , N/A ,$35.18 ,$21.84 ,$70.20 , N/A ,$59.28 ,$50.70 ,$50.70 , N/A ,$50.70 ,$37.44 , N/A 
ST. ELIZABETH'S HOSPITAL,27204583,N/A,HC LARYNGOSCOPE GLIDESCOPE,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204591,N/A,HC PROBE,272,1 ,$97.02 ,$63.06 ,$25.52 ,$97.02 , N/A ,$44.63 ,$54.33 , N/A ,$27.17 ,$32.79 , N/A ,$37.74 , N/A ,$43.76 ,$43.76 , N/A ,$63.06 , N/A ,$48.51 , N/A , N/A , N/A , N/A ,$72.77 ,$58.21 ,$58.21 , N/A ,$58.21 ,$73.74 ,$73.74 ,$73.74 ,$97.02 , N/A ,$82.47 , N/A ,$63.06 , N/A ,$97.02 ,$54.33 , N/A ,$25.52 , N/A , N/A , N/A , N/A ,$77.62 , N/A ,$43.76 ,$27.17 ,$87.32 , N/A ,$73.74 ,$63.06 ,$63.06 , N/A ,$63.06 ,$46.57 , N/A 
ST. ELIZABETH'S HOSPITAL,27204602,N/A,HC TRAY LACERATION,272,1 ,$36.00 ,$23.40 ,$9.47 ,$36.00 , N/A ,$16.56 ,$20.16 , N/A ,$10.08 ,$12.17 , N/A ,$14.00 , N/A ,$16.24 ,$16.24 , N/A ,$23.40 , N/A ,$18.00 , N/A , N/A , N/A , N/A ,$27.00 ,$21.60 ,$21.60 , N/A ,$21.60 ,$27.36 ,$27.36 ,$27.36 ,$36.00 , N/A ,$30.60 , N/A ,$23.40 , N/A ,$36.00 ,$20.16 , N/A ,$9.47 , N/A , N/A , N/A , N/A ,$28.80 , N/A ,$16.24 ,$10.08 ,$32.40 , N/A ,$27.36 ,$23.40 ,$23.40 , N/A ,$23.40 ,$17.28 , N/A 
ST. ELIZABETH'S HOSPITAL,27204603,N/A,HC TRAY UMBILICAL CATH,272,1 ,$176.21 ,$114.54 ,$46.34 ,$176.21 , N/A ,$81.06 ,$98.68 , N/A ,$49.34 ,$59.56 , N/A ,$68.55 , N/A ,$79.47 ,$79.47 , N/A ,$114.54 , N/A ,$88.11 , N/A , N/A , N/A , N/A ,$132.16 ,$105.73 ,$105.73 , N/A ,$105.73 ,$133.92 ,$133.92 ,$133.92 ,$176.21 , N/A ,$149.78 , N/A ,$114.54 , N/A ,$176.21 ,$98.68 , N/A ,$46.34 , N/A , N/A , N/A , N/A ,$140.97 , N/A ,$79.47 ,$49.34 ,$158.59 , N/A ,$133.92 ,$114.54 ,$114.54 , N/A ,$114.54 ,$84.58 , N/A 
ST. ELIZABETH'S HOSPITAL,27204604,N/A,HC TUBE TRACH COMBITUBE,272,1 ,$25.00 ,$16.25 ,$6.58 ,$25.00 , N/A ,$11.50 ,$14.00 , N/A ,$7.00 ,$8.45 , N/A ,$9.73 , N/A ,$11.28 ,$11.28 , N/A ,$16.25 , N/A ,$12.50 , N/A , N/A , N/A , N/A ,$18.75 ,$15.00 ,$15.00 , N/A ,$15.00 ,$19.00 ,$19.00 ,$19.00 ,$25.00 , N/A ,$21.25 , N/A ,$16.25 , N/A ,$25.00 ,$14.00 , N/A ,$6.58 , N/A , N/A , N/A , N/A ,$20.00 , N/A ,$11.28 ,$7.00 ,$22.50 , N/A ,$19.00 ,$16.25 ,$16.25 , N/A ,$16.25 ,$12.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204605,N/A,HC TUBE LARYNGOSCOPE DOUBLE LUMEN AIRTRAQ,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204614,N/A,HC TUBING IV,272,1 ,$19.95 ,$12.97 ,$5.25 ,$19.95 , N/A ,$9.18 ,$11.17 , N/A ,$5.59 ,$6.74 , N/A ,$7.76 , N/A ,$9.00 ,$9.00 , N/A ,$12.97 , N/A ,$9.98 , N/A , N/A , N/A , N/A ,$14.96 ,$11.97 ,$11.97 , N/A ,$11.97 ,$15.16 ,$15.16 ,$15.16 ,$19.95 , N/A ,$16.96 , N/A ,$12.97 , N/A ,$19.95 ,$11.17 , N/A ,$5.25 , N/A , N/A , N/A , N/A ,$15.96 , N/A ,$9.00 ,$5.59 ,$17.96 , N/A ,$15.16 ,$12.97 ,$12.97 , N/A ,$12.97 ,$9.58 , N/A 
ST. ELIZABETH'S HOSPITAL,27204617,N/A,HC HANDPIECE BREAST BIOPSY,272,1 ,$437.00 ,$284.05 ,$114.93 ,$437.00 , N/A ,$201.02 ,$244.72 , N/A ,$122.36 ,$147.71 , N/A ,$169.99 , N/A ,$197.09 ,$197.09 , N/A ,$284.05 , N/A ,$218.50 , N/A , N/A , N/A , N/A ,$327.75 ,$262.20 ,$262.20 , N/A ,$262.20 ,$332.12 ,$332.12 ,$332.12 ,$437.00 , N/A ,$371.45 , N/A ,$284.05 , N/A ,$437.00 ,$244.72 , N/A ,$114.93 , N/A , N/A , N/A , N/A ,$349.60 , N/A ,$197.09 ,$122.36 ,$393.30 , N/A ,$332.12 ,$284.05 ,$284.05 , N/A ,$284.05 ,$209.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204618,N/A,HC HANDPIECE BREAST BIOPSY - MRI,272,1 ,$625.00 ,$406.25 ,$164.38 ,$625.00 , N/A ,$287.50 ,$350.00 , N/A ,$175.00 ,$211.25 , N/A ,$243.13 , N/A ,$281.88 ,$281.88 , N/A ,$406.25 , N/A ,$312.50 , N/A , N/A , N/A , N/A ,$468.75 ,$375.00 ,$375.00 , N/A ,$375.00 ,$475.00 ,$475.00 ,$475.00 ,$625.00 , N/A ,$531.25 , N/A ,$406.25 , N/A ,$625.00 ,$350.00 , N/A ,$164.38 , N/A , N/A , N/A , N/A ,$500.00 , N/A ,$281.88 ,$175.00 ,$562.50 , N/A ,$475.00 ,$406.25 ,$406.25 , N/A ,$406.25 ,$300.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204619,N/A,HC NEEDLE LUNG BX FRANSEEN,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204620,C1769,HC GUIDEWIRE PERC NEPHROSTOMY  SET,272,1 ,$329.78 ,$214.36 ,$86.73 ,$329.78 , N/A ,$151.70 ,$184.68 , N/A ,$92.34 ,$111.47 , N/A ,$128.28 , N/A ,$148.73 ,$148.73 , N/A ,$214.36 , N/A ,$164.89 , N/A , N/A , N/A , N/A ,$247.34 ,$197.87 ,$197.87 , N/A ,$197.87 ,$250.63 ,$250.63 ,$250.63 ,$329.78 , N/A ,$280.31 , N/A ,$214.36 , N/A ,$329.78 ,$184.68 , N/A ,$86.73 , N/A , N/A , N/A , N/A ,$263.82 , N/A ,$148.73 ,$92.34 ,$296.80 , N/A ,$250.63 ,$214.36 ,$214.36 , N/A ,$214.36 ,$158.29 , N/A 
ST. ELIZABETH'S HOSPITAL,27204621,N/A,HC MARKER FIDUCIAL BLOCK,272,1 ,$312.00 ,$202.80 ,$82.06 ,$312.00 , N/A ,$143.52 ,$174.72 , N/A ,$87.36 ,$105.46 , N/A ,$121.37 , N/A ,$140.71 ,$140.71 , N/A ,$202.80 , N/A ,$156.00 , N/A , N/A , N/A , N/A ,$234.00 ,$187.20 ,$187.20 , N/A ,$187.20 ,$237.12 ,$237.12 ,$237.12 ,$312.00 , N/A ,$265.20 , N/A ,$202.80 , N/A ,$312.00 ,$174.72 , N/A ,$82.06 , N/A , N/A , N/A , N/A ,$249.60 , N/A ,$140.71 ,$87.36 ,$280.80 , N/A ,$237.12 ,$202.80 ,$202.80 , N/A ,$202.80 ,$149.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204622,N/A,HC MARKER BIOPSY SITE,272,1 ,$187.00 ,$121.55 ,$49.18 ,$187.00 , N/A ,$86.02 ,$104.72 , N/A ,$52.36 ,$63.21 , N/A ,$72.74 , N/A ,$84.34 ,$84.34 , N/A ,$121.55 , N/A ,$93.50 , N/A , N/A , N/A , N/A ,$140.25 ,$112.20 ,$112.20 , N/A ,$112.20 ,$142.12 ,$142.12 ,$142.12 ,$187.00 , N/A ,$158.95 , N/A ,$121.55 , N/A ,$187.00 ,$104.72 , N/A ,$49.18 , N/A , N/A , N/A , N/A ,$149.60 , N/A ,$84.34 ,$52.36 ,$168.30 , N/A ,$142.12 ,$121.55 ,$121.55 , N/A ,$121.55 ,$89.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204623,N/A,HC NEEDLE GUIDE,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204624,N/A,HC DEVICE BIOPSY COAXIAL ADJUSTABLE,272,1 ,$175.00 ,$113.75 ,$46.03 ,$175.00 , N/A ,$80.50 ,$98.00 , N/A ,$49.00 ,$59.15 , N/A ,$68.08 , N/A ,$78.93 ,$78.93 , N/A ,$113.75 , N/A ,$87.50 , N/A , N/A , N/A , N/A ,$131.25 ,$105.00 ,$105.00 , N/A ,$105.00 ,$133.00 ,$133.00 ,$133.00 ,$175.00 , N/A ,$148.75 , N/A ,$113.75 , N/A ,$175.00 ,$98.00 , N/A ,$46.03 , N/A , N/A , N/A , N/A ,$140.00 , N/A ,$78.93 ,$49.00 ,$157.50 , N/A ,$133.00 ,$113.75 ,$113.75 , N/A ,$113.75 ,$84.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204625,N/A,HC TRAY BREAST BIOPSY,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204626,N/A,HC TUBE ENDOTRACH W/PNEUMONIA RESIST AGENT,272,1 ,$250.00 ,$162.50 ,$65.75 ,$250.00 , N/A ,$115.00 ,$140.00 , N/A ,$70.00 ,$84.50 , N/A ,$97.25 , N/A ,$112.75 ,$112.75 , N/A ,$162.50 , N/A ,$125.00 , N/A , N/A , N/A , N/A ,$187.50 ,$150.00 ,$150.00 , N/A ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 , N/A ,$162.50 , N/A ,$250.00 ,$140.00 , N/A ,$65.75 , N/A , N/A , N/A , N/A ,$200.00 , N/A ,$112.75 ,$70.00 ,$225.00 , N/A ,$190.00 ,$162.50 ,$162.50 , N/A ,$162.50 ,$120.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204627,C1769,HC GUIDEWIRE PERC NEPHROSTOMY SET 22 GAUGE,272,1 ,$264.25 ,$171.76 ,$69.50 ,$264.25 , N/A ,$121.56 ,$147.98 , N/A ,$73.99 ,$89.32 , N/A ,$102.79 , N/A ,$119.18 ,$119.18 , N/A ,$171.76 , N/A ,$132.13 , N/A , N/A , N/A , N/A ,$198.19 ,$158.55 ,$158.55 , N/A ,$158.55 ,$200.83 ,$200.83 ,$200.83 ,$264.25 , N/A ,$224.61 , N/A ,$171.76 , N/A ,$264.25 ,$147.98 , N/A ,$69.50 , N/A , N/A , N/A , N/A ,$211.40 , N/A ,$119.18 ,$73.99 ,$237.83 , N/A ,$200.83 ,$171.76 ,$171.76 , N/A ,$171.76 ,$126.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27204628,N/A,HC KIT W/NEEDLE BIOPSY,272,1 ,$62.00 ,$40.30 ,$16.31 ,$62.00 , N/A ,$28.52 ,$34.72 , N/A ,$17.36 ,$20.96 , N/A ,$24.12 , N/A ,$27.96 ,$27.96 , N/A ,$40.30 , N/A ,$31.00 , N/A , N/A , N/A , N/A ,$46.50 ,$37.20 ,$37.20 , N/A ,$37.20 ,$47.12 ,$47.12 ,$47.12 ,$62.00 , N/A ,$52.70 , N/A ,$40.30 , N/A ,$62.00 ,$34.72 , N/A ,$16.31 , N/A , N/A , N/A , N/A ,$49.60 , N/A ,$27.96 ,$17.36 ,$55.80 , N/A ,$47.12 ,$40.30 ,$40.30 , N/A ,$40.30 ,$29.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204629,N/A,HC DEVICE BIOPSY COAXIAL ADJUSTABLE 22 GAUGE,272,1 ,$187.00 ,$121.55 ,$49.18 ,$187.00 , N/A ,$86.02 ,$104.72 , N/A ,$52.36 ,$63.21 , N/A ,$72.74 , N/A ,$84.34 ,$84.34 , N/A ,$121.55 , N/A ,$93.50 , N/A , N/A , N/A , N/A ,$140.25 ,$112.20 ,$112.20 , N/A ,$112.20 ,$142.12 ,$142.12 ,$142.12 ,$187.00 , N/A ,$158.95 , N/A ,$121.55 , N/A ,$187.00 ,$104.72 , N/A ,$49.18 , N/A , N/A , N/A , N/A ,$149.60 , N/A ,$84.34 ,$52.36 ,$168.30 , N/A ,$142.12 ,$121.55 ,$121.55 , N/A ,$121.55 ,$89.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27204638,N/A,HC NEEDLE EMG NATUS,272,1 ,$26.97 ,$17.53 ,$7.09 ,$26.97 , N/A ,$12.41 ,$15.10 , N/A ,$7.55 ,$9.12 , N/A ,$10.49 , N/A ,$12.16 ,$12.16 , N/A ,$17.53 , N/A ,$13.49 , N/A , N/A , N/A , N/A ,$20.23 ,$16.18 ,$16.18 , N/A ,$16.18 ,$20.50 ,$20.50 ,$20.50 ,$26.97 , N/A ,$22.92 , N/A ,$17.53 , N/A ,$26.97 ,$15.10 , N/A ,$7.09 , N/A , N/A , N/A , N/A ,$21.58 , N/A ,$12.16 ,$7.55 ,$24.27 , N/A ,$20.50 ,$17.53 ,$17.53 , N/A ,$17.53 ,$12.95 , N/A 
ST. ELIZABETH'S HOSPITAL,27204754,N/A,HC DEVICE BREAST BIOPSY ATEC,272,1 ,$461.00 ,$299.65 ,$121.24 ,$461.00 , N/A ,$212.06 ,$258.16 , N/A ,$129.08 ,$155.82 , N/A ,$179.33 , N/A ,$207.91 ,$207.91 , N/A ,$299.65 , N/A ,$230.50 , N/A , N/A , N/A , N/A ,$345.75 ,$276.60 ,$276.60 , N/A ,$276.60 ,$350.36 ,$350.36 ,$350.36 ,$461.00 , N/A ,$391.85 , N/A ,$299.65 , N/A ,$461.00 ,$258.16 , N/A ,$121.24 , N/A , N/A , N/A , N/A ,$368.80 , N/A ,$207.91 ,$129.08 ,$414.90 , N/A ,$350.36 ,$299.65 ,$299.65 , N/A ,$299.65 ,$221.28 , N/A 
ST. ELIZABETH'S HOSPITAL,27204755,N/A,HC DEVICE BREAST BIOPSY,272,1 ,$490.00 ,$318.50 ,$128.87 ,$490.00 , N/A ,$225.40 ,$274.40 , N/A ,$137.20 ,$165.62 , N/A ,$190.61 , N/A ,$220.99 ,$220.99 , N/A ,$318.50 , N/A ,$245.00 , N/A , N/A , N/A , N/A ,$367.50 ,$294.00 ,$294.00 , N/A ,$294.00 ,$372.40 ,$372.40 ,$372.40 ,$490.00 , N/A ,$416.50 , N/A ,$318.50 , N/A ,$490.00 ,$274.40 , N/A ,$128.87 , N/A , N/A , N/A , N/A ,$392.00 , N/A ,$220.99 ,$137.20 ,$441.00 , N/A ,$372.40 ,$318.50 ,$318.50 , N/A ,$318.50 ,$235.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27204756,N/A,HC CLIP BREAST BIOPSY,272,1 ,$151.00 ,$98.15 ,$39.71 ,$151.00 , N/A ,$69.46 ,$84.56 , N/A ,$42.28 ,$51.04 , N/A ,$58.74 , N/A ,$68.10 ,$68.10 , N/A ,$98.15 , N/A ,$75.50 , N/A , N/A , N/A , N/A ,$113.25 ,$90.60 ,$90.60 , N/A ,$90.60 ,$114.76 ,$114.76 ,$114.76 ,$151.00 , N/A ,$128.35 , N/A ,$98.15 , N/A ,$151.00 ,$84.56 , N/A ,$39.71 , N/A , N/A , N/A , N/A ,$120.80 , N/A ,$68.10 ,$42.28 ,$135.90 , N/A ,$114.76 ,$98.15 ,$98.15 , N/A ,$98.15 ,$72.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27204771,N/A,HC BLADE LARYNGOSCOPE,272,1 ,$118.00 ,$76.70 ,$31.03 ,$118.00 , N/A ,$54.28 ,$66.08 , N/A ,$33.04 ,$39.88 , N/A ,$45.90 , N/A ,$53.22 ,$53.22 , N/A ,$76.70 , N/A ,$59.00 , N/A , N/A , N/A , N/A ,$88.50 ,$70.80 ,$70.80 , N/A ,$70.80 ,$89.68 ,$89.68 ,$89.68 ,$118.00 , N/A ,$100.30 , N/A ,$76.70 , N/A ,$118.00 ,$66.08 , N/A ,$31.03 , N/A , N/A , N/A , N/A ,$94.40 , N/A ,$53.22 ,$33.04 ,$106.20 , N/A ,$89.68 ,$76.70 ,$76.70 , N/A ,$76.70 ,$56.64 , N/A 
ST. ELIZABETH'S HOSPITAL,27204773,N/A,HC CAUTERY PEN HIGH TEMP,272,1 ,$219.00 ,$142.35 ,$57.60 ,$219.00 , N/A ,$100.74 ,$122.64 , N/A ,$61.32 ,$74.02 , N/A ,$85.19 , N/A ,$98.77 ,$98.77 , N/A ,$142.35 , N/A ,$109.50 , N/A , N/A , N/A , N/A ,$164.25 ,$131.40 ,$131.40 , N/A ,$131.40 ,$166.44 ,$166.44 ,$166.44 ,$219.00 , N/A ,$186.15 , N/A ,$142.35 , N/A ,$219.00 ,$122.64 , N/A ,$57.60 , N/A , N/A , N/A , N/A ,$175.20 , N/A ,$98.77 ,$61.32 ,$197.10 , N/A ,$166.44 ,$142.35 ,$142.35 , N/A ,$142.35 ,$105.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27204783,N/A,HC NASAL BRIDLE,272,1 ,$300.00 ,$195.00 ,$78.90 ,$300.00 , N/A ,$138.00 ,$168.00 , N/A ,$84.00 ,$101.40 , N/A ,$116.70 , N/A ,$135.30 ,$135.30 , N/A ,$195.00 , N/A ,$150.00 , N/A , N/A , N/A , N/A ,$225.00 ,$180.00 ,$180.00 , N/A ,$180.00 ,$228.00 ,$228.00 ,$228.00 ,$300.00 , N/A ,$255.00 , N/A ,$195.00 , N/A ,$300.00 ,$168.00 , N/A ,$78.90 , N/A , N/A , N/A , N/A ,$240.00 , N/A ,$135.30 ,$84.00 ,$270.00 , N/A ,$228.00 ,$195.00 ,$195.00 , N/A ,$195.00 ,$144.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204805,N/A,HC CHEST TUBE THAL-QUICK,272,1 ,$525.00 ,$341.25 ,$138.08 ,$525.00 , N/A ,$241.50 ,$294.00 , N/A ,$147.00 ,$177.45 , N/A ,$204.23 , N/A ,$236.78 ,$236.78 , N/A ,$341.25 , N/A ,$262.50 , N/A , N/A , N/A , N/A ,$393.75 ,$315.00 ,$315.00 , N/A ,$315.00 ,$399.00 ,$399.00 ,$399.00 ,$525.00 , N/A ,$446.25 , N/A ,$341.25 , N/A ,$525.00 ,$294.00 , N/A ,$138.08 , N/A , N/A , N/A , N/A ,$420.00 , N/A ,$236.78 ,$147.00 ,$472.50 , N/A ,$399.00 ,$341.25 ,$341.25 , N/A ,$341.25 ,$252.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204824,N/A,HC NEEDLE RADIOFREQUENCY,272,1 ,"$1,285.00 ",$835.25 ,$337.96 ,"$1,285.00 ", N/A ,$591.10 ,$719.60 , N/A ,$359.80 ,$434.33 , N/A ,$499.87 , N/A ,$579.54 ,$579.54 , N/A ,$835.25 , N/A ,$642.50 , N/A , N/A , N/A , N/A ,$963.75 ,$771.00 ,$771.00 , N/A ,$771.00 ,$976.60 ,$976.60 ,$976.60 ,"$1,285.00 ", N/A ,"$1,092.25 ", N/A ,$835.25 , N/A ,"$1,285.00 ",$719.60 , N/A ,$337.96 , N/A , N/A , N/A , N/A ,"$1,028.00 ", N/A ,$579.54 ,$359.80 ,"$1,156.50 ", N/A ,$976.60 ,$835.25 ,$835.25 , N/A ,$835.25 ,$616.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27204837,N/A,HC TUBE GASTROSTOMY FEEDING EXTENDED,272,1 ,$146.25 ,$95.06 ,$38.46 ,$146.25 , N/A ,$67.28 ,$81.90 , N/A ,$40.95 ,$49.43 , N/A ,$56.89 , N/A ,$65.96 ,$65.96 , N/A ,$95.06 , N/A ,$73.13 , N/A , N/A , N/A , N/A ,$109.69 ,$87.75 ,$87.75 , N/A ,$87.75 ,$111.15 ,$111.15 ,$111.15 ,$146.25 , N/A ,$124.31 , N/A ,$95.06 , N/A ,$146.25 ,$81.90 , N/A ,$38.46 , N/A , N/A , N/A , N/A ,$117.00 , N/A ,$65.96 ,$40.95 ,$131.63 , N/A ,$111.15 ,$95.06 ,$95.06 , N/A ,$95.06 ,$70.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27204839,N/A,HC ADAPTER SWIVEL FIBEROPTIC,272,1 ,$29.40 ,$19.11 ,$7.73 ,$29.40 , N/A ,$13.52 ,$16.46 , N/A ,$8.23 ,$9.94 , N/A ,$11.44 , N/A ,$13.26 ,$13.26 , N/A ,$19.11 , N/A ,$14.70 , N/A , N/A , N/A , N/A ,$22.05 ,$17.64 ,$17.64 , N/A ,$17.64 ,$22.34 ,$22.34 ,$22.34 ,$29.40 , N/A ,$24.99 , N/A ,$19.11 , N/A ,$29.40 ,$16.46 , N/A ,$7.73 , N/A , N/A , N/A , N/A ,$23.52 , N/A ,$13.26 ,$8.23 ,$26.46 , N/A ,$22.34 ,$19.11 ,$19.11 , N/A ,$19.11 ,$14.11 , N/A 
ST. ELIZABETH'S HOSPITAL,27204859,N/A,HC HEMOSTAT SURGICAL,272,1 ,$525.00 ,$341.25 ,$138.08 ,$525.00 , N/A ,$241.50 ,$294.00 , N/A ,$147.00 ,$177.45 , N/A ,$204.23 , N/A ,$236.78 ,$236.78 , N/A ,$341.25 , N/A ,$262.50 , N/A , N/A , N/A , N/A ,$393.75 ,$315.00 ,$315.00 , N/A ,$315.00 ,$399.00 ,$399.00 ,$399.00 ,$525.00 , N/A ,$446.25 , N/A ,$341.25 , N/A ,$525.00 ,$294.00 , N/A ,$138.08 , N/A , N/A , N/A , N/A ,$420.00 , N/A ,$236.78 ,$147.00 ,$472.50 , N/A ,$399.00 ,$341.25 ,$341.25 , N/A ,$341.25 ,$252.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204860,N/A,HC HEMOSTAT MATRIX,272,1 ,"$1,195.00 ",$776.75 ,$314.29 ,"$1,195.00 ", N/A ,$549.70 ,$669.20 , N/A ,$334.60 ,$403.91 , N/A ,$464.86 , N/A ,$538.95 ,$538.95 , N/A ,$776.75 , N/A ,$597.50 , N/A , N/A , N/A , N/A ,$896.25 ,$717.00 ,$717.00 , N/A ,$717.00 ,$908.20 ,$908.20 ,$908.20 ,"$1,195.00 ", N/A ,"$1,015.75 ", N/A ,$776.75 , N/A ,"$1,195.00 ",$669.20 , N/A ,$314.29 , N/A , N/A , N/A , N/A ,$956.00 , N/A ,$538.95 ,$334.60 ,"$1,075.50 ", N/A ,$908.20 ,$776.75 ,$776.75 , N/A ,$776.75 ,$573.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27204865,N/A,HC INTRODUCER/SHEATH,272,1 ,$195.00 ,$126.75 ,$51.29 ,$195.00 , N/A ,$89.70 ,$109.20 , N/A ,$54.60 ,$65.91 , N/A ,$75.86 , N/A ,$87.95 ,$87.95 , N/A ,$126.75 , N/A ,$97.50 , N/A , N/A , N/A , N/A ,$146.25 ,$117.00 ,$117.00 , N/A ,$117.00 ,$148.20 ,$148.20 ,$148.20 ,$195.00 , N/A ,$165.75 , N/A ,$126.75 , N/A ,$195.00 ,$109.20 , N/A ,$51.29 , N/A , N/A , N/A , N/A ,$156.00 , N/A ,$87.95 ,$54.60 ,$175.50 , N/A ,$148.20 ,$126.75 ,$126.75 , N/A ,$126.75 ,$93.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27204874,N/A,HC TUBING IV PUMP,272,1 ,$19.47 ,$12.66 ,$5.12 ,$19.47 , N/A ,$8.96 ,$10.90 , N/A ,$5.45 ,$6.58 , N/A ,$7.57 , N/A ,$8.78 ,$8.78 , N/A ,$12.66 , N/A ,$9.74 , N/A , N/A , N/A , N/A ,$14.60 ,$11.68 ,$11.68 , N/A ,$11.68 ,$14.80 ,$14.80 ,$14.80 ,$19.47 , N/A ,$16.55 , N/A ,$12.66 , N/A ,$19.47 ,$10.90 , N/A ,$5.12 , N/A , N/A , N/A , N/A ,$15.58 , N/A ,$8.78 ,$5.45 ,$17.52 , N/A ,$14.80 ,$12.66 ,$12.66 , N/A ,$12.66 ,$9.35 , N/A 
ST. ELIZABETH'S HOSPITAL,27204888,N/A,HC KIT CATHETER PLEURX DRAINAGE,272,1 ,$300.00 ,$195.00 ,$78.90 ,$300.00 , N/A ,$138.00 ,$168.00 , N/A ,$84.00 ,$101.40 , N/A ,$116.70 , N/A ,$135.30 ,$135.30 , N/A ,$195.00 , N/A ,$150.00 , N/A , N/A , N/A , N/A ,$225.00 ,$180.00 ,$180.00 , N/A ,$180.00 ,$228.00 ,$228.00 ,$228.00 ,$300.00 , N/A ,$255.00 , N/A ,$195.00 , N/A ,$300.00 ,$168.00 , N/A ,$78.90 , N/A , N/A , N/A , N/A ,$240.00 , N/A ,$135.30 ,$84.00 ,$270.00 , N/A ,$228.00 ,$195.00 ,$195.00 , N/A ,$195.00 ,$144.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204895,N/A,HC KIT EVACUATOR,272,1 ,$69.00 ,$44.85 ,$18.15 ,$69.00 , N/A ,$31.74 ,$38.64 , N/A ,$19.32 ,$23.32 , N/A ,$26.84 , N/A ,$31.12 ,$31.12 , N/A ,$44.85 , N/A ,$34.50 , N/A , N/A , N/A , N/A ,$51.75 ,$41.40 ,$41.40 , N/A ,$41.40 ,$52.44 ,$52.44 ,$52.44 ,$69.00 , N/A ,$58.65 , N/A ,$44.85 , N/A ,$69.00 ,$38.64 , N/A ,$18.15 , N/A , N/A , N/A , N/A ,$55.20 , N/A ,$31.12 ,$19.32 ,$62.10 , N/A ,$52.44 ,$44.85 ,$44.85 , N/A ,$44.85 ,$33.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27204900,N/A,HC KIT IAP MONITOR,272,1 ,$192.00 ,$124.80 ,$50.50 ,$192.00 , N/A ,$88.32 ,$107.52 , N/A ,$53.76 ,$64.90 , N/A ,$74.69 , N/A ,$86.59 ,$86.59 , N/A ,$124.80 , N/A ,$96.00 , N/A , N/A , N/A , N/A ,$144.00 ,$115.20 ,$115.20 , N/A ,$115.20 ,$145.92 ,$145.92 ,$145.92 ,$192.00 , N/A ,$163.20 , N/A ,$124.80 , N/A ,$192.00 ,$107.52 , N/A ,$50.50 , N/A , N/A , N/A , N/A ,$153.60 , N/A ,$86.59 ,$53.76 ,$172.80 , N/A ,$145.92 ,$124.80 ,$124.80 , N/A ,$124.80 ,$92.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27204911,N/A,HC KIT PERC TRACH INTRODUCER,272,1 ,"$1,431.00 ",$930.15 ,$376.35 ,"$1,431.00 ", N/A ,$658.26 ,$801.36 , N/A ,$400.68 ,$483.68 , N/A ,$556.66 , N/A ,$645.38 ,$645.38 , N/A ,$930.15 , N/A ,$715.50 , N/A , N/A , N/A , N/A ,"$1,073.25 ",$858.60 ,$858.60 , N/A ,$858.60 ,"$1,087.56 ","$1,087.56 ","$1,087.56 ","$1,431.00 ", N/A ,"$1,216.35 ", N/A ,$930.15 , N/A ,"$1,431.00 ",$801.36 , N/A ,$376.35 , N/A , N/A , N/A , N/A ,"$1,144.80 ", N/A ,$645.38 ,$400.68 ,"$1,287.90 ", N/A ,"$1,087.56 ",$930.15 ,$930.15 , N/A ,$930.15 ,$686.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27204917,N/A,HC KIT PNEUMOTHORAX ARROW,272,1 ,$375.00 ,$243.75 ,$98.63 ,$375.00 , N/A ,$172.50 ,$210.00 , N/A ,$105.00 ,$126.75 , N/A ,$145.88 , N/A ,$169.13 ,$169.13 , N/A ,$243.75 , N/A ,$187.50 , N/A , N/A , N/A , N/A ,$281.25 ,$225.00 ,$225.00 , N/A ,$225.00 ,$285.00 ,$285.00 ,$285.00 ,$375.00 , N/A ,$318.75 , N/A ,$243.75 , N/A ,$375.00 ,$210.00 , N/A ,$98.63 , N/A , N/A , N/A , N/A ,$300.00 , N/A ,$169.13 ,$105.00 ,$337.50 , N/A ,$285.00 ,$243.75 ,$243.75 , N/A ,$243.75 ,$180.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27204922,N/A,HC LIFT SLING MEDIUM,272,1 ,$82.00 ,$53.30 ,$21.57 ,$82.00 , N/A ,$37.72 ,$45.92 , N/A ,$22.96 ,$27.72 , N/A ,$31.90 , N/A ,$36.98 ,$36.98 , N/A ,$53.30 , N/A ,$41.00 , N/A , N/A , N/A , N/A ,$61.50 ,$49.20 ,$49.20 , N/A ,$49.20 ,$62.32 ,$62.32 ,$62.32 ,$82.00 , N/A ,$69.70 , N/A ,$53.30 , N/A ,$82.00 ,$45.92 , N/A ,$21.57 , N/A , N/A , N/A , N/A ,$65.60 , N/A ,$36.98 ,$22.96 ,$73.80 , N/A ,$62.32 ,$53.30 ,$53.30 , N/A ,$53.30 ,$39.36 , N/A 
ST. ELIZABETH'S HOSPITAL,27204923,N/A,HC LIFT SLING LARGE/X-LARGE,272,1 ,$105.00 ,$68.25 ,$27.62 ,$105.00 , N/A ,$48.30 ,$58.80 , N/A ,$29.40 ,$35.49 , N/A ,$40.85 , N/A ,$47.36 ,$47.36 , N/A ,$68.25 , N/A ,$52.50 , N/A , N/A , N/A , N/A ,$78.75 ,$63.00 ,$63.00 , N/A ,$63.00 ,$79.80 ,$79.80 ,$79.80 ,$105.00 , N/A ,$89.25 , N/A ,$68.25 , N/A ,$105.00 ,$58.80 , N/A ,$27.62 , N/A , N/A , N/A , N/A ,$84.00 , N/A ,$47.36 ,$29.40 ,$94.50 , N/A ,$79.80 ,$68.25 ,$68.25 , N/A ,$68.25 ,$50.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27204924,N/A,HC LIFT SLING CEILING REPOSITION,272,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$55.20 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 ,$78.00 ,$78.00 , N/A ,$78.00 ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27204941,N/A,HC NEEDLE EPIDURAL,272,1 ,$38.70 ,$25.16 ,$10.18 ,$38.70 , N/A ,$17.80 ,$21.67 , N/A ,$10.84 ,$13.08 , N/A ,$15.05 , N/A ,$17.45 ,$17.45 , N/A ,$25.16 , N/A ,$19.35 , N/A , N/A , N/A , N/A ,$29.03 ,$23.22 ,$23.22 , N/A ,$23.22 ,$29.41 ,$29.41 ,$29.41 ,$38.70 , N/A ,$32.90 , N/A ,$25.16 , N/A ,$38.70 ,$21.67 , N/A ,$10.18 , N/A , N/A , N/A , N/A ,$30.96 , N/A ,$17.45 ,$10.84 ,$34.83 , N/A ,$29.41 ,$25.16 ,$25.16 , N/A ,$25.16 ,$18.58 , N/A 
ST. ELIZABETH'S HOSPITAL,27204942,N/A,HC NEEDLE BIOPSY BREAST,272,1 ,$52.00 ,$33.80 ,$13.68 ,$52.00 , N/A ,$23.92 ,$29.12 , N/A ,$14.56 ,$17.58 , N/A ,$20.23 , N/A ,$23.45 ,$23.45 , N/A ,$33.80 , N/A ,$26.00 , N/A , N/A , N/A , N/A ,$39.00 ,$31.20 ,$31.20 , N/A ,$31.20 ,$39.52 ,$39.52 ,$39.52 ,$52.00 , N/A ,$44.20 , N/A ,$33.80 , N/A ,$52.00 ,$29.12 , N/A ,$13.68 , N/A , N/A , N/A , N/A ,$41.60 , N/A ,$23.45 ,$14.56 ,$46.80 , N/A ,$39.52 ,$33.80 ,$33.80 , N/A ,$33.80 ,$24.96 , N/A 
ST. ELIZABETH'S HOSPITAL,27204996,N/A,HC PROBE TEMP SENSOR,272,1 ,$340.00 ,$221.00 ,$89.42 ,$340.00 , N/A ,$156.40 ,$190.40 , N/A ,$95.20 ,$114.92 , N/A ,$132.26 , N/A ,$153.34 ,$153.34 , N/A ,$221.00 , N/A ,$170.00 , N/A , N/A , N/A , N/A ,$255.00 ,$204.00 ,$204.00 , N/A ,$204.00 ,$258.40 ,$258.40 ,$258.40 ,$340.00 , N/A ,$289.00 , N/A ,$221.00 , N/A ,$340.00 ,$190.40 , N/A ,$89.42 , N/A , N/A , N/A , N/A ,$272.00 , N/A ,$153.34 ,$95.20 ,$306.00 , N/A ,$258.40 ,$221.00 ,$221.00 , N/A ,$221.00 ,$163.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205060,N/A,HC TRAY PICC LINE,272,1 ,$665.00 ,$432.25 ,$174.90 ,$665.00 , N/A ,$305.90 ,$372.40 , N/A ,$186.20 ,$224.77 , N/A ,$258.69 , N/A ,$299.92 ,$299.92 , N/A ,$432.25 , N/A ,$332.50 , N/A , N/A , N/A , N/A ,$498.75 ,$399.00 ,$399.00 , N/A ,$399.00 ,$505.40 ,$505.40 ,$505.40 ,$665.00 , N/A ,$565.25 , N/A ,$432.25 , N/A ,$665.00 ,$372.40 , N/A ,$174.90 , N/A , N/A , N/A , N/A ,$532.00 , N/A ,$299.92 ,$186.20 ,$598.50 , N/A ,$505.40 ,$432.25 ,$432.25 , N/A ,$432.25 ,$319.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205065,N/A,HC TRAY TUBING THORACENTESIS,272,1 ,$225.00 ,$146.25 ,$59.18 ,$225.00 , N/A ,$103.50 ,$126.00 , N/A ,$63.00 ,$76.05 , N/A ,$87.53 , N/A ,$101.48 ,$101.48 , N/A ,$146.25 , N/A ,$112.50 , N/A , N/A , N/A , N/A ,$168.75 ,$135.00 ,$135.00 , N/A ,$135.00 ,$171.00 ,$171.00 ,$171.00 ,$225.00 , N/A ,$191.25 , N/A ,$146.25 , N/A ,$225.00 ,$126.00 , N/A ,$59.18 , N/A , N/A , N/A , N/A ,$180.00 , N/A ,$101.48 ,$63.00 ,$202.50 , N/A ,$171.00 ,$146.25 ,$146.25 , N/A ,$146.25 ,$108.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27205067,N/A,HC TRAY CHEST PNEUMOTHORAX WAYNE,272,1 ,$594.00 ,$386.10 ,$156.22 ,$594.00 , N/A ,$273.24 ,$332.64 , N/A ,$166.32 ,$200.77 , N/A ,$231.07 , N/A ,$267.89 ,$267.89 , N/A ,$386.10 , N/A ,$297.00 , N/A , N/A , N/A , N/A ,$445.50 ,$356.40 ,$356.40 , N/A ,$356.40 ,$451.44 ,$451.44 ,$451.44 ,$594.00 , N/A ,$504.90 , N/A ,$386.10 , N/A ,$594.00 ,$332.64 , N/A ,$156.22 , N/A , N/A , N/A , N/A ,$475.20 , N/A ,$267.89 ,$166.32 ,$534.60 , N/A ,$451.44 ,$386.10 ,$386.10 , N/A ,$386.10 ,$285.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27205072,N/A,HC BAG DRAINAGE GRAVITY,272,1 ,$19.00 ,$12.35 ,$5.00 ,$19.00 , N/A ,$8.74 ,$10.64 , N/A ,$5.32 ,$6.42 , N/A ,$7.39 , N/A ,$8.57 ,$8.57 , N/A ,$12.35 , N/A ,$9.50 , N/A , N/A , N/A , N/A ,$14.25 ,$11.40 ,$11.40 , N/A ,$11.40 ,$14.44 ,$14.44 ,$14.44 ,$19.00 , N/A ,$16.15 , N/A ,$12.35 , N/A ,$19.00 ,$10.64 , N/A ,$5.00 , N/A , N/A , N/A , N/A ,$15.20 , N/A ,$8.57 ,$5.32 ,$17.10 , N/A ,$14.44 ,$12.35 ,$12.35 , N/A ,$12.35 ,$9.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27205074,N/A,HC TUBE TRACH,272,1 ,$333.54 ,$216.80 ,$87.72 ,$333.54 , N/A ,$153.43 ,$186.78 , N/A ,$93.39 ,$112.74 , N/A ,$129.75 , N/A ,$150.43 ,$150.43 , N/A ,$216.80 , N/A ,$166.77 , N/A , N/A , N/A , N/A ,$250.16 ,$200.12 ,$200.12 , N/A ,$200.12 ,$253.49 ,$253.49 ,$253.49 ,$333.54 , N/A ,$283.51 , N/A ,$216.80 , N/A ,$333.54 ,$186.78 , N/A ,$87.72 , N/A , N/A , N/A , N/A ,$266.83 , N/A ,$150.43 ,$93.39 ,$300.19 , N/A ,$253.49 ,$216.80 ,$216.80 , N/A ,$216.80 ,$160.10 , N/A 
ST. ELIZABETH'S HOSPITAL,27205086,N/A,HC CANISTER WOUND VAC,272,1 ,$84.00 ,$54.60 ,$22.09 ,$84.00 , N/A ,$38.64 ,$47.04 , N/A ,$23.52 ,$28.39 , N/A ,$32.68 , N/A ,$37.88 ,$37.88 , N/A ,$54.60 , N/A ,$42.00 , N/A , N/A , N/A , N/A ,$63.00 ,$50.40 ,$50.40 , N/A ,$50.40 ,$63.84 ,$63.84 ,$63.84 ,$84.00 , N/A ,$71.40 , N/A ,$54.60 , N/A ,$84.00 ,$47.04 , N/A ,$22.09 , N/A , N/A , N/A , N/A ,$67.20 , N/A ,$37.88 ,$23.52 ,$75.60 , N/A ,$63.84 ,$54.60 ,$54.60 , N/A ,$54.60 ,$40.32 , N/A 
ST. ELIZABETH'S HOSPITAL,27205093,N/A,HC DILATOR VESSEL,272,1 ,$24.00 ,$15.60 ,$6.31 ,$24.00 , N/A ,$11.04 ,$13.44 , N/A ,$6.72 ,$8.11 , N/A ,$9.34 , N/A ,$10.82 ,$10.82 , N/A ,$15.60 , N/A ,$12.00 , N/A , N/A , N/A , N/A ,$18.00 ,$14.40 ,$14.40 , N/A ,$14.40 ,$18.24 ,$18.24 ,$18.24 ,$24.00 , N/A ,$20.40 , N/A ,$15.60 , N/A ,$24.00 ,$13.44 , N/A ,$6.31 , N/A , N/A , N/A , N/A ,$19.20 , N/A ,$10.82 ,$6.72 ,$21.60 , N/A ,$18.24 ,$15.60 ,$15.60 , N/A ,$15.60 ,$11.52 , N/A 
ST. ELIZABETH'S HOSPITAL,27205094,N/A,HC CUSHION WAFFLE,272,1 ,$58.20 ,$37.83 ,$15.31 ,$58.20 , N/A ,$26.77 ,$32.59 , N/A ,$16.30 ,$19.67 , N/A ,$22.64 , N/A ,$26.25 ,$26.25 , N/A ,$37.83 , N/A ,$29.10 , N/A , N/A , N/A , N/A ,$43.65 ,$34.92 ,$34.92 , N/A ,$34.92 ,$44.23 ,$44.23 ,$44.23 ,$58.20 , N/A ,$49.47 , N/A ,$37.83 , N/A ,$58.20 ,$32.59 , N/A ,$15.31 , N/A , N/A , N/A , N/A ,$46.56 , N/A ,$26.25 ,$16.30 ,$52.38 , N/A ,$44.23 ,$37.83 ,$37.83 , N/A ,$37.83 ,$27.94 , N/A 
ST. ELIZABETH'S HOSPITAL,27205127,C1886,HC CATHETER TISSUE ABLATION,272,1 ,"$13,278.00 ","$8,630.70 ","$3,492.11 ","$13,278.00 ", N/A ,"$6,107.88 ","$7,435.68 ", N/A ,"$3,717.84 ","$4,487.96 ", N/A ,"$5,165.14 ", N/A ,"$5,988.38 ","$5,988.38 ", N/A ,"$8,630.70 ", N/A ,"$6,639.00 ", N/A , N/A , N/A , N/A ,"$9,958.50 ","$7,966.80 ","$7,966.80 ", N/A ,"$7,966.80 ","$10,091.28 ","$10,091.28 ","$10,091.28 ","$13,278.00 ", N/A ,"$11,286.30 ", N/A ,"$8,630.70 ", N/A ,"$13,278.00 ","$7,435.68 ", N/A ,"$3,492.11 ", N/A , N/A , N/A , N/A ,"$10,622.40 ", N/A ,"$5,988.38 ","$3,717.84 ","$11,950.20 ", N/A ,"$10,091.28 ","$8,630.70 ","$8,630.70 ", N/A ,"$8,630.70 ","$6,373.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205145,N/A,HC LIFT SLING SMALL,272,1 ,$68.00 ,$44.20 ,$17.88 ,$68.00 , N/A ,$31.28 ,$38.08 , N/A ,$19.04 ,$22.98 , N/A ,$26.45 , N/A ,$30.67 ,$30.67 , N/A ,$44.20 , N/A ,$34.00 , N/A , N/A , N/A , N/A ,$51.00 ,$40.80 ,$40.80 , N/A ,$40.80 ,$51.68 ,$51.68 ,$51.68 ,$68.00 , N/A ,$57.80 , N/A ,$44.20 , N/A ,$68.00 ,$38.08 , N/A ,$17.88 , N/A , N/A , N/A , N/A ,$54.40 , N/A ,$30.67 ,$19.04 ,$61.20 , N/A ,$51.68 ,$44.20 ,$44.20 , N/A ,$44.20 ,$32.64 , N/A 
ST. ELIZABETH'S HOSPITAL,27205146,N/A,HC LIFT SLING LEG,272,1 ,$56.00 ,$36.40 ,$14.73 ,$56.00 , N/A ,$25.76 ,$31.36 , N/A ,$15.68 ,$18.93 , N/A ,$21.78 , N/A ,$25.26 ,$25.26 , N/A ,$36.40 , N/A ,$28.00 , N/A , N/A , N/A , N/A ,$42.00 ,$33.60 ,$33.60 , N/A ,$33.60 ,$42.56 ,$42.56 ,$42.56 ,$56.00 , N/A ,$47.60 , N/A ,$36.40 , N/A ,$56.00 ,$31.36 , N/A ,$14.73 , N/A , N/A , N/A , N/A ,$44.80 , N/A ,$25.26 ,$15.68 ,$50.40 , N/A ,$42.56 ,$36.40 ,$36.40 , N/A ,$36.40 ,$26.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27205148,C1751,HC KIT POWER PICC,272,1 ,$771.61 ,$501.55 ,$202.93 ,$771.61 , N/A ,$354.94 ,$432.10 , N/A ,$216.05 ,$260.80 , N/A ,$300.16 , N/A ,$348.00 ,$348.00 , N/A ,$501.55 , N/A ,$385.81 , N/A , N/A , N/A , N/A ,$578.71 ,$462.97 ,$462.97 , N/A ,$462.97 ,$586.42 ,$586.42 ,$586.42 ,$771.61 , N/A ,$655.87 , N/A ,$501.55 , N/A ,$771.61 ,$432.10 , N/A ,$202.93 , N/A , N/A , N/A , N/A ,$617.29 , N/A ,$348.00 ,$216.05 ,$694.45 , N/A ,$586.42 ,$501.55 ,$501.55 , N/A ,$501.55 ,$370.37 , N/A 
ST. ELIZABETH'S HOSPITAL,27205181,N/A,HC STRYKER AIR 2 MATTRESS OVERLAY,272,1 ,$65.88 ,$42.82 ,$17.33 ,$65.88 , N/A ,$30.30 ,$36.89 , N/A ,$18.45 ,$22.27 , N/A ,$25.63 , N/A ,$29.71 ,$29.71 , N/A ,$42.82 , N/A ,$32.94 , N/A , N/A , N/A , N/A ,$49.41 ,$39.53 ,$39.53 , N/A ,$39.53 ,$50.07 ,$50.07 ,$50.07 ,$65.88 , N/A ,$56.00 , N/A ,$42.82 , N/A ,$65.88 ,$36.89 , N/A ,$17.33 , N/A , N/A , N/A , N/A ,$52.70 , N/A ,$29.71 ,$18.45 ,$59.29 , N/A ,$50.07 ,$42.82 ,$42.82 , N/A ,$42.82 ,$31.62 , N/A 
ST. ELIZABETH'S HOSPITAL,27205231,N/A,HC KIT ENDOVENOUS VEIN PROCEDURE,272,1 ,$780.00 ,$507.00 ,$205.14 ,$780.00 , N/A ,$358.80 ,$436.80 , N/A ,$218.40 ,$263.64 , N/A ,$303.42 , N/A ,$351.78 ,$351.78 , N/A ,$507.00 , N/A ,$390.00 , N/A , N/A , N/A , N/A ,$585.00 ,$468.00 ,$468.00 , N/A ,$468.00 ,$592.80 ,$592.80 ,$592.80 ,$780.00 , N/A ,$663.00 , N/A ,$507.00 , N/A ,$780.00 ,$436.80 , N/A ,$205.14 , N/A , N/A , N/A , N/A ,$624.00 , N/A ,$351.78 ,$218.40 ,$702.00 , N/A ,$592.80 ,$507.00 ,$507.00 , N/A ,$507.00 ,$374.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27205232,C1894,HC INTRODUCER/SHEATH W/CATH NEEDLE RADIAL ARTERY,272,1 ,$31.71 ,$20.61 ,$8.34 ,$31.71 , N/A ,$14.59 ,$17.76 , N/A ,$8.88 ,$10.72 , N/A ,$12.34 , N/A ,$14.30 ,$14.30 , N/A ,$20.61 , N/A ,$15.86 , N/A , N/A , N/A , N/A ,$23.78 ,$19.03 ,$19.03 , N/A ,$19.03 ,$24.10 ,$24.10 ,$24.10 ,$31.71 , N/A ,$26.95 , N/A ,$20.61 , N/A ,$31.71 ,$17.76 , N/A ,$8.34 , N/A , N/A , N/A , N/A ,$25.37 , N/A ,$14.30 ,$8.88 ,$28.54 , N/A ,$24.10 ,$20.61 ,$20.61 , N/A ,$20.61 ,$15.22 , N/A 
ST. ELIZABETH'S HOSPITAL,27205233,N/A,HC KIT ARTERIAL LINE W/RADIOPAQUE CATH,272,1 ,$150.00 ,$97.50 ,$39.45 ,$150.00 , N/A ,$69.00 ,$84.00 , N/A ,$42.00 ,$50.70 , N/A ,$58.35 , N/A ,$67.65 ,$67.65 , N/A ,$97.50 , N/A ,$75.00 , N/A , N/A , N/A , N/A ,$112.50 ,$90.00 ,$90.00 , N/A ,$90.00 ,$114.00 ,$114.00 ,$114.00 ,$150.00 , N/A ,$127.50 , N/A ,$97.50 , N/A ,$150.00 ,$84.00 , N/A ,$39.45 , N/A , N/A , N/A , N/A ,$120.00 , N/A ,$67.65 ,$42.00 ,$135.00 , N/A ,$114.00 ,$97.50 ,$97.50 , N/A ,$97.50 ,$72.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27205234,N/A,HC KIT CATHETER HEAT EXCHANGE QUATTRO,272,1 ,"$3,300.00 ","$2,145.00 ",$867.90 ,"$3,300.00 ", N/A ,"$1,518.00 ","$1,848.00 ", N/A ,$924.00 ,"$1,115.40 ", N/A ,"$1,283.70 ", N/A ,"$1,488.30 ","$1,488.30 ", N/A ,"$2,145.00 ", N/A ,"$1,650.00 ", N/A , N/A , N/A , N/A ,"$2,475.00 ","$1,980.00 ","$1,980.00 ", N/A ,"$1,980.00 ","$2,508.00 ","$2,508.00 ","$2,508.00 ","$3,300.00 ", N/A ,"$2,805.00 ", N/A ,"$2,145.00 ", N/A ,"$3,300.00 ","$1,848.00 ", N/A ,$867.90 , N/A , N/A , N/A , N/A ,"$2,640.00 ", N/A ,"$1,488.30 ",$924.00 ,"$2,970.00 ", N/A ,"$2,508.00 ","$2,145.00 ","$2,145.00 ", N/A ,"$2,145.00 ","$1,584.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205235,N/A,HC KIT CATHETER HEAT EXCHANGE SOLEX,272,1 ,$600.00 ,$390.00 ,$157.80 ,$600.00 , N/A ,$276.00 ,$336.00 , N/A ,$168.00 ,$202.80 , N/A ,$233.40 , N/A ,$270.60 ,$270.60 , N/A ,$390.00 , N/A ,$300.00 , N/A , N/A , N/A , N/A ,$450.00 ,$360.00 ,$360.00 , N/A ,$360.00 ,$456.00 ,$456.00 ,$456.00 ,$600.00 , N/A ,$510.00 , N/A ,$390.00 , N/A ,$600.00 ,$336.00 , N/A ,$157.80 , N/A , N/A , N/A , N/A ,$480.00 , N/A ,$270.60 ,$168.00 ,$540.00 , N/A ,$456.00 ,$390.00 ,$390.00 , N/A ,$390.00 ,$288.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27205236,N/A,HC SYSTEM BIOPSY NEEDLE/INTRODUCER,272,1 ,$151.00 ,$98.15 ,$39.71 ,$151.00 , N/A ,$69.46 ,$84.56 , N/A ,$42.28 ,$51.04 , N/A ,$58.74 , N/A ,$68.10 ,$68.10 , N/A ,$98.15 , N/A ,$75.50 , N/A , N/A , N/A , N/A ,$113.25 ,$90.60 ,$90.60 , N/A ,$90.60 ,$114.76 ,$114.76 ,$114.76 ,$151.00 , N/A ,$128.35 , N/A ,$98.15 , N/A ,$151.00 ,$84.56 , N/A ,$39.71 , N/A , N/A , N/A , N/A ,$120.80 , N/A ,$68.10 ,$42.28 ,$135.90 , N/A ,$114.76 ,$98.15 ,$98.15 , N/A ,$98.15 ,$72.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27205237,C1889,HC COIL EMBOLIZATION LOOP,272,1 ,$152.21 ,$98.94 ,$40.03 ,$152.21 , N/A ,$70.02 ,$85.24 , N/A ,$42.62 ,$51.45 , N/A ,$59.21 , N/A ,$68.65 ,$68.65 , N/A ,$98.94 , N/A ,$76.11 , N/A , N/A , N/A , N/A ,$114.16 ,$91.33 ,$91.33 , N/A ,$91.33 ,$115.68 ,$115.68 ,$115.68 ,$152.21 , N/A ,$129.38 , N/A ,$98.94 , N/A ,$152.21 ,$85.24 , N/A ,$40.03 , N/A , N/A , N/A , N/A ,$121.77 , N/A ,$68.65 ,$42.62 ,$136.99 , N/A ,$115.68 ,$98.94 ,$98.94 , N/A ,$98.94 ,$73.06 , N/A 
ST. ELIZABETH'S HOSPITAL,27205238,C1887,HC CATHETER GUIDING BERENSTEIN,272,1 ,$44.39 ,$28.85 ,$11.67 ,$44.39 , N/A ,$20.42 ,$24.86 , N/A ,$12.43 ,$15.00 , N/A ,$17.27 , N/A ,$20.02 ,$20.02 , N/A ,$28.85 , N/A ,$22.20 , N/A , N/A , N/A , N/A ,$33.29 ,$26.63 ,$26.63 , N/A ,$26.63 ,$33.74 ,$33.74 ,$33.74 ,$44.39 , N/A ,$37.73 , N/A ,$28.85 , N/A ,$44.39 ,$24.86 , N/A ,$11.67 , N/A , N/A , N/A , N/A ,$35.51 , N/A ,$20.02 ,$12.43 ,$39.95 , N/A ,$33.74 ,$28.85 ,$28.85 , N/A ,$28.85 ,$21.31 , N/A 
ST. ELIZABETH'S HOSPITAL,27205239,C1887,HC CATHETER TORCON KMP TIP,272,1 ,$44.39 ,$28.85 ,$11.67 ,$44.39 , N/A ,$20.42 ,$24.86 , N/A ,$12.43 ,$15.00 , N/A ,$17.27 , N/A ,$20.02 ,$20.02 , N/A ,$28.85 , N/A ,$22.20 , N/A , N/A , N/A , N/A ,$33.29 ,$26.63 ,$26.63 , N/A ,$26.63 ,$33.74 ,$33.74 ,$33.74 ,$44.39 , N/A ,$37.73 , N/A ,$28.85 , N/A ,$44.39 ,$24.86 , N/A ,$11.67 , N/A , N/A , N/A , N/A ,$35.51 , N/A ,$20.02 ,$12.43 ,$39.95 , N/A ,$33.74 ,$28.85 ,$28.85 , N/A ,$28.85 ,$21.31 , N/A 
ST. ELIZABETH'S HOSPITAL,27205240,C1894,HC SHEATH SAFE 4FR 5FR 6FR,272,1 ,$65.53 ,$42.59 ,$17.23 ,$65.53 , N/A ,$30.14 ,$36.70 , N/A ,$18.35 ,$22.15 , N/A ,$25.49 , N/A ,$29.55 ,$29.55 , N/A ,$42.59 , N/A ,$32.77 , N/A , N/A , N/A , N/A ,$49.15 ,$39.32 ,$39.32 , N/A ,$39.32 ,$49.80 ,$49.80 ,$49.80 ,$65.53 , N/A ,$55.70 , N/A ,$42.59 , N/A ,$65.53 ,$36.70 , N/A ,$17.23 , N/A , N/A , N/A , N/A ,$52.42 , N/A ,$29.55 ,$18.35 ,$58.98 , N/A ,$49.80 ,$42.59 ,$42.59 , N/A ,$42.59 ,$31.45 , N/A 
ST. ELIZABETH'S HOSPITAL,27205241,C1887,HC CATHETER MIKAELSSON,272,1 ,$39.11 ,$25.42 ,$10.29 ,$39.11 , N/A ,$17.99 ,$21.90 , N/A ,$10.95 ,$13.22 , N/A ,$15.21 , N/A ,$17.64 ,$17.64 , N/A ,$25.42 , N/A ,$19.56 , N/A , N/A , N/A , N/A ,$29.33 ,$23.47 ,$23.47 , N/A ,$23.47 ,$29.72 ,$29.72 ,$29.72 ,$39.11 , N/A ,$33.24 , N/A ,$25.42 , N/A ,$39.11 ,$21.90 , N/A ,$10.29 , N/A , N/A , N/A , N/A ,$31.29 , N/A ,$17.64 ,$10.95 ,$35.20 , N/A ,$29.72 ,$25.42 ,$25.42 , N/A ,$25.42 ,$18.77 , N/A 
ST. ELIZABETH'S HOSPITAL,27205242,C1887,HC CATHETER GUIDING SOS OMNI,272,1 ,$121.56 ,$79.01 ,$31.97 ,$121.56 , N/A ,$55.92 ,$68.07 , N/A ,$34.04 ,$41.09 , N/A ,$47.29 , N/A ,$54.82 ,$54.82 , N/A ,$79.01 , N/A ,$60.78 , N/A , N/A , N/A , N/A ,$91.17 ,$72.94 ,$72.94 , N/A ,$72.94 ,$92.39 ,$92.39 ,$92.39 ,$121.56 , N/A ,$103.33 , N/A ,$79.01 , N/A ,$121.56 ,$68.07 , N/A ,$31.97 , N/A , N/A , N/A , N/A ,$97.25 , N/A ,$54.82 ,$34.04 ,$109.40 , N/A ,$92.39 ,$79.01 ,$79.01 , N/A ,$79.01 ,$58.35 , N/A 
ST. ELIZABETH'S HOSPITAL,27205244,C1769,HC GUIDEWIRE ROSEN 180,272,1 ,$33.82 ,$21.98 ,$8.89 ,$33.82 , N/A ,$15.56 ,$18.94 , N/A ,$9.47 ,$11.43 , N/A ,$13.16 , N/A ,$15.25 ,$15.25 , N/A ,$21.98 , N/A ,$16.91 , N/A , N/A , N/A , N/A ,$25.37 ,$20.29 ,$20.29 , N/A ,$20.29 ,$25.70 ,$25.70 ,$25.70 ,$33.82 , N/A ,$28.75 , N/A ,$21.98 , N/A ,$33.82 ,$18.94 , N/A ,$8.89 , N/A , N/A , N/A , N/A ,$27.06 , N/A ,$15.25 ,$9.47 ,$30.44 , N/A ,$25.70 ,$21.98 ,$21.98 , N/A ,$21.98 ,$16.23 , N/A 
ST. ELIZABETH'S HOSPITAL,27205245,C1769,HC GUIDEWIRE GLIDEWIRE PERIPHERAL DOUBLE ANGLE,272,1 ,$819.18 ,$532.47 ,$215.44 ,$819.18 , N/A ,$376.82 ,$458.74 , N/A ,$229.37 ,$276.88 , N/A ,$318.66 , N/A ,$369.45 ,$369.45 , N/A ,$532.47 , N/A ,$409.59 , N/A , N/A , N/A , N/A ,$614.39 ,$491.51 ,$491.51 , N/A ,$491.51 ,$622.58 ,$622.58 ,$622.58 ,$819.18 , N/A ,$696.30 , N/A ,$532.47 , N/A ,$819.18 ,$458.74 , N/A ,$215.44 , N/A , N/A , N/A , N/A ,$655.34 , N/A ,$369.45 ,$229.37 ,$737.26 , N/A ,$622.58 ,$532.47 ,$532.47 , N/A ,$532.47 ,$393.21 , N/A 
ST. ELIZABETH'S HOSPITAL,27205246,C1750,HC CATHETER HEMODIALYSIS TUNNEL PERMA CATH,272,1 ,$491.51 ,$319.48 ,$129.27 ,$491.51 , N/A ,$226.09 ,$275.25 , N/A ,$137.62 ,$166.13 , N/A ,$191.20 , N/A ,$221.67 ,$221.67 , N/A ,$319.48 , N/A ,$245.76 , N/A , N/A , N/A , N/A ,$368.63 ,$294.91 ,$294.91 , N/A ,$294.91 ,$373.55 ,$373.55 ,$373.55 ,$491.51 , N/A ,$417.78 , N/A ,$319.48 , N/A ,$491.51 ,$275.25 , N/A ,$129.27 , N/A , N/A , N/A , N/A ,$393.21 , N/A ,$221.67 ,$137.62 ,$442.36 , N/A ,$373.55 ,$319.48 ,$319.48 , N/A ,$319.48 ,$235.92 , N/A 
ST. ELIZABETH'S HOSPITAL,27205247,C1729,HC CATHETER DRAIN DAWSON MUELLER,272,1 ,$181.80 ,$118.17 ,$47.81 ,$181.80 , N/A ,$83.63 ,$101.81 , N/A ,$50.90 ,$61.45 , N/A ,$70.72 , N/A ,$81.99 ,$81.99 , N/A ,$118.17 , N/A ,$90.90 , N/A , N/A , N/A , N/A ,$136.35 ,$109.08 ,$109.08 , N/A ,$109.08 ,$138.17 ,$138.17 ,$138.17 ,$181.80 , N/A ,$154.53 , N/A ,$118.17 , N/A ,$181.80 ,$101.81 , N/A ,$47.81 , N/A , N/A , N/A , N/A ,$145.44 , N/A ,$81.99 ,$50.90 ,$163.62 , N/A ,$138.17 ,$118.17 ,$118.17 , N/A ,$118.17 ,$87.26 , N/A 
ST. ELIZABETH'S HOSPITAL,27205248,C1729,HC CATHETER DRAIN BILIARY,272,1 ,$195.55 ,$127.11 ,$51.43 ,$195.55 , N/A ,$89.95 ,$109.51 , N/A ,$54.75 ,$66.10 , N/A ,$76.07 , N/A ,$88.19 ,$88.19 , N/A ,$127.11 , N/A ,$97.78 , N/A , N/A , N/A , N/A ,$146.66 ,$117.33 ,$117.33 , N/A ,$117.33 ,$148.62 ,$148.62 ,$148.62 ,$195.55 , N/A ,$166.22 , N/A ,$127.11 , N/A ,$195.55 ,$109.51 , N/A ,$51.43 , N/A , N/A , N/A , N/A ,$156.44 , N/A ,$88.19 ,$54.75 ,$176.00 , N/A ,$148.62 ,$127.11 ,$127.11 , N/A ,$127.11 ,$93.86 , N/A 
ST. ELIZABETH'S HOSPITAL,27205249,C1729,HC CATHETER DRAIN MULTI PURPOSE,272,1 ,$195.55 ,$127.11 ,$51.43 ,$195.55 , N/A ,$89.95 ,$109.51 , N/A ,$54.75 ,$66.10 , N/A ,$76.07 , N/A ,$88.19 ,$88.19 , N/A ,$127.11 , N/A ,$97.78 , N/A , N/A , N/A , N/A ,$146.66 ,$117.33 ,$117.33 , N/A ,$117.33 ,$148.62 ,$148.62 ,$148.62 ,$195.55 , N/A ,$166.22 , N/A ,$127.11 , N/A ,$195.55 ,$109.51 , N/A ,$51.43 , N/A , N/A , N/A , N/A ,$156.44 , N/A ,$88.19 ,$54.75 ,$176.00 , N/A ,$148.62 ,$127.11 ,$127.11 , N/A ,$127.11 ,$93.86 , N/A 
ST. ELIZABETH'S HOSPITAL,27205250,N/A,HC DEVICE FASTENER CATHETER,272,1 ,$20.00 ,$13.00 ,$5.26 ,$20.00 , N/A ,$9.20 ,$11.20 , N/A ,$5.60 ,$6.76 , N/A ,$7.78 , N/A ,$9.02 ,$9.02 , N/A ,$13.00 , N/A ,$10.00 , N/A , N/A , N/A , N/A ,$15.00 ,$12.00 ,$12.00 , N/A ,$12.00 ,$15.20 ,$15.20 ,$15.20 ,$20.00 , N/A ,$17.00 , N/A ,$13.00 , N/A ,$20.00 ,$11.20 , N/A ,$5.26 , N/A , N/A , N/A , N/A ,$16.00 , N/A ,$9.02 ,$5.60 ,$18.00 , N/A ,$15.20 ,$13.00 ,$13.00 , N/A ,$13.00 ,$9.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27205251,C1729,HC CATHETER DRAINAGE PIGTAIL LOCKING,272,1 ,$158.55 ,$103.06 ,$41.70 ,$158.55 , N/A ,$72.93 ,$88.79 , N/A ,$44.39 ,$53.59 , N/A ,$61.68 , N/A ,$71.51 ,$71.51 , N/A ,$103.06 , N/A ,$79.28 , N/A , N/A , N/A , N/A ,$118.91 ,$95.13 ,$95.13 , N/A ,$95.13 ,$120.50 ,$120.50 ,$120.50 ,$158.55 , N/A ,$134.77 , N/A ,$103.06 , N/A ,$158.55 ,$88.79 , N/A ,$41.70 , N/A , N/A , N/A , N/A ,$126.84 , N/A ,$71.51 ,$44.39 ,$142.70 , N/A ,$120.50 ,$103.06 ,$103.06 , N/A ,$103.06 ,$76.10 , N/A 
ST. ELIZABETH'S HOSPITAL,27205252,C1729,HC CATHETER DRAINAGE J-TIP,272,1 ,$158.55 ,$103.06 ,$41.70 ,$158.55 , N/A ,$72.93 ,$88.79 , N/A ,$44.39 ,$53.59 , N/A ,$61.68 , N/A ,$71.51 ,$71.51 , N/A ,$103.06 , N/A ,$79.28 , N/A , N/A , N/A , N/A ,$118.91 ,$95.13 ,$95.13 , N/A ,$95.13 ,$120.50 ,$120.50 ,$120.50 ,$158.55 , N/A ,$134.77 , N/A ,$103.06 , N/A ,$158.55 ,$88.79 , N/A ,$41.70 , N/A , N/A , N/A , N/A ,$126.84 , N/A ,$71.51 ,$44.39 ,$142.70 , N/A ,$120.50 ,$103.06 ,$103.06 , N/A ,$103.06 ,$76.10 , N/A 
ST. ELIZABETH'S HOSPITAL,27205253,C1729,HC SYSTEM PLUERIX DRAIN W/CATHETER,272,1 ,"$1,291.65 ",$839.57 ,$339.70 ,"$1,291.65 ", N/A ,$594.16 ,$723.32 , N/A ,$361.66 ,$436.58 , N/A ,$502.45 , N/A ,$582.53 ,$582.53 , N/A ,$839.57 , N/A ,$645.83 , N/A , N/A , N/A , N/A ,$968.74 ,$774.99 ,$774.99 , N/A ,$774.99 ,$981.65 ,$981.65 ,$981.65 ,"$1,291.65 ", N/A ,"$1,097.90 ", N/A ,$839.57 , N/A ,"$1,291.65 ",$723.32 , N/A ,$339.70 , N/A , N/A , N/A , N/A ,"$1,033.32 ", N/A ,$582.53 ,$361.66 ,"$1,162.49 ", N/A ,$981.65 ,$839.57 ,$839.57 , N/A ,$839.57 ,$619.99 , N/A 
ST. ELIZABETH'S HOSPITAL,27205254,C1729,HC KIT CATHETER DRAINAGE ASPIRA,272,1 ,"$1,255.72 ",$816.22 ,$330.25 ,"$1,255.72 ", N/A ,$577.63 ,$703.20 , N/A ,$351.60 ,$424.43 , N/A ,$488.48 , N/A ,$566.33 ,$566.33 , N/A ,$816.22 , N/A ,$627.86 , N/A , N/A , N/A , N/A ,$941.79 ,$753.43 ,$753.43 , N/A ,$753.43 ,$954.35 ,$954.35 ,$954.35 ,"$1,255.72 ", N/A ,"$1,067.36 ", N/A ,$816.22 , N/A ,"$1,255.72 ",$703.20 , N/A ,$330.25 , N/A , N/A , N/A , N/A ,"$1,004.58 ", N/A ,$566.33 ,$351.60 ,"$1,130.15 ", N/A ,$954.35 ,$816.22 ,$816.22 , N/A ,$816.22 ,$602.75 , N/A 
ST. ELIZABETH'S HOSPITAL,27205255,C1729,HC CATHETER MULTIPURPOSE,272,1 ,$43.34 ,$28.17 ,$11.40 ,$43.34 , N/A ,$19.94 ,$24.27 , N/A ,$12.14 ,$14.65 , N/A ,$16.86 , N/A ,$19.55 ,$19.55 , N/A ,$28.17 , N/A ,$21.67 , N/A , N/A , N/A , N/A ,$32.51 ,$26.00 ,$26.00 , N/A ,$26.00 ,$32.94 ,$32.94 ,$32.94 ,$43.34 , N/A ,$36.84 , N/A ,$28.17 , N/A ,$43.34 ,$24.27 , N/A ,$11.40 , N/A , N/A , N/A , N/A ,$34.67 , N/A ,$19.55 ,$12.14 ,$39.01 , N/A ,$32.94 ,$28.17 ,$28.17 , N/A ,$28.17 ,$20.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27205256,C1729,HC CATHETER TEFLON,272,1 ,$168.06 ,$109.24 ,$44.20 ,$168.06 , N/A ,$77.31 ,$94.11 , N/A ,$47.06 ,$56.80 , N/A ,$65.38 , N/A ,$75.80 ,$75.80 , N/A ,$109.24 , N/A ,$84.03 , N/A , N/A , N/A , N/A ,$126.05 ,$100.84 ,$100.84 , N/A ,$100.84 ,$127.73 ,$127.73 ,$127.73 ,$168.06 , N/A ,$142.85 , N/A ,$109.24 , N/A ,$168.06 ,$94.11 , N/A ,$44.20 , N/A , N/A , N/A , N/A ,$134.45 , N/A ,$75.80 ,$47.06 ,$151.25 , N/A ,$127.73 ,$109.24 ,$109.24 , N/A ,$109.24 ,$80.67 , N/A 
ST. ELIZABETH'S HOSPITAL,27205257,C1887,HC SET CATHETER BIOPSY,272,1 ,"$1,203.92 ",$782.55 ,$316.63 ,"$1,203.92 ", N/A ,$553.80 ,$674.20 , N/A ,$337.10 ,$406.93 , N/A ,$468.32 , N/A ,$542.97 ,$542.97 , N/A ,$782.55 , N/A ,$601.96 , N/A , N/A , N/A , N/A ,$902.94 ,$722.35 ,$722.35 , N/A ,$722.35 ,$914.98 ,$914.98 ,$914.98 ,"$1,203.92 ", N/A ,"$1,023.33 ", N/A ,$782.55 , N/A ,"$1,203.92 ",$674.20 , N/A ,$316.63 , N/A , N/A , N/A , N/A ,$963.14 , N/A ,$542.97 ,$337.10 ,"$1,083.53 ", N/A ,$914.98 ,$782.55 ,$782.55 , N/A ,$782.55 ,$577.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27205259,C1887,HC CATHETER ANGIO VISCERAL KMP SLIP,272,1 ,$80.00 ,$52.00 ,$21.04 ,$80.00 , N/A ,$36.80 ,$44.80 , N/A ,$22.40 ,$27.04 , N/A ,$31.12 , N/A ,$36.08 ,$36.08 , N/A ,$52.00 , N/A ,$40.00 , N/A , N/A , N/A , N/A ,$60.00 ,$48.00 ,$48.00 , N/A ,$48.00 ,$60.80 ,$60.80 ,$60.80 ,$80.00 , N/A ,$68.00 , N/A ,$52.00 , N/A ,$80.00 ,$44.80 , N/A ,$21.04 , N/A , N/A , N/A , N/A ,$64.00 , N/A ,$36.08 ,$22.40 ,$72.00 , N/A ,$60.80 ,$52.00 ,$52.00 , N/A ,$52.00 ,$38.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27205260,C1887,HC CATHETER TORCON KMP BEACON TIP,272,1 ,$42.00 ,$27.30 ,$11.05 ,$42.00 , N/A ,$19.32 ,$23.52 , N/A ,$11.76 ,$14.20 , N/A ,$16.34 , N/A ,$18.94 ,$18.94 , N/A ,$27.30 , N/A ,$21.00 , N/A , N/A , N/A , N/A ,$31.50 ,$25.20 ,$25.20 , N/A ,$25.20 ,$31.92 ,$31.92 ,$31.92 ,$42.00 , N/A ,$35.70 , N/A ,$27.30 , N/A ,$42.00 ,$23.52 , N/A ,$11.05 , N/A , N/A , N/A , N/A ,$33.60 , N/A ,$18.94 ,$11.76 ,$37.80 , N/A ,$31.92 ,$27.30 ,$27.30 , N/A ,$27.30 ,$20.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27205262,N/A,HC BRONCHOSCOPE,272,1 ,$900.00 ,$585.00 ,$236.70 ,$900.00 , N/A ,$414.00 ,$504.00 , N/A ,$252.00 ,$304.20 , N/A ,$350.10 , N/A ,$405.90 ,$405.90 , N/A ,$585.00 , N/A ,$450.00 , N/A , N/A , N/A , N/A ,$675.00 ,$540.00 ,$540.00 , N/A ,$540.00 ,$684.00 ,$684.00 ,$684.00 ,$900.00 , N/A ,$765.00 , N/A ,$585.00 , N/A ,$900.00 ,$504.00 , N/A ,$236.70 , N/A , N/A , N/A , N/A ,$720.00 , N/A ,$405.90 ,$252.00 ,$810.00 , N/A ,$684.00 ,$585.00 ,$585.00 , N/A ,$585.00 ,$432.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27205265,N/A,HC SYSTEM DIRECT VISUALIZATION SPYSCOPE,272,1 ,$38.00 ,$24.70 ,$9.99 ,$38.00 , N/A ,$17.48 ,$21.28 , N/A ,$10.64 ,$12.84 , N/A ,$14.78 , N/A ,$17.14 ,$17.14 , N/A ,$24.70 , N/A ,$19.00 , N/A , N/A , N/A , N/A ,$28.50 ,$22.80 ,$22.80 , N/A ,$22.80 ,$28.88 ,$28.88 ,$28.88 ,$38.00 , N/A ,$32.30 , N/A ,$24.70 , N/A ,$38.00 ,$21.28 , N/A ,$9.99 , N/A , N/A , N/A , N/A ,$30.40 , N/A ,$17.14 ,$10.64 ,$34.20 , N/A ,$28.88 ,$24.70 ,$24.70 , N/A ,$24.70 ,$18.24 , N/A 
ST. ELIZABETH'S HOSPITAL,27205272,N/A,HC SENSOR HEMODYNAMIC MONITOR NONINVASIVE,272,1 ,$408.00 ,$265.20 ,$107.30 ,$408.00 , N/A ,$187.68 ,$228.48 , N/A ,$114.24 ,$137.90 , N/A ,$158.71 , N/A ,$184.01 ,$184.01 , N/A ,$265.20 , N/A ,$204.00 , N/A , N/A , N/A , N/A ,$306.00 ,$244.80 ,$244.80 , N/A ,$244.80 ,$310.08 ,$310.08 ,$310.08 ,$408.00 , N/A ,$346.80 , N/A ,$265.20 , N/A ,$408.00 ,$228.48 , N/A ,$107.30 , N/A , N/A , N/A , N/A ,$326.40 , N/A ,$184.01 ,$114.24 ,$367.20 , N/A ,$310.08 ,$265.20 ,$265.20 , N/A ,$265.20 ,$195.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27205347,N/A,HC NEEDLE CURVED TROFLEX,272,1 ,$949.00 ,$616.85 ,$249.59 ,$949.00 , N/A ,$436.54 ,$531.44 , N/A ,$265.72 ,$320.76 , N/A ,$369.16 , N/A ,$428.00 ,$428.00 , N/A ,$616.85 , N/A ,$474.50 , N/A , N/A , N/A , N/A ,$711.75 ,$569.40 ,$569.40 , N/A ,$569.40 ,$721.24 ,$721.24 ,$721.24 ,$949.00 , N/A ,$806.65 , N/A ,$616.85 , N/A ,$949.00 ,$531.44 , N/A ,$249.59 , N/A , N/A , N/A , N/A ,$759.20 , N/A ,$428.00 ,$265.72 ,$854.10 , N/A ,$721.24 ,$616.85 ,$616.85 , N/A ,$616.85 ,$455.52 , N/A 
ST. ELIZABETH'S HOSPITAL,27205348,N/A,HC CATHETER ANGIOGRAPHIC TIP,272,1 ,$41.00 ,$26.65 ,$10.78 ,$41.00 , N/A ,$18.86 ,$22.96 , N/A ,$11.48 ,$13.86 , N/A ,$15.95 , N/A ,$18.49 ,$18.49 , N/A ,$26.65 , N/A ,$20.50 , N/A , N/A , N/A , N/A ,$30.75 ,$24.60 ,$24.60 , N/A ,$24.60 ,$31.16 ,$31.16 ,$31.16 ,$41.00 , N/A ,$34.85 , N/A ,$26.65 , N/A ,$41.00 ,$22.96 , N/A ,$10.78 , N/A , N/A , N/A , N/A ,$32.80 , N/A ,$18.49 ,$11.48 ,$36.90 , N/A ,$31.16 ,$26.65 ,$26.65 , N/A ,$26.65 ,$19.68 , N/A 
ST. ELIZABETH'S HOSPITAL,27205349,C1884,HC EMBOLIZATION PROTECTIVE SYSTEM CEREBRAL,272,1 ,"$10,200.00 ","$6,630.00 ","$2,682.60 ","$10,200.00 ", N/A ,"$4,692.00 ","$5,712.00 ", N/A ,"$2,856.00 ","$3,447.60 ", N/A ,"$3,967.80 ", N/A ,"$4,600.20 ","$4,600.20 ", N/A ,"$6,630.00 ", N/A ,"$5,100.00 ", N/A , N/A , N/A , N/A ,"$7,650.00 ","$6,120.00 ","$6,120.00 ", N/A ,"$6,120.00 ","$7,752.00 ","$7,752.00 ","$7,752.00 ","$10,200.00 ", N/A ,"$8,670.00 ", N/A ,"$6,630.00 ", N/A ,"$10,200.00 ","$5,712.00 ", N/A ,"$2,682.60 ", N/A , N/A , N/A , N/A ,"$8,160.00 ", N/A ,"$4,600.20 ","$2,856.00 ","$9,180.00 ", N/A ,"$7,752.00 ","$6,630.00 ","$6,630.00 ", N/A ,"$6,630.00 ","$4,896.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205358,N/A,HC KIT CATHETER/GUIDEWIRE NITINOL PICC SINGLE LUMEN,272,1 ,$405.00 ,$263.25 ,$106.52 ,$405.00 , N/A ,$186.30 ,$226.80 , N/A ,$113.40 ,$136.89 , N/A ,$157.55 , N/A ,$182.66 ,$182.66 , N/A ,$263.25 , N/A ,$202.50 , N/A , N/A , N/A , N/A ,$303.75 ,$243.00 ,$243.00 , N/A ,$243.00 ,$307.80 ,$307.80 ,$307.80 ,$405.00 , N/A ,$344.25 , N/A ,$263.25 , N/A ,$405.00 ,$226.80 , N/A ,$106.52 , N/A , N/A , N/A , N/A ,$324.00 , N/A ,$182.66 ,$113.40 ,$364.50 , N/A ,$307.80 ,$263.25 ,$263.25 , N/A ,$263.25 ,$194.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27205359,N/A,HC KIT CATHETER/GUIDEWIRE NITINOL PICC DOUBLE LUMEN,272,1 ,$441.00 ,$286.65 ,$115.98 ,$441.00 , N/A ,$202.86 ,$246.96 , N/A ,$123.48 ,$149.06 , N/A ,$171.55 , N/A ,$198.89 ,$198.89 , N/A ,$286.65 , N/A ,$220.50 , N/A , N/A , N/A , N/A ,$330.75 ,$264.60 ,$264.60 , N/A ,$264.60 ,$335.16 ,$335.16 ,$335.16 ,$441.00 , N/A ,$374.85 , N/A ,$286.65 , N/A ,$441.00 ,$246.96 , N/A ,$115.98 , N/A , N/A , N/A , N/A ,$352.80 , N/A ,$198.89 ,$123.48 ,$396.90 , N/A ,$335.16 ,$286.65 ,$286.65 , N/A ,$286.65 ,$211.68 , N/A 
ST. ELIZABETH'S HOSPITAL,27205361,N/A,HC STYLET BEVEL,272,1 ,$108.00 ,$70.20 ,$28.40 ,$108.00 , N/A ,$49.68 ,$60.48 , N/A ,$30.24 ,$36.50 , N/A ,$42.01 , N/A ,$48.71 ,$48.71 , N/A ,$70.20 , N/A ,$54.00 , N/A , N/A , N/A , N/A ,$81.00 ,$64.80 ,$64.80 , N/A ,$64.80 ,$82.08 ,$82.08 ,$82.08 ,$108.00 , N/A ,$91.80 , N/A ,$70.20 , N/A ,$108.00 ,$60.48 , N/A ,$28.40 , N/A , N/A , N/A , N/A ,$86.40 , N/A ,$48.71 ,$30.24 ,$97.20 , N/A ,$82.08 ,$70.20 ,$70.20 , N/A ,$70.20 ,$51.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27205362,C1751,HC TRAY W/CATHETER DUAL-LUMEN,272,1 ,$208.00 ,$135.20 ,$54.70 ,$208.00 , N/A ,$95.68 ,$116.48 , N/A ,$58.24 ,$70.30 , N/A ,$80.91 , N/A ,$93.81 ,$93.81 , N/A ,$135.20 , N/A ,$104.00 , N/A , N/A , N/A , N/A ,$156.00 ,$124.80 ,$124.80 , N/A ,$124.80 ,$158.08 ,$158.08 ,$158.08 ,$208.00 , N/A ,$176.80 , N/A ,$135.20 , N/A ,$208.00 ,$116.48 , N/A ,$54.70 , N/A , N/A , N/A , N/A ,$166.40 , N/A ,$93.81 ,$58.24 ,$187.20 , N/A ,$158.08 ,$135.20 ,$135.20 , N/A ,$135.20 ,$99.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27205363,C1751,HC CATHETER SWAN GANZ THERMODILUTION VIP,272,1 ,$573.00 ,$372.45 ,$150.70 ,$573.00 , N/A ,$263.58 ,$320.88 , N/A ,$160.44 ,$193.67 , N/A ,$222.90 , N/A ,$258.42 ,$258.42 , N/A ,$372.45 , N/A ,$286.50 , N/A , N/A , N/A , N/A ,$429.75 ,$343.80 ,$343.80 , N/A ,$343.80 ,$435.48 ,$435.48 ,$435.48 ,$573.00 , N/A ,$487.05 , N/A ,$372.45 , N/A ,$573.00 ,$320.88 , N/A ,$150.70 , N/A , N/A , N/A , N/A ,$458.40 , N/A ,$258.42 ,$160.44 ,$515.70 , N/A ,$435.48 ,$372.45 ,$372.45 , N/A ,$372.45 ,$275.04 , N/A 
ST. ELIZABETH'S HOSPITAL,27205364,C1751,HC CATHETER SWAN GANZ THERMODILUTION C-TIP,272,1 ,"$1,185.00 ",$770.25 ,$311.66 ,"$1,185.00 ", N/A ,$545.10 ,$663.60 , N/A ,$331.80 ,$400.53 , N/A ,$460.97 , N/A ,$534.44 ,$534.44 , N/A ,$770.25 , N/A ,$592.50 , N/A , N/A , N/A , N/A ,$888.75 ,$711.00 ,$711.00 , N/A ,$711.00 ,$900.60 ,$900.60 ,$900.60 ,"$1,185.00 ", N/A ,"$1,007.25 ", N/A ,$770.25 , N/A ,"$1,185.00 ",$663.60 , N/A ,$311.66 , N/A , N/A , N/A , N/A ,$948.00 , N/A ,$534.44 ,$331.80 ,"$1,066.50 ", N/A ,$900.60 ,$770.25 ,$770.25 , N/A ,$770.25 ,$568.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27205365,N/A,HC KIT CATHETER HEAT EXCHANGE ICY,272,1 ,$546.00 ,$354.90 ,$143.60 ,$546.00 , N/A ,$251.16 ,$305.76 , N/A ,$152.88 ,$184.55 , N/A ,$212.39 , N/A ,$246.25 ,$246.25 , N/A ,$354.90 , N/A ,$273.00 , N/A , N/A , N/A , N/A ,$409.50 ,$327.60 ,$327.60 , N/A ,$327.60 ,$414.96 ,$414.96 ,$414.96 ,$546.00 , N/A ,$464.10 , N/A ,$354.90 , N/A ,$546.00 ,$305.76 , N/A ,$143.60 , N/A , N/A , N/A , N/A ,$436.80 , N/A ,$246.25 ,$152.88 ,$491.40 , N/A ,$414.96 ,$354.90 ,$354.90 , N/A ,$354.90 ,$262.08 , N/A 
ST. ELIZABETH'S HOSPITAL,27205367,C1887,HC CATHETER RADIAL TIGER,272,1 ,$105.00 ,$68.25 ,$27.62 ,$105.00 , N/A ,$48.30 ,$58.80 , N/A ,$29.40 ,$35.49 , N/A ,$40.85 , N/A ,$47.36 ,$47.36 , N/A ,$68.25 , N/A ,$52.50 , N/A , N/A , N/A , N/A ,$78.75 ,$63.00 ,$63.00 , N/A ,$63.00 ,$79.80 ,$79.80 ,$79.80 ,$105.00 , N/A ,$89.25 , N/A ,$68.25 , N/A ,$105.00 ,$58.80 , N/A ,$27.62 , N/A , N/A , N/A , N/A ,$84.00 , N/A ,$47.36 ,$29.40 ,$94.50 , N/A ,$79.80 ,$68.25 ,$68.25 , N/A ,$68.25 ,$50.40 , N/A 
ST. ELIZABETH'S HOSPITAL,27205368,C1894,HC SHEATH INTRODUCER 6FR W/MINI GUIDEWIRE,272,1 ,$29.00 ,$18.85 ,$7.63 ,$29.00 , N/A ,$13.34 ,$16.24 , N/A ,$8.12 ,$9.80 , N/A ,$11.28 , N/A ,$13.08 ,$13.08 , N/A ,$18.85 , N/A ,$14.50 , N/A , N/A , N/A , N/A ,$21.75 ,$17.40 ,$17.40 , N/A ,$17.40 ,$22.04 ,$22.04 ,$22.04 ,$29.00 , N/A ,$24.65 , N/A ,$18.85 , N/A ,$29.00 ,$16.24 , N/A ,$7.63 , N/A , N/A , N/A , N/A ,$23.20 , N/A ,$13.08 ,$8.12 ,$26.10 , N/A ,$22.04 ,$18.85 ,$18.85 , N/A ,$18.85 ,$13.92 , N/A 
ST. ELIZABETH'S HOSPITAL,27205369,C1894,HC SHEATH INTRODUCER 6FR,272,1 ,$60.00 ,$39.00 ,$15.78 ,$60.00 , N/A ,$27.60 ,$33.60 , N/A ,$16.80 ,$20.28 , N/A ,$23.34 , N/A ,$27.06 ,$27.06 , N/A ,$39.00 , N/A ,$30.00 , N/A , N/A , N/A , N/A ,$45.00 ,$36.00 ,$36.00 , N/A ,$36.00 ,$45.60 ,$45.60 ,$45.60 ,$60.00 , N/A ,$51.00 , N/A ,$39.00 , N/A ,$60.00 ,$33.60 , N/A ,$15.78 , N/A , N/A , N/A , N/A ,$48.00 , N/A ,$27.06 ,$16.80 ,$54.00 , N/A ,$45.60 ,$39.00 ,$39.00 , N/A ,$39.00 ,$28.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27205370,C1887,HC CATHETER GUIDING TAPER TIP,272,1 ,$144.00 ,$93.60 ,$37.87 ,$144.00 , N/A ,$66.24 ,$80.64 , N/A ,$40.32 ,$48.67 , N/A ,$56.02 , N/A ,$64.94 ,$64.94 , N/A ,$93.60 , N/A ,$72.00 , N/A , N/A , N/A , N/A ,$108.00 ,$86.40 ,$86.40 , N/A ,$86.40 ,$109.44 ,$109.44 ,$109.44 ,$144.00 , N/A ,$122.40 , N/A ,$93.60 , N/A ,$144.00 ,$80.64 , N/A ,$37.87 , N/A , N/A , N/A , N/A ,$115.20 , N/A ,$64.94 ,$40.32 ,$129.60 , N/A ,$109.44 ,$93.60 ,$93.60 , N/A ,$93.60 ,$69.12 , N/A 
ST. ELIZABETH'S HOSPITAL,27205371,C1894,HC SHEATH INTRODUCER 8FR,272,1 ,$65.00 ,$42.25 ,$17.10 ,$65.00 , N/A ,$29.90 ,$36.40 , N/A ,$18.20 ,$21.97 , N/A ,$25.29 , N/A ,$29.32 ,$29.32 , N/A ,$42.25 , N/A ,$32.50 , N/A , N/A , N/A , N/A ,$48.75 ,$39.00 ,$39.00 , N/A ,$39.00 ,$49.40 ,$49.40 ,$49.40 ,$65.00 , N/A ,$55.25 , N/A ,$42.25 , N/A ,$65.00 ,$36.40 , N/A ,$17.10 , N/A , N/A , N/A , N/A ,$52.00 , N/A ,$29.32 ,$18.20 ,$58.50 , N/A ,$49.40 ,$42.25 ,$42.25 , N/A ,$42.25 ,$31.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205372,C1887,HC CATHETER DIAGNOSTIC,272,1 ,$31.00 ,$20.15 ,$8.15 ,$31.00 , N/A ,$14.26 ,$17.36 , N/A ,$8.68 ,$10.48 , N/A ,$12.06 , N/A ,$13.98 ,$13.98 , N/A ,$20.15 , N/A ,$15.50 , N/A , N/A , N/A , N/A ,$23.25 ,$18.60 ,$18.60 , N/A ,$18.60 ,$23.56 ,$23.56 ,$23.56 ,$31.00 , N/A ,$26.35 , N/A ,$20.15 , N/A ,$31.00 ,$17.36 , N/A ,$8.15 , N/A , N/A , N/A , N/A ,$24.80 , N/A ,$13.98 ,$8.68 ,$27.90 , N/A ,$23.56 ,$20.15 ,$20.15 , N/A ,$20.15 ,$14.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27205373,C1887,HC CATHETER WEDGE PRESSURE,272,1 ,$189.00 ,$122.85 ,$49.71 ,$189.00 , N/A ,$86.94 ,$105.84 , N/A ,$52.92 ,$63.88 , N/A ,$73.52 , N/A ,$85.24 ,$85.24 , N/A ,$122.85 , N/A ,$94.50 , N/A , N/A , N/A , N/A ,$141.75 ,$113.40 ,$113.40 , N/A ,$113.40 ,$143.64 ,$143.64 ,$143.64 ,$189.00 , N/A ,$160.65 , N/A ,$122.85 , N/A ,$189.00 ,$105.84 , N/A ,$49.71 , N/A , N/A , N/A , N/A ,$151.20 , N/A ,$85.24 ,$52.92 ,$170.10 , N/A ,$143.64 ,$122.85 ,$122.85 , N/A ,$122.85 ,$90.72 , N/A 
ST. ELIZABETH'S HOSPITAL,27205382,C1769,HC GUIDEWIRE STRAIGHT SHAPEABLE V-18,272,1 ,$240.00 ,$156.00 ,$63.12 ,$240.00 , N/A ,$110.40 ,$134.40 , N/A ,$67.20 ,$81.12 , N/A ,$93.36 , N/A ,$108.24 ,$108.24 , N/A ,$156.00 , N/A ,$120.00 , N/A , N/A , N/A , N/A ,$180.00 ,$144.00 ,$144.00 , N/A ,$144.00 ,$182.40 ,$182.40 ,$182.40 ,$240.00 , N/A ,$204.00 , N/A ,$156.00 , N/A ,$240.00 ,$134.40 , N/A ,$63.12 , N/A , N/A , N/A , N/A ,$192.00 , N/A ,$108.24 ,$67.20 ,$216.00 , N/A ,$182.40 ,$156.00 ,$156.00 , N/A ,$156.00 ,$115.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205383,N/A,HC NEEDLE TROCAR BIOPSY,272,1 ,$46.00 ,$29.90 ,$12.10 ,$46.00 , N/A ,$21.16 ,$25.76 , N/A ,$12.88 ,$15.55 , N/A ,$17.89 , N/A ,$20.75 ,$20.75 , N/A ,$29.90 , N/A ,$23.00 , N/A , N/A , N/A , N/A ,$34.50 ,$27.60 ,$27.60 , N/A ,$27.60 ,$34.96 ,$34.96 ,$34.96 ,$46.00 , N/A ,$39.10 , N/A ,$29.90 , N/A ,$46.00 ,$25.76 , N/A ,$12.10 , N/A , N/A , N/A , N/A ,$36.80 , N/A ,$20.75 ,$12.88 ,$41.40 , N/A ,$34.96 ,$29.90 ,$29.90 , N/A ,$29.90 ,$22.08 , N/A 
ST. ELIZABETH'S HOSPITAL,27205406,N/A,HC KIT BALLOON SYSTEM AVAFLEX,272,1 ,"$7,132.00 ","$4,635.80 ","$1,875.72 ","$7,132.00 ", N/A ,"$3,280.72 ","$3,993.92 ", N/A ,"$1,996.96 ","$2,410.62 ", N/A ,"$2,774.35 ", N/A ,"$3,216.53 ","$3,216.53 ", N/A ,"$4,635.80 ", N/A ,"$3,566.00 ", N/A , N/A , N/A , N/A ,"$5,349.00 ","$4,279.20 ","$4,279.20 ", N/A ,"$4,279.20 ","$5,420.32 ","$5,420.32 ","$5,420.32 ","$7,132.00 ", N/A ,"$6,062.20 ", N/A ,"$4,635.80 ", N/A ,"$7,132.00 ","$3,993.92 ", N/A ,"$1,875.72 ", N/A , N/A , N/A , N/A ,"$5,705.60 ", N/A ,"$3,216.53 ","$1,996.96 ","$6,418.80 ", N/A ,"$5,420.32 ","$4,635.80 ","$4,635.80 ", N/A ,"$4,635.80 ","$3,423.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205420,C1769,HC GUIDEWIRE AMPLATZ SUPER STIFF 145 CM,272,1 ,$167.00 ,$108.55 ,$43.92 ,$167.00 , N/A ,$76.82 ,$93.52 , N/A ,$46.76 ,$56.45 , N/A ,$64.96 , N/A ,$75.32 ,$75.32 , N/A ,$108.55 , N/A ,$83.50 , N/A , N/A , N/A , N/A ,$125.25 ,$100.20 ,$100.20 , N/A ,$100.20 ,$126.92 ,$126.92 ,$126.92 ,$167.00 , N/A ,$141.95 , N/A ,$108.55 , N/A ,$167.00 ,$93.52 , N/A ,$43.92 , N/A , N/A , N/A , N/A ,$133.60 , N/A ,$75.32 ,$46.76 ,$150.30 , N/A ,$126.92 ,$108.55 ,$108.55 , N/A ,$108.55 ,$80.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27205426,C1725,HC CATHETER BALOON PERIPHERAL FLASH OSTIAL,272,1 ,"$3,150.00 ","$2,047.50 ",$828.45 ,"$3,150.00 ", N/A ,"$1,449.00 ","$1,764.00 ", N/A ,$882.00 ,"$1,064.70 ", N/A ,"$1,225.35 ", N/A ,"$1,420.65 ","$1,420.65 ", N/A ,"$2,047.50 ", N/A ,"$1,575.00 ", N/A , N/A , N/A , N/A ,"$2,362.50 ","$1,890.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$2,394.00 ","$2,394.00 ","$2,394.00 ","$3,150.00 ", N/A ,"$2,677.50 ", N/A ,"$2,047.50 ", N/A ,"$3,150.00 ","$1,764.00 ", N/A ,$828.45 , N/A , N/A , N/A , N/A ,"$2,520.00 ", N/A ,"$1,420.65 ",$882.00 ,"$2,835.00 ", N/A ,"$2,394.00 ","$2,047.50 ","$2,047.50 ", N/A ,"$2,047.50 ","$1,512.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205427,N/A,HC TRAY GENERAL PROCEDURE,272,1 ,$108.00 ,$70.20 ,$28.40 ,$108.00 , N/A ,$49.68 ,$60.48 , N/A ,$30.24 ,$36.50 , N/A ,$42.01 , N/A ,$48.71 ,$48.71 , N/A ,$70.20 , N/A ,$54.00 , N/A , N/A , N/A , N/A ,$81.00 ,$64.80 ,$64.80 , N/A ,$64.80 ,$82.08 ,$82.08 ,$82.08 ,$108.00 , N/A ,$91.80 , N/A ,$70.20 , N/A ,$108.00 ,$60.48 , N/A ,$28.40 , N/A , N/A , N/A , N/A ,$86.40 , N/A ,$48.71 ,$30.24 ,$97.20 , N/A ,$82.08 ,$70.20 ,$70.20 , N/A ,$70.20 ,$51.84 , N/A 
ST. ELIZABETH'S HOSPITAL,27205440,N/A,HC PUSHER CEMENT,272,1 ,$181.00 ,$117.65 ,$47.60 ,$181.00 , N/A ,$83.26 ,$101.36 , N/A ,$50.68 ,$61.18 , N/A ,$70.41 , N/A ,$81.63 ,$81.63 , N/A ,$117.65 , N/A ,$90.50 , N/A , N/A , N/A , N/A ,$135.75 ,$108.60 ,$108.60 , N/A ,$108.60 ,$137.56 ,$137.56 ,$137.56 ,$181.00 , N/A ,$153.85 , N/A ,$117.65 , N/A ,$181.00 ,$101.36 , N/A ,$47.60 , N/A , N/A , N/A , N/A ,$144.80 , N/A ,$81.63 ,$50.68 ,$162.90 , N/A ,$137.56 ,$117.65 ,$117.65 , N/A ,$117.65 ,$86.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27205442,N/A,HC EXTRACTOR CATHETER OUTAKE STAND ALONE HEMODIALYSIS,272,1 ,$42.00 ,$27.30 ,$11.05 ,$42.00 , N/A ,$19.32 ,$23.52 , N/A ,$11.76 ,$14.20 , N/A ,$16.34 , N/A ,$18.94 ,$18.94 , N/A ,$27.30 , N/A ,$21.00 , N/A , N/A , N/A , N/A ,$31.50 ,$25.20 ,$25.20 , N/A ,$25.20 ,$31.92 ,$31.92 ,$31.92 ,$42.00 , N/A ,$35.70 , N/A ,$27.30 , N/A ,$42.00 ,$23.52 , N/A ,$11.05 , N/A , N/A , N/A , N/A ,$33.60 , N/A ,$18.94 ,$11.76 ,$37.80 , N/A ,$31.92 ,$27.30 ,$27.30 , N/A ,$27.30 ,$20.16 , N/A 
ST. ELIZABETH'S HOSPITAL,27205446,N/A,HC DRAINAGE BAG CONNECTOR,272,1 ,$22.00 ,$14.30 ,$5.79 ,$22.00 , N/A ,$10.12 ,$12.32 , N/A ,$6.16 ,$7.44 , N/A ,$8.56 , N/A ,$9.92 ,$9.92 , N/A ,$14.30 , N/A ,$11.00 , N/A , N/A , N/A , N/A ,$16.50 ,$13.20 ,$13.20 , N/A ,$13.20 ,$16.72 ,$16.72 ,$16.72 ,$22.00 , N/A ,$18.70 , N/A ,$14.30 , N/A ,$22.00 ,$12.32 , N/A ,$5.79 , N/A , N/A , N/A , N/A ,$17.60 , N/A ,$9.92 ,$6.16 ,$19.80 , N/A ,$16.72 ,$14.30 ,$14.30 , N/A ,$14.30 ,$10.56 , N/A 
ST. ELIZABETH'S HOSPITAL,27205448,N/A,HC PLASMA TUBE,272,1 ,$15.24 ,$9.91 ,$4.01 ,$15.24 , N/A ,$7.01 ,$8.53 , N/A ,$4.27 ,$5.15 , N/A ,$5.93 , N/A ,$6.87 ,$6.87 , N/A ,$9.91 , N/A ,$7.62 , N/A , N/A , N/A , N/A ,$11.43 ,$9.14 ,$9.14 , N/A ,$9.14 ,$11.58 ,$11.58 ,$11.58 ,$15.24 , N/A ,$12.95 , N/A ,$9.91 , N/A ,$15.24 ,$8.53 , N/A ,$4.01 , N/A , N/A , N/A , N/A ,$12.19 , N/A ,$6.87 ,$4.27 ,$13.72 , N/A ,$11.58 ,$9.91 ,$9.91 , N/A ,$9.91 ,$7.32 , N/A 
ST. ELIZABETH'S HOSPITAL,27205455,C1769,HC BABY J GUIDEWIRE,272,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$55.20 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 ,$78.00 ,$78.00 , N/A ,$78.00 ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27205456,C1769,HC CONFIDA TAVR WIRE,272,1 ,$550.00 ,$357.50 ,$144.65 ,$550.00 , N/A ,$253.00 ,$308.00 , N/A ,$154.00 ,$185.90 , N/A ,$213.95 , N/A ,$248.05 ,$248.05 , N/A ,$357.50 , N/A ,$275.00 , N/A , N/A , N/A , N/A ,$412.50 ,$330.00 ,$330.00 , N/A ,$330.00 ,$418.00 ,$418.00 ,$418.00 ,$550.00 , N/A ,$467.50 , N/A ,$357.50 , N/A ,$550.00 ,$308.00 , N/A ,$144.65 , N/A , N/A , N/A , N/A ,$440.00 , N/A ,$248.05 ,$154.00 ,$495.00 , N/A ,$418.00 ,$357.50 ,$357.50 , N/A ,$357.50 ,$264.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27205459,N/A,HC BALLOON BUTTON,272,1 ,"$1,312.50 ",$853.13 ,$345.19 ,"$1,312.50 ", N/A ,$603.75 ,$735.00 , N/A ,$367.50 ,$443.63 , N/A ,$510.56 , N/A ,$591.94 ,$591.94 , N/A ,$853.13 , N/A ,$656.25 , N/A , N/A , N/A , N/A ,$984.38 ,$787.50 ,$787.50 , N/A ,$787.50 ,$997.50 ,$997.50 ,$997.50 ,"$1,312.50 ", N/A ,"$1,115.63 ", N/A ,$853.13 , N/A ,"$1,312.50 ",$735.00 , N/A ,$345.19 , N/A , N/A , N/A , N/A ,"$1,050.00 ", N/A ,$591.94 ,$367.50 ,"$1,181.25 ", N/A ,$997.50 ,$853.13 ,$853.13 , N/A ,$853.13 ,$630.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27205460,C1887,HC ANGIOGRAPHIC CATHETER,272,1 ,$690.00 ,$448.50 ,$181.47 ,$690.00 , N/A ,$317.40 ,$386.40 , N/A ,$193.20 ,$233.22 , N/A ,$268.41 , N/A ,$311.19 ,$311.19 , N/A ,$448.50 , N/A ,$345.00 , N/A , N/A , N/A , N/A ,$517.50 ,$414.00 ,$414.00 , N/A ,$414.00 ,$524.40 ,$524.40 ,$524.40 ,$690.00 , N/A ,$586.50 , N/A ,$448.50 , N/A ,$690.00 ,$386.40 , N/A ,$181.47 , N/A , N/A , N/A , N/A ,$552.00 , N/A ,$311.19 ,$193.20 ,$621.00 , N/A ,$524.40 ,$448.50 ,$448.50 , N/A ,$448.50 ,$331.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205462,C1757,HC ANGIOJET THROMBECTOMY KIT,272,1 ,$107.40 ,$69.81 ,$28.25 ,$107.40 , N/A ,$49.40 ,$60.14 , N/A ,$30.07 ,$36.30 , N/A ,$41.78 , N/A ,$48.44 ,$48.44 , N/A ,$69.81 , N/A ,$53.70 , N/A , N/A , N/A , N/A ,$80.55 ,$64.44 ,$64.44 , N/A ,$64.44 ,$81.62 ,$81.62 ,$81.62 ,$107.40 , N/A ,$91.29 , N/A ,$69.81 , N/A ,$107.40 ,$60.14 , N/A ,$28.25 , N/A , N/A , N/A , N/A ,$85.92 , N/A ,$48.44 ,$30.07 ,$96.66 , N/A ,$81.62 ,$69.81 ,$69.81 , N/A ,$69.81 ,$51.55 , N/A 
ST. ELIZABETH'S HOSPITAL,27205463,C1887,HC RENEGADE HI-FLO MICROCATHETER,272,1 ,"$1,586.58 ","$1,031.28 ",$417.27 ,"$1,586.58 ", N/A ,$729.83 ,$888.48 , N/A ,$444.24 ,$536.26 , N/A ,$617.18 , N/A ,$715.55 ,$715.55 , N/A ,"$1,031.28 ", N/A ,$793.29 , N/A , N/A , N/A , N/A ,"$1,189.94 ",$951.95 ,$951.95 , N/A ,$951.95 ,"$1,205.80 ","$1,205.80 ","$1,205.80 ","$1,586.58 ", N/A ,"$1,348.59 ", N/A ,"$1,031.28 ", N/A ,"$1,586.58 ",$888.48 , N/A ,$417.27 , N/A , N/A , N/A , N/A ,"$1,269.26 ", N/A ,$715.55 ,$444.24 ,"$1,427.92 ", N/A ,"$1,205.80 ","$1,031.28 ","$1,031.28 ", N/A ,"$1,031.28 ",$761.56 , N/A 
ST. ELIZABETH'S HOSPITAL,27205469,C1887,HC EMBOLIZATION GELATIN SYRINGE,272,1 ,$150.00 ,$97.50 ,$39.45 ,$150.00 , N/A ,$69.00 ,$84.00 , N/A ,$42.00 ,$50.70 , N/A ,$58.35 , N/A ,$67.65 ,$67.65 , N/A ,$97.50 , N/A ,$75.00 , N/A , N/A , N/A , N/A ,$112.50 ,$90.00 ,$90.00 , N/A ,$90.00 ,$114.00 ,$114.00 ,$114.00 ,$150.00 , N/A ,$127.50 , N/A ,$97.50 , N/A ,$150.00 ,$84.00 , N/A ,$39.45 , N/A , N/A , N/A , N/A ,$120.00 , N/A ,$67.65 ,$42.00 ,$135.00 , N/A ,$114.00 ,$97.50 ,$97.50 , N/A ,$97.50 ,$72.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27205470,N/A,HC SOFT TISSUE BIOPSY NEEDLE,272,1 ,$165.00 ,$107.25 ,$43.40 ,$165.00 , N/A ,$75.90 ,$92.40 , N/A ,$46.20 ,$55.77 , N/A ,$64.19 , N/A ,$74.42 ,$74.42 , N/A ,$107.25 , N/A ,$82.50 , N/A , N/A , N/A , N/A ,$123.75 ,$99.00 ,$99.00 , N/A ,$99.00 ,$125.40 ,$125.40 ,$125.40 ,$165.00 , N/A ,$140.25 , N/A ,$107.25 , N/A ,$165.00 ,$92.40 , N/A ,$43.40 , N/A , N/A , N/A , N/A ,$132.00 , N/A ,$74.42 ,$46.20 ,$148.50 , N/A ,$125.40 ,$107.25 ,$107.25 , N/A ,$107.25 ,$79.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205471,C1769,HC VASCULAR GUIDEWIRE NIT-VU,272,1 ,$121.26 ,$78.82 ,$31.89 ,$121.26 , N/A ,$55.78 ,$67.91 , N/A ,$33.95 ,$40.99 , N/A ,$47.17 , N/A ,$54.69 ,$54.69 , N/A ,$78.82 , N/A ,$60.63 , N/A , N/A , N/A , N/A ,$90.95 ,$72.76 ,$72.76 , N/A ,$72.76 ,$92.16 ,$92.16 ,$92.16 ,$121.26 , N/A ,$103.07 , N/A ,$78.82 , N/A ,$121.26 ,$67.91 , N/A ,$31.89 , N/A , N/A , N/A , N/A ,$97.01 , N/A ,$54.69 ,$33.95 ,$109.13 , N/A ,$92.16 ,$78.82 ,$78.82 , N/A ,$78.82 ,$58.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205484,N/A,HC WATCHMAN DELIVERY SYSTEM,272,1 ,"$5,700.00 ","$3,705.00 ","$1,499.10 ","$5,700.00 ", N/A ,"$2,622.00 ","$3,192.00 ", N/A ,"$1,596.00 ","$1,926.60 ", N/A ,"$2,217.30 ", N/A ,"$2,570.70 ","$2,570.70 ", N/A ,"$3,705.00 ", N/A ,"$2,850.00 ", N/A , N/A , N/A , N/A ,"$4,275.00 ","$3,420.00 ","$3,420.00 ", N/A ,"$3,420.00 ","$4,332.00 ","$4,332.00 ","$4,332.00 ","$5,700.00 ", N/A ,"$4,845.00 ", N/A ,"$3,705.00 ", N/A ,"$5,700.00 ","$3,192.00 ", N/A ,"$1,499.10 ", N/A , N/A , N/A , N/A ,"$4,560.00 ", N/A ,"$2,570.70 ","$1,596.00 ","$5,130.00 ", N/A ,"$4,332.00 ","$3,705.00 ","$3,705.00 ", N/A ,"$3,705.00 ","$2,736.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205485,N/A,HC WATCHMAN SYSTEM ACCESS,272,1 ,"$4,500.00 ","$2,925.00 ","$1,183.50 ","$4,500.00 ", N/A ,"$2,070.00 ","$2,520.00 ", N/A ,"$1,260.00 ","$1,521.00 ", N/A ,"$1,750.50 ", N/A ,"$2,029.50 ","$2,029.50 ", N/A ,"$2,925.00 ", N/A ,"$2,250.00 ", N/A , N/A , N/A , N/A ,"$3,375.00 ","$2,700.00 ","$2,700.00 ", N/A ,"$2,700.00 ","$3,420.00 ","$3,420.00 ","$3,420.00 ","$4,500.00 ", N/A ,"$3,825.00 ", N/A ,"$2,925.00 ", N/A ,"$4,500.00 ","$2,520.00 ", N/A ,"$1,183.50 ", N/A , N/A , N/A , N/A ,"$3,600.00 ", N/A ,"$2,029.50 ","$1,260.00 ","$4,050.00 ", N/A ,"$3,420.00 ","$2,925.00 ","$2,925.00 ", N/A ,"$2,925.00 ","$2,160.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205486,N/A,HC POINTCOIL LIVER FIDUCIAL MARKERS KIT,272,1 ,"$1,173.00 ",$762.45 ,$308.50 ,"$1,173.00 ", N/A ,$539.58 ,$656.88 , N/A ,$328.44 ,$396.47 , N/A ,$456.30 , N/A ,$529.02 ,$529.02 , N/A ,$762.45 , N/A ,$586.50 , N/A , N/A , N/A , N/A ,$879.75 ,$703.80 ,$703.80 , N/A ,$703.80 ,$891.48 ,$891.48 ,$891.48 ,"$1,173.00 ", N/A ,$997.05 , N/A ,$762.45 , N/A ,"$1,173.00 ",$656.88 , N/A ,$308.50 , N/A , N/A , N/A , N/A ,$938.40 , N/A ,$529.02 ,$328.44 ,"$1,055.70 ", N/A ,$891.48 ,$762.45 ,$762.45 , N/A ,$762.45 ,$563.04 , N/A 
ST. ELIZABETH'S HOSPITAL,27205487,N/A,HC BOTTLE DRAINAGE SAFETY VAC,272,1 ,$91.71 ,$59.61 ,$24.12 ,$91.71 , N/A ,$42.19 ,$51.36 , N/A ,$25.68 ,$31.00 , N/A ,$35.68 , N/A ,$41.36 ,$41.36 , N/A ,$59.61 , N/A ,$45.86 , N/A , N/A , N/A , N/A ,$68.78 ,$55.03 ,$55.03 , N/A ,$55.03 ,$69.70 ,$69.70 ,$69.70 ,$91.71 , N/A ,$77.95 , N/A ,$59.61 , N/A ,$91.71 ,$51.36 , N/A ,$24.12 , N/A , N/A , N/A , N/A ,$73.37 , N/A ,$41.36 ,$25.68 ,$82.54 , N/A ,$69.70 ,$59.61 ,$59.61 , N/A ,$59.61 ,$44.02 , N/A 
ST. ELIZABETH'S HOSPITAL,27205488,N/A,HC GRAM BLOOD CULTURE TEST KIT,272,1 ,$240.00 ,$156.00 ,$63.12 ,$240.00 , N/A ,$110.40 ,$134.40 , N/A ,$67.20 ,$81.12 , N/A ,$93.36 , N/A ,$108.24 ,$108.24 , N/A ,$156.00 , N/A ,$120.00 , N/A , N/A , N/A , N/A ,$180.00 ,$144.00 ,$144.00 , N/A ,$144.00 ,$182.40 ,$182.40 ,$182.40 ,$240.00 , N/A ,$204.00 , N/A ,$156.00 , N/A ,$240.00 ,$134.40 , N/A ,$63.12 , N/A , N/A , N/A , N/A ,$192.00 , N/A ,$108.24 ,$67.20 ,$216.00 , N/A ,$182.40 ,$156.00 ,$156.00 , N/A ,$156.00 ,$115.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205489,N/A,HC GRAM BLOOD CULTURE NUCLEIC ACID TEST KIT,272,1 ,"$3,420.00 ","$2,223.00 ",$899.46 ,"$3,420.00 ", N/A ,"$1,573.20 ","$1,915.20 ", N/A ,$957.60 ,"$1,155.96 ", N/A ,"$1,330.38 ", N/A ,"$1,542.42 ","$1,542.42 ", N/A ,"$2,223.00 ", N/A ,"$1,710.00 ", N/A , N/A , N/A , N/A ,"$2,565.00 ","$2,052.00 ","$2,052.00 ", N/A ,"$2,052.00 ","$2,599.20 ","$2,599.20 ","$2,599.20 ","$3,420.00 ", N/A ,"$2,907.00 ", N/A ,"$2,223.00 ", N/A ,"$3,420.00 ","$1,915.20 ", N/A ,$899.46 , N/A , N/A , N/A , N/A ,"$2,736.00 ", N/A ,"$1,542.42 ",$957.60 ,"$3,078.00 ", N/A ,"$2,599.20 ","$2,223.00 ","$2,223.00 ", N/A ,"$2,223.00 ","$1,641.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205496,N/A,HC FILMARRAY GI PANEL KIT,272,1 ,"$12,903.75 ","$8,387.44 ","$3,393.69 ","$12,903.75 ", N/A ,"$5,935.73 ","$7,226.10 ", N/A ,"$3,613.05 ","$4,361.47 ", N/A ,"$5,019.56 ", N/A ,"$5,819.59 ","$5,819.59 ", N/A ,"$8,387.44 ", N/A ,"$6,451.88 ", N/A , N/A , N/A , N/A ,"$9,677.81 ","$7,742.25 ","$7,742.25 ", N/A ,"$7,742.25 ","$9,806.85 ","$9,806.85 ","$9,806.85 ","$12,903.75 ", N/A ,"$10,968.19 ", N/A ,"$8,387.44 ", N/A ,"$12,903.75 ","$7,226.10 ", N/A ,"$3,393.69 ", N/A , N/A , N/A , N/A ,"$10,323.00 ", N/A ,"$5,819.59 ","$3,613.05 ","$11,613.38 ", N/A ,"$9,806.85 ","$8,387.44 ","$8,387.44 ", N/A ,"$8,387.44 ","$6,193.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,27205497,N/A,HC CANNULA PERFUSION,272,1 ,$90.00 ,$58.50 ,$23.67 ,$90.00 , N/A ,$41.40 ,$50.40 , N/A ,$25.20 ,$30.42 , N/A ,$35.01 , N/A ,$40.59 ,$40.59 , N/A ,$58.50 , N/A ,$45.00 , N/A , N/A , N/A , N/A ,$67.50 ,$54.00 ,$54.00 , N/A ,$54.00 ,$68.40 ,$68.40 ,$68.40 ,$90.00 , N/A ,$76.50 , N/A ,$58.50 , N/A ,$90.00 ,$50.40 , N/A ,$23.67 , N/A , N/A , N/A , N/A ,$72.00 , N/A ,$40.59 ,$25.20 ,$81.00 , N/A ,$68.40 ,$58.50 ,$58.50 , N/A ,$58.50 ,$43.20 , N/A 
ST. ELIZABETH'S HOSPITAL,27205499,N/A,HC BLOOD GROUPING REAGENT ANTI-FYB,272,1 ,"$1,034.91 ",$672.69 ,$272.18 ,"$1,034.91 ", N/A ,$476.06 ,$579.55 , N/A ,$289.77 ,$349.80 , N/A ,$402.58 , N/A ,$466.74 ,$466.74 , N/A ,$672.69 , N/A ,$517.46 , N/A , N/A , N/A , N/A ,$776.18 ,$620.95 ,$620.95 , N/A ,$620.95 ,$786.53 ,$786.53 ,$786.53 ,"$1,034.91 ", N/A ,$879.67 , N/A ,$672.69 , N/A ,"$1,034.91 ",$579.55 , N/A ,$272.18 , N/A , N/A , N/A , N/A ,$827.93 , N/A ,$466.74 ,$289.77 ,$931.42 , N/A ,$786.53 ,$672.69 ,$672.69 , N/A ,$672.69 ,$496.76 , N/A 
ST. ELIZABETH'S HOSPITAL,27205501,N/A,HC SET DRAIN,272,1 ,$631.80 ,$410.67 ,$166.16 ,$631.80 , N/A ,$290.63 ,$353.81 , N/A ,$176.90 ,$213.55 , N/A ,$245.77 , N/A ,$284.94 ,$284.94 , N/A ,$410.67 , N/A ,$315.90 , N/A , N/A , N/A , N/A ,$473.85 ,$379.08 ,$379.08 , N/A ,$379.08 ,$480.17 ,$480.17 ,$480.17 ,$631.80 , N/A ,$537.03 , N/A ,$410.67 , N/A ,$631.80 ,$353.81 , N/A ,$166.16 , N/A , N/A , N/A , N/A ,$505.44 , N/A ,$284.94 ,$176.90 ,$568.62 , N/A ,$480.17 ,$410.67 ,$410.67 , N/A ,$410.67 ,$303.26 , N/A 
ST. ELIZABETH'S HOSPITAL,27271715,C1715,HC NEEDLE BRACHYTHERAPY,272,1 ,$176.00 ,$114.40 ,$46.29 ,$176.00 , N/A ,$80.96 ,$98.56 , N/A ,$49.28 ,$59.49 , N/A ,$68.46 , N/A ,$79.38 ,$79.38 , N/A ,$114.40 , N/A ,$88.00 , N/A , N/A , N/A , N/A ,$132.00 ,$105.60 ,$105.60 , N/A ,$105.60 ,$133.76 ,$133.76 ,$133.76 ,$176.00 , N/A ,$149.60 , N/A ,$114.40 , N/A ,$176.00 ,$98.56 , N/A ,$46.29 , N/A , N/A , N/A , N/A ,$140.80 , N/A ,$79.38 ,$49.28 ,$158.40 , N/A ,$133.76 ,$114.40 ,$114.40 , N/A ,$114.40 ,$84.48 , N/A 
ST. ELIZABETH'S HOSPITAL,27271729,C1729,HC CATHETER DRAINAGE,272,1 ,$43.83 ,$28.49 ,$11.53 ,$43.83 , N/A ,$20.16 ,$24.54 , N/A ,$12.27 ,$14.81 , N/A ,$17.05 , N/A ,$19.77 ,$19.77 , N/A ,$28.49 , N/A ,$21.92 , N/A , N/A , N/A , N/A ,$32.87 ,$26.30 ,$26.30 , N/A ,$26.30 ,$33.31 ,$33.31 ,$33.31 ,$43.83 , N/A ,$37.26 , N/A ,$28.49 , N/A ,$43.83 ,$24.54 , N/A ,$11.53 , N/A , N/A , N/A , N/A ,$35.06 , N/A ,$19.77 ,$12.27 ,$39.45 , N/A ,$33.31 ,$28.49 ,$28.49 , N/A ,$28.49 ,$21.04 , N/A 
ST. ELIZABETH'S HOSPITAL,27271751,C1751,HC CATHETER INFUSION PERIPH CENTRAL OR MIDLINE (OTHER THAN HEMO),272,1 ,$543.52 ,$353.29 ,$142.95 ,$543.52 , N/A ,$250.02 ,$304.37 , N/A ,$152.19 ,$183.71 , N/A ,$211.43 , N/A ,$245.13 ,$245.13 , N/A ,$353.29 , N/A ,$271.76 , N/A , N/A , N/A , N/A ,$407.64 ,$326.11 ,$326.11 , N/A ,$326.11 ,$413.08 ,$413.08 ,$413.08 ,$543.52 , N/A ,$461.99 , N/A ,$353.29 , N/A ,$543.52 ,$304.37 , N/A ,$142.95 , N/A , N/A , N/A , N/A ,$434.82 , N/A ,$245.13 ,$152.19 ,$489.17 , N/A ,$413.08 ,$353.29 ,$353.29 , N/A ,$353.29 ,$260.89 , N/A 
ST. ELIZABETH'S HOSPITAL,27271757,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY,272,1 ,$151.83 ,$98.69 ,$39.93 ,$151.83 , N/A ,$69.84 ,$85.02 , N/A ,$42.51 ,$51.32 , N/A ,$59.06 , N/A ,$68.48 ,$68.48 , N/A ,$98.69 , N/A ,$75.92 , N/A , N/A , N/A , N/A ,$113.87 ,$91.10 ,$91.10 , N/A ,$91.10 ,$115.39 ,$115.39 ,$115.39 ,$151.83 , N/A ,$129.06 , N/A ,$98.69 , N/A ,$151.83 ,$85.02 , N/A ,$39.93 , N/A , N/A , N/A , N/A ,$121.46 , N/A ,$68.48 ,$42.51 ,$136.65 , N/A ,$115.39 ,$98.69 ,$98.69 , N/A ,$98.69 ,$72.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27272900,S2900,HC SURGERY ROBOTIC TECHNICAL SYSTEM,272,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,27280053,N/A,HC KIT CV CATH 7FR MULTILUM PRESSURE,272,1 ,$312.50 ,$203.13 ,$82.19 ,$312.50 , N/A ,$143.75 ,$175.00 , N/A ,$87.50 ,$105.63 , N/A ,$121.56 , N/A ,$140.94 ,$140.94 , N/A ,$203.13 , N/A ,$156.25 , N/A , N/A , N/A , N/A ,$234.38 ,$187.50 ,$187.50 , N/A ,$187.50 ,$237.50 ,$237.50 ,$237.50 ,$312.50 , N/A ,$265.63 , N/A ,$203.13 , N/A ,$312.50 ,$175.00 , N/A ,$82.19 , N/A , N/A , N/A , N/A ,$250.00 , N/A ,$140.94 ,$87.50 ,$281.25 , N/A ,$237.50 ,$203.13 ,$203.13 , N/A ,$203.13 ,$150.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27280140,N/A,HC CATH FOLEY 6 FR W/STYLET,270,1 ,$62.50 ,$40.63 ,$16.44 ,$62.50 , N/A ,$28.75 ,$35.00 , N/A ,$17.50 ,$21.13 , N/A ,$24.31 , N/A ,$28.19 ,$28.19 , N/A ,$40.63 , N/A ,$31.25 , N/A , N/A , N/A , N/A ,$46.88 ,$37.50 ,$37.50 , N/A ,$37.50 ,$47.50 ,$47.50 ,$47.50 ,$62.50 , N/A ,$53.13 , N/A ,$40.63 , N/A ,$62.50 ,$35.00 , N/A ,$16.44 , N/A , N/A , N/A , N/A ,$50.00 , N/A ,$28.19 ,$17.50 ,$56.25 , N/A ,$47.50 ,$40.63 ,$40.63 , N/A ,$40.63 ,$30.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27282050,C1760,HC MANTA VASCULAR CLOSURE DEVICE,272,1 ,"$2,200.00 ","$1,430.00 ",$578.60 ,"$2,200.00 ", N/A ,"$1,012.00 ","$1,232.00 ", N/A ,$616.00 ,$743.60 , N/A ,$855.80 , N/A ,$992.20 ,$992.20 , N/A ,"$1,430.00 ", N/A ,"$1,100.00 ", N/A , N/A , N/A , N/A ,"$1,650.00 ","$1,320.00 ","$1,320.00 ", N/A ,"$1,320.00 ","$1,672.00 ","$1,672.00 ","$1,672.00 ","$2,200.00 ", N/A ,"$1,870.00 ", N/A ,"$1,430.00 ", N/A ,"$2,200.00 ","$1,232.00 ", N/A ,$578.60 , N/A , N/A , N/A , N/A ,"$1,760.00 ", N/A ,$992.20 ,$616.00 ,"$1,980.00 ", N/A ,"$1,672.00 ","$1,430.00 ","$1,430.00 ", N/A ,"$1,430.00 ","$1,056.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27400012,L0450,HC HEART HUGGER SUPPORT HARNESS,274,1 ,$279.00 ,$181.35 ,$73.38 ,$399.88 ,$399.88 , N/A ,$156.24 ,$159.95 ,$78.12 ,$94.30 ,$159.95 ,$114.95 ,$159.95 ,$125.83 ,$125.83 ,$159.95 ,$125.83 ,$279.00 ,$139.50 ,$399.88 ,$159.95 ,$159.95 ,$163.15 ,$209.25 ,$167.40 ,$167.40 ,$159.95 ,$167.40 ,$139.50 ,$139.50 ,$139.50 ,$279.00 , N/A ,$237.15 ,$279.00 ,$181.35 ,$159.95 ,$279.00 ,$156.24 ,$159.95 ,$73.38 , N/A , N/A , N/A ,$167.95 ,$223.20 ,$359.89 ,$125.83 ,$78.12 ,$251.10 ,$159.95 ,$139.50 , N/A , N/A ,$159.95 , N/A ,$133.92 , N/A 
ST. ELIZABETH'S HOSPITAL,27400018,L1830,HC KNEE BRACE - HINGED,274,1 ,$155.84 ,$101.30 ,$40.99 ,$222.13 ,$222.13 , N/A ,$87.27 ,$88.85 ,$43.64 ,$52.67 ,$88.85 ,$64.21 ,$88.85 ,$70.28 ,$70.28 ,$88.85 ,$70.28 ,$155.84 ,$77.92 ,$222.12 ,$88.85 ,$88.85 ,$90.62 ,$116.88 ,$93.50 ,$93.50 ,$88.85 ,$93.50 ,$77.92 ,$77.92 ,$77.92 ,$155.84 , N/A ,$132.46 ,$155.84 ,$101.30 ,$88.85 ,$155.84 ,$87.27 ,$88.85 ,$40.99 , N/A , N/A , N/A ,$93.29 ,$124.67 ,$199.91 ,$70.28 ,$43.64 ,$140.26 ,$88.85 ,$77.92 , N/A , N/A ,$88.85 , N/A ,$74.80 , N/A 
ST. ELIZABETH'S HOSPITAL,27400066,L4398,HC DROP FOOT BRACE (AFO),274,1 ,$177.55 ,$115.41 ,$46.70 ,$251.76 ,$251.75 , N/A ,$99.43 ,$100.70 ,$49.71 ,$60.01 ,$100.70 ,$73.15 ,$100.70 ,$80.08 ,$80.08 ,$100.70 ,$80.08 ,$177.55 ,$88.78 ,$251.76 ,$100.70 ,$100.70 ,$102.72 ,$133.16 ,$106.53 ,$106.53 ,$100.70 ,$106.53 ,$88.78 ,$88.78 ,$88.78 ,$177.55 , N/A ,$150.92 ,$177.55 ,$115.41 ,$100.70 ,$177.55 ,$99.43 ,$100.70 ,$46.70 , N/A , N/A , N/A ,$105.74 ,$142.04 ,$226.58 ,$80.08 ,$49.71 ,$159.80 ,$100.70 ,$88.78 , N/A , N/A ,$100.70 , N/A ,$85.22 , N/A 
ST. ELIZABETH'S HOSPITAL,27400069,L8501,HC PASSEY MUIR VALVE,274,1 ,$187.50 ,$121.88 ,$49.31 ,$347.68 ,$347.68 , N/A ,$105.00 ,$139.07 ,$52.50 ,$63.38 ,$139.07 ,$77.25 ,$139.07 ,$84.56 ,$84.56 ,$139.07 ,$84.56 ,$187.50 ,$93.75 ,$347.67 ,$139.07 ,$139.07 ,$141.85 ,$140.63 ,$112.50 ,$112.50 ,$139.07 ,$112.50 ,$93.75 ,$93.75 ,$93.75 ,$187.50 , N/A ,$159.38 ,$187.50 ,$121.88 ,$139.07 ,$187.50 ,$105.00 ,$139.07 ,$49.31 , N/A , N/A , N/A ,$146.02 ,$150.00 ,$312.90 ,$84.56 ,$52.50 ,$168.75 ,$139.07 ,$93.75 , N/A , N/A ,$139.07 , N/A ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27400116,L4210,HC PADS COLLAR CERVICAL,274,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A , N/A ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$77.25 , N/A ,$84.56 ,$84.56 , N/A ,$84.56 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$93.75 ,$93.75 ,$93.75 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27400126,N/A,HC ORTHOSIS ANKLE/FOOT,274,1 ,$69.27 ,$45.03 ,$18.22 ,$69.27 , N/A , N/A ,$38.79 , N/A ,$19.40 ,$23.41 , N/A ,$26.95 , N/A ,$31.24 ,$31.24 , N/A ,$31.24 , N/A ,$34.64 , N/A , N/A , N/A , N/A ,$51.95 ,$41.56 ,$41.56 , N/A ,$41.56 ,$34.64 ,$34.64 ,$34.64 ,$69.27 , N/A ,$58.88 , N/A ,$45.03 , N/A ,$69.27 ,$38.79 , N/A ,$18.22 , N/A , N/A , N/A , N/A ,$55.42 , N/A ,$31.24 ,$19.40 ,$62.34 , N/A ,$34.64 , N/A , N/A , N/A , N/A ,$33.25 , N/A 
ST. ELIZABETH'S HOSPITAL,27500049,C1721,HC ICD DEFIB DUAL CHAMBER T7,275,1 ,"$29,750.00 ","$19,337.50 ","$7,824.25 ","$29,750.00 ", N/A ,"$13,685.00 ","$16,660.00 ", N/A ,"$8,330.00 ","$10,055.50 ", N/A ,"$11,572.75 ", N/A ,"$13,417.25 ","$13,417.25 ", N/A ,"$13,417.25 ", N/A ,"$14,875.00 ", N/A , N/A , N/A , N/A ,"$22,312.50 ","$17,850.00 ","$17,850.00 ", N/A ,"$17,850.00 ","$14,875.00 ","$14,875.00 ","$14,875.00 ","$29,750.00 ", N/A ,"$25,287.50 ", N/A ,"$19,337.50 ", N/A ,"$29,750.00 ","$16,660.00 ", N/A ,"$7,824.25 ", N/A , N/A , N/A , N/A ,"$23,800.00 ", N/A ,"$13,417.25 ","$8,330.00 ","$26,775.00 ", N/A ,"$14,875.00 ","$11,215.75 ","$11,215.75 ", N/A ,"$11,215.75 ","$14,280.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500052,C1721,HC ICD DEFIB DUAL CHAMBER T10,275,1 ,"$33,500.00 ","$21,775.00 ","$8,810.50 ","$33,500.00 ", N/A ,"$15,410.00 ","$18,760.00 ", N/A ,"$9,380.00 ","$11,323.00 ", N/A ,"$13,031.50 ", N/A ,"$15,108.50 ","$15,108.50 ", N/A ,"$15,108.50 ", N/A ,"$16,750.00 ", N/A , N/A , N/A , N/A ,"$25,125.00 ","$20,100.00 ","$20,100.00 ", N/A ,"$20,100.00 ","$16,750.00 ","$16,750.00 ","$16,750.00 ","$33,500.00 ", N/A ,"$28,475.00 ", N/A ,"$21,775.00 ", N/A ,"$33,500.00 ","$18,760.00 ", N/A ,"$8,810.50 ", N/A , N/A , N/A , N/A ,"$26,800.00 ", N/A ,"$15,108.50 ","$9,380.00 ","$30,150.00 ", N/A ,"$16,750.00 ","$12,629.50 ","$12,629.50 ", N/A ,"$12,629.50 ","$16,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500066,C1722,HC ICD DEFIB SINGLE CHAMBER T2,275,1 ,"$27,250.00 ","$17,712.50 ","$7,166.75 ","$27,250.00 ", N/A ,"$12,535.00 ","$15,260.00 ", N/A ,"$7,630.00 ","$9,210.50 ", N/A ,"$10,600.25 ", N/A ,"$12,289.75 ","$12,289.75 ", N/A ,"$12,289.75 ", N/A ,"$13,625.00 ", N/A , N/A , N/A , N/A ,"$20,437.50 ","$16,350.00 ","$16,350.00 ", N/A ,"$16,350.00 ","$13,625.00 ","$13,625.00 ","$13,625.00 ","$27,250.00 ", N/A ,"$23,162.50 ", N/A ,"$17,712.50 ", N/A ,"$27,250.00 ","$15,260.00 ", N/A ,"$7,166.75 ", N/A , N/A , N/A , N/A ,"$21,800.00 ", N/A ,"$12,289.75 ","$7,630.00 ","$24,525.00 ", N/A ,"$13,625.00 ","$10,273.25 ","$10,273.25 ", N/A ,"$10,273.25 ","$13,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500069,C1722,HC ICD DEFIB SINGLE CHAMBER T5,275,1 ,"$31,000.00 ","$20,150.00 ","$8,153.00 ","$31,000.00 ", N/A ,"$14,260.00 ","$17,360.00 ", N/A ,"$8,680.00 ","$10,478.00 ", N/A ,"$12,059.00 ", N/A ,"$13,981.00 ","$13,981.00 ", N/A ,"$13,981.00 ", N/A ,"$15,500.00 ", N/A , N/A , N/A , N/A ,"$23,250.00 ","$18,600.00 ","$18,600.00 ", N/A ,"$18,600.00 ","$15,500.00 ","$15,500.00 ","$15,500.00 ","$31,000.00 ", N/A ,"$26,350.00 ", N/A ,"$20,150.00 ", N/A ,"$31,000.00 ","$17,360.00 ", N/A ,"$8,153.00 ", N/A , N/A , N/A , N/A ,"$24,800.00 ", N/A ,"$13,981.00 ","$8,680.00 ","$27,900.00 ", N/A ,"$15,500.00 ","$11,687.00 ","$11,687.00 ", N/A ,"$11,687.00 ","$14,880.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500083,C1722,HC ICD DEFIB SINGLE CHAMBER T19,275,1 ,"$48,500.00 ","$31,525.00 ","$12,755.50 ","$48,500.00 ", N/A ,"$22,310.00 ","$27,160.00 ", N/A ,"$13,580.00 ","$16,393.00 ", N/A ,"$18,866.50 ", N/A ,"$21,873.50 ","$21,873.50 ", N/A ,"$21,873.50 ", N/A ,"$24,250.00 ", N/A , N/A , N/A , N/A ,"$36,375.00 ","$29,100.00 ","$29,100.00 ", N/A ,"$29,100.00 ","$24,250.00 ","$24,250.00 ","$24,250.00 ","$48,500.00 ", N/A ,"$41,225.00 ", N/A ,"$31,525.00 ", N/A ,"$48,500.00 ","$27,160.00 ", N/A ,"$12,755.50 ", N/A , N/A , N/A , N/A ,"$38,800.00 ", N/A ,"$21,873.50 ","$13,580.00 ","$43,650.00 ", N/A ,"$24,250.00 ","$18,284.50 ","$18,284.50 ", N/A ,"$18,284.50 ","$23,280.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500095,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T9,275,1 ,"$9,900.00 ","$6,435.00 ","$2,603.70 ","$9,900.00 ", N/A ,"$4,554.00 ","$5,544.00 ", N/A ,"$2,772.00 ","$3,346.20 ", N/A ,"$3,851.10 ", N/A ,"$4,464.90 ","$4,464.90 ", N/A ,"$4,464.90 ", N/A ,"$4,950.00 ", N/A , N/A , N/A , N/A ,"$7,425.00 ","$5,940.00 ","$5,940.00 ", N/A ,"$5,940.00 ","$4,950.00 ","$4,950.00 ","$4,950.00 ","$9,900.00 ", N/A ,"$8,415.00 ", N/A ,"$6,435.00 ", N/A ,"$9,900.00 ","$5,544.00 ", N/A ,"$2,603.70 ", N/A , N/A , N/A , N/A ,"$7,920.00 ", N/A ,"$4,464.90 ","$2,772.00 ","$8,910.00 ", N/A ,"$4,950.00 ","$3,732.30 ","$3,732.30 ", N/A ,"$3,732.30 ","$4,752.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500096,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T10,275,1 ,"$10,500.00 ","$6,825.00 ","$2,761.50 ","$10,500.00 ", N/A ,"$4,830.00 ","$5,880.00 ", N/A ,"$2,940.00 ","$3,549.00 ", N/A ,"$4,084.50 ", N/A ,"$4,735.50 ","$4,735.50 ", N/A ,"$4,735.50 ", N/A ,"$5,250.00 ", N/A , N/A , N/A , N/A ,"$7,875.00 ","$6,300.00 ","$6,300.00 ", N/A ,"$6,300.00 ","$5,250.00 ","$5,250.00 ","$5,250.00 ","$10,500.00 ", N/A ,"$8,925.00 ", N/A ,"$6,825.00 ", N/A ,"$10,500.00 ","$5,880.00 ", N/A ,"$2,761.50 ", N/A , N/A , N/A , N/A ,"$8,400.00 ", N/A ,"$4,735.50 ","$2,940.00 ","$9,450.00 ", N/A ,"$5,250.00 ","$3,958.50 ","$3,958.50 ", N/A ,"$3,958.50 ","$5,040.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500099,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T13,275,1 ,"$12,300.00 ","$7,995.00 ","$3,234.90 ","$12,300.00 ", N/A ,"$5,658.00 ","$6,888.00 ", N/A ,"$3,444.00 ","$4,157.40 ", N/A ,"$4,784.70 ", N/A ,"$5,547.30 ","$5,547.30 ", N/A ,"$5,547.30 ", N/A ,"$6,150.00 ", N/A , N/A , N/A , N/A ,"$9,225.00 ","$7,380.00 ","$7,380.00 ", N/A ,"$7,380.00 ","$6,150.00 ","$6,150.00 ","$6,150.00 ","$12,300.00 ", N/A ,"$10,455.00 ", N/A ,"$7,995.00 ", N/A ,"$12,300.00 ","$6,888.00 ", N/A ,"$3,234.90 ", N/A , N/A , N/A , N/A ,"$9,840.00 ", N/A ,"$5,547.30 ","$3,444.00 ","$11,070.00 ", N/A ,"$6,150.00 ","$4,637.10 ","$4,637.10 ", N/A ,"$4,637.10 ","$5,904.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500101,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T15,275,1 ,"$13,500.00 ","$8,775.00 ","$3,550.50 ","$13,500.00 ", N/A ,"$6,210.00 ","$7,560.00 ", N/A ,"$3,780.00 ","$4,563.00 ", N/A ,"$5,251.50 ", N/A ,"$6,088.50 ","$6,088.50 ", N/A ,"$6,088.50 ", N/A ,"$6,750.00 ", N/A , N/A , N/A , N/A ,"$10,125.00 ","$8,100.00 ","$8,100.00 ", N/A ,"$8,100.00 ","$6,750.00 ","$6,750.00 ","$6,750.00 ","$13,500.00 ", N/A ,"$11,475.00 ", N/A ,"$8,775.00 ", N/A ,"$13,500.00 ","$7,560.00 ", N/A ,"$3,550.50 ", N/A , N/A , N/A , N/A ,"$10,800.00 ", N/A ,"$6,088.50 ","$3,780.00 ","$12,150.00 ", N/A ,"$6,750.00 ","$5,089.50 ","$5,089.50 ", N/A ,"$5,089.50 ","$6,480.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500117,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T7,275,1 ,"$7,500.00 ","$4,875.00 ","$1,972.50 ","$7,500.00 ", N/A ,"$3,450.00 ","$4,200.00 ", N/A ,"$2,100.00 ","$2,535.00 ", N/A ,"$2,917.50 ", N/A ,"$3,382.50 ","$3,382.50 ", N/A ,"$3,382.50 ", N/A ,"$3,750.00 ", N/A , N/A , N/A , N/A ,"$5,625.00 ","$4,500.00 ","$4,500.00 ", N/A ,"$4,500.00 ","$3,750.00 ","$3,750.00 ","$3,750.00 ","$7,500.00 ", N/A ,"$6,375.00 ", N/A ,"$4,875.00 ", N/A ,"$7,500.00 ","$4,200.00 ", N/A ,"$1,972.50 ", N/A , N/A , N/A , N/A ,"$6,000.00 ", N/A ,"$3,382.50 ","$2,100.00 ","$6,750.00 ", N/A ,"$3,750.00 ","$2,827.50 ","$2,827.50 ", N/A ,"$2,827.50 ","$3,600.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500122,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T12,275,1 ,"$10,500.00 ","$6,825.00 ","$2,761.50 ","$10,500.00 ", N/A ,"$4,830.00 ","$5,880.00 ", N/A ,"$2,940.00 ","$3,549.00 ", N/A ,"$4,084.50 ", N/A ,"$4,735.50 ","$4,735.50 ", N/A ,"$4,735.50 ", N/A ,"$5,250.00 ", N/A , N/A , N/A , N/A ,"$7,875.00 ","$6,300.00 ","$6,300.00 ", N/A ,"$6,300.00 ","$5,250.00 ","$5,250.00 ","$5,250.00 ","$10,500.00 ", N/A ,"$8,925.00 ", N/A ,"$6,825.00 ", N/A ,"$10,500.00 ","$5,880.00 ", N/A ,"$2,761.50 ", N/A , N/A , N/A , N/A ,"$8,400.00 ", N/A ,"$4,735.50 ","$2,940.00 ","$9,450.00 ", N/A ,"$5,250.00 ","$3,958.50 ","$3,958.50 ", N/A ,"$3,958.50 ","$5,040.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500139,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T29,275,1 ,"$17,850.00 ","$11,602.50 ","$4,694.55 ","$17,850.00 ", N/A ,"$8,211.00 ","$9,996.00 ", N/A ,"$4,998.00 ","$6,033.30 ", N/A ,"$6,943.65 ", N/A ,"$8,050.35 ","$8,050.35 ", N/A ,"$8,050.35 ", N/A ,"$8,925.00 ", N/A , N/A , N/A , N/A ,"$13,387.50 ","$10,710.00 ","$10,710.00 ", N/A ,"$10,710.00 ","$8,925.00 ","$8,925.00 ","$8,925.00 ","$17,850.00 ", N/A ,"$15,172.50 ", N/A ,"$11,602.50 ", N/A ,"$17,850.00 ","$9,996.00 ", N/A ,"$4,694.55 ", N/A , N/A , N/A , N/A ,"$14,280.00 ", N/A ,"$8,050.35 ","$4,998.00 ","$16,065.00 ", N/A ,"$8,925.00 ","$6,729.45 ","$6,729.45 ", N/A ,"$6,729.45 ","$8,568.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500150,C1882,HC ICD DEFIB OTHR SINGLE/DUAL CHAMBER T11,275,1 ,"$41,000.00 ","$26,650.00 ","$10,783.00 ","$41,000.00 ", N/A ,"$18,860.00 ","$22,960.00 ", N/A ,"$11,480.00 ","$13,858.00 ", N/A ,"$15,949.00 ", N/A ,"$18,491.00 ","$18,491.00 ", N/A ,"$18,491.00 ", N/A ,"$20,500.00 ", N/A , N/A , N/A , N/A ,"$30,750.00 ","$24,600.00 ","$24,600.00 ", N/A ,"$24,600.00 ","$20,500.00 ","$20,500.00 ","$20,500.00 ","$41,000.00 ", N/A ,"$34,850.00 ", N/A ,"$26,650.00 ", N/A ,"$41,000.00 ","$22,960.00 ", N/A ,"$10,783.00 ", N/A , N/A , N/A , N/A ,"$32,800.00 ", N/A ,"$18,491.00 ","$11,480.00 ","$36,900.00 ", N/A ,"$20,500.00 ","$15,457.00 ","$15,457.00 ", N/A ,"$15,457.00 ","$19,680.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500152,C1882,HC ICD DEFIB OTHR SINGLE/DUAL CHAMBER T13,275,1 ,"$43,500.00 ","$28,275.00 ","$11,440.50 ","$43,500.00 ", N/A ,"$20,010.00 ","$24,360.00 ", N/A ,"$12,180.00 ","$14,703.00 ", N/A ,"$16,921.50 ", N/A ,"$19,618.50 ","$19,618.50 ", N/A ,"$19,618.50 ", N/A ,"$21,750.00 ", N/A , N/A , N/A , N/A ,"$32,625.00 ","$26,100.00 ","$26,100.00 ", N/A ,"$26,100.00 ","$21,750.00 ","$21,750.00 ","$21,750.00 ","$43,500.00 ", N/A ,"$36,975.00 ", N/A ,"$28,275.00 ", N/A ,"$43,500.00 ","$24,360.00 ", N/A ,"$11,440.50 ", N/A , N/A , N/A , N/A ,"$34,800.00 ", N/A ,"$19,618.50 ","$12,180.00 ","$39,150.00 ", N/A ,"$21,750.00 ","$16,399.50 ","$16,399.50 ", N/A ,"$16,399.50 ","$20,880.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500154,C1882,HC ICD DEFIB OTHR SINGLE/DUAL CHAMBER T15,275,1 ,"$46,000.00 ","$29,900.00 ","$12,098.00 ","$46,000.00 ", N/A ,"$21,160.00 ","$25,760.00 ", N/A ,"$12,880.00 ","$15,548.00 ", N/A ,"$17,894.00 ", N/A ,"$20,746.00 ","$20,746.00 ", N/A ,"$20,746.00 ", N/A ,"$23,000.00 ", N/A , N/A , N/A , N/A ,"$34,500.00 ","$27,600.00 ","$27,600.00 ", N/A ,"$27,600.00 ","$23,000.00 ","$23,000.00 ","$23,000.00 ","$46,000.00 ", N/A ,"$39,100.00 ", N/A ,"$29,900.00 ", N/A ,"$46,000.00 ","$25,760.00 ", N/A ,"$12,098.00 ", N/A , N/A , N/A , N/A ,"$36,800.00 ", N/A ,"$20,746.00 ","$12,880.00 ","$41,400.00 ", N/A ,"$23,000.00 ","$17,342.00 ","$17,342.00 ", N/A ,"$17,342.00 ","$22,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500184,C2621,HC PACEMAKER OTHER THAN SINGLE/DUAL T14,275,1 ,"$16,218.75 ","$10,542.19 ","$4,265.53 ","$16,218.75 ", N/A ,"$7,460.63 ","$9,082.50 ", N/A ,"$4,541.25 ","$5,481.94 ", N/A ,"$6,309.09 ", N/A ,"$7,314.66 ","$7,314.66 ", N/A ,"$7,314.66 ", N/A ,"$8,109.38 ", N/A , N/A , N/A , N/A ,"$12,164.06 ","$9,731.25 ","$9,731.25 ", N/A ,"$9,731.25 ","$8,109.38 ","$8,109.38 ","$8,109.38 ","$16,218.75 ", N/A ,"$13,785.94 ", N/A ,"$10,542.19 ", N/A ,"$16,218.75 ","$9,082.50 ", N/A ,"$4,265.53 ", N/A , N/A , N/A , N/A ,"$12,975.00 ", N/A ,"$7,314.66 ","$4,541.25 ","$14,596.88 ", N/A ,"$8,109.38 ","$6,114.47 ","$6,114.47 ", N/A ,"$6,114.47 ","$7,785.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27500187,C2621,HC PACEMAKER OTHER THAN SINGLE/DUAL T17,275,1 ,"$17,400.00 ","$11,310.00 ","$4,576.20 ","$17,400.00 ", N/A ,"$8,004.00 ","$9,744.00 ", N/A ,"$4,872.00 ","$5,881.20 ", N/A ,"$6,768.60 ", N/A ,"$7,847.40 ","$7,847.40 ", N/A ,"$7,847.40 ", N/A ,"$8,700.00 ", N/A , N/A , N/A , N/A ,"$13,050.00 ","$10,440.00 ","$10,440.00 ", N/A ,"$10,440.00 ","$8,700.00 ","$8,700.00 ","$8,700.00 ","$17,400.00 ", N/A ,"$14,790.00 ", N/A ,"$11,310.00 ", N/A ,"$17,400.00 ","$9,744.00 ", N/A ,"$4,576.20 ", N/A , N/A , N/A , N/A ,"$13,920.00 ", N/A ,"$7,847.40 ","$4,872.00 ","$15,660.00 ", N/A ,"$8,700.00 ","$6,559.80 ","$6,559.80 ", N/A ,"$6,559.80 ","$8,352.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27800136,C1751,HC MULTI CATH 3 LUMEN 7FR,278,1 ,$66.06 ,$42.94 ,$17.37 ,$66.06 , N/A , N/A ,$36.99 , N/A ,$18.50 ,$22.33 , N/A ,$25.70 , N/A ,$29.79 ,$29.79 , N/A ,$29.79 , N/A ,$33.03 , N/A , N/A , N/A , N/A ,$49.55 ,$39.64 ,$39.64 , N/A ,$39.64 ,$33.03 ,$33.03 ,$33.03 ,$66.06 , N/A ,$56.15 , N/A ,$42.94 , N/A ,$66.06 ,$36.99 , N/A ,$17.37 , N/A , N/A , N/A , N/A ,$52.85 , N/A ,$29.79 ,$18.50 ,$59.45 , N/A ,$33.03 , N/A , N/A , N/A , N/A ,$31.71 , N/A 
ST. ELIZABETH'S HOSPITAL,27800140,C1751,HC KIT ARROW CVP 16G SINGLE,278,1 ,$79.00 ,$51.35 ,$20.78 ,$79.00 , N/A , N/A ,$44.24 , N/A ,$22.12 ,$26.70 , N/A ,$30.73 , N/A ,$35.63 ,$35.63 , N/A ,$35.63 , N/A ,$39.50 , N/A , N/A , N/A , N/A ,$59.25 ,$47.40 ,$47.40 , N/A ,$47.40 ,$39.50 ,$39.50 ,$39.50 ,$79.00 , N/A ,$67.15 , N/A ,$51.35 , N/A ,$79.00 ,$44.24 , N/A ,$20.78 , N/A , N/A , N/A , N/A ,$63.20 , N/A ,$35.63 ,$22.12 ,$71.10 , N/A ,$39.50 , N/A , N/A , N/A , N/A ,$37.92 , N/A 
ST. ELIZABETH'S HOSPITAL,27800160,C1752,HC SHORT TERM DIALYSIS CATH,278,1 ,$396.38 ,$257.65 ,$104.25 ,$396.38 , N/A , N/A ,$221.97 , N/A ,$110.99 ,$133.98 , N/A ,$154.19 , N/A ,$178.77 ,$178.77 , N/A ,$178.77 , N/A ,$198.19 , N/A , N/A , N/A , N/A ,$297.29 ,$237.83 ,$237.83 , N/A ,$237.83 ,$198.19 ,$198.19 ,$198.19 ,$396.38 , N/A ,$336.92 , N/A ,$257.65 , N/A ,$396.38 ,$221.97 , N/A ,$104.25 , N/A , N/A , N/A , N/A ,$317.10 , N/A ,$178.77 ,$110.99 ,$356.74 , N/A ,$198.19 , N/A , N/A , N/A , N/A ,$190.26 , N/A 
ST. ELIZABETH'S HOSPITAL,27800170,C1760,HC PERCLOSE,278,1 ,$500.00 ,$325.00 ,$131.50 ,$500.00 , N/A , N/A ,$280.00 , N/A ,$140.00 ,$169.00 , N/A ,$194.50 , N/A ,$225.50 ,$225.50 , N/A ,$225.50 , N/A ,$250.00 , N/A , N/A , N/A , N/A ,$375.00 ,$300.00 ,$300.00 , N/A ,$300.00 ,$250.00 ,$250.00 ,$250.00 ,$500.00 , N/A ,$425.00 , N/A ,$325.00 , N/A ,$500.00 ,$280.00 , N/A ,$131.50 , N/A , N/A , N/A , N/A ,$400.00 , N/A ,$225.50 ,$140.00 ,$450.00 , N/A ,$250.00 , N/A , N/A , N/A , N/A ,$240.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27800494,C1788,HC PORT BARD 8FR,278,1 ,$774.00 ,$503.10 ,$203.56 ,$774.00 , N/A , N/A ,$433.44 , N/A ,$216.72 ,$261.61 , N/A ,$301.09 , N/A ,$349.07 ,$349.07 , N/A ,$349.07 , N/A ,$387.00 , N/A , N/A , N/A , N/A ,$580.50 ,$464.40 ,$464.40 , N/A ,$464.40 ,$387.00 ,$387.00 ,$387.00 ,$774.00 , N/A ,$657.90 , N/A ,$503.10 , N/A ,$774.00 ,$433.44 , N/A ,$203.56 , N/A , N/A , N/A , N/A ,$619.20 , N/A ,$349.07 ,$216.72 ,$696.60 , N/A ,$387.00 , N/A , N/A , N/A , N/A ,$371.52 , N/A 
ST. ELIZABETH'S HOSPITAL,27800506,C1874,HC DRUG ELUTING STENT,278,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,240.25 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$1,375.00 ","$1,375.00 ","$1,375.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$1,375.00 ","$1,036.75 ","$1,036.75 ", N/A ,"$1,036.75 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27800535,C1876,HC STENT BARE METAL,278,1 ,"$1,750.00 ","$1,137.50 ",$460.25 ,"$1,750.00 ", N/A ,$805.00 ,$980.00 , N/A ,$490.00 ,$591.50 , N/A ,$680.75 , N/A ,$789.25 ,$789.25 , N/A ,$789.25 , N/A ,$875.00 , N/A , N/A , N/A , N/A ,"$1,312.50 ","$1,050.00 ","$1,050.00 ", N/A ,"$1,050.00 ",$875.00 ,$875.00 ,$875.00 ,"$1,750.00 ", N/A ,"$1,487.50 ", N/A ,"$1,137.50 ", N/A ,"$1,750.00 ",$980.00 , N/A ,$460.25 , N/A , N/A , N/A , N/A ,"$1,400.00 ", N/A ,$789.25 ,$490.00 ,"$1,575.00 ", N/A ,$875.00 ,$659.75 ,$659.75 , N/A ,$659.75 ,$840.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27800542,C1876,HC URETERAL STENT,278,1 ,$245.00 ,$159.25 ,$64.44 ,$245.00 , N/A , N/A ,$137.20 , N/A ,$68.60 ,$82.81 , N/A ,$95.31 , N/A ,$110.50 ,$110.50 , N/A ,$110.50 , N/A ,$122.50 , N/A , N/A , N/A , N/A ,$183.75 ,$147.00 ,$147.00 , N/A ,$147.00 ,$122.50 ,$122.50 ,$122.50 ,$245.00 , N/A ,$208.25 , N/A ,$159.25 , N/A ,$245.00 ,$137.20 , N/A ,$64.44 , N/A , N/A , N/A , N/A ,$196.00 , N/A ,$110.50 ,$68.60 ,$220.50 , N/A ,$122.50 , N/A , N/A , N/A , N/A ,$117.60 , N/A 
ST. ELIZABETH'S HOSPITAL,27800553,A4648,HC TISSUE MARKER IMPLANTABLE,278,1 ,$431.13 ,$280.23 ,$113.39 ,$431.13 , N/A , N/A ,$241.43 , N/A ,$120.72 ,$145.72 , N/A ,$167.71 , N/A ,$194.44 ,$194.44 , N/A ,$194.44 , N/A ,$215.57 , N/A , N/A , N/A , N/A ,$323.35 ,$258.68 ,$258.68 , N/A ,$258.68 ,$215.57 ,$215.57 ,$215.57 ,$431.13 , N/A ,$366.46 , N/A ,$280.23 , N/A ,$431.13 ,$241.43 , N/A ,$113.39 , N/A , N/A , N/A , N/A ,$344.90 , N/A ,$194.44 ,$120.72 ,$388.02 , N/A ,$215.57 , N/A , N/A , N/A , N/A ,$206.94 , N/A 
ST. ELIZABETH'S HOSPITAL,27800557,C1880,HC IVC FILTER,278,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,014.75 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,125.00 ","$1,125.00 ","$1,125.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,125.00 ",$848.25 ,$848.25 , N/A ,$848.25 ,"$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801344,N/A,HC MEMBRANE SEPRAFILM,278,1 ,$581.84 ,$378.20 ,$153.02 ,$581.84 , N/A , N/A ,$325.83 , N/A ,$162.92 ,$196.66 , N/A ,$226.34 , N/A ,$262.41 ,$262.41 , N/A ,$262.41 , N/A ,$290.92 , N/A , N/A , N/A , N/A ,$436.38 ,$349.10 ,$349.10 , N/A ,$349.10 ,$290.92 ,$290.92 ,$290.92 ,$581.84 , N/A ,$494.56 , N/A ,$378.20 , N/A ,$581.84 ,$325.83 , N/A ,$153.02 , N/A , N/A , N/A , N/A ,$465.47 , N/A ,$262.41 ,$162.92 ,$523.66 , N/A ,$290.92 , N/A , N/A , N/A , N/A ,$279.28 , N/A 
ST. ELIZABETH'S HOSPITAL,27801361,C1874,HC GRAFTMASTER JO STENT,278,1 ,"$6,250.00 ","$4,062.50 ","$1,643.75 ","$6,250.00 ", N/A ,"$2,875.00 ","$3,500.00 ", N/A ,"$1,750.00 ","$2,112.50 ", N/A ,"$2,431.25 ", N/A ,"$2,818.75 ","$2,818.75 ", N/A ,"$2,818.75 ", N/A ,"$3,125.00 ", N/A , N/A , N/A , N/A ,"$4,687.50 ","$3,750.00 ","$3,750.00 ", N/A ,"$3,750.00 ","$3,125.00 ","$3,125.00 ","$3,125.00 ","$6,250.00 ", N/A ,"$5,312.50 ", N/A ,"$4,062.50 ", N/A ,"$6,250.00 ","$3,500.00 ", N/A ,"$1,643.75 ", N/A , N/A , N/A , N/A ,"$5,000.00 ", N/A ,"$2,818.75 ","$1,750.00 ","$5,625.00 ", N/A ,"$3,125.00 ","$2,356.25 ","$2,356.25 ", N/A ,"$2,356.25 ","$3,000.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801363,C1874,HC VIABAHN 10-15 CM COVERED STENTS,278,1 ,"$10,500.00 ","$6,825.00 ","$2,761.50 ","$10,500.00 ", N/A ,"$4,830.00 ","$5,880.00 ", N/A ,"$2,940.00 ","$3,549.00 ", N/A ,"$4,084.50 ", N/A ,"$4,735.50 ","$4,735.50 ", N/A ,"$4,735.50 ", N/A ,"$5,250.00 ", N/A , N/A , N/A , N/A ,"$7,875.00 ","$6,300.00 ","$6,300.00 ", N/A ,"$6,300.00 ","$5,250.00 ","$5,250.00 ","$5,250.00 ","$10,500.00 ", N/A ,"$8,925.00 ", N/A ,"$6,825.00 ", N/A ,"$10,500.00 ","$5,880.00 ", N/A ,"$2,761.50 ", N/A , N/A , N/A , N/A ,"$8,400.00 ", N/A ,"$4,735.50 ","$2,940.00 ","$9,450.00 ", N/A ,"$5,250.00 ","$3,958.50 ","$3,958.50 ", N/A ,"$3,958.50 ","$5,040.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801410,C1714,HC CROSSER C1714,278,1 ,"$4,250.00 ","$2,762.50 ","$1,117.75 ","$4,250.00 ", N/A ,"$1,955.00 ","$2,380.00 ", N/A ,"$1,190.00 ","$1,436.50 ", N/A ,"$1,653.25 ", N/A ,"$1,916.75 ","$1,916.75 ", N/A ,"$1,916.75 ", N/A ,"$2,125.00 ", N/A , N/A , N/A , N/A ,"$3,187.50 ","$2,550.00 ","$2,550.00 ", N/A ,"$2,550.00 ","$2,125.00 ","$2,125.00 ","$2,125.00 ","$4,250.00 ", N/A ,"$3,612.50 ", N/A ,"$2,762.50 ", N/A ,"$4,250.00 ","$2,380.00 ", N/A ,"$1,117.75 ", N/A , N/A , N/A , N/A ,"$3,400.00 ", N/A ,"$1,916.75 ","$1,190.00 ","$3,825.00 ", N/A ,"$2,125.00 ","$1,602.25 ","$1,602.25 ", N/A ,"$1,602.25 ","$2,040.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801484,C1894,HC INTRODUCER MICROPUNCTURE SET,278,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A , N/A ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$56.38 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$62.50 ,$62.50 ,$62.50 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27801563,C2623,HC CATH TRANSLUMINAL DRUG COATED ADMIRAL,278,1 ,"$3,750.00 ","$2,437.50 ",$986.25 ,"$3,750.00 ", N/A ,"$1,725.00 ","$2,100.00 ", N/A ,"$1,050.00 ","$1,267.50 ", N/A ,"$1,458.75 ", N/A ,"$1,691.25 ","$1,691.25 ", N/A ,"$1,691.25 ", N/A ,"$1,875.00 ", N/A , N/A , N/A , N/A ,"$2,812.50 ","$2,250.00 ","$2,250.00 ", N/A ,"$2,250.00 ","$1,875.00 ","$1,875.00 ","$1,875.00 ","$3,750.00 ", N/A ,"$3,187.50 ", N/A ,"$2,437.50 ", N/A ,"$3,750.00 ","$2,100.00 ", N/A ,$986.25 , N/A , N/A , N/A , N/A ,"$3,000.00 ", N/A ,"$1,691.25 ","$1,050.00 ","$3,375.00 ", N/A ,"$1,875.00 ","$1,413.75 ","$1,413.75 ", N/A ,"$1,413.75 ","$1,800.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801564,C2623,HC CATH TRANSLUMINAL DRUG COATED ADMIRAL LARGE,278,1 ,"$4,250.00 ","$2,762.50 ","$1,117.75 ","$4,250.00 ", N/A ,"$1,955.00 ","$2,380.00 ", N/A ,"$1,190.00 ","$1,436.50 ", N/A ,"$1,653.25 ", N/A ,"$1,916.75 ","$1,916.75 ", N/A ,"$1,916.75 ", N/A ,"$2,125.00 ", N/A , N/A , N/A , N/A ,"$3,187.50 ","$2,550.00 ","$2,550.00 ", N/A ,"$2,550.00 ","$2,125.00 ","$2,125.00 ","$2,125.00 ","$4,250.00 ", N/A ,"$3,612.50 ", N/A ,"$2,762.50 ", N/A ,"$4,250.00 ","$2,380.00 ", N/A ,"$1,117.75 ", N/A , N/A , N/A , N/A ,"$3,400.00 ", N/A ,"$1,916.75 ","$1,190.00 ","$3,825.00 ", N/A ,"$2,125.00 ","$1,602.25 ","$1,602.25 ", N/A ,"$1,602.25 ","$2,040.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801565,C2623,HC CATH TRANSLUMINAL DRUG COATED LUTONIX,278,1 ,"$3,750.00 ","$2,437.50 ",$986.25 ,"$3,750.00 ", N/A ,"$1,725.00 ","$2,100.00 ", N/A ,"$1,050.00 ","$1,267.50 ", N/A ,"$1,458.75 ", N/A ,"$1,691.25 ","$1,691.25 ", N/A ,"$1,691.25 ", N/A ,"$1,875.00 ", N/A , N/A , N/A , N/A ,"$2,812.50 ","$2,250.00 ","$2,250.00 ", N/A ,"$2,250.00 ","$1,875.00 ","$1,875.00 ","$1,875.00 ","$3,750.00 ", N/A ,"$3,187.50 ", N/A ,"$2,437.50 ", N/A ,"$3,750.00 ","$2,100.00 ", N/A ,$986.25 , N/A , N/A , N/A , N/A ,"$3,000.00 ", N/A ,"$1,691.25 ","$1,050.00 ","$3,375.00 ", N/A ,"$1,875.00 ","$1,413.75 ","$1,413.75 ", N/A ,"$1,413.75 ","$1,800.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801566,C1889,HC COIL EMBOLIZATION AMPLATZER PLUG,278,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,014.75 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,125.00 ","$1,125.00 ","$1,125.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,125.00 ",$848.25 ,$848.25 , N/A ,$848.25 ,"$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801567,C1889,HC COIL EMBOLIZATION AZUR,278,1 ,"$1,250.00 ",$812.50 ,$328.75 ,"$1,250.00 ", N/A ,$575.00 ,$700.00 , N/A ,$350.00 ,$422.50 , N/A ,$486.25 , N/A ,$563.75 ,$563.75 , N/A ,$563.75 , N/A ,$625.00 , N/A , N/A , N/A , N/A ,$937.50 ,$750.00 ,$750.00 , N/A ,$750.00 ,$625.00 ,$625.00 ,$625.00 ,"$1,250.00 ", N/A ,"$1,062.50 ", N/A ,$812.50 , N/A ,"$1,250.00 ",$700.00 , N/A ,$328.75 , N/A , N/A , N/A , N/A ,"$1,000.00 ", N/A ,$563.75 ,$350.00 ,"$1,125.00 ", N/A ,$625.00 , N/A , N/A , N/A , N/A ,$600.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27801568,C1889,HC COIL EMBOLIZATION NESTER,278,1 ,$187.50 ,$121.88 ,$49.31 ,$187.50 , N/A , N/A ,$105.00 , N/A ,$52.50 ,$63.38 , N/A ,$72.94 , N/A ,$84.56 ,$84.56 , N/A ,$84.56 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$140.63 ,$112.50 ,$112.50 , N/A ,$112.50 ,$93.75 ,$93.75 ,$93.75 ,$187.50 , N/A ,$159.38 , N/A ,$121.88 , N/A ,$187.50 ,$105.00 , N/A ,$49.31 , N/A , N/A , N/A , N/A ,$150.00 , N/A ,$84.56 ,$52.50 ,$168.75 , N/A ,$93.75 , N/A , N/A , N/A , N/A ,$90.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27801570,C1874,HC FLAIR STENT COVERED,278,1 ,"$6,250.00 ","$4,062.50 ","$1,643.75 ","$6,250.00 ", N/A ,"$2,875.00 ","$3,500.00 ", N/A ,"$1,750.00 ","$2,112.50 ", N/A ,"$2,431.25 ", N/A ,"$2,818.75 ","$2,818.75 ", N/A ,"$2,818.75 ", N/A ,"$3,125.00 ", N/A , N/A , N/A , N/A ,"$4,687.50 ","$3,750.00 ","$3,750.00 ", N/A ,"$3,750.00 ","$3,125.00 ","$3,125.00 ","$3,125.00 ","$6,250.00 ", N/A ,"$5,312.50 ", N/A ,"$4,062.50 ", N/A ,"$6,250.00 ","$3,500.00 ", N/A ,"$1,643.75 ", N/A , N/A , N/A , N/A ,"$5,000.00 ", N/A ,"$2,818.75 ","$1,750.00 ","$5,625.00 ", N/A ,"$3,125.00 ","$2,356.25 ","$2,356.25 ", N/A ,"$2,356.25 ","$3,000.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801571,C1874,HC FLUENCY STENT COVERED,278,1 ,"$5,250.00 ","$3,412.50 ","$1,380.75 ","$5,250.00 ", N/A ,"$2,415.00 ","$2,940.00 ", N/A ,"$1,470.00 ","$1,774.50 ", N/A ,"$2,042.25 ", N/A ,"$2,367.75 ","$2,367.75 ", N/A ,"$2,367.75 ", N/A ,"$2,625.00 ", N/A , N/A , N/A , N/A ,"$3,937.50 ","$3,150.00 ","$3,150.00 ", N/A ,"$3,150.00 ","$2,625.00 ","$2,625.00 ","$2,625.00 ","$5,250.00 ", N/A ,"$4,462.50 ", N/A ,"$3,412.50 ", N/A ,"$5,250.00 ","$2,940.00 ", N/A ,"$1,380.75 ", N/A , N/A , N/A , N/A ,"$4,200.00 ", N/A ,"$2,367.75 ","$1,470.00 ","$4,725.00 ", N/A ,"$2,625.00 ","$1,979.25 ","$1,979.25 ", N/A ,"$1,979.25 ","$2,520.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801572,C1874,HC ICAST STENT COVERED,278,1 ,"$6,750.00 ","$4,387.50 ","$1,775.25 ","$6,750.00 ", N/A ,"$3,105.00 ","$3,780.00 ", N/A ,"$1,890.00 ","$2,281.50 ", N/A ,"$2,625.75 ", N/A ,"$3,044.25 ","$3,044.25 ", N/A ,"$3,044.25 ", N/A ,"$3,375.00 ", N/A , N/A , N/A , N/A ,"$5,062.50 ","$4,050.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$3,375.00 ","$3,375.00 ","$3,375.00 ","$6,750.00 ", N/A ,"$5,737.50 ", N/A ,"$4,387.50 ", N/A ,"$6,750.00 ","$3,780.00 ", N/A ,"$1,775.25 ", N/A , N/A , N/A , N/A ,"$5,400.00 ", N/A ,"$3,044.25 ","$1,890.00 ","$6,075.00 ", N/A ,"$3,375.00 ","$2,544.75 ","$2,544.75 ", N/A ,"$2,544.75 ","$3,240.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801573,C1880,HC IVC FILTER FEMORAL,278,1 ,"$3,250.00 ","$2,112.50 ",$854.75 ,"$3,250.00 ", N/A ,"$1,495.00 ","$1,820.00 ", N/A ,$910.00 ,"$1,098.50 ", N/A ,"$1,264.25 ", N/A ,"$1,465.75 ","$1,465.75 ", N/A ,"$1,465.75 ", N/A ,"$1,625.00 ", N/A , N/A , N/A , N/A ,"$2,437.50 ","$1,950.00 ","$1,950.00 ", N/A ,"$1,950.00 ","$1,625.00 ","$1,625.00 ","$1,625.00 ","$3,250.00 ", N/A ,"$2,762.50 ", N/A ,"$2,112.50 ", N/A ,"$3,250.00 ","$1,820.00 ", N/A ,$854.75 , N/A , N/A , N/A , N/A ,"$2,600.00 ", N/A ,"$1,465.75 ",$910.00 ,"$2,925.00 ", N/A ,"$1,625.00 ","$1,225.25 ","$1,225.25 ", N/A ,"$1,225.25 ","$1,560.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801574,C1880,HC IVC FILTER JUGULAR,278,1 ,"$6,250.00 ","$4,062.50 ","$1,643.75 ","$6,250.00 ", N/A ,"$2,875.00 ","$3,500.00 ", N/A ,"$1,750.00 ","$2,112.50 ", N/A ,"$2,431.25 ", N/A ,"$2,818.75 ","$2,818.75 ", N/A ,"$2,818.75 ", N/A ,"$3,125.00 ", N/A , N/A , N/A , N/A ,"$4,687.50 ","$3,750.00 ","$3,750.00 ", N/A ,"$3,750.00 ","$3,125.00 ","$3,125.00 ","$3,125.00 ","$6,250.00 ", N/A ,"$5,312.50 ", N/A ,"$4,062.50 ", N/A ,"$6,250.00 ","$3,500.00 ", N/A ,"$1,643.75 ", N/A , N/A , N/A , N/A ,"$5,000.00 ", N/A ,"$2,818.75 ","$1,750.00 ","$5,625.00 ", N/A ,"$3,125.00 ","$2,356.25 ","$2,356.25 ", N/A ,"$2,356.25 ","$3,000.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801575,C1713,HC KIT BONE CEMENT,278,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,014.75 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,125.00 ","$1,125.00 ","$1,125.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,125.00 ",$848.25 ,$848.25 , N/A ,$848.25 ,"$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801576,C1876,HC STENT PV NON-COVRD PARAMOUNT MINI,278,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,014.75 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,125.00 ","$1,125.00 ","$1,125.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,125.00 ",$848.25 ,$848.25 , N/A ,$848.25 ,"$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801577,C1876,HC STENT PV NON-COVRD PROTÉGÉ,278,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,240.25 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$1,375.00 ","$1,375.00 ","$1,375.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$1,375.00 ","$1,036.75 ","$1,036.75 ", N/A ,"$1,036.75 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801578,C1876,HC STENT PV NON-COVRD SELF EXPANDING LG DIA,278,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,240.25 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$1,375.00 ","$1,375.00 ","$1,375.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$1,375.00 ","$1,036.75 ","$1,036.75 ", N/A ,"$1,036.75 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801579,C1876,HC STENT PV NON-COVRD SELF EXPANDING MED DIA,278,1 ,"$2,250.00 ","$1,462.50 ",$591.75 ,"$2,250.00 ", N/A ,"$1,035.00 ","$1,260.00 ", N/A ,$630.00 ,$760.50 , N/A ,$875.25 , N/A ,"$1,014.75 ","$1,014.75 ", N/A ,"$1,014.75 ", N/A ,"$1,125.00 ", N/A , N/A , N/A , N/A ,"$1,687.50 ","$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,125.00 ","$1,125.00 ","$1,125.00 ","$2,250.00 ", N/A ,"$1,912.50 ", N/A ,"$1,462.50 ", N/A ,"$2,250.00 ","$1,260.00 ", N/A ,$591.75 , N/A , N/A , N/A , N/A ,"$1,800.00 ", N/A ,"$1,014.75 ",$630.00 ,"$2,025.00 ", N/A ,"$1,125.00 ",$848.25 ,$848.25 , N/A ,$848.25 ,"$1,080.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801580,C1876,HC STENT PV NON-COVRD SELF EXPANDING XLG DIA,278,1 ,"$3,250.00 ","$2,112.50 ",$854.75 ,"$3,250.00 ", N/A ,"$1,495.00 ","$1,820.00 ", N/A ,$910.00 ,"$1,098.50 ", N/A ,"$1,264.25 ", N/A ,"$1,465.75 ","$1,465.75 ", N/A ,"$1,465.75 ", N/A ,"$1,625.00 ", N/A , N/A , N/A , N/A ,"$2,437.50 ","$1,950.00 ","$1,950.00 ", N/A ,"$1,950.00 ","$1,625.00 ","$1,625.00 ","$1,625.00 ","$3,250.00 ", N/A ,"$2,762.50 ", N/A ,"$2,112.50 ", N/A ,"$3,250.00 ","$1,820.00 ", N/A ,$854.75 , N/A , N/A , N/A , N/A ,"$2,600.00 ", N/A ,"$1,465.75 ",$910.00 ,"$2,925.00 ", N/A ,"$1,625.00 ","$1,225.25 ","$1,225.25 ", N/A ,"$1,225.25 ","$1,560.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801581,C1876,HC STENT PV NON-COVRD SUPERA,278,1 ,"$4,400.00 ","$2,860.00 ","$1,157.20 ","$4,400.00 ", N/A ,"$2,024.00 ","$2,464.00 ", N/A ,"$1,232.00 ","$1,487.20 ", N/A ,"$1,711.60 ", N/A ,"$1,984.40 ","$1,984.40 ", N/A ,"$1,984.40 ", N/A ,"$2,200.00 ", N/A , N/A , N/A , N/A ,"$3,300.00 ","$2,640.00 ","$2,640.00 ", N/A ,"$2,640.00 ","$2,200.00 ","$2,200.00 ","$2,200.00 ","$4,400.00 ", N/A ,"$3,740.00 ", N/A ,"$2,860.00 ", N/A ,"$4,400.00 ","$2,464.00 ", N/A ,"$1,157.20 ", N/A , N/A , N/A , N/A ,"$3,520.00 ", N/A ,"$1,984.40 ","$1,232.00 ","$3,960.00 ", N/A ,"$2,200.00 ","$1,658.80 ","$1,658.80 ", N/A ,"$1,658.80 ","$2,112.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801582,C1876,HC STENT PV NON-COVRD VISI-PRO,278,1 ,"$2,750.00 ","$1,787.50 ",$723.25 ,"$2,750.00 ", N/A ,"$1,265.00 ","$1,540.00 ", N/A ,$770.00 ,$929.50 , N/A ,"$1,069.75 ", N/A ,"$1,240.25 ","$1,240.25 ", N/A ,"$1,240.25 ", N/A ,"$1,375.00 ", N/A , N/A , N/A , N/A ,"$2,062.50 ","$1,650.00 ","$1,650.00 ", N/A ,"$1,650.00 ","$1,375.00 ","$1,375.00 ","$1,375.00 ","$2,750.00 ", N/A ,"$2,337.50 ", N/A ,"$1,787.50 ", N/A ,"$2,750.00 ","$1,540.00 ", N/A ,$723.25 , N/A , N/A , N/A , N/A ,"$2,200.00 ", N/A ,"$1,240.25 ",$770.00 ,"$2,475.00 ", N/A ,"$1,375.00 ","$1,036.75 ","$1,036.75 ", N/A ,"$1,036.75 ","$1,320.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801593,C1764,HC RECORDER CARDIAC EVENT IMPLANT T11,278,1 ,"$11,100.00 ","$7,215.00 ","$2,919.30 ","$11,100.00 ", N/A ,"$5,106.00 ","$6,216.00 ", N/A ,"$3,108.00 ","$3,751.80 ", N/A ,"$4,317.90 ", N/A ,"$5,006.10 ","$5,006.10 ", N/A ,"$5,006.10 ", N/A ,"$5,550.00 ", N/A , N/A , N/A , N/A ,"$8,325.00 ","$6,660.00 ","$6,660.00 ", N/A ,"$6,660.00 ","$5,550.00 ","$5,550.00 ","$5,550.00 ","$11,100.00 ", N/A ,"$9,435.00 ", N/A ,"$7,215.00 ", N/A ,"$11,100.00 ","$6,216.00 ", N/A ,"$2,919.30 ", N/A , N/A , N/A , N/A ,"$8,880.00 ", N/A ,"$5,006.10 ","$3,108.00 ","$9,990.00 ", N/A ,"$5,550.00 ","$4,184.70 ","$4,184.70 ", N/A ,"$4,184.70 ","$5,328.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801664,C1817,HC IMPLANT SEPTAL DEFECT SYSTEM INTRA-CARDIAC T29,278,1 ,"$23,500.00 ","$15,275.00 ","$6,180.50 ","$23,500.00 ", N/A ,"$10,810.00 ","$13,160.00 ", N/A ,"$6,580.00 ","$7,943.00 ", N/A ,"$9,141.50 ", N/A ,"$10,598.50 ","$10,598.50 ", N/A ,"$10,598.50 ", N/A ,"$11,750.00 ", N/A , N/A , N/A , N/A ,"$17,625.00 ","$14,100.00 ","$14,100.00 ", N/A ,"$14,100.00 ","$11,750.00 ","$11,750.00 ","$11,750.00 ","$23,500.00 ", N/A ,"$19,975.00 ", N/A ,"$15,275.00 ", N/A ,"$23,500.00 ","$13,160.00 ", N/A ,"$6,180.50 ", N/A , N/A , N/A , N/A ,"$18,800.00 ", N/A ,"$10,598.50 ","$6,580.00 ","$21,150.00 ", N/A ,"$11,750.00 ","$8,859.50 ","$8,859.50 ", N/A ,"$8,859.50 ","$11,280.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801669,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T5,278,1 ,"$2,100.00 ","$1,365.00 ",$552.30 ,"$2,100.00 ", N/A ,$966.00 ,"$1,176.00 ", N/A ,$588.00 ,$709.80 , N/A ,$816.90 , N/A ,$947.10 ,$947.10 , N/A ,$947.10 , N/A ,"$1,050.00 ", N/A , N/A , N/A , N/A ,"$1,575.00 ","$1,260.00 ","$1,260.00 ", N/A ,"$1,260.00 ","$1,050.00 ","$1,050.00 ","$1,050.00 ","$2,100.00 ", N/A ,"$1,785.00 ", N/A ,"$1,365.00 ", N/A ,"$2,100.00 ","$1,176.00 ", N/A ,$552.30 , N/A , N/A , N/A , N/A ,"$1,680.00 ", N/A ,$947.10 ,$588.00 ,"$1,890.00 ", N/A ,"$1,050.00 ",$791.70 ,$791.70 , N/A ,$791.70 ,"$1,008.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801705,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T2,278,1 ,$900.00 ,$585.00 ,$236.70 ,$900.00 , N/A , N/A ,$504.00 , N/A ,$252.00 ,$304.20 , N/A ,$350.10 , N/A ,$405.90 ,$405.90 , N/A ,$405.90 , N/A ,$450.00 , N/A , N/A , N/A , N/A ,$675.00 ,$540.00 ,$540.00 , N/A ,$540.00 ,$450.00 ,$450.00 ,$450.00 ,$900.00 , N/A ,$765.00 , N/A ,$585.00 , N/A ,$900.00 ,$504.00 , N/A ,$236.70 , N/A , N/A , N/A , N/A ,$720.00 , N/A ,$405.90 ,$252.00 ,$810.00 , N/A ,$450.00 , N/A , N/A , N/A , N/A ,$432.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27801728,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T25,278,1 ,"$6,900.00 ","$4,485.00 ","$1,814.70 ","$6,900.00 ", N/A ,"$3,174.00 ","$3,864.00 ", N/A ,"$1,932.00 ","$2,332.20 ", N/A ,"$2,684.10 ", N/A ,"$3,111.90 ","$3,111.90 ", N/A ,"$3,111.90 ", N/A ,"$3,450.00 ", N/A , N/A , N/A , N/A ,"$5,175.00 ","$4,140.00 ","$4,140.00 ", N/A ,"$4,140.00 ","$3,450.00 ","$3,450.00 ","$3,450.00 ","$6,900.00 ", N/A ,"$5,865.00 ", N/A ,"$4,485.00 ", N/A ,"$6,900.00 ","$3,864.00 ", N/A ,"$1,814.70 ", N/A , N/A , N/A , N/A ,"$5,520.00 ", N/A ,"$3,111.90 ","$1,932.00 ","$6,210.00 ", N/A ,"$3,450.00 ","$2,601.30 ","$2,601.30 ", N/A ,"$2,601.30 ","$3,312.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801769,C1880,HC FILTER VENA CAVA T7,278,1 ,"$3,300.00 ","$2,145.00 ",$867.90 ,"$3,300.00 ", N/A ,"$1,518.00 ","$1,848.00 ", N/A ,$924.00 ,"$1,115.40 ", N/A ,"$1,283.70 ", N/A ,"$1,488.30 ","$1,488.30 ", N/A ,"$1,488.30 ", N/A ,"$1,650.00 ", N/A , N/A , N/A , N/A ,"$2,475.00 ","$1,980.00 ","$1,980.00 ", N/A ,"$1,980.00 ","$1,650.00 ","$1,650.00 ","$1,650.00 ","$3,300.00 ", N/A ,"$2,805.00 ", N/A ,"$2,145.00 ", N/A ,"$3,300.00 ","$1,848.00 ", N/A ,$867.90 , N/A , N/A , N/A , N/A ,"$2,640.00 ", N/A ,"$1,488.30 ",$924.00 ,"$2,970.00 ", N/A ,"$1,650.00 ","$1,244.10 ","$1,244.10 ", N/A ,"$1,244.10 ","$1,584.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801770,C1880,HC FILTER VENA CAVA T8,278,1 ,"$5,025.00 ","$3,266.25 ","$1,321.58 ","$5,025.00 ", N/A ,"$2,311.50 ","$2,814.00 ", N/A ,"$1,407.00 ","$1,698.45 ", N/A ,"$1,954.73 ", N/A ,"$2,266.28 ","$2,266.28 ", N/A ,"$2,266.28 ", N/A ,"$2,512.50 ", N/A , N/A , N/A , N/A ,"$3,768.75 ","$3,015.00 ","$3,015.00 ", N/A ,"$3,015.00 ","$2,512.50 ","$2,512.50 ","$2,512.50 ","$5,025.00 ", N/A ,"$4,271.25 ", N/A ,"$3,266.25 ", N/A ,"$5,025.00 ","$2,814.00 ", N/A ,"$1,321.58 ", N/A , N/A , N/A , N/A ,"$4,020.00 ", N/A ,"$2,266.28 ","$1,407.00 ","$4,522.50 ", N/A ,"$2,512.50 ","$1,894.43 ","$1,894.43 ", N/A ,"$1,894.43 ","$2,412.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801819,C1895,HC LEAD ICD ENDOCARDIAL DUAL COIL T7,278,1 ,"$9,300.00 ","$6,045.00 ","$2,445.90 ","$9,300.00 ", N/A ,"$4,278.00 ","$5,208.00 ", N/A ,"$2,604.00 ","$3,143.40 ", N/A ,"$3,617.70 ", N/A ,"$4,194.30 ","$4,194.30 ", N/A ,"$4,194.30 ", N/A ,"$4,650.00 ", N/A , N/A , N/A , N/A ,"$6,975.00 ","$5,580.00 ","$5,580.00 ", N/A ,"$5,580.00 ","$4,650.00 ","$4,650.00 ","$4,650.00 ","$9,300.00 ", N/A ,"$7,905.00 ", N/A ,"$6,045.00 ", N/A ,"$9,300.00 ","$5,208.00 ", N/A ,"$2,445.90 ", N/A , N/A , N/A , N/A ,"$7,440.00 ", N/A ,"$4,194.30 ","$2,604.00 ","$8,370.00 ", N/A ,"$4,650.00 ","$3,506.10 ","$3,506.10 ", N/A ,"$3,506.10 ","$4,464.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801954,C1896,HC LEAD ICD NON ENDOCARDIAL T20,278,1 ,"$12,300.00 ","$7,995.00 ","$3,234.90 ","$12,300.00 ", N/A ,"$5,658.00 ","$6,888.00 ", N/A ,"$3,444.00 ","$4,157.40 ", N/A ,"$4,784.70 ", N/A ,"$5,547.30 ","$5,547.30 ", N/A ,"$5,547.30 ", N/A ,"$6,150.00 ", N/A , N/A , N/A , N/A ,"$9,225.00 ","$7,380.00 ","$7,380.00 ", N/A ,"$7,380.00 ","$6,150.00 ","$6,150.00 ","$6,150.00 ","$12,300.00 ", N/A ,"$10,455.00 ", N/A ,"$7,995.00 ", N/A ,"$12,300.00 ","$6,888.00 ", N/A ,"$3,234.90 ", N/A , N/A , N/A , N/A ,"$9,840.00 ", N/A ,"$5,547.30 ","$3,444.00 ","$11,070.00 ", N/A ,"$6,150.00 ","$4,637.10 ","$4,637.10 ", N/A ,"$4,637.10 ","$5,904.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27801970,C1898,HC LEAD PACEMAKER NON TRANSVENOUS SINGLE PASS T4,278,1 ,"$1,200.00 ",$780.00 ,$315.60 ,"$1,200.00 ", N/A ,$552.00 ,$672.00 , N/A ,$336.00 ,$405.60 , N/A ,$466.80 , N/A ,$541.20 ,$541.20 , N/A ,$541.20 , N/A ,$600.00 , N/A , N/A , N/A , N/A ,$900.00 ,$720.00 ,$720.00 , N/A ,$720.00 ,$600.00 ,$600.00 ,$600.00 ,"$1,200.00 ", N/A ,"$1,020.00 ", N/A ,$780.00 , N/A ,"$1,200.00 ",$672.00 , N/A ,$315.60 , N/A , N/A , N/A , N/A ,$960.00 , N/A ,$541.20 ,$336.00 ,"$1,080.00 ", N/A ,$600.00 , N/A , N/A , N/A , N/A ,$576.00 , N/A 
ST. ELIZABETH'S HOSPITAL,27801989,C1900,HC LEAD VENTRICULAR CORONARY VENOUS T3,278,1 ,"$14,700.00 ","$9,555.00 ","$3,866.10 ","$14,700.00 ", N/A ,"$6,762.00 ","$8,232.00 ", N/A ,"$4,116.00 ","$4,968.60 ", N/A ,"$5,718.30 ", N/A ,"$6,629.70 ","$6,629.70 ", N/A ,"$6,629.70 ", N/A ,"$7,350.00 ", N/A , N/A , N/A , N/A ,"$11,025.00 ","$8,820.00 ","$8,820.00 ", N/A ,"$8,820.00 ","$7,350.00 ","$7,350.00 ","$7,350.00 ","$14,700.00 ", N/A ,"$12,495.00 ", N/A ,"$9,555.00 ", N/A ,"$14,700.00 ","$8,232.00 ", N/A ,"$3,866.10 ", N/A , N/A , N/A , N/A ,"$11,760.00 ", N/A ,"$6,629.70 ","$4,116.00 ","$13,230.00 ", N/A ,"$7,350.00 ","$5,541.90 ","$5,541.90 ", N/A ,"$5,541.90 ","$7,056.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802035,N/A,HC IMPLANT SURGICAL T20,278,1 ,"$3,300.00 ","$2,145.00 ",$867.90 ,"$3,300.00 ", N/A ,"$1,518.00 ","$1,848.00 ", N/A ,$924.00 ,"$1,115.40 ", N/A ,"$1,283.70 ", N/A ,"$1,488.30 ","$1,488.30 ", N/A ,"$1,488.30 ", N/A ,"$1,650.00 ", N/A , N/A , N/A , N/A ,"$2,475.00 ","$1,980.00 ","$1,980.00 ", N/A ,"$1,980.00 ","$1,650.00 ","$1,650.00 ","$1,650.00 ","$3,300.00 ", N/A ,"$2,805.00 ", N/A ,"$2,145.00 ", N/A ,"$3,300.00 ","$1,848.00 ", N/A ,$867.90 , N/A , N/A , N/A , N/A ,"$2,640.00 ", N/A ,"$1,488.30 ",$924.00 ,"$2,970.00 ", N/A ,"$1,650.00 ","$1,244.10 ","$1,244.10 ", N/A ,"$1,244.10 ","$1,584.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802130,C2624,HC SENSOR PULM ARTERY W/CATHETER,278,1 ,"$43,000.00 ","$27,950.00 ","$11,309.00 ","$43,000.00 ", N/A ,"$19,780.00 ","$24,080.00 ", N/A ,"$12,040.00 ","$14,534.00 ", N/A ,"$16,727.00 ", N/A ,"$19,393.00 ","$19,393.00 ", N/A ,"$19,393.00 ", N/A ,"$21,500.00 ", N/A , N/A , N/A , N/A ,"$32,250.00 ","$25,800.00 ","$25,800.00 ", N/A ,"$25,800.00 ","$21,500.00 ","$21,500.00 ","$21,500.00 ","$43,000.00 ", N/A ,"$36,550.00 ", N/A ,"$27,950.00 ", N/A ,"$43,000.00 ","$24,080.00 ", N/A ,"$11,309.00 ", N/A , N/A , N/A , N/A ,"$34,400.00 ", N/A ,"$19,393.00 ","$12,040.00 ","$38,700.00 ", N/A ,"$21,500.00 ","$16,211.00 ","$16,211.00 ", N/A ,"$16,211.00 ","$20,640.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802132,N/A,HC DEVICE CLOSURE LAA,278,1 ,"$42,000.00 ","$27,300.00 ","$11,046.00 ","$42,000.00 ", N/A ,"$19,320.00 ","$23,520.00 ", N/A ,"$11,760.00 ","$14,196.00 ", N/A ,"$16,338.00 ", N/A ,"$18,942.00 ","$18,942.00 ", N/A ,"$18,942.00 ", N/A ,"$21,000.00 ", N/A , N/A , N/A , N/A ,"$31,500.00 ","$25,200.00 ","$25,200.00 ", N/A ,"$25,200.00 ","$21,000.00 ","$21,000.00 ","$21,000.00 ","$42,000.00 ", N/A ,"$35,700.00 ", N/A ,"$27,300.00 ", N/A ,"$42,000.00 ","$23,520.00 ", N/A ,"$11,046.00 ", N/A , N/A , N/A , N/A ,"$33,600.00 ", N/A ,"$18,942.00 ","$11,760.00 ","$37,800.00 ", N/A ,"$21,000.00 ","$15,834.00 ","$15,834.00 ", N/A ,"$15,834.00 ","$20,160.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802134,N/A,HC DEVICE VENTRICULAR ASSIST LEFT,278,1 ,"$51,500.00 ","$33,475.00 ","$13,544.50 ","$51,500.00 ", N/A ,"$23,690.00 ","$28,840.00 ", N/A ,"$14,420.00 ","$17,407.00 ", N/A ,"$20,033.50 ", N/A ,"$23,226.50 ","$23,226.50 ", N/A ,"$23,226.50 ", N/A ,"$25,750.00 ", N/A , N/A , N/A , N/A ,"$38,625.00 ","$30,900.00 ","$30,900.00 ", N/A ,"$30,900.00 ","$25,750.00 ","$25,750.00 ","$25,750.00 ","$51,500.00 ", N/A ,"$43,775.00 ", N/A ,"$33,475.00 ", N/A ,"$51,500.00 ","$28,840.00 ", N/A ,"$13,544.50 ", N/A , N/A , N/A , N/A ,"$41,200.00 ", N/A ,"$23,226.50 ","$14,420.00 ","$46,350.00 ", N/A ,"$25,750.00 ","$19,415.50 ","$19,415.50 ", N/A ,"$19,415.50 ","$24,720.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802136,N/A,HC SYSTEM HEART VALVE TRANSCATH COREVALVE,278,1 ,"$76,500.00 ","$49,725.00 ","$20,119.50 ","$76,500.00 ", N/A ,"$35,190.00 ","$42,840.00 ", N/A ,"$21,420.00 ","$25,857.00 ", N/A ,"$29,758.50 ", N/A ,"$34,501.50 ","$34,501.50 ", N/A ,"$34,501.50 ", N/A ,"$38,250.00 ", N/A , N/A , N/A , N/A ,"$57,375.00 ","$45,900.00 ","$45,900.00 ", N/A ,"$45,900.00 ","$38,250.00 ","$38,250.00 ","$38,250.00 ","$76,500.00 ", N/A ,"$65,025.00 ", N/A ,"$49,725.00 ", N/A ,"$76,500.00 ","$42,840.00 ", N/A ,"$20,119.50 ", N/A , N/A , N/A , N/A ,"$61,200.00 ", N/A ,"$34,501.50 ","$21,420.00 ","$68,850.00 ", N/A ,"$38,250.00 ","$28,840.50 ","$28,840.50 ", N/A ,"$28,840.50 ","$36,720.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802137,N/A,HC SYSTEM HEART VALVE TRANSCATH SAPIEN 3,278,1 ,"$75,000.00 ","$48,750.00 ","$19,725.00 ","$75,000.00 ", N/A ,"$34,500.00 ","$42,000.00 ", N/A ,"$21,000.00 ","$25,350.00 ", N/A ,"$29,175.00 ", N/A ,"$33,825.00 ","$33,825.00 ", N/A ,"$33,825.00 ", N/A ,"$37,500.00 ", N/A , N/A , N/A , N/A ,"$56,250.00 ","$45,000.00 ","$45,000.00 ", N/A ,"$45,000.00 ","$37,500.00 ","$37,500.00 ","$37,500.00 ","$75,000.00 ", N/A ,"$63,750.00 ", N/A ,"$48,750.00 ", N/A ,"$75,000.00 ","$42,000.00 ", N/A ,"$19,725.00 ", N/A , N/A , N/A , N/A ,"$60,000.00 ", N/A ,"$33,825.00 ","$21,000.00 ","$67,500.00 ", N/A ,"$37,500.00 ","$28,275.00 ","$28,275.00 ", N/A ,"$28,275.00 ","$36,000.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802152,C2615,HC SEALANT PULMONARY LIQUID,278,1 ,"$2,550.00 ","$1,657.50 ",$670.65 ,"$2,550.00 ", N/A ,"$1,173.00 ","$1,428.00 ", N/A ,$714.00 ,$861.90 , N/A ,$991.95 , N/A ,"$1,150.05 ","$1,150.05 ", N/A ,"$1,150.05 ", N/A ,"$1,275.00 ", N/A , N/A , N/A , N/A ,"$1,912.50 ","$1,530.00 ","$1,530.00 ", N/A ,"$1,530.00 ","$1,275.00 ","$1,275.00 ","$1,275.00 ","$2,550.00 ", N/A ,"$2,167.50 ", N/A ,"$1,657.50 ", N/A ,"$2,550.00 ","$1,428.00 ", N/A ,$670.65 , N/A , N/A , N/A , N/A ,"$2,040.00 ", N/A ,"$1,150.05 ",$714.00 ,"$2,295.00 ", N/A ,"$1,275.00 ",$961.35 ,$961.35 , N/A ,$961.35 ,"$1,224.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802160,C1713,HC CEMENT BONE VERTAPLEX,278,1 ,$181.00 ,$117.65 ,$47.60 ,$181.00 , N/A , N/A ,$101.36 , N/A ,$50.68 ,$61.18 , N/A ,$70.41 , N/A ,$81.63 ,$81.63 , N/A ,$81.63 , N/A ,$90.50 , N/A , N/A , N/A , N/A ,$135.75 ,$108.60 ,$108.60 , N/A ,$108.60 ,$90.50 ,$90.50 ,$90.50 ,$181.00 , N/A ,$153.85 , N/A ,$117.65 , N/A ,$181.00 ,$101.36 , N/A ,$47.60 , N/A , N/A , N/A , N/A ,$144.80 , N/A ,$81.63 ,$50.68 ,$162.90 , N/A ,$90.50 , N/A , N/A , N/A , N/A ,$86.88 , N/A 
ST. ELIZABETH'S HOSPITAL,27802173,C1713,HC KIT SPINEJACK SYTEM,278,1 ,"$11,245.00 ","$7,309.25 ","$2,957.44 ","$11,245.00 ", N/A ,"$5,172.70 ","$6,297.20 ", N/A ,"$3,148.60 ","$3,800.81 ", N/A ,"$4,374.31 ", N/A ,"$5,071.50 ","$5,071.50 ", N/A ,"$5,071.50 ", N/A ,"$5,622.50 ", N/A , N/A , N/A , N/A ,"$8,433.75 ","$6,747.00 ","$6,747.00 ", N/A ,"$6,747.00 ","$5,622.50 ","$5,622.50 ","$5,622.50 ","$11,245.00 ", N/A ,"$9,558.25 ", N/A ,"$7,309.25 ", N/A ,"$11,245.00 ","$6,297.20 ", N/A ,"$2,957.44 ", N/A , N/A , N/A , N/A ,"$8,996.00 ", N/A ,"$5,071.50 ","$3,148.60 ","$10,120.50 ", N/A ,"$5,622.50 ","$4,239.37 ","$4,239.37 ", N/A ,"$4,239.37 ","$5,397.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802179,C1876,HC TRYTON SIDE BRANCH STENT,278,1 ,"$2,600.00 ","$1,690.00 ",$683.80 ,"$2,600.00 ", N/A ,"$1,196.00 ","$1,456.00 ", N/A ,$728.00 ,$878.80 , N/A ,"$1,011.40 ", N/A ,"$1,172.60 ","$1,172.60 ", N/A ,"$1,172.60 ", N/A ,"$1,300.00 ", N/A , N/A , N/A , N/A ,"$1,950.00 ","$1,560.00 ","$1,560.00 ", N/A ,"$1,560.00 ","$1,300.00 ","$1,300.00 ","$1,300.00 ","$2,600.00 ", N/A ,"$2,210.00 ", N/A ,"$1,690.00 ", N/A ,"$2,600.00 ","$1,456.00 ", N/A ,$683.80 , N/A , N/A , N/A , N/A ,"$2,080.00 ", N/A ,"$1,172.60 ",$728.00 ,"$2,340.00 ", N/A ,"$1,300.00 ",$980.20 ,$980.20 , N/A ,$980.20 ,"$1,248.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27802182,C1876,HC WALLSTENT ENDOPROSTHESIS TRACHEOBRONCHIAL,278,1 ,"$2,475.00 ","$1,608.75 ",$650.93 ,"$2,475.00 ", N/A ,"$1,138.50 ","$1,386.00 ", N/A ,$693.00 ,$836.55 , N/A ,$962.78 , N/A ,"$1,116.23 ","$1,116.23 ", N/A ,"$1,116.23 ", N/A ,"$1,237.50 ", N/A , N/A , N/A , N/A ,"$1,856.25 ","$1,485.00 ","$1,485.00 ", N/A ,"$1,485.00 ","$1,237.50 ","$1,237.50 ","$1,237.50 ","$2,475.00 ", N/A ,"$2,103.75 ", N/A ,"$1,608.75 ", N/A ,"$2,475.00 ","$1,386.00 ", N/A ,$650.93 , N/A , N/A , N/A , N/A ,"$1,980.00 ", N/A ,"$1,116.23 ",$693.00 ,"$2,227.50 ", N/A ,"$1,237.50 ",$933.08 ,$933.08 , N/A ,$933.08 ,"$1,188.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27870000,N/A,HC IMPLANTS,278,1 ,"$4,132.93 ","$2,686.40 ","$1,086.96 ","$4,132.93 ", N/A ,"$1,901.15 ","$2,314.44 ", N/A ,"$1,157.22 ","$1,396.93 ", N/A ,"$1,607.71 ", N/A ,"$1,863.95 ","$1,863.95 ", N/A ,"$1,863.95 ", N/A ,"$2,066.47 ", N/A , N/A , N/A , N/A ,"$3,099.70 ","$2,479.76 ","$2,479.76 ", N/A ,"$2,479.76 ","$2,066.47 ","$2,066.47 ","$2,066.47 ","$4,132.93 ", N/A ,"$3,512.99 ", N/A ,"$2,686.40 ", N/A ,"$4,132.93 ","$2,314.44 ", N/A ,"$1,086.96 ", N/A , N/A , N/A , N/A ,"$3,306.34 ", N/A ,"$1,863.95 ","$1,157.22 ","$3,719.64 ", N/A ,"$2,066.47 ","$1,558.11 ","$1,558.11 ", N/A ,"$1,558.11 ","$1,983.81 ", N/A 
ST. ELIZABETH'S HOSPITAL,27871762,C1762,"HC CONNECTIVE TISSUE, HUMAN (INCLUDES FASCIA LATA",278,1 ,"$9,300.00 ","$6,045.00 ","$2,445.90 ","$9,300.00 ", N/A ,"$4,278.00 ","$5,208.00 ", N/A ,"$2,604.00 ","$3,143.40 ", N/A ,"$3,617.70 ", N/A ,"$4,194.30 ","$4,194.30 ", N/A ,"$4,194.30 ", N/A ,"$4,650.00 ", N/A , N/A , N/A , N/A ,"$6,975.00 ","$5,580.00 ","$5,580.00 ", N/A ,"$5,580.00 ","$4,650.00 ","$4,650.00 ","$4,650.00 ","$9,300.00 ", N/A ,"$7,905.00 ", N/A ,"$6,045.00 ", N/A ,"$9,300.00 ","$5,208.00 ", N/A ,"$2,445.90 ", N/A , N/A , N/A , N/A ,"$7,440.00 ", N/A ,"$4,194.30 ","$2,604.00 ","$8,370.00 ", N/A ,"$4,650.00 ","$3,506.10 ","$3,506.10 ", N/A ,"$3,506.10 ","$4,464.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27871768,C1768,"HC GRAFT, VASCULAR",278,1 ,"$1,361.19 ",$884.77 ,$357.99 ,"$1,361.19 ", N/A ,$626.15 ,$762.27 , N/A ,$381.13 ,$460.08 , N/A ,$529.50 , N/A ,$613.90 ,$613.90 , N/A ,$613.90 , N/A ,$680.60 , N/A , N/A , N/A , N/A ,"$1,020.89 ",$816.71 ,$816.71 , N/A ,$816.71 ,$680.60 ,$680.60 ,$680.60 ,"$1,361.19 ", N/A ,"$1,157.01 ", N/A ,$884.77 , N/A ,"$1,361.19 ",$762.27 , N/A ,$357.99 , N/A , N/A , N/A , N/A ,"$1,088.95 ", N/A ,$613.90 ,$381.13 ,"$1,225.07 ", N/A ,$680.60 , N/A , N/A , N/A , N/A ,$653.37 , N/A 
ST. ELIZABETH'S HOSPITAL,27871819,C1819,HC WIRE LOCALIZATION BREAST,278,1 ,$821.00 ,$533.65 ,$215.92 ,$821.00 , N/A , N/A ,$459.76 , N/A ,$229.88 ,$277.50 , N/A ,$319.37 , N/A ,$370.27 ,$370.27 , N/A ,$370.27 , N/A ,$410.50 , N/A , N/A , N/A , N/A ,$615.75 ,$492.60 ,$492.60 , N/A ,$492.60 ,$410.50 ,$410.50 ,$410.50 ,$821.00 , N/A ,$697.85 , N/A ,$533.65 , N/A ,$821.00 ,$459.76 , N/A ,$215.92 , N/A , N/A , N/A , N/A ,$656.80 , N/A ,$370.27 ,$229.88 ,$738.90 , N/A ,$410.50 , N/A , N/A , N/A , N/A ,$394.08 , N/A 
ST. ELIZABETH'S HOSPITAL,27871892,C1892,"HC INTRODUCER/SHEATH, GUIDING, INTRACARDIAC EPL, FIXED-CURVE, PEEL-AWAY",278,1 ,$48.60 ,$31.59 ,$12.78 ,$48.60 , N/A , N/A ,$27.22 , N/A ,$13.61 ,$16.43 , N/A ,$18.91 , N/A ,$21.92 ,$21.92 , N/A ,$21.92 , N/A ,$24.30 , N/A , N/A , N/A , N/A ,$36.45 ,$29.16 ,$29.16 , N/A ,$29.16 ,$24.30 ,$24.30 ,$24.30 ,$48.60 , N/A ,$41.31 , N/A ,$31.59 , N/A ,$48.60 ,$27.22 , N/A ,$12.78 , N/A , N/A , N/A , N/A ,$38.88 , N/A ,$21.92 ,$13.61 ,$43.74 , N/A ,$24.30 , N/A , N/A , N/A , N/A ,$23.33 , N/A 
ST. ELIZABETH'S HOSPITAL,27878699,L8699,HC PROSTHETIC IMPLANTS NOS,278,1 ,"$3,300.00 ","$2,145.00 ",$867.90 ,"$3,300.00 ", N/A ,"$1,518.00 ","$1,848.00 ", N/A ,$924.00 ,"$1,115.40 ", N/A ,"$1,283.70 ", N/A ,"$1,488.30 ","$1,488.30 ", N/A ,"$1,488.30 ", N/A ,"$1,650.00 ", N/A , N/A , N/A , N/A ,"$2,475.00 ","$1,980.00 ","$1,980.00 ", N/A ,"$1,980.00 ","$1,650.00 ","$1,650.00 ","$1,650.00 ","$3,300.00 ", N/A ,"$2,805.00 ", N/A ,"$2,145.00 ", N/A ,"$3,300.00 ","$1,848.00 ", N/A ,$867.90 , N/A , N/A , N/A , N/A ,"$2,640.00 ", N/A ,"$1,488.30 ",$924.00 ,"$2,970.00 ", N/A ,"$1,650.00 ","$1,244.10 ","$1,244.10 ", N/A ,"$1,244.10 ","$1,584.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,27879354,C9354,HC PERICARDIAL TISSUE MATRIX NON-HUMAN PER SQ CM,278,1 ,"$2,100.00 ","$1,365.00 ",$552.30 ,"$2,100.00 ", N/A ,$966.00 ,"$1,176.00 ", N/A ,$588.00 ,$709.80 , N/A ,$816.90 , N/A ,$947.10 ,$947.10 , N/A ,$947.10 , N/A ,"$1,050.00 ", N/A , N/A , N/A , N/A ,"$1,575.00 ","$1,260.00 ","$1,260.00 ", N/A ,"$1,260.00 ","$1,050.00 ","$1,050.00 ","$1,050.00 ","$2,100.00 ", N/A ,"$1,785.00 ", N/A ,"$1,365.00 ", N/A ,"$2,100.00 ","$1,176.00 ", N/A ,$552.30 , N/A , N/A , N/A , N/A ,"$1,680.00 ", N/A ,$947.10 ,$588.00 ,"$1,890.00 ", N/A ,"$1,050.00 ",$791.70 ,$791.70 , N/A ,$791.70 ,"$1,008.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,29200003,N/A,HC CRUTCHES PER PAIR,271,1 ,$99.27 ,$64.53 ,$26.11 ,$99.27 , N/A ,$45.66 ,$55.59 , N/A ,$27.80 ,$33.55 , N/A ,$38.62 , N/A ,$44.77 ,$44.77 , N/A ,$64.53 , N/A ,$49.64 , N/A , N/A , N/A , N/A ,$74.45 ,$59.56 ,$59.56 , N/A ,$59.56 ,$75.45 ,$75.45 ,$75.45 ,$99.27 , N/A ,$84.38 , N/A ,$64.53 , N/A ,$99.27 ,$55.59 , N/A ,$26.11 , N/A , N/A , N/A , N/A ,$79.42 , N/A ,$44.77 ,$27.80 ,$89.34 , N/A ,$75.45 ,$64.53 ,$64.53 , N/A ,$64.53 ,$47.65 , N/A 
ST. ELIZABETH'S HOSPITAL,30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$104.00 ,$67.60 ,$3.42 ,$104.00 , N/A ,$47.84 ,$58.24 , N/A ,$29.12 ,$35.15 , N/A ,$40.46 , N/A ,$46.90 ,$46.90 , N/A ,$67.60 , N/A ,$3.42 , N/A , N/A , N/A , N/A ,$78.00 ,$62.40 ,$62.40 , N/A ,$62.40 ,$72.80 ,$72.80 ,$72.80 ,$104.00 , N/A ,$88.40 , N/A ,$67.60 , N/A ,$104.00 ,$58.24 , N/A ,$27.35 , N/A , N/A , N/A , N/A ,$83.20 , N/A ,$46.90 ,$29.12 ,$93.60 , N/A ,$72.80 ,$6.28 ,$6.28 , N/A ,$6.28 ,$49.92 , N/A 
ST. ELIZABETH'S HOSPITAL,30000010,36415,HC VENIPUNCTURE,300,1 ,$33.00 ,$21.45 ,$2.25 ,$33.00 ,$7.50 ,$15.18 ,$18.48 ,$3.00 ,$9.24 ,$11.15 ,$3.00 ,$12.84 ,$3.00 ,$14.88 ,$14.88 ,$3.00 ,$3.75 ,$5.70 ,$3.55 ,$7.50 ,$3.00 ,$3.00 ,$3.06 ,$24.75 , N/A , N/A ,$3.00 , N/A ,$3.90 ,$3.90 ,$3.90 ,$33.00 , N/A ,$28.05 ,$7.50 ,$21.45 ,$3.00 ,$3.00 ,$18.48 ,$3.00 ,$8.68 , N/A ,$2.48 ,$2.36 ,$3.15 ,$26.40 ,$6.75 ,$14.88 ,$9.24 ,$29.70 ,$3.00 ,$3.90 ,$6.00 ,$6.00 ,$3.00 ,$6.00 ,$15.84 ,$2.25 
ST. ELIZABETH'S HOSPITAL,30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$202.00 ,$131.30 ,$46.46 ,$277.93 ,$277.93 ,$92.92 ,$113.12 ,$111.17 ,$56.56 ,$68.28 ,$111.17 ,$78.58 ,$111.17 ,$91.10 ,$91.10 ,$111.17 ,$131.30 ,$202.00 ,$101.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$151.50 ,$121.20 ,$121.20 ,$111.17 ,$121.20 ,$141.40 ,$141.40 ,$141.40 ,$202.00 , N/A ,$171.70 ,$202.00 ,$131.30 ,$111.17 ,$202.00 ,$113.12 ,$111.17 ,$53.13 , N/A ,$51.11 ,$48.78 ,$116.73 ,$161.60 ,$250.12 ,$91.10 ,$56.56 ,$181.80 ,$111.17 ,$141.40 , N/A , N/A ,$111.17 , N/A ,$96.96 ,$46.46 
ST. ELIZABETH'S HOSPITAL,30000104,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$67.00 ,$43.55 ,$4.27 ,$67.00 ,$10.68 ,$7.37 ,$37.52 ,$4.27 ,$18.76 ,$23.65 ,$4.27 ,$27.60 ,$4.27 ,$30.22 ,$30.22 ,$4.27 ,$5.34 ,$8.11 ,$8.18 ,$10.68 ,$4.27 ,$4.27 ,$4.36 ,$50.25 ,$40.20 ,$40.20 ,$4.27 ,$40.20 ,$6.18 ,$6.18 ,$6.18 ,$67.00 , N/A ,$56.95 ,$10.68 ,$43.55 ,$4.27 ,$67.00 ,$37.52 ,$4.27 ,$17.62 , N/A ,$7.38 ,$7.05 ,$4.48 ,$53.60 ,$9.61 ,$30.22 ,$18.76 ,$60.30 ,$4.27 ,$6.18 ,$8.54 ,$8.54 ,$4.27 ,$8.54 ,$32.16 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30000105,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$37.00 ,$24.05 ,$7.33 ,$37.00 ,$18.33 ,$12.32 ,$20.72 ,$7.33 ,$10.36 ,$13.06 ,$7.33 ,$15.24 ,$7.33 ,$16.69 ,$16.69 ,$7.33 ,$9.16 ,$13.93 ,$13.84 ,$18.33 ,$7.33 ,$7.33 ,$7.48 ,$27.75 ,$22.20 ,$22.20 ,$7.33 ,$22.20 ,$10.34 ,$10.34 ,$10.34 ,$37.00 , N/A ,$31.45 ,$18.33 ,$24.05 ,$7.33 ,$37.00 ,$20.72 ,$7.33 ,$9.73 , N/A ,$33.95 ,$32.40 ,$7.70 ,$29.60 ,$16.49 ,$16.69 ,$10.36 ,$33.30 ,$7.33 ,$10.34 ,$14.66 ,$14.66 ,$7.33 ,$14.66 ,$17.76 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30000107,89190,HC SMEAR NASAL EOSINOPHILS,300,1 ,$64.00 ,$41.60 ,$5.79 ,$64.00 ,$14.48 ,$8.19 ,$35.84 ,$5.79 ,$17.92 ,$22.59 ,$5.79 ,$26.37 ,$5.79 ,$28.86 ,$28.86 ,$5.79 ,$7.24 ,$11.00 ,$10.06 ,$14.48 ,$5.79 ,$5.79 ,$5.91 ,$48.00 ,$38.40 ,$38.40 ,$5.79 ,$38.40 ,$7.53 ,$7.53 ,$7.53 ,$64.00 , N/A ,$54.40 ,$14.48 ,$41.60 ,$5.79 ,$64.00 ,$35.84 ,$5.79 ,$16.83 , N/A ,$33.95 ,$32.40 ,$6.08 ,$51.20 ,$13.03 ,$28.86 ,$17.92 ,$57.60 ,$5.79 ,$7.53 ,$11.58 ,$11.58 ,$5.79 ,$11.58 ,$30.72 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30000112,89320,HC SEMEN ANALYSIS COMPLETE,300,1 ,$404.00 ,$262.60 ,$12.31 ,$404.00 ,$30.78 ,$17.34 ,$226.24 ,$12.31 ,$113.12 ,$122.26 ,$12.31 ,$122.26 ,$12.31 ,$182.20 ,$182.20 ,$12.31 ,$15.39 ,$23.39 ,$23.27 ,$30.78 ,$12.31 ,$12.31 ,$12.56 ,$303.00 ,$242.40 ,$242.40 ,$12.31 ,$242.40 ,$17.41 ,$17.41 ,$17.41 ,$404.00 , N/A ,$343.40 ,$30.78 ,$262.60 ,$12.31 ,$404.00 ,$226.24 ,$12.31 ,$106.25 , N/A ,$33.95 ,$32.40 ,$12.93 ,$323.20 ,$27.70 ,$182.20 ,$113.12 ,$363.60 ,$12.31 ,$17.41 ,$24.62 ,$24.62 ,$12.31 ,$24.62 ,$193.92 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30000213,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$253.00 ,$164.45 ,$46.46 ,$277.93 ,$277.93 ,$116.38 ,$141.68 ,$111.17 ,$70.84 ,$85.51 ,$111.17 ,$98.42 ,$111.17 ,$114.10 ,$114.10 ,$111.17 ,$164.45 ,$211.22 ,$126.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$189.75 ,$151.80 ,$151.80 ,$111.17 ,$151.80 ,$177.10 ,$177.10 ,$177.10 ,$253.00 , N/A ,$215.05 ,$253.00 ,$164.45 ,$111.17 ,$253.00 ,$141.68 ,$111.17 ,$66.54 , N/A ,$51.11 ,$48.78 ,$116.73 ,$202.40 ,$250.12 ,$114.10 ,$70.84 ,$227.70 ,$111.17 ,$177.10 , N/A , N/A ,$111.17 , N/A ,$121.44 ,$46.46 
ST. ELIZABETH'S HOSPITAL,30000218,86927,HC FFP THAWING EACH UNIT,300,1 ,$115.00 ,$74.75 ,$15.61 ,$367.60 ,$367.60 ,$15.61 ,$64.40 ,$147.04 ,$32.20 ,$40.60 ,$147.04 ,$47.38 ,$115.00 ,$51.87 ,$51.87 ,$115.00 ,$74.75 ,$115.00 ,$35.85 ,$367.59 ,$147.04 ,$147.04 ,$115.00 ,$86.25 ,$69.00 ,$69.00 ,$147.04 ,$69.00 ,$80.50 ,$80.50 ,$80.50 ,$115.00 , N/A ,$97.75 ,$115.00 ,$74.75 ,$147.04 ,$115.00 ,$64.40 ,$147.04 ,$30.25 , N/A ,$42.96 ,$41.00 ,$154.39 ,$92.00 ,$330.83 ,$51.87 ,$32.20 ,$103.50 ,$147.04 ,$80.50 ,$115.00 ,$115.00 ,$115.00 ,$115.00 ,$55.20 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30000243,89050,HC BODY FLUID CELL COUNT,300,1 ,$122.00 ,$79.30 ,$4.72 ,$122.00 ,$11.80 ,$8.16 ,$68.32 ,$4.72 ,$34.16 ,$43.07 ,$4.72 ,$47.91 ,$4.72 ,$55.02 ,$55.02 ,$4.72 ,$5.90 ,$8.97 ,$9.44 ,$11.80 ,$4.72 ,$4.72 ,$4.81 ,$91.50 ,$73.20 ,$73.20 ,$4.72 ,$73.20 ,$6.83 ,$6.83 ,$6.83 ,$122.00 , N/A ,$103.70 ,$11.80 ,$79.30 ,$4.72 ,$122.00 ,$68.32 ,$4.72 ,$32.09 , N/A ,$33.95 ,$32.40 ,$4.96 ,$97.60 ,$10.62 ,$55.02 ,$34.16 ,$109.80 ,$4.72 ,$6.83 ,$9.44 ,$9.44 ,$4.72 ,$9.44 ,$58.56 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30000252,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$106.00 ,$68.90 ,$12.05 ,$106.00 ,$30.13 ,$17.34 ,$59.36 ,$12.05 ,$29.68 ,$37.42 ,$12.05 ,$43.67 ,$12.05 ,$47.81 ,$47.81 ,$12.05 ,$15.06 ,$22.90 ,$23.27 ,$30.13 ,$12.05 ,$12.05 ,$12.29 ,$79.50 ,$63.60 ,$63.60 ,$12.05 ,$63.60 ,$17.41 ,$17.41 ,$17.41 ,$106.00 , N/A ,$90.10 ,$30.13 ,$68.90 ,$12.05 ,$106.00 ,$59.36 ,$12.05 ,$27.88 , N/A ,$33.95 ,$32.40 ,$12.65 ,$84.80 ,$27.11 ,$47.81 ,$29.68 ,$95.40 ,$12.05 ,$17.41 ,$24.10 ,$24.10 ,$12.05 ,$24.10 ,$50.88 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30000260,36600,HC ARTERIAL PUNCTURE,300,1 ,$375.00 ,$243.75 ,$46.46 ,$375.00 ,$277.93 ,$172.50 ,$210.00 ,$111.17 ,$105.00 ,$126.75 ,$111.17 ,$145.88 ,$111.17 ,$169.13 ,$169.13 ,$111.17 ,$243.75 ,$211.22 ,$187.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$281.25 ,$225.00 ,$225.00 ,$111.17 ,$225.00 ,$262.50 ,$262.50 ,$262.50 ,$375.00 , N/A ,$318.75 ,$277.92 ,$243.75 ,$111.17 ,$375.00 ,$210.00 ,$111.17 ,$98.63 , N/A ,$51.11 ,$48.78 ,$116.73 ,$300.00 ,$250.12 ,$169.13 ,$105.00 ,$337.50 ,$111.17 ,$262.50 , N/A , N/A ,$111.17 , N/A ,$180.00 ,$46.46 
ST. ELIZABETH'S HOSPITAL,30000463,76120,HC CINERADIOGRAPHY 76120,320,1 ,$319.00 ,$207.35 ,$53.35 ,$319.00 ,$268.33 ,$104.52 ,$178.64 ,$107.33 ,$89.32 ,$112.61 ,$107.33 ,$131.43 ,$107.33 ,$143.87 ,$143.87 ,$107.33 ,$118.89 ,$203.93 ,$224.26 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$239.25 ,$191.40 ,$191.40 ,$107.33 ,$191.40 ,$116.91 ,$116.91 ,$116.91 ,$319.00 , N/A ,$271.15 ,$268.33 ,$207.35 ,$107.33 ,$319.00 ,$178.64 ,$107.33 ,$83.90 , N/A ,$58.69 ,$56.02 ,$112.70 ,$255.20 ,$241.50 ,$143.87 ,$89.32 ,$287.10 ,$107.33 ,$116.91 ,$319.00 ,$319.00 ,$107.33 ,$319.00 ,$153.12 ,$53.35 
ST. ELIZABETH'S HOSPITAL,30002015,89050,HC BODY FLUID CELL COUNT,300,1 ,$5.00 ,$3.25 ,$1.32 ,$30.86 ,$11.80 ,$5.00 ,$2.80 ,$4.72 ,$1.40 ,$1.77 ,$4.72 ,$2.06 ,$4.72 ,$2.26 ,$2.26 ,$4.72 ,$5.00 ,$5.00 ,$5.00 ,$11.80 ,$4.72 ,$4.72 ,$4.81 ,$3.75 ,$3.00 ,$3.00 ,$4.72 ,$3.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 , N/A ,$4.25 ,$5.00 ,$3.25 ,$4.72 ,$5.00 ,$2.80 ,$4.72 ,$1.32 , N/A ,$5.00 ,$5.00 ,$4.96 ,$4.00 ,$10.62 ,$2.26 ,$1.40 ,$4.50 ,$4.72 ,$5.00 ,$5.00 ,$5.00 ,$4.72 ,$5.00 ,$2.40 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30100121,80164,HC VALPROIC ACID,301,1 ,$213.00 ,$138.45 ,$12.40 ,$213.00 ,$33.85 ,$23.35 ,$119.28 ,$13.54 ,$59.64 ,$75.19 ,$13.54 ,$87.76 ,$13.54 ,$96.06 ,$96.06 ,$13.54 ,$16.93 ,$25.73 ,$26.42 ,$33.85 ,$13.54 ,$13.54 ,$13.81 ,$159.75 ,$127.80 ,$127.80 ,$13.54 ,$127.80 ,$19.57 ,$19.57 ,$19.57 ,$213.00 , N/A ,$181.05 ,$33.85 ,$138.45 ,$13.54 ,$213.00 ,$119.28 ,$13.54 ,$56.02 , N/A ,$13.64 ,$13.02 ,$14.22 ,$170.40 ,$30.47 ,$96.06 ,$59.64 ,$191.70 ,$13.54 ,$19.57 ,$27.08 ,$27.08 ,$13.54 ,$27.08 ,$102.24 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30100124,80170,HC GENTAMICIN,301,1 ,$198.00 ,$128.70 ,$12.40 ,$198.00 ,$40.95 ,$28.26 ,$110.88 ,$16.38 ,$55.44 ,$69.89 ,$16.38 ,$81.58 ,$16.38 ,$89.30 ,$89.30 ,$16.38 ,$20.48 ,$31.12 ,$32.08 ,$40.95 ,$16.38 ,$16.38 ,$16.71 ,$148.50 ,$118.80 ,$118.80 ,$16.38 ,$118.80 ,$23.66 ,$23.66 ,$23.66 ,$198.00 , N/A ,$168.30 ,$40.95 ,$128.70 ,$16.38 ,$198.00 ,$110.88 ,$16.38 ,$52.07 , N/A ,$13.64 ,$13.02 ,$17.20 ,$158.40 ,$36.86 ,$89.30 ,$55.44 ,$178.20 ,$16.38 ,$23.66 ,$32.76 ,$32.76 ,$16.38 ,$32.76 ,$95.04 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$72.00 ,$46.80 ,$8.17 ,$72.00 ,$20.43 ,$14.09 ,$40.32 ,$8.17 ,$20.16 ,$25.42 ,$8.17 ,$29.66 ,$8.17 ,$32.47 ,$32.47 ,$8.17 ,$10.21 ,$15.52 ,$15.73 ,$20.43 ,$8.17 ,$8.17 ,$8.33 ,$54.00 ,$43.20 ,$43.20 ,$8.17 ,$43.20 ,$11.80 ,$11.80 ,$11.80 ,$72.00 , N/A ,$61.20 ,$20.43 ,$46.80 ,$8.17 ,$72.00 ,$40.32 ,$8.17 ,$18.94 , N/A ,$11.88 ,$11.34 ,$8.58 ,$57.60 ,$18.38 ,$32.47 ,$20.16 ,$64.80 ,$8.17 ,$11.80 ,$16.34 ,$16.34 ,$8.17 ,$16.34 ,$34.56 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100165,82040,HC ALBUMIN SERUM,301,1 ,$88.00 ,$57.20 ,$4.81 ,$88.00 ,$12.38 ,$8.52 ,$49.28 ,$4.95 ,$24.64 ,$31.06 ,$4.95 ,$36.26 ,$4.95 ,$39.69 ,$39.69 ,$4.95 ,$6.19 ,$9.41 ,$9.44 ,$12.38 ,$4.95 ,$4.95 ,$5.05 ,$66.00 ,$52.80 ,$52.80 ,$4.95 ,$52.80 ,$7.15 ,$7.15 ,$7.15 ,$88.00 , N/A ,$74.80 ,$12.38 ,$57.20 ,$4.95 ,$88.00 ,$49.28 ,$4.95 ,$23.14 , N/A ,$5.29 ,$5.05 ,$5.20 ,$70.40 ,$11.14 ,$39.69 ,$24.64 ,$79.20 ,$4.95 ,$7.15 ,$9.90 ,$9.90 ,$4.95 ,$9.90 ,$42.24 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100166,82042,HC ALBUMIN BODY FLUID,301,1 ,$88.00 ,$57.20 ,$4.81 ,$88.00 ,$19.45 ,$8.93 ,$49.28 ,$7.78 ,$24.64 ,$31.06 ,$7.78 ,$36.26 ,$7.78 ,$39.69 ,$39.69 ,$7.78 ,$9.73 ,$14.78 ,$13.84 ,$19.45 ,$7.78 ,$7.78 ,$7.94 ,$66.00 ,$52.80 ,$52.80 ,$7.78 ,$52.80 ,$10.11 ,$10.11 ,$10.11 ,$88.00 , N/A ,$74.80 ,$19.45 ,$57.20 ,$7.78 ,$88.00 ,$49.28 ,$7.78 ,$23.14 , N/A ,$5.29 ,$5.05 ,$8.17 ,$70.40 ,$17.51 ,$39.69 ,$24.64 ,$79.20 ,$7.78 ,$10.11 ,$15.56 ,$15.56 ,$7.78 ,$15.56 ,$42.24 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$114.00 ,$74.10 ,$3.86 ,$114.00 ,$14.45 ,$9.98 ,$63.84 ,$5.78 ,$31.92 ,$40.24 ,$5.78 ,$46.97 ,$5.78 ,$51.41 ,$51.41 ,$5.78 ,$7.23 ,$10.98 ,$11.32 ,$14.45 ,$5.78 ,$5.78 ,$5.90 ,$85.50 ,$68.40 ,$68.40 ,$5.78 ,$68.40 ,$8.35 ,$8.35 ,$8.35 ,$114.00 , N/A ,$96.90 ,$14.45 ,$74.10 ,$5.78 ,$114.00 ,$63.84 ,$5.78 ,$29.98 , N/A ,$4.25 ,$4.05 ,$6.07 ,$91.20 ,$13.01 ,$51.41 ,$31.92 ,$102.60 ,$5.78 ,$8.35 ,$11.56 ,$11.56 ,$5.78 ,$11.56 ,$54.72 ,$3.86 
ST. ELIZABETH'S HOSPITAL,30100176,82105,HC GL AFP,301,1 ,$150.00 ,$97.50 ,$10.80 ,$150.00 ,$41.93 ,$28.93 ,$84.00 ,$16.77 ,$42.00 ,$52.95 ,$16.77 ,$61.80 ,$16.77 ,$67.65 ,$67.65 ,$16.77 ,$20.96 ,$31.86 ,$32.71 ,$41.93 ,$16.77 ,$16.77 ,$17.11 ,$112.50 ,$90.00 ,$90.00 ,$16.77 ,$90.00 ,$24.23 ,$24.23 ,$24.23 ,$150.00 , N/A ,$127.50 ,$41.93 ,$97.50 ,$16.77 ,$150.00 ,$84.00 ,$16.77 ,$39.45 , N/A ,$11.88 ,$11.34 ,$17.61 ,$120.00 ,$37.73 ,$67.65 ,$42.00 ,$135.00 ,$16.77 ,$24.23 ,$33.54 ,$33.54 ,$16.77 ,$33.54 ,$72.00 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100186,82140,HC AMMONIA,301,1 ,$129.00 ,$83.85 ,$10.80 ,$129.00 ,$36.43 ,$25.13 ,$72.24 ,$14.57 ,$36.12 ,$45.54 ,$14.57 ,$53.15 ,$14.57 ,$58.18 ,$58.18 ,$14.57 ,$18.21 ,$27.68 ,$28.31 ,$36.43 ,$14.57 ,$14.57 ,$14.86 ,$96.75 ,$77.40 ,$77.40 ,$14.57 ,$77.40 ,$21.05 ,$21.05 ,$21.05 ,$129.00 , N/A ,$109.65 ,$36.43 ,$83.85 ,$14.57 ,$129.00 ,$72.24 ,$14.57 ,$33.93 , N/A ,$11.88 ,$11.34 ,$15.30 ,$103.20 ,$32.78 ,$58.18 ,$36.12 ,$116.10 ,$14.57 ,$21.05 ,$29.14 ,$29.14 ,$14.57 ,$29.14 ,$61.92 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100188,82150,HC AMYLASE,301,1 ,$101.00 ,$65.65 ,$6.48 ,$101.00 ,$16.20 ,$11.17 ,$56.56 ,$6.48 ,$28.28 ,$35.65 ,$6.48 ,$41.61 ,$6.48 ,$45.55 ,$45.55 ,$6.48 ,$8.10 ,$12.31 ,$12.58 ,$16.20 ,$6.48 ,$6.48 ,$6.61 ,$75.75 ,$60.60 ,$60.60 ,$6.48 ,$60.60 ,$9.36 ,$9.36 ,$9.36 ,$101.00 , N/A ,$85.85 ,$16.20 ,$65.65 ,$6.48 ,$101.00 ,$56.56 ,$6.48 ,$26.56 , N/A ,$11.88 ,$11.34 ,$6.80 ,$80.80 ,$14.58 ,$45.55 ,$28.28 ,$90.90 ,$6.48 ,$9.36 ,$12.96 ,$12.96 ,$6.48 ,$12.96 ,$48.48 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100201,82232,HC BETA 2 MICROGLOBULIN,301,1 ,$135.00 ,$87.75 ,$16.18 ,$135.00 ,$40.45 ,$27.88 ,$75.60 ,$16.18 ,$37.80 ,$47.66 ,$16.18 ,$55.62 ,$16.18 ,$60.89 ,$60.89 ,$16.18 ,$20.23 ,$30.74 ,$31.45 ,$40.45 ,$16.18 ,$16.18 ,$16.50 ,$101.25 ,$81.00 ,$81.00 ,$16.18 ,$81.00 ,$23.36 ,$23.36 ,$23.36 ,$135.00 , N/A ,$114.75 ,$40.45 ,$87.75 ,$16.18 ,$135.00 ,$75.60 ,$16.18 ,$35.51 , N/A ,$27.81 ,$26.54 ,$16.99 ,$108.00 ,$36.41 ,$60.89 ,$37.80 ,$121.50 ,$16.18 ,$23.36 ,$32.36 ,$32.36 ,$16.18 ,$32.36 ,$64.80 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$44.00 ,$28.60 ,$4.81 ,$44.00 ,$12.55 ,$8.65 ,$24.64 ,$5.02 ,$12.32 ,$15.53 ,$5.02 ,$18.13 ,$5.02 ,$19.84 ,$19.84 ,$5.02 ,$6.28 ,$9.54 ,$9.44 ,$12.55 ,$5.02 ,$5.02 ,$5.12 ,$33.00 ,$26.40 ,$26.40 ,$5.02 ,$26.40 ,$7.24 ,$7.24 ,$7.24 ,$44.00 , N/A ,$37.40 ,$12.55 ,$28.60 ,$5.02 ,$44.00 ,$24.64 ,$5.02 ,$11.57 , N/A ,$5.29 ,$5.05 ,$5.27 ,$35.20 ,$11.30 ,$19.84 ,$12.32 ,$39.60 ,$5.02 ,$7.24 ,$10.04 ,$10.04 ,$5.02 ,$10.04 ,$21.12 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$115.00 ,$74.75 ,$4.81 ,$115.00 ,$12.55 ,$8.65 ,$64.40 ,$5.02 ,$32.20 ,$40.60 ,$5.02 ,$47.38 ,$5.02 ,$51.87 ,$51.87 ,$5.02 ,$6.28 ,$9.54 ,$9.44 ,$12.55 ,$5.02 ,$5.02 ,$5.12 ,$86.25 ,$69.00 ,$69.00 ,$5.02 ,$69.00 ,$7.24 ,$7.24 ,$7.24 ,$115.00 , N/A ,$97.75 ,$12.55 ,$74.75 ,$5.02 ,$115.00 ,$64.40 ,$5.02 ,$30.25 , N/A ,$5.29 ,$5.05 ,$5.27 ,$92.00 ,$11.30 ,$51.87 ,$32.20 ,$103.50 ,$5.02 ,$7.24 ,$10.04 ,$10.04 ,$5.02 ,$10.04 ,$55.20 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100205,82270,HC OCCULT BLOOD FECAL SCRN,301,1 ,$44.00 ,$28.60 ,$4.38 ,$44.00 ,$10.95 ,$5.62 ,$24.64 ,$4.38 ,$12.32 ,$15.53 ,$4.38 ,$18.13 ,$4.38 ,$19.84 ,$19.84 ,$4.38 ,$5.48 ,$8.32 ,$7.55 ,$10.95 ,$4.38 ,$4.38 ,$4.47 ,$33.00 ,$26.40 ,$26.40 ,$4.38 ,$26.40 ,$5.69 ,$5.69 ,$5.69 ,$44.00 , N/A ,$37.40 ,$10.95 ,$28.60 ,$4.38 ,$44.00 ,$24.64 ,$4.38 ,$11.57 , N/A ,$5.29 ,$5.05 ,$4.60 ,$35.20 ,$9.86 ,$19.84 ,$12.32 ,$39.60 ,$4.38 ,$5.69 ,$8.76 ,$8.76 ,$4.38 ,$8.76 ,$21.12 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100212,82306,HC VITAMIN D 25 OH,301,1 ,$221.00 ,$143.65 ,$29.08 ,$221.00 ,$74.00 ,$51.03 ,$123.76 ,$29.60 ,$61.88 ,$78.01 ,$29.60 ,$91.05 ,$29.60 ,$99.67 ,$99.67 ,$29.60 ,$37.00 ,$56.24 ,$57.24 ,$74.00 ,$29.60 ,$29.60 ,$30.19 ,$165.75 ,$132.60 ,$132.60 ,$29.60 ,$132.60 ,$42.76 ,$42.76 ,$42.76 ,$221.00 , N/A ,$187.85 ,$74.00 ,$143.65 ,$29.60 ,$221.00 ,$123.76 ,$29.60 ,$58.12 , N/A ,$31.99 ,$30.53 ,$31.08 ,$176.80 ,$66.60 ,$99.67 ,$61.88 ,$198.90 ,$29.60 ,$42.76 ,$59.20 ,$59.20 ,$29.60 ,$59.20 ,$106.08 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30100214,82310,HC CALCIUM,301,1 ,$120.00 ,$78.00 ,$4.81 ,$120.00 ,$12.90 ,$8.89 ,$67.20 ,$5.16 ,$33.60 ,$42.36 ,$5.16 ,$49.44 ,$5.16 ,$54.12 ,$54.12 ,$5.16 ,$6.45 ,$9.80 ,$10.06 ,$12.90 ,$5.16 ,$5.16 ,$5.26 ,$90.00 ,$72.00 ,$72.00 ,$5.16 ,$72.00 ,$7.45 ,$7.45 ,$7.45 ,$120.00 , N/A ,$102.00 ,$12.90 ,$78.00 ,$5.16 ,$120.00 ,$67.20 ,$5.16 ,$31.56 , N/A ,$5.29 ,$5.05 ,$5.42 ,$96.00 ,$11.61 ,$54.12 ,$33.60 ,$108.00 ,$5.16 ,$7.45 ,$10.32 ,$10.32 ,$5.16 ,$10.32 ,$57.60 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$109.00 ,$70.85 ,$6.03 ,$109.00 ,$15.08 ,$10.40 ,$61.04 ,$6.03 ,$30.52 ,$38.48 ,$6.03 ,$44.91 ,$6.03 ,$49.16 ,$49.16 ,$6.03 ,$7.54 ,$11.46 ,$11.95 ,$15.08 ,$6.03 ,$6.03 ,$6.15 ,$81.75 ,$65.40 ,$65.40 ,$6.03 ,$65.40 ,$8.71 ,$8.71 ,$8.71 ,$109.00 , N/A ,$92.65 ,$15.08 ,$70.85 ,$6.03 ,$109.00 ,$61.04 ,$6.03 ,$28.67 , N/A ,$11.88 ,$11.34 ,$6.33 ,$87.20 ,$13.57 ,$49.16 ,$30.52 ,$98.10 ,$6.03 ,$8.71 ,$12.06 ,$12.06 ,$6.03 ,$12.06 ,$52.32 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100222,82374,HC BICARBONATE,301,1 ,$84.00 ,$54.60 ,$4.81 ,$84.00 ,$12.20 ,$8.44 ,$47.04 ,$4.88 ,$23.52 ,$29.65 ,$4.88 ,$34.61 ,$4.88 ,$37.88 ,$37.88 ,$4.88 ,$6.10 ,$9.27 ,$9.44 ,$12.20 ,$4.88 ,$4.88 ,$4.98 ,$63.00 ,$50.40 ,$50.40 ,$4.88 ,$50.40 ,$7.06 ,$7.06 ,$7.06 ,$84.00 , N/A ,$71.40 ,$12.20 ,$54.60 ,$4.88 ,$84.00 ,$47.04 ,$4.88 ,$22.09 , N/A ,$5.29 ,$5.05 ,$5.12 ,$67.20 ,$10.98 ,$37.88 ,$23.52 ,$75.60 ,$4.88 ,$7.06 ,$9.76 ,$9.76 ,$4.88 ,$9.76 ,$40.32 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100226,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$421.00 ,$273.65 ,$10.80 ,$421.00 ,$47.40 ,$32.71 ,$235.76 ,$18.96 ,$117.88 ,$142.15 ,$18.96 ,$142.15 ,$18.96 ,$189.87 ,$189.87 ,$18.96 ,$23.70 ,$36.02 ,$36.48 ,$47.40 ,$18.96 ,$18.96 ,$19.34 ,$315.75 ,$252.60 ,$252.60 ,$18.96 ,$252.60 ,$27.39 ,$27.39 ,$27.39 ,$421.00 , N/A ,$357.85 ,$47.40 ,$273.65 ,$18.96 ,$421.00 ,$235.76 ,$18.96 ,$110.72 , N/A ,$11.88 ,$11.34 ,$19.91 ,$336.80 ,$42.66 ,$189.87 ,$117.88 ,$378.90 ,$18.96 ,$27.39 ,$37.92 ,$37.92 ,$18.96 ,$37.92 ,$202.08 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100237,82435,HC CHLORIDE,301,1 ,$93.00 ,$60.45 ,$4.60 ,$93.00 ,$11.50 ,$7.93 ,$52.08 ,$4.60 ,$26.04 ,$32.83 ,$4.60 ,$38.32 ,$4.60 ,$41.94 ,$41.94 ,$4.60 ,$5.75 ,$8.74 ,$8.81 ,$11.50 ,$4.60 ,$4.60 ,$4.69 ,$69.75 ,$55.80 ,$55.80 ,$4.60 ,$55.80 ,$6.64 ,$6.64 ,$6.64 ,$93.00 , N/A ,$79.05 ,$11.50 ,$60.45 ,$4.60 ,$93.00 ,$52.08 ,$4.60 ,$24.46 , N/A ,$5.29 ,$5.05 ,$4.83 ,$74.40 ,$10.35 ,$41.94 ,$26.04 ,$83.70 ,$4.60 ,$6.64 ,$9.20 ,$9.20 ,$4.60 ,$9.20 ,$44.64 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100238,82436,HC CHLORIDE URINE,301,1 ,$93.00 ,$60.45 ,$4.81 ,$93.00 ,$14.38 ,$8.66 ,$52.08 ,$5.75 ,$26.04 ,$32.83 ,$5.75 ,$37.73 ,$5.75 ,$41.94 ,$41.94 ,$5.75 ,$7.19 ,$10.93 ,$10.06 ,$14.38 ,$5.75 ,$5.75 ,$5.87 ,$69.75 ,$55.80 ,$55.80 ,$5.75 ,$55.80 ,$7.48 ,$7.48 ,$7.48 ,$93.00 , N/A ,$79.05 ,$14.38 ,$60.45 ,$5.75 ,$93.00 ,$52.08 ,$5.75 ,$24.46 , N/A ,$5.29 ,$5.05 ,$6.04 ,$74.40 ,$12.94 ,$41.94 ,$26.04 ,$83.70 ,$5.75 ,$7.48 ,$11.50 ,$11.50 ,$5.75 ,$11.50 ,$44.64 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100241,82465,HC CHOLESTEROL,301,1 ,$112.00 ,$72.80 ,$4.35 ,$112.00 ,$10.88 ,$7.51 ,$62.72 ,$4.35 ,$31.36 ,$39.54 ,$4.35 ,$44.18 ,$4.35 ,$50.51 ,$50.51 ,$4.35 ,$5.44 ,$8.27 ,$8.18 ,$10.88 ,$4.35 ,$4.35 ,$4.44 ,$84.00 ,$67.20 ,$67.20 ,$4.35 ,$67.20 ,$6.29 ,$6.29 ,$6.29 ,$112.00 , N/A ,$95.20 ,$10.88 ,$72.80 ,$4.35 ,$112.00 ,$62.72 ,$4.35 ,$29.46 , N/A ,$5.29 ,$5.05 ,$4.57 ,$89.60 ,$9.79 ,$50.51 ,$31.36 ,$100.80 ,$4.35 ,$6.29 ,$8.70 ,$8.70 ,$4.35 ,$8.70 ,$53.76 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100254,82533,HC CORTISOL TOTAL,301,1 ,$254.00 ,$165.10 ,$16.30 ,$254.00 ,$40.75 ,$28.12 ,$142.24 ,$16.30 ,$71.12 ,$89.66 ,$16.30 ,$104.65 ,$16.30 ,$114.55 ,$114.55 ,$16.30 ,$20.38 ,$30.97 ,$31.45 ,$40.75 ,$16.30 ,$16.30 ,$16.63 ,$190.50 ,$152.40 ,$152.40 ,$16.30 ,$152.40 ,$23.54 ,$23.54 ,$23.54 ,$254.00 , N/A ,$215.90 ,$40.75 ,$165.10 ,$16.30 ,$254.00 ,$142.24 ,$16.30 ,$66.80 , N/A ,$27.81 ,$26.54 ,$17.12 ,$203.20 ,$36.68 ,$114.55 ,$71.12 ,$228.60 ,$16.30 ,$23.54 ,$32.60 ,$32.60 ,$16.30 ,$32.60 ,$121.92 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$160.00 ,$104.00 ,$4.81 ,$160.00 ,$16.28 ,$11.24 ,$89.60 ,$6.51 ,$44.80 ,$56.48 ,$6.51 ,$65.92 ,$6.51 ,$72.16 ,$72.16 ,$6.51 ,$8.14 ,$12.37 ,$12.58 ,$16.28 ,$6.51 ,$6.51 ,$6.64 ,$120.00 ,$96.00 ,$96.00 ,$6.51 ,$96.00 ,$9.40 ,$9.40 ,$9.40 ,$160.00 , N/A ,$136.00 ,$16.28 ,$104.00 ,$6.51 ,$160.00 ,$89.60 ,$6.51 ,$42.08 , N/A ,$5.29 ,$5.05 ,$6.84 ,$128.00 ,$14.65 ,$72.16 ,$44.80 ,$144.00 ,$6.51 ,$9.40 ,$13.02 ,$13.02 ,$6.51 ,$13.02 ,$76.80 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$184.00 ,$119.60 ,$10.80 ,$184.00 ,$28.88 ,$19.92 ,$103.04 ,$11.55 ,$51.52 ,$64.95 ,$11.55 ,$75.81 ,$11.55 ,$82.98 ,$82.98 ,$11.55 ,$14.44 ,$21.95 ,$22.64 ,$28.88 ,$11.55 ,$11.55 ,$11.78 ,$138.00 ,$110.40 ,$110.40 ,$11.55 ,$110.40 ,$16.68 ,$16.68 ,$16.68 ,$184.00 , N/A ,$156.40 ,$28.88 ,$119.60 ,$11.55 ,$184.00 ,$103.04 ,$11.55 ,$48.39 , N/A ,$11.88 ,$11.34 ,$12.13 ,$147.20 ,$25.99 ,$82.98 ,$51.52 ,$165.60 ,$11.55 ,$16.68 ,$23.10 ,$23.10 ,$11.55 ,$23.10 ,$88.32 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100262,82565,HC CREATININE,301,1 ,$67.00 ,$43.55 ,$4.81 ,$67.00 ,$12.80 ,$8.84 ,$37.52 ,$5.12 ,$18.76 ,$23.65 ,$5.12 ,$27.60 ,$5.12 ,$30.22 ,$30.22 ,$5.12 ,$6.40 ,$9.73 ,$10.06 ,$12.80 ,$5.12 ,$5.12 ,$5.22 ,$50.25 ,$40.20 ,$40.20 ,$5.12 ,$40.20 ,$7.40 ,$7.40 ,$7.40 ,$67.00 , N/A ,$56.95 ,$12.80 ,$43.55 ,$5.12 ,$5.12 ,$37.52 ,$5.12 ,$17.62 , N/A ,$5.29 ,$5.05 ,$5.38 ,$53.60 ,$11.52 ,$30.22 ,$18.76 ,$60.30 ,$5.12 ,$7.40 ,$10.24 ,$10.24 ,$5.12 ,$10.24 ,$32.16 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$86.00 ,$55.90 ,$4.81 ,$86.00 ,$12.95 ,$8.93 ,$48.16 ,$5.18 ,$24.08 ,$30.36 ,$5.18 ,$35.43 ,$5.18 ,$38.79 ,$38.79 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$64.50 ,$51.60 ,$51.60 ,$5.18 ,$51.60 ,$7.48 ,$7.48 ,$7.48 ,$86.00 , N/A ,$73.10 ,$12.95 ,$55.90 ,$5.18 ,$86.00 ,$48.16 ,$5.18 ,$22.62 , N/A ,$5.29 ,$5.05 ,$5.44 ,$68.80 ,$11.66 ,$38.79 ,$24.08 ,$77.40 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$41.28 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100266,82575,HC CREATININE CLEARANCE,301,1 ,$216.00 ,$140.40 ,$9.46 ,$216.00 ,$23.65 ,$16.29 ,$120.96 ,$9.46 ,$60.48 ,$70.89 ,$9.46 ,$70.89 ,$9.46 ,$97.42 ,$97.42 ,$9.46 ,$11.83 ,$17.97 ,$18.24 ,$23.65 ,$9.46 ,$9.46 ,$9.65 ,$162.00 ,$129.60 ,$129.60 ,$9.46 ,$129.60 ,$13.66 ,$13.66 ,$13.66 ,$216.00 , N/A ,$183.60 ,$23.65 ,$140.40 ,$9.46 ,$216.00 ,$120.96 ,$9.46 ,$56.81 , N/A ,$11.88 ,$11.34 ,$9.93 ,$172.80 ,$21.29 ,$97.42 ,$60.48 ,$194.40 ,$9.46 ,$13.66 ,$18.92 ,$18.92 ,$9.46 ,$18.92 ,$103.68 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100269,82607,HC VITAMIN B12,301,1 ,$92.00 ,$59.80 ,$14.54 ,$92.00 ,$37.70 ,$25.99 ,$51.52 ,$15.08 ,$25.76 ,$32.48 ,$15.08 ,$37.90 ,$15.08 ,$41.49 ,$41.49 ,$15.08 ,$18.85 ,$28.65 ,$28.93 ,$37.70 ,$15.08 ,$15.08 ,$15.38 ,$69.00 ,$55.20 ,$55.20 ,$15.08 ,$55.20 ,$21.78 ,$21.78 ,$21.78 ,$92.00 , N/A ,$78.20 ,$37.70 ,$59.80 ,$15.08 ,$92.00 ,$51.52 ,$15.08 ,$24.20 , N/A ,$15.99 ,$15.27 ,$15.83 ,$73.60 ,$33.93 ,$41.49 ,$25.76 ,$82.80 ,$15.08 ,$21.78 ,$30.16 ,$30.16 ,$15.08 ,$30.16 ,$44.16 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100276,82670,HC ESTRADIOL,301,1 ,$82.00 ,$53.30 ,$19.55 ,$82.00 ,$69.85 ,$19.55 ,$45.92 ,$27.94 ,$22.96 ,$28.95 ,$27.94 ,$33.78 ,$27.94 ,$36.98 ,$36.98 ,$27.94 ,$34.93 ,$53.09 ,$54.10 ,$69.85 ,$27.94 ,$27.94 ,$28.50 ,$61.50 ,$49.20 ,$49.20 ,$27.94 ,$49.20 ,$40.35 ,$40.35 ,$40.35 ,$82.00 , N/A ,$69.70 ,$69.85 ,$53.30 ,$27.94 ,$82.00 ,$45.92 ,$27.94 ,$21.57 , N/A ,$27.81 ,$26.54 ,$29.34 ,$65.60 ,$62.87 ,$36.98 ,$22.96 ,$73.80 ,$27.94 ,$40.35 ,$55.88 ,$55.88 ,$27.94 ,$55.88 ,$39.36 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100290,82728,HC FERRITIN,301,1 ,$152.00 ,$98.80 ,$10.80 ,$152.00 ,$34.08 ,$23.49 ,$85.12 ,$13.63 ,$42.56 ,$53.66 ,$13.63 ,$62.62 ,$13.63 ,$68.55 ,$68.55 ,$13.63 ,$17.04 ,$25.90 ,$26.42 ,$34.08 ,$13.63 ,$13.63 ,$13.90 ,$114.00 ,$91.20 ,$91.20 ,$13.63 ,$91.20 ,$19.70 ,$19.70 ,$19.70 ,$152.00 , N/A ,$129.20 ,$34.08 ,$98.80 ,$13.63 ,$152.00 ,$85.12 ,$13.63 ,$39.98 , N/A ,$11.88 ,$11.34 ,$14.31 ,$121.60 ,$30.67 ,$68.55 ,$42.56 ,$136.80 ,$13.63 ,$19.70 ,$27.26 ,$27.26 ,$13.63 ,$27.26 ,$72.96 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$433.00 ,$281.45 ,$29.08 ,$433.00 ,$161.03 ,$80.69 ,$242.48 ,$64.41 ,$121.24 ,$152.85 ,$64.41 ,$178.40 ,$64.41 ,$195.28 ,$195.28 ,$64.41 ,$80.51 ,$122.38 ,$125.17 ,$161.03 ,$64.41 ,$64.41 ,$65.70 ,$324.75 ,$259.80 ,$259.80 ,$64.41 ,$259.80 ,$93.04 ,$93.04 ,$93.04 ,$433.00 , N/A ,$368.05 ,$161.03 ,$281.45 ,$64.41 ,$433.00 ,$242.48 ,$64.41 ,$113.88 , N/A ,$31.99 ,$30.53 ,$67.63 ,$346.40 ,$144.92 ,$195.28 ,$121.24 ,$389.70 ,$64.41 ,$93.04 ,$128.82 ,$128.82 ,$64.41 ,$128.82 ,$207.84 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30100292,82746,HC FOLIC ACID SERUM,301,1 ,$110.00 ,$71.50 ,$10.80 ,$110.00 ,$36.75 ,$25.34 ,$61.60 ,$14.70 ,$30.80 ,$38.83 ,$14.70 ,$45.32 ,$14.70 ,$49.61 ,$49.61 ,$14.70 ,$18.38 ,$27.93 ,$28.31 ,$36.75 ,$14.70 ,$14.70 ,$14.99 ,$82.50 ,$66.00 ,$66.00 ,$14.70 ,$66.00 ,$21.24 ,$21.24 ,$21.24 ,$110.00 , N/A ,$93.50 ,$36.75 ,$71.50 ,$14.70 ,$110.00 ,$61.60 ,$14.70 ,$28.93 , N/A ,$11.88 ,$11.34 ,$15.44 ,$88.00 ,$33.08 ,$49.61 ,$30.80 ,$99.00 ,$14.70 ,$21.24 ,$29.40 ,$29.40 ,$14.70 ,$29.40 ,$52.80 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100295,82784,HC GAMMAGLOBULIN,301,1 ,$66.00 ,$42.90 ,$9.30 ,$66.00 ,$23.25 ,$16.03 ,$36.96 ,$9.30 ,$18.48 ,$23.30 ,$9.30 ,$27.19 ,$9.30 ,$29.77 ,$29.77 ,$9.30 ,$11.63 ,$17.67 ,$18.24 ,$23.25 ,$9.30 ,$9.30 ,$9.49 ,$49.50 ,$39.60 ,$39.60 ,$9.30 ,$39.60 ,$13.44 ,$13.44 ,$13.44 ,$66.00 , N/A ,$56.10 ,$23.25 ,$42.90 ,$9.30 ,$66.00 ,$36.96 ,$9.30 ,$17.36 , N/A ,$11.88 ,$11.34 ,$9.77 ,$52.80 ,$20.93 ,$29.77 ,$18.48 ,$59.40 ,$9.30 ,$13.44 ,$18.60 ,$18.60 ,$9.30 ,$18.60 ,$31.68 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$92.00 ,$59.80 ,$3.93 ,$92.00 ,$9.83 ,$6.76 ,$51.52 ,$3.93 ,$25.76 ,$32.48 ,$3.93 ,$37.90 ,$3.93 ,$41.49 ,$41.49 ,$3.93 ,$4.91 ,$7.47 ,$7.55 ,$9.83 ,$3.93 ,$3.93 ,$4.01 ,$69.00 ,$55.20 ,$55.20 ,$3.93 ,$55.20 ,$5.68 ,$5.68 ,$5.68 ,$92.00 , N/A ,$78.20 ,$9.83 ,$59.80 ,$3.93 ,$92.00 ,$51.52 ,$3.93 ,$24.20 , N/A ,$5.29 ,$5.05 ,$4.13 ,$73.60 ,$8.84 ,$41.49 ,$25.76 ,$82.80 ,$3.93 ,$5.68 ,$7.86 ,$7.86 ,$3.93 ,$7.86 ,$44.16 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100312,82947,HC GLUCOSE,301,1 ,$71.00 ,$46.15 ,$3.93 ,$71.00 ,$9.83 ,$6.76 ,$39.76 ,$3.93 ,$19.88 ,$25.06 ,$3.93 ,$29.25 ,$3.93 ,$32.02 ,$32.02 ,$3.93 ,$4.91 ,$7.47 ,$7.55 ,$9.83 ,$3.93 ,$3.93 ,$4.01 ,$53.25 ,$42.60 ,$42.60 ,$3.93 ,$42.60 ,$5.68 ,$5.68 ,$5.68 ,$71.00 , N/A ,$60.35 ,$9.83 ,$46.15 ,$3.93 ,$71.00 ,$39.76 ,$3.93 ,$18.67 , N/A ,$5.29 ,$5.05 ,$4.13 ,$56.80 ,$8.84 ,$32.02 ,$19.88 ,$63.90 ,$3.93 ,$5.68 ,$7.86 ,$7.86 ,$3.93 ,$7.86 ,$34.08 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100313,82950,HC GLUCOSE SCREEN,301,1 ,$107.00 ,$69.55 ,$4.75 ,$107.00 ,$11.88 ,$8.19 ,$59.92 ,$4.75 ,$29.96 ,$37.77 ,$4.75 ,$44.08 ,$4.75 ,$48.26 ,$48.26 ,$4.75 ,$5.94 ,$9.03 ,$9.44 ,$11.88 ,$4.75 ,$4.75 ,$4.85 ,$80.25 ,$64.20 ,$64.20 ,$4.75 ,$64.20 ,$6.85 ,$6.85 ,$6.85 ,$107.00 , N/A ,$90.95 ,$11.88 ,$69.55 ,$4.75 ,$107.00 ,$59.92 ,$4.75 ,$28.14 , N/A ,$5.29 ,$5.05 ,$4.99 ,$85.60 ,$10.69 ,$48.26 ,$29.96 ,$96.30 ,$4.75 ,$6.85 ,$9.50 ,$9.50 ,$4.75 ,$9.50 ,$51.36 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$214.00 ,$139.10 ,$10.80 ,$214.00 ,$32.18 ,$22.19 ,$119.84 ,$12.87 ,$59.92 ,$75.54 ,$12.87 ,$88.17 ,$12.87 ,$96.51 ,$96.51 ,$12.87 ,$16.09 ,$24.45 ,$25.16 ,$32.18 ,$12.87 ,$12.87 ,$13.13 ,$160.50 ,$128.40 ,$128.40 ,$12.87 ,$128.40 ,$18.59 ,$18.59 ,$18.59 ,$214.00 , N/A ,$181.90 ,$32.18 ,$139.10 ,$12.87 ,$214.00 ,$119.84 ,$12.87 ,$56.28 , N/A ,$11.88 ,$11.34 ,$13.51 ,$171.20 ,$28.96 ,$96.51 ,$59.92 ,$192.60 ,$12.87 ,$18.59 ,$25.74 ,$25.74 ,$12.87 ,$25.74 ,$102.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$52.00 ,$33.80 ,$3.92 ,$52.00 ,$9.80 ,$6.76 ,$29.12 ,$3.92 ,$14.56 ,$18.36 ,$3.92 ,$21.42 ,$3.92 ,$23.45 ,$23.45 ,$3.92 ,$4.90 ,$7.45 ,$7.55 ,$9.80 ,$3.92 ,$3.92 ,$4.00 ,$39.00 ,$31.20 ,$31.20 ,$3.92 ,$31.20 ,$5.67 ,$5.67 ,$5.67 ,$52.00 , N/A ,$44.20 ,$9.80 ,$33.80 ,$3.92 ,$52.00 ,$29.12 ,$3.92 ,$13.68 , N/A ,$11.88 ,$11.34 ,$4.12 ,$41.60 ,$8.82 ,$23.45 ,$14.56 ,$46.80 ,$3.92 ,$5.67 ,$7.84 ,$7.84 ,$3.92 ,$7.84 ,$24.96 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100318,82962,HC GLUCOSE BY DEVICE,301,1 ,$56.00 ,$36.40 ,$3.28 ,$56.00 ,$8.20 ,$4.03 ,$31.36 ,$3.28 ,$15.68 ,$19.77 ,$3.28 ,$23.07 ,$3.28 ,$25.26 ,$25.26 ,$3.28 ,$4.10 ,$6.23 ,$5.66 ,$8.20 ,$3.28 ,$3.28 ,$3.35 ,$42.00 ,$33.60 ,$33.60 ,$3.28 ,$33.60 ,$4.26 ,$4.26 ,$4.26 ,$56.00 , N/A ,$47.60 ,$8.20 ,$36.40 ,$3.28 ,$56.00 ,$31.36 ,$3.28 ,$14.73 , N/A ,$5.29 ,$5.05 ,$3.44 ,$44.80 ,$7.38 ,$25.26 ,$15.68 ,$50.40 ,$3.28 ,$4.26 ,$6.56 ,$6.56 ,$3.28 ,$6.56 ,$26.88 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100319,82977,HC GGT/GGTP,301,1 ,$171.00 ,$111.15 ,$4.81 ,$171.00 ,$18.00 ,$12.41 ,$95.76 ,$7.20 ,$47.88 ,$60.36 ,$7.20 ,$70.45 ,$7.20 ,$77.12 ,$77.12 ,$7.20 ,$9.00 ,$13.68 ,$13.84 ,$18.00 ,$7.20 ,$7.20 ,$7.34 ,$128.25 ,$102.60 ,$102.60 ,$7.20 ,$102.60 ,$10.40 ,$10.40 ,$10.40 ,$171.00 , N/A ,$145.35 ,$18.00 ,$111.15 ,$7.20 ,$171.00 ,$95.76 ,$7.20 ,$44.97 , N/A ,$5.29 ,$5.05 ,$7.56 ,$136.80 ,$16.20 ,$77.12 ,$47.88 ,$153.90 ,$7.20 ,$10.40 ,$14.40 ,$14.40 ,$7.20 ,$14.40 ,$82.08 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100322,83001,HC FSH,301,1 ,$233.00 ,$151.45 ,$18.58 ,$233.00 ,$46.45 ,$32.04 ,$130.48 ,$18.58 ,$65.24 ,$82.25 ,$18.58 ,$96.00 ,$18.58 ,$105.08 ,$105.08 ,$18.58 ,$23.23 ,$35.30 ,$35.85 ,$46.45 ,$18.58 ,$18.58 ,$18.95 ,$174.75 ,$139.80 ,$139.80 ,$18.58 ,$139.80 ,$26.85 ,$26.85 ,$26.85 ,$233.00 , N/A ,$198.05 ,$46.45 ,$151.45 ,$18.58 ,$233.00 ,$130.48 ,$18.58 ,$61.28 , N/A ,$27.81 ,$26.54 ,$19.51 ,$186.40 ,$41.81 ,$105.08 ,$65.24 ,$209.70 ,$18.58 ,$26.85 ,$37.16 ,$37.16 ,$18.58 ,$37.16 ,$111.84 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100325,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$75.00 ,$48.75 ,$18.52 ,$75.00 ,$46.30 ,$31.92 ,$42.00 ,$18.52 ,$21.00 ,$26.48 ,$18.52 ,$30.90 ,$18.52 ,$33.83 ,$33.83 ,$18.52 ,$23.15 ,$35.19 ,$35.85 ,$46.30 ,$18.52 ,$18.52 ,$18.89 ,$56.25 ,$45.00 ,$45.00 ,$18.52 ,$45.00 ,$26.74 ,$26.74 ,$26.74 ,$75.00 , N/A ,$63.75 ,$46.30 ,$48.75 ,$18.52 ,$75.00 ,$42.00 ,$18.52 ,$19.73 , N/A ,$27.81 ,$26.54 ,$19.45 ,$60.00 ,$41.67 ,$33.83 ,$21.00 ,$67.50 ,$18.52 ,$26.74 ,$37.04 ,$37.04 ,$18.52 ,$37.04 ,$36.00 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100327,83010,HC HAPTOGLOBIN,301,1 ,$109.00 ,$70.85 ,$10.80 ,$109.00 ,$31.45 ,$21.68 ,$61.04 ,$12.58 ,$30.52 ,$38.48 ,$12.58 ,$44.91 ,$12.58 ,$49.16 ,$49.16 ,$12.58 ,$15.73 ,$23.90 ,$24.53 ,$31.45 ,$12.58 ,$12.58 ,$12.83 ,$81.75 ,$65.40 ,$65.40 ,$12.58 ,$65.40 ,$18.16 ,$18.16 ,$18.16 ,$109.00 , N/A ,$92.65 ,$31.45 ,$70.85 ,$12.58 ,$109.00 ,$61.04 ,$12.58 ,$28.67 , N/A ,$11.88 ,$11.34 ,$13.21 ,$87.20 ,$28.31 ,$49.16 ,$30.52 ,$98.10 ,$12.58 ,$18.16 ,$25.16 ,$25.16 ,$12.58 ,$25.16 ,$52.32 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$87.00 ,$56.55 ,$9.71 ,$87.00 ,$24.28 ,$16.73 ,$48.72 ,$9.71 ,$24.36 ,$30.71 ,$9.71 ,$35.84 ,$9.71 ,$39.24 ,$39.24 ,$9.71 ,$12.14 ,$18.45 ,$18.87 ,$24.28 ,$9.71 ,$9.71 ,$9.90 ,$65.25 ,$52.20 ,$52.20 ,$9.71 ,$52.20 ,$14.03 ,$14.03 ,$14.03 ,$87.00 , N/A ,$73.95 ,$24.28 ,$56.55 ,$9.71 ,$87.00 ,$48.72 ,$9.71 ,$22.88 , N/A ,$11.88 ,$11.34 ,$10.20 ,$69.60 ,$21.85 ,$39.24 ,$24.36 ,$78.30 ,$9.71 ,$14.03 ,$19.42 ,$19.42 ,$9.71 ,$19.42 ,$41.76 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100393,83540,HC IRON TOTAL,301,1 ,$148.00 ,$96.20 ,$4.81 ,$148.00 ,$16.18 ,$11.17 ,$82.88 ,$6.47 ,$41.44 ,$48.47 ,$6.47 ,$48.47 ,$6.47 ,$66.75 ,$66.75 ,$6.47 ,$8.09 ,$12.29 ,$12.58 ,$16.18 ,$6.47 ,$6.47 ,$6.60 ,$111.00 ,$88.80 ,$88.80 ,$6.47 ,$88.80 ,$9.35 ,$9.35 ,$9.35 ,$148.00 , N/A ,$125.80 ,$16.18 ,$96.20 ,$6.47 ,$148.00 ,$82.88 ,$6.47 ,$38.92 , N/A ,$5.29 ,$5.05 ,$6.79 ,$118.40 ,$14.56 ,$66.75 ,$41.44 ,$133.20 ,$6.47 ,$9.35 ,$12.94 ,$12.94 ,$6.47 ,$12.94 ,$71.04 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$53.00 ,$34.45 ,$8.74 ,$53.00 ,$21.85 ,$15.07 ,$29.68 ,$8.74 ,$14.84 ,$18.71 ,$8.74 ,$21.84 ,$8.74 ,$23.90 ,$23.90 ,$8.74 ,$10.93 ,$16.61 ,$16.98 ,$21.85 ,$8.74 ,$8.74 ,$8.91 ,$39.75 ,$31.80 ,$31.80 ,$8.74 ,$31.80 ,$12.62 ,$12.62 ,$12.62 ,$53.00 , N/A ,$45.05 ,$21.85 ,$34.45 ,$8.74 ,$53.00 ,$29.68 ,$8.74 ,$13.94 , N/A ,$11.88 ,$11.34 ,$9.18 ,$42.40 ,$19.67 ,$23.90 ,$14.84 ,$47.70 ,$8.74 ,$12.62 ,$17.48 ,$17.48 ,$8.74 ,$17.48 ,$25.44 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$105.00 ,$68.25 ,$10.80 ,$105.00 ,$28.93 ,$18.41 ,$58.80 ,$11.57 ,$29.40 ,$37.07 ,$11.57 ,$43.26 ,$11.57 ,$47.36 ,$47.36 ,$11.57 ,$14.46 ,$21.98 ,$20.76 ,$28.93 ,$11.57 ,$11.57 ,$11.80 ,$78.75 ,$63.00 ,$63.00 ,$11.57 ,$63.00 ,$15.43 ,$15.43 ,$15.43 ,$105.00 , N/A ,$89.25 ,$28.93 ,$68.25 ,$11.57 ,$105.00 ,$58.80 ,$11.57 ,$27.62 , N/A ,$11.88 ,$11.34 ,$12.15 ,$84.00 ,$26.03 ,$47.36 ,$29.40 ,$94.50 ,$11.57 ,$15.43 ,$23.14 ,$23.14 ,$11.57 ,$23.14 ,$50.40 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$120.00 ,$78.00 ,$4.81 ,$120.00 ,$15.10 ,$10.41 ,$67.20 ,$6.04 ,$33.60 ,$42.36 ,$6.04 ,$45.21 ,$6.04 ,$54.12 ,$54.12 ,$6.04 ,$7.55 ,$11.48 ,$11.95 ,$15.10 ,$6.04 ,$6.04 ,$6.16 ,$90.00 ,$72.00 ,$72.00 ,$6.04 ,$72.00 ,$8.72 ,$8.72 ,$8.72 ,$120.00 , N/A ,$102.00 ,$15.10 ,$78.00 ,$6.04 ,$120.00 ,$67.20 ,$6.04 ,$31.56 , N/A ,$5.29 ,$5.05 ,$6.34 ,$96.00 ,$13.59 ,$54.12 ,$33.60 ,$108.00 ,$6.04 ,$8.72 ,$12.08 ,$12.08 ,$6.04 ,$12.08 ,$57.60 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100408,83663,HC FETAL LUNG MATURITY,301,1 ,$489.00 ,$317.85 ,$18.91 ,$489.00 ,$47.28 ,$32.62 ,$273.84 ,$18.91 ,$136.92 ,$141.78 ,$18.91 ,$141.78 ,$18.91 ,$220.54 ,$220.54 ,$18.91 ,$23.64 ,$35.93 ,$36.48 ,$47.28 ,$18.91 ,$18.91 ,$19.29 ,$366.75 ,$293.40 ,$293.40 ,$18.91 ,$293.40 ,$27.31 ,$27.31 ,$27.31 ,$489.00 , N/A ,$415.65 ,$47.28 ,$317.85 ,$18.91 ,$489.00 ,$273.84 ,$18.91 ,$128.61 , N/A ,$33.95 ,$32.40 ,$19.86 ,$391.20 ,$42.55 ,$220.54 ,$136.92 ,$440.10 ,$18.91 ,$27.31 ,$37.82 ,$37.82 ,$18.91 ,$37.82 ,$234.72 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30100409,83690,HC LIPASE,301,1 ,$147.00 ,$95.55 ,$4.81 ,$147.00 ,$17.23 ,$11.87 ,$82.32 ,$6.89 ,$41.16 ,$51.65 ,$6.89 ,$51.65 ,$6.89 ,$66.30 ,$66.30 ,$6.89 ,$8.61 ,$13.09 ,$13.21 ,$17.23 ,$6.89 ,$6.89 ,$7.03 ,$110.25 ,$88.20 ,$88.20 ,$6.89 ,$88.20 ,$9.95 ,$9.95 ,$9.95 ,$147.00 , N/A ,$124.95 ,$17.23 ,$95.55 ,$6.89 ,$147.00 ,$82.32 ,$6.89 ,$38.66 , N/A ,$5.29 ,$5.05 ,$7.23 ,$117.60 ,$15.50 ,$66.30 ,$41.16 ,$132.30 ,$6.89 ,$9.95 ,$13.78 ,$13.78 ,$6.89 ,$13.78 ,$70.56 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100415,83718,HC CHOLESTEROL HDL,301,1 ,$108.00 ,$70.20 ,$8.19 ,$108.00 ,$20.48 ,$14.11 ,$60.48 ,$8.19 ,$30.24 ,$38.12 ,$8.19 ,$44.50 ,$8.19 ,$48.71 ,$48.71 ,$8.19 ,$10.24 ,$15.56 ,$15.73 ,$20.48 ,$8.19 ,$8.19 ,$8.35 ,$81.00 ,$64.80 ,$64.80 ,$8.19 ,$64.80 ,$11.83 ,$11.83 ,$11.83 ,$108.00 , N/A ,$91.80 ,$20.48 ,$70.20 ,$8.19 ,$108.00 ,$60.48 ,$8.19 ,$28.40 , N/A ,$11.88 ,$11.34 ,$8.60 ,$86.40 ,$18.43 ,$48.71 ,$30.24 ,$97.20 ,$8.19 ,$11.83 ,$16.38 ,$16.38 ,$8.19 ,$16.38 ,$51.84 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100416,83721,HC CHOLESTEROL LDL,301,1 ,$89.00 ,$57.85 ,$10.50 ,$89.00 ,$26.25 ,$16.43 ,$49.84 ,$10.50 ,$24.92 ,$31.42 ,$10.50 ,$36.67 ,$10.50 ,$40.14 ,$40.14 ,$10.50 ,$13.13 ,$19.95 ,$18.24 ,$26.25 ,$10.50 ,$10.50 ,$10.71 ,$66.75 ,$53.40 ,$53.40 ,$10.50 ,$53.40 ,$13.78 ,$13.78 ,$13.78 ,$89.00 , N/A ,$75.65 ,$26.25 ,$57.85 ,$10.50 ,$89.00 ,$49.84 ,$10.50 ,$23.41 , N/A ,$11.88 ,$11.34 ,$11.03 ,$71.20 ,$23.63 ,$40.14 ,$24.92 ,$80.10 ,$10.50 ,$13.78 ,$21.00 ,$21.00 ,$10.50 ,$21.00 ,$42.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100417,83735,HC MAGNESIUM,301,1 ,$127.00 ,$82.55 ,$4.81 ,$127.00 ,$16.75 ,$11.55 ,$71.12 ,$6.70 ,$35.56 ,$44.83 ,$6.70 ,$52.32 ,$6.70 ,$57.28 ,$57.28 ,$6.70 ,$8.38 ,$12.73 ,$13.21 ,$16.75 ,$6.70 ,$6.70 ,$6.83 ,$95.25 ,$76.20 ,$76.20 ,$6.70 ,$76.20 ,$9.67 ,$9.67 ,$9.67 ,$127.00 , N/A ,$107.95 ,$16.75 ,$82.55 ,$6.70 ,$127.00 ,$71.12 ,$6.70 ,$33.40 , N/A ,$5.29 ,$5.05 ,$7.04 ,$101.60 ,$15.08 ,$57.28 ,$35.56 ,$114.30 ,$6.70 ,$9.67 ,$13.40 ,$13.40 ,$6.70 ,$13.40 ,$60.96 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100435,83874,HC MYOGLOBIN,301,1 ,$107.00 ,$69.55 ,$10.80 ,$107.00 ,$32.30 ,$22.26 ,$59.92 ,$12.92 ,$29.96 ,$37.77 ,$12.92 ,$44.08 ,$12.92 ,$48.26 ,$48.26 ,$12.92 ,$16.15 ,$24.55 ,$25.16 ,$32.30 ,$12.92 ,$12.92 ,$13.18 ,$80.25 ,$64.20 ,$64.20 ,$12.92 ,$64.20 ,$18.66 ,$18.66 ,$18.66 ,$107.00 , N/A ,$90.95 ,$32.30 ,$69.55 ,$12.92 ,$107.00 ,$59.92 ,$12.92 ,$28.14 , N/A ,$11.88 ,$11.34 ,$13.57 ,$85.60 ,$29.07 ,$48.26 ,$29.96 ,$96.30 ,$12.92 ,$18.66 ,$25.84 ,$25.84 ,$12.92 ,$25.84 ,$51.36 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$186.00 ,$120.90 ,$29.08 ,$186.00 ,$98.15 ,$48.90 ,$104.16 ,$39.26 ,$52.08 ,$65.66 ,$39.26 ,$76.63 ,$39.26 ,$83.89 ,$83.89 ,$39.26 ,$49.08 ,$74.59 ,$68.56 ,$98.15 ,$39.26 ,$39.26 ,$40.05 ,$139.50 ,$111.60 ,$111.60 ,$39.26 ,$111.60 ,$51.04 ,$51.04 ,$51.04 ,$186.00 , N/A ,$158.10 ,$98.15 ,$120.90 ,$39.26 ,$186.00 ,$104.16 ,$39.26 ,$48.92 , N/A ,$31.99 ,$30.53 ,$41.22 ,$148.80 ,$88.34 ,$83.89 ,$52.08 ,$167.40 ,$39.26 ,$51.04 ,$78.52 ,$78.52 ,$39.26 ,$78.52 ,$89.28 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30100668,83930,HC OSMOLALITY BLOOD,301,1 ,$101.00 ,$65.65 ,$4.81 ,$101.00 ,$16.53 ,$11.06 ,$56.56 ,$6.61 ,$28.28 ,$35.65 ,$6.61 ,$41.61 ,$6.61 ,$45.55 ,$45.55 ,$6.61 ,$8.26 ,$12.56 ,$12.58 ,$16.53 ,$6.61 ,$6.61 ,$6.74 ,$75.75 ,$60.60 ,$60.60 ,$6.61 ,$60.60 ,$9.56 ,$9.56 ,$9.56 ,$101.00 , N/A ,$85.85 ,$16.53 ,$65.65 ,$6.61 ,$101.00 ,$56.56 ,$6.61 ,$26.56 , N/A ,$5.29 ,$5.05 ,$6.94 ,$80.80 ,$14.87 ,$45.55 ,$28.28 ,$90.90 ,$6.61 ,$9.56 ,$13.22 ,$13.22 ,$6.61 ,$13.22 ,$48.48 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100669,83935,HC OSMOLALITY URINE,301,1 ,$150.00 ,$97.50 ,$4.81 ,$150.00 ,$17.05 ,$11.74 ,$84.00 ,$6.82 ,$42.00 ,$51.09 ,$6.82 ,$51.09 ,$6.82 ,$67.65 ,$67.65 ,$6.82 ,$8.53 ,$12.96 ,$13.21 ,$17.05 ,$6.82 ,$6.82 ,$6.96 ,$112.50 ,$90.00 ,$90.00 ,$6.82 ,$90.00 ,$9.84 ,$9.84 ,$9.84 ,$150.00 , N/A ,$127.50 ,$17.05 ,$97.50 ,$6.82 ,$150.00 ,$84.00 ,$6.82 ,$39.45 , N/A ,$5.29 ,$5.05 ,$7.16 ,$120.00 ,$15.35 ,$67.65 ,$42.00 ,$135.00 ,$6.82 ,$9.84 ,$13.64 ,$13.64 ,$6.82 ,$13.64 ,$72.00 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$209.00 ,$135.85 ,$25.28 ,$209.00 ,$103.20 ,$71.16 ,$117.04 ,$41.28 ,$58.52 ,$73.78 ,$41.28 ,$86.11 ,$41.28 ,$94.26 ,$94.26 ,$41.28 ,$51.60 ,$78.43 ,$79.89 ,$103.20 ,$41.28 ,$41.28 ,$42.11 ,$156.75 ,$125.40 ,$125.40 ,$41.28 ,$125.40 ,$59.62 ,$59.62 ,$59.62 ,$209.00 , N/A ,$177.65 ,$103.20 ,$135.85 ,$41.28 ,$209.00 ,$117.04 ,$41.28 ,$54.97 , N/A ,$27.81 ,$26.54 ,$43.34 ,$167.20 ,$92.88 ,$94.26 ,$58.52 ,$188.10 ,$41.28 ,$59.62 ,$82.56 ,$82.56 ,$41.28 ,$82.56 ,$100.32 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100673,83986,HC PH BODY FLUID,301,1 ,$58.00 ,$37.70 ,$3.58 ,$58.00 ,$8.95 ,$6.18 ,$32.48 ,$3.58 ,$16.24 ,$20.47 ,$3.58 ,$23.90 ,$3.58 ,$26.16 ,$26.16 ,$3.58 ,$4.48 ,$6.80 ,$6.92 ,$8.95 ,$3.58 ,$3.58 ,$3.65 ,$43.50 ,$34.80 ,$34.80 ,$3.58 ,$34.80 ,$5.17 ,$5.17 ,$5.17 ,$58.00 , N/A ,$49.30 ,$8.95 ,$37.70 ,$3.58 ,$58.00 ,$32.48 ,$3.58 ,$15.25 , N/A ,$5.29 ,$5.05 ,$3.76 ,$46.40 ,$8.06 ,$26.16 ,$16.24 ,$52.20 ,$3.58 ,$5.17 ,$7.16 ,$7.16 ,$3.58 ,$7.16 ,$27.84 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$115.00 ,$74.75 ,$4.81 ,$115.00 ,$12.95 ,$8.93 ,$64.40 ,$5.18 ,$32.20 ,$40.60 ,$5.18 ,$47.38 ,$5.18 ,$51.87 ,$51.87 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$86.25 ,$69.00 ,$69.00 ,$5.18 ,$69.00 ,$7.48 ,$7.48 ,$7.48 ,$115.00 , N/A ,$97.75 ,$12.95 ,$74.75 ,$5.18 ,$115.00 ,$64.40 ,$5.18 ,$30.25 , N/A ,$5.29 ,$5.05 ,$5.44 ,$92.00 ,$11.66 ,$51.87 ,$32.20 ,$103.50 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$55.20 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100684,84100,HC PHOSPHORUS,301,1 ,$108.00 ,$70.20 ,$4.74 ,$108.00 ,$11.85 ,$8.17 ,$60.48 ,$4.74 ,$30.24 ,$35.49 ,$4.74 ,$35.49 ,$4.74 ,$48.71 ,$48.71 ,$4.74 ,$5.93 ,$9.01 ,$9.44 ,$11.85 ,$4.74 ,$4.74 ,$4.83 ,$81.00 ,$64.80 ,$64.80 ,$4.74 ,$64.80 ,$6.85 ,$6.85 ,$6.85 ,$108.00 , N/A ,$91.80 ,$11.85 ,$70.20 ,$4.74 ,$108.00 ,$60.48 ,$4.74 ,$28.40 , N/A ,$5.29 ,$5.05 ,$4.98 ,$86.40 ,$10.67 ,$48.71 ,$30.24 ,$97.20 ,$4.74 ,$6.85 ,$9.48 ,$9.48 ,$4.74 ,$9.48 ,$51.84 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100685,84105,HC PHOSPHORUS URINE,301,1 ,$64.00 ,$41.60 ,$4.81 ,$64.00 ,$14.45 ,$8.93 ,$35.84 ,$5.78 ,$17.92 ,$22.59 ,$5.78 ,$26.37 ,$5.78 ,$28.86 ,$28.86 ,$5.78 ,$7.23 ,$10.98 ,$10.06 ,$14.45 ,$5.78 ,$5.78 ,$5.90 ,$48.00 ,$38.40 ,$38.40 ,$5.78 ,$38.40 ,$7.51 ,$7.51 ,$7.51 ,$64.00 , N/A ,$54.40 ,$14.45 ,$41.60 ,$5.78 ,$64.00 ,$35.84 ,$5.78 ,$16.83 , N/A ,$5.29 ,$5.05 ,$6.07 ,$51.20 ,$13.01 ,$28.86 ,$17.92 ,$57.60 ,$5.78 ,$7.51 ,$11.56 ,$11.56 ,$5.78 ,$11.56 ,$30.72 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100688,84112,HC PLACENTAL ALPHA MICROGLOBULIN,301,1 ,$157.00 ,$102.05 ,$29.08 ,$245.28 ,$245.28 ,$80.69 ,$87.92 ,$98.11 ,$43.96 ,$55.42 ,$98.11 ,$64.68 ,$98.11 ,$70.81 ,$70.81 ,$98.11 ,$122.64 ,$157.00 ,$157.00 ,$245.28 ,$98.11 ,$98.11 ,$100.07 ,$117.75 ,$94.20 ,$94.20 ,$98.11 ,$94.20 ,$127.54 ,$127.54 ,$127.54 ,$157.00 , N/A ,$133.45 ,$157.00 ,$102.05 ,$98.11 ,$157.00 ,$87.92 ,$98.11 ,$41.29 , N/A ,$31.99 ,$30.53 ,$103.02 ,$125.60 ,$220.75 ,$70.81 ,$43.96 ,$141.30 ,$98.11 ,$127.54 ,$157.00 ,$157.00 ,$98.11 ,$157.00 ,$75.36 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30100691,84132,HC POTASSIUM,301,1 ,$36.00 ,$23.40 ,$4.76 ,$36.00 ,$11.90 ,$7.93 ,$20.16 ,$4.76 ,$10.08 ,$12.71 ,$4.76 ,$14.83 ,$4.76 ,$16.24 ,$16.24 ,$4.76 ,$5.95 ,$9.04 ,$8.81 ,$11.90 ,$4.76 ,$4.76 ,$4.86 ,$27.00 ,$21.60 ,$21.60 ,$4.76 ,$21.60 ,$6.64 ,$6.64 ,$6.64 ,$36.00 , N/A ,$30.60 ,$11.90 ,$23.40 ,$4.76 ,$36.00 ,$20.16 ,$4.76 ,$9.47 , N/A ,$5.29 ,$5.05 ,$5.00 ,$28.80 ,$10.71 ,$16.24 ,$10.08 ,$32.40 ,$4.76 ,$6.64 ,$9.52 ,$9.52 ,$4.76 ,$9.52 ,$17.28 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100694,84133,HC POTASSIUM URINE,301,1 ,$84.00 ,$54.60 ,$4.73 ,$84.00 ,$11.83 ,$7.42 ,$47.04 ,$4.73 ,$23.52 ,$29.65 ,$4.73 ,$32.32 ,$4.73 ,$37.88 ,$37.88 ,$4.73 ,$5.91 ,$8.99 ,$8.18 ,$11.83 ,$4.73 ,$4.73 ,$4.82 ,$63.00 ,$50.40 ,$50.40 ,$4.73 ,$50.40 ,$6.23 ,$6.23 ,$6.23 ,$84.00 , N/A ,$71.40 ,$11.83 ,$54.60 ,$4.73 ,$84.00 ,$47.04 ,$4.73 ,$22.09 , N/A ,$5.29 ,$5.05 ,$4.97 ,$67.20 ,$10.64 ,$37.88 ,$23.52 ,$75.60 ,$4.73 ,$6.23 ,$9.46 ,$9.46 ,$4.73 ,$9.46 ,$40.32 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100695,84134,HC PREALBUMIN,301,1 ,$147.00 ,$95.55 ,$10.80 ,$147.00 ,$36.48 ,$25.13 ,$82.32 ,$14.59 ,$41.16 ,$51.89 ,$14.59 ,$60.56 ,$14.59 ,$66.30 ,$66.30 ,$14.59 ,$18.24 ,$27.72 ,$28.31 ,$36.48 ,$14.59 ,$14.59 ,$14.88 ,$110.25 ,$88.20 ,$88.20 ,$14.59 ,$88.20 ,$21.07 ,$21.07 ,$21.07 ,$147.00 , N/A ,$124.95 ,$36.48 ,$95.55 ,$14.59 ,$147.00 ,$82.32 ,$14.59 ,$38.66 , N/A ,$11.88 ,$11.34 ,$15.32 ,$117.60 ,$32.83 ,$66.30 ,$41.16 ,$132.30 ,$14.59 ,$21.07 ,$29.18 ,$29.18 ,$14.59 ,$29.18 ,$70.56 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100696,84144,HC PROGESTERONE,301,1 ,$121.00 ,$78.65 ,$14.54 ,$121.00 ,$52.15 ,$35.96 ,$67.76 ,$20.86 ,$33.88 ,$42.71 ,$20.86 ,$49.85 ,$20.86 ,$54.57 ,$54.57 ,$20.86 ,$26.08 ,$39.63 ,$40.26 ,$52.15 ,$20.86 ,$20.86 ,$21.28 ,$90.75 ,$72.60 ,$72.60 ,$20.86 ,$72.60 ,$30.13 ,$30.13 ,$30.13 ,$121.00 , N/A ,$102.85 ,$52.15 ,$78.65 ,$20.86 ,$121.00 ,$67.76 ,$20.86 ,$31.82 , N/A ,$15.99 ,$15.27 ,$21.90 ,$96.80 ,$46.94 ,$54.57 ,$33.88 ,$108.90 ,$20.86 ,$30.13 ,$41.72 ,$41.72 ,$20.86 ,$41.72 ,$58.08 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100697,84146,HC PROLACTIN,301,1 ,$209.00 ,$135.85 ,$19.38 ,$209.00 ,$48.45 ,$33.41 ,$117.04 ,$19.38 ,$58.52 ,$73.78 ,$19.38 ,$86.11 ,$19.38 ,$94.26 ,$94.26 ,$19.38 ,$24.23 ,$36.82 ,$37.74 ,$48.45 ,$19.38 ,$19.38 ,$19.77 ,$156.75 ,$125.40 ,$125.40 ,$19.38 ,$125.40 ,$27.99 ,$27.99 ,$27.99 ,$209.00 , N/A ,$177.65 ,$48.45 ,$135.85 ,$19.38 ,$209.00 ,$117.04 ,$19.38 ,$54.97 , N/A ,$27.81 ,$26.54 ,$20.35 ,$167.20 ,$43.61 ,$94.26 ,$58.52 ,$188.10 ,$19.38 ,$27.99 ,$38.76 ,$38.76 ,$19.38 ,$38.76 ,$100.32 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100698,84153,HC PSA TOTAL,301,1 ,$254.00 ,$165.10 ,$10.80 ,$254.00 ,$45.98 ,$31.71 ,$142.24 ,$18.39 ,$71.12 ,$89.66 ,$18.39 ,$104.65 ,$18.39 ,$114.55 ,$114.55 ,$18.39 ,$22.99 ,$34.94 ,$35.85 ,$45.98 ,$18.39 ,$18.39 ,$18.76 ,$190.50 ,$152.40 ,$152.40 ,$18.39 ,$152.40 ,$26.57 ,$26.57 ,$26.57 ,$254.00 , N/A ,$215.90 ,$45.98 ,$165.10 ,$18.39 ,$254.00 ,$142.24 ,$18.39 ,$66.80 , N/A ,$11.88 ,$11.34 ,$19.31 ,$203.20 ,$41.38 ,$114.55 ,$71.12 ,$228.60 ,$18.39 ,$26.57 ,$36.78 ,$36.78 ,$18.39 ,$36.78 ,$121.92 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100699,84154,HC PSA FREE,301,1 ,$211.00 ,$137.15 ,$10.80 ,$211.00 ,$45.98 ,$31.71 ,$118.16 ,$18.39 ,$59.08 ,$74.48 ,$18.39 ,$86.93 ,$18.39 ,$95.16 ,$95.16 ,$18.39 ,$22.99 ,$34.94 ,$35.85 ,$45.98 ,$18.39 ,$18.39 ,$18.76 ,$158.25 ,$126.60 ,$126.60 ,$18.39 ,$126.60 ,$26.57 ,$26.57 ,$26.57 ,$211.00 , N/A ,$179.35 ,$45.98 ,$137.15 ,$18.39 ,$211.00 ,$118.16 ,$18.39 ,$55.49 , N/A ,$11.88 ,$11.34 ,$19.31 ,$168.80 ,$41.38 ,$95.16 ,$59.08 ,$189.90 ,$18.39 ,$26.57 ,$36.78 ,$36.78 ,$18.39 ,$36.78 ,$101.28 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100700,84155,HC PROTEIN TOTAL,301,1 ,$88.00 ,$57.20 ,$3.67 ,$88.00 ,$9.18 ,$6.32 ,$49.28 ,$3.67 ,$24.64 ,$31.06 ,$3.67 ,$36.26 ,$3.67 ,$39.69 ,$39.69 ,$3.67 ,$4.59 ,$6.97 ,$6.92 ,$9.18 ,$3.67 ,$3.67 ,$3.74 ,$66.00 ,$52.80 ,$52.80 ,$3.67 ,$52.80 ,$5.29 ,$5.29 ,$5.29 ,$88.00 , N/A ,$74.80 ,$9.18 ,$57.20 ,$3.67 ,$88.00 ,$49.28 ,$3.67 ,$23.14 , N/A ,$5.29 ,$5.05 ,$3.85 ,$70.40 ,$8.26 ,$39.69 ,$24.64 ,$79.20 ,$3.67 ,$5.29 ,$7.34 ,$7.34 ,$3.67 ,$7.34 ,$42.24 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$95.00 ,$61.75 ,$3.67 ,$95.00 ,$9.18 ,$6.32 ,$53.20 ,$3.67 ,$26.60 ,$27.46 ,$3.67 ,$27.46 ,$3.67 ,$42.85 ,$42.85 ,$3.67 ,$4.59 ,$6.97 ,$6.92 ,$9.18 ,$3.67 ,$3.67 ,$3.74 ,$71.25 ,$57.00 ,$57.00 ,$3.67 ,$57.00 ,$5.29 ,$5.29 ,$5.29 ,$95.00 , N/A ,$80.75 ,$9.18 ,$61.75 ,$3.67 ,$95.00 ,$53.20 ,$3.67 ,$24.99 , N/A ,$5.29 ,$5.05 ,$3.85 ,$76.00 ,$8.26 ,$42.85 ,$26.60 ,$85.50 ,$3.67 ,$5.29 ,$7.34 ,$7.34 ,$3.67 ,$7.34 ,$45.60 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$90.00 ,$58.50 ,$4.00 ,$90.00 ,$10.00 ,$6.32 ,$50.40 ,$4.00 ,$25.20 ,$31.77 ,$4.00 ,$37.08 ,$4.00 ,$40.59 ,$40.59 ,$4.00 ,$5.00 ,$7.60 ,$6.92 ,$10.00 ,$4.00 ,$4.00 ,$4.08 ,$67.50 ,$54.00 ,$54.00 ,$4.00 ,$54.00 ,$5.29 ,$5.29 ,$5.29 ,$90.00 , N/A ,$76.50 ,$10.00 ,$58.50 ,$4.00 ,$90.00 ,$50.40 ,$4.00 ,$23.67 , N/A ,$5.29 ,$5.05 ,$4.20 ,$72.00 ,$9.00 ,$40.59 ,$25.20 ,$81.00 ,$4.00 ,$5.29 ,$8.00 ,$8.00 ,$4.00 ,$8.00 ,$43.20 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100721,84295,HC SODIUM,301,1 ,$93.00 ,$60.45 ,$4.81 ,$93.00 ,$12.03 ,$8.30 ,$52.08 ,$4.81 ,$26.04 ,$32.83 ,$4.81 ,$38.32 ,$4.81 ,$41.94 ,$41.94 ,$4.81 ,$6.01 ,$9.14 ,$9.44 ,$12.03 ,$4.81 ,$4.81 ,$4.91 ,$69.75 ,$55.80 ,$55.80 ,$4.81 ,$55.80 ,$6.96 ,$6.96 ,$6.96 ,$93.00 , N/A ,$79.05 ,$12.03 ,$60.45 ,$4.81 ,$93.00 ,$52.08 ,$4.81 ,$24.46 , N/A ,$5.29 ,$5.05 ,$5.05 ,$74.40 ,$10.82 ,$41.94 ,$26.04 ,$83.70 ,$4.81 ,$6.96 ,$9.62 ,$9.62 ,$4.81 ,$9.62 ,$44.64 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100724,84300,HC SODIUM URINE,301,1 ,$84.00 ,$54.60 ,$4.81 ,$84.00 ,$12.65 ,$8.40 ,$47.04 ,$5.06 ,$23.52 ,$29.65 ,$5.06 ,$34.61 ,$5.06 ,$37.88 ,$37.88 ,$5.06 ,$6.33 ,$9.61 ,$9.44 ,$12.65 ,$5.06 ,$5.06 ,$5.16 ,$63.00 ,$50.40 ,$50.40 ,$5.06 ,$50.40 ,$7.02 ,$7.02 ,$7.02 ,$84.00 , N/A ,$71.40 ,$12.65 ,$54.60 ,$5.06 ,$84.00 ,$47.04 ,$5.06 ,$22.09 , N/A ,$5.29 ,$5.05 ,$5.31 ,$67.20 ,$11.39 ,$37.88 ,$23.52 ,$75.60 ,$5.06 ,$7.02 ,$10.12 ,$10.12 ,$5.06 ,$10.12 ,$40.32 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100725,84302,HC SODIUM OTHER FLUID,301,1 ,$44.00 ,$28.60 ,$4.81 ,$44.00 ,$12.15 ,$8.40 ,$24.64 ,$4.86 ,$12.32 ,$15.53 ,$4.86 ,$18.13 ,$4.86 ,$19.84 ,$19.84 ,$4.86 ,$6.08 ,$9.23 ,$9.44 ,$12.15 ,$4.86 ,$4.86 ,$4.96 ,$33.00 ,$26.40 ,$26.40 ,$4.86 ,$26.40 ,$7.02 ,$7.02 ,$7.02 ,$44.00 , N/A ,$37.40 ,$12.15 ,$28.60 ,$4.86 ,$44.00 ,$24.64 ,$4.86 ,$11.57 , N/A ,$5.29 ,$5.05 ,$5.10 ,$35.20 ,$10.94 ,$19.84 ,$12.32 ,$39.60 ,$4.86 ,$7.02 ,$9.72 ,$9.72 ,$4.86 ,$9.72 ,$21.12 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100739,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$63.00 ,$40.95 ,$6.87 ,$63.00 ,$17.18 ,$11.85 ,$35.28 ,$6.87 ,$17.64 ,$22.24 ,$6.87 ,$25.96 ,$6.87 ,$28.41 ,$28.41 ,$6.87 ,$8.59 ,$13.05 ,$13.21 ,$17.18 ,$6.87 ,$6.87 ,$7.01 ,$47.25 ,$37.80 ,$37.80 ,$6.87 ,$37.80 ,$9.92 ,$9.92 ,$9.92 ,$63.00 , N/A ,$53.55 ,$17.18 ,$40.95 ,$6.87 ,$63.00 ,$35.28 ,$6.87 ,$16.57 , N/A ,$15.99 ,$15.27 ,$7.21 ,$50.40 ,$15.46 ,$28.41 ,$17.64 ,$56.70 ,$6.87 ,$9.92 ,$13.74 ,$13.74 ,$6.87 ,$13.74 ,$30.24 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100740,84439,HC T4 FREE,301,1 ,$153.00 ,$99.45 ,$9.02 ,$153.00 ,$22.55 ,$15.54 ,$85.68 ,$9.02 ,$42.84 ,$54.01 ,$9.02 ,$63.04 ,$9.02 ,$69.00 ,$69.00 ,$9.02 ,$11.28 ,$17.14 ,$17.61 ,$22.55 ,$9.02 ,$9.02 ,$9.20 ,$114.75 ,$91.80 ,$91.80 ,$9.02 ,$91.80 ,$13.03 ,$13.03 ,$13.03 ,$153.00 , N/A ,$130.05 ,$22.55 ,$99.45 ,$9.02 ,$153.00 ,$85.68 ,$9.02 ,$40.24 , N/A ,$15.99 ,$15.27 ,$9.47 ,$122.40 ,$20.30 ,$69.00 ,$42.84 ,$137.70 ,$9.02 ,$13.03 ,$18.04 ,$18.04 ,$9.02 ,$18.04 ,$73.44 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$168.00 ,$109.20 ,$14.54 ,$168.00 ,$42.00 ,$28.96 ,$94.08 ,$16.80 ,$47.04 ,$59.30 ,$16.80 ,$69.22 ,$16.80 ,$75.77 ,$75.77 ,$16.80 ,$21.00 ,$31.92 ,$32.71 ,$42.00 ,$16.80 ,$16.80 ,$17.14 ,$126.00 ,$100.80 ,$100.80 ,$16.80 ,$100.80 ,$24.27 ,$24.27 ,$24.27 ,$168.00 , N/A ,$142.80 ,$42.00 ,$109.20 ,$16.80 ,$168.00 ,$94.08 ,$16.80 ,$44.18 , N/A ,$15.99 ,$15.27 ,$17.64 ,$134.40 ,$37.80 ,$75.77 ,$47.04 ,$151.20 ,$16.80 ,$24.27 ,$33.60 ,$33.60 ,$16.80 ,$33.60 ,$80.64 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100746,84450,HC AST,301,1 ,$125.00 ,$81.25 ,$4.81 ,$125.00 ,$12.95 ,$8.93 ,$70.00 ,$5.18 ,$35.00 ,$44.13 ,$5.18 ,$51.50 ,$5.18 ,$56.38 ,$56.38 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$93.75 ,$75.00 ,$75.00 ,$5.18 ,$75.00 ,$7.48 ,$7.48 ,$7.48 ,$125.00 , N/A ,$106.25 ,$12.95 ,$81.25 ,$5.18 ,$125.00 ,$70.00 ,$5.18 ,$32.88 , N/A ,$5.29 ,$5.05 ,$5.44 ,$100.00 ,$11.66 ,$56.38 ,$35.00 ,$112.50 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$60.00 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100747,84460,HC ALT,301,1 ,$120.00 ,$78.00 ,$4.81 ,$120.00 ,$13.25 ,$9.12 ,$67.20 ,$5.30 ,$33.60 ,$42.36 ,$5.30 ,$49.44 ,$5.30 ,$54.12 ,$54.12 ,$5.30 ,$6.63 ,$10.07 ,$10.06 ,$13.25 ,$5.30 ,$5.30 ,$5.41 ,$90.00 ,$72.00 ,$72.00 ,$5.30 ,$72.00 ,$7.66 ,$7.66 ,$7.66 ,$120.00 , N/A ,$102.00 ,$13.25 ,$78.00 ,$5.30 ,$120.00 ,$67.20 ,$5.30 ,$31.56 , N/A ,$5.29 ,$5.05 ,$5.57 ,$96.00 ,$11.93 ,$54.12 ,$33.60 ,$108.00 ,$5.30 ,$7.66 ,$10.60 ,$10.60 ,$5.30 ,$10.60 ,$57.60 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100748,84466,HC TRANSFERRIN,301,1 ,$130.00 ,$84.50 ,$10.80 ,$130.00 ,$31.90 ,$22.02 ,$72.80 ,$12.76 ,$36.40 ,$45.89 ,$12.76 ,$53.56 ,$12.76 ,$58.63 ,$58.63 ,$12.76 ,$15.95 ,$24.24 ,$24.53 ,$31.90 ,$12.76 ,$12.76 ,$13.02 ,$97.50 ,$78.00 ,$78.00 ,$12.76 ,$78.00 ,$18.43 ,$18.43 ,$18.43 ,$130.00 , N/A ,$110.50 ,$31.90 ,$84.50 ,$12.76 ,$130.00 ,$72.80 ,$12.76 ,$34.19 , N/A ,$11.88 ,$11.34 ,$13.40 ,$104.00 ,$28.71 ,$58.63 ,$36.40 ,$117.00 ,$12.76 ,$18.43 ,$25.52 ,$25.52 ,$12.76 ,$25.52 ,$62.40 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100750,84478,HC TRIGLYCERIDES,301,1 ,$182.00 ,$118.30 ,$4.81 ,$182.00 ,$14.35 ,$9.92 ,$101.92 ,$5.74 ,$50.96 ,$58.28 ,$5.74 ,$58.28 ,$5.74 ,$82.08 ,$82.08 ,$5.74 ,$7.18 ,$10.91 ,$11.32 ,$14.35 ,$5.74 ,$5.74 ,$5.85 ,$136.50 ,$109.20 ,$109.20 ,$5.74 ,$109.20 ,$8.29 ,$8.29 ,$8.29 ,$182.00 , N/A ,$154.70 ,$14.35 ,$118.30 ,$5.74 ,$182.00 ,$101.92 ,$5.74 ,$47.87 , N/A ,$5.29 ,$5.05 ,$6.03 ,$145.60 ,$12.92 ,$82.08 ,$50.96 ,$163.80 ,$5.74 ,$8.29 ,$11.48 ,$11.48 ,$5.74 ,$11.48 ,$87.36 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100754,84480,HC T3 TOTAL,301,1 ,$61.00 ,$39.65 ,$14.18 ,$61.00 ,$35.45 ,$19.02 ,$34.16 ,$14.18 ,$17.08 ,$21.53 ,$14.18 ,$25.13 ,$14.18 ,$27.51 ,$27.51 ,$14.18 ,$17.73 ,$26.94 ,$27.68 ,$35.45 ,$14.18 ,$14.18 ,$14.46 ,$45.75 ,$36.60 ,$36.60 ,$14.18 ,$36.60 ,$20.48 ,$20.48 ,$20.48 ,$61.00 , N/A ,$51.85 ,$35.45 ,$39.65 ,$14.18 ,$61.00 ,$34.16 ,$14.18 ,$16.04 , N/A ,$15.99 ,$15.27 ,$14.89 ,$48.80 ,$31.91 ,$27.51 ,$17.08 ,$54.90 ,$14.18 ,$20.48 ,$28.36 ,$28.36 ,$14.18 ,$28.36 ,$29.28 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100755,84481,HC T3 FREE,301,1 ,$144.00 ,$93.60 ,$14.54 ,$144.00 ,$42.35 ,$19.55 ,$80.64 ,$16.94 ,$40.32 ,$50.83 ,$16.94 ,$59.33 ,$16.94 ,$64.94 ,$64.94 ,$16.94 ,$21.18 ,$32.19 ,$32.71 ,$42.35 ,$16.94 ,$16.94 ,$17.28 ,$108.00 ,$86.40 ,$86.40 ,$16.94 ,$86.40 ,$24.47 ,$24.47 ,$24.47 ,$144.00 , N/A ,$122.40 ,$42.35 ,$93.60 ,$16.94 ,$144.00 ,$80.64 ,$16.94 ,$37.87 , N/A ,$15.99 ,$15.27 ,$17.79 ,$115.20 ,$38.12 ,$64.94 ,$40.32 ,$129.60 ,$16.94 ,$24.47 ,$33.88 ,$33.88 ,$16.94 ,$33.88 ,$69.12 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100758,84484,HC TROPONIN QN,301,1 ,$201.00 ,$130.65 ,$10.80 ,$201.00 ,$31.18 ,$16.98 ,$112.56 ,$12.47 ,$56.28 ,$70.95 ,$12.47 ,$75.75 ,$12.47 ,$90.65 ,$90.65 ,$12.47 ,$15.59 ,$23.69 ,$22.02 ,$31.18 ,$12.47 ,$12.47 ,$12.72 ,$150.75 ,$120.60 ,$120.60 ,$12.47 ,$120.60 ,$16.21 ,$16.21 ,$16.21 ,$201.00 , N/A ,$170.85 ,$31.18 ,$130.65 ,$12.47 ,$201.00 ,$112.56 ,$12.47 ,$52.86 , N/A ,$11.88 ,$11.34 ,$13.09 ,$160.80 ,$28.06 ,$90.65 ,$56.28 ,$180.90 ,$12.47 ,$16.21 ,$24.94 ,$24.94 ,$12.47 ,$24.94 ,$96.48 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100761,84520,HC BUN,301,1 ,$63.00 ,$40.95 ,$3.95 ,$63.00 ,$9.88 ,$6.81 ,$35.28 ,$3.95 ,$17.64 ,$22.24 ,$3.95 ,$25.96 ,$3.95 ,$28.41 ,$28.41 ,$3.95 ,$4.94 ,$7.51 ,$7.55 ,$9.88 ,$3.95 ,$3.95 ,$4.03 ,$47.25 ,$37.80 ,$37.80 ,$3.95 ,$37.80 ,$5.71 ,$5.71 ,$5.71 ,$63.00 , N/A ,$53.55 ,$9.88 ,$40.95 ,$3.95 ,$3.95 ,$35.28 ,$3.95 ,$16.57 , N/A ,$5.29 ,$5.05 ,$4.15 ,$50.40 ,$8.89 ,$28.41 ,$17.64 ,$56.70 ,$3.95 ,$5.71 ,$7.90 ,$7.90 ,$3.95 ,$7.90 ,$30.24 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100764,84540,HC UREA URINE,301,1 ,$103.00 ,$66.95 ,$4.81 ,$103.00 ,$13.90 ,$8.19 ,$57.68 ,$5.56 ,$28.84 ,$35.59 ,$5.56 ,$35.59 ,$5.56 ,$46.45 ,$46.45 ,$5.56 ,$6.95 ,$10.56 ,$9.44 ,$13.90 ,$5.56 ,$5.56 ,$5.67 ,$77.25 ,$61.80 ,$61.80 ,$5.56 ,$61.80 ,$7.23 ,$7.23 ,$7.23 ,$103.00 , N/A ,$87.55 ,$13.90 ,$66.95 ,$5.56 ,$103.00 ,$57.68 ,$5.56 ,$27.09 , N/A ,$5.29 ,$5.05 ,$5.84 ,$82.40 ,$12.51 ,$46.45 ,$28.84 ,$92.70 ,$5.56 ,$7.23 ,$11.12 ,$11.12 ,$5.56 ,$11.12 ,$49.44 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100765,84550,HC URIC ACID,301,1 ,$43.00 ,$27.95 ,$4.52 ,$43.00 ,$11.30 ,$7.79 ,$24.08 ,$4.52 ,$12.04 ,$15.18 ,$4.52 ,$17.72 ,$4.52 ,$19.39 ,$19.39 ,$4.52 ,$5.65 ,$8.59 ,$8.81 ,$11.30 ,$4.52 ,$4.52 ,$4.61 ,$32.25 ,$25.80 ,$25.80 ,$4.52 ,$25.80 ,$6.53 ,$6.53 ,$6.53 ,$43.00 , N/A ,$36.55 ,$11.30 ,$27.95 ,$4.52 ,$43.00 ,$24.08 ,$4.52 ,$11.31 , N/A ,$5.29 ,$5.05 ,$4.75 ,$34.40 ,$10.17 ,$19.39 ,$12.04 ,$38.70 ,$4.52 ,$6.53 ,$9.04 ,$9.04 ,$4.52 ,$9.04 ,$20.64 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100766,84560,HC URIC ACID OTH SRC,301,1 ,$108.00 ,$70.20 ,$4.81 ,$108.00 ,$12.70 ,$8.19 ,$60.48 ,$5.08 ,$30.24 ,$35.59 ,$5.08 ,$35.59 ,$5.08 ,$48.71 ,$48.71 ,$5.08 ,$6.35 ,$9.65 ,$9.44 ,$12.70 ,$5.08 ,$5.08 ,$5.18 ,$81.00 ,$64.80 ,$64.80 ,$5.08 ,$64.80 ,$6.85 ,$6.85 ,$6.85 ,$108.00 , N/A ,$91.80 ,$12.70 ,$70.20 ,$5.08 ,$108.00 ,$60.48 ,$5.08 ,$28.40 , N/A ,$5.29 ,$5.05 ,$5.33 ,$86.40 ,$11.43 ,$48.71 ,$30.24 ,$97.20 ,$5.08 ,$6.85 ,$10.16 ,$10.16 ,$5.08 ,$10.16 ,$51.84 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100802,84702,HC HCG QN,301,1 ,$201.00 ,$130.65 ,$14.54 ,$201.00 ,$37.63 ,$25.95 ,$112.56 ,$15.05 ,$56.28 ,$70.95 ,$15.05 ,$82.81 ,$15.05 ,$90.65 ,$90.65 ,$15.05 ,$18.81 ,$28.60 ,$28.93 ,$37.63 ,$15.05 ,$15.05 ,$15.35 ,$150.75 ,$120.60 ,$120.60 ,$15.05 ,$120.60 ,$21.75 ,$21.75 ,$21.75 ,$201.00 , N/A ,$170.85 ,$37.63 ,$130.65 ,$15.05 ,$201.00 ,$112.56 ,$15.05 ,$52.86 , N/A ,$15.99 ,$15.27 ,$15.80 ,$160.80 ,$33.86 ,$90.65 ,$56.28 ,$180.90 ,$15.05 ,$21.75 ,$30.10 ,$30.10 ,$15.05 ,$30.10 ,$96.48 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30100808,84703,HC HCG QL,301,1 ,$89.00 ,$57.85 ,$7.52 ,$89.00 ,$18.80 ,$12.95 ,$49.84 ,$7.52 ,$24.92 ,$31.42 ,$7.52 ,$36.67 ,$7.52 ,$40.14 ,$40.14 ,$7.52 ,$9.40 ,$14.29 ,$14.47 ,$18.80 ,$7.52 ,$7.52 ,$7.67 ,$66.75 ,$53.40 ,$53.40 ,$7.52 ,$53.40 ,$10.87 ,$10.87 ,$10.87 ,$89.00 , N/A ,$75.65 ,$18.80 ,$57.85 ,$7.52 ,$89.00 ,$49.84 ,$7.52 ,$23.41 , N/A ,$11.88 ,$11.34 ,$7.90 ,$71.20 ,$16.92 ,$40.14 ,$24.92 ,$80.10 ,$7.52 ,$10.87 ,$15.04 ,$15.04 ,$7.52 ,$15.04 ,$42.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30100810,88720,HC BILICHECK TEST,301,1 ,$32.00 ,$20.80 ,$4.81 ,$32.00 ,$12.55 ,$8.65 ,$17.92 ,$5.02 ,$8.96 ,$11.30 ,$5.02 ,$13.18 ,$5.02 ,$14.43 ,$14.43 ,$5.02 ,$6.28 ,$9.54 ,$9.44 ,$12.55 ,$5.02 ,$5.02 ,$5.12 ,$24.00 ,$19.20 ,$19.20 ,$5.02 ,$19.20 ,$7.24 ,$7.24 ,$7.24 ,$32.00 , N/A ,$27.20 ,$12.55 ,$20.80 ,$5.02 ,$32.00 ,$17.92 ,$5.02 ,$8.42 , N/A ,$5.29 ,$5.05 ,$5.27 ,$25.60 ,$11.30 ,$14.43 ,$8.96 ,$28.80 ,$5.02 ,$7.24 ,$10.04 ,$10.04 ,$5.02 ,$10.04 ,$15.36 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30100820,83664,HC LAMELLAR BODY CT,301,1 ,$73.00 ,$47.45 ,$19.20 ,$73.00 ,$48.30 ,$32.62 ,$40.88 ,$19.32 ,$20.44 ,$25.77 ,$19.32 ,$30.08 ,$19.32 ,$32.92 ,$32.92 ,$19.32 ,$24.15 ,$36.71 ,$36.48 ,$48.30 ,$19.32 ,$19.32 ,$19.71 ,$54.75 ,$43.80 ,$43.80 ,$19.32 ,$43.80 ,$27.31 ,$27.31 ,$27.31 ,$73.00 , N/A ,$62.05 ,$48.30 ,$47.45 ,$19.32 ,$73.00 ,$40.88 ,$19.32 ,$19.20 , N/A ,$33.95 ,$32.40 ,$20.29 ,$58.40 ,$43.47 ,$32.92 ,$20.44 ,$65.70 ,$19.32 ,$27.31 ,$38.64 ,$38.64 ,$19.32 ,$38.64 ,$35.04 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30100833,84403,HC TESTOSTERONE,301,1 ,$196.00 ,$127.40 ,$25.28 ,$196.00 ,$64.53 ,$44.50 ,$109.76 ,$25.81 ,$54.88 ,$69.19 ,$25.81 ,$80.75 ,$25.81 ,$88.40 ,$88.40 ,$25.81 ,$32.26 ,$49.04 ,$50.32 ,$64.53 ,$25.81 ,$25.81 ,$26.33 ,$147.00 ,$117.60 ,$117.60 ,$25.81 ,$117.60 ,$37.28 ,$37.28 ,$37.28 ,$196.00 , N/A ,$166.60 ,$64.53 ,$127.40 ,$25.81 ,$196.00 ,$109.76 ,$25.81 ,$51.55 , N/A ,$27.81 ,$26.54 ,$27.10 ,$156.80 ,$58.07 ,$88.40 ,$54.88 ,$176.40 ,$25.81 ,$37.28 ,$51.62 ,$51.62 ,$25.81 ,$51.62 ,$94.08 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30100860,84145,HC PROCALCITONIN,301,1 ,$81.66 ,$53.08 ,$21.48 ,$81.66 ,$68.05 ,$46.17 ,$45.73 ,$27.22 ,$22.86 ,$28.83 ,$27.22 ,$33.64 ,$27.22 ,$36.83 ,$36.83 ,$27.22 ,$34.03 ,$51.72 ,$52.21 ,$68.05 ,$27.22 ,$27.22 ,$27.76 ,$61.25 ,$49.00 ,$49.00 ,$27.22 ,$49.00 ,$38.70 ,$38.70 ,$38.70 ,$81.66 , N/A ,$69.41 ,$68.05 ,$53.08 ,$27.22 ,$81.66 ,$45.73 ,$27.22 ,$21.48 , N/A ,$27.81 ,$26.54 ,$28.58 ,$65.33 ,$61.25 ,$36.83 ,$22.86 ,$73.49 ,$27.22 ,$38.70 ,$54.44 ,$54.44 ,$27.22 ,$54.44 ,$39.20 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101011,83630,HC LACTOFERRIN FECAL QL,301,1 ,$59.10 ,$38.42 ,$10.80 ,$59.10 ,$49.25 ,$33.83 ,$33.10 ,$19.70 ,$16.55 ,$20.86 ,$19.70 ,$24.35 ,$19.70 ,$26.65 ,$26.65 ,$19.70 ,$24.63 ,$37.43 ,$38.37 ,$49.25 ,$19.70 ,$19.70 ,$20.09 ,$44.33 ,$35.46 ,$35.46 ,$19.70 ,$35.46 ,$28.35 ,$28.35 ,$28.35 ,$59.10 , N/A ,$50.24 ,$49.25 ,$38.42 ,$19.70 ,$59.10 ,$33.10 ,$19.70 ,$15.54 , N/A ,$11.88 ,$11.34 ,$20.69 ,$47.28 ,$44.33 ,$26.65 ,$16.55 ,$53.19 ,$19.70 ,$28.35 ,$39.40 ,$39.40 ,$19.70 ,$39.40 ,$28.37 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$179.00 ,$116.35 ,$10.80 ,$179.00 ,$48.28 ,$31.71 ,$100.24 ,$19.31 ,$50.12 ,$63.19 ,$19.31 ,$73.75 ,$19.31 ,$80.73 ,$80.73 ,$19.31 ,$24.14 ,$36.69 ,$35.85 ,$48.28 ,$19.31 ,$19.31 ,$19.70 ,$134.25 ,$107.40 ,$107.40 ,$19.31 ,$107.40 ,$26.57 ,$26.57 ,$26.57 ,$179.00 , N/A ,$152.15 ,$48.28 ,$116.35 ,$19.31 ,$179.00 ,$100.24 ,$19.31 ,$47.08 , N/A ,$11.88 ,$11.34 ,$20.28 ,$143.20 ,$43.45 ,$80.73 ,$50.12 ,$161.10 ,$19.31 ,$26.57 ,$38.62 ,$38.62 ,$19.31 ,$38.62 ,$85.92 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101063,83519,HC ACETYLCHOLINE RECEPTR AB TIER 1-90,301,1 ,$55.00 ,$35.75 ,$9.67 ,$55.00 ,$46.00 ,$23.29 ,$30.80 ,$18.40 ,$15.40 ,$19.42 ,$18.40 ,$22.66 ,$18.40 ,$24.81 ,$24.81 ,$18.40 ,$23.00 ,$34.96 ,$32.08 ,$46.00 ,$18.40 ,$18.40 ,$18.77 ,$41.25 ,$33.00 ,$33.00 ,$18.40 ,$33.00 ,$23.92 ,$23.92 ,$23.92 ,$55.00 , N/A ,$46.75 ,$46.00 ,$35.75 ,$18.40 ,$55.00 ,$30.80 ,$18.40 ,$14.47 , N/A ,$10.64 ,$10.15 ,$19.32 ,$44.00 ,$41.40 ,$24.81 ,$15.40 ,$49.50 ,$18.40 ,$23.92 ,$36.80 ,$36.80 ,$18.40 ,$36.80 ,$26.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101065,83520,HC ANTI-NEURONAL CELL AB-90,301,1 ,$446.00 ,$289.90 ,$9.67 ,$446.00 ,$43.18 ,$22.31 ,$249.76 ,$17.27 ,$124.88 ,$141.97 ,$17.27 ,$141.97 ,$17.27 ,$201.15 ,$201.15 ,$17.27 ,$21.59 ,$32.81 ,$30.19 ,$43.18 ,$17.27 ,$17.27 ,$17.62 ,$334.50 ,$267.60 ,$267.60 ,$17.27 ,$267.60 ,$22.45 ,$22.45 ,$22.45 ,$446.00 , N/A ,$379.10 ,$43.18 ,$289.90 ,$17.27 ,$446.00 ,$249.76 ,$17.27 ,$117.30 , N/A ,$10.64 ,$10.15 ,$18.13 ,$356.80 ,$38.86 ,$201.15 ,$124.88 ,$401.40 ,$17.27 ,$22.45 ,$34.54 ,$34.54 ,$17.27 ,$34.54 ,$214.08 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101070,83986,HC PH BODY FLUID -QW,301,1 ,$58.00 ,$37.70 ,$3.58 ,$58.00 ,$8.95 ,$6.18 ,$32.48 ,$3.58 ,$16.24 ,$20.47 ,$3.58 ,$23.90 ,$3.58 ,$26.16 ,$26.16 ,$3.58 ,$4.48 ,$6.80 ,$6.92 ,$8.95 ,$3.58 ,$3.58 ,$3.65 ,$43.50 ,$34.80 ,$34.80 ,$3.58 ,$34.80 ,$5.17 ,$5.17 ,$5.17 ,$58.00 , N/A ,$49.30 ,$8.95 ,$37.70 ,$3.58 ,$58.00 ,$32.48 ,$3.58 ,$15.25 , N/A ,$5.29 ,$5.05 ,$3.76 ,$46.40 ,$8.06 ,$26.16 ,$16.24 ,$52.20 ,$3.58 ,$5.17 ,$7.16 ,$7.16 ,$3.58 ,$7.16 ,$27.84 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101075,80048,HC BASIC METABOLIC PANEL,301,1 ,$341.00 ,$221.65 ,$8.46 ,$341.00 ,$21.15 ,$14.60 ,$190.96 ,$8.46 ,$95.48 ,$76.28 ,$8.46 ,$76.28 ,$8.46 ,$153.79 ,$153.79 ,$8.46 ,$10.58 ,$16.07 ,$16.35 ,$21.15 ,$8.46 ,$8.46 ,$8.63 ,$255.75 ,$204.60 ,$204.60 ,$8.46 ,$204.60 ,$12.22 ,$12.22 ,$12.22 ,$341.00 , N/A ,$289.85 ,$21.15 ,$221.65 ,$8.46 ,$8.46 ,$190.96 ,$8.46 ,$89.68 , N/A ,$10.84 ,$10.34 ,$8.88 ,$272.80 ,$19.04 ,$153.79 ,$95.48 ,$306.90 ,$8.46 ,$12.22 ,$16.92 ,$16.92 ,$8.46 ,$16.92 ,$163.68 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101076,80050,HC GENERAL HEALTH PANEL,301,1 ,$322.00 ,$209.30 ,$9.85 ,$322.00 , N/A ,$47.65 ,$180.32 , N/A ,$90.16 ,$113.67 , N/A ,$132.66 , N/A ,$145.22 ,$145.22 , N/A ,$209.30 , N/A ,$82.40 , N/A , N/A , N/A , N/A ,$241.50 ,$193.20 ,$193.20 , N/A ,$193.20 ,$225.40 ,$225.40 ,$225.40 ,$322.00 , N/A ,$273.70 , N/A ,$209.30 , N/A ,$322.00 ,$180.32 , N/A ,$84.69 , N/A ,$10.84 ,$10.34 , N/A ,$257.60 , N/A ,$145.22 ,$90.16 ,$289.80 , N/A ,$225.40 ,$90.72 ,$90.72 , N/A ,$90.72 ,$154.56 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101078,80051,HC ELECTROLYTE PANEL,301,1 ,$163.00 ,$105.95 ,$7.01 ,$163.00 ,$17.53 ,$12.09 ,$91.28 ,$7.01 ,$45.64 ,$57.54 ,$7.01 ,$63.25 ,$7.01 ,$73.51 ,$73.51 ,$7.01 ,$8.76 ,$13.32 ,$13.84 ,$17.53 ,$7.01 ,$7.01 ,$7.15 ,$122.25 ,$97.80 ,$97.80 ,$7.01 ,$97.80 ,$10.13 ,$10.13 ,$10.13 ,$163.00 , N/A ,$138.55 ,$17.53 ,$105.95 ,$7.01 ,$163.00 ,$91.28 ,$7.01 ,$42.87 , N/A ,$10.84 ,$10.34 ,$7.36 ,$130.40 ,$15.77 ,$73.51 ,$45.64 ,$146.70 ,$7.01 ,$10.13 ,$14.02 ,$14.02 ,$7.01 ,$14.02 ,$78.24 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101080,80053,HC COMPREHENSIVE METABOLIC PANEL,301,1 ,$320.00 ,$208.00 ,$9.85 ,$320.00 ,$26.40 ,$18.22 ,$179.20 ,$10.56 ,$89.60 ,$95.28 ,$10.56 ,$95.28 ,$10.56 ,$144.32 ,$144.32 ,$10.56 ,$13.20 ,$20.06 ,$20.76 ,$26.40 ,$10.56 ,$10.56 ,$10.77 ,$240.00 ,$192.00 ,$192.00 ,$10.56 ,$192.00 ,$15.26 ,$15.26 ,$15.26 ,$320.00 , N/A ,$272.00 ,$26.40 ,$208.00 ,$10.56 ,$10.56 ,$179.20 ,$10.56 ,$84.16 , N/A ,$10.84 ,$10.34 ,$11.09 ,$256.00 ,$23.76 ,$144.32 ,$89.60 ,$288.00 ,$10.56 ,$15.26 ,$21.12 ,$21.12 ,$10.56 ,$21.12 ,$153.60 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101082,80061,HC LIPID PANEL,301,1 ,$121.00 ,$78.65 ,$9.85 ,$121.00 ,$33.48 ,$23.10 ,$67.76 ,$13.39 ,$33.88 ,$42.71 ,$13.39 ,$49.85 ,$13.39 ,$54.57 ,$54.57 ,$13.39 ,$16.74 ,$25.44 ,$25.79 ,$33.48 ,$13.39 ,$13.39 ,$13.66 ,$90.75 ,$72.60 ,$72.60 ,$13.39 ,$72.60 ,$19.34 ,$19.34 ,$19.34 ,$121.00 , N/A ,$102.85 ,$33.48 ,$78.65 ,$13.39 ,$121.00 ,$67.76 ,$13.39 ,$31.82 , N/A ,$10.84 ,$10.34 ,$14.06 ,$96.80 ,$30.13 ,$54.57 ,$33.88 ,$108.90 ,$13.39 ,$19.34 ,$26.78 ,$26.78 ,$13.39 ,$26.78 ,$58.08 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101083,80061,HC LIPID PANEL - 90,301,1 ,$242.00 ,$157.30 ,$9.85 ,$242.00 ,$33.48 ,$23.10 ,$135.52 ,$13.39 ,$67.76 ,$85.43 ,$13.39 ,$99.70 ,$13.39 ,$109.14 ,$109.14 ,$13.39 ,$16.74 ,$25.44 ,$25.79 ,$33.48 ,$13.39 ,$13.39 ,$13.66 ,$181.50 ,$145.20 ,$145.20 ,$13.39 ,$145.20 ,$19.34 ,$19.34 ,$19.34 ,$242.00 , N/A ,$205.70 ,$33.48 ,$157.30 ,$13.39 ,$242.00 ,$135.52 ,$13.39 ,$63.65 , N/A ,$10.84 ,$10.34 ,$14.06 ,$193.60 ,$30.13 ,$109.14 ,$67.76 ,$217.80 ,$13.39 ,$19.34 ,$26.78 ,$26.78 ,$13.39 ,$26.78 ,$116.16 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101084,80069,HC RENAL PANEL,301,1 ,$184.00 ,$119.60 ,$8.68 ,$184.00 ,$21.70 ,$14.96 ,$103.04 ,$8.68 ,$51.52 ,$64.95 ,$8.68 ,$75.81 ,$8.68 ,$82.98 ,$82.98 ,$8.68 ,$10.85 ,$16.49 ,$16.98 ,$21.70 ,$8.68 ,$8.68 ,$8.85 ,$138.00 ,$110.40 ,$110.40 ,$8.68 ,$110.40 ,$12.55 ,$12.55 ,$12.55 ,$184.00 , N/A ,$156.40 ,$21.70 ,$119.60 ,$8.68 ,$184.00 ,$103.04 ,$8.68 ,$48.39 , N/A ,$10.84 ,$10.34 ,$9.11 ,$147.20 ,$19.53 ,$82.98 ,$51.52 ,$165.60 ,$8.68 ,$12.55 ,$17.36 ,$17.36 ,$8.68 ,$17.36 ,$88.32 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101086,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$336.00 ,$218.40 ,$9.85 ,$336.00 ,$119.08 ,$82.09 ,$188.16 ,$47.63 ,$94.08 ,$118.61 ,$47.63 ,$138.43 ,$47.63 ,$151.54 ,$151.54 ,$47.63 ,$59.54 ,$90.50 ,$92.47 ,$119.08 ,$47.63 ,$47.63 ,$48.58 ,$252.00 ,$201.60 ,$201.60 ,$47.63 ,$201.60 ,$68.81 ,$68.81 ,$68.81 ,$336.00 , N/A ,$285.60 ,$119.08 ,$218.40 ,$47.63 ,$336.00 ,$188.16 ,$47.63 ,$88.37 , N/A ,$10.84 ,$10.34 ,$50.01 ,$268.80 ,$107.17 ,$151.54 ,$94.08 ,$302.40 ,$47.63 ,$68.81 ,$95.26 ,$95.26 ,$47.63 ,$95.26 ,$161.28 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101087,80074,HC HEPATITIS PANEL ACUTE - 90,301,1 ,$336.00 ,$218.40 ,$9.85 ,$336.00 ,$119.08 ,$82.09 ,$188.16 ,$47.63 ,$94.08 ,$118.61 ,$47.63 ,$138.43 ,$47.63 ,$151.54 ,$151.54 ,$47.63 ,$59.54 ,$90.50 ,$92.47 ,$119.08 ,$47.63 ,$47.63 ,$48.58 ,$252.00 ,$201.60 ,$201.60 ,$47.63 ,$201.60 ,$68.81 ,$68.81 ,$68.81 ,$336.00 , N/A ,$285.60 ,$119.08 ,$218.40 ,$47.63 ,$336.00 ,$188.16 ,$47.63 ,$88.37 , N/A ,$10.84 ,$10.34 ,$50.01 ,$268.80 ,$107.17 ,$151.54 ,$94.08 ,$302.40 ,$47.63 ,$68.81 ,$95.26 ,$95.26 ,$47.63 ,$95.26 ,$161.28 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101088,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$207.00 ,$134.55 ,$8.17 ,$207.00 ,$20.43 ,$14.07 ,$115.92 ,$8.17 ,$57.96 ,$61.27 ,$8.17 ,$61.27 ,$8.17 ,$93.36 ,$93.36 ,$8.17 ,$10.21 ,$15.52 ,$15.73 ,$20.43 ,$8.17 ,$8.17 ,$8.33 ,$155.25 ,$124.20 ,$124.20 ,$8.17 ,$124.20 ,$11.80 ,$11.80 ,$11.80 ,$207.00 , N/A ,$175.95 ,$20.43 ,$134.55 ,$8.17 ,$207.00 ,$115.92 ,$8.17 ,$54.44 , N/A ,$10.84 ,$10.34 ,$8.58 ,$165.60 ,$18.38 ,$93.36 ,$57.96 ,$186.30 ,$8.17 ,$11.80 ,$16.34 ,$16.34 ,$8.17 ,$16.34 ,$99.36 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101089,80150,HC AMIKACIN - 90,301,1 ,$59.00 ,$38.35 ,$12.40 ,$59.00 ,$37.70 ,$19.55 ,$33.04 ,$15.08 ,$16.52 ,$20.83 ,$15.08 ,$24.31 ,$15.08 ,$26.61 ,$26.61 ,$15.08 ,$18.85 ,$28.65 ,$28.93 ,$37.70 ,$15.08 ,$15.08 ,$15.38 ,$44.25 ,$35.40 ,$35.40 ,$15.08 ,$35.40 ,$21.78 ,$21.78 ,$21.78 ,$59.00 , N/A ,$50.15 ,$37.70 ,$38.35 ,$15.08 ,$59.00 ,$33.04 ,$15.08 ,$15.52 , N/A ,$13.64 ,$13.02 ,$15.83 ,$47.20 ,$33.93 ,$26.61 ,$16.52 ,$53.10 ,$15.08 ,$21.78 ,$30.16 ,$30.16 ,$15.08 ,$30.16 ,$28.32 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101091,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$190.00 ,$123.50 ,$12.40 ,$190.00 ,$36.43 ,$25.10 ,$106.40 ,$14.57 ,$53.20 ,$67.07 ,$14.57 ,$78.28 ,$14.57 ,$85.69 ,$85.69 ,$14.57 ,$18.21 ,$27.68 ,$28.31 ,$36.43 ,$14.57 ,$14.57 ,$14.86 ,$142.50 ,$114.00 ,$114.00 ,$14.57 ,$114.00 ,$21.03 ,$21.03 ,$21.03 ,$190.00 , N/A ,$161.50 ,$36.43 ,$123.50 ,$14.57 ,$190.00 ,$106.40 ,$14.57 ,$49.97 , N/A ,$13.64 ,$13.02 ,$15.30 ,$152.00 ,$32.78 ,$85.69 ,$53.20 ,$171.00 ,$14.57 ,$21.03 ,$29.14 ,$29.14 ,$14.57 ,$29.14 ,$91.20 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101093,80157,HC CARBAMAZEPINE FREE - 90,301,1 ,$84.00 ,$54.60 ,$12.40 ,$84.00 ,$33.13 ,$22.86 ,$47.04 ,$13.25 ,$23.52 ,$29.65 ,$13.25 ,$34.61 ,$13.25 ,$37.88 ,$37.88 ,$13.25 ,$16.56 ,$25.18 ,$25.79 ,$33.13 ,$13.25 ,$13.25 ,$13.52 ,$63.00 ,$50.40 ,$50.40 ,$13.25 ,$50.40 ,$19.15 ,$19.15 ,$19.15 ,$84.00 , N/A ,$71.40 ,$33.13 ,$54.60 ,$13.25 ,$84.00 ,$47.04 ,$13.25 ,$22.09 , N/A ,$13.64 ,$13.02 ,$13.91 ,$67.20 ,$29.81 ,$37.88 ,$23.52 ,$75.60 ,$13.25 ,$19.15 ,$26.50 ,$26.50 ,$13.25 ,$26.50 ,$40.32 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101094,80158,HC CYCLOSPORINE - 90,301,1 ,$125.00 ,$81.25 ,$12.40 ,$125.00 ,$45.13 ,$31.12 ,$70.00 ,$18.05 ,$35.00 ,$44.13 ,$18.05 ,$51.50 ,$18.05 ,$56.38 ,$56.38 ,$18.05 ,$22.56 ,$34.30 ,$35.23 ,$45.13 ,$18.05 ,$18.05 ,$18.41 ,$93.75 ,$75.00 ,$75.00 ,$18.05 ,$75.00 ,$26.08 ,$26.08 ,$26.08 ,$125.00 , N/A ,$106.25 ,$45.13 ,$81.25 ,$18.05 ,$125.00 ,$70.00 ,$18.05 ,$32.88 , N/A ,$13.64 ,$13.02 ,$18.95 ,$100.00 ,$40.61 ,$56.38 ,$35.00 ,$112.50 ,$18.05 ,$26.08 ,$36.10 ,$36.10 ,$18.05 ,$36.10 ,$60.00 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101096,80162,HC DIGOXIN LEVELS,301,1 ,$113.00 ,$73.45 ,$12.40 ,$113.00 ,$33.20 ,$22.89 ,$63.28 ,$13.28 ,$31.64 ,$39.89 ,$13.28 ,$46.56 ,$13.28 ,$50.96 ,$50.96 ,$13.28 ,$16.60 ,$25.23 ,$25.79 ,$33.20 ,$13.28 ,$13.28 ,$13.55 ,$84.75 ,$67.80 ,$67.80 ,$13.28 ,$67.80 ,$19.18 ,$19.18 ,$19.18 ,$113.00 , N/A ,$96.05 ,$33.20 ,$73.45 ,$13.28 ,$113.00 ,$63.28 ,$13.28 ,$29.72 , N/A ,$13.64 ,$13.02 ,$13.94 ,$90.40 ,$29.88 ,$50.96 ,$31.64 ,$101.70 ,$13.28 ,$19.18 ,$26.56 ,$26.56 ,$13.28 ,$26.56 ,$54.24 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101097,80164,HC VALPROIC ACID - 90,301,1 ,$90.00 ,$58.50 ,$12.40 ,$90.00 ,$33.85 ,$23.35 ,$50.40 ,$13.54 ,$25.20 ,$31.77 ,$13.54 ,$37.08 ,$13.54 ,$40.59 ,$40.59 ,$13.54 ,$16.93 ,$25.73 ,$26.42 ,$33.85 ,$13.54 ,$13.54 ,$13.81 ,$67.50 ,$54.00 ,$54.00 ,$13.54 ,$54.00 ,$19.57 ,$19.57 ,$19.57 ,$90.00 , N/A ,$76.50 ,$33.85 ,$58.50 ,$13.54 ,$90.00 ,$50.40 ,$13.54 ,$23.67 , N/A ,$13.64 ,$13.02 ,$14.22 ,$72.00 ,$30.47 ,$40.59 ,$25.20 ,$81.00 ,$13.54 ,$19.57 ,$27.08 ,$27.08 ,$13.54 ,$27.08 ,$43.20 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101098,80165,HC VALPROIC ACID FREE - 90,301,1 ,$66.00 ,$42.90 ,$12.40 ,$66.00 ,$33.85 ,$22.59 ,$36.96 ,$13.54 ,$18.48 ,$23.30 ,$13.54 ,$27.19 ,$13.54 ,$29.77 ,$29.77 ,$13.54 ,$16.93 ,$25.73 ,$26.42 ,$33.85 ,$13.54 ,$13.54 ,$13.81 ,$49.50 ,$39.60 ,$39.60 ,$13.54 ,$39.60 ,$19.57 ,$19.57 ,$19.57 ,$66.00 , N/A ,$56.10 ,$33.85 ,$42.90 ,$13.54 ,$66.00 ,$36.96 ,$13.54 ,$17.36 , N/A ,$13.64 ,$13.02 ,$14.22 ,$52.80 ,$30.47 ,$29.77 ,$18.48 ,$59.40 ,$13.54 ,$19.57 ,$27.08 ,$27.08 ,$13.54 ,$27.08 ,$31.68 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101100,80169,HC EVEROLIMUS - 90,301,1 ,$220.00 ,$143.00 ,$12.40 ,$220.00 ,$34.33 ,$22.94 ,$123.20 ,$13.73 ,$61.60 ,$77.66 ,$13.73 ,$90.64 ,$13.73 ,$99.22 ,$99.22 ,$13.73 ,$17.16 ,$26.09 ,$26.42 ,$34.33 ,$13.73 ,$13.73 ,$14.00 ,$165.00 ,$132.00 ,$132.00 ,$13.73 ,$132.00 ,$19.84 ,$19.84 ,$19.84 ,$220.00 , N/A ,$187.00 ,$34.33 ,$143.00 ,$13.73 ,$220.00 ,$123.20 ,$13.73 ,$57.86 , N/A ,$13.64 ,$13.02 ,$14.42 ,$176.00 ,$30.89 ,$99.22 ,$61.60 ,$198.00 ,$13.73 ,$19.84 ,$27.46 ,$27.46 ,$13.73 ,$27.46 ,$105.60 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101105,80176,HC LIDOCAINE - 90,301,1 ,$88.00 ,$57.20 ,$12.40 ,$88.00 ,$36.73 ,$25.32 ,$49.28 ,$14.69 ,$24.64 ,$31.06 ,$14.69 ,$36.26 ,$14.69 ,$39.69 ,$39.69 ,$14.69 ,$18.36 ,$27.91 ,$28.31 ,$36.73 ,$14.69 ,$14.69 ,$14.98 ,$66.00 ,$52.80 ,$52.80 ,$14.69 ,$52.80 ,$21.22 ,$21.22 ,$21.22 ,$88.00 , N/A ,$74.80 ,$36.73 ,$57.20 ,$14.69 ,$88.00 ,$49.28 ,$14.69 ,$23.14 , N/A ,$13.64 ,$13.02 ,$15.42 ,$70.40 ,$33.05 ,$39.69 ,$24.64 ,$79.20 ,$14.69 ,$21.22 ,$29.38 ,$29.38 ,$14.69 ,$29.38 ,$42.24 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101107,80178,HC LITHIUM,301,1 ,$69.00 ,$44.85 ,$6.61 ,$69.00 ,$16.53 ,$11.39 ,$38.64 ,$6.61 ,$19.32 ,$24.36 ,$6.61 ,$28.43 ,$6.61 ,$31.12 ,$31.12 ,$6.61 ,$8.26 ,$12.56 ,$12.58 ,$16.53 ,$6.61 ,$6.61 ,$6.74 ,$51.75 ,$41.40 ,$41.40 ,$6.61 ,$41.40 ,$9.56 ,$9.56 ,$9.56 ,$69.00 , N/A ,$58.65 ,$16.53 ,$44.85 ,$6.61 ,$69.00 ,$38.64 ,$6.61 ,$18.15 , N/A ,$13.64 ,$13.02 ,$6.94 ,$55.20 ,$14.87 ,$31.12 ,$19.32 ,$62.10 ,$6.61 ,$9.56 ,$13.22 ,$13.22 ,$6.61 ,$13.22 ,$33.12 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101109,80183,HC OXCARBAZEPINE - 90,301,1 ,$81.00 ,$52.65 ,$12.40 ,$81.00 ,$33.13 ,$22.16 ,$45.36 ,$13.25 ,$22.68 ,$28.59 ,$13.25 ,$33.37 ,$13.25 ,$36.53 ,$36.53 ,$13.25 ,$16.56 ,$25.18 ,$25.79 ,$33.13 ,$13.25 ,$13.25 ,$13.52 ,$60.75 ,$48.60 ,$48.60 ,$13.25 ,$48.60 ,$19.15 ,$19.15 ,$19.15 ,$81.00 , N/A ,$68.85 ,$33.13 ,$52.65 ,$13.25 ,$81.00 ,$45.36 ,$13.25 ,$21.30 , N/A ,$13.64 ,$13.02 ,$13.91 ,$64.80 ,$29.81 ,$36.53 ,$22.68 ,$72.90 ,$13.25 ,$19.15 ,$26.50 ,$26.50 ,$13.25 ,$26.50 ,$38.88 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101111,80184,HC PHENOBARBITAL,301,1 ,$198.00 ,$128.70 ,$12.40 ,$198.00 ,$38.25 ,$18.74 ,$110.88 ,$15.30 ,$55.44 ,$69.89 ,$15.30 ,$81.58 ,$15.30 ,$89.30 ,$89.30 ,$15.30 ,$19.13 ,$29.07 ,$26.42 ,$38.25 ,$15.30 ,$15.30 ,$15.61 ,$148.50 ,$118.80 ,$118.80 ,$15.30 ,$118.80 ,$19.89 ,$19.89 ,$19.89 ,$198.00 , N/A ,$168.30 ,$38.25 ,$128.70 ,$15.30 ,$198.00 ,$110.88 ,$15.30 ,$52.07 , N/A ,$13.64 ,$13.02 ,$16.07 ,$158.40 ,$34.43 ,$89.30 ,$55.44 ,$178.20 ,$15.30 ,$19.89 ,$30.60 ,$30.60 ,$15.30 ,$30.60 ,$95.04 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101112,80185,HC PHENYTOIN TOTAL,301,1 ,$208.00 ,$135.20 ,$12.40 ,$208.00 ,$33.13 ,$22.86 ,$116.48 ,$13.25 ,$58.24 ,$73.42 ,$13.25 ,$85.70 ,$13.25 ,$93.81 ,$93.81 ,$13.25 ,$16.56 ,$25.18 ,$25.79 ,$33.13 ,$13.25 ,$13.25 ,$13.52 ,$156.00 ,$124.80 ,$124.80 ,$13.25 ,$124.80 ,$19.15 ,$19.15 ,$19.15 ,$208.00 , N/A ,$176.80 ,$33.13 ,$135.20 ,$13.25 ,$208.00 ,$116.48 ,$13.25 ,$54.70 , N/A ,$13.64 ,$13.02 ,$13.91 ,$166.40 ,$29.81 ,$93.81 ,$58.24 ,$187.20 ,$13.25 ,$19.15 ,$26.50 ,$26.50 ,$13.25 ,$26.50 ,$99.84 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101114,80186,HC PHENYTOIN FREE - 90,301,1 ,$158.00 ,$102.70 ,$12.40 ,$158.00 ,$34.40 ,$23.73 ,$88.48 ,$13.76 ,$44.24 ,$55.77 ,$13.76 ,$65.10 ,$13.76 ,$71.26 ,$71.26 ,$13.76 ,$17.20 ,$26.14 ,$26.42 ,$34.40 ,$13.76 ,$13.76 ,$14.04 ,$118.50 ,$94.80 ,$94.80 ,$13.76 ,$94.80 ,$19.88 ,$19.88 ,$19.88 ,$158.00 , N/A ,$134.30 ,$34.40 ,$102.70 ,$13.76 ,$158.00 ,$88.48 ,$13.76 ,$41.55 , N/A ,$13.64 ,$13.02 ,$14.45 ,$126.40 ,$30.96 ,$71.26 ,$44.24 ,$142.20 ,$13.76 ,$19.88 ,$27.52 ,$27.52 ,$13.76 ,$27.52 ,$75.84 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101118,80195,HC RAPAMYCIN (SIROLIMUS) - 90,301,1 ,$118.00 ,$76.70 ,$12.40 ,$118.00 ,$34.33 ,$23.66 ,$66.08 ,$13.73 ,$33.04 ,$41.65 ,$13.73 ,$48.62 ,$13.73 ,$53.22 ,$53.22 ,$13.73 ,$17.16 ,$26.09 ,$26.42 ,$34.33 ,$13.73 ,$13.73 ,$14.00 ,$88.50 ,$70.80 ,$70.80 ,$13.73 ,$70.80 ,$19.84 ,$19.84 ,$19.84 ,$118.00 , N/A ,$100.30 ,$34.33 ,$76.70 ,$13.73 ,$118.00 ,$66.08 ,$13.73 ,$31.03 , N/A ,$13.64 ,$13.02 ,$14.42 ,$94.40 ,$30.89 ,$53.22 ,$33.04 ,$106.20 ,$13.73 ,$19.84 ,$27.46 ,$27.46 ,$13.73 ,$27.46 ,$56.64 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101119,80197,HC TACROLIMUS - 90,301,1 ,$79.00 ,$51.35 ,$12.40 ,$79.00 ,$34.33 ,$23.66 ,$44.24 ,$13.73 ,$22.12 ,$27.89 ,$13.73 ,$32.55 ,$13.73 ,$35.63 ,$35.63 ,$13.73 ,$17.16 ,$26.09 ,$26.42 ,$34.33 ,$13.73 ,$13.73 ,$14.00 ,$59.25 ,$47.40 ,$47.40 ,$13.73 ,$47.40 ,$19.84 ,$19.84 ,$19.84 ,$79.00 , N/A ,$67.15 ,$34.33 ,$51.35 ,$13.73 ,$79.00 ,$44.24 ,$13.73 ,$20.78 , N/A ,$13.64 ,$13.02 ,$14.42 ,$63.20 ,$30.89 ,$35.63 ,$22.12 ,$71.10 ,$13.73 ,$19.84 ,$27.46 ,$27.46 ,$13.73 ,$27.46 ,$37.92 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101120,80198,HC THEOPHYLLINE,301,1 ,$198.00 ,$128.70 ,$12.40 ,$198.00 ,$35.35 ,$24.40 ,$110.88 ,$14.14 ,$55.44 ,$69.89 ,$14.14 ,$81.58 ,$14.14 ,$89.30 ,$89.30 ,$14.14 ,$17.68 ,$26.87 ,$27.68 ,$35.35 ,$14.14 ,$14.14 ,$14.42 ,$148.50 ,$118.80 ,$118.80 ,$14.14 ,$118.80 ,$20.42 ,$20.42 ,$20.42 ,$198.00 , N/A ,$168.30 ,$35.35 ,$128.70 ,$14.14 ,$198.00 ,$110.88 ,$14.14 ,$52.07 , N/A ,$13.64 ,$13.02 ,$14.85 ,$158.40 ,$31.82 ,$89.30 ,$55.44 ,$178.20 ,$14.14 ,$20.42 ,$28.28 ,$28.28 ,$14.14 ,$28.28 ,$95.04 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101124,80201,HC TOPIRAMATE - 90,301,1 ,$133.00 ,$86.45 ,$11.92 ,$133.00 ,$29.80 ,$20.56 ,$74.48 ,$11.92 ,$37.24 ,$46.95 ,$11.92 ,$54.80 ,$11.92 ,$59.98 ,$59.98 ,$11.92 ,$14.90 ,$22.65 ,$23.27 ,$29.80 ,$11.92 ,$11.92 ,$12.16 ,$99.75 ,$79.80 ,$79.80 ,$11.92 ,$79.80 ,$17.21 ,$17.21 ,$17.21 ,$133.00 , N/A ,$113.05 ,$29.80 ,$86.45 ,$11.92 ,$133.00 ,$74.48 ,$11.92 ,$34.98 , N/A ,$13.64 ,$13.02 ,$12.52 ,$106.40 ,$26.82 ,$59.98 ,$37.24 ,$119.70 ,$11.92 ,$17.21 ,$23.84 ,$23.84 ,$11.92 ,$23.84 ,$63.84 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101125,80202,HC VANCOMYCIN,301,1 ,$205.00 ,$133.25 ,$12.40 ,$205.00 ,$33.85 ,$23.35 ,$114.80 ,$13.54 ,$57.40 ,$72.37 ,$13.54 ,$84.46 ,$13.54 ,$92.46 ,$92.46 ,$13.54 ,$16.93 ,$25.73 ,$26.42 ,$33.85 ,$13.54 ,$13.54 ,$13.81 ,$153.75 ,$123.00 ,$123.00 ,$13.54 ,$123.00 ,$19.57 ,$19.57 ,$19.57 ,$205.00 , N/A ,$174.25 ,$33.85 ,$133.25 ,$13.54 ,$205.00 ,$114.80 ,$13.54 ,$53.92 , N/A ,$13.64 ,$13.02 ,$14.22 ,$164.00 ,$30.47 ,$92.46 ,$57.40 ,$184.50 ,$13.54 ,$19.57 ,$27.08 ,$27.08 ,$13.54 ,$27.08 ,$98.40 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101126,80203,HC ZONISAMIDE - 90,301,1 ,$178.00 ,$115.70 ,$12.40 ,$178.00 ,$33.13 ,$22.16 ,$99.68 ,$13.25 ,$49.84 ,$62.83 ,$13.25 ,$73.34 ,$13.25 ,$80.28 ,$80.28 ,$13.25 ,$16.56 ,$25.18 ,$25.79 ,$33.13 ,$13.25 ,$13.25 ,$13.52 ,$133.50 ,$106.80 ,$106.80 ,$13.25 ,$106.80 ,$19.15 ,$19.15 ,$19.15 ,$178.00 , N/A ,$151.30 ,$33.13 ,$115.70 ,$13.25 ,$178.00 ,$99.68 ,$13.25 ,$46.81 , N/A ,$13.64 ,$13.02 ,$13.91 ,$142.40 ,$29.81 ,$80.28 ,$49.84 ,$160.20 ,$13.25 ,$19.15 ,$26.50 ,$26.50 ,$13.25 ,$26.50 ,$85.44 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101131,80299,HC THERAPEUTIC DRUG OTHER - 90,301,1 ,$438.00 ,$284.70 ,$12.40 ,$438.00 ,$46.60 ,$22.84 ,$245.28 ,$18.64 ,$122.64 ,$113.20 ,$18.64 ,$113.20 ,$18.64 ,$197.54 ,$197.54 ,$18.64 ,$23.30 ,$35.42 ,$32.71 ,$46.60 ,$18.64 ,$18.64 ,$19.01 ,$328.50 ,$262.80 ,$262.80 ,$18.64 ,$262.80 ,$24.23 ,$24.23 ,$24.23 ,$438.00 , N/A ,$372.30 ,$46.60 ,$284.70 ,$18.64 ,$438.00 ,$245.28 ,$18.64 ,$115.19 , N/A ,$13.64 ,$13.02 ,$19.57 ,$350.40 ,$41.94 ,$197.54 ,$122.64 ,$394.20 ,$18.64 ,$24.23 ,$37.28 ,$37.28 ,$18.64 ,$37.28 ,$210.24 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101133,80306,HC DRUG SCREEN PRESUMPTIVE INSTRMNT ASSIST DIR OPTICAL T2,301,1 ,$239.00 ,$155.35 ,$10.80 ,$239.00 ,$42.85 ,$34.49 ,$133.84 ,$17.14 ,$66.92 ,$84.37 ,$17.14 ,$98.47 ,$17.14 ,$107.79 ,$107.79 ,$17.14 ,$21.43 ,$32.57 ,$30.19 ,$42.85 ,$17.14 ,$17.14 ,$17.48 ,$179.25 ,$143.40 ,$143.40 ,$17.14 ,$143.40 ,$22.28 ,$22.28 ,$22.28 ,$239.00 , N/A ,$203.15 ,$42.85 ,$155.35 ,$17.14 ,$239.00 ,$133.84 ,$17.14 ,$62.86 , N/A ,$11.88 ,$11.34 ,$18.00 ,$191.20 ,$38.57 ,$107.79 ,$66.92 ,$215.10 ,$17.14 ,$22.28 ,$34.28 ,$34.28 ,$17.14 ,$34.28 ,$114.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101137,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4,301,1 ,$346.00 ,$224.90 ,$29.08 ,$346.00 ,$155.35 ,$137.95 ,$193.76 ,$62.14 ,$96.88 ,$122.14 ,$62.14 ,$142.55 ,$62.14 ,$156.05 ,$156.05 ,$62.14 ,$77.68 ,$118.07 ,$112.59 ,$155.35 ,$62.14 ,$62.14 ,$63.38 ,$259.50 ,$207.60 ,$207.60 ,$62.14 ,$207.60 ,$84.05 ,$84.05 ,$84.05 ,$346.00 , N/A ,$294.10 ,$155.35 ,$224.90 ,$62.14 ,$346.00 ,$193.76 ,$62.14 ,$91.00 , N/A ,$31.99 ,$30.53 ,$65.25 ,$276.80 ,$139.82 ,$156.05 ,$96.88 ,$311.40 ,$62.14 ,$84.05 ,$124.28 ,$124.28 ,$62.14 ,$124.28 ,$166.08 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101140,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T1-90,301,1 ,$118.00 ,$76.70 ,$29.08 ,$155.35 ,$155.35 ,$118.00 ,$66.08 ,$62.14 ,$33.04 ,$41.65 ,$62.14 ,$48.62 ,$62.14 ,$53.22 ,$53.22 ,$62.14 ,$77.68 ,$118.00 ,$112.59 ,$155.35 ,$62.14 ,$62.14 ,$63.38 ,$88.50 ,$70.80 ,$70.80 ,$62.14 ,$70.80 ,$84.05 ,$84.05 ,$84.05 ,$118.00 , N/A ,$100.30 ,$118.00 ,$76.70 ,$62.14 ,$118.00 ,$66.08 ,$62.14 ,$31.03 , N/A ,$31.99 ,$30.53 ,$65.25 ,$94.40 ,$139.82 ,$53.22 ,$33.04 ,$106.20 ,$62.14 ,$84.05 ,$118.00 ,$118.00 ,$62.14 ,$118.00 ,$56.64 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101142,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T3-90,301,1 ,$632.00 ,$410.80 ,$29.08 ,$632.00 ,$155.35 ,$137.95 ,$353.92 ,$62.14 ,$176.96 ,$223.10 ,$62.14 ,$260.38 ,$62.14 ,$285.03 ,$285.03 ,$62.14 ,$77.68 ,$118.07 ,$112.59 ,$155.35 ,$62.14 ,$62.14 ,$63.38 ,$474.00 ,$379.20 ,$379.20 ,$62.14 ,$379.20 ,$84.05 ,$84.05 ,$84.05 ,$632.00 , N/A ,$537.20 ,$155.35 ,$410.80 ,$62.14 ,$632.00 ,$353.92 ,$62.14 ,$166.22 , N/A ,$31.99 ,$30.53 ,$65.25 ,$505.60 ,$139.82 ,$285.03 ,$176.96 ,$568.80 ,$62.14 ,$84.05 ,$124.28 ,$124.28 ,$62.14 ,$124.28 ,$303.36 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101143,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4-90,301,1 ,$346.00 ,$224.90 ,$29.08 ,$346.00 ,$155.35 ,$137.95 ,$193.76 ,$62.14 ,$96.88 ,$122.14 ,$62.14 ,$142.55 ,$62.14 ,$156.05 ,$156.05 ,$62.14 ,$77.68 ,$118.07 ,$112.59 ,$155.35 ,$62.14 ,$62.14 ,$63.38 ,$259.50 ,$207.60 ,$207.60 ,$62.14 ,$207.60 ,$84.05 ,$84.05 ,$84.05 ,$346.00 , N/A ,$294.10 ,$155.35 ,$224.90 ,$62.14 ,$346.00 ,$193.76 ,$62.14 ,$91.00 , N/A ,$31.99 ,$30.53 ,$65.25 ,$276.80 ,$139.82 ,$156.05 ,$96.88 ,$311.40 ,$62.14 ,$84.05 ,$124.28 ,$124.28 ,$62.14 ,$124.28 ,$166.08 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101146,80323,HC NICOTINE - 90,301,1 ,$136.00 ,$88.40 ,$0.02 ,$136.00 , N/A ,$0.02 ,$76.16 , N/A ,$38.08 , N/A , N/A , N/A , N/A ,$61.34 ,$61.34 , N/A ,$88.40 , N/A ,$68.00 , N/A , N/A , N/A , N/A ,$102.00 ,$81.60 ,$81.60 , N/A ,$81.60 ,$26.46 ,$26.46 ,$26.46 ,$136.00 , N/A ,$115.60 , N/A ,$88.40 , N/A ,$136.00 ,$76.16 , N/A ,$35.77 , N/A ,$31.99 ,$30.53 , N/A ,$108.80 , N/A ,$61.34 ,$38.08 ,$122.40 , N/A ,$26.46 , N/A , N/A , N/A , N/A ,$65.28 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101150,80346,HC BENZODIAZEPINES 1-12  -90,301,1 ,$312.00 ,$202.80 ,$0.02 ,$312.00 , N/A ,$0.02 ,$174.72 , N/A ,$87.36 , N/A , N/A , N/A , N/A ,$140.71 ,$140.71 , N/A ,$202.80 , N/A ,$156.00 , N/A , N/A , N/A , N/A ,$234.00 ,$187.20 ,$187.20 , N/A ,$187.20 ,$20.94 ,$20.94 ,$20.94 ,$312.00 , N/A ,$265.20 , N/A ,$202.80 , N/A ,$312.00 ,$174.72 , N/A ,$82.06 , N/A ,$31.99 ,$30.53 , N/A ,$249.60 , N/A ,$140.71 ,$87.36 ,$280.80 , N/A ,$20.94 , N/A , N/A , N/A , N/A ,$149.76 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101152,80353,HC COCAINE QN -90,301,1 ,$42.00 ,$27.30 ,$0.02 ,$42.00 , N/A ,$0.02 ,$23.52 , N/A ,$11.76 , N/A , N/A , N/A , N/A ,$18.94 ,$18.94 , N/A ,$27.30 , N/A ,$21.00 , N/A , N/A , N/A , N/A ,$31.50 ,$25.20 ,$25.20 , N/A ,$25.20 ,$15.86 ,$15.86 ,$15.86 ,$42.00 , N/A ,$35.70 , N/A ,$27.30 , N/A ,$42.00 ,$23.52 , N/A ,$11.05 , N/A ,$11.88 ,$11.34 , N/A ,$33.60 , N/A ,$18.94 ,$11.76 ,$37.80 , N/A ,$15.86 , N/A , N/A , N/A , N/A ,$20.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101155,82010,HC ACETONE KETONES SERUM QN-90,301,1 ,$145.47 ,$94.56 ,$8.17 ,$145.47 ,$20.43 ,$14.09 ,$81.46 ,$8.17 ,$40.73 ,$51.35 ,$8.17 ,$59.93 ,$8.17 ,$65.61 ,$65.61 ,$8.17 ,$10.21 ,$15.52 ,$15.73 ,$20.43 ,$8.17 ,$8.17 ,$8.33 ,$109.10 ,$87.28 ,$87.28 ,$8.17 ,$87.28 ,$11.80 ,$11.80 ,$11.80 ,$145.47 , N/A ,$123.65 ,$20.43 ,$94.56 ,$8.17 ,$145.47 ,$81.46 ,$8.17 ,$38.26 , N/A ,$11.88 ,$11.34 ,$8.58 ,$116.38 ,$18.38 ,$65.61 ,$40.73 ,$130.92 ,$8.17 ,$11.80 ,$16.34 ,$16.34 ,$8.17 ,$16.34 ,$69.83 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101157,82017,HC ACYLCARNITINES QN EA SPEC-90,301,1 ,$126.00 ,$81.90 ,$10.80 ,$126.00 ,$42.18 ,$29.09 ,$70.56 ,$16.87 ,$35.28 ,$44.48 ,$16.87 ,$51.91 ,$16.87 ,$56.83 ,$56.83 ,$16.87 ,$21.09 ,$32.05 ,$32.71 ,$42.18 ,$16.87 ,$16.87 ,$17.21 ,$94.50 ,$75.60 ,$75.60 ,$16.87 ,$75.60 ,$24.36 ,$24.36 ,$24.36 ,$126.00 , N/A ,$107.10 ,$42.18 ,$81.90 ,$16.87 ,$126.00 ,$70.56 ,$16.87 ,$33.14 , N/A ,$11.88 ,$11.34 ,$17.71 ,$100.80 ,$37.96 ,$56.83 ,$35.28 ,$113.40 ,$16.87 ,$24.36 ,$33.74 ,$33.74 ,$16.87 ,$33.74 ,$60.48 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101158,82024,HC ACTH -90,301,1 ,$224.00 ,$145.60 ,$25.28 ,$224.00 ,$96.55 ,$66.59 ,$125.44 ,$38.62 ,$62.72 ,$79.07 ,$38.62 ,$92.29 ,$38.62 ,$101.02 ,$101.02 ,$38.62 ,$48.28 ,$73.38 ,$74.85 ,$96.55 ,$38.62 ,$38.62 ,$39.39 ,$168.00 ,$134.40 ,$134.40 ,$38.62 ,$134.40 ,$55.78 ,$55.78 ,$55.78 ,$224.00 , N/A ,$190.40 ,$96.55 ,$145.60 ,$38.62 ,$224.00 ,$125.44 ,$38.62 ,$58.91 , N/A ,$27.81 ,$26.54 ,$40.55 ,$179.20 ,$86.90 ,$101.02 ,$62.72 ,$201.60 ,$38.62 ,$55.78 ,$77.24 ,$77.24 ,$38.62 ,$77.24 ,$107.52 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101159,82040,HC ALBUMIN-90,301,1 ,$6.12 ,$3.98 ,$1.61 ,$12.38 ,$12.38 ,$6.12 ,$3.43 ,$4.95 ,$1.71 ,$2.16 ,$4.95 ,$2.52 ,$4.95 ,$2.76 ,$2.76 ,$4.95 ,$6.12 ,$6.12 ,$6.12 ,$12.38 ,$4.95 ,$4.95 ,$5.05 ,$4.59 ,$3.67 ,$3.67 ,$4.95 ,$3.67 ,$6.12 ,$6.12 ,$6.12 ,$6.12 , N/A ,$5.20 ,$6.12 ,$3.98 ,$4.95 ,$6.12 ,$3.43 ,$4.95 ,$1.61 , N/A ,$5.29 ,$5.05 ,$5.20 ,$4.90 ,$11.14 ,$2.76 ,$1.71 ,$5.51 ,$4.95 ,$6.12 ,$6.12 ,$6.12 ,$4.95 ,$6.12 ,$2.94 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101162,82085,HC ALDOLASE-90,301,1 ,$99.00 ,$64.35 ,$9.71 ,$99.00 ,$24.28 ,$16.73 ,$55.44 ,$9.71 ,$27.72 ,$34.95 ,$9.71 ,$40.79 ,$9.71 ,$44.65 ,$44.65 ,$9.71 ,$12.14 ,$18.45 ,$18.87 ,$24.28 ,$9.71 ,$9.71 ,$9.90 ,$74.25 ,$59.40 ,$59.40 ,$9.71 ,$59.40 ,$14.03 ,$14.03 ,$14.03 ,$99.00 , N/A ,$84.15 ,$24.28 ,$64.35 ,$9.71 ,$99.00 ,$55.44 ,$9.71 ,$26.04 , N/A ,$11.88 ,$11.34 ,$10.20 ,$79.20 ,$21.85 ,$44.65 ,$27.72 ,$89.10 ,$9.71 ,$14.03 ,$19.42 ,$19.42 ,$9.71 ,$19.42 ,$47.52 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101163,82088,HC ALDOSTERONE-90,301,1 ,$246.00 ,$159.90 ,$25.28 ,$246.00 ,$101.88 ,$70.26 ,$137.76 ,$40.75 ,$68.88 ,$86.84 ,$40.75 ,$101.35 ,$40.75 ,$110.95 ,$110.95 ,$40.75 ,$50.94 ,$77.43 ,$79.26 ,$101.88 ,$40.75 ,$40.75 ,$41.57 ,$184.50 ,$147.60 ,$147.60 ,$40.75 ,$147.60 ,$58.86 ,$58.86 ,$58.86 ,$246.00 , N/A ,$209.10 ,$101.88 ,$159.90 ,$40.75 ,$246.00 ,$137.76 ,$40.75 ,$64.70 , N/A ,$27.81 ,$26.54 ,$42.79 ,$196.80 ,$91.69 ,$110.95 ,$68.88 ,$221.40 ,$40.75 ,$58.86 ,$81.50 ,$81.50 ,$40.75 ,$81.50 ,$118.08 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101164,82103,HC ALPHA-1 ANTITRYPSIN TOTAL-90,301,1 ,$51.00 ,$33.15 ,$10.80 ,$51.00 ,$33.60 ,$23.17 ,$28.56 ,$13.44 ,$14.28 ,$18.00 ,$13.44 ,$21.01 ,$13.44 ,$23.00 ,$23.00 ,$13.44 ,$16.80 ,$25.54 ,$25.79 ,$33.60 ,$13.44 ,$13.44 ,$13.71 ,$38.25 ,$30.60 ,$30.60 ,$13.44 ,$30.60 ,$19.41 ,$19.41 ,$19.41 ,$51.00 , N/A ,$43.35 ,$33.60 ,$33.15 ,$13.44 ,$51.00 ,$28.56 ,$13.44 ,$13.41 , N/A ,$11.88 ,$11.34 ,$14.11 ,$40.80 ,$30.24 ,$23.00 ,$14.28 ,$45.90 ,$13.44 ,$19.41 ,$26.88 ,$26.88 ,$13.44 ,$26.88 ,$24.48 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101165,82104,HC ALPHA-1 ANTITRYPSIN PHENO-90,301,1 ,$259.00 ,$168.35 ,$10.80 ,$259.00 ,$36.15 ,$24.94 ,$145.04 ,$14.46 ,$72.52 ,$91.43 ,$14.46 ,$106.71 ,$14.46 ,$116.81 ,$116.81 ,$14.46 ,$18.08 ,$27.47 ,$28.31 ,$36.15 ,$14.46 ,$14.46 ,$14.75 ,$194.25 ,$155.40 ,$155.40 ,$14.46 ,$155.40 ,$20.89 ,$20.89 ,$20.89 ,$259.00 , N/A ,$220.15 ,$36.15 ,$168.35 ,$14.46 ,$259.00 ,$145.04 ,$14.46 ,$68.12 , N/A ,$11.88 ,$11.34 ,$15.18 ,$207.20 ,$32.54 ,$116.81 ,$72.52 ,$233.10 ,$14.46 ,$20.89 ,$28.92 ,$28.92 ,$14.46 ,$28.92 ,$124.32 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101166,82105,HC ALPHA FETOPROTEIN SERUM-90,301,1 ,$150.00 ,$97.50 ,$10.80 ,$150.00 ,$41.93 ,$28.93 ,$84.00 ,$16.77 ,$42.00 ,$52.95 ,$16.77 ,$61.80 ,$16.77 ,$67.65 ,$67.65 ,$16.77 ,$20.96 ,$31.86 ,$32.71 ,$41.93 ,$16.77 ,$16.77 ,$17.11 ,$112.50 ,$90.00 ,$90.00 ,$16.77 ,$90.00 ,$24.23 ,$24.23 ,$24.23 ,$150.00 , N/A ,$127.50 ,$41.93 ,$97.50 ,$16.77 ,$150.00 ,$84.00 ,$16.77 ,$39.45 , N/A ,$11.88 ,$11.34 ,$17.61 ,$120.00 ,$37.73 ,$67.65 ,$42.00 ,$135.00 ,$16.77 ,$24.23 ,$33.54 ,$33.54 ,$16.77 ,$33.54 ,$72.00 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101169,82108,HC ALUMINUM-90,301,1 ,$146.00 ,$94.90 ,$13.17 ,$146.00 ,$63.70 ,$43.93 ,$81.76 ,$25.48 ,$40.88 ,$51.54 ,$25.48 ,$60.15 ,$25.48 ,$65.85 ,$65.85 ,$25.48 ,$31.85 ,$48.41 ,$49.69 ,$63.70 ,$25.48 ,$25.48 ,$25.99 ,$109.50 ,$87.60 ,$87.60 ,$25.48 ,$87.60 ,$36.80 ,$36.80 ,$36.80 ,$146.00 , N/A ,$124.10 ,$63.70 ,$94.90 ,$25.48 ,$146.00 ,$81.76 ,$25.48 ,$38.40 , N/A ,$14.49 ,$13.83 ,$26.75 ,$116.80 ,$57.33 ,$65.85 ,$40.88 ,$131.40 ,$25.48 ,$36.80 ,$50.96 ,$50.96 ,$25.48 ,$50.96 ,$70.08 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101172,82131,HC AMINO ACID QN SINGLE-90,301,1 ,$167.00 ,$108.55 ,$10.80 ,$167.00 ,$57.45 ,$29.09 ,$93.52 ,$22.98 ,$46.76 ,$58.95 ,$22.98 ,$68.80 ,$22.98 ,$75.32 ,$75.32 ,$22.98 ,$28.73 ,$43.66 ,$40.26 ,$57.45 ,$22.98 ,$22.98 ,$23.44 ,$125.25 ,$100.20 ,$100.20 ,$22.98 ,$100.20 ,$29.87 ,$29.87 ,$29.87 ,$167.00 , N/A ,$141.95 ,$57.45 ,$108.55 ,$22.98 ,$167.00 ,$93.52 ,$22.98 ,$43.92 , N/A ,$11.88 ,$11.34 ,$24.13 ,$133.60 ,$51.71 ,$75.32 ,$46.76 ,$150.30 ,$22.98 ,$29.87 ,$45.96 ,$45.96 ,$22.98 ,$45.96 ,$80.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101176,82140,HC AMMONIA-90,301,1 ,$129.00 ,$83.85 ,$10.80 ,$129.00 ,$36.43 ,$25.13 ,$72.24 ,$14.57 ,$36.12 ,$45.54 ,$14.57 ,$53.15 ,$14.57 ,$58.18 ,$58.18 ,$14.57 ,$18.21 ,$27.68 ,$28.31 ,$36.43 ,$14.57 ,$14.57 ,$14.86 ,$96.75 ,$77.40 ,$77.40 ,$14.57 ,$77.40 ,$21.05 ,$21.05 ,$21.05 ,$129.00 , N/A ,$109.65 ,$36.43 ,$83.85 ,$14.57 ,$129.00 ,$72.24 ,$14.57 ,$33.93 , N/A ,$11.88 ,$11.34 ,$15.30 ,$103.20 ,$32.78 ,$58.18 ,$36.12 ,$116.10 ,$14.57 ,$21.05 ,$29.14 ,$29.14 ,$14.57 ,$29.14 ,$61.92 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101178,82157,HC ANDROSTENEDIONE-90,301,1 ,$109.00 ,$70.85 ,$25.28 ,$109.00 ,$73.20 ,$50.47 ,$61.04 ,$29.28 ,$30.52 ,$38.48 ,$29.28 ,$44.91 ,$29.28 ,$49.16 ,$49.16 ,$29.28 ,$36.60 ,$55.63 ,$56.61 ,$73.20 ,$29.28 ,$29.28 ,$29.87 ,$81.75 ,$65.40 ,$65.40 ,$29.28 ,$65.40 ,$42.29 ,$42.29 ,$42.29 ,$109.00 , N/A ,$92.65 ,$73.20 ,$70.85 ,$29.28 ,$109.00 ,$61.04 ,$29.28 ,$28.67 , N/A ,$27.81 ,$26.54 ,$30.74 ,$87.20 ,$65.88 ,$49.16 ,$30.52 ,$98.10 ,$29.28 ,$42.29 ,$58.56 ,$58.56 ,$29.28 ,$58.56 ,$52.32 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101179,82164,HC ANGIOTENSIN 1 ENZYME (ACE)-90,301,1 ,$208.00 ,$135.20 ,$10.80 ,$208.00 ,$36.50 ,$25.17 ,$116.48 ,$14.60 ,$58.24 ,$73.42 ,$14.60 ,$85.70 ,$14.60 ,$93.81 ,$93.81 ,$14.60 ,$18.25 ,$27.74 ,$28.31 ,$36.50 ,$14.60 ,$14.60 ,$14.89 ,$156.00 ,$124.80 ,$124.80 ,$14.60 ,$124.80 ,$21.09 ,$21.09 ,$21.09 ,$208.00 , N/A ,$176.80 ,$36.50 ,$135.20 ,$14.60 ,$208.00 ,$116.48 ,$14.60 ,$54.70 , N/A ,$11.88 ,$11.34 ,$15.33 ,$166.40 ,$32.85 ,$93.81 ,$58.24 ,$187.20 ,$14.60 ,$21.09 ,$29.20 ,$29.20 ,$14.60 ,$29.20 ,$99.84 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101180,82172,HC APOLIPOPROTEIN SERUM-90,301,1 ,$26.00 ,$16.90 ,$6.84 ,$52.73 ,$52.73 ,$26.00 ,$14.56 ,$21.09 ,$7.28 ,$9.18 ,$21.09 ,$10.71 ,$21.09 ,$11.73 ,$11.73 ,$21.09 ,$26.00 ,$26.00 ,$26.00 ,$52.73 ,$21.09 ,$21.09 ,$21.51 ,$19.50 ,$15.60 ,$15.60 ,$21.09 ,$15.60 ,$26.00 ,$26.00 ,$26.00 ,$26.00 , N/A ,$22.10 ,$26.00 ,$16.90 ,$21.09 ,$26.00 ,$14.56 ,$21.09 ,$6.84 , N/A ,$11.88 ,$11.34 ,$22.14 ,$20.80 ,$47.45 ,$11.73 ,$7.28 ,$23.40 ,$21.09 ,$26.00 ,$26.00 ,$26.00 ,$21.09 ,$26.00 ,$12.48 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101181,82175,HC ARSENIC-90,301,1 ,$146.00 ,$94.90 ,$13.17 ,$146.00 ,$47.43 ,$32.71 ,$81.76 ,$18.97 ,$40.88 ,$51.54 ,$18.97 ,$60.15 ,$18.97 ,$65.85 ,$65.85 ,$18.97 ,$23.71 ,$36.04 ,$36.48 ,$47.43 ,$18.97 ,$18.97 ,$19.35 ,$109.50 ,$87.60 ,$87.60 ,$18.97 ,$87.60 ,$27.40 ,$27.40 ,$27.40 ,$146.00 , N/A ,$124.10 ,$47.43 ,$94.90 ,$18.97 ,$146.00 ,$81.76 ,$18.97 ,$38.40 , N/A ,$14.49 ,$13.83 ,$19.92 ,$116.80 ,$42.68 ,$65.85 ,$40.88 ,$131.40 ,$18.97 ,$27.40 ,$37.94 ,$37.94 ,$18.97 ,$37.94 ,$70.08 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101184,82232,HC BETA 2 MICROGLOBULIN-90,301,1 ,$48.00 ,$31.20 ,$12.62 ,$48.00 ,$40.45 ,$27.88 ,$26.88 ,$16.18 ,$13.44 ,$16.94 ,$16.18 ,$19.78 ,$16.18 ,$21.65 ,$21.65 ,$16.18 ,$20.23 ,$30.74 ,$31.45 ,$40.45 ,$16.18 ,$16.18 ,$16.50 ,$36.00 ,$28.80 ,$28.80 ,$16.18 ,$28.80 ,$23.36 ,$23.36 ,$23.36 ,$48.00 , N/A ,$40.80 ,$40.45 ,$31.20 ,$16.18 ,$48.00 ,$26.88 ,$16.18 ,$12.62 , N/A ,$27.81 ,$26.54 ,$16.99 ,$38.40 ,$36.41 ,$21.65 ,$13.44 ,$43.20 ,$16.18 ,$23.36 ,$32.36 ,$32.36 ,$16.18 ,$32.36 ,$23.04 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101188,82270,HC OCCULT BLOOD FECAL SCRN,301,1 ,$44.00 ,$28.60 ,$4.38 ,$44.00 ,$10.95 ,$5.62 ,$24.64 ,$4.38 ,$12.32 ,$15.53 ,$4.38 ,$18.13 ,$4.38 ,$19.84 ,$19.84 ,$4.38 ,$5.48 ,$8.32 ,$7.55 ,$10.95 ,$4.38 ,$4.38 ,$4.47 ,$33.00 ,$26.40 ,$26.40 ,$4.38 ,$26.40 ,$5.69 ,$5.69 ,$5.69 ,$44.00 , N/A ,$37.40 ,$10.95 ,$28.60 ,$4.38 ,$44.00 ,$24.64 ,$4.38 ,$11.57 , N/A ,$5.29 ,$5.05 ,$4.60 ,$35.20 ,$9.86 ,$19.84 ,$12.32 ,$39.60 ,$4.38 ,$5.69 ,$8.76 ,$8.76 ,$4.38 ,$8.76 ,$21.12 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101193,82271,HC OCCULT BLOOD GASTRIC-QW,301,1 ,$32.00 ,$20.80 ,$4.81 ,$32.00 ,$13.30 ,$5.62 ,$17.92 ,$5.32 ,$8.96 ,$11.30 ,$5.32 ,$13.18 ,$5.32 ,$14.43 ,$14.43 ,$5.32 ,$6.65 ,$10.11 ,$9.44 ,$13.30 ,$5.32 ,$5.32 ,$5.43 ,$24.00 ,$19.20 ,$19.20 ,$5.32 ,$19.20 ,$6.92 ,$6.92 ,$6.92 ,$32.00 , N/A ,$27.20 ,$13.30 ,$20.80 ,$5.32 ,$32.00 ,$17.92 ,$5.32 ,$8.42 , N/A ,$5.29 ,$5.05 ,$5.59 ,$25.60 ,$11.97 ,$14.43 ,$8.96 ,$28.80 ,$5.32 ,$6.92 ,$10.64 ,$10.64 ,$5.32 ,$10.64 ,$15.36 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101195,82274,HC OCCULT BLOOD FECAL HGB-QW,301,1 ,$70.00 ,$45.50 ,$10.80 ,$70.00 ,$39.80 ,$27.42 ,$39.20 ,$15.92 ,$19.60 ,$24.71 ,$15.92 ,$28.84 ,$15.92 ,$31.57 ,$31.57 ,$15.92 ,$19.90 ,$30.25 ,$30.82 ,$39.80 ,$15.92 ,$15.92 ,$16.24 ,$52.50 ,$42.00 ,$42.00 ,$15.92 ,$42.00 ,$22.97 ,$22.97 ,$22.97 ,$70.00 , N/A ,$59.50 ,$39.80 ,$45.50 ,$15.92 ,$70.00 ,$39.20 ,$15.92 ,$18.41 , N/A ,$11.88 ,$11.34 ,$16.72 ,$56.00 ,$35.82 ,$31.57 ,$19.60 ,$63.00 ,$15.92 ,$22.97 ,$31.84 ,$31.84 ,$15.92 ,$31.84 ,$33.60 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101196,82300,HC CADMIUM-90,301,1 ,$84.00 ,$54.60 ,$13.17 ,$84.00 ,$59.10 ,$39.90 ,$47.04 ,$23.64 ,$23.52 ,$29.65 ,$23.64 ,$34.61 ,$23.64 ,$37.88 ,$37.88 ,$23.64 ,$29.55 ,$44.92 ,$44.66 ,$59.10 ,$23.64 ,$23.64 ,$24.11 ,$63.00 ,$50.40 ,$50.40 ,$23.64 ,$50.40 ,$33.44 ,$33.44 ,$33.44 ,$84.00 , N/A ,$71.40 ,$59.10 ,$54.60 ,$23.64 ,$84.00 ,$47.04 ,$23.64 ,$22.09 , N/A ,$14.49 ,$13.83 ,$24.82 ,$67.20 ,$53.19 ,$37.88 ,$23.52 ,$75.60 ,$23.64 ,$33.44 ,$47.28 ,$47.28 ,$23.64 ,$47.28 ,$40.32 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101197,82306,HC VITAMIN D 25 OH-90,301,1 ,$36.00 ,$23.40 ,$9.47 ,$74.00 ,$74.00 ,$36.00 ,$20.16 ,$29.60 ,$10.08 ,$12.71 ,$29.60 ,$14.83 ,$29.60 ,$16.24 ,$16.24 ,$29.60 ,$36.00 ,$36.00 ,$36.00 ,$74.00 ,$29.60 ,$29.60 ,$30.19 ,$27.00 ,$21.60 ,$21.60 ,$29.60 ,$21.60 ,$36.00 ,$36.00 ,$36.00 ,$36.00 , N/A ,$30.60 ,$36.00 ,$23.40 ,$29.60 ,$36.00 ,$20.16 ,$29.60 ,$9.47 , N/A ,$31.99 ,$30.53 ,$31.08 ,$28.80 ,$66.60 ,$16.24 ,$10.08 ,$32.40 ,$29.60 ,$36.00 ,$36.00 ,$36.00 ,$29.60 ,$36.00 ,$17.28 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101199,82308,HC CALCITONIN-90,301,1 ,$160.00 ,$104.00 ,$25.28 ,$160.00 ,$66.98 ,$46.17 ,$89.60 ,$26.79 ,$44.80 ,$56.48 ,$26.79 ,$65.92 ,$26.79 ,$72.16 ,$72.16 ,$26.79 ,$33.49 ,$50.90 ,$52.21 ,$66.98 ,$26.79 ,$26.79 ,$27.33 ,$120.00 ,$96.00 ,$96.00 ,$26.79 ,$96.00 ,$38.70 ,$38.70 ,$38.70 ,$160.00 , N/A ,$136.00 ,$66.98 ,$104.00 ,$26.79 ,$160.00 ,$89.60 ,$26.79 ,$42.08 , N/A ,$27.81 ,$26.54 ,$28.13 ,$128.00 ,$60.28 ,$72.16 ,$44.80 ,$144.00 ,$26.79 ,$38.70 ,$53.58 ,$53.58 ,$26.79 ,$53.58 ,$76.80 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101203,82340,HC CALCIUM URINE QN TIMED-90,301,1 ,$109.00 ,$70.85 ,$6.03 ,$109.00 ,$15.08 ,$10.40 ,$61.04 ,$6.03 ,$30.52 ,$38.48 ,$6.03 ,$44.91 ,$6.03 ,$49.16 ,$49.16 ,$6.03 ,$7.54 ,$11.46 ,$11.95 ,$15.08 ,$6.03 ,$6.03 ,$6.15 ,$81.75 ,$65.40 ,$65.40 ,$6.03 ,$65.40 ,$8.71 ,$8.71 ,$8.71 ,$109.00 , N/A ,$92.65 ,$15.08 ,$70.85 ,$6.03 ,$109.00 ,$61.04 ,$6.03 ,$28.67 , N/A ,$11.88 ,$11.34 ,$6.33 ,$87.20 ,$13.57 ,$49.16 ,$30.52 ,$98.10 ,$6.03 ,$8.71 ,$12.06 ,$12.06 ,$6.03 ,$12.06 ,$52.32 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101204,82360,HC CALCULUS ANALYSIS QN-90,301,1 ,$92.00 ,$59.80 ,$10.80 ,$92.00 ,$32.18 ,$18.01 ,$51.52 ,$12.87 ,$25.76 ,$32.48 ,$12.87 ,$37.90 ,$12.87 ,$41.49 ,$41.49 ,$12.87 ,$16.09 ,$24.45 ,$25.16 ,$32.18 ,$12.87 ,$12.87 ,$13.13 ,$69.00 ,$55.20 ,$55.20 ,$12.87 ,$55.20 ,$18.59 ,$18.59 ,$18.59 ,$92.00 , N/A ,$78.20 ,$32.18 ,$59.80 ,$12.87 ,$92.00 ,$51.52 ,$12.87 ,$24.20 , N/A ,$11.88 ,$11.34 ,$13.51 ,$73.60 ,$28.96 ,$41.49 ,$25.76 ,$82.80 ,$12.87 ,$18.59 ,$25.74 ,$25.74 ,$12.87 ,$25.74 ,$44.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101205,82365,HC CALCULUS ANLYS INFRARED-90,301,1 ,$74.00 ,$48.10 ,$10.80 ,$74.00 ,$32.25 ,$18.36 ,$41.44 ,$12.90 ,$20.72 ,$26.12 ,$12.90 ,$30.49 ,$12.90 ,$33.37 ,$33.37 ,$12.90 ,$16.13 ,$24.51 ,$25.16 ,$32.25 ,$12.90 ,$12.90 ,$13.16 ,$55.50 ,$44.40 ,$44.40 ,$12.90 ,$44.40 ,$18.63 ,$18.63 ,$18.63 ,$74.00 , N/A ,$62.90 ,$32.25 ,$48.10 ,$12.90 ,$74.00 ,$41.44 ,$12.90 ,$19.46 , N/A ,$11.88 ,$11.34 ,$13.55 ,$59.20 ,$29.03 ,$33.37 ,$20.72 ,$66.60 ,$12.90 ,$18.63 ,$25.80 ,$25.80 ,$12.90 ,$25.80 ,$35.52 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101207,82373,HC CARBOHY DEFICIENT TRANSFER CONGENTIAL-90,301,1 ,$153.00 ,$99.45 ,$10.80 ,$153.00 ,$45.15 ,$31.13 ,$85.68 ,$18.06 ,$42.84 ,$54.01 ,$18.06 ,$63.04 ,$18.06 ,$69.00 ,$69.00 ,$18.06 ,$22.58 ,$34.31 ,$35.23 ,$45.15 ,$18.06 ,$18.06 ,$18.42 ,$114.75 ,$91.80 ,$91.80 ,$18.06 ,$91.80 ,$26.08 ,$26.08 ,$26.08 ,$153.00 , N/A ,$130.05 ,$45.15 ,$99.45 ,$18.06 ,$153.00 ,$85.68 ,$18.06 ,$40.24 , N/A ,$11.88 ,$11.34 ,$18.96 ,$122.40 ,$40.64 ,$69.00 ,$42.84 ,$137.70 ,$18.06 ,$26.08 ,$36.12 ,$36.12 ,$18.06 ,$36.12 ,$73.44 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101208,82378,HC CARBINOEMBRYONIC AG (CEA)-90,301,1 ,$13.00 ,$8.45 ,$3.42 ,$32.50 ,$32.50 ,$13.00 ,$7.28 ,$13.00 ,$3.64 ,$4.59 ,$13.00 ,$5.36 ,$13.00 ,$5.86 ,$5.86 ,$13.00 ,$13.00 ,$13.00 ,$13.00 ,$32.50 ,$13.00 ,$13.00 ,$13.00 ,$9.75 ,$7.80 ,$7.80 ,$13.00 ,$7.80 ,$13.00 ,$13.00 ,$13.00 ,$13.00 , N/A ,$11.05 ,$13.00 ,$8.45 ,$13.00 ,$13.00 ,$7.28 ,$13.00 ,$3.42 , N/A ,$11.88 ,$11.34 ,$13.65 ,$10.40 ,$29.25 ,$5.86 ,$3.64 ,$11.70 ,$13.00 ,$13.00 ,$13.00 ,$13.00 ,$13.00 ,$13.00 ,$6.24 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101209,82379,HC CARNITINE TOTAL AND FREE QN-90,301,1 ,$129.00 ,$83.85 ,$10.80 ,$129.00 ,$42.18 ,$29.09 ,$72.24 ,$16.87 ,$36.12 ,$45.54 ,$16.87 ,$53.15 ,$16.87 ,$58.18 ,$58.18 ,$16.87 ,$21.09 ,$32.05 ,$32.71 ,$42.18 ,$16.87 ,$16.87 ,$17.21 ,$96.75 ,$77.40 ,$77.40 ,$16.87 ,$77.40 ,$24.36 ,$24.36 ,$24.36 ,$129.00 , N/A ,$109.65 ,$42.18 ,$83.85 ,$16.87 ,$129.00 ,$72.24 ,$16.87 ,$33.93 , N/A ,$11.88 ,$11.34 ,$17.71 ,$103.20 ,$37.96 ,$58.18 ,$36.12 ,$116.10 ,$16.87 ,$24.36 ,$33.74 ,$33.74 ,$16.87 ,$33.74 ,$61.92 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101210,82380,HC CAROTENE-90,301,1 ,$111.00 ,$72.15 ,$9.22 ,$111.00 ,$23.05 ,$15.91 ,$62.16 ,$9.22 ,$31.08 ,$39.18 ,$9.22 ,$45.73 ,$9.22 ,$50.06 ,$50.06 ,$9.22 ,$11.53 ,$17.52 ,$17.61 ,$23.05 ,$9.22 ,$9.22 ,$9.40 ,$83.25 ,$66.60 ,$66.60 ,$9.22 ,$66.60 ,$13.33 ,$13.33 ,$13.33 ,$111.00 , N/A ,$94.35 ,$23.05 ,$72.15 ,$9.22 ,$111.00 ,$62.16 ,$9.22 ,$29.19 , N/A ,$11.88 ,$11.34 ,$9.68 ,$88.80 ,$20.75 ,$50.06 ,$31.08 ,$99.90 ,$9.22 ,$13.33 ,$18.44 ,$18.44 ,$9.22 ,$18.44 ,$53.28 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101211,82384,HC CATECHOLAMINE FRACTION-90,301,1 ,$175.00 ,$113.75 ,$25.25 ,$175.00 ,$63.13 ,$43.52 ,$98.00 ,$25.25 ,$49.00 ,$61.78 ,$25.25 ,$72.10 ,$25.25 ,$78.93 ,$78.93 ,$25.25 ,$31.56 ,$47.98 ,$49.06 ,$63.13 ,$25.25 ,$25.25 ,$25.76 ,$131.25 ,$105.00 ,$105.00 ,$25.25 ,$105.00 ,$36.48 ,$36.48 ,$36.48 ,$175.00 , N/A ,$148.75 ,$63.13 ,$113.75 ,$25.25 ,$175.00 ,$98.00 ,$25.25 ,$46.03 , N/A ,$27.81 ,$26.54 ,$26.51 ,$140.00 ,$56.81 ,$78.93 ,$49.00 ,$157.50 ,$25.25 ,$36.48 ,$50.50 ,$50.50 ,$25.25 ,$50.50 ,$84.00 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101212,82390,HC CERULOPLASMIN-90,301,1 ,$123.00 ,$79.95 ,$10.74 ,$123.00 ,$26.85 ,$18.52 ,$68.88 ,$10.74 ,$34.44 ,$43.42 ,$10.74 ,$50.68 ,$10.74 ,$55.47 ,$55.47 ,$10.74 ,$13.43 ,$20.41 ,$20.76 ,$26.85 ,$10.74 ,$10.74 ,$10.95 ,$92.25 ,$73.80 ,$73.80 ,$10.74 ,$73.80 ,$15.51 ,$15.51 ,$15.51 ,$123.00 , N/A ,$104.55 ,$26.85 ,$79.95 ,$10.74 ,$123.00 ,$68.88 ,$10.74 ,$32.35 , N/A ,$11.88 ,$11.34 ,$11.28 ,$98.40 ,$24.17 ,$55.47 ,$34.44 ,$110.70 ,$10.74 ,$15.51 ,$21.48 ,$21.48 ,$10.74 ,$21.48 ,$59.04 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101213,82397,HC CHEMILUMINESCENT ASSAY-90,301,1 ,$128.00 ,$83.20 ,$10.80 ,$128.00 ,$35.30 ,$24.36 ,$71.68 ,$14.12 ,$35.84 ,$45.18 ,$14.12 ,$52.74 ,$14.12 ,$57.73 ,$57.73 ,$14.12 ,$17.65 ,$26.83 ,$27.68 ,$35.30 ,$14.12 ,$14.12 ,$14.40 ,$96.00 ,$76.80 ,$76.80 ,$14.12 ,$76.80 ,$20.40 ,$20.40 ,$20.40 ,$128.00 , N/A ,$108.80 ,$35.30 ,$83.20 ,$14.12 ,$128.00 ,$71.68 ,$14.12 ,$33.66 , N/A ,$11.88 ,$11.34 ,$14.83 ,$102.40 ,$31.77 ,$57.73 ,$35.84 ,$115.20 ,$14.12 ,$20.40 ,$28.24 ,$28.24 ,$14.12 ,$28.24 ,$61.44 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101215,82438,HC CHLORIDE OTHER SOURCE-90,301,1 ,$97.00 ,$63.05 ,$4.81 ,$97.00 ,$12.50 ,$8.44 ,$54.32 ,$5.00 ,$27.16 ,$34.24 ,$5.00 ,$36.61 ,$5.00 ,$43.75 ,$43.75 ,$5.00 ,$6.25 ,$9.50 ,$9.44 ,$12.50 ,$5.00 ,$5.00 ,$5.10 ,$72.75 ,$58.20 ,$58.20 ,$5.00 ,$58.20 ,$7.06 ,$7.06 ,$7.06 ,$97.00 , N/A ,$82.45 ,$12.50 ,$63.05 ,$5.00 ,$97.00 ,$54.32 ,$5.00 ,$25.51 , N/A ,$5.29 ,$5.05 ,$5.25 ,$77.60 ,$11.25 ,$43.75 ,$27.16 ,$87.30 ,$5.00 ,$7.06 ,$10.00 ,$10.00 ,$5.00 ,$10.00 ,$46.56 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101219,82507,HC CITRATE-90,301,1 ,$193.00 ,$125.45 ,$10.80 ,$193.00 ,$69.50 ,$22.03 ,$108.08 ,$27.80 ,$54.04 ,$68.13 ,$27.80 ,$79.52 ,$27.80 ,$87.04 ,$87.04 ,$27.80 ,$34.75 ,$52.82 ,$54.10 ,$69.50 ,$27.80 ,$27.80 ,$28.36 ,$144.75 ,$115.80 ,$115.80 ,$27.80 ,$115.80 ,$40.16 ,$40.16 ,$40.16 ,$193.00 , N/A ,$164.05 ,$69.50 ,$125.45 ,$27.80 ,$193.00 ,$108.08 ,$27.80 ,$50.76 , N/A ,$11.88 ,$11.34 ,$29.19 ,$154.40 ,$62.55 ,$87.04 ,$54.04 ,$173.70 ,$27.80 ,$40.16 ,$55.60 ,$55.60 ,$27.80 ,$55.60 ,$92.64 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101220,82523,HC COLLAGEN CROSS LINKS ANY METHOD-90,301,1 ,$110.00 ,$71.50 ,$16.67 ,$110.00 ,$46.70 ,$32.24 ,$61.60 ,$18.68 ,$30.80 ,$38.83 ,$18.68 ,$45.32 ,$18.68 ,$49.61 ,$49.61 ,$18.68 ,$23.35 ,$35.49 ,$36.48 ,$46.70 ,$18.68 ,$18.68 ,$19.05 ,$82.50 ,$66.00 ,$66.00 ,$18.68 ,$66.00 ,$26.99 ,$26.99 ,$26.99 ,$110.00 , N/A ,$93.50 ,$46.70 ,$71.50 ,$18.68 ,$110.00 ,$61.60 ,$18.68 ,$28.93 , N/A ,$18.34 ,$17.50 ,$19.61 ,$88.00 ,$42.03 ,$49.61 ,$30.80 ,$99.00 ,$18.68 ,$26.99 ,$37.36 ,$37.36 ,$18.68 ,$37.36 ,$52.80 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30101221,82525,HC COPPER-90,301,1 ,$141.00 ,$91.65 ,$12.41 ,$141.00 ,$31.03 ,$20.76 ,$78.96 ,$12.41 ,$39.48 ,$49.77 ,$12.41 ,$58.09 ,$12.41 ,$63.59 ,$63.59 ,$12.41 ,$15.51 ,$23.58 ,$23.90 ,$31.03 ,$12.41 ,$12.41 ,$12.66 ,$105.75 ,$84.60 ,$84.60 ,$12.41 ,$84.60 ,$17.93 ,$17.93 ,$17.93 ,$141.00 , N/A ,$119.85 ,$31.03 ,$91.65 ,$12.41 ,$141.00 ,$78.96 ,$12.41 ,$37.08 , N/A ,$14.49 ,$13.83 ,$13.03 ,$112.80 ,$27.92 ,$63.59 ,$39.48 ,$126.90 ,$12.41 ,$17.93 ,$24.82 ,$24.82 ,$12.41 ,$24.82 ,$67.68 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101222,82530,HC CORTISOL FREE-90,301,1 ,$440.00 ,$286.00 ,$10.80 ,$440.00 ,$41.78 ,$28.81 ,$246.40 ,$16.71 ,$123.20 ,$125.25 ,$16.71 ,$125.25 ,$16.71 ,$198.44 ,$198.44 ,$16.71 ,$20.89 ,$31.75 ,$32.71 ,$41.78 ,$16.71 ,$16.71 ,$17.04 ,$330.00 ,$264.00 ,$264.00 ,$16.71 ,$264.00 ,$24.14 ,$24.14 ,$24.14 ,$440.00 , N/A ,$374.00 ,$41.78 ,$286.00 ,$16.71 ,$440.00 ,$246.40 ,$16.71 ,$115.72 , N/A ,$11.88 ,$11.34 ,$17.55 ,$352.00 ,$37.60 ,$198.44 ,$123.20 ,$396.00 ,$16.71 ,$24.14 ,$33.42 ,$33.42 ,$16.71 ,$33.42 ,$211.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101223,82533,HC CORTISOL TOTAL-90,301,1 ,$254.00 ,$165.10 ,$16.30 ,$254.00 ,$40.75 ,$28.12 ,$142.24 ,$16.30 ,$71.12 ,$89.66 ,$16.30 ,$104.65 ,$16.30 ,$114.55 ,$114.55 ,$16.30 ,$20.38 ,$30.97 ,$31.45 ,$40.75 ,$16.30 ,$16.30 ,$16.63 ,$190.50 ,$152.40 ,$152.40 ,$16.30 ,$152.40 ,$23.54 ,$23.54 ,$23.54 ,$254.00 , N/A ,$215.90 ,$40.75 ,$165.10 ,$16.30 ,$254.00 ,$142.24 ,$16.30 ,$66.80 , N/A ,$27.81 ,$26.54 ,$17.12 ,$203.20 ,$36.68 ,$114.55 ,$71.12 ,$228.60 ,$16.30 ,$23.54 ,$32.60 ,$32.60 ,$16.30 ,$32.60 ,$121.92 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101224,82542,HC CHROMO SPECTROMETRY -90,301,1 ,$252.00 ,$163.80 ,$10.80 ,$252.00 ,$60.23 ,$32.31 ,$141.12 ,$24.09 ,$70.56 ,$88.96 ,$24.09 ,$103.82 ,$24.09 ,$113.65 ,$113.65 ,$24.09 ,$30.11 ,$45.77 ,$42.14 ,$60.23 ,$24.09 ,$24.09 ,$24.57 ,$189.00 ,$151.20 ,$151.20 ,$24.09 ,$151.20 ,$31.32 ,$31.32 ,$31.32 ,$252.00 , N/A ,$214.20 ,$60.23 ,$163.80 ,$24.09 ,$252.00 ,$141.12 ,$24.09 ,$66.28 , N/A ,$11.88 ,$11.34 ,$25.29 ,$201.60 ,$54.20 ,$113.65 ,$70.56 ,$226.80 ,$24.09 ,$31.32 ,$48.18 ,$48.18 ,$24.09 ,$48.18 ,$120.96 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101225,82550,HC CREATINE KINASE (CPK) TOTAL-90,301,1 ,$8.00 ,$5.20 ,$2.10 ,$16.28 ,$16.28 ,$8.00 ,$4.48 ,$6.51 ,$2.24 ,$2.82 ,$6.51 ,$3.30 ,$6.51 ,$3.61 ,$3.61 ,$6.51 ,$8.00 ,$8.00 ,$8.00 ,$16.28 ,$6.51 ,$6.51 ,$6.64 ,$6.00 ,$4.80 ,$4.80 ,$6.51 ,$4.80 ,$8.00 ,$8.00 ,$8.00 ,$8.00 , N/A ,$6.80 ,$8.00 ,$5.20 ,$6.51 ,$8.00 ,$4.48 ,$6.51 ,$2.10 , N/A ,$5.29 ,$5.05 ,$6.84 ,$6.40 ,$14.65 ,$3.61 ,$2.24 ,$7.20 ,$6.51 ,$8.00 ,$8.00 ,$8.00 ,$6.51 ,$8.00 ,$3.84 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101226,82552,HC CREATINE KINASE (CPK) ISO-90,301,1 ,$8.00 ,$5.20 ,$2.10 ,$20.00 ,$20.00 ,$8.00 ,$4.48 ,$8.00 ,$2.24 ,$2.82 ,$8.00 ,$3.30 ,$8.00 ,$3.61 ,$3.61 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$20.00 ,$8.00 ,$8.00 ,$8.00 ,$6.00 ,$4.80 ,$4.80 ,$8.00 ,$4.80 ,$8.00 ,$8.00 ,$8.00 ,$8.00 , N/A ,$6.80 ,$8.00 ,$5.20 ,$8.00 ,$8.00 ,$4.48 ,$8.00 ,$2.10 , N/A ,$8.00 ,$8.00 ,$8.40 ,$6.40 ,$18.00 ,$3.61 ,$2.24 ,$7.20 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$3.84 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101231,82570,HC CREATININE OTH SOURCE-90,301,1 ,$86.00 ,$55.90 ,$4.81 ,$86.00 ,$12.95 ,$8.93 ,$48.16 ,$5.18 ,$24.08 ,$30.36 ,$5.18 ,$35.43 ,$5.18 ,$38.79 ,$38.79 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$64.50 ,$51.60 ,$51.60 ,$5.18 ,$51.60 ,$7.48 ,$7.48 ,$7.48 ,$86.00 , N/A ,$73.10 ,$12.95 ,$55.90 ,$5.18 ,$86.00 ,$48.16 ,$5.18 ,$22.62 , N/A ,$5.29 ,$5.05 ,$5.44 ,$68.80 ,$11.66 ,$38.79 ,$24.08 ,$77.40 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$41.28 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101233,82595,HC CRYOGLOBULIN QL OR SQN-90,301,1 ,$40.00 ,$26.00 ,$6.47 ,$40.00 ,$16.18 ,$11.17 ,$22.40 ,$6.47 ,$11.20 ,$14.12 ,$6.47 ,$16.48 ,$6.47 ,$18.04 ,$18.04 ,$6.47 ,$8.09 ,$12.29 ,$12.58 ,$16.18 ,$6.47 ,$6.47 ,$6.60 ,$30.00 ,$24.00 ,$24.00 ,$6.47 ,$24.00 ,$9.33 ,$9.33 ,$9.33 ,$40.00 , N/A ,$34.00 ,$16.18 ,$26.00 ,$6.47 ,$40.00 ,$22.40 ,$6.47 ,$10.52 , N/A ,$11.88 ,$11.34 ,$6.79 ,$32.00 ,$14.56 ,$18.04 ,$11.20 ,$36.00 ,$6.47 ,$9.33 ,$12.94 ,$12.94 ,$6.47 ,$12.94 ,$19.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101234,82600,HC CYANIDE-90,301,1 ,$115.00 ,$74.75 ,$13.17 ,$115.00 ,$48.50 ,$33.44 ,$64.40 ,$19.40 ,$32.20 ,$40.60 ,$19.40 ,$47.38 ,$19.40 ,$51.87 ,$51.87 ,$19.40 ,$24.25 ,$36.86 ,$37.74 ,$48.50 ,$19.40 ,$19.40 ,$19.79 ,$86.25 ,$69.00 ,$69.00 ,$19.40 ,$69.00 ,$28.02 ,$28.02 ,$28.02 ,$115.00 , N/A ,$97.75 ,$48.50 ,$74.75 ,$19.40 ,$115.00 ,$64.40 ,$19.40 ,$30.25 , N/A ,$14.49 ,$13.83 ,$20.37 ,$92.00 ,$43.65 ,$51.87 ,$32.20 ,$103.50 ,$19.40 ,$28.02 ,$38.80 ,$38.80 ,$19.40 ,$38.80 ,$55.20 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101236,82608,HC VITAMIN B-12 BINDING CAPACITY-90,301,1 ,$131.00 ,$85.15 ,$10.80 ,$131.00 ,$35.80 ,$24.69 ,$73.36 ,$14.32 ,$36.68 ,$46.24 ,$14.32 ,$53.97 ,$14.32 ,$59.08 ,$59.08 ,$14.32 ,$17.90 ,$27.21 ,$27.68 ,$35.80 ,$14.32 ,$14.32 ,$14.61 ,$98.25 ,$78.60 ,$78.60 ,$14.32 ,$78.60 ,$20.68 ,$20.68 ,$20.68 ,$131.00 , N/A ,$111.35 ,$35.80 ,$85.15 ,$14.32 ,$131.00 ,$73.36 ,$14.32 ,$34.45 , N/A ,$11.88 ,$11.34 ,$15.04 ,$104.80 ,$32.22 ,$59.08 ,$36.68 ,$117.90 ,$14.32 ,$20.68 ,$28.64 ,$28.64 ,$14.32 ,$28.64 ,$62.88 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101237,82626,HC DHEA-90,301,1 ,$186.00 ,$120.90 ,$10.80 ,$186.00 ,$63.18 ,$43.56 ,$104.16 ,$25.27 ,$52.08 ,$65.66 ,$25.27 ,$76.63 ,$25.27 ,$83.89 ,$83.89 ,$25.27 ,$31.59 ,$48.01 ,$49.06 ,$63.18 ,$25.27 ,$25.27 ,$25.78 ,$139.50 ,$111.60 ,$111.60 ,$25.27 ,$111.60 ,$36.50 ,$36.50 ,$36.50 ,$186.00 , N/A ,$158.10 ,$63.18 ,$120.90 ,$25.27 ,$186.00 ,$104.16 ,$25.27 ,$48.92 , N/A ,$11.88 ,$11.34 ,$26.53 ,$148.80 ,$56.86 ,$83.89 ,$52.08 ,$167.40 ,$25.27 ,$36.50 ,$50.54 ,$50.54 ,$25.27 ,$50.54 ,$89.28 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101238,82627,HC DHEA SULFATE-90,301,1 ,$23.20 ,$15.08 ,$6.10 ,$55.58 ,$55.58 ,$23.20 ,$12.99 ,$22.23 ,$6.50 ,$8.19 ,$22.23 ,$9.56 ,$22.23 ,$10.46 ,$10.46 ,$22.23 ,$23.20 ,$23.20 ,$23.20 ,$55.58 ,$22.23 ,$22.23 ,$22.67 ,$17.40 ,$13.92 ,$13.92 ,$22.23 ,$13.92 ,$23.20 ,$23.20 ,$23.20 ,$23.20 , N/A ,$19.72 ,$23.20 ,$15.08 ,$22.23 ,$23.20 ,$12.99 ,$22.23 ,$6.10 , N/A ,$23.20 ,$23.20 ,$23.34 ,$18.56 ,$50.02 ,$10.46 ,$6.50 ,$20.88 ,$22.23 ,$23.20 ,$23.20 ,$23.20 ,$22.23 ,$23.20 ,$11.14 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101240,82652,HC VITAMIN D (1 25 DIHYDROXY)-90,301,1 ,$244.00 ,$158.60 ,$29.08 ,$244.00 ,$96.25 ,$66.38 ,$136.64 ,$38.50 ,$68.32 ,$86.13 ,$38.50 ,$100.53 ,$38.50 ,$110.04 ,$110.04 ,$38.50 ,$48.13 ,$73.15 ,$74.85 ,$96.25 ,$38.50 ,$38.50 ,$39.27 ,$183.00 ,$146.40 ,$146.40 ,$38.50 ,$146.40 ,$55.61 ,$55.61 ,$55.61 ,$244.00 , N/A ,$207.40 ,$96.25 ,$158.60 ,$38.50 ,$244.00 ,$136.64 ,$38.50 ,$64.17 , N/A ,$31.99 ,$30.53 ,$40.43 ,$195.20 ,$86.63 ,$110.04 ,$68.32 ,$219.60 ,$38.50 ,$55.61 ,$77.00 ,$77.00 ,$38.50 ,$77.00 ,$117.12 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101241,82656,HC ELASTASE PANCREATIC EL1 FECAL QL OR SQN-90,301,1 ,$220.00 ,$143.00 ,$10.80 ,$220.00 ,$28.83 ,$19.90 ,$123.20 ,$11.53 ,$61.60 ,$77.66 ,$11.53 ,$86.49 ,$11.53 ,$99.22 ,$99.22 ,$11.53 ,$14.41 ,$21.91 ,$22.64 ,$28.83 ,$11.53 ,$11.53 ,$11.76 ,$165.00 ,$132.00 ,$132.00 ,$11.53 ,$132.00 ,$16.65 ,$16.65 ,$16.65 ,$220.00 , N/A ,$187.00 ,$28.83 ,$143.00 ,$11.53 ,$220.00 ,$123.20 ,$11.53 ,$57.86 , N/A ,$11.88 ,$11.34 ,$12.11 ,$176.00 ,$25.94 ,$99.22 ,$61.60 ,$198.00 ,$11.53 ,$16.65 ,$23.06 ,$23.06 ,$11.53 ,$23.06 ,$105.60 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101242,82657,HC ENZYME ACT NONRAD SUBS-90,301,1 ,$292.00 ,$189.80 ,$10.80 ,$292.00 ,$55.43 ,$31.13 ,$163.52 ,$22.17 ,$81.76 ,$103.08 ,$22.17 ,$120.30 ,$22.17 ,$131.69 ,$131.69 ,$22.17 ,$27.71 ,$42.12 ,$39.00 ,$55.43 ,$22.17 ,$22.17 ,$22.61 ,$219.00 ,$175.20 ,$175.20 ,$22.17 ,$175.20 ,$28.82 ,$28.82 ,$28.82 ,$292.00 , N/A ,$248.20 ,$55.43 ,$189.80 ,$22.17 ,$292.00 ,$163.52 ,$22.17 ,$76.80 , N/A ,$11.88 ,$11.34 ,$23.28 ,$233.60 ,$49.88 ,$131.69 ,$81.76 ,$262.80 ,$22.17 ,$28.82 ,$44.34 ,$44.34 ,$22.17 ,$44.34 ,$140.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101243,82657,HC ENZYME ACT NONRAD SUBS LYE-90,301,1 ,$640.00 ,$416.00 ,$10.80 ,$640.00 ,$55.43 ,$31.13 ,$358.40 ,$22.17 ,$179.20 ,$135.34 ,$22.17 ,$135.34 ,$22.17 ,$288.64 ,$288.64 ,$22.17 ,$27.71 ,$42.12 ,$39.00 ,$55.43 ,$22.17 ,$22.17 ,$22.61 ,$480.00 ,$384.00 ,$384.00 ,$22.17 ,$384.00 ,$28.82 ,$28.82 ,$28.82 ,$640.00 , N/A ,$544.00 ,$55.43 ,$416.00 ,$22.17 ,$640.00 ,$358.40 ,$22.17 ,$168.32 , N/A ,$11.88 ,$11.34 ,$23.28 ,$512.00 ,$49.88 ,$288.64 ,$179.20 ,$576.00 ,$22.17 ,$28.82 ,$44.34 ,$44.34 ,$22.17 ,$44.34 ,$307.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101245,82668,HC ERYTHROPOIETIN-90,301,1 ,$142.00 ,$92.30 ,$10.80 ,$142.00 ,$46.98 ,$32.41 ,$79.52 ,$18.79 ,$39.76 ,$50.13 ,$18.79 ,$58.50 ,$18.79 ,$64.04 ,$64.04 ,$18.79 ,$23.49 ,$35.70 ,$36.48 ,$46.98 ,$18.79 ,$18.79 ,$19.17 ,$106.50 ,$85.20 ,$85.20 ,$18.79 ,$85.20 ,$27.14 ,$27.14 ,$27.14 ,$142.00 , N/A ,$120.70 ,$46.98 ,$92.30 ,$18.79 ,$142.00 ,$79.52 ,$18.79 ,$37.35 , N/A ,$11.88 ,$11.34 ,$19.73 ,$113.60 ,$42.28 ,$64.04 ,$39.76 ,$127.80 ,$18.79 ,$27.14 ,$37.58 ,$37.58 ,$18.79 ,$37.58 ,$68.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101246,82670,HC ESTRADIOL-90,301,1 ,$18.00 ,$11.70 ,$4.73 ,$45.00 ,$45.00 ,$18.00 ,$10.08 ,$18.00 ,$5.04 ,$6.35 ,$18.00 ,$7.42 ,$18.00 ,$8.12 ,$8.12 ,$18.00 ,$18.00 ,$18.00 ,$18.00 ,$45.00 ,$18.00 ,$18.00 ,$18.00 ,$13.50 ,$10.80 ,$10.80 ,$18.00 ,$10.80 ,$18.00 ,$18.00 ,$18.00 ,$18.00 , N/A ,$15.30 ,$18.00 ,$11.70 ,$18.00 ,$18.00 ,$10.08 ,$18.00 ,$4.73 , N/A ,$18.00 ,$18.00 ,$18.90 ,$14.40 ,$40.50 ,$8.12 ,$5.04 ,$16.20 ,$18.00 ,$18.00 ,$18.00 ,$18.00 ,$18.00 ,$18.00 ,$8.64 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101248,82671,HC ESTROGEN FRACTIONATED-90,301,1 ,$321.00 ,$208.65 ,$25.28 ,$321.00 ,$80.75 ,$44.08 ,$179.76 ,$32.30 ,$89.88 ,$113.31 ,$32.30 ,$132.25 ,$32.30 ,$144.77 ,$144.77 ,$32.30 ,$40.38 ,$61.37 ,$62.90 ,$80.75 ,$32.30 ,$32.30 ,$32.95 ,$240.75 ,$192.60 ,$192.60 ,$32.30 ,$192.60 ,$46.66 ,$46.66 ,$46.66 ,$321.00 , N/A ,$272.85 ,$80.75 ,$208.65 ,$32.30 ,$321.00 ,$179.76 ,$32.30 ,$84.42 , N/A ,$27.81 ,$26.54 ,$33.92 ,$256.80 ,$72.68 ,$144.77 ,$89.88 ,$288.90 ,$32.30 ,$46.66 ,$64.60 ,$64.60 ,$32.30 ,$64.60 ,$154.08 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101249,82672,HC ESTROGEN TOTAL-90,301,1 ,$160.00 ,$104.00 ,$21.70 ,$160.00 ,$54.25 ,$37.40 ,$89.60 ,$21.70 ,$44.80 ,$56.48 ,$21.70 ,$65.92 ,$21.70 ,$72.16 ,$72.16 ,$21.70 ,$27.13 ,$41.23 ,$42.14 ,$54.25 ,$21.70 ,$21.70 ,$22.13 ,$120.00 ,$96.00 ,$96.00 ,$21.70 ,$96.00 ,$31.34 ,$31.34 ,$31.34 ,$160.00 , N/A ,$136.00 ,$54.25 ,$104.00 ,$21.70 ,$160.00 ,$89.60 ,$21.70 ,$42.08 , N/A ,$27.81 ,$26.54 ,$22.79 ,$128.00 ,$48.83 ,$72.16 ,$44.80 ,$144.00 ,$21.70 ,$31.34 ,$43.40 ,$43.40 ,$21.70 ,$43.40 ,$76.80 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101250,82677,HC ESTRIOL-90,301,1 ,$106.00 ,$68.90 ,$19.18 ,$106.00 ,$60.45 ,$19.18 ,$59.36 ,$24.18 ,$29.68 ,$37.42 ,$24.18 ,$43.67 ,$24.18 ,$47.81 ,$47.81 ,$24.18 ,$30.23 ,$45.94 ,$47.18 ,$60.45 ,$24.18 ,$24.18 ,$24.66 ,$79.50 ,$63.60 ,$63.60 ,$24.18 ,$63.60 ,$34.93 ,$34.93 ,$34.93 ,$106.00 , N/A ,$90.10 ,$60.45 ,$68.90 ,$24.18 ,$106.00 ,$59.36 ,$24.18 ,$27.88 , N/A ,$27.81 ,$26.54 ,$25.39 ,$84.80 ,$54.41 ,$47.81 ,$29.68 ,$95.40 ,$24.18 ,$34.93 ,$48.36 ,$48.36 ,$24.18 ,$48.36 ,$50.88 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101251,82679,HC ESTRONE-90,301,1 ,$74.00 ,$48.10 ,$19.27 ,$74.00 ,$62.38 ,$19.27 ,$41.44 ,$24.95 ,$20.72 ,$26.12 ,$24.95 ,$30.49 ,$24.95 ,$33.37 ,$33.37 ,$24.95 ,$31.19 ,$47.41 ,$48.43 ,$62.38 ,$24.95 ,$24.95 ,$25.45 ,$55.50 ,$44.40 ,$44.40 ,$24.95 ,$44.40 ,$36.05 ,$36.05 ,$36.05 ,$74.00 , N/A ,$62.90 ,$62.38 ,$48.10 ,$24.95 ,$74.00 ,$41.44 ,$24.95 ,$19.46 , N/A ,$27.81 ,$26.54 ,$26.20 ,$59.20 ,$56.14 ,$33.37 ,$20.72 ,$66.60 ,$24.95 ,$36.05 ,$49.90 ,$49.90 ,$24.95 ,$49.90 ,$35.52 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101252,82693,HC ETHYLENE GLYCOL-90,301,1 ,$243.00 ,$157.95 ,$13.17 ,$243.00 ,$37.25 ,$25.67 ,$136.08 ,$14.90 ,$68.04 ,$85.78 ,$14.90 ,$100.12 ,$14.90 ,$109.59 ,$109.59 ,$14.90 ,$18.63 ,$28.31 ,$28.93 ,$37.25 ,$14.90 ,$14.90 ,$15.20 ,$182.25 ,$145.80 ,$145.80 ,$14.90 ,$145.80 ,$21.53 ,$21.53 ,$21.53 ,$243.00 , N/A ,$206.55 ,$37.25 ,$157.95 ,$14.90 ,$243.00 ,$136.08 ,$14.90 ,$63.91 , N/A ,$14.49 ,$13.83 ,$15.65 ,$194.40 ,$33.53 ,$109.59 ,$68.04 ,$218.70 ,$14.90 ,$21.53 ,$29.80 ,$29.80 ,$14.90 ,$29.80 ,$116.64 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101253,82705,HC FECAL FAT QUALITATIVE-90,301,1 ,$117.00 ,$76.05 ,$4.81 ,$117.00 ,$12.75 ,$4.90 ,$65.52 ,$5.10 ,$32.76 ,$38.20 ,$5.10 ,$38.20 ,$5.10 ,$52.77 ,$52.77 ,$5.10 ,$6.38 ,$9.69 ,$10.06 ,$12.75 ,$5.10 ,$5.10 ,$5.20 ,$87.75 ,$70.20 ,$70.20 ,$5.10 ,$70.20 ,$7.36 ,$7.36 ,$7.36 ,$117.00 , N/A ,$99.45 ,$12.75 ,$76.05 ,$5.10 ,$117.00 ,$65.52 ,$5.10 ,$30.77 , N/A ,$5.29 ,$5.05 ,$5.36 ,$93.60 ,$11.48 ,$52.77 ,$32.76 ,$105.30 ,$5.10 ,$7.36 ,$10.20 ,$10.20 ,$5.10 ,$10.20 ,$56.16 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101254,82710,HC FECAL FAT QN-90,301,1 ,$108.00 ,$70.20 ,$6.02 ,$108.00 ,$42.00 ,$6.02 ,$60.48 ,$16.80 ,$30.24 ,$38.12 ,$16.80 ,$44.50 ,$16.80 ,$48.71 ,$48.71 ,$16.80 ,$21.00 ,$31.92 ,$32.71 ,$42.00 ,$16.80 ,$16.80 ,$17.14 ,$81.00 ,$64.80 ,$64.80 ,$16.80 ,$64.80 ,$24.27 ,$24.27 ,$24.27 ,$108.00 , N/A ,$91.80 ,$42.00 ,$70.20 ,$16.80 ,$108.00 ,$60.48 ,$16.80 ,$28.40 , N/A ,$11.88 ,$11.34 ,$17.64 ,$86.40 ,$37.80 ,$48.71 ,$30.24 ,$97.20 ,$16.80 ,$24.27 ,$33.60 ,$33.60 ,$16.80 ,$33.60 ,$51.84 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101255,82726,HC FATTY ACIDS VERY LONG CHAIN-90,301,1 ,$214.00 ,$139.10 ,$10.80 ,$214.00 ,$49.38 ,$31.13 ,$119.84 ,$19.75 ,$59.92 ,$75.54 ,$19.75 ,$88.17 ,$19.75 ,$96.51 ,$96.51 ,$19.75 ,$24.69 ,$37.53 ,$35.23 ,$49.38 ,$19.75 ,$19.75 ,$20.15 ,$160.50 ,$128.40 ,$128.40 ,$19.75 ,$128.40 ,$26.08 ,$26.08 ,$26.08 ,$214.00 , N/A ,$181.90 ,$49.38 ,$139.10 ,$19.75 ,$214.00 ,$119.84 ,$19.75 ,$56.28 , N/A ,$11.88 ,$11.34 ,$20.74 ,$171.20 ,$44.44 ,$96.51 ,$59.92 ,$192.60 ,$19.75 ,$26.08 ,$39.50 ,$39.50 ,$19.75 ,$39.50 ,$102.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101256,82728,HC FERRITIN-90,301,1 ,$94.00 ,$61.10 ,$10.80 ,$94.00 ,$34.08 ,$23.49 ,$52.64 ,$13.63 ,$26.32 ,$33.18 ,$13.63 ,$38.73 ,$13.63 ,$42.39 ,$42.39 ,$13.63 ,$17.04 ,$25.90 ,$26.42 ,$34.08 ,$13.63 ,$13.63 ,$13.90 ,$70.50 ,$56.40 ,$56.40 ,$13.63 ,$56.40 ,$19.70 ,$19.70 ,$19.70 ,$94.00 , N/A ,$79.90 ,$34.08 ,$61.10 ,$13.63 ,$94.00 ,$52.64 ,$13.63 ,$24.72 , N/A ,$11.88 ,$11.34 ,$14.31 ,$75.20 ,$30.67 ,$42.39 ,$26.32 ,$84.60 ,$13.63 ,$19.70 ,$27.26 ,$27.26 ,$13.63 ,$27.26 ,$45.12 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101259,82747,HC FOLIC ACID RBC-90,301,1 ,$109.00 ,$70.85 ,$6.71 ,$109.00 ,$44.13 ,$29.87 ,$61.04 ,$17.65 ,$30.52 ,$38.48 ,$17.65 ,$44.91 ,$17.65 ,$49.16 ,$49.16 ,$17.65 ,$22.06 ,$33.54 ,$33.34 ,$44.13 ,$17.65 ,$17.65 ,$18.00 ,$81.75 ,$65.40 ,$65.40 ,$17.65 ,$65.40 ,$25.03 ,$25.03 ,$25.03 ,$109.00 , N/A ,$92.65 ,$44.13 ,$70.85 ,$17.65 ,$109.00 ,$61.04 ,$17.65 ,$28.67 , N/A ,$7.38 ,$7.05 ,$18.53 ,$87.20 ,$39.71 ,$49.16 ,$30.52 ,$98.10 ,$17.65 ,$25.03 ,$35.30 ,$35.30 ,$17.65 ,$35.30 ,$52.32 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30101262,82784,HC GAMMAGLOBULIN-90,301,1 ,$66.00 ,$42.90 ,$9.30 ,$66.00 ,$23.25 ,$16.03 ,$36.96 ,$9.30 ,$18.48 ,$23.30 ,$9.30 ,$27.19 ,$9.30 ,$29.77 ,$29.77 ,$9.30 ,$11.63 ,$17.67 ,$18.24 ,$23.25 ,$9.30 ,$9.30 ,$9.49 ,$49.50 ,$39.60 ,$39.60 ,$9.30 ,$39.60 ,$13.44 ,$13.44 ,$13.44 ,$66.00 , N/A ,$56.10 ,$23.25 ,$42.90 ,$9.30 ,$66.00 ,$36.96 ,$9.30 ,$17.36 , N/A ,$11.88 ,$11.34 ,$9.77 ,$52.80 ,$20.93 ,$29.77 ,$18.48 ,$59.40 ,$9.30 ,$13.44 ,$18.60 ,$18.60 ,$9.30 ,$18.60 ,$31.68 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101263,82785,HC GAMMAGLOBULIN IGE-90,301,1 ,$135.00 ,$87.75 ,$10.80 ,$135.00 ,$41.15 ,$28.40 ,$75.60 ,$16.46 ,$37.80 ,$47.66 ,$16.46 ,$55.62 ,$16.46 ,$60.89 ,$60.89 ,$16.46 ,$20.58 ,$31.27 ,$32.08 ,$41.15 ,$16.46 ,$16.46 ,$16.79 ,$101.25 ,$81.00 ,$81.00 ,$16.46 ,$81.00 ,$23.78 ,$23.78 ,$23.78 ,$135.00 , N/A ,$114.75 ,$41.15 ,$87.75 ,$16.46 ,$135.00 ,$75.60 ,$16.46 ,$35.51 , N/A ,$11.88 ,$11.34 ,$17.28 ,$108.00 ,$37.04 ,$60.89 ,$37.80 ,$121.50 ,$16.46 ,$23.78 ,$32.92 ,$32.92 ,$16.46 ,$32.92 ,$64.80 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101265,82787,HC IMMUNOGLOBULIN SUBCLASSES-90,301,1 ,$148.00 ,$96.20 ,$8.02 ,$148.00 ,$20.05 ,$13.83 ,$82.88 ,$8.02 ,$41.44 ,$52.24 ,$8.02 ,$60.15 ,$8.02 ,$66.75 ,$66.75 ,$8.02 ,$10.03 ,$15.24 ,$15.73 ,$20.05 ,$8.02 ,$8.02 ,$8.18 ,$111.00 ,$88.80 ,$88.80 ,$8.02 ,$88.80 ,$11.58 ,$11.58 ,$11.58 ,$148.00 , N/A ,$125.80 ,$20.05 ,$96.20 ,$8.02 ,$148.00 ,$82.88 ,$8.02 ,$38.92 , N/A ,$18.34 ,$17.50 ,$8.42 ,$118.40 ,$18.05 ,$66.75 ,$41.44 ,$133.20 ,$8.02 ,$11.58 ,$16.04 ,$16.04 ,$8.02 ,$16.04 ,$71.04 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30101267,82930,HC GASTRIC ACID FREE TOTAL-90,301,1 ,$67.00 ,$43.55 ,$6.71 ,$67.00 ,$16.78 ,$9.40 ,$37.52 ,$6.71 ,$18.76 ,$23.65 ,$6.71 ,$27.60 ,$6.71 ,$30.22 ,$30.22 ,$6.71 ,$8.39 ,$12.75 ,$11.95 ,$16.78 ,$6.71 ,$6.71 ,$6.84 ,$50.25 ,$40.20 ,$40.20 ,$6.71 ,$40.20 ,$8.72 ,$8.72 ,$8.72 ,$67.00 , N/A ,$56.95 ,$16.78 ,$43.55 ,$6.71 ,$67.00 ,$37.52 ,$6.71 ,$17.62 , N/A ,$11.88 ,$11.34 ,$7.05 ,$53.60 ,$15.10 ,$30.22 ,$18.76 ,$60.30 ,$6.71 ,$8.72 ,$13.42 ,$13.42 ,$6.71 ,$13.42 ,$32.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101268,82941,HC GASTRIN-90,301,1 ,$25.00 ,$16.25 ,$6.58 ,$44.08 ,$44.08 ,$25.00 ,$14.00 ,$17.63 ,$7.00 ,$8.83 ,$17.63 ,$10.30 ,$17.63 ,$11.28 ,$11.28 ,$17.63 ,$22.04 ,$25.00 ,$25.00 ,$44.08 ,$17.63 ,$17.63 ,$17.98 ,$18.75 ,$15.00 ,$15.00 ,$17.63 ,$15.00 ,$25.00 ,$25.00 ,$25.00 ,$25.00 , N/A ,$21.25 ,$25.00 ,$16.25 ,$17.63 ,$25.00 ,$14.00 ,$17.63 ,$6.58 , N/A ,$25.00 ,$25.00 ,$18.51 ,$20.00 ,$39.67 ,$11.28 ,$7.00 ,$22.50 ,$17.63 ,$25.00 ,$25.00 ,$25.00 ,$17.63 ,$25.00 ,$12.00 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101274,82955,HC G6PD ENZYME QN-90,301,1 ,$34.86 ,$22.66 ,$9.17 ,$34.86 ,$24.25 ,$16.73 ,$19.52 ,$9.70 ,$9.76 ,$12.31 ,$9.70 ,$14.36 ,$9.70 ,$15.72 ,$15.72 ,$9.70 ,$12.13 ,$18.43 ,$18.87 ,$24.25 ,$9.70 ,$9.70 ,$9.89 ,$26.15 ,$20.92 ,$20.92 ,$9.70 ,$20.92 ,$14.00 ,$14.00 ,$14.00 ,$34.86 , N/A ,$29.63 ,$24.25 ,$22.66 ,$9.70 ,$34.86 ,$19.52 ,$9.70 ,$9.17 , N/A ,$11.88 ,$11.34 ,$10.19 ,$27.89 ,$21.83 ,$15.72 ,$9.76 ,$31.37 ,$9.70 ,$14.00 ,$19.40 ,$19.40 ,$9.70 ,$19.40 ,$16.73 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101276,82985,HC FRUCTOSAMINE-90,301,1 ,$10.00 ,$6.50 ,$2.63 ,$25.00 ,$25.00 ,$10.00 ,$5.60 ,$10.00 ,$2.80 ,$3.53 ,$10.00 ,$4.12 ,$10.00 ,$4.51 ,$4.51 ,$10.00 ,$10.00 ,$10.00 ,$10.00 ,$25.00 ,$10.00 ,$10.00 ,$10.00 ,$7.50 ,$6.00 ,$6.00 ,$10.00 ,$6.00 ,$10.00 ,$10.00 ,$10.00 ,$10.00 , N/A ,$8.50 ,$10.00 ,$6.50 ,$10.00 ,$10.00 ,$5.60 ,$10.00 ,$2.63 , N/A ,$10.00 ,$10.00 ,$10.50 ,$8.00 ,$22.50 ,$4.51 ,$2.80 ,$9.00 ,$10.00 ,$10.00 ,$10.00 ,$10.00 ,$10.00 ,$10.00 ,$4.80 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101279,83003,HC GROWTH HORMONE (HGH)-90,301,1 ,$94.00 ,$61.10 ,$16.67 ,$94.00 ,$41.68 ,$28.12 ,$52.64 ,$16.67 ,$26.32 ,$33.18 ,$16.67 ,$38.73 ,$16.67 ,$42.39 ,$42.39 ,$16.67 ,$20.84 ,$31.67 ,$32.08 ,$41.68 ,$16.67 ,$16.67 ,$17.00 ,$70.50 ,$56.40 ,$56.40 ,$16.67 ,$56.40 ,$24.08 ,$24.08 ,$24.08 ,$94.00 , N/A ,$79.90 ,$41.68 ,$61.10 ,$16.67 ,$94.00 ,$52.64 ,$16.67 ,$24.72 , N/A ,$27.81 ,$26.54 ,$17.50 ,$75.20 ,$37.51 ,$42.39 ,$26.32 ,$84.60 ,$16.67 ,$24.08 ,$33.34 ,$33.34 ,$16.67 ,$33.34 ,$45.12 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101282,83013,HC H PYLORI BREATH TEST-90,301,1 ,$304.00 ,$197.60 ,$29.08 ,$304.00 ,$168.40 ,$116.11 ,$170.24 ,$67.36 ,$85.12 ,$107.31 ,$67.36 ,$125.25 ,$67.36 ,$137.10 ,$137.10 ,$67.36 ,$84.20 ,$127.98 ,$130.84 ,$168.40 ,$67.36 ,$67.36 ,$68.71 ,$228.00 ,$182.40 ,$182.40 ,$67.36 ,$182.40 ,$97.29 ,$97.29 ,$97.29 ,$304.00 , N/A ,$258.40 ,$168.40 ,$197.60 ,$67.36 ,$304.00 ,$170.24 ,$67.36 ,$79.95 , N/A ,$31.99 ,$30.53 ,$70.73 ,$243.20 ,$151.56 ,$137.10 ,$85.12 ,$273.60 ,$67.36 ,$97.29 ,$134.72 ,$134.72 ,$67.36 ,$134.72 ,$145.92 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101283,83018,HC HEAVY METAL QN EACH-90,301,1 ,$135.06 ,$87.79 ,$13.17 ,$135.06 ,$54.90 ,$37.87 ,$75.63 ,$21.96 ,$37.82 ,$47.68 ,$21.96 ,$55.64 ,$21.96 ,$60.91 ,$60.91 ,$21.96 ,$27.45 ,$41.72 ,$42.77 ,$54.90 ,$21.96 ,$21.96 ,$22.40 ,$101.30 ,$81.04 ,$81.04 ,$21.96 ,$81.04 ,$31.73 ,$31.73 ,$31.73 ,$135.06 , N/A ,$114.80 ,$54.90 ,$87.79 ,$21.96 ,$135.06 ,$75.63 ,$21.96 ,$35.52 , N/A ,$14.49 ,$13.83 ,$23.06 ,$108.05 ,$49.41 ,$60.91 ,$37.82 ,$121.55 ,$21.96 ,$31.73 ,$43.92 ,$43.92 ,$21.96 ,$43.92 ,$64.83 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101285,83021,HC HEMOGLOBIN FRACT QN-90,301,1 ,$98.00 ,$63.70 ,$10.21 ,$98.00 ,$45.15 ,$31.13 ,$54.88 ,$18.06 ,$27.44 ,$34.59 ,$18.06 ,$40.38 ,$18.06 ,$44.20 ,$44.20 ,$18.06 ,$22.58 ,$34.31 ,$35.23 ,$45.15 ,$18.06 ,$18.06 ,$18.42 ,$73.50 ,$58.80 ,$58.80 ,$18.06 ,$58.80 ,$26.08 ,$26.08 ,$26.08 ,$98.00 , N/A ,$83.30 ,$45.15 ,$63.70 ,$18.06 ,$98.00 ,$54.88 ,$18.06 ,$25.77 , N/A ,$11.23 ,$10.72 ,$18.96 ,$78.40 ,$40.64 ,$44.20 ,$27.44 ,$88.20 ,$18.06 ,$26.08 ,$36.12 ,$36.12 ,$18.06 ,$36.12 ,$47.04 ,$10.21 
ST. ELIZABETH'S HOSPITAL,30101286,83030,HC HEMOGLOBIN FETAL,301,1 ,$80.00 ,$52.00 ,$6.14 ,$80.00 ,$26.85 ,$6.14 ,$44.80 ,$10.74 ,$22.40 ,$28.24 ,$10.74 ,$32.96 ,$10.74 ,$36.08 ,$36.08 ,$10.74 ,$13.43 ,$20.41 ,$18.87 ,$26.85 ,$10.74 ,$10.74 ,$10.95 ,$60.00 ,$48.00 ,$48.00 ,$10.74 ,$48.00 ,$13.96 ,$13.96 ,$13.96 ,$80.00 , N/A ,$68.00 ,$26.85 ,$52.00 ,$10.74 ,$80.00 ,$44.80 ,$10.74 ,$21.04 , N/A ,$11.88 ,$11.34 ,$11.28 ,$64.00 ,$24.17 ,$36.08 ,$22.40 ,$72.00 ,$10.74 ,$13.96 ,$21.48 ,$21.48 ,$10.74 ,$21.48 ,$38.40 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101289,83051,HC HEMOGLOBIN PLASMA-90,301,1 ,$83.00 ,$53.95 ,$6.14 ,$83.00 ,$18.28 ,$6.14 ,$46.48 ,$7.31 ,$23.24 ,$29.30 ,$7.31 ,$34.20 ,$7.31 ,$37.43 ,$37.43 ,$7.31 ,$9.14 ,$13.89 ,$14.47 ,$18.28 ,$7.31 ,$7.31 ,$7.46 ,$62.25 ,$49.80 ,$49.80 ,$7.31 ,$49.80 ,$10.56 ,$10.56 ,$10.56 ,$83.00 , N/A ,$70.55 ,$18.28 ,$53.95 ,$7.31 ,$83.00 ,$46.48 ,$7.31 ,$21.83 , N/A ,$11.88 ,$11.34 ,$7.68 ,$66.40 ,$16.45 ,$37.43 ,$23.24 ,$74.70 ,$7.31 ,$10.56 ,$14.62 ,$14.62 ,$7.31 ,$14.62 ,$39.84 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101292,83090,HC HOMOCYSTEINE-90,301,1 ,$250.00 ,$162.50 ,$17.92 ,$250.00 ,$44.80 ,$29.09 ,$140.00 ,$17.92 ,$70.00 ,$88.25 ,$17.92 ,$103.00 ,$17.92 ,$112.75 ,$112.75 ,$17.92 ,$22.40 ,$34.05 ,$32.71 ,$44.80 ,$17.92 ,$17.92 ,$18.28 ,$187.50 ,$150.00 ,$150.00 ,$17.92 ,$150.00 ,$24.36 ,$24.36 ,$24.36 ,$250.00 , N/A ,$212.50 ,$44.80 ,$162.50 ,$17.92 ,$250.00 ,$140.00 ,$17.92 ,$65.75 , N/A ,$27.81 ,$26.54 ,$18.82 ,$200.00 ,$40.32 ,$112.75 ,$70.00 ,$225.00 ,$17.92 ,$24.36 ,$35.84 ,$35.84 ,$17.92 ,$35.84 ,$120.00 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101294,83497,HC HYDROXYINDOLACET 5 (HIAA)-90,301,1 ,$125.00 ,$81.25 ,$12.90 ,$125.00 ,$32.25 ,$22.23 ,$70.00 ,$12.90 ,$35.00 ,$44.13 ,$12.90 ,$51.50 ,$12.90 ,$56.38 ,$56.38 ,$12.90 ,$16.13 ,$24.51 ,$25.16 ,$32.25 ,$12.90 ,$12.90 ,$13.16 ,$93.75 ,$75.00 ,$75.00 ,$12.90 ,$75.00 ,$18.63 ,$18.63 ,$18.63 ,$125.00 , N/A ,$106.25 ,$32.25 ,$81.25 ,$12.90 ,$125.00 ,$70.00 ,$12.90 ,$32.88 , N/A ,$15.99 ,$15.27 ,$13.55 ,$100.00 ,$29.03 ,$56.38 ,$35.00 ,$112.50 ,$12.90 ,$18.63 ,$25.80 ,$25.80 ,$12.90 ,$25.80 ,$60.00 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101295,83498,HC HYDROXYPROGESTERONE 17D-90,301,1 ,$24.36 ,$15.83 ,$6.41 ,$60.90 ,$60.90 ,$24.36 ,$13.64 ,$24.36 ,$6.82 ,$8.60 ,$24.36 ,$10.04 ,$24.36 ,$10.99 ,$10.99 ,$24.36 ,$24.36 ,$24.36 ,$24.36 ,$60.90 ,$24.36 ,$24.36 ,$24.36 ,$18.27 ,$14.62 ,$14.62 ,$24.36 ,$14.62 ,$24.36 ,$24.36 ,$24.36 ,$24.36 , N/A ,$20.71 ,$24.36 ,$15.83 ,$24.36 ,$24.36 ,$13.64 ,$24.36 ,$6.41 , N/A ,$24.36 ,$24.36 ,$25.58 ,$19.49 ,$54.81 ,$10.99 ,$6.82 ,$21.92 ,$24.36 ,$24.36 ,$24.36 ,$24.36 ,$24.36 ,$24.36 ,$11.69 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101296,83505,HC HYDROXYPROLIN TOTAL-90,301,1 ,$179.00 ,$116.35 ,$24.30 ,$179.00 ,$60.75 ,$41.91 ,$100.24 ,$24.30 ,$50.12 ,$63.19 ,$24.30 ,$73.75 ,$24.30 ,$80.73 ,$80.73 ,$24.30 ,$30.38 ,$46.17 ,$47.18 ,$60.75 ,$24.30 ,$24.30 ,$24.79 ,$134.25 ,$107.40 ,$107.40 ,$24.30 ,$107.40 ,$35.11 ,$35.11 ,$35.11 ,$179.00 , N/A ,$152.15 ,$60.75 ,$116.35 ,$24.30 ,$179.00 ,$100.24 ,$24.30 ,$47.08 , N/A ,$27.81 ,$26.54 ,$25.52 ,$143.20 ,$54.68 ,$80.73 ,$50.12 ,$161.10 ,$24.30 ,$35.11 ,$48.60 ,$48.60 ,$24.30 ,$48.60 ,$85.92 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101297,83516,HC MLT NON INFECT QL/SQ-90,301,1 ,$237.00 ,$154.05 ,$9.67 ,$237.00 ,$28.83 ,$19.90 ,$132.72 ,$11.53 ,$66.36 ,$83.66 ,$11.53 ,$97.64 ,$11.53 ,$106.89 ,$106.89 ,$11.53 ,$14.41 ,$21.91 ,$22.64 ,$28.83 ,$11.53 ,$11.53 ,$11.76 ,$177.75 ,$142.20 ,$142.20 ,$11.53 ,$142.20 ,$16.65 ,$16.65 ,$16.65 ,$237.00 , N/A ,$201.45 ,$28.83 ,$154.05 ,$11.53 ,$237.00 ,$132.72 ,$11.53 ,$62.33 , N/A ,$10.64 ,$10.15 ,$12.11 ,$189.60 ,$25.94 ,$106.89 ,$66.36 ,$213.30 ,$11.53 ,$16.65 ,$23.06 ,$23.06 ,$11.53 ,$23.06 ,$113.76 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101300,83516,HC MLT NON INFECT QL/SQ TTG-90,301,1 ,$187.00 ,$121.55 ,$9.67 ,$187.00 ,$28.83 ,$19.90 ,$104.72 ,$11.53 ,$52.36 ,$66.01 ,$11.53 ,$77.04 ,$11.53 ,$84.34 ,$84.34 ,$11.53 ,$14.41 ,$21.91 ,$22.64 ,$28.83 ,$11.53 ,$11.53 ,$11.76 ,$140.25 ,$112.20 ,$112.20 ,$11.53 ,$112.20 ,$16.65 ,$16.65 ,$16.65 ,$187.00 , N/A ,$158.95 ,$28.83 ,$121.55 ,$11.53 ,$187.00 ,$104.72 ,$11.53 ,$49.18 , N/A ,$10.64 ,$10.15 ,$12.11 ,$149.60 ,$25.94 ,$84.34 ,$52.36 ,$168.30 ,$11.53 ,$16.65 ,$23.06 ,$23.06 ,$11.53 ,$23.06 ,$89.76 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101302,83519,HC QN RIA-90,301,1 ,$259.00 ,$168.35 ,$9.67 ,$259.00 ,$46.00 ,$23.29 ,$145.04 ,$18.40 ,$72.52 ,$91.43 ,$18.40 ,$106.71 ,$18.40 ,$116.81 ,$116.81 ,$18.40 ,$23.00 ,$34.96 ,$32.08 ,$46.00 ,$18.40 ,$18.40 ,$18.77 ,$194.25 ,$155.40 ,$155.40 ,$18.40 ,$155.40 ,$23.92 ,$23.92 ,$23.92 ,$259.00 , N/A ,$220.15 ,$46.00 ,$168.35 ,$18.40 ,$259.00 ,$145.04 ,$18.40 ,$68.12 , N/A ,$10.64 ,$10.15 ,$19.32 ,$207.20 ,$41.40 ,$116.81 ,$72.52 ,$233.10 ,$18.40 ,$23.92 ,$36.80 ,$36.80 ,$18.40 ,$36.80 ,$124.32 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101303,83520,HC IMMUNOASSAY QN OTHER-90,301,1 ,$155.00 ,$100.75 ,$9.67 ,$155.00 ,$43.18 ,$22.31 ,$86.80 ,$17.27 ,$43.40 ,$54.72 ,$17.27 ,$63.86 ,$17.27 ,$69.91 ,$69.91 ,$17.27 ,$21.59 ,$32.81 ,$30.19 ,$43.18 ,$17.27 ,$17.27 ,$17.62 ,$116.25 ,$93.00 ,$93.00 ,$17.27 ,$93.00 ,$22.45 ,$22.45 ,$22.45 ,$155.00 , N/A ,$131.75 ,$43.18 ,$100.75 ,$17.27 ,$155.00 ,$86.80 ,$17.27 ,$40.77 , N/A ,$10.64 ,$10.15 ,$18.13 ,$124.00 ,$38.86 ,$69.91 ,$43.40 ,$139.50 ,$17.27 ,$22.45 ,$34.54 ,$34.54 ,$17.27 ,$34.54 ,$74.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101305,83520,HC IMMUNOASSAY QN OTHER MBL-90,301,1 ,$376.00 ,$244.40 ,$9.67 ,$376.00 ,$43.18 ,$22.31 ,$210.56 ,$17.27 ,$105.28 ,$132.73 ,$17.27 ,$141.97 ,$17.27 ,$169.58 ,$169.58 ,$17.27 ,$21.59 ,$32.81 ,$30.19 ,$43.18 ,$17.27 ,$17.27 ,$17.62 ,$282.00 ,$225.60 ,$225.60 ,$17.27 ,$225.60 ,$22.45 ,$22.45 ,$22.45 ,$376.00 , N/A ,$319.60 ,$43.18 ,$244.40 ,$17.27 ,$376.00 ,$210.56 ,$17.27 ,$98.89 , N/A ,$10.64 ,$10.15 ,$18.13 ,$300.80 ,$38.86 ,$169.58 ,$105.28 ,$338.40 ,$17.27 ,$22.45 ,$34.54 ,$34.54 ,$17.27 ,$34.54 ,$180.48 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101306,83520,HC IMMUNOASSAY QN ENZYME-90,301,1 ,$187.20 ,$121.68 ,$9.67 ,$187.20 ,$43.18 ,$22.31 ,$104.83 ,$17.27 ,$52.42 ,$66.08 ,$17.27 ,$77.13 ,$17.27 ,$84.43 ,$84.43 ,$17.27 ,$21.59 ,$32.81 ,$30.19 ,$43.18 ,$17.27 ,$17.27 ,$17.62 ,$140.40 ,$112.32 ,$112.32 ,$17.27 ,$112.32 ,$22.45 ,$22.45 ,$22.45 ,$187.20 , N/A ,$159.12 ,$43.18 ,$121.68 ,$17.27 ,$187.20 ,$104.83 ,$17.27 ,$49.23 , N/A ,$10.64 ,$10.15 ,$18.13 ,$149.76 ,$38.86 ,$84.43 ,$52.42 ,$168.48 ,$17.27 ,$22.45 ,$34.54 ,$34.54 ,$17.27 ,$34.54 ,$89.86 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101307,83525,HC INSULIN TOTAL-90,301,1 ,$121.00 ,$78.65 ,$11.43 ,$121.00 ,$28.58 ,$19.71 ,$67.76 ,$11.43 ,$33.88 ,$42.71 ,$11.43 ,$49.85 ,$11.43 ,$54.57 ,$54.57 ,$11.43 ,$14.29 ,$21.72 ,$22.02 ,$28.58 ,$11.43 ,$11.43 ,$11.66 ,$90.75 ,$72.60 ,$72.60 ,$11.43 ,$72.60 ,$16.51 ,$16.51 ,$16.51 ,$121.00 , N/A ,$102.85 ,$28.58 ,$78.65 ,$11.43 ,$121.00 ,$67.76 ,$11.43 ,$31.82 , N/A ,$15.99 ,$15.27 ,$12.00 ,$96.80 ,$25.72 ,$54.57 ,$33.88 ,$108.90 ,$11.43 ,$16.51 ,$22.86 ,$22.86 ,$11.43 ,$22.86 ,$58.08 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101310,83586,HC KETOSTEROIDS (17-KS)-90,301,1 ,$94.00 ,$61.10 ,$12.80 ,$94.00 ,$32.00 ,$22.07 ,$52.64 ,$12.80 ,$26.32 ,$33.18 ,$12.80 ,$38.73 ,$12.80 ,$42.39 ,$42.39 ,$12.80 ,$16.00 ,$24.32 ,$24.53 ,$32.00 ,$12.80 ,$12.80 ,$13.06 ,$70.50 ,$56.40 ,$56.40 ,$12.80 ,$56.40 ,$18.49 ,$18.49 ,$18.49 ,$94.00 , N/A ,$79.90 ,$32.00 ,$61.10 ,$12.80 ,$94.00 ,$52.64 ,$12.80 ,$24.72 , N/A ,$15.99 ,$15.27 ,$13.44 ,$75.20 ,$28.80 ,$42.39 ,$26.32 ,$84.60 ,$12.80 ,$18.49 ,$25.60 ,$25.60 ,$12.80 ,$25.60 ,$45.12 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101313,83625,HC LDH ISOENZYMES-90,301,1 ,$165.00 ,$107.25 ,$10.80 ,$165.00 ,$31.98 ,$19.81 ,$92.40 ,$12.79 ,$46.20 ,$58.25 ,$12.79 ,$67.98 ,$12.79 ,$74.42 ,$74.42 ,$12.79 ,$15.99 ,$24.30 ,$24.53 ,$31.98 ,$12.79 ,$12.79 ,$13.05 ,$123.75 ,$99.00 ,$99.00 ,$12.79 ,$99.00 ,$18.49 ,$18.49 ,$18.49 ,$165.00 , N/A ,$140.25 ,$31.98 ,$107.25 ,$12.79 ,$165.00 ,$92.40 ,$12.79 ,$43.40 , N/A ,$11.88 ,$11.34 ,$13.43 ,$132.00 ,$28.78 ,$74.42 ,$46.20 ,$148.50 ,$12.79 ,$18.49 ,$25.58 ,$25.58 ,$12.79 ,$25.58 ,$79.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101316,83655,HC LEAD-90,301,1 ,$67.00 ,$43.55 ,$12.11 ,$67.00 ,$30.28 ,$20.86 ,$37.52 ,$12.11 ,$18.76 ,$23.65 ,$12.11 ,$27.60 ,$12.11 ,$30.22 ,$30.22 ,$12.11 ,$15.14 ,$23.01 ,$23.27 ,$30.28 ,$12.11 ,$12.11 ,$12.35 ,$50.25 ,$40.20 ,$40.20 ,$12.11 ,$40.20 ,$17.49 ,$17.49 ,$17.49 ,$67.00 , N/A ,$56.95 ,$30.28 ,$43.55 ,$12.11 ,$67.00 ,$37.52 ,$12.11 ,$17.62 , N/A ,$14.49 ,$13.83 ,$12.72 ,$53.60 ,$27.25 ,$30.22 ,$18.76 ,$60.30 ,$12.11 ,$17.49 ,$24.22 ,$24.22 ,$12.11 ,$24.22 ,$32.16 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101317,83661,HC FETAL LUNG MATURITY L/S RATIO-90,301,1 ,$547.00 ,$355.55 ,$10.80 ,$547.00 ,$54.98 ,$37.91 ,$306.32 ,$21.99 ,$153.16 ,$164.76 ,$21.99 ,$164.76 ,$21.99 ,$246.70 ,$246.70 ,$21.99 ,$27.49 ,$41.78 ,$42.77 ,$54.98 ,$21.99 ,$21.99 ,$22.43 ,$410.25 ,$328.20 ,$328.20 ,$21.99 ,$328.20 ,$31.76 ,$31.76 ,$31.76 ,$547.00 , N/A ,$464.95 ,$54.98 ,$355.55 ,$21.99 ,$547.00 ,$306.32 ,$21.99 ,$143.86 , N/A ,$11.88 ,$11.34 ,$23.09 ,$437.60 ,$49.48 ,$246.70 ,$153.16 ,$492.30 ,$21.99 ,$31.76 ,$43.98 ,$43.98 ,$21.99 ,$43.98 ,$262.56 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101326,83735,HC MAGNESIUM-90,301,1 ,$127.00 ,$82.55 ,$4.81 ,$127.00 ,$16.75 ,$11.55 ,$71.12 ,$6.70 ,$35.56 ,$44.83 ,$6.70 ,$52.32 ,$6.70 ,$57.28 ,$57.28 ,$6.70 ,$8.38 ,$12.73 ,$13.21 ,$16.75 ,$6.70 ,$6.70 ,$6.83 ,$95.25 ,$76.20 ,$76.20 ,$6.70 ,$76.20 ,$9.67 ,$9.67 ,$9.67 ,$127.00 , N/A ,$107.95 ,$16.75 ,$82.55 ,$6.70 ,$127.00 ,$71.12 ,$6.70 ,$33.40 , N/A ,$5.29 ,$5.05 ,$7.04 ,$101.60 ,$15.08 ,$57.28 ,$35.56 ,$114.30 ,$6.70 ,$9.67 ,$13.40 ,$13.40 ,$6.70 ,$13.40 ,$60.96 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101327,83785,HC MANGANESE-90,301,1 ,$180.00 ,$117.00 ,$13.17 ,$180.00 ,$66.63 ,$42.40 ,$100.80 ,$26.65 ,$50.40 ,$63.54 ,$26.65 ,$74.16 ,$26.65 ,$81.18 ,$81.18 ,$26.65 ,$33.31 ,$50.64 ,$47.81 ,$66.63 ,$26.65 ,$26.65 ,$27.18 ,$135.00 ,$108.00 ,$108.00 ,$26.65 ,$108.00 ,$35.53 ,$35.53 ,$35.53 ,$180.00 , N/A ,$153.00 ,$66.63 ,$117.00 ,$26.65 ,$180.00 ,$100.80 ,$26.65 ,$47.34 , N/A ,$14.49 ,$13.83 ,$27.98 ,$144.00 ,$59.96 ,$81.18 ,$50.40 ,$162.00 ,$26.65 ,$35.53 ,$53.30 ,$53.30 ,$26.65 ,$53.30 ,$86.40 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101328,83789,HC MASS SPEC QN EACH-90,301,1 ,$440.00 ,$286.00 ,$10.80 ,$440.00 ,$60.28 ,$31.13 ,$246.40 ,$24.11 ,$123.20 ,$146.36 ,$24.11 ,$146.36 ,$24.11 ,$198.44 ,$198.44 ,$24.11 ,$30.14 ,$45.81 ,$42.14 ,$60.28 ,$24.11 ,$24.11 ,$24.59 ,$330.00 ,$264.00 ,$264.00 ,$24.11 ,$264.00 ,$31.34 ,$31.34 ,$31.34 ,$440.00 , N/A ,$374.00 ,$60.28 ,$286.00 ,$24.11 ,$440.00 ,$246.40 ,$24.11 ,$115.72 , N/A ,$11.88 ,$11.34 ,$25.32 ,$352.00 ,$54.25 ,$198.44 ,$123.20 ,$396.00 ,$24.11 ,$31.34 ,$48.22 ,$48.22 ,$24.11 ,$48.22 ,$211.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101329,83825,HC MERCURY-90,301,1 ,$107.00 ,$69.55 ,$13.17 ,$107.00 ,$40.65 ,$28.04 ,$59.92 ,$16.26 ,$29.96 ,$37.77 ,$16.26 ,$44.08 ,$16.26 ,$48.26 ,$48.26 ,$16.26 ,$20.33 ,$30.89 ,$31.45 ,$40.65 ,$16.26 ,$16.26 ,$16.59 ,$80.25 ,$64.20 ,$64.20 ,$16.26 ,$64.20 ,$23.48 ,$23.48 ,$23.48 ,$107.00 , N/A ,$90.95 ,$40.65 ,$69.55 ,$16.26 ,$107.00 ,$59.92 ,$16.26 ,$28.14 , N/A ,$14.49 ,$13.83 ,$17.07 ,$85.60 ,$36.59 ,$48.26 ,$29.96 ,$96.30 ,$16.26 ,$23.48 ,$32.52 ,$32.52 ,$16.26 ,$32.52 ,$51.36 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101330,83835,HC METANEPHRINES-90,301,1 ,$239.00 ,$155.35 ,$16.94 ,$239.00 ,$42.35 ,$29.21 ,$133.84 ,$16.94 ,$66.92 ,$84.37 ,$16.94 ,$98.47 ,$16.94 ,$107.79 ,$107.79 ,$16.94 ,$21.18 ,$32.19 ,$32.71 ,$42.35 ,$16.94 ,$16.94 ,$17.28 ,$179.25 ,$143.40 ,$143.40 ,$16.94 ,$143.40 ,$24.47 ,$24.47 ,$24.47 ,$239.00 , N/A ,$203.15 ,$42.35 ,$155.35 ,$16.94 ,$239.00 ,$133.84 ,$16.94 ,$62.86 , N/A ,$27.81 ,$26.54 ,$17.79 ,$191.20 ,$38.12 ,$107.79 ,$66.92 ,$215.10 ,$16.94 ,$24.47 ,$33.88 ,$33.88 ,$16.94 ,$33.88 ,$114.72 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101333,83873,HC MYELIN BASIC PROTEIN (CSF)-90,301,1 ,$92.00 ,$59.80 ,$10.80 ,$92.00 ,$43.00 ,$28.12 ,$51.52 ,$17.20 ,$25.76 ,$32.48 ,$17.20 ,$37.90 ,$17.20 ,$41.49 ,$41.49 ,$17.20 ,$21.50 ,$32.68 ,$33.34 ,$43.00 ,$17.20 ,$17.20 ,$17.54 ,$69.00 ,$55.20 ,$55.20 ,$17.20 ,$55.20 ,$24.86 ,$24.86 ,$24.86 ,$92.00 , N/A ,$78.20 ,$43.00 ,$59.80 ,$17.20 ,$92.00 ,$51.52 ,$17.20 ,$24.20 , N/A ,$11.88 ,$11.34 ,$18.06 ,$73.60 ,$38.70 ,$41.49 ,$25.76 ,$82.80 ,$17.20 ,$24.86 ,$34.40 ,$34.40 ,$17.20 ,$34.40 ,$44.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101334,83874,HC MYOGLOBIN-90,301,1 ,$107.00 ,$69.55 ,$10.80 ,$107.00 ,$32.30 ,$22.26 ,$59.92 ,$12.92 ,$29.96 ,$37.77 ,$12.92 ,$44.08 ,$12.92 ,$48.26 ,$48.26 ,$12.92 ,$16.15 ,$24.55 ,$25.16 ,$32.30 ,$12.92 ,$12.92 ,$13.18 ,$80.25 ,$64.20 ,$64.20 ,$12.92 ,$64.20 ,$18.66 ,$18.66 ,$18.66 ,$107.00 , N/A ,$90.95 ,$32.30 ,$69.55 ,$12.92 ,$107.00 ,$59.92 ,$12.92 ,$28.14 , N/A ,$11.88 ,$11.34 ,$13.57 ,$85.60 ,$29.07 ,$48.26 ,$29.96 ,$96.30 ,$12.92 ,$18.66 ,$25.84 ,$25.84 ,$12.92 ,$25.84 ,$51.36 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101337,83883,HC NEPHELOMETRY EA ANALYTE-90,301,1 ,$119.00 ,$77.35 ,$13.60 ,$119.00 ,$34.00 ,$23.43 ,$66.64 ,$13.60 ,$33.32 ,$42.01 ,$13.60 ,$49.03 ,$13.60 ,$53.67 ,$53.67 ,$13.60 ,$17.00 ,$25.84 ,$26.42 ,$34.00 ,$13.60 ,$13.60 ,$13.87 ,$89.25 ,$71.40 ,$71.40 ,$13.60 ,$71.40 ,$19.64 ,$19.64 ,$19.64 ,$119.00 , N/A ,$101.15 ,$34.00 ,$77.35 ,$13.60 ,$119.00 ,$66.64 ,$13.60 ,$31.30 , N/A ,$18.34 ,$17.50 ,$14.28 ,$95.20 ,$30.60 ,$53.67 ,$33.32 ,$107.10 ,$13.60 ,$19.64 ,$27.20 ,$27.20 ,$13.60 ,$27.20 ,$57.12 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30101339,83915,HC NUCLEOTIDASE 5 -90,301,1 ,$232.00 ,$150.80 ,$10.80 ,$232.00 ,$27.88 ,$19.23 ,$129.92 ,$11.15 ,$64.96 ,$81.90 ,$11.15 ,$83.59 ,$11.15 ,$104.63 ,$104.63 ,$11.15 ,$13.94 ,$21.19 ,$21.39 ,$27.88 ,$11.15 ,$11.15 ,$11.37 ,$174.00 ,$139.20 ,$139.20 ,$11.15 ,$139.20 ,$16.11 ,$16.11 ,$16.11 ,$232.00 , N/A ,$197.20 ,$27.88 ,$150.80 ,$11.15 ,$232.00 ,$129.92 ,$11.15 ,$61.02 , N/A ,$11.88 ,$11.34 ,$11.71 ,$185.60 ,$25.09 ,$104.63 ,$64.96 ,$208.80 ,$11.15 ,$16.11 ,$22.30 ,$22.30 ,$11.15 ,$22.30 ,$111.36 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101340,83916,HC OLIGOCLONAL BANDS-90,301,1 ,$109.00 ,$70.85 ,$10.80 ,$109.00 ,$68.48 ,$34.67 ,$61.04 ,$27.39 ,$30.52 ,$38.48 ,$27.39 ,$44.91 ,$27.39 ,$49.16 ,$49.16 ,$27.39 ,$34.24 ,$52.04 ,$47.81 ,$68.48 ,$27.39 ,$27.39 ,$27.94 ,$81.75 ,$65.40 ,$65.40 ,$27.39 ,$65.40 ,$35.61 ,$35.61 ,$35.61 ,$109.00 , N/A ,$92.65 ,$68.48 ,$70.85 ,$27.39 ,$109.00 ,$61.04 ,$27.39 ,$28.67 , N/A ,$11.88 ,$11.34 ,$28.76 ,$87.20 ,$61.63 ,$49.16 ,$30.52 ,$98.10 ,$27.39 ,$35.61 ,$54.78 ,$54.78 ,$27.39 ,$54.78 ,$52.32 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101343,83935,HC OSMOLALITY URINE-90,301,1 ,$150.00 ,$97.50 ,$4.81 ,$150.00 ,$17.05 ,$11.74 ,$84.00 ,$6.82 ,$42.00 ,$51.09 ,$6.82 ,$51.09 ,$6.82 ,$67.65 ,$67.65 ,$6.82 ,$8.53 ,$12.96 ,$13.21 ,$17.05 ,$6.82 ,$6.82 ,$6.96 ,$112.50 ,$90.00 ,$90.00 ,$6.82 ,$90.00 ,$9.84 ,$9.84 ,$9.84 ,$150.00 , N/A ,$127.50 ,$17.05 ,$97.50 ,$6.82 ,$150.00 ,$84.00 ,$6.82 ,$39.45 , N/A ,$5.29 ,$5.05 ,$7.16 ,$120.00 ,$15.35 ,$67.65 ,$42.00 ,$135.00 ,$6.82 ,$9.84 ,$13.64 ,$13.64 ,$6.82 ,$13.64 ,$72.00 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101344,83937,HC OSTEOCALCIN-90,301,1 ,$122.00 ,$79.30 ,$25.28 ,$122.00 ,$74.63 ,$51.47 ,$68.32 ,$29.85 ,$34.16 ,$43.07 ,$29.85 ,$50.26 ,$29.85 ,$55.02 ,$55.02 ,$29.85 ,$37.31 ,$56.72 ,$57.87 ,$74.63 ,$29.85 ,$29.85 ,$30.45 ,$91.50 ,$73.20 ,$73.20 ,$29.85 ,$73.20 ,$43.11 ,$43.11 ,$43.11 ,$122.00 , N/A ,$103.70 ,$74.63 ,$79.30 ,$29.85 ,$122.00 ,$68.32 ,$29.85 ,$32.09 , N/A ,$27.81 ,$26.54 ,$31.34 ,$97.60 ,$67.16 ,$55.02 ,$34.16 ,$109.80 ,$29.85 ,$43.11 ,$59.70 ,$59.70 ,$29.85 ,$59.70 ,$58.56 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101345,83945,HC OXALATE-90,301,1 ,$260.00 ,$169.00 ,$10.80 ,$260.00 ,$36.13 ,$22.19 ,$145.60 ,$14.45 ,$72.80 ,$91.78 ,$14.45 ,$96.48 ,$14.45 ,$117.26 ,$117.26 ,$14.45 ,$18.06 ,$27.46 ,$25.16 ,$36.13 ,$14.45 ,$14.45 ,$14.74 ,$195.00 ,$156.00 ,$156.00 ,$14.45 ,$156.00 ,$18.79 ,$18.79 ,$18.79 ,$260.00 , N/A ,$221.00 ,$36.13 ,$169.00 ,$14.45 ,$260.00 ,$145.60 ,$14.45 ,$68.38 , N/A ,$11.88 ,$11.34 ,$15.17 ,$208.00 ,$32.51 ,$117.26 ,$72.80 ,$234.00 ,$14.45 ,$18.79 ,$28.90 ,$28.90 ,$14.45 ,$28.90 ,$124.80 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101351,83993,HC CALPROTECTIN STOOL-90,301,1 ,$190.00 ,$123.50 ,$10.80 ,$190.00 ,$49.08 ,$33.83 ,$106.40 ,$19.63 ,$53.20 ,$67.07 ,$19.63 ,$78.28 ,$19.63 ,$85.69 ,$85.69 ,$19.63 ,$24.54 ,$37.30 ,$38.37 ,$49.08 ,$19.63 ,$19.63 ,$20.02 ,$142.50 ,$114.00 ,$114.00 ,$19.63 ,$114.00 ,$28.35 ,$28.35 ,$28.35 ,$190.00 , N/A ,$161.50 ,$49.08 ,$123.50 ,$19.63 ,$190.00 ,$106.40 ,$19.63 ,$49.97 , N/A ,$11.88 ,$11.34 ,$20.61 ,$152.00 ,$44.17 ,$85.69 ,$53.20 ,$171.00 ,$19.63 ,$28.35 ,$39.26 ,$39.26 ,$19.63 ,$39.26 ,$91.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101352,84030,HC NEWBORN SCREEN PKU-90,301,1 ,$151.00 ,$98.15 ,$4.81 ,$151.00 ,$13.75 ,$9.49 ,$84.56 ,$5.50 ,$42.28 ,$53.30 ,$5.50 ,$55.85 ,$5.50 ,$68.10 ,$68.10 ,$5.50 ,$6.88 ,$10.45 ,$10.69 ,$13.75 ,$5.50 ,$5.50 ,$5.61 ,$113.25 ,$90.60 ,$90.60 ,$5.50 ,$90.60 ,$7.94 ,$7.94 ,$7.94 ,$151.00 , N/A ,$128.35 ,$13.75 ,$98.15 ,$5.50 ,$151.00 ,$84.56 ,$5.50 ,$39.71 , N/A ,$5.29 ,$5.05 ,$5.78 ,$120.80 ,$12.38 ,$68.10 ,$42.28 ,$135.90 ,$5.50 ,$7.94 ,$11.00 ,$11.00 ,$5.50 ,$11.00 ,$72.48 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101353,84066,HC PHOSPHATASE ACID PROSTATIC-90,301,1 ,$79.00 ,$51.35 ,$9.66 ,$79.00 ,$24.15 ,$16.64 ,$44.24 ,$9.66 ,$22.12 ,$27.89 ,$9.66 ,$32.55 ,$9.66 ,$35.63 ,$35.63 ,$9.66 ,$12.08 ,$18.35 ,$18.87 ,$24.15 ,$9.66 ,$9.66 ,$9.85 ,$59.25 ,$47.40 ,$47.40 ,$9.66 ,$47.40 ,$13.95 ,$13.95 ,$13.95 ,$79.00 , N/A ,$67.15 ,$24.15 ,$51.35 ,$9.66 ,$79.00 ,$44.24 ,$9.66 ,$20.78 , N/A ,$11.88 ,$11.34 ,$10.14 ,$63.20 ,$21.74 ,$35.63 ,$22.12 ,$71.10 ,$9.66 ,$13.95 ,$19.32 ,$19.32 ,$9.66 ,$19.32 ,$37.92 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101354,84075,HC ALKALINE PHOSPHATASE-90,301,1 ,$115.00 ,$74.75 ,$4.81 ,$115.00 ,$12.95 ,$8.93 ,$64.40 ,$5.18 ,$32.20 ,$40.60 ,$5.18 ,$47.38 ,$5.18 ,$51.87 ,$51.87 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$86.25 ,$69.00 ,$69.00 ,$5.18 ,$69.00 ,$7.48 ,$7.48 ,$7.48 ,$115.00 , N/A ,$97.75 ,$12.95 ,$74.75 ,$5.18 ,$115.00 ,$64.40 ,$5.18 ,$30.25 , N/A ,$5.29 ,$5.05 ,$5.44 ,$92.00 ,$11.66 ,$51.87 ,$32.20 ,$103.50 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$55.20 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101356,84080,HC ALK PHOS ISOENZ-90,301,1 ,$72.00 ,$46.80 ,$10.80 ,$72.00 ,$36.95 ,$25.50 ,$40.32 ,$14.78 ,$20.16 ,$25.42 ,$14.78 ,$29.66 ,$14.78 ,$32.47 ,$32.47 ,$14.78 ,$18.48 ,$28.08 ,$28.93 ,$36.95 ,$14.78 ,$14.78 ,$15.08 ,$54.00 ,$43.20 ,$43.20 ,$14.78 ,$43.20 ,$21.36 ,$21.36 ,$21.36 ,$72.00 , N/A ,$61.20 ,$36.95 ,$46.80 ,$14.78 ,$72.00 ,$40.32 ,$14.78 ,$18.94 , N/A ,$11.88 ,$11.34 ,$15.52 ,$57.60 ,$33.26 ,$32.47 ,$20.16 ,$64.80 ,$14.78 ,$21.36 ,$29.56 ,$29.56 ,$14.78 ,$29.56 ,$34.56 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101358,84105,HC PHOSPHORUS URINE-90,301,1 ,$64.00 ,$41.60 ,$4.81 ,$64.00 ,$14.45 ,$8.93 ,$35.84 ,$5.78 ,$17.92 ,$22.59 ,$5.78 ,$26.37 ,$5.78 ,$28.86 ,$28.86 ,$5.78 ,$7.23 ,$10.98 ,$10.06 ,$14.45 ,$5.78 ,$5.78 ,$5.90 ,$48.00 ,$38.40 ,$38.40 ,$5.78 ,$38.40 ,$7.51 ,$7.51 ,$7.51 ,$64.00 , N/A ,$54.40 ,$14.45 ,$41.60 ,$5.78 ,$64.00 ,$35.84 ,$5.78 ,$16.83 , N/A ,$5.29 ,$5.05 ,$6.07 ,$51.20 ,$13.01 ,$28.86 ,$17.92 ,$57.60 ,$5.78 ,$7.51 ,$11.56 ,$11.56 ,$5.78 ,$11.56 ,$30.72 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101360,84112,HC EVAL C/V AMNIOTIC FLD QL EA,301,1 ,$157.00 ,$102.05 ,$29.08 ,$245.28 ,$245.28 ,$80.69 ,$87.92 ,$98.11 ,$43.96 ,$55.42 ,$98.11 ,$64.68 ,$98.11 ,$70.81 ,$70.81 ,$98.11 ,$122.64 ,$157.00 ,$157.00 ,$245.28 ,$98.11 ,$98.11 ,$100.07 ,$117.75 ,$94.20 ,$94.20 ,$98.11 ,$94.20 ,$127.54 ,$127.54 ,$127.54 ,$157.00 , N/A ,$133.45 ,$157.00 ,$102.05 ,$98.11 ,$157.00 ,$87.92 ,$98.11 ,$41.29 , N/A ,$31.99 ,$30.53 ,$103.02 ,$125.60 ,$220.75 ,$70.81 ,$43.96 ,$141.30 ,$98.11 ,$127.54 ,$157.00 ,$157.00 ,$98.11 ,$157.00 ,$75.36 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101361,84120,HC PORPHYRINS QN FRACT-90,301,1 ,$98.00 ,$63.70 ,$10.80 ,$98.00 ,$36.78 ,$25.36 ,$54.88 ,$14.71 ,$27.44 ,$34.59 ,$14.71 ,$40.38 ,$14.71 ,$44.20 ,$44.20 ,$14.71 ,$18.39 ,$27.95 ,$28.31 ,$36.78 ,$14.71 ,$14.71 ,$15.00 ,$73.50 ,$58.80 ,$58.80 ,$14.71 ,$58.80 ,$21.26 ,$21.26 ,$21.26 ,$98.00 , N/A ,$83.30 ,$36.78 ,$63.70 ,$14.71 ,$98.00 ,$54.88 ,$14.71 ,$25.77 , N/A ,$11.88 ,$11.34 ,$15.45 ,$78.40 ,$33.10 ,$44.20 ,$27.44 ,$88.20 ,$14.71 ,$21.26 ,$29.42 ,$29.42 ,$14.71 ,$29.42 ,$47.04 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101364,84133,HC POTASSIUM URINE-90,301,1 ,$84.00 ,$54.60 ,$4.73 ,$84.00 ,$11.83 ,$7.42 ,$47.04 ,$4.73 ,$23.52 ,$29.65 ,$4.73 ,$32.32 ,$4.73 ,$37.88 ,$37.88 ,$4.73 ,$5.91 ,$8.99 ,$8.18 ,$11.83 ,$4.73 ,$4.73 ,$4.82 ,$63.00 ,$50.40 ,$50.40 ,$4.73 ,$50.40 ,$6.23 ,$6.23 ,$6.23 ,$84.00 , N/A ,$71.40 ,$11.83 ,$54.60 ,$4.73 ,$84.00 ,$47.04 ,$4.73 ,$22.09 , N/A ,$5.29 ,$5.05 ,$4.97 ,$67.20 ,$10.64 ,$37.88 ,$23.52 ,$75.60 ,$4.73 ,$6.23 ,$9.46 ,$9.46 ,$4.73 ,$9.46 ,$40.32 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101365,84134,HC PREALBUMIN-90,301,1 ,$12.00 ,$7.80 ,$3.16 ,$30.00 ,$30.00 ,$12.00 ,$6.72 ,$12.00 ,$3.36 ,$4.24 ,$12.00 ,$4.94 ,$12.00 ,$5.41 ,$5.41 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$30.00 ,$12.00 ,$12.00 ,$12.00 ,$9.00 ,$7.20 ,$7.20 ,$12.00 ,$7.20 ,$12.00 ,$12.00 ,$12.00 ,$12.00 , N/A ,$10.20 ,$12.00 ,$7.80 ,$12.00 ,$12.00 ,$6.72 ,$12.00 ,$3.16 , N/A ,$11.88 ,$11.34 ,$12.60 ,$9.60 ,$27.00 ,$5.41 ,$3.36 ,$10.80 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$5.76 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101366,84140,HC PREGNENOLONE-90,301,1 ,$108.00 ,$70.20 ,$20.67 ,$108.00 ,$51.68 ,$35.65 ,$60.48 ,$20.67 ,$30.24 ,$38.12 ,$20.67 ,$44.50 ,$20.67 ,$48.71 ,$48.71 ,$20.67 ,$25.84 ,$39.27 ,$40.26 ,$51.68 ,$20.67 ,$20.67 ,$21.08 ,$81.00 ,$64.80 ,$64.80 ,$20.67 ,$64.80 ,$29.86 ,$29.86 ,$29.86 ,$108.00 , N/A ,$91.80 ,$51.68 ,$70.20 ,$20.67 ,$108.00 ,$60.48 ,$20.67 ,$28.40 , N/A ,$27.81 ,$26.54 ,$21.70 ,$86.40 ,$46.51 ,$48.71 ,$30.24 ,$97.20 ,$20.67 ,$29.86 ,$41.34 ,$41.34 ,$20.67 ,$41.34 ,$51.84 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101369,84145,HC PROCALCITONIN (PCT)-90,301,1 ,$344.00 ,$223.60 ,$25.28 ,$344.00 ,$68.05 ,$46.17 ,$192.64 ,$27.22 ,$96.32 ,$121.43 ,$27.22 ,$141.73 ,$27.22 ,$155.14 ,$155.14 ,$27.22 ,$34.03 ,$51.72 ,$52.21 ,$68.05 ,$27.22 ,$27.22 ,$27.76 ,$258.00 ,$206.40 ,$206.40 ,$27.22 ,$206.40 ,$38.70 ,$38.70 ,$38.70 ,$344.00 , N/A ,$292.40 ,$68.05 ,$223.60 ,$27.22 ,$344.00 ,$192.64 ,$27.22 ,$90.47 , N/A ,$27.81 ,$26.54 ,$28.58 ,$275.20 ,$61.25 ,$155.14 ,$96.32 ,$309.60 ,$27.22 ,$38.70 ,$54.44 ,$54.44 ,$27.22 ,$54.44 ,$165.12 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101372,84155,HC PROTEIN TOTAL-90,301,1 ,$88.00 ,$57.20 ,$3.67 ,$88.00 ,$9.18 ,$6.32 ,$49.28 ,$3.67 ,$24.64 ,$31.06 ,$3.67 ,$36.26 ,$3.67 ,$39.69 ,$39.69 ,$3.67 ,$4.59 ,$6.97 ,$6.92 ,$9.18 ,$3.67 ,$3.67 ,$3.74 ,$66.00 ,$52.80 ,$52.80 ,$3.67 ,$52.80 ,$5.29 ,$5.29 ,$5.29 ,$88.00 , N/A ,$74.80 ,$9.18 ,$57.20 ,$3.67 ,$88.00 ,$49.28 ,$3.67 ,$23.14 , N/A ,$5.29 ,$5.05 ,$3.85 ,$70.40 ,$8.26 ,$39.69 ,$24.64 ,$79.20 ,$3.67 ,$5.29 ,$7.34 ,$7.34 ,$3.67 ,$7.34 ,$42.24 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101373,84156,HC PROTEIN TOTAL URINE-90,301,1 ,$7.50 ,$4.88 ,$1.97 ,$9.18 ,$9.18 ,$6.32 ,$4.20 ,$3.67 ,$2.10 ,$2.65 ,$3.67 ,$3.09 ,$3.67 ,$3.38 ,$3.38 ,$3.67 ,$4.59 ,$6.97 ,$6.92 ,$9.18 ,$3.67 ,$3.67 ,$3.74 ,$5.63 ,$4.50 ,$4.50 ,$3.67 ,$4.50 ,$5.29 ,$5.29 ,$5.29 ,$7.50 , N/A ,$6.38 ,$7.50 ,$4.88 ,$3.67 ,$7.50 ,$4.20 ,$3.67 ,$1.97 , N/A ,$5.29 ,$5.05 ,$3.85 ,$6.00 ,$8.26 ,$3.38 ,$2.10 ,$6.75 ,$3.67 ,$5.29 ,$7.34 ,$7.34 ,$3.67 ,$7.34 ,$3.60 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101374,84157,HC PROTEIN TOTAL OTH SRC-90,301,1 ,$6.96 ,$4.52 ,$1.83 ,$10.00 ,$10.00 ,$6.32 ,$3.90 ,$4.00 ,$1.95 ,$2.46 ,$4.00 ,$2.87 ,$4.00 ,$3.14 ,$3.14 ,$4.00 ,$5.00 ,$6.96 ,$6.92 ,$10.00 ,$4.00 ,$4.00 ,$4.08 ,$5.22 ,$4.18 ,$4.18 ,$4.00 ,$4.18 ,$5.29 ,$5.29 ,$5.29 ,$6.96 , N/A ,$5.92 ,$6.96 ,$4.52 ,$4.00 ,$6.96 ,$3.90 ,$4.00 ,$1.83 , N/A ,$5.29 ,$5.05 ,$4.20 ,$5.57 ,$9.00 ,$3.14 ,$1.95 ,$6.26 ,$4.00 ,$5.29 ,$6.96 ,$6.96 ,$4.00 ,$6.96 ,$3.34 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101375,84165,HC PROTEIN ELECTROPHORESIS-90,301,1 ,$163.00 ,$105.95 ,$10.74 ,$163.00 ,$26.85 ,$18.52 ,$91.28 ,$10.74 ,$45.64 ,$57.54 ,$10.74 ,$67.16 ,$10.74 ,$73.51 ,$73.51 ,$10.74 ,$13.43 ,$20.41 ,$20.76 ,$26.85 ,$10.74 ,$10.74 ,$10.95 ,$122.25 ,$97.80 ,$97.80 ,$10.74 ,$97.80 ,$15.51 ,$15.51 ,$15.51 ,$163.00 , N/A ,$138.55 ,$26.85 ,$105.95 ,$10.74 ,$163.00 ,$91.28 ,$10.74 ,$42.87 , N/A ,$11.88 ,$11.34 ,$11.28 ,$130.40 ,$24.17 ,$73.51 ,$45.64 ,$146.70 ,$10.74 ,$15.51 ,$21.48 ,$21.48 ,$10.74 ,$21.48 ,$78.24 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101377,84166,HC PROTEIN EP OTH FLUID-90,301,1 ,$109.00 ,$70.85 ,$10.80 ,$109.00 ,$44.58 ,$30.73 ,$61.04 ,$17.83 ,$30.52 ,$38.48 ,$17.83 ,$44.91 ,$17.83 ,$49.16 ,$49.16 ,$17.83 ,$22.29 ,$33.88 ,$34.60 ,$44.58 ,$17.83 ,$17.83 ,$18.19 ,$81.75 ,$65.40 ,$65.40 ,$17.83 ,$65.40 ,$25.75 ,$25.75 ,$25.75 ,$109.00 , N/A ,$92.65 ,$44.58 ,$70.85 ,$17.83 ,$109.00 ,$61.04 ,$17.83 ,$28.67 , N/A ,$11.88 ,$11.34 ,$18.72 ,$87.20 ,$40.12 ,$49.16 ,$30.52 ,$98.10 ,$17.83 ,$25.75 ,$35.66 ,$35.66 ,$17.83 ,$35.66 ,$52.32 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101379,84181,HC PROTEIN WESTERN BLOT-90,301,1 ,$209.00 ,$135.85 ,$9.67 ,$209.00 ,$42.58 ,$29.37 ,$117.04 ,$17.03 ,$58.52 ,$73.78 ,$17.03 ,$86.11 ,$17.03 ,$94.26 ,$94.26 ,$17.03 ,$21.29 ,$32.36 ,$32.71 ,$42.58 ,$17.03 ,$17.03 ,$17.37 ,$156.75 ,$125.40 ,$125.40 ,$17.03 ,$125.40 ,$24.60 ,$24.60 ,$24.60 ,$209.00 , N/A ,$177.65 ,$42.58 ,$135.85 ,$17.03 ,$209.00 ,$117.04 ,$17.03 ,$54.97 , N/A ,$10.64 ,$10.15 ,$17.88 ,$167.20 ,$38.32 ,$94.26 ,$58.52 ,$188.10 ,$17.03 ,$24.60 ,$34.06 ,$34.06 ,$17.03 ,$34.06 ,$100.32 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101380,84182,HC PROTEIN WEST BLOT BAND ID-90,301,1 ,$446.00 ,$289.90 ,$16.67 ,$446.00 ,$73.03 ,$31.03 ,$249.76 ,$29.21 ,$124.88 ,$157.44 ,$29.21 ,$177.37 ,$29.21 ,$201.15 ,$201.15 ,$29.21 ,$36.51 ,$55.50 ,$50.95 ,$73.03 ,$29.21 ,$29.21 ,$29.79 ,$334.50 ,$267.60 ,$267.60 ,$29.21 ,$267.60 ,$37.97 ,$37.97 ,$37.97 ,$446.00 , N/A ,$379.10 ,$73.03 ,$289.90 ,$29.21 ,$446.00 ,$249.76 ,$29.21 ,$117.30 , N/A ,$18.34 ,$17.50 ,$30.67 ,$356.80 ,$65.72 ,$201.15 ,$124.88 ,$401.40 ,$29.21 ,$37.97 ,$58.42 ,$58.42 ,$29.21 ,$58.42 ,$214.08 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30101382,84206,HC PROINSULIN-90,301,1 ,$237.00 ,$154.05 ,$25.28 ,$237.00 ,$66.73 ,$30.71 ,$132.72 ,$26.69 ,$66.36 ,$83.66 ,$26.69 ,$97.64 ,$26.69 ,$106.89 ,$106.89 ,$26.69 ,$33.36 ,$50.71 ,$46.55 ,$66.73 ,$26.69 ,$26.69 ,$27.22 ,$177.75 ,$142.20 ,$142.20 ,$26.69 ,$142.20 ,$34.70 ,$34.70 ,$34.70 ,$237.00 , N/A ,$201.45 ,$66.73 ,$154.05 ,$26.69 ,$237.00 ,$132.72 ,$26.69 ,$62.33 , N/A ,$27.81 ,$26.54 ,$28.02 ,$189.60 ,$60.05 ,$106.89 ,$66.36 ,$213.30 ,$26.69 ,$34.70 ,$53.38 ,$53.38 ,$26.69 ,$53.38 ,$113.76 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101383,84207,HC VITAMIN B6-90,301,1 ,$193.00 ,$125.45 ,$10.80 ,$193.00 ,$70.25 ,$48.44 ,$108.08 ,$28.10 ,$54.04 ,$68.13 ,$28.10 ,$79.52 ,$28.10 ,$87.04 ,$87.04 ,$28.10 ,$35.13 ,$53.39 ,$54.72 ,$70.25 ,$28.10 ,$28.10 ,$28.66 ,$144.75 ,$115.80 ,$115.80 ,$28.10 ,$115.80 ,$40.59 ,$40.59 ,$40.59 ,$193.00 , N/A ,$164.05 ,$70.25 ,$125.45 ,$28.10 ,$193.00 ,$108.08 ,$28.10 ,$50.76 , N/A ,$11.88 ,$11.34 ,$29.51 ,$154.40 ,$63.23 ,$87.04 ,$54.04 ,$173.70 ,$28.10 ,$40.59 ,$56.20 ,$56.20 ,$28.10 ,$56.20 ,$92.64 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101386,84238,HC RECEPTOR ASSAY NON ENDO-90,301,1 ,$497.00 ,$323.05 ,$29.08 ,$497.00 ,$91.43 ,$63.04 ,$278.32 ,$36.57 ,$139.16 ,$175.44 ,$36.57 ,$204.76 ,$36.57 ,$224.15 ,$224.15 ,$36.57 ,$45.71 ,$69.48 ,$71.08 ,$91.43 ,$36.57 ,$36.57 ,$37.30 ,$372.75 ,$298.20 ,$298.20 ,$36.57 ,$298.20 ,$52.82 ,$52.82 ,$52.82 ,$497.00 , N/A ,$422.45 ,$91.43 ,$323.05 ,$36.57 ,$497.00 ,$278.32 ,$36.57 ,$130.71 , N/A ,$31.99 ,$30.53 ,$38.40 ,$397.60 ,$82.28 ,$224.15 ,$139.16 ,$447.30 ,$36.57 ,$52.82 ,$73.14 ,$73.14 ,$36.57 ,$73.14 ,$238.56 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101387,84244,HC RENIN-90,301,1 ,$144.00 ,$93.60 ,$21.99 ,$144.00 ,$54.98 ,$37.92 ,$80.64 ,$21.99 ,$40.32 ,$50.83 ,$21.99 ,$59.33 ,$21.99 ,$64.94 ,$64.94 ,$21.99 ,$27.49 ,$41.78 ,$42.77 ,$54.98 ,$21.99 ,$21.99 ,$22.43 ,$108.00 ,$86.40 ,$86.40 ,$21.99 ,$86.40 ,$31.77 ,$31.77 ,$31.77 ,$144.00 , N/A ,$122.40 ,$54.98 ,$93.60 ,$21.99 ,$144.00 ,$80.64 ,$21.99 ,$37.87 , N/A ,$27.81 ,$26.54 ,$23.09 ,$115.20 ,$49.48 ,$64.94 ,$40.32 ,$129.60 ,$21.99 ,$31.77 ,$43.98 ,$43.98 ,$21.99 ,$43.98 ,$69.12 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101388,84255,HC SELENIUM-90,301,1 ,$73.00 ,$47.45 ,$10.80 ,$73.00 ,$63.83 ,$44.01 ,$40.88 ,$25.53 ,$20.44 ,$25.77 ,$25.53 ,$30.08 ,$25.53 ,$32.92 ,$32.92 ,$25.53 ,$31.91 ,$48.51 ,$49.69 ,$63.83 ,$25.53 ,$25.53 ,$26.04 ,$54.75 ,$43.80 ,$43.80 ,$25.53 ,$43.80 ,$36.88 ,$36.88 ,$36.88 ,$73.00 , N/A ,$62.05 ,$63.83 ,$47.45 ,$25.53 ,$73.00 ,$40.88 ,$25.53 ,$19.20 , N/A ,$11.88 ,$11.34 ,$26.81 ,$58.40 ,$57.44 ,$32.92 ,$20.44 ,$65.70 ,$25.53 ,$36.88 ,$51.06 ,$51.06 ,$25.53 ,$51.06 ,$35.04 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101389,84252,HC VITAMIN B-2 (RIBOFLAVIN)-90,301,1 ,$323.00 ,$209.95 ,$10.80 ,$323.00 ,$50.60 ,$34.90 ,$180.88 ,$20.24 ,$90.44 ,$114.02 ,$20.24 ,$133.08 ,$20.24 ,$145.67 ,$145.67 ,$20.24 ,$25.30 ,$38.46 ,$39.00 ,$50.60 ,$20.24 ,$20.24 ,$20.64 ,$242.25 ,$193.80 ,$193.80 ,$20.24 ,$193.80 ,$29.24 ,$29.24 ,$29.24 ,$323.00 , N/A ,$274.55 ,$50.60 ,$209.95 ,$20.24 ,$323.00 ,$180.88 ,$20.24 ,$84.95 , N/A ,$11.88 ,$11.34 ,$21.25 ,$258.40 ,$45.54 ,$145.67 ,$90.44 ,$290.70 ,$20.24 ,$29.24 ,$40.48 ,$40.48 ,$20.24 ,$40.48 ,$155.04 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101390,84270,HC SEX HORMONE BIND GLOB-90,301,1 ,$41.00 ,$26.65 ,$10.78 ,$54.33 ,$54.33 ,$37.47 ,$22.96 ,$21.73 ,$11.48 ,$14.47 ,$21.73 ,$16.89 ,$21.73 ,$18.49 ,$18.49 ,$21.73 ,$27.16 ,$41.00 ,$41.00 ,$54.33 ,$21.73 ,$21.73 ,$22.16 ,$30.75 ,$24.60 ,$24.60 ,$21.73 ,$24.60 ,$31.40 ,$31.40 ,$31.40 ,$41.00 , N/A ,$34.85 ,$41.00 ,$26.65 ,$21.73 ,$41.00 ,$22.96 ,$21.73 ,$10.78 , N/A ,$11.88 ,$11.34 ,$22.82 ,$32.80 ,$48.89 ,$18.49 ,$11.48 ,$36.90 ,$21.73 ,$31.40 ,$41.00 ,$41.00 ,$21.73 ,$41.00 ,$19.68 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101394,84300,HC SODIUM URINE-90,301,1 ,$84.00 ,$54.60 ,$4.81 ,$84.00 ,$12.65 ,$8.40 ,$47.04 ,$5.06 ,$23.52 ,$29.65 ,$5.06 ,$34.61 ,$5.06 ,$37.88 ,$37.88 ,$5.06 ,$6.33 ,$9.61 ,$9.44 ,$12.65 ,$5.06 ,$5.06 ,$5.16 ,$63.00 ,$50.40 ,$50.40 ,$5.06 ,$50.40 ,$7.02 ,$7.02 ,$7.02 ,$84.00 , N/A ,$71.40 ,$12.65 ,$54.60 ,$5.06 ,$84.00 ,$47.04 ,$5.06 ,$22.09 , N/A ,$5.29 ,$5.05 ,$5.31 ,$67.20 ,$11.39 ,$37.88 ,$23.52 ,$75.60 ,$5.06 ,$7.02 ,$10.12 ,$10.12 ,$5.06 ,$10.12 ,$40.32 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101395,84302,HC SODIUM OTHER FLUID-90,301,1 ,$44.00 ,$28.60 ,$4.81 ,$44.00 ,$12.15 ,$8.40 ,$24.64 ,$4.86 ,$12.32 ,$15.53 ,$4.86 ,$18.13 ,$4.86 ,$19.84 ,$19.84 ,$4.86 ,$6.08 ,$9.23 ,$9.44 ,$12.15 ,$4.86 ,$4.86 ,$4.96 ,$33.00 ,$26.40 ,$26.40 ,$4.86 ,$26.40 ,$7.02 ,$7.02 ,$7.02 ,$44.00 , N/A ,$37.40 ,$12.15 ,$28.60 ,$4.86 ,$44.00 ,$24.64 ,$4.86 ,$11.57 , N/A ,$5.29 ,$5.05 ,$5.10 ,$35.20 ,$10.94 ,$19.84 ,$12.32 ,$39.60 ,$4.86 ,$7.02 ,$9.72 ,$9.72 ,$4.86 ,$9.72 ,$21.12 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101396,84305,HC SOMATOMEDIN-90,301,1 ,$197.00 ,$128.05 ,$21.26 ,$197.00 ,$53.15 ,$36.65 ,$110.32 ,$21.26 ,$55.16 ,$69.54 ,$21.26 ,$81.16 ,$21.26 ,$88.85 ,$88.85 ,$21.26 ,$26.58 ,$40.39 ,$41.52 ,$53.15 ,$21.26 ,$21.26 ,$21.69 ,$147.75 ,$118.20 ,$118.20 ,$21.26 ,$118.20 ,$30.72 ,$30.72 ,$30.72 ,$197.00 , N/A ,$167.45 ,$53.15 ,$128.05 ,$21.26 ,$197.00 ,$110.32 ,$21.26 ,$51.81 , N/A ,$27.81 ,$26.54 ,$22.32 ,$157.60 ,$47.84 ,$88.85 ,$55.16 ,$177.30 ,$21.26 ,$30.72 ,$42.52 ,$42.52 ,$21.26 ,$42.52 ,$94.56 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101398,84311,HC SPECTROPHOTOMETRY-90,301,1 ,$64.00 ,$41.60 ,$8.10 ,$64.00 ,$20.25 ,$12.04 ,$35.84 ,$8.10 ,$17.92 ,$22.59 ,$8.10 ,$26.37 ,$8.10 ,$28.86 ,$28.86 ,$8.10 ,$10.13 ,$15.39 ,$13.84 ,$20.25 ,$8.10 ,$8.10 ,$8.26 ,$48.00 ,$38.40 ,$38.40 ,$8.10 ,$38.40 ,$10.53 ,$10.53 ,$10.53 ,$64.00 , N/A ,$54.40 ,$20.25 ,$41.60 ,$8.10 ,$64.00 ,$35.84 ,$8.10 ,$16.83 , N/A ,$11.88 ,$11.34 ,$8.51 ,$51.20 ,$18.23 ,$28.86 ,$17.92 ,$57.60 ,$8.10 ,$10.53 ,$16.20 ,$16.20 ,$8.10 ,$16.20 ,$30.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101402,84376,HC SUGARS SINGLE QL-90,301,1 ,$46.00 ,$29.90 ,$4.81 ,$46.00 ,$13.75 ,$9.49 ,$25.76 ,$5.50 ,$12.88 ,$16.24 ,$5.50 ,$18.95 ,$5.50 ,$20.75 ,$20.75 ,$5.50 ,$6.88 ,$10.45 ,$10.69 ,$13.75 ,$5.50 ,$5.50 ,$5.61 ,$34.50 ,$27.60 ,$27.60 ,$5.50 ,$27.60 ,$7.94 ,$7.94 ,$7.94 ,$46.00 , N/A ,$39.10 ,$13.75 ,$29.90 ,$5.50 ,$46.00 ,$25.76 ,$5.50 ,$12.10 , N/A ,$5.29 ,$5.05 ,$5.78 ,$36.80 ,$12.38 ,$20.75 ,$12.88 ,$41.40 ,$5.50 ,$7.94 ,$11.00 ,$11.00 ,$5.50 ,$11.00 ,$22.08 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101405,84392,HC SULFATE URINE-90,301,1 ,$36.00 ,$23.40 ,$3.86 ,$36.00 ,$13.73 ,$8.19 ,$20.16 ,$5.49 ,$10.08 ,$12.71 ,$5.49 ,$14.83 ,$5.49 ,$16.24 ,$16.24 ,$5.49 ,$6.86 ,$10.43 ,$9.44 ,$13.73 ,$5.49 ,$5.49 ,$5.60 ,$27.00 ,$21.60 ,$21.60 ,$5.49 ,$21.60 ,$7.14 ,$7.14 ,$7.14 ,$36.00 , N/A ,$30.60 ,$13.73 ,$23.40 ,$5.49 ,$36.00 ,$20.16 ,$5.49 ,$9.47 , N/A ,$4.25 ,$4.05 ,$5.76 ,$28.80 ,$12.35 ,$16.24 ,$10.08 ,$32.40 ,$5.49 ,$7.14 ,$10.98 ,$10.98 ,$5.49 ,$10.98 ,$17.28 ,$3.86 
ST. ELIZABETH'S HOSPITAL,30101406,84402,HC TESTOSTERONE FREE-90,301,1 ,$241.00 ,$156.65 ,$25.28 ,$241.00 ,$63.68 ,$43.91 ,$134.96 ,$25.47 ,$67.48 ,$85.07 ,$25.47 ,$99.29 ,$25.47 ,$108.69 ,$108.69 ,$25.47 ,$31.84 ,$48.39 ,$49.69 ,$63.68 ,$25.47 ,$25.47 ,$25.98 ,$180.75 ,$144.60 ,$144.60 ,$25.47 ,$144.60 ,$36.79 ,$36.79 ,$36.79 ,$241.00 , N/A ,$204.85 ,$63.68 ,$156.65 ,$25.47 ,$241.00 ,$134.96 ,$25.47 ,$63.38 , N/A ,$27.81 ,$26.54 ,$26.74 ,$192.80 ,$57.31 ,$108.69 ,$67.48 ,$216.90 ,$25.47 ,$36.79 ,$50.94 ,$50.94 ,$25.47 ,$50.94 ,$115.68 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101407,84403,HC TESTOSTERONE TOTAL-90,301,1 ,$196.00 ,$127.40 ,$25.28 ,$196.00 ,$64.53 ,$44.50 ,$109.76 ,$25.81 ,$54.88 ,$69.19 ,$25.81 ,$80.75 ,$25.81 ,$88.40 ,$88.40 ,$25.81 ,$32.26 ,$49.04 ,$50.32 ,$64.53 ,$25.81 ,$25.81 ,$26.33 ,$147.00 ,$117.60 ,$117.60 ,$25.81 ,$117.60 ,$37.28 ,$37.28 ,$37.28 ,$196.00 , N/A ,$166.60 ,$64.53 ,$127.40 ,$25.81 ,$196.00 ,$109.76 ,$25.81 ,$51.55 , N/A ,$27.81 ,$26.54 ,$27.10 ,$156.80 ,$58.07 ,$88.40 ,$54.88 ,$176.40 ,$25.81 ,$37.28 ,$51.62 ,$51.62 ,$25.81 ,$51.62 ,$94.08 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101408,84425,HC VITAMIN B1-90,301,1 ,$386.00 ,$250.90 ,$10.80 ,$386.00 ,$53.08 ,$36.61 ,$216.16 ,$21.23 ,$108.08 ,$136.26 ,$21.23 ,$159.03 ,$21.23 ,$174.09 ,$174.09 ,$21.23 ,$26.54 ,$40.34 ,$40.89 ,$53.08 ,$21.23 ,$21.23 ,$21.65 ,$289.50 ,$231.60 ,$231.60 ,$21.23 ,$231.60 ,$30.67 ,$30.67 ,$30.67 ,$386.00 , N/A ,$328.10 ,$53.08 ,$250.90 ,$21.23 ,$386.00 ,$216.16 ,$21.23 ,$101.52 , N/A ,$11.88 ,$11.34 ,$22.29 ,$308.80 ,$47.77 ,$174.09 ,$108.08 ,$347.40 ,$21.23 ,$30.67 ,$42.46 ,$42.46 ,$21.23 ,$42.46 ,$185.28 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101409,84430,HC THIOCYANATE-90,301,1 ,$402.00 ,$261.30 ,$11.63 ,$402.00 ,$29.08 ,$20.07 ,$225.12 ,$11.63 ,$112.56 ,$87.14 ,$11.63 ,$87.14 ,$11.63 ,$181.30 ,$181.30 ,$11.63 ,$14.54 ,$22.10 ,$22.64 ,$29.08 ,$11.63 ,$11.63 ,$11.86 ,$301.50 ,$241.20 ,$241.20 ,$11.63 ,$241.20 ,$16.81 ,$16.81 ,$16.81 ,$402.00 , N/A ,$341.70 ,$29.08 ,$261.30 ,$11.63 ,$402.00 ,$225.12 ,$11.63 ,$105.73 , N/A ,$14.49 ,$13.83 ,$12.21 ,$321.60 ,$26.17 ,$181.30 ,$112.56 ,$361.80 ,$11.63 ,$16.81 ,$23.26 ,$23.26 ,$11.63 ,$23.26 ,$192.96 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101410,84432,HC THYROGLOBULIN-90,301,1 ,$145.00 ,$94.25 ,$16.06 ,$145.00 ,$40.15 ,$27.70 ,$81.20 ,$16.06 ,$40.60 ,$51.19 ,$16.06 ,$59.74 ,$16.06 ,$65.40 ,$65.40 ,$16.06 ,$20.08 ,$30.51 ,$31.45 ,$40.15 ,$16.06 ,$16.06 ,$16.38 ,$108.75 ,$87.00 ,$87.00 ,$16.06 ,$87.00 ,$23.19 ,$23.19 ,$23.19 ,$145.00 , N/A ,$123.25 ,$40.15 ,$94.25 ,$16.06 ,$145.00 ,$81.20 ,$16.06 ,$38.14 , N/A ,$27.81 ,$26.54 ,$16.86 ,$116.00 ,$36.14 ,$65.40 ,$40.60 ,$130.50 ,$16.06 ,$23.19 ,$32.12 ,$32.12 ,$16.06 ,$32.12 ,$69.60 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101411,84432,HC THYROGLOBULIN FNA-90,301,1 ,$36.00 ,$23.40 ,$9.47 ,$40.15 ,$40.15 ,$27.70 ,$20.16 ,$16.06 ,$10.08 ,$12.71 ,$16.06 ,$14.83 ,$16.06 ,$16.24 ,$16.24 ,$16.06 ,$20.08 ,$30.51 ,$31.45 ,$40.15 ,$16.06 ,$16.06 ,$16.38 ,$27.00 ,$21.60 ,$21.60 ,$16.06 ,$21.60 ,$23.19 ,$23.19 ,$23.19 ,$36.00 , N/A ,$30.60 ,$36.00 ,$23.40 ,$16.06 ,$36.00 ,$20.16 ,$16.06 ,$9.47 , N/A ,$27.81 ,$26.54 ,$16.86 ,$28.80 ,$36.14 ,$16.24 ,$10.08 ,$32.40 ,$16.06 ,$23.19 ,$32.12 ,$32.12 ,$16.06 ,$32.12 ,$17.28 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101412,84436,HC THYROXINE (T-4) TOTAL-90,301,1 ,$14.00 ,$9.10 ,$3.68 ,$17.18 ,$17.18 ,$11.85 ,$7.84 ,$6.87 ,$3.92 ,$4.94 ,$6.87 ,$5.77 ,$6.87 ,$6.31 ,$6.31 ,$6.87 ,$8.59 ,$13.05 ,$13.21 ,$17.18 ,$6.87 ,$6.87 ,$7.01 ,$10.50 ,$8.40 ,$8.40 ,$6.87 ,$8.40 ,$9.92 ,$9.92 ,$9.92 ,$14.00 , N/A ,$11.90 ,$14.00 ,$9.10 ,$6.87 ,$14.00 ,$7.84 ,$6.87 ,$3.68 , N/A ,$14.00 ,$14.00 ,$7.21 ,$11.20 ,$15.46 ,$6.31 ,$3.92 ,$12.60 ,$6.87 ,$9.92 ,$13.74 ,$13.74 ,$6.87 ,$13.74 ,$6.72 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101415,84442,HC THYROXINE BIND GLOB-90,301,1 ,$32.00 ,$20.80 ,$8.42 ,$36.95 ,$36.95 ,$25.50 ,$17.92 ,$14.78 ,$8.96 ,$11.30 ,$14.78 ,$13.18 ,$14.78 ,$14.43 ,$14.43 ,$14.78 ,$18.48 ,$28.08 ,$28.93 ,$36.95 ,$14.78 ,$14.78 ,$15.08 ,$24.00 ,$19.20 ,$19.20 ,$14.78 ,$19.20 ,$21.36 ,$21.36 ,$21.36 ,$32.00 , N/A ,$27.20 ,$32.00 ,$20.80 ,$14.78 ,$32.00 ,$17.92 ,$14.78 ,$8.42 , N/A ,$15.99 ,$15.27 ,$15.52 ,$25.60 ,$33.26 ,$14.43 ,$8.96 ,$28.80 ,$14.78 ,$21.36 ,$29.56 ,$29.56 ,$14.78 ,$29.56 ,$15.36 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101417,84445,HC THYROID STIM IMMUNO GLOB-90,301,1 ,$86.70 ,$56.36 ,$22.80 ,$127.15 ,$127.15 ,$86.70 ,$48.55 ,$50.86 ,$24.28 ,$30.61 ,$50.86 ,$35.72 ,$50.86 ,$39.10 ,$39.10 ,$50.86 ,$63.58 ,$86.70 ,$86.70 ,$127.15 ,$50.86 ,$50.86 ,$51.88 ,$65.03 ,$52.02 ,$52.02 ,$50.86 ,$52.02 ,$73.46 ,$73.46 ,$73.46 ,$86.70 , N/A ,$73.70 ,$86.70 ,$56.36 ,$50.86 ,$86.70 ,$48.55 ,$50.86 ,$22.80 , N/A ,$27.81 ,$26.54 ,$53.40 ,$69.36 ,$114.44 ,$39.10 ,$24.28 ,$78.03 ,$50.86 ,$73.46 ,$86.70 ,$86.70 ,$50.86 ,$86.70 ,$41.62 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101418,84446,HC VITAMIN E-90,301,1 ,$123.00 ,$79.95 ,$10.80 ,$123.00 ,$35.45 ,$24.45 ,$68.88 ,$14.18 ,$34.44 ,$43.42 ,$14.18 ,$50.68 ,$14.18 ,$55.47 ,$55.47 ,$14.18 ,$17.73 ,$26.94 ,$27.68 ,$35.45 ,$14.18 ,$14.18 ,$14.46 ,$92.25 ,$73.80 ,$73.80 ,$14.18 ,$73.80 ,$20.48 ,$20.48 ,$20.48 ,$123.00 , N/A ,$104.55 ,$35.45 ,$79.95 ,$14.18 ,$123.00 ,$68.88 ,$14.18 ,$32.35 , N/A ,$11.88 ,$11.34 ,$14.89 ,$98.40 ,$31.91 ,$55.47 ,$34.44 ,$110.70 ,$14.18 ,$20.48 ,$28.36 ,$28.36 ,$14.18 ,$28.36 ,$59.04 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101420,84466,HC TRANSFERRIN-90,301,1 ,$153.00 ,$99.45 ,$10.80 ,$153.00 ,$31.90 ,$22.02 ,$85.68 ,$12.76 ,$42.84 ,$54.01 ,$12.76 ,$63.04 ,$12.76 ,$69.00 ,$69.00 ,$12.76 ,$15.95 ,$24.24 ,$24.53 ,$31.90 ,$12.76 ,$12.76 ,$13.02 ,$114.75 ,$91.80 ,$91.80 ,$12.76 ,$91.80 ,$18.43 ,$18.43 ,$18.43 ,$153.00 , N/A ,$130.05 ,$31.90 ,$99.45 ,$12.76 ,$153.00 ,$85.68 ,$12.76 ,$40.24 , N/A ,$11.88 ,$11.34 ,$13.40 ,$122.40 ,$28.71 ,$69.00 ,$42.84 ,$137.70 ,$12.76 ,$18.43 ,$25.52 ,$25.52 ,$12.76 ,$25.52 ,$73.44 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101422,84479,HC T3 UPTAKE-90,301,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101423,84480,HC T3 TOTAL-90,301,1 ,$58.00 ,$37.70 ,$14.18 ,$58.00 ,$35.45 ,$19.02 ,$32.48 ,$14.18 ,$16.24 ,$20.47 ,$14.18 ,$23.90 ,$14.18 ,$26.16 ,$26.16 ,$14.18 ,$17.73 ,$26.94 ,$27.68 ,$35.45 ,$14.18 ,$14.18 ,$14.46 ,$43.50 ,$34.80 ,$34.80 ,$14.18 ,$34.80 ,$20.48 ,$20.48 ,$20.48 ,$58.00 , N/A ,$49.30 ,$35.45 ,$37.70 ,$14.18 ,$58.00 ,$32.48 ,$14.18 ,$15.25 , N/A ,$15.99 ,$15.27 ,$14.89 ,$46.40 ,$31.91 ,$26.16 ,$16.24 ,$52.20 ,$14.18 ,$20.48 ,$28.36 ,$28.36 ,$14.18 ,$28.36 ,$27.84 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101424,84481,HC T3 FREE-90,301,1 ,$144.00 ,$93.60 ,$14.54 ,$144.00 ,$42.35 ,$19.55 ,$80.64 ,$16.94 ,$40.32 ,$50.83 ,$16.94 ,$59.33 ,$16.94 ,$64.94 ,$64.94 ,$16.94 ,$21.18 ,$32.19 ,$32.71 ,$42.35 ,$16.94 ,$16.94 ,$17.28 ,$108.00 ,$86.40 ,$86.40 ,$16.94 ,$86.40 ,$24.47 ,$24.47 ,$24.47 ,$144.00 , N/A ,$122.40 ,$42.35 ,$93.60 ,$16.94 ,$144.00 ,$80.64 ,$16.94 ,$37.87 , N/A ,$15.99 ,$15.27 ,$17.79 ,$115.20 ,$38.12 ,$64.94 ,$40.32 ,$129.60 ,$16.94 ,$24.47 ,$33.88 ,$33.88 ,$16.94 ,$33.88 ,$69.12 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101425,84482,HC T3 REVERSE-90,301,1 ,$406.00 ,$263.90 ,$14.54 ,$406.00 ,$39.40 ,$27.18 ,$227.36 ,$15.76 ,$113.68 ,$118.15 ,$15.76 ,$118.15 ,$15.76 ,$183.11 ,$183.11 ,$15.76 ,$19.70 ,$29.94 ,$30.82 ,$39.40 ,$15.76 ,$15.76 ,$16.08 ,$304.50 ,$243.60 ,$243.60 ,$15.76 ,$243.60 ,$22.76 ,$22.76 ,$22.76 ,$406.00 , N/A ,$345.10 ,$39.40 ,$263.90 ,$15.76 ,$406.00 ,$227.36 ,$15.76 ,$106.78 , N/A ,$15.99 ,$15.27 ,$16.55 ,$324.80 ,$35.46 ,$183.11 ,$113.68 ,$365.40 ,$15.76 ,$22.76 ,$31.52 ,$31.52 ,$15.76 ,$31.52 ,$194.88 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101433,84540,HC UREA URINE-90,301,1 ,$103.00 ,$66.95 ,$4.81 ,$103.00 ,$13.90 ,$8.19 ,$57.68 ,$5.56 ,$28.84 ,$35.59 ,$5.56 ,$35.59 ,$5.56 ,$46.45 ,$46.45 ,$5.56 ,$6.95 ,$10.56 ,$9.44 ,$13.90 ,$5.56 ,$5.56 ,$5.67 ,$77.25 ,$61.80 ,$61.80 ,$5.56 ,$61.80 ,$7.23 ,$7.23 ,$7.23 ,$103.00 , N/A ,$87.55 ,$13.90 ,$66.95 ,$5.56 ,$103.00 ,$57.68 ,$5.56 ,$27.09 , N/A ,$5.29 ,$5.05 ,$5.84 ,$82.40 ,$12.51 ,$46.45 ,$28.84 ,$92.70 ,$5.56 ,$7.23 ,$11.12 ,$11.12 ,$5.56 ,$11.12 ,$49.44 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101434,84560,HC URIC ACID OTH SRC-90,301,1 ,$108.00 ,$70.20 ,$4.81 ,$108.00 ,$12.70 ,$8.19 ,$60.48 ,$5.08 ,$30.24 ,$35.59 ,$5.08 ,$35.59 ,$5.08 ,$48.71 ,$48.71 ,$5.08 ,$6.35 ,$9.65 ,$9.44 ,$12.70 ,$5.08 ,$5.08 ,$5.18 ,$81.00 ,$64.80 ,$64.80 ,$5.08 ,$64.80 ,$6.85 ,$6.85 ,$6.85 ,$108.00 , N/A ,$91.80 ,$12.70 ,$70.20 ,$5.08 ,$108.00 ,$60.48 ,$5.08 ,$28.40 , N/A ,$5.29 ,$5.05 ,$5.33 ,$86.40 ,$11.43 ,$48.71 ,$30.24 ,$97.20 ,$5.08 ,$6.85 ,$10.16 ,$10.16 ,$5.08 ,$10.16 ,$51.84 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101435,84585,HC VANILLYLMAND AC (VMA)-90,301,1 ,$148.00 ,$96.20 ,$15.50 ,$148.00 ,$38.75 ,$26.72 ,$82.88 ,$15.50 ,$41.44 ,$52.24 ,$15.50 ,$60.98 ,$15.50 ,$66.75 ,$66.75 ,$15.50 ,$19.38 ,$29.45 ,$30.19 ,$38.75 ,$15.50 ,$15.50 ,$15.81 ,$111.00 ,$88.80 ,$88.80 ,$15.50 ,$88.80 ,$22.39 ,$22.39 ,$22.39 ,$148.00 , N/A ,$125.80 ,$38.75 ,$96.20 ,$15.50 ,$148.00 ,$82.88 ,$15.50 ,$38.92 , N/A ,$27.81 ,$26.54 ,$16.28 ,$118.40 ,$34.88 ,$66.75 ,$41.44 ,$133.20 ,$15.50 ,$22.39 ,$31.00 ,$31.00 ,$15.50 ,$31.00 ,$71.04 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101436,84586,HC VASOACTIVE INTEST PEPTIDE-90,301,1 ,$226.11 ,$146.97 ,$25.28 ,$226.11 ,$88.33 ,$60.90 ,$126.62 ,$35.33 ,$63.31 ,$79.82 ,$35.33 ,$93.16 ,$35.33 ,$101.98 ,$101.98 ,$35.33 ,$44.16 ,$67.13 ,$68.56 ,$88.33 ,$35.33 ,$35.33 ,$36.04 ,$169.58 ,$135.67 ,$135.67 ,$35.33 ,$135.67 ,$51.04 ,$51.04 ,$51.04 ,$226.11 , N/A ,$192.19 ,$88.33 ,$146.97 ,$35.33 ,$226.11 ,$126.62 ,$35.33 ,$59.47 , N/A ,$27.81 ,$26.54 ,$37.10 ,$180.89 ,$79.49 ,$101.98 ,$63.31 ,$203.50 ,$35.33 ,$51.04 ,$70.66 ,$70.66 ,$35.33 ,$70.66 ,$108.53 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101437,84588,HC VASOPRESSIN (ADH)-90,301,1 ,$176.00 ,$114.40 ,$25.28 ,$176.00 ,$84.85 ,$48.90 ,$98.56 ,$33.94 ,$49.28 ,$62.13 ,$33.94 ,$72.51 ,$33.94 ,$79.38 ,$79.38 ,$33.94 ,$42.43 ,$64.49 ,$66.05 ,$84.85 ,$33.94 ,$33.94 ,$34.62 ,$132.00 ,$105.60 ,$105.60 ,$33.94 ,$105.60 ,$49.02 ,$49.02 ,$49.02 ,$176.00 , N/A ,$149.60 ,$84.85 ,$114.40 ,$33.94 ,$176.00 ,$98.56 ,$33.94 ,$46.29 , N/A ,$27.81 ,$26.54 ,$35.64 ,$140.80 ,$76.37 ,$79.38 ,$49.28 ,$158.40 ,$33.94 ,$49.02 ,$67.88 ,$67.88 ,$33.94 ,$67.88 ,$84.48 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101438,84590,HC VITAMIN A-90,301,1 ,$80.00 ,$52.00 ,$10.80 ,$80.00 ,$29.03 ,$19.99 ,$44.80 ,$11.61 ,$22.40 ,$28.24 ,$11.61 ,$32.96 ,$11.61 ,$36.08 ,$36.08 ,$11.61 ,$14.51 ,$22.06 ,$22.64 ,$29.03 ,$11.61 ,$11.61 ,$11.84 ,$60.00 ,$48.00 ,$48.00 ,$11.61 ,$48.00 ,$16.77 ,$16.77 ,$16.77 ,$80.00 , N/A ,$68.00 ,$29.03 ,$52.00 ,$11.61 ,$80.00 ,$44.80 ,$11.61 ,$21.04 , N/A ,$11.88 ,$11.34 ,$12.19 ,$64.00 ,$26.12 ,$36.08 ,$22.40 ,$72.00 ,$11.61 ,$16.77 ,$23.22 ,$23.22 ,$11.61 ,$23.22 ,$38.40 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101439,84591,HC VITAMIN A OTHER-90,301,1 ,$84.00 ,$54.60 ,$12.40 ,$84.00 ,$42.65 ,$19.99 ,$47.04 ,$17.06 ,$23.52 ,$29.65 ,$17.06 ,$34.61 ,$17.06 ,$37.88 ,$37.88 ,$17.06 ,$21.33 ,$32.41 ,$29.56 ,$42.65 ,$17.06 ,$17.06 ,$17.40 ,$63.00 ,$50.40 ,$50.40 ,$17.06 ,$50.40 ,$22.18 ,$22.18 ,$22.18 ,$84.00 , N/A ,$71.40 ,$42.65 ,$54.60 ,$17.06 ,$84.00 ,$47.04 ,$17.06 ,$22.09 , N/A ,$13.64 ,$13.02 ,$17.91 ,$67.20 ,$38.39 ,$37.88 ,$23.52 ,$75.60 ,$17.06 ,$22.18 ,$34.12 ,$34.12 ,$17.06 ,$34.12 ,$40.32 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101440,84597,HC VITAMIN K-90,301,1 ,$196.00 ,$127.40 ,$10.80 ,$196.00 ,$34.30 ,$19.55 ,$109.76 ,$13.72 ,$54.88 ,$69.19 ,$13.72 ,$80.75 ,$13.72 ,$88.40 ,$88.40 ,$13.72 ,$17.15 ,$26.07 ,$26.42 ,$34.30 ,$13.72 ,$13.72 ,$13.99 ,$147.00 ,$117.60 ,$117.60 ,$13.72 ,$117.60 ,$19.81 ,$19.81 ,$19.81 ,$196.00 , N/A ,$166.60 ,$34.30 ,$127.40 ,$13.72 ,$196.00 ,$109.76 ,$13.72 ,$51.55 , N/A ,$11.88 ,$11.34 ,$14.41 ,$156.80 ,$30.87 ,$88.40 ,$54.88 ,$176.40 ,$13.72 ,$19.81 ,$27.44 ,$27.44 ,$13.72 ,$27.44 ,$94.08 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101441,84600,HC VOLATILES-90,301,1 ,$318.00 ,$206.70 ,$10.80 ,$318.00 ,$42.78 ,$27.42 ,$178.08 ,$17.11 ,$89.04 ,$112.25 ,$17.11 ,$120.49 ,$17.11 ,$143.42 ,$143.42 ,$17.11 ,$21.39 ,$32.51 ,$31.45 ,$42.78 ,$17.11 ,$17.11 ,$17.45 ,$238.50 ,$190.80 ,$190.80 ,$17.11 ,$190.80 ,$23.23 ,$23.23 ,$23.23 ,$318.00 , N/A ,$270.30 ,$42.78 ,$206.70 ,$17.11 ,$318.00 ,$178.08 ,$17.11 ,$83.63 , N/A ,$11.88 ,$11.34 ,$17.97 ,$254.40 ,$38.50 ,$143.42 ,$89.04 ,$286.20 ,$17.11 ,$23.23 ,$34.22 ,$34.22 ,$17.11 ,$34.22 ,$152.64 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101442,84630,HC ZINC-90,301,1 ,$128.00 ,$83.20 ,$11.39 ,$128.00 ,$28.48 ,$19.50 ,$71.68 ,$11.39 ,$35.84 ,$45.18 ,$11.39 ,$52.74 ,$11.39 ,$57.73 ,$57.73 ,$11.39 ,$14.24 ,$21.64 ,$22.02 ,$28.48 ,$11.39 ,$11.39 ,$11.62 ,$96.00 ,$76.80 ,$76.80 ,$11.39 ,$76.80 ,$16.45 ,$16.45 ,$16.45 ,$128.00 , N/A ,$108.80 ,$28.48 ,$83.20 ,$11.39 ,$128.00 ,$71.68 ,$11.39 ,$33.66 , N/A ,$14.49 ,$13.83 ,$11.96 ,$102.40 ,$25.63 ,$57.73 ,$35.84 ,$115.20 ,$11.39 ,$16.45 ,$22.78 ,$22.78 ,$11.39 ,$22.78 ,$61.44 ,$13.17 
ST. ELIZABETH'S HOSPITAL,30101443,84681,HC C PEPTIDE-90,301,1 ,$144.00 ,$93.60 ,$10.80 ,$144.00 ,$52.03 ,$35.88 ,$80.64 ,$20.81 ,$40.32 ,$50.83 ,$20.81 ,$59.33 ,$20.81 ,$64.94 ,$64.94 ,$20.81 ,$26.01 ,$39.54 ,$40.26 ,$52.03 ,$20.81 ,$20.81 ,$21.23 ,$108.00 ,$86.40 ,$86.40 ,$20.81 ,$86.40 ,$30.07 ,$30.07 ,$30.07 ,$144.00 , N/A ,$122.40 ,$52.03 ,$93.60 ,$20.81 ,$144.00 ,$80.64 ,$20.81 ,$37.87 , N/A ,$11.88 ,$11.34 ,$21.85 ,$115.20 ,$46.82 ,$64.94 ,$40.32 ,$129.60 ,$20.81 ,$30.07 ,$41.62 ,$41.62 ,$20.81 ,$41.62 ,$69.12 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101444,84702,HC HCG QN-90,301,1 ,$201.00 ,$130.65 ,$14.54 ,$201.00 ,$37.63 ,$25.95 ,$112.56 ,$15.05 ,$56.28 ,$70.95 ,$15.05 ,$82.81 ,$15.05 ,$90.65 ,$90.65 ,$15.05 ,$18.81 ,$28.60 ,$28.93 ,$37.63 ,$15.05 ,$15.05 ,$15.35 ,$150.75 ,$120.60 ,$120.60 ,$15.05 ,$120.60 ,$21.75 ,$21.75 ,$21.75 ,$201.00 , N/A ,$170.85 ,$37.63 ,$130.65 ,$15.05 ,$201.00 ,$112.56 ,$15.05 ,$52.86 , N/A ,$15.99 ,$15.27 ,$15.80 ,$160.80 ,$33.86 ,$90.65 ,$56.28 ,$180.90 ,$15.05 ,$21.75 ,$30.10 ,$30.10 ,$15.05 ,$30.10 ,$96.48 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101445,84703,HC HCG QL URI NE-QW,301,1 ,$89.00 ,$57.85 ,$7.52 ,$89.00 ,$18.80 ,$12.95 ,$49.84 ,$7.52 ,$24.92 ,$31.42 ,$7.52 ,$36.67 ,$7.52 ,$40.14 ,$40.14 ,$7.52 ,$9.40 ,$14.29 ,$14.47 ,$18.80 ,$7.52 ,$7.52 ,$7.67 ,$66.75 ,$53.40 ,$53.40 ,$7.52 ,$53.40 ,$10.87 ,$10.87 ,$10.87 ,$89.00 , N/A ,$75.65 ,$18.80 ,$57.85 ,$7.52 ,$89.00 ,$49.84 ,$7.52 ,$23.41 , N/A ,$11.88 ,$11.34 ,$7.90 ,$71.20 ,$16.92 ,$40.14 ,$24.92 ,$80.10 ,$7.52 ,$10.87 ,$15.04 ,$15.04 ,$7.52 ,$15.04 ,$42.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101458,G0480,HC DRUG SCRN DEFNT 1-7 CLS T4-90,301,1 ,$157.00 ,$102.05 ,$29.08 ,$286.08 ,$286.08 ,$120.10 ,$87.92 ,$114.43 ,$43.96 ,$32.69 ,$114.43 ,$32.69 ,$114.43 ,$70.81 ,$70.81 ,$114.43 ,$143.04 ,$157.00 ,$157.00 ,$286.08 ,$114.43 ,$114.43 ,$116.72 ,$117.75 ,$94.20 ,$94.20 ,$114.43 ,$94.20 ,$148.76 ,$148.76 ,$148.76 ,$157.00 , N/A ,$133.45 ,$157.00 ,$102.05 ,$114.43 ,$157.00 ,$87.92 ,$114.43 ,$41.29 , N/A ,$31.99 ,$30.53 ,$120.15 ,$125.60 ,$257.47 ,$70.81 ,$43.96 ,$141.30 ,$114.43 ,$148.76 ,$157.00 ,$157.00 ,$114.43 ,$157.00 ,$75.36 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101463,G0483,HC DRUG SCRN DEFINT 22+ CLASS-90,301,1 ,$262.00 ,$170.30 ,$29.08 ,$617.30 ,$617.30 ,$262.00 ,$146.72 ,$246.92 ,$73.36 ,$32.69 ,$246.92 ,$32.69 ,$246.92 ,$118.16 ,$118.16 ,$246.92 ,$262.00 ,$262.00 ,$262.00 ,$617.30 ,$246.92 ,$246.92 ,$251.86 ,$196.50 ,$157.20 ,$157.20 ,$246.92 ,$157.20 ,$262.00 ,$262.00 ,$262.00 ,$262.00 , N/A ,$222.70 ,$262.00 ,$170.30 ,$246.92 ,$262.00 ,$146.72 ,$246.92 ,$68.91 , N/A ,$31.99 ,$30.53 ,$259.27 ,$209.60 ,$555.57 ,$118.16 ,$73.36 ,$235.80 ,$246.92 ,$262.00 ,$262.00 ,$262.00 ,$246.92 ,$262.00 ,$125.76 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101464,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$50.00 ,$32.50 ,$4.23 ,$50.00 ,$10.58 ,$5.62 ,$28.00 ,$4.23 ,$14.00 ,$17.65 ,$4.23 ,$20.60 ,$4.23 ,$22.55 ,$22.55 ,$4.23 ,$5.29 ,$8.04 ,$7.55 ,$10.58 ,$4.23 ,$4.23 ,$4.31 ,$37.50 ,$30.00 ,$30.00 ,$4.23 ,$30.00 ,$5.50 ,$5.50 ,$5.50 ,$50.00 , N/A ,$42.50 ,$10.58 ,$32.50 ,$4.23 ,$50.00 ,$28.00 ,$4.23 ,$13.15 , N/A ,$5.29 ,$5.05 ,$4.44 ,$40.00 ,$9.52 ,$22.55 ,$14.00 ,$45.00 ,$4.23 ,$5.50 ,$8.46 ,$8.46 ,$4.23 ,$8.46 ,$24.00 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101477,83519,HC QN RIA MUSK-90,301,1 ,"$2,500.00 ","$1,625.00 ",$9.67 ,"$2,500.00 ",$46.00 ,$23.29 ,"$1,400.00 ",$18.40 ,$700.00 ,$111.71 ,$18.40 ,$111.71 ,$18.40 ,"$1,127.50 ","$1,127.50 ",$18.40 ,$23.00 ,$34.96 ,$32.08 ,$46.00 ,$18.40 ,$18.40 ,$18.77 ,"$1,875.00 ","$1,500.00 ","$1,500.00 ",$18.40 ,"$1,500.00 ",$23.92 ,$23.92 ,$23.92 ,"$2,500.00 ", N/A ,"$2,125.00 ",$46.00 ,"$1,625.00 ",$18.40 ,"$2,500.00 ","$1,400.00 ",$18.40 ,$657.50 , N/A ,$10.64 ,$10.15 ,$19.32 ,"$2,000.00 ",$41.40 ,"$1,127.50 ",$700.00 ,"$2,250.00 ",$18.40 ,$23.92 ,$36.80 ,$36.80 ,$18.40 ,$36.80 ,"$1,200.00 ",$9.67 
ST. ELIZABETH'S HOSPITAL,30101478,82800,HC BLOOD GAS PH,301,1 ,$108.00 ,$70.20 ,$10.48 ,$108.00 ,$27.50 ,$10.48 ,$60.48 ,$11.00 ,$30.24 ,$38.12 ,$11.00 ,$44.50 ,$11.00 ,$48.71 ,$48.71 ,$11.00 ,$13.75 ,$20.90 ,$19.50 ,$27.50 ,$11.00 ,$11.00 ,$11.22 ,$81.00 ,$64.80 ,$64.80 ,$11.00 ,$64.80 ,$14.30 ,$14.30 ,$14.30 ,$108.00 , N/A ,$91.80 ,$27.50 ,$70.20 ,$11.00 ,$108.00 ,$60.48 ,$11.00 ,$28.40 , N/A ,$11.88 ,$11.34 ,$11.55 ,$86.40 ,$24.75 ,$48.71 ,$30.24 ,$97.20 ,$11.00 ,$14.30 ,$22.00 ,$22.00 ,$11.00 ,$22.00 ,$51.84 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101479,82803,HC BLOOD GAS PH PO2  AND /OR PCO2,301,1 ,$230.00 ,$149.50 ,$10.80 ,$230.00 ,$65.18 ,$20.81 ,$128.80 ,$26.07 ,$64.40 ,$81.19 ,$26.07 ,$94.76 ,$26.07 ,$103.73 ,$103.73 ,$26.07 ,$32.59 ,$49.53 ,$45.29 ,$65.18 ,$26.07 ,$26.07 ,$26.59 ,$172.50 ,$138.00 ,$138.00 ,$26.07 ,$138.00 ,$33.89 ,$33.89 ,$33.89 ,$230.00 , N/A ,$195.50 ,$65.18 ,$149.50 ,$26.07 ,$230.00 ,$128.80 ,$26.07 ,$60.49 , N/A ,$11.88 ,$11.34 ,$27.37 ,$184.00 ,$58.66 ,$103.73 ,$64.40 ,$207.00 ,$26.07 ,$33.89 ,$52.14 ,$52.14 ,$26.07 ,$52.14 ,$110.40 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101480,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$615.00 ,$399.75 ,$10.80 ,$615.00 ,$196.93 ,$48.83 ,$344.40 ,$78.77 ,$172.20 ,$217.10 ,$78.77 ,$253.38 ,$78.77 ,$277.37 ,$277.37 ,$78.77 ,$98.46 ,$149.66 ,$137.76 ,$196.93 ,$78.77 ,$78.77 ,$80.35 ,$461.25 ,$369.00 ,$369.00 ,$78.77 ,$369.00 ,$102.40 ,$102.40 ,$102.40 ,$615.00 , N/A ,$522.75 ,$196.93 ,$399.75 ,$78.77 ,$615.00 ,$344.40 ,$78.77 ,$161.75 , N/A ,$11.88 ,$11.34 ,$82.71 ,$492.00 ,$177.23 ,$277.37 ,$172.20 ,$553.50 ,$78.77 ,$102.40 ,$157.54 ,$157.54 ,$78.77 ,$157.54 ,$295.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101481,82947,HC GLUCOSE,301,1 ,$71.00 ,$46.15 ,$3.93 ,$71.00 ,$9.83 ,$6.76 ,$39.76 ,$3.93 ,$19.88 ,$25.06 ,$3.93 ,$29.25 ,$3.93 ,$32.02 ,$32.02 ,$3.93 ,$4.91 ,$7.47 ,$7.55 ,$9.83 ,$3.93 ,$3.93 ,$4.01 ,$53.25 ,$42.60 ,$42.60 ,$3.93 ,$42.60 ,$5.68 ,$5.68 ,$5.68 ,$71.00 , N/A ,$60.35 ,$9.83 ,$46.15 ,$3.93 ,$71.00 ,$39.76 ,$3.93 ,$18.67 , N/A ,$5.29 ,$5.05 ,$4.13 ,$56.80 ,$8.84 ,$32.02 ,$19.88 ,$63.90 ,$3.93 ,$5.68 ,$7.86 ,$7.86 ,$3.93 ,$7.86 ,$34.08 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101482,84132,HC POTASSIUM,301,1 ,$36.00 ,$23.40 ,$4.76 ,$36.00 ,$11.90 ,$7.93 ,$20.16 ,$4.76 ,$10.08 ,$12.71 ,$4.76 ,$14.83 ,$4.76 ,$16.24 ,$16.24 ,$4.76 ,$5.95 ,$9.04 ,$8.81 ,$11.90 ,$4.76 ,$4.76 ,$4.86 ,$27.00 ,$21.60 ,$21.60 ,$4.76 ,$21.60 ,$6.64 ,$6.64 ,$6.64 ,$36.00 , N/A ,$30.60 ,$11.90 ,$23.40 ,$4.76 ,$36.00 ,$20.16 ,$4.76 ,$9.47 , N/A ,$5.29 ,$5.05 ,$5.00 ,$28.80 ,$10.71 ,$16.24 ,$10.08 ,$32.40 ,$4.76 ,$6.64 ,$9.52 ,$9.52 ,$4.76 ,$9.52 ,$17.28 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101483,84302,HC SODIUM OTHER FLUID,301,1 ,$44.00 ,$28.60 ,$4.81 ,$44.00 ,$12.15 ,$8.40 ,$24.64 ,$4.86 ,$12.32 ,$15.53 ,$4.86 ,$18.13 ,$4.86 ,$19.84 ,$19.84 ,$4.86 ,$6.08 ,$9.23 ,$9.44 ,$12.15 ,$4.86 ,$4.86 ,$4.96 ,$33.00 ,$26.40 ,$26.40 ,$4.86 ,$26.40 ,$7.02 ,$7.02 ,$7.02 ,$44.00 , N/A ,$37.40 ,$12.15 ,$28.60 ,$4.86 ,$44.00 ,$24.64 ,$4.86 ,$11.57 , N/A ,$5.29 ,$5.05 ,$5.10 ,$35.20 ,$10.94 ,$19.84 ,$12.32 ,$39.60 ,$4.86 ,$7.02 ,$9.72 ,$9.72 ,$4.86 ,$9.72 ,$21.12 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101484,82330,HC CALCIUM IONIZED STAT,301,1 ,$50.00 ,$32.50 ,$10.80 ,$50.00 ,$34.20 ,$23.56 ,$28.00 ,$13.68 ,$14.00 ,$17.65 ,$13.68 ,$20.60 ,$13.68 ,$22.55 ,$22.55 ,$13.68 ,$17.10 ,$25.99 ,$26.42 ,$34.20 ,$13.68 ,$13.68 ,$13.95 ,$37.50 ,$30.00 ,$30.00 ,$13.68 ,$30.00 ,$19.76 ,$19.76 ,$19.76 ,$50.00 , N/A ,$42.50 ,$34.20 ,$32.50 ,$13.68 ,$50.00 ,$28.00 ,$13.68 ,$13.15 , N/A ,$11.88 ,$11.34 ,$14.36 ,$40.00 ,$30.78 ,$22.55 ,$14.00 ,$45.00 ,$13.68 ,$19.76 ,$27.36 ,$27.36 ,$13.68 ,$27.36 ,$24.00 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101485,83605,HC LACTATE/LACTIC ACID BLOOD,301,1 ,$105.00 ,$68.25 ,$10.80 ,$105.00 ,$28.93 ,$18.41 ,$58.80 ,$11.57 ,$29.40 ,$37.07 ,$11.57 ,$43.26 ,$11.57 ,$47.36 ,$47.36 ,$11.57 ,$14.46 ,$21.98 ,$20.76 ,$28.93 ,$11.57 ,$11.57 ,$11.80 ,$78.75 ,$63.00 ,$63.00 ,$11.57 ,$63.00 ,$15.43 ,$15.43 ,$15.43 ,$105.00 , N/A ,$89.25 ,$28.93 ,$68.25 ,$11.57 ,$105.00 ,$58.80 ,$11.57 ,$27.62 , N/A ,$11.88 ,$11.34 ,$12.15 ,$84.00 ,$26.03 ,$47.36 ,$29.40 ,$94.50 ,$11.57 ,$15.43 ,$23.14 ,$23.14 ,$11.57 ,$23.14 ,$50.40 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101497,80373,HC TRAMADOL-90,301,1 ,$104.00 ,$67.60 ,$0.02 ,$104.00 , N/A ,$0.02 ,$58.24 , N/A ,$29.12 , N/A , N/A , N/A , N/A ,$46.90 ,$46.90 , N/A ,$67.60 , N/A ,$52.00 , N/A , N/A , N/A , N/A ,$78.00 ,$62.40 ,$62.40 , N/A ,$62.40 ,$15.99 ,$15.99 ,$15.99 ,$104.00 , N/A ,$88.40 , N/A ,$67.60 , N/A ,$104.00 ,$58.24 , N/A ,$27.35 , N/A ,$11.88 ,$11.34 , N/A ,$83.20 , N/A ,$46.90 ,$29.12 ,$93.60 , N/A ,$15.99 , N/A , N/A , N/A , N/A ,$49.92 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101498,80354,HC FENTANYL -90,301,1 ,$52.00 ,$33.80 ,$0.02 ,$52.00 , N/A ,$0.02 ,$29.12 , N/A ,$14.56 , N/A , N/A , N/A , N/A ,$23.45 ,$23.45 , N/A ,$33.80 , N/A ,$26.00 , N/A , N/A , N/A , N/A ,$39.00 ,$31.20 ,$31.20 , N/A ,$31.20 ,$19.83 ,$19.83 ,$19.83 ,$52.00 , N/A ,$44.20 , N/A ,$33.80 , N/A ,$52.00 ,$29.12 , N/A ,$13.68 , N/A ,$11.88 ,$11.34 , N/A ,$41.60 , N/A ,$23.45 ,$14.56 ,$46.80 , N/A ,$19.83 , N/A , N/A , N/A , N/A ,$24.96 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101503,G0328,HC OCCULT BLOOD FECAL SCRN - AMB-QW,301,1 ,$70.00 ,$45.50 ,$10.80 ,$70.00 ,$45.13 ,$27.42 ,$39.20 ,$18.05 ,$19.60 ,$24.71 ,$18.05 ,$28.84 ,$18.05 ,$31.57 ,$31.57 ,$18.05 ,$22.56 ,$34.30 ,$31.45 ,$45.13 ,$18.05 ,$18.05 ,$18.41 ,$52.50 ,$42.00 ,$42.00 ,$18.05 ,$42.00 ,$23.47 ,$23.47 ,$23.47 ,$70.00 , N/A ,$59.50 ,$45.13 ,$45.50 ,$18.05 ,$70.00 ,$39.20 ,$18.05 ,$18.41 , N/A ,$11.88 ,$11.34 ,$18.95 ,$56.00 ,$40.61 ,$31.57 ,$19.60 ,$63.00 ,$18.05 ,$23.47 ,$36.10 ,$36.10 ,$18.05 ,$36.10 ,$33.60 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101505,80200,HC TOBRAMYCIN,301,1 ,$171.00 ,$111.15 ,$12.40 ,$171.00 ,$40.33 ,$19.55 ,$95.76 ,$16.13 ,$47.88 ,$60.36 ,$16.13 ,$70.45 ,$16.13 ,$77.12 ,$77.12 ,$16.13 ,$20.16 ,$30.65 ,$31.45 ,$40.33 ,$16.13 ,$16.13 ,$16.45 ,$128.25 ,$102.60 ,$102.60 ,$16.13 ,$102.60 ,$23.30 ,$23.30 ,$23.30 ,$171.00 , N/A ,$145.35 ,$40.33 ,$111.15 ,$16.13 ,$171.00 ,$95.76 ,$16.13 ,$44.97 , N/A ,$13.64 ,$13.02 ,$16.94 ,$136.80 ,$36.29 ,$77.12 ,$47.88 ,$153.90 ,$16.13 ,$23.30 ,$32.26 ,$32.26 ,$16.13 ,$32.26 ,$82.08 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101509,82330,HC CALCIUM IONIZED STAT -90,301,1 ,$57.60 ,$37.44 ,$10.80 ,$57.60 ,$34.20 ,$23.56 ,$32.26 ,$13.68 ,$16.13 ,$20.33 ,$13.68 ,$23.73 ,$13.68 ,$25.98 ,$25.98 ,$13.68 ,$17.10 ,$25.99 ,$26.42 ,$34.20 ,$13.68 ,$13.68 ,$13.95 ,$43.20 ,$34.56 ,$34.56 ,$13.68 ,$34.56 ,$19.76 ,$19.76 ,$19.76 ,$57.60 , N/A ,$48.96 ,$34.20 ,$37.44 ,$13.68 ,$57.60 ,$32.26 ,$13.68 ,$15.15 , N/A ,$11.88 ,$11.34 ,$14.36 ,$46.08 ,$30.78 ,$25.98 ,$16.13 ,$51.84 ,$13.68 ,$19.76 ,$27.36 ,$27.36 ,$13.68 ,$27.36 ,$27.65 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101516,80321,HC ALCOHOL BIOMARKERS 1-2 - 90,301,1 ,$52.00 ,$33.80 ,$0.02 ,$52.00 , N/A ,$0.02 ,$29.12 , N/A ,$14.56 , N/A , N/A , N/A , N/A ,$23.45 ,$23.45 , N/A ,$33.80 , N/A ,$26.00 , N/A , N/A , N/A , N/A ,$39.00 ,$31.20 ,$31.20 , N/A ,$31.20 ,$17.51 ,$17.51 ,$17.51 ,$52.00 , N/A ,$44.20 , N/A ,$33.80 , N/A ,$52.00 ,$29.12 , N/A ,$13.68 , N/A ,$31.99 ,$30.53 , N/A ,$41.60 , N/A ,$23.45 ,$14.56 ,$46.80 , N/A ,$17.51 , N/A , N/A , N/A , N/A ,$24.96 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101531,82633,HC DESOXYCORTICOSTERONE 11  -90,301,1 ,$176.00 ,$114.40 ,$25.28 ,$176.00 ,$77.45 ,$47.64 ,$98.56 ,$30.98 ,$49.28 ,$62.13 ,$30.98 ,$72.51 ,$30.98 ,$79.38 ,$79.38 ,$30.98 ,$38.73 ,$58.86 ,$60.39 ,$77.45 ,$30.98 ,$30.98 ,$31.60 ,$132.00 ,$105.60 ,$105.60 ,$30.98 ,$105.60 ,$44.76 ,$44.76 ,$44.76 ,$176.00 , N/A ,$149.60 ,$77.45 ,$114.40 ,$30.98 ,$176.00 ,$98.56 ,$30.98 ,$46.29 , N/A ,$27.81 ,$26.54 ,$32.53 ,$140.80 ,$69.71 ,$79.38 ,$49.28 ,$158.40 ,$30.98 ,$44.76 ,$61.96 ,$61.96 ,$30.98 ,$61.96 ,$84.48 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101536,84443,HC THYROID STIMULATING HORM-90,301,1 ,$63.00 ,$40.95 ,$14.54 ,$63.00 ,$42.00 ,$28.96 ,$35.28 ,$16.80 ,$17.64 ,$22.24 ,$16.80 ,$25.96 ,$16.80 ,$28.41 ,$28.41 ,$16.80 ,$21.00 ,$31.92 ,$32.71 ,$42.00 ,$16.80 ,$16.80 ,$17.14 ,$47.25 ,$37.80 ,$37.80 ,$16.80 ,$37.80 ,$24.27 ,$24.27 ,$24.27 ,$63.00 , N/A ,$53.55 ,$42.00 ,$40.95 ,$16.80 ,$63.00 ,$35.28 ,$16.80 ,$16.57 , N/A ,$15.99 ,$15.27 ,$17.64 ,$50.40 ,$37.80 ,$28.41 ,$17.64 ,$56.70 ,$16.80 ,$24.27 ,$33.60 ,$33.60 ,$16.80 ,$33.60 ,$30.24 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101543,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$16.00 ,$10.40 ,$4.21 ,$40.00 ,$40.00 ,$16.00 ,$8.96 ,$16.00 ,$4.48 ,$5.65 ,$16.00 ,$6.59 ,$16.00 ,$7.22 ,$7.22 ,$16.00 ,$16.00 ,$16.00 ,$16.00 ,$40.00 ,$16.00 ,$16.00 ,$16.00 ,$12.00 ,$9.60 ,$9.60 ,$16.00 ,$9.60 ,$16.00 ,$16.00 ,$16.00 ,$16.00 , N/A ,$13.60 ,$16.00 ,$10.40 ,$16.00 ,$16.00 ,$8.96 ,$16.00 ,$4.21 , N/A ,$10.84 ,$10.34 ,$16.80 ,$12.80 ,$36.00 ,$7.22 ,$4.48 ,$14.40 ,$16.00 ,$16.00 ,$16.00 ,$16.00 ,$16.00 ,$16.00 ,$7.68 ,$9.85 
ST. ELIZABETH'S HOSPITAL,30101545,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101546,80164,HC VALPROCIC ACID,301,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101548,80178,HC LITHIUM,301,1 ,$14.00 ,$9.10 ,$3.68 ,$16.53 ,$16.53 ,$11.39 ,$7.84 ,$6.61 ,$3.92 ,$4.94 ,$6.61 ,$5.77 ,$6.61 ,$6.31 ,$6.31 ,$6.61 ,$8.26 ,$12.56 ,$12.58 ,$16.53 ,$6.61 ,$6.61 ,$6.74 ,$10.50 ,$8.40 ,$8.40 ,$6.61 ,$8.40 ,$9.56 ,$9.56 ,$9.56 ,$14.00 , N/A ,$11.90 ,$14.00 ,$9.10 ,$6.61 ,$14.00 ,$7.84 ,$6.61 ,$3.68 , N/A ,$13.64 ,$13.02 ,$6.94 ,$11.20 ,$14.87 ,$6.31 ,$3.92 ,$12.60 ,$6.61 ,$9.56 ,$13.22 ,$13.22 ,$6.61 ,$13.22 ,$6.72 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101549,80184,HC PHENOBARBITAL,301,1 ,$5.00 ,$3.25 ,$1.32 ,$12.50 ,$12.50 ,$5.00 ,$2.80 ,$5.00 ,$1.40 ,$1.77 ,$5.00 ,$2.06 ,$5.00 ,$2.26 ,$2.26 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$12.50 ,$5.00 ,$5.00 ,$5.00 ,$3.75 ,$3.00 ,$3.00 ,$5.00 ,$3.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 , N/A ,$4.25 ,$5.00 ,$3.25 ,$5.00 ,$5.00 ,$2.80 ,$5.00 ,$1.32 , N/A ,$5.00 ,$5.00 ,$5.25 ,$4.00 ,$11.25 ,$2.26 ,$1.40 ,$4.50 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$2.40 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101551,80198,HC THEOPHYLLINE,301,1 ,$5.00 ,$3.25 ,$1.32 ,$12.50 ,$12.50 ,$5.00 ,$2.80 ,$5.00 ,$1.40 ,$1.77 ,$5.00 ,$2.06 ,$5.00 ,$2.26 ,$2.26 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$12.50 ,$5.00 ,$5.00 ,$5.00 ,$3.75 ,$3.00 ,$3.00 ,$5.00 ,$3.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 , N/A ,$4.25 ,$5.00 ,$3.25 ,$5.00 ,$5.00 ,$2.80 ,$5.00 ,$1.32 , N/A ,$5.00 ,$5.00 ,$5.25 ,$4.00 ,$11.25 ,$2.26 ,$1.40 ,$4.50 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$2.40 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101552,80200,HC TOBRAMYCIN,301,1 ,$5.00 ,$3.25 ,$1.32 ,$12.50 ,$12.50 ,$5.00 ,$2.80 ,$5.00 ,$1.40 ,$1.77 ,$5.00 ,$2.06 ,$5.00 ,$2.26 ,$2.26 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$12.50 ,$5.00 ,$5.00 ,$5.00 ,$3.75 ,$3.00 ,$3.00 ,$5.00 ,$3.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 , N/A ,$4.25 ,$5.00 ,$3.25 ,$5.00 ,$5.00 ,$2.80 ,$5.00 ,$1.32 , N/A ,$5.00 ,$5.00 ,$5.25 ,$4.00 ,$11.25 ,$2.26 ,$1.40 ,$4.50 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$2.40 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101556,82042,HC ALBUMIN OTHER SOURCE,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101559,82150,HC AMYLASE,301,1 ,$4.87 ,$3.17 ,$1.28 ,$12.18 ,$12.18 ,$4.87 ,$2.73 ,$4.87 ,$1.36 ,$1.72 ,$4.87 ,$2.01 ,$4.87 ,$2.20 ,$2.20 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$12.18 ,$4.87 ,$4.87 ,$4.87 ,$3.65 ,$2.92 ,$2.92 ,$4.87 ,$2.92 ,$4.87 ,$4.87 ,$4.87 ,$4.87 , N/A ,$4.14 ,$4.87 ,$3.17 ,$4.87 ,$4.87 ,$2.73 ,$4.87 ,$1.28 , N/A ,$4.87 ,$4.87 ,$5.11 ,$3.90 ,$10.96 ,$2.20 ,$1.36 ,$4.38 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$2.34 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101561,82247,HC BILIRUBIN TOTAL,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101562,82248,HC BILIRUBIN DIRECT T1,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101565,82310,HC CALCIUM,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101566,82340,HC CALCIUM URINE QN TIMED,301,1 ,$3.12 ,$2.03 ,$0.82 ,$10.80 ,$7.80 ,$3.12 ,$1.75 ,$3.12 ,$0.87 ,$1.10 ,$3.12 ,$1.29 ,$3.12 ,$1.41 ,$1.41 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$7.80 ,$3.12 ,$3.12 ,$3.12 ,$2.34 ,$1.87 ,$1.87 ,$3.12 ,$1.87 ,$3.12 ,$3.12 ,$3.12 ,$3.12 , N/A ,$2.65 ,$3.12 ,$2.03 ,$3.12 ,$3.12 ,$1.75 ,$3.12 ,$0.82 , N/A ,$3.12 ,$3.12 ,$3.28 ,$2.50 ,$7.02 ,$1.41 ,$0.87 ,$2.81 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$1.50 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101567,82374,HC BICARBONATE -90,301,1 ,$8.00 ,$5.20 ,$2.10 ,$12.20 ,$12.20 ,$8.00 ,$4.48 ,$4.88 ,$2.24 ,$2.82 ,$4.88 ,$3.30 ,$4.88 ,$3.61 ,$3.61 ,$4.88 ,$6.10 ,$8.00 ,$8.00 ,$12.20 ,$4.88 ,$4.88 ,$4.98 ,$6.00 ,$4.80 ,$4.80 ,$4.88 ,$4.80 ,$7.06 ,$7.06 ,$7.06 ,$8.00 , N/A ,$6.80 ,$8.00 ,$5.20 ,$4.88 ,$8.00 ,$4.48 ,$4.88 ,$2.10 , N/A ,$5.29 ,$5.05 ,$5.12 ,$6.40 ,$10.98 ,$3.61 ,$2.24 ,$7.20 ,$4.88 ,$7.06 ,$8.00 ,$8.00 ,$4.88 ,$8.00 ,$3.84 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101568,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$3.25 ,$2.11 ,$0.85 ,$10.80 ,$8.13 ,$3.25 ,$1.82 ,$3.25 ,$0.91 ,$1.15 ,$3.25 ,$1.34 ,$3.25 ,$1.47 ,$1.47 ,$3.25 ,$3.25 ,$3.25 ,$3.25 ,$8.13 ,$3.25 ,$3.25 ,$3.25 ,$2.44 ,$1.95 ,$1.95 ,$3.25 ,$1.95 ,$3.25 ,$3.25 ,$3.25 ,$3.25 , N/A ,$2.76 ,$3.25 ,$2.11 ,$3.25 ,$3.25 ,$1.82 ,$3.25 ,$0.85 , N/A ,$3.25 ,$3.25 ,$3.41 ,$2.60 ,$7.31 ,$1.47 ,$0.91 ,$2.93 ,$3.25 ,$3.25 ,$3.25 ,$3.25 ,$3.25 ,$3.25 ,$1.56 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101569,82436,HC CHLORIDE URINE,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101570,82465,HC CHOLESTEROL,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101571,82533,HC CORTISOL TOTAL,301,1 ,$4.87 ,$3.17 ,$1.28 ,$25.28 ,$12.18 ,$4.87 ,$2.73 ,$4.87 ,$1.36 ,$1.72 ,$4.87 ,$2.01 ,$4.87 ,$2.20 ,$2.20 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$12.18 ,$4.87 ,$4.87 ,$4.87 ,$3.65 ,$2.92 ,$2.92 ,$4.87 ,$2.92 ,$4.87 ,$4.87 ,$4.87 ,$4.87 , N/A ,$4.14 ,$4.87 ,$3.17 ,$4.87 ,$4.87 ,$2.73 ,$4.87 ,$1.28 , N/A ,$4.87 ,$4.87 ,$5.11 ,$3.90 ,$10.96 ,$2.20 ,$1.36 ,$4.38 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$4.87 ,$2.34 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101572,82570,HC CREATININE OTH SOURCE,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101581,82945,HC GLUCOSE BODY FLUID,301,1 ,$2.79 ,$1.81 ,$0.73 ,$6.98 ,$6.98 ,$2.79 ,$1.56 ,$2.79 ,$0.78 ,$0.98 ,$2.79 ,$1.15 ,$2.79 ,$1.26 ,$1.26 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$6.98 ,$2.79 ,$2.79 ,$2.79 ,$2.09 ,$1.67 ,$1.67 ,$2.79 ,$1.67 ,$2.79 ,$2.79 ,$2.79 ,$2.79 , N/A ,$2.37 ,$2.79 ,$1.81 ,$2.79 ,$2.79 ,$1.56 ,$2.79 ,$0.73 , N/A ,$2.79 ,$2.79 ,$2.93 ,$2.23 ,$6.28 ,$1.26 ,$0.78 ,$2.51 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$1.34 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101584,82977,HC GGT / GGTP,301,1 ,$2.88 ,$1.87 ,$0.76 ,$7.20 ,$7.20 ,$2.88 ,$1.61 ,$2.88 ,$0.81 ,$1.02 ,$2.88 ,$1.19 ,$2.88 ,$1.30 ,$1.30 ,$2.88 ,$2.88 ,$2.88 ,$2.88 ,$7.20 ,$2.88 ,$2.88 ,$2.88 ,$2.16 ,$1.73 ,$1.73 ,$2.88 ,$1.73 ,$2.88 ,$2.88 ,$2.88 ,$2.88 , N/A ,$2.45 ,$2.88 ,$1.87 ,$2.88 ,$2.88 ,$1.61 ,$2.88 ,$0.76 , N/A ,$2.88 ,$2.88 ,$3.02 ,$2.30 ,$6.48 ,$1.30 ,$0.81 ,$2.59 ,$2.88 ,$2.88 ,$2.88 ,$2.88 ,$2.88 ,$2.88 ,$1.38 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101585,83001,HC FSH,301,1 ,$2.05 ,$1.33 ,$0.54 ,$25.28 ,$5.13 ,$2.05 ,$1.15 ,$2.05 ,$0.57 ,$0.72 ,$2.05 ,$0.84 ,$2.05 ,$0.92 ,$0.92 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$5.13 ,$2.05 ,$2.05 ,$2.05 ,$1.54 ,$1.23 ,$1.23 ,$2.05 ,$1.23 ,$2.05 ,$2.05 ,$2.05 ,$2.05 , N/A ,$1.74 ,$2.05 ,$1.33 ,$2.05 ,$2.05 ,$1.15 ,$2.05 ,$0.54 , N/A ,$2.05 ,$2.05 ,$2.15 ,$1.64 ,$4.61 ,$0.92 ,$0.57 ,$1.85 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$0.98 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101586,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$2.15 ,$1.40 ,$0.57 ,$25.28 ,$5.38 ,$2.15 ,$1.20 ,$2.15 ,$0.60 ,$0.76 ,$2.15 ,$0.89 ,$2.15 ,$0.97 ,$0.97 ,$2.15 ,$2.15 ,$2.15 ,$2.15 ,$5.38 ,$2.15 ,$2.15 ,$2.15 ,$1.61 ,$1.29 ,$1.29 ,$2.15 ,$1.29 ,$2.15 ,$2.15 ,$2.15 ,$2.15 , N/A ,$1.83 ,$2.15 ,$1.40 ,$2.15 ,$2.15 ,$1.20 ,$2.15 ,$0.57 , N/A ,$2.15 ,$2.15 ,$2.26 ,$1.72 ,$4.84 ,$0.97 ,$0.60 ,$1.94 ,$2.15 ,$2.15 ,$2.15 ,$2.15 ,$2.15 ,$2.15 ,$1.03 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101587,83010,HC HAPTOGLOBIN,301,1 ,$1.50 ,$0.98 ,$0.39 ,$10.80 ,$3.75 ,$1.50 ,$0.84 ,$1.50 ,$0.42 ,$0.53 ,$1.50 ,$0.62 ,$1.50 ,$0.68 ,$0.68 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$3.75 ,$1.50 ,$1.50 ,$1.50 ,$1.13 ,$0.90 ,$0.90 ,$1.50 ,$0.90 ,$1.50 ,$1.50 ,$1.50 ,$1.50 , N/A ,$1.28 ,$1.50 ,$0.98 ,$1.50 ,$1.50 ,$0.84 ,$1.50 ,$0.39 , N/A ,$1.50 ,$1.50 ,$1.58 ,$1.20 ,$3.38 ,$0.68 ,$0.42 ,$1.35 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$0.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101589,83036,HC GLYCOSYLATED HGB -90,301,1 ,$30.00 ,$19.50 ,$7.89 ,$30.00 ,$24.28 ,$16.73 ,$16.80 ,$9.71 ,$8.40 ,$10.59 ,$9.71 ,$12.36 ,$9.71 ,$13.53 ,$13.53 ,$9.71 ,$12.14 ,$18.45 ,$18.87 ,$24.28 ,$9.71 ,$9.71 ,$9.90 ,$22.50 ,$18.00 ,$18.00 ,$9.71 ,$18.00 ,$14.03 ,$14.03 ,$14.03 ,$30.00 , N/A ,$25.50 ,$24.28 ,$19.50 ,$9.71 ,$30.00 ,$16.80 ,$9.71 ,$7.89 , N/A ,$11.88 ,$11.34 ,$10.20 ,$24.00 ,$21.85 ,$13.53 ,$8.40 ,$27.00 ,$9.71 ,$14.03 ,$19.42 ,$19.42 ,$9.71 ,$19.42 ,$14.40 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101592,83540,HC IRON TOTAL,301,1 ,$1.50 ,$0.98 ,$0.39 ,$4.81 ,$3.75 ,$1.50 ,$0.84 ,$1.50 ,$0.42 ,$0.53 ,$1.50 ,$0.62 ,$1.50 ,$0.68 ,$0.68 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$3.75 ,$1.50 ,$1.50 ,$1.50 ,$1.13 ,$0.90 ,$0.90 ,$1.50 ,$0.90 ,$1.50 ,$1.50 ,$1.50 ,$1.50 , N/A ,$1.28 ,$1.50 ,$0.98 ,$1.50 ,$1.50 ,$0.84 ,$1.50 ,$0.39 , N/A ,$1.50 ,$1.50 ,$1.58 ,$1.20 ,$3.38 ,$0.68 ,$0.42 ,$1.35 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$1.50 ,$0.72 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101593,83550,HC IRON BINDING CAPACITY,301,1 ,$1.69 ,$1.10 ,$0.44 ,$10.80 ,$4.23 ,$1.69 ,$0.95 ,$1.69 ,$0.47 ,$0.60 ,$1.69 ,$0.70 ,$1.69 ,$0.76 ,$0.76 ,$1.69 ,$1.69 ,$1.69 ,$1.69 ,$4.23 ,$1.69 ,$1.69 ,$1.69 ,$1.27 ,$1.01 ,$1.01 ,$1.69 ,$1.01 ,$1.69 ,$1.69 ,$1.69 ,$1.69 , N/A ,$1.44 ,$1.69 ,$1.10 ,$1.69 ,$1.69 ,$0.95 ,$1.69 ,$0.44 , N/A ,$1.69 ,$1.69 ,$1.77 ,$1.35 ,$3.80 ,$0.76 ,$0.47 ,$1.52 ,$1.69 ,$1.69 ,$1.69 ,$1.69 ,$1.69 ,$1.69 ,$0.81 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101595,83690,HC LIPASE,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101598,83930,HC OSMOLALITY BLOOD,301,1 ,$3.12 ,$2.03 ,$0.82 ,$7.80 ,$7.80 ,$3.12 ,$1.75 ,$3.12 ,$0.87 ,$1.10 ,$3.12 ,$1.29 ,$3.12 ,$1.41 ,$1.41 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$7.80 ,$3.12 ,$3.12 ,$3.12 ,$2.34 ,$1.87 ,$1.87 ,$3.12 ,$1.87 ,$3.12 ,$3.12 ,$3.12 ,$3.12 , N/A ,$2.65 ,$3.12 ,$2.03 ,$3.12 ,$3.12 ,$1.75 ,$3.12 ,$0.82 , N/A ,$3.12 ,$3.12 ,$3.28 ,$2.50 ,$7.02 ,$1.41 ,$0.87 ,$2.81 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$1.50 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101599,83935,HC OSMOLALITY URINE,301,1 ,$3.12 ,$2.03 ,$0.82 ,$7.80 ,$7.80 ,$3.12 ,$1.75 ,$3.12 ,$0.87 ,$1.10 ,$3.12 ,$1.29 ,$3.12 ,$1.41 ,$1.41 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$7.80 ,$3.12 ,$3.12 ,$3.12 ,$2.34 ,$1.87 ,$1.87 ,$3.12 ,$1.87 ,$3.12 ,$3.12 ,$3.12 ,$3.12 , N/A ,$2.65 ,$3.12 ,$2.03 ,$3.12 ,$3.12 ,$1.75 ,$3.12 ,$0.82 , N/A ,$3.12 ,$3.12 ,$3.28 ,$2.50 ,$7.02 ,$1.41 ,$0.87 ,$2.81 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$1.50 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101600,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$7.00 ,$4.55 ,$1.84 ,$25.28 ,$17.50 ,$7.00 ,$3.92 ,$7.00 ,$1.96 ,$2.47 ,$7.00 ,$2.88 ,$7.00 ,$3.16 ,$3.16 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$17.50 ,$7.00 ,$7.00 ,$7.00 ,$5.25 ,$4.20 ,$4.20 ,$7.00 ,$4.20 ,$7.00 ,$7.00 ,$7.00 ,$7.00 , N/A ,$5.95 ,$7.00 ,$4.55 ,$7.00 ,$7.00 ,$3.92 ,$7.00 ,$1.84 , N/A ,$7.00 ,$7.00 ,$7.35 ,$5.60 ,$15.75 ,$3.16 ,$1.96 ,$6.30 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$3.36 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101601,84075,HC ALKALINE PHOSPHATASE,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101602,84105,HC PHOSPHORUS UR,301,1 ,$6.00 ,$3.90 ,$1.58 ,$14.45 ,$14.45 ,$6.00 ,$3.36 ,$5.78 ,$1.68 ,$2.12 ,$5.78 ,$2.47 ,$5.78 ,$2.71 ,$2.71 ,$5.78 ,$6.00 ,$6.00 ,$6.00 ,$14.45 ,$5.78 ,$5.78 ,$5.90 ,$4.50 ,$3.60 ,$3.60 ,$5.78 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$5.78 ,$6.00 ,$3.36 ,$5.78 ,$1.58 , N/A ,$5.29 ,$5.05 ,$6.07 ,$4.80 ,$13.01 ,$2.71 ,$1.68 ,$5.40 ,$5.78 ,$6.00 ,$6.00 ,$6.00 ,$5.78 ,$6.00 ,$2.88 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101604,84133,HC POTASSIUM UR,301,1 ,$4.87 ,$3.17 ,$1.28 ,$11.83 ,$11.83 ,$4.87 ,$2.73 ,$4.73 ,$1.36 ,$1.72 ,$4.73 ,$2.01 ,$4.73 ,$2.20 ,$2.20 ,$4.73 ,$4.87 ,$4.87 ,$4.87 ,$11.83 ,$4.73 ,$4.73 ,$4.82 ,$3.65 ,$2.92 ,$2.92 ,$4.73 ,$2.92 ,$4.87 ,$4.87 ,$4.87 ,$4.87 , N/A ,$4.14 ,$4.87 ,$3.17 ,$4.73 ,$4.87 ,$2.73 ,$4.73 ,$1.28 , N/A ,$4.87 ,$4.87 ,$4.97 ,$3.90 ,$10.64 ,$2.20 ,$1.36 ,$4.38 ,$4.73 ,$4.87 ,$4.87 ,$4.87 ,$4.73 ,$4.87 ,$2.34 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101608,84146,HC PROLACTIN,301,1 ,$2.05 ,$1.33 ,$0.54 ,$25.28 ,$5.13 ,$2.05 ,$1.15 ,$2.05 ,$0.57 ,$0.72 ,$2.05 ,$0.84 ,$2.05 ,$0.92 ,$0.92 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$5.13 ,$2.05 ,$2.05 ,$2.05 ,$1.54 ,$1.23 ,$1.23 ,$2.05 ,$1.23 ,$2.05 ,$2.05 ,$2.05 ,$2.05 , N/A ,$1.74 ,$2.05 ,$1.33 ,$2.05 ,$2.05 ,$1.15 ,$2.05 ,$0.54 , N/A ,$2.05 ,$2.05 ,$2.15 ,$1.64 ,$4.61 ,$0.92 ,$0.57 ,$1.85 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$0.98 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30101609,84153,HC PSA TOTAL,301,1 ,$2.50 ,$1.63 ,$0.66 ,$10.80 ,$6.25 ,$2.50 ,$1.40 ,$2.50 ,$0.70 ,$0.88 ,$2.50 ,$1.03 ,$2.50 ,$1.13 ,$1.13 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$6.25 ,$2.50 ,$2.50 ,$2.50 ,$1.88 ,$1.50 ,$1.50 ,$2.50 ,$1.50 ,$2.50 ,$2.50 ,$2.50 ,$2.50 , N/A ,$2.13 ,$2.50 ,$1.63 ,$2.50 ,$2.50 ,$1.40 ,$2.50 ,$0.66 , N/A ,$2.50 ,$2.50 ,$2.63 ,$2.00 ,$5.63 ,$1.13 ,$0.70 ,$2.25 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$1.20 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101610,84154,HC PSA FREE,301,1 ,$3.50 ,$2.28 ,$0.92 ,$10.80 ,$8.75 ,$3.50 ,$1.96 ,$3.50 ,$0.98 ,$1.24 ,$3.50 ,$1.44 ,$3.50 ,$1.58 ,$1.58 ,$3.50 ,$3.50 ,$3.50 ,$3.50 ,$8.75 ,$3.50 ,$3.50 ,$3.50 ,$2.63 ,$2.10 ,$2.10 ,$3.50 ,$2.10 ,$3.50 ,$3.50 ,$3.50 ,$3.50 , N/A ,$2.98 ,$3.50 ,$2.28 ,$3.50 ,$3.50 ,$1.96 ,$3.50 ,$0.92 , N/A ,$3.50 ,$3.50 ,$3.68 ,$2.80 ,$7.88 ,$1.58 ,$0.98 ,$3.15 ,$3.50 ,$3.50 ,$3.50 ,$3.50 ,$3.50 ,$3.50 ,$1.68 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101613,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$3.39 ,$2.20 ,$0.89 ,$8.48 ,$8.48 ,$3.39 ,$1.90 ,$3.39 ,$0.95 ,$1.20 ,$3.39 ,$1.40 ,$3.39 ,$1.53 ,$1.53 ,$3.39 ,$3.39 ,$3.39 ,$3.39 ,$8.48 ,$3.39 ,$3.39 ,$3.39 ,$2.54 ,$2.03 ,$2.03 ,$3.39 ,$2.03 ,$3.39 ,$3.39 ,$3.39 ,$3.39 , N/A ,$2.88 ,$3.39 ,$2.20 ,$3.39 ,$3.39 ,$1.90 ,$3.39 ,$0.89 , N/A ,$3.39 ,$3.39 ,$3.56 ,$2.71 ,$7.63 ,$1.53 ,$0.95 ,$3.05 ,$3.39 ,$3.39 ,$3.39 ,$3.39 ,$3.39 ,$3.39 ,$1.63 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101617,84300,HC SODIUM URINE,301,1 ,$3.12 ,$2.03 ,$0.82 ,$7.80 ,$7.80 ,$3.12 ,$1.75 ,$3.12 ,$0.87 ,$1.10 ,$3.12 ,$1.29 ,$3.12 ,$1.41 ,$1.41 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$7.80 ,$3.12 ,$3.12 ,$3.12 ,$2.34 ,$1.87 ,$1.87 ,$3.12 ,$1.87 ,$3.12 ,$3.12 ,$3.12 ,$3.12 , N/A ,$2.65 ,$3.12 ,$2.03 ,$3.12 ,$3.12 ,$1.75 ,$3.12 ,$0.82 , N/A ,$3.12 ,$3.12 ,$3.28 ,$2.50 ,$7.02 ,$1.41 ,$0.87 ,$2.81 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$1.50 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101618,84302,HC SODIUM OTHER FLUID,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101621,84450,HC AST,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101622,84466,HC TRANSFERRIN,301,1 ,$4.43 ,$2.88 ,$1.17 ,$11.08 ,$11.08 ,$4.43 ,$2.48 ,$4.43 ,$1.24 ,$1.56 ,$4.43 ,$1.83 ,$4.43 ,$2.00 ,$2.00 ,$4.43 ,$4.43 ,$4.43 ,$4.43 ,$11.08 ,$4.43 ,$4.43 ,$4.43 ,$3.32 ,$2.66 ,$2.66 ,$4.43 ,$2.66 ,$4.43 ,$4.43 ,$4.43 ,$4.43 , N/A ,$3.77 ,$4.43 ,$2.88 ,$4.43 ,$4.43 ,$2.48 ,$4.43 ,$1.17 , N/A ,$4.43 ,$4.43 ,$4.65 ,$3.54 ,$9.97 ,$2.00 ,$1.24 ,$3.99 ,$4.43 ,$4.43 ,$4.43 ,$4.43 ,$4.43 ,$4.43 ,$2.13 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101623,84478,HC TRIGLYCERIDES,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101626,84520,HC BUN,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101627,84540,HC UREA URINE,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101628,84560,HC URIC ACID OTH SRC,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101630,84702,HC HCG QN,301,1 ,$4.24 ,$2.76 ,$1.12 ,$14.54 ,$10.60 ,$4.24 ,$2.37 ,$4.24 ,$1.19 ,$1.50 ,$4.24 ,$1.75 ,$4.24 ,$1.91 ,$1.91 ,$4.24 ,$4.24 ,$4.24 ,$4.24 ,$10.60 ,$4.24 ,$4.24 ,$4.24 ,$3.18 ,$2.54 ,$2.54 ,$4.24 ,$2.54 ,$4.24 ,$4.24 ,$4.24 ,$4.24 , N/A ,$3.60 ,$4.24 ,$2.76 ,$4.24 ,$4.24 ,$2.37 ,$4.24 ,$1.12 , N/A ,$4.24 ,$4.24 ,$4.45 ,$3.39 ,$9.54 ,$1.91 ,$1.19 ,$3.82 ,$4.24 ,$4.24 ,$4.24 ,$4.24 ,$4.24 ,$4.24 ,$2.04 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101636,83735,HC MAGNESIUM,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101638,84100,HC PHOSPHORUS,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101643,81596,HC CHRONIC HEP C VIRUS ASSAYS-90,301,1 ,$292.00 ,$189.80 ,$38.33 ,$292.00 ,$180.48 ,$88.43 ,$163.52 ,$72.19 ,$81.76 ,$98.70 ,$72.19 ,$113.59 ,$72.19 ,$131.69 ,$131.69 ,$72.19 ,$90.24 ,$137.16 ,$125.80 ,$180.48 ,$72.19 ,$72.19 ,$73.63 ,$219.00 ,$175.20 ,$175.20 ,$72.19 ,$175.20 ,$93.85 ,$93.85 ,$93.85 ,$292.00 , N/A ,$248.20 ,$180.48 ,$189.80 ,$72.19 ,$292.00 ,$163.52 ,$72.19 ,$76.80 , N/A ,$42.16 ,$40.25 ,$75.80 ,$233.60 ,$162.43 ,$131.69 ,$81.76 ,$262.80 ,$72.19 ,$93.85 ,$144.38 ,$144.38 ,$72.19 ,$144.38 ,$140.16 ,$38.33 
ST. ELIZABETH'S HOSPITAL,30101653,82642,HC DIHYDROTESTOSTERONE-90,301,1 ,$68.00 ,$44.20 ,$14.54 ,$73.20 ,$73.20 ,$39.85 ,$38.08 ,$29.28 ,$19.04 ,$22.98 ,$29.28 ,$26.45 ,$29.28 ,$30.67 ,$30.67 ,$29.28 ,$36.60 ,$55.63 ,$56.61 ,$73.20 ,$29.28 ,$29.28 ,$29.87 ,$51.00 ,$40.80 ,$40.80 ,$29.28 ,$40.80 ,$42.29 ,$42.29 ,$42.29 ,$68.00 , N/A ,$57.80 ,$68.00 ,$44.20 ,$29.28 ,$68.00 ,$38.08 ,$29.28 ,$17.88 , N/A ,$15.99 ,$15.27 ,$30.74 ,$54.40 ,$65.88 ,$30.67 ,$19.04 ,$61.20 ,$29.28 ,$42.29 ,$58.56 ,$58.56 ,$29.28 ,$58.56 ,$32.64 ,$14.54 
ST. ELIZABETH'S HOSPITAL,30101664,80307,HC DRUG SCREEN UMBILICAL CORD-90,301,1 ,$316.00 ,$205.40 ,$29.08 ,$316.00 ,$155.35 ,$137.95 ,$176.96 ,$62.14 ,$88.48 ,$111.55 ,$62.14 ,$130.19 ,$62.14 ,$142.52 ,$142.52 ,$62.14 ,$77.68 ,$118.07 ,$112.59 ,$155.35 ,$62.14 ,$62.14 ,$63.38 ,$237.00 ,$189.60 ,$189.60 ,$62.14 ,$189.60 ,$84.05 ,$84.05 ,$84.05 ,$316.00 , N/A ,$268.60 ,$155.35 ,$205.40 ,$62.14 ,$316.00 ,$176.96 ,$62.14 ,$83.11 , N/A ,$31.99 ,$30.53 ,$65.25 ,$252.80 ,$139.82 ,$142.52 ,$88.48 ,$284.40 ,$62.14 ,$84.05 ,$124.28 ,$124.28 ,$62.14 ,$124.28 ,$151.68 ,$29.08 
ST. ELIZABETH'S HOSPITAL,30101675,83050,HC METHEMOGLOBIN-90,301,1 ,$13.00 ,$8.45 ,$3.42 ,$20.50 ,$20.50 ,$6.07 ,$7.28 ,$8.20 ,$3.64 ,$4.59 ,$8.20 ,$5.36 ,$8.20 ,$5.86 ,$5.86 ,$8.20 ,$10.25 ,$13.00 ,$13.00 ,$20.50 ,$8.20 ,$8.20 ,$8.36 ,$9.75 ,$7.80 ,$7.80 ,$8.20 ,$7.80 ,$10.66 ,$10.66 ,$10.66 ,$13.00 , N/A ,$11.05 ,$13.00 ,$8.45 ,$8.20 ,$13.00 ,$7.28 ,$8.20 ,$3.42 , N/A ,$11.88 ,$11.34 ,$8.61 ,$10.40 ,$18.45 ,$5.86 ,$3.64 ,$11.70 ,$8.20 ,$10.66 ,$13.00 ,$13.00 ,$8.20 ,$13.00 ,$6.24 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101678,83516,HC FLUOR AB SCR AQUAPORIN 4-90,301,1 ,"$1,600.00 ","$1,040.00 ",$9.67 ,"$1,600.00 ",$28.83 ,$19.90 ,$896.00 ,$11.53 ,$448.00 ,$117.03 ,$11.53 ,$117.03 ,$11.53 ,$721.60 ,$721.60 ,$11.53 ,$14.41 ,$21.91 ,$22.64 ,$28.83 ,$11.53 ,$11.53 ,$11.76 ,"$1,200.00 ",$960.00 ,$960.00 ,$11.53 ,$960.00 ,$16.65 ,$16.65 ,$16.65 ,"$1,600.00 ", N/A ,"$1,360.00 ",$28.83 ,"$1,040.00 ",$11.53 ,"$1,600.00 ",$896.00 ,$11.53 ,$420.80 , N/A ,$10.64 ,$10.15 ,$12.11 ,"$1,280.00 ",$25.94 ,$721.60 ,$448.00 ,"$1,440.00 ",$11.53 ,$16.65 ,$23.06 ,$23.06 ,$11.53 ,$23.06 ,$768.00 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101688,84132,HC POTASSIUM,301,1 ,$2.82 ,$1.83 ,$0.74 ,$7.05 ,$7.05 ,$2.82 ,$1.58 ,$2.82 ,$0.79 ,$1.00 ,$2.82 ,$1.16 ,$2.82 ,$1.27 ,$1.27 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$7.05 ,$2.82 ,$2.82 ,$2.82 ,$2.12 ,$1.69 ,$1.69 ,$2.82 ,$1.69 ,$2.82 ,$2.82 ,$2.82 ,$2.82 , N/A ,$2.40 ,$2.82 ,$1.83 ,$2.82 ,$2.82 ,$1.58 ,$2.82 ,$0.74 , N/A ,$2.82 ,$2.82 ,$2.96 ,$2.26 ,$6.35 ,$1.27 ,$0.79 ,$2.54 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$2.82 ,$1.35 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101689,82565,HC CREATININE,301,1 ,$2.79 ,$1.81 ,$0.73 ,$6.98 ,$6.98 ,$2.79 ,$1.56 ,$2.79 ,$0.78 ,$0.98 ,$2.79 ,$1.15 ,$2.79 ,$1.26 ,$1.26 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$6.98 ,$2.79 ,$2.79 ,$2.79 ,$2.09 ,$1.67 ,$1.67 ,$2.79 ,$1.67 ,$2.79 ,$2.79 ,$2.79 ,$2.79 , N/A ,$2.37 ,$2.79 ,$1.81 ,$2.79 ,$2.79 ,$1.56 ,$2.79 ,$0.73 , N/A ,$2.79 ,$2.79 ,$2.93 ,$2.23 ,$6.28 ,$1.26 ,$0.78 ,$2.51 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$2.79 ,$1.34 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30101706,80230,HC DRUG ASSAY INFLIXIMAB-90,301,1 ,$367.00 ,$238.55 ,$12.40 ,$367.00 ,$96.43 ,$47.25 ,$205.52 ,$38.57 ,$102.76 ,$124.05 ,$38.57 ,$142.76 ,$38.57 ,$165.52 ,$165.52 ,$38.57 ,$48.21 ,$73.28 ,$183.50 ,$96.43 ,$38.57 ,$38.57 ,$39.34 ,$275.25 ,$220.20 ,$220.20 ,$38.57 ,$220.20 ,$50.14 ,$50.14 ,$50.14 ,$367.00 , N/A ,$311.95 ,$96.43 ,$238.55 ,$38.57 ,$367.00 ,$205.52 ,$38.57 ,$96.52 , N/A ,$13.64 ,$13.02 ,$40.50 ,$293.60 ,$86.78 ,$165.52 ,$102.76 ,$330.30 ,$38.57 ,$50.14 ,$77.14 ,$77.14 ,$38.57 ,$77.14 ,$176.16 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30101722,82542,HC COL CHROMOTOGRAPHY QUAL/QUAN-90,301,1 ,$27.90 ,$18.14 ,$7.34 ,$60.23 ,$60.23 ,$27.90 ,$15.62 ,$24.09 ,$7.81 ,$9.85 ,$24.09 ,$11.49 ,$24.09 ,$12.58 ,$12.58 ,$24.09 ,$27.90 ,$27.90 ,$27.90 ,$60.23 ,$24.09 ,$24.09 ,$24.57 ,$20.93 ,$16.74 ,$16.74 ,$24.09 ,$16.74 ,$27.90 ,$27.90 ,$27.90 ,$27.90 , N/A ,$23.72 ,$27.90 ,$18.14 ,$24.09 ,$27.90 ,$15.62 ,$24.09 ,$7.34 , N/A ,$11.88 ,$11.34 ,$25.29 ,$22.32 ,$54.20 ,$12.58 ,$7.81 ,$25.11 ,$24.09 ,$27.90 ,$27.90 ,$27.90 ,$24.09 ,$27.90 ,$13.39 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30101751,83519,HC ACETYLCHOLINE RECEPTR AB TIER 3-90,301,1 ,$616.00 ,$400.40 ,$9.67 ,$616.00 ,$46.00 ,$23.29 ,$344.96 ,$18.40 ,$172.48 ,$111.71 ,$18.40 ,$111.71 ,$18.40 ,$277.82 ,$277.82 ,$18.40 ,$23.00 ,$34.96 ,$32.08 ,$46.00 ,$18.40 ,$18.40 ,$18.77 ,$462.00 ,$369.60 ,$369.60 ,$18.40 ,$369.60 ,$23.92 ,$23.92 ,$23.92 ,$616.00 , N/A ,$523.60 ,$46.00 ,$400.40 ,$18.40 ,$616.00 ,$344.96 ,$18.40 ,$162.01 , N/A ,$10.64 ,$10.15 ,$19.32 ,$492.80 ,$41.40 ,$277.82 ,$172.48 ,$554.40 ,$18.40 ,$23.92 ,$36.80 ,$36.80 ,$18.40 ,$36.80 ,$295.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30101766,82542,HC COL CHROMOTOGRAPHY NONDRUG QUAL/QUAN-90,301,1 ,"$3,706.00 ","$2,408.90 ",$10.80 ,"$3,706.00 ",$60.23 ,$32.31 ,"$2,075.36 ",$24.09 ,"$1,037.68 ",$146.26 ,$24.09 ,$146.26 ,$24.09 ,"$1,671.41 ","$1,671.41 ",$24.09 ,$30.11 ,$45.77 ,$42.14 ,$60.23 ,$24.09 ,$24.09 ,$24.57 ,"$2,779.50 ","$2,223.60 ","$2,223.60 ",$24.09 ,"$2,223.60 ",$31.32 ,$31.32 ,$31.32 ,"$3,706.00 ", N/A ,"$3,150.10 ",$60.23 ,"$2,408.90 ",$24.09 ,"$3,706.00 ","$2,075.36 ",$24.09 ,$974.68 , N/A ,$11.88 ,$11.34 ,$25.29 ,"$2,964.80 ",$54.20 ,"$1,671.41 ","$1,037.68 ","$3,335.40 ",$24.09 ,$31.32 ,$48.18 ,$48.18 ,$24.09 ,$48.18 ,"$1,778.88 ",$10.80 
ST. ELIZABETH'S HOSPITAL,30101777,82542,HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC-90,301,1 ,"$3,706.00 ","$2,408.90 ",$10.80 ,"$3,706.00 ",$60.23 ,$32.31 ,"$2,075.36 ",$24.09 ,"$1,037.68 ",$146.26 ,$24.09 ,$146.26 ,$24.09 ,"$1,671.41 ","$1,671.41 ",$24.09 ,$30.11 ,$45.77 ,$42.14 ,$60.23 ,$24.09 ,$24.09 ,$24.57 ,"$2,779.50 ","$2,223.60 ","$2,223.60 ",$24.09 ,"$2,223.60 ",$31.32 ,$31.32 ,$31.32 ,"$3,706.00 ", N/A ,"$3,150.10 ",$60.23 ,"$2,408.90 ",$24.09 ,"$3,706.00 ","$2,075.36 ",$24.09 ,$974.68 , N/A ,$11.88 ,$11.34 ,$25.29 ,"$2,964.80 ",$54.20 ,"$1,671.41 ","$1,037.68 ","$3,335.40 ",$24.09 ,$31.32 ,$48.18 ,$48.18 ,$24.09 ,$48.18 ,"$1,778.88 ",$10.80 
ST. ELIZABETH'S HOSPITAL,30101778,84591,HC ASSAY OF NOT VITAMIN-90,301,1 ,$176.00 ,$114.40 ,$12.40 ,$176.00 ,$42.65 ,$19.99 ,$98.56 ,$17.06 ,$49.28 ,$62.13 ,$17.06 ,$72.51 ,$17.06 ,$79.38 ,$79.38 ,$17.06 ,$21.33 ,$32.41 ,$29.56 ,$42.65 ,$17.06 ,$17.06 ,$17.40 ,$132.00 ,$105.60 ,$105.60 ,$17.06 ,$105.60 ,$22.18 ,$22.18 ,$22.18 ,$176.00 , N/A ,$149.60 ,$42.65 ,$114.40 ,$17.06 ,$176.00 ,$98.56 ,$17.06 ,$46.29 , N/A ,$13.64 ,$13.02 ,$17.91 ,$140.80 ,$38.39 ,$79.38 ,$49.28 ,$158.40 ,$17.06 ,$22.18 ,$34.12 ,$34.12 ,$17.06 ,$34.12 ,$84.48 ,$12.40 
ST. ELIZABETH'S HOSPITAL,30200108,86022,HC PLATELET AB ID (HIT),302,1 ,$325.00 ,$211.25 ,$9.67 ,$325.00 ,$45.93 ,$25.15 ,$182.00 ,$18.37 ,$91.00 ,$114.73 ,$18.37 ,$133.90 ,$18.37 ,$146.58 ,$146.58 ,$18.37 ,$22.96 ,$34.90 ,$35.85 ,$45.93 ,$18.37 ,$18.37 ,$18.74 ,$243.75 ,$195.00 ,$195.00 ,$18.37 ,$195.00 ,$26.53 ,$26.53 ,$26.53 ,$325.00 , N/A ,$276.25 ,$45.93 ,$211.25 ,$18.37 ,$325.00 ,$182.00 ,$18.37 ,$85.48 , N/A ,$10.64 ,$10.15 ,$19.29 ,$260.00 ,$41.33 ,$146.58 ,$91.00 ,$292.50 ,$18.37 ,$26.53 ,$36.74 ,$36.74 ,$18.37 ,$36.74 ,$156.00 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$91.00 ,$59.15 ,$5.18 ,$91.00 ,$12.95 ,$8.93 ,$50.96 ,$5.18 ,$25.48 ,$32.12 ,$5.18 ,$37.49 ,$5.18 ,$41.04 ,$41.04 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$68.25 ,$54.60 ,$54.60 ,$5.18 ,$54.60 ,$7.48 ,$7.48 ,$7.48 ,$91.00 , N/A ,$77.35 ,$12.95 ,$59.15 ,$5.18 ,$91.00 ,$50.96 ,$5.18 ,$23.93 , N/A ,$10.64 ,$10.15 ,$5.44 ,$72.80 ,$11.66 ,$41.04 ,$25.48 ,$81.90 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$43.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$177.00 ,$115.05 ,$5.18 ,$177.00 ,$12.95 ,$8.93 ,$99.12 ,$5.18 ,$49.56 ,$52.49 ,$5.18 ,$52.49 ,$5.18 ,$79.83 ,$79.83 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$132.75 ,$106.20 ,$106.20 ,$5.18 ,$106.20 ,$7.48 ,$7.48 ,$7.48 ,$177.00 , N/A ,$150.45 ,$12.95 ,$115.05 ,$5.18 ,$177.00 ,$99.12 ,$5.18 ,$46.55 , N/A ,$10.64 ,$10.15 ,$5.44 ,$141.60 ,$11.66 ,$79.83 ,$49.56 ,$159.30 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$84.96 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200189,86376,HC MICROSOMAL AB,302,1 ,$178.00 ,$115.70 ,$14.55 ,$178.00 ,$36.38 ,$25.10 ,$99.68 ,$14.55 ,$49.84 ,$62.83 ,$14.55 ,$73.34 ,$14.55 ,$80.28 ,$80.28 ,$14.55 ,$18.19 ,$27.65 ,$28.31 ,$36.38 ,$14.55 ,$14.55 ,$14.84 ,$133.50 ,$106.80 ,$106.80 ,$14.55 ,$106.80 ,$21.02 ,$21.02 ,$21.02 ,$178.00 , N/A ,$151.30 ,$36.38 ,$115.70 ,$14.55 ,$178.00 ,$99.68 ,$14.55 ,$46.81 , N/A ,$27.81 ,$26.54 ,$15.28 ,$142.40 ,$32.74 ,$80.28 ,$49.84 ,$160.20 ,$14.55 ,$21.02 ,$29.10 ,$29.10 ,$14.55 ,$29.10 ,$85.44 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30200198,86431,HC RHEUMATOID FACTOR QN,302,1 ,$238.00 ,$154.70 ,$5.67 ,$238.00 ,$14.18 ,$9.78 ,$133.28 ,$5.67 ,$66.64 ,$42.50 ,$5.67 ,$42.50 ,$5.67 ,$107.34 ,$107.34 ,$5.67 ,$7.09 ,$10.77 ,$10.69 ,$14.18 ,$5.67 ,$5.67 ,$5.78 ,$178.50 ,$142.80 ,$142.80 ,$5.67 ,$142.80 ,$8.19 ,$8.19 ,$8.19 ,$238.00 , N/A ,$202.30 ,$14.18 ,$154.70 ,$5.67 ,$238.00 ,$133.28 ,$5.67 ,$62.59 , N/A ,$10.64 ,$10.15 ,$5.95 ,$190.40 ,$12.76 ,$107.34 ,$66.64 ,$214.20 ,$5.67 ,$8.19 ,$11.34 ,$11.34 ,$5.67 ,$11.34 ,$114.24 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200201,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$124.00 ,$80.60 ,$4.27 ,$124.00 ,$10.68 ,$7.37 ,$69.44 ,$4.27 ,$34.72 ,$32.04 ,$4.27 ,$32.04 ,$4.27 ,$55.92 ,$55.92 ,$4.27 ,$5.34 ,$8.11 ,$8.18 ,$10.68 ,$4.27 ,$4.27 ,$4.36 ,$93.00 ,$74.40 ,$74.40 ,$4.27 ,$74.40 ,$6.18 ,$6.18 ,$6.18 ,$124.00 , N/A ,$105.40 ,$10.68 ,$80.60 ,$4.27 ,$124.00 ,$69.44 ,$4.27 ,$32.61 , N/A ,$10.64 ,$10.15 ,$4.48 ,$99.20 ,$9.61 ,$55.92 ,$34.72 ,$111.60 ,$4.27 ,$6.18 ,$8.54 ,$8.54 ,$4.27 ,$8.54 ,$59.52 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200270,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$177.00 ,$115.05 ,$9.67 ,$177.00 ,$34.28 ,$23.64 ,$99.12 ,$13.71 ,$49.56 ,$62.48 ,$13.71 ,$72.92 ,$13.71 ,$79.83 ,$79.83 ,$13.71 ,$17.14 ,$26.05 ,$26.42 ,$34.28 ,$13.71 ,$13.71 ,$13.98 ,$132.75 ,$106.20 ,$106.20 ,$13.71 ,$106.20 ,$19.80 ,$19.80 ,$19.80 ,$177.00 , N/A ,$150.45 ,$34.28 ,$115.05 ,$13.71 ,$177.00 ,$99.12 ,$13.71 ,$46.55 , N/A ,$10.64 ,$10.15 ,$14.40 ,$141.60 ,$30.85 ,$79.83 ,$49.56 ,$159.30 ,$13.71 ,$19.80 ,$27.42 ,$27.42 ,$13.71 ,$27.42 ,$84.96 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200288,86762,HC RUBELLA AB,302,1 ,$138.00 ,$89.70 ,$9.67 ,$138.00 ,$35.98 ,$24.82 ,$77.28 ,$14.39 ,$38.64 ,$48.71 ,$14.39 ,$56.86 ,$14.39 ,$62.24 ,$62.24 ,$14.39 ,$17.99 ,$27.34 ,$27.68 ,$35.98 ,$14.39 ,$14.39 ,$14.68 ,$103.50 ,$82.80 ,$82.80 ,$14.39 ,$82.80 ,$20.79 ,$20.79 ,$20.79 ,$138.00 , N/A ,$117.30 ,$35.98 ,$89.70 ,$14.39 ,$138.00 ,$77.28 ,$14.39 ,$36.29 , N/A ,$10.64 ,$10.15 ,$15.11 ,$110.40 ,$32.38 ,$62.24 ,$38.64 ,$124.20 ,$14.39 ,$20.79 ,$28.78 ,$28.78 ,$14.39 ,$28.78 ,$66.24 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200291,86765,HC RUBEOLA AB,302,1 ,$105.00 ,$68.25 ,$9.67 ,$105.00 ,$32.20 ,$22.21 ,$58.80 ,$12.88 ,$29.40 ,$37.07 ,$12.88 ,$43.26 ,$12.88 ,$47.36 ,$47.36 ,$12.88 ,$16.10 ,$24.47 ,$25.16 ,$32.20 ,$12.88 ,$12.88 ,$13.14 ,$78.75 ,$63.00 ,$63.00 ,$12.88 ,$63.00 ,$18.60 ,$18.60 ,$18.60 ,$105.00 , N/A ,$89.25 ,$32.20 ,$68.25 ,$12.88 ,$105.00 ,$58.80 ,$12.88 ,$27.62 , N/A ,$10.64 ,$10.15 ,$13.52 ,$84.00 ,$28.98 ,$47.36 ,$29.40 ,$94.50 ,$12.88 ,$18.60 ,$25.76 ,$25.76 ,$12.88 ,$25.76 ,$50.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200298,86780,HC TREPONEMA P AB CONFIRM,302,1 ,$124.00 ,$80.60 ,$13.24 ,$124.00 ,$33.10 ,$22.82 ,$69.44 ,$13.24 ,$34.72 ,$43.77 ,$13.24 ,$51.09 ,$13.24 ,$55.92 ,$55.92 ,$13.24 ,$16.55 ,$25.16 ,$25.79 ,$33.10 ,$13.24 ,$13.24 ,$13.50 ,$93.00 ,$74.40 ,$74.40 ,$13.24 ,$74.40 ,$19.12 ,$19.12 ,$19.12 ,$124.00 , N/A ,$105.40 ,$33.10 ,$80.60 ,$13.24 ,$124.00 ,$69.44 ,$13.24 ,$32.61 , N/A ,$18.34 ,$17.50 ,$13.90 ,$99.20 ,$29.79 ,$55.92 ,$34.72 ,$111.60 ,$13.24 ,$19.12 ,$26.48 ,$26.48 ,$13.24 ,$26.48 ,$59.52 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200299,86787,HC VARICELLA ZOSTER ATB,302,1 ,$150.00 ,$97.50 ,$9.67 ,$150.00 ,$32.20 ,$22.21 ,$84.00 ,$12.88 ,$42.00 ,$52.95 ,$12.88 ,$61.80 ,$12.88 ,$67.65 ,$67.65 ,$12.88 ,$16.10 ,$24.47 ,$25.16 ,$32.20 ,$12.88 ,$12.88 ,$13.14 ,$112.50 ,$90.00 ,$90.00 ,$12.88 ,$90.00 ,$18.60 ,$18.60 ,$18.60 ,$150.00 , N/A ,$127.50 ,$32.20 ,$97.50 ,$12.88 ,$150.00 ,$84.00 ,$12.88 ,$39.45 , N/A ,$10.64 ,$10.15 ,$13.52 ,$120.00 ,$28.98 ,$67.65 ,$42.00 ,$135.00 ,$12.88 ,$18.60 ,$25.76 ,$25.76 ,$12.88 ,$25.76 ,$72.00 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200507,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$232.00 ,$150.80 ,$9.67 ,$232.00 ,$32.38 ,$22.31 ,$129.92 ,$12.95 ,$64.96 ,$81.90 ,$12.95 ,$95.58 ,$12.95 ,$104.63 ,$104.63 ,$12.95 ,$16.19 ,$24.61 ,$25.16 ,$32.38 ,$12.95 ,$12.95 ,$13.21 ,$174.00 ,$139.20 ,$139.20 ,$12.95 ,$139.20 ,$18.71 ,$18.71 ,$18.71 ,$232.00 , N/A ,$197.20 ,$32.38 ,$150.80 ,$12.95 ,$232.00 ,$129.92 ,$12.95 ,$61.02 , N/A ,$10.64 ,$10.15 ,$13.60 ,$185.60 ,$29.14 ,$104.63 ,$64.96 ,$208.80 ,$12.95 ,$18.71 ,$25.90 ,$25.90 ,$12.95 ,$25.90 ,$111.36 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200543,86704,HC HEP CORE AB,302,1 ,$202.00 ,$131.30 ,$9.67 ,$202.00 ,$30.13 ,$20.77 ,$113.12 ,$12.05 ,$56.56 ,$71.31 ,$12.05 ,$83.22 ,$12.05 ,$91.10 ,$91.10 ,$12.05 ,$15.06 ,$22.90 ,$23.27 ,$30.13 ,$12.05 ,$12.05 ,$12.29 ,$151.50 ,$121.20 ,$121.20 ,$12.05 ,$121.20 ,$17.41 ,$17.41 ,$17.41 ,$202.00 , N/A ,$171.70 ,$30.13 ,$131.30 ,$12.05 ,$202.00 ,$113.12 ,$12.05 ,$53.13 , N/A ,$10.64 ,$10.15 ,$12.65 ,$161.60 ,$27.11 ,$91.10 ,$56.56 ,$181.80 ,$12.05 ,$17.41 ,$24.10 ,$24.10 ,$12.05 ,$24.10 ,$96.96 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200544,86705,HC HEP B CORE IGM,302,1 ,$181.00 ,$117.65 ,$9.67 ,$181.00 ,$29.43 ,$20.28 ,$101.36 ,$11.77 ,$50.68 ,$63.89 ,$11.77 ,$74.57 ,$11.77 ,$81.63 ,$81.63 ,$11.77 ,$14.71 ,$22.36 ,$22.64 ,$29.43 ,$11.77 ,$11.77 ,$12.01 ,$135.75 ,$108.60 ,$108.60 ,$11.77 ,$108.60 ,$17.00 ,$17.00 ,$17.00 ,$181.00 , N/A ,$153.85 ,$29.43 ,$117.65 ,$11.77 ,$181.00 ,$101.36 ,$11.77 ,$47.60 , N/A ,$10.64 ,$10.15 ,$12.36 ,$144.80 ,$26.48 ,$81.63 ,$50.68 ,$162.90 ,$11.77 ,$17.00 ,$23.54 ,$23.54 ,$11.77 ,$23.54 ,$86.88 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200545,86706,HC HEP B SURFACE AB,302,1 ,$146.00 ,$94.90 ,$9.67 ,$146.00 ,$26.85 ,$18.52 ,$81.76 ,$10.74 ,$40.88 ,$51.54 ,$10.74 ,$60.15 ,$10.74 ,$65.85 ,$65.85 ,$10.74 ,$13.43 ,$20.41 ,$20.76 ,$26.85 ,$10.74 ,$10.74 ,$10.95 ,$109.50 ,$87.60 ,$87.60 ,$10.74 ,$87.60 ,$15.51 ,$15.51 ,$15.51 ,$146.00 , N/A ,$124.10 ,$26.85 ,$94.90 ,$10.74 ,$146.00 ,$81.76 ,$10.74 ,$38.40 , N/A ,$10.64 ,$10.15 ,$11.28 ,$116.80 ,$24.17 ,$65.85 ,$40.88 ,$131.40 ,$10.74 ,$15.51 ,$21.48 ,$21.48 ,$10.74 ,$21.48 ,$70.08 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200548,86709,HC HEP A AB IGM,302,1 ,$157.00 ,$102.05 ,$9.67 ,$157.00 ,$28.15 ,$19.41 ,$87.92 ,$11.26 ,$43.96 ,$55.42 ,$11.26 ,$64.68 ,$11.26 ,$70.81 ,$70.81 ,$11.26 ,$14.08 ,$21.39 ,$22.02 ,$28.15 ,$11.26 ,$11.26 ,$11.49 ,$117.75 ,$94.20 ,$94.20 ,$11.26 ,$94.20 ,$16.26 ,$16.26 ,$16.26 ,$157.00 , N/A ,$133.45 ,$28.15 ,$102.05 ,$11.26 ,$157.00 ,$87.92 ,$11.26 ,$41.29 , N/A ,$10.64 ,$10.15 ,$11.82 ,$125.60 ,$25.34 ,$70.81 ,$43.96 ,$141.30 ,$11.26 ,$16.26 ,$22.52 ,$22.52 ,$11.26 ,$22.52 ,$75.36 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200559,86850,HC AB SCREEN,302,1 ,$192.00 ,$124.80 ,$9.67 ,$192.00 ,$122.48 ,$19.22 ,$107.52 ,$48.99 ,$53.76 ,$59.31 ,$48.99 ,$59.31 ,$48.99 ,$86.59 ,$86.59 ,$48.99 ,$12.21 ,$93.08 ,$16.98 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$144.00 ,$115.20 ,$115.20 ,$48.99 ,$115.20 ,$12.70 ,$12.70 ,$12.70 ,$192.00 , N/A ,$163.20 ,$122.48 ,$124.80 ,$48.99 ,$192.00 ,$107.52 ,$48.99 ,$50.50 , N/A ,$10.64 ,$10.15 ,$51.44 ,$153.60 ,$110.23 ,$86.59 ,$53.76 ,$172.80 ,$48.99 ,$12.70 ,$19.54 ,$19.54 ,$48.99 ,$19.54 ,$92.16 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200560,86860,HC ELUTION,302,1 ,$133.00 ,$86.45 ,$9.67 ,$367.60 ,$367.60 ,$24.83 ,$74.48 ,$147.04 ,$37.24 ,$46.95 ,$147.04 ,$54.80 ,$133.00 ,$59.98 ,$59.98 ,$133.00 ,$86.45 ,$133.00 ,$57.24 ,$367.59 ,$147.04 ,$147.04 ,$133.00 ,$99.75 ,$79.80 ,$79.80 ,$147.04 ,$79.80 ,$93.10 ,$93.10 ,$93.10 ,$133.00 , N/A ,$113.05 ,$133.00 ,$86.45 ,$147.04 ,$133.00 ,$74.48 ,$147.04 ,$34.98 , N/A ,$10.64 ,$10.15 ,$154.39 ,$106.40 ,$330.83 ,$59.98 ,$37.24 ,$119.70 ,$147.04 ,$93.10 ,$133.00 ,$133.00 ,$133.00 ,$133.00 ,$63.84 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200561,86870,HC RBC AB ID PANEL,302,1 ,$267.00 ,$173.55 ,$9.67 ,$717.84 ,$717.83 ,$34.04 ,$149.52 ,$287.13 ,$74.76 ,$94.25 ,$287.13 ,$110.00 ,$267.00 ,$120.42 ,$120.42 ,$267.00 ,$173.55 ,$267.00 ,$78.63 ,$717.84 ,$287.13 ,$287.13 ,$267.00 ,$200.25 ,$160.20 ,$160.20 ,$287.13 ,$160.20 ,$186.90 ,$186.90 ,$186.90 ,$267.00 , N/A ,$226.95 ,$267.00 ,$173.55 ,$287.13 ,$267.00 ,$149.52 ,$287.13 ,$70.22 , N/A ,$10.64 ,$10.15 ,$301.49 ,$213.60 ,$646.05 ,$120.42 ,$74.76 ,$240.30 ,$287.13 ,$186.90 ,$267.00 ,$267.00 ,$267.00 ,$267.00 ,$128.16 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200562,86880,HC COOMBS DIRECT,302,1 ,$86.00 ,$55.90 ,$6.74 ,$137.20 ,$137.20 ,$9.26 ,$48.16 ,$54.88 ,$24.08 ,$30.36 ,$54.88 ,$35.43 ,$54.88 ,$38.79 ,$38.79 ,$54.88 ,$6.74 ,$86.00 ,$10.69 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$64.50 ,$51.60 ,$51.60 ,$54.88 ,$51.60 ,$7.79 ,$7.79 ,$7.79 ,$86.00 , N/A ,$73.10 ,$86.00 ,$55.90 ,$54.88 ,$86.00 ,$48.16 ,$54.88 ,$22.62 , N/A ,$10.64 ,$10.15 ,$57.62 ,$68.80 ,$123.48 ,$38.79 ,$24.08 ,$77.40 ,$54.88 ,$7.79 ,$10.78 ,$10.78 ,$54.88 ,$10.78 ,$41.28 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200565,86900,HC BLOOD TYPING ABO,302,1 ,$128.00 ,$83.20 ,$3.74 ,$277.93 ,$277.93 ,$5.15 ,$71.68 ,$111.17 ,$35.84 ,$22.42 ,$111.17 ,$22.42 ,$111.17 ,$57.73 ,$57.73 ,$111.17 ,$3.74 ,$128.00 ,$5.66 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$96.00 ,$76.80 ,$76.80 ,$111.17 ,$76.80 ,$4.32 ,$4.32 ,$4.32 ,$128.00 , N/A ,$108.80 ,$128.00 ,$83.20 ,$111.17 ,$128.00 ,$71.68 ,$111.17 ,$33.66 , N/A ,$6.59 ,$6.29 ,$116.73 ,$102.40 ,$250.12 ,$57.73 ,$35.84 ,$115.20 ,$111.17 ,$4.32 ,$5.98 ,$5.98 ,$111.17 ,$5.98 ,$61.44 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200566,86901,HC BLOOD TYPING RH,302,1 ,$92.00 ,$59.80 ,$3.74 ,$92.00 ,$83.43 ,$5.15 ,$51.52 ,$33.37 ,$25.76 ,$22.42 ,$33.37 ,$22.42 ,$33.37 ,$41.49 ,$41.49 ,$33.37 ,$3.74 ,$63.41 ,$5.66 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$69.00 ,$55.20 ,$55.20 ,$33.37 ,$55.20 ,$4.32 ,$4.32 ,$4.32 ,$92.00 , N/A ,$78.20 ,$83.43 ,$59.80 ,$33.37 ,$92.00 ,$51.52 ,$33.37 ,$24.20 , N/A ,$6.59 ,$6.29 ,$35.04 ,$73.60 ,$75.08 ,$41.49 ,$25.76 ,$82.80 ,$33.37 ,$4.32 ,$5.98 ,$5.98 ,$33.37 ,$5.98 ,$44.16 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200567,86902,HC RBC AG SCR RGT SERUM,302,1 ,$242.00 ,$157.30 ,$5.99 ,$717.84 ,$717.83 ,$6.60 ,$135.52 ,$287.13 ,$67.76 ,$38.57 ,$287.13 ,$38.57 ,$242.00 ,$109.14 ,$109.14 ,$242.00 ,$7.94 ,$242.00 ,$11.32 ,$717.84 ,$287.13 ,$287.13 ,$242.00 ,$181.50 ,$145.20 ,$145.20 ,$287.13 ,$145.20 ,$8.26 ,$8.26 ,$8.26 ,$242.00 , N/A ,$205.70 ,$242.00 ,$157.30 ,$287.13 ,$242.00 ,$135.52 ,$287.13 ,$63.65 , N/A ,$6.59 ,$6.29 ,$301.49 ,$193.60 ,$646.05 ,$109.14 ,$67.76 ,$217.80 ,$287.13 ,$8.26 ,$12.70 ,$12.70 ,$242.00 ,$12.70 ,$116.16 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200568,86905,HC RBC ANTIGEN OTHER THAN ABO OR RH(D) EACH,302,1 ,$184.00 ,$119.60 ,$4.79 ,$717.84 ,$717.83 ,$6.60 ,$103.04 ,$287.13 ,$51.52 ,$28.67 ,$287.13 ,$28.67 ,$184.00 ,$82.98 ,$82.98 ,$184.00 ,$4.79 ,$184.00 ,$7.55 ,$717.84 ,$287.13 ,$287.13 ,$184.00 ,$138.00 ,$110.40 ,$110.40 ,$287.13 ,$110.40 ,$5.53 ,$5.53 ,$5.53 ,$184.00 , N/A ,$156.40 ,$184.00 ,$119.60 ,$287.13 ,$184.00 ,$103.04 ,$287.13 ,$48.39 , N/A ,$6.59 ,$6.29 ,$301.49 ,$147.20 ,$646.05 ,$82.98 ,$51.52 ,$165.60 ,$287.13 ,$5.53 ,$7.66 ,$7.66 ,$184.00 ,$7.66 ,$88.32 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200569,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$150.00 ,$97.50 ,$5.99 ,$367.60 ,$367.60 ,$27.63 ,$84.00 ,$147.04 ,$42.00 ,$52.95 ,$147.04 ,$61.80 ,$147.04 ,$67.65 ,$67.65 ,$147.04 ,$97.50 ,$150.00 ,$63.53 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$112.50 ,$90.00 ,$90.00 ,$147.04 ,$90.00 ,$105.00 ,$105.00 ,$105.00 ,$150.00 , N/A ,$127.50 ,$150.00 ,$97.50 ,$147.04 ,$150.00 ,$84.00 ,$147.04 ,$39.45 , N/A ,$6.59 ,$6.29 ,$154.39 ,$120.00 ,$330.83 ,$67.65 ,$42.00 ,$135.00 ,$147.04 ,$105.00 ,$150.00 ,$150.00 ,$147.04 ,$150.00 ,$72.00 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200571,86922,HC CROSSMATCH AHG,302,1 ,$137.00 ,$89.05 ,$29.63 ,$367.60 ,$367.60 ,$29.63 ,$76.72 ,$147.04 ,$38.36 ,$48.36 ,$147.04 ,$56.44 ,$137.00 ,$61.79 ,$61.79 ,$137.00 ,$89.05 ,$137.00 ,$67.93 ,$367.59 ,$147.04 ,$147.04 ,$137.00 ,$102.75 ,$82.20 ,$82.20 ,$147.04 ,$82.20 ,$95.90 ,$95.90 ,$95.90 ,$137.00 , N/A ,$116.45 ,$137.00 ,$89.05 ,$147.04 ,$137.00 ,$76.72 ,$147.04 ,$36.03 , N/A ,$42.96 ,$41.00 ,$154.39 ,$109.60 ,$330.83 ,$61.79 ,$38.36 ,$123.30 ,$147.04 ,$95.90 ,$137.00 ,$137.00 ,$137.00 ,$137.00 ,$65.76 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30200572,86923,HC CROSSMATCH ELECTRONIC,302,1 ,$61.00 ,$39.65 ,$16.04 ,$367.60 ,$367.60 ,$22.02 ,$34.16 ,$147.04 ,$17.08 ,$21.53 ,$147.04 ,$25.13 ,$61.00 ,$27.51 ,$27.51 ,$61.00 ,$39.65 ,$61.00 ,$50.95 ,$367.59 ,$147.04 ,$147.04 ,$61.00 ,$45.75 ,$36.60 ,$36.60 ,$147.04 ,$36.60 ,$42.70 ,$42.70 ,$42.70 ,$61.00 , N/A ,$51.85 ,$61.00 ,$39.65 ,$147.04 ,$61.00 ,$34.16 ,$147.04 ,$16.04 , N/A ,$42.96 ,$41.00 ,$154.39 ,$48.80 ,$330.83 ,$27.51 ,$17.08 ,$54.90 ,$147.04 ,$42.70 ,$61.00 ,$61.00 ,$61.00 ,$61.00 ,$29.28 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30200842,86318,HC IMMUNO INFECTIOUS AB QL SQ -QW,302,1 ,$45.00 ,$29.25 ,$11.84 ,$45.23 ,$45.23 ,$22.31 ,$25.20 ,$18.09 ,$12.60 ,$15.89 ,$18.09 ,$18.54 ,$18.09 ,$20.30 ,$20.30 ,$18.09 ,$22.61 ,$34.37 ,$31.45 ,$45.23 ,$18.09 ,$18.09 ,$18.45 ,$33.75 ,$27.00 ,$27.00 ,$18.09 ,$27.00 ,$23.52 ,$23.52 ,$23.52 ,$45.00 , N/A ,$38.25 ,$45.00 ,$29.25 ,$18.09 ,$45.00 ,$25.20 ,$18.09 ,$11.84 , N/A ,$18.34 ,$17.50 ,$18.99 ,$36.00 ,$40.70 ,$20.30 ,$12.60 ,$40.50 ,$18.09 ,$23.52 ,$36.18 ,$36.18 ,$18.09 ,$36.18 ,$21.60 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200843,86000,HC AGGLUTININS FEBRILE EA AG-90,302,1 ,$124.00 ,$80.60 ,$6.98 ,$124.00 ,$17.45 ,$12.02 ,$69.44 ,$6.98 ,$34.72 ,$43.77 ,$6.98 ,$51.09 ,$6.98 ,$55.92 ,$55.92 ,$6.98 ,$8.73 ,$13.26 ,$13.84 ,$17.45 ,$6.98 ,$6.98 ,$7.12 ,$93.00 ,$74.40 ,$74.40 ,$6.98 ,$74.40 ,$10.09 ,$10.09 ,$10.09 ,$124.00 , N/A ,$105.40 ,$17.45 ,$80.60 ,$6.98 ,$124.00 ,$69.44 ,$6.98 ,$32.61 , N/A ,$10.64 ,$10.15 ,$7.33 ,$99.20 ,$15.71 ,$55.92 ,$34.72 ,$111.60 ,$6.98 ,$10.09 ,$13.96 ,$13.96 ,$6.98 ,$13.96 ,$59.52 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200845,86003,HC RAST ALLERGEN IGE QN SQ EA-90,302,1 ,$44.00 ,$28.60 ,$5.22 ,$44.00 ,$13.05 ,$9.00 ,$24.64 ,$5.22 ,$12.32 ,$15.53 ,$5.22 ,$18.13 ,$5.22 ,$19.84 ,$19.84 ,$5.22 ,$6.53 ,$9.92 ,$10.06 ,$13.05 ,$5.22 ,$5.22 ,$5.32 ,$33.00 ,$26.40 ,$26.40 ,$5.22 ,$26.40 ,$7.54 ,$7.54 ,$7.54 ,$44.00 , N/A ,$37.40 ,$13.05 ,$28.60 ,$5.22 ,$44.00 ,$24.64 ,$5.22 ,$11.57 , N/A ,$10.64 ,$10.15 ,$5.48 ,$35.20 ,$11.75 ,$19.84 ,$12.32 ,$39.60 ,$5.22 ,$7.54 ,$10.44 ,$10.44 ,$5.22 ,$10.44 ,$21.12 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200847,86021,HC LEUKO AB ID-90,302,1 ,$169.00 ,$109.85 ,$9.67 ,$169.00 ,$37.63 ,$25.95 ,$94.64 ,$15.05 ,$47.32 ,$59.66 ,$15.05 ,$69.63 ,$15.05 ,$76.22 ,$76.22 ,$15.05 ,$18.81 ,$28.60 ,$28.93 ,$37.63 ,$15.05 ,$15.05 ,$15.35 ,$126.75 ,$101.40 ,$101.40 ,$15.05 ,$101.40 ,$21.75 ,$21.75 ,$21.75 ,$169.00 , N/A ,$143.65 ,$37.63 ,$109.85 ,$15.05 ,$169.00 ,$94.64 ,$15.05 ,$44.45 , N/A ,$10.64 ,$10.15 ,$15.80 ,$135.20 ,$33.86 ,$76.22 ,$47.32 ,$152.10 ,$15.05 ,$21.75 ,$30.10 ,$30.10 ,$15.05 ,$30.10 ,$81.12 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200851,86022,HC PLATELET AB ID-90,302,1 ,$370.00 ,$240.50 ,$9.67 ,$370.00 ,$45.93 ,$25.15 ,$207.20 ,$18.37 ,$103.60 ,$130.61 ,$18.37 ,$137.67 ,$18.37 ,$166.87 ,$166.87 ,$18.37 ,$22.96 ,$34.90 ,$35.85 ,$45.93 ,$18.37 ,$18.37 ,$18.74 ,$277.50 ,$222.00 ,$222.00 ,$18.37 ,$222.00 ,$26.53 ,$26.53 ,$26.53 ,$370.00 , N/A ,$314.50 ,$45.93 ,$240.50 ,$18.37 ,$370.00 ,$207.20 ,$18.37 ,$97.31 , N/A ,$10.64 ,$10.15 ,$19.29 ,$296.00 ,$41.33 ,$166.87 ,$103.60 ,$333.00 ,$18.37 ,$26.53 ,$36.74 ,$36.74 ,$18.37 ,$36.74 ,$177.60 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200856,86022,HC PLATELET CROSSMATCH,302,1 ,$325.00 ,$211.25 ,$9.67 ,$325.00 ,$45.93 ,$25.15 ,$182.00 ,$18.37 ,$91.00 ,$114.73 ,$18.37 ,$133.90 ,$18.37 ,$146.58 ,$146.58 ,$18.37 ,$22.96 ,$34.90 ,$35.85 ,$45.93 ,$18.37 ,$18.37 ,$18.74 ,$243.75 ,$195.00 ,$195.00 ,$18.37 ,$195.00 ,$26.53 ,$26.53 ,$26.53 ,$325.00 , N/A ,$276.25 ,$45.93 ,$211.25 ,$18.37 ,$325.00 ,$182.00 ,$18.37 ,$85.48 , N/A ,$10.64 ,$10.15 ,$19.29 ,$260.00 ,$41.33 ,$146.58 ,$91.00 ,$292.50 ,$18.37 ,$26.53 ,$36.74 ,$36.74 ,$18.37 ,$36.74 ,$156.00 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200857,86023,HC PLATELET ASSOC AB ID IGG-90,302,1 ,$51.00 ,$33.15 ,$9.67 ,$51.00 ,$31.15 ,$21.47 ,$28.56 ,$12.46 ,$14.28 ,$18.00 ,$12.46 ,$21.01 ,$12.46 ,$23.00 ,$23.00 ,$12.46 ,$15.58 ,$23.67 ,$23.90 ,$31.15 ,$12.46 ,$12.46 ,$12.71 ,$38.25 ,$30.60 ,$30.60 ,$12.46 ,$30.60 ,$17.99 ,$17.99 ,$17.99 ,$51.00 , N/A ,$43.35 ,$31.15 ,$33.15 ,$12.46 ,$51.00 ,$28.56 ,$12.46 ,$13.41 , N/A ,$10.64 ,$10.15 ,$13.08 ,$40.80 ,$28.04 ,$23.00 ,$14.28 ,$45.90 ,$12.46 ,$17.99 ,$24.92 ,$24.92 ,$12.46 ,$24.92 ,$24.48 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200858,86038,HC ANA SCREEN-90,302,1 ,$191.00 ,$124.15 ,$9.67 ,$191.00 ,$30.23 ,$20.84 ,$106.96 ,$12.09 ,$53.48 ,$67.42 ,$12.09 ,$78.69 ,$12.09 ,$86.14 ,$86.14 ,$12.09 ,$15.11 ,$22.97 ,$23.27 ,$30.23 ,$12.09 ,$12.09 ,$12.33 ,$143.25 ,$114.60 ,$114.60 ,$12.09 ,$114.60 ,$17.46 ,$17.46 ,$17.46 ,$191.00 , N/A ,$162.35 ,$30.23 ,$124.15 ,$12.09 ,$191.00 ,$106.96 ,$12.09 ,$50.23 , N/A ,$10.64 ,$10.15 ,$12.69 ,$152.80 ,$27.20 ,$86.14 ,$53.48 ,$171.90 ,$12.09 ,$17.46 ,$24.18 ,$24.18 ,$12.09 ,$24.18 ,$91.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200859,86039,HC ANA TITER-90,302,1 ,$73.00 ,$47.45 ,$9.67 ,$73.00 ,$27.90 ,$19.25 ,$40.88 ,$11.16 ,$20.44 ,$25.77 ,$11.16 ,$30.08 ,$11.16 ,$32.92 ,$32.92 ,$11.16 ,$13.95 ,$21.20 ,$21.39 ,$27.90 ,$11.16 ,$11.16 ,$11.38 ,$54.75 ,$43.80 ,$43.80 ,$11.16 ,$43.80 ,$16.12 ,$16.12 ,$16.12 ,$73.00 , N/A ,$62.05 ,$27.90 ,$47.45 ,$11.16 ,$73.00 ,$40.88 ,$11.16 ,$19.20 , N/A ,$10.64 ,$10.15 ,$11.72 ,$58.40 ,$25.11 ,$32.92 ,$20.44 ,$65.70 ,$11.16 ,$16.12 ,$22.32 ,$22.32 ,$11.16 ,$22.32 ,$35.04 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200860,86060,HC ASO-90,302,1 ,$330.00 ,$214.50 ,$7.30 ,$330.00 ,$18.25 ,$12.58 ,$184.80 ,$7.30 ,$92.40 ,$54.73 ,$7.30 ,$54.73 ,$7.30 ,$148.83 ,$148.83 ,$7.30 ,$9.13 ,$13.87 ,$14.47 ,$18.25 ,$7.30 ,$7.30 ,$7.45 ,$247.50 ,$198.00 ,$198.00 ,$7.30 ,$198.00 ,$10.54 ,$10.54 ,$10.54 ,$330.00 , N/A ,$280.50 ,$18.25 ,$214.50 ,$7.30 ,$330.00 ,$184.80 ,$7.30 ,$86.79 , N/A ,$10.64 ,$10.15 ,$7.67 ,$264.00 ,$16.43 ,$148.83 ,$92.40 ,$297.00 ,$7.30 ,$10.54 ,$14.60 ,$14.60 ,$7.30 ,$14.60 ,$158.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200861,86140,HC C-REACTIVE PROTEIN-90,302,1 ,$91.00 ,$59.15 ,$5.18 ,$91.00 ,$12.95 ,$8.93 ,$50.96 ,$5.18 ,$25.48 ,$32.12 ,$5.18 ,$37.49 ,$5.18 ,$41.04 ,$41.04 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$68.25 ,$54.60 ,$54.60 ,$5.18 ,$54.60 ,$7.48 ,$7.48 ,$7.48 ,$91.00 , N/A ,$77.35 ,$12.95 ,$59.15 ,$5.18 ,$91.00 ,$50.96 ,$5.18 ,$23.93 , N/A ,$10.64 ,$10.15 ,$5.44 ,$72.80 ,$11.66 ,$41.04 ,$25.48 ,$81.90 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$43.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200864,86146,HC BETA 2 GLYCO AB-90,302,1 ,$456.00 ,$296.40 ,$10.80 ,$456.00 ,$63.63 ,$43.86 ,$255.36 ,$25.45 ,$127.68 ,$160.97 ,$25.45 ,$187.87 ,$25.45 ,$205.66 ,$205.66 ,$25.45 ,$31.81 ,$48.36 ,$49.06 ,$63.63 ,$25.45 ,$25.45 ,$25.96 ,$342.00 ,$273.60 ,$273.60 ,$25.45 ,$273.60 ,$36.76 ,$36.76 ,$36.76 ,$456.00 , N/A ,$387.60 ,$63.63 ,$296.40 ,$25.45 ,$456.00 ,$255.36 ,$25.45 ,$119.93 , N/A ,$11.88 ,$11.34 ,$26.72 ,$364.80 ,$57.26 ,$205.66 ,$127.68 ,$410.40 ,$25.45 ,$36.76 ,$50.90 ,$50.90 ,$25.45 ,$50.90 ,$218.88 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30200865,86147,HC CARDIOLIPIN AB EA-90,302,1 ,$125.00 ,$81.25 ,$16.67 ,$125.00 ,$63.63 ,$43.86 ,$70.00 ,$25.45 ,$35.00 ,$44.13 ,$25.45 ,$51.50 ,$25.45 ,$56.38 ,$56.38 ,$25.45 ,$31.81 ,$48.36 ,$49.06 ,$63.63 ,$25.45 ,$25.45 ,$25.96 ,$93.75 ,$75.00 ,$75.00 ,$25.45 ,$75.00 ,$36.76 ,$36.76 ,$36.76 ,$125.00 , N/A ,$106.25 ,$63.63 ,$81.25 ,$25.45 ,$125.00 ,$70.00 ,$25.45 ,$32.88 , N/A ,$18.34 ,$17.50 ,$26.72 ,$100.00 ,$57.26 ,$56.38 ,$35.00 ,$112.50 ,$25.45 ,$36.76 ,$50.90 ,$50.90 ,$25.45 ,$50.90 ,$60.00 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200866,86148,HC ANTI-PHOSPHATIDYLSERINE AB-90,302,1 ,$85.00 ,$55.25 ,$10.80 ,$85.00 ,$40.18 ,$27.70 ,$47.60 ,$16.07 ,$23.80 ,$30.01 ,$16.07 ,$35.02 ,$16.07 ,$38.34 ,$38.34 ,$16.07 ,$20.09 ,$30.53 ,$31.45 ,$40.18 ,$16.07 ,$16.07 ,$16.39 ,$63.75 ,$51.00 ,$51.00 ,$16.07 ,$51.00 ,$23.21 ,$23.21 ,$23.21 ,$85.00 , N/A ,$72.25 ,$40.18 ,$55.25 ,$16.07 ,$85.00 ,$47.60 ,$16.07 ,$22.36 , N/A ,$11.88 ,$11.34 ,$16.87 ,$68.00 ,$36.16 ,$38.34 ,$23.80 ,$76.50 ,$16.07 ,$23.21 ,$32.14 ,$32.14 ,$16.07 ,$32.14 ,$40.80 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30200868,86157,HC COLD AGGLUTININ TITER-90,302,1 ,$201.00 ,$130.65 ,$8.06 ,$201.00 ,$20.15 ,$13.91 ,$112.56 ,$8.06 ,$56.28 ,$60.43 ,$8.06 ,$60.43 ,$8.06 ,$90.65 ,$90.65 ,$8.06 ,$10.08 ,$15.31 ,$15.73 ,$20.15 ,$8.06 ,$8.06 ,$8.22 ,$150.75 ,$120.60 ,$120.60 ,$8.06 ,$120.60 ,$11.65 ,$11.65 ,$11.65 ,$201.00 , N/A ,$170.85 ,$20.15 ,$130.65 ,$8.06 ,$201.00 ,$112.56 ,$8.06 ,$52.86 , N/A ,$10.64 ,$10.15 ,$8.46 ,$160.80 ,$18.14 ,$90.65 ,$56.28 ,$180.90 ,$8.06 ,$11.65 ,$16.12 ,$16.12 ,$8.06 ,$16.12 ,$96.48 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200869,86160,HC COMPLEMENT AG EA-90,302,1 ,$296.00 ,$192.40 ,$9.67 ,$296.00 ,$30.00 ,$20.69 ,$165.76 ,$12.00 ,$82.88 ,$89.94 ,$12.00 ,$89.94 ,$12.00 ,$133.50 ,$133.50 ,$12.00 ,$15.00 ,$22.80 ,$23.27 ,$30.00 ,$12.00 ,$12.00 ,$12.24 ,$222.00 ,$177.60 ,$177.60 ,$12.00 ,$177.60 ,$17.33 ,$17.33 ,$17.33 ,$296.00 , N/A ,$251.60 ,$30.00 ,$192.40 ,$12.00 ,$296.00 ,$165.76 ,$12.00 ,$77.85 , N/A ,$10.64 ,$10.15 ,$12.60 ,$236.80 ,$27.00 ,$133.50 ,$82.88 ,$266.40 ,$12.00 ,$17.33 ,$24.00 ,$24.00 ,$12.00 ,$24.00 ,$142.08 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200870,86161,HC C1 ESTERASE INHIBITOR-90,302,1 ,$254.00 ,$165.10 ,$9.67 ,$254.00 ,$30.00 ,$20.69 ,$142.24 ,$12.00 ,$71.12 ,$89.66 ,$12.00 ,$89.94 ,$12.00 ,$114.55 ,$114.55 ,$12.00 ,$15.00 ,$22.80 ,$23.27 ,$30.00 ,$12.00 ,$12.00 ,$12.24 ,$190.50 ,$152.40 ,$152.40 ,$12.00 ,$152.40 ,$17.33 ,$17.33 ,$17.33 ,$254.00 , N/A ,$215.90 ,$30.00 ,$165.10 ,$12.00 ,$254.00 ,$142.24 ,$12.00 ,$66.80 , N/A ,$10.64 ,$10.15 ,$12.60 ,$203.20 ,$27.00 ,$114.55 ,$71.12 ,$228.60 ,$12.00 ,$17.33 ,$24.00 ,$24.00 ,$12.00 ,$24.00 ,$121.92 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200871,86162,HC COMPLEMENT TOTAL-90,302,1 ,$188.00 ,$122.20 ,$9.67 ,$188.00 ,$50.80 ,$35.02 ,$105.28 ,$20.32 ,$52.64 ,$66.36 ,$20.32 ,$77.46 ,$20.32 ,$84.79 ,$84.79 ,$20.32 ,$25.40 ,$38.61 ,$39.63 ,$50.80 ,$20.32 ,$20.32 ,$20.73 ,$141.00 ,$112.80 ,$112.80 ,$20.32 ,$112.80 ,$29.35 ,$29.35 ,$29.35 ,$188.00 , N/A ,$159.80 ,$50.80 ,$122.20 ,$20.32 ,$188.00 ,$105.28 ,$20.32 ,$49.44 , N/A ,$10.64 ,$10.15 ,$21.34 ,$150.40 ,$45.72 ,$84.79 ,$52.64 ,$169.20 ,$20.32 ,$29.35 ,$40.64 ,$40.64 ,$20.32 ,$40.64 ,$90.24 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200873,86200,HC CCP AB-90,302,1 ,$252.00 ,$163.80 ,$9.67 ,$252.00 ,$32.38 ,$22.31 ,$141.12 ,$12.95 ,$70.56 ,$88.96 ,$12.95 ,$97.04 ,$12.95 ,$113.65 ,$113.65 ,$12.95 ,$16.19 ,$24.61 ,$25.16 ,$32.38 ,$12.95 ,$12.95 ,$13.21 ,$189.00 ,$151.20 ,$151.20 ,$12.95 ,$151.20 ,$18.71 ,$18.71 ,$18.71 ,$252.00 , N/A ,$214.20 ,$32.38 ,$163.80 ,$12.95 ,$252.00 ,$141.12 ,$12.95 ,$66.28 , N/A ,$10.64 ,$10.15 ,$13.60 ,$201.60 ,$29.14 ,$113.65 ,$70.56 ,$226.80 ,$12.95 ,$18.71 ,$25.90 ,$25.90 ,$12.95 ,$25.90 ,$120.96 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200874,86215,HC DEOXYRIBONUCLEASE AB-90,302,1 ,$93.00 ,$60.45 ,$9.67 ,$93.00 ,$33.13 ,$22.86 ,$52.08 ,$13.25 ,$26.04 ,$32.83 ,$13.25 ,$38.32 ,$13.25 ,$41.94 ,$41.94 ,$13.25 ,$16.56 ,$25.18 ,$25.79 ,$33.13 ,$13.25 ,$13.25 ,$13.52 ,$69.75 ,$55.80 ,$55.80 ,$13.25 ,$55.80 ,$19.14 ,$19.14 ,$19.14 ,$93.00 , N/A ,$79.05 ,$33.13 ,$60.45 ,$13.25 ,$93.00 ,$52.08 ,$13.25 ,$24.46 , N/A ,$10.64 ,$10.15 ,$13.91 ,$74.40 ,$29.81 ,$41.94 ,$26.04 ,$83.70 ,$13.25 ,$19.14 ,$26.50 ,$26.50 ,$13.25 ,$26.50 ,$44.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200875,86225,HC DNA DOUBLE STRAND AB-90,302,1 ,$201.00 ,$130.65 ,$9.67 ,$201.00 ,$34.35 ,$23.68 ,$112.56 ,$13.74 ,$56.28 ,$70.95 ,$13.74 ,$82.81 ,$13.74 ,$90.65 ,$90.65 ,$13.74 ,$17.18 ,$26.11 ,$26.42 ,$34.35 ,$13.74 ,$13.74 ,$14.01 ,$150.75 ,$120.60 ,$120.60 ,$13.74 ,$120.60 ,$19.85 ,$19.85 ,$19.85 ,$201.00 , N/A ,$170.85 ,$34.35 ,$130.65 ,$13.74 ,$201.00 ,$112.56 ,$13.74 ,$52.86 , N/A ,$10.64 ,$10.15 ,$14.43 ,$160.80 ,$30.92 ,$90.65 ,$56.28 ,$180.90 ,$13.74 ,$19.85 ,$27.48 ,$27.48 ,$13.74 ,$27.48 ,$96.48 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200876,86226,HC DNA SINGLE STRAND AB-90,302,1 ,$230.00 ,$149.50 ,$9.67 ,$230.00 ,$30.28 ,$20.88 ,$128.80 ,$12.11 ,$64.40 ,$81.19 ,$12.11 ,$90.78 ,$12.11 ,$103.73 ,$103.73 ,$12.11 ,$15.14 ,$23.01 ,$23.27 ,$30.28 ,$12.11 ,$12.11 ,$12.35 ,$172.50 ,$138.00 ,$138.00 ,$12.11 ,$138.00 ,$17.49 ,$17.49 ,$17.49 ,$230.00 , N/A ,$195.50 ,$30.28 ,$149.50 ,$12.11 ,$230.00 ,$128.80 ,$12.11 ,$60.49 , N/A ,$10.64 ,$10.15 ,$12.72 ,$184.00 ,$27.25 ,$103.73 ,$64.40 ,$207.00 ,$12.11 ,$17.49 ,$24.22 ,$24.22 ,$12.11 ,$24.22 ,$110.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200877,86235,HC ENA AB-90,302,1 ,$185.00 ,$120.25 ,$16.67 ,$185.00 ,$44.83 ,$30.57 ,$103.60 ,$17.93 ,$51.80 ,$65.31 ,$17.93 ,$76.22 ,$17.93 ,$83.44 ,$83.44 ,$17.93 ,$22.41 ,$34.07 ,$34.60 ,$44.83 ,$17.93 ,$17.93 ,$18.29 ,$138.75 ,$111.00 ,$111.00 ,$17.93 ,$111.00 ,$25.91 ,$25.91 ,$25.91 ,$185.00 , N/A ,$157.25 ,$44.83 ,$120.25 ,$17.93 ,$185.00 ,$103.60 ,$17.93 ,$48.66 , N/A ,$18.34 ,$17.50 ,$18.83 ,$148.00 ,$40.34 ,$83.44 ,$51.80 ,$166.50 ,$17.93 ,$25.91 ,$35.86 ,$35.86 ,$17.93 ,$35.86 ,$88.80 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200878,86255,HC FLUOR AB SCR-90,302,1 ,$177.00 ,$115.05 ,$12.05 ,$177.00 ,$30.13 ,$20.77 ,$99.12 ,$12.05 ,$49.56 ,$62.48 ,$12.05 ,$72.92 ,$12.05 ,$79.83 ,$79.83 ,$12.05 ,$15.06 ,$22.90 ,$23.27 ,$30.13 ,$12.05 ,$12.05 ,$12.29 ,$132.75 ,$106.20 ,$106.20 ,$12.05 ,$106.20 ,$17.41 ,$17.41 ,$17.41 ,$177.00 , N/A ,$150.45 ,$30.13 ,$115.05 ,$12.05 ,$177.00 ,$99.12 ,$12.05 ,$46.55 , N/A ,$18.34 ,$17.50 ,$12.65 ,$141.60 ,$27.11 ,$79.83 ,$49.56 ,$159.30 ,$12.05 ,$17.41 ,$24.10 ,$24.10 ,$12.05 ,$24.10 ,$84.96 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200879,86256,HC FLUOR AB TITER-90,302,1 ,$284.00 ,$184.60 ,$12.05 ,$284.00 ,$30.13 ,$20.77 ,$159.04 ,$12.05 ,$79.52 ,$90.32 ,$12.05 ,$90.32 ,$12.05 ,$128.08 ,$128.08 ,$12.05 ,$15.06 ,$22.90 ,$23.27 ,$30.13 ,$12.05 ,$12.05 ,$12.29 ,$213.00 ,$170.40 ,$170.40 ,$12.05 ,$170.40 ,$17.41 ,$17.41 ,$17.41 ,$284.00 , N/A ,$241.40 ,$30.13 ,$184.60 ,$12.05 ,$284.00 ,$159.04 ,$12.05 ,$74.69 , N/A ,$18.34 ,$17.50 ,$12.65 ,$227.20 ,$27.11 ,$128.08 ,$79.52 ,$255.60 ,$12.05 ,$17.41 ,$24.10 ,$24.10 ,$12.05 ,$24.10 ,$136.32 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200880,86300,HC TUMOR AG CA 15-3 (27.29)-90,302,1 ,$244.00 ,$158.60 ,$20.81 ,$244.00 ,$52.03 ,$35.88 ,$136.64 ,$20.81 ,$68.32 ,$86.13 ,$20.81 ,$100.53 ,$20.81 ,$110.04 ,$110.04 ,$20.81 ,$26.01 ,$39.54 ,$40.26 ,$52.03 ,$20.81 ,$20.81 ,$21.23 ,$183.00 ,$146.40 ,$146.40 ,$20.81 ,$146.40 ,$30.07 ,$30.07 ,$30.07 ,$244.00 , N/A ,$207.40 ,$52.03 ,$158.60 ,$20.81 ,$244.00 ,$136.64 ,$20.81 ,$64.17 , N/A ,$28.20 ,$26.92 ,$21.85 ,$195.20 ,$46.82 ,$110.04 ,$68.32 ,$219.60 ,$20.81 ,$30.07 ,$41.62 ,$41.62 ,$20.81 ,$41.62 ,$117.12 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30200881,86301,HC TUMOR AG CA 19-9  -90,302,1 ,$230.00 ,$149.50 ,$20.81 ,$230.00 ,$52.03 ,$35.88 ,$128.80 ,$20.81 ,$64.40 ,$81.19 ,$20.81 ,$94.76 ,$20.81 ,$103.73 ,$103.73 ,$20.81 ,$26.01 ,$39.54 ,$40.26 ,$52.03 ,$20.81 ,$20.81 ,$21.23 ,$172.50 ,$138.00 ,$138.00 ,$20.81 ,$138.00 ,$30.07 ,$30.07 ,$30.07 ,$230.00 , N/A ,$195.50 ,$52.03 ,$149.50 ,$20.81 ,$230.00 ,$128.80 ,$20.81 ,$60.49 , N/A ,$28.20 ,$26.92 ,$21.85 ,$184.00 ,$46.82 ,$103.73 ,$64.40 ,$207.00 ,$20.81 ,$30.07 ,$41.62 ,$41.62 ,$20.81 ,$41.62 ,$110.40 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30200882,86304,HC TUMOR AG CA 125 -90,302,1 ,$110.00 ,$71.50 ,$20.81 ,$110.00 ,$52.03 ,$35.88 ,$61.60 ,$20.81 ,$30.80 ,$38.83 ,$20.81 ,$45.32 ,$20.81 ,$49.61 ,$49.61 ,$20.81 ,$26.01 ,$39.54 ,$40.26 ,$52.03 ,$20.81 ,$20.81 ,$21.23 ,$82.50 ,$66.00 ,$66.00 ,$20.81 ,$66.00 ,$30.07 ,$30.07 ,$30.07 ,$110.00 , N/A ,$93.50 ,$52.03 ,$71.50 ,$20.81 ,$110.00 ,$61.60 ,$20.81 ,$28.93 , N/A ,$28.20 ,$26.92 ,$21.85 ,$88.00 ,$46.82 ,$49.61 ,$30.80 ,$99.00 ,$20.81 ,$30.07 ,$41.62 ,$41.62 ,$20.81 ,$41.62 ,$52.80 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30200886,86632,HC CHLAMYDIA AB IGM-90,302,1 ,$475.00 ,$308.75 ,$7.71 ,$475.00 ,$31.70 ,$21.88 ,$266.00 ,$12.68 ,$133.00 ,$95.08 ,$12.68 ,$95.08 ,$12.68 ,$214.23 ,$214.23 ,$12.68 ,$15.85 ,$24.09 ,$24.53 ,$31.70 ,$12.68 ,$12.68 ,$12.93 ,$356.25 ,$285.00 ,$285.00 ,$12.68 ,$285.00 ,$18.32 ,$18.32 ,$18.32 ,$475.00 , N/A ,$403.75 ,$31.70 ,$308.75 ,$12.68 ,$475.00 ,$266.00 ,$12.68 ,$124.93 , N/A ,$8.48 ,$8.10 ,$13.31 ,$380.00 ,$28.53 ,$214.23 ,$133.00 ,$427.50 ,$12.68 ,$18.32 ,$25.36 ,$25.36 ,$12.68 ,$25.36 ,$228.00 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30200887,86635,HC COCCIDIOIDES AB-90,302,1 ,$144.00 ,$93.60 ,$11.47 ,$144.00 ,$28.68 ,$19.79 ,$80.64 ,$11.47 ,$40.32 ,$50.83 ,$11.47 ,$59.33 ,$11.47 ,$64.94 ,$64.94 ,$11.47 ,$14.34 ,$21.79 ,$22.02 ,$28.68 ,$11.47 ,$11.47 ,$11.70 ,$108.00 ,$86.40 ,$86.40 ,$11.47 ,$86.40 ,$16.58 ,$16.58 ,$16.58 ,$144.00 , N/A ,$122.40 ,$28.68 ,$93.60 ,$11.47 ,$144.00 ,$80.64 ,$11.47 ,$37.87 , N/A ,$18.34 ,$17.50 ,$12.04 ,$115.20 ,$25.81 ,$64.94 ,$40.32 ,$129.60 ,$11.47 ,$16.58 ,$22.94 ,$22.94 ,$11.47 ,$22.94 ,$69.12 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200889,86641,HC CRYPTOCOCCAL AB-90,302,1 ,$164.00 ,$106.60 ,$14.41 ,$164.00 ,$36.03 ,$24.85 ,$91.84 ,$14.41 ,$45.92 ,$57.89 ,$14.41 ,$67.57 ,$14.41 ,$73.96 ,$73.96 ,$14.41 ,$18.01 ,$27.38 ,$27.68 ,$36.03 ,$14.41 ,$14.41 ,$14.70 ,$123.00 ,$98.40 ,$98.40 ,$14.41 ,$98.40 ,$20.81 ,$20.81 ,$20.81 ,$164.00 , N/A ,$139.40 ,$36.03 ,$106.60 ,$14.41 ,$164.00 ,$91.84 ,$14.41 ,$43.13 , N/A ,$18.34 ,$17.50 ,$15.13 ,$131.20 ,$32.42 ,$73.96 ,$45.92 ,$147.60 ,$14.41 ,$20.81 ,$28.82 ,$28.82 ,$14.41 ,$28.82 ,$78.72 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200890,86644,HC CMV AB-90,302,1 ,$125.00 ,$81.25 ,$14.39 ,$125.00 ,$35.98 ,$24.82 ,$70.00 ,$14.39 ,$35.00 ,$44.13 ,$14.39 ,$51.50 ,$14.39 ,$56.38 ,$56.38 ,$14.39 ,$17.99 ,$27.34 ,$27.68 ,$35.98 ,$14.39 ,$14.39 ,$14.68 ,$93.75 ,$75.00 ,$75.00 ,$14.39 ,$75.00 ,$20.79 ,$20.79 ,$20.79 ,$125.00 , N/A ,$106.25 ,$35.98 ,$81.25 ,$14.39 ,$125.00 ,$70.00 ,$14.39 ,$32.88 , N/A ,$18.34 ,$17.50 ,$15.11 ,$100.00 ,$32.38 ,$56.38 ,$35.00 ,$112.50 ,$14.39 ,$20.79 ,$28.78 ,$28.78 ,$14.39 ,$28.78 ,$60.00 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200891,86645,HC CMV AB IGM-90,302,1 ,$114.00 ,$74.10 ,$16.67 ,$114.00 ,$42.13 ,$29.03 ,$63.84 ,$16.85 ,$31.92 ,$40.24 ,$16.85 ,$46.97 ,$16.85 ,$51.41 ,$51.41 ,$16.85 ,$21.06 ,$32.02 ,$32.71 ,$42.13 ,$16.85 ,$16.85 ,$17.19 ,$85.50 ,$68.40 ,$68.40 ,$16.85 ,$68.40 ,$24.34 ,$24.34 ,$24.34 ,$114.00 , N/A ,$96.90 ,$42.13 ,$74.10 ,$16.85 ,$114.00 ,$63.84 ,$16.85 ,$29.98 , N/A ,$18.34 ,$17.50 ,$17.69 ,$91.20 ,$37.91 ,$51.41 ,$31.92 ,$102.60 ,$16.85 ,$24.34 ,$33.70 ,$33.70 ,$16.85 ,$33.70 ,$54.72 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200892,86648,HC DIPTHERIA-90,302,1 ,$145.00 ,$94.25 ,$15.21 ,$145.00 ,$38.03 ,$26.23 ,$81.20 ,$15.21 ,$40.60 ,$51.19 ,$15.21 ,$59.74 ,$15.21 ,$65.40 ,$65.40 ,$15.21 ,$19.01 ,$28.90 ,$29.56 ,$38.03 ,$15.21 ,$15.21 ,$15.51 ,$108.75 ,$87.00 ,$87.00 ,$15.21 ,$87.00 ,$21.97 ,$21.97 ,$21.97 ,$145.00 , N/A ,$123.25 ,$38.03 ,$94.25 ,$15.21 ,$145.00 ,$81.20 ,$15.21 ,$38.14 , N/A ,$18.34 ,$17.50 ,$15.97 ,$116.00 ,$34.22 ,$65.40 ,$40.60 ,$130.50 ,$15.21 ,$21.97 ,$30.42 ,$30.42 ,$15.21 ,$30.42 ,$69.60 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200897,86658,HC ENTEROVIRUS AB-90,302,1 ,$59.00 ,$38.35 ,$13.03 ,$59.00 ,$32.58 ,$22.47 ,$33.04 ,$13.03 ,$16.52 ,$20.83 ,$13.03 ,$24.31 ,$13.03 ,$26.61 ,$26.61 ,$13.03 ,$16.29 ,$24.76 ,$25.16 ,$32.58 ,$13.03 ,$13.03 ,$13.29 ,$44.25 ,$35.40 ,$35.40 ,$13.03 ,$35.40 ,$18.81 ,$18.81 ,$18.81 ,$59.00 , N/A ,$50.15 ,$32.58 ,$38.35 ,$13.03 ,$59.00 ,$33.04 ,$13.03 ,$15.52 , N/A ,$18.34 ,$17.50 ,$13.68 ,$47.20 ,$29.32 ,$26.61 ,$16.52 ,$53.10 ,$13.03 ,$18.81 ,$26.06 ,$26.06 ,$13.03 ,$26.06 ,$28.32 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200898,86663,HC EBV EARLY AG-90,302,1 ,$102.00 ,$66.30 ,$13.12 ,$102.00 ,$32.80 ,$22.61 ,$57.12 ,$13.12 ,$28.56 ,$36.01 ,$13.12 ,$42.02 ,$13.12 ,$46.00 ,$46.00 ,$13.12 ,$16.40 ,$24.93 ,$25.16 ,$32.80 ,$13.12 ,$13.12 ,$13.38 ,$76.50 ,$61.20 ,$61.20 ,$13.12 ,$61.20 ,$18.95 ,$18.95 ,$18.95 ,$102.00 , N/A ,$86.70 ,$32.80 ,$66.30 ,$13.12 ,$102.00 ,$57.12 ,$13.12 ,$26.83 , N/A ,$18.34 ,$17.50 ,$13.78 ,$81.60 ,$29.52 ,$46.00 ,$28.56 ,$91.80 ,$13.12 ,$18.95 ,$26.24 ,$26.24 ,$13.12 ,$26.24 ,$48.96 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200899,86664,HC EBV NUCLEAR AG-90,302,1 ,$166.00 ,$107.90 ,$15.29 ,$166.00 ,$38.23 ,$26.37 ,$92.96 ,$15.29 ,$46.48 ,$58.60 ,$15.29 ,$68.39 ,$15.29 ,$74.87 ,$74.87 ,$15.29 ,$19.11 ,$29.05 ,$29.56 ,$38.23 ,$15.29 ,$15.29 ,$15.60 ,$124.50 ,$99.60 ,$99.60 ,$15.29 ,$99.60 ,$22.09 ,$22.09 ,$22.09 ,$166.00 , N/A ,$141.10 ,$38.23 ,$107.90 ,$15.29 ,$166.00 ,$92.96 ,$15.29 ,$43.66 , N/A ,$18.34 ,$17.50 ,$16.05 ,$132.80 ,$34.40 ,$74.87 ,$46.48 ,$149.40 ,$15.29 ,$22.09 ,$30.58 ,$30.58 ,$15.29 ,$30.58 ,$79.68 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200900,86665,HC EBV VIRAL CAP-90,302,1 ,$253.00 ,$164.45 ,$16.67 ,$253.00 ,$45.35 ,$31.27 ,$141.68 ,$18.14 ,$70.84 ,$89.31 ,$18.14 ,$104.24 ,$18.14 ,$114.10 ,$114.10 ,$18.14 ,$22.68 ,$34.47 ,$35.23 ,$45.35 ,$18.14 ,$18.14 ,$18.50 ,$189.75 ,$151.80 ,$151.80 ,$18.14 ,$151.80 ,$26.21 ,$26.21 ,$26.21 ,$253.00 , N/A ,$215.05 ,$45.35 ,$164.45 ,$18.14 ,$253.00 ,$141.68 ,$18.14 ,$66.54 , N/A ,$18.34 ,$17.50 ,$19.05 ,$202.40 ,$40.82 ,$114.10 ,$70.84 ,$227.70 ,$18.14 ,$26.21 ,$36.28 ,$36.28 ,$18.14 ,$36.28 ,$121.44 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200901,86666,HC EHRLICHIA AB-90,302,1 ,$253.00 ,$164.45 ,$10.18 ,$253.00 ,$25.45 ,$17.54 ,$141.68 ,$10.18 ,$70.84 ,$76.21 ,$10.18 ,$76.21 ,$10.18 ,$114.10 ,$114.10 ,$10.18 ,$12.73 ,$19.34 ,$19.50 ,$25.45 ,$10.18 ,$10.18 ,$10.38 ,$189.75 ,$151.80 ,$151.80 ,$10.18 ,$151.80 ,$14.70 ,$14.70 ,$14.70 ,$253.00 , N/A ,$215.05 ,$25.45 ,$164.45 ,$10.18 ,$253.00 ,$141.68 ,$10.18 ,$66.54 , N/A ,$18.34 ,$17.50 ,$10.69 ,$202.40 ,$22.91 ,$114.10 ,$70.84 ,$227.70 ,$10.18 ,$14.70 ,$20.36 ,$20.36 ,$10.18 ,$20.36 ,$121.44 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200903,86671,HC FUNGUS AB NOS-90,302,1 ,$380.00 ,$247.00 ,$9.67 ,$380.00 ,$30.63 ,$21.14 ,$212.80 ,$12.25 ,$106.40 ,$91.81 ,$12.25 ,$91.81 ,$12.25 ,$171.38 ,$171.38 ,$12.25 ,$15.31 ,$23.28 ,$23.90 ,$30.63 ,$12.25 ,$12.25 ,$12.50 ,$285.00 ,$228.00 ,$228.00 ,$12.25 ,$228.00 ,$17.71 ,$17.71 ,$17.71 ,$380.00 , N/A ,$323.00 ,$30.63 ,$247.00 ,$12.25 ,$380.00 ,$212.80 ,$12.25 ,$99.94 , N/A ,$10.64 ,$10.15 ,$12.86 ,$304.00 ,$27.56 ,$171.38 ,$106.40 ,$342.00 ,$12.25 ,$17.71 ,$24.50 ,$24.50 ,$12.25 ,$24.50 ,$182.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200906,86682,HC HELMINTH ANTIBODY-90,302,1 ,$224.00 ,$145.60 ,$9.67 ,$224.00 ,$32.53 ,$22.44 ,$125.44 ,$13.01 ,$62.72 ,$79.07 ,$13.01 ,$92.29 ,$13.01 ,$101.02 ,$101.02 ,$13.01 ,$16.26 ,$24.72 ,$25.16 ,$32.53 ,$13.01 ,$13.01 ,$13.27 ,$168.00 ,$134.40 ,$134.40 ,$13.01 ,$134.40 ,$18.79 ,$18.79 ,$18.79 ,$224.00 , N/A ,$190.40 ,$32.53 ,$145.60 ,$13.01 ,$224.00 ,$125.44 ,$13.01 ,$58.91 , N/A ,$10.64 ,$10.15 ,$13.66 ,$179.20 ,$29.27 ,$101.02 ,$62.72 ,$201.60 ,$13.01 ,$18.79 ,$26.02 ,$26.02 ,$13.01 ,$26.02 ,$107.52 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200907,86684,HC HAEMOPHILUS INFLUENZA AB-90,302,1 ,$132.00 ,$85.80 ,$9.67 ,$132.00 ,$39.60 ,$27.32 ,$73.92 ,$15.84 ,$36.96 ,$46.60 ,$15.84 ,$54.38 ,$15.84 ,$59.53 ,$59.53 ,$15.84 ,$19.80 ,$30.10 ,$30.82 ,$39.60 ,$15.84 ,$15.84 ,$16.16 ,$99.00 ,$79.20 ,$79.20 ,$15.84 ,$79.20 ,$22.88 ,$22.88 ,$22.88 ,$132.00 , N/A ,$112.20 ,$39.60 ,$85.80 ,$15.84 ,$132.00 ,$73.92 ,$15.84 ,$34.72 , N/A ,$10.64 ,$10.15 ,$16.63 ,$105.60 ,$35.64 ,$59.53 ,$36.96 ,$118.80 ,$15.84 ,$22.88 ,$31.68 ,$31.68 ,$15.84 ,$31.68 ,$63.36 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200909,86689,HC HTLV OR HIV AB CONF-90,302,1 ,$393.00 ,$255.45 ,$16.67 ,$393.00 ,$48.38 ,$33.36 ,$220.08 ,$19.35 ,$110.04 ,$138.73 ,$19.35 ,$145.14 ,$19.35 ,$177.24 ,$177.24 ,$19.35 ,$24.19 ,$36.77 ,$37.74 ,$48.38 ,$19.35 ,$19.35 ,$19.74 ,$294.75 ,$235.80 ,$235.80 ,$19.35 ,$235.80 ,$27.96 ,$27.96 ,$27.96 ,$393.00 , N/A ,$334.05 ,$48.38 ,$255.45 ,$19.35 ,$393.00 ,$220.08 ,$19.35 ,$103.36 , N/A ,$18.34 ,$17.50 ,$20.32 ,$314.40 ,$43.54 ,$177.24 ,$110.04 ,$353.70 ,$19.35 ,$27.96 ,$38.70 ,$38.70 ,$19.35 ,$38.70 ,$188.64 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200911,86694,HC HERPES SIMPLEX AB-90,302,1 ,$251.00 ,$163.15 ,$14.39 ,$251.00 ,$35.98 ,$24.82 ,$140.56 ,$14.39 ,$70.28 ,$88.60 ,$14.39 ,$103.41 ,$14.39 ,$113.20 ,$113.20 ,$14.39 ,$17.99 ,$27.34 ,$27.68 ,$35.98 ,$14.39 ,$14.39 ,$14.68 ,$188.25 ,$150.60 ,$150.60 ,$14.39 ,$150.60 ,$20.79 ,$20.79 ,$20.79 ,$251.00 , N/A ,$213.35 ,$35.98 ,$163.15 ,$14.39 ,$251.00 ,$140.56 ,$14.39 ,$66.01 , N/A ,$18.34 ,$17.50 ,$15.11 ,$200.80 ,$32.38 ,$113.20 ,$70.28 ,$225.90 ,$14.39 ,$20.79 ,$28.78 ,$28.78 ,$14.39 ,$28.78 ,$120.48 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200912,86695,HC HERPES SIMPLEX AB I-90,302,1 ,$180.00 ,$117.00 ,$13.19 ,$180.00 ,$32.98 ,$22.73 ,$100.80 ,$13.19 ,$50.40 ,$63.54 ,$13.19 ,$74.16 ,$13.19 ,$81.18 ,$81.18 ,$13.19 ,$16.49 ,$25.06 ,$25.79 ,$32.98 ,$13.19 ,$13.19 ,$13.45 ,$135.00 ,$108.00 ,$108.00 ,$13.19 ,$108.00 ,$19.05 ,$19.05 ,$19.05 ,$180.00 , N/A ,$153.00 ,$32.98 ,$117.00 ,$13.19 ,$180.00 ,$100.80 ,$13.19 ,$47.34 , N/A ,$18.34 ,$17.50 ,$13.85 ,$144.00 ,$29.68 ,$81.18 ,$50.40 ,$162.00 ,$13.19 ,$19.05 ,$26.38 ,$26.38 ,$13.19 ,$26.38 ,$86.40 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200913,86696,HC HERPES SIMPLEX AB II-90,302,1 ,$93.00 ,$60.45 ,$9.67 ,$93.00 ,$48.38 ,$33.36 ,$52.08 ,$19.35 ,$26.04 ,$32.83 ,$19.35 ,$38.32 ,$19.35 ,$41.94 ,$41.94 ,$19.35 ,$24.19 ,$36.77 ,$37.74 ,$48.38 ,$19.35 ,$19.35 ,$19.74 ,$69.75 ,$55.80 ,$55.80 ,$19.35 ,$55.80 ,$27.96 ,$27.96 ,$27.96 ,$93.00 , N/A ,$79.05 ,$48.38 ,$60.45 ,$19.35 ,$93.00 ,$52.08 ,$19.35 ,$24.46 , N/A ,$10.64 ,$10.15 ,$20.32 ,$74.40 ,$43.54 ,$41.94 ,$26.04 ,$83.70 ,$19.35 ,$27.96 ,$38.70 ,$38.70 ,$19.35 ,$38.70 ,$44.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200914,86698,HC HISTOPLASMA AB-90,302,1 ,$228.00 ,$148.20 ,$13.79 ,$228.00 ,$34.48 ,$21.54 ,$127.68 ,$13.79 ,$63.84 ,$80.48 ,$13.79 ,$93.68 ,$13.79 ,$102.83 ,$102.83 ,$13.79 ,$17.24 ,$26.20 ,$24.53 ,$34.48 ,$13.79 ,$13.79 ,$14.07 ,$171.00 ,$136.80 ,$136.80 ,$13.79 ,$136.80 ,$18.04 ,$18.04 ,$18.04 ,$228.00 , N/A ,$193.80 ,$34.48 ,$148.20 ,$13.79 ,$228.00 ,$127.68 ,$13.79 ,$59.96 , N/A ,$18.34 ,$17.50 ,$14.48 ,$182.40 ,$31.03 ,$102.83 ,$63.84 ,$205.20 ,$13.79 ,$18.04 ,$27.58 ,$27.58 ,$13.79 ,$27.58 ,$109.44 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200915,86701,HC HIV-1 AB-90,302,1 ,$165.00 ,$107.25 ,$8.89 ,$165.00 ,$22.23 ,$15.31 ,$92.40 ,$8.89 ,$46.20 ,$58.25 ,$8.89 ,$67.98 ,$8.89 ,$74.42 ,$74.42 ,$8.89 ,$11.11 ,$16.89 ,$16.98 ,$22.23 ,$8.89 ,$8.89 ,$9.07 ,$123.75 ,$99.00 ,$99.00 ,$8.89 ,$99.00 ,$12.83 ,$12.83 ,$12.83 ,$165.00 , N/A ,$140.25 ,$22.23 ,$107.25 ,$8.89 ,$165.00 ,$92.40 ,$8.89 ,$43.40 , N/A ,$10.64 ,$10.15 ,$9.33 ,$132.00 ,$20.00 ,$74.42 ,$46.20 ,$148.50 ,$8.89 ,$12.83 ,$17.78 ,$17.78 ,$8.89 ,$17.78 ,$79.20 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200918,86702,HC HIV-2 AB-90,302,1 ,$165.00 ,$107.25 ,$9.67 ,$165.00 ,$33.80 ,$23.31 ,$92.40 ,$13.52 ,$46.20 ,$58.25 ,$13.52 ,$67.98 ,$13.52 ,$74.42 ,$74.42 ,$13.52 ,$16.90 ,$25.69 ,$26.42 ,$33.80 ,$13.52 ,$13.52 ,$13.79 ,$123.75 ,$99.00 ,$99.00 ,$13.52 ,$99.00 ,$19.53 ,$19.53 ,$19.53 ,$165.00 , N/A ,$140.25 ,$33.80 ,$107.25 ,$13.52 ,$165.00 ,$92.40 ,$13.52 ,$43.40 , N/A ,$10.64 ,$10.15 ,$14.20 ,$132.00 ,$30.42 ,$74.42 ,$46.20 ,$148.50 ,$13.52 ,$19.53 ,$27.04 ,$27.04 ,$13.52 ,$27.04 ,$79.20 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200921,86706,HC HEP B SURFACE AB-90,302,1 ,$146.00 ,$94.90 ,$9.67 ,$146.00 ,$26.85 ,$18.52 ,$81.76 ,$10.74 ,$40.88 ,$51.54 ,$10.74 ,$60.15 ,$10.74 ,$65.85 ,$65.85 ,$10.74 ,$13.43 ,$20.41 ,$20.76 ,$26.85 ,$10.74 ,$10.74 ,$10.95 ,$109.50 ,$87.60 ,$87.60 ,$10.74 ,$87.60 ,$15.51 ,$15.51 ,$15.51 ,$146.00 , N/A ,$124.10 ,$26.85 ,$94.90 ,$10.74 ,$146.00 ,$81.76 ,$10.74 ,$38.40 , N/A ,$10.64 ,$10.15 ,$11.28 ,$116.80 ,$24.17 ,$65.85 ,$40.88 ,$131.40 ,$10.74 ,$15.51 ,$21.48 ,$21.48 ,$10.74 ,$21.48 ,$70.08 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200923,86707,HC HEP B E AB-90,302,1 ,$186.00 ,$120.90 ,$9.67 ,$186.00 ,$28.93 ,$19.95 ,$104.16 ,$11.57 ,$52.08 ,$65.66 ,$11.57 ,$76.63 ,$11.57 ,$83.89 ,$83.89 ,$11.57 ,$14.46 ,$21.98 ,$22.64 ,$28.93 ,$11.57 ,$11.57 ,$11.80 ,$139.50 ,$111.60 ,$111.60 ,$11.57 ,$111.60 ,$16.71 ,$16.71 ,$16.71 ,$186.00 , N/A ,$158.10 ,$28.93 ,$120.90 ,$11.57 ,$186.00 ,$104.16 ,$11.57 ,$48.92 , N/A ,$10.64 ,$10.15 ,$12.15 ,$148.80 ,$26.03 ,$83.89 ,$52.08 ,$167.40 ,$11.57 ,$16.71 ,$23.14 ,$23.14 ,$11.57 ,$23.14 ,$89.28 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200924,86708,HC HEP A AB TOTAL-90,302,1 ,$195.00 ,$126.75 ,$9.67 ,$195.00 ,$30.98 ,$21.35 ,$109.20 ,$12.39 ,$54.60 ,$68.84 ,$12.39 ,$80.34 ,$12.39 ,$87.95 ,$87.95 ,$12.39 ,$15.49 ,$23.54 ,$23.90 ,$30.98 ,$12.39 ,$12.39 ,$12.64 ,$146.25 ,$117.00 ,$117.00 ,$12.39 ,$117.00 ,$17.89 ,$17.89 ,$17.89 ,$195.00 , N/A ,$165.75 ,$30.98 ,$126.75 ,$12.39 ,$195.00 ,$109.20 ,$12.39 ,$51.29 , N/A ,$10.64 ,$10.15 ,$13.01 ,$156.00 ,$27.88 ,$87.95 ,$54.60 ,$175.50 ,$12.39 ,$17.89 ,$24.78 ,$24.78 ,$12.39 ,$24.78 ,$93.60 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200925,86709,HC HEP A AB IGM-90,302,1 ,$364.00 ,$236.60 ,$9.67 ,$364.00 ,$28.15 ,$19.41 ,$203.84 ,$11.26 ,$101.92 ,$84.43 ,$11.26 ,$84.43 ,$11.26 ,$164.16 ,$164.16 ,$11.26 ,$14.08 ,$21.39 ,$22.02 ,$28.15 ,$11.26 ,$11.26 ,$11.49 ,$273.00 ,$218.40 ,$218.40 ,$11.26 ,$218.40 ,$16.26 ,$16.26 ,$16.26 ,$364.00 , N/A ,$309.40 ,$28.15 ,$236.60 ,$11.26 ,$364.00 ,$203.84 ,$11.26 ,$95.73 , N/A ,$10.64 ,$10.15 ,$11.82 ,$291.20 ,$25.34 ,$164.16 ,$101.92 ,$327.60 ,$11.26 ,$16.26 ,$22.52 ,$22.52 ,$11.26 ,$22.52 ,$174.72 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200926,86710,HC INFLUENZA AB-90,302,1 ,$93.00 ,$60.45 ,$9.67 ,$93.00 ,$33.88 ,$23.38 ,$52.08 ,$13.55 ,$26.04 ,$32.83 ,$13.55 ,$38.32 ,$13.55 ,$41.94 ,$41.94 ,$13.55 ,$16.94 ,$25.75 ,$26.42 ,$33.88 ,$13.55 ,$13.55 ,$13.82 ,$69.75 ,$55.80 ,$55.80 ,$13.55 ,$55.80 ,$19.58 ,$19.58 ,$19.58 ,$93.00 , N/A ,$79.05 ,$33.88 ,$60.45 ,$13.55 ,$93.00 ,$52.08 ,$13.55 ,$24.46 , N/A ,$10.64 ,$10.15 ,$14.23 ,$74.40 ,$30.49 ,$41.94 ,$26.04 ,$83.70 ,$13.55 ,$19.58 ,$27.10 ,$27.10 ,$13.55 ,$27.10 ,$44.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200927,86713,HC LEGIONELLA AB-90,302,1 ,$157.00 ,$102.05 ,$15.30 ,$157.00 ,$38.25 ,$26.37 ,$87.92 ,$15.30 ,$43.96 ,$55.42 ,$15.30 ,$64.68 ,$15.30 ,$70.81 ,$70.81 ,$15.30 ,$19.13 ,$29.07 ,$29.56 ,$38.25 ,$15.30 ,$15.30 ,$15.61 ,$117.75 ,$94.20 ,$94.20 ,$15.30 ,$94.20 ,$22.10 ,$22.10 ,$22.10 ,$157.00 , N/A ,$133.45 ,$38.25 ,$102.05 ,$15.30 ,$157.00 ,$87.92 ,$15.30 ,$41.29 , N/A ,$18.34 ,$17.50 ,$16.07 ,$125.60 ,$34.43 ,$70.81 ,$43.96 ,$141.30 ,$15.30 ,$22.10 ,$30.60 ,$30.60 ,$15.30 ,$30.60 ,$75.36 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200931,86735,HC MUMPS AB-90,302,1 ,$138.00 ,$89.70 ,$9.67 ,$138.00 ,$32.63 ,$22.51 ,$77.28 ,$13.05 ,$38.64 ,$48.71 ,$13.05 ,$56.86 ,$13.05 ,$62.24 ,$62.24 ,$13.05 ,$16.31 ,$24.80 ,$25.16 ,$32.63 ,$13.05 ,$13.05 ,$13.31 ,$103.50 ,$82.80 ,$82.80 ,$13.05 ,$82.80 ,$18.85 ,$18.85 ,$18.85 ,$138.00 , N/A ,$117.30 ,$32.63 ,$89.70 ,$13.05 ,$138.00 ,$77.28 ,$13.05 ,$36.29 , N/A ,$10.64 ,$10.15 ,$13.70 ,$110.40 ,$29.36 ,$62.24 ,$38.64 ,$124.20 ,$13.05 ,$18.85 ,$26.10 ,$26.10 ,$13.05 ,$26.10 ,$66.24 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200932,86738,HC MYCOPLASMA AB-90,302,1 ,$114.00 ,$74.10 ,$13.24 ,$114.00 ,$33.10 ,$22.84 ,$63.84 ,$13.24 ,$31.92 ,$40.24 ,$13.24 ,$46.97 ,$13.24 ,$51.41 ,$51.41 ,$13.24 ,$16.55 ,$25.16 ,$25.79 ,$33.10 ,$13.24 ,$13.24 ,$13.50 ,$85.50 ,$68.40 ,$68.40 ,$13.24 ,$68.40 ,$19.12 ,$19.12 ,$19.12 ,$114.00 , N/A ,$96.90 ,$33.10 ,$74.10 ,$13.24 ,$114.00 ,$63.84 ,$13.24 ,$29.98 , N/A ,$18.34 ,$17.50 ,$13.90 ,$91.20 ,$29.79 ,$51.41 ,$31.92 ,$102.60 ,$13.24 ,$19.12 ,$26.48 ,$26.48 ,$13.24 ,$26.48 ,$54.72 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200934,86744,HC NOCARDIA AB-90,302,1 ,$76.00 ,$49.40 ,$15.99 ,$76.00 ,$39.98 ,$22.73 ,$42.56 ,$15.99 ,$21.28 ,$26.83 ,$15.99 ,$31.31 ,$15.99 ,$34.28 ,$34.28 ,$15.99 ,$19.99 ,$30.38 ,$27.68 ,$39.98 ,$15.99 ,$15.99 ,$16.31 ,$57.00 ,$45.60 ,$45.60 ,$15.99 ,$45.60 ,$20.79 ,$20.79 ,$20.79 ,$76.00 , N/A ,$64.60 ,$39.98 ,$49.40 ,$15.99 ,$76.00 ,$42.56 ,$15.99 ,$19.99 , N/A ,$18.34 ,$17.50 ,$16.79 ,$60.80 ,$35.98 ,$34.28 ,$21.28 ,$68.40 ,$15.99 ,$20.79 ,$31.98 ,$31.98 ,$15.99 ,$31.98 ,$36.48 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200935,86747,HC PARVOVIRUS AB-90,302,1 ,$152.00 ,$98.80 ,$15.03 ,$152.00 ,$37.58 ,$25.92 ,$85.12 ,$15.03 ,$42.56 ,$53.66 ,$15.03 ,$62.62 ,$15.03 ,$68.55 ,$68.55 ,$15.03 ,$18.79 ,$28.56 ,$28.93 ,$37.58 ,$15.03 ,$15.03 ,$15.33 ,$114.00 ,$91.20 ,$91.20 ,$15.03 ,$91.20 ,$21.71 ,$21.71 ,$21.71 ,$152.00 , N/A ,$129.20 ,$37.58 ,$98.80 ,$15.03 ,$152.00 ,$85.12 ,$15.03 ,$39.98 , N/A ,$18.34 ,$17.50 ,$15.78 ,$121.60 ,$33.82 ,$68.55 ,$42.56 ,$136.80 ,$15.03 ,$21.71 ,$30.06 ,$30.06 ,$15.03 ,$30.06 ,$72.96 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200937,86753,HC PROTOZOA AB-90,302,1 ,$205.00 ,$133.25 ,$9.67 ,$205.00 ,$30.98 ,$21.35 ,$114.80 ,$12.39 ,$57.40 ,$72.37 ,$12.39 ,$84.46 ,$12.39 ,$92.46 ,$92.46 ,$12.39 ,$15.49 ,$23.54 ,$23.90 ,$30.98 ,$12.39 ,$12.39 ,$12.64 ,$153.75 ,$123.00 ,$123.00 ,$12.39 ,$123.00 ,$17.89 ,$17.89 ,$17.89 ,$205.00 , N/A ,$174.25 ,$30.98 ,$133.25 ,$12.39 ,$205.00 ,$114.80 ,$12.39 ,$53.92 , N/A ,$10.64 ,$10.15 ,$13.01 ,$164.00 ,$27.88 ,$92.46 ,$57.40 ,$184.50 ,$12.39 ,$17.89 ,$24.78 ,$24.78 ,$12.39 ,$24.78 ,$98.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200939,86757,HC RICKETTSIA AB-90,302,1 ,$122.00 ,$79.30 ,$16.67 ,$122.00 ,$48.38 ,$33.36 ,$68.32 ,$19.35 ,$34.16 ,$43.07 ,$19.35 ,$50.26 ,$19.35 ,$55.02 ,$55.02 ,$19.35 ,$24.19 ,$36.77 ,$37.74 ,$48.38 ,$19.35 ,$19.35 ,$19.74 ,$91.50 ,$73.20 ,$73.20 ,$19.35 ,$73.20 ,$27.96 ,$27.96 ,$27.96 ,$122.00 , N/A ,$103.70 ,$48.38 ,$79.30 ,$19.35 ,$122.00 ,$68.32 ,$19.35 ,$32.09 , N/A ,$18.34 ,$17.50 ,$20.32 ,$97.60 ,$43.54 ,$55.02 ,$34.16 ,$109.80 ,$19.35 ,$27.96 ,$38.70 ,$38.70 ,$19.35 ,$38.70 ,$58.56 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200940,86762,HC RUBELLA AB-90,302,1 ,$130.00 ,$84.50 ,$9.67 ,$130.00 ,$35.98 ,$24.82 ,$72.80 ,$14.39 ,$36.40 ,$45.89 ,$14.39 ,$53.56 ,$14.39 ,$58.63 ,$58.63 ,$14.39 ,$17.99 ,$27.34 ,$27.68 ,$35.98 ,$14.39 ,$14.39 ,$14.68 ,$97.50 ,$78.00 ,$78.00 ,$14.39 ,$78.00 ,$20.79 ,$20.79 ,$20.79 ,$130.00 , N/A ,$110.50 ,$35.98 ,$84.50 ,$14.39 ,$130.00 ,$72.80 ,$14.39 ,$34.19 , N/A ,$10.64 ,$10.15 ,$15.11 ,$104.00 ,$32.38 ,$58.63 ,$36.40 ,$117.00 ,$14.39 ,$20.79 ,$28.78 ,$28.78 ,$14.39 ,$28.78 ,$62.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200941,86765,HC RUBEOLA AB-90,302,1 ,$105.00 ,$68.25 ,$9.67 ,$105.00 ,$32.20 ,$22.21 ,$58.80 ,$12.88 ,$29.40 ,$37.07 ,$12.88 ,$43.26 ,$12.88 ,$47.36 ,$47.36 ,$12.88 ,$16.10 ,$24.47 ,$25.16 ,$32.20 ,$12.88 ,$12.88 ,$13.14 ,$78.75 ,$63.00 ,$63.00 ,$12.88 ,$63.00 ,$18.60 ,$18.60 ,$18.60 ,$105.00 , N/A ,$89.25 ,$32.20 ,$68.25 ,$12.88 ,$105.00 ,$58.80 ,$12.88 ,$27.62 , N/A ,$10.64 ,$10.15 ,$13.52 ,$84.00 ,$28.98 ,$47.36 ,$29.40 ,$94.50 ,$12.88 ,$18.60 ,$25.76 ,$25.76 ,$12.88 ,$25.76 ,$50.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200943,86774,HC TETANUS AB-90,302,1 ,$146.00 ,$94.90 ,$14.80 ,$146.00 ,$37.00 ,$25.50 ,$81.76 ,$14.80 ,$40.88 ,$51.54 ,$14.80 ,$60.15 ,$14.80 ,$65.85 ,$65.85 ,$14.80 ,$18.50 ,$28.12 ,$28.93 ,$37.00 ,$14.80 ,$14.80 ,$15.10 ,$109.50 ,$87.60 ,$87.60 ,$14.80 ,$87.60 ,$21.37 ,$21.37 ,$21.37 ,$146.00 , N/A ,$124.10 ,$37.00 ,$94.90 ,$14.80 ,$146.00 ,$81.76 ,$14.80 ,$38.40 , N/A ,$18.34 ,$17.50 ,$15.54 ,$116.80 ,$33.30 ,$65.85 ,$40.88 ,$131.40 ,$14.80 ,$21.37 ,$29.60 ,$29.60 ,$14.80 ,$29.60 ,$70.08 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200945,86778,HC TOXOPLASMA AB IGM-90,302,1 ,$257.00 ,$167.05 ,$14.41 ,$257.00 ,$36.03 ,$24.83 ,$143.92 ,$14.41 ,$71.96 ,$90.72 ,$14.41 ,$105.88 ,$14.41 ,$115.91 ,$115.91 ,$14.41 ,$18.01 ,$27.38 ,$27.68 ,$36.03 ,$14.41 ,$14.41 ,$14.70 ,$192.75 ,$154.20 ,$154.20 ,$14.41 ,$154.20 ,$20.81 ,$20.81 ,$20.81 ,$257.00 , N/A ,$218.45 ,$36.03 ,$167.05 ,$14.41 ,$257.00 ,$143.92 ,$14.41 ,$67.59 , N/A ,$18.34 ,$17.50 ,$15.13 ,$205.60 ,$32.42 ,$115.91 ,$71.96 ,$231.30 ,$14.41 ,$20.81 ,$28.82 ,$28.82 ,$14.41 ,$28.82 ,$123.36 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200946,86780,HC TREPONEMA P AB CONFIRM-90,302,1 ,$124.00 ,$80.60 ,$13.24 ,$124.00 ,$33.10 ,$22.82 ,$69.44 ,$13.24 ,$34.72 ,$43.77 ,$13.24 ,$51.09 ,$13.24 ,$55.92 ,$55.92 ,$13.24 ,$16.55 ,$25.16 ,$25.79 ,$33.10 ,$13.24 ,$13.24 ,$13.50 ,$93.00 ,$74.40 ,$74.40 ,$13.24 ,$74.40 ,$19.12 ,$19.12 ,$19.12 ,$124.00 , N/A ,$105.40 ,$33.10 ,$80.60 ,$13.24 ,$124.00 ,$69.44 ,$13.24 ,$32.61 , N/A ,$18.34 ,$17.50 ,$13.90 ,$99.20 ,$29.79 ,$55.92 ,$34.72 ,$111.60 ,$13.24 ,$19.12 ,$26.48 ,$26.48 ,$13.24 ,$26.48 ,$59.52 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200947,86784,HC TRICHANELLA AB-90,302,1 ,$78.00 ,$50.70 ,$12.56 ,$78.00 ,$31.40 ,$21.67 ,$43.68 ,$12.56 ,$21.84 ,$27.53 ,$12.56 ,$32.14 ,$12.56 ,$35.18 ,$35.18 ,$12.56 ,$15.70 ,$23.86 ,$24.53 ,$31.40 ,$12.56 ,$12.56 ,$12.81 ,$58.50 ,$46.80 ,$46.80 ,$12.56 ,$46.80 ,$18.15 ,$18.15 ,$18.15 ,$78.00 , N/A ,$66.30 ,$31.40 ,$50.70 ,$12.56 ,$78.00 ,$43.68 ,$12.56 ,$20.51 , N/A ,$18.34 ,$17.50 ,$13.19 ,$62.40 ,$28.26 ,$35.18 ,$21.84 ,$70.20 ,$12.56 ,$18.15 ,$25.12 ,$25.12 ,$12.56 ,$25.12 ,$37.44 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200948,86787,HC VARICELLA ZOSTER AB-90,302,1 ,$150.00 ,$97.50 ,$9.67 ,$150.00 ,$32.20 ,$22.21 ,$84.00 ,$12.88 ,$42.00 ,$52.95 ,$12.88 ,$61.80 ,$12.88 ,$67.65 ,$67.65 ,$12.88 ,$16.10 ,$24.47 ,$25.16 ,$32.20 ,$12.88 ,$12.88 ,$13.14 ,$112.50 ,$90.00 ,$90.00 ,$12.88 ,$90.00 ,$18.60 ,$18.60 ,$18.60 ,$150.00 , N/A ,$127.50 ,$32.20 ,$97.50 ,$12.88 ,$150.00 ,$84.00 ,$12.88 ,$39.45 , N/A ,$10.64 ,$10.15 ,$13.52 ,$120.00 ,$28.98 ,$67.65 ,$42.00 ,$135.00 ,$12.88 ,$18.60 ,$25.76 ,$25.76 ,$12.88 ,$25.76 ,$72.00 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200949,86788,HC WEST NILE VIRUS AB IGM-90,302,1 ,$104.00 ,$67.60 ,$16.67 ,$104.00 ,$42.13 ,$29.03 ,$58.24 ,$16.85 ,$29.12 ,$36.71 ,$16.85 ,$42.85 ,$16.85 ,$46.90 ,$46.90 ,$16.85 ,$21.06 ,$32.02 ,$32.71 ,$42.13 ,$16.85 ,$16.85 ,$17.19 ,$78.00 ,$62.40 ,$62.40 ,$16.85 ,$62.40 ,$24.34 ,$24.34 ,$24.34 ,$104.00 , N/A ,$88.40 ,$42.13 ,$67.60 ,$16.85 ,$104.00 ,$58.24 ,$16.85 ,$27.35 , N/A ,$18.34 ,$17.50 ,$17.69 ,$83.20 ,$37.91 ,$46.90 ,$29.12 ,$93.60 ,$16.85 ,$24.34 ,$33.70 ,$33.70 ,$16.85 ,$33.70 ,$49.92 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200950,86789,HC WEST NILE AB-90,302,1 ,$104.00 ,$67.60 ,$14.39 ,$104.00 ,$35.98 ,$24.82 ,$58.24 ,$14.39 ,$29.12 ,$36.71 ,$14.39 ,$42.85 ,$14.39 ,$46.90 ,$46.90 ,$14.39 ,$17.99 ,$27.34 ,$27.68 ,$35.98 ,$14.39 ,$14.39 ,$14.68 ,$78.00 ,$62.40 ,$62.40 ,$14.39 ,$62.40 ,$20.79 ,$20.79 ,$20.79 ,$104.00 , N/A ,$88.40 ,$35.98 ,$67.60 ,$14.39 ,$104.00 ,$58.24 ,$14.39 ,$27.35 , N/A ,$18.34 ,$17.50 ,$15.11 ,$83.20 ,$32.38 ,$46.90 ,$29.12 ,$93.60 ,$14.39 ,$20.79 ,$28.78 ,$28.78 ,$14.39 ,$28.78 ,$49.92 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200951,86790,HC VIRUS AB NOT SPECIFIED-90,302,1 ,$431.00 ,$280.15 ,$9.67 ,$431.00 ,$32.20 ,$22.21 ,$241.36 ,$12.88 ,$120.68 ,$96.58 ,$12.88 ,$96.58 ,$12.88 ,$194.38 ,$194.38 ,$12.88 ,$16.10 ,$24.47 ,$25.16 ,$32.20 ,$12.88 ,$12.88 ,$13.14 ,$323.25 ,$258.60 ,$258.60 ,$12.88 ,$258.60 ,$18.60 ,$18.60 ,$18.60 ,$431.00 , N/A ,$366.35 ,$32.20 ,$280.15 ,$12.88 ,$431.00 ,$241.36 ,$12.88 ,$113.35 , N/A ,$10.64 ,$10.15 ,$13.52 ,$344.80 ,$28.98 ,$194.38 ,$120.68 ,$387.90 ,$12.88 ,$18.60 ,$25.76 ,$25.76 ,$12.88 ,$25.76 ,$206.88 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200953,86800,HC THYROGLOBULIN AB-90,302,1 ,$192.00 ,$124.80 ,$15.91 ,$192.00 ,$39.78 ,$27.42 ,$107.52 ,$15.91 ,$53.76 ,$67.78 ,$15.91 ,$79.10 ,$15.91 ,$86.59 ,$86.59 ,$15.91 ,$19.89 ,$30.23 ,$30.82 ,$39.78 ,$15.91 ,$15.91 ,$16.23 ,$144.00 ,$115.20 ,$115.20 ,$15.91 ,$115.20 ,$22.97 ,$22.97 ,$22.97 ,$192.00 , N/A ,$163.20 ,$39.78 ,$124.80 ,$15.91 ,$192.00 ,$107.52 ,$15.91 ,$50.50 , N/A ,$27.81 ,$26.54 ,$16.71 ,$153.60 ,$35.80 ,$86.59 ,$53.76 ,$172.80 ,$15.91 ,$22.97 ,$31.82 ,$31.82 ,$15.91 ,$31.82 ,$92.16 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30200954,86803,HC HEP C AB-90,302,1 ,$20.00 ,$13.00 ,$5.26 ,$35.68 ,$35.68 ,$20.00 ,$11.20 ,$14.27 ,$5.60 ,$7.06 ,$14.27 ,$8.24 ,$14.27 ,$9.02 ,$9.02 ,$14.27 ,$17.84 ,$20.00 ,$20.00 ,$35.68 ,$14.27 ,$14.27 ,$14.56 ,$15.00 ,$12.00 ,$12.00 ,$14.27 ,$12.00 ,$20.00 ,$20.00 ,$20.00 ,$20.00 , N/A ,$17.00 ,$20.00 ,$13.00 ,$14.27 ,$20.00 ,$11.20 ,$14.27 ,$5.26 , N/A ,$18.34 ,$17.50 ,$14.98 ,$16.00 ,$32.11 ,$9.02 ,$5.60 ,$18.00 ,$14.27 ,$20.00 ,$20.00 ,$20.00 ,$14.27 ,$20.00 ,$9.60 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200955,86803,HC HEP C AB,302,1 ,$176.00 ,$114.40 ,$14.27 ,$176.00 ,$35.68 ,$24.61 ,$98.56 ,$14.27 ,$49.28 ,$62.13 ,$14.27 ,$72.51 ,$14.27 ,$79.38 ,$79.38 ,$14.27 ,$17.84 ,$27.11 ,$27.68 ,$35.68 ,$14.27 ,$14.27 ,$14.56 ,$132.00 ,$105.60 ,$105.60 ,$14.27 ,$105.60 ,$20.61 ,$20.61 ,$20.61 ,$176.00 , N/A ,$149.60 ,$35.68 ,$114.40 ,$14.27 ,$176.00 ,$98.56 ,$14.27 ,$46.29 , N/A ,$18.34 ,$17.50 ,$14.98 ,$140.80 ,$32.11 ,$79.38 ,$49.28 ,$158.40 ,$14.27 ,$20.61 ,$28.54 ,$28.54 ,$14.27 ,$28.54 ,$84.48 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30200956,86804,HC HEP C AB CONFIRM-90,302,1 ,$464.00 ,$301.60 ,$10.80 ,$464.00 ,$38.73 ,$26.71 ,$259.84 ,$15.49 ,$129.92 ,$116.10 ,$15.49 ,$116.10 ,$15.49 ,$209.26 ,$209.26 ,$15.49 ,$19.36 ,$29.43 ,$30.19 ,$38.73 ,$15.49 ,$15.49 ,$15.80 ,$348.00 ,$278.40 ,$278.40 ,$15.49 ,$278.40 ,$22.37 ,$22.37 ,$22.37 ,$464.00 , N/A ,$394.40 ,$38.73 ,$301.60 ,$15.49 ,$464.00 ,$259.84 ,$15.49 ,$122.03 , N/A ,$11.88 ,$11.34 ,$16.26 ,$371.20 ,$34.85 ,$209.26 ,$129.92 ,$417.60 ,$15.49 ,$22.37 ,$30.98 ,$30.98 ,$15.49 ,$30.98 ,$222.72 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30200960,86812,HC HLA TYPING SINGLE A/B/C-90,302,1 ,$229.00 ,$148.85 ,$25.81 ,$229.00 ,$64.53 ,$44.49 ,$128.24 ,$25.81 ,$64.12 ,$80.84 ,$25.81 ,$94.35 ,$25.81 ,$103.28 ,$103.28 ,$25.81 ,$32.26 ,$49.04 ,$50.32 ,$64.53 ,$25.81 ,$25.81 ,$26.33 ,$171.75 ,$137.40 ,$137.40 ,$25.81 ,$137.40 ,$37.27 ,$37.27 ,$37.27 ,$229.00 , N/A ,$194.65 ,$64.53 ,$148.85 ,$25.81 ,$229.00 ,$128.24 ,$25.81 ,$60.23 , N/A ,$42.96 ,$41.00 ,$27.10 ,$183.20 ,$58.07 ,$103.28 ,$64.12 ,$206.10 ,$25.81 ,$37.27 ,$51.62 ,$51.62 ,$25.81 ,$51.62 ,$109.92 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30200964,86850,HC AB SCREEN-90,302,1 ,$101.00 ,$65.65 ,$9.67 ,$122.48 ,$122.48 ,$19.22 ,$56.56 ,$48.99 ,$28.28 ,$35.65 ,$48.99 ,$41.61 ,$48.99 ,$45.55 ,$45.55 ,$48.99 ,$12.21 ,$93.08 ,$16.98 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$75.75 ,$60.60 ,$60.60 ,$48.99 ,$60.60 ,$12.70 ,$12.70 ,$12.70 ,$101.00 , N/A ,$85.85 ,$101.00 ,$65.65 ,$48.99 ,$101.00 ,$56.56 ,$48.99 ,$26.56 , N/A ,$10.64 ,$10.15 ,$51.44 ,$80.80 ,$110.23 ,$45.55 ,$28.28 ,$90.90 ,$48.99 ,$12.70 ,$19.54 ,$19.54 ,$48.99 ,$19.54 ,$48.48 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200966,86850,HC AB SCREEN-90,302,1 ,$192.00 ,$124.80 ,$9.67 ,$192.00 ,$122.48 ,$19.22 ,$107.52 ,$48.99 ,$53.76 ,$59.31 ,$48.99 ,$59.31 ,$48.99 ,$86.59 ,$86.59 ,$48.99 ,$12.21 ,$93.08 ,$16.98 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$144.00 ,$115.20 ,$115.20 ,$48.99 ,$115.20 ,$12.70 ,$12.70 ,$12.70 ,$192.00 , N/A ,$163.20 ,$122.48 ,$124.80 ,$48.99 ,$192.00 ,$107.52 ,$48.99 ,$50.50 , N/A ,$10.64 ,$10.15 ,$51.44 ,$153.60 ,$110.23 ,$86.59 ,$53.76 ,$172.80 ,$48.99 ,$12.70 ,$19.54 ,$19.54 ,$48.99 ,$19.54 ,$92.16 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200970,86860,HC ELUTION-90,302,1 ,$133.00 ,$86.45 ,$9.67 ,$367.60 ,$367.60 ,$24.83 ,$74.48 ,$147.04 ,$37.24 ,$46.95 ,$147.04 ,$54.80 ,$133.00 ,$59.98 ,$59.98 ,$133.00 ,$86.45 ,$133.00 ,$57.24 ,$367.59 ,$147.04 ,$147.04 ,$133.00 ,$99.75 ,$79.80 ,$79.80 ,$147.04 ,$79.80 ,$93.10 ,$93.10 ,$93.10 ,$133.00 , N/A ,$113.05 ,$133.00 ,$86.45 ,$147.04 ,$133.00 ,$74.48 ,$147.04 ,$34.98 , N/A ,$10.64 ,$10.15 ,$154.39 ,$106.40 ,$330.83 ,$59.98 ,$37.24 ,$119.70 ,$147.04 ,$93.10 ,$133.00 ,$133.00 ,$133.00 ,$133.00 ,$63.84 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200974,86870,HC RBC AB ID PANEL-90,302,1 ,$267.00 ,$173.55 ,$9.67 ,$717.84 ,$717.83 ,$34.04 ,$149.52 ,$287.13 ,$74.76 ,$94.25 ,$287.13 ,$110.00 ,$267.00 ,$120.42 ,$120.42 ,$267.00 ,$173.55 ,$267.00 ,$78.63 ,$717.84 ,$287.13 ,$287.13 ,$267.00 ,$200.25 ,$160.20 ,$160.20 ,$287.13 ,$160.20 ,$186.90 ,$186.90 ,$186.90 ,$267.00 , N/A ,$226.95 ,$267.00 ,$173.55 ,$287.13 ,$267.00 ,$149.52 ,$287.13 ,$70.22 , N/A ,$10.64 ,$10.15 ,$301.49 ,$213.60 ,$646.05 ,$120.42 ,$74.76 ,$240.30 ,$287.13 ,$186.90 ,$267.00 ,$267.00 ,$267.00 ,$267.00 ,$128.16 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200976,86880,HC COOMBS DIRECT-90,302,1 ,$86.00 ,$55.90 ,$6.74 ,$137.20 ,$137.20 ,$9.26 ,$48.16 ,$54.88 ,$24.08 ,$30.36 ,$54.88 ,$35.43 ,$54.88 ,$38.79 ,$38.79 ,$54.88 ,$6.74 ,$86.00 ,$10.69 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$64.50 ,$51.60 ,$51.60 ,$54.88 ,$51.60 ,$7.79 ,$7.79 ,$7.79 ,$86.00 , N/A ,$73.10 ,$86.00 ,$55.90 ,$54.88 ,$86.00 ,$48.16 ,$54.88 ,$22.62 , N/A ,$10.64 ,$10.15 ,$57.62 ,$68.80 ,$123.48 ,$38.79 ,$24.08 ,$77.40 ,$54.88 ,$7.79 ,$10.78 ,$10.78 ,$54.88 ,$10.78 ,$41.28 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200978,86886,HC INDIRECT TITER-90,302,1 ,$184.00 ,$119.60 ,$6.48 ,$367.60 ,$367.60 ,$8.93 ,$103.04 ,$147.04 ,$51.52 ,$38.76 ,$147.04 ,$38.76 ,$147.04 ,$82.98 ,$82.98 ,$147.04 ,$6.48 ,$184.00 ,$10.06 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$138.00 ,$110.40 ,$110.40 ,$147.04 ,$110.40 ,$7.48 ,$7.48 ,$7.48 ,$184.00 , N/A ,$156.40 ,$184.00 ,$119.60 ,$147.04 ,$184.00 ,$103.04 ,$147.04 ,$48.39 , N/A ,$10.64 ,$10.15 ,$154.39 ,$147.20 ,$330.83 ,$82.98 ,$51.52 ,$165.60 ,$147.04 ,$7.48 ,$10.36 ,$10.36 ,$147.04 ,$10.36 ,$88.32 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30200981,86900,HC BLOOD TYPING ABO-90,302,1 ,$128.00 ,$83.20 ,$3.74 ,$277.93 ,$277.93 ,$5.15 ,$71.68 ,$111.17 ,$35.84 ,$22.42 ,$111.17 ,$22.42 ,$111.17 ,$57.73 ,$57.73 ,$111.17 ,$3.74 ,$128.00 ,$5.66 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$96.00 ,$76.80 ,$76.80 ,$111.17 ,$76.80 ,$4.32 ,$4.32 ,$4.32 ,$128.00 , N/A ,$108.80 ,$128.00 ,$83.20 ,$111.17 ,$128.00 ,$71.68 ,$111.17 ,$33.66 , N/A ,$6.59 ,$6.29 ,$116.73 ,$102.40 ,$250.12 ,$57.73 ,$35.84 ,$115.20 ,$111.17 ,$4.32 ,$5.98 ,$5.98 ,$111.17 ,$5.98 ,$61.44 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200983,86901,HC BLOOD TYPING RH-90,302,1 ,$92.00 ,$59.80 ,$3.74 ,$92.00 ,$83.43 ,$5.15 ,$51.52 ,$33.37 ,$25.76 ,$22.42 ,$33.37 ,$22.42 ,$33.37 ,$41.49 ,$41.49 ,$33.37 ,$3.74 ,$63.41 ,$5.66 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$69.00 ,$55.20 ,$55.20 ,$33.37 ,$55.20 ,$4.32 ,$4.32 ,$4.32 ,$92.00 , N/A ,$78.20 ,$83.43 ,$59.80 ,$33.37 ,$92.00 ,$51.52 ,$33.37 ,$24.20 , N/A ,$6.59 ,$6.29 ,$35.04 ,$73.60 ,$75.08 ,$41.49 ,$25.76 ,$82.80 ,$33.37 ,$4.32 ,$5.98 ,$5.98 ,$33.37 ,$5.98 ,$44.16 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200988,86902,HC RBC AG SCR RGT SERUM ANTISERA-90,302,1 ,$963.00 ,$625.95 ,$5.99 ,$963.00 ,$717.83 ,$6.60 ,$539.28 ,$287.13 ,$269.64 ,$38.57 ,$287.13 ,$38.57 ,$287.13 ,$434.31 ,$434.31 ,$287.13 ,$7.94 ,$545.56 ,$11.32 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$722.25 ,$577.80 ,$577.80 ,$287.13 ,$577.80 ,$8.26 ,$8.26 ,$8.26 ,$963.00 , N/A ,$818.55 ,$717.84 ,$625.95 ,$287.13 ,$963.00 ,$539.28 ,$287.13 ,$253.27 , N/A ,$6.59 ,$6.29 ,$301.49 ,$770.40 ,$646.05 ,$434.31 ,$269.64 ,$866.70 ,$287.13 ,$8.26 ,$12.70 ,$12.70 ,$287.13 ,$12.70 ,$462.24 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200989,86902,HC RBC AG SCR RGT SERUM-90,302,1 ,$242.00 ,$157.30 ,$5.99 ,$717.84 ,$717.83 ,$6.60 ,$135.52 ,$287.13 ,$67.76 ,$38.57 ,$287.13 ,$38.57 ,$242.00 ,$109.14 ,$109.14 ,$242.00 ,$7.94 ,$242.00 ,$11.32 ,$717.84 ,$287.13 ,$287.13 ,$242.00 ,$181.50 ,$145.20 ,$145.20 ,$287.13 ,$145.20 ,$8.26 ,$8.26 ,$8.26 ,$242.00 , N/A ,$205.70 ,$242.00 ,$157.30 ,$287.13 ,$242.00 ,$135.52 ,$287.13 ,$63.65 , N/A ,$6.59 ,$6.29 ,$301.49 ,$193.60 ,$646.05 ,$109.14 ,$67.76 ,$217.80 ,$287.13 ,$8.26 ,$12.70 ,$12.70 ,$242.00 ,$12.70 ,$116.16 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200990,86904,HC RBC AG SCR PAT SERUM-90,302,1 ,$45.00 ,$29.25 ,$5.99 ,$83.43 ,$83.43 ,$16.40 ,$25.20 ,$33.37 ,$12.60 ,$15.89 ,$33.37 ,$18.54 ,$33.37 ,$20.30 ,$20.30 ,$33.37 ,$20.43 ,$45.00 ,$28.31 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$33.75 ,$27.00 ,$27.00 ,$33.37 ,$27.00 ,$21.24 ,$21.24 ,$21.24 ,$45.00 , N/A ,$38.25 ,$45.00 ,$29.25 ,$33.37 ,$45.00 ,$25.20 ,$33.37 ,$11.84 , N/A ,$6.59 ,$6.29 ,$35.04 ,$36.00 ,$75.08 ,$20.30 ,$12.60 ,$40.50 ,$33.37 ,$21.24 ,$32.68 ,$32.68 ,$33.37 ,$32.68 ,$21.60 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200997,86905,HC RBC AG TYPING NON ABO/RH-90,302,1 ,$184.00 ,$119.60 ,$4.79 ,$717.84 ,$717.83 ,$6.60 ,$103.04 ,$287.13 ,$51.52 ,$28.67 ,$287.13 ,$28.67 ,$184.00 ,$82.98 ,$82.98 ,$184.00 ,$4.79 ,$184.00 ,$7.55 ,$717.84 ,$287.13 ,$287.13 ,$184.00 ,$138.00 ,$110.40 ,$110.40 ,$287.13 ,$110.40 ,$5.53 ,$5.53 ,$5.53 ,$184.00 , N/A ,$156.40 ,$184.00 ,$119.60 ,$287.13 ,$184.00 ,$103.04 ,$287.13 ,$48.39 , N/A ,$6.59 ,$6.29 ,$301.49 ,$147.20 ,$646.05 ,$82.98 ,$51.52 ,$165.60 ,$287.13 ,$5.53 ,$7.66 ,$7.66 ,$184.00 ,$7.66 ,$88.32 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30200998,86906,HC RH PHENOTYPE COMPLETE-90,302,1 ,$83.00 ,$53.95 ,$5.99 ,$83.43 ,$83.43 ,$13.37 ,$46.48 ,$33.37 ,$23.24 ,$29.30 ,$33.37 ,$34.20 ,$33.37 ,$37.43 ,$37.43 ,$33.37 ,$9.69 ,$63.41 ,$15.10 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$62.25 ,$49.80 ,$49.80 ,$33.37 ,$49.80 ,$11.19 ,$11.19 ,$11.19 ,$83.00 , N/A ,$70.55 ,$83.00 ,$53.95 ,$33.37 ,$83.00 ,$46.48 ,$33.37 ,$21.83 , N/A ,$6.59 ,$6.29 ,$35.04 ,$66.40 ,$75.08 ,$37.43 ,$23.24 ,$74.70 ,$33.37 ,$11.19 ,$15.50 ,$15.50 ,$33.37 ,$15.50 ,$39.84 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201003,86970,HC RBC PRETREAT CHEM-90,302,1 ,$104.00 ,$67.60 ,$23.22 ,$104.00 ,$83.43 ,$23.22 ,$58.24 ,$33.37 ,$29.12 ,$36.71 ,$33.37 ,$42.85 ,$33.37 ,$46.90 ,$46.90 ,$33.37 ,$67.60 ,$63.41 ,$53.47 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$78.00 ,$62.40 ,$62.40 ,$33.37 ,$62.40 ,$72.80 ,$72.80 ,$72.80 ,$104.00 , N/A ,$88.40 ,$83.43 ,$67.60 ,$33.37 ,$104.00 ,$58.24 ,$33.37 ,$27.35 , N/A ,$42.96 ,$41.00 ,$35.04 ,$83.20 ,$75.08 ,$46.90 ,$29.12 ,$93.60 ,$33.37 ,$72.80 ,$67.68 ,$67.68 ,$33.37 ,$67.68 ,$49.92 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30201005,86971,HC RBC PRETREAT ENZYME-90,302,1 ,$44.00 ,$28.60 ,$11.57 ,$717.84 ,$717.83 ,$18.41 ,$24.64 ,$287.13 ,$12.32 ,$15.53 ,$287.13 ,$18.13 ,$44.00 ,$19.84 ,$19.84 ,$44.00 ,$28.60 ,$44.00 ,$42.77 ,$717.84 ,$287.13 ,$287.13 ,$44.00 ,$33.00 ,$26.40 ,$26.40 ,$287.13 ,$26.40 ,$30.80 ,$30.80 ,$30.80 ,$44.00 , N/A ,$37.40 ,$44.00 ,$28.60 ,$287.13 ,$44.00 ,$24.64 ,$287.13 ,$11.57 , N/A ,$42.96 ,$41.00 ,$301.49 ,$35.20 ,$646.05 ,$19.84 ,$12.32 ,$39.60 ,$287.13 ,$30.80 ,$44.00 ,$44.00 ,$44.00 ,$44.00 ,$21.12 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30201007,86972,HC RBC PRETREAT DENSITY SEP-90,302,1 ,$101.00 ,$65.65 ,$26.56 ,$367.60 ,$367.60 ,$32.43 ,$56.56 ,$147.04 ,$28.28 ,$35.65 ,$147.04 ,$41.61 ,$101.00 ,$45.55 ,$45.55 ,$101.00 ,$65.65 ,$101.00 ,$74.22 ,$367.59 ,$147.04 ,$147.04 ,$101.00 ,$75.75 ,$60.60 ,$60.60 ,$147.04 ,$60.60 ,$70.70 ,$70.70 ,$70.70 ,$101.00 , N/A ,$85.85 ,$101.00 ,$65.65 ,$147.04 ,$101.00 ,$56.56 ,$147.04 ,$26.56 , N/A ,$42.96 ,$41.00 ,$154.39 ,$80.80 ,$330.83 ,$45.55 ,$28.28 ,$90.90 ,$147.04 ,$70.70 ,$101.00 ,$101.00 ,$101.00 ,$101.00 ,$48.48 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30201011,86976,HC RBC PRETREAT SERUM DIL-90,302,1 ,$47.00 ,$30.55 ,$12.36 ,$60.90 ,$60.90 ,$27.63 ,$26.32 ,$24.36 ,$13.16 ,$16.59 ,$24.36 ,$19.36 ,$24.36 ,$21.20 ,$21.20 ,$24.36 ,$30.55 ,$46.27 ,$47.00 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$35.25 ,$28.20 ,$28.20 ,$24.36 ,$28.20 ,$32.90 ,$32.90 ,$32.90 ,$47.00 , N/A ,$39.95 ,$47.00 ,$30.55 ,$24.36 ,$47.00 ,$26.32 ,$24.36 ,$12.36 , N/A ,$42.96 ,$41.00 ,$25.58 ,$37.60 ,$54.80 ,$21.20 ,$13.16 ,$42.30 ,$24.36 ,$32.90 ,$47.00 ,$47.00 ,$24.36 ,$47.00 ,$22.56 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30201016,86977,HC RBC PRETREAT NEUTRAL SERUM INHIBIT-90,302,1 ,$106.00 ,$68.90 ,$27.63 ,$367.60 ,$367.60 ,$27.63 ,$59.36 ,$147.04 ,$29.68 ,$37.42 ,$147.04 ,$43.67 ,$106.00 ,$47.81 ,$47.81 ,$106.00 ,$68.90 ,$106.00 ,$63.53 ,$367.59 ,$147.04 ,$147.04 ,$106.00 ,$79.50 ,$63.60 ,$63.60 ,$147.04 ,$63.60 ,$74.20 ,$74.20 ,$74.20 ,$106.00 , N/A ,$90.10 ,$106.00 ,$68.90 ,$147.04 ,$106.00 ,$59.36 ,$147.04 ,$27.88 , N/A ,$42.96 ,$41.00 ,$154.39 ,$84.80 ,$330.83 ,$47.81 ,$29.68 ,$95.40 ,$147.04 ,$74.20 ,$106.00 ,$106.00 ,$106.00 ,$106.00 ,$50.88 ,$39.05 
ST. ELIZABETH'S HOSPITAL,30201020,86978,HC RBC PRETREAT ABSOR-90,302,1 ,$74.00 ,$48.10 ,$5.99 ,$83.43 ,$83.43 ,$27.63 ,$41.44 ,$33.37 ,$20.72 ,$26.12 ,$33.37 ,$30.49 ,$33.37 ,$33.37 ,$33.37 ,$33.37 ,$48.10 ,$63.41 ,$63.53 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$55.50 ,$44.40 ,$44.40 ,$33.37 ,$44.40 ,$51.80 ,$51.80 ,$51.80 ,$74.00 , N/A ,$62.90 ,$74.00 ,$48.10 ,$33.37 ,$74.00 ,$41.44 ,$33.37 ,$19.46 , N/A ,$6.59 ,$6.29 ,$35.04 ,$59.20 ,$75.08 ,$33.37 ,$20.72 ,$66.60 ,$33.37 ,$51.80 ,$67.68 ,$67.68 ,$33.37 ,$67.68 ,$35.52 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201022,87801,HC INFECT MLT  ORG AMP-90,302,1 ,$360.00 ,$234.00 ,$7.71 ,$360.00 ,$175.50 ,$121.01 ,$201.60 ,$70.20 ,$100.80 ,$127.08 ,$70.20 ,$148.32 ,$70.20 ,$162.36 ,$162.36 ,$70.20 ,$87.75 ,$133.38 ,$135.87 ,$175.50 ,$70.20 ,$70.20 ,$71.60 ,$270.00 ,$216.00 ,$216.00 ,$70.20 ,$216.00 ,$101.39 ,$101.39 ,$101.39 ,$360.00 , N/A ,$306.00 ,$175.50 ,$234.00 ,$70.20 ,$360.00 ,$201.60 ,$70.20 ,$94.68 , N/A ,$8.48 ,$8.10 ,$73.71 ,$288.00 ,$157.95 ,$162.36 ,$100.80 ,$324.00 ,$70.20 ,$101.39 ,$140.40 ,$140.40 ,$70.20 ,$140.40 ,$172.80 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30201025,86316,HC TUMOR AG OTHER AG QN-90,302,1 ,$857.00 ,$557.05 ,$10.80 ,$857.00 ,$52.03 ,$35.88 ,$479.92 ,$20.81 ,$239.96 ,$156.07 ,$20.81 ,$156.07 ,$20.81 ,$386.51 ,$386.51 ,$20.81 ,$26.01 ,$39.54 ,$40.26 ,$52.03 ,$20.81 ,$20.81 ,$21.23 ,$642.75 ,$514.20 ,$514.20 ,$20.81 ,$514.20 ,$30.07 ,$30.07 ,$30.07 ,$857.00 , N/A ,$728.45 ,$52.03 ,$557.05 ,$20.81 ,$857.00 ,$479.92 ,$20.81 ,$225.39 , N/A ,$11.88 ,$11.34 ,$21.85 ,$685.60 ,$46.82 ,$386.51 ,$239.96 ,$771.30 ,$20.81 ,$30.07 ,$41.62 ,$41.62 ,$20.81 ,$41.62 ,$411.36 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30201026,86317,HC INFECTIOUS AB QN-90,302,1 ,$19.00 ,$12.35 ,$5.00 ,$37.48 ,$37.48 ,$19.00 ,$10.64 ,$14.99 ,$5.32 ,$6.71 ,$14.99 ,$7.83 ,$14.99 ,$8.57 ,$8.57 ,$14.99 ,$18.74 ,$19.00 ,$19.00 ,$37.48 ,$14.99 ,$14.99 ,$15.29 ,$14.25 ,$11.40 ,$11.40 ,$14.99 ,$11.40 ,$19.00 ,$19.00 ,$19.00 ,$19.00 , N/A ,$16.15 ,$19.00 ,$12.35 ,$14.99 ,$19.00 ,$10.64 ,$14.99 ,$5.00 , N/A ,$18.34 ,$17.50 ,$15.74 ,$15.20 ,$33.73 ,$8.57 ,$5.32 ,$17.10 ,$14.99 ,$19.00 ,$19.00 ,$19.00 ,$14.99 ,$19.00 ,$9.12 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201028,86329,HC IMMUNODIFFUSION NOS-90,302,1 ,$18.00 ,$11.70 ,$4.73 ,$35.13 ,$35.13 ,$18.00 ,$10.08 ,$14.05 ,$5.04 ,$6.35 ,$14.05 ,$7.42 ,$14.05 ,$8.12 ,$8.12 ,$14.05 ,$17.56 ,$18.00 ,$18.00 ,$35.13 ,$14.05 ,$14.05 ,$14.33 ,$13.50 ,$10.80 ,$10.80 ,$14.05 ,$10.80 ,$18.00 ,$18.00 ,$18.00 ,$18.00 , N/A ,$15.30 ,$18.00 ,$11.70 ,$14.05 ,$18.00 ,$10.08 ,$14.05 ,$4.73 , N/A ,$18.00 ,$17.50 ,$14.75 ,$14.40 ,$31.61 ,$8.12 ,$5.04 ,$16.20 ,$14.05 ,$18.00 ,$18.00 ,$18.00 ,$14.05 ,$18.00 ,$8.64 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201029,86331,HC IMMUNODIFF EL EA AG AB QL-90,302,1 ,$73.00 ,$47.45 ,$11.98 ,$73.00 ,$29.95 ,$20.65 ,$40.88 ,$11.98 ,$20.44 ,$25.77 ,$11.98 ,$30.08 ,$11.98 ,$32.92 ,$32.92 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$54.75 ,$43.80 ,$43.80 ,$11.98 ,$43.80 ,$17.30 ,$17.30 ,$17.30 ,$73.00 , N/A ,$62.05 ,$29.95 ,$47.45 ,$11.98 ,$73.00 ,$40.88 ,$11.98 ,$19.20 , N/A ,$18.34 ,$17.50 ,$12.58 ,$58.40 ,$26.96 ,$32.92 ,$20.44 ,$65.70 ,$11.98 ,$17.30 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$35.04 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201030,86332,HC IMMUNE COMPLEX ASSAY-90,302,1 ,$127.00 ,$82.55 ,$16.67 ,$127.00 ,$60.93 ,$42.02 ,$71.12 ,$24.37 ,$35.56 ,$44.83 ,$24.37 ,$52.32 ,$24.37 ,$57.28 ,$57.28 ,$24.37 ,$30.46 ,$46.30 ,$47.18 ,$60.93 ,$24.37 ,$24.37 ,$24.86 ,$95.25 ,$76.20 ,$76.20 ,$24.37 ,$76.20 ,$35.20 ,$35.20 ,$35.20 ,$127.00 , N/A ,$107.95 ,$60.93 ,$82.55 ,$24.37 ,$127.00 ,$71.12 ,$24.37 ,$33.40 , N/A ,$18.34 ,$17.50 ,$25.59 ,$101.60 ,$54.83 ,$57.28 ,$35.56 ,$114.30 ,$24.37 ,$35.20 ,$48.74 ,$48.74 ,$24.37 ,$48.74 ,$60.96 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201031,86334,HC IMMUNOFIX ELECTRO SERUM -90,302,1 ,$358.00 ,$232.70 ,$16.67 ,$358.00 ,$55.85 ,$38.52 ,$200.48 ,$22.34 ,$100.24 ,$126.37 ,$22.34 ,$147.50 ,$22.34 ,$161.46 ,$161.46 ,$22.34 ,$27.93 ,$42.45 ,$43.40 ,$55.85 ,$22.34 ,$22.34 ,$22.79 ,$268.50 ,$214.80 ,$214.80 ,$22.34 ,$214.80 ,$32.28 ,$32.28 ,$32.28 ,$358.00 , N/A ,$304.30 ,$55.85 ,$232.70 ,$22.34 ,$358.00 ,$200.48 ,$22.34 ,$94.15 , N/A ,$18.34 ,$17.50 ,$23.46 ,$286.40 ,$50.27 ,$161.46 ,$100.24 ,$322.20 ,$22.34 ,$32.28 ,$44.68 ,$44.68 ,$22.34 ,$44.68 ,$171.84 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201032,86335,HC IMMUNOFIX ELECTRO OTH-90,302,1 ,$358.00 ,$232.70 ,$16.67 ,$358.00 ,$73.38 ,$50.59 ,$200.48 ,$29.35 ,$100.24 ,$126.37 ,$29.35 ,$147.50 ,$29.35 ,$161.46 ,$161.46 ,$29.35 ,$36.69 ,$55.77 ,$56.61 ,$73.38 ,$29.35 ,$29.35 ,$29.94 ,$268.50 ,$214.80 ,$214.80 ,$29.35 ,$214.80 ,$42.39 ,$42.39 ,$42.39 ,$358.00 , N/A ,$304.30 ,$73.38 ,$232.70 ,$29.35 ,$358.00 ,$200.48 ,$29.35 ,$94.15 , N/A ,$18.34 ,$17.50 ,$30.82 ,$286.40 ,$66.04 ,$161.46 ,$100.24 ,$322.20 ,$29.35 ,$42.39 ,$58.70 ,$58.70 ,$29.35 ,$58.70 ,$171.84 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201033,86336,HC INHIBIN A-90,302,1 ,$152.00 ,$98.80 ,$10.80 ,$152.00 ,$38.98 ,$26.86 ,$85.12 ,$15.59 ,$42.56 ,$53.66 ,$15.59 ,$62.62 ,$15.59 ,$68.55 ,$68.55 ,$15.59 ,$19.49 ,$29.62 ,$30.19 ,$38.98 ,$15.59 ,$15.59 ,$15.90 ,$114.00 ,$91.20 ,$91.20 ,$15.59 ,$91.20 ,$22.52 ,$22.52 ,$22.52 ,$152.00 , N/A ,$129.20 ,$38.98 ,$98.80 ,$15.59 ,$152.00 ,$85.12 ,$15.59 ,$39.98 , N/A ,$11.88 ,$11.34 ,$16.37 ,$121.60 ,$35.08 ,$68.55 ,$42.56 ,$136.80 ,$15.59 ,$22.52 ,$31.18 ,$31.18 ,$15.59 ,$31.18 ,$72.96 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30201034,86337,HC INSULIN AB-90,302,1 ,$510.00 ,$331.50 ,$21.41 ,$510.00 ,$53.53 ,$36.91 ,$285.60 ,$21.41 ,$142.80 ,$160.46 ,$21.41 ,$160.46 ,$21.41 ,$230.01 ,$230.01 ,$21.41 ,$26.76 ,$40.68 ,$41.52 ,$53.53 ,$21.41 ,$21.41 ,$21.84 ,$382.50 ,$306.00 ,$306.00 ,$21.41 ,$306.00 ,$30.93 ,$30.93 ,$30.93 ,$510.00 , N/A ,$433.50 ,$53.53 ,$331.50 ,$21.41 ,$510.00 ,$285.60 ,$21.41 ,$134.13 , N/A ,$27.81 ,$26.54 ,$22.48 ,$408.00 ,$48.17 ,$230.01 ,$142.80 ,$459.00 ,$21.41 ,$30.93 ,$42.82 ,$42.82 ,$21.41 ,$42.82 ,$244.80 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30201035,86340,HC INTRINSIC FACTOR AB-90,302,1 ,$104.00 ,$67.60 ,$15.08 ,$104.00 ,$37.70 ,$25.99 ,$58.24 ,$15.08 ,$29.12 ,$36.71 ,$15.08 ,$42.85 ,$15.08 ,$46.90 ,$46.90 ,$15.08 ,$18.85 ,$28.65 ,$28.93 ,$37.70 ,$15.08 ,$15.08 ,$15.38 ,$78.00 ,$62.40 ,$62.40 ,$15.08 ,$62.40 ,$21.78 ,$21.78 ,$21.78 ,$104.00 , N/A ,$88.40 ,$37.70 ,$67.60 ,$15.08 ,$104.00 ,$58.24 ,$15.08 ,$27.35 , N/A ,$27.81 ,$26.54 ,$15.83 ,$83.20 ,$33.93 ,$46.90 ,$29.12 ,$93.60 ,$15.08 ,$21.78 ,$30.16 ,$30.16 ,$15.08 ,$30.16 ,$49.92 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30201036,86341,HC ISLET CELL AB-90,302,1 ,$164.00 ,$106.60 ,$16.67 ,$164.00 ,$58.93 ,$34.13 ,$91.84 ,$23.57 ,$45.92 ,$57.89 ,$23.57 ,$67.57 ,$23.57 ,$73.96 ,$73.96 ,$23.57 ,$29.46 ,$44.78 ,$40.89 ,$58.93 ,$23.57 ,$23.57 ,$24.04 ,$123.00 ,$98.40 ,$98.40 ,$23.57 ,$98.40 ,$30.64 ,$30.64 ,$30.64 ,$164.00 , N/A ,$139.40 ,$58.93 ,$106.60 ,$23.57 ,$164.00 ,$91.84 ,$23.57 ,$43.13 , N/A ,$18.34 ,$17.50 ,$24.75 ,$131.20 ,$53.03 ,$73.96 ,$45.92 ,$147.60 ,$23.57 ,$30.64 ,$47.14 ,$47.14 ,$23.57 ,$47.14 ,$78.72 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201037,86343,HC LEUKOCYTE HISTAMINE RELEASE-90,302,1 ,$296.00 ,$192.40 ,$12.46 ,$296.00 ,$31.15 ,$21.49 ,$165.76 ,$12.46 ,$82.88 ,$93.40 ,$12.46 ,$93.40 ,$12.46 ,$133.50 ,$133.50 ,$12.46 ,$15.58 ,$23.67 ,$23.90 ,$31.15 ,$12.46 ,$12.46 ,$12.71 ,$222.00 ,$177.60 ,$177.60 ,$12.46 ,$177.60 ,$17.99 ,$17.99 ,$17.99 ,$296.00 , N/A ,$251.60 ,$31.15 ,$192.40 ,$12.46 ,$296.00 ,$165.76 ,$12.46 ,$77.85 , N/A ,$18.34 ,$17.50 ,$13.08 ,$236.80 ,$28.04 ,$133.50 ,$82.88 ,$266.40 ,$12.46 ,$17.99 ,$24.92 ,$24.92 ,$12.46 ,$24.92 ,$142.08 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201040,86355,HC B CELLS TOTAL COUNT-90,302,1 ,$194.00 ,$126.10 ,$16.67 ,$194.00 ,$94.33 ,$65.03 ,$108.64 ,$37.73 ,$54.32 ,$68.48 ,$37.73 ,$79.93 ,$37.73 ,$87.49 ,$87.49 ,$37.73 ,$47.16 ,$71.69 ,$72.97 ,$94.33 ,$37.73 ,$37.73 ,$38.48 ,$145.50 ,$116.40 ,$116.40 ,$37.73 ,$116.40 ,$54.50 ,$54.50 ,$54.50 ,$194.00 , N/A ,$164.90 ,$94.33 ,$126.10 ,$37.73 ,$194.00 ,$108.64 ,$37.73 ,$51.02 , N/A ,$18.34 ,$17.50 ,$39.62 ,$155.20 ,$84.89 ,$87.49 ,$54.32 ,$174.60 ,$37.73 ,$54.50 ,$75.46 ,$75.46 ,$37.73 ,$75.46 ,$93.12 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201042,86357,HC CD8 TOTAL COUNT-90,302,1 ,$258.00 ,$167.70 ,$16.67 ,$258.00 ,$94.33 ,$65.03 ,$144.48 ,$37.73 ,$72.24 ,$91.07 ,$37.73 ,$106.30 ,$37.73 ,$116.36 ,$116.36 ,$37.73 ,$47.16 ,$71.69 ,$72.97 ,$94.33 ,$37.73 ,$37.73 ,$38.48 ,$193.50 ,$154.80 ,$154.80 ,$37.73 ,$154.80 ,$54.50 ,$54.50 ,$54.50 ,$258.00 , N/A ,$219.30 ,$94.33 ,$167.70 ,$37.73 ,$258.00 ,$144.48 ,$37.73 ,$67.85 , N/A ,$18.34 ,$17.50 ,$39.62 ,$206.40 ,$84.89 ,$116.36 ,$72.24 ,$232.20 ,$37.73 ,$54.50 ,$75.46 ,$75.46 ,$37.73 ,$75.46 ,$123.84 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201043,86359,HC T CELLS TOTAL COUNT-90,302,1 ,$201.00 ,$130.65 ,$16.67 ,$201.00 ,$94.33 ,$65.03 ,$112.56 ,$37.73 ,$56.28 ,$70.95 ,$37.73 ,$82.81 ,$37.73 ,$90.65 ,$90.65 ,$37.73 ,$47.16 ,$71.69 ,$72.97 ,$94.33 ,$37.73 ,$37.73 ,$38.48 ,$150.75 ,$120.60 ,$120.60 ,$37.73 ,$120.60 ,$54.50 ,$54.50 ,$54.50 ,$201.00 , N/A ,$170.85 ,$94.33 ,$130.65 ,$37.73 ,$201.00 ,$112.56 ,$37.73 ,$52.86 , N/A ,$18.34 ,$17.50 ,$39.62 ,$160.80 ,$84.89 ,$90.65 ,$56.28 ,$180.90 ,$37.73 ,$54.50 ,$75.46 ,$75.46 ,$37.73 ,$75.46 ,$96.48 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201045,86360,HC ABS T CELLS CD4 CD8 RATIO-90,302,1 ,$341.00 ,$221.65 ,$16.67 ,$341.00 ,$117.45 ,$80.99 ,$190.96 ,$46.98 ,$95.48 ,$120.37 ,$46.98 ,$140.49 ,$46.98 ,$153.79 ,$153.79 ,$46.98 ,$58.73 ,$89.26 ,$91.21 ,$117.45 ,$46.98 ,$46.98 ,$47.92 ,$255.75 ,$204.60 ,$204.60 ,$46.98 ,$204.60 ,$67.86 ,$67.86 ,$67.86 ,$341.00 , N/A ,$289.85 ,$117.45 ,$221.65 ,$46.98 ,$341.00 ,$190.96 ,$46.98 ,$89.68 , N/A ,$18.34 ,$17.50 ,$49.33 ,$272.80 ,$105.71 ,$153.79 ,$95.48 ,$306.90 ,$46.98 ,$67.86 ,$93.96 ,$93.96 ,$46.98 ,$93.96 ,$163.68 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201046,86361,HC T CELLS CD4 COUNT-90,302,1 ,$220.00 ,$143.00 ,$16.67 ,$220.00 ,$66.95 ,$23.29 ,$123.20 ,$26.78 ,$61.60 ,$77.66 ,$26.78 ,$90.64 ,$26.78 ,$99.22 ,$99.22 ,$26.78 ,$33.48 ,$50.88 ,$52.21 ,$66.95 ,$26.78 ,$26.78 ,$27.32 ,$165.00 ,$132.00 ,$132.00 ,$26.78 ,$132.00 ,$38.68 ,$38.68 ,$38.68 ,$220.00 , N/A ,$187.00 ,$66.95 ,$143.00 ,$26.78 ,$220.00 ,$123.20 ,$26.78 ,$57.86 , N/A ,$18.34 ,$17.50 ,$28.12 ,$176.00 ,$60.26 ,$99.22 ,$61.60 ,$198.00 ,$26.78 ,$38.68 ,$53.56 ,$53.56 ,$26.78 ,$53.56 ,$105.60 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201047,86376,HC MICROSOMAL AB-90,302,1 ,$35.00 ,$22.75 ,$9.21 ,$36.38 ,$36.38 ,$25.10 ,$19.60 ,$14.55 ,$9.80 ,$12.36 ,$14.55 ,$14.42 ,$14.55 ,$15.79 ,$15.79 ,$14.55 ,$18.19 ,$27.65 ,$28.31 ,$36.38 ,$14.55 ,$14.55 ,$14.84 ,$26.25 ,$21.00 ,$21.00 ,$14.55 ,$21.00 ,$21.02 ,$21.02 ,$21.02 ,$35.00 , N/A ,$29.75 ,$35.00 ,$22.75 ,$14.55 ,$35.00 ,$19.60 ,$14.55 ,$9.21 , N/A ,$27.81 ,$26.54 ,$15.28 ,$28.00 ,$32.74 ,$15.79 ,$9.80 ,$31.50 ,$14.55 ,$21.02 ,$29.10 ,$29.10 ,$14.55 ,$29.10 ,$16.80 ,$25.28 
ST. ELIZABETH'S HOSPITAL,30201048,86382,HC NEUTRALIZATION TEST VIRAL-90,302,1 ,$437.00 ,$284.05 ,$16.67 ,$437.00 ,$42.28 ,$29.16 ,$244.72 ,$16.91 ,$122.36 ,$126.74 ,$16.91 ,$126.74 ,$16.91 ,$197.09 ,$197.09 ,$16.91 ,$21.14 ,$32.13 ,$32.71 ,$42.28 ,$16.91 ,$16.91 ,$17.25 ,$327.75 ,$262.20 ,$262.20 ,$16.91 ,$262.20 ,$24.43 ,$24.43 ,$24.43 ,$437.00 , N/A ,$371.45 ,$42.28 ,$284.05 ,$16.91 ,$437.00 ,$244.72 ,$16.91 ,$114.93 , N/A ,$18.34 ,$17.50 ,$17.76 ,$349.60 ,$38.05 ,$197.09 ,$122.36 ,$393.30 ,$16.91 ,$24.43 ,$33.82 ,$33.82 ,$16.91 ,$33.82 ,$209.76 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201052,86431,HC RHEUMATOID FACTOR QN-90,302,1 ,$70.00 ,$45.50 ,$5.67 ,$70.00 ,$14.18 ,$9.78 ,$39.20 ,$5.67 ,$19.60 ,$24.71 ,$5.67 ,$28.84 ,$5.67 ,$31.57 ,$31.57 ,$5.67 ,$7.09 ,$10.77 ,$10.69 ,$14.18 ,$5.67 ,$5.67 ,$5.78 ,$52.50 ,$42.00 ,$42.00 ,$5.67 ,$42.00 ,$8.19 ,$8.19 ,$8.19 ,$70.00 , N/A ,$59.50 ,$14.18 ,$45.50 ,$5.67 ,$70.00 ,$39.20 ,$5.67 ,$18.41 , N/A ,$10.64 ,$10.15 ,$5.95 ,$56.00 ,$12.76 ,$31.57 ,$19.60 ,$63.00 ,$5.67 ,$8.19 ,$11.34 ,$11.34 ,$5.67 ,$11.34 ,$33.60 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201053,86480,HC TB QUANTIFERON GOLD-90,302,1 ,$283.00 ,$183.95 ,$16.67 ,$283.00 ,$154.95 ,$106.84 ,$158.48 ,$61.98 ,$79.24 ,$99.90 ,$61.98 ,$116.60 ,$61.98 ,$127.63 ,$127.63 ,$61.98 ,$77.48 ,$117.76 ,$120.14 ,$154.95 ,$61.98 ,$61.98 ,$63.22 ,$212.25 ,$169.80 ,$169.80 ,$61.98 ,$169.80 ,$89.53 ,$89.53 ,$89.53 ,$283.00 , N/A ,$240.55 ,$154.95 ,$183.95 ,$61.98 ,$283.00 ,$158.48 ,$61.98 ,$74.43 , N/A ,$18.34 ,$17.50 ,$65.08 ,$226.40 ,$139.46 ,$127.63 ,$79.24 ,$254.70 ,$61.98 ,$89.53 ,$123.96 ,$123.96 ,$61.98 ,$123.96 ,$135.84 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201054,86592,HC SYPHILIS VDRL RPR QL-90,302,1 ,$124.00 ,$80.60 ,$4.27 ,$124.00 ,$10.68 ,$7.37 ,$69.44 ,$4.27 ,$34.72 ,$32.04 ,$4.27 ,$32.04 ,$4.27 ,$55.92 ,$55.92 ,$4.27 ,$5.34 ,$8.11 ,$8.18 ,$10.68 ,$4.27 ,$4.27 ,$4.36 ,$93.00 ,$74.40 ,$74.40 ,$4.27 ,$74.40 ,$6.18 ,$6.18 ,$6.18 ,$124.00 , N/A ,$105.40 ,$10.68 ,$80.60 ,$4.27 ,$124.00 ,$69.44 ,$4.27 ,$32.61 , N/A ,$10.64 ,$10.15 ,$4.48 ,$99.20 ,$9.61 ,$55.92 ,$34.72 ,$111.60 ,$4.27 ,$6.18 ,$8.54 ,$8.54 ,$4.27 ,$8.54 ,$59.52 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201055,86603,HC ADENOVIRUS AB-90,302,1 ,$279.00 ,$181.35 ,$12.87 ,$279.00 ,$32.18 ,$22.19 ,$156.24 ,$12.87 ,$78.12 ,$96.48 ,$12.87 ,$96.48 ,$12.87 ,$125.83 ,$125.83 ,$12.87 ,$16.09 ,$24.45 ,$25.16 ,$32.18 ,$12.87 ,$12.87 ,$13.13 ,$209.25 ,$167.40 ,$167.40 ,$12.87 ,$167.40 ,$18.59 ,$18.59 ,$18.59 ,$279.00 , N/A ,$237.15 ,$32.18 ,$181.35 ,$12.87 ,$279.00 ,$156.24 ,$12.87 ,$73.38 , N/A ,$18.34 ,$17.50 ,$13.51 ,$223.20 ,$28.96 ,$125.83 ,$78.12 ,$251.10 ,$12.87 ,$18.59 ,$25.74 ,$25.74 ,$12.87 ,$25.74 ,$133.92 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201056,86606,HC ASPERGILLUS AB-90,302,1 ,$228.00 ,$148.20 ,$15.05 ,$228.00 ,$37.63 ,$25.95 ,$127.68 ,$15.05 ,$63.84 ,$80.48 ,$15.05 ,$93.94 ,$15.05 ,$102.83 ,$102.83 ,$15.05 ,$18.81 ,$28.60 ,$28.93 ,$37.63 ,$15.05 ,$15.05 ,$15.35 ,$171.00 ,$136.80 ,$136.80 ,$15.05 ,$136.80 ,$21.75 ,$21.75 ,$21.75 ,$228.00 , N/A ,$193.80 ,$37.63 ,$148.20 ,$15.05 ,$228.00 ,$127.68 ,$15.05 ,$59.96 , N/A ,$18.34 ,$17.50 ,$15.80 ,$182.40 ,$33.86 ,$102.83 ,$63.84 ,$205.20 ,$15.05 ,$21.75 ,$30.10 ,$30.10 ,$15.05 ,$30.10 ,$109.44 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201057,86609,HC BACTERIUM AB NOS-90,302,1 ,$570.00 ,$370.50 ,$12.88 ,$570.00 ,$32.20 ,$22.21 ,$319.20 ,$12.88 ,$159.60 ,$96.58 ,$12.88 ,$96.58 ,$12.88 ,$257.07 ,$257.07 ,$12.88 ,$16.10 ,$24.47 ,$25.16 ,$32.20 ,$12.88 ,$12.88 ,$13.14 ,$427.50 ,$342.00 ,$342.00 ,$12.88 ,$342.00 ,$18.60 ,$18.60 ,$18.60 ,$570.00 , N/A ,$484.50 ,$32.20 ,$370.50 ,$12.88 ,$570.00 ,$319.20 ,$12.88 ,$149.91 , N/A ,$28.20 ,$26.92 ,$13.52 ,$456.00 ,$28.98 ,$257.07 ,$159.60 ,$513.00 ,$12.88 ,$18.60 ,$25.76 ,$25.76 ,$12.88 ,$25.76 ,$273.60 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30201058,86611,HC BARTONELLA SCREEN AB-90,302,1 ,$74.00 ,$48.10 ,$10.18 ,$74.00 ,$25.45 ,$17.54 ,$41.44 ,$10.18 ,$20.72 ,$26.12 ,$10.18 ,$30.49 ,$10.18 ,$33.37 ,$33.37 ,$10.18 ,$12.73 ,$19.34 ,$19.50 ,$25.45 ,$10.18 ,$10.18 ,$10.38 ,$55.50 ,$44.40 ,$44.40 ,$10.18 ,$44.40 ,$14.70 ,$14.70 ,$14.70 ,$74.00 , N/A ,$62.90 ,$25.45 ,$48.10 ,$10.18 ,$74.00 ,$41.44 ,$10.18 ,$19.46 , N/A ,$18.34 ,$17.50 ,$10.69 ,$59.20 ,$22.91 ,$33.37 ,$20.72 ,$66.60 ,$10.18 ,$14.70 ,$20.36 ,$20.36 ,$10.18 ,$20.36 ,$35.52 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201060,86612,HC BLASTOMYCES AB-90,302,1 ,$207.00 ,$134.55 ,$12.90 ,$207.00 ,$32.25 ,$22.24 ,$115.92 ,$12.90 ,$57.96 ,$73.07 ,$12.90 ,$85.28 ,$12.90 ,$93.36 ,$93.36 ,$12.90 ,$16.13 ,$24.51 ,$25.16 ,$32.25 ,$12.90 ,$12.90 ,$13.16 ,$155.25 ,$124.20 ,$124.20 ,$12.90 ,$124.20 ,$18.64 ,$18.64 ,$18.64 ,$207.00 , N/A ,$175.95 ,$32.25 ,$134.55 ,$12.90 ,$207.00 ,$115.92 ,$12.90 ,$54.44 , N/A ,$18.34 ,$17.50 ,$13.55 ,$165.60 ,$29.03 ,$93.36 ,$57.96 ,$186.30 ,$12.90 ,$18.64 ,$25.80 ,$25.80 ,$12.90 ,$25.80 ,$99.36 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201061,86615,HC BORDETELLA AB-90,302,1 ,$275.00 ,$178.75 ,$13.19 ,$275.00 ,$32.98 ,$22.73 ,$154.00 ,$13.19 ,$77.00 ,$97.08 ,$13.19 ,$98.82 ,$13.19 ,$124.03 ,$124.03 ,$13.19 ,$16.49 ,$25.06 ,$25.79 ,$32.98 ,$13.19 ,$13.19 ,$13.45 ,$206.25 ,$165.00 ,$165.00 ,$13.19 ,$165.00 ,$19.05 ,$19.05 ,$19.05 ,$275.00 , N/A ,$233.75 ,$32.98 ,$178.75 ,$13.19 ,$275.00 ,$154.00 ,$13.19 ,$72.33 , N/A ,$18.34 ,$17.50 ,$13.85 ,$220.00 ,$29.68 ,$124.03 ,$77.00 ,$247.50 ,$13.19 ,$19.05 ,$26.38 ,$26.38 ,$13.19 ,$26.38 ,$132.00 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201062,86617,HC LYME DISEASE AB CONFIRM-90,302,1 ,$157.00 ,$102.05 ,$15.49 ,$157.00 ,$38.73 ,$26.71 ,$87.92 ,$15.49 ,$43.96 ,$55.42 ,$15.49 ,$64.68 ,$15.49 ,$70.81 ,$70.81 ,$15.49 ,$19.36 ,$29.43 ,$30.19 ,$38.73 ,$15.49 ,$15.49 ,$15.80 ,$117.75 ,$94.20 ,$94.20 ,$15.49 ,$94.20 ,$22.37 ,$22.37 ,$22.37 ,$157.00 , N/A ,$133.45 ,$38.73 ,$102.05 ,$15.49 ,$157.00 ,$87.92 ,$15.49 ,$41.29 , N/A ,$18.34 ,$17.50 ,$16.26 ,$125.60 ,$34.85 ,$70.81 ,$43.96 ,$141.30 ,$15.49 ,$22.37 ,$30.98 ,$30.98 ,$15.49 ,$30.98 ,$75.36 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201063,86618,HC LYME AB-90,302,1 ,$189.00 ,$122.85 ,$16.67 ,$189.00 ,$42.58 ,$29.37 ,$105.84 ,$17.03 ,$52.92 ,$66.72 ,$17.03 ,$77.87 ,$17.03 ,$85.24 ,$85.24 ,$17.03 ,$21.29 ,$32.36 ,$32.71 ,$42.58 ,$17.03 ,$17.03 ,$17.37 ,$141.75 ,$113.40 ,$113.40 ,$17.03 ,$113.40 ,$24.60 ,$24.60 ,$24.60 ,$189.00 , N/A ,$160.65 ,$42.58 ,$122.85 ,$17.03 ,$189.00 ,$105.84 ,$17.03 ,$49.71 , N/A ,$18.34 ,$17.50 ,$17.88 ,$151.20 ,$38.32 ,$85.24 ,$52.92 ,$170.10 ,$17.03 ,$24.60 ,$34.06 ,$34.06 ,$17.03 ,$34.06 ,$90.72 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201065,86622,HC BRUCELLA AB-90,302,1 ,$112.00 ,$72.80 ,$8.93 ,$112.00 ,$22.33 ,$15.40 ,$62.72 ,$8.93 ,$31.36 ,$39.54 ,$8.93 ,$46.14 ,$8.93 ,$50.51 ,$50.51 ,$8.93 ,$11.16 ,$16.97 ,$17.61 ,$22.33 ,$8.93 ,$8.93 ,$9.11 ,$84.00 ,$67.20 ,$67.20 ,$8.93 ,$67.20 ,$12.90 ,$12.90 ,$12.90 ,$112.00 , N/A ,$95.20 ,$22.33 ,$72.80 ,$8.93 ,$112.00 ,$62.72 ,$8.93 ,$29.46 , N/A ,$18.34 ,$17.50 ,$9.38 ,$89.60 ,$20.09 ,$50.51 ,$31.36 ,$100.80 ,$8.93 ,$12.90 ,$17.86 ,$17.86 ,$8.93 ,$17.86 ,$53.76 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201066,86628,HC CANDIDA AB-90,302,1 ,$45.00 ,$29.25 ,$7.71 ,$45.00 ,$30.03 ,$20.70 ,$25.20 ,$12.01 ,$12.60 ,$15.89 ,$12.01 ,$18.54 ,$12.01 ,$20.30 ,$20.30 ,$12.01 ,$15.01 ,$22.82 ,$23.27 ,$30.03 ,$12.01 ,$12.01 ,$12.25 ,$33.75 ,$27.00 ,$27.00 ,$12.01 ,$27.00 ,$17.34 ,$17.34 ,$17.34 ,$45.00 , N/A ,$38.25 ,$30.03 ,$29.25 ,$12.01 ,$45.00 ,$25.20 ,$12.01 ,$11.84 , N/A ,$8.48 ,$8.10 ,$12.61 ,$36.00 ,$27.02 ,$20.30 ,$12.60 ,$40.50 ,$12.01 ,$17.34 ,$24.02 ,$24.02 ,$12.01 ,$24.02 ,$21.60 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30201067,86631,HC CHLAMYDIA AB-90,302,1 ,$279.00 ,$181.35 ,$7.71 ,$279.00 ,$29.55 ,$20.39 ,$156.24 ,$11.82 ,$78.12 ,$88.64 ,$11.82 ,$88.64 ,$11.82 ,$125.83 ,$125.83 ,$11.82 ,$14.78 ,$22.46 ,$22.64 ,$29.55 ,$11.82 ,$11.82 ,$12.06 ,$209.25 ,$167.40 ,$167.40 ,$11.82 ,$167.40 ,$17.08 ,$17.08 ,$17.08 ,$279.00 , N/A ,$237.15 ,$29.55 ,$181.35 ,$11.82 ,$279.00 ,$156.24 ,$11.82 ,$73.38 , N/A ,$8.48 ,$8.10 ,$12.41 ,$223.20 ,$26.60 ,$125.83 ,$78.12 ,$251.10 ,$11.82 ,$17.08 ,$23.64 ,$23.64 ,$11.82 ,$23.64 ,$133.92 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30201079,86711,HC AB JOHN CUNNINGHAM VIRUS-90,302,1 ,"$2,267.00 ","$1,473.55 ",$9.67 ,"$2,267.00 ",$42.23 ,$24.24 ,"$1,269.52 ",$16.89 ,$634.76 ,$107.88 ,$16.89 ,$107.88 ,$16.89 ,"$1,022.42 ","$1,022.42 ",$16.89 ,$21.11 ,$32.09 ,$29.56 ,$42.23 ,$16.89 ,$16.89 ,$17.23 ,"$1,700.25 ","$1,360.20 ","$1,360.20 ",$16.89 ,"$1,360.20 ",$21.96 ,$21.96 ,$21.96 ,"$2,267.00 ", N/A ,"$1,926.95 ",$42.23 ,"$1,473.55 ",$16.89 ,"$2,267.00 ","$1,269.52 ",$16.89 ,$596.22 , N/A ,$10.64 ,$10.15 ,$17.73 ,"$1,813.60 ",$38.00 ,"$1,022.42 ",$634.76 ,"$2,040.30 ",$16.89 ,$21.96 ,$33.78 ,$33.78 ,$16.89 ,$33.78 ,"$1,088.16 ",$9.67 
ST. ELIZABETH'S HOSPITAL,30201088,86008,HC ALLERGEN IGE QN/SEMI-QN RECOMB/COMP EA-90,302,1 ,$40.16 ,$26.10 ,$9.67 ,$44.83 ,$44.83 ,$27.13 ,$22.49 ,$17.93 ,$11.24 ,$14.18 ,$17.93 ,$16.55 ,$17.93 ,$18.11 ,$18.11 ,$17.93 ,$22.41 ,$34.07 ,$34.60 ,$44.83 ,$17.93 ,$17.93 ,$18.29 ,$30.12 ,$24.10 ,$24.10 ,$17.93 ,$24.10 ,$25.91 ,$25.91 ,$25.91 ,$40.16 , N/A ,$34.14 ,$40.16 ,$26.10 ,$17.93 ,$40.16 ,$22.49 ,$17.93 ,$10.56 , N/A ,$10.64 ,$10.15 ,$18.83 ,$32.13 ,$40.34 ,$18.11 ,$11.24 ,$36.14 ,$17.93 ,$25.91 ,$35.86 ,$35.86 ,$17.93 ,$35.86 ,$19.28 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201096,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201108,86431,HC RHEUMATOID FACTOR QN,302,1 ,$2.40 ,$1.56 ,$0.63 ,$9.67 ,$6.00 ,$2.40 ,$1.34 ,$2.40 ,$0.67 ,$0.85 ,$2.40 ,$0.99 ,$2.40 ,$1.08 ,$1.08 ,$2.40 ,$2.40 ,$2.40 ,$2.40 ,$6.00 ,$2.40 ,$2.40 ,$2.40 ,$1.80 ,$1.44 ,$1.44 ,$2.40 ,$1.44 ,$2.40 ,$2.40 ,$2.40 ,$2.40 , N/A ,$2.04 ,$2.40 ,$1.56 ,$2.40 ,$2.40 ,$1.34 ,$2.40 ,$0.63 , N/A ,$2.40 ,$2.40 ,$2.52 ,$1.92 ,$5.40 ,$1.08 ,$0.67 ,$2.16 ,$2.40 ,$2.40 ,$2.40 ,$2.40 ,$2.40 ,$2.40 ,$1.15 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201110,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$2.05 ,$1.33 ,$0.54 ,$9.67 ,$5.13 ,$2.05 ,$1.15 ,$2.05 ,$0.57 ,$0.72 ,$2.05 ,$0.84 ,$2.05 ,$0.92 ,$0.92 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$5.13 ,$2.05 ,$2.05 ,$2.05 ,$1.54 ,$1.23 ,$1.23 ,$2.05 ,$1.23 ,$2.05 ,$2.05 ,$2.05 ,$2.05 , N/A ,$1.74 ,$2.05 ,$1.33 ,$2.05 ,$2.05 ,$1.15 ,$2.05 ,$0.54 , N/A ,$2.05 ,$2.05 ,$2.15 ,$1.64 ,$4.61 ,$0.92 ,$0.57 ,$1.85 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$2.05 ,$0.98 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201121,86704,HC HEP CORE AB,302,1 ,$2.75 ,$1.79 ,$0.72 ,$9.67 ,$6.88 ,$2.75 ,$1.54 ,$2.75 ,$0.77 ,$0.97 ,$2.75 ,$1.13 ,$2.75 ,$1.24 ,$1.24 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$6.88 ,$2.75 ,$2.75 ,$2.75 ,$2.06 ,$1.65 ,$1.65 ,$2.75 ,$1.65 ,$2.75 ,$2.75 ,$2.75 ,$2.75 , N/A ,$2.34 ,$2.75 ,$1.79 ,$2.75 ,$2.75 ,$1.54 ,$2.75 ,$0.72 , N/A ,$2.75 ,$2.75 ,$2.89 ,$2.20 ,$6.19 ,$1.24 ,$0.77 ,$2.48 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$1.32 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201122,86705,HC HEP B CORE IGM,302,1 ,$2.75 ,$1.79 ,$0.72 ,$9.67 ,$6.88 ,$2.75 ,$1.54 ,$2.75 ,$0.77 ,$0.97 ,$2.75 ,$1.13 ,$2.75 ,$1.24 ,$1.24 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$6.88 ,$2.75 ,$2.75 ,$2.75 ,$2.06 ,$1.65 ,$1.65 ,$2.75 ,$1.65 ,$2.75 ,$2.75 ,$2.75 ,$2.75 , N/A ,$2.34 ,$2.75 ,$1.79 ,$2.75 ,$2.75 ,$1.54 ,$2.75 ,$0.72 , N/A ,$2.75 ,$2.75 ,$2.89 ,$2.20 ,$6.19 ,$1.24 ,$0.77 ,$2.48 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$1.32 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201123,86706,HC HEP B SURFACE AB,302,1 ,$2.66 ,$1.73 ,$0.70 ,$9.67 ,$6.65 ,$2.66 ,$1.49 ,$2.66 ,$0.74 ,$0.94 ,$2.66 ,$1.10 ,$2.66 ,$1.20 ,$1.20 ,$2.66 ,$2.66 ,$2.66 ,$2.66 ,$6.65 ,$2.66 ,$2.66 ,$2.66 ,$2.00 ,$1.60 ,$1.60 ,$2.66 ,$1.60 ,$2.66 ,$2.66 ,$2.66 ,$2.66 , N/A ,$2.26 ,$2.66 ,$1.73 ,$2.66 ,$2.66 ,$1.49 ,$2.66 ,$0.70 , N/A ,$2.66 ,$2.66 ,$2.79 ,$2.13 ,$5.99 ,$1.20 ,$0.74 ,$2.39 ,$2.66 ,$2.66 ,$2.66 ,$2.66 ,$2.66 ,$2.66 ,$1.28 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201125,86709,HC HEP A AB (HAAB) IGM,302,1 ,$4.60 ,$2.99 ,$1.21 ,$11.50 ,$11.50 ,$4.60 ,$2.58 ,$4.60 ,$1.29 ,$1.62 ,$4.60 ,$1.90 ,$4.60 ,$2.07 ,$2.07 ,$4.60 ,$4.60 ,$4.60 ,$4.60 ,$11.50 ,$4.60 ,$4.60 ,$4.60 ,$3.45 ,$2.76 ,$2.76 ,$4.60 ,$2.76 ,$4.60 ,$4.60 ,$4.60 ,$4.60 , N/A ,$3.91 ,$4.60 ,$2.99 ,$4.60 ,$4.60 ,$2.58 ,$4.60 ,$1.21 , N/A ,$4.60 ,$4.60 ,$4.83 ,$3.68 ,$10.35 ,$2.07 ,$1.29 ,$4.14 ,$4.60 ,$4.60 ,$4.60 ,$4.60 ,$4.60 ,$4.60 ,$2.21 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201127,86762,HC RUBELLA AB,302,1 ,$4.20 ,$2.73 ,$1.10 ,$10.50 ,$10.50 ,$4.20 ,$2.35 ,$4.20 ,$1.18 ,$1.48 ,$4.20 ,$1.73 ,$4.20 ,$1.89 ,$1.89 ,$4.20 ,$4.20 ,$4.20 ,$4.20 ,$10.50 ,$4.20 ,$4.20 ,$4.20 ,$3.15 ,$2.52 ,$2.52 ,$4.20 ,$2.52 ,$4.20 ,$4.20 ,$4.20 ,$4.20 , N/A ,$3.57 ,$4.20 ,$2.73 ,$4.20 ,$4.20 ,$2.35 ,$4.20 ,$1.10 , N/A ,$4.20 ,$4.20 ,$4.41 ,$3.36 ,$9.45 ,$1.89 ,$1.18 ,$3.78 ,$4.20 ,$4.20 ,$4.20 ,$4.20 ,$4.20 ,$4.20 ,$2.02 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30201132,86803,HC HEP C AB,302,1 ,$2.75 ,$1.79 ,$0.72 ,$16.67 ,$6.88 ,$2.75 ,$1.54 ,$2.75 ,$0.77 ,$0.97 ,$2.75 ,$1.13 ,$2.75 ,$1.24 ,$1.24 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$6.88 ,$2.75 ,$2.75 ,$2.75 ,$2.06 ,$1.65 ,$1.65 ,$2.75 ,$1.65 ,$2.75 ,$2.75 ,$2.75 ,$2.75 , N/A ,$2.34 ,$2.75 ,$1.79 ,$2.75 ,$2.75 ,$1.54 ,$2.75 ,$0.72 , N/A ,$2.75 ,$2.75 ,$2.89 ,$2.20 ,$6.19 ,$1.24 ,$0.77 ,$2.48 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$2.75 ,$1.32 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201134,86902,HC RBC AG SCR RGT SERUM T1-90,302,1 ,$88.00 ,$57.20 ,$5.99 ,$717.84 ,$717.83 ,$6.60 ,$49.28 ,$287.13 ,$24.64 ,$31.06 ,$287.13 ,$36.26 ,$88.00 ,$39.69 ,$39.69 ,$88.00 ,$7.94 ,$88.00 ,$11.32 ,$717.84 ,$287.13 ,$287.13 ,$88.00 ,$66.00 ,$52.80 ,$52.80 ,$287.13 ,$52.80 ,$8.26 ,$8.26 ,$8.26 ,$88.00 , N/A ,$74.80 ,$88.00 ,$57.20 ,$287.13 ,$88.00 ,$49.28 ,$287.13 ,$23.14 , N/A ,$6.59 ,$6.29 ,$301.49 ,$70.40 ,$646.05 ,$39.69 ,$24.64 ,$79.20 ,$287.13 ,$8.26 ,$12.70 ,$12.70 ,$88.00 ,$12.70 ,$42.24 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201135,86902,HC RBC AG SCR RGT SERUM T2-90,302,1 ,$184.00 ,$119.60 ,$5.99 ,$717.84 ,$717.83 ,$6.60 ,$103.04 ,$287.13 ,$51.52 ,$38.57 ,$287.13 ,$38.57 ,$184.00 ,$82.98 ,$82.98 ,$184.00 ,$7.94 ,$184.00 ,$11.32 ,$717.84 ,$287.13 ,$287.13 ,$184.00 ,$138.00 ,$110.40 ,$110.40 ,$287.13 ,$110.40 ,$8.26 ,$8.26 ,$8.26 ,$184.00 , N/A ,$156.40 ,$184.00 ,$119.60 ,$287.13 ,$184.00 ,$103.04 ,$287.13 ,$48.39 , N/A ,$6.59 ,$6.29 ,$301.49 ,$147.20 ,$646.05 ,$82.98 ,$51.52 ,$165.60 ,$287.13 ,$8.26 ,$12.70 ,$12.70 ,$184.00 ,$12.70 ,$88.32 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201136,86902,HC RBC AG SCR RGT SERUM T3-90,302,1 ,$198.00 ,$128.70 ,$5.99 ,$717.84 ,$717.83 ,$6.60 ,$110.88 ,$287.13 ,$55.44 ,$38.57 ,$287.13 ,$38.57 ,$198.00 ,$89.30 ,$89.30 ,$198.00 ,$7.94 ,$198.00 ,$11.32 ,$717.84 ,$287.13 ,$287.13 ,$198.00 ,$148.50 ,$118.80 ,$118.80 ,$287.13 ,$118.80 ,$8.26 ,$8.26 ,$8.26 ,$198.00 , N/A ,$168.30 ,$198.00 ,$128.70 ,$287.13 ,$198.00 ,$110.88 ,$287.13 ,$52.07 , N/A ,$6.59 ,$6.29 ,$301.49 ,$158.40 ,$646.05 ,$89.30 ,$55.44 ,$178.20 ,$287.13 ,$8.26 ,$12.70 ,$12.70 ,$198.00 ,$12.70 ,$95.04 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201137,86902,HC RBC AG SCR RGT SERUM T4-90,302,1 ,$244.00 ,$158.60 ,$5.99 ,$717.84 ,$717.83 ,$6.60 ,$136.64 ,$287.13 ,$68.32 ,$38.57 ,$287.13 ,$38.57 ,$244.00 ,$110.04 ,$110.04 ,$244.00 ,$7.94 ,$244.00 ,$11.32 ,$717.84 ,$287.13 ,$287.13 ,$244.00 ,$183.00 ,$146.40 ,$146.40 ,$287.13 ,$146.40 ,$8.26 ,$8.26 ,$8.26 ,$244.00 , N/A ,$207.40 ,$244.00 ,$158.60 ,$287.13 ,$244.00 ,$136.64 ,$287.13 ,$64.17 , N/A ,$6.59 ,$6.29 ,$301.49 ,$195.20 ,$646.05 ,$110.04 ,$68.32 ,$219.60 ,$287.13 ,$8.26 ,$12.70 ,$12.70 ,$244.00 ,$12.70 ,$117.12 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201138,86905,HC RBC AG TYPING NON ABO/RH T1-90,302,1 ,$88.00 ,$57.20 ,$4.79 ,$717.84 ,$717.83 ,$6.60 ,$49.28 ,$287.13 ,$24.64 ,$28.67 ,$287.13 ,$28.67 ,$88.00 ,$39.69 ,$39.69 ,$88.00 ,$4.79 ,$88.00 ,$7.55 ,$717.84 ,$287.13 ,$287.13 ,$88.00 ,$66.00 ,$52.80 ,$52.80 ,$287.13 ,$52.80 ,$5.53 ,$5.53 ,$5.53 ,$88.00 , N/A ,$74.80 ,$88.00 ,$57.20 ,$287.13 ,$88.00 ,$49.28 ,$287.13 ,$23.14 , N/A ,$6.59 ,$6.29 ,$301.49 ,$70.40 ,$646.05 ,$39.69 ,$24.64 ,$79.20 ,$287.13 ,$5.53 ,$7.66 ,$7.66 ,$88.00 ,$7.66 ,$42.24 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201139,86905,HC RBC AG TYPING NON ABO/RH T2-90,302,1 ,$184.00 ,$119.60 ,$4.79 ,$717.84 ,$717.83 ,$6.60 ,$103.04 ,$287.13 ,$51.52 ,$28.67 ,$287.13 ,$28.67 ,$184.00 ,$82.98 ,$82.98 ,$184.00 ,$4.79 ,$184.00 ,$7.55 ,$717.84 ,$287.13 ,$287.13 ,$184.00 ,$138.00 ,$110.40 ,$110.40 ,$287.13 ,$110.40 ,$5.53 ,$5.53 ,$5.53 ,$184.00 , N/A ,$156.40 ,$184.00 ,$119.60 ,$287.13 ,$184.00 ,$103.04 ,$287.13 ,$48.39 , N/A ,$6.59 ,$6.29 ,$301.49 ,$147.20 ,$646.05 ,$82.98 ,$51.52 ,$165.60 ,$287.13 ,$5.53 ,$7.66 ,$7.66 ,$184.00 ,$7.66 ,$88.32 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201140,86905,HC RBC AG TYPING NON ABO/RH T3-90,302,1 ,$198.00 ,$128.70 ,$4.79 ,$717.84 ,$717.83 ,$6.60 ,$110.88 ,$287.13 ,$55.44 ,$28.67 ,$287.13 ,$28.67 ,$198.00 ,$89.30 ,$89.30 ,$198.00 ,$4.79 ,$198.00 ,$7.55 ,$717.84 ,$287.13 ,$287.13 ,$198.00 ,$148.50 ,$118.80 ,$118.80 ,$287.13 ,$118.80 ,$5.53 ,$5.53 ,$5.53 ,$198.00 , N/A ,$168.30 ,$198.00 ,$128.70 ,$287.13 ,$198.00 ,$110.88 ,$287.13 ,$52.07 , N/A ,$6.59 ,$6.29 ,$301.49 ,$158.40 ,$646.05 ,$89.30 ,$55.44 ,$178.20 ,$287.13 ,$5.53 ,$7.66 ,$7.66 ,$198.00 ,$7.66 ,$95.04 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201141,86905,HC RBC AG TYPING NON ABO/RH T4-90,302,1 ,$244.00 ,$158.60 ,$4.79 ,$717.84 ,$717.83 ,$6.60 ,$136.64 ,$287.13 ,$68.32 ,$28.67 ,$287.13 ,$28.67 ,$244.00 ,$110.04 ,$110.04 ,$244.00 ,$4.79 ,$244.00 ,$7.55 ,$717.84 ,$287.13 ,$287.13 ,$244.00 ,$183.00 ,$146.40 ,$146.40 ,$287.13 ,$146.40 ,$5.53 ,$5.53 ,$5.53 ,$244.00 , N/A ,$207.40 ,$244.00 ,$158.60 ,$287.13 ,$244.00 ,$136.64 ,$287.13 ,$64.17 , N/A ,$6.59 ,$6.29 ,$301.49 ,$195.20 ,$646.05 ,$110.04 ,$68.32 ,$219.60 ,$287.13 ,$5.53 ,$7.66 ,$7.66 ,$244.00 ,$7.66 ,$117.12 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201148,83986,HC PH BODY FLUID,302,1 ,$2.50 ,$1.63 ,$0.66 ,$6.25 ,$6.25 ,$2.50 ,$1.40 ,$2.50 ,$0.70 ,$0.88 ,$2.50 ,$1.03 ,$2.50 ,$1.13 ,$1.13 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$6.25 ,$2.50 ,$2.50 ,$2.50 ,$1.88 ,$1.50 ,$1.50 ,$2.50 ,$1.50 ,$2.50 ,$2.50 ,$2.50 ,$2.50 , N/A ,$2.13 ,$2.50 ,$1.63 ,$2.50 ,$2.50 ,$1.40 ,$2.50 ,$0.66 , N/A ,$2.50 ,$2.50 ,$2.63 ,$2.00 ,$5.63 ,$1.13 ,$0.70 ,$2.25 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$2.50 ,$1.20 ,$4.81 
ST. ELIZABETH'S HOSPITAL,30201152,86255,HC FLUOR AB SCR AQUAPORIN-90,302,1 ,"$1,948.00 ","$1,266.20 ",$12.05 ,"$1,948.00 ",$30.13 ,$20.77 ,"$1,090.88 ",$12.05 ,$545.44 ,$90.32 ,$12.05 ,$90.32 ,$12.05 ,$878.55 ,$878.55 ,$12.05 ,$15.06 ,$22.90 ,$23.27 ,$30.13 ,$12.05 ,$12.05 ,$12.29 ,"$1,461.00 ","$1,168.80 ","$1,168.80 ",$12.05 ,"$1,168.80 ",$17.41 ,$17.41 ,$17.41 ,"$1,948.00 ", N/A ,"$1,655.80 ",$30.13 ,"$1,266.20 ",$12.05 ,"$1,948.00 ","$1,090.88 ",$12.05 ,$512.32 , N/A ,$18.34 ,$17.50 ,$12.65 ,"$1,558.40 ",$27.11 ,$878.55 ,$545.44 ,"$1,753.20 ",$12.05 ,$17.41 ,$24.10 ,$24.10 ,$12.05 ,$24.10 ,$935.04 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201166,86780,HC ANTIBODY TREPONEMA PALLIDUM-90,302,1 ,$24.00 ,$15.60 ,$6.31 ,$33.10 ,$33.10 ,$22.82 ,$13.44 ,$13.24 ,$6.72 ,$8.47 ,$13.24 ,$9.89 ,$13.24 ,$10.82 ,$10.82 ,$13.24 ,$16.55 ,$24.00 ,$24.00 ,$33.10 ,$13.24 ,$13.24 ,$13.50 ,$18.00 ,$14.40 ,$14.40 ,$13.24 ,$14.40 ,$19.12 ,$19.12 ,$19.12 ,$24.00 , N/A ,$20.40 ,$24.00 ,$15.60 ,$13.24 ,$24.00 ,$13.44 ,$13.24 ,$6.31 , N/A ,$18.34 ,$17.50 ,$13.90 ,$19.20 ,$29.79 ,$10.82 ,$6.72 ,$21.60 ,$13.24 ,$19.12 ,$24.00 ,$24.00 ,$13.24 ,$24.00 ,$11.52 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30201167,87428,HC SARSCOV  AND  INFLUENZA VIRUS A AND B AG IA,302,1 ,$266.00 ,$172.90 ,$7.71 ,$266.00 ,$77.35 ,$128.61 ,$148.96 ,$30.94 ,$74.48 ,$89.91 ,$30.94 ,$103.47 ,$30.94 ,$119.97 ,$119.97 ,$30.94 ,$38.68 ,$58.79 ,$133.00 ,$77.35 ,$30.94 ,$30.94 ,$31.56 ,$199.50 ,$159.60 ,$159.60 ,$30.94 ,$159.60 ,$186.20 ,$186.20 ,$186.20 ,$266.00 , N/A ,$226.10 ,$77.35 ,$172.90 ,$30.94 ,$266.00 ,$148.96 ,$30.94 ,$69.96 , N/A ,$8.48 ,$8.10 ,$32.49 ,$212.80 ,$69.62 ,$119.97 ,$74.48 ,$239.40 ,$30.94 ,$186.20 ,$147.24 ,$147.24 ,$30.94 ,$147.24 ,$127.68 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30201168,86905,HC RBC AG TYPING NON ABO/RH T5-90,302,1 ,$332.00 ,$215.80 ,$4.79 ,$717.84 ,$717.83 ,$6.60 ,$185.92 ,$287.13 ,$92.96 ,$28.67 ,$287.13 ,$28.67 ,$287.13 ,$149.73 ,$149.73 ,$287.13 ,$4.79 ,$332.00 ,$7.55 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$249.00 ,$199.20 ,$199.20 ,$287.13 ,$199.20 ,$5.53 ,$5.53 ,$5.53 ,$332.00 , N/A ,$282.20 ,$332.00 ,$215.80 ,$287.13 ,$332.00 ,$185.92 ,$287.13 ,$87.32 , N/A ,$6.59 ,$6.29 ,$301.49 ,$265.60 ,$646.05 ,$149.73 ,$92.96 ,$298.80 ,$287.13 ,$5.53 ,$7.66 ,$7.66 ,$287.13 ,$7.66 ,$159.36 ,$5.99 
ST. ELIZABETH'S HOSPITAL,30201169,86255,HC FLUOR AB SCR -90,302,1 ,"$1,000.00 ",$650.00 ,$12.05 ,"$1,000.00 ",$30.13 ,$20.77 ,$560.00 ,$12.05 ,$280.00 ,$90.32 ,$12.05 ,$90.32 ,$12.05 ,$451.00 ,$451.00 ,$12.05 ,$15.06 ,$22.90 ,$23.27 ,$30.13 ,$12.05 ,$12.05 ,$12.29 ,$750.00 ,$600.00 ,$600.00 ,$12.05 ,$600.00 ,$17.41 ,$17.41 ,$17.41 ,"$1,000.00 ", N/A ,$850.00 ,$30.13 ,$650.00 ,$12.05 ,"$1,000.00 ",$560.00 ,$12.05 ,$263.00 , N/A ,$18.34 ,$17.50 ,$12.65 ,$800.00 ,$27.11 ,$451.00 ,$280.00 ,$900.00 ,$12.05 ,$17.41 ,$24.10 ,$24.10 ,$12.05 ,$24.10 ,$480.00 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30500102,85004,HC WBC W/AUTO DIFFERENTIAL,305,1 ,$85.00 ,$55.25 ,$6.47 ,$85.00 ,$16.18 ,$11.17 ,$47.60 ,$6.47 ,$23.80 ,$30.01 ,$6.47 ,$35.02 ,$6.47 ,$38.34 ,$38.34 ,$6.47 ,$8.09 ,$12.29 ,$12.58 ,$16.18 ,$6.47 ,$6.47 ,$6.60 ,$63.75 ,$51.00 ,$51.00 ,$6.47 ,$51.00 ,$9.33 ,$9.33 ,$9.33 ,$85.00 , N/A ,$72.25 ,$16.18 ,$55.25 ,$6.47 ,$85.00 ,$47.60 ,$6.47 ,$22.36 , N/A ,$7.38 ,$7.05 ,$6.79 ,$68.00 ,$14.56 ,$38.34 ,$23.80 ,$76.50 ,$6.47 ,$9.33 ,$12.94 ,$12.94 ,$6.47 ,$12.94 ,$40.80 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$50.00 ,$32.50 ,$3.80 ,$50.00 ,$9.50 ,$5.93 ,$28.00 ,$3.80 ,$14.00 ,$17.65 ,$3.80 ,$20.60 ,$3.80 ,$22.55 ,$22.55 ,$3.80 ,$4.75 ,$7.22 ,$6.92 ,$9.50 ,$3.80 ,$3.80 ,$3.88 ,$37.50 ,$30.00 ,$30.00 ,$3.80 ,$30.00 ,$4.97 ,$4.97 ,$4.97 ,$50.00 , N/A ,$42.50 ,$9.50 ,$32.50 ,$3.80 ,$50.00 ,$28.00 ,$3.80 ,$13.15 , N/A ,$7.38 ,$7.05 ,$3.99 ,$40.00 ,$8.55 ,$22.55 ,$14.00 ,$45.00 ,$3.80 ,$4.97 ,$7.60 ,$7.60 ,$3.80 ,$7.60 ,$24.00 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500104,85014,HC HEMATOCRIT,305,1 ,$42.00 ,$27.30 ,$2.37 ,$42.00 ,$5.93 ,$4.08 ,$23.52 ,$2.37 ,$11.76 ,$14.83 ,$2.37 ,$17.30 ,$2.37 ,$18.94 ,$18.94 ,$2.37 ,$2.96 ,$4.50 ,$4.40 ,$5.93 ,$2.37 ,$2.37 ,$2.42 ,$31.50 ,$25.20 ,$25.20 ,$2.37 ,$25.20 ,$3.42 ,$3.42 ,$3.42 ,$42.00 , N/A ,$35.70 ,$5.93 ,$27.30 ,$2.37 ,$2.37 ,$23.52 ,$2.37 ,$11.05 , N/A ,$7.38 ,$7.05 ,$2.49 ,$33.60 ,$5.33 ,$18.94 ,$11.76 ,$37.80 ,$2.37 ,$3.42 ,$4.74 ,$4.74 ,$2.37 ,$4.74 ,$20.16 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500106,85018,HC HGB,305,1 ,$42.00 ,$27.30 ,$2.37 ,$42.00 ,$5.93 ,$4.08 ,$23.52 ,$2.37 ,$11.76 ,$14.83 ,$2.37 ,$17.30 ,$2.37 ,$18.94 ,$18.94 ,$2.37 ,$2.96 ,$4.50 ,$4.40 ,$5.93 ,$2.37 ,$2.37 ,$2.42 ,$31.50 ,$25.20 ,$25.20 ,$2.37 ,$25.20 ,$3.42 ,$3.42 ,$3.42 ,$42.00 , N/A ,$35.70 ,$5.93 ,$27.30 ,$2.37 ,$2.37 ,$23.52 ,$2.37 ,$11.05 , N/A ,$7.38 ,$7.05 ,$2.49 ,$33.60 ,$5.33 ,$18.94 ,$11.76 ,$37.80 ,$2.37 ,$3.42 ,$4.74 ,$4.74 ,$2.37 ,$4.74 ,$20.16 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$147.00 ,$95.55 ,$6.71 ,$147.00 ,$19.43 ,$13.41 ,$82.32 ,$7.77 ,$41.16 ,$51.89 ,$7.77 ,$60.56 ,$7.77 ,$66.30 ,$66.30 ,$7.77 ,$9.71 ,$14.76 ,$15.10 ,$19.43 ,$7.77 ,$7.77 ,$7.93 ,$110.25 ,$88.20 ,$88.20 ,$7.77 ,$88.20 ,$11.22 ,$11.22 ,$11.22 ,$147.00 , N/A ,$124.95 ,$19.43 ,$95.55 ,$7.77 ,$7.77 ,$82.32 ,$7.77 ,$38.66 , N/A ,$7.38 ,$7.05 ,$8.16 ,$117.60 ,$17.48 ,$66.30 ,$41.16 ,$132.30 ,$7.77 ,$11.22 ,$15.54 ,$15.54 ,$7.77 ,$15.54 ,$70.56 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500108,85027,HC CBC W/O DIFF,305,1 ,$139.00 ,$90.35 ,$6.47 ,$139.00 ,$16.18 ,$11.17 ,$77.84 ,$6.47 ,$38.92 ,$49.07 ,$6.47 ,$57.27 ,$6.47 ,$62.69 ,$62.69 ,$6.47 ,$8.09 ,$12.29 ,$12.58 ,$16.18 ,$6.47 ,$6.47 ,$6.60 ,$104.25 ,$83.40 ,$83.40 ,$6.47 ,$83.40 ,$9.33 ,$9.33 ,$9.33 ,$139.00 , N/A ,$118.15 ,$16.18 ,$90.35 ,$6.47 ,$6.47 ,$77.84 ,$6.47 ,$36.56 , N/A ,$7.38 ,$7.05 ,$6.79 ,$111.20 ,$14.56 ,$62.69 ,$38.92 ,$125.10 ,$6.47 ,$9.33 ,$12.94 ,$12.94 ,$6.47 ,$12.94 ,$66.72 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500111,85045,HC RETIC COUNT AUTO,305,1 ,$71.00 ,$46.15 ,$3.99 ,$71.00 ,$9.98 ,$6.90 ,$39.76 ,$3.99 ,$19.88 ,$25.06 ,$3.99 ,$29.25 ,$3.99 ,$32.02 ,$32.02 ,$3.99 ,$4.99 ,$7.58 ,$7.55 ,$9.98 ,$3.99 ,$3.99 ,$4.07 ,$53.25 ,$42.60 ,$42.60 ,$3.99 ,$42.60 ,$5.77 ,$5.77 ,$5.77 ,$71.00 , N/A ,$60.35 ,$9.98 ,$46.15 ,$3.99 ,$71.00 ,$39.76 ,$3.99 ,$18.67 , N/A ,$7.38 ,$7.05 ,$4.19 ,$56.80 ,$8.98 ,$32.02 ,$19.88 ,$63.90 ,$3.99 ,$5.77 ,$7.98 ,$7.98 ,$3.99 ,$7.98 ,$34.08 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$60.00 ,$39.00 ,$2.54 ,$60.00 ,$6.35 ,$4.38 ,$33.60 ,$2.54 ,$16.80 ,$21.18 ,$2.54 ,$24.72 ,$2.54 ,$27.06 ,$27.06 ,$2.54 ,$3.18 ,$4.83 ,$5.03 ,$6.35 ,$2.54 ,$2.54 ,$2.59 ,$45.00 ,$36.00 ,$36.00 ,$2.54 ,$36.00 ,$3.67 ,$3.67 ,$3.67 ,$60.00 , N/A ,$51.00 ,$6.35 ,$39.00 ,$2.54 ,$60.00 ,$33.60 ,$2.54 ,$15.78 , N/A ,$7.38 ,$7.05 ,$2.67 ,$48.00 ,$5.72 ,$27.06 ,$16.80 ,$54.00 ,$2.54 ,$3.67 ,$5.08 ,$5.08 ,$2.54 ,$5.08 ,$28.80 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$75.00 ,$48.75 ,$4.48 ,$75.00 ,$11.20 ,$7.70 ,$42.00 ,$4.48 ,$21.00 ,$26.48 ,$4.48 ,$30.90 ,$4.48 ,$33.83 ,$33.83 ,$4.48 ,$5.60 ,$8.51 ,$8.81 ,$11.20 ,$4.48 ,$4.48 ,$4.57 ,$56.25 ,$45.00 ,$45.00 ,$4.48 ,$45.00 ,$6.46 ,$6.46 ,$6.46 ,$75.00 , N/A ,$63.75 ,$11.20 ,$48.75 ,$4.48 ,$75.00 ,$42.00 ,$4.48 ,$19.73 , N/A ,$7.38 ,$7.05 ,$4.70 ,$60.00 ,$10.08 ,$33.83 ,$21.00 ,$67.50 ,$4.48 ,$6.46 ,$8.96 ,$8.96 ,$4.48 ,$8.96 ,$36.00 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500116,85097,HC BONE MARROW SMEAR INTERP,305,1 ,$56.00 ,$36.40 ,$14.73 ,"$1,615.20 ","$1,615.20 ",$56.00 ,$31.36 ,$646.08 ,$15.68 ,$19.77 ,$646.08 ,$23.07 ,$56.00 ,$25.26 ,$25.26 ,$56.00 ,$36.40 ,$56.00 ,$56.00 ,"$1,615.20 ",$646.08 ,$646.08 ,$56.00 ,$42.00 ,$33.60 ,$33.60 ,$646.08 ,$33.60 ,$56.00 ,$56.00 ,$56.00 ,$56.00 , N/A ,$47.60 ,$56.00 ,$36.40 ,$646.08 ,$56.00 ,$31.36 ,$646.08 ,$14.73 , N/A ,$33.95 ,$32.40 ,$678.38 ,$44.80 ,"$1,453.68 ",$25.26 ,$15.68 ,$50.40 ,$646.08 ,$56.00 ,$56.00 ,$56.00 ,$56.00 ,$56.00 ,$26.88 ,$30.86 
ST. ELIZABETH'S HOSPITAL,30500168,85347,HC ACTIVATED CLOTTING TIME,305,1 ,$52.00 ,$33.80 ,$3.92 ,$52.00 ,$10.70 ,$6.14 ,$29.12 ,$4.28 ,$14.56 ,$18.36 ,$4.28 ,$21.42 ,$4.28 ,$23.45 ,$23.45 ,$4.28 ,$5.35 ,$8.13 ,$8.18 ,$10.70 ,$4.28 ,$4.28 ,$4.37 ,$39.00 ,$31.20 ,$31.20 ,$4.28 ,$31.20 ,$6.15 ,$6.15 ,$6.15 ,$52.00 , N/A ,$44.20 ,$10.70 ,$33.80 ,$4.28 ,$52.00 ,$29.12 ,$4.28 ,$13.68 , N/A ,$4.31 ,$4.12 ,$4.49 ,$41.60 ,$9.63 ,$23.45 ,$14.56 ,$46.80 ,$4.28 ,$6.15 ,$8.56 ,$8.56 ,$4.28 ,$8.56 ,$24.96 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500175,85379,HC D DIMER QN,305,1 ,$157.00 ,$102.05 ,$10.18 ,$157.00 ,$25.45 ,$17.54 ,$87.92 ,$10.18 ,$43.96 ,$55.42 ,$10.18 ,$64.68 ,$10.18 ,$70.81 ,$70.81 ,$10.18 ,$12.73 ,$19.34 ,$19.50 ,$25.45 ,$10.18 ,$10.18 ,$10.38 ,$117.75 ,$94.20 ,$94.20 ,$10.18 ,$94.20 ,$14.70 ,$14.70 ,$14.70 ,$157.00 , N/A ,$133.45 ,$25.45 ,$102.05 ,$10.18 ,$157.00 ,$87.92 ,$10.18 ,$41.29 , N/A ,$12.79 ,$12.21 ,$10.69 ,$125.60 ,$22.91 ,$70.81 ,$43.96 ,$141.30 ,$10.18 ,$14.70 ,$20.36 ,$20.36 ,$10.18 ,$20.36 ,$75.36 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500176,85384,HC FIBRINOGEN,305,1 ,$110.00 ,$71.50 ,$3.92 ,$110.00 ,$24.30 ,$14.65 ,$61.60 ,$9.72 ,$30.80 ,$38.83 ,$9.72 ,$45.32 ,$9.72 ,$49.61 ,$49.61 ,$9.72 ,$12.15 ,$18.47 ,$16.98 ,$24.30 ,$9.72 ,$9.72 ,$9.91 ,$82.50 ,$66.00 ,$66.00 ,$9.72 ,$66.00 ,$12.64 ,$12.64 ,$12.64 ,$110.00 , N/A ,$93.50 ,$24.30 ,$71.50 ,$9.72 ,$110.00 ,$61.60 ,$9.72 ,$28.93 , N/A ,$4.31 ,$4.12 ,$10.21 ,$88.00 ,$21.87 ,$49.61 ,$30.80 ,$99.00 ,$9.72 ,$12.64 ,$19.44 ,$19.44 ,$9.72 ,$19.44 ,$52.80 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500185,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$125.00 ,$81.25 ,$6.14 ,$125.00 ,$19.33 ,$6.14 ,$70.00 ,$7.73 ,$35.00 ,$44.13 ,$7.73 ,$51.50 ,$7.73 ,$56.38 ,$56.38 ,$7.73 ,$9.66 ,$14.69 ,$15.10 ,$19.33 ,$7.73 ,$7.73 ,$7.88 ,$93.75 ,$75.00 ,$75.00 ,$7.73 ,$75.00 ,$11.17 ,$11.17 ,$11.17 ,$125.00 , N/A ,$106.25 ,$19.33 ,$81.25 ,$7.73 ,$125.00 ,$70.00 ,$7.73 ,$32.88 , N/A ,$11.23 ,$10.72 ,$8.12 ,$100.00 ,$17.39 ,$56.38 ,$35.00 ,$112.50 ,$7.73 ,$11.17 ,$15.46 ,$15.46 ,$7.73 ,$15.46 ,$60.00 ,$10.21 
ST. ELIZABETH'S HOSPITAL,30500187,85520,HC HEPARIN ASSAY,305,1 ,$155.00 ,$100.75 ,$11.63 ,$155.00 ,$32.73 ,$22.58 ,$86.80 ,$13.09 ,$43.40 ,$54.72 ,$13.09 ,$63.86 ,$13.09 ,$69.91 ,$69.91 ,$13.09 ,$16.36 ,$24.87 ,$25.16 ,$32.73 ,$13.09 ,$13.09 ,$13.35 ,$116.25 ,$93.00 ,$93.00 ,$13.09 ,$93.00 ,$18.92 ,$18.92 ,$18.92 ,$155.00 , N/A ,$131.75 ,$32.73 ,$100.75 ,$13.09 ,$155.00 ,$86.80 ,$13.09 ,$40.77 , N/A ,$12.79 ,$12.21 ,$13.74 ,$124.00 ,$29.45 ,$69.91 ,$43.40 ,$139.50 ,$13.09 ,$18.92 ,$26.18 ,$26.18 ,$13.09 ,$26.18 ,$74.40 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500190,85540,HC LEUKOCYTE ALK PHOS,305,1 ,$124.00 ,$80.60 ,$6.71 ,$124.00 ,$21.50 ,$14.84 ,$69.44 ,$8.60 ,$34.72 ,$43.77 ,$8.60 ,$51.09 ,$8.60 ,$55.92 ,$55.92 ,$8.60 ,$10.75 ,$16.34 ,$16.98 ,$21.50 ,$8.60 ,$8.60 ,$8.77 ,$93.00 ,$74.40 ,$74.40 ,$8.60 ,$74.40 ,$12.43 ,$12.43 ,$12.43 ,$124.00 , N/A ,$105.40 ,$21.50 ,$80.60 ,$8.60 ,$124.00 ,$69.44 ,$8.60 ,$32.61 , N/A ,$7.38 ,$7.05 ,$9.03 ,$99.20 ,$19.35 ,$55.92 ,$34.72 ,$111.60 ,$8.60 ,$12.43 ,$17.20 ,$17.20 ,$8.60 ,$17.20 ,$59.52 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500192,85576,HC PLATELET AGGREGATION EA,305,1 ,$105.00 ,$68.25 ,$11.63 ,$105.00 ,$62.28 ,$37.03 ,$58.80 ,$24.91 ,$29.40 ,$37.07 ,$24.91 ,$43.26 ,$24.91 ,$47.36 ,$47.36 ,$24.91 ,$31.14 ,$47.33 ,$43.40 ,$62.28 ,$24.91 ,$24.91 ,$25.41 ,$78.75 ,$63.00 ,$63.00 ,$24.91 ,$63.00 ,$32.38 ,$32.38 ,$32.38 ,$105.00 , N/A ,$89.25 ,$62.28 ,$68.25 ,$24.91 ,$105.00 ,$58.80 ,$24.91 ,$27.62 , N/A ,$12.79 ,$12.21 ,$26.16 ,$84.00 ,$56.05 ,$47.36 ,$29.40 ,$94.50 ,$24.91 ,$32.38 ,$49.82 ,$49.82 ,$24.91 ,$49.82 ,$50.40 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$78.00 ,$50.70 ,$3.92 ,$78.00 ,$10.73 ,$6.77 ,$43.68 ,$4.29 ,$21.84 ,$27.53 ,$4.29 ,$32.14 ,$4.29 ,$35.18 ,$35.18 ,$4.29 ,$5.36 ,$8.15 ,$7.55 ,$10.73 ,$4.29 ,$4.29 ,$4.38 ,$58.50 ,$46.80 ,$46.80 ,$4.29 ,$46.80 ,$5.68 ,$5.68 ,$5.68 ,$78.00 , N/A ,$66.30 ,$10.73 ,$50.70 ,$4.29 ,$78.00 ,$43.68 ,$4.29 ,$20.51 , N/A ,$4.31 ,$4.12 ,$4.50 ,$62.40 ,$9.65 ,$35.18 ,$21.84 ,$70.20 ,$4.29 ,$5.68 ,$8.58 ,$8.58 ,$4.29 ,$8.58 ,$37.44 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500205,85652,HC SED RATE AUTO,305,1 ,$63.00 ,$40.95 ,$2.70 ,$63.00 ,$6.75 ,$4.66 ,$35.28 ,$2.70 ,$17.64 ,$22.24 ,$2.70 ,$25.96 ,$2.70 ,$28.41 ,$28.41 ,$2.70 ,$3.38 ,$5.13 ,$5.03 ,$6.75 ,$2.70 ,$2.70 ,$2.75 ,$47.25 ,$37.80 ,$37.80 ,$2.70 ,$37.80 ,$3.90 ,$3.90 ,$3.90 ,$63.00 , N/A ,$53.55 ,$6.75 ,$40.95 ,$2.70 ,$63.00 ,$35.28 ,$2.70 ,$16.57 , N/A ,$7.38 ,$7.05 ,$2.84 ,$50.40 ,$6.08 ,$28.41 ,$17.64 ,$56.70 ,$2.70 ,$3.90 ,$5.40 ,$5.40 ,$2.70 ,$5.40 ,$30.24 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500206,85660,HC SICKLE CELL RBC,305,1 ,$121.00 ,$78.65 ,$5.51 ,$121.00 ,$13.78 ,$9.50 ,$67.76 ,$5.51 ,$33.88 ,$41.28 ,$5.51 ,$41.28 ,$5.51 ,$54.57 ,$54.57 ,$5.51 ,$6.89 ,$10.47 ,$10.69 ,$13.78 ,$5.51 ,$5.51 ,$5.62 ,$90.75 ,$72.60 ,$72.60 ,$5.51 ,$72.60 ,$7.96 ,$7.96 ,$7.96 ,$121.00 , N/A ,$102.85 ,$13.78 ,$78.65 ,$5.51 ,$121.00 ,$67.76 ,$5.51 ,$31.82 , N/A ,$7.38 ,$7.05 ,$5.79 ,$96.80 ,$12.40 ,$54.57 ,$33.88 ,$108.90 ,$5.51 ,$7.96 ,$11.02 ,$11.02 ,$5.51 ,$11.02 ,$58.08 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500211,85730,HC PTT,305,1 ,$94.00 ,$61.10 ,$3.92 ,$94.00 ,$15.03 ,$10.36 ,$52.64 ,$6.01 ,$26.32 ,$33.18 ,$6.01 ,$38.73 ,$6.01 ,$42.39 ,$42.39 ,$6.01 ,$7.51 ,$11.42 ,$11.95 ,$15.03 ,$6.01 ,$6.01 ,$6.13 ,$70.50 ,$56.40 ,$56.40 ,$6.01 ,$56.40 ,$8.67 ,$8.67 ,$8.67 ,$94.00 , N/A ,$79.90 ,$15.03 ,$61.10 ,$6.01 ,$94.00 ,$52.64 ,$6.01 ,$24.72 , N/A ,$4.31 ,$4.12 ,$6.31 ,$75.20 ,$13.52 ,$42.39 ,$26.32 ,$84.60 ,$6.01 ,$8.67 ,$12.02 ,$12.02 ,$6.01 ,$12.02 ,$45.12 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500234,85014,HC HEMATOCRIT-90,305,1 ,$74.00 ,$48.10 ,$2.37 ,$74.00 ,$5.93 ,$4.08 ,$41.44 ,$2.37 ,$20.72 ,$24.10 ,$2.37 ,$24.10 ,$2.37 ,$33.37 ,$33.37 ,$2.37 ,$2.96 ,$4.50 ,$4.40 ,$5.93 ,$2.37 ,$2.37 ,$2.42 ,$55.50 ,$44.40 ,$44.40 ,$2.37 ,$44.40 ,$3.42 ,$3.42 ,$3.42 ,$74.00 , N/A ,$62.90 ,$5.93 ,$48.10 ,$2.37 ,$2.37 ,$41.44 ,$2.37 ,$19.46 , N/A ,$7.38 ,$7.05 ,$2.49 ,$59.20 ,$5.33 ,$33.37 ,$20.72 ,$66.60 ,$2.37 ,$3.42 ,$4.74 ,$4.74 ,$2.37 ,$4.74 ,$35.52 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500238,85018,HC HGB-90,305,1 ,$74.00 ,$48.10 ,$2.37 ,$74.00 ,$5.93 ,$4.08 ,$41.44 ,$2.37 ,$20.72 ,$24.10 ,$2.37 ,$24.10 ,$2.37 ,$33.37 ,$33.37 ,$2.37 ,$2.96 ,$4.50 ,$4.40 ,$5.93 ,$2.37 ,$2.37 ,$2.42 ,$55.50 ,$44.40 ,$44.40 ,$2.37 ,$44.40 ,$3.42 ,$3.42 ,$3.42 ,$74.00 , N/A ,$62.90 ,$5.93 ,$48.10 ,$2.37 ,$2.37 ,$41.44 ,$2.37 ,$19.46 , N/A ,$7.38 ,$7.05 ,$2.49 ,$59.20 ,$5.33 ,$33.37 ,$20.72 ,$66.60 ,$2.37 ,$3.42 ,$4.74 ,$4.74 ,$2.37 ,$4.74 ,$35.52 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500239,85025,HC CBC AUTO W/AUTO DIFF-90,305,1 ,$260.00 ,$169.00 ,$6.71 ,$260.00 ,$19.43 ,$13.41 ,$145.60 ,$7.77 ,$72.80 ,$78.83 ,$7.77 ,$78.83 ,$7.77 ,$117.26 ,$117.26 ,$7.77 ,$9.71 ,$14.76 ,$15.10 ,$19.43 ,$7.77 ,$7.77 ,$7.93 ,$195.00 ,$156.00 ,$156.00 ,$7.77 ,$156.00 ,$11.22 ,$11.22 ,$11.22 ,$260.00 , N/A ,$221.00 ,$19.43 ,$169.00 ,$7.77 ,$7.77 ,$145.60 ,$7.77 ,$68.38 , N/A ,$7.38 ,$7.05 ,$8.16 ,$208.00 ,$17.48 ,$117.26 ,$72.80 ,$234.00 ,$7.77 ,$11.22 ,$15.54 ,$15.54 ,$7.77 ,$15.54 ,$124.80 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500244,85041,HC BLOOD COUNT RBC AUTO-90,305,1 ,$61.00 ,$39.65 ,$3.02 ,$61.00 ,$7.55 ,$4.55 ,$34.16 ,$3.02 ,$17.08 ,$21.53 ,$3.02 ,$25.13 ,$3.02 ,$27.51 ,$27.51 ,$3.02 ,$3.78 ,$5.74 ,$5.66 ,$7.55 ,$3.02 ,$3.02 ,$3.08 ,$45.75 ,$36.60 ,$36.60 ,$3.02 ,$36.60 ,$4.36 ,$4.36 ,$4.36 ,$61.00 , N/A ,$51.85 ,$7.55 ,$39.65 ,$3.02 ,$61.00 ,$34.16 ,$3.02 ,$16.04 , N/A ,$7.38 ,$7.05 ,$3.17 ,$48.80 ,$6.80 ,$27.51 ,$17.08 ,$54.90 ,$3.02 ,$4.36 ,$6.04 ,$6.04 ,$3.02 ,$6.04 ,$29.28 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500249,85210,HC FACTOR II-90,305,1 ,$177.00 ,$115.05 ,$3.92 ,$177.00 ,$32.45 ,$22.38 ,$99.12 ,$12.98 ,$49.56 ,$62.48 ,$12.98 ,$72.92 ,$12.98 ,$79.83 ,$79.83 ,$12.98 ,$16.23 ,$24.66 ,$25.16 ,$32.45 ,$12.98 ,$12.98 ,$13.24 ,$132.75 ,$106.20 ,$106.20 ,$12.98 ,$106.20 ,$18.76 ,$18.76 ,$18.76 ,$177.00 , N/A ,$150.45 ,$32.45 ,$115.05 ,$12.98 ,$177.00 ,$99.12 ,$12.98 ,$46.55 , N/A ,$4.31 ,$4.12 ,$13.63 ,$141.60 ,$29.21 ,$79.83 ,$49.56 ,$159.30 ,$12.98 ,$18.76 ,$25.96 ,$25.96 ,$12.98 ,$25.96 ,$84.96 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500250,85220,HC FACTOR V-90,305,1 ,$79.00 ,$51.35 ,$11.63 ,$79.00 ,$44.13 ,$30.42 ,$44.24 ,$17.65 ,$22.12 ,$27.89 ,$17.65 ,$32.55 ,$17.65 ,$35.63 ,$35.63 ,$17.65 ,$22.06 ,$33.54 ,$33.97 ,$44.13 ,$17.65 ,$17.65 ,$18.00 ,$59.25 ,$47.40 ,$47.40 ,$17.65 ,$47.40 ,$25.49 ,$25.49 ,$25.49 ,$79.00 , N/A ,$67.15 ,$44.13 ,$51.35 ,$17.65 ,$79.00 ,$44.24 ,$17.65 ,$20.78 , N/A ,$12.79 ,$12.21 ,$18.53 ,$63.20 ,$39.71 ,$35.63 ,$22.12 ,$71.10 ,$17.65 ,$25.49 ,$35.30 ,$35.30 ,$17.65 ,$35.30 ,$37.92 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500251,85230,HC FACTOR VII-90,305,1 ,$179.00 ,$116.35 ,$11.63 ,$179.00 ,$44.75 ,$30.87 ,$100.24 ,$17.90 ,$50.12 ,$63.19 ,$17.90 ,$73.75 ,$17.90 ,$80.73 ,$80.73 ,$17.90 ,$22.38 ,$34.01 ,$34.60 ,$44.75 ,$17.90 ,$17.90 ,$18.26 ,$134.25 ,$107.40 ,$107.40 ,$17.90 ,$107.40 ,$25.86 ,$25.86 ,$25.86 ,$179.00 , N/A ,$152.15 ,$44.75 ,$116.35 ,$17.90 ,$179.00 ,$100.24 ,$17.90 ,$47.08 , N/A ,$12.79 ,$12.21 ,$18.80 ,$143.20 ,$40.28 ,$80.73 ,$50.12 ,$161.10 ,$17.90 ,$25.86 ,$35.80 ,$35.80 ,$17.90 ,$35.80 ,$85.92 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500252,85240,HC FACTOR VIII AHG-90,305,1 ,$266.00 ,$172.90 ,$11.63 ,$266.00 ,$44.75 ,$30.87 ,$148.96 ,$17.90 ,$74.48 ,$93.90 ,$17.90 ,$109.59 ,$17.90 ,$119.97 ,$119.97 ,$17.90 ,$22.38 ,$34.01 ,$34.60 ,$44.75 ,$17.90 ,$17.90 ,$18.26 ,$199.50 ,$159.60 ,$159.60 ,$17.90 ,$159.60 ,$25.86 ,$25.86 ,$25.86 ,$266.00 , N/A ,$226.10 ,$44.75 ,$172.90 ,$17.90 ,$266.00 ,$148.96 ,$17.90 ,$69.96 , N/A ,$12.79 ,$12.21 ,$18.80 ,$212.80 ,$40.28 ,$119.97 ,$74.48 ,$239.40 ,$17.90 ,$25.86 ,$35.80 ,$35.80 ,$17.90 ,$35.80 ,$127.68 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500253,85245,HC FACTOR VIII VW RISTO-90,305,1 ,$208.00 ,$135.20 ,$11.63 ,$208.00 ,$57.35 ,$24.43 ,$116.48 ,$22.94 ,$58.24 ,$73.42 ,$22.94 ,$85.70 ,$22.94 ,$93.81 ,$93.81 ,$22.94 ,$28.68 ,$43.59 ,$44.66 ,$57.35 ,$22.94 ,$22.94 ,$23.40 ,$156.00 ,$124.80 ,$124.80 ,$22.94 ,$124.80 ,$33.14 ,$33.14 ,$33.14 ,$208.00 , N/A ,$176.80 ,$57.35 ,$135.20 ,$22.94 ,$208.00 ,$116.48 ,$22.94 ,$54.70 , N/A ,$12.79 ,$12.21 ,$24.09 ,$166.40 ,$51.62 ,$93.81 ,$58.24 ,$187.20 ,$22.94 ,$33.14 ,$45.88 ,$45.88 ,$22.94 ,$45.88 ,$99.84 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500254,85246,HC FACTOR VIII VW AG-90,305,1 ,$23.82 ,$15.48 ,$6.26 ,$57.35 ,$57.35 ,$23.82 ,$13.34 ,$22.94 ,$6.67 ,$8.41 ,$22.94 ,$9.81 ,$22.94 ,$10.74 ,$10.74 ,$22.94 ,$23.82 ,$23.82 ,$23.82 ,$57.35 ,$22.94 ,$22.94 ,$23.40 ,$17.87 ,$14.29 ,$14.29 ,$22.94 ,$14.29 ,$23.82 ,$23.82 ,$23.82 ,$23.82 , N/A ,$20.25 ,$23.82 ,$15.48 ,$22.94 ,$23.82 ,$13.34 ,$22.94 ,$6.26 , N/A ,$12.79 ,$12.21 ,$24.09 ,$19.06 ,$51.62 ,$10.74 ,$6.67 ,$21.44 ,$22.94 ,$23.82 ,$23.82 ,$23.82 ,$22.94 ,$23.82 ,$11.43 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500255,85247,HC FACTOR VW MULTIM ANALY-90,305,1 ,$276.00 ,$179.40 ,$11.63 ,$276.00 ,$57.35 ,$24.43 ,$154.56 ,$22.94 ,$77.28 ,$97.43 ,$22.94 ,$113.71 ,$22.94 ,$124.48 ,$124.48 ,$22.94 ,$28.68 ,$43.59 ,$44.66 ,$57.35 ,$22.94 ,$22.94 ,$23.40 ,$207.00 ,$165.60 ,$165.60 ,$22.94 ,$165.60 ,$33.14 ,$33.14 ,$33.14 ,$276.00 , N/A ,$234.60 ,$57.35 ,$179.40 ,$22.94 ,$276.00 ,$154.56 ,$22.94 ,$72.59 , N/A ,$12.79 ,$12.21 ,$24.09 ,$220.80 ,$51.62 ,$124.48 ,$77.28 ,$248.40 ,$22.94 ,$33.14 ,$45.88 ,$45.88 ,$22.94 ,$45.88 ,$132.48 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500256,85250,HC FACTOR IX-90,305,1 ,$293.00 ,$190.45 ,$11.63 ,$293.00 ,$47.60 ,$32.83 ,$164.08 ,$19.04 ,$82.04 ,$103.43 ,$19.04 ,$120.72 ,$19.04 ,$132.14 ,$132.14 ,$19.04 ,$23.80 ,$36.18 ,$37.11 ,$47.60 ,$19.04 ,$19.04 ,$19.42 ,$219.75 ,$175.80 ,$175.80 ,$19.04 ,$175.80 ,$27.51 ,$27.51 ,$27.51 ,$293.00 , N/A ,$249.05 ,$47.60 ,$190.45 ,$19.04 ,$293.00 ,$164.08 ,$19.04 ,$77.06 , N/A ,$12.79 ,$12.21 ,$19.99 ,$234.40 ,$42.84 ,$132.14 ,$82.04 ,$263.70 ,$19.04 ,$27.51 ,$38.08 ,$38.08 ,$19.04 ,$38.08 ,$140.64 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500257,85260,HC FACTOR X-90,305,1 ,$191.00 ,$124.15 ,$11.63 ,$191.00 ,$44.75 ,$30.87 ,$106.96 ,$17.90 ,$53.48 ,$67.42 ,$17.90 ,$78.69 ,$17.90 ,$86.14 ,$86.14 ,$17.90 ,$22.38 ,$34.01 ,$34.60 ,$44.75 ,$17.90 ,$17.90 ,$18.26 ,$143.25 ,$114.60 ,$114.60 ,$17.90 ,$114.60 ,$25.86 ,$25.86 ,$25.86 ,$191.00 , N/A ,$162.35 ,$44.75 ,$124.15 ,$17.90 ,$191.00 ,$106.96 ,$17.90 ,$50.23 , N/A ,$12.79 ,$12.21 ,$18.80 ,$152.80 ,$40.28 ,$86.14 ,$53.48 ,$171.90 ,$17.90 ,$25.86 ,$35.80 ,$35.80 ,$17.90 ,$35.80 ,$91.68 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500259,85280,HC FACTOR XI-90,305,1 ,$52.00 ,$33.80 ,$11.63 ,$52.00 ,$48.38 ,$33.34 ,$29.12 ,$19.35 ,$14.56 ,$18.36 ,$19.35 ,$21.42 ,$19.35 ,$23.45 ,$23.45 ,$19.35 ,$24.19 ,$36.77 ,$37.74 ,$48.38 ,$19.35 ,$19.35 ,$19.74 ,$39.00 ,$31.20 ,$31.20 ,$19.35 ,$31.20 ,$27.95 ,$27.95 ,$27.95 ,$52.00 , N/A ,$44.20 ,$48.38 ,$33.80 ,$19.35 ,$52.00 ,$29.12 ,$19.35 ,$13.68 , N/A ,$12.79 ,$12.21 ,$20.32 ,$41.60 ,$43.54 ,$23.45 ,$14.56 ,$46.80 ,$19.35 ,$27.95 ,$38.70 ,$38.70 ,$19.35 ,$38.70 ,$24.96 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500261,85300,HC ANTITHROMBIN III ACT-90,305,1 ,$168.00 ,$109.20 ,$11.63 ,$168.00 ,$29.63 ,$20.44 ,$94.08 ,$11.85 ,$47.04 ,$59.30 ,$11.85 ,$69.22 ,$11.85 ,$75.77 ,$75.77 ,$11.85 ,$14.81 ,$22.52 ,$23.27 ,$29.63 ,$11.85 ,$11.85 ,$12.09 ,$126.00 ,$100.80 ,$100.80 ,$11.85 ,$100.80 ,$17.12 ,$17.12 ,$17.12 ,$168.00 , N/A ,$142.80 ,$29.63 ,$109.20 ,$11.85 ,$168.00 ,$94.08 ,$11.85 ,$44.18 , N/A ,$12.79 ,$12.21 ,$12.44 ,$134.40 ,$26.66 ,$75.77 ,$47.04 ,$151.20 ,$11.85 ,$17.12 ,$23.70 ,$23.70 ,$11.85 ,$23.70 ,$80.64 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500263,85302,HC PROTEIN C AG-90,305,1 ,$98.00 ,$63.70 ,$11.63 ,$98.00 ,$30.03 ,$20.72 ,$54.88 ,$12.01 ,$27.44 ,$34.59 ,$12.01 ,$40.38 ,$12.01 ,$44.20 ,$44.20 ,$12.01 ,$15.01 ,$22.82 ,$23.27 ,$30.03 ,$12.01 ,$12.01 ,$12.25 ,$73.50 ,$58.80 ,$58.80 ,$12.01 ,$58.80 ,$17.36 ,$17.36 ,$17.36 ,$98.00 , N/A ,$83.30 ,$30.03 ,$63.70 ,$12.01 ,$98.00 ,$54.88 ,$12.01 ,$25.77 , N/A ,$12.79 ,$12.21 ,$12.61 ,$78.40 ,$27.02 ,$44.20 ,$27.44 ,$88.20 ,$12.01 ,$17.36 ,$24.02 ,$24.02 ,$12.01 ,$24.02 ,$47.04 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500264,85303,HC PROTEIN C ACTIVITY-90,305,1 ,$287.00 ,$186.55 ,$11.63 ,$287.00 ,$34.60 ,$23.84 ,$160.72 ,$13.84 ,$80.36 ,$101.31 ,$13.84 ,$103.67 ,$13.84 ,$129.44 ,$129.44 ,$13.84 ,$17.30 ,$26.30 ,$27.05 ,$34.60 ,$13.84 ,$13.84 ,$14.12 ,$215.25 ,$172.20 ,$172.20 ,$13.84 ,$172.20 ,$19.98 ,$19.98 ,$19.98 ,$287.00 , N/A ,$243.95 ,$34.60 ,$186.55 ,$13.84 ,$287.00 ,$160.72 ,$13.84 ,$75.48 , N/A ,$12.79 ,$12.21 ,$14.53 ,$229.60 ,$31.14 ,$129.44 ,$80.36 ,$258.30 ,$13.84 ,$19.98 ,$27.68 ,$27.68 ,$13.84 ,$27.68 ,$137.76 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500265,85305,HC PROTEIN S TOTAL-90,305,1 ,$287.00 ,$186.55 ,$11.61 ,$287.00 ,$29.03 ,$19.99 ,$160.72 ,$11.61 ,$80.36 ,$86.96 ,$11.61 ,$86.96 ,$11.61 ,$129.44 ,$129.44 ,$11.61 ,$14.51 ,$22.06 ,$22.64 ,$29.03 ,$11.61 ,$11.61 ,$11.84 ,$215.25 ,$172.20 ,$172.20 ,$11.61 ,$172.20 ,$16.77 ,$16.77 ,$16.77 ,$287.00 , N/A ,$243.95 ,$29.03 ,$186.55 ,$11.61 ,$287.00 ,$160.72 ,$11.61 ,$75.48 , N/A ,$12.79 ,$12.21 ,$12.19 ,$229.60 ,$26.12 ,$129.44 ,$80.36 ,$258.30 ,$11.61 ,$16.77 ,$23.22 ,$23.22 ,$11.61 ,$23.22 ,$137.76 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500266,85306,HC PROTEIN S FREE-90,305,1 ,$49.00 ,$31.85 ,$11.63 ,$49.00 ,$38.30 ,$26.41 ,$27.44 ,$15.32 ,$13.72 ,$17.30 ,$15.32 ,$20.19 ,$15.32 ,$22.10 ,$22.10 ,$15.32 ,$19.15 ,$29.11 ,$29.56 ,$38.30 ,$15.32 ,$15.32 ,$15.63 ,$36.75 ,$29.40 ,$29.40 ,$15.32 ,$29.40 ,$22.14 ,$22.14 ,$22.14 ,$49.00 , N/A ,$41.65 ,$38.30 ,$31.85 ,$15.32 ,$49.00 ,$27.44 ,$15.32 ,$12.89 , N/A ,$12.79 ,$12.21 ,$16.09 ,$39.20 ,$34.47 ,$22.10 ,$13.72 ,$44.10 ,$15.32 ,$22.14 ,$30.64 ,$30.64 ,$15.32 ,$30.64 ,$23.52 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500267,85307,HC ACTIVATED PROTEIN C RESIST-90,305,1 ,$202.00 ,$131.30 ,$10.80 ,$202.00 ,$38.30 ,$26.41 ,$113.12 ,$15.32 ,$56.56 ,$71.31 ,$15.32 ,$83.22 ,$15.32 ,$91.10 ,$91.10 ,$15.32 ,$19.15 ,$29.11 ,$29.56 ,$38.30 ,$15.32 ,$15.32 ,$15.63 ,$151.50 ,$121.20 ,$121.20 ,$15.32 ,$121.20 ,$22.14 ,$22.14 ,$22.14 ,$202.00 , N/A ,$171.70 ,$38.30 ,$131.30 ,$15.32 ,$202.00 ,$113.12 ,$15.32 ,$53.13 , N/A ,$11.88 ,$11.34 ,$16.09 ,$161.60 ,$34.47 ,$91.10 ,$56.56 ,$181.80 ,$15.32 ,$22.14 ,$30.64 ,$30.64 ,$15.32 ,$30.64 ,$96.96 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30500276,85397,HC COAGUL/FIBRINOLYSIS CLOT ACT-90,305,1 ,$250.00 ,$162.50 ,$11.63 ,$250.00 ,$77.15 ,$24.43 ,$140.00 ,$30.86 ,$70.00 ,$88.25 ,$30.86 ,$103.00 ,$30.86 ,$112.75 ,$112.75 ,$30.86 ,$38.58 ,$58.63 ,$54.10 ,$77.15 ,$30.86 ,$30.86 ,$31.48 ,$187.50 ,$150.00 ,$150.00 ,$30.86 ,$150.00 ,$40.12 ,$40.12 ,$40.12 ,$250.00 , N/A ,$212.50 ,$77.15 ,$162.50 ,$30.86 ,$250.00 ,$140.00 ,$30.86 ,$65.75 , N/A ,$12.79 ,$12.21 ,$32.40 ,$200.00 ,$69.44 ,$112.75 ,$70.00 ,$225.00 ,$30.86 ,$40.12 ,$61.72 ,$61.72 ,$30.86 ,$61.72 ,$120.00 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500277,85415,HC PLASMINGEN ACTIVATOR INHIB-90,305,1 ,$248.00 ,$161.20 ,$11.63 ,$248.00 ,$42.98 ,$29.65 ,$138.88 ,$17.19 ,$69.44 ,$87.54 ,$17.19 ,$102.18 ,$17.19 ,$111.85 ,$111.85 ,$17.19 ,$21.49 ,$32.66 ,$33.34 ,$42.98 ,$17.19 ,$17.19 ,$17.53 ,$186.00 ,$148.80 ,$148.80 ,$17.19 ,$148.80 ,$24.83 ,$24.83 ,$24.83 ,$248.00 , N/A ,$210.80 ,$42.98 ,$161.20 ,$17.19 ,$248.00 ,$138.88 ,$17.19 ,$65.22 , N/A ,$12.79 ,$12.21 ,$18.05 ,$198.40 ,$38.68 ,$111.85 ,$69.44 ,$223.20 ,$17.19 ,$24.83 ,$34.38 ,$34.38 ,$17.19 ,$34.38 ,$119.04 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500278,85420,HC PLASMINOGEN ACTIVITY-90,305,1 ,$111.00 ,$72.15 ,$6.53 ,$111.00 ,$16.33 ,$11.27 ,$62.16 ,$6.53 ,$31.08 ,$39.18 ,$6.53 ,$45.73 ,$6.53 ,$50.06 ,$50.06 ,$6.53 ,$8.16 ,$12.41 ,$12.58 ,$16.33 ,$6.53 ,$6.53 ,$6.66 ,$83.25 ,$66.60 ,$66.60 ,$6.53 ,$66.60 ,$9.44 ,$9.44 ,$9.44 ,$111.00 , N/A ,$94.35 ,$16.33 ,$72.15 ,$6.53 ,$111.00 ,$62.16 ,$6.53 ,$29.19 , N/A ,$12.79 ,$12.21 ,$6.86 ,$88.80 ,$14.69 ,$50.06 ,$31.08 ,$99.90 ,$6.53 ,$9.44 ,$13.06 ,$13.06 ,$6.53 ,$13.06 ,$53.28 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500283,85520,HC HEPARIN ASSAY-90,305,1 ,$140.00 ,$91.00 ,$11.63 ,$140.00 ,$32.73 ,$22.58 ,$78.40 ,$13.09 ,$39.20 ,$49.42 ,$13.09 ,$57.68 ,$13.09 ,$63.14 ,$63.14 ,$13.09 ,$16.36 ,$24.87 ,$25.16 ,$32.73 ,$13.09 ,$13.09 ,$13.35 ,$105.00 ,$84.00 ,$84.00 ,$13.09 ,$84.00 ,$18.92 ,$18.92 ,$18.92 ,$140.00 , N/A ,$119.00 ,$32.73 ,$91.00 ,$13.09 ,$140.00 ,$78.40 ,$13.09 ,$36.82 , N/A ,$12.79 ,$12.21 ,$13.74 ,$112.00 ,$29.45 ,$63.14 ,$39.20 ,$126.00 ,$13.09 ,$18.92 ,$26.18 ,$26.18 ,$13.09 ,$26.18 ,$67.20 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500287,85549,HC MURAMIDASE-90,305,1 ,$92.00 ,$59.80 ,$10.80 ,$92.00 ,$46.88 ,$32.34 ,$51.52 ,$18.75 ,$25.76 ,$32.48 ,$18.75 ,$37.90 ,$18.75 ,$41.49 ,$41.49 ,$18.75 ,$23.44 ,$35.63 ,$36.48 ,$46.88 ,$18.75 ,$18.75 ,$19.13 ,$69.00 ,$55.20 ,$55.20 ,$18.75 ,$55.20 ,$27.08 ,$27.08 ,$27.08 ,$92.00 , N/A ,$78.20 ,$46.88 ,$59.80 ,$18.75 ,$92.00 ,$51.52 ,$18.75 ,$24.20 , N/A ,$11.88 ,$11.34 ,$19.69 ,$73.60 ,$42.19 ,$41.49 ,$25.76 ,$82.80 ,$18.75 ,$27.08 ,$37.50 ,$37.50 ,$18.75 ,$37.50 ,$44.16 ,$10.80 
ST. ELIZABETH'S HOSPITAL,30500289,85597,HC PLATELET NEUTRALIZATION-90,305,1 ,$90.00 ,$58.50 ,$11.63 ,$90.00 ,$44.95 ,$30.99 ,$50.40 ,$17.98 ,$25.20 ,$31.77 ,$17.98 ,$37.08 ,$17.98 ,$40.59 ,$40.59 ,$17.98 ,$22.48 ,$34.16 ,$34.60 ,$44.95 ,$17.98 ,$17.98 ,$18.34 ,$67.50 ,$54.00 ,$54.00 ,$17.98 ,$54.00 ,$25.96 ,$25.96 ,$25.96 ,$90.00 , N/A ,$76.50 ,$44.95 ,$58.50 ,$17.98 ,$90.00 ,$50.40 ,$17.98 ,$23.67 , N/A ,$12.79 ,$12.21 ,$18.88 ,$72.00 ,$40.46 ,$40.59 ,$25.20 ,$81.00 ,$17.98 ,$25.96 ,$35.96 ,$35.96 ,$17.98 ,$35.96 ,$43.20 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500290,85598,HC HEXAGN NEUTRALIZATION PHOSPH-90,305,1 ,$79.00 ,$51.35 ,$11.63 ,$79.00 ,$44.95 ,$30.99 ,$44.24 ,$17.98 ,$22.12 ,$27.89 ,$17.98 ,$32.55 ,$17.98 ,$35.63 ,$35.63 ,$17.98 ,$22.48 ,$34.16 ,$34.60 ,$44.95 ,$17.98 ,$17.98 ,$18.34 ,$59.25 ,$47.40 ,$47.40 ,$17.98 ,$47.40 ,$25.96 ,$25.96 ,$25.96 ,$79.00 , N/A ,$67.15 ,$44.95 ,$51.35 ,$17.98 ,$79.00 ,$44.24 ,$17.98 ,$20.78 , N/A ,$12.79 ,$12.21 ,$18.88 ,$63.20 ,$40.46 ,$35.63 ,$22.12 ,$71.10 ,$17.98 ,$25.96 ,$35.96 ,$35.96 ,$17.98 ,$35.96 ,$37.92 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500297,85613,HC RUSSELL VIPER VENOM SCR T1-90,305,1 ,$106.00 ,$68.90 ,$9.58 ,$106.00 ,$23.95 ,$16.50 ,$59.36 ,$9.58 ,$29.68 ,$37.42 ,$9.58 ,$43.67 ,$9.58 ,$47.81 ,$47.81 ,$9.58 ,$11.98 ,$18.20 ,$18.87 ,$23.95 ,$9.58 ,$9.58 ,$9.77 ,$79.50 ,$63.60 ,$63.60 ,$9.58 ,$63.60 ,$13.83 ,$13.83 ,$13.83 ,$106.00 , N/A ,$90.10 ,$23.95 ,$68.90 ,$9.58 ,$106.00 ,$59.36 ,$9.58 ,$27.88 , N/A ,$12.79 ,$12.21 ,$10.06 ,$84.80 ,$21.56 ,$47.81 ,$29.68 ,$95.40 ,$9.58 ,$13.83 ,$19.16 ,$19.16 ,$9.58 ,$19.16 ,$50.88 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500301,85660,HC SICKLE CELL RBC-90,305,1 ,$66.00 ,$42.90 ,$5.51 ,$66.00 ,$13.78 ,$9.50 ,$36.96 ,$5.51 ,$18.48 ,$23.30 ,$5.51 ,$27.19 ,$5.51 ,$29.77 ,$29.77 ,$5.51 ,$6.89 ,$10.47 ,$10.69 ,$13.78 ,$5.51 ,$5.51 ,$5.62 ,$49.50 ,$39.60 ,$39.60 ,$5.51 ,$39.60 ,$7.96 ,$7.96 ,$7.96 ,$66.00 , N/A ,$56.10 ,$13.78 ,$42.90 ,$5.51 ,$66.00 ,$36.96 ,$5.51 ,$17.36 , N/A ,$7.38 ,$7.05 ,$5.79 ,$52.80 ,$12.40 ,$29.77 ,$18.48 ,$59.40 ,$5.51 ,$7.96 ,$11.02 ,$11.02 ,$5.51 ,$11.02 ,$31.68 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500303,85660,HC SICKLE CELL RBC,305,1 ,$121.00 ,$78.65 ,$5.51 ,$121.00 ,$13.78 ,$9.50 ,$67.76 ,$5.51 ,$33.88 ,$41.28 ,$5.51 ,$41.28 ,$5.51 ,$54.57 ,$54.57 ,$5.51 ,$6.89 ,$10.47 ,$10.69 ,$13.78 ,$5.51 ,$5.51 ,$5.62 ,$90.75 ,$72.60 ,$72.60 ,$5.51 ,$72.60 ,$7.96 ,$7.96 ,$7.96 ,$121.00 , N/A ,$102.85 ,$13.78 ,$78.65 ,$5.51 ,$121.00 ,$67.76 ,$5.51 ,$31.82 , N/A ,$7.38 ,$7.05 ,$5.79 ,$96.80 ,$12.40 ,$54.57 ,$33.88 ,$108.90 ,$5.51 ,$7.96 ,$11.02 ,$11.02 ,$5.51 ,$11.02 ,$58.08 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500304,85670,HC THROMBIN TIME PLASMA-90,305,1 ,$124.00 ,$80.60 ,$3.92 ,$124.00 ,$14.43 ,$9.96 ,$69.44 ,$5.77 ,$34.72 ,$43.24 ,$5.77 ,$43.24 ,$5.77 ,$55.92 ,$55.92 ,$5.77 ,$7.21 ,$10.96 ,$11.32 ,$14.43 ,$5.77 ,$5.77 ,$5.89 ,$93.00 ,$74.40 ,$74.40 ,$5.77 ,$74.40 ,$8.33 ,$8.33 ,$8.33 ,$124.00 , N/A ,$105.40 ,$14.43 ,$80.60 ,$5.77 ,$124.00 ,$69.44 ,$5.77 ,$32.61 , N/A ,$4.31 ,$4.12 ,$6.06 ,$99.20 ,$12.98 ,$55.92 ,$34.72 ,$111.60 ,$5.77 ,$8.33 ,$11.54 ,$11.54 ,$5.77 ,$11.54 ,$59.52 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500305,85730,HC PTT-90,305,1 ,$94.00 ,$61.10 ,$3.92 ,$94.00 ,$15.03 ,$10.36 ,$52.64 ,$6.01 ,$26.32 ,$33.18 ,$6.01 ,$38.73 ,$6.01 ,$42.39 ,$42.39 ,$6.01 ,$7.51 ,$11.42 ,$11.95 ,$15.03 ,$6.01 ,$6.01 ,$6.13 ,$70.50 ,$56.40 ,$56.40 ,$6.01 ,$56.40 ,$8.67 ,$8.67 ,$8.67 ,$94.00 , N/A ,$79.90 ,$15.03 ,$61.10 ,$6.01 ,$94.00 ,$52.64 ,$6.01 ,$24.72 , N/A ,$4.31 ,$4.12 ,$6.31 ,$75.20 ,$13.52 ,$42.39 ,$26.32 ,$84.60 ,$6.01 ,$8.67 ,$12.02 ,$12.02 ,$6.01 ,$12.02 ,$45.12 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500307,85732,HC PTT MIXING STUDY T1-90,305,1 ,$10.00 ,$6.50 ,$2.63 ,$16.18 ,$16.18 ,$10.00 ,$5.60 ,$6.47 ,$2.80 ,$3.53 ,$6.47 ,$4.12 ,$6.47 ,$4.51 ,$4.51 ,$6.47 ,$8.09 ,$10.00 ,$10.00 ,$16.18 ,$6.47 ,$6.47 ,$6.60 ,$7.50 ,$6.00 ,$6.00 ,$6.47 ,$6.00 ,$9.33 ,$9.33 ,$9.33 ,$10.00 , N/A ,$8.50 ,$10.00 ,$6.50 ,$6.47 ,$10.00 ,$5.60 ,$6.47 ,$2.63 , N/A ,$4.31 ,$4.12 ,$6.79 ,$8.00 ,$14.56 ,$4.51 ,$2.80 ,$9.00 ,$6.47 ,$9.33 ,$10.00 ,$10.00 ,$6.47 ,$10.00 ,$4.80 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500310,85810,HC VISCOSITY-90,305,1 ,$48.00 ,$31.20 ,$10.21 ,$48.00 ,$29.18 ,$20.13 ,$26.88 ,$11.67 ,$13.44 ,$16.94 ,$11.67 ,$19.78 ,$11.67 ,$21.65 ,$21.65 ,$11.67 ,$14.59 ,$22.17 ,$22.64 ,$29.18 ,$11.67 ,$11.67 ,$11.90 ,$36.00 ,$28.80 ,$28.80 ,$11.67 ,$28.80 ,$16.86 ,$16.86 ,$16.86 ,$48.00 , N/A ,$40.80 ,$29.18 ,$31.20 ,$11.67 ,$48.00 ,$26.88 ,$11.67 ,$12.62 , N/A ,$11.23 ,$10.72 ,$12.25 ,$38.40 ,$26.26 ,$21.65 ,$13.44 ,$43.20 ,$11.67 ,$16.86 ,$23.34 ,$23.34 ,$11.67 ,$23.34 ,$23.04 ,$10.21 
ST. ELIZABETH'S HOSPITAL,30500327,85041,HC BLOOD COUNT RBS AUTO,305,1 ,$35.00 ,$22.75 ,$3.02 ,$35.00 ,$7.55 ,$4.55 ,$19.60 ,$3.02 ,$9.80 ,$12.36 ,$3.02 ,$14.42 ,$3.02 ,$15.79 ,$15.79 ,$3.02 ,$3.78 ,$5.74 ,$5.66 ,$7.55 ,$3.02 ,$3.02 ,$3.08 ,$26.25 ,$21.00 ,$21.00 ,$3.02 ,$21.00 ,$4.36 ,$4.36 ,$4.36 ,$35.00 , N/A ,$29.75 ,$7.55 ,$22.75 ,$3.02 ,$35.00 ,$19.60 ,$3.02 ,$9.21 , N/A ,$7.38 ,$7.05 ,$3.17 ,$28.00 ,$6.80 ,$15.79 ,$9.80 ,$31.50 ,$3.02 ,$4.36 ,$6.04 ,$6.04 ,$3.02 ,$6.04 ,$16.80 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500331,85378,HC FDP (D-DIMER) QL/SEMI-QN,305,1 ,$137.00 ,$89.05 ,$9.72 ,$137.00 ,$24.30 ,$12.29 ,$76.72 ,$9.72 ,$38.36 ,$48.36 ,$9.72 ,$56.44 ,$9.72 ,$61.79 ,$61.79 ,$9.72 ,$12.15 ,$18.47 ,$16.98 ,$24.30 ,$9.72 ,$9.72 ,$9.91 ,$102.75 ,$82.20 ,$82.20 ,$9.72 ,$82.20 ,$12.64 ,$12.64 ,$12.64 ,$137.00 , N/A ,$116.45 ,$24.30 ,$89.05 ,$9.72 ,$137.00 ,$76.72 ,$9.72 ,$36.03 , N/A ,$12.79 ,$12.21 ,$10.21 ,$109.60 ,$21.87 ,$61.79 ,$38.36 ,$123.30 ,$9.72 ,$12.64 ,$19.44 ,$19.44 ,$9.72 ,$19.44 ,$65.76 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500341,85046,HC BLOOD COUNT RETICULOCYTES AUTO,305,1 ,$60.00 ,$39.00 ,$5.57 ,$60.00 ,$13.93 ,$9.63 ,$33.60 ,$5.57 ,$16.80 ,$21.18 ,$5.57 ,$24.72 ,$5.57 ,$27.06 ,$27.06 ,$5.57 ,$6.96 ,$10.58 ,$10.69 ,$13.93 ,$5.57 ,$5.57 ,$5.68 ,$45.00 ,$36.00 ,$36.00 ,$5.57 ,$36.00 ,$8.05 ,$8.05 ,$8.05 ,$60.00 , N/A ,$51.00 ,$13.93 ,$39.00 ,$5.57 ,$60.00 ,$33.60 ,$5.57 ,$15.78 , N/A ,$7.38 ,$7.05 ,$5.85 ,$48.00 ,$12.53 ,$27.06 ,$16.80 ,$54.00 ,$5.57 ,$8.05 ,$11.14 ,$11.14 ,$5.57 ,$11.14 ,$28.80 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500831,85384,HC FIBRINOGEN,305,1 ,$4.79 ,$3.11 ,$1.26 ,$11.98 ,$11.98 ,$4.79 ,$2.68 ,$4.79 ,$1.34 ,$1.69 ,$4.79 ,$1.97 ,$4.79 ,$2.16 ,$2.16 ,$4.79 ,$4.79 ,$4.79 ,$4.79 ,$11.98 ,$4.79 ,$4.79 ,$4.79 ,$3.59 ,$2.87 ,$2.87 ,$4.79 ,$2.87 ,$4.79 ,$4.79 ,$4.79 ,$4.79 , N/A ,$4.07 ,$4.79 ,$3.11 ,$4.79 ,$4.79 ,$2.68 ,$4.79 ,$1.26 , N/A ,$4.31 ,$4.12 ,$5.03 ,$3.83 ,$10.78 ,$2.16 ,$1.34 ,$4.31 ,$4.79 ,$4.79 ,$4.79 ,$4.79 ,$4.79 ,$4.79 ,$2.30 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500832,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$75.00 ,$48.75 ,$6.14 ,$75.00 ,$19.33 ,$6.14 ,$42.00 ,$7.73 ,$21.00 ,$26.48 ,$7.73 ,$30.90 ,$7.73 ,$33.83 ,$33.83 ,$7.73 ,$9.66 ,$14.69 ,$15.10 ,$19.33 ,$7.73 ,$7.73 ,$7.88 ,$56.25 ,$45.00 ,$45.00 ,$7.73 ,$45.00 ,$11.17 ,$11.17 ,$11.17 ,$75.00 , N/A ,$63.75 ,$19.33 ,$48.75 ,$7.73 ,$75.00 ,$42.00 ,$7.73 ,$19.73 , N/A ,$11.23 ,$10.72 ,$8.12 ,$60.00 ,$17.39 ,$33.83 ,$21.00 ,$67.50 ,$7.73 ,$11.17 ,$15.46 ,$15.46 ,$7.73 ,$15.46 ,$36.00 ,$10.21 
ST. ELIZABETH'S HOSPITAL,30500833,85520,HC HEPARIN ASSAY,305,1 ,$3.12 ,$2.03 ,$0.82 ,$11.63 ,$7.80 ,$3.12 ,$1.75 ,$3.12 ,$0.87 ,$1.10 ,$3.12 ,$1.29 ,$3.12 ,$1.41 ,$1.41 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$7.80 ,$3.12 ,$3.12 ,$3.12 ,$2.34 ,$1.87 ,$1.87 ,$3.12 ,$1.87 ,$3.12 ,$3.12 ,$3.12 ,$3.12 , N/A ,$2.65 ,$3.12 ,$2.03 ,$3.12 ,$3.12 ,$1.75 ,$3.12 ,$0.82 , N/A ,$3.12 ,$3.12 ,$3.28 ,$2.50 ,$7.02 ,$1.41 ,$0.87 ,$2.81 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$3.12 ,$1.50 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30500836,85610,HC PROTHROMBIN TIME (PT),305,1 ,$2.17 ,$1.41 ,$0.57 ,$5.43 ,$5.43 ,$2.17 ,$1.22 ,$2.17 ,$0.61 ,$0.77 ,$2.17 ,$0.89 ,$2.17 ,$0.98 ,$0.98 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$5.43 ,$2.17 ,$2.17 ,$2.17 ,$1.63 ,$1.30 ,$1.30 ,$2.17 ,$1.30 ,$2.17 ,$2.17 ,$2.17 ,$2.17 , N/A ,$1.84 ,$2.17 ,$1.41 ,$2.17 ,$2.17 ,$1.22 ,$2.17 ,$0.57 , N/A ,$2.17 ,$2.17 ,$2.28 ,$1.74 ,$4.88 ,$0.98 ,$0.61 ,$1.95 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$1.04 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500838,85730,HC PARTIAL THROMBO TIME (PTT),305,1 ,$2.17 ,$1.41 ,$0.57 ,$5.43 ,$5.43 ,$2.17 ,$1.22 ,$2.17 ,$0.61 ,$0.77 ,$2.17 ,$0.89 ,$2.17 ,$0.98 ,$0.98 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$5.43 ,$2.17 ,$2.17 ,$2.17 ,$1.63 ,$1.30 ,$1.30 ,$2.17 ,$1.30 ,$2.17 ,$2.17 ,$2.17 ,$2.17 , N/A ,$1.84 ,$2.17 ,$1.41 ,$2.17 ,$2.17 ,$1.22 ,$2.17 ,$0.57 , N/A ,$2.17 ,$2.17 ,$2.28 ,$1.74 ,$4.88 ,$0.98 ,$0.61 ,$1.95 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$2.17 ,$1.04 ,$3.92 
ST. ELIZABETH'S HOSPITAL,30500842,85660,HC SICKLE CELL RBC,305,1 ,$5.00 ,$3.25 ,$1.32 ,$12.50 ,$12.50 ,$5.00 ,$2.80 ,$5.00 ,$1.40 ,$1.77 ,$5.00 ,$2.06 ,$5.00 ,$2.26 ,$2.26 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$12.50 ,$5.00 ,$5.00 ,$5.00 ,$3.75 ,$3.00 ,$3.00 ,$5.00 ,$3.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 , N/A ,$4.25 ,$5.00 ,$3.25 ,$5.00 ,$5.00 ,$2.80 ,$5.00 ,$1.32 , N/A ,$5.00 ,$5.00 ,$5.25 ,$4.00 ,$11.25 ,$2.26 ,$1.40 ,$4.50 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$2.40 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500849,85652,HC SED RATE AUTO-90,305,1 ,$111.00 ,$72.15 ,$2.70 ,$111.00 ,$6.75 ,$4.66 ,$62.16 ,$2.70 ,$31.08 ,$27.37 ,$2.70 ,$27.37 ,$2.70 ,$50.06 ,$50.06 ,$2.70 ,$3.38 ,$5.13 ,$5.03 ,$6.75 ,$2.70 ,$2.70 ,$2.75 ,$83.25 ,$66.60 ,$66.60 ,$2.70 ,$66.60 ,$3.90 ,$3.90 ,$3.90 ,$111.00 , N/A ,$94.35 ,$6.75 ,$72.15 ,$2.70 ,$111.00 ,$62.16 ,$2.70 ,$29.19 , N/A ,$7.38 ,$7.05 ,$2.84 ,$88.80 ,$6.08 ,$50.06 ,$31.08 ,$99.90 ,$2.70 ,$3.90 ,$5.40 ,$5.40 ,$2.70 ,$5.40 ,$53.28 ,$6.71 
ST. ELIZABETH'S HOSPITAL,30500852,85246,HC CLOT FACTOR VIII VW ANTIGEN-90,305,1 ,$208.00 ,$135.20 ,$11.63 ,$208.00 ,$57.35 ,$24.43 ,$116.48 ,$22.94 ,$58.24 ,$73.42 ,$22.94 ,$85.70 ,$22.94 ,$93.81 ,$93.81 ,$22.94 ,$28.68 ,$43.59 ,$44.66 ,$57.35 ,$22.94 ,$22.94 ,$23.40 ,$156.00 ,$124.80 ,$124.80 ,$22.94 ,$124.80 ,$33.14 ,$33.14 ,$33.14 ,$208.00 , N/A ,$176.80 ,$57.35 ,$135.20 ,$22.94 ,$208.00 ,$116.48 ,$22.94 ,$54.70 , N/A ,$12.79 ,$12.21 ,$24.09 ,$166.40 ,$51.62 ,$93.81 ,$58.24 ,$187.20 ,$22.94 ,$33.14 ,$45.88 ,$45.88 ,$22.94 ,$45.88 ,$99.84 ,$11.63 
ST. ELIZABETH'S HOSPITAL,30600101,87015,HC CONCENTRATION INFECTIOUS AGENT,306,1 ,$161.00 ,$104.65 ,$6.68 ,$161.00 ,$16.70 ,$11.52 ,$90.16 ,$6.68 ,$45.08 ,$50.06 ,$6.68 ,$50.06 ,$6.68 ,$72.61 ,$72.61 ,$6.68 ,$8.35 ,$12.69 ,$13.21 ,$16.70 ,$6.68 ,$6.68 ,$6.81 ,$120.75 ,$96.60 ,$96.60 ,$6.68 ,$96.60 ,$9.65 ,$9.65 ,$9.65 ,$161.00 , N/A ,$136.85 ,$16.70 ,$104.65 ,$6.68 ,$161.00 ,$90.16 ,$6.68 ,$42.34 , N/A ,$8.48 ,$8.10 ,$7.01 ,$128.80 ,$15.03 ,$72.61 ,$45.08 ,$144.90 ,$6.68 ,$9.65 ,$13.36 ,$13.36 ,$6.68 ,$13.36 ,$77.28 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600102,87040,HC BLOOD CULTURE,306,1 ,$252.00 ,$163.80 ,$10.32 ,$252.00 ,$25.80 ,$17.80 ,$141.12 ,$10.32 ,$70.56 ,$77.34 ,$10.32 ,$77.34 ,$10.32 ,$113.65 ,$113.65 ,$10.32 ,$12.90 ,$19.61 ,$20.13 ,$25.80 ,$10.32 ,$10.32 ,$10.53 ,$189.00 ,$151.20 ,$151.20 ,$10.32 ,$151.20 ,$14.91 ,$14.91 ,$14.91 ,$252.00 , N/A ,$214.20 ,$25.80 ,$163.80 ,$10.32 ,$252.00 ,$141.12 ,$10.32 ,$66.28 , N/A ,$28.20 ,$26.92 ,$10.84 ,$201.60 ,$23.22 ,$113.65 ,$70.56 ,$226.80 ,$10.32 ,$14.91 ,$20.64 ,$20.64 ,$10.32 ,$20.64 ,$120.96 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600103,87045,HC STOOL CULTURE,306,1 ,$276.00 ,$179.40 ,$7.71 ,$276.00 ,$23.60 ,$16.28 ,$154.56 ,$9.44 ,$77.28 ,$70.80 ,$9.44 ,$70.80 ,$9.44 ,$124.48 ,$124.48 ,$9.44 ,$11.80 ,$17.94 ,$18.24 ,$23.60 ,$9.44 ,$9.44 ,$9.63 ,$207.00 ,$165.60 ,$165.60 ,$9.44 ,$165.60 ,$13.64 ,$13.64 ,$13.64 ,$276.00 , N/A ,$234.60 ,$23.60 ,$179.40 ,$9.44 ,$276.00 ,$154.56 ,$9.44 ,$72.59 , N/A ,$8.48 ,$8.10 ,$9.91 ,$220.80 ,$21.24 ,$124.48 ,$77.28 ,$248.40 ,$9.44 ,$13.64 ,$18.88 ,$18.88 ,$9.44 ,$18.88 ,$132.48 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600104,87046,HC STOOL CULTURE ADD ISO,306,1 ,$54.00 ,$35.10 ,$7.71 ,$54.00 ,$23.60 ,$16.28 ,$30.24 ,$9.44 ,$15.12 ,$19.06 ,$9.44 ,$22.25 ,$9.44 ,$24.35 ,$24.35 ,$9.44 ,$11.80 ,$17.94 ,$18.24 ,$23.60 ,$9.44 ,$9.44 ,$9.63 ,$40.50 ,$32.40 ,$32.40 ,$9.44 ,$32.40 ,$13.64 ,$13.64 ,$13.64 ,$54.00 , N/A ,$45.90 ,$23.60 ,$35.10 ,$9.44 ,$54.00 ,$30.24 ,$9.44 ,$14.20 , N/A ,$8.48 ,$8.10 ,$9.91 ,$43.20 ,$21.24 ,$24.35 ,$15.12 ,$48.60 ,$9.44 ,$13.64 ,$18.88 ,$18.88 ,$9.44 ,$18.88 ,$25.92 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600109,87070,HC BODY FLUID CULTURE,306,1 ,$242.00 ,$157.30 ,$7.71 ,$242.00 ,$21.55 ,$14.84 ,$135.52 ,$8.62 ,$67.76 ,$85.43 ,$8.62 ,$87.42 ,$8.62 ,$109.14 ,$109.14 ,$8.62 ,$10.78 ,$16.38 ,$16.98 ,$21.55 ,$8.62 ,$8.62 ,$8.79 ,$181.50 ,$145.20 ,$145.20 ,$8.62 ,$145.20 ,$12.44 ,$12.44 ,$12.44 ,$242.00 , N/A ,$205.70 ,$21.55 ,$157.30 ,$8.62 ,$242.00 ,$135.52 ,$8.62 ,$63.65 , N/A ,$8.48 ,$8.10 ,$9.05 ,$193.60 ,$19.40 ,$109.14 ,$67.76 ,$217.80 ,$8.62 ,$12.44 ,$17.24 ,$17.24 ,$8.62 ,$17.24 ,$116.16 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600119,87075,HC CULTURE ANAEROBIC,306,1 ,$475.00 ,$308.75 ,$7.71 ,$475.00 ,$23.68 ,$16.31 ,$266.00 ,$9.47 ,$133.00 ,$70.98 ,$9.47 ,$70.98 ,$9.47 ,$214.23 ,$214.23 ,$9.47 ,$11.84 ,$17.99 ,$18.24 ,$23.68 ,$9.47 ,$9.47 ,$9.66 ,$356.25 ,$285.00 ,$285.00 ,$9.47 ,$285.00 ,$13.68 ,$13.68 ,$13.68 ,$475.00 , N/A ,$403.75 ,$23.68 ,$308.75 ,$9.47 ,$475.00 ,$266.00 ,$9.47 ,$124.93 , N/A ,$8.48 ,$8.10 ,$9.94 ,$380.00 ,$21.31 ,$214.23 ,$133.00 ,$427.50 ,$9.47 ,$13.68 ,$18.94 ,$18.94 ,$9.47 ,$18.94 ,$228.00 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600121,87076,HC CULTURE ANAEROBIC ID,306,1 ,$130.00 ,$84.50 ,$7.32 ,$130.00 ,$20.20 ,$7.32 ,$72.80 ,$8.08 ,$36.40 ,$45.89 ,$8.08 ,$53.56 ,$8.08 ,$58.63 ,$58.63 ,$8.08 ,$10.10 ,$15.35 ,$15.73 ,$20.20 ,$8.08 ,$8.08 ,$8.24 ,$97.50 ,$78.00 ,$78.00 ,$8.08 ,$78.00 ,$11.66 ,$11.66 ,$11.66 ,$130.00 , N/A ,$110.50 ,$20.20 ,$84.50 ,$8.08 ,$130.00 ,$72.80 ,$8.08 ,$34.19 , N/A ,$8.48 ,$8.10 ,$8.48 ,$104.00 ,$18.18 ,$58.63 ,$36.40 ,$117.00 ,$8.08 ,$11.66 ,$16.16 ,$16.16 ,$8.08 ,$16.16 ,$62.40 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600134,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$185.00 ,$120.25 ,$7.71 ,$185.00 ,$20.18 ,$13.91 ,$103.60 ,$8.07 ,$51.80 ,$65.31 ,$8.07 ,$76.22 ,$8.07 ,$83.44 ,$83.44 ,$8.07 ,$10.09 ,$15.33 ,$15.73 ,$20.18 ,$8.07 ,$8.07 ,$8.23 ,$138.75 ,$111.00 ,$111.00 ,$8.07 ,$111.00 ,$11.66 ,$11.66 ,$11.66 ,$185.00 , N/A ,$157.25 ,$20.18 ,$120.25 ,$8.07 ,$185.00 ,$103.60 ,$8.07 ,$48.66 , N/A ,$8.48 ,$8.10 ,$8.47 ,$148.00 ,$18.16 ,$83.44 ,$51.80 ,$166.50 ,$8.07 ,$11.66 ,$16.14 ,$16.14 ,$8.07 ,$16.14 ,$88.80 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600135,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$151.00 ,$98.15 ,$7.71 ,$151.00 ,$20.23 ,$13.97 ,$84.56 ,$8.09 ,$42.28 ,$53.30 ,$8.09 ,$62.21 ,$8.09 ,$68.10 ,$68.10 ,$8.09 ,$10.11 ,$15.37 ,$15.73 ,$20.23 ,$8.09 ,$8.09 ,$8.25 ,$113.25 ,$90.60 ,$90.60 ,$8.09 ,$90.60 ,$11.69 ,$11.69 ,$11.69 ,$151.00 , N/A ,$128.35 ,$20.23 ,$98.15 ,$8.09 ,$151.00 ,$84.56 ,$8.09 ,$39.71 , N/A ,$8.48 ,$8.10 ,$8.49 ,$120.80 ,$18.20 ,$68.10 ,$42.28 ,$135.90 ,$8.09 ,$11.69 ,$16.18 ,$16.18 ,$8.09 ,$16.18 ,$72.48 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600138,87102,HC CULTURE FUNGUS OTHER,306,1 ,$258.00 ,$167.70 ,$7.71 ,$258.00 ,$21.03 ,$14.49 ,$144.48 ,$8.41 ,$72.24 ,$63.05 ,$8.41 ,$63.05 ,$8.41 ,$116.36 ,$116.36 ,$8.41 ,$10.51 ,$15.98 ,$16.35 ,$21.03 ,$8.41 ,$8.41 ,$8.58 ,$193.50 ,$154.80 ,$154.80 ,$8.41 ,$154.80 ,$12.14 ,$12.14 ,$12.14 ,$258.00 , N/A ,$219.30 ,$21.03 ,$167.70 ,$8.41 ,$258.00 ,$144.48 ,$8.41 ,$67.85 , N/A ,$8.48 ,$8.10 ,$8.83 ,$206.40 ,$18.92 ,$116.36 ,$72.24 ,$232.20 ,$8.41 ,$12.14 ,$16.82 ,$16.82 ,$8.41 ,$16.82 ,$123.84 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600142,87106,HC CULTURE FUNGUS ID,306,1 ,$149.00 ,$96.85 ,$7.71 ,$149.00 ,$25.80 ,$17.80 ,$83.44 ,$10.32 ,$41.72 ,$52.60 ,$10.32 ,$61.39 ,$10.32 ,$67.20 ,$67.20 ,$10.32 ,$12.90 ,$19.61 ,$20.13 ,$25.80 ,$10.32 ,$10.32 ,$10.53 ,$111.75 ,$89.40 ,$89.40 ,$10.32 ,$89.40 ,$14.91 ,$14.91 ,$14.91 ,$149.00 , N/A ,$126.65 ,$25.80 ,$96.85 ,$10.32 ,$149.00 ,$83.44 ,$10.32 ,$39.19 , N/A ,$8.48 ,$8.10 ,$10.84 ,$119.20 ,$23.22 ,$67.20 ,$41.72 ,$134.10 ,$10.32 ,$14.91 ,$20.64 ,$20.64 ,$10.32 ,$20.64 ,$71.52 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600159,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$89.00 ,$57.85 ,$5.18 ,$89.00 ,$12.95 ,$8.93 ,$49.84 ,$5.18 ,$24.92 ,$31.42 ,$5.18 ,$36.67 ,$5.18 ,$40.14 ,$40.14 ,$5.18 ,$6.48 ,$9.84 ,$10.06 ,$12.95 ,$5.18 ,$5.18 ,$5.28 ,$66.75 ,$53.40 ,$53.40 ,$5.18 ,$53.40 ,$7.48 ,$7.48 ,$7.48 ,$89.00 , N/A ,$75.65 ,$12.95 ,$57.85 ,$5.18 ,$89.00 ,$49.84 ,$5.18 ,$23.41 , N/A ,$8.48 ,$8.10 ,$5.44 ,$71.20 ,$11.66 ,$40.14 ,$24.92 ,$80.10 ,$5.18 ,$7.48 ,$10.36 ,$10.36 ,$5.18 ,$10.36 ,$42.72 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600163,87172,HC PINWORM EXAM,306,1 ,$77.00 ,$50.05 ,$4.27 ,$77.00 ,$10.68 ,$7.37 ,$43.12 ,$4.27 ,$21.56 ,$27.18 ,$4.27 ,$31.72 ,$4.27 ,$34.73 ,$34.73 ,$4.27 ,$5.34 ,$8.11 ,$8.18 ,$10.68 ,$4.27 ,$4.27 ,$4.36 ,$57.75 ,$46.20 ,$46.20 ,$4.27 ,$46.20 ,$6.18 ,$6.18 ,$6.18 ,$77.00 , N/A ,$65.45 ,$10.68 ,$50.05 ,$4.27 ,$77.00 ,$43.12 ,$4.27 ,$20.25 , N/A ,$8.48 ,$8.10 ,$4.48 ,$61.60 ,$9.61 ,$34.73 ,$21.56 ,$69.30 ,$4.27 ,$6.18 ,$8.54 ,$8.54 ,$4.27 ,$8.54 ,$36.96 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600166,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$31.00 ,$20.15 ,$4.75 ,$31.00 ,$11.88 ,$8.19 ,$17.36 ,$4.75 ,$8.68 ,$10.94 ,$4.75 ,$12.77 ,$4.75 ,$13.98 ,$13.98 ,$4.75 ,$5.94 ,$9.03 ,$9.44 ,$11.88 ,$4.75 ,$4.75 ,$4.85 ,$23.25 ,$18.60 ,$18.60 ,$4.75 ,$18.60 ,$6.85 ,$6.85 ,$6.85 ,$31.00 , N/A ,$26.35 ,$11.88 ,$20.15 ,$4.75 ,$31.00 ,$17.36 ,$4.75 ,$8.15 , N/A ,$8.48 ,$8.10 ,$4.99 ,$24.80 ,$10.69 ,$13.98 ,$8.68 ,$27.90 ,$4.75 ,$6.85 ,$9.50 ,$9.50 ,$4.75 ,$9.50 ,$14.88 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600169,87184,HC SENSITIVITY DISK KB,306,1 ,$127.00 ,$82.55 ,$7.48 ,$127.00 ,$18.70 ,$11.90 ,$71.12 ,$7.48 ,$35.56 ,$44.83 ,$7.48 ,$52.32 ,$7.48 ,$57.28 ,$57.28 ,$7.48 ,$9.35 ,$14.21 ,$13.21 ,$18.70 ,$7.48 ,$7.48 ,$7.63 ,$95.25 ,$76.20 ,$76.20 ,$7.48 ,$76.20 ,$9.96 ,$9.96 ,$9.96 ,$127.00 , N/A ,$107.95 ,$18.70 ,$82.55 ,$7.48 ,$127.00 ,$71.12 ,$7.48 ,$33.40 , N/A ,$8.48 ,$8.10 ,$7.85 ,$101.60 ,$16.83 ,$57.28 ,$35.56 ,$114.30 ,$7.48 ,$9.96 ,$14.96 ,$14.96 ,$7.48 ,$14.96 ,$60.96 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600171,87185,HC BETA LACTAMASE,306,1 ,$92.00 ,$59.80 ,$4.75 ,$92.00 ,$11.88 ,$8.19 ,$51.52 ,$4.75 ,$25.76 ,$32.48 ,$4.75 ,$35.59 ,$4.75 ,$41.49 ,$41.49 ,$4.75 ,$5.94 ,$9.03 ,$9.44 ,$11.88 ,$4.75 ,$4.75 ,$4.85 ,$69.00 ,$55.20 ,$55.20 ,$4.75 ,$55.20 ,$6.85 ,$6.85 ,$6.85 ,$92.00 , N/A ,$78.20 ,$11.88 ,$59.80 ,$4.75 ,$92.00 ,$51.52 ,$4.75 ,$24.20 , N/A ,$8.48 ,$8.10 ,$4.99 ,$73.60 ,$10.69 ,$41.49 ,$25.76 ,$82.80 ,$4.75 ,$6.85 ,$9.50 ,$9.50 ,$4.75 ,$9.50 ,$44.16 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600172,87186,HC SENSITIVITY MIC,306,1 ,$280.00 ,$182.00 ,$7.71 ,$280.00 ,$21.63 ,$14.91 ,$156.80 ,$8.65 ,$78.40 ,$64.82 ,$8.65 ,$64.82 ,$8.65 ,$126.28 ,$126.28 ,$8.65 ,$10.81 ,$16.44 ,$16.98 ,$21.63 ,$8.65 ,$8.65 ,$8.82 ,$210.00 ,$168.00 ,$168.00 ,$8.65 ,$168.00 ,$12.49 ,$12.49 ,$12.49 ,$280.00 , N/A ,$238.00 ,$21.63 ,$182.00 ,$8.65 ,$280.00 ,$156.80 ,$8.65 ,$73.64 , N/A ,$8.48 ,$8.10 ,$9.08 ,$224.00 ,$19.46 ,$126.28 ,$78.40 ,$252.00 ,$8.65 ,$12.49 ,$17.30 ,$17.30 ,$8.65 ,$17.30 ,$134.40 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$84.00 ,$54.60 ,$4.27 ,$84.00 ,$10.68 ,$7.37 ,$47.04 ,$4.27 ,$23.52 ,$29.65 ,$4.27 ,$34.61 ,$4.27 ,$37.88 ,$37.88 ,$4.27 ,$5.34 ,$8.11 ,$8.18 ,$10.68 ,$4.27 ,$4.27 ,$4.36 ,$63.00 ,$50.40 ,$50.40 ,$4.27 ,$50.40 ,$6.18 ,$6.18 ,$6.18 ,$84.00 , N/A ,$71.40 ,$10.68 ,$54.60 ,$4.27 ,$84.00 ,$47.04 ,$4.27 ,$22.09 , N/A ,$8.48 ,$8.10 ,$4.48 ,$67.20 ,$9.61 ,$37.88 ,$23.52 ,$75.60 ,$4.27 ,$6.18 ,$8.54 ,$8.54 ,$4.27 ,$8.54 ,$40.32 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600176,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$107.00 ,$69.55 ,$5.39 ,$107.00 ,$13.48 ,$9.26 ,$59.92 ,$5.39 ,$29.96 ,$37.77 ,$5.39 ,$44.08 ,$5.39 ,$48.26 ,$48.26 ,$5.39 ,$6.74 ,$10.24 ,$10.69 ,$13.48 ,$5.39 ,$5.39 ,$5.50 ,$80.25 ,$64.20 ,$64.20 ,$5.39 ,$64.20 ,$7.79 ,$7.79 ,$7.79 ,$107.00 , N/A ,$90.95 ,$13.48 ,$69.55 ,$5.39 ,$107.00 ,$59.92 ,$5.39 ,$28.14 , N/A ,$8.48 ,$8.10 ,$5.66 ,$85.60 ,$12.13 ,$48.26 ,$29.96 ,$96.30 ,$5.39 ,$7.79 ,$10.78 ,$10.78 ,$5.39 ,$10.78 ,$51.36 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600183,87210,HC SMEAR WET MOUNT,306,1 ,$62.00 ,$40.30 ,$5.82 ,$62.00 ,$14.55 ,$7.37 ,$34.72 ,$5.82 ,$17.36 ,$21.89 ,$5.82 ,$25.54 ,$5.82 ,$27.96 ,$27.96 ,$5.82 ,$7.28 ,$11.06 ,$10.06 ,$14.55 ,$5.82 ,$5.82 ,$5.94 ,$46.50 ,$37.20 ,$37.20 ,$5.82 ,$37.20 ,$7.57 ,$7.57 ,$7.57 ,$62.00 , N/A ,$52.70 ,$14.55 ,$40.30 ,$5.82 ,$62.00 ,$34.72 ,$5.82 ,$16.31 , N/A ,$8.48 ,$8.10 ,$6.11 ,$49.60 ,$13.10 ,$27.96 ,$17.36 ,$55.80 ,$5.82 ,$7.57 ,$11.64 ,$11.64 ,$5.82 ,$11.64 ,$29.76 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600185,87220,HC TISSUE KOH PREP,306,1 ,$66.00 ,$42.90 ,$4.27 ,$66.00 ,$10.68 ,$7.37 ,$36.96 ,$4.27 ,$18.48 ,$23.30 ,$4.27 ,$27.19 ,$4.27 ,$29.77 ,$29.77 ,$4.27 ,$5.34 ,$8.11 ,$8.18 ,$10.68 ,$4.27 ,$4.27 ,$4.36 ,$49.50 ,$39.60 ,$39.60 ,$4.27 ,$39.60 ,$6.18 ,$6.18 ,$6.18 ,$66.00 , N/A ,$56.10 ,$10.68 ,$42.90 ,$4.27 ,$66.00 ,$36.96 ,$4.27 ,$17.36 , N/A ,$8.48 ,$8.10 ,$4.48 ,$52.80 ,$9.61 ,$29.77 ,$18.48 ,$59.40 ,$4.27 ,$6.18 ,$8.54 ,$8.54 ,$4.27 ,$8.54 ,$31.68 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$43.00 ,$27.95 ,$9.67 ,$43.00 ,$29.95 ,$20.69 ,$24.08 ,$11.98 ,$12.04 ,$15.18 ,$11.98 ,$17.72 ,$11.98 ,$19.39 ,$19.39 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$32.25 ,$25.80 ,$25.80 ,$11.98 ,$25.80 ,$17.32 ,$17.32 ,$17.32 ,$43.00 , N/A ,$36.55 ,$29.95 ,$27.95 ,$11.98 ,$43.00 ,$24.08 ,$11.98 ,$11.31 , N/A ,$10.64 ,$10.15 ,$12.58 ,$34.40 ,$26.96 ,$19.39 ,$12.04 ,$38.70 ,$11.98 ,$17.32 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$20.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600215,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$193.00 ,$125.45 ,$9.67 ,$193.00 ,$34.55 ,$20.69 ,$108.08 ,$13.82 ,$54.04 ,$68.13 ,$13.82 ,$79.52 ,$13.82 ,$87.04 ,$87.04 ,$13.82 ,$17.28 ,$26.26 ,$23.90 ,$34.55 ,$13.82 ,$13.82 ,$14.10 ,$144.75 ,$115.80 ,$115.80 ,$13.82 ,$115.80 ,$17.97 ,$17.97 ,$17.97 ,$193.00 , N/A ,$164.05 ,$34.55 ,$125.45 ,$13.82 ,$193.00 ,$108.08 ,$13.82 ,$50.76 , N/A ,$10.64 ,$10.15 ,$14.51 ,$154.40 ,$31.10 ,$87.04 ,$54.04 ,$173.70 ,$13.82 ,$17.97 ,$27.64 ,$27.64 ,$13.82 ,$27.64 ,$92.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600216,87329,HC EIA QL GIARDIA AG,306,1 ,$193.00 ,$125.45 ,$9.67 ,$193.00 ,$29.95 ,$20.69 ,$108.08 ,$11.98 ,$54.04 ,$68.13 ,$11.98 ,$79.52 ,$11.98 ,$87.04 ,$87.04 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$144.75 ,$115.80 ,$115.80 ,$11.98 ,$115.80 ,$17.32 ,$17.32 ,$17.32 ,$193.00 , N/A ,$164.05 ,$29.95 ,$125.45 ,$11.98 ,$193.00 ,$108.08 ,$11.98 ,$50.76 , N/A ,$10.64 ,$10.15 ,$12.58 ,$154.40 ,$26.96 ,$87.04 ,$54.04 ,$173.70 ,$11.98 ,$17.32 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$92.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600219,87340,HC EIA QL HEPATITIS ABC B AG,306,1 ,$162.00 ,$105.30 ,$9.67 ,$162.00 ,$25.83 ,$17.80 ,$90.72 ,$10.33 ,$45.36 ,$57.19 ,$10.33 ,$66.74 ,$10.33 ,$73.06 ,$73.06 ,$10.33 ,$12.91 ,$19.63 ,$20.13 ,$25.83 ,$10.33 ,$10.33 ,$10.54 ,$121.50 ,$97.20 ,$97.20 ,$10.33 ,$97.20 ,$14.92 ,$14.92 ,$14.92 ,$162.00 , N/A ,$137.70 ,$25.83 ,$105.30 ,$10.33 ,$162.00 ,$90.72 ,$10.33 ,$42.61 , N/A ,$10.64 ,$10.15 ,$10.85 ,$129.60 ,$23.24 ,$73.06 ,$45.36 ,$145.80 ,$10.33 ,$14.92 ,$20.66 ,$20.66 ,$10.33 ,$20.66 ,$77.76 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600227,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$98.00 ,$63.70 ,$9.67 ,$98.00 ,$29.95 ,$20.69 ,$54.88 ,$11.98 ,$27.44 ,$34.59 ,$11.98 ,$40.38 ,$11.98 ,$44.20 ,$44.20 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$73.50 ,$58.80 ,$58.80 ,$11.98 ,$58.80 ,$17.32 ,$17.32 ,$17.32 ,$98.00 , N/A ,$83.30 ,$29.95 ,$63.70 ,$11.98 ,$98.00 ,$54.88 ,$11.98 ,$25.77 , N/A ,$10.64 ,$10.15 ,$12.58 ,$78.40 ,$26.96 ,$44.20 ,$27.44 ,$88.20 ,$11.98 ,$17.32 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$47.04 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600228,87430,HC RAPID STREP,306,1 ,$114.00 ,$74.10 ,$9.67 ,$114.00 ,$42.03 ,$20.69 ,$63.84 ,$16.81 ,$31.92 ,$40.24 ,$16.81 ,$46.97 ,$16.81 ,$51.41 ,$51.41 ,$16.81 ,$21.01 ,$31.94 ,$29.56 ,$42.03 ,$16.81 ,$16.81 ,$17.15 ,$85.50 ,$68.40 ,$68.40 ,$16.81 ,$68.40 ,$21.85 ,$21.85 ,$21.85 ,$114.00 , N/A ,$96.90 ,$42.03 ,$74.10 ,$16.81 ,$114.00 ,$63.84 ,$16.81 ,$29.98 , N/A ,$10.64 ,$10.15 ,$17.65 ,$91.20 ,$37.82 ,$51.41 ,$31.92 ,$102.60 ,$16.81 ,$21.85 ,$33.62 ,$33.62 ,$16.81 ,$33.62 ,$54.72 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600236,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$367.00 ,$238.55 ,$9.67 ,$367.00 ,$87.73 ,$60.50 ,$205.52 ,$35.09 ,$102.76 ,$129.55 ,$35.09 ,$151.20 ,$35.09 ,$165.52 ,$165.52 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$275.25 ,$220.20 ,$220.20 ,$35.09 ,$220.20 ,$50.69 ,$50.69 ,$50.69 ,$367.00 , N/A ,$311.95 ,$87.73 ,$238.55 ,$35.09 ,$367.00 ,$205.52 ,$35.09 ,$96.52 , N/A ,$10.64 ,$10.15 ,$36.84 ,$293.60 ,$78.95 ,$165.52 ,$102.76 ,$330.30 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$176.16 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600249,87591,HC NEISSERIA AMP,306,1 ,$371.00 ,$241.15 ,$25.64 ,$371.00 ,$87.73 ,$60.50 ,$207.76 ,$35.09 ,$103.88 ,$130.96 ,$35.09 ,$152.85 ,$35.09 ,$167.32 ,$167.32 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$278.25 ,$222.60 ,$222.60 ,$35.09 ,$222.60 ,$50.69 ,$50.69 ,$50.69 ,$371.00 , N/A ,$315.35 ,$87.73 ,$241.15 ,$35.09 ,$371.00 ,$207.76 ,$35.09 ,$97.57 , N/A ,$28.20 ,$26.92 ,$36.84 ,$296.80 ,$78.95 ,$167.32 ,$103.88 ,$333.90 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$178.08 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600269,87807,HC QL RSV,306,1 ,$184.00 ,$119.60 ,$7.71 ,$184.00 ,$32.75 ,$20.69 ,$103.04 ,$13.10 ,$51.52 ,$64.95 ,$13.10 ,$75.81 ,$13.10 ,$82.98 ,$82.98 ,$13.10 ,$16.38 ,$24.89 ,$23.27 ,$32.75 ,$13.10 ,$13.10 ,$13.36 ,$138.00 ,$110.40 ,$110.40 ,$13.10 ,$110.40 ,$17.32 ,$17.32 ,$17.32 ,$184.00 , N/A ,$156.40 ,$32.75 ,$119.60 ,$13.10 ,$184.00 ,$103.04 ,$13.10 ,$48.39 , N/A ,$8.48 ,$8.10 ,$13.76 ,$147.20 ,$29.48 ,$82.98 ,$51.52 ,$165.60 ,$13.10 ,$17.32 ,$26.20 ,$26.20 ,$13.10 ,$26.20 ,$88.32 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600270,87880,HC OPTICAL STREP,306,1 ,$60.00 ,$39.00 ,$7.71 ,$60.00 ,$41.33 ,$20.69 ,$33.60 ,$16.53 ,$16.80 ,$21.18 ,$16.53 ,$24.72 ,$16.53 ,$27.06 ,$27.06 ,$16.53 ,$20.66 ,$31.41 ,$28.93 ,$41.33 ,$16.53 ,$16.53 ,$16.86 ,$45.00 ,$36.00 ,$36.00 ,$16.53 ,$36.00 ,$21.49 ,$21.49 ,$21.49 ,$60.00 , N/A ,$51.00 ,$41.33 ,$39.00 ,$16.53 ,$60.00 ,$33.60 ,$16.53 ,$15.78 , N/A ,$8.48 ,$8.10 ,$17.36 ,$48.00 ,$37.19 ,$27.06 ,$16.80 ,$54.00 ,$16.53 ,$21.49 ,$33.06 ,$33.06 ,$16.53 ,$33.06 ,$28.80 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600271,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$181.00 ,$117.65 ,$7.71 ,$181.00 ,$40.18 ,$20.69 ,$101.36 ,$16.07 ,$50.68 ,$63.89 ,$16.07 ,$74.57 ,$16.07 ,$81.63 ,$81.63 ,$16.07 ,$20.09 ,$30.53 ,$28.31 ,$40.18 ,$16.07 ,$16.07 ,$16.39 ,$135.75 ,$108.60 ,$108.60 ,$16.07 ,$108.60 ,$20.89 ,$20.89 ,$20.89 ,$181.00 , N/A ,$153.85 ,$40.18 ,$117.65 ,$16.07 ,$181.00 ,$101.36 ,$16.07 ,$47.60 , N/A ,$8.48 ,$8.10 ,$16.87 ,$144.80 ,$36.16 ,$81.63 ,$50.68 ,$162.90 ,$16.07 ,$20.89 ,$32.14 ,$32.14 ,$16.07 ,$32.14 ,$86.88 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600283,87804,HC QL INFLUENZA A/B,306,1 ,$269.00 ,$174.85 ,$7.71 ,$269.00 ,$41.38 ,$20.69 ,$150.64 ,$16.55 ,$75.32 ,$94.96 ,$16.55 ,$110.83 ,$16.55 ,$121.32 ,$121.32 ,$16.55 ,$20.69 ,$31.45 ,$28.93 ,$41.38 ,$16.55 ,$16.55 ,$16.88 ,$201.75 ,$161.40 ,$161.40 ,$16.55 ,$161.40 ,$21.52 ,$21.52 ,$21.52 ,$269.00 , N/A ,$228.65 ,$41.38 ,$174.85 ,$16.55 ,$269.00 ,$150.64 ,$16.55 ,$70.75 , N/A ,$8.48 ,$8.10 ,$17.38 ,$215.20 ,$37.24 ,$121.32 ,$75.32 ,$242.10 ,$16.55 ,$21.52 ,$33.10 ,$33.10 ,$16.55 ,$33.10 ,$129.12 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600299,87071,HC CULTURE AEROBIC OTHER SOURCE QN,306,1 ,$149.00 ,$96.85 ,$7.71 ,$149.00 ,$24.73 ,$16.28 ,$83.44 ,$9.89 ,$41.72 ,$52.60 ,$9.89 ,$61.39 ,$9.89 ,$67.20 ,$67.20 ,$9.89 ,$12.36 ,$18.79 ,$18.24 ,$24.73 ,$9.89 ,$9.89 ,$10.09 ,$111.75 ,$89.40 ,$89.40 ,$9.89 ,$89.40 ,$13.64 ,$13.64 ,$13.64 ,$149.00 , N/A ,$126.65 ,$24.73 ,$96.85 ,$9.89 ,$149.00 ,$83.44 ,$9.89 ,$39.19 , N/A ,$8.48 ,$8.10 ,$10.38 ,$119.20 ,$22.25 ,$67.20 ,$41.72 ,$134.10 ,$9.89 ,$13.64 ,$19.78 ,$19.78 ,$9.89 ,$19.78 ,$71.52 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600302,87149,HC CULTURE TYPING ID NUCLEIC ACID,306,1 ,$70.00 ,$45.50 ,$7.71 ,$70.00 ,$50.13 ,$34.56 ,$39.20 ,$20.05 ,$19.60 ,$24.71 ,$20.05 ,$28.84 ,$20.05 ,$31.57 ,$31.57 ,$20.05 ,$25.06 ,$38.10 ,$39.00 ,$50.13 ,$20.05 ,$20.05 ,$20.45 ,$52.50 ,$42.00 ,$42.00 ,$20.05 ,$42.00 ,$28.96 ,$28.96 ,$28.96 ,$70.00 , N/A ,$59.50 ,$50.13 ,$45.50 ,$20.05 ,$70.00 ,$39.20 ,$20.05 ,$18.41 , N/A ,$8.48 ,$8.10 ,$21.05 ,$56.00 ,$45.11 ,$31.57 ,$19.60 ,$63.00 ,$20.05 ,$28.96 ,$40.10 ,$40.10 ,$20.05 ,$40.10 ,$33.60 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600303,87176,HC HOMOGENIZATION TISSUE,306,1 ,$71.00 ,$46.15 ,$5.88 ,$71.00 ,$14.70 ,$10.15 ,$39.76 ,$5.88 ,$19.88 ,$25.06 ,$5.88 ,$29.25 ,$5.88 ,$32.02 ,$32.02 ,$5.88 ,$7.35 ,$11.17 ,$11.32 ,$14.70 ,$5.88 ,$5.88 ,$6.00 ,$53.25 ,$42.60 ,$42.60 ,$5.88 ,$42.60 ,$8.50 ,$8.50 ,$8.50 ,$71.00 , N/A ,$60.35 ,$14.70 ,$46.15 ,$5.88 ,$71.00 ,$39.76 ,$5.88 ,$18.67 , N/A ,$8.48 ,$8.10 ,$6.17 ,$56.80 ,$13.23 ,$32.02 ,$19.88 ,$63.90 ,$5.88 ,$8.50 ,$11.76 ,$11.76 ,$5.88 ,$11.76 ,$34.08 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600317,87427,HC SHIGELLA LIKE TOXIN AG,306,1 ,$156.00 ,$101.40 ,$9.67 ,$156.00 ,$29.95 ,$20.69 ,$87.36 ,$11.98 ,$43.68 ,$55.07 ,$11.98 ,$64.27 ,$11.98 ,$70.36 ,$70.36 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$117.00 ,$93.60 ,$93.60 ,$11.98 ,$93.60 ,$17.32 ,$17.32 ,$17.32 ,$156.00 , N/A ,$132.60 ,$29.95 ,$101.40 ,$11.98 ,$156.00 ,$87.36 ,$11.98 ,$41.03 , N/A ,$10.64 ,$10.15 ,$12.58 ,$124.80 ,$26.96 ,$70.36 ,$43.68 ,$140.40 ,$11.98 ,$17.32 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$74.88 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600318,87449,HC EIA QL MLT AG INF,306,1 ,$43.00 ,$27.95 ,$9.67 ,$43.00 ,$29.95 ,$20.69 ,$24.08 ,$11.98 ,$12.04 ,$15.18 ,$11.98 ,$17.72 ,$11.98 ,$19.39 ,$19.39 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$32.25 ,$25.80 ,$25.80 ,$11.98 ,$25.80 ,$17.32 ,$17.32 ,$17.32 ,$43.00 , N/A ,$36.55 ,$29.95 ,$27.95 ,$11.98 ,$43.00 ,$24.08 ,$11.98 ,$11.31 , N/A ,$10.64 ,$10.15 ,$12.58 ,$34.40 ,$26.96 ,$19.39 ,$12.04 ,$38.70 ,$11.98 ,$17.32 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$20.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600333,87808,HC TRICHOMONAS VAGINITIS OPTICAL,306,1 ,$168.00 ,$109.20 ,$7.71 ,$168.00 ,$38.23 ,$20.69 ,$94.08 ,$15.29 ,$47.04 ,$59.30 ,$15.29 ,$69.22 ,$15.29 ,$75.77 ,$75.77 ,$15.29 ,$19.11 ,$29.05 ,$26.42 ,$38.23 ,$15.29 ,$15.29 ,$15.60 ,$126.00 ,$100.80 ,$100.80 ,$15.29 ,$100.80 ,$19.88 ,$19.88 ,$19.88 ,$168.00 , N/A ,$142.80 ,$38.23 ,$109.20 ,$15.29 ,$168.00 ,$94.08 ,$15.29 ,$44.18 , N/A ,$8.48 ,$8.10 ,$16.05 ,$134.40 ,$34.40 ,$75.77 ,$47.04 ,$151.20 ,$15.29 ,$19.88 ,$30.58 ,$30.58 ,$15.29 ,$30.58 ,$80.64 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600336,87507,HC IF AG DNA/RNA PROBE TQ 12-25 TARGETS,306,1 ,"$1,250.34 ",$812.72 ,$25.64 ,"$1,250.34 ","$1,041.95 ",$694.80 ,$700.19 ,$416.78 ,$350.10 ,$441.37 ,$416.78 ,$515.14 ,$416.78 ,$563.90 ,$563.90 ,$416.78 ,$520.98 ,$791.88 ,$808.29 ,"$1,041.95 ",$416.78 ,$416.78 ,$425.12 ,$937.76 ,$750.20 ,$750.20 ,$416.78 ,$750.20 ,$602.02 ,$602.02 ,$602.02 ,"$1,250.34 ", N/A ,"$1,062.79 ","$1,041.95 ",$812.72 ,$416.78 ,"$1,250.34 ",$700.19 ,$416.78 ,$328.84 , N/A ,$28.20 ,$26.92 ,$437.62 ,"$1,000.27 ",$937.76 ,$563.90 ,$350.10 ,"$1,125.31 ",$416.78 ,$602.02 ,$833.56 ,$833.56 ,$416.78 ,$833.56 ,$600.16 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600338,87581,HC IF AG PROBE MYCOPLASMA PNEUMONIAE,306,1 ,$222.00 ,$144.30 ,$25.64 ,$222.00 ,$87.73 ,$60.50 ,$124.32 ,$35.09 ,$62.16 ,$78.37 ,$35.09 ,$91.46 ,$35.09 ,$100.12 ,$100.12 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$166.50 ,$133.20 ,$133.20 ,$35.09 ,$133.20 ,$50.69 ,$50.69 ,$50.69 ,$222.00 , N/A ,$188.70 ,$87.73 ,$144.30 ,$35.09 ,$222.00 ,$124.32 ,$35.09 ,$58.39 , N/A ,$28.20 ,$26.92 ,$36.84 ,$177.60 ,$78.95 ,$100.12 ,$62.16 ,$199.80 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$106.56 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600339,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,"$1,500.00 ",$975.00 ,$25.64 ,"$1,500.00 ","$1,041.95 ",$701.82 ,$840.00 ,$416.78 ,$420.00 ,$529.50 ,$416.78 ,$618.00 ,$416.78 ,$676.50 ,$676.50 ,$416.78 ,$520.98 ,$791.88 ,$808.29 ,"$1,041.95 ",$416.78 ,$416.78 ,$425.12 ,"$1,125.00 ",$900.00 ,$900.00 ,$416.78 ,$900.00 ,$602.02 ,$602.02 ,$602.02 ,"$1,500.00 ", N/A ,"$1,275.00 ","$1,041.95 ",$975.00 ,$416.78 ,"$1,500.00 ",$840.00 ,$416.78 ,$394.50 , N/A ,$28.20 ,$26.92 ,$437.62 ,"$1,200.00 ",$937.76 ,$676.50 ,$420.00 ,"$1,350.00 ",$416.78 ,$602.02 ,$833.56 ,$833.56 ,$416.78 ,$833.56 ,$720.00 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600344,87530,HC HSV QUANT  TYPE 1  AND  2 DNA QN RT PCR,306,1 ,$508.00 ,$330.20 ,$25.64 ,$508.00 ,$107.10 ,$73.85 ,$284.48 ,$42.84 ,$142.24 ,$179.32 ,$42.84 ,$209.30 ,$42.84 ,$229.11 ,$229.11 ,$42.84 ,$53.55 ,$81.40 ,$83.03 ,$107.10 ,$42.84 ,$42.84 ,$43.70 ,$381.00 ,$304.80 ,$304.80 ,$42.84 ,$304.80 ,$61.88 ,$61.88 ,$61.88 ,$508.00 , N/A ,$431.80 ,$107.10 ,$330.20 ,$42.84 ,$508.00 ,$284.48 ,$42.84 ,$133.60 , N/A ,$28.20 ,$26.92 ,$44.98 ,$406.40 ,$96.39 ,$229.11 ,$142.24 ,$457.20 ,$42.84 ,$61.88 ,$85.68 ,$85.68 ,$42.84 ,$85.68 ,$243.84 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600356,87077,HC CULTURE AEROBIC ID ADDL-90,306,1 ,$7.00 ,$4.55 ,$1.84 ,$17.50 ,$17.50 ,$7.00 ,$3.92 ,$7.00 ,$1.96 ,$2.47 ,$7.00 ,$2.88 ,$7.00 ,$3.16 ,$3.16 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$17.50 ,$7.00 ,$7.00 ,$7.00 ,$5.25 ,$4.20 ,$4.20 ,$7.00 ,$4.20 ,$7.00 ,$7.00 ,$7.00 ,$7.00 , N/A ,$5.95 ,$7.00 ,$4.55 ,$7.00 ,$7.00 ,$3.92 ,$7.00 ,$1.84 , N/A ,$7.00 ,$7.00 ,$7.35 ,$5.60 ,$15.75 ,$3.16 ,$1.96 ,$6.30 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$3.36 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600357,87077,HC CULTURE AEROBIC ID ADDL T1,306,1 ,$120.00 ,$78.00 ,$7.32 ,$120.00 ,$20.20 ,$7.32 ,$67.20 ,$8.08 ,$33.60 ,$42.36 ,$8.08 ,$49.44 ,$8.08 ,$54.12 ,$54.12 ,$8.08 ,$10.10 ,$15.35 ,$15.73 ,$20.20 ,$8.08 ,$8.08 ,$8.24 ,$90.00 ,$72.00 ,$72.00 ,$8.08 ,$72.00 ,$11.66 ,$11.66 ,$11.66 ,$120.00 , N/A ,$102.00 ,$20.20 ,$78.00 ,$8.08 ,$120.00 ,$67.20 ,$8.08 ,$31.56 , N/A ,$8.48 ,$8.10 ,$8.48 ,$96.00 ,$18.18 ,$54.12 ,$33.60 ,$108.00 ,$8.08 ,$11.66 ,$16.16 ,$16.16 ,$8.08 ,$16.16 ,$57.60 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600359,87081,HC CULTURE SCR PRESUMP PATHOGENS-90,306,1 ,$360.00 ,$234.00 ,$6.63 ,$360.00 ,$16.58 ,$11.43 ,$201.60 ,$6.63 ,$100.80 ,$67.25 ,$6.63 ,$67.25 ,$6.63 ,$162.36 ,$162.36 ,$6.63 ,$8.29 ,$12.60 ,$12.58 ,$16.58 ,$6.63 ,$6.63 ,$6.76 ,$270.00 ,$216.00 ,$216.00 ,$6.63 ,$216.00 ,$9.57 ,$9.57 ,$9.57 ,$360.00 , N/A ,$306.00 ,$16.58 ,$234.00 ,$6.63 ,$360.00 ,$201.60 ,$6.63 ,$94.68 , N/A ,$8.48 ,$8.10 ,$6.96 ,$288.00 ,$14.92 ,$162.36 ,$100.80 ,$324.00 ,$6.63 ,$9.57 ,$13.26 ,$13.26 ,$6.63 ,$13.26 ,$172.80 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600360,87081,HC CULTURE SCR PRESUMP PATHOGENS T1,306,1 ,$198.00 ,$128.70 ,$6.63 ,$198.00 ,$16.58 ,$11.43 ,$110.88 ,$6.63 ,$55.44 ,$67.25 ,$6.63 ,$67.25 ,$6.63 ,$89.30 ,$89.30 ,$6.63 ,$8.29 ,$12.60 ,$12.58 ,$16.58 ,$6.63 ,$6.63 ,$6.76 ,$148.50 ,$118.80 ,$118.80 ,$6.63 ,$118.80 ,$9.57 ,$9.57 ,$9.57 ,$198.00 , N/A ,$168.30 ,$16.58 ,$128.70 ,$6.63 ,$198.00 ,$110.88 ,$6.63 ,$52.07 , N/A ,$8.48 ,$8.10 ,$6.96 ,$158.40 ,$14.92 ,$89.30 ,$55.44 ,$178.20 ,$6.63 ,$9.57 ,$13.26 ,$13.26 ,$6.63 ,$13.26 ,$95.04 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600363,87103,HC CULTURE FUNGUS BLOOD-90,306,1 ,$235.00 ,$152.75 ,$15.54 ,$235.00 ,$51.15 ,$15.54 ,$131.60 ,$20.46 ,$65.80 ,$82.96 ,$20.46 ,$96.82 ,$20.46 ,$105.99 ,$105.99 ,$20.46 ,$25.58 ,$38.87 ,$35.85 ,$51.15 ,$20.46 ,$20.46 ,$20.87 ,$176.25 ,$141.00 ,$141.00 ,$20.46 ,$141.00 ,$26.60 ,$26.60 ,$26.60 ,$235.00 , N/A ,$199.75 ,$51.15 ,$152.75 ,$20.46 ,$235.00 ,$131.60 ,$20.46 ,$61.81 , N/A ,$28.20 ,$26.92 ,$21.48 ,$188.00 ,$46.04 ,$105.99 ,$65.80 ,$211.50 ,$20.46 ,$26.60 ,$40.92 ,$40.92 ,$20.46 ,$40.92 ,$112.80 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600364,87106,HC CULTURE FUNGUS ID YEAST-90,306,1 ,$38.00 ,$24.70 ,$7.71 ,$38.00 ,$25.80 ,$17.80 ,$21.28 ,$10.32 ,$10.64 ,$13.41 ,$10.32 ,$15.66 ,$10.32 ,$17.14 ,$17.14 ,$10.32 ,$12.90 ,$19.61 ,$20.13 ,$25.80 ,$10.32 ,$10.32 ,$10.53 ,$28.50 ,$22.80 ,$22.80 ,$10.32 ,$22.80 ,$14.91 ,$14.91 ,$14.91 ,$38.00 , N/A ,$32.30 ,$25.80 ,$24.70 ,$10.32 ,$38.00 ,$21.28 ,$10.32 ,$9.99 , N/A ,$8.48 ,$8.10 ,$10.84 ,$30.40 ,$23.22 ,$17.14 ,$10.64 ,$34.20 ,$10.32 ,$14.91 ,$20.64 ,$20.64 ,$10.32 ,$20.64 ,$18.24 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600365,87107,HC CULTURE FUNGUS ID MOLD-90,306,1 ,$38.00 ,$24.70 ,$9.99 ,$38.00 ,$25.80 ,$17.80 ,$21.28 ,$10.32 ,$10.64 ,$13.41 ,$10.32 ,$15.66 ,$10.32 ,$17.14 ,$17.14 ,$10.32 ,$12.90 ,$19.61 ,$20.13 ,$25.80 ,$10.32 ,$10.32 ,$10.53 ,$28.50 ,$22.80 ,$22.80 ,$10.32 ,$22.80 ,$14.91 ,$14.91 ,$14.91 ,$38.00 , N/A ,$32.30 ,$25.80 ,$24.70 ,$10.32 ,$38.00 ,$21.28 ,$10.32 ,$9.99 , N/A ,$28.20 ,$26.92 ,$10.84 ,$30.40 ,$23.22 ,$17.14 ,$10.64 ,$34.20 ,$10.32 ,$14.91 ,$20.64 ,$20.64 ,$10.32 ,$20.64 ,$18.24 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600367,87110,HC CULTURE CHLAMYDIA-90,306,1 ,$368.00 ,$239.20 ,$7.71 ,$368.00 ,$49.00 ,$33.78 ,$206.08 ,$19.60 ,$103.04 ,$129.90 ,$19.60 ,$146.82 ,$19.60 ,$165.97 ,$165.97 ,$19.60 ,$24.50 ,$37.24 ,$37.74 ,$49.00 ,$19.60 ,$19.60 ,$19.99 ,$276.00 ,$220.80 ,$220.80 ,$19.60 ,$220.80 ,$28.30 ,$28.30 ,$28.30 ,$368.00 , N/A ,$312.80 ,$49.00 ,$239.20 ,$19.60 ,$368.00 ,$206.08 ,$19.60 ,$96.78 , N/A ,$8.48 ,$8.10 ,$20.58 ,$294.40 ,$44.10 ,$165.97 ,$103.04 ,$331.20 ,$19.60 ,$28.30 ,$39.20 ,$39.20 ,$19.60 ,$39.20 ,$176.64 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600368,87116,HC CULTURE AFB/TB/MYCOBACT-90,306,1 ,$295.00 ,$191.75 ,$10.80 ,$295.00 ,$27.00 ,$18.64 ,$165.20 ,$10.80 ,$82.60 ,$80.98 ,$10.80 ,$80.98 ,$10.80 ,$133.05 ,$133.05 ,$10.80 ,$13.50 ,$20.52 ,$20.76 ,$27.00 ,$10.80 ,$10.80 ,$11.02 ,$221.25 ,$177.00 ,$177.00 ,$10.80 ,$177.00 ,$15.60 ,$15.60 ,$15.60 ,$295.00 , N/A ,$250.75 ,$27.00 ,$191.75 ,$10.80 ,$295.00 ,$165.20 ,$10.80 ,$77.59 , N/A ,$28.20 ,$26.92 ,$11.34 ,$236.00 ,$24.30 ,$133.05 ,$82.60 ,$265.50 ,$10.80 ,$15.60 ,$21.60 ,$21.60 ,$10.80 ,$21.60 ,$141.60 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600369,87118,HC CULTURE MYCOBACTERIA ID-90,306,1 ,$151.00 ,$98.15 ,$14.61 ,$151.00 ,$36.53 ,$18.87 ,$84.56 ,$14.61 ,$42.28 ,$53.30 ,$14.61 ,$62.21 ,$14.61 ,$68.10 ,$68.10 ,$14.61 ,$18.26 ,$27.76 ,$25.79 ,$36.53 ,$14.61 ,$14.61 ,$14.90 ,$113.25 ,$90.60 ,$90.60 ,$14.61 ,$90.60 ,$18.99 ,$18.99 ,$18.99 ,$151.00 , N/A ,$128.35 ,$36.53 ,$98.15 ,$14.61 ,$151.00 ,$84.56 ,$14.61 ,$39.71 , N/A ,$28.20 ,$26.92 ,$15.34 ,$120.80 ,$32.87 ,$68.10 ,$42.28 ,$135.90 ,$14.61 ,$18.99 ,$29.22 ,$29.22 ,$14.61 ,$29.22 ,$72.48 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600370,87140,HC CULTURE TYPE IF EA ANTISERUM-90,306,1 ,$16.00 ,$10.40 ,$4.21 ,$25.64 ,$13.93 ,$9.61 ,$8.96 ,$5.57 ,$4.48 ,$5.65 ,$5.57 ,$6.59 ,$5.57 ,$7.22 ,$7.22 ,$5.57 ,$6.96 ,$10.58 ,$10.69 ,$13.93 ,$5.57 ,$5.57 ,$5.68 ,$12.00 ,$9.60 ,$9.60 ,$5.57 ,$9.60 ,$8.05 ,$8.05 ,$8.05 ,$16.00 , N/A ,$13.60 ,$13.93 ,$10.40 ,$5.57 ,$16.00 ,$8.96 ,$5.57 ,$4.21 , N/A ,$16.00 ,$16.00 ,$5.85 ,$12.80 ,$12.53 ,$7.22 ,$4.48 ,$14.40 ,$5.57 ,$8.05 ,$11.14 ,$11.14 ,$5.57 ,$11.14 ,$7.68 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600375,87149,HC CULTURE TYPING ID NUCLEIC ACID-90,306,1 ,$576.00 ,$374.40 ,$7.71 ,$576.00 ,$50.13 ,$34.56 ,$322.56 ,$20.05 ,$161.28 ,$150.28 ,$20.05 ,$150.28 ,$20.05 ,$259.78 ,$259.78 ,$20.05 ,$25.06 ,$38.10 ,$39.00 ,$50.13 ,$20.05 ,$20.05 ,$20.45 ,$432.00 ,$345.60 ,$345.60 ,$20.05 ,$345.60 ,$28.96 ,$28.96 ,$28.96 ,$576.00 , N/A ,$489.60 ,$50.13 ,$374.40 ,$20.05 ,$576.00 ,$322.56 ,$20.05 ,$151.49 , N/A ,$8.48 ,$8.10 ,$21.05 ,$460.80 ,$45.11 ,$259.78 ,$161.28 ,$518.40 ,$20.05 ,$28.96 ,$40.10 ,$40.10 ,$20.05 ,$40.10 ,$276.48 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600377,87153,HC ID NUCLEAR ACID SEQ METH ID-90,306,1 ,"$1,510.00 ",$981.50 ,$25.64 ,"$1,510.00 ",$288.40 ,$198.85 ,$845.60 ,$115.36 ,$422.80 ,$533.03 ,$115.36 ,$622.12 ,$115.36 ,$681.01 ,$681.01 ,$115.36 ,$144.20 ,$219.18 ,$223.93 ,$288.40 ,$115.36 ,$115.36 ,$117.67 ,"$1,132.50 ",$906.00 ,$906.00 ,$115.36 ,$906.00 ,$166.62 ,$166.62 ,$166.62 ,"$1,510.00 ", N/A ,"$1,283.50 ",$288.40 ,$981.50 ,$115.36 ,"$1,510.00 ",$845.60 ,$115.36 ,$397.13 , N/A ,$28.20 ,$26.92 ,$121.13 ,"$1,208.00 ",$259.56 ,$681.01 ,$422.80 ,"$1,359.00 ",$115.36 ,$166.62 ,$230.72 ,$230.72 ,$115.36 ,$230.72 ,$724.80 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600380,87177,HC SMEAR OVA PARASITE CONC/ID-90,306,1 ,$112.00 ,$72.80 ,$7.71 ,$112.00 ,$22.25 ,$15.02 ,$62.72 ,$8.90 ,$31.36 ,$39.54 ,$8.90 ,$46.14 ,$8.90 ,$50.51 ,$50.51 ,$8.90 ,$11.13 ,$16.91 ,$16.98 ,$22.25 ,$8.90 ,$8.90 ,$9.08 ,$84.00 ,$67.20 ,$67.20 ,$8.90 ,$67.20 ,$12.86 ,$12.86 ,$12.86 ,$112.00 , N/A ,$95.20 ,$22.25 ,$72.80 ,$8.90 ,$112.00 ,$62.72 ,$8.90 ,$29.46 , N/A ,$8.48 ,$8.10 ,$9.35 ,$89.60 ,$20.03 ,$50.51 ,$31.36 ,$100.80 ,$8.90 ,$12.86 ,$17.80 ,$17.80 ,$8.90 ,$17.80 ,$53.76 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600388,87186,HC SENSITIVITY MIC INIT PLATE-90,306,1 ,$157.00 ,$102.05 ,$7.71 ,$157.00 ,$21.63 ,$14.91 ,$87.92 ,$8.65 ,$43.96 ,$55.42 ,$8.65 ,$64.68 ,$8.65 ,$70.81 ,$70.81 ,$8.65 ,$10.81 ,$16.44 ,$16.98 ,$21.63 ,$8.65 ,$8.65 ,$8.82 ,$117.75 ,$94.20 ,$94.20 ,$8.65 ,$94.20 ,$12.49 ,$12.49 ,$12.49 ,$157.00 , N/A ,$133.45 ,$21.63 ,$102.05 ,$8.65 ,$157.00 ,$87.92 ,$8.65 ,$41.29 , N/A ,$8.48 ,$8.10 ,$9.08 ,$125.60 ,$19.46 ,$70.81 ,$43.96 ,$141.30 ,$8.65 ,$12.49 ,$17.30 ,$17.30 ,$8.65 ,$17.30 ,$75.36 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600395,87206,HC SMEAR ACID FAST/FLUOR-90,306,1 ,$107.00 ,$69.55 ,$5.39 ,$107.00 ,$13.48 ,$9.26 ,$59.92 ,$5.39 ,$29.96 ,$37.77 ,$5.39 ,$44.08 ,$5.39 ,$48.26 ,$48.26 ,$5.39 ,$6.74 ,$10.24 ,$10.69 ,$13.48 ,$5.39 ,$5.39 ,$5.50 ,$80.25 ,$64.20 ,$64.20 ,$5.39 ,$64.20 ,$7.79 ,$7.79 ,$7.79 ,$107.00 , N/A ,$90.95 ,$13.48 ,$69.55 ,$5.39 ,$107.00 ,$59.92 ,$5.39 ,$28.14 , N/A ,$8.48 ,$8.10 ,$5.66 ,$85.60 ,$12.13 ,$48.26 ,$29.96 ,$96.30 ,$5.39 ,$7.79 ,$10.78 ,$10.78 ,$5.39 ,$10.78 ,$51.36 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600397,87207,HC SPECIAL STAIN INCL BODIES/PARASITES-90,306,1 ,$103.00 ,$66.95 ,$5.99 ,$103.00 ,$14.98 ,$10.34 ,$57.68 ,$5.99 ,$28.84 ,$36.36 ,$5.99 ,$42.44 ,$5.99 ,$46.45 ,$46.45 ,$5.99 ,$7.49 ,$11.38 ,$11.32 ,$14.98 ,$5.99 ,$5.99 ,$6.11 ,$77.25 ,$61.80 ,$61.80 ,$5.99 ,$61.80 ,$8.66 ,$8.66 ,$8.66 ,$103.00 , N/A ,$87.55 ,$14.98 ,$66.95 ,$5.99 ,$103.00 ,$57.68 ,$5.99 ,$27.09 , N/A ,$8.48 ,$8.10 ,$6.29 ,$82.40 ,$13.48 ,$46.45 ,$28.84 ,$92.70 ,$5.99 ,$8.66 ,$11.98 ,$11.98 ,$5.99 ,$11.98 ,$49.44 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600402,87252,HC CULTURE VIRUS ID TISSUE-90,306,1 ,$378.00 ,$245.70 ,$25.64 ,$378.00 ,$65.18 ,$40.04 ,$211.68 ,$26.07 ,$105.84 ,$133.43 ,$26.07 ,$155.74 ,$26.07 ,$170.48 ,$170.48 ,$26.07 ,$32.59 ,$49.53 ,$50.32 ,$65.18 ,$26.07 ,$26.07 ,$26.59 ,$283.50 ,$226.80 ,$226.80 ,$26.07 ,$226.80 ,$37.66 ,$37.66 ,$37.66 ,$378.00 , N/A ,$321.30 ,$65.18 ,$245.70 ,$26.07 ,$378.00 ,$211.68 ,$26.07 ,$99.41 , N/A ,$28.20 ,$26.92 ,$27.37 ,$302.40 ,$58.66 ,$170.48 ,$105.84 ,$340.20 ,$26.07 ,$37.66 ,$52.14 ,$52.14 ,$26.07 ,$52.14 ,$181.44 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600403,87253,HC CULTURE VIRUS ID ADDL EA-90,306,1 ,$97.00 ,$63.05 ,$20.20 ,$97.00 ,$50.50 ,$34.81 ,$54.32 ,$20.20 ,$27.16 ,$34.24 ,$20.20 ,$39.96 ,$20.20 ,$43.75 ,$43.75 ,$20.20 ,$25.25 ,$38.38 ,$39.00 ,$50.50 ,$20.20 ,$20.20 ,$20.60 ,$72.75 ,$58.20 ,$58.20 ,$20.20 ,$58.20 ,$29.19 ,$29.19 ,$29.19 ,$97.00 , N/A ,$82.45 ,$50.50 ,$63.05 ,$20.20 ,$97.00 ,$54.32 ,$20.20 ,$25.51 , N/A ,$28.20 ,$26.92 ,$21.21 ,$77.60 ,$45.45 ,$43.75 ,$27.16 ,$87.30 ,$20.20 ,$29.19 ,$40.40 ,$40.40 ,$20.20 ,$40.40 ,$46.56 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600405,87254,HC VIRUS ISOL SHELL ID-90,306,1 ,$222.00 ,$144.30 ,$19.56 ,$222.00 ,$48.90 ,$33.71 ,$124.32 ,$19.56 ,$62.16 ,$78.37 ,$19.56 ,$91.46 ,$19.56 ,$100.12 ,$100.12 ,$19.56 ,$24.45 ,$37.16 ,$37.74 ,$48.90 ,$19.56 ,$19.56 ,$19.95 ,$166.50 ,$133.20 ,$133.20 ,$19.56 ,$133.20 ,$28.25 ,$28.25 ,$28.25 ,$222.00 , N/A ,$188.70 ,$48.90 ,$144.30 ,$19.56 ,$222.00 ,$124.32 ,$19.56 ,$58.39 , N/A ,$28.20 ,$26.92 ,$20.54 ,$177.60 ,$44.01 ,$100.12 ,$62.16 ,$199.80 ,$19.56 ,$28.25 ,$39.12 ,$39.12 ,$19.56 ,$39.12 ,$106.56 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600407,87260,HC IF ADENOVIRUS AG-90,306,1 ,$84.00 ,$54.60 ,$9.67 ,$84.00 ,$36.08 ,$20.69 ,$47.04 ,$14.43 ,$23.52 ,$29.65 ,$14.43 ,$34.61 ,$14.43 ,$37.88 ,$37.88 ,$14.43 ,$18.04 ,$27.42 ,$25.16 ,$36.08 ,$14.43 ,$14.43 ,$14.72 ,$63.00 ,$50.40 ,$50.40 ,$14.43 ,$50.40 ,$18.76 ,$18.76 ,$18.76 ,$84.00 , N/A ,$71.40 ,$36.08 ,$54.60 ,$14.43 ,$84.00 ,$47.04 ,$14.43 ,$22.09 , N/A ,$10.64 ,$10.15 ,$15.15 ,$67.20 ,$32.47 ,$37.88 ,$23.52 ,$75.60 ,$14.43 ,$18.76 ,$28.86 ,$28.86 ,$14.43 ,$28.86 ,$40.32 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600413,87290,HC IF VARICELLA ZOETER AG-90,306,1 ,$70.00 ,$45.50 ,$9.67 ,$70.00 ,$33.55 ,$20.69 ,$39.20 ,$13.42 ,$19.60 ,$24.71 ,$13.42 ,$28.84 ,$13.42 ,$31.57 ,$31.57 ,$13.42 ,$16.78 ,$25.50 ,$23.27 ,$33.55 ,$13.42 ,$13.42 ,$13.69 ,$52.50 ,$42.00 ,$42.00 ,$13.42 ,$42.00 ,$17.45 ,$17.45 ,$17.45 ,$70.00 , N/A ,$59.50 ,$33.55 ,$45.50 ,$13.42 ,$70.00 ,$39.20 ,$13.42 ,$18.41 , N/A ,$10.64 ,$10.15 ,$14.09 ,$56.00 ,$30.20 ,$31.57 ,$19.60 ,$63.00 ,$13.42 ,$17.45 ,$26.84 ,$26.84 ,$13.42 ,$26.84 ,$33.60 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600414,87299,HC ANTIBODY DETECT IF NOS-90,306,1 ,$70.00 ,$45.50 ,$9.67 ,$70.00 ,$40.25 ,$20.69 ,$39.20 ,$16.10 ,$19.60 ,$24.71 ,$16.10 ,$28.84 ,$16.10 ,$31.57 ,$31.57 ,$16.10 ,$20.13 ,$30.59 ,$28.31 ,$40.25 ,$16.10 ,$16.10 ,$16.42 ,$52.50 ,$42.00 ,$42.00 ,$16.10 ,$42.00 ,$20.93 ,$20.93 ,$20.93 ,$70.00 , N/A ,$59.50 ,$40.25 ,$45.50 ,$16.10 ,$70.00 ,$39.20 ,$16.10 ,$18.41 , N/A ,$10.64 ,$10.15 ,$16.91 ,$56.00 ,$36.23 ,$31.57 ,$19.60 ,$63.00 ,$16.10 ,$20.93 ,$32.20 ,$32.20 ,$16.10 ,$32.20 ,$33.60 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600415,87305,HC EIA QL ASPERGILLUS AG-90,306,1 ,$320.00 ,$208.00 ,$7.71 ,$320.00 ,$29.95 ,$20.69 ,$179.20 ,$11.98 ,$89.60 ,$89.85 ,$11.98 ,$89.85 ,$11.98 ,$144.32 ,$144.32 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$240.00 ,$192.00 ,$192.00 ,$11.98 ,$192.00 ,$17.32 ,$17.32 ,$17.32 ,$320.00 , N/A ,$272.00 ,$29.95 ,$208.00 ,$11.98 ,$320.00 ,$179.20 ,$11.98 ,$84.16 , N/A ,$8.48 ,$8.10 ,$12.58 ,$256.00 ,$26.96 ,$144.32 ,$89.60 ,$288.00 ,$11.98 ,$17.32 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$153.60 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600419,87338,HC EIA QL H PYLORI AG STOOL-90,306,1 ,$325.00 ,$211.25 ,$9.67 ,$325.00 ,$35.95 ,$24.80 ,$182.00 ,$14.38 ,$91.00 ,$114.73 ,$14.38 ,$133.90 ,$14.38 ,$146.58 ,$146.58 ,$14.38 ,$17.98 ,$27.32 ,$27.68 ,$35.95 ,$14.38 ,$14.38 ,$14.67 ,$243.75 ,$195.00 ,$195.00 ,$14.38 ,$195.00 ,$20.77 ,$20.77 ,$20.77 ,$325.00 , N/A ,$276.25 ,$35.95 ,$211.25 ,$14.38 ,$325.00 ,$182.00 ,$14.38 ,$85.48 , N/A ,$10.64 ,$10.15 ,$15.10 ,$260.00 ,$32.36 ,$146.58 ,$91.00 ,$292.50 ,$14.38 ,$20.77 ,$28.76 ,$28.76 ,$14.38 ,$28.76 ,$156.00 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600423,87341,HC EIA QL HEPATITIS B AG NEUT-90,306,1 ,$122.00 ,$79.30 ,$9.67 ,$122.00 ,$25.83 ,$17.80 ,$68.32 ,$10.33 ,$34.16 ,$43.07 ,$10.33 ,$50.26 ,$10.33 ,$55.02 ,$55.02 ,$10.33 ,$12.91 ,$19.63 ,$20.13 ,$25.83 ,$10.33 ,$10.33 ,$10.54 ,$91.50 ,$73.20 ,$73.20 ,$10.33 ,$73.20 ,$14.92 ,$14.92 ,$14.92 ,$122.00 , N/A ,$103.70 ,$25.83 ,$79.30 ,$10.33 ,$122.00 ,$68.32 ,$10.33 ,$32.09 , N/A ,$10.64 ,$10.15 ,$10.85 ,$97.60 ,$23.24 ,$55.02 ,$34.16 ,$109.80 ,$10.33 ,$14.92 ,$20.66 ,$20.66 ,$10.33 ,$20.66 ,$58.56 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600424,87350,HC HEPATITIS BE AG QL-90,306,1 ,$120.00 ,$78.00 ,$9.67 ,$120.00 ,$28.83 ,$19.86 ,$67.20 ,$11.53 ,$33.60 ,$42.36 ,$11.53 ,$49.44 ,$11.53 ,$54.12 ,$54.12 ,$11.53 ,$14.41 ,$21.91 ,$22.64 ,$28.83 ,$11.53 ,$11.53 ,$11.76 ,$90.00 ,$72.00 ,$72.00 ,$11.53 ,$72.00 ,$16.65 ,$16.65 ,$16.65 ,$120.00 , N/A ,$102.00 ,$28.83 ,$78.00 ,$11.53 ,$120.00 ,$67.20 ,$11.53 ,$31.56 , N/A ,$10.64 ,$10.15 ,$12.11 ,$96.00 ,$25.94 ,$54.12 ,$33.60 ,$108.00 ,$11.53 ,$16.65 ,$23.06 ,$23.06 ,$11.53 ,$23.06 ,$57.60 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600426,87385,HC EIA QL HISTOPLASMA AG-90,306,1 ,$404.00 ,$262.60 ,$9.67 ,$404.00 ,$33.13 ,$20.69 ,$226.24 ,$13.25 ,$113.12 ,$89.85 ,$13.25 ,$89.85 ,$13.25 ,$182.20 ,$182.20 ,$13.25 ,$16.56 ,$25.18 ,$23.27 ,$33.13 ,$13.25 ,$13.25 ,$13.52 ,$303.00 ,$242.40 ,$242.40 ,$13.25 ,$242.40 ,$17.32 ,$17.32 ,$17.32 ,$404.00 , N/A ,$343.40 ,$33.13 ,$262.60 ,$13.25 ,$404.00 ,$226.24 ,$13.25 ,$106.25 , N/A ,$10.64 ,$10.15 ,$13.91 ,$323.20 ,$29.81 ,$182.20 ,$113.12 ,$363.60 ,$13.25 ,$17.32 ,$26.50 ,$26.50 ,$13.25 ,$26.50 ,$193.92 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600427,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$191.00 ,$124.15 ,$9.67 ,$191.00 ,$60.20 ,$41.79 ,$106.96 ,$24.08 ,$53.48 ,$67.42 ,$24.08 ,$78.69 ,$24.08 ,$86.14 ,$86.14 ,$24.08 ,$30.10 ,$45.75 ,$46.55 ,$60.20 ,$24.08 ,$24.08 ,$24.56 ,$143.25 ,$114.60 ,$114.60 ,$24.08 ,$114.60 ,$34.78 ,$34.78 ,$34.78 ,$191.00 , N/A ,$162.35 ,$60.20 ,$124.15 ,$24.08 ,$191.00 ,$106.96 ,$24.08 ,$50.23 , N/A ,$10.64 ,$10.15 ,$25.28 ,$152.80 ,$54.18 ,$86.14 ,$53.48 ,$171.90 ,$24.08 ,$34.78 ,$48.16 ,$48.16 ,$24.08 ,$48.16 ,$91.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600432,87449,HC EIA QL MLT AG INF-90,306,1 ,$508.00 ,$330.20 ,$9.67 ,$508.00 ,$29.95 ,$20.69 ,$284.48 ,$11.98 ,$142.24 ,$121.61 ,$11.98 ,$121.61 ,$11.98 ,$229.11 ,$229.11 ,$11.98 ,$14.98 ,$22.76 ,$23.27 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$381.00 ,$304.80 ,$304.80 ,$11.98 ,$304.80 ,$17.32 ,$17.32 ,$17.32 ,$508.00 , N/A ,$431.80 ,$29.95 ,$330.20 ,$11.98 ,$508.00 ,$284.48 ,$11.98 ,$133.60 , N/A ,$10.64 ,$10.15 ,$12.58 ,$406.40 ,$26.96 ,$229.11 ,$142.24 ,$457.20 ,$11.98 ,$17.32 ,$23.96 ,$23.96 ,$11.98 ,$23.96 ,$243.84 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600437,87486,HC CHLAMYDIA PNEUM AMP PROBE,306,1 ,$126.00 ,$81.90 ,$25.64 ,$126.00 ,$87.73 ,$60.50 ,$70.56 ,$35.09 ,$35.28 ,$44.48 ,$35.09 ,$51.91 ,$35.09 ,$56.83 ,$56.83 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$94.50 ,$75.60 ,$75.60 ,$35.09 ,$75.60 ,$50.69 ,$50.69 ,$50.69 ,$126.00 , N/A ,$107.10 ,$87.73 ,$81.90 ,$35.09 ,$126.00 ,$70.56 ,$35.09 ,$33.14 , N/A ,$28.20 ,$26.92 ,$36.84 ,$100.80 ,$78.95 ,$56.83 ,$35.28 ,$113.40 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$60.48 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600438,87491,HC CHLAMYDIA TRACH AMP-90,306,1 ,$348.00 ,$226.20 ,$9.67 ,$348.00 ,$87.73 ,$60.50 ,$194.88 ,$35.09 ,$97.44 ,$122.84 ,$35.09 ,$143.38 ,$35.09 ,$156.95 ,$156.95 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$261.00 ,$208.80 ,$208.80 ,$35.09 ,$208.80 ,$50.69 ,$50.69 ,$50.69 ,$348.00 , N/A ,$295.80 ,$87.73 ,$226.20 ,$35.09 ,$348.00 ,$194.88 ,$35.09 ,$91.52 , N/A ,$10.64 ,$10.15 ,$36.84 ,$278.40 ,$78.95 ,$156.95 ,$97.44 ,$313.20 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$167.04 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600441,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$118.00 ,$76.70 ,$9.67 ,$118.00 ,$93.18 ,$60.50 ,$66.08 ,$37.27 ,$33.04 ,$41.65 ,$37.27 ,$48.62 ,$37.27 ,$53.22 ,$53.22 ,$37.27 ,$46.59 ,$70.81 ,$67.93 ,$93.18 ,$37.27 ,$37.27 ,$38.02 ,$88.50 ,$70.80 ,$70.80 ,$37.27 ,$70.80 ,$50.69 ,$50.69 ,$50.69 ,$118.00 , N/A ,$100.30 ,$93.18 ,$76.70 ,$37.27 ,$118.00 ,$66.08 ,$37.27 ,$31.03 , N/A ,$10.64 ,$10.15 ,$39.13 ,$94.40 ,$83.86 ,$53.22 ,$33.04 ,$106.20 ,$37.27 ,$50.69 ,$74.54 ,$74.54 ,$37.27 ,$74.54 ,$56.64 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600442,87496,HC INFECT AMP (CMV) MENI-90,306,1 ,$907.00 ,$589.55 ,$25.64 ,$907.00 ,$87.73 ,$60.50 ,$507.92 ,$35.09 ,$253.96 ,$263.01 ,$35.09 ,$263.01 ,$35.09 ,$409.06 ,$409.06 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$680.25 ,$544.20 ,$544.20 ,$35.09 ,$544.20 ,$50.69 ,$50.69 ,$50.69 ,$907.00 , N/A ,$770.95 ,$87.73 ,$589.55 ,$35.09 ,$907.00 ,$507.92 ,$35.09 ,$238.54 , N/A ,$28.20 ,$26.92 ,$36.84 ,$725.60 ,$78.95 ,$409.06 ,$253.96 ,$816.30 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$435.36 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600443,87497,HC CMV QN-90,306,1 ,$210.00 ,$136.50 ,$25.64 ,$210.00 ,$107.10 ,$73.85 ,$117.60 ,$42.84 ,$58.80 ,$74.13 ,$42.84 ,$86.52 ,$42.84 ,$94.71 ,$94.71 ,$42.84 ,$53.55 ,$81.40 ,$83.03 ,$107.10 ,$42.84 ,$42.84 ,$43.70 ,$157.50 ,$126.00 ,$126.00 ,$42.84 ,$126.00 ,$61.88 ,$61.88 ,$61.88 ,$210.00 , N/A ,$178.50 ,$107.10 ,$136.50 ,$42.84 ,$210.00 ,$117.60 ,$42.84 ,$55.23 , N/A ,$28.20 ,$26.92 ,$44.98 ,$168.00 ,$96.39 ,$94.71 ,$58.80 ,$189.00 ,$42.84 ,$61.88 ,$85.68 ,$85.68 ,$42.84 ,$85.68 ,$100.80 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600444,87498,HC ENTEROVIRUS AMP PROBE-90,306,1 ,$534.00 ,$347.10 ,$25.64 ,$534.00 ,$87.73 ,$60.50 ,$299.04 ,$35.09 ,$149.52 ,$188.50 ,$35.09 ,$220.01 ,$35.09 ,$240.83 ,$240.83 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$400.50 ,$320.40 ,$320.40 ,$35.09 ,$320.40 ,$50.69 ,$50.69 ,$50.69 ,$534.00 , N/A ,$453.90 ,$87.73 ,$347.10 ,$35.09 ,$534.00 ,$299.04 ,$35.09 ,$140.44 , N/A ,$28.20 ,$26.92 ,$36.84 ,$427.20 ,$78.95 ,$240.83 ,$149.52 ,$480.60 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$256.32 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600446,87502,HC INFLUENZA VIRUS MULTIPLE DNA/RNA-90,306,1 ,$180.00 ,$117.00 ,$16.67 ,$239.50 ,$239.50 ,$146.70 ,$100.80 ,$95.80 ,$50.40 ,$63.54 ,$95.80 ,$74.16 ,$95.80 ,$81.18 ,$81.18 ,$95.80 ,$119.75 ,$180.00 ,$167.32 ,$239.50 ,$95.80 ,$95.80 ,$97.72 ,$135.00 ,$108.00 ,$108.00 ,$95.80 ,$108.00 ,$124.54 ,$124.54 ,$124.54 ,$180.00 , N/A ,$153.00 ,$180.00 ,$117.00 ,$95.80 ,$180.00 ,$100.80 ,$95.80 ,$47.34 , N/A ,$18.34 ,$17.50 ,$100.59 ,$144.00 ,$215.55 ,$81.18 ,$50.40 ,$162.00 ,$95.80 ,$124.54 ,$180.00 ,$180.00 ,$95.80 ,$180.00 ,$86.40 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30600447,87516,HC PROBE HEP B AMP-90,306,1 ,$966.00 ,$627.90 ,$25.64 ,$966.00 ,$87.73 ,$60.50 ,$540.96 ,$35.09 ,$270.48 ,$263.01 ,$35.09 ,$263.01 ,$35.09 ,$435.67 ,$435.67 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$724.50 ,$579.60 ,$579.60 ,$35.09 ,$579.60 ,$50.69 ,$50.69 ,$50.69 ,$966.00 , N/A ,$821.10 ,$87.73 ,$627.90 ,$35.09 ,$966.00 ,$540.96 ,$35.09 ,$254.06 , N/A ,$28.20 ,$26.92 ,$36.84 ,$772.80 ,$78.95 ,$435.67 ,$270.48 ,$869.40 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$463.68 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600449,87521,HC HEPATITIS C PROBE AND RVRS TRNSC-90,306,1 ,$428.00 ,$278.20 ,$25.64 ,$428.00 ,$87.73 ,$60.50 ,$239.68 ,$35.09 ,$119.84 ,$151.08 ,$35.09 ,$176.34 ,$35.09 ,$193.03 ,$193.03 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$321.00 ,$256.80 ,$256.80 ,$35.09 ,$256.80 ,$50.69 ,$50.69 ,$50.69 ,$428.00 , N/A ,$363.80 ,$87.73 ,$278.20 ,$35.09 ,$428.00 ,$239.68 ,$35.09 ,$112.56 , N/A ,$28.20 ,$26.92 ,$36.84 ,$342.40 ,$78.95 ,$193.03 ,$119.84 ,$385.20 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$205.44 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600451,87522,HC HEPATITIS C QN-90,306,1 ,$419.00 ,$272.35 ,$25.64 ,$419.00 ,$107.10 ,$73.85 ,$234.64 ,$42.84 ,$117.32 ,$147.91 ,$42.84 ,$172.63 ,$42.84 ,$188.97 ,$188.97 ,$42.84 ,$53.55 ,$81.40 ,$83.03 ,$107.10 ,$42.84 ,$42.84 ,$43.70 ,$314.25 ,$251.40 ,$251.40 ,$42.84 ,$251.40 ,$61.88 ,$61.88 ,$61.88 ,$419.00 , N/A ,$356.15 ,$107.10 ,$272.35 ,$42.84 ,$419.00 ,$234.64 ,$42.84 ,$110.20 , N/A ,$28.20 ,$26.92 ,$44.98 ,$335.20 ,$96.39 ,$188.97 ,$117.32 ,$377.10 ,$42.84 ,$61.88 ,$85.68 ,$85.68 ,$42.84 ,$85.68 ,$201.12 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600453,87529,HC HERPES SIMPLEX AMP-90,306,1 ,$752.00 ,$488.80 ,$25.64 ,$752.00 ,$87.73 ,$60.50 ,$421.12 ,$35.09 ,$210.56 ,$263.01 ,$35.09 ,$263.01 ,$35.09 ,$339.15 ,$339.15 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$564.00 ,$451.20 ,$451.20 ,$35.09 ,$451.20 ,$50.69 ,$50.69 ,$50.69 ,$752.00 , N/A ,$639.20 ,$87.73 ,$488.80 ,$35.09 ,$752.00 ,$421.12 ,$35.09 ,$197.78 , N/A ,$28.20 ,$26.92 ,$36.84 ,$601.60 ,$78.95 ,$339.15 ,$210.56 ,$676.80 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$360.96 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600454,87530,HC HSV QUANT-90,306,1 ,$286.00 ,$185.90 ,$25.64 ,$286.00 ,$107.10 ,$73.85 ,$160.16 ,$42.84 ,$80.08 ,$100.96 ,$42.84 ,$117.83 ,$42.84 ,$128.99 ,$128.99 ,$42.84 ,$53.55 ,$81.40 ,$83.03 ,$107.10 ,$42.84 ,$42.84 ,$43.70 ,$214.50 ,$171.60 ,$171.60 ,$42.84 ,$171.60 ,$61.88 ,$61.88 ,$61.88 ,$286.00 , N/A ,$243.10 ,$107.10 ,$185.90 ,$42.84 ,$286.00 ,$160.16 ,$42.84 ,$75.22 , N/A ,$28.20 ,$26.92 ,$44.98 ,$228.80 ,$96.39 ,$128.99 ,$80.08 ,$257.40 ,$42.84 ,$61.88 ,$85.68 ,$85.68 ,$42.84 ,$85.68 ,$137.28 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600458,87536,HC HIV-1 QN-90,306,1 ,$984.00 ,$639.60 ,$25.64 ,$984.00 ,$212.75 ,$146.70 ,$551.04 ,$85.10 ,$275.52 ,$347.35 ,$85.10 ,$405.41 ,$85.10 ,$443.78 ,$443.78 ,$85.10 ,$106.38 ,$161.69 ,$164.80 ,$212.75 ,$85.10 ,$85.10 ,$86.80 ,$738.00 ,$590.40 ,$590.40 ,$85.10 ,$590.40 ,$122.92 ,$122.92 ,$122.92 ,$984.00 , N/A ,$836.40 ,$212.75 ,$639.60 ,$85.10 ,$984.00 ,$551.04 ,$85.10 ,$258.79 , N/A ,$28.20 ,$26.92 ,$89.36 ,$787.20 ,$191.48 ,$443.78 ,$275.52 ,$885.60 ,$85.10 ,$122.92 ,$170.20 ,$170.20 ,$85.10 ,$170.20 ,$472.32 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600460,87591,HC NEISSERIA AMP-90,306,1 ,$350.00 ,$227.50 ,$25.64 ,$350.00 ,$87.73 ,$60.50 ,$196.00 ,$35.09 ,$98.00 ,$123.55 ,$35.09 ,$144.20 ,$35.09 ,$157.85 ,$157.85 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$262.50 ,$210.00 ,$210.00 ,$35.09 ,$210.00 ,$50.69 ,$50.69 ,$50.69 ,$350.00 , N/A ,$297.50 ,$87.73 ,$227.50 ,$35.09 ,$350.00 ,$196.00 ,$35.09 ,$92.05 , N/A ,$28.20 ,$26.92 ,$36.84 ,$280.00 ,$78.95 ,$157.85 ,$98.00 ,$315.00 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$168.00 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600467,87651,HC INFECT AMP (GRP A STREP),306,1 ,$349.00 ,$226.85 ,$25.64 ,$349.00 ,$87.73 ,$60.50 ,$195.44 ,$35.09 ,$97.72 ,$123.20 ,$35.09 ,$143.79 ,$35.09 ,$157.40 ,$157.40 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$261.75 ,$209.40 ,$209.40 ,$35.09 ,$209.40 ,$50.69 ,$50.69 ,$50.69 ,$349.00 , N/A ,$296.65 ,$87.73 ,$226.85 ,$35.09 ,$349.00 ,$195.44 ,$35.09 ,$91.79 , N/A ,$28.20 ,$26.92 ,$36.84 ,$279.20 ,$78.95 ,$157.40 ,$97.72 ,$314.10 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$167.52 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600469,87661,HC TRICHOMONAS VAG AMP PROBE-90,306,1 ,$432.00 ,$280.80 ,$25.64 ,$432.00 ,$87.73 ,$58.64 ,$241.92 ,$35.09 ,$120.96 ,$152.50 ,$35.09 ,$177.98 ,$35.09 ,$194.83 ,$194.83 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$324.00 ,$259.20 ,$259.20 ,$35.09 ,$259.20 ,$50.69 ,$50.69 ,$50.69 ,$432.00 , N/A ,$367.20 ,$87.73 ,$280.80 ,$35.09 ,$432.00 ,$241.92 ,$35.09 ,$113.62 , N/A ,$28.20 ,$26.92 ,$36.84 ,$345.60 ,$78.95 ,$194.83 ,$120.96 ,$388.80 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$207.36 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600471,87798,HC INFECT AMP-90,306,1 ,$568.00 ,$369.20 ,$25.64 ,$568.00 ,$87.73 ,$60.50 ,$318.08 ,$35.09 ,$159.04 ,$200.50 ,$35.09 ,$234.02 ,$35.09 ,$256.17 ,$256.17 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$426.00 ,$340.80 ,$340.80 ,$35.09 ,$340.80 ,$50.69 ,$50.69 ,$50.69 ,$568.00 , N/A ,$482.80 ,$87.73 ,$369.20 ,$35.09 ,$568.00 ,$318.08 ,$35.09 ,$149.38 , N/A ,$28.20 ,$26.92 ,$36.84 ,$454.40 ,$78.95 ,$256.17 ,$159.04 ,$511.20 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$272.64 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600475,87798,HC PROBE VZV DNA QUAL RT PCR-90,306,1 ,$200.00 ,$130.00 ,$25.64 ,$200.00 ,$87.73 ,$60.50 ,$112.00 ,$35.09 ,$56.00 ,$70.60 ,$35.09 ,$82.40 ,$35.09 ,$90.20 ,$90.20 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$150.00 ,$120.00 ,$120.00 ,$35.09 ,$120.00 ,$50.69 ,$50.69 ,$50.69 ,$200.00 , N/A ,$170.00 ,$87.73 ,$130.00 ,$35.09 ,$200.00 ,$112.00 ,$35.09 ,$52.60 , N/A ,$28.20 ,$26.92 ,$36.84 ,$160.00 ,$78.95 ,$90.20 ,$56.00 ,$180.00 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$96.00 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600476,87798,HC INFECT AMP T1,306,1 ,$126.00 ,$81.90 ,$25.64 ,$126.00 ,$87.73 ,$60.50 ,$70.56 ,$35.09 ,$35.28 ,$44.48 ,$35.09 ,$51.91 ,$35.09 ,$56.83 ,$56.83 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$94.50 ,$75.60 ,$75.60 ,$35.09 ,$75.60 ,$50.69 ,$50.69 ,$50.69 ,$126.00 , N/A ,$107.10 ,$87.73 ,$81.90 ,$35.09 ,$126.00 ,$70.56 ,$35.09 ,$33.14 , N/A ,$28.20 ,$26.92 ,$36.84 ,$100.80 ,$78.95 ,$56.83 ,$35.28 ,$113.40 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$60.48 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600478,87799,HC INFECT AGENT QN-90,306,1 ,$520.00 ,$338.00 ,$25.64 ,$520.00 ,$107.10 ,$73.85 ,$291.20 ,$42.84 ,$145.60 ,$183.56 ,$42.84 ,$214.24 ,$42.84 ,$234.52 ,$234.52 ,$42.84 ,$53.55 ,$81.40 ,$83.03 ,$107.10 ,$42.84 ,$42.84 ,$43.70 ,$390.00 ,$312.00 ,$312.00 ,$42.84 ,$312.00 ,$61.88 ,$61.88 ,$61.88 ,$520.00 , N/A ,$442.00 ,$107.10 ,$338.00 ,$42.84 ,$520.00 ,$291.20 ,$42.84 ,$136.76 , N/A ,$28.20 ,$26.92 ,$44.98 ,$416.00 ,$96.39 ,$234.52 ,$145.60 ,$468.00 ,$42.84 ,$61.88 ,$85.68 ,$85.68 ,$42.84 ,$85.68 ,$249.60 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600481,87900,HC PHENOTYPE INFCT AGT DRG SUS-90,306,1 ,$169.00 ,$109.85 ,$25.64 ,$325.88 ,$325.88 ,$169.00 ,$94.64 ,$130.35 ,$47.32 ,$59.66 ,$130.35 ,$69.63 ,$130.35 ,$76.22 ,$76.22 ,$130.35 ,$162.94 ,$169.00 ,$169.00 ,$325.88 ,$130.35 ,$130.35 ,$132.96 ,$126.75 ,$101.40 ,$101.40 ,$130.35 ,$101.40 ,$169.00 ,$169.00 ,$169.00 ,$169.00 , N/A ,$143.65 ,$169.00 ,$109.85 ,$130.35 ,$169.00 ,$94.64 ,$130.35 ,$44.45 , N/A ,$28.20 ,$26.92 ,$136.87 ,$135.20 ,$293.29 ,$76.22 ,$47.32 ,$152.10 ,$130.35 ,$169.00 ,$169.00 ,$169.00 ,$130.35 ,$169.00 ,$81.12 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600482,87901,HC GENOTYPE HIV 1-90,306,1 ,"$2,311.00 ","$1,502.15 ",$25.64 ,"$2,311.00 ",$643.63 ,$443.80 ,"$1,294.16 ",$257.45 ,$647.08 ,$815.78 ,$257.45 ,$952.13 ,$257.45 ,"$1,042.26 ","$1,042.26 ",$257.45 ,$321.81 ,$489.16 ,$499.44 ,$643.63 ,$257.45 ,$257.45 ,$262.60 ,"$1,733.25 ","$1,386.60 ","$1,386.60 ",$257.45 ,"$1,386.60 ",$371.87 ,$371.87 ,$371.87 ,"$2,311.00 ", N/A ,"$1,964.35 ",$643.63 ,"$1,502.15 ",$257.45 ,"$2,311.00 ","$1,294.16 ",$257.45 ,$607.79 , N/A ,$28.20 ,$26.92 ,$270.32 ,"$1,848.80 ",$579.26 ,"$1,042.26 ",$647.08 ,"$2,079.90 ",$257.45 ,$371.87 ,$514.90 ,$514.90 ,$257.45 ,$514.90 ,"$1,109.28 ",$25.64 
ST. ELIZABETH'S HOSPITAL,30600483,87902,HC GENTOYPE HEP C-90,306,1 ,"$1,174.00 ",$763.10 ,$25.64 ,"$1,174.00 ",$643.63 ,$443.80 ,$657.44 ,$257.45 ,$328.72 ,$414.42 ,$257.45 ,$483.69 ,$257.45 ,$529.47 ,$529.47 ,$257.45 ,$321.81 ,$489.16 ,$499.44 ,$643.63 ,$257.45 ,$257.45 ,$262.60 ,$880.50 ,$704.40 ,$704.40 ,$257.45 ,$704.40 ,$371.87 ,$371.87 ,$371.87 ,"$1,174.00 ", N/A ,$997.90 ,$643.63 ,$763.10 ,$257.45 ,"$1,174.00 ",$657.44 ,$257.45 ,$308.76 , N/A ,$28.20 ,$26.92 ,$270.32 ,$939.20 ,$579.26 ,$529.47 ,$328.72 ,"$1,056.60 ",$257.45 ,$371.87 ,$514.90 ,$514.90 ,$257.45 ,$514.90 ,$563.52 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600486,87906,HC GENOTYPE DNA/RNA HIV1-90,306,1 ,$924.00 ,$600.60 ,$16.67 ,$924.00 ,$321.83 ,$221.90 ,$517.44 ,$128.73 ,$258.72 ,$326.17 ,$128.73 ,$380.69 ,$128.73 ,$416.72 ,$416.72 ,$128.73 ,$160.91 ,$244.59 ,$249.72 ,$321.83 ,$128.73 ,$128.73 ,$131.30 ,$693.00 ,$554.40 ,$554.40 ,$128.73 ,$554.40 ,$185.94 ,$185.94 ,$185.94 ,$924.00 , N/A ,$785.40 ,$321.83 ,$600.60 ,$128.73 ,$924.00 ,$517.44 ,$128.73 ,$243.01 , N/A ,$18.34 ,$17.50 ,$135.17 ,$739.20 ,$289.64 ,$416.72 ,$258.72 ,$831.60 ,$128.73 ,$185.94 ,$257.46 ,$257.46 ,$128.73 ,$257.46 ,$443.52 ,$16.67 
ST. ELIZABETH'S HOSPITAL,30600502,87341,HC EIA QL HEPATITIS B AG NEUT,306,1 ,$116.00 ,$75.40 ,$9.67 ,$116.00 ,$25.83 ,$17.80 ,$64.96 ,$10.33 ,$32.48 ,$40.95 ,$10.33 ,$47.79 ,$10.33 ,$52.32 ,$52.32 ,$10.33 ,$12.91 ,$19.63 ,$20.13 ,$25.83 ,$10.33 ,$10.33 ,$10.54 ,$87.00 ,$69.60 ,$69.60 ,$10.33 ,$69.60 ,$14.92 ,$14.92 ,$14.92 ,$116.00 , N/A ,$98.60 ,$25.83 ,$75.40 ,$10.33 ,$116.00 ,$64.96 ,$10.33 ,$30.51 , N/A ,$10.64 ,$10.15 ,$10.85 ,$92.80 ,$23.24 ,$52.32 ,$32.48 ,$104.40 ,$10.33 ,$14.92 ,$20.66 ,$20.66 ,$10.33 ,$20.66 ,$55.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600503,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB-90,306,1 ,$191.00 ,$124.15 ,$9.67 ,$191.00 ,$60.20 ,$41.79 ,$106.96 ,$24.08 ,$53.48 ,$67.42 ,$24.08 ,$78.69 ,$24.08 ,$86.14 ,$86.14 ,$24.08 ,$30.10 ,$45.75 ,$46.55 ,$60.20 ,$24.08 ,$24.08 ,$24.56 ,$143.25 ,$114.60 ,$114.60 ,$24.08 ,$114.60 ,$34.78 ,$34.78 ,$34.78 ,$191.00 , N/A ,$162.35 ,$60.20 ,$124.15 ,$24.08 ,$191.00 ,$106.96 ,$24.08 ,$50.23 , N/A ,$10.64 ,$10.15 ,$25.28 ,$152.80 ,$54.18 ,$86.14 ,$53.48 ,$171.90 ,$24.08 ,$34.78 ,$48.16 ,$48.16 ,$24.08 ,$48.16 ,$91.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600516,87040,HC BACTERIA BLOOD CULTURE T1,306,1 ,$5.00 ,$3.25 ,$1.32 ,$25.64 ,$12.50 ,$5.00 ,$2.80 ,$5.00 ,$1.40 ,$1.77 ,$5.00 ,$2.06 ,$5.00 ,$2.26 ,$2.26 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$12.50 ,$5.00 ,$5.00 ,$5.00 ,$3.75 ,$3.00 ,$3.00 ,$5.00 ,$3.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 , N/A ,$4.25 ,$5.00 ,$3.25 ,$5.00 ,$5.00 ,$2.80 ,$5.00 ,$1.32 , N/A ,$5.00 ,$5.00 ,$5.25 ,$4.00 ,$11.25 ,$2.26 ,$1.40 ,$4.50 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$5.00 ,$2.40 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600517,87045,HC STOOL CULTURE,306,1 ,$12.00 ,$7.80 ,$3.16 ,$23.60 ,$23.60 ,$12.00 ,$6.72 ,$9.44 ,$3.36 ,$4.24 ,$9.44 ,$4.94 ,$9.44 ,$5.41 ,$5.41 ,$9.44 ,$11.80 ,$12.00 ,$12.00 ,$23.60 ,$9.44 ,$9.44 ,$9.63 ,$9.00 ,$7.20 ,$7.20 ,$9.44 ,$7.20 ,$12.00 ,$12.00 ,$12.00 ,$12.00 , N/A ,$10.20 ,$12.00 ,$7.80 ,$9.44 ,$12.00 ,$6.72 ,$9.44 ,$3.16 , N/A ,$8.48 ,$8.10 ,$9.91 ,$9.60 ,$21.24 ,$5.41 ,$3.36 ,$10.80 ,$9.44 ,$12.00 ,$12.00 ,$12.00 ,$9.44 ,$12.00 ,$5.76 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600518,87046,HC STOOL CULTURE OTH SRC,306,1 ,$8.00 ,$5.20 ,$2.10 ,$20.00 ,$20.00 ,$8.00 ,$4.48 ,$8.00 ,$2.24 ,$2.82 ,$8.00 ,$3.30 ,$8.00 ,$3.61 ,$3.61 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$20.00 ,$8.00 ,$8.00 ,$8.00 ,$6.00 ,$4.80 ,$4.80 ,$8.00 ,$4.80 ,$8.00 ,$8.00 ,$8.00 ,$8.00 , N/A ,$6.80 ,$8.00 ,$5.20 ,$8.00 ,$8.00 ,$4.48 ,$8.00 ,$2.10 , N/A ,$8.00 ,$8.00 ,$8.40 ,$6.40 ,$18.00 ,$3.61 ,$2.24 ,$7.20 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$3.84 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600519,87070,HC BODY FLUID CULTURE,306,1 ,$1.87 ,$1.22 ,$0.49 ,$7.71 ,$4.68 ,$1.87 ,$1.05 ,$1.87 ,$0.52 ,$0.66 ,$1.87 ,$0.77 ,$1.87 ,$0.84 ,$0.84 ,$1.87 ,$1.87 ,$1.87 ,$1.87 ,$4.68 ,$1.87 ,$1.87 ,$1.87 ,$1.40 ,$1.12 ,$1.12 ,$1.87 ,$1.12 ,$1.87 ,$1.87 ,$1.87 ,$1.87 , N/A ,$1.59 ,$1.87 ,$1.22 ,$1.87 ,$1.87 ,$1.05 ,$1.87 ,$0.49 , N/A ,$1.87 ,$1.87 ,$1.96 ,$1.50 ,$4.21 ,$0.84 ,$0.52 ,$1.68 ,$1.87 ,$1.87 ,$1.87 ,$1.87 ,$1.87 ,$1.87 ,$0.90 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600520,87071,HC CULTURE AEROBIC OTH QN,306,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600522,87075,HC CULTURE ANAEROBIC,306,1 ,$8.00 ,$5.20 ,$2.10 ,$20.00 ,$20.00 ,$8.00 ,$4.48 ,$8.00 ,$2.24 ,$2.82 ,$8.00 ,$3.30 ,$8.00 ,$3.61 ,$3.61 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$20.00 ,$8.00 ,$8.00 ,$8.00 ,$6.00 ,$4.80 ,$4.80 ,$8.00 ,$4.80 ,$8.00 ,$8.00 ,$8.00 ,$8.00 , N/A ,$6.80 ,$8.00 ,$5.20 ,$8.00 ,$8.00 ,$4.48 ,$8.00 ,$2.10 , N/A ,$8.00 ,$8.00 ,$8.40 ,$6.40 ,$18.00 ,$3.61 ,$2.24 ,$7.20 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$3.84 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600523,87076,HC CULTURE ANAEROBIC ID,306,1 ,$12.00 ,$7.80 ,$3.16 ,$20.20 ,$20.20 ,$7.32 ,$6.72 ,$8.08 ,$3.36 ,$4.24 ,$8.08 ,$4.94 ,$8.08 ,$5.41 ,$5.41 ,$8.08 ,$10.10 ,$12.00 ,$12.00 ,$20.20 ,$8.08 ,$8.08 ,$8.24 ,$9.00 ,$7.20 ,$7.20 ,$8.08 ,$7.20 ,$11.66 ,$11.66 ,$11.66 ,$12.00 , N/A ,$10.20 ,$12.00 ,$7.80 ,$8.08 ,$12.00 ,$6.72 ,$8.08 ,$3.16 , N/A ,$8.48 ,$8.10 ,$8.48 ,$9.60 ,$18.18 ,$5.41 ,$3.36 ,$10.80 ,$8.08 ,$11.66 ,$12.00 ,$12.00 ,$8.08 ,$12.00 ,$5.76 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600524,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600526,87081,HC CULTURE SCR PRESUMP PATHOGENS,306,1 ,$1.72 ,$1.12 ,$0.45 ,$7.71 ,$4.30 ,$1.72 ,$0.96 ,$1.72 ,$0.48 ,$0.61 ,$1.72 ,$0.71 ,$1.72 ,$0.78 ,$0.78 ,$1.72 ,$1.72 ,$1.72 ,$1.72 ,$4.30 ,$1.72 ,$1.72 ,$1.72 ,$1.29 ,$1.03 ,$1.03 ,$1.72 ,$1.03 ,$1.72 ,$1.72 ,$1.72 ,$1.72 , N/A ,$1.46 ,$1.72 ,$1.12 ,$1.72 ,$1.72 ,$0.96 ,$1.72 ,$0.45 , N/A ,$1.72 ,$1.72 ,$1.81 ,$1.38 ,$3.87 ,$0.78 ,$0.48 ,$1.55 ,$1.72 ,$1.72 ,$1.72 ,$1.72 ,$1.72 ,$1.72 ,$0.83 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600527,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600528,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$0.56 ,$0.36 ,$0.15 ,$7.71 ,$1.40 ,$0.56 ,$0.31 ,$0.56 ,$0.16 ,$0.20 ,$0.56 ,$0.23 ,$0.56 ,$0.25 ,$0.25 ,$0.56 ,$0.56 ,$0.56 ,$0.56 ,$1.40 ,$0.56 ,$0.56 ,$0.56 ,$0.42 ,$0.34 ,$0.34 ,$0.56 ,$0.34 ,$0.56 ,$0.56 ,$0.56 ,$0.56 , N/A ,$0.48 ,$0.56 ,$0.36 ,$0.56 ,$0.56 ,$0.31 ,$0.56 ,$0.15 , N/A ,$0.56 ,$0.56 ,$0.59 ,$0.45 ,$1.26 ,$0.25 ,$0.16 ,$0.50 ,$0.56 ,$0.56 ,$0.56 ,$0.56 ,$0.56 ,$0.56 ,$0.27 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600531,87102,HC CULTURE FUNGUS OTHER,306,1 ,$3.00 ,$1.95 ,$0.79 ,$7.71 ,$7.50 ,$3.00 ,$1.68 ,$3.00 ,$0.84 ,$1.06 ,$3.00 ,$1.24 ,$3.00 ,$1.35 ,$1.35 ,$3.00 ,$3.00 ,$3.00 ,$3.00 ,$7.50 ,$3.00 ,$3.00 ,$3.00 ,$2.25 ,$1.80 ,$1.80 ,$3.00 ,$1.80 ,$3.00 ,$3.00 ,$3.00 ,$3.00 , N/A ,$2.55 ,$3.00 ,$1.95 ,$3.00 ,$3.00 ,$1.68 ,$3.00 ,$0.79 , N/A ,$3.00 ,$3.00 ,$3.15 ,$2.40 ,$6.75 ,$1.35 ,$0.84 ,$2.70 ,$3.00 ,$3.00 ,$3.00 ,$3.00 ,$3.00 ,$3.00 ,$1.44 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600533,87106,HC CULTURE FUNGUS ID YEAST,306,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600536,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$1.09 ,$0.71 ,$0.29 ,$7.71 ,$2.73 ,$1.09 ,$0.61 ,$1.09 ,$0.31 ,$0.38 ,$1.09 ,$0.45 ,$1.09 ,$0.49 ,$0.49 ,$1.09 ,$1.09 ,$1.09 ,$1.09 ,$2.73 ,$1.09 ,$1.09 ,$1.09 ,$0.82 ,$0.65 ,$0.65 ,$1.09 ,$0.65 ,$1.09 ,$1.09 ,$1.09 ,$1.09 , N/A ,$0.93 ,$1.09 ,$0.71 ,$1.09 ,$1.09 ,$0.61 ,$1.09 ,$0.29 , N/A ,$1.09 ,$1.09 ,$1.14 ,$0.87 ,$2.45 ,$0.49 ,$0.31 ,$0.98 ,$1.09 ,$1.09 ,$1.09 ,$1.09 ,$1.09 ,$1.09 ,$0.52 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600537,87149,HC CULTURE TYPING ID NUCLEIC ACID,306,1 ,$11.00 ,$7.15 ,$2.89 ,$27.50 ,$27.50 ,$11.00 ,$6.16 ,$11.00 ,$3.08 ,$3.88 ,$11.00 ,$4.53 ,$11.00 ,$4.96 ,$4.96 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$27.50 ,$11.00 ,$11.00 ,$11.00 ,$8.25 ,$6.60 ,$6.60 ,$11.00 ,$6.60 ,$11.00 ,$11.00 ,$11.00 ,$11.00 , N/A ,$9.35 ,$11.00 ,$7.15 ,$11.00 ,$11.00 ,$6.16 ,$11.00 ,$2.89 , N/A ,$8.48 ,$8.10 ,$11.55 ,$8.80 ,$24.75 ,$4.96 ,$3.08 ,$9.90 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$5.28 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600541,87172,HC PINWORM EXAM,306,1 ,$2.65 ,$1.72 ,$0.70 ,$7.71 ,$6.63 ,$2.65 ,$1.48 ,$2.65 ,$0.74 ,$0.94 ,$2.65 ,$1.09 ,$2.65 ,$1.20 ,$1.20 ,$2.65 ,$2.65 ,$2.65 ,$2.65 ,$6.63 ,$2.65 ,$2.65 ,$2.65 ,$1.99 ,$1.59 ,$1.59 ,$2.65 ,$1.59 ,$2.65 ,$2.65 ,$2.65 ,$2.65 , N/A ,$2.25 ,$2.65 ,$1.72 ,$2.65 ,$2.65 ,$1.48 ,$2.65 ,$0.70 , N/A ,$2.65 ,$2.65 ,$2.78 ,$2.12 ,$5.96 ,$1.20 ,$0.74 ,$2.39 ,$2.65 ,$2.65 ,$2.65 ,$2.65 ,$2.65 ,$2.65 ,$1.27 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600542,87176,HC HOMOGENIZATION TISSUE,306,1 ,$2.58 ,$1.68 ,$0.68 ,$7.71 ,$6.45 ,$2.58 ,$1.44 ,$2.58 ,$0.72 ,$0.91 ,$2.58 ,$1.06 ,$2.58 ,$1.16 ,$1.16 ,$2.58 ,$2.58 ,$2.58 ,$2.58 ,$6.45 ,$2.58 ,$2.58 ,$2.58 ,$1.94 ,$1.55 ,$1.55 ,$2.58 ,$1.55 ,$2.58 ,$2.58 ,$2.58 ,$2.58 , N/A ,$2.19 ,$2.58 ,$1.68 ,$2.58 ,$2.58 ,$1.44 ,$2.58 ,$0.68 , N/A ,$2.58 ,$2.58 ,$2.71 ,$2.06 ,$5.81 ,$1.16 ,$0.72 ,$2.32 ,$2.58 ,$2.58 ,$2.58 ,$2.58 ,$2.58 ,$2.58 ,$1.24 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600544,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$16.00 ,$10.40 ,$4.21 ,$16.00 ,$11.88 ,$8.19 ,$8.96 ,$4.75 ,$4.48 ,$5.65 ,$4.75 ,$6.59 ,$4.75 ,$7.22 ,$7.22 ,$4.75 ,$5.94 ,$9.03 ,$9.44 ,$11.88 ,$4.75 ,$4.75 ,$4.85 ,$12.00 ,$9.60 ,$9.60 ,$4.75 ,$9.60 ,$6.85 ,$6.85 ,$6.85 ,$16.00 , N/A ,$13.60 ,$11.88 ,$10.40 ,$4.75 ,$16.00 ,$8.96 ,$4.75 ,$4.21 , N/A ,$8.48 ,$8.10 ,$4.99 ,$12.80 ,$10.69 ,$7.22 ,$4.48 ,$14.40 ,$4.75 ,$6.85 ,$9.50 ,$9.50 ,$4.75 ,$9.50 ,$7.68 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600545,87184,HC SENSITIVITY DISK KB,306,1 ,$11.00 ,$7.15 ,$2.89 ,$18.70 ,$18.70 ,$11.00 ,$6.16 ,$7.48 ,$3.08 ,$3.88 ,$7.48 ,$4.53 ,$7.48 ,$4.96 ,$4.96 ,$7.48 ,$9.35 ,$11.00 ,$11.00 ,$18.70 ,$7.48 ,$7.48 ,$7.63 ,$8.25 ,$6.60 ,$6.60 ,$7.48 ,$6.60 ,$9.96 ,$9.96 ,$9.96 ,$11.00 , N/A ,$9.35 ,$11.00 ,$7.15 ,$7.48 ,$11.00 ,$6.16 ,$7.48 ,$2.89 , N/A ,$8.48 ,$8.10 ,$7.85 ,$8.80 ,$16.83 ,$4.96 ,$3.08 ,$9.90 ,$7.48 ,$9.96 ,$11.00 ,$11.00 ,$7.48 ,$11.00 ,$5.28 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600546,87185,HC BETA LACTAMASE,306,1 ,$1.20 ,$0.78 ,$0.32 ,$7.71 ,$3.00 ,$1.20 ,$0.67 ,$1.20 ,$0.34 ,$0.42 ,$1.20 ,$0.49 ,$1.20 ,$0.54 ,$0.54 ,$1.20 ,$1.20 ,$1.20 ,$1.20 ,$3.00 ,$1.20 ,$1.20 ,$1.20 ,$0.90 ,$0.72 ,$0.72 ,$1.20 ,$0.72 ,$1.20 ,$1.20 ,$1.20 ,$1.20 , N/A ,$1.02 ,$1.20 ,$0.78 ,$1.20 ,$1.20 ,$0.67 ,$1.20 ,$0.32 , N/A ,$1.20 ,$1.20 ,$1.26 ,$0.96 ,$2.70 ,$0.54 ,$0.34 ,$1.08 ,$1.20 ,$1.20 ,$1.20 ,$1.20 ,$1.20 ,$1.20 ,$0.58 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600547,87186,HC SENSITIVITY MIC,306,1 ,$7.00 ,$4.55 ,$1.84 ,$17.50 ,$17.50 ,$7.00 ,$3.92 ,$7.00 ,$1.96 ,$2.47 ,$7.00 ,$2.88 ,$7.00 ,$3.16 ,$3.16 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$17.50 ,$7.00 ,$7.00 ,$7.00 ,$5.25 ,$4.20 ,$4.20 ,$7.00 ,$4.20 ,$7.00 ,$7.00 ,$7.00 ,$7.00 , N/A ,$5.95 ,$7.00 ,$4.55 ,$7.00 ,$7.00 ,$3.92 ,$7.00 ,$1.84 , N/A ,$7.00 ,$7.00 ,$7.35 ,$5.60 ,$15.75 ,$3.16 ,$1.96 ,$6.30 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$7.00 ,$3.36 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600551,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$0.78 ,$0.51 ,$0.21 ,$7.71 ,$1.95 ,$0.78 ,$0.44 ,$0.78 ,$0.22 ,$0.28 ,$0.78 ,$0.32 ,$0.78 ,$0.35 ,$0.35 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$1.95 ,$0.78 ,$0.78 ,$0.78 ,$0.59 ,$0.47 ,$0.47 ,$0.78 ,$0.47 ,$0.78 ,$0.78 ,$0.78 ,$0.78 , N/A ,$0.66 ,$0.78 ,$0.51 ,$0.78 ,$0.78 ,$0.44 ,$0.78 ,$0.21 , N/A ,$0.78 ,$0.78 ,$0.82 ,$0.62 ,$1.76 ,$0.35 ,$0.22 ,$0.70 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$0.37 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600552,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$16.00 ,$10.40 ,$4.21 ,$16.00 ,$13.48 ,$9.26 ,$8.96 ,$5.39 ,$4.48 ,$5.65 ,$5.39 ,$6.59 ,$5.39 ,$7.22 ,$7.22 ,$5.39 ,$6.74 ,$10.24 ,$10.69 ,$13.48 ,$5.39 ,$5.39 ,$5.50 ,$12.00 ,$9.60 ,$9.60 ,$5.39 ,$9.60 ,$7.79 ,$7.79 ,$7.79 ,$16.00 , N/A ,$13.60 ,$13.48 ,$10.40 ,$5.39 ,$16.00 ,$8.96 ,$5.39 ,$4.21 , N/A ,$8.48 ,$8.10 ,$5.66 ,$12.80 ,$12.13 ,$7.22 ,$4.48 ,$14.40 ,$5.39 ,$7.79 ,$10.78 ,$10.78 ,$5.39 ,$10.78 ,$7.68 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600555,87255,HC VIRUS ID NON-IMMUNOLOGIC OTHER THAN CYTOPATHIC-90,306,1 ,$48.00 ,$31.20 ,$12.62 ,$84.65 ,$84.65 ,$48.00 ,$26.88 ,$33.86 ,$13.44 ,$16.94 ,$33.86 ,$19.78 ,$33.86 ,$21.65 ,$21.65 ,$33.86 ,$42.33 ,$48.00 ,$48.00 ,$84.65 ,$33.86 ,$33.86 ,$34.54 ,$36.00 ,$28.80 ,$28.80 ,$33.86 ,$28.80 ,$48.00 ,$48.00 ,$48.00 ,$48.00 , N/A ,$40.80 ,$48.00 ,$31.20 ,$33.86 ,$48.00 ,$26.88 ,$33.86 ,$12.62 , N/A ,$28.20 ,$26.92 ,$35.55 ,$38.40 ,$76.19 ,$21.65 ,$13.44 ,$43.20 ,$33.86 ,$48.00 ,$48.00 ,$48.00 ,$33.86 ,$48.00 ,$23.04 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600556,87327,HC EIA QL CRYPTOCOCCUS AG,306,1 ,$113.00 ,$73.45 ,$9.67 ,$113.00 ,$33.55 ,$20.69 ,$63.28 ,$13.42 ,$31.64 ,$39.89 ,$13.42 ,$46.56 ,$13.42 ,$50.96 ,$50.96 ,$13.42 ,$16.78 ,$25.50 ,$23.27 ,$33.55 ,$13.42 ,$13.42 ,$13.69 ,$84.75 ,$67.80 ,$67.80 ,$13.42 ,$67.80 ,$17.45 ,$17.45 ,$17.45 ,$113.00 , N/A ,$96.05 ,$33.55 ,$73.45 ,$13.42 ,$113.00 ,$63.28 ,$13.42 ,$29.72 , N/A ,$10.64 ,$10.15 ,$14.09 ,$90.40 ,$30.20 ,$50.96 ,$31.64 ,$101.70 ,$13.42 ,$17.45 ,$26.84 ,$26.84 ,$13.42 ,$26.84 ,$54.24 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600557,87329,HC EIA QL GIARDIA AG,306,1 ,$22.00 ,$14.30 ,$5.79 ,$29.95 ,$29.95 ,$20.69 ,$12.32 ,$11.98 ,$6.16 ,$7.77 ,$11.98 ,$9.06 ,$11.98 ,$9.92 ,$9.92 ,$11.98 ,$14.98 ,$22.00 ,$22.00 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$16.50 ,$13.20 ,$13.20 ,$11.98 ,$13.20 ,$17.32 ,$17.32 ,$17.32 ,$22.00 , N/A ,$18.70 ,$22.00 ,$14.30 ,$11.98 ,$22.00 ,$12.32 ,$11.98 ,$5.79 , N/A ,$10.64 ,$10.15 ,$12.58 ,$17.60 ,$26.96 ,$9.92 ,$6.16 ,$19.80 ,$11.98 ,$17.32 ,$22.00 ,$22.00 ,$11.98 ,$22.00 ,$10.56 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600559,87340,HC EIA QL HEPATITIS B AG,306,1 ,$3.48 ,$2.26 ,$0.92 ,$9.67 ,$8.70 ,$3.48 ,$1.95 ,$3.48 ,$0.97 ,$1.23 ,$3.48 ,$1.43 ,$3.48 ,$1.57 ,$1.57 ,$3.48 ,$3.48 ,$3.48 ,$3.48 ,$8.70 ,$3.48 ,$3.48 ,$3.48 ,$2.61 ,$2.09 ,$2.09 ,$3.48 ,$2.09 ,$3.48 ,$3.48 ,$3.48 ,$3.48 , N/A ,$2.96 ,$3.48 ,$2.26 ,$3.48 ,$3.48 ,$1.95 ,$3.48 ,$0.92 , N/A ,$3.48 ,$3.48 ,$3.65 ,$2.78 ,$7.83 ,$1.57 ,$0.97 ,$3.13 ,$3.48 ,$3.48 ,$3.48 ,$3.48 ,$3.48 ,$3.48 ,$1.67 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600561,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$6.00 ,$3.90 ,$1.58 ,$15.00 ,$15.00 ,$6.00 ,$3.36 ,$6.00 ,$1.68 ,$2.12 ,$6.00 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$15.00 ,$6.00 ,$6.00 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$6.00 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$6.00 ,$6.00 ,$3.36 ,$6.00 ,$1.58 , N/A ,$6.00 ,$6.00 ,$6.30 ,$4.80 ,$13.50 ,$2.71 ,$1.68 ,$5.40 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600562,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$11.00 ,$7.15 ,$2.89 ,$27.50 ,$27.50 ,$11.00 ,$6.16 ,$11.00 ,$3.08 ,$3.88 ,$11.00 ,$4.53 ,$11.00 ,$4.96 ,$4.96 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$27.50 ,$11.00 ,$11.00 ,$11.00 ,$8.25 ,$6.60 ,$6.60 ,$11.00 ,$6.60 ,$11.00 ,$11.00 ,$11.00 ,$11.00 , N/A ,$9.35 ,$11.00 ,$7.15 ,$11.00 ,$11.00 ,$6.16 ,$11.00 ,$2.89 , N/A ,$10.64 ,$10.15 ,$11.55 ,$8.80 ,$24.75 ,$4.96 ,$3.08 ,$9.90 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$11.00 ,$5.28 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600563,87427,HC SHIGELLA LIKE TOXIN AG,306,1 ,$16.00 ,$10.40 ,$4.21 ,$29.95 ,$29.95 ,$16.00 ,$8.96 ,$11.98 ,$4.48 ,$5.65 ,$11.98 ,$6.59 ,$11.98 ,$7.22 ,$7.22 ,$11.98 ,$14.98 ,$16.00 ,$16.00 ,$29.95 ,$11.98 ,$11.98 ,$12.22 ,$12.00 ,$9.60 ,$9.60 ,$11.98 ,$9.60 ,$16.00 ,$16.00 ,$16.00 ,$16.00 , N/A ,$13.60 ,$16.00 ,$10.40 ,$11.98 ,$16.00 ,$8.96 ,$11.98 ,$4.21 , N/A ,$10.64 ,$10.15 ,$12.58 ,$12.80 ,$26.96 ,$7.22 ,$4.48 ,$14.40 ,$11.98 ,$16.00 ,$16.00 ,$16.00 ,$11.98 ,$16.00 ,$7.68 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600567,87483,HC INFECT AMP CNS DNA/RNA 14 TARGETS,306,1 ,$716.00 ,$465.40 ,$25.64 ,"$1,041.95 ","$1,041.95 ",$716.00 ,$400.96 ,$416.78 ,$200.48 ,$252.75 ,$416.78 ,$294.99 ,$416.78 ,$322.92 ,$322.92 ,$416.78 ,$520.98 ,$716.00 ,$716.00 ,"$1,041.95 ",$416.78 ,$416.78 ,$425.12 ,$537.00 ,$429.60 ,$429.60 ,$416.78 ,$429.60 ,$602.02 ,$602.02 ,$602.02 ,$716.00 , N/A ,$608.60 ,$716.00 ,$465.40 ,$416.78 ,$716.00 ,$400.96 ,$416.78 ,$188.31 , N/A ,$28.20 ,$26.92 ,$437.62 ,$572.80 ,$937.76 ,$322.92 ,$200.48 ,$644.40 ,$416.78 ,$602.02 ,$716.00 ,$716.00 ,$416.78 ,$716.00 ,$343.68 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600570,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$19.00 ,$12.35 ,$5.00 ,$47.50 ,$47.50 ,$19.00 ,$10.64 ,$19.00 ,$5.32 ,$6.71 ,$19.00 ,$7.83 ,$19.00 ,$8.57 ,$8.57 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$47.50 ,$19.00 ,$19.00 ,$19.00 ,$14.25 ,$11.40 ,$11.40 ,$19.00 ,$11.40 ,$19.00 ,$19.00 ,$19.00 ,$19.00 , N/A ,$16.15 ,$19.00 ,$12.35 ,$19.00 ,$19.00 ,$10.64 ,$19.00 ,$5.00 , N/A ,$10.64 ,$10.15 ,$19.95 ,$15.20 ,$42.75 ,$8.57 ,$5.32 ,$17.10 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$9.12 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600573,87581,HC IF AG PROBE MYCOPLASMA PNEUMONIAE,306,1 ,$44.00 ,$28.60 ,$11.57 ,$87.73 ,$87.73 ,$44.00 ,$24.64 ,$35.09 ,$12.32 ,$15.53 ,$35.09 ,$18.13 ,$35.09 ,$19.84 ,$19.84 ,$35.09 ,$43.86 ,$44.00 ,$44.00 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$33.00 ,$26.40 ,$26.40 ,$35.09 ,$26.40 ,$44.00 ,$44.00 ,$44.00 ,$44.00 , N/A ,$37.40 ,$44.00 ,$28.60 ,$35.09 ,$44.00 ,$24.64 ,$35.09 ,$11.57 , N/A ,$28.20 ,$26.92 ,$36.84 ,$35.20 ,$78.95 ,$19.84 ,$12.32 ,$39.60 ,$35.09 ,$44.00 ,$44.00 ,$44.00 ,$35.09 ,$44.00 ,$21.12 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600575,87591,HC NEISSERIA AMP,306,1 ,$19.00 ,$12.35 ,$5.00 ,$47.50 ,$47.50 ,$19.00 ,$10.64 ,$19.00 ,$5.32 ,$6.71 ,$19.00 ,$7.83 ,$19.00 ,$8.57 ,$8.57 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$47.50 ,$19.00 ,$19.00 ,$19.00 ,$14.25 ,$11.40 ,$11.40 ,$19.00 ,$11.40 ,$19.00 ,$19.00 ,$19.00 ,$19.00 , N/A ,$16.15 ,$19.00 ,$12.35 ,$19.00 ,$19.00 ,$10.64 ,$19.00 ,$5.00 , N/A ,$19.00 ,$19.00 ,$19.95 ,$15.20 ,$42.75 ,$8.57 ,$5.32 ,$17.10 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$19.00 ,$9.12 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600583,87808,HC TRICHOMONAS VAGINITIS OPTICAL,306,1 ,$4.68 ,$3.04 ,$1.23 ,$11.70 ,$11.70 ,$4.68 ,$2.62 ,$4.68 ,$1.31 ,$1.65 ,$4.68 ,$1.93 ,$4.68 ,$2.11 ,$2.11 ,$4.68 ,$4.68 ,$4.68 ,$4.68 ,$11.70 ,$4.68 ,$4.68 ,$4.68 ,$3.51 ,$2.81 ,$2.81 ,$4.68 ,$2.81 ,$4.68 ,$4.68 ,$4.68 ,$4.68 , N/A ,$3.98 ,$4.68 ,$3.04 ,$4.68 ,$4.68 ,$2.62 ,$4.68 ,$1.23 , N/A ,$4.68 ,$4.68 ,$4.91 ,$3.74 ,$10.53 ,$2.11 ,$1.31 ,$4.21 ,$4.68 ,$4.68 ,$4.68 ,$4.68 ,$4.68 ,$4.68 ,$2.25 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600590,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$22.00 ,$14.30 ,$5.79 ,$34.55 ,$34.55 ,$20.69 ,$12.32 ,$13.82 ,$6.16 ,$7.77 ,$13.82 ,$9.06 ,$13.82 ,$9.92 ,$9.92 ,$13.82 ,$17.28 ,$22.00 ,$22.00 ,$34.55 ,$13.82 ,$13.82 ,$14.10 ,$16.50 ,$13.20 ,$13.20 ,$13.82 ,$13.20 ,$17.97 ,$17.97 ,$17.97 ,$22.00 , N/A ,$18.70 ,$22.00 ,$14.30 ,$13.82 ,$22.00 ,$12.32 ,$13.82 ,$5.79 , N/A ,$10.64 ,$10.15 ,$14.51 ,$17.60 ,$31.10 ,$9.92 ,$6.16 ,$19.80 ,$13.82 ,$17.97 ,$22.00 ,$22.00 ,$13.82 ,$22.00 ,$10.56 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600593,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$181.00 ,$117.65 ,$7.71 ,$181.00 ,$40.18 ,$20.69 ,$101.36 ,$16.07 ,$50.68 ,$63.89 ,$16.07 ,$74.57 ,$16.07 ,$81.63 ,$81.63 ,$16.07 ,$20.09 ,$30.53 ,$28.31 ,$40.18 ,$16.07 ,$16.07 ,$16.39 ,$135.75 ,$108.60 ,$108.60 ,$16.07 ,$108.60 ,$20.89 ,$20.89 ,$20.89 ,$181.00 , N/A ,$153.85 ,$40.18 ,$117.65 ,$16.07 ,$181.00 ,$101.36 ,$16.07 ,$47.60 , N/A ,$8.48 ,$8.10 ,$16.87 ,$144.80 ,$36.16 ,$81.63 ,$50.68 ,$162.90 ,$16.07 ,$20.89 ,$32.14 ,$32.14 ,$16.07 ,$32.14 ,$86.88 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600611,87512,HC G VAGINALIS DNA SCREEN QN-90,306,1 ,$264.00 ,$171.60 ,$25.64 ,$264.00 ,$104.40 ,$71.98 ,$147.84 ,$41.76 ,$73.92 ,$93.19 ,$41.76 ,$108.77 ,$41.76 ,$119.06 ,$119.06 ,$41.76 ,$52.20 ,$79.34 ,$81.14 ,$104.40 ,$41.76 ,$41.76 ,$42.60 ,$198.00 ,$158.40 ,$158.40 ,$41.76 ,$158.40 ,$60.32 ,$60.32 ,$60.32 ,$264.00 , N/A ,$224.40 ,$104.40 ,$171.60 ,$41.76 ,$264.00 ,$147.84 ,$41.76 ,$69.43 , N/A ,$28.20 ,$26.92 ,$43.85 ,$211.20 ,$93.96 ,$119.06 ,$73.92 ,$237.60 ,$41.76 ,$60.32 ,$83.52 ,$83.52 ,$41.76 ,$83.52 ,$126.72 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600614,87220,HC TISSUE KOH PREP,306,1 ,$0.78 ,$0.51 ,$0.21 ,$7.71 ,$1.95 ,$0.78 ,$0.44 ,$0.78 ,$0.22 ,$0.28 ,$0.78 ,$0.32 ,$0.78 ,$0.35 ,$0.35 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$1.95 ,$0.78 ,$0.78 ,$0.78 ,$0.59 ,$0.47 ,$0.47 ,$0.78 ,$0.47 ,$0.78 ,$0.78 ,$0.78 ,$0.78 , N/A ,$0.66 ,$0.78 ,$0.51 ,$0.78 ,$0.78 ,$0.44 ,$0.78 ,$0.21 , N/A ,$0.78 ,$0.78 ,$0.82 ,$0.62 ,$1.76 ,$0.35 ,$0.22 ,$0.70 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$0.78 ,$0.37 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30600619,87481,HC CANDIDA SPECIES DNA/RNA AMP PROBE TECH-90,306,1 ,$240.00 ,$156.00 ,$9.67 ,$240.00 ,$87.73 ,$60.50 ,$134.40 ,$35.09 ,$67.20 ,$84.72 ,$35.09 ,$98.88 ,$35.09 ,$108.24 ,$108.24 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$180.00 ,$144.00 ,$144.00 ,$35.09 ,$144.00 ,$50.69 ,$50.69 ,$50.69 ,$240.00 , N/A ,$204.00 ,$87.73 ,$156.00 ,$35.09 ,$240.00 ,$134.40 ,$35.09 ,$63.12 , N/A ,$10.64 ,$10.15 ,$36.84 ,$192.00 ,$78.95 ,$108.24 ,$67.20 ,$216.00 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$115.20 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600620,87641,HC MRSA AMP-90,306,1 ,$88.00 ,$57.20 ,$23.14 ,$88.00 ,$87.73 ,$60.50 ,$49.28 ,$35.09 ,$24.64 ,$31.06 ,$35.09 ,$36.26 ,$35.09 ,$39.69 ,$39.69 ,$35.09 ,$43.86 ,$66.67 ,$67.93 ,$87.73 ,$35.09 ,$35.09 ,$35.79 ,$66.00 ,$52.80 ,$52.80 ,$35.09 ,$52.80 ,$50.69 ,$50.69 ,$50.69 ,$88.00 , N/A ,$74.80 ,$87.73 ,$57.20 ,$35.09 ,$88.00 ,$49.28 ,$35.09 ,$23.14 , N/A ,$28.20 ,$26.92 ,$36.84 ,$70.40 ,$78.95 ,$39.69 ,$24.64 ,$79.20 ,$35.09 ,$50.69 ,$70.18 ,$70.18 ,$35.09 ,$70.18 ,$42.24 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600623,87635,HC COVID-19 LAB TEST CDC-90,306,1 ,$436.00 ,$283.40 ,$25.64 ,$436.00 ,$128.28 ,$89.79 ,$244.16 ,$51.31 ,$122.08 ,$147.37 ,$51.31 ,$169.60 ,$51.31 ,$196.64 ,$196.64 ,$51.31 ,$64.14 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$52.34 ,$327.00 ,$261.60 ,$261.60 ,$51.31 ,$261.60 ,$305.20 ,$305.20 ,$305.20 ,$436.00 , N/A ,$370.60 ,$128.28 ,$283.40 ,$51.31 ,$51.31 ,$244.16 ,$51.31 ,$114.67 , N/A ,$28.20 ,$26.92 ,$53.88 ,$348.80 ,$115.45 ,$196.64 ,$122.08 ,$392.40 ,$51.31 ,$305.20 ,$102.62 ,$102.62 ,$51.31 ,$102.62 ,$209.28 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600627,87480,HC CANDIDA SPECIES DNA SCREEN-90,306,1 ,$53.00 ,$34.45 ,$9.67 ,$53.00 ,$50.13 ,$34.56 ,$29.68 ,$20.05 ,$14.84 ,$18.71 ,$20.05 ,$21.84 ,$20.05 ,$23.90 ,$23.90 ,$20.05 ,$25.06 ,$38.10 ,$39.00 ,$50.13 ,$20.05 ,$20.05 ,$20.45 ,$39.75 ,$31.80 ,$31.80 ,$20.05 ,$31.80 ,$28.96 ,$28.96 ,$28.96 ,$53.00 , N/A ,$45.05 ,$50.13 ,$34.45 ,$20.05 ,$53.00 ,$29.68 ,$20.05 ,$13.94 , N/A ,$10.64 ,$10.15 ,$21.05 ,$42.40 ,$45.11 ,$23.90 ,$14.84 ,$47.70 ,$20.05 ,$28.96 ,$40.10 ,$40.10 ,$20.05 ,$40.10 ,$25.44 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30600628,87510,HC G VAGINALIS DNA SCREEN-90,306,1 ,$53.00 ,$34.45 ,$13.94 ,$53.00 ,$50.13 ,$34.56 ,$29.68 ,$20.05 ,$14.84 ,$18.71 ,$20.05 ,$21.84 ,$20.05 ,$23.90 ,$23.90 ,$20.05 ,$25.06 ,$38.10 ,$39.00 ,$50.13 ,$20.05 ,$20.05 ,$20.45 ,$39.75 ,$31.80 ,$31.80 ,$20.05 ,$31.80 ,$28.96 ,$28.96 ,$28.96 ,$53.00 , N/A ,$45.05 ,$50.13 ,$34.45 ,$20.05 ,$53.00 ,$29.68 ,$20.05 ,$13.94 , N/A ,$28.20 ,$26.92 ,$21.05 ,$42.40 ,$45.11 ,$23.90 ,$14.84 ,$47.70 ,$20.05 ,$28.96 ,$40.10 ,$40.10 ,$20.05 ,$40.10 ,$25.44 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600629,87660,HC TRICHOMONAS DNA SCREEN-90,306,1 ,$53.00 ,$34.45 ,$13.94 ,$53.00 ,$50.13 ,$34.56 ,$29.68 ,$20.05 ,$14.84 ,$18.71 ,$20.05 ,$21.84 ,$20.05 ,$23.90 ,$23.90 ,$20.05 ,$25.06 ,$38.10 ,$39.00 ,$50.13 ,$20.05 ,$20.05 ,$20.45 ,$39.75 ,$31.80 ,$31.80 ,$20.05 ,$31.80 ,$28.96 ,$28.96 ,$28.96 ,$53.00 , N/A ,$45.05 ,$50.13 ,$34.45 ,$20.05 ,$53.00 ,$29.68 ,$20.05 ,$13.94 , N/A ,$28.20 ,$26.92 ,$21.05 ,$42.40 ,$45.11 ,$23.90 ,$14.84 ,$47.70 ,$20.05 ,$28.96 ,$40.10 ,$40.10 ,$20.05 ,$40.10 ,$25.44 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600637,87635,HC COVID-19 LAB PCR TEST,306,1 ,$436.00 ,$283.40 ,$25.64 ,$436.00 ,$128.28 ,$89.79 ,$244.16 ,$51.31 ,$122.08 ,$147.37 ,$51.31 ,$169.60 ,$51.31 ,$196.64 ,$196.64 ,$51.31 ,$64.14 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$52.34 ,$327.00 ,$261.60 ,$261.60 ,$51.31 ,$261.60 ,$305.20 ,$305.20 ,$305.20 ,$436.00 , N/A ,$370.60 ,$128.28 ,$283.40 ,$51.31 ,$51.31 ,$244.16 ,$51.31 ,$114.67 , N/A ,$28.20 ,$26.92 ,$53.88 ,$348.80 ,$115.45 ,$196.64 ,$122.08 ,$392.40 ,$51.31 ,$305.20 ,$102.62 ,$102.62 ,$51.31 ,$102.62 ,$209.28 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600638,87635,HC COVID-19 LAB TEST - 2 DAY COMPLETION - 90,306,1 ,$75.00 ,$48.75 ,$19.73 ,$128.28 ,$128.28 ,$75.00 ,$42.00 ,$51.31 ,$21.00 ,$25.35 ,$51.31 ,$29.18 ,$51.31 ,$33.83 ,$33.83 ,$51.31 ,$64.14 ,$75.00 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$52.34 ,$56.25 ,$45.00 ,$45.00 ,$51.31 ,$45.00 ,$52.50 ,$52.50 ,$52.50 ,$75.00 , N/A ,$63.75 ,$75.00 ,$48.75 ,$51.31 ,$51.31 ,$42.00 ,$51.31 ,$19.73 , N/A ,$28.20 ,$26.92 ,$53.88 ,$60.00 ,$115.45 ,$33.83 ,$21.00 ,$67.50 ,$51.31 ,$52.50 ,$75.00 ,$75.00 ,$51.31 ,$75.00 ,$36.00 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30600648,87106,HC CULT FUNGI IDENTIFICATION YEAST-90,306,1 ,$160.00 ,$104.00 ,$7.71 ,$160.00 ,$25.80 ,$17.80 ,$89.60 ,$10.32 ,$44.80 ,$56.48 ,$10.32 ,$65.92 ,$10.32 ,$72.16 ,$72.16 ,$10.32 ,$12.90 ,$19.61 ,$20.13 ,$25.80 ,$10.32 ,$10.32 ,$10.53 ,$120.00 ,$96.00 ,$96.00 ,$10.32 ,$96.00 ,$14.91 ,$14.91 ,$14.91 ,$160.00 , N/A ,$136.00 ,$25.80 ,$104.00 ,$10.32 ,$160.00 ,$89.60 ,$10.32 ,$42.08 , N/A ,$8.48 ,$8.10 ,$10.84 ,$128.00 ,$23.22 ,$72.16 ,$44.80 ,$144.00 ,$10.32 ,$14.91 ,$20.64 ,$20.64 ,$10.32 ,$20.64 ,$76.80 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30650285,87556,HC M.TUERCULOD DNA PROBE-90,306,1 ,"$3,706.00 ","$2,408.90 ",$25.64 ,"$3,706.00 ",$104.20 ,$60.50 ,"$2,075.36 ",$41.68 ,"$1,037.68 ",$263.01 ,$41.68 ,$263.01 ,$41.68 ,"$1,671.41 ","$1,671.41 ",$41.68 ,$52.10 ,$79.19 ,$72.97 ,$104.20 ,$41.68 ,$41.68 ,$42.51 ,"$2,779.50 ","$2,223.60 ","$2,223.60 ",$41.68 ,"$2,223.60 ",$54.18 ,$54.18 ,$54.18 ,"$3,706.00 ", N/A ,"$3,150.10 ",$104.20 ,"$2,408.90 ",$41.68 ,"$3,706.00 ","$2,075.36 ",$41.68 ,$974.68 , N/A ,$28.20 ,$26.92 ,$43.76 ,"$2,964.80 ",$93.78 ,"$1,671.41 ","$1,037.68 ","$3,335.40 ",$41.68 ,$54.18 ,$83.36 ,$83.36 ,$41.68 ,$83.36 ,"$1,778.88 ",$25.64 
ST. ELIZABETH'S HOSPITAL,30682004,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$40.00 ,$26.00 ,$9.67 ,$93.18 ,$93.18 ,$40.00 ,$22.40 ,$37.27 ,$11.20 ,$14.12 ,$37.27 ,$16.48 ,$37.27 ,$18.04 ,$18.04 ,$37.27 ,$40.00 ,$40.00 ,$40.00 ,$93.18 ,$37.27 ,$37.27 ,$38.02 ,$30.00 ,$24.00 ,$24.00 ,$37.27 ,$24.00 ,$40.00 ,$40.00 ,$40.00 ,$40.00 , N/A ,$34.00 ,$40.00 ,$26.00 ,$37.27 ,$40.00 ,$22.40 ,$37.27 ,$10.52 , N/A ,$10.64 ,$10.15 ,$39.13 ,$32.00 ,$83.86 ,$18.04 ,$11.20 ,$36.00 ,$37.27 ,$40.00 ,$40.00 ,$40.00 ,$37.27 ,$40.00 ,$19.20 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30682005,87430,HC RAPID STREP,306,1 ,$4.34 ,$2.82 ,$1.14 ,$10.85 ,$10.85 ,$4.34 ,$2.43 ,$4.34 ,$1.22 ,$1.53 ,$4.34 ,$1.79 ,$4.34 ,$1.96 ,$1.96 ,$4.34 ,$4.34 ,$4.34 ,$4.34 ,$10.85 ,$4.34 ,$4.34 ,$4.34 ,$3.26 ,$2.60 ,$2.60 ,$4.34 ,$2.60 ,$4.34 ,$4.34 ,$4.34 ,$4.34 , N/A ,$3.69 ,$4.34 ,$2.82 ,$4.34 ,$4.34 ,$2.43 ,$4.34 ,$1.14 , N/A ,$4.34 ,$4.34 ,$4.56 ,$3.47 ,$9.77 ,$1.96 ,$1.22 ,$3.91 ,$4.34 ,$4.34 ,$4.34 ,$4.34 ,$4.34 ,$4.34 ,$2.08 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30682006,87807,HC QL RSV,306,1 ,$14.00 ,$9.10 ,$3.68 ,$32.75 ,$32.75 ,$14.00 ,$7.84 ,$13.10 ,$3.92 ,$4.94 ,$13.10 ,$5.77 ,$13.10 ,$6.31 ,$6.31 ,$13.10 ,$14.00 ,$14.00 ,$14.00 ,$32.75 ,$13.10 ,$13.10 ,$13.36 ,$10.50 ,$8.40 ,$8.40 ,$13.10 ,$8.40 ,$14.00 ,$14.00 ,$14.00 ,$14.00 , N/A ,$11.90 ,$14.00 ,$9.10 ,$13.10 ,$14.00 ,$7.84 ,$13.10 ,$3.68 , N/A ,$8.48 ,$8.10 ,$13.76 ,$11.20 ,$29.48 ,$6.31 ,$3.92 ,$12.60 ,$13.10 ,$14.00 ,$14.00 ,$14.00 ,$13.10 ,$14.00 ,$6.72 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30682007,87651,HC INFECT AMP (GRP A STREP),306,1 ,$30.00 ,$19.50 ,$7.89 ,$75.00 ,$75.00 ,$30.00 ,$16.80 ,$30.00 ,$8.40 ,$10.59 ,$30.00 ,$12.36 ,$30.00 ,$13.53 ,$13.53 ,$30.00 ,$30.00 ,$30.00 ,$30.00 ,$75.00 ,$30.00 ,$30.00 ,$30.00 ,$22.50 ,$18.00 ,$18.00 ,$30.00 ,$18.00 ,$30.00 ,$30.00 ,$30.00 ,$30.00 , N/A ,$25.50 ,$30.00 ,$19.50 ,$30.00 ,$30.00 ,$16.80 ,$30.00 ,$7.89 , N/A ,$28.20 ,$26.92 ,$31.50 ,$24.00 ,$67.50 ,$13.53 ,$8.40 ,$27.00 ,$30.00 ,$30.00 ,$30.00 ,$30.00 ,$30.00 ,$30.00 ,$14.40 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30682008,87804,HC QL INFLUENZA A/B,306,1 ,$20.00 ,$13.00 ,$5.26 ,$41.38 ,$41.38 ,$20.00 ,$11.20 ,$16.55 ,$5.60 ,$7.06 ,$16.55 ,$8.24 ,$16.55 ,$9.02 ,$9.02 ,$16.55 ,$20.00 ,$20.00 ,$20.00 ,$41.38 ,$16.55 ,$16.55 ,$16.88 ,$15.00 ,$12.00 ,$12.00 ,$16.55 ,$12.00 ,$20.00 ,$20.00 ,$20.00 ,$20.00 , N/A ,$17.00 ,$20.00 ,$13.00 ,$16.55 ,$20.00 ,$11.20 ,$16.55 ,$5.26 , N/A ,$8.48 ,$8.10 ,$17.38 ,$16.00 ,$37.24 ,$9.02 ,$5.60 ,$18.00 ,$16.55 ,$20.00 ,$20.00 ,$20.00 ,$16.55 ,$20.00 ,$9.60 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30682010,87635,HC COVID-19 LAB TEST NON-CDC-90,306,1 ,$436.00 ,$283.40 ,$25.64 ,$436.00 ,$128.28 ,$89.79 ,$244.16 ,$51.31 ,$122.08 ,$147.37 ,$51.31 ,$169.60 ,$51.31 ,$196.64 ,$196.64 ,$51.31 ,$64.14 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$52.34 ,$327.00 ,$261.60 ,$261.60 ,$51.31 ,$261.60 ,$305.20 ,$305.20 ,$305.20 ,$436.00 , N/A ,$370.60 ,$128.28 ,$283.40 ,$51.31 ,$51.31 ,$244.16 ,$51.31 ,$114.67 , N/A ,$28.20 ,$26.92 ,$53.88 ,$348.80 ,$115.45 ,$196.64 ,$122.08 ,$392.40 ,$51.31 ,$305.20 ,$102.62 ,$102.62 ,$51.31 ,$102.62 ,$209.28 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30682012,87635,HC COVID-19 LAB TEST,306,1 ,$436.00 ,$283.40 ,$25.64 ,$436.00 ,$128.28 ,$89.79 ,$244.16 ,$51.31 ,$122.08 ,$147.37 ,$51.31 ,$169.60 ,$51.31 ,$196.64 ,$196.64 ,$51.31 ,$64.14 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$52.34 ,$327.00 ,$261.60 ,$261.60 ,$51.31 ,$261.60 ,$305.20 ,$305.20 ,$305.20 ,$436.00 , N/A ,$370.60 ,$128.28 ,$283.40 ,$51.31 ,$51.31 ,$244.16 ,$51.31 ,$114.67 , N/A ,$28.20 ,$26.92 ,$53.88 ,$348.80 ,$115.45 ,$196.64 ,$122.08 ,$392.40 ,$51.31 ,$305.20 ,$102.62 ,$102.62 ,$51.31 ,$102.62 ,$209.28 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30682015,86769,HC SARS-COV-2 COVID-19 ANTIBODY-90,306,1 ,$130.00 ,$84.50 ,$9.67 ,$130.00 ,$105.33 ,$73.73 ,$72.80 ,$42.13 ,$36.40 ,$43.94 ,$42.13 ,$50.57 ,$42.13 ,$58.63 ,$58.63 ,$42.13 ,$52.66 ,$80.05 ,$65.00 ,$105.33 ,$42.13 ,$42.13 ,$42.97 ,$97.50 ,$78.00 ,$78.00 ,$42.13 ,$78.00 ,$91.00 ,$91.00 ,$91.00 ,$130.00 , N/A ,$110.50 ,$105.33 ,$84.50 ,$42.13 ,$130.00 ,$72.80 ,$42.13 ,$34.19 , N/A ,$10.64 ,$10.15 ,$44.24 ,$104.00 ,$94.79 ,$58.63 ,$36.40 ,$117.00 ,$42.13 ,$91.00 ,$84.26 ,$84.26 ,$42.13 ,$84.26 ,$62.40 ,$9.67 
ST. ELIZABETH'S HOSPITAL,30682023,87426,HC SARS COVID ANTIGEN TEST,306,1 ,$90.00 ,$58.50 ,$7.71 ,$90.00 ,$88.33 ,$79.15 ,$50.40 ,$35.33 ,$25.20 ,$30.42 ,$35.33 ,$35.01 ,$35.33 ,$40.59 ,$40.59 ,$35.33 ,$44.16 ,$67.13 ,$45.00 ,$88.33 ,$35.33 ,$35.33 ,$36.04 ,$67.50 ,$54.00 ,$54.00 ,$35.33 ,$54.00 ,$63.00 ,$63.00 ,$63.00 ,$90.00 , N/A ,$76.50 ,$88.33 ,$58.50 ,$35.33 ,$37.79 ,$50.40 ,$35.33 ,$23.67 , N/A ,$8.48 ,$8.10 ,$37.10 ,$72.00 ,$79.49 ,$40.59 ,$25.20 ,$81.00 ,$35.33 ,$63.00 ,$90.00 ,$90.00 ,$35.33 ,$90.00 ,$43.20 ,$7.71 
ST. ELIZABETH'S HOSPITAL,30682024,87635,HC SARS-COV-2 COVID-19 TEST,306,1 ,$82.00 ,$53.30 ,$21.57 ,$128.28 ,$128.28 ,$82.00 ,$45.92 ,$51.31 ,$22.96 ,$27.72 ,$51.31 ,$31.90 ,$51.31 ,$36.98 ,$36.98 ,$51.31 ,$64.14 ,$82.00 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$52.34 ,$61.50 ,$49.20 ,$49.20 ,$51.31 ,$49.20 ,$57.40 ,$57.40 ,$57.40 ,$82.00 , N/A ,$69.70 ,$82.00 ,$53.30 ,$51.31 ,$51.31 ,$45.92 ,$51.31 ,$21.57 , N/A ,$28.20 ,$26.92 ,$53.88 ,$65.60 ,$115.45 ,$36.98 ,$22.96 ,$73.80 ,$51.31 ,$57.40 ,$82.00 ,$82.00 ,$51.31 ,$82.00 ,$39.36 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30682025,87635,HC COVID-19 LAB TEST - 2 DAY COMPLETION,306,1 ,$82.00 ,$53.30 ,$21.57 ,$128.28 ,$128.28 ,$82.00 ,$45.92 ,$51.31 ,$22.96 ,$27.72 ,$51.31 ,$31.90 ,$51.31 ,$36.98 ,$36.98 ,$51.31 ,$64.14 ,$82.00 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$52.34 ,$61.50 ,$49.20 ,$49.20 ,$51.31 ,$49.20 ,$57.40 ,$57.40 ,$57.40 ,$82.00 , N/A ,$69.70 ,$82.00 ,$53.30 ,$51.31 ,$51.31 ,$45.92 ,$51.31 ,$21.57 , N/A ,$28.20 ,$26.92 ,$53.88 ,$65.60 ,$115.45 ,$36.98 ,$22.96 ,$73.80 ,$51.31 ,$57.40 ,$82.00 ,$82.00 ,$51.31 ,$82.00 ,$39.36 ,$25.64 
ST. ELIZABETH'S HOSPITAL,30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$197.00 ,$128.05 ,$3.17 ,$197.00 ,$7.93 ,$5.46 ,$110.32 ,$3.17 ,$55.16 ,$32.22 ,$3.17 ,$32.22 ,$3.17 ,$88.85 ,$88.85 ,$3.17 ,$3.96 ,$6.02 ,$6.29 ,$7.93 ,$3.17 ,$3.17 ,$3.23 ,$147.75 ,$118.20 ,$118.20 ,$3.17 ,$118.20 ,$4.58 ,$4.58 ,$4.58 ,$197.00 , N/A ,$167.45 ,$7.93 ,$128.05 ,$3.17 ,$3.17 ,$110.32 ,$3.17 ,$51.81 , N/A ,$4.25 ,$4.05 ,$3.33 ,$157.60 ,$7.13 ,$88.85 ,$55.16 ,$177.30 ,$3.17 ,$4.58 ,$6.34 ,$6.34 ,$3.17 ,$6.34 ,$94.56 ,$3.86 
ST. ELIZABETH'S HOSPITAL,30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$82.00 ,$53.30 ,$2.25 ,$82.00 ,$5.63 ,$3.87 ,$45.92 ,$2.25 ,$22.96 ,$22.79 ,$2.25 ,$22.79 ,$2.25 ,$36.98 ,$36.98 ,$2.25 ,$2.81 ,$4.28 ,$4.40 ,$5.63 ,$2.25 ,$2.25 ,$2.30 ,$61.50 ,$49.20 ,$49.20 ,$2.25 ,$49.20 ,$3.24 ,$3.24 ,$3.24 ,$82.00 , N/A ,$69.70 ,$5.63 ,$53.30 ,$2.25 ,$82.00 ,$45.92 ,$2.25 ,$21.57 , N/A ,$2.67 ,$2.55 ,$2.36 ,$65.60 ,$5.06 ,$36.98 ,$22.96 ,$73.80 ,$2.25 ,$3.24 ,$4.50 ,$4.50 ,$2.25 ,$4.50 ,$39.36 ,$2.43 
ST. ELIZABETH'S HOSPITAL,30700115,81015,HC URINALYSIS MICRO ONLY,307,1 ,$51.00 ,$33.15 ,$3.05 ,$51.00 ,$7.63 ,$5.25 ,$28.56 ,$3.05 ,$14.28 ,$18.00 ,$3.05 ,$21.01 ,$3.05 ,$23.00 ,$23.00 ,$3.05 ,$3.81 ,$5.80 ,$5.66 ,$7.63 ,$3.05 ,$3.05 ,$3.11 ,$38.25 ,$30.60 ,$30.60 ,$3.05 ,$30.60 ,$4.41 ,$4.41 ,$4.41 ,$51.00 , N/A ,$43.35 ,$7.63 ,$33.15 ,$3.05 ,$51.00 ,$28.56 ,$3.05 ,$13.41 , N/A ,$4.25 ,$4.05 ,$3.20 ,$40.80 ,$6.86 ,$23.00 ,$14.28 ,$45.90 ,$3.05 ,$4.41 ,$6.10 ,$6.10 ,$3.05 ,$6.10 ,$24.48 ,$3.86 
ST. ELIZABETH'S HOSPITAL,30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$54.00 ,$35.10 ,$3.86 ,$54.00 ,$21.53 ,$10.90 ,$30.24 ,$8.61 ,$15.12 ,$19.06 ,$8.61 ,$22.25 ,$8.61 ,$24.35 ,$24.35 ,$8.61 ,$10.76 ,$16.36 ,$15.10 ,$21.53 ,$8.61 ,$8.61 ,$8.78 ,$40.50 ,$32.40 ,$32.40 ,$8.61 ,$32.40 ,$11.19 ,$11.19 ,$11.19 ,$54.00 , N/A ,$45.90 ,$21.53 ,$35.10 ,$8.61 ,$8.61 ,$30.24 ,$8.61 ,$14.20 , N/A ,$4.25 ,$4.05 ,$9.04 ,$43.20 ,$19.37 ,$24.35 ,$15.12 ,$48.60 ,$8.61 ,$11.19 ,$17.22 ,$17.22 ,$8.61 ,$17.22 ,$25.92 ,$3.86 
ST. ELIZABETH'S HOSPITAL,30700117,81050,HC VOLUME MEASUREMENT URINE,307,1 ,$48.00 ,$31.20 ,$3.64 ,$48.00 ,$9.10 ,$5.16 ,$26.88 ,$3.64 ,$13.44 ,$16.94 ,$3.64 ,$19.78 ,$3.64 ,$21.65 ,$21.65 ,$3.64 ,$4.55 ,$6.92 ,$6.29 ,$9.10 ,$3.64 ,$3.64 ,$3.71 ,$36.00 ,$28.80 ,$28.80 ,$3.64 ,$28.80 ,$4.73 ,$4.73 ,$4.73 ,$48.00 , N/A ,$40.80 ,$9.10 ,$31.20 ,$3.64 ,$48.00 ,$26.88 ,$3.64 ,$12.62 , N/A ,$4.25 ,$4.05 ,$3.82 ,$38.40 ,$8.19 ,$21.65 ,$13.44 ,$43.20 ,$3.64 ,$4.73 ,$7.28 ,$7.28 ,$3.64 ,$7.28 ,$23.04 ,$3.86 
ST. ELIZABETH'S HOSPITAL,30700120,81002,HC URANALYSIS NON AUTO W/O MICRO,307,1 ,$24.00 ,$15.60 ,$2.43 ,$24.00 ,$8.70 ,$4.41 ,$13.44 ,$3.48 ,$6.72 ,$8.47 ,$3.48 ,$9.89 ,$3.48 ,$10.82 ,$10.82 ,$3.48 ,$4.35 ,$6.61 ,$6.29 ,$8.70 ,$3.48 ,$3.48 ,$3.55 ,$18.00 ,$14.40 ,$14.40 ,$3.48 ,$14.40 ,$4.52 ,$4.52 ,$4.52 ,$24.00 , N/A ,$20.40 ,$8.70 ,$15.60 ,$3.48 ,$24.00 ,$13.44 ,$3.48 ,$6.31 , N/A ,$2.67 ,$2.55 ,$3.65 ,$19.20 ,$7.83 ,$10.82 ,$6.72 ,$21.60 ,$3.48 ,$4.52 ,$6.96 ,$6.96 ,$3.48 ,$6.96 ,$11.52 ,$2.43 
ST. ELIZABETH'S HOSPITAL,31000129,81206,HC BCR/ABL1 GENE MAJOR BP QL/QN DIAG -90,310,1 ,$411.00 ,$267.15 ,$102.18 ,$411.00 ,$409.90 ,$102.18 ,$230.16 ,$163.96 ,$115.08 ,$145.08 ,$163.96 ,$169.33 ,$163.96 ,$185.36 ,$185.36 ,$163.96 ,$204.95 ,$311.52 ,$205.50 ,$409.90 ,$163.96 ,$163.96 ,$167.24 ,$308.25 ,$246.60 ,$246.60 ,$163.96 ,$246.60 ,$236.83 ,$236.83 ,$236.83 ,$411.00 , N/A ,$349.35 ,$409.90 ,$267.15 ,$163.96 ,$411.00 ,$230.16 ,$163.96 ,$108.09 , N/A ,$137.27 ,$131.03 ,$172.16 ,$328.80 ,$368.91 ,$185.36 ,$115.08 ,$369.90 ,$163.96 ,$236.83 ,$327.92 ,$327.92 ,$163.96 ,$327.92 ,$197.28 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000131,81207,HC BCR/ABL1 GENE MINOR BP DIAG -90,310,1 ,$411.00 ,$267.15 ,$90.91 ,$411.00 ,$362.10 ,$90.91 ,$230.16 ,$144.84 ,$115.08 ,$145.08 ,$144.84 ,$169.33 ,$144.84 ,$185.36 ,$185.36 ,$144.84 ,$181.05 ,$275.20 ,$205.50 ,$362.10 ,$144.84 ,$144.84 ,$147.74 ,$308.25 ,$246.60 ,$246.60 ,$144.84 ,$246.60 ,$209.21 ,$209.21 ,$209.21 ,$411.00 , N/A ,$349.35 ,$362.10 ,$267.15 ,$144.84 ,$411.00 ,$230.16 ,$144.84 ,$108.09 , N/A ,$137.27 ,$131.03 ,$152.08 ,$328.80 ,$325.89 ,$185.36 ,$115.08 ,$369.90 ,$144.84 ,$209.21 ,$289.68 ,$289.68 ,$144.84 ,$289.68 ,$197.28 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000133,81208,HC BCR/ABL1 GENE OTH BP QL/QN-90,310,1 ,$571.00 ,$371.15 ,$90.91 ,$571.00 ,$536.55 ,$90.91 ,$319.76 ,$214.62 ,$159.88 ,$201.56 ,$214.62 ,$235.25 ,$214.62 ,$257.52 ,$257.52 ,$214.62 ,$268.28 ,$407.78 ,$285.50 ,$536.55 ,$214.62 ,$214.62 ,$218.91 ,$428.25 ,$342.60 ,$342.60 ,$214.62 ,$342.60 ,$279.01 ,$279.01 ,$279.01 ,$571.00 , N/A ,$485.35 ,$536.55 ,$371.15 ,$214.62 ,$571.00 ,$319.76 ,$214.62 ,$150.17 , N/A ,$137.27 ,$131.03 ,$225.35 ,$456.80 ,$482.90 ,$257.52 ,$159.88 ,$513.90 ,$214.62 ,$279.01 ,$429.24 ,$429.24 ,$214.62 ,$429.24 ,$274.08 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000137,81220,HC CYSTIC FIBROSIS GENE COMMON VARIANTS -90,310,1 ,$465.00 ,$302.25 ,$38.33 ,"$1,162.50 ","$1,162.50 ",$465.00 ,$260.40 ,$465.00 ,$130.20 ,$164.15 ,$465.00 ,$191.58 ,$465.00 ,$209.72 ,$209.72 ,$465.00 ,$465.00 ,$465.00 ,$232.50 ,"$1,162.50 ",$465.00 ,$465.00 ,$465.00 ,$348.75 ,$279.00 ,$279.00 ,$465.00 ,$279.00 ,$465.00 ,$465.00 ,$465.00 ,$465.00 , N/A ,$395.25 ,$465.00 ,$302.25 ,$465.00 ,$465.00 ,$260.40 ,$465.00 ,$122.30 , N/A ,$42.16 ,$40.25 ,$488.25 ,$372.00 ,"$1,046.25 ",$209.72 ,$130.20 ,$418.50 ,$465.00 ,$465.00 ,$465.00 ,$465.00 ,$465.00 ,$465.00 ,$223.20 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000143,81240,HC F2 GENE ANAL 20210G A VAR -90,310,1 ,$706.00 ,$458.90 ,$38.33 ,$706.00 ,$164.23 ,$53.11 ,$395.36 ,$65.69 ,$197.68 ,$249.22 ,$65.69 ,$290.87 ,$65.69 ,$318.41 ,$318.41 ,$65.69 ,$82.11 ,$124.81 ,$353.00 ,$164.23 ,$65.69 ,$65.69 ,$67.00 ,$529.50 ,$423.60 ,$423.60 ,$65.69 ,$423.60 ,$85.40 ,$85.40 ,$85.40 ,$706.00 , N/A ,$600.10 ,$164.23 ,$458.90 ,$65.69 ,$706.00 ,$395.36 ,$65.69 ,$185.68 , N/A ,$42.16 ,$40.25 ,$68.97 ,$564.80 ,$147.80 ,$318.41 ,$197.68 ,$635.40 ,$65.69 ,$85.40 ,$131.38 ,$131.38 ,$65.69 ,$131.38 ,$338.88 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000145,81241,HC F5 GENE ANAL LEIDEN VAR -90,310,1 ,$226.00 ,$146.90 ,$38.33 ,$226.00 ,$183.43 ,$47.58 ,$126.56 ,$73.37 ,$63.28 ,$79.78 ,$73.37 ,$93.11 ,$73.37 ,$101.93 ,$101.93 ,$73.37 ,$91.71 ,$139.40 ,$113.00 ,$183.43 ,$73.37 ,$73.37 ,$74.84 ,$169.50 ,$135.60 ,$135.60 ,$73.37 ,$135.60 ,$95.38 ,$95.38 ,$95.38 ,$226.00 , N/A ,$192.10 ,$183.43 ,$146.90 ,$73.37 ,$226.00 ,$126.56 ,$73.37 ,$59.44 , N/A ,$42.16 ,$40.25 ,$77.04 ,$180.80 ,$165.08 ,$101.93 ,$63.28 ,$203.40 ,$73.37 ,$95.38 ,$146.74 ,$146.74 ,$73.37 ,$146.74 ,$108.48 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000146,81243,HC FMR1 GENE DETECTION -90,310,1 ,$588.00 ,$382.20 ,$38.33 ,$588.00 , N/A ,$92.49 ,$329.28 , N/A ,$164.64 ,$207.56 , N/A ,$242.26 , N/A ,$265.19 ,$265.19 , N/A ,$71.30 ,$264.60 ,$294.00 ,$411.60 , N/A , N/A , N/A ,$441.00 ,$352.80 ,$352.80 , N/A ,$352.80 ,$74.15 ,$74.15 ,$74.15 ,$588.00 , N/A ,$499.80 , N/A ,$382.20 , N/A ,$588.00 ,$329.28 , N/A ,$154.64 , N/A ,$42.16 ,$40.25 , N/A ,$470.40 ,$352.80 ,$265.19 ,$164.64 ,$529.20 , N/A ,$74.15 ,$114.08 ,$114.08 , N/A ,$114.08 ,$282.24 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000147,81244,HC FMR1 GENE CHARACTERIZATION - 90,310,1 ,$305.00 ,$198.25 ,$29.52 ,$305.00 ,$112.23 ,$29.52 ,$170.80 ,$44.89 ,$85.40 ,$107.67 ,$44.89 ,$125.66 ,$44.89 ,$137.56 ,$137.56 ,$44.89 ,$56.11 ,$85.29 ,$152.50 ,$112.23 ,$44.89 ,$44.89 ,$45.79 ,$228.75 ,$183.00 ,$183.00 ,$44.89 ,$183.00 ,$58.36 ,$58.36 ,$58.36 ,$305.00 , N/A ,$259.25 ,$112.23 ,$198.25 ,$44.89 ,$305.00 ,$170.80 ,$44.89 ,$80.22 , N/A ,$42.16 ,$40.25 ,$47.13 ,$244.00 ,$101.00 ,$137.56 ,$85.40 ,$274.50 ,$44.89 ,$58.36 ,$89.78 ,$89.78 ,$44.89 ,$89.78 ,$146.40 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000149,81256,HC HFE GENE ANALYSIS -90,310,1 ,$588.00 ,$382.20 ,$38.33 ,$588.00 ,$163.40 ,$69.81 ,$329.28 ,$65.36 ,$164.64 ,$207.56 ,$65.36 ,$242.26 ,$65.36 ,$265.19 ,$265.19 ,$65.36 ,$81.70 ,$124.18 ,$294.00 ,$163.40 ,$65.36 ,$65.36 ,$66.67 ,$441.00 ,$352.80 ,$352.80 ,$65.36 ,$352.80 ,$94.41 ,$94.41 ,$94.41 ,$588.00 , N/A ,$499.80 ,$163.40 ,$382.20 ,$65.36 ,$588.00 ,$329.28 ,$65.36 ,$154.64 , N/A ,$42.16 ,$40.25 ,$68.63 ,$470.40 ,$147.06 ,$265.19 ,$164.64 ,$529.20 ,$65.36 ,$94.41 ,$130.72 ,$130.72 ,$65.36 ,$130.72 ,$282.24 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000154,81270,HC JAK2 GENE ANALYSIS-90,310,1 ,"$1,222.00 ",$794.30 ,$38.33 ,"$1,222.00 ",$229.15 ,$60.43 ,$684.32 ,$91.66 ,$342.16 ,$431.37 ,$91.66 ,$503.46 ,$91.66 ,$551.12 ,$551.12 ,$91.66 ,$114.58 ,$174.15 ,$611.00 ,$229.15 ,$91.66 ,$91.66 ,$93.49 ,$916.50 ,$733.20 ,$733.20 ,$91.66 ,$733.20 ,$132.41 ,$132.41 ,$132.41 ,"$1,222.00 ", N/A ,"$1,038.70 ",$229.15 ,$794.30 ,$91.66 ,"$1,222.00 ",$684.32 ,$91.66 ,$321.39 , N/A ,$42.16 ,$40.25 ,$96.24 ,$977.60 ,$206.24 ,$551.12 ,$342.16 ,"$1,099.80 ",$91.66 ,$132.41 ,$183.32 ,$183.32 ,$91.66 ,$183.32 ,$586.56 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000157,81291,HC MTHFR GENE ANALYSIS-90,310,1 ,$519.00 ,$337.35 ,$38.33 ,$519.00 ,$163.35 ,$81.38 ,$290.64 ,$65.34 ,$145.32 ,$183.21 ,$65.34 ,$213.83 ,$65.34 ,$234.07 ,$234.07 ,$65.34 ,$81.68 ,$124.15 ,$259.50 ,$163.35 ,$65.34 ,$65.34 ,$66.65 ,$389.25 ,$311.40 ,$311.40 ,$65.34 ,$311.40 ,$84.94 ,$84.94 ,$84.94 ,$519.00 , N/A ,$441.15 ,$163.35 ,$337.35 ,$65.34 ,$519.00 ,$290.64 ,$65.34 ,$136.50 , N/A ,$42.16 ,$40.25 ,$68.61 ,$415.20 ,$147.02 ,$234.07 ,$145.32 ,$467.10 ,$65.34 ,$84.94 ,$130.68 ,$130.68 ,$65.34 ,$130.68 ,$249.12 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000174,81372,HC CLASS 1 TYPING COMPLETE LOW RESOLUTION-90,310,1 ,"$1,028.00 ",$668.20 ,$124.79 ,"$1,028.00 ","$1,008.98 ",$502.46 ,$575.68 ,$403.59 ,$287.84 ,$362.88 ,$403.59 ,$423.54 ,$403.59 ,$463.63 ,$463.63 ,$403.59 ,$504.49 ,$766.82 ,$514.00 ,"$1,008.98 ",$403.59 ,$403.59 ,$411.66 ,$771.00 ,$616.80 ,$616.80 ,$403.59 ,$616.80 ,$524.67 ,$524.67 ,$524.67 ,"$1,028.00 ", N/A ,$873.80 ,"$1,008.98 ",$668.20 ,$403.59 ,"$1,028.00 ",$575.68 ,$403.59 ,$270.36 , N/A ,$137.27 ,$131.03 ,$423.77 ,$822.40 ,$908.08 ,$463.63 ,$287.84 ,$925.20 ,$403.59 ,$524.67 ,$807.18 ,$807.18 ,$403.59 ,$807.18 ,$493.44 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000176,81374,HC HLA CLS I TYPNG LW ANTGN EA-90,310,1 ,$280.00 ,$182.00 ,$38.33 ,$280.00 ,$185.83 ,$170.29 ,$156.80 ,$74.33 ,$78.40 ,$98.84 ,$74.33 ,$115.36 ,$74.33 ,$126.28 ,$126.28 ,$74.33 ,$92.91 ,$141.23 ,$140.00 ,$185.83 ,$74.33 ,$74.33 ,$75.82 ,$210.00 ,$168.00 ,$168.00 ,$74.33 ,$168.00 ,$105.08 ,$105.08 ,$105.08 ,$280.00 , N/A ,$238.00 ,$185.83 ,$182.00 ,$74.33 ,$280.00 ,$156.80 ,$74.33 ,$73.64 , N/A ,$42.16 ,$40.25 ,$78.05 ,$224.00 ,$167.24 ,$126.28 ,$78.40 ,$252.00 ,$74.33 ,$105.08 ,$148.66 ,$148.66 ,$74.33 ,$148.66 ,$134.40 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000177,81376,HC HLA CLASS 2 TYPE LOW RESOLUTION 1 LOCUS-90,310,1 ,$437.00 ,$284.05 ,$99.47 ,$437.00 ,$305.55 ,$99.47 ,$244.72 ,$122.22 ,$122.36 ,$154.26 ,$122.22 ,$180.04 ,$122.22 ,$197.09 ,$197.09 ,$122.22 ,$152.78 ,$232.22 ,$218.50 ,$305.55 ,$122.22 ,$122.22 ,$124.66 ,$327.75 ,$262.20 ,$262.20 ,$122.22 ,$262.20 ,$176.54 ,$176.54 ,$176.54 ,$437.00 , N/A ,$371.45 ,$305.55 ,$284.05 ,$122.22 ,$437.00 ,$244.72 ,$122.22 ,$114.93 , N/A ,$137.27 ,$131.03 ,$128.33 ,$349.60 ,$275.00 ,$197.09 ,$122.36 ,$393.30 ,$122.22 ,$176.54 ,$244.44 ,$244.44 ,$122.22 ,$244.44 ,$209.76 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000178,81377,HC HLA CLASS 2 TYPE 1 AG EQV LR-90,310,1 ,"$1,228.00 ",$798.20 ,$38.33 ,"$1,228.00 ",$236.85 ,$80.92 ,$687.68 ,$94.74 ,$343.84 ,$433.48 ,$94.74 ,$505.94 ,$94.74 ,$553.83 ,$553.83 ,$94.74 ,$118.43 ,$180.01 ,$614.00 ,$236.85 ,$94.74 ,$94.74 ,$96.63 ,$921.00 ,$736.80 ,$736.80 ,$94.74 ,$736.80 ,$132.61 ,$132.61 ,$132.61 ,"$1,228.00 ", N/A ,"$1,043.80 ",$236.85 ,$798.20 ,$94.74 ,"$1,228.00 ",$687.68 ,$94.74 ,$322.96 , N/A ,$42.16 ,$40.25 ,$99.48 ,$982.40 ,$213.17 ,$553.83 ,$343.84 ,"$1,105.20 ",$94.74 ,$132.61 ,$189.48 ,$189.48 ,$94.74 ,$189.48 ,$589.44 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000180,81383,HC HLA 2 TYPE 1 ALLELE HIGH RESOLUTION -90,310,1 ,"$1,228.00 ",$798.20 ,$38.33 ,"$1,228.00 ",$272.83 ,$72.89 ,$687.68 ,$109.13 ,$343.84 ,$433.48 ,$109.13 ,$505.94 ,$109.13 ,$553.83 ,$553.83 ,$109.13 ,$136.41 ,$207.35 ,$614.00 ,$272.83 ,$109.13 ,$109.13 ,$111.31 ,$921.00 ,$736.80 ,$736.80 ,$109.13 ,$736.80 ,$157.64 ,$157.64 ,$157.64 ,"$1,228.00 ", N/A ,"$1,043.80 ",$272.83 ,$798.20 ,$109.13 ,"$1,228.00 ",$687.68 ,$109.13 ,$322.96 , N/A ,$42.16 ,$40.25 ,$114.59 ,$982.40 ,$245.54 ,$553.83 ,$343.84 ,"$1,105.20 ",$109.13 ,$157.64 ,$218.26 ,$218.26 ,$109.13 ,$218.26 ,$589.44 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000181,81400,HC MOLECULAR PATH PROC LEVEL 1-90,310,1 ,$672.00 ,$436.80 ,$38.33 ,$672.00 ,$159.90 ,$71.94 ,$376.32 ,$63.96 ,$188.16 ,$237.22 ,$63.96 ,$276.86 ,$63.96 ,$303.07 ,$303.07 ,$63.96 ,$79.95 ,$121.52 ,$336.00 ,$159.90 ,$63.96 ,$63.96 ,$65.24 ,$504.00 ,$403.20 ,$403.20 ,$63.96 ,$403.20 ,$83.15 ,$83.15 ,$83.15 ,$672.00 , N/A ,$571.20 ,$159.90 ,$436.80 ,$63.96 ,$672.00 ,$376.32 ,$63.96 ,$176.74 , N/A ,$42.16 ,$40.25 ,$67.16 ,$537.60 ,$143.91 ,$303.07 ,$188.16 ,$604.80 ,$63.96 ,$83.15 ,$127.92 ,$127.92 ,$63.96 ,$127.92 ,$322.56 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000183,81401,HC MOLECULAR PATH PROC LEVEL 2-90,310,1 ,"$1,179.00 ",$766.35 ,$38.33 ,"$1,179.00 ", N/A ,$68.25 ,$660.24 , N/A ,$330.12 ,$416.19 , N/A ,$485.75 , N/A ,$531.73 ,$531.73 , N/A ,$171.25 ,$530.55 ,$589.50 ,$825.30 , N/A , N/A , N/A ,$884.25 ,$707.40 ,$707.40 , N/A ,$707.40 ,$178.10 ,$178.10 ,$178.10 ,"$1,179.00 ", N/A ,"$1,002.15 ", N/A ,$766.35 , N/A ,"$1,179.00 ",$660.24 , N/A ,$310.08 , N/A ,$42.16 ,$40.25 , N/A ,$943.20 ,$707.40 ,$531.73 ,$330.12 ,"$1,061.10 ", N/A ,$178.10 ,$274.00 ,$274.00 , N/A ,$274.00 ,$565.92 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000184,81403,HC MOLECULAR PATH PROC LEVEL 4-90,310,1 ,"$1,528.00 ",$993.20 ,$38.33 ,"$1,528.00 ", N/A ,$105.00 ,$855.68 , N/A ,$427.84 ,$539.38 , N/A ,$629.54 , N/A ,$689.13 ,$689.13 , N/A ,$231.50 ,$687.60 ,$764.00 ,"$1,069.60 ", N/A , N/A , N/A ,"$1,146.00 ",$916.80 ,$916.80 , N/A ,$916.80 ,$240.76 ,$240.76 ,$240.76 ,"$1,528.00 ", N/A ,"$1,298.80 ", N/A ,$993.20 , N/A ,"$1,528.00 ",$855.68 , N/A ,$401.86 , N/A ,$42.16 ,$40.25 , N/A ,"$1,222.40 ",$916.80 ,$689.13 ,$427.84 ,"$1,375.20 ", N/A ,$240.76 ,$370.40 ,$370.40 , N/A ,$370.40 ,$733.44 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000186,81404,HC MOLECULAR PATH PROC LEVEL 5-90,310,1 ,$384.00 ,$249.60 ,$38.33 ,$384.00 , N/A ,$183.75 ,$215.04 , N/A ,$107.52 ,$135.55 , N/A ,$158.21 , N/A ,$173.18 ,$173.18 , N/A ,$343.54 ,$172.80 ,$192.00 ,$268.80 , N/A , N/A , N/A ,$288.00 ,$230.40 ,$230.40 , N/A ,$230.40 ,$357.28 ,$357.28 ,$357.28 ,$384.00 , N/A ,$326.40 , N/A ,$249.60 , N/A ,$384.00 ,$215.04 , N/A ,$100.99 , N/A ,$42.16 ,$40.25 , N/A ,$307.20 ,$230.40 ,$173.18 ,$107.52 ,$345.60 , N/A ,$357.28 ,$384.00 ,$384.00 , N/A ,$384.00 ,$184.32 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000188,81406,HC MOLECULAR PATH PROC LEVEL 7-90,310,1 ,"$8,552.00 ","$5,558.80 ",$104.65 ,"$8,552.00 ", N/A ,$104.65 ,"$4,789.12 ", N/A ,"$2,394.56 ","$1,717.35 ", N/A ,"$1,717.35 ", N/A ,"$3,856.95 ","$3,856.95 ", N/A ,$353.60 ,"$3,848.40 ","$4,276.00 ","$5,986.40 ", N/A , N/A , N/A ,"$6,414.00 ","$5,131.20 ","$5,131.20 ", N/A ,"$5,131.20 ",$367.74 ,$367.74 ,$367.74 ,"$8,552.00 ", N/A ,"$7,269.20 ", N/A ,"$5,558.80 ", N/A ,"$8,552.00 ","$4,789.12 ", N/A ,"$2,249.18 ", N/A ,$137.27 ,$131.03 , N/A ,"$6,841.60 ","$5,131.20 ","$3,856.95 ","$2,394.56 ","$7,696.80 ", N/A ,$367.74 ,$565.76 ,$565.76 , N/A ,$565.76 ,"$4,104.96 ",$124.79 
ST. ELIZABETH'S HOSPITAL,31000191,81479,HC IBD CELIAC UNLISTED MOLECULAR PATH-90,310,1 ,"$1,059.00 ",$688.35 ,$32.69 ,"$1,059.00 ", N/A ,$78.75 ,$593.04 , N/A ,$296.52 ,$32.69 , N/A ,$32.69 , N/A ,$477.61 ,$477.61 , N/A ,$688.35 ,$476.55 ,$529.50 ,$741.30 , N/A , N/A , N/A ,$794.25 ,$635.40 ,$635.40 , N/A ,$635.40 ,$741.30 ,$741.30 ,$741.30 ,"$1,059.00 ", N/A ,$900.15 , N/A ,$688.35 , N/A ,"$1,059.00 ",$593.04 , N/A ,$278.52 , N/A ,$42.16 ,$40.25 , N/A ,$847.20 ,$635.40 ,$477.61 ,$296.52 ,$953.10 , N/A ,$741.30 ,$529.50 ,$529.50 , N/A ,$529.50 ,$508.32 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000200,0001U,HC RBC DNA HUMAN GENE ANLYS 35 AG 11 BLOOD GRP-90,310,1 ,"$1,208.00 ",$785.20 ,$38.33 ,"$1,800.00 ","$1,800.00 ",$512.05 ,$676.48 ,$720.00 ,$338.24 ,$408.30 ,$720.00 ,$469.91 ,$720.00 ,$544.81 ,$544.81 ,$720.00 ,$900.00 ,"$1,208.00 ",$604.00 ,"$1,800.00 ",$720.00 ,$720.00 ,$734.40 ,$906.00 ,$724.80 ,$724.80 ,$720.00 ,$724.80 ,$936.00 ,$936.00 ,$936.00 ,"$1,208.00 ", N/A ,"$1,026.80 ","$1,208.00 ",$785.20 ,$720.00 ,"$1,208.00 ",$676.48 ,$720.00 ,$317.70 , N/A ,$42.16 ,$40.25 ,$756.00 ,$966.40 ,"$1,620.00 ",$544.81 ,$338.24 ,"$1,087.20 ",$720.00 ,$936.00 ,"$1,208.00 ","$1,208.00 ",$720.00 ,"$1,208.00 ",$579.84 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000205,81219,HC CALR GENE ANALYSIS EXON 9-90,310,1 ,"$1,064.00 ",$691.60 ,$121.63 ,"$1,064.00 ",$304.08 ,$193.94 ,$595.84 ,$121.63 ,$297.92 ,$375.59 ,$121.63 ,$438.37 ,$121.63 ,$479.86 ,$479.86 ,$121.63 ,$152.04 ,$231.10 ,$532.00 ,$304.08 ,$121.63 ,$121.63 ,$124.06 ,$798.00 ,$638.40 ,$638.40 ,$121.63 ,$638.40 ,$175.68 ,$175.68 ,$175.68 ,"$1,064.00 ", N/A ,$904.40 ,$304.08 ,$691.60 ,$121.63 ,"$1,064.00 ",$595.84 ,$121.63 ,$279.83 , N/A ,$137.27 ,$131.03 ,$127.71 ,$851.20 ,$273.67 ,$479.86 ,$297.92 ,$957.60 ,$121.63 ,$175.68 ,$243.26 ,$243.26 ,$121.63 ,$243.26 ,$510.72 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000208,81402,HC MOLECULAR PATHOLOGY PROC LEVEL 3-90,310,1 ,$877.00 ,$570.05 ,$38.33 ,$877.00 , N/A ,$105.00 ,$491.12 , N/A ,$245.56 ,$309.58 , N/A ,$361.32 , N/A ,$395.53 ,$395.53 , N/A ,$187.91 ,$394.65 ,$438.50 ,$613.90 , N/A , N/A , N/A ,$657.75 ,$526.20 ,$526.20 , N/A ,$526.20 ,$195.43 ,$195.43 ,$195.43 ,$877.00 , N/A ,$745.45 , N/A ,$570.05 , N/A ,$877.00 ,$491.12 , N/A ,$230.65 , N/A ,$42.16 ,$40.25 , N/A ,$701.60 ,$526.20 ,$395.53 ,$245.56 ,$789.30 , N/A ,$195.43 ,$300.66 ,$300.66 , N/A ,$300.66 ,$420.96 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31000209,81232,HC DPYD GENE ANALYSIS COMMON VARIANT-90,310,1 ,"$1,518.00 ",$986.70 ,$124.79 ,"$1,518.00 ",$437.03 ,$214.15 ,$850.08 ,$174.81 ,$425.04 ,$535.85 ,$174.81 ,$625.42 ,$174.81 ,$684.62 ,$684.62 ,$174.81 ,$218.51 ,$332.14 ,$759.00 ,$437.03 ,$174.81 ,$174.81 ,$178.31 ,"$1,138.50 ",$910.80 ,$910.80 ,$174.81 ,$910.80 ,$227.25 ,$227.25 ,$227.25 ,"$1,518.00 ", N/A ,"$1,290.30 ",$437.03 ,$986.70 ,$174.81 ,"$1,518.00 ",$850.08 ,$174.81 ,$399.23 , N/A ,$137.27 ,$131.03 ,$183.55 ,"$1,214.40 ",$393.32 ,$684.62 ,$425.04 ,"$1,366.20 ",$174.81 ,$227.25 ,$349.62 ,$349.62 ,$174.81 ,$349.62 ,$728.64 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000216,81382,HC HLA CLASS 2 HIGH RESOLUTION ONE LOCUS EA - 90,310,1 ,$730.00 ,$474.50 ,$100.75 ,$730.00 ,$309.20 ,$100.75 ,$408.80 ,$123.68 ,$204.40 ,$257.69 ,$123.68 ,$300.76 ,$123.68 ,$329.23 ,$329.23 ,$123.68 ,$154.60 ,$234.99 ,$365.00 ,$309.20 ,$123.68 ,$123.68 ,$126.15 ,$547.50 ,$438.00 ,$438.00 ,$123.68 ,$438.00 ,$178.65 ,$178.65 ,$178.65 ,$730.00 , N/A ,$620.50 ,$309.20 ,$474.50 ,$123.68 ,$730.00 ,$408.80 ,$123.68 ,$191.99 , N/A ,$137.27 ,$131.03 ,$129.86 ,$584.00 ,$278.28 ,$329.23 ,$204.40 ,$657.00 ,$123.68 ,$178.65 ,$247.36 ,$247.36 ,$123.68 ,$247.36 ,$350.40 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000224,81335,HC TPMT GENE ANALYSIS COMMON VARIANTS-90,310,1 ,$720.00 ,$468.00 ,$124.79 ,$720.00 ,$437.03 ,$214.15 ,$403.20 ,$174.81 ,$201.60 ,$254.16 ,$174.81 ,$296.64 ,$174.81 ,$324.72 ,$324.72 ,$174.81 ,$218.51 ,$332.14 ,$360.00 ,$437.03 ,$174.81 ,$174.81 ,$178.31 ,$540.00 ,$432.00 ,$432.00 ,$174.81 ,$432.00 ,$227.25 ,$227.25 ,$227.25 ,$720.00 , N/A ,$612.00 ,$437.03 ,$468.00 ,$174.81 ,$720.00 ,$403.20 ,$174.81 ,$189.36 , N/A ,$137.27 ,$131.03 ,$183.55 ,$576.00 ,$393.32 ,$324.72 ,$201.60 ,$648.00 ,$174.81 ,$227.25 ,$349.62 ,$349.62 ,$174.81 ,$349.62 ,$345.60 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000226,81450,HC TARGET GENOMIC SEQ ANALYSIS HEMATOLYMPHOID 5-50 GENES-90,310,1 ,"$2,732.00 ","$1,775.80 ",$124.79 ,"$2,732.00 ","$1,898.83 ","$1,258.37 ","$1,529.92 ",$759.53 ,$764.96 ,$964.40 ,$759.53 ,"$1,125.58 ",$759.53 ,"$1,232.13 ","$1,232.13 ",$759.53 ,$949.41 ,"$1,443.11 ","$1,366.00 ","$1,898.83 ",$759.53 ,$759.53 ,$774.72 ,"$2,049.00 ","$1,639.20 ","$1,639.20 ",$759.53 ,"$1,639.20 ",$987.39 ,$987.39 ,$987.39 ,"$2,732.00 ", N/A ,"$2,322.20 ","$1,898.83 ","$1,775.80 ",$759.53 ,"$2,732.00 ","$1,529.92 ",$759.53 ,$718.52 , N/A ,$137.27 ,$131.03 ,$797.51 ,"$2,185.60 ","$1,708.94 ","$1,232.13 ",$764.96 ,"$2,458.80 ",$759.53 ,$987.39 ,"$1,519.06 ","$1,519.06 ",$759.53 ,"$1,519.06 ","$1,311.36 ",$124.79 
ST. ELIZABETH'S HOSPITAL,31000251,81314,HC PDGFRA GENE ANALYSIS TARGETED SEQ-90,310,1 ,"$1,291.00 ",$839.15 ,$124.79 ,"$1,291.00 ",$823.78 ,$385.37 ,$722.96 ,$329.51 ,$361.48 ,$455.72 ,$329.51 ,$531.89 ,$329.51 ,$582.24 ,$582.24 ,$329.51 ,$411.89 ,$626.07 ,$645.50 ,$823.78 ,$329.51 ,$329.51 ,$336.10 ,$968.25 ,$774.60 ,$774.60 ,$329.51 ,$774.60 ,$428.36 ,$428.36 ,$428.36 ,"$1,291.00 ", N/A ,"$1,097.35 ",$823.78 ,$839.15 ,$329.51 ,"$1,291.00 ",$722.96 ,$329.51 ,$339.53 , N/A ,$137.27 ,$131.03 ,$345.99 ,"$1,032.80 ",$741.40 ,$582.24 ,$361.48 ,"$1,161.90 ",$329.51 ,$428.36 ,$659.02 ,$659.02 ,$329.51 ,$659.02 ,$619.68 ,$124.79 
ST. ELIZABETH'S HOSPITAL,31000253,81420,HC FETAL CHROMOSOME ANEUPLOIDY -90,310,1 ,"$2,611.00 ","$1,697.15 ",$354.15 ,"$2,611.00 ","$1,897.63 ",$875.00 ,"$1,462.16 ",$759.05 ,$731.08 ,$921.68 ,$759.05 ,"$1,075.73 ",$759.05 ,"$1,177.56 ","$1,177.56 ",$759.05 ,$948.81 ,"$1,442.20 ","$1,305.50 ","$1,897.63 ",$759.05 ,$759.05 ,$774.23 ,"$1,958.25 ","$1,566.60 ","$1,566.60 ",$759.05 ,"$1,566.60 ",$986.77 ,$986.77 ,$986.77 ,"$2,611.00 ", N/A ,"$2,219.35 ","$1,897.63 ","$1,697.15 ",$759.05 ,"$2,611.00 ","$1,462.16 ",$759.05 ,$686.69 , N/A ,$389.57 ,$371.86 ,$797.00 ,"$2,088.80 ","$1,707.86 ","$1,177.56 ",$731.08 ,"$2,349.90 ",$759.05 ,$986.77 ,"$1,518.10 ","$1,518.10 ",$759.05 ,"$1,518.10 ","$1,253.28 ",$354.15 
ST. ELIZABETH'S HOSPITAL,31000271,0037U,HC TRGT GEN SEQ DNA 324 GENES-90,310,1 ,"$7,672.00 ","$4,986.80 ",$354.15 ,"$8,750.00 ","$8,750.00 ","$4,287.50 ","$4,296.32 ","$3,500.00 ","$2,148.16 ","$2,593.14 ","$3,500.00 ","$2,984.41 ","$3,500.00 ","$3,460.07 ","$3,460.07 ","$3,500.00 ","$4,375.00 ","$6,650.00 ","$3,836.00 ","$8,750.00 ","$3,500.00 ","$3,500.00 ","$3,570.00 ","$5,754.00 ","$4,603.20 ","$4,603.20 ","$3,500.00 ","$4,603.20 ","$4,550.00 ","$4,550.00 ","$4,550.00 ","$7,672.00 ", N/A ,"$6,521.20 ","$7,672.00 ","$4,986.80 ","$3,500.00 ","$7,672.00 ","$4,296.32 ","$3,500.00 ","$2,017.74 ", N/A ,$389.57 ,$371.86 ,"$3,675.00 ","$6,137.60 ","$7,875.00 ","$3,460.07 ","$2,148.16 ","$6,904.80 ","$3,500.00 ","$4,550.00 ","$7,000.00 ","$7,000.00 ","$3,500.00 ","$7,000.00 ","$3,682.56 ",$354.15 
ST. ELIZABETH'S HOSPITAL,31000280,81403,HC MOLECULAR PATHOLOGY PROC LEVEL 4-90,310,1 ,$574.00 ,$373.10 ,$38.33 ,$574.00 , N/A ,$105.00 ,$321.44 , N/A ,$160.72 ,$202.62 , N/A ,$236.49 , N/A ,$258.87 ,$258.87 , N/A ,$231.50 ,$258.30 ,$287.00 ,$401.80 , N/A , N/A , N/A ,$430.50 ,$344.40 ,$344.40 , N/A ,$344.40 ,$240.76 ,$240.76 ,$240.76 ,$574.00 , N/A ,$487.90 , N/A ,$373.10 , N/A ,$574.00 ,$321.44 , N/A ,$150.96 , N/A ,$42.16 ,$40.25 , N/A ,$459.20 ,$344.40 ,$258.87 ,$160.72 ,$516.60 , N/A ,$240.76 ,$370.40 ,$370.40 , N/A ,$370.40 ,$275.52 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$106.00 ,$68.90 ,$27.88 ,$106.00 ,$83.43 ,$44.82 ,$59.36 ,$33.37 ,$29.68 ,$37.42 ,$33.37 ,$43.67 ,$33.37 ,$47.81 ,$47.81 ,$33.37 ,$68.90 ,$63.41 ,$53.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$79.50 ,$63.60 ,$63.60 ,$33.37 ,$63.60 ,$50.08 ,$50.08 ,$50.08 ,$106.00 , N/A ,$90.10 ,$83.43 ,$68.90 ,$33.37 ,$106.00 ,$59.36 ,$33.37 ,$27.88 , N/A ,$33.95 ,$32.40 ,$35.04 ,$84.80 ,$75.08 ,$47.81 ,$29.68 ,$95.40 ,$33.37 ,$50.08 ,$67.68 ,$67.68 ,$33.37 ,$67.68 ,$50.88 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100102,88108,HC CYTOPATH CONCENTRATION,311,1 ,$96.36 ,$62.63 ,$25.34 ,$96.36 ,$83.43 ,$57.23 ,$53.96 ,$33.37 ,$26.98 ,$34.02 ,$33.37 ,$39.70 ,$33.37 ,$43.46 ,$43.46 ,$33.37 ,$62.63 ,$63.41 ,$48.18 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$72.27 ,$57.82 ,$57.82 ,$33.37 ,$57.82 ,$45.77 ,$45.77 ,$45.77 ,$96.36 , N/A ,$81.91 ,$83.43 ,$62.63 ,$33.37 ,$96.36 ,$53.96 ,$33.37 ,$25.34 , N/A ,$33.95 ,$32.40 ,$35.04 ,$77.09 ,$75.08 ,$43.46 ,$26.98 ,$86.72 ,$33.37 ,$45.77 ,$67.68 ,$67.68 ,$33.37 ,$67.68 ,$46.25 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$226.00 ,$146.90 ,$33.94 ,$226.00 ,$122.48 ,$54.83 ,$126.56 ,$48.99 ,$63.28 ,$79.78 ,$48.99 ,$93.11 ,$48.99 ,$101.93 ,$101.93 ,$48.99 ,$146.90 ,$93.08 ,$113.00 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$169.50 ,$135.60 ,$135.60 ,$48.99 ,$135.60 ,$47.06 ,$47.06 ,$47.06 ,$226.00 , N/A ,$192.10 ,$122.48 ,$146.90 ,$48.99 ,$226.00 ,$126.56 ,$48.99 ,$59.44 , N/A ,$37.33 ,$35.64 ,$51.44 ,$180.80 ,$110.23 ,$101.93 ,$63.28 ,$203.40 ,$48.99 ,$47.06 ,$99.52 ,$99.52 ,$48.99 ,$99.52 ,$108.48 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31100107,88142,HC THINPREP PAP,311,1 ,$119.00 ,$77.35 ,$20.26 ,$119.00 ,$50.65 ,$34.93 ,$66.64 ,$20.26 ,$33.32 ,$42.01 ,$20.26 ,$49.03 ,$20.26 ,$53.67 ,$53.67 ,$20.26 ,$25.33 ,$38.49 ,$59.50 ,$50.65 ,$20.26 ,$20.26 ,$20.67 ,$89.25 ,$71.40 ,$71.40 ,$20.26 ,$71.40 ,$29.26 ,$29.26 ,$29.26 ,$119.00 , N/A ,$101.15 ,$50.65 ,$77.35 ,$20.26 ,$20.26 ,$66.64 ,$20.26 ,$31.30 , N/A ,$24.61 ,$23.49 ,$21.27 ,$95.20 ,$45.59 ,$53.67 ,$33.32 ,$107.10 ,$20.26 ,$29.26 ,$40.52 ,$40.52 ,$20.26 ,$40.52 ,$57.12 ,$22.37 
ST. ELIZABETH'S HOSPITAL,31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$295.00 ,$191.75 ,$30.86 ,$295.00 ,$122.48 ,$82.06 ,$165.20 ,$48.99 ,$82.60 ,$104.14 ,$48.99 ,$121.54 ,$48.99 ,$133.05 ,$133.05 ,$48.99 ,$191.75 ,$93.08 ,$147.50 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$221.25 ,$177.00 ,$177.00 ,$48.99 ,$177.00 ,$98.01 ,$98.01 ,$98.01 ,$295.00 , N/A ,$250.75 ,$122.48 ,$191.75 ,$48.99 ,$89.83 ,$165.20 ,$48.99 ,$77.59 , N/A ,$33.95 ,$32.40 ,$51.44 ,$236.00 ,$110.23 ,$133.05 ,$82.60 ,$265.50 ,$48.99 ,$98.01 ,$99.52 ,$99.52 ,$48.99 ,$99.52 ,$141.60 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100240,88161,HC CYTOPATH SMEAR OTHER SOURCE W/PREP,311,1 ,$220.00 ,$143.00 ,$24.36 ,$220.00 ,$60.90 ,$36.40 ,$123.20 ,$24.36 ,$61.60 ,$77.66 ,$24.36 ,$90.64 ,$24.36 ,$99.22 ,$99.22 ,$24.36 ,$143.00 ,$46.27 ,$110.00 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$165.00 ,$132.00 ,$132.00 ,$24.36 ,$132.00 ,$49.22 ,$49.22 ,$49.22 ,$220.00 , N/A ,$187.00 ,$60.89 ,$143.00 ,$24.36 ,$220.00 ,$123.20 ,$24.36 ,$57.86 , N/A ,$33.95 ,$32.40 ,$25.58 ,$176.00 ,$54.80 ,$99.22 ,$61.60 ,$198.00 ,$24.36 ,$49.22 ,$49.34 ,$49.34 ,$24.36 ,$49.34 ,$105.60 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100244,88184,HC FLOW CYTO 1ST MARKER-90,311,1 ,$227.00 ,$147.55 ,$33.94 ,$717.84 ,$717.83 ,$99.26 ,$127.12 ,$287.13 ,$63.56 ,$80.13 ,$287.13 ,$93.52 ,$227.00 ,$102.38 ,$102.38 ,$227.00 ,$147.55 ,$227.00 ,$113.50 ,$717.84 ,$287.13 ,$287.13 ,$227.00 ,$170.25 ,$136.20 ,$136.20 ,$287.13 ,$136.20 ,$81.21 ,$81.21 ,$81.21 ,$227.00 , N/A ,$192.95 ,$227.00 ,$147.55 ,$287.13 ,$227.00 ,$127.12 ,$287.13 ,$59.70 , N/A ,$37.33 ,$35.64 ,$301.49 ,$181.60 ,$646.05 ,$102.38 ,$63.56 ,$204.30 ,$287.13 ,$81.21 ,$227.00 ,$227.00 ,$227.00 ,$227.00 ,$108.96 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31100246,88185,HC FLOW CYTO EA ADD MARKER-90,311,1 ,$240.00 ,$156.00 ,$29.71 ,$240.00 , N/A ,$59.62 ,$134.40 , N/A ,$67.20 ,$84.72 , N/A ,$98.88 , N/A ,$108.24 ,$108.24 , N/A ,$156.00 , N/A ,$120.00 , N/A , N/A , N/A , N/A ,$180.00 ,$144.00 ,$144.00 , N/A ,$144.00 ,$29.71 ,$29.71 ,$29.71 ,$240.00 , N/A ,$204.00 , N/A ,$156.00 , N/A ,$240.00 ,$134.40 , N/A ,$63.12 , N/A ,$37.33 ,$35.64 , N/A ,$192.00 , N/A ,$108.24 ,$67.20 ,$216.00 , N/A ,$29.71 ,$46.06 ,$46.06 , N/A ,$46.06 ,$115.20 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31100249,88188,HC FLOW CYTO INT 9-15 MARKERS-90,311,1 ,$391.00 ,$254.15 ,$30.86 ,$391.00 , N/A ,$105.26 ,$218.96 , N/A ,$109.48 ,$138.02 , N/A ,$161.09 , N/A ,$176.34 ,$176.34 , N/A ,$254.15 , N/A ,$195.50 , N/A , N/A , N/A , N/A ,$293.25 ,$234.60 ,$234.60 , N/A ,$234.60 ,$84.16 ,$84.16 ,$84.16 ,$391.00 , N/A ,$332.35 , N/A ,$254.15 , N/A ,$391.00 ,$218.96 , N/A ,$102.83 , N/A ,$33.95 ,$32.40 , N/A ,$312.80 , N/A ,$176.34 ,$109.48 ,$351.90 , N/A ,$84.16 ,$125.62 ,$125.62 , N/A ,$125.62 ,$187.68 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100251,88230,HC TISSUE CULT NONNEO LYMPHOCYTE-90,311,1 ,$464.00 ,$301.60 ,$33.94 ,$464.00 ,$291.23 ,$200.83 ,$259.84 ,$116.49 ,$129.92 ,$163.79 ,$116.49 ,$191.17 ,$116.49 ,$209.26 ,$209.26 ,$116.49 ,$145.61 ,$221.33 ,$232.00 ,$291.23 ,$116.49 ,$116.49 ,$118.82 ,$348.00 ,$278.40 ,$278.40 ,$116.49 ,$278.40 ,$168.27 ,$168.27 ,$168.27 ,$464.00 , N/A ,$394.40 ,$291.23 ,$301.60 ,$116.49 ,$464.00 ,$259.84 ,$116.49 ,$122.03 , N/A ,$37.33 ,$35.64 ,$122.31 ,$371.20 ,$262.10 ,$209.26 ,$129.92 ,$417.60 ,$116.49 ,$168.27 ,$232.98 ,$232.98 ,$116.49 ,$232.98 ,$222.72 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31100255,88237,HC TISSUE CULT BONE/BLD-90,311,1 ,$525.00 ,$341.25 ,$33.94 ,$525.00 ,$359.38 ,$217.74 ,$294.00 ,$143.75 ,$147.00 ,$185.33 ,$143.75 ,$216.30 ,$143.75 ,$236.78 ,$236.78 ,$143.75 ,$179.69 ,$273.13 ,$262.50 ,$359.38 ,$143.75 ,$143.75 ,$146.63 ,$393.75 ,$315.00 ,$315.00 ,$143.75 ,$315.00 ,$186.88 ,$186.88 ,$186.88 ,$525.00 , N/A ,$446.25 ,$359.38 ,$341.25 ,$143.75 ,$525.00 ,$294.00 ,$143.75 ,$138.08 , N/A ,$37.33 ,$35.64 ,$150.94 ,$420.00 ,$323.44 ,$236.78 ,$147.00 ,$472.50 ,$143.75 ,$186.88 ,$287.50 ,$287.50 ,$143.75 ,$287.50 ,$252.00 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31100257,88262,HC CHROM COUNT 15-20/2-90,311,1 ,$535.00 ,$347.75 ,$38.33 ,$535.00 ,$313.73 ,$214.87 ,$299.60 ,$125.49 ,$149.80 ,$188.86 ,$125.49 ,$220.42 ,$125.49 ,$241.29 ,$241.29 ,$125.49 ,$156.86 ,$238.43 ,$267.50 ,$313.73 ,$125.49 ,$125.49 ,$128.00 ,$401.25 ,$321.00 ,$321.00 ,$125.49 ,$321.00 ,$180.04 ,$180.04 ,$180.04 ,$535.00 , N/A ,$454.75 ,$313.73 ,$347.75 ,$125.49 ,$535.00 ,$299.60 ,$125.49 ,$140.71 , N/A ,$42.16 ,$40.25 ,$131.76 ,$428.00 ,$282.35 ,$241.29 ,$149.80 ,$481.50 ,$125.49 ,$180.04 ,$250.98 ,$250.98 ,$125.49 ,$250.98 ,$256.80 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100258,88264,HC CHROM ANLYS ANALYZE 20-90,311,1 ,$552.00 ,$358.80 ,$38.33 ,$552.00 ,$361.53 ,$214.87 ,$309.12 ,$144.61 ,$154.56 ,$194.86 ,$144.61 ,$227.42 ,$144.61 ,$248.95 ,$248.95 ,$144.61 ,$180.76 ,$274.76 ,$276.00 ,$361.53 ,$144.61 ,$144.61 ,$147.50 ,$414.00 ,$331.20 ,$331.20 ,$144.61 ,$331.20 ,$187.99 ,$187.99 ,$187.99 ,$552.00 , N/A ,$469.20 ,$361.53 ,$358.80 ,$144.61 ,$552.00 ,$309.12 ,$144.61 ,$145.18 , N/A ,$42.16 ,$40.25 ,$151.84 ,$441.60 ,$325.37 ,$248.95 ,$154.56 ,$496.80 ,$144.61 ,$187.99 ,$289.22 ,$289.22 ,$144.61 ,$289.22 ,$264.96 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100261,88271,HC MCG DNA PROBE(FISH)-90,311,1 ,$646.00 ,$419.90 ,$21.42 ,$646.00 ,$53.55 ,$24.96 ,$361.76 ,$21.42 ,$180.88 ,$160.55 ,$21.42 ,$160.55 ,$21.42 ,$291.35 ,$291.35 ,$21.42 ,$26.78 ,$40.70 ,$323.00 ,$53.55 ,$21.42 ,$21.42 ,$21.85 ,$484.50 ,$387.60 ,$387.60 ,$21.42 ,$387.60 ,$30.94 ,$30.94 ,$30.94 ,$646.00 , N/A ,$549.10 ,$53.55 ,$419.90 ,$21.42 ,$646.00 ,$361.76 ,$21.42 ,$169.90 , N/A ,$42.16 ,$40.25 ,$22.49 ,$516.80 ,$48.20 ,$291.35 ,$180.88 ,$581.40 ,$21.42 ,$30.94 ,$42.84 ,$42.84 ,$21.42 ,$42.84 ,$310.08 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100267,88273,HC MCG CHROM INSITU 10-30 -90,311,1 ,$142.00 ,$92.30 ,$34.81 ,$142.00 ,$87.03 ,$55.39 ,$79.52 ,$34.81 ,$39.76 ,$50.13 ,$34.81 ,$58.50 ,$34.81 ,$64.04 ,$64.04 ,$34.81 ,$43.51 ,$66.14 ,$71.00 ,$87.03 ,$34.81 ,$34.81 ,$35.51 ,$106.50 ,$85.20 ,$85.20 ,$34.81 ,$85.20 ,$46.41 ,$46.41 ,$46.41 ,$142.00 , N/A ,$120.70 ,$87.03 ,$92.30 ,$34.81 ,$142.00 ,$79.52 ,$34.81 ,$37.35 , N/A ,$42.16 ,$40.25 ,$36.55 ,$113.60 ,$78.32 ,$64.04 ,$39.76 ,$127.80 ,$34.81 ,$46.41 ,$69.62 ,$69.62 ,$34.81 ,$69.62 ,$68.16 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100269,88275,HC MCG INTERPH INSITU 100 -90,311,1 ,$322.00 ,$209.30 ,$38.33 ,$322.00 ,$127.98 ,$69.23 ,$180.32 ,$51.19 ,$90.16 ,$113.67 ,$51.19 ,$132.66 ,$51.19 ,$145.22 ,$145.22 ,$51.19 ,$63.99 ,$97.26 ,$161.00 ,$127.98 ,$51.19 ,$51.19 ,$52.21 ,$241.50 ,$193.20 ,$193.20 ,$51.19 ,$193.20 ,$66.55 ,$66.55 ,$66.55 ,$322.00 , N/A ,$273.70 ,$127.98 ,$209.30 ,$51.19 ,$322.00 ,$180.32 ,$51.19 ,$84.69 , N/A ,$42.16 ,$40.25 ,$53.75 ,$257.60 ,$115.18 ,$145.22 ,$90.16 ,$289.80 ,$51.19 ,$66.55 ,$102.38 ,$102.38 ,$51.19 ,$102.38 ,$154.56 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100273,88280,HC CHROM ADDL KARYO-90,311,1 ,$377.00 ,$245.05 ,$33.47 ,$377.00 ,$83.68 ,$43.26 ,$211.12 ,$33.47 ,$105.56 ,$133.08 ,$33.47 ,$155.32 ,$33.47 ,$170.03 ,$170.03 ,$33.47 ,$41.84 ,$63.59 ,$188.50 ,$83.68 ,$33.47 ,$33.47 ,$34.14 ,$282.75 ,$226.20 ,$226.20 ,$33.47 ,$226.20 ,$43.51 ,$43.51 ,$43.51 ,$377.00 , N/A ,$320.45 ,$83.68 ,$245.05 ,$33.47 ,$377.00 ,$211.12 ,$33.47 ,$99.15 , N/A ,$42.16 ,$40.25 ,$35.14 ,$301.60 ,$75.31 ,$170.03 ,$105.56 ,$339.30 ,$33.47 ,$43.51 ,$66.94 ,$66.94 ,$33.47 ,$66.94 ,$180.96 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100274,88289,HC CHROM ADDL HIGH RES-90,311,1 ,$164.00 ,$106.60 ,$34.43 ,$164.00 ,$86.08 ,$50.91 ,$91.84 ,$34.43 ,$45.92 ,$57.89 ,$34.43 ,$67.57 ,$34.43 ,$73.96 ,$73.96 ,$34.43 ,$43.04 ,$65.42 ,$82.00 ,$86.08 ,$34.43 ,$34.43 ,$35.12 ,$123.00 ,$98.40 ,$98.40 ,$34.43 ,$98.40 ,$49.74 ,$49.74 ,$49.74 ,$164.00 , N/A ,$139.40 ,$86.08 ,$106.60 ,$34.43 ,$164.00 ,$91.84 ,$34.43 ,$43.13 , N/A ,$42.16 ,$40.25 ,$36.15 ,$131.20 ,$77.47 ,$73.96 ,$45.92 ,$147.60 ,$34.43 ,$49.74 ,$68.86 ,$68.86 ,$34.43 ,$68.86 ,$78.72 ,$38.33 
ST. ELIZABETH'S HOSPITAL,31100283,88120,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC-90,311,1 ,$551.00 ,$358.15 ,$33.94 ,$551.00 ,$367.60 ,$477.17 ,$308.56 ,$147.04 ,$154.28 ,$194.50 ,$147.04 ,$227.01 ,$147.04 ,$248.50 ,$248.50 ,$147.04 ,$358.15 ,$279.37 ,$275.50 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$413.25 ,$330.60 ,$330.60 ,$147.04 ,$330.60 ,$551.00 ,$551.00 ,$551.00 ,$551.00 , N/A ,$468.35 ,$367.59 ,$358.15 ,$147.04 ,$551.00 ,$308.56 ,$147.04 ,$144.91 , N/A ,$37.33 ,$35.64 ,$154.39 ,$440.80 ,$330.83 ,$248.50 ,$154.28 ,$495.90 ,$147.04 ,$551.00 ,$298.32 ,$298.32 ,$147.04 ,$298.32 ,$264.48 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31100299,88104,HC CYTOPATH FLD SMEAR,311,1 ,$18.00 ,$11.70 ,$4.73 ,$83.43 ,$83.43 ,$18.00 ,$10.08 ,$33.37 ,$5.04 ,$6.35 ,$33.37 ,$7.42 ,$18.00 ,$8.12 ,$8.12 ,$18.00 ,$11.70 ,$18.00 ,$9.00 ,$83.43 ,$33.37 ,$33.37 ,$18.00 ,$13.50 ,$10.80 ,$10.80 ,$33.37 ,$10.80 ,$18.00 ,$18.00 ,$18.00 ,$18.00 , N/A ,$15.30 ,$18.00 ,$11.70 ,$33.37 ,$18.00 ,$10.08 ,$33.37 ,$4.73 , N/A ,$18.00 ,$18.00 ,$35.04 ,$14.40 ,$75.08 ,$8.12 ,$5.04 ,$16.20 ,$33.37 ,$18.00 ,$18.00 ,$18.00 ,$18.00 ,$18.00 ,$8.64 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100304,88173,HC FINE NEEDLE INTERP,311,1 ,$36.00 ,$23.40 ,$9.47 ,$122.48 ,$122.48 ,$36.00 ,$20.16 ,$48.99 ,$10.08 ,$12.71 ,$48.99 ,$14.83 ,$36.00 ,$16.24 ,$16.24 ,$36.00 ,$23.40 ,$36.00 ,$18.00 ,$122.48 ,$48.99 ,$48.99 ,$36.00 ,$27.00 ,$21.60 ,$21.60 ,$48.99 ,$21.60 ,$36.00 ,$36.00 ,$36.00 ,$36.00 , N/A ,$30.60 ,$36.00 ,$23.40 ,$48.99 ,$36.00 ,$20.16 ,$48.99 ,$9.47 , N/A ,$33.95 ,$32.40 ,$51.44 ,$28.80 ,$110.23 ,$16.24 ,$10.08 ,$32.40 ,$48.99 ,$36.00 ,$36.00 ,$36.00 ,$36.00 ,$36.00 ,$17.28 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100312,88189,HC FLOW CYTO INT >16 MARKERS-90,311,1 ,$144.00 ,$93.60 ,$30.86 ,$144.00 , N/A ,$129.69 ,$80.64 , N/A ,$40.32 ,$50.83 , N/A ,$59.33 , N/A ,$64.94 ,$64.94 , N/A ,$93.60 , N/A ,$72.00 , N/A , N/A , N/A , N/A ,$108.00 ,$86.40 ,$86.40 , N/A ,$86.40 ,$113.02 ,$113.02 ,$113.02 ,$144.00 , N/A ,$122.40 , N/A ,$93.60 , N/A ,$144.00 ,$80.64 , N/A ,$37.87 , N/A ,$33.95 ,$32.40 , N/A ,$115.20 , N/A ,$64.94 ,$40.32 ,$129.60 , N/A ,$113.02 ,$144.00 ,$144.00 , N/A ,$144.00 ,$69.12 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31100314,88142,HC THINPREP PAP,311,1 ,$8.00 ,$5.20 ,$2.10 ,$22.37 ,$20.00 ,$8.00 ,$4.48 ,$8.00 ,$2.24 ,$2.82 ,$8.00 ,$3.30 ,$8.00 ,$3.61 ,$3.61 ,$8.00 ,$8.00 ,$8.00 ,$4.00 ,$20.00 ,$8.00 ,$8.00 ,$8.00 ,$6.00 ,$4.80 ,$4.80 ,$8.00 ,$4.80 ,$8.00 ,$8.00 ,$8.00 ,$8.00 , N/A ,$6.80 ,$8.00 ,$5.20 ,$8.00 ,$8.00 ,$4.48 ,$8.00 ,$2.10 , N/A ,$8.00 ,$8.00 ,$8.40 ,$6.40 ,$18.00 ,$3.61 ,$2.24 ,$7.20 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$3.84 ,$22.37 
ST. ELIZABETH'S HOSPITAL,31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$97.00 ,$63.05 ,$13.91 ,$97.00 ,$60.90 ,$37.14 ,$54.32 ,$24.36 ,$27.16 ,$34.24 ,$24.36 ,$39.96 ,$24.36 ,$43.75 ,$43.75 ,$24.36 ,$63.05 ,$46.27 ,$48.50 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$72.75 ,$58.20 ,$58.20 ,$24.36 ,$58.20 ,$13.91 ,$13.91 ,$13.91 ,$97.00 , N/A ,$82.45 ,$60.89 ,$63.05 ,$24.36 ,$97.00 ,$54.32 ,$24.36 ,$25.51 , N/A ,$33.95 ,$32.40 ,$25.58 ,$77.60 ,$54.80 ,$43.75 ,$27.16 ,$87.30 ,$24.36 ,$13.91 ,$49.34 ,$49.34 ,$24.36 ,$49.34 ,$46.56 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$226.00 ,$146.90 ,$24.36 ,$226.00 ,$60.90 ,$77.09 ,$126.56 ,$24.36 ,$63.28 ,$79.78 ,$24.36 ,$93.11 ,$24.36 ,$101.93 ,$101.93 ,$24.36 ,$146.90 ,$46.27 ,$113.00 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$169.50 ,$135.60 ,$135.60 ,$24.36 ,$135.60 ,$28.98 ,$28.98 ,$28.98 ,$226.00 , N/A ,$192.10 ,$60.89 ,$146.90 ,$24.36 ,$226.00 ,$126.56 ,$24.36 ,$59.44 , N/A ,$33.95 ,$32.40 ,$25.58 ,$180.80 ,$54.80 ,$101.93 ,$63.28 ,$203.40 ,$24.36 ,$28.98 ,$49.34 ,$49.34 ,$24.36 ,$49.34 ,$108.48 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$257.00 ,$167.05 ,$30.86 ,$257.00 ,$122.48 ,$84.84 ,$143.92 ,$48.99 ,$71.96 ,$90.72 ,$48.99 ,$105.88 ,$48.99 ,$115.91 ,$115.91 ,$48.99 ,$167.05 ,$93.08 ,$128.50 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$192.75 ,$154.20 ,$154.20 ,$48.99 ,$154.20 ,$35.01 ,$35.01 ,$35.01 ,$257.00 , N/A ,$218.45 ,$122.48 ,$167.05 ,$48.99 ,$257.00 ,$143.92 ,$48.99 ,$67.59 , N/A ,$33.95 ,$32.40 ,$51.44 ,$205.60 ,$110.23 ,$115.91 ,$71.96 ,$231.30 ,$48.99 ,$35.01 ,$99.52 ,$99.52 ,$48.99 ,$99.52 ,$123.36 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$455.00 ,$295.75 ,$30.86 ,$455.00 ,$122.48 ,$114.26 ,$254.80 ,$48.99 ,$127.40 ,$160.62 ,$48.99 ,$187.46 ,$48.99 ,$205.21 ,$205.21 ,$48.99 ,$295.75 ,$93.08 ,$227.50 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$341.25 ,$273.00 ,$273.00 ,$48.99 ,$273.00 ,$36.74 ,$36.74 ,$36.74 ,$455.00 , N/A ,$386.75 ,$122.48 ,$295.75 ,$48.99 ,$35.62 ,$254.80 ,$48.99 ,$119.67 , N/A ,$33.95 ,$32.40 ,$51.44 ,$364.00 ,$110.23 ,$205.21 ,$127.40 ,$409.50 ,$48.99 ,$36.74 ,$99.52 ,$99.52 ,$48.99 ,$99.52 ,$218.40 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200110,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,$776.00 ,$504.40 ,$33.94 ,$776.00 ,$717.83 ,$240.21 ,$434.56 ,$287.13 ,$217.28 ,$273.93 ,$287.13 ,$319.71 ,$287.13 ,$349.98 ,$349.98 ,$287.13 ,$504.40 ,$545.56 ,$388.00 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$582.00 ,$465.60 ,$465.60 ,$287.13 ,$465.60 ,$223.30 ,$223.30 ,$223.30 ,$776.00 , N/A ,$659.60 ,$717.84 ,$504.40 ,$287.13 ,$217.17 ,$434.56 ,$287.13 ,$204.09 , N/A ,$37.33 ,$35.64 ,$301.49 ,$620.80 ,$646.05 ,$349.98 ,$217.28 ,$698.40 ,$287.13 ,$223.30 ,$582.52 ,$582.52 ,$287.13 ,$582.52 ,$372.48 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200113,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,$854.00 ,$555.10 ,$33.94 ,"$1,615.20 ","$1,615.20 ",$334.44 ,$478.24 ,$646.08 ,$239.12 ,$301.46 ,$646.08 ,$351.85 ,$646.08 ,$385.15 ,$385.15 ,$646.08 ,$555.10 ,$854.00 ,$427.00 ,"$1,615.20 ",$646.08 ,$646.08 ,$659.00 ,$640.50 ,$512.40 ,$512.40 ,$646.08 ,$512.40 ,$313.42 ,$313.42 ,$313.42 ,$854.00 , N/A ,$725.90 ,$854.00 ,$555.10 ,$646.08 ,$854.00 ,$478.24 ,$646.08 ,$224.60 , N/A ,$37.33 ,$35.64 ,$678.38 ,$683.20 ,"$1,453.68 ",$385.15 ,$239.12 ,$768.60 ,$646.08 ,$313.42 ,$854.00 ,$854.00 ,$646.08 ,$854.00 ,$409.92 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200116,88311,HC DECALCIFICATION,312,1 ,$125.00 ,$81.25 ,$10.89 ,$125.00 , N/A ,$11.60 ,$70.00 , N/A ,$35.00 ,$44.13 , N/A ,$51.50 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$10.89 ,$10.89 ,$10.89 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A ,$33.95 ,$32.40 , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$10.89 ,$17.44 ,$17.44 , N/A ,$17.44 ,$60.00 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200123,88312,HC SPECIAL STAIN I,312,1 ,$265.00 ,$172.25 ,$30.86 ,$265.00 ,$122.48 ,$132.00 ,$148.40 ,$48.99 ,$74.20 ,$93.55 ,$48.99 ,$109.18 ,$48.99 ,$119.52 ,$119.52 ,$48.99 ,$172.25 ,$93.08 ,$132.50 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$198.75 ,$159.00 ,$159.00 ,$48.99 ,$159.00 ,$88.83 ,$88.83 ,$88.83 ,$265.00 , N/A ,$225.25 ,$122.48 ,$172.25 ,$48.99 ,$265.00 ,$148.40 ,$48.99 ,$69.70 , N/A ,$33.95 ,$32.40 ,$51.44 ,$212.00 ,$110.23 ,$119.52 ,$74.20 ,$238.50 ,$48.99 ,$88.83 ,$99.52 ,$99.52 ,$48.99 ,$99.52 ,$127.20 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200125,88313,HC SPECIAL STAIN II,312,1 ,$248.00 ,$161.20 ,$30.86 ,$248.00 ,$83.43 ,$108.71 ,$138.88 ,$33.37 ,$69.44 ,$87.54 ,$33.37 ,$102.18 ,$33.37 ,$111.85 ,$111.85 ,$33.37 ,$161.20 ,$63.41 ,$124.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$186.00 ,$148.80 ,$148.80 ,$33.37 ,$148.80 ,$73.33 ,$73.33 ,$73.33 ,$248.00 , N/A ,$210.80 ,$83.43 ,$161.20 ,$33.37 ,$248.00 ,$138.88 ,$33.37 ,$65.22 , N/A ,$33.95 ,$32.40 ,$35.04 ,$198.40 ,$75.08 ,$111.85 ,$69.44 ,$223.20 ,$33.37 ,$73.33 ,$67.68 ,$67.68 ,$33.37 ,$67.68 ,$119.04 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200159,88321,HC CONSULT REFERRED SLIDES,312,1 ,$451.00 ,$293.15 ,$30.86 ,$451.00 ,$83.43 ,$141.31 ,$252.56 ,$33.37 ,$126.28 ,$159.20 ,$33.37 ,$185.81 ,$33.37 ,$203.40 ,$203.40 ,$33.37 ,$293.15 ,$63.41 ,$225.50 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$338.25 ,$270.60 ,$270.60 ,$33.37 ,$270.60 ,$129.97 ,$129.97 ,$129.97 ,$451.00 , N/A ,$383.35 ,$83.43 ,$293.15 ,$33.37 ,$451.00 ,$252.56 ,$33.37 ,$118.61 , N/A ,$33.95 ,$32.40 ,$35.04 ,$360.80 ,$75.08 ,$203.40 ,$126.28 ,$405.90 ,$33.37 ,$129.97 ,$67.68 ,$67.68 ,$33.37 ,$67.68 ,$216.48 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200164,88323,HC CONSULT/SLIDE PREP,312,1 ,$598.00 ,$388.70 ,$30.86 ,$598.00 ,$122.48 ,$96.50 ,$334.88 ,$48.99 ,$167.44 ,$211.09 ,$48.99 ,$246.38 ,$48.99 ,$269.70 ,$269.70 ,$48.99 ,$388.70 ,$93.08 ,$299.00 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$448.50 ,$358.80 ,$358.80 ,$48.99 ,$358.80 ,$32.42 ,$32.42 ,$32.42 ,$598.00 , N/A ,$508.30 ,$122.48 ,$388.70 ,$48.99 ,$598.00 ,$334.88 ,$48.99 ,$157.27 , N/A ,$33.95 ,$32.40 ,$51.44 ,$478.40 ,$110.23 ,$269.70 ,$167.44 ,$538.20 ,$48.99 ,$32.42 ,$99.52 ,$99.52 ,$48.99 ,$99.52 ,$287.04 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$218.00 ,$141.70 ,$30.86 ,$367.60 ,$367.60 ,$52.68 ,$122.08 ,$147.04 ,$61.04 ,$76.95 ,$147.04 ,$89.82 ,$147.04 ,$98.32 ,$98.32 ,$147.04 ,$141.70 ,$218.00 ,$109.00 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$163.50 ,$130.80 ,$130.80 ,$147.04 ,$130.80 ,$40.18 ,$40.18 ,$40.18 ,$218.00 , N/A ,$185.30 ,$218.00 ,$141.70 ,$147.04 ,$44.37 ,$122.08 ,$147.04 ,$57.33 , N/A ,$33.95 ,$32.40 ,$154.39 ,$174.40 ,$330.83 ,$98.32 ,$61.04 ,$196.20 ,$147.04 ,$40.18 ,$218.00 ,$218.00 ,$147.04 ,$218.00 ,$104.64 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$110.00 ,$71.50 ,$18.83 ,$110.00 , N/A ,$18.83 ,$61.60 , N/A ,$30.80 ,$38.83 , N/A ,$45.32 , N/A ,$49.61 ,$49.61 , N/A ,$71.50 , N/A ,$55.00 , N/A , N/A , N/A , N/A ,$82.50 ,$66.00 ,$66.00 , N/A ,$66.00 ,$26.40 ,$26.40 ,$26.40 ,$110.00 , N/A ,$93.50 , N/A ,$71.50 , N/A ,$25.42 ,$61.60 , N/A ,$28.93 , N/A ,$33.95 ,$32.40 , N/A ,$88.00 , N/A ,$49.61 ,$30.80 ,$99.00 , N/A ,$26.40 ,$48.16 ,$48.16 , N/A ,$48.16 ,$52.80 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$564.00 ,$366.60 ,$33.94 ,$564.00 ,$367.60 ,$116.48 ,$315.84 ,$147.04 ,$157.92 ,$199.09 ,$147.04 ,$232.37 ,$147.04 ,$254.36 ,$254.36 ,$147.04 ,$366.60 ,$279.37 ,$282.00 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$423.00 ,$338.40 ,$338.40 ,$147.04 ,$338.40 ,$102.18 ,$102.18 ,$102.18 ,$564.00 , N/A ,$479.40 ,$367.59 ,$366.60 ,$147.04 ,$86.62 ,$315.84 ,$147.04 ,$148.33 , N/A ,$37.33 ,$35.64 ,$154.39 ,$451.20 ,$330.83 ,$254.36 ,$157.92 ,$507.60 ,$147.04 ,$102.18 ,$298.32 ,$298.32 ,$147.04 ,$298.32 ,$270.72 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200202,88361,HC MORPHO ANLYS COMP ASSIST,312,1 ,$618.00 ,$401.70 ,$33.94 ,$717.84 ,$717.83 ,$156.98 ,$346.08 ,$287.13 ,$173.04 ,$218.15 ,$287.13 ,$254.62 ,$287.13 ,$278.72 ,$278.72 ,$287.13 ,$401.70 ,$545.56 ,$309.00 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$463.50 ,$370.80 ,$370.80 ,$287.13 ,$370.80 ,$103.47 ,$103.47 ,$103.47 ,$618.00 , N/A ,$525.30 ,$618.00 ,$401.70 ,$287.13 ,$84.07 ,$346.08 ,$287.13 ,$162.53 , N/A ,$37.33 ,$35.64 ,$301.49 ,$494.40 ,$646.05 ,$278.72 ,$173.04 ,$556.20 ,$287.13 ,$103.47 ,$582.52 ,$582.52 ,$287.13 ,$582.52 ,$296.64 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200212,G0416,HC PROSTATE NEEDLE BX SAMPLING 1-20 SPEC,312,1 ,$839.00 ,$545.35 ,$33.94 ,$839.00 ,$717.83 ,$695.50 ,$469.84 ,$287.13 ,$234.92 ,$296.17 ,$287.13 ,$345.67 ,$287.13 ,$378.39 ,$378.39 ,$287.13 ,$545.35 ,$545.56 ,$419.50 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$629.25 ,$503.40 ,$503.40 ,$287.13 ,$503.40 ,$587.30 ,$587.30 ,$587.30 ,$839.00 , N/A ,$713.15 ,$717.84 ,$545.35 ,$287.13 ,$839.00 ,$469.84 ,$287.13 ,$220.66 , N/A ,$37.33 ,$35.64 ,$301.49 ,$671.20 ,$646.05 ,$378.39 ,$234.92 ,$755.10 ,$287.13 ,$587.30 ,$582.52 ,$582.52 ,$287.13 ,$582.52 ,$402.72 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$360.00 ,$234.00 ,$30.86 ,$367.60 ,$367.60 ,$103.16 ,$201.60 ,$147.04 ,$100.80 ,$127.08 ,$147.04 ,$148.32 ,$147.04 ,$162.36 ,$162.36 ,$147.04 ,$234.00 ,$279.37 ,$180.00 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$270.00 ,$216.00 ,$216.00 ,$147.04 ,$216.00 ,$85.38 ,$85.38 ,$85.38 ,$360.00 , N/A ,$306.00 ,$360.00 ,$234.00 ,$147.04 ,$74.24 ,$201.60 ,$147.04 ,$94.68 , N/A ,$33.95 ,$32.40 ,$154.39 ,$288.00 ,$330.83 ,$162.36 ,$100.80 ,$324.00 ,$147.04 ,$85.38 ,$298.32 ,$298.32 ,$147.04 ,$298.32 ,$172.80 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200240,88365,HC EPSTEIN BARR ISH,312,1 ,$252.00 ,$163.80 ,$30.86 ,$367.60 ,$367.60 ,$177.50 ,$141.12 ,$147.04 ,$70.56 ,$88.96 ,$147.04 ,$103.82 ,$147.04 ,$113.65 ,$113.65 ,$147.04 ,$163.80 ,$252.00 ,$126.00 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$189.00 ,$151.20 ,$151.20 ,$147.04 ,$151.20 ,$160.30 ,$160.30 ,$160.30 ,$252.00 , N/A ,$214.20 ,$252.00 ,$163.80 ,$147.04 ,$252.00 ,$141.12 ,$147.04 ,$66.28 , N/A ,$33.95 ,$32.40 ,$154.39 ,$201.60 ,$330.83 ,$113.65 ,$70.56 ,$226.80 ,$147.04 ,$160.30 ,$252.00 ,$252.00 ,$147.04 ,$252.00 ,$120.96 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200249,88344,HC IMMUNOHISTOCHEM EA AB STAIN,312,1 ,$288.00 ,$187.20 ,$30.86 ,$717.84 ,$717.83 ,$88.38 ,$161.28 ,$287.13 ,$80.64 ,$101.66 ,$287.13 ,$118.66 ,$287.13 ,$129.89 ,$129.89 ,$287.13 ,$187.20 ,$288.00 ,$144.00 ,$717.84 ,$287.13 ,$287.13 ,$288.00 ,$216.00 ,$172.80 ,$172.80 ,$287.13 ,$172.80 ,$160.30 ,$160.30 ,$160.30 ,$288.00 , N/A ,$244.80 ,$288.00 ,$187.20 ,$287.13 ,$288.00 ,$161.28 ,$287.13 ,$75.74 , N/A ,$33.95 ,$32.40 ,$301.49 ,$230.40 ,$646.05 ,$129.89 ,$80.64 ,$259.20 ,$287.13 ,$160.30 ,$288.00 ,$288.00 ,$287.13 ,$288.00 ,$138.24 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200255,88312,HC SPECIAL STAIN I-90,312,1 ,$462.00 ,$300.30 ,$30.86 ,$462.00 ,$122.48 ,$132.00 ,$258.72 ,$48.99 ,$129.36 ,$163.09 ,$48.99 ,$190.34 ,$48.99 ,$208.36 ,$208.36 ,$48.99 ,$300.30 ,$93.08 ,$231.00 ,$122.48 ,$48.99 ,$48.99 ,$49.97 ,$346.50 ,$277.20 ,$277.20 ,$48.99 ,$277.20 ,$88.83 ,$88.83 ,$88.83 ,$462.00 , N/A ,$392.70 ,$122.48 ,$300.30 ,$48.99 ,$462.00 ,$258.72 ,$48.99 ,$121.51 , N/A ,$33.95 ,$32.40 ,$51.44 ,$369.60 ,$110.23 ,$208.36 ,$129.36 ,$415.80 ,$48.99 ,$88.83 ,$99.52 ,$99.52 ,$48.99 ,$99.52 ,$221.76 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200256,88313,HC SPECIAL STAIN II-90,312,1 ,$248.00 ,$161.20 ,$30.86 ,$248.00 ,$83.43 ,$108.71 ,$138.88 ,$33.37 ,$69.44 ,$87.54 ,$33.37 ,$102.18 ,$33.37 ,$111.85 ,$111.85 ,$33.37 ,$161.20 ,$63.41 ,$124.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$186.00 ,$148.80 ,$148.80 ,$33.37 ,$148.80 ,$73.33 ,$73.33 ,$73.33 ,$248.00 , N/A ,$210.80 ,$83.43 ,$161.20 ,$33.37 ,$248.00 ,$138.88 ,$33.37 ,$65.22 , N/A ,$33.95 ,$32.40 ,$35.04 ,$198.40 ,$75.08 ,$111.85 ,$69.44 ,$223.20 ,$33.37 ,$73.33 ,$67.68 ,$67.68 ,$33.37 ,$67.68 ,$119.04 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200265,88341,HC IMMUNOHISOCHEM EA AD SGL STN-90,312,1 ,$288.00 ,$187.20 ,$30.86 ,$288.00 , N/A ,$52.78 ,$161.28 , N/A ,$80.64 ,$101.66 , N/A ,$118.66 , N/A ,$129.89 ,$129.89 , N/A ,$187.20 , N/A ,$144.00 , N/A , N/A , N/A , N/A ,$216.00 ,$172.80 ,$172.80 , N/A ,$172.80 ,$77.06 ,$77.06 ,$77.06 ,$288.00 , N/A ,$244.80 , N/A ,$187.20 , N/A ,$68.12 ,$161.28 , N/A ,$75.74 , N/A ,$33.95 ,$32.40 , N/A ,$230.40 , N/A ,$129.89 ,$80.64 ,$259.20 , N/A ,$77.06 ,$130.50 ,$130.50 , N/A ,$130.50 ,$138.24 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200266,88341,HC IMMUNOHISOCHEMIS EA AD SGL STN,312,1 ,$288.00 ,$187.20 ,$30.86 ,$288.00 , N/A ,$52.78 ,$161.28 , N/A ,$80.64 ,$101.66 , N/A ,$118.66 , N/A ,$129.89 ,$129.89 , N/A ,$187.20 , N/A ,$144.00 , N/A , N/A , N/A , N/A ,$216.00 ,$172.80 ,$172.80 , N/A ,$172.80 ,$77.06 ,$77.06 ,$77.06 ,$288.00 , N/A ,$244.80 , N/A ,$187.20 , N/A ,$68.12 ,$161.28 , N/A ,$75.74 , N/A ,$33.95 ,$32.40 , N/A ,$230.40 , N/A ,$129.89 ,$80.64 ,$259.20 , N/A ,$77.06 ,$130.50 ,$130.50 , N/A ,$130.50 ,$138.24 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200269,88342,HC IMMUNOHISOCHEMISTR EA AB INIT-90,312,1 ,$360.00 ,$234.00 ,$30.86 ,$367.60 ,$367.60 ,$103.16 ,$201.60 ,$147.04 ,$100.80 ,$127.08 ,$147.04 ,$148.32 ,$147.04 ,$162.36 ,$162.36 ,$147.04 ,$234.00 ,$279.37 ,$180.00 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$270.00 ,$216.00 ,$216.00 ,$147.04 ,$216.00 ,$85.38 ,$85.38 ,$85.38 ,$360.00 , N/A ,$306.00 ,$360.00 ,$234.00 ,$147.04 ,$74.24 ,$201.60 ,$147.04 ,$94.68 , N/A ,$33.95 ,$32.40 ,$154.39 ,$288.00 ,$330.83 ,$162.36 ,$100.80 ,$324.00 ,$147.04 ,$85.38 ,$298.32 ,$298.32 ,$147.04 ,$298.32 ,$172.80 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200271,88344,HC IMMUNOHISOCHEMISTR EA ADDL-90,312,1 ,$288.00 ,$187.20 ,$30.86 ,$717.84 ,$717.83 ,$88.38 ,$161.28 ,$287.13 ,$80.64 ,$101.66 ,$287.13 ,$118.66 ,$287.13 ,$129.89 ,$129.89 ,$287.13 ,$187.20 ,$288.00 ,$144.00 ,$717.84 ,$287.13 ,$287.13 ,$288.00 ,$216.00 ,$172.80 ,$172.80 ,$287.13 ,$172.80 ,$160.30 ,$160.30 ,$160.30 ,$288.00 , N/A ,$244.80 ,$288.00 ,$187.20 ,$287.13 ,$288.00 ,$161.28 ,$287.13 ,$75.74 , N/A ,$33.95 ,$32.40 ,$301.49 ,$230.40 ,$646.05 ,$129.89 ,$80.64 ,$259.20 ,$287.13 ,$160.30 ,$288.00 ,$288.00 ,$287.13 ,$288.00 ,$138.24 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200272,88346,HC IF DIRECT-90,312,1 ,"$1,284.00 ",$834.60 ,$30.86 ,"$1,284.00 ",$717.83 ,$99.82 ,$719.04 ,$287.13 ,$359.52 ,$453.25 ,$287.13 ,$529.01 ,$287.13 ,$579.08 ,$579.08 ,$287.13 ,$834.60 ,$545.56 ,$642.00 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$963.00 ,$770.40 ,$770.40 ,$287.13 ,$770.40 ,$88.83 ,$88.83 ,$88.83 ,"$1,284.00 ", N/A ,"$1,091.40 ",$717.84 ,$834.60 ,$287.13 ,"$1,284.00 ",$719.04 ,$287.13 ,$337.69 , N/A ,$33.95 ,$32.40 ,$301.49 ,"$1,027.20 ",$646.05 ,$579.08 ,$359.52 ,"$1,155.60 ",$287.13 ,$88.83 ,$582.52 ,$582.52 ,$287.13 ,$582.52 ,$616.32 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200276,88361,HC MORPHO ANLYS COMP ASSIST-90,312,1 ,$618.00 ,$401.70 ,$33.94 ,$717.84 ,$717.83 ,$156.98 ,$346.08 ,$287.13 ,$173.04 ,$218.15 ,$287.13 ,$254.62 ,$287.13 ,$278.72 ,$278.72 ,$287.13 ,$401.70 ,$545.56 ,$309.00 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$463.50 ,$370.80 ,$370.80 ,$287.13 ,$370.80 ,$103.47 ,$103.47 ,$103.47 ,$618.00 , N/A ,$525.30 ,$618.00 ,$401.70 ,$287.13 ,$84.07 ,$346.08 ,$287.13 ,$162.53 , N/A ,$37.33 ,$35.64 ,$301.49 ,$494.40 ,$646.05 ,$278.72 ,$173.04 ,$556.20 ,$287.13 ,$103.47 ,$582.52 ,$582.52 ,$287.13 ,$582.52 ,$296.64 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200278,88364,HC IN SITU HYBRID(FISH) EA ADL-90,312,1 ,$703.00 ,$456.95 ,$30.86 ,$703.00 , N/A ,$80.61 ,$393.68 , N/A ,$196.84 ,$248.16 , N/A ,$289.64 , N/A ,$317.05 ,$317.05 , N/A ,$456.95 , N/A ,$351.50 , N/A , N/A , N/A , N/A ,$527.25 ,$421.80 ,$421.80 , N/A ,$421.80 ,$117.68 ,$117.68 ,$117.68 ,$703.00 , N/A ,$597.55 , N/A ,$456.95 , N/A ,$703.00 ,$393.68 , N/A ,$184.89 , N/A ,$33.95 ,$32.40 , N/A ,$562.40 , N/A ,$317.05 ,$196.84 ,$632.70 , N/A ,$117.68 ,$219.12 ,$219.12 , N/A ,$219.12 ,$337.44 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200281,88368,HC MORPHO ANLYS IN SITU HYBRID-90,312,1 ,$445.00 ,$289.25 ,$33.94 ,$717.84 ,$717.83 ,$257.95 ,$249.20 ,$287.13 ,$124.60 ,$157.09 ,$287.13 ,$183.34 ,$287.13 ,$200.70 ,$200.70 ,$287.13 ,$289.25 ,$445.00 ,$222.50 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$333.75 ,$267.00 ,$267.00 ,$287.13 ,$267.00 ,$102.61 ,$102.61 ,$102.61 ,$445.00 , N/A ,$378.25 ,$445.00 ,$289.25 ,$287.13 ,$445.00 ,$249.20 ,$287.13 ,$117.04 , N/A ,$37.33 ,$35.64 ,$301.49 ,$356.00 ,$646.05 ,$200.70 ,$124.60 ,$400.50 ,$287.13 ,$102.61 ,$445.00 ,$445.00 ,$287.13 ,$445.00 ,$213.60 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200282,88373,HC MORPH ANLY AUTO EA ADDL-90,312,1 ,$84.00 ,$54.60 ,$22.09 ,$84.00 , N/A ,$45.41 ,$47.04 , N/A ,$23.52 ,$29.65 , N/A ,$34.61 , N/A ,$37.88 ,$37.88 , N/A ,$54.60 , N/A ,$42.00 , N/A , N/A , N/A , N/A ,$63.00 ,$50.40 ,$50.40 , N/A ,$50.40 ,$57.27 ,$57.27 ,$57.27 ,$84.00 , N/A ,$71.40 , N/A ,$54.60 , N/A ,$84.00 ,$47.04 , N/A ,$22.09 , N/A ,$37.33 ,$35.64 , N/A ,$67.20 , N/A ,$37.88 ,$23.52 ,$75.60 , N/A ,$57.27 ,$84.00 ,$84.00 , N/A ,$84.00 ,$40.32 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200283,88374,HC MORPH ANLY AUTO EA MULTIPLX-90,312,1 ,$84.00 ,$54.60 ,$22.09 ,$367.60 ,$367.60 ,$84.00 ,$47.04 ,$147.04 ,$23.52 ,$29.65 ,$147.04 ,$34.61 ,$84.00 ,$37.88 ,$37.88 ,$84.00 ,$54.60 ,$84.00 ,$42.00 ,$367.59 ,$147.04 ,$147.04 ,$84.00 ,$63.00 ,$50.40 ,$50.40 ,$147.04 ,$50.40 ,$84.00 ,$84.00 ,$84.00 ,$84.00 , N/A ,$71.40 ,$84.00 ,$54.60 ,$147.04 ,$84.00 ,$47.04 ,$147.04 ,$22.09 , N/A ,$37.33 ,$35.64 ,$154.39 ,$67.20 ,$330.83 ,$37.88 ,$23.52 ,$75.60 ,$147.04 ,$84.00 ,$84.00 ,$84.00 ,$84.00 ,$84.00 ,$40.32 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200284,88377,HC MORPH ANLZ INST HYB EA MTPL-90,312,1 ,$773.00 ,$502.45 ,$33.94 ,$773.00 ,$367.60 ,$170.19 ,$432.88 ,$147.04 ,$216.44 ,$272.87 ,$147.04 ,$318.48 ,$147.04 ,$348.62 ,$348.62 ,$147.04 ,$502.45 ,$279.37 ,$386.50 ,$367.59 ,$147.04 ,$147.04 ,$149.98 ,$579.75 ,$463.80 ,$463.80 ,$147.04 ,$463.80 ,$390.79 ,$390.79 ,$390.79 ,$773.00 , N/A ,$657.05 ,$367.59 ,$502.45 ,$147.04 ,$773.00 ,$432.88 ,$147.04 ,$203.30 , N/A ,$37.33 ,$35.64 ,$154.39 ,$618.40 ,$330.83 ,$348.62 ,$216.44 ,$695.70 ,$147.04 ,$390.79 ,$298.32 ,$298.32 ,$147.04 ,$298.32 ,$371.04 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200285,88380,HC MICRODISSECTION LASER CAPTR-90,312,1 ,"$1,482.00 ",$963.30 ,$33.94 ,"$1,482.00 ", N/A ,$681.72 ,$829.92 , N/A ,$414.96 ,$523.15 , N/A ,$610.58 , N/A ,$668.38 ,$668.38 , N/A ,$963.30 , N/A ,$741.00 , N/A , N/A , N/A , N/A ,"$1,111.50 ",$889.20 ,$889.20 , N/A ,$889.20 ,$94.56 ,$94.56 ,$94.56 ,"$1,482.00 ", N/A ,"$1,259.70 ", N/A ,$963.30 , N/A ,"$1,482.00 ",$829.92 , N/A ,$389.77 , N/A ,$37.33 ,$35.64 , N/A ,"$1,185.60 ", N/A ,$668.38 ,$414.96 ,"$1,333.80 ", N/A ,$94.56 ,$157.72 ,$157.72 , N/A ,$157.72 ,$711.36 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200290,P9100,HC PATHOGEN TEST FOR PLATELETS,312,1 ,$96.36 ,$62.63 ,$25.34 ,$636.31 ,$137.20 ,$44.33 ,$53.96 ,$54.88 ,$26.98 ,$32.69 ,$54.88 ,$32.69 ,$54.88 ,$43.46 ,$43.46 ,$54.88 ,$62.63 ,$96.36 ,$48.18 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$72.27 ,$57.82 ,$57.82 ,$54.88 ,$57.82 ,$67.45 ,$67.45 ,$67.45 ,$96.36 , N/A ,$81.91 ,$96.36 ,$62.63 ,$54.88 ,$96.36 ,$53.96 ,$54.88 ,$25.34 , N/A ,$96.36 ,$96.36 ,$57.62 ,$77.09 ,$123.48 ,$43.46 ,$26.98 ,$86.72 ,$54.88 ,$67.45 ,$67.68 ,$67.68 ,$54.88 ,$67.68 ,$46.25 ,$636.31 
ST. ELIZABETH'S HOSPITAL,31200295,88323,HC CONSULT/SLIDE PREP,312,1 ,$6.00 ,$3.90 ,$1.58 ,$122.48 ,$122.48 ,$6.00 ,$3.36 ,$48.99 ,$1.68 ,$2.12 ,$48.99 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$3.90 ,$6.00 ,$3.00 ,$122.48 ,$48.99 ,$48.99 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$48.99 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$48.99 ,$6.00 ,$3.36 ,$48.99 ,$1.58 , N/A ,$6.00 ,$6.00 ,$51.44 ,$4.80 ,$110.23 ,$2.71 ,$1.68 ,$5.40 ,$48.99 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200296,88311,HC DECALCIFICATION,312,1 ,$6.00 ,$3.90 ,$1.58 ,$30.86 , N/A ,$6.00 ,$3.36 , N/A ,$1.68 ,$2.12 , N/A ,$2.47 , N/A ,$2.71 ,$2.71 , N/A ,$3.90 , N/A ,$3.00 , N/A , N/A , N/A , N/A ,$4.50 ,$3.60 ,$3.60 , N/A ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 , N/A ,$3.90 , N/A ,$6.00 ,$3.36 , N/A ,$1.58 , N/A ,$6.00 ,$6.00 , N/A ,$4.80 , N/A ,$2.71 ,$1.68 ,$5.40 , N/A ,$6.00 ,$6.00 ,$6.00 , N/A ,$6.00 ,$2.88 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200297,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$15.00 ,$9.75 ,$3.95 ,$60.90 ,$60.90 ,$15.00 ,$8.40 ,$24.36 ,$4.20 ,$5.30 ,$24.36 ,$6.18 ,$15.00 ,$6.77 ,$6.77 ,$15.00 ,$9.75 ,$15.00 ,$7.50 ,$60.89 ,$24.36 ,$24.36 ,$15.00 ,$11.25 ,$9.00 ,$9.00 ,$24.36 ,$9.00 ,$15.00 ,$15.00 ,$15.00 ,$15.00 , N/A ,$12.75 ,$15.00 ,$9.75 ,$24.36 ,$15.00 ,$8.40 ,$24.36 ,$3.95 , N/A ,$15.00 ,$15.00 ,$25.58 ,$12.00 ,$54.80 ,$6.77 ,$4.20 ,$13.50 ,$24.36 ,$15.00 ,$15.00 ,$15.00 ,$15.00 ,$15.00 ,$7.20 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200298,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$15.00 ,$9.75 ,$3.95 ,$122.48 ,$122.48 ,$15.00 ,$8.40 ,$48.99 ,$4.20 ,$5.30 ,$48.99 ,$6.18 ,$15.00 ,$6.77 ,$6.77 ,$15.00 ,$9.75 ,$15.00 ,$7.50 ,$122.48 ,$48.99 ,$48.99 ,$15.00 ,$11.25 ,$9.00 ,$9.00 ,$48.99 ,$9.00 ,$15.00 ,$15.00 ,$15.00 ,$15.00 , N/A ,$12.75 ,$15.00 ,$9.75 ,$48.99 ,$15.00 ,$8.40 ,$48.99 ,$3.95 , N/A ,$15.00 ,$15.00 ,$51.44 ,$12.00 ,$110.23 ,$6.77 ,$4.20 ,$13.50 ,$48.99 ,$15.00 ,$15.00 ,$15.00 ,$15.00 ,$15.00 ,$7.20 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200299,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$36.00 ,$23.40 ,$9.47 ,$122.48 ,$122.48 ,$36.00 ,$20.16 ,$48.99 ,$10.08 ,$12.71 ,$48.99 ,$14.83 ,$36.00 ,$16.24 ,$16.24 ,$36.00 ,$23.40 ,$36.00 ,$18.00 ,$122.48 ,$48.99 ,$48.99 ,$36.00 ,$27.00 ,$21.60 ,$21.60 ,$48.99 ,$21.60 ,$36.00 ,$36.00 ,$36.00 ,$36.00 , N/A ,$30.60 ,$36.00 ,$23.40 ,$48.99 ,$35.62 ,$20.16 ,$48.99 ,$9.47 , N/A ,$33.95 ,$32.40 ,$51.44 ,$28.80 ,$110.23 ,$16.24 ,$10.08 ,$32.40 ,$48.99 ,$36.00 ,$36.00 ,$36.00 ,$36.00 ,$36.00 ,$17.28 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200300,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,$48.00 ,$31.20 ,$12.62 ,$717.84 ,$717.83 ,$48.00 ,$26.88 ,$287.13 ,$13.44 ,$16.94 ,$287.13 ,$19.78 ,$48.00 ,$21.65 ,$21.65 ,$48.00 ,$31.20 ,$48.00 ,$24.00 ,$717.84 ,$287.13 ,$287.13 ,$48.00 ,$36.00 ,$28.80 ,$28.80 ,$287.13 ,$28.80 ,$48.00 ,$48.00 ,$48.00 ,$48.00 , N/A ,$40.80 ,$48.00 ,$31.20 ,$287.13 ,$48.00 ,$26.88 ,$287.13 ,$12.62 , N/A ,$37.33 ,$35.64 ,$301.49 ,$38.40 ,$646.05 ,$21.65 ,$13.44 ,$43.20 ,$287.13 ,$48.00 ,$48.00 ,$48.00 ,$48.00 ,$48.00 ,$23.04 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200301,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,$40.00 ,$26.00 ,$10.52 ,"$1,615.20 ","$1,615.20 ",$40.00 ,$22.40 ,$646.08 ,$11.20 ,$14.12 ,$646.08 ,$16.48 ,$40.00 ,$18.04 ,$18.04 ,$40.00 ,$26.00 ,$40.00 ,$20.00 ,"$1,615.20 ",$646.08 ,$646.08 ,$40.00 ,$30.00 ,$24.00 ,$24.00 ,$646.08 ,$24.00 ,$40.00 ,$40.00 ,$40.00 ,$40.00 , N/A ,$34.00 ,$40.00 ,$26.00 ,$646.08 ,$40.00 ,$22.40 ,$646.08 ,$10.52 , N/A ,$37.33 ,$35.64 ,$678.38 ,$32.00 ,"$1,453.68 ",$18.04 ,$11.20 ,$36.00 ,$646.08 ,$40.00 ,$40.00 ,$40.00 ,$40.00 ,$40.00 ,$19.20 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200302,88300,HC GROSS ONLY LEVEL I,312,1 ,$6.00 ,$3.90 ,$1.58 ,$60.90 ,$60.90 ,$6.00 ,$3.36 ,$24.36 ,$1.68 ,$2.12 ,$24.36 ,$2.47 ,$6.00 ,$2.71 ,$2.71 ,$6.00 ,$3.90 ,$6.00 ,$3.00 ,$60.89 ,$24.36 ,$24.36 ,$6.00 ,$4.50 ,$3.60 ,$3.60 ,$24.36 ,$3.60 ,$6.00 ,$6.00 ,$6.00 ,$6.00 , N/A ,$5.10 ,$6.00 ,$3.90 ,$24.36 ,$6.00 ,$3.36 ,$24.36 ,$1.58 , N/A ,$6.00 ,$6.00 ,$25.58 ,$4.80 ,$54.80 ,$2.71 ,$1.68 ,$5.40 ,$24.36 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$6.00 ,$2.88 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200303,88312,HC SPECIAL STAIN I,312,1 ,$12.00 ,$7.80 ,$3.16 ,$122.48 ,$122.48 ,$12.00 ,$6.72 ,$48.99 ,$3.36 ,$4.24 ,$48.99 ,$4.94 ,$12.00 ,$5.41 ,$5.41 ,$12.00 ,$7.80 ,$12.00 ,$6.00 ,$122.48 ,$48.99 ,$48.99 ,$12.00 ,$9.00 ,$7.20 ,$7.20 ,$48.99 ,$7.20 ,$12.00 ,$12.00 ,$12.00 ,$12.00 , N/A ,$10.20 ,$12.00 ,$7.80 ,$48.99 ,$12.00 ,$6.72 ,$48.99 ,$3.16 , N/A ,$12.00 ,$12.00 ,$51.44 ,$9.60 ,$110.23 ,$5.41 ,$3.36 ,$10.80 ,$48.99 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$5.76 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200304,88313,HC SPECIAL STAIN II,312,1 ,$8.00 ,$5.20 ,$2.10 ,$83.43 ,$83.43 ,$8.00 ,$4.48 ,$33.37 ,$2.24 ,$2.82 ,$33.37 ,$3.30 ,$8.00 ,$3.61 ,$3.61 ,$8.00 ,$5.20 ,$8.00 ,$4.00 ,$83.43 ,$33.37 ,$33.37 ,$8.00 ,$6.00 ,$4.80 ,$4.80 ,$33.37 ,$4.80 ,$8.00 ,$8.00 ,$8.00 ,$8.00 , N/A ,$6.80 ,$8.00 ,$5.20 ,$33.37 ,$8.00 ,$4.48 ,$33.37 ,$2.10 , N/A ,$8.00 ,$8.00 ,$35.04 ,$6.40 ,$75.08 ,$3.61 ,$2.24 ,$7.20 ,$33.37 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$8.00 ,$3.84 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200305,88342,HC IMMUNOHISOCHEMIST EA AB REPEAT,312,1 ,$90.00 ,$58.50 ,$23.67 ,$367.60 ,$367.60 ,$90.00 ,$50.40 ,$147.04 ,$25.20 ,$31.77 ,$147.04 ,$37.08 ,$90.00 ,$40.59 ,$40.59 ,$90.00 ,$58.50 ,$90.00 ,$45.00 ,$367.59 ,$147.04 ,$147.04 ,$90.00 ,$67.50 ,$54.00 ,$54.00 ,$147.04 ,$54.00 ,$85.38 ,$85.38 ,$85.38 ,$90.00 , N/A ,$76.50 ,$90.00 ,$58.50 ,$147.04 ,$74.24 ,$50.40 ,$147.04 ,$23.67 , N/A ,$33.95 ,$32.40 ,$154.39 ,$72.00 ,$330.83 ,$40.59 ,$25.20 ,$81.00 ,$147.04 ,$85.38 ,$90.00 ,$90.00 ,$90.00 ,$90.00 ,$43.20 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200307,88341,HC IMMUNOHISOCHEMIS EA AD SGL STN,312,1 ,$42.00 ,$27.30 ,$11.05 ,$42.00 , N/A ,$42.00 ,$23.52 , N/A ,$11.76 ,$14.83 , N/A ,$17.30 , N/A ,$18.94 ,$18.94 , N/A ,$27.30 , N/A ,$21.00 , N/A , N/A , N/A , N/A ,$31.50 ,$25.20 ,$25.20 , N/A ,$25.20 ,$42.00 ,$42.00 ,$42.00 ,$42.00 , N/A ,$35.70 , N/A ,$27.30 , N/A ,$42.00 ,$23.52 , N/A ,$11.05 , N/A ,$33.95 ,$32.40 , N/A ,$33.60 , N/A ,$18.94 ,$11.76 ,$37.80 , N/A ,$42.00 ,$42.00 ,$42.00 , N/A ,$42.00 ,$20.16 ,$30.86 
ST. ELIZABETH'S HOSPITAL,31200308,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$15.00 ,$9.75 ,$3.95 ,$122.48 ,$122.48 ,$15.00 ,$8.40 ,$48.99 ,$4.20 ,$5.30 ,$48.99 ,$6.18 ,$15.00 ,$6.77 ,$6.77 ,$15.00 ,$9.75 ,$15.00 ,$7.50 ,$122.48 ,$48.99 ,$48.99 ,$15.00 ,$11.25 ,$9.00 ,$9.00 ,$48.99 ,$9.00 ,$15.00 ,$15.00 ,$15.00 ,$15.00 , N/A ,$12.75 ,$15.00 ,$9.75 ,$48.99 ,$15.00 ,$8.40 ,$48.99 ,$3.95 , N/A ,$15.00 ,$15.00 ,$51.44 ,$12.00 ,$110.23 ,$6.77 ,$4.20 ,$13.50 ,$48.99 ,$15.00 ,$15.00 ,$15.00 ,$15.00 ,$15.00 ,$7.20 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200315,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$72.00 ,$46.80 ,$18.94 ,$367.60 ,$367.60 ,$72.00 ,$40.32 ,$147.04 ,$20.16 ,$25.42 ,$147.04 ,$29.66 ,$72.00 ,$32.47 ,$32.47 ,$72.00 ,$46.80 ,$72.00 ,$36.00 ,$367.59 ,$147.04 ,$147.04 ,$72.00 ,$54.00 ,$43.20 ,$43.20 ,$147.04 ,$43.20 ,$72.00 ,$72.00 ,$72.00 ,$72.00 , N/A ,$61.20 ,$72.00 ,$46.80 ,$147.04 ,$72.00 ,$40.32 ,$147.04 ,$18.94 , N/A ,$37.33 ,$35.64 ,$154.39 ,$57.60 ,$330.83 ,$32.47 ,$20.16 ,$64.80 ,$147.04 ,$72.00 ,$72.00 ,$72.00 ,$72.00 ,$72.00 ,$34.56 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200319,88361,HC MORPHO ANLYS COMP ASSIST,312,1 ,$90.00 ,$58.50 ,$23.67 ,$717.84 ,$717.83 ,$90.00 ,$50.40 ,$287.13 ,$25.20 ,$31.77 ,$287.13 ,$37.08 ,$90.00 ,$40.59 ,$40.59 ,$90.00 ,$58.50 ,$90.00 ,$45.00 ,$717.84 ,$287.13 ,$287.13 ,$90.00 ,$67.50 ,$54.00 ,$54.00 ,$287.13 ,$54.00 ,$90.00 ,$90.00 ,$90.00 ,$90.00 , N/A ,$76.50 ,$90.00 ,$58.50 ,$287.13 ,$84.07 ,$50.40 ,$287.13 ,$23.67 , N/A ,$37.33 ,$35.64 ,$301.49 ,$72.00 ,$646.05 ,$40.59 ,$25.20 ,$81.00 ,$287.13 ,$90.00 ,$90.00 ,$90.00 ,$90.00 ,$90.00 ,$43.20 ,$33.94 
ST. ELIZABETH'S HOSPITAL,31200320,G0416,HC PROSTATE NEEDLE BX SAMPLING 1-20 SPEC,312,1 ,$839.00 ,$545.35 ,$33.94 ,$839.00 ,$717.83 ,$695.50 ,$469.84 ,$287.13 ,$234.92 ,$296.17 ,$287.13 ,$345.67 ,$287.13 ,$378.39 ,$378.39 ,$287.13 ,$545.35 ,$545.56 ,$419.50 ,$717.84 ,$287.13 ,$287.13 ,$292.88 ,$629.25 ,$503.40 ,$503.40 ,$287.13 ,$503.40 ,$587.30 ,$587.30 ,$587.30 ,$839.00 , N/A ,$713.15 ,$717.84 ,$545.35 ,$287.13 ,$839.00 ,$469.84 ,$287.13 ,$220.66 , N/A ,$37.33 ,$35.64 ,$301.49 ,$671.20 ,$646.05 ,$378.39 ,$234.92 ,$755.10 ,$287.13 ,$587.30 ,$582.52 ,$582.52 ,$287.13 ,$582.52 ,$402.72 ,$33.94 
ST. ELIZABETH'S HOSPITAL,32000003,22510,HC VERTEBROPLASTY INJ PERC THOR,320,1 ,"$8,410.00 ","$5,466.50 ",$365.00 ,"$8,410.00 ","$6,979.95 ","$3,868.60 ","$4,709.60 ","$2,791.98 ","$2,354.80 ","$2,968.73 ","$2,791.98 ","$3,464.92 ","$2,791.98 ","$3,792.91 ","$3,792.91 ","$2,791.98 ",$566.40 ,"$5,304.75 ","$4,205.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$6,307.50 ","$5,046.00 ","$5,046.00 ","$2,791.98 ","$5,046.00 ","$5,887.00 ","$5,887.00 ","$5,887.00 ","$8,410.00 ", N/A ,"$7,148.50 ","$6,979.94 ","$5,466.50 ","$2,791.98 ","$8,410.00 ","$4,709.60 ","$2,791.98 ","$2,211.83 ", N/A ,"$5,170.04 ","$4,935.04 ","$2,931.58 ","$6,728.00 ","$6,281.95 ","$3,792.91 ","$2,354.80 ","$7,569.00 ","$2,791.98 ","$5,887.00 ",$365.00 ,$365.00 ,"$2,791.98 ",$365.00 ,"$4,036.80 ","$4,700.04 "
ST. ELIZABETH'S HOSPITAL,32000004,22511,HC VERTEBROPLASTY INJ PERC LUMBAR,320,1 ,"$8,890.00 ","$5,778.50 ",$365.00 ,"$8,890.00 ","$6,979.95 ","$4,089.40 ","$4,978.40 ","$2,791.98 ","$2,489.20 ","$3,004.82 ","$2,791.98 ","$3,458.21 ","$2,791.98 ","$4,009.39 ","$4,009.39 ","$2,791.98 ",$533.98 ,"$5,304.75 ","$4,445.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$6,667.50 ","$5,334.00 ","$5,334.00 ","$2,791.98 ","$5,334.00 ","$6,223.00 ","$6,223.00 ","$6,223.00 ","$8,890.00 ", N/A ,"$7,556.50 ","$6,979.94 ","$5,778.50 ","$2,791.98 ","$8,890.00 ","$4,978.40 ","$2,791.98 ","$2,338.07 ", N/A ,"$5,170.04 ","$4,935.04 ","$2,931.58 ","$7,112.00 ","$6,281.95 ","$4,009.39 ","$2,489.20 ","$8,001.00 ","$2,791.98 ","$6,223.00 ",$365.00 ,$365.00 ,"$2,791.98 ",$365.00 ,"$4,267.20 ","$4,700.04 "
ST. ELIZABETH'S HOSPITAL,32000005,22512,HC VERTEBROPLASTY INJ PERC ADDL,320,1 ,"$5,838.00 ","$3,794.70 ",$276.88 ,"$5,838.00 ", N/A ,"$2,685.48 ","$3,269.28 ", N/A ,"$1,634.64 ","$2,060.81 ", N/A ,"$2,405.26 ", N/A ,"$2,632.94 ","$2,632.94 ", N/A ,$276.88 , N/A ,"$2,919.00 ", N/A , N/A , N/A , N/A ,"$4,378.50 ","$3,502.80 ","$3,502.80 ", N/A ,"$3,502.80 ","$4,086.60 ","$4,086.60 ","$4,086.60 ","$5,838.00 ", N/A ,"$4,962.30 ", N/A ,"$3,794.70 ", N/A ,"$5,838.00 ","$3,269.28 ", N/A ,"$1,535.39 ", N/A ,"$5,170.04 ","$4,935.04 ", N/A ,"$4,670.40 ", N/A ,"$2,632.94 ","$1,634.64 ","$5,254.20 ", N/A ,"$4,086.60 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$2,802.24 ","$4,700.04 "
ST. ELIZABETH'S HOSPITAL,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$330.00 ,$214.50 ,$64.80 ,$330.00 , N/A ,$151.80 ,$184.80 , N/A ,$92.40 ,$111.54 , N/A ,$128.37 , N/A ,$148.83 ,$148.83 , N/A ,$64.80 , N/A ,$165.00 , N/A , N/A , N/A , N/A ,$247.50 ,$198.00 ,$198.00 , N/A ,$198.00 ,$231.00 ,$231.00 ,$231.00 ,$330.00 , N/A ,$280.50 , N/A ,$214.50 , N/A ,$330.00 ,$184.80 , N/A ,$86.79 , N/A , N/A , N/A , N/A ,$264.00 , N/A ,$148.83 ,$92.40 ,$297.00 , N/A ,$231.00 ,$330.00 ,$330.00 , N/A ,$330.00 ,$158.40 , N/A 
ST. ELIZABETH'S HOSPITAL,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$233.00 ,$151.45 ,$61.28 ,$233.00 , N/A ,$107.18 ,$130.48 , N/A ,$65.24 ,$78.75 , N/A ,$90.64 , N/A ,$105.08 ,$105.08 , N/A ,$64.80 , N/A ,$116.50 , N/A , N/A , N/A , N/A ,$174.75 ,$139.80 ,$139.80 , N/A ,$139.80 ,$163.10 ,$163.10 ,$163.10 ,$233.00 , N/A ,$198.05 , N/A ,$151.45 , N/A ,$233.00 ,$130.48 , N/A ,$61.28 , N/A , N/A , N/A , N/A ,$186.40 , N/A ,$105.08 ,$65.24 ,$209.70 , N/A ,$163.10 ,$233.00 ,$233.00 , N/A ,$233.00 ,$111.84 , N/A 
ST. ELIZABETH'S HOSPITAL,32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$273.00 ,$177.45 ,$71.80 ,$273.00 , N/A ,$125.58 ,$152.88 , N/A ,$76.44 ,$92.27 , N/A ,$106.20 , N/A ,$123.12 ,$123.12 , N/A ,$86.08 , N/A ,$136.50 , N/A , N/A , N/A , N/A ,$204.75 ,$163.80 ,$163.80 , N/A ,$163.80 ,$191.10 ,$191.10 ,$191.10 ,$273.00 , N/A ,$232.05 , N/A ,$177.45 , N/A ,$273.00 ,$152.88 , N/A ,$71.80 , N/A , N/A , N/A , N/A ,$218.40 , N/A ,$123.12 ,$76.44 ,$245.70 , N/A ,$191.10 ,$273.00 ,$273.00 , N/A ,$273.00 ,$131.04 , N/A 
ST. ELIZABETH'S HOSPITAL,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$293.00 ,$190.45 ,$77.06 ,$332.78 , N/A ,$134.78 ,$164.08 , N/A ,$82.04 ,$99.03 , N/A ,$113.98 , N/A ,$132.14 ,$132.14 , N/A ,$94.16 , N/A ,$146.50 , N/A , N/A , N/A , N/A ,$219.75 ,$175.80 ,$175.80 , N/A ,$175.80 ,$205.10 ,$205.10 ,$205.10 ,$293.00 , N/A ,$249.05 , N/A ,$190.45 , N/A ,$293.00 ,$164.08 , N/A ,$77.06 , N/A ,$293.00 ,$293.00 , N/A ,$234.40 , N/A ,$132.14 ,$82.04 ,$263.70 , N/A ,$205.10 ,$293.00 ,$293.00 , N/A ,$293.00 ,$140.64 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$314.00 ,$204.10 ,$82.58 ,$332.78 , N/A ,$144.44 ,$175.84 , N/A ,$87.92 ,$106.13 , N/A ,$122.15 , N/A ,$141.61 ,$141.61 , N/A ,$87.68 , N/A ,$157.00 , N/A , N/A , N/A , N/A ,$235.50 ,$188.40 ,$188.40 , N/A ,$188.40 ,$219.80 ,$219.80 ,$219.80 ,$314.00 , N/A ,$266.90 , N/A ,$204.10 , N/A ,$314.00 ,$175.84 , N/A ,$82.58 , N/A ,$314.00 ,$314.00 , N/A ,$251.20 , N/A ,$141.61 ,$87.92 ,$282.60 , N/A ,$219.80 ,$314.00 ,$314.00 , N/A ,$314.00 ,$150.72 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$314.00 ,$204.10 ,$52.71 ,$314.00 , N/A ,$144.44 ,$175.84 , N/A ,$87.92 ,$106.13 , N/A ,$122.15 , N/A ,$141.61 ,$141.61 , N/A ,$52.71 , N/A ,$157.00 , N/A , N/A , N/A , N/A ,$235.50 ,$188.40 ,$188.40 , N/A ,$188.40 ,$219.80 ,$219.80 ,$219.80 ,$314.00 , N/A ,$266.90 , N/A ,$204.10 , N/A ,$314.00 ,$175.84 , N/A ,$82.58 , N/A , N/A , N/A , N/A ,$251.20 , N/A ,$141.61 ,$87.92 ,$282.60 , N/A ,$219.80 ,$314.00 ,$314.00 , N/A ,$314.00 ,$150.72 , N/A 
ST. ELIZABETH'S HOSPITAL,32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$214.00 ,$139.10 ,$56.28 ,$332.78 , N/A ,$98.44 ,$119.84 , N/A ,$59.92 ,$72.33 , N/A ,$83.25 , N/A ,$96.51 ,$96.51 , N/A ,$67.26 , N/A ,$107.00 , N/A , N/A , N/A , N/A ,$160.50 ,$128.40 ,$128.40 , N/A ,$128.40 ,$149.80 ,$149.80 ,$149.80 ,$214.00 , N/A ,$181.90 , N/A ,$139.10 , N/A ,$214.00 ,$119.84 , N/A ,$56.28 , N/A ,$214.00 ,$214.00 , N/A ,$171.20 , N/A ,$96.51 ,$59.92 ,$192.60 , N/A ,$149.80 ,$214.00 ,$214.00 , N/A ,$214.00 ,$102.72 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000018,32550,HC INSERT CATH PLEURAL INDWELL W/,320,1 ,"$13,532.00 ","$8,795.80 ",$270.71 ,"$13,532.00 ","$7,841.65 ","$6,224.72 ","$7,577.92 ","$3,136.66 ","$3,788.96 ","$4,573.82 ","$3,136.66 ","$5,263.95 ","$3,136.66 ","$6,102.93 ","$6,102.93 ","$3,136.66 ",$270.71 ,"$5,959.66 ","$6,766.00 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$10,149.00 ","$8,119.20 ","$8,119.20 ","$3,136.66 ","$8,119.20 ","$9,472.40 ","$9,472.40 ","$9,472.40 ","$13,532.00 ", N/A ,"$11,502.20 ","$7,841.66 ","$8,795.80 ","$3,136.66 ","$13,532.00 ","$7,577.92 ","$3,136.66 ","$3,558.92 ", N/A ,$729.45 ,$696.30 ,"$3,293.49 ","$10,825.60 ","$7,057.49 ","$6,102.93 ","$3,788.96 ","$12,178.80 ","$3,136.66 ","$9,472.40 ",$365.00 ,$365.00 ,"$3,136.66 ",$365.00 ,"$6,495.36 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$3,694.00 ","$2,401.10 ",$212.59 ,"$7,055.60 ","$7,055.60 ","$1,699.24 ","$2,068.64 ","$2,822.24 ","$1,034.32 ","$1,248.57 ","$2,822.24 ","$1,436.97 ","$2,822.24 ","$1,665.99 ","$1,665.99 ","$2,822.24 ",$212.59 ,"$3,694.00 ","$1,847.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$2,770.50 ","$2,216.40 ","$2,216.40 ","$2,822.24 ","$2,216.40 ","$2,585.80 ","$2,585.80 ","$2,585.80 ","$3,694.00 ", N/A ,"$3,139.90 ","$3,694.00 ","$2,401.10 ","$2,822.24 ","$3,694.00 ","$2,068.64 ","$2,822.24 ",$971.52 , N/A ,"$1,094.17 ","$1,044.44 ","$2,963.35 ","$2,955.20 ","$6,350.04 ","$1,665.99 ","$1,034.32 ","$3,324.60 ","$2,822.24 ","$2,585.80 ",$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$1,773.12 ",$994.70 
ST. ELIZABETH'S HOSPITAL,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$2,462.00 ","$1,600.30 ",$212.59 ,"$3,465.89 ","$3,465.88 ","$1,132.52 ","$1,378.72 ","$1,386.35 ",$689.36 ,$832.16 ,"$1,386.35 ",$957.72 ,"$1,386.35 ","$1,110.36 ","$1,110.36 ","$1,386.35 ",$212.59 ,"$2,462.00 ","$1,231.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$1,846.50 ","$1,477.20 ","$1,477.20 ","$1,386.35 ","$1,477.20 ","$1,723.40 ","$1,723.40 ","$1,723.40 ","$2,462.00 ", N/A ,"$2,092.70 ","$2,462.00 ","$1,600.30 ","$1,386.35 ","$2,462.00 ","$1,378.72 ","$1,386.35 ",$647.51 , N/A ,$729.45 ,$696.30 ,"$1,455.67 ","$1,969.60 ","$3,119.30 ","$1,110.36 ",$689.36 ,"$2,215.80 ","$1,386.35 ","$1,723.40 ",$365.00 ,$365.00 ,"$1,386.35 ",$365.00 ,"$1,181.76 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000020,32552,HC REMOVAL TUNNELED PLEURAL CATH,320,1 ,"$3,236.00 ","$2,103.40 ",$205.49 ,"$3,236.00 ","$1,332.25 ","$1,488.56 ","$1,812.16 ",$532.90 ,$906.08 ,"$1,093.77 ",$532.90 ,"$1,258.80 ",$532.90 ,"$1,459.44 ","$1,459.44 ",$532.90 ,$205.49 ,"$1,012.50 ","$1,618.00 ","$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,"$2,427.00 ","$1,941.60 ","$1,941.60 ",$532.90 ,"$1,941.60 ","$2,265.20 ","$2,265.20 ","$2,265.20 ","$3,236.00 ", N/A ,"$2,750.60 ","$1,332.24 ","$2,103.40 ",$532.90 ,"$3,236.00 ","$1,812.16 ",$532.90 ,$851.07 , N/A ,$729.45 ,$696.30 ,$559.55 ,"$2,588.80 ","$1,199.01 ","$1,459.44 ",$906.08 ,"$2,912.40 ",$532.90 ,"$2,265.20 ",$365.00 ,$365.00 ,$532.90 ,$365.00 ,"$1,553.28 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000022,32562,HC INSTILL FIBRO CHEST TUBE SUBSQ DAY,320,1 ,"$2,039.00 ","$1,325.35 ",$78.15 ,"$2,039.00 ","$1,332.25 ",$937.94 ,"$1,141.84 ",$532.90 ,$570.92 ,$689.18 ,$532.90 ,$793.17 ,$532.90 ,$919.59 ,$919.59 ,$532.90 ,$78.15 ,"$1,012.50 ","$1,019.50 ","$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,"$1,529.25 ","$1,223.40 ","$1,223.40 ",$532.90 ,"$1,223.40 ","$1,427.30 ","$1,427.30 ","$1,427.30 ","$2,039.00 ", N/A ,"$1,733.15 ","$1,332.24 ","$1,325.35 ",$532.90 ,"$2,039.00 ","$1,141.84 ",$532.90 ,$536.26 , N/A ,$706.08 ,$673.98 ,$559.55 ,"$1,631.20 ","$1,199.01 ",$919.59 ,$570.92 ,"$1,835.10 ",$532.90 ,"$1,427.30 ",$365.00 ,$365.00 ,$532.90 ,$365.00 ,$978.72 ,$641.89 
ST. ELIZABETH'S HOSPITAL,32000026,36000,HC IV START > 3YR OLD,320,1 ,$428.00 ,$278.20 ,$112.56 ,$428.00 , N/A ,$196.88 ,$239.68 , N/A ,$119.84 ,$144.66 , N/A ,$166.49 , N/A ,$193.03 ,$193.03 , N/A ,$278.20 , N/A ,$214.00 , N/A , N/A , N/A , N/A ,$321.00 ,$256.80 ,$256.80 , N/A ,$256.80 ,$299.60 ,$299.60 ,$299.60 ,$428.00 , N/A ,$363.80 , N/A ,$278.20 , N/A ,$428.00 ,$239.68 , N/A ,$112.56 , N/A ,$294.13 ,$280.76 , N/A ,$342.40 , N/A ,$193.03 ,$119.84 ,$385.20 , N/A ,$299.60 ,$365.00 ,$365.00 , N/A ,$365.00 ,$205.44 ,$267.39 
ST. ELIZABETH'S HOSPITAL,32000027,36002,HC INJ PSEUDOANEURYSM (THROMBIN),320,1 ,$995.00 ,$646.75 ,$137.40 ,"$1,332.25 ","$1,332.25 ",$457.70 ,$557.20 ,$532.90 ,$278.60 ,$336.31 ,$532.90 ,$387.06 ,$532.90 ,$448.75 ,$448.75 ,$532.90 ,$137.40 ,$995.00 ,$497.50 ,"$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,$746.25 ,$597.00 ,$597.00 ,$532.90 ,$597.00 ,$696.50 ,$696.50 ,$696.50 ,$995.00 , N/A ,$845.75 ,$995.00 ,$646.75 ,$532.90 ,$995.00 ,$557.20 ,$532.90 ,$261.69 , N/A , N/A , N/A ,$559.55 ,$796.00 ,"$1,199.01 ",$448.75 ,$278.60 ,$895.50 ,$532.90 ,$696.50 ,$365.00 ,$365.00 ,$532.90 ,$365.00 ,$477.60 , N/A 
ST. ELIZABETH'S HOSPITAL,32000028,36005,HC VENOGRAM INJECTION 36005,320,1 ,"$1,009.00 ",$655.85 ,$63.38 ,"$1,009.00 ", N/A ,$464.14 ,$565.04 , N/A ,$282.52 ,$341.04 , N/A ,$392.50 , N/A ,$455.06 ,$455.06 , N/A ,$63.38 , N/A ,$504.50 , N/A , N/A , N/A , N/A ,$756.75 ,$605.40 ,$605.40 , N/A ,$605.40 ,$706.30 ,$706.30 ,$706.30 ,"$1,009.00 ", N/A ,$857.65 , N/A ,$655.85 , N/A ,"$1,009.00 ",$565.04 , N/A ,$265.37 , N/A ,$366.06 ,$349.42 , N/A ,$807.20 , N/A ,$455.06 ,$282.52 ,$908.10 , N/A ,$706.30 ,$365.00 ,$365.00 , N/A ,$365.00 ,$484.32 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000029,36410,HC VENIPUNCTURE > AGE 3 REQUIR MD,361,1 ,$228.00 ,$148.20 ,$46.46 ,$228.00 , N/A ,$104.88 ,$127.68 , N/A ,$63.84 ,$77.06 , N/A ,$88.69 , N/A ,$102.83 ,$102.83 , N/A ,$102.83 , N/A ,$114.00 , N/A , N/A , N/A , N/A ,$171.00 ,$136.80 ,$136.80 , N/A ,$136.80 ,$173.28 ,$173.28 ,$173.28 ,$228.00 , N/A ,$193.80 , N/A ,$148.20 , N/A ,$228.00 ,$127.68 , N/A ,$59.96 , N/A ,$51.11 ,$48.78 , N/A ,$182.40 , N/A ,$102.83 ,$63.84 ,$205.20 , N/A ,$173.28 , N/A , N/A , N/A , N/A ,$109.44 ,$46.46 
ST. ELIZABETH'S HOSPITAL,32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$540.00 ,$351.00 ,$47.54 ,"$1,631.64 ",$504.20 ,$248.40 ,$302.40 ,$201.68 ,$151.20 ,$182.52 ,$201.68 ,$210.06 ,$201.68 ,$243.54 ,$243.54 ,$201.68 ,$47.54 ,$383.20 ,$270.00 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$405.00 ,$324.00 ,$324.00 ,$201.68 ,$324.00 ,$378.00 ,$378.00 ,$378.00 ,$540.00 , N/A ,$459.00 ,$504.21 ,$351.00 ,$201.68 ,$540.00 ,$302.40 ,$201.68 ,$142.02 , N/A ,$540.00 ,$540.00 ,$211.76 ,$432.00 ,$453.79 ,$243.54 ,$151.20 ,$486.00 ,$201.68 ,$378.00 ,$365.00 ,$365.00 ,$201.68 ,$365.00 ,$259.20 ,"$1,631.64 "
ST. ELIZABETH'S HOSPITAL,32000031,36598,HC CONTRAST INJ CENTRAL VENOUS CATH W/FLUORO,320,1 ,$540.00 ,$351.00 ,$47.54 ,"$1,631.64 ",$504.20 ,$248.40 ,$302.40 ,$201.68 ,$151.20 ,$182.52 ,$201.68 ,$210.06 ,$201.68 ,$243.54 ,$243.54 ,$201.68 ,$47.54 ,$383.20 ,$270.00 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$405.00 ,$324.00 ,$324.00 ,$201.68 ,$324.00 ,$378.00 ,$378.00 ,$378.00 ,$540.00 , N/A ,$459.00 ,$504.21 ,$351.00 ,$201.68 ,$540.00 ,$302.40 ,$201.68 ,$142.02 , N/A ,$540.00 ,$540.00 ,$211.76 ,$432.00 ,$453.79 ,$243.54 ,$151.20 ,$486.00 ,$201.68 ,$378.00 ,$365.00 ,$365.00 ,$201.68 ,$365.00 ,$259.20 ,"$1,631.64 "
ST. ELIZABETH'S HOSPITAL,32000032,42400,HC BX GLAND SALIVARY NEEDLE,320,1 ,"$2,164.00 ","$1,406.60 ",$67.91 ,"$2,164.00 ","$1,533.75 ",$995.44 ,"$1,211.84 ",$613.50 ,$605.92 ,$731.43 ,$613.50 ,$841.80 ,$613.50 ,$975.96 ,$975.96 ,$613.50 ,$67.91 ,"$1,165.65 ","$1,082.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,623.00 ","$1,298.40 ","$1,298.40 ",$613.50 ,"$1,298.40 ","$1,514.80 ","$1,514.80 ","$1,514.80 ","$2,164.00 ", N/A ,"$1,839.40 ","$1,533.75 ","$1,406.60 ",$613.50 ,"$2,164.00 ","$1,211.84 ",$613.50 ,$569.13 , N/A ,$641.39 ,$612.23 ,$644.18 ,"$1,731.20 ","$1,380.37 ",$975.96 ,$605.92 ,"$1,947.60 ",$613.50 ,"$1,514.80 ",$365.00 ,$365.00 ,$613.50 ,$365.00 ,"$1,038.72 ",$583.08 
ST. ELIZABETH'S HOSPITAL,32000033,42550,HC SIALOGRAM INJECTION,320,1 ,$229.00 ,$148.85 ,$60.23 ,$332.78 , N/A ,$105.34 ,$128.24 , N/A ,$64.12 ,$77.40 , N/A ,$89.08 , N/A ,$103.28 ,$103.28 , N/A ,$79.60 , N/A ,$114.50 , N/A , N/A , N/A , N/A ,$171.75 ,$137.40 ,$137.40 , N/A ,$137.40 ,$160.30 ,$160.30 ,$160.30 ,$229.00 , N/A ,$194.65 , N/A ,$148.85 , N/A ,$229.00 ,$128.24 , N/A ,$60.23 , N/A ,$229.00 ,$229.00 , N/A ,$183.20 , N/A ,$103.28 ,$64.12 ,$206.10 , N/A ,$160.30 ,$229.00 ,$229.00 , N/A ,$229.00 ,$109.92 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,"$1,476.00 ",$959.40 ,$52.91 ,"$1,476.00 ",$668.93 ,$678.96 ,$826.56 ,$267.57 ,$413.28 ,$498.89 ,$267.57 ,$574.16 ,$267.57 ,$665.68 ,$665.68 ,$267.57 ,$52.91 ,$508.38 ,$738.00 ,$668.92 ,$267.57 ,$267.57 ,$272.92 ,"$1,107.00 ",$885.60 ,$885.60 ,$267.57 ,$885.60 ,"$1,033.20 ","$1,033.20 ","$1,033.20 ","$1,476.00 ", N/A ,"$1,254.60 ",$668.92 ,$959.40 ,$267.57 ,"$1,476.00 ",$826.56 ,$267.57 ,$388.19 , N/A ,$634.93 ,$606.07 ,$280.95 ,"$1,180.80 ",$602.03 ,$665.68 ,$413.28 ,"$1,328.40 ",$267.57 ,"$1,033.20 ",$365.00 ,$365.00 ,$267.57 ,$365.00 ,$708.48 ,$577.21 
ST. ELIZABETH'S HOSPITAL,32000036,43761,HC REPOSITION G-TUBE,320,1 ,"$1,918.00 ","$1,246.70 ",$114.47 ,"$1,918.00 ",$655.88 ,$882.28 ,"$1,074.08 ",$262.35 ,$537.04 ,$648.28 ,$262.35 ,$746.10 ,$262.35 ,$865.02 ,$865.02 ,$262.35 ,$139.69 ,$498.46 ,$959.00 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,"$1,438.50 ","$1,150.80 ","$1,150.80 ",$262.35 ,"$1,150.80 ","$1,342.60 ","$1,342.60 ","$1,342.60 ","$1,918.00 ", N/A ,"$1,630.30 ",$655.86 ,"$1,246.70 ",$262.35 ,"$1,918.00 ","$1,074.08 ",$262.35 ,$504.43 , N/A ,$125.92 ,$120.19 ,$275.47 ,"$1,534.40 ",$590.28 ,$865.02 ,$537.04 ,"$1,726.20 ",$262.35 ,"$1,342.60 ",$365.00 ,$365.00 ,$262.35 ,$365.00 ,$920.64 ,$114.47 
ST. ELIZABETH'S HOSPITAL,32000043,47536,HC CHG PERC BIL DRAIN CATH,320,1 ,"$8,869.00 ","$5,764.85 ",$168.86 ,"$8,869.00 ","$7,841.65 ","$4,079.74 ","$4,966.64 ","$3,136.66 ","$2,483.32 ","$2,997.72 ","$3,136.66 ","$3,450.04 ","$3,136.66 ","$3,999.92 ","$3,999.92 ","$3,136.66 ",$168.86 ,"$5,959.66 ","$4,434.50 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$6,651.75 ","$5,321.40 ","$5,321.40 ","$3,136.66 ","$5,321.40 ","$6,208.30 ","$6,208.30 ","$6,208.30 ","$8,869.00 ", N/A ,"$7,538.65 ","$7,841.66 ","$5,764.85 ","$3,136.66 ","$8,869.00 ","$4,966.64 ","$3,136.66 ","$2,332.55 ", N/A ,"$1,775.16 ","$1,694.47 ","$3,293.49 ","$7,095.20 ","$7,057.49 ","$3,999.92 ","$2,483.32 ","$7,982.10 ","$3,136.66 ","$6,208.30 ",$365.00 ,$365.00 ,"$3,136.66 ",$365.00 ,"$4,257.12 ","$1,613.78 "
ST. ELIZABETH'S HOSPITAL,32000044,47535,HC REVISE/REINSERT TUBE TRNSHEPAT,320,1 ,"$8,869.00 ","$5,764.85 ",$251.44 ,"$8,869.00 ","$7,841.65 ","$4,079.74 ","$4,966.64 ","$3,136.66 ","$2,483.32 ","$2,997.72 ","$3,136.66 ","$3,450.04 ","$3,136.66 ","$3,999.92 ","$3,999.92 ","$3,136.66 ",$251.44 ,"$5,959.66 ","$4,434.50 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$6,651.75 ","$5,321.40 ","$5,321.40 ","$3,136.66 ","$5,321.40 ","$6,208.30 ","$6,208.30 ","$6,208.30 ","$8,869.00 ", N/A ,"$7,538.65 ","$7,841.66 ","$5,764.85 ","$3,136.66 ","$8,869.00 ","$4,966.64 ","$3,136.66 ","$2,332.55 ", N/A ,"$1,775.16 ","$1,694.47 ","$3,293.49 ","$7,095.20 ","$7,057.49 ","$3,999.92 ","$2,483.32 ","$7,982.10 ","$3,136.66 ","$6,208.30 ",$365.00 ,$365.00 ,"$3,136.66 ",$365.00 ,"$4,257.12 ","$1,613.78 "
ST. ELIZABETH'S HOSPITAL,32000051,49406,HC DRN ABSC RETROPERITONEAL PERC,320,1 ,"$3,830.00 ","$2,489.50 ",$251.15 ,"$3,830.00 ","$3,467.90 ","$1,761.80 ","$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$251.15 ,"$2,635.59 ","$1,915.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$2,489.50 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$365.00 ,$365.00 ,"$1,387.16 ",$365.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000053,49423,HC EXCHG CATH ABSC/CYST DRAIN,320,1 ,"$4,135.00 ","$2,687.75 ",$90.11 ,"$4,135.00 ","$4,003.20 ","$1,902.10 ","$2,315.60 ","$1,601.28 ","$1,157.80 ","$1,397.63 ","$1,601.28 ","$1,608.52 ","$1,601.28 ","$1,864.89 ","$1,864.89 ","$1,601.28 ",$90.11 ,"$3,042.44 ","$2,067.50 ","$4,003.21 ","$1,601.28 ","$1,601.28 ","$1,633.31 ","$3,101.25 ","$2,481.00 ","$2,481.00 ","$1,601.28 ","$2,481.00 ","$2,894.50 ","$2,894.50 ","$2,894.50 ","$4,135.00 ", N/A ,"$3,514.75 ","$4,003.21 ","$2,687.75 ","$1,601.28 ","$4,135.00 ","$2,315.60 ","$1,601.28 ","$1,087.51 ", N/A ,$729.45 ,$696.30 ,"$1,681.34 ","$3,308.00 ","$3,602.89 ","$1,864.89 ","$1,157.80 ","$3,721.50 ","$1,601.28 ","$2,894.50 ",$365.00 ,$365.00 ,"$1,601.28 ",$365.00 ,"$1,984.80 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000054,49424,HC INJ CONTRAST ABSC/CYST,320,1 ,$654.00 ,$425.10 ,$49.21 ,$654.00 , N/A ,$300.84 ,$366.24 , N/A ,$183.12 ,$221.05 , N/A ,$254.41 , N/A ,$294.95 ,$294.95 , N/A ,$49.21 , N/A ,$327.00 , N/A , N/A , N/A , N/A ,$490.50 ,$392.40 ,$392.40 , N/A ,$392.40 ,$457.80 ,$457.80 ,$457.80 ,$654.00 , N/A ,$555.90 , N/A ,$425.10 , N/A ,$654.00 ,$366.24 , N/A ,$172.00 , N/A ,$366.06 ,$349.42 , N/A ,$523.20 , N/A ,$294.95 ,$183.12 ,$588.60 , N/A ,$457.80 ,$365.00 ,$365.00 , N/A ,$365.00 ,$313.92 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000055,49427,HC INJ PREV PLACED SHUNT,320,1 ,$680.00 ,$442.00 ,$51.08 ,$680.00 , N/A ,$312.80 ,$380.80 , N/A ,$190.40 ,$229.84 , N/A ,$264.52 , N/A ,$306.68 ,$306.68 , N/A ,$51.08 , N/A ,$340.00 , N/A , N/A , N/A , N/A ,$510.00 ,$408.00 ,$408.00 , N/A ,$408.00 ,$476.00 ,$476.00 ,$476.00 ,$680.00 , N/A ,$578.00 , N/A ,$442.00 , N/A ,$680.00 ,$380.80 , N/A ,$178.84 , N/A , N/A , N/A , N/A ,$544.00 , N/A ,$306.68 ,$190.40 ,$612.00 , N/A ,$476.00 ,$365.00 ,$365.00 , N/A ,$365.00 ,$326.40 , N/A 
ST. ELIZABETH'S HOSPITAL,32000056,49440,HC INSERT GASTRO TUBE FLUORO,320,1 ,"$6,311.00 ","$4,102.15 ",$262.41 ,"$6,311.00 ","$4,003.20 ","$2,903.06 ","$3,534.16 ","$1,601.28 ","$1,767.08 ","$2,133.12 ","$1,601.28 ","$2,454.98 ","$1,601.28 ","$2,846.26 ","$2,846.26 ","$1,601.28 ",$262.41 ,"$3,042.44 ","$3,155.50 ","$4,003.21 ","$1,601.28 ","$1,601.28 ","$1,633.31 ","$4,733.25 ","$3,786.60 ","$3,786.60 ","$1,601.28 ","$3,786.60 ","$4,417.70 ","$4,417.70 ","$4,417.70 ","$6,311.00 ", N/A ,"$5,364.35 ","$4,003.21 ","$4,102.15 ","$1,601.28 ","$6,311.00 ","$3,534.16 ","$1,601.28 ","$1,659.79 ", N/A ,$825.28 ,$787.76 ,"$1,681.34 ","$5,048.80 ","$3,602.89 ","$2,846.26 ","$1,767.08 ","$5,679.90 ","$1,601.28 ","$4,417.70 ",$365.00 ,$365.00 ,"$1,601.28 ",$365.00 ,"$3,029.28 ",$750.25 
ST. ELIZABETH'S HOSPITAL,32000057,49441,HC INSERT DUODEN/JEJUN TBE FLUORO,320,1 ,"$6,311.00 ","$4,102.15 ",$312.28 ,"$6,311.00 ","$4,003.20 ","$2,903.06 ","$3,534.16 ","$1,601.28 ","$1,767.08 ","$2,133.12 ","$1,601.28 ","$2,454.98 ","$1,601.28 ","$2,846.26 ","$2,846.26 ","$1,601.28 ",$312.28 ,"$3,042.44 ","$3,155.50 ","$4,003.21 ","$1,601.28 ","$1,601.28 ","$1,633.31 ","$4,733.25 ","$3,786.60 ","$3,786.60 ","$1,601.28 ","$3,786.60 ","$4,417.70 ","$4,417.70 ","$4,417.70 ","$6,311.00 ", N/A ,"$5,364.35 ","$4,003.21 ","$4,102.15 ","$1,601.28 ","$6,311.00 ","$3,534.16 ","$1,601.28 ","$1,659.79 ", N/A ,$825.28 ,$787.76 ,"$1,681.34 ","$5,048.80 ","$3,602.89 ","$2,846.26 ","$1,767.08 ","$5,679.90 ","$1,601.28 ","$4,417.70 ",$365.00 ,$365.00 ,"$1,601.28 ",$365.00 ,"$3,029.28 ",$750.25 
ST. ELIZABETH'S HOSPITAL,32000058,49442,HC INSERT CECOS/OTHR TBE FLUORO,320,1 ,"$4,147.00 ","$2,695.55 ",$263.14 ,"$4,147.00 ","$2,555.83 ","$1,907.62 ","$2,322.32 ","$1,022.33 ","$1,161.16 ","$1,401.69 ","$1,022.33 ","$1,613.18 ","$1,022.33 ","$1,870.30 ","$1,870.30 ","$1,022.33 ",$263.14 ,"$1,942.43 ","$2,073.50 ","$2,555.83 ","$1,022.33 ","$1,022.33 ","$1,042.78 ","$3,110.25 ","$2,488.20 ","$2,488.20 ","$1,022.33 ","$2,488.20 ","$2,902.90 ","$2,902.90 ","$2,902.90 ","$4,147.00 ", N/A ,"$3,524.95 ","$2,555.83 ","$2,695.55 ","$1,022.33 ","$4,147.00 ","$2,322.32 ","$1,022.33 ","$1,090.66 ", N/A ,"$2,089.13 ","$1,994.17 ","$1,073.45 ","$3,317.60 ","$2,300.25 ","$1,870.30 ","$1,161.16 ","$3,732.30 ","$1,022.33 ","$2,902.90 ",$365.00 ,$365.00 ,"$1,022.33 ",$365.00 ,"$1,990.56 ","$1,899.21 "
ST. ELIZABETH'S HOSPITAL,32000059,49446,HC CHG G-TB TO GJ-TB PERC FLUORO,320,1 ,"$6,311.00 ","$4,102.15 ",$189.56 ,"$6,311.00 ","$4,003.20 ","$2,903.06 ","$3,534.16 ","$1,601.28 ","$1,767.08 ","$2,133.12 ","$1,601.28 ","$2,454.98 ","$1,601.28 ","$2,846.26 ","$2,846.26 ","$1,601.28 ",$189.56 ,"$3,042.44 ","$3,155.50 ","$4,003.21 ","$1,601.28 ","$1,601.28 ","$1,633.31 ","$4,733.25 ","$3,786.60 ","$3,786.60 ","$1,601.28 ","$3,786.60 ","$4,417.70 ","$4,417.70 ","$4,417.70 ","$6,311.00 ", N/A ,"$5,364.35 ","$4,003.21 ","$4,102.15 ","$1,601.28 ","$6,311.00 ","$3,534.16 ","$1,601.28 ","$1,659.79 ", N/A ,"$1,139.12 ","$1,087.34 ","$1,681.34 ","$5,048.80 ","$3,602.89 ","$2,846.26 ","$1,767.08 ","$5,679.90 ","$1,601.28 ","$4,417.70 ",$365.00 ,$365.00 ,"$1,601.28 ",$365.00 ,"$3,029.28 ","$1,035.56 "
ST. ELIZABETH'S HOSPITAL,32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$3,306.00 ","$2,148.90 ",$84.16 ,"$3,306.00 ","$1,994.33 ","$1,520.76 ","$1,851.36 ",$797.73 ,$925.68 ,"$1,117.43 ",$797.73 ,"$1,286.03 ",$797.73 ,"$1,491.01 ","$1,491.01 ",$797.73 ,$84.16 ,"$1,515.69 ","$1,653.00 ","$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$2,479.50 ","$1,983.60 ","$1,983.60 ",$797.73 ,"$1,983.60 ","$2,314.20 ","$2,314.20 ","$2,314.20 ","$3,306.00 ", N/A ,"$2,810.10 ","$1,994.33 ","$2,148.90 ",$797.73 ,"$3,306.00 ","$1,851.36 ",$797.73 ,$869.48 , N/A ,$634.93 ,$606.07 ,$837.62 ,"$2,644.80 ","$1,794.89 ","$1,491.01 ",$925.68 ,"$2,975.40 ",$797.73 ,"$2,314.20 ",$365.00 ,$365.00 ,$797.73 ,$365.00 ,"$1,586.88 ",$577.21 
ST. ELIZABETH'S HOSPITAL,32000061,49451,HC RPLC DUODEN/JEJUN TB FLUORO,320,1 ,"$3,306.00 ","$2,148.90 ",$116.06 ,"$3,306.00 ","$1,994.33 ","$1,520.76 ","$1,851.36 ",$797.73 ,$925.68 ,"$1,117.43 ",$797.73 ,"$1,286.03 ",$797.73 ,"$1,491.01 ","$1,491.01 ",$797.73 ,$116.06 ,"$1,515.69 ","$1,653.00 ","$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$2,479.50 ","$1,983.60 ","$1,983.60 ",$797.73 ,"$1,983.60 ","$2,314.20 ","$2,314.20 ","$2,314.20 ","$3,306.00 ", N/A ,"$2,810.10 ","$1,994.33 ","$2,148.90 ",$797.73 ,"$3,306.00 ","$1,851.36 ",$797.73 ,$869.48 , N/A ,$634.93 ,$606.07 ,$837.62 ,"$2,644.80 ","$1,794.89 ","$1,491.01 ",$925.68 ,"$2,975.40 ",$797.73 ,"$2,314.20 ",$365.00 ,$365.00 ,$797.73 ,$365.00 ,"$1,586.88 ",$577.21 
ST. ELIZABETH'S HOSPITAL,32000062,49452,HC RPLC GASTRO-JEJUN TB FLUORO,361,1 ,"$8,054.00 ","$5,235.10 ",$577.21 ,"$8,054.00 ","$1,994.33 ","$2,125.00 ","$4,510.24 ",$797.73 ,"$2,255.12 ","$2,722.25 ",$797.73 ,"$3,133.01 ",$797.73 ,"$3,632.35 ","$3,632.35 ",$797.73 ,"$3,632.35 ","$1,515.69 ","$4,027.00 ","$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$6,040.50 ","$4,832.40 ","$4,832.40 ",$797.73 ,"$4,832.40 ","$6,121.04 ","$6,121.04 ","$6,121.04 ","$8,054.00 ", N/A ,"$6,845.90 ","$1,994.33 ","$5,235.10 ",$797.73 ,"$8,054.00 ","$4,510.24 ",$797.73 ,"$2,118.20 ", N/A ,$634.93 ,$606.07 ,$837.62 ,"$6,443.20 ","$1,794.89 ","$3,632.35 ","$2,255.12 ","$7,248.60 ",$797.73 ,"$6,121.04 ","$1,890.00 ","$1,890.00 ",$797.73 ,"$1,890.00 ","$3,865.92 ",$577.21 
ST. ELIZABETH'S HOSPITAL,32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,"$1,067.00 ",$693.55 ,$38.98 ,"$1,067.00 ",$567.13 ,$490.82 ,$597.52 ,$226.85 ,$298.76 ,$360.65 ,$226.85 ,$415.06 ,$226.85 ,$481.22 ,$481.22 ,$226.85 ,$38.98 ,$431.02 ,$533.50 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$800.25 ,$640.20 ,$640.20 ,$226.85 ,$640.20 ,$746.90 ,$746.90 ,$746.90 ,"$1,067.00 ", N/A ,$906.95 ,$567.13 ,$693.55 ,$226.85 ,"$1,067.00 ",$597.52 ,$226.85 ,$280.62 , N/A ,$366.06 ,$349.42 ,$238.19 ,$853.60 ,$510.41 ,$481.22 ,$298.76 ,$960.30 ,$226.85 ,$746.90 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$512.16 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000065,49999,HC ABD/PERITONEUM/OMNTM UNLSTD,320,1 ,"$7,540.00 ","$4,901.00 ",$365.00 ,"$7,540.00 ","$1,994.33 ","$3,468.40 ","$4,222.40 ",$797.73 ,"$2,111.20 ","$2,548.52 ",$797.73 ,"$2,933.06 ",$797.73 ,"$3,400.54 ","$3,400.54 ",$797.73 ,"$4,901.00 ","$1,515.69 ","$3,770.00 ","$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$5,655.00 ","$4,524.00 ","$4,524.00 ",$797.73 ,"$4,524.00 ","$5,278.00 ","$5,278.00 ","$5,278.00 ","$7,540.00 ", N/A ,"$6,409.00 ","$1,994.33 ","$4,901.00 ",$797.73 ,"$7,540.00 ","$4,222.40 ",$797.73 ,"$1,983.02 ", N/A ,"$1,775.16 ","$1,694.47 ",$837.62 ,"$6,032.00 ","$1,794.89 ","$3,400.54 ","$2,111.20 ","$6,786.00 ",$797.73 ,"$5,278.00 ",$365.00 ,$365.00 ,$797.73 ,$365.00 ,"$3,619.20 ","$1,613.78 "
ST. ELIZABETH'S HOSPITAL,32000066,49405,HC DRN ABSC PERIRENAL  PERC,320,1 ,"$3,830.00 ","$2,489.50 ",$251.56 ,"$3,830.00 ","$3,467.90 ","$1,761.80 ","$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$251.56 ,"$2,635.59 ","$1,915.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$2,489.50 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$365.00 ,$365.00 ,"$1,387.16 ",$365.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000067,50382,HC CHANGE URETERAL STENT PERCU,320,1 ,"$7,565.00 ","$4,917.25 ",$327.00 ,"$7,565.00 ","$4,413.08 ","$3,479.90 ","$4,236.40 ","$1,765.23 ","$2,118.20 ","$2,556.97 ","$1,765.23 ","$2,942.79 ","$1,765.23 ","$3,411.82 ","$3,411.82 ","$1,765.23 ",$327.00 ,"$3,353.94 ","$3,782.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$5,673.75 ","$4,539.00 ","$4,539.00 ","$1,765.23 ","$4,539.00 ","$5,295.50 ","$5,295.50 ","$5,295.50 ","$7,565.00 ", N/A ,"$6,430.25 ","$4,413.08 ","$4,917.25 ","$1,765.23 ","$7,565.00 ","$4,236.40 ","$1,765.23 ","$1,989.60 ", N/A ,"$2,434.56 ","$2,323.90 ","$1,853.49 ","$6,052.00 ","$3,971.77 ","$3,411.82 ","$2,118.20 ","$6,808.50 ","$1,765.23 ","$5,295.50 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$3,631.20 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,32000068,50384,HC REM URETERAL STENT PERCU,320,1 ,"$7,565.00 ","$4,917.25 ",$292.91 ,"$7,565.00 ","$4,413.08 ","$3,479.90 ","$4,236.40 ","$1,765.23 ","$2,118.20 ","$2,556.97 ","$1,765.23 ","$2,942.79 ","$1,765.23 ","$3,411.82 ","$3,411.82 ","$1,765.23 ",$292.91 ,"$3,353.94 ","$3,782.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$5,673.75 ","$4,539.00 ","$4,539.00 ","$1,765.23 ","$4,539.00 ","$5,295.50 ","$5,295.50 ","$5,295.50 ","$7,565.00 ", N/A ,"$6,430.25 ","$4,413.08 ","$4,917.25 ","$1,765.23 ","$7,565.00 ","$4,236.40 ","$1,765.23 ","$1,989.60 ", N/A ,"$1,144.54 ","$1,092.51 ","$1,853.49 ","$6,052.00 ","$3,971.77 ","$3,411.82 ","$2,118.20 ","$6,808.50 ","$1,765.23 ","$5,295.50 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$3,631.20 ","$1,040.49 "
ST. ELIZABETH'S HOSPITAL,32000069,50385,HC URETERAL STENT CHNG USING SNARE,320,1 ,"$5,095.00 ","$3,311.75 ",$280.10 ,"$5,095.00 ","$4,413.08 ","$2,343.70 ","$2,853.20 ","$1,765.23 ","$1,426.60 ","$1,722.11 ","$1,765.23 ","$1,981.96 ","$1,765.23 ","$2,297.85 ","$2,297.85 ","$1,765.23 ",$280.10 ,"$3,353.94 ","$2,547.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$3,821.25 ","$3,057.00 ","$3,057.00 ","$1,765.23 ","$3,057.00 ","$3,566.50 ","$3,566.50 ","$3,566.50 ","$5,095.00 ", N/A ,"$4,330.75 ","$4,413.08 ","$3,311.75 ","$1,765.23 ","$5,095.00 ","$2,853.20 ","$1,765.23 ","$1,339.99 ", N/A ,"$2,434.56 ","$2,323.90 ","$1,853.49 ","$4,076.00 ","$3,971.77 ","$2,297.85 ","$1,426.60 ","$4,585.50 ","$1,765.23 ","$3,566.50 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$2,445.60 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,32000070,50386,HC URETERAL STENT REMOVAL USNG SNARE,320,1 ,"$5,095.00 ","$3,311.75 ",$209.34 ,"$5,095.00 ","$4,413.08 ","$2,343.70 ","$2,853.20 ","$1,765.23 ","$1,426.60 ","$1,722.11 ","$1,765.23 ","$1,981.96 ","$1,765.23 ","$2,297.85 ","$2,297.85 ","$1,765.23 ",$209.34 ,"$3,353.94 ","$2,547.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$3,821.25 ","$3,057.00 ","$3,057.00 ","$1,765.23 ","$3,057.00 ","$3,566.50 ","$3,566.50 ","$3,566.50 ","$5,095.00 ", N/A ,"$4,330.75 ","$4,413.08 ","$3,311.75 ","$1,765.23 ","$5,095.00 ","$2,853.20 ","$1,765.23 ","$1,339.99 ", N/A ,"$1,144.54 ","$1,092.51 ","$1,853.49 ","$4,076.00 ","$3,971.77 ","$2,297.85 ","$1,426.60 ","$4,585.50 ","$1,765.23 ","$3,566.50 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$2,445.60 ","$1,040.49 "
ST. ELIZABETH'S HOSPITAL,32000071,50387,HC CHANGE EXT/INT URET STENT,320,1 ,"$7,775.00 ","$5,053.75 ",$108.29 ,"$7,775.00 ","$4,413.08 ","$3,576.50 ","$4,354.00 ","$1,765.23 ","$2,177.00 ","$2,627.95 ","$1,765.23 ","$3,024.48 ","$1,765.23 ","$3,506.53 ","$3,506.53 ","$1,765.23 ",$108.29 ,"$3,353.94 ","$3,887.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$5,831.25 ","$4,665.00 ","$4,665.00 ","$1,765.23 ","$4,665.00 ","$5,442.50 ","$5,442.50 ","$5,442.50 ","$7,775.00 ", N/A ,"$6,608.75 ","$4,413.08 ","$5,053.75 ","$1,765.23 ","$7,775.00 ","$4,354.00 ","$1,765.23 ","$2,044.83 ", N/A ,"$1,144.54 ","$1,092.51 ","$1,853.49 ","$6,220.00 ","$3,971.77 ","$3,506.53 ","$2,177.00 ","$6,997.50 ","$1,765.23 ","$5,442.50 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$3,732.00 ","$1,040.49 "
ST. ELIZABETH'S HOSPITAL,32000072,50389,HC REM NEPHRO TUBE FLUORO,320,1 ,$983.00 ,$638.95 ,$68.63 ,"$1,417.96 ","$1,417.95 ",$452.18 ,$550.48 ,$567.18 ,$275.24 ,$332.25 ,$567.18 ,$382.39 ,$567.18 ,$443.33 ,$443.33 ,$567.18 ,$68.63 ,$983.00 ,$491.50 ,"$1,417.96 ",$567.18 ,$567.18 ,$578.53 ,$737.25 ,$589.80 ,$589.80 ,$567.18 ,$589.80 ,$688.10 ,$688.10 ,$688.10 ,$983.00 , N/A ,$835.55 ,$983.00 ,$638.95 ,$567.18 ,$983.00 ,$550.48 ,$567.18 ,$258.53 , N/A ,$983.00 ,$983.00 ,$595.54 ,$786.40 ,"$1,276.16 ",$443.33 ,$275.24 ,$884.70 ,$567.18 ,$688.10 ,$365.00 ,$365.00 ,$567.18 ,$365.00 ,$471.84 ,"$1,040.49 "
ST. ELIZABETH'S HOSPITAL,32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$9,086.00 ","$5,905.90 ",$260.01 ,"$9,086.00 ","$7,577.85 ","$4,179.56 ","$5,088.16 ","$3,031.14 ","$2,544.08 ","$3,071.07 ","$3,031.14 ","$3,534.45 ","$3,031.14 ","$4,097.79 ","$4,097.79 ","$3,031.14 ",$260.01 ,"$5,759.17 ","$4,543.00 ","$7,577.86 ","$3,031.14 ","$3,031.14 ","$3,091.77 ","$6,814.50 ","$5,451.60 ","$5,451.60 ","$3,031.14 ","$5,451.60 ","$6,360.20 ","$6,360.20 ","$6,360.20 ","$9,086.00 ", N/A ,"$7,723.10 ","$7,577.86 ","$5,905.90 ","$3,031.14 ","$9,086.00 ","$5,088.16 ","$3,031.14 ","$2,389.62 ", N/A ,"$2,434.56 ","$2,323.90 ","$3,182.70 ","$7,268.80 ","$6,820.07 ","$4,097.79 ","$2,544.08 ","$8,177.40 ","$3,031.14 ","$6,360.20 ",$365.00 ,$365.00 ,"$3,031.14 ",$365.00 ,"$4,361.28 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$2,597.00 ","$1,688.05 ",$127.93 ,"$4,413.08 ","$4,413.08 ","$1,194.62 ","$1,454.32 ","$1,765.23 ",$727.16 ,$877.79 ,"$1,765.23 ","$1,010.23 ","$1,765.23 ","$1,171.25 ","$1,171.25 ","$1,765.23 ",$127.93 ,"$2,597.00 ","$1,298.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$1,947.75 ","$1,558.20 ","$1,558.20 ","$1,765.23 ","$1,558.20 ","$1,817.90 ","$1,817.90 ","$1,817.90 ","$2,597.00 ", N/A ,"$2,207.45 ","$2,597.00 ","$1,688.05 ","$1,765.23 ","$2,597.00 ","$1,454.32 ","$1,765.23 ",$683.01 , N/A ,"$1,144.54 ","$1,092.51 ","$1,853.49 ","$2,077.60 ","$3,971.77 ","$1,171.25 ",$727.16 ,"$2,337.30 ","$1,765.23 ","$1,817.90 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$1,246.56 ","$1,040.49 "
ST. ELIZABETH'S HOSPITAL,32000081,50684,HC INJ URETEROGRAPHY,320,1 ,"$5,075.00 ","$3,298.75 ",$64.20 ,"$5,075.00 ", N/A ,"$2,334.50 ","$2,842.00 ", N/A ,"$1,421.00 ","$1,715.35 ", N/A ,"$1,974.18 ", N/A ,"$2,288.83 ","$2,288.83 ", N/A ,$64.20 , N/A ,"$2,537.50 ", N/A , N/A , N/A , N/A ,"$3,806.25 ","$3,045.00 ","$3,045.00 ", N/A ,"$3,045.00 ","$3,552.50 ","$3,552.50 ","$3,552.50 ","$5,075.00 ", N/A ,"$4,313.75 ", N/A ,"$3,298.75 ", N/A ,"$5,075.00 ","$2,842.00 ", N/A ,"$1,334.73 ", N/A ,$366.06 ,$349.42 , N/A ,"$4,060.00 ", N/A ,"$2,288.83 ","$1,421.00 ","$4,567.50 ", N/A ,"$3,552.50 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$2,436.00 ",$332.78 
ST. ELIZABETH'S HOSPITAL,32000082,50688,HC CHG TUBE URETEROSTOMY,320,1 ,"$7,775.00 ","$5,053.75 ",$97.71 ,"$7,775.00 ","$4,413.08 ","$3,576.50 ","$4,354.00 ","$1,765.23 ","$2,177.00 ","$2,627.95 ","$1,765.23 ","$3,024.48 ","$1,765.23 ","$3,506.53 ","$3,506.53 ","$1,765.23 ",$97.71 ,"$3,353.94 ","$3,887.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$5,831.25 ","$4,665.00 ","$4,665.00 ","$1,765.23 ","$4,665.00 ","$5,442.50 ","$5,442.50 ","$5,442.50 ","$7,775.00 ", N/A ,"$6,608.75 ","$4,413.08 ","$5,053.75 ","$1,765.23 ","$7,775.00 ","$4,354.00 ","$1,765.23 ","$2,044.83 ", N/A ,$220.37 ,$210.36 ,"$1,853.49 ","$6,220.00 ","$3,971.77 ","$3,506.53 ","$2,177.00 ","$6,997.50 ","$1,765.23 ","$5,442.50 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$3,732.00 ",$200.34 
ST. ELIZABETH'S HOSPITAL,32000083,50690,HC INJ ILEAL CONDUIT,320,1 ,$990.00 ,$643.50 ,$88.65 ,$990.00 , N/A ,$455.40 ,$554.40 , N/A ,$277.20 ,$334.62 , N/A ,$385.11 , N/A ,$446.49 ,$446.49 , N/A ,$88.65 , N/A ,$495.00 , N/A , N/A , N/A , N/A ,$742.50 ,$594.00 ,$594.00 , N/A ,$594.00 ,$693.00 ,$693.00 ,$693.00 ,$990.00 , N/A ,$841.50 , N/A ,$643.50 , N/A ,$990.00 ,$554.40 , N/A ,$260.37 , N/A ,$366.06 ,$349.42 , N/A ,$792.00 , N/A ,$446.49 ,$277.20 ,$891.00 , N/A ,$693.00 ,$365.00 ,$365.00 , N/A ,$365.00 ,$475.20 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000085,51600,HC INJ CYSTOGRAM,320,1 ,"$5,075.00 ","$3,298.75 ",$57.16 ,"$5,075.00 ", N/A ,"$2,334.50 ","$2,842.00 ", N/A ,"$1,421.00 ","$1,715.35 ", N/A ,"$1,974.18 ", N/A ,"$2,288.83 ","$2,288.83 ", N/A ,$57.16 , N/A ,"$2,537.50 ", N/A , N/A , N/A , N/A ,"$3,806.25 ","$3,045.00 ","$3,045.00 ", N/A ,"$3,045.00 ","$3,552.50 ","$3,552.50 ","$3,552.50 ","$5,075.00 ", N/A ,"$4,313.75 ", N/A ,"$3,298.75 ", N/A ,"$5,075.00 ","$2,842.00 ", N/A ,"$1,334.73 ", N/A ,$366.06 ,$349.42 , N/A ,"$4,060.00 ", N/A ,"$2,288.83 ","$1,421.00 ","$4,567.50 ", N/A ,"$3,552.50 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$2,436.00 ",$332.78 
ST. ELIZABETH'S HOSPITAL,32000086,51610,HC INJ URETHROCYSTOGRAM RETRO,320,1 ,$594.00 ,$386.10 ,$81.85 ,$594.00 , N/A ,$273.24 ,$332.64 , N/A ,$166.32 ,$200.77 , N/A ,$231.07 , N/A ,$267.89 ,$267.89 , N/A ,$81.85 , N/A ,$297.00 , N/A , N/A , N/A , N/A ,$445.50 ,$356.40 ,$356.40 , N/A ,$356.40 ,$415.80 ,$415.80 ,$415.80 ,$594.00 , N/A ,$504.90 , N/A ,$386.10 , N/A ,$594.00 ,$332.64 , N/A ,$156.22 , N/A ,$366.06 ,$349.42 , N/A ,$475.20 , N/A ,$267.89 ,$166.32 ,$534.60 , N/A ,$415.80 ,$365.00 ,$365.00 , N/A ,$365.00 ,$285.12 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,"$5,075.00 ","$3,298.75 ",$73.59 ,"$5,075.00 ", N/A ,"$2,334.50 ","$2,842.00 ", N/A ,"$1,421.00 ","$1,715.35 ", N/A ,"$1,974.18 ", N/A ,"$2,288.83 ","$2,288.83 ", N/A ,$73.59 , N/A ,"$2,537.50 ", N/A , N/A , N/A , N/A ,"$3,806.25 ","$3,045.00 ","$3,045.00 ", N/A ,"$3,045.00 ","$3,552.50 ","$3,552.50 ","$3,552.50 ","$5,075.00 ", N/A ,"$4,313.75 ", N/A ,"$3,298.75 ", N/A ,"$5,075.00 ","$2,842.00 ", N/A ,"$1,334.73 ", N/A ,$366.06 ,$349.42 , N/A ,"$4,060.00 ", N/A ,"$2,288.83 ","$1,421.00 ","$4,567.50 ", N/A ,"$3,552.50 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$2,436.00 ",$332.78 
ST. ELIZABETH'S HOSPITAL,32000089,61070,HC PUNCT ASP/INJ SHUNT TUBE,320,1 ,"$2,395.00 ","$1,556.75 ",$75.58 ,"$2,395.00 ","$1,565.08 ","$1,101.70 ","$1,341.20 ",$626.03 ,$670.60 ,$809.51 ,$626.03 ,$931.66 ,$626.03 ,"$1,080.15 ","$1,080.15 ",$626.03 ,$75.58 ,"$1,189.46 ","$1,197.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,796.25 ","$1,437.00 ","$1,437.00 ",$626.03 ,"$1,437.00 ","$1,676.50 ","$1,676.50 ","$1,676.50 ","$2,395.00 ", N/A ,"$2,035.75 ","$1,565.07 ","$1,556.75 ",$626.03 ,"$2,395.00 ","$1,341.20 ",$626.03 ,$629.89 , N/A ,$366.06 ,$349.42 ,$657.33 ,"$1,916.00 ","$1,408.57 ","$1,080.15 ",$670.60 ,"$2,155.50 ",$626.03 ,"$1,676.50 ",$365.00 ,$365.00 ,$626.03 ,$365.00 ,"$1,149.60 ",$332.78 
ST. ELIZABETH'S HOSPITAL,32000090,62272,HC LUMBAR PUNCTURE DRAIN,320,1 ,"$1,811.00 ","$1,177.15 ",$123.26 ,"$1,811.00 ","$1,565.08 ",$833.06 ,"$1,014.16 ",$626.03 ,$507.08 ,$612.12 ,$626.03 ,$704.48 ,$626.03 ,$816.76 ,$816.76 ,$626.03 ,$123.26 ,"$1,189.46 ",$905.50 ,"$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,358.25 ","$1,086.60 ","$1,086.60 ",$626.03 ,"$1,086.60 ","$1,267.70 ","$1,267.70 ","$1,267.70 ","$1,811.00 ", N/A ,"$1,539.35 ","$1,565.07 ","$1,177.15 ",$626.03 ,"$1,811.00 ","$1,014.16 ",$626.03 ,$476.29 , N/A ,$544.79 ,$520.02 ,$657.33 ,"$1,448.80 ","$1,408.57 ",$816.76 ,$507.08 ,"$1,629.90 ",$626.03 ,"$1,267.70 ",$365.00 ,$365.00 ,$626.03 ,$365.00 ,$869.28 ,$495.26 
ST. ELIZABETH'S HOSPITAL,32000091,62284,HC INJ MYELOGRAM,320,1 ,"$1,136.00 ",$738.40 ,$110.53 ,"$1,136.00 ", N/A ,$522.56 ,$636.16 , N/A ,$318.08 ,$383.97 , N/A ,$441.90 , N/A ,$512.34 ,$512.34 , N/A ,$110.53 , N/A ,$568.00 , N/A , N/A , N/A , N/A ,$852.00 ,$681.60 ,$681.60 , N/A ,$681.60 ,$795.20 ,$795.20 ,$795.20 ,"$1,136.00 ", N/A ,$965.60 , N/A ,$738.40 , N/A ,"$1,136.00 ",$636.16 , N/A ,$298.77 , N/A ,$638.58 ,$609.56 , N/A ,$908.80 , N/A ,$512.34 ,$318.08 ,"$1,022.40 ", N/A ,$795.20 ,$365.00 ,$365.00 , N/A ,$365.00 ,$545.28 ,$580.53 
ST. ELIZABETH'S HOSPITAL,32000093,62290,HC INJ DISKOGRAM LUMBAR EA LEVEL,320,1 ,"$3,568.00 ","$2,319.20 ",$207.04 ,"$3,568.00 ", N/A ,"$1,641.28 ","$1,998.08 ", N/A ,$999.04 ,"$1,205.98 ", N/A ,"$1,387.95 ", N/A ,"$1,609.17 ","$1,609.17 ", N/A ,$207.04 , N/A ,"$1,784.00 ", N/A , N/A , N/A , N/A ,"$2,676.00 ","$2,140.80 ","$2,140.80 ", N/A ,"$2,140.80 ","$2,497.60 ","$2,497.60 ","$2,497.60 ","$3,568.00 ", N/A ,"$3,032.80 ", N/A ,"$2,319.20 ", N/A ,"$3,568.00 ","$1,998.08 ", N/A ,$938.38 , N/A ,$638.58 ,$609.56 , N/A ,"$2,854.40 ", N/A ,"$1,609.17 ",$999.04 ,"$3,211.20 ", N/A ,"$2,497.60 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$1,712.64 ",$580.53 
ST. ELIZABETH'S HOSPITAL,32000094,62291,HC INJ DISKOGRAM CERVICAL EA LVL,320,1 ,"$2,944.00 ","$1,913.60 ",$191.93 ,"$2,944.00 ", N/A ,"$1,354.24 ","$1,648.64 ", N/A ,$824.32 ,$995.07 , N/A ,"$1,145.22 ", N/A ,"$1,327.74 ","$1,327.74 ", N/A ,$191.93 , N/A ,"$1,472.00 ", N/A , N/A , N/A , N/A ,"$2,208.00 ","$1,766.40 ","$1,766.40 ", N/A ,"$1,766.40 ","$2,060.80 ","$2,060.80 ","$2,060.80 ","$2,944.00 ", N/A ,"$2,502.40 ", N/A ,"$1,913.60 ", N/A ,"$2,944.00 ","$1,648.64 ", N/A ,$774.27 , N/A ,$638.58 ,$609.56 , N/A ,"$2,355.20 ", N/A ,"$1,327.74 ",$824.32 ,"$2,649.60 ", N/A ,"$2,060.80 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$1,413.12 ",$580.53 
ST. ELIZABETH'S HOSPITAL,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$436.00 ,$283.40 ,$29.24 ,$436.00 ,$199.38 ,$37.04 ,$244.16 ,$79.75 ,$122.08 ,$153.91 ,$79.75 ,$179.63 ,$79.75 ,$196.64 ,$196.64 ,$79.75 ,$29.24 ,$151.52 ,$56.37 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$327.00 ,$261.60 ,$261.60 ,$79.75 ,$261.60 ,$29.46 ,$29.46 ,$29.46 ,$436.00 , N/A ,$370.60 ,$199.36 ,$283.40 ,$79.75 ,$436.00 ,$244.16 ,$79.75 ,$114.67 , N/A ,$88.02 ,$84.02 ,$83.74 ,$348.80 ,$179.43 ,$196.64 ,$122.08 ,$392.40 ,$79.75 ,$29.46 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$209.28 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$307.00 ,$199.55 ,$29.24 ,$307.00 ,$199.38 ,$37.04 ,$171.92 ,$79.75 ,$85.96 ,$108.37 ,$79.75 ,$126.48 ,$79.75 ,$138.46 ,$138.46 ,$79.75 ,$29.24 ,$151.52 ,$56.37 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$230.25 ,$184.20 ,$184.20 ,$79.75 ,$184.20 ,$29.46 ,$29.46 ,$29.46 ,$307.00 , N/A ,$260.95 ,$199.36 ,$199.55 ,$79.75 ,$307.00 ,$171.92 ,$79.75 ,$80.74 , N/A ,$58.69 ,$56.02 ,$83.74 ,$245.60 ,$179.43 ,$138.46 ,$85.96 ,$276.30 ,$79.75 ,$29.46 ,$307.00 ,$307.00 ,$79.75 ,$307.00 ,$147.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$591.00 ,$384.15 ,$38.42 ,$591.00 ,$268.33 ,$49.80 ,$330.96 ,$107.33 ,$165.48 ,$208.62 ,$107.33 ,$243.49 ,$107.33 ,$266.54 ,$266.54 ,$107.33 ,$39.43 ,$203.93 ,$73.54 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$443.25 ,$354.60 ,$354.60 ,$107.33 ,$354.60 ,$38.42 ,$38.42 ,$38.42 ,$591.00 , N/A ,$502.35 ,$268.33 ,$384.15 ,$107.33 ,$591.00 ,$330.96 ,$107.33 ,$155.43 , N/A ,$58.69 ,$56.02 ,$112.70 ,$472.80 ,$241.50 ,$266.54 ,$165.48 ,$531.90 ,$107.33 ,$38.42 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$283.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$641.00 ,$416.65 ,$53.35 ,$641.00 ,$268.33 ,$71.70 ,$358.96 ,$107.33 ,$179.48 ,$226.27 ,$107.33 ,$264.09 ,$107.33 ,$289.09 ,$289.09 ,$107.33 ,$56.95 ,$203.93 ,$106.93 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$480.75 ,$384.60 ,$384.60 ,$107.33 ,$384.60 ,$55.80 ,$55.80 ,$55.80 ,$641.00 , N/A ,$544.85 ,$268.33 ,$416.65 ,$107.33 ,$641.00 ,$358.96 ,$107.33 ,$168.58 , N/A ,$58.69 ,$56.02 ,$112.70 ,$512.80 ,$241.50 ,$289.09 ,$179.48 ,$576.90 ,$107.33 ,$55.80 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$307.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$459.00 ,$298.35 ,$27.61 ,$459.00 ,$199.38 ,$37.64 ,$257.04 ,$79.75 ,$128.52 ,$162.03 ,$79.75 ,$189.11 ,$79.75 ,$207.01 ,$207.01 ,$79.75 ,$27.61 ,$151.52 ,$54.47 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$344.25 ,$275.40 ,$275.40 ,$79.75 ,$275.40 ,$28.47 ,$28.47 ,$28.47 ,$459.00 , N/A ,$390.15 ,$199.36 ,$298.35 ,$79.75 ,$459.00 ,$257.04 ,$79.75 ,$120.72 , N/A ,$58.69 ,$56.02 ,$83.74 ,$367.20 ,$179.43 ,$207.01 ,$128.52 ,$413.10 ,$79.75 ,$28.47 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$220.32 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$769.00 ,$499.85 ,$42.39 ,$769.00 ,$268.33 ,$54.66 ,$430.64 ,$107.33 ,$215.32 ,$271.46 ,$107.33 ,$313.85 ,$107.33 ,$346.82 ,$346.82 ,$107.33 ,$43.10 ,$203.93 ,$81.17 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$576.75 ,$461.40 ,$461.40 ,$107.33 ,$461.40 ,$42.39 ,$42.39 ,$42.39 ,$769.00 , N/A ,$653.65 ,$268.33 ,$499.85 ,$107.33 ,$769.00 ,$430.64 ,$107.33 ,$202.25 , N/A ,$58.69 ,$56.02 ,$112.70 ,$615.20 ,$241.50 ,$346.82 ,$215.32 ,$692.10 ,$107.33 ,$42.39 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$369.12 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$374.00 ,$243.10 ,$35.93 ,$374.00 ,$199.38 ,$44.94 ,$209.44 ,$79.75 ,$104.72 ,$132.02 ,$79.75 ,$154.09 ,$79.75 ,$168.67 ,$168.67 ,$79.75 ,$36.58 ,$151.52 ,$68.77 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$280.50 ,$224.40 ,$224.40 ,$79.75 ,$224.40 ,$35.93 ,$35.93 ,$35.93 ,$374.00 , N/A ,$317.90 ,$199.36 ,$243.10 ,$79.75 ,$374.00 ,$209.44 ,$79.75 ,$98.36 , N/A ,$58.69 ,$56.02 ,$83.74 ,$299.20 ,$179.43 ,$168.67 ,$104.72 ,$336.60 ,$79.75 ,$35.93 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$179.52 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$591.00 ,$384.15 ,$41.88 ,$591.00 ,$268.33 ,$55.28 ,$330.96 ,$107.33 ,$165.48 ,$208.62 ,$107.33 ,$243.49 ,$107.33 ,$266.54 ,$266.54 ,$107.33 ,$43.10 ,$203.93 ,$80.22 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$443.25 ,$354.60 ,$354.60 ,$107.33 ,$354.60 ,$41.88 ,$41.88 ,$41.88 ,$591.00 , N/A ,$502.35 ,$268.33 ,$384.15 ,$107.33 ,$591.00 ,$330.96 ,$107.33 ,$155.43 , N/A ,$58.69 ,$56.02 ,$112.70 ,$472.80 ,$241.50 ,$266.54 ,$165.48 ,$531.90 ,$107.33 ,$41.88 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$283.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$429.00 ,$278.85 ,$29.65 ,$429.00 ,$199.38 ,$40.68 ,$240.24 ,$79.75 ,$120.12 ,$151.44 ,$79.75 ,$176.75 ,$79.75 ,$193.48 ,$193.48 ,$79.75 ,$29.65 ,$151.52 ,$61.14 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$321.75 ,$257.40 ,$257.40 ,$79.75 ,$257.40 ,$31.95 ,$31.95 ,$31.95 ,$429.00 , N/A ,$364.65 ,$199.36 ,$278.85 ,$79.75 ,$429.00 ,$240.24 ,$79.75 ,$112.83 , N/A ,$58.69 ,$56.02 ,$83.74 ,$343.20 ,$179.43 ,$193.48 ,$120.12 ,$386.10 ,$79.75 ,$31.95 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$205.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$580.00 ,$377.00 ,$33.73 ,$580.00 ,$199.38 ,$48.58 ,$324.80 ,$79.75 ,$162.40 ,$204.74 ,$79.75 ,$238.96 ,$79.75 ,$261.58 ,$261.58 ,$79.75 ,$33.73 ,$151.52 ,$70.68 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$435.00 ,$348.00 ,$348.00 ,$79.75 ,$348.00 ,$36.92 ,$36.92 ,$36.92 ,$580.00 , N/A ,$493.00 ,$199.36 ,$377.00 ,$79.75 ,$580.00 ,$324.80 ,$79.75 ,$152.54 , N/A ,$58.69 ,$56.02 ,$83.74 ,$464.00 ,$179.43 ,$261.58 ,$162.40 ,$522.00 ,$79.75 ,$36.92 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$278.40 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$440.00 ,$286.00 ,$33.31 ,$440.00 ,$268.33 ,$45.54 ,$246.40 ,$107.33 ,$123.20 ,$155.32 ,$107.33 ,$181.28 ,$107.33 ,$198.44 ,$198.44 ,$107.33 ,$33.31 ,$203.93 ,$67.82 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$330.00 ,$264.00 ,$264.00 ,$107.33 ,$264.00 ,$35.43 ,$35.43 ,$35.43 ,$440.00 , N/A ,$374.00 ,$268.33 ,$286.00 ,$107.33 ,$440.00 ,$246.40 ,$107.33 ,$115.72 , N/A ,$58.69 ,$56.02 ,$112.70 ,$352.00 ,$241.50 ,$198.44 ,$123.20 ,$396.00 ,$107.33 ,$35.43 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$211.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$591.00 ,$384.15 ,$38.61 ,$591.00 ,$268.33 ,$55.88 ,$330.96 ,$107.33 ,$165.48 ,$208.62 ,$107.33 ,$243.49 ,$107.33 ,$266.54 ,$266.54 ,$107.33 ,$38.61 ,$203.93 ,$80.22 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$443.25 ,$354.60 ,$354.60 ,$107.33 ,$354.60 ,$41.88 ,$41.88 ,$41.88 ,$591.00 , N/A ,$502.35 ,$268.33 ,$384.15 ,$107.33 ,$591.00 ,$330.96 ,$107.33 ,$155.43 , N/A ,$58.69 ,$56.02 ,$112.70 ,$472.80 ,$241.50 ,$266.54 ,$165.48 ,$531.90 ,$107.33 ,$41.88 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$283.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$591.00 ,$384.15 ,$51.65 ,$591.00 ,$199.38 ,$65.62 ,$330.96 ,$79.75 ,$165.48 ,$208.62 ,$79.75 ,$243.49 ,$79.75 ,$266.54 ,$266.54 ,$79.75 ,$51.65 ,$151.52 ,$99.30 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$443.25 ,$354.60 ,$354.60 ,$79.75 ,$354.60 ,$51.83 ,$51.83 ,$51.83 ,$591.00 , N/A ,$502.35 ,$199.36 ,$384.15 ,$79.75 ,$591.00 ,$330.96 ,$79.75 ,$155.43 , N/A ,$58.69 ,$56.02 ,$83.74 ,$472.80 ,$179.43 ,$266.54 ,$165.48 ,$531.90 ,$79.75 ,$51.83 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$283.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000114,70336,HC MRI TMJ,320,1 ,"$4,045.00 ","$2,629.25 ",$224.13 ,"$4,045.00 ",$567.13 ,$660.20 ,"$2,265.20 ",$226.85 ,"$1,132.60 ","$1,427.89 ",$226.85 ,"$1,666.54 ",$226.85 ,"$1,824.30 ","$1,824.30 ",$226.85 ,$258.98 ,$431.02 ,"$2,022.50 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$3,033.75 ","$2,427.00 ","$2,427.00 ",$226.85 ,"$2,427.00 ",$318.27 ,$318.27 ,$318.27 ,"$4,045.00 ", N/A ,"$3,438.25 ",$567.13 ,"$2,629.25 ",$226.85 ,"$4,045.00 ","$2,265.20 ",$226.85 ,"$1,063.84 ", N/A ,$246.54 ,$235.34 ,$238.19 ,"$3,236.00 ",$510.41 ,"$1,824.30 ","$1,132.60 ","$3,640.50 ",$226.85 ,$318.27 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,"$1,941.60 ",$224.13 
ST. ELIZABETH'S HOSPITAL,32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$428.00 ,$278.20 ,$28.03 ,$428.00 ,$199.38 ,$35.22 ,$239.68 ,$79.75 ,$119.84 ,$151.08 ,$79.75 ,$176.34 ,$79.75 ,$193.03 ,$193.03 ,$79.75 ,$28.03 ,$151.52 ,$58.28 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$321.00 ,$256.80 ,$256.80 ,$79.75 ,$256.80 ,$30.47 ,$30.47 ,$30.47 ,$428.00 , N/A ,$363.80 ,$199.36 ,$278.20 ,$79.75 ,$428.00 ,$239.68 ,$79.75 ,$112.56 , N/A ,$58.69 ,$56.02 ,$83.74 ,$342.40 ,$179.43 ,$193.03 ,$119.84 ,$385.20 ,$79.75 ,$30.47 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$205.44 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000120,70390,HC XRAY SIALOGRAPHY,320,1 ,$764.00 ,$496.60 ,$117.41 ,$764.00 ,$567.13 ,$148.90 ,$427.84 ,$226.85 ,$213.92 ,$269.69 ,$226.85 ,$314.77 ,$226.85 ,$344.56 ,$344.56 ,$226.85 ,$125.41 ,$431.02 ,$225.21 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$573.00 ,$458.40 ,$458.40 ,$226.85 ,$458.40 ,$117.41 ,$117.41 ,$117.41 ,$764.00 , N/A ,$649.40 ,$567.13 ,$496.60 ,$226.85 ,$764.00 ,$427.84 ,$226.85 ,$200.93 , N/A ,$334.40 ,$319.20 ,$238.19 ,$611.20 ,$510.41 ,$344.56 ,$213.92 ,$687.60 ,$226.85 ,$117.41 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$366.72 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000121,71045,HC XR CHEST 1V,320,1 ,$322.00 ,$209.30 ,$18.14 ,$322.00 ,$199.38 ,$18.70 ,$180.32 ,$79.75 ,$90.16 ,$113.67 ,$79.75 ,$121.29 ,$79.75 ,$145.22 ,$145.22 ,$79.75 ,$21.09 ,$151.52 ,$42.06 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$241.50 ,$193.20 ,$193.20 ,$79.75 ,$193.20 ,$22.02 ,$22.02 ,$22.02 ,$322.00 , N/A ,$273.70 ,$199.36 ,$209.30 ,$79.75 ,$18.14 ,$180.32 ,$79.75 ,$84.69 , N/A ,$58.69 ,$56.02 ,$83.74 ,$257.60 ,$179.43 ,$145.22 ,$90.16 ,$289.80 ,$79.75 ,$22.02 ,$322.00 ,$322.00 ,$79.75 ,$322.00 ,$154.56 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000124,71045,HC XR CHEST 1V EMPLOYEE,320,1 ,$322.00 ,$209.30 ,$18.14 ,$322.00 ,$199.38 ,$18.70 ,$180.32 ,$79.75 ,$90.16 ,$113.67 ,$79.75 ,$121.29 ,$79.75 ,$145.22 ,$145.22 ,$79.75 ,$21.09 ,$151.52 ,$42.06 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$241.50 ,$193.20 ,$193.20 ,$79.75 ,$193.20 ,$22.02 ,$22.02 ,$22.02 ,$322.00 , N/A ,$273.70 ,$199.36 ,$209.30 ,$79.75 ,$18.14 ,$180.32 ,$79.75 ,$84.69 , N/A ,$58.69 ,$56.02 ,$83.74 ,$257.60 ,$179.43 ,$145.22 ,$90.16 ,$289.80 ,$79.75 ,$22.02 ,$322.00 ,$322.00 ,$79.75 ,$322.00 ,$154.56 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000127,71046,HC XR CHEST 2V,320,1 ,$542.00 ,$352.30 ,$24.70 ,$542.00 ,$199.38 ,$34.24 ,$303.52 ,$79.75 ,$151.76 ,$191.33 ,$79.75 ,$219.55 ,$79.75 ,$244.44 ,$244.44 ,$79.75 ,$28.43 ,$151.52 ,$55.42 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$406.50 ,$325.20 ,$325.20 ,$79.75 ,$325.20 ,$28.97 ,$28.97 ,$28.97 ,$542.00 , N/A ,$460.70 ,$199.36 ,$352.30 ,$79.75 ,$24.70 ,$303.52 ,$79.75 ,$142.55 , N/A ,$58.69 ,$56.02 ,$83.74 ,$433.60 ,$179.43 ,$244.44 ,$151.76 ,$487.80 ,$79.75 ,$28.97 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$260.16 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$511.00 ,$332.15 ,$35.93 ,$511.00 ,$199.38 ,$43.56 ,$286.16 ,$79.75 ,$143.08 ,$180.38 ,$79.75 ,$210.53 ,$79.75 ,$230.46 ,$230.46 ,$79.75 ,$36.18 ,$151.52 ,$68.77 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$383.25 ,$306.60 ,$306.60 ,$79.75 ,$306.60 ,$35.93 ,$35.93 ,$35.93 ,$511.00 , N/A ,$434.35 ,$199.36 ,$332.15 ,$79.75 ,$511.00 ,$286.16 ,$79.75 ,$134.39 , N/A ,$58.69 ,$56.02 ,$83.74 ,$408.80 ,$179.43 ,$230.46 ,$143.08 ,$459.90 ,$79.75 ,$35.93 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$245.28 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000131,71048,HC XR CHEST PA/LAT W/OBLIQUES,320,1 ,$503.00 ,$326.95 ,$37.41 ,$503.00 ,$268.33 ,$44.80 ,$281.68 ,$107.33 ,$140.84 ,$177.56 ,$107.33 ,$207.24 ,$107.33 ,$226.85 ,$226.85 ,$107.33 ,$38.61 ,$203.93 ,$71.64 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$377.25 ,$301.80 ,$301.80 ,$107.33 ,$301.80 ,$37.41 ,$37.41 ,$37.41 ,$503.00 , N/A ,$427.55 ,$268.33 ,$326.95 ,$107.33 ,$503.00 ,$281.68 ,$107.33 ,$132.29 , N/A ,$58.69 ,$56.02 ,$112.70 ,$402.40 ,$241.50 ,$226.85 ,$140.84 ,$452.70 ,$107.33 ,$37.41 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$241.44 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$542.00 ,$352.30 ,$24.70 ,$542.00 ,$199.38 ,$34.24 ,$303.52 ,$79.75 ,$151.76 ,$191.33 ,$79.75 ,$219.55 ,$79.75 ,$244.44 ,$244.44 ,$79.75 ,$28.43 ,$151.52 ,$55.42 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$406.50 ,$325.20 ,$325.20 ,$79.75 ,$325.20 ,$28.97 ,$28.97 ,$28.97 ,$542.00 , N/A ,$460.70 ,$199.36 ,$352.30 ,$79.75 ,$24.70 ,$303.52 ,$79.75 ,$142.55 , N/A ,$58.69 ,$56.02 ,$83.74 ,$433.60 ,$179.43 ,$244.44 ,$151.76 ,$487.80 ,$79.75 ,$28.97 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$260.16 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000137,71100,HC XR RIBS 2V UNI,320,1 ,$547.00 ,$355.55 ,$32.10 ,$547.00 ,$199.38 ,$39.48 ,$306.32 ,$79.75 ,$153.16 ,$193.09 ,$79.75 ,$225.36 ,$79.75 ,$246.70 ,$246.70 ,$79.75 ,$32.10 ,$151.52 ,$62.10 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$410.25 ,$328.20 ,$328.20 ,$79.75 ,$328.20 ,$32.45 ,$32.45 ,$32.45 ,$547.00 , N/A ,$464.95 ,$199.36 ,$355.55 ,$79.75 ,$547.00 ,$306.32 ,$79.75 ,$143.86 , N/A ,$58.69 ,$56.02 ,$83.74 ,$437.60 ,$179.43 ,$246.70 ,$153.16 ,$492.30 ,$79.75 ,$32.45 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$262.56 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$336.00 ,$218.40 ,$35.93 ,$336.00 ,$268.33 ,$47.98 ,$188.16 ,$107.33 ,$94.08 ,$118.61 ,$107.33 ,$138.43 ,$107.33 ,$151.54 ,$151.54 ,$107.33 ,$36.18 ,$203.93 ,$68.77 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$252.00 ,$201.60 ,$201.60 ,$107.33 ,$201.60 ,$35.93 ,$35.93 ,$35.93 ,$336.00 , N/A ,$285.60 ,$268.33 ,$218.40 ,$107.33 ,$336.00 ,$188.16 ,$107.33 ,$88.37 , N/A ,$58.69 ,$56.02 ,$112.70 ,$268.80 ,$241.50 ,$151.54 ,$94.08 ,$302.40 ,$107.33 ,$35.93 ,$336.00 ,$336.00 ,$107.33 ,$336.00 ,$161.28 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$710.00 ,$461.50 ,$36.92 ,$710.00 ,$268.33 ,$50.42 ,$397.60 ,$107.33 ,$198.80 ,$250.63 ,$107.33 ,$282.41 ,$107.33 ,$320.21 ,$320.21 ,$107.33 ,$36.99 ,$203.93 ,$70.68 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$532.50 ,$426.00 ,$426.00 ,$107.33 ,$426.00 ,$36.92 ,$36.92 ,$36.92 ,$710.00 , N/A ,$603.50 ,$268.33 ,$461.50 ,$107.33 ,$710.00 ,$397.60 ,$107.33 ,$186.73 , N/A ,$58.69 ,$56.02 ,$112.70 ,$568.00 ,$241.50 ,$320.21 ,$198.80 ,$639.00 ,$107.33 ,$36.92 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$340.80 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$887.00 ,$576.55 ,$45.36 ,$887.00 ,$268.33 ,$67.44 ,$496.72 ,$107.33 ,$248.36 ,$313.11 ,$107.33 ,$341.31 ,$107.33 ,$400.04 ,$400.04 ,$107.33 ,$45.95 ,$203.93 ,$86.90 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$665.25 ,$532.20 ,$532.20 ,$107.33 ,$532.20 ,$45.36 ,$45.36 ,$45.36 ,$887.00 , N/A ,$753.95 ,$268.33 ,$576.55 ,$107.33 ,$887.00 ,$496.72 ,$107.33 ,$233.28 , N/A ,$58.69 ,$56.02 ,$112.70 ,$709.60 ,$241.50 ,$400.04 ,$248.36 ,$798.30 ,$107.33 ,$45.36 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$425.76 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000141,71120,HC XR STERNUM 2+V,320,1 ,$549.00 ,$356.85 ,$29.46 ,$549.00 ,$199.38 ,$40.68 ,$307.44 ,$79.75 ,$153.72 ,$193.80 ,$79.75 ,$219.55 ,$79.75 ,$247.60 ,$247.60 ,$79.75 ,$30.06 ,$151.52 ,$56.37 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$411.75 ,$329.40 ,$329.40 ,$79.75 ,$329.40 ,$29.46 ,$29.46 ,$29.46 ,$549.00 , N/A ,$466.65 ,$199.36 ,$356.85 ,$79.75 ,$549.00 ,$307.44 ,$79.75 ,$144.39 , N/A ,$58.69 ,$56.02 ,$83.74 ,$439.20 ,$179.43 ,$247.60 ,$153.72 ,$494.10 ,$79.75 ,$29.46 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$263.52 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$530.00 ,$344.50 ,$36.92 ,$530.00 ,$199.38 ,$48.58 ,$296.80 ,$79.75 ,$148.40 ,$187.09 ,$79.75 ,$218.36 ,$79.75 ,$239.03 ,$239.03 ,$79.75 ,$38.21 ,$151.52 ,$70.68 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$397.50 ,$318.00 ,$318.00 ,$79.75 ,$318.00 ,$36.92 ,$36.92 ,$36.92 ,$530.00 , N/A ,$450.50 ,$199.36 ,$344.50 ,$79.75 ,$530.00 ,$296.80 ,$79.75 ,$139.39 , N/A ,$58.69 ,$56.02 ,$83.74 ,$424.00 ,$179.43 ,$239.03 ,$148.40 ,$477.00 ,$79.75 ,$36.92 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$254.40 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$2,898.00 ","$1,883.70 ",$105.85 ,"$2,898.00 ",$268.33 ,$750.00 ,"$1,622.88 ",$107.33 ,$811.44 ,"$1,022.99 ",$107.33 ,"$1,193.98 ",$107.33 ,"$1,307.00 ","$1,307.00 ",$107.33 ,$105.85 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$2,173.50 ","$1,738.80 ","$1,738.80 ",$107.33 ,"$1,738.80 ",$139.76 ,$139.76 ,$139.76 ,"$2,898.00 ", N/A ,"$2,463.30 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,898.00 ","$1,622.88 ",$107.33 ,$762.17 , N/A ,$146.41 ,$139.76 ,$112.70 ,"$2,318.40 ",$241.50 ,"$1,307.00 ",$811.44 ,"$2,608.20 ",$107.33 ,$139.76 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,391.04 ",$133.10 
ST. ELIZABETH'S HOSPITAL,32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$2,715.00 ","$1,764.75 ",$133.10 ,"$2,715.00 ",$440.25 ,$750.00 ,"$1,520.40 ",$176.10 ,$760.20 ,$958.40 ,$176.10 ,"$1,118.58 ",$176.10 ,"$1,224.47 ","$1,224.47 ",$176.10 ,$144.56 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,036.25 ","$1,629.00 ","$1,629.00 ",$176.10 ,"$1,629.00 ",$186.96 ,$186.96 ,$186.96 ,"$2,715.00 ", N/A ,"$2,307.75 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,715.00 ","$1,520.40 ",$176.10 ,$714.05 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$2,172.00 ",$396.23 ,"$1,224.47 ",$760.20 ,"$2,443.50 ",$176.10 ,$186.96 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,303.20 ",$133.10 
ST. ELIZABETH'S HOSPITAL,32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$3,600.00 ","$2,340.00 ",$133.10 ,"$3,600.00 ",$440.25 ,$750.00 ,"$2,016.00 ",$176.10 ,"$1,008.00 ","$1,270.80 ",$176.10 ,"$1,483.20 ",$176.10 ,"$1,623.60 ","$1,623.60 ",$176.10 ,$179.10 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,700.00 ","$2,160.00 ","$2,160.00 ",$176.10 ,"$2,160.00 ",$228.18 ,$228.18 ,$228.18 ,"$3,600.00 ", N/A ,"$3,060.00 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,600.00 ","$2,016.00 ",$176.10 ,$946.80 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$2,880.00 ",$396.23 ,"$1,623.60 ","$1,008.00 ","$3,240.00 ",$176.10 ,$228.18 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,728.00 ",$133.10 
ST. ELIZABETH'S HOSPITAL,32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$3,482.00 ","$2,263.30 ",$176.10 ,"$3,482.00 ",$440.25 ,$750.00 ,"$1,949.92 ",$176.10 ,$974.96 ,"$1,229.15 ",$176.10 ,"$1,434.58 ",$176.10 ,"$1,570.38 ","$1,570.38 ",$176.10 ,$253.89 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,611.50 ","$2,089.20 ","$2,089.20 ",$176.10 ,"$2,089.20 ",$278.52 ,$278.52 ,$278.52 ,"$3,482.00 ", N/A ,"$2,959.70 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,482.00 ","$1,949.92 ",$176.10 ,$915.77 , N/A ,$330.88 ,$315.84 ,$184.91 ,"$2,785.60 ",$396.23 ,"$1,570.38 ",$974.96 ,"$3,133.80 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,671.36 ",$300.80 
ST. ELIZABETH'S HOSPITAL,32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$2,449.00 ","$1,591.85 ",$226.85 ,"$2,449.00 ",$567.13 ,"$1,100.00 ","$1,371.44 ",$226.85 ,$685.72 ,$864.50 ,$226.85 ,"$1,008.99 ",$226.85 ,"$1,104.50 ","$1,104.50 ",$226.85 ,$356.58 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,836.75 ","$1,469.40 ","$1,469.40 ",$226.85 ,"$1,469.40 ",$317.61 ,$317.61 ,$317.61 ,"$2,449.00 ", N/A ,"$2,081.65 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,449.00 ","$1,371.44 ",$226.85 ,$644.09 , N/A ,$502.16 ,$479.34 ,$238.19 ,"$1,959.20 ",$510.41 ,"$1,104.50 ",$685.72 ,"$2,204.10 ",$226.85 ,$317.61 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,175.52 ",$456.51 
ST. ELIZABETH'S HOSPITAL,32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$2,674.00 ","$1,738.10 ",$387.54 ,"$2,674.00 ","$1,763.33 ","$1,100.00 ","$1,497.44 ",$705.33 ,$748.72 ,$943.92 ,$705.33 ,"$1,101.69 ",$705.33 ,"$1,205.97 ","$1,205.97 ",$705.33 ,$387.54 ,"$1,340.13 ","$1,493.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$2,005.50 ","$1,604.40 ","$1,604.40 ",$705.33 ,"$1,604.40 ",$505.56 ,$505.56 ,$505.56 ,"$2,674.00 ", N/A ,"$2,272.90 ","$1,763.33 ","$1,708.00 ",$705.33 ,"$2,674.00 ","$1,497.44 ",$705.33 ,$703.26 , N/A ,$502.16 ,$479.34 ,$740.60 ,"$2,139.20 ","$1,586.99 ","$1,205.97 ",$748.72 ,"$2,406.60 ",$705.33 ,$505.56 ,"$1,700.00 ","$1,700.00 ",$705.33 ,"$1,700.00 ","$1,283.52 ",$456.51 
ST. ELIZABETH'S HOSPITAL,32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$3,030.00 ","$1,969.50 ",$363.05 ,"$3,030.00 ",$907.63 ,"$1,100.00 ","$1,696.80 ",$363.05 ,$848.40 ,"$1,069.59 ",$363.05 ,"$1,248.36 ",$363.05 ,"$1,366.53 ","$1,366.53 ",$363.05 ,$485.34 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,272.50 ","$1,818.00 ","$1,818.00 ",$363.05 ,"$1,818.00 ",$532.55 ,$532.55 ,$532.55 ,"$3,030.00 ", N/A ,"$2,575.50 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,030.00 ","$1,696.80 ",$363.05 ,$796.89 , N/A ,$502.16 ,$479.34 ,$381.20 ,"$2,424.00 ",$816.86 ,"$1,366.53 ",$848.40 ,"$2,727.00 ",$363.05 ,$532.55 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,454.40 ",$456.51 
ST. ELIZABETH'S HOSPITAL,32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$479.00 ,$311.35 ,$20.69 ,$479.00 ,$199.38 ,$29.74 ,$268.24 ,$79.75 ,$134.12 ,$164.47 ,$79.75 ,$164.47 ,$79.75 ,$216.03 ,$216.03 ,$79.75 ,$20.69 ,$151.52 ,$41.11 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$359.25 ,$287.40 ,$287.40 ,$79.75 ,$287.40 ,$21.53 ,$21.53 ,$21.53 ,$479.00 , N/A ,$407.15 ,$199.36 ,$311.35 ,$79.75 ,$479.00 ,$268.24 ,$79.75 ,$125.98 , N/A ,$58.69 ,$56.02 ,$83.74 ,$383.20 ,$179.43 ,$216.03 ,$134.12 ,$431.10 ,$79.75 ,$21.53 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$229.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000156,72020,HC XR C-SPINE 1V,320,1 ,$479.00 ,$311.35 ,$20.69 ,$479.00 ,$199.38 ,$29.74 ,$268.24 ,$79.75 ,$134.12 ,$164.47 ,$79.75 ,$164.47 ,$79.75 ,$216.03 ,$216.03 ,$79.75 ,$20.69 ,$151.52 ,$41.11 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$359.25 ,$287.40 ,$287.40 ,$79.75 ,$287.40 ,$21.53 ,$21.53 ,$21.53 ,$479.00 , N/A ,$407.15 ,$199.36 ,$311.35 ,$79.75 ,$479.00 ,$268.24 ,$79.75 ,$125.98 , N/A ,$58.69 ,$56.02 ,$83.74 ,$383.20 ,$179.43 ,$216.03 ,$134.12 ,$431.10 ,$79.75 ,$21.53 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$229.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000160,72020,HC XR SPINE 1V (T SPINE),320,1 ,$479.00 ,$311.35 ,$20.69 ,$479.00 ,$199.38 ,$29.74 ,$268.24 ,$79.75 ,$134.12 ,$164.47 ,$79.75 ,$164.47 ,$79.75 ,$216.03 ,$216.03 ,$79.75 ,$20.69 ,$151.52 ,$41.11 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$359.25 ,$287.40 ,$287.40 ,$79.75 ,$287.40 ,$21.53 ,$21.53 ,$21.53 ,$479.00 , N/A ,$407.15 ,$199.36 ,$311.35 ,$79.75 ,$479.00 ,$268.24 ,$79.75 ,$125.98 , N/A ,$58.69 ,$56.02 ,$83.74 ,$383.20 ,$179.43 ,$216.03 ,$134.12 ,$431.10 ,$79.75 ,$21.53 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$229.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000161,72020,HC XR L-SPINE 1V,320,1 ,$479.00 ,$311.35 ,$20.69 ,$479.00 ,$199.38 ,$29.74 ,$268.24 ,$79.75 ,$134.12 ,$164.47 ,$79.75 ,$164.47 ,$79.75 ,$216.03 ,$216.03 ,$79.75 ,$20.69 ,$151.52 ,$41.11 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$359.25 ,$287.40 ,$287.40 ,$79.75 ,$287.40 ,$21.53 ,$21.53 ,$21.53 ,$479.00 , N/A ,$407.15 ,$199.36 ,$311.35 ,$79.75 ,$479.00 ,$268.24 ,$79.75 ,$125.98 , N/A ,$58.69 ,$56.02 ,$83.74 ,$383.20 ,$179.43 ,$216.03 ,$134.12 ,$431.10 ,$79.75 ,$21.53 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$229.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$614.00 ,$399.10 ,$35.35 ,$614.00 ,$199.38 ,$49.80 ,$343.84 ,$79.75 ,$171.92 ,$216.74 ,$79.75 ,$247.02 ,$79.75 ,$276.91 ,$276.91 ,$79.75 ,$35.35 ,$151.52 ,$67.82 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$460.50 ,$368.40 ,$368.40 ,$79.75 ,$368.40 ,$35.43 ,$35.43 ,$35.43 ,$614.00 , N/A ,$521.90 ,$199.36 ,$399.10 ,$79.75 ,$614.00 ,$343.84 ,$79.75 ,$161.48 , N/A ,$58.69 ,$56.02 ,$83.74 ,$491.20 ,$179.43 ,$276.91 ,$171.92 ,$552.60 ,$79.75 ,$35.43 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$294.72 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,"$1,052.00 ",$683.80 ,$48.35 ,"$1,052.00 ",$268.33 ,$67.44 ,$589.12 ,$107.33 ,$294.56 ,$371.36 ,$107.33 ,$417.40 ,$107.33 ,$474.45 ,$474.45 ,$107.33 ,$49.21 ,$203.93 ,$92.62 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$789.00 ,$631.20 ,$631.20 ,$107.33 ,$631.20 ,$48.35 ,$48.35 ,$48.35 ,"$1,052.00 ", N/A ,$894.20 ,$268.33 ,$683.80 ,$107.33 ,"$1,052.00 ",$589.12 ,$107.33 ,$276.68 , N/A ,$58.69 ,$56.02 ,$112.70 ,$841.60 ,$241.50 ,$474.45 ,$294.56 ,$946.80 ,$107.33 ,$48.35 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$504.96 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,$898.00 ,$583.70 ,$53.35 ,$898.00 ,$268.33 ,$88.72 ,$502.88 ,$107.33 ,$251.44 ,$316.99 ,$107.33 ,$369.98 ,$107.33 ,$405.00 ,$405.00 ,$107.33 ,$58.59 ,$203.93 ,$111.70 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$673.50 ,$538.80 ,$538.80 ,$107.33 ,$538.80 ,$58.28 ,$58.28 ,$58.28 ,$898.00 , N/A ,$763.30 ,$268.33 ,$583.70 ,$107.33 ,$898.00 ,$502.88 ,$107.33 ,$236.17 , N/A ,$58.69 ,$56.02 ,$112.70 ,$718.40 ,$241.50 ,$405.00 ,$251.44 ,$808.20 ,$107.33 ,$58.28 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$431.04 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000172,72070,HC XR T-SPINE 2V,320,1 ,$544.00 ,$353.60 ,$28.43 ,$544.00 ,$268.33 ,$41.90 ,$304.64 ,$107.33 ,$152.32 ,$192.03 ,$107.33 ,$224.13 ,$107.33 ,$245.34 ,$245.34 ,$107.33 ,$28.43 ,$203.93 ,$61.14 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$408.00 ,$326.40 ,$326.40 ,$107.33 ,$326.40 ,$31.95 ,$31.95 ,$31.95 ,$544.00 , N/A ,$462.40 ,$268.33 ,$353.60 ,$107.33 ,$544.00 ,$304.64 ,$107.33 ,$143.07 , N/A ,$58.69 ,$56.02 ,$112.70 ,$435.20 ,$241.50 ,$245.34 ,$152.32 ,$489.60 ,$107.33 ,$31.95 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$261.12 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000174,72072,HC XR T-SPINE 3V,320,1 ,$629.00 ,$408.85 ,$34.95 ,$629.00 ,$268.33 ,$49.20 ,$352.24 ,$107.33 ,$176.12 ,$222.04 ,$107.33 ,$259.15 ,$107.33 ,$283.68 ,$283.68 ,$107.33 ,$34.95 ,$203.93 ,$67.82 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$471.75 ,$377.40 ,$377.40 ,$107.33 ,$377.40 ,$35.43 ,$35.43 ,$35.43 ,$629.00 , N/A ,$534.65 ,$268.33 ,$408.85 ,$107.33 ,$629.00 ,$352.24 ,$107.33 ,$165.43 , N/A ,$58.69 ,$56.02 ,$112.70 ,$503.20 ,$241.50 ,$283.68 ,$176.12 ,$566.10 ,$107.33 ,$35.43 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$301.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$883.00 ,$573.95 ,$35.43 ,$883.00 ,$268.33 ,$52.84 ,$494.48 ,$107.33 ,$247.24 ,$266.70 ,$107.33 ,$266.70 ,$107.33 ,$398.23 ,$398.23 ,$107.33 ,$35.76 ,$203.93 ,$67.82 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$662.25 ,$529.80 ,$529.80 ,$107.33 ,$529.80 ,$35.43 ,$35.43 ,$35.43 ,$883.00 , N/A ,$750.55 ,$268.33 ,$573.95 ,$107.33 ,$883.00 ,$494.48 ,$107.33 ,$232.23 , N/A ,$58.69 ,$56.02 ,$112.70 ,$706.40 ,$241.50 ,$398.23 ,$247.24 ,$794.70 ,$107.33 ,$35.43 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$423.84 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000181,72110,HC XR L-SPINE 4+V,320,1 ,"$1,094.00 ",$711.10 ,$47.58 ,"$1,094.00 ",$268.33 ,$72.30 ,$612.64 ,$107.33 ,$306.32 ,$386.18 ,$107.33 ,$450.73 ,$107.33 ,$493.39 ,$493.39 ,$107.33 ,$47.58 ,$203.93 ,$94.53 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$820.50 ,$656.40 ,$656.40 ,$107.33 ,$656.40 ,$49.34 ,$49.34 ,$49.34 ,"$1,094.00 ", N/A ,$929.90 ,$268.33 ,$711.10 ,$107.33 ,"$1,094.00 ",$612.64 ,$107.33 ,$287.72 , N/A ,$58.69 ,$56.02 ,$112.70 ,$875.20 ,$241.50 ,$493.39 ,$306.32 ,$984.60 ,$107.33 ,$49.34 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$525.12 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000183,72120,HC XR L-SPINE BENDING ONLY MIN 4V,320,1 ,$178.00 ,$115.70 ,$36.99 ,$268.33 ,$268.33 ,$72.30 ,$99.68 ,$107.33 ,$49.84 ,$62.83 ,$107.33 ,$73.34 ,$107.33 ,$80.28 ,$80.28 ,$107.33 ,$36.99 ,$178.00 ,$84.99 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$133.50 ,$106.80 ,$106.80 ,$107.33 ,$106.80 ,$44.37 ,$44.37 ,$44.37 ,$178.00 , N/A ,$151.30 ,$178.00 ,$115.70 ,$107.33 ,$178.00 ,$99.68 ,$107.33 ,$46.81 , N/A ,$58.69 ,$56.02 ,$112.70 ,$142.40 ,$241.50 ,$80.28 ,$49.84 ,$160.20 ,$107.33 ,$44.37 ,$178.00 ,$178.00 ,$107.33 ,$178.00 ,$85.44 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,"$1,110.00 ",$721.50 ,$53.35 ,"$1,110.00 ",$268.33 ,$100.88 ,$621.60 ,$107.33 ,$310.80 ,$391.83 ,$107.33 ,$457.32 ,$107.33 ,$500.61 ,$500.61 ,$107.33 ,$58.18 ,$203.93 ,$111.70 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$832.50 ,$666.00 ,$666.00 ,$107.33 ,$666.00 ,$58.28 ,$58.28 ,$58.28 ,"$1,110.00 ", N/A ,$943.50 ,$268.33 ,$721.50 ,$107.33 ,"$1,110.00 ",$621.60 ,$107.33 ,$291.93 , N/A ,$58.69 ,$56.02 ,$112.70 ,$888.00 ,$241.50 ,$500.61 ,$310.80 ,$999.00 ,$107.33 ,$58.28 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$532.80 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000186,72170,HC XR PELVIS 1-2V,320,1 ,$379.00 ,$246.35 ,$23.95 ,$379.00 ,$268.33 ,$32.78 ,$212.24 ,$107.33 ,$106.12 ,$133.79 ,$107.33 ,$156.15 ,$107.33 ,$170.93 ,$170.93 ,$107.33 ,$23.95 ,$203.93 ,$64.96 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$284.25 ,$227.40 ,$227.40 ,$107.33 ,$227.40 ,$33.95 ,$33.95 ,$33.95 ,$379.00 , N/A ,$322.15 ,$268.33 ,$246.35 ,$107.33 ,$379.00 ,$212.24 ,$107.33 ,$99.68 , N/A ,$58.69 ,$56.02 ,$112.70 ,$303.20 ,$241.50 ,$170.93 ,$106.12 ,$341.10 ,$107.33 ,$33.95 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$181.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$388.00 ,$252.20 ,$36.99 ,$388.00 ,$268.33 ,$55.88 ,$217.28 ,$107.33 ,$108.64 ,$136.96 ,$107.33 ,$159.86 ,$107.33 ,$174.99 ,$174.99 ,$107.33 ,$36.99 ,$203.93 ,$77.36 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$291.00 ,$232.80 ,$232.80 ,$107.33 ,$232.80 ,$40.40 ,$40.40 ,$40.40 ,$388.00 , N/A ,$329.80 ,$268.33 ,$252.20 ,$107.33 ,$388.00 ,$217.28 ,$107.33 ,$102.04 , N/A ,$58.69 ,$56.02 ,$112.70 ,$310.40 ,$241.50 ,$174.99 ,$108.64 ,$349.20 ,$107.33 ,$40.40 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$186.24 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$514.00 ,$334.10 ,$34.95 ,$514.00 ,$268.33 ,$46.16 ,$287.84 ,$107.33 ,$143.92 ,$181.44 ,$107.33 ,$211.77 ,$107.33 ,$231.81 ,$231.81 ,$107.33 ,$34.95 ,$203.93 ,$67.82 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$385.50 ,$308.40 ,$308.40 ,$107.33 ,$308.40 ,$35.43 ,$35.43 ,$35.43 ,$514.00 , N/A ,$436.90 ,$268.33 ,$334.10 ,$107.33 ,$514.00 ,$287.84 ,$107.33 ,$135.18 , N/A ,$58.69 ,$56.02 ,$112.70 ,$411.20 ,$241.50 ,$231.81 ,$143.92 ,$462.60 ,$107.33 ,$35.43 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$246.72 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$474.00 ,$308.10 ,$29.65 ,$474.00 ,$199.38 ,$38.26 ,$265.44 ,$79.75 ,$132.72 ,$167.32 ,$79.75 ,$195.29 ,$79.75 ,$213.77 ,$213.77 ,$79.75 ,$29.65 ,$151.52 ,$58.28 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$355.50 ,$284.40 ,$284.40 ,$79.75 ,$284.40 ,$30.47 ,$30.47 ,$30.47 ,$474.00 , N/A ,$402.90 ,$199.36 ,$308.10 ,$79.75 ,$474.00 ,$265.44 ,$79.75 ,$124.66 , N/A ,$58.69 ,$56.02 ,$83.74 ,$379.20 ,$179.43 ,$213.77 ,$132.72 ,$426.60 ,$79.75 ,$30.47 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$227.52 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000194,62302,HC XR MYELOGRAM C-SPINE,320,1 ,"$4,535.00 ","$2,947.75 ",$154.18 ,"$4,535.00 ","$1,763.33 ","$2,086.10 ","$2,539.60 ",$705.33 ,"$1,269.80 ","$1,600.86 ",$705.33 ,"$1,699.43 ",$705.33 ,"$2,045.29 ","$2,045.29 ",$705.33 ,$154.18 ,"$1,340.13 ","$2,267.50 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,401.25 ","$2,721.00 ","$2,721.00 ",$705.33 ,"$2,721.00 ","$3,174.50 ","$3,174.50 ","$3,174.50 ","$4,535.00 ", N/A ,"$3,854.75 ","$1,763.33 ","$2,947.75 ",$705.33 ,"$4,535.00 ","$2,539.60 ",$705.33 ,"$1,192.71 ", N/A ,$638.58 ,$609.56 ,$740.60 ,"$3,628.00 ","$1,586.99 ","$2,045.29 ","$1,269.80 ","$4,081.50 ",$705.33 ,"$3,174.50 ",$365.00 ,$365.00 ,$705.33 ,$365.00 ,"$2,176.80 ",$580.53 
ST. ELIZABETH'S HOSPITAL,32000195,62303,HC XR MYELOGRAM T-SPINE,320,1 ,"$4,816.00 ","$3,130.40 ",$154.59 ,"$4,816.00 ","$1,763.33 ","$2,215.36 ","$2,696.96 ",$705.33 ,"$1,348.48 ","$1,695.36 ",$705.33 ,"$1,695.36 ",$705.33 ,"$2,172.02 ","$2,172.02 ",$705.33 ,$154.59 ,"$1,340.13 ","$2,408.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,612.00 ","$2,889.60 ","$2,889.60 ",$705.33 ,"$2,889.60 ","$3,371.20 ","$3,371.20 ","$3,371.20 ","$4,816.00 ", N/A ,"$4,093.60 ","$1,763.33 ","$3,130.40 ",$705.33 ,"$4,816.00 ","$2,696.96 ",$705.33 ,"$1,266.61 ", N/A ,$638.58 ,$609.56 ,$740.60 ,"$3,852.80 ","$1,586.99 ","$2,172.02 ","$1,348.48 ","$4,334.40 ",$705.33 ,"$3,371.20 ",$365.00 ,$365.00 ,$705.33 ,$365.00 ,"$2,311.68 ",$580.53 
ST. ELIZABETH'S HOSPITAL,32000196,62304,HC XR MYELOGRAM L-SPINE,320,1 ,"$4,868.00 ","$3,164.20 ",$152.04 ,"$4,868.00 ","$1,763.33 ","$2,239.28 ","$2,726.08 ",$705.33 ,"$1,363.04 ","$1,663.32 ",$705.33 ,"$1,663.32 ",$705.33 ,"$2,195.47 ","$2,195.47 ",$705.33 ,$152.04 ,"$1,340.13 ","$2,434.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,651.00 ","$2,920.80 ","$2,920.80 ",$705.33 ,"$2,920.80 ","$3,407.60 ","$3,407.60 ","$3,407.60 ","$4,868.00 ", N/A ,"$4,137.80 ","$1,763.33 ","$3,164.20 ",$705.33 ,"$4,868.00 ","$2,726.08 ",$705.33 ,"$1,280.28 ", N/A ,$638.58 ,$609.56 ,$740.60 ,"$3,894.40 ","$1,586.99 ","$2,195.47 ","$1,363.04 ","$4,381.20 ",$705.33 ,"$3,407.60 ",$365.00 ,$365.00 ,$705.33 ,$365.00 ,"$2,336.64 ",$580.53 
ST. ELIZABETH'S HOSPITAL,32000197,62305,HC XR MYELOGRAM >2 REGIONS,320,1 ,"$5,215.00 ","$3,389.75 ",$158.71 ,"$5,215.00 ","$1,763.33 ","$2,398.90 ","$2,920.40 ",$705.33 ,"$1,460.20 ","$1,735.86 ",$705.33 ,"$1,735.86 ",$705.33 ,"$2,351.97 ","$2,351.97 ",$705.33 ,$158.71 ,"$1,340.13 ","$2,607.50 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,911.25 ","$3,129.00 ","$3,129.00 ",$705.33 ,"$3,129.00 ","$3,650.50 ","$3,650.50 ","$3,650.50 ","$5,215.00 ", N/A ,"$4,432.75 ","$1,763.33 ","$3,389.75 ",$705.33 ,"$5,215.00 ","$2,920.40 ",$705.33 ,"$1,371.55 ", N/A ,$638.58 ,$609.56 ,$740.60 ,"$4,172.00 ","$1,586.99 ","$2,351.97 ","$1,460.20 ","$4,693.50 ",$705.33 ,"$3,650.50 ",$365.00 ,$365.00 ,$705.33 ,$365.00 ,"$2,503.20 ",$580.53 
ST. ELIZABETH'S HOSPITAL,32000200,72295,HC XR DISKOGRAM L-SPINE,320,1 ,"$4,545.00 ","$2,954.25 ",$83.12 ,"$4,545.00 ","$4,327.80 ",$158.62 ,"$2,545.20 ","$1,731.12 ","$1,272.60 ",$600.69 ,"$1,731.12 ",$600.69 ,"$1,731.12 ","$2,049.80 ","$2,049.80 ","$1,731.12 ",$88.74 ,"$3,289.12 ",$159.39 ,"$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$3,408.75 ","$2,727.00 ","$2,727.00 ","$1,731.12 ","$2,727.00 ",$83.12 ,$83.12 ,$83.12 ,"$4,545.00 ", N/A ,"$3,863.25 ","$4,327.80 ","$2,954.25 ","$1,731.12 ","$4,545.00 ","$2,545.20 ","$1,731.12 ","$1,195.34 ", N/A ,$334.40 ,$319.20 ,"$1,817.68 ","$3,636.00 ","$3,895.02 ","$2,049.80 ","$1,272.60 ","$4,090.50 ","$1,731.12 ",$83.12 ,$365.00 ,$365.00 ,"$1,731.12 ",$365.00 ,"$2,181.60 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000201,73000,HC XRAY CLAVICLE,320,1 ,$440.00 ,$286.00 ,$28.97 ,$440.00 ,$199.38 ,$37.64 ,$246.40 ,$79.75 ,$123.20 ,$155.32 ,$79.75 ,$181.28 ,$79.75 ,$198.44 ,$198.44 ,$79.75 ,$29.65 ,$151.52 ,$55.42 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$330.00 ,$264.00 ,$264.00 ,$79.75 ,$264.00 ,$28.97 ,$28.97 ,$28.97 ,$440.00 , N/A ,$374.00 ,$199.36 ,$286.00 ,$79.75 ,$440.00 ,$246.40 ,$79.75 ,$115.72 , N/A ,$58.69 ,$56.02 ,$83.74 ,$352.00 ,$179.43 ,$198.44 ,$123.20 ,$396.00 ,$79.75 ,$28.97 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$211.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000204,73010,HC XRAY SCAPULA,320,1 ,$440.00 ,$286.00 ,$18.65 ,$440.00 ,$268.33 ,$38.86 ,$246.40 ,$107.33 ,$123.20 ,$155.32 ,$107.33 ,$181.28 ,$107.33 ,$198.44 ,$198.44 ,$107.33 ,$18.65 ,$203.93 ,$61.14 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$330.00 ,$264.00 ,$264.00 ,$107.33 ,$264.00 ,$31.95 ,$31.95 ,$31.95 ,$440.00 , N/A ,$374.00 ,$268.33 ,$286.00 ,$107.33 ,$440.00 ,$246.40 ,$107.33 ,$115.72 , N/A ,$58.69 ,$56.02 ,$112.70 ,$352.00 ,$241.50 ,$198.44 ,$123.20 ,$396.00 ,$107.33 ,$31.95 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$211.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$554.00 ,$360.10 ,$17.43 ,$554.00 ,$199.38 ,$29.74 ,$310.24 ,$79.75 ,$155.12 ,$168.44 ,$79.75 ,$168.44 ,$79.75 ,$249.85 ,$249.85 ,$79.75 ,$17.43 ,$151.52 ,$42.06 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$415.50 ,$332.40 ,$332.40 ,$79.75 ,$332.40 ,$22.02 ,$22.02 ,$22.02 ,$554.00 , N/A ,$470.90 ,$199.36 ,$360.10 ,$79.75 ,$554.00 ,$310.24 ,$79.75 ,$145.70 , N/A ,$88.02 ,$84.02 ,$83.74 ,$443.20 ,$179.43 ,$249.85 ,$155.12 ,$498.60 ,$79.75 ,$22.02 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$265.92 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$391.00 ,$254.15 ,$17.43 ,$391.00 ,$199.38 ,$29.74 ,$218.96 ,$79.75 ,$109.48 ,$138.02 ,$79.75 ,$161.09 ,$79.75 ,$176.34 ,$176.34 ,$79.75 ,$17.43 ,$151.52 ,$42.06 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$293.25 ,$234.60 ,$234.60 ,$79.75 ,$234.60 ,$22.02 ,$22.02 ,$22.02 ,$391.00 , N/A ,$332.35 ,$199.36 ,$254.15 ,$79.75 ,$391.00 ,$218.96 ,$79.75 ,$102.83 , N/A ,$58.69 ,$56.02 ,$83.74 ,$312.80 ,$179.43 ,$176.34 ,$109.48 ,$351.90 ,$79.75 ,$22.02 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$187.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$410.00 ,$266.50 ,$28.97 ,$410.00 ,$199.38 ,$38.26 ,$229.60 ,$79.75 ,$114.80 ,$144.73 ,$79.75 ,$168.92 ,$79.75 ,$184.91 ,$184.91 ,$79.75 ,$31.28 ,$151.52 ,$55.42 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$307.50 ,$246.00 ,$246.00 ,$79.75 ,$246.00 ,$28.97 ,$28.97 ,$28.97 ,$410.00 , N/A ,$348.50 ,$199.36 ,$266.50 ,$79.75 ,$410.00 ,$229.60 ,$79.75 ,$107.83 , N/A ,$58.69 ,$56.02 ,$83.74 ,$328.00 ,$179.43 ,$184.91 ,$114.80 ,$369.00 ,$79.75 ,$28.97 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$196.80 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$582.00 ,$378.30 ,$28.97 ,$582.00 ,$199.38 ,$38.26 ,$325.92 ,$79.75 ,$162.96 ,$205.45 ,$79.75 ,$239.78 ,$79.75 ,$262.48 ,$262.48 ,$79.75 ,$31.28 ,$151.52 ,$55.42 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$436.50 ,$349.20 ,$349.20 ,$79.75 ,$349.20 ,$28.97 ,$28.97 ,$28.97 ,$582.00 , N/A ,$494.70 ,$199.36 ,$378.30 ,$79.75 ,$582.00 ,$325.92 ,$79.75 ,$153.07 , N/A ,$88.02 ,$84.02 ,$83.74 ,$465.60 ,$179.43 ,$262.48 ,$162.96 ,$523.80 ,$79.75 ,$28.97 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$279.36 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,539.00 ","$1,000.35 ",$116.40 ,"$1,539.00 ",$907.63 ,$145.26 ,$861.84 ,$363.05 ,$430.92 ,$543.27 ,$363.05 ,$634.07 ,$363.05 ,$694.09 ,$694.09 ,$363.05 ,$129.89 ,$689.79 ,$223.31 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,154.25 ",$923.40 ,$923.40 ,$363.05 ,$923.40 ,$116.40 ,$116.40 ,$116.40 ,"$1,539.00 ", N/A ,"$1,308.15 ",$907.62 ,"$1,000.35 ",$363.05 ,"$1,539.00 ",$861.84 ,$363.05 ,$404.76 , N/A ,$334.40 ,$319.20 ,$381.20 ,"$1,231.20 ",$816.86 ,$694.09 ,$430.92 ,"$1,385.10 ",$363.05 ,$116.40 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$738.72 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$505.00 ,$328.25 ,$23.95 ,$505.00 ,$199.38 ,$49.80 ,$282.80 ,$79.75 ,$141.40 ,$178.27 ,$79.75 ,$208.06 ,$79.75 ,$227.76 ,$227.76 ,$79.75 ,$23.95 ,$151.52 ,$71.64 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$378.75 ,$303.00 ,$303.00 ,$79.75 ,$303.00 ,$37.41 ,$37.41 ,$37.41 ,$505.00 , N/A ,$429.25 ,$199.36 ,$328.25 ,$79.75 ,$505.00 ,$282.80 ,$79.75 ,$132.82 , N/A ,$58.69 ,$56.02 ,$83.74 ,$404.00 ,$179.43 ,$227.76 ,$141.40 ,$454.50 ,$79.75 ,$37.41 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$242.40 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$440.00 ,$286.00 ,$29.65 ,$440.00 ,$199.38 ,$37.64 ,$246.40 ,$79.75 ,$123.20 ,$155.32 ,$79.75 ,$181.28 ,$79.75 ,$198.44 ,$198.44 ,$79.75 ,$29.65 ,$151.52 ,$58.28 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$330.00 ,$264.00 ,$264.00 ,$79.75 ,$264.00 ,$30.47 ,$30.47 ,$30.47 ,$440.00 , N/A ,$374.00 ,$199.36 ,$286.00 ,$79.75 ,$440.00 ,$246.40 ,$79.75 ,$115.72 , N/A ,$58.69 ,$56.02 ,$83.74 ,$352.00 ,$179.43 ,$198.44 ,$123.20 ,$396.00 ,$79.75 ,$30.47 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$211.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$359.00 ,$233.35 ,$25.99 ,$359.00 ,$199.38 ,$37.64 ,$201.04 ,$79.75 ,$100.52 ,$126.73 ,$79.75 ,$147.91 ,$79.75 ,$161.91 ,$161.91 ,$79.75 ,$25.99 ,$151.52 ,$50.65 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$269.25 ,$215.40 ,$215.40 ,$79.75 ,$215.40 ,$26.49 ,$26.49 ,$26.49 ,$359.00 , N/A ,$305.15 ,$199.36 ,$233.35 ,$79.75 ,$359.00 ,$201.04 ,$79.75 ,$94.42 , N/A ,$58.69 ,$56.02 ,$83.74 ,$287.20 ,$179.43 ,$161.91 ,$100.52 ,$323.10 ,$79.75 ,$26.49 ,$359.00 ,$359.00 ,$79.75 ,$359.00 ,$172.32 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$440.00 ,$286.00 ,$29.46 ,$440.00 ,$199.38 ,$46.76 ,$246.40 ,$79.75 ,$123.20 ,$155.32 ,$79.75 ,$181.28 ,$79.75 ,$198.44 ,$198.44 ,$79.75 ,$29.65 ,$151.52 ,$56.37 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$330.00 ,$264.00 ,$264.00 ,$79.75 ,$264.00 ,$29.46 ,$29.46 ,$29.46 ,$440.00 , N/A ,$374.00 ,$199.36 ,$286.00 ,$79.75 ,$440.00 ,$246.40 ,$79.75 ,$115.72 , N/A ,$58.69 ,$56.02 ,$83.74 ,$352.00 ,$179.43 ,$198.44 ,$123.20 ,$396.00 ,$79.75 ,$29.46 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$211.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,"$1,214.00 ",$789.10 ,$105.85 ,"$1,214.00 ",$907.63 ,$127.02 ,$679.84 ,$363.05 ,$339.92 ,$428.54 ,$363.05 ,$500.17 ,$363.05 ,$547.51 ,$547.51 ,$363.05 ,$105.85 ,$689.79 ,$207.09 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,$910.50 ,$728.40 ,$728.40 ,$363.05 ,$728.40 ,$107.96 ,$107.96 ,$107.96 ,"$1,214.00 ", N/A ,"$1,031.90 ",$907.62 ,$789.10 ,$363.05 ,"$1,214.00 ",$679.84 ,$363.05 ,$319.28 , N/A ,$334.40 ,$319.20 ,$381.20 ,$971.20 ,$816.86 ,$547.51 ,$339.92 ,"$1,092.60 ",$363.05 ,$107.96 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$582.72 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$386.00 ,$250.90 ,$26.39 ,$386.00 ,$199.38 ,$36.44 ,$216.16 ,$79.75 ,$108.08 ,$136.26 ,$79.75 ,$159.03 ,$79.75 ,$174.09 ,$174.09 ,$79.75 ,$26.39 ,$151.52 ,$52.56 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$289.50 ,$231.60 ,$231.60 ,$79.75 ,$231.60 ,$27.48 ,$27.48 ,$27.48 ,$386.00 , N/A ,$328.10 ,$199.36 ,$250.90 ,$79.75 ,$386.00 ,$216.16 ,$79.75 ,$101.52 , N/A ,$58.69 ,$56.02 ,$83.74 ,$308.80 ,$179.43 ,$174.09 ,$108.08 ,$347.40 ,$79.75 ,$27.48 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$185.28 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$440.00 ,$286.00 ,$28.97 ,$440.00 ,$268.33 ,$41.30 ,$246.40 ,$107.33 ,$123.20 ,$155.32 ,$107.33 ,$181.28 ,$107.33 ,$198.44 ,$198.44 ,$107.33 ,$29.65 ,$203.93 ,$55.42 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$330.00 ,$264.00 ,$264.00 ,$107.33 ,$264.00 ,$28.97 ,$28.97 ,$28.97 ,$440.00 , N/A ,$374.00 ,$268.33 ,$286.00 ,$107.33 ,$440.00 ,$246.40 ,$107.33 ,$115.72 , N/A ,$58.69 ,$56.02 ,$112.70 ,$352.00 ,$241.50 ,$198.44 ,$123.20 ,$396.00 ,$107.33 ,$28.97 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$211.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$602.00 ,$391.30 ,$31.69 ,$602.00 ,$199.38 ,$40.08 ,$337.12 ,$79.75 ,$168.56 ,$212.51 ,$79.75 ,$248.02 ,$79.75 ,$271.50 ,$271.50 ,$79.75 ,$31.69 ,$151.52 ,$63.05 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$451.50 ,$361.20 ,$361.20 ,$79.75 ,$361.20 ,$32.94 ,$32.94 ,$32.94 ,$602.00 , N/A ,$511.70 ,$199.36 ,$391.30 ,$79.75 ,$602.00 ,$337.12 ,$79.75 ,$158.33 , N/A ,$88.02 ,$84.02 ,$83.74 ,$481.60 ,$179.43 ,$271.50 ,$168.56 ,$541.80 ,$79.75 ,$32.94 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$288.96 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$424.00 ,$275.60 ,$31.69 ,$424.00 ,$199.38 ,$40.08 ,$237.44 ,$79.75 ,$118.72 ,$149.67 ,$79.75 ,$174.69 ,$79.75 ,$191.22 ,$191.22 ,$79.75 ,$31.69 ,$151.52 ,$63.05 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$318.00 ,$254.40 ,$254.40 ,$79.75 ,$254.40 ,$32.94 ,$32.94 ,$32.94 ,$424.00 , N/A ,$360.40 ,$199.36 ,$275.60 ,$79.75 ,$424.00 ,$237.44 ,$79.75 ,$111.51 , N/A ,$58.69 ,$56.02 ,$83.74 ,$339.20 ,$179.43 ,$191.22 ,$118.72 ,$381.60 ,$79.75 ,$32.94 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$203.52 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$359.00 ,$233.35 ,$38.91 ,$359.00 ,$199.38 ,$50.42 ,$201.04 ,$79.75 ,$100.52 ,$126.73 ,$79.75 ,$147.91 ,$79.75 ,$161.91 ,$161.91 ,$79.75 ,$39.84 ,$151.52 ,$74.50 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$269.25 ,$215.40 ,$215.40 ,$79.75 ,$215.40 ,$38.91 ,$38.91 ,$38.91 ,$359.00 , N/A ,$305.15 ,$199.36 ,$233.35 ,$79.75 ,$359.00 ,$201.04 ,$79.75 ,$94.42 , N/A ,$58.69 ,$56.02 ,$83.74 ,$287.20 ,$179.43 ,$161.91 ,$100.52 ,$323.10 ,$79.75 ,$38.91 ,$359.00 ,$359.00 ,$79.75 ,$359.00 ,$172.32 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$509.00 ,$330.85 ,$38.91 ,$509.00 ,$199.38 ,$50.42 ,$285.04 ,$79.75 ,$142.52 ,$179.68 ,$79.75 ,$209.71 ,$79.75 ,$229.56 ,$229.56 ,$79.75 ,$39.84 ,$151.52 ,$74.50 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$381.75 ,$305.40 ,$305.40 ,$79.75 ,$305.40 ,$38.91 ,$38.91 ,$38.91 ,$509.00 , N/A ,$432.65 ,$199.36 ,$330.85 ,$79.75 ,$509.00 ,$285.04 ,$79.75 ,$133.87 , N/A ,$88.02 ,$84.02 ,$83.74 ,$407.20 ,$179.43 ,$229.56 ,$142.52 ,$458.10 ,$79.75 ,$38.91 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$244.32 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,"$1,236.00 ",$803.40 ,$125.36 ,"$1,236.00 ",$907.63 ,$146.46 ,$692.16 ,$363.05 ,$346.08 ,$436.31 ,$363.05 ,$509.23 ,$363.05 ,$557.44 ,$557.44 ,$363.05 ,$135.60 ,$689.79 ,$240.48 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,$927.00 ,$741.60 ,$741.60 ,$363.05 ,$741.60 ,$125.36 ,$125.36 ,$125.36 ,"$1,236.00 ", N/A ,"$1,050.60 ",$907.62 ,$803.40 ,$363.05 ,"$1,236.00 ",$692.16 ,$363.05 ,$325.07 , N/A ,$334.40 ,$319.20 ,$381.20 ,$988.80 ,$816.86 ,$557.44 ,$346.08 ,"$1,112.40 ",$363.05 ,$125.36 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$593.28 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$423.00 ,$274.95 ,$28.43 ,$423.00 ,$268.33 ,$35.82 ,$236.88 ,$107.33 ,$118.44 ,$149.32 ,$107.33 ,$174.28 ,$107.33 ,$190.77 ,$190.77 ,$107.33 ,$28.43 ,$203.93 ,$55.42 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$317.25 ,$253.80 ,$253.80 ,$107.33 ,$253.80 ,$28.97 ,$28.97 ,$28.97 ,$423.00 , N/A ,$359.55 ,$268.33 ,$274.95 ,$107.33 ,$423.00 ,$236.88 ,$107.33 ,$111.25 , N/A ,$88.02 ,$84.02 ,$112.70 ,$338.40 ,$241.50 ,$190.77 ,$118.44 ,$380.70 ,$107.33 ,$28.97 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$203.04 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$298.00 ,$193.70 ,$28.43 ,$298.00 ,$268.33 ,$35.82 ,$166.88 ,$107.33 ,$83.44 ,$105.19 ,$107.33 ,$122.78 ,$107.33 ,$134.40 ,$134.40 ,$107.33 ,$28.43 ,$203.93 ,$55.42 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$223.50 ,$178.80 ,$178.80 ,$107.33 ,$178.80 ,$28.97 ,$28.97 ,$28.97 ,$298.00 , N/A ,$253.30 ,$268.33 ,$193.70 ,$107.33 ,$298.00 ,$166.88 ,$107.33 ,$78.37 , N/A ,$58.69 ,$56.02 ,$112.70 ,$238.40 ,$241.50 ,$134.40 ,$83.44 ,$268.20 ,$107.33 ,$28.97 ,$298.00 ,$298.00 ,$107.33 ,$298.00 ,$143.04 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$389.00 ,$252.85 ,$34.44 ,$389.00 ,$199.38 ,$43.12 ,$217.84 ,$79.75 ,$108.92 ,$137.32 ,$79.75 ,$160.27 ,$79.75 ,$175.44 ,$175.44 ,$79.75 ,$34.54 ,$151.52 ,$65.91 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$291.75 ,$233.40 ,$233.40 ,$79.75 ,$233.40 ,$34.44 ,$34.44 ,$34.44 ,$389.00 , N/A ,$330.65 ,$199.36 ,$252.85 ,$79.75 ,$389.00 ,$217.84 ,$79.75 ,$102.31 , N/A ,$58.69 ,$56.02 ,$83.74 ,$311.20 ,$179.43 ,$175.44 ,$108.92 ,$350.10 ,$79.75 ,$34.44 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$186.72 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$367.00 ,$238.55 ,$37.41 ,$367.00 ,$199.38 ,$44.94 ,$205.52 ,$79.75 ,$102.76 ,$129.55 ,$79.75 ,$151.20 ,$79.75 ,$165.52 ,$165.52 ,$79.75 ,$37.80 ,$151.52 ,$71.64 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$275.25 ,$220.20 ,$220.20 ,$79.75 ,$220.20 ,$37.41 ,$37.41 ,$37.41 ,$367.00 , N/A ,$311.95 ,$199.36 ,$238.55 ,$79.75 ,$367.00 ,$205.52 ,$79.75 ,$96.52 , N/A ,$58.69 ,$56.02 ,$83.74 ,$293.60 ,$179.43 ,$165.52 ,$102.76 ,$330.30 ,$79.75 ,$37.41 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$176.16 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,572.00 ","$1,021.80 ",$116.91 ,"$1,572.00 ",$907.63 ,$130.66 ,$880.32 ,$363.05 ,$440.16 ,$554.92 ,$363.05 ,$647.66 ,$363.05 ,$708.97 ,$708.97 ,$363.05 ,$131.11 ,$689.79 ,$224.26 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,179.00 ",$943.20 ,$943.20 ,$363.05 ,$943.20 ,$116.91 ,$116.91 ,$116.91 ,"$1,572.00 ", N/A ,"$1,336.20 ",$907.62 ,"$1,021.80 ",$363.05 ,"$1,572.00 ",$880.32 ,$363.05 ,$413.44 , N/A ,$334.40 ,$319.20 ,$381.20 ,"$1,257.60 ",$816.86 ,$708.97 ,$440.16 ,"$1,414.80 ",$363.05 ,$116.91 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$754.56 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$432.00 ,$280.80 ,$32.10 ,$432.00 ,$199.38 ,$38.86 ,$241.92 ,$79.75 ,$120.96 ,$152.50 ,$79.75 ,$177.98 ,$79.75 ,$194.83 ,$194.83 ,$79.75 ,$32.10 ,$151.52 ,$64.00 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$324.00 ,$259.20 ,$259.20 ,$79.75 ,$259.20 ,$33.44 ,$33.44 ,$33.44 ,$432.00 , N/A ,$367.20 ,$199.36 ,$280.80 ,$79.75 ,$432.00 ,$241.92 ,$79.75 ,$113.62 , N/A ,$58.69 ,$56.02 ,$83.74 ,$345.60 ,$179.43 ,$194.83 ,$120.96 ,$388.80 ,$79.75 ,$33.44 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$207.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$553.00 ,$359.45 ,$38.91 ,$553.00 ,$199.38 ,$48.58 ,$309.68 ,$79.75 ,$154.84 ,$195.21 ,$79.75 ,$227.84 ,$79.75 ,$249.40 ,$249.40 ,$79.75 ,$39.03 ,$151.52 ,$74.50 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$414.75 ,$331.80 ,$331.80 ,$79.75 ,$331.80 ,$38.91 ,$38.91 ,$38.91 ,$553.00 , N/A ,$470.05 ,$199.36 ,$359.45 ,$79.75 ,$553.00 ,$309.68 ,$79.75 ,$145.44 , N/A ,$58.69 ,$56.02 ,$83.74 ,$442.40 ,$179.43 ,$249.40 ,$154.84 ,$497.70 ,$79.75 ,$38.91 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$265.44 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$546.00 ,$354.90 ,$42.39 ,$546.00 ,$268.33 ,$55.28 ,$305.76 ,$107.33 ,$152.88 ,$192.74 ,$107.33 ,$224.95 ,$107.33 ,$246.25 ,$246.25 ,$107.33 ,$43.50 ,$203.93 ,$81.17 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$409.50 ,$327.60 ,$327.60 ,$107.33 ,$327.60 ,$42.39 ,$42.39 ,$42.39 ,$546.00 , N/A ,$464.10 ,$268.33 ,$354.90 ,$107.33 ,$546.00 ,$305.76 ,$107.33 ,$143.60 , N/A ,$58.69 ,$56.02 ,$112.70 ,$436.80 ,$241.50 ,$246.25 ,$152.88 ,$491.40 ,$107.33 ,$42.39 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$262.08 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000267,73565,HC XR KNEE STAND,320,1 ,$629.00 ,$408.85 ,$39.43 ,$629.00 ,$199.38 ,$44.34 ,$352.24 ,$79.75 ,$176.12 ,$222.04 ,$79.75 ,$259.15 ,$79.75 ,$283.68 ,$283.68 ,$79.75 ,$39.43 ,$151.52 ,$76.41 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$471.75 ,$377.40 ,$377.40 ,$79.75 ,$377.40 ,$39.90 ,$39.90 ,$39.90 ,$629.00 , N/A ,$534.65 ,$199.36 ,$408.85 ,$79.75 ,$629.00 ,$352.24 ,$79.75 ,$165.43 , N/A ,$58.69 ,$56.02 ,$83.74 ,$503.20 ,$179.43 ,$283.68 ,$176.12 ,$566.10 ,$79.75 ,$39.90 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$301.92 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,304.00 ",$847.60 ,$137.78 ,"$1,304.00 ",$907.63 ,$185.38 ,$730.24 ,$363.05 ,$365.12 ,$460.31 ,$363.05 ,$537.25 ,$363.05 ,$588.10 ,$588.10 ,$363.05 ,$148.23 ,$689.79 ,$264.32 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,$978.00 ,$782.40 ,$782.40 ,$363.05 ,$782.40 ,$137.78 ,$137.78 ,$137.78 ,"$1,304.00 ", N/A ,"$1,108.40 ",$907.62 ,$847.60 ,$363.05 ,"$1,304.00 ",$730.24 ,$363.05 ,$342.95 , N/A ,$334.40 ,$319.20 ,$381.20 ,"$1,043.20 ",$816.86 ,$588.10 ,$365.12 ,"$1,173.60 ",$363.05 ,$137.78 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$625.92 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$463.00 ,$300.95 ,$29.24 ,$463.00 ,$199.38 ,$35.22 ,$259.28 ,$79.75 ,$129.64 ,$163.44 ,$79.75 ,$190.76 ,$79.75 ,$208.81 ,$208.81 ,$79.75 ,$29.24 ,$151.52 ,$57.33 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$347.25 ,$277.80 ,$277.80 ,$79.75 ,$277.80 ,$29.97 ,$29.97 ,$29.97 ,$463.00 , N/A ,$393.55 ,$199.36 ,$300.95 ,$79.75 ,$463.00 ,$259.28 ,$79.75 ,$121.77 , N/A ,$58.69 ,$56.02 ,$83.74 ,$370.40 ,$179.43 ,$208.81 ,$129.64 ,$416.70 ,$79.75 ,$29.97 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$222.24 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$657.00 ,$427.05 ,$29.24 ,$657.00 ,$199.38 ,$35.22 ,$367.92 ,$79.75 ,$183.96 ,$228.97 ,$79.75 ,$228.97 ,$79.75 ,$296.31 ,$296.31 ,$79.75 ,$29.24 ,$151.52 ,$57.33 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$492.75 ,$394.20 ,$394.20 ,$79.75 ,$394.20 ,$29.97 ,$29.97 ,$29.97 ,$657.00 , N/A ,$558.45 ,$199.36 ,$427.05 ,$79.75 ,$657.00 ,$367.92 ,$79.75 ,$172.79 , N/A ,$88.02 ,$84.02 ,$83.74 ,$525.60 ,$179.43 ,$296.31 ,$183.96 ,$591.30 ,$79.75 ,$29.97 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$315.36 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$230.00 ,$149.50 ,$28.97 ,$230.00 ,$199.38 ,$41.90 ,$128.80 ,$79.75 ,$64.40 ,$81.19 ,$79.75 ,$94.76 ,$79.75 ,$103.73 ,$103.73 ,$79.75 ,$29.65 ,$151.52 ,$55.42 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$172.50 ,$138.00 ,$138.00 ,$79.75 ,$138.00 ,$28.97 ,$28.97 ,$28.97 ,$230.00 , N/A ,$195.50 ,$199.36 ,$149.50 ,$79.75 ,$230.00 ,$128.80 ,$79.75 ,$60.49 , N/A ,$58.69 ,$56.02 ,$83.74 ,$184.00 ,$179.43 ,$103.73 ,$64.40 ,$207.00 ,$79.75 ,$28.97 ,$230.00 ,$230.00 ,$79.75 ,$230.00 ,$110.40 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$376.00 ,$244.40 ,$30.06 ,$376.00 ,$199.38 ,$37.04 ,$210.56 ,$79.75 ,$105.28 ,$132.73 ,$79.75 ,$154.91 ,$79.75 ,$169.58 ,$169.58 ,$79.75 ,$30.06 ,$151.52 ,$60.19 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$282.00 ,$225.60 ,$225.60 ,$79.75 ,$225.60 ,$31.46 ,$31.46 ,$31.46 ,$376.00 , N/A ,$319.60 ,$199.36 ,$244.40 ,$79.75 ,$376.00 ,$210.56 ,$79.75 ,$98.89 , N/A ,$58.69 ,$56.02 ,$83.74 ,$300.80 ,$179.43 ,$169.58 ,$105.28 ,$338.40 ,$79.75 ,$31.46 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$180.48 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$432.00 ,$280.80 ,$34.44 ,$432.00 ,$199.38 ,$43.72 ,$241.92 ,$79.75 ,$120.96 ,$152.50 ,$79.75 ,$177.98 ,$79.75 ,$194.83 ,$194.83 ,$79.75 ,$34.95 ,$151.52 ,$65.91 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$324.00 ,$259.20 ,$259.20 ,$79.75 ,$259.20 ,$34.44 ,$34.44 ,$34.44 ,$432.00 , N/A ,$367.20 ,$199.36 ,$280.80 ,$79.75 ,$432.00 ,$241.92 ,$79.75 ,$113.62 , N/A ,$58.69 ,$56.02 ,$83.74 ,$345.60 ,$179.43 ,$194.83 ,$120.96 ,$388.80 ,$79.75 ,$34.44 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$207.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,289.00 ",$837.85 ,$124.86 ,"$1,289.00 ",$907.63 ,$137.34 ,$721.84 ,$363.05 ,$360.92 ,$455.02 ,$363.05 ,$531.07 ,$363.05 ,$581.34 ,$581.34 ,$363.05 ,$130.71 ,$689.79 ,$239.52 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,$966.75 ,$773.40 ,$773.40 ,$363.05 ,$773.40 ,$124.86 ,$124.86 ,$124.86 ,"$1,289.00 ", N/A ,"$1,095.65 ",$907.62 ,$837.85 ,$363.05 ,"$1,289.00 ",$721.84 ,$363.05 ,$339.01 , N/A ,$334.40 ,$319.20 ,$381.20 ,"$1,031.20 ",$816.86 ,$581.34 ,$360.92 ,"$1,160.10 ",$363.05 ,$124.86 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$618.72 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$399.00 ,$259.35 ,$25.58 ,$399.00 ,$199.38 ,$35.82 ,$223.44 ,$79.75 ,$111.72 ,$140.85 ,$79.75 ,$164.39 ,$79.75 ,$179.95 ,$179.95 ,$79.75 ,$25.58 ,$151.52 ,$51.60 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$299.25 ,$239.40 ,$239.40 ,$79.75 ,$239.40 ,$26.99 ,$26.99 ,$26.99 ,$399.00 , N/A ,$339.15 ,$199.36 ,$259.35 ,$79.75 ,$399.00 ,$223.44 ,$79.75 ,$104.94 , N/A ,$58.69 ,$56.02 ,$83.74 ,$319.20 ,$179.43 ,$179.95 ,$111.72 ,$359.10 ,$79.75 ,$26.99 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$191.52 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$566.00 ,$367.90 ,$25.58 ,$566.00 ,$199.38 ,$35.82 ,$316.96 ,$79.75 ,$158.48 ,$199.80 ,$79.75 ,$209.20 ,$79.75 ,$255.27 ,$255.27 ,$79.75 ,$25.58 ,$151.52 ,$51.60 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$424.50 ,$339.60 ,$339.60 ,$79.75 ,$339.60 ,$26.99 ,$26.99 ,$26.99 ,$566.00 , N/A ,$481.10 ,$199.36 ,$367.90 ,$79.75 ,$566.00 ,$316.96 ,$79.75 ,$148.86 , N/A ,$88.02 ,$84.02 ,$83.74 ,$452.80 ,$179.43 ,$255.27 ,$158.48 ,$509.40 ,$79.75 ,$26.99 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$271.68 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$432.00 ,$280.80 ,$31.95 ,$432.00 ,$199.38 ,$42.52 ,$241.92 ,$79.75 ,$120.96 ,$152.50 ,$79.75 ,$177.98 ,$79.75 ,$194.83 ,$194.83 ,$79.75 ,$32.50 ,$151.52 ,$61.14 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$324.00 ,$259.20 ,$259.20 ,$79.75 ,$259.20 ,$31.95 ,$31.95 ,$31.95 ,$432.00 , N/A ,$367.20 ,$199.36 ,$280.80 ,$79.75 ,$432.00 ,$241.92 ,$79.75 ,$113.62 , N/A ,$58.69 ,$56.02 ,$83.74 ,$345.60 ,$179.43 ,$194.83 ,$120.96 ,$388.80 ,$79.75 ,$31.95 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$207.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$440.00 ,$286.00 ,$25.99 ,$440.00 ,$199.38 ,$36.44 ,$246.40 ,$79.75 ,$123.20 ,$155.32 ,$79.75 ,$181.28 ,$79.75 ,$198.44 ,$198.44 ,$79.75 ,$25.99 ,$151.52 ,$50.65 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$330.00 ,$264.00 ,$264.00 ,$79.75 ,$264.00 ,$26.49 ,$26.49 ,$26.49 ,$440.00 , N/A ,$374.00 ,$199.36 ,$286.00 ,$79.75 ,$440.00 ,$246.40 ,$79.75 ,$115.72 , N/A ,$58.69 ,$56.02 ,$83.74 ,$352.00 ,$179.43 ,$198.44 ,$123.20 ,$396.00 ,$79.75 ,$26.49 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$211.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$367.00 ,$238.55 ,$28.03 ,$367.00 ,$199.38 ,$41.90 ,$205.52 ,$79.75 ,$102.76 ,$129.55 ,$79.75 ,$151.20 ,$79.75 ,$165.52 ,$165.52 ,$79.75 ,$28.03 ,$151.52 ,$59.24 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$275.25 ,$220.20 ,$220.20 ,$79.75 ,$220.20 ,$30.96 ,$30.96 ,$30.96 ,$367.00 , N/A ,$311.95 ,$199.36 ,$238.55 ,$79.75 ,$367.00 ,$205.52 ,$79.75 ,$96.52 , N/A ,$58.69 ,$56.02 ,$83.74 ,$293.60 ,$179.43 ,$165.52 ,$102.76 ,$330.30 ,$79.75 ,$30.96 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$176.16 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$428.00 ,$278.20 ,$26.39 ,$428.00 ,$199.38 ,$31.76 ,$239.68 ,$79.75 ,$119.84 ,$151.08 ,$79.75 ,$176.34 ,$79.75 ,$193.03 ,$193.03 ,$79.75 ,$26.39 ,$151.52 ,$51.60 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$321.00 ,$256.80 ,$256.80 ,$79.75 ,$256.80 ,$26.99 ,$26.99 ,$26.99 ,$428.00 , N/A ,$363.80 ,$199.36 ,$278.20 ,$79.75 ,$428.00 ,$239.68 ,$79.75 ,$112.56 , N/A ,$58.69 ,$56.02 ,$83.74 ,$342.40 ,$179.43 ,$193.03 ,$119.84 ,$385.20 ,$79.75 ,$26.99 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$205.44 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$745.00 ,$484.25 ,$31.69 ,$745.00 ,$268.33 ,$37.96 ,$417.20 ,$107.33 ,$208.60 ,$245.61 ,$107.33 ,$245.61 ,$107.33 ,$336.00 ,$336.00 ,$107.33 ,$31.69 ,$203.93 ,$62.10 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$558.75 ,$447.00 ,$447.00 ,$107.33 ,$447.00 ,$32.45 ,$32.45 ,$32.45 ,$745.00 , N/A ,$633.25 ,$268.33 ,$484.25 ,$107.33 ,$745.00 ,$417.20 ,$107.33 ,$195.94 , N/A ,$58.69 ,$56.02 ,$112.70 ,$596.00 ,$241.50 ,$336.00 ,$208.60 ,$670.50 ,$107.33 ,$32.45 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$357.60 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,$876.00 ,$569.40 ,$42.39 ,$876.00 ,$268.33 ,$59.54 ,$490.56 ,$107.33 ,$245.28 ,$309.23 ,$107.33 ,$319.99 ,$107.33 ,$395.08 ,$395.08 ,$107.33 ,$42.69 ,$203.93 ,$81.17 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$657.00 ,$525.60 ,$525.60 ,$107.33 ,$525.60 ,$42.39 ,$42.39 ,$42.39 ,$876.00 , N/A ,$744.60 ,$268.33 ,$569.40 ,$107.33 ,$876.00 ,$490.56 ,$107.33 ,$230.39 , N/A ,$58.69 ,$56.02 ,$112.70 ,$700.80 ,$241.50 ,$395.08 ,$245.28 ,$788.40 ,$107.33 ,$42.39 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$420.48 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000299,74190,HC S AND I PERITONEOGRAM,320,1 ,"$1,338.00 ",$869.70 ,$29.34 ,"$1,338.00 ","$1,190.93 ",$412.14 ,$749.28 ,$476.37 ,$374.64 ,$416.70 ,$476.37 ,$416.70 ,$476.37 ,$603.44 ,$603.44 ,$476.37 ,$29.34 ,$905.10 ,$94.90 ,"$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,"$1,003.50 ",$802.80 ,$802.80 ,$476.37 ,$802.80 ,$74.36 ,$74.36 ,$74.36 ,"$1,338.00 ", N/A ,"$1,137.30 ","$1,190.92 ",$869.70 ,$476.37 ,"$1,338.00 ",$749.28 ,$476.37 ,$351.89 , N/A ,$334.40 ,$319.20 ,$500.19 ,"$1,070.40 ","$1,071.82 ",$603.44 ,$374.64 ,"$1,204.20 ",$476.37 ,$74.36 ,$365.00 ,$365.00 ,$476.37 ,$365.00 ,$642.24 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$922.00 ,$599.30 ,$53.35 ,$922.00 ,$440.25 ,$121.54 ,$516.32 ,$176.10 ,$258.16 ,$325.47 ,$176.10 ,$379.86 ,$176.10 ,$415.82 ,$415.82 ,$176.10 ,$88.33 ,$334.60 ,$168.93 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$691.50 ,$553.20 ,$553.20 ,$176.10 ,$553.20 ,$88.10 ,$88.10 ,$88.10 ,$922.00 , N/A ,$783.70 ,$440.26 ,$599.30 ,$176.10 ,$922.00 ,$516.32 ,$176.10 ,$242.49 , N/A ,$58.69 ,$56.02 ,$184.91 ,$737.60 ,$396.23 ,$415.82 ,$258.16 ,$829.80 ,$176.10 ,$88.10 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$442.56 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,"$1,085.00 ",$705.25 ,$117.32 ,"$1,085.00 ",$440.25 ,$117.90 ,$607.60 ,$176.10 ,$303.80 ,$383.01 ,$176.10 ,$447.02 ,$176.10 ,$489.34 ,$489.34 ,$176.10 ,$128.26 ,$334.60 ,$270.05 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$813.75 ,$651.00 ,$651.00 ,$176.10 ,$651.00 ,$140.75 ,$140.75 ,$140.75 ,"$1,085.00 ", N/A ,$922.25 ,$440.26 ,$705.25 ,$176.10 ,"$1,085.00 ",$607.60 ,$176.10 ,$285.36 , N/A ,$129.05 ,$123.19 ,$184.91 ,$868.00 ,$396.23 ,$489.34 ,$303.80 ,$976.50 ,$176.10 ,$140.75 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$520.80 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,"$1,298.00 ",$843.70 ,$107.89 ,"$1,298.00 ",$440.25 ,$139.78 ,$726.88 ,$176.10 ,$363.44 ,$458.19 ,$176.10 ,$534.78 ,$176.10 ,$585.40 ,$585.40 ,$176.10 ,$107.89 ,$334.60 ,$234.75 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$973.50 ,$778.80 ,$778.80 ,$176.10 ,$778.80 ,$122.37 ,$122.37 ,$122.37 ,"$1,298.00 ", N/A ,"$1,103.30 ",$440.26 ,$843.70 ,$176.10 ,"$1,298.00 ",$726.88 ,$176.10 ,$341.37 , N/A ,$129.05 ,$123.19 ,$184.91 ,"$1,038.40 ",$396.23 ,$585.40 ,$363.44 ,"$1,168.20 ",$176.10 ,$122.37 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$623.04 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,"$1,277.00 ",$830.05 ,$117.32 ,"$1,277.00 ",$440.25 ,$155.58 ,$715.12 ,$176.10 ,$357.56 ,$450.78 ,$176.10 ,$526.12 ,$176.10 ,$575.93 ,$575.93 ,$176.10 ,$124.19 ,$334.60 ,$272.91 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$957.75 ,$766.20 ,$766.20 ,$176.10 ,$766.20 ,$142.25 ,$142.25 ,$142.25 ,"$1,277.00 ", N/A ,"$1,085.45 ",$440.26 ,$830.05 ,$176.10 ,"$1,277.00 ",$715.12 ,$176.10 ,$335.85 , N/A ,$129.05 ,$123.19 ,$184.91 ,"$1,021.60 ",$396.23 ,$575.93 ,$357.56 ,"$1,149.30 ",$176.10 ,$142.25 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$612.96 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000311,74250,HC XRAY SMALL BOWEL,320,1 ,"$1,058.00 ",$687.70 ,$107.08 ,"$1,058.00 ",$440.25 ,$150.12 ,$592.48 ,$176.10 ,$296.24 ,$373.47 ,$176.10 ,$435.90 ,$176.10 ,$477.16 ,$477.16 ,$176.10 ,$107.08 ,$334.60 ,$239.52 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$793.50 ,$634.80 ,$634.80 ,$176.10 ,$634.80 ,$124.86 ,$124.86 ,$124.86 ,"$1,058.00 ", N/A ,$899.30 ,$440.26 ,$687.70 ,$176.10 ,"$1,058.00 ",$592.48 ,$176.10 ,$278.25 , N/A ,$129.05 ,$123.19 ,$184.91 ,$846.40 ,$396.23 ,$477.16 ,$296.24 ,$952.20 ,$176.10 ,$124.86 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$507.84 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000315,74270,HC XRAY COLON BARIUM,320,1 ,"$1,155.00 ",$750.75 ,$117.32 ,"$1,155.00 ",$440.25 ,$156.20 ,$646.80 ,$176.10 ,$323.40 ,$407.72 ,$176.10 ,$475.86 ,$176.10 ,$520.91 ,$520.91 ,$176.10 ,$133.56 ,$334.60 ,$339.68 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$866.25 ,$693.00 ,$693.00 ,$176.10 ,$693.00 ,$177.02 ,$177.02 ,$177.02 ,"$1,155.00 ", N/A ,$981.75 ,$440.26 ,$750.75 ,$176.10 ,"$1,155.00 ",$646.80 ,$176.10 ,$303.77 , N/A ,$129.05 ,$123.19 ,$184.91 ,$924.00 ,$396.23 ,$520.91 ,$323.40 ,"$1,039.50 ",$176.10 ,$177.02 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$554.40 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,"$1,155.00 ",$750.75 ,$117.32 ,"$1,155.00 ",$440.25 ,$156.20 ,$646.80 ,$176.10 ,$323.40 ,$407.72 ,$176.10 ,$475.86 ,$176.10 ,$520.91 ,$520.91 ,$176.10 ,$133.56 ,$334.60 ,$339.68 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$866.25 ,$693.00 ,$693.00 ,$176.10 ,$693.00 ,$177.02 ,$177.02 ,$177.02 ,"$1,155.00 ", N/A ,$981.75 ,$440.26 ,$750.75 ,$176.10 ,"$1,155.00 ",$646.80 ,$176.10 ,$303.77 , N/A ,$129.05 ,$123.19 ,$184.91 ,$924.00 ,$396.23 ,$520.91 ,$323.40 ,"$1,039.50 ",$176.10 ,$177.02 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$554.40 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,"$1,155.00 ",$750.75 ,$117.32 ,"$1,155.00 ",$440.25 ,$156.20 ,$646.80 ,$176.10 ,$323.40 ,$407.72 ,$176.10 ,$475.86 ,$176.10 ,$520.91 ,$520.91 ,$176.10 ,$133.56 ,$334.60 ,$339.68 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$866.25 ,$693.00 ,$693.00 ,$176.10 ,$693.00 ,$177.02 ,$177.02 ,$177.02 ,"$1,155.00 ", N/A ,$981.75 ,$440.26 ,$750.75 ,$176.10 ,"$1,155.00 ",$646.80 ,$176.10 ,$303.77 , N/A ,$129.05 ,$123.19 ,$184.91 ,$924.00 ,$396.23 ,$520.91 ,$323.40 ,"$1,039.50 ",$176.10 ,$177.02 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$554.40 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000320,74280,HC XRAY COLON BARIUM AIR CONTRAST,320,1 ,"$1,380.00 ",$897.00 ,$117.32 ,"$1,380.00 ",$440.25 ,$254.68 ,$772.80 ,$176.10 ,$386.40 ,$487.14 ,$176.10 ,$568.56 ,$176.10 ,$622.38 ,$622.38 ,$176.10 ,$205.69 ,$334.60 ,$477.04 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,035.00 ",$828.00 ,$828.00 ,$176.10 ,$828.00 ,$248.55 ,$248.55 ,$248.55 ,"$1,380.00 ", N/A ,"$1,173.00 ",$440.26 ,$897.00 ,$176.10 ,"$1,380.00 ",$772.80 ,$176.10 ,$362.94 , N/A ,$129.05 ,$123.19 ,$184.91 ,"$1,104.00 ",$396.23 ,$622.38 ,$386.40 ,"$1,242.00 ",$176.10 ,$248.55 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$662.40 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000322,74283,HC THERAPEUTIC COLON,320,1 ,$780.00 ,$507.00 ,$117.32 ,$780.00 ,$440.25 ,$155.58 ,$436.80 ,$176.10 ,$218.40 ,$275.34 ,$176.10 ,$321.36 ,$176.10 ,$351.78 ,$351.78 ,$176.10 ,$197.94 ,$334.60 ,$350.17 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$585.00 ,$468.00 ,$468.00 ,$176.10 ,$468.00 ,$182.48 ,$182.48 ,$182.48 ,$780.00 , N/A ,$663.00 ,$440.26 ,$507.00 ,$176.10 ,$780.00 ,$436.80 ,$176.10 ,$205.14 , N/A ,$129.05 ,$123.19 ,$184.91 ,$624.00 ,$396.23 ,$351.78 ,$218.40 ,$702.00 ,$176.10 ,$182.48 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$374.40 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,"$1,249.00 ",$811.85 ,$17.19 ,"$1,249.00 ", N/A ,$63.60 ,$699.44 , N/A ,$349.72 ,$400.90 , N/A ,$400.90 , N/A ,$563.30 ,$563.30 , N/A ,$17.19 , N/A ,$624.50 , N/A , N/A , N/A , N/A ,$936.75 ,$749.40 ,$749.40 , N/A ,$749.40 ,$47.34 ,$47.34 ,$47.34 ,"$1,249.00 ", N/A ,"$1,061.65 ", N/A ,$811.85 , N/A ,"$1,249.00 ",$699.44 , N/A ,$328.49 , N/A ,$334.40 ,$319.20 , N/A ,$999.20 , N/A ,$563.30 ,$349.72 ,"$1,124.10 ", N/A ,$47.34 ,$365.00 ,$365.00 , N/A ,$365.00 ,$599.52 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000324,74301,HC CHOLANGIOGRAPHY OPERATIVE ADDL,320,1 ,$576.00 ,$374.40 ,$13.06 ,$576.00 , N/A ,$38.78 ,$322.56 , N/A ,$161.28 ,$203.33 , N/A ,$231.84 , N/A ,$259.78 ,$259.78 , N/A ,$13.06 , N/A ,$288.00 , N/A , N/A , N/A , N/A ,$432.00 ,$345.60 ,$345.60 , N/A ,$345.60 ,$60.03 ,$60.03 ,$60.03 ,$576.00 , N/A ,$489.60 , N/A ,$374.40 , N/A ,$576.00 ,$322.56 , N/A ,$151.49 , N/A ,$334.40 ,$319.20 , N/A ,$460.80 , N/A ,$259.78 ,$161.28 ,$518.40 , N/A ,$60.03 ,$365.00 ,$365.00 , N/A ,$365.00 ,$276.48 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000325,47531,HC XRAY CHOLANGIOGRAM THRU CATH,320,1 ,"$1,050.00 ",$682.50 ,$89.40 ,"$7,841.66 ","$7,841.65 ",$483.00 ,$588.00 ,"$3,136.66 ",$294.00 ,$354.90 ,"$3,136.66 ",$408.45 ,"$1,050.00 ",$473.55 ,$473.55 ,"$1,050.00 ",$89.40 ,"$1,050.00 ",$525.00 ,"$7,841.66 ","$3,136.66 ","$3,136.66 ","$1,050.00 ",$787.50 ,$630.00 ,$630.00 ,"$3,136.66 ",$630.00 ,$735.00 ,$735.00 ,$735.00 ,"$1,050.00 ", N/A ,$892.50 ,"$1,050.00 ",$682.50 ,"$3,136.66 ","$1,050.00 ",$588.00 ,"$3,136.66 ",$276.15 , N/A ,$129.05 ,$123.19 ,"$3,293.49 ",$840.00 ,"$7,057.49 ",$473.55 ,$294.00 ,$945.00 ,"$3,136.66 ",$735.00 ,$365.00 ,$365.00 ,"$1,050.00 ",$365.00 ,$504.00 ,$117.32 
ST. ELIZABETH'S HOSPITAL,32000326,47532,HC PERCUTAN CHOLANGIOGRAM,320,1 ,"$6,230.00 ","$4,049.50 ",$272.80 ,"$7,841.66 ","$7,841.65 ","$2,865.80 ","$3,488.80 ","$3,136.66 ","$1,744.40 ","$2,105.74 ","$3,136.66 ","$2,423.47 ","$3,136.66 ","$2,809.73 ","$2,809.73 ","$3,136.66 ",$272.80 ,"$5,959.66 ","$3,115.00 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$4,672.50 ","$3,738.00 ","$3,738.00 ","$3,136.66 ","$3,738.00 ","$4,361.00 ","$4,361.00 ","$4,361.00 ","$6,230.00 ", N/A ,"$5,295.50 ","$6,230.00 ","$4,049.50 ","$3,136.66 ","$6,230.00 ","$3,488.80 ","$3,136.66 ","$1,638.49 ", N/A ,$366.06 ,$349.42 ,"$3,293.49 ","$4,984.00 ","$7,057.49 ","$2,809.73 ","$1,744.40 ","$5,607.00 ","$3,136.66 ","$4,361.00 ",$365.00 ,$365.00 ,"$3,136.66 ",$365.00 ,"$2,990.40 ",$332.78 
ST. ELIZABETH'S HOSPITAL,32000328,74328,HC XRAY ERCP BILIARY ONLY,320,1 ,"$1,620.00 ","$1,053.00 ",$29.51 ,"$1,620.00 ", N/A ,$156.90 ,$907.20 , N/A ,$453.60 ,$571.86 , N/A ,$667.44 , N/A ,$730.62 ,$730.62 , N/A ,$29.51 , N/A ,$810.00 , N/A , N/A , N/A , N/A ,"$1,215.00 ",$972.00 ,$972.00 , N/A ,$972.00 ,$179.49 ,$179.49 ,$179.49 ,"$1,620.00 ", N/A ,"$1,377.00 ", N/A ,"$1,053.00 ", N/A ,"$1,620.00 ",$907.20 , N/A ,$426.06 , N/A ,$334.40 ,$319.20 , N/A ,"$1,296.00 ", N/A ,$730.62 ,$453.60 ,"$1,458.00 ", N/A ,$179.49 ,$365.00 ,$365.00 , N/A ,$365.00 ,$777.60 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000329,74329,HC ERCP PANCREATIC,320,1 ,"$1,619.00 ","$1,052.35 ",$29.51 ,"$1,619.00 ", N/A ,$125.38 ,$906.64 , N/A ,$453.32 ,$571.51 , N/A ,$667.03 , N/A ,$730.17 ,$730.17 , N/A ,$29.51 , N/A ,$809.50 , N/A , N/A , N/A , N/A ,"$1,214.25 ",$971.40 ,$971.40 , N/A ,$971.40 ,$179.49 ,$179.49 ,$179.49 ,"$1,619.00 ", N/A ,"$1,376.15 ", N/A ,"$1,052.35 ", N/A ,"$1,619.00 ",$906.64 , N/A ,$425.80 , N/A ,$334.40 ,$319.20 , N/A ,"$1,295.20 ", N/A ,$730.17 ,$453.32 ,"$1,457.10 ", N/A ,$179.49 ,$365.00 ,$365.00 , N/A ,$365.00 ,$777.12 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000330,74330,HC XRAY ERCP CATH BILIARY AND PANCREAS,320,1 ,"$1,955.00 ","$1,270.75 ",$36.66 ,"$1,955.00 ", N/A ,$233.84 ,"$1,094.80 ", N/A ,$547.40 ,$690.12 , N/A ,$805.46 , N/A ,$881.71 ,$881.71 , N/A ,$36.66 , N/A ,$977.50 , N/A , N/A , N/A , N/A ,"$1,466.25 ","$1,173.00 ","$1,173.00 ", N/A ,"$1,173.00 ",$179.49 ,$179.49 ,$179.49 ,"$1,955.00 ", N/A ,"$1,661.75 ", N/A ,"$1,270.75 ", N/A ,"$1,955.00 ","$1,094.80 ", N/A ,$514.17 , N/A ,$334.40 ,$319.20 , N/A ,"$1,564.00 ", N/A ,$881.71 ,$547.40 ,"$1,759.50 ", N/A ,$179.49 ,$365.00 ,$365.00 , N/A ,$365.00 ,$938.40 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000331,74340,HC INTRODUCTION LONG GI TUBE,320,1 ,"$1,237.00 ",$804.05 ,$33.98 ,"$1,237.00 ", N/A ,$154.48 ,$692.72 , N/A ,$346.36 ,$436.66 , N/A ,$509.64 , N/A ,$557.89 ,$557.89 , N/A ,$33.98 , N/A ,$618.50 , N/A , N/A , N/A , N/A ,$927.75 ,$742.20 ,$742.20 , N/A ,$742.20 ,$149.27 ,$149.27 ,$149.27 ,"$1,237.00 ", N/A ,"$1,051.45 ", N/A ,$804.05 , N/A ,"$1,237.00 ",$692.72 , N/A ,$325.33 , N/A ,$334.40 ,$319.20 , N/A ,$989.60 , N/A ,$557.89 ,$346.36 ,"$1,113.30 ", N/A ,$149.27 ,$365.00 ,$365.00 , N/A ,$365.00 ,$593.76 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000335,74400,HC XRAY IVP W OR W/O TOMO,320,1 ,"$1,514.00 ",$984.10 ,$132.30 ,"$1,514.00 ",$440.25 ,$158.02 ,$847.84 ,$176.10 ,$423.92 ,$534.44 ,$176.10 ,$623.77 ,$176.10 ,$682.81 ,$682.81 ,$176.10 ,$140.90 ,$334.60 ,$253.83 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,135.50 ",$908.40 ,$908.40 ,$176.10 ,$908.40 ,$132.30 ,$132.30 ,$132.30 ,"$1,514.00 ", N/A ,"$1,286.90 ",$440.26 ,$984.10 ,$176.10 ,"$1,514.00 ",$847.84 ,$176.10 ,$398.18 , N/A ,$366.06 ,$349.42 ,$184.91 ,"$1,211.20 ",$396.23 ,$682.81 ,$423.92 ,"$1,362.60 ",$176.10 ,$132.30 ,$365.00 ,$365.00 ,$176.10 ,$365.00 ,$726.72 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,"$1,133.00 ",$736.45 ,$64.25 ,"$1,133.00 ",$907.63 ,$315.48 ,$634.48 ,$363.05 ,$317.24 ,$399.95 ,$363.05 ,$466.80 ,$363.05 ,$510.98 ,$510.98 ,$363.05 ,$64.29 ,$689.79 ,$123.15 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,$849.75 ,$679.80 ,$679.80 ,$363.05 ,$679.80 ,$64.25 ,$64.25 ,$64.25 ,"$1,133.00 ", N/A ,$963.05 ,$907.62 ,$736.45 ,$363.05 ,"$1,133.00 ",$634.48 ,$363.05 ,$297.98 , N/A ,$366.06 ,$349.42 ,$381.20 ,$906.40 ,$816.86 ,$510.98 ,$317.24 ,"$1,019.70 ",$363.05 ,$64.25 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$543.84 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,"$1,201.00 ",$780.65 ,$74.36 ,"$1,201.00 ",$907.63 ,$315.48 ,$672.56 ,$363.05 ,$336.28 ,$423.95 ,$363.05 ,$494.81 ,$363.05 ,$541.65 ,$541.65 ,$363.05 ,$141.30 ,$689.79 ,$129.43 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,$900.75 ,$720.60 ,$720.60 ,$363.05 ,$720.60 ,$74.36 ,$74.36 ,$74.36 ,"$1,201.00 ", N/A ,"$1,020.85 ",$907.62 ,$780.65 ,$363.05 ,"$1,201.00 ",$672.56 ,$363.05 ,$315.86 , N/A ,$334.40 ,$319.20 ,$381.20 ,$960.80 ,$816.86 ,$541.65 ,$336.28 ,"$1,080.90 ",$363.05 ,$74.36 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$576.48 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000341,50431,HC ANGIO NEPHROSTGRAM,320,1 ,"$1,636.00 ","$1,063.40 ",$82.89 ,"$1,636.00 ","$1,417.95 ",$752.56 ,$916.16 ,$567.18 ,$458.08 ,$552.97 ,$567.18 ,$636.40 ,$567.18 ,$737.84 ,$737.84 ,$567.18 ,$82.89 ,"$1,077.65 ",$818.00 ,"$1,417.96 ",$567.18 ,$567.18 ,$578.53 ,"$1,227.00 ",$981.60 ,$981.60 ,$567.18 ,$981.60 ,"$1,145.20 ","$1,145.20 ","$1,145.20 ","$1,636.00 ", N/A ,"$1,390.60 ","$1,417.96 ","$1,063.40 ",$567.18 ,"$1,636.00 ",$916.16 ,$567.18 ,$430.27 , N/A ,$366.06 ,$349.42 ,$595.54 ,"$1,308.80 ","$1,276.16 ",$737.84 ,$458.08 ,"$1,472.40 ",$567.18 ,"$1,145.20 ",$365.00 ,$365.00 ,$567.18 ,$365.00 ,$785.28 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,"$1,391.00 ",$904.15 ,$31.69 ,"$1,391.00 ",$907.63 ,$82.02 ,$778.96 ,$363.05 ,$389.48 ,$248.73 ,$363.05 ,$248.73 ,$363.05 ,$627.34 ,$627.34 ,$363.05 ,$31.69 ,$689.79 ,$62.10 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,043.25 ",$834.60 ,$834.60 ,$363.05 ,$834.60 ,$32.45 ,$32.45 ,$32.45 ,"$1,391.00 ", N/A ,"$1,182.35 ",$907.62 ,$904.15 ,$363.05 ,"$1,391.00 ",$778.96 ,$363.05 ,$365.83 , N/A ,$334.40 ,$319.20 ,$381.20 ,"$1,112.80 ",$816.86 ,$627.34 ,$389.48 ,"$1,251.90 ",$363.05 ,$32.45 ,$365.00 ,$365.00 ,$363.05 ,$365.00 ,$667.68 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000344,74450,HC CYSTOURETHROGRAM RETROGRADE,320,1 ,$984.00 ,$639.60 ,$19.89 ,$984.00 ,$567.13 ,$315.48 ,$551.04 ,$226.85 ,$275.52 ,$347.35 ,$226.85 ,$405.41 ,$226.85 ,$443.78 ,$443.78 ,$226.85 ,$19.89 ,$431.02 ,$150.51 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$738.00 ,$590.40 ,$590.40 ,$226.85 ,$590.40 ,$83.03 ,$83.03 ,$83.03 ,$984.00 , N/A ,$836.40 ,$567.13 ,$639.60 ,$226.85 ,$984.00 ,$551.04 ,$226.85 ,$258.79 , N/A ,$334.40 ,$319.20 ,$238.19 ,$787.20 ,$510.41 ,$443.78 ,$275.52 ,$885.60 ,$226.85 ,$83.03 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$472.32 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,"$1,010.00 ",$656.50 ,$103.49 ,"$1,010.00 ",$567.13 ,$132.48 ,$565.60 ,$226.85 ,$282.80 ,$356.53 ,$226.85 ,$416.12 ,$226.85 ,$455.51 ,$455.51 ,$226.85 ,$111.55 ,$431.02 ,$198.50 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$757.50 ,$606.00 ,$606.00 ,$226.85 ,$606.00 ,$103.49 ,$103.49 ,$103.49 ,"$1,010.00 ", N/A ,$858.50 ,$567.13 ,$656.50 ,$226.85 ,"$1,010.00 ",$565.60 ,$226.85 ,$265.63 , N/A ,$334.40 ,$319.20 ,$238.19 ,$808.00 ,$510.41 ,$455.51 ,$282.80 ,$909.00 ,$226.85 ,$103.49 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$484.80 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000348,74470,HC RENAL CYST STUDY S AND I,320,1 ,$672.00 ,$436.80 ,$32.75 ,"$1,190.93 ","$1,190.93 ",$412.14 ,$376.32 ,$476.37 ,$188.16 ,$237.22 ,$476.37 ,$276.86 ,$476.37 ,$303.07 ,$303.07 ,$476.37 ,$32.75 ,$672.00 ,$127.52 ,"$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,$504.00 ,$403.20 ,$403.20 ,$476.37 ,$403.20 ,$71.18 ,$71.18 ,$71.18 ,$672.00 , N/A ,$571.20 ,$672.00 ,$436.80 ,$476.37 ,$672.00 ,$376.32 ,$476.37 ,$176.74 , N/A ,$334.40 ,$319.20 ,$500.19 ,$537.60 ,"$1,071.82 ",$303.07 ,$188.16 ,$604.80 ,$476.37 ,$71.18 ,$365.00 ,$365.00 ,$476.37 ,$365.00 ,$322.56 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$5,095.00 ","$3,311.75 ",$261.75 ,"$5,095.00 ","$4,413.08 ","$2,343.70 ","$2,853.20 ","$1,765.23 ","$1,426.60 ","$1,722.11 ","$1,765.23 ","$1,981.96 ","$1,765.23 ","$2,297.85 ","$2,297.85 ","$1,765.23 ",$261.75 ,"$3,353.94 ","$2,547.50 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$3,821.25 ","$3,057.00 ","$3,057.00 ","$1,765.23 ","$3,057.00 ","$3,566.50 ","$3,566.50 ","$3,566.50 ","$5,095.00 ", N/A ,"$4,330.75 ","$4,413.08 ","$3,311.75 ","$1,765.23 ","$5,095.00 ","$2,853.20 ","$1,765.23 ","$1,339.99 ", N/A ,"$1,144.54 ","$1,092.51 ","$1,853.49 ","$4,076.00 ","$3,971.77 ","$2,297.85 ","$1,426.60 ","$4,585.50 ","$1,765.23 ","$3,566.50 ",$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$2,445.60 ","$1,040.49 "
ST. ELIZABETH'S HOSPITAL,32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$4,785.00 ","$3,110.25 ",$93.56 ,"$4,785.00 ","$4,413.08 ",$150.72 ,"$2,679.60 ","$1,765.23 ","$1,339.80 ",$747.35 ,"$1,765.23 ",$747.35 ,"$1,765.23 ","$2,158.04 ","$2,158.04 ","$1,765.23 ",$100.15 ,"$3,353.94 ",$179.43 ,"$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$3,588.75 ","$2,871.00 ","$2,871.00 ","$1,765.23 ","$2,871.00 ",$93.56 ,$93.56 ,$93.56 ,"$4,785.00 ", N/A ,"$4,067.25 ","$4,413.08 ","$3,110.25 ","$1,765.23 ","$4,785.00 ","$2,679.60 ","$1,765.23 ","$1,258.46 ", N/A ,$334.40 ,$319.20 ,"$1,853.49 ","$3,828.00 ","$3,971.77 ","$2,158.04 ","$1,339.80 ","$4,306.50 ","$1,765.23 ",$93.56 ,$365.00 ,$365.00 ,"$1,765.23 ",$365.00 ,"$2,296.80 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$831.00 ,$540.15 ,$88.59 ,$831.00 ,$567.13 ,$109.38 ,$465.36 ,$226.85 ,$232.68 ,$293.34 ,$226.85 ,$342.37 ,$226.85 ,$374.78 ,$374.78 ,$226.85 ,$98.11 ,$431.02 ,$169.89 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$623.25 ,$498.60 ,$498.60 ,$226.85 ,$498.60 ,$88.59 ,$88.59 ,$88.59 ,$831.00 , N/A ,$706.35 ,$567.13 ,$540.15 ,$226.85 ,$831.00 ,$465.36 ,$226.85 ,$218.55 , N/A ,$334.40 ,$319.20 ,$238.19 ,$664.80 ,$510.41 ,$374.78 ,$232.68 ,$747.90 ,$226.85 ,$88.59 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$398.88 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000355,75605,HC THORACIC AORTA,320,1 ,"$11,688.00 ","$7,597.20 ",$83.75 ,"$11,753.38 ","$11,753.38 ",$282.64 ,"$6,545.28 ","$4,701.35 ","$3,272.64 ",$921.46 ,"$4,701.35 ",$921.46 ,"$4,701.35 ","$5,271.29 ","$5,271.29 ","$4,701.35 ",$83.75 ,"$8,932.56 ",$209.95 ,"$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$8,766.00 ","$7,012.80 ","$7,012.80 ","$4,701.35 ","$7,012.80 ",$109.46 ,$109.46 ,$109.46 ,"$11,688.00 ", N/A ,"$9,934.80 ","$11,688.00 ","$7,597.20 ","$4,701.35 ","$11,688.00 ","$6,545.28 ","$4,701.35 ","$3,073.94 ", N/A ,$334.40 ,$319.20 ,"$4,936.42 ","$9,350.40 ","$10,578.04 ","$5,271.29 ","$3,272.64 ","$10,519.20 ","$4,701.35 ",$109.46 ,$365.00 ,$365.00 ,"$4,701.35 ",$365.00 ,"$5,610.24 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000356,75625,HC ABDOMINAL AORTAGRAM 75625,320,1 ,"$5,324.00 ","$3,460.60 ",$74.48 ,"$7,055.60 ","$7,055.60 ",$283.26 ,"$2,981.44 ","$2,822.24 ","$1,490.72 ",$909.56 ,"$2,822.24 ",$909.56 ,"$2,822.24 ","$2,401.12 ","$2,401.12 ","$2,822.24 ",$74.48 ,"$5,324.00 ",$205.18 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$3,993.00 ","$3,194.40 ","$3,194.40 ","$2,822.24 ","$3,194.40 ",$106.97 ,$106.97 ,$106.97 ,"$5,324.00 ", N/A ,"$4,525.40 ","$5,324.00 ","$3,460.60 ","$2,822.24 ","$5,324.00 ","$2,981.44 ","$2,822.24 ","$1,400.21 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$4,259.20 ","$6,350.04 ","$2,401.12 ","$1,490.72 ","$4,791.60 ","$2,822.24 ",$106.97 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$2,555.52 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000357,75630,HC AORTA WITH RUNOFF 75630,320,1 ,"$5,790.00 ","$3,763.50 ",$79.78 ,"$7,055.60 ","$7,055.60 ",$289.94 ,"$3,242.40 ","$2,822.24 ","$1,621.20 ",$921.46 ,"$2,822.24 ",$921.46 ,"$2,822.24 ","$2,611.29 ","$2,611.29 ","$2,822.24 ",$79.78 ,"$5,362.25 ",$209.00 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$4,342.50 ","$3,474.00 ","$3,474.00 ","$2,822.24 ","$3,474.00 ",$108.96 ,$108.96 ,$108.96 ,"$5,790.00 ", N/A ,"$4,921.50 ","$5,790.00 ","$3,763.50 ","$2,822.24 ","$5,790.00 ","$3,242.40 ","$2,822.24 ","$1,522.77 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$4,632.00 ","$6,350.04 ","$2,611.29 ","$1,621.20 ","$5,211.00 ","$2,822.24 ",$108.96 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$2,779.20 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000370,75705,HC ANGIO SPINAL,320,1 ,"$11,688.00 ","$7,597.20 ",$158.33 ,"$11,753.38 ","$11,753.38 ",$317.30 ,"$6,545.28 ","$4,701.35 ","$3,272.64 ","$1,546.12 ","$4,701.35 ","$1,546.12 ","$4,701.35 ","$5,271.29 ","$5,271.29 ","$4,701.35 ",$158.33 ,"$8,932.56 ",$363.62 ,"$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$8,766.00 ","$7,012.80 ","$7,012.80 ","$4,701.35 ","$7,012.80 ",$189.60 ,$189.60 ,$189.60 ,"$11,688.00 ", N/A ,"$9,934.80 ","$11,688.00 ","$7,597.20 ","$4,701.35 ","$11,688.00 ","$6,545.28 ","$4,701.35 ","$3,073.94 ", N/A ,$334.40 ,$319.20 ,"$4,936.42 ","$9,350.40 ","$10,578.04 ","$5,271.29 ","$3,272.64 ","$10,519.20 ","$4,701.35 ",$189.60 ,$365.00 ,$365.00 ,"$4,701.35 ",$365.00 ,"$5,610.24 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000371,75710,HC ANGIO EXTREMITY UNI 75710,320,1 ,"$5,182.00 ","$3,368.30 ",$85.06 ,"$7,055.60 ","$7,055.60 ",$318.52 ,"$2,901.92 ","$2,822.24 ","$1,450.96 ",$961.06 ,"$2,822.24 ",$961.06 ,"$2,822.24 ","$2,337.08 ","$2,337.08 ","$2,822.24 ",$85.06 ,"$5,182.00 ",$217.58 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$3,886.50 ","$3,109.20 ","$3,109.20 ","$2,822.24 ","$3,109.20 ",$113.43 ,$113.43 ,$113.43 ,"$5,182.00 ", N/A ,"$4,404.70 ","$5,182.00 ","$3,368.30 ","$2,822.24 ","$5,182.00 ","$2,901.92 ","$2,822.24 ","$1,362.87 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$4,145.60 ","$6,350.04 ","$2,337.08 ","$1,450.96 ","$4,663.80 ","$2,822.24 ",$113.43 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$2,487.36 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000372,75710,HC ANGIO EXTREMITY UNI OR,320,1 ,"$5,182.00 ","$3,368.30 ",$85.06 ,"$7,055.60 ","$7,055.60 ",$318.52 ,"$2,901.92 ","$2,822.24 ","$1,450.96 ",$961.06 ,"$2,822.24 ",$961.06 ,"$2,822.24 ","$2,337.08 ","$2,337.08 ","$2,822.24 ",$85.06 ,"$5,182.00 ",$217.58 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$3,886.50 ","$3,109.20 ","$3,109.20 ","$2,822.24 ","$3,109.20 ",$113.43 ,$113.43 ,$113.43 ,"$5,182.00 ", N/A ,"$4,404.70 ","$5,182.00 ","$3,368.30 ","$2,822.24 ","$5,182.00 ","$2,901.92 ","$2,822.24 ","$1,362.87 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$4,145.60 ","$6,350.04 ","$2,337.08 ","$1,450.96 ","$4,663.80 ","$2,822.24 ",$113.43 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$2,487.36 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000373,75716,HC ANGIO EXTREMITY BILAT 75716,320,1 ,"$5,810.00 ","$3,776.50 ",$88.24 ,"$7,055.60 ","$7,055.60 ",$367.66 ,"$3,253.60 ","$2,822.24 ","$1,626.80 ","$1,107.41 ","$2,822.24 ","$1,107.41 ","$2,822.24 ","$2,620.31 ","$2,620.31 ","$2,822.24 ",$88.24 ,"$5,362.25 ",$220.44 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$4,357.50 ","$3,486.00 ","$3,486.00 ","$2,822.24 ","$3,486.00 ",$114.92 ,$114.92 ,$114.92 ,"$5,810.00 ", N/A ,"$4,938.50 ","$5,810.00 ","$3,776.50 ","$2,822.24 ","$5,810.00 ","$3,253.60 ","$2,822.24 ","$1,528.03 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$4,648.00 ","$6,350.04 ","$2,620.31 ","$1,626.80 ","$5,229.00 ","$2,822.24 ",$114.92 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$2,788.80 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000375,36251,HC ANGIO SEL RENAL UNILA 36251,320,1 ,"$3,257.00 ","$2,117.05 ",$345.28 ,"$7,055.60 ","$7,055.60 ","$1,498.22 ","$1,823.92 ","$2,822.24 ",$911.96 ,"$1,100.87 ","$2,822.24 ","$1,266.97 ","$2,822.24 ","$1,468.91 ","$1,468.91 ","$2,822.24 ",$345.28 ,"$3,257.00 ","$1,628.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$2,442.75 ","$1,954.20 ","$1,954.20 ","$2,822.24 ","$1,954.20 ","$2,279.90 ","$2,279.90 ","$2,279.90 ","$3,257.00 ", N/A ,"$2,768.45 ","$3,257.00 ","$2,117.05 ","$2,822.24 ","$3,257.00 ","$1,823.92 ","$2,822.24 ",$856.59 , N/A ,"$2,821.51 ","$2,693.26 ","$2,963.35 ","$2,605.60 ","$6,350.04 ","$1,468.91 ",$911.96 ,"$2,931.30 ","$2,822.24 ","$2,279.90 ",$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$1,563.36 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,32000376,36252,HC ANGIO SEL RENAL BILAT 36252,320,1 ,"$7,035.00 ","$4,572.75 ",$365.00 ,"$7,055.60 ","$7,055.60 ","$3,236.10 ","$3,939.60 ","$2,822.24 ","$1,969.80 ","$2,377.83 ","$2,822.24 ","$2,736.62 ","$2,822.24 ","$3,172.79 ","$3,172.79 ","$2,822.24 ",$489.59 ,"$5,362.25 ","$3,517.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,276.25 ","$4,221.00 ","$4,221.00 ","$2,822.24 ","$4,221.00 ","$4,924.50 ","$4,924.50 ","$4,924.50 ","$7,035.00 ", N/A ,"$5,979.75 ","$7,035.00 ","$4,572.75 ","$2,822.24 ","$7,035.00 ","$3,939.60 ","$2,822.24 ","$1,850.21 ", N/A ,"$2,821.51 ","$2,693.26 ","$2,963.35 ","$5,628.00 ","$6,350.04 ","$3,172.79 ","$1,969.80 ","$6,331.50 ","$2,822.24 ","$4,924.50 ",$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,376.80 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,32000378,75726,"HC ANGIO VISERAL, SEL, OR SUPRASEL 75726",320,1 ,"$5,342.00 ","$3,472.30 ",$95.16 ,"$11,753.38 ","$11,753.38 ",$313.66 ,"$2,991.52 ","$4,701.35 ","$1,495.76 ","$1,052.01 ","$4,701.35 ","$1,052.01 ","$4,701.35 ","$2,409.24 ","$2,409.24 ","$4,701.35 ",$95.16 ,"$5,342.00 ",$240.48 ,"$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$4,006.50 ","$3,205.20 ","$3,205.20 ","$4,701.35 ","$3,205.20 ",$125.36 ,$125.36 ,$125.36 ,"$5,342.00 ", N/A ,"$4,540.70 ","$5,342.00 ","$3,472.30 ","$4,701.35 ","$5,342.00 ","$2,991.52 ","$4,701.35 ","$1,404.95 ", N/A ,$334.40 ,$319.20 ,"$4,936.42 ","$4,273.60 ","$10,578.04 ","$2,409.24 ","$1,495.76 ","$4,807.80 ","$4,701.35 ",$125.36 ,$365.00 ,$365.00 ,"$4,701.35 ",$365.00 ,"$2,564.16 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000382,75731,HC ANGIO ADRENAL UNILATERAL,320,1 ,"$2,039.00 ","$1,325.35 ",$118.79 ,"$7,055.60 ","$7,055.60 ",$318.52 ,"$1,141.84 ","$2,822.24 ",$570.92 ,$719.77 ,"$2,822.24 ",$840.07 ,"$2,039.00 ",$919.59 ,$919.59 ,"$2,039.00 ",$118.79 ,"$2,039.00 ",$295.90 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,039.00 ","$1,529.25 ","$1,223.40 ","$1,223.40 ","$2,822.24 ","$1,223.40 ",$154.32 ,$154.32 ,$154.32 ,"$2,039.00 ", N/A ,"$1,733.15 ","$2,039.00 ","$1,325.35 ","$2,822.24 ","$2,039.00 ","$1,141.84 ","$2,822.24 ",$536.26 , N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$1,631.20 ","$6,350.04 ",$919.59 ,$570.92 ,"$1,835.10 ","$2,822.24 ",$154.32 ,$365.00 ,$365.00 ,"$2,039.00 ",$365.00 ,$978.72 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000383,75733,HC ANGIO ADRENAL BILATERAL,320,1 ,"$7,030.00 ","$4,569.50 ",$131.64 ,"$7,055.60 ","$7,055.60 ",$366.46 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ","$1,363.52 ","$2,822.24 ","$1,363.52 ","$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$131.64 ,"$5,362.25 ",$313.16 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$163.43 ,$163.43 ,$163.43 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$163.43 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000384,75736,HC ANGIO PELVIC SELECT,320,1 ,"$12,036.00 ","$7,823.40 ",$109.01 ,"$12,036.00 ","$11,753.38 ",$313.04 ,"$6,740.16 ","$4,701.35 ","$3,370.08 ","$1,178.13 ","$4,701.35 ","$1,178.13 ","$4,701.35 ","$5,428.24 ","$5,428.24 ","$4,701.35 ",$109.01 ,"$8,932.56 ",$269.19 ,"$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$9,027.00 ","$7,221.60 ","$7,221.60 ","$4,701.35 ","$7,221.60 ",$140.42 ,$140.42 ,$140.42 ,"$12,036.00 ", N/A ,"$10,230.60 ","$11,753.37 ","$7,823.40 ","$4,701.35 ","$12,036.00 ","$6,740.16 ","$4,701.35 ","$3,165.47 ", N/A ,$334.40 ,$319.20 ,"$4,936.42 ","$9,628.80 ","$10,578.04 ","$5,428.24 ","$3,370.08 ","$10,832.40 ","$4,701.35 ",$140.42 ,$365.00 ,$365.00 ,"$4,701.35 ",$365.00 ,"$5,777.28 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000387,75746,HC ANGIO PULMONARY NONSELECT,320,1 ,"$3,073.00 ","$1,997.45 ",$99.24 ,"$7,055.60 ","$7,055.60 ",$300.28 ,"$1,720.88 ","$2,822.24 ",$860.44 ,"$1,079.16 ","$2,822.24 ","$1,079.16 ","$2,822.24 ","$1,385.92 ","$1,385.92 ","$2,822.24 ",$99.24 ,"$3,073.00 ",$246.20 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$2,304.75 ","$1,843.80 ","$1,843.80 ","$2,822.24 ","$1,843.80 ",$128.33 ,$128.33 ,$128.33 ,"$3,073.00 ", N/A ,"$2,612.05 ","$3,073.00 ","$1,997.45 ","$2,822.24 ","$3,073.00 ","$1,720.88 ","$2,822.24 ",$808.20 , N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$2,458.40 ","$6,350.04 ","$1,385.92 ",$860.44 ,"$2,765.70 ","$2,822.24 ",$128.33 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$1,475.04 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000388,75756,HC ANGIO INTERNAL MAMMARY,320,1 ,"$7,030.00 ","$4,569.50 ",$126.94 ,"$7,055.60 ","$7,055.60 ",$319.12 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ","$1,296.85 ","$2,822.24 ","$1,296.85 ","$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$126.94 ,"$5,362.25 ",$302.57 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$157.80 ,$157.80 ,$157.80 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$157.80 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000389,75774,HC ANGIO EA VESSEL ADDL 75774,320,1 ,"$3,073.00 ","$1,997.45 ",$63.06 ,"$3,073.00 ", N/A ,$253.46 ,"$1,720.88 ", N/A ,$860.44 ,$779.01 , N/A ,$779.01 , N/A ,"$1,385.92 ","$1,385.92 ", N/A ,$63.06 , N/A ,"$1,536.50 ", N/A , N/A , N/A , N/A ,"$2,304.75 ","$1,843.80 ","$1,843.80 ", N/A ,"$1,843.80 ",$91.56 ,$91.56 ,$91.56 ,"$3,073.00 ", N/A ,"$2,612.05 ", N/A ,"$1,997.45 ", N/A ,"$3,073.00 ","$1,720.88 ", N/A ,$808.20 , N/A ,$334.40 ,$319.20 , N/A ,"$2,458.40 ", N/A ,"$1,385.92 ",$860.44 ,"$2,765.70 ", N/A ,$91.56 ,$365.00 ,$365.00 , N/A ,$365.00 ,"$1,475.04 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000393,75809,HC SHUNTOGRAM NONVASCULAR,320,1 ,$791.00 ,$514.15 ,$72.85 ,$791.00 ,$268.33 ,$133.70 ,$442.96 ,$107.33 ,$221.48 ,$279.22 ,$107.33 ,$325.89 ,$107.33 ,$356.74 ,$356.74 ,$107.33 ,$72.85 ,$203.93 ,$191.83 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$593.25 ,$474.60 ,$474.60 ,$107.33 ,$474.60 ,$100.02 ,$100.02 ,$100.02 ,$791.00 , N/A ,$672.35 ,$268.33 ,$514.15 ,$107.33 ,$791.00 ,$442.96 ,$107.33 ,$208.03 , N/A ,$334.40 ,$319.20 ,$112.70 ,$632.80 ,$241.50 ,$356.74 ,$221.48 ,$711.90 ,$107.33 ,$100.02 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$379.68 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000395,75820,HC VENOGRAM EXTREMITY UNI 75820,320,1 ,"$2,006.00 ","$1,303.90 ",$74.89 ,"$3,465.89 ","$3,465.88 ",$162.88 ,"$1,123.36 ","$1,386.35 ",$561.68 ,$708.12 ,"$1,386.35 ",$826.47 ,"$1,386.35 ",$904.71 ,$904.71 ,"$1,386.35 ",$74.89 ,"$2,006.00 ",$206.14 ,"$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$1,504.50 ","$1,203.60 ","$1,203.60 ","$1,386.35 ","$1,203.60 ",$107.46 ,$107.46 ,$107.46 ,"$2,006.00 ", N/A ,"$1,705.10 ","$2,006.00 ","$1,303.90 ","$1,386.35 ","$2,006.00 ","$1,123.36 ","$1,386.35 ",$527.58 , N/A ,$334.40 ,$319.20 ,"$1,455.67 ","$1,604.80 ","$3,119.30 ",$904.71 ,$561.68 ,"$1,805.40 ","$1,386.35 ",$107.46 ,$365.00 ,$365.00 ,"$1,386.35 ",$365.00 ,$962.88 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000397,75822,HC VENOGRAM EXTREMITY BILAT,320,1 ,"$2,775.00 ","$1,803.75 ",$80.59 ,"$3,465.89 ","$3,465.88 ",$182.34 ,"$1,554.00 ","$1,386.35 ",$777.00 ,$937.26 ,"$1,386.35 ",$937.26 ,"$1,386.35 ","$1,251.53 ","$1,251.53 ","$1,386.35 ",$80.59 ,"$2,634.07 ",$210.90 ,"$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$2,081.25 ","$1,665.00 ","$1,665.00 ","$1,386.35 ","$1,665.00 ",$109.95 ,$109.95 ,$109.95 ,"$2,775.00 ", N/A ,"$2,358.75 ","$2,775.00 ","$1,803.75 ","$1,386.35 ","$2,775.00 ","$1,554.00 ","$1,386.35 ",$729.83 , N/A ,$334.40 ,$319.20 ,"$1,455.67 ","$2,220.00 ","$3,119.30 ","$1,251.53 ",$777.00 ,"$2,497.50 ","$1,386.35 ",$109.95 ,$365.00 ,$365.00 ,"$1,386.35 ",$365.00 ,"$1,332.00 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000398,75825,HC VENOGRAPHY CAVAL INFERIOR,320,1 ,"$4,643.00 ","$3,017.95 ",$75.70 ,"$7,055.60 ","$7,055.60 ",$269.28 ,"$2,600.08 ","$2,822.24 ","$1,300.04 ",$881.86 ,"$2,822.24 ",$881.86 ,"$2,822.24 ","$2,093.99 ","$2,093.99 ","$2,822.24 ",$75.70 ,"$4,643.00 ",$200.41 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$3,482.25 ","$2,785.80 ","$2,785.80 ","$2,822.24 ","$2,785.80 ",$104.49 ,$104.49 ,$104.49 ,"$4,643.00 ", N/A ,"$3,946.55 ","$4,643.00 ","$3,017.95 ","$2,822.24 ","$4,643.00 ","$2,600.08 ","$2,822.24 ","$1,221.11 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$3,714.40 ","$6,350.04 ","$2,093.99 ","$1,300.04 ","$4,178.70 ","$2,822.24 ",$104.49 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$2,228.64 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000399,75827,HC VENOGRAPHY CAVAL SUPERIOR,320,1 ,"$1,731.00 ","$1,125.15 ",$82.21 ,"$3,465.89 ","$3,465.88 ",$274.74 ,$969.36 ,"$1,386.35 ",$484.68 ,$611.04 ,"$1,386.35 ",$713.17 ,"$1,386.35 ",$780.68 ,$780.68 ,"$1,386.35 ",$82.21 ,"$1,731.00 ",$211.86 ,"$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$1,298.25 ","$1,038.60 ","$1,038.60 ","$1,386.35 ","$1,038.60 ",$110.45 ,$110.45 ,$110.45 ,"$1,731.00 ", N/A ,"$1,471.35 ","$1,731.00 ","$1,125.15 ","$1,386.35 ","$1,731.00 ",$969.36 ,"$1,386.35 ",$455.25 , N/A ,$334.40 ,$319.20 ,"$1,455.67 ","$1,384.80 ","$3,119.30 ",$780.68 ,$484.68 ,"$1,557.90 ","$1,386.35 ",$110.45 ,$365.00 ,$365.00 ,"$1,386.35 ",$365.00 ,$830.88 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000400,75831,HC VENOGRAM RENAL UNILAT,320,1 ,"$7,030.00 ","$4,569.50 ",$83.44 ,"$7,055.60 ","$7,055.60 ",$275.36 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ",$953.13 ,"$2,822.24 ",$953.13 ,"$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$83.44 ,"$5,362.25 ",$217.58 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$113.43 ,$113.43 ,$113.43 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$113.43 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000401,75833,HC VENOGRAM RENAL BILAT,320,1 ,"$7,030.00 ","$4,569.50 ",$95.98 ,"$7,055.60 ","$7,055.60 ",$304.54 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ","$1,047.50 ","$2,822.24 ","$1,047.50 ","$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$95.98 ,"$5,362.25 ",$236.75 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$123.53 ,$123.53 ,$123.53 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$123.53 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000402,75840,HC VENOGRAM ADRENAL UNILAT,320,1 ,"$7,030.00 ","$4,569.50 ",$91.59 ,"$7,055.60 ","$7,055.60 ",$269.88 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ","$1,020.35 ","$2,822.24 ","$1,020.35 ","$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$91.59 ,"$5,362.25 ",$233.80 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$121.88 ,$121.88 ,$121.88 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$121.88 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000403,75842,HC VENOGRAM ADRENAL BILAT,320,1 ,"$11,688.00 ","$7,597.20 ",$106.98 ,"$11,753.38 ","$11,753.38 ",$302.72 ,"$6,545.28 ","$4,701.35 ","$3,272.64 ","$1,154.40 ","$4,701.35 ","$1,154.40 ","$4,701.35 ","$5,271.29 ","$5,271.29 ","$4,701.35 ",$106.98 ,"$8,932.56 ",$269.19 ,"$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$8,766.00 ","$7,012.80 ","$7,012.80 ","$4,701.35 ","$7,012.80 ",$140.42 ,$140.42 ,$140.42 ,"$11,688.00 ", N/A ,"$9,934.80 ","$11,688.00 ","$7,597.20 ","$4,701.35 ","$11,688.00 ","$6,545.28 ","$4,701.35 ","$3,073.94 ", N/A ,$334.40 ,$319.20 ,"$4,936.42 ","$9,350.40 ","$10,578.04 ","$5,271.29 ","$3,272.64 ","$10,519.20 ","$4,701.35 ",$140.42 ,$365.00 ,$365.00 ,"$4,701.35 ",$365.00 ,"$5,610.24 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000404,75860,HC VENOGRAPHY SINUS/ JUGULAR,320,1 ,"$7,434.00 ","$4,832.10 ",$89.14 ,"$7,434.00 ","$7,055.60 ",$278.40 ,"$4,163.04 ","$2,822.24 ","$2,081.52 ",$988.76 ,"$2,822.24 ",$988.76 ,"$2,822.24 ","$3,352.73 ","$3,352.73 ","$2,822.24 ",$89.14 ,"$5,362.25 ",$228.07 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,575.50 ","$4,460.40 ","$4,460.40 ","$2,822.24 ","$4,460.40 ",$118.89 ,$118.89 ,$118.89 ,"$7,434.00 ", N/A ,"$6,318.90 ","$7,055.60 ","$4,832.10 ","$2,822.24 ","$7,434.00 ","$4,163.04 ","$2,822.24 ","$1,955.14 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,947.20 ","$6,350.04 ","$3,352.73 ","$2,081.52 ","$6,690.60 ","$2,822.24 ",$118.89 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,568.32 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000409,75885,HC TRANSHEPATIC PORTOGRAPHY W/ HEMO,320,1 ,"$7,030.00 ","$4,569.50 ",$87.51 ,"$7,055.60 ","$7,055.60 ",$275.36 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ",$988.76 ,"$2,822.24 ",$988.76 ,"$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$87.51 ,"$5,362.25 ",$226.17 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$117.90 ,$117.90 ,$117.90 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$117.90 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000410,75887,HC TRANSHEPATIC PORTOGRAPHY WO HEMO,320,1 ,"$2,039.00 ","$1,325.35 ",$89.14 ,"$7,055.60 ","$7,055.60 ",$279.60 ,"$1,141.84 ","$2,822.24 ",$570.92 ,$719.77 ,"$2,822.24 ",$840.07 ,"$2,039.00 ",$919.59 ,$919.59 ,"$2,039.00 ",$89.14 ,"$2,039.00 ",$227.12 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,039.00 ","$1,529.25 ","$1,223.40 ","$1,223.40 ","$2,822.24 ","$1,223.40 ",$118.40 ,$118.40 ,$118.40 ,"$2,039.00 ", N/A ,"$1,733.15 ","$2,039.00 ","$1,325.35 ","$2,822.24 ","$2,039.00 ","$1,141.84 ","$2,822.24 ",$536.26 , N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$1,631.20 ","$6,350.04 ",$919.59 ,$570.92 ,"$1,835.10 ","$2,822.24 ",$118.40 ,$365.00 ,$365.00 ,"$2,039.00 ",$365.00 ,$978.72 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000411,75889,HC VENOGRAM HEPATIC W/HEMO,320,1 ,"$7,030.00 ","$4,569.50 ",$88.33 ,"$7,055.60 ","$7,055.60 ",$275.36 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ",$996.62 ,"$2,822.24 ",$996.62 ,"$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$88.33 ,"$5,362.25 ",$227.12 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$118.40 ,$118.40 ,$118.40 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$118.40 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000412,75891,HC VENOGRAM HEPATIC W/O HEMO,320,1 ,"$7,030.00 ","$4,569.50 ",$88.74 ,"$7,055.60 ","$7,055.60 ",$275.96 ,"$3,936.80 ","$2,822.24 ","$1,968.40 ","$1,000.59 ","$2,822.24 ","$1,000.59 ","$2,822.24 ","$3,170.53 ","$3,170.53 ","$2,822.24 ",$88.74 ,"$5,362.25 ",$229.98 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,272.50 ","$4,218.00 ","$4,218.00 ","$2,822.24 ","$4,218.00 ",$119.88 ,$119.88 ,$119.88 ,"$7,030.00 ", N/A ,"$5,975.50 ","$7,030.00 ","$4,569.50 ","$2,822.24 ","$7,030.00 ","$3,936.80 ","$2,822.24 ","$1,848.89 ", N/A ,$334.40 ,$319.20 ,"$2,963.35 ","$5,624.00 ","$6,350.04 ","$3,170.53 ","$1,968.40 ","$6,327.00 ","$2,822.24 ",$119.88 ,$365.00 ,$365.00 ,"$2,822.24 ",$365.00 ,"$3,374.40 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000413,75893,HC VENOGRAM SAMPLING CATH,320,1 ,"$11,688.00 ","$7,597.20 ",$95.66 ,"$11,753.38 ","$11,753.38 ",$273.52 ,"$6,545.28 ","$4,701.35 ","$3,272.64 ","$1,044.15 ","$4,701.35 ","$1,044.15 ","$4,701.35 ","$5,271.29 ","$5,271.29 ","$4,701.35 ",$95.66 ,"$8,932.56 ",$243.34 ,"$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$8,766.00 ","$7,012.80 ","$7,012.80 ","$4,701.35 ","$7,012.80 ",$126.84 ,$126.84 ,$126.84 ,"$11,688.00 ", N/A ,"$9,934.80 ","$11,688.00 ","$7,597.20 ","$4,701.35 ","$11,688.00 ","$6,545.28 ","$4,701.35 ","$3,073.94 ", N/A ,$334.40 ,$319.20 ,"$4,936.42 ","$9,350.40 ","$10,578.04 ","$5,271.29 ","$3,272.64 ","$10,519.20 ","$4,701.35 ",$126.84 ,$365.00 ,$365.00 ,"$4,701.35 ",$365.00 ,"$5,610.24 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000414,75894,HC TRANSCATH EMBOLIZATION 75894,320,1 ,"$6,945.00 ","$4,514.25 ",$95.10 ,"$6,945.00 ", N/A ,"$1,699.10 ","$3,889.20 ", N/A ,"$1,944.60 ","$2,451.59 ", N/A ,"$2,861.34 ", N/A ,"$3,132.20 ","$3,132.20 ", N/A ,$95.10 , N/A ,"$3,472.50 ", N/A , N/A , N/A , N/A ,"$5,208.75 ","$4,167.00 ","$4,167.00 ", N/A ,"$4,167.00 ","$1,372.26 ","$1,372.26 ","$1,372.26 ","$6,945.00 ", N/A ,"$5,903.25 ", N/A ,"$4,514.25 ", N/A ,"$6,945.00 ","$3,889.20 ", N/A ,"$1,826.54 ", N/A ,$334.40 ,$319.20 , N/A ,"$5,556.00 ", N/A ,"$3,132.20 ","$1,944.60 ","$6,250.50 ", N/A ,"$1,372.26 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$3,333.60 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000417,75898,HC TRANSCATH ANGIO EXIST 75898,320,1 ,"$2,775.00 ","$1,803.75 ",$59.91 ,"$7,055.60 ","$7,055.60 ",$136.14 ,"$1,554.00 ","$2,822.24 ",$777.00 ,$519.08 ,"$2,822.24 ",$519.08 ,"$2,775.00 ","$1,251.53 ","$1,251.53 ","$2,775.00 ",$120.54 ,"$2,775.00 ",$121.71 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,775.00 ","$2,081.25 ","$1,665.00 ","$1,665.00 ","$2,822.24 ","$1,665.00 ",$59.91 ,$59.91 ,$59.91 ,"$2,775.00 ", N/A ,"$2,358.75 ","$2,775.00 ","$1,803.75 ","$2,822.24 ","$2,775.00 ","$1,554.00 ","$2,822.24 ",$729.83 , N/A ,$366.06 ,$349.42 ,"$2,963.35 ","$2,220.00 ","$6,350.04 ","$1,251.53 ",$777.00 ,"$2,497.50 ","$2,822.24 ",$59.91 ,$365.00 ,$365.00 ,"$2,775.00 ",$365.00 ,"$1,332.00 ",$332.78 
ST. ELIZABETH'S HOSPITAL,32000421,75901,HC REMOVE PERICATH OBST CV CATH,320,1 ,$281.00 ,$182.65 ,$73.90 ,$304.00 , N/A ,$257.12 ,$157.36 , N/A ,$78.68 ,$99.19 , N/A ,$115.77 , N/A ,$126.73 ,$126.73 , N/A ,$265.49 , N/A ,$140.50 , N/A , N/A , N/A , N/A ,$210.75 ,$168.60 ,$168.60 , N/A ,$168.60 ,$246.08 ,$246.08 ,$246.08 ,$281.00 , N/A ,$238.85 , N/A ,$182.65 , N/A ,$281.00 ,$157.36 , N/A ,$73.90 , N/A ,$281.00 ,$281.00 , N/A ,$224.80 , N/A ,$126.73 ,$78.68 ,$252.90 , N/A ,$246.08 ,$281.00 ,$281.00 , N/A ,$281.00 ,$134.88 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000422,75902,HC REMOVE INTRALUMN OBST CV CATH,320,1 ,$783.00 ,$508.95 ,$83.63 ,$783.00 , N/A ,$103.92 ,$438.48 , N/A ,$219.24 ,$276.40 , N/A ,$322.60 , N/A ,$353.13 ,$353.13 , N/A ,$92.40 , N/A ,$391.50 , N/A , N/A , N/A , N/A ,$587.25 ,$469.80 ,$469.80 , N/A ,$469.80 ,$83.63 ,$83.63 ,$83.63 ,$783.00 , N/A ,$665.55 , N/A ,$508.95 , N/A ,$783.00 ,$438.48 , N/A ,$205.93 , N/A ,$334.40 ,$319.20 , N/A ,$626.40 , N/A ,$353.13 ,$219.24 ,$704.70 , N/A ,$83.63 ,$365.00 ,$365.00 , N/A ,$365.00 ,$375.84 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000423,37191,HC IVC FILTER PLACEMENT 37191,320,1 ,"$12,010.00 ","$7,806.50 ",$292.18 ,"$12,010.00 ","$11,753.38 ","$5,524.60 ","$6,725.60 ","$4,701.35 ","$3,362.80 ","$4,059.38 ","$4,701.35 ","$4,671.89 ","$4,701.35 ","$5,416.51 ","$5,416.51 ","$4,701.35 ",$292.18 ,"$8,932.56 ","$6,005.00 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$9,007.50 ","$7,206.00 ","$7,206.00 ","$4,701.35 ","$7,206.00 ","$8,407.00 ","$8,407.00 ","$8,407.00 ","$12,010.00 ", N/A ,"$10,208.50 ","$11,753.37 ","$7,806.50 ","$4,701.35 ","$12,010.00 ","$6,725.60 ","$4,701.35 ","$3,158.63 ", N/A ,"$4,198.04 ","$4,007.22 ","$4,936.42 ","$9,608.00 ","$10,578.04 ","$5,416.51 ","$3,362.80 ","$10,809.00 ","$4,701.35 ","$8,407.00 ",$365.00 ,$365.00 ,"$4,701.35 ",$365.00 ,"$5,764.80 ","$3,816.40 "
ST. ELIZABETH'S HOSPITAL,32000435,75970,HC TRANSCATH BX,320,1 ,"$2,681.00 ","$1,742.65 ",$48.86 ,"$2,681.00 ", N/A ,$803.84 ,"$1,501.36 ", N/A ,$750.68 ,$946.39 , N/A ,"$1,104.57 ", N/A ,"$1,209.13 ","$1,209.13 ", N/A ,$48.86 , N/A ,"$1,340.50 ", N/A , N/A , N/A , N/A ,"$2,010.75 ","$1,608.60 ","$1,608.60 ", N/A ,"$1,608.60 ",$655.58 ,$655.58 ,$655.58 ,"$2,681.00 ", N/A ,"$2,278.85 ", N/A ,"$1,742.65 ", N/A ,"$2,681.00 ","$1,501.36 ", N/A ,$705.10 , N/A ,$334.40 ,$319.20 , N/A ,"$2,144.80 ", N/A ,"$1,209.13 ",$750.68 ,"$2,412.90 ", N/A ,$655.58 ,$365.00 ,$365.00 , N/A ,$365.00 ,"$1,286.88 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000438,47533,HC TRANSHEPATIC DRAINAGE,320,1 ,"$10,232.00 ","$6,650.80 ",$341.19 ,"$10,232.00 ","$7,841.65 ","$4,706.72 ","$5,729.92 ","$3,136.66 ","$2,864.96 ","$3,458.42 ","$3,136.66 ","$3,980.25 ","$3,136.66 ","$4,614.63 ","$4,614.63 ","$3,136.66 ",$341.19 ,"$5,959.66 ","$5,116.00 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$7,674.00 ","$6,139.20 ","$6,139.20 ","$3,136.66 ","$6,139.20 ","$7,162.40 ","$7,162.40 ","$7,162.40 ","$10,232.00 ", N/A ,"$8,697.20 ","$7,841.66 ","$6,650.80 ","$3,136.66 ","$10,232.00 ","$5,729.92 ","$3,136.66 ","$2,691.02 ", N/A ,"$1,775.16 ","$1,694.47 ","$3,293.49 ","$8,185.60 ","$7,057.49 ","$4,614.63 ","$2,864.96 ","$9,208.80 ","$3,136.66 ","$7,162.40 ",$365.00 ,$365.00 ,"$3,136.66 ",$365.00 ,"$4,911.36 ","$1,613.78 "
ST. ELIZABETH'S HOSPITAL,32000439,47534,HC PLACE BILIARY DRAINAGE CATH,320,1 ,"$10,232.00 ","$6,650.80 ",$365.00 ,"$10,232.00 ","$7,841.65 ","$4,706.72 ","$5,729.92 ","$3,136.66 ","$2,864.96 ","$3,458.42 ","$3,136.66 ","$3,980.25 ","$3,136.66 ","$4,614.63 ","$4,614.63 ","$3,136.66 ",$475.01 ,"$5,959.66 ","$5,116.00 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$7,674.00 ","$6,139.20 ","$6,139.20 ","$3,136.66 ","$6,139.20 ","$7,162.40 ","$7,162.40 ","$7,162.40 ","$10,232.00 ", N/A ,"$8,697.20 ","$7,841.66 ","$6,650.80 ","$3,136.66 ","$10,232.00 ","$5,729.92 ","$3,136.66 ","$2,691.02 ", N/A ,"$1,775.16 ","$1,694.47 ","$3,293.49 ","$8,185.60 ","$7,057.49 ","$4,614.63 ","$2,864.96 ","$9,208.80 ","$3,136.66 ","$7,162.40 ",$365.00 ,$365.00 ,"$3,136.66 ",$365.00 ,"$4,911.36 ","$1,613.78 "
ST. ELIZABETH'S HOSPITAL,32000440,75984,HC CHANGE PERC DRAINAGE TUBE OR CATH,320,1 ,"$5,907.00 ","$3,839.55 ",$73.66 ,"$5,907.00 ", N/A ,$142.82 ,"$3,307.92 ", N/A ,"$1,653.96 ",$798.77 , N/A ,$798.77 , N/A ,"$2,664.06 ","$2,664.06 ", N/A ,$73.66 , N/A ,"$2,953.50 ", N/A , N/A , N/A , N/A ,"$4,430.25 ","$3,544.20 ","$3,544.20 ", N/A ,"$3,544.20 ",$94.55 ,$94.55 ,$94.55 ,"$5,907.00 ", N/A ,"$5,020.95 ", N/A ,"$3,839.55 ", N/A ,"$5,907.00 ","$3,307.92 ", N/A ,"$1,553.54 ", N/A ,$334.40 ,$319.20 , N/A ,"$4,725.60 ", N/A ,"$2,664.06 ","$1,653.96 ","$5,316.30 ", N/A ,$94.55 ,$365.00 ,$365.00 , N/A ,$365.00 ,"$2,835.36 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000444,49406,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER,320,1 ,"$3,830.00 ","$2,489.50 ",$251.15 ,"$3,830.00 ","$3,467.90 ","$1,761.80 ","$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$251.15 ,"$2,635.59 ","$1,915.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$2,489.50 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$365.00 ,$365.00 ,"$1,387.16 ",$365.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$2,507.00 ","$1,629.55 ",$72.85 ,"$2,507.00 ", N/A ,$148.16 ,"$1,403.92 ", N/A ,$701.96 ,$707.75 , N/A ,$707.75 , N/A ,"$1,130.66 ","$1,130.66 ", N/A ,$72.85 , N/A ,"$1,253.50 ", N/A , N/A , N/A , N/A ,"$1,880.25 ","$1,504.20 ","$1,504.20 ", N/A ,"$1,504.20 ",$88.10 ,$88.10 ,$88.10 ,"$2,507.00 ", N/A ,"$2,130.95 ", N/A ,"$1,629.55 ", N/A ,"$2,507.00 ","$1,403.92 ", N/A ,$659.34 , N/A ,$334.40 ,$319.20 , N/A ,"$2,005.60 ", N/A ,"$1,130.66 ",$701.96 ,"$2,256.30 ", N/A ,$88.10 ,$365.00 ,$365.00 , N/A ,$365.00 ,"$1,203.36 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$818.00 ,$531.70 ,$34.14 ,$818.00 ,$567.13 ,$124.58 ,$458.08 ,$226.85 ,$229.04 ,$288.75 ,$226.85 ,$337.02 ,$226.85 ,$368.92 ,$368.92 ,$226.85 ,$34.14 ,$431.02 ,$84.99 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$613.50 ,$490.80 ,$490.80 ,$226.85 ,$490.80 ,$44.37 ,$44.37 ,$44.37 ,$818.00 , N/A ,$695.30 ,$567.13 ,$531.70 ,$226.85 ,$818.00 ,$458.08 ,$226.85 ,$215.13 , N/A ,$58.69 ,$56.02 ,$238.19 ,$654.40 ,$510.41 ,$368.92 ,$229.04 ,$736.20 ,$226.85 ,$44.37 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$392.64 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000464,76010,HC BABYGRAM,320,1 ,$415.00 ,$269.75 ,$25.50 ,$415.00 ,$199.38 ,$34.00 ,$232.40 ,$79.75 ,$116.20 ,$146.50 ,$79.75 ,$170.98 ,$79.75 ,$187.17 ,$187.17 ,$79.75 ,$25.99 ,$151.52 ,$48.74 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$311.25 ,$249.00 ,$249.00 ,$79.75 ,$249.00 ,$25.50 ,$25.50 ,$25.50 ,$415.00 , N/A ,$352.75 ,$199.36 ,$269.75 ,$79.75 ,$415.00 ,$232.40 ,$79.75 ,$109.15 , N/A ,$58.69 ,$56.02 ,$83.74 ,$332.00 ,$179.43 ,$187.17 ,$116.20 ,$373.50 ,$79.75 ,$25.50 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$199.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000465,76080,HC ABSCESS FISTULA OR SINUS TRACT,320,1 ,"$1,188.00 ",$772.20 ,$43.38 ,"$1,190.93 ","$1,190.93 ",$64.40 ,$665.28 ,$476.37 ,$332.64 ,$323.96 ,$476.37 ,$323.96 ,$476.37 ,$535.79 ,$535.79 ,$476.37 ,$43.91 ,$905.10 ,$83.08 ,"$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,$891.00 ,$712.80 ,$712.80 ,$476.37 ,$712.80 ,$43.38 ,$43.38 ,$43.38 ,"$1,188.00 ", N/A ,"$1,009.80 ","$1,188.00 ",$772.20 ,$476.37 ,"$1,188.00 ",$665.28 ,$476.37 ,$312.44 , N/A ,$334.40 ,$319.20 ,$500.19 ,$950.40 ,"$1,071.82 ",$535.79 ,$332.64 ,"$1,069.20 ",$476.37 ,$43.38 ,$365.00 ,$365.00 ,$476.37 ,$365.00 ,$570.24 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000466,76080,HC ABSCESS FISTULA DRAINAGE CATH CHECK,320,1 ,"$1,188.00 ",$772.20 ,$43.38 ,"$1,190.93 ","$1,190.93 ",$64.40 ,$665.28 ,$476.37 ,$332.64 ,$323.96 ,$476.37 ,$323.96 ,$476.37 ,$535.79 ,$535.79 ,$476.37 ,$43.91 ,$905.10 ,$83.08 ,"$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,$891.00 ,$712.80 ,$712.80 ,$476.37 ,$712.80 ,$43.38 ,$43.38 ,$43.38 ,"$1,188.00 ", N/A ,"$1,009.80 ","$1,188.00 ",$772.20 ,$476.37 ,"$1,188.00 ",$665.28 ,$476.37 ,$312.44 , N/A ,$334.40 ,$319.20 ,$500.19 ,$950.40 ,"$1,071.82 ",$535.79 ,$332.64 ,"$1,069.20 ",$476.37 ,$43.38 ,$365.00 ,$365.00 ,$476.37 ,$365.00 ,$570.24 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$368.00 ,$239.20 ,$12.08 ,"$1,190.93 ","$1,190.93 ",$20.62 ,$206.08 ,$476.37 ,$103.04 ,$102.31 ,$476.37 ,$102.31 ,$368.00 ,$165.97 ,$165.97 ,$368.00 ,$31.28 ,$368.00 ,$22.99 ,"$1,190.92 ",$476.37 ,$476.37 ,$368.00 ,$276.00 ,$220.80 ,$220.80 ,$476.37 ,$220.80 ,$12.08 ,$12.08 ,$12.08 ,$368.00 , N/A ,$312.80 ,$368.00 ,$239.20 ,$476.37 ,$28.70 ,$206.08 ,$476.37 ,$96.78 , N/A ,$58.69 ,$56.02 ,$500.19 ,$294.40 ,"$1,071.82 ",$165.97 ,$103.04 ,$331.20 ,$476.37 ,$12.08 ,$365.00 ,$365.00 ,$368.00 ,$365.00 ,$176.64 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000468,76100,HC RADIOLOGICAL EXAM TOMOGRAPHY SINGL,320,1 ,"$2,887.00 ","$1,876.55 ",$53.35 ,"$2,887.00 ",$268.33 ,$136.14 ,"$1,616.72 ",$107.33 ,$808.36 ,$672.19 ,$107.33 ,$672.19 ,$107.33 ,"$1,302.04 ","$1,302.04 ",$107.33 ,$76.10 ,$203.93 ,$169.89 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$2,165.25 ","$1,732.20 ","$1,732.20 ",$107.33 ,"$1,732.20 ",$88.59 ,$88.59 ,$88.59 ,"$2,887.00 ", N/A ,"$2,453.95 ",$268.33 ,"$1,876.55 ",$107.33 ,"$2,887.00 ","$1,616.72 ",$107.33 ,$759.28 , N/A ,$58.69 ,$56.02 ,$112.70 ,"$2,309.60 ",$241.50 ,"$1,302.04 ",$808.36 ,"$2,598.30 ",$107.33 ,$88.59 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,"$1,385.76 ",$53.35 
ST. ELIZABETH'S HOSPITAL,32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$946.00 ,$614.90 ,$100.52 ,$946.00 , N/A ,$171.40 ,$529.76 , N/A ,$264.88 ,$333.94 , N/A ,$389.75 , N/A ,$426.65 ,$426.65 , N/A ,$103.81 , N/A ,$473.00 , N/A , N/A , N/A , N/A ,$709.50 ,$567.60 ,$567.60 , N/A ,$567.60 ,$100.52 ,$100.52 ,$100.52 ,$946.00 , N/A ,$804.10 , N/A ,$614.90 , N/A ,$946.00 ,$529.76 , N/A ,$248.80 , N/A ,$334.40 ,$319.20 , N/A ,$756.80 , N/A ,$426.65 ,$264.88 ,$851.40 , N/A ,$100.52 ,$365.00 ,$365.00 , N/A ,$365.00 ,$454.08 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,"$1,025.00 ",$666.25 ,$86.90 ,"$1,025.00 ", N/A ,$86.90 ,$574.00 , N/A ,$287.00 ,$361.83 , N/A ,$422.30 , N/A ,$462.28 ,$462.28 , N/A ,$109.93 , N/A ,$512.50 , N/A , N/A , N/A , N/A ,$768.75 ,$615.00 ,$615.00 , N/A ,$615.00 ,$102.99 ,$102.99 ,$102.99 ,"$1,025.00 ", N/A ,$871.25 , N/A ,$666.25 , N/A ,"$1,025.00 ",$574.00 , N/A ,$269.58 , N/A ,$334.40 ,$319.20 , N/A ,$820.00 , N/A ,$462.28 ,$287.00 ,$922.50 , N/A ,$102.99 ,$365.00 ,$365.00 , N/A ,$365.00 ,$492.00 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,$442.00 ,$287.30 ,$59.54 ,$442.00 , N/A ,$59.54 ,$247.52 , N/A ,$123.76 ,$156.03 , N/A ,$182.10 , N/A ,$199.34 ,$199.34 , N/A ,$94.44 , N/A ,$221.00 , N/A , N/A , N/A , N/A ,$331.50 ,$265.20 ,$265.20 , N/A ,$265.20 ,$95.04 ,$95.04 ,$95.04 ,$442.00 , N/A ,$375.70 , N/A ,$287.30 , N/A ,$442.00 ,$247.52 , N/A ,$116.25 , N/A ,$334.40 ,$319.20 , N/A ,$353.60 , N/A ,$199.34 ,$123.76 ,$397.80 , N/A ,$95.04 ,$365.00 ,$365.00 , N/A ,$365.00 ,$212.16 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$5,177.00 ","$3,365.05 ",$214.53 ,"$5,177.00 ","$3,467.90 ","$2,381.42 ","$2,899.12 ","$1,387.16 ","$1,449.56 ","$1,749.83 ","$1,387.16 ","$2,013.85 ","$1,387.16 ","$2,334.83 ","$2,334.83 ","$1,387.16 ",$214.53 ,"$2,635.59 ","$2,588.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,882.75 ","$3,106.20 ","$3,106.20 ","$1,387.16 ","$3,106.20 ","$3,623.90 ","$3,623.90 ","$3,623.90 ","$5,177.00 ", N/A ,"$4,400.45 ","$3,467.89 ","$3,365.05 ","$1,387.16 ",$619.99 ,"$2,899.12 ","$1,387.16 ","$1,361.55 ", N/A ,"$1,299.83 ","$1,240.74 ","$1,456.52 ","$4,141.60 ","$3,121.10 ","$2,334.83 ","$1,449.56 ","$4,659.30 ","$1,387.16 ","$3,623.90 ",$365.00 ,$365.00 ,"$1,387.16 ",$365.00 ,"$2,484.96 ","$1,181.66 "
ST. ELIZABETH'S HOSPITAL,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,"$4,541.00 ","$2,951.65 ",$114.47 ,"$4,541.00 ","$1,533.75 ","$2,088.86 ","$2,542.96 ",$613.50 ,"$1,271.48 ","$1,534.86 ",$613.50 ,"$1,766.45 ",$613.50 ,"$2,047.99 ","$2,047.99 ",$613.50 ,$128.79 ,"$1,165.65 ","$2,270.50 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,405.75 ","$2,724.60 ","$2,724.60 ",$613.50 ,"$2,724.60 ","$3,178.70 ","$3,178.70 ","$3,178.70 ","$4,541.00 ", N/A ,"$3,859.85 ","$1,533.75 ","$2,951.65 ",$613.50 ,$266.06 ,"$2,542.96 ",$613.50 ,"$1,194.28 ", N/A ,$125.92 ,$120.19 ,$644.18 ,"$3,632.80 ","$1,380.37 ","$2,047.99 ","$1,271.48 ","$4,086.90 ",$613.50 ,"$3,178.70 ",$365.00 ,$365.00 ,$613.50 ,$365.00 ,"$2,179.68 ",$114.47 
ST. ELIZABETH'S HOSPITAL,32000490,77053,HC GALACTOGRAM SINGLE DUCT,320,1 ,$351.00 ,$228.15 ,$40.72 ,$567.13 ,$567.13 ,$90.54 ,$196.56 ,$226.85 ,$98.28 ,$123.90 ,$226.85 ,$144.61 ,$226.85 ,$158.30 ,$158.30 ,$226.85 ,$44.33 ,$351.00 ,$105.98 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$263.25 ,$210.60 ,$210.60 ,$226.85 ,$210.60 ,$55.31 ,$55.31 ,$55.31 ,$351.00 , N/A ,$298.35 ,$351.00 ,$228.15 ,$226.85 ,$40.72 ,$196.56 ,$226.85 ,$92.31 , N/A ,$334.40 ,$319.20 ,$238.19 ,$280.80 ,$510.41 ,$158.30 ,$98.28 ,$315.90 ,$226.85 ,$55.31 ,$351.00 ,$351.00 ,$226.85 ,$351.00 ,$168.48 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000491,77054,HC GALACTOGRAM MULTI DUCT,320,1 ,$485.00 ,$315.25 ,$58.18 ,$567.13 ,$567.13 ,$124.58 ,$271.60 ,$226.85 ,$135.80 ,$171.21 ,$226.85 ,$199.82 ,$226.85 ,$218.74 ,$218.74 ,$226.85 ,$58.18 ,$431.02 ,$140.32 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$363.75 ,$291.00 ,$291.00 ,$226.85 ,$291.00 ,$73.19 ,$73.19 ,$73.19 ,$485.00 , N/A ,$412.25 ,$485.00 ,$315.25 ,$226.85 ,$485.00 ,$271.60 ,$226.85 ,$127.56 , N/A ,$334.40 ,$319.20 ,$238.19 ,$388.00 ,$510.41 ,$218.74 ,$135.80 ,$436.50 ,$226.85 ,$73.19 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$232.80 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$591.00 ,$384.15 ,$32.45 ,$591.00 ,$268.33 ,$44.34 ,$330.96 ,$107.33 ,$165.48 ,$208.62 ,$107.33 ,$243.49 ,$107.33 ,$266.54 ,$266.54 ,$107.33 ,$39.43 ,$203.93 ,$62.10 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$443.25 ,$354.60 ,$354.60 ,$107.33 ,$354.60 ,$32.45 ,$32.45 ,$32.45 ,$591.00 , N/A ,$502.35 ,$268.33 ,$384.15 ,$107.33 ,$591.00 ,$330.96 ,$107.33 ,$155.43 , N/A ,$58.69 ,$56.02 ,$112.70 ,$472.80 ,$241.50 ,$266.54 ,$165.48 ,$531.90 ,$107.33 ,$32.45 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$283.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000493,77074,HC BONE SURVEY LIMITED,320,1 ,$641.00 ,$416.65 ,$53.35 ,$641.00 ,$268.33 ,$85.68 ,$358.96 ,$107.33 ,$179.48 ,$226.27 ,$107.33 ,$264.09 ,$107.33 ,$289.09 ,$289.09 ,$107.33 ,$54.51 ,$203.93 ,$120.28 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$480.75 ,$384.60 ,$384.60 ,$107.33 ,$384.60 ,$62.76 ,$62.76 ,$62.76 ,$641.00 , N/A ,$544.85 ,$268.33 ,$416.65 ,$107.33 ,$641.00 ,$358.96 ,$107.33 ,$168.58 , N/A ,$58.69 ,$56.02 ,$112.70 ,$512.80 ,$241.50 ,$289.09 ,$179.48 ,$576.90 ,$107.33 ,$62.76 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$307.68 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,"$1,412.00 ",$917.80 ,$53.35 ,"$1,412.00 ",$268.33 ,$136.14 ,$790.72 ,$107.33 ,$395.36 ,$498.44 ,$107.33 ,$581.74 ,$107.33 ,$636.81 ,$636.81 ,$107.33 ,$89.55 ,$203.93 ,$174.66 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,059.00 ",$847.20 ,$847.20 ,$107.33 ,$847.20 ,$91.07 ,$91.07 ,$91.07 ,"$1,412.00 ", N/A ,"$1,200.20 ",$268.33 ,$917.80 ,$107.33 ,"$1,412.00 ",$790.72 ,$107.33 ,$371.36 , N/A ,$58.69 ,$56.02 ,$112.70 ,"$1,129.60 ",$241.50 ,$636.81 ,$395.36 ,"$1,270.80 ",$107.33 ,$91.07 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$677.76 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$726.00 ,$471.90 ,$53.35 ,$726.00 ,$268.33 ,$119.72 ,$406.56 ,$107.33 ,$203.28 ,$256.28 ,$107.33 ,$299.11 ,$107.33 ,$327.43 ,$327.43 ,$107.33 ,$90.36 ,$203.93 ,$176.56 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$544.50 ,$435.60 ,$435.60 ,$107.33 ,$435.60 ,$92.07 ,$92.07 ,$92.07 ,$726.00 , N/A ,$617.10 ,$268.33 ,$471.90 ,$107.33 ,$726.00 ,$406.56 ,$107.33 ,$190.94 , N/A ,$58.69 ,$56.02 ,$112.70 ,$580.80 ,$241.50 ,$327.43 ,$203.28 ,$653.40 ,$107.33 ,$92.07 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$348.48 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000496,77080,HC BONE DENSITY DXA,320,1 ,$530.00 ,$344.50 ,$33.73 ,$530.00 ,$268.33 ,$162.32 ,$296.80 ,$107.33 ,$148.40 ,$187.09 ,$107.33 ,$218.36 ,$107.33 ,$239.03 ,$239.03 ,$107.33 ,$33.73 ,$203.93 ,$81.17 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$397.50 ,$318.00 ,$318.00 ,$107.33 ,$318.00 ,$42.39 ,$42.39 ,$42.39 ,$530.00 , N/A ,$450.50 ,$268.33 ,$344.50 ,$107.33 ,$530.00 ,$296.80 ,$107.33 ,$139.39 , N/A ,$92.69 ,$88.47 ,$112.70 ,$424.00 ,$241.50 ,$239.03 ,$148.40 ,$477.00 ,$107.33 ,$42.39 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$254.40 ,$84.26 
ST. ELIZABETH'S HOSPITAL,32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$388.00 ,$252.20 ,$25.99 ,$388.00 ,$199.38 ,$34.60 ,$217.28 ,$79.75 ,$108.64 ,$136.96 ,$79.75 ,$159.86 ,$79.75 ,$174.99 ,$174.99 ,$79.75 ,$25.99 ,$151.52 ,$62.10 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$291.00 ,$232.80 ,$232.80 ,$79.75 ,$232.80 ,$32.45 ,$32.45 ,$32.45 ,$388.00 , N/A ,$329.80 ,$199.36 ,$252.20 ,$79.75 ,$388.00 ,$217.28 ,$79.75 ,$102.04 , N/A ,$92.69 ,$88.47 ,$83.74 ,$310.40 ,$179.43 ,$174.99 ,$108.64 ,$349.20 ,$79.75 ,$32.45 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$186.24 ,$84.26 
ST. ELIZABETH'S HOSPITAL,32000498,77086,HC BONE DENSITY VERTEB FX ASSEMT,320,1 ,$239.25 ,$155.51 ,$30.06 ,$239.25 ,$199.38 ,$47.22 ,$133.98 ,$79.75 ,$66.99 ,$84.46 ,$79.75 ,$98.57 ,$79.75 ,$107.90 ,$107.90 ,$79.75 ,$30.06 ,$151.52 ,$71.64 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$179.44 ,$143.55 ,$143.55 ,$79.75 ,$143.55 ,$37.41 ,$37.41 ,$37.41 ,$239.25 , N/A ,$203.36 ,$199.36 ,$155.51 ,$79.75 ,$239.25 ,$133.98 ,$79.75 ,$62.92 , N/A ,$92.69 ,$88.47 ,$83.74 ,$191.40 ,$179.43 ,$107.90 ,$66.99 ,$215.33 ,$79.75 ,$37.41 ,$239.25 ,$239.25 ,$79.75 ,$239.25 ,$114.84 ,$84.26 
ST. ELIZABETH'S HOSPITAL,32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$818.00 ,$531.70 ,$34.14 ,$818.00 ,$567.13 ,$124.58 ,$458.08 ,$226.85 ,$229.04 ,$288.75 ,$226.85 ,$337.02 ,$226.85 ,$368.92 ,$368.92 ,$226.85 ,$34.14 ,$431.02 ,$84.99 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$613.50 ,$490.80 ,$490.80 ,$226.85 ,$490.80 ,$44.37 ,$44.37 ,$44.37 ,$818.00 , N/A ,$695.30 ,$567.13 ,$531.70 ,$226.85 ,$818.00 ,$458.08 ,$226.85 ,$215.13 , N/A ,$58.69 ,$56.02 ,$238.19 ,$654.40 ,$510.41 ,$368.92 ,$229.04 ,$736.20 ,$226.85 ,$44.37 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$392.64 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000503,20501,HC INJ TRACT SINOGRAM DIAG,320,1 ,$263.00 ,$170.95 ,$48.81 ,$332.78 , N/A ,$120.98 ,$147.28 , N/A ,$73.64 ,$88.89 , N/A ,$102.31 , N/A ,$118.61 ,$118.61 , N/A ,$48.81 , N/A ,$131.50 , N/A , N/A , N/A , N/A ,$197.25 ,$157.80 ,$157.80 , N/A ,$157.80 ,$184.10 ,$184.10 ,$184.10 ,$263.00 , N/A ,$223.55 , N/A ,$170.95 , N/A ,$263.00 ,$147.28 , N/A ,$69.17 , N/A ,$263.00 ,$263.00 , N/A ,$210.40 , N/A ,$118.61 ,$73.64 ,$236.70 , N/A ,$184.10 ,$263.00 ,$263.00 , N/A ,$263.00 ,$126.24 ,$332.78 
ST. ELIZABETH'S HOSPITAL,32000504,20550,HC INJ SINGLE TENDON/LIGAMENT,320,1 ,"$1,001.00 ",$650.65 ,$51.85 ,"$1,001.00 ",$643.95 ,$460.46 ,$560.56 ,$257.58 ,$280.28 ,$338.34 ,$257.58 ,$389.39 ,$257.58 ,$451.45 ,$451.45 ,$257.58 ,$51.85 ,$489.39 ,$500.50 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$750.75 ,$600.60 ,$600.60 ,$257.58 ,$600.60 ,$700.70 ,$700.70 ,$700.70 ,"$1,001.00 ", N/A ,$850.85 ,$643.94 ,$650.65 ,$257.58 ,"$1,001.00 ",$560.56 ,$257.58 ,$263.26 , N/A ,$341.32 ,$325.80 ,$270.46 ,$800.80 ,$579.55 ,$451.45 ,$280.28 ,$900.90 ,$257.58 ,$700.70 ,$365.00 ,$365.00 ,$257.58 ,$365.00 ,$480.48 ,$310.29 
ST. ELIZABETH'S HOSPITAL,32000504,20550,HC INJ SINGLE TENDON/LIGAMENT,320,1 ,"$1,421.00 ",$923.65 ,$51.85 ,"$1,421.00 ",$965.90 ,$653.66 ,$795.76 ,$386.36 ,$397.88 ,$480.30 ,$386.36 ,$552.77 ,$386.36 ,$640.87 ,$640.87 ,$386.36 ,$51.85 ,$734.09 ,$710.50 ,$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$1,065.75 ",$852.60 ,$852.60 ,$386.36 ,$852.60 ,$994.70 ,$994.70 ,$994.70 ,"$1,421.00 ", N/A ,"$1,207.85 ",$965.91 ,$923.65 ,$386.36 ,"$1,421.00 ",$795.76 ,$386.36 ,$373.72 , N/A ,$511.98 ,$488.71 ,$405.68 ,"$1,136.80 ",$869.32 ,$640.87 ,$397.88 ,"$1,278.90 ",$386.36 ,$994.70 ,$365.00 ,$365.00 ,$386.36 ,$365.00 ,$682.08 ,$465.44 
ST. ELIZABETH'S HOSPITAL,32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,"$1,258.00 ",$817.70 ,$49.69 ,"$1,258.00 ",$643.95 ,$578.68 ,$704.48 ,$257.58 ,$352.24 ,$425.20 ,$257.58 ,$489.36 ,$257.58 ,$567.36 ,$567.36 ,$257.58 ,$49.69 ,$489.39 ,$629.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$943.50 ,$754.80 ,$754.80 ,$257.58 ,$754.80 ,$880.60 ,$880.60 ,$880.60 ,"$1,258.00 ", N/A ,"$1,069.30 ",$643.94 ,$817.70 ,$257.58 ,"$1,258.00 ",$704.48 ,$257.58 ,$330.85 , N/A ,$341.32 ,$325.80 ,$270.46 ,"$1,006.40 ",$579.55 ,$567.36 ,$352.24 ,"$1,132.20 ",$257.58 ,$880.60 ,$365.00 ,$365.00 ,$257.58 ,$365.00 ,$603.84 ,$310.29 
ST. ELIZABETH'S HOSPITAL,32000506,20553,HC INJ TRIGGER PT 3+ MUSC GROUP,320,1 ,"$1,472.00 ",$956.80 ,$56.34 ,"$1,472.00 ",$643.95 ,$677.12 ,$824.32 ,$257.58 ,$412.16 ,$497.54 ,$257.58 ,$572.61 ,$257.58 ,$663.87 ,$663.87 ,$257.58 ,$56.34 ,$489.39 ,$736.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,"$1,104.00 ",$883.20 ,$883.20 ,$257.58 ,$883.20 ,"$1,030.40 ","$1,030.40 ","$1,030.40 ","$1,472.00 ", N/A ,"$1,251.20 ",$643.94 ,$956.80 ,$257.58 ,"$1,472.00 ",$824.32 ,$257.58 ,$387.14 , N/A ,$341.32 ,$325.80 ,$270.46 ,"$1,177.60 ",$579.55 ,$663.87 ,$412.16 ,"$1,324.80 ",$257.58 ,"$1,030.40 ",$365.00 ,$365.00 ,$257.58 ,$365.00 ,$706.56 ,$310.29 
ST. ELIZABETH'S HOSPITAL,32000509,77072,HC BONE AGE STUDIES,320,1 ,$815.00 ,$529.75 ,$20.52 ,$815.00 ,$268.33 ,$26.10 ,$456.40 ,$107.33 ,$228.20 ,$153.81 ,$107.33 ,$153.81 ,$107.33 ,$367.57 ,$367.57 ,$107.33 ,$21.09 ,$203.93 ,$39.20 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$611.25 ,$489.00 ,$489.00 ,$107.33 ,$489.00 ,$20.52 ,$20.52 ,$20.52 ,$815.00 , N/A ,$692.75 ,$268.33 ,$529.75 ,$107.33 ,$815.00 ,$456.40 ,$107.33 ,$214.35 , N/A ,$58.69 ,$56.02 ,$112.70 ,$652.00 ,$241.50 ,$367.57 ,$228.20 ,$733.50 ,$107.33 ,$20.52 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$391.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,"$2,141.00 ","$1,391.65 ",$117.55 ,"$2,141.00 ","$1,332.25 ",$984.86 ,"$1,198.96 ",$532.90 ,$599.48 ,$723.66 ,$532.90 ,$832.85 ,$532.90 ,$965.59 ,$965.59 ,$532.90 ,$117.55 ,"$1,012.50 ","$1,070.50 ","$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,"$1,605.75 ","$1,284.60 ","$1,284.60 ",$532.90 ,"$1,284.60 ","$1,498.70 ","$1,498.70 ","$1,498.70 ","$2,141.00 ", N/A ,"$1,819.85 ","$1,332.24 ","$1,391.65 ",$532.90 ,"$2,141.00 ","$1,198.96 ",$532.90 ,$563.08 , N/A ,$729.45 ,$696.30 ,$559.55 ,"$1,712.80 ","$1,199.01 ",$965.59 ,$599.48 ,"$1,926.90 ",$532.90 ,"$1,498.70 ",$365.00 ,$365.00 ,$532.90 ,$365.00 ,"$1,027.68 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$2,462.00 ","$1,600.30 ",$142.73 ,"$2,462.00 ","$1,332.25 ","$1,132.52 ","$1,378.72 ",$532.90 ,$689.36 ,$832.16 ,$532.90 ,$957.72 ,$532.90 ,"$1,110.36 ","$1,110.36 ",$532.90 ,$142.73 ,"$1,012.50 ","$1,231.00 ","$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,"$1,846.50 ","$1,477.20 ","$1,477.20 ",$532.90 ,"$1,477.20 ","$1,723.40 ","$1,723.40 ","$1,723.40 ","$2,462.00 ", N/A ,"$2,092.70 ","$1,332.24 ","$1,600.30 ",$532.90 ,"$2,462.00 ","$1,378.72 ",$532.90 ,$647.51 , N/A ,$729.45 ,$696.30 ,$559.55 ,"$1,969.60 ","$1,199.01 ","$1,110.36 ",$689.36 ,"$2,215.80 ",$532.90 ,"$1,723.40 ",$365.00 ,$365.00 ,$532.90 ,$365.00 ,"$1,181.76 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000533,32557,HC PLEURAL DRAINAGE W/IMAGING 32557,320,1 ,"$3,236.00 ","$2,103.40 ",$193.89 ,"$3,465.89 ","$3,465.88 ","$1,488.56 ","$1,812.16 ","$1,386.35 ",$906.08 ,"$1,093.77 ","$1,386.35 ","$1,258.80 ","$1,386.35 ","$1,459.44 ","$1,459.44 ","$1,386.35 ",$193.89 ,"$2,634.07 ","$1,618.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$2,427.00 ","$1,941.60 ","$1,941.60 ","$1,386.35 ","$1,941.60 ","$2,265.20 ","$2,265.20 ","$2,265.20 ","$3,236.00 ", N/A ,"$2,750.60 ","$3,236.00 ","$2,103.40 ","$1,386.35 ","$3,236.00 ","$1,812.16 ","$1,386.35 ",$851.07 , N/A ,$729.45 ,$696.30 ,"$1,455.67 ","$2,588.80 ","$3,119.30 ","$1,459.44 ",$906.08 ,"$2,912.40 ","$1,386.35 ","$2,265.20 ",$365.00 ,$365.00 ,"$1,386.35 ",$365.00 ,"$1,553.28 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000542,20551,HC INJ TENDON ORIGIN,320,1 ,$901.00 ,$585.65 ,$51.54 ,$901.00 ,$643.95 ,$414.46 ,$504.56 ,$257.58 ,$252.28 ,$304.54 ,$257.58 ,$350.49 ,$257.58 ,$406.35 ,$406.35 ,$257.58 ,$51.54 ,$489.39 ,$450.50 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$675.75 ,$540.60 ,$540.60 ,$257.58 ,$540.60 ,$630.70 ,$630.70 ,$630.70 ,$901.00 , N/A ,$765.85 ,$643.94 ,$585.65 ,$257.58 ,$901.00 ,$504.56 ,$257.58 ,$236.96 , N/A ,$341.32 ,$325.80 ,$270.46 ,$720.80 ,$579.55 ,$406.35 ,$252.28 ,$810.90 ,$257.58 ,$630.70 ,$365.00 ,$365.00 ,$257.58 ,$365.00 ,$432.48 ,$310.29 
ST. ELIZABETH'S HOSPITAL,32000543,72074,HC XR T-SPINE 4 + VIEWS,320,1 ,$790.00 ,$513.50 ,$40.25 ,$790.00 ,$268.33 ,$61.36 ,$442.40 ,$107.33 ,$221.20 ,$278.87 ,$107.33 ,$313.85 ,$107.33 ,$356.29 ,$356.29 ,$107.33 ,$40.25 ,$203.93 ,$77.36 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$592.50 ,$474.00 ,$474.00 ,$107.33 ,$474.00 ,$40.40 ,$40.40 ,$40.40 ,$790.00 , N/A ,$671.50 ,$268.33 ,$513.50 ,$107.33 ,$790.00 ,$442.40 ,$107.33 ,$207.77 , N/A ,$58.69 ,$56.02 ,$112.70 ,$632.00 ,$241.50 ,$356.29 ,$221.20 ,$711.00 ,$107.33 ,$40.40 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$379.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000548,51100,HC ASPIRATE BLADDER BY NEEDLE,320,1 ,"$2,597.00 ","$1,688.05 ",$50.80 ,"$2,597.00 ",$655.88 ,"$1,194.62 ","$1,454.32 ",$262.35 ,$727.16 ,$877.79 ,$262.35 ,"$1,010.23 ",$262.35 ,"$1,171.25 ","$1,171.25 ",$262.35 ,$50.80 ,$498.46 ,"$1,298.50 ",$655.86 ,$262.35 ,$262.35 ,$267.59 ,"$1,947.75 ","$1,558.20 ","$1,558.20 ",$262.35 ,"$1,558.20 ","$1,817.90 ","$1,817.90 ","$1,817.90 ","$2,597.00 ", N/A ,"$2,207.45 ",$655.86 ,"$1,688.05 ",$262.35 ,"$2,597.00 ","$1,454.32 ",$262.35 ,$683.01 , N/A ,$125.92 ,$120.19 ,$275.47 ,"$2,077.60 ",$590.28 ,"$1,171.25 ",$727.16 ,"$2,337.30 ",$262.35 ,"$1,817.90 ",$365.00 ,$365.00 ,$262.35 ,$365.00 ,"$1,246.56 ",$114.47 
ST. ELIZABETH'S HOSPITAL,32000551,77077,HC XR JOINT SRVY SINGLE 2 JOINTS,320,1 ,$310.00 ,$201.50 ,$31.46 ,$310.00 ,$268.33 ,$46.76 ,$173.60 ,$107.33 ,$86.80 ,$109.43 ,$107.33 ,$127.72 ,$107.33 ,$139.81 ,$139.81 ,$107.33 ,$37.39 ,$203.93 ,$60.19 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$232.50 ,$186.00 ,$186.00 ,$107.33 ,$186.00 ,$31.46 ,$31.46 ,$31.46 ,$310.00 , N/A ,$263.50 ,$268.33 ,$201.50 ,$107.33 ,$310.00 ,$173.60 ,$107.33 ,$81.53 , N/A ,$58.69 ,$56.02 ,$112.70 ,$248.00 ,$241.50 ,$139.81 ,$86.80 ,$279.00 ,$107.33 ,$31.46 ,$310.00 ,$310.00 ,$107.33 ,$310.00 ,$148.80 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000551,77077,HC XR JOINT SRVY SINGLE 2 JOINTS,320,1 ,$465.00 ,$302.25 ,$31.46 ,$465.00 ,$268.33 ,$46.76 ,$260.40 ,$107.33 ,$130.20 ,$164.15 ,$107.33 ,$191.58 ,$107.33 ,$209.72 ,$209.72 ,$107.33 ,$37.39 ,$203.93 ,$60.19 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$348.75 ,$279.00 ,$279.00 ,$107.33 ,$279.00 ,$31.46 ,$31.46 ,$31.46 ,$465.00 , N/A ,$395.25 ,$268.33 ,$302.25 ,$107.33 ,$465.00 ,$260.40 ,$107.33 ,$122.30 , N/A ,$58.69 ,$56.02 ,$112.70 ,$372.00 ,$241.50 ,$209.72 ,$130.20 ,$418.50 ,$107.33 ,$31.46 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$223.20 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000552,70100,HC XR MANDIBLE <3V,320,1 ,$356.00 ,$231.40 ,$35.43 ,$356.00 ,$199.38 ,$43.72 ,$199.36 ,$79.75 ,$99.68 ,$125.67 ,$79.75 ,$146.67 ,$79.75 ,$160.56 ,$160.56 ,$79.75 ,$36.58 ,$151.52 ,$67.82 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$267.00 ,$213.60 ,$213.60 ,$79.75 ,$213.60 ,$35.43 ,$35.43 ,$35.43 ,$356.00 , N/A ,$302.60 ,$199.36 ,$231.40 ,$79.75 ,$356.00 ,$199.36 ,$79.75 ,$93.63 , N/A ,$58.69 ,$56.02 ,$83.74 ,$284.80 ,$179.43 ,$160.56 ,$99.68 ,$320.40 ,$79.75 ,$35.43 ,$356.00 ,$356.00 ,$79.75 ,$356.00 ,$170.88 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000556,77071,HC XR JOINT STRESS BY PHYS,320,1 ,$260.00 ,$169.00 ,$68.38 ,$260.00 ,$199.38 ,$88.82 ,$145.60 ,$79.75 ,$72.80 ,$91.78 ,$79.75 ,$107.12 ,$79.75 ,$117.26 ,$117.26 ,$79.75 ,$70.75 ,$151.52 ,$153.86 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$195.00 ,$156.00 ,$156.00 ,$79.75 ,$156.00 ,$73.94 ,$73.94 ,$73.94 ,$260.00 , N/A ,$221.00 ,$199.36 ,$169.00 ,$79.75 ,$260.00 ,$145.60 ,$79.75 ,$68.38 , N/A , N/A , N/A ,$83.74 ,$208.00 ,$179.43 ,$117.26 ,$72.80 ,$234.00 ,$79.75 ,$73.94 ,$260.00 ,$260.00 ,$79.75 ,$260.00 ,$124.80 , N/A 
ST. ELIZABETH'S HOSPITAL,32000556,77071,HC XR JOINT STRESS BY PHYS,320,1 ,$368.00 ,$239.20 ,$70.75 ,$368.00 ,$199.38 ,$88.82 ,$206.08 ,$79.75 ,$103.04 ,$129.90 ,$79.75 ,$151.62 ,$79.75 ,$165.97 ,$165.97 ,$79.75 ,$70.75 ,$151.52 ,$153.86 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$276.00 ,$220.80 ,$220.80 ,$79.75 ,$220.80 ,$73.94 ,$73.94 ,$73.94 ,$368.00 , N/A ,$312.80 ,$199.36 ,$239.20 ,$79.75 ,$368.00 ,$206.08 ,$79.75 ,$96.78 , N/A , N/A , N/A ,$83.74 ,$294.40 ,$179.43 ,$165.97 ,$103.04 ,$331.20 ,$79.75 ,$73.94 ,$365.00 ,$365.00 ,$79.75 ,$365.00 ,$176.64 , N/A 
ST. ELIZABETH'S HOSPITAL,32000560,49460,HC MECHAN REMOVAL OF OBSTRUCT MATERIAL FROM G/J/D TUBE FLUOR/CONT,320,1 ,"$1,609.00 ","$1,045.85 ",$63.69 ,"$1,994.33 ","$1,994.33 ",$740.14 ,$901.04 ,$797.73 ,$450.52 ,$543.84 ,$797.73 ,$625.90 ,$797.73 ,$725.66 ,$725.66 ,$797.73 ,$63.69 ,"$1,515.69 ",$804.50 ,"$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$1,206.75 ",$965.40 ,$965.40 ,$797.73 ,$965.40 ,"$1,126.30 ","$1,126.30 ","$1,126.30 ","$1,609.00 ", N/A ,"$1,367.65 ","$1,609.00 ","$1,045.85 ",$797.73 ,"$1,609.00 ",$901.04 ,$797.73 ,$423.17 , N/A ,$634.93 ,$606.07 ,$837.62 ,"$1,287.20 ","$1,794.89 ",$725.66 ,$450.52 ,"$1,448.10 ",$797.73 ,"$1,126.30 ",$365.00 ,$365.00 ,$797.73 ,$365.00 ,$772.32 ,$577.21 
ST. ELIZABETH'S HOSPITAL,32000561,49405,HC ABSCESS DRAIN KIDN/LIV/SPLN/LUNG VISERAL 49405,320,1 ,"$3,830.00 ","$2,489.50 ",$251.56 ,"$3,830.00 ","$3,467.90 ","$1,761.80 ","$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$251.56 ,"$2,635.59 ","$1,915.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$2,489.50 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$365.00 ,$365.00 ,"$1,387.16 ",$365.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000562,49406,HC ABSCESS DRAIN PERI/ RETROPER PERC 49406,320,1 ,"$3,830.00 ","$2,489.50 ",$251.15 ,"$3,830.00 ","$3,467.90 ","$1,761.80 ","$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$251.15 ,"$2,635.59 ","$1,915.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$2,489.50 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$365.00 ,$365.00 ,"$1,387.16 ",$365.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000563,49407,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER TV OR TR,320,1 ,"$3,830.00 ","$2,489.50 ",$267.50 ,"$3,830.00 ","$3,467.90 ","$1,761.80 ","$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$267.50 ,"$2,635.59 ","$1,915.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$2,489.50 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$365.00 ,$365.00 ,"$1,387.16 ",$365.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,32000564,0075T,HC STENT VERTEBRAL EXTRACRANIAL 0075T,320,1 ,"$17,904.00 ","$11,637.60 ",$365.00 ,"$17,904.00 ", N/A ,"$4,303.72 ","$10,026.24 ", N/A ,"$5,013.12 ","$6,051.55 ", N/A ,"$6,964.66 ", N/A ,"$8,074.70 ","$8,074.70 ", N/A ,"$11,637.60 ", N/A ,"$8,952.00 ", N/A , N/A , N/A , N/A ,"$13,428.00 ","$10,742.40 ","$10,742.40 ", N/A ,"$10,742.40 ","$12,532.80 ","$12,532.80 ","$12,532.80 ","$17,904.00 ", N/A ,"$15,218.40 ", N/A ,"$11,637.60 ", N/A ,"$17,904.00 ","$10,026.24 ", N/A ,"$4,708.75 ", N/A , N/A , N/A , N/A ,"$14,323.20 ", N/A ,"$8,074.70 ","$5,013.12 ","$16,113.60 ", N/A ,"$12,532.80 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$8,593.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,32000565,37218,HC STENT CAROTID INTRATHORACIC 37218,320,1 ,"$9,365.00 ","$6,087.25 ",$365.00 ,"$9,365.00 ", N/A ,"$4,307.90 ","$5,244.40 ", N/A ,"$2,622.20 ","$3,165.37 ", N/A ,"$3,642.99 ", N/A ,"$4,223.62 ","$4,223.62 ", N/A ,"$1,117.14 ", N/A ,"$4,682.50 ", N/A , N/A , N/A , N/A ,"$7,023.75 ","$5,619.00 ","$5,619.00 ", N/A ,"$5,619.00 ","$6,555.50 ","$6,555.50 ","$6,555.50 ","$9,365.00 ", N/A ,"$7,960.25 ", N/A ,"$6,087.25 ", N/A ,"$9,365.00 ","$5,244.40 ", N/A ,"$2,463.00 ", N/A , N/A , N/A , N/A ,"$7,492.00 ", N/A ,"$4,223.62 ","$2,622.20 ","$8,428.50 ", N/A ,"$6,555.50 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$4,495.20 ", N/A 
ST. ELIZABETH'S HOSPITAL,32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$356.00 ,$231.40 ,$35.43 ,$356.00 ,$199.38 ,$43.72 ,$199.36 ,$79.75 ,$99.68 ,$125.67 ,$79.75 ,$146.67 ,$79.75 ,$160.56 ,$160.56 ,$79.75 ,$36.58 ,$151.52 ,$67.82 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$267.00 ,$213.60 ,$213.60 ,$79.75 ,$213.60 ,$35.43 ,$35.43 ,$35.43 ,$356.00 , N/A ,$302.60 ,$199.36 ,$231.40 ,$79.75 ,$356.00 ,$199.36 ,$79.75 ,$93.63 , N/A ,$58.69 ,$56.02 ,$83.74 ,$284.80 ,$179.43 ,$160.56 ,$99.68 ,$320.40 ,$79.75 ,$35.43 ,$356.00 ,$356.00 ,$79.75 ,$356.00 ,$170.88 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$182.00 ,$118.30 ,$36.99 ,$199.38 ,$199.38 ,$43.74 ,$101.92 ,$79.75 ,$50.96 ,$64.25 ,$79.75 ,$74.98 ,$79.75 ,$82.08 ,$82.08 ,$79.75 ,$36.99 ,$151.52 ,$71.64 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$136.50 ,$109.20 ,$109.20 ,$79.75 ,$109.20 ,$37.41 ,$37.41 ,$37.41 ,$182.00 , N/A ,$154.70 ,$182.00 ,$118.30 ,$79.75 ,$182.00 ,$101.92 ,$79.75 ,$47.87 , N/A ,$58.69 ,$56.02 ,$83.74 ,$145.60 ,$179.43 ,$82.08 ,$50.96 ,$163.80 ,$79.75 ,$37.41 ,$182.00 ,$182.00 ,$79.75 ,$182.00 ,$87.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$300.00 ,$195.00 ,$53.35 ,$300.00 ,$268.33 ,$79.44 ,$168.00 ,$107.33 ,$84.00 ,$105.90 ,$107.33 ,$123.60 ,$107.33 ,$135.30 ,$135.30 ,$107.33 ,$67.55 ,$203.93 ,$130.78 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$225.00 ,$180.00 ,$180.00 ,$107.33 ,$180.00 ,$68.22 ,$68.22 ,$68.22 ,$300.00 , N/A ,$255.00 ,$268.33 ,$195.00 ,$107.33 ,$300.00 ,$168.00 ,$107.33 ,$78.90 , N/A ,$58.69 ,$56.02 ,$112.70 ,$240.00 ,$241.50 ,$135.30 ,$84.00 ,$270.00 ,$107.33 ,$68.22 ,$300.00 ,$300.00 ,$107.33 ,$300.00 ,$144.00 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$182.00 ,$118.30 ,$28.84 ,$199.38 ,$199.38 ,$34.50 ,$101.92 ,$79.75 ,$50.96 ,$64.25 ,$79.75 ,$74.98 ,$79.75 ,$82.08 ,$82.08 ,$79.75 ,$28.84 ,$151.52 ,$57.33 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$136.50 ,$109.20 ,$109.20 ,$79.75 ,$109.20 ,$29.97 ,$29.97 ,$29.97 ,$182.00 , N/A ,$154.70 ,$182.00 ,$118.30 ,$79.75 ,$182.00 ,$101.92 ,$79.75 ,$47.87 , N/A ,$58.69 ,$56.02 ,$83.74 ,$145.60 ,$179.43 ,$82.08 ,$50.96 ,$163.80 ,$79.75 ,$29.97 ,$182.00 ,$182.00 ,$79.75 ,$182.00 ,$87.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$182.00 ,$118.30 ,$44.33 ,$199.38 ,$199.38 ,$51.76 ,$101.92 ,$79.75 ,$50.96 ,$64.25 ,$79.75 ,$74.98 ,$79.75 ,$82.08 ,$82.08 ,$79.75 ,$44.33 ,$151.52 ,$84.99 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$136.50 ,$109.20 ,$109.20 ,$79.75 ,$109.20 ,$44.37 ,$44.37 ,$44.37 ,$182.00 , N/A ,$154.70 ,$182.00 ,$118.30 ,$79.75 ,$182.00 ,$101.92 ,$79.75 ,$47.87 , N/A ,$58.69 ,$56.02 ,$83.74 ,$145.60 ,$179.43 ,$82.08 ,$50.96 ,$163.80 ,$79.75 ,$44.37 ,$182.00 ,$182.00 ,$79.75 ,$182.00 ,$87.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$321.00 ,$208.65 ,$53.35 ,$321.00 ,$268.33 ,$64.06 ,$179.76 ,$107.33 ,$89.88 ,$113.31 ,$107.33 ,$132.25 ,$107.33 ,$144.77 ,$144.77 ,$107.33 ,$56.14 ,$203.93 ,$105.98 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$240.75 ,$192.60 ,$192.60 ,$107.33 ,$192.60 ,$55.31 ,$55.31 ,$55.31 ,$321.00 , N/A ,$272.85 ,$268.33 ,$208.65 ,$107.33 ,$321.00 ,$179.76 ,$107.33 ,$84.42 , N/A ,$58.69 ,$56.02 ,$112.70 ,$256.80 ,$241.50 ,$144.77 ,$89.88 ,$288.90 ,$107.33 ,$55.31 ,$321.00 ,$321.00 ,$107.33 ,$321.00 ,$154.08 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$317.00 ,$206.05 ,$37.39 ,$317.00 ,$268.33 ,$48.06 ,$177.52 ,$107.33 ,$88.76 ,$111.90 ,$107.33 ,$130.60 ,$107.33 ,$142.97 ,$142.97 ,$107.33 ,$37.39 ,$203.93 ,$72.59 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$237.75 ,$190.20 ,$190.20 ,$107.33 ,$190.20 ,$37.92 ,$37.92 ,$37.92 ,$317.00 , N/A ,$269.45 ,$268.33 ,$206.05 ,$107.33 ,$317.00 ,$177.52 ,$107.33 ,$83.37 , N/A ,$58.69 ,$56.02 ,$112.70 ,$253.60 ,$241.50 ,$142.97 ,$88.76 ,$285.30 ,$107.33 ,$37.92 ,$317.00 ,$317.00 ,$107.33 ,$317.00 ,$152.16 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$336.00 ,$218.40 ,$48.40 ,$336.00 ,$268.33 ,$57.90 ,$188.16 ,$107.33 ,$94.08 ,$118.61 ,$107.33 ,$138.43 ,$107.33 ,$151.54 ,$151.54 ,$107.33 ,$48.40 ,$203.93 ,$93.58 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$252.00 ,$201.60 ,$201.60 ,$107.33 ,$201.60 ,$48.84 ,$48.84 ,$48.84 ,$336.00 , N/A ,$285.60 ,$268.33 ,$218.40 ,$107.33 ,$336.00 ,$188.16 ,$107.33 ,$88.37 , N/A ,$58.69 ,$56.02 ,$112.70 ,$268.80 ,$241.50 ,$151.54 ,$94.08 ,$302.40 ,$107.33 ,$48.84 ,$336.00 ,$336.00 ,$107.33 ,$336.00 ,$161.28 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$672.00 ,$436.80 ,$53.35 ,$672.00 ,$268.33 ,$69.58 ,$376.32 ,$107.33 ,$188.16 ,$237.22 ,$107.33 ,$276.86 ,$107.33 ,$303.07 ,$303.07 ,$107.33 ,$56.95 ,$203.93 ,$113.61 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$504.00 ,$403.20 ,$403.20 ,$107.33 ,$403.20 ,$59.28 ,$59.28 ,$59.28 ,$672.00 , N/A ,$571.20 ,$268.33 ,$436.80 ,$107.33 ,$672.00 ,$376.32 ,$107.33 ,$176.74 , N/A ,$58.69 ,$56.02 ,$112.70 ,$537.60 ,$241.50 ,$303.07 ,$188.16 ,$604.80 ,$107.33 ,$59.28 ,$365.00 ,$365.00 ,$107.33 ,$365.00 ,$322.56 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$258.00 ,$167.70 ,$25.99 ,$258.00 ,$199.38 ,$33.28 ,$144.48 ,$79.75 ,$72.24 ,$91.07 ,$79.75 ,$106.30 ,$79.75 ,$116.36 ,$116.36 ,$79.75 ,$25.99 ,$151.52 ,$53.51 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$193.50 ,$154.80 ,$154.80 ,$79.75 ,$154.80 ,$27.98 ,$27.98 ,$27.98 ,$258.00 , N/A ,$219.30 ,$199.36 ,$167.70 ,$79.75 ,$258.00 ,$144.48 ,$79.75 ,$67.85 , N/A ,$88.02 ,$84.02 ,$83.74 ,$206.40 ,$179.43 ,$116.36 ,$72.24 ,$232.20 ,$79.75 ,$27.98 ,$258.00 ,$258.00 ,$79.75 ,$258.00 ,$123.84 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$182.00 ,$118.30 ,$25.99 ,$199.38 ,$199.38 ,$33.28 ,$101.92 ,$79.75 ,$50.96 ,$64.25 ,$79.75 ,$74.98 ,$79.75 ,$82.08 ,$82.08 ,$79.75 ,$25.99 ,$151.52 ,$53.51 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$136.50 ,$109.20 ,$109.20 ,$79.75 ,$109.20 ,$27.98 ,$27.98 ,$27.98 ,$182.00 , N/A ,$154.70 ,$182.00 ,$118.30 ,$79.75 ,$182.00 ,$101.92 ,$79.75 ,$47.87 , N/A ,$58.69 ,$56.02 ,$83.74 ,$145.60 ,$179.43 ,$82.08 ,$50.96 ,$163.80 ,$79.75 ,$27.98 ,$182.00 ,$182.00 ,$79.75 ,$182.00 ,$87.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$258.00 ,$167.70 ,$32.50 ,$258.00 ,$199.38 ,$39.44 ,$144.48 ,$79.75 ,$72.24 ,$91.07 ,$79.75 ,$106.30 ,$79.75 ,$116.36 ,$116.36 ,$79.75 ,$32.50 ,$151.52 ,$64.96 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$193.50 ,$154.80 ,$154.80 ,$79.75 ,$154.80 ,$33.95 ,$33.95 ,$33.95 ,$258.00 , N/A ,$219.30 ,$199.36 ,$167.70 ,$79.75 ,$258.00 ,$144.48 ,$79.75 ,$67.85 , N/A ,$88.02 ,$84.02 ,$83.74 ,$206.40 ,$179.43 ,$116.36 ,$72.24 ,$232.20 ,$79.75 ,$33.95 ,$258.00 ,$258.00 ,$79.75 ,$258.00 ,$123.84 ,$80.02 
ST. ELIZABETH'S HOSPITAL,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$182.00 ,$118.30 ,$32.50 ,$199.38 ,$199.38 ,$39.44 ,$101.92 ,$79.75 ,$50.96 ,$64.25 ,$79.75 ,$74.98 ,$79.75 ,$82.08 ,$82.08 ,$79.75 ,$32.50 ,$151.52 ,$64.96 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$136.50 ,$109.20 ,$109.20 ,$79.75 ,$109.20 ,$33.95 ,$33.95 ,$33.95 ,$182.00 , N/A ,$154.70 ,$182.00 ,$118.30 ,$79.75 ,$182.00 ,$101.92 ,$79.75 ,$47.87 , N/A ,$58.69 ,$56.02 ,$83.74 ,$145.60 ,$179.43 ,$82.08 ,$50.96 ,$163.80 ,$79.75 ,$33.95 ,$182.00 ,$182.00 ,$79.75 ,$182.00 ,$87.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000584,72240,HC XR MYELOGRAPHY C-SPINE,320,1 ,"$2,036.49 ","$1,323.72 ",$82.13 ,"$2,036.49 ","$1,763.33 ",$179.30 ,"$1,140.43 ",$705.33 ,$570.22 ,$584.98 ,$705.33 ,$584.98 ,$705.33 ,$918.46 ,$918.46 ,$705.33 ,$88.33 ,"$1,340.13 ",$157.49 ,"$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$1,527.37 ","$1,221.89 ","$1,221.89 ",$705.33 ,"$1,221.89 ",$82.13 ,$82.13 ,$82.13 ,"$2,036.49 ", N/A ,"$1,731.02 ","$1,763.33 ","$1,323.72 ",$705.33 ,"$2,036.49 ","$1,140.43 ",$705.33 ,$535.60 , N/A ,$334.40 ,$319.20 ,$740.60 ,"$1,629.19 ","$1,586.99 ",$918.46 ,$570.22 ,"$1,832.84 ",$705.33 ,$82.13 ,$365.00 ,$365.00 ,$705.33 ,$365.00 ,$977.52 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000586,72265,HC XR MYELOGRAPHY L-SPINE,320,1 ,"$2,036.49 ","$1,323.72 ",$79.14 ,"$2,036.49 ","$1,763.33 ",$174.44 ,"$1,140.43 ",$705.33 ,$570.22 ,$565.37 ,$705.33 ,$565.37 ,$705.33 ,$918.46 ,$918.46 ,$705.33 ,$86.29 ,"$1,340.13 ",$151.76 ,"$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$1,527.37 ","$1,221.89 ","$1,221.89 ",$705.33 ,"$1,221.89 ",$79.14 ,$79.14 ,$79.14 ,"$2,036.49 ", N/A ,"$1,731.02 ","$1,763.33 ","$1,323.72 ",$705.33 ,"$2,036.49 ","$1,140.43 ",$705.33 ,$535.60 , N/A ,$334.40 ,$319.20 ,$740.60 ,"$1,629.19 ","$1,586.99 ",$918.46 ,$570.22 ,"$1,832.84 ",$705.33 ,$79.14 ,$365.00 ,$365.00 ,$705.33 ,$365.00 ,$977.52 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000588,72275,HC XR EPIDUROGRAPHY,320,1 ,$839.00 ,$545.35 ,$117.90 ,$839.00 , N/A ,$133.10 ,$469.84 , N/A ,$234.92 ,$296.17 , N/A ,$345.67 , N/A ,$378.39 ,$378.39 , N/A ,$545.35 , N/A ,$419.50 , N/A , N/A , N/A , N/A ,$629.25 ,$503.40 ,$503.40 , N/A ,$503.40 ,$117.90 ,$117.90 ,$117.90 ,$839.00 , N/A ,$713.15 , N/A ,$545.35 , N/A ,$839.00 ,$469.84 , N/A ,$220.66 , N/A , N/A , N/A , N/A ,$671.20 , N/A ,$378.39 ,$234.92 ,$755.10 , N/A ,$117.90 ,$365.00 ,$365.00 , N/A ,$365.00 ,$402.72 , N/A 
ST. ELIZABETH'S HOSPITAL,32000591,75956,HC ENDOVASC REPR THOR AORTA W/SUBCL S AND I,320,1 ,"$2,622.00 ","$1,704.30 ",$304.00 ,"$2,622.00 ", N/A ,$765.24 ,"$1,468.32 ", N/A ,$734.16 ,$925.57 , N/A ,"$1,080.26 ", N/A ,"$1,182.52 ","$1,182.52 ", N/A ,$459.59 , N/A ,"$1,311.00 ", N/A , N/A , N/A , N/A ,"$1,966.50 ","$1,573.20 ","$1,573.20 ", N/A ,"$1,573.20 ","$1,835.40 ","$1,835.40 ","$1,835.40 ","$2,622.00 ", N/A ,"$2,228.70 ", N/A ,"$1,704.30 ", N/A ,"$2,622.00 ","$1,468.32 ", N/A ,$689.59 , N/A ,$334.40 ,$319.20 , N/A ,"$2,097.60 ", N/A ,"$1,182.52 ",$734.16 ,"$2,359.80 ", N/A ,"$1,835.40 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$1,258.56 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000592,75957,HC ENDOVASC REPR THOR AORTA W/O SUBCL S AND I,320,1 ,"$2,622.00 ","$1,704.30 ",$304.00 ,"$2,622.00 ", N/A ,$653.24 ,"$1,468.32 ", N/A ,$734.16 ,$925.57 , N/A ,"$1,080.26 ", N/A ,"$1,182.52 ","$1,182.52 ", N/A ,$392.59 , N/A ,"$1,311.00 ", N/A , N/A , N/A , N/A ,"$1,966.50 ","$1,573.20 ","$1,573.20 ", N/A ,"$1,573.20 ","$1,835.40 ","$1,835.40 ","$1,835.40 ","$2,622.00 ", N/A ,"$2,228.70 ", N/A ,"$1,704.30 ", N/A ,"$2,622.00 ","$1,468.32 ", N/A ,$689.59 , N/A ,$334.40 ,$319.20 , N/A ,"$2,097.60 ", N/A ,"$1,182.52 ",$734.16 ,"$2,359.80 ", N/A ,"$1,835.40 ",$365.00 ,$365.00 , N/A ,$365.00 ,"$1,258.56 ",$304.00 
ST. ELIZABETH'S HOSPITAL,32000593,75958,HC PLACE PROX EXT PROSTH ENDOVASC THOR AORTA S AND I,320,1 ,"$1,713.00 ","$1,113.45 ",$261.46 ,"$1,713.00 ", N/A ,$435.04 ,$959.28 , N/A ,$479.64 ,$604.69 , N/A ,$705.76 , N/A ,$772.56 ,$772.56 , N/A ,$261.46 , N/A ,$856.50 , N/A , N/A , N/A , N/A ,"$1,284.75 ","$1,027.80 ","$1,027.80 ", N/A ,"$1,027.80 ","$1,199.10 ","$1,199.10 ","$1,199.10 ","$1,713.00 ", N/A ,"$1,456.05 ", N/A ,"$1,113.45 ", N/A ,"$1,713.00 ",$959.28 , N/A ,$450.52 , N/A ,$334.40 ,$319.20 , N/A ,"$1,370.40 ", N/A ,$772.56 ,$479.64 ,"$1,541.70 ", N/A ,"$1,199.10 ",$365.00 ,$365.00 , N/A ,$365.00 ,$822.24 ,$304.00 
ST. ELIZABETH'S HOSPITAL,32000595,76000,HC FLUOROSCOPY >1HR,320,1 ,$818.00 ,$531.70 ,$34.14 ,$818.00 ,$567.13 ,$124.58 ,$458.08 ,$226.85 ,$229.04 ,$288.75 ,$226.85 ,$337.02 ,$226.85 ,$368.92 ,$368.92 ,$226.85 ,$34.14 ,$431.02 ,$84.99 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$613.50 ,$490.80 ,$490.80 ,$226.85 ,$490.80 ,$44.37 ,$44.37 ,$44.37 ,$818.00 , N/A ,$695.30 ,$567.13 ,$531.70 ,$226.85 ,$818.00 ,$458.08 ,$226.85 ,$215.13 , N/A ,$58.69 ,$56.02 ,$238.19 ,$654.40 ,$510.41 ,$368.92 ,$229.04 ,$736.20 ,$226.85 ,$44.37 ,$365.00 ,$365.00 ,$226.85 ,$365.00 ,$392.64 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000606,76125,HC CINERADIOGRAPHY/VIDEORADIOGRAPHY EXAM,320,1 ,$532.00 ,$345.80 ,$16.48 ,$532.00 , N/A ,$61.18 ,$297.92 , N/A ,$148.96 ,$187.80 , N/A ,$219.18 , N/A ,$239.93 ,$239.93 , N/A ,$16.48 , N/A ,$266.00 , N/A , N/A , N/A , N/A ,$399.00 ,$319.20 ,$319.20 , N/A ,$319.20 ,$44.91 ,$44.91 ,$44.91 ,$532.00 , N/A ,$452.20 , N/A ,$345.80 , N/A ,$532.00 ,$297.92 , N/A ,$139.92 , N/A ,$58.69 ,$56.02 , N/A ,$425.60 , N/A ,$239.93 ,$148.96 ,$478.80 , N/A ,$44.91 ,$365.00 ,$365.00 , N/A ,$365.00 ,$255.36 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000611,G1004,HC RAD AUC CDSM NATL DECISION SUPPORT COMPANY,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,"$1,667.00 ","$1,083.55 ",$53.35 ,"$1,667.00 ", N/A ,$83.60 ,$933.52 , N/A ,$466.76 ,$563.45 , N/A ,$648.46 , N/A ,$751.82 ,$751.82 , N/A ,$63.48 , N/A ,$833.50 , N/A , N/A , N/A , N/A ,"$1,250.25 ","$1,000.20 ","$1,000.20 ", N/A ,"$1,000.20 ",$65.96 ,$65.96 ,$65.96 ,"$1,667.00 ", N/A ,"$1,416.95 ", N/A ,"$1,083.55 ", N/A ,"$1,667.00 ",$933.52 , N/A ,$438.42 , N/A ,$58.69 ,$56.02 , N/A ,"$1,333.60 ", N/A ,$751.82 ,$466.76 ,"$1,500.30 ", N/A ,$65.96 ,$365.00 ,$365.00 , N/A ,$365.00 ,$800.16 ,$53.35 
ST. ELIZABETH'S HOSPITAL,32000613,G1002,HC RAD AUC CDSM MEDCURRENT,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000614,G1003,HC RAD AUC CDSM MEDICALIS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000615,G1005,HC RAD AUC CDSM NATIONAL IMAGING ASSOCIATES,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000616,G1006,HC RAD AUC CDSM TEST APPROPRIATE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000617,G1007,HC RAD AUC CDSM AIM SPECIALTY HEALTH,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000618,G1008,HC RAD AUC CDSM CRANBERRY PEAK,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000619,G1009,HC RAD AUC CDSM SAGE HEALTH MGMT SOLUTIONS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000620,G1010,HC RAD AUC CDSM STANSON,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000621,G1011,HC RAD AUC CDSM QUALIFIED TOOL NOS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,32000623,G1001,HC RAD AUC CDSM EVICORE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,33300006,C2639,HC IODINE 125 PER SOURCE NON STRANDED,333,1 ,$105.00 ,$68.25 ,$27.62 ,"$1,751.63 ",$87.05 ,$48.30 ,$58.80 ,$34.82 ,$29.40 ,$35.49 ,$34.82 ,$40.85 ,$34.82 ,$47.36 ,$47.36 ,$34.82 ,$68.25 ,$66.16 ,$52.50 ,$87.05 ,$34.82 ,$34.82 ,$35.52 ,$78.75 ,$63.00 ,$63.00 ,$34.82 ,$63.00 ,$73.50 ,$73.50 ,$73.50 ,$105.00 , N/A ,$89.25 ,$87.05 ,$68.25 ,$34.82 ,$105.00 ,$58.80 ,$34.82 ,$27.62 , N/A ,$105.00 ,$105.00 ,$36.56 ,$84.00 ,$78.35 ,$47.36 ,$29.40 ,$94.50 ,$34.82 ,$73.50 ,$105.00 ,$105.00 ,$34.82 ,$105.00 ,$50.40 ,"$1,751.63 "
ST. ELIZABETH'S HOSPITAL,33300009,77285,HC SIMULATION INTERMED,333,1 ,$914.00 ,$594.10 ,$240.38 ,$914.00 ,$834.65 ,$515.18 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$469.24 ,$634.33 ,$914.00 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$564.53 ,$564.53 ,$564.53 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$638.39 ,$609.37 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$564.53 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$580.35 
ST. ELIZABETH'S HOSPITAL,33300010,77290,HC SIMULATION COMPLEX,333,1 ,$914.00 ,$594.10 ,$240.38 ,$914.00 ,$834.65 ,$835.24 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$454.98 ,$634.33 ,$914.00 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$601.29 ,$601.29 ,$601.29 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$638.39 ,$609.37 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$601.29 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$580.35 
ST. ELIZABETH'S HOSPITAL,33300011,77295,HC SIMULATION 3-D,333,1 ,"$3,385.00 ","$2,200.25 ",$302.50 ,"$3,385.00 ","$3,112.35 ",$621.72 ,"$1,895.60 ","$1,244.94 ",$947.80 ,"$1,194.91 ","$1,244.94 ","$1,394.62 ","$1,244.94 ","$1,526.64 ","$1,526.64 ","$1,244.94 ",$302.50 ,"$2,365.39 ",$719.71 ,"$3,112.36 ","$1,244.94 ","$1,244.94 ","$1,269.84 ","$2,538.75 ","$2,031.00 ","$2,031.00 ","$1,244.94 ","$2,031.00 ",$375.38 ,$375.38 ,$375.38 ,"$3,385.00 ", N/A ,"$2,877.25 ","$3,112.36 ","$2,200.25 ","$1,244.94 ","$3,385.00 ","$1,895.60 ","$1,244.94 ",$890.26 , N/A ,$638.39 ,$609.37 ,"$1,307.19 ","$2,708.00 ","$2,801.12 ","$1,526.64 ",$947.80 ,"$3,046.50 ","$1,244.94 ",$375.38 ,$525.00 ,$525.00 ,"$1,244.94 ",$525.00 ,"$1,624.80 ",$580.35 
ST. ELIZABETH'S HOSPITAL,33300015,77300,HC DOSIMETRY CALCULATION BASIC,333,1 ,$351.00 ,$228.15 ,$39.43 ,$351.00 ,$312.75 ,$72.12 ,$196.56 ,$125.10 ,$98.28 ,$123.90 ,$125.10 ,$144.61 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$39.43 ,$237.68 ,$91.67 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$47.85 ,$47.85 ,$47.85 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$103.52 ,$98.82 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$47.85 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$94.11 
ST. ELIZABETH'S HOSPITAL,33300017,77301,HC IMRT TX PLAN,333,1 ,"$3,385.00 ","$2,200.25 ",$409.99 ,"$3,385.00 ","$3,112.35 ","$3,127.96 ","$1,895.60 ","$1,244.94 ",$947.80 ,"$1,194.91 ","$1,244.94 ","$1,394.62 ","$1,244.94 ","$1,526.64 ","$1,526.64 ","$1,244.94 ","$1,706.01 ","$2,365.39 ","$3,385.00 ","$3,112.36 ","$1,244.94 ","$1,244.94 ","$1,269.84 ","$2,538.75 ","$2,031.00 ","$2,031.00 ","$1,244.94 ","$2,031.00 ","$2,146.44 ","$2,146.44 ","$2,146.44 ","$3,385.00 ", N/A ,"$2,877.25 ","$3,112.36 ","$2,200.25 ","$1,244.94 ","$3,385.00 ","$1,895.60 ","$1,244.94 ",$890.26 , N/A ,$450.99 ,$430.49 ,"$1,307.19 ","$2,708.00 ","$2,801.12 ","$1,526.64 ",$947.80 ,"$3,046.50 ","$1,244.94 ","$2,146.44 ",$525.00 ,$525.00 ,"$1,244.94 ",$525.00 ,"$1,624.80 ",$409.99 
ST. ELIZABETH'S HOSPITAL,33300018,77306,HC ISODOSE PLAN SIMPLE,333,1 ,$914.00 ,$594.10 ,$87.83 ,$914.00 ,$834.65 ,$127.96 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$87.83 ,$634.33 ,$206.23 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$107.63 ,$107.63 ,$107.63 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$450.99 ,$430.49 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$107.63 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$409.99 
ST. ELIZABETH'S HOSPITAL,33300022,77307,HC ISODOSE PLAN COMPLEX,333,1 ,$914.00 ,$594.10 ,$159.35 ,$914.00 ,$834.65 ,$235.44 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$159.35 ,$634.33 ,$372.30 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$194.22 ,$194.22 ,$194.22 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$450.99 ,$430.49 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$194.22 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$409.99 
ST. ELIZABETH'S HOSPITAL,33300024,77321,HC PORT PLAN SPECIAL,333,1 ,$914.00 ,$594.10 ,$52.48 ,$914.00 ,$834.65 ,$111.04 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$52.48 ,$634.33 ,$118.38 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$61.76 ,$61.76 ,$61.76 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$450.99 ,$430.49 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$61.76 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$409.99 
ST. ELIZABETH'S HOSPITAL,33300027,77318,HC BRACHY ISODOSE PLAN COMPLEX,333,1 ,$914.00 ,$594.10 ,$240.38 ,$914.00 ,$834.65 ,$354.74 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$365.05 ,$634.33 ,$626.32 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$326.84 ,$326.84 ,$326.84 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$360.18 ,$343.81 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$326.84 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$327.44 
ST. ELIZABETH'S HOSPITAL,33300029,77331,HC DOSIMETRY CALCULATION SPECIAL,333,1 ,$351.00 ,$228.15 ,$22.73 ,$351.00 ,$312.75 ,$36.36 ,$196.56 ,$125.10 ,$98.28 ,$123.90 ,$125.10 ,$144.61 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$22.73 ,$237.68 ,$51.60 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$26.99 ,$26.99 ,$26.99 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$103.52 ,$98.82 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$26.99 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$94.11 
ST. ELIZABETH'S HOSPITAL,33300030,77332,HC TREATMENT DEVICE SIMPLE,333,1 ,$351.00 ,$228.15 ,$17.84 ,$351.00 ,$312.75 ,$95.96 ,$196.56 ,$125.10 ,$98.28 ,$123.90 ,$125.10 ,$144.61 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$17.84 ,$237.68 ,$77.36 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$40.40 ,$40.40 ,$40.40 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$217.95 ,$208.05 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$40.40 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$198.14 
ST. ELIZABETH'S HOSPITAL,33300031,77333,HC TREATMENT DEVICE INTERM,333,1 ,$351.00 ,$228.15 ,$33.22 ,$351.00 ,$312.75 ,$33.22 ,$196.56 ,$125.10 ,$98.28 ,$123.90 ,$125.10 ,$144.61 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$120.53 ,$237.68 ,$188.97 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$98.52 ,$98.52 ,$98.52 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$217.95 ,$208.05 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$98.52 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$198.14 
ST. ELIZABETH'S HOSPITAL,33300032,77334,HC TREATMENT DEVICE COMPLEX,333,1 ,$914.00 ,$594.10 ,$76.93 ,$914.00 ,$834.65 ,$170.02 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$76.93 ,$634.33 ,$183.24 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$95.54 ,$95.54 ,$95.54 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$217.95 ,$208.05 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$95.54 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$198.14 
ST. ELIZABETH'S HOSPITAL,33300033,77336,HC MEDICAL PHYSICS CONTINUING,333,1 ,$351.00 ,$228.15 ,$92.31 ,$351.00 ,$312.75 ,$97.22 ,$196.56 ,$125.10 ,$98.28 ,$123.90 ,$125.10 ,$144.61 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$101.51 ,$237.68 ,$305.68 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$113.22 ,$113.22 ,$113.22 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$126.57 ,$120.81 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$113.22 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$115.06 
ST. ELIZABETH'S HOSPITAL,33300034,77338,HC MLC DEVICE FOR IMRT,333,1 ,$914.00 ,$594.10 ,$240.38 ,$914.00 ,$834.65 ,$485.54 ,$511.84 ,$333.86 ,$255.92 ,$322.64 ,$333.86 ,$376.57 ,$333.86 ,$412.21 ,$412.21 ,$333.86 ,$283.56 ,$634.33 ,$740.79 ,$834.64 ,$333.86 ,$333.86 ,$340.53 ,$685.50 ,$548.40 ,$548.40 ,$333.86 ,$548.40 ,$386.46 ,$386.46 ,$386.46 ,$914.00 , N/A ,$776.90 ,$834.64 ,$594.10 ,$333.86 ,$914.00 ,$511.84 ,$333.86 ,$240.38 , N/A ,$868.68 ,$829.20 ,$350.55 ,$731.20 ,$751.18 ,$412.21 ,$255.92 ,$822.60 ,$333.86 ,$386.46 ,$525.00 ,$525.00 ,$333.86 ,$525.00 ,$438.72 ,$789.71 
ST. ELIZABETH'S HOSPITAL,33300036,77370,HC SPECIAL MED PHYSICS CONSULT,333,1 ,$351.00 ,$228.15 ,$92.31 ,$351.00 ,$312.75 ,$217.58 ,$196.56 ,$125.10 ,$98.28 ,$123.90 ,$125.10 ,$144.61 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$161.43 ,$237.68 ,$305.68 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$176.75 ,$176.75 ,$176.75 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$126.57 ,$120.81 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$176.75 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$115.06 
ST. ELIZABETH'S HOSPITAL,33300037,77402,HC RAD THRPY SIMPLE >1MEV,333,1 ,$332.00 ,$215.80 ,$87.32 ,$332.00 ,$295.25 ,$326.28 ,$185.92 ,$118.10 ,$92.96 ,$117.20 ,$118.10 ,$136.78 ,$118.10 ,$149.73 ,$149.73 ,$118.10 ,$215.80 ,$224.38 ,$288.93 ,$295.24 ,$118.10 ,$118.10 ,$120.46 ,$249.00 ,$199.20 ,$199.20 ,$118.10 ,$199.20 ,$232.40 ,$232.40 ,$232.40 ,$332.00 , N/A ,$282.20 ,$295.24 ,$215.80 ,$118.10 ,$332.00 ,$185.92 ,$118.10 ,$87.32 , N/A ,$313.78 ,$299.51 ,$124.01 ,$265.60 ,$265.72 ,$149.73 ,$92.96 ,$298.80 ,$118.10 ,$232.40 ,$332.00 ,$332.00 ,$118.10 ,$332.00 ,$159.36 ,$285.25 
ST. ELIZABETH'S HOSPITAL,33300041,77407,HC RAD THRPY INTERMEDIATE,333,1 ,$637.00 ,$414.05 ,$167.53 ,$789.71 ,$595.78 ,$472.50 ,$356.72 ,$238.31 ,$178.36 ,$224.86 ,$238.31 ,$262.44 ,$238.31 ,$287.29 ,$287.29 ,$238.31 ,$414.05 ,$452.79 ,$554.35 ,$595.77 ,$238.31 ,$238.31 ,$243.07 ,$477.75 ,$382.20 ,$382.20 ,$238.31 ,$382.20 ,$445.90 ,$445.90 ,$445.90 ,$637.00 , N/A ,$541.45 ,$595.77 ,$414.05 ,$238.31 ,$637.00 ,$356.72 ,$238.31 ,$167.53 , N/A ,$637.00 ,$637.00 ,$250.23 ,$509.60 ,$536.19 ,$287.29 ,$178.36 ,$573.30 ,$238.31 ,$445.90 ,$525.00 ,$525.00 ,$238.31 ,$525.00 ,$305.76 ,$789.71 
ST. ELIZABETH'S HOSPITAL,33300045,77412,HC RAD THRPY COMPLEX,333,1 ,$637.00 ,$414.05 ,$167.53 ,$789.71 ,$595.78 ,$430.46 ,$356.72 ,$238.31 ,$178.36 ,$224.86 ,$238.31 ,$262.44 ,$238.31 ,$287.29 ,$287.29 ,$238.31 ,$414.05 ,$452.79 ,$554.35 ,$595.77 ,$238.31 ,$238.31 ,$243.07 ,$477.75 ,$382.20 ,$382.20 ,$238.31 ,$382.20 ,$445.90 ,$445.90 ,$445.90 ,$637.00 , N/A ,$541.45 ,$595.77 ,$414.05 ,$238.31 ,$637.00 ,$356.72 ,$238.31 ,$167.53 , N/A ,$637.00 ,$637.00 ,$250.23 ,$509.60 ,$536.19 ,$287.29 ,$178.36 ,$573.30 ,$238.31 ,$445.90 ,$525.00 ,$525.00 ,$238.31 ,$525.00 ,$305.76 ,$789.71 
ST. ELIZABETH'S HOSPITAL,33300051,77386,HC IMRT TREATMENT COMPLEX,333,1 ,"$1,476.00 ",$959.40 ,$388.19 ,"$1,476.00 ","$1,337.25 ",$677.38 ,$826.56 ,$534.90 ,$413.28 ,$521.03 ,$534.90 ,$608.11 ,$534.90 ,$665.68 ,$665.68 ,$534.90 ,$959.40 ,"$1,016.32 ","$1,283.88 ","$1,337.26 ",$534.90 ,$534.90 ,$545.60 ,"$1,107.00 ",$885.60 ,$885.60 ,$534.90 ,$885.60 ,"$1,033.20 ","$1,033.20 ","$1,033.20 ","$1,476.00 ", N/A ,"$1,254.60 ","$1,337.26 ",$959.40 ,$534.90 ,"$1,476.00 ",$826.56 ,$534.90 ,$388.19 , N/A ,$868.68 ,$829.20 ,$561.65 ,"$1,180.80 ","$1,203.53 ",$665.68 ,$413.28 ,"$1,328.40 ",$534.90 ,"$1,033.20 ",$525.00 ,$525.00 ,$534.90 ,$525.00 ,$708.48 ,$789.71 
ST. ELIZABETH'S HOSPITAL,33300052,77417,HC PORT FILMS,333,1 ,$399.00 ,$259.35 ,$15.39 ,$399.00 , N/A ,$28.20 ,$223.44 , N/A ,$111.72 ,$140.85 , N/A ,$163.54 , N/A ,$179.95 ,$179.95 , N/A ,$15.39 , N/A ,$199.50 , N/A , N/A , N/A , N/A ,$299.25 ,$239.40 ,$239.40 , N/A ,$239.40 ,$16.05 ,$16.05 ,$16.05 ,$399.00 , N/A ,$339.15 , N/A ,$259.35 , N/A ,$399.00 ,$223.44 , N/A ,$104.94 , N/A ,$58.69 ,$56.02 , N/A ,$319.20 , N/A ,$179.95 ,$111.72 ,$359.10 , N/A ,$16.05 ,$399.00 ,$399.00 , N/A ,$399.00 ,$191.52 ,$53.35 
ST. ELIZABETH'S HOSPITAL,33300054,77385,HC IMRT TREATMENT SIMPLE,333,1 ,"$1,476.00 ",$959.40 ,$388.19 ,"$1,476.00 ","$1,337.25 ",$674.88 ,$826.56 ,$534.90 ,$413.28 ,$521.03 ,$534.90 ,$608.11 ,$534.90 ,$665.68 ,$665.68 ,$534.90 ,$959.40 ,"$1,016.32 ","$1,283.88 ","$1,337.26 ",$534.90 ,$534.90 ,$545.60 ,"$1,107.00 ",$885.60 ,$885.60 ,$534.90 ,$885.60 ,"$1,033.20 ","$1,033.20 ","$1,033.20 ","$1,476.00 ", N/A ,"$1,254.60 ","$1,337.26 ",$959.40 ,$534.90 ,"$1,476.00 ",$826.56 ,$534.90 ,$388.19 , N/A ,$868.68 ,$829.20 ,$561.65 ,"$1,180.80 ","$1,203.53 ",$665.68 ,$413.28 ,"$1,328.40 ",$534.90 ,"$1,033.20 ",$525.00 ,$525.00 ,$534.90 ,$525.00 ,$708.48 ,$789.71 
ST. ELIZABETH'S HOSPITAL,33300056,77427,HC RADIATION MNGT 5 TREATMENTS,333,1 ,$685.00 ,$445.25 ,$118.09 ,$685.00 , N/A ,$357.24 ,$383.60 , N/A ,$191.80 ,$241.81 , N/A ,$282.22 , N/A ,$308.94 ,$308.94 , N/A ,$243.20 , N/A ,$342.50 , N/A , N/A , N/A , N/A ,$513.75 ,$411.00 ,$411.00 , N/A ,$411.00 ,$285.29 ,$285.29 ,$285.29 ,$685.00 , N/A ,$582.25 , N/A ,$445.25 , N/A ,$685.00 ,$383.60 , N/A ,$180.16 , N/A ,$129.90 ,$123.99 , N/A ,$548.00 , N/A ,$308.94 ,$191.80 ,$616.50 , N/A ,$285.29 ,$525.00 ,$525.00 , N/A ,$525.00 ,$328.80 ,$118.09 
ST. ELIZABETH'S HOSPITAL,33300057,77470,HC SPECIAL TREATMENT PROCEDURE,333,1 ,"$1,476.00 ",$959.40 ,$34.95 ,"$1,476.00 ","$1,337.25 ",$180.06 ,$826.56 ,$534.90 ,$413.28 ,$447.27 ,$534.90 ,$447.27 ,$534.90 ,$665.68 ,$665.68 ,$534.90 ,$34.95 ,"$1,016.32 ",$68.77 ,"$1,337.26 ",$534.90 ,$534.90 ,$545.60 ,"$1,107.00 ",$885.60 ,$885.60 ,$534.90 ,$885.60 ,$35.93 ,$35.93 ,$35.93 ,"$1,476.00 ", N/A ,"$1,254.60 ","$1,337.26 ",$959.40 ,$534.90 ,"$1,476.00 ",$826.56 ,$534.90 ,$388.19 , N/A ,"$1,227.17 ","$1,171.39 ",$561.65 ,"$1,180.80 ","$1,203.53 ",$665.68 ,$413.28 ,"$1,328.40 ",$534.90 ,$35.93 ,$525.00 ,$525.00 ,$534.90 ,$525.00 ,$708.48 ,"$1,115.61 "
ST. ELIZABETH'S HOSPITAL,33300065,77778,HC INTERSTITIAL APPL-COMPLE,333,1 ,"$2,001.00 ","$1,300.65 ",$509.82 ,"$3,434.42 ","$1,748.43 ",$509.82 ,"$1,120.56 ",$699.37 ,$560.28 ,$706.35 ,$699.37 ,$824.41 ,$699.37 ,$902.45 ,$902.45 ,$699.37 ,$534.50 ,"$1,328.81 ","$1,050.32 ","$1,748.44 ",$699.37 ,$699.37 ,$713.36 ,"$1,500.75 ","$1,200.60 ","$1,200.60 ",$699.37 ,"$1,200.60 ",$548.19 ,$548.19 ,$548.19 ,"$2,001.00 ", N/A ,"$1,700.85 ","$1,748.44 ","$1,300.65 ",$699.37 ,"$2,001.00 ","$1,120.56 ",$699.37 ,$526.26 , N/A ,"$2,001.00 ","$2,001.00 ",$734.34 ,"$1,600.80 ","$1,573.59 ",$902.45 ,$560.28 ,"$1,800.90 ",$699.37 ,$548.19 ,$525.00 ,$525.00 ,$699.37 ,$525.00 ,$960.48 ,"$3,434.42 "
ST. ELIZABETH'S HOSPITAL,33300071,77372,HC SRS TREATMENT,333,1 ,"$21,704.00 ","$14,107.60 ","$1,190.98 ","$21,704.00 ","$19,168.80 ","$1,576.18 ","$12,154.24 ","$7,667.52 ","$6,077.12 ","$7,661.51 ","$7,667.52 ","$8,942.05 ","$7,667.52 ","$9,788.50 ","$9,788.50 ","$7,667.52 ","$1,190.98 ","$14,568.28 ","$2,886.08 ","$19,168.79 ","$7,667.52 ","$7,667.52 ","$7,820.87 ","$16,278.00 ","$13,022.40 ","$13,022.40 ","$7,667.52 ","$13,022.40 ","$1,504.82 ","$1,504.82 ","$1,504.82 ","$21,704.00 ", N/A ,"$18,448.40 ","$19,168.79 ","$14,107.60 ","$7,667.52 ","$21,704.00 ","$12,154.24 ","$7,667.52 ","$5,708.15 ", N/A ,"$4,794.06 ","$4,576.15 ","$8,050.90 ","$17,363.20 ","$17,251.91 ","$9,788.50 ","$6,077.12 ","$19,533.60 ","$7,667.52 ","$1,504.82 ","$14,107.60 ","$14,107.60 ","$7,667.52 ","$14,107.60 ","$10,417.92 ","$4,358.24 "
ST. ELIZABETH'S HOSPITAL,33300072,77373,HC SRT TREATMENT,333,1 ,"$4,800.00 ","$3,120.00 ",$789.71 ,"$4,800.00 ","$4,274.63 ","$2,941.66 ","$2,688.00 ","$1,709.85 ","$1,344.00 ","$1,694.40 ","$1,709.85 ","$1,977.60 ","$1,709.85 ","$2,164.80 ","$2,164.80 ","$1,709.85 ","$1,231.04 ","$3,248.72 ","$3,494.09 ","$4,274.63 ","$1,709.85 ","$1,709.85 ","$1,744.05 ","$3,600.00 ","$2,880.00 ","$2,880.00 ","$1,709.85 ","$2,880.00 ","$1,821.90 ","$1,821.90 ","$1,821.90 ","$4,800.00 ", N/A ,"$4,080.00 ","$4,274.63 ","$3,120.00 ","$1,709.85 ","$4,800.00 ","$2,688.00 ","$1,709.85 ","$1,262.40 ", N/A ,$868.68 ,$829.20 ,"$1,795.34 ","$3,840.00 ","$3,847.17 ","$2,164.80 ","$1,344.00 ","$4,320.00 ","$1,709.85 ","$1,821.90 ","$3,120.00 ","$3,120.00 ","$1,709.85 ","$3,120.00 ","$2,304.00 ",$789.71 
ST. ELIZABETH'S HOSPITAL,33300084,77293,HC RESPIRATORY MOTION MGMT SIM,333,1 ,"$1,624.00 ","$1,055.60 ",$379.80 ,"$1,624.00 ", N/A ,$571.94 ,$909.44 , N/A ,$454.72 ,$573.27 , N/A ,$669.09 , N/A ,$732.42 ,$732.42 , N/A ,$379.80 , N/A ,$960.76 , N/A , N/A , N/A , N/A ,"$1,218.00 ",$974.40 ,$974.40 , N/A ,$974.40 ,$500.60 ,$500.60 ,$500.60 ,"$1,624.00 ", N/A ,"$1,380.40 ", N/A ,"$1,055.60 ", N/A ,"$1,624.00 ",$909.44 , N/A ,$427.11 , N/A ,$638.39 ,$609.37 , N/A ,"$1,299.20 ", N/A ,$732.42 ,$454.72 ,"$1,461.60 ", N/A ,$500.60 ,$525.00 ,$525.00 , N/A ,$525.00 ,$779.52 ,$580.35 
ST. ELIZABETH'S HOSPITAL,33300085,C2638,HC IODINE 125 PER SOURCE STRANDED,333,1 ,$109.00 ,$70.85 ,$28.67 ,"$1,751.63 ",$95.48 ,$50.14 ,$61.04 ,$38.19 ,$30.52 ,$36.84 ,$38.19 ,$42.40 ,$38.19 ,$49.16 ,$49.16 ,$38.19 ,$70.85 ,$72.56 ,$54.50 ,$95.48 ,$38.19 ,$38.19 ,$38.95 ,$81.75 ,$65.40 ,$65.40 ,$38.19 ,$65.40 ,$76.30 ,$76.30 ,$76.30 ,$109.00 , N/A ,$92.65 ,$95.48 ,$70.85 ,$38.19 ,$109.00 ,$61.04 ,$38.19 ,$28.67 , N/A ,$109.00 ,$109.00 ,$40.10 ,$87.20 ,$85.93 ,$49.16 ,$30.52 ,$98.10 ,$38.19 ,$76.30 ,$109.00 ,$109.00 ,$38.19 ,$109.00 ,$52.32 ,"$1,751.63 "
ST. ELIZABETH'S HOSPITAL,33300089,77371,"HC SRS, MULTISOURCE",333,1 ,"$21,704.00 ","$14,107.60 ","$1,499.30 ","$21,704.00 ","$19,168.80 ","$2,645.88 ","$12,154.24 ","$7,667.52 ","$6,077.12 ","$7,661.51 ","$7,667.52 ","$8,942.05 ","$7,667.52 ","$9,788.50 ","$9,788.50 ","$7,667.52 ","$14,107.60 ","$14,568.28 ","$3,301.52 ","$19,168.79 ","$7,667.52 ","$7,667.52 ","$7,820.87 ","$16,278.00 ","$13,022.40 ","$13,022.40 ","$7,667.52 ","$13,022.40 ","$1,499.30 ","$1,499.30 ","$1,499.30 ","$21,704.00 ", N/A ,"$18,448.40 ","$19,168.79 ","$14,107.60 ","$7,667.52 ","$21,704.00 ","$12,154.24 ","$7,667.52 ","$5,708.15 ", N/A ,"$4,794.06 ","$4,576.15 ","$8,050.90 ","$17,363.20 ","$17,251.91 ","$9,788.50 ","$6,077.12 ","$19,533.60 ","$7,667.52 ","$1,499.30 ","$14,107.60 ","$14,107.60 ","$7,667.52 ","$14,107.60 ","$10,417.92 ","$4,358.24 "
ST. ELIZABETH'S HOSPITAL,33300090,77435,HC SBRT MANAGEMENT,333,1 ,"$2,635.00 ","$1,712.75 ",$118.09 ,"$2,635.00 ", N/A ,"$1,346.84 ","$1,475.60 ", N/A ,$737.80 ,$930.16 , N/A ,"$1,085.62 ", N/A ,"$1,188.39 ","$1,188.39 ", N/A ,$821.50 , N/A ,"$1,317.50 ", N/A , N/A , N/A , N/A ,"$1,976.25 ","$1,581.00 ","$1,581.00 ", N/A ,"$1,581.00 ",$967.79 ,$967.79 ,$967.79 ,"$2,635.00 ", N/A ,"$2,239.75 ", N/A ,"$1,712.75 ", N/A ,"$2,635.00 ","$1,475.60 ", N/A ,$693.01 , N/A ,$129.90 ,$123.99 , N/A ,"$2,108.00 ", N/A ,"$1,188.39 ",$737.80 ,"$2,371.50 ", N/A ,$967.79 ,$525.00 ,$525.00 , N/A ,$525.00 ,"$1,264.80 ",$118.09 
ST. ELIZABETH'S HOSPITAL,33300091,77261,HC RADIOLOGY TREATMENT PLANNING; SIMPLE,333,1 ,$293.00 ,$190.45 ,$77.06 ,$409.99 , N/A ,$142.92 ,$164.08 , N/A ,$82.04 ,$103.43 , N/A ,$120.72 , N/A ,$132.14 ,$132.14 , N/A ,$90.81 , N/A ,$146.50 , N/A , N/A , N/A , N/A ,$219.75 ,$175.80 ,$175.80 , N/A ,$175.80 ,$107.96 ,$107.96 ,$107.96 ,$293.00 , N/A ,$249.05 , N/A ,$190.45 , N/A ,$293.00 ,$164.08 , N/A ,$77.06 , N/A ,$293.00 ,$293.00 , N/A ,$234.40 , N/A ,$132.14 ,$82.04 ,$263.70 , N/A ,$107.96 ,$293.00 ,$293.00 , N/A ,$293.00 ,$140.64 ,$409.99 
ST. ELIZABETH'S HOSPITAL,33300092,77262,HC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE,333,1 ,$790.00 ,$513.50 ,$137.11 ,$790.00 , N/A ,$217.12 ,$442.40 , N/A ,$221.20 ,$278.87 , N/A ,$325.48 , N/A ,$356.29 ,$356.29 , N/A ,$137.11 , N/A ,$395.00 , N/A , N/A , N/A , N/A ,$592.50 ,$474.00 ,$474.00 , N/A ,$474.00 ,$162.96 ,$162.96 ,$162.96 ,$790.00 , N/A ,$671.50 , N/A ,$513.50 , N/A ,$790.00 ,$442.40 , N/A ,$207.77 , N/A ,$450.99 ,$430.49 , N/A ,$632.00 , N/A ,$356.29 ,$221.20 ,$711.00 , N/A ,$162.96 ,$525.00 ,$525.00 , N/A ,$525.00 ,$379.20 ,$409.99 
ST. ELIZABETH'S HOSPITAL,33300093,77263,HC RADIOLOGY TREATMENT PLANNING; COMPLEX,333,1 ,"$1,287.00 ",$836.55 ,$215.51 ,"$1,287.00 ", N/A ,$321.58 ,$720.72 , N/A ,$360.36 ,$454.31 , N/A ,$530.24 , N/A ,$580.44 ,$580.44 , N/A ,$215.51 , N/A ,$643.50 , N/A , N/A , N/A , N/A ,$965.25 ,$772.20 ,$772.20 , N/A ,$772.20 ,$254.81 ,$254.81 ,$254.81 ,"$1,287.00 ", N/A ,"$1,093.95 ", N/A ,$836.55 , N/A ,"$1,287.00 ",$720.72 , N/A ,$338.48 , N/A ,$450.99 ,$430.49 , N/A ,"$1,029.60 ", N/A ,$580.44 ,$360.36 ,"$1,158.30 ", N/A ,$254.81 ,$525.00 ,$525.00 , N/A ,$525.00 ,$617.76 ,$409.99 
ST. ELIZABETH'S HOSPITAL,33300095,77431,HC RADIATION MGMT 1/2 FRACTIONS ONLY,333,1 ,$685.00 ,$445.25 ,$118.09 ,$685.00 , N/A ,$195.22 ,$383.60 , N/A ,$191.80 ,$241.81 , N/A ,$282.22 , N/A ,$308.94 ,$308.94 , N/A ,$135.41 , N/A ,$342.50 , N/A , N/A , N/A , N/A ,$513.75 ,$411.00 ,$411.00 , N/A ,$411.00 ,$157.01 ,$157.01 ,$157.01 ,$685.00 , N/A ,$582.25 , N/A ,$445.25 , N/A ,$685.00 ,$383.60 , N/A ,$180.16 , N/A ,$129.90 ,$123.99 , N/A ,$548.00 , N/A ,$308.94 ,$191.80 ,$616.50 , N/A ,$157.01 ,$525.00 ,$525.00 , N/A ,$525.00 ,$328.80 ,$118.09 
ST. ELIZABETH'S HOSPITAL,33300096,77432,HC STEREOTACTIC RADIATION TRMT CRANIAL LESION,333,1 ,$685.00 ,$445.25 ,$118.09 ,$685.00 , N/A ,$685.00 ,$383.60 , N/A ,$191.80 ,$241.81 , N/A ,$282.22 , N/A ,$308.94 ,$308.94 , N/A ,$545.04 , N/A ,$342.50 , N/A , N/A , N/A , N/A ,$513.75 ,$411.00 ,$411.00 , N/A ,$411.00 ,$642.23 ,$642.23 ,$642.23 ,$685.00 , N/A ,$582.25 , N/A ,$445.25 , N/A ,$685.00 ,$383.60 , N/A ,$180.16 , N/A ,$129.90 ,$123.99 , N/A ,$548.00 , N/A ,$308.94 ,$191.80 ,$616.50 , N/A ,$642.23 ,$525.00 ,$525.00 , N/A ,$525.00 ,$328.80 ,$118.09 
ST. ELIZABETH'S HOSPITAL,33300097,G6017,HC INTRAFRACTION TRACK MOTION,333,1 ,$641.00 ,$416.65 ,$30.14 ,$641.00 , N/A ,$294.86 ,$358.96 , N/A ,$179.48 ,$216.66 , N/A ,$249.35 , N/A ,$289.09 ,$289.09 , N/A ,$416.65 , N/A ,$320.50 , N/A , N/A , N/A , N/A ,$480.75 ,$384.60 ,$384.60 , N/A ,$384.60 ,$30.14 ,$30.14 ,$30.14 ,$641.00 , N/A ,$544.85 , N/A ,$416.65 , N/A ,$641.00 ,$358.96 , N/A ,$168.58 , N/A , N/A , N/A , N/A ,$512.80 , N/A ,$289.09 ,$179.48 ,$576.90 , N/A ,$30.14 ,$525.00 ,$525.00 , N/A ,$525.00 ,$307.68 , N/A 
ST. ELIZABETH'S HOSPITAL,33301001,31575,HC LARYNGOSCOPY FLEX FIBEROPTC,333,1 ,$478.00 ,$310.70 ,$86.36 ,$478.00 ,$405.73 ,$219.88 ,$267.68 ,$162.29 ,$133.84 ,$161.56 ,$162.29 ,$185.94 ,$162.29 ,$215.58 ,$215.58 ,$162.29 ,$86.36 ,$308.35 ,$239.00 ,$405.72 ,$162.29 ,$162.29 ,$165.54 ,$358.50 ,$286.80 ,$286.80 ,$162.29 ,$286.80 ,$334.60 ,$334.60 ,$334.60 ,$478.00 , N/A ,$406.30 ,$405.72 ,$310.70 ,$162.29 ,$478.00 ,$267.68 ,$162.29 ,$125.71 , N/A ,$425.85 ,$406.50 ,$170.40 ,$382.40 ,$365.15 ,$215.58 ,$133.84 ,$430.20 ,$162.29 ,$334.60 ,$478.00 ,$478.00 ,$162.29 ,$478.00 ,$229.44 ,$387.14 
ST. ELIZABETH'S HOSPITAL,33301002,49411,HC PLCMT INSTST DEV ABD/PELV/RETR,333,1 ,"$3,809.00 ","$2,475.85 ",$235.79 ,"$3,809.00 ","$3,112.35 ","$1,752.14 ","$2,133.04 ","$1,244.94 ","$1,066.52 ","$1,287.44 ","$1,244.94 ","$1,481.70 ","$1,244.94 ","$1,717.86 ","$1,717.86 ","$1,244.94 ",$235.79 ,"$2,365.39 ","$1,904.50 ","$3,112.36 ","$1,244.94 ","$1,244.94 ","$1,269.84 ","$2,856.75 ","$2,285.40 ","$2,285.40 ","$1,244.94 ","$2,285.40 ","$2,666.30 ","$2,666.30 ","$2,666.30 ","$3,809.00 ", N/A ,"$3,237.65 ","$3,112.36 ","$2,475.85 ","$1,244.94 ","$3,809.00 ","$2,133.04 ","$1,244.94 ","$1,001.77 ", N/A ,$802.81 ,$766.32 ,"$1,307.19 ","$3,047.20 ","$2,801.12 ","$1,717.86 ","$1,066.52 ","$3,428.10 ","$1,244.94 ","$2,666.30 ",$525.00 ,$525.00 ,"$1,244.94 ",$525.00 ,"$1,828.32 ",$729.83 
ST. ELIZABETH'S HOSPITAL,33301005,77280,HC SIMULATION SMP,333,1 ,$351.00 ,$228.15 ,$92.31 ,$409.99 ,$312.75 ,$284.86 ,$196.56 ,$125.10 ,$98.28 ,$123.90 ,$125.10 ,$144.61 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$279.44 ,$237.68 ,$351.00 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$336.99 ,$336.99 ,$336.99 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$351.00 ,$351.00 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$336.99 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$409.99 
ST. ELIZABETH'S HOSPITAL,33301008,77399,HC IMAGE FUSION DOSIMETRY,333,1 ,$351.00 ,$228.15 ,$92.31 ,$351.00 ,$312.75 ,$161.46 ,$196.56 ,$125.10 ,$98.28 ,$118.64 ,$125.10 ,$136.54 ,$125.10 ,$158.30 ,$158.30 ,$125.10 ,$228.15 ,$237.68 ,$305.68 ,$312.74 ,$125.10 ,$125.10 ,$127.60 ,$263.25 ,$210.60 ,$210.60 ,$125.10 ,$210.60 ,$245.70 ,$245.70 ,$245.70 ,$351.00 , N/A ,$298.35 ,$312.74 ,$228.15 ,$125.10 ,$351.00 ,$196.56 ,$125.10 ,$92.31 , N/A ,$129.90 ,$123.99 ,$131.36 ,$280.80 ,$281.47 ,$158.30 ,$98.28 ,$315.90 ,$125.10 ,$245.70 ,$351.00 ,$351.00 ,$125.10 ,$351.00 ,$168.48 ,$118.09 
ST. ELIZABETH'S HOSPITAL,33500002,96401,HC CHEMO SQ/IM NON ANTI-NEOPLAST,335,1 ,$236.00 ,$153.40 ,$61.12 ,$236.00 ,$152.80 ,$108.56 ,$132.16 ,$61.12 ,$66.08 ,$83.31 ,$61.12 ,$97.23 ,$61.12 ,$106.44 ,$106.44 ,$61.12 ,$93.76 ,$116.14 ,$118.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$177.00 ,$141.60 ,$141.60 ,$61.12 ,$141.60 ,$165.20 ,$165.20 ,$165.20 ,$236.00 , N/A ,$200.60 ,$152.81 ,$153.40 ,$61.12 ,$236.00 ,$132.16 ,$61.12 ,$62.07 , N/A , N/A , N/A ,$64.18 ,$188.80 ,$137.53 ,$106.44 ,$66.08 ,$212.40 ,$61.12 ,$165.20 ,$236.00 ,$236.00 ,$61.12 ,$236.00 ,$113.28 , N/A 
ST. ELIZABETH'S HOSPITAL,33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$236.00 ,$153.40 ,$62.07 ,$504.21 ,$504.20 ,$108.56 ,$132.16 ,$201.68 ,$66.08 ,$83.31 ,$201.68 ,$97.23 ,$201.68 ,$106.44 ,$106.44 ,$201.68 ,$130.23 ,$236.00 ,$118.00 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$177.00 ,$141.60 ,$141.60 ,$201.68 ,$141.60 ,$165.20 ,$165.20 ,$165.20 ,$236.00 , N/A ,$200.60 ,$236.00 ,$153.40 ,$201.68 ,$236.00 ,$132.16 ,$201.68 ,$62.07 , N/A , N/A , N/A ,$211.76 ,$188.80 ,$453.79 ,$106.44 ,$66.08 ,$212.40 ,$201.68 ,$165.20 ,$236.00 ,$236.00 ,$201.68 ,$236.00 ,$113.28 , N/A 
ST. ELIZABETH'S HOSPITAL,33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$228.00 ,$148.20 ,$59.96 ,$228.00 ,$152.80 ,$104.88 ,$127.68 ,$61.12 ,$63.84 ,$80.48 ,$61.12 ,$93.94 ,$61.12 ,$102.83 ,$102.83 ,$61.12 ,$71.03 ,$116.14 ,$114.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$171.00 ,$136.80 ,$136.80 ,$61.12 ,$136.80 ,$159.60 ,$159.60 ,$159.60 ,$228.00 , N/A ,$193.80 ,$152.81 ,$148.20 ,$61.12 ,$228.00 ,$127.68 ,$61.12 ,$59.96 , N/A , N/A , N/A ,$64.18 ,$182.40 ,$137.53 ,$102.83 ,$63.84 ,$205.20 ,$61.12 ,$159.60 ,$228.00 ,$228.00 ,$61.12 ,$228.00 ,$109.44 , N/A 
ST. ELIZABETH'S HOSPITAL,33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$535.00 ,$347.75 ,$140.71 ,$785.88 ,$785.88 ,$246.10 ,$299.60 ,$314.35 ,$149.80 ,$188.86 ,$314.35 ,$220.42 ,$314.35 ,$241.29 ,$241.29 ,$314.35 ,$168.54 ,$535.00 ,$267.50 ,$785.87 ,$314.35 ,$314.35 ,$320.63 ,$401.25 ,$321.00 ,$321.00 ,$314.35 ,$321.00 ,$374.50 ,$374.50 ,$374.50 ,$535.00 , N/A ,$454.75 ,$535.00 ,$347.75 ,$314.35 ,$535.00 ,$299.60 ,$314.35 ,$140.71 , N/A ,$329.90 ,$314.91 ,$330.07 ,$428.00 ,$707.28 ,$241.29 ,$149.80 ,$481.50 ,$314.35 ,$374.50 ,$360.00 ,$360.00 ,$314.35 ,$360.00 ,$256.80 ,$299.91 
ST. ELIZABETH'S HOSPITAL,33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$238.00 ,$154.70 ,$36.14 ,$468.85 ,$152.80 ,$109.48 ,$133.28 ,$61.12 ,$66.64 ,$84.01 ,$61.12 ,$98.06 ,$61.12 ,$107.34 ,$107.34 ,$61.12 ,$36.14 ,$116.14 ,$119.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$178.50 ,$142.80 ,$142.80 ,$61.12 ,$142.80 ,$166.60 ,$166.60 ,$166.60 ,$238.00 , N/A ,$202.30 ,$152.81 ,$154.70 ,$61.12 ,$238.00 ,$133.28 ,$61.12 ,$62.59 , N/A ,$238.00 ,$238.00 ,$64.18 ,$190.40 ,$137.53 ,$107.34 ,$66.64 ,$214.20 ,$61.12 ,$166.60 ,$238.00 ,$238.00 ,$61.12 ,$238.00 ,$114.24 ,$468.85 
ST. ELIZABETH'S HOSPITAL,33500008,96417,HC CHEMO IV INFUSION EA ADDL <1H,335,1 ,$356.00 ,$231.40 ,$61.12 ,$356.00 ,$152.80 ,$163.76 ,$199.36 ,$61.12 ,$99.68 ,$125.67 ,$61.12 ,$146.67 ,$61.12 ,$160.56 ,$160.56 ,$61.12 ,$82.05 ,$116.14 ,$178.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$267.00 ,$213.60 ,$213.60 ,$61.12 ,$213.60 ,$249.20 ,$249.20 ,$249.20 ,$356.00 , N/A ,$302.60 ,$152.81 ,$231.40 ,$61.12 ,$356.00 ,$199.36 ,$61.12 ,$93.63 , N/A ,$329.90 ,$314.91 ,$64.18 ,$284.80 ,$137.53 ,$160.56 ,$99.68 ,$320.40 ,$61.12 ,$249.20 ,$356.00 ,$356.00 ,$61.12 ,$356.00 ,$170.88 ,$299.91 
ST. ELIZABETH'S HOSPITAL,33500012,96450,HC CHEMO CNS,335,1 ,"$1,115.00 ",$724.75 ,$98.85 ,"$1,115.00 ",$785.88 ,$512.90 ,$624.40 ,$314.35 ,$312.20 ,$393.60 ,$314.35 ,$459.38 ,$314.35 ,$502.87 ,$502.87 ,$314.35 ,$98.85 ,$597.26 ,$557.50 ,$785.87 ,$314.35 ,$314.35 ,$320.63 ,$836.25 ,$669.00 ,$669.00 ,$314.35 ,$669.00 ,$780.50 ,$780.50 ,$780.50 ,"$1,115.00 ", N/A ,$947.75 ,$785.87 ,$724.75 ,$314.35 ,"$1,115.00 ",$624.40 ,$314.35 ,$293.25 , N/A ,$515.74 ,$492.29 ,$330.07 ,$892.00 ,$707.28 ,$502.87 ,$312.20 ,"$1,003.50 ",$314.35 ,$780.50 ,$360.00 ,$360.00 ,$314.35 ,$360.00 ,$535.20 ,$468.85 
ST. ELIZABETH'S HOSPITAL,33500013,96402,HC CHEMOTHERAPY INJECTION-HORMONAL ANTI-NEO,335,1 ,$236.00 ,$153.40 ,$41.04 ,$236.00 ,$152.80 ,$108.56 ,$132.16 ,$61.12 ,$66.08 ,$83.31 ,$61.12 ,$97.23 ,$61.12 ,$106.44 ,$106.44 ,$61.12 ,$41.04 ,$116.14 ,$118.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$177.00 ,$141.60 ,$141.60 ,$61.12 ,$141.60 ,$165.20 ,$165.20 ,$165.20 ,$236.00 , N/A ,$200.60 ,$152.81 ,$153.40 ,$61.12 ,$236.00 ,$132.16 ,$61.12 ,$62.07 , N/A , N/A , N/A ,$64.18 ,$188.80 ,$137.53 ,$106.44 ,$66.08 ,$212.40 ,$61.12 ,$165.20 ,$236.00 ,$236.00 ,$61.12 ,$236.00 ,$113.28 , N/A 
ST. ELIZABETH'S HOSPITAL,33500015,G6002,HC STEREOSCOPIC X-RAY GUIDANCE FOR LOCALIZATION G6002,333,1 ,$534.00 ,$347.10 ,$64.70 ,$534.00 , N/A ,$245.64 ,$299.04 , N/A ,$149.52 ,$188.50 , N/A ,$220.01 , N/A ,$240.83 ,$240.83 , N/A ,$64.70 , N/A ,$148.90 , N/A , N/A , N/A , N/A ,$400.50 ,$320.40 ,$320.40 , N/A ,$320.40 ,$77.66 ,$77.66 ,$77.66 ,$534.00 , N/A ,$453.90 , N/A ,$347.10 , N/A ,$534.00 ,$299.04 , N/A ,$140.44 , N/A ,$334.40 ,$319.20 , N/A ,$427.20 , N/A ,$240.83 ,$149.52 ,$480.60 , N/A ,$77.66 ,$525.00 ,$525.00 , N/A ,$525.00 ,$256.32 ,$304.00 
ST. ELIZABETH'S HOSPITAL,33500028,96440,HC CHEMO ADMIN PLEURAL CAVITY W/THORACENTESIS,335,1 ,$402.00 ,$261.30 ,$105.73 ,$785.88 ,$785.88 ,$184.92 ,$225.12 ,$314.35 ,$112.56 ,$141.91 ,$314.35 ,$165.62 ,$314.35 ,$181.30 ,$181.30 ,$314.35 ,$167.56 ,$402.00 ,$201.00 ,$785.87 ,$314.35 ,$314.35 ,$320.63 ,$301.50 ,$241.20 ,$241.20 ,$314.35 ,$241.20 ,$281.40 ,$281.40 ,$281.40 ,$402.00 , N/A ,$341.70 ,$402.00 ,$261.30 ,$314.35 ,$402.00 ,$225.12 ,$314.35 ,$105.73 , N/A ,$402.00 ,$402.00 ,$330.07 ,$321.60 ,$707.28 ,$181.30 ,$112.56 ,$361.80 ,$314.35 ,$281.40 ,$360.00 ,$360.00 ,$314.35 ,$360.00 ,$192.96 ,$663.14 
ST. ELIZABETH'S HOSPITAL,34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$315.00 ,$204.75 ,$82.85 ,$929.10 ,$929.10 ,$129.16 ,$176.40 ,$371.64 ,$88.20 ,$111.20 ,$371.64 ,$129.78 ,$315.00 ,$142.07 ,$142.07 ,$315.00 ,$88.04 ,$315.00 ,$197.64 ,$929.10 ,$371.64 ,$371.64 ,$315.00 ,$236.25 ,$189.00 ,$189.00 ,$371.64 ,$189.00 ,$103.16 ,$103.16 ,$103.16 ,$315.00 , N/A ,$267.75 ,$315.00 ,$204.75 ,$371.64 ,$315.00 ,$176.40 ,$371.64 ,$82.85 , N/A ,$315.00 ,$315.00 ,$390.22 ,$252.00 ,$836.19 ,$142.07 ,$88.20 ,$283.50 ,$371.64 ,$103.16 ,$315.00 ,$315.00 ,$315.00 ,$315.00 ,$151.20 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,357.00 ",$882.05 ,$248.19 ,"$1,357.00 ",$929.10 ,$382.76 ,$759.92 ,$371.64 ,$379.96 ,$479.02 ,$371.64 ,$559.08 ,$371.64 ,$612.01 ,$612.01 ,$371.64 ,$248.19 ,$706.11 ,$596.47 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,017.75 ",$814.20 ,$814.20 ,$371.64 ,$814.20 ,$310.97 ,$310.97 ,$310.97 ,"$1,357.00 ", N/A ,"$1,153.45 ",$929.10 ,$882.05 ,$371.64 ,"$1,357.00 ",$759.92 ,$371.64 ,$356.89 , N/A ,$443.74 ,$423.57 ,$390.22 ,"$1,085.60 ",$836.19 ,$612.01 ,$379.96 ,"$1,221.30 ",$371.64 ,$310.97 ,"$1,357.00 ","$1,357.00 ",$371.64 ,"$1,357.00 ",$651.36 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000007,78018,HC NM THYROID CA METS WHOLE BODY,340,1 ,"$2,930.00 ","$1,904.50 ",$315.73 ,"$2,930.00 ","$1,206.13 ",$497.16 ,"$1,640.80 ",$482.45 ,$820.40 ,"$1,034.29 ",$482.45 ,"$1,207.16 ",$482.45 ,"$1,321.43 ","$1,321.43 ",$482.45 ,$315.73 ,$916.65 ,$750.14 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$2,197.50 ","$1,758.00 ","$1,758.00 ",$482.45 ,"$1,758.00 ",$391.11 ,$391.11 ,$391.11 ,"$2,930.00 ", N/A ,"$2,490.50 ","$1,206.12 ","$1,904.50 ",$482.45 ,"$2,930.00 ","$1,640.80 ",$482.45 ,$770.59 , N/A ,$443.74 ,$423.57 ,$506.57 ,"$2,344.00 ","$1,085.51 ","$1,321.43 ",$820.40 ,"$2,637.00 ",$482.45 ,$391.11 ,"$1,650.00 ","$1,650.00 ",$482.45 ,"$1,650.00 ","$1,406.40 ",$403.40 
ST. ELIZABETH'S HOSPITAL,34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,186.00 ",$770.90 ,$226.02 ,"$1,186.00 ",$929.10 ,$226.02 ,$664.16 ,$371.64 ,$332.08 ,$418.66 ,$371.64 ,$488.63 ,$371.64 ,$534.89 ,$534.89 ,$371.64 ,$294.23 ,$706.11 ,$715.70 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$889.50 ,$711.60 ,$711.60 ,$371.64 ,$711.60 ,$373.07 ,$373.07 ,$373.07 ,"$1,186.00 ", N/A ,"$1,008.10 ",$929.10 ,$770.90 ,$371.64 ,"$1,186.00 ",$664.16 ,$371.64 ,$311.92 , N/A ,$396.02 ,$378.02 ,$390.22 ,$948.80 ,$836.19 ,$534.89 ,$332.08 ,"$1,067.40 ",$371.64 ,$373.07 ,"$1,186.00 ","$1,186.00 ",$371.64 ,"$1,186.00 ",$569.28 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$1,579.00 ","$1,026.35 ",$343.03 ,"$1,579.00 ","$1,206.13 ",$461.90 ,$884.24 ,$482.45 ,$442.12 ,$557.39 ,$482.45 ,$650.55 ,$482.45 ,$712.13 ,$712.13 ,$482.45 ,$343.03 ,$916.65 ,$820.73 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$1,184.25 ",$947.40 ,$947.40 ,$482.45 ,$947.40 ,$427.88 ,$427.88 ,$427.88 ,"$1,579.00 ", N/A ,"$1,342.15 ","$1,206.12 ","$1,026.35 ",$482.45 ,"$1,579.00 ",$884.24 ,$482.45 ,$415.28 , N/A ,$443.74 ,$423.57 ,$506.57 ,"$1,263.20 ","$1,085.51 ",$712.13 ,$442.12 ,"$1,421.10 ",$482.45 ,$427.88 ,"$1,579.00 ","$1,579.00 ",$482.45 ,"$1,579.00 ",$757.92 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,013.00 ",$658.45 ,$200.50 ,"$1,013.00 ",$929.10 ,$302.02 ,$567.28 ,$371.64 ,$283.64 ,$357.59 ,$371.64 ,$417.36 ,$371.64 ,$456.86 ,$456.86 ,$371.64 ,$200.50 ,$706.11 ,$469.60 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$759.75 ,$607.80 ,$607.80 ,$371.64 ,$607.80 ,$244.89 ,$244.89 ,$244.89 ,"$1,013.00 ", N/A ,$861.05 ,$929.10 ,$658.45 ,$371.64 ,"$1,013.00 ",$567.28 ,$371.64 ,$266.42 , N/A ,$396.02 ,$378.02 ,$390.22 ,$810.40 ,$836.19 ,$456.86 ,$283.64 ,$911.70 ,$371.64 ,$244.89 ,"$1,013.00 ","$1,013.00 ",$371.64 ,"$1,013.00 ",$486.24 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$2,121.00 ","$1,378.65 ",$334.88 ,"$2,121.00 ",$929.10 ,$512.70 ,"$1,187.76 ",$371.64 ,$593.88 ,$748.71 ,$371.64 ,$873.85 ,$371.64 ,$956.57 ,$956.57 ,$371.64 ,$334.88 ,$706.11 ,$809.28 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,590.75 ","$1,272.60 ","$1,272.60 ",$371.64 ,"$1,272.60 ",$421.91 ,$421.91 ,$421.91 ,"$2,121.00 ", N/A ,"$1,802.85 ",$929.10 ,"$1,378.65 ",$371.64 ,"$2,121.00 ","$1,187.76 ",$371.64 ,$557.82 , N/A ,$443.74 ,$423.57 ,$390.22 ,"$1,696.80 ",$836.19 ,$956.57 ,$593.88 ,"$1,908.90 ",$371.64 ,$421.91 ,"$1,650.00 ","$1,650.00 ",$371.64 ,"$1,650.00 ","$1,018.08 ",$403.40 
ST. ELIZABETH'S HOSPITAL,34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$1,582.00 ","$1,028.30 ",$338.14 ,"$1,582.00 ",$929.10 ,$429.68 ,$885.92 ,$371.64 ,$442.96 ,$558.45 ,$371.64 ,$651.78 ,$371.64 ,$713.48 ,$713.48 ,$371.64 ,$338.14 ,$706.11 ,$815.96 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,186.50 ",$949.20 ,$949.20 ,$371.64 ,$949.20 ,$425.39 ,$425.39 ,$425.39 ,"$1,582.00 ", N/A ,"$1,344.70 ",$929.10 ,"$1,028.30 ",$371.64 ,"$1,582.00 ",$885.92 ,$371.64 ,$416.07 , N/A ,$443.74 ,$423.57 ,$390.22 ,"$1,265.60 ",$836.19 ,$713.48 ,$442.96 ,"$1,423.80 ",$371.64 ,$425.39 ,"$1,582.00 ","$1,582.00 ",$371.64 ,"$1,582.00 ",$759.36 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000027,78278,HC GI BLEED SCAN,340,1 ,"$1,447.00 ",$940.55 ,$347.51 ,"$1,447.00 ",$929.10 ,$429.12 ,$810.32 ,$371.64 ,$405.16 ,$510.79 ,$371.64 ,$596.16 ,$371.64 ,$652.60 ,$652.60 ,$371.64 ,$347.51 ,$706.11 ,$827.40 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,085.25 ",$868.20 ,$868.20 ,$371.64 ,$868.20 ,$431.36 ,$431.36 ,$431.36 ,"$1,447.00 ", N/A ,"$1,229.95 ",$929.10 ,$940.55 ,$371.64 ,"$1,447.00 ",$810.32 ,$371.64 ,$380.56 , N/A ,$443.74 ,$423.57 ,$390.22 ,"$1,157.60 ",$836.19 ,$652.60 ,$405.16 ,"$1,302.30 ",$371.64 ,$431.36 ,"$1,447.00 ","$1,447.00 ",$371.64 ,"$1,447.00 ",$694.56 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,066.00 ",$692.90 ,$280.36 ,"$1,066.00 ",$929.10 ,$430.28 ,$596.96 ,$371.64 ,$298.48 ,$376.30 ,$371.64 ,$439.19 ,$371.64 ,$480.77 ,$480.77 ,$371.64 ,$343.44 ,$706.11 ,$818.82 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$799.50 ,$639.60 ,$639.60 ,$371.64 ,$639.60 ,$426.89 ,$426.89 ,$426.89 ,"$1,066.00 ", N/A ,$906.10 ,$929.10 ,$692.90 ,$371.64 ,"$1,066.00 ",$596.96 ,$371.64 ,$280.36 , N/A ,$396.02 ,$378.02 ,$390.22 ,$852.80 ,$836.19 ,$480.77 ,$298.48 ,$959.40 ,$371.64 ,$426.89 ,"$1,066.00 ","$1,066.00 ",$371.64 ,"$1,066.00 ",$511.68 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000029,78300,HC BONE SCAN LIMITED,340,1 ,$427.00 ,$277.55 ,$112.30 ,$929.10 ,$929.10 ,$261.88 ,$239.12 ,$371.64 ,$119.56 ,$150.73 ,$371.64 ,$175.92 ,$371.64 ,$192.58 ,$192.58 ,$371.64 ,$229.03 ,$427.00 ,$427.00 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$320.25 ,$256.20 ,$256.20 ,$371.64 ,$256.20 ,$285.98 ,$285.98 ,$285.98 ,$427.00 , N/A ,$362.95 ,$427.00 ,$277.55 ,$371.64 ,$427.00 ,$239.12 ,$371.64 ,$112.30 , N/A ,$396.02 ,$378.02 ,$390.22 ,$341.60 ,$836.19 ,$192.58 ,$119.56 ,$384.30 ,$371.64 ,$285.98 ,$427.00 ,$427.00 ,$371.64 ,$427.00 ,$204.96 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$2,297.00 ","$1,493.05 ",$295.04 ,"$2,297.00 ",$929.10 ,$379.22 ,"$1,286.32 ",$371.64 ,$643.16 ,$810.84 ,$371.64 ,$946.36 ,$371.64 ,"$1,035.95 ","$1,035.95 ",$371.64 ,$295.04 ,$706.11 ,$716.66 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,722.75 ","$1,378.20 ","$1,378.20 ",$371.64 ,"$1,378.20 ",$373.56 ,$373.56 ,$373.56 ,"$2,297.00 ", N/A ,"$1,952.45 ",$929.10 ,"$1,493.05 ",$371.64 ,"$2,297.00 ","$1,286.32 ",$371.64 ,$604.11 , N/A ,$396.02 ,$378.02 ,$390.22 ,"$1,837.60 ",$836.19 ,"$1,035.95 ",$643.16 ,"$2,067.30 ",$371.64 ,$373.56 ,"$1,650.00 ","$1,650.00 ",$371.64 ,"$1,650.00 ","$1,102.56 ",$360.02 
ST. ELIZABETH'S HOSPITAL,34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$1,822.00 ","$1,184.30 ",$343.44 ,"$1,822.00 ",$929.10 ,$438.84 ,"$1,020.32 ",$371.64 ,$510.16 ,$643.17 ,$371.64 ,$750.66 ,$371.64 ,$821.72 ,$821.72 ,$371.64 ,$343.44 ,$706.11 ,$816.91 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,366.50 ","$1,093.20 ","$1,093.20 ",$371.64 ,"$1,093.20 ",$425.88 ,$425.88 ,$425.88 ,"$1,822.00 ", N/A ,"$1,548.70 ",$929.10 ,"$1,184.30 ",$371.64 ,"$1,822.00 ","$1,020.32 ",$371.64 ,$479.19 , N/A ,$396.02 ,$378.02 ,$390.22 ,"$1,457.60 ",$836.19 ,$821.72 ,$510.16 ,"$1,639.80 ",$371.64 ,$425.88 ,"$1,650.00 ","$1,650.00 ",$371.64 ,"$1,650.00 ",$874.56 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$2,152.00 ","$1,398.80 ",$316.54 ,"$3,220.85 ","$3,220.85 ",$494.12 ,"$1,205.12 ","$1,288.34 ",$602.56 ,$759.66 ,"$1,288.34 ",$886.62 ,"$1,288.34 ",$970.55 ,$970.55 ,"$1,288.34 ",$316.54 ,"$2,152.00 ",$750.14 ,"$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,314.10 ","$1,614.00 ","$1,291.20 ","$1,291.20 ","$1,288.34 ","$1,291.20 ",$391.11 ,$391.11 ,$391.11 ,"$2,152.00 ", N/A ,"$1,829.20 ","$2,152.00 ","$1,398.80 ","$1,288.34 ","$2,152.00 ","$1,205.12 ","$1,288.34 ",$565.98 , N/A ,$443.74 ,$423.57 ,"$1,352.76 ","$1,721.60 ","$2,898.75 ",$970.55 ,$602.56 ,"$1,936.80 ","$1,288.34 ",$391.11 ,"$1,650.00 ","$1,650.00 ","$1,288.34 ","$1,650.00 ","$1,032.96 ",$403.40 
ST. ELIZABETH'S HOSPITAL,34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$5,826.00 ","$3,786.90 ",$457.65 ,"$5,826.00 ","$3,220.85 ",$717.80 ,"$3,262.56 ","$1,288.34 ","$1,631.28 ","$2,056.58 ","$1,288.34 ","$2,400.31 ","$1,288.34 ","$2,627.53 ","$2,627.53 ","$1,288.34 ",$457.65 ,"$2,447.84 ","$1,084.19 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,314.10 ","$4,369.50 ","$3,495.60 ","$3,495.60 ","$1,288.34 ","$3,495.60 ",$565.31 ,$565.31 ,$565.31 ,"$5,826.00 ", N/A ,"$4,952.10 ","$3,220.84 ","$3,786.90 ","$1,288.34 ","$5,826.00 ","$3,262.56 ","$1,288.34 ","$1,532.24 ", N/A ,$971.55 ,$927.39 ,"$1,352.76 ","$4,660.80 ","$2,898.75 ","$2,627.53 ","$1,631.28 ","$5,243.40 ","$1,288.34 ",$565.31 ,"$1,650.00 ","$1,650.00 ","$1,288.34 ","$1,650.00 ","$2,796.48 ",$883.23 
ST. ELIZABETH'S HOSPITAL,34000043,78466,HC CARDIAC SCAN,340,1 ,$941.00 ,$611.65 ,$185.84 ,$941.00 ,$929.10 ,$262.50 ,$526.96 ,$371.64 ,$263.48 ,$332.17 ,$371.64 ,$387.69 ,$371.64 ,$424.39 ,$424.39 ,$371.64 ,$185.84 ,$706.11 ,$446.70 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$705.75 ,$564.60 ,$564.60 ,$371.64 ,$564.60 ,$232.97 ,$232.97 ,$232.97 ,$941.00 , N/A ,$799.85 ,$929.10 ,$611.65 ,$371.64 ,$941.00 ,$526.96 ,$371.64 ,$247.48 , N/A ,$443.74 ,$423.57 ,$390.22 ,$752.80 ,$836.19 ,$424.39 ,$263.48 ,$846.90 ,$371.64 ,$232.97 ,$941.00 ,$941.00 ,$371.64 ,$941.00 ,$451.68 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000044,78472,HC MUGA RESTING SGL,340,1 ,"$1,988.00 ","$1,292.20 ",$209.88 ,"$1,988.00 ",$929.10 ,$364.62 ,"$1,113.28 ",$371.64 ,$556.64 ,$701.76 ,$371.64 ,$819.06 ,$371.64 ,$896.59 ,$896.59 ,$371.64 ,$209.88 ,$706.11 ,$498.21 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,491.00 ","$1,192.80 ","$1,192.80 ",$371.64 ,"$1,192.80 ",$259.80 ,$259.80 ,$259.80 ,"$1,988.00 ", N/A ,"$1,689.80 ",$929.10 ,"$1,292.20 ",$371.64 ,"$1,988.00 ","$1,113.28 ",$371.64 ,$522.84 , N/A ,$396.02 ,$378.02 ,$390.22 ,"$1,590.40 ",$836.19 ,$896.59 ,$556.64 ,"$1,789.20 ",$371.64 ,$259.80 ,"$1,650.00 ","$1,650.00 ",$371.64 ,"$1,650.00 ",$954.24 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000047,78580,HC LUNG PERFUS,340,1 ,"$1,444.00 ",$938.60 ,$232.29 ,"$1,444.00 ",$929.10 ,$317.20 ,$808.64 ,$371.64 ,$404.32 ,$509.73 ,$371.64 ,$594.93 ,$371.64 ,$651.24 ,$651.24 ,$371.64 ,$232.29 ,$706.11 ,$556.40 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$1,083.00 ",$866.40 ,$866.40 ,$371.64 ,$866.40 ,$290.10 ,$290.10 ,$290.10 ,"$1,444.00 ", N/A ,"$1,227.40 ",$929.10 ,$938.60 ,$371.64 ,"$1,444.00 ",$808.64 ,$371.64 ,$379.77 , N/A ,$443.74 ,$423.57 ,$390.22 ,"$1,155.20 ",$836.19 ,$651.24 ,$404.32 ,"$1,299.60 ",$371.64 ,$290.10 ,"$1,444.00 ","$1,444.00 ",$371.64 ,"$1,444.00 ",$693.12 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$2,859.00 ","$1,858.35 ",$325.10 ,"$2,859.00 ","$1,206.13 ",$475.36 ,"$1,601.04 ",$482.45 ,$800.52 ,"$1,009.23 ",$482.45 ,"$1,177.91 ",$482.45 ,"$1,289.41 ","$1,289.41 ",$482.45 ,$325.10 ,$916.65 ,$776.85 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$2,144.25 ","$1,715.40 ","$1,715.40 ",$482.45 ,"$1,715.40 ",$405.02 ,$405.02 ,$405.02 ,"$2,859.00 ", N/A ,"$2,430.15 ","$1,206.12 ","$1,858.35 ",$482.45 ,"$2,859.00 ","$1,601.04 ",$482.45 ,$751.92 , N/A ,$443.74 ,$423.57 ,$506.57 ,"$2,287.20 ","$1,085.51 ","$1,289.41 ",$800.52 ,"$2,573.10 ",$482.45 ,$405.02 ,"$1,650.00 ","$1,650.00 ",$482.45 ,"$1,650.00 ","$1,372.32 ",$403.40 
ST. ELIZABETH'S HOSPITAL,34000053,78601,HC BRAIN W/FLOW < 4 VIEWS STAT,340,1 ,$993.00 ,$645.45 ,$221.70 ,$993.00 ,$929.10 ,$338.48 ,$556.08 ,$371.64 ,$278.04 ,$350.53 ,$371.64 ,$409.12 ,$371.64 ,$447.84 ,$447.84 ,$371.64 ,$221.70 ,$706.11 ,$527.79 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$744.75 ,$595.80 ,$595.80 ,$371.64 ,$595.80 ,$275.21 ,$275.21 ,$275.21 ,$993.00 , N/A ,$844.05 ,$929.10 ,$645.45 ,$371.64 ,$993.00 ,$556.08 ,$371.64 ,$261.16 , N/A ,$396.02 ,$378.02 ,$390.22 ,$794.40 ,$836.19 ,$447.84 ,$278.04 ,$893.70 ,$371.64 ,$275.21 ,$993.00 ,$993.00 ,$371.64 ,$993.00 ,$476.64 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000056,78630,HC CISTERNOGRAPHY,340,1 ,$888.00 ,$577.20 ,$233.54 ,"$1,206.13 ","$1,206.13 ",$543.36 ,$497.28 ,$482.45 ,$248.64 ,$313.46 ,$482.45 ,$365.86 ,$482.45 ,$400.49 ,$400.49 ,$482.45 ,$352.81 ,$888.00 ,$837.90 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,$666.00 ,$532.80 ,$532.80 ,$482.45 ,$532.80 ,$436.82 ,$436.82 ,$436.82 ,$888.00 , N/A ,$754.80 ,$888.00 ,$577.20 ,$482.45 ,$888.00 ,$497.28 ,$482.45 ,$233.54 , N/A ,$443.74 ,$423.57 ,$506.57 ,$710.40 ,"$1,085.51 ",$400.49 ,$248.64 ,$799.20 ,$482.45 ,$436.82 ,$888.00 ,$888.00 ,$482.45 ,$888.00 ,$426.24 ,$403.40 
ST. ELIZABETH'S HOSPITAL,34000057,78645,HC CSF SHUNT EVALUATION,340,1 ,"$1,293.00 ",$840.45 ,$340.06 ,"$1,293.00 ","$1,206.13 ",$432.12 ,$724.08 ,$482.45 ,$362.04 ,$456.43 ,$482.45 ,$532.72 ,$482.45 ,$583.14 ,$583.14 ,$482.45 ,$342.63 ,$916.65 ,$818.82 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,$969.75 ,$775.80 ,$775.80 ,$482.45 ,$775.80 ,$426.89 ,$426.89 ,$426.89 ,"$1,293.00 ", N/A ,"$1,099.05 ","$1,206.12 ",$840.45 ,$482.45 ,"$1,293.00 ",$724.08 ,$482.45 ,$340.06 , N/A ,$396.02 ,$378.02 ,$506.57 ,"$1,034.40 ","$1,085.51 ",$583.14 ,$362.04 ,"$1,163.70 ",$482.45 ,$426.89 ,"$1,293.00 ","$1,293.00 ",$482.45 ,"$1,293.00 ",$620.64 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$1,659.00 ","$1,078.35 ",$216.40 ,"$1,659.00 ","$1,206.13 ",$343.36 ,$929.04 ,$482.45 ,$464.52 ,$585.63 ,$482.45 ,$683.51 ,$482.45 ,$748.21 ,$748.21 ,$482.45 ,$216.40 ,$916.65 ,$512.52 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$1,244.25 ",$995.40 ,$995.40 ,$482.45 ,$995.40 ,$267.26 ,$267.26 ,$267.26 ,"$1,659.00 ", N/A ,"$1,410.15 ","$1,206.12 ","$1,078.35 ",$482.45 ,"$1,659.00 ",$929.04 ,$482.45 ,$436.32 , N/A ,$396.02 ,$378.02 ,$506.57 ,"$1,327.20 ","$1,085.51 ",$748.21 ,$464.52 ,"$1,493.10 ",$482.45 ,$267.26 ,"$1,650.00 ","$1,650.00 ",$482.45 ,"$1,650.00 ",$796.32 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$1,883.00 ","$1,223.95 ",$144.99 ,"$1,883.00 ","$1,206.13 ",$218.72 ,"$1,054.48 ",$482.45 ,$527.24 ,$664.70 ,$482.45 ,$775.80 ,$482.45 ,$849.23 ,$849.23 ,$482.45 ,$144.99 ,$916.65 ,$325.65 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$1,412.25 ","$1,129.80 ","$1,129.80 ",$482.45 ,"$1,129.80 ",$170.04 ,$170.04 ,$170.04 ,"$1,883.00 ", N/A ,"$1,600.55 ","$1,206.12 ","$1,223.95 ",$482.45 ,"$1,883.00 ","$1,054.48 ",$482.45 ,$495.23 , N/A ,$396.02 ,$378.02 ,$506.57 ,"$1,506.40 ","$1,085.51 ",$849.23 ,$527.24 ,"$1,694.70 ",$482.45 ,$170.04 ,"$1,650.00 ","$1,650.00 ",$482.45 ,"$1,650.00 ",$903.84 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000065,78709,HC KIDNEY W AND W/O PHARM INTERVEN,340,1 ,"$3,382.00 ","$2,198.30 ",$349.14 ,"$3,382.00 ","$1,206.13 ",$533.64 ,"$1,893.92 ",$482.45 ,$946.96 ,"$1,193.85 ",$482.45 ,"$1,393.38 ",$482.45 ,"$1,525.28 ","$1,525.28 ",$482.45 ,$349.14 ,$916.65 ,$826.45 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$2,536.50 ","$2,029.20 ","$2,029.20 ",$482.45 ,"$2,029.20 ",$430.86 ,$430.86 ,$430.86 ,"$3,382.00 ", N/A ,"$2,874.70 ","$1,206.12 ","$2,198.30 ",$482.45 ,"$3,382.00 ","$1,893.92 ",$482.45 ,$889.47 , N/A ,$396.02 ,$378.02 ,$506.57 ,"$2,705.60 ","$1,085.51 ","$1,525.28 ",$946.96 ,"$3,043.80 ",$482.45 ,$430.86 ,"$1,650.00 ","$1,650.00 ",$482.45 ,"$1,650.00 ","$1,623.36 ",$360.02 
ST. ELIZABETH'S HOSPITAL,34000066,78740,HC URETERAL REFLUX STUDY,340,1 ,$993.00 ,$645.45 ,$221.70 ,$993.00 ,$929.10 ,$346.40 ,$556.08 ,$371.64 ,$278.04 ,$350.53 ,$371.64 ,$409.12 ,$371.64 ,$447.84 ,$447.84 ,$371.64 ,$221.70 ,$706.11 ,$525.88 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$744.75 ,$595.80 ,$595.80 ,$371.64 ,$595.80 ,$274.20 ,$274.20 ,$274.20 ,$993.00 , N/A ,$844.05 ,$929.10 ,$645.45 ,$371.64 ,$993.00 ,$556.08 ,$371.64 ,$261.16 , N/A ,$396.02 ,$378.02 ,$390.22 ,$794.40 ,$836.19 ,$447.84 ,$278.04 ,$893.70 ,$371.64 ,$274.20 ,$993.00 ,$993.00 ,$371.64 ,$993.00 ,$476.64 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000067,78761,HC TESTICULAR IMAG W/FLOW,340,1 ,"$1,127.00 ",$732.55 ,$205.80 ,"$1,127.00 ",$929.10 ,$318.42 ,$631.12 ,$371.64 ,$315.56 ,$397.83 ,$371.64 ,$464.32 ,$371.64 ,$508.28 ,$508.28 ,$371.64 ,$205.80 ,$706.11 ,$483.91 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$845.25 ,$676.20 ,$676.20 ,$371.64 ,$676.20 ,$252.35 ,$252.35 ,$252.35 ,"$1,127.00 ", N/A ,$957.95 ,$929.10 ,$732.55 ,$371.64 ,"$1,127.00 ",$631.12 ,$371.64 ,$296.40 , N/A ,$396.02 ,$378.02 ,$390.22 ,$901.60 ,$836.19 ,$508.28 ,$315.56 ,"$1,014.30 ",$371.64 ,$252.35 ,"$1,127.00 ","$1,127.00 ",$371.64 ,"$1,127.00 ",$540.96 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$2,049.00 ","$1,331.85 ",$314.60 ,"$3,220.85 ","$3,220.85 ",$511.14 ,"$1,147.44 ","$1,288.34 ",$573.72 ,$723.30 ,"$1,288.34 ",$844.19 ,"$1,288.34 ",$924.10 ,$924.10 ,"$1,288.34 ",$314.60 ,"$2,049.00 ",$773.98 ,"$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,314.10 ","$1,536.75 ","$1,229.40 ","$1,229.40 ","$1,288.34 ","$1,229.40 ",$403.53 ,$403.53 ,$403.53 ,"$2,049.00 ", N/A ,"$1,741.65 ","$2,049.00 ","$1,331.85 ","$1,288.34 ","$2,049.00 ","$1,147.44 ","$1,288.34 ",$538.89 , N/A ,$971.55 ,$927.39 ,"$1,352.76 ","$1,639.20 ","$2,898.75 ",$924.10 ,$573.72 ,"$1,844.10 ","$1,288.34 ",$403.53 ,"$1,650.00 ","$1,650.00 ","$1,288.34 ","$1,650.00 ",$983.52 ,$883.23 
ST. ELIZABETH'S HOSPITAL,34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$1,535.00 ",$997.75 ,$384.19 ,"$3,220.85 ","$3,220.85 ",$535.46 ,$859.60 ,"$1,288.34 ",$429.80 ,$541.86 ,"$1,288.34 ",$632.42 ,"$1,288.34 ",$692.29 ,$692.29 ,"$1,288.34 ",$384.19 ,"$1,535.00 ",$794.97 ,"$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,314.10 ","$1,151.25 ",$921.00 ,$921.00 ,"$1,288.34 ",$921.00 ,$414.47 ,$414.47 ,$414.47 ,"$1,535.00 ", N/A ,"$1,304.75 ","$1,535.00 ",$997.75 ,"$1,288.34 ","$1,535.00 ",$859.60 ,"$1,288.34 ",$403.71 , N/A ,$971.55 ,$927.39 ,"$1,352.76 ","$1,228.00 ","$2,898.75 ",$692.29 ,$429.80 ,"$1,381.50 ","$1,288.34 ",$414.47 ,"$1,535.00 ","$1,535.00 ","$1,288.34 ","$1,535.00 ",$736.80 ,$883.23 
ST. ELIZABETH'S HOSPITAL,34000075,78803,HC TUMOR IMAGING (SPECT) OCTREO,340,1 ,"$1,535.00 ",$997.75 ,$384.19 ,"$3,220.85 ","$3,220.85 ",$535.46 ,$859.60 ,"$1,288.34 ",$429.80 ,$541.86 ,"$1,288.34 ",$632.42 ,"$1,288.34 ",$692.29 ,$692.29 ,"$1,288.34 ",$384.19 ,"$1,535.00 ",$794.97 ,"$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,314.10 ","$1,151.25 ",$921.00 ,$921.00 ,"$1,288.34 ",$921.00 ,$414.47 ,$414.47 ,$414.47 ,"$1,535.00 ", N/A ,"$1,304.75 ","$1,535.00 ",$997.75 ,"$1,288.34 ","$1,535.00 ",$859.60 ,"$1,288.34 ",$403.71 , N/A ,$971.55 ,$927.39 ,"$1,352.76 ","$1,228.00 ","$2,898.75 ",$692.29 ,$429.80 ,"$1,381.50 ","$1,288.34 ",$414.47 ,"$1,535.00 ","$1,535.00 ","$1,288.34 ","$1,535.00 ",$736.80 ,$883.23 
ST. ELIZABETH'S HOSPITAL,34000081,79005,HC NM RADIOPAHARM THRPY ORAL,340,1 ,"$2,482.00 ","$1,613.30 ",$62.15 ,"$2,482.00 ",$623.65 ,$98.44 ,"$1,389.92 ",$249.46 ,$694.96 ,$560.78 ,$249.46 ,$560.78 ,$249.46 ,"$1,119.38 ","$1,119.38 ",$249.46 ,$62.15 ,$473.97 ,$134.69 ,$623.65 ,$249.46 ,$249.46 ,$254.45 ,"$1,861.50 ","$1,489.20 ","$1,489.20 ",$249.46 ,"$1,489.20 ",$70.37 ,$70.37 ,$70.37 ,"$2,482.00 ", N/A ,"$2,109.70 ",$623.65 ,"$1,613.30 ",$249.46 ,"$2,482.00 ","$1,389.92 ",$249.46 ,$652.77 , N/A ,$322.27 ,$307.62 ,$261.93 ,"$1,985.60 ",$561.28 ,"$1,119.38 ",$694.96 ,"$2,233.80 ",$249.46 ,$70.37 ,"$1,650.00 ","$1,650.00 ",$249.46 ,"$1,650.00 ","$1,191.36 ",$292.97 
ST. ELIZABETH'S HOSPITAL,34000090,78597,HC PULM PERF DIFF W/IMG,340,1 ,"$3,020.00 ","$1,963.00 ",$193.58 ,"$3,020.00 ",$929.10 ,$283.92 ,"$1,691.20 ",$371.64 ,$845.60 ,"$1,066.06 ",$371.64 ,"$1,244.24 ",$371.64 ,"$1,362.02 ","$1,362.02 ",$371.64 ,$193.58 ,$706.11 ,$456.15 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,"$2,265.00 ","$1,812.00 ","$1,812.00 ",$371.64 ,"$1,812.00 ",$237.78 ,$237.78 ,$237.78 ,"$3,020.00 ", N/A ,"$2,567.00 ",$929.10 ,"$1,963.00 ",$371.64 ,"$3,020.00 ","$1,691.20 ",$371.64 ,$794.26 , N/A ,$443.74 ,$423.57 ,$390.22 ,"$2,416.00 ",$836.19 ,"$1,362.02 ",$845.60 ,"$2,718.00 ",$371.64 ,$237.78 ,"$1,650.00 ","$1,650.00 ",$371.64 ,"$1,650.00 ","$1,449.60 ",$403.40 
ST. ELIZABETH'S HOSPITAL,34000091,78598,HC NM PULM VENT AND PERF DIFF W/IMG,340,1 ,"$3,359.00 ","$2,183.35 ",$304.41 ,"$3,359.00 ","$1,206.13 ",$459.96 ,"$1,881.04 ",$482.45 ,$940.52 ,"$1,185.73 ",$482.45 ,"$1,383.91 ",$482.45 ,"$1,514.91 ","$1,514.91 ",$482.45 ,$304.41 ,$916.65 ,$728.20 ,"$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$2,519.25 ","$2,015.40 ","$2,015.40 ",$482.45 ,"$2,015.40 ",$379.68 ,$379.68 ,$379.68 ,"$3,359.00 ", N/A ,"$2,855.15 ","$1,206.12 ","$2,183.35 ",$482.45 ,"$3,359.00 ","$1,881.04 ",$482.45 ,$883.42 , N/A ,$443.74 ,$423.57 ,$506.57 ,"$2,687.20 ","$1,085.51 ","$1,514.91 ",$940.52 ,"$3,023.10 ",$482.45 ,$379.68 ,"$1,650.00 ","$1,650.00 ",$482.45 ,"$1,650.00 ","$1,612.32 ",$403.40 
ST. ELIZABETH'S HOSPITAL,34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$2,288.00 ","$1,487.20 ",$403.40 ,"$2,288.00 ","$1,206.13 ",$711.84 ,"$1,281.28 ",$482.45 ,$640.64 ,$807.66 ,$482.45 ,$942.66 ,$482.45 ,"$1,031.89 ","$1,031.89 ",$482.45 ,$456.13 ,$916.65 ,"$1,106.99 ","$1,206.12 ",$482.45 ,$482.45 ,$492.10 ,"$1,716.00 ","$1,372.80 ","$1,372.80 ",$482.45 ,"$1,372.80 ",$577.07 ,$577.07 ,$577.07 ,"$2,288.00 ", N/A ,"$1,944.80 ","$1,206.12 ","$1,487.20 ",$482.45 ,"$2,288.00 ","$1,281.28 ",$482.45 ,$601.74 , N/A ,$443.74 ,$423.57 ,$506.57 ,"$1,830.40 ","$1,085.51 ","$1,031.89 ",$640.64 ,"$2,059.20 ",$482.45 ,$577.07 ,"$1,650.00 ","$1,650.00 ",$482.45 ,"$1,650.00 ","$1,098.24 ",$403.40 
ST. ELIZABETH'S HOSPITAL,34000093,78071,HC PARATHYROID IMG W/SPECT 78071,340,1 ,"$1,043.00 ",$677.95 ,$274.31 ,"$1,043.00 ",$929.10 ,$533.22 ,$584.08 ,$371.64 ,$292.04 ,$368.18 ,$371.64 ,$429.72 ,$371.64 ,$470.39 ,$470.39 ,$371.64 ,$338.14 ,$706.11 ,$820.73 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$782.25 ,$625.80 ,$625.80 ,$371.64 ,$625.80 ,$427.88 ,$427.88 ,$427.88 ,"$1,043.00 ", N/A ,$886.55 ,$929.10 ,$677.95 ,$371.64 ,"$1,043.00 ",$584.08 ,$371.64 ,$274.31 , N/A ,$396.02 ,$378.02 ,$390.22 ,$834.40 ,$836.19 ,$470.39 ,$292.04 ,$938.70 ,$371.64 ,$427.88 ,"$1,043.00 ","$1,043.00 ",$371.64 ,"$1,043.00 ",$500.64 ,$360.02 
ST. ELIZABETH'S HOSPITAL,34100007,A9538,HC NM PYROPHOSPHATE 99M VIAL,343,1 ,$13.00 ,$8.45 ,$3.42 ,$13.00 , N/A , N/A ,$7.28 , N/A ,$3.64 ,$4.59 , N/A ,$5.36 , N/A ,$5.86 ,$5.86 , N/A ,$8.45 , N/A , N/A , N/A , N/A , N/A , N/A ,$9.75 ,$7.80 ,$7.80 , N/A ,$7.80 ,$9.10 ,$9.10 ,$9.10 ,$13.00 , N/A ,$11.05 , N/A ,$8.45 , N/A ,$13.00 ,$7.28 , N/A ,$3.42 , N/A , N/A , N/A , N/A ,$10.40 , N/A ,$5.86 ,$3.64 ,$11.70 , N/A ,$9.10 ,$13.00 ,$13.00 , N/A ,$13.00 ,$6.24 , N/A 
ST. ELIZABETH'S HOSPITAL,34100020,0042T,HC CT CEREBRAL PERFUSION W/BLOOD FLOW,351,1 ,"$1,755.00 ","$1,140.75 ",$273.92 ,"$1,755.00 ", N/A ,$750.00 ,$982.80 , N/A ,$491.40 ,$593.19 , N/A ,$682.70 , N/A ,$791.51 ,$791.51 , N/A ,"$1,140.75 ", N/A ,"$1,049.00 ", N/A , N/A , N/A , N/A ,"$1,316.25 ","$1,053.00 ","$1,053.00 ", N/A ,"$1,053.00 ","$1,228.50 ","$1,228.50 ","$1,228.50 ","$1,755.00 ", N/A ,"$1,491.75 ", N/A ,"$1,319.00 ", N/A ,"$1,755.00 ",$982.80 , N/A ,$461.57 , N/A ,$301.31 ,$287.62 , N/A ,"$1,404.00 ", N/A ,$791.51 ,$491.40 ,"$1,579.50 ", N/A ,"$1,228.50 ",$900.00 ,$900.00 , N/A ,$900.00 ,$842.40 ,$273.92 
ST. ELIZABETH'S HOSPITAL,34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$574.75 ,$373.59 ,$151.16 ,$574.75 , N/A , N/A ,$321.86 , N/A ,$160.93 ,$202.89 , N/A ,$236.80 , N/A ,$259.21 ,$259.21 , N/A ,$373.59 , N/A , N/A , N/A , N/A , N/A , N/A ,$431.06 ,$344.85 ,$344.85 , N/A ,$344.85 ,$402.33 ,$402.33 ,$402.33 ,$574.75 , N/A ,$488.54 , N/A ,$373.59 , N/A ,$574.75 ,$321.86 , N/A ,$151.16 , N/A , N/A , N/A , N/A ,$459.80 , N/A ,$259.21 ,$160.93 ,$517.28 , N/A ,$402.33 ,$574.75 ,$574.75 , N/A ,$574.75 ,$275.88 , N/A 
ST. ELIZABETH'S HOSPITAL,34300003,A9502,HC TETROFOSMIN/MYOVUE,343,1 ,$593.00 ,$385.45 ,$155.96 ,$593.00 , N/A , N/A ,$332.08 , N/A ,$166.04 ,$209.33 , N/A ,$244.32 , N/A ,$267.44 ,$267.44 , N/A ,$385.45 , N/A , N/A , N/A , N/A , N/A , N/A ,$444.75 ,$355.80 ,$355.80 , N/A ,$355.80 ,$415.10 ,$415.10 ,$415.10 ,$593.00 , N/A ,$504.05 , N/A ,$385.45 , N/A ,$593.00 ,$332.08 , N/A ,$155.96 , N/A , N/A , N/A , N/A ,$474.40 , N/A ,$267.44 ,$166.04 ,$533.70 , N/A ,$415.10 ,$175.87 ,$175.87 , N/A ,$175.87 ,$284.64 , N/A 
ST. ELIZABETH'S HOSPITAL,34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$156.00 ,$101.40 ,$26.83 ,$156.00 , N/A , N/A ,$87.36 , N/A ,$43.68 ,$55.07 , N/A ,$64.27 , N/A ,$70.36 ,$70.36 , N/A ,$101.40 , N/A , N/A , N/A , N/A , N/A , N/A ,$117.00 ,$93.60 ,$93.60 , N/A ,$93.60 ,$109.20 ,$109.20 ,$109.20 ,$156.00 , N/A ,$132.60 , N/A ,$101.40 , N/A ,$156.00 ,$87.36 , N/A ,$41.03 , N/A , N/A , N/A , N/A ,$124.80 , N/A ,$70.36 ,$43.68 ,$140.40 , N/A ,$109.20 ,$26.83 ,$26.83 , N/A ,$26.83 ,$74.88 , N/A 
ST. ELIZABETH'S HOSPITAL,34300006,A9505,HC DIAGNUCLIDE THALL 201 PER MCI,343,1 ,$113.00 ,$73.45 ,$29.72 ,$113.00 , N/A , N/A ,$63.28 , N/A ,$31.64 ,$39.89 , N/A ,$46.56 , N/A ,$50.96 ,$50.96 , N/A ,$73.45 , N/A , N/A , N/A , N/A , N/A , N/A ,$84.75 ,$67.80 ,$67.80 , N/A ,$67.80 ,$79.10 ,$79.10 ,$79.10 ,$113.00 , N/A ,$96.05 , N/A ,$73.45 , N/A ,$113.00 ,$63.28 , N/A ,$29.72 , N/A , N/A , N/A , N/A ,$90.40 , N/A ,$50.96 ,$31.64 ,$101.70 , N/A ,$79.10 ,$113.00 ,$113.00 , N/A ,$113.00 ,$54.24 , N/A 
ST. ELIZABETH'S HOSPITAL,34300009,A9512,HC TECHNETIUM TC99 PERTECH PER MCI,343,1 ,$118.00 ,$76.70 ,$19.42 ,$118.00 , N/A , N/A ,$66.08 , N/A ,$33.04 ,$39.88 , N/A ,$45.90 , N/A ,$53.22 ,$53.22 , N/A ,$76.70 , N/A , N/A , N/A , N/A , N/A , N/A ,$88.50 ,$70.80 ,$70.80 , N/A ,$70.80 ,$82.60 ,$82.60 ,$82.60 ,$118.00 , N/A ,$100.30 , N/A ,$76.70 , N/A ,$118.00 ,$66.08 , N/A ,$31.03 , N/A , N/A , N/A , N/A ,$94.40 , N/A ,$53.22 ,$33.04 ,$106.20 , N/A ,$82.60 ,$19.42 ,$19.42 , N/A ,$19.42 ,$56.64 , N/A 
ST. ELIZABETH'S HOSPITAL,34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$665.00 ,$432.25 ,$174.90 ,$665.00 , N/A , N/A ,$372.40 , N/A ,$186.20 ,$234.75 , N/A ,$273.98 , N/A ,$299.92 ,$299.92 , N/A ,$432.25 , N/A , N/A , N/A , N/A , N/A , N/A ,$498.75 ,$399.00 ,$399.00 , N/A ,$399.00 ,$465.50 ,$465.50 ,$465.50 ,$665.00 , N/A ,$565.25 , N/A ,$432.25 , N/A ,$665.00 ,$372.40 , N/A ,$174.90 , N/A , N/A , N/A , N/A ,$532.00 , N/A ,$299.92 ,$186.20 ,$598.50 , N/A ,$465.50 ,$186.71 ,$186.71 , N/A ,$186.71 ,$319.20 , N/A 
ST. ELIZABETH'S HOSPITAL,34300011,A9517,HC DIAGNUCLIDE I131 CAPS PER MCI,343,1 ,$130.00 ,$84.50 ,$20.12 ,$645.69 ,$50.30 ,$33.80 ,$72.80 ,$20.12 ,$36.40 ,$45.89 ,$20.12 ,$53.56 ,$20.12 ,$58.63 ,$58.63 ,$20.12 ,$84.50 ,$38.23 ,$65.00 ,$50.30 ,$20.12 ,$20.12 ,$20.52 ,$97.50 ,$78.00 ,$78.00 ,$20.12 ,$78.00 ,$91.00 ,$91.00 ,$91.00 ,$130.00 , N/A ,$110.50 ,$50.30 ,$84.50 ,$20.12 ,$130.00 ,$72.80 ,$20.12 ,$34.19 , N/A ,$130.00 ,$130.00 ,$21.13 ,$104.00 ,$45.27 ,$58.63 ,$36.40 ,$117.00 ,$20.12 ,$91.00 ,$33.20 ,$33.20 ,$20.12 ,$33.20 ,$62.40 ,$645.69 
ST. ELIZABETH'S HOSPITAL,34300014,A9528,HC DIAGNUCLIDE I131 NECK/CHST,343,1 ,$137.00 ,$89.05 ,$36.03 ,$137.00 , N/A , N/A ,$76.72 , N/A ,$38.36 ,$46.31 , N/A ,$53.29 , N/A ,$61.79 ,$61.79 , N/A ,$89.05 , N/A , N/A , N/A , N/A , N/A , N/A ,$102.75 ,$82.20 ,$82.20 , N/A ,$82.20 ,$95.90 ,$95.90 ,$95.90 ,$137.00 , N/A ,$116.45 , N/A ,$89.05 , N/A ,$137.00 ,$76.72 , N/A ,$36.03 , N/A , N/A , N/A , N/A ,$109.60 , N/A ,$61.79 ,$38.36 ,$123.30 , N/A ,$95.90 ,$137.00 ,$137.00 , N/A ,$137.00 ,$65.76 , N/A 
ST. ELIZABETH'S HOSPITAL,34300015,A9530,HC THERAPEUTIC ISOTOPE SOLUTION PER MCI,343,1 ,$28.00 ,$18.20 ,$7.28 ,$306.14 ,$33.35 ,$7.28 ,$15.68 ,$13.34 ,$7.84 ,$9.46 ,$13.34 ,$10.89 ,$13.34 ,$12.63 ,$12.63 ,$13.34 ,$18.20 ,$25.35 ,$14.00 ,$33.35 ,$13.34 ,$13.34 ,$13.61 ,$21.00 ,$16.80 ,$16.80 ,$13.34 ,$16.80 ,$19.60 ,$19.60 ,$19.60 ,$28.00 , N/A ,$23.80 ,$28.00 ,$18.20 ,$13.34 ,$28.00 ,$15.68 ,$13.34 ,$7.36 , N/A ,$28.00 ,$28.00 ,$14.01 ,$22.40 ,$30.02 ,$12.63 ,$7.84 ,$25.20 ,$13.34 ,$19.60 ,$22.01 ,$22.01 ,$13.34 ,$22.01 ,$13.44 ,$306.14 
ST. ELIZABETH'S HOSPITAL,34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$206.00 ,$133.90 ,$54.18 ,$206.00 , N/A , N/A ,$115.36 , N/A ,$57.68 ,$72.72 , N/A ,$84.87 , N/A ,$92.91 ,$92.91 , N/A ,$133.90 , N/A , N/A , N/A , N/A , N/A , N/A ,$154.50 ,$123.60 ,$123.60 , N/A ,$123.60 ,$144.20 ,$144.20 ,$144.20 ,$206.00 , N/A ,$175.10 , N/A ,$133.90 , N/A ,$206.00 ,$115.36 , N/A ,$54.18 , N/A , N/A , N/A , N/A ,$164.80 , N/A ,$92.91 ,$57.68 ,$185.40 , N/A ,$144.20 ,$138.60 ,$138.60 , N/A ,$138.60 ,$98.88 , N/A 
ST. ELIZABETH'S HOSPITAL,34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$334.59 ,$217.48 ,$51.96 ,$334.59 , N/A , N/A ,$187.37 , N/A ,$93.69 ,$118.11 , N/A ,$137.85 , N/A ,$150.90 ,$150.90 , N/A ,$217.48 , N/A , N/A , N/A , N/A , N/A , N/A ,$250.94 ,$200.75 ,$200.75 , N/A ,$200.75 ,$234.21 ,$234.21 ,$234.21 ,$334.59 , N/A ,$284.40 , N/A ,$217.48 , N/A ,$334.59 ,$187.37 , N/A ,$88.00 , N/A , N/A , N/A , N/A ,$267.67 , N/A ,$150.90 ,$93.69 ,$301.13 , N/A ,$234.21 ,$51.96 ,$51.96 , N/A ,$51.96 ,$160.60 , N/A 
ST. ELIZABETH'S HOSPITAL,34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$112.00 ,$72.80 ,$29.46 ,$112.00 , N/A , N/A ,$62.72 , N/A ,$31.36 ,$39.54 , N/A ,$46.14 , N/A ,$50.51 ,$50.51 , N/A ,$72.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$84.00 ,$67.20 ,$67.20 , N/A ,$67.20 ,$78.40 ,$78.40 ,$78.40 ,$112.00 , N/A ,$95.20 , N/A ,$72.80 , N/A ,$112.00 ,$62.72 , N/A ,$29.46 , N/A , N/A , N/A , N/A ,$89.60 , N/A ,$50.51 ,$31.36 ,$100.80 , N/A ,$78.40 ,$55.95 ,$55.95 , N/A ,$55.95 ,$53.76 , N/A 
ST. ELIZABETH'S HOSPITAL,34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$139.00 ,$90.35 ,$36.56 ,$139.00 , N/A , N/A ,$77.84 , N/A ,$38.92 ,$49.07 , N/A ,$57.27 , N/A ,$62.69 ,$62.69 , N/A ,$90.35 , N/A , N/A , N/A , N/A , N/A , N/A ,$104.25 ,$83.40 ,$83.40 , N/A ,$83.40 ,$97.30 ,$97.30 ,$97.30 ,$139.00 , N/A ,$118.15 , N/A ,$90.35 , N/A ,$139.00 ,$77.84 , N/A ,$36.56 , N/A , N/A , N/A , N/A ,$111.20 , N/A ,$62.69 ,$38.92 ,$125.10 , N/A ,$97.30 ,$139.00 ,$139.00 , N/A ,$139.00 ,$66.72 , N/A 
ST. ELIZABETH'S HOSPITAL,34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$2,684.00 ","$1,744.60 ",$521.90 ,"$2,684.00 ", N/A , N/A ,"$1,503.04 ", N/A ,$751.52 ,$947.45 , N/A ,"$1,105.81 ", N/A ,"$1,210.48 ","$1,210.48 ", N/A ,"$1,744.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,013.00 ","$1,610.40 ","$1,610.40 ", N/A ,"$1,610.40 ","$1,878.80 ","$1,878.80 ","$1,878.80 ","$2,684.00 ", N/A ,"$2,281.40 ", N/A ,"$1,744.60 ", N/A ,"$2,684.00 ","$1,503.04 ", N/A ,$705.89 , N/A , N/A , N/A , N/A ,"$2,147.20 ", N/A ,"$1,210.48 ",$751.52 ,"$2,415.60 ", N/A ,"$1,878.80 ",$521.90 ,$521.90 , N/A ,$521.90 ,"$1,288.32 ", N/A 
ST. ELIZABETH'S HOSPITAL,34300026,A9548,HC DIAGNUCLIDE IN-111 DTPA,343,1 ,"$1,075.00 ",$698.75 ,$282.73 ,"$1,075.00 ", N/A , N/A ,$602.00 , N/A ,$301.00 ,$379.48 , N/A ,$442.90 , N/A ,$484.83 ,$484.83 , N/A ,$698.75 , N/A , N/A , N/A , N/A , N/A , N/A ,$806.25 ,$645.00 ,$645.00 , N/A ,$645.00 ,$752.50 ,$752.50 ,$752.50 ,"$1,075.00 ", N/A ,$913.75 , N/A ,$698.75 , N/A ,"$1,075.00 ",$602.00 , N/A ,$282.73 , N/A , N/A , N/A , N/A ,$860.00 , N/A ,$484.83 ,$301.00 ,$967.50 , N/A ,$752.50 ,$312.91 ,$312.91 , N/A ,$312.91 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,34300029,A9552,HC DIAGNUCLIDE 18FDG,343,1 ,$538.00 ,$349.70 ,$141.49 ,$538.00 , N/A , N/A ,$301.28 , N/A ,$150.64 ,$189.91 , N/A ,$221.66 , N/A ,$242.64 ,$242.64 , N/A ,$349.70 , N/A , N/A , N/A , N/A , N/A , N/A ,$403.50 ,$322.80 ,$322.80 , N/A ,$322.80 ,$376.60 ,$376.60 ,$376.60 ,$538.00 , N/A ,$457.30 , N/A ,$349.70 , N/A ,$538.00 ,$301.28 , N/A ,$141.49 , N/A , N/A , N/A , N/A ,$430.40 , N/A ,$242.64 ,$150.64 ,$484.20 , N/A ,$376.60 ,$491.06 ,$491.06 , N/A ,$491.06 ,$258.24 , N/A 
ST. ELIZABETH'S HOSPITAL,34300033,A9558,HC DIAGNUCLIDE XE133 10 MCI,343,1 ,$192.00 ,$124.80 ,$50.50 ,$192.00 , N/A , N/A ,$107.52 , N/A ,$53.76 ,$67.78 , N/A ,$79.10 , N/A ,$86.59 ,$86.59 , N/A ,$124.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$144.00 ,$115.20 ,$115.20 , N/A ,$115.20 ,$134.40 ,$134.40 ,$134.40 ,$192.00 , N/A ,$163.20 , N/A ,$124.80 , N/A ,$192.00 ,$107.52 , N/A ,$50.50 , N/A , N/A , N/A , N/A ,$153.60 , N/A ,$86.59 ,$53.76 ,$172.80 , N/A ,$134.40 ,$192.00 ,$192.00 , N/A ,$192.00 ,$92.16 , N/A 
ST. ELIZABETH'S HOSPITAL,34300035,A9560,HC TC99M GI BLD MUGA UP TO 30MCI,343,1 ,$152.00 ,$98.80 ,$39.98 ,$152.00 , N/A , N/A ,$85.12 , N/A ,$42.56 ,$53.66 , N/A ,$62.62 , N/A ,$68.55 ,$68.55 , N/A ,$98.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$114.00 ,$91.20 ,$91.20 , N/A ,$91.20 ,$106.40 ,$106.40 ,$106.40 ,$152.00 , N/A ,$129.20 , N/A ,$98.80 , N/A ,$152.00 ,$85.12 , N/A ,$39.98 , N/A , N/A , N/A , N/A ,$121.60 , N/A ,$68.55 ,$42.56 ,$136.80 , N/A ,$106.40 ,$152.00 ,$152.00 , N/A ,$152.00 ,$72.96 , N/A 
ST. ELIZABETH'S HOSPITAL,34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$152.00 ,$98.80 ,$39.98 ,$152.00 , N/A , N/A ,$85.12 , N/A ,$42.56 ,$53.66 , N/A ,$62.62 , N/A ,$68.55 ,$68.55 , N/A ,$98.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$114.00 ,$91.20 ,$91.20 , N/A ,$91.20 ,$106.40 ,$106.40 ,$106.40 ,$152.00 , N/A ,$129.20 , N/A ,$98.80 , N/A ,$152.00 ,$85.12 , N/A ,$39.98 , N/A , N/A , N/A , N/A ,$121.60 , N/A ,$68.55 ,$42.56 ,$136.80 , N/A ,$106.40 ,$152.00 ,$152.00 , N/A ,$152.00 ,$72.96 , N/A 
ST. ELIZABETH'S HOSPITAL,34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,$224.00 ,$145.60 ,$58.91 ,$224.00 , N/A , N/A ,$125.44 , N/A ,$62.72 ,$79.07 , N/A ,$92.29 , N/A ,$101.02 ,$101.02 , N/A ,$145.60 , N/A , N/A , N/A , N/A , N/A , N/A ,$168.00 ,$134.40 ,$134.40 , N/A ,$134.40 ,$156.80 ,$156.80 ,$156.80 ,$224.00 , N/A ,$190.40 , N/A ,$145.60 , N/A ,$224.00 ,$125.44 , N/A ,$58.91 , N/A , N/A , N/A , N/A ,$179.20 , N/A ,$101.02 ,$62.72 ,$201.60 , N/A ,$156.80 ,$224.00 ,$224.00 , N/A ,$224.00 ,$107.52 , N/A 
ST. ELIZABETH'S HOSPITAL,34300038,A9572,HC DIAGNUCLIDE OCTREOTIDE PER DOSE UP TO 6MCI,343,1 ,"$2,765.00 ","$1,797.25 ",$727.20 ,"$2,765.00 ", N/A , N/A ,"$1,548.40 ", N/A ,$774.20 ,$976.05 , N/A ,"$1,139.18 ", N/A ,"$1,247.02 ","$1,247.02 ", N/A ,"$1,797.25 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,073.75 ","$1,659.00 ","$1,659.00 ", N/A ,"$1,659.00 ","$1,935.50 ","$1,935.50 ","$1,935.50 ","$2,765.00 ", N/A ,"$2,350.25 ", N/A ,"$1,797.25 ", N/A ,"$2,765.00 ","$1,548.40 ", N/A ,$727.20 , N/A , N/A , N/A , N/A ,"$2,212.00 ", N/A ,"$1,247.02 ",$774.20 ,"$2,488.50 ", N/A ,"$1,935.50 ","$2,765.00 ","$2,765.00 ", N/A ,"$2,765.00 ","$1,327.20 ", N/A 
ST. ELIZABETH'S HOSPITAL,34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$297.54 ,$193.40 ,$77.36 ,$297.54 , N/A ,$77.36 ,$166.62 , N/A ,$83.31 ,$105.03 , N/A ,$122.59 , N/A ,$134.19 ,$134.19 , N/A ,$134.19 , N/A ,$148.77 , N/A , N/A , N/A , N/A ,$223.16 ,$178.52 ,$178.52 , N/A ,$178.52 ,$226.13 ,$226.13 ,$226.13 ,$297.54 , N/A ,$252.91 , N/A ,$193.40 , N/A ,$297.54 ,$166.62 , N/A ,$78.25 , N/A ,$143.94 ,$137.39 , N/A ,$238.03 , N/A ,$134.19 ,$83.31 ,$267.79 , N/A ,$226.13 ,$190.82 ,$190.82 , N/A ,$190.82 ,$142.82 ,$130.85 
ST. ELIZABETH'S HOSPITAL,34300056,A9568,HC TC99M CEA DOSE UP TO 45 MCI,343,1 ,"$2,684.00 ","$1,744.60 ",$705.89 ,"$2,684.00 ", N/A , N/A ,"$1,503.04 ", N/A ,$751.52 ,$907.19 , N/A ,"$1,044.08 ", N/A ,"$1,210.48 ","$1,210.48 ", N/A ,"$1,744.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,013.00 ","$1,610.40 ","$1,610.40 ", N/A ,"$1,610.40 ","$1,878.80 ","$1,878.80 ","$1,878.80 ","$2,684.00 ", N/A ,"$2,281.40 ", N/A ,"$1,744.60 ", N/A ,"$2,684.00 ","$1,503.04 ", N/A ,$705.89 , N/A , N/A , N/A , N/A ,"$2,147.20 ", N/A ,"$1,210.48 ",$751.52 ,"$2,415.60 ", N/A ,"$1,878.80 ","$1,953.96 ","$1,953.96 ", N/A ,"$1,953.96 ","$1,288.32 ", N/A 
ST. ELIZABETH'S HOSPITAL,34300057,A9569,HC TC99M EXAMETAZIME CERETEC DX PER DOSE,343,1 ,"$4,939.00 ","$3,210.35 ","$1,298.96 ","$4,939.00 ", N/A , N/A ,"$2,765.84 ", N/A ,"$1,382.92 ","$1,743.47 ", N/A ,"$2,034.87 ", N/A ,"$2,227.49 ","$2,227.49 ", N/A ,"$3,210.35 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,704.25 ","$2,963.40 ","$2,963.40 ", N/A ,"$2,963.40 ","$3,457.30 ","$3,457.30 ","$3,457.30 ","$4,939.00 ", N/A ,"$4,198.15 ", N/A ,"$3,210.35 ", N/A ,"$4,939.00 ","$2,765.84 ", N/A ,"$1,298.96 ", N/A , N/A , N/A , N/A ,"$3,951.20 ", N/A ,"$2,227.49 ","$1,382.92 ","$4,445.10 ", N/A ,"$3,457.30 ","$2,760.22 ","$2,760.22 ", N/A ,"$2,760.22 ","$2,370.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,34300058,A9500,HC SESTAMIBI PER STUDY DOSE,343,1 ,$642.00 ,$417.30 ,$168.85 ,$642.00 , N/A , N/A ,$359.52 , N/A ,$179.76 ,$226.63 , N/A ,$264.50 , N/A ,$289.54 ,$289.54 , N/A ,$417.30 , N/A , N/A , N/A , N/A , N/A , N/A ,$481.50 ,$385.20 ,$385.20 , N/A ,$385.20 ,$449.40 ,$449.40 ,$449.40 ,$642.00 , N/A ,$545.70 , N/A ,$417.30 , N/A ,$642.00 ,$359.52 , N/A ,$168.85 , N/A , N/A , N/A , N/A ,$513.60 , N/A ,$289.54 ,$179.76 ,$577.80 , N/A ,$449.40 ,$584.10 ,$584.10 , N/A ,$584.10 ,$308.16 , N/A 
ST. ELIZABETH'S HOSPITAL,34300060,A9520,HC DIAGNUCLIDE TC-99 TILMANOCEPT DIAG UP TO 0.5 MCI,343,1 ,"$1,523.00 ",$989.95 ,$400.55 ,"$1,523.00 ", N/A , N/A ,$852.88 , N/A ,$426.44 ,$537.62 , N/A ,$627.48 , N/A ,$686.87 ,$686.87 , N/A ,$989.95 , N/A , N/A , N/A , N/A , N/A , N/A ,"$1,142.25 ",$913.80 ,$913.80 , N/A ,$913.80 ,"$1,066.10 ","$1,066.10 ","$1,066.10 ","$1,523.00 ", N/A ,"$1,294.55 ", N/A ,$989.95 , N/A ,"$1,523.00 ",$852.88 , N/A ,$400.55 , N/A , N/A , N/A , N/A ,"$1,218.40 ", N/A ,$686.87 ,$426.44 ,"$1,370.70 ", N/A ,"$1,066.10 ", N/A , N/A , N/A , N/A ,$731.04 , N/A 
ST. ELIZABETH'S HOSPITAL,34300072,A9595,"HC PIFLUFOLASTAT F-18, DIAGNOSTIC, 1 MILLICURIE",343,1 ,"$1,579.00 ","$1,026.35 ",$410.54 ,"$1,579.00 ","$1,354.45 ",$410.54 ,$884.24 ,$541.78 ,$442.12 ,$533.70 ,$541.78 ,$614.23 ,$541.78 ,$712.13 ,$712.13 ,$541.78 ,"$1,026.35 ","$1,029.38 ", N/A ,"$1,354.45 ",$541.78 ,$541.78 ,$552.61 ,"$1,184.25 ",$947.40 ,$947.40 ,$541.78 ,$947.40 ,"$1,105.30 ","$1,105.30 ","$1,105.30 ","$1,579.00 ", N/A ,"$1,342.15 ","$1,354.45 ","$1,026.35 ",$541.78 ,"$1,579.00 ",$884.24 ,$541.78 ,$415.28 , N/A , N/A , N/A ,$568.87 ,"$1,263.20 ","$1,219.00 ",$712.13 ,$442.12 ,"$1,421.10 ",$541.78 ,"$1,105.30 ",$893.94 ,$893.94 ,$541.78 ,$893.94 ,$757.92 , N/A 
ST. ELIZABETH'S HOSPITAL,35000002,20615,HC ASP/INJ CYST BONE,350,1 ,"$2,570.00 ","$1,670.50 ",$206.18 ,"$2,570.00 ","$1,533.75 ",$750.00 ,"$1,439.20 ",$613.50 ,$719.60 ,$868.66 ,$613.50 ,$999.73 ,$613.50 ,"$1,159.07 ","$1,159.07 ",$613.50 ,$206.18 ,"$1,165.65 ","$1,049.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,927.50 ","$1,542.00 ","$1,542.00 ",$613.50 ,"$1,542.00 ","$1,799.00 ","$1,799.00 ","$1,799.00 ","$2,570.00 ", N/A ,"$2,184.50 ","$1,533.75 ","$1,319.00 ",$613.50 ,"$2,570.00 ","$1,439.20 ",$613.50 ,$675.91 , N/A ,"$1,876.99 ","$1,791.67 ",$644.18 ,"$2,056.00 ","$1,380.37 ","$1,159.07 ",$719.60 ,"$2,313.00 ",$613.50 ,"$1,799.00 ",$900.00 ,$900.00 ,$613.50 ,$900.00 ,"$1,233.60 ","$1,706.35 "
ST. ELIZABETH'S HOSPITAL,35000003,20982,HC ABLATION BONE TUMOR RADIOFREQUENCY,350,1 ,"$24,679.00 ","$16,041.35 ",$481.95 ,"$24,679.00 ","$15,438.00 ",$750.00 ,"$13,820.24 ","$6,175.20 ","$6,910.12 ","$8,341.50 ","$6,175.20 ","$9,600.13 ","$6,175.20 ","$11,130.23 ","$11,130.23 ","$6,175.20 ",$481.95 ,"$11,732.88 ","$1,049.00 ","$15,438.00 ","$6,175.20 ","$6,175.20 ","$6,298.70 ","$18,509.25 ","$14,807.40 ","$14,807.40 ","$6,175.20 ","$14,807.40 ","$17,275.30 ","$17,275.30 ","$17,275.30 ","$24,679.00 ", N/A ,"$20,977.15 ","$15,438.00 ","$1,319.00 ","$6,175.20 ","$24,679.00 ","$13,820.24 ","$6,175.20 ","$6,490.58 ", N/A ,"$3,033.99 ","$2,896.08 ","$6,483.96 ","$19,743.20 ","$13,894.20 ","$11,130.23 ","$6,910.12 ","$22,211.10 ","$6,175.20 ","$17,275.30 ",$900.00 ,$900.00 ,"$6,175.20 ",$900.00 ,"$11,845.92 ","$2,758.17 "
ST. ELIZABETH'S HOSPITAL,35000005,21501,HC I AND D ABSC NECK/THORAX,350,1 ,"$10,156.00 ","$6,601.40 ",$437.98 ,"$10,156.00 ","$5,843.93 ",$750.00 ,"$5,687.36 ","$2,337.57 ","$2,843.68 ","$3,432.73 ","$2,337.57 ","$3,950.68 ","$2,337.57 ","$4,580.36 ","$4,580.36 ","$2,337.57 ",$437.98 ,"$4,441.38 ","$1,049.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$7,617.00 ","$6,093.60 ","$6,093.60 ","$2,337.57 ","$6,093.60 ","$7,109.20 ","$7,109.20 ","$7,109.20 ","$10,156.00 ", N/A ,"$8,632.60 ","$5,843.93 ","$1,319.00 ","$2,337.57 ","$10,156.00 ","$5,687.36 ","$2,337.57 ","$2,671.03 ", N/A ,"$1,105.10 ","$1,054.87 ","$2,454.45 ","$8,124.80 ","$5,259.53 ","$4,580.36 ","$2,843.68 ","$9,140.40 ","$2,337.57 ","$7,109.20 ",$900.00 ,$900.00 ,"$2,337.57 ",$900.00 ,"$4,874.88 ","$1,004.64 "
ST. ELIZABETH'S HOSPITAL,35000006,21550,HC BX TISSUE NECK/THORAX,350,1 ,"$2,516.00 ","$1,635.40 ",$201.76 ,"$3,467.90 ","$3,467.90 ",$750.00 ,"$1,408.96 ","$1,387.16 ",$704.48 ,$850.41 ,"$1,387.16 ",$978.72 ,"$1,387.16 ","$1,134.72 ","$1,134.72 ","$1,387.16 ",$201.76 ,"$2,516.00 ","$1,049.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,887.00 ","$1,509.60 ","$1,509.60 ","$1,387.16 ","$1,509.60 ","$1,761.20 ","$1,761.20 ","$1,761.20 ","$2,516.00 ", N/A ,"$2,138.60 ","$2,516.00 ","$1,319.00 ","$1,387.16 ","$2,516.00 ","$1,408.96 ","$1,387.16 ",$661.71 , N/A ,$679.51 ,$648.63 ,"$1,456.52 ","$2,012.80 ","$3,121.10 ","$1,134.72 ",$704.48 ,"$2,264.40 ","$1,387.16 ","$1,761.20 ",$900.00 ,$900.00 ,"$1,387.16 ",$900.00 ,"$1,207.68 ",$617.74 
ST. ELIZABETH'S HOSPITAL,35000013,32400,HC BX PLEURA NEEDLE PERC,350,1 ,"$2,754.00 ","$1,790.10 ",$110.76 ,"$3,467.90 ","$3,467.90 ",$750.00 ,"$1,542.24 ","$1,387.16 ",$771.12 ,$930.85 ,"$1,387.16 ","$1,071.31 ","$1,387.16 ","$1,242.05 ","$1,242.05 ","$1,387.16 ",$110.76 ,"$2,635.59 ","$1,049.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,065.50 ","$1,652.40 ","$1,652.40 ","$1,387.16 ","$1,652.40 ","$1,927.80 ","$1,927.80 ","$1,927.80 ","$2,754.00 ", N/A ,"$2,340.90 ","$2,754.00 ","$1,319.00 ","$1,387.16 ","$2,754.00 ","$1,542.24 ","$1,387.16 ",$724.30 , N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$2,203.20 ","$3,121.10 ","$1,242.05 ",$771.12 ,"$2,478.60 ","$1,387.16 ","$1,927.80 ",$900.00 ,$900.00 ,"$1,387.16 ",$900.00 ,"$1,321.92 ",$663.14 
ST. ELIZABETH'S HOSPITAL,35000017,32998,HC LUNG ABLATION,350,1 ,"$13,004.00 ","$8,452.60 ",$566.91 ,"$13,004.00 ","$12,471.18 ",$750.00 ,"$7,282.24 ","$4,988.47 ","$3,641.12 ","$4,395.35 ","$4,988.47 ","$5,058.56 ","$4,988.47 ","$5,864.80 ","$5,864.80 ","$4,988.47 ",$566.91 ,"$9,478.10 ","$1,049.00 ","$12,471.19 ","$4,988.47 ","$4,988.47 ","$5,088.24 ","$9,753.00 ","$7,802.40 ","$7,802.40 ","$4,988.47 ","$7,802.40 ","$9,102.80 ","$9,102.80 ","$9,102.80 ","$13,004.00 ", N/A ,"$11,053.40 ","$12,471.19 ","$1,319.00 ","$4,988.47 ","$13,004.00 ","$7,282.24 ","$4,988.47 ","$3,420.05 ", N/A ,"$4,198.04 ","$4,007.22 ","$5,237.89 ","$10,403.20 ","$11,224.07 ","$5,864.80 ","$3,641.12 ","$11,703.60 ","$4,988.47 ","$9,102.80 ",$900.00 ,$900.00 ,"$4,988.47 ",$900.00 ,"$6,241.92 ","$3,816.40 "
ST. ELIZABETH'S HOSPITAL,35000018,47000,HC BX LIVER NEEDLE PERC,350,1 ,"$4,505.00 ","$2,928.25 ",$112.40 ,"$4,505.00 ","$3,467.90 ",$750.00 ,"$2,522.80 ","$1,387.16 ","$1,261.40 ","$1,522.69 ","$1,387.16 ","$1,752.45 ","$1,387.16 ","$2,031.76 ","$2,031.76 ","$1,387.16 ",$112.40 ,"$2,635.59 ","$1,049.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,378.75 ","$2,703.00 ","$2,703.00 ","$1,387.16 ","$2,703.00 ","$3,153.50 ","$3,153.50 ","$3,153.50 ","$4,505.00 ", N/A ,"$3,829.25 ","$3,467.89 ","$1,319.00 ","$1,387.16 ","$4,505.00 ","$2,522.80 ","$1,387.16 ","$1,184.82 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,604.00 ","$3,121.10 ","$2,031.76 ","$1,261.40 ","$4,054.50 ","$1,387.16 ","$3,153.50 ",$900.00 ,$900.00 ,"$1,387.16 ",$900.00 ,"$2,162.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,35000020,49405,HC PERC DRN ABSC/HEM/CYST VISCERAL,350,1 ,"$3,830.00 ","$2,489.50 ",$251.56 ,"$3,830.00 ","$3,467.90 ",$750.00 ,"$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$251.56 ,"$2,635.59 ","$1,049.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$1,319.00 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$900.00 ,$900.00 ,"$1,387.16 ",$900.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,35000021,47382,HC ABLATION TUMR LIVER RADIO PERC,350,1 ,"$13,007.00 ","$8,454.55 ",$750.00 ,"$13,007.00 ","$12,471.18 ",$750.00 ,"$7,283.92 ","$4,988.47 ","$3,641.96 ","$4,396.37 ","$4,988.47 ","$5,059.72 ","$4,988.47 ","$5,866.16 ","$5,866.16 ","$4,988.47 ",$951.19 ,"$9,478.10 ","$1,049.00 ","$12,471.19 ","$4,988.47 ","$4,988.47 ","$5,088.24 ","$9,755.25 ","$7,804.20 ","$7,804.20 ","$4,988.47 ","$7,804.20 ","$9,104.90 ","$9,104.90 ","$9,104.90 ","$13,007.00 ", N/A ,"$11,055.95 ","$12,471.19 ","$1,319.00 ","$4,988.47 ","$13,007.00 ","$7,283.92 ","$4,988.47 ","$3,420.84 ", N/A ,"$4,806.14 ","$4,587.68 ","$5,237.89 ","$10,405.60 ","$11,224.07 ","$5,866.16 ","$3,641.96 ","$11,706.30 ","$4,988.47 ","$9,104.90 ",$900.00 ,$900.00 ,"$4,988.47 ",$900.00 ,"$6,243.36 ","$4,369.22 "
ST. ELIZABETH'S HOSPITAL,35000023,48102,HC BX PANCREAS NEEDLE PERC,350,1 ,"$3,830.00 ","$2,489.50 ",$303.68 ,"$3,830.00 ","$3,467.90 ",$750.00 ,"$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$303.68 ,"$2,635.59 ","$1,049.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$1,319.00 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$900.00 ,$900.00 ,"$1,387.16 ",$900.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,35000025,49180,HC ABDOM/RETRO/MASS BIOP,350,1 ,"$2,834.00 ","$1,842.10 ",$106.90 ,"$3,467.90 ","$3,467.90 ",$750.00 ,"$1,587.04 ","$1,387.16 ",$793.52 ,$957.89 ,"$1,387.16 ","$1,102.43 ","$1,387.16 ","$1,278.13 ","$1,278.13 ","$1,387.16 ",$106.90 ,"$2,635.59 ","$1,049.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,125.50 ","$1,700.40 ","$1,700.40 ","$1,387.16 ","$1,700.40 ","$1,983.80 ","$1,983.80 ","$1,983.80 ","$2,834.00 ", N/A ,"$2,408.90 ","$2,834.00 ","$1,319.00 ","$1,387.16 ","$2,834.00 ","$1,587.04 ","$1,387.16 ",$745.34 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$2,267.20 ","$3,121.10 ","$1,278.13 ",$793.52 ,"$2,550.60 ","$1,387.16 ","$1,983.80 ",$900.00 ,$900.00 ,"$1,387.16 ",$900.00 ,"$1,360.32 ",$583.08 
ST. ELIZABETH'S HOSPITAL,35000026,50200,"HC PERC BIOPSY/KIDNEY, NEEDLE",350,1 ,"$2,802.00 ","$1,821.30 ",$163.59 ,"$3,467.90 ","$3,467.90 ",$750.00 ,"$1,569.12 ","$1,387.16 ",$784.56 ,$947.08 ,"$1,387.16 ","$1,089.98 ","$1,387.16 ","$1,263.70 ","$1,263.70 ","$1,387.16 ",$163.59 ,"$2,635.59 ","$1,049.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,101.50 ","$1,681.20 ","$1,681.20 ","$1,387.16 ","$1,681.20 ","$1,961.40 ","$1,961.40 ","$1,961.40 ","$2,802.00 ", N/A ,"$2,381.70 ","$2,802.00 ","$1,319.00 ","$1,387.16 ","$2,802.00 ","$1,569.12 ","$1,387.16 ",$736.93 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$2,241.60 ","$3,121.10 ","$1,263.70 ",$784.56 ,"$2,521.80 ","$1,387.16 ","$1,961.40 ",$900.00 ,$900.00 ,"$1,387.16 ",$900.00 ,"$1,344.96 ",$583.08 
ST. ELIZABETH'S HOSPITAL,35000027,50390,HC RENAL CYST/PELVIS ASP/INJ,350,1 ,"$2,269.00 ","$1,474.85 ",$123.70 ,"$2,269.00 ","$1,533.75 ",$750.00 ,"$1,270.64 ",$613.50 ,$635.32 ,$766.92 ,$613.50 ,$882.64 ,$613.50 ,"$1,023.32 ","$1,023.32 ",$613.50 ,$123.70 ,"$1,165.65 ","$1,049.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,701.75 ","$1,361.40 ","$1,361.40 ",$613.50 ,"$1,361.40 ","$1,588.30 ","$1,588.30 ","$1,588.30 ","$2,269.00 ", N/A ,"$1,928.65 ","$1,533.75 ","$1,319.00 ",$613.50 ,"$2,269.00 ","$1,270.64 ",$613.50 ,$596.75 , N/A ,$641.39 ,$612.23 ,$644.18 ,"$1,815.20 ","$1,380.37 ","$1,023.32 ",$635.32 ,"$2,042.10 ",$613.50 ,"$1,588.30 ",$900.00 ,$900.00 ,$613.50 ,$900.00 ,"$1,089.12 ",$583.08 
ST. ELIZABETH'S HOSPITAL,35000029,60699,HC UNLISTED PROCEDURE ENDOCRINE SYSTEM,350,1 ,"$13,007.00 ","$8,454.55 ",$750.00 ,"$13,007.00 ","$12,471.18 ",$750.00 ,"$7,283.92 ","$4,988.47 ","$3,641.96 ","$4,396.37 ","$4,988.47 ","$5,059.72 ","$4,988.47 ","$5,866.16 ","$5,866.16 ","$4,988.47 ","$8,454.55 ","$9,478.10 ","$1,049.00 ","$12,471.19 ","$4,988.47 ","$4,988.47 ","$5,088.24 ","$9,755.25 ","$7,804.20 ","$7,804.20 ","$4,988.47 ","$7,804.20 ","$9,104.90 ","$9,104.90 ","$9,104.90 ","$13,007.00 ", N/A ,"$11,055.95 ","$12,471.19 ","$1,319.00 ","$4,988.47 ","$13,007.00 ","$7,283.92 ","$4,988.47 ","$3,420.84 ", N/A ,"$2,551.93 ","$2,435.94 ","$5,237.89 ","$10,405.60 ","$11,224.07 ","$5,866.16 ","$3,641.96 ","$11,706.30 ","$4,988.47 ","$9,104.90 ",$900.00 ,$900.00 ,"$4,988.47 ",$900.00 ,"$6,243.36 ","$2,319.94 "
ST. ELIZABETH'S HOSPITAL,35000032,64430,HC INJ ANEST AGENT PUDENDAL NERVE,350,1 ,"$3,019.00 ","$1,962.35 ",$70.73 ,"$3,019.00 ","$2,028.93 ",$750.00 ,"$1,690.64 ",$811.57 ,$845.32 ,"$1,020.42 ",$811.57 ,"$1,174.39 ",$811.57 ,"$1,361.57 ","$1,361.57 ",$811.57 ,$70.73 ,"$1,541.99 ","$1,049.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,264.25 ","$1,811.40 ","$1,811.40 ",$811.57 ,"$1,811.40 ","$2,113.30 ","$2,113.30 ","$2,113.30 ","$3,019.00 ", N/A ,"$2,566.15 ","$2,028.93 ","$1,319.00 ",$811.57 ,"$3,019.00 ","$1,690.64 ",$811.57 ,$794.00 , N/A ,$463.72 ,$442.64 ,$852.15 ,"$2,415.20 ","$1,826.04 ","$1,361.57 ",$845.32 ,"$2,717.10 ",$811.57 ,"$2,113.30 ",$900.00 ,$900.00 ,$811.57 ,$900.00 ,"$1,449.12 ",$421.56 
ST. ELIZABETH'S HOSPITAL,35000033,64505,HC INJ SPENOPALANTINE GANGLION,350,1 ,"$1,092.00 ",$709.80 ,$138.68 ,"$1,092.00 ",$643.95 ,$750.00 ,$611.52 ,$257.58 ,$305.76 ,$369.10 ,$257.58 ,$424.79 ,$257.58 ,$492.49 ,$492.49 ,$257.58 ,$138.68 ,$489.39 ,"$1,049.00 ",$643.94 ,$257.58 ,$257.58 ,$262.73 ,$819.00 ,$655.20 ,$655.20 ,$257.58 ,$655.20 ,$764.40 ,$764.40 ,$764.40 ,"$1,092.00 ", N/A ,$928.20 ,$643.94 ,"$1,092.00 ",$257.58 ,"$1,092.00 ",$611.52 ,$257.58 ,$287.20 , N/A ,$463.72 ,$442.64 ,$270.46 ,$873.60 ,$579.55 ,$492.49 ,$305.76 ,$982.80 ,$257.58 ,$764.40 ,$900.00 ,$900.00 ,$257.58 ,$900.00 ,$524.16 ,$421.56 
ST. ELIZABETH'S HOSPITAL,35000034,64530,HC INJ CELIAC PLEXUS BLOCK,350,1 ,"$2,995.00 ","$1,946.75 ",$120.79 ,"$2,995.00 ","$2,028.93 ",$750.00 ,"$1,677.20 ",$811.57 ,$838.60 ,"$1,012.31 ",$811.57 ,"$1,165.06 ",$811.57 ,"$1,350.75 ","$1,350.75 ",$811.57 ,$120.79 ,"$1,541.99 ","$1,049.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,246.25 ","$1,797.00 ","$1,797.00 ",$811.57 ,"$1,797.00 ","$2,096.50 ","$2,096.50 ","$2,096.50 ","$2,995.00 ", N/A ,"$2,545.75 ","$2,028.93 ","$1,319.00 ",$811.57 ,"$2,995.00 ","$1,677.20 ",$811.57 ,$787.69 , N/A ,$463.72 ,$442.64 ,$852.15 ,"$2,396.00 ","$1,826.04 ","$1,350.75 ",$838.60 ,"$2,695.50 ",$811.57 ,"$2,096.50 ",$900.00 ,$900.00 ,$811.57 ,$900.00 ,"$1,437.60 ",$421.56 
ST. ELIZABETH'S HOSPITAL,35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$2,177.00 ","$1,415.05 ",$85.06 ,"$2,177.00 ",$268.33 ,$750.00 ,"$1,219.12 ",$107.33 ,$609.56 ,$768.48 ,$107.33 ,$816.82 ,$107.33 ,$981.83 ,$981.83 ,$107.33 ,$85.06 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,632.75 ","$1,306.20 ","$1,306.20 ",$107.33 ,"$1,306.20 ",$102.00 ,$102.00 ,$102.00 ,"$2,177.00 ", N/A ,"$1,850.45 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,177.00 ","$1,219.12 ",$107.33 ,$572.55 , N/A ,$301.31 ,$287.62 ,$112.70 ,"$1,741.60 ",$241.50 ,$981.83 ,$609.56 ,"$1,959.30 ",$107.33 ,$102.00 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,044.96 ",$273.92 
ST. ELIZABETH'S HOSPITAL,35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,497.00 ","$1,623.05 ",$122.96 ,"$2,497.00 ",$440.25 ,$750.00 ,"$1,398.32 ",$176.10 ,$699.16 ,$881.44 ,$176.10 ,"$1,028.76 ",$176.10 ,"$1,126.15 ","$1,126.15 ",$176.10 ,$122.96 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,872.75 ","$1,498.20 ","$1,498.20 ",$176.10 ,"$1,498.20 ",$148.70 ,$148.70 ,$148.70 ,"$2,497.00 ", N/A ,"$2,122.45 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,497.00 ","$1,398.32 ",$176.10 ,$656.71 , N/A ,$301.31 ,$287.62 ,$184.91 ,"$1,997.60 ",$396.23 ,"$1,126.15 ",$699.16 ,"$2,247.30 ",$176.10 ,$148.70 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,198.56 ",$273.92 
ST. ELIZABETH'S HOSPITAL,35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$3,068.00 ","$1,994.20 ",$147.41 ,"$3,068.00 ",$440.25 ,$750.00 ,"$1,718.08 ",$176.10 ,$859.04 ,"$1,083.00 ",$176.10 ,"$1,264.02 ",$176.10 ,"$1,383.67 ","$1,383.67 ",$176.10 ,$147.41 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,301.00 ","$1,840.80 ","$1,840.80 ",$176.10 ,"$1,840.80 ",$178.01 ,$178.01 ,$178.01 ,"$3,068.00 ", N/A ,"$2,607.80 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,068.00 ","$1,718.08 ",$176.10 ,$806.88 , N/A ,$301.31 ,$287.62 ,$184.91 ,"$2,454.40 ",$396.23 ,"$1,383.67 ",$859.04 ,"$2,761.20 ",$176.10 ,$178.01 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,472.64 ",$273.92 
ST. ELIZABETH'S HOSPITAL,35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$2,006.00 ","$1,303.90 ",$107.33 ,"$2,006.00 ",$268.33 ,$750.00 ,"$1,123.36 ",$107.33 ,$561.68 ,$708.12 ,$107.33 ,$826.47 ,$107.33 ,$904.71 ,$904.71 ,$107.33 ,$127.04 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,504.50 ","$1,203.60 ","$1,203.60 ",$107.33 ,"$1,203.60 ",$155.66 ,$155.66 ,$155.66 ,"$2,006.00 ", N/A ,"$1,705.10 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,006.00 ","$1,123.36 ",$107.33 ,$527.58 , N/A ,$146.41 ,$139.76 ,$112.70 ,"$1,604.80 ",$241.50 ,$904.71 ,$561.68 ,"$1,805.40 ",$107.33 ,$155.66 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,$962.88 ,$133.10 
ST. ELIZABETH'S HOSPITAL,35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,212.00 ","$1,437.80 ",$133.10 ,"$2,212.00 ",$440.25 ,$750.00 ,"$1,238.72 ",$176.10 ,$619.36 ,$780.84 ,$176.10 ,$911.34 ,$176.10 ,$997.61 ,$997.61 ,$176.10 ,$164.94 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,659.00 ","$1,327.20 ","$1,327.20 ",$176.10 ,"$1,327.20 ",$278.37 ,$278.37 ,$278.37 ,"$2,212.00 ", N/A ,"$1,880.20 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,212.00 ","$1,238.72 ",$176.10 ,$581.76 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$1,769.60 ",$396.23 ,$997.61 ,$619.36 ,"$1,990.80 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,061.76 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$2,409.00 ","$1,565.85 ",$133.10 ,"$2,409.00 ",$440.25 ,$750.00 ,"$1,349.04 ",$176.10 ,$674.52 ,$850.38 ,$176.10 ,$992.51 ,$176.10 ,"$1,086.46 ","$1,086.46 ",$176.10 ,$197.04 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,806.75 ","$1,445.40 ","$1,445.40 ",$176.10 ,"$1,445.40 ",$278.52 ,$278.52 ,$278.52 ,"$2,409.00 ", N/A ,"$2,047.65 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,409.00 ","$1,349.04 ",$176.10 ,$633.57 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$1,927.20 ",$396.23 ,"$1,086.46 ",$674.52 ,"$2,168.10 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,156.32 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$2,201.00 ","$1,430.65 ",$107.33 ,"$2,201.00 ",$268.33 ,$750.00 ,"$1,232.56 ",$107.33 ,$616.28 ,$776.95 ,$107.33 ,$906.81 ,$107.33 ,$992.65 ,$992.65 ,$107.33 ,$112.78 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,650.75 ","$1,320.60 ","$1,320.60 ",$107.33 ,"$1,320.60 ",$134.30 ,$134.30 ,$134.30 ,"$2,201.00 ", N/A ,"$1,870.85 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,201.00 ","$1,232.56 ",$107.33 ,$578.86 , N/A ,$146.41 ,$139.76 ,$112.70 ,"$1,760.80 ",$241.50 ,$992.65 ,$616.28 ,"$1,980.90 ",$107.33 ,$134.30 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,056.48 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,429.00 ","$1,578.85 ",$128.26 ,"$2,429.00 ",$440.25 ,$750.00 ,"$1,360.24 ",$176.10 ,$680.12 ,$857.44 ,$176.10 ,"$1,000.75 ",$176.10 ,"$1,095.48 ","$1,095.48 ",$176.10 ,$128.26 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,821.75 ","$1,457.40 ","$1,457.40 ",$176.10 ,"$1,457.40 ",$154.67 ,$154.67 ,$154.67 ,"$2,429.00 ", N/A ,"$2,064.65 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,429.00 ","$1,360.24 ",$176.10 ,$638.83 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$1,943.20 ",$396.23 ,"$1,095.48 ",$680.12 ,"$2,186.10 ",$176.10 ,$154.67 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,165.92 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,546.00 ","$1,654.90 ",$133.10 ,"$2,546.00 ",$440.25 ,$750.00 ,"$1,425.76 ",$176.10 ,$712.88 ,$898.74 ,$176.10 ,"$1,048.95 ",$176.10 ,"$1,148.25 ","$1,148.25 ",$176.10 ,$162.49 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,909.50 ","$1,527.60 ","$1,527.60 ",$176.10 ,"$1,527.60 ",$195.41 ,$195.41 ,$195.41 ,"$2,546.00 ", N/A ,"$2,164.10 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,546.00 ","$1,425.76 ",$176.10 ,$669.60 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$2,036.80 ",$396.23 ,"$1,148.25 ",$712.88 ,"$2,291.40 ",$176.10 ,$195.41 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,222.08 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$1,738.00 ","$1,129.70 ",$107.33 ,"$1,738.00 ",$268.33 ,$750.00 ,$973.28 ,$107.33 ,$486.64 ,$613.51 ,$107.33 ,$716.06 ,$107.33 ,$783.84 ,$783.84 ,$107.33 ,$116.45 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,303.50 ","$1,042.80 ","$1,042.80 ",$107.33 ,"$1,042.80 ",$139.76 ,$139.76 ,$139.76 ,"$1,738.00 ", N/A ,"$1,477.30 ",$268.33 ,"$1,319.00 ",$107.33 ,"$1,738.00 ",$973.28 ,$107.33 ,$457.09 , N/A ,$146.41 ,$139.76 ,$112.70 ,"$1,390.40 ",$241.50 ,$783.84 ,$486.64 ,"$1,564.20 ",$107.33 ,$139.76 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,$834.24 ,$133.10 
ST. ELIZABETH'S HOSPITAL,35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,463.00 ","$1,600.95 ",$133.10 ,"$2,463.00 ",$440.25 ,$750.00 ,"$1,379.28 ",$176.10 ,$689.64 ,$869.44 ,$176.10 ,"$1,014.76 ",$176.10 ,"$1,110.81 ","$1,110.81 ",$176.10 ,$155.16 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,847.25 ","$1,477.80 ","$1,477.80 ",$176.10 ,"$1,477.80 ",$185.96 ,$185.96 ,$185.96 ,"$2,463.00 ", N/A ,"$2,093.55 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,463.00 ","$1,379.28 ",$176.10 ,$647.77 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$1,970.40 ",$396.23 ,"$1,110.81 ",$689.64 ,"$2,216.70 ",$176.10 ,$185.96 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,182.24 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$2,567.00 ","$1,668.55 ",$133.10 ,"$2,567.00 ",$440.25 ,$750.00 ,"$1,437.52 ",$176.10 ,$718.76 ,$906.15 ,$176.10 ,"$1,057.60 ",$176.10 ,"$1,157.72 ","$1,157.72 ",$176.10 ,$189.70 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,925.25 ","$1,540.20 ","$1,540.20 ",$176.10 ,"$1,540.20 ",$227.69 ,$227.69 ,$227.69 ,"$2,567.00 ", N/A ,"$2,181.95 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,567.00 ","$1,437.52 ",$176.10 ,$675.12 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$2,053.60 ",$396.23 ,"$1,157.72 ",$718.76 ,"$2,310.30 ",$176.10 ,$227.69 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,232.16 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$3,068.00 ","$1,994.20 ",$176.10 ,"$3,068.00 ",$440.25 ,$750.00 ,"$1,718.08 ",$176.10 ,$859.04 ,"$1,083.00 ",$176.10 ,"$1,264.02 ",$176.10 ,"$1,383.67 ","$1,383.67 ",$176.10 ,$250.63 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,301.00 ","$1,840.80 ","$1,840.80 ",$176.10 ,"$1,840.80 ",$278.52 ,$278.52 ,$278.52 ,"$3,068.00 ", N/A ,"$2,607.80 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,068.00 ","$1,718.08 ",$176.10 ,$806.88 , N/A ,$385.90 ,$368.36 ,$184.91 ,"$2,454.40 ",$396.23 ,"$1,383.67 ",$859.04 ,"$2,761.20 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,472.64 ",$350.82 
ST. ELIZABETH'S HOSPITAL,35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$3,068.00 ","$1,994.20 ",$133.10 ,"$3,068.00 ",$440.25 ,$750.00 ,"$1,718.08 ",$176.10 ,$859.04 ,"$1,083.00 ",$176.10 ,"$1,264.02 ",$176.10 ,"$1,383.67 ","$1,383.67 ",$176.10 ,$250.23 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,301.00 ","$1,840.80 ","$1,840.80 ",$176.10 ,"$1,840.80 ",$278.52 ,$278.52 ,$278.52 ,"$3,068.00 ", N/A ,"$2,607.80 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,068.00 ","$1,718.08 ",$176.10 ,$806.88 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$2,454.40 ",$396.23 ,"$1,383.67 ",$859.04 ,"$2,761.20 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,472.64 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$2,561.00 ","$1,664.65 ",$214.15 ,"$2,561.00 ",$567.13 ,"$1,100.00 ","$1,434.16 ",$226.85 ,$717.08 ,$904.03 ,$226.85 ,"$1,055.13 ",$226.85 ,"$1,155.01 ","$1,155.01 ",$226.85 ,$214.15 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,920.75 ","$1,536.60 ","$1,536.60 ",$226.85 ,"$1,536.60 ",$276.38 ,$276.38 ,$276.38 ,"$2,561.00 ", N/A ,"$2,176.85 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,561.00 ","$1,434.16 ",$226.85 ,$673.54 , N/A ,$365.28 ,$348.67 ,$238.19 ,"$2,048.80 ",$510.41 ,"$1,155.01 ",$717.08 ,"$2,304.90 ",$226.85 ,$276.38 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,229.28 ",$332.07 
ST. ELIZABETH'S HOSPITAL,35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$2,992.00 ","$1,944.80 ",$107.08 ,"$2,992.00 ",$268.33 ,$750.00 ,"$1,675.52 ",$107.33 ,$837.76 ,"$1,056.18 ",$107.33 ,"$1,232.70 ",$107.33 ,"$1,349.39 ","$1,349.39 ",$107.33 ,$107.08 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$2,244.00 ","$1,795.20 ","$1,795.20 ",$107.33 ,"$1,795.20 ",$155.16 ,$155.16 ,$155.16 ,"$2,992.00 ", N/A ,"$2,543.20 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,992.00 ","$1,675.52 ",$107.33 ,$786.90 , N/A ,$166.19 ,$158.63 ,$112.70 ,"$2,393.60 ",$241.50 ,"$1,349.39 ",$837.76 ,"$2,692.80 ",$107.33 ,$155.16 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,436.16 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$3,199.00 ","$2,079.35 ",$144.15 ,"$3,199.00 ",$907.63 ,$750.00 ,"$1,791.44 ",$363.05 ,$895.72 ,"$1,129.25 ",$363.05 ,"$1,317.99 ",$363.05 ,"$1,442.75 ","$1,442.75 ",$363.05 ,$144.15 ,$689.79 ,"$1,049.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,399.25 ","$1,919.40 ","$1,919.40 ",$363.05 ,"$1,919.40 ",$231.66 ,$231.66 ,$231.66 ,"$3,199.00 ", N/A ,"$2,719.15 ",$907.62 ,"$1,319.00 ",$363.05 ,"$3,199.00 ","$1,791.44 ",$363.05 ,$841.34 , N/A ,$166.19 ,$158.63 ,$381.20 ,"$2,559.20 ",$816.86 ,"$1,442.75 ",$895.72 ,"$2,879.10 ",$363.05 ,$231.66 ,$900.00 ,$900.00 ,$363.05 ,$900.00 ,"$1,535.52 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000056,72127,HC CT C-SPINE W AND W/O CONTRAST,350,1 ,"$3,399.00 ","$2,209.35 ",$151.08 ,"$3,399.00 ",$440.25 ,$750.00 ,"$1,903.44 ",$176.10 ,$951.72 ,"$1,199.85 ",$176.10 ,"$1,400.39 ",$176.10 ,"$1,532.95 ","$1,532.95 ",$176.10 ,$179.10 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,549.25 ","$2,039.40 ","$2,039.40 ",$176.10 ,"$2,039.40 ",$278.37 ,$278.37 ,$278.37 ,"$3,399.00 ", N/A ,"$2,889.15 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,399.00 ","$1,903.44 ",$176.10 ,$893.94 , N/A ,$166.19 ,$158.63 ,$184.91 ,"$2,719.20 ",$396.23 ,"$1,532.95 ",$951.72 ,"$3,059.10 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,631.52 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$2,898.00 ","$1,883.70 ",$106.66 ,"$2,898.00 ",$268.33 ,$750.00 ,"$1,622.88 ",$107.33 ,$811.44 ,"$1,022.99 ",$107.33 ,"$1,193.98 ",$107.33 ,"$1,307.00 ","$1,307.00 ",$107.33 ,$106.66 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$2,173.50 ","$1,738.80 ","$1,738.80 ",$107.33 ,"$1,738.80 ",$155.16 ,$155.16 ,$155.16 ,"$2,898.00 ", N/A ,"$2,463.30 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,898.00 ","$1,622.88 ",$107.33 ,$762.17 , N/A ,$166.19 ,$158.63 ,$112.70 ,"$2,318.40 ",$241.50 ,"$1,307.00 ",$811.44 ,"$2,608.20 ",$107.33 ,$155.16 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,391.04 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$2,886.00 ","$1,875.90 ",$145.38 ,"$2,886.00 ",$440.25 ,$750.00 ,"$1,616.16 ",$176.10 ,$808.08 ,"$1,018.76 ",$176.10 ,"$1,189.03 ",$176.10 ,"$1,301.59 ","$1,301.59 ",$176.10 ,$145.38 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,164.50 ","$1,731.60 ","$1,731.60 ",$176.10 ,"$1,731.60 ",$233.66 ,$233.66 ,$233.66 ,"$2,886.00 ", N/A ,"$2,453.10 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,886.00 ","$1,616.16 ",$176.10 ,$759.02 , N/A ,$166.19 ,$158.63 ,$184.91 ,"$2,308.80 ",$396.23 ,"$1,301.59 ",$808.08 ,"$2,597.40 ",$176.10 ,$233.66 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,385.28 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$3,338.00 ","$2,169.70 ",$151.08 ,"$3,338.00 ",$440.25 ,$750.00 ,"$1,869.28 ",$176.10 ,$934.64 ,"$1,178.31 ",$176.10 ,"$1,375.26 ",$176.10 ,"$1,505.44 ","$1,505.44 ",$176.10 ,$180.33 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,503.50 ","$2,002.80 ","$2,002.80 ",$176.10 ,"$2,002.80 ",$278.37 ,$278.37 ,$278.37 ,"$3,338.00 ", N/A ,"$2,837.30 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,338.00 ","$1,869.28 ",$176.10 ,$877.89 , N/A ,$166.19 ,$158.63 ,$184.91 ,"$2,670.40 ",$396.23 ,"$1,505.44 ",$934.64 ,"$3,004.20 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,602.24 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$2,898.00 ","$1,883.70 ",$106.26 ,"$2,898.00 ",$268.33 ,$750.00 ,"$1,622.88 ",$107.33 ,$811.44 ,"$1,022.99 ",$107.33 ,"$1,193.98 ",$107.33 ,"$1,307.00 ","$1,307.00 ",$107.33 ,$106.26 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$2,173.50 ","$1,738.80 ","$1,738.80 ",$107.33 ,"$1,738.80 ",$155.16 ,$155.16 ,$155.16 ,"$2,898.00 ", N/A ,"$2,463.30 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,898.00 ","$1,622.88 ",$107.33 ,$762.17 , N/A ,$166.19 ,$158.63 ,$112.70 ,"$2,318.40 ",$241.50 ,"$1,307.00 ",$811.44 ,"$2,608.20 ",$107.33 ,$155.16 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,391.04 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$3,142.00 ","$2,042.30 ",$144.15 ,"$3,142.00 ",$907.63 ,$750.00 ,"$1,759.52 ",$363.05 ,$879.76 ,"$1,109.13 ",$363.05 ,"$1,294.50 ",$363.05 ,"$1,417.04 ","$1,417.04 ",$363.05 ,$144.15 ,$689.79 ,"$1,049.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,356.50 ","$1,885.20 ","$1,885.20 ",$363.05 ,"$1,885.20 ",$232.16 ,$232.16 ,$232.16 ,"$3,142.00 ", N/A ,"$2,670.70 ",$907.62 ,"$1,319.00 ",$363.05 ,"$3,142.00 ","$1,759.52 ",$363.05 ,$826.35 , N/A ,$166.19 ,$158.63 ,$381.20 ,"$2,513.60 ",$816.86 ,"$1,417.04 ",$879.76 ,"$2,827.80 ",$363.05 ,$232.16 ,$900.00 ,$900.00 ,$363.05 ,$900.00 ,"$1,508.16 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$3,338.00 ","$2,169.70 ",$151.08 ,"$3,338.00 ",$440.25 ,$750.00 ,"$1,869.28 ",$176.10 ,$934.64 ,"$1,178.31 ",$176.10 ,"$1,375.26 ",$176.10 ,"$1,505.44 ","$1,505.44 ",$176.10 ,$178.70 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,503.50 ","$2,002.80 ","$2,002.80 ",$176.10 ,"$2,002.80 ",$278.37 ,$278.37 ,$278.37 ,"$3,338.00 ", N/A ,"$2,837.30 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,338.00 ","$1,869.28 ",$176.10 ,$877.89 , N/A ,$166.19 ,$158.63 ,$184.91 ,"$2,670.40 ",$396.23 ,"$1,505.44 ",$934.64 ,"$3,004.20 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,602.24 ",$151.08 
ST. ELIZABETH'S HOSPITAL,35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$3,275.00 ","$2,128.75 ",$176.10 ,"$3,275.00 ",$440.25 ,$750.00 ,"$1,834.00 ",$176.10 ,$917.00 ,"$1,156.08 ",$176.10 ,"$1,349.30 ",$176.10 ,"$1,477.03 ","$1,477.03 ",$176.10 ,$287.90 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,456.25 ","$1,965.00 ","$1,965.00 ",$176.10 ,"$1,965.00 ",$278.52 ,$278.52 ,$278.52 ,"$3,275.00 ", N/A ,"$2,783.75 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,275.00 ","$1,834.00 ",$176.10 ,$861.33 , N/A ,$330.88 ,$315.84 ,$184.91 ,"$2,620.00 ",$396.23 ,"$1,477.03 ",$917.00 ,"$2,947.50 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,572.00 ",$300.80 
ST. ELIZABETH'S HOSPITAL,35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$2,350.00 ","$1,527.50 ",$105.85 ,"$2,350.00 ",$268.33 ,$750.00 ,"$1,316.00 ",$107.33 ,$658.00 ,$829.55 ,$107.33 ,$968.20 ,$107.33 ,"$1,059.85 ","$1,059.85 ",$107.33 ,$105.85 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,762.50 ","$1,410.00 ","$1,410.00 ",$107.33 ,"$1,410.00 ",$126.84 ,$126.84 ,$126.84 ,"$2,350.00 ", N/A ,"$1,997.50 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,350.00 ","$1,316.00 ",$107.33 ,$618.05 , N/A ,$331.21 ,$316.16 ,$112.70 ,"$1,880.00 ",$241.50 ,"$1,059.85 ",$658.00 ,"$2,115.00 ",$107.33 ,$126.84 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,128.00 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,586.00 ","$1,680.90 ",$176.10 ,"$2,586.00 ",$440.25 ,$750.00 ,"$1,448.16 ",$176.10 ,$724.08 ,$912.86 ,$176.10 ,"$1,065.43 ",$176.10 ,"$1,166.29 ","$1,166.29 ",$176.10 ,$230.14 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,939.50 ","$1,551.60 ","$1,551.60 ",$176.10 ,"$1,551.60 ",$245.09 ,$245.09 ,$245.09 ,"$2,586.00 ", N/A ,"$2,198.10 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,586.00 ","$1,448.16 ",$176.10 ,$680.12 , N/A ,$331.21 ,$316.16 ,$184.91 ,"$2,068.80 ",$396.23 ,"$1,166.29 ",$724.08 ,"$2,327.40 ",$176.10 ,$245.09 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,241.28 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$3,275.00 ","$2,128.75 ",$176.10 ,"$3,275.00 ",$440.25 ,$750.00 ,"$1,834.00 ",$176.10 ,$917.00 ,"$1,156.08 ",$176.10 ,"$1,349.30 ",$176.10 ,"$1,477.03 ","$1,477.03 ",$176.10 ,$257.34 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,456.25 ","$1,965.00 ","$1,965.00 ",$176.10 ,"$1,965.00 ",$278.37 ,$278.37 ,$278.37 ,"$3,275.00 ", N/A ,"$2,783.75 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,275.00 ","$1,834.00 ",$176.10 ,$861.33 , N/A ,$331.21 ,$316.16 ,$184.91 ,"$2,620.00 ",$396.23 ,"$1,477.03 ",$917.00 ,"$2,947.50 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,572.00 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,706.00 ","$1,108.90 ",$107.33 ,"$1,706.00 ",$268.33 ,$750.00 ,$955.36 ,$107.33 ,$477.68 ,$602.22 ,$107.33 ,$702.87 ,$107.33 ,$769.41 ,$769.41 ,$107.33 ,$149.86 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,279.50 ","$1,023.60 ","$1,023.60 ",$107.33 ,"$1,023.60 ",$155.16 ,$155.16 ,$155.16 ,"$1,706.00 ", N/A ,"$1,450.10 ",$268.33 ,"$1,319.00 ",$107.33 ,"$1,706.00 ",$955.36 ,$107.33 ,$448.68 , N/A ,$146.41 ,$139.76 ,$112.70 ,"$1,364.80 ",$241.50 ,$769.41 ,$477.68 ,"$1,535.40 ",$107.33 ,$155.16 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,$818.88 ,$133.10 
ST. ELIZABETH'S HOSPITAL,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$2,420.00 ","$1,573.00 ",$149.86 ,"$2,420.00 ",$552.78 ,$750.00 ,"$1,355.20 ",$221.11 ,$677.60 ,$854.26 ,$221.11 ,$997.04 ,$221.11 ,"$1,091.42 ","$1,091.42 ",$221.11 ,$149.86 ,$420.10 ,"$1,049.00 ",$552.77 ,$221.11 ,$221.11 ,$225.53 ,"$1,815.00 ","$1,452.00 ","$1,452.00 ",$221.11 ,"$1,452.00 ",$155.16 ,$155.16 ,$155.16 ,"$2,420.00 ", N/A ,"$2,057.00 ",$552.77 ,"$1,319.00 ",$221.11 ,"$2,420.00 ","$1,355.20 ",$221.11 ,$636.46 , N/A ,$219.62 ,$209.63 ,$232.17 ,"$1,936.00 ",$497.49 ,"$1,091.42 ",$677.60 ,"$2,178.00 ",$221.11 ,$155.16 ,$900.00 ,$900.00 ,$221.11 ,$900.00 ,"$1,161.60 ",$199.65 
ST. ELIZABETH'S HOSPITAL,35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,161.00 ","$1,404.65 ",$133.10 ,"$2,161.00 ",$907.63 ,$750.00 ,"$1,210.16 ",$363.05 ,$605.08 ,$762.83 ,$363.05 ,$890.33 ,$363.05 ,$974.61 ,$974.61 ,$363.05 ,$190.61 ,$689.79 ,"$1,049.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,620.75 ","$1,296.60 ","$1,296.60 ",$363.05 ,"$1,296.60 ",$229.68 ,$229.68 ,$229.68 ,"$2,161.00 ", N/A ,"$1,836.85 ",$907.62 ,"$1,319.00 ",$363.05 ,"$2,161.00 ","$1,210.16 ",$363.05 ,$568.34 , N/A ,$146.41 ,$139.76 ,$381.20 ,"$1,728.80 ",$816.86 ,$974.61 ,$605.08 ,"$1,944.90 ",$363.05 ,$229.68 ,$900.00 ,$900.00 ,$363.05 ,$900.00 ,"$1,037.28 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$2,905.00 ","$1,888.25 ",$199.65 ,"$2,905.00 ","$1,072.85 ",$750.00 ,"$1,626.80 ",$429.14 ,$813.40 ,"$1,025.47 ",$429.14 ,"$1,196.86 ",$429.14 ,"$1,310.16 ","$1,310.16 ",$429.14 ,$252.04 ,$815.37 ,"$1,049.00 ","$1,072.86 ",$429.14 ,$429.14 ,$437.73 ,"$2,178.75 ","$1,743.00 ","$1,743.00 ",$429.14 ,"$1,743.00 ",$278.37 ,$278.37 ,$278.37 ,"$2,905.00 ", N/A ,"$2,469.25 ","$1,072.86 ","$1,319.00 ",$429.14 ,"$2,905.00 ","$1,626.80 ",$429.14 ,$764.02 , N/A ,$219.62 ,$209.63 ,$450.60 ,"$2,324.00 ",$965.57 ,"$1,310.16 ",$813.40 ,"$2,614.50 ",$429.14 ,$278.37 ,$900.00 ,$900.00 ,$429.14 ,$900.00 ,"$1,394.40 ",$199.65 
ST. ELIZABETH'S HOSPITAL,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$2,388.00 ","$1,552.20 ",$133.10 ,"$2,388.00 ",$440.25 ,$750.00 ,"$1,337.28 ",$176.10 ,$668.64 ,$842.96 ,$176.10 ,$983.86 ,$176.10 ,"$1,076.99 ","$1,076.99 ",$176.10 ,$252.04 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,791.00 ","$1,432.80 ","$1,432.80 ",$176.10 ,"$1,432.80 ",$278.37 ,$278.37 ,$278.37 ,"$2,388.00 ", N/A ,"$2,029.80 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,388.00 ","$1,337.28 ",$176.10 ,$628.04 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$1,910.40 ",$396.23 ,"$1,076.99 ",$668.64 ,"$2,149.20 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,146.24 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$3,388.00 ","$2,202.20 ",$176.10 ,"$3,388.00 ",$440.25 ,$750.00 ,"$1,897.28 ",$176.10 ,$948.64 ,"$1,195.96 ",$176.10 ,"$1,395.86 ",$176.10 ,"$1,527.99 ","$1,527.99 ",$176.10 ,$278.74 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,541.00 ","$2,032.80 ","$2,032.80 ",$176.10 ,"$2,032.80 ",$278.52 ,$278.52 ,$278.52 ,"$3,388.00 ", N/A ,"$2,879.80 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,388.00 ","$1,897.28 ",$176.10 ,$891.04 , N/A ,$330.88 ,$315.84 ,$184.91 ,"$2,710.40 ",$396.23 ,"$1,527.99 ",$948.64 ,"$3,049.20 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,626.24 ",$300.80 
ST. ELIZABETH'S HOSPITAL,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$2,301.00 ","$1,495.65 ",$106.26 ,"$2,301.00 ",$552.78 ,$750.00 ,"$1,288.56 ",$221.11 ,$644.28 ,$812.25 ,$221.11 ,$948.01 ,$221.11 ,"$1,037.75 ","$1,037.75 ",$221.11 ,$106.26 ,$420.10 ,"$1,049.00 ",$552.77 ,$221.11 ,$221.11 ,$225.53 ,"$1,725.75 ","$1,380.60 ","$1,380.60 ",$221.11 ,"$1,380.60 ",$155.16 ,$155.16 ,$155.16 ,"$2,301.00 ", N/A ,"$1,955.85 ",$552.77 ,"$1,319.00 ",$221.11 ,"$2,301.00 ","$1,288.56 ",$221.11 ,$605.16 , N/A ,$219.62 ,$209.63 ,$232.17 ,"$1,840.80 ",$497.49 ,"$1,037.75 ",$644.28 ,"$2,070.90 ",$221.11 ,$155.16 ,$900.00 ,$900.00 ,$221.11 ,$900.00 ,"$1,104.48 ",$199.65 
ST. ELIZABETH'S HOSPITAL,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,622.00 ","$1,054.30 ",$106.26 ,"$1,622.00 ",$268.33 ,$750.00 ,$908.32 ,$107.33 ,$454.16 ,$572.57 ,$107.33 ,$668.26 ,$107.33 ,$731.52 ,$731.52 ,$107.33 ,$106.26 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,216.50 ",$973.20 ,$973.20 ,$107.33 ,$973.20 ,$155.16 ,$155.16 ,$155.16 ,"$1,622.00 ", N/A ,"$1,378.70 ",$268.33 ,"$1,319.00 ",$107.33 ,"$1,622.00 ",$908.32 ,$107.33 ,$426.59 , N/A ,$146.41 ,$139.76 ,$112.70 ,"$1,297.60 ",$241.50 ,$731.52 ,$454.16 ,"$1,459.80 ",$107.33 ,$155.16 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,$778.56 ,$133.10 
ST. ELIZABETH'S HOSPITAL,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$1,820.00 ","$1,183.00 ",$133.10 ,"$1,820.00 ",$440.25 ,$750.00 ,"$1,019.20 ",$176.10 ,$509.60 ,$642.46 ,$176.10 ,$749.84 ,$176.10 ,$820.82 ,$820.82 ,$176.10 ,$144.98 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,365.00 ","$1,092.00 ","$1,092.00 ",$176.10 ,"$1,092.00 ",$233.66 ,$233.66 ,$233.66 ,"$1,820.00 ", N/A ,"$1,547.00 ",$440.26 ,"$1,319.00 ",$176.10 ,"$1,820.00 ","$1,019.20 ",$176.10 ,$478.66 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$1,456.00 ",$396.23 ,$820.82 ,$509.60 ,"$1,638.00 ",$176.10 ,$233.66 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,$873.60 ,$133.10 
ST. ELIZABETH'S HOSPITAL,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,582.00 ","$1,678.30 ",$144.98 ,"$2,582.00 ","$1,072.85 ",$750.00 ,"$1,445.92 ",$429.14 ,$722.96 ,$911.45 ,$429.14 ,"$1,063.78 ",$429.14 ,"$1,164.48 ","$1,164.48 ",$429.14 ,$144.98 ,$815.37 ,"$1,049.00 ","$1,072.86 ",$429.14 ,$429.14 ,$437.73 ,"$1,936.50 ","$1,549.20 ","$1,549.20 ",$429.14 ,"$1,549.20 ",$233.66 ,$233.66 ,$233.66 ,"$2,582.00 ", N/A ,"$2,194.70 ","$1,072.86 ","$1,319.00 ",$429.14 ,"$2,582.00 ","$1,445.92 ",$429.14 ,$679.07 , N/A ,$219.62 ,$209.63 ,$450.60 ,"$2,065.60 ",$965.57 ,"$1,164.48 ",$722.96 ,"$2,323.80 ",$429.14 ,$233.66 ,$900.00 ,$900.00 ,$429.14 ,$900.00 ,"$1,239.36 ",$199.65 
ST. ELIZABETH'S HOSPITAL,35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$3,226.00 ","$2,096.90 ",$178.29 ,"$3,226.00 ","$1,072.85 ",$750.00 ,"$1,806.56 ",$429.14 ,$903.28 ,"$1,138.78 ",$429.14 ,"$1,329.11 ",$429.14 ,"$1,454.93 ","$1,454.93 ",$429.14 ,$178.29 ,$815.37 ,"$1,049.00 ","$1,072.86 ",$429.14 ,$429.14 ,$437.73 ,"$2,419.50 ","$1,935.60 ","$1,935.60 ",$429.14 ,"$1,935.60 ",$278.37 ,$278.37 ,$278.37 ,"$3,226.00 ", N/A ,"$2,742.10 ","$1,072.86 ","$1,319.00 ",$429.14 ,"$3,226.00 ","$1,806.56 ",$429.14 ,$848.44 , N/A ,$219.62 ,$209.63 ,$450.60 ,"$2,580.80 ",$965.57 ,"$1,454.93 ",$903.28 ,"$2,903.40 ",$429.14 ,$278.37 ,$900.00 ,$900.00 ,$429.14 ,$900.00 ,"$1,548.48 ",$199.65 
ST. ELIZABETH'S HOSPITAL,35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,274.00 ","$1,478.10 ",$133.10 ,"$2,274.00 ",$440.25 ,$750.00 ,"$1,273.44 ",$176.10 ,$636.72 ,$802.72 ,$176.10 ,$936.89 ,$176.10 ,"$1,025.57 ","$1,025.57 ",$176.10 ,$178.29 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,705.50 ","$1,364.40 ","$1,364.40 ",$176.10 ,"$1,364.40 ",$278.37 ,$278.37 ,$278.37 ,"$2,274.00 ", N/A ,"$1,932.90 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,274.00 ","$1,273.44 ",$176.10 ,$598.06 , N/A ,$146.41 ,$139.76 ,$184.91 ,"$1,819.20 ",$396.23 ,"$1,025.57 ",$636.72 ,"$2,046.60 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,091.52 ",$133.10 
ST. ELIZABETH'S HOSPITAL,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$2,536.00 ","$1,648.40 ",$176.10 ,"$2,536.00 ",$440.25 ,$750.00 ,"$1,420.16 ",$176.10 ,$710.08 ,$895.21 ,$176.10 ,"$1,044.83 ",$176.10 ,"$1,143.74 ","$1,143.74 ",$176.10 ,$306.05 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,902.00 ","$1,521.60 ","$1,521.60 ",$176.10 ,"$1,521.60 ",$278.03 ,$278.03 ,$278.03 ,"$2,536.00 ", N/A ,"$2,155.60 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,536.00 ","$1,420.16 ",$176.10 ,$666.97 , N/A ,$330.88 ,$315.84 ,$184.91 ,"$2,028.80 ",$396.23 ,"$1,143.74 ",$710.08 ,"$2,282.40 ",$176.10 ,$278.03 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,217.28 ",$300.80 
ST. ELIZABETH'S HOSPITAL,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$3,599.00 ","$2,339.35 ",$278.03 ,"$3,599.00 ","$1,072.85 ",$750.00 ,"$2,015.44 ",$429.14 ,"$1,007.72 ","$1,270.45 ",$429.14 ,"$1,482.79 ",$429.14 ,"$1,623.15 ","$1,623.15 ",$429.14 ,$306.05 ,$815.37 ,"$1,049.00 ","$1,072.86 ",$429.14 ,$429.14 ,$437.73 ,"$2,699.25 ","$2,159.40 ","$2,159.40 ",$429.14 ,"$2,159.40 ",$278.03 ,$278.03 ,$278.03 ,"$3,599.00 ", N/A ,"$3,059.15 ","$1,072.86 ","$1,319.00 ",$429.14 ,"$3,599.00 ","$2,015.44 ",$429.14 ,$946.54 , N/A ,$496.32 ,$473.76 ,$450.60 ,"$2,879.20 ",$965.57 ,"$1,623.15 ","$1,007.72 ","$3,239.10 ",$429.14 ,$278.03 ,$900.00 ,$900.00 ,$429.14 ,$900.00 ,"$1,727.52 ",$451.20 
ST. ELIZABETH'S HOSPITAL,35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$2,350.00 ","$1,527.50 ",$104.63 ,"$2,350.00 ",$268.33 ,$750.00 ,"$1,316.00 ",$107.33 ,$658.00 ,$829.55 ,$107.33 ,$968.20 ,$107.33 ,"$1,059.85 ","$1,059.85 ",$107.33 ,$104.63 ,$203.93 ,"$1,049.00 ",$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,762.50 ","$1,410.00 ","$1,410.00 ",$107.33 ,"$1,410.00 ",$125.36 ,$125.36 ,$125.36 ,"$2,350.00 ", N/A ,"$1,997.50 ",$268.33 ,"$1,319.00 ",$107.33 ,"$2,350.00 ","$1,316.00 ",$107.33 ,$618.05 , N/A ,$331.21 ,$316.16 ,$112.70 ,"$1,880.00 ",$241.50 ,"$1,059.85 ",$658.00 ,"$2,115.00 ",$107.33 ,$125.36 ,$900.00 ,$900.00 ,$107.33 ,$900.00 ,"$1,128.00 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$2,318.00 ","$1,506.70 ",$176.10 ,"$2,318.00 ",$440.25 ,$750.00 ,"$1,298.08 ",$176.10 ,$649.04 ,$818.25 ,$176.10 ,$955.02 ,$176.10 ,"$1,045.42 ","$1,045.42 ",$176.10 ,$229.33 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,738.50 ","$1,390.80 ","$1,390.80 ",$176.10 ,"$1,390.80 ",$244.08 ,$244.08 ,$244.08 ,"$2,318.00 ", N/A ,"$1,970.30 ",$440.26 ,"$1,319.00 ",$176.10 ,"$2,318.00 ","$1,298.08 ",$176.10 ,$609.63 , N/A ,$331.21 ,$316.16 ,$184.91 ,"$1,854.40 ",$396.23 ,"$1,045.42 ",$649.04 ,"$2,086.20 ",$176.10 ,$244.08 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,112.64 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,275.00 ","$2,128.75 ",$176.10 ,"$3,275.00 ",$440.25 ,$750.00 ,"$1,834.00 ",$176.10 ,$917.00 ,"$1,156.08 ",$176.10 ,"$1,349.30 ",$176.10 ,"$1,477.03 ","$1,477.03 ",$176.10 ,$258.56 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,456.25 ","$1,965.00 ","$1,965.00 ",$176.10 ,"$1,965.00 ",$278.37 ,$278.37 ,$278.37 ,"$3,275.00 ", N/A ,"$2,783.75 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,275.00 ","$1,834.00 ",$176.10 ,$861.33 , N/A ,$331.21 ,$316.16 ,$184.91 ,"$2,620.00 ",$396.23 ,"$1,477.03 ",$917.00 ,"$2,947.50 ",$176.10 ,$278.37 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,572.00 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,374.00 ","$2,193.10 ",$176.10 ,"$3,374.00 ",$440.25 ,$750.00 ,"$1,889.44 ",$176.10 ,$944.72 ,"$1,191.02 ",$176.10 ,"$1,390.09 ",$176.10 ,"$1,521.67 ","$1,521.67 ",$176.10 ,$287.49 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$2,530.50 ","$2,024.40 ","$2,024.40 ",$176.10 ,"$2,024.40 ",$278.52 ,$278.52 ,$278.52 ,"$3,374.00 ", N/A ,"$2,867.90 ",$440.26 ,"$1,319.00 ",$176.10 ,"$3,374.00 ","$1,889.44 ",$176.10 ,$887.36 , N/A ,$330.88 ,$315.84 ,$184.91 ,"$2,699.20 ",$396.23 ,"$1,521.67 ",$944.72 ,"$3,036.60 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,"$1,619.52 ",$300.80 
ST. ELIZABETH'S HOSPITAL,35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$4,591.00 ","$2,984.15 ",$131.11 ,"$4,591.00 ",$567.13 ,$750.00 ,"$2,570.96 ",$226.85 ,"$1,285.48 ","$1,597.00 ",$226.85 ,"$1,597.00 ",$226.85 ,"$2,070.54 ","$2,070.54 ",$226.85 ,$131.11 ,$431.02 ,"$1,049.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$3,443.25 ","$2,754.60 ","$2,754.60 ",$226.85 ,"$2,754.60 ",$157.64 ,$157.64 ,$157.64 ,"$4,591.00 ", N/A ,"$3,902.35 ",$567.13 ,"$1,319.00 ",$226.85 ,"$4,591.00 ","$2,570.96 ",$226.85 ,"$1,207.43 ", N/A ,$331.21 ,$316.16 ,$238.19 ,"$3,672.80 ",$510.41 ,"$2,070.54 ","$1,285.48 ","$4,131.90 ",$226.85 ,$157.64 ,$900.00 ,$900.00 ,$226.85 ,$900.00 ,"$2,203.68 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$4,753.00 ","$3,089.45 ",$288.31 ,"$4,753.00 ",$907.63 ,$750.00 ,"$2,661.68 ",$363.05 ,"$1,330.84 ","$1,677.81 ",$363.05 ,"$1,958.24 ",$363.05 ,"$2,143.60 ","$2,143.60 ",$363.05 ,$288.31 ,$689.79 ,"$1,049.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,564.75 ","$2,851.80 ","$2,851.80 ",$363.05 ,"$2,851.80 ",$317.61 ,$317.61 ,$317.61 ,"$4,753.00 ", N/A ,"$4,040.05 ",$907.62 ,"$1,319.00 ",$363.05 ,"$4,753.00 ","$2,661.68 ",$363.05 ,"$1,250.04 ", N/A ,$331.21 ,$316.16 ,$381.20 ,"$3,802.40 ",$816.86 ,"$2,143.60 ","$1,330.84 ","$4,277.70 ",$363.05 ,$317.61 ,$900.00 ,$900.00 ,$363.05 ,$900.00 ,"$2,281.44 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$6,551.00 ","$4,258.15 ",$301.10 ,"$6,551.00 ",$907.63 ,$750.00 ,"$3,668.56 ",$363.05 ,"$1,834.28 ","$2,312.50 ",$363.05 ,"$2,699.01 ",$363.05 ,"$2,954.50 ","$2,954.50 ",$363.05 ,$324.99 ,$689.79 ,"$1,049.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$4,913.25 ","$3,930.60 ","$3,930.60 ",$363.05 ,"$3,930.60 ",$362.97 ,$362.97 ,$362.97 ,"$6,551.00 ", N/A ,"$5,568.35 ",$907.62 ,"$1,319.00 ",$363.05 ,"$6,551.00 ","$3,668.56 ",$363.05 ,"$1,722.91 ", N/A ,$331.21 ,$316.16 ,$381.20 ,"$5,240.80 ",$816.86 ,"$2,954.50 ","$1,834.28 ","$5,895.90 ",$363.05 ,$362.97 ,$900.00 ,$900.00 ,$363.05 ,$900.00 ,"$3,144.48 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,$99.00 ,$64.35 ,$26.04 ,$199.38 ,$199.38 ,$99.00 ,$55.44 ,$79.75 ,$27.72 ,$34.95 ,$79.75 ,$40.79 ,$79.75 ,$44.65 ,$44.65 ,$79.75 ,$91.59 ,$99.00 ,$99.00 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$74.25 ,$59.40 ,$59.40 ,$79.75 ,$59.40 ,$86.10 ,$86.10 ,$86.10 ,$99.00 , N/A ,$84.15 ,$99.00 ,$99.00 ,$79.75 ,$99.00 ,$55.44 ,$79.75 ,$26.04 , N/A , N/A , N/A ,$83.74 ,$79.20 ,$179.43 ,$44.65 ,$27.72 ,$89.10 ,$79.75 ,$86.10 ,$99.00 ,$99.00 ,$79.75 ,$99.00 ,$47.52 , N/A 
ST. ELIZABETH'S HOSPITAL,35000089,75572,HC CT HEART WO/W CONT FUNCT EVAL,350,1 ,$715.00 ,$464.75 ,$176.10 ,$715.00 ,$440.25 ,$715.00 ,$400.40 ,$176.10 ,$200.20 ,$252.40 ,$176.10 ,$294.58 ,$176.10 ,$322.47 ,$322.47 ,$176.10 ,$188.28 ,$334.60 ,$715.00 ,$440.26 ,$176.10 ,$176.10 ,$179.63 ,$536.25 ,$429.00 ,$429.00 ,$176.10 ,$429.00 ,$251.19 ,$251.19 ,$251.19 ,$715.00 , N/A ,$607.75 ,$440.26 ,$715.00 ,$176.10 ,$715.00 ,$400.40 ,$176.10 ,$188.05 , N/A , N/A , N/A ,$184.91 ,$572.00 ,$396.23 ,$322.47 ,$200.20 ,$643.50 ,$176.10 ,$251.19 ,$715.00 ,$715.00 ,$176.10 ,$715.00 ,$343.20 , N/A 
ST. ELIZABETH'S HOSPITAL,35000094,75574,HC CTA HEART CORONARY W/CONTRAST 3D POST,350,1 ,"$1,756.00 ","$1,141.40 ",$176.10 ,"$1,756.00 ",$440.25 ,$750.00 ,$983.36 ,$176.10 ,$491.68 ,$619.87 ,$176.10 ,$723.47 ,$176.10 ,$791.96 ,$791.96 ,$176.10 ,$274.66 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,317.00 ","$1,053.60 ","$1,053.60 ",$176.10 ,"$1,053.60 ",$278.52 ,$278.52 ,$278.52 ,"$1,756.00 ", N/A ,"$1,492.60 ",$440.26 ,"$1,319.00 ",$176.10 ,"$1,756.00 ",$983.36 ,$176.10 ,$461.83 , N/A , N/A , N/A ,$184.91 ,"$1,404.80 ",$396.23 ,$791.96 ,$491.68 ,"$1,580.40 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,$842.88 , N/A 
ST. ELIZABETH'S HOSPITAL,35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$1,744.00 ","$1,133.60 ",$176.10 ,"$1,744.00 ",$440.25 ,$750.00 ,$976.64 ,$176.10 ,$488.32 ,$615.63 ,$176.10 ,$718.53 ,$176.10 ,$786.54 ,$786.54 ,$176.10 ,$385.50 ,$334.60 ,"$1,049.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,308.00 ","$1,046.40 ","$1,046.40 ",$176.10 ,"$1,046.40 ",$278.52 ,$278.52 ,$278.52 ,"$1,744.00 ", N/A ,"$1,482.40 ",$440.26 ,"$1,319.00 ",$176.10 ,"$1,744.00 ",$976.64 ,$176.10 ,$458.67 , N/A ,$330.88 ,$315.84 ,$184.91 ,"$1,395.20 ",$396.23 ,$786.54 ,$488.32 ,"$1,569.60 ",$176.10 ,$278.52 ,$900.00 ,$900.00 ,$176.10 ,$900.00 ,$837.12 ,$300.80 
ST. ELIZABETH'S HOSPITAL,35000099,76376,HC 3D RENDER CT NOT REQUIRE INDEP,350,1 ,$912.00 ,$592.80 ,$16.61 ,$912.00 , N/A ,$419.52 ,$510.72 , N/A ,$255.36 ,$193.41 , N/A ,$193.41 , N/A ,$411.31 ,$411.31 , N/A ,$16.61 , N/A ,$912.00 , N/A , N/A , N/A , N/A ,$684.00 ,$547.20 ,$547.20 , N/A ,$547.20 ,$18.54 ,$18.54 ,$18.54 ,$912.00 , N/A ,$775.20 , N/A ,$912.00 , N/A ,$912.00 ,$510.72 , N/A ,$239.86 , N/A , N/A , N/A , N/A ,$729.60 , N/A ,$411.31 ,$255.36 ,$820.80 , N/A ,$18.54 ,$900.00 ,$900.00 , N/A ,$900.00 ,$437.76 , N/A 
ST. ELIZABETH'S HOSPITAL,35000100,76377,HC 3D RENDER CT REQUIRES INDEPENDENT,350,1 ,$836.00 ,$543.40 ,$41.88 ,$836.00 , N/A ,$384.56 ,$468.16 , N/A ,$234.08 ,$295.11 , N/A ,$344.43 , N/A ,$377.04 ,$377.04 , N/A ,$41.88 , N/A ,$836.00 , N/A , N/A , N/A , N/A ,$627.00 ,$501.60 ,$501.60 , N/A ,$501.60 ,$43.88 ,$43.88 ,$43.88 ,$836.00 , N/A ,$710.60 , N/A ,$836.00 , N/A ,$836.00 ,$468.16 , N/A ,$219.87 , N/A , N/A , N/A , N/A ,$668.80 , N/A ,$377.04 ,$234.08 ,$752.40 , N/A ,$43.88 ,$836.00 ,$836.00 , N/A ,$836.00 ,$401.28 , N/A 
ST. ELIZABETH'S HOSPITAL,35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,"$2,023.00 ","$1,314.95 ",$79.75 ,"$2,023.00 ",$199.38 ,$750.00 ,"$1,132.88 ",$79.75 ,$566.44 ,$714.12 ,$79.75 ,$833.48 ,$79.75 ,$912.37 ,$912.37 ,$79.75 ,$112.38 ,$151.52 ,"$1,049.00 ",$199.36 ,$79.75 ,$79.75 ,$81.34 ,"$1,517.25 ","$1,213.80 ","$1,213.80 ",$79.75 ,"$1,213.80 ",$86.10 ,$86.10 ,$86.10 ,"$2,023.00 ", N/A ,"$1,719.55 ",$199.36 ,"$1,319.00 ",$79.75 ,"$2,023.00 ","$1,132.88 ",$79.75 ,$532.05 , N/A ,$146.41 ,$139.76 ,$83.74 ,"$1,618.40 ",$179.43 ,$912.37 ,$566.44 ,"$1,820.70 ",$79.75 ,$86.10 ,$900.00 ,$900.00 ,$79.75 ,$900.00 ,$971.04 ,$133.10 
ST. ELIZABETH'S HOSPITAL,35000104,77011,HC CT GUIDED LOCALIZATION STEREO,350,1 ,"$1,986.00 ","$1,290.90 ",$102.66 ,"$1,986.00 ", N/A ,$750.00 ,"$1,112.16 ", N/A ,$556.08 ,$701.06 , N/A ,$818.23 , N/A ,$895.69 ,$895.69 , N/A ,$202.01 , N/A ,"$1,049.00 ", N/A , N/A , N/A , N/A ,"$1,489.50 ","$1,191.60 ","$1,191.60 ", N/A ,"$1,191.60 ",$232.67 ,$232.67 ,$232.67 ,"$1,986.00 ", N/A ,"$1,688.10 ", N/A ,"$1,319.00 ", N/A ,"$1,986.00 ","$1,112.16 ", N/A ,$522.32 , N/A ,$112.93 ,$107.79 , N/A ,"$1,588.80 ", N/A ,$895.69 ,$556.08 ,"$1,787.40 ", N/A ,$232.67 ,$900.00 ,$900.00 , N/A ,$900.00 ,$953.28 ,$102.66 
ST. ELIZABETH'S HOSPITAL,35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$1,646.00 ","$1,069.90 ",$89.14 ,"$1,646.00 ", N/A ,$750.00 ,$921.76 , N/A ,$460.88 ,$581.04 , N/A ,$678.15 , N/A ,$742.35 ,$742.35 , N/A ,$89.14 , N/A ,"$1,049.00 ", N/A , N/A , N/A , N/A ,"$1,234.50 ",$987.60 ,$987.60 , N/A ,$987.60 ,$107.96 ,$107.96 ,$107.96 ,"$1,646.00 ", N/A ,"$1,399.10 ", N/A ,"$1,319.00 ", N/A ,"$1,646.00 ",$921.76 , N/A ,$432.90 , N/A ,$112.93 ,$107.79 , N/A ,"$1,316.80 ", N/A ,$742.35 ,$460.88 ,"$1,481.40 ", N/A ,$107.96 ,$900.00 ,$900.00 , N/A ,$900.00 ,$790.08 ,$102.66 
ST. ELIZABETH'S HOSPITAL,35000109,77013,HC CT GUIDED FOR ABLATION,350,1 ,"$1,821.00 ","$1,183.65 ",$102.66 ,"$1,821.00 ", N/A ,$750.00 ,"$1,019.76 ", N/A ,$509.88 ,$642.81 , N/A ,$750.25 , N/A ,$821.27 ,$821.27 , N/A ,$234.55 , N/A ,"$1,049.00 ", N/A , N/A , N/A , N/A ,"$1,365.75 ","$1,092.60 ","$1,092.60 ", N/A ,"$1,092.60 ",$612.69 ,$612.69 ,$612.69 ,"$1,821.00 ", N/A ,"$1,547.85 ", N/A ,"$1,319.00 ", N/A ,"$1,821.00 ","$1,019.76 ", N/A ,$478.92 , N/A ,$112.93 ,$107.79 , N/A ,"$1,456.80 ", N/A ,$821.27 ,$509.88 ,"$1,638.90 ", N/A ,$612.69 ,$900.00 ,$900.00 , N/A ,$900.00 ,$874.08 ,$102.66 
ST. ELIZABETH'S HOSPITAL,35000111,77014,HC CT GUIDED THRPY PLACEMENT UNENHAN,350,1 ,"$1,342.00 ",$872.30 ,$92.81 ,"$1,342.00 ", N/A ,$750.00 ,$751.52 , N/A ,$375.76 ,$473.73 , N/A ,$552.90 , N/A ,$605.24 ,$605.24 , N/A ,$92.81 , N/A ,"$1,049.00 ", N/A , N/A , N/A , N/A ,"$1,006.50 ",$805.20 ,$805.20 , N/A ,$805.20 ,$106.47 ,$106.47 ,$106.47 ,"$1,342.00 ", N/A ,"$1,140.70 ", N/A ,"$1,319.00 ", N/A ,"$1,342.00 ",$751.52 , N/A ,$352.95 , N/A ,$112.93 ,$107.79 , N/A ,"$1,073.60 ", N/A ,$605.24 ,$375.76 ,"$1,207.80 ", N/A ,$106.47 ,$900.00 ,$900.00 , N/A ,$900.00 ,$644.16 ,$102.66 
ST. ELIZABETH'S HOSPITAL,35000112,77387,HC CT GUIDED THRPY PLACEMENT CONE BEAM,350,1 ,$769.00 ,$499.85 ,$202.25 ,$769.00 , N/A ,$750.00 ,$430.64 , N/A ,$215.32 ,$259.92 , N/A ,$299.14 , N/A ,$346.82 ,$346.82 , N/A ,$499.85 , N/A ,$769.00 , N/A , N/A , N/A , N/A ,$576.75 ,$461.40 ,$461.40 , N/A ,$461.40 ,$538.30 ,$538.30 ,$538.30 ,$769.00 , N/A ,$653.65 , N/A ,$769.00 , N/A ,$769.00 ,$430.64 , N/A ,$202.25 , N/A , N/A , N/A , N/A ,$615.20 , N/A ,$346.82 ,$215.32 ,$692.10 , N/A ,$538.30 ,$769.00 ,$769.00 , N/A ,$769.00 ,$369.12 , N/A 
ST. ELIZABETH'S HOSPITAL,35000113,51102,HC ASPIRATION OF BLADDER AND INSERT SUPRAPUBIC CATH,350,1 ,"$7,775.00 ","$5,053.75 ",$187.35 ,"$7,775.00 ","$4,413.08 ",$750.00 ,"$4,354.00 ","$1,765.23 ","$2,177.00 ","$2,627.95 ","$1,765.23 ","$3,024.48 ","$1,765.23 ","$3,506.53 ","$3,506.53 ","$1,765.23 ",$187.35 ,"$3,353.94 ","$1,049.00 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$5,831.25 ","$4,665.00 ","$4,665.00 ","$1,765.23 ","$4,665.00 ","$5,442.50 ","$5,442.50 ","$5,442.50 ","$7,775.00 ", N/A ,"$6,608.75 ","$4,413.08 ","$1,319.00 ","$1,765.23 ","$7,775.00 ","$4,354.00 ","$1,765.23 ","$2,044.83 ", N/A ,"$2,434.56 ","$2,323.90 ","$1,853.49 ","$6,220.00 ","$3,971.77 ","$3,506.53 ","$2,177.00 ","$6,997.50 ","$1,765.23 ","$5,442.50 ",$900.00 ,$900.00 ,"$1,765.23 ",$900.00 ,"$3,732.00 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,35000116,64510,HC INJECT STELLATE GANGLION,350,1 ,"$2,674.00 ","$1,738.10 ",$98.16 ,"$2,674.00 ","$2,028.93 ",$750.00 ,"$1,497.44 ",$811.57 ,$748.72 ,$903.81 ,$811.57 ,"$1,040.19 ",$811.57 ,"$1,205.97 ","$1,205.97 ",$811.57 ,$98.16 ,"$1,541.99 ","$1,049.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,005.50 ","$1,604.40 ","$1,604.40 ",$811.57 ,"$1,604.40 ","$1,871.80 ","$1,871.80 ","$1,871.80 ","$2,674.00 ", N/A ,"$2,272.90 ","$2,028.93 ","$1,319.00 ",$811.57 ,"$2,674.00 ","$1,497.44 ",$811.57 ,$703.26 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,139.20 ","$1,826.04 ","$1,205.97 ",$748.72 ,"$2,406.60 ",$811.57 ,"$1,871.80 ",$900.00 ,$900.00 ,$811.57 ,$900.00 ,"$1,283.52 ",$764.55 
ST. ELIZABETH'S HOSPITAL,35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$5,955.00 ","$3,870.75 ",$301.10 ,"$5,955.00 ",$907.63 ,$750.00 ,"$3,334.80 ",$363.05 ,"$1,667.40 ","$2,102.12 ",$363.05 ,"$2,453.46 ",$363.05 ,"$2,685.71 ","$2,685.71 ",$363.05 ,$362.28 ,$689.79 ,"$1,049.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$4,466.25 ","$3,573.00 ","$3,573.00 ",$363.05 ,"$3,573.00 ",$400.73 ,$400.73 ,$400.73 ,"$5,955.00 ", N/A ,"$5,061.75 ",$907.62 ,"$1,319.00 ",$363.05 ,"$5,955.00 ","$3,334.80 ",$363.05 ,"$1,566.17 ", N/A ,$331.21 ,$316.16 ,$381.20 ,"$4,764.00 ",$816.86 ,"$2,685.71 ","$1,667.40 ","$5,359.50 ",$363.05 ,$400.73 ,$900.00 ,$900.00 ,$363.05 ,$900.00 ,"$2,858.40 ",$301.10 
ST. ELIZABETH'S HOSPITAL,35000121,G0260,HC INJ ARTHROGRAM SI W/ANES,350,1 ,"$3,353.00 ","$2,179.45 ",$310.29 ,"$3,353.00 ","$1,565.08 ",$750.00 ,"$1,877.68 ",$626.03 ,$938.84 ,"$1,133.31 ",$626.03 ,"$1,304.32 ",$626.03 ,"$1,512.20 ","$1,512.20 ",$626.03 ,"$2,179.45 ","$1,189.46 ","$1,049.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,514.75 ","$2,011.80 ","$2,011.80 ",$626.03 ,"$2,011.80 ","$2,347.10 ","$2,347.10 ","$2,347.10 ","$3,353.00 ", N/A ,"$2,850.05 ","$1,565.07 ","$1,319.00 ",$626.03 ,"$3,353.00 ","$1,877.68 ",$626.03 ,$881.84 , N/A ,$341.32 ,$325.80 ,$657.33 ,"$2,682.40 ","$1,408.57 ","$1,512.20 ",$938.84 ,"$3,017.70 ",$626.03 ,"$2,347.10 ",$900.00 ,$900.00 ,$626.03 ,$900.00 ,"$1,609.44 ",$310.29 
ST. ELIZABETH'S HOSPITAL,35000132,G0260,HC INJECTION SACRO JOINT W/ ANESTH,350,1 ,"$3,353.00 ","$2,179.45 ",$310.29 ,"$3,353.00 ","$1,565.08 ",$750.00 ,"$1,877.68 ",$626.03 ,$938.84 ,"$1,133.31 ",$626.03 ,"$1,304.32 ",$626.03 ,"$1,512.20 ","$1,512.20 ",$626.03 ,"$2,179.45 ","$1,189.46 ","$1,049.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,514.75 ","$2,011.80 ","$2,011.80 ",$626.03 ,"$2,011.80 ","$2,347.10 ","$2,347.10 ","$2,347.10 ","$3,353.00 ", N/A ,"$2,850.05 ","$1,565.07 ","$1,319.00 ",$626.03 ,"$3,353.00 ","$1,877.68 ",$626.03 ,$881.84 , N/A ,$341.32 ,$325.80 ,$657.33 ,"$2,682.40 ","$1,408.57 ","$1,512.20 ",$938.84 ,"$3,017.70 ",$626.03 ,"$2,347.10 ",$900.00 ,$900.00 ,$626.03 ,$900.00 ,"$1,609.44 ",$310.29 
ST. ELIZABETH'S HOSPITAL,35000133,48999,HC CRYO ABLATION PANCREAS UNLISTED,350,1 ,"$1,669.00 ","$1,084.85 ",$438.95 ,"$1,669.00 ","$1,533.75 ",$750.00 ,$934.64 ,$613.50 ,$467.32 ,$564.12 ,$613.50 ,$649.24 ,$613.50 ,$752.72 ,$752.72 ,$613.50 ,"$1,084.85 ","$1,165.65 ","$1,049.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,251.75 ","$1,001.40 ","$1,001.40 ",$613.50 ,"$1,001.40 ","$1,168.30 ","$1,168.30 ","$1,168.30 ","$1,669.00 ", N/A ,"$1,418.65 ","$1,533.75 ","$1,319.00 ",$613.50 ,"$1,669.00 ",$934.64 ,$613.50 ,$438.95 , N/A ,"$1,669.00 ","$1,669.00 ",$644.18 ,"$1,335.20 ","$1,380.37 ",$752.72 ,$467.32 ,"$1,502.10 ",$613.50 ,"$1,168.30 ",$900.00 ,$900.00 ,$613.50 ,$900.00 ,$801.12 ,"$1,613.78 "
ST. ELIZABETH'S HOSPITAL,35000135,22513,HC VERTEBROPLASTY INJ PERC THOR  KYPHOPLASTY,350,1 ,"$16,456.00 ","$10,696.40 ",$681.55 ,"$16,456.00 ","$15,438.00 ",$750.00 ,"$9,215.36 ","$6,175.20 ","$4,607.68 ","$5,562.13 ","$6,175.20 ","$6,401.38 ","$6,175.20 ","$7,421.66 ","$7,421.66 ","$6,175.20 ",$681.55 ,"$11,732.88 ","$1,049.00 ","$15,438.00 ","$6,175.20 ","$6,175.20 ","$6,298.70 ","$12,342.00 ","$9,873.60 ","$9,873.60 ","$6,175.20 ","$9,873.60 ","$11,519.20 ","$11,519.20 ","$11,519.20 ","$16,456.00 ", N/A ,"$13,987.60 ","$15,438.00 ","$1,319.00 ","$6,175.20 ","$16,456.00 ","$9,215.36 ","$6,175.20 ","$4,327.93 ", N/A ,"$13,126.30 ","$12,529.65 ","$6,483.96 ","$13,164.80 ","$13,894.20 ","$7,421.66 ","$4,607.68 ","$14,810.40 ","$6,175.20 ","$11,519.20 ",$900.00 ,$900.00 ,"$6,175.20 ",$900.00 ,"$7,898.88 ","$11,933.00 "
ST. ELIZABETH'S HOSPITAL,35000136,22514,HC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,350,1 ,"$16,516.00 ","$10,735.40 ",$633.48 ,"$16,516.00 ","$15,438.00 ",$750.00 ,"$9,248.96 ","$6,175.20 ","$4,624.48 ","$5,582.41 ","$6,175.20 ","$6,424.72 ","$6,175.20 ","$7,448.72 ","$7,448.72 ","$6,175.20 ",$633.48 ,"$11,732.88 ","$1,049.00 ","$15,438.00 ","$6,175.20 ","$6,175.20 ","$6,298.70 ","$12,387.00 ","$9,909.60 ","$9,909.60 ","$6,175.20 ","$9,909.60 ","$11,561.20 ","$11,561.20 ","$11,561.20 ","$16,516.00 ", N/A ,"$14,038.60 ","$15,438.00 ","$1,319.00 ","$6,175.20 ","$16,516.00 ","$9,248.96 ","$6,175.20 ","$4,343.71 ", N/A ,"$13,126.30 ","$12,529.65 ","$6,483.96 ","$13,212.80 ","$13,894.20 ","$7,448.72 ","$4,624.48 ","$14,864.40 ","$6,175.20 ","$11,561.20 ",$900.00 ,$900.00 ,"$6,175.20 ",$900.00 ,"$7,927.68 ","$11,933.00 "
ST. ELIZABETH'S HOSPITAL,35000137,22515,HC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,350,1 ,"$9,758.00 ","$6,342.70 ",$295.59 ,"$11,933.00 ", N/A ,$750.00 ,"$5,464.48 ", N/A ,"$2,732.24 ","$3,298.20 ", N/A ,"$3,795.86 ", N/A ,"$4,400.86 ","$4,400.86 ", N/A ,$295.59 , N/A ,"$1,049.00 ", N/A , N/A , N/A , N/A ,"$7,318.50 ","$5,854.80 ","$5,854.80 ", N/A ,"$5,854.80 ","$6,830.60 ","$6,830.60 ","$6,830.60 ","$9,758.00 ", N/A ,"$8,294.30 ", N/A ,"$1,319.00 ", N/A ,"$9,758.00 ","$5,464.48 ", N/A ,"$2,566.35 ", N/A ,"$9,758.00 ","$9,758.00 ", N/A ,"$7,806.40 ", N/A ,"$4,400.86 ","$2,732.24 ","$8,782.20 ", N/A ,"$6,830.60 ",$900.00 ,$900.00 , N/A ,$900.00 ,"$4,683.84 ","$11,933.00 "
ST. ELIZABETH'S HOSPITAL,35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,$230.00 ,$149.50 ,$60.49 ,$268.33 ,$268.33 ,$230.00 ,$128.80 ,$107.33 ,$64.40 ,$77.74 ,$107.33 ,$89.47 ,$107.33 ,$103.73 ,$103.73 ,$107.33 ,$111.55 ,$203.93 ,$230.00 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$172.50 ,$138.00 ,$138.00 ,$107.33 ,$138.00 ,$161.00 ,$161.00 ,$161.00 ,$230.00 , N/A ,$195.50 ,$230.00 ,$230.00 ,$107.33 ,$230.00 ,$128.80 ,$107.33 ,$60.49 , N/A ,$146.41 ,$139.76 ,$112.70 ,$184.00 ,$241.50 ,$103.73 ,$64.40 ,$207.00 ,$107.33 ,$161.00 ,$230.00 ,$230.00 ,$107.33 ,$230.00 ,$110.40 ,$133.10 
ST. ELIZABETH'S HOSPITAL,36000025,10021,HC ASP FINE NDL W/O IMAGING GUIDE,360,1 ,"$1,424.00 ",$925.60 ,$112.87 ,"$1,424.00 ",$851.90 ,"$1,424.00 ",$797.44 ,$340.76 ,$398.72 ,$481.31 ,$340.76 ,$553.94 ,$340.76 ,$642.22 ,$642.22 ,$340.76 ,$642.22 ,$647.44 ,$712.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,068.00 ",$854.40 ,$854.40 ,$340.76 ,$854.40 ,"$1,082.24 ","$1,082.24 ","$1,082.24 ","$1,424.00 ", N/A ,"$1,210.40 ",$851.90 ,$925.60 ,$340.76 ,$112.87 ,$797.44 ,$340.76 ,$374.51 , N/A ,$641.39 ,$612.23 ,$357.80 ,"$1,139.20 ",$766.71 ,$642.22 ,$398.72 ,"$1,281.60 ",$340.76 ,"$1,082.24 ",$920.00 ,$920.00 ,$340.76 ,$920.00 ,$683.52 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$808.00 ,$525.20 ,$177.04 ,$808.00 ,$442.60 ,$808.00 ,$452.48 ,$177.04 ,$226.24 ,$273.10 ,$177.04 ,$314.31 ,$177.04 ,$364.41 ,$364.41 ,$177.04 ,$364.41 ,$336.38 ,$404.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$606.00 ,$484.80 ,$484.80 ,$177.04 ,$484.80 ,$614.08 ,$614.08 ,$614.08 ,$808.00 , N/A ,$686.80 ,$442.60 ,$525.20 ,$177.04 ,$808.00 ,$452.48 ,$177.04 ,$212.50 , N/A ,$316.84 ,$302.44 ,$185.89 ,$646.40 ,$398.34 ,$364.41 ,$226.24 ,$727.20 ,$177.04 ,$614.08 ,$808.00 ,$808.00 ,$177.04 ,$808.00 ,$387.84 ,$288.04 
ST. ELIZABETH'S HOSPITAL,36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,$823.00 ,$534.95 ,$216.45 ,"$3,467.90 ","$3,467.90 ",$823.00 ,$460.88 ,"$1,387.16 ",$230.44 ,$278.17 ,"$1,387.16 ",$320.15 ,$823.00 ,$371.17 ,$371.17 ,$823.00 ,$371.17 ,$823.00 ,$411.50 ,"$3,467.89 ","$1,387.16 ","$1,387.16 ",$823.00 ,$617.25 ,$493.80 ,$493.80 ,"$1,387.16 ",$493.80 ,$625.48 ,$625.48 ,$625.48 ,$823.00 , N/A ,$699.55 ,$823.00 ,$534.95 ,"$1,387.16 ",$823.00 ,$460.88 ,"$1,387.16 ",$216.45 , N/A ,$823.00 ,$823.00 ,"$1,456.52 ",$658.40 ,"$3,121.10 ",$371.17 ,$230.44 ,$740.70 ,"$1,387.16 ",$625.48 ,$823.00 ,$823.00 ,$823.00 ,$823.00 ,$395.04 ,"$1,004.64 "
ST. ELIZABETH'S HOSPITAL,36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,"$1,004.00 ",$652.60 ,$264.05 ,"$1,004.00 ",$851.90 ,"$1,004.00 ",$562.24 ,$340.76 ,$281.12 ,$339.35 ,$340.76 ,$390.56 ,$340.76 ,$452.80 ,$452.80 ,$340.76 ,$452.80 ,$647.44 ,$502.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$753.00 ,$602.40 ,$602.40 ,$340.76 ,$602.40 ,$763.04 ,$763.04 ,$763.04 ,"$1,004.00 ", N/A ,$853.40 ,$851.90 ,$652.60 ,$340.76 ,"$1,004.00 ",$562.24 ,$340.76 ,$264.05 , N/A ,$316.84 ,$302.44 ,$357.80 ,$803.20 ,$766.71 ,$452.80 ,$281.12 ,$903.60 ,$340.76 ,$763.04 ,$920.00 ,$920.00 ,$340.76 ,$920.00 ,$481.92 ,$288.04 
ST. ELIZABETH'S HOSPITAL,36000035,10030,HC GUIDE CATHET FLUID DRAINAGE,360,1 ,"$1,022.00 ",$664.30 ,$268.79 ,"$1,533.75 ","$1,533.75 ","$1,022.00 ",$572.32 ,$613.50 ,$286.16 ,$345.44 ,$613.50 ,$397.56 ,$613.50 ,$460.92 ,$460.92 ,$613.50 ,$460.92 ,"$1,022.00 ",$511.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,$766.50 ,$613.20 ,$613.20 ,$613.50 ,$613.20 ,$776.72 ,$776.72 ,$776.72 ,"$1,022.00 ", N/A ,$868.70 ,"$1,022.00 ",$664.30 ,$613.50 ,"$1,022.00 ",$572.32 ,$613.50 ,$268.79 , N/A ,"$1,022.00 ","$1,022.00 ",$644.18 ,$817.60 ,"$1,380.37 ",$460.92 ,$286.16 ,$919.80 ,$613.50 ,$776.72 ,"$1,022.00 ","$1,022.00 ",$613.50 ,"$1,022.00 ",$490.56 ,"$1,004.64 "
ST. ELIZABETH'S HOSPITAL,36000078,19000,HC ASP CYST BREAST,360,1 ,"$1,752.00 ","$1,138.80 ",$177.68 ,"$1,752.00 ","$1,533.75 ","$1,752.00 ",$981.12 ,$613.50 ,$490.56 ,$592.18 ,$613.50 ,$681.53 ,$613.50 ,$790.15 ,$790.15 ,$613.50 ,$790.15 ,"$1,165.65 ",$876.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,314.00 ","$1,051.20 ","$1,051.20 ",$613.50 ,"$1,051.20 ","$1,331.52 ","$1,331.52 ","$1,331.52 ","$1,752.00 ", N/A ,"$1,489.20 ","$1,533.75 ","$1,138.80 ",$613.50 ,$177.68 ,$981.12 ,$613.50 ,$460.78 , N/A ,$641.39 ,$612.23 ,$644.18 ,"$1,401.60 ","$1,380.37 ",$790.15 ,$490.56 ,"$1,576.80 ",$613.50 ,"$1,331.52 ","$1,500.00 ","$1,500.00 ",$613.50 ,"$1,500.00 ",$840.96 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$727.00 ,$472.55 ,$29.74 ,$727.00 , N/A ,$727.00 ,$407.12 , N/A ,$203.56 ,$245.73 , N/A ,$282.80 , N/A ,$327.88 ,$327.88 , N/A ,$327.88 , N/A ,$363.50 , N/A , N/A , N/A , N/A ,$545.25 ,$436.20 ,$436.20 , N/A ,$436.20 ,$552.52 ,$552.52 ,$552.52 ,$727.00 , N/A ,$617.95 , N/A ,$472.55 , N/A ,$29.74 ,$407.12 , N/A ,$191.20 , N/A ,$641.39 ,$612.23 , N/A ,$581.60 , N/A ,$327.88 ,$203.56 ,$654.30 , N/A ,$552.52 ,$727.00 ,$727.00 , N/A ,$727.00 ,$348.96 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36000080,19020,HC BREAST ABSCESS DRAINAGE,360,1 ,"$8,759.00 ","$5,693.35 ","$1,004.64 ","$8,759.00 ","$3,467.90 ","$3,200.00 ","$4,905.04 ","$1,387.16 ","$2,452.52 ","$2,960.54 ","$1,387.16 ","$3,407.25 ","$1,387.16 ","$3,950.31 ","$3,950.31 ","$1,387.16 ","$3,950.31 ","$2,635.59 ","$4,379.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$6,569.25 ","$5,255.40 ","$5,255.40 ","$1,387.16 ","$5,255.40 ","$6,656.84 ","$6,656.84 ","$6,656.84 ","$8,759.00 ", N/A ,"$7,445.15 ","$3,467.89 ","$5,693.35 ","$1,387.16 ","$8,759.00 ","$4,905.04 ","$1,387.16 ","$2,303.62 ", N/A ,"$1,105.10 ","$1,054.87 ","$1,456.52 ","$7,007.20 ","$3,121.10 ","$3,950.31 ","$2,452.52 ","$7,883.10 ","$1,387.16 ","$6,656.84 ","$2,690.00 ","$2,690.00 ","$1,387.16 ","$2,690.00 ","$4,204.32 ","$1,004.64 "
ST. ELIZABETH'S HOSPITAL,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$624.00 ,$405.60 ,$164.11 ,$624.00 , N/A ,$624.00 ,$349.44 , N/A ,$174.72 ,$210.91 , N/A ,$242.74 , N/A ,$281.42 ,$281.42 , N/A ,$281.42 , N/A ,$312.00 , N/A , N/A , N/A , N/A ,$468.00 ,$374.40 ,$374.40 , N/A ,$374.40 ,$474.24 ,$474.24 ,$474.24 ,$624.00 , N/A ,$530.40 , N/A ,$405.60 , N/A ,$624.00 ,$349.44 , N/A ,$164.11 , N/A , N/A , N/A , N/A ,$499.20 , N/A ,$281.42 ,$174.72 ,$561.60 , N/A ,$474.24 ,$624.00 ,$624.00 , N/A ,$624.00 ,$299.52 , N/A 
ST. ELIZABETH'S HOSPITAL,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$440.00 ,$286.00 ,$115.72 ,$440.00 , N/A ,$440.00 ,$246.40 , N/A ,$123.20 ,$148.72 , N/A ,$171.16 , N/A ,$198.44 ,$198.44 , N/A ,$198.44 , N/A ,$220.00 , N/A , N/A , N/A , N/A ,$330.00 ,$264.00 ,$264.00 , N/A ,$264.00 ,$334.40 ,$334.40 ,$334.40 ,$440.00 , N/A ,$374.00 , N/A ,$286.00 , N/A ,$440.00 ,$246.40 , N/A ,$115.72 , N/A , N/A , N/A , N/A ,$352.00 , N/A ,$198.44 ,$123.20 ,$396.00 , N/A ,$334.40 ,$440.00 ,$440.00 , N/A ,$440.00 ,$211.20 , N/A 
ST. ELIZABETH'S HOSPITAL,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$3,856.00 ","$2,506.40 ",$620.94 ,"$3,856.00 ","$3,467.90 ","$3,200.00 ","$2,159.36 ","$1,387.16 ","$1,079.68 ","$1,303.33 ","$1,387.16 ","$1,499.98 ","$1,387.16 ","$1,739.06 ","$1,739.06 ","$1,387.16 ","$1,739.06 ","$2,635.59 ","$1,928.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,892.00 ","$2,313.60 ","$2,313.60 ","$1,387.16 ","$2,313.60 ","$2,930.56 ","$2,930.56 ","$2,930.56 ","$3,856.00 ", N/A ,"$3,277.60 ","$3,467.89 ","$2,506.40 ","$1,387.16 ",$620.94 ,"$2,159.36 ","$1,387.16 ","$1,014.13 ", N/A ,"$1,299.83 ","$1,240.74 ","$1,456.52 ","$3,084.80 ","$3,121.10 ","$1,739.06 ","$1,079.68 ","$3,470.40 ","$1,387.16 ","$2,930.56 ","$1,890.00 ","$1,890.00 ","$1,387.16 ","$1,890.00 ","$1,850.88 ","$1,181.66 "
ST. ELIZABETH'S HOSPITAL,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$5,471.00 ","$3,556.15 ",$620.94 ,"$5,843.93 ","$5,843.93 ","$4,800.00 ","$3,063.76 ","$2,337.57 ","$1,531.88 ","$1,849.20 ","$2,337.57 ","$2,128.22 ","$2,337.57 ","$2,467.42 ","$2,467.42 ","$2,337.57 ","$2,467.42 ","$4,441.38 ","$2,735.50 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$4,103.25 ","$3,282.60 ","$3,282.60 ","$2,337.57 ","$3,282.60 ","$4,157.96 ","$4,157.96 ","$4,157.96 ","$5,471.00 ", N/A ,"$4,650.35 ","$5,471.00 ","$3,556.15 ","$2,337.57 ",$620.94 ,"$3,063.76 ","$2,337.57 ","$1,438.87 ", N/A ,"$1,949.74 ","$1,861.11 ","$2,454.45 ","$4,376.80 ","$5,259.53 ","$2,467.42 ","$1,531.88 ","$4,923.90 ","$2,337.57 ","$4,157.96 ","$2,835.00 ","$2,835.00 ","$2,337.57 ","$2,835.00 ","$2,626.08 ","$1,772.49 "
ST. ELIZABETH'S HOSPITAL,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$4,458.00 ","$2,897.70 ",$114.47 ,"$4,458.00 ","$1,533.75 ","$3,200.00 ","$2,496.48 ",$613.50 ,"$1,248.24 ","$1,506.80 ",$613.50 ,"$1,734.16 ",$613.50 ,"$2,010.56 ","$2,010.56 ",$613.50 ,"$2,010.56 ","$1,165.65 ","$2,229.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,343.50 ","$2,674.80 ","$2,674.80 ",$613.50 ,"$2,674.80 ","$3,388.08 ","$3,388.08 ","$3,388.08 ","$4,458.00 ", N/A ,"$3,789.30 ","$1,533.75 ","$2,897.70 ",$613.50 ,$464.28 ,"$2,496.48 ",$613.50 ,"$1,172.45 ", N/A ,$125.92 ,$120.19 ,$644.18 ,"$3,566.40 ","$1,380.37 ","$2,010.56 ","$1,248.24 ","$4,012.20 ",$613.50 ,"$3,388.08 ","$1,500.00 ","$1,500.00 ",$613.50 ,"$1,500.00 ","$2,139.84 ",$114.47 
ST. ELIZABETH'S HOSPITAL,36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$2,548.00 ","$1,656.20 ",$583.08 ,"$3,467.90 ","$3,467.90 ","$2,125.00 ","$1,426.88 ","$1,387.16 ",$713.44 ,$861.22 ,"$1,387.16 ",$991.17 ,"$1,387.16 ","$1,149.15 ","$1,149.15 ","$1,387.16 ","$1,149.15 ","$2,548.00 ","$1,274.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,911.00 ","$1,528.80 ","$1,528.80 ","$1,387.16 ","$1,528.80 ","$1,936.48 ","$1,936.48 ","$1,936.48 ","$2,548.00 ", N/A ,"$2,165.80 ","$2,548.00 ","$1,656.20 ","$1,387.16 ","$2,548.00 ","$1,426.88 ","$1,387.16 ",$670.12 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$2,038.40 ","$3,121.10 ","$1,149.15 ",$713.44 ,"$2,293.20 ","$1,387.16 ","$1,936.48 ","$1,890.00 ","$1,890.00 ","$1,387.16 ","$1,890.00 ","$1,223.04 ",$583.08 
ST. ELIZABETH'S HOSPITAL,36000089,20220,HC BX BONE NEEDLE SUPERFIC FAC,360,1 ,"$4,286.00 ","$2,785.90 ",$617.74 ,"$4,286.00 ","$3,467.90 ","$2,125.00 ","$2,400.16 ","$1,387.16 ","$1,200.08 ","$1,448.67 ","$1,387.16 ","$1,667.25 ","$1,387.16 ","$1,932.99 ","$1,932.99 ","$1,387.16 ","$1,932.99 ","$2,635.59 ","$2,143.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,214.50 ","$2,571.60 ","$2,571.60 ","$1,387.16 ","$2,571.60 ","$3,257.36 ","$3,257.36 ","$3,257.36 ","$4,286.00 ", N/A ,"$3,643.10 ","$3,467.89 ","$2,785.90 ","$1,387.16 ","$4,286.00 ","$2,400.16 ","$1,387.16 ","$1,127.22 ", N/A ,$679.51 ,$648.63 ,"$1,456.52 ","$3,428.80 ","$3,121.10 ","$1,932.99 ","$1,200.08 ","$3,857.40 ","$1,387.16 ","$3,257.36 ","$1,500.00 ","$1,500.00 ","$1,387.16 ","$1,500.00 ","$2,057.28 ",$617.74 
ST. ELIZABETH'S HOSPITAL,36000090,20225,HC BX BONE NEEDLE DEEP,360,1 ,"$6,037.00 ","$3,924.05 ",$617.74 ,"$6,037.00 ","$3,467.90 ","$3,200.00 ","$3,380.72 ","$1,387.16 ","$1,690.36 ","$2,040.51 ","$1,387.16 ","$2,348.39 ","$1,387.16 ","$2,722.69 ","$2,722.69 ","$1,387.16 ","$2,722.69 ","$2,635.59 ","$3,018.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$4,527.75 ","$3,622.20 ","$3,622.20 ","$1,387.16 ","$3,622.20 ","$4,588.12 ","$4,588.12 ","$4,588.12 ","$6,037.00 ", N/A ,"$5,131.45 ","$3,467.89 ","$3,924.05 ","$1,387.16 ","$6,037.00 ","$3,380.72 ","$1,387.16 ","$1,587.73 ", N/A ,$679.51 ,$648.63 ,"$1,456.52 ","$4,829.60 ","$3,121.10 ","$2,722.69 ","$1,690.36 ","$5,433.30 ","$1,387.16 ","$4,588.12 ","$1,890.00 ","$1,890.00 ","$1,387.16 ","$1,890.00 ","$2,897.76 ",$617.74 
ST. ELIZABETH'S HOSPITAL,36000101,29085,HC CAST APPL; HAND AND FOREARM,360,1 ,"$1,067.00 ",$693.55 ,$139.29 ,"$1,067.00 ",$348.23 ,$490.82 ,$597.52 ,$139.29 ,$298.76 ,$360.65 ,$139.29 ,$439.60 ,$139.29 ,$481.22 ,$481.22 ,$139.29 ,$481.22 ,$264.64 ,$533.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$800.25 ,$640.20 ,$640.20 ,$139.29 ,$640.20 ,$810.92 ,$810.92 ,$810.92 ,"$1,067.00 ", N/A ,$906.95 ,$348.22 ,$693.55 ,$139.29 ,"$1,067.00 ",$597.52 ,$139.29 ,$280.62 , N/A ,$342.83 ,$327.24 ,$146.25 ,$853.60 ,$313.39 ,$481.22 ,$298.76 ,$960.30 ,$139.29 ,$810.92 ,$920.00 ,$920.00 ,$139.29 ,$920.00 ,$512.16 ,$311.66 
ST. ELIZABETH'S HOSPITAL,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,"$1,756.00 ","$1,141.40 ",$461.83 ,"$1,756.00 ", N/A ,"$1,756.00 ",$983.36 , N/A ,$491.68 ,$593.53 , N/A ,$683.08 , N/A ,$791.96 ,$791.96 , N/A ,$791.96 , N/A ,$878.00 , N/A , N/A , N/A , N/A ,"$1,317.00 ","$1,053.60 ","$1,053.60 ", N/A ,"$1,053.60 ","$1,334.56 ","$1,334.56 ","$1,334.56 ","$1,756.00 ", N/A ,"$1,492.60 ", N/A ,"$1,141.40 ", N/A ,$494.86 ,$983.36 , N/A ,$461.83 , N/A ,"$1,299.83 ","$1,240.74 ", N/A ,"$1,404.80 ", N/A ,$791.96 ,$491.68 ,"$1,580.40 ", N/A ,"$1,334.56 ",$920.00 ,$920.00 , N/A ,$920.00 ,$842.88 ,"$1,181.66 "
ST. ELIZABETH'S HOSPITAL,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,"$1,927.00 ","$1,252.55 ",$485.95 ,"$1,927.00 ", N/A ,"$1,927.00 ","$1,079.12 ", N/A ,$539.56 ,$651.33 , N/A ,$749.60 , N/A ,$869.08 ,$869.08 , N/A ,$869.08 , N/A ,$963.50 , N/A , N/A , N/A , N/A ,"$1,445.25 ","$1,156.20 ","$1,156.20 ", N/A ,"$1,156.20 ","$1,464.52 ","$1,464.52 ","$1,464.52 ","$1,927.00 ", N/A ,"$1,637.95 ", N/A ,"$1,252.55 ", N/A ,$485.95 ,"$1,079.12 ", N/A ,$506.80 , N/A ,"$1,299.83 ","$1,240.74 ", N/A ,"$1,541.60 ", N/A ,$869.08 ,$539.56 ,"$1,734.30 ", N/A ,"$1,464.52 ",$920.00 ,$920.00 , N/A ,$920.00 ,$924.96 ,"$1,181.66 "
ST. ELIZABETH'S HOSPITAL,36000110,19085,HC BX BREAST 1ST LESION MR IMAG,360,1 ,"$5,177.00 ","$3,365.05 ",$949.78 ,"$5,177.00 ","$3,467.90 ","$4,200.00 ","$2,899.12 ","$1,387.16 ","$1,449.56 ","$1,749.83 ","$1,387.16 ","$2,013.85 ","$1,387.16 ","$2,334.83 ","$2,334.83 ","$1,387.16 ","$2,334.83 ","$2,635.59 ","$2,588.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,882.75 ","$3,106.20 ","$3,106.20 ","$1,387.16 ","$3,106.20 ","$3,934.52 ","$3,934.52 ","$3,934.52 ","$5,177.00 ", N/A ,"$4,400.45 ","$3,467.89 ","$3,365.05 ","$1,387.16 ",$949.78 ,"$2,899.12 ","$1,387.16 ","$1,361.55 ", N/A ,"$1,299.83 ","$1,240.74 ","$1,456.52 ","$4,141.60 ","$3,121.10 ","$2,334.83 ","$1,449.56 ","$4,659.30 ","$1,387.16 ","$3,934.52 ","$1,890.00 ","$1,890.00 ","$1,387.16 ","$1,890.00 ","$2,484.96 ","$1,181.66 "
ST. ELIZABETH'S HOSPITAL,36000111,19086,HC BX BREAST ADDN LESION MR IMAG,360,1 ,"$2,588.00 ","$1,682.20 ",$680.64 ,"$2,588.00 ", N/A ,"$2,125.00 ","$1,449.28 ", N/A ,$724.64 ,$874.74 , N/A ,"$1,006.73 ", N/A ,"$1,167.19 ","$1,167.19 ", N/A ,"$1,167.19 ", N/A ,"$1,294.00 ", N/A , N/A , N/A , N/A ,"$1,941.00 ","$1,552.80 ","$1,552.80 ", N/A ,"$1,552.80 ","$1,966.88 ","$1,966.88 ","$1,966.88 ","$2,588.00 ", N/A ,"$2,199.80 ", N/A ,"$1,682.20 ", N/A ,$751.20 ,"$1,449.28 ", N/A ,$680.64 , N/A ,"$1,299.83 ","$1,240.74 ", N/A ,"$2,070.40 ", N/A ,"$1,167.19 ",$724.64 ,"$2,329.20 ", N/A ,"$1,966.88 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,242.24 ","$1,181.66 "
ST. ELIZABETH'S HOSPITAL,36000112,19287,HC PERCUTAN DEV BREAST 1ST MR GUIDE,360,1 ,"$4,541.00 ","$2,951.65 ",$114.47 ,"$4,541.00 ","$1,533.75 ","$4,200.00 ","$2,542.96 ",$613.50 ,"$1,271.48 ","$1,534.86 ",$613.50 ,"$1,766.45 ",$613.50 ,"$2,047.99 ","$2,047.99 ",$613.50 ,"$2,047.99 ","$1,165.65 ","$2,270.50 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,405.75 ","$2,724.60 ","$2,724.60 ",$613.50 ,"$2,724.60 ","$3,451.16 ","$3,451.16 ","$3,451.16 ","$4,541.00 ", N/A ,"$3,859.85 ","$1,533.75 ","$2,951.65 ",$613.50 ,$796.53 ,"$2,542.96 ",$613.50 ,"$1,194.28 ", N/A ,$125.92 ,$120.19 ,$644.18 ,"$3,632.80 ","$1,380.37 ","$2,047.99 ","$1,271.48 ","$4,086.90 ",$613.50 ,"$3,451.16 ","$1,500.00 ","$1,500.00 ",$613.50 ,"$1,500.00 ","$2,179.68 ",$114.47 
ST. ELIZABETH'S HOSPITAL,36000113,19288,HC PERCUTAN DEV BREAST ADDN MR GUIDE,360,1 ,"$2,148.00 ","$1,396.20 ",$114.47 ,"$2,148.00 ", N/A ,"$2,125.00 ","$1,202.88 ", N/A ,$601.44 ,$726.02 , N/A ,$835.57 , N/A ,$968.75 ,$968.75 , N/A ,$968.75 , N/A ,"$1,074.00 ", N/A , N/A , N/A , N/A ,"$1,611.00 ","$1,288.80 ","$1,288.80 ", N/A ,"$1,288.80 ","$1,632.48 ","$1,632.48 ","$1,632.48 ","$2,148.00 ", N/A ,"$1,825.80 ", N/A ,"$1,396.20 ", N/A ,$628.63 ,"$1,202.88 ", N/A ,$564.92 , N/A ,$125.92 ,$120.19 , N/A ,"$1,718.40 ", N/A ,$968.75 ,$601.44 ,"$1,933.20 ", N/A ,"$1,632.48 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,031.04 ",$114.47 
ST. ELIZABETH'S HOSPITAL,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,"$2,271.00 ","$1,476.15 ",$114.47 ,"$2,271.00 ", N/A ,"$2,125.00 ","$1,271.76 ", N/A ,$635.88 ,$767.60 , N/A ,$883.42 , N/A ,"$1,024.22 ","$1,024.22 ", N/A ,"$1,024.22 ", N/A ,"$1,135.50 ", N/A , N/A , N/A , N/A ,"$1,703.25 ","$1,362.60 ","$1,362.60 ", N/A ,"$1,362.60 ","$1,725.96 ","$1,725.96 ","$1,725.96 ","$2,271.00 ", N/A ,"$1,930.35 ", N/A ,"$1,476.15 ", N/A ,$189.78 ,"$1,271.76 ", N/A ,$597.27 , N/A ,$125.92 ,$120.19 , N/A ,"$1,816.80 ", N/A ,"$1,024.22 ",$635.88 ,"$2,043.90 ", N/A ,"$1,725.96 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,090.08 ",$114.47 
ST. ELIZABETH'S HOSPITAL,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,"$2,229.00 ","$1,448.85 ",$114.47 ,"$2,229.00 ", N/A ,"$2,125.00 ","$1,248.24 ", N/A ,$624.12 ,$753.40 , N/A ,$867.08 , N/A ,"$1,005.28 ","$1,005.28 ", N/A ,"$1,005.28 ", N/A ,"$1,114.50 ", N/A , N/A , N/A , N/A ,"$1,671.75 ","$1,337.40 ","$1,337.40 ", N/A ,"$1,337.40 ","$1,694.04 ","$1,694.04 ","$1,694.04 ","$2,229.00 ", N/A ,"$1,894.65 ", N/A ,"$1,448.85 ", N/A ,$391.77 ,"$1,248.24 ", N/A ,$586.23 , N/A ,$125.92 ,$120.19 , N/A ,"$1,783.20 ", N/A ,"$1,005.28 ",$624.12 ,"$2,006.10 ", N/A ,"$1,694.04 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,069.92 ",$114.47 
ST. ELIZABETH'S HOSPITAL,36000119,36471,HC INJ SCLEROSING SOLUTN MULT VEIN,360,1 ,"$1,384.00 ",$899.60 ,$340.76 ,"$1,384.00 ",$851.90 ,"$1,384.00 ",$775.04 ,$340.76 ,$387.52 ,$467.79 ,$340.76 ,$538.38 ,$340.76 ,$624.18 ,$624.18 ,$340.76 ,$624.18 ,$647.44 ,$692.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,038.00 ",$830.40 ,$830.40 ,$340.76 ,$830.40 ,"$1,051.84 ","$1,051.84 ","$1,051.84 ","$1,384.00 ", N/A ,"$1,176.40 ",$851.90 ,$899.60 ,$340.76 ,"$1,384.00 ",$775.04 ,$340.76 ,$363.99 , N/A ,$925.41 ,$883.34 ,$357.80 ,"$1,107.20 ",$766.71 ,$624.18 ,$387.52 ,"$1,245.60 ",$340.76 ,"$1,051.84 ",$920.00 ,$920.00 ,$340.76 ,$920.00 ,$664.32 ,$841.28 
ST. ELIZABETH'S HOSPITAL,36000122,36555,HC INS CATH CV NON-TUNL <5 YRS,360,1 ,"$3,236.00 ","$2,103.40 ",$851.07 ,"$7,055.60 ","$7,055.60 ","$2,125.00 ","$1,812.16 ","$2,822.24 ",$906.08 ,"$1,093.77 ","$2,822.24 ","$1,258.80 ","$2,822.24 ","$1,459.44 ","$1,459.44 ","$2,822.24 ","$1,459.44 ","$3,236.00 ","$1,618.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$2,427.00 ","$1,941.60 ","$1,941.60 ","$2,822.24 ","$1,941.60 ","$2,459.36 ","$2,459.36 ","$2,459.36 ","$3,236.00 ", N/A ,"$2,750.60 ","$3,236.00 ","$2,103.40 ","$2,822.24 ","$3,236.00 ","$1,812.16 ","$2,822.24 ",$851.07 , N/A , N/A , N/A ,"$2,963.35 ","$2,588.80 ","$6,350.04 ","$1,459.44 ",$906.08 ,"$2,912.40 ","$2,822.24 ","$2,459.36 ","$1,500.00 ","$1,500.00 ","$2,822.24 ","$1,500.00 ","$1,553.28 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$4,404.00 ","$2,862.60 ","$1,158.25 ","$7,055.60 ","$7,055.60 ","$2,125.00 ","$2,466.24 ","$2,822.24 ","$1,233.12 ","$1,488.55 ","$2,822.24 ","$1,713.16 ","$2,822.24 ","$1,986.20 ","$1,986.20 ","$2,822.24 ","$1,986.20 ","$4,404.00 ","$2,202.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$3,303.00 ","$2,642.40 ","$2,642.40 ","$2,822.24 ","$2,642.40 ","$3,347.04 ","$3,347.04 ","$3,347.04 ","$4,404.00 ", N/A ,"$3,743.40 ","$4,404.00 ","$2,862.60 ","$2,822.24 ","$4,404.00 ","$2,466.24 ","$2,822.24 ","$1,158.25 ", N/A ,"$1,794.80 ","$1,713.22 ","$2,963.35 ","$3,523.20 ","$6,350.04 ","$1,986.20 ","$1,233.12 ","$3,963.60 ","$2,822.24 ","$3,347.04 ","$1,500.00 ","$1,500.00 ","$2,822.24 ","$1,500.00 ","$2,113.92 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000125,36558,HC INSERT TUNNELED CVC > 5 YEARS OLD,360,1 ,"$6,568.00 ","$4,269.20 ","$1,631.64 ","$7,055.60 ","$7,055.60 ","$3,200.00 ","$3,678.08 ","$2,822.24 ","$1,839.04 ","$2,219.98 ","$2,822.24 ","$2,554.95 ","$2,822.24 ","$2,962.17 ","$2,962.17 ","$2,822.24 ","$2,962.17 ","$5,362.25 ","$3,284.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$4,926.00 ","$3,940.80 ","$3,940.80 ","$2,822.24 ","$3,940.80 ","$4,991.68 ","$4,991.68 ","$4,991.68 ","$6,568.00 ", N/A ,"$5,582.80 ","$6,568.00 ","$4,269.20 ","$2,822.24 ","$6,568.00 ","$3,678.08 ","$2,822.24 ","$1,727.38 ", N/A ,"$1,794.80 ","$1,713.22 ","$2,963.35 ","$5,254.40 ","$6,350.04 ","$2,962.17 ","$1,839.04 ","$5,911.20 ","$2,822.24 ","$4,991.68 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,152.64 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$11,156.00 ","$7,251.40 ","$1,631.64 ","$11,156.00 ","$7,055.60 ","$4,200.00 ","$6,247.36 ","$2,822.24 ","$3,123.68 ","$3,770.73 ","$2,822.24 ","$4,339.68 ","$2,822.24 ","$5,031.36 ","$5,031.36 ","$2,822.24 ","$5,031.36 ","$5,362.25 ","$5,578.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,367.00 ","$6,693.60 ","$6,693.60 ","$2,822.24 ","$6,693.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,156.00 ", N/A ,"$9,482.60 ","$7,055.60 ","$7,251.40 ","$2,822.24 ","$11,156.00 ","$6,247.36 ","$2,822.24 ","$2,934.03 ", N/A ,"$1,794.80 ","$1,713.22 ","$2,963.35 ","$8,924.80 ","$6,350.04 ","$5,031.36 ","$3,123.68 ","$10,040.40 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,354.88 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000131,36568,HC INS CATH PERIPH CV W/O PORT <5,360,1 ,"$4,244.00 ","$2,758.60 ","$1,116.17 ","$4,244.00 ","$3,465.88 ","$2,125.00 ","$2,376.64 ","$1,386.35 ","$1,188.32 ","$1,434.47 ","$1,386.35 ","$1,650.92 ","$1,386.35 ","$1,914.04 ","$1,914.04 ","$1,386.35 ","$1,914.04 ","$2,634.07 ","$2,122.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$3,183.00 ","$2,546.40 ","$2,546.40 ","$1,386.35 ","$2,546.40 ","$3,225.44 ","$3,225.44 ","$3,225.44 ","$4,244.00 ", N/A ,"$3,607.40 ","$3,465.89 ","$2,758.60 ","$1,386.35 ","$4,244.00 ","$2,376.64 ","$1,386.35 ","$1,116.17 ", N/A , N/A , N/A ,"$1,455.67 ","$3,395.20 ","$3,119.30 ","$1,914.04 ","$1,188.32 ","$3,819.60 ","$1,386.35 ","$3,225.44 ","$1,500.00 ","$1,500.00 ","$1,386.35 ","$1,500.00 ","$2,037.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$4,780.00 ","$3,107.00 ",$474.97 ,"$4,780.00 ","$3,465.88 ","$2,125.00 ","$2,676.80 ","$1,386.35 ","$1,338.40 ","$1,615.64 ","$1,386.35 ","$1,859.42 ","$1,386.35 ","$2,155.78 ","$2,155.78 ","$1,386.35 ","$2,155.78 ","$2,634.07 ","$2,390.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$3,585.00 ","$2,868.00 ","$2,868.00 ","$1,386.35 ","$2,868.00 ","$3,632.80 ","$3,632.80 ","$3,632.80 ","$4,780.00 ", N/A ,"$4,063.00 ","$3,465.89 ","$3,107.00 ","$1,386.35 ","$4,780.00 ","$2,676.80 ","$1,386.35 ","$1,257.14 ", N/A ,$522.47 ,$498.72 ,"$1,455.67 ","$3,824.00 ","$3,119.30 ","$2,155.78 ","$1,338.40 ","$4,302.00 ","$1,386.35 ","$3,632.80 ","$1,500.00 ","$1,500.00 ","$1,386.35 ","$1,500.00 ","$2,294.40 ",$474.97 
ST. ELIZABETH'S HOSPITAL,36000134,36578,HC REPLACE CATH CV W/PORT/PUMP,360,1 ,"$11,156.00 ","$7,251.40 ",$474.97 ,"$11,156.00 ","$7,055.60 ","$3,200.00 ","$6,247.36 ","$2,822.24 ","$3,123.68 ","$3,770.73 ","$2,822.24 ","$4,339.68 ","$2,822.24 ","$5,031.36 ","$5,031.36 ","$2,822.24 ","$5,031.36 ","$5,362.25 ","$5,578.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,367.00 ","$6,693.60 ","$6,693.60 ","$2,822.24 ","$6,693.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,156.00 ", N/A ,"$9,482.60 ","$7,055.60 ","$7,251.40 ","$2,822.24 ","$11,156.00 ","$6,247.36 ","$2,822.24 ","$2,934.03 ", N/A ,$522.47 ,$498.72 ,"$2,963.35 ","$8,924.80 ","$6,350.04 ","$5,031.36 ","$3,123.68 ","$10,040.40 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,354.88 ",$474.97 
ST. ELIZABETH'S HOSPITAL,36000135,36580,HC REPL CATH CV NON-TNL W/O PORT,360,1 ,"$4,404.00 ","$2,862.60 ",$474.97 ,"$4,404.00 ","$3,465.88 ","$2,125.00 ","$2,466.24 ","$1,386.35 ","$1,233.12 ","$1,488.55 ","$1,386.35 ","$1,713.16 ","$1,386.35 ","$1,986.20 ","$1,986.20 ","$1,386.35 ","$1,986.20 ","$2,634.07 ","$2,202.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$3,303.00 ","$2,642.40 ","$2,642.40 ","$1,386.35 ","$2,642.40 ","$3,347.04 ","$3,347.04 ","$3,347.04 ","$4,404.00 ", N/A ,"$3,743.40 ","$3,465.89 ","$2,862.60 ","$1,386.35 ","$4,404.00 ","$2,466.24 ","$1,386.35 ","$1,158.25 ", N/A ,$522.47 ,$498.72 ,"$1,455.67 ","$3,523.20 ","$3,119.30 ","$1,986.20 ","$1,233.12 ","$3,963.60 ","$1,386.35 ","$3,347.04 ","$1,500.00 ","$1,500.00 ","$1,386.35 ","$1,500.00 ","$2,113.92 ",$474.97 
ST. ELIZABETH'S HOSPITAL,36000136,36581,HC REPL CATH CV TNL W/O PORT,360,1 ,"$11,156.00 ","$7,251.40 ","$1,631.64 ","$11,156.00 ","$7,055.60 ","$3,200.00 ","$6,247.36 ","$2,822.24 ","$3,123.68 ","$3,770.73 ","$2,822.24 ","$4,339.68 ","$2,822.24 ","$5,031.36 ","$5,031.36 ","$2,822.24 ","$5,031.36 ","$5,362.25 ","$5,578.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,367.00 ","$6,693.60 ","$6,693.60 ","$2,822.24 ","$6,693.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,156.00 ", N/A ,"$9,482.60 ","$7,055.60 ","$7,251.40 ","$2,822.24 ","$11,156.00 ","$6,247.36 ","$2,822.24 ","$2,934.03 ", N/A ,"$1,794.80 ","$1,713.22 ","$2,963.35 ","$8,924.80 ","$6,350.04 ","$5,031.36 ","$3,123.68 ","$10,040.40 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,354.88 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000137,36582,HC REPL DEVICE CV TNL W/PORT,360,1 ,"$11,156.00 ","$7,251.40 ","$1,631.64 ","$11,156.00 ","$7,055.60 ","$4,200.00 ","$6,247.36 ","$2,822.24 ","$3,123.68 ","$3,770.73 ","$2,822.24 ","$4,339.68 ","$2,822.24 ","$5,031.36 ","$5,031.36 ","$2,822.24 ","$5,031.36 ","$5,362.25 ","$5,578.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,367.00 ","$6,693.60 ","$6,693.60 ","$2,822.24 ","$6,693.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,156.00 ", N/A ,"$9,482.60 ","$7,055.60 ","$7,251.40 ","$2,822.24 ","$11,156.00 ","$6,247.36 ","$2,822.24 ","$2,934.03 ", N/A ,"$1,794.80 ","$1,713.22 ","$2,963.35 ","$8,924.80 ","$6,350.04 ","$5,031.36 ","$3,123.68 ","$10,040.40 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,354.88 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000139,36584,HC REPL PICC W/O PORT/PUMP,360,1 ,"$2,148.00 ","$1,396.20 ",$135.95 ,"$3,465.89 ","$3,465.88 ","$2,125.00 ","$1,202.88 ","$1,386.35 ",$601.44 ,$726.02 ,"$1,386.35 ",$835.57 ,"$1,386.35 ",$968.75 ,$968.75 ,"$1,386.35 ",$968.75 ,"$2,148.00 ","$1,074.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$1,611.00 ","$1,288.80 ","$1,288.80 ","$1,386.35 ","$1,288.80 ","$1,632.48 ","$1,632.48 ","$1,632.48 ","$2,148.00 ", N/A ,"$1,825.80 ","$2,148.00 ","$1,396.20 ","$1,386.35 ","$2,148.00 ","$1,202.88 ","$1,386.35 ",$564.92 , N/A ,$149.55 ,$142.75 ,"$1,455.67 ","$1,718.40 ","$3,119.30 ",$968.75 ,$601.44 ,"$1,933.20 ","$1,386.35 ","$1,632.48 ","$1,500.00 ","$1,500.00 ","$1,386.35 ","$1,500.00 ","$1,031.04 ",$135.95 
ST. ELIZABETH'S HOSPITAL,36000140,36585,HC REPL PICC W/PORT,360,1 ,"$11,156.00 ","$7,251.40 ","$1,631.64 ","$11,156.00 ","$7,055.60 ","$4,200.00 ","$6,247.36 ","$2,822.24 ","$3,123.68 ","$3,770.73 ","$2,822.24 ","$4,339.68 ","$2,822.24 ","$5,031.36 ","$5,031.36 ","$2,822.24 ","$5,031.36 ","$5,362.25 ","$5,578.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,367.00 ","$6,693.60 ","$6,693.60 ","$2,822.24 ","$6,693.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,156.00 ", N/A ,"$9,482.60 ","$7,055.60 ","$7,251.40 ","$2,822.24 ","$11,156.00 ","$6,247.36 ","$2,822.24 ","$2,934.03 ", N/A ,"$1,794.80 ","$1,713.22 ","$2,963.35 ","$8,924.80 ","$6,350.04 ","$5,031.36 ","$3,123.68 ","$10,040.40 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,354.88 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$3,230.00 ","$2,099.50 ",$135.95 ,"$3,230.00 ","$1,332.25 ","$2,125.00 ","$1,808.80 ",$532.90 ,$904.40 ,"$1,091.74 ",$532.90 ,"$1,256.47 ",$532.90 ,"$1,456.73 ","$1,456.73 ",$532.90 ,"$1,456.73 ","$1,012.50 ","$1,615.00 ","$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,"$2,422.50 ","$1,938.00 ","$1,938.00 ",$532.90 ,"$1,938.00 ","$2,454.80 ","$2,454.80 ","$2,454.80 ","$3,230.00 ", N/A ,"$2,745.50 ","$1,332.24 ","$2,099.50 ",$532.90 ,"$3,230.00 ","$1,808.80 ",$532.90 ,$849.49 , N/A ,$149.55 ,$142.75 ,$559.55 ,"$2,584.00 ","$1,199.01 ","$1,456.73 ",$904.40 ,"$2,907.00 ",$532.90 ,"$2,454.80 ","$1,500.00 ","$1,500.00 ",$532.90 ,"$1,500.00 ","$1,550.40 ",$135.95 
ST. ELIZABETH'S HOSPITAL,36000142,36590,HC REM TNL CV ACC W/PORT/PUMP,360,1 ,"$3,230.00 ","$2,099.50 ",$849.49 ,"$3,465.89 ","$3,465.88 ","$2,125.00 ","$1,808.80 ","$1,386.35 ",$904.40 ,"$1,091.74 ","$1,386.35 ","$1,256.47 ","$1,386.35 ","$1,456.73 ","$1,456.73 ","$1,386.35 ","$1,456.73 ","$2,634.07 ","$1,615.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$2,422.50 ","$1,938.00 ","$1,938.00 ","$1,386.35 ","$1,938.00 ","$2,454.80 ","$2,454.80 ","$2,454.80 ","$3,230.00 ", N/A ,"$2,745.50 ","$3,230.00 ","$2,099.50 ","$1,386.35 ","$3,230.00 ","$1,808.80 ","$1,386.35 ",$849.49 , N/A ,"$1,359.03 ","$1,297.25 ","$1,455.67 ","$2,584.00 ","$3,119.30 ","$1,456.73 ",$904.40 ,"$2,907.00 ","$1,386.35 ","$2,454.80 ","$1,890.00 ","$1,890.00 ","$1,386.35 ","$1,890.00 ","$1,550.40 ","$1,235.48 "
ST. ELIZABETH'S HOSPITAL,36000144,36595,HC REM PERICATHETER MAT CV DEV,360,1 ,"$1,300.00 ",$845.00 ,$341.90 ,"$7,055.60 ","$7,055.60 ","$1,300.00 ",$728.00 ,"$2,822.24 ",$364.00 ,$439.40 ,"$2,822.24 ",$505.70 ,"$1,300.00 ",$586.30 ,$586.30 ,"$1,300.00 ",$586.30 ,"$1,300.00 ",$650.00 ,"$7,055.60 ","$2,822.24 ","$2,822.24 ","$1,300.00 ",$975.00 ,$780.00 ,$780.00 ,"$2,822.24 ",$780.00 ,$988.00 ,$988.00 ,$988.00 ,"$1,300.00 ", N/A ,"$1,105.00 ","$1,300.00 ",$845.00 ,"$2,822.24 ","$1,300.00 ",$728.00 ,"$2,822.24 ",$341.90 , N/A ,"$1,300.00 ","$1,297.25 ","$2,963.35 ","$1,040.00 ","$6,350.04 ",$586.30 ,$364.00 ,"$1,170.00 ","$2,822.24 ",$988.00 ,"$1,300.00 ","$1,300.00 ","$1,300.00 ","$1,300.00 ",$624.00 ,"$1,235.48 "
ST. ELIZABETH'S HOSPITAL,36000145,36596,HC REM INTRALUM MAT CV LUMEN,360,1 ,"$4,319.00 ","$2,807.35 ",$135.95 ,"$4,319.00 ","$3,465.88 ","$2,125.00 ","$2,418.64 ","$1,386.35 ","$1,209.32 ","$1,459.82 ","$1,386.35 ","$1,680.09 ","$1,386.35 ","$1,947.87 ","$1,947.87 ","$1,386.35 ","$1,947.87 ","$2,634.07 ","$2,159.50 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$3,239.25 ","$2,591.40 ","$2,591.40 ","$1,386.35 ","$2,591.40 ","$3,282.44 ","$3,282.44 ","$3,282.44 ","$4,319.00 ", N/A ,"$3,671.15 ","$3,465.89 ","$2,807.35 ","$1,386.35 ","$4,319.00 ","$2,418.64 ","$1,386.35 ","$1,135.90 ", N/A ,$149.55 ,$142.75 ,"$1,455.67 ","$3,455.20 ","$3,119.30 ","$1,947.87 ","$1,209.32 ","$3,887.10 ","$1,386.35 ","$3,282.44 ","$1,500.00 ","$1,500.00 ","$1,386.35 ","$1,500.00 ","$2,073.12 ",$135.95 
ST. ELIZABETH'S HOSPITAL,36000146,36597,HC REPOSITION CENTRAL VENOUS CATH,360,1 ,$311.00 ,$202.15 ,$81.79 ,"$3,465.89 ","$3,465.88 ",$311.00 ,$174.16 ,"$1,386.35 ",$87.08 ,$105.12 ,"$1,386.35 ",$120.98 ,$311.00 ,$140.26 ,$140.26 ,$311.00 ,$140.26 ,$311.00 ,$155.50 ,"$3,465.89 ","$1,386.35 ","$1,386.35 ",$311.00 ,$233.25 ,$186.60 ,$186.60 ,"$1,386.35 ",$186.60 ,$236.36 ,$236.36 ,$236.36 ,$311.00 , N/A ,$264.35 ,$311.00 ,$202.15 ,"$1,386.35 ",$311.00 ,$174.16 ,"$1,386.35 ",$81.79 , N/A ,$311.00 ,$311.00 ,"$1,455.67 ",$248.80 ,"$3,119.30 ",$140.26 ,$87.08 ,$279.90 ,"$1,386.35 ",$236.36 ,$311.00 ,$311.00 ,$311.00 ,$311.00 ,$149.28 ,"$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,"$1,226.00 ",$796.90 ,$322.44 ,"$2,565.01 ", N/A ,"$1,226.00 ",$686.56 , N/A ,$343.28 ,$414.39 , N/A ,$476.91 , N/A ,$552.93 ,$552.93 , N/A ,$552.93 , N/A ,$613.00 , N/A , N/A , N/A , N/A ,$919.50 ,$735.60 ,$735.60 , N/A ,$735.60 ,$931.76 ,$931.76 ,$931.76 ,"$1,226.00 ", N/A ,"$1,042.10 ", N/A ,$796.90 , N/A ,"$1,226.00 ",$686.56 , N/A ,$322.44 , N/A ,"$1,226.00 ","$1,226.00 ", N/A ,$980.80 , N/A ,$552.93 ,$343.28 ,"$1,103.40 ", N/A ,$931.76 ,$920.00 ,$920.00 , N/A ,$920.00 ,$588.48 ,"$2,565.01 "
ST. ELIZABETH'S HOSPITAL,36000158,38221,HC BX BONE MARROW ONLY,360,1 ,"$2,368.00 ","$1,539.20 ",$583.08 ,"$3,467.90 ","$3,467.90 ","$2,125.00 ","$1,326.08 ","$1,387.16 ",$663.04 ,$800.38 ,"$1,387.16 ",$921.15 ,"$1,387.16 ","$1,067.97 ","$1,067.97 ","$1,387.16 ","$1,067.97 ","$2,368.00 ","$1,184.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,776.00 ","$1,420.80 ","$1,420.80 ","$1,387.16 ","$1,420.80 ","$1,799.68 ","$1,799.68 ","$1,799.68 ","$2,368.00 ", N/A ,"$2,012.80 ","$2,368.00 ","$1,539.20 ","$1,387.16 ","$2,368.00 ","$1,326.08 ","$1,387.16 ",$622.78 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$1,894.40 ","$3,121.10 ","$1,067.97 ",$663.04 ,"$2,131.20 ","$1,387.16 ","$1,799.68 ","$1,500.00 ","$1,500.00 ","$1,387.16 ","$1,500.00 ","$1,136.64 ",$583.08 
ST. ELIZABETH'S HOSPITAL,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$3,244.00 ","$2,108.60 ",$853.17 ,"$3,467.90 ","$3,467.90 ","$3,187.50 ","$1,816.64 ","$1,387.16 ",$908.32 ,"$1,096.47 ","$1,387.16 ","$1,261.92 ","$1,387.16 ","$1,463.04 ","$1,463.04 ","$1,387.16 ","$1,463.04 ","$2,635.59 ","$1,622.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,433.00 ","$1,946.40 ","$1,946.40 ","$1,387.16 ","$1,946.40 ","$2,465.44 ","$2,465.44 ","$2,465.44 ","$3,244.00 ", N/A ,"$2,757.40 ","$3,244.00 ","$2,108.60 ","$1,387.16 ","$3,244.00 ","$1,816.64 ","$1,387.16 ",$853.17 , N/A ,"$1,019.27 ",$972.94 ,"$1,456.52 ","$2,595.20 ","$3,121.10 ","$1,463.04 ",$908.32 ,"$2,919.60 ","$1,387.16 ","$2,465.44 ","$2,835.00 ","$2,835.00 ","$1,387.16 ","$2,835.00 ","$1,557.12 ",$926.61 
ST. ELIZABETH'S HOSPITAL,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$2,287.00 ","$1,486.55 ",$601.48 ,"$3,467.90 ","$3,467.90 ","$2,125.00 ","$1,280.72 ","$1,387.16 ",$640.36 ,$773.01 ,"$1,387.16 ",$889.64 ,"$1,387.16 ","$1,031.44 ","$1,031.44 ","$1,387.16 ","$1,031.44 ","$2,287.00 ","$1,143.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,715.25 ","$1,372.20 ","$1,372.20 ","$1,387.16 ","$1,372.20 ","$1,738.12 ","$1,738.12 ","$1,738.12 ","$2,287.00 ", N/A ,"$1,943.95 ","$2,287.00 ","$1,486.55 ","$1,387.16 ","$2,287.00 ","$1,280.72 ","$1,387.16 ",$601.48 , N/A ,$679.51 ,$648.63 ,"$1,456.52 ","$1,829.60 ","$3,121.10 ","$1,031.44 ",$640.36 ,"$2,058.30 ","$1,387.16 ","$1,738.12 ","$1,890.00 ","$1,890.00 ","$1,387.16 ","$1,890.00 ","$1,097.76 ",$617.74 
ST. ELIZABETH'S HOSPITAL,36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,$993.00 ,$645.45 ,$261.16 ,$993.00 ,$929.10 ,$993.00 ,$556.08 ,$371.64 ,$278.04 ,$335.63 ,$371.64 ,$386.28 ,$371.64 ,$447.84 ,$447.84 ,$371.64 ,$447.84 ,$706.11 ,$496.50 ,$929.10 ,$371.64 ,$371.64 ,$379.07 ,$744.75 ,$595.80 ,$595.80 ,$371.64 ,$595.80 ,$754.68 ,$754.68 ,$754.68 ,$993.00 , N/A ,$844.05 ,$929.10 ,$645.45 ,$371.64 ,$993.00 ,$556.08 ,$371.64 ,$261.16 , N/A , N/A , N/A ,$390.22 ,$794.40 ,$836.19 ,$447.84 ,$278.04 ,$893.70 ,$371.64 ,$754.68 ,$920.00 ,$920.00 ,$371.64 ,$920.00 ,$476.64 , N/A 
ST. ELIZABETH'S HOSPITAL,36000162,38999,HC HEMIC OR LYMPHATIC SYSTEM UNLISTED,360,1 ,$724.00 ,$470.60 ,$190.41 ,"$2,319.94 ",$978.28 ,$724.00 ,$405.44 ,$391.31 ,$202.72 ,$244.71 ,$391.31 ,$281.64 ,$391.31 ,$326.52 ,$326.52 ,$391.31 ,$326.52 ,$724.00 ,$362.00 ,$978.28 ,$391.31 ,$391.31 ,$399.14 ,$543.00 ,$434.40 ,$434.40 ,$391.31 ,$434.40 ,$550.24 ,$550.24 ,$550.24 ,$724.00 , N/A ,$615.40 ,$724.00 ,$470.60 ,$391.31 ,$724.00 ,$405.44 ,$391.31 ,$190.41 , N/A ,$724.00 ,$724.00 ,$410.88 ,$579.20 ,$880.45 ,$326.52 ,$202.72 ,$651.60 ,$391.31 ,$550.24 ,$724.00 ,$724.00 ,$391.31 ,$724.00 ,$347.52 ,"$2,319.94 "
ST. ELIZABETH'S HOSPITAL,36000171,47490,HC CHOLECYSTOSTOMY PERC,360,1 ,"$8,869.00 ","$5,764.85 ","$1,613.78 ","$8,869.00 ","$7,841.65 ","$7,500.00 ","$4,966.64 ","$3,136.66 ","$2,483.32 ","$2,997.72 ","$3,136.66 ","$3,450.04 ","$3,136.66 ","$3,999.92 ","$3,999.92 ","$3,136.66 ","$3,999.92 ","$5,959.66 ","$4,434.50 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$6,651.75 ","$5,321.40 ","$5,321.40 ","$3,136.66 ","$5,321.40 ","$6,740.44 ","$6,740.44 ","$6,740.44 ","$8,869.00 ", N/A ,"$7,538.65 ","$7,841.66 ","$5,764.85 ","$3,136.66 ","$8,869.00 ","$4,966.64 ","$3,136.66 ","$2,332.55 ", N/A ,"$1,775.16 ","$1,694.47 ","$3,293.49 ","$7,095.20 ","$7,057.49 ","$3,999.92 ","$2,483.32 ","$7,982.10 ","$3,136.66 ","$6,740.44 ","$3,600.00 ","$3,600.00 ","$3,136.66 ","$3,600.00 ","$4,257.12 ","$1,613.78 "
ST. ELIZABETH'S HOSPITAL,36000176,49418,HC INSERT INTRAPERITONEAL CATH,360,1 ,"$13,532.00 ","$8,795.80 ",$577.21 ,"$13,532.00 ","$7,841.65 ","$3,200.00 ","$7,577.92 ","$3,136.66 ","$3,788.96 ","$4,573.82 ","$3,136.66 ","$5,263.95 ","$3,136.66 ","$6,102.93 ","$6,102.93 ","$3,136.66 ","$6,102.93 ","$5,959.66 ","$6,766.00 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$3,199.40 ","$10,149.00 ","$8,119.20 ","$8,119.20 ","$3,136.66 ","$8,119.20 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$13,532.00 ", N/A ,"$11,502.20 ","$7,841.66 ","$8,795.80 ","$3,136.66 ","$13,532.00 ","$7,577.92 ","$3,136.66 ","$3,558.92 ", N/A ,$634.93 ,$606.07 ,"$3,293.49 ","$10,825.60 ","$7,057.49 ","$6,102.93 ","$3,788.96 ","$12,178.80 ","$3,136.66 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$3,136.66 ","$3,600.00 ","$6,495.36 ",$577.21 
ST. ELIZABETH'S HOSPITAL,36000178,49422,HC REM CATH INTRAPERITONEAL,360,1 ,"$11,156.00 ","$7,251.40 ",$663.14 ,"$11,156.00 ","$7,055.60 ","$2,125.00 ","$6,247.36 ","$2,822.24 ","$3,123.68 ","$3,770.73 ","$2,822.24 ","$4,339.68 ","$2,822.24 ","$5,031.36 ","$5,031.36 ","$2,822.24 ","$5,031.36 ","$5,362.25 ","$5,578.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,367.00 ","$6,693.60 ","$6,693.60 ","$2,822.24 ","$6,693.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,156.00 ", N/A ,"$9,482.60 ","$7,055.60 ","$7,251.40 ","$2,822.24 ","$11,156.00 ","$6,247.36 ","$2,822.24 ","$2,934.03 ", N/A ,$729.45 ,$696.30 ,"$2,963.35 ","$8,924.80 ","$6,350.04 ","$5,031.36 ","$3,123.68 ","$10,040.40 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,354.88 ",$663.14 
ST. ELIZABETH'S HOSPITAL,36000183,51710,HC CHG TUBE CYSTOSTOMY CPLX,360,1 ,"$2,597.00 ","$1,688.05 ",$200.34 ,"$2,597.00 ","$1,417.95 ","$2,125.00 ","$1,454.32 ",$567.18 ,$727.16 ,$877.79 ,$567.18 ,"$1,010.23 ",$567.18 ,"$1,171.25 ","$1,171.25 ",$567.18 ,"$1,171.25 ","$1,077.65 ","$1,298.50 ","$1,417.96 ",$567.18 ,$567.18 ,$578.53 ,"$1,947.75 ","$1,558.20 ","$1,558.20 ",$567.18 ,"$1,558.20 ","$1,973.72 ","$1,973.72 ","$1,973.72 ","$2,597.00 ", N/A ,"$2,207.45 ","$1,417.96 ","$1,688.05 ",$567.18 ,"$2,597.00 ","$1,454.32 ",$567.18 ,$683.01 , N/A ,$220.37 ,$210.36 ,$595.54 ,"$2,077.60 ","$1,276.16 ","$1,171.25 ",$727.16 ,"$2,337.30 ",$567.18 ,"$1,973.72 ","$1,500.00 ","$1,500.00 ",$567.18 ,"$1,500.00 ","$1,246.56 ",$200.34 
ST. ELIZABETH'S HOSPITAL,36000188,55700,HC BX PROSTATE NEEDLE/PUNCH,360,1 ,"$3,858.00 ","$2,507.70 ","$1,014.65 ","$4,413.08 ","$4,413.08 ","$3,200.00 ","$2,160.48 ","$1,765.23 ","$1,080.24 ","$1,304.00 ","$1,765.23 ","$1,500.76 ","$1,765.23 ","$1,739.96 ","$1,739.96 ","$1,765.23 ","$1,739.96 ","$3,353.94 ","$1,929.00 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$2,893.50 ","$2,314.80 ","$2,314.80 ","$1,765.23 ","$2,314.80 ","$2,932.08 ","$2,932.08 ","$2,932.08 ","$3,858.00 ", N/A ,"$3,279.30 ","$3,858.00 ","$2,507.70 ","$1,765.23 ","$3,858.00 ","$2,160.48 ","$1,765.23 ","$1,014.65 ", N/A ,"$1,217.58 ","$1,162.23 ","$1,853.49 ","$3,086.40 ","$3,971.77 ","$1,739.96 ","$1,080.24 ","$3,472.20 ","$1,765.23 ","$2,932.08 ","$1,890.00 ","$1,890.00 ","$1,765.23 ","$1,890.00 ","$1,851.84 ","$1,106.89 "
ST. ELIZABETH'S HOSPITAL,36000190,61624,HC OCC/EMB TRANSCATH CNS PERC,360,1 ,"$7,297.00 ","$4,743.05 ","$1,919.11 ","$7,297.00 ", N/A ,"$7,297.00 ","$4,086.32 ", N/A ,"$2,043.16 ","$2,466.39 ", N/A ,"$2,838.53 ", N/A ,"$3,290.95 ","$3,290.95 ", N/A ,"$3,290.95 ", N/A ,"$3,648.50 ", N/A , N/A , N/A , N/A ,"$5,472.75 ","$4,378.20 ","$4,378.20 ", N/A ,"$4,378.20 ","$5,545.72 ","$5,545.72 ","$5,545.72 ","$7,297.00 ", N/A ,"$6,202.45 ", N/A ,"$4,743.05 ", N/A ,"$7,297.00 ","$4,086.32 ", N/A ,"$1,919.11 ", N/A ,"$4,198.04 ","$4,007.22 ", N/A ,"$5,837.60 ", N/A ,"$3,290.95 ","$2,043.16 ","$6,567.30 ", N/A ,"$5,545.72 ","$5,500.00 ","$5,500.00 ", N/A ,"$5,500.00 ","$3,502.56 ","$3,816.40 "
ST. ELIZABETH'S HOSPITAL,36000191,61626,HC OCC/EMB TRANSCATH EXT CRAN VSS,360,1 ,"$30,211.00 ","$19,637.15 ","$3,816.40 ","$30,211.00 ","$24,756.83 ","$6,000.00 ","$16,918.16 ","$9,902.73 ","$8,459.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$15,105.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,658.25 ","$18,126.60 ","$18,126.60 ","$9,902.73 ","$18,126.60 ","$22,960.36 ","$22,960.36 ","$22,960.36 ","$30,211.00 ", N/A ,"$25,679.35 ","$24,756.81 ","$19,637.15 ","$9,902.73 ","$30,211.00 ","$16,918.16 ","$9,902.73 ","$7,945.49 ", N/A ,"$4,198.04 ","$4,007.22 ","$10,397.87 ","$24,168.80 ","$22,281.13 ","$6,645.60 ","$8,459.08 ","$27,189.90 ","$9,902.73 ","$22,960.36 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$14,501.28 ","$3,816.40 "
ST. ELIZABETH'S HOSPITAL,36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,700.00 ","$1,105.00 ",$447.10 ,"$1,700.00 ","$1,565.08 ","$1,700.00 ",$952.00 ,$626.03 ,$476.00 ,$574.60 ,$626.03 ,$661.30 ,$626.03 ,$766.70 ,$766.70 ,$626.03 ,$766.70 ,"$1,189.46 ",$850.00 ,"$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,275.00 ","$1,020.00 ","$1,020.00 ",$626.03 ,"$1,020.00 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,700.00 ", N/A ,"$1,445.00 ","$1,565.07 ","$1,105.00 ",$626.03 ,"$1,700.00 ",$952.00 ,$626.03 ,$447.10 , N/A ,$544.79 ,$520.02 ,$657.33 ,"$1,360.00 ","$1,408.57 ",$766.70 ,$476.00 ,"$1,530.00 ",$626.03 ,"$1,292.00 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ",$816.00 ,$495.26 
ST. ELIZABETH'S HOSPITAL,36000216,50593,HC ABLATION RENAL PERC CRYO,360,1 ,"$32,942.00 ","$21,412.30 ","$2,213.24 ","$32,942.00 ","$21,952.48 ","$5,500.00 ","$18,447.52 ","$8,780.99 ","$9,223.76 ","$11,134.40 ","$8,780.99 ","$12,814.44 ","$8,780.99 ","$6,645.60 ","$6,645.60 ","$8,780.99 ","$6,645.60 ","$16,683.89 ","$16,471.00 ","$21,952.49 ","$8,780.99 ","$8,780.99 ","$8,956.61 ","$24,706.50 ","$19,765.20 ","$19,765.20 ","$8,780.99 ","$19,765.20 ","$25,035.92 ","$25,035.92 ","$25,035.92 ","$32,942.00 ", N/A ,"$28,000.70 ","$21,952.49 ","$21,412.30 ","$8,780.99 ","$32,942.00 ","$18,447.52 ","$8,780.99 ","$8,663.75 ", N/A ,"$2,434.56 ","$2,323.90 ","$9,220.04 ","$26,353.60 ","$19,757.24 ","$6,645.60 ","$9,223.76 ","$29,647.80 ","$8,780.99 ","$25,035.92 ","$4,800.00 ","$4,800.00 ","$8,780.99 ","$4,800.00 ","$15,812.16 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,36000222,36571,HC INS CATH PERIPH CV W/PORT >5,360,1 ,"$11,156.00 ","$7,251.40 ","$1,631.64 ","$11,156.00 ","$7,055.60 ","$4,200.00 ","$6,247.36 ","$2,822.24 ","$3,123.68 ","$3,770.73 ","$2,822.24 ","$4,339.68 ","$2,822.24 ","$5,031.36 ","$5,031.36 ","$2,822.24 ","$5,031.36 ","$5,362.25 ","$5,578.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,367.00 ","$6,693.60 ","$6,693.60 ","$2,822.24 ","$6,693.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,156.00 ", N/A ,"$9,482.60 ","$7,055.60 ","$7,251.40 ","$2,822.24 ","$11,156.00 ","$6,247.36 ","$2,822.24 ","$2,934.03 ", N/A ,"$1,794.80 ","$1,713.22 ","$2,963.35 ","$8,924.80 ","$6,350.04 ","$5,031.36 ","$3,123.68 ","$10,040.40 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,354.88 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,36000250,49419,HC INSERT TUN IP CATH W/PORT,360,1 ,"$18,545.00 ","$12,054.25 ",$663.14 ,"$18,545.00 ","$11,753.38 ","$3,200.00 ","$10,385.20 ","$4,701.35 ","$5,192.60 ","$4,859.14 ","$4,701.35 ","$5,584.90 ","$4,701.35 ","$6,645.60 ","$6,645.60 ","$4,701.35 ","$6,645.60 ","$8,932.56 ","$9,272.50 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$13,908.75 ","$11,127.00 ","$11,127.00 ","$4,701.35 ","$11,127.00 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$18,545.00 ", N/A ,"$15,763.25 ","$11,753.37 ","$12,054.25 ","$4,701.35 ","$18,545.00 ","$10,385.20 ","$4,701.35 ","$4,877.34 ", N/A ,$729.45 ,$696.30 ,"$4,936.42 ","$14,836.00 ","$10,578.04 ","$6,645.60 ","$5,192.60 ","$16,690.50 ","$4,701.35 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$4,701.35 ","$4,800.00 ","$8,901.60 ",$663.14 
ST. ELIZABETH'S HOSPITAL,36000251,50592,HC ABLATION RENAL PERC RADIOFREQ,360,1 ,"$19,848.00 ","$12,901.20 ","$2,213.24 ","$19,848.00 ","$12,471.18 ","$5,000.00 ","$11,114.88 ","$4,988.47 ","$5,557.44 ","$4,859.14 ","$4,988.47 ","$5,584.90 ","$4,988.47 ","$6,645.60 ","$6,645.60 ","$4,988.47 ","$6,645.60 ","$9,478.10 ","$9,924.00 ","$12,471.19 ","$4,988.47 ","$4,988.47 ","$5,088.24 ","$14,886.00 ","$11,908.80 ","$11,908.80 ","$4,988.47 ","$11,908.80 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$19,848.00 ", N/A ,"$16,870.80 ","$12,471.19 ","$12,901.20 ","$4,988.47 ","$19,848.00 ","$11,114.88 ","$4,988.47 ","$5,220.02 ", N/A ,"$2,434.56 ","$2,323.90 ","$5,237.89 ","$15,878.40 ","$11,224.07 ","$6,645.60 ","$5,557.44 ","$17,863.20 ","$4,988.47 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$4,988.47 ","$4,800.00 ","$9,527.04 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,36000310,64421,HC INJ ANES INTERCOSTAL NERVE EA ADDNT LEVEL,360,1 ,"$3,902.00 ","$2,536.30 ",$421.56 ,"$3,902.00 ","$2,028.93 ","$2,125.00 ","$2,185.12 ",$811.57 ,"$1,092.56 ","$1,318.88 ",$811.57 ,"$1,517.88 ",$811.57 ,"$1,759.80 ","$1,759.80 ",$811.57 ,"$1,759.80 ","$1,541.99 ","$1,951.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,926.50 ","$2,341.20 ","$2,341.20 ",$811.57 ,"$2,341.20 ","$2,965.52 ","$2,965.52 ","$2,965.52 ","$3,902.00 ", N/A ,"$3,316.70 ","$2,028.93 ","$2,536.30 ",$811.57 ,"$3,902.00 ","$2,185.12 ",$811.57 ,"$1,026.23 ", N/A ,$463.72 ,$442.64 ,$852.15 ,"$3,121.60 ","$1,826.04 ","$1,759.80 ","$1,092.56 ","$3,511.80 ",$811.57 ,"$2,965.52 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$1,872.96 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36000311,64420,HC INJ INTERCOSTAL NERVE;SINGLE,360,1 ,"$2,347.00 ","$1,525.55 ",$421.56 ,"$2,347.00 ","$1,565.08 ","$2,125.00 ","$1,314.32 ",$626.03 ,$657.16 ,$793.29 ,$626.03 ,$912.98 ,$626.03 ,"$1,058.50 ","$1,058.50 ",$626.03 ,"$1,058.50 ","$1,189.46 ","$1,173.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,760.25 ","$1,408.20 ","$1,408.20 ",$626.03 ,"$1,408.20 ","$1,783.72 ","$1,783.72 ","$1,783.72 ","$2,347.00 ", N/A ,"$1,994.95 ","$1,565.07 ","$1,525.55 ",$626.03 ,"$2,347.00 ","$1,314.32 ",$626.03 ,$617.26 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$1,877.60 ","$1,408.57 ","$1,058.50 ",$657.16 ,"$2,112.30 ",$626.03 ,"$1,783.72 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,126.56 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36000313,64493,HC INJ FACET LUMBO SACRAL;SINGLE,360,1 ,"$2,413.00 ","$1,568.45 ",$634.62 ,"$2,413.00 ","$2,028.93 ","$2,125.00 ","$1,351.28 ",$811.57 ,$675.64 ,$815.59 ,$811.57 ,$938.66 ,$811.57 ,"$1,088.26 ","$1,088.26 ",$811.57 ,"$1,088.26 ","$1,541.99 ","$1,206.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$1,809.75 ","$1,447.80 ","$1,447.80 ",$811.57 ,"$1,447.80 ","$1,833.88 ","$1,833.88 ","$1,833.88 ","$2,413.00 ", N/A ,"$2,051.05 ","$2,028.93 ","$1,568.45 ",$811.57 ,"$2,413.00 ","$1,351.28 ",$811.57 ,$634.62 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$1,930.40 ","$1,826.04 ","$1,088.26 ",$675.64 ,"$2,171.70 ",$811.57 ,"$1,833.88 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$1,158.24 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36000314,64494,HC INJ FACET LUMBO/SACRAL;2ND LEVEL,360,1 ,"$3,102.00 ","$2,016.30 ",$815.83 ,"$3,102.00 ", N/A ,"$3,102.00 ","$1,737.12 ", N/A ,$868.56 ,"$1,048.48 ", N/A ,"$1,206.68 ", N/A ,"$1,399.00 ","$1,399.00 ", N/A ,"$1,399.00 ", N/A ,"$1,551.00 ", N/A , N/A , N/A , N/A ,"$2,326.50 ","$1,861.20 ","$1,861.20 ", N/A ,"$1,861.20 ","$2,357.52 ","$2,357.52 ","$2,357.52 ","$3,102.00 ", N/A ,"$2,636.70 ", N/A ,"$2,016.30 ", N/A ,"$3,102.00 ","$1,737.12 ", N/A ,$815.83 , N/A ,"$1,261.50 ","$1,204.16 ", N/A ,"$2,481.60 ", N/A ,"$1,399.00 ",$868.56 ,"$2,791.80 ", N/A ,"$2,357.52 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$1,488.96 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36000314,64494,HC INJ FACET LUMBO/SACRAL;2ND LEVEL,360,1 ,"$2,068.00 ","$1,344.20 ",$543.88 ,"$2,068.00 ", N/A ,"$2,068.00 ","$1,158.08 ", N/A ,$579.04 ,$698.98 , N/A ,$804.45 , N/A ,$932.67 ,$932.67 , N/A ,$932.67 , N/A ,"$1,034.00 ", N/A , N/A , N/A , N/A ,"$1,551.00 ","$1,240.80 ","$1,240.80 ", N/A ,"$1,240.80 ","$1,571.68 ","$1,571.68 ","$1,571.68 ","$2,068.00 ", N/A ,"$1,757.80 ", N/A ,"$1,344.20 ", N/A ,"$2,068.00 ","$1,158.08 ", N/A ,$543.88 , N/A ,$841.01 ,$802.78 , N/A ,"$1,654.40 ", N/A ,$932.67 ,$579.04 ,"$1,861.20 ", N/A ,"$1,571.68 ",$920.00 ,$920.00 , N/A ,$920.00 ,$992.64 ,$764.55 
ST. ELIZABETH'S HOSPITAL,36000316,64490,HC INJ FACET CER/THORACIC;SINGLE,360,1 ,"$4,343.00 ","$2,822.95 ",$764.55 ,"$4,343.00 ","$2,028.93 ","$2,125.00 ","$2,432.08 ",$811.57 ,"$1,216.04 ","$1,467.93 ",$811.57 ,"$1,689.43 ",$811.57 ,"$1,958.69 ","$1,958.69 ",$811.57 ,"$1,958.69 ","$1,541.99 ","$2,171.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$3,257.25 ","$2,605.80 ","$2,605.80 ",$811.57 ,"$2,605.80 ","$3,300.68 ","$3,300.68 ","$3,300.68 ","$4,343.00 ", N/A ,"$3,691.55 ","$2,028.93 ","$2,822.95 ",$811.57 ,"$4,343.00 ","$2,432.08 ",$811.57 ,"$1,142.21 ", N/A ,$841.01 ,$802.78 ,$852.15 ,"$3,474.40 ","$1,826.04 ","$1,958.69 ","$1,216.04 ","$3,908.70 ",$811.57 ,"$3,300.68 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$2,084.64 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36000317,64491,HC INJ FACET CER/THORACIC 2ND LEVEL,360,1 ,"$2,142.00 ","$1,392.30 ",$563.35 ,"$2,142.00 ", N/A ,"$2,125.00 ","$1,199.52 ", N/A ,$599.76 ,$724.00 , N/A ,$833.24 , N/A ,$966.04 ,$966.04 , N/A ,$966.04 , N/A ,"$1,071.00 ", N/A , N/A , N/A , N/A ,"$1,606.50 ","$1,285.20 ","$1,285.20 ", N/A ,"$1,285.20 ","$1,627.92 ","$1,627.92 ","$1,627.92 ","$2,142.00 ", N/A ,"$1,820.70 ", N/A ,"$1,392.30 ", N/A ,"$2,142.00 ","$1,199.52 ", N/A ,$563.35 , N/A ,$841.01 ,$802.78 , N/A ,"$1,713.60 ", N/A ,$966.04 ,$599.76 ,"$1,927.80 ", N/A ,"$1,627.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,028.16 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36000319,20526,HC INJECTION;CARPAL TUNNEL,360,1 ,"$1,186.00 ",$770.90 ,$257.58 ,"$1,186.00 ",$643.95 ,"$1,186.00 ",$664.16 ,$257.58 ,$332.08 ,$400.87 ,$257.58 ,$461.35 ,$257.58 ,$534.89 ,$534.89 ,$257.58 ,$534.89 ,$489.39 ,$593.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$889.50 ,$711.60 ,$711.60 ,$257.58 ,$711.60 ,$901.36 ,$901.36 ,$901.36 ,"$1,186.00 ", N/A ,"$1,008.10 ",$643.94 ,$770.90 ,$257.58 ,"$1,186.00 ",$664.16 ,$257.58 ,$311.92 , N/A ,$341.32 ,$325.80 ,$270.46 ,$948.80 ,$579.55 ,$534.89 ,$332.08 ,"$1,067.40 ",$257.58 ,$901.36 ,$920.00 ,$920.00 ,$257.58 ,$920.00 ,$569.28 ,$310.29 
ST. ELIZABETH'S HOSPITAL,36000322,64479,HC INJ TRANSF CERV/THORACIC SINGLE,360,1 ,"$3,628.00 ","$2,358.20 ",$764.55 ,"$3,628.00 ","$2,028.93 ","$2,125.00 ","$2,031.68 ",$811.57 ,"$1,015.84 ","$1,226.26 ",$811.57 ,"$1,411.29 ",$811.57 ,"$1,636.23 ","$1,636.23 ",$811.57 ,"$1,636.23 ","$1,541.99 ","$1,814.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,721.00 ","$2,176.80 ","$2,176.80 ",$811.57 ,"$2,176.80 ","$2,757.28 ","$2,757.28 ","$2,757.28 ","$3,628.00 ", N/A ,"$3,083.80 ","$2,028.93 ","$2,358.20 ",$811.57 ,"$3,628.00 ","$2,031.68 ",$811.57 ,$954.16 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,902.40 ","$1,826.04 ","$1,636.23 ","$1,015.84 ","$3,265.20 ",$811.57 ,"$2,757.28 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$1,741.44 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36000322,64479,HC INJ TRANSF CERV/THORACIC SINGLE,360,1 ,"$5,442.00 ","$3,537.30 ","$1,146.82 ","$5,442.00 ","$3,043.40 ","$3,187.50 ","$3,047.52 ","$1,217.36 ","$1,523.76 ","$1,839.40 ","$1,217.36 ","$2,116.94 ","$1,217.36 ","$2,454.34 ","$2,454.34 ","$1,217.36 ","$2,454.34 ","$2,312.98 ","$2,721.00 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,241.71 ","$4,081.50 ","$3,265.20 ","$3,265.20 ","$1,217.36 ","$3,265.20 ","$4,135.92 ","$4,135.92 ","$4,135.92 ","$5,442.00 ", N/A ,"$4,625.70 ","$3,043.40 ","$3,537.30 ","$1,217.36 ","$5,442.00 ","$3,047.52 ","$1,217.36 ","$1,431.25 ", N/A ,"$1,261.50 ","$1,204.16 ","$1,278.23 ","$4,353.60 ","$2,739.06 ","$2,454.34 ","$1,523.76 ","$4,897.80 ","$1,217.36 ","$4,135.92 ","$2,250.00 ","$2,250.00 ","$1,217.36 ","$2,250.00 ","$2,612.16 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36000324,64483,HC INJ TRANSF LUMBAR SACRAL SINGLE,360,1 ,"$6,590.00 ","$4,283.50 ","$1,146.82 ","$6,590.00 ","$3,043.40 ","$3,187.50 ","$3,690.40 ","$1,217.36 ","$1,845.20 ","$2,227.42 ","$1,217.36 ","$2,563.51 ","$1,217.36 ","$2,972.09 ","$2,972.09 ","$1,217.36 ","$2,972.09 ","$2,312.98 ","$3,295.00 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,241.71 ","$4,942.50 ","$3,954.00 ","$3,954.00 ","$1,217.36 ","$3,954.00 ","$5,008.40 ","$5,008.40 ","$5,008.40 ","$6,590.00 ", N/A ,"$5,601.50 ","$3,043.40 ","$4,283.50 ","$1,217.36 ","$6,590.00 ","$3,690.40 ","$1,217.36 ","$1,733.17 ", N/A ,"$1,261.50 ","$1,204.16 ","$1,278.23 ","$5,272.00 ","$2,739.06 ","$2,972.09 ","$1,845.20 ","$5,931.00 ","$1,217.36 ","$5,008.40 ","$2,250.00 ","$2,250.00 ","$1,217.36 ","$2,250.00 ","$3,163.20 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36000324,64483,HC INJ TRANSF LUMBAR SACRAL SINGLE,360,1 ,"$3,431.00 ","$2,230.15 ",$764.55 ,"$3,431.00 ","$2,028.93 ","$2,125.00 ","$1,921.36 ",$811.57 ,$960.68 ,"$1,159.68 ",$811.57 ,"$1,334.66 ",$811.57 ,"$1,547.38 ","$1,547.38 ",$811.57 ,"$1,547.38 ","$1,541.99 ","$1,715.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,573.25 ","$2,058.60 ","$2,058.60 ",$811.57 ,"$2,058.60 ","$2,607.56 ","$2,607.56 ","$2,607.56 ","$3,431.00 ", N/A ,"$2,916.35 ","$2,028.93 ","$2,230.15 ",$811.57 ,"$3,431.00 ","$1,921.36 ",$811.57 ,$902.35 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,744.80 ","$1,826.04 ","$1,547.38 ",$960.68 ,"$3,087.90 ",$811.57 ,"$2,607.56 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$1,646.88 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36000325,64484,HC INJ TRANSF LUMBAR SACRAL ADDL,360,1 ,"$2,525.00 ","$1,641.25 ",$664.08 ,"$2,525.00 ", N/A ,"$2,125.00 ","$1,414.00 ", N/A ,$707.00 ,$853.45 , N/A ,$982.23 , N/A ,"$1,138.78 ","$1,138.78 ", N/A ,"$1,138.78 ", N/A ,"$1,262.50 ", N/A , N/A , N/A , N/A ,"$1,893.75 ","$1,515.00 ","$1,515.00 ", N/A ,"$1,515.00 ","$1,919.00 ","$1,919.00 ","$1,919.00 ","$2,525.00 ", N/A ,"$2,146.25 ", N/A ,"$1,641.25 ", N/A ,"$2,525.00 ","$1,414.00 ", N/A ,$664.08 , N/A ,$841.01 ,$802.78 , N/A ,"$2,020.00 ", N/A ,"$1,138.78 ",$707.00 ,"$2,272.50 ", N/A ,"$1,919.00 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,212.00 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36000325,64484,HC INJ TRANSF LUMBAR SACRAL ADDL,360,1 ,"$4,867.00 ","$3,163.55 ","$1,146.82 ","$4,867.00 ", N/A ,"$3,187.50 ","$2,725.52 ", N/A ,"$1,362.76 ","$1,645.05 ", N/A ,"$1,893.26 ", N/A ,"$2,195.02 ","$2,195.02 ", N/A ,"$2,195.02 ", N/A ,"$2,433.50 ", N/A , N/A , N/A , N/A ,"$3,650.25 ","$2,920.20 ","$2,920.20 ", N/A ,"$2,920.20 ","$3,698.92 ","$3,698.92 ","$3,698.92 ","$4,867.00 ", N/A ,"$4,136.95 ", N/A ,"$3,163.55 ", N/A ,"$4,867.00 ","$2,725.52 ", N/A ,"$1,280.02 ", N/A ,"$1,261.50 ","$1,204.16 ", N/A ,"$3,893.60 ", N/A ,"$2,195.02 ","$1,362.76 ","$4,380.30 ", N/A ,"$3,698.92 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$2,336.16 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36000326,64405,HC NERVE BLOCK; OCCIPITAL,360,1 ,$743.70 ,$483.41 ,$195.59 ,$743.70 ,$643.95 ,$743.70 ,$416.47 ,$257.58 ,$208.24 ,$251.37 ,$257.58 ,$289.30 ,$257.58 ,$335.41 ,$335.41 ,$257.58 ,$335.41 ,$489.39 ,$371.85 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$557.78 ,$446.22 ,$446.22 ,$257.58 ,$446.22 ,$565.21 ,$565.21 ,$565.21 ,$743.70 , N/A ,$632.15 ,$643.94 ,$483.41 ,$257.58 ,$743.70 ,$416.47 ,$257.58 ,$195.59 , N/A ,$463.72 ,$442.64 ,$270.46 ,$594.96 ,$579.55 ,$335.41 ,$208.24 ,$669.33 ,$257.58 ,$565.21 ,$743.70 ,$743.70 ,$257.58 ,$743.70 ,$356.98 ,$421.56 
ST. ELIZABETH'S HOSPITAL,36000327,64445,HC NERVE BLOCK;SCIATIC SINGLE,360,1 ,"$2,551.00 ","$1,658.15 ",$421.56 ,"$2,551.00 ","$1,565.08 ","$2,125.00 ","$1,428.56 ",$626.03 ,$714.28 ,$862.24 ,$626.03 ,$992.34 ,$626.03 ,"$1,150.50 ","$1,150.50 ",$626.03 ,"$1,150.50 ","$1,189.46 ","$1,275.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,913.25 ","$1,530.60 ","$1,530.60 ",$626.03 ,"$1,530.60 ","$1,938.76 ","$1,938.76 ","$1,938.76 ","$2,551.00 ", N/A ,"$2,168.35 ","$1,565.07 ","$1,658.15 ",$626.03 ,"$2,551.00 ","$1,428.56 ",$626.03 ,$670.91 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$2,040.80 ","$1,408.57 ","$1,150.50 ",$714.28 ,"$2,295.90 ",$626.03 ,"$1,938.76 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,224.48 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36000331,64520,HC NERVE BLOCK;L/S PARAVERTEBAL SYMP,360,1 ,"$2,674.00 ","$1,738.10 ",$703.26 ,"$2,674.00 ","$2,028.93 ","$2,125.00 ","$1,497.44 ",$811.57 ,$748.72 ,$903.81 ,$811.57 ,"$1,040.19 ",$811.57 ,"$1,205.97 ","$1,205.97 ",$811.57 ,"$1,205.97 ","$1,541.99 ","$1,337.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,005.50 ","$1,604.40 ","$1,604.40 ",$811.57 ,"$1,604.40 ","$2,032.24 ","$2,032.24 ","$2,032.24 ","$2,674.00 ", N/A ,"$2,272.90 ","$2,028.93 ","$1,738.10 ",$811.57 ,"$2,674.00 ","$1,497.44 ",$811.57 ,$703.26 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,139.20 ","$1,826.04 ","$1,205.97 ",$748.72 ,"$2,406.60 ",$811.57 ,"$2,032.24 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$1,283.52 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36000334,63650,HC IMPLANT NEUROELECTRODES,360,1 ,"$14,067.00 ","$9,143.55 ","$3,200.00 ","$15,192.81 ","$15,192.80 ","$3,200.00 ","$7,877.52 ","$6,077.12 ","$3,938.76 ","$4,754.65 ","$6,077.12 ","$5,472.06 ","$6,077.12 ","$6,344.22 ","$6,344.22 ","$6,077.12 ","$6,344.22 ","$11,546.54 ","$7,033.50 ","$15,192.81 ","$6,077.12 ","$6,077.12 ","$6,198.67 ","$10,550.25 ","$8,440.20 ","$8,440.20 ","$6,077.12 ","$8,440.20 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$14,067.00 ", N/A ,"$11,956.95 ","$14,067.00 ","$9,143.55 ","$6,077.12 ","$14,067.00 ","$7,877.52 ","$6,077.12 ","$3,699.62 ", N/A ,"$5,170.04 ","$4,935.04 ","$6,380.98 ","$11,253.60 ","$13,673.53 ","$6,344.22 ","$3,938.76 ","$12,660.30 ","$6,077.12 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$6,077.12 ","$4,800.00 ","$6,752.16 ","$4,700.04 "
ST. ELIZABETH'S HOSPITAL,36000352,37192,HC IVC FILTER REPOSITIONING 37192,360,1 ,"$10,517.00 ","$6,836.05 ","$2,765.97 ","$10,517.00 ","$7,055.60 ","$4,200.00 ","$5,889.52 ","$2,822.24 ","$2,944.76 ","$3,554.75 ","$2,822.24 ","$4,091.11 ","$2,822.24 ","$4,743.17 ","$4,743.17 ","$2,822.24 ","$4,743.17 ","$5,362.25 ","$5,258.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$7,887.75 ","$6,310.20 ","$6,310.20 ","$2,822.24 ","$6,310.20 ","$7,992.92 ","$7,992.92 ","$7,992.92 ","$10,517.00 ", N/A ,"$8,939.45 ","$7,055.60 ","$6,836.05 ","$2,822.24 ","$10,517.00 ","$5,889.52 ","$2,822.24 ","$2,765.97 ", N/A ,"$3,285.62 ","$3,136.28 ","$2,963.35 ","$8,413.60 ","$6,350.04 ","$4,743.17 ","$2,944.76 ","$9,465.30 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,048.16 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,36000355,36831,HC THROMBECTOMY OPEN AV FISTULA W/O REVISION,360,1 ,"$1,246.00 ",$809.90 ,$327.70 ,"$11,753.38 ","$11,753.38 ","$1,246.00 ",$697.76 ,"$4,701.35 ",$348.88 ,$421.15 ,"$4,701.35 ",$484.69 ,"$1,246.00 ",$561.95 ,$561.95 ,"$1,246.00 ",$561.95 ,"$1,246.00 ",$623.00 ,"$11,753.37 ","$4,701.35 ","$4,701.35 ","$1,246.00 ",$934.50 ,$747.60 ,$747.60 ,"$4,701.35 ",$747.60 ,$946.96 ,$946.96 ,$946.96 ,"$1,246.00 ", N/A ,"$1,059.10 ","$1,246.00 ",$809.90 ,"$4,701.35 ","$1,246.00 ",$697.76 ,"$4,701.35 ",$327.70 , N/A ,"$1,246.00 ","$1,246.00 ","$4,936.42 ",$996.80 ,"$10,578.04 ",$561.95 ,$348.88 ,"$1,121.40 ","$4,701.35 ",$946.96 ,"$1,246.00 ","$1,246.00 ","$1,246.00 ","$1,246.00 ",$598.08 ,"$2,986.93 "
ST. ELIZABETH'S HOSPITAL,36000359,33880,HC ENDOVASC REPAIR TAA W/LT SUBCLVN ARTERY,360,1 ,"$9,428.00 ","$6,128.20 ","$1,635.00 ","$9,428.00 ", N/A ,"$7,500.00 ","$5,279.68 ", N/A ,"$2,639.84 ","$3,186.66 ", N/A ,"$3,667.49 ", N/A ,"$4,252.03 ","$4,252.03 ", N/A ,"$4,252.03 ", N/A ,"$4,714.00 ", N/A , N/A , N/A , N/A ,"$7,071.00 ","$5,656.80 ","$5,656.80 ", N/A ,"$5,656.80 ","$7,165.28 ","$7,165.28 ","$7,165.28 ","$9,428.00 ", N/A ,"$8,013.80 ", N/A ,"$6,128.20 ", N/A ,"$9,428.00 ","$5,279.68 ", N/A ,"$2,479.56 ", N/A , N/A , N/A , N/A ,"$7,542.40 ", N/A ,"$4,252.03 ","$2,639.84 ","$8,485.20 ", N/A ,"$7,165.28 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$4,525.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000360,33881,HC ENDOVASC REPAIR TAA W/O LT SUBCLVN ARTERY,360,1 ,"$9,428.00 ","$6,128.20 ","$1,635.00 ","$9,428.00 ", N/A ,"$7,500.00 ","$5,279.68 ", N/A ,"$2,639.84 ","$3,186.66 ", N/A ,"$3,667.49 ", N/A ,"$4,252.03 ","$4,252.03 ", N/A ,"$4,252.03 ", N/A ,"$4,714.00 ", N/A , N/A , N/A , N/A ,"$7,071.00 ","$5,656.80 ","$5,656.80 ", N/A ,"$5,656.80 ","$7,165.28 ","$7,165.28 ","$7,165.28 ","$9,428.00 ", N/A ,"$8,013.80 ", N/A ,"$6,128.20 ", N/A ,"$9,428.00 ","$5,279.68 ", N/A ,"$2,479.56 ", N/A , N/A , N/A , N/A ,"$7,542.40 ", N/A ,"$4,252.03 ","$2,639.84 ","$8,485.20 ", N/A ,"$7,165.28 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$4,525.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000361,33883,HC PLACE ENDOVASC PROSTHESIS PROXM EXT TAA INIT,360,1 ,"$16,193.00 ","$10,525.45 ","$1,635.00 ","$16,193.00 ", N/A ,"$7,500.00 ","$9,068.08 ", N/A ,"$4,534.04 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$8,096.50 ", N/A , N/A , N/A , N/A ,"$12,144.75 ","$9,715.80 ","$9,715.80 ", N/A ,"$9,715.80 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$16,193.00 ", N/A ,"$13,764.05 ", N/A ,"$10,525.45 ", N/A ,"$16,193.00 ","$9,068.08 ", N/A ,"$4,258.76 ", N/A , N/A , N/A , N/A ,"$12,954.40 ", N/A ,"$6,645.60 ","$4,534.04 ","$14,573.70 ", N/A ,"$7,301.00 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$7,772.64 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000386,59320,HC CERCLAGE CERVIX VAGINAL W/PREG,360,1 ,"$12,271.00 ","$7,976.15 ","$2,125.00 ","$12,271.00 ","$6,466.58 ","$2,125.00 ","$6,871.76 ","$2,586.63 ","$3,435.88 ","$4,147.60 ","$2,586.63 ","$4,773.42 ","$2,586.63 ","$5,534.22 ","$5,534.22 ","$2,586.63 ","$5,534.22 ","$4,914.60 ","$6,135.50 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$9,203.25 ","$7,362.60 ","$7,362.60 ","$2,586.63 ","$7,362.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$12,271.00 ", N/A ,"$10,430.35 ","$6,466.58 ","$7,976.15 ","$2,586.63 ","$12,271.00 ","$6,871.76 ","$2,586.63 ","$3,227.27 ", N/A , N/A , N/A ,"$2,715.96 ","$9,816.80 ","$5,819.92 ","$5,534.22 ","$3,435.88 ","$11,043.90 ","$2,586.63 ","$7,301.00 ","$2,690.00 ","$2,690.00 ","$2,586.63 ","$2,690.00 ","$5,890.08 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000393,61645,HC PERC ART THROMBECTOMY/INFUS W/GUID,360,1 ,"$18,656.00 ","$12,126.40 ","$1,635.00 ","$18,656.00 ", N/A ,"$6,000.00 ","$10,447.36 ", N/A ,"$5,223.68 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$9,328.00 ", N/A , N/A , N/A , N/A ,"$13,992.00 ","$11,193.60 ","$11,193.60 ", N/A ,"$11,193.60 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$18,656.00 ", N/A ,"$15,857.60 ", N/A ,"$12,126.40 ", N/A ,"$18,656.00 ","$10,447.36 ", N/A ,"$4,906.53 ", N/A ,"$4,198.04 ","$4,007.22 ", N/A ,"$14,924.80 ", N/A ,"$6,645.60 ","$5,223.68 ","$16,790.40 ", N/A ,"$7,301.00 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$8,954.88 ","$3,816.40 "
ST. ELIZABETH'S HOSPITAL,36000397,27301,HC I AND D ABSC/BURSA THIGH/KNEE,360,1 ,"$7,977.00 ","$5,185.05 ","$1,004.64 ","$7,977.00 ","$5,843.93 ","$4,200.00 ","$4,467.12 ","$2,337.57 ","$2,233.56 ","$2,696.23 ","$2,337.57 ","$3,103.05 ","$2,337.57 ","$3,597.63 ","$3,597.63 ","$2,337.57 ","$3,597.63 ","$4,441.38 ","$3,988.50 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$5,982.75 ","$4,786.20 ","$4,786.20 ","$2,337.57 ","$4,786.20 ","$6,062.52 ","$6,062.52 ","$6,062.52 ","$7,977.00 ", N/A ,"$6,780.45 ","$5,843.93 ","$5,185.05 ","$2,337.57 ","$7,977.00 ","$4,467.12 ","$2,337.57 ","$2,097.95 ", N/A ,"$1,105.10 ","$1,054.87 ","$2,454.45 ","$6,381.60 ","$5,259.53 ","$3,597.63 ","$2,233.56 ","$7,179.30 ","$2,337.57 ","$6,062.52 ","$2,690.00 ","$2,690.00 ","$2,337.57 ","$2,690.00 ","$3,828.96 ","$1,004.64 "
ST. ELIZABETH'S HOSPITAL,36000420,26735,HC TX FX OPEN SHAFT FINGER/THUMB W/INT FIX EACH,360,1 ,"$9,417.00 ","$6,121.05 ","$2,476.67 ","$9,417.00 ","$6,979.95 ","$5,000.00 ","$5,273.52 ","$2,791.98 ","$2,636.76 ","$3,182.95 ","$2,791.98 ","$3,663.21 ","$2,791.98 ","$4,247.07 ","$4,247.07 ","$2,791.98 ","$4,247.07 ","$5,304.75 ","$4,708.50 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$7,062.75 ","$5,650.20 ","$5,650.20 ","$2,791.98 ","$5,650.20 ","$7,156.92 ","$7,156.92 ","$7,156.92 ","$9,417.00 ", N/A ,"$8,004.45 ","$6,979.94 ","$6,121.05 ","$2,791.98 ","$9,417.00 ","$5,273.52 ","$2,791.98 ","$2,476.67 ", N/A ,"$4,726.18 ","$4,511.36 ","$2,931.58 ","$7,533.60 ","$6,281.95 ","$4,247.07 ","$2,636.76 ","$8,475.30 ","$2,791.98 ","$7,156.92 ","$2,690.00 ","$2,690.00 ","$2,791.98 ","$2,690.00 ","$4,520.16 ","$4,296.53 "
ST. ELIZABETH'S HOSPITAL,36000440,31622,HC BRONCHOSCOPY DIAG W/W/O WASHING,360,1 ,"$3,487.00 ","$2,266.55 ",$917.08 ,"$3,687.53 ","$3,687.53 ","$3,200.00 ","$1,952.72 ","$1,475.01 ",$976.36 ,"$1,178.61 ","$1,475.01 ","$1,356.44 ","$1,475.01 ","$1,572.64 ","$1,572.64 ","$1,475.01 ","$1,572.64 ","$2,802.52 ","$1,743.50 ","$3,687.52 ","$1,475.01 ","$1,475.01 ","$1,504.51 ","$2,615.25 ","$2,092.20 ","$2,092.20 ","$1,475.01 ","$2,092.20 ","$2,650.12 ","$2,650.12 ","$2,650.12 ","$3,487.00 ", N/A ,"$2,963.95 ","$3,487.00 ","$2,266.55 ","$1,475.01 ","$3,487.00 ","$1,952.72 ","$1,475.01 ",$917.08 , N/A ,"$1,825.48 ","$1,742.51 ","$1,548.76 ","$2,789.60 ","$3,318.77 ","$1,572.64 ",$976.36 ,"$3,138.30 ","$1,475.01 ","$2,650.12 ","$1,890.00 ","$1,890.00 ","$1,475.01 ","$1,890.00 ","$1,673.76 ","$1,659.53 "
ST. ELIZABETH'S HOSPITAL,36000444,41110,HC EXCISION LESION TONGUE W/O CLOSURE,360,1 ,"$2,911.00 ","$1,892.15 ",$765.59 ,"$6,742.71 ","$6,742.70 ","$2,125.00 ","$1,630.16 ","$2,697.08 ",$815.08 ,$983.92 ,"$2,697.08 ","$1,132.38 ","$2,697.08 ","$1,312.86 ","$1,312.86 ","$2,697.08 ","$1,312.86 ","$2,911.00 ","$1,455.50 ","$6,742.71 ","$2,697.08 ","$2,697.08 ","$2,751.03 ","$2,183.25 ","$1,746.60 ","$1,746.60 ","$2,697.08 ","$1,746.60 ","$2,212.36 ","$2,212.36 ","$2,212.36 ","$2,911.00 ", N/A ,"$2,474.35 ","$2,911.00 ","$1,892.15 ","$2,697.08 ","$2,911.00 ","$1,630.16 ","$2,697.08 ",$765.59 , N/A ,"$1,349.44 ","$1,288.10 ","$2,831.93 ","$2,328.80 ","$6,068.44 ","$1,312.86 ",$815.08 ,"$2,619.90 ","$2,697.08 ","$2,212.36 ","$1,890.00 ","$1,890.00 ","$2,697.08 ","$1,890.00 ","$1,397.28 ","$1,226.76 "
ST. ELIZABETH'S HOSPITAL,36000480,59160,HC D AND C POST DELIVERY,360,1 ,"$4,589.00 ","$2,982.85 ","$1,206.91 ","$6,466.58 ","$6,466.58 ","$4,200.00 ","$2,569.84 ","$2,586.63 ","$1,284.92 ","$1,551.08 ","$2,586.63 ","$1,785.12 ","$2,586.63 ","$2,069.64 ","$2,069.64 ","$2,586.63 ","$2,069.64 ","$4,589.00 ","$2,294.50 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$3,441.75 ","$2,753.40 ","$2,753.40 ","$2,586.63 ","$2,753.40 ","$3,487.64 ","$3,487.64 ","$3,487.64 ","$4,589.00 ", N/A ,"$3,900.65 ","$4,589.00 ","$2,982.85 ","$2,586.63 ","$4,589.00 ","$2,569.84 ","$2,586.63 ","$1,206.91 ", N/A , N/A , N/A ,"$2,715.96 ","$3,671.20 ","$5,819.92 ","$2,069.64 ","$1,284.92 ","$4,130.10 ","$2,586.63 ","$3,487.64 ","$2,690.00 ","$2,690.00 ","$2,586.63 ","$2,690.00 ","$2,202.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000569,64486,HC TAP BLOCK W/INJ UNILT,360,1 ,"$1,333.00 ",$866.45 ,$350.58 ,"$1,333.00 ", N/A ,"$1,333.00 ",$746.48 , N/A ,$373.24 ,$450.55 , N/A ,$518.54 , N/A ,$601.18 ,$601.18 , N/A ,$601.18 , N/A ,$666.50 , N/A , N/A , N/A , N/A ,$999.75 ,$799.80 ,$799.80 , N/A ,$799.80 ,"$1,013.08 ","$1,013.08 ","$1,013.08 ","$1,333.00 ", N/A ,"$1,133.05 ", N/A ,$866.45 , N/A ,"$1,333.00 ",$746.48 , N/A ,$350.58 , N/A ,$463.72 ,$442.64 , N/A ,"$1,066.40 ", N/A ,$601.18 ,$373.24 ,"$1,199.70 ", N/A ,"$1,013.08 ",$920.00 ,$920.00 , N/A ,$920.00 ,$639.84 ,$421.56 
ST. ELIZABETH'S HOSPITAL,36000581,30801,HC ABLATION SOFT TISSUE INF TURBINATES UNI/BIL,360,1 ,"$3,200.00 ","$2,080.00 ",$114.47 ,"$3,334.08 ","$3,334.08 ","$2,125.00 ","$1,792.00 ","$1,333.63 ",$896.00 ,"$1,081.60 ","$1,333.63 ","$1,244.80 ","$1,333.63 ","$1,443.20 ","$1,443.20 ","$1,333.63 ","$1,443.20 ","$2,533.89 ","$1,600.00 ","$3,334.07 ","$1,333.63 ","$1,333.63 ","$1,360.30 ","$2,400.00 ","$1,920.00 ","$1,920.00 ","$1,333.63 ","$1,920.00 ","$2,432.00 ","$2,432.00 ","$2,432.00 ","$3,200.00 ", N/A ,"$2,720.00 ","$3,200.00 ","$2,080.00 ","$1,333.63 ","$3,200.00 ","$1,792.00 ","$1,333.63 ",$841.60 , N/A ,$125.92 ,$120.19 ,"$1,400.31 ","$2,560.00 ","$3,000.66 ","$1,443.20 ",$896.00 ,"$2,880.00 ","$1,333.63 ","$2,432.00 ","$1,890.00 ","$1,890.00 ","$1,333.63 ","$1,890.00 ","$1,536.00 ",$114.47 
ST. ELIZABETH'S HOSPITAL,36000582,57410,HC PELVIC EXAM W/ANES,360,1 ,"$8,825.00 ","$5,736.25 ","$1,236.49 ","$8,825.00 ","$6,466.58 ","$3,200.00 ","$4,942.00 ","$2,586.63 ","$2,471.00 ","$2,982.85 ","$2,586.63 ","$3,432.93 ","$2,586.63 ","$3,980.08 ","$3,980.08 ","$2,586.63 ","$3,980.08 ","$4,914.60 ","$4,412.50 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$6,618.75 ","$5,295.00 ","$5,295.00 ","$2,586.63 ","$5,295.00 ","$6,707.00 ","$6,707.00 ","$6,707.00 ","$8,825.00 ", N/A ,"$7,501.25 ","$6,466.58 ","$5,736.25 ","$2,586.63 ","$8,825.00 ","$4,942.00 ","$2,586.63 ","$2,320.98 ", N/A ,"$1,360.14 ","$1,298.31 ","$2,715.96 ","$7,060.00 ","$5,819.92 ","$3,980.08 ","$2,471.00 ","$7,942.50 ","$2,586.63 ","$6,707.00 ","$2,690.00 ","$2,690.00 ","$2,586.63 ","$2,690.00 ","$4,236.00 ","$1,236.49 "
ST. ELIZABETH'S HOSPITAL,36000583,33221,HC INSERT PACEMAKER PULSE GENERATOR MULT LEADS,360,1 ,"$49,356.00 ","$32,081.40 ","$4,200.00 ","$49,356.00 ","$45,902.88 ","$4,200.00 ","$27,639.36 ","$18,361.15 ","$13,819.68 ","$16,682.33 ","$18,361.15 ","$19,199.48 ","$18,361.15 ","$22,259.56 ","$22,259.56 ","$18,361.15 ","$22,259.56 ","$34,886.18 ","$24,678.00 ","$45,902.87 ","$18,361.15 ","$18,361.15 ","$18,728.37 ","$37,017.00 ","$29,613.60 ","$29,613.60 ","$18,361.15 ","$29,613.60 ","$37,510.56 ","$37,510.56 ","$37,510.56 ","$49,356.00 ", N/A ,"$41,952.60 ","$45,902.87 ","$32,081.40 ","$18,361.15 ","$49,356.00 ","$27,639.36 ","$18,361.15 ","$12,980.63 ", N/A ,"$8,482.36 ","$8,096.80 ","$19,279.21 ","$39,484.80 ","$41,312.59 ","$22,259.56 ","$13,819.68 ","$44,420.40 ","$18,361.15 ","$37,510.56 ","$22,140.00 ","$22,140.00 ","$18,361.15 ","$22,140.00 ","$23,690.88 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,36000584,33990,HC INSERT VAD ARTERIAL ACCESS,360,1 ,"$4,962.00 ","$3,225.30 ","$1,305.01 ","$4,962.00 ", N/A ,"$4,962.00 ","$2,778.72 ", N/A ,"$1,389.36 ","$1,677.16 ", N/A ,"$1,930.22 ", N/A ,"$2,237.86 ","$2,237.86 ", N/A ,"$2,237.86 ", N/A ,"$2,481.00 ", N/A , N/A , N/A , N/A ,"$3,721.50 ","$2,977.20 ","$2,977.20 ", N/A ,"$2,977.20 ","$3,771.12 ","$3,771.12 ","$3,771.12 ","$4,962.00 ", N/A ,"$4,217.70 ", N/A ,"$3,225.30 ", N/A ,"$4,962.00 ","$2,778.72 ", N/A ,"$1,305.01 ", N/A , N/A , N/A , N/A ,"$3,969.60 ", N/A ,"$2,237.86 ","$1,389.36 ","$4,465.80 ", N/A ,"$3,771.12 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$2,381.76 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000585,33220,HC REPAIR PACEMAKER DUAL LEAD,360,1 ,"$8,094.00 ","$5,261.10 ","$2,128.72 ","$8,487.15 ","$8,487.15 ","$5,000.00 ","$4,532.64 ","$3,394.86 ","$2,266.32 ","$2,735.77 ","$3,394.86 ","$3,148.57 ","$3,394.86 ","$3,650.39 ","$3,650.39 ","$3,394.86 ","$3,650.39 ","$6,450.23 ","$4,047.00 ","$8,487.14 ","$3,394.86 ","$3,394.86 ","$3,462.75 ","$6,070.50 ","$4,856.40 ","$4,856.40 ","$3,394.86 ","$4,856.40 ","$6,151.44 ","$6,151.44 ","$6,151.44 ","$8,094.00 ", N/A ,"$6,879.90 ","$8,094.00 ","$5,261.10 ","$3,394.86 ","$8,094.00 ","$4,532.64 ","$3,394.86 ","$2,128.72 ", N/A ,"$6,139.39 ","$5,860.32 ","$3,564.60 ","$6,475.20 ","$7,638.43 ","$3,650.39 ","$2,266.32 ","$7,284.60 ","$3,394.86 ","$6,151.44 ","$3,600.00 ","$3,600.00 ","$3,394.86 ","$3,600.00 ","$3,885.12 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,36000586,33218,HC REPAIR PACEMAKER SINGLE LEAD,360,1 ,"$8,094.00 ","$5,261.10 ","$2,128.72 ","$8,487.15 ","$8,487.15 ","$5,000.00 ","$4,532.64 ","$3,394.86 ","$2,266.32 ","$2,735.77 ","$3,394.86 ","$3,148.57 ","$3,394.86 ","$3,650.39 ","$3,650.39 ","$3,394.86 ","$3,650.39 ","$6,450.23 ","$4,047.00 ","$8,487.14 ","$3,394.86 ","$3,394.86 ","$3,462.75 ","$6,070.50 ","$4,856.40 ","$4,856.40 ","$3,394.86 ","$4,856.40 ","$6,151.44 ","$6,151.44 ","$6,151.44 ","$8,094.00 ", N/A ,"$6,879.90 ","$8,094.00 ","$5,261.10 ","$3,394.86 ","$8,094.00 ","$4,532.64 ","$3,394.86 ","$2,128.72 ", N/A ,"$6,139.39 ","$5,860.32 ","$3,564.60 ","$6,475.20 ","$7,638.43 ","$3,650.39 ","$2,266.32 ","$7,284.60 ","$3,394.86 ","$6,151.44 ","$3,600.00 ","$3,600.00 ","$3,394.86 ","$3,600.00 ","$3,885.12 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,36000587,59300,HC EPISIOTOMY/VAGINAL REPAIR,360,1 ,"$7,022.00 ","$4,564.30 ","$1,236.49 ","$7,022.00 ","$6,466.58 ","$3,200.00 ","$3,932.32 ","$2,586.63 ","$1,966.16 ","$2,373.44 ","$2,586.63 ","$2,731.56 ","$2,586.63 ","$3,166.92 ","$3,166.92 ","$2,586.63 ","$3,166.92 ","$4,914.60 ","$3,511.00 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$5,266.50 ","$4,213.20 ","$4,213.20 ","$2,586.63 ","$4,213.20 ","$5,336.72 ","$5,336.72 ","$5,336.72 ","$7,022.00 ", N/A ,"$5,968.70 ","$6,466.58 ","$4,564.30 ","$2,586.63 ","$7,022.00 ","$3,932.32 ","$2,586.63 ","$1,846.79 ", N/A ,"$1,360.14 ","$1,298.31 ","$2,715.96 ","$5,617.60 ","$5,819.92 ","$3,166.92 ","$1,966.16 ","$6,319.80 ","$2,586.63 ","$5,336.72 ","$2,690.00 ","$2,690.00 ","$2,586.63 ","$2,690.00 ","$3,370.56 ","$1,236.49 "
ST. ELIZABETH'S HOSPITAL,36000588,31500,HC INTUBATION RESUSCITATION,360,1 ,$405.00 ,$263.25 ,$106.52 ,$647.47 ,$521.45 ,$405.00 ,$226.80 ,$208.58 ,$113.40 ,$136.89 ,$208.58 ,$157.55 ,$208.58 ,$182.66 ,$182.66 ,$208.58 ,$182.66 ,$396.30 ,$202.50 ,$521.44 ,$208.58 ,$208.58 ,$212.75 ,$303.75 ,$243.00 ,$243.00 ,$208.58 ,$243.00 ,$307.80 ,$307.80 ,$307.80 ,$405.00 , N/A ,$344.25 ,$405.00 ,$263.25 ,$208.58 ,$405.00 ,$226.80 ,$208.58 ,$106.52 , N/A ,$405.00 ,$405.00 ,$219.01 ,$324.00 ,$469.30 ,$182.66 ,$113.40 ,$364.50 ,$208.58 ,$307.80 ,$405.00 ,$405.00 ,$208.58 ,$405.00 ,$194.40 ,$647.47 
ST. ELIZABETH'S HOSPITAL,36000589,19020,HC MASTOTOMY W/EXPL/DRAIN ABSCESS DEEP-LT,360,1 ,"$8,759.00 ","$5,693.35 ","$1,004.64 ","$8,759.00 ","$3,467.90 ","$3,200.00 ","$4,905.04 ","$1,387.16 ","$2,452.52 ","$2,960.54 ","$1,387.16 ","$3,407.25 ","$1,387.16 ","$3,950.31 ","$3,950.31 ","$1,387.16 ","$3,950.31 ","$2,635.59 ","$4,379.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$6,569.25 ","$5,255.40 ","$5,255.40 ","$1,387.16 ","$5,255.40 ","$6,656.84 ","$6,656.84 ","$6,656.84 ","$8,759.00 ", N/A ,"$7,445.15 ","$3,467.89 ","$5,693.35 ","$1,387.16 ","$8,759.00 ","$4,905.04 ","$1,387.16 ","$2,303.62 ", N/A ,"$1,105.10 ","$1,054.87 ","$1,456.52 ","$7,007.20 ","$3,121.10 ","$3,950.31 ","$2,452.52 ","$7,883.10 ","$1,387.16 ","$6,656.84 ","$2,690.00 ","$2,690.00 ","$1,387.16 ","$2,690.00 ","$4,204.32 ","$1,004.64 "
ST. ELIZABETH'S HOSPITAL,36000590,19020,HC MASTOTOMY W/EXPL/DRAIN ABSCESS DEEP-RT,360,1 ,"$8,759.00 ","$5,693.35 ","$1,004.64 ","$8,759.00 ","$3,467.90 ","$3,200.00 ","$4,905.04 ","$1,387.16 ","$2,452.52 ","$2,960.54 ","$1,387.16 ","$3,407.25 ","$1,387.16 ","$3,950.31 ","$3,950.31 ","$1,387.16 ","$3,950.31 ","$2,635.59 ","$4,379.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$6,569.25 ","$5,255.40 ","$5,255.40 ","$1,387.16 ","$5,255.40 ","$6,656.84 ","$6,656.84 ","$6,656.84 ","$8,759.00 ", N/A ,"$7,445.15 ","$3,467.89 ","$5,693.35 ","$1,387.16 ","$8,759.00 ","$4,905.04 ","$1,387.16 ","$2,303.62 ", N/A ,"$1,105.10 ","$1,054.87 ","$1,456.52 ","$7,007.20 ","$3,121.10 ","$3,950.31 ","$2,452.52 ","$7,883.10 ","$1,387.16 ","$6,656.84 ","$2,690.00 ","$2,690.00 ","$1,387.16 ","$2,690.00 ","$4,204.32 ","$1,004.64 "
ST. ELIZABETH'S HOSPITAL,36000591,69420,HC MYRINGOTOMY ASPIR W/EUSTACHIAN INFLATION,360,1 ,$835.00 ,$542.75 ,$208.58 ,"$1,226.76 ",$521.45 ,$835.00 ,$467.60 ,$208.58 ,$233.80 ,$282.23 ,$208.58 ,$324.82 ,$208.58 ,$376.59 ,$376.59 ,$208.58 ,$376.59 ,$396.30 ,$417.50 ,$521.44 ,$208.58 ,$208.58 ,$212.75 ,$626.25 ,$501.00 ,$501.00 ,$208.58 ,$501.00 ,$634.60 ,$634.60 ,$634.60 ,$835.00 , N/A ,$709.75 ,$521.44 ,$542.75 ,$208.58 ,$835.00 ,$467.60 ,$208.58 ,$219.61 , N/A ,$835.00 ,$835.00 ,$219.01 ,$668.00 ,$469.30 ,$376.59 ,$233.80 ,$751.50 ,$208.58 ,$634.60 ,$835.00 ,$835.00 ,$208.58 ,$835.00 ,$400.80 ,"$1,226.76 "
ST. ELIZABETH'S HOSPITAL,36000592,N/A,HC PERFUSION,360,1 ,"$17,768.00 ","$11,549.20 ","$4,672.98 ","$17,768.00 ", N/A ,"$8,173.28 ","$9,950.08 ", N/A ,"$4,975.04 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$8,884.00 ", N/A , N/A , N/A , N/A ,"$13,326.00 ","$10,660.80 ","$10,660.80 ", N/A ,"$10,660.80 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$17,768.00 ", N/A ,"$15,102.80 ", N/A ,"$11,549.20 ", N/A ,"$17,768.00 ","$9,950.08 ", N/A ,"$4,672.98 ", N/A , N/A , N/A , N/A ,"$14,214.40 ", N/A ,"$6,645.60 ","$4,975.04 ","$15,991.20 ", N/A ,"$7,301.00 ", N/A , N/A , N/A , N/A ,"$8,528.64 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000650,36475,HC ABLATION THPY EXTREM PERC RADFQ INIT VEIN,360,1 ,"$9,492.00 ","$6,169.80 ","$2,312.16 ","$9,492.00 ","$7,055.60 ","$4,200.00 ","$5,315.52 ","$2,822.24 ","$2,657.76 ","$3,208.30 ","$2,822.24 ","$3,692.39 ","$2,822.24 ","$4,280.89 ","$4,280.89 ","$2,822.24 ","$4,280.89 ","$5,362.25 ","$4,746.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$7,119.00 ","$5,695.20 ","$5,695.20 ","$2,822.24 ","$5,695.20 ","$7,213.92 ","$7,213.92 ","$7,213.92 ","$9,492.00 ", N/A ,"$8,068.20 ","$7,055.60 ","$6,169.80 ","$2,822.24 ","$9,492.00 ","$5,315.52 ","$2,822.24 ","$2,496.40 ", N/A ,"$2,543.38 ","$2,427.77 ","$2,963.35 ","$7,593.60 ","$6,350.04 ","$4,280.89 ","$2,657.76 ","$8,542.80 ","$2,822.24 ","$7,213.92 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$4,556.16 ","$2,312.16 "
ST. ELIZABETH'S HOSPITAL,36000651,36476,HC ABLATION THPY EXTREM PERC RADFQ ADDL VEIN,360,1 ,"$4,076.00 ","$2,649.40 ",$920.00 ,"$4,076.00 ", N/A ,"$2,125.00 ","$2,282.56 ", N/A ,"$1,141.28 ","$1,377.69 ", N/A ,"$1,585.56 ", N/A ,"$1,838.28 ","$1,838.28 ", N/A ,"$1,838.28 ", N/A ,"$2,038.00 ", N/A , N/A , N/A , N/A ,"$3,057.00 ","$2,445.60 ","$2,445.60 ", N/A ,"$2,445.60 ","$3,097.76 ","$3,097.76 ","$3,097.76 ","$4,076.00 ", N/A ,"$3,464.60 ", N/A ,"$2,649.40 ", N/A ,"$4,076.00 ","$2,282.56 ", N/A ,"$1,071.99 ", N/A ,"$2,543.38 ","$2,427.77 ", N/A ,"$3,260.80 ", N/A ,"$1,838.28 ","$1,141.28 ","$3,668.40 ", N/A ,"$3,097.76 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,956.48 ","$2,312.16 "
ST. ELIZABETH'S HOSPITAL,36000652,36478,HC ABLATION THPY EXTREM PERC LASER INIT VEIN,360,1 ,"$6,263.00 ","$4,070.95 ","$1,647.17 ","$7,055.60 ","$7,055.60 ","$4,200.00 ","$3,507.28 ","$2,822.24 ","$1,753.64 ","$2,116.89 ","$2,822.24 ","$2,436.31 ","$2,822.24 ","$2,824.61 ","$2,824.61 ","$2,822.24 ","$2,824.61 ","$5,362.25 ","$3,131.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$4,697.25 ","$3,757.80 ","$3,757.80 ","$2,822.24 ","$3,757.80 ","$4,759.88 ","$4,759.88 ","$4,759.88 ","$6,263.00 ", N/A ,"$5,323.55 ","$6,263.00 ","$4,070.95 ","$2,822.24 ","$6,263.00 ","$3,507.28 ","$2,822.24 ","$1,647.17 ", N/A ,"$2,543.38 ","$2,427.77 ","$2,963.35 ","$5,010.40 ","$6,350.04 ","$2,824.61 ","$1,753.64 ","$5,636.70 ","$2,822.24 ","$4,759.88 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,006.24 ","$2,312.16 "
ST. ELIZABETH'S HOSPITAL,36000653,36479,HC ABLATION THPY EXTREM PERC LASER ADDL VEIN,360,1 ,"$3,570.00 ","$2,320.50 ",$920.00 ,"$3,570.00 ", N/A ,"$2,125.00 ","$1,999.20 ", N/A ,$999.60 ,"$1,206.66 ", N/A ,"$1,388.73 ", N/A ,"$1,610.07 ","$1,610.07 ", N/A ,"$1,610.07 ", N/A ,"$1,785.00 ", N/A , N/A , N/A , N/A ,"$2,677.50 ","$2,142.00 ","$2,142.00 ", N/A ,"$2,142.00 ","$2,713.20 ","$2,713.20 ","$2,713.20 ","$3,570.00 ", N/A ,"$3,034.50 ", N/A ,"$2,320.50 ", N/A ,"$3,570.00 ","$1,999.20 ", N/A ,$938.91 , N/A ,"$2,543.38 ","$2,427.77 ", N/A ,"$2,856.00 ", N/A ,"$1,610.07 ",$999.60 ,"$3,213.00 ", N/A ,"$2,713.20 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,713.60 ","$2,312.16 "
ST. ELIZABETH'S HOSPITAL,36000667,37765,HC STAB PHLEBECTOMRY VEINS EXTREM 10-20 INCISIONS,360,1 ,"$9,818.00 ","$6,381.70 ",$841.28 ,"$9,818.00 ","$7,055.60 ","$4,200.00 ","$5,498.08 ","$2,822.24 ","$2,749.04 ","$3,318.48 ","$2,822.24 ","$3,819.20 ","$2,822.24 ","$4,427.92 ","$4,427.92 ","$2,822.24 ","$4,427.92 ","$5,362.25 ","$4,909.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$7,363.50 ","$5,890.80 ","$5,890.80 ","$2,822.24 ","$5,890.80 ","$7,461.68 ","$7,461.68 ","$7,461.68 ","$9,818.00 ", N/A ,"$8,345.30 ","$7,055.60 ","$6,381.70 ","$2,822.24 ","$9,818.00 ","$5,498.08 ","$2,822.24 ","$2,582.13 ", N/A ,$925.41 ,$883.34 ,"$2,963.35 ","$7,854.40 ","$6,350.04 ","$4,427.92 ","$2,749.04 ","$8,836.20 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$4,712.64 ",$841.28 
ST. ELIZABETH'S HOSPITAL,36000668,37766,HC STAB PHLEBECTOMRY VEINS EXTREM >20 INCISIONS,360,1 ,"$11,520.00 ","$7,488.00 ",$841.28 ,"$11,520.00 ","$7,055.60 ","$4,200.00 ","$6,451.20 ","$2,822.24 ","$3,225.60 ","$3,893.76 ","$2,822.24 ","$4,481.28 ","$2,822.24 ","$5,195.52 ","$5,195.52 ","$2,822.24 ","$5,195.52 ","$5,362.25 ","$5,760.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,640.00 ","$6,912.00 ","$6,912.00 ","$2,822.24 ","$6,912.00 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$11,520.00 ", N/A ,"$9,792.00 ","$7,055.60 ","$7,488.00 ","$2,822.24 ","$11,520.00 ","$6,451.20 ","$2,822.24 ","$3,029.76 ", N/A ,$925.41 ,$883.34 ,"$2,963.35 ","$9,216.00 ","$6,350.04 ","$5,195.52 ","$3,225.60 ","$10,368.00 ","$2,822.24 ","$7,301.00 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,529.60 ",$841.28 
ST. ELIZABETH'S HOSPITAL,36000671,59812,HC TX ABORTION INCOMPLETE SURGICALLY ANY TRIMESTER,360,1 ,"$5,713.00 ","$3,713.45 ","$1,502.52 ","$6,466.58 ","$6,466.58 ","$5,500.00 ","$3,199.28 ","$2,586.63 ","$1,599.64 ","$1,930.99 ","$2,586.63 ","$2,222.36 ","$2,586.63 ","$2,576.56 ","$2,576.56 ","$2,586.63 ","$2,576.56 ","$4,914.60 ","$2,856.50 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$4,284.75 ","$3,427.80 ","$3,427.80 ","$2,586.63 ","$3,427.80 ","$4,341.88 ","$4,341.88 ","$4,341.88 ","$5,713.00 ", N/A ,"$4,856.05 ","$5,713.00 ","$3,713.45 ","$2,586.63 ","$5,713.00 ","$3,199.28 ","$2,586.63 ","$1,502.52 ", N/A , N/A , N/A ,"$2,715.96 ","$4,570.40 ","$5,819.92 ","$2,576.56 ","$1,599.64 ","$5,141.70 ","$2,586.63 ","$4,341.88 ","$2,690.00 ","$2,690.00 ","$2,586.63 ","$2,690.00 ","$2,742.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,36000680,50590,HC LITHOTRIPSY EXTRCORPOREAL SHOCK WAVE UNI,360,1 ,"$16,504.00 ","$10,727.60 ","$2,468.59 ","$16,504.00 ","$7,577.85 ","$5,500.00 ","$9,242.24 ","$3,031.14 ","$4,621.12 ","$6,072.48 ","$3,031.14 ","$6,420.06 ","$3,031.14 ","$7,443.30 ","$7,443.30 ","$3,031.14 ","$7,443.30 ","$5,759.17 ","$8,252.00 ","$7,577.86 ","$3,031.14 ","$3,031.14 ","$3,091.77 ","$12,378.00 ","$9,902.40 ","$9,902.40 ","$3,031.14 ","$9,902.40 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$16,504.00 ", N/A ,"$14,028.40 ","$7,577.86 ","$10,727.60 ","$3,031.14 ","$16,504.00 ","$9,242.24 ","$3,031.14 ","$4,340.55 ", N/A ,"$2,715.45 ","$2,592.02 ","$3,182.70 ","$13,203.20 ","$6,820.07 ","$7,443.30 ","$4,621.12 ","$14,853.60 ","$3,031.14 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$3,031.14 ","$4,800.00 ","$7,921.92 ","$2,468.59 "
ST. ELIZABETH'S HOSPITAL,36000681,50590,HC LITHOTRIPSY EXTRCORPOREAL SHOCK WAVE BIL,360,1 ,"$21,788.00 ","$14,162.20 ","$2,468.59 ","$21,788.00 ","$7,577.85 ","$5,500.00 ","$12,201.28 ","$3,031.14 ","$6,100.64 ","$6,072.48 ","$3,031.14 ","$6,980.05 ","$3,031.14 ","$8,308.56 ","$8,308.56 ","$3,031.14 ","$8,308.56 ","$5,759.17 ","$10,894.00 ","$7,577.86 ","$3,031.14 ","$3,031.14 ","$3,091.77 ","$16,341.00 ","$13,072.80 ","$13,072.80 ","$3,031.14 ","$13,072.80 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$21,788.00 ", N/A ,"$18,519.80 ","$7,577.86 ","$14,162.20 ","$3,031.14 ","$21,788.00 ","$12,201.28 ","$3,031.14 ","$5,730.24 ", N/A ,"$2,715.45 ","$2,592.02 ","$3,182.70 ","$17,430.40 ","$6,820.07 ","$8,308.56 ","$6,100.64 ","$19,609.20 ","$3,031.14 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$3,031.14 ","$4,800.00 ","$10,458.24 ","$2,468.59 "
ST. ELIZABETH'S HOSPITAL,36000688,20680,HC REM IMPL WIRE DEEP,360,1 ,"$9,846.00 ","$6,399.90 ","$1,235.48 ","$9,846.00 ","$5,843.93 ","$4,200.00 ","$5,513.76 ","$2,337.57 ","$2,756.88 ","$3,327.95 ","$2,337.57 ","$3,830.09 ","$2,337.57 ","$4,440.55 ","$4,440.55 ","$2,337.57 ","$4,440.55 ","$4,441.38 ","$4,923.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$7,384.50 ","$5,907.60 ","$5,907.60 ","$2,337.57 ","$5,907.60 ","$7,482.96 ","$7,482.96 ","$7,482.96 ","$9,846.00 ", N/A ,"$8,369.10 ","$5,843.93 ","$6,399.90 ","$2,337.57 ","$9,846.00 ","$5,513.76 ","$2,337.57 ","$2,589.50 ", N/A ,"$1,359.03 ","$1,297.25 ","$2,454.45 ","$7,876.80 ","$5,259.53 ","$4,440.55 ","$2,756.88 ","$8,861.40 ","$2,337.57 ","$7,301.00 ","$2,690.00 ","$2,690.00 ","$2,337.57 ","$2,690.00 ","$4,726.08 ","$1,235.48 "
ST. ELIZABETH'S HOSPITAL,36000719,41010,HC INCISION LINGUAL FRENUM,360,1 ,"$5,094.00 ","$3,311.10 ","$1,226.76 ","$5,094.00 ","$3,334.08 ","$2,125.00 ","$2,852.64 ","$1,333.63 ","$1,426.32 ","$1,721.77 ","$1,333.63 ","$1,981.57 ","$1,333.63 ","$2,297.39 ","$2,297.39 ","$1,333.63 ","$2,297.39 ","$2,533.89 ","$2,547.00 ","$3,334.07 ","$1,333.63 ","$1,333.63 ","$1,360.30 ","$3,820.50 ","$3,056.40 ","$3,056.40 ","$1,333.63 ","$3,056.40 ","$3,871.44 ","$3,871.44 ","$3,871.44 ","$5,094.00 ", N/A ,"$4,329.90 ","$3,334.07 ","$3,311.10 ","$1,333.63 ","$5,094.00 ","$2,852.64 ","$1,333.63 ","$1,339.72 ", N/A ,"$1,349.44 ","$1,288.10 ","$1,400.31 ","$4,075.20 ","$3,000.66 ","$2,297.39 ","$1,426.32 ","$4,584.60 ","$1,333.63 ","$3,871.44 ","$1,890.00 ","$1,890.00 ","$1,333.63 ","$1,890.00 ","$2,445.12 ","$1,226.76 "
ST. ELIZABETH'S HOSPITAL,36000741,31575,HC LARYNGOSCOPY FLEX DIAGNOSTIC,360,1 ,$478.00 ,$310.70 ,$125.71 ,$478.00 ,$405.73 ,$478.00 ,$267.68 ,$162.29 ,$133.84 ,$161.56 ,$162.29 ,$185.94 ,$162.29 ,$215.58 ,$215.58 ,$162.29 ,$215.58 ,$308.35 ,$239.00 ,$405.72 ,$162.29 ,$162.29 ,$165.54 ,$358.50 ,$286.80 ,$286.80 ,$162.29 ,$286.80 ,$363.28 ,$363.28 ,$363.28 ,$478.00 , N/A ,$406.30 ,$405.72 ,$310.70 ,$162.29 ,$478.00 ,$267.68 ,$162.29 ,$125.71 , N/A ,$425.85 ,$406.50 ,$170.40 ,$382.40 ,$365.15 ,$215.58 ,$133.84 ,$430.20 ,$162.29 ,$363.28 ,$478.00 ,$478.00 ,$162.29 ,$478.00 ,$229.44 ,$387.14 
ST. ELIZABETH'S HOSPITAL,36000751,58323,HC SPERM WASHING ARTIFICIAL INSEMINATION,360,1 ,$511.00 ,$332.15 ,$22.84 ,$511.00 ,$419.90 ,$22.84 ,$286.16 ,$167.96 ,$143.08 ,$172.72 ,$167.96 ,$198.78 ,$167.96 ,$230.46 ,$230.46 ,$167.96 ,$230.46 ,$319.12 ,$255.50 ,$419.89 ,$167.96 ,$167.96 ,$171.32 ,$383.25 ,$306.60 ,$306.60 ,$167.96 ,$306.60 ,$388.36 ,$388.36 ,$388.36 ,$511.00 , N/A ,$434.35 ,$419.89 ,$332.15 ,$167.96 ,$511.00 ,$286.16 ,$167.96 ,$134.39 , N/A ,$323.76 ,$309.05 ,$176.36 ,$408.80 ,$377.90 ,$230.46 ,$143.08 ,$459.90 ,$167.96 ,$388.36 ,$511.00 ,$511.00 ,$167.96 ,$511.00 ,$245.28 ,$294.33 
ST. ELIZABETH'S HOSPITAL,36000755,41018,HC I AND D MASTICATOR SPACE,360,1 ,"$4,058.37 ","$2,637.94 ","$1,067.35 ","$4,058.37 ","$3,334.08 ","$2,125.00 ","$2,272.69 ","$1,333.63 ","$1,136.34 ","$1,371.73 ","$1,333.63 ","$1,578.71 ","$1,333.63 ","$1,830.32 ","$1,830.32 ","$1,333.63 ","$1,830.32 ","$2,533.89 ","$2,029.19 ","$3,334.07 ","$1,333.63 ","$1,333.63 ","$1,360.30 ","$3,043.78 ","$2,435.02 ","$2,435.02 ","$1,333.63 ","$2,435.02 ","$3,084.36 ","$3,084.36 ","$3,084.36 ","$4,058.37 ", N/A ,"$3,449.61 ","$3,334.07 ","$2,637.94 ","$1,333.63 ","$4,058.37 ","$2,272.69 ","$1,333.63 ","$1,067.35 ", N/A ,"$1,349.44 ","$1,288.10 ","$1,400.31 ","$3,246.70 ","$3,000.66 ","$1,830.32 ","$1,136.34 ","$3,652.53 ","$1,333.63 ","$3,084.36 ","$1,890.00 ","$1,890.00 ","$1,333.63 ","$1,890.00 ","$1,948.02 ","$1,226.76 "
ST. ELIZABETH'S HOSPITAL,36000758,43460,HC PRESSURE TREATMENT ESOPHAGUS,360,1 ,"$1,569.12 ","$1,019.93 ",$412.68 ,"$1,569.12 ", N/A ,"$1,569.12 ",$878.71 , N/A ,$439.35 ,$530.36 , N/A ,$610.39 , N/A ,$707.67 ,$707.67 , N/A ,$707.67 , N/A ,$784.56 , N/A , N/A , N/A , N/A ,"$1,176.84 ",$941.47 ,$941.47 , N/A ,$941.47 ,"$1,192.53 ","$1,192.53 ","$1,192.53 ","$1,569.12 ", N/A ,"$1,333.75 ", N/A ,"$1,019.93 ", N/A ,"$1,569.12 ",$878.71 , N/A ,$412.68 , N/A , N/A , N/A , N/A ,"$1,255.30 ", N/A ,$707.67 ,$439.35 ,"$1,412.21 ", N/A ,"$1,192.53 ","$1,569.12 ","$1,569.12 ", N/A ,"$1,569.12 ",$753.18 , N/A 
ST. ELIZABETH'S HOSPITAL,36000761,54115,HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE,360,1 ,"$6,748.71 ","$4,386.66 ","$1,774.91 ","$6,748.71 ","$5,843.93 ","$2,125.00 ","$3,779.28 ","$2,337.57 ","$1,889.64 ","$2,281.06 ","$2,337.57 ","$2,625.25 ","$2,337.57 ","$3,043.67 ","$3,043.67 ","$2,337.57 ","$3,043.67 ","$4,441.38 ","$3,374.36 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$5,061.53 ","$4,049.23 ","$4,049.23 ","$2,337.57 ","$4,049.23 ","$5,129.02 ","$5,129.02 ","$5,129.02 ","$6,748.71 ", N/A ,"$5,736.40 ","$5,843.93 ","$4,386.66 ","$2,337.57 ","$6,748.71 ","$3,779.28 ","$2,337.57 ","$1,774.91 ", N/A ,"$2,522.55 ","$2,407.89 ","$2,454.45 ","$5,398.97 ","$5,259.53 ","$3,043.67 ","$1,889.64 ","$6,073.84 ","$2,337.57 ","$5,129.02 ","$2,690.00 ","$2,690.00 ","$2,337.57 ","$2,690.00 ","$3,239.38 ","$2,293.23 "
ST. ELIZABETH'S HOSPITAL,36000768,20930,HC ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED,360,1 ,"$6,992.23 ","$4,544.95 ",$920.00 ,"$6,992.23 ", N/A ,"$2,125.00 ","$3,915.65 ", N/A ,"$1,957.82 ","$2,363.37 ", N/A ,"$2,719.98 ", N/A ,"$3,153.50 ","$3,153.50 ", N/A ,"$3,153.50 ", N/A ,"$3,496.12 ", N/A , N/A , N/A , N/A ,"$5,244.17 ","$4,195.34 ","$4,195.34 ", N/A ,"$4,195.34 ","$5,314.09 ","$5,314.09 ","$5,314.09 ","$6,992.23 ", N/A ,"$5,943.40 ", N/A ,"$4,544.95 ", N/A ,"$6,992.23 ","$3,915.65 ", N/A ,"$1,838.96 ", N/A ,"$4,683.81 ","$4,470.91 ", N/A ,"$5,593.78 ", N/A ,"$3,153.50 ","$1,957.82 ","$6,293.01 ", N/A ,"$5,314.09 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,356.27 ","$4,258.01 "
ST. ELIZABETH'S HOSPITAL,36060014,N/A,HC OR LEVEL 1 ADDL 15MIN,360,1 ,"$1,093.00 ",$710.45 ,$287.46 ,"$1,093.00 ", N/A ,$502.78 ,$612.08 , N/A ,$306.04 ,$369.43 , N/A ,$425.18 , N/A ,$492.94 ,$492.94 , N/A ,$492.94 , N/A ,$546.50 , N/A , N/A , N/A , N/A ,$819.75 ,$655.80 ,$655.80 , N/A ,$655.80 ,$830.68 ,$830.68 ,$830.68 ,"$1,093.00 ", N/A ,$929.05 , N/A ,$710.45 , N/A ,"$1,093.00 ",$612.08 , N/A ,$287.46 , N/A , N/A , N/A , N/A ,$874.40 , N/A ,$492.94 ,$306.04 ,$983.70 , N/A ,$830.68 , N/A , N/A , N/A , N/A ,$524.64 , N/A 
ST. ELIZABETH'S HOSPITAL,36060016,N/A,HC OR LEVEL 2 ADDL 15MIN,360,1 ,"$1,161.00 ",$754.65 ,$305.34 ,"$1,161.00 ", N/A ,$534.06 ,$650.16 , N/A ,$325.08 ,$392.42 , N/A ,$451.63 , N/A ,$523.61 ,$523.61 , N/A ,$523.61 , N/A ,$580.50 , N/A , N/A , N/A , N/A ,$870.75 ,$696.60 ,$696.60 , N/A ,$696.60 ,$882.36 ,$882.36 ,$882.36 ,"$1,161.00 ", N/A ,$986.85 , N/A ,$754.65 , N/A ,"$1,161.00 ",$650.16 , N/A ,$305.34 , N/A , N/A , N/A , N/A ,$928.80 , N/A ,$523.61 ,$325.08 ,"$1,044.90 ", N/A ,$882.36 , N/A , N/A , N/A , N/A ,$557.28 , N/A 
ST. ELIZABETH'S HOSPITAL,36060018,N/A,HC OR LEVEL 3 ADDL 15MIN,360,1 ,"$1,298.00 ",$843.70 ,$341.37 ,"$1,298.00 ", N/A ,$597.08 ,$726.88 , N/A ,$363.44 ,$438.72 , N/A ,$504.92 , N/A ,$585.40 ,$585.40 , N/A ,$585.40 , N/A ,$649.00 , N/A , N/A , N/A , N/A ,$973.50 ,$778.80 ,$778.80 , N/A ,$778.80 ,$986.48 ,$986.48 ,$986.48 ,"$1,298.00 ", N/A ,"$1,103.30 ", N/A ,$843.70 , N/A ,"$1,298.00 ",$726.88 , N/A ,$341.37 , N/A , N/A , N/A , N/A ,"$1,038.40 ", N/A ,$585.40 ,$363.44 ,"$1,168.20 ", N/A ,$986.48 , N/A , N/A , N/A , N/A ,$623.04 , N/A 
ST. ELIZABETH'S HOSPITAL,36060020,N/A,HC OR LEVEL 4 ADDL 15MIN,360,1 ,"$1,346.00 ",$874.90 ,$354.00 ,"$1,346.00 ", N/A ,$619.16 ,$753.76 , N/A ,$376.88 ,$454.95 , N/A ,$523.59 , N/A ,$607.05 ,$607.05 , N/A ,$607.05 , N/A ,$673.00 , N/A , N/A , N/A , N/A ,"$1,009.50 ",$807.60 ,$807.60 , N/A ,$807.60 ,"$1,022.96 ","$1,022.96 ","$1,022.96 ","$1,346.00 ", N/A ,"$1,144.10 ", N/A ,$874.90 , N/A ,"$1,346.00 ",$753.76 , N/A ,$354.00 , N/A , N/A , N/A , N/A ,"$1,076.80 ", N/A ,$607.05 ,$376.88 ,"$1,211.40 ", N/A ,"$1,022.96 ", N/A , N/A , N/A , N/A ,$646.08 , N/A 
ST. ELIZABETH'S HOSPITAL,36060022,N/A,HC OR LEVEL 5 ADDL 15MIN,360,1 ,"$1,596.00 ","$1,037.40 ",$419.75 ,"$1,596.00 ", N/A ,$734.16 ,$893.76 , N/A ,$446.88 ,$539.45 , N/A ,$620.84 , N/A ,$719.80 ,$719.80 , N/A ,$719.80 , N/A ,$798.00 , N/A , N/A , N/A , N/A ,"$1,197.00 ",$957.60 ,$957.60 , N/A ,$957.60 ,"$1,212.96 ","$1,212.96 ","$1,212.96 ","$1,596.00 ", N/A ,"$1,356.60 ", N/A ,"$1,037.40 ", N/A ,"$1,596.00 ",$893.76 , N/A ,$419.75 , N/A , N/A , N/A , N/A ,"$1,276.80 ", N/A ,$719.80 ,$446.88 ,"$1,436.40 ", N/A ,"$1,212.96 ", N/A , N/A , N/A , N/A ,$766.08 , N/A 
ST. ELIZABETH'S HOSPITAL,36060025,N/A,HC OR LEVEL 1 INITIAL 30MIN,360,1 ,"$3,060.00 ","$1,989.00 ",$804.78 ,"$3,060.00 ", N/A ,"$1,407.60 ","$1,713.60 ", N/A ,$856.80 ,"$1,034.28 ", N/A ,"$1,190.34 ", N/A ,"$1,380.06 ","$1,380.06 ", N/A ,"$1,380.06 ", N/A ,"$1,530.00 ", N/A , N/A , N/A , N/A ,"$2,295.00 ","$1,836.00 ","$1,836.00 ", N/A ,"$1,836.00 ","$2,325.60 ","$2,325.60 ","$2,325.60 ","$3,060.00 ", N/A ,"$2,601.00 ", N/A ,"$1,989.00 ", N/A ,"$3,060.00 ","$1,713.60 ", N/A ,$804.78 , N/A , N/A , N/A , N/A ,"$2,448.00 ", N/A ,"$1,380.06 ",$856.80 ,"$2,754.00 ", N/A ,"$2,325.60 ", N/A , N/A , N/A , N/A ,"$1,468.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060026,N/A,HC OR LEVEL 2 INITIAL 30MIN,360,1 ,"$3,318.00 ","$2,156.70 ",$872.63 ,"$3,318.00 ", N/A ,"$1,526.28 ","$1,858.08 ", N/A ,$929.04 ,"$1,121.48 ", N/A ,"$1,290.70 ", N/A ,"$1,496.42 ","$1,496.42 ", N/A ,"$1,496.42 ", N/A ,"$1,659.00 ", N/A , N/A , N/A , N/A ,"$2,488.50 ","$1,990.80 ","$1,990.80 ", N/A ,"$1,990.80 ","$2,521.68 ","$2,521.68 ","$2,521.68 ","$3,318.00 ", N/A ,"$2,820.30 ", N/A ,"$2,156.70 ", N/A ,"$3,318.00 ","$1,858.08 ", N/A ,$872.63 , N/A , N/A , N/A , N/A ,"$2,654.40 ", N/A ,"$1,496.42 ",$929.04 ,"$2,986.20 ", N/A ,"$2,521.68 ", N/A , N/A , N/A , N/A ,"$1,592.64 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060027,N/A,HC OR LEVEL 3 INITIAL 30MIN,360,1 ,"$3,706.00 ","$2,408.90 ",$974.68 ,"$3,706.00 ", N/A ,"$1,704.76 ","$2,075.36 ", N/A ,"$1,037.68 ","$1,252.63 ", N/A ,"$1,441.63 ", N/A ,"$1,671.41 ","$1,671.41 ", N/A ,"$1,671.41 ", N/A ,"$1,853.00 ", N/A , N/A , N/A , N/A ,"$2,779.50 ","$2,223.60 ","$2,223.60 ", N/A ,"$2,223.60 ","$2,816.56 ","$2,816.56 ","$2,816.56 ","$3,706.00 ", N/A ,"$3,150.10 ", N/A ,"$2,408.90 ", N/A ,"$3,706.00 ","$2,075.36 ", N/A ,$974.68 , N/A , N/A , N/A , N/A ,"$2,964.80 ", N/A ,"$1,671.41 ","$1,037.68 ","$3,335.40 ", N/A ,"$2,816.56 ", N/A , N/A , N/A , N/A ,"$1,778.88 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060028,N/A,HC OR LEVEL 4 INITIAL 30MIN,360,1 ,"$3,848.00 ","$2,501.20 ","$1,012.02 ","$3,848.00 ", N/A ,"$1,770.08 ","$2,154.88 ", N/A ,"$1,077.44 ","$1,300.62 ", N/A ,"$1,496.87 ", N/A ,"$1,735.45 ","$1,735.45 ", N/A ,"$1,735.45 ", N/A ,"$1,924.00 ", N/A , N/A , N/A , N/A ,"$2,886.00 ","$2,308.80 ","$2,308.80 ", N/A ,"$2,308.80 ","$2,924.48 ","$2,924.48 ","$2,924.48 ","$3,848.00 ", N/A ,"$3,270.80 ", N/A ,"$2,501.20 ", N/A ,"$3,848.00 ","$2,154.88 ", N/A ,"$1,012.02 ", N/A , N/A , N/A , N/A ,"$3,078.40 ", N/A ,"$1,735.45 ","$1,077.44 ","$3,463.20 ", N/A ,"$2,924.48 ", N/A , N/A , N/A , N/A ,"$1,847.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060029,N/A,HC OR LEVEL 5 INITIAL 30MIN,360,1 ,"$4,560.00 ","$2,964.00 ","$1,199.28 ","$4,560.00 ", N/A ,"$2,097.60 ","$2,553.60 ", N/A ,"$1,276.80 ","$1,541.28 ", N/A ,"$1,773.84 ", N/A ,"$2,056.56 ","$2,056.56 ", N/A ,"$2,056.56 ", N/A ,"$2,280.00 ", N/A , N/A , N/A , N/A ,"$3,420.00 ","$2,736.00 ","$2,736.00 ", N/A ,"$2,736.00 ","$3,465.60 ","$3,465.60 ","$3,465.60 ","$4,560.00 ", N/A ,"$3,876.00 ", N/A ,"$2,964.00 ", N/A ,"$4,560.00 ","$2,553.60 ", N/A ,"$1,199.28 ", N/A , N/A , N/A , N/A ,"$3,648.00 ", N/A ,"$2,056.56 ","$1,276.80 ","$4,104.00 ", N/A ,"$3,465.60 ", N/A , N/A , N/A , N/A ,"$2,188.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060031,N/A,HC CARDIAC OR LEVEL 1 INITIAL 30MIN,360,1 ,"$12,178.00 ","$7,915.70 ","$3,202.81 ","$12,178.00 ", N/A ,"$5,601.88 ","$6,819.68 ", N/A ,"$3,409.84 ","$4,116.16 ", N/A ,"$4,737.24 ", N/A ,"$5,492.28 ","$5,492.28 ", N/A ,"$5,492.28 ", N/A ,"$6,089.00 ", N/A , N/A , N/A , N/A ,"$9,133.50 ","$7,306.80 ","$7,306.80 ", N/A ,"$7,306.80 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$12,178.00 ", N/A ,"$10,351.30 ", N/A ,"$7,915.70 ", N/A ,"$12,178.00 ","$6,819.68 ", N/A ,"$3,202.81 ", N/A , N/A , N/A , N/A ,"$9,742.40 ", N/A ,"$5,492.28 ","$3,409.84 ","$10,960.20 ", N/A ,"$7,301.00 ", N/A , N/A , N/A , N/A ,"$5,845.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060032,N/A,HC CARDIAC OR LEVEL 1 ADDL 15MIN,360,1 ,"$1,872.00 ","$1,216.80 ",$492.34 ,"$1,872.00 ", N/A ,$861.12 ,"$1,048.32 ", N/A ,$524.16 ,$632.74 , N/A ,$728.21 , N/A ,$844.27 ,$844.27 , N/A ,$844.27 , N/A ,$936.00 , N/A , N/A , N/A , N/A ,"$1,404.00 ","$1,123.20 ","$1,123.20 ", N/A ,"$1,123.20 ","$1,422.72 ","$1,422.72 ","$1,422.72 ","$1,872.00 ", N/A ,"$1,591.20 ", N/A ,"$1,216.80 ", N/A ,"$1,872.00 ","$1,048.32 ", N/A ,$492.34 , N/A , N/A , N/A , N/A ,"$1,497.60 ", N/A ,$844.27 ,$524.16 ,"$1,684.80 ", N/A ,"$1,422.72 ", N/A , N/A , N/A , N/A ,$898.56 , N/A 
ST. ELIZABETH'S HOSPITAL,36060033,N/A,HC CARDIAC OR LEVEL 2 INITIAL 30MIN,360,1 ,"$14,614.00 ","$9,499.10 ","$3,843.48 ","$14,614.00 ", N/A ,"$6,722.44 ","$8,183.84 ", N/A ,"$4,091.92 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,590.91 ","$6,590.91 ", N/A ,"$6,590.91 ", N/A ,"$7,307.00 ", N/A , N/A , N/A , N/A ,"$10,960.50 ","$8,768.40 ","$8,768.40 ", N/A ,"$8,768.40 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$14,614.00 ", N/A ,"$12,421.90 ", N/A ,"$9,499.10 ", N/A ,"$14,614.00 ","$8,183.84 ", N/A ,"$3,843.48 ", N/A , N/A , N/A , N/A ,"$11,691.20 ", N/A ,"$6,590.91 ","$4,091.92 ","$13,152.60 ", N/A ,"$7,301.00 ", N/A , N/A , N/A , N/A ,"$7,014.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060034,N/A,HC CARDIAC OR LEVEL 2 ADDL 15MIN,360,1 ,"$2,246.00 ","$1,459.90 ",$590.70 ,"$2,246.00 ", N/A ,"$1,033.16 ","$1,257.76 ", N/A ,$628.88 ,$759.15 , N/A ,$873.69 , N/A ,"$1,012.95 ","$1,012.95 ", N/A ,"$1,012.95 ", N/A ,"$1,123.00 ", N/A , N/A , N/A , N/A ,"$1,684.50 ","$1,347.60 ","$1,347.60 ", N/A ,"$1,347.60 ","$1,706.96 ","$1,706.96 ","$1,706.96 ","$2,246.00 ", N/A ,"$1,909.10 ", N/A ,"$1,459.90 ", N/A ,"$2,246.00 ","$1,257.76 ", N/A ,$590.70 , N/A , N/A , N/A , N/A ,"$1,796.80 ", N/A ,"$1,012.95 ",$628.88 ,"$2,021.40 ", N/A ,"$1,706.96 ", N/A , N/A , N/A , N/A ,"$1,078.08 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060040,N/A,HC OR LEVEL LITHOTRIPSY INITIAL 45 MIN,360,1 ,"$18,157.00 ","$11,802.05 ","$4,775.29 ","$18,157.00 ", N/A ,"$8,352.22 ","$10,167.92 ", N/A ,"$5,083.96 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$9,078.50 ", N/A , N/A , N/A , N/A ,"$13,617.75 ","$10,894.20 ","$10,894.20 ", N/A ,"$10,894.20 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$18,157.00 ", N/A ,"$15,433.45 ", N/A ,"$11,802.05 ", N/A ,"$18,157.00 ","$10,167.92 ", N/A ,"$4,775.29 ", N/A , N/A , N/A , N/A ,"$14,525.60 ", N/A ,"$6,645.60 ","$5,083.96 ","$16,341.30 ", N/A ,"$7,301.00 ", N/A , N/A , N/A , N/A ,"$8,715.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,36060041,N/A,HC OR LEVEL LITHOTRIPSY ADDL 15 MIN,360,1 ,"$1,236.00 ",$803.40 ,$325.07 ,"$1,236.00 ", N/A ,$568.56 ,$692.16 , N/A ,$346.08 ,$417.77 , N/A ,$480.80 , N/A ,$557.44 ,$557.44 , N/A ,$557.44 , N/A ,$618.00 , N/A , N/A , N/A , N/A ,$927.00 ,$741.60 ,$741.60 , N/A ,$741.60 ,$939.36 ,$939.36 ,$939.36 ,"$1,236.00 ", N/A ,"$1,050.60 ", N/A ,$803.40 , N/A ,"$1,236.00 ",$692.16 , N/A ,$325.07 , N/A , N/A , N/A , N/A ,$988.80 , N/A ,$557.44 ,$346.08 ,"$1,112.40 ", N/A ,$939.36 , N/A , N/A , N/A , N/A ,$593.28 , N/A 
ST. ELIZABETH'S HOSPITAL,36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,"$1,096.00 ",$712.40 ,$257.58 ,"$1,096.00 ",$643.95 ,"$1,096.00 ",$613.76 ,$257.58 ,$306.88 ,$370.45 ,$257.58 ,$426.34 ,$257.58 ,$494.30 ,$494.30 ,$257.58 ,$494.30 ,$489.39 ,$548.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$822.00 ,$657.60 ,$657.60 ,$257.58 ,$657.60 ,$832.96 ,$832.96 ,$832.96 ,"$1,096.00 ", N/A ,$931.60 ,$643.94 ,$712.40 ,$257.58 ,"$1,096.00 ",$613.76 ,$257.58 ,$288.25 , N/A ,$463.72 ,$442.64 ,$270.46 ,$876.80 ,$579.55 ,$494.30 ,$306.88 ,$986.40 ,$257.58 ,$832.96 ,$920.00 ,$920.00 ,$257.58 ,$920.00 ,$526.08 ,$421.56 
ST. ELIZABETH'S HOSPITAL,36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,"$3,019.00 ","$1,962.35 ",$421.56 ,"$3,019.00 ","$2,028.93 ","$2,125.00 ","$1,690.64 ",$811.57 ,$845.32 ,"$1,020.42 ",$811.57 ,"$1,174.39 ",$811.57 ,"$1,361.57 ","$1,361.57 ",$811.57 ,"$1,361.57 ","$1,541.99 ","$1,509.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,264.25 ","$1,811.40 ","$1,811.40 ",$811.57 ,"$1,811.40 ","$2,294.44 ","$2,294.44 ","$2,294.44 ","$3,019.00 ", N/A ,"$2,566.15 ","$2,028.93 ","$1,962.35 ",$811.57 ,"$3,019.00 ","$1,690.64 ",$811.57 ,$794.00 , N/A ,$463.72 ,$442.64 ,$852.15 ,"$2,415.20 ","$1,826.04 ","$1,361.57 ",$845.32 ,"$2,717.10 ",$811.57 ,"$2,294.44 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$1,449.12 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36100001,47537,HC REM BIL CATH W G SI CHOLANG,361,1 ,"$2,167.00 ","$1,408.55 ",$200.34 ,"$2,167.00 ","$1,994.33 ","$2,125.00 ","$1,213.52 ",$797.73 ,$606.76 ,$732.45 ,$797.73 ,$842.96 ,$797.73 ,$977.32 ,$977.32 ,$797.73 ,$977.32 ,"$1,515.69 ","$1,083.50 ","$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$1,625.25 ","$1,300.20 ","$1,300.20 ",$797.73 ,"$1,300.20 ","$1,646.92 ","$1,646.92 ","$1,646.92 ","$2,167.00 ", N/A ,"$1,841.95 ","$1,994.33 ","$1,408.55 ",$797.73 ,"$2,167.00 ","$1,213.52 ",$797.73 ,$569.92 , N/A ,$220.37 ,$210.36 ,$837.62 ,"$1,733.60 ","$1,794.89 ",$977.32 ,$606.76 ,"$1,950.30 ",$797.73 ,"$1,646.92 ","$1,890.00 ","$1,890.00 ",$797.73 ,"$1,890.00 ","$1,040.16 ",$200.34 
ST. ELIZABETH'S HOSPITAL,36100002,47538,HC PLC BILE SNT W G SI EX/REMOVAL CHOLANG,361,1 ,"$15,007.00 ","$9,754.55 ","$3,946.84 ","$15,007.00 ","$12,471.18 ","$4,200.00 ","$8,403.92 ","$4,988.47 ","$4,201.96 ","$4,859.14 ","$4,988.47 ","$5,584.90 ","$4,988.47 ","$6,645.60 ","$6,645.60 ","$4,988.47 ","$6,645.60 ","$9,478.10 ","$7,503.50 ","$12,471.19 ","$4,988.47 ","$4,988.47 ","$5,088.24 ","$11,255.25 ","$9,004.20 ","$9,004.20 ","$4,988.47 ","$9,004.20 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$15,007.00 ", N/A ,"$12,755.95 ","$12,471.19 ","$9,754.55 ","$4,988.47 ","$15,007.00 ","$8,403.92 ","$4,988.47 ","$3,946.84 ", N/A ,"$4,806.14 ","$4,587.68 ","$5,237.89 ","$12,005.60 ","$11,224.07 ","$6,645.60 ","$4,201.96 ","$13,506.30 ","$4,988.47 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$4,988.47 ","$4,800.00 ","$7,203.36 ","$4,369.22 "
ST. ELIZABETH'S HOSPITAL,36100003,47540,HC PLC BILE SNT W GD SI  NEW ACCESS,361,1 ,"$13,007.00 ","$8,454.55 ","$3,420.84 ","$13,007.00 ","$12,471.18 ","$4,200.00 ","$7,283.92 ","$4,988.47 ","$3,641.96 ","$4,396.37 ","$4,988.47 ","$5,059.72 ","$4,988.47 ","$5,866.16 ","$5,866.16 ","$4,988.47 ","$5,866.16 ","$9,478.10 ","$6,503.50 ","$12,471.19 ","$4,988.47 ","$4,988.47 ","$5,088.24 ","$9,755.25 ","$7,804.20 ","$7,804.20 ","$4,988.47 ","$7,804.20 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$13,007.00 ", N/A ,"$11,055.95 ","$12,471.19 ","$8,454.55 ","$4,988.47 ","$13,007.00 ","$7,283.92 ","$4,988.47 ","$3,420.84 ", N/A ,"$4,806.14 ","$4,587.68 ","$5,237.89 ","$10,405.60 ","$11,224.07 ","$5,866.16 ","$3,641.96 ","$11,706.30 ","$4,988.47 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$4,988.47 ","$4,800.00 ","$6,243.36 ","$4,369.22 "
ST. ELIZABETH'S HOSPITAL,36100004,50430,HC INJ NEPH URET W G SI NEW ACCESS,361,1 ,"$1,636.00 ","$1,063.40 ",$332.78 ,"$1,636.00 ","$1,417.95 ","$1,636.00 ",$916.16 ,$567.18 ,$458.08 ,$552.97 ,$567.18 ,$636.40 ,$567.18 ,$737.84 ,$737.84 ,$567.18 ,$737.84 ,"$1,077.65 ",$818.00 ,"$1,417.96 ",$567.18 ,$567.18 ,$578.53 ,"$1,227.00 ",$981.60 ,$981.60 ,$567.18 ,$981.60 ,"$1,243.36 ","$1,243.36 ","$1,243.36 ","$1,636.00 ", N/A ,"$1,390.60 ","$1,417.96 ","$1,063.40 ",$567.18 ,"$1,636.00 ",$916.16 ,$567.18 ,$430.27 , N/A ,$366.06 ,$349.42 ,$595.54 ,"$1,308.80 ","$1,276.16 ",$737.84 ,$458.08 ,"$1,472.40 ",$567.18 ,"$1,243.36 ","$1,500.00 ","$1,500.00 ",$567.18 ,"$1,500.00 ",$785.28 ,$332.78 
ST. ELIZABETH'S HOSPITAL,36100005,50433,HC PL NEPH CAT W GD S AND I NEW ACCESS,361,1 ,"$5,095.00 ","$3,311.75 ","$1,040.49 ","$7,577.86 ","$7,577.85 ","$3,200.00 ","$2,853.20 ","$3,031.14 ","$1,426.60 ","$1,722.11 ","$3,031.14 ","$1,981.96 ","$3,031.14 ","$2,297.85 ","$2,297.85 ","$3,031.14 ","$2,297.85 ","$5,095.00 ","$2,547.50 ","$7,577.86 ","$3,031.14 ","$3,031.14 ","$3,091.77 ","$3,821.25 ","$3,057.00 ","$3,057.00 ","$3,031.14 ","$3,057.00 ","$3,872.20 ","$3,872.20 ","$3,872.20 ","$5,095.00 ", N/A ,"$4,330.75 ","$5,095.00 ","$3,311.75 ","$3,031.14 ","$5,095.00 ","$2,853.20 ","$3,031.14 ","$1,339.99 ", N/A ,"$1,144.54 ","$1,092.51 ","$3,182.70 ","$4,076.00 ","$6,820.07 ","$2,297.85 ","$1,426.60 ","$4,585.50 ","$3,031.14 ","$3,872.20 ","$2,690.00 ","$2,690.00 ","$3,031.14 ","$2,690.00 ","$2,445.60 ","$1,040.49 "
ST. ELIZABETH'S HOSPITAL,36100006,50434,HC CONVERT NEPH CTH NEPHUR CTH WG S AND I EXST TRACT,361,1 ,"$1,702.00 ","$1,106.30 ",$447.63 ,"$4,413.08 ","$4,413.08 ","$1,702.00 ",$953.12 ,"$1,765.23 ",$476.56 ,$575.28 ,"$1,765.23 ",$662.08 ,"$1,702.00 ",$767.60 ,$767.60 ,"$1,702.00 ",$767.60 ,"$1,702.00 ",$851.00 ,"$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,702.00 ","$1,276.50 ","$1,021.20 ","$1,021.20 ","$1,765.23 ","$1,021.20 ","$1,293.52 ","$1,293.52 ","$1,293.52 ","$1,702.00 ", N/A ,"$1,446.70 ","$1,702.00 ","$1,106.30 ","$1,765.23 ","$1,702.00 ",$953.12 ,"$1,765.23 ",$447.63 , N/A ,"$1,144.54 ","$1,092.51 ","$1,853.49 ","$1,361.60 ","$3,971.77 ",$767.60 ,$476.56 ,"$1,531.80 ","$1,765.23 ","$1,293.52 ","$1,500.00 ","$1,500.00 ","$1,702.00 ","$1,500.00 ",$816.96 ,"$1,040.49 "
ST. ELIZABETH'S HOSPITAL,36100007,50606,HC ENDO BX URETER/RENAL PELVIS W/G SI,361,1 ,"$1,407.00 ",$914.55 ,$370.04 ,"$1,407.00 ", N/A ,"$1,407.00 ",$787.92 , N/A ,$393.96 ,$475.57 , N/A ,$547.32 , N/A ,$634.56 ,$634.56 , N/A ,$634.56 , N/A ,$703.50 , N/A , N/A , N/A , N/A ,"$1,055.25 ",$844.20 ,$844.20 , N/A ,$844.20 ,"$1,069.32 ","$1,069.32 ","$1,069.32 ","$1,407.00 ", N/A ,"$1,195.95 ", N/A ,$914.55 , N/A ,"$1,407.00 ",$787.92 , N/A ,$370.04 , N/A , N/A , N/A , N/A ,"$1,125.60 ", N/A ,$634.56 ,$393.96 ,"$1,266.30 ", N/A ,"$1,069.32 ",$920.00 ,$920.00 , N/A ,$920.00 ,$675.36 , N/A 
ST. ELIZABETH'S HOSPITAL,36100008,50694,HC PL URT STNT W G SI NEW ACCESS WO NEPH CATH,361,1 ,"$9,086.00 ","$5,905.90 ","$2,213.24 ","$9,086.00 ","$7,577.85 ","$4,200.00 ","$5,088.16 ","$3,031.14 ","$2,544.08 ","$3,071.07 ","$3,031.14 ","$3,534.45 ","$3,031.14 ","$4,097.79 ","$4,097.79 ","$3,031.14 ","$4,097.79 ","$5,759.17 ","$4,543.00 ","$7,577.86 ","$3,031.14 ","$3,031.14 ","$3,091.77 ","$6,814.50 ","$5,451.60 ","$5,451.60 ","$3,031.14 ","$5,451.60 ","$6,905.36 ","$6,905.36 ","$6,905.36 ","$9,086.00 ", N/A ,"$7,723.10 ","$7,577.86 ","$5,905.90 ","$3,031.14 ","$9,086.00 ","$5,088.16 ","$3,031.14 ","$2,389.62 ", N/A ,"$2,434.56 ","$2,323.90 ","$3,182.70 ","$7,268.80 ","$6,820.07 ","$4,097.79 ","$2,544.08 ","$8,177.40 ","$3,031.14 ","$6,905.36 ","$3,600.00 ","$3,600.00 ","$3,031.14 ","$3,600.00 ","$4,361.28 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,36100009,50695,HC PL URT STNT W G SI NEW ACCESS WITH NEPH CATH,361,1 ,"$9,086.00 ","$5,905.90 ","$2,213.24 ","$9,086.00 ","$7,577.85 ","$4,200.00 ","$5,088.16 ","$3,031.14 ","$2,544.08 ","$3,071.07 ","$3,031.14 ","$3,534.45 ","$3,031.14 ","$4,097.79 ","$4,097.79 ","$3,031.14 ","$4,097.79 ","$5,759.17 ","$4,543.00 ","$7,577.86 ","$3,031.14 ","$3,031.14 ","$3,091.77 ","$6,814.50 ","$5,451.60 ","$5,451.60 ","$3,031.14 ","$5,451.60 ","$6,905.36 ","$6,905.36 ","$6,905.36 ","$9,086.00 ", N/A ,"$7,723.10 ","$7,577.86 ","$5,905.90 ","$3,031.14 ","$9,086.00 ","$5,088.16 ","$3,031.14 ","$2,389.62 ", N/A ,"$2,434.56 ","$2,323.90 ","$3,182.70 ","$7,268.80 ","$6,820.07 ","$4,097.79 ","$2,544.08 ","$8,177.40 ","$3,031.14 ","$6,905.36 ","$3,600.00 ","$3,600.00 ","$3,031.14 ","$3,600.00 ","$4,361.28 ","$2,213.24 "
ST. ELIZABETH'S HOSPITAL,36100010,50705,HC URETERAL EMBOL OR OCCLUSION W/G SI,361,1 ,"$1,407.00 ",$914.55 ,$370.04 ,"$1,407.00 ", N/A ,"$1,407.00 ",$787.92 , N/A ,$393.96 ,$475.57 , N/A ,$547.32 , N/A ,$634.56 ,$634.56 , N/A ,$634.56 , N/A ,$703.50 , N/A , N/A , N/A , N/A ,"$1,055.25 ",$844.20 ,$844.20 , N/A ,$844.20 ,"$1,069.32 ","$1,069.32 ","$1,069.32 ","$1,407.00 ", N/A ,"$1,195.95 ", N/A ,$914.55 , N/A ,"$1,407.00 ",$787.92 , N/A ,$370.04 , N/A , N/A , N/A , N/A ,"$1,125.60 ", N/A ,$634.56 ,$393.96 ,"$1,266.30 ", N/A ,"$1,069.32 ",$920.00 ,$920.00 , N/A ,$920.00 ,$675.36 , N/A 
ST. ELIZABETH'S HOSPITAL,36100011,49185,HC SCLEROTHERAPY FLUID COLLECTION PERC INJECT IG SI,361,1 ,"$2,147.00 ","$1,395.55 ",$564.66 ,"$2,147.00 ","$1,533.75 ","$2,147.00 ","$1,202.32 ",$613.50 ,$601.16 ,$725.69 ,$613.50 ,$835.18 ,$613.50 ,$968.30 ,$968.30 ,$613.50 ,$968.30 ,"$1,165.65 ","$1,073.50 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,610.25 ","$1,288.20 ","$1,288.20 ",$613.50 ,"$1,288.20 ","$1,631.72 ","$1,631.72 ","$1,631.72 ","$2,147.00 ", N/A ,"$1,824.95 ","$1,533.75 ","$1,395.55 ",$613.50 ,"$2,147.00 ","$1,202.32 ",$613.50 ,$564.66 , N/A ,$729.45 ,$696.30 ,$644.18 ,"$1,717.60 ","$1,380.37 ",$968.30 ,$601.16 ,"$1,932.30 ",$613.50 ,"$1,631.72 ","$1,500.00 ","$1,500.00 ",$613.50 ,"$1,500.00 ","$1,030.56 ",$663.14 
ST. ELIZABETH'S HOSPITAL,36100015,11010,HC DEBRID/REMOVE FOREIGN BODY SKIN/SUBQ TISSUE,361,1 ,"$4,160.00 ","$2,704.00 ",$613.50 ,"$4,160.00 ","$1,533.75 ","$3,200.00 ","$2,329.60 ",$613.50 ,"$1,164.80 ","$1,406.08 ",$613.50 ,"$1,618.24 ",$613.50 ,"$1,876.16 ","$1,876.16 ",$613.50 ,"$1,876.16 ","$1,165.65 ","$2,080.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,120.00 ","$2,496.00 ","$2,496.00 ",$613.50 ,"$2,496.00 ","$3,161.60 ","$3,161.60 ","$3,161.60 ","$4,160.00 ", N/A ,"$3,536.00 ","$1,533.75 ","$2,704.00 ",$613.50 ,"$4,160.00 ","$2,329.60 ",$613.50 ,"$1,094.08 ", N/A ,"$1,359.03 ","$1,297.25 ",$644.18 ,"$3,328.00 ","$1,380.37 ","$1,876.16 ","$1,164.80 ","$3,744.00 ",$613.50 ,"$3,161.60 ","$1,500.00 ","$1,500.00 ",$613.50 ,"$1,500.00 ","$1,996.80 ","$1,235.48 "
ST. ELIZABETH'S HOSPITAL,36100016,11011,HC DEBRID/REMOVE FOREIGN BODY SKIN/SUBQ TISS/MUSCLE,361,1 ,"$1,080.00 ",$702.00 ,$284.04 ,"$3,013.75 ","$1,533.75 ","$1,080.00 ",$604.80 ,$613.50 ,$302.40 ,$365.04 ,$613.50 ,$420.12 ,$613.50 ,$487.08 ,$487.08 ,$613.50 ,$487.08 ,"$1,080.00 ",$540.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,$810.00 ,$648.00 ,$648.00 ,$613.50 ,$648.00 ,$820.80 ,$820.80 ,$820.80 ,"$1,080.00 ", N/A ,$918.00 ,"$1,080.00 ",$702.00 ,$613.50 ,"$1,080.00 ",$604.80 ,$613.50 ,$284.04 , N/A ,"$1,080.00 ","$1,080.00 ",$644.18 ,$864.00 ,"$1,380.37 ",$487.08 ,$302.40 ,$972.00 ,$613.50 ,$820.80 ,"$1,080.00 ","$1,080.00 ",$613.50 ,"$1,080.00 ",$518.40 ,"$3,013.75 "
ST. ELIZABETH'S HOSPITAL,36100017,11012,HC DEBRID/REMOVE FOREIGN BODY SKIN/SUBQ TISS/MUSCLE/BONE,361,1 ,"$6,695.00 ","$4,351.75 ","$1,235.48 ","$6,695.00 ","$5,843.93 ","$3,200.00 ","$3,749.20 ","$2,337.57 ","$1,874.60 ","$2,262.91 ","$2,337.57 ","$2,604.36 ","$2,337.57 ","$3,019.45 ","$3,019.45 ","$2,337.57 ","$3,019.45 ","$4,441.38 ","$3,347.50 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$5,021.25 ","$4,017.00 ","$4,017.00 ","$2,337.57 ","$4,017.00 ","$5,088.20 ","$5,088.20 ","$5,088.20 ","$6,695.00 ", N/A ,"$5,690.75 ","$5,843.93 ","$4,351.75 ","$2,337.57 ","$6,695.00 ","$3,749.20 ","$2,337.57 ","$1,760.79 ", N/A ,"$1,359.03 ","$1,297.25 ","$2,454.45 ","$5,356.00 ","$5,259.53 ","$3,019.45 ","$1,874.60 ","$6,025.50 ","$2,337.57 ","$5,088.20 ","$1,500.00 ","$1,500.00 ","$2,337.57 ","$1,500.00 ","$3,213.60 ","$1,235.48 "
ST. ELIZABETH'S HOSPITAL,36100026,36510,HC UMBILICAL CATHETER INSERTION NEWBORN,361,1 ,"$2,155.00 ","$1,400.75 ",$566.77 ,"$2,155.00 ", N/A ,"$2,155.00 ","$1,206.80 ", N/A ,$603.40 ,$728.39 , N/A ,$838.30 , N/A ,$971.91 ,$971.91 , N/A ,$971.91 , N/A ,"$1,077.50 ", N/A , N/A , N/A , N/A ,"$1,616.25 ","$1,293.00 ","$1,293.00 ", N/A ,"$1,293.00 ","$1,637.80 ","$1,637.80 ","$1,637.80 ","$2,155.00 ", N/A ,"$1,831.75 ", N/A ,"$1,400.75 ", N/A ,"$2,155.00 ","$1,206.80 ", N/A ,$566.77 , N/A , N/A , N/A , N/A ,"$1,724.00 ", N/A ,$971.91 ,$603.40 ,"$1,939.50 ", N/A ,"$1,637.80 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,034.40 ", N/A 
ST. ELIZABETH'S HOSPITAL,36100036,62269,HC BIOPSY PERC SPINAL CORD,361,1 ,"$1,399.00 ",$909.35 ,$367.94 ,"$3,467.90 ","$3,467.90 ","$1,399.00 ",$783.44 ,"$1,387.16 ",$391.72 ,$472.86 ,"$1,387.16 ",$544.21 ,"$1,387.16 ",$630.95 ,$630.95 ,"$1,387.16 ",$630.95 ,"$1,399.00 ",$699.50 ,"$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,399.00 ","$1,049.25 ",$839.40 ,$839.40 ,"$1,387.16 ",$839.40 ,"$1,063.24 ","$1,063.24 ","$1,063.24 ","$1,399.00 ", N/A ,"$1,189.15 ","$1,399.00 ",$909.35 ,"$1,387.16 ","$1,399.00 ",$783.44 ,"$1,387.16 ",$367.94 , N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$1,119.20 ","$3,121.10 ",$630.95 ,$391.72 ,"$1,259.10 ","$1,387.16 ","$1,063.24 ","$1,399.00 ","$1,399.00 ","$1,387.16 ","$1,399.00 ",$671.52 ,$663.14 
ST. ELIZABETH'S HOSPITAL,36100042,20600,HC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-BIL,361,1 ,"$2,840.00 ","$1,846.00 ",$386.36 ,"$2,840.00 ",$965.90 ,"$2,840.00 ","$1,590.40 ",$386.36 ,$795.20 ,$959.92 ,$386.36 ,"$1,104.76 ",$386.36 ,"$1,280.84 ","$1,280.84 ",$386.36 ,"$1,280.84 ",$734.09 ,"$1,420.00 ",$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$2,130.00 ","$1,704.00 ","$1,704.00 ",$386.36 ,"$1,704.00 ","$2,158.40 ","$2,158.40 ","$2,158.40 ","$2,840.00 ", N/A ,"$2,414.00 ",$965.91 ,"$1,846.00 ",$386.36 ,"$2,840.00 ","$1,590.40 ",$386.36 ,$746.92 , N/A ,$511.98 ,$488.71 ,$405.68 ,"$2,272.00 ",$869.32 ,"$1,280.84 ",$795.20 ,"$2,556.00 ",$386.36 ,"$2,158.40 ","$1,380.00 ","$1,380.00 ",$386.36 ,"$1,380.00 ","$1,363.20 ",$465.44 
ST. ELIZABETH'S HOSPITAL,36100043,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-BIL,361,1 ,"$1,894.00 ","$1,231.10 ",$386.36 ,"$1,894.00 ",$965.90 ,"$1,894.00 ","$1,060.64 ",$386.36 ,$530.32 ,$640.17 ,$386.36 ,$736.77 ,$386.36 ,$854.19 ,$854.19 ,$386.36 ,$854.19 ,$734.09 ,$947.00 ,$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$1,420.50 ","$1,136.40 ","$1,136.40 ",$386.36 ,"$1,136.40 ","$1,439.44 ","$1,439.44 ","$1,439.44 ","$1,894.00 ", N/A ,"$1,609.90 ",$965.91 ,"$1,231.10 ",$386.36 ,"$1,894.00 ","$1,060.64 ",$386.36 ,$498.12 , N/A ,$511.98 ,$488.71 ,$405.68 ,"$1,515.20 ",$869.32 ,$854.19 ,$530.32 ,"$1,704.60 ",$386.36 ,"$1,439.44 ","$1,380.00 ","$1,380.00 ",$386.36 ,"$1,380.00 ",$909.12 ,$465.44 
ST. ELIZABETH'S HOSPITAL,36100044,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-BIL,361,1 ,"$1,601.00 ","$1,040.65 ",$386.36 ,"$1,601.00 ",$965.90 ,"$1,601.00 ",$896.56 ,$386.36 ,$448.28 ,$541.14 ,$386.36 ,$622.79 ,$386.36 ,$722.05 ,$722.05 ,$386.36 ,$722.05 ,$734.09 ,$800.50 ,$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$1,200.75 ",$960.60 ,$960.60 ,$386.36 ,$960.60 ,"$1,216.76 ","$1,216.76 ","$1,216.76 ","$1,601.00 ", N/A ,"$1,360.85 ",$965.91 ,"$1,040.65 ",$386.36 ,"$1,601.00 ",$896.56 ,$386.36 ,$421.06 , N/A ,$511.98 ,$488.71 ,$405.68 ,"$1,280.80 ",$869.32 ,$722.05 ,$448.28 ,"$1,440.90 ",$386.36 ,"$1,216.76 ","$1,380.00 ","$1,380.00 ",$386.36 ,"$1,380.00 ",$768.48 ,$465.44 
ST. ELIZABETH'S HOSPITAL,36100046,15271,HC APPL SKIN SUB TAL <100 INIT 25CM-LT,361,1 ,"$1,159.00 ",$753.35 ,$304.82 ,"$4,221.50 ","$4,221.50 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$324.52 ,$391.74 ,"$1,688.60 ",$450.85 ,"$1,159.00 ",$522.71 ,$522.71 ,"$1,159.00 ",$522.71 ,"$1,159.00 ",$579.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,159.00 ",$869.25 ,$695.40 ,$695.40 ,"$1,688.60 ",$695.40 ,$880.84 ,$880.84 ,$880.84 ,"$1,159.00 ", N/A ,$985.15 ,"$1,159.00 ",$753.35 ,"$1,688.60 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$304.82 , N/A ,"$1,159.00 ","$1,159.00 ","$1,773.03 ",$927.20 ,"$3,799.34 ",$522.71 ,$324.52 ,"$1,043.10 ","$1,688.60 ",$880.84 ,"$1,159.00 ","$1,159.00 ","$1,159.00 ","$1,159.00 ",$556.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100047,15271,HC APPL SKIN SUB TAL <100 INIT 25CM-RT,361,1 ,"$1,159.00 ",$753.35 ,$304.82 ,"$4,221.50 ","$4,221.50 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$324.52 ,$391.74 ,"$1,688.60 ",$450.85 ,"$1,159.00 ",$522.71 ,$522.71 ,"$1,159.00 ",$522.71 ,"$1,159.00 ",$579.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,159.00 ",$869.25 ,$695.40 ,$695.40 ,"$1,688.60 ",$695.40 ,$880.84 ,$880.84 ,$880.84 ,"$1,159.00 ", N/A ,$985.15 ,"$1,159.00 ",$753.35 ,"$1,688.60 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$304.82 , N/A ,"$1,159.00 ","$1,159.00 ","$1,773.03 ",$927.20 ,"$3,799.34 ",$522.71 ,$324.52 ,"$1,043.10 ","$1,688.60 ",$880.84 ,"$1,159.00 ","$1,159.00 ","$1,159.00 ","$1,159.00 ",$556.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100048,15272,HC APPL SKIN SUB TAL <100 ADDL 25CM-LT,361,1 ,$415.00 ,$269.75 ,$109.15 ,"$1,518.42 ", N/A ,$415.00 ,$232.40 , N/A ,$116.20 ,$140.27 , N/A ,$161.44 , N/A ,$187.17 ,$187.17 , N/A ,$187.17 , N/A ,$207.50 , N/A , N/A , N/A , N/A ,$311.25 ,$249.00 ,$249.00 , N/A ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 , N/A ,$269.75 , N/A ,$415.00 ,$232.40 , N/A ,$109.15 , N/A ,$415.00 ,$415.00 , N/A ,$332.00 , N/A ,$187.17 ,$116.20 ,$373.50 , N/A ,$315.40 ,$415.00 ,$415.00 , N/A ,$415.00 ,$199.20 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100049,15272,HC APPL SKIN SUB TAL <100 ADDL 25CM-RT,361,1 ,$415.00 ,$269.75 ,$109.15 ,"$1,518.42 ", N/A ,$415.00 ,$232.40 , N/A ,$116.20 ,$140.27 , N/A ,$161.44 , N/A ,$187.17 ,$187.17 , N/A ,$187.17 , N/A ,$207.50 , N/A , N/A , N/A , N/A ,$311.25 ,$249.00 ,$249.00 , N/A ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 , N/A ,$269.75 , N/A ,$415.00 ,$232.40 , N/A ,$109.15 , N/A ,$415.00 ,$415.00 , N/A ,$332.00 , N/A ,$187.17 ,$116.20 ,$373.50 , N/A ,$315.40 ,$415.00 ,$415.00 , N/A ,$415.00 ,$199.20 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100050,15273,HC APPL SKIN SUB TAL >100 INIT 100CM-LT,361,1 ,"$1,713.00 ","$1,113.45 ",$450.52 ,"$8,678.76 ","$8,678.75 ","$1,713.00 ",$959.28 ,"$3,471.50 ",$479.64 ,$578.99 ,"$3,471.50 ",$666.36 ,"$1,713.00 ",$772.56 ,$772.56 ,"$1,713.00 ",$772.56 ,"$1,713.00 ",$856.50 ,"$8,678.76 ","$3,471.50 ","$3,471.50 ","$1,713.00 ","$1,284.75 ","$1,027.80 ","$1,027.80 ","$3,471.50 ","$1,027.80 ","$1,301.88 ","$1,301.88 ","$1,301.88 ","$1,713.00 ", N/A ,"$1,456.05 ","$1,713.00 ","$1,113.45 ","$3,471.50 ","$1,713.00 ",$959.28 ,"$3,471.50 ",$450.52 , N/A ,"$1,670.26 ","$1,594.34 ","$3,645.08 ","$1,370.40 ","$7,810.88 ",$772.56 ,$479.64 ,"$1,541.70 ","$3,471.50 ","$1,301.88 ","$1,713.00 ","$1,713.00 ","$1,713.00 ","$1,713.00 ",$822.24 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100051,15273,HC APPL SKIN SUB TAL >100 INIT 100CM-RT,361,1 ,"$1,713.00 ","$1,113.45 ",$450.52 ,"$8,678.76 ","$8,678.75 ","$1,713.00 ",$959.28 ,"$3,471.50 ",$479.64 ,$578.99 ,"$3,471.50 ",$666.36 ,"$1,713.00 ",$772.56 ,$772.56 ,"$1,713.00 ",$772.56 ,"$1,713.00 ",$856.50 ,"$8,678.76 ","$3,471.50 ","$3,471.50 ","$1,713.00 ","$1,284.75 ","$1,027.80 ","$1,027.80 ","$3,471.50 ","$1,027.80 ","$1,301.88 ","$1,301.88 ","$1,301.88 ","$1,713.00 ", N/A ,"$1,456.05 ","$1,713.00 ","$1,113.45 ","$3,471.50 ","$1,713.00 ",$959.28 ,"$3,471.50 ",$450.52 , N/A ,"$1,670.26 ","$1,594.34 ","$3,645.08 ","$1,370.40 ","$7,810.88 ",$772.56 ,$479.64 ,"$1,541.70 ","$3,471.50 ","$1,301.88 ","$1,713.00 ","$1,713.00 ","$1,713.00 ","$1,713.00 ",$822.24 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100052,15274,HC APPL SKIN SUB TAL >100 ADDL 100CM-LT,361,1 ,"$1,124.00 ",$730.60 ,$295.61 ,"$1,518.42 ", N/A ,"$1,124.00 ",$629.44 , N/A ,$314.72 ,$379.91 , N/A ,$437.24 , N/A ,$506.92 ,$506.92 , N/A ,$506.92 , N/A ,$562.00 , N/A , N/A , N/A , N/A ,$843.00 ,$674.40 ,$674.40 , N/A ,$674.40 ,$854.24 ,$854.24 ,$854.24 ,"$1,124.00 ", N/A ,$955.40 , N/A ,$730.60 , N/A ,"$1,124.00 ",$629.44 , N/A ,$295.61 , N/A ,"$1,124.00 ","$1,124.00 ", N/A ,$899.20 , N/A ,$506.92 ,$314.72 ,"$1,011.60 ", N/A ,$854.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$539.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100053,15274,HC APPL SKIN SUB TAL >100 ADDL 100CM-RT,361,1 ,"$1,124.00 ",$730.60 ,$295.61 ,"$1,518.42 ", N/A ,"$1,124.00 ",$629.44 , N/A ,$314.72 ,$379.91 , N/A ,$437.24 , N/A ,$506.92 ,$506.92 , N/A ,$506.92 , N/A ,$562.00 , N/A , N/A , N/A , N/A ,$843.00 ,$674.40 ,$674.40 , N/A ,$674.40 ,$854.24 ,$854.24 ,$854.24 ,"$1,124.00 ", N/A ,$955.40 , N/A ,$730.60 , N/A ,"$1,124.00 ",$629.44 , N/A ,$295.61 , N/A ,"$1,124.00 ","$1,124.00 ", N/A ,$899.20 , N/A ,$506.92 ,$314.72 ,"$1,011.60 ", N/A ,$854.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$539.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100054,15275,HC APPL SKIN SUB OTH <100 INIT 25CM-LT,361,1 ,"$1,159.00 ",$753.35 ,$304.82 ,"$4,221.50 ","$4,221.50 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$324.52 ,$391.74 ,"$1,688.60 ",$450.85 ,"$1,159.00 ",$522.71 ,$522.71 ,"$1,159.00 ",$522.71 ,"$1,159.00 ",$579.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,159.00 ",$869.25 ,$695.40 ,$695.40 ,"$1,688.60 ",$695.40 ,$880.84 ,$880.84 ,$880.84 ,"$1,159.00 ", N/A ,$985.15 ,"$1,159.00 ",$753.35 ,"$1,688.60 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$304.82 , N/A ,"$1,159.00 ","$1,159.00 ","$1,773.03 ",$927.20 ,"$3,799.34 ",$522.71 ,$324.52 ,"$1,043.10 ","$1,688.60 ",$880.84 ,"$1,159.00 ","$1,159.00 ","$1,159.00 ","$1,159.00 ",$556.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100055,15275,HC APPL SKIN SUB OTH <100 INIT 25CM-RT,361,1 ,"$1,159.00 ",$753.35 ,$304.82 ,"$4,221.50 ","$4,221.50 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$324.52 ,$391.74 ,"$1,688.60 ",$450.85 ,"$1,159.00 ",$522.71 ,$522.71 ,"$1,159.00 ",$522.71 ,"$1,159.00 ",$579.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,159.00 ",$869.25 ,$695.40 ,$695.40 ,"$1,688.60 ",$695.40 ,$880.84 ,$880.84 ,$880.84 ,"$1,159.00 ", N/A ,$985.15 ,"$1,159.00 ",$753.35 ,"$1,688.60 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$304.82 , N/A ,"$1,159.00 ","$1,159.00 ","$1,773.03 ",$927.20 ,"$3,799.34 ",$522.71 ,$324.52 ,"$1,043.10 ","$1,688.60 ",$880.84 ,"$1,159.00 ","$1,159.00 ","$1,159.00 ","$1,159.00 ",$556.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100056,15276,HC APPL SKIN SUB OTH <100 ADDL 25CM-LT,361,1 ,$415.00 ,$269.75 ,$109.15 ,"$1,518.42 ", N/A ,$415.00 ,$232.40 , N/A ,$116.20 ,$140.27 , N/A ,$161.44 , N/A ,$187.17 ,$187.17 , N/A ,$187.17 , N/A ,$207.50 , N/A , N/A , N/A , N/A ,$311.25 ,$249.00 ,$249.00 , N/A ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 , N/A ,$269.75 , N/A ,$415.00 ,$232.40 , N/A ,$109.15 , N/A ,$415.00 ,$415.00 , N/A ,$332.00 , N/A ,$187.17 ,$116.20 ,$373.50 , N/A ,$315.40 ,$415.00 ,$415.00 , N/A ,$415.00 ,$199.20 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100057,15276,HC APPL SKIN SUB OTH <100 ADDL 25CM-RT,361,1 ,$415.00 ,$269.75 ,$109.15 ,"$1,518.42 ", N/A ,$415.00 ,$232.40 , N/A ,$116.20 ,$140.27 , N/A ,$161.44 , N/A ,$187.17 ,$187.17 , N/A ,$187.17 , N/A ,$207.50 , N/A , N/A , N/A , N/A ,$311.25 ,$249.00 ,$249.00 , N/A ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 , N/A ,$269.75 , N/A ,$415.00 ,$232.40 , N/A ,$109.15 , N/A ,$415.00 ,$415.00 , N/A ,$332.00 , N/A ,$187.17 ,$116.20 ,$373.50 , N/A ,$315.40 ,$415.00 ,$415.00 , N/A ,$415.00 ,$199.20 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100058,15277,HC APPL SKIN SUB OTH >100 INIT 100CM-LT,361,1 ,"$1,713.00 ","$1,113.45 ",$450.52 ,"$4,221.50 ","$4,221.50 ","$1,713.00 ",$959.28 ,"$1,688.60 ",$479.64 ,$578.99 ,"$1,688.60 ",$666.36 ,"$1,688.60 ",$772.56 ,$772.56 ,"$1,688.60 ",$772.56 ,"$1,713.00 ",$856.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,713.00 ","$1,284.75 ","$1,027.80 ","$1,027.80 ","$1,688.60 ","$1,027.80 ","$1,301.88 ","$1,301.88 ","$1,301.88 ","$1,713.00 ", N/A ,"$1,456.05 ","$1,713.00 ","$1,113.45 ","$1,688.60 ","$1,713.00 ",$959.28 ,"$1,688.60 ",$450.52 , N/A ,"$1,670.26 ","$1,594.34 ","$1,773.03 ","$1,370.40 ","$3,799.34 ",$772.56 ,$479.64 ,"$1,541.70 ","$1,688.60 ","$1,301.88 ","$1,713.00 ","$1,713.00 ","$1,688.60 ","$1,713.00 ",$822.24 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100059,15277,HC APPL SKIN SUB OTH >100 INIT 100CM-RT,361,1 ,"$1,713.00 ","$1,113.45 ",$450.52 ,"$4,221.50 ","$4,221.50 ","$1,713.00 ",$959.28 ,"$1,688.60 ",$479.64 ,$578.99 ,"$1,688.60 ",$666.36 ,"$1,688.60 ",$772.56 ,$772.56 ,"$1,688.60 ",$772.56 ,"$1,713.00 ",$856.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,713.00 ","$1,284.75 ","$1,027.80 ","$1,027.80 ","$1,688.60 ","$1,027.80 ","$1,301.88 ","$1,301.88 ","$1,301.88 ","$1,713.00 ", N/A ,"$1,456.05 ","$1,713.00 ","$1,113.45 ","$1,688.60 ","$1,713.00 ",$959.28 ,"$1,688.60 ",$450.52 , N/A ,"$1,670.26 ","$1,594.34 ","$1,773.03 ","$1,370.40 ","$3,799.34 ",$772.56 ,$479.64 ,"$1,541.70 ","$1,688.60 ","$1,301.88 ","$1,713.00 ","$1,713.00 ","$1,688.60 ","$1,713.00 ",$822.24 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100060,15278,HC APPL SKIN SUB OTH >100 ADDL 100CM-LT,361,1 ,"$1,124.00 ",$730.60 ,$295.61 ,"$1,518.42 ", N/A ,"$1,124.00 ",$629.44 , N/A ,$314.72 ,$379.91 , N/A ,$437.24 , N/A ,$506.92 ,$506.92 , N/A ,$506.92 , N/A ,$562.00 , N/A , N/A , N/A , N/A ,$843.00 ,$674.40 ,$674.40 , N/A ,$674.40 ,$854.24 ,$854.24 ,$854.24 ,"$1,124.00 ", N/A ,$955.40 , N/A ,$730.60 , N/A ,"$1,124.00 ",$629.44 , N/A ,$295.61 , N/A ,"$1,124.00 ","$1,124.00 ", N/A ,$899.20 , N/A ,$506.92 ,$314.72 ,"$1,011.60 ", N/A ,$854.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$539.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100061,15278,HC APPL SKIN SUB OTH >100 ADDL 100CM-RT,361,1 ,"$1,124.00 ",$730.60 ,$295.61 ,"$1,518.42 ", N/A ,"$1,124.00 ",$629.44 , N/A ,$314.72 ,$379.91 , N/A ,$437.24 , N/A ,$506.92 ,$506.92 , N/A ,$506.92 , N/A ,$562.00 , N/A , N/A , N/A , N/A ,$843.00 ,$674.40 ,$674.40 , N/A ,$674.40 ,$854.24 ,$854.24 ,$854.24 ,"$1,124.00 ", N/A ,$955.40 , N/A ,$730.60 , N/A ,"$1,124.00 ",$629.44 , N/A ,$295.61 , N/A ,"$1,124.00 ","$1,124.00 ", N/A ,$899.20 , N/A ,$506.92 ,$314.72 ,"$1,011.60 ", N/A ,$854.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$539.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100063,20600,HC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-LT,361,1 ,"$2,002.00 ","$1,301.30 ",$257.58 ,"$2,002.00 ",$643.95 ,"$2,002.00 ","$1,121.12 ",$257.58 ,$560.56 ,$676.68 ,$257.58 ,$778.78 ,$257.58 ,$902.90 ,$902.90 ,$257.58 ,$902.90 ,$489.39 ,"$1,001.00 ",$643.94 ,$257.58 ,$257.58 ,$262.73 ,"$1,501.50 ","$1,201.20 ","$1,201.20 ",$257.58 ,"$1,201.20 ","$1,521.52 ","$1,521.52 ","$1,521.52 ","$2,002.00 ", N/A ,"$1,701.70 ",$643.94 ,"$1,301.30 ",$257.58 ,"$2,002.00 ","$1,121.12 ",$257.58 ,$526.53 , N/A ,$341.32 ,$325.80 ,$270.46 ,"$1,601.60 ",$579.55 ,$902.90 ,$560.56 ,"$1,801.80 ",$257.58 ,"$1,521.52 ",$920.00 ,$920.00 ,$257.58 ,$920.00 ,$960.96 ,$310.29 
ST. ELIZABETH'S HOSPITAL,36100064,20600,HC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-RT,361,1 ,"$2,002.00 ","$1,301.30 ",$257.58 ,"$2,002.00 ",$643.95 ,"$2,002.00 ","$1,121.12 ",$257.58 ,$560.56 ,$676.68 ,$257.58 ,$778.78 ,$257.58 ,$902.90 ,$902.90 ,$257.58 ,$902.90 ,$489.39 ,"$1,001.00 ",$643.94 ,$257.58 ,$257.58 ,$262.73 ,"$1,501.50 ","$1,201.20 ","$1,201.20 ",$257.58 ,"$1,201.20 ","$1,521.52 ","$1,521.52 ","$1,521.52 ","$2,002.00 ", N/A ,"$1,701.70 ",$643.94 ,"$1,301.30 ",$257.58 ,"$2,002.00 ","$1,121.12 ",$257.58 ,$526.53 , N/A ,$341.32 ,$325.80 ,$270.46 ,"$1,601.60 ",$579.55 ,$902.90 ,$560.56 ,"$1,801.80 ",$257.58 ,"$1,521.52 ",$920.00 ,$920.00 ,$257.58 ,$920.00 ,$960.96 ,$310.29 
ST. ELIZABETH'S HOSPITAL,36100065,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-LT,361,1 ,"$1,154.00 ",$750.10 ,$257.58 ,"$1,154.00 ",$643.95 ,"$1,154.00 ",$646.24 ,$257.58 ,$323.12 ,$390.05 ,$257.58 ,$448.91 ,$257.58 ,$520.45 ,$520.45 ,$257.58 ,$520.45 ,$489.39 ,$577.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$865.50 ,$692.40 ,$692.40 ,$257.58 ,$692.40 ,$877.04 ,$877.04 ,$877.04 ,"$1,154.00 ", N/A ,$980.90 ,$643.94 ,$750.10 ,$257.58 ,"$1,154.00 ",$646.24 ,$257.58 ,$303.50 , N/A ,$341.32 ,$325.80 ,$270.46 ,$923.20 ,$579.55 ,$520.45 ,$323.12 ,"$1,038.60 ",$257.58 ,$877.04 ,$920.00 ,$920.00 ,$257.58 ,$920.00 ,$553.92 ,$310.29 
ST. ELIZABETH'S HOSPITAL,36100066,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-RT,361,1 ,"$1,154.00 ",$750.10 ,$257.58 ,"$1,154.00 ",$643.95 ,"$1,154.00 ",$646.24 ,$257.58 ,$323.12 ,$390.05 ,$257.58 ,$448.91 ,$257.58 ,$520.45 ,$520.45 ,$257.58 ,$520.45 ,$489.39 ,$577.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$865.50 ,$692.40 ,$692.40 ,$257.58 ,$692.40 ,$877.04 ,$877.04 ,$877.04 ,"$1,154.00 ", N/A ,$980.90 ,$643.94 ,$750.10 ,$257.58 ,"$1,154.00 ",$646.24 ,$257.58 ,$303.50 , N/A ,$341.32 ,$325.80 ,$270.46 ,$923.20 ,$579.55 ,$520.45 ,$323.12 ,"$1,038.60 ",$257.58 ,$877.04 ,$920.00 ,$920.00 ,$257.58 ,$920.00 ,$553.92 ,$310.29 
ST. ELIZABETH'S HOSPITAL,36100067,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,361,1 ,"$1,192.00 ",$774.80 ,$257.58 ,"$1,192.00 ",$643.95 ,"$1,192.00 ",$667.52 ,$257.58 ,$333.76 ,$402.90 ,$257.58 ,$463.69 ,$257.58 ,$537.59 ,$537.59 ,$257.58 ,$537.59 ,$489.39 ,$596.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$894.00 ,$715.20 ,$715.20 ,$257.58 ,$715.20 ,$905.92 ,$905.92 ,$905.92 ,"$1,192.00 ", N/A ,"$1,013.20 ",$643.94 ,$774.80 ,$257.58 ,"$1,192.00 ",$667.52 ,$257.58 ,$313.50 , N/A ,$341.32 ,$325.80 ,$270.46 ,$953.60 ,$579.55 ,$537.59 ,$333.76 ,"$1,072.80 ",$257.58 ,$905.92 ,$920.00 ,$920.00 ,$257.58 ,$920.00 ,$572.16 ,$310.29 
ST. ELIZABETH'S HOSPITAL,36100068,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,361,1 ,"$1,192.00 ",$774.80 ,$257.58 ,"$1,192.00 ",$643.95 ,"$1,192.00 ",$667.52 ,$257.58 ,$333.76 ,$402.90 ,$257.58 ,$463.69 ,$257.58 ,$537.59 ,$537.59 ,$257.58 ,$537.59 ,$489.39 ,$596.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$894.00 ,$715.20 ,$715.20 ,$257.58 ,$715.20 ,$905.92 ,$905.92 ,$905.92 ,"$1,192.00 ", N/A ,"$1,013.20 ",$643.94 ,$774.80 ,$257.58 ,"$1,192.00 ",$667.52 ,$257.58 ,$313.50 , N/A ,$341.32 ,$325.80 ,$270.46 ,$953.60 ,$579.55 ,$537.59 ,$333.76 ,"$1,072.80 ",$257.58 ,$905.92 ,$920.00 ,$920.00 ,$257.58 ,$920.00 ,$572.16 ,$310.29 
ST. ELIZABETH'S HOSPITAL,36100069,29125,HC APPL SHRT ARM SPLNT STAT-LT,361,1 ,$742.00 ,$482.30 ,$111.17 ,$742.00 ,$277.93 ,$341.32 ,$415.52 ,$111.17 ,$207.76 ,$250.80 ,$111.17 ,$305.70 ,$111.17 ,$334.64 ,$334.64 ,$111.17 ,$334.64 ,$211.22 ,$371.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$556.50 ,$445.20 ,$445.20 ,$111.17 ,$445.20 ,$563.92 ,$563.92 ,$563.92 ,$742.00 , N/A ,$630.70 ,$277.92 ,$482.30 ,$111.17 ,$742.00 ,$415.52 ,$111.17 ,$195.15 , N/A ,$265.74 ,$253.66 ,$116.73 ,$593.60 ,$250.12 ,$334.64 ,$207.76 ,$667.80 ,$111.17 ,$563.92 ,$742.00 ,$742.00 ,$111.17 ,$742.00 ,$356.16 ,$241.58 
ST. ELIZABETH'S HOSPITAL,36100070,29125,HC APPL SHRT ARM SPLNT STAT-RT,361,1 ,$742.00 ,$482.30 ,$111.17 ,$742.00 ,$277.93 ,$341.32 ,$415.52 ,$111.17 ,$207.76 ,$250.80 ,$111.17 ,$305.70 ,$111.17 ,$334.64 ,$334.64 ,$111.17 ,$334.64 ,$211.22 ,$371.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$556.50 ,$445.20 ,$445.20 ,$111.17 ,$445.20 ,$563.92 ,$563.92 ,$563.92 ,$742.00 , N/A ,$630.70 ,$277.92 ,$482.30 ,$111.17 ,$742.00 ,$415.52 ,$111.17 ,$195.15 , N/A ,$265.74 ,$253.66 ,$116.73 ,$593.60 ,$250.12 ,$334.64 ,$207.76 ,$667.80 ,$111.17 ,$563.92 ,$742.00 ,$742.00 ,$111.17 ,$742.00 ,$356.16 ,$241.58 
ST. ELIZABETH'S HOSPITAL,36100071,37187,HC THROMBECTOMY VENOUS MECH-LT,361,1 ,"$4,357.00 ","$2,832.05 ","$1,145.89 ","$24,756.83 ","$24,756.83 ","$4,357.00 ","$2,439.92 ","$9,902.73 ","$1,219.96 ","$1,472.67 ","$9,902.73 ","$1,694.87 ","$4,357.00 ","$1,965.01 ","$1,965.01 ","$4,357.00 ","$1,965.01 ","$4,357.00 ","$2,178.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$4,357.00 ","$3,267.75 ","$2,614.20 ","$2,614.20 ","$9,902.73 ","$2,614.20 ","$3,311.32 ","$3,311.32 ","$3,311.32 ","$4,357.00 ", N/A ,"$3,703.45 ","$4,357.00 ","$2,832.05 ","$9,902.73 ","$4,357.00 ","$2,439.92 ","$9,902.73 ","$1,145.89 ", N/A ,"$3,285.62 ","$3,136.28 ","$10,397.87 ","$3,485.60 ","$22,281.13 ","$1,965.01 ","$1,219.96 ","$3,921.30 ","$9,902.73 ","$3,311.32 ","$4,357.00 ","$4,357.00 ","$4,357.00 ","$4,357.00 ","$2,091.36 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,36100072,37187,HC THROMBECTOMY VENOUS MECH-RT,361,1 ,"$4,357.00 ","$2,832.05 ","$1,145.89 ","$24,756.83 ","$24,756.83 ","$4,357.00 ","$2,439.92 ","$9,902.73 ","$1,219.96 ","$1,472.67 ","$9,902.73 ","$1,694.87 ","$4,357.00 ","$1,965.01 ","$1,965.01 ","$4,357.00 ","$1,965.01 ","$4,357.00 ","$2,178.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$4,357.00 ","$3,267.75 ","$2,614.20 ","$2,614.20 ","$9,902.73 ","$2,614.20 ","$3,311.32 ","$3,311.32 ","$3,311.32 ","$4,357.00 ", N/A ,"$3,703.45 ","$4,357.00 ","$2,832.05 ","$9,902.73 ","$4,357.00 ","$2,439.92 ","$9,902.73 ","$1,145.89 ", N/A ,"$3,285.62 ","$3,136.28 ","$10,397.87 ","$3,485.60 ","$22,281.13 ","$1,965.01 ","$1,219.96 ","$3,921.30 ","$9,902.73 ","$3,311.32 ","$4,357.00 ","$4,357.00 ","$4,357.00 ","$4,357.00 ","$2,091.36 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,36100076,C5271,HC APPL SKIN SUB TAL LOW <100 INIT 25CM-LT,361,1 ,"$2,854.00 ","$1,855.10 ",$516.34 ,"$2,854.00 ","$1,290.85 ","$2,854.00 ","$1,598.24 ",$516.34 ,$799.12 ,$964.65 ,$516.34 ,"$1,110.21 ",$516.34 ,"$1,287.15 ","$1,287.15 ",$516.34 ,"$1,287.15 ",$981.05 ,"$1,427.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$2,140.50 ","$1,712.40 ","$1,712.40 ",$516.34 ,"$1,712.40 ","$2,169.04 ","$2,169.04 ","$2,169.04 ","$2,854.00 ", N/A ,"$2,425.90 ","$1,290.85 ","$1,855.10 ",$516.34 ,"$2,854.00 ","$1,598.24 ",$516.34 ,$750.60 , N/A ,"$1,670.26 ","$1,594.34 ",$542.16 ,"$2,283.20 ","$1,161.77 ","$1,287.15 ",$799.12 ,"$2,568.60 ",$516.34 ,"$2,169.04 ",$920.00 ,$920.00 ,$516.34 ,$920.00 ,"$1,369.92 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100077,C5271,HC APPL SKIN SUB TAL LOW <100 INIT 25CM-RT,361,1 ,"$2,854.00 ","$1,855.10 ",$516.34 ,"$2,854.00 ","$1,290.85 ","$2,854.00 ","$1,598.24 ",$516.34 ,$799.12 ,$964.65 ,$516.34 ,"$1,110.21 ",$516.34 ,"$1,287.15 ","$1,287.15 ",$516.34 ,"$1,287.15 ",$981.05 ,"$1,427.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$2,140.50 ","$1,712.40 ","$1,712.40 ",$516.34 ,"$1,712.40 ","$2,169.04 ","$2,169.04 ","$2,169.04 ","$2,854.00 ", N/A ,"$2,425.90 ","$1,290.85 ","$1,855.10 ",$516.34 ,"$2,854.00 ","$1,598.24 ",$516.34 ,$750.60 , N/A ,"$1,670.26 ","$1,594.34 ",$542.16 ,"$2,283.20 ","$1,161.77 ","$1,287.15 ",$799.12 ,"$2,568.60 ",$516.34 ,"$2,169.04 ",$920.00 ,$920.00 ,$516.34 ,$920.00 ,"$1,369.92 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100078,C5272,HC APPL SKIN SUB TAL LOW<100 ADDL 25CM-LT,361,1 ,$949.00 ,$616.85 ,$249.59 ,"$1,518.42 ", N/A ,$949.00 ,$531.44 , N/A ,$265.72 ,$320.76 , N/A ,$369.16 , N/A ,$428.00 ,$428.00 , N/A ,$428.00 , N/A ,$474.50 , N/A , N/A , N/A , N/A ,$711.75 ,$569.40 ,$569.40 , N/A ,$569.40 ,$721.24 ,$721.24 ,$721.24 ,$949.00 , N/A ,$806.65 , N/A ,$616.85 , N/A ,$949.00 ,$531.44 , N/A ,$249.59 , N/A ,$949.00 ,$949.00 , N/A ,$759.20 , N/A ,$428.00 ,$265.72 ,$854.10 , N/A ,$721.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$455.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100079,C5272,HC APPL SKIN SUB TAL LOW<100 ADDL 25CM-RT,361,1 ,$949.00 ,$616.85 ,$249.59 ,"$1,518.42 ", N/A ,$949.00 ,$531.44 , N/A ,$265.72 ,$320.76 , N/A ,$369.16 , N/A ,$428.00 ,$428.00 , N/A ,$428.00 , N/A ,$474.50 , N/A , N/A , N/A , N/A ,$711.75 ,$569.40 ,$569.40 , N/A ,$569.40 ,$721.24 ,$721.24 ,$721.24 ,$949.00 , N/A ,$806.65 , N/A ,$616.85 , N/A ,$949.00 ,$531.44 , N/A ,$249.59 , N/A ,$949.00 ,$949.00 , N/A ,$759.20 , N/A ,$428.00 ,$265.72 ,$854.10 , N/A ,$721.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$455.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100080,C5273,HC APPL SKIN SUB TAL LOW>100 INIT 100CM-LT,361,1 ,"$9,281.00 ","$6,032.65 ","$1,518.42 ","$9,281.00 ","$4,221.50 ","$3,200.00 ","$5,197.36 ","$1,688.60 ","$2,598.68 ","$3,136.98 ","$1,688.60 ","$3,610.31 ","$1,688.60 ","$4,185.73 ","$4,185.73 ","$1,688.60 ","$4,185.73 ","$3,208.33 ","$4,640.50 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$6,960.75 ","$5,568.60 ","$5,568.60 ","$1,688.60 ","$5,568.60 ","$7,053.56 ","$7,053.56 ","$7,053.56 ","$9,281.00 ", N/A ,"$7,888.85 ","$4,221.49 ","$6,032.65 ","$1,688.60 ","$9,281.00 ","$5,197.36 ","$1,688.60 ","$2,440.90 ", N/A ,"$1,670.26 ","$1,594.34 ","$1,773.03 ","$7,424.80 ","$3,799.34 ","$4,185.73 ","$2,598.68 ","$8,352.90 ","$1,688.60 ","$7,053.56 ","$1,890.00 ","$1,890.00 ","$1,688.60 ","$1,890.00 ","$4,454.88 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100081,C5273,HC APPL SKIN SUB TAL LOW>100 INIT 100CM-RT,361,1 ,"$9,281.00 ","$6,032.65 ","$1,518.42 ","$9,281.00 ","$4,221.50 ","$3,200.00 ","$5,197.36 ","$1,688.60 ","$2,598.68 ","$3,136.98 ","$1,688.60 ","$3,610.31 ","$1,688.60 ","$4,185.73 ","$4,185.73 ","$1,688.60 ","$4,185.73 ","$3,208.33 ","$4,640.50 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$6,960.75 ","$5,568.60 ","$5,568.60 ","$1,688.60 ","$5,568.60 ","$7,053.56 ","$7,053.56 ","$7,053.56 ","$9,281.00 ", N/A ,"$7,888.85 ","$4,221.49 ","$6,032.65 ","$1,688.60 ","$9,281.00 ","$5,197.36 ","$1,688.60 ","$2,440.90 ", N/A ,"$1,670.26 ","$1,594.34 ","$1,773.03 ","$7,424.80 ","$3,799.34 ","$4,185.73 ","$2,598.68 ","$8,352.90 ","$1,688.60 ","$7,053.56 ","$1,890.00 ","$1,890.00 ","$1,688.60 ","$1,890.00 ","$4,454.88 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100082,C5274,HC APPL SKIN SUB TAL LOW>100 ADDL 100CM-LT,361,1 ,$956.00 ,$621.40 ,$251.43 ,"$1,518.42 ", N/A ,$956.00 ,$535.36 , N/A ,$267.68 ,$323.13 , N/A ,$371.88 , N/A ,$431.16 ,$431.16 , N/A ,$431.16 , N/A ,$478.00 , N/A , N/A , N/A , N/A ,$717.00 ,$573.60 ,$573.60 , N/A ,$573.60 ,$726.56 ,$726.56 ,$726.56 ,$956.00 , N/A ,$812.60 , N/A ,$621.40 , N/A ,$956.00 ,$535.36 , N/A ,$251.43 , N/A ,$956.00 ,$956.00 , N/A ,$764.80 , N/A ,$431.16 ,$267.68 ,$860.40 , N/A ,$726.56 ,$920.00 ,$920.00 , N/A ,$920.00 ,$458.88 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100083,C5274,HC APPL SKIN SUB TAL LOW>100 ADDL 100CM-RT,361,1 ,$956.00 ,$621.40 ,$251.43 ,"$1,518.42 ", N/A ,$956.00 ,$535.36 , N/A ,$267.68 ,$323.13 , N/A ,$371.88 , N/A ,$431.16 ,$431.16 , N/A ,$431.16 , N/A ,$478.00 , N/A , N/A , N/A , N/A ,$717.00 ,$573.60 ,$573.60 , N/A ,$573.60 ,$726.56 ,$726.56 ,$726.56 ,$956.00 , N/A ,$812.60 , N/A ,$621.40 , N/A ,$956.00 ,$535.36 , N/A ,$251.43 , N/A ,$956.00 ,$956.00 , N/A ,$764.80 , N/A ,$431.16 ,$267.68 ,$860.40 , N/A ,$726.56 ,$920.00 ,$920.00 , N/A ,$920.00 ,$458.88 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100084,C5275,HC APPL SKIN SUB OTH LOW<100 INIT 25CM-LT,361,1 ,"$2,771.00 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,290.85 ","$2,771.00 ","$1,551.76 ",$516.34 ,$775.88 ,$936.60 ,$516.34 ,"$1,077.92 ",$516.34 ,"$1,249.72 ","$1,249.72 ",$516.34 ,"$1,249.72 ",$981.05 ,"$1,385.50 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$2,078.25 ","$1,662.60 ","$1,662.60 ",$516.34 ,"$1,662.60 ","$2,105.96 ","$2,105.96 ","$2,105.96 ","$2,771.00 ", N/A ,"$2,355.35 ","$1,290.85 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,551.76 ",$516.34 ,$728.77 , N/A ,"$1,670.26 ","$1,594.34 ",$542.16 ,"$2,216.80 ","$1,161.77 ","$1,249.72 ",$775.88 ,"$2,493.90 ",$516.34 ,"$2,105.96 ",$920.00 ,$920.00 ,$516.34 ,$920.00 ,"$1,330.08 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100085,C5275,HC APPL SKIN SUB OTH LOW<100 INIT 25CM-RT,361,1 ,"$2,771.00 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,290.85 ","$2,771.00 ","$1,551.76 ",$516.34 ,$775.88 ,$936.60 ,$516.34 ,"$1,077.92 ",$516.34 ,"$1,249.72 ","$1,249.72 ",$516.34 ,"$1,249.72 ",$981.05 ,"$1,385.50 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$2,078.25 ","$1,662.60 ","$1,662.60 ",$516.34 ,"$1,662.60 ","$2,105.96 ","$2,105.96 ","$2,105.96 ","$2,771.00 ", N/A ,"$2,355.35 ","$1,290.85 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,551.76 ",$516.34 ,$728.77 , N/A ,"$1,670.26 ","$1,594.34 ",$542.16 ,"$2,216.80 ","$1,161.77 ","$1,249.72 ",$775.88 ,"$2,493.90 ",$516.34 ,"$2,105.96 ",$920.00 ,$920.00 ,$516.34 ,$920.00 ,"$1,330.08 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100086,C5276,HC APPL SKIN SUB OTH LOW<100 ADDL 25CM-LT,361,1 ,$949.00 ,$616.85 ,$249.59 ,"$1,518.42 ", N/A ,$949.00 ,$531.44 , N/A ,$265.72 ,$320.76 , N/A ,$369.16 , N/A ,$428.00 ,$428.00 , N/A ,$428.00 , N/A ,$474.50 , N/A , N/A , N/A , N/A ,$711.75 ,$569.40 ,$569.40 , N/A ,$569.40 ,$721.24 ,$721.24 ,$721.24 ,$949.00 , N/A ,$806.65 , N/A ,$616.85 , N/A ,$949.00 ,$531.44 , N/A ,$249.59 , N/A ,$949.00 ,$949.00 , N/A ,$759.20 , N/A ,$428.00 ,$265.72 ,$854.10 , N/A ,$721.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$455.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100087,C5276,HC APPL SKIN SUB OTH LOW<100 ADDL 25CM-RT,361,1 ,$949.00 ,$616.85 ,$249.59 ,"$1,518.42 ", N/A ,$949.00 ,$531.44 , N/A ,$265.72 ,$320.76 , N/A ,$369.16 , N/A ,$428.00 ,$428.00 , N/A ,$428.00 , N/A ,$474.50 , N/A , N/A , N/A , N/A ,$711.75 ,$569.40 ,$569.40 , N/A ,$569.40 ,$721.24 ,$721.24 ,$721.24 ,$949.00 , N/A ,$806.65 , N/A ,$616.85 , N/A ,$949.00 ,$531.44 , N/A ,$249.59 , N/A ,$949.00 ,$949.00 , N/A ,$759.20 , N/A ,$428.00 ,$265.72 ,$854.10 , N/A ,$721.24 ,$920.00 ,$920.00 , N/A ,$920.00 ,$455.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100088,C5277,HC APPL SKIN SUB OTH LOW>100 INIT 100CM-LT,361,1 ,"$2,771.00 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,290.85 ","$2,771.00 ","$1,551.76 ",$516.34 ,$775.88 ,$936.60 ,$516.34 ,"$1,077.92 ",$516.34 ,"$1,249.72 ","$1,249.72 ",$516.34 ,"$1,249.72 ",$981.05 ,"$1,385.50 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$2,078.25 ","$1,662.60 ","$1,662.60 ",$516.34 ,"$1,662.60 ","$2,105.96 ","$2,105.96 ","$2,105.96 ","$2,771.00 ", N/A ,"$2,355.35 ","$1,290.85 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,551.76 ",$516.34 ,$728.77 , N/A ,"$1,670.26 ","$1,594.34 ",$542.16 ,"$2,216.80 ","$1,161.77 ","$1,249.72 ",$775.88 ,"$2,493.90 ",$516.34 ,"$2,105.96 ",$920.00 ,$920.00 ,$516.34 ,$920.00 ,"$1,330.08 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100089,C5277,HC APPL SKIN SUB OTH LOW>100 INIT 100CM-RT,361,1 ,"$2,771.00 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,290.85 ","$2,771.00 ","$1,551.76 ",$516.34 ,$775.88 ,$936.60 ,$516.34 ,"$1,077.92 ",$516.34 ,"$1,249.72 ","$1,249.72 ",$516.34 ,"$1,249.72 ",$981.05 ,"$1,385.50 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$2,078.25 ","$1,662.60 ","$1,662.60 ",$516.34 ,"$1,662.60 ","$2,105.96 ","$2,105.96 ","$2,105.96 ","$2,771.00 ", N/A ,"$2,355.35 ","$1,290.85 ","$1,801.15 ",$516.34 ,"$2,771.00 ","$1,551.76 ",$516.34 ,$728.77 , N/A ,"$1,670.26 ","$1,594.34 ",$542.16 ,"$2,216.80 ","$1,161.77 ","$1,249.72 ",$775.88 ,"$2,493.90 ",$516.34 ,"$2,105.96 ",$920.00 ,$920.00 ,$516.34 ,$920.00 ,"$1,330.08 ","$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100090,C5278,HC APPL SKIN SUB OTH LOW>100 ADDL 100CM-LT,361,1 ,$956.00 ,$621.40 ,$251.43 ,"$1,518.42 ", N/A ,$956.00 ,$535.36 , N/A ,$267.68 ,$323.13 , N/A ,$371.88 , N/A ,$431.16 ,$431.16 , N/A ,$431.16 , N/A ,$478.00 , N/A , N/A , N/A , N/A ,$717.00 ,$573.60 ,$573.60 , N/A ,$573.60 ,$726.56 ,$726.56 ,$726.56 ,$956.00 , N/A ,$812.60 , N/A ,$621.40 , N/A ,$956.00 ,$535.36 , N/A ,$251.43 , N/A ,$956.00 ,$956.00 , N/A ,$764.80 , N/A ,$431.16 ,$267.68 ,$860.40 , N/A ,$726.56 ,$920.00 ,$920.00 , N/A ,$920.00 ,$458.88 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100091,C5278,HC APPL SKIN SUB OTH LOW>100 ADDL 100CM-RT,361,1 ,$956.00 ,$621.40 ,$251.43 ,"$1,518.42 ", N/A ,$956.00 ,$535.36 , N/A ,$267.68 ,$323.13 , N/A ,$371.88 , N/A ,$431.16 ,$431.16 , N/A ,$431.16 , N/A ,$478.00 , N/A , N/A , N/A , N/A ,$717.00 ,$573.60 ,$573.60 , N/A ,$573.60 ,$726.56 ,$726.56 ,$726.56 ,$956.00 , N/A ,$812.60 , N/A ,$621.40 , N/A ,$956.00 ,$535.36 , N/A ,$251.43 , N/A ,$956.00 ,$956.00 , N/A ,$764.80 , N/A ,$431.16 ,$267.68 ,$860.40 , N/A ,$726.56 ,$920.00 ,$920.00 , N/A ,$920.00 ,$458.88 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,36100092,N/A,HC BEDSIDE SURG PROC LEVEL 1,361,1 ,$665.00 ,$432.25 ,$174.90 ,$665.00 , N/A ,$305.90 ,$372.40 , N/A ,$186.20 ,$224.77 , N/A ,$258.69 , N/A ,$299.92 ,$299.92 , N/A ,$299.92 , N/A ,$332.50 , N/A , N/A , N/A , N/A ,$498.75 ,$399.00 ,$399.00 , N/A ,$399.00 ,$505.40 ,$505.40 ,$505.40 ,$665.00 , N/A ,$565.25 , N/A ,$432.25 , N/A ,$665.00 ,$372.40 , N/A ,$174.90 , N/A , N/A , N/A , N/A ,$532.00 , N/A ,$299.92 ,$186.20 ,$598.50 , N/A ,$505.40 , N/A , N/A , N/A , N/A ,$319.20 , N/A 
ST. ELIZABETH'S HOSPITAL,36100093,N/A,HC CENTRAL LINE INSERTION,361,1 ,"$2,238.00 ","$1,454.70 ",$588.59 ,"$2,238.00 ", N/A ,"$1,029.48 ","$1,253.28 ", N/A ,$626.64 ,$756.44 , N/A ,$870.58 , N/A ,"$1,009.34 ","$1,009.34 ", N/A ,"$1,009.34 ", N/A ,"$1,119.00 ", N/A , N/A , N/A , N/A ,"$1,678.50 ","$1,342.80 ","$1,342.80 ", N/A ,"$1,342.80 ","$1,700.88 ","$1,700.88 ","$1,700.88 ","$2,238.00 ", N/A ,"$1,902.30 ", N/A ,"$1,454.70 ", N/A ,"$2,238.00 ","$1,253.28 ", N/A ,$588.59 , N/A , N/A , N/A , N/A ,"$1,790.40 ", N/A ,"$1,009.34 ",$626.64 ,"$2,014.20 ", N/A ,"$1,700.88 ", N/A , N/A , N/A , N/A ,"$1,074.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$3,485.00 ","$2,265.25 ",$421.56 ,"$3,485.00 ","$1,565.08 ","$2,125.00 ","$1,951.60 ",$626.03 ,$975.80 ,"$1,177.93 ",$626.03 ,"$1,355.67 ",$626.03 ,"$1,571.74 ","$1,571.74 ",$626.03 ,"$1,571.74 ","$1,189.46 ","$1,742.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,613.75 ","$2,091.00 ","$2,091.00 ",$626.03 ,"$2,091.00 ","$2,648.60 ","$2,648.60 ","$2,648.60 ","$3,485.00 ", N/A ,"$2,962.25 ","$1,565.07 ","$2,265.25 ",$626.03 ,"$3,485.00 ","$1,951.60 ",$626.03 ,$916.56 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$2,788.00 ","$1,408.57 ","$1,571.74 ",$975.80 ,"$3,136.50 ",$626.03 ,"$2,648.60 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,672.80 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$2,689.00 ","$1,747.85 ",$421.56 ,"$2,689.00 ","$1,565.08 ","$2,125.00 ","$1,505.84 ",$626.03 ,$752.92 ,$908.88 ,$626.03 ,"$1,046.02 ",$626.03 ,"$1,212.74 ","$1,212.74 ",$626.03 ,"$1,212.74 ","$1,189.46 ","$1,344.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,016.75 ","$1,613.40 ","$1,613.40 ",$626.03 ,"$1,613.40 ","$2,043.64 ","$2,043.64 ","$2,043.64 ","$2,689.00 ", N/A ,"$2,285.65 ","$1,565.07 ","$1,747.85 ",$626.03 ,"$2,689.00 ","$1,505.84 ",$626.03 ,$707.21 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$2,151.20 ","$1,408.57 ","$1,212.74 ",$752.92 ,"$2,420.10 ",$626.03 ,"$2,043.64 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,290.72 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36100102,62322,HC INJ INTRLAMNR LUM/SAC W/O GUIDE,361,1 ,"$3,485.00 ","$2,265.25 ",$421.56 ,"$3,485.00 ","$1,565.08 ","$2,125.00 ","$1,951.60 ",$626.03 ,$975.80 ,"$1,177.93 ",$626.03 ,"$1,355.67 ",$626.03 ,"$1,571.74 ","$1,571.74 ",$626.03 ,"$1,571.74 ","$1,189.46 ","$1,742.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,613.75 ","$2,091.00 ","$2,091.00 ",$626.03 ,"$2,091.00 ","$2,648.60 ","$2,648.60 ","$2,648.60 ","$3,485.00 ", N/A ,"$2,962.25 ","$1,565.07 ","$2,265.25 ",$626.03 ,"$3,485.00 ","$1,951.60 ",$626.03 ,$916.56 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$2,788.00 ","$1,408.57 ","$1,571.74 ",$975.80 ,"$3,136.50 ",$626.03 ,"$2,648.60 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,672.80 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$2,689.00 ","$1,747.85 ",$421.56 ,"$2,689.00 ","$1,565.08 ","$2,125.00 ","$1,505.84 ",$626.03 ,$752.92 ,$908.88 ,$626.03 ,"$1,046.02 ",$626.03 ,"$1,212.74 ","$1,212.74 ",$626.03 ,"$1,212.74 ","$1,189.46 ","$1,344.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,016.75 ","$1,613.40 ","$1,613.40 ",$626.03 ,"$1,613.40 ","$2,043.64 ","$2,043.64 ","$2,043.64 ","$2,689.00 ", N/A ,"$2,285.65 ","$1,565.07 ","$1,747.85 ",$626.03 ,"$2,689.00 ","$1,505.84 ",$626.03 ,$707.21 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$2,151.20 ","$1,408.57 ","$1,212.74 ",$752.92 ,"$2,420.10 ",$626.03 ,"$2,043.64 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,290.72 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36100108,29445,HC APPL CAST LEG RIGID CONTACT -BIL,361,1 ,"$2,557.00 ","$1,662.05 ",$356.75 ,"$2,557.00 ",$891.88 ,"$1,176.22 ","$1,431.92 ",$356.75 ,$715.96 ,$864.27 ,$356.75 ,"$1,053.48 ",$356.75 ,"$1,153.21 ","$1,153.21 ",$356.75 ,"$1,153.21 ",$677.83 ,"$1,278.50 ",$891.88 ,$356.75 ,$356.75 ,$363.89 ,"$1,917.75 ","$1,534.20 ","$1,534.20 ",$356.75 ,"$1,534.20 ","$1,943.32 ","$1,943.32 ","$1,943.32 ","$2,557.00 ", N/A ,"$2,173.45 ",$891.88 ,"$1,662.05 ",$356.75 ,"$2,557.00 ","$1,431.92 ",$356.75 ,$672.49 , N/A ,$514.24 ,$490.86 ,$374.59 ,"$2,045.60 ",$802.69 ,"$1,153.21 ",$715.96 ,"$2,301.30 ",$356.75 ,"$1,943.32 ","$1,380.00 ","$1,380.00 ",$356.75 ,"$1,380.00 ","$1,227.36 ",$467.49 
ST. ELIZABETH'S HOSPITAL,36100109,29445,HC APPL CAST LEG RIGID CONTACT -LT,361,1 ,"$1,462.00 ",$950.30 ,$237.84 ,"$1,462.00 ",$594.60 ,$672.52 ,$818.72 ,$237.84 ,$409.36 ,$494.16 ,$237.84 ,$602.34 ,$237.84 ,$659.36 ,$659.36 ,$237.84 ,$659.36 ,$451.89 ,$731.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,"$1,096.50 ",$877.20 ,$877.20 ,$237.84 ,$877.20 ,"$1,111.12 ","$1,111.12 ","$1,111.12 ","$1,462.00 ", N/A ,"$1,242.70 ",$594.59 ,$950.30 ,$237.84 ,"$1,462.00 ",$818.72 ,$237.84 ,$384.51 , N/A ,$342.83 ,$327.24 ,$249.73 ,"$1,169.60 ",$535.13 ,$659.36 ,$409.36 ,"$1,315.80 ",$237.84 ,"$1,111.12 ",$920.00 ,$920.00 ,$237.84 ,$920.00 ,$701.76 ,$311.66 
ST. ELIZABETH'S HOSPITAL,36100110,29445,HC APPL CAST LEG RIGID CONTACT -RT,361,1 ,"$1,462.00 ",$950.30 ,$237.84 ,"$1,462.00 ",$594.60 ,$672.52 ,$818.72 ,$237.84 ,$409.36 ,$494.16 ,$237.84 ,$602.34 ,$237.84 ,$659.36 ,$659.36 ,$237.84 ,$659.36 ,$451.89 ,$731.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,"$1,096.50 ",$877.20 ,$877.20 ,$237.84 ,$877.20 ,"$1,111.12 ","$1,111.12 ","$1,111.12 ","$1,462.00 ", N/A ,"$1,242.70 ",$594.59 ,$950.30 ,$237.84 ,"$1,462.00 ",$818.72 ,$237.84 ,$384.51 , N/A ,$342.83 ,$327.24 ,$249.73 ,"$1,169.60 ",$535.13 ,$659.36 ,$409.36 ,"$1,315.80 ",$237.84 ,"$1,111.12 ",$920.00 ,$920.00 ,$237.84 ,$920.00 ,$701.76 ,$311.66 
ST. ELIZABETH'S HOSPITAL,36100111,38220,HC ASP BONE MARROW ONLY - BIL,361,1 ,"$3,269.00 ","$2,124.85 ",$859.75 ,"$3,467.90 ","$3,467.90 ","$3,187.50 ","$1,830.64 ","$1,387.16 ",$915.32 ,"$1,104.92 ","$1,387.16 ","$1,271.64 ","$1,387.16 ","$1,474.32 ","$1,474.32 ","$1,387.16 ","$1,474.32 ","$2,635.59 ","$1,634.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,451.75 ","$1,961.40 ","$1,961.40 ","$1,387.16 ","$1,961.40 ","$2,484.44 ","$2,484.44 ","$2,484.44 ","$3,269.00 ", N/A ,"$2,778.65 ","$3,269.00 ","$2,124.85 ","$1,387.16 ","$3,269.00 ","$1,830.64 ","$1,387.16 ",$859.75 , N/A ,$962.09 ,$918.36 ,"$1,456.52 ","$2,615.20 ","$3,121.10 ","$1,474.32 ",$915.32 ,"$2,942.10 ","$1,387.16 ","$2,484.44 ","$2,250.00 ","$2,250.00 ","$1,387.16 ","$2,250.00 ","$1,569.12 ",$874.63 
ST. ELIZABETH'S HOSPITAL,36100112,38220,HC ASP BONE MARROW ONLY - LT,361,1 ,"$2,178.00 ","$1,415.70 ",$572.81 ,"$3,467.90 ","$3,467.90 ","$2,125.00 ","$1,219.68 ","$1,387.16 ",$609.84 ,$736.16 ,"$1,387.16 ",$847.24 ,"$1,387.16 ",$982.28 ,$982.28 ,"$1,387.16 ",$982.28 ,"$2,178.00 ","$1,089.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,633.50 ","$1,306.80 ","$1,306.80 ","$1,387.16 ","$1,306.80 ","$1,655.28 ","$1,655.28 ","$1,655.28 ","$2,178.00 ", N/A ,"$1,851.30 ","$2,178.00 ","$1,415.70 ","$1,387.16 ","$2,178.00 ","$1,219.68 ","$1,387.16 ",$572.81 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$1,742.40 ","$3,121.10 ",$982.28 ,$609.84 ,"$1,960.20 ","$1,387.16 ","$1,655.28 ","$1,500.00 ","$1,500.00 ","$1,387.16 ","$1,500.00 ","$1,045.44 ",$583.08 
ST. ELIZABETH'S HOSPITAL,36100113,38220,HC ASP BONE MARROW ONLY - RT,361,1 ,"$2,178.00 ","$1,415.70 ",$572.81 ,"$3,467.90 ","$3,467.90 ","$2,125.00 ","$1,219.68 ","$1,387.16 ",$609.84 ,$736.16 ,"$1,387.16 ",$847.24 ,"$1,387.16 ",$982.28 ,$982.28 ,"$1,387.16 ",$982.28 ,"$2,178.00 ","$1,089.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,633.50 ","$1,306.80 ","$1,306.80 ","$1,387.16 ","$1,306.80 ","$1,655.28 ","$1,655.28 ","$1,655.28 ","$2,178.00 ", N/A ,"$1,851.30 ","$2,178.00 ","$1,415.70 ","$1,387.16 ","$2,178.00 ","$1,219.68 ","$1,387.16 ",$572.81 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$1,742.40 ","$3,121.10 ",$982.28 ,$609.84 ,"$1,960.20 ","$1,387.16 ","$1,655.28 ","$1,500.00 ","$1,500.00 ","$1,387.16 ","$1,500.00 ","$1,045.44 ",$583.08 
ST. ELIZABETH'S HOSPITAL,36100114,38221,HC BX BONE MARROW ONLY - BIL,361,1 ,"$3,978.00 ","$2,585.70 ",$874.63 ,"$5,843.93 ","$5,843.93 ","$3,187.50 ","$2,227.68 ","$2,337.57 ","$1,113.84 ","$1,344.56 ","$2,337.57 ","$1,547.44 ","$2,337.57 ","$1,794.08 ","$1,794.08 ","$2,337.57 ","$1,794.08 ","$3,978.00 ","$1,989.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$2,983.50 ","$2,386.80 ","$2,386.80 ","$2,337.57 ","$2,386.80 ","$3,023.28 ","$3,023.28 ","$3,023.28 ","$3,978.00 ", N/A ,"$3,381.30 ","$3,978.00 ","$2,585.70 ","$2,337.57 ","$3,978.00 ","$2,227.68 ","$2,337.57 ","$1,046.21 ", N/A ,$962.09 ,$918.36 ,"$2,454.45 ","$3,182.40 ","$5,259.53 ","$1,794.08 ","$1,113.84 ","$3,580.20 ","$2,337.57 ","$3,023.28 ","$2,250.00 ","$2,250.00 ","$2,337.57 ","$2,250.00 ","$1,909.44 ",$874.63 
ST. ELIZABETH'S HOSPITAL,36100115,38221,HC BX BONE MARROW ONLY - LT,361,1 ,"$2,368.00 ","$1,539.20 ",$583.08 ,"$3,467.90 ","$3,467.90 ","$2,125.00 ","$1,326.08 ","$1,387.16 ",$663.04 ,$800.38 ,"$1,387.16 ",$921.15 ,"$1,387.16 ","$1,067.97 ","$1,067.97 ","$1,387.16 ","$1,067.97 ","$2,368.00 ","$1,184.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,776.00 ","$1,420.80 ","$1,420.80 ","$1,387.16 ","$1,420.80 ","$1,799.68 ","$1,799.68 ","$1,799.68 ","$2,368.00 ", N/A ,"$2,012.80 ","$2,368.00 ","$1,539.20 ","$1,387.16 ","$2,368.00 ","$1,326.08 ","$1,387.16 ",$622.78 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$1,894.40 ","$3,121.10 ","$1,067.97 ",$663.04 ,"$2,131.20 ","$1,387.16 ","$1,799.68 ","$1,500.00 ","$1,500.00 ","$1,387.16 ","$1,500.00 ","$1,136.64 ",$583.08 
ST. ELIZABETH'S HOSPITAL,36100116,38221,HC BX BONE MARROW ONLY - RT,361,1 ,"$2,368.00 ","$1,539.20 ",$583.08 ,"$3,467.90 ","$3,467.90 ","$2,125.00 ","$1,326.08 ","$1,387.16 ",$663.04 ,$800.38 ,"$1,387.16 ",$921.15 ,"$1,387.16 ","$1,067.97 ","$1,067.97 ","$1,387.16 ","$1,067.97 ","$2,368.00 ","$1,184.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$1,776.00 ","$1,420.80 ","$1,420.80 ","$1,387.16 ","$1,420.80 ","$1,799.68 ","$1,799.68 ","$1,799.68 ","$2,368.00 ", N/A ,"$2,012.80 ","$2,368.00 ","$1,539.20 ","$1,387.16 ","$2,368.00 ","$1,326.08 ","$1,387.16 ",$622.78 , N/A ,$641.39 ,$612.23 ,"$1,456.52 ","$1,894.40 ","$3,121.10 ","$1,067.97 ",$663.04 ,"$2,131.20 ","$1,387.16 ","$1,799.68 ","$1,500.00 ","$1,500.00 ","$1,387.16 ","$1,500.00 ","$1,136.64 ",$583.08 
ST. ELIZABETH'S HOSPITAL,36100117,90945,HC CONT RENAL REPLACMENT THERAPY INIT DAY,361,1 ,"$1,053.00 ",$684.45 ,$276.94 ,"$1,053.00 ",$896.60 ,$484.38 ,$589.68 ,$358.64 ,$294.84 ,$355.91 ,$358.64 ,$433.84 ,$358.64 ,$474.90 ,$474.90 ,$358.64 ,$474.90 ,$681.41 ,$526.50 ,$896.59 ,$358.64 ,$358.64 ,$365.81 ,$789.75 ,$631.80 ,$631.80 ,$358.64 ,$631.80 ,$800.28 ,$800.28 ,$800.28 ,"$1,053.00 ", N/A ,$895.05 ,$896.59 ,$684.45 ,$358.64 ,"$1,053.00 ",$589.68 ,$358.64 ,$276.94 , N/A ,$993.55 ,$948.39 ,$376.57 ,$842.40 ,$806.93 ,$474.90 ,$294.84 ,$947.70 ,$358.64 ,$800.28 , N/A , N/A ,$358.64 , N/A ,$505.44 ,$903.23 
ST. ELIZABETH'S HOSPITAL,36100118,90945,HC CONT RENAL REPLACMENT THERAPY SUBSQ DAY,361,1 ,"$1,053.00 ",$684.45 ,$276.94 ,"$1,053.00 ",$896.60 ,$484.38 ,$589.68 ,$358.64 ,$294.84 ,$355.91 ,$358.64 ,$433.84 ,$358.64 ,$474.90 ,$474.90 ,$358.64 ,$474.90 ,$681.41 ,$526.50 ,$896.59 ,$358.64 ,$358.64 ,$365.81 ,$789.75 ,$631.80 ,$631.80 ,$358.64 ,$631.80 ,$800.28 ,$800.28 ,$800.28 ,"$1,053.00 ", N/A ,$895.05 ,$896.59 ,$684.45 ,$358.64 ,"$1,053.00 ",$589.68 ,$358.64 ,$276.94 , N/A ,$993.55 ,$948.39 ,$376.57 ,$842.40 ,$806.93 ,$474.90 ,$294.84 ,$947.70 ,$358.64 ,$800.28 , N/A , N/A ,$358.64 , N/A ,$505.44 ,$903.23 
ST. ELIZABETH'S HOSPITAL,36100119,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-BIL,361,1 ,"$2,914.00 ","$1,894.10 ",$766.38 ,"$2,914.00 ", N/A ,"$2,914.00 ","$1,631.84 ", N/A ,$815.92 ,$984.93 , N/A ,"$1,133.55 ", N/A ,"$1,314.21 ","$1,314.21 ", N/A ,"$1,314.21 ", N/A ,"$1,457.00 ", N/A , N/A , N/A , N/A ,"$2,185.50 ","$1,748.40 ","$1,748.40 ", N/A ,"$1,748.40 ","$2,214.64 ","$2,214.64 ","$2,214.64 ","$2,914.00 ", N/A ,"$2,476.90 ", N/A ,"$1,894.10 ", N/A ,"$2,914.00 ","$1,631.84 ", N/A ,$766.38 , N/A ,"$1,261.50 ","$1,204.16 ", N/A ,"$2,331.20 ", N/A ,"$1,314.21 ",$815.92 ,"$2,622.60 ", N/A ,"$2,214.64 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$1,398.72 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36100120,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-LT,361,1 ,"$1,943.00 ","$1,262.95 ",$511.01 ,"$1,943.00 ", N/A ,"$1,943.00 ","$1,088.08 ", N/A ,$544.04 ,$656.73 , N/A ,$755.83 , N/A ,$876.29 ,$876.29 , N/A ,$876.29 , N/A ,$971.50 , N/A , N/A , N/A , N/A ,"$1,457.25 ","$1,165.80 ","$1,165.80 ", N/A ,"$1,165.80 ","$1,476.68 ","$1,476.68 ","$1,476.68 ","$1,943.00 ", N/A ,"$1,651.55 ", N/A ,"$1,262.95 ", N/A ,"$1,943.00 ","$1,088.08 ", N/A ,$511.01 , N/A ,$841.01 ,$802.78 , N/A ,"$1,554.40 ", N/A ,$876.29 ,$544.04 ,"$1,748.70 ", N/A ,"$1,476.68 ",$920.00 ,$920.00 , N/A ,$920.00 ,$932.64 ,$764.55 
ST. ELIZABETH'S HOSPITAL,36100121,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-RT,361,1 ,"$1,943.00 ","$1,262.95 ",$511.01 ,"$1,943.00 ", N/A ,"$1,943.00 ","$1,088.08 ", N/A ,$544.04 ,$656.73 , N/A ,$755.83 , N/A ,$876.29 ,$876.29 , N/A ,$876.29 , N/A ,$971.50 , N/A , N/A , N/A , N/A ,"$1,457.25 ","$1,165.80 ","$1,165.80 ", N/A ,"$1,165.80 ","$1,476.68 ","$1,476.68 ","$1,476.68 ","$1,943.00 ", N/A ,"$1,651.55 ", N/A ,"$1,262.95 ", N/A ,"$1,943.00 ","$1,088.08 ", N/A ,$511.01 , N/A ,$841.01 ,$802.78 , N/A ,"$1,554.40 ", N/A ,$876.29 ,$544.04 ,"$1,748.70 ", N/A ,"$1,476.68 ",$920.00 ,$920.00 , N/A ,$920.00 ,$932.64 ,$764.55 
ST. ELIZABETH'S HOSPITAL,36100122,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-BIL,361,1 ,"$3,414.00 ","$2,219.10 ",$897.88 ,"$4,327.80 ","$4,327.80 ","$3,187.50 ","$1,911.84 ","$1,731.12 ",$955.92 ,"$1,153.93 ","$1,731.12 ","$1,328.05 ","$1,731.12 ","$1,539.71 ","$1,539.71 ","$1,731.12 ","$1,539.71 ","$3,289.12 ","$1,707.00 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$2,560.50 ","$2,048.40 ","$2,048.40 ","$1,731.12 ","$2,048.40 ","$2,594.64 ","$2,594.64 ","$2,594.64 ","$3,414.00 ", N/A ,"$2,901.90 ","$3,414.00 ","$2,219.10 ","$1,731.12 ","$3,414.00 ","$1,911.84 ","$1,731.12 ",$897.88 , N/A ,"$1,261.50 ","$1,204.16 ","$1,817.68 ","$2,731.20 ","$3,895.02 ","$1,539.71 ",$955.92 ,"$3,072.60 ","$1,731.12 ","$2,594.64 ","$3,414.00 ","$3,414.00 ","$1,731.12 ","$3,414.00 ","$1,638.72 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36100123,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-LT,361,1 ,"$2,276.00 ","$1,479.40 ",$598.59 ,"$4,327.80 ","$4,327.80 ","$2,125.00 ","$1,274.56 ","$1,731.12 ",$637.28 ,$769.29 ,"$1,731.12 ",$885.36 ,"$1,731.12 ","$1,026.48 ","$1,026.48 ","$1,731.12 ","$1,026.48 ","$2,276.00 ","$1,138.00 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$1,707.00 ","$1,365.60 ","$1,365.60 ","$1,731.12 ","$1,365.60 ","$1,729.76 ","$1,729.76 ","$1,729.76 ","$2,276.00 ", N/A ,"$1,934.60 ","$2,276.00 ","$1,479.40 ","$1,731.12 ","$2,276.00 ","$1,274.56 ","$1,731.12 ",$598.59 , N/A ,$841.01 ,$802.78 ,"$1,817.68 ","$1,820.80 ","$3,895.02 ","$1,026.48 ",$637.28 ,"$2,048.40 ","$1,731.12 ","$1,729.76 ","$2,276.00 ","$2,276.00 ","$1,731.12 ","$2,276.00 ","$1,092.48 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100124,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-RT,361,1 ,"$2,276.00 ","$1,479.40 ",$598.59 ,"$4,327.80 ","$4,327.80 ","$2,125.00 ","$1,274.56 ","$1,731.12 ",$637.28 ,$769.29 ,"$1,731.12 ",$885.36 ,"$1,731.12 ","$1,026.48 ","$1,026.48 ","$1,731.12 ","$1,026.48 ","$2,276.00 ","$1,138.00 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$1,707.00 ","$1,365.60 ","$1,365.60 ","$1,731.12 ","$1,365.60 ","$1,729.76 ","$1,729.76 ","$1,729.76 ","$2,276.00 ", N/A ,"$1,934.60 ","$2,276.00 ","$1,479.40 ","$1,731.12 ","$2,276.00 ","$1,274.56 ","$1,731.12 ",$598.59 , N/A ,$841.01 ,$802.78 ,"$1,817.68 ","$1,820.80 ","$3,895.02 ","$1,026.48 ",$637.28 ,"$2,048.40 ","$1,731.12 ","$1,729.76 ","$2,276.00 ","$2,276.00 ","$1,731.12 ","$2,276.00 ","$1,092.48 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100125,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-BIL,361,1 ,"$3,577.00 ","$2,325.05 ",$940.75 ,"$3,577.00 ", N/A ,"$3,187.50 ","$2,003.12 ", N/A ,"$1,001.56 ","$1,209.03 ", N/A ,"$1,391.45 ", N/A ,"$1,613.23 ","$1,613.23 ", N/A ,"$1,613.23 ", N/A ,"$1,788.50 ", N/A , N/A , N/A , N/A ,"$2,682.75 ","$2,146.20 ","$2,146.20 ", N/A ,"$2,146.20 ","$2,718.52 ","$2,718.52 ","$2,718.52 ","$3,577.00 ", N/A ,"$3,040.45 ", N/A ,"$2,325.05 ", N/A ,"$3,577.00 ","$2,003.12 ", N/A ,$940.75 , N/A ,"$1,261.50 ","$1,204.16 ", N/A ,"$2,861.60 ", N/A ,"$1,613.23 ","$1,001.56 ","$3,219.30 ", N/A ,"$2,718.52 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$1,716.96 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36100126,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-LT,361,1 ,"$2,385.00 ","$1,550.25 ",$627.26 ,"$2,385.00 ", N/A ,"$2,125.00 ","$1,335.60 ", N/A ,$667.80 ,$806.13 , N/A ,$927.77 , N/A ,"$1,075.64 ","$1,075.64 ", N/A ,"$1,075.64 ", N/A ,"$1,192.50 ", N/A , N/A , N/A , N/A ,"$1,788.75 ","$1,431.00 ","$1,431.00 ", N/A ,"$1,431.00 ","$1,812.60 ","$1,812.60 ","$1,812.60 ","$2,385.00 ", N/A ,"$2,027.25 ", N/A ,"$1,550.25 ", N/A ,"$2,385.00 ","$1,335.60 ", N/A ,$627.26 , N/A ,$841.01 ,$802.78 , N/A ,"$1,908.00 ", N/A ,"$1,075.64 ",$667.80 ,"$2,146.50 ", N/A ,"$1,812.60 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,144.80 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100127,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-RT,361,1 ,"$2,385.00 ","$1,550.25 ",$627.26 ,"$2,385.00 ", N/A ,"$2,125.00 ","$1,335.60 ", N/A ,$667.80 ,$806.13 , N/A ,$927.77 , N/A ,"$1,075.64 ","$1,075.64 ", N/A ,"$1,075.64 ", N/A ,"$1,192.50 ", N/A , N/A , N/A , N/A ,"$1,788.75 ","$1,431.00 ","$1,431.00 ", N/A ,"$1,431.00 ","$1,812.60 ","$1,812.60 ","$1,812.60 ","$2,385.00 ", N/A ,"$2,027.25 ", N/A ,"$1,550.25 ", N/A ,"$2,385.00 ","$1,335.60 ", N/A ,$627.26 , N/A ,$841.01 ,$802.78 , N/A ,"$1,908.00 ", N/A ,"$1,075.64 ",$667.80 ,"$2,146.50 ", N/A ,"$1,812.60 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,144.80 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100128,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-BIL,361,1 ,"$6,020.00 ","$3,913.00 ","$1,146.82 ","$6,020.00 ","$4,327.80 ","$3,187.50 ","$3,371.20 ","$1,731.12 ","$1,685.60 ","$2,034.76 ","$1,731.12 ","$2,341.78 ","$1,731.12 ","$2,715.02 ","$2,715.02 ","$1,731.12 ","$2,715.02 ","$3,289.12 ","$3,010.00 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$4,515.00 ","$3,612.00 ","$3,612.00 ","$1,731.12 ","$3,612.00 ","$4,575.20 ","$4,575.20 ","$4,575.20 ","$6,020.00 ", N/A ,"$5,117.00 ","$4,327.80 ","$3,913.00 ","$1,731.12 ","$6,020.00 ","$3,371.20 ","$1,731.12 ","$1,583.26 ", N/A ,"$1,261.50 ","$1,204.16 ","$1,817.68 ","$4,816.00 ","$3,895.02 ","$2,715.02 ","$1,685.60 ","$5,418.00 ","$1,731.12 ","$4,575.20 ","$4,035.00 ","$4,035.00 ","$1,731.12 ","$4,035.00 ","$2,889.60 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36100129,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-LT,361,1 ,"$4,014.00 ","$2,609.10 ",$764.55 ,"$4,327.80 ","$4,327.80 ","$2,125.00 ","$2,247.84 ","$1,731.12 ","$1,123.92 ","$1,356.73 ","$1,731.12 ","$1,561.45 ","$1,731.12 ","$1,810.31 ","$1,810.31 ","$1,731.12 ","$1,810.31 ","$3,289.12 ","$2,007.00 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$3,010.50 ","$2,408.40 ","$2,408.40 ","$1,731.12 ","$2,408.40 ","$3,050.64 ","$3,050.64 ","$3,050.64 ","$4,014.00 ", N/A ,"$3,411.90 ","$4,014.00 ","$2,609.10 ","$1,731.12 ","$4,014.00 ","$2,247.84 ","$1,731.12 ","$1,055.68 ", N/A ,$841.01 ,$802.78 ,"$1,817.68 ","$3,211.20 ","$3,895.02 ","$1,810.31 ","$1,123.92 ","$3,612.60 ","$1,731.12 ","$3,050.64 ","$2,690.00 ","$2,690.00 ","$1,731.12 ","$2,690.00 ","$1,926.72 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100130,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-RT,361,1 ,"$4,014.00 ","$2,609.10 ",$764.55 ,"$4,327.80 ","$4,327.80 ","$2,125.00 ","$2,247.84 ","$1,731.12 ","$1,123.92 ","$1,356.73 ","$1,731.12 ","$1,561.45 ","$1,731.12 ","$1,810.31 ","$1,810.31 ","$1,731.12 ","$1,810.31 ","$3,289.12 ","$2,007.00 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$3,010.50 ","$2,408.40 ","$2,408.40 ","$1,731.12 ","$2,408.40 ","$3,050.64 ","$3,050.64 ","$3,050.64 ","$4,014.00 ", N/A ,"$3,411.90 ","$4,014.00 ","$2,609.10 ","$1,731.12 ","$4,014.00 ","$2,247.84 ","$1,731.12 ","$1,055.68 ", N/A ,$841.01 ,$802.78 ,"$1,817.68 ","$3,211.20 ","$3,895.02 ","$1,810.31 ","$1,123.92 ","$3,612.60 ","$1,731.12 ","$3,050.64 ","$2,690.00 ","$2,690.00 ","$1,731.12 ","$2,690.00 ","$1,926.72 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100131,64640,HC DESTROY NERVE PERIPHERAL-BIL,361,1 ,"$7,813.00 ","$5,078.45 ","$1,146.82 ","$7,813.00 ","$3,043.40 ","$3,187.50 ","$4,375.28 ","$1,217.36 ","$2,187.64 ","$2,640.79 ","$1,217.36 ","$3,039.26 ","$1,217.36 ","$3,523.66 ","$3,523.66 ","$1,217.36 ","$3,523.66 ","$2,312.98 ","$3,906.50 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,241.71 ","$5,859.75 ","$4,687.80 ","$4,687.80 ","$1,217.36 ","$4,687.80 ","$5,937.88 ","$5,937.88 ","$5,937.88 ","$7,813.00 ", N/A ,"$6,641.05 ","$3,043.40 ","$5,078.45 ","$1,217.36 ","$7,813.00 ","$4,375.28 ","$1,217.36 ","$2,054.82 ", N/A ,"$1,261.50 ","$1,204.16 ","$1,278.23 ","$6,250.40 ","$2,739.06 ","$3,523.66 ","$2,187.64 ","$7,031.70 ","$1,217.36 ","$5,937.88 ","$2,250.00 ","$2,250.00 ","$1,217.36 ","$2,250.00 ","$3,750.24 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,36100132,64640,HC DESTROY NERVE PERIPHERAL-LT,361,1 ,"$5,209.00 ","$3,385.85 ",$764.55 ,"$5,209.00 ","$2,028.93 ","$2,125.00 ","$2,917.04 ",$811.57 ,"$1,458.52 ","$1,760.64 ",$811.57 ,"$2,026.30 ",$811.57 ,"$2,349.26 ","$2,349.26 ",$811.57 ,"$2,349.26 ","$1,541.99 ","$2,604.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$3,906.75 ","$3,125.40 ","$3,125.40 ",$811.57 ,"$3,125.40 ","$3,958.84 ","$3,958.84 ","$3,958.84 ","$5,209.00 ", N/A ,"$4,427.65 ","$2,028.93 ","$3,385.85 ",$811.57 ,"$5,209.00 ","$2,917.04 ",$811.57 ,"$1,369.97 ", N/A ,$841.01 ,$802.78 ,$852.15 ,"$4,167.20 ","$1,826.04 ","$2,349.26 ","$1,458.52 ","$4,688.10 ",$811.57 ,"$3,958.84 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$2,500.32 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100133,64640,HC DESTROY NERVE PERIPHERAL-RT,361,1 ,"$5,209.00 ","$3,385.85 ",$764.55 ,"$5,209.00 ","$2,028.93 ","$2,125.00 ","$2,917.04 ",$811.57 ,"$1,458.52 ","$1,760.64 ",$811.57 ,"$2,026.30 ",$811.57 ,"$2,349.26 ","$2,349.26 ",$811.57 ,"$2,349.26 ","$1,541.99 ","$2,604.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$3,906.75 ","$3,125.40 ","$3,125.40 ",$811.57 ,"$3,125.40 ","$3,958.84 ","$3,958.84 ","$3,958.84 ","$5,209.00 ", N/A ,"$4,427.65 ","$2,028.93 ","$3,385.85 ",$811.57 ,"$5,209.00 ","$2,917.04 ",$811.57 ,"$1,369.97 ", N/A ,$841.01 ,$802.78 ,$852.15 ,"$4,167.20 ","$1,826.04 ","$2,349.26 ","$1,458.52 ","$4,688.10 ",$811.57 ,"$3,958.84 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$2,500.32 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100135,31625,HC BRONCHOSCOPY BX SGL/MULT SITES,361,1 ,"$3,327.00 ","$2,162.55 ",$875.00 ,"$3,687.53 ","$3,687.53 ","$3,200.00 ","$1,863.12 ","$1,475.01 ",$931.56 ,"$1,124.53 ","$1,475.01 ","$1,294.20 ","$1,475.01 ","$1,500.48 ","$1,500.48 ","$1,475.01 ","$1,500.48 ","$2,802.52 ","$1,663.50 ","$3,687.52 ","$1,475.01 ","$1,475.01 ","$1,504.51 ","$2,495.25 ","$1,996.20 ","$1,996.20 ","$1,475.01 ","$1,996.20 ","$2,528.52 ","$2,528.52 ","$2,528.52 ","$3,327.00 ", N/A ,"$2,827.95 ","$3,327.00 ","$2,162.55 ","$1,475.01 ","$3,327.00 ","$1,863.12 ","$1,475.01 ",$875.00 , N/A ,"$1,825.48 ","$1,742.51 ","$1,548.76 ","$2,661.60 ","$3,318.77 ","$1,500.48 ",$931.56 ,"$2,994.30 ","$1,475.01 ","$2,528.52 ","$1,890.00 ","$1,890.00 ","$1,475.01 ","$1,890.00 ","$1,596.96 ","$1,659.53 "
ST. ELIZABETH'S HOSPITAL,36100139,31646,HC BRONCHOSCOPY W/ASP TREE SUBS,361,1 ,"$3,215.00 ","$2,089.75 ",$370.57 ,"$3,215.00 ",$926.43 ,"$2,125.00 ","$1,800.40 ",$370.57 ,$900.20 ,"$1,086.67 ",$370.57 ,"$1,250.64 ",$370.57 ,"$1,449.97 ","$1,449.97 ",$370.57 ,"$1,449.97 ",$704.08 ,"$1,607.50 ",$926.42 ,$370.57 ,$370.57 ,$377.98 ,"$2,411.25 ","$1,929.00 ","$1,929.00 ",$370.57 ,"$1,929.00 ","$2,443.40 ","$2,443.40 ","$2,443.40 ","$3,215.00 ", N/A ,"$2,732.75 ",$926.42 ,"$2,089.75 ",$370.57 ,"$3,215.00 ","$1,800.40 ",$370.57 ,$845.55 , N/A ,"$1,825.48 ","$1,742.51 ",$389.10 ,"$2,572.00 ",$833.78 ,"$1,449.97 ",$900.20 ,"$2,893.50 ",$370.57 ,"$2,443.40 ",$920.00 ,$920.00 ,$370.57 ,$920.00 ,"$1,543.20 ","$1,659.53 "
ST. ELIZABETH'S HOSPITAL,36100140,31623,HC BRONCHOSCOPY W/BRUSHING,361,1 ,"$3,082.00 ","$2,003.30 ",$810.57 ,"$3,687.53 ","$3,687.53 ","$3,082.00 ","$1,725.92 ","$1,475.01 ",$862.96 ,"$1,041.72 ","$1,475.01 ","$1,198.90 ","$1,475.01 ","$1,389.98 ","$1,389.98 ","$1,475.01 ","$1,389.98 ","$2,802.52 ","$1,541.00 ","$3,687.52 ","$1,475.01 ","$1,475.01 ","$1,504.51 ","$2,311.50 ","$1,849.20 ","$1,849.20 ","$1,475.01 ","$1,849.20 ","$2,342.32 ","$2,342.32 ","$2,342.32 ","$3,082.00 ", N/A ,"$2,619.70 ","$3,082.00 ","$2,003.30 ","$1,475.01 ","$3,082.00 ","$1,725.92 ","$1,475.01 ",$810.57 , N/A ,"$1,825.48 ","$1,742.51 ","$1,548.76 ","$2,465.60 ","$3,318.77 ","$1,389.98 ",$862.96 ,"$2,773.80 ","$1,475.01 ","$2,342.32 ","$1,890.00 ","$1,890.00 ","$1,475.01 ","$1,890.00 ","$1,479.36 ","$1,659.53 "
ST. ELIZABETH'S HOSPITAL,36100141,31628,HC BRONCHOSCOPY W/BX TRANSHC BRONCH SGL,361,1 ,"$3,307.00 ","$2,149.55 ",$869.74 ,"$7,634.68 ","$7,634.68 ","$3,200.00 ","$1,851.92 ","$3,053.87 ",$925.96 ,"$1,117.77 ","$3,053.87 ","$1,286.42 ","$3,053.87 ","$1,491.46 ","$1,491.46 ","$3,053.87 ","$1,491.46 ","$3,307.00 ","$1,653.50 ","$7,634.67 ","$3,053.87 ","$3,053.87 ","$3,114.94 ","$2,480.25 ","$1,984.20 ","$1,984.20 ","$3,053.87 ","$1,984.20 ","$2,513.32 ","$2,513.32 ","$2,513.32 ","$3,307.00 ", N/A ,"$2,810.95 ","$3,307.00 ","$2,149.55 ","$3,053.87 ","$3,307.00 ","$1,851.92 ","$3,053.87 ",$869.74 , N/A ,"$1,825.48 ","$1,742.51 ","$3,206.56 ","$2,645.60 ","$6,871.20 ","$1,491.46 ",$925.96 ,"$2,976.30 ","$3,053.87 ","$2,513.32 ","$1,890.00 ","$1,890.00 ","$3,053.87 ","$1,890.00 ","$1,587.36 ","$1,659.53 "
ST. ELIZABETH'S HOSPITAL,36100143,31624,HC BRONCHOSCOPY W/LAVAGE ALVEOLAR,361,1 ,"$3,155.00 ","$2,050.75 ",$829.77 ,"$3,687.53 ","$3,687.53 ","$3,155.00 ","$1,766.80 ","$1,475.01 ",$883.40 ,"$1,066.39 ","$1,475.01 ","$1,227.30 ","$1,475.01 ","$1,422.91 ","$1,422.91 ","$1,475.01 ","$1,422.91 ","$2,802.52 ","$1,577.50 ","$3,687.52 ","$1,475.01 ","$1,475.01 ","$1,504.51 ","$2,366.25 ","$1,893.00 ","$1,893.00 ","$1,475.01 ","$1,893.00 ","$2,397.80 ","$2,397.80 ","$2,397.80 ","$3,155.00 ", N/A ,"$2,681.75 ","$3,155.00 ","$2,050.75 ","$1,475.01 ","$3,155.00 ","$1,766.80 ","$1,475.01 ",$829.77 , N/A ,"$1,825.48 ","$1,742.51 ","$1,548.76 ","$2,524.00 ","$3,318.77 ","$1,422.91 ",$883.40 ,"$2,839.50 ","$1,475.01 ","$2,397.80 ","$1,890.00 ","$1,890.00 ","$1,475.01 ","$1,890.00 ","$1,514.40 ","$1,659.53 "
ST. ELIZABETH'S HOSPITAL,36100144,N/A,HC DEBRIDEMENT OF WOUND,361,1 ,$386.00 ,$250.90 ,$101.52 ,$386.00 , N/A ,$177.56 ,$216.16 , N/A ,$108.08 ,$130.47 , N/A ,$150.15 , N/A ,$174.09 ,$174.09 , N/A ,$174.09 , N/A ,$193.00 , N/A , N/A , N/A , N/A ,$289.50 ,$231.60 ,$231.60 , N/A ,$231.60 ,$293.36 ,$293.36 ,$293.36 ,$386.00 , N/A ,$328.10 , N/A ,$250.90 , N/A ,$386.00 ,$216.16 , N/A ,$101.52 , N/A , N/A , N/A , N/A ,$308.80 , N/A ,$174.09 ,$108.08 ,$347.40 , N/A ,$293.36 , N/A , N/A , N/A , N/A ,$185.28 , N/A 
ST. ELIZABETH'S HOSPITAL,36100145,68040,HC EXPRESS CONJUNCTIVAL FOLLICLES,361,1 ,"$1,251.00 ",$813.15 ,$257.89 ,"$1,263.19 ",$644.73 ,"$1,251.00 ",$700.56 ,$257.89 ,$350.28 ,$422.84 ,$257.89 ,$486.64 ,$257.89 ,$564.20 ,$564.20 ,$257.89 ,$564.20 ,$490.00 ,$625.50 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$938.25 ,$750.60 ,$750.60 ,$257.89 ,$750.60 ,$950.76 ,$950.76 ,$950.76 ,"$1,251.00 ", N/A ,"$1,063.35 ",$644.74 ,$813.15 ,$257.89 ,"$1,251.00 ",$700.56 ,$257.89 ,$329.01 , N/A ,"$1,251.00 ","$1,251.00 ",$270.78 ,"$1,000.80 ",$580.26 ,$564.20 ,$350.28 ,"$1,125.90 ",$257.89 ,$950.76 ,$920.00 ,$920.00 ,$257.89 ,$920.00 ,$600.48 ,"$1,263.19 "
ST. ELIZABETH'S HOSPITAL,36100146,51720,HC INSTILL ANTICARCINOG BLADDER,361,1 ,"$1,840.00 ","$1,196.00 ",$262.35 ,"$1,840.00 ",$655.88 ,$846.40 ,"$1,030.40 ",$262.35 ,$515.20 ,$621.92 ,$262.35 ,$715.76 ,$262.35 ,$829.84 ,$829.84 ,$262.35 ,$829.84 ,$498.46 ,$920.00 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,"$1,380.00 ","$1,104.00 ","$1,104.00 ",$262.35 ,"$1,104.00 ","$1,398.40 ","$1,398.40 ","$1,398.40 ","$1,840.00 ", N/A ,"$1,564.00 ",$655.86 ,"$1,196.00 ",$262.35 ,"$1,840.00 ","$1,030.40 ",$262.35 ,$483.92 , N/A ,"$1,144.54 ","$1,092.51 ",$275.47 ,"$1,472.00 ",$590.28 ,$829.84 ,$515.20 ,"$1,656.00 ",$262.35 ,"$1,398.40 ",$920.00 ,$920.00 ,$262.35 ,$920.00 ,$883.20 ,"$1,040.49 "
ST. ELIZABETH'S HOSPITAL,36100147,31520,HC LARYNGSCPY WW/O TRACH DX NEWB,361,1 ,"$1,078.00 ",$700.70 ,$283.51 ,"$1,078.00 ",$926.43 ,"$1,078.00 ",$603.68 ,$370.57 ,$301.84 ,$364.36 ,$370.57 ,$419.34 ,$370.57 ,$486.18 ,$486.18 ,$370.57 ,$486.18 ,$704.08 ,$539.00 ,$926.42 ,$370.57 ,$370.57 ,$377.98 ,$808.50 ,$646.80 ,$646.80 ,$370.57 ,$646.80 ,$819.28 ,$819.28 ,$819.28 ,"$1,078.00 ", N/A ,$916.30 ,$926.42 ,$700.70 ,$370.57 ,"$1,078.00 ",$603.68 ,$370.57 ,$283.51 , N/A , N/A , N/A ,$389.10 ,$862.40 ,$833.78 ,$486.18 ,$301.84 ,$970.20 ,$370.57 ,$819.28 ,$920.00 ,$920.00 ,$370.57 ,$920.00 ,$517.44 , N/A 
ST. ELIZABETH'S HOSPITAL,36100148,64488,HC INJ TAP BLOCK W/GUIDE- BIL,361,1 ,"$1,846.00 ","$1,199.90 ",$421.56 ,"$1,846.00 ", N/A ,"$1,846.00 ","$1,033.76 ", N/A ,$516.88 ,$623.95 , N/A ,$718.09 , N/A ,$832.55 ,$832.55 , N/A ,$832.55 , N/A ,$923.00 , N/A , N/A , N/A , N/A ,"$1,384.50 ","$1,107.60 ","$1,107.60 ", N/A ,"$1,107.60 ","$1,402.96 ","$1,402.96 ","$1,402.96 ","$1,846.00 ", N/A ,"$1,569.10 ", N/A ,"$1,199.90 ", N/A ,"$1,846.00 ","$1,033.76 ", N/A ,$485.50 , N/A ,$463.72 ,$442.64 , N/A ,"$1,476.80 ", N/A ,$832.55 ,$516.88 ,"$1,661.40 ", N/A ,"$1,402.96 ",$920.00 ,$920.00 , N/A ,$920.00 ,$886.08 ,$421.56 
ST. ELIZABETH'S HOSPITAL,36100153,36514,HC PLASMA PHERESIS THERAPY,361,1 ,"$4,280.00 ","$2,782.00 ","$1,125.64 ","$4,280.00 ","$3,361.78 ","$3,200.00 ","$2,396.80 ","$1,344.71 ","$1,198.40 ","$1,446.64 ","$1,344.71 ","$1,664.92 ","$1,344.71 ","$1,930.28 ","$1,930.28 ","$1,344.71 ","$1,930.28 ","$2,554.95 ","$2,140.00 ","$3,361.78 ","$1,344.71 ","$1,344.71 ","$1,371.60 ","$3,210.00 ","$2,568.00 ","$2,568.00 ","$1,344.71 ","$2,568.00 ","$3,252.80 ","$3,252.80 ","$3,252.80 ","$4,280.00 ", N/A ,"$3,638.00 ","$3,361.78 ","$2,782.00 ","$1,344.71 ","$4,280.00 ","$2,396.80 ","$1,344.71 ","$1,125.64 ", N/A ,"$2,726.80 ","$2,602.86 ","$1,411.95 ","$3,424.00 ","$3,025.60 ","$1,930.28 ","$1,198.40 ","$3,852.00 ","$1,344.71 ","$3,252.80 ","$1,890.00 ","$1,890.00 ","$1,344.71 ","$1,890.00 ","$2,054.40 ","$2,478.91 "
ST. ELIZABETH'S HOSPITAL,36100156,38222,HC BONE MARROW ASPIRATION (BX/ASP SAME SITE),361,1 ,"$8,348.00 ","$5,426.20 ",$583.08 ,"$8,348.00 ","$5,843.93 ","$2,125.00 ","$4,674.88 ","$2,337.57 ","$2,337.44 ","$2,821.62 ","$2,337.57 ","$3,247.37 ","$2,337.57 ","$3,764.95 ","$3,764.95 ","$2,337.57 ","$3,764.95 ","$4,441.38 ","$4,174.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$6,261.00 ","$5,008.80 ","$5,008.80 ","$2,337.57 ","$5,008.80 ","$6,344.48 ","$6,344.48 ","$6,344.48 ","$8,348.00 ", N/A ,"$7,095.80 ","$5,843.93 ","$5,426.20 ","$2,337.57 ","$8,348.00 ","$4,674.88 ","$2,337.57 ","$2,195.52 ", N/A ,$641.39 ,$612.23 ,"$2,454.45 ","$6,678.40 ","$5,259.53 ","$3,764.95 ","$2,337.44 ","$7,513.20 ","$2,337.57 ","$6,344.48 ","$1,890.00 ","$1,890.00 ","$2,337.57 ","$1,890.00 ","$4,007.04 ",$583.08 
ST. ELIZABETH'S HOSPITAL,36100161,19296,HC PLACE RADIOTHERAPY CATH BREAST,361,1 ,"$21,997.00 ","$14,298.05 ","$2,705.24 ","$21,997.00 ","$21,976.50 ","$5,500.00 ","$12,318.32 ","$8,790.60 ","$6,159.16 ","$4,859.14 ","$8,790.60 ","$5,584.90 ","$8,790.60 ","$6,645.60 ","$6,645.60 ","$8,790.60 ","$6,645.60 ","$16,702.14 ","$10,998.50 ","$21,976.50 ","$8,790.60 ","$8,790.60 ","$8,966.41 ","$16,497.75 ","$13,198.20 ","$13,198.20 ","$8,790.60 ","$13,198.20 ","$8,112.00 ","$8,112.00 ","$8,112.00 ","$21,997.00 ", N/A ,"$18,697.45 ","$21,976.50 ","$14,298.05 ","$8,790.60 ","$21,997.00 ","$12,318.32 ","$8,790.60 ","$5,785.21 ", N/A ,"$2,975.76 ","$2,840.50 ","$9,230.13 ","$17,597.60 ","$19,778.85 ","$6,645.60 ","$6,159.16 ","$19,797.30 ","$8,790.60 ","$7,301.00 ","$4,800.00 ","$4,800.00 ","$8,790.60 ","$4,800.00 ","$10,558.56 ","$2,705.24 "
ST. ELIZABETH'S HOSPITAL,36100163,32701,HC THORACIC STEREO RAD THRPY W/TX,361,1 ,"$1,848.00 ","$1,201.20 ",$486.02 ,"$1,848.00 ", N/A ,$850.08 ,"$1,034.88 ", N/A ,$517.44 ,$624.62 , N/A ,$718.87 , N/A ,$833.45 ,$833.45 , N/A ,$833.45 , N/A ,$924.00 , N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,108.80 ","$1,108.80 ", N/A ,"$1,108.80 ","$1,404.48 ","$1,404.48 ","$1,404.48 ","$1,848.00 ", N/A ,"$1,570.80 ", N/A ,"$1,201.20 ", N/A ,"$1,848.00 ","$1,034.88 ", N/A ,$486.02 , N/A , N/A , N/A , N/A ,"$1,478.40 ", N/A ,$833.45 ,$517.44 ,"$1,663.20 ", N/A ,"$1,404.48 ", N/A , N/A , N/A , N/A ,$887.04 , N/A 
ST. ELIZABETH'S HOSPITAL,36100164,N/A,HC BEDSIDE SURG PROC LEVEL 2,361,1 ,"$1,332.00 ",$865.80 ,$350.32 ,"$1,332.00 ", N/A ,$612.72 ,$745.92 , N/A ,$372.96 ,$450.22 , N/A ,$518.15 , N/A ,$600.73 ,$600.73 , N/A ,$600.73 , N/A ,$666.00 , N/A , N/A , N/A , N/A ,$999.00 ,$799.20 ,$799.20 , N/A ,$799.20 ,"$1,012.32 ","$1,012.32 ","$1,012.32 ","$1,332.00 ", N/A ,"$1,132.20 ", N/A ,$865.80 , N/A ,"$1,332.00 ",$745.92 , N/A ,$350.32 , N/A , N/A , N/A , N/A ,"$1,065.60 ", N/A ,$600.73 ,$372.96 ,"$1,198.80 ", N/A ,"$1,012.32 ", N/A , N/A , N/A , N/A ,$639.36 , N/A 
ST. ELIZABETH'S HOSPITAL,36100165,N/A,HC BEDSIDE SURG PROC LEVEL 3,361,1 ,"$1,998.00 ","$1,298.70 ",$525.47 ,"$1,998.00 ", N/A ,$919.08 ,"$1,118.88 ", N/A ,$559.44 ,$675.32 , N/A ,$777.22 , N/A ,$901.10 ,$901.10 , N/A ,$901.10 , N/A ,$999.00 , N/A , N/A , N/A , N/A ,"$1,498.50 ","$1,198.80 ","$1,198.80 ", N/A ,"$1,198.80 ","$1,518.48 ","$1,518.48 ","$1,518.48 ","$1,998.00 ", N/A ,"$1,698.30 ", N/A ,"$1,298.70 ", N/A ,"$1,998.00 ","$1,118.88 ", N/A ,$525.47 , N/A , N/A , N/A , N/A ,"$1,598.40 ", N/A ,$901.10 ,$559.44 ,"$1,798.20 ", N/A ,"$1,518.48 ", N/A , N/A , N/A , N/A ,$959.04 , N/A 
ST. ELIZABETH'S HOSPITAL,36100166,N/A,HC BEDSIDE SURG PROC LEVEL 4,361,1 ,"$2,664.00 ","$1,731.60 ",$700.63 ,"$2,664.00 ", N/A ,"$1,225.44 ","$1,491.84 ", N/A ,$745.92 ,$900.43 , N/A ,"$1,036.30 ", N/A ,"$1,201.46 ","$1,201.46 ", N/A ,"$1,201.46 ", N/A ,"$1,332.00 ", N/A , N/A , N/A , N/A ,"$1,998.00 ","$1,598.40 ","$1,598.40 ", N/A ,"$1,598.40 ","$2,024.64 ","$2,024.64 ","$2,024.64 ","$2,664.00 ", N/A ,"$2,264.40 ", N/A ,"$1,731.60 ", N/A ,"$2,664.00 ","$1,491.84 ", N/A ,$700.63 , N/A , N/A , N/A , N/A ,"$2,131.20 ", N/A ,"$1,201.46 ",$745.92 ,"$2,397.60 ", N/A ,"$2,024.64 ", N/A , N/A , N/A , N/A ,"$1,278.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,36100196,64447,HC FEMORAL NERVE BLOCK SINGLE,361,1 ,"$2,378.00 ","$1,545.70 ",$421.56 ,"$2,378.00 ","$1,565.08 ","$2,378.00 ","$1,331.68 ",$626.03 ,$665.84 ,$803.76 ,$626.03 ,$925.04 ,$626.03 ,"$1,072.48 ","$1,072.48 ",$626.03 ,"$1,072.48 ","$1,189.46 ","$1,189.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,783.50 ","$1,426.80 ","$1,426.80 ",$626.03 ,"$1,426.80 ","$1,807.28 ","$1,807.28 ","$1,807.28 ","$2,378.00 ", N/A ,"$2,021.30 ","$1,565.07 ","$1,545.70 ",$626.03 ,"$2,378.00 ","$1,331.68 ",$626.03 ,$625.41 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$1,902.40 ","$1,408.57 ","$1,072.48 ",$665.84 ,"$2,140.20 ",$626.03 ,"$1,807.28 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,141.44 ",$421.56 
ST. ELIZABETH'S HOSPITAL,36100233,11105,HC BIOPSY SKIN PUNCH ADDL LESN,361,1 ,$446.00 ,$289.90 ,$117.30 ,$617.74 , N/A ,$446.00 ,$249.76 , N/A ,$124.88 ,$150.75 , N/A ,$173.49 , N/A ,$201.15 ,$201.15 , N/A ,$201.15 , N/A ,$223.00 , N/A , N/A , N/A , N/A ,$334.50 ,$267.60 ,$267.60 , N/A ,$267.60 ,$338.96 ,$338.96 ,$338.96 ,$446.00 , N/A ,$379.10 , N/A ,$289.90 , N/A ,$446.00 ,$249.76 , N/A ,$117.30 , N/A ,$446.00 ,$446.00 , N/A ,$356.80 , N/A ,$201.15 ,$124.88 ,$401.40 , N/A ,$338.96 ,$446.00 ,$446.00 , N/A ,$446.00 ,$214.08 ,$617.74 
ST. ELIZABETH'S HOSPITAL,36100235,11102,HC BIOPSY SKIN TANGENTIAL INIT LESN,361,1 ,$511.29 ,$332.34 ,$134.47 ,$617.74 ,$442.60 ,$511.29 ,$286.32 ,$177.04 ,$143.16 ,$172.82 ,$177.04 ,$198.89 ,$177.04 ,$230.59 ,$230.59 ,$177.04 ,$230.59 ,$336.38 ,$255.65 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$383.47 ,$306.77 ,$306.77 ,$177.04 ,$306.77 ,$388.58 ,$388.58 ,$388.58 ,$511.29 , N/A ,$434.60 ,$442.60 ,$332.34 ,$177.04 ,$511.29 ,$286.32 ,$177.04 ,$134.47 , N/A ,$511.29 ,$511.29 ,$185.89 ,$409.03 ,$398.34 ,$230.59 ,$143.16 ,$460.16 ,$177.04 ,$388.58 ,$511.29 ,$511.29 ,$177.04 ,$511.29 ,$245.42 ,$617.74 
ST. ELIZABETH'S HOSPITAL,36100236,11104,HC BIOPSY SKIN PUNCH INIT LESN,361,1 ,$446.00 ,$289.90 ,$117.30 ,$851.90 ,$851.90 ,$205.16 ,$249.76 ,$340.76 ,$124.88 ,$150.75 ,$340.76 ,$173.49 ,$340.76 ,$201.15 ,$201.15 ,$340.76 ,$201.15 ,$446.00 ,$223.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$334.50 ,$267.60 ,$267.60 ,$340.76 ,$267.60 ,$338.96 ,$338.96 ,$338.96 ,$446.00 , N/A ,$379.10 ,$446.00 ,$289.90 ,$340.76 ,$446.00 ,$249.76 ,$340.76 ,$117.30 , N/A ,$446.00 ,$446.00 ,$357.80 ,$356.80 ,$766.71 ,$201.15 ,$124.88 ,$401.40 ,$340.76 ,$338.96 ,$446.00 ,$446.00 ,$340.76 ,$446.00 ,$214.08 ,$617.74 
ST. ELIZABETH'S HOSPITAL,36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,"$1,103.00 ",$716.95 ,$290.09 ,"$1,290.85 ","$1,290.85 ","$1,103.00 ",$617.68 ,$516.34 ,$308.84 ,$372.81 ,$516.34 ,$429.07 ,$516.34 ,$497.45 ,$497.45 ,$516.34 ,$497.45 ,$981.05 ,$551.50 ,"$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,$827.25 ,$661.80 ,$661.80 ,$516.34 ,$661.80 ,$838.28 ,$838.28 ,$838.28 ,"$1,103.00 ", N/A ,$937.55 ,"$1,103.00 ",$716.95 ,$516.34 ,"$1,103.00 ",$617.68 ,$516.34 ,$290.09 , N/A ,$679.51 ,$648.63 ,$542.16 ,$882.40 ,"$1,161.77 ",$497.45 ,$308.84 ,$992.70 ,$516.34 ,$838.28 ,"$1,103.00 ","$1,103.00 ",$516.34 ,"$1,103.00 ",$529.44 ,$617.74 
ST. ELIZABETH'S HOSPITAL,36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$1,255.00 ",$815.75 ,$148.00 ,"$1,533.75 ","$1,533.75 ","$1,255.00 ",$702.80 ,$613.50 ,$351.40 ,$424.19 ,$613.50 ,$488.20 ,$613.50 ,$566.01 ,$566.01 ,$613.50 ,$566.01 ,"$1,165.65 ",$627.50 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,$941.25 ,$753.00 ,$753.00 ,$613.50 ,$753.00 ,$953.80 ,$953.80 ,$953.80 ,"$1,255.00 ", N/A ,"$1,066.75 ","$1,255.00 ",$815.75 ,$613.50 ,$148.00 ,$702.80 ,$613.50 ,$330.07 , N/A ,$641.39 ,$612.23 ,$644.18 ,"$1,004.00 ","$1,380.37 ",$566.01 ,$351.40 ,"$1,129.50 ",$613.50 ,$953.80 ,"$1,255.00 ","$1,255.00 ",$613.50 ,"$1,255.00 ",$602.40 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,"$1,255.00 ",$815.75 ,$66.21 ,"$1,255.00 ", N/A ,"$1,255.00 ",$702.80 , N/A ,$351.40 ,$424.19 , N/A ,$488.20 , N/A ,$566.01 ,$566.01 , N/A ,$566.01 , N/A ,$627.50 , N/A , N/A , N/A , N/A ,$941.25 ,$753.00 ,$753.00 , N/A ,$753.00 ,$953.80 ,$953.80 ,$953.80 ,"$1,255.00 ", N/A ,"$1,066.75 ", N/A ,$815.75 , N/A ,$66.21 ,$702.80 , N/A ,$330.07 , N/A ,$641.39 ,$612.23 , N/A ,"$1,004.00 ", N/A ,$566.01 ,$351.40 ,"$1,129.50 ", N/A ,$953.80 ,$920.00 ,$920.00 , N/A ,$920.00 ,$602.40 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36100240,10007,HC ASP FINE NDL W/FLUORO GUIDE INIT LESN,361,1 ,"$1,255.00 ",$815.75 ,$330.07 ,"$1,533.75 ","$1,533.75 ","$1,255.00 ",$702.80 ,$613.50 ,$351.40 ,$424.19 ,$613.50 ,$488.20 ,$613.50 ,$566.01 ,$566.01 ,$613.50 ,$566.01 ,"$1,165.65 ",$627.50 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,$941.25 ,$753.00 ,$753.00 ,$613.50 ,$753.00 ,$953.80 ,$953.80 ,$953.80 ,"$1,255.00 ", N/A ,"$1,066.75 ","$1,255.00 ",$815.75 ,$613.50 ,$333.44 ,$702.80 ,$613.50 ,$330.07 , N/A ,$641.39 ,$612.23 ,$644.18 ,"$1,004.00 ","$1,380.37 ",$566.01 ,$351.40 ,"$1,129.50 ",$613.50 ,$953.80 ,"$1,255.00 ","$1,255.00 ",$613.50 ,"$1,255.00 ",$602.40 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36100241,10008,HC ASP FINE NDL W/FLUORO GUIDE EA ADDL LESN,361,1 ,"$1,444.00 ",$938.60 ,$177.04 ,"$1,444.00 ", N/A ,"$1,444.00 ",$808.64 , N/A ,$404.32 ,$488.07 , N/A ,$561.72 , N/A ,$651.24 ,$651.24 , N/A ,$651.24 , N/A ,$722.00 , N/A , N/A , N/A , N/A ,"$1,083.00 ",$866.40 ,$866.40 , N/A ,$866.40 ,"$1,097.44 ","$1,097.44 ","$1,097.44 ","$1,444.00 ", N/A ,"$1,227.40 ", N/A ,$938.60 , N/A ,$177.04 ,$808.64 , N/A ,$379.77 , N/A ,$641.39 ,$612.23 , N/A ,"$1,155.20 ", N/A ,$651.24 ,$404.32 ,"$1,299.60 ", N/A ,"$1,097.44 ",$920.00 ,$920.00 , N/A ,$920.00 ,$693.12 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36100243,10010,HC ASP FINE NDL W/CT GUIDE EA ADDL LESN,361,1 ,"$1,444.00 ",$938.60 ,$301.87 ,"$1,444.00 ", N/A ,"$1,444.00 ",$808.64 , N/A ,$404.32 ,$488.07 , N/A ,$561.72 , N/A ,$651.24 ,$651.24 , N/A ,$651.24 , N/A ,$722.00 , N/A , N/A , N/A , N/A ,"$1,083.00 ",$866.40 ,$866.40 , N/A ,$866.40 ,"$1,097.44 ","$1,097.44 ","$1,097.44 ","$1,444.00 ", N/A ,"$1,227.40 ", N/A ,$938.60 , N/A ,$301.87 ,$808.64 , N/A ,$379.77 , N/A ,$641.39 ,$612.23 , N/A ,"$1,155.20 ", N/A ,$651.24 ,$404.32 ,"$1,299.60 ", N/A ,"$1,097.44 ",$920.00 ,$920.00 , N/A ,$920.00 ,$693.12 ,$583.08 
ST. ELIZABETH'S HOSPITAL,36100246,36572,HC INS CATH PERIPH CV W/O PORT W/GUIDANCE <5,361,1 ,"$2,029.00 ","$1,318.85 ",$532.90 ,"$2,029.00 ","$1,332.25 ","$2,029.00 ","$1,136.24 ",$532.90 ,$568.12 ,$685.80 ,$532.90 ,$789.28 ,$532.90 ,$915.08 ,$915.08 ,$532.90 ,$915.08 ,"$1,012.50 ","$1,014.50 ","$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,"$1,521.75 ","$1,217.40 ","$1,217.40 ",$532.90 ,"$1,217.40 ","$1,542.04 ","$1,542.04 ","$1,542.04 ","$2,029.00 ", N/A ,"$1,724.65 ","$1,332.24 ","$1,318.85 ",$532.90 ,"$2,029.00 ","$1,136.24 ",$532.90 ,$533.63 , N/A , N/A , N/A ,$559.55 ,"$1,623.20 ","$1,199.01 ",$915.08 ,$568.12 ,"$1,826.10 ",$532.90 ,"$1,542.04 ","$1,500.00 ","$1,500.00 ",$532.90 ,"$1,500.00 ",$973.92 , N/A 
ST. ELIZABETH'S HOSPITAL,36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,"$6,504.00 ","$4,227.60 ",$474.97 ,"$6,504.00 ","$3,465.88 ","$2,125.00 ","$3,642.24 ","$1,386.35 ","$1,821.12 ","$2,198.35 ","$1,386.35 ","$2,530.06 ","$1,386.35 ","$2,933.30 ","$2,933.30 ","$1,386.35 ","$2,933.30 ","$2,634.07 ","$3,252.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$4,878.00 ","$3,902.40 ","$3,902.40 ","$1,386.35 ","$3,902.40 ","$4,943.04 ","$4,943.04 ","$4,943.04 ","$6,504.00 ", N/A ,"$5,528.40 ","$3,465.89 ","$4,227.60 ","$1,386.35 ","$6,504.00 ","$3,642.24 ","$1,386.35 ","$1,710.55 ", N/A ,$522.47 ,$498.72 ,"$1,455.67 ","$5,203.20 ","$3,119.30 ","$2,933.30 ","$1,821.12 ","$5,853.60 ","$1,386.35 ","$4,943.04 ","$1,890.00 ","$1,890.00 ","$1,386.35 ","$1,890.00 ","$3,121.92 ",$474.97 
ST. ELIZABETH'S HOSPITAL,36100263,64999,HC INJECTION PEDICLE SCREW,361,1 ,$772.00 ,$501.80 ,$203.04 ,$772.00 ,$643.95 ,$772.00 ,$432.32 ,$257.58 ,$216.16 ,$260.94 ,$257.58 ,$300.31 ,$257.58 ,$348.17 ,$348.17 ,$257.58 ,$348.17 ,$489.39 ,$386.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$579.00 ,$463.20 ,$463.20 ,$257.58 ,$463.20 ,$586.72 ,$586.72 ,$586.72 ,$772.00 , N/A ,$656.20 ,$643.94 ,$501.80 ,$257.58 ,$772.00 ,$432.32 ,$257.58 ,$203.04 , N/A ,$463.72 ,$442.64 ,$270.46 ,$617.60 ,$579.55 ,$348.17 ,$216.16 ,$694.80 ,$257.58 ,$586.72 ,$772.00 ,$772.00 ,$257.58 ,$772.00 ,$370.56 ,$421.56 
ST. ELIZABETH'S HOSPITAL,36100264,33016,HC PERICARDIOCENTESIS W/ OR W/O IMAGING,361,1 ,"$5,034.00 ","$3,272.10 ","$1,323.94 ","$5,034.00 ","$3,465.88 ","$3,200.00 ","$2,819.04 ","$1,386.35 ","$1,409.52 ","$1,701.49 ","$1,386.35 ","$1,958.23 ","$1,386.35 ","$2,270.33 ","$2,270.33 ","$1,386.35 ","$2,270.33 ","$2,634.07 ","$2,517.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$3,775.50 ","$3,020.40 ","$3,020.40 ","$1,386.35 ","$3,020.40 ","$3,825.84 ","$3,825.84 ","$3,825.84 ","$5,034.00 ", N/A ,"$4,278.90 ","$3,465.89 ","$3,272.10 ","$1,386.35 ","$5,034.00 ","$2,819.04 ","$1,386.35 ","$1,323.94 ", N/A ,"$3,285.62 ","$3,136.28 ","$1,455.67 ","$4,027.20 ","$3,119.30 ","$2,270.33 ","$1,409.52 ","$4,530.60 ","$1,386.35 ","$3,825.84 ","$1,500.00 ","$1,500.00 ","$1,386.35 ","$1,500.00 ","$2,416.32 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,36100270,62328,HC LUMBAR PUNCTURE DIAGNOSTIC W/FLUORO OR CT GUID,361,1 ,"$2,473.00 ","$1,607.45 ",$495.26 ,"$2,473.00 ","$1,565.08 ","$2,125.00 ","$1,384.88 ",$626.03 ,$692.44 ,$835.87 ,$626.03 ,$962.00 ,$626.03 ,"$1,115.32 ","$1,115.32 ",$626.03 ,"$1,115.32 ","$1,189.46 ","$1,236.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,854.75 ","$1,483.80 ","$1,483.80 ",$626.03 ,"$1,483.80 ","$1,879.48 ","$1,879.48 ","$1,879.48 ","$2,473.00 ", N/A ,"$2,102.05 ","$1,565.07 ","$1,607.45 ",$626.03 ,"$2,473.00 ","$1,384.88 ",$626.03 ,$650.40 , N/A ,$544.79 ,$520.02 ,$657.33 ,"$1,978.40 ","$1,408.57 ","$1,115.32 ",$692.44 ,"$2,225.70 ",$626.03 ,"$1,879.48 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,187.04 ",$495.26 
ST. ELIZABETH'S HOSPITAL,36100271,62329,HC LUMBAR PUNCTURE THERAPEUTIC/DRAINAGE W//FLUORO OR CT GUID,361,1 ,"$2,250.00 ","$1,462.50 ",$495.26 ,"$2,250.00 ","$1,565.08 ","$2,125.00 ","$1,260.00 ",$626.03 ,$630.00 ,$760.50 ,$626.03 ,$875.25 ,$626.03 ,"$1,014.75 ","$1,014.75 ",$626.03 ,"$1,014.75 ","$1,189.46 ","$1,125.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,687.50 ","$1,350.00 ","$1,350.00 ",$626.03 ,"$1,350.00 ","$1,710.00 ","$1,710.00 ","$1,710.00 ","$2,250.00 ", N/A ,"$1,912.50 ","$1,565.07 ","$1,462.50 ",$626.03 ,"$2,250.00 ","$1,260.00 ",$626.03 ,$591.75 , N/A ,$544.79 ,$520.02 ,$657.33 ,"$1,800.00 ","$1,408.57 ","$1,014.75 ",$630.00 ,"$2,025.00 ",$626.03 ,"$1,710.00 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,080.00 ",$495.26 
ST. ELIZABETH'S HOSPITAL,36100273,64454,HC INJ ANESTHETIC/STEROID GENICULAR NERVES W/FLUORO OR CT GUID,361,1 ,$950.00 ,$617.50 ,$249.85 ,"$1,565.08 ","$1,565.08 ",$950.00 ,$532.00 ,$626.03 ,$266.00 ,$321.10 ,$626.03 ,$369.55 ,$626.03 ,$428.45 ,$428.45 ,$626.03 ,$428.45 ,$950.00 ,$475.00 ,"$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,$712.50 ,$570.00 ,$570.00 ,$626.03 ,$570.00 ,$722.00 ,$722.00 ,$722.00 ,$950.00 , N/A ,$807.50 ,$950.00 ,$617.50 ,$626.03 ,$950.00 ,$532.00 ,$626.03 ,$249.85 , N/A ,$463.72 ,$442.64 ,$657.33 ,$760.00 ,"$1,408.57 ",$428.45 ,$266.00 ,$855.00 ,$626.03 ,$722.00 ,$950.00 ,$950.00 ,$626.03 ,$950.00 ,$456.00 ,$421.56 
ST. ELIZABETH'S HOSPITAL,36100274,64624,HC DESTRUST NEUROLYTIC AGENT GENICULAR NERVE W/IMG GUID,361,1 ,"$6,802.00 ","$4,421.30 ",$764.55 ,"$6,802.00 ","$4,327.80 ","$2,125.00 ","$3,809.12 ","$1,731.12 ","$1,904.56 ","$2,299.08 ","$1,731.12 ","$2,645.98 ","$1,731.12 ","$3,067.70 ","$3,067.70 ","$1,731.12 ","$3,067.70 ","$3,289.12 ","$3,401.00 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$1,765.74 ","$5,101.50 ","$4,081.20 ","$4,081.20 ","$1,731.12 ","$4,081.20 ","$5,169.52 ","$5,169.52 ","$5,169.52 ","$6,802.00 ", N/A ,"$5,781.70 ","$4,327.80 ","$4,421.30 ","$1,731.12 ","$6,802.00 ","$3,809.12 ","$1,731.12 ","$1,788.93 ", N/A ,$841.01 ,$802.78 ,"$1,817.68 ","$5,441.60 ","$3,895.02 ","$3,067.70 ","$1,904.56 ","$6,121.80 ","$1,731.12 ","$5,169.52 ","$2,690.00 ","$2,690.00 ","$1,731.12 ","$2,690.00 ","$3,264.96 ",$764.55 
ST. ELIZABETH'S HOSPITAL,36100281,32408,HC CORE NDL BX LUNG/MEDIASTINUM PERQ W IMG,361,1 ,"$4,807.00 ","$3,124.55 ",$663.14 ,"$4,807.00 ","$3,467.90 ","$2,125.00 ","$2,691.92 ","$1,387.16 ","$1,345.96 ","$1,624.77 ","$1,387.16 ","$1,869.92 ","$1,387.16 ","$2,167.96 ","$2,167.96 ","$1,387.16 ","$2,167.96 ","$2,635.59 ","$2,403.50 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,605.25 ","$2,884.20 ","$2,884.20 ","$1,387.16 ","$2,884.20 ","$3,653.32 ","$3,653.32 ","$3,653.32 ","$4,807.00 ", N/A ,"$4,085.95 ","$3,467.89 ","$3,124.55 ","$1,387.16 ","$4,807.00 ","$2,691.92 ","$1,387.16 ","$1,264.24 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,845.60 ","$3,121.10 ","$2,167.96 ","$1,345.96 ","$4,326.30 ","$1,387.16 ","$3,653.32 ","$1,890.00 ","$1,890.00 ","$1,387.16 ","$1,890.00 ","$2,307.36 ",$663.14 
ST. ELIZABETH'S HOSPITAL,36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,$238.00 ,$154.70 ,$62.59 ,"$4,413.08 ","$4,413.08 ",$109.48 ,$133.28 ,"$1,765.23 ",$66.64 ,$80.44 ,"$1,765.23 ",$92.58 ,$238.00 ,$107.34 ,$107.34 ,$238.00 ,$107.34 ,$238.00 ,$119.00 ,"$4,413.08 ","$1,765.23 ","$1,765.23 ",$238.00 ,$178.50 ,$142.80 ,$142.80 ,"$1,765.23 ",$142.80 ,$180.88 ,$180.88 ,$180.88 ,$238.00 , N/A ,$202.30 ,$238.00 ,$154.70 ,"$1,765.23 ",$238.00 ,$133.28 ,"$1,765.23 ",$62.59 , N/A , N/A , N/A ,"$1,853.49 ",$190.40 ,"$3,971.77 ",$107.34 ,$66.64 ,$214.20 ,"$1,765.23 ",$180.88 ,$238.00 ,$238.00 ,$238.00 ,$238.00 ,$114.24 , N/A 
ST. ELIZABETH'S HOSPITAL,37000003,N/A,HC GENERAL ANESTHESIA PER 15 MINS,370,1 ,$547.00 ,$355.55 ,$143.86 ,$547.00 , N/A ,$251.62 ,$306.32 , N/A ,$153.16 ,$184.89 , N/A ,$212.78 , N/A ,$246.70 ,$246.70 , N/A ,$246.70 , N/A ,$273.50 , N/A , N/A , N/A , N/A ,$410.25 ,$328.20 ,$328.20 , N/A ,$328.20 ,$415.72 ,$415.72 ,$415.72 ,$547.00 , N/A ,$464.95 , N/A ,$355.55 , N/A ,$547.00 ,$306.32 , N/A ,$143.86 , N/A , N/A , N/A , N/A ,$437.60 , N/A ,$246.70 ,$153.16 ,$492.30 , N/A ,$415.72 ,$355.55 ,$355.55 , N/A ,$355.55 ,$262.56 , N/A 
ST. ELIZABETH'S HOSPITAL,37000006,N/A,HC MONITORED ANESTHESIA PER 15 MINS,370,1 ,$406.00 ,$263.90 ,$106.78 ,$406.00 , N/A ,$186.76 ,$227.36 , N/A ,$113.68 ,$137.23 , N/A ,$157.93 , N/A ,$183.11 ,$183.11 , N/A ,$183.11 , N/A ,$203.00 , N/A , N/A , N/A , N/A ,$304.50 ,$243.60 ,$243.60 , N/A ,$243.60 ,$308.56 ,$308.56 ,$308.56 ,$406.00 , N/A ,$345.10 , N/A ,$263.90 , N/A ,$406.00 ,$227.36 , N/A ,$106.78 , N/A , N/A , N/A , N/A ,$324.80 , N/A ,$183.11 ,$113.68 ,$365.40 , N/A ,$308.56 ,$263.90 ,$263.90 , N/A ,$263.90 ,$194.88 , N/A 
ST. ELIZABETH'S HOSPITAL,37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,$405.00 ,$263.25 ,$106.52 ,$647.47 ,$521.45 ,$405.00 ,$226.80 ,$208.58 ,$113.40 ,$136.89 ,$208.58 ,$157.55 ,$208.58 ,$182.66 ,$182.66 ,$208.58 ,$182.66 ,$396.30 ,$202.50 ,$521.44 ,$208.58 ,$208.58 ,$212.75 ,$303.75 ,$243.00 ,$243.00 ,$208.58 ,$243.00 ,$307.80 ,$307.80 ,$307.80 ,$405.00 , N/A ,$344.25 ,$405.00 ,$263.25 ,$208.58 ,$405.00 ,$226.80 ,$208.58 ,$106.52 , N/A ,$405.00 ,$405.00 ,$219.01 ,$324.00 ,$469.30 ,$182.66 ,$113.40 ,$364.50 ,$208.58 ,$307.80 ,$405.00 ,$405.00 ,$208.58 ,$405.00 ,$194.40 ,$647.47 
ST. ELIZABETH'S HOSPITAL,37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,"$3,211.00 ","$2,087.15 ",$421.56 ,"$3,211.00 ","$2,028.93 ","$1,477.06 ","$1,798.16 ",$811.57 ,$899.08 ,"$1,085.32 ",$811.57 ,"$1,249.08 ",$811.57 ,"$1,448.16 ","$1,448.16 ",$811.57 ,"$1,448.16 ","$1,541.99 ","$1,605.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,408.25 ","$1,926.60 ","$1,926.60 ",$811.57 ,"$1,926.60 ","$2,440.36 ","$2,440.36 ","$2,440.36 ","$3,211.00 ", N/A ,"$2,729.35 ","$2,028.93 ","$2,087.15 ",$811.57 ,"$3,211.00 ","$1,798.16 ",$811.57 ,$844.49 , N/A ,$463.72 ,$442.64 ,$852.15 ,"$2,568.80 ","$1,826.04 ","$1,448.16 ",$899.08 ,"$2,889.90 ",$811.57 ,"$2,440.36 ","$2,087.15 ","$2,087.15 ",$811.57 ,"$2,087.15 ","$1,541.28 ",$421.56 
ST. ELIZABETH'S HOSPITAL,37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$280.00 ,$182.00 ,$22.61 ,$280.00 , N/A ,$128.80 ,$156.80 , N/A ,$78.40 ,$98.44 , N/A ,$98.44 , N/A ,$126.28 ,$126.28 , N/A ,$126.28 , N/A ,$140.00 , N/A , N/A , N/A , N/A ,$210.00 ,$168.00 ,$168.00 , N/A ,$168.00 ,$212.80 ,$212.80 ,$212.80 ,$280.00 , N/A ,$238.00 , N/A ,$182.00 , N/A ,$280.00 ,$156.80 , N/A ,$73.64 , N/A ,$24.87 ,$23.74 , N/A ,$224.00 , N/A ,$126.28 ,$78.40 ,$252.00 , N/A ,$212.80 ,$182.00 ,$182.00 , N/A ,$182.00 ,$134.40 ,$22.61 
ST. ELIZABETH'S HOSPITAL,37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$260.00 ,$169.00 ,$22.61 ,$260.00 , N/A ,$119.60 ,$145.60 , N/A ,$72.80 ,$91.78 , N/A ,$107.12 , N/A ,$117.26 ,$117.26 , N/A ,$117.26 , N/A ,$130.00 , N/A , N/A , N/A , N/A ,$195.00 ,$156.00 ,$156.00 , N/A ,$156.00 ,$197.60 ,$197.60 ,$197.60 ,$260.00 , N/A ,$221.00 , N/A ,$169.00 , N/A ,$200.00 ,$145.60 , N/A ,$68.38 , N/A ,$24.87 ,$23.74 , N/A ,$208.00 , N/A ,$117.26 ,$72.80 ,$234.00 , N/A ,$197.60 ,$169.00 ,$169.00 , N/A ,$169.00 ,$124.80 ,$22.61 
ST. ELIZABETH'S HOSPITAL,37000021,64447,HC FEMORAL NERVE BLOCK SINGLE,370,1 ,"$2,378.00 ","$1,545.70 ",$421.56 ,"$2,378.00 ","$1,565.08 ","$1,093.88 ","$1,331.68 ",$626.03 ,$665.84 ,$803.76 ,$626.03 ,$925.04 ,$626.03 ,"$1,072.48 ","$1,072.48 ",$626.03 ,"$1,072.48 ","$1,189.46 ","$1,189.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,783.50 ","$1,426.80 ","$1,426.80 ",$626.03 ,"$1,426.80 ","$1,807.28 ","$1,807.28 ","$1,807.28 ","$2,378.00 ", N/A ,"$2,021.30 ","$1,565.07 ","$1,545.70 ",$626.03 ,"$2,378.00 ","$1,331.68 ",$626.03 ,$625.41 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$1,902.40 ","$1,408.57 ","$1,072.48 ",$665.84 ,"$2,140.20 ",$626.03 ,"$1,807.28 ","$1,545.70 ","$1,545.70 ",$626.03 ,"$1,545.70 ","$1,141.44 ",$421.56 
ST. ELIZABETH'S HOSPITAL,37000023,64416,HC INTRASCALENE BLOCK CONTINUOUS,370,1 ,"$3,221.00 ","$2,093.65 ",$421.56 ,"$3,221.00 ","$2,028.93 ","$1,481.66 ","$1,803.76 ",$811.57 ,$901.88 ,"$1,088.70 ",$811.57 ,"$1,252.97 ",$811.57 ,"$1,452.67 ","$1,452.67 ",$811.57 ,"$1,452.67 ","$1,541.99 ","$1,610.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,415.75 ","$1,932.60 ","$1,932.60 ",$811.57 ,"$1,932.60 ","$2,447.96 ","$2,447.96 ","$2,447.96 ","$3,221.00 ", N/A ,"$2,737.85 ","$2,028.93 ","$2,093.65 ",$811.57 ,"$3,221.00 ","$1,803.76 ",$811.57 ,$847.12 , N/A ,$463.72 ,$442.64 ,$852.15 ,"$2,576.80 ","$1,826.04 ","$1,452.67 ",$901.88 ,"$2,898.90 ",$811.57 ,"$2,447.96 ","$2,093.65 ","$2,093.65 ",$811.57 ,"$2,093.65 ","$1,546.08 ",$421.56 
ST. ELIZABETH'S HOSPITAL,37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,"$1,055.00 ",$685.75 ,$22.61 ,"$1,055.00 ", N/A ,$485.30 ,$590.80 , N/A ,$295.40 ,$225.68 , N/A ,$225.68 , N/A ,$475.81 ,$475.81 , N/A ,$475.81 , N/A ,$527.50 , N/A , N/A , N/A , N/A ,$791.25 ,$633.00 ,$633.00 , N/A ,$633.00 ,$801.80 ,$801.80 ,$801.80 ,"$1,055.00 ", N/A ,$896.75 , N/A ,$685.75 , N/A ,"$1,055.00 ",$590.80 , N/A ,$277.47 , N/A ,$24.87 ,$23.74 , N/A ,$844.00 , N/A ,$475.81 ,$295.40 ,$949.50 , N/A ,$801.80 ,$685.75 ,$685.75 , N/A ,$685.75 ,$506.40 ,$22.61 
ST. ELIZABETH'S HOSPITAL,37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,"$1,055.00 ",$685.75 ,$22.61 ,"$1,055.00 ", N/A ,$485.30 ,$590.80 , N/A ,$295.40 ,$117.28 , N/A ,$117.28 , N/A ,$475.81 ,$475.81 , N/A ,$475.81 , N/A ,$527.50 , N/A , N/A , N/A , N/A ,$791.25 ,$633.00 ,$633.00 , N/A ,$633.00 ,$801.80 ,$801.80 ,$801.80 ,"$1,055.00 ", N/A ,$896.75 , N/A ,$685.75 , N/A ,"$1,055.00 ",$590.80 , N/A ,$277.47 , N/A ,$24.87 ,$23.74 , N/A ,$844.00 , N/A ,$475.81 ,$295.40 ,$949.50 , N/A ,$801.80 ,$685.75 ,$685.75 , N/A ,$685.75 ,$506.40 ,$22.61 
ST. ELIZABETH'S HOSPITAL,37000074,99155,HC MODERATE SEDATION DIFF PHY <5YR 1ST 15MIN,370,1 ,"$1,151.00 ",$748.15 ,$22.61 ,"$1,151.00 ", N/A ,$529.46 ,$644.56 , N/A ,$322.28 ,$406.30 , N/A ,$474.21 , N/A ,$519.10 ,$519.10 , N/A ,$519.10 , N/A ,$575.50 , N/A , N/A , N/A , N/A ,$863.25 ,$690.60 ,$690.60 , N/A ,$690.60 ,$874.76 ,$874.76 ,$874.76 ,"$1,151.00 ", N/A ,$978.35 , N/A ,$748.15 , N/A ,"$1,151.00 ",$644.56 , N/A ,$302.71 , N/A ,$24.87 ,$23.74 , N/A ,$920.80 , N/A ,$519.10 ,$322.28 ,"$1,035.90 ", N/A ,$874.76 ,$748.15 ,$748.15 , N/A ,$748.15 ,$552.48 ,$22.61 
ST. ELIZABETH'S HOSPITAL,37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,"$1,151.00 ",$748.15 ,$22.61 ,"$1,151.00 ", N/A ,$529.46 ,$644.56 , N/A ,$322.28 ,$406.30 , N/A ,$474.21 , N/A ,$519.10 ,$519.10 , N/A ,$519.10 , N/A ,$575.50 , N/A , N/A , N/A , N/A ,$863.25 ,$690.60 ,$690.60 , N/A ,$690.60 ,$874.76 ,$874.76 ,$874.76 ,"$1,151.00 ", N/A ,$978.35 , N/A ,$748.15 , N/A ,$200.00 ,$644.56 , N/A ,$302.71 , N/A ,$24.87 ,$23.74 , N/A ,$920.80 , N/A ,$519.10 ,$322.28 ,"$1,035.90 ", N/A ,$874.76 ,$748.15 ,$748.15 , N/A ,$748.15 ,$552.48 ,$22.61 
ST. ELIZABETH'S HOSPITAL,37000078,N/A,HC ANESTHESIA REGIONAL PER CASE,370,1 ,"$1,539.00 ","$1,000.35 ",$404.76 ,"$1,539.00 ", N/A ,$707.94 ,$861.84 , N/A ,$430.92 ,$520.18 , N/A ,$598.67 , N/A ,$694.09 ,$694.09 , N/A ,$694.09 , N/A ,$769.50 , N/A , N/A , N/A , N/A ,"$1,154.25 ",$923.40 ,$923.40 , N/A ,$923.40 ,"$1,169.64 ","$1,169.64 ","$1,169.64 ","$1,539.00 ", N/A ,"$1,308.15 ", N/A ,"$1,000.35 ", N/A ,"$1,539.00 ",$861.84 , N/A ,$404.76 , N/A , N/A , N/A , N/A ,"$1,231.20 ", N/A ,$694.09 ,$430.92 ,"$1,385.10 ", N/A ,"$1,169.64 ","$1,000.35 ","$1,000.35 ", N/A ,"$1,000.35 ",$738.72 , N/A 
ST. ELIZABETH'S HOSPITAL,37000080,N/A,HC ANESTHESIA LOCAL,370,1 ,$308.00 ,$200.20 ,$81.00 ,$308.00 , N/A ,$141.68 ,$172.48 , N/A ,$86.24 ,$104.10 , N/A ,$119.81 , N/A ,$138.91 ,$138.91 , N/A ,$138.91 , N/A ,$154.00 , N/A , N/A , N/A , N/A ,$231.00 ,$184.80 ,$184.80 , N/A ,$184.80 ,$234.08 ,$234.08 ,$234.08 ,$308.00 , N/A ,$261.80 , N/A ,$200.20 , N/A ,$308.00 ,$172.48 , N/A ,$81.00 , N/A , N/A , N/A , N/A ,$246.40 , N/A ,$138.91 ,$86.24 ,$277.20 , N/A ,$234.08 ,$200.20 ,$200.20 , N/A ,$200.20 ,$147.84 , N/A 
ST. ELIZABETH'S HOSPITAL,37001000,1967,HC EPIDURAL/SPINAL FOR LABOR,370,1 ,$827.00 ,$537.55 ,$217.50 ,$827.00 , N/A ,$380.42 ,$463.12 , N/A ,$231.56 ,$279.53 , N/A ,$321.70 , N/A ,$372.98 ,$372.98 , N/A ,$372.98 , N/A ,$413.50 , N/A , N/A , N/A , N/A ,$620.25 ,$496.20 ,$496.20 , N/A ,$496.20 ,$628.52 ,$628.52 ,$628.52 ,$827.00 , N/A ,$702.95 , N/A ,$537.55 , N/A ,$827.00 ,$463.12 , N/A ,$217.50 , N/A , N/A , N/A , N/A ,$661.60 , N/A ,$372.98 ,$231.56 ,$744.30 , N/A ,$628.52 ,$537.55 ,$537.55 , N/A ,$537.55 ,$396.96 , N/A 
ST. ELIZABETH'S HOSPITAL,37080000,64447,HC FEMORAL NERVE BLOCK SINGLE,360,1 ,"$2,378.00 ","$1,545.70 ",$421.56 ,"$2,378.00 ","$1,565.08 ","$2,378.00 ","$1,331.68 ",$626.03 ,$665.84 ,$803.76 ,$626.03 ,$925.04 ,$626.03 ,"$1,072.48 ","$1,072.48 ",$626.03 ,"$1,072.48 ","$1,189.46 ","$1,189.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,783.50 ","$1,426.80 ","$1,426.80 ",$626.03 ,"$1,426.80 ","$1,807.28 ","$1,807.28 ","$1,807.28 ","$2,378.00 ", N/A ,"$2,021.30 ","$1,565.07 ","$1,545.70 ",$626.03 ,"$2,378.00 ","$1,331.68 ",$626.03 ,$625.41 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$1,902.40 ","$1,408.57 ","$1,072.48 ",$665.84 ,"$2,140.20 ",$626.03 ,"$1,807.28 ","$1,500.00 ","$1,500.00 ",$626.03 ,"$1,500.00 ","$1,141.44 ",$421.56 
ST. ELIZABETH'S HOSPITAL,37080001,64415,HC INTRASCALENE BLOCK SINGLE,360,1 ,"$3,019.00 ","$1,962.35 ",$421.56 ,"$3,019.00 ","$2,028.93 ","$2,125.00 ","$1,690.64 ",$811.57 ,$845.32 ,"$1,020.42 ",$811.57 ,"$1,174.39 ",$811.57 ,"$1,361.57 ","$1,361.57 ",$811.57 ,"$1,361.57 ","$1,541.99 ","$1,509.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,264.25 ","$1,811.40 ","$1,811.40 ",$811.57 ,"$1,811.40 ","$2,294.44 ","$2,294.44 ","$2,294.44 ","$3,019.00 ", N/A ,"$2,566.15 ","$2,028.93 ","$1,962.35 ",$811.57 ,"$3,019.00 ","$1,690.64 ",$811.57 ,$794.00 , N/A ,$463.72 ,$442.64 ,$852.15 ,"$2,415.20 ","$1,826.04 ","$1,361.57 ",$845.32 ,"$2,717.10 ",$811.57 ,"$2,294.44 ","$1,500.00 ","$1,500.00 ",$811.57 ,"$1,500.00 ","$1,449.12 ",$421.56 
ST. ELIZABETH'S HOSPITAL,37200001,1967,HC ANES ELECTROCONVULSIVE THERAPY,372,1 ,$407.00 ,$264.55 ,$107.04 ,$407.00 , N/A ,$187.22 ,$227.92 , N/A ,$113.96 ,$137.57 , N/A ,$158.32 , N/A ,$183.56 ,$183.56 , N/A ,$183.56 , N/A ,$203.50 , N/A , N/A , N/A , N/A ,$305.25 ,$244.20 ,$244.20 , N/A ,$244.20 ,$309.32 ,$309.32 ,$309.32 ,$407.00 , N/A ,$345.95 , N/A ,$264.55 , N/A ,$407.00 ,$227.92 , N/A ,$107.04 , N/A , N/A , N/A , N/A ,$325.60 , N/A ,$183.56 ,$113.96 ,$366.30 , N/A ,$309.32 ,$264.55 ,$264.55 , N/A ,$264.55 ,$195.36 , N/A 
ST. ELIZABETH'S HOSPITAL,39000148,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$201.00 ,$130.65 ,$52.86 ,$636.31 ,$211.00 ,$92.46 ,$112.56 ,$84.40 ,$56.28 ,$67.94 ,$84.40 ,$78.19 ,$84.40 ,$90.65 ,$90.65 ,$84.40 ,$90.65 ,$160.36 ,$100.50 ,$211.00 ,$84.40 ,$84.40 ,$86.09 ,$150.75 ,$120.60 ,$120.60 ,$84.40 ,$120.60 ,$152.76 ,$152.76 ,$152.76 ,$201.00 , N/A ,$170.85 ,$201.00 ,$130.65 ,$84.40 ,$201.00 ,$112.56 ,$84.40 ,$52.86 , N/A ,$201.00 ,$201.00 ,$88.62 ,$160.80 ,$189.90 ,$90.65 ,$56.28 ,$180.90 ,$84.40 ,$152.76 ,$170.00 ,$170.00 ,$84.40 ,$170.00 ,$96.48 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000151,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,$449.76 ,$292.34 ,$118.29 ,$636.31 ,$382.68 ,$206.89 ,$251.87 ,$153.07 ,$125.93 ,$152.02 ,$153.07 ,$174.96 ,$153.07 ,$202.84 ,$202.84 ,$153.07 ,$202.84 ,$290.83 ,$224.88 ,$382.68 ,$153.07 ,$153.07 ,$156.13 ,$337.32 ,$269.86 ,$269.86 ,$153.07 ,$269.86 ,$341.82 ,$341.82 ,$341.82 ,$449.76 , N/A ,$382.30 ,$382.68 ,$292.34 ,$153.07 ,$449.76 ,$251.87 ,$153.07 ,$118.29 , N/A ,$449.76 ,$449.76 ,$160.72 ,$359.81 ,$344.41 ,$202.84 ,$125.93 ,$404.78 ,$153.07 ,$341.82 ,$170.00 ,$170.00 ,$153.07 ,$170.00 ,$215.88 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000152,P9033,HC PLATELETS L/R IRR EA,390,1 ,"$1,302.00 ",$846.30 ,$170.00 ,"$1,302.00 ",$544.15 ,$598.92 ,$729.12 ,$217.66 ,$364.56 ,$440.08 ,$217.66 ,$506.48 ,$217.66 ,$587.20 ,$587.20 ,$217.66 ,$587.20 ,$413.55 ,$651.00 ,$544.15 ,$217.66 ,$217.66 ,$222.01 ,$976.50 ,$781.20 ,$781.20 ,$217.66 ,$781.20 ,$989.52 ,$989.52 ,$989.52 ,"$1,302.00 ", N/A ,"$1,106.70 ",$544.15 ,$846.30 ,$217.66 ,"$1,302.00 ",$729.12 ,$217.66 ,$342.43 , N/A ,$699.94 ,$668.13 ,$228.54 ,"$1,041.60 ",$489.74 ,$587.20 ,$364.56 ,"$1,171.80 ",$217.66 ,$989.52 ,$170.00 ,$170.00 ,$217.66 ,$170.00 ,$624.96 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000160,P9059,HC PLASMA FROZEN 8-24 HRS EA UNIT,390,1 ,$182.00 ,$118.30 ,$47.87 ,$636.31 ,$181.60 ,$83.72 ,$101.92 ,$72.64 ,$50.96 ,$61.52 ,$72.64 ,$70.80 ,$72.64 ,$82.08 ,$82.08 ,$72.64 ,$82.08 ,$138.02 ,$91.00 ,$181.60 ,$72.64 ,$72.64 ,$74.09 ,$136.50 ,$109.20 ,$109.20 ,$72.64 ,$109.20 ,$138.32 ,$138.32 ,$138.32 ,$182.00 , N/A ,$154.70 ,$181.60 ,$118.30 ,$72.64 ,$182.00 ,$101.92 ,$72.64 ,$47.87 , N/A ,$182.00 ,$182.00 ,$76.27 ,$145.60 ,$163.44 ,$82.08 ,$50.96 ,$163.80 ,$72.64 ,$138.32 ,$170.00 ,$170.00 ,$72.64 ,$170.00 ,$87.36 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000161,P9011,HC BLOOD SPLIT UNIT SPECIFY AMT,390,1 ,$415.00 ,$269.75 ,$109.15 ,$636.31 ,$376.73 ,$190.90 ,$232.40 ,$150.69 ,$116.20 ,$140.27 ,$150.69 ,$161.44 ,$150.69 ,$187.17 ,$187.17 ,$150.69 ,$187.17 ,$286.31 ,$207.50 ,$376.73 ,$150.69 ,$150.69 ,$153.70 ,$311.25 ,$249.00 ,$249.00 ,$150.69 ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 ,$376.73 ,$269.75 ,$150.69 ,$415.00 ,$232.40 ,$150.69 ,$109.15 , N/A ,$415.00 ,$415.00 ,$158.22 ,$332.00 ,$339.05 ,$187.17 ,$116.20 ,$373.50 ,$150.69 ,$315.40 ,$170.00 ,$170.00 ,$150.69 ,$170.00 ,$199.20 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000162,P9012,HC CRYOPRECIPITATE EA UNIT T1,390,1 ,$112.00 ,$72.80 ,$29.46 ,$636.31 ,$203.83 ,$51.52 ,$62.72 ,$81.53 ,$31.36 ,$37.86 ,$81.53 ,$43.57 ,$81.53 ,$50.51 ,$50.51 ,$81.53 ,$50.51 ,$112.00 ,$56.00 ,$203.83 ,$81.53 ,$81.53 ,$83.16 ,$84.00 ,$67.20 ,$67.20 ,$81.53 ,$67.20 ,$85.12 ,$85.12 ,$85.12 ,$112.00 , N/A ,$95.20 ,$112.00 ,$72.80 ,$81.53 ,$112.00 ,$62.72 ,$81.53 ,$29.46 , N/A ,$112.00 ,$112.00 ,$85.61 ,$89.60 ,$183.44 ,$50.51 ,$31.36 ,$100.80 ,$81.53 ,$85.12 ,$112.00 ,$112.00 ,$81.53 ,$112.00 ,$53.76 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000164,P9016,HC RED CELLS L/R EA T1,390,1 ,$636.00 ,$413.40 ,$167.27 ,$636.31 ,$480.98 ,$292.56 ,$356.16 ,$192.39 ,$178.08 ,$214.97 ,$192.39 ,$247.40 ,$192.39 ,$286.84 ,$286.84 ,$192.39 ,$286.84 ,$365.54 ,$318.00 ,$480.98 ,$192.39 ,$192.39 ,$196.24 ,$477.00 ,$381.60 ,$381.60 ,$192.39 ,$381.60 ,$483.36 ,$483.36 ,$483.36 ,$636.00 , N/A ,$540.60 ,$480.98 ,$413.40 ,$192.39 ,$636.00 ,$356.16 ,$192.39 ,$167.27 , N/A ,$636.00 ,$636.00 ,$202.01 ,$508.80 ,$432.88 ,$286.84 ,$178.08 ,$572.40 ,$192.39 ,$483.36 ,$170.00 ,$170.00 ,$192.39 ,$170.00 ,$305.28 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000173,P9035,HC PLATELETS PHER L/R EA T1,390,1 ,"$1,904.00 ","$1,237.60 ",$170.00 ,"$1,904.00 ","$1,242.28 ",$875.84 ,"$1,066.24 ",$496.91 ,$533.12 ,$643.55 ,$496.91 ,$740.66 ,$496.91 ,$858.70 ,$858.70 ,$496.91 ,$858.70 ,$944.13 ,$952.00 ,"$1,242.28 ",$496.91 ,$496.91 ,$506.85 ,"$1,428.00 ","$1,142.40 ","$1,142.40 ",$496.91 ,"$1,142.40 ","$1,447.04 ","$1,447.04 ","$1,447.04 ","$1,904.00 ", N/A ,"$1,618.40 ","$1,242.28 ","$1,237.60 ",$496.91 ,"$1,904.00 ","$1,066.24 ",$496.91 ,$500.75 , N/A ,$699.94 ,$668.13 ,$521.76 ,"$1,523.20 ","$1,118.05 ",$858.70 ,$533.12 ,"$1,713.60 ",$496.91 ,"$1,447.04 ",$170.00 ,$170.00 ,$496.91 ,$170.00 ,$913.92 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000180,P9037,HC PLATELETS PHER L/R IRR EA T2,390,1 ,"$2,194.00 ","$1,426.10 ",$170.00 ,"$2,194.00 ","$1,575.80 ","$1,009.24 ","$1,228.64 ",$630.32 ,$614.32 ,$741.57 ,$630.32 ,$853.47 ,$630.32 ,$989.49 ,$989.49 ,$630.32 ,$989.49 ,"$1,197.61 ","$1,097.00 ","$1,575.80 ",$630.32 ,$630.32 ,$642.93 ,"$1,645.50 ","$1,316.40 ","$1,316.40 ",$630.32 ,"$1,316.40 ","$1,667.44 ","$1,667.44 ","$1,667.44 ","$2,194.00 ", N/A ,"$1,864.90 ","$1,575.80 ","$1,426.10 ",$630.32 ,"$2,194.00 ","$1,228.64 ",$630.32 ,$577.02 , N/A ,$699.94 ,$668.13 ,$661.84 ,"$1,755.20 ","$1,418.22 ",$989.49 ,$614.32 ,"$1,974.60 ",$630.32 ,"$1,667.44 ",$170.00 ,$170.00 ,$630.32 ,$170.00 ,"$1,053.12 ",$636.31 
ST. ELIZABETH'S HOSPITAL,39000187,P9040,HC RED CELLS L/R IRR EA T1,390,1 ,$409.00 ,$265.85 ,$107.57 ,$665.08 ,$665.08 ,$188.14 ,$229.04 ,$266.03 ,$114.52 ,$138.24 ,$266.03 ,$159.10 ,$266.03 ,$184.46 ,$184.46 ,$266.03 ,$184.46 ,$409.00 ,$204.50 ,$665.08 ,$266.03 ,$266.03 ,$271.35 ,$306.75 ,$245.40 ,$245.40 ,$266.03 ,$245.40 ,$310.84 ,$310.84 ,$310.84 ,$409.00 , N/A ,$347.65 ,$409.00 ,$265.85 ,$266.03 ,$409.00 ,$229.04 ,$266.03 ,$107.57 , N/A ,$409.00 ,$409.00 ,$279.33 ,$327.20 ,$598.57 ,$184.46 ,$114.52 ,$368.10 ,$266.03 ,$310.84 ,$170.00 ,$170.00 ,$266.03 ,$170.00 ,$196.32 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000198,P9058,HC RBC LEUKORED CMV NEG IRRAD,390,1 ,$443.00 ,$287.95 ,$116.51 ,$636.31 ,$622.48 ,$203.78 ,$248.08 ,$248.99 ,$124.04 ,$149.73 ,$248.99 ,$172.33 ,$248.99 ,$199.79 ,$199.79 ,$248.99 ,$199.79 ,$443.00 ,$221.50 ,$622.48 ,$248.99 ,$248.99 ,$253.97 ,$332.25 ,$265.80 ,$265.80 ,$248.99 ,$265.80 ,$336.68 ,$336.68 ,$336.68 ,$443.00 , N/A ,$376.55 ,$443.00 ,$287.95 ,$248.99 ,$443.00 ,$248.08 ,$248.99 ,$116.51 , N/A ,$443.00 ,$443.00 ,$261.44 ,$354.40 ,$560.23 ,$199.79 ,$124.04 ,$398.70 ,$248.99 ,$336.68 ,$170.00 ,$170.00 ,$248.99 ,$170.00 ,$212.64 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39000205,P9073,HC PLATELETS PHERESIS PATH REDUCED EA UN T1,390,1 ,"$1,138.00 ",$739.70 ,$170.00 ,"$1,490.33 ","$1,490.33 ",$523.48 ,$637.28 ,$596.13 ,$318.64 ,$384.64 ,$596.13 ,$442.68 ,$596.13 ,$513.24 ,$513.24 ,$596.13 ,$513.24 ,"$1,132.65 ",$569.00 ,"$1,490.33 ",$596.13 ,$596.13 ,$608.05 ,$853.50 ,$682.80 ,$682.80 ,$596.13 ,$682.80 ,$864.88 ,$864.88 ,$864.88 ,"$1,138.00 ", N/A ,$967.30 ,"$1,138.00 ",$739.70 ,$596.13 ,"$1,138.00 ",$637.28 ,$596.13 ,$299.29 , N/A ,$699.94 ,$668.13 ,$625.94 ,$910.40 ,"$1,341.29 ",$513.24 ,$318.64 ,"$1,024.20 ",$596.13 ,$864.88 ,$170.00 ,$170.00 ,$596.13 ,$170.00 ,$546.24 ,$636.31 
ST. ELIZABETH'S HOSPITAL,39100001,36430,HC BLOOD PROD ADMIN,391,1 ,"$1,559.00 ","$1,013.35 ",$170.00 ,"$1,559.00 ",$978.28 ,$717.14 ,$873.04 ,$391.31 ,$436.52 ,$526.94 ,$391.31 ,$606.45 ,$391.31 ,$703.11 ,$703.11 ,$391.31 ,$703.11 ,$743.49 ,$779.50 ,$978.28 ,$391.31 ,$391.31 ,$399.14 ,"$1,169.25 ",$935.40 ,$935.40 ,$391.31 ,$935.40 ,"$1,184.84 ","$1,184.84 ","$1,184.84 ","$1,559.00 ", N/A ,"$1,325.15 ",$978.28 ,"$1,013.35 ",$391.31 ,"$1,559.00 ",$873.04 ,$391.31 ,$410.02 , N/A ,$699.94 ,$668.13 ,$410.88 ,"$1,247.20 ",$880.45 ,$703.11 ,$436.52 ,"$1,403.10 ",$391.31 ,"$1,184.84 ",$170.00 ,$170.00 ,$391.31 ,$170.00 ,$748.32 ,$636.31 
ST. ELIZABETH'S HOSPITAL,40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$720.00 ,$468.00 ,$66.22 ,$720.00 ,$272.83 ,$232.92 ,$403.20 ,$109.13 ,$201.60 ,$254.16 ,$109.13 ,$296.64 ,$109.13 ,$324.72 ,$324.72 ,$109.13 ,$136.41 ,$207.35 ,$318.70 ,$272.83 ,$109.13 ,$109.13 ,$111.31 ,$540.00 ,$432.00 ,$432.00 ,$109.13 ,$432.00 ,$166.08 ,$166.08 ,$166.08 ,$720.00 , N/A ,$612.00 ,$272.83 ,$468.00 ,$109.13 ,$122.32 ,$403.20 ,$109.13 ,$189.36 , N/A ,$72.84 ,$69.53 ,$114.59 ,$576.00 ,$245.54 ,$324.72 ,$201.60 ,$648.00 ,$109.13 ,$166.08 ,$360.00 ,$360.00 ,$109.13 ,$360.00 ,$345.60 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$720.00 ,$468.00 ,$66.22 ,$720.00 ,$272.83 ,$232.92 ,$403.20 ,$109.13 ,$201.60 ,$254.16 ,$109.13 ,$296.64 ,$109.13 ,$324.72 ,$324.72 ,$109.13 ,$136.41 ,$207.35 ,$318.70 ,$272.83 ,$109.13 ,$109.13 ,$111.31 ,$540.00 ,$432.00 ,$432.00 ,$109.13 ,$432.00 ,$166.08 ,$166.08 ,$166.08 ,$720.00 , N/A ,$612.00 ,$272.83 ,$468.00 ,$109.13 ,$122.32 ,$403.20 ,$109.13 ,$189.36 , N/A ,$72.84 ,$69.53 ,$114.59 ,$576.00 ,$245.54 ,$324.72 ,$201.60 ,$648.00 ,$109.13 ,$166.08 ,$360.00 ,$360.00 ,$109.13 ,$360.00 ,$345.60 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$720.00 ,$468.00 ,$66.22 ,$720.00 ,$272.83 ,$232.92 ,$403.20 ,$109.13 ,$201.60 ,$254.16 ,$109.13 ,$296.64 ,$109.13 ,$324.72 ,$324.72 ,$109.13 ,$136.41 ,$207.35 ,$318.70 ,$272.83 ,$109.13 ,$109.13 ,$111.31 ,$540.00 ,$432.00 ,$432.00 ,$109.13 ,$432.00 ,$166.08 ,$166.08 ,$166.08 ,$720.00 , N/A ,$612.00 ,$272.83 ,$468.00 ,$109.13 ,$122.32 ,$403.20 ,$109.13 ,$189.36 , N/A ,$72.84 ,$69.53 ,$114.59 ,$576.00 ,$245.54 ,$324.72 ,$201.60 ,$648.00 ,$109.13 ,$166.08 ,$360.00 ,$360.00 ,$109.13 ,$360.00 ,$345.60 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100006,77066,HC MAMMOGRAM DIAG W/CAD UPGRADE BIL,401,1 ,$720.00 ,$468.00 ,$66.22 ,$720.00 ,$272.83 ,$232.92 ,$403.20 ,$109.13 ,$201.60 ,$254.16 ,$109.13 ,$296.64 ,$109.13 ,$324.72 ,$324.72 ,$109.13 ,$136.41 ,$207.35 ,$318.70 ,$272.83 ,$109.13 ,$109.13 ,$111.31 ,$540.00 ,$432.00 ,$432.00 ,$109.13 ,$432.00 ,$166.08 ,$166.08 ,$166.08 ,$720.00 , N/A ,$612.00 ,$272.83 ,$468.00 ,$109.13 ,$122.32 ,$403.20 ,$109.13 ,$189.36 , N/A ,$72.84 ,$69.53 ,$114.59 ,$576.00 ,$245.54 ,$324.72 ,$201.60 ,$648.00 ,$109.13 ,$166.08 ,$360.00 ,$360.00 ,$109.13 ,$360.00 ,$345.60 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$582.00 ,$378.30 ,$66.22 ,$582.00 ,$214.15 ,$182.08 ,$325.92 ,$85.66 ,$162.96 ,$205.45 ,$85.66 ,$239.78 ,$85.66 ,$262.48 ,$262.48 ,$85.66 ,$107.08 ,$162.75 ,$249.06 ,$214.15 ,$85.66 ,$85.66 ,$87.37 ,$436.50 ,$349.20 ,$349.20 ,$85.66 ,$349.20 ,$129.83 ,$129.83 ,$129.83 ,$582.00 , N/A ,$494.70 ,$214.15 ,$378.30 ,$85.66 ,$95.73 ,$325.92 ,$85.66 ,$153.07 , N/A ,$72.84 ,$69.53 ,$89.94 ,$465.60 ,$192.74 ,$262.48 ,$162.96 ,$523.80 ,$85.66 ,$129.83 ,$360.00 ,$360.00 ,$85.66 ,$360.00 ,$279.36 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$582.00 ,$378.30 ,$66.22 ,$582.00 ,$214.15 ,$182.08 ,$325.92 ,$85.66 ,$162.96 ,$205.45 ,$85.66 ,$239.78 ,$85.66 ,$262.48 ,$262.48 ,$85.66 ,$107.08 ,$162.75 ,$249.06 ,$214.15 ,$85.66 ,$85.66 ,$87.37 ,$436.50 ,$349.20 ,$349.20 ,$85.66 ,$349.20 ,$129.83 ,$129.83 ,$129.83 ,$582.00 , N/A ,$494.70 ,$214.15 ,$378.30 ,$85.66 ,$95.73 ,$325.92 ,$85.66 ,$153.07 , N/A ,$72.84 ,$69.53 ,$89.94 ,$465.60 ,$192.74 ,$262.48 ,$162.96 ,$523.80 ,$85.66 ,$129.83 ,$360.00 ,$360.00 ,$85.66 ,$360.00 ,$279.36 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$582.00 ,$378.30 ,$66.22 ,$582.00 ,$214.15 ,$182.08 ,$325.92 ,$85.66 ,$162.96 ,$205.45 ,$85.66 ,$239.78 ,$85.66 ,$262.48 ,$262.48 ,$85.66 ,$107.08 ,$162.75 ,$249.06 ,$214.15 ,$85.66 ,$85.66 ,$87.37 ,$436.50 ,$349.20 ,$349.20 ,$85.66 ,$349.20 ,$129.83 ,$129.83 ,$129.83 ,$582.00 , N/A ,$494.70 ,$214.15 ,$378.30 ,$85.66 ,$95.73 ,$325.92 ,$85.66 ,$153.07 , N/A ,$72.84 ,$69.53 ,$89.94 ,$465.60 ,$192.74 ,$262.48 ,$162.96 ,$523.80 ,$85.66 ,$129.83 ,$360.00 ,$360.00 ,$85.66 ,$360.00 ,$279.36 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100010,77065,HC MAMMOGRAM DIAG UNIL W/CAD UPGRADE,401,1 ,$582.00 ,$378.30 ,$66.22 ,$582.00 ,$214.15 ,$182.08 ,$325.92 ,$85.66 ,$162.96 ,$205.45 ,$85.66 ,$239.78 ,$85.66 ,$262.48 ,$262.48 ,$85.66 ,$107.08 ,$162.75 ,$249.06 ,$214.15 ,$85.66 ,$85.66 ,$87.37 ,$436.50 ,$349.20 ,$349.20 ,$85.66 ,$349.20 ,$129.83 ,$129.83 ,$129.83 ,$582.00 , N/A ,$494.70 ,$214.15 ,$378.30 ,$85.66 ,$95.73 ,$325.92 ,$85.66 ,$153.07 , N/A ,$72.84 ,$69.53 ,$89.94 ,$465.60 ,$192.74 ,$262.48 ,$162.96 ,$523.80 ,$85.66 ,$129.83 ,$360.00 ,$360.00 ,$85.66 ,$360.00 ,$279.36 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$64.00 ,$41.60 ,$16.83 ,$66.22 ,$57.05 ,$29.44 ,$35.84 ,$22.82 ,$17.92 ,$22.59 ,$22.82 ,$26.37 ,$22.82 ,$28.86 ,$28.86 ,$22.82 ,$28.53 ,$43.36 ,$64.00 ,$57.05 ,$22.82 ,$22.82 ,$23.28 ,$48.00 ,$38.40 ,$38.40 ,$22.82 ,$38.40 ,$34.77 ,$34.77 ,$34.77 ,$64.00 , N/A ,$54.40 ,$57.05 ,$41.60 ,$22.82 ,$26.59 ,$35.84 ,$22.82 ,$16.83 , N/A ,$64.00 ,$64.00 ,$23.96 ,$51.20 ,$51.35 ,$28.86 ,$17.92 ,$57.60 ,$22.82 ,$34.77 ,$64.00 ,$64.00 ,$22.82 ,$64.00 ,$30.72 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40200007,51798,HC US BLADDER SCAN,402,1 ,$452.00 ,$293.80 ,$12.94 ,$452.00 ,$137.20 ,$207.92 ,$253.12 ,$54.88 ,$126.56 ,$152.78 ,$54.88 ,$175.83 ,$54.88 ,$203.85 ,$203.85 ,$54.88 ,$12.94 ,$104.27 ,$226.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$339.00 ,$271.20 ,$271.20 ,$54.88 ,$271.20 ,$316.40 ,$316.40 ,$316.40 ,$452.00 , N/A ,$384.20 ,$137.20 ,$293.80 ,$54.88 ,$452.00 ,$253.12 ,$54.88 ,$118.88 , N/A ,$125.92 ,$120.19 ,$57.62 ,$361.60 ,$123.48 ,$203.85 ,$126.56 ,$406.80 ,$54.88 ,$316.40 ,$452.00 ,$452.00 ,$54.88 ,$452.00 ,$216.96 ,$114.47 
ST. ELIZABETH'S HOSPITAL,40200009,49407,HC DRAIN ABSC PELVIC TRNSVAG PERC,402,1 ,"$3,830.00 ","$2,489.50 ",$267.50 ,"$3,830.00 ","$3,467.90 ","$1,761.80 ","$2,144.80 ","$1,387.16 ","$1,072.40 ","$1,294.54 ","$1,387.16 ","$1,489.87 ","$1,387.16 ","$1,727.33 ","$1,727.33 ","$1,387.16 ",$267.50 ,"$2,635.59 ","$1,915.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,872.50 ","$2,298.00 ","$2,298.00 ","$1,387.16 ","$2,298.00 ","$2,681.00 ","$2,681.00 ","$2,681.00 ","$3,830.00 ", N/A ,"$3,255.50 ","$3,467.89 ","$2,489.50 ","$1,387.16 ","$3,830.00 ","$2,144.80 ","$1,387.16 ","$1,007.29 ", N/A ,$729.45 ,$696.30 ,"$1,456.52 ","$3,064.00 ","$3,121.10 ","$1,727.33 ","$1,072.40 ","$3,447.00 ","$1,387.16 ","$2,681.00 ",$610.00 ,$610.00 ,"$1,387.16 ",$610.00 ,"$1,838.40 ",$663.14 
ST. ELIZABETH'S HOSPITAL,40200010,59000,HC AMNIOCENTESIS DIAGNOSTIC,402,1 ,"$2,034.00 ","$1,322.10 ",$110.94 ,"$2,034.00 ","$1,562.55 ",$935.64 ,"$1,139.04 ",$625.02 ,$569.52 ,$687.49 ,$625.02 ,$791.23 ,$625.02 ,$917.33 ,$917.33 ,$625.02 ,$110.94 ,"$1,187.53 ","$1,017.00 ","$1,562.54 ",$625.02 ,$625.02 ,$637.52 ,"$1,525.50 ","$1,220.40 ","$1,220.40 ",$625.02 ,"$1,220.40 ","$1,423.80 ","$1,423.80 ","$1,423.80 ","$2,034.00 ", N/A ,"$1,728.90 ","$1,562.54 ","$1,322.10 ",$625.02 ,"$2,034.00 ","$1,139.04 ",$625.02 ,$534.94 , N/A , N/A , N/A ,$656.27 ,"$1,627.20 ","$1,406.29 ",$917.33 ,$569.52 ,"$1,830.60 ",$625.02 ,"$1,423.80 ",$610.00 ,$610.00 ,$625.02 ,$610.00 ,$976.32 , N/A 
ST. ELIZABETH'S HOSPITAL,40200011,60300,HC ASP/INJ CYST THYROID,402,1 ,"$2,546.00 ","$1,654.90 ",$63.81 ,"$2,546.00 ","$1,533.75 ","$1,171.16 ","$1,425.76 ",$613.50 ,$712.88 ,$860.55 ,$613.50 ,$990.39 ,$613.50 ,"$1,148.25 ","$1,148.25 ",$613.50 ,$63.81 ,"$1,165.65 ","$1,273.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,909.50 ","$1,527.60 ","$1,527.60 ",$613.50 ,"$1,527.60 ","$1,782.20 ","$1,782.20 ","$1,782.20 ","$2,546.00 ", N/A ,"$2,164.10 ","$1,533.75 ","$1,654.90 ",$613.50 ,"$2,546.00 ","$1,425.76 ",$613.50 ,$669.60 , N/A ,$641.39 ,$612.23 ,$644.18 ,"$2,036.80 ","$1,380.37 ","$1,148.25 ",$712.88 ,"$2,291.40 ",$613.50 ,"$1,782.20 ",$610.00 ,$610.00 ,$613.50 ,$610.00 ,"$1,222.08 ",$583.08 
ST. ELIZABETH'S HOSPITAL,40200012,76506,HC US ENCEPHALOGRAM,402,1 ,"$1,075.00 ",$698.75 ,$104.63 ,"$1,075.00 ",$268.33 ,$112.42 ,$602.00 ,$107.33 ,$301.00 ,$379.48 ,$107.33 ,$442.90 ,$107.33 ,$484.83 ,$484.83 ,$107.33 ,$104.63 ,$203.93 ,$224.26 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$806.25 ,$645.00 ,$645.00 ,$107.33 ,$645.00 ,$116.91 ,$116.91 ,$116.91 ,"$1,075.00 ", N/A ,$913.75 ,$268.33 ,$698.75 ,$107.33 ,"$1,075.00 ",$602.00 ,$107.33 ,$282.73 , N/A ,$160.38 ,$153.09 ,$112.70 ,$860.00 ,$241.50 ,$484.83 ,$301.00 ,$967.50 ,$107.33 ,$116.91 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$516.00 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,"$1,205.00 ",$783.25 ,$104.63 ,"$1,205.00 ",$268.33 ,$163.50 ,$674.80 ,$107.33 ,$337.40 ,$425.37 ,$107.33 ,$496.46 ,$107.33 ,$543.46 ,$543.46 ,$107.33 ,$104.63 ,$203.93 ,$233.80 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$903.75 ,$723.00 ,$723.00 ,$107.33 ,$723.00 ,$121.88 ,$121.88 ,$121.88 ,"$1,205.00 ", N/A ,"$1,024.25 ",$268.33 ,$783.25 ,$107.33 ,"$1,205.00 ",$674.80 ,$107.33 ,$316.92 , N/A ,$160.38 ,$153.09 ,$112.70 ,$964.00 ,$241.50 ,$543.46 ,$337.40 ,"$1,084.50 ",$107.33 ,$121.88 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$578.40 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200014,76604,HC US CHEST,402,1 ,"$1,044.00 ",$678.60 ,$37.80 ,"$1,044.00 ",$268.33 ,$110.00 ,$584.64 ,$107.33 ,$292.32 ,$368.53 ,$107.33 ,$430.13 ,$107.33 ,$470.84 ,$470.84 ,$107.33 ,$37.80 ,$203.93 ,$166.07 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$783.00 ,$626.40 ,$626.40 ,$107.33 ,$626.40 ,$86.60 ,$86.60 ,$86.60 ,"$1,044.00 ", N/A ,$887.40 ,$268.33 ,$678.60 ,$107.33 ,"$1,044.00 ",$584.64 ,$107.33 ,$274.57 , N/A ,$160.38 ,$153.09 ,$112.70 ,$835.20 ,$241.50 ,$470.84 ,$292.32 ,$939.60 ,$107.33 ,$86.60 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$501.12 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200015,76641,HC US BREAST COMPLETE,402,1 ,$958.00 ,$622.70 ,$76.42 ,$958.00 ,$268.33 ,$125.48 ,$536.48 ,$107.33 ,$268.24 ,$338.17 ,$107.33 ,$394.70 ,$107.33 ,$432.06 ,$432.06 ,$107.33 ,$84.66 ,$203.93 ,$188.97 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$718.50 ,$574.80 ,$574.80 ,$107.33 ,$574.80 ,$98.52 ,$98.52 ,$98.52 ,$958.00 , N/A ,$814.30 ,$268.33 ,$622.70 ,$107.33 ,$76.42 ,$536.48 ,$107.33 ,$251.95 , N/A ,$160.38 ,$153.09 ,$112.70 ,$766.40 ,$241.50 ,$432.06 ,$268.24 ,$862.20 ,$107.33 ,$98.52 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$459.84 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200016,76642,HC US BREAST LIMITED,402,1 ,$479.00 ,$311.35 ,$58.57 ,$479.00 ,$199.38 ,$96.28 ,$268.24 ,$79.75 ,$134.12 ,$169.09 ,$79.75 ,$197.35 ,$79.75 ,$216.03 ,$216.03 ,$79.75 ,$64.70 ,$151.52 ,$143.18 ,$199.36 ,$79.75 ,$79.75 ,$81.34 ,$359.25 ,$287.40 ,$287.40 ,$79.75 ,$287.40 ,$74.67 ,$74.67 ,$74.67 ,$479.00 , N/A ,$407.15 ,$199.36 ,$311.35 ,$79.75 ,$58.57 ,$268.24 ,$79.75 ,$125.98 , N/A ,$160.38 ,$153.09 ,$83.74 ,$383.20 ,$179.43 ,$216.03 ,$134.12 ,$431.10 ,$79.75 ,$74.67 ,$479.00 ,$479.00 ,$79.75 ,$479.00 ,$229.92 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,038.00 ",$674.70 ,$97.70 ,"$1,038.00 ",$268.33 ,$172.62 ,$581.28 ,$107.33 ,$290.64 ,$366.41 ,$107.33 ,$427.66 ,$107.33 ,$468.14 ,$468.14 ,$107.33 ,$97.70 ,$203.93 ,$217.58 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$778.50 ,$622.80 ,$622.80 ,$107.33 ,$622.80 ,$113.43 ,$113.43 ,$113.43 ,"$1,038.00 ", N/A ,$882.30 ,$268.33 ,$674.70 ,$107.33 ,"$1,038.00 ",$581.28 ,$107.33 ,$272.99 , N/A ,$160.38 ,$153.09 ,$112.70 ,$830.40 ,$241.50 ,$468.14 ,$290.64 ,$934.20 ,$107.33 ,$113.43 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$498.24 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200018,76705,HC US ABDOMEN LTD,402,1 ,"$1,528.00 ",$993.20 ,$73.66 ,"$1,528.00 ",$268.33 ,$140.38 ,$855.68 ,$107.33 ,$427.84 ,$539.38 ,$107.33 ,$629.54 ,$107.33 ,$689.13 ,$689.13 ,$107.33 ,$73.66 ,$203.93 ,$165.12 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,146.00 ",$916.80 ,$916.80 ,$107.33 ,$916.80 ,$86.10 ,$86.10 ,$86.10 ,"$1,528.00 ", N/A ,"$1,298.80 ",$268.33 ,$993.20 ,$107.33 ,"$1,528.00 ",$855.68 ,$107.33 ,$401.86 , N/A ,$160.38 ,$153.09 ,$112.70 ,"$1,222.40 ",$241.50 ,$689.13 ,$427.84 ,"$1,375.20 ",$107.33 ,$86.10 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$733.44 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200019,76770,HC US RETROPERITIONEAL,402,1 ,"$1,661.00 ","$1,079.65 ",$91.18 ,"$1,661.00 ",$268.33 ,$172.62 ,$930.16 ,$107.33 ,$465.08 ,$586.33 ,$107.33 ,$684.33 ,$107.33 ,$749.11 ,$749.11 ,$107.33 ,$91.18 ,$203.93 ,$203.27 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,245.75 ",$996.60 ,$996.60 ,$107.33 ,$996.60 ,$105.98 ,$105.98 ,$105.98 ,"$1,661.00 ", N/A ,"$1,411.85 ",$268.33 ,"$1,079.65 ",$107.33 ,"$1,661.00 ",$930.16 ,$107.33 ,$436.84 , N/A ,$160.38 ,$153.09 ,$112.70 ,"$1,328.80 ",$241.50 ,$749.11 ,$465.08 ,"$1,494.90 ",$107.33 ,$105.98 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$797.28 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$990.00 ,$643.50 ,$37.39 ,$990.00 ,$268.33 ,$148.90 ,$554.40 ,$107.33 ,$277.20 ,$349.47 ,$107.33 ,$407.88 ,$107.33 ,$446.49 ,$446.49 ,$107.33 ,$37.39 ,$203.93 ,$79.27 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$742.50 ,$594.00 ,$594.00 ,$107.33 ,$594.00 ,$41.39 ,$41.39 ,$41.39 ,$990.00 , N/A ,$841.50 ,$268.33 ,$643.50 ,$107.33 ,$990.00 ,$554.40 ,$107.33 ,$260.37 , N/A ,$160.38 ,$153.09 ,$112.70 ,$792.00 ,$241.50 ,$446.49 ,$277.20 ,$891.00 ,$107.33 ,$41.39 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$475.20 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200021,76776,HC US KIDNEY TRANSPLANT W/DOPPLER,402,1 ,$965.00 ,$627.25 ,$107.33 ,$965.00 ,$268.33 ,$205.44 ,$540.40 ,$107.33 ,$270.20 ,$340.65 ,$107.33 ,$397.58 ,$107.33 ,$435.22 ,$435.22 ,$107.33 ,$139.99 ,$203.93 ,$314.88 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$723.75 ,$579.00 ,$579.00 ,$107.33 ,$579.00 ,$164.10 ,$164.10 ,$164.10 ,$965.00 , N/A ,$820.25 ,$268.33 ,$627.25 ,$107.33 ,$965.00 ,$540.40 ,$107.33 ,$253.80 , N/A ,$160.38 ,$153.09 ,$112.70 ,$772.00 ,$241.50 ,$435.22 ,$270.20 ,$868.50 ,$107.33 ,$164.10 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$463.20 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,"$1,041.00 ",$676.65 ,$87.10 ,"$1,041.00 ",$268.33 ,$147.08 ,$582.96 ,$107.33 ,$291.48 ,$367.47 ,$107.33 ,$428.89 ,$107.33 ,$469.49 ,$469.49 ,$107.33 ,$87.10 ,$203.93 ,$194.69 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$780.75 ,$624.60 ,$624.60 ,$107.33 ,$624.60 ,$101.51 ,$101.51 ,$101.51 ,"$1,041.00 ", N/A ,$884.85 ,$268.33 ,$676.65 ,$107.33 ,"$1,041.00 ",$582.96 ,$107.33 ,$273.78 , N/A , N/A , N/A ,$112.70 ,$832.80 ,$241.50 ,$469.49 ,$291.48 ,$936.90 ,$107.33 ,$101.51 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$499.68 , N/A 
ST. ELIZABETH'S HOSPITAL,40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$399.00 ,$259.35 ,$26.08 ,$399.00 , N/A ,$52.84 ,$223.44 , N/A ,$111.72 ,$140.85 , N/A ,$164.39 , N/A ,$179.95 ,$179.95 , N/A ,$26.08 , N/A ,$199.50 , N/A , N/A , N/A , N/A ,$299.25 ,$239.40 ,$239.40 , N/A ,$239.40 ,$30.30 ,$30.30 ,$30.30 ,$399.00 , N/A ,$339.15 , N/A ,$259.35 , N/A ,$399.00 ,$223.44 , N/A ,$104.94 , N/A , N/A , N/A , N/A ,$319.20 , N/A ,$179.95 ,$111.72 ,$359.10 , N/A ,$30.30 ,$399.00 ,$399.00 , N/A ,$399.00 ,$191.52 , N/A 
ST. ELIZABETH'S HOSPITAL,40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,"$1,248.00 ",$811.20 ,$107.33 ,"$1,248.00 ",$268.33 ,$172.62 ,$698.88 ,$107.33 ,$349.44 ,$440.54 ,$107.33 ,$514.18 ,$107.33 ,$562.85 ,$562.85 ,$107.33 ,$108.30 ,$203.93 ,$242.38 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$936.00 ,$748.80 ,$748.80 ,$107.33 ,$748.80 ,$126.35 ,$126.35 ,$126.35 ,"$1,248.00 ", N/A ,"$1,060.80 ",$268.33 ,$811.20 ,$107.33 ,"$1,248.00 ",$698.88 ,$107.33 ,$328.22 , N/A , N/A , N/A ,$112.70 ,$998.40 ,$241.50 ,$562.85 ,$349.44 ,"$1,123.20 ",$107.33 ,$126.35 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$599.04 , N/A 
ST. ELIZABETH'S HOSPITAL,40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,$847.00 ,$550.55 ,$51.25 ,$847.00 , N/A ,$89.92 ,$474.32 , N/A ,$237.16 ,$298.99 , N/A ,$348.96 , N/A ,$382.00 ,$382.00 , N/A ,$51.25 , N/A ,$423.50 , N/A , N/A , N/A , N/A ,$635.25 ,$508.20 ,$508.20 , N/A ,$508.20 ,$59.61 ,$59.61 ,$59.61 ,$847.00 , N/A ,$719.95 , N/A ,$550.55 , N/A ,$847.00 ,$474.32 , N/A ,$222.76 , N/A , N/A , N/A , N/A ,$677.60 , N/A ,$382.00 ,$237.16 ,$762.30 , N/A ,$59.61 ,$610.00 ,$610.00 , N/A ,$610.00 ,$406.56 , N/A 
ST. ELIZABETH'S HOSPITAL,40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,"$1,121.00 ",$728.65 ,$103.11 ,"$1,121.00 ",$567.13 ,$179.90 ,$627.76 ,$226.85 ,$313.88 ,$395.71 ,$226.85 ,$461.85 ,$226.85 ,$505.57 ,$505.57 ,$226.85 ,$103.11 ,$431.02 ,$224.35 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$840.75 ,$672.60 ,$672.60 ,$226.85 ,$672.60 ,$117.06 ,$117.06 ,$117.06 ,"$1,121.00 ", N/A ,$952.85 ,$567.13 ,$728.65 ,$226.85 ,"$1,121.00 ",$627.76 ,$226.85 ,$294.82 , N/A , N/A , N/A ,$238.19 ,$896.80 ,$510.41 ,$505.57 ,$313.88 ,"$1,008.90 ",$226.85 ,$117.06 ,$610.00 ,$610.00 ,$226.85 ,$610.00 ,$538.08 , N/A 
ST. ELIZABETH'S HOSPITAL,40200029,76812,HC US PREGNANCY DETAILED ADDL,402,1 ,$706.50 ,$459.23 ,$112.42 ,$706.50 , N/A ,$112.42 ,$395.64 , N/A ,$197.82 ,$249.39 , N/A ,$291.08 , N/A ,$318.63 ,$318.63 , N/A ,$133.05 , N/A ,$353.25 , N/A , N/A , N/A , N/A ,$529.88 ,$423.90 ,$423.90 , N/A ,$423.90 ,$154.17 ,$154.17 ,$154.17 ,$706.50 , N/A ,$600.53 , N/A ,$459.23 , N/A ,$706.50 ,$395.64 , N/A ,$185.81 , N/A , N/A , N/A , N/A ,$565.20 , N/A ,$318.63 ,$197.82 ,$635.85 , N/A ,$154.17 ,$610.00 ,$610.00 , N/A ,$610.00 ,$339.12 , N/A 
ST. ELIZABETH'S HOSPITAL,40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$837.00 ,$544.05 ,$85.06 ,$837.00 ,$268.33 ,$111.82 ,$468.72 ,$107.33 ,$234.36 ,$295.46 ,$107.33 ,$344.84 ,$107.33 ,$377.49 ,$377.49 ,$107.33 ,$85.06 ,$203.93 ,$189.92 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$627.75 ,$502.20 ,$502.20 ,$107.33 ,$502.20 ,$99.02 ,$99.02 ,$99.02 ,$837.00 , N/A ,$711.45 ,$268.33 ,$544.05 ,$107.33 ,$837.00 ,$468.72 ,$107.33 ,$220.13 , N/A , N/A , N/A ,$112.70 ,$669.60 ,$241.50 ,$377.49 ,$234.36 ,$753.30 ,$107.33 ,$99.02 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$401.76 , N/A 
ST. ELIZABETH'S HOSPITAL,40200031,76815,HC US FETAL HEART BEAT,402,1 ,$831.00 ,$540.15 ,$62.25 ,$831.00 ,$268.33 ,$108.16 ,$465.36 ,$107.33 ,$232.68 ,$293.34 ,$107.33 ,$342.37 ,$107.33 ,$374.78 ,$374.78 ,$107.33 ,$62.25 ,$203.93 ,$138.41 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$623.25 ,$498.60 ,$498.60 ,$107.33 ,$498.60 ,$72.20 ,$72.20 ,$72.20 ,$831.00 , N/A ,$706.35 ,$268.33 ,$540.15 ,$107.33 ,$831.00 ,$465.36 ,$107.33 ,$218.55 , N/A , N/A , N/A ,$112.70 ,$664.80 ,$241.50 ,$374.78 ,$232.68 ,$747.90 ,$107.33 ,$72.20 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$398.88 , N/A 
ST. ELIZABETH'S HOSPITAL,40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,"$1,021.00 ",$663.65 ,$70.40 ,"$1,021.00 ",$268.33 ,$111.82 ,$571.76 ,$107.33 ,$285.88 ,$360.41 ,$107.33 ,$420.65 ,$107.33 ,$460.47 ,$460.47 ,$107.33 ,$70.40 ,$203.93 ,$157.49 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$765.75 ,$612.60 ,$612.60 ,$107.33 ,$612.60 ,$82.13 ,$82.13 ,$82.13 ,"$1,021.00 ", N/A ,$867.85 ,$268.33 ,$663.65 ,$107.33 ,"$1,021.00 ",$571.76 ,$107.33 ,$268.52 , N/A , N/A , N/A ,$112.70 ,$816.80 ,$241.50 ,$460.47 ,$285.88 ,$918.90 ,$107.33 ,$82.13 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$490.08 , N/A 
ST. ELIZABETH'S HOSPITAL,40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,$792.00 ,$514.80 ,$57.36 ,$792.00 ,$268.33 ,$97.22 ,$443.52 ,$107.33 ,$221.76 ,$279.58 ,$107.33 ,$326.30 ,$107.33 ,$357.19 ,$357.19 ,$107.33 ,$57.36 ,$203.93 ,$133.64 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$594.00 ,$475.20 ,$475.20 ,$107.33 ,$475.20 ,$69.71 ,$69.71 ,$69.71 ,$792.00 , N/A ,$673.20 ,$268.33 ,$514.80 ,$107.33 ,$792.00 ,$443.52 ,$107.33 ,$208.30 , N/A , N/A , N/A ,$112.70 ,$633.60 ,$241.50 ,$357.19 ,$221.76 ,$712.80 ,$107.33 ,$69.71 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$380.16 , N/A 
ST. ELIZABETH'S HOSPITAL,40200036,76820,HC US FETAL DOPLR VELO UMB,402,1 ,$515.00 ,$334.75 ,$26.39 ,$515.00 ,$268.33 ,$40.68 ,$288.40 ,$107.33 ,$144.20 ,$181.80 ,$107.33 ,$212.18 ,$107.33 ,$232.27 ,$232.27 ,$107.33 ,$26.39 ,$203.93 ,$59.24 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$386.25 ,$309.00 ,$309.00 ,$107.33 ,$309.00 ,$30.96 ,$30.96 ,$30.96 ,$515.00 , N/A ,$437.75 ,$268.33 ,$334.75 ,$107.33 ,$515.00 ,$288.40 ,$107.33 ,$135.45 , N/A , N/A , N/A ,$112.70 ,$412.00 ,$241.50 ,$232.27 ,$144.20 ,$463.50 ,$107.33 ,$30.96 ,$515.00 ,$515.00 ,$107.33 ,$515.00 ,$247.20 , N/A 
ST. ELIZABETH'S HOSPITAL,40200038,76830,HC US TRANSVAGINAL,402,1 ,"$1,021.00 ",$663.65 ,$107.33 ,"$1,021.00 ",$268.33 ,$164.10 ,$571.76 ,$107.33 ,$285.88 ,$360.41 ,$107.33 ,$420.65 ,$107.33 ,$460.47 ,$460.47 ,$107.33 ,$107.48 ,$203.93 ,$233.80 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$765.75 ,$612.60 ,$612.60 ,$107.33 ,$612.60 ,$121.88 ,$121.88 ,$121.88 ,"$1,021.00 ", N/A ,$867.85 ,$268.33 ,$663.65 ,$107.33 ,"$1,021.00 ",$571.76 ,$107.33 ,$268.52 , N/A ,$160.38 ,$153.09 ,$112.70 ,$816.80 ,$241.50 ,$460.47 ,$285.88 ,$918.90 ,$107.33 ,$121.88 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$490.08 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200039,76831,HC US HYSTEROSONOGRAM,402,1 ,$807.00 ,$524.55 ,$101.36 ,$807.00 ,$567.13 ,$162.28 ,$451.92 ,$226.85 ,$225.96 ,$284.87 ,$226.85 ,$332.48 ,$226.85 ,$363.96 ,$363.96 ,$226.85 ,$101.36 ,$431.02 ,$220.44 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$605.25 ,$484.20 ,$484.20 ,$226.85 ,$484.20 ,$114.92 ,$114.92 ,$114.92 ,$807.00 , N/A ,$685.95 ,$567.13 ,$524.55 ,$226.85 ,$807.00 ,$451.92 ,$226.85 ,$212.24 , N/A ,$366.06 ,$349.42 ,$238.19 ,$645.60 ,$510.41 ,$363.96 ,$225.96 ,$726.30 ,$226.85 ,$114.92 ,$610.00 ,$610.00 ,$226.85 ,$610.00 ,$387.36 ,$332.78 
ST. ELIZABETH'S HOSPITAL,40200040,76856,HC US PELVIS NON OB,402,1 ,"$1,559.00 ","$1,013.35 ",$81.89 ,"$1,559.00 ",$268.33 ,$163.50 ,$873.04 ,$107.33 ,$436.52 ,$550.33 ,$107.33 ,$642.31 ,$107.33 ,$703.11 ,$703.11 ,$107.33 ,$90.36 ,$203.93 ,$201.37 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,169.25 ",$935.40 ,$935.40 ,$107.33 ,$935.40 ,$104.99 ,$104.99 ,$104.99 ,"$1,559.00 ", N/A ,"$1,325.15 ",$268.33 ,"$1,013.35 ",$107.33 ,$81.89 ,$873.04 ,$107.33 ,$410.02 , N/A ,$160.38 ,$153.09 ,$112.70 ,"$1,247.20 ",$241.50 ,$703.11 ,$436.52 ,"$1,403.10 ",$107.33 ,$104.99 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$748.32 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$632.00 ,$410.80 ,$30.06 ,$632.00 ,$268.33 ,$111.82 ,$353.92 ,$107.33 ,$176.96 ,$223.10 ,$107.33 ,$260.38 ,$107.33 ,$285.03 ,$285.03 ,$107.33 ,$30.06 ,$203.93 ,$64.00 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$474.00 ,$379.20 ,$379.20 ,$107.33 ,$379.20 ,$33.44 ,$33.44 ,$33.44 ,$632.00 , N/A ,$537.20 ,$268.33 ,$410.80 ,$107.33 ,$632.00 ,$353.92 ,$107.33 ,$166.22 , N/A ,$160.38 ,$153.09 ,$112.70 ,$505.60 ,$241.50 ,$285.03 ,$176.96 ,$568.80 ,$107.33 ,$33.44 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$303.36 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200042,76870,HC US SCROTUM,402,1 ,"$1,105.00 ",$718.25 ,$87.10 ,"$1,105.00 ",$268.33 ,$165.92 ,$618.80 ,$107.33 ,$309.40 ,$390.07 ,$107.33 ,$455.26 ,$107.33 ,$498.36 ,$498.36 ,$107.33 ,$87.10 ,$203.93 ,$196.60 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$828.75 ,$663.00 ,$663.00 ,$107.33 ,$663.00 ,$102.50 ,$102.50 ,$102.50 ,"$1,105.00 ", N/A ,$939.25 ,$268.33 ,$718.25 ,$107.33 ,"$1,105.00 ",$618.80 ,$107.33 ,$290.62 , N/A ,$160.38 ,$153.09 ,$112.70 ,$884.00 ,$241.50 ,$498.36 ,$309.40 ,$994.50 ,$107.33 ,$102.50 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$530.40 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200043,76872,HC ULTRA BX PROS,402,1 ,"$1,326.00 ",$861.90 ,$107.33 ,"$1,326.00 ",$268.33 ,$172.62 ,$742.56 ,$107.33 ,$371.28 ,$468.08 ,$107.33 ,$546.31 ,$107.33 ,$598.03 ,$598.03 ,$107.33 ,$210.89 ,$203.93 ,$254.78 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$994.50 ,$795.60 ,$795.60 ,$107.33 ,$795.60 ,$132.80 ,$132.80 ,$132.80 ,"$1,326.00 ", N/A ,"$1,127.10 ",$268.33 ,$861.90 ,$107.33 ,"$1,326.00 ",$742.56 ,$107.33 ,$348.74 , N/A ,$160.38 ,$153.09 ,$112.70 ,"$1,060.80 ",$241.50 ,$598.03 ,$371.28 ,"$1,193.40 ",$107.33 ,$132.80 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$636.48 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200044,76873,HC US TRANSRECTAL PROSTATE VOLUME,402,1 ,$331.00 ,$215.15 ,$87.05 ,$331.00 ,$268.33 ,$172.62 ,$185.36 ,$107.33 ,$92.68 ,$116.84 ,$107.33 ,$136.37 ,$107.33 ,$149.28 ,$149.28 ,$107.33 ,$120.53 ,$203.93 ,$256.69 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$248.25 ,$198.60 ,$198.60 ,$107.33 ,$198.60 ,$133.80 ,$133.80 ,$133.80 ,$331.00 , N/A ,$281.35 ,$268.33 ,$215.15 ,$107.33 ,$331.00 ,$185.36 ,$107.33 ,$87.05 , N/A ,$160.38 ,$153.09 ,$112.70 ,$264.80 ,$241.50 ,$149.28 ,$92.68 ,$297.90 ,$107.33 ,$133.80 ,$331.00 ,$331.00 ,$107.33 ,$331.00 ,$158.88 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$731.00 ,$475.15 ,$34.95 ,$731.00 ,$268.33 ,$154.98 ,$409.36 ,$107.33 ,$204.68 ,$258.04 ,$107.33 ,$301.17 ,$107.33 ,$329.68 ,$329.68 ,$107.33 ,$34.95 ,$203.93 ,$153.67 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$548.25 ,$438.60 ,$438.60 ,$107.33 ,$438.60 ,$80.15 ,$80.15 ,$80.15 ,$731.00 , N/A ,$621.35 ,$268.33 ,$475.15 ,$107.33 ,$731.00 ,$409.36 ,$107.33 ,$192.25 , N/A ,$160.38 ,$153.09 ,$112.70 ,$584.80 ,$241.50 ,$329.68 ,$204.68 ,$657.90 ,$107.33 ,$80.15 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$350.88 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$547.00 ,$355.55 ,$18.80 ,$547.00 ,$268.33 ,$18.80 ,$306.32 ,$107.33 ,$153.16 ,$193.09 ,$107.33 ,$225.36 ,$107.33 ,$246.70 ,$246.70 ,$107.33 ,$40.65 ,$203.93 ,$87.85 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$410.25 ,$328.20 ,$328.20 ,$107.33 ,$328.20 ,$45.86 ,$45.86 ,$45.86 ,$547.00 , N/A ,$464.95 ,$268.33 ,$355.55 ,$107.33 ,$547.00 ,$306.32 ,$107.33 ,$143.86 , N/A ,$160.38 ,$153.09 ,$112.70 ,$437.60 ,$241.50 ,$246.70 ,$153.16 ,$492.30 ,$107.33 ,$45.86 ,$547.00 ,$547.00 ,$107.33 ,$547.00 ,$262.56 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200050,76936,HC US GUIDED COMPRESSION RPR,402,1 ,"$1,035.00 ",$672.75 ,$106.40 ,"$1,035.00 ",$652.30 ,$191.46 ,$579.60 ,$260.92 ,$289.80 ,$365.36 ,$260.92 ,$426.42 ,$260.92 ,$466.79 ,$466.79 ,$260.92 ,$207.44 ,$495.74 ,$460.92 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$776.25 ,$621.00 ,$621.00 ,$260.92 ,$621.00 ,$240.27 ,$240.27 ,$240.27 ,"$1,035.00 ", N/A ,$879.75 ,$652.29 ,$672.75 ,$260.92 ,"$1,035.00 ",$579.60 ,$260.92 ,$272.21 , N/A ,$117.04 ,$111.72 ,$273.97 ,$828.00 ,$587.06 ,$466.79 ,$289.80 ,$931.50 ,$260.92 ,$240.27 ,$610.00 ,$610.00 ,$260.92 ,$610.00 ,$496.80 ,$106.40 
ST. ELIZABETH'S HOSPITAL,40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$784.00 ,$509.60 ,$27.33 ,$784.00 , N/A ,$35.82 ,$439.04 , N/A ,$219.52 ,$189.91 , N/A ,$189.91 , N/A ,$353.58 ,$353.58 , N/A ,$31.38 , N/A ,$392.00 , N/A , N/A , N/A , N/A ,$588.00 ,$470.40 ,$470.40 , N/A ,$470.40 ,$27.33 ,$27.33 ,$27.33 ,$784.00 , N/A ,$666.40 , N/A ,$509.60 , N/A ,$784.00 ,$439.04 , N/A ,$206.19 , N/A ,$117.04 ,$111.72 , N/A ,$627.20 , N/A ,$353.58 ,$219.52 ,$705.60 , N/A ,$27.33 ,$610.00 ,$610.00 , N/A ,$610.00 ,$376.32 ,$106.40 
ST. ELIZABETH'S HOSPITAL,40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,046.00 ",$679.90 ,$29.07 ,"$1,046.00 ", N/A ,$294.80 ,$585.76 , N/A ,$292.88 ,$361.15 , N/A ,$361.15 , N/A ,$471.75 ,$471.75 , N/A ,$33.73 , N/A ,$523.00 , N/A , N/A , N/A , N/A ,$784.50 ,$627.60 ,$627.60 , N/A ,$627.60 ,$34.94 ,$34.94 ,$34.94 ,"$1,046.00 ", N/A ,$889.10 , N/A ,$679.90 , N/A ,$29.07 ,$585.76 , N/A ,$275.10 , N/A ,$117.04 ,$111.72 , N/A ,$836.80 , N/A ,$471.75 ,$292.88 ,$941.40 , N/A ,$34.94 ,$610.00 ,$610.00 , N/A ,$610.00 ,$502.08 ,$106.40 
ST. ELIZABETH'S HOSPITAL,40200059,76946,HC US GUIDED AMNIOCENTESIS,402,1 ,"$1,423.00 ",$924.95 ,$17.43 ,"$1,423.00 ", N/A ,$35.22 ,$796.88 , N/A ,$398.44 ,$149.84 , N/A ,$149.84 , N/A ,$641.77 ,$641.77 , N/A ,$17.43 , N/A ,$711.50 , N/A , N/A , N/A , N/A ,"$1,067.25 ",$853.80 ,$853.80 , N/A ,$853.80 ,$18.54 ,$18.54 ,$18.54 ,"$1,423.00 ", N/A ,"$1,209.55 ", N/A ,$924.95 , N/A ,"$1,423.00 ",$796.88 , N/A ,$374.25 , N/A ,$117.04 ,$111.72 , N/A ,"$1,138.40 ", N/A ,$641.77 ,$398.44 ,"$1,280.70 ", N/A ,$18.54 ,$610.00 ,$610.00 , N/A ,$610.00 ,$683.04 ,$106.40 
ST. ELIZABETH'S HOSPITAL,40200060,77387,HC US GUIDED RAD THRPY FIELDS,402,1 ,$769.00 ,$499.85 ,$65.14 ,$769.00 , N/A ,$65.14 ,$430.64 , N/A ,$215.32 ,$259.92 , N/A ,$299.14 , N/A ,$346.82 ,$346.82 , N/A ,$499.85 , N/A ,$143.18 , N/A , N/A , N/A , N/A ,$576.75 ,$461.40 ,$461.40 , N/A ,$461.40 ,$538.30 ,$538.30 ,$538.30 ,$769.00 , N/A ,$653.65 , N/A ,$499.85 , N/A ,$769.00 ,$430.64 , N/A ,$202.25 , N/A , N/A , N/A , N/A ,$615.20 , N/A ,$346.82 ,$215.32 ,$692.10 , N/A ,$538.30 ,$610.00 ,$610.00 , N/A ,$610.00 ,$369.12 , N/A 
ST. ELIZABETH'S HOSPITAL,40200061,76965,HC US GUIDED INTERSTITIAL THRPY,402,1 ,"$1,414.00 ",$919.10 ,$32.10 ,"$1,414.00 ", N/A ,$90.54 ,$791.84 , N/A ,$395.92 ,$276.42 , N/A ,$276.42 , N/A ,$637.71 ,$637.71 , N/A ,$32.10 , N/A ,$707.00 , N/A , N/A , N/A , N/A ,"$1,060.50 ",$848.40 ,$848.40 , N/A ,$848.40 ,$34.94 ,$34.94 ,$34.94 ,"$1,414.00 ", N/A ,"$1,201.90 ", N/A ,$919.10 , N/A ,"$1,414.00 ",$791.84 , N/A ,$371.88 , N/A ,$117.04 ,$111.72 , N/A ,"$1,131.20 ", N/A ,$637.71 ,$395.92 ,"$1,272.60 ", N/A ,$34.94 ,$610.00 ,$610.00 , N/A ,$610.00 ,$678.72 ,$106.40 
ST. ELIZABETH'S HOSPITAL,40200062,76998,HC US INTRAOPERATIVE,402,1 ,"$1,055.00 ",$685.75 ,$83.30 ,"$1,055.00 ", N/A ,$134.82 ,$590.80 , N/A ,$295.40 ,$372.42 , N/A ,$434.66 , N/A ,$475.81 ,$475.81 , N/A ,$83.30 , N/A ,$527.50 , N/A , N/A , N/A , N/A ,$791.25 ,$633.00 ,$633.00 , N/A ,$633.00 ,$738.50 ,$738.50 ,$738.50 ,"$1,055.00 ", N/A ,$896.75 , N/A ,$685.75 , N/A ,"$1,055.00 ",$590.80 , N/A ,$277.47 , N/A ,$117.04 ,$111.72 , N/A ,$844.00 , N/A ,$475.81 ,$295.40 ,$949.50 , N/A ,$738.50 ,$610.00 ,$610.00 , N/A ,$610.00 ,$506.40 ,$106.40 
ST. ELIZABETH'S HOSPITAL,40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,"$1,795.00 ","$1,166.75 ",$145.80 ,"$1,795.00 ",$567.13 ,$825.70 ,"$1,005.20 ",$226.85 ,$502.60 ,$633.64 ,$226.85 ,$739.54 ,$226.85 ,$809.55 ,$809.55 ,$226.85 ,$260.81 ,$431.02 ,$595.42 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,346.25 ","$1,077.00 ","$1,077.00 ",$226.85 ,"$1,077.00 ","$1,256.50 ","$1,256.50 ","$1,256.50 ","$1,795.00 ", N/A ,"$1,525.75 ",$567.13 ,"$1,166.75 ",$226.85 ,"$1,795.00 ","$1,005.20 ",$226.85 ,$472.09 , N/A ,$160.38 ,$153.09 ,$238.19 ,"$1,436.00 ",$510.41 ,$809.55 ,$502.60 ,"$1,615.50 ",$226.85 ,"$1,256.50 ",$610.00 ,$610.00 ,$226.85 ,$610.00 ,$861.60 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200067,93975,HC DUPLEX ABD/PEL/RETRO CMPL AORTA,402,1 ,"$1,795.00 ","$1,166.75 ",$145.80 ,"$1,795.00 ",$567.13 ,$825.70 ,"$1,005.20 ",$226.85 ,$502.60 ,$633.64 ,$226.85 ,$739.54 ,$226.85 ,$809.55 ,$809.55 ,$226.85 ,$260.81 ,$431.02 ,$595.42 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,346.25 ","$1,077.00 ","$1,077.00 ",$226.85 ,"$1,077.00 ","$1,256.50 ","$1,256.50 ","$1,256.50 ","$1,795.00 ", N/A ,"$1,525.75 ",$567.13 ,"$1,166.75 ",$226.85 ,"$1,795.00 ","$1,005.20 ",$226.85 ,$472.09 , N/A ,$160.38 ,$153.09 ,$238.19 ,"$1,436.00 ",$510.41 ,$809.55 ,$502.60 ,"$1,615.50 ",$226.85 ,"$1,256.50 ",$610.00 ,$610.00 ,$226.85 ,$610.00 ,$861.60 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,354.00 ",$880.10 ,$107.33 ,"$1,354.00 ",$268.33 ,$622.84 ,$758.24 ,$107.33 ,$379.12 ,$477.96 ,$107.33 ,$557.85 ,$107.33 ,$610.65 ,$610.65 ,$107.33 ,$148.54 ,$203.93 ,$334.91 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,015.50 ",$812.40 ,$812.40 ,$107.33 ,$812.40 ,$947.80 ,$947.80 ,$947.80 ,"$1,354.00 ", N/A ,"$1,150.90 ",$268.33 ,$880.10 ,$107.33 ,"$1,354.00 ",$758.24 ,$107.33 ,$356.10 , N/A ,$160.38 ,$153.09 ,$112.70 ,"$1,083.20 ",$241.50 ,$610.65 ,$379.12 ,"$1,218.60 ",$107.33 ,$947.80 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$649.92 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,921,1 ,"$1,461.00 ",$949.65 ,$145.80 ,"$1,461.00 ",$567.13 ,$672.06 ,$818.16 ,$226.85 ,$409.08 ,$515.73 ,$226.85 ,$601.93 ,$226.85 ,$658.91 ,$658.91 ,$226.85 ,$177.28 ,$431.02 ,$402.73 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,095.75 ",$876.60 ,$876.60 ,$226.85 ,$876.60 ,"$1,110.36 ","$1,110.36 ","$1,110.36 ","$1,461.00 ", N/A ,"$1,241.85 ",$567.13 ,$949.65 ,$226.85 ,"$1,461.00 ",$818.16 ,$226.85 ,$384.24 , N/A ,$160.38 ,$153.09 ,$238.19 ,"$1,168.80 ",$510.41 ,$658.91 ,$409.08 ,"$1,314.90 ",$226.85 ,"$1,110.36 ",$949.65 ,$949.65 ,$226.85 ,$949.65 ,$701.28 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,"$1,037.00 ",$674.05 ,$107.33 ,"$1,037.00 ",$268.33 ,$477.02 ,$580.72 ,$107.33 ,$290.36 ,$366.06 ,$107.33 ,$427.24 ,$107.33 ,$467.69 ,$467.69 ,$107.33 ,$116.35 ,$203.93 ,$257.65 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$777.75 ,$622.20 ,$622.20 ,$107.33 ,$622.20 ,$725.90 ,$725.90 ,$725.90 ,"$1,037.00 ", N/A ,$881.45 ,$268.33 ,$674.05 ,$107.33 ,"$1,037.00 ",$580.72 ,$107.33 ,$272.73 , N/A ,$160.38 ,$153.09 ,$112.70 ,$829.60 ,$241.50 ,$467.69 ,$290.36 ,$933.30 ,$107.33 ,$725.90 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$497.76 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200075,76706,HC US AORTA (SCREENING),402,1 ,$348.00 ,$226.20 ,$91.52 ,$348.00 ,$268.33 ,$128.52 ,$194.88 ,$107.33 ,$97.44 ,$122.84 ,$107.33 ,$143.38 ,$107.33 ,$156.95 ,$156.95 ,$107.33 ,$99.33 ,$203.93 ,$230.94 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$261.00 ,$208.80 ,$208.80 ,$107.33 ,$208.80 ,$120.38 ,$120.38 ,$120.38 ,$348.00 , N/A ,$295.80 ,$268.33 ,$226.20 ,$107.33 ,$348.00 ,$194.88 ,$107.33 ,$91.52 , N/A ,$160.38 ,$153.09 ,$112.70 ,$278.40 ,$241.50 ,$156.95 ,$97.44 ,$313.20 ,$107.33 ,$120.38 ,$348.00 ,$348.00 ,$107.33 ,$348.00 ,$167.04 ,$145.80 
ST. ELIZABETH'S HOSPITAL,40200092,76813,HC US FETAL NUCHAL TRANSLUCENCY SNG,402,1 ,$983.00 ,$638.95 ,$76.10 ,$983.00 ,$268.33 ,$124.58 ,$550.48 ,$107.33 ,$275.24 ,$347.00 ,$107.33 ,$405.00 ,$107.33 ,$443.33 ,$443.33 ,$107.33 ,$76.10 ,$203.93 ,$164.16 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$737.25 ,$589.80 ,$589.80 ,$107.33 ,$589.80 ,$85.61 ,$85.61 ,$85.61 ,$983.00 , N/A ,$835.55 ,$268.33 ,$638.95 ,$107.33 ,$983.00 ,$550.48 ,$107.33 ,$258.53 , N/A ,$103.79 ,$99.07 ,$112.70 ,$786.40 ,$241.50 ,$443.33 ,$275.24 ,$884.70 ,$107.33 ,$85.61 ,$610.00 ,$610.00 ,$107.33 ,$610.00 ,$471.84 ,$94.35 
ST. ELIZABETH'S HOSPITAL,40200093,76814,HC US FETAL NUCHAL TRANSLUCENCY ADDL,402,1 ,$274.00 ,$178.10 ,$34.95 ,$274.00 , N/A ,$58.92 ,$153.44 , N/A ,$76.72 ,$96.72 , N/A ,$112.89 , N/A ,$123.57 ,$123.57 , N/A ,$34.95 , N/A ,$137.00 , N/A , N/A , N/A , N/A ,$205.50 ,$164.40 ,$164.40 , N/A ,$164.40 ,$40.40 ,$40.40 ,$40.40 ,$274.00 , N/A ,$232.90 , N/A ,$178.10 , N/A ,$274.00 ,$153.44 , N/A ,$72.06 , N/A ,$103.79 ,$99.07 , N/A ,$219.20 , N/A ,$123.57 ,$76.72 ,$246.60 , N/A ,$40.40 ,$274.00 ,$274.00 , N/A ,$274.00 ,$131.52 ,$94.35 
ST. ELIZABETH'S HOSPITAL,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$653.00 ,$424.45 ,$66.22 ,$653.00 ,$225.55 ,$192.40 ,$365.68 ,$90.22 ,$182.84 ,$230.51 ,$90.22 ,$269.04 ,$90.22 ,$294.50 ,$294.50 ,$90.22 ,$112.78 ,$171.42 ,$263.37 ,$225.55 ,$90.22 ,$90.22 ,$92.02 ,$489.75 ,$391.80 ,$391.80 ,$90.22 ,$391.80 ,$137.28 ,$137.28 ,$137.28 ,$653.00 , N/A ,$555.05 ,$225.55 ,$424.45 ,$90.22 ,$101.20 ,$365.68 ,$90.22 ,$171.74 , N/A ,$72.84 ,$69.53 ,$94.73 ,$522.40 ,$203.00 ,$294.50 ,$182.84 ,$587.70 ,$90.22 ,$137.28 ,$360.00 ,$360.00 ,$90.22 ,$360.00 ,$313.44 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$653.00 ,$424.45 ,$66.22 ,$653.00 ,$225.55 ,$192.40 ,$365.68 ,$90.22 ,$182.84 ,$230.51 ,$90.22 ,$269.04 ,$90.22 ,$294.50 ,$294.50 ,$90.22 ,$112.78 ,$171.42 ,$263.37 ,$225.55 ,$90.22 ,$90.22 ,$92.02 ,$489.75 ,$391.80 ,$391.80 ,$90.22 ,$391.80 ,$137.28 ,$137.28 ,$137.28 ,$653.00 , N/A ,$555.05 ,$225.55 ,$424.45 ,$90.22 ,$101.20 ,$365.68 ,$90.22 ,$171.74 , N/A ,$72.84 ,$69.53 ,$94.73 ,$522.40 ,$203.00 ,$294.50 ,$182.84 ,$587.70 ,$90.22 ,$137.28 ,$360.00 ,$360.00 ,$90.22 ,$360.00 ,$313.44 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$61.00 ,$39.65 ,$16.04 ,$66.22 ,$57.05 ,$45.36 ,$34.16 ,$22.82 ,$17.08 ,$21.53 ,$22.82 ,$25.13 ,$22.82 ,$27.51 ,$27.51 ,$22.82 ,$28.53 ,$43.36 ,$61.00 ,$57.05 ,$22.82 ,$22.82 ,$23.28 ,$45.75 ,$36.60 ,$36.60 ,$22.82 ,$36.60 ,$34.77 ,$34.77 ,$34.77 ,$61.00 , N/A ,$51.85 ,$57.05 ,$39.65 ,$22.82 ,$26.59 ,$34.16 ,$22.82 ,$16.04 , N/A ,$61.00 ,$61.00 ,$23.96 ,$48.80 ,$51.35 ,$27.51 ,$17.08 ,$54.90 ,$22.82 ,$34.77 ,$61.00 ,$61.00 ,$22.82 ,$61.00 ,$29.28 ,$66.22 
ST. ELIZABETH'S HOSPITAL,40300007,77063,HC SCREEN DIG BREAST TOMO BIL-52,403,1 ,$61.00 ,$39.65 ,$16.04 ,$61.00 ,$57.05 ,$45.36 ,$34.16 ,$22.82 ,$17.08 ,$21.53 ,$22.82 ,$25.13 ,$22.82 ,$27.51 ,$27.51 ,$22.82 ,$28.53 ,$43.36 ,$61.00 ,$57.05 ,$22.82 ,$22.82 ,$23.28 ,$45.75 ,$36.60 ,$36.60 ,$22.82 ,$36.60 ,$34.77 ,$34.77 ,$34.77 ,$61.00 , N/A ,$51.85 ,$57.05 ,$39.65 ,$22.82 ,$26.59 ,$34.16 ,$22.82 ,$16.04 , N/A ,$36.42 ,$34.77 ,$23.96 ,$48.80 ,$51.35 ,$27.51 ,$17.08 ,$54.90 ,$22.82 ,$34.77 ,$61.00 ,$61.00 ,$22.82 ,$61.00 ,$29.28 ,$33.11 
ST. ELIZABETH'S HOSPITAL,41000002,31502,HC CHG TUBE TRACHEOTOMY,410,1 ,$731.00 ,$475.15 ,$46.40 ,$731.00 ,$521.45 ,$336.26 ,$409.36 ,$208.58 ,$204.68 ,$247.08 ,$208.58 ,$284.36 ,$208.58 ,$329.68 ,$329.68 ,$208.58 ,$46.40 ,$396.30 ,$365.50 ,$521.44 ,$208.58 ,$208.58 ,$212.75 ,$548.25 ,$438.60 ,$438.60 ,$208.58 ,$438.60 ,$555.56 ,$555.56 ,$555.56 ,$731.00 , N/A ,$621.35 ,$521.44 ,$475.15 ,$208.58 ,$731.00 ,$409.36 ,$208.58 ,$192.25 , N/A ,$220.37 ,$210.36 ,$219.01 ,$584.80 ,$469.30 ,$329.68 ,$204.68 ,$657.90 ,$208.58 ,$555.56 ,$220.00 ,$220.00 ,$208.58 ,$220.00 ,$350.88 ,$200.34 
ST. ELIZABETH'S HOSPITAL,41000005,92950,HC CPR,480,1 ,$944.00 ,$613.60 ,$242.11 ,$944.00 ,$652.30 ,$434.24 ,$528.64 ,$260.92 ,$264.32 ,$333.23 ,$260.92 ,$388.93 ,$260.92 ,$425.74 ,$425.74 ,$260.92 ,$242.11 ,$495.74 ,$472.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$708.00 ,$566.40 ,$566.40 ,$260.92 ,$566.40 ,$717.44 ,$717.44 ,$717.44 ,$944.00 , N/A ,$802.40 ,$652.29 ,$613.60 ,$260.92 ,$944.00 ,$528.64 ,$260.92 ,$248.27 , N/A ,$712.22 ,$679.84 ,$273.97 ,$755.20 ,$587.06 ,$425.74 ,$264.32 ,$849.60 ,$260.92 ,$717.44 ,$944.00 ,$944.00 ,$260.92 ,$944.00 ,$453.12 ,$647.47 
ST. ELIZABETH'S HOSPITAL,41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,"$1,670.00 ","$1,085.50 ",$120.30 ,"$1,670.00 ","$1,200.73 ",$768.20 ,$935.20 ,$480.29 ,$467.60 ,$589.51 ,$480.29 ,$688.04 ,$480.29 ,$753.17 ,$753.17 ,$480.29 ,$120.30 ,$912.54 ,$835.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,"$1,252.50 ","$1,002.00 ","$1,002.00 ",$480.29 ,"$1,002.00 ","$1,269.20 ","$1,269.20 ","$1,269.20 ","$1,670.00 ", N/A ,"$1,419.50 ","$1,200.71 ","$1,085.50 ",$480.29 ,"$1,670.00 ",$935.20 ,$480.29 ,$439.21 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,336.00 ","$1,080.64 ",$753.17 ,$467.60 ,"$1,503.00 ",$480.29 ,"$1,269.20 ",$220.00 ,$220.00 ,$480.29 ,$220.00 ,$801.60 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000010,94002,HC VENTIL HI FREQ INTL DAY,410,1 ,"$1,670.00 ","$1,085.50 ",$120.30 ,"$1,670.00 ","$1,200.73 ",$768.20 ,$935.20 ,$480.29 ,$467.60 ,$589.51 ,$480.29 ,$688.04 ,$480.29 ,$753.17 ,$753.17 ,$480.29 ,$120.30 ,$912.54 ,$835.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,"$1,252.50 ","$1,002.00 ","$1,002.00 ",$480.29 ,"$1,002.00 ","$1,269.20 ","$1,269.20 ","$1,269.20 ","$1,670.00 ", N/A ,"$1,419.50 ","$1,200.71 ","$1,085.50 ",$480.29 ,"$1,670.00 ",$935.20 ,$480.29 ,$439.21 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,336.00 ","$1,080.64 ",$753.17 ,$467.60 ,"$1,503.00 ",$480.29 ,"$1,269.20 ",$220.00 ,$220.00 ,$480.29 ,$220.00 ,$801.60 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000014,94002,HC VENT WEANING FIRST DAY,410,1 ,"$1,670.00 ","$1,085.50 ",$120.30 ,"$1,670.00 ","$1,200.73 ",$768.20 ,$935.20 ,$480.29 ,$467.60 ,$589.51 ,$480.29 ,$688.04 ,$480.29 ,$753.17 ,$753.17 ,$480.29 ,$120.30 ,$912.54 ,$835.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,"$1,252.50 ","$1,002.00 ","$1,002.00 ",$480.29 ,"$1,002.00 ","$1,269.20 ","$1,269.20 ","$1,269.20 ","$1,670.00 ", N/A ,"$1,419.50 ","$1,200.71 ","$1,085.50 ",$480.29 ,"$1,670.00 ",$935.20 ,$480.29 ,$439.21 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,336.00 ","$1,080.64 ",$753.17 ,$467.60 ,"$1,503.00 ",$480.29 ,"$1,269.20 ",$220.00 ,$220.00 ,$480.29 ,$220.00 ,$801.60 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000015,94002,HC VENT NEONATAL INTL DAY,410,1 ,"$1,670.00 ","$1,085.50 ",$120.30 ,"$1,670.00 ","$1,200.73 ",$768.20 ,$935.20 ,$480.29 ,$467.60 ,$589.51 ,$480.29 ,$688.04 ,$480.29 ,$753.17 ,$753.17 ,$480.29 ,$120.30 ,$912.54 ,$835.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,"$1,252.50 ","$1,002.00 ","$1,002.00 ",$480.29 ,"$1,002.00 ","$1,269.20 ","$1,269.20 ","$1,269.20 ","$1,670.00 ", N/A ,"$1,419.50 ","$1,200.71 ","$1,085.50 ",$480.29 ,"$1,670.00 ",$935.20 ,$480.29 ,$439.21 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,336.00 ","$1,080.64 ",$753.17 ,$467.60 ,"$1,503.00 ",$480.29 ,"$1,269.20 ",$220.00 ,$220.00 ,$480.29 ,$220.00 ,$801.60 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000016,94660,HC VENT NONINVAS NEO INTL DAY,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000018,94660,HC VENT NONINVAS PEDS INTL DAY,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,"$1,292.00 ",$839.80 ,$84.28 ,"$1,292.00 ","$1,200.73 ",$594.32 ,$723.52 ,$480.29 ,$361.76 ,$436.70 ,$480.29 ,$502.59 ,$480.29 ,$582.69 ,$582.69 ,$480.29 ,$84.28 ,$912.54 ,$646.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,$969.00 ,$775.20 ,$775.20 ,$480.29 ,$775.20 ,$981.92 ,$981.92 ,$981.92 ,"$1,292.00 ", N/A ,"$1,098.20 ","$1,200.71 ",$839.80 ,$480.29 ,"$1,292.00 ",$723.52 ,$480.29 ,$339.80 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,033.60 ","$1,080.64 ",$582.69 ,$361.76 ,"$1,162.80 ",$480.29 ,$981.92 ,$220.00 ,$220.00 ,$480.29 ,$220.00 ,$620.16 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000028,94003,HC VENT HI FREQ SUBQ DAY,410,1 ,"$1,292.00 ",$839.80 ,$84.28 ,"$1,292.00 ","$1,200.73 ",$594.32 ,$723.52 ,$480.29 ,$361.76 ,$436.70 ,$480.29 ,$502.59 ,$480.29 ,$582.69 ,$582.69 ,$480.29 ,$84.28 ,$912.54 ,$646.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,$969.00 ,$775.20 ,$775.20 ,$480.29 ,$775.20 ,$981.92 ,$981.92 ,$981.92 ,"$1,292.00 ", N/A ,"$1,098.20 ","$1,200.71 ",$839.80 ,$480.29 ,"$1,292.00 ",$723.52 ,$480.29 ,$339.80 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,033.60 ","$1,080.64 ",$582.69 ,$361.76 ,"$1,162.80 ",$480.29 ,$981.92 ,$220.00 ,$220.00 ,$480.29 ,$220.00 ,$620.16 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000030,94003,HC VENT WEANING SUBQ DAY,410,1 ,"$1,292.00 ",$839.80 ,$84.28 ,"$1,292.00 ","$1,200.73 ",$594.32 ,$723.52 ,$480.29 ,$361.76 ,$436.70 ,$480.29 ,$502.59 ,$480.29 ,$582.69 ,$582.69 ,$480.29 ,$84.28 ,$912.54 ,$646.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,$969.00 ,$775.20 ,$775.20 ,$480.29 ,$775.20 ,$981.92 ,$981.92 ,$981.92 ,"$1,292.00 ", N/A ,"$1,098.20 ","$1,200.71 ",$839.80 ,$480.29 ,"$1,292.00 ",$723.52 ,$480.29 ,$339.80 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,033.60 ","$1,080.64 ",$582.69 ,$361.76 ,"$1,162.80 ",$480.29 ,$981.92 ,$220.00 ,$220.00 ,$480.29 ,$220.00 ,$620.16 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000031,94003,HC VENT NEONATL SUBQ DAY,410,1 ,"$1,292.00 ",$839.80 ,$84.28 ,"$1,292.00 ","$1,200.73 ",$594.32 ,$723.52 ,$480.29 ,$361.76 ,$436.70 ,$480.29 ,$502.59 ,$480.29 ,$582.69 ,$582.69 ,$480.29 ,$84.28 ,$912.54 ,$646.00 ,"$1,200.71 ",$480.29 ,$480.29 ,$489.89 ,$969.00 ,$775.20 ,$775.20 ,$480.29 ,$775.20 ,$981.92 ,$981.92 ,$981.92 ,"$1,292.00 ", N/A ,"$1,098.20 ","$1,200.71 ",$839.80 ,$480.29 ,"$1,292.00 ",$723.52 ,$480.29 ,$339.80 , N/A ,$772.20 ,$737.10 ,$504.30 ,"$1,033.60 ","$1,080.64 ",$582.69 ,$361.76 ,"$1,162.80 ",$480.29 ,$981.92 ,$220.00 ,$220.00 ,$480.29 ,$220.00 ,$620.16 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000033,94660,HC VENT NONINVAS PEDS SUBQ DAY,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000034,94640,HC IPPB,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000040,94640,HC EZ PAP TREATMENT,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000043,94640,HC PERI NEB WITH INSTRUCTION,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000044,94640,HC UPDRAFT W/INSTRUCT AND EVAL,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000046,94640,HC HIGH EFF NEB AERO EACH,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000047,94640,HC HIGH EFF NEB AERO W/INSTR/TEACH DEVICE,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000049,94642,HC AEROSOL INHALATION PENTAMIDINE,410,1 ,$764.00 ,$496.60 ,$185.31 ,$764.00 ,$463.28 ,$351.44 ,$427.84 ,$185.31 ,$213.92 ,$269.69 ,$185.31 ,$314.77 ,$185.31 ,$344.56 ,$344.56 ,$185.31 ,$496.60 ,$352.09 ,$382.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$573.00 ,$458.40 ,$458.40 ,$185.31 ,$458.40 ,$580.64 ,$580.64 ,$580.64 ,$764.00 , N/A ,$649.40 ,$463.28 ,$496.60 ,$185.31 ,$764.00 ,$427.84 ,$185.31 ,$200.93 , N/A ,$255.75 ,$244.13 ,$194.58 ,$611.20 ,$416.95 ,$344.56 ,$213.92 ,$687.60 ,$185.31 ,$580.64 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$366.72 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$507.00 ,$329.55 ,$71.68 ,$507.00 ,$277.93 ,$233.22 ,$283.92 ,$111.17 ,$141.96 ,$178.97 ,$111.17 ,$208.88 ,$111.17 ,$228.66 ,$228.66 ,$111.17 ,$74.48 ,$211.22 ,$253.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$380.25 ,$304.20 ,$304.20 ,$111.17 ,$304.20 ,$385.32 ,$385.32 ,$385.32 ,$507.00 , N/A ,$430.95 ,$277.92 ,$329.55 ,$111.17 ,$507.00 ,$283.92 ,$111.17 ,$133.34 , N/A ,$78.85 ,$75.26 ,$116.73 ,$405.60 ,$250.12 ,$228.66 ,$141.96 ,$456.30 ,$111.17 ,$385.32 ,$220.00 ,$220.00 ,$111.17 ,$220.00 ,$243.36 ,$71.68 
ST. ELIZABETH'S HOSPITAL,41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$178.00 ,$115.70 ,$19.46 ,$178.00 , N/A ,$81.88 ,$99.68 , N/A ,$49.84 ,$62.83 , N/A ,$73.34 , N/A ,$80.28 ,$80.28 , N/A ,$19.46 , N/A ,$89.00 , N/A , N/A , N/A , N/A ,$133.50 ,$106.80 ,$106.80 , N/A ,$106.80 ,$135.28 ,$135.28 ,$135.28 ,$178.00 , N/A ,$151.30 , N/A ,$115.70 , N/A ,$178.00 ,$99.68 , N/A ,$46.81 , N/A ,$78.85 ,$75.26 , N/A ,$142.40 , N/A ,$80.28 ,$49.84 ,$160.20 , N/A ,$135.28 ,$178.00 ,$178.00 , N/A ,$178.00 ,$85.44 ,$71.68 
ST. ELIZABETH'S HOSPITAL,41000052,94660,HC CPAP,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000053,94660,HC CPAP DAILY EST PT,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$208.00 ,$135.20 ,$20.69 ,$463.28 ,$463.28 ,$95.68 ,$116.48 ,$185.31 ,$58.24 ,$73.42 ,$185.31 ,$85.70 ,$185.31 ,$93.81 ,$93.81 ,$185.31 ,$20.69 ,$208.00 ,$104.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$156.00 ,$124.80 ,$124.80 ,$185.31 ,$124.80 ,$158.08 ,$158.08 ,$158.08 ,$208.00 , N/A ,$176.80 ,$208.00 ,$135.20 ,$185.31 ,$208.00 ,$116.48 ,$185.31 ,$54.70 , N/A ,$38.06 ,$36.33 ,$194.58 ,$166.40 ,$416.95 ,$93.81 ,$58.24 ,$187.20 ,$185.31 ,$158.08 ,$208.00 ,$208.00 ,$185.31 ,$208.00 ,$99.84 ,$34.60 
ST. ELIZABETH'S HOSPITAL,41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$149.00 ,$96.85 ,$27.93 ,$277.93 ,$277.93 ,$68.54 ,$83.44 ,$111.17 ,$41.72 ,$52.60 ,$111.17 ,$61.39 ,$111.17 ,$67.20 ,$67.20 ,$111.17 ,$27.93 ,$149.00 ,$74.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$111.75 ,$89.40 ,$89.40 ,$111.17 ,$89.40 ,$113.24 ,$113.24 ,$113.24 ,$149.00 , N/A ,$126.65 ,$149.00 ,$96.85 ,$111.17 ,$149.00 ,$83.44 ,$111.17 ,$39.19 , N/A ,$149.00 ,$149.00 ,$116.73 ,$119.20 ,$250.12 ,$67.20 ,$41.72 ,$134.10 ,$111.17 ,$113.24 ,$149.00 ,$149.00 ,$111.17 ,$149.00 ,$71.52 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$149.00 ,$96.85 ,$27.93 ,$277.93 ,$277.93 ,$68.54 ,$83.44 ,$111.17 ,$41.72 ,$52.60 ,$111.17 ,$61.39 ,$111.17 ,$67.20 ,$67.20 ,$111.17 ,$27.93 ,$149.00 ,$74.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$111.75 ,$89.40 ,$89.40 ,$111.17 ,$89.40 ,$113.24 ,$113.24 ,$113.24 ,$149.00 , N/A ,$126.65 ,$149.00 ,$96.85 ,$111.17 ,$149.00 ,$83.44 ,$111.17 ,$39.19 , N/A ,$149.00 ,$149.00 ,$116.73 ,$119.20 ,$250.12 ,$67.20 ,$41.72 ,$134.10 ,$111.17 ,$113.24 ,$149.00 ,$149.00 ,$111.17 ,$149.00 ,$71.52 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$122.00 ,$79.30 ,$32.09 ,$277.93 ,$277.93 ,$56.12 ,$68.32 ,$111.17 ,$34.16 ,$41.24 ,$111.17 ,$47.46 ,$111.17 ,$55.02 ,$55.02 ,$111.17 ,$43.00 ,$122.00 ,$61.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$91.50 ,$73.20 ,$73.20 ,$111.17 ,$73.20 ,$92.72 ,$92.72 ,$92.72 ,$122.00 , N/A ,$103.70 ,$122.00 ,$79.30 ,$111.17 ,$122.00 ,$68.32 ,$111.17 ,$32.09 , N/A ,$122.00 ,$122.00 ,$116.73 ,$97.60 ,$250.12 ,$55.02 ,$34.16 ,$109.80 ,$111.17 ,$92.72 ,$122.00 ,$122.00 ,$111.17 ,$122.00 ,$58.56 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$122.00 ,$79.30 ,$32.09 ,$277.93 ,$277.93 ,$56.12 ,$68.32 ,$111.17 ,$34.16 ,$41.24 ,$111.17 ,$47.46 ,$111.17 ,$55.02 ,$55.02 ,$111.17 ,$43.00 ,$122.00 ,$61.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$91.50 ,$73.20 ,$73.20 ,$111.17 ,$73.20 ,$92.72 ,$92.72 ,$92.72 ,$122.00 , N/A ,$103.70 ,$122.00 ,$79.30 ,$111.17 ,$122.00 ,$68.32 ,$111.17 ,$32.09 , N/A ,$122.00 ,$122.00 ,$116.73 ,$97.60 ,$250.12 ,$55.02 ,$34.16 ,$109.80 ,$111.17 ,$92.72 ,$122.00 ,$122.00 ,$111.17 ,$122.00 ,$58.56 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000067,94799,HC PEP THERAPY FLUTTER,410,1 ,$499.00 ,$324.35 ,$71.68 ,$499.00 ,$344.13 ,$229.54 ,$279.44 ,$137.65 ,$139.72 ,$168.66 ,$137.65 ,$194.11 ,$137.65 ,$225.05 ,$225.05 ,$137.65 ,$324.35 ,$261.53 ,$249.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$374.25 ,$299.40 ,$299.40 ,$137.65 ,$299.40 ,$379.24 ,$379.24 ,$379.24 ,$499.00 , N/A ,$424.15 ,$344.11 ,$324.35 ,$137.65 ,$499.00 ,$279.44 ,$137.65 ,$131.24 , N/A ,$78.85 ,$75.26 ,$144.53 ,$399.20 ,$309.70 ,$225.05 ,$139.72 ,$449.10 ,$137.65 ,$379.24 ,$220.00 ,$220.00 ,$137.65 ,$220.00 ,$239.52 ,$71.68 
ST. ELIZABETH'S HOSPITAL,41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$79.00 ,$51.35 ,$12.54 ,$232.50 ,$60.90 ,$36.34 ,$44.24 ,$24.36 ,$22.12 ,$27.89 ,$24.36 ,$32.55 ,$24.36 ,$35.63 ,$35.63 ,$24.36 ,$12.54 ,$46.27 ,$39.50 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$59.25 ,$47.40 ,$47.40 ,$24.36 ,$47.40 ,$60.04 ,$60.04 ,$60.04 ,$79.00 , N/A ,$67.15 ,$60.89 ,$51.35 ,$24.36 ,$79.00 ,$44.24 ,$24.36 ,$20.78 , N/A ,$79.00 ,$79.00 ,$25.58 ,$63.20 ,$54.80 ,$35.63 ,$22.12 ,$71.10 ,$24.36 ,$60.04 ,$79.00 ,$79.00 ,$24.36 ,$79.00 ,$37.92 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000069,G0238,HC RESP THRP FUNCTION,410,1 ,$115.00 ,$74.75 ,$12.54 ,$232.50 ,$60.90 ,$52.90 ,$64.40 ,$24.36 ,$32.20 ,$40.60 ,$24.36 ,$47.38 ,$24.36 ,$51.87 ,$51.87 ,$24.36 ,$12.54 ,$46.27 ,$57.50 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$86.25 ,$69.00 ,$69.00 ,$24.36 ,$69.00 ,$87.40 ,$87.40 ,$87.40 ,$115.00 , N/A ,$97.75 ,$60.89 ,$74.75 ,$24.36 ,$115.00 ,$64.40 ,$24.36 ,$30.25 , N/A ,$115.00 ,$115.00 ,$25.58 ,$92.00 ,$54.80 ,$51.87 ,$32.20 ,$103.50 ,$24.36 ,$87.40 ,$115.00 ,$115.00 ,$24.36 ,$115.00 ,$55.20 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$115.00 ,$74.75 ,$2.25 ,$115.00 ,$83.43 ,$52.90 ,$64.40 ,$33.37 ,$32.20 ,$40.60 ,$33.37 ,$47.38 ,$33.37 ,$51.87 ,$51.87 ,$33.37 ,$15.80 ,$63.41 ,$57.50 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$86.25 ,$69.00 ,$69.00 ,$33.37 ,$69.00 ,$87.40 ,$87.40 ,$87.40 ,$115.00 , N/A ,$97.75 ,$83.43 ,$74.75 ,$33.37 ,$115.00 ,$64.40 ,$33.37 ,$30.25 , N/A ,$2.48 ,$2.36 ,$35.04 ,$92.00 ,$75.08 ,$51.87 ,$32.20 ,$103.50 ,$33.37 ,$87.40 ,$115.00 ,$115.00 ,$33.37 ,$115.00 ,$55.20 ,$2.25 
ST. ELIZABETH'S HOSPITAL,41000073,94660,HC VENT NONINVAS NEON SUBQ DAY,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000074,94640,HC IPPB SUBSQ,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000075,94640,HC IPV INIT,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000076,94640,HC NEBULIZER SUBSQ,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000077,94762,HC PULSE OX PER DAY,410,1 ,$652.00 ,$423.80 ,$32.10 ,$652.00 ,$344.13 ,$299.92 ,$365.12 ,$137.65 ,$182.56 ,$230.16 ,$137.65 ,$268.62 ,$137.65 ,$294.05 ,$294.05 ,$137.65 ,$32.10 ,$261.53 ,$326.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$489.00 ,$391.20 ,$391.20 ,$137.65 ,$391.20 ,$495.52 ,$495.52 ,$495.52 ,$652.00 , N/A ,$554.20 ,$344.11 ,$423.80 ,$137.65 ,$652.00 ,$365.12 ,$137.65 ,$171.48 , N/A ,$78.85 ,$75.26 ,$144.53 ,$521.60 ,$309.70 ,$294.05 ,$182.56 ,$586.80 ,$137.65 ,$495.52 ,$220.00 ,$220.00 ,$137.65 ,$220.00 ,$312.96 ,$71.68 
ST. ELIZABETH'S HOSPITAL,41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$390.00 ,$253.50 ,$49.31 ,$702.00 ,$463.28 ,$179.40 ,$218.40 ,$185.31 ,$109.20 ,$137.67 ,$185.31 ,$160.68 ,$185.31 ,$175.89 ,$175.89 ,$185.31 ,$49.31 ,$352.09 ,$195.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$292.50 ,$234.00 ,$234.00 ,$185.31 ,$234.00 ,$296.40 ,$296.40 ,$296.40 ,$390.00 , N/A ,$331.50 ,$390.00 ,$253.50 ,$185.31 ,$390.00 ,$218.40 ,$185.31 ,$102.57 , N/A ,$390.00 ,$390.00 ,$194.58 ,$312.00 ,$416.95 ,$175.89 ,$109.20 ,$351.00 ,$185.31 ,$296.40 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$187.20 ,$702.00 
ST. ELIZABETH'S HOSPITAL,41000086,94640,HC IPV SUBSQ,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000087,94669,HC MECHANICAL CHEST WALL OSCILLATION INITIAL,410,1 ,$764.00 ,$496.60 ,$2.25 ,$764.00 ,$463.28 ,$351.44 ,$427.84 ,$185.31 ,$213.92 ,$258.23 ,$185.31 ,$297.20 ,$185.31 ,$344.56 ,$344.56 ,$185.31 ,$23.04 ,$352.09 ,$382.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$573.00 ,$458.40 ,$458.40 ,$185.31 ,$458.40 ,$580.64 ,$580.64 ,$580.64 ,$764.00 , N/A ,$649.40 ,$463.28 ,$496.60 ,$185.31 ,$764.00 ,$427.84 ,$185.31 ,$200.93 , N/A ,$2.48 ,$2.36 ,$194.58 ,$611.20 ,$416.95 ,$344.56 ,$213.92 ,$687.60 ,$185.31 ,$580.64 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$366.72 ,$2.25 
ST. ELIZABETH'S HOSPITAL,41000088,94669,HC MECHANICAL CHEST WALL OSCILLATION SUBSQ,410,1 ,$764.00 ,$496.60 ,$2.25 ,$764.00 ,$463.28 ,$351.44 ,$427.84 ,$185.31 ,$213.92 ,$258.23 ,$185.31 ,$297.20 ,$185.31 ,$344.56 ,$344.56 ,$185.31 ,$23.04 ,$352.09 ,$382.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$573.00 ,$458.40 ,$458.40 ,$185.31 ,$458.40 ,$580.64 ,$580.64 ,$580.64 ,$764.00 , N/A ,$649.40 ,$463.28 ,$496.60 ,$185.31 ,$764.00 ,$427.84 ,$185.31 ,$200.93 , N/A ,$2.48 ,$2.36 ,$194.58 ,$611.20 ,$416.95 ,$344.56 ,$213.92 ,$687.60 ,$185.31 ,$580.64 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$366.72 ,$2.25 
ST. ELIZABETH'S HOSPITAL,41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000091,94640,HC AEROSOL INHALATION INIT,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000092,94640,HC AEROSOL INHALATION SUBSQ,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000093,94640,HC HELIOX INIT,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41000094,94640,HC HELIOX SUBSQ,410,1 ,$250.00 ,$162.50 ,$13.76 ,$463.28 ,$463.28 ,$115.00 ,$140.00 ,$185.31 ,$70.00 ,$88.25 ,$185.31 ,$103.00 ,$185.31 ,$112.75 ,$112.75 ,$185.31 ,$13.76 ,$250.00 ,$125.00 ,$463.28 ,$185.31 ,$185.31 ,$189.02 ,$187.50 ,$150.00 ,$150.00 ,$185.31 ,$150.00 ,$190.00 ,$190.00 ,$190.00 ,$250.00 , N/A ,$212.50 ,$250.00 ,$162.50 ,$185.31 ,$250.00 ,$140.00 ,$185.31 ,$65.75 , N/A ,$250.00 ,$244.13 ,$194.58 ,$200.00 ,$416.95 ,$112.75 ,$70.00 ,$225.00 ,$185.31 ,$190.00 ,$220.00 ,$220.00 ,$185.31 ,$220.00 ,$120.00 ,$232.50 
ST. ELIZABETH'S HOSPITAL,41300000,99183,HC HYPERBARIC O2 PER SESSION,413,1 ,"$1,790.00 ","$1,163.50 ",$141.03 ,"$1,790.00 ", N/A ,$823.40 ,"$1,002.40 ", N/A ,$501.20 ,$631.87 , N/A ,$737.48 , N/A ,$807.29 ,$807.29 , N/A ,$141.03 , N/A ,$895.00 , N/A , N/A , N/A , N/A ,"$1,342.50 ","$1,074.00 ","$1,074.00 ", N/A ,"$1,074.00 ","$1,360.40 ","$1,360.40 ","$1,360.40 ","$1,790.00 ", N/A ,"$1,521.50 ", N/A ,"$1,163.50 ", N/A ,"$1,790.00 ","$1,002.40 ", N/A ,$470.77 , N/A , N/A , N/A , N/A ,"$1,432.00 ", N/A ,$807.29 ,$501.20 ,"$1,611.00 ", N/A ,"$1,360.40 ",$550.00 ,$550.00 , N/A ,$550.00 ,$859.20 , N/A 
ST. ELIZABETH'S HOSPITAL,41300002,G0277,HC HYPERBARIC O2 PER 30 MIN,413,1 ,"$1,274.00 ",$828.10 ,$117.58 ,"$1,274.00 ",$293.95 ,$586.04 ,$713.44 ,$117.58 ,$356.72 ,$430.61 ,$117.58 ,$495.59 ,$117.58 ,$574.57 ,$574.57 ,$117.58 ,$213.33 ,$223.39 ,$637.00 ,$293.94 ,$117.58 ,$117.58 ,$119.93 ,$955.50 ,$764.40 ,$764.40 ,$117.58 ,$764.40 ,$968.24 ,$968.24 ,$968.24 ,"$1,274.00 ", N/A ,"$1,082.90 ",$293.94 ,$828.10 ,$117.58 ,"$1,274.00 ",$713.44 ,$117.58 ,$335.06 , N/A ,$522.47 ,$498.72 ,$123.46 ,"$1,019.20 ",$264.55 ,$574.57 ,$356.72 ,"$1,146.60 ",$117.58 ,$968.24 ,$550.00 ,$550.00 ,$117.58 ,$550.00 ,$611.52 ,$474.97 
ST. ELIZABETH'S HOSPITAL,42000016,97022,HC WHIRLPOOL 15 MINUTES,420,1 ,$193.00 ,$125.45 ,$17.22 ,$193.00 ,$43.05 ,$155.00 ,$108.08 ,$17.22 ,$54.04 ,$68.13 ,$17.22 ,$79.52 ,$17.22 ,$87.04 ,$87.04 ,$17.22 ,$21.53 ,$32.72 ,$96.50 ,$43.05 ,$17.22 ,$17.22 ,$17.56 ,$144.75 ,$115.80 ,$115.80 ,$17.22 ,$115.80 ,$189.00 ,$189.00 ,$189.00 ,$193.00 , N/A ,$164.05 ,$43.05 ,$125.45 ,$17.22 ,$193.00 ,$108.08 ,$17.22 ,$50.76 , N/A ,$29.12 ,$27.79 ,$18.08 ,$154.40 ,$38.75 ,$87.04 ,$54.04 ,$173.70 ,$17.22 ,$171.00 ,$193.00 ,$193.00 ,$17.22 ,$193.00 ,$92.64 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000017,97022,HC WHIRLPOOL 30 MINUTES,420,1 ,$193.00 ,$125.45 ,$17.22 ,$193.00 ,$43.05 ,$155.00 ,$108.08 ,$17.22 ,$54.04 ,$68.13 ,$17.22 ,$79.52 ,$17.22 ,$87.04 ,$87.04 ,$17.22 ,$21.53 ,$32.72 ,$96.50 ,$43.05 ,$17.22 ,$17.22 ,$17.56 ,$144.75 ,$115.80 ,$115.80 ,$17.22 ,$115.80 ,$189.00 ,$189.00 ,$189.00 ,$193.00 , N/A ,$164.05 ,$43.05 ,$125.45 ,$17.22 ,$193.00 ,$108.08 ,$17.22 ,$50.76 , N/A ,$29.12 ,$27.79 ,$18.08 ,$154.40 ,$38.75 ,$87.04 ,$54.04 ,$173.70 ,$17.22 ,$171.00 ,$193.00 ,$193.00 ,$17.22 ,$193.00 ,$92.64 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000018,97022,HC WHIRLPOOL 45 MINUTES,420,1 ,$193.00 ,$125.45 ,$17.22 ,$193.00 ,$43.05 ,$155.00 ,$108.08 ,$17.22 ,$54.04 ,$68.13 ,$17.22 ,$79.52 ,$17.22 ,$87.04 ,$87.04 ,$17.22 ,$21.53 ,$32.72 ,$96.50 ,$43.05 ,$17.22 ,$17.22 ,$17.56 ,$144.75 ,$115.80 ,$115.80 ,$17.22 ,$115.80 ,$189.00 ,$189.00 ,$189.00 ,$193.00 , N/A ,$164.05 ,$43.05 ,$125.45 ,$17.22 ,$193.00 ,$108.08 ,$17.22 ,$50.76 , N/A ,$29.12 ,$27.79 ,$18.08 ,$154.40 ,$38.75 ,$87.04 ,$54.04 ,$173.70 ,$17.22 ,$171.00 ,$193.00 ,$193.00 ,$17.22 ,$193.00 ,$92.64 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000019,97022,HC WHIRLPOOL 60 MINUTES,420,1 ,$193.00 ,$125.45 ,$17.22 ,$193.00 ,$43.05 ,$155.00 ,$108.08 ,$17.22 ,$54.04 ,$68.13 ,$17.22 ,$79.52 ,$17.22 ,$87.04 ,$87.04 ,$17.22 ,$21.53 ,$32.72 ,$96.50 ,$43.05 ,$17.22 ,$17.22 ,$17.56 ,$144.75 ,$115.80 ,$115.80 ,$17.22 ,$115.80 ,$189.00 ,$189.00 ,$189.00 ,$193.00 , N/A ,$164.05 ,$43.05 ,$125.45 ,$17.22 ,$193.00 ,$108.08 ,$17.22 ,$50.76 , N/A ,$29.12 ,$27.79 ,$18.08 ,$154.40 ,$38.75 ,$87.04 ,$54.04 ,$173.70 ,$17.22 ,$171.00 ,$193.00 ,$193.00 ,$17.22 ,$193.00 ,$92.64 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$193.00 ,$125.45 ,$14.77 ,$323.94 ,$36.93 ,$155.00 ,$108.08 ,$14.77 ,$54.04 ,$68.13 ,$14.77 ,$79.52 ,$14.77 ,$87.04 ,$87.04 ,$14.77 ,$18.46 ,$28.06 ,$96.50 ,$36.93 ,$14.77 ,$14.77 ,$15.07 ,$144.75 ,$115.80 ,$115.80 ,$14.77 ,$115.80 ,$189.00 ,$189.00 ,$189.00 ,$193.00 , N/A ,$164.05 ,$36.93 ,$125.45 ,$14.77 ,$193.00 ,$108.08 ,$14.77 ,$50.76 , N/A ,$193.00 ,$193.00 ,$15.51 ,$154.40 ,$33.23 ,$87.04 ,$54.04 ,$173.70 ,$14.77 ,$171.00 ,$193.00 ,$193.00 ,$14.77 ,$193.00 ,$92.64 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$224.00 ,$145.60 ,$19.68 ,$323.94 ,$49.20 ,$155.00 ,$125.44 ,$19.68 ,$62.72 ,$79.07 ,$19.68 ,$92.29 ,$19.68 ,$101.02 ,$101.02 ,$19.68 ,$24.60 ,$37.39 ,$112.00 ,$49.20 ,$19.68 ,$19.68 ,$20.07 ,$168.00 ,$134.40 ,$134.40 ,$19.68 ,$134.40 ,$189.00 ,$189.00 ,$189.00 ,$224.00 , N/A ,$190.40 ,$49.20 ,$145.60 ,$19.68 ,$224.00 ,$125.44 ,$19.68 ,$58.91 , N/A ,$224.00 ,$224.00 ,$20.66 ,$179.20 ,$44.28 ,$101.02 ,$62.72 ,$201.60 ,$19.68 ,$171.00 ,$215.00 ,$215.00 ,$19.68 ,$215.00 ,$107.52 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$201.00 ,$130.65 ,$14.36 ,$323.94 ,$35.90 ,$155.00 ,$112.56 ,$14.36 ,$56.28 ,$70.95 ,$14.36 ,$82.81 ,$14.36 ,$90.65 ,$90.65 ,$14.36 ,$17.95 ,$27.28 ,$100.50 ,$35.90 ,$14.36 ,$14.36 ,$14.65 ,$150.75 ,$120.60 ,$120.60 ,$14.36 ,$120.60 ,$189.00 ,$189.00 ,$189.00 ,$201.00 , N/A ,$170.85 ,$35.90 ,$130.65 ,$14.36 ,$201.00 ,$112.56 ,$14.36 ,$52.86 , N/A ,$201.00 ,$201.00 ,$15.08 ,$160.80 ,$32.31 ,$90.65 ,$56.28 ,$180.90 ,$14.36 ,$171.00 ,$201.00 ,$201.00 ,$14.36 ,$201.00 ,$96.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$155.00 ,$100.75 ,$29.76 ,$323.94 ,$74.40 ,$155.00 ,$86.80 ,$29.76 ,$43.40 ,$54.72 ,$29.76 ,$63.86 ,$29.76 ,$69.91 ,$69.91 ,$29.76 ,$37.20 ,$56.54 ,$77.50 ,$74.40 ,$29.76 ,$29.76 ,$30.36 ,$116.25 ,$93.00 ,$93.00 ,$29.76 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$74.40 ,$100.75 ,$29.76 ,$155.00 ,$86.80 ,$29.76 ,$40.77 , N/A ,$155.00 ,$155.00 ,$31.25 ,$124.00 ,$66.96 ,$69.91 ,$43.40 ,$139.50 ,$29.76 ,$155.00 ,$155.00 ,$155.00 ,$29.76 ,$155.00 ,$74.40 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$196.00 ,$127.40 ,$34.43 ,$323.94 ,$86.08 ,$155.00 ,$109.76 ,$34.43 ,$54.88 ,$69.19 ,$34.43 ,$80.75 ,$34.43 ,$88.40 ,$88.40 ,$34.43 ,$43.04 ,$65.42 ,$98.00 ,$86.08 ,$34.43 ,$34.43 ,$35.12 ,$147.00 ,$117.60 ,$117.60 ,$34.43 ,$117.60 ,$189.00 ,$189.00 ,$189.00 ,$196.00 , N/A ,$166.60 ,$86.08 ,$127.40 ,$34.43 ,$196.00 ,$109.76 ,$34.43 ,$51.55 , N/A ,$196.00 ,$196.00 ,$36.15 ,$156.80 ,$77.47 ,$88.40 ,$54.88 ,$176.40 ,$34.43 ,$171.00 ,$196.00 ,$196.00 ,$34.43 ,$196.00 ,$94.08 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$196.00 ,$127.40 ,$29.76 ,$323.94 ,$74.40 ,$155.00 ,$109.76 ,$29.76 ,$54.88 ,$69.19 ,$29.76 ,$80.75 ,$29.76 ,$88.40 ,$88.40 ,$29.76 ,$37.20 ,$56.54 ,$98.00 ,$74.40 ,$29.76 ,$29.76 ,$30.36 ,$147.00 ,$117.60 ,$117.60 ,$29.76 ,$117.60 ,$189.00 ,$189.00 ,$189.00 ,$196.00 , N/A ,$166.60 ,$74.40 ,$127.40 ,$29.76 ,$196.00 ,$109.76 ,$29.76 ,$51.55 , N/A ,$196.00 ,$196.00 ,$31.25 ,$156.80 ,$66.96 ,$88.40 ,$54.88 ,$176.40 ,$29.76 ,$171.00 ,$196.00 ,$196.00 ,$29.76 ,$196.00 ,$94.08 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$169.00 ,$109.85 ,$29.64 ,$323.94 ,$74.10 ,$155.00 ,$94.64 ,$29.64 ,$47.32 ,$59.66 ,$29.64 ,$69.63 ,$29.64 ,$76.22 ,$76.22 ,$29.64 ,$37.05 ,$56.32 ,$84.50 ,$74.10 ,$29.64 ,$29.64 ,$30.23 ,$126.75 ,$101.40 ,$101.40 ,$29.64 ,$101.40 ,$169.00 ,$169.00 ,$169.00 ,$169.00 , N/A ,$143.65 ,$74.10 ,$109.85 ,$29.64 ,$169.00 ,$94.64 ,$29.64 ,$44.45 , N/A ,$169.00 ,$169.00 ,$31.12 ,$135.20 ,$66.69 ,$76.22 ,$47.32 ,$152.10 ,$29.64 ,$169.00 ,$169.00 ,$169.00 ,$29.64 ,$169.00 ,$81.12 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$168.00 ,$109.20 ,$27.44 ,$323.94 ,$68.60 ,$155.00 ,$94.08 ,$27.44 ,$47.04 ,$59.30 ,$27.44 ,$69.22 ,$27.44 ,$75.77 ,$75.77 ,$27.44 ,$34.30 ,$52.14 ,$84.00 ,$68.60 ,$27.44 ,$27.44 ,$27.99 ,$126.00 ,$100.80 ,$100.80 ,$27.44 ,$100.80 ,$168.00 ,$168.00 ,$168.00 ,$168.00 , N/A ,$142.80 ,$68.60 ,$109.20 ,$27.44 ,$168.00 ,$94.08 ,$27.44 ,$44.18 , N/A ,$168.00 ,$168.00 ,$28.81 ,$134.40 ,$61.74 ,$75.77 ,$47.04 ,$151.20 ,$27.44 ,$168.00 ,$168.00 ,$168.00 ,$27.44 ,$168.00 ,$80.64 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000063,97150,HC GROUP TREATMENT 15MIN,420,1 ,$137.00 ,$89.05 ,$17.78 ,$137.00 ,$44.45 ,$137.00 ,$76.72 ,$17.78 ,$38.36 ,$48.36 ,$17.78 ,$56.44 ,$17.78 ,$61.79 ,$61.79 ,$17.78 ,$22.23 ,$33.78 ,$68.50 ,$44.45 ,$17.78 ,$17.78 ,$18.14 ,$102.75 ,$82.20 ,$82.20 ,$17.78 ,$82.20 ,$137.00 ,$137.00 ,$137.00 ,$137.00 , N/A ,$116.45 ,$44.45 ,$89.05 ,$17.78 ,$137.00 ,$76.72 ,$17.78 ,$36.03 , N/A ,$116.26 ,$110.97 ,$18.67 ,$109.60 ,$40.01 ,$61.79 ,$38.36 ,$123.30 ,$17.78 ,$137.00 ,$137.00 ,$137.00 ,$17.78 ,$137.00 ,$65.76 ,$105.69 
ST. ELIZABETH'S HOSPITAL,42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$160.00 ,$104.00 ,$37.24 ,$323.94 ,$93.10 ,$155.00 ,$89.60 ,$37.24 ,$44.80 ,$56.48 ,$37.24 ,$65.92 ,$37.24 ,$72.16 ,$72.16 ,$37.24 ,$46.55 ,$70.76 ,$80.00 ,$93.10 ,$37.24 ,$37.24 ,$37.98 ,$120.00 ,$96.00 ,$96.00 ,$37.24 ,$96.00 ,$160.00 ,$160.00 ,$160.00 ,$160.00 , N/A ,$136.00 ,$93.10 ,$104.00 ,$37.24 ,$160.00 ,$89.60 ,$37.24 ,$42.08 , N/A ,$160.00 ,$160.00 ,$39.10 ,$128.00 ,$83.79 ,$72.16 ,$44.80 ,$144.00 ,$37.24 ,$160.00 ,$160.00 ,$160.00 ,$37.24 ,$160.00 ,$76.80 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000083,97598,HC DEBR SKIN PART THICKNESS EA ADDN>20CM FACIL,420,1 ,$935.00 ,$607.75 ,$33.59 ,$935.00 , N/A ,$155.00 ,$523.60 , N/A ,$261.80 ,$90.47 , N/A ,$90.47 , N/A ,$421.69 ,$421.69 , N/A ,$33.59 , N/A ,$467.50 , N/A , N/A , N/A , N/A ,$701.25 ,$561.00 ,$561.00 , N/A ,$561.00 ,$189.00 ,$189.00 ,$189.00 ,$935.00 , N/A ,$794.75 , N/A ,$607.75 , N/A ,$935.00 ,$523.60 , N/A ,$245.91 , N/A ,$125.92 ,$120.19 , N/A ,$748.00 , N/A ,$421.69 ,$261.80 ,$841.50 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$448.80 ,$114.47 
ST. ELIZABETH'S HOSPITAL,42000084,97602,HC DEBRIDEMENT NONSELECTIVE,420,1 ,$586.00 ,$380.90 ,$154.12 ,$586.00 , N/A ,$155.00 ,$328.16 , N/A ,$164.08 ,$206.86 , N/A ,$241.43 , N/A ,$264.29 ,$264.29 , N/A ,$380.90 , N/A ,$293.00 , N/A , N/A , N/A , N/A ,$439.50 ,$351.60 ,$351.60 , N/A ,$351.60 ,$189.00 ,$189.00 ,$189.00 ,$586.00 , N/A ,$498.10 , N/A ,$380.90 , N/A ,$586.00 ,$328.16 , N/A ,$154.12 , N/A ,$303.34 ,$289.55 , N/A ,$468.80 , N/A ,$264.29 ,$164.08 ,$527.40 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$281.28 ,$275.76 
ST. ELIZABETH'S HOSPITAL,42000085,97605,HC NWPT <50 SQ CM FAC,420,1 ,$685.00 ,$445.25 ,$31.75 ,$685.00 ,$105.88 ,$155.00 ,$383.60 ,$42.35 ,$191.80 ,$208.50 ,$42.35 ,$208.50 ,$42.35 ,$308.94 ,$308.94 ,$42.35 ,$31.75 ,$80.47 ,$342.50 ,$105.88 ,$42.35 ,$42.35 ,$43.20 ,$513.75 ,$411.00 ,$411.00 ,$42.35 ,$411.00 ,$189.00 ,$189.00 ,$189.00 ,$685.00 , N/A ,$582.25 ,$105.88 ,$445.25 ,$42.35 ,$685.00 ,$383.60 ,$42.35 ,$180.16 , N/A ,$303.34 ,$289.55 ,$44.47 ,$548.00 ,$95.29 ,$308.94 ,$191.80 ,$616.50 ,$42.35 ,$171.00 ,$215.00 ,$215.00 ,$42.35 ,$215.00 ,$328.80 ,$275.76 
ST. ELIZABETH'S HOSPITAL,42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$973.00 ,$632.45 ,$34.73 ,$973.00 ,$124.88 ,$155.00 ,$544.88 ,$49.95 ,$272.44 ,$225.01 ,$49.95 ,$225.01 ,$49.95 ,$438.82 ,$438.82 ,$49.95 ,$34.73 ,$94.91 ,$486.50 ,$124.88 ,$49.95 ,$49.95 ,$50.95 ,$729.75 ,$583.80 ,$583.80 ,$49.95 ,$583.80 ,$189.00 ,$189.00 ,$189.00 ,$973.00 , N/A ,$827.05 ,$124.88 ,$632.45 ,$49.95 ,$973.00 ,$544.88 ,$49.95 ,$255.90 , N/A ,$303.34 ,$289.55 ,$52.45 ,$778.40 ,$112.39 ,$438.82 ,$272.44 ,$875.70 ,$49.95 ,$171.00 ,$215.00 ,$215.00 ,$49.95 ,$215.00 ,$467.04 ,$275.76 
ST. ELIZABETH'S HOSPITAL,42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$150.00 ,$97.50 ,$33.67 ,$323.94 ,$84.18 ,$69.00 ,$84.00 ,$33.67 ,$42.00 ,$52.95 ,$33.67 ,$61.80 ,$33.67 ,$67.65 ,$67.65 ,$33.67 ,$42.09 ,$63.97 ,$75.00 ,$84.18 ,$33.67 ,$33.67 ,$34.34 ,$112.50 ,$90.00 ,$90.00 ,$33.67 ,$90.00 ,$150.00 ,$150.00 ,$150.00 ,$150.00 , N/A ,$127.50 ,$84.18 ,$97.50 ,$33.67 ,$150.00 ,$84.00 ,$33.67 ,$39.45 , N/A ,$150.00 ,$150.00 ,$35.35 ,$120.00 ,$75.76 ,$67.65 ,$42.00 ,$135.00 ,$33.67 ,$150.00 ,$150.00 ,$150.00 ,$33.67 ,$150.00 ,$72.00 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000094,97761,HC PROSTHETIC TRAINING EA 15 MIN,420,1 ,$197.00 ,$128.05 ,$41.60 ,$323.94 ,$104.00 ,$155.00 ,$110.32 ,$41.60 ,$55.16 ,$69.54 ,$41.60 ,$81.16 ,$41.60 ,$88.85 ,$88.85 ,$41.60 ,$52.00 ,$79.04 ,$98.50 ,$104.00 ,$41.60 ,$41.60 ,$42.43 ,$147.75 ,$118.20 ,$118.20 ,$41.60 ,$118.20 ,$189.00 ,$189.00 ,$189.00 ,$197.00 , N/A ,$167.45 ,$104.00 ,$128.05 ,$41.60 ,$197.00 ,$110.32 ,$41.60 ,$51.81 , N/A ,$197.00 ,$197.00 ,$43.68 ,$157.60 ,$93.60 ,$88.85 ,$55.16 ,$177.30 ,$41.60 ,$171.00 ,$197.00 ,$197.00 ,$41.60 ,$197.00 ,$94.56 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000095,97763,HC ORTHTC/PRSTHTC CHECK EA 15MIN,420,1 ,$108.00 ,$70.20 ,$28.40 ,$323.94 ,$134.05 ,$108.00 ,$60.48 ,$53.62 ,$30.24 ,$38.12 ,$53.62 ,$44.50 ,$53.62 ,$48.71 ,$48.71 ,$53.62 ,$67.03 ,$101.88 ,$54.00 ,$134.05 ,$53.62 ,$53.62 ,$54.69 ,$81.00 ,$64.80 ,$64.80 ,$53.62 ,$64.80 ,$108.00 ,$108.00 ,$108.00 ,$108.00 , N/A ,$91.80 ,$108.00 ,$70.20 ,$53.62 ,$108.00 ,$60.48 ,$53.62 ,$28.40 , N/A ,$108.00 ,$108.00 ,$56.30 ,$86.40 ,$120.65 ,$48.71 ,$30.24 ,$97.20 ,$53.62 ,$108.00 ,$108.00 ,$108.00 ,$53.62 ,$108.00 ,$51.84 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000160,97113,HC THERAPEUTIC ACT W/AQUA,420,1 ,$178.00 ,$115.70 ,$36.99 ,$323.94 ,$92.48 ,$155.00 ,$99.68 ,$36.99 ,$49.84 ,$62.83 ,$36.99 ,$73.34 ,$36.99 ,$80.28 ,$80.28 ,$36.99 ,$46.24 ,$70.28 ,$89.00 ,$92.48 ,$36.99 ,$36.99 ,$37.73 ,$133.50 ,$106.80 ,$106.80 ,$36.99 ,$106.80 ,$178.00 ,$178.00 ,$178.00 ,$178.00 , N/A ,$151.30 ,$92.48 ,$115.70 ,$36.99 ,$178.00 ,$99.68 ,$36.99 ,$46.81 , N/A ,$178.00 ,$178.00 ,$38.84 ,$142.40 ,$83.23 ,$80.28 ,$49.84 ,$160.20 ,$36.99 ,$171.00 ,$178.00 ,$178.00 ,$36.99 ,$178.00 ,$85.44 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42000161,97024,HC DIATHERMY,420,1 ,$175.00 ,$113.75 ,$7.22 ,$175.00 ,$18.05 ,$155.00 ,$98.00 ,$7.22 ,$49.00 ,$61.78 ,$7.22 ,$63.99 ,$7.22 ,$78.93 ,$78.93 ,$7.22 ,$9.03 ,$13.72 ,$87.50 ,$18.05 ,$7.22 ,$7.22 ,$7.36 ,$131.25 ,$105.00 ,$105.00 ,$7.22 ,$105.00 ,$175.00 ,$175.00 ,$175.00 ,$175.00 , N/A ,$148.75 ,$18.05 ,$113.75 ,$7.22 ,$175.00 ,$98.00 ,$7.22 ,$46.03 , N/A ,$29.12 ,$27.79 ,$7.58 ,$140.00 ,$16.25 ,$78.93 ,$49.00 ,$157.50 ,$7.22 ,$171.00 ,$175.00 ,$175.00 ,$7.22 ,$175.00 ,$84.00 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000204,97010,HC HOT/COLD PACK 15MIN,420,1 ,$87.00 ,$56.55 ,$22.88 ,$87.00 , N/A ,$87.00 ,$48.72 , N/A ,$24.36 ,$24.90 , N/A ,$24.90 , N/A ,$39.24 ,$39.24 , N/A ,$56.55 , N/A ,$43.50 , N/A , N/A , N/A , N/A ,$65.25 ,$52.20 ,$52.20 , N/A ,$52.20 ,$87.00 ,$87.00 ,$87.00 ,$87.00 , N/A ,$73.95 , N/A ,$56.55 , N/A ,$87.00 ,$48.72 , N/A ,$22.88 , N/A ,$29.12 ,$27.79 , N/A ,$69.60 , N/A ,$39.24 ,$24.36 ,$78.30 , N/A ,$87.00 ,$87.00 ,$87.00 , N/A ,$87.00 ,$41.76 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000205,97010,HC HOT/COLD PACK 30MIN,420,1 ,$87.00 ,$56.55 ,$22.88 ,$87.00 , N/A ,$87.00 ,$48.72 , N/A ,$24.36 ,$24.90 , N/A ,$24.90 , N/A ,$39.24 ,$39.24 , N/A ,$56.55 , N/A ,$43.50 , N/A , N/A , N/A , N/A ,$65.25 ,$52.20 ,$52.20 , N/A ,$52.20 ,$87.00 ,$87.00 ,$87.00 ,$87.00 , N/A ,$73.95 , N/A ,$56.55 , N/A ,$87.00 ,$48.72 , N/A ,$22.88 , N/A ,$29.12 ,$27.79 , N/A ,$69.60 , N/A ,$39.24 ,$24.36 ,$78.30 , N/A ,$87.00 ,$87.00 ,$87.00 , N/A ,$87.00 ,$41.76 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000206,G0283,HC ELECT STIM (UNATTEND) OTHER 15MIN,420,1 ,$277.00 ,$180.05 ,$12.35 ,$277.00 ,$30.88 ,$155.00 ,$155.12 ,$12.35 ,$77.56 ,$83.00 ,$12.35 ,$83.00 ,$12.35 ,$124.93 ,$124.93 ,$12.35 ,$15.44 ,$23.47 ,$138.50 ,$30.88 ,$12.35 ,$12.35 ,$12.60 ,$207.75 ,$166.20 ,$166.20 ,$12.35 ,$166.20 ,$189.00 ,$189.00 ,$189.00 ,$277.00 , N/A ,$235.45 ,$30.88 ,$180.05 ,$12.35 ,$277.00 ,$155.12 ,$12.35 ,$72.85 , N/A ,$29.12 ,$27.79 ,$12.97 ,$221.60 ,$27.79 ,$124.93 ,$77.56 ,$249.30 ,$12.35 ,$171.00 ,$215.00 ,$215.00 ,$12.35 ,$215.00 ,$132.96 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000207,G0283,HC ELECT STIM (UNATTEND) OTHER 30MIN,420,1 ,$277.00 ,$180.05 ,$12.35 ,$277.00 ,$30.88 ,$155.00 ,$155.12 ,$12.35 ,$77.56 ,$83.00 ,$12.35 ,$83.00 ,$12.35 ,$124.93 ,$124.93 ,$12.35 ,$15.44 ,$23.47 ,$138.50 ,$30.88 ,$12.35 ,$12.35 ,$12.60 ,$207.75 ,$166.20 ,$166.20 ,$12.35 ,$166.20 ,$189.00 ,$189.00 ,$189.00 ,$277.00 , N/A ,$235.45 ,$30.88 ,$180.05 ,$12.35 ,$277.00 ,$155.12 ,$12.35 ,$72.85 , N/A ,$29.12 ,$27.79 ,$12.97 ,$221.60 ,$27.79 ,$124.93 ,$77.56 ,$249.30 ,$12.35 ,$171.00 ,$215.00 ,$215.00 ,$12.35 ,$215.00 ,$132.96 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000208,G0283,HC ELECT STIM (UNATTEND) OTHER 45MIN,420,1 ,$277.00 ,$180.05 ,$12.35 ,$277.00 ,$30.88 ,$155.00 ,$155.12 ,$12.35 ,$77.56 ,$83.00 ,$12.35 ,$83.00 ,$12.35 ,$124.93 ,$124.93 ,$12.35 ,$15.44 ,$23.47 ,$138.50 ,$30.88 ,$12.35 ,$12.35 ,$12.60 ,$207.75 ,$166.20 ,$166.20 ,$12.35 ,$166.20 ,$189.00 ,$189.00 ,$189.00 ,$277.00 , N/A ,$235.45 ,$30.88 ,$180.05 ,$12.35 ,$277.00 ,$155.12 ,$12.35 ,$72.85 , N/A ,$29.12 ,$27.79 ,$12.97 ,$221.60 ,$27.79 ,$124.93 ,$77.56 ,$249.30 ,$12.35 ,$171.00 ,$215.00 ,$215.00 ,$12.35 ,$215.00 ,$132.96 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000209,G0283,HC ELECT STIM (UNATTEND) OTHER 60MIN,420,1 ,$277.00 ,$180.05 ,$12.35 ,$277.00 ,$30.88 ,$155.00 ,$155.12 ,$12.35 ,$77.56 ,$83.00 ,$12.35 ,$83.00 ,$12.35 ,$124.93 ,$124.93 ,$12.35 ,$15.44 ,$23.47 ,$138.50 ,$30.88 ,$12.35 ,$12.35 ,$12.60 ,$207.75 ,$166.20 ,$166.20 ,$12.35 ,$166.20 ,$189.00 ,$189.00 ,$189.00 ,$277.00 , N/A ,$235.45 ,$30.88 ,$180.05 ,$12.35 ,$277.00 ,$155.12 ,$12.35 ,$72.85 , N/A ,$29.12 ,$27.79 ,$12.97 ,$221.60 ,$27.79 ,$124.93 ,$77.56 ,$249.30 ,$12.35 ,$171.00 ,$215.00 ,$215.00 ,$12.35 ,$215.00 ,$132.96 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000210,97016,HC APPLY VASOPNEUMATIC DEVICE 15MIN,420,1 ,$90.00 ,$58.50 ,$12.02 ,$90.00 ,$30.05 ,$90.00 ,$50.40 ,$12.02 ,$25.20 ,$31.77 ,$12.02 ,$37.08 ,$12.02 ,$40.59 ,$40.59 ,$12.02 ,$15.03 ,$22.84 ,$45.00 ,$30.05 ,$12.02 ,$12.02 ,$12.26 ,$67.50 ,$54.00 ,$54.00 ,$12.02 ,$54.00 ,$90.00 ,$90.00 ,$90.00 ,$90.00 , N/A ,$76.50 ,$30.05 ,$58.50 ,$12.02 ,$90.00 ,$50.40 ,$12.02 ,$23.67 , N/A ,$29.12 ,$27.79 ,$12.62 ,$72.00 ,$27.05 ,$40.59 ,$25.20 ,$81.00 ,$12.02 ,$90.00 ,$90.00 ,$90.00 ,$12.02 ,$90.00 ,$43.20 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000211,97016,HC APPLY VASOPNEUMATIC DEVICE 30MIN,420,1 ,$90.00 ,$58.50 ,$12.02 ,$90.00 ,$30.05 ,$90.00 ,$50.40 ,$12.02 ,$25.20 ,$31.77 ,$12.02 ,$37.08 ,$12.02 ,$40.59 ,$40.59 ,$12.02 ,$15.03 ,$22.84 ,$45.00 ,$30.05 ,$12.02 ,$12.02 ,$12.26 ,$67.50 ,$54.00 ,$54.00 ,$12.02 ,$54.00 ,$90.00 ,$90.00 ,$90.00 ,$90.00 , N/A ,$76.50 ,$30.05 ,$58.50 ,$12.02 ,$90.00 ,$50.40 ,$12.02 ,$23.67 , N/A ,$29.12 ,$27.79 ,$12.62 ,$72.00 ,$27.05 ,$40.59 ,$25.20 ,$81.00 ,$12.02 ,$90.00 ,$90.00 ,$90.00 ,$12.02 ,$90.00 ,$43.20 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000212,97016,HC APPLY VASOPNEUMATIC DEVICE 45MIN,420,1 ,$90.00 ,$58.50 ,$12.02 ,$90.00 ,$30.05 ,$90.00 ,$50.40 ,$12.02 ,$25.20 ,$31.77 ,$12.02 ,$37.08 ,$12.02 ,$40.59 ,$40.59 ,$12.02 ,$15.03 ,$22.84 ,$45.00 ,$30.05 ,$12.02 ,$12.02 ,$12.26 ,$67.50 ,$54.00 ,$54.00 ,$12.02 ,$54.00 ,$90.00 ,$90.00 ,$90.00 ,$90.00 , N/A ,$76.50 ,$30.05 ,$58.50 ,$12.02 ,$90.00 ,$50.40 ,$12.02 ,$23.67 , N/A ,$29.12 ,$27.79 ,$12.62 ,$72.00 ,$27.05 ,$40.59 ,$25.20 ,$81.00 ,$12.02 ,$90.00 ,$90.00 ,$90.00 ,$12.02 ,$90.00 ,$43.20 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000213,97016,HC APPLY VASOPNEUMATIC DEVICE 60MIN,420,1 ,$90.00 ,$58.50 ,$12.02 ,$90.00 ,$30.05 ,$90.00 ,$50.40 ,$12.02 ,$25.20 ,$31.77 ,$12.02 ,$37.08 ,$12.02 ,$40.59 ,$40.59 ,$12.02 ,$15.03 ,$22.84 ,$45.00 ,$30.05 ,$12.02 ,$12.02 ,$12.26 ,$67.50 ,$54.00 ,$54.00 ,$12.02 ,$54.00 ,$90.00 ,$90.00 ,$90.00 ,$90.00 , N/A ,$76.50 ,$30.05 ,$58.50 ,$12.02 ,$90.00 ,$50.40 ,$12.02 ,$23.67 , N/A ,$29.12 ,$27.79 ,$12.62 ,$72.00 ,$27.05 ,$40.59 ,$25.20 ,$81.00 ,$12.02 ,$90.00 ,$90.00 ,$90.00 ,$12.02 ,$90.00 ,$43.20 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000214,97012,HC TRACTION MECHANICAL APPL 15 MIN,420,1 ,$122.00 ,$79.30 ,$14.44 ,$122.00 ,$36.10 ,$122.00 ,$68.32 ,$14.44 ,$34.16 ,$43.07 ,$14.44 ,$50.26 ,$14.44 ,$55.02 ,$55.02 ,$14.44 ,$18.05 ,$27.44 ,$61.00 ,$36.10 ,$14.44 ,$14.44 ,$14.73 ,$91.50 ,$73.20 ,$73.20 ,$14.44 ,$73.20 ,$122.00 ,$122.00 ,$122.00 ,$122.00 , N/A ,$103.70 ,$36.10 ,$79.30 ,$14.44 ,$122.00 ,$68.32 ,$14.44 ,$32.09 , N/A ,$29.12 ,$27.79 ,$15.16 ,$97.60 ,$32.49 ,$55.02 ,$34.16 ,$109.80 ,$14.44 ,$122.00 ,$122.00 ,$122.00 ,$14.44 ,$122.00 ,$58.56 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000215,97012,HC TRACTION MECHANICAL APPL 30 MIN,420,1 ,$122.00 ,$79.30 ,$14.44 ,$122.00 ,$36.10 ,$122.00 ,$68.32 ,$14.44 ,$34.16 ,$43.07 ,$14.44 ,$50.26 ,$14.44 ,$55.02 ,$55.02 ,$14.44 ,$18.05 ,$27.44 ,$61.00 ,$36.10 ,$14.44 ,$14.44 ,$14.73 ,$91.50 ,$73.20 ,$73.20 ,$14.44 ,$73.20 ,$122.00 ,$122.00 ,$122.00 ,$122.00 , N/A ,$103.70 ,$36.10 ,$79.30 ,$14.44 ,$122.00 ,$68.32 ,$14.44 ,$32.09 , N/A ,$29.12 ,$27.79 ,$15.16 ,$97.60 ,$32.49 ,$55.02 ,$34.16 ,$109.80 ,$14.44 ,$122.00 ,$122.00 ,$122.00 ,$14.44 ,$122.00 ,$58.56 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000267,N/A,HC THERAPY ASSESSMENT - SELF PAY,420,1 ,$125.00 ,$81.25 ,$32.88 ,$125.00 , N/A ,$125.00 ,$70.00 , N/A ,$35.00 ,$42.25 , N/A ,$48.63 , N/A ,$56.38 ,$56.38 , N/A ,$81.25 , N/A ,$62.50 , N/A , N/A , N/A , N/A ,$93.75 ,$75.00 ,$75.00 , N/A ,$75.00 ,$125.00 ,$125.00 ,$125.00 ,$125.00 , N/A ,$106.25 , N/A ,$81.25 , N/A ,$125.00 ,$70.00 , N/A ,$32.88 , N/A , N/A , N/A , N/A ,$100.00 , N/A ,$56.38 ,$35.00 ,$112.50 , N/A ,$125.00 ,$125.00 ,$125.00 , N/A ,$125.00 ,$60.00 , N/A 
ST. ELIZABETH'S HOSPITAL,42000268,N/A,HC THERAPY TREATMENT 30MIN - SELF PAY,420,1 ,$75.00 ,$48.75 ,$19.73 ,$75.00 , N/A ,$75.00 ,$42.00 , N/A ,$21.00 ,$25.35 , N/A ,$29.18 , N/A ,$33.83 ,$33.83 , N/A ,$48.75 , N/A ,$37.50 , N/A , N/A , N/A , N/A ,$56.25 ,$45.00 ,$45.00 , N/A ,$45.00 ,$75.00 ,$75.00 ,$75.00 ,$75.00 , N/A ,$63.75 , N/A ,$48.75 , N/A ,$75.00 ,$42.00 , N/A ,$19.73 , N/A , N/A , N/A , N/A ,$60.00 , N/A ,$33.83 ,$21.00 ,$67.50 , N/A ,$75.00 ,$75.00 ,$75.00 , N/A ,$75.00 ,$36.00 , N/A 
ST. ELIZABETH'S HOSPITAL,42000269,N/A,HC THERAPY GROUP - SELF PAY,420,1 ,$30.00 ,$19.50 ,$7.89 ,$30.00 , N/A ,$30.00 ,$16.80 , N/A ,$8.40 ,$10.14 , N/A ,$11.67 , N/A ,$13.53 ,$13.53 , N/A ,$19.50 , N/A ,$15.00 , N/A , N/A , N/A , N/A ,$22.50 ,$18.00 ,$18.00 , N/A ,$18.00 ,$30.00 ,$30.00 ,$30.00 ,$30.00 , N/A ,$25.50 , N/A ,$19.50 , N/A ,$30.00 ,$16.80 , N/A ,$7.89 , N/A , N/A , N/A , N/A ,$24.00 , N/A ,$13.53 ,$8.40 ,$27.00 , N/A ,$30.00 ,$30.00 ,$30.00 , N/A ,$30.00 ,$14.40 , N/A 
ST. ELIZABETH'S HOSPITAL,42000270,20560,HC NEEDLE INSERTION W/O INJ 1-2 MUSC SELF PAY,420,1 ,$30.00 ,$19.50 ,$7.89 ,$60.90 ,$60.90 ,$30.00 ,$16.80 ,$24.36 ,$8.40 ,$10.14 ,$24.36 ,$11.67 ,$24.36 ,$13.53 ,$13.53 ,$24.36 ,$19.35 ,$30.00 ,$15.00 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$22.50 ,$18.00 ,$18.00 ,$24.36 ,$18.00 ,$30.00 ,$30.00 ,$30.00 ,$30.00 , N/A ,$25.50 ,$30.00 ,$19.50 ,$24.36 ,$30.00 ,$16.80 ,$24.36 ,$7.89 , N/A ,$29.12 ,$27.79 ,$25.58 ,$24.00 ,$54.80 ,$13.53 ,$8.40 ,$27.00 ,$24.36 ,$30.00 ,$30.00 ,$30.00 ,$24.36 ,$30.00 ,$14.40 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42000271,20561,HC NEEDLE INSERTION W/O INJ 3+ MUSC SELF PAY,420,1 ,$40.00 ,$26.00 ,$10.52 ,$60.90 ,$60.90 ,$40.00 ,$22.40 ,$24.36 ,$11.20 ,$13.52 ,$24.36 ,$15.56 ,$24.36 ,$18.04 ,$18.04 ,$24.36 ,$28.31 ,$40.00 ,$20.00 ,$60.89 ,$24.36 ,$24.36 ,$24.84 ,$30.00 ,$24.00 ,$24.00 ,$24.36 ,$24.00 ,$40.00 ,$40.00 ,$40.00 ,$40.00 , N/A ,$34.00 ,$40.00 ,$26.00 ,$24.36 ,$40.00 ,$22.40 ,$24.36 ,$10.52 , N/A ,$29.12 ,$27.79 ,$25.58 ,$32.00 ,$54.80 ,$18.04 ,$11.20 ,$36.00 ,$24.36 ,$40.00 ,$40.00 ,$40.00 ,$24.36 ,$40.00 ,$19.20 ,$26.47 
ST. ELIZABETH'S HOSPITAL,42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$253.33 ,$155.00 ,$189.28 ,$101.33 ,$94.64 ,$119.31 ,$101.33 ,$139.26 ,$101.33 ,$152.44 ,$152.44 ,$101.33 ,$126.66 ,$192.53 ,$169.00 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$253.50 ,$202.80 ,$202.80 ,$101.33 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$253.33 ,$219.70 ,$101.33 ,$338.00 ,$189.28 ,$101.33 ,$88.89 , N/A ,$338.00 ,$338.00 ,$106.40 ,$270.40 ,$227.99 ,$152.44 ,$94.64 ,$304.20 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$162.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$253.33 ,$155.00 ,$189.28 ,$101.33 ,$94.64 ,$119.31 ,$101.33 ,$139.26 ,$101.33 ,$152.44 ,$152.44 ,$101.33 ,$126.66 ,$192.53 ,$169.00 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$253.50 ,$202.80 ,$202.80 ,$101.33 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$253.33 ,$219.70 ,$101.33 ,$338.00 ,$189.28 ,$101.33 ,$88.89 , N/A ,$338.00 ,$338.00 ,$106.40 ,$270.40 ,$227.99 ,$152.44 ,$94.64 ,$304.20 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$162.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$253.33 ,$155.00 ,$189.28 ,$101.33 ,$94.64 ,$119.31 ,$101.33 ,$139.26 ,$101.33 ,$152.44 ,$152.44 ,$101.33 ,$126.66 ,$192.53 ,$169.00 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$253.50 ,$202.80 ,$202.80 ,$101.33 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$253.33 ,$219.70 ,$101.33 ,$338.00 ,$189.28 ,$101.33 ,$88.89 , N/A ,$338.00 ,$338.00 ,$106.40 ,$270.40 ,$227.99 ,$152.44 ,$94.64 ,$304.20 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$162.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$253.33 ,$155.00 ,$189.28 ,$101.33 ,$94.64 ,$119.31 ,$101.33 ,$139.26 ,$101.33 ,$152.44 ,$152.44 ,$101.33 ,$126.66 ,$192.53 ,$169.00 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$253.50 ,$202.80 ,$202.80 ,$101.33 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$253.33 ,$219.70 ,$101.33 ,$338.00 ,$189.28 ,$101.33 ,$88.89 , N/A ,$338.00 ,$338.00 ,$106.40 ,$270.40 ,$227.99 ,$152.44 ,$94.64 ,$304.20 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$162.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400047,97161,HC PT EVAL LOW COMPLEXITY 75MIN,424,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$253.33 ,$155.00 ,$189.28 ,$101.33 ,$94.64 ,$119.31 ,$101.33 ,$139.26 ,$101.33 ,$152.44 ,$152.44 ,$101.33 ,$126.66 ,$192.53 ,$169.00 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$253.50 ,$202.80 ,$202.80 ,$101.33 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$253.33 ,$219.70 ,$101.33 ,$338.00 ,$189.28 ,$101.33 ,$88.89 , N/A ,$338.00 ,$338.00 ,$106.40 ,$270.40 ,$227.99 ,$152.44 ,$94.64 ,$304.20 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$162.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400048,97161,HC PT EVAL LOW COMPLEXITY 90MIN,424,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$253.33 ,$155.00 ,$189.28 ,$101.33 ,$94.64 ,$119.31 ,$101.33 ,$139.26 ,$101.33 ,$152.44 ,$152.44 ,$101.33 ,$126.66 ,$192.53 ,$169.00 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$253.50 ,$202.80 ,$202.80 ,$101.33 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$253.33 ,$219.70 ,$101.33 ,$338.00 ,$189.28 ,$101.33 ,$88.89 , N/A ,$338.00 ,$338.00 ,$106.40 ,$270.40 ,$227.99 ,$152.44 ,$94.64 ,$304.20 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$162.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$451.00 ,$293.15 ,$101.33 ,$451.00 ,$253.33 ,$155.00 ,$252.56 ,$101.33 ,$126.28 ,$159.20 ,$101.33 ,$185.81 ,$101.33 ,$203.40 ,$203.40 ,$101.33 ,$126.66 ,$192.53 ,$225.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$338.25 ,$270.60 ,$270.60 ,$101.33 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$253.33 ,$293.15 ,$101.33 ,$451.00 ,$252.56 ,$101.33 ,$118.61 , N/A ,$356.33 ,$340.14 ,$106.40 ,$360.80 ,$227.99 ,$203.40 ,$126.28 ,$405.90 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$216.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$451.00 ,$293.15 ,$101.33 ,$451.00 ,$253.33 ,$155.00 ,$252.56 ,$101.33 ,$126.28 ,$159.20 ,$101.33 ,$185.81 ,$101.33 ,$203.40 ,$203.40 ,$101.33 ,$126.66 ,$192.53 ,$225.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$338.25 ,$270.60 ,$270.60 ,$101.33 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$253.33 ,$293.15 ,$101.33 ,$451.00 ,$252.56 ,$101.33 ,$118.61 , N/A ,$356.33 ,$340.14 ,$106.40 ,$360.80 ,$227.99 ,$203.40 ,$126.28 ,$405.90 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$216.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$451.00 ,$293.15 ,$101.33 ,$451.00 ,$253.33 ,$155.00 ,$252.56 ,$101.33 ,$126.28 ,$159.20 ,$101.33 ,$185.81 ,$101.33 ,$203.40 ,$203.40 ,$101.33 ,$126.66 ,$192.53 ,$225.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$338.25 ,$270.60 ,$270.60 ,$101.33 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$253.33 ,$293.15 ,$101.33 ,$451.00 ,$252.56 ,$101.33 ,$118.61 , N/A ,$356.33 ,$340.14 ,$106.40 ,$360.80 ,$227.99 ,$203.40 ,$126.28 ,$405.90 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$216.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$451.00 ,$293.15 ,$101.33 ,$451.00 ,$253.33 ,$155.00 ,$252.56 ,$101.33 ,$126.28 ,$159.20 ,$101.33 ,$185.81 ,$101.33 ,$203.40 ,$203.40 ,$101.33 ,$126.66 ,$192.53 ,$225.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$338.25 ,$270.60 ,$270.60 ,$101.33 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$253.33 ,$293.15 ,$101.33 ,$451.00 ,$252.56 ,$101.33 ,$118.61 , N/A ,$356.33 ,$340.14 ,$106.40 ,$360.80 ,$227.99 ,$203.40 ,$126.28 ,$405.90 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$216.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400059,97162,HC PT EVAL MOD COMPLEXITY 75MIN,424,1 ,$451.00 ,$293.15 ,$101.33 ,$451.00 ,$253.33 ,$155.00 ,$252.56 ,$101.33 ,$126.28 ,$159.20 ,$101.33 ,$185.81 ,$101.33 ,$203.40 ,$203.40 ,$101.33 ,$126.66 ,$192.53 ,$225.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$338.25 ,$270.60 ,$270.60 ,$101.33 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$253.33 ,$293.15 ,$101.33 ,$451.00 ,$252.56 ,$101.33 ,$118.61 , N/A ,$356.33 ,$340.14 ,$106.40 ,$360.80 ,$227.99 ,$203.40 ,$126.28 ,$405.90 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$216.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400060,97162,HC PT EVAL MOD COMPLEXITY 90MIN,424,1 ,$451.00 ,$293.15 ,$101.33 ,$451.00 ,$253.33 ,$155.00 ,$252.56 ,$101.33 ,$126.28 ,$159.20 ,$101.33 ,$185.81 ,$101.33 ,$203.40 ,$203.40 ,$101.33 ,$126.66 ,$192.53 ,$225.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$338.25 ,$270.60 ,$270.60 ,$101.33 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$253.33 ,$293.15 ,$101.33 ,$451.00 ,$252.56 ,$101.33 ,$118.61 , N/A ,$356.33 ,$340.14 ,$106.40 ,$360.80 ,$227.99 ,$203.40 ,$126.28 ,$405.90 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$216.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$563.00 ,$365.95 ,$101.33 ,$563.00 ,$253.33 ,$155.00 ,$315.28 ,$101.33 ,$157.64 ,$198.74 ,$101.33 ,$231.96 ,$101.33 ,$253.91 ,$253.91 ,$101.33 ,$126.66 ,$192.53 ,$281.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$422.25 ,$337.80 ,$337.80 ,$101.33 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$253.33 ,$365.95 ,$101.33 ,$563.00 ,$315.28 ,$101.33 ,$148.07 , N/A ,$356.33 ,$340.14 ,$106.40 ,$450.40 ,$227.99 ,$253.91 ,$157.64 ,$506.70 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$270.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$563.00 ,$365.95 ,$101.33 ,$563.00 ,$253.33 ,$155.00 ,$315.28 ,$101.33 ,$157.64 ,$198.74 ,$101.33 ,$231.96 ,$101.33 ,$253.91 ,$253.91 ,$101.33 ,$126.66 ,$192.53 ,$281.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$422.25 ,$337.80 ,$337.80 ,$101.33 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$253.33 ,$365.95 ,$101.33 ,$563.00 ,$315.28 ,$101.33 ,$148.07 , N/A ,$356.33 ,$340.14 ,$106.40 ,$450.40 ,$227.99 ,$253.91 ,$157.64 ,$506.70 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$270.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$563.00 ,$365.95 ,$101.33 ,$563.00 ,$253.33 ,$155.00 ,$315.28 ,$101.33 ,$157.64 ,$198.74 ,$101.33 ,$231.96 ,$101.33 ,$253.91 ,$253.91 ,$101.33 ,$126.66 ,$192.53 ,$281.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$422.25 ,$337.80 ,$337.80 ,$101.33 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$253.33 ,$365.95 ,$101.33 ,$563.00 ,$315.28 ,$101.33 ,$148.07 , N/A ,$356.33 ,$340.14 ,$106.40 ,$450.40 ,$227.99 ,$253.91 ,$157.64 ,$506.70 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$270.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$563.00 ,$365.95 ,$101.33 ,$563.00 ,$253.33 ,$155.00 ,$315.28 ,$101.33 ,$157.64 ,$198.74 ,$101.33 ,$231.96 ,$101.33 ,$253.91 ,$253.91 ,$101.33 ,$126.66 ,$192.53 ,$281.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$422.25 ,$337.80 ,$337.80 ,$101.33 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$253.33 ,$365.95 ,$101.33 ,$563.00 ,$315.28 ,$101.33 ,$148.07 , N/A ,$356.33 ,$340.14 ,$106.40 ,$450.40 ,$227.99 ,$253.91 ,$157.64 ,$506.70 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$270.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400071,97163,HC PT EVAL HIGH COMPLEXITY 75MIN,424,1 ,$563.00 ,$365.95 ,$101.33 ,$563.00 ,$253.33 ,$155.00 ,$315.28 ,$101.33 ,$157.64 ,$198.74 ,$101.33 ,$231.96 ,$101.33 ,$253.91 ,$253.91 ,$101.33 ,$126.66 ,$192.53 ,$281.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$422.25 ,$337.80 ,$337.80 ,$101.33 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$253.33 ,$365.95 ,$101.33 ,$563.00 ,$315.28 ,$101.33 ,$148.07 , N/A ,$356.33 ,$340.14 ,$106.40 ,$450.40 ,$227.99 ,$253.91 ,$157.64 ,$506.70 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$270.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400072,97163,HC PT EVAL HIGH COMPLEXITY 90MIN,424,1 ,$563.00 ,$365.95 ,$101.33 ,$563.00 ,$253.33 ,$155.00 ,$315.28 ,$101.33 ,$157.64 ,$198.74 ,$101.33 ,$231.96 ,$101.33 ,$253.91 ,$253.91 ,$101.33 ,$126.66 ,$192.53 ,$281.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$422.25 ,$337.80 ,$337.80 ,$101.33 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$253.33 ,$365.95 ,$101.33 ,$563.00 ,$315.28 ,$101.33 ,$148.07 , N/A ,$356.33 ,$340.14 ,$106.40 ,$450.40 ,$227.99 ,$253.91 ,$157.64 ,$506.70 ,$101.33 ,$171.00 ,$215.00 ,$215.00 ,$101.33 ,$215.00 ,$270.24 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$221.00 ,$143.65 ,$58.12 ,$323.94 ,$173.55 ,$155.00 ,$123.76 ,$69.42 ,$61.88 ,$78.01 ,$69.42 ,$91.05 ,$69.42 ,$99.67 ,$99.67 ,$69.42 ,$86.78 ,$131.90 ,$110.50 ,$173.55 ,$69.42 ,$69.42 ,$70.81 ,$165.75 ,$132.60 ,$132.60 ,$69.42 ,$132.60 ,$189.00 ,$189.00 ,$189.00 ,$221.00 , N/A ,$187.85 ,$173.55 ,$143.65 ,$69.42 ,$221.00 ,$123.76 ,$69.42 ,$58.12 , N/A ,$221.00 ,$221.00 ,$72.89 ,$176.80 ,$156.20 ,$99.67 ,$61.88 ,$198.90 ,$69.42 ,$171.00 ,$215.00 ,$215.00 ,$69.42 ,$215.00 ,$106.08 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$221.00 ,$143.65 ,$58.12 ,$323.94 ,$173.55 ,$155.00 ,$123.76 ,$69.42 ,$61.88 ,$78.01 ,$69.42 ,$91.05 ,$69.42 ,$99.67 ,$99.67 ,$69.42 ,$86.78 ,$131.90 ,$110.50 ,$173.55 ,$69.42 ,$69.42 ,$70.81 ,$165.75 ,$132.60 ,$132.60 ,$69.42 ,$132.60 ,$189.00 ,$189.00 ,$189.00 ,$221.00 , N/A ,$187.85 ,$173.55 ,$143.65 ,$69.42 ,$221.00 ,$123.76 ,$69.42 ,$58.12 , N/A ,$221.00 ,$221.00 ,$72.89 ,$176.80 ,$156.20 ,$99.67 ,$61.88 ,$198.90 ,$69.42 ,$171.00 ,$215.00 ,$215.00 ,$69.42 ,$215.00 ,$106.08 ,$323.94 
ST. ELIZABETH'S HOSPITAL,42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$221.00 ,$143.65 ,$58.12 ,$323.94 ,$173.55 ,$155.00 ,$123.76 ,$69.42 ,$61.88 ,$78.01 ,$69.42 ,$91.05 ,$69.42 ,$99.67 ,$99.67 ,$69.42 ,$86.78 ,$131.90 ,$110.50 ,$173.55 ,$69.42 ,$69.42 ,$70.81 ,$165.75 ,$132.60 ,$132.60 ,$69.42 ,$132.60 ,$189.00 ,$189.00 ,$189.00 ,$221.00 , N/A ,$187.85 ,$173.55 ,$143.65 ,$69.42 ,$221.00 ,$123.76 ,$69.42 ,$58.12 , N/A ,$221.00 ,$221.00 ,$72.89 ,$176.80 ,$156.20 ,$99.67 ,$61.88 ,$198.90 ,$69.42 ,$171.00 ,$215.00 ,$215.00 ,$69.42 ,$215.00 ,$106.08 ,$323.94 
ST. ELIZABETH'S HOSPITAL,43000015,97533,HC PERCEPTUAL ACTIVITY EA 15 MIN,430,1 ,$132.00 ,$85.80 ,$34.72 ,$515.32 ,$159.33 ,$132.00 ,$73.92 ,$63.73 ,$36.96 ,$46.60 ,$63.73 ,$54.38 ,$63.73 ,$59.53 ,$59.53 ,$63.73 ,$79.66 ,$121.09 ,$66.00 ,$159.33 ,$63.73 ,$63.73 ,$65.00 ,$99.00 ,$79.20 ,$79.20 ,$63.73 ,$79.20 ,$132.00 ,$132.00 ,$132.00 ,$132.00 , N/A ,$112.20 ,$132.00 ,$85.80 ,$63.73 ,$132.00 ,$73.92 ,$63.73 ,$34.72 , N/A ,$132.00 ,$132.00 ,$66.92 ,$105.60 ,$143.39 ,$59.53 ,$36.96 ,$118.80 ,$63.73 ,$132.00 ,$132.00 ,$132.00 ,$63.73 ,$132.00 ,$63.36 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$132.00 ,$85.80 ,$33.02 ,$515.32 ,$82.55 ,$132.00 ,$73.92 ,$33.02 ,$36.96 ,$46.60 ,$33.02 ,$54.38 ,$33.02 ,$59.53 ,$59.53 ,$33.02 ,$41.28 ,$62.74 ,$66.00 ,$82.55 ,$33.02 ,$33.02 ,$33.68 ,$99.00 ,$79.20 ,$79.20 ,$33.02 ,$79.20 ,$132.00 ,$132.00 ,$132.00 ,$132.00 , N/A ,$112.20 ,$82.55 ,$85.80 ,$33.02 ,$132.00 ,$73.92 ,$33.02 ,$34.72 , N/A ,$132.00 ,$132.00 ,$34.67 ,$105.60 ,$74.30 ,$59.53 ,$36.96 ,$118.80 ,$33.02 ,$132.00 ,$132.00 ,$132.00 ,$33.02 ,$132.00 ,$63.36 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43000023,97537,HC WORK TASK ANALYSIS EA 15 MIN,430,1 ,$128.00 ,$83.20 ,$32.10 ,$515.32 ,$80.25 ,$128.00 ,$71.68 ,$32.10 ,$35.84 ,$45.18 ,$32.10 ,$52.74 ,$32.10 ,$57.73 ,$57.73 ,$32.10 ,$40.13 ,$60.99 ,$64.00 ,$80.25 ,$32.10 ,$32.10 ,$32.74 ,$96.00 ,$76.80 ,$76.80 ,$32.10 ,$76.80 ,$128.00 ,$128.00 ,$128.00 ,$128.00 , N/A ,$108.80 ,$80.25 ,$83.20 ,$32.10 ,$128.00 ,$71.68 ,$32.10 ,$33.66 , N/A ,$128.00 ,$128.00 ,$33.71 ,$102.40 ,$72.23 ,$57.73 ,$35.84 ,$115.20 ,$32.10 ,$128.00 ,$128.00 ,$128.00 ,$32.10 ,$128.00 ,$61.44 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43000024,97542,HC SEATING CLINIC EA 15 MIN,430,1 ,$124.00 ,$80.60 ,$32.10 ,$515.32 ,$80.25 ,$124.00 ,$69.44 ,$32.10 ,$34.72 ,$43.77 ,$32.10 ,$51.09 ,$32.10 ,$55.92 ,$55.92 ,$32.10 ,$40.13 ,$60.99 ,$62.00 ,$80.25 ,$32.10 ,$32.10 ,$32.74 ,$93.00 ,$74.40 ,$74.40 ,$32.10 ,$74.40 ,$124.00 ,$124.00 ,$124.00 ,$124.00 , N/A ,$105.40 ,$80.25 ,$80.60 ,$32.10 ,$124.00 ,$69.44 ,$32.10 ,$32.61 , N/A ,$124.00 ,$124.00 ,$33.71 ,$99.20 ,$72.23 ,$55.92 ,$34.72 ,$111.60 ,$32.10 ,$124.00 ,$124.00 ,$124.00 ,$32.10 ,$124.00 ,$59.52 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$135.00 ,$87.75 ,$35.51 ,$323.94 ,$121.10 ,$135.00 ,$75.60 ,$48.44 ,$37.80 ,$47.66 ,$48.44 ,$55.62 ,$48.44 ,$60.89 ,$60.89 ,$48.44 ,$60.55 ,$92.04 ,$67.50 ,$121.10 ,$48.44 ,$48.44 ,$49.41 ,$101.25 ,$81.00 ,$81.00 ,$48.44 ,$81.00 ,$135.00 ,$135.00 ,$135.00 ,$135.00 , N/A ,$114.75 ,$121.10 ,$87.75 ,$48.44 ,$135.00 ,$75.60 ,$48.44 ,$35.51 , N/A ,$135.00 ,$135.00 ,$50.86 ,$108.00 ,$108.99 ,$60.89 ,$37.80 ,$121.50 ,$48.44 ,$135.00 ,$135.00 ,$135.00 ,$48.44 ,$135.00 ,$64.80 ,$323.94 
ST. ELIZABETH'S HOSPITAL,43000035,97545,HC WORK HARDENING/CONDITIONING FIRST 2 HRS,430,1 ,$326.00 ,$211.90 ,$85.74 ,$326.00 , N/A ,$155.00 ,$182.56 , N/A ,$91.28 ,$115.08 , N/A ,$134.31 , N/A ,$147.03 ,$147.03 , N/A ,$211.90 , N/A ,$163.00 , N/A , N/A , N/A , N/A ,$244.50 ,$195.60 ,$195.60 , N/A ,$195.60 ,$189.00 ,$189.00 ,$189.00 ,$326.00 , N/A ,$277.10 , N/A ,$211.90 , N/A ,$326.00 ,$182.56 , N/A ,$85.74 , N/A ,$326.00 ,$326.00 , N/A ,$260.80 , N/A ,$147.03 ,$91.28 ,$293.40 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$156.48 ,$323.94 
ST. ELIZABETH'S HOSPITAL,43000036,97546,HC WORK HARDENING/CONDITIONINS ADD 1 HOUR,430,1 ,$111.00 ,$72.15 ,$29.19 ,$323.94 , N/A ,$111.00 ,$62.16 , N/A ,$31.08 ,$39.18 , N/A ,$45.73 , N/A ,$50.06 ,$50.06 , N/A ,$72.15 , N/A ,$55.50 , N/A , N/A , N/A , N/A ,$83.25 ,$66.60 ,$66.60 , N/A ,$66.60 ,$111.00 ,$111.00 ,$111.00 ,$111.00 , N/A ,$94.35 , N/A ,$72.15 , N/A ,$111.00 ,$62.16 , N/A ,$29.19 , N/A ,$111.00 ,$111.00 , N/A ,$88.80 , N/A ,$50.06 ,$31.08 ,$99.90 , N/A ,$111.00 ,$111.00 ,$111.00 , N/A ,$111.00 ,$53.28 ,$323.94 
ST. ELIZABETH'S HOSPITAL,43000038,97018,HC PARAFFIN BATH THERAPY 15MIN,430,1 ,$100.00 ,$65.00 ,$5.91 ,$100.00 ,$14.78 ,$100.00 ,$56.00 ,$5.91 ,$28.00 ,$33.80 ,$5.91 ,$38.90 ,$5.91 ,$45.10 ,$45.10 ,$5.91 ,$7.39 ,$11.23 ,$50.00 ,$14.78 ,$5.91 ,$5.91 ,$6.03 ,$75.00 ,$60.00 ,$60.00 ,$5.91 ,$60.00 ,$100.00 ,$100.00 ,$100.00 ,$100.00 , N/A ,$85.00 ,$14.78 ,$65.00 ,$5.91 ,$100.00 ,$56.00 ,$5.91 ,$26.30 , N/A ,$29.12 ,$27.79 ,$6.21 ,$80.00 ,$13.30 ,$45.10 ,$28.00 ,$90.00 ,$5.91 ,$100.00 ,$100.00 ,$100.00 ,$5.91 ,$100.00 ,$48.00 ,$26.47 
ST. ELIZABETH'S HOSPITAL,43000039,97018,HC PARAFFIN BATH THERAPY 30MIN,430,1 ,$100.00 ,$65.00 ,$5.91 ,$100.00 ,$14.78 ,$100.00 ,$56.00 ,$5.91 ,$28.00 ,$33.80 ,$5.91 ,$38.90 ,$5.91 ,$45.10 ,$45.10 ,$5.91 ,$7.39 ,$11.23 ,$50.00 ,$14.78 ,$5.91 ,$5.91 ,$6.03 ,$75.00 ,$60.00 ,$60.00 ,$5.91 ,$60.00 ,$100.00 ,$100.00 ,$100.00 ,$100.00 , N/A ,$85.00 ,$14.78 ,$65.00 ,$5.91 ,$100.00 ,$56.00 ,$5.91 ,$26.30 , N/A ,$29.12 ,$27.79 ,$6.21 ,$80.00 ,$13.30 ,$45.10 ,$28.00 ,$90.00 ,$5.91 ,$100.00 ,$100.00 ,$100.00 ,$5.91 ,$100.00 ,$48.00 ,$26.47 
ST. ELIZABETH'S HOSPITAL,43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$78.00 ,$50.70 ,$20.51 ,$78.00 ,$58.35 ,$78.00 ,$43.68 ,$23.34 ,$21.84 ,$26.36 ,$23.34 ,$30.34 ,$23.34 ,$35.18 ,$35.18 ,$23.34 ,$29.18 ,$44.35 ,$39.00 ,$58.35 ,$23.34 ,$23.34 ,$23.81 ,$58.50 ,$46.80 ,$46.80 ,$23.34 ,$46.80 ,$78.00 ,$78.00 ,$78.00 ,$78.00 , N/A ,$66.30 ,$58.35 ,$50.70 ,$23.34 ,$78.00 ,$43.68 ,$23.34 ,$20.51 , N/A ,$29.12 ,$27.79 ,$24.51 ,$62.40 ,$52.52 ,$35.18 ,$21.84 ,$70.20 ,$23.34 ,$78.00 ,$78.00 ,$78.00 ,$23.34 ,$78.00 ,$37.44 ,$26.47 
ST. ELIZABETH'S HOSPITAL,43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$78.00 ,$50.70 ,$20.51 ,$78.00 ,$56.63 ,$78.00 ,$43.68 ,$22.65 ,$21.84 ,$26.36 ,$22.65 ,$30.34 ,$22.65 ,$35.18 ,$35.18 ,$22.65 ,$27.90 ,$43.04 ,$39.00 ,$56.63 ,$22.65 ,$22.65 ,$23.10 ,$58.50 ,$46.80 ,$46.80 ,$22.65 ,$46.80 ,$78.00 ,$78.00 ,$78.00 ,$78.00 , N/A ,$66.30 ,$56.63 ,$50.70 ,$22.65 ,$78.00 ,$43.68 ,$22.65 ,$20.51 , N/A ,$29.12 ,$27.79 ,$23.78 ,$62.40 ,$50.96 ,$35.18 ,$21.84 ,$70.20 ,$22.65 ,$78.00 ,$78.00 ,$78.00 ,$22.65 ,$78.00 ,$37.44 ,$26.47 
ST. ELIZABETH'S HOSPITAL,43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$338.00 ,$219.70 ,$88.89 ,$515.32 ,$254.95 ,$155.00 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A ,$338.00 ,$338.00 ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$162.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$338.00 ,$219.70 ,$88.89 ,$515.32 ,$254.95 ,$155.00 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A ,$338.00 ,$338.00 ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$162.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$338.00 ,$219.70 ,$88.89 ,$515.32 ,$254.95 ,$155.00 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A ,$338.00 ,$338.00 ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$162.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$338.00 ,$219.70 ,$88.89 ,$515.32 ,$254.95 ,$155.00 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A ,$338.00 ,$338.00 ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$162.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400038,97165,HC OT EVAL LOW COMPLEXITY 75MIN,434,1 ,$338.00 ,$219.70 ,$88.89 ,$515.32 ,$254.95 ,$155.00 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A ,$338.00 ,$338.00 ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$162.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400039,97165,HC OT EVAL LOW COMPLEXITY 90MIN,434,1 ,$338.00 ,$219.70 ,$88.89 ,$515.32 ,$254.95 ,$155.00 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A ,$338.00 ,$338.00 ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$162.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400041,97165,HC OT EVAL LOW COMPLEXITY 120MIN,434,1 ,$338.00 ,$219.70 ,$88.89 ,$515.32 ,$254.95 ,$155.00 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$189.00 ,$189.00 ,$189.00 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A ,$338.00 ,$338.00 ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$162.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$451.00 ,$293.15 ,$101.98 ,$515.32 ,$254.95 ,$155.00 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A ,$451.00 ,$451.00 ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$216.48 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$451.00 ,$293.15 ,$101.98 ,$515.32 ,$254.95 ,$155.00 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A ,$451.00 ,$451.00 ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$216.48 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$451.00 ,$293.15 ,$101.98 ,$515.32 ,$254.95 ,$155.00 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A ,$451.00 ,$451.00 ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$216.48 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$451.00 ,$293.15 ,$101.98 ,$515.32 ,$254.95 ,$155.00 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A ,$451.00 ,$451.00 ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$216.48 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400050,97166,HC OT EVAL MOD COMPLEXITY 75MIN,434,1 ,$451.00 ,$293.15 ,$101.98 ,$515.32 ,$254.95 ,$155.00 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A ,$451.00 ,$451.00 ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$216.48 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400051,97166,HC OT EVAL MOD COMPLEXITY 90MIN,434,1 ,$451.00 ,$293.15 ,$101.98 ,$515.32 ,$254.95 ,$155.00 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A ,$451.00 ,$451.00 ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$216.48 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400053,97166,HC OT EVAL MOD COMPLEXITY 120MIN,434,1 ,$451.00 ,$293.15 ,$101.98 ,$515.32 ,$254.95 ,$155.00 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$189.00 ,$189.00 ,$189.00 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A ,$451.00 ,$451.00 ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$216.48 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$155.00 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A ,$563.00 ,$541.09 ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$270.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$155.00 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A ,$563.00 ,$541.09 ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$270.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$155.00 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A ,$563.00 ,$541.09 ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$270.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$155.00 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A ,$563.00 ,$541.09 ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$270.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400062,97167,HC OT EVAL HIGH COMPLEXITY 75MIN,434,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$155.00 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A ,$563.00 ,$541.09 ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$270.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400063,97167,HC OT EVAL HIGH COMPLEXITY 90MIN,434,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$155.00 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A ,$563.00 ,$541.09 ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$270.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400065,97167,HC OT EVAL HIGH COMPLEXITY 120MIN,434,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$155.00 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$189.00 ,$189.00 ,$189.00 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A ,$563.00 ,$541.09 ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$171.00 ,$215.00 ,$215.00 ,$101.98 ,$215.00 ,$270.24 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$221.00 ,$143.65 ,$58.12 ,$515.32 ,$174.38 ,$155.00 ,$123.76 ,$69.75 ,$61.88 ,$78.01 ,$69.75 ,$91.05 ,$69.75 ,$99.67 ,$99.67 ,$69.75 ,$87.19 ,$132.53 ,$110.50 ,$174.38 ,$69.75 ,$69.75 ,$71.15 ,$165.75 ,$132.60 ,$132.60 ,$69.75 ,$132.60 ,$189.00 ,$189.00 ,$189.00 ,$221.00 , N/A ,$187.85 ,$174.38 ,$143.65 ,$69.75 ,$221.00 ,$123.76 ,$69.75 ,$58.12 , N/A ,$221.00 ,$221.00 ,$73.24 ,$176.80 ,$156.94 ,$99.67 ,$61.88 ,$198.90 ,$69.75 ,$171.00 ,$215.00 ,$215.00 ,$69.75 ,$215.00 ,$106.08 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$221.00 ,$143.65 ,$58.12 ,$515.32 ,$174.38 ,$155.00 ,$123.76 ,$69.75 ,$61.88 ,$78.01 ,$69.75 ,$91.05 ,$69.75 ,$99.67 ,$99.67 ,$69.75 ,$87.19 ,$132.53 ,$110.50 ,$174.38 ,$69.75 ,$69.75 ,$71.15 ,$165.75 ,$132.60 ,$132.60 ,$69.75 ,$132.60 ,$189.00 ,$189.00 ,$189.00 ,$221.00 , N/A ,$187.85 ,$174.38 ,$143.65 ,$69.75 ,$221.00 ,$123.76 ,$69.75 ,$58.12 , N/A ,$221.00 ,$221.00 ,$73.24 ,$176.80 ,$156.94 ,$99.67 ,$61.88 ,$198.90 ,$69.75 ,$171.00 ,$215.00 ,$215.00 ,$69.75 ,$215.00 ,$106.08 ,$515.32 
ST. ELIZABETH'S HOSPITAL,43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$221.00 ,$143.65 ,$58.12 ,$515.32 ,$174.38 ,$155.00 ,$123.76 ,$69.75 ,$61.88 ,$78.01 ,$69.75 ,$91.05 ,$69.75 ,$99.67 ,$99.67 ,$69.75 ,$87.19 ,$132.53 ,$110.50 ,$174.38 ,$69.75 ,$69.75 ,$71.15 ,$165.75 ,$132.60 ,$132.60 ,$69.75 ,$132.60 ,$189.00 ,$189.00 ,$189.00 ,$221.00 , N/A ,$187.85 ,$174.38 ,$143.65 ,$69.75 ,$221.00 ,$123.76 ,$69.75 ,$58.12 , N/A ,$221.00 ,$221.00 ,$73.24 ,$176.80 ,$156.94 ,$99.67 ,$61.88 ,$198.90 ,$69.75 ,$171.00 ,$215.00 ,$215.00 ,$69.75 ,$215.00 ,$106.08 ,$515.32 
ST. ELIZABETH'S HOSPITAL,44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$155.00 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$189.00 ,$189.00 ,$189.00 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A ,$263.38 ,$251.41 ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$171.00 ,$215.00 ,$215.00 ,$77.53 ,$215.00 ,$172.80 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$155.00 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$189.00 ,$189.00 ,$189.00 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A ,$263.38 ,$251.41 ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$171.00 ,$215.00 ,$215.00 ,$77.53 ,$215.00 ,$172.80 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$155.00 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$189.00 ,$189.00 ,$189.00 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A ,$263.38 ,$251.41 ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$171.00 ,$215.00 ,$215.00 ,$77.53 ,$215.00 ,$172.80 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$155.00 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$189.00 ,$189.00 ,$189.00 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A ,$263.38 ,$251.41 ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$171.00 ,$215.00 ,$215.00 ,$77.53 ,$215.00 ,$172.80 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$343.00 ,$222.95 ,$85.76 ,$343.00 ,$214.40 ,$155.00 ,$192.08 ,$85.76 ,$96.04 ,$121.08 ,$85.76 ,$141.32 ,$85.76 ,$154.69 ,$154.69 ,$85.76 ,$107.20 ,$162.94 ,$171.50 ,$214.40 ,$85.76 ,$85.76 ,$87.48 ,$257.25 ,$205.80 ,$205.80 ,$85.76 ,$205.80 ,$189.00 ,$189.00 ,$189.00 ,$343.00 , N/A ,$291.55 ,$214.40 ,$222.95 ,$85.76 ,$343.00 ,$192.08 ,$85.76 ,$90.21 , N/A ,$263.38 ,$251.41 ,$90.05 ,$274.40 ,$192.96 ,$154.69 ,$96.04 ,$308.70 ,$85.76 ,$171.00 ,$215.00 ,$215.00 ,$85.76 ,$215.00 ,$164.64 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$343.00 ,$222.95 ,$85.76 ,$343.00 ,$214.40 ,$155.00 ,$192.08 ,$85.76 ,$96.04 ,$121.08 ,$85.76 ,$141.32 ,$85.76 ,$154.69 ,$154.69 ,$85.76 ,$107.20 ,$162.94 ,$171.50 ,$214.40 ,$85.76 ,$85.76 ,$87.48 ,$257.25 ,$205.80 ,$205.80 ,$85.76 ,$205.80 ,$189.00 ,$189.00 ,$189.00 ,$343.00 , N/A ,$291.55 ,$214.40 ,$222.95 ,$85.76 ,$343.00 ,$192.08 ,$85.76 ,$90.21 , N/A ,$263.38 ,$251.41 ,$90.05 ,$274.40 ,$192.96 ,$154.69 ,$96.04 ,$308.70 ,$85.76 ,$171.00 ,$215.00 ,$215.00 ,$85.76 ,$215.00 ,$164.64 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$343.00 ,$222.95 ,$85.76 ,$343.00 ,$214.40 ,$155.00 ,$192.08 ,$85.76 ,$96.04 ,$121.08 ,$85.76 ,$141.32 ,$85.76 ,$154.69 ,$154.69 ,$85.76 ,$107.20 ,$162.94 ,$171.50 ,$214.40 ,$85.76 ,$85.76 ,$87.48 ,$257.25 ,$205.80 ,$205.80 ,$85.76 ,$205.80 ,$189.00 ,$189.00 ,$189.00 ,$343.00 , N/A ,$291.55 ,$214.40 ,$222.95 ,$85.76 ,$343.00 ,$192.08 ,$85.76 ,$90.21 , N/A ,$263.38 ,$251.41 ,$90.05 ,$274.40 ,$192.96 ,$154.69 ,$96.04 ,$308.70 ,$85.76 ,$171.00 ,$215.00 ,$215.00 ,$85.76 ,$215.00 ,$164.64 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$343.00 ,$222.95 ,$85.76 ,$343.00 ,$214.40 ,$155.00 ,$192.08 ,$85.76 ,$96.04 ,$121.08 ,$85.76 ,$141.32 ,$85.76 ,$154.69 ,$154.69 ,$85.76 ,$107.20 ,$162.94 ,$171.50 ,$214.40 ,$85.76 ,$85.76 ,$87.48 ,$257.25 ,$205.80 ,$205.80 ,$85.76 ,$205.80 ,$189.00 ,$189.00 ,$189.00 ,$343.00 , N/A ,$291.55 ,$214.40 ,$222.95 ,$85.76 ,$343.00 ,$192.08 ,$85.76 ,$90.21 , N/A ,$263.38 ,$251.41 ,$90.05 ,$274.40 ,$192.96 ,$154.69 ,$96.04 ,$308.70 ,$85.76 ,$171.00 ,$215.00 ,$215.00 ,$85.76 ,$215.00 ,$164.64 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000032,92508,HC SPEECH THERAPY TREATMENT GROUP 15MIN,440,1 ,$104.00 ,$67.60 ,$23.73 ,$104.00 ,$59.33 ,$104.00 ,$58.24 ,$23.73 ,$29.12 ,$36.71 ,$23.73 ,$42.85 ,$23.73 ,$46.90 ,$46.90 ,$23.73 ,$29.66 ,$45.09 ,$52.00 ,$59.33 ,$23.73 ,$23.73 ,$24.20 ,$78.00 ,$62.40 ,$62.40 ,$23.73 ,$62.40 ,$104.00 ,$104.00 ,$104.00 ,$104.00 , N/A ,$88.40 ,$59.33 ,$67.60 ,$23.73 ,$104.00 ,$58.24 ,$23.73 ,$27.35 , N/A ,$77.80 ,$74.27 ,$24.92 ,$83.20 ,$53.39 ,$46.90 ,$29.12 ,$93.60 ,$23.73 ,$104.00 ,$104.00 ,$104.00 ,$23.73 ,$104.00 ,$49.92 ,$70.73 
ST. ELIZABETH'S HOSPITAL,44000033,92508,HC SPEECH THERAPY TREATMENT GROUP 30MIN,440,1 ,$104.00 ,$67.60 ,$23.73 ,$104.00 ,$59.33 ,$104.00 ,$58.24 ,$23.73 ,$29.12 ,$36.71 ,$23.73 ,$42.85 ,$23.73 ,$46.90 ,$46.90 ,$23.73 ,$29.66 ,$45.09 ,$52.00 ,$59.33 ,$23.73 ,$23.73 ,$24.20 ,$78.00 ,$62.40 ,$62.40 ,$23.73 ,$62.40 ,$104.00 ,$104.00 ,$104.00 ,$104.00 , N/A ,$88.40 ,$59.33 ,$67.60 ,$23.73 ,$104.00 ,$58.24 ,$23.73 ,$27.35 , N/A ,$77.80 ,$74.27 ,$24.92 ,$83.20 ,$53.39 ,$46.90 ,$29.12 ,$93.60 ,$23.73 ,$104.00 ,$104.00 ,$104.00 ,$23.73 ,$104.00 ,$49.92 ,$70.73 
ST. ELIZABETH'S HOSPITAL,44000034,92508,HC SPEECH THERAPY TREATMENT GROUP 45MIN,440,1 ,$104.00 ,$67.60 ,$23.73 ,$104.00 ,$59.33 ,$104.00 ,$58.24 ,$23.73 ,$29.12 ,$36.71 ,$23.73 ,$42.85 ,$23.73 ,$46.90 ,$46.90 ,$23.73 ,$29.66 ,$45.09 ,$52.00 ,$59.33 ,$23.73 ,$23.73 ,$24.20 ,$78.00 ,$62.40 ,$62.40 ,$23.73 ,$62.40 ,$104.00 ,$104.00 ,$104.00 ,$104.00 , N/A ,$88.40 ,$59.33 ,$67.60 ,$23.73 ,$104.00 ,$58.24 ,$23.73 ,$27.35 , N/A ,$77.80 ,$74.27 ,$24.92 ,$83.20 ,$53.39 ,$46.90 ,$29.12 ,$93.60 ,$23.73 ,$104.00 ,$104.00 ,$104.00 ,$23.73 ,$104.00 ,$49.92 ,$70.73 
ST. ELIZABETH'S HOSPITAL,44000035,92508,HC SPEECH THERAPY TREATMENT GROUP 60MIN,440,1 ,$104.00 ,$67.60 ,$23.73 ,$104.00 ,$59.33 ,$104.00 ,$58.24 ,$23.73 ,$29.12 ,$36.71 ,$23.73 ,$42.85 ,$23.73 ,$46.90 ,$46.90 ,$23.73 ,$29.66 ,$45.09 ,$52.00 ,$59.33 ,$23.73 ,$23.73 ,$24.20 ,$78.00 ,$62.40 ,$62.40 ,$23.73 ,$62.40 ,$104.00 ,$104.00 ,$104.00 ,$104.00 , N/A ,$88.40 ,$59.33 ,$67.60 ,$23.73 ,$104.00 ,$58.24 ,$23.73 ,$27.35 , N/A ,$77.80 ,$74.27 ,$24.92 ,$83.20 ,$53.39 ,$46.90 ,$29.12 ,$93.60 ,$23.73 ,$104.00 ,$104.00 ,$104.00 ,$23.73 ,$104.00 ,$49.92 ,$70.73 
ST. ELIZABETH'S HOSPITAL,44000042,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 15MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000043,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 30MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000044,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 45MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000045,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 60MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000046,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 75MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000047,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 90MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000048,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 105MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000049,92609,HC SPEECH THERAPY SPEECH GENERATING DVC 120MIN,440,1 ,$155.00 ,$100.75 ,$40.77 ,$262.08 ,$262.08 ,$155.00 ,$86.80 ,$104.83 ,$43.40 ,$54.72 ,$104.83 ,$63.86 ,$104.83 ,$69.91 ,$69.91 ,$104.83 ,$131.04 ,$155.00 ,$77.50 ,$262.08 ,$104.83 ,$104.83 ,$106.93 ,$116.25 ,$93.00 ,$93.00 ,$104.83 ,$93.00 ,$155.00 ,$155.00 ,$155.00 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$104.83 ,$155.00 ,$86.80 ,$104.83 ,$40.77 , N/A ,$155.00 ,$155.00 ,$110.07 ,$124.00 ,$235.87 ,$69.91 ,$43.40 ,$139.50 ,$104.83 ,$155.00 ,$155.00 ,$155.00 ,$104.83 ,$155.00 ,$74.40 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000055,96125,HC COGNITIVE PERF TESTING PER HOUR,440,1 ,$375.00 ,$243.75 ,$98.63 ,$770.25 ,$263.50 ,$155.00 ,$210.00 ,$105.40 ,$105.00 ,$132.38 ,$105.40 ,$154.50 ,$105.40 ,$169.13 ,$169.13 ,$105.40 ,$131.75 ,$200.26 ,$187.50 ,$263.50 ,$105.40 ,$105.40 ,$107.51 ,$281.25 ,$225.00 ,$225.00 ,$105.40 ,$225.00 ,$189.00 ,$189.00 ,$189.00 ,$375.00 , N/A ,$318.75 ,$263.50 ,$243.75 ,$105.40 ,$375.00 ,$210.00 ,$105.40 ,$98.63 , N/A ,$375.00 ,$375.00 ,$110.67 ,$300.00 ,$237.15 ,$169.13 ,$105.00 ,$337.50 ,$105.40 ,$171.00 ,$215.00 ,$215.00 ,$105.40 ,$215.00 ,$180.00 ,$770.25 
ST. ELIZABETH'S HOSPITAL,44000062,92606,HC THERAP SVC NON-SPEECH DVC -15 MIN,440,1 ,$88.00 ,$57.20 ,$23.14 ,$239.44 , N/A ,$88.00 ,$49.28 , N/A ,$24.64 ,$29.74 , N/A ,$34.23 , N/A ,$39.69 ,$39.69 , N/A ,$57.20 , N/A ,$44.00 , N/A , N/A , N/A , N/A ,$66.00 ,$52.80 ,$52.80 , N/A ,$52.80 ,$88.00 ,$88.00 ,$88.00 ,$88.00 , N/A ,$74.80 , N/A ,$57.20 , N/A ,$88.00 ,$49.28 , N/A ,$23.14 , N/A ,$88.00 ,$88.00 , N/A ,$70.40 , N/A ,$39.69 ,$24.64 ,$79.20 , N/A ,$88.00 ,$88.00 ,$88.00 , N/A ,$88.00 ,$42.24 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000063,92606,HC THERAP SVC NON-SPEECH DVC -30 MIN,440,1 ,$88.00 ,$57.20 ,$23.14 ,$239.44 , N/A ,$88.00 ,$49.28 , N/A ,$24.64 ,$29.74 , N/A ,$34.23 , N/A ,$39.69 ,$39.69 , N/A ,$57.20 , N/A ,$44.00 , N/A , N/A , N/A , N/A ,$66.00 ,$52.80 ,$52.80 , N/A ,$52.80 ,$88.00 ,$88.00 ,$88.00 ,$88.00 , N/A ,$74.80 , N/A ,$57.20 , N/A ,$88.00 ,$49.28 , N/A ,$23.14 , N/A ,$88.00 ,$88.00 , N/A ,$70.40 , N/A ,$39.69 ,$24.64 ,$79.20 , N/A ,$88.00 ,$88.00 ,$88.00 , N/A ,$88.00 ,$42.24 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000064,92606,HC THERAP SVC NON-SPEECH DVC -45 MIN,440,1 ,$88.00 ,$57.20 ,$23.14 ,$239.44 , N/A ,$88.00 ,$49.28 , N/A ,$24.64 ,$29.74 , N/A ,$34.23 , N/A ,$39.69 ,$39.69 , N/A ,$57.20 , N/A ,$44.00 , N/A , N/A , N/A , N/A ,$66.00 ,$52.80 ,$52.80 , N/A ,$52.80 ,$88.00 ,$88.00 ,$88.00 ,$88.00 , N/A ,$74.80 , N/A ,$57.20 , N/A ,$88.00 ,$49.28 , N/A ,$23.14 , N/A ,$88.00 ,$88.00 , N/A ,$70.40 , N/A ,$39.69 ,$24.64 ,$79.20 , N/A ,$88.00 ,$88.00 ,$88.00 , N/A ,$88.00 ,$42.24 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000065,92606,HC THERAP SVC NON-SPEECH DVC -60 MIN,440,1 ,$88.00 ,$57.20 ,$23.14 ,$239.44 , N/A ,$88.00 ,$49.28 , N/A ,$24.64 ,$29.74 , N/A ,$34.23 , N/A ,$39.69 ,$39.69 , N/A ,$57.20 , N/A ,$44.00 , N/A , N/A , N/A , N/A ,$66.00 ,$52.80 ,$52.80 , N/A ,$52.80 ,$88.00 ,$88.00 ,$88.00 ,$88.00 , N/A ,$74.80 , N/A ,$57.20 , N/A ,$88.00 ,$49.28 , N/A ,$23.14 , N/A ,$88.00 ,$88.00 , N/A ,$70.40 , N/A ,$39.69 ,$24.64 ,$79.20 , N/A ,$88.00 ,$88.00 ,$88.00 , N/A ,$88.00 ,$42.24 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44000066,96110,HC DEV SCREEN W/SCORE  AND  INTERP - 15 MIN,440,1 ,$301.00 ,$195.65 ,$79.16 ,$770.25 , N/A ,$155.00 ,$168.56 , N/A ,$84.28 ,$106.25 , N/A ,$124.01 , N/A ,$135.75 ,$135.75 , N/A ,$195.65 , N/A ,$150.50 , N/A , N/A , N/A , N/A ,$225.75 ,$180.60 ,$180.60 , N/A ,$180.60 ,$189.00 ,$189.00 ,$189.00 ,$301.00 , N/A ,$255.85 , N/A ,$195.65 , N/A ,$301.00 ,$168.56 , N/A ,$79.16 , N/A ,$301.00 ,$301.00 , N/A ,$240.80 , N/A ,$135.75 ,$84.28 ,$270.90 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$144.48 ,$770.25 
ST. ELIZABETH'S HOSPITAL,44000067,96110,HC DEV SCREEN W/SCORE  AND  INTERP-30 MIN,440,1 ,$301.00 ,$195.65 ,$79.16 ,$770.25 , N/A ,$155.00 ,$168.56 , N/A ,$84.28 ,$106.25 , N/A ,$124.01 , N/A ,$135.75 ,$135.75 , N/A ,$195.65 , N/A ,$150.50 , N/A , N/A , N/A , N/A ,$225.75 ,$180.60 ,$180.60 , N/A ,$180.60 ,$189.00 ,$189.00 ,$189.00 ,$301.00 , N/A ,$255.85 , N/A ,$195.65 , N/A ,$301.00 ,$168.56 , N/A ,$79.16 , N/A ,$301.00 ,$301.00 , N/A ,$240.80 , N/A ,$135.75 ,$84.28 ,$270.90 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$144.48 ,$770.25 
ST. ELIZABETH'S HOSPITAL,44000068,96110,HC DEV SCREEN W/SCORE  AND  INTERP-45 MIN,440,1 ,$301.00 ,$195.65 ,$79.16 ,$770.25 , N/A ,$155.00 ,$168.56 , N/A ,$84.28 ,$106.25 , N/A ,$124.01 , N/A ,$135.75 ,$135.75 , N/A ,$195.65 , N/A ,$150.50 , N/A , N/A , N/A , N/A ,$225.75 ,$180.60 ,$180.60 , N/A ,$180.60 ,$189.00 ,$189.00 ,$189.00 ,$301.00 , N/A ,$255.85 , N/A ,$195.65 , N/A ,$301.00 ,$168.56 , N/A ,$79.16 , N/A ,$301.00 ,$301.00 , N/A ,$240.80 , N/A ,$135.75 ,$84.28 ,$270.90 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$144.48 ,$770.25 
ST. ELIZABETH'S HOSPITAL,44000069,96110,HC DEV SCREEN W/SCORE  AND  INTERP-60 MIN,440,1 ,$301.00 ,$195.65 ,$79.16 ,$770.25 , N/A ,$155.00 ,$168.56 , N/A ,$84.28 ,$106.25 , N/A ,$124.01 , N/A ,$135.75 ,$135.75 , N/A ,$195.65 , N/A ,$150.50 , N/A , N/A , N/A , N/A ,$225.75 ,$180.60 ,$180.60 , N/A ,$180.60 ,$189.00 ,$189.00 ,$189.00 ,$301.00 , N/A ,$255.85 , N/A ,$195.65 , N/A ,$301.00 ,$168.56 , N/A ,$79.16 , N/A ,$301.00 ,$301.00 , N/A ,$240.80 , N/A ,$135.75 ,$84.28 ,$270.90 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$144.48 ,$770.25 
ST. ELIZABETH'S HOSPITAL,44200001,96105,HC ASSESS. APHASIA PER HOUR,442,1 ,$379.00 ,$246.35 ,$99.68 ,$770.25 ,$250.53 ,$155.00 ,$212.24 ,$100.21 ,$106.12 ,$133.79 ,$100.21 ,$156.15 ,$100.21 ,$170.93 ,$170.93 ,$100.21 ,$125.26 ,$190.40 ,$189.50 ,$250.53 ,$100.21 ,$100.21 ,$102.21 ,$284.25 ,$227.40 ,$227.40 ,$100.21 ,$227.40 ,$189.00 ,$189.00 ,$189.00 ,$379.00 , N/A ,$322.15 ,$250.53 ,$246.35 ,$100.21 ,$379.00 ,$212.24 ,$100.21 ,$99.68 , N/A ,$379.00 ,$379.00 ,$105.22 ,$303.20 ,$225.47 ,$170.93 ,$106.12 ,$341.10 ,$100.21 ,$171.00 ,$215.00 ,$215.00 ,$100.21 ,$215.00 ,$181.92 ,$770.25 
ST. ELIZABETH'S HOSPITAL,44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$281.00 ,$182.65 ,$73.90 ,$281.00 ,$216.25 ,$155.00 ,$157.36 ,$86.50 ,$78.68 ,$99.19 ,$86.50 ,$115.77 ,$86.50 ,$126.73 ,$126.73 ,$86.50 ,$89.39 ,$164.35 ,$140.50 ,$216.25 ,$86.50 ,$86.50 ,$88.23 ,$210.75 ,$168.60 ,$168.60 ,$86.50 ,$168.60 ,$189.00 ,$189.00 ,$189.00 ,$281.00 , N/A ,$238.85 ,$216.25 ,$182.65 ,$86.50 ,$281.00 ,$157.36 ,$86.50 ,$73.90 , N/A ,$263.38 ,$251.41 ,$90.83 ,$224.80 ,$194.63 ,$126.73 ,$78.68 ,$252.90 ,$86.50 ,$171.00 ,$215.00 ,$215.00 ,$86.50 ,$215.00 ,$134.88 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$281.00 ,$182.65 ,$73.90 ,$281.00 ,$216.25 ,$155.00 ,$157.36 ,$86.50 ,$78.68 ,$99.19 ,$86.50 ,$115.77 ,$86.50 ,$126.73 ,$126.73 ,$86.50 ,$89.39 ,$164.35 ,$140.50 ,$216.25 ,$86.50 ,$86.50 ,$88.23 ,$210.75 ,$168.60 ,$168.60 ,$86.50 ,$168.60 ,$189.00 ,$189.00 ,$189.00 ,$281.00 , N/A ,$238.85 ,$216.25 ,$182.65 ,$86.50 ,$281.00 ,$157.36 ,$86.50 ,$73.90 , N/A ,$263.38 ,$251.41 ,$90.83 ,$224.80 ,$194.63 ,$126.73 ,$78.68 ,$252.90 ,$86.50 ,$171.00 ,$215.00 ,$215.00 ,$86.50 ,$215.00 ,$134.88 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$281.00 ,$182.65 ,$73.90 ,$281.00 ,$216.25 ,$155.00 ,$157.36 ,$86.50 ,$78.68 ,$99.19 ,$86.50 ,$115.77 ,$86.50 ,$126.73 ,$126.73 ,$86.50 ,$89.39 ,$164.35 ,$140.50 ,$216.25 ,$86.50 ,$86.50 ,$88.23 ,$210.75 ,$168.60 ,$168.60 ,$86.50 ,$168.60 ,$189.00 ,$189.00 ,$189.00 ,$281.00 , N/A ,$238.85 ,$216.25 ,$182.65 ,$86.50 ,$281.00 ,$157.36 ,$86.50 ,$73.90 , N/A ,$263.38 ,$251.41 ,$90.83 ,$224.80 ,$194.63 ,$126.73 ,$78.68 ,$252.90 ,$86.50 ,$171.00 ,$215.00 ,$215.00 ,$86.50 ,$215.00 ,$134.88 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$281.00 ,$182.65 ,$73.90 ,$281.00 ,$216.25 ,$155.00 ,$157.36 ,$86.50 ,$78.68 ,$99.19 ,$86.50 ,$115.77 ,$86.50 ,$126.73 ,$126.73 ,$86.50 ,$89.39 ,$164.35 ,$140.50 ,$216.25 ,$86.50 ,$86.50 ,$88.23 ,$210.75 ,$168.60 ,$168.60 ,$86.50 ,$168.60 ,$189.00 ,$189.00 ,$189.00 ,$281.00 , N/A ,$238.85 ,$216.25 ,$182.65 ,$86.50 ,$281.00 ,$157.36 ,$86.50 ,$73.90 , N/A ,$263.38 ,$251.41 ,$90.83 ,$224.80 ,$194.63 ,$126.73 ,$78.68 ,$252.90 ,$86.50 ,$171.00 ,$215.00 ,$215.00 ,$86.50 ,$215.00 ,$134.88 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$705.00 ,$458.25 ,$53.35 ,$705.00 ,$233.18 ,$155.00 ,$394.80 ,$93.27 ,$197.40 ,$248.87 ,$93.27 ,$290.46 ,$93.27 ,$317.96 ,$317.96 ,$93.27 ,$116.59 ,$177.21 ,$352.50 ,$233.18 ,$93.27 ,$93.27 ,$95.14 ,$528.75 ,$423.00 ,$423.00 ,$93.27 ,$423.00 ,$189.00 ,$189.00 ,$189.00 ,$705.00 , N/A ,$599.25 ,$233.18 ,$458.25 ,$93.27 ,$705.00 ,$394.80 ,$93.27 ,$185.42 , N/A ,$58.69 ,$56.02 ,$97.93 ,$564.00 ,$209.86 ,$317.96 ,$197.40 ,$634.50 ,$93.27 ,$171.00 ,$215.00 ,$215.00 ,$93.27 ,$215.00 ,$338.40 ,$53.35 
ST. ELIZABETH'S HOSPITAL,44400040,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN,444,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$155.00 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$189.00 ,$189.00 ,$189.00 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A ,$263.38 ,$251.41 ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$171.00 ,$215.00 ,$215.00 ,$134.52 ,$215.00 ,$145.44 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400041,92522,HC EVALUATE SPEECH PRODUCTION 15MIN,444,1 ,$246.00 ,$159.90 ,$64.70 ,$283.35 ,$283.35 ,$155.00 ,$137.76 ,$113.34 ,$68.88 ,$86.84 ,$113.34 ,$101.35 ,$113.34 ,$110.95 ,$110.95 ,$113.34 ,$141.68 ,$215.35 ,$123.00 ,$283.35 ,$113.34 ,$113.34 ,$115.61 ,$184.50 ,$147.60 ,$147.60 ,$113.34 ,$147.60 ,$189.00 ,$189.00 ,$189.00 ,$246.00 , N/A ,$209.10 ,$246.00 ,$159.90 ,$113.34 ,$246.00 ,$137.76 ,$113.34 ,$64.70 , N/A ,$246.00 ,$246.00 ,$119.01 ,$196.80 ,$255.02 ,$110.95 ,$68.88 ,$221.40 ,$113.34 ,$171.00 ,$215.00 ,$215.00 ,$113.34 ,$215.00 ,$118.08 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$512.00 ,$332.80 ,$134.66 ,$571.95 ,$571.95 ,$155.00 ,$286.72 ,$228.78 ,$143.36 ,$180.74 ,$228.78 ,$210.94 ,$228.78 ,$230.91 ,$230.91 ,$228.78 ,$285.98 ,$434.68 ,$256.00 ,$571.95 ,$228.78 ,$228.78 ,$233.36 ,$384.00 ,$307.20 ,$307.20 ,$228.78 ,$307.20 ,$189.00 ,$189.00 ,$189.00 ,$512.00 , N/A ,$435.20 ,$512.00 ,$332.80 ,$228.78 ,$512.00 ,$286.72 ,$228.78 ,$134.66 , N/A ,$263.38 ,$251.41 ,$240.22 ,$409.60 ,$514.76 ,$230.91 ,$143.36 ,$460.80 ,$228.78 ,$171.00 ,$215.00 ,$215.00 ,$228.78 ,$215.00 ,$245.76 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400043,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 15MIN,444,1 ,$261.00 ,$169.65 ,$68.64 ,$279.28 ,$279.28 ,$155.00 ,$146.16 ,$111.71 ,$73.08 ,$92.13 ,$111.71 ,$107.53 ,$111.71 ,$117.71 ,$117.71 ,$111.71 ,$139.64 ,$212.25 ,$130.50 ,$279.28 ,$111.71 ,$111.71 ,$113.94 ,$195.75 ,$156.60 ,$156.60 ,$111.71 ,$156.60 ,$189.00 ,$189.00 ,$189.00 ,$261.00 , N/A ,$221.85 ,$261.00 ,$169.65 ,$111.71 ,$261.00 ,$146.16 ,$111.71 ,$68.64 , N/A ,$261.00 ,$251.41 ,$117.30 ,$208.80 ,$251.35 ,$117.71 ,$73.08 ,$234.90 ,$111.71 ,$171.00 ,$215.00 ,$215.00 ,$111.71 ,$215.00 ,$125.28 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400045,92607,HC EVAL AAC; SP GEN 1ST HR,444,1 ,$550.00 ,$357.50 ,$125.02 ,$550.00 ,$312.55 ,$155.00 ,$308.00 ,$125.02 ,$154.00 ,$194.15 ,$125.02 ,$226.60 ,$125.02 ,$248.05 ,$248.05 ,$125.02 ,$156.28 ,$237.54 ,$275.00 ,$312.55 ,$125.02 ,$125.02 ,$127.52 ,$412.50 ,$330.00 ,$330.00 ,$125.02 ,$330.00 ,$189.00 ,$189.00 ,$189.00 ,$550.00 , N/A ,$467.50 ,$312.55 ,$357.50 ,$125.02 ,$550.00 ,$308.00 ,$125.02 ,$144.65 , N/A ,$263.38 ,$251.41 ,$131.27 ,$440.00 ,$281.30 ,$248.05 ,$154.00 ,$495.00 ,$125.02 ,$171.00 ,$215.00 ,$215.00 ,$125.02 ,$215.00 ,$264.00 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400046,92608,HC EVAL AAC ADD 1/2 HR,444,1 ,$274.00 ,$178.10 ,$49.67 ,$274.00 ,$124.18 ,$155.00 ,$153.44 ,$49.67 ,$76.72 ,$96.72 ,$49.67 ,$112.89 ,$49.67 ,$123.57 ,$123.57 ,$49.67 ,$62.09 ,$94.37 ,$137.00 ,$124.18 ,$49.67 ,$49.67 ,$50.66 ,$205.50 ,$164.40 ,$164.40 ,$49.67 ,$164.40 ,$189.00 ,$189.00 ,$189.00 ,$274.00 , N/A ,$232.90 ,$124.18 ,$178.10 ,$49.67 ,$274.00 ,$153.44 ,$49.67 ,$72.06 , N/A ,$263.38 ,$251.41 ,$52.15 ,$219.20 ,$111.76 ,$123.57 ,$76.72 ,$246.60 ,$49.67 ,$171.00 ,$215.00 ,$215.00 ,$49.67 ,$215.00 ,$131.52 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400047,92605,HC EVAL NON SP GEN DEVICE,444,1 ,$550.00 ,$357.50 ,$144.65 ,$550.00 , N/A ,$155.00 ,$308.00 , N/A ,$154.00 ,$185.90 , N/A ,$213.95 , N/A ,$248.05 ,$248.05 , N/A ,$357.50 , N/A ,$275.00 , N/A , N/A , N/A , N/A ,$412.50 ,$330.00 ,$330.00 , N/A ,$330.00 ,$189.00 ,$189.00 ,$189.00 ,$550.00 , N/A ,$467.50 , N/A ,$357.50 , N/A ,$550.00 ,$308.00 , N/A ,$144.65 , N/A ,$263.38 ,$251.41 , N/A ,$440.00 , N/A ,$248.05 ,$154.00 ,$495.00 , N/A ,$171.00 ,$215.00 ,$215.00 , N/A ,$215.00 ,$264.00 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$155.00 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$189.00 ,$189.00 ,$189.00 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A ,$263.38 ,$251.41 ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$171.00 ,$215.00 ,$215.00 ,$134.52 ,$215.00 ,$145.44 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$155.00 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$189.00 ,$189.00 ,$189.00 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A ,$263.38 ,$251.41 ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$171.00 ,$215.00 ,$215.00 ,$134.52 ,$215.00 ,$145.44 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400054,92521,HC EVALUATION OF SPEECH FLUENCY 60MIN,444,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$155.00 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$189.00 ,$189.00 ,$189.00 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A ,$263.38 ,$251.41 ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$171.00 ,$215.00 ,$215.00 ,$134.52 ,$215.00 ,$145.44 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400055,92522,HC EVALUATE SPEECH PRODUCTION 30MIN,444,1 ,$246.00 ,$159.90 ,$64.70 ,$283.35 ,$283.35 ,$155.00 ,$137.76 ,$113.34 ,$68.88 ,$86.84 ,$113.34 ,$101.35 ,$113.34 ,$110.95 ,$110.95 ,$113.34 ,$141.68 ,$215.35 ,$123.00 ,$283.35 ,$113.34 ,$113.34 ,$115.61 ,$184.50 ,$147.60 ,$147.60 ,$113.34 ,$147.60 ,$189.00 ,$189.00 ,$189.00 ,$246.00 , N/A ,$209.10 ,$246.00 ,$159.90 ,$113.34 ,$246.00 ,$137.76 ,$113.34 ,$64.70 , N/A ,$246.00 ,$246.00 ,$119.01 ,$196.80 ,$255.02 ,$110.95 ,$68.88 ,$221.40 ,$113.34 ,$171.00 ,$215.00 ,$215.00 ,$113.34 ,$215.00 ,$118.08 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400056,92522,HC EVALUATE SPEECH PRODUCTION 45MIN,444,1 ,$246.00 ,$159.90 ,$64.70 ,$283.35 ,$283.35 ,$155.00 ,$137.76 ,$113.34 ,$68.88 ,$86.84 ,$113.34 ,$101.35 ,$113.34 ,$110.95 ,$110.95 ,$113.34 ,$141.68 ,$215.35 ,$123.00 ,$283.35 ,$113.34 ,$113.34 ,$115.61 ,$184.50 ,$147.60 ,$147.60 ,$113.34 ,$147.60 ,$189.00 ,$189.00 ,$189.00 ,$246.00 , N/A ,$209.10 ,$246.00 ,$159.90 ,$113.34 ,$246.00 ,$137.76 ,$113.34 ,$64.70 , N/A ,$246.00 ,$246.00 ,$119.01 ,$196.80 ,$255.02 ,$110.95 ,$68.88 ,$221.40 ,$113.34 ,$171.00 ,$215.00 ,$215.00 ,$113.34 ,$215.00 ,$118.08 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400057,92522,HC EVALUATE SPEECH PRODUCTION 60MIN,444,1 ,$246.00 ,$159.90 ,$64.70 ,$283.35 ,$283.35 ,$155.00 ,$137.76 ,$113.34 ,$68.88 ,$86.84 ,$113.34 ,$101.35 ,$113.34 ,$110.95 ,$110.95 ,$113.34 ,$141.68 ,$215.35 ,$123.00 ,$283.35 ,$113.34 ,$113.34 ,$115.61 ,$184.50 ,$147.60 ,$147.60 ,$113.34 ,$147.60 ,$189.00 ,$189.00 ,$189.00 ,$246.00 , N/A ,$209.10 ,$246.00 ,$159.90 ,$113.34 ,$246.00 ,$137.76 ,$113.34 ,$64.70 , N/A ,$246.00 ,$246.00 ,$119.01 ,$196.80 ,$255.02 ,$110.95 ,$68.88 ,$221.40 ,$113.34 ,$171.00 ,$215.00 ,$215.00 ,$113.34 ,$215.00 ,$118.08 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$512.00 ,$332.80 ,$134.66 ,$571.95 ,$571.95 ,$155.00 ,$286.72 ,$228.78 ,$143.36 ,$180.74 ,$228.78 ,$210.94 ,$228.78 ,$230.91 ,$230.91 ,$228.78 ,$285.98 ,$434.68 ,$256.00 ,$571.95 ,$228.78 ,$228.78 ,$233.36 ,$384.00 ,$307.20 ,$307.20 ,$228.78 ,$307.20 ,$189.00 ,$189.00 ,$189.00 ,$512.00 , N/A ,$435.20 ,$512.00 ,$332.80 ,$228.78 ,$512.00 ,$286.72 ,$228.78 ,$134.66 , N/A ,$263.38 ,$251.41 ,$240.22 ,$409.60 ,$514.76 ,$230.91 ,$143.36 ,$460.80 ,$228.78 ,$171.00 ,$215.00 ,$215.00 ,$228.78 ,$215.00 ,$245.76 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$512.00 ,$332.80 ,$134.66 ,$571.95 ,$571.95 ,$155.00 ,$286.72 ,$228.78 ,$143.36 ,$180.74 ,$228.78 ,$210.94 ,$228.78 ,$230.91 ,$230.91 ,$228.78 ,$285.98 ,$434.68 ,$256.00 ,$571.95 ,$228.78 ,$228.78 ,$233.36 ,$384.00 ,$307.20 ,$307.20 ,$228.78 ,$307.20 ,$189.00 ,$189.00 ,$189.00 ,$512.00 , N/A ,$435.20 ,$512.00 ,$332.80 ,$228.78 ,$512.00 ,$286.72 ,$228.78 ,$134.66 , N/A ,$263.38 ,$251.41 ,$240.22 ,$409.60 ,$514.76 ,$230.91 ,$143.36 ,$460.80 ,$228.78 ,$171.00 ,$215.00 ,$215.00 ,$228.78 ,$215.00 ,$245.76 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$512.00 ,$332.80 ,$134.66 ,$571.95 ,$571.95 ,$155.00 ,$286.72 ,$228.78 ,$143.36 ,$180.74 ,$228.78 ,$210.94 ,$228.78 ,$230.91 ,$230.91 ,$228.78 ,$285.98 ,$434.68 ,$256.00 ,$571.95 ,$228.78 ,$228.78 ,$233.36 ,$384.00 ,$307.20 ,$307.20 ,$228.78 ,$307.20 ,$189.00 ,$189.00 ,$189.00 ,$512.00 , N/A ,$435.20 ,$512.00 ,$332.80 ,$228.78 ,$512.00 ,$286.72 ,$228.78 ,$134.66 , N/A ,$263.38 ,$251.41 ,$240.22 ,$409.60 ,$514.76 ,$230.91 ,$143.36 ,$460.80 ,$228.78 ,$171.00 ,$215.00 ,$215.00 ,$228.78 ,$215.00 ,$245.76 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$261.00 ,$169.65 ,$68.64 ,$279.28 ,$279.28 ,$155.00 ,$146.16 ,$111.71 ,$73.08 ,$92.13 ,$111.71 ,$107.53 ,$111.71 ,$117.71 ,$117.71 ,$111.71 ,$139.64 ,$212.25 ,$130.50 ,$279.28 ,$111.71 ,$111.71 ,$113.94 ,$195.75 ,$156.60 ,$156.60 ,$111.71 ,$156.60 ,$189.00 ,$189.00 ,$189.00 ,$261.00 , N/A ,$221.85 ,$261.00 ,$169.65 ,$111.71 ,$261.00 ,$146.16 ,$111.71 ,$68.64 , N/A ,$261.00 ,$251.41 ,$117.30 ,$208.80 ,$251.35 ,$117.71 ,$73.08 ,$234.90 ,$111.71 ,$171.00 ,$215.00 ,$215.00 ,$111.71 ,$215.00 ,$125.28 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$261.00 ,$169.65 ,$68.64 ,$279.28 ,$279.28 ,$155.00 ,$146.16 ,$111.71 ,$73.08 ,$92.13 ,$111.71 ,$107.53 ,$111.71 ,$117.71 ,$117.71 ,$111.71 ,$139.64 ,$212.25 ,$130.50 ,$279.28 ,$111.71 ,$111.71 ,$113.94 ,$195.75 ,$156.60 ,$156.60 ,$111.71 ,$156.60 ,$189.00 ,$189.00 ,$189.00 ,$261.00 , N/A ,$221.85 ,$261.00 ,$169.65 ,$111.71 ,$261.00 ,$146.16 ,$111.71 ,$68.64 , N/A ,$261.00 ,$251.41 ,$117.30 ,$208.80 ,$251.35 ,$117.71 ,$73.08 ,$234.90 ,$111.71 ,$171.00 ,$215.00 ,$215.00 ,$111.71 ,$215.00 ,$125.28 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$261.00 ,$169.65 ,$68.64 ,$279.28 ,$279.28 ,$155.00 ,$146.16 ,$111.71 ,$73.08 ,$92.13 ,$111.71 ,$107.53 ,$111.71 ,$117.71 ,$117.71 ,$111.71 ,$139.64 ,$212.25 ,$130.50 ,$279.28 ,$111.71 ,$111.71 ,$113.94 ,$195.75 ,$156.60 ,$156.60 ,$111.71 ,$156.60 ,$189.00 ,$189.00 ,$189.00 ,$261.00 , N/A ,$221.85 ,$261.00 ,$169.65 ,$111.71 ,$261.00 ,$146.16 ,$111.71 ,$68.64 , N/A ,$261.00 ,$251.41 ,$117.30 ,$208.80 ,$251.35 ,$117.71 ,$73.08 ,$234.90 ,$111.71 ,$171.00 ,$215.00 ,$215.00 ,$111.71 ,$215.00 ,$125.28 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400094,92597,HC VOICE PROST EVAL/FITTING 15MIN,444,1 ,$732.00 ,$475.80 ,$73.71 ,$732.00 ,$184.28 ,$155.00 ,$409.92 ,$73.71 ,$204.96 ,$258.40 ,$73.71 ,$301.58 ,$73.71 ,$330.13 ,$330.13 ,$73.71 ,$92.14 ,$140.05 ,$366.00 ,$184.28 ,$73.71 ,$73.71 ,$75.18 ,$549.00 ,$439.20 ,$439.20 ,$73.71 ,$439.20 ,$189.00 ,$189.00 ,$189.00 ,$732.00 , N/A ,$622.20 ,$184.28 ,$475.80 ,$73.71 ,$732.00 ,$409.92 ,$73.71 ,$192.52 , N/A ,$263.38 ,$251.41 ,$77.40 ,$585.60 ,$165.85 ,$330.13 ,$204.96 ,$658.80 ,$73.71 ,$171.00 ,$215.00 ,$215.00 ,$73.71 ,$215.00 ,$351.36 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400095,92597,HC VOICE PROST EVAL/FITTING 30MIN,444,1 ,$732.00 ,$475.80 ,$73.71 ,$732.00 ,$184.28 ,$155.00 ,$409.92 ,$73.71 ,$204.96 ,$258.40 ,$73.71 ,$301.58 ,$73.71 ,$330.13 ,$330.13 ,$73.71 ,$92.14 ,$140.05 ,$366.00 ,$184.28 ,$73.71 ,$73.71 ,$75.18 ,$549.00 ,$439.20 ,$439.20 ,$73.71 ,$439.20 ,$189.00 ,$189.00 ,$189.00 ,$732.00 , N/A ,$622.20 ,$184.28 ,$475.80 ,$73.71 ,$732.00 ,$409.92 ,$73.71 ,$192.52 , N/A ,$263.38 ,$251.41 ,$77.40 ,$585.60 ,$165.85 ,$330.13 ,$204.96 ,$658.80 ,$73.71 ,$171.00 ,$215.00 ,$215.00 ,$73.71 ,$215.00 ,$351.36 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400096,92597,HC VOICE PROST EVAL/FITTING 45MIN,444,1 ,$732.00 ,$475.80 ,$73.71 ,$732.00 ,$184.28 ,$155.00 ,$409.92 ,$73.71 ,$204.96 ,$258.40 ,$73.71 ,$301.58 ,$73.71 ,$330.13 ,$330.13 ,$73.71 ,$92.14 ,$140.05 ,$366.00 ,$184.28 ,$73.71 ,$73.71 ,$75.18 ,$549.00 ,$439.20 ,$439.20 ,$73.71 ,$439.20 ,$189.00 ,$189.00 ,$189.00 ,$732.00 , N/A ,$622.20 ,$184.28 ,$475.80 ,$73.71 ,$732.00 ,$409.92 ,$73.71 ,$192.52 , N/A ,$263.38 ,$251.41 ,$77.40 ,$585.60 ,$165.85 ,$330.13 ,$204.96 ,$658.80 ,$73.71 ,$171.00 ,$215.00 ,$215.00 ,$73.71 ,$215.00 ,$351.36 ,$239.44 
ST. ELIZABETH'S HOSPITAL,44400097,92597,HC VOICE PROST EVAL/FITTING 60MIN,444,1 ,$732.00 ,$475.80 ,$73.71 ,$732.00 ,$184.28 ,$155.00 ,$409.92 ,$73.71 ,$204.96 ,$258.40 ,$73.71 ,$301.58 ,$73.71 ,$330.13 ,$330.13 ,$73.71 ,$92.14 ,$140.05 ,$366.00 ,$184.28 ,$73.71 ,$73.71 ,$75.18 ,$549.00 ,$439.20 ,$439.20 ,$73.71 ,$439.20 ,$189.00 ,$189.00 ,$189.00 ,$732.00 , N/A ,$622.20 ,$184.28 ,$475.80 ,$73.71 ,$732.00 ,$409.92 ,$73.71 ,$192.52 , N/A ,$263.38 ,$251.41 ,$77.40 ,$585.60 ,$165.85 ,$330.13 ,$204.96 ,$658.80 ,$73.71 ,$171.00 ,$215.00 ,$215.00 ,$73.71 ,$215.00 ,$351.36 ,$239.44 
ST. ELIZABETH'S HOSPITAL,45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$913.00 ,$593.45 ,$240.12 ,$913.00 ,$851.90 ,$419.98 ,$511.28 ,$340.76 ,$255.64 ,$308.59 ,$340.76 ,$355.16 ,$340.76 ,$411.76 ,$411.76 ,$340.76 ,$411.76 ,$647.44 ,$456.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$684.75 ,$547.80 ,$547.80 ,$340.76 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$851.90 ,$593.45 ,$340.76 ,$913.00 ,$511.28 ,$340.76 ,$240.12 , N/A , N/A , N/A ,$357.80 ,$730.40 ,$766.71 ,$411.76 ,$255.64 ,$821.70 ,$340.76 ,$693.88 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$815.00 ,$529.75 ,$214.35 ,"$1,533.75 ","$1,533.75 ",$374.90 ,$456.40 ,$613.50 ,$228.20 ,$275.47 ,$613.50 ,$317.04 ,$613.50 ,$367.57 ,$367.57 ,$613.50 ,$367.57 ,$815.00 ,$407.50 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,$611.25 ,$489.00 ,$489.00 ,$613.50 ,$489.00 ,$619.40 ,$619.40 ,$619.40 ,$815.00 , N/A ,$692.75 ,$815.00 ,$529.75 ,$613.50 ,$815.00 ,$456.40 ,$613.50 ,$214.35 , N/A , N/A , N/A ,$644.18 ,$652.00 ,"$1,380.37 ",$367.57 ,$228.20 ,$733.50 ,$613.50 ,$619.40 ,$400.00 ,$400.00 ,$613.50 ,$400.00 ,$391.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000004,10081,HC I AND D CYST PILONIDAL CPLX,450,1 ,"$2,548.00 ","$1,656.20 ",$400.00 ,"$2,548.00 ","$1,533.75 ","$1,172.08 ","$1,426.88 ",$613.50 ,$713.44 ,$861.22 ,$613.50 ,$991.17 ,$613.50 ,"$1,149.15 ","$1,149.15 ",$613.50 ,"$1,149.15 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,911.00 ","$1,528.80 ","$1,528.80 ",$613.50 ,"$1,528.80 ","$1,936.48 ","$1,936.48 ","$1,936.48 ","$2,548.00 ", N/A ,"$2,165.80 ","$1,533.75 ","$1,656.20 ",$613.50 ,"$2,548.00 ","$1,426.88 ",$613.50 ,$670.12 , N/A , N/A , N/A ,$644.18 ,"$2,038.40 ","$1,380.37 ","$1,149.15 ",$713.44 ,"$2,293.20 ",$613.50 ,"$1,936.48 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$1,223.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$532.00 ,$345.80 ,$139.92 ,$851.90 ,$851.90 ,$244.72 ,$297.92 ,$340.76 ,$148.96 ,$179.82 ,$340.76 ,$206.95 ,$340.76 ,$239.93 ,$239.93 ,$340.76 ,$239.93 ,$532.00 ,$266.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$399.00 ,$319.20 ,$319.20 ,$340.76 ,$319.20 ,$404.32 ,$404.32 ,$404.32 ,$532.00 , N/A ,$452.20 ,$532.00 ,$345.80 ,$340.76 ,$532.00 ,$297.92 ,$340.76 ,$139.92 , N/A , N/A , N/A ,$357.80 ,$425.60 ,$766.71 ,$239.93 ,$148.96 ,$478.80 ,$340.76 ,$404.32 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$255.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$823.00 ,$534.95 ,$177.04 ,$823.00 ,$442.60 ,$378.58 ,$460.88 ,$177.04 ,$230.44 ,$278.17 ,$177.04 ,$320.15 ,$177.04 ,$371.17 ,$371.17 ,$177.04 ,$371.17 ,$336.38 ,$411.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$617.25 ,$493.80 ,$493.80 ,$177.04 ,$493.80 ,$625.48 ,$625.48 ,$625.48 ,$823.00 , N/A ,$699.55 ,$442.60 ,$534.95 ,$177.04 ,$823.00 ,$460.88 ,$177.04 ,$216.45 , N/A , N/A , N/A ,$185.89 ,$658.40 ,$398.34 ,$371.17 ,$230.44 ,$740.70 ,$177.04 ,$625.48 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$395.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45000010,11732,HC AVULSION NAIL PL PT/CO EA ADDL FAC,450,1 ,$499.00 ,$324.35 ,$131.24 ,$499.00 , N/A ,$229.54 ,$279.44 , N/A ,$139.72 ,$168.66 , N/A ,$194.11 , N/A ,$225.05 ,$225.05 , N/A ,$225.05 , N/A ,$249.50 , N/A , N/A , N/A , N/A ,$374.25 ,$299.40 ,$299.40 , N/A ,$299.40 ,$379.24 ,$379.24 ,$379.24 ,$499.00 , N/A ,$424.15 , N/A ,$324.35 , N/A ,$499.00 ,$279.44 , N/A ,$131.24 , N/A , N/A , N/A , N/A ,$399.20 , N/A ,$225.05 ,$139.72 ,$449.10 , N/A ,$379.24 ,$400.00 ,$400.00 , N/A ,$400.00 ,$239.52 , N/A 
ST. ELIZABETH'S HOSPITAL,45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000012,11760,HC REPAIR NAIL BED,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,290.85 ","$1,290.85 ",$509.68 ,$620.48 ,$516.34 ,$310.24 ,$374.50 ,$516.34 ,$431.01 ,$516.34 ,$499.71 ,$499.71 ,$516.34 ,$499.71 ,$981.05 ,$554.00 ,"$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,$831.00 ,$664.80 ,$664.80 ,$516.34 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,"$1,108.00 ",$720.20 ,$516.34 ,"$1,108.00 ",$620.48 ,$516.34 ,$291.40 , N/A , N/A , N/A ,$542.16 ,$886.40 ,"$1,161.77 ",$499.71 ,$310.24 ,$997.20 ,$516.34 ,$842.08 ,$400.00 ,$400.00 ,$516.34 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,$734.00 ,$477.10 ,$193.04 ,$851.90 ,$851.90 ,$337.64 ,$411.04 ,$340.76 ,$205.52 ,$248.09 ,$340.76 ,$285.53 ,$340.76 ,$331.03 ,$331.03 ,$340.76 ,$331.03 ,$647.44 ,$367.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$550.50 ,$440.40 ,$440.40 ,$340.76 ,$440.40 ,$557.84 ,$557.84 ,$557.84 ,$734.00 , N/A ,$623.90 ,$734.00 ,$477.10 ,$340.76 ,$734.00 ,$411.04 ,$340.76 ,$193.04 , N/A , N/A , N/A ,$357.80 ,$587.20 ,$766.71 ,$331.03 ,$205.52 ,$660.60 ,$340.76 ,$557.84 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$352.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$554.00 ,$360.10 ,$145.70 ,$554.00 ,$442.60 ,$254.84 ,$310.24 ,$177.04 ,$155.12 ,$187.25 ,$177.04 ,$215.51 ,$177.04 ,$249.85 ,$249.85 ,$177.04 ,$249.85 ,$336.38 ,$277.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$415.50 ,$332.40 ,$332.40 ,$177.04 ,$332.40 ,$421.04 ,$421.04 ,$421.04 ,$554.00 , N/A ,$470.90 ,$442.60 ,$360.10 ,$177.04 ,$554.00 ,$310.24 ,$177.04 ,$145.70 , N/A , N/A , N/A ,$185.89 ,$443.20 ,$398.34 ,$249.85 ,$155.12 ,$498.60 ,$177.04 ,$421.04 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$265.92 , N/A 
ST. ELIZABETH'S HOSPITAL,45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$611.00 ,$397.15 ,$160.69 ,$611.00 ,$442.60 ,$281.06 ,$342.16 ,$177.04 ,$171.08 ,$206.52 ,$177.04 ,$237.68 ,$177.04 ,$275.56 ,$275.56 ,$177.04 ,$275.56 ,$336.38 ,$305.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$458.25 ,$366.60 ,$366.60 ,$177.04 ,$366.60 ,$464.36 ,$464.36 ,$464.36 ,$611.00 , N/A ,$519.35 ,$442.60 ,$397.15 ,$177.04 ,$611.00 ,$342.16 ,$177.04 ,$160.69 , N/A , N/A , N/A ,$185.89 ,$488.80 ,$398.34 ,$275.56 ,$171.08 ,$549.90 ,$177.04 ,$464.36 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$293.28 , N/A 
ST. ELIZABETH'S HOSPITAL,45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$716.00 ,$465.40 ,$177.04 ,$716.00 ,$442.60 ,$329.36 ,$400.96 ,$177.04 ,$200.48 ,$242.01 ,$177.04 ,$278.52 ,$177.04 ,$322.92 ,$322.92 ,$177.04 ,$322.92 ,$336.38 ,$358.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$537.00 ,$429.60 ,$429.60 ,$177.04 ,$429.60 ,$544.16 ,$544.16 ,$544.16 ,$716.00 , N/A ,$608.60 ,$442.60 ,$465.40 ,$177.04 ,$716.00 ,$400.96 ,$177.04 ,$188.31 , N/A , N/A , N/A ,$185.89 ,$572.80 ,$398.34 ,$322.92 ,$200.48 ,$644.40 ,$177.04 ,$544.16 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$343.68 , N/A 
ST. ELIZABETH'S HOSPITAL,45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$823.00 ,$534.95 ,$216.45 ,$851.90 ,$851.90 ,$378.58 ,$460.88 ,$340.76 ,$230.44 ,$278.17 ,$340.76 ,$320.15 ,$340.76 ,$371.17 ,$371.17 ,$340.76 ,$371.17 ,$647.44 ,$411.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$617.25 ,$493.80 ,$493.80 ,$340.76 ,$493.80 ,$625.48 ,$625.48 ,$625.48 ,$823.00 , N/A ,$699.55 ,$823.00 ,$534.95 ,$340.76 ,$823.00 ,$460.88 ,$340.76 ,$216.45 , N/A , N/A , N/A ,$357.80 ,$658.40 ,$766.71 ,$371.17 ,$230.44 ,$740.70 ,$340.76 ,$625.48 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$395.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$929.00 ,$603.85 ,$244.33 ,$929.00 ,$851.90 ,$427.34 ,$520.24 ,$340.76 ,$260.12 ,$314.00 ,$340.76 ,$361.38 ,$340.76 ,$418.98 ,$418.98 ,$340.76 ,$418.98 ,$647.44 ,$464.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$696.75 ,$557.40 ,$557.40 ,$340.76 ,$557.40 ,$706.04 ,$706.04 ,$706.04 ,$929.00 , N/A ,$789.65 ,$851.90 ,$603.85 ,$340.76 ,$929.00 ,$520.24 ,$340.76 ,$244.33 , N/A , N/A , N/A ,$357.80 ,$743.20 ,$766.71 ,$418.98 ,$260.12 ,$836.10 ,$340.76 ,$706.04 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$445.92 , N/A 
ST. ELIZABETH'S HOSPITAL,45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$511.29 ,$332.34 ,$134.47 ,$511.29 ,$442.60 ,$235.19 ,$286.32 ,$177.04 ,$143.16 ,$172.82 ,$177.04 ,$198.89 ,$177.04 ,$230.59 ,$230.59 ,$177.04 ,$230.59 ,$336.38 ,$255.65 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$383.47 ,$306.77 ,$306.77 ,$177.04 ,$306.77 ,$388.58 ,$388.58 ,$388.58 ,$511.29 , N/A ,$434.60 ,$442.60 ,$332.34 ,$177.04 ,$511.29 ,$286.32 ,$177.04 ,$134.47 , N/A , N/A , N/A ,$185.89 ,$409.03 ,$398.34 ,$230.59 ,$143.16 ,$460.16 ,$177.04 ,$388.58 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$245.42 , N/A 
ST. ELIZABETH'S HOSPITAL,45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$554.00 ,$360.10 ,$145.70 ,$554.00 ,$442.60 ,$254.84 ,$310.24 ,$177.04 ,$155.12 ,$187.25 ,$177.04 ,$215.51 ,$177.04 ,$249.85 ,$249.85 ,$177.04 ,$249.85 ,$336.38 ,$277.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$415.50 ,$332.40 ,$332.40 ,$177.04 ,$332.40 ,$421.04 ,$421.04 ,$421.04 ,$554.00 , N/A ,$470.90 ,$442.60 ,$360.10 ,$177.04 ,$554.00 ,$310.24 ,$177.04 ,$145.70 , N/A , N/A , N/A ,$185.89 ,$443.20 ,$398.34 ,$249.85 ,$155.12 ,$498.60 ,$177.04 ,$421.04 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$265.92 , N/A 
ST. ELIZABETH'S HOSPITAL,45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$611.00 ,$397.15 ,$160.69 ,$611.00 ,$442.60 ,$281.06 ,$342.16 ,$177.04 ,$171.08 ,$206.52 ,$177.04 ,$237.68 ,$177.04 ,$275.56 ,$275.56 ,$177.04 ,$275.56 ,$336.38 ,$305.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$458.25 ,$366.60 ,$366.60 ,$177.04 ,$366.60 ,$464.36 ,$464.36 ,$464.36 ,$611.00 , N/A ,$519.35 ,$442.60 ,$397.15 ,$177.04 ,$611.00 ,$342.16 ,$177.04 ,$160.69 , N/A , N/A , N/A ,$185.89 ,$488.80 ,$398.34 ,$275.56 ,$171.08 ,$549.90 ,$177.04 ,$464.36 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$293.28 , N/A 
ST. ELIZABETH'S HOSPITAL,45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$611.00 ,$397.15 ,$160.69 ,$611.00 ,$442.60 ,$281.06 ,$342.16 ,$177.04 ,$171.08 ,$206.52 ,$177.04 ,$237.68 ,$177.04 ,$275.56 ,$275.56 ,$177.04 ,$275.56 ,$336.38 ,$305.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$458.25 ,$366.60 ,$366.60 ,$177.04 ,$366.60 ,$464.36 ,$464.36 ,$464.36 ,$611.00 , N/A ,$519.35 ,$442.60 ,$397.15 ,$177.04 ,$611.00 ,$342.16 ,$177.04 ,$160.69 , N/A , N/A , N/A ,$185.89 ,$488.80 ,$398.34 ,$275.56 ,$171.08 ,$549.90 ,$177.04 ,$464.36 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$293.28 , N/A 
ST. ELIZABETH'S HOSPITAL,45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$734.00 ,$477.10 ,$177.04 ,$734.00 ,$442.60 ,$337.64 ,$411.04 ,$177.04 ,$205.52 ,$248.09 ,$177.04 ,$285.53 ,$177.04 ,$331.03 ,$331.03 ,$177.04 ,$331.03 ,$336.38 ,$367.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$550.50 ,$440.40 ,$440.40 ,$177.04 ,$440.40 ,$557.84 ,$557.84 ,$557.84 ,$734.00 , N/A ,$623.90 ,$442.60 ,$477.10 ,$177.04 ,$734.00 ,$411.04 ,$177.04 ,$193.04 , N/A , N/A , N/A ,$185.89 ,$587.20 ,$398.34 ,$331.03 ,$205.52 ,$660.60 ,$177.04 ,$557.84 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$352.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$823.00 ,$534.95 ,$216.45 ,$851.90 ,$851.90 ,$378.58 ,$460.88 ,$340.76 ,$230.44 ,$278.17 ,$340.76 ,$320.15 ,$340.76 ,$371.17 ,$371.17 ,$340.76 ,$371.17 ,$647.44 ,$411.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$617.25 ,$493.80 ,$493.80 ,$340.76 ,$493.80 ,$625.48 ,$625.48 ,$625.48 ,$823.00 , N/A ,$699.55 ,$823.00 ,$534.95 ,$340.76 ,$823.00 ,$460.88 ,$340.76 ,$216.45 , N/A , N/A , N/A ,$357.80 ,$658.40 ,$766.71 ,$371.17 ,$230.44 ,$740.70 ,$340.76 ,$625.48 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$395.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45000025,12017,HC SIMP F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$734.00 ,$477.10 ,$193.04 ,$851.90 ,$851.90 ,$337.64 ,$411.04 ,$340.76 ,$205.52 ,$248.09 ,$340.76 ,$285.53 ,$340.76 ,$331.03 ,$331.03 ,$340.76 ,$331.03 ,$647.44 ,$367.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$550.50 ,$440.40 ,$440.40 ,$340.76 ,$440.40 ,$557.84 ,$557.84 ,$557.84 ,$734.00 , N/A ,$623.90 ,$734.00 ,$477.10 ,$340.76 ,$734.00 ,$411.04 ,$340.76 ,$193.04 , N/A , N/A , N/A ,$357.80 ,$587.20 ,$766.71 ,$331.03 ,$205.52 ,$660.60 ,$340.76 ,$557.84 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$352.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000026,12018,HC SIMP F/E/E/N/L/MM OVER 30CM,450,1 ,$734.00 ,$477.10 ,$177.04 ,$734.00 ,$442.60 ,$337.64 ,$411.04 ,$177.04 ,$205.52 ,$248.09 ,$177.04 ,$285.53 ,$177.04 ,$331.03 ,$331.03 ,$177.04 ,$331.03 ,$336.38 ,$367.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$550.50 ,$440.40 ,$440.40 ,$177.04 ,$440.40 ,$557.84 ,$557.84 ,$557.84 ,$734.00 , N/A ,$623.90 ,$442.60 ,$477.10 ,$177.04 ,$734.00 ,$411.04 ,$177.04 ,$193.04 , N/A , N/A , N/A ,$185.89 ,$587.20 ,$398.34 ,$331.03 ,$205.52 ,$660.60 ,$177.04 ,$557.84 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$352.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$2,303.00 ","$1,496.95 ",$400.00 ,"$2,303.00 ","$1,290.85 ","$1,059.38 ","$1,289.68 ",$516.34 ,$644.84 ,$778.41 ,$516.34 ,$895.87 ,$516.34 ,"$1,038.65 ","$1,038.65 ",$516.34 ,"$1,038.65 ",$981.05 ,"$1,075.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,727.25 ","$1,381.80 ","$1,381.80 ",$516.34 ,"$1,381.80 ","$1,750.28 ","$1,750.28 ","$1,750.28 ","$2,303.00 ", N/A ,"$1,957.55 ","$1,290.85 ","$1,496.95 ",$516.34 ,"$2,303.00 ","$1,289.68 ",$516.34 ,$605.69 , N/A , N/A , N/A ,$542.16 ,"$1,842.40 ","$1,161.77 ","$1,038.65 ",$644.84 ,"$2,072.70 ",$516.34 ,"$1,750.28 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,"$1,105.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000028,12021,HC SIMP SUPERFICIAL DEHISCENC/PAK,450,1 ,"$1,051.00 ",$683.15 ,$276.41 ,"$1,051.00 ",$851.90 ,$483.46 ,$588.56 ,$340.76 ,$294.28 ,$355.24 ,$340.76 ,$408.84 ,$340.76 ,$474.00 ,$474.00 ,$340.76 ,$474.00 ,$647.44 ,$525.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$788.25 ,$630.60 ,$630.60 ,$340.76 ,$630.60 ,$798.76 ,$798.76 ,$798.76 ,"$1,051.00 ", N/A ,$893.35 ,$851.90 ,$683.15 ,$340.76 ,"$1,051.00 ",$588.56 ,$340.76 ,$276.41 , N/A , N/A , N/A ,$357.80 ,$840.80 ,$766.71 ,$474.00 ,$294.28 ,$945.90 ,$340.76 ,$798.76 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$504.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,"$1,240.00 ",$806.00 ,$326.12 ,"$1,240.00 ",$851.90 ,$570.40 ,$694.40 ,$340.76 ,$347.20 ,$419.12 ,$340.76 ,$482.36 ,$340.76 ,$559.24 ,$559.24 ,$340.76 ,$559.24 ,$647.44 ,$620.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$930.00 ,$744.00 ,$744.00 ,$340.76 ,$744.00 ,$942.40 ,$942.40 ,$942.40 ,"$1,240.00 ", N/A ,"$1,054.00 ",$851.90 ,$806.00 ,$340.76 ,"$1,240.00 ",$694.40 ,$340.76 ,$326.12 , N/A , N/A , N/A ,$357.80 ,$992.00 ,$766.71 ,$559.24 ,$347.20 ,"$1,116.00 ",$340.76 ,$942.40 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$595.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,"$1,240.00 ",$806.00 ,$326.12 ,"$1,240.00 ",$851.90 ,$570.40 ,$694.40 ,$340.76 ,$347.20 ,$419.12 ,$340.76 ,$482.36 ,$340.76 ,$559.24 ,$559.24 ,$340.76 ,$559.24 ,$647.44 ,$620.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$930.00 ,$744.00 ,$744.00 ,$340.76 ,$744.00 ,$942.40 ,$942.40 ,$942.40 ,"$1,240.00 ", N/A ,"$1,054.00 ",$851.90 ,$806.00 ,$340.76 ,"$1,240.00 ",$694.40 ,$340.76 ,$326.12 , N/A , N/A , N/A ,$357.80 ,$992.00 ,$766.71 ,$559.24 ,$347.20 ,"$1,116.00 ",$340.76 ,$942.40 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$595.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,"$1,240.00 ",$806.00 ,$326.12 ,"$1,240.00 ",$851.90 ,$570.40 ,$694.40 ,$340.76 ,$347.20 ,$419.12 ,$340.76 ,$482.36 ,$340.76 ,$559.24 ,$559.24 ,$340.76 ,$559.24 ,$647.44 ,$620.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$930.00 ,$744.00 ,$744.00 ,$340.76 ,$744.00 ,$942.40 ,$942.40 ,$942.40 ,"$1,240.00 ", N/A ,"$1,054.00 ",$851.90 ,$806.00 ,$340.76 ,"$1,240.00 ",$694.40 ,$340.76 ,$326.12 , N/A , N/A , N/A ,$357.80 ,$992.00 ,$766.71 ,$559.24 ,$347.20 ,"$1,116.00 ",$340.76 ,$942.40 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$595.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,"$2,164.00 ","$1,406.60 ",$340.76 ,"$2,164.00 ",$851.90 ,$995.44 ,"$1,211.84 ",$340.76 ,$605.92 ,$731.43 ,$340.76 ,$841.80 ,$340.76 ,$975.96 ,$975.96 ,$340.76 ,$975.96 ,$647.44 ,"$1,075.00 ",$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,623.00 ","$1,298.40 ","$1,298.40 ",$340.76 ,"$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ",$851.90 ,"$1,406.60 ",$340.76 ,"$2,164.00 ","$1,211.84 ",$340.76 ,$569.13 , N/A , N/A , N/A ,$357.80 ,"$1,731.20 ",$766.71 ,$975.96 ,$605.92 ,"$1,947.60 ",$340.76 ,"$1,644.64 ",$400.00 ,$400.00 ,$340.76 ,$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$2,164.00 ","$1,290.85 ",$995.44 ,"$1,211.84 ",$516.34 ,$605.92 ,$731.43 ,$516.34 ,$841.80 ,$516.34 ,$975.96 ,$975.96 ,$516.34 ,$975.96 ,$981.05 ,"$1,075.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,623.00 ","$1,298.40 ","$1,298.40 ",$516.34 ,"$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ","$1,290.85 ","$1,406.60 ",$516.34 ,"$2,164.00 ","$1,211.84 ",$516.34 ,$569.13 , N/A , N/A , N/A ,$542.16 ,"$1,731.20 ","$1,161.77 ",$975.96 ,$605.92 ,"$1,947.60 ",$516.34 ,"$1,644.64 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000034,12037,HC INTRM S/A/T/EXT OVER 30CM,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$4,221.50 ","$4,221.50 ",$995.44 ,"$1,211.84 ","$1,688.60 ",$605.92 ,$731.43 ,"$1,688.60 ",$841.80 ,"$1,688.60 ",$975.96 ,$975.96 ,"$1,688.60 ",$975.96 ,"$2,164.00 ","$1,075.00 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$1,623.00 ","$1,298.40 ","$1,298.40 ","$1,688.60 ","$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ","$2,164.00 ","$1,406.60 ","$1,688.60 ","$2,164.00 ","$1,211.84 ","$1,688.60 ",$569.13 , N/A , N/A , N/A ,"$1,773.03 ","$1,731.20 ","$3,799.34 ",$975.96 ,$605.92 ,"$1,947.60 ","$1,688.60 ","$1,644.64 ",$400.00 ,$400.00 ,"$1,688.60 ",$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,108.00 ",$851.90 ,$509.68 ,$620.48 ,$340.76 ,$310.24 ,$374.50 ,$340.76 ,$431.01 ,$340.76 ,$499.71 ,$499.71 ,$340.76 ,$499.71 ,$647.44 ,$554.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$831.00 ,$664.80 ,$664.80 ,$340.76 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,$851.90 ,$720.20 ,$340.76 ,"$1,108.00 ",$620.48 ,$340.76 ,$291.40 , N/A , N/A , N/A ,$357.80 ,$886.40 ,$766.71 ,$499.71 ,$310.24 ,$997.20 ,$340.76 ,$842.08 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,"$1,240.00 ",$806.00 ,$326.12 ,"$1,240.00 ",$851.90 ,$570.40 ,$694.40 ,$340.76 ,$347.20 ,$419.12 ,$340.76 ,$482.36 ,$340.76 ,$559.24 ,$559.24 ,$340.76 ,$559.24 ,$647.44 ,$620.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$930.00 ,$744.00 ,$744.00 ,$340.76 ,$744.00 ,$942.40 ,$942.40 ,$942.40 ,"$1,240.00 ", N/A ,"$1,054.00 ",$851.90 ,$806.00 ,$340.76 ,"$1,240.00 ",$694.40 ,$340.76 ,$326.12 , N/A , N/A , N/A ,$357.80 ,$992.00 ,$766.71 ,$559.24 ,$347.20 ,"$1,116.00 ",$340.76 ,$942.40 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$595.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,290.85 ","$1,290.85 ",$509.68 ,$620.48 ,$516.34 ,$310.24 ,$374.50 ,$516.34 ,$431.01 ,$516.34 ,$499.71 ,$499.71 ,$516.34 ,$499.71 ,$981.05 ,$554.00 ,"$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,$831.00 ,$664.80 ,$664.80 ,$516.34 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,"$1,108.00 ",$720.20 ,$516.34 ,"$1,108.00 ",$620.48 ,$516.34 ,$291.40 , N/A , N/A , N/A ,$542.16 ,$886.40 ,"$1,161.77 ",$499.71 ,$310.24 ,$997.20 ,$516.34 ,$842.08 ,$400.00 ,$400.00 ,$516.34 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,290.85 ","$1,290.85 ",$509.68 ,$620.48 ,$516.34 ,$310.24 ,$374.50 ,$516.34 ,$431.01 ,$516.34 ,$499.71 ,$499.71 ,$516.34 ,$499.71 ,$981.05 ,$554.00 ,"$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,$831.00 ,$664.80 ,$664.80 ,$516.34 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,"$1,108.00 ",$720.20 ,$516.34 ,"$1,108.00 ",$620.48 ,$516.34 ,$291.40 , N/A , N/A , N/A ,$542.16 ,$886.40 ,"$1,161.77 ",$499.71 ,$310.24 ,$997.20 ,$516.34 ,$842.08 ,$400.00 ,$400.00 ,$516.34 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,290.85 ","$1,290.85 ",$509.68 ,$620.48 ,$516.34 ,$310.24 ,$374.50 ,$516.34 ,$431.01 ,$516.34 ,$499.71 ,$499.71 ,$516.34 ,$499.71 ,$981.05 ,$554.00 ,"$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,$831.00 ,$664.80 ,$664.80 ,$516.34 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,"$1,108.00 ",$720.20 ,$516.34 ,"$1,108.00 ",$620.48 ,$516.34 ,$291.40 , N/A , N/A , N/A ,$542.16 ,$886.40 ,"$1,161.77 ",$499.71 ,$310.24 ,$997.20 ,$516.34 ,$842.08 ,$400.00 ,$400.00 ,$516.34 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000040,12047,HC INTRM N/H/F/GEN OVER 30CM,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$4,221.50 ","$4,221.50 ",$995.44 ,"$1,211.84 ","$1,688.60 ",$605.92 ,$731.43 ,"$1,688.60 ",$841.80 ,"$1,688.60 ",$975.96 ,$975.96 ,"$1,688.60 ",$975.96 ,"$2,164.00 ","$1,075.00 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$1,623.00 ","$1,298.40 ","$1,298.40 ","$1,688.60 ","$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ","$2,164.00 ","$1,406.60 ","$1,688.60 ","$2,164.00 ","$1,211.84 ","$1,688.60 ",$569.13 , N/A , N/A , N/A ,"$1,773.03 ","$1,731.20 ","$3,799.34 ",$975.96 ,$605.92 ,"$1,947.60 ","$1,688.60 ","$1,644.64 ",$400.00 ,$400.00 ,"$1,688.60 ",$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,"$1,364.00 ",$886.60 ,$340.76 ,"$1,364.00 ",$851.90 ,$627.44 ,$763.84 ,$340.76 ,$381.92 ,$461.03 ,$340.76 ,$530.60 ,$340.76 ,$615.16 ,$615.16 ,$340.76 ,$615.16 ,$647.44 ,$682.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,023.00 ",$818.40 ,$818.40 ,$340.76 ,$818.40 ,"$1,036.64 ","$1,036.64 ","$1,036.64 ","$1,364.00 ", N/A ,"$1,159.40 ",$851.90 ,$886.60 ,$340.76 ,"$1,364.00 ",$763.84 ,$340.76 ,$358.73 , N/A , N/A , N/A ,$357.80 ,"$1,091.20 ",$766.71 ,$615.16 ,$381.92 ,"$1,227.60 ",$340.76 ,"$1,036.64 ",$400.00 ,$400.00 ,$340.76 ,$400.00 ,$654.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,"$1,240.00 ",$806.00 ,$326.12 ,"$1,240.00 ",$851.90 ,$570.40 ,$694.40 ,$340.76 ,$347.20 ,$419.12 ,$340.76 ,$482.36 ,$340.76 ,$559.24 ,$559.24 ,$340.76 ,$559.24 ,$647.44 ,$620.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$930.00 ,$744.00 ,$744.00 ,$340.76 ,$744.00 ,$942.40 ,$942.40 ,$942.40 ,"$1,240.00 ", N/A ,"$1,054.00 ",$851.90 ,$806.00 ,$340.76 ,"$1,240.00 ",$694.40 ,$340.76 ,$326.12 , N/A , N/A , N/A ,$357.80 ,$992.00 ,$766.71 ,$559.24 ,$347.20 ,"$1,116.00 ",$340.76 ,$942.40 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$595.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,"$1,240.00 ",$806.00 ,$326.12 ,"$1,240.00 ",$851.90 ,$570.40 ,$694.40 ,$340.76 ,$347.20 ,$419.12 ,$340.76 ,$482.36 ,$340.76 ,$559.24 ,$559.24 ,$340.76 ,$559.24 ,$647.44 ,$620.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$930.00 ,$744.00 ,$744.00 ,$340.76 ,$744.00 ,$942.40 ,$942.40 ,$942.40 ,"$1,240.00 ", N/A ,"$1,054.00 ",$851.90 ,$806.00 ,$340.76 ,"$1,240.00 ",$694.40 ,$340.76 ,$326.12 , N/A , N/A , N/A ,$357.80 ,$992.00 ,$766.71 ,$559.24 ,$347.20 ,"$1,116.00 ",$340.76 ,$942.40 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$595.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,"$1,240.00 ",$806.00 ,$326.12 ,"$1,240.00 ",$851.90 ,$570.40 ,$694.40 ,$340.76 ,$347.20 ,$419.12 ,$340.76 ,$482.36 ,$340.76 ,$559.24 ,$559.24 ,$340.76 ,$559.24 ,$647.44 ,$620.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$930.00 ,$744.00 ,$744.00 ,$340.76 ,$744.00 ,$942.40 ,$942.40 ,$942.40 ,"$1,240.00 ", N/A ,"$1,054.00 ",$851.90 ,$806.00 ,$340.76 ,"$1,240.00 ",$694.40 ,$340.76 ,$326.12 , N/A , N/A , N/A ,$357.80 ,$992.00 ,$766.71 ,$559.24 ,$347.20 ,"$1,116.00 ",$340.76 ,$942.40 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$595.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000045,12055,HC INTRM F/E/E/N/L/MM 12.6-20.0CM,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,108.00 ",$851.90 ,$509.68 ,$620.48 ,$340.76 ,$310.24 ,$374.50 ,$340.76 ,$431.01 ,$340.76 ,$499.71 ,$499.71 ,$340.76 ,$499.71 ,$647.44 ,$554.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$831.00 ,$664.80 ,$664.80 ,$340.76 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,$851.90 ,$720.20 ,$340.76 ,"$1,108.00 ",$620.48 ,$340.76 ,$291.40 , N/A , N/A , N/A ,$357.80 ,$886.40 ,$766.71 ,$499.71 ,$310.24 ,$997.20 ,$340.76 ,$842.08 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000046,12056,HC INTRM F/E/E/N/L/MM 20.1-30.0CM,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,108.00 ",$851.90 ,$509.68 ,$620.48 ,$340.76 ,$310.24 ,$374.50 ,$340.76 ,$431.01 ,$340.76 ,$499.71 ,$499.71 ,$340.76 ,$499.71 ,$647.44 ,$554.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$831.00 ,$664.80 ,$664.80 ,$340.76 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,$851.90 ,$720.20 ,$340.76 ,"$1,108.00 ",$620.48 ,$340.76 ,$291.40 , N/A , N/A , N/A ,$357.80 ,$886.40 ,$766.71 ,$499.71 ,$310.24 ,$997.20 ,$340.76 ,$842.08 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000047,12057,HC INTRM F/E/E/N/L/MM OVER 30.0CM,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,108.00 ",$851.90 ,$509.68 ,$620.48 ,$340.76 ,$310.24 ,$374.50 ,$340.76 ,$431.01 ,$340.76 ,$499.71 ,$499.71 ,$340.76 ,$499.71 ,$647.44 ,$554.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$831.00 ,$664.80 ,$664.80 ,$340.76 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,$851.90 ,$720.20 ,$340.76 ,"$1,108.00 ",$620.48 ,$340.76 ,$291.40 , N/A , N/A , N/A ,$357.80 ,$886.40 ,$766.71 ,$499.71 ,$310.24 ,$997.20 ,$340.76 ,$842.08 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$2,164.00 ","$1,290.85 ",$995.44 ,"$1,211.84 ",$516.34 ,$605.92 ,$731.43 ,$516.34 ,$841.80 ,$516.34 ,$975.96 ,$975.96 ,$516.34 ,$975.96 ,$981.05 ,"$1,075.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,623.00 ","$1,298.40 ","$1,298.40 ",$516.34 ,"$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ","$1,290.85 ","$1,406.60 ",$516.34 ,"$2,164.00 ","$1,211.84 ",$516.34 ,$569.13 , N/A , N/A , N/A ,$542.16 ,"$1,731.20 ","$1,161.77 ",$975.96 ,$605.92 ,"$1,947.60 ",$516.34 ,"$1,644.64 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$2,164.00 ","$1,290.85 ",$995.44 ,"$1,211.84 ",$516.34 ,$605.92 ,$731.43 ,$516.34 ,$841.80 ,$516.34 ,$975.96 ,$975.96 ,$516.34 ,$975.96 ,$981.05 ,"$1,075.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,623.00 ","$1,298.40 ","$1,298.40 ",$516.34 ,"$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ","$1,290.85 ","$1,406.60 ",$516.34 ,"$2,164.00 ","$1,211.84 ",$516.34 ,$569.13 , N/A , N/A , N/A ,$542.16 ,"$1,731.20 ","$1,161.77 ",$975.96 ,$605.92 ,"$1,947.60 ",$516.34 ,"$1,644.64 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,290.85 ","$1,290.85 ",$509.68 ,$620.48 ,$516.34 ,$310.24 ,$374.50 ,$516.34 ,$431.01 ,$516.34 ,$499.71 ,$499.71 ,$516.34 ,$499.71 ,$981.05 ,$554.00 ,"$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,$831.00 ,$664.80 ,$664.80 ,$516.34 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,"$1,108.00 ",$720.20 ,$516.34 ,"$1,108.00 ",$620.48 ,$516.34 ,$291.40 , N/A , N/A , N/A ,$542.16 ,$886.40 ,"$1,161.77 ",$499.71 ,$310.24 ,$997.20 ,$516.34 ,$842.08 ,$400.00 ,$400.00 ,$516.34 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,"$2,028.00 ","$1,318.20 ",$400.00 ,"$2,028.00 ","$1,290.85 ",$932.88 ,"$1,135.68 ",$516.34 ,$567.84 ,$685.46 ,$516.34 ,$788.89 ,$516.34 ,$914.63 ,$914.63 ,$516.34 ,$914.63 ,$981.05 ,"$1,014.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,521.00 ","$1,216.80 ","$1,216.80 ",$516.34 ,"$1,216.80 ","$1,541.28 ","$1,541.28 ","$1,541.28 ","$2,028.00 ", N/A ,"$1,723.80 ","$1,290.85 ","$1,318.20 ",$516.34 ,"$2,028.00 ","$1,135.68 ",$516.34 ,$533.36 , N/A , N/A , N/A ,$542.16 ,"$1,622.40 ","$1,161.77 ",$914.63 ,$567.84 ,"$1,825.20 ",$516.34 ,"$1,541.28 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,$973.44 , N/A 
ST. ELIZABETH'S HOSPITAL,45000053,13122,HC CMPLX S/A/L EA ADDL 5 CM OR LESS,450,1 ,"$1,013.00 ",$658.45 ,$266.42 ,"$1,013.00 ", N/A ,$465.98 ,$567.28 , N/A ,$283.64 ,$342.39 , N/A ,$394.06 , N/A ,$456.86 ,$456.86 , N/A ,$456.86 , N/A ,$506.50 , N/A , N/A , N/A , N/A ,$759.75 ,$607.80 ,$607.80 , N/A ,$607.80 ,$769.88 ,$769.88 ,$769.88 ,"$1,013.00 ", N/A ,$861.05 , N/A ,$658.45 , N/A ,"$1,013.00 ",$567.28 , N/A ,$266.42 , N/A , N/A , N/A , N/A ,$810.40 , N/A ,$456.86 ,$283.64 ,$911.70 , N/A ,$769.88 ,$400.00 ,$400.00 , N/A ,$400.00 ,$486.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000054,13131,HC CMPLX F/C/C/M/N/A/G/H/F 1.1-2.5 CM,450,1 ,"$2,028.00 ","$1,318.20 ",$340.76 ,"$2,028.00 ",$851.90 ,$932.88 ,"$1,135.68 ",$340.76 ,$567.84 ,$685.46 ,$340.76 ,$788.89 ,$340.76 ,$914.63 ,$914.63 ,$340.76 ,$914.63 ,$647.44 ,"$1,014.00 ",$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,521.00 ","$1,216.80 ","$1,216.80 ",$340.76 ,"$1,216.80 ","$1,541.28 ","$1,541.28 ","$1,541.28 ","$2,028.00 ", N/A ,"$1,723.80 ",$851.90 ,"$1,318.20 ",$340.76 ,"$2,028.00 ","$1,135.68 ",$340.76 ,$533.36 , N/A , N/A , N/A ,$357.80 ,"$1,622.40 ",$766.71 ,$914.63 ,$567.84 ,"$1,825.20 ",$340.76 ,"$1,541.28 ",$400.00 ,$400.00 ,$340.76 ,$400.00 ,$973.44 , N/A 
ST. ELIZABETH'S HOSPITAL,45000055,13132,HC CMPLX F/C/C/M/N/A/G/H/F 2.6-7.5 CM,450,1 ,"$2,107.00 ","$1,369.55 ",$400.00 ,"$2,107.00 ","$1,290.85 ",$969.22 ,"$1,179.92 ",$516.34 ,$589.96 ,$712.17 ,$516.34 ,$819.62 ,$516.34 ,$950.26 ,$950.26 ,$516.34 ,$950.26 ,$981.05 ,"$1,053.50 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,580.25 ","$1,264.20 ","$1,264.20 ",$516.34 ,"$1,264.20 ","$1,601.32 ","$1,601.32 ","$1,601.32 ","$2,107.00 ", N/A ,"$1,790.95 ","$1,290.85 ","$1,369.55 ",$516.34 ,"$2,107.00 ","$1,179.92 ",$516.34 ,$554.14 , N/A , N/A , N/A ,$542.16 ,"$1,685.60 ","$1,161.77 ",$950.26 ,$589.96 ,"$1,896.30 ",$516.34 ,"$1,601.32 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,"$1,011.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000056,13133,HC CMPLX F/C/C/M/N/A/G/H/F EA ADDL 5 CM OR LESS,450,1 ,"$1,396.00 ",$907.40 ,$367.15 ,"$1,396.00 ", N/A ,$642.16 ,$781.76 , N/A ,$390.88 ,$471.85 , N/A ,$543.04 , N/A ,$629.60 ,$629.60 , N/A ,$629.60 , N/A ,$698.00 , N/A , N/A , N/A , N/A ,"$1,047.00 ",$837.60 ,$837.60 , N/A ,$837.60 ,"$1,060.96 ","$1,060.96 ","$1,060.96 ","$1,396.00 ", N/A ,"$1,186.60 ", N/A ,$907.40 , N/A ,"$1,396.00 ",$781.76 , N/A ,$367.15 , N/A , N/A , N/A , N/A ,"$1,116.80 ", N/A ,$629.60 ,$390.88 ,"$1,256.40 ", N/A ,"$1,060.96 ",$400.00 ,$400.00 , N/A ,$400.00 ,$670.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$2,164.00 ","$1,290.85 ",$995.44 ,"$1,211.84 ",$516.34 ,$605.92 ,$731.43 ,$516.34 ,$841.80 ,$516.34 ,$975.96 ,$975.96 ,$516.34 ,$975.96 ,$981.05 ,"$1,075.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,623.00 ","$1,298.40 ","$1,298.40 ",$516.34 ,"$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ","$1,290.85 ","$1,406.60 ",$516.34 ,"$2,164.00 ","$1,211.84 ",$516.34 ,$569.13 , N/A , N/A , N/A ,$542.16 ,"$1,731.20 ","$1,161.77 ",$975.96 ,$605.92 ,"$1,947.60 ",$516.34 ,"$1,644.64 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$2,164.00 ","$1,290.85 ",$995.44 ,"$1,211.84 ",$516.34 ,$605.92 ,$731.43 ,$516.34 ,$841.80 ,$516.34 ,$975.96 ,$975.96 ,$516.34 ,$975.96 ,$981.05 ,"$1,075.00 ","$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,623.00 ","$1,298.40 ","$1,298.40 ",$516.34 ,"$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ","$1,290.85 ","$1,406.60 ",$516.34 ,"$2,164.00 ","$1,211.84 ",$516.34 ,$569.13 , N/A , N/A , N/A ,$542.16 ,"$1,731.20 ","$1,161.77 ",$975.96 ,$605.92 ,"$1,947.60 ",$516.34 ,"$1,644.64 ",$400.00 ,$400.00 ,$516.34 ,$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000060,13153,HC CMPLX E/N/E/L EA ADDL 5 CM OR LESS,450,1 ,"$2,164.00 ","$1,406.60 ",$400.00 ,"$2,164.00 ", N/A ,$995.44 ,"$1,211.84 ", N/A ,$605.92 ,$731.43 , N/A ,$841.80 , N/A ,$975.96 ,$975.96 , N/A ,$975.96 , N/A ,"$1,075.00 ", N/A , N/A , N/A , N/A ,"$1,623.00 ","$1,298.40 ","$1,298.40 ", N/A ,"$1,298.40 ","$1,644.64 ","$1,644.64 ","$1,644.64 ","$2,164.00 ", N/A ,"$1,839.40 ", N/A ,"$1,406.60 ", N/A ,"$2,164.00 ","$1,211.84 ", N/A ,$569.13 , N/A , N/A , N/A , N/A ,"$1,731.20 ", N/A ,$975.96 ,$605.92 ,"$1,947.60 ", N/A ,"$1,644.64 ",$400.00 ,$400.00 , N/A ,$400.00 ,"$1,038.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$494.00 ,$321.10 ,$129.92 ,$494.00 ,$442.60 ,$227.24 ,$276.64 ,$177.04 ,$138.32 ,$166.97 ,$177.04 ,$192.17 ,$177.04 ,$222.79 ,$222.79 ,$177.04 ,$222.79 ,$336.38 ,$247.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$370.50 ,$296.40 ,$296.40 ,$177.04 ,$296.40 ,$375.44 ,$375.44 ,$375.44 ,$494.00 , N/A ,$419.90 ,$442.60 ,$321.10 ,$177.04 ,$494.00 ,$276.64 ,$177.04 ,$129.92 , N/A , N/A , N/A ,$185.89 ,$395.20 ,$398.34 ,$222.79 ,$138.32 ,$444.60 ,$177.04 ,$375.44 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$237.12 , N/A 
ST. ELIZABETH'S HOSPITAL,45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$907.00 ,$589.55 ,$177.04 ,$907.00 ,$442.60 ,$417.22 ,$507.92 ,$177.04 ,$253.96 ,$306.57 ,$177.04 ,$352.82 ,$177.04 ,$409.06 ,$409.06 ,$177.04 ,$409.06 ,$336.38 ,$453.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$680.25 ,$544.20 ,$544.20 ,$177.04 ,$544.20 ,$689.32 ,$689.32 ,$689.32 ,$907.00 , N/A ,$770.95 ,$442.60 ,$589.55 ,$177.04 ,$907.00 ,$507.92 ,$177.04 ,$238.54 , N/A , N/A , N/A ,$185.89 ,$725.60 ,$398.34 ,$409.06 ,$253.96 ,$816.30 ,$177.04 ,$689.32 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$435.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$991.00 ,$644.15 ,$177.04 ,$991.00 ,$442.60 ,$455.86 ,$554.96 ,$177.04 ,$277.48 ,$334.96 ,$177.04 ,$385.50 ,$177.04 ,$446.94 ,$446.94 ,$177.04 ,$446.94 ,$336.38 ,$495.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$743.25 ,$594.60 ,$594.60 ,$177.04 ,$594.60 ,$753.16 ,$753.16 ,$753.16 ,$991.00 , N/A ,$842.35 ,$442.60 ,$644.15 ,$177.04 ,$991.00 ,$554.96 ,$177.04 ,$260.63 , N/A , N/A , N/A ,$185.89 ,$792.80 ,$398.34 ,$446.94 ,$277.48 ,$891.90 ,$177.04 ,$753.16 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$475.68 , N/A 
ST. ELIZABETH'S HOSPITAL,45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,"$1,046.00 ",$679.90 ,$275.10 ,"$1,046.00 ",$851.90 ,$481.16 ,$585.76 ,$340.76 ,$292.88 ,$353.55 ,$340.76 ,$406.89 ,$340.76 ,$471.75 ,$471.75 ,$340.76 ,$471.75 ,$647.44 ,$523.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$784.50 ,$627.60 ,$627.60 ,$340.76 ,$627.60 ,$794.96 ,$794.96 ,$794.96 ,"$1,046.00 ", N/A ,$889.10 ,$851.90 ,$679.90 ,$340.76 ,"$1,046.00 ",$585.76 ,$340.76 ,$275.10 , N/A , N/A , N/A ,$357.80 ,$836.80 ,$766.71 ,$471.75 ,$292.88 ,$941.40 ,$340.76 ,$794.96 ,$400.00 ,$400.00 ,$340.76 ,$400.00 ,$502.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,"$1,618.00 ","$1,051.70 ",$177.04 ,"$1,618.00 ",$442.60 ,$744.28 ,$906.08 ,$177.04 ,$453.04 ,$546.88 ,$177.04 ,$629.40 ,$177.04 ,$729.72 ,$729.72 ,$177.04 ,$729.72 ,$336.38 ,$809.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,"$1,213.50 ",$970.80 ,$970.80 ,$177.04 ,$970.80 ,"$1,229.68 ","$1,229.68 ","$1,229.68 ","$1,618.00 ", N/A ,"$1,375.30 ",$442.60 ,"$1,051.70 ",$177.04 ,"$1,618.00 ",$906.08 ,$177.04 ,$425.53 , N/A , N/A , N/A ,$185.89 ,"$1,294.40 ",$398.34 ,$729.72 ,$453.04 ,"$1,456.20 ",$177.04 ,"$1,229.68 ",$400.00 ,$400.00 ,$177.04 ,$400.00 ,$776.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000068,20103,HC EXPL PENTR WOUND EXTREMITY,450,1 ,"$4,358.00 ","$2,832.70 ",$400.00 ,"$4,358.00 ","$1,533.75 ","$2,000.00 ","$2,440.48 ",$613.50 ,"$1,220.24 ","$1,473.00 ",$613.50 ,"$1,695.26 ",$613.50 ,"$1,965.46 ","$1,965.46 ",$613.50 ,"$1,965.46 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,268.50 ","$2,614.80 ","$2,614.80 ",$613.50 ,"$2,614.80 ","$3,312.08 ","$3,312.08 ","$3,312.08 ","$4,358.00 ", N/A ,"$3,704.30 ","$1,533.75 ","$2,832.70 ",$613.50 ,"$4,358.00 ","$2,440.48 ",$613.50 ,"$1,146.15 ", N/A , N/A , N/A ,$644.18 ,"$3,486.40 ","$1,380.37 ","$1,965.46 ","$1,220.24 ","$3,922.20 ",$613.50 ,"$3,312.08 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$2,091.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,"$2,002.00 ","$1,301.30 ",$257.58 ,"$2,002.00 ",$643.95 ,$920.92 ,"$1,121.12 ",$257.58 ,$560.56 ,$676.68 ,$257.58 ,$778.78 ,$257.58 ,$902.90 ,$902.90 ,$257.58 ,$902.90 ,$489.39 ,"$1,001.00 ",$643.94 ,$257.58 ,$257.58 ,$262.73 ,"$1,501.50 ","$1,201.20 ","$1,201.20 ",$257.58 ,"$1,201.20 ","$1,521.52 ","$1,521.52 ","$1,521.52 ","$2,002.00 ", N/A ,"$1,701.70 ",$643.94 ,"$1,301.30 ",$257.58 ,"$2,002.00 ","$1,121.12 ",$257.58 ,$526.53 , N/A , N/A , N/A ,$270.46 ,"$1,601.60 ",$579.55 ,$902.90 ,$560.56 ,"$1,801.80 ",$257.58 ,"$1,521.52 ",$400.00 ,$400.00 ,$257.58 ,$400.00 ,$960.96 , N/A 
ST. ELIZABETH'S HOSPITAL,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,"$2,840.00 ","$1,846.00 ",$386.36 ,"$2,840.00 ",$965.90 ,"$1,306.40 ","$1,590.40 ",$386.36 ,$795.20 ,$959.92 ,$386.36 ,"$1,104.76 ",$386.36 ,"$1,280.84 ","$1,280.84 ",$386.36 ,"$1,280.84 ",$734.09 ,"$1,075.00 ",$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$2,130.00 ","$1,704.00 ","$1,704.00 ",$386.36 ,"$1,704.00 ","$2,158.40 ","$2,158.40 ","$2,158.40 ","$2,840.00 ", N/A ,"$2,414.00 ",$965.91 ,"$1,846.00 ",$386.36 ,"$2,840.00 ","$1,590.40 ",$386.36 ,$746.92 , N/A , N/A , N/A ,$405.68 ,"$2,272.00 ",$869.32 ,"$1,280.84 ",$795.20 ,"$2,556.00 ",$386.36 ,"$2,158.40 ",$400.00 ,$400.00 ,$386.36 ,$400.00 ,"$1,363.20 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,"$1,154.00 ",$750.10 ,$257.58 ,"$1,154.00 ",$643.95 ,$530.84 ,$646.24 ,$257.58 ,$323.12 ,$390.05 ,$257.58 ,$448.91 ,$257.58 ,$520.45 ,$520.45 ,$257.58 ,$520.45 ,$489.39 ,$577.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$865.50 ,$692.40 ,$692.40 ,$257.58 ,$692.40 ,$877.04 ,$877.04 ,$877.04 ,"$1,154.00 ", N/A ,$980.90 ,$643.94 ,$750.10 ,$257.58 ,"$1,154.00 ",$646.24 ,$257.58 ,$303.50 , N/A , N/A , N/A ,$270.46 ,$923.20 ,$579.55 ,$520.45 ,$323.12 ,"$1,038.60 ",$257.58 ,$877.04 ,$400.00 ,$400.00 ,$257.58 ,$400.00 ,$553.92 , N/A 
ST. ELIZABETH'S HOSPITAL,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,"$1,894.00 ","$1,231.10 ",$386.36 ,"$1,894.00 ",$965.90 ,$871.24 ,"$1,060.64 ",$386.36 ,$530.32 ,$640.17 ,$386.36 ,$736.77 ,$386.36 ,$854.19 ,$854.19 ,$386.36 ,$854.19 ,$734.09 ,$947.00 ,$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$1,420.50 ","$1,136.40 ","$1,136.40 ",$386.36 ,"$1,136.40 ","$1,439.44 ","$1,439.44 ","$1,439.44 ","$1,894.00 ", N/A ,"$1,609.90 ",$965.91 ,"$1,231.10 ",$386.36 ,"$1,894.00 ","$1,060.64 ",$386.36 ,$498.12 , N/A , N/A , N/A ,$405.68 ,"$1,515.20 ",$869.32 ,$854.19 ,$530.32 ,"$1,704.60 ",$386.36 ,"$1,439.44 ",$400.00 ,$400.00 ,$386.36 ,$400.00 ,$909.12 , N/A 
ST. ELIZABETH'S HOSPITAL,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,"$1,601.00 ","$1,040.65 ",$386.36 ,"$1,601.00 ",$965.90 ,$736.46 ,$896.56 ,$386.36 ,$448.28 ,$541.14 ,$386.36 ,$622.79 ,$386.36 ,$722.05 ,$722.05 ,$386.36 ,$722.05 ,$734.09 ,$800.50 ,$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$1,200.75 ",$960.60 ,$960.60 ,$386.36 ,$960.60 ,"$1,216.76 ","$1,216.76 ","$1,216.76 ","$1,601.00 ", N/A ,"$1,360.85 ",$965.91 ,"$1,040.65 ",$386.36 ,"$1,601.00 ",$896.56 ,$386.36 ,$421.06 , N/A , N/A , N/A ,$405.68 ,"$1,280.80 ",$869.32 ,$722.05 ,$448.28 ,"$1,440.90 ",$386.36 ,"$1,216.76 ",$400.00 ,$400.00 ,$386.36 ,$400.00 ,$768.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,"$1,192.00 ",$774.80 ,$257.58 ,"$1,192.00 ",$643.95 ,$548.32 ,$667.52 ,$257.58 ,$333.76 ,$402.90 ,$257.58 ,$463.69 ,$257.58 ,$537.59 ,$537.59 ,$257.58 ,$537.59 ,$489.39 ,$596.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$894.00 ,$715.20 ,$715.20 ,$257.58 ,$715.20 ,$905.92 ,$905.92 ,$905.92 ,"$1,192.00 ", N/A ,"$1,013.20 ",$643.94 ,$774.80 ,$257.58 ,"$1,192.00 ",$667.52 ,$257.58 ,$313.50 , N/A , N/A , N/A ,$270.46 ,$953.60 ,$579.55 ,$537.59 ,$333.76 ,"$1,072.80 ",$257.58 ,$905.92 ,$400.00 ,$400.00 ,$257.58 ,$400.00 ,$572.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000072,20612,HC INJ GANGLION CYST,450,1 ,$337.00 ,$219.05 ,$88.63 ,$643.95 ,$643.95 ,$155.02 ,$188.72 ,$257.58 ,$94.36 ,$113.91 ,$257.58 ,$131.09 ,$257.58 ,$151.99 ,$151.99 ,$257.58 ,$151.99 ,$337.00 ,$168.50 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$252.75 ,$202.20 ,$202.20 ,$257.58 ,$202.20 ,$256.12 ,$256.12 ,$256.12 ,$337.00 , N/A ,$286.45 ,$337.00 ,$219.05 ,$257.58 ,$337.00 ,$188.72 ,$257.58 ,$88.63 , N/A , N/A , N/A ,$270.46 ,$269.60 ,$579.55 ,$151.99 ,$94.36 ,$303.30 ,$257.58 ,$256.12 ,$337.00 ,$337.00 ,$257.58 ,$337.00 ,$161.76 , N/A 
ST. ELIZABETH'S HOSPITAL,45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,"$1,613.00 ","$1,048.45 ",$304.80 ,"$1,613.00 ",$762.00 ,$741.98 ,$903.28 ,$304.80 ,$451.64 ,$545.19 ,$304.80 ,$627.46 ,$304.80 ,$727.46 ,$727.46 ,$304.80 ,$727.46 ,$579.12 ,$806.50 ,$762.00 ,$304.80 ,$304.80 ,$310.90 ,"$1,209.75 ",$967.80 ,$967.80 ,$304.80 ,$967.80 ,"$1,225.88 ","$1,225.88 ","$1,225.88 ","$1,613.00 ", N/A ,"$1,371.05 ",$762.00 ,"$1,048.45 ",$304.80 ,"$1,613.00 ",$903.28 ,$304.80 ,$424.22 , N/A , N/A , N/A ,$320.04 ,"$1,290.40 ",$685.80 ,$727.46 ,$451.64 ,"$1,451.70 ",$304.80 ,"$1,225.88 ",$400.00 ,$400.00 ,$304.80 ,$400.00 ,$774.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000075,23655,HC TX DISL SHLDR W/MAN/ANES CLS,450,1 ,"$5,395.00 ","$3,506.75 ",$400.00 ,"$5,395.00 ","$3,432.95 ","$2,000.00 ","$3,021.20 ","$1,373.18 ","$1,510.60 ","$1,823.51 ","$1,373.18 ","$2,098.66 ","$1,373.18 ","$2,433.15 ","$2,433.15 ","$1,373.18 ","$2,433.15 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,046.25 ","$3,237.00 ","$3,237.00 ","$1,373.18 ","$3,237.00 ","$4,100.20 ","$4,100.20 ","$4,100.20 ","$5,395.00 ", N/A ,"$4,585.75 ","$3,432.94 ","$3,506.75 ","$1,373.18 ","$5,395.00 ","$3,021.20 ","$1,373.18 ","$1,418.89 ", N/A , N/A , N/A ,"$1,441.84 ","$4,316.00 ","$3,089.65 ","$2,433.15 ","$1,510.60 ","$4,855.50 ","$1,373.18 ","$4,100.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,589.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,"$1,855.00 ","$1,205.75 ",$304.80 ,"$1,855.00 ",$762.00 ,$853.30 ,"$1,038.80 ",$304.80 ,$519.40 ,$626.99 ,$304.80 ,$721.60 ,$304.80 ,$836.61 ,$836.61 ,$304.80 ,$836.61 ,$579.12 ,$927.50 ,$762.00 ,$304.80 ,$304.80 ,$310.90 ,"$1,391.25 ","$1,113.00 ","$1,113.00 ",$304.80 ,"$1,113.00 ","$1,409.80 ","$1,409.80 ","$1,409.80 ","$1,855.00 ", N/A ,"$1,576.75 ",$762.00 ,"$1,205.75 ",$304.80 ,"$1,855.00 ","$1,038.80 ",$304.80 ,$487.87 , N/A , N/A , N/A ,$320.04 ,"$1,484.00 ",$685.80 ,$836.61 ,$519.40 ,"$1,669.50 ",$304.80 ,"$1,409.80 ",$400.00 ,$400.00 ,$304.80 ,$400.00 ,$890.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,"$4,020.00 ","$2,613.00 ",$400.00 ,"$4,020.00 ","$3,432.95 ","$1,849.20 ","$2,251.20 ","$1,373.18 ","$1,125.60 ","$1,358.76 ","$1,373.18 ","$1,563.78 ","$1,373.18 ","$1,813.02 ","$1,813.02 ","$1,373.18 ","$1,813.02 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,015.00 ","$2,412.00 ","$2,412.00 ","$1,373.18 ","$2,412.00 ","$3,055.20 ","$3,055.20 ","$3,055.20 ","$4,020.00 ", N/A ,"$3,417.00 ","$3,432.94 ","$2,613.00 ","$1,373.18 ","$4,020.00 ","$2,251.20 ","$1,373.18 ","$1,057.26 ", N/A , N/A , N/A ,"$1,441.84 ","$3,216.00 ","$3,089.65 ","$1,813.02 ","$1,125.60 ","$3,618.00 ","$1,373.18 ","$3,055.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,929.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000083,26010,HC DRAIN ABSC FINGER SIMPLE,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000084,26011,HC DRAIN ABSC FINGER COMPLCD,450,1 ,"$4,358.00 ","$2,832.70 ",$400.00 ,"$4,358.00 ","$3,467.90 ","$2,000.00 ","$2,440.48 ","$1,387.16 ","$1,220.24 ","$1,473.00 ","$1,387.16 ","$1,695.26 ","$1,387.16 ","$1,965.46 ","$1,965.46 ","$1,387.16 ","$1,965.46 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,268.50 ","$2,614.80 ","$2,614.80 ","$1,387.16 ","$2,614.80 ","$3,312.08 ","$3,312.08 ","$3,312.08 ","$4,358.00 ", N/A ,"$3,704.30 ","$3,467.89 ","$2,832.70 ","$1,387.16 ","$4,358.00 ","$2,440.48 ","$1,387.16 ","$1,146.15 ", N/A , N/A , N/A ,"$1,456.52 ","$3,486.40 ","$3,121.10 ","$1,965.46 ","$1,220.24 ","$3,922.20 ","$1,387.16 ","$3,312.08 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$2,091.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000087,26725,HC TX FX PHALANX PROX W/MAN CLS,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000088,26742,HC TX FX (M-P)(I-P) JT W/MAN,450,1 ,"$1,075.00 ",$698.75 ,$282.73 ,"$3,432.95 ","$3,432.95 ",$494.50 ,$602.00 ,"$1,373.18 ",$301.00 ,$363.35 ,"$1,373.18 ",$418.18 ,"$1,075.00 ",$484.83 ,$484.83 ,"$1,075.00 ",$484.83 ,"$1,075.00 ",$537.50 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,075.00 ",$806.25 ,$645.00 ,$645.00 ,"$1,373.18 ",$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,"$1,075.00 ",$698.75 ,"$1,373.18 ","$1,075.00 ",$602.00 ,"$1,373.18 ",$282.73 , N/A , N/A , N/A ,"$1,441.84 ",$860.00 ,"$3,089.65 ",$484.83 ,$301.00 ,$967.50 ,"$1,373.18 ",$817.00 ,$400.00 ,$400.00 ,"$1,075.00 ",$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000089,26755,HC TX FX PHALANX DIST W/MAN CLS,450,1 ,"$1,327.00 ",$862.55 ,$203.20 ,"$1,327.00 ",$508.00 ,$610.42 ,$743.12 ,$203.20 ,$371.56 ,$448.53 ,$203.20 ,$516.20 ,$203.20 ,$598.48 ,$598.48 ,$203.20 ,$598.48 ,$386.08 ,$663.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$995.25 ,$796.20 ,$796.20 ,$203.20 ,$796.20 ,"$1,008.52 ","$1,008.52 ","$1,008.52 ","$1,327.00 ", N/A ,"$1,127.95 ",$508.00 ,$862.55 ,$203.20 ,"$1,327.00 ",$743.12 ,$203.20 ,$349.00 , N/A , N/A , N/A ,$213.36 ,"$1,061.60 ",$457.20 ,$598.48 ,$371.56 ,"$1,194.30 ",$203.20 ,"$1,008.52 ",$400.00 ,$400.00 ,$203.20 ,$400.00 ,$636.96 , N/A 
ST. ELIZABETH'S HOSPITAL,45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$9,418.00 ","$6,121.70 ",$400.00 ,"$9,418.00 ","$6,979.95 ","$2,000.00 ","$5,274.08 ","$2,791.98 ","$2,637.04 ","$2,282.50 ","$2,791.98 ","$3,663.60 ","$2,791.98 ","$4,247.52 ","$4,247.52 ","$2,791.98 ","$4,247.52 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$7,063.50 ","$5,650.80 ","$5,650.80 ","$2,791.98 ","$5,650.80 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$9,418.00 ", N/A ,"$8,005.30 ","$6,979.94 ","$6,121.70 ","$2,791.98 ","$9,418.00 ","$5,274.08 ","$2,791.98 ","$2,476.93 ", N/A , N/A , N/A ,"$2,931.58 ","$7,534.40 ","$6,281.95 ","$4,247.52 ","$2,637.04 ","$8,476.20 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$4,520.64 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000092,27250,HC TX DISCL HIP CLOSED W/O ANES,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$814.00 ,$529.10 ,$203.20 ,$814.00 ,$508.00 ,$374.44 ,$455.84 ,$203.20 ,$227.92 ,$275.13 ,$203.20 ,$316.65 ,$203.20 ,$367.11 ,$367.11 ,$203.20 ,$367.11 ,$386.08 ,$407.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$610.50 ,$488.40 ,$488.40 ,$203.20 ,$488.40 ,$618.64 ,$618.64 ,$618.64 ,$814.00 , N/A ,$691.90 ,$508.00 ,$529.10 ,$203.20 ,$814.00 ,$455.84 ,$203.20 ,$214.08 , N/A , N/A , N/A ,$213.36 ,$651.20 ,$457.20 ,$367.11 ,$227.92 ,$732.60 ,$203.20 ,$618.64 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$390.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000097,28190,HC REM FB FOOT SUBQ,450,1 ,"$4,160.00 ","$2,704.00 ",$400.00 ,"$4,160.00 ","$1,533.75 ","$1,913.60 ","$2,329.60 ",$613.50 ,"$1,164.80 ","$1,406.08 ",$613.50 ,"$1,618.24 ",$613.50 ,"$1,876.16 ","$1,876.16 ",$613.50 ,"$1,876.16 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,120.00 ","$2,496.00 ","$2,496.00 ",$613.50 ,"$2,496.00 ","$3,161.60 ","$3,161.60 ","$3,161.60 ","$4,160.00 ", N/A ,"$3,536.00 ","$1,533.75 ","$2,704.00 ",$613.50 ,"$4,160.00 ","$2,329.60 ",$613.50 ,"$1,094.08 ", N/A , N/A , N/A ,$644.18 ,"$3,328.00 ","$1,380.37 ","$1,876.16 ","$1,164.80 ","$3,744.00 ",$613.50 ,"$3,161.60 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$1,996.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000098,29065,HC APPL CAST ARM LONG,450,1 ,"$1,067.00 ",$693.55 ,$237.84 ,"$1,067.00 ",$594.60 ,$490.82 ,$597.52 ,$237.84 ,$298.76 ,$360.65 ,$237.84 ,$439.60 ,$237.84 ,$481.22 ,$481.22 ,$237.84 ,$481.22 ,$451.89 ,$533.50 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$800.25 ,$640.20 ,$640.20 ,$237.84 ,$640.20 ,$810.92 ,$810.92 ,$810.92 ,"$1,067.00 ", N/A ,$906.95 ,$594.59 ,$693.55 ,$237.84 ,"$1,067.00 ",$597.52 ,$237.84 ,$280.62 , N/A , N/A , N/A ,$249.73 ,$853.60 ,$535.13 ,$481.22 ,$298.76 ,$960.30 ,$237.84 ,$810.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$512.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,"$1,562.00 ","$1,015.30 ",$356.75 ,"$1,562.00 ",$891.88 ,$718.52 ,$874.72 ,$356.75 ,$437.36 ,$527.96 ,$356.75 ,$643.54 ,$356.75 ,$704.46 ,$704.46 ,$356.75 ,$704.46 ,$677.83 ,$781.00 ,$891.88 ,$356.75 ,$356.75 ,$363.89 ,"$1,171.50 ",$937.20 ,$937.20 ,$356.75 ,$937.20 ,"$1,187.12 ","$1,187.12 ","$1,187.12 ","$1,562.00 ", N/A ,"$1,327.70 ",$891.88 ,"$1,015.30 ",$356.75 ,"$1,562.00 ",$874.72 ,$356.75 ,$410.81 , N/A , N/A , N/A ,$374.59 ,"$1,249.60 ",$802.69 ,$704.46 ,$437.36 ,"$1,405.80 ",$356.75 ,"$1,187.12 ",$400.00 ,$400.00 ,$356.75 ,$400.00 ,$749.76 , N/A 
ST. ELIZABETH'S HOSPITAL,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,"$1,042.00 ",$677.30 ,$139.29 ,"$1,042.00 ",$348.23 ,$479.32 ,$583.52 ,$139.29 ,$291.76 ,$352.20 ,$139.29 ,$429.30 ,$139.29 ,$469.94 ,$469.94 ,$139.29 ,$469.94 ,$264.64 ,$521.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$781.50 ,$625.20 ,$625.20 ,$139.29 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$348.22 ,$677.30 ,$139.29 ,"$1,042.00 ",$583.52 ,$139.29 ,$274.05 , N/A , N/A , N/A ,$146.25 ,$833.60 ,$313.39 ,$469.94 ,$291.76 ,$937.80 ,$139.29 ,$791.92 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$742.00 ,$482.30 ,$111.17 ,$742.00 ,$277.93 ,$341.32 ,$415.52 ,$111.17 ,$207.76 ,$250.80 ,$111.17 ,$305.70 ,$111.17 ,$334.64 ,$334.64 ,$111.17 ,$334.64 ,$211.22 ,$371.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$556.50 ,$445.20 ,$445.20 ,$111.17 ,$445.20 ,$563.92 ,$563.92 ,$563.92 ,$742.00 , N/A ,$630.70 ,$277.92 ,$482.30 ,$111.17 ,$742.00 ,$415.52 ,$111.17 ,$195.15 , N/A , N/A , N/A ,$116.73 ,$593.60 ,$250.12 ,$334.64 ,$207.76 ,$667.80 ,$111.17 ,$563.92 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$356.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,"$1,226.00 ",$796.90 ,$111.17 ,"$1,226.00 ",$277.93 ,$563.96 ,$686.56 ,$111.17 ,$343.28 ,$414.39 ,$111.17 ,$505.11 ,$111.17 ,$552.93 ,$552.93 ,$111.17 ,$552.93 ,$211.22 ,$613.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$919.50 ,$735.60 ,$735.60 ,$111.17 ,$735.60 ,$931.76 ,$931.76 ,$931.76 ,"$1,226.00 ", N/A ,"$1,042.10 ",$277.92 ,$796.90 ,$111.17 ,"$1,226.00 ",$686.56 ,$111.17 ,$322.44 , N/A , N/A , N/A ,$116.73 ,$980.80 ,$250.12 ,$552.93 ,$343.28 ,"$1,103.40 ",$111.17 ,$931.76 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$588.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$482.00 ,$313.30 ,$111.17 ,$482.00 ,$277.93 ,$221.72 ,$269.92 ,$111.17 ,$134.96 ,$162.92 ,$111.17 ,$198.58 ,$111.17 ,$217.38 ,$217.38 ,$111.17 ,$217.38 ,$211.22 ,$241.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$361.50 ,$289.20 ,$289.20 ,$111.17 ,$289.20 ,$366.32 ,$366.32 ,$366.32 ,$482.00 , N/A ,$409.70 ,$277.92 ,$313.30 ,$111.17 ,$482.00 ,$269.92 ,$111.17 ,$126.77 , N/A , N/A , N/A ,$116.73 ,$385.60 ,$250.12 ,$217.38 ,$134.96 ,$433.80 ,$111.17 ,$366.32 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$231.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$121.54 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000105,29240,HC STRAPPING SHLDR,450,1 ,$325.00 ,$211.25 ,$85.48 ,$325.00 ,$277.93 ,$149.50 ,$182.00 ,$111.17 ,$91.00 ,$109.85 ,$111.17 ,$133.90 ,$111.17 ,$146.58 ,$146.58 ,$111.17 ,$146.58 ,$211.22 ,$162.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$243.75 ,$195.00 ,$195.00 ,$111.17 ,$195.00 ,$247.00 ,$247.00 ,$247.00 ,$325.00 , N/A ,$276.25 ,$277.92 ,$211.25 ,$111.17 ,$325.00 ,$182.00 ,$111.17 ,$85.48 , N/A , N/A , N/A ,$116.73 ,$260.00 ,$250.12 ,$146.58 ,$91.00 ,$292.50 ,$111.17 ,$247.00 ,$325.00 ,$325.00 ,$111.17 ,$325.00 ,$156.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000106,29405,HC APPL CAST SHORT LEG,450,1 ,"$1,190.00 ",$773.50 ,$237.84 ,"$1,190.00 ",$594.60 ,$547.40 ,$666.40 ,$237.84 ,$333.20 ,$402.22 ,$237.84 ,$490.28 ,$237.84 ,$536.69 ,$536.69 ,$237.84 ,$536.69 ,$451.89 ,$595.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$892.50 ,$714.00 ,$714.00 ,$237.84 ,$714.00 ,$904.40 ,$904.40 ,$904.40 ,"$1,190.00 ", N/A ,"$1,011.50 ",$594.59 ,$773.50 ,$237.84 ,"$1,190.00 ",$666.40 ,$237.84 ,$312.97 , N/A , N/A , N/A ,$249.73 ,$952.00 ,$535.13 ,$536.69 ,$333.20 ,"$1,071.00 ",$237.84 ,$904.40 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$571.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,"$1,190.00 ",$773.50 ,$139.29 ,"$1,190.00 ",$348.23 ,$547.40 ,$666.40 ,$139.29 ,$333.20 ,$402.22 ,$139.29 ,$490.28 ,$139.29 ,$536.69 ,$536.69 ,$139.29 ,$536.69 ,$264.64 ,$595.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$892.50 ,$714.00 ,$714.00 ,$139.29 ,$714.00 ,$904.40 ,$904.40 ,$904.40 ,"$1,190.00 ", N/A ,"$1,011.50 ",$348.22 ,$773.50 ,$139.29 ,"$1,190.00 ",$666.40 ,$139.29 ,$312.97 , N/A , N/A , N/A ,$146.25 ,$952.00 ,$313.39 ,$536.69 ,$333.20 ,"$1,071.00 ",$139.29 ,$904.40 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$571.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$631.00 ,$410.15 ,$139.29 ,$631.00 ,$348.23 ,$290.26 ,$353.36 ,$139.29 ,$176.68 ,$213.28 ,$139.29 ,$259.97 ,$139.29 ,$284.58 ,$284.58 ,$139.29 ,$284.58 ,$264.64 ,$315.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$473.25 ,$378.60 ,$378.60 ,$139.29 ,$378.60 ,$479.56 ,$479.56 ,$479.56 ,$631.00 , N/A ,$536.35 ,$348.22 ,$410.15 ,$139.29 ,$631.00 ,$353.36 ,$139.29 ,$165.95 , N/A , N/A , N/A ,$146.25 ,$504.80 ,$313.39 ,$284.58 ,$176.68 ,$567.90 ,$139.29 ,$479.56 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$302.88 , N/A 
ST. ELIZABETH'S HOSPITAL,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$846.00 ,$549.90 ,$208.93 ,$846.00 ,$522.33 ,$389.16 ,$473.76 ,$208.93 ,$236.88 ,$285.95 ,$208.93 ,$348.55 ,$208.93 ,$381.55 ,$381.55 ,$208.93 ,$381.55 ,$396.97 ,$423.00 ,$522.32 ,$208.93 ,$208.93 ,$213.11 ,$634.50 ,$507.60 ,$507.60 ,$208.93 ,$507.60 ,$642.96 ,$642.96 ,$642.96 ,$846.00 , N/A ,$719.10 ,$522.32 ,$549.90 ,$208.93 ,$846.00 ,$473.76 ,$208.93 ,$222.50 , N/A , N/A , N/A ,$219.38 ,$676.80 ,$470.09 ,$381.55 ,$236.88 ,$761.40 ,$208.93 ,$642.96 ,$400.00 ,$400.00 ,$208.93 ,$400.00 ,$406.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000110,30300,HC REM FB INTRANASAL,450,1 ,$817.00 ,$531.05 ,$111.17 ,$817.00 ,$277.93 ,$375.82 ,$457.52 ,$111.17 ,$228.76 ,$276.15 ,$111.17 ,$317.81 ,$111.17 ,$368.47 ,$368.47 ,$111.17 ,$368.47 ,$211.22 ,$408.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$612.75 ,$490.20 ,$490.20 ,$111.17 ,$490.20 ,$620.92 ,$620.92 ,$620.92 ,$817.00 , N/A ,$694.45 ,$277.92 ,$531.05 ,$111.17 ,$817.00 ,$457.52 ,$111.17 ,$214.87 , N/A , N/A , N/A ,$116.73 ,$653.60 ,$250.12 ,$368.47 ,$228.76 ,$735.30 ,$111.17 ,$620.92 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$392.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$418.00 ,$271.70 ,$109.93 ,$418.00 ,$277.93 ,$192.28 ,$234.08 ,$111.17 ,$117.04 ,$141.28 ,$111.17 ,$162.60 ,$111.17 ,$188.52 ,$188.52 ,$111.17 ,$188.52 ,$211.22 ,$209.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$313.50 ,$250.80 ,$250.80 ,$111.17 ,$250.80 ,$317.68 ,$317.68 ,$317.68 ,$418.00 , N/A ,$355.30 ,$277.92 ,$271.70 ,$111.17 ,$418.00 ,$234.08 ,$111.17 ,$109.93 , N/A , N/A , N/A ,$116.73 ,$334.40 ,$250.12 ,$188.52 ,$117.04 ,$376.20 ,$111.17 ,$317.68 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$200.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$383.00 ,$248.95 ,$100.73 ,$383.00 ,$277.93 ,$176.18 ,$214.48 ,$111.17 ,$107.24 ,$129.45 ,$111.17 ,$148.99 ,$111.17 ,$172.73 ,$172.73 ,$111.17 ,$172.73 ,$211.22 ,$191.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$287.25 ,$229.80 ,$229.80 ,$111.17 ,$229.80 ,$291.08 ,$291.08 ,$291.08 ,$383.00 , N/A ,$325.55 ,$277.92 ,$248.95 ,$111.17 ,$383.00 ,$214.48 ,$111.17 ,$100.73 , N/A , N/A , N/A ,$116.73 ,$306.40 ,$250.12 ,$172.73 ,$107.24 ,$344.70 ,$111.17 ,$291.08 ,$383.00 ,$383.00 ,$111.17 ,$383.00 ,$183.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$731.00 ,$475.15 ,$111.17 ,$731.00 ,$277.93 ,$336.26 ,$409.36 ,$111.17 ,$204.68 ,$247.08 ,$111.17 ,$284.36 ,$111.17 ,$329.68 ,$329.68 ,$111.17 ,$329.68 ,$211.22 ,$365.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$548.25 ,$438.60 ,$438.60 ,$111.17 ,$438.60 ,$555.56 ,$555.56 ,$555.56 ,$731.00 , N/A ,$621.35 ,$277.92 ,$475.15 ,$111.17 ,$731.00 ,$409.36 ,$111.17 ,$192.25 , N/A , N/A , N/A ,$116.73 ,$584.80 ,$250.12 ,$329.68 ,$204.68 ,$657.90 ,$111.17 ,$555.56 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$350.88 , N/A 
ST. ELIZABETH'S HOSPITAL,45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$662.00 ,$430.30 ,$174.11 ,$668.93 ,$668.93 ,$304.52 ,$370.72 ,$267.57 ,$185.36 ,$223.76 ,$267.57 ,$257.52 ,$267.57 ,$298.56 ,$298.56 ,$267.57 ,$298.56 ,$508.38 ,$331.00 ,$668.92 ,$267.57 ,$267.57 ,$272.92 ,$496.50 ,$397.20 ,$397.20 ,$267.57 ,$397.20 ,$503.12 ,$503.12 ,$503.12 ,$662.00 , N/A ,$562.70 ,$662.00 ,$430.30 ,$267.57 ,$662.00 ,$370.72 ,$267.57 ,$174.11 , N/A , N/A , N/A ,$280.95 ,$529.60 ,$602.03 ,$298.56 ,$185.36 ,$595.80 ,$267.57 ,$503.12 ,$400.00 ,$400.00 ,$267.57 ,$400.00 ,$317.76 , N/A 
ST. ELIZABETH'S HOSPITAL,45000136,40800,HC DRAINAGE MOUTH LESION,450,1 ,"$2,099.00 ","$1,364.35 ",$400.00 ,"$2,099.00 ","$1,533.75 ",$965.54 ,"$1,175.44 ",$613.50 ,$587.72 ,$709.46 ,$613.50 ,$816.51 ,$613.50 ,$946.65 ,$946.65 ,$613.50 ,$946.65 ,"$1,165.65 ","$1,049.50 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,574.25 ","$1,259.40 ","$1,259.40 ",$613.50 ,"$1,259.40 ","$1,595.24 ","$1,595.24 ","$1,595.24 ","$2,099.00 ", N/A ,"$1,784.15 ","$1,533.75 ","$1,364.35 ",$613.50 ,"$2,099.00 ","$1,175.44 ",$613.50 ,$552.04 , N/A , N/A , N/A ,$644.18 ,"$1,679.20 ","$1,380.37 ",$946.65 ,$587.72 ,"$1,889.10 ",$613.50 ,"$1,595.24 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$1,007.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$653.00 ,$424.45 ,$171.74 ,$668.93 ,$668.93 ,$300.38 ,$365.68 ,$267.57 ,$182.84 ,$220.71 ,$267.57 ,$254.02 ,$267.57 ,$294.50 ,$294.50 ,$267.57 ,$294.50 ,$508.38 ,$326.50 ,$668.92 ,$267.57 ,$267.57 ,$272.92 ,$489.75 ,$391.80 ,$391.80 ,$267.57 ,$391.80 ,$496.28 ,$496.28 ,$496.28 ,$653.00 , N/A ,$555.05 ,$653.00 ,$424.45 ,$267.57 ,$653.00 ,$365.68 ,$267.57 ,$171.74 , N/A , N/A , N/A ,$280.95 ,$522.40 ,$602.03 ,$294.50 ,$182.84 ,$587.70 ,$267.57 ,$496.28 ,$400.00 ,$400.00 ,$267.57 ,$400.00 ,$313.44 , N/A 
ST. ELIZABETH'S HOSPITAL,45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$913.00 ,$593.45 ,$111.17 ,$913.00 ,$277.93 ,$419.98 ,$511.28 ,$111.17 ,$255.64 ,$308.59 ,$111.17 ,$355.16 ,$111.17 ,$411.76 ,$411.76 ,$111.17 ,$411.76 ,$211.22 ,$456.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$684.75 ,$547.80 ,$547.80 ,$111.17 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$277.92 ,$593.45 ,$111.17 ,$913.00 ,$511.28 ,$111.17 ,$240.12 , N/A , N/A , N/A ,$116.73 ,$730.40 ,$250.12 ,$411.76 ,$255.64 ,$821.70 ,$111.17 ,$693.88 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000140,42700,HC I AND D ABSC PERITONSILLAR,450,1 ,"$7,116.00 ","$4,625.40 ",$208.58 ,"$7,116.00 ",$521.45 ,"$2,000.00 ","$3,984.96 ",$208.58 ,"$1,992.48 ","$2,282.50 ",$208.58 ,"$2,768.12 ",$208.58 ,"$3,209.32 ","$3,209.32 ",$208.58 ,"$3,209.32 ",$396.30 ,"$1,075.00 ",$521.44 ,$208.58 ,$208.58 ,$212.75 ,"$5,337.00 ","$4,269.60 ","$4,269.60 ",$208.58 ,"$4,269.60 ","$5,408.16 ","$5,408.16 ","$5,408.16 ","$7,116.00 ", N/A ,"$6,048.60 ",$521.44 ,"$4,625.40 ",$208.58 ,"$7,116.00 ","$3,984.96 ",$208.58 ,"$1,871.51 ", N/A , N/A , N/A ,$219.01 ,"$5,692.80 ",$469.30 ,"$3,209.32 ","$1,992.48 ","$6,404.40 ",$208.58 ,"$5,354.00 ",$400.00 ,$400.00 ,$208.58 ,$400.00 ,"$3,415.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000141,42809,HC REMOVE PHARYNX FOREIGN BODY,450,1 ,$662.00 ,$430.30 ,$174.11 ,$668.93 ,$668.93 ,$304.52 ,$370.72 ,$267.57 ,$185.36 ,$223.76 ,$267.57 ,$257.52 ,$267.57 ,$298.56 ,$298.56 ,$267.57 ,$298.56 ,$508.38 ,$331.00 ,$668.92 ,$267.57 ,$267.57 ,$272.92 ,$496.50 ,$397.20 ,$397.20 ,$267.57 ,$397.20 ,$503.12 ,$503.12 ,$503.12 ,$662.00 , N/A ,$562.70 ,$662.00 ,$430.30 ,$267.57 ,$662.00 ,$370.72 ,$267.57 ,$174.11 , N/A , N/A , N/A ,$280.95 ,$529.60 ,$602.03 ,$298.56 ,$185.36 ,$595.80 ,$267.57 ,$503.12 ,$400.00 ,$400.00 ,$267.57 ,$400.00 ,$317.76 , N/A 
ST. ELIZABETH'S HOSPITAL,45000143,43753,HC GASTRIC LAVAGE,450,1 ,$964.00 ,$626.60 ,$253.53 ,$964.00 ,$652.30 ,$443.44 ,$539.84 ,$260.92 ,$269.92 ,$325.83 ,$260.92 ,$375.00 ,$260.92 ,$434.76 ,$434.76 ,$260.92 ,$434.76 ,$495.74 ,$482.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$723.00 ,$578.40 ,$578.40 ,$260.92 ,$578.40 ,$732.64 ,$732.64 ,$732.64 ,$964.00 , N/A ,$819.40 ,$652.29 ,$626.60 ,$260.92 ,$964.00 ,$539.84 ,$260.92 ,$253.53 , N/A , N/A , N/A ,$273.97 ,$771.20 ,$587.06 ,$434.76 ,$269.92 ,$867.60 ,$260.92 ,$732.64 ,$400.00 ,$400.00 ,$260.92 ,$400.00 ,$462.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45000146,46040,HC INCISION RECTAL ABSCESS,450,1 ,"$3,455.00 ","$2,245.75 ",$400.00 ,"$3,455.00 ","$2,555.83 ","$1,589.30 ","$1,934.80 ","$1,022.33 ",$967.40 ,"$1,167.79 ","$1,022.33 ","$1,344.00 ","$1,022.33 ","$1,558.21 ","$1,558.21 ","$1,022.33 ","$1,558.21 ","$1,942.43 ","$1,075.00 ","$2,555.83 ","$1,022.33 ","$1,022.33 ","$1,042.78 ","$2,591.25 ","$2,073.00 ","$2,073.00 ","$1,022.33 ","$2,073.00 ","$2,625.80 ","$2,625.80 ","$2,625.80 ","$3,455.00 ", N/A ,"$2,936.75 ","$2,555.83 ","$2,245.75 ","$1,022.33 ","$3,455.00 ","$1,934.80 ","$1,022.33 ",$908.67 , N/A , N/A , N/A ,"$1,073.45 ","$2,764.00 ","$2,300.25 ","$1,558.21 ",$967.40 ,"$3,109.50 ","$1,022.33 ","$2,625.80 ",$400.00 ,$400.00 ,"$1,022.33 ",$400.00 ,"$1,658.40 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$2,227.00 ","$1,447.55 ",$400.00 ,"$2,227.00 ","$1,955.93 ","$1,024.42 ","$1,247.12 ",$782.37 ,$623.56 ,$752.73 ,$782.37 ,$866.30 ,$782.37 ,"$1,004.38 ","$1,004.38 ",$782.37 ,"$1,004.38 ","$1,486.51 ","$1,075.00 ","$1,955.93 ",$782.37 ,$782.37 ,$798.02 ,"$1,670.25 ","$1,336.20 ","$1,336.20 ",$782.37 ,"$1,336.20 ","$1,692.52 ","$1,692.52 ","$1,692.52 ","$2,227.00 ", N/A ,"$1,892.95 ","$1,955.93 ","$1,447.55 ",$782.37 ,"$2,227.00 ","$1,247.12 ",$782.37 ,$585.70 , N/A , N/A , N/A ,$821.49 ,"$1,781.60 ","$1,760.34 ","$1,004.38 ",$623.56 ,"$2,004.30 ",$782.37 ,"$1,692.52 ",$400.00 ,$400.00 ,$782.37 ,$400.00 ,"$1,068.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,"$1,096.00 ",$712.40 ,$262.35 ,"$1,096.00 ",$655.88 ,$504.16 ,$613.76 ,$262.35 ,$306.88 ,$370.45 ,$262.35 ,$426.34 ,$262.35 ,$494.30 ,$494.30 ,$262.35 ,$494.30 ,$498.46 ,$548.00 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,$822.00 ,$657.60 ,$657.60 ,$262.35 ,$657.60 ,$832.96 ,$832.96 ,$832.96 ,"$1,096.00 ", N/A ,$931.60 ,$655.86 ,$712.40 ,$262.35 ,"$1,096.00 ",$613.76 ,$262.35 ,$288.25 , N/A , N/A , N/A ,$275.47 ,$876.80 ,$590.28 ,$494.30 ,$306.88 ,$986.40 ,$262.35 ,$832.96 ,$400.00 ,$400.00 ,$262.35 ,$400.00 ,$526.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000150,46600,HC ANOSCOPY,450,1 ,$418.00 ,$271.70 ,$109.93 ,$418.00 ,$277.93 ,$192.28 ,$234.08 ,$111.17 ,$117.04 ,$141.28 ,$111.17 ,$162.60 ,$111.17 ,$188.52 ,$188.52 ,$111.17 ,$188.52 ,$211.22 ,$209.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$313.50 ,$250.80 ,$250.80 ,$111.17 ,$250.80 ,$317.68 ,$317.68 ,$317.68 ,$418.00 , N/A ,$355.30 ,$277.92 ,$271.70 ,$111.17 ,$418.00 ,$234.08 ,$111.17 ,$109.93 , N/A , N/A , N/A ,$116.73 ,$334.40 ,$250.12 ,$188.52 ,$117.04 ,$376.20 ,$111.17 ,$317.68 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$200.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,"$1,096.00 ",$712.40 ,$262.35 ,"$1,096.00 ",$655.88 ,$504.16 ,$613.76 ,$262.35 ,$306.88 ,$370.45 ,$262.35 ,$426.34 ,$262.35 ,$494.30 ,$494.30 ,$262.35 ,$494.30 ,$498.46 ,$548.00 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,$822.00 ,$657.60 ,$657.60 ,$262.35 ,$657.60 ,$832.96 ,$832.96 ,$832.96 ,"$1,096.00 ", N/A ,$931.60 ,$655.86 ,$712.40 ,$262.35 ,"$1,096.00 ",$613.76 ,$262.35 ,$288.25 , N/A , N/A , N/A ,$275.47 ,$876.80 ,$590.28 ,$494.30 ,$306.88 ,$986.40 ,$262.35 ,$832.96 ,$400.00 ,$400.00 ,$262.35 ,$400.00 ,$526.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,"$1,075.00 ",$698.75 ,$262.35 ,"$1,075.00 ",$655.88 ,$494.50 ,$602.00 ,$262.35 ,$301.00 ,$363.35 ,$262.35 ,$418.18 ,$262.35 ,$484.83 ,$484.83 ,$262.35 ,$484.83 ,$498.46 ,$537.50 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,$806.25 ,$645.00 ,$645.00 ,$262.35 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$655.86 ,$698.75 ,$262.35 ,"$1,075.00 ",$602.00 ,$262.35 ,$282.73 , N/A , N/A , N/A ,$275.47 ,$860.00 ,$590.28 ,$484.83 ,$301.00 ,$967.50 ,$262.35 ,$817.00 ,$400.00 ,$400.00 ,$262.35 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,"$1,087.00 ",$706.55 ,$262.35 ,"$1,087.00 ",$655.88 ,$500.02 ,$608.72 ,$262.35 ,$304.36 ,$367.41 ,$262.35 ,$422.84 ,$262.35 ,$490.24 ,$490.24 ,$262.35 ,$490.24 ,$498.46 ,$543.50 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,$815.25 ,$652.20 ,$652.20 ,$262.35 ,$652.20 ,$826.12 ,$826.12 ,$826.12 ,"$1,087.00 ", N/A ,$923.95 ,$655.86 ,$706.55 ,$262.35 ,"$1,087.00 ",$608.72 ,$262.35 ,$285.88 , N/A , N/A , N/A ,$275.47 ,$869.60 ,$590.28 ,$490.24 ,$304.36 ,$978.30 ,$262.35 ,$826.12 ,$400.00 ,$400.00 ,$262.35 ,$400.00 ,$521.76 , N/A 
ST. ELIZABETH'S HOSPITAL,45000161,54700,HC I AND D EPIDIDYMIS TESTIS OR SCROTAL SPACE,450,1 ,"$6,094.00 ","$3,961.10 ",$400.00 ,"$6,094.00 ","$4,413.08 ","$2,000.00 ","$3,412.64 ","$1,765.23 ","$1,706.32 ","$2,059.77 ","$1,765.23 ","$2,370.57 ","$1,765.23 ","$2,748.39 ","$2,748.39 ","$1,765.23 ","$2,748.39 ","$3,353.94 ","$1,075.00 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$4,570.50 ","$3,656.40 ","$3,656.40 ","$1,765.23 ","$3,656.40 ","$4,631.44 ","$4,631.44 ","$4,631.44 ","$6,094.00 ", N/A ,"$5,179.90 ","$4,413.08 ","$3,961.10 ","$1,765.23 ","$6,094.00 ","$3,412.64 ","$1,765.23 ","$1,602.72 ", N/A , N/A , N/A ,"$1,853.49 ","$4,875.20 ","$3,971.77 ","$2,748.39 ","$1,706.32 ","$5,484.60 ","$1,765.23 ","$4,631.44 ",$400.00 ,$400.00 ,"$1,765.23 ",$400.00 ,"$2,925.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000162,55100,HC DRAIN ABSC SCROTAL WALL,450,1 ,"$4,882.00 ","$3,173.30 ",$400.00 ,"$4,882.00 ","$3,467.90 ","$2,000.00 ","$2,733.92 ","$1,387.16 ","$1,366.96 ","$1,650.12 ","$1,387.16 ","$1,899.10 ","$1,387.16 ","$2,201.78 ","$2,201.78 ","$1,387.16 ","$2,201.78 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,661.50 ","$2,929.20 ","$2,929.20 ","$1,387.16 ","$2,929.20 ","$3,710.32 ","$3,710.32 ","$3,710.32 ","$4,882.00 ", N/A ,"$4,149.70 ","$3,467.89 ","$3,173.30 ","$1,387.16 ","$4,882.00 ","$2,733.92 ","$1,387.16 ","$1,283.97 ", N/A , N/A , N/A ,"$1,456.52 ","$3,905.60 ","$3,121.10 ","$2,201.78 ","$1,366.96 ","$4,393.80 ","$1,387.16 ","$3,710.32 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$2,343.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,"$1,403.00 ",$911.95 ,$278.05 ,"$1,403.00 ",$695.13 ,$645.38 ,$785.68 ,$278.05 ,$392.84 ,$474.21 ,$278.05 ,$545.77 ,$278.05 ,$632.75 ,$632.75 ,$278.05 ,$632.75 ,$528.30 ,$701.50 ,$695.13 ,$278.05 ,$278.05 ,$283.61 ,"$1,052.25 ",$841.80 ,$841.80 ,$278.05 ,$841.80 ,"$1,066.28 ","$1,066.28 ","$1,066.28 ","$1,403.00 ", N/A ,"$1,192.55 ",$695.13 ,$911.95 ,$278.05 ,"$1,403.00 ",$785.68 ,$278.05 ,$368.99 , N/A , N/A , N/A ,$291.95 ,"$1,122.40 ",$625.61 ,$632.75 ,$392.84 ,"$1,262.70 ",$278.05 ,"$1,066.28 ",$400.00 ,$400.00 ,$278.05 ,$400.00 ,$673.44 , N/A 
ST. ELIZABETH'S HOSPITAL,45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$758.00 ,$492.70 ,$167.96 ,$758.00 ,$419.90 ,$348.68 ,$424.48 ,$167.96 ,$212.24 ,$256.20 ,$167.96 ,$294.86 ,$167.96 ,$341.86 ,$341.86 ,$167.96 ,$341.86 ,$319.12 ,$379.00 ,$419.89 ,$167.96 ,$167.96 ,$171.32 ,$568.50 ,$454.80 ,$454.80 ,$167.96 ,$454.80 ,$576.08 ,$576.08 ,$576.08 ,$758.00 , N/A ,$644.30 ,$419.89 ,$492.70 ,$167.96 ,$758.00 ,$424.48 ,$167.96 ,$199.35 , N/A , N/A , N/A ,$176.36 ,$606.40 ,$377.90 ,$341.86 ,$212.24 ,$682.20 ,$167.96 ,$576.08 ,$400.00 ,$400.00 ,$167.96 ,$400.00 ,$363.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000165,58301,HC REM DVC INTRAUTERINE,450,1 ,"$1,138.00 ",$739.70 ,$278.05 ,"$1,138.00 ",$695.13 ,$523.48 ,$637.28 ,$278.05 ,$318.64 ,$384.64 ,$278.05 ,$442.68 ,$278.05 ,$513.24 ,$513.24 ,$278.05 ,$513.24 ,$528.30 ,$569.00 ,$695.13 ,$278.05 ,$278.05 ,$283.61 ,$853.50 ,$682.80 ,$682.80 ,$278.05 ,$682.80 ,$864.88 ,$864.88 ,$864.88 ,"$1,138.00 ", N/A ,$967.30 ,$695.13 ,$739.70 ,$278.05 ,"$1,138.00 ",$637.28 ,$278.05 ,$299.29 , N/A , N/A , N/A ,$291.95 ,$910.40 ,$625.61 ,$513.24 ,$318.64 ,"$1,024.20 ",$278.05 ,$864.88 ,$400.00 ,$400.00 ,$278.05 ,$400.00 ,$546.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000166,59414,HC DELIVERY OF PLACENTA,450,1 ,"$9,289.00 ","$6,037.85 ",$400.00 ,"$9,289.00 ","$6,466.58 ","$2,000.00 ","$5,201.84 ","$2,586.63 ","$2,600.92 ","$2,282.50 ","$2,586.63 ","$3,613.42 ","$2,586.63 ","$4,189.34 ","$4,189.34 ","$2,586.63 ","$4,189.34 ","$4,914.60 ","$1,075.00 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$6,966.75 ","$5,573.40 ","$5,573.40 ","$2,586.63 ","$5,573.40 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$9,289.00 ", N/A ,"$7,895.65 ","$6,466.58 ","$6,037.85 ","$2,586.63 ","$9,289.00 ","$5,201.84 ","$2,586.63 ","$2,443.01 ", N/A , N/A , N/A ,"$2,715.96 ","$7,431.20 ","$5,819.92 ","$4,189.34 ","$2,600.92 ","$8,360.10 ","$2,586.63 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,586.63 ",$400.00 ,"$4,458.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$772.00 ,$501.80 ,$203.04 ,$772.00 ,$643.95 ,$355.12 ,$432.32 ,$257.58 ,$216.16 ,$260.94 ,$257.58 ,$300.31 ,$257.58 ,$348.17 ,$348.17 ,$257.58 ,$348.17 ,$489.39 ,$386.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$579.00 ,$463.20 ,$463.20 ,$257.58 ,$463.20 ,$586.72 ,$586.72 ,$586.72 ,$772.00 , N/A ,$656.20 ,$643.94 ,$501.80 ,$257.58 ,$772.00 ,$432.32 ,$257.58 ,$203.04 , N/A , N/A , N/A ,$270.46 ,$617.60 ,$579.55 ,$348.17 ,$216.16 ,$694.80 ,$257.58 ,$586.72 ,$400.00 ,$400.00 ,$257.58 ,$400.00 ,$370.56 , N/A 
ST. ELIZABETH'S HOSPITAL,45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,"$2,327.00 ","$1,512.55 ",$400.00 ,"$2,327.00 ","$1,565.08 ","$1,070.42 ","$1,303.12 ",$626.03 ,$651.56 ,$786.53 ,$626.03 ,$905.20 ,$626.03 ,"$1,049.48 ","$1,049.48 ",$626.03 ,"$1,049.48 ","$1,189.46 ","$1,075.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,745.25 ","$1,396.20 ","$1,396.20 ",$626.03 ,"$1,396.20 ","$1,768.52 ","$1,768.52 ","$1,768.52 ","$2,327.00 ", N/A ,"$1,977.95 ","$1,565.07 ","$1,512.55 ",$626.03 ,"$2,327.00 ","$1,303.12 ",$626.03 ,$612.00 , N/A , N/A , N/A ,$657.33 ,"$1,861.60 ","$1,408.57 ","$1,049.48 ",$651.56 ,"$2,094.30 ",$626.03 ,"$1,768.52 ",$400.00 ,$400.00 ,$626.03 ,$400.00 ,"$1,116.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$474.00 ,$308.10 ,$111.17 ,$474.00 ,$277.93 ,$218.04 ,$265.44 ,$111.17 ,$132.72 ,$160.21 ,$111.17 ,$184.39 ,$111.17 ,$213.77 ,$213.77 ,$111.17 ,$213.77 ,$211.22 ,$237.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$355.50 ,$284.40 ,$284.40 ,$111.17 ,$284.40 ,$360.24 ,$360.24 ,$360.24 ,$474.00 , N/A ,$402.90 ,$277.92 ,$308.10 ,$111.17 ,$474.00 ,$265.44 ,$111.17 ,$124.66 , N/A , N/A , N/A ,$116.73 ,$379.20 ,$250.12 ,$213.77 ,$132.72 ,$426.60 ,$111.17 ,$360.24 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$227.52 , N/A 
ST. ELIZABETH'S HOSPITAL,45000172,65210,HC REM EYE FB CONJUCT EMBED,450,1 ,"$1,042.00 ",$677.30 ,$267.57 ,"$1,042.00 ",$668.93 ,$479.32 ,$583.52 ,$267.57 ,$291.76 ,$352.20 ,$267.57 ,$405.34 ,$267.57 ,$469.94 ,$469.94 ,$267.57 ,$469.94 ,$508.38 ,$521.00 ,$668.92 ,$267.57 ,$267.57 ,$272.92 ,$781.50 ,$625.20 ,$625.20 ,$267.57 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$668.92 ,$677.30 ,$267.57 ,"$1,042.00 ",$583.52 ,$267.57 ,$274.05 , N/A , N/A , N/A ,$280.95 ,$833.60 ,$602.03 ,$469.94 ,$291.76 ,$937.80 ,$267.57 ,$791.92 ,$400.00 ,$400.00 ,$267.57 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$474.00 ,$308.10 ,$124.66 ,$668.93 ,$668.93 ,$218.04 ,$265.44 ,$267.57 ,$132.72 ,$160.21 ,$267.57 ,$184.39 ,$267.57 ,$213.77 ,$213.77 ,$267.57 ,$213.77 ,$474.00 ,$237.00 ,$668.92 ,$267.57 ,$267.57 ,$272.92 ,$355.50 ,$284.40 ,$284.40 ,$267.57 ,$284.40 ,$360.24 ,$360.24 ,$360.24 ,$474.00 , N/A ,$402.90 ,$474.00 ,$308.10 ,$267.57 ,$474.00 ,$265.44 ,$267.57 ,$124.66 , N/A , N/A , N/A ,$280.95 ,$379.20 ,$602.03 ,$213.77 ,$132.72 ,$426.60 ,$267.57 ,$360.24 ,$400.00 ,$400.00 ,$267.57 ,$400.00 ,$227.52 , N/A 
ST. ELIZABETH'S HOSPITAL,45000174,65222,HC REM FB CORNL W/ SLIT LA,450,1 ,$424.00 ,$275.60 ,$111.17 ,$424.00 ,$277.93 ,$195.04 ,$237.44 ,$111.17 ,$118.72 ,$143.31 ,$111.17 ,$164.94 ,$111.17 ,$191.22 ,$191.22 ,$111.17 ,$191.22 ,$211.22 ,$212.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$318.00 ,$254.40 ,$254.40 ,$111.17 ,$254.40 ,$322.24 ,$322.24 ,$322.24 ,$424.00 , N/A ,$360.40 ,$277.92 ,$275.60 ,$111.17 ,$424.00 ,$237.44 ,$111.17 ,$111.51 , N/A , N/A , N/A ,$116.73 ,$339.20 ,$250.12 ,$191.22 ,$118.72 ,$381.60 ,$111.17 ,$322.24 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$203.52 , N/A 
ST. ELIZABETH'S HOSPITAL,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,"$1,876.00 ","$1,219.40 ",$386.84 ,"$1,876.00 ",$967.10 ,$862.96 ,"$1,050.56 ",$386.84 ,$525.28 ,$634.09 ,$386.84 ,$729.76 ,$386.84 ,$846.08 ,$846.08 ,$386.84 ,$846.08 ,$735.00 ,$938.00 ,$967.11 ,$386.84 ,$386.84 ,$394.58 ,"$1,407.00 ","$1,125.60 ","$1,125.60 ",$386.84 ,"$1,125.60 ","$1,425.76 ","$1,425.76 ","$1,425.76 ","$1,876.00 ", N/A ,"$1,594.60 ",$967.11 ,"$1,219.40 ",$386.84 ,"$1,876.00 ","$1,050.56 ",$386.84 ,$493.39 , N/A , N/A , N/A ,$406.18 ,"$1,500.80 ",$870.40 ,$846.08 ,$525.28 ,"$1,688.40 ",$386.84 ,"$1,425.76 ",$400.00 ,$400.00 ,$386.84 ,$400.00 ,$900.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,"$1,251.00 ",$813.15 ,$257.89 ,"$1,251.00 ",$644.73 ,$575.46 ,$700.56 ,$257.89 ,$350.28 ,$422.84 ,$257.89 ,$486.64 ,$257.89 ,$564.20 ,$564.20 ,$257.89 ,$564.20 ,$490.00 ,$625.50 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$938.25 ,$750.60 ,$750.60 ,$257.89 ,$750.60 ,$950.76 ,$950.76 ,$950.76 ,"$1,251.00 ", N/A ,"$1,063.35 ",$644.74 ,$813.15 ,$257.89 ,"$1,251.00 ",$700.56 ,$257.89 ,$329.01 , N/A , N/A , N/A ,$270.78 ,"$1,000.80 ",$580.26 ,$564.20 ,$350.28 ,"$1,125.90 ",$257.89 ,$950.76 ,$400.00 ,$400.00 ,$257.89 ,$400.00 ,$600.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000179,69000,HC DRAIN ABSC/HEMA EAR EXT SMP,450,1 ,"$1,004.00 ",$652.60 ,$264.05 ,"$1,533.75 ","$1,533.75 ",$461.84 ,$562.24 ,$613.50 ,$281.12 ,$339.35 ,$613.50 ,$390.56 ,$613.50 ,$452.80 ,$452.80 ,$613.50 ,$452.80 ,"$1,004.00 ",$502.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,$753.00 ,$602.40 ,$602.40 ,$613.50 ,$602.40 ,$763.04 ,$763.04 ,$763.04 ,"$1,004.00 ", N/A ,$853.40 ,"$1,004.00 ",$652.60 ,$613.50 ,"$1,004.00 ",$562.24 ,$613.50 ,$264.05 , N/A , N/A , N/A ,$644.18 ,$803.20 ,"$1,380.37 ",$452.80 ,$281.12 ,$903.60 ,$613.50 ,$763.04 ,$400.00 ,$400.00 ,$613.50 ,$400.00 ,$481.92 , N/A 
ST. ELIZABETH'S HOSPITAL,45000181,69200,HC FB REMOVAL EAR,450,1 ,$817.00 ,$531.05 ,$111.17 ,$817.00 ,$277.93 ,$375.82 ,$457.52 ,$111.17 ,$228.76 ,$276.15 ,$111.17 ,$317.81 ,$111.17 ,$368.47 ,$368.47 ,$111.17 ,$368.47 ,$211.22 ,$408.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$612.75 ,$490.20 ,$490.20 ,$111.17 ,$490.20 ,$620.92 ,$620.92 ,$620.92 ,$817.00 , N/A ,$694.45 ,$277.92 ,$531.05 ,$111.17 ,$817.00 ,$457.52 ,$111.17 ,$214.87 , N/A , N/A , N/A ,$116.73 ,$653.60 ,$250.12 ,$368.47 ,$228.76 ,$735.30 ,$111.17 ,$620.92 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$392.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$114.76 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$442.00 ,$287.30 ,$54.88 ,$442.00 ,$137.20 ,$203.32 ,$247.52 ,$54.88 ,$123.76 ,$149.40 ,$54.88 ,$171.94 ,$54.88 ,$199.34 ,$199.34 ,$54.88 ,$199.34 ,$104.27 ,$221.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$331.50 ,$265.20 ,$265.20 ,$54.88 ,$265.20 ,$335.92 ,$335.92 ,$335.92 ,$442.00 , N/A ,$375.70 ,$137.20 ,$287.30 ,$54.88 ,$442.00 ,$247.52 ,$54.88 ,$116.25 , N/A , N/A , N/A ,$57.62 ,$353.60 ,$123.48 ,$199.34 ,$123.76 ,$397.80 ,$54.88 ,$335.92 ,$400.00 ,$400.00 ,$54.88 ,$400.00 ,$212.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000186,92953,HC TEMPORARY EXTERNAL PACING,450,1 ,"$2,441.00 ","$1,586.65 ",$400.00 ,"$2,441.00 ","$1,384.58 ","$1,122.86 ","$1,366.96 ",$553.83 ,$683.48 ,$825.06 ,$553.83 ,$949.55 ,$553.83 ,"$1,100.89 ","$1,100.89 ",$553.83 ,"$1,100.89 ","$1,052.28 ","$1,075.00 ","$1,384.58 ",$553.83 ,$553.83 ,$564.91 ,"$1,830.75 ","$1,464.60 ","$1,464.60 ",$553.83 ,"$1,464.60 ","$1,855.16 ","$1,855.16 ","$1,855.16 ","$2,441.00 ", N/A ,"$2,074.85 ","$1,384.58 ","$1,586.65 ",$553.83 ,"$2,441.00 ","$1,366.96 ",$553.83 ,$641.98 , N/A , N/A , N/A ,$581.52 ,"$1,952.80 ","$1,246.12 ","$1,100.89 ",$683.48 ,"$2,196.90 ",$553.83 ,"$1,855.16 ",$400.00 ,$400.00 ,$553.83 ,$400.00 ,"$1,171.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000188,99281,HC ER LEVEL 1,450,1 ,$483.00 ,$313.95 ,$71.51 ,$483.00 ,$178.78 ,$222.18 ,$270.48 ,$71.51 ,$135.24 ,$163.25 ,$71.51 ,$199.00 ,$71.51 ,$217.83 ,$217.83 ,$71.51 ,$217.83 ,$135.87 ,$241.50 ,$178.78 ,$71.51 ,$71.51 ,$72.94 ,$362.25 ,$289.80 ,$289.80 ,$71.51 ,$289.80 ,$367.08 ,$367.08 ,$367.08 ,$483.00 , N/A ,$410.55 ,$178.78 ,$313.95 ,$71.51 ,$483.00 ,$270.48 ,$71.51 ,$127.03 , N/A , N/A , N/A ,$75.09 ,$386.40 ,$160.90 ,$217.83 ,$135.24 ,$434.70 ,$71.51 ,$367.08 ,$400.00 ,$400.00 ,$71.51 ,$400.00 ,$231.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000189,99282,HC ER LEVEL 2,450,1 ,$884.00 ,$574.60 ,$129.50 ,$884.00 ,$323.75 ,$406.64 ,$495.04 ,$129.50 ,$247.52 ,$298.79 ,$129.50 ,$364.21 ,$129.50 ,$398.68 ,$398.68 ,$129.50 ,$398.68 ,$246.05 ,$442.00 ,$323.74 ,$129.50 ,$129.50 ,$132.09 ,$663.00 ,$530.40 ,$530.40 ,$129.50 ,$530.40 ,$671.84 ,$671.84 ,$671.84 ,$884.00 , N/A ,$751.40 ,$323.74 ,$574.60 ,$129.50 ,$884.00 ,$495.04 ,$129.50 ,$232.49 , N/A , N/A , N/A ,$135.98 ,$707.20 ,$291.37 ,$398.68 ,$247.52 ,$795.60 ,$129.50 ,$671.84 ,$650.00 ,$650.00 ,$129.50 ,$650.00 ,$424.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000190,99283,HC ER LEVEL 3,450,1 ,"$1,329.00 ",$863.85 ,$228.15 ,"$1,329.00 ",$570.38 ,$611.34 ,$744.24 ,$228.15 ,$372.12 ,$449.20 ,$228.15 ,$547.55 ,$228.15 ,$599.38 ,$599.38 ,$228.15 ,$599.38 ,$433.49 ,$664.50 ,$570.38 ,$228.15 ,$228.15 ,$232.72 ,$996.75 ,$797.40 ,$797.40 ,$228.15 ,$797.40 ,"$1,010.04 ","$1,010.04 ","$1,010.04 ","$1,329.00 ", N/A ,"$1,129.65 ",$570.38 ,$863.85 ,$228.15 ,"$1,329.00 ",$744.24 ,$228.15 ,$349.53 , N/A , N/A , N/A ,$239.56 ,"$1,063.20 ",$513.35 ,$599.38 ,$372.12 ,"$1,196.10 ",$228.15 ,"$1,010.04 ","$1,100.00 ","$1,100.00 ",$228.15 ,"$1,100.00 ",$637.92 , N/A 
ST. ELIZABETH'S HOSPITAL,45000191,99284,HC ER LEVEL 4,450,1 ,"$1,985.00 ","$1,290.25 ",$134.76 ,"$1,985.00 ",$896.60 ,$913.10 ,"$1,111.60 ",$358.64 ,$555.80 ,$670.93 ,$358.64 ,$817.82 ,$358.64 ,$895.24 ,$895.24 ,$358.64 ,$895.24 ,$681.41 ,$992.50 ,$896.59 ,$358.64 ,$358.64 ,$365.81 ,"$1,488.75 ","$1,191.00 ","$1,191.00 ",$358.64 ,"$1,191.00 ","$1,508.60 ","$1,508.60 ","$1,508.60 ","$1,985.00 ", N/A ,"$1,687.25 ",$896.59 ,"$1,290.25 ",$358.64 ,"$1,985.00 ","$1,111.60 ",$358.64 ,$522.06 , N/A ,$148.24 ,$141.50 ,$376.57 ,"$1,588.00 ",$806.93 ,$895.24 ,$555.80 ,"$1,786.50 ",$358.64 ,"$1,508.60 ","$1,800.00 ","$1,800.00 ",$358.64 ,"$1,800.00 ",$952.80 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45000192,99285,HC ER LEVEL 5,450,1 ,"$3,029.00 ","$1,968.85 ",$134.76 ,"$3,029.00 ","$1,286.95 ","$1,393.34 ","$1,696.24 ",$514.78 ,$848.12 ,"$1,023.80 ",$514.78 ,"$1,247.95 ",$514.78 ,"$1,366.08 ","$1,366.08 ",$514.78 ,"$1,366.08 ",$978.07 ,"$1,075.00 ","$1,286.94 ",$514.78 ,$514.78 ,$525.07 ,"$2,271.75 ","$1,817.40 ","$1,817.40 ",$514.78 ,"$1,817.40 ","$2,302.04 ","$2,302.04 ","$2,302.04 ","$3,029.00 ", N/A ,"$2,574.65 ","$1,286.94 ","$1,968.85 ",$514.78 ,"$3,029.00 ","$1,696.24 ",$514.78 ,$796.63 , N/A ,$148.24 ,$141.50 ,$540.52 ,"$2,423.20 ","$1,158.25 ","$1,366.08 ",$848.12 ,"$2,726.10 ",$514.78 ,"$2,302.04 ","$2,900.00 ","$2,900.00 ",$514.78 ,"$2,900.00 ","$1,453.92 ",$134.76 
ST. ELIZABETH'S HOSPITAL,45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$6,626.00 ","$4,306.90 ",$134.76 ,"$6,626.00 ","$1,835.90 ","$2,000.00 ","$3,710.56 ",$734.36 ,"$1,855.28 ","$2,239.59 ",$734.36 ,"$2,184.06 ",$734.36 ,"$2,988.33 ","$2,988.33 ",$734.36 ,"$2,988.33 ","$1,395.28 ","$1,075.00 ","$1,835.89 ",$734.36 ,$734.36 ,$749.04 ,"$4,969.50 ","$3,975.60 ","$3,975.60 ",$734.36 ,"$3,975.60 ","$5,035.76 ","$5,035.76 ","$5,035.76 ","$6,626.00 ", N/A ,"$5,632.10 ","$1,835.89 ","$4,306.90 ",$734.36 ,"$6,626.00 ","$3,710.56 ",$734.36 ,"$1,742.64 ", N/A ,$148.24 ,$141.50 ,$771.08 ,"$5,300.80 ","$1,652.30 ","$2,988.33 ","$1,855.28 ","$5,963.40 ",$734.36 ,"$5,035.76 ","$3,200.00 ","$3,200.00 ",$734.36 ,"$3,200.00 ","$3,180.48 ",$134.76 
ST. ELIZABETH'S HOSPITAL,45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,"$1,992.00 ","$1,294.80 ",$400.00 ,"$1,992.00 ", N/A ,$916.32 ,"$1,115.52 ", N/A ,$557.76 ,$673.30 , N/A ,$820.70 , N/A ,$898.39 ,$898.39 , N/A ,$898.39 , N/A ,$996.00 , N/A , N/A , N/A , N/A ,"$1,494.00 ","$1,195.20 ","$1,195.20 ", N/A ,"$1,195.20 ","$1,513.92 ","$1,513.92 ","$1,513.92 ","$1,992.00 ", N/A ,"$1,693.20 ", N/A ,"$1,294.80 ", N/A ,"$1,992.00 ","$1,115.52 ", N/A ,$523.90 , N/A , N/A , N/A , N/A ,"$1,593.60 ", N/A ,$898.39 ,$557.76 ,"$1,792.80 ", N/A ,"$1,513.92 ",$400.00 ,$400.00 , N/A ,$400.00 ,$956.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,"$2,714.00 ","$1,764.10 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,248.44 ","$1,519.84 ","$1,373.18 ",$759.92 ,$917.33 ,"$1,373.18 ","$1,055.75 ","$1,373.18 ","$1,224.01 ","$1,224.01 ","$1,373.18 ","$1,224.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,035.50 ","$1,628.40 ","$1,628.40 ","$1,373.18 ","$1,628.40 ","$2,062.64 ","$2,062.64 ","$2,062.64 ","$2,714.00 ", N/A ,"$2,306.90 ","$2,714.00 ","$1,764.10 ","$1,373.18 ","$2,714.00 ","$1,519.84 ","$1,373.18 ",$713.78 , N/A , N/A , N/A ,"$1,441.84 ","$2,171.20 ","$3,089.65 ","$1,224.01 ",$759.92 ,"$2,442.60 ","$1,373.18 ","$2,062.64 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,302.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000197,26700,HC TX DISL (M-P) W/O ANES CLS,450,1 ,"$1,132.00 ",$735.80 ,$203.20 ,"$1,132.00 ",$508.00 ,$520.72 ,$633.92 ,$203.20 ,$316.96 ,$382.62 ,$203.20 ,$440.35 ,$203.20 ,$510.53 ,$510.53 ,$203.20 ,$510.53 ,$386.08 ,$566.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$849.00 ,$679.20 ,$679.20 ,$203.20 ,$679.20 ,$860.32 ,$860.32 ,$860.32 ,"$1,132.00 ", N/A ,$962.20 ,$508.00 ,$735.80 ,$203.20 ,"$1,132.00 ",$633.92 ,$203.20 ,$297.72 , N/A , N/A , N/A ,$213.36 ,$905.60 ,$457.20 ,$510.53 ,$316.96 ,"$1,018.80 ",$203.20 ,$860.32 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$543.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$731.00 ,$475.15 ,$192.25 ,$731.00 ,$508.00 ,$336.26 ,$409.36 ,$203.20 ,$204.68 ,$247.08 ,$203.20 ,$284.36 ,$203.20 ,$329.68 ,$329.68 ,$203.20 ,$329.68 ,$386.08 ,$365.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$548.25 ,$438.60 ,$438.60 ,$203.20 ,$438.60 ,$555.56 ,$555.56 ,$555.56 ,$731.00 , N/A ,$621.35 ,$508.00 ,$475.15 ,$203.20 ,$731.00 ,$409.36 ,$203.20 ,$192.25 , N/A , N/A , N/A ,$213.36 ,$584.80 ,$457.20 ,$329.68 ,$204.68 ,$657.90 ,$203.20 ,$555.56 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$350.88 , N/A 
ST. ELIZABETH'S HOSPITAL,45000201,31525,HC LARYNGOSCOPE DIRECT DX,450,1 ,"$3,994.00 ","$2,596.10 ",$400.00 ,"$3,994.00 ","$3,687.53 ","$1,837.24 ","$2,236.64 ","$1,475.01 ","$1,118.32 ","$1,349.97 ","$1,475.01 ","$1,553.67 ","$1,475.01 ","$1,801.29 ","$1,801.29 ","$1,475.01 ","$1,801.29 ","$2,802.52 ","$1,075.00 ","$3,687.52 ","$1,475.01 ","$1,475.01 ","$1,504.51 ","$2,995.50 ","$2,396.40 ","$2,396.40 ","$1,475.01 ","$2,396.40 ","$3,035.44 ","$3,035.44 ","$3,035.44 ","$3,994.00 ", N/A ,"$3,394.90 ","$3,687.52 ","$2,596.10 ","$1,475.01 ","$3,994.00 ","$2,236.64 ","$1,475.01 ","$1,050.42 ", N/A , N/A , N/A ,"$1,548.76 ","$3,195.20 ","$3,318.77 ","$1,801.29 ","$1,118.32 ","$3,594.60 ","$1,475.01 ","$3,035.44 ",$400.00 ,$400.00 ,"$1,475.01 ",$400.00 ,"$1,917.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000203,27840,HC TX DISL ANKE W/O ANES CLS,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,"$3,285.00 ","$2,135.25 ",$400.00 ,"$3,467.90 ","$3,467.90 ","$1,511.10 ","$1,839.60 ","$1,387.16 ",$919.80 ,"$1,110.33 ","$1,387.16 ","$1,277.87 ","$1,387.16 ","$1,481.54 ","$1,481.54 ","$1,387.16 ","$1,481.54 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,463.75 ","$1,971.00 ","$1,971.00 ","$1,387.16 ","$1,971.00 ","$2,496.60 ","$2,496.60 ","$2,496.60 ","$3,285.00 ", N/A ,"$2,792.25 ","$3,285.00 ","$2,135.25 ","$1,387.16 ","$3,285.00 ","$1,839.60 ","$1,387.16 ",$863.96 , N/A , N/A , N/A ,"$1,456.52 ","$2,628.00 ","$3,121.10 ","$1,481.54 ",$919.80 ,"$2,956.50 ","$1,387.16 ","$2,496.60 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$1,576.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000211,26641,HC CLSD DISCL THUMB W/MANIP,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000212,25690,HC CLSD WRIST DISLOC,450,1 ,"$3,964.77 ","$2,577.10 ",$400.00 ,"$3,964.77 ","$3,432.95 ","$1,823.79 ","$2,220.27 ","$1,373.18 ","$1,110.14 ","$1,340.09 ","$1,373.18 ","$1,542.30 ","$1,373.18 ","$1,788.11 ","$1,788.11 ","$1,373.18 ","$1,788.11 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,973.58 ","$2,378.86 ","$2,378.86 ","$1,373.18 ","$2,378.86 ","$3,013.23 ","$3,013.23 ","$3,013.23 ","$3,964.77 ", N/A ,"$3,370.05 ","$3,432.94 ","$2,577.10 ","$1,373.18 ","$3,964.77 ","$2,220.27 ","$1,373.18 ","$1,042.73 ", N/A , N/A , N/A ,"$1,441.84 ","$3,171.82 ","$3,089.65 ","$1,788.11 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,013.23 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,903.09 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000213,26720,HC FINGER FX W/O MANIP,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$507.00 ,$329.55 ,$133.34 ,$785.88 ,$785.88 ,$233.22 ,$283.92 ,$314.35 ,$141.96 ,$171.37 ,$314.35 ,$197.22 ,$314.35 ,$228.66 ,$228.66 ,$314.35 ,$228.66 ,$507.00 ,$253.50 ,$785.87 ,$314.35 ,$314.35 ,$320.63 ,$380.25 ,$304.20 ,$304.20 ,$314.35 ,$304.20 ,$385.32 ,$385.32 ,$385.32 ,$507.00 , N/A ,$430.95 ,$507.00 ,$329.55 ,$314.35 ,$507.00 ,$283.92 ,$314.35 ,$133.34 , N/A , N/A , N/A ,$330.07 ,$405.60 ,$707.28 ,$228.66 ,$141.96 ,$456.30 ,$314.35 ,$385.32 ,$400.00 ,$400.00 ,$314.35 ,$400.00 ,$243.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000215,27786,HC DIST FIB FX W/O MANIP,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000218,23500,HC CLOSED TREATMENT CLAVICLE FX,450,1 ,$428.00 ,$278.20 ,$112.56 ,$508.00 ,$508.00 ,$196.88 ,$239.68 ,$203.20 ,$119.84 ,$144.66 ,$203.20 ,$166.49 ,$203.20 ,$193.03 ,$193.03 ,$203.20 ,$193.03 ,$386.08 ,$214.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$321.00 ,$256.80 ,$256.80 ,$203.20 ,$256.80 ,$325.28 ,$325.28 ,$325.28 ,$428.00 , N/A ,$363.80 ,$428.00 ,$278.20 ,$203.20 ,$428.00 ,$239.68 ,$203.20 ,$112.56 , N/A , N/A , N/A ,$213.36 ,$342.40 ,$457.20 ,$193.03 ,$119.84 ,$385.20 ,$203.20 ,$325.28 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$205.44 , N/A 
ST. ELIZABETH'S HOSPITAL,45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$2,714.00 ","$1,764.10 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,248.44 ","$1,519.84 ","$1,373.18 ",$759.92 ,$917.33 ,"$1,373.18 ","$1,055.75 ","$1,373.18 ","$1,224.01 ","$1,224.01 ","$1,373.18 ","$1,224.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,035.50 ","$1,628.40 ","$1,628.40 ","$1,373.18 ","$1,628.40 ","$2,062.64 ","$2,062.64 ","$2,062.64 ","$2,714.00 ", N/A ,"$2,306.90 ","$2,714.00 ","$1,764.10 ","$1,373.18 ","$2,714.00 ","$1,519.84 ","$1,373.18 ",$713.78 , N/A , N/A , N/A ,"$1,441.84 ","$2,171.20 ","$3,089.65 ","$1,224.01 ",$759.92 ,"$2,442.60 ","$1,373.18 ","$2,062.64 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,302.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000221,10121,HC RM FB SUBQ W/INC COMPL,450,1 ,"$7,116.00 ","$4,625.40 ",$400.00 ,"$7,116.00 ","$3,467.90 ","$2,000.00 ","$3,984.96 ","$1,387.16 ","$1,992.48 ","$2,282.50 ","$1,387.16 ","$2,768.12 ","$1,387.16 ","$3,209.32 ","$3,209.32 ","$1,387.16 ","$3,209.32 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$5,337.00 ","$4,269.60 ","$4,269.60 ","$1,387.16 ","$4,269.60 ","$5,408.16 ","$5,408.16 ","$5,408.16 ","$7,116.00 ", N/A ,"$6,048.60 ","$3,467.89 ","$4,625.40 ","$1,387.16 ","$7,116.00 ","$3,984.96 ","$1,387.16 ","$1,871.51 ", N/A , N/A , N/A ,"$1,456.52 ","$5,692.80 ","$3,121.10 ","$3,209.32 ","$1,992.48 ","$6,404.40 ","$1,387.16 ","$5,354.00 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$3,415.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000222,29540,HC STRAPPING; ANKLE,450,1 ,$708.00 ,$460.20 ,$139.29 ,$708.00 ,$348.23 ,$325.68 ,$396.48 ,$139.29 ,$198.24 ,$239.30 ,$139.29 ,$291.33 ,$139.29 ,$319.31 ,$319.31 ,$139.29 ,$319.31 ,$264.64 ,$354.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$531.00 ,$424.80 ,$424.80 ,$139.29 ,$424.80 ,$538.08 ,$538.08 ,$538.08 ,$708.00 , N/A ,$601.80 ,$348.22 ,$460.20 ,$139.29 ,$708.00 ,$396.48 ,$139.29 ,$186.20 , N/A , N/A , N/A ,$146.25 ,$566.40 ,$313.39 ,$319.31 ,$198.24 ,$637.20 ,$139.29 ,$538.08 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$339.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000226,23505,HC CLOSED CLAVICLE FX W/MANIP,450,1 ,"$3,589.00 ","$2,332.85 ",$400.00 ,"$3,589.00 ","$3,432.95 ","$1,650.94 ","$2,009.84 ","$1,373.18 ","$1,004.92 ","$1,213.08 ","$1,373.18 ","$1,396.12 ","$1,373.18 ","$1,618.64 ","$1,618.64 ","$1,373.18 ","$1,618.64 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,691.75 ","$2,153.40 ","$2,153.40 ","$1,373.18 ","$2,153.40 ","$2,727.64 ","$2,727.64 ","$2,727.64 ","$3,589.00 ", N/A ,"$3,050.65 ","$3,432.94 ","$2,332.85 ","$1,373.18 ","$3,589.00 ","$2,009.84 ","$1,373.18 ",$943.91 , N/A , N/A , N/A ,"$1,441.84 ","$2,871.20 ","$3,089.65 ","$1,618.64 ","$1,004.92 ","$3,230.10 ","$1,373.18 ","$2,727.64 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,722.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000227,25600,HC CLSD DIS.RADIUS W/O MANIP,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000228,26750,HC CLSD DIST PHALANGEAL W/O MANIP,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000231,25505,HC RADIUS FX W MANIP,450,1 ,"$3,964.77 ","$2,577.10 ",$400.00 ,"$3,964.77 ","$3,432.95 ","$1,823.79 ","$2,220.27 ","$1,373.18 ","$1,110.14 ","$1,340.09 ","$1,373.18 ","$1,542.30 ","$1,373.18 ","$1,788.11 ","$1,788.11 ","$1,373.18 ","$1,788.11 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,973.58 ","$2,378.86 ","$2,378.86 ","$1,373.18 ","$2,378.86 ","$3,013.23 ","$3,013.23 ","$3,013.23 ","$3,964.77 ", N/A ,"$3,370.05 ","$3,432.94 ","$2,577.10 ","$1,373.18 ","$3,964.77 ","$2,220.27 ","$1,373.18 ","$1,042.73 ", N/A , N/A , N/A ,"$1,441.84 ","$3,171.82 ","$3,089.65 ","$1,788.11 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,013.23 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,903.09 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000235,28470,HC CLSD METATARSAL W/O MANIP,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000238,26670,HC HAND DISL W/MANIP W/O ANES,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$742.00 ,$482.30 ,$195.15 ,$742.00 ,$508.00 ,$341.32 ,$415.52 ,$203.20 ,$207.76 ,$250.80 ,$203.20 ,$288.64 ,$203.20 ,$334.64 ,$334.64 ,$203.20 ,$334.64 ,$386.08 ,$371.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$556.50 ,$445.20 ,$445.20 ,$203.20 ,$445.20 ,$563.92 ,$563.92 ,$563.92 ,$742.00 , N/A ,$630.70 ,$508.00 ,$482.30 ,$203.20 ,$742.00 ,$415.52 ,$203.20 ,$195.15 , N/A , N/A , N/A ,$213.36 ,$593.60 ,$457.20 ,$334.64 ,$207.76 ,$667.80 ,$203.20 ,$563.92 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$356.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000249,28515,HC TOE FX W/MANIP,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000251,24650,HC RADIAL HEAD W/O RED;ADULT,450,1 ,"$1,327.00 ",$862.55 ,$203.20 ,"$1,327.00 ",$508.00 ,$610.42 ,$743.12 ,$203.20 ,$371.56 ,$448.53 ,$203.20 ,$516.20 ,$203.20 ,$598.48 ,$598.48 ,$203.20 ,$598.48 ,$386.08 ,$663.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$995.25 ,$796.20 ,$796.20 ,$203.20 ,$796.20 ,"$1,008.52 ","$1,008.52 ","$1,008.52 ","$1,327.00 ", N/A ,"$1,127.95 ",$508.00 ,$862.55 ,$203.20 ,"$1,327.00 ",$743.12 ,$203.20 ,$349.00 , N/A , N/A , N/A ,$213.36 ,"$1,061.60 ",$457.20 ,$598.48 ,$371.56 ,"$1,194.30 ",$203.20 ,"$1,008.52 ",$400.00 ,$400.00 ,$203.20 ,$400.00 ,$636.96 , N/A 
ST. ELIZABETH'S HOSPITAL,45000252,20520,HC MUSCLE FB REM W/ INC,450,1 ,"$4,358.00 ","$2,832.70 ",$400.00 ,"$4,358.00 ","$3,467.90 ","$2,000.00 ","$2,440.48 ","$1,387.16 ","$1,220.24 ","$1,473.00 ","$1,387.16 ","$1,695.26 ","$1,387.16 ","$1,965.46 ","$1,965.46 ","$1,387.16 ","$1,965.46 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,268.50 ","$2,614.80 ","$2,614.80 ","$1,387.16 ","$2,614.80 ","$3,312.08 ","$3,312.08 ","$3,312.08 ","$4,358.00 ", N/A ,"$3,704.30 ","$3,467.89 ","$2,832.70 ","$1,387.16 ","$4,358.00 ","$2,440.48 ","$1,387.16 ","$1,146.15 ", N/A , N/A , N/A ,"$1,456.52 ","$3,486.40 ","$3,121.10 ","$1,965.46 ","$1,220.24 ","$3,922.20 ","$1,387.16 ","$3,312.08 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$2,091.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000258,29345,HC LONG LEG CAST,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000263,11305,HC SHAVING SKIN LESION,450,1 ,$494.00 ,$321.10 ,$129.92 ,$494.00 ,$442.60 ,$227.24 ,$276.64 ,$177.04 ,$138.32 ,$166.97 ,$177.04 ,$192.17 ,$177.04 ,$222.79 ,$222.79 ,$177.04 ,$222.79 ,$336.38 ,$247.00 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$370.50 ,$296.40 ,$296.40 ,$177.04 ,$296.40 ,$375.44 ,$375.44 ,$375.44 ,$494.00 , N/A ,$419.90 ,$442.60 ,$321.10 ,$177.04 ,$494.00 ,$276.64 ,$177.04 ,$129.92 , N/A , N/A , N/A ,$185.89 ,$395.20 ,$398.34 ,$222.79 ,$138.32 ,$444.60 ,$177.04 ,$375.44 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$237.12 , N/A 
ST. ELIZABETH'S HOSPITAL,45000264,11400,HC EXC LESION 0.5<,450,1 ,"$1,906.00 ","$1,238.90 ",$400.00 ,"$1,906.00 ","$1,533.75 ",$876.76 ,"$1,067.36 ",$613.50 ,$533.68 ,$644.23 ,$613.50 ,$741.43 ,$613.50 ,$859.61 ,$859.61 ,$613.50 ,$859.61 ,"$1,165.65 ",$953.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,429.50 ","$1,143.60 ","$1,143.60 ",$613.50 ,"$1,143.60 ","$1,448.56 ","$1,448.56 ","$1,448.56 ","$1,906.00 ", N/A ,"$1,620.10 ","$1,533.75 ","$1,238.90 ",$613.50 ,"$1,906.00 ","$1,067.36 ",$613.50 ,$501.28 , N/A , N/A , N/A ,$644.18 ,"$1,524.80 ","$1,380.37 ",$859.61 ,$533.68 ,"$1,715.40 ",$613.50 ,"$1,448.56 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,$914.88 , N/A 
ST. ELIZABETH'S HOSPITAL,45000270,20606,HC ARTHROCNT ASP/INJ JT INTRM W/ULTRA,450,1 ,"$1,108.00 ",$720.20 ,$291.40 ,"$1,565.08 ","$1,565.08 ",$509.68 ,$620.48 ,$626.03 ,$310.24 ,$374.50 ,$626.03 ,$431.01 ,$626.03 ,$499.71 ,$499.71 ,$626.03 ,$499.71 ,"$1,108.00 ",$554.00 ,"$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,$831.00 ,$664.80 ,$664.80 ,$626.03 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,"$1,108.00 ",$720.20 ,$626.03 ,"$1,108.00 ",$620.48 ,$626.03 ,$291.40 , N/A , N/A , N/A ,$657.33 ,$886.40 ,"$1,408.57 ",$499.71 ,$310.24 ,$997.20 ,$626.03 ,$842.08 ,$400.00 ,$400.00 ,$626.03 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000271,20604,HC ARTHROCNT ASP/INJ JT SMALL W/ULTRA,450,1 ,"$1,108.00 ",$720.20 ,$257.58 ,"$1,108.00 ",$643.95 ,$509.68 ,$620.48 ,$257.58 ,$310.24 ,$374.50 ,$257.58 ,$431.01 ,$257.58 ,$499.71 ,$499.71 ,$257.58 ,$499.71 ,$489.39 ,$554.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$831.00 ,$664.80 ,$664.80 ,$257.58 ,$664.80 ,$842.08 ,$842.08 ,$842.08 ,"$1,108.00 ", N/A ,$941.80 ,$643.94 ,$720.20 ,$257.58 ,"$1,108.00 ",$620.48 ,$257.58 ,$291.40 , N/A , N/A , N/A ,$270.46 ,$886.40 ,$579.55 ,$499.71 ,$310.24 ,$997.20 ,$257.58 ,$842.08 ,$400.00 ,$400.00 ,$257.58 ,$400.00 ,$531.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,"$1,045.00 ",$679.25 ,$257.58 ,"$1,045.00 ",$643.95 ,$480.70 ,$585.20 ,$257.58 ,$292.60 ,$353.21 ,$257.58 ,$406.51 ,$257.58 ,$471.30 ,$471.30 ,$257.58 ,$471.30 ,$489.39 ,$522.50 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$783.75 ,$627.00 ,$627.00 ,$257.58 ,$627.00 ,$794.20 ,$794.20 ,$794.20 ,"$1,045.00 ", N/A ,$888.25 ,$643.94 ,$679.25 ,$257.58 ,"$1,045.00 ",$585.20 ,$257.58 ,$274.84 , N/A , N/A , N/A ,$270.46 ,$836.00 ,$579.55 ,$471.30 ,$292.60 ,$940.50 ,$257.58 ,$794.20 ,$400.00 ,$400.00 ,$257.58 ,$400.00 ,$501.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,"$1,481.00 ",$962.65 ,$386.36 ,"$1,481.00 ",$965.90 ,$681.26 ,$829.36 ,$386.36 ,$414.68 ,$500.58 ,$386.36 ,$576.11 ,$386.36 ,$667.93 ,$667.93 ,$386.36 ,$667.93 ,$734.09 ,$740.50 ,$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$1,110.75 ",$888.60 ,$888.60 ,$386.36 ,$888.60 ,"$1,125.56 ","$1,125.56 ","$1,125.56 ","$1,481.00 ", N/A ,"$1,258.85 ",$965.91 ,$962.65 ,$386.36 ,"$1,481.00 ",$829.36 ,$386.36 ,$389.50 , N/A , N/A , N/A ,$405.68 ,"$1,184.80 ",$869.32 ,$667.93 ,$414.68 ,"$1,332.90 ",$386.36 ,"$1,125.56 ",$400.00 ,$400.00 ,$386.36 ,$400.00 ,$710.88 , N/A 
ST. ELIZABETH'S HOSPITAL,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$114.76 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$442.00 ,$287.30 ,$54.88 ,$442.00 ,$137.20 ,$203.32 ,$247.52 ,$54.88 ,$123.76 ,$149.40 ,$54.88 ,$171.94 ,$54.88 ,$199.34 ,$199.34 ,$54.88 ,$199.34 ,$104.27 ,$221.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$331.50 ,$265.20 ,$265.20 ,$54.88 ,$265.20 ,$335.92 ,$335.92 ,$335.92 ,$442.00 , N/A ,$375.70 ,$137.20 ,$287.30 ,$54.88 ,$442.00 ,$247.52 ,$54.88 ,$116.25 , N/A , N/A , N/A ,$57.62 ,$353.60 ,$123.48 ,$199.34 ,$123.76 ,$397.80 ,$54.88 ,$335.92 ,$400.00 ,$400.00 ,$54.88 ,$400.00 ,$212.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000274,99281,HC ER LEVEL 1-25,450,1 ,$483.00 ,$313.95 ,$71.51 ,$483.00 ,$178.78 ,$222.18 ,$270.48 ,$71.51 ,$135.24 ,$163.25 ,$71.51 ,$199.00 ,$71.51 ,$217.83 ,$217.83 ,$71.51 ,$217.83 ,$135.87 ,$241.50 ,$178.78 ,$71.51 ,$71.51 ,$72.94 ,$362.25 ,$289.80 ,$289.80 ,$71.51 ,$289.80 ,$367.08 ,$367.08 ,$367.08 ,$483.00 , N/A ,$410.55 ,$178.78 ,$313.95 ,$71.51 ,$483.00 ,$270.48 ,$71.51 ,$127.03 , N/A , N/A , N/A ,$75.09 ,$386.40 ,$160.90 ,$217.83 ,$135.24 ,$434.70 ,$71.51 ,$367.08 ,$400.00 ,$400.00 ,$71.51 ,$400.00 ,$231.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45000275,99282,HC ER LEVEL 2-25,450,1 ,$884.00 ,$574.60 ,$129.50 ,$884.00 ,$323.75 ,$406.64 ,$495.04 ,$129.50 ,$247.52 ,$298.79 ,$129.50 ,$364.21 ,$129.50 ,$398.68 ,$398.68 ,$129.50 ,$398.68 ,$246.05 ,$442.00 ,$323.74 ,$129.50 ,$129.50 ,$132.09 ,$663.00 ,$530.40 ,$530.40 ,$129.50 ,$530.40 ,$671.84 ,$671.84 ,$671.84 ,$884.00 , N/A ,$751.40 ,$323.74 ,$574.60 ,$129.50 ,$884.00 ,$495.04 ,$129.50 ,$232.49 , N/A , N/A , N/A ,$135.98 ,$707.20 ,$291.37 ,$398.68 ,$247.52 ,$795.60 ,$129.50 ,$671.84 ,$650.00 ,$650.00 ,$129.50 ,$650.00 ,$424.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000276,99283,HC ER LEVEL 3-25,450,1 ,"$1,329.00 ",$863.85 ,$228.15 ,"$1,329.00 ",$570.38 ,$611.34 ,$744.24 ,$228.15 ,$372.12 ,$449.20 ,$228.15 ,$547.55 ,$228.15 ,$599.38 ,$599.38 ,$228.15 ,$599.38 ,$433.49 ,$664.50 ,$570.38 ,$228.15 ,$228.15 ,$232.72 ,$996.75 ,$797.40 ,$797.40 ,$228.15 ,$797.40 ,"$1,010.04 ","$1,010.04 ","$1,010.04 ","$1,329.00 ", N/A ,"$1,129.65 ",$570.38 ,$863.85 ,$228.15 ,"$1,329.00 ",$744.24 ,$228.15 ,$349.53 , N/A , N/A , N/A ,$239.56 ,"$1,063.20 ",$513.35 ,$599.38 ,$372.12 ,"$1,196.10 ",$228.15 ,"$1,010.04 ","$1,100.00 ","$1,100.00 ",$228.15 ,"$1,100.00 ",$637.92 , N/A 
ST. ELIZABETH'S HOSPITAL,45000277,99284,HC ER LEVEL 4-25,450,1 ,"$1,985.00 ","$1,290.25 ",$134.76 ,"$1,985.00 ",$896.60 ,$913.10 ,"$1,111.60 ",$358.64 ,$555.80 ,$670.93 ,$358.64 ,$817.82 ,$358.64 ,$895.24 ,$895.24 ,$358.64 ,$895.24 ,$681.41 ,$992.50 ,$896.59 ,$358.64 ,$358.64 ,$365.81 ,"$1,488.75 ","$1,191.00 ","$1,191.00 ",$358.64 ,"$1,191.00 ","$1,508.60 ","$1,508.60 ","$1,508.60 ","$1,985.00 ", N/A ,"$1,687.25 ",$896.59 ,"$1,290.25 ",$358.64 ,"$1,985.00 ","$1,111.60 ",$358.64 ,$522.06 , N/A ,$148.24 ,$141.50 ,$376.57 ,"$1,588.00 ",$806.93 ,$895.24 ,$555.80 ,"$1,786.50 ",$358.64 ,"$1,508.60 ","$1,800.00 ","$1,800.00 ",$358.64 ,"$1,800.00 ",$952.80 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45000278,99285,HC ER LEVEL 5-25,450,1 ,"$3,029.00 ","$1,968.85 ",$134.76 ,"$3,029.00 ","$1,286.95 ","$1,393.34 ","$1,696.24 ",$514.78 ,$848.12 ,"$1,023.80 ",$514.78 ,"$1,247.95 ",$514.78 ,"$1,366.08 ","$1,366.08 ",$514.78 ,"$1,366.08 ",$978.07 ,"$1,075.00 ","$1,286.94 ",$514.78 ,$514.78 ,$525.07 ,"$2,271.75 ","$1,817.40 ","$1,817.40 ",$514.78 ,"$1,817.40 ","$2,302.04 ","$2,302.04 ","$2,302.04 ","$3,029.00 ", N/A ,"$2,574.65 ","$1,286.94 ","$1,968.85 ",$514.78 ,"$3,029.00 ","$1,696.24 ",$514.78 ,$796.63 , N/A ,$148.24 ,$141.50 ,$540.52 ,"$2,423.20 ","$1,158.25 ","$1,366.08 ",$848.12 ,"$2,726.10 ",$514.78 ,"$2,302.04 ","$2,900.00 ","$2,900.00 ",$514.78 ,"$2,900.00 ","$1,453.92 ",$134.76 
ST. ELIZABETH'S HOSPITAL,45000279,99291,HC CRITICAL CARE 30-74 MIN -25,450,1 ,"$6,626.00 ","$4,306.90 ",$134.76 ,"$6,626.00 ","$1,835.90 ","$2,000.00 ","$3,710.56 ",$734.36 ,"$1,855.28 ","$2,239.59 ",$734.36 ,"$2,184.06 ",$734.36 ,"$2,988.33 ","$2,988.33 ",$734.36 ,"$2,988.33 ","$1,395.28 ","$1,075.00 ","$1,835.89 ",$734.36 ,$734.36 ,$749.04 ,"$4,969.50 ","$3,975.60 ","$3,975.60 ",$734.36 ,"$3,975.60 ","$5,035.76 ","$5,035.76 ","$5,035.76 ","$6,626.00 ", N/A ,"$5,632.10 ","$1,835.89 ","$4,306.90 ",$734.36 ,"$6,626.00 ","$3,710.56 ",$734.36 ,"$1,742.64 ", N/A ,$148.24 ,$141.50 ,$771.08 ,"$5,300.80 ","$1,652.30 ","$2,988.33 ","$1,855.28 ","$5,963.40 ",$734.36 ,"$5,035.76 ","$3,200.00 ","$3,200.00 ",$734.36 ,"$3,200.00 ","$3,180.48 ",$134.76 
ST. ELIZABETH'S HOSPITAL,45000280,99292,HC CRITICAL CARE ADDL 30MIN -25,450,1 ,"$1,992.00 ","$1,294.80 ",$400.00 ,"$1,992.00 ", N/A ,$916.32 ,"$1,115.52 ", N/A ,$557.76 ,$673.30 , N/A ,$820.70 , N/A ,$898.39 ,$898.39 , N/A ,$898.39 , N/A ,$996.00 , N/A , N/A , N/A , N/A ,"$1,494.00 ","$1,195.20 ","$1,195.20 ", N/A ,"$1,195.20 ","$1,513.92 ","$1,513.92 ","$1,513.92 ","$1,992.00 ", N/A ,"$1,693.20 ", N/A ,"$1,294.80 ", N/A ,"$1,992.00 ","$1,115.52 ", N/A ,$523.90 , N/A , N/A , N/A , N/A ,"$1,593.60 ", N/A ,$898.39 ,$557.76 ,"$1,792.80 ", N/A ,"$1,513.92 ",$400.00 ,$400.00 , N/A ,$400.00 ,$956.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000286,11401,HC EXCISION LESION BENIGN TRUNK/ARM/LEG  0.6-1.0CM,450,1 ,"$2,275.00 ","$1,478.75 ",$340.76 ,"$2,275.00 ",$851.90 ,"$1,046.50 ","$1,274.00 ",$340.76 ,$637.00 ,$768.95 ,$340.76 ,$884.98 ,$340.76 ,"$1,026.03 ","$1,026.03 ",$340.76 ,"$1,026.03 ",$647.44 ,"$1,075.00 ",$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,706.25 ","$1,365.00 ","$1,365.00 ",$340.76 ,"$1,365.00 ","$1,729.00 ","$1,729.00 ","$1,729.00 ","$2,275.00 ", N/A ,"$1,933.75 ",$851.90 ,"$1,478.75 ",$340.76 ,"$2,275.00 ","$1,274.00 ",$340.76 ,$598.33 , N/A , N/A , N/A ,$357.80 ,"$1,820.00 ",$766.71 ,"$1,026.03 ",$637.00 ,"$2,047.50 ",$340.76 ,"$1,729.00 ",$400.00 ,$400.00 ,$340.76 ,$400.00 ,"$1,092.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000287,11402,HC EXCISION LESION BENIGN TRUNK/ARM/LEG 1.1-2.0CM,450,1 ,"$1,757.00 ","$1,142.05 ",$400.00 ,"$1,757.00 ","$1,533.75 ",$808.22 ,$983.92 ,$613.50 ,$491.96 ,$593.87 ,$613.50 ,$683.47 ,$613.50 ,$792.41 ,$792.41 ,$613.50 ,$792.41 ,"$1,165.65 ",$878.50 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,317.75 ","$1,054.20 ","$1,054.20 ",$613.50 ,"$1,054.20 ","$1,335.32 ","$1,335.32 ","$1,335.32 ","$1,757.00 ", N/A ,"$1,493.45 ","$1,533.75 ","$1,142.05 ",$613.50 ,"$1,757.00 ",$983.92 ,$613.50 ,$462.09 , N/A , N/A , N/A ,$644.18 ,"$1,405.60 ","$1,380.37 ",$792.41 ,$491.96 ,"$1,581.30 ",$613.50 ,"$1,335.32 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,$843.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000291,11422,HC EXCISION LESION BENIGN SCALP/NECK/HAND/FEET 1.1-2.0CM,450,1 ,"$4,160.00 ","$2,704.00 ",$400.00 ,"$4,160.00 ","$3,467.90 ","$1,913.60 ","$2,329.60 ","$1,387.16 ","$1,164.80 ","$1,406.08 ","$1,387.16 ","$1,618.24 ","$1,387.16 ","$1,876.16 ","$1,876.16 ","$1,387.16 ","$1,876.16 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$3,120.00 ","$2,496.00 ","$2,496.00 ","$1,387.16 ","$2,496.00 ","$3,161.60 ","$3,161.60 ","$3,161.60 ","$4,160.00 ", N/A ,"$3,536.00 ","$3,467.89 ","$2,704.00 ","$1,387.16 ","$4,160.00 ","$2,329.60 ","$1,387.16 ","$1,094.08 ", N/A , N/A , N/A ,"$1,456.52 ","$3,328.00 ","$3,121.10 ","$1,876.16 ","$1,164.80 ","$3,744.00 ","$1,387.16 ","$3,161.60 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$1,996.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000296,20100,HC EXPLORE WOUND NECK,450,1 ,"$3,251.00 ","$2,113.15 ",$400.00 ,"$3,251.00 ","$1,114.70 ","$1,495.46 ","$1,820.56 ",$445.88 ,$910.28 ,"$1,098.84 ",$445.88 ,"$1,264.64 ",$445.88 ,"$1,466.20 ","$1,466.20 ",$445.88 ,"$1,466.20 ",$847.17 ,"$1,075.00 ","$1,114.70 ",$445.88 ,$445.88 ,$454.80 ,"$2,438.25 ","$1,950.60 ","$1,950.60 ",$445.88 ,"$1,950.60 ","$2,470.76 ","$2,470.76 ","$2,470.76 ","$3,251.00 ", N/A ,"$2,763.35 ","$1,114.70 ","$2,113.15 ",$445.88 ,"$3,251.00 ","$1,820.56 ",$445.88 ,$855.01 , N/A , N/A , N/A ,$468.17 ,"$2,600.80 ","$1,003.23 ","$1,466.20 ",$910.28 ,"$2,925.90 ",$445.88 ,"$2,470.76 ",$400.00 ,$400.00 ,$445.88 ,$400.00 ,"$1,560.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000297,20101,HC EXPLORE WOUND CHEST,450,1 ,"$6,728.00 ","$4,373.20 ",$400.00 ,"$6,728.00 ","$4,221.50 ","$2,000.00 ","$3,767.68 ","$1,688.60 ","$1,883.84 ","$2,274.06 ","$1,688.60 ","$2,617.19 ","$1,688.60 ","$3,034.33 ","$3,034.33 ","$1,688.60 ","$3,034.33 ","$3,208.33 ","$1,075.00 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$5,046.00 ","$4,036.80 ","$4,036.80 ","$1,688.60 ","$4,036.80 ","$5,113.28 ","$5,113.28 ","$5,113.28 ","$6,728.00 ", N/A ,"$5,718.80 ","$4,221.49 ","$4,373.20 ","$1,688.60 ","$6,728.00 ","$3,767.68 ","$1,688.60 ","$1,769.46 ", N/A , N/A , N/A ,"$1,773.03 ","$5,382.40 ","$3,799.34 ","$3,034.33 ","$1,883.84 ","$6,055.20 ","$1,688.60 ","$5,113.28 ",$400.00 ,$400.00 ,"$1,688.60 ",$400.00 ,"$3,229.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000298,20102,HC EXPLORE WOUND ABDOMEN/FLANK/BACK,450,1 ,"$6,728.00 ","$4,373.20 ",$400.00 ,"$6,728.00 ","$4,221.50 ","$2,000.00 ","$3,767.68 ","$1,688.60 ","$1,883.84 ","$2,274.06 ","$1,688.60 ","$2,617.19 ","$1,688.60 ","$3,034.33 ","$3,034.33 ","$1,688.60 ","$3,034.33 ","$3,208.33 ","$1,075.00 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$5,046.00 ","$4,036.80 ","$4,036.80 ","$1,688.60 ","$4,036.80 ","$5,113.28 ","$5,113.28 ","$5,113.28 ","$6,728.00 ", N/A ,"$5,718.80 ","$4,221.49 ","$4,373.20 ","$1,688.60 ","$6,728.00 ","$3,767.68 ","$1,688.60 ","$1,769.46 ", N/A , N/A , N/A ,"$1,773.03 ","$5,382.40 ","$3,799.34 ","$3,034.33 ","$1,883.84 ","$6,055.20 ","$1,688.60 ","$5,113.28 ",$400.00 ,$400.00 ,"$1,688.60 ",$400.00 ,"$3,229.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000299,20525,HC REMOVAL FOREIGN BODY MUSCLE DEEP/COMPLICATED,450,1 ,"$8,722.00 ","$5,669.30 ",$400.00 ,"$8,722.00 ","$5,843.93 ","$2,000.00 ","$4,884.32 ","$2,337.57 ","$2,442.16 ","$2,282.50 ","$2,337.57 ","$3,392.86 ","$2,337.57 ","$3,933.62 ","$3,933.62 ","$2,337.57 ","$3,933.62 ","$4,441.38 ","$1,075.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$6,541.50 ","$5,233.20 ","$5,233.20 ","$2,337.57 ","$5,233.20 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,722.00 ", N/A ,"$7,413.70 ","$5,843.93 ","$5,669.30 ","$2,337.57 ","$8,722.00 ","$4,884.32 ","$2,337.57 ","$2,293.89 ", N/A , N/A , N/A ,"$2,454.45 ","$6,977.60 ","$5,259.53 ","$3,933.62 ","$2,442.16 ","$7,849.80 ","$2,337.57 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,337.57 ",$400.00 ,"$4,186.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000301,24200,HC REMOVE FOREIGN BODY UPPER ARM/ELBOW SUBQ,450,1 ,"$3,952.00 ","$2,568.80 ",$400.00 ,"$3,952.00 ","$3,467.90 ","$1,817.92 ","$2,213.12 ","$1,387.16 ","$1,106.56 ","$1,335.78 ","$1,387.16 ","$1,537.33 ","$1,387.16 ","$1,782.35 ","$1,782.35 ","$1,387.16 ","$1,782.35 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$2,964.00 ","$2,371.20 ","$2,371.20 ","$1,387.16 ","$2,371.20 ","$3,003.52 ","$3,003.52 ","$3,003.52 ","$3,952.00 ", N/A ,"$3,359.20 ","$3,467.89 ","$2,568.80 ","$1,387.16 ","$3,952.00 ","$2,213.12 ","$1,387.16 ","$1,039.38 ", N/A , N/A , N/A ,"$1,456.52 ","$3,161.60 ","$3,121.10 ","$1,782.35 ","$1,106.56 ","$3,556.80 ","$1,387.16 ","$3,003.52 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$1,896.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000303,24620,HC CLOSED TX ELBOW FRACTURE W/MANIP,450,1 ,"$1,205.00 ",$783.25 ,$316.92 ,"$3,432.95 ","$3,432.95 ",$554.30 ,$674.80 ,"$1,373.18 ",$337.40 ,$407.29 ,"$1,373.18 ",$468.75 ,"$1,205.00 ",$543.46 ,$543.46 ,"$1,205.00 ",$543.46 ,"$1,205.00 ",$602.50 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,205.00 ",$903.75 ,$723.00 ,$723.00 ,"$1,373.18 ",$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ","$1,205.00 ",$783.25 ,"$1,373.18 ","$1,205.00 ",$674.80 ,"$1,373.18 ",$316.92 , N/A , N/A , N/A ,"$1,441.84 ",$964.00 ,"$3,089.65 ",$543.46 ,$337.40 ,"$1,084.50 ","$1,373.18 ",$915.80 ,$400.00 ,$400.00 ,"$1,205.00 ",$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000306,28192,HC REMOVE FOREIGN BODY FOOT DEEP,450,1 ,"$8,322.00 ","$5,409.30 ",$400.00 ,"$8,322.00 ","$3,467.90 ","$2,000.00 ","$4,660.32 ","$1,387.16 ","$2,330.16 ","$2,282.50 ","$1,387.16 ","$3,237.26 ","$1,387.16 ","$3,753.22 ","$3,753.22 ","$1,387.16 ","$3,753.22 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$6,241.50 ","$4,993.20 ","$4,993.20 ","$1,387.16 ","$4,993.20 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,322.00 ", N/A ,"$7,073.70 ","$3,467.89 ","$5,409.30 ","$1,387.16 ","$8,322.00 ","$4,660.32 ","$1,387.16 ","$2,188.69 ", N/A , N/A , N/A ,"$1,456.52 ","$6,657.60 ","$3,121.10 ","$3,753.22 ","$2,330.16 ","$7,489.80 ","$1,387.16 ","$5,354.00 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$3,994.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$468.12 ,$304.28 ,$123.12 ,$468.12 ,$405.73 ,$215.34 ,$262.15 ,$162.29 ,$131.07 ,$158.22 ,$162.29 ,$182.10 ,$162.29 ,$211.12 ,$211.12 ,$162.29 ,$211.12 ,$308.35 ,$234.06 ,$405.72 ,$162.29 ,$162.29 ,$165.54 ,$351.09 ,$280.87 ,$280.87 ,$162.29 ,$280.87 ,$355.77 ,$355.77 ,$355.77 ,$468.12 , N/A ,$397.90 ,$405.72 ,$304.28 ,$162.29 ,$468.12 ,$262.15 ,$162.29 ,$123.12 , N/A , N/A , N/A ,$170.40 ,$374.50 ,$365.15 ,$211.12 ,$131.07 ,$421.31 ,$162.29 ,$355.77 ,$400.00 ,$400.00 ,$162.29 ,$400.00 ,$224.70 , N/A 
ST. ELIZABETH'S HOSPITAL,45000314,41252,HC RPR LAC MOUTH/TONGUE >2.6CM OR COMPLEX,450,1 ,"$2,133.00 ","$1,386.45 ",$208.58 ,"$2,133.00 ",$521.45 ,$981.18 ,"$1,194.48 ",$208.58 ,$597.24 ,$720.95 ,$208.58 ,$829.74 ,$208.58 ,$961.98 ,$961.98 ,$208.58 ,$961.98 ,$396.30 ,"$1,066.50 ",$521.44 ,$208.58 ,$208.58 ,$212.75 ,"$1,599.75 ","$1,279.80 ","$1,279.80 ",$208.58 ,"$1,279.80 ","$1,621.08 ","$1,621.08 ","$1,621.08 ","$2,133.00 ", N/A ,"$1,813.05 ",$521.44 ,"$1,386.45 ",$208.58 ,"$2,133.00 ","$1,194.48 ",$208.58 ,$560.98 , N/A , N/A , N/A ,$219.01 ,"$1,706.40 ",$469.30 ,$961.98 ,$597.24 ,"$1,919.70 ",$208.58 ,"$1,621.08 ",$400.00 ,$400.00 ,$208.58 ,$400.00 ,"$1,023.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000320,11770,HC EXCISION PILONIDAL CYST/SINUS SIMPLE,450,1 ,"$6,695.00 ","$4,351.75 ",$400.00 ,"$6,695.00 ","$5,843.93 ","$2,000.00 ","$3,749.20 ","$2,337.57 ","$1,874.60 ","$2,262.91 ","$2,337.57 ","$2,604.36 ","$2,337.57 ","$3,019.45 ","$3,019.45 ","$2,337.57 ","$3,019.45 ","$4,441.38 ","$1,075.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$5,021.25 ","$4,017.00 ","$4,017.00 ","$2,337.57 ","$4,017.00 ","$5,088.20 ","$5,088.20 ","$5,088.20 ","$6,695.00 ", N/A ,"$5,690.75 ","$5,843.93 ","$4,351.75 ","$2,337.57 ","$6,695.00 ","$3,749.20 ","$2,337.57 ","$1,760.79 ", N/A , N/A , N/A ,"$2,454.45 ","$5,356.00 ","$5,259.53 ","$3,019.45 ","$1,874.60 ","$6,025.50 ","$2,337.57 ","$5,088.20 ",$400.00 ,$400.00 ,"$2,337.57 ",$400.00 ,"$3,213.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000321,21315,HC CLOSED TX FRACTURE NASAL BONE W/O STABILIZATION,450,1 ,"$5,009.00 ","$3,255.85 ",$400.00 ,"$5,009.00 ","$3,334.08 ","$2,000.00 ","$2,805.04 ","$1,333.63 ","$1,402.52 ","$1,693.04 ","$1,333.63 ","$1,948.50 ","$1,333.63 ","$2,259.06 ","$2,259.06 ","$1,333.63 ","$2,259.06 ","$2,533.89 ","$1,075.00 ","$3,334.07 ","$1,333.63 ","$1,333.63 ","$1,360.30 ","$3,756.75 ","$3,005.40 ","$3,005.40 ","$1,333.63 ","$3,005.40 ","$3,806.84 ","$3,806.84 ","$3,806.84 ","$5,009.00 ", N/A ,"$4,257.65 ","$3,334.07 ","$3,255.85 ","$1,333.63 ","$5,009.00 ","$2,805.04 ","$1,333.63 ","$1,317.37 ", N/A , N/A , N/A ,"$1,400.31 ","$4,007.20 ","$3,000.66 ","$2,259.06 ","$1,402.52 ","$4,508.10 ","$1,333.63 ","$3,806.84 ",$400.00 ,$400.00 ,"$1,333.63 ",$400.00 ,"$2,404.32 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000322,23330,HC REMOVE FOREIGN BODY SHOULDER SUBQ,450,1 ,"$4,160.00 ","$2,704.00 ",$400.00 ,"$4,160.00 ","$1,533.75 ","$1,913.60 ","$2,329.60 ",$613.50 ,"$1,164.80 ","$1,406.08 ",$613.50 ,"$1,618.24 ",$613.50 ,"$1,876.16 ","$1,876.16 ",$613.50 ,"$1,876.16 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,120.00 ","$2,496.00 ","$2,496.00 ",$613.50 ,"$2,496.00 ","$3,161.60 ","$3,161.60 ","$3,161.60 ","$4,160.00 ", N/A ,"$3,536.00 ","$1,533.75 ","$2,704.00 ",$613.50 ,"$4,160.00 ","$2,329.60 ",$613.50 ,"$1,094.08 ", N/A , N/A , N/A ,$644.18 ,"$3,328.00 ","$1,380.37 ","$1,876.16 ","$1,164.80 ","$3,744.00 ",$613.50 ,"$3,161.60 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$1,996.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000326,24670,HC CLOSED TX FX ULNAR PROX END W/MANIP,450,1 ,"$1,049.00 ",$681.85 ,$203.20 ,"$1,049.00 ",$508.00 ,$482.54 ,$587.44 ,$203.20 ,$293.72 ,$354.56 ,$203.20 ,$408.06 ,$203.20 ,$473.10 ,$473.10 ,$203.20 ,$473.10 ,$386.08 ,$524.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$786.75 ,$629.40 ,$629.40 ,$203.20 ,$629.40 ,$797.24 ,$797.24 ,$797.24 ,"$1,049.00 ", N/A ,$891.65 ,$508.00 ,$681.85 ,$203.20 ,"$1,049.00 ",$587.44 ,$203.20 ,$275.89 , N/A , N/A , N/A ,$213.36 ,$839.20 ,$457.20 ,$473.10 ,$293.72 ,$944.10 ,$203.20 ,$797.24 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$503.52 , N/A 
ST. ELIZABETH'S HOSPITAL,45000327,26765,HC TX FX OPEN FINGER/THUMB W/INT FIX EACH,450,1 ,"$10,279.00 ","$6,681.35 ",$400.00 ,"$10,279.00 ","$6,979.95 ","$2,000.00 ","$5,756.24 ","$2,791.98 ","$2,878.12 ","$2,282.50 ","$2,791.98 ","$3,998.53 ","$2,791.98 ","$4,635.83 ","$4,635.83 ","$2,791.98 ","$4,635.83 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$7,709.25 ","$6,167.40 ","$6,167.40 ","$2,791.98 ","$6,167.40 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$10,279.00 ", N/A ,"$8,737.15 ","$6,979.94 ","$6,681.35 ","$2,791.98 ","$10,279.00 ","$5,756.24 ","$2,791.98 ","$2,703.38 ", N/A , N/A , N/A ,"$2,931.58 ","$8,223.20 ","$6,281.95 ","$4,635.83 ","$2,878.12 ","$9,251.10 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$4,933.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000329,27752,HC CLSD TX FX TIBIAL SHAFT W/MANIP,450,1 ,"$4,313.00 ","$2,803.45 ",$400.00 ,"$4,313.00 ","$3,432.95 ","$1,983.98 ","$2,415.28 ","$1,373.18 ","$1,207.64 ","$1,457.79 ","$1,373.18 ","$1,677.76 ","$1,373.18 ","$1,945.16 ","$1,945.16 ","$1,373.18 ","$1,945.16 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,234.75 ","$2,587.80 ","$2,587.80 ","$1,373.18 ","$2,587.80 ","$3,277.88 ","$3,277.88 ","$3,277.88 ","$4,313.00 ", N/A ,"$3,666.05 ","$3,432.94 ","$2,803.45 ","$1,373.18 ","$4,313.00 ","$2,415.28 ","$1,373.18 ","$1,134.32 ", N/A , N/A , N/A ,"$1,441.84 ","$3,450.40 ","$3,089.65 ","$1,945.16 ","$1,207.64 ","$3,881.70 ","$1,373.18 ","$3,277.88 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,070.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$814.00 ,$529.10 ,$203.20 ,$814.00 ,$508.00 ,$374.44 ,$455.84 ,$203.20 ,$227.92 ,$275.13 ,$203.20 ,$316.65 ,$203.20 ,$367.11 ,$367.11 ,$203.20 ,$367.11 ,$386.08 ,$407.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$610.50 ,$488.40 ,$488.40 ,$203.20 ,$488.40 ,$618.64 ,$618.64 ,$618.64 ,$814.00 , N/A ,$691.90 ,$508.00 ,$529.10 ,$203.20 ,$814.00 ,$455.84 ,$203.20 ,$214.08 , N/A , N/A , N/A ,$213.36 ,$651.20 ,$457.20 ,$367.11 ,$227.92 ,$732.60 ,$203.20 ,$618.64 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$390.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45000333,29200,HC STRAPPING THORAX,450,1 ,$644.00 ,$418.60 ,$139.29 ,$644.00 ,$348.23 ,$296.24 ,$360.64 ,$139.29 ,$180.32 ,$217.67 ,$139.29 ,$243.36 ,$139.29 ,$290.44 ,$290.44 ,$139.29 ,$290.44 ,$264.64 ,$322.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$483.00 ,$386.40 ,$386.40 ,$139.29 ,$386.40 ,$489.44 ,$489.44 ,$489.44 ,$644.00 , N/A ,$547.40 ,$348.22 ,$418.60 ,$139.29 ,$644.00 ,$360.64 ,$139.29 ,$169.37 , N/A , N/A , N/A ,$146.25 ,$515.20 ,$313.39 ,$290.44 ,$180.32 ,$579.60 ,$139.29 ,$489.44 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$309.12 , N/A 
ST. ELIZABETH'S HOSPITAL,45000334,29260,HC STRAPPING ELBOW/WRIST,450,1 ,$325.00 ,$211.25 ,$54.88 ,$325.00 ,$137.20 ,$149.50 ,$182.00 ,$54.88 ,$91.00 ,$109.85 ,$54.88 ,$133.90 ,$54.88 ,$146.58 ,$146.58 ,$54.88 ,$146.58 ,$104.27 ,$162.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$243.75 ,$195.00 ,$195.00 ,$54.88 ,$195.00 ,$247.00 ,$247.00 ,$247.00 ,$325.00 , N/A ,$276.25 ,$137.20 ,$211.25 ,$54.88 ,$325.00 ,$182.00 ,$54.88 ,$85.48 , N/A , N/A , N/A ,$57.62 ,$260.00 ,$123.48 ,$146.58 ,$91.00 ,$292.50 ,$54.88 ,$247.00 ,$325.00 ,$325.00 ,$54.88 ,$325.00 ,$156.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000335,29530,HC STRAPPING KNEE,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$121.54 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000336,29550,HC STRAPPING TOES,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000338,30906,HC CONTROL NASAL HEMORRHAGE SUBSQ,450,1 ,$723.00 ,$469.95 ,$190.15 ,$723.00 ,$521.45 ,$332.58 ,$404.88 ,$208.58 ,$202.44 ,$244.37 ,$208.58 ,$281.25 ,$208.58 ,$326.07 ,$326.07 ,$208.58 ,$326.07 ,$396.30 ,$361.50 ,$521.44 ,$208.58 ,$208.58 ,$212.75 ,$542.25 ,$433.80 ,$433.80 ,$208.58 ,$433.80 ,$549.48 ,$549.48 ,$549.48 ,$723.00 , N/A ,$614.55 ,$521.44 ,$469.95 ,$208.58 ,$723.00 ,$404.88 ,$208.58 ,$190.15 , N/A , N/A , N/A ,$219.01 ,$578.40 ,$469.30 ,$326.07 ,$202.44 ,$650.70 ,$208.58 ,$549.48 ,$400.00 ,$400.00 ,$208.58 ,$400.00 ,$347.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45000346,23625,HC CLOSED TX GR TUBER HUM FX W/MANIP,450,1 ,"$4,758.00 ","$3,092.70 ",$400.00 ,"$4,758.00 ","$3,432.95 ","$2,000.00 ","$2,664.48 ","$1,373.18 ","$1,332.24 ","$1,608.20 ","$1,373.18 ","$1,850.86 ","$1,373.18 ","$2,145.86 ","$2,145.86 ","$1,373.18 ","$2,145.86 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,568.50 ","$2,854.80 ","$2,854.80 ","$1,373.18 ","$2,854.80 ","$3,616.08 ","$3,616.08 ","$3,616.08 ","$4,758.00 ", N/A ,"$4,044.30 ","$3,432.94 ","$3,092.70 ","$1,373.18 ","$4,758.00 ","$2,664.48 ","$1,373.18 ","$1,251.35 ", N/A , N/A , N/A ,"$1,441.84 ","$3,806.40 ","$3,089.65 ","$2,145.86 ","$1,332.24 ","$4,282.20 ","$1,373.18 ","$3,616.08 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,283.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000350,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI-LT,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$114.76 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000351,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI-RT,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$114.76 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000352,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI-50,450,1 ,$442.00 ,$287.30 ,$54.88 ,$442.00 ,$137.20 ,$203.32 ,$247.52 ,$54.88 ,$123.76 ,$149.40 ,$54.88 ,$171.94 ,$54.88 ,$199.34 ,$199.34 ,$54.88 ,$199.34 ,$104.27 ,$221.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$331.50 ,$265.20 ,$265.20 ,$54.88 ,$265.20 ,$335.92 ,$335.92 ,$335.92 ,$442.00 , N/A ,$375.70 ,$137.20 ,$287.30 ,$54.88 ,$442.00 ,$247.52 ,$54.88 ,$116.25 , N/A , N/A , N/A ,$57.62 ,$353.60 ,$123.48 ,$199.34 ,$123.76 ,$397.80 ,$54.88 ,$335.92 ,$400.00 ,$400.00 ,$54.88 ,$400.00 ,$212.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000357,23650,HC TX DISL SHLDR W/MAN CLS-LT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000358,23650,HC TX DISL SHLDR W/MAN CLS-RT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000359,23655,HC TX DISL SHLDR W/MAN/ANES CLS-LT,450,1 ,"$5,395.00 ","$3,506.75 ",$400.00 ,"$5,395.00 ","$3,432.95 ","$2,000.00 ","$3,021.20 ","$1,373.18 ","$1,510.60 ","$1,823.51 ","$1,373.18 ","$2,098.66 ","$1,373.18 ","$2,433.15 ","$2,433.15 ","$1,373.18 ","$2,433.15 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,046.25 ","$3,237.00 ","$3,237.00 ","$1,373.18 ","$3,237.00 ","$4,100.20 ","$4,100.20 ","$4,100.20 ","$5,395.00 ", N/A ,"$4,585.75 ","$3,432.94 ","$3,506.75 ","$1,373.18 ","$5,395.00 ","$3,021.20 ","$1,373.18 ","$1,418.89 ", N/A , N/A , N/A ,"$1,441.84 ","$4,316.00 ","$3,089.65 ","$2,433.15 ","$1,510.60 ","$4,855.50 ","$1,373.18 ","$4,100.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,589.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000360,23655,HC TX DISL SHLDR W/MAN/ANES CLS-RT,450,1 ,"$5,395.00 ","$3,506.75 ",$400.00 ,"$5,395.00 ","$3,432.95 ","$2,000.00 ","$3,021.20 ","$1,373.18 ","$1,510.60 ","$1,823.51 ","$1,373.18 ","$2,098.66 ","$1,373.18 ","$2,433.15 ","$2,433.15 ","$1,373.18 ","$2,433.15 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,046.25 ","$3,237.00 ","$3,237.00 ","$1,373.18 ","$3,237.00 ","$4,100.20 ","$4,100.20 ","$4,100.20 ","$5,395.00 ", N/A ,"$4,585.75 ","$3,432.94 ","$3,506.75 ","$1,373.18 ","$5,395.00 ","$3,021.20 ","$1,373.18 ","$1,418.89 ", N/A , N/A , N/A ,"$1,441.84 ","$4,316.00 ","$3,089.65 ","$2,433.15 ","$1,510.60 ","$4,855.50 ","$1,373.18 ","$4,100.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,589.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000365,24600,HC TX DISL ELBOW W/O ANES CLS-LT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000366,24600,HC TX DISL ELBOW W/O ANES CLS-RT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000367,24620,HC CLOSED TX ELBOW FRACTURE W/MANIP-LT,450,1 ,"$1,205.00 ",$783.25 ,$316.92 ,"$3,432.95 ","$3,432.95 ",$554.30 ,$674.80 ,"$1,373.18 ",$337.40 ,$407.29 ,"$1,373.18 ",$468.75 ,"$1,205.00 ",$543.46 ,$543.46 ,"$1,205.00 ",$543.46 ,"$1,205.00 ",$602.50 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,205.00 ",$903.75 ,$723.00 ,$723.00 ,"$1,373.18 ",$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ","$1,205.00 ",$783.25 ,"$1,373.18 ","$1,205.00 ",$674.80 ,"$1,373.18 ",$316.92 , N/A , N/A , N/A ,"$1,441.84 ",$964.00 ,"$3,089.65 ",$543.46 ,$337.40 ,"$1,084.50 ","$1,373.18 ",$915.80 ,$400.00 ,$400.00 ,"$1,205.00 ",$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000368,24620,HC CLOSED TX ELBOW FRACTURE W/MANIP-RT,450,1 ,"$1,205.00 ",$783.25 ,$316.92 ,"$3,432.95 ","$3,432.95 ",$554.30 ,$674.80 ,"$1,373.18 ",$337.40 ,$407.29 ,"$1,373.18 ",$468.75 ,"$1,205.00 ",$543.46 ,$543.46 ,"$1,205.00 ",$543.46 ,"$1,205.00 ",$602.50 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,205.00 ",$903.75 ,$723.00 ,$723.00 ,"$1,373.18 ",$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ","$1,205.00 ",$783.25 ,"$1,373.18 ","$1,205.00 ",$674.80 ,"$1,373.18 ",$316.92 , N/A , N/A , N/A ,"$1,441.84 ",$964.00 ,"$3,089.65 ",$543.46 ,$337.40 ,"$1,084.50 ","$1,373.18 ",$915.80 ,$400.00 ,$400.00 ,"$1,205.00 ",$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000369,24640,HC DISLOCATION NURSEMAID ELBOW-LT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000370,24640,HC DISLOCATION NURSEMAID ELBOW-RT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000371,25505,HC RADIUS FX W MANIP-LT,450,1 ,"$3,964.77 ","$2,577.10 ",$400.00 ,"$3,964.77 ","$3,432.95 ","$1,823.79 ","$2,220.27 ","$1,373.18 ","$1,110.14 ","$1,340.09 ","$1,373.18 ","$1,542.30 ","$1,373.18 ","$1,788.11 ","$1,788.11 ","$1,373.18 ","$1,788.11 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,973.58 ","$2,378.86 ","$2,378.86 ","$1,373.18 ","$2,378.86 ","$3,013.23 ","$3,013.23 ","$3,013.23 ","$3,964.77 ", N/A ,"$3,370.05 ","$3,432.94 ","$2,577.10 ","$1,373.18 ","$3,964.77 ","$2,220.27 ","$1,373.18 ","$1,042.73 ", N/A , N/A , N/A ,"$1,441.84 ","$3,171.82 ","$3,089.65 ","$1,788.11 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,013.23 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,903.09 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000372,25505,HC RADIUS FX W MANIP-RT,450,1 ,"$3,964.77 ","$2,577.10 ",$400.00 ,"$3,964.77 ","$3,432.95 ","$1,823.79 ","$2,220.27 ","$1,373.18 ","$1,110.14 ","$1,340.09 ","$1,373.18 ","$1,542.30 ","$1,373.18 ","$1,788.11 ","$1,788.11 ","$1,373.18 ","$1,788.11 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,973.58 ","$2,378.86 ","$2,378.86 ","$1,373.18 ","$2,378.86 ","$3,013.23 ","$3,013.23 ","$3,013.23 ","$3,964.77 ", N/A ,"$3,370.05 ","$3,432.94 ","$2,577.10 ","$1,373.18 ","$3,964.77 ","$2,220.27 ","$1,373.18 ","$1,042.73 ", N/A , N/A , N/A ,"$1,441.84 ","$3,171.82 ","$3,089.65 ","$1,788.11 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,013.23 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,903.09 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000373,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP-LT,450,1 ,"$6,179.00 ","$4,016.35 ",$400.00 ,"$6,179.00 ","$3,432.95 ","$2,000.00 ","$3,460.24 ","$1,373.18 ","$1,730.12 ","$2,088.50 ","$1,373.18 ","$2,403.63 ","$1,373.18 ","$2,786.73 ","$2,786.73 ","$1,373.18 ","$2,786.73 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,634.25 ","$3,707.40 ","$3,707.40 ","$1,373.18 ","$3,707.40 ","$4,696.04 ","$4,696.04 ","$4,696.04 ","$6,179.00 ", N/A ,"$5,252.15 ","$3,432.94 ","$4,016.35 ","$1,373.18 ","$6,179.00 ","$3,460.24 ","$1,373.18 ","$1,625.08 ", N/A , N/A , N/A ,"$1,441.84 ","$4,943.20 ","$3,089.65 ","$2,786.73 ","$1,730.12 ","$5,561.10 ","$1,373.18 ","$4,696.04 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,965.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000374,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP-RT,450,1 ,"$6,179.00 ","$4,016.35 ",$400.00 ,"$6,179.00 ","$3,432.95 ","$2,000.00 ","$3,460.24 ","$1,373.18 ","$1,730.12 ","$2,088.50 ","$1,373.18 ","$2,403.63 ","$1,373.18 ","$2,786.73 ","$2,786.73 ","$1,373.18 ","$2,786.73 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,634.25 ","$3,707.40 ","$3,707.40 ","$1,373.18 ","$3,707.40 ","$4,696.04 ","$4,696.04 ","$4,696.04 ","$6,179.00 ", N/A ,"$5,252.15 ","$3,432.94 ","$4,016.35 ","$1,373.18 ","$6,179.00 ","$3,460.24 ","$1,373.18 ","$1,625.08 ", N/A , N/A , N/A ,"$1,441.84 ","$4,943.20 ","$3,089.65 ","$2,786.73 ","$1,730.12 ","$5,561.10 ","$1,373.18 ","$4,696.04 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,965.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000375,25605,"HC CLOSED TX DIST RAD/ULNA FX,MANIPUL-LT",450,1 ,"$4,020.00 ","$2,613.00 ",$400.00 ,"$4,020.00 ","$3,432.95 ","$1,849.20 ","$2,251.20 ","$1,373.18 ","$1,125.60 ","$1,358.76 ","$1,373.18 ","$1,563.78 ","$1,373.18 ","$1,813.02 ","$1,813.02 ","$1,373.18 ","$1,813.02 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,015.00 ","$2,412.00 ","$2,412.00 ","$1,373.18 ","$2,412.00 ","$3,055.20 ","$3,055.20 ","$3,055.20 ","$4,020.00 ", N/A ,"$3,417.00 ","$3,432.94 ","$2,613.00 ","$1,373.18 ","$4,020.00 ","$2,251.20 ","$1,373.18 ","$1,057.26 ", N/A , N/A , N/A ,"$1,441.84 ","$3,216.00 ","$3,089.65 ","$1,813.02 ","$1,125.60 ","$3,618.00 ","$1,373.18 ","$3,055.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,929.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000376,25605,"HC CLOSED TX DIST RAD/ULNA FX,MANIPUL-RT",450,1 ,"$4,020.00 ","$2,613.00 ",$400.00 ,"$4,020.00 ","$3,432.95 ","$1,849.20 ","$2,251.20 ","$1,373.18 ","$1,125.60 ","$1,358.76 ","$1,373.18 ","$1,563.78 ","$1,373.18 ","$1,813.02 ","$1,813.02 ","$1,373.18 ","$1,813.02 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,015.00 ","$2,412.00 ","$2,412.00 ","$1,373.18 ","$2,412.00 ","$3,055.20 ","$3,055.20 ","$3,055.20 ","$4,020.00 ", N/A ,"$3,417.00 ","$3,432.94 ","$2,613.00 ","$1,373.18 ","$4,020.00 ","$2,251.20 ","$1,373.18 ","$1,057.26 ", N/A , N/A , N/A ,"$1,441.84 ","$3,216.00 ","$3,089.65 ","$1,813.02 ","$1,125.60 ","$3,618.00 ","$1,373.18 ","$3,055.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,929.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000379,26600,HC CLSD METACARPAL W/O MANIP-LT,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000380,26600,HC CLSD METACARPAL W/O MANIP-RT,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000381,26605,HC CLSD METACARPAL FX W/MANIP-LT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000382,26605,HC CLSD METACARPAL FX W/MANIP-RT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000385,26670,HC HAND DISL W/MANIP W/O ANES-LT,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000386,26670,HC HAND DISL W/MANIP W/O ANES-RT,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000387,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT-LT,450,1 ,$814.00 ,$529.10 ,$203.20 ,$814.00 ,$508.00 ,$374.44 ,$455.84 ,$203.20 ,$227.92 ,$275.13 ,$203.20 ,$316.65 ,$203.20 ,$367.11 ,$367.11 ,$203.20 ,$367.11 ,$386.08 ,$407.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$610.50 ,$488.40 ,$488.40 ,$203.20 ,$488.40 ,$618.64 ,$618.64 ,$618.64 ,$814.00 , N/A ,$691.90 ,$508.00 ,$529.10 ,$203.20 ,$814.00 ,$455.84 ,$203.20 ,$214.08 , N/A , N/A , N/A ,$213.36 ,$651.20 ,$457.20 ,$367.11 ,$227.92 ,$732.60 ,$203.20 ,$618.64 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$390.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45000388,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT-RT,450,1 ,$814.00 ,$529.10 ,$203.20 ,$814.00 ,$508.00 ,$374.44 ,$455.84 ,$203.20 ,$227.92 ,$275.13 ,$203.20 ,$316.65 ,$203.20 ,$367.11 ,$367.11 ,$203.20 ,$367.11 ,$386.08 ,$407.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$610.50 ,$488.40 ,$488.40 ,$203.20 ,$488.40 ,$618.64 ,$618.64 ,$618.64 ,$814.00 , N/A ,$691.90 ,$508.00 ,$529.10 ,$203.20 ,$814.00 ,$455.84 ,$203.20 ,$214.08 , N/A , N/A , N/A ,$213.36 ,$651.20 ,$457.20 ,$367.11 ,$227.92 ,$732.60 ,$203.20 ,$618.64 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$390.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45000391,27560,HC TX DSL PTLR W/O ANS CL-LT,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000392,27560,HC TX DSL PTLR W/O ANS CL-RT,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000397,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP-LT,450,1 ,"$2,714.00 ","$1,764.10 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,248.44 ","$1,519.84 ","$1,373.18 ",$759.92 ,$917.33 ,"$1,373.18 ","$1,055.75 ","$1,373.18 ","$1,224.01 ","$1,224.01 ","$1,373.18 ","$1,224.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,035.50 ","$1,628.40 ","$1,628.40 ","$1,373.18 ","$1,628.40 ","$2,062.64 ","$2,062.64 ","$2,062.64 ","$2,714.00 ", N/A ,"$2,306.90 ","$2,714.00 ","$1,764.10 ","$1,373.18 ","$2,714.00 ","$1,519.84 ","$1,373.18 ",$713.78 , N/A , N/A , N/A ,"$1,441.84 ","$2,171.20 ","$3,089.65 ","$1,224.01 ",$759.92 ,"$2,442.60 ","$1,373.18 ","$2,062.64 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,302.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000398,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP-RT,450,1 ,"$2,714.00 ","$1,764.10 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,248.44 ","$1,519.84 ","$1,373.18 ",$759.92 ,$917.33 ,"$1,373.18 ","$1,055.75 ","$1,373.18 ","$1,224.01 ","$1,224.01 ","$1,373.18 ","$1,224.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,035.50 ","$1,628.40 ","$1,628.40 ","$1,373.18 ","$1,628.40 ","$2,062.64 ","$2,062.64 ","$2,062.64 ","$2,714.00 ", N/A ,"$2,306.90 ","$2,714.00 ","$1,764.10 ","$1,373.18 ","$2,714.00 ","$1,519.84 ","$1,373.18 ",$713.78 , N/A , N/A , N/A ,"$1,441.84 ","$2,171.20 ","$3,089.65 ","$1,224.01 ",$759.92 ,"$2,442.60 ","$1,373.18 ","$2,062.64 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,302.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000403,29065,HC APPL CAST ARM LONG-LT,450,1 ,"$1,067.00 ",$693.55 ,$237.84 ,"$1,067.00 ",$594.60 ,$490.82 ,$597.52 ,$237.84 ,$298.76 ,$360.65 ,$237.84 ,$439.60 ,$237.84 ,$481.22 ,$481.22 ,$237.84 ,$481.22 ,$451.89 ,$533.50 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$800.25 ,$640.20 ,$640.20 ,$237.84 ,$640.20 ,$810.92 ,$810.92 ,$810.92 ,"$1,067.00 ", N/A ,$906.95 ,$594.59 ,$693.55 ,$237.84 ,"$1,067.00 ",$597.52 ,$237.84 ,$280.62 , N/A , N/A , N/A ,$249.73 ,$853.60 ,$535.13 ,$481.22 ,$298.76 ,$960.30 ,$237.84 ,$810.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$512.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000404,29065,HC APPL CAST ARM LONG-RT,450,1 ,"$1,067.00 ",$693.55 ,$237.84 ,"$1,067.00 ",$594.60 ,$490.82 ,$597.52 ,$237.84 ,$298.76 ,$360.65 ,$237.84 ,$439.60 ,$237.84 ,$481.22 ,$481.22 ,$237.84 ,$481.22 ,$451.89 ,$533.50 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$800.25 ,$640.20 ,$640.20 ,$237.84 ,$640.20 ,$810.92 ,$810.92 ,$810.92 ,"$1,067.00 ", N/A ,$906.95 ,$594.59 ,$693.55 ,$237.84 ,"$1,067.00 ",$597.52 ,$237.84 ,$280.62 , N/A , N/A , N/A ,$249.73 ,$853.60 ,$535.13 ,$481.22 ,$298.76 ,$960.30 ,$237.84 ,$810.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$512.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000405,29105,HC APPL SPLNT ARM LONG-LT,450,1 ,"$1,042.00 ",$677.30 ,$139.29 ,"$1,042.00 ",$348.23 ,$479.32 ,$583.52 ,$139.29 ,$291.76 ,$352.20 ,$139.29 ,$429.30 ,$139.29 ,$469.94 ,$469.94 ,$139.29 ,$469.94 ,$264.64 ,$521.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$781.50 ,$625.20 ,$625.20 ,$139.29 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$348.22 ,$677.30 ,$139.29 ,"$1,042.00 ",$583.52 ,$139.29 ,$274.05 , N/A , N/A , N/A ,$146.25 ,$833.60 ,$313.39 ,$469.94 ,$291.76 ,$937.80 ,$139.29 ,$791.92 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000406,29105,HC APPL SPLNT ARM LONG-RT,450,1 ,"$1,042.00 ",$677.30 ,$139.29 ,"$1,042.00 ",$348.23 ,$479.32 ,$583.52 ,$139.29 ,$291.76 ,$352.20 ,$139.29 ,$429.30 ,$139.29 ,$469.94 ,$469.94 ,$139.29 ,$469.94 ,$264.64 ,$521.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$781.50 ,$625.20 ,$625.20 ,$139.29 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$348.22 ,$677.30 ,$139.29 ,"$1,042.00 ",$583.52 ,$139.29 ,$274.05 , N/A , N/A , N/A ,$146.25 ,$833.60 ,$313.39 ,$469.94 ,$291.76 ,$937.80 ,$139.29 ,$791.92 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000407,29126,HC APPL SHRT ARM SPLNT DYNAM-LT,450,1 ,$482.00 ,$313.30 ,$111.17 ,$482.00 ,$277.93 ,$221.72 ,$269.92 ,$111.17 ,$134.96 ,$162.92 ,$111.17 ,$198.58 ,$111.17 ,$217.38 ,$217.38 ,$111.17 ,$217.38 ,$211.22 ,$241.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$361.50 ,$289.20 ,$289.20 ,$111.17 ,$289.20 ,$366.32 ,$366.32 ,$366.32 ,$482.00 , N/A ,$409.70 ,$277.92 ,$313.30 ,$111.17 ,$482.00 ,$269.92 ,$111.17 ,$126.77 , N/A , N/A , N/A ,$116.73 ,$385.60 ,$250.12 ,$217.38 ,$134.96 ,$433.80 ,$111.17 ,$366.32 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$231.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000408,29126,HC APPL SHRT ARM SPLNT DYNAM-RT,450,1 ,$482.00 ,$313.30 ,$111.17 ,$482.00 ,$277.93 ,$221.72 ,$269.92 ,$111.17 ,$134.96 ,$162.92 ,$111.17 ,$198.58 ,$111.17 ,$217.38 ,$217.38 ,$111.17 ,$217.38 ,$211.22 ,$241.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$361.50 ,$289.20 ,$289.20 ,$111.17 ,$289.20 ,$366.32 ,$366.32 ,$366.32 ,$482.00 , N/A ,$409.70 ,$277.92 ,$313.30 ,$111.17 ,$482.00 ,$269.92 ,$111.17 ,$126.77 , N/A , N/A , N/A ,$116.73 ,$385.60 ,$250.12 ,$217.38 ,$134.96 ,$433.80 ,$111.17 ,$366.32 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$231.36 , N/A 
ST. ELIZABETH'S HOSPITAL,45000409,29240,HC STRAPPING SHLDR-LT,450,1 ,$325.00 ,$211.25 ,$85.48 ,$325.00 ,$277.93 ,$149.50 ,$182.00 ,$111.17 ,$91.00 ,$109.85 ,$111.17 ,$133.90 ,$111.17 ,$146.58 ,$146.58 ,$111.17 ,$146.58 ,$211.22 ,$162.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$243.75 ,$195.00 ,$195.00 ,$111.17 ,$195.00 ,$247.00 ,$247.00 ,$247.00 ,$325.00 , N/A ,$276.25 ,$277.92 ,$211.25 ,$111.17 ,$325.00 ,$182.00 ,$111.17 ,$85.48 , N/A , N/A , N/A ,$116.73 ,$260.00 ,$250.12 ,$146.58 ,$91.00 ,$292.50 ,$111.17 ,$247.00 ,$325.00 ,$325.00 ,$111.17 ,$325.00 ,$156.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000410,29240,HC STRAPPING SHLDR-RT,450,1 ,$325.00 ,$211.25 ,$85.48 ,$325.00 ,$277.93 ,$149.50 ,$182.00 ,$111.17 ,$91.00 ,$109.85 ,$111.17 ,$133.90 ,$111.17 ,$146.58 ,$146.58 ,$111.17 ,$146.58 ,$211.22 ,$162.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$243.75 ,$195.00 ,$195.00 ,$111.17 ,$195.00 ,$247.00 ,$247.00 ,$247.00 ,$325.00 , N/A ,$276.25 ,$277.92 ,$211.25 ,$111.17 ,$325.00 ,$182.00 ,$111.17 ,$85.48 , N/A , N/A , N/A ,$116.73 ,$260.00 ,$250.12 ,$146.58 ,$91.00 ,$292.50 ,$111.17 ,$247.00 ,$325.00 ,$325.00 ,$111.17 ,$325.00 ,$156.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000413,29345,HC LONG LEG CAST-LT,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000414,29345,HC LONG LEG CAST-RT,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000415,29405,HC APPLY SHORT LEG CAST-LT,450,1 ,"$1,190.00 ",$773.50 ,$237.84 ,"$1,190.00 ",$594.60 ,$547.40 ,$666.40 ,$237.84 ,$333.20 ,$402.22 ,$237.84 ,$490.28 ,$237.84 ,$536.69 ,$536.69 ,$237.84 ,$536.69 ,$451.89 ,$595.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$892.50 ,$714.00 ,$714.00 ,$237.84 ,$714.00 ,$904.40 ,$904.40 ,$904.40 ,"$1,190.00 ", N/A ,"$1,011.50 ",$594.59 ,$773.50 ,$237.84 ,"$1,190.00 ",$666.40 ,$237.84 ,$312.97 , N/A , N/A , N/A ,$249.73 ,$952.00 ,$535.13 ,$536.69 ,$333.20 ,"$1,071.00 ",$237.84 ,$904.40 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$571.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000416,29405,HC APPLY SHORT LEG CAST-RT,450,1 ,"$1,190.00 ",$773.50 ,$237.84 ,"$1,190.00 ",$594.60 ,$547.40 ,$666.40 ,$237.84 ,$333.20 ,$402.22 ,$237.84 ,$490.28 ,$237.84 ,$536.69 ,$536.69 ,$237.84 ,$536.69 ,$451.89 ,$595.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$892.50 ,$714.00 ,$714.00 ,$237.84 ,$714.00 ,$904.40 ,$904.40 ,$904.40 ,"$1,190.00 ", N/A ,"$1,011.50 ",$594.59 ,$773.50 ,$237.84 ,"$1,190.00 ",$666.40 ,$237.84 ,$312.97 , N/A , N/A , N/A ,$249.73 ,$952.00 ,$535.13 ,$536.69 ,$333.20 ,"$1,071.00 ",$237.84 ,$904.40 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$571.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000417,29505,HC APPL LONG LEG SPLNT-LT,450,1 ,"$1,190.00 ",$773.50 ,$139.29 ,"$1,190.00 ",$348.23 ,$547.40 ,$666.40 ,$139.29 ,$333.20 ,$402.22 ,$139.29 ,$490.28 ,$139.29 ,$536.69 ,$536.69 ,$139.29 ,$536.69 ,$264.64 ,$595.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$892.50 ,$714.00 ,$714.00 ,$139.29 ,$714.00 ,$904.40 ,$904.40 ,$904.40 ,"$1,190.00 ", N/A ,"$1,011.50 ",$348.22 ,$773.50 ,$139.29 ,"$1,190.00 ",$666.40 ,$139.29 ,$312.97 , N/A , N/A , N/A ,$146.25 ,$952.00 ,$313.39 ,$536.69 ,$333.20 ,"$1,071.00 ",$139.29 ,$904.40 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$571.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000418,29505,HC APPL LONG LEG SPLNT-RT,450,1 ,"$1,190.00 ",$773.50 ,$139.29 ,"$1,190.00 ",$348.23 ,$547.40 ,$666.40 ,$139.29 ,$333.20 ,$402.22 ,$139.29 ,$490.28 ,$139.29 ,$536.69 ,$536.69 ,$139.29 ,$536.69 ,$264.64 ,$595.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$892.50 ,$714.00 ,$714.00 ,$139.29 ,$714.00 ,$904.40 ,$904.40 ,$904.40 ,"$1,190.00 ", N/A ,"$1,011.50 ",$348.22 ,$773.50 ,$139.29 ,"$1,190.00 ",$666.40 ,$139.29 ,$312.97 , N/A , N/A , N/A ,$146.25 ,$952.00 ,$313.39 ,$536.69 ,$333.20 ,"$1,071.00 ",$139.29 ,$904.40 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$571.20 , N/A 
ST. ELIZABETH'S HOSPITAL,45000419,29515,HC APPL SHRT LEG SPLNT FAC-LT,450,1 ,$631.00 ,$410.15 ,$139.29 ,$631.00 ,$348.23 ,$290.26 ,$353.36 ,$139.29 ,$176.68 ,$213.28 ,$139.29 ,$259.97 ,$139.29 ,$284.58 ,$284.58 ,$139.29 ,$284.58 ,$264.64 ,$315.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$473.25 ,$378.60 ,$378.60 ,$139.29 ,$378.60 ,$479.56 ,$479.56 ,$479.56 ,$631.00 , N/A ,$536.35 ,$348.22 ,$410.15 ,$139.29 ,$631.00 ,$353.36 ,$139.29 ,$165.95 , N/A , N/A , N/A ,$146.25 ,$504.80 ,$313.39 ,$284.58 ,$176.68 ,$567.90 ,$139.29 ,$479.56 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$302.88 , N/A 
ST. ELIZABETH'S HOSPITAL,45000420,29515,HC APPL SHRT LEG SPLNT FAC-RT,450,1 ,$631.00 ,$410.15 ,$139.29 ,$631.00 ,$348.23 ,$290.26 ,$353.36 ,$139.29 ,$176.68 ,$213.28 ,$139.29 ,$259.97 ,$139.29 ,$284.58 ,$284.58 ,$139.29 ,$284.58 ,$264.64 ,$315.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$473.25 ,$378.60 ,$378.60 ,$139.29 ,$378.60 ,$479.56 ,$479.56 ,$479.56 ,$631.00 , N/A ,$536.35 ,$348.22 ,$410.15 ,$139.29 ,$631.00 ,$353.36 ,$139.29 ,$165.95 , N/A , N/A , N/A ,$146.25 ,$504.80 ,$313.39 ,$284.58 ,$176.68 ,$567.90 ,$139.29 ,$479.56 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$302.88 , N/A 
ST. ELIZABETH'S HOSPITAL,45000421,29530,HC STRAPPING KNEE-LT,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$121.54 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000422,29530,HC STRAPPING KNEE-RT,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$121.54 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000423,30300,HC REMOVE NASAL FOREIGN BODY-LT,450,1 ,$817.00 ,$531.05 ,$111.17 ,$817.00 ,$277.93 ,$375.82 ,$457.52 ,$111.17 ,$228.76 ,$276.15 ,$111.17 ,$317.81 ,$111.17 ,$368.47 ,$368.47 ,$111.17 ,$368.47 ,$211.22 ,$408.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$612.75 ,$490.20 ,$490.20 ,$111.17 ,$490.20 ,$620.92 ,$620.92 ,$620.92 ,$817.00 , N/A ,$694.45 ,$277.92 ,$531.05 ,$111.17 ,$817.00 ,$457.52 ,$111.17 ,$214.87 , N/A , N/A , N/A ,$116.73 ,$653.60 ,$250.12 ,$368.47 ,$228.76 ,$735.30 ,$111.17 ,$620.92 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$392.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000424,30300,HC REMOVE NASAL FOREIGN BODY-RT,450,1 ,$817.00 ,$531.05 ,$111.17 ,$817.00 ,$277.93 ,$375.82 ,$457.52 ,$111.17 ,$228.76 ,$276.15 ,$111.17 ,$317.81 ,$111.17 ,$368.47 ,$368.47 ,$111.17 ,$368.47 ,$211.22 ,$408.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$612.75 ,$490.20 ,$490.20 ,$111.17 ,$490.20 ,$620.92 ,$620.92 ,$620.92 ,$817.00 , N/A ,$694.45 ,$277.92 ,$531.05 ,$111.17 ,$817.00 ,$457.52 ,$111.17 ,$214.87 , N/A , N/A , N/A ,$116.73 ,$653.60 ,$250.12 ,$368.47 ,$228.76 ,$735.30 ,$111.17 ,$620.92 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$392.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000425,30901,HC CNTRL NOSEBLEED ANT SMP-LT,450,1 ,$418.00 ,$271.70 ,$109.93 ,$418.00 ,$277.93 ,$192.28 ,$234.08 ,$111.17 ,$117.04 ,$141.28 ,$111.17 ,$162.60 ,$111.17 ,$188.52 ,$188.52 ,$111.17 ,$188.52 ,$211.22 ,$209.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$313.50 ,$250.80 ,$250.80 ,$111.17 ,$250.80 ,$317.68 ,$317.68 ,$317.68 ,$418.00 , N/A ,$355.30 ,$277.92 ,$271.70 ,$111.17 ,$418.00 ,$234.08 ,$111.17 ,$109.93 , N/A , N/A , N/A ,$116.73 ,$334.40 ,$250.12 ,$188.52 ,$117.04 ,$376.20 ,$111.17 ,$317.68 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$200.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000426,30901,HC CNTRL NOSEBLEED ANT SMP-RT,450,1 ,$418.00 ,$271.70 ,$109.93 ,$418.00 ,$277.93 ,$192.28 ,$234.08 ,$111.17 ,$117.04 ,$141.28 ,$111.17 ,$162.60 ,$111.17 ,$188.52 ,$188.52 ,$111.17 ,$188.52 ,$211.22 ,$209.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$313.50 ,$250.80 ,$250.80 ,$111.17 ,$250.80 ,$317.68 ,$317.68 ,$317.68 ,$418.00 , N/A ,$355.30 ,$277.92 ,$271.70 ,$111.17 ,$418.00 ,$234.08 ,$111.17 ,$109.93 , N/A , N/A , N/A ,$116.73 ,$334.40 ,$250.12 ,$188.52 ,$117.04 ,$376.20 ,$111.17 ,$317.68 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$200.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000431,32551,HC TUBE THORACOSTOMY-LT,450,1 ,"$2,462.00 ","$1,600.30 ",$400.00 ,"$3,465.89 ","$3,465.88 ","$1,132.52 ","$1,378.72 ","$1,386.35 ",$689.36 ,$832.16 ,"$1,386.35 ",$957.72 ,"$1,386.35 ","$1,110.36 ","$1,110.36 ","$1,386.35 ","$1,110.36 ","$2,462.00 ","$1,075.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$1,846.50 ","$1,477.20 ","$1,477.20 ","$1,386.35 ","$1,477.20 ","$1,871.12 ","$1,871.12 ","$1,871.12 ","$2,462.00 ", N/A ,"$2,092.70 ","$2,462.00 ","$1,600.30 ","$1,386.35 ","$2,462.00 ","$1,378.72 ","$1,386.35 ",$647.51 , N/A , N/A , N/A ,"$1,455.67 ","$1,969.60 ","$3,119.30 ","$1,110.36 ",$689.36 ,"$2,215.80 ","$1,386.35 ","$1,871.12 ",$400.00 ,$400.00 ,"$1,386.35 ",$400.00 ,"$1,181.76 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000432,32551,HC TUBE THORACOSTOMY-RT,450,1 ,"$2,462.00 ","$1,600.30 ",$400.00 ,"$3,465.89 ","$3,465.88 ","$1,132.52 ","$1,378.72 ","$1,386.35 ",$689.36 ,$832.16 ,"$1,386.35 ",$957.72 ,"$1,386.35 ","$1,110.36 ","$1,110.36 ","$1,386.35 ","$1,110.36 ","$2,462.00 ","$1,075.00 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$1,846.50 ","$1,477.20 ","$1,477.20 ","$1,386.35 ","$1,477.20 ","$1,871.12 ","$1,871.12 ","$1,871.12 ","$2,462.00 ", N/A ,"$2,092.70 ","$2,462.00 ","$1,600.30 ","$1,386.35 ","$2,462.00 ","$1,378.72 ","$1,386.35 ",$647.51 , N/A , N/A , N/A ,"$1,455.67 ","$1,969.60 ","$3,119.30 ","$1,110.36 ",$689.36 ,"$2,215.80 ","$1,386.35 ","$1,871.12 ",$400.00 ,$400.00 ,"$1,386.35 ",$400.00 ,"$1,181.76 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000439,64450,HC INJ ANES OTHER THAN PERIPHERAL-LT,450,1 ,"$2,327.00 ","$1,512.55 ",$400.00 ,"$2,327.00 ","$1,565.08 ","$1,070.42 ","$1,303.12 ",$626.03 ,$651.56 ,$786.53 ,$626.03 ,$905.20 ,$626.03 ,"$1,049.48 ","$1,049.48 ",$626.03 ,"$1,049.48 ","$1,189.46 ","$1,075.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,745.25 ","$1,396.20 ","$1,396.20 ",$626.03 ,"$1,396.20 ","$1,768.52 ","$1,768.52 ","$1,768.52 ","$2,327.00 ", N/A ,"$1,977.95 ","$1,565.07 ","$1,512.55 ",$626.03 ,"$2,327.00 ","$1,303.12 ",$626.03 ,$612.00 , N/A , N/A , N/A ,$657.33 ,"$1,861.60 ","$1,408.57 ","$1,049.48 ",$651.56 ,"$2,094.30 ",$626.03 ,"$1,768.52 ",$400.00 ,$400.00 ,$626.03 ,$400.00 ,"$1,116.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000440,64450,HC INJ ANES OTHER THAN PERIPHERAL-RT,450,1 ,"$2,327.00 ","$1,512.55 ",$400.00 ,"$2,327.00 ","$1,565.08 ","$1,070.42 ","$1,303.12 ",$626.03 ,$651.56 ,$786.53 ,$626.03 ,$905.20 ,$626.03 ,"$1,049.48 ","$1,049.48 ",$626.03 ,"$1,049.48 ","$1,189.46 ","$1,075.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,745.25 ","$1,396.20 ","$1,396.20 ",$626.03 ,"$1,396.20 ","$1,768.52 ","$1,768.52 ","$1,768.52 ","$2,327.00 ", N/A ,"$1,977.95 ","$1,565.07 ","$1,512.55 ",$626.03 ,"$2,327.00 ","$1,303.12 ",$626.03 ,$612.00 , N/A , N/A , N/A ,$657.33 ,"$1,861.60 ","$1,408.57 ","$1,049.48 ",$651.56 ,"$2,094.30 ",$626.03 ,"$1,768.52 ",$400.00 ,$400.00 ,$626.03 ,$400.00 ,"$1,116.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000453,69200,HC REM FOREIGN BODY CANAL AUD EXT-LT,450,1 ,$817.00 ,$531.05 ,$111.17 ,$817.00 ,$277.93 ,$375.82 ,$457.52 ,$111.17 ,$228.76 ,$276.15 ,$111.17 ,$317.81 ,$111.17 ,$368.47 ,$368.47 ,$111.17 ,$368.47 ,$211.22 ,$408.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$612.75 ,$490.20 ,$490.20 ,$111.17 ,$490.20 ,$620.92 ,$620.92 ,$620.92 ,$817.00 , N/A ,$694.45 ,$277.92 ,$531.05 ,$111.17 ,$817.00 ,$457.52 ,$111.17 ,$214.87 , N/A , N/A , N/A ,$116.73 ,$653.60 ,$250.12 ,$368.47 ,$228.76 ,$735.30 ,$111.17 ,$620.92 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$392.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000454,69200,HC REM FOREIGN BODY CANAL AUD EXT-RT,450,1 ,$817.00 ,$531.05 ,$111.17 ,$817.00 ,$277.93 ,$375.82 ,$457.52 ,$111.17 ,$228.76 ,$276.15 ,$111.17 ,$317.81 ,$111.17 ,$368.47 ,$368.47 ,$111.17 ,$368.47 ,$211.22 ,$408.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$612.75 ,$490.20 ,$490.20 ,$111.17 ,$490.20 ,$620.92 ,$620.92 ,$620.92 ,$817.00 , N/A ,$694.45 ,$277.92 ,$531.05 ,$111.17 ,$817.00 ,$457.52 ,$111.17 ,$214.87 , N/A , N/A , N/A ,$116.73 ,$653.60 ,$250.12 ,$368.47 ,$228.76 ,$735.30 ,$111.17 ,$620.92 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$392.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000455,69210,HC REMOVE CERUMEN IMPACTED W/INSTRUMENT-LT,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$114.76 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000456,69210,HC REMOVE CERUMEN IMPACTED W/INSTRUMENT-RT,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$114.76 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000457,29365,HC APPL CAST CYCLINDER THIGH TO ANKLE,450,1 ,"$1,126.00 ",$731.90 ,$237.84 ,"$1,126.00 ",$594.60 ,$517.96 ,$630.56 ,$237.84 ,$315.28 ,$380.59 ,$237.84 ,$463.91 ,$237.84 ,$507.83 ,$507.83 ,$237.84 ,$507.83 ,$451.89 ,$563.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$844.50 ,$675.60 ,$675.60 ,$237.84 ,$675.60 ,$855.76 ,$855.76 ,$855.76 ,"$1,126.00 ", N/A ,$957.10 ,$594.59 ,$731.90 ,$237.84 ,"$1,126.00 ",$630.56 ,$237.84 ,$296.14 , N/A , N/A , N/A ,$249.73 ,$900.80 ,$535.13 ,$507.83 ,$315.28 ,"$1,013.40 ",$237.84 ,$855.76 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$540.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000458,29131,HC APPL FINGER SPLINT DYNAMIC-LT,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$121.54 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000459,29131,HC APPL FINGER SPLINT DYNAMIC-RT,450,1 ,$295.00 ,$191.75 ,$54.88 ,$295.00 ,$137.20 ,$135.70 ,$165.20 ,$54.88 ,$82.60 ,$99.71 ,$54.88 ,$121.54 ,$54.88 ,$133.05 ,$133.05 ,$54.88 ,$133.05 ,$104.27 ,$147.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$221.25 ,$177.00 ,$177.00 ,$54.88 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$137.20 ,$191.75 ,$54.88 ,$295.00 ,$165.20 ,$54.88 ,$77.59 , N/A , N/A , N/A ,$57.62 ,$236.00 ,$123.48 ,$133.05 ,$82.60 ,$265.50 ,$54.88 ,$224.20 ,$295.00 ,$295.00 ,$54.88 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000460,29130,HC APPL SPLNT FINGER STATIC - LT,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$121.54 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000461,29130,HC APPL SPLNT FINGER STATIC - RT,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$121.54 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000462,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ULTRA -LT,450,1 ,"$1,045.00 ",$679.25 ,$257.58 ,"$1,045.00 ",$643.95 ,$480.70 ,$585.20 ,$257.58 ,$292.60 ,$353.21 ,$257.58 ,$406.51 ,$257.58 ,$471.30 ,$471.30 ,$257.58 ,$471.30 ,$489.39 ,$522.50 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$783.75 ,$627.00 ,$627.00 ,$257.58 ,$627.00 ,$794.20 ,$794.20 ,$794.20 ,"$1,045.00 ", N/A ,$888.25 ,$643.94 ,$679.25 ,$257.58 ,"$1,045.00 ",$585.20 ,$257.58 ,$274.84 , N/A , N/A , N/A ,$270.46 ,$836.00 ,$579.55 ,$471.30 ,$292.60 ,$940.50 ,$257.58 ,$794.20 ,$400.00 ,$400.00 ,$257.58 ,$400.00 ,$501.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000463,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ULTRA -RT,450,1 ,"$1,045.00 ",$679.25 ,$257.58 ,"$1,045.00 ",$643.95 ,$480.70 ,$585.20 ,$257.58 ,$292.60 ,$353.21 ,$257.58 ,$406.51 ,$257.58 ,$471.30 ,$471.30 ,$257.58 ,$471.30 ,$489.39 ,$522.50 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$783.75 ,$627.00 ,$627.00 ,$257.58 ,$627.00 ,$794.20 ,$794.20 ,$794.20 ,"$1,045.00 ", N/A ,$888.25 ,$643.94 ,$679.25 ,$257.58 ,"$1,045.00 ",$585.20 ,$257.58 ,$274.84 , N/A , N/A , N/A ,$270.46 ,$836.00 ,$579.55 ,$471.30 ,$292.60 ,$940.50 ,$257.58 ,$794.20 ,$400.00 ,$400.00 ,$257.58 ,$400.00 ,$501.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000464,30901,HC CNTRL NOSEBLEED ANT SMP- BIL,450,1 ,"$1,114.00 ",$724.10 ,$111.17 ,"$1,114.00 ",$277.93 ,$512.44 ,$623.84 ,$111.17 ,$311.92 ,$376.53 ,$111.17 ,$433.35 ,$111.17 ,$502.41 ,$502.41 ,$111.17 ,$502.41 ,$211.22 ,$557.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$835.50 ,$668.40 ,$668.40 ,$111.17 ,$668.40 ,$846.64 ,$846.64 ,$846.64 ,"$1,114.00 ", N/A ,$946.90 ,$277.92 ,$724.10 ,$111.17 ,"$1,114.00 ",$623.84 ,$111.17 ,$292.98 , N/A , N/A , N/A ,$116.73 ,$891.20 ,$250.12 ,$502.41 ,$311.92 ,"$1,002.60 ",$111.17 ,$846.64 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$534.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45000465,53620,HC DILAT URETHRAL STRICTURE FILFORM INIT,450,1 ,"$2,762.00 ","$1,795.30 ",$400.00 ,"$2,762.00 ","$1,417.95 ","$1,270.52 ","$1,546.72 ",$567.18 ,$773.36 ,$933.56 ,$567.18 ,"$1,074.42 ",$567.18 ,"$1,245.66 ","$1,245.66 ",$567.18 ,"$1,245.66 ","$1,077.65 ","$1,075.00 ","$1,417.96 ",$567.18 ,$567.18 ,$578.53 ,"$2,071.50 ","$1,657.20 ","$1,657.20 ",$567.18 ,"$1,657.20 ","$2,099.12 ","$2,099.12 ","$2,099.12 ","$2,762.00 ", N/A ,"$2,347.70 ","$1,417.96 ","$1,795.30 ",$567.18 ,"$2,762.00 ","$1,546.72 ",$567.18 ,$726.41 , N/A , N/A , N/A ,$595.54 ,"$2,209.60 ","$1,276.16 ","$1,245.66 ",$773.36 ,"$2,485.80 ",$567.18 ,"$2,099.12 ",$400.00 ,$400.00 ,$567.18 ,$400.00 ,"$1,325.76 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000467,27842,HC CLOSED TX ANKLE DISLOC W/ANESTH W/W/O FIXATION,450,1 ,"$5,790.00 ","$3,763.50 ",$400.00 ,"$5,790.00 ","$3,432.95 ","$2,000.00 ","$3,242.40 ","$1,373.18 ","$1,621.20 ","$1,957.02 ","$1,373.18 ","$2,252.31 ","$1,373.18 ","$2,611.29 ","$2,611.29 ","$1,373.18 ","$2,611.29 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,342.50 ","$3,474.00 ","$3,474.00 ","$1,373.18 ","$3,474.00 ","$4,400.40 ","$4,400.40 ","$4,400.40 ","$5,790.00 ", N/A ,"$4,921.50 ","$3,432.94 ","$3,763.50 ","$1,373.18 ","$5,790.00 ","$3,242.40 ","$1,373.18 ","$1,522.77 ", N/A , N/A , N/A ,"$1,441.84 ","$4,632.00 ","$3,089.65 ","$2,611.29 ","$1,621.20 ","$5,211.00 ","$1,373.18 ","$4,400.40 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,779.20 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000468,23525,HC CLOSED TX STERN-CLAV DISLOC W/MANIP,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000469,26010,HC DRAIN ABSC FINGER SIMPLE-F1,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000470,26010,HC DRAIN ABSC FINGER SIMPLE-F2,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000471,26010,HC DRAIN ABSC FINGER SIMPLE-F3,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000472,26010,HC DRAIN ABSC FINGER SIMPLE-F4,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000473,26010,HC DRAIN ABSC FINGER SIMPLE-F5,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000474,26010,HC DRAIN ABSC FINGER SIMPLE-F6,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000475,26010,HC DRAIN ABSC FINGER SIMPLE-F7,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000476,26010,HC DRAIN ABSC FINGER SIMPLE-F8,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000477,26010,HC DRAIN ABSC FINGER SIMPLE-F9,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000478,26010,HC DRAIN ABSC FINGER SIMPLE-FA,450,1 ,$913.00 ,$593.45 ,$177.04 ,$913.00 ,$442.60 ,$419.98 ,$511.28 ,$177.04 ,$255.64 ,$308.59 ,$177.04 ,$355.16 ,$177.04 ,$411.76 ,$411.76 ,$177.04 ,$411.76 ,$336.38 ,$456.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$684.75 ,$547.80 ,$547.80 ,$177.04 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$442.60 ,$593.45 ,$177.04 ,$913.00 ,$511.28 ,$177.04 ,$240.12 , N/A , N/A , N/A ,$185.89 ,$730.40 ,$398.34 ,$411.76 ,$255.64 ,$821.70 ,$177.04 ,$693.88 ,$400.00 ,$400.00 ,$177.04 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000479,11740,HC EVAC HEMATOMA SUBUNGAL-F1,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000480,11740,HC EVAC HEMATOMA SUBUNGAL-F2,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000481,11740,HC EVAC HEMATOMA SUBUNGAL-F3,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000482,11740,HC EVAC HEMATOMA SUBUNGAL-F4,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000483,11740,HC EVAC HEMATOMA SUBUNGAL-F5,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000484,11740,HC EVAC HEMATOMA SUBUNGAL-F6,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000485,11740,HC EVAC HEMATOMA SUBUNGAL-F7,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000486,11740,HC EVAC HEMATOMA SUBUNGAL-F8,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000487,11740,HC EVAC HEMATOMA SUBUNGAL-F9,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000488,11740,HC EVAC HEMATOMA SUBUNGAL-FA,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000489,11740,HC EVAC HEMATOMA SUBUNGAL-T5,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000490,11740,HC EVAC HEMATOMA SUBUNGAL-TA,450,1 ,$295.00 ,$191.75 ,$77.59 ,$295.00 ,$277.93 ,$135.70 ,$165.20 ,$111.17 ,$82.60 ,$99.71 ,$111.17 ,$114.76 ,$111.17 ,$133.05 ,$133.05 ,$111.17 ,$133.05 ,$211.22 ,$147.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$221.25 ,$177.00 ,$177.00 ,$111.17 ,$177.00 ,$224.20 ,$224.20 ,$224.20 ,$295.00 , N/A ,$250.75 ,$277.92 ,$191.75 ,$111.17 ,$295.00 ,$165.20 ,$111.17 ,$77.59 , N/A , N/A , N/A ,$116.73 ,$236.00 ,$250.12 ,$133.05 ,$82.60 ,$265.50 ,$111.17 ,$224.20 ,$295.00 ,$295.00 ,$111.17 ,$295.00 ,$141.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45000491,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED -LT,450,1 ,"$3,401.00 ","$2,210.65 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,564.46 ","$1,904.56 ","$1,373.18 ",$952.28 ,"$1,149.54 ","$1,373.18 ","$1,322.99 ","$1,373.18 ","$1,533.85 ","$1,533.85 ","$1,373.18 ","$1,533.85 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,550.75 ","$2,040.60 ","$2,040.60 ","$1,373.18 ","$2,040.60 ","$2,584.76 ","$2,584.76 ","$2,584.76 ","$3,401.00 ", N/A ,"$2,890.85 ","$3,401.00 ","$2,210.65 ","$1,373.18 ","$3,401.00 ","$1,904.56 ","$1,373.18 ",$894.46 , N/A , N/A , N/A ,"$1,441.84 ","$2,720.80 ","$3,089.65 ","$1,533.85 ",$952.28 ,"$3,060.90 ","$1,373.18 ","$2,584.76 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,632.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000492,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED -RT,450,1 ,"$3,401.00 ","$2,210.65 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,564.46 ","$1,904.56 ","$1,373.18 ",$952.28 ,"$1,149.54 ","$1,373.18 ","$1,322.99 ","$1,373.18 ","$1,533.85 ","$1,533.85 ","$1,373.18 ","$1,533.85 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,550.75 ","$2,040.60 ","$2,040.60 ","$1,373.18 ","$2,040.60 ","$2,584.76 ","$2,584.76 ","$2,584.76 ","$3,401.00 ", N/A ,"$2,890.85 ","$3,401.00 ","$2,210.65 ","$1,373.18 ","$3,401.00 ","$1,904.56 ","$1,373.18 ",$894.46 , N/A , N/A , N/A ,"$1,441.84 ","$2,720.80 ","$3,089.65 ","$1,533.85 ",$952.28 ,"$3,060.90 ","$1,373.18 ","$2,584.76 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,632.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000493,36600,HC ARTERIAL PUNCTURE,450,1 ,$375.00 ,$243.75 ,$98.63 ,$375.00 ,$277.93 ,$172.50 ,$210.00 ,$111.17 ,$105.00 ,$126.75 ,$111.17 ,$145.88 ,$111.17 ,$169.13 ,$169.13 ,$111.17 ,$169.13 ,$211.22 ,$187.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$281.25 ,$225.00 ,$225.00 ,$111.17 ,$225.00 ,$285.00 ,$285.00 ,$285.00 ,$375.00 , N/A ,$318.75 ,$277.92 ,$243.75 ,$111.17 ,$375.00 ,$210.00 ,$111.17 ,$98.63 , N/A , N/A , N/A ,$116.73 ,$300.00 ,$250.12 ,$169.13 ,$105.00 ,$337.50 ,$111.17 ,$285.00 ,$375.00 ,$375.00 ,$111.17 ,$375.00 ,$180.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000494,67938,HC REMOVE EMBEDDED FB EYELID-BI,450,1 ,"$1,876.00 ","$1,219.40 ",$386.84 ,"$1,876.00 ",$967.10 ,$862.96 ,"$1,050.56 ",$386.84 ,$525.28 ,$634.09 ,$386.84 ,$729.76 ,$386.84 ,$846.08 ,$846.08 ,$386.84 ,$846.08 ,$735.00 ,$938.00 ,$967.11 ,$386.84 ,$386.84 ,$394.58 ,"$1,407.00 ","$1,125.60 ","$1,125.60 ",$386.84 ,"$1,125.60 ","$1,425.76 ","$1,425.76 ","$1,425.76 ","$1,876.00 ", N/A ,"$1,594.60 ",$967.11 ,"$1,219.40 ",$386.84 ,"$1,876.00 ","$1,050.56 ",$386.84 ,$493.39 , N/A , N/A , N/A ,$406.18 ,"$1,500.80 ",$870.40 ,$846.08 ,$525.28 ,"$1,688.40 ",$386.84 ,"$1,425.76 ",$400.00 ,$400.00 ,$386.84 ,$400.00 ,$900.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000495,67938,HC REMOVE EMBEDDED FB EYELID-LT,450,1 ,"$1,251.00 ",$813.15 ,$257.89 ,"$1,251.00 ",$644.73 ,$575.46 ,$700.56 ,$257.89 ,$350.28 ,$422.84 ,$257.89 ,$486.64 ,$257.89 ,$564.20 ,$564.20 ,$257.89 ,$564.20 ,$490.00 ,$625.50 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$938.25 ,$750.60 ,$750.60 ,$257.89 ,$750.60 ,$950.76 ,$950.76 ,$950.76 ,"$1,251.00 ", N/A ,"$1,063.35 ",$644.74 ,$813.15 ,$257.89 ,"$1,251.00 ",$700.56 ,$257.89 ,$329.01 , N/A , N/A , N/A ,$270.78 ,"$1,000.80 ",$580.26 ,$564.20 ,$350.28 ,"$1,125.90 ",$257.89 ,$950.76 ,$400.00 ,$400.00 ,$257.89 ,$400.00 ,$600.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000496,67938,HC REMOVE EMBEDDED FB EYELID-RT,450,1 ,"$1,251.00 ",$813.15 ,$257.89 ,"$1,251.00 ",$644.73 ,$575.46 ,$700.56 ,$257.89 ,$350.28 ,$422.84 ,$257.89 ,$486.64 ,$257.89 ,$564.20 ,$564.20 ,$257.89 ,$564.20 ,$490.00 ,$625.50 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$938.25 ,$750.60 ,$750.60 ,$257.89 ,$750.60 ,$950.76 ,$950.76 ,$950.76 ,"$1,251.00 ", N/A ,"$1,063.35 ",$644.74 ,$813.15 ,$257.89 ,"$1,251.00 ",$700.56 ,$257.89 ,$329.01 , N/A , N/A , N/A ,$270.78 ,"$1,000.80 ",$580.26 ,$564.20 ,$350.28 ,"$1,125.90 ",$257.89 ,$950.76 ,$400.00 ,$400.00 ,$257.89 ,$400.00 ,$600.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000497,27086,HC REMOVE FB PELVIS/HIP SUBQ TISSUE,450,1 ,"$4,160.00 ","$2,704.00 ",$400.00 ,"$5,843.93 ","$5,843.93 ","$1,913.60 ","$2,329.60 ","$2,337.57 ","$1,164.80 ","$1,406.08 ","$2,337.57 ","$1,618.24 ","$2,337.57 ","$1,876.16 ","$1,876.16 ","$2,337.57 ","$1,876.16 ","$4,160.00 ","$1,075.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$3,120.00 ","$2,496.00 ","$2,496.00 ","$2,337.57 ","$2,496.00 ","$3,161.60 ","$3,161.60 ","$3,161.60 ","$4,160.00 ", N/A ,"$3,536.00 ","$4,160.00 ","$2,704.00 ","$2,337.57 ","$4,160.00 ","$2,329.60 ","$2,337.57 ","$1,094.08 ", N/A , N/A , N/A ,"$2,454.45 ","$3,328.00 ","$5,259.53 ","$1,876.16 ","$1,164.80 ","$3,744.00 ","$2,337.57 ","$3,161.60 ",$400.00 ,$400.00 ,"$2,337.57 ",$400.00 ,"$1,996.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000498,69210,HC REMOVE CERUMEN IMPACTED W/INSTRUMENT-BIL,450,1 ,$442.00 ,$287.30 ,$54.88 ,$442.00 ,$137.20 ,$203.32 ,$247.52 ,$54.88 ,$123.76 ,$149.40 ,$54.88 ,$171.94 ,$54.88 ,$199.34 ,$199.34 ,$54.88 ,$199.34 ,$104.27 ,$221.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$331.50 ,$265.20 ,$265.20 ,$54.88 ,$265.20 ,$335.92 ,$335.92 ,$335.92 ,$442.00 , N/A ,$375.70 ,$137.20 ,$287.30 ,$54.88 ,$442.00 ,$247.52 ,$54.88 ,$116.25 , N/A , N/A , N/A ,$57.62 ,$353.60 ,$123.48 ,$199.34 ,$123.76 ,$397.80 ,$54.88 ,$335.92 ,$400.00 ,$400.00 ,$54.88 ,$400.00 ,$212.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000499,26540,HC REPAIR LIGAMENT META/INTER PHAL JOINT,450,1 ,"$6,181.00 ","$4,017.65 ",$400.00 ,"$6,979.95 ","$6,979.95 ","$2,000.00 ","$3,461.36 ","$2,791.98 ","$1,730.68 ","$2,089.18 ","$2,791.98 ","$2,404.41 ","$2,791.98 ","$2,787.63 ","$2,787.63 ","$2,791.98 ","$2,787.63 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$4,635.75 ","$3,708.60 ","$3,708.60 ","$2,791.98 ","$3,708.60 ","$4,697.56 ","$4,697.56 ","$4,697.56 ","$6,181.00 ", N/A ,"$5,253.85 ","$6,181.00 ","$4,017.65 ","$2,791.98 ","$6,181.00 ","$3,461.36 ","$2,791.98 ","$1,625.60 ", N/A , N/A , N/A ,"$2,931.58 ","$4,944.80 ","$6,281.95 ","$2,787.63 ","$1,730.68 ","$5,562.90 ","$2,791.98 ","$4,697.56 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$2,966.88 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000500,57200,HC REPAIR SUTURE VAGINA COLPORRHAPHY,450,1 ,"$6,089.00 ","$3,957.85 ",$400.00 ,"$6,466.58 ","$6,466.58 ","$2,000.00 ","$3,409.84 ","$2,586.63 ","$1,704.92 ","$2,058.08 ","$2,586.63 ","$2,368.62 ","$2,586.63 ","$2,746.14 ","$2,746.14 ","$2,586.63 ","$2,746.14 ","$4,914.60 ","$1,075.00 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$4,566.75 ","$3,653.40 ","$3,653.40 ","$2,586.63 ","$3,653.40 ","$4,627.64 ","$4,627.64 ","$4,627.64 ","$6,089.00 ", N/A ,"$5,175.65 ","$6,089.00 ","$3,957.85 ","$2,586.63 ","$6,089.00 ","$3,409.84 ","$2,586.63 ","$1,601.41 ", N/A , N/A , N/A ,"$2,715.96 ","$4,871.20 ","$5,819.92 ","$2,746.14 ","$1,704.92 ","$5,480.10 ","$2,586.63 ","$4,627.64 ",$400.00 ,$400.00 ,"$2,586.63 ",$400.00 ,"$2,922.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000501,28208,HC REPAIR TENDON EXTENSOR FOOT-LT,450,1 ,"$8,302.00 ","$5,396.30 ",$400.00 ,"$8,302.00 ","$6,979.95 ","$2,000.00 ","$4,649.12 ","$2,791.98 ","$2,324.56 ","$2,282.50 ","$2,791.98 ","$3,229.48 ","$2,791.98 ","$3,744.20 ","$3,744.20 ","$2,791.98 ","$3,744.20 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$6,226.50 ","$4,981.20 ","$4,981.20 ","$2,791.98 ","$4,981.20 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,302.00 ", N/A ,"$7,056.70 ","$6,979.94 ","$5,396.30 ","$2,791.98 ","$8,302.00 ","$4,649.12 ","$2,791.98 ","$2,183.43 ", N/A , N/A , N/A ,"$2,931.58 ","$6,641.60 ","$6,281.95 ","$3,744.20 ","$2,324.56 ","$7,471.80 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,984.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000502,28208,HC REPAIR TENDON EXTENSOR FOOT-RT,450,1 ,"$8,302.00 ","$5,396.30 ",$400.00 ,"$8,302.00 ","$6,979.95 ","$2,000.00 ","$4,649.12 ","$2,791.98 ","$2,324.56 ","$2,282.50 ","$2,791.98 ","$3,229.48 ","$2,791.98 ","$3,744.20 ","$3,744.20 ","$2,791.98 ","$3,744.20 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$6,226.50 ","$4,981.20 ","$4,981.20 ","$2,791.98 ","$4,981.20 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,302.00 ", N/A ,"$7,056.70 ","$6,979.94 ","$5,396.30 ","$2,791.98 ","$8,302.00 ","$4,649.12 ","$2,791.98 ","$2,183.43 ", N/A , N/A , N/A ,"$2,931.58 ","$6,641.60 ","$6,281.95 ","$3,744.20 ","$2,324.56 ","$7,471.80 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,984.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000503,29550,HC STRAPPING TOES-T1,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000504,29550,HC STRAPPING TOES-T2,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000505,29550,HC STRAPPING TOES-T3,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000506,29550,HC STRAPPING TOES-T4,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000507,29550,HC STRAPPING TOES-T5,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000508,29550,HC STRAPPING TOES-T6,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000509,29550,HC STRAPPING TOES-T7,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000510,29550,HC STRAPPING TOES-T8,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000511,29550,HC STRAPPING TOES-T9,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000512,29550,HC STRAPPING TOES-TA,450,1 ,$263.00 ,$170.95 ,$54.88 ,$263.00 ,$137.20 ,$120.98 ,$147.28 ,$54.88 ,$73.64 ,$88.89 ,$54.88 ,$108.36 ,$54.88 ,$118.61 ,$118.61 ,$54.88 ,$118.61 ,$104.27 ,$131.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$197.25 ,$157.80 ,$157.80 ,$54.88 ,$157.80 ,$199.88 ,$199.88 ,$199.88 ,$263.00 , N/A ,$223.55 ,$137.20 ,$170.95 ,$54.88 ,$263.00 ,$147.28 ,$54.88 ,$69.17 , N/A , N/A , N/A ,$57.62 ,$210.40 ,$123.48 ,$118.61 ,$73.64 ,$236.70 ,$54.88 ,$199.88 ,$263.00 ,$263.00 ,$54.88 ,$263.00 ,$126.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000513,29580,HC APPLY UNNA BOOT-LT,450,1 ,$644.00 ,$418.60 ,$139.29 ,$644.00 ,$348.23 ,$296.24 ,$360.64 ,$139.29 ,$180.32 ,$217.67 ,$139.29 ,$265.33 ,$139.29 ,$290.44 ,$290.44 ,$139.29 ,$290.44 ,$264.64 ,$322.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$483.00 ,$386.40 ,$386.40 ,$139.29 ,$386.40 ,$489.44 ,$489.44 ,$489.44 ,$644.00 , N/A ,$547.40 ,$348.22 ,$418.60 ,$139.29 ,$644.00 ,$360.64 ,$139.29 ,$169.37 , N/A , N/A , N/A ,$146.25 ,$515.20 ,$313.39 ,$290.44 ,$180.32 ,$579.60 ,$139.29 ,$489.44 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$309.12 , N/A 
ST. ELIZABETH'S HOSPITAL,45000514,29580,HC APPLY UNNA BOOT-RT,450,1 ,$644.00 ,$418.60 ,$139.29 ,$644.00 ,$348.23 ,$296.24 ,$360.64 ,$139.29 ,$180.32 ,$217.67 ,$139.29 ,$265.33 ,$139.29 ,$290.44 ,$290.44 ,$139.29 ,$290.44 ,$264.64 ,$322.00 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$483.00 ,$386.40 ,$386.40 ,$139.29 ,$386.40 ,$489.44 ,$489.44 ,$489.44 ,$644.00 , N/A ,$547.40 ,$348.22 ,$418.60 ,$139.29 ,$644.00 ,$360.64 ,$139.29 ,$169.37 , N/A , N/A , N/A ,$146.25 ,$515.20 ,$313.39 ,$290.44 ,$180.32 ,$579.60 ,$139.29 ,$489.44 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$309.12 , N/A 
ST. ELIZABETH'S HOSPITAL,45000515,32551,HC TUBE THORACOSTOMY-BIL,450,1 ,"$3,694.00 ","$2,401.10 ",$400.00 ,"$7,055.60 ","$7,055.60 ","$1,699.24 ","$2,068.64 ","$2,822.24 ","$1,034.32 ","$1,248.57 ","$2,822.24 ","$1,436.97 ","$2,822.24 ","$1,665.99 ","$1,665.99 ","$2,822.24 ","$1,665.99 ","$3,694.00 ","$1,075.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$2,770.50 ","$2,216.40 ","$2,216.40 ","$2,822.24 ","$2,216.40 ","$2,807.44 ","$2,807.44 ","$2,807.44 ","$3,694.00 ", N/A ,"$3,139.90 ","$3,694.00 ","$2,401.10 ","$2,822.24 ","$3,694.00 ","$2,068.64 ","$2,822.24 ",$971.52 , N/A , N/A , N/A ,"$2,963.35 ","$2,955.20 ","$6,350.04 ","$1,665.99 ","$1,034.32 ","$3,324.60 ","$2,822.24 ","$2,807.44 ",$400.00 ,$400.00 ,"$2,822.24 ",$400.00 ,"$1,773.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000516,26775,HC TX DISLOC I-P JOINT W/ANES/MAN,450,1 ,"$1,124.00 ",$730.60 ,$237.84 ,"$1,124.00 ",$594.60 ,$517.04 ,$629.44 ,$237.84 ,$314.72 ,$379.91 ,$237.84 ,$437.24 ,$237.84 ,$506.92 ,$506.92 ,$237.84 ,$506.92 ,$451.89 ,$562.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$843.00 ,$674.40 ,$674.40 ,$237.84 ,$674.40 ,$854.24 ,$854.24 ,$854.24 ,"$1,124.00 ", N/A ,$955.40 ,$594.59 ,$730.60 ,$237.84 ,"$1,124.00 ",$629.44 ,$237.84 ,$295.61 , N/A , N/A , N/A ,$249.73 ,$899.20 ,$535.13 ,$506.92 ,$314.72 ,"$1,011.60 ",$237.84 ,$854.24 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$539.52 , N/A 
ST. ELIZABETH'S HOSPITAL,45000517,24640,HC DISLOCATION NURSEMAID ELBOW-BIL,450,1 ,"$1,855.00 ","$1,205.75 ",$304.80 ,"$1,855.00 ",$762.00 ,$853.30 ,"$1,038.80 ",$304.80 ,$519.40 ,$626.99 ,$304.80 ,$721.60 ,$304.80 ,$836.61 ,$836.61 ,$304.80 ,$836.61 ,$579.12 ,$927.50 ,$762.00 ,$304.80 ,$304.80 ,$310.90 ,"$1,391.25 ","$1,113.00 ","$1,113.00 ",$304.80 ,"$1,113.00 ","$1,409.80 ","$1,409.80 ","$1,409.80 ","$1,855.00 ", N/A ,"$1,576.75 ",$762.00 ,"$1,205.75 ",$304.80 ,"$1,855.00 ","$1,038.80 ",$304.80 ,$487.87 , N/A , N/A , N/A ,$320.04 ,"$1,484.00 ",$685.80 ,$836.61 ,$519.40 ,"$1,669.50 ",$304.80 ,"$1,409.80 ",$400.00 ,$400.00 ,$304.80 ,$400.00 ,$890.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000518,27200,HC TX FX COCCYGEAL CLOSED,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000519,27502,HC TX FX FEMUR W/MAN W/W/O TRACTION-LT,450,1 ,"$4,095.00 ","$2,661.75 ",$400.00 ,"$4,095.00 ","$3,432.95 ","$1,883.70 ","$2,293.20 ","$1,373.18 ","$1,146.60 ","$1,384.11 ","$1,373.18 ","$1,592.96 ","$1,373.18 ","$1,846.85 ","$1,846.85 ","$1,373.18 ","$1,846.85 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,071.25 ","$2,457.00 ","$2,457.00 ","$1,373.18 ","$2,457.00 ","$3,112.20 ","$3,112.20 ","$3,112.20 ","$4,095.00 ", N/A ,"$3,480.75 ","$3,432.94 ","$2,661.75 ","$1,373.18 ","$4,095.00 ","$2,293.20 ","$1,373.18 ","$1,076.99 ", N/A , N/A , N/A ,"$1,441.84 ","$3,276.00 ","$3,089.65 ","$1,846.85 ","$1,146.60 ","$3,685.50 ","$1,373.18 ","$3,112.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,965.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000520,27502,HC TX FX FEMUR W/MAN W/W/O TRACTION-RT,450,1 ,"$4,095.00 ","$2,661.75 ",$400.00 ,"$4,095.00 ","$3,432.95 ","$1,883.70 ","$2,293.20 ","$1,373.18 ","$1,146.60 ","$1,384.11 ","$1,373.18 ","$1,592.96 ","$1,373.18 ","$1,846.85 ","$1,846.85 ","$1,373.18 ","$1,846.85 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,071.25 ","$2,457.00 ","$2,457.00 ","$1,373.18 ","$2,457.00 ","$3,112.20 ","$3,112.20 ","$3,112.20 ","$4,095.00 ", N/A ,"$3,480.75 ","$3,432.94 ","$2,661.75 ","$1,373.18 ","$4,095.00 ","$2,293.20 ","$1,373.18 ","$1,076.99 ", N/A , N/A , N/A ,"$1,441.84 ","$3,276.00 ","$3,089.65 ","$1,846.85 ","$1,146.60 ","$3,685.50 ","$1,373.18 ","$3,112.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,965.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000521,28405,HC TX FX CALCANEAL W/MANIP -LT,450,1 ,"$3,396.00 ","$2,207.40 ",$203.20 ,"$3,396.00 ",$508.00 ,"$1,562.16 ","$1,901.76 ",$203.20 ,$950.88 ,"$1,147.85 ",$203.20 ,"$1,321.04 ",$203.20 ,"$1,531.60 ","$1,531.60 ",$203.20 ,"$1,531.60 ",$386.08 ,"$1,075.00 ",$508.00 ,$203.20 ,$203.20 ,$207.26 ,"$2,547.00 ","$2,037.60 ","$2,037.60 ",$203.20 ,"$2,037.60 ","$2,580.96 ","$2,580.96 ","$2,580.96 ","$3,396.00 ", N/A ,"$2,886.60 ",$508.00 ,"$2,207.40 ",$203.20 ,"$3,396.00 ","$1,901.76 ",$203.20 ,$893.15 , N/A , N/A , N/A ,$213.36 ,"$2,716.80 ",$457.20 ,"$1,531.60 ",$950.88 ,"$3,056.40 ",$203.20 ,"$2,580.96 ",$400.00 ,$400.00 ,$203.20 ,$400.00 ,"$1,630.08 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000522,28405,HC TX FX CALCANEAL W/MANIP -RT,450,1 ,"$3,396.00 ","$2,207.40 ",$203.20 ,"$3,396.00 ",$508.00 ,"$1,562.16 ","$1,901.76 ",$203.20 ,$950.88 ,"$1,147.85 ",$203.20 ,"$1,321.04 ",$203.20 ,"$1,531.60 ","$1,531.60 ",$203.20 ,"$1,531.60 ",$386.08 ,"$1,075.00 ",$508.00 ,$203.20 ,$203.20 ,$207.26 ,"$2,547.00 ","$2,037.60 ","$2,037.60 ",$203.20 ,"$2,037.60 ","$2,580.96 ","$2,580.96 ","$2,580.96 ","$3,396.00 ", N/A ,"$2,886.60 ",$508.00 ,"$2,207.40 ",$203.20 ,"$3,396.00 ","$1,901.76 ",$203.20 ,$893.15 , N/A , N/A , N/A ,$213.36 ,"$2,716.80 ",$457.20 ,"$1,531.60 ",$950.88 ,"$3,056.40 ",$203.20 ,"$2,580.96 ",$400.00 ,$400.00 ,$203.20 ,$400.00 ,"$1,630.08 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000523,26746,HC TX FX FINGER W/FIXATION OPEN,450,1 ,"$10,279.00 ","$6,681.35 ",$400.00 ,"$10,279.00 ","$6,979.95 ","$2,000.00 ","$5,756.24 ","$2,791.98 ","$2,878.12 ","$2,282.50 ","$2,791.98 ","$3,998.53 ","$2,791.98 ","$4,635.83 ","$4,635.83 ","$2,791.98 ","$4,635.83 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$7,709.25 ","$6,167.40 ","$6,167.40 ","$2,791.98 ","$6,167.40 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$10,279.00 ", N/A ,"$8,737.15 ","$6,979.94 ","$6,681.35 ","$2,791.98 ","$10,279.00 ","$5,756.24 ","$2,791.98 ","$2,703.38 ", N/A , N/A , N/A ,"$2,931.58 ","$8,223.20 ","$6,281.95 ","$4,635.83 ","$2,878.12 ","$9,251.10 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$4,933.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000524,26740,HC TX FX FINGER W/O MANIP CLOSED,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000525,24576,HC TX FX HUMERUS CONDYLAR W/O MANIP CLOSED,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000526,23600,HC TX FX HUMERUS PROXIMAL W/O MANIP CLOSED,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000527,24500,HC TX FX HUMERUS SHAFT W/O MANIP CLOSED-LT,450,1 ,"$1,184.00 ",$769.60 ,$203.20 ,"$1,184.00 ",$508.00 ,$544.64 ,$663.04 ,$203.20 ,$331.52 ,$400.19 ,$203.20 ,$460.58 ,$203.20 ,$533.98 ,$533.98 ,$203.20 ,$533.98 ,$386.08 ,$592.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$888.00 ,$710.40 ,$710.40 ,$203.20 ,$710.40 ,$899.84 ,$899.84 ,$899.84 ,"$1,184.00 ", N/A ,"$1,006.40 ",$508.00 ,$769.60 ,$203.20 ,"$1,184.00 ",$663.04 ,$203.20 ,$311.39 , N/A , N/A , N/A ,$213.36 ,$947.20 ,$457.20 ,$533.98 ,$331.52 ,"$1,065.60 ",$203.20 ,$899.84 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$568.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000528,24500,HC TX FX HUMERUS SHAFT W/O MANIP CLOSED-RT,450,1 ,"$1,184.00 ",$769.60 ,$203.20 ,"$1,184.00 ",$508.00 ,$544.64 ,$663.04 ,$203.20 ,$331.52 ,$400.19 ,$203.20 ,$460.58 ,$203.20 ,$533.98 ,$533.98 ,$203.20 ,$533.98 ,$386.08 ,$592.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$888.00 ,$710.40 ,$710.40 ,$203.20 ,$710.40 ,$899.84 ,$899.84 ,$899.84 ,"$1,184.00 ", N/A ,"$1,006.40 ",$508.00 ,$769.60 ,$203.20 ,"$1,184.00 ",$663.04 ,$203.20 ,$311.39 , N/A , N/A , N/A ,$213.36 ,$947.20 ,$457.20 ,$533.98 ,$331.52 ,"$1,065.60 ",$203.20 ,$899.84 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$568.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000529,28600,HC TX FX METATARSAL W/O ANES,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000530,25560,HC TX FX RADIUS/ULNA W/O MAN CLOSED -LT,450,1 ,$913.00 ,$593.45 ,$203.20 ,$913.00 ,$508.00 ,$419.98 ,$511.28 ,$203.20 ,$255.64 ,$308.59 ,$203.20 ,$355.16 ,$203.20 ,$411.76 ,$411.76 ,$203.20 ,$411.76 ,$386.08 ,$456.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$684.75 ,$547.80 ,$547.80 ,$203.20 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$508.00 ,$593.45 ,$203.20 ,$913.00 ,$511.28 ,$203.20 ,$240.12 , N/A , N/A , N/A ,$213.36 ,$730.40 ,$457.20 ,$411.76 ,$255.64 ,$821.70 ,$203.20 ,$693.88 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000531,25560,HC TX FX RADIUS/ULNA W/O MAN CLOSED -RT,450,1 ,$913.00 ,$593.45 ,$203.20 ,$913.00 ,$508.00 ,$419.98 ,$511.28 ,$203.20 ,$255.64 ,$308.59 ,$203.20 ,$355.16 ,$203.20 ,$411.76 ,$411.76 ,$203.20 ,$411.76 ,$386.08 ,$456.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$684.75 ,$547.80 ,$547.80 ,$203.20 ,$547.80 ,$693.88 ,$693.88 ,$693.88 ,$913.00 , N/A ,$776.05 ,$508.00 ,$593.45 ,$203.20 ,$913.00 ,$511.28 ,$203.20 ,$240.12 , N/A , N/A , N/A ,$213.36 ,$730.40 ,$457.20 ,$411.76 ,$255.64 ,$821.70 ,$203.20 ,$693.88 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$438.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000532,23575,HC TX FX SCAPULA CLOSED W/MANIP W/W/O TRACTION,450,1 ,"$1,075.00 ",$698.75 ,$282.73 ,"$3,432.95 ","$3,432.95 ",$494.50 ,$602.00 ,"$1,373.18 ",$301.00 ,$363.35 ,"$1,373.18 ",$418.18 ,"$1,075.00 ",$484.83 ,$484.83 ,"$1,075.00 ",$484.83 ,"$1,075.00 ",$537.50 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,075.00 ",$806.25 ,$645.00 ,$645.00 ,"$1,373.18 ",$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,"$1,075.00 ",$698.75 ,"$1,373.18 ","$1,075.00 ",$602.00 ,"$1,373.18 ",$282.73 , N/A , N/A , N/A ,"$1,441.84 ",$860.00 ,"$3,089.65 ",$484.83 ,$301.00 ,$967.50 ,"$1,373.18 ",$817.00 ,$400.00 ,$400.00 ,"$1,075.00 ",$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000533,28430,HC TX FX TALUS W/O MAN CLOSED,450,1 ,$851.00 ,$553.15 ,$203.20 ,$851.00 ,$508.00 ,$391.46 ,$476.56 ,$203.20 ,$238.28 ,$287.64 ,$203.20 ,$331.04 ,$203.20 ,$383.80 ,$383.80 ,$203.20 ,$383.80 ,$386.08 ,$425.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$638.25 ,$510.60 ,$510.60 ,$203.20 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$508.00 ,$553.15 ,$203.20 ,$851.00 ,$476.56 ,$203.20 ,$223.81 , N/A , N/A , N/A ,$213.36 ,$680.80 ,$457.20 ,$383.80 ,$238.28 ,$765.90 ,$203.20 ,$646.76 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$408.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000534,27825,HC TX FX TIBIA DISTAL W/MANIP W/W/O ANES-LT,450,1 ,"$5,432.00 ","$3,530.80 ",$400.00 ,"$5,432.00 ","$3,432.95 ","$2,000.00 ","$3,041.92 ","$1,373.18 ","$1,520.96 ","$1,836.02 ","$1,373.18 ","$2,113.05 ","$1,373.18 ","$2,449.83 ","$2,449.83 ","$1,373.18 ","$2,449.83 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,074.00 ","$3,259.20 ","$3,259.20 ","$1,373.18 ","$3,259.20 ","$4,128.32 ","$4,128.32 ","$4,128.32 ","$5,432.00 ", N/A ,"$4,617.20 ","$3,432.94 ","$3,530.80 ","$1,373.18 ","$5,432.00 ","$3,041.92 ","$1,373.18 ","$1,428.62 ", N/A , N/A , N/A ,"$1,441.84 ","$4,345.60 ","$3,089.65 ","$2,449.83 ","$1,520.96 ","$4,888.80 ","$1,373.18 ","$4,128.32 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,607.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000535,27825,HC TX FX TIBIA DISTAL W/MANIP W/W/O ANES-RT,450,1 ,"$5,432.00 ","$3,530.80 ",$400.00 ,"$5,432.00 ","$3,432.95 ","$2,000.00 ","$3,041.92 ","$1,373.18 ","$1,520.96 ","$1,836.02 ","$1,373.18 ","$2,113.05 ","$1,373.18 ","$2,449.83 ","$2,449.83 ","$1,373.18 ","$2,449.83 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,074.00 ","$3,259.20 ","$3,259.20 ","$1,373.18 ","$3,259.20 ","$4,128.32 ","$4,128.32 ","$4,128.32 ","$5,432.00 ", N/A ,"$4,617.20 ","$3,432.94 ","$3,530.80 ","$1,373.18 ","$5,432.00 ","$3,041.92 ","$1,373.18 ","$1,428.62 ", N/A , N/A , N/A ,"$1,441.84 ","$4,345.60 ","$3,089.65 ","$2,449.83 ","$1,520.96 ","$4,888.80 ","$1,373.18 ","$4,128.32 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,607.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000536,27824,HC TX FX TIBIA DISTAL WGT BEAR W/MAN W/W/O ANES CLS-LT,450,1 ,$936.00 ,$608.40 ,$203.20 ,$936.00 ,$508.00 ,$430.56 ,$524.16 ,$203.20 ,$262.08 ,$316.37 ,$203.20 ,$364.10 ,$203.20 ,$422.14 ,$422.14 ,$203.20 ,$422.14 ,$386.08 ,$468.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$702.00 ,$561.60 ,$561.60 ,$203.20 ,$561.60 ,$711.36 ,$711.36 ,$711.36 ,$936.00 , N/A ,$795.60 ,$508.00 ,$608.40 ,$203.20 ,$936.00 ,$524.16 ,$203.20 ,$246.17 , N/A , N/A , N/A ,$213.36 ,$748.80 ,$457.20 ,$422.14 ,$262.08 ,$842.40 ,$203.20 ,$711.36 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$449.28 , N/A 
ST. ELIZABETH'S HOSPITAL,45000537,27824,HC TX FX TIBIA DISTAL WGT BEAR W/MAN W/W/O ANES CLS-RT,450,1 ,$936.00 ,$608.40 ,$203.20 ,$936.00 ,$508.00 ,$430.56 ,$524.16 ,$203.20 ,$262.08 ,$316.37 ,$203.20 ,$364.10 ,$203.20 ,$422.14 ,$422.14 ,$203.20 ,$422.14 ,$386.08 ,$468.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$702.00 ,$561.60 ,$561.60 ,$203.20 ,$561.60 ,$711.36 ,$711.36 ,$711.36 ,$936.00 , N/A ,$795.60 ,$508.00 ,$608.40 ,$203.20 ,$936.00 ,$524.16 ,$203.20 ,$246.17 , N/A , N/A , N/A ,$213.36 ,$748.80 ,$457.20 ,$422.14 ,$262.08 ,$842.40 ,$203.20 ,$711.36 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$449.28 , N/A 
ST. ELIZABETH'S HOSPITAL,45000538,27530,HC TX FX TIBIAL W/O MANIP CLOSED,450,1 ,"$1,075.00 ",$698.75 ,$203.20 ,"$1,075.00 ",$508.00 ,$494.50 ,$602.00 ,$203.20 ,$301.00 ,$363.35 ,$203.20 ,$418.18 ,$203.20 ,$484.83 ,$484.83 ,$203.20 ,$484.83 ,$386.08 ,$537.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$806.25 ,$645.00 ,$645.00 ,$203.20 ,$645.00 ,$817.00 ,$817.00 ,$817.00 ,"$1,075.00 ", N/A ,$913.75 ,$508.00 ,$698.75 ,$203.20 ,"$1,075.00 ",$602.00 ,$203.20 ,$282.73 , N/A , N/A , N/A ,$213.36 ,$860.00 ,$457.20 ,$484.83 ,$301.00 ,$967.50 ,$203.20 ,$817.00 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$516.00 , N/A 
ST. ELIZABETH'S HOSPITAL,45000539,22315,HC TX FX/DISLOC VERT CAST/BRACE W/MANIP OR TRACTION,450,1 ,"$4,328.00 ","$2,813.20 ",$400.00 ,"$6,979.95 ","$6,979.95 ","$1,990.88 ","$2,423.68 ","$2,791.98 ","$1,211.84 ","$1,462.86 ","$2,791.98 ","$1,683.59 ","$2,791.98 ","$1,951.93 ","$1,951.93 ","$2,791.98 ","$1,951.93 ","$4,328.00 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$3,246.00 ","$2,596.80 ","$2,596.80 ","$2,791.98 ","$2,596.80 ","$3,289.28 ","$3,289.28 ","$3,289.28 ","$4,328.00 ", N/A ,"$3,678.80 ","$4,328.00 ","$2,813.20 ","$2,791.98 ","$4,328.00 ","$2,423.68 ","$2,791.98 ","$1,138.26 ", N/A , N/A , N/A ,"$2,931.58 ","$3,462.40 ","$6,281.95 ","$1,951.93 ","$1,211.84 ","$3,895.20 ","$2,791.98 ","$3,289.28 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$2,077.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000540,29075,HC APPL CAST ARM SHORT-BIL,450,1 ,"$1,562.00 ","$1,015.30 ",$356.75 ,"$1,562.00 ",$891.88 ,$718.52 ,$874.72 ,$356.75 ,$437.36 ,$527.96 ,$356.75 ,$643.54 ,$356.75 ,$704.46 ,$704.46 ,$356.75 ,$704.46 ,$677.83 ,$781.00 ,$891.88 ,$356.75 ,$356.75 ,$363.89 ,"$1,171.50 ",$937.20 ,$937.20 ,$356.75 ,$937.20 ,"$1,187.12 ","$1,187.12 ","$1,187.12 ","$1,562.00 ", N/A ,"$1,327.70 ",$891.88 ,"$1,015.30 ",$356.75 ,"$1,562.00 ",$874.72 ,$356.75 ,$410.81 , N/A , N/A , N/A ,$374.59 ,"$1,249.60 ",$802.69 ,$704.46 ,$437.36 ,"$1,405.80 ",$356.75 ,"$1,187.12 ",$400.00 ,$400.00 ,$356.75 ,$400.00 ,$749.76 , N/A 
ST. ELIZABETH'S HOSPITAL,45000541,29075,HC APPL CAST ARM SHORT-LT,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000542,29075,HC APPL CAST ARM SHORT-RT,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000543,29085,HC APPL CAST HAND/FOREARM - LT,450,1 ,"$1,067.00 ",$693.55 ,$139.29 ,"$1,067.00 ",$348.23 ,$490.82 ,$597.52 ,$139.29 ,$298.76 ,$360.65 ,$139.29 ,$439.60 ,$139.29 ,$481.22 ,$481.22 ,$139.29 ,$481.22 ,$264.64 ,$533.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$800.25 ,$640.20 ,$640.20 ,$139.29 ,$640.20 ,$810.92 ,$810.92 ,$810.92 ,"$1,067.00 ", N/A ,$906.95 ,$348.22 ,$693.55 ,$139.29 ,"$1,067.00 ",$597.52 ,$139.29 ,$280.62 , N/A , N/A , N/A ,$146.25 ,$853.60 ,$313.39 ,$481.22 ,$298.76 ,$960.30 ,$139.29 ,$810.92 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$512.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000544,29085,HC APPL CAST HAND/FOREARM - RT,450,1 ,"$1,067.00 ",$693.55 ,$139.29 ,"$1,067.00 ",$348.23 ,$490.82 ,$597.52 ,$139.29 ,$298.76 ,$360.65 ,$139.29 ,$439.60 ,$139.29 ,$481.22 ,$481.22 ,$139.29 ,$481.22 ,$264.64 ,$533.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$800.25 ,$640.20 ,$640.20 ,$139.29 ,$640.20 ,$810.92 ,$810.92 ,$810.92 ,"$1,067.00 ", N/A ,$906.95 ,$348.22 ,$693.55 ,$139.29 ,"$1,067.00 ",$597.52 ,$139.29 ,$280.62 , N/A , N/A , N/A ,$146.25 ,$853.60 ,$313.39 ,$481.22 ,$298.76 ,$960.30 ,$139.29 ,$810.92 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$512.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000545,29355,HC APPL LONG LEG CAST WALKING-LT,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000546,29355,HC APPL LONG LEG CAST WALKING-RT,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000547,29125,HC APPL SHRT ARM SPLNT STAT-BIL,450,1 ,"$1,226.00 ",$796.90 ,$111.17 ,"$1,226.00 ",$277.93 ,$563.96 ,$686.56 ,$111.17 ,$343.28 ,$414.39 ,$111.17 ,$505.11 ,$111.17 ,$552.93 ,$552.93 ,$111.17 ,$552.93 ,$211.22 ,$613.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$919.50 ,$735.60 ,$735.60 ,$111.17 ,$735.60 ,$931.76 ,$931.76 ,$931.76 ,"$1,226.00 ", N/A ,"$1,042.10 ",$277.92 ,$796.90 ,$111.17 ,"$1,226.00 ",$686.56 ,$111.17 ,$322.44 , N/A , N/A , N/A ,$116.73 ,$980.80 ,$250.12 ,$552.93 ,$343.28 ,"$1,103.40 ",$111.17 ,$931.76 ,$400.00 ,$400.00 ,$111.17 ,$400.00 ,$588.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45000548,29425,HC APPLY SHORT LEG CAST WALKING,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45000549,29515,HC APPL SHRT LEG SPLNT FAC-BIL,450,1 ,$846.00 ,$549.90 ,$208.93 ,$846.00 ,$522.33 ,$389.16 ,$473.76 ,$208.93 ,$236.88 ,$285.95 ,$208.93 ,$348.55 ,$208.93 ,$381.55 ,$381.55 ,$208.93 ,$381.55 ,$396.97 ,$423.00 ,$522.32 ,$208.93 ,$208.93 ,$213.11 ,$634.50 ,$507.60 ,$507.60 ,$208.93 ,$507.60 ,$642.96 ,$642.96 ,$642.96 ,$846.00 , N/A ,$719.10 ,$522.32 ,$549.90 ,$208.93 ,$846.00 ,$473.76 ,$208.93 ,$222.50 , N/A , N/A , N/A ,$219.38 ,$676.80 ,$470.09 ,$381.55 ,$236.88 ,$761.40 ,$208.93 ,$642.96 ,$400.00 ,$400.00 ,$208.93 ,$400.00 ,$406.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000550,67700,HC BLEPHAROT EYELID DRAIN ABSC-E1,450,1 ,"$1,268.00 ",$824.20 ,$257.89 ,"$1,268.00 ",$644.73 ,$583.28 ,$710.08 ,$257.89 ,$355.04 ,$428.58 ,$257.89 ,$493.25 ,$257.89 ,$571.87 ,$571.87 ,$257.89 ,$571.87 ,$490.00 ,$634.00 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$951.00 ,$760.80 ,$760.80 ,$257.89 ,$760.80 ,$963.68 ,$963.68 ,$963.68 ,"$1,268.00 ", N/A ,"$1,077.80 ",$644.74 ,$824.20 ,$257.89 ,"$1,268.00 ",$710.08 ,$257.89 ,$333.48 , N/A , N/A , N/A ,$270.78 ,"$1,014.40 ",$580.26 ,$571.87 ,$355.04 ,"$1,141.20 ",$257.89 ,$963.68 ,$400.00 ,$400.00 ,$257.89 ,$400.00 ,$608.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000551,67700,HC BLEPHAROT EYELID DRAIN ABSC-E2,450,1 ,"$1,268.00 ",$824.20 ,$257.89 ,"$1,268.00 ",$644.73 ,$583.28 ,$710.08 ,$257.89 ,$355.04 ,$428.58 ,$257.89 ,$493.25 ,$257.89 ,$571.87 ,$571.87 ,$257.89 ,$571.87 ,$490.00 ,$634.00 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$951.00 ,$760.80 ,$760.80 ,$257.89 ,$760.80 ,$963.68 ,$963.68 ,$963.68 ,"$1,268.00 ", N/A ,"$1,077.80 ",$644.74 ,$824.20 ,$257.89 ,"$1,268.00 ",$710.08 ,$257.89 ,$333.48 , N/A , N/A , N/A ,$270.78 ,"$1,014.40 ",$580.26 ,$571.87 ,$355.04 ,"$1,141.20 ",$257.89 ,$963.68 ,$400.00 ,$400.00 ,$257.89 ,$400.00 ,$608.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000552,67700,HC BLEPHAROT EYELID DRAIN ABSC-E3,450,1 ,"$1,268.00 ",$824.20 ,$257.89 ,"$1,268.00 ",$644.73 ,$583.28 ,$710.08 ,$257.89 ,$355.04 ,$428.58 ,$257.89 ,$493.25 ,$257.89 ,$571.87 ,$571.87 ,$257.89 ,$571.87 ,$490.00 ,$634.00 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$951.00 ,$760.80 ,$760.80 ,$257.89 ,$760.80 ,$963.68 ,$963.68 ,$963.68 ,"$1,268.00 ", N/A ,"$1,077.80 ",$644.74 ,$824.20 ,$257.89 ,"$1,268.00 ",$710.08 ,$257.89 ,$333.48 , N/A , N/A , N/A ,$270.78 ,"$1,014.40 ",$580.26 ,$571.87 ,$355.04 ,"$1,141.20 ",$257.89 ,$963.68 ,$400.00 ,$400.00 ,$257.89 ,$400.00 ,$608.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000553,67700,HC BLEPHAROT EYELID DRAIN ABSC-E4,450,1 ,"$1,268.00 ",$824.20 ,$257.89 ,"$1,268.00 ",$644.73 ,$583.28 ,$710.08 ,$257.89 ,$355.04 ,$428.58 ,$257.89 ,$493.25 ,$257.89 ,$571.87 ,$571.87 ,$257.89 ,$571.87 ,$490.00 ,$634.00 ,$644.74 ,$257.89 ,$257.89 ,$263.05 ,$951.00 ,$760.80 ,$760.80 ,$257.89 ,$760.80 ,$963.68 ,$963.68 ,$963.68 ,"$1,268.00 ", N/A ,"$1,077.80 ",$644.74 ,$824.20 ,$257.89 ,"$1,268.00 ",$710.08 ,$257.89 ,$333.48 , N/A , N/A , N/A ,$270.78 ,"$1,014.40 ",$580.26 ,$571.87 ,$355.04 ,"$1,141.20 ",$257.89 ,$963.68 ,$400.00 ,$400.00 ,$257.89 ,$400.00 ,$608.64 , N/A 
ST. ELIZABETH'S HOSPITAL,45000554,29581,HC APPLY MULTI COMP LOWER LEG-LT,450,1 ,$659.00 ,$428.35 ,$139.29 ,$659.00 ,$348.23 ,$303.14 ,$369.04 ,$139.29 ,$184.52 ,$222.74 ,$139.29 ,$256.35 ,$139.29 ,$297.21 ,$297.21 ,$139.29 ,$297.21 ,$264.64 ,$329.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$494.25 ,$395.40 ,$395.40 ,$139.29 ,$395.40 ,$500.84 ,$500.84 ,$500.84 ,$659.00 , N/A ,$560.15 ,$348.22 ,$428.35 ,$139.29 ,$659.00 ,$369.04 ,$139.29 ,$173.32 , N/A , N/A , N/A ,$146.25 ,$527.20 ,$313.39 ,$297.21 ,$184.52 ,$593.10 ,$139.29 ,$500.84 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$316.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000555,29581,HC APPLY MULTI COMP LOWER LEG-RT,450,1 ,$659.00 ,$428.35 ,$139.29 ,$659.00 ,$348.23 ,$303.14 ,$369.04 ,$139.29 ,$184.52 ,$222.74 ,$139.29 ,$256.35 ,$139.29 ,$297.21 ,$297.21 ,$139.29 ,$297.21 ,$264.64 ,$329.50 ,$348.22 ,$139.29 ,$139.29 ,$142.07 ,$494.25 ,$395.40 ,$395.40 ,$139.29 ,$395.40 ,$500.84 ,$500.84 ,$500.84 ,$659.00 , N/A ,$560.15 ,$348.22 ,$428.35 ,$139.29 ,$659.00 ,$369.04 ,$139.29 ,$173.32 , N/A , N/A , N/A ,$146.25 ,$527.20 ,$313.39 ,$297.21 ,$184.52 ,$593.10 ,$139.29 ,$500.84 ,$400.00 ,$400.00 ,$139.29 ,$400.00 ,$316.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45000556,20103,HC EXPL PENTR WOUND EXTREMITY - LT,450,1 ,"$4,358.00 ","$2,832.70 ",$400.00 ,"$4,358.00 ","$1,533.75 ","$2,000.00 ","$2,440.48 ",$613.50 ,"$1,220.24 ","$1,473.00 ",$613.50 ,"$1,695.26 ",$613.50 ,"$1,965.46 ","$1,965.46 ",$613.50 ,"$1,965.46 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,268.50 ","$2,614.80 ","$2,614.80 ",$613.50 ,"$2,614.80 ","$3,312.08 ","$3,312.08 ","$3,312.08 ","$4,358.00 ", N/A ,"$3,704.30 ","$1,533.75 ","$2,832.70 ",$613.50 ,"$4,358.00 ","$2,440.48 ",$613.50 ,"$1,146.15 ", N/A , N/A , N/A ,$644.18 ,"$3,486.40 ","$1,380.37 ","$1,965.46 ","$1,220.24 ","$3,922.20 ",$613.50 ,"$3,312.08 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$2,091.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000557,20103,HC EXPL PENTR WOUND EXTREMITY - RT,450,1 ,"$4,358.00 ","$2,832.70 ",$400.00 ,"$4,358.00 ","$1,533.75 ","$2,000.00 ","$2,440.48 ",$613.50 ,"$1,220.24 ","$1,473.00 ",$613.50 ,"$1,695.26 ",$613.50 ,"$1,965.46 ","$1,965.46 ",$613.50 ,"$1,965.46 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,268.50 ","$2,614.80 ","$2,614.80 ",$613.50 ,"$2,614.80 ","$3,312.08 ","$3,312.08 ","$3,312.08 ","$4,358.00 ", N/A ,"$3,704.30 ","$1,533.75 ","$2,832.70 ",$613.50 ,"$4,358.00 ","$2,440.48 ",$613.50 ,"$1,146.15 ", N/A , N/A , N/A ,$644.18 ,"$3,486.40 ","$1,380.37 ","$1,965.46 ","$1,220.24 ","$3,922.20 ",$613.50 ,"$3,312.08 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$2,091.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000558,28193,HC REMOVE FB FOOT COMPLICATED-50,450,1 ,"$8,304.00 ","$5,397.60 ",$400.00 ,"$8,304.00 ","$3,467.90 ","$2,000.00 ","$4,650.24 ","$1,387.16 ","$2,325.12 ","$2,282.50 ","$1,387.16 ","$3,230.26 ","$1,387.16 ","$3,745.10 ","$3,745.10 ","$1,387.16 ","$3,745.10 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$6,228.00 ","$4,982.40 ","$4,982.40 ","$1,387.16 ","$4,982.40 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,304.00 ", N/A ,"$7,058.40 ","$3,467.89 ","$5,397.60 ","$1,387.16 ","$8,304.00 ","$4,650.24 ","$1,387.16 ","$2,183.95 ", N/A , N/A , N/A ,"$1,456.52 ","$6,643.20 ","$3,121.10 ","$3,745.10 ","$2,325.12 ","$7,473.60 ","$1,387.16 ","$5,354.00 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$3,985.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000559,28193,HC REMOVE FB FOOT COMPLICATED-LT,450,1 ,"$5,536.00 ","$3,598.40 ",$400.00 ,"$5,536.00 ","$3,467.90 ","$2,000.00 ","$3,100.16 ","$1,387.16 ","$1,550.08 ","$1,871.17 ","$1,387.16 ","$2,153.50 ","$1,387.16 ","$2,496.74 ","$2,496.74 ","$1,387.16 ","$2,496.74 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$4,152.00 ","$3,321.60 ","$3,321.60 ","$1,387.16 ","$3,321.60 ","$4,207.36 ","$4,207.36 ","$4,207.36 ","$5,536.00 ", N/A ,"$4,705.60 ","$3,467.89 ","$3,598.40 ","$1,387.16 ","$5,536.00 ","$3,100.16 ","$1,387.16 ","$1,455.97 ", N/A , N/A , N/A ,"$1,456.52 ","$4,428.80 ","$3,121.10 ","$2,496.74 ","$1,550.08 ","$4,982.40 ","$1,387.16 ","$4,207.36 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$2,657.28 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000560,28193,HC REMOVE FB FOOT COMPLICATED-RT,450,1 ,"$5,536.00 ","$3,598.40 ",$400.00 ,"$5,536.00 ","$3,467.90 ","$2,000.00 ","$3,100.16 ","$1,387.16 ","$1,550.08 ","$1,871.17 ","$1,387.16 ","$2,153.50 ","$1,387.16 ","$2,496.74 ","$2,496.74 ","$1,387.16 ","$2,496.74 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$4,152.00 ","$3,321.60 ","$3,321.60 ","$1,387.16 ","$3,321.60 ","$4,207.36 ","$4,207.36 ","$4,207.36 ","$5,536.00 ", N/A ,"$4,705.60 ","$3,467.89 ","$3,598.40 ","$1,387.16 ","$5,536.00 ","$3,100.16 ","$1,387.16 ","$1,455.97 ", N/A , N/A , N/A ,"$1,456.52 ","$4,428.80 ","$3,121.10 ","$2,496.74 ","$1,550.08 ","$4,982.40 ","$1,387.16 ","$4,207.36 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$2,657.28 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000561,28190,HC REMOVE FB FOOT SUBCUT,450,1 ,"$4,160.00 ","$2,704.00 ",$400.00 ,"$4,160.00 ","$1,533.75 ","$1,913.60 ","$2,329.60 ",$613.50 ,"$1,164.80 ","$1,406.08 ",$613.50 ,"$1,618.24 ",$613.50 ,"$1,876.16 ","$1,876.16 ",$613.50 ,"$1,876.16 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,120.00 ","$2,496.00 ","$2,496.00 ",$613.50 ,"$2,496.00 ","$3,161.60 ","$3,161.60 ","$3,161.60 ","$4,160.00 ", N/A ,"$3,536.00 ","$1,533.75 ","$2,704.00 ",$613.50 ,"$4,160.00 ","$2,329.60 ",$613.50 ,"$1,094.08 ", N/A , N/A , N/A ,$644.18 ,"$3,328.00 ","$1,380.37 ","$1,876.16 ","$1,164.80 ","$3,744.00 ",$613.50 ,"$3,161.60 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$1,996.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000562,28190,HC REMOVE FB FOOT SUBCUT,450,1 ,"$4,160.00 ","$2,704.00 ",$400.00 ,"$4,160.00 ","$1,533.75 ","$1,913.60 ","$2,329.60 ",$613.50 ,"$1,164.80 ","$1,406.08 ",$613.50 ,"$1,618.24 ",$613.50 ,"$1,876.16 ","$1,876.16 ",$613.50 ,"$1,876.16 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$3,120.00 ","$2,496.00 ","$2,496.00 ",$613.50 ,"$2,496.00 ","$3,161.60 ","$3,161.60 ","$3,161.60 ","$4,160.00 ", N/A ,"$3,536.00 ","$1,533.75 ","$2,704.00 ",$613.50 ,"$4,160.00 ","$2,329.60 ",$613.50 ,"$1,094.08 ", N/A , N/A , N/A ,$644.18 ,"$3,328.00 ","$1,380.37 ","$1,876.16 ","$1,164.80 ","$3,744.00 ",$613.50 ,"$3,161.60 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$1,996.80 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000563,25270,HC REPAIR TEND/MUSC/EXTENSOR FOREARM/WRIST PRIMARY-LT,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$6,979.95 ","$2,000.00 ","$4,320.96 ","$2,791.98 ","$2,160.48 ","$2,282.50 ","$2,791.98 ","$3,001.52 ","$2,791.98 ","$3,479.92 ","$3,479.92 ","$2,791.98 ","$3,479.92 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$2,791.98 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$6,979.94 ","$5,015.40 ","$2,791.98 ","$7,716.00 ","$4,320.96 ","$2,791.98 ","$2,029.31 ", N/A , N/A , N/A ,"$2,931.58 ","$6,172.80 ","$6,281.95 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000564,25270,HC REPAIR TEND/MUSC/EXTENSOR FOREARM/WRIST PRIMARY-RT,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$6,979.95 ","$2,000.00 ","$4,320.96 ","$2,791.98 ","$2,160.48 ","$2,282.50 ","$2,791.98 ","$3,001.52 ","$2,791.98 ","$3,479.92 ","$3,479.92 ","$2,791.98 ","$3,479.92 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$2,791.98 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$6,979.94 ","$5,015.40 ","$2,791.98 ","$7,716.00 ","$4,320.96 ","$2,791.98 ","$2,029.31 ", N/A , N/A , N/A ,"$2,931.58 ","$6,172.80 ","$6,281.95 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000565,25260,HC REPAIR TEND/MUSC/FLEXOR FOREARM/WRIST PRIMARY-LT,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$6,979.95 ","$2,000.00 ","$4,320.96 ","$2,791.98 ","$2,160.48 ","$2,282.50 ","$2,791.98 ","$3,001.52 ","$2,791.98 ","$3,479.92 ","$3,479.92 ","$2,791.98 ","$3,479.92 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$2,791.98 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$6,979.94 ","$5,015.40 ","$2,791.98 ","$7,716.00 ","$4,320.96 ","$2,791.98 ","$2,029.31 ", N/A , N/A , N/A ,"$2,931.58 ","$6,172.80 ","$6,281.95 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000566,25260,HC REPAIR TEND/MUSC/FLEXOR FOREARM/WRIST PRIMARY-RT,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$6,979.95 ","$2,000.00 ","$4,320.96 ","$2,791.98 ","$2,160.48 ","$2,282.50 ","$2,791.98 ","$3,001.52 ","$2,791.98 ","$3,479.92 ","$3,479.92 ","$2,791.98 ","$3,479.92 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$2,791.98 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$6,979.94 ","$5,015.40 ","$2,791.98 ","$7,716.00 ","$4,320.96 ","$2,791.98 ","$2,029.31 ", N/A , N/A , N/A ,"$2,931.58 ","$6,172.80 ","$6,281.95 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000567,26410,HC REPAIR TENDON HAND W/O GRAFT EA TENDON-LT,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$3,432.95 ","$2,000.00 ","$4,320.96 ","$1,373.18 ","$2,160.48 ","$2,282.50 ","$1,373.18 ","$3,001.52 ","$1,373.18 ","$3,479.92 ","$3,479.92 ","$1,373.18 ","$3,479.92 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$1,373.18 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$3,432.94 ","$5,015.40 ","$1,373.18 ","$7,716.00 ","$4,320.96 ","$1,373.18 ","$2,029.31 ", N/A , N/A , N/A ,"$1,441.84 ","$6,172.80 ","$3,089.65 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$1,373.18 ","$5,354.00 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000568,26410,HC REPAIR TENDON HAND W/O GRAFT EA TENDON-RT,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$3,432.95 ","$2,000.00 ","$4,320.96 ","$1,373.18 ","$2,160.48 ","$2,282.50 ","$1,373.18 ","$3,001.52 ","$1,373.18 ","$3,479.92 ","$3,479.92 ","$1,373.18 ","$3,479.92 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$1,373.18 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$3,432.94 ","$5,015.40 ","$1,373.18 ","$7,716.00 ","$4,320.96 ","$1,373.18 ","$2,029.31 ", N/A , N/A , N/A ,"$1,441.84 ","$6,172.80 ","$3,089.65 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$1,373.18 ","$5,354.00 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000569,26705,HC TX DISLOC (M-P) W/ANES CLOSED,450,1 ,"$5,704.00 ","$3,707.60 ",$400.00 ,"$5,704.00 ","$3,432.95 ","$2,000.00 ","$3,194.24 ","$1,373.18 ","$1,597.12 ","$1,927.95 ","$1,373.18 ","$2,218.86 ","$1,373.18 ","$2,572.50 ","$2,572.50 ","$1,373.18 ","$2,572.50 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,278.00 ","$3,422.40 ","$3,422.40 ","$1,373.18 ","$3,422.40 ","$4,335.04 ","$4,335.04 ","$4,335.04 ","$5,704.00 ", N/A ,"$4,848.40 ","$3,432.94 ","$3,707.60 ","$1,373.18 ","$5,704.00 ","$3,194.24 ","$1,373.18 ","$1,500.15 ", N/A , N/A , N/A ,"$1,441.84 ","$4,563.20 ","$3,089.65 ","$2,572.50 ","$1,597.12 ","$5,133.60 ","$1,373.18 ","$4,335.04 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,737.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000570,24605,HC TX DISLOC ELBOW W/ANES CLOSED-LT,450,1 ,"$5,704.00 ","$3,707.60 ",$400.00 ,"$5,704.00 ","$3,432.95 ","$2,000.00 ","$3,194.24 ","$1,373.18 ","$1,597.12 ","$1,927.95 ","$1,373.18 ","$2,218.86 ","$1,373.18 ","$2,572.50 ","$2,572.50 ","$1,373.18 ","$2,572.50 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,278.00 ","$3,422.40 ","$3,422.40 ","$1,373.18 ","$3,422.40 ","$4,335.04 ","$4,335.04 ","$4,335.04 ","$5,704.00 ", N/A ,"$4,848.40 ","$3,432.94 ","$3,707.60 ","$1,373.18 ","$5,704.00 ","$3,194.24 ","$1,373.18 ","$1,500.15 ", N/A , N/A , N/A ,"$1,441.84 ","$4,563.20 ","$3,089.65 ","$2,572.50 ","$1,597.12 ","$5,133.60 ","$1,373.18 ","$4,335.04 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,737.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000571,24605,HC TX DISLOC ELBOW W/ANES CLOSED-RT,450,1 ,"$5,704.00 ","$3,707.60 ",$400.00 ,"$5,704.00 ","$3,432.95 ","$2,000.00 ","$3,194.24 ","$1,373.18 ","$1,597.12 ","$1,927.95 ","$1,373.18 ","$2,218.86 ","$1,373.18 ","$2,572.50 ","$2,572.50 ","$1,373.18 ","$2,572.50 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,278.00 ","$3,422.40 ","$3,422.40 ","$1,373.18 ","$3,422.40 ","$4,335.04 ","$4,335.04 ","$4,335.04 ","$5,704.00 ", N/A ,"$4,848.40 ","$3,432.94 ","$3,707.60 ","$1,373.18 ","$5,704.00 ","$3,194.24 ","$1,373.18 ","$1,500.15 ", N/A , N/A , N/A ,"$1,441.84 ","$4,563.20 ","$3,089.65 ","$2,572.50 ","$1,597.12 ","$5,133.60 ","$1,373.18 ","$4,335.04 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,737.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000572,23665,HC TX DISLOC SHOULDER FX HUMERW/MANIP-LT,450,1 ,"$5,395.00 ","$3,506.75 ",$400.00 ,"$5,395.00 ","$3,432.95 ","$2,000.00 ","$3,021.20 ","$1,373.18 ","$1,510.60 ","$1,823.51 ","$1,373.18 ","$2,098.66 ","$1,373.18 ","$2,433.15 ","$2,433.15 ","$1,373.18 ","$2,433.15 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,046.25 ","$3,237.00 ","$3,237.00 ","$1,373.18 ","$3,237.00 ","$4,100.20 ","$4,100.20 ","$4,100.20 ","$5,395.00 ", N/A ,"$4,585.75 ","$3,432.94 ","$3,506.75 ","$1,373.18 ","$5,395.00 ","$3,021.20 ","$1,373.18 ","$1,418.89 ", N/A , N/A , N/A ,"$1,441.84 ","$4,316.00 ","$3,089.65 ","$2,433.15 ","$1,510.60 ","$4,855.50 ","$1,373.18 ","$4,100.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,589.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000573,23665,HC TX DISLOC SHOULDER FX HUMERW/MANIP-RT,450,1 ,"$5,395.00 ","$3,506.75 ",$400.00 ,"$5,395.00 ","$3,432.95 ","$2,000.00 ","$3,021.20 ","$1,373.18 ","$1,510.60 ","$1,823.51 ","$1,373.18 ","$2,098.66 ","$1,373.18 ","$2,433.15 ","$2,433.15 ","$1,373.18 ","$2,433.15 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,046.25 ","$3,237.00 ","$3,237.00 ","$1,373.18 ","$3,237.00 ","$4,100.20 ","$4,100.20 ","$4,100.20 ","$5,395.00 ", N/A ,"$4,585.75 ","$3,432.94 ","$3,506.75 ","$1,373.18 ","$5,395.00 ","$3,021.20 ","$1,373.18 ","$1,418.89 ", N/A , N/A , N/A ,"$1,441.84 ","$4,316.00 ","$3,089.65 ","$2,433.15 ","$1,510.60 ","$4,855.50 ","$1,373.18 ","$4,100.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,589.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000574,23650,HC TX DISLOC SHOULDER W/MANIP CLOSED-BIL,450,1 ,"$1,613.00 ","$1,048.45 ",$304.80 ,"$1,613.00 ",$762.00 ,$741.98 ,$903.28 ,$304.80 ,$451.64 ,$545.19 ,$304.80 ,$627.46 ,$304.80 ,$727.46 ,$727.46 ,$304.80 ,$727.46 ,$579.12 ,$806.50 ,$762.00 ,$304.80 ,$304.80 ,$310.90 ,"$1,209.75 ",$967.80 ,$967.80 ,$304.80 ,$967.80 ,"$1,225.88 ","$1,225.88 ","$1,225.88 ","$1,613.00 ", N/A ,"$1,371.05 ",$762.00 ,"$1,048.45 ",$304.80 ,"$1,613.00 ",$903.28 ,$304.80 ,$424.22 , N/A , N/A , N/A ,$320.04 ,"$1,290.40 ",$685.80 ,$727.46 ,$451.64 ,"$1,451.70 ",$304.80 ,"$1,225.88 ",$400.00 ,$400.00 ,$304.80 ,$400.00 ,$774.24 , N/A 
ST. ELIZABETH'S HOSPITAL,45000575,27810,HC TX FX BIMALL ANKLE W/MANIP CLOSED-LT,450,1 ,"$2,714.00 ","$1,764.10 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,248.44 ","$1,519.84 ","$1,373.18 ",$759.92 ,$917.33 ,"$1,373.18 ","$1,055.75 ","$1,373.18 ","$1,224.01 ","$1,224.01 ","$1,373.18 ","$1,224.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,035.50 ","$1,628.40 ","$1,628.40 ","$1,373.18 ","$1,628.40 ","$2,062.64 ","$2,062.64 ","$2,062.64 ","$2,714.00 ", N/A ,"$2,306.90 ","$2,714.00 ","$1,764.10 ","$1,373.18 ","$2,714.00 ","$1,519.84 ","$1,373.18 ",$713.78 , N/A , N/A , N/A ,"$1,441.84 ","$2,171.20 ","$3,089.65 ","$1,224.01 ",$759.92 ,"$2,442.60 ","$1,373.18 ","$2,062.64 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,302.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000576,27810,HC TX FX BIMALL ANKLE W/MANIP CLOSED-RT,450,1 ,"$2,714.00 ","$1,764.10 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,248.44 ","$1,519.84 ","$1,373.18 ",$759.92 ,$917.33 ,"$1,373.18 ","$1,055.75 ","$1,373.18 ","$1,224.01 ","$1,224.01 ","$1,373.18 ","$1,224.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,035.50 ","$1,628.40 ","$1,628.40 ","$1,373.18 ","$1,628.40 ","$2,062.64 ","$2,062.64 ","$2,062.64 ","$2,714.00 ", N/A ,"$2,306.90 ","$2,714.00 ","$1,764.10 ","$1,373.18 ","$2,714.00 ","$1,519.84 ","$1,373.18 ",$713.78 , N/A , N/A , N/A ,"$1,441.84 ","$2,171.20 ","$3,089.65 ","$1,224.01 ",$759.92 ,"$2,442.60 ","$1,373.18 ","$2,062.64 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,302.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000577,27752,HC TX FX TIBIAL SHAFT W/MANIP CLOSED - LT,450,1 ,"$4,313.00 ","$2,803.45 ",$400.00 ,"$4,313.00 ","$3,432.95 ","$1,983.98 ","$2,415.28 ","$1,373.18 ","$1,207.64 ","$1,457.79 ","$1,373.18 ","$1,677.76 ","$1,373.18 ","$1,945.16 ","$1,945.16 ","$1,373.18 ","$1,945.16 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,234.75 ","$2,587.80 ","$2,587.80 ","$1,373.18 ","$2,587.80 ","$3,277.88 ","$3,277.88 ","$3,277.88 ","$4,313.00 ", N/A ,"$3,666.05 ","$3,432.94 ","$2,803.45 ","$1,373.18 ","$4,313.00 ","$2,415.28 ","$1,373.18 ","$1,134.32 ", N/A , N/A , N/A ,"$1,441.84 ","$3,450.40 ","$3,089.65 ","$1,945.16 ","$1,207.64 ","$3,881.70 ","$1,373.18 ","$3,277.88 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,070.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000578,27752,HC TX FX TIBIAL SHAFT W/MANIP CLOSED - RT,450,1 ,"$4,313.00 ","$2,803.45 ",$400.00 ,"$4,313.00 ","$3,432.95 ","$1,983.98 ","$2,415.28 ","$1,373.18 ","$1,207.64 ","$1,457.79 ","$1,373.18 ","$1,677.76 ","$1,373.18 ","$1,945.16 ","$1,945.16 ","$1,373.18 ","$1,945.16 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,234.75 ","$2,587.80 ","$2,587.80 ","$1,373.18 ","$2,587.80 ","$3,277.88 ","$3,277.88 ","$3,277.88 ","$4,313.00 ", N/A ,"$3,666.05 ","$3,432.94 ","$2,803.45 ","$1,373.18 ","$4,313.00 ","$2,415.28 ","$1,373.18 ","$1,134.32 ", N/A , N/A , N/A ,"$1,441.84 ","$3,450.40 ","$3,089.65 ","$1,945.16 ","$1,207.64 ","$3,881.70 ","$1,373.18 ","$3,277.88 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,070.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,45000579,25650,HC TX FX ULNAR STYLOID CLOSED - LT,450,1 ,$946.00 ,$614.90 ,$203.20 ,$946.00 ,$508.00 ,$435.16 ,$529.76 ,$203.20 ,$264.88 ,$319.75 ,$203.20 ,$367.99 ,$203.20 ,$426.65 ,$426.65 ,$203.20 ,$426.65 ,$386.08 ,$473.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$709.50 ,$567.60 ,$567.60 ,$203.20 ,$567.60 ,$718.96 ,$718.96 ,$718.96 ,$946.00 , N/A ,$804.10 ,$508.00 ,$614.90 ,$203.20 ,$946.00 ,$529.76 ,$203.20 ,$248.80 , N/A , N/A , N/A ,$213.36 ,$756.80 ,$457.20 ,$426.65 ,$264.88 ,$851.40 ,$203.20 ,$718.96 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$454.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000580,25650,HC TX FX ULNAR STYLOID CLOSED - RT,450,1 ,$946.00 ,$614.90 ,$203.20 ,$946.00 ,$508.00 ,$435.16 ,$529.76 ,$203.20 ,$264.88 ,$319.75 ,$203.20 ,$367.99 ,$203.20 ,$426.65 ,$426.65 ,$203.20 ,$426.65 ,$386.08 ,$473.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$709.50 ,$567.60 ,$567.60 ,$203.20 ,$567.60 ,$718.96 ,$718.96 ,$718.96 ,$946.00 , N/A ,$804.10 ,$508.00 ,$614.90 ,$203.20 ,$946.00 ,$529.76 ,$203.20 ,$248.80 , N/A , N/A , N/A ,$213.36 ,$756.80 ,$457.20 ,$426.65 ,$264.88 ,$851.40 ,$203.20 ,$718.96 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$454.08 , N/A 
ST. ELIZABETH'S HOSPITAL,45000581,25600,HC DISTAL RADIUS W/O MANIP CLOSED - LT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45000582,25600,HC DISTAL RADIUS W/O MANIP CLOSED - RT,450,1 ,"$1,205.00 ",$783.25 ,$203.20 ,"$1,205.00 ",$508.00 ,$554.30 ,$674.80 ,$203.20 ,$337.40 ,$407.29 ,$203.20 ,$468.75 ,$203.20 ,$543.46 ,$543.46 ,$203.20 ,$543.46 ,$386.08 ,$602.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$903.75 ,$723.00 ,$723.00 ,$203.20 ,$723.00 ,$915.80 ,$915.80 ,$915.80 ,"$1,205.00 ", N/A ,"$1,024.25 ",$508.00 ,$783.25 ,$203.20 ,"$1,205.00 ",$674.80 ,$203.20 ,$316.92 , N/A , N/A , N/A ,$213.36 ,$964.00 ,$457.20 ,$543.46 ,$337.40 ,"$1,084.50 ",$203.20 ,$915.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$578.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45001024,27768,HC CLSD TX POSTERIOR WITH MANIP,450,1 ,$564.00 ,$366.60 ,$148.33 ,"$3,432.95 ","$3,432.95 ",$259.44 ,$315.84 ,"$1,373.18 ",$157.92 ,$190.63 ,"$1,373.18 ",$219.40 ,$564.00 ,$254.36 ,$254.36 ,$564.00 ,$254.36 ,$564.00 ,$282.00 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ",$564.00 ,$423.00 ,$338.40 ,$338.40 ,"$1,373.18 ",$338.40 ,$428.64 ,$428.64 ,$428.64 ,$564.00 , N/A ,$479.40 ,$564.00 ,$366.60 ,"$1,373.18 ",$564.00 ,$315.84 ,"$1,373.18 ",$148.33 , N/A , N/A , N/A ,"$1,441.84 ",$451.20 ,"$3,089.65 ",$254.36 ,$157.92 ,$507.60 ,"$1,373.18 ",$428.64 ,$400.00 ,$400.00 ,$564.00 ,$400.00 ,$270.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45001168,52281,HC CYSTOURETHROSCOPY W/CALIBRATION/DILATION,450,1 ,"$5,378.97 ","$3,496.33 ",$400.00 ,"$5,378.97 ","$4,413.08 ","$2,000.00 ","$3,012.22 ","$1,765.23 ","$1,506.11 ","$1,818.09 ","$1,765.23 ","$2,092.42 ","$1,765.23 ","$2,425.92 ","$2,425.92 ","$1,765.23 ","$2,425.92 ","$3,353.94 ","$1,075.00 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$1,800.54 ","$4,034.23 ","$3,227.38 ","$3,227.38 ","$1,765.23 ","$3,227.38 ","$4,088.02 ","$4,088.02 ","$4,088.02 ","$5,378.97 ", N/A ,"$4,572.12 ","$4,413.08 ","$3,496.33 ","$1,765.23 ","$5,378.97 ","$3,012.22 ","$1,765.23 ","$1,414.67 ", N/A , N/A , N/A ,"$1,853.49 ","$4,303.18 ","$3,971.77 ","$2,425.92 ","$1,506.11 ","$4,841.07 ","$1,765.23 ","$4,088.02 ",$400.00 ,$400.00 ,"$1,765.23 ",$400.00 ,"$2,581.91 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001169,54235,HC INJ PENILE W/RX AGENT,450,1 ,$635.00 ,$412.75 ,$167.01 ,$655.88 ,$655.88 ,$292.10 ,$355.60 ,$262.35 ,$177.80 ,$214.63 ,$262.35 ,$247.02 ,$262.35 ,$286.39 ,$286.39 ,$262.35 ,$286.39 ,$498.46 ,$317.50 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,$476.25 ,$381.00 ,$381.00 ,$262.35 ,$381.00 ,$482.60 ,$482.60 ,$482.60 ,$635.00 , N/A ,$539.75 ,$635.00 ,$412.75 ,$262.35 ,$635.00 ,$355.60 ,$262.35 ,$167.01 , N/A , N/A , N/A ,$275.47 ,$508.00 ,$590.28 ,$286.39 ,$177.80 ,$571.50 ,$262.35 ,$482.60 ,$400.00 ,$400.00 ,$262.35 ,$400.00 ,$304.80 , N/A 
ST. ELIZABETH'S HOSPITAL,45001228,69020,HC DRAIN EXT AUDITORY CANAL,450,1 ,"$2,278.00 ","$1,480.70 ",$400.00 ,"$2,278.00 ","$1,533.75 ","$1,047.88 ","$1,275.68 ",$613.50 ,$637.84 ,$769.96 ,$613.50 ,$886.14 ,$613.50 ,"$1,027.38 ","$1,027.38 ",$613.50 ,"$1,027.38 ","$1,165.65 ","$1,075.00 ","$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,"$1,708.50 ","$1,366.80 ","$1,366.80 ",$613.50 ,"$1,366.80 ","$1,731.28 ","$1,731.28 ","$1,731.28 ","$2,278.00 ", N/A ,"$1,936.30 ","$1,533.75 ","$1,480.70 ",$613.50 ,"$2,278.00 ","$1,275.68 ",$613.50 ,$599.11 , N/A , N/A , N/A ,$644.18 ,"$1,822.40 ","$1,380.37 ","$1,027.38 ",$637.84 ,"$2,050.20 ",$613.50 ,"$1,731.28 ",$400.00 ,$400.00 ,$613.50 ,$400.00 ,"$1,093.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001272,23665,HC TX FX DISLOC SHOULDER HUMERW/MANIP,450,1 ,"$5,395.00 ","$3,506.75 ",$400.00 ,"$5,395.00 ","$3,432.95 ","$2,000.00 ","$3,021.20 ","$1,373.18 ","$1,510.60 ","$1,823.51 ","$1,373.18 ","$2,098.66 ","$1,373.18 ","$2,433.15 ","$2,433.15 ","$1,373.18 ","$2,433.15 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,046.25 ","$3,237.00 ","$3,237.00 ","$1,373.18 ","$3,237.00 ","$4,100.20 ","$4,100.20 ","$4,100.20 ","$5,395.00 ", N/A ,"$4,585.75 ","$3,432.94 ","$3,506.75 ","$1,373.18 ","$5,395.00 ","$3,021.20 ","$1,373.18 ","$1,418.89 ", N/A , N/A , N/A ,"$1,441.84 ","$4,316.00 ","$3,089.65 ","$2,433.15 ","$1,510.60 ","$4,855.50 ","$1,373.18 ","$4,100.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,589.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001273,23675,HC TX FX DISLOC SHOULDER W/PROX HUM W/MANIP,450,1 ,"$4,663.00 ","$3,030.95 ",$400.00 ,"$4,663.00 ","$3,432.95 ","$2,000.00 ","$2,611.28 ","$1,373.18 ","$1,305.64 ","$1,576.09 ","$1,373.18 ","$1,813.91 ","$1,373.18 ","$2,103.01 ","$2,103.01 ","$1,373.18 ","$2,103.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,497.25 ","$2,797.80 ","$2,797.80 ","$1,373.18 ","$2,797.80 ","$3,543.88 ","$3,543.88 ","$3,543.88 ","$4,663.00 ", N/A ,"$3,963.55 ","$3,432.94 ","$3,030.95 ","$1,373.18 ","$4,663.00 ","$2,611.28 ","$1,373.18 ","$1,226.37 ", N/A , N/A , N/A ,"$1,441.84 ","$3,730.40 ","$3,089.65 ","$2,103.01 ","$1,305.64 ","$4,196.70 ","$1,373.18 ","$3,543.88 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,238.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001274,24500,HC TX FX HUMERUS SHAFT W/O MANIP CLOSED,450,1 ,"$1,184.00 ",$769.60 ,$203.20 ,"$1,184.00 ",$508.00 ,$544.64 ,$663.04 ,$203.20 ,$331.52 ,$400.19 ,$203.20 ,$460.58 ,$203.20 ,$533.98 ,$533.98 ,$203.20 ,$533.98 ,$386.08 ,$592.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$888.00 ,$710.40 ,$710.40 ,$203.20 ,$710.40 ,$899.84 ,$899.84 ,$899.84 ,"$1,184.00 ", N/A ,"$1,006.40 ",$508.00 ,$769.60 ,$203.20 ,"$1,184.00 ",$663.04 ,$203.20 ,$311.39 , N/A , N/A , N/A ,$213.36 ,$947.20 ,$457.20 ,$533.98 ,$331.52 ,"$1,065.60 ",$203.20 ,$899.84 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$568.32 , N/A 
ST. ELIZABETH'S HOSPITAL,45001277,24577,HC TX FX HUMERUS CONDYLAR W/MANIP CLOSED,450,1 ,"$4,758.00 ","$3,092.70 ",$400.00 ,"$4,758.00 ","$3,432.95 ","$2,000.00 ","$2,664.48 ","$1,373.18 ","$1,332.24 ","$1,608.20 ","$1,373.18 ","$1,850.86 ","$1,373.18 ","$2,145.86 ","$2,145.86 ","$1,373.18 ","$2,145.86 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,568.50 ","$2,854.80 ","$2,854.80 ","$1,373.18 ","$2,854.80 ","$3,616.08 ","$3,616.08 ","$3,616.08 ","$4,758.00 ", N/A ,"$4,044.30 ","$3,432.94 ","$3,092.70 ","$1,373.18 ","$4,758.00 ","$2,664.48 ","$1,373.18 ","$1,251.35 ", N/A , N/A , N/A ,"$1,441.84 ","$3,806.40 ","$3,089.65 ","$2,145.86 ","$1,332.24 ","$4,282.20 ","$1,373.18 ","$3,616.08 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,283.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001279,25260,HC REPAIR TEND/MUSC/FLEXOR FOREARM/WRIST PRIMARY,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$6,979.95 ","$2,000.00 ","$4,320.96 ","$2,791.98 ","$2,160.48 ","$2,282.50 ","$2,791.98 ","$3,001.52 ","$2,791.98 ","$3,479.92 ","$3,479.92 ","$2,791.98 ","$3,479.92 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$2,791.98 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$6,979.94 ","$5,015.40 ","$2,791.98 ","$7,716.00 ","$4,320.96 ","$2,791.98 ","$2,029.31 ", N/A , N/A , N/A ,"$2,931.58 ","$6,172.80 ","$6,281.95 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001280,25270,HC REPAIR TEND/MUSC/EXTENSOR FOREARM/WRIST PRIMARY,450,1 ,"$7,716.00 ","$5,015.40 ",$400.00 ,"$7,716.00 ","$6,979.95 ","$2,000.00 ","$4,320.96 ","$2,791.98 ","$2,160.48 ","$2,282.50 ","$2,791.98 ","$3,001.52 ","$2,791.98 ","$3,479.92 ","$3,479.92 ","$2,791.98 ","$3,479.92 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$5,787.00 ","$4,629.60 ","$4,629.60 ","$2,791.98 ","$4,629.60 ","$5,864.16 ","$5,864.16 ","$5,864.16 ","$7,716.00 ", N/A ,"$6,558.60 ","$6,979.94 ","$5,015.40 ","$2,791.98 ","$7,716.00 ","$4,320.96 ","$2,791.98 ","$2,029.31 ", N/A , N/A , N/A ,"$2,931.58 ","$6,172.80 ","$6,281.95 ","$3,479.92 ","$2,160.48 ","$6,944.40 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,703.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$3,401.00 ","$2,210.65 ",$400.00 ,"$3,432.95 ","$3,432.95 ","$1,564.46 ","$1,904.56 ","$1,373.18 ",$952.28 ,"$1,149.54 ","$1,373.18 ","$1,322.99 ","$1,373.18 ","$1,533.85 ","$1,533.85 ","$1,373.18 ","$1,533.85 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,550.75 ","$2,040.60 ","$2,040.60 ","$1,373.18 ","$2,040.60 ","$2,584.76 ","$2,584.76 ","$2,584.76 ","$3,401.00 ", N/A ,"$2,890.85 ","$3,401.00 ","$2,210.65 ","$1,373.18 ","$3,401.00 ","$1,904.56 ","$1,373.18 ",$894.46 , N/A , N/A , N/A ,"$1,441.84 ","$2,720.80 ","$3,089.65 ","$1,533.85 ",$952.28 ,"$3,060.90 ","$1,373.18 ","$2,584.76 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,632.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001291,27502,HC TX FX FEMUR W/MAN W/W/O TRACTION,450,1 ,"$4,095.00 ","$2,661.75 ",$400.00 ,"$4,095.00 ","$3,432.95 ","$1,883.70 ","$2,293.20 ","$1,373.18 ","$1,146.60 ","$1,384.11 ","$1,373.18 ","$1,592.96 ","$1,373.18 ","$1,846.85 ","$1,846.85 ","$1,373.18 ","$1,846.85 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,071.25 ","$2,457.00 ","$2,457.00 ","$1,373.18 ","$2,457.00 ","$3,112.20 ","$3,112.20 ","$3,112.20 ","$4,095.00 ", N/A ,"$3,480.75 ","$3,432.94 ","$2,661.75 ","$1,373.18 ","$4,095.00 ","$2,293.20 ","$1,373.18 ","$1,076.99 ", N/A , N/A , N/A ,"$1,441.84 ","$3,276.00 ","$3,089.65 ","$1,846.85 ","$1,146.60 ","$3,685.50 ","$1,373.18 ","$3,112.20 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,965.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001296,27762,HC TX FX CLOSED MEDIAL MALLEOLUS W/MANIP,450,1 ,"$3,964.77 ","$2,577.10 ",$400.00 ,"$3,964.77 ","$3,432.95 ","$1,823.79 ","$2,220.27 ","$1,373.18 ","$1,110.14 ","$1,340.09 ","$1,373.18 ","$1,542.30 ","$1,373.18 ","$1,788.11 ","$1,788.11 ","$1,373.18 ","$1,788.11 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$2,973.58 ","$2,378.86 ","$2,378.86 ","$1,373.18 ","$2,378.86 ","$3,013.23 ","$3,013.23 ","$3,013.23 ","$3,964.77 ", N/A ,"$3,370.05 ","$3,432.94 ","$2,577.10 ","$1,373.18 ","$3,964.77 ","$2,220.27 ","$1,373.18 ","$1,042.73 ", N/A , N/A , N/A ,"$1,441.84 ","$3,171.82 ","$3,089.65 ","$1,788.11 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,013.23 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,903.09 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001298,27816,HC TX FX CLOSED TRIMALLEOLAR ANKLE W/O MANIP,450,1 ,$705.00 ,$458.25 ,$185.42 ,$705.00 ,$508.00 ,$324.30 ,$394.80 ,$203.20 ,$197.40 ,$238.29 ,$203.20 ,$274.25 ,$203.20 ,$317.96 ,$317.96 ,$203.20 ,$317.96 ,$386.08 ,$352.50 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$528.75 ,$423.00 ,$423.00 ,$203.20 ,$423.00 ,$535.80 ,$535.80 ,$535.80 ,$705.00 , N/A ,$599.25 ,$508.00 ,$458.25 ,$203.20 ,$705.00 ,$394.80 ,$203.20 ,$185.42 , N/A , N/A , N/A ,$213.36 ,$564.00 ,$457.20 ,$317.96 ,$197.40 ,$634.50 ,$203.20 ,$535.80 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$338.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45001299,27824,HC TX FX TIBIA DISTAL WGT BEAR W/MAN W/W/O ANES CLS,450,1 ,$936.00 ,$608.40 ,$203.20 ,$936.00 ,$508.00 ,$430.56 ,$524.16 ,$203.20 ,$262.08 ,$316.37 ,$203.20 ,$364.10 ,$203.20 ,$422.14 ,$422.14 ,$203.20 ,$422.14 ,$386.08 ,$468.00 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$702.00 ,$561.60 ,$561.60 ,$203.20 ,$561.60 ,$711.36 ,$711.36 ,$711.36 ,$936.00 , N/A ,$795.60 ,$508.00 ,$608.40 ,$203.20 ,$936.00 ,$524.16 ,$203.20 ,$246.17 , N/A , N/A , N/A ,$213.36 ,$748.80 ,$457.20 ,$422.14 ,$262.08 ,$842.40 ,$203.20 ,$711.36 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$449.28 , N/A 
ST. ELIZABETH'S HOSPITAL,45001300,27825,HC TX FX TIBIA DISTAL W/MANIP W/W/O ANES,450,1 ,"$5,432.00 ","$3,530.80 ",$400.00 ,"$5,432.00 ","$3,432.95 ","$2,000.00 ","$3,041.92 ","$1,373.18 ","$1,520.96 ","$1,836.02 ","$1,373.18 ","$2,113.05 ","$1,373.18 ","$2,449.83 ","$2,449.83 ","$1,373.18 ","$2,449.83 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$4,074.00 ","$3,259.20 ","$3,259.20 ","$1,373.18 ","$3,259.20 ","$4,128.32 ","$4,128.32 ","$4,128.32 ","$5,432.00 ", N/A ,"$4,617.20 ","$3,432.94 ","$3,530.80 ","$1,373.18 ","$5,432.00 ","$3,041.92 ","$1,373.18 ","$1,428.62 ", N/A , N/A , N/A ,"$1,441.84 ","$4,345.60 ","$3,089.65 ","$2,449.83 ","$1,520.96 ","$4,888.80 ","$1,373.18 ","$4,128.32 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$2,607.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001302,28193,HC REMOVE FB FOOT COMPLICATED,450,1 ,"$8,304.00 ","$5,397.60 ",$400.00 ,"$8,304.00 ","$3,467.90 ","$2,000.00 ","$4,650.24 ","$1,387.16 ","$2,325.12 ","$2,282.50 ","$1,387.16 ","$3,230.26 ","$1,387.16 ","$3,745.10 ","$3,745.10 ","$1,387.16 ","$3,745.10 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$6,228.00 ","$4,982.40 ","$4,982.40 ","$1,387.16 ","$4,982.40 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,304.00 ", N/A ,"$7,058.40 ","$3,467.89 ","$5,397.60 ","$1,387.16 ","$8,304.00 ","$4,650.24 ","$1,387.16 ","$2,183.95 ", N/A , N/A , N/A ,"$1,456.52 ","$6,643.20 ","$3,121.10 ","$3,745.10 ","$2,325.12 ","$7,473.60 ","$1,387.16 ","$5,354.00 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$3,985.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001302,28193,HC REMOVE FB FOOT COMPLICATED,450,1 ,"$5,536.00 ","$3,598.40 ",$400.00 ,"$5,536.00 ","$3,467.90 ","$2,000.00 ","$3,100.16 ","$1,387.16 ","$1,550.08 ","$1,871.17 ","$1,387.16 ","$2,153.50 ","$1,387.16 ","$2,496.74 ","$2,496.74 ","$1,387.16 ","$2,496.74 ","$2,635.59 ","$1,075.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$4,152.00 ","$3,321.60 ","$3,321.60 ","$1,387.16 ","$3,321.60 ","$4,207.36 ","$4,207.36 ","$4,207.36 ","$5,536.00 ", N/A ,"$4,705.60 ","$3,467.89 ","$3,598.40 ","$1,387.16 ","$5,536.00 ","$3,100.16 ","$1,387.16 ","$1,455.97 ", N/A , N/A , N/A ,"$1,456.52 ","$4,428.80 ","$3,121.10 ","$2,496.74 ","$1,550.08 ","$4,982.40 ","$1,387.16 ","$4,207.36 ",$400.00 ,$400.00 ,"$1,387.16 ",$400.00 ,"$2,657.28 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001303,28208,HC REPAIR TENDON EXTENSOR FOOT,450,1 ,"$8,302.00 ","$5,396.30 ",$400.00 ,"$8,302.00 ","$6,979.95 ","$2,000.00 ","$4,649.12 ","$2,791.98 ","$2,324.56 ","$2,282.50 ","$2,791.98 ","$3,229.48 ","$2,791.98 ","$3,744.20 ","$3,744.20 ","$2,791.98 ","$3,744.20 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$6,226.50 ","$4,981.20 ","$4,981.20 ","$2,791.98 ","$4,981.20 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,302.00 ", N/A ,"$7,056.70 ","$6,979.94 ","$5,396.30 ","$2,791.98 ","$8,302.00 ","$4,649.12 ","$2,791.98 ","$2,183.43 ", N/A , N/A , N/A ,"$2,931.58 ","$6,641.60 ","$6,281.95 ","$3,744.20 ","$2,324.56 ","$7,471.80 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,984.96 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001304,28405,HC TX FX CALCANEAL W/MANIP,450,1 ,"$3,396.00 ","$2,207.40 ",$203.20 ,"$3,396.00 ",$508.00 ,"$1,562.16 ","$1,901.76 ",$203.20 ,$950.88 ,"$1,147.85 ",$203.20 ,"$1,321.04 ",$203.20 ,"$1,531.60 ","$1,531.60 ",$203.20 ,"$1,531.60 ",$386.08 ,"$1,075.00 ",$508.00 ,$203.20 ,$203.20 ,$207.26 ,"$2,547.00 ","$2,037.60 ","$2,037.60 ",$203.20 ,"$2,037.60 ","$2,580.96 ","$2,580.96 ","$2,580.96 ","$3,396.00 ", N/A ,"$2,886.60 ",$508.00 ,"$2,207.40 ",$203.20 ,"$3,396.00 ","$1,901.76 ",$203.20 ,$893.15 , N/A , N/A , N/A ,$213.36 ,"$2,716.80 ",$457.20 ,"$1,531.60 ",$950.88 ,"$3,056.40 ",$203.20 ,"$2,580.96 ",$400.00 ,$400.00 ,$203.20 ,$400.00 ,"$1,630.08 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001308,29355,HC APPL LONG LEG CAST WALKING,450,1 ,"$1,042.00 ",$677.30 ,$237.84 ,"$1,042.00 ",$594.60 ,$479.32 ,$583.52 ,$237.84 ,$291.76 ,$352.20 ,$237.84 ,$429.30 ,$237.84 ,$469.94 ,$469.94 ,$237.84 ,$469.94 ,$451.89 ,$521.00 ,$594.59 ,$237.84 ,$237.84 ,$242.59 ,$781.50 ,$625.20 ,$625.20 ,$237.84 ,$625.20 ,$791.92 ,$791.92 ,$791.92 ,"$1,042.00 ", N/A ,$885.70 ,$594.59 ,$677.30 ,$237.84 ,"$1,042.00 ",$583.52 ,$237.84 ,$274.05 , N/A , N/A , N/A ,$249.73 ,$833.60 ,$535.13 ,$469.94 ,$291.76 ,$937.80 ,$237.84 ,$791.92 ,$400.00 ,$400.00 ,$237.84 ,$400.00 ,$500.16 , N/A 
ST. ELIZABETH'S HOSPITAL,45001317,67935,HC REPAIR EYELID WOUND FULL THICKNESS,450,1 ,"$5,548.00 ","$3,606.20 ",$400.00 ,"$5,548.00 ","$4,932.05 ","$2,000.00 ","$3,106.88 ","$1,972.82 ","$1,553.44 ","$1,875.22 ","$1,972.82 ","$2,158.17 ","$1,972.82 ","$2,502.15 ","$2,502.15 ","$1,972.82 ","$2,502.15 ","$3,748.37 ","$1,075.00 ","$4,932.06 ","$1,972.82 ","$1,972.82 ","$2,012.28 ","$4,161.00 ","$3,328.80 ","$3,328.80 ","$1,972.82 ","$3,328.80 ","$4,216.48 ","$4,216.48 ","$4,216.48 ","$5,548.00 ", N/A ,"$4,715.80 ","$4,932.06 ","$3,606.20 ","$1,972.82 ","$5,548.00 ","$3,106.88 ","$1,972.82 ","$1,459.12 ", N/A , N/A , N/A ,"$2,071.46 ","$4,438.40 ","$4,438.86 ","$2,502.15 ","$1,553.44 ","$4,993.20 ","$1,972.82 ","$4,216.48 ",$400.00 ,$400.00 ,"$1,972.82 ",$400.00 ,"$2,663.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$883.00 ,$573.95 ,$232.23 ,$883.00 ,$655.88 ,$406.18 ,$494.48 ,$262.35 ,$247.24 ,$298.45 ,$262.35 ,$343.49 ,$262.35 ,$398.23 ,$398.23 ,$262.35 ,$398.23 ,$498.46 ,$441.50 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,$662.25 ,$529.80 ,$529.80 ,$262.35 ,$529.80 ,$671.08 ,$671.08 ,$671.08 ,$883.00 , N/A ,$750.55 ,$655.86 ,$573.95 ,$262.35 ,$883.00 ,$494.48 ,$262.35 ,$232.23 , N/A , N/A , N/A ,$275.47 ,$706.40 ,$590.28 ,$398.23 ,$247.24 ,$794.70 ,$262.35 ,$671.08 ,$400.00 ,$400.00 ,$262.35 ,$400.00 ,$423.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,$705.00 ,$458.25 ,$185.42 ,$705.00 ,$655.88 ,$324.30 ,$394.80 ,$262.35 ,$197.40 ,$238.29 ,$262.35 ,$274.25 ,$262.35 ,$317.96 ,$317.96 ,$262.35 ,$317.96 ,$498.46 ,$352.50 ,$655.86 ,$262.35 ,$262.35 ,$267.59 ,$528.75 ,$423.00 ,$423.00 ,$262.35 ,$423.00 ,$535.80 ,$535.80 ,$535.80 ,$705.00 , N/A ,$599.25 ,$655.86 ,$458.25 ,$262.35 ,$705.00 ,$394.80 ,$262.35 ,$185.42 , N/A , N/A , N/A ,$275.47 ,$564.00 ,$590.28 ,$317.96 ,$197.40 ,$634.50 ,$262.35 ,$535.80 ,$400.00 ,$400.00 ,$262.35 ,$400.00 ,$338.40 , N/A 
ST. ELIZABETH'S HOSPITAL,45001336,26591,HC REPAIR HAND MUSCLE INTRINSIC,450,1 ,"$8,163.00 ","$5,305.95 ",$400.00 ,"$8,163.00 ","$6,979.95 ","$2,000.00 ","$4,571.28 ","$2,791.98 ","$2,285.64 ","$2,282.50 ","$2,791.98 ","$3,175.41 ","$2,791.98 ","$3,681.51 ","$3,681.51 ","$2,791.98 ","$3,681.51 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$6,122.25 ","$4,897.80 ","$4,897.80 ","$2,791.98 ","$4,897.80 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,163.00 ", N/A ,"$6,938.55 ","$6,979.94 ","$5,305.95 ","$2,791.98 ","$8,163.00 ","$4,571.28 ","$2,791.98 ","$2,146.87 ", N/A , N/A , N/A ,"$2,931.58 ","$6,530.40 ","$6,281.95 ","$3,681.51 ","$2,285.64 ","$7,346.70 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$3,918.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001338,41251,HC RPR LAC MOUTH/TONGUE POSTERIOR 1/3,450,1 ,$808.00 ,$525.20 ,$208.58 ,$808.00 ,$521.45 ,$371.68 ,$452.48 ,$208.58 ,$226.24 ,$273.10 ,$208.58 ,$314.31 ,$208.58 ,$364.41 ,$364.41 ,$208.58 ,$364.41 ,$396.30 ,$404.00 ,$521.44 ,$208.58 ,$208.58 ,$212.75 ,$606.00 ,$484.80 ,$484.80 ,$208.58 ,$484.80 ,$614.08 ,$614.08 ,$614.08 ,$808.00 , N/A ,$686.80 ,$521.44 ,$525.20 ,$208.58 ,$808.00 ,$452.48 ,$208.58 ,$212.50 , N/A , N/A , N/A ,$219.01 ,$646.40 ,$469.30 ,$364.41 ,$226.24 ,$727.20 ,$208.58 ,$614.08 ,$400.00 ,$400.00 ,$208.58 ,$400.00 ,$387.84 , N/A 
ST. ELIZABETH'S HOSPITAL,45001341,42720,HC I AND D ABSCESS PHARYNGEAL INTRAORAL APPROACH,450,1 ,"$9,429.00 ","$6,128.85 ",$400.00 ,"$9,429.00 ","$6,742.70 ","$2,000.00 ","$5,280.24 ","$2,697.08 ","$2,640.12 ","$2,282.50 ","$2,697.08 ","$3,667.88 ","$2,697.08 ","$4,252.48 ","$4,252.48 ","$2,697.08 ","$4,252.48 ","$5,124.46 ","$1,075.00 ","$6,742.71 ","$2,697.08 ","$2,697.08 ","$2,751.03 ","$7,071.75 ","$5,657.40 ","$5,657.40 ","$2,697.08 ","$5,657.40 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$9,429.00 ", N/A ,"$8,014.65 ","$6,742.71 ","$6,128.85 ","$2,697.08 ","$9,429.00 ","$5,280.24 ","$2,697.08 ","$2,479.83 ", N/A , N/A , N/A ,"$2,831.93 ","$7,543.20 ","$6,068.44 ","$4,252.48 ","$2,640.12 ","$8,486.10 ","$2,697.08 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,697.08 ",$400.00 ,"$4,525.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001343,37799,HC REPAIR/SUTURE MINOR VESSEL,450,1 ,"$1,860.00 ","$1,209.00 ",$400.00 ,"$1,860.00 ","$1,332.25 ",$855.60 ,"$1,041.60 ",$532.90 ,$520.80 ,$628.68 ,$532.90 ,$723.54 ,$532.90 ,$838.86 ,$838.86 ,$532.90 ,$838.86 ,"$1,012.50 ",$930.00 ,"$1,332.24 ",$532.90 ,$532.90 ,$543.55 ,"$1,395.00 ","$1,116.00 ","$1,116.00 ",$532.90 ,"$1,116.00 ","$1,413.60 ","$1,413.60 ","$1,413.60 ","$1,860.00 ", N/A ,"$1,581.00 ","$1,332.24 ","$1,209.00 ",$532.90 ,"$1,860.00 ","$1,041.60 ",$532.90 ,$489.18 , N/A , N/A , N/A ,$559.55 ,"$1,488.00 ","$1,199.01 ",$838.86 ,$520.80 ,"$1,674.00 ",$532.90 ,"$1,413.60 ",$400.00 ,$400.00 ,$532.90 ,$400.00 ,$892.80 , N/A 
ST. ELIZABETH'S HOSPITAL,45001347,27503,HC CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,450,1 ,"$4,042.00 ","$2,627.30 ",$400.00 ,"$4,042.00 ","$3,432.95 ","$1,859.32 ","$2,263.52 ","$1,373.18 ","$1,131.76 ","$1,366.20 ","$1,373.18 ","$1,572.34 ","$1,373.18 ","$1,822.94 ","$1,822.94 ","$1,373.18 ","$1,822.94 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$3,031.50 ","$2,425.20 ","$2,425.20 ","$1,373.18 ","$2,425.20 ","$3,071.92 ","$3,071.92 ","$3,071.92 ","$4,042.00 ", N/A ,"$3,435.70 ","$3,432.94 ","$2,627.30 ","$1,373.18 ","$4,042.00 ","$2,263.52 ","$1,373.18 ","$1,063.05 ", N/A , N/A , N/A ,"$1,441.84 ","$3,233.60 ","$3,089.65 ","$1,822.94 ","$1,131.76 ","$3,637.80 ","$1,373.18 ","$3,071.92 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$1,940.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001350,P9612,HC STRAIGHT CATH FOR URINE SPECIMEN,450,1 ,$201.00 ,$130.65 ,$3.00 ,$201.00 ,$7.50 ,$92.46 ,$112.56 ,$3.00 ,$56.28 ,$67.94 ,$3.00 ,$18.21 ,$3.00 ,$90.65 ,$90.65 ,$3.00 ,$90.65 ,$5.70 ,$100.50 ,$7.50 ,$3.00 ,$3.00 ,$3.06 ,$150.75 ,$120.60 ,$120.60 ,$3.00 ,$120.60 ,$152.76 ,$152.76 ,$152.76 ,$201.00 , N/A ,$170.85 ,$7.50 ,$130.65 ,$3.00 ,$201.00 ,$112.56 ,$3.00 ,$52.86 , N/A , N/A , N/A ,$3.15 ,$160.80 ,$6.75 ,$90.65 ,$56.28 ,$180.90 ,$3.00 ,$152.76 ,$201.00 ,$201.00 ,$3.00 ,$201.00 ,$96.48 , N/A 
ST. ELIZABETH'S HOSPITAL,45001352,26545,HC RECONSTRUCT FINGER JOINT,450,1 ,"$9,417.00 ","$6,121.05 ",$400.00 ,"$9,417.00 ","$6,979.95 ","$2,000.00 ","$5,273.52 ","$2,791.98 ","$2,636.76 ","$2,282.50 ","$2,791.98 ","$3,663.21 ","$2,791.98 ","$4,247.07 ","$4,247.07 ","$2,791.98 ","$4,247.07 ","$5,304.75 ","$1,075.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$2,847.82 ","$7,062.75 ","$5,650.20 ","$5,650.20 ","$2,791.98 ","$5,650.20 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$9,417.00 ", N/A ,"$8,004.45 ","$6,979.94 ","$6,121.05 ","$2,791.98 ","$9,417.00 ","$5,273.52 ","$2,791.98 ","$2,476.67 ", N/A , N/A , N/A ,"$2,931.58 ","$7,533.60 ","$6,281.95 ","$4,247.07 ","$2,636.76 ","$8,475.30 ","$2,791.98 ","$5,354.00 ",$400.00 ,$400.00 ,"$2,791.98 ",$400.00 ,"$4,520.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,45001355,25660,HC CLTX RDCRPL/INTERCARPL DISLC 1 >BONES W MAN,450,1 ,$587.13 ,$381.63 ,$154.42 ,$587.13 ,$508.00 ,$270.08 ,$328.79 ,$203.20 ,$164.40 ,$198.45 ,$203.20 ,$228.39 ,$203.20 ,$264.80 ,$264.80 ,$203.20 ,$264.80 ,$386.08 ,$293.57 ,$508.00 ,$203.20 ,$203.20 ,$207.26 ,$440.35 ,$352.28 ,$352.28 ,$203.20 ,$352.28 ,$446.22 ,$446.22 ,$446.22 ,$587.13 , N/A ,$499.06 ,$508.00 ,$381.63 ,$203.20 ,$587.13 ,$328.79 ,$203.20 ,$154.42 , N/A , N/A , N/A ,$213.36 ,$469.70 ,$457.20 ,$264.80 ,$164.40 ,$528.42 ,$203.20 ,$446.22 ,$400.00 ,$400.00 ,$203.20 ,$400.00 ,$281.82 , N/A 
ST. ELIZABETH'S HOSPITAL,45001360,31577,HC LARYNGOSCOPY FLX RMVL FOREIGN BODY(S),450,1 ,"$1,072.14 ",$696.89 ,$281.97 ,"$1,072.14 ",$926.43 ,$493.18 ,$600.40 ,$370.57 ,$300.20 ,$362.38 ,$370.57 ,$417.06 ,$370.57 ,$483.54 ,$483.54 ,$370.57 ,$483.54 ,$704.08 ,$536.07 ,$926.42 ,$370.57 ,$370.57 ,$377.98 ,$804.11 ,$643.28 ,$643.28 ,$370.57 ,$643.28 ,$814.83 ,$814.83 ,$814.83 ,"$1,072.14 ", N/A ,$911.32 ,$926.42 ,$696.89 ,$370.57 ,"$1,072.14 ",$600.40 ,$370.57 ,$281.97 , N/A , N/A , N/A ,$389.10 ,$857.71 ,$833.78 ,$483.54 ,$300.20 ,$964.93 ,$370.57 ,$814.83 ,$400.00 ,$400.00 ,$370.57 ,$400.00 ,$514.63 , N/A 
ST. ELIZABETH'S HOSPITAL,45080002,42000,HC I AND D PALATE OR UVULA,450,1 ,"$1,577.00 ","$1,025.05 ",$208.58 ,"$1,577.00 ",$521.45 ,$725.42 ,$883.12 ,$208.58 ,$441.56 ,$533.03 ,$208.58 ,$613.45 ,$208.58 ,$711.23 ,$711.23 ,$208.58 ,$711.23 ,$396.30 ,$788.50 ,$521.44 ,$208.58 ,$208.58 ,$212.75 ,"$1,182.75 ",$946.20 ,$946.20 ,$208.58 ,$946.20 ,"$1,198.52 ","$1,198.52 ","$1,198.52 ","$1,577.00 ", N/A ,"$1,340.45 ",$521.44 ,"$1,025.05 ",$208.58 ,"$1,577.00 ",$883.12 ,$208.58 ,$414.75 , N/A , N/A , N/A ,$219.01 ,"$1,261.60 ",$469.30 ,$711.23 ,$441.56 ,"$1,419.30 ",$208.58 ,"$1,198.52 ",$400.00 ,$400.00 ,$208.58 ,$400.00 ,$756.96 , N/A 
ST. ELIZABETH'S HOSPITAL,45080003,59409,HC DELIVERY VAGINAL,450,1 ,"$6,089.00 ","$3,957.85 ",$400.00 ,"$6,466.58 ","$6,466.58 ","$2,000.00 ","$3,409.84 ","$2,586.63 ","$1,704.92 ","$2,058.08 ","$2,586.63 ","$2,368.62 ","$2,586.63 ","$2,746.14 ","$2,746.14 ","$2,586.63 ","$2,746.14 ","$4,914.60 ","$1,075.00 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$4,566.75 ","$3,653.40 ","$3,653.40 ","$2,586.63 ","$3,653.40 ","$4,627.64 ","$4,627.64 ","$4,627.64 ","$6,089.00 ", N/A ,"$5,175.65 ","$6,089.00 ","$3,957.85 ","$2,586.63 ","$6,089.00 ","$3,409.84 ","$2,586.63 ","$1,601.41 ", N/A , N/A , N/A ,"$2,715.96 ","$4,871.20 ","$5,819.92 ","$2,746.14 ","$1,704.92 ","$5,480.10 ","$2,586.63 ","$4,627.64 ",$400.00 ,$400.00 ,"$2,586.63 ",$400.00 ,"$2,922.72 ", N/A 
ST. ELIZABETH'S HOSPITAL,45080004,23605,HC CLOSED RX PROX HUMERUS FX MANIP,450,1 ,"$8,357.00 ","$5,432.05 ",$400.00 ,"$8,357.00 ","$3,432.95 ","$2,000.00 ","$4,679.92 ","$1,373.18 ","$2,339.96 ","$2,282.50 ","$1,373.18 ","$3,250.87 ","$1,373.18 ","$3,769.01 ","$3,769.01 ","$1,373.18 ","$3,769.01 ","$2,609.04 ","$1,075.00 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$1,400.64 ","$6,267.75 ","$5,014.20 ","$5,014.20 ","$1,373.18 ","$5,014.20 ","$5,949.00 ","$5,949.00 ","$5,949.00 ","$8,357.00 ", N/A ,"$7,103.45 ","$3,432.94 ","$5,432.05 ","$1,373.18 ","$8,357.00 ","$4,679.92 ","$1,373.18 ","$2,197.89 ", N/A , N/A , N/A ,"$1,441.84 ","$6,685.60 ","$3,089.65 ","$3,769.01 ","$2,339.96 ","$7,521.30 ","$1,373.18 ","$5,354.00 ",$400.00 ,$400.00 ,"$1,373.18 ",$400.00 ,"$4,011.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,45600006,G0380,HC URGENT CARE NEW LEVEL 1,456,1 ,$345.00 ,$224.25 ,$69.64 ,$345.00 ,$174.10 ,$158.70 ,$193.20 ,$69.64 ,$96.60 ,$116.61 ,$69.64 ,$134.21 ,$69.64 ,$155.60 ,$155.60 ,$69.64 ,$155.60 ,$132.31 ,$172.50 ,$174.10 ,$69.64 ,$69.64 ,$71.03 ,$258.75 ,$207.00 ,$207.00 ,$69.64 ,$207.00 ,$262.20 ,$262.20 ,$262.20 ,$345.00 , N/A ,$293.25 ,$174.10 ,$224.25 ,$69.64 ,$345.00 ,$193.20 ,$69.64 ,$90.74 , N/A , N/A , N/A ,$73.12 ,$276.00 ,$156.69 ,$155.60 ,$96.60 ,$310.50 ,$69.64 ,$262.20 ,$345.00 ,$345.00 ,$69.64 ,$345.00 ,$165.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45600007,G0381,HC URGENT CARE NEW LEVEL 2,456,1 ,$415.00 ,$269.75 ,$94.36 ,$415.00 ,$235.90 ,$190.90 ,$232.40 ,$94.36 ,$116.20 ,$140.27 ,$94.36 ,$161.44 ,$94.36 ,$187.17 ,$187.17 ,$94.36 ,$187.17 ,$179.28 ,$207.50 ,$235.90 ,$94.36 ,$94.36 ,$96.25 ,$311.25 ,$249.00 ,$249.00 ,$94.36 ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 ,$235.90 ,$269.75 ,$94.36 ,$415.00 ,$232.40 ,$94.36 ,$109.15 , N/A ,$148.24 ,$141.50 ,$99.08 ,$332.00 ,$212.31 ,$187.17 ,$116.20 ,$373.50 ,$94.36 ,$315.40 ,$375.00 ,$375.00 ,$94.36 ,$375.00 ,$199.20 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600008,G0382,HC URGENT CARE NEW LEVEL 3,456,1 ,$502.00 ,$326.30 ,$132.03 ,$502.00 ,$446.13 ,$230.92 ,$281.12 ,$178.45 ,$140.56 ,$169.68 ,$178.45 ,$195.28 ,$178.45 ,$226.40 ,$226.40 ,$178.45 ,$226.40 ,$339.05 ,$251.00 ,$446.12 ,$178.45 ,$178.45 ,$182.02 ,$376.50 ,$301.20 ,$301.20 ,$178.45 ,$301.20 ,$381.52 ,$381.52 ,$381.52 ,$502.00 , N/A ,$426.70 ,$446.12 ,$326.30 ,$178.45 ,$502.00 ,$281.12 ,$178.45 ,$132.03 , N/A ,$148.24 ,$141.50 ,$187.37 ,$401.60 ,$401.51 ,$226.40 ,$140.56 ,$451.80 ,$178.45 ,$381.52 ,$375.00 ,$375.00 ,$178.45 ,$375.00 ,$240.96 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600009,G0383,HC URGENT CARE NEW LEVEL 4,456,1 ,$723.00 ,$469.95 ,$190.15 ,$723.00 ,$563.63 ,$332.58 ,$404.88 ,$225.45 ,$202.44 ,$244.37 ,$225.45 ,$281.25 ,$225.45 ,$326.07 ,$326.07 ,$225.45 ,$326.07 ,$428.36 ,$254.00 ,$563.63 ,$225.45 ,$225.45 ,$229.96 ,$542.25 ,$433.80 ,$433.80 ,$225.45 ,$433.80 ,$487.00 ,$487.00 ,$487.00 ,$723.00 , N/A ,$614.55 ,$563.63 ,$469.95 ,$225.45 ,$723.00 ,$404.88 ,$225.45 ,$190.15 , N/A , N/A , N/A ,$236.72 ,$578.40 ,$507.26 ,$326.07 ,$202.44 ,$650.70 ,$225.45 ,$438.00 ,$375.00 ,$375.00 ,$225.45 ,$375.00 ,$347.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45600010,G0384,HC URGENT CARE NEW LEVEL 5,456,1 ,$889.00 ,$577.85 ,$233.81 ,$889.00 ,$785.45 ,$408.94 ,$497.84 ,$314.18 ,$248.92 ,$300.48 ,$314.18 ,$345.82 ,$314.18 ,$400.94 ,$400.94 ,$314.18 ,$400.94 ,$596.95 ,$254.00 ,$785.46 ,$314.18 ,$314.18 ,$320.47 ,$666.75 ,$533.40 ,$533.40 ,$314.18 ,$533.40 ,$487.00 ,$487.00 ,$487.00 ,$889.00 , N/A ,$755.65 ,$785.46 ,$577.85 ,$314.18 ,$889.00 ,$497.84 ,$314.18 ,$233.81 , N/A , N/A , N/A ,$329.89 ,$711.20 ,$706.91 ,$400.94 ,$248.92 ,$800.10 ,$314.18 ,$438.00 ,$375.00 ,$375.00 ,$314.18 ,$375.00 ,$426.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45600011,G0380,HC URGENT CARE LEVEL 1,456,1 ,$345.00 ,$224.25 ,$69.64 ,$345.00 ,$174.10 ,$158.70 ,$193.20 ,$69.64 ,$96.60 ,$116.61 ,$69.64 ,$134.21 ,$69.64 ,$155.60 ,$155.60 ,$69.64 ,$155.60 ,$132.31 ,$172.50 ,$174.10 ,$69.64 ,$69.64 ,$71.03 ,$258.75 ,$207.00 ,$207.00 ,$69.64 ,$207.00 ,$262.20 ,$262.20 ,$262.20 ,$345.00 , N/A ,$293.25 ,$174.10 ,$224.25 ,$69.64 ,$345.00 ,$193.20 ,$69.64 ,$90.74 , N/A , N/A , N/A ,$73.12 ,$276.00 ,$156.69 ,$155.60 ,$96.60 ,$310.50 ,$69.64 ,$262.20 ,$345.00 ,$345.00 ,$69.64 ,$345.00 ,$165.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45600012,G0381,HC URGENT CARE LEVEL 2,456,1 ,$415.00 ,$269.75 ,$94.36 ,$415.00 ,$235.90 ,$190.90 ,$232.40 ,$94.36 ,$116.20 ,$140.27 ,$94.36 ,$161.44 ,$94.36 ,$187.17 ,$187.17 ,$94.36 ,$187.17 ,$179.28 ,$207.50 ,$235.90 ,$94.36 ,$94.36 ,$96.25 ,$311.25 ,$249.00 ,$249.00 ,$94.36 ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 ,$235.90 ,$269.75 ,$94.36 ,$415.00 ,$232.40 ,$94.36 ,$109.15 , N/A ,$148.24 ,$141.50 ,$99.08 ,$332.00 ,$212.31 ,$187.17 ,$116.20 ,$373.50 ,$94.36 ,$315.40 ,$375.00 ,$375.00 ,$94.36 ,$375.00 ,$199.20 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600013,G0382,HC URGENT CARE LEVEL 3,456,1 ,$502.00 ,$326.30 ,$132.03 ,$502.00 ,$446.13 ,$230.92 ,$281.12 ,$178.45 ,$140.56 ,$169.68 ,$178.45 ,$195.28 ,$178.45 ,$226.40 ,$226.40 ,$178.45 ,$226.40 ,$339.05 ,$251.00 ,$446.12 ,$178.45 ,$178.45 ,$182.02 ,$376.50 ,$301.20 ,$301.20 ,$178.45 ,$301.20 ,$381.52 ,$381.52 ,$381.52 ,$502.00 , N/A ,$426.70 ,$446.12 ,$326.30 ,$178.45 ,$502.00 ,$281.12 ,$178.45 ,$132.03 , N/A ,$148.24 ,$141.50 ,$187.37 ,$401.60 ,$401.51 ,$226.40 ,$140.56 ,$451.80 ,$178.45 ,$381.52 ,$375.00 ,$375.00 ,$178.45 ,$375.00 ,$240.96 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600014,G0383,HC URGENT CARE LEVEL 4,456,1 ,$723.00 ,$469.95 ,$190.15 ,$723.00 ,$563.63 ,$332.58 ,$404.88 ,$225.45 ,$202.44 ,$244.37 ,$225.45 ,$281.25 ,$225.45 ,$326.07 ,$326.07 ,$225.45 ,$326.07 ,$428.36 ,$254.00 ,$563.63 ,$225.45 ,$225.45 ,$229.96 ,$542.25 ,$433.80 ,$433.80 ,$225.45 ,$433.80 ,$487.00 ,$487.00 ,$487.00 ,$723.00 , N/A ,$614.55 ,$563.63 ,$469.95 ,$225.45 ,$723.00 ,$404.88 ,$225.45 ,$190.15 , N/A , N/A , N/A ,$236.72 ,$578.40 ,$507.26 ,$326.07 ,$202.44 ,$650.70 ,$225.45 ,$438.00 ,$375.00 ,$375.00 ,$225.45 ,$375.00 ,$347.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45600015,G0384,HC URGENT CARE LEVEL 5,456,1 ,$889.00 ,$577.85 ,$233.81 ,$889.00 ,$785.45 ,$408.94 ,$497.84 ,$314.18 ,$248.92 ,$300.48 ,$314.18 ,$345.82 ,$314.18 ,$400.94 ,$400.94 ,$314.18 ,$400.94 ,$596.95 ,$254.00 ,$785.46 ,$314.18 ,$314.18 ,$320.47 ,$666.75 ,$533.40 ,$533.40 ,$314.18 ,$533.40 ,$487.00 ,$487.00 ,$487.00 ,$889.00 , N/A ,$755.65 ,$785.46 ,$577.85 ,$314.18 ,$889.00 ,$497.84 ,$314.18 ,$233.81 , N/A , N/A , N/A ,$329.89 ,$711.20 ,$706.91 ,$400.94 ,$248.92 ,$800.10 ,$314.18 ,$438.00 ,$375.00 ,$375.00 ,$314.18 ,$375.00 ,$426.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45600016,G0380,HC URGENT CARE NEW LEVEL 1-25,456,1 ,$345.00 ,$224.25 ,$69.64 ,$345.00 ,$174.10 ,$158.70 ,$193.20 ,$69.64 ,$96.60 ,$116.61 ,$69.64 ,$134.21 ,$69.64 ,$155.60 ,$155.60 ,$69.64 ,$155.60 ,$132.31 ,$172.50 ,$174.10 ,$69.64 ,$69.64 ,$71.03 ,$258.75 ,$207.00 ,$207.00 ,$69.64 ,$207.00 ,$262.20 ,$262.20 ,$262.20 ,$345.00 , N/A ,$293.25 ,$174.10 ,$224.25 ,$69.64 ,$345.00 ,$193.20 ,$69.64 ,$90.74 , N/A , N/A , N/A ,$73.12 ,$276.00 ,$156.69 ,$155.60 ,$96.60 ,$310.50 ,$69.64 ,$262.20 ,$345.00 ,$345.00 ,$69.64 ,$345.00 ,$165.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45600017,G0381,HC URGENT CARE NEW LEVEL 2-25,456,1 ,$415.00 ,$269.75 ,$94.36 ,$415.00 ,$235.90 ,$190.90 ,$232.40 ,$94.36 ,$116.20 ,$140.27 ,$94.36 ,$161.44 ,$94.36 ,$187.17 ,$187.17 ,$94.36 ,$187.17 ,$179.28 ,$207.50 ,$235.90 ,$94.36 ,$94.36 ,$96.25 ,$311.25 ,$249.00 ,$249.00 ,$94.36 ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 ,$235.90 ,$269.75 ,$94.36 ,$415.00 ,$232.40 ,$94.36 ,$109.15 , N/A ,$148.24 ,$141.50 ,$99.08 ,$332.00 ,$212.31 ,$187.17 ,$116.20 ,$373.50 ,$94.36 ,$315.40 ,$375.00 ,$375.00 ,$94.36 ,$375.00 ,$199.20 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600018,G0382,HC URGENT CARE NEW LEVEL 3-25,456,1 ,$502.00 ,$326.30 ,$132.03 ,$502.00 ,$446.13 ,$230.92 ,$281.12 ,$178.45 ,$140.56 ,$169.68 ,$178.45 ,$195.28 ,$178.45 ,$226.40 ,$226.40 ,$178.45 ,$226.40 ,$339.05 ,$251.00 ,$446.12 ,$178.45 ,$178.45 ,$182.02 ,$376.50 ,$301.20 ,$301.20 ,$178.45 ,$301.20 ,$381.52 ,$381.52 ,$381.52 ,$502.00 , N/A ,$426.70 ,$446.12 ,$326.30 ,$178.45 ,$502.00 ,$281.12 ,$178.45 ,$132.03 , N/A ,$148.24 ,$141.50 ,$187.37 ,$401.60 ,$401.51 ,$226.40 ,$140.56 ,$451.80 ,$178.45 ,$381.52 ,$375.00 ,$375.00 ,$178.45 ,$375.00 ,$240.96 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600019,G0383,HC URGENT CARE NEW LEVEL 4-25,456,1 ,$723.00 ,$469.95 ,$190.15 ,$723.00 ,$563.63 ,$332.58 ,$404.88 ,$225.45 ,$202.44 ,$244.37 ,$225.45 ,$281.25 ,$225.45 ,$326.07 ,$326.07 ,$225.45 ,$326.07 ,$428.36 ,$254.00 ,$563.63 ,$225.45 ,$225.45 ,$229.96 ,$542.25 ,$433.80 ,$433.80 ,$225.45 ,$433.80 ,$487.00 ,$487.00 ,$487.00 ,$723.00 , N/A ,$614.55 ,$563.63 ,$469.95 ,$225.45 ,$723.00 ,$404.88 ,$225.45 ,$190.15 , N/A , N/A , N/A ,$236.72 ,$578.40 ,$507.26 ,$326.07 ,$202.44 ,$650.70 ,$225.45 ,$438.00 ,$375.00 ,$375.00 ,$225.45 ,$375.00 ,$347.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45600020,G0384,HC URGENT CARE NEW LEVEL 5-25,456,1 ,$889.00 ,$577.85 ,$233.81 ,$889.00 ,$785.45 ,$408.94 ,$497.84 ,$314.18 ,$248.92 ,$300.48 ,$314.18 ,$345.82 ,$314.18 ,$400.94 ,$400.94 ,$314.18 ,$400.94 ,$596.95 ,$254.00 ,$785.46 ,$314.18 ,$314.18 ,$320.47 ,$666.75 ,$533.40 ,$533.40 ,$314.18 ,$533.40 ,$487.00 ,$487.00 ,$487.00 ,$889.00 , N/A ,$755.65 ,$785.46 ,$577.85 ,$314.18 ,$889.00 ,$497.84 ,$314.18 ,$233.81 , N/A , N/A , N/A ,$329.89 ,$711.20 ,$706.91 ,$400.94 ,$248.92 ,$800.10 ,$314.18 ,$438.00 ,$375.00 ,$375.00 ,$314.18 ,$375.00 ,$426.72 , N/A 
ST. ELIZABETH'S HOSPITAL,45600021,G0380,HC URGENT CARE ESTAB LEVEL 1-25,456,1 ,$345.00 ,$224.25 ,$69.64 ,$345.00 ,$174.10 ,$158.70 ,$193.20 ,$69.64 ,$96.60 ,$116.61 ,$69.64 ,$134.21 ,$69.64 ,$155.60 ,$155.60 ,$69.64 ,$155.60 ,$132.31 ,$172.50 ,$174.10 ,$69.64 ,$69.64 ,$71.03 ,$258.75 ,$207.00 ,$207.00 ,$69.64 ,$207.00 ,$262.20 ,$262.20 ,$262.20 ,$345.00 , N/A ,$293.25 ,$174.10 ,$224.25 ,$69.64 ,$345.00 ,$193.20 ,$69.64 ,$90.74 , N/A , N/A , N/A ,$73.12 ,$276.00 ,$156.69 ,$155.60 ,$96.60 ,$310.50 ,$69.64 ,$262.20 ,$345.00 ,$345.00 ,$69.64 ,$345.00 ,$165.60 , N/A 
ST. ELIZABETH'S HOSPITAL,45600022,G0381,HC URGENT CARE ESTAB LEVEL 2-25,456,1 ,$415.00 ,$269.75 ,$94.36 ,$415.00 ,$235.90 ,$190.90 ,$232.40 ,$94.36 ,$116.20 ,$140.27 ,$94.36 ,$161.44 ,$94.36 ,$187.17 ,$187.17 ,$94.36 ,$187.17 ,$179.28 ,$207.50 ,$235.90 ,$94.36 ,$94.36 ,$96.25 ,$311.25 ,$249.00 ,$249.00 ,$94.36 ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 ,$235.90 ,$269.75 ,$94.36 ,$415.00 ,$232.40 ,$94.36 ,$109.15 , N/A ,$148.24 ,$141.50 ,$99.08 ,$332.00 ,$212.31 ,$187.17 ,$116.20 ,$373.50 ,$94.36 ,$315.40 ,$375.00 ,$375.00 ,$94.36 ,$375.00 ,$199.20 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600023,G0382,HC URGENT CARE ESTAB LEVEL 3-25,456,1 ,$502.00 ,$326.30 ,$132.03 ,$502.00 ,$446.13 ,$230.92 ,$281.12 ,$178.45 ,$140.56 ,$169.68 ,$178.45 ,$195.28 ,$178.45 ,$226.40 ,$226.40 ,$178.45 ,$226.40 ,$339.05 ,$251.00 ,$446.12 ,$178.45 ,$178.45 ,$182.02 ,$376.50 ,$301.20 ,$301.20 ,$178.45 ,$301.20 ,$381.52 ,$381.52 ,$381.52 ,$502.00 , N/A ,$426.70 ,$446.12 ,$326.30 ,$178.45 ,$502.00 ,$281.12 ,$178.45 ,$132.03 , N/A ,$148.24 ,$141.50 ,$187.37 ,$401.60 ,$401.51 ,$226.40 ,$140.56 ,$451.80 ,$178.45 ,$381.52 ,$375.00 ,$375.00 ,$178.45 ,$375.00 ,$240.96 ,$134.76 
ST. ELIZABETH'S HOSPITAL,45600024,G0383,HC URGENT CARE ESTAB LEVEL 4-25,456,1 ,$723.00 ,$469.95 ,$190.15 ,$723.00 ,$563.63 ,$332.58 ,$404.88 ,$225.45 ,$202.44 ,$244.37 ,$225.45 ,$281.25 ,$225.45 ,$326.07 ,$326.07 ,$225.45 ,$326.07 ,$428.36 ,$254.00 ,$563.63 ,$225.45 ,$225.45 ,$229.96 ,$542.25 ,$433.80 ,$433.80 ,$225.45 ,$433.80 ,$487.00 ,$487.00 ,$487.00 ,$723.00 , N/A ,$614.55 ,$563.63 ,$469.95 ,$225.45 ,$723.00 ,$404.88 ,$225.45 ,$190.15 , N/A , N/A , N/A ,$236.72 ,$578.40 ,$507.26 ,$326.07 ,$202.44 ,$650.70 ,$225.45 ,$438.00 ,$375.00 ,$375.00 ,$225.45 ,$375.00 ,$347.04 , N/A 
ST. ELIZABETH'S HOSPITAL,45600025,G0384,HC URGENT CARE ESTAB LEVEL 5-25,456,1 ,$889.00 ,$577.85 ,$233.81 ,$889.00 ,$785.45 ,$408.94 ,$497.84 ,$314.18 ,$248.92 ,$300.48 ,$314.18 ,$345.82 ,$314.18 ,$400.94 ,$400.94 ,$314.18 ,$400.94 ,$596.95 ,$254.00 ,$785.46 ,$314.18 ,$314.18 ,$320.47 ,$666.75 ,$533.40 ,$533.40 ,$314.18 ,$533.40 ,$487.00 ,$487.00 ,$487.00 ,$889.00 , N/A ,$755.65 ,$785.46 ,$577.85 ,$314.18 ,$889.00 ,$497.84 ,$314.18 ,$233.81 , N/A , N/A , N/A ,$329.89 ,$711.20 ,$706.91 ,$400.94 ,$248.92 ,$800.10 ,$314.18 ,$438.00 ,$375.00 ,$375.00 ,$314.18 ,$375.00 ,$426.72 , N/A 
ST. ELIZABETH'S HOSPITAL,46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$463.00 ,$300.95 ,$22.73 ,$463.00 ,$344.13 ,$212.98 ,$259.28 ,$137.65 ,$129.64 ,$163.44 ,$137.65 ,$190.76 ,$137.65 ,$208.81 ,$208.81 ,$137.65 ,$22.73 ,$261.53 ,$231.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$347.25 ,$277.80 ,$277.80 ,$137.65 ,$277.80 ,$351.88 ,$351.88 ,$351.88 ,$463.00 , N/A ,$393.55 ,$344.11 ,$300.95 ,$137.65 ,$463.00 ,$259.28 ,$137.65 ,$121.77 , N/A ,$78.85 ,$75.26 ,$144.53 ,$370.40 ,$309.70 ,$208.81 ,$129.64 ,$416.70 ,$137.65 ,$351.88 ,$463.00 ,$463.00 ,$137.65 ,$463.00 ,$222.24 ,$71.68 
ST. ELIZABETH'S HOSPITAL,46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$653.00 ,$424.45 ,$34.95 ,$653.00 ,$652.30 ,$300.38 ,$365.68 ,$260.92 ,$182.84 ,$230.51 ,$260.92 ,$269.04 ,$260.92 ,$294.50 ,$294.50 ,$260.92 ,$34.95 ,$495.74 ,$326.50 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$489.75 ,$391.80 ,$391.80 ,$260.92 ,$391.80 ,$496.28 ,$496.28 ,$496.28 ,$653.00 , N/A ,$555.05 ,$652.29 ,$424.45 ,$260.92 ,$653.00 ,$365.68 ,$260.92 ,$171.74 , N/A ,$78.85 ,$75.26 ,$273.97 ,$522.40 ,$587.06 ,$294.50 ,$182.84 ,$587.70 ,$260.92 ,$496.28 ,$653.00 ,$653.00 ,$260.92 ,$653.00 ,$313.44 ,$71.68 
ST. ELIZABETH'S HOSPITAL,46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,"$1,258.00 ",$817.70 ,$41.06 ,"$1,258.00 ",$652.30 ,$578.68 ,$704.48 ,$260.92 ,$352.24 ,$401.55 ,$260.92 ,$401.55 ,$260.92 ,$567.36 ,$567.36 ,$260.92 ,$41.06 ,$495.74 ,$629.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$943.50 ,$754.80 ,$754.80 ,$260.92 ,$754.80 ,$956.08 ,$956.08 ,$956.08 ,"$1,258.00 ", N/A ,"$1,069.30 ",$652.29 ,$817.70 ,$260.92 ,"$1,258.00 ",$704.48 ,$260.92 ,$330.85 , N/A ,$240.93 ,$229.98 ,$273.97 ,"$1,006.40 ",$587.06 ,$567.36 ,$352.24 ,"$1,132.20 ",$260.92 ,$956.08 ,$740.00 ,$740.00 ,$260.92 ,$740.00 ,$603.84 ,$219.03 
ST. ELIZABETH'S HOSPITAL,46000007,94150,HC VITAL CAPACITY TOTAL,460,1 ,$105.00 ,$68.25 ,$27.62 ,$344.13 ,$344.13 ,$48.30 ,$58.80 ,$137.65 ,$29.40 ,$37.07 ,$137.65 ,$43.26 ,$105.00 ,$47.36 ,$47.36 ,$105.00 ,$68.25 ,$105.00 ,$52.50 ,$344.11 ,$137.65 ,$137.65 ,$105.00 ,$78.75 ,$63.00 ,$63.00 ,$137.65 ,$63.00 ,$79.80 ,$79.80 ,$79.80 ,$105.00 , N/A ,$89.25 ,$105.00 ,$68.25 ,$137.65 ,$105.00 ,$58.80 ,$137.65 ,$27.62 , N/A ,$78.85 ,$75.26 ,$144.53 ,$84.00 ,$309.70 ,$47.36 ,$29.40 ,$94.50 ,$137.65 ,$79.80 ,$105.00 ,$105.00 ,$105.00 ,$105.00 ,$50.40 ,$71.68 
ST. ELIZABETH'S HOSPITAL,46000013,94726,HC PLETHYSMOGRAPHY,460,1 ,$901.00 ,$585.65 ,$51.96 ,$901.00 ,$652.30 ,$414.46 ,$504.56 ,$260.92 ,$252.28 ,$318.05 ,$260.92 ,$371.21 ,$260.92 ,$406.35 ,$406.35 ,$260.92 ,$51.96 ,$495.74 ,$450.50 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$675.75 ,$540.60 ,$540.60 ,$260.92 ,$540.60 ,$684.76 ,$684.76 ,$684.76 ,$901.00 , N/A ,$765.85 ,$652.29 ,$585.65 ,$260.92 ,$901.00 ,$504.56 ,$260.92 ,$236.96 , N/A ,$78.85 ,$75.26 ,$273.97 ,$720.80 ,$587.06 ,$406.35 ,$252.28 ,$810.90 ,$260.92 ,$684.76 ,$740.00 ,$740.00 ,$260.92 ,$740.00 ,$432.48 ,$71.68 
ST. ELIZABETH'S HOSPITAL,46000014,94618,HC WALK TEST 6 MIN,460,1 ,$633.00 ,$411.45 ,$13.76 ,$633.00 ,$277.93 ,$291.18 ,$354.48 ,$111.17 ,$177.24 ,$145.25 ,$111.17 ,$145.25 ,$111.17 ,$285.48 ,$285.48 ,$111.17 ,$13.76 ,$211.22 ,$316.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$474.75 ,$379.80 ,$379.80 ,$111.17 ,$379.80 ,$481.08 ,$481.08 ,$481.08 ,$633.00 , N/A ,$538.05 ,$277.92 ,$411.45 ,$111.17 ,$633.00 ,$354.48 ,$111.17 ,$166.48 , N/A ,$240.93 ,$229.98 ,$116.73 ,$506.40 ,$250.12 ,$285.48 ,$177.24 ,$569.70 ,$111.17 ,$481.08 ,$633.00 ,$633.00 ,$111.17 ,$633.00 ,$303.84 ,$219.03 
ST. ELIZABETH'S HOSPITAL,46000016,94621,HC PULMONARY STRESS TEST CPLX,460,1 ,"$1,640.00 ","$1,066.00 ",$105.56 ,"$1,640.00 ",$652.30 ,$754.40 ,$918.40 ,$260.92 ,$459.20 ,$578.92 ,$260.92 ,$675.68 ,$260.92 ,$739.64 ,$739.64 ,$260.92 ,$105.56 ,$495.74 ,$820.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,"$1,230.00 ",$984.00 ,$984.00 ,$260.92 ,$984.00 ,"$1,246.40 ","$1,246.40 ","$1,246.40 ","$1,640.00 ", N/A ,"$1,394.00 ",$652.29 ,"$1,066.00 ",$260.92 ,"$1,640.00 ",$918.40 ,$260.92 ,$431.32 , N/A ,$240.93 ,$229.98 ,$273.97 ,"$1,312.00 ",$587.06 ,$739.64 ,$459.20 ,"$1,476.00 ",$260.92 ,"$1,246.40 ",$740.00 ,$740.00 ,$260.92 ,$740.00 ,$787.20 ,$219.03 
ST. ELIZABETH'S HOSPITAL,46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$535.00 ,$347.75 ,$60.21 ,$535.00 , N/A ,$246.10 ,$299.60 , N/A ,$149.80 ,$188.86 , N/A ,$220.42 , N/A ,$241.29 ,$241.29 , N/A ,$60.21 , N/A ,$267.50 , N/A , N/A , N/A , N/A ,$401.25 ,$321.00 ,$321.00 , N/A ,$321.00 ,$406.60 ,$406.60 ,$406.60 ,$535.00 , N/A ,$454.75 , N/A ,$347.75 , N/A ,$535.00 ,$299.60 , N/A ,$140.71 , N/A ,$78.85 ,$75.26 , N/A ,$428.00 , N/A ,$241.29 ,$149.80 ,$481.50 , N/A ,$406.60 ,$535.00 ,$535.00 , N/A ,$535.00 ,$256.80 ,$71.68 
ST. ELIZABETH'S HOSPITAL,46000018,94762,HC OXIMETRY OVERNIGHT,460,1 ,$652.00 ,$423.80 ,$32.10 ,$652.00 ,$344.13 ,$299.92 ,$365.12 ,$137.65 ,$182.56 ,$230.16 ,$137.65 ,$268.62 ,$137.65 ,$294.05 ,$294.05 ,$137.65 ,$32.10 ,$261.53 ,$326.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$489.00 ,$391.20 ,$391.20 ,$137.65 ,$391.20 ,$495.52 ,$495.52 ,$495.52 ,$652.00 , N/A ,$554.20 ,$344.11 ,$423.80 ,$137.65 ,$652.00 ,$365.12 ,$137.65 ,$171.48 , N/A ,$78.85 ,$75.26 ,$144.53 ,$521.60 ,$309.70 ,$294.05 ,$182.56 ,$586.80 ,$137.65 ,$495.52 ,$652.00 ,$652.00 ,$137.65 ,$652.00 ,$312.96 ,$71.68 
ST. ELIZABETH'S HOSPITAL,46000021,94760,HC PULSE OX SINGLE,460,1 ,$67.00 ,$43.55 ,$3.16 ,$67.00 , N/A ,$30.82 ,$37.52 , N/A ,$18.76 ,$23.65 , N/A ,$27.60 , N/A ,$30.22 ,$30.22 , N/A ,$3.16 , N/A ,$33.50 , N/A , N/A , N/A , N/A ,$50.25 ,$40.20 ,$40.20 , N/A ,$40.20 ,$50.92 ,$50.92 ,$50.92 ,$67.00 , N/A ,$56.95 , N/A ,$43.55 , N/A ,$67.00 ,$37.52 , N/A ,$17.62 , N/A , N/A , N/A , N/A ,$53.60 , N/A ,$30.22 ,$18.76 ,$60.30 , N/A ,$50.92 ,$67.00 ,$67.00 , N/A ,$67.00 ,$32.16 , N/A 
ST. ELIZABETH'S HOSPITAL,46000022,94200,HC MAXIMAL VOL VENTILATION,942,1 ,$195.00 ,$126.75 ,$14.98 ,$195.00 ,$137.20 ,$89.70 ,$109.20 ,$54.88 ,$54.60 ,$68.84 ,$54.88 ,$80.34 ,$54.88 ,$87.95 ,$87.95 ,$54.88 ,$14.98 ,$104.27 ,$97.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$146.25 ,$117.00 ,$117.00 ,$54.88 ,$117.00 ,$148.20 ,$148.20 ,$148.20 ,$195.00 , N/A ,$165.75 ,$137.20 ,$126.75 ,$54.88 ,$195.00 ,$109.20 ,$54.88 ,$51.29 , N/A , N/A , N/A ,$57.62 ,$156.00 ,$123.48 ,$87.95 ,$54.60 ,$175.50 ,$54.88 ,$148.20 ,$165.00 ,$165.00 ,$54.88 ,$165.00 ,$93.60 , N/A 
ST. ELIZABETH'S HOSPITAL,46000023,94761,HC PULSE OX MULTI DETERMIN,360,1 ,$239.00 ,$155.35 ,$61.25 ,$239.00 , N/A ,$109.94 ,$133.84 , N/A ,$66.92 ,$80.78 , N/A ,$61.25 , N/A ,$107.79 ,$107.79 , N/A ,$107.79 , N/A ,$119.50 , N/A , N/A , N/A , N/A ,$179.25 ,$143.40 ,$143.40 , N/A ,$143.40 ,$181.64 ,$181.64 ,$181.64 ,$239.00 , N/A ,$203.15 , N/A ,$155.35 , N/A ,$239.00 ,$133.84 , N/A ,$62.86 , N/A , N/A , N/A , N/A ,$191.20 , N/A ,$107.79 ,$66.92 ,$215.10 , N/A ,$181.64 , N/A , N/A , N/A , N/A ,$114.72 , N/A 
ST. ELIZABETH'S HOSPITAL,46000028,94690,HC O2 UPTAKE EXPIRED GAS REST,460,1 ,$462.00 ,$300.30 ,$47.99 ,$462.00 ,$137.20 ,$212.52 ,$258.72 ,$54.88 ,$129.36 ,$163.09 ,$54.88 ,$190.34 ,$54.88 ,$208.36 ,$208.36 ,$54.88 ,$47.99 ,$104.27 ,$231.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$346.50 ,$277.20 ,$277.20 ,$54.88 ,$277.20 ,$351.12 ,$351.12 ,$351.12 ,$462.00 , N/A ,$392.70 ,$137.20 ,$300.30 ,$54.88 ,$462.00 ,$258.72 ,$54.88 ,$121.51 , N/A ,$78.85 ,$75.26 ,$57.62 ,$369.60 ,$123.48 ,$208.36 ,$129.36 ,$415.80 ,$54.88 ,$351.12 ,$462.00 ,$462.00 ,$54.88 ,$462.00 ,$221.76 ,$71.68 
ST. ELIZABETH'S HOSPITAL,47000000,92585,HC AUDITORY EVOKED POTENT COMPR,470,1 ,"$1,972.00 ","$1,281.80 ",$518.64 ,"$1,972.00 ", N/A ,$907.12 ,"$1,104.32 ", N/A ,$552.16 ,$696.12 , N/A ,$812.46 , N/A ,$889.37 ,$889.37 , N/A ,"$1,281.80 ", N/A ,$986.00 , N/A , N/A , N/A , N/A ,"$1,479.00 ","$1,183.20 ","$1,183.20 ", N/A ,"$1,183.20 ","$1,498.72 ","$1,498.72 ","$1,498.72 ","$1,972.00 ", N/A ,"$1,676.20 ", N/A ,"$1,281.80 ", N/A ,"$1,972.00 ","$1,104.32 ", N/A ,$518.64 , N/A , N/A , N/A , N/A ,"$1,577.60 ", N/A ,$889.37 ,$552.16 ,"$1,774.80 ", N/A ,"$1,498.72 ","$1,525.00 ","$1,525.00 ", N/A ,"$1,525.00 ",$946.56 , N/A 
ST. ELIZABETH'S HOSPITAL,47000001,92587,HC DISTORTION EVOKED POTENT LTD,470,1 ,$514.00 ,$334.10 ,$5.20 ,$652.30 ,$652.30 ,$236.44 ,$287.84 ,$260.92 ,$143.92 ,$36.60 ,$260.92 ,$36.60 ,$260.92 ,$231.81 ,$231.81 ,$260.92 ,$5.20 ,$495.74 ,$257.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$385.50 ,$308.40 ,$308.40 ,$260.92 ,$308.40 ,$390.64 ,$390.64 ,$390.64 ,$514.00 , N/A ,$436.90 ,$514.00 ,$334.10 ,$260.92 ,$514.00 ,$287.84 ,$260.92 ,$135.18 , N/A ,$229.97 ,$219.51 ,$273.97 ,$411.20 ,$587.06 ,$231.81 ,$143.92 ,$462.60 ,$260.92 ,$390.64 ,$514.00 ,$514.00 ,$260.92 ,$514.00 ,$246.72 ,$209.06 
ST. ELIZABETH'S HOSPITAL,47000003,92586,HC NEWBORN HEARING SCREENING,470,1 ,$447.00 ,$290.55 ,$117.56 ,$447.00 , N/A ,$205.62 ,$250.32 , N/A ,$125.16 ,$157.79 , N/A ,$184.16 , N/A ,$201.60 ,$201.60 , N/A ,$290.55 , N/A ,$223.50 , N/A , N/A , N/A , N/A ,$335.25 ,$268.20 ,$268.20 , N/A ,$268.20 ,$339.72 ,$339.72 ,$339.72 ,$447.00 , N/A ,$379.95 , N/A ,$290.55 , N/A ,$447.00 ,$250.32 , N/A ,$117.56 , N/A , N/A , N/A , N/A ,$357.60 , N/A ,$201.60 ,$125.16 ,$402.30 , N/A ,$339.72 ,$447.00 ,$447.00 , N/A ,$447.00 ,$214.56 , N/A 
ST. ELIZABETH'S HOSPITAL,47100001,92550,HC AUD TYMPAN/REFLEX THRESHOLD MEASURE,471,1 ,$405.00 ,$263.25 ,$28.40 ,$405.00 ,$344.13 ,$186.30 ,$226.80 ,$137.65 ,$113.40 ,$136.89 ,$137.65 ,$157.55 ,$137.65 ,$182.66 ,$182.66 ,$137.65 ,$28.40 ,$261.53 ,$202.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$303.75 ,$243.00 ,$243.00 ,$137.65 ,$243.00 ,$307.80 ,$307.80 ,$307.80 ,$405.00 , N/A ,$344.25 ,$344.11 ,$263.25 ,$137.65 ,$405.00 ,$226.80 ,$137.65 ,$106.52 , N/A ,$229.97 ,$219.51 ,$144.53 ,$324.00 ,$309.70 ,$182.66 ,$113.40 ,$364.50 ,$137.65 ,$307.80 ,$405.00 ,$405.00 ,$137.65 ,$405.00 ,$194.40 ,$209.06 
ST. ELIZABETH'S HOSPITAL,47100003,92567,HC TYMPANOMETRY IMPED TEST,471,1 ,$212.00 ,$137.80 ,$13.45 ,$212.00 ,$83.43 ,$97.52 ,$118.72 ,$33.37 ,$59.36 ,$74.84 ,$33.37 ,$87.34 ,$33.37 ,$95.61 ,$95.61 ,$33.37 ,$13.45 ,$63.41 ,$106.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$159.00 ,$127.20 ,$127.20 ,$33.37 ,$127.20 ,$161.12 ,$161.12 ,$161.12 ,$212.00 , N/A ,$180.20 ,$83.43 ,$137.80 ,$33.37 ,$212.00 ,$118.72 ,$33.37 ,$55.76 , N/A ,$145.56 ,$138.95 ,$35.04 ,$169.60 ,$75.08 ,$95.61 ,$59.36 ,$190.80 ,$33.37 ,$161.12 ,$212.00 ,$212.00 ,$33.37 ,$212.00 ,$101.76 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100004,92570,HC AUD ACOUSTIC REFLEX DECAY,471,1 ,$607.00 ,$394.55 ,$38.08 ,$607.00 ,$344.13 ,$279.22 ,$339.92 ,$137.65 ,$169.96 ,$205.17 ,$137.65 ,$236.12 ,$137.65 ,$273.76 ,$273.76 ,$137.65 ,$38.08 ,$261.53 ,$303.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$455.25 ,$364.20 ,$364.20 ,$137.65 ,$364.20 ,$461.32 ,$461.32 ,$461.32 ,$607.00 , N/A ,$515.95 ,$344.11 ,$394.55 ,$137.65 ,$607.00 ,$339.92 ,$137.65 ,$159.64 , N/A ,$125.92 ,$120.19 ,$144.53 ,$485.60 ,$309.70 ,$273.76 ,$169.96 ,$546.30 ,$137.65 ,$461.32 ,$607.00 ,$607.00 ,$137.65 ,$607.00 ,$291.36 ,$114.47 
ST. ELIZABETH'S HOSPITAL,47100005,92568,HC AUD ACOUSTIC REFLEX TESTING,471,1 ,$182.00 ,$118.30 ,$2.25 ,$182.00 ,$83.43 ,$83.72 ,$101.92 ,$33.37 ,$50.96 ,$64.25 ,$33.37 ,$74.98 ,$33.37 ,$82.08 ,$82.08 ,$33.37 ,$19.69 ,$63.41 ,$91.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$136.50 ,$109.20 ,$109.20 ,$33.37 ,$109.20 ,$138.32 ,$138.32 ,$138.32 ,$182.00 , N/A ,$154.70 ,$83.43 ,$118.30 ,$33.37 ,$182.00 ,$101.92 ,$33.37 ,$47.87 , N/A ,$2.48 ,$2.36 ,$35.04 ,$145.60 ,$75.08 ,$82.08 ,$50.96 ,$163.80 ,$33.37 ,$138.32 ,$182.00 ,$182.00 ,$33.37 ,$182.00 ,$87.36 ,$2.25 
ST. ELIZABETH'S HOSPITAL,47100006,92557,HC AUD COMPREHENSIVE AUDIO,471,1 ,$609.00 ,$395.85 ,$41.46 ,$609.00 ,$344.13 ,$280.14 ,$341.04 ,$137.65 ,$170.52 ,$214.98 ,$137.65 ,$250.91 ,$137.65 ,$274.66 ,$274.66 ,$137.65 ,$41.46 ,$261.53 ,$304.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$456.75 ,$365.40 ,$365.40 ,$137.65 ,$365.40 ,$462.84 ,$462.84 ,$462.84 ,$609.00 , N/A ,$517.65 ,$344.11 ,$395.85 ,$137.65 ,$609.00 ,$341.04 ,$137.65 ,$160.17 , N/A ,$145.56 ,$138.95 ,$144.53 ,$487.20 ,$309.70 ,$274.66 ,$170.52 ,$548.10 ,$137.65 ,$462.84 ,$609.00 ,$609.00 ,$137.65 ,$609.00 ,$292.32 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100007,92582,HC AUD CONDITION PLAY AUDIOMETRY,471,1 ,$592.00 ,$384.80 ,$93.53 ,$592.00 ,$344.13 ,$272.32 ,$331.52 ,$137.65 ,$165.76 ,$208.98 ,$137.65 ,$243.90 ,$137.65 ,$266.99 ,$266.99 ,$137.65 ,$93.53 ,$261.53 ,$296.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$444.00 ,$355.20 ,$355.20 ,$137.65 ,$355.20 ,$449.92 ,$449.92 ,$449.92 ,$592.00 , N/A ,$503.20 ,$344.11 ,$384.80 ,$137.65 ,$592.00 ,$331.52 ,$137.65 ,$155.70 , N/A ,$125.92 ,$120.19 ,$144.53 ,$473.60 ,$309.70 ,$266.99 ,$165.76 ,$532.80 ,$137.65 ,$449.92 ,$592.00 ,$592.00 ,$137.65 ,$592.00 ,$284.16 ,$114.47 
ST. ELIZABETH'S HOSPITAL,47100008,92588,HC AUD EVOKED OTOACOUS EMISSIONS COMP EVAL,471,1 ,$558.00 ,$362.70 ,$6.83 ,$652.30 ,$652.30 ,$256.68 ,$312.48 ,$260.92 ,$156.24 ,$43.99 ,$260.92 ,$43.99 ,$260.92 ,$251.66 ,$251.66 ,$260.92 ,$6.83 ,$495.74 ,$279.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$418.50 ,$334.80 ,$334.80 ,$260.92 ,$334.80 ,$424.08 ,$424.08 ,$424.08 ,$558.00 , N/A ,$474.30 ,$558.00 ,$362.70 ,$260.92 ,$558.00 ,$312.48 ,$260.92 ,$146.75 , N/A ,$229.97 ,$219.51 ,$273.97 ,$446.40 ,$587.06 ,$251.66 ,$156.24 ,$502.20 ,$260.92 ,$424.08 ,$558.00 ,$558.00 ,$260.92 ,$558.00 ,$267.84 ,$209.06 
ST. ELIZABETH'S HOSPITAL,47100009,92558,HC AUD EVOKED OTOACOUS EMISSIONS SCREENING,471,1 ,$448.00 ,$291.20 ,$117.82 ,$448.00 , N/A ,$206.08 ,$250.88 , N/A ,$125.44 ,$151.42 , N/A ,$174.27 , N/A ,$202.05 ,$202.05 , N/A ,$291.20 , N/A ,$224.00 , N/A , N/A , N/A , N/A ,$336.00 ,$268.80 ,$268.80 , N/A ,$268.80 ,$340.48 ,$340.48 ,$340.48 ,$448.00 , N/A ,$380.80 , N/A ,$291.20 , N/A ,$448.00 ,$250.88 , N/A ,$117.82 , N/A ,$145.56 ,$138.95 , N/A ,$358.40 , N/A ,$202.05 ,$125.44 ,$403.20 , N/A ,$340.48 ,$448.00 ,$448.00 , N/A ,$448.00 ,$215.04 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100010,92586,HC AUD EVOKED POTENTIAL LIMITED,471,1 ,$447.00 ,$290.55 ,$117.56 ,$447.00 , N/A ,$205.62 ,$250.32 , N/A ,$125.16 ,$157.79 , N/A ,$184.16 , N/A ,$201.60 ,$201.60 , N/A ,$290.55 , N/A ,$223.50 , N/A , N/A , N/A , N/A ,$335.25 ,$268.20 ,$268.20 , N/A ,$268.20 ,$339.72 ,$339.72 ,$339.72 ,$447.00 , N/A ,$379.95 , N/A ,$290.55 , N/A ,$447.00 ,$250.32 , N/A ,$117.56 , N/A , N/A , N/A , N/A ,$357.60 , N/A ,$201.60 ,$125.16 ,$402.30 , N/A ,$339.72 ,$447.00 ,$447.00 , N/A ,$447.00 ,$214.56 , N/A 
ST. ELIZABETH'S HOSPITAL,47100011,92553,HC AUD PURE TONE AIR  AND  BONE,471,1 ,$371.00 ,$241.15 ,$49.21 ,$371.00 ,$344.13 ,$170.66 ,$207.76 ,$137.65 ,$103.88 ,$130.96 ,$137.65 ,$152.85 ,$137.65 ,$167.32 ,$167.32 ,$137.65 ,$49.21 ,$261.53 ,$185.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$278.25 ,$222.60 ,$222.60 ,$137.65 ,$222.60 ,$281.96 ,$281.96 ,$281.96 ,$371.00 , N/A ,$315.35 ,$344.11 ,$241.15 ,$137.65 ,$371.00 ,$207.76 ,$137.65 ,$97.57 , N/A ,$145.56 ,$138.95 ,$144.53 ,$296.80 ,$309.70 ,$167.32 ,$103.88 ,$333.90 ,$137.65 ,$281.96 ,$371.00 ,$371.00 ,$137.65 ,$371.00 ,$178.08 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100012,92553,HC AUD PURE TONE AIR  AND  BONE -52,471,1 ,$371.00 ,$241.15 ,$49.21 ,$371.00 ,$172.05 ,$170.66 ,$207.76 ,$68.82 ,$103.88 ,$130.96 ,$68.82 ,$152.85 ,$68.82 ,$167.32 ,$167.32 ,$68.82 ,$49.21 ,$130.76 ,$185.50 ,$172.06 ,$68.82 ,$68.82 ,$70.20 ,$278.25 ,$222.60 ,$222.60 ,$68.82 ,$222.60 ,$281.96 ,$281.96 ,$281.96 ,$371.00 , N/A ,$315.35 ,$172.06 ,$241.15 ,$68.82 ,$371.00 ,$207.76 ,$68.82 ,$97.57 , N/A ,$72.79 ,$69.48 ,$72.26 ,$296.80 ,$154.85 ,$167.32 ,$103.88 ,$333.90 ,$68.82 ,$281.96 ,$371.00 ,$371.00 ,$68.82 ,$371.00 ,$178.08 ,$66.17 
ST. ELIZABETH'S HOSPITAL,47100013,92552,HC AUD PURE TONE AIR ONLY,471,1 ,$319.00 ,$207.35 ,$40.65 ,$319.00 ,$277.93 ,$146.74 ,$178.64 ,$111.17 ,$89.32 ,$112.61 ,$111.17 ,$131.43 ,$111.17 ,$143.87 ,$143.87 ,$111.17 ,$40.65 ,$211.22 ,$159.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$239.25 ,$191.40 ,$191.40 ,$111.17 ,$191.40 ,$242.44 ,$242.44 ,$242.44 ,$319.00 , N/A ,$271.15 ,$277.92 ,$207.35 ,$111.17 ,$319.00 ,$178.64 ,$111.17 ,$83.90 , N/A ,$145.56 ,$138.95 ,$116.73 ,$255.20 ,$250.12 ,$143.87 ,$89.32 ,$287.10 ,$111.17 ,$242.44 ,$319.00 ,$319.00 ,$111.17 ,$319.00 ,$153.12 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100014,92583,HC AUD SELECT PICTURE AUDIOMETRY,471,1 ,$182.00 ,$118.30 ,$47.87 ,$182.00 ,$137.20 ,$83.72 ,$101.92 ,$54.88 ,$50.96 ,$64.25 ,$54.88 ,$74.98 ,$54.88 ,$82.08 ,$82.08 ,$54.88 ,$61.03 ,$104.27 ,$91.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$136.50 ,$109.20 ,$109.20 ,$54.88 ,$109.20 ,$138.32 ,$138.32 ,$138.32 ,$182.00 , N/A ,$154.70 ,$137.20 ,$118.30 ,$54.88 ,$182.00 ,$101.92 ,$54.88 ,$47.87 , N/A ,$125.92 ,$120.19 ,$57.62 ,$145.60 ,$123.48 ,$82.08 ,$50.96 ,$163.80 ,$54.88 ,$138.32 ,$182.00 ,$182.00 ,$54.88 ,$182.00 ,$87.36 ,$114.47 
ST. ELIZABETH'S HOSPITAL,47100015,92555,HC AUD SPEECH THRESHOLD,471,1 ,$212.00 ,$137.80 ,$30.88 ,$212.00 ,$83.43 ,$97.52 ,$118.72 ,$33.37 ,$59.36 ,$74.84 ,$33.37 ,$87.34 ,$33.37 ,$95.61 ,$95.61 ,$33.37 ,$30.88 ,$63.41 ,$106.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$159.00 ,$127.20 ,$127.20 ,$33.37 ,$127.20 ,$161.12 ,$161.12 ,$161.12 ,$212.00 , N/A ,$180.20 ,$83.43 ,$137.80 ,$33.37 ,$212.00 ,$118.72 ,$33.37 ,$55.76 , N/A ,$145.56 ,$138.95 ,$35.04 ,$169.60 ,$75.08 ,$95.61 ,$59.36 ,$190.80 ,$33.37 ,$161.12 ,$212.00 ,$212.00 ,$33.37 ,$212.00 ,$101.76 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100016,92556,HC AUD SPEECH THRESHOLD W/SPEECH RECOGNITION,471,1 ,$254.00 ,$165.10 ,$48.40 ,$254.00 ,$137.20 ,$116.84 ,$142.24 ,$54.88 ,$71.12 ,$89.66 ,$54.88 ,$104.65 ,$54.88 ,$114.55 ,$114.55 ,$54.88 ,$48.40 ,$104.27 ,$127.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$190.50 ,$152.40 ,$152.40 ,$54.88 ,$152.40 ,$193.04 ,$193.04 ,$193.04 ,$254.00 , N/A ,$215.90 ,$137.20 ,$165.10 ,$54.88 ,$254.00 ,$142.24 ,$54.88 ,$66.80 , N/A ,$145.56 ,$138.95 ,$57.62 ,$203.20 ,$123.48 ,$114.55 ,$71.12 ,$228.60 ,$54.88 ,$193.04 ,$254.00 ,$254.00 ,$54.88 ,$254.00 ,$121.92 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100017,92579,HC AUD VISUAL REINFORCEMENT AUDIOMETRY,471,1 ,$228.00 ,$148.20 ,$48.24 ,$344.13 ,$344.13 ,$104.88 ,$127.68 ,$137.65 ,$63.84 ,$80.48 ,$137.65 ,$93.94 ,$137.65 ,$102.83 ,$102.83 ,$137.65 ,$48.24 ,$228.00 ,$114.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$171.00 ,$136.80 ,$136.80 ,$137.65 ,$136.80 ,$173.28 ,$173.28 ,$173.28 ,$228.00 , N/A ,$193.80 ,$228.00 ,$148.20 ,$137.65 ,$228.00 ,$127.68 ,$137.65 ,$59.96 , N/A ,$145.56 ,$138.95 ,$144.53 ,$182.40 ,$309.70 ,$102.83 ,$63.84 ,$205.20 ,$137.65 ,$173.28 ,$228.00 ,$228.00 ,$137.65 ,$228.00 ,$109.44 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100018,92563,HC TONE DECAY TEST,471,1 ,$182.00 ,$118.30 ,$2.25 ,$182.00 ,$83.43 ,$83.72 ,$101.92 ,$33.37 ,$50.96 ,$64.25 ,$33.37 ,$74.98 ,$33.37 ,$82.08 ,$82.08 ,$33.37 ,$38.61 ,$63.41 ,$91.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$136.50 ,$109.20 ,$109.20 ,$33.37 ,$109.20 ,$138.32 ,$138.32 ,$138.32 ,$182.00 , N/A ,$154.70 ,$83.43 ,$118.30 ,$33.37 ,$182.00 ,$101.92 ,$33.37 ,$47.87 , N/A ,$2.48 ,$2.36 ,$35.04 ,$145.60 ,$75.08 ,$82.08 ,$50.96 ,$163.80 ,$33.37 ,$138.32 ,$182.00 ,$182.00 ,$33.37 ,$182.00 ,$87.36 ,$2.25 
ST. ELIZABETH'S HOSPITAL,47100028,92552,HC EARLY INTER AUD PURE TONE AIR ONLY,471,1 ,$319.00 ,$207.35 ,$40.65 ,$319.00 ,$277.93 ,$146.74 ,$178.64 ,$111.17 ,$89.32 ,$112.61 ,$111.17 ,$131.43 ,$111.17 ,$143.87 ,$143.87 ,$111.17 ,$40.65 ,$211.22 ,$159.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$239.25 ,$191.40 ,$191.40 ,$111.17 ,$191.40 ,$242.44 ,$242.44 ,$242.44 ,$319.00 , N/A ,$271.15 ,$277.92 ,$207.35 ,$111.17 ,$319.00 ,$178.64 ,$111.17 ,$83.90 , N/A ,$145.56 ,$138.95 ,$116.73 ,$255.20 ,$250.12 ,$143.87 ,$89.32 ,$287.10 ,$111.17 ,$242.44 ,$319.00 ,$319.00 ,$111.17 ,$319.00 ,$153.12 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100029,92553,HC EARLY INTER AUD PURE TONE AIR  AND  BONE,471,1 ,$371.00 ,$241.15 ,$49.21 ,$371.00 ,$344.13 ,$170.66 ,$207.76 ,$137.65 ,$103.88 ,$130.96 ,$137.65 ,$152.85 ,$137.65 ,$167.32 ,$167.32 ,$137.65 ,$49.21 ,$261.53 ,$185.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$278.25 ,$222.60 ,$222.60 ,$137.65 ,$222.60 ,$281.96 ,$281.96 ,$281.96 ,$371.00 , N/A ,$315.35 ,$344.11 ,$241.15 ,$137.65 ,$371.00 ,$207.76 ,$137.65 ,$97.57 , N/A ,$145.56 ,$138.95 ,$144.53 ,$296.80 ,$309.70 ,$167.32 ,$103.88 ,$333.90 ,$137.65 ,$281.96 ,$371.00 ,$371.00 ,$137.65 ,$371.00 ,$178.08 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100030,92555,HC EARLY INTER AUD SPEECH THRESHOLD,471,1 ,$212.00 ,$137.80 ,$30.88 ,$212.00 ,$83.43 ,$97.52 ,$118.72 ,$33.37 ,$59.36 ,$74.84 ,$33.37 ,$87.34 ,$33.37 ,$95.61 ,$95.61 ,$33.37 ,$30.88 ,$63.41 ,$106.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$159.00 ,$127.20 ,$127.20 ,$33.37 ,$127.20 ,$161.12 ,$161.12 ,$161.12 ,$212.00 , N/A ,$180.20 ,$83.43 ,$137.80 ,$33.37 ,$212.00 ,$118.72 ,$33.37 ,$55.76 , N/A ,$145.56 ,$138.95 ,$35.04 ,$169.60 ,$75.08 ,$95.61 ,$59.36 ,$190.80 ,$33.37 ,$161.12 ,$212.00 ,$212.00 ,$33.37 ,$212.00 ,$101.76 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100031,92556,HC EARLY INTER AUD SPEECH THRESHOLD W/SPCH RECOG,471,1 ,$254.00 ,$165.10 ,$48.40 ,$254.00 ,$137.20 ,$116.84 ,$142.24 ,$54.88 ,$71.12 ,$89.66 ,$54.88 ,$104.65 ,$54.88 ,$114.55 ,$114.55 ,$54.88 ,$48.40 ,$104.27 ,$127.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$190.50 ,$152.40 ,$152.40 ,$54.88 ,$152.40 ,$193.04 ,$193.04 ,$193.04 ,$254.00 , N/A ,$215.90 ,$137.20 ,$165.10 ,$54.88 ,$254.00 ,$142.24 ,$54.88 ,$66.80 , N/A ,$145.56 ,$138.95 ,$57.62 ,$203.20 ,$123.48 ,$114.55 ,$71.12 ,$228.60 ,$54.88 ,$193.04 ,$254.00 ,$254.00 ,$54.88 ,$254.00 ,$121.92 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100032,92557,HC EARLY INTER AUD COMPREHENSIVE AUDIO,471,1 ,$609.00 ,$395.85 ,$41.46 ,$609.00 ,$344.13 ,$280.14 ,$341.04 ,$137.65 ,$170.52 ,$214.98 ,$137.65 ,$250.91 ,$137.65 ,$274.66 ,$274.66 ,$137.65 ,$41.46 ,$261.53 ,$304.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$456.75 ,$365.40 ,$365.40 ,$137.65 ,$365.40 ,$462.84 ,$462.84 ,$462.84 ,$609.00 , N/A ,$517.65 ,$344.11 ,$395.85 ,$137.65 ,$609.00 ,$341.04 ,$137.65 ,$160.17 , N/A ,$145.56 ,$138.95 ,$144.53 ,$487.20 ,$309.70 ,$274.66 ,$170.52 ,$548.10 ,$137.65 ,$462.84 ,$609.00 ,$609.00 ,$137.65 ,$609.00 ,$292.32 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100033,92567,HC EARLY INTER TYMPANOMETRY IMPED TEST,471,1 ,$212.00 ,$137.80 ,$13.45 ,$212.00 ,$83.43 ,$97.52 ,$118.72 ,$33.37 ,$59.36 ,$74.84 ,$33.37 ,$87.34 ,$33.37 ,$95.61 ,$95.61 ,$33.37 ,$13.45 ,$63.41 ,$106.00 ,$83.43 ,$33.37 ,$33.37 ,$34.04 ,$159.00 ,$127.20 ,$127.20 ,$33.37 ,$127.20 ,$161.12 ,$161.12 ,$161.12 ,$212.00 , N/A ,$180.20 ,$83.43 ,$137.80 ,$33.37 ,$212.00 ,$118.72 ,$33.37 ,$55.76 , N/A ,$145.56 ,$138.95 ,$35.04 ,$169.60 ,$75.08 ,$95.61 ,$59.36 ,$190.80 ,$33.37 ,$161.12 ,$212.00 ,$212.00 ,$33.37 ,$212.00 ,$101.76 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100034,92579,HC EARLY INTER VISUAL REINFORCEMENT AUDIOMETRY,471,1 ,$228.00 ,$148.20 ,$48.24 ,$344.13 ,$344.13 ,$104.88 ,$127.68 ,$137.65 ,$63.84 ,$80.48 ,$137.65 ,$93.94 ,$137.65 ,$102.83 ,$102.83 ,$137.65 ,$48.24 ,$228.00 ,$114.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$171.00 ,$136.80 ,$136.80 ,$137.65 ,$136.80 ,$173.28 ,$173.28 ,$173.28 ,$228.00 , N/A ,$193.80 ,$228.00 ,$148.20 ,$137.65 ,$228.00 ,$127.68 ,$137.65 ,$59.96 , N/A ,$145.56 ,$138.95 ,$144.53 ,$182.40 ,$309.70 ,$102.83 ,$63.84 ,$205.20 ,$137.65 ,$173.28 ,$228.00 ,$228.00 ,$137.65 ,$228.00 ,$109.44 ,$132.33 
ST. ELIZABETH'S HOSPITAL,47100035,92582,HC EARLY INTER CONDITION PLAY AUDIOMETRY,471,1 ,$592.00 ,$384.80 ,$93.53 ,$592.00 ,$344.13 ,$272.32 ,$331.52 ,$137.65 ,$165.76 ,$208.98 ,$137.65 ,$243.90 ,$137.65 ,$266.99 ,$266.99 ,$137.65 ,$93.53 ,$261.53 ,$296.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$444.00 ,$355.20 ,$355.20 ,$137.65 ,$355.20 ,$449.92 ,$449.92 ,$449.92 ,$592.00 , N/A ,$503.20 ,$344.11 ,$384.80 ,$137.65 ,$592.00 ,$331.52 ,$137.65 ,$155.70 , N/A ,$125.92 ,$120.19 ,$144.53 ,$473.60 ,$309.70 ,$266.99 ,$165.76 ,$532.80 ,$137.65 ,$449.92 ,$592.00 ,$592.00 ,$137.65 ,$592.00 ,$284.16 ,$114.47 
ST. ELIZABETH'S HOSPITAL,47100036,92587,HC EARLY INTER AUDITORY EVOKED POTENT LTD,471,1 ,$514.00 ,$334.10 ,$5.20 ,$652.30 ,$652.30 ,$236.44 ,$287.84 ,$260.92 ,$143.92 ,$36.60 ,$260.92 ,$36.60 ,$260.92 ,$231.81 ,$231.81 ,$260.92 ,$5.20 ,$495.74 ,$257.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$385.50 ,$308.40 ,$308.40 ,$260.92 ,$308.40 ,$390.64 ,$390.64 ,$390.64 ,$514.00 , N/A ,$436.90 ,$514.00 ,$334.10 ,$260.92 ,$514.00 ,$287.84 ,$260.92 ,$135.18 , N/A ,$229.97 ,$219.51 ,$273.97 ,$411.20 ,$587.06 ,$231.81 ,$143.92 ,$462.60 ,$260.92 ,$390.64 ,$514.00 ,$514.00 ,$260.92 ,$514.00 ,$246.72 ,$209.06 
ST. ELIZABETH'S HOSPITAL,48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$2,294.00 ","$1,491.10 ",$138.14 ,"$2,294.00 ","$1,384.58 ","$1,055.24 ","$1,284.64 ",$553.83 ,$642.32 ,$809.78 ,$553.83 ,$945.13 ,$553.83 ,"$1,034.59 ","$1,034.59 ",$553.83 ,$138.14 ,"$1,052.28 ","$1,147.00 ","$1,384.58 ",$553.83 ,$553.83 ,$564.91 ,"$1,720.50 ","$1,376.40 ","$1,376.40 ",$553.83 ,"$1,376.40 ","$1,743.44 ","$1,743.44 ","$1,743.44 ","$2,294.00 ", N/A ,"$1,949.90 ","$1,384.58 ","$1,491.10 ",$553.83 ,"$2,294.00 ","$1,284.64 ",$553.83 ,$603.32 , N/A ,$642.43 ,$613.23 ,$581.52 ,"$1,835.20 ","$1,246.12 ","$1,034.59 ",$642.32 ,"$2,064.60 ",$553.83 ,"$1,743.44 ","$2,294.00 ","$2,294.00 ",$553.83 ,"$2,294.00 ","$1,101.12 ",$584.03 
ST. ELIZABETH'S HOSPITAL,48000006,92961,HC CARDIOVERSION INTERNAL,480,1 ,"$1,538.00 ",$999.70 ,$334.55 ,"$1,538.00 ","$1,384.58 ","$1,538.00 ",$861.28 ,$553.83 ,$430.64 ,$542.91 ,$553.83 ,$633.66 ,$553.83 ,$693.64 ,$693.64 ,$553.83 ,$334.55 ,"$1,052.28 ",$769.00 ,"$1,384.58 ",$553.83 ,$553.83 ,$564.91 ,"$1,153.50 ",$922.80 ,$922.80 ,$553.83 ,$922.80 ,"$1,168.88 ","$1,168.88 ","$1,168.88 ","$1,538.00 ", N/A ,"$1,307.30 ","$1,384.58 ",$999.70 ,$553.83 ,"$1,538.00 ",$861.28 ,$553.83 ,$404.49 , N/A ,$642.43 ,$613.23 ,$581.52 ,"$1,230.40 ","$1,246.12 ",$693.64 ,$430.64 ,"$1,384.20 ",$553.83 ,"$1,168.88 ","$1,538.00 ","$1,538.00 ",$553.83 ,"$1,538.00 ",$738.24 ,$584.03 
ST. ELIZABETH'S HOSPITAL,48000008,G0269,HC PLACE OCCLUSIVE DEVICE A/VV G0269,480,1 ,$601.00 ,$390.65 ,$158.06 ,$601.00 , N/A ,$601.00 ,$336.56 , N/A ,$168.28 ,$203.14 , N/A ,$233.79 , N/A ,$271.05 ,$271.05 , N/A ,$390.65 , N/A ,$300.50 , N/A , N/A , N/A , N/A ,$450.75 ,$360.60 ,$360.60 , N/A ,$360.60 ,$456.76 ,$456.76 ,$456.76 ,$601.00 , N/A ,$510.85 , N/A ,$390.65 , N/A ,$601.00 ,$336.56 , N/A ,$158.06 , N/A , N/A , N/A , N/A ,$480.80 , N/A ,$271.05 ,$168.28 ,$540.90 , N/A ,$456.76 ,$601.00 ,$601.00 , N/A ,$601.00 ,$288.48 , N/A 
ST. ELIZABETH'S HOSPITAL,48000015,93618,HC ARRHYTHMIA INDUCTION ELECTRIC,480,1 ,"$1,841.00 ","$1,196.65 ",$294.88 ,"$5,006.13 ","$2,745.18 ","$1,841.00 ","$1,030.96 ","$1,098.07 ",$515.48 ,$649.87 ,"$1,098.07 ",$758.49 ,"$1,098.07 ",$830.29 ,$830.29 ,"$1,098.07 ",$294.88 ,"$1,841.00 ",$920.50 ,"$2,745.18 ","$1,098.07 ","$1,098.07 ","$1,120.03 ","$1,380.75 ","$1,104.60 ","$1,104.60 ","$1,098.07 ","$1,104.60 ","$1,399.16 ","$1,399.16 ","$1,399.16 ","$1,841.00 ", N/A ,"$1,564.85 ","$1,841.00 ","$1,196.65 ","$1,098.07 ","$1,841.00 ","$1,030.96 ","$1,098.07 ",$484.18 , N/A ,"$1,841.00 ","$1,841.00 ","$1,152.97 ","$1,472.80 ","$2,470.66 ",$830.29 ,$515.48 ,"$1,656.90 ","$1,098.07 ","$1,399.16 ","$1,841.00 ","$1,841.00 ","$1,098.07 ","$1,841.00 ",$883.68 ,"$5,006.13 "
ST. ELIZABETH'S HOSPITAL,48000016,G0166,HC COUNTERPULSATION EXTERNAL,480,1 ,$458.00 ,$297.70 ,$66.22 ,$458.00 ,$277.93 ,$210.68 ,$256.48 ,$111.17 ,$128.24 ,$154.80 ,$111.17 ,$178.16 ,$111.17 ,$206.56 ,$206.56 ,$111.17 ,$132.05 ,$211.22 ,$229.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$343.50 ,$274.80 ,$274.80 ,$111.17 ,$274.80 ,$348.08 ,$348.08 ,$348.08 ,$458.00 , N/A ,$389.30 ,$277.92 ,$297.70 ,$111.17 ,$458.00 ,$256.48 ,$111.17 ,$120.45 , N/A ,$72.84 ,$69.53 ,$116.73 ,$366.40 ,$250.12 ,$206.56 ,$128.24 ,$412.20 ,$111.17 ,$348.08 ,$458.00 ,$458.00 ,$111.17 ,$458.00 ,$219.84 ,$66.22 
ST. ELIZABETH'S HOSPITAL,48000017,93640,HC EP EVAL CARDIO/DEFIB LEADS,480,1 ,"$2,107.00 ","$1,369.55 ",$240.18 ,"$2,107.00 ", N/A ,"$2,107.00 ","$1,179.92 ", N/A ,$589.96 ,$743.77 , N/A ,$868.08 , N/A ,$950.26 ,$950.26 , N/A ,$240.18 , N/A ,"$1,053.50 ", N/A , N/A , N/A , N/A ,"$1,580.25 ","$1,264.20 ","$1,264.20 ", N/A ,"$1,264.20 ","$1,601.32 ","$1,601.32 ","$1,601.32 ","$2,107.00 ", N/A ,"$1,790.95 ", N/A ,"$1,369.55 ", N/A ,"$2,107.00 ","$1,179.92 ", N/A ,$554.14 , N/A ,$267.10 ,$254.96 , N/A ,"$1,685.60 ", N/A ,$950.26 ,$589.96 ,"$1,896.30 ", N/A ,"$1,601.32 ","$2,107.00 ","$2,107.00 ", N/A ,"$2,107.00 ","$1,011.36 ",$242.82 
ST. ELIZABETH'S HOSPITAL,48000018,93624,HC EP FOLLOW UP,480,1 ,"$14,997.00 ","$9,748.05 ",$325.46 ,"$14,997.00 ","$14,981.38 ","$7,500.00 ","$8,398.32 ","$5,992.55 ","$4,199.16 ","$1,122.91 ","$5,992.55 ","$1,122.91 ","$5,992.55 ","$6,763.65 ","$6,763.65 ","$5,992.55 ",$325.46 ,"$11,385.85 ","$7,498.50 ","$14,981.38 ","$5,992.55 ","$5,992.55 ","$6,112.40 ","$11,247.75 ","$8,998.20 ","$8,998.20 ","$5,992.55 ","$8,998.20 ","$11,397.72 ","$11,397.72 ","$11,397.72 ","$14,997.00 ", N/A ,"$12,747.45 ","$14,981.38 ","$9,748.05 ","$5,992.55 ","$14,997.00 ","$8,398.32 ","$5,992.55 ","$3,944.21 ", N/A ,"$12,632.57 ","$12,058.36 ","$6,292.18 ","$11,997.60 ","$13,483.24 ","$6,763.65 ","$4,199.16 ","$13,497.30 ","$5,992.55 ","$11,397.72 ","$2,670.00 ","$2,670.00 ","$5,992.55 ","$2,670.00 ","$7,198.56 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48000019,93610,HC EP INTRA-ATRIAL PACING,480,1 ,"$14,997.00 ","$9,748.05 ",$220.90 ,"$14,997.00 ","$14,981.38 ","$7,500.00 ","$8,398.32 ","$5,992.55 ","$4,199.16 ",$876.15 ,"$5,992.55 ",$876.15 ,"$5,992.55 ","$6,763.65 ","$6,763.65 ","$5,992.55 ",$220.90 ,"$11,385.85 ","$7,498.50 ","$14,981.38 ","$5,992.55 ","$5,992.55 ","$6,112.40 ","$11,247.75 ","$8,998.20 ","$8,998.20 ","$5,992.55 ","$8,998.20 ","$11,397.72 ","$11,397.72 ","$11,397.72 ","$14,997.00 ", N/A ,"$12,747.45 ","$14,981.38 ","$9,748.05 ","$5,992.55 ","$14,997.00 ","$8,398.32 ","$5,992.55 ","$3,944.21 ", N/A ,"$5,506.74 ","$5,256.44 ","$6,292.18 ","$11,997.60 ","$13,483.24 ","$6,763.65 ","$4,199.16 ","$13,497.30 ","$5,992.55 ","$11,397.72 ","$2,670.00 ","$2,670.00 ","$5,992.55 ","$2,670.00 ","$7,198.56 ","$5,006.13 "
ST. ELIZABETH'S HOSPITAL,48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$158.00 ,$102.70 ,$17.01 ,$292.61 ,$137.20 ,$72.68 ,$88.48 ,$54.88 ,$44.24 ,$55.77 ,$54.88 ,$65.10 ,$54.88 ,$71.26 ,$71.26 ,$54.88 ,$17.01 ,$104.27 ,$79.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$118.50 ,$94.80 ,$94.80 ,$54.88 ,$94.80 ,$120.08 ,$120.08 ,$120.08 ,$158.00 , N/A ,$134.30 ,$137.20 ,$102.70 ,$54.88 ,$158.00 ,$88.48 ,$54.88 ,$41.55 , N/A ,$158.00 ,$158.00 ,$57.62 ,$126.40 ,$123.48 ,$71.26 ,$44.24 ,$142.20 ,$54.88 ,$120.08 ,$158.00 ,$158.00 ,$54.88 ,$158.00 ,$75.84 ,$292.61 
ST. ELIZABETH'S HOSPITAL,48100002,33206,HC INS/REPL PCMKR PERM ATRIAL 33206,481,1 ,"$27,510.00 ","$17,881.50 ","$4,859.14 ","$27,510.00 ","$25,627.60 ","$12,000.00 ","$15,405.60 ","$10,251.04 ","$7,702.80 ","$4,859.14 ","$10,251.04 ","$5,584.90 ","$10,251.04 ","$6,645.60 ","$6,645.60 ","$10,251.04 ","$6,645.60 ","$19,476.98 ","$13,755.00 ","$25,627.61 ","$10,251.04 ","$10,251.04 ","$10,456.06 ","$20,632.50 ","$16,506.00 ","$16,506.00 ","$10,251.04 ","$16,506.00 ","$20,907.60 ","$20,907.60 ","$20,907.60 ","$27,510.00 ", N/A ,"$23,383.50 ","$25,627.61 ","$17,881.50 ","$10,251.04 ","$27,510.00 ","$15,405.60 ","$10,251.04 ","$7,235.13 ", N/A ,"$8,482.36 ","$8,096.80 ","$10,763.59 ","$22,008.00 ","$23,064.84 ","$6,645.60 ","$7,702.80 ","$24,759.00 ","$10,251.04 ","$20,907.60 ","$22,140.00 ","$22,140.00 ","$10,251.04 ","$22,140.00 ","$13,204.80 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100003,33207,HC INS/REPL PACEMKR PERM VENTRIC 33207,481,1 ,"$27,510.00 ","$17,881.50 ","$4,859.14 ","$27,510.00 ","$25,627.60 ","$12,000.00 ","$15,405.60 ","$10,251.04 ","$7,702.80 ","$4,859.14 ","$10,251.04 ","$5,584.90 ","$10,251.04 ","$6,645.60 ","$6,645.60 ","$10,251.04 ","$6,645.60 ","$19,476.98 ","$13,755.00 ","$25,627.61 ","$10,251.04 ","$10,251.04 ","$10,456.06 ","$20,632.50 ","$16,506.00 ","$16,506.00 ","$10,251.04 ","$16,506.00 ","$20,907.60 ","$20,907.60 ","$20,907.60 ","$27,510.00 ", N/A ,"$23,383.50 ","$25,627.61 ","$17,881.50 ","$10,251.04 ","$27,510.00 ","$15,405.60 ","$10,251.04 ","$7,235.13 ", N/A ,"$8,482.36 ","$8,096.80 ","$10,763.59 ","$22,008.00 ","$23,064.84 ","$6,645.60 ","$7,702.80 ","$24,759.00 ","$10,251.04 ","$20,907.60 ","$22,140.00 ","$22,140.00 ","$10,251.04 ","$22,140.00 ","$13,204.80 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100004,33208,HC INS/REPL PACEMKR PERM A/V 33208,481,1 ,"$27,510.00 ","$17,881.50 ","$4,859.14 ","$27,510.00 ","$25,627.60 ","$12,000.00 ","$15,405.60 ","$10,251.04 ","$7,702.80 ","$4,859.14 ","$10,251.04 ","$5,584.90 ","$10,251.04 ","$6,645.60 ","$6,645.60 ","$10,251.04 ","$6,645.60 ","$19,476.98 ","$13,755.00 ","$25,627.61 ","$10,251.04 ","$10,251.04 ","$10,456.06 ","$20,632.50 ","$16,506.00 ","$16,506.00 ","$10,251.04 ","$16,506.00 ","$20,907.60 ","$20,907.60 ","$20,907.60 ","$27,510.00 ", N/A ,"$23,383.50 ","$25,627.61 ","$17,881.50 ","$10,251.04 ","$27,510.00 ","$15,405.60 ","$10,251.04 ","$7,235.13 ", N/A ,"$8,482.36 ","$8,096.80 ","$10,763.59 ","$22,008.00 ","$23,064.84 ","$6,645.60 ","$7,702.80 ","$24,759.00 ","$10,251.04 ","$20,907.60 ","$22,140.00 ","$22,140.00 ","$10,251.04 ","$22,140.00 ","$13,204.80 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100005,33210,HC INS/REPL TPM SGL ELEC/CATH 33210,481,1 ,"$20,802.00 ","$13,521.30 ","$2,986.93 ","$20,802.00 ","$20,108.50 ","$5,000.00 ","$11,649.12 ","$8,043.40 ","$5,824.56 ","$4,859.14 ","$8,043.40 ","$5,584.90 ","$8,043.40 ","$6,645.60 ","$6,645.60 ","$8,043.40 ","$6,645.60 ","$15,282.47 ","$10,401.00 ","$20,108.51 ","$8,043.40 ","$8,043.40 ","$8,204.27 ","$15,601.50 ","$12,481.20 ","$12,481.20 ","$8,043.40 ","$12,481.20 ","$15,809.52 ","$15,809.52 ","$15,809.52 ","$20,802.00 ", N/A ,"$17,681.70 ","$20,108.51 ","$13,521.30 ","$8,043.40 ","$20,802.00 ","$11,649.12 ","$8,043.40 ","$5,470.93 ", N/A ,"$3,285.62 ","$3,136.28 ","$8,445.57 ","$16,641.60 ","$18,097.66 ","$6,645.60 ","$5,824.56 ","$18,721.80 ","$8,043.40 ","$15,809.52 ","$4,800.00 ","$4,800.00 ","$8,043.40 ","$4,800.00 ","$9,984.96 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100006,33212,HC INS PULSE GEN SGL CHAMBER 33212,481,1 ,"$20,802.00 ","$13,521.30 ","$4,200.00 ","$20,802.00 ","$20,108.50 ","$4,200.00 ","$11,649.12 ","$8,043.40 ","$5,824.56 ","$4,859.14 ","$8,043.40 ","$5,584.90 ","$8,043.40 ","$6,645.60 ","$6,645.60 ","$8,043.40 ","$6,645.60 ","$15,282.47 ","$10,401.00 ","$20,108.51 ","$8,043.40 ","$8,043.40 ","$8,204.27 ","$15,601.50 ","$12,481.20 ","$12,481.20 ","$8,043.40 ","$12,481.20 ","$15,809.52 ","$15,809.52 ","$15,809.52 ","$20,802.00 ", N/A ,"$17,681.70 ","$20,108.51 ","$13,521.30 ","$8,043.40 ","$20,802.00 ","$11,649.12 ","$8,043.40 ","$5,470.93 ", N/A ,"$8,482.36 ","$8,096.80 ","$8,445.57 ","$16,641.60 ","$18,097.66 ","$6,645.60 ","$5,824.56 ","$18,721.80 ","$8,043.40 ","$15,809.52 ","$20,802.00 ","$20,802.00 ","$8,043.40 ","$20,802.00 ","$9,984.96 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100007,33213,HC INS PULSE GEN DUAL CHAMBER 33213,481,1 ,"$27,510.00 ","$17,881.50 ","$4,200.00 ","$27,510.00 ","$25,627.60 ","$4,200.00 ","$15,405.60 ","$10,251.04 ","$7,702.80 ","$4,859.14 ","$10,251.04 ","$5,584.90 ","$10,251.04 ","$6,645.60 ","$6,645.60 ","$10,251.04 ","$6,645.60 ","$19,476.98 ","$13,755.00 ","$25,627.61 ","$10,251.04 ","$10,251.04 ","$10,456.06 ","$20,632.50 ","$16,506.00 ","$16,506.00 ","$10,251.04 ","$16,506.00 ","$20,907.60 ","$20,907.60 ","$20,907.60 ","$27,510.00 ", N/A ,"$23,383.50 ","$25,627.61 ","$17,881.50 ","$10,251.04 ","$27,510.00 ","$15,405.60 ","$10,251.04 ","$7,235.13 ", N/A ,"$8,482.36 ","$8,096.80 ","$10,763.59 ","$22,008.00 ","$23,064.84 ","$6,645.60 ","$7,702.80 ","$24,759.00 ","$10,251.04 ","$20,907.60 ","$22,140.00 ","$22,140.00 ","$10,251.04 ","$22,140.00 ","$13,204.80 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100008,33214,HC UPGRADE PACEMAKER SYSTEM 33214,481,1 ,"$27,510.00 ","$17,881.50 ","$4,859.14 ","$27,510.00 ","$25,627.60 ","$12,000.00 ","$15,405.60 ","$10,251.04 ","$7,702.80 ","$4,859.14 ","$10,251.04 ","$5,584.90 ","$10,251.04 ","$6,645.60 ","$6,645.60 ","$10,251.04 ","$6,645.60 ","$19,476.98 ","$13,755.00 ","$25,627.61 ","$10,251.04 ","$10,251.04 ","$10,456.06 ","$20,632.50 ","$16,506.00 ","$16,506.00 ","$10,251.04 ","$16,506.00 ","$20,907.60 ","$20,907.60 ","$20,907.60 ","$27,510.00 ", N/A ,"$23,383.50 ","$25,627.61 ","$17,881.50 ","$10,251.04 ","$27,510.00 ","$15,405.60 ","$10,251.04 ","$7,235.13 ", N/A ,"$8,482.36 ","$8,096.80 ","$10,763.59 ","$22,008.00 ","$23,064.84 ","$6,645.60 ","$7,702.80 ","$24,759.00 ","$10,251.04 ","$20,907.60 ","$22,140.00 ","$22,140.00 ","$10,251.04 ","$22,140.00 ","$13,204.80 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100009,33215,HC REPOSITION PACE/DEFIB LEAD 33215,481,1 ,"$7,035.00 ","$4,572.75 ","$1,850.21 ","$7,055.60 ","$7,055.60 ","$4,200.00 ","$3,939.60 ","$2,822.24 ","$1,969.80 ","$2,377.83 ","$2,822.24 ","$2,736.62 ","$2,822.24 ","$3,172.79 ","$3,172.79 ","$2,822.24 ","$3,172.79 ","$5,362.25 ","$3,517.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,276.25 ","$4,221.00 ","$4,221.00 ","$2,822.24 ","$4,221.00 ","$5,346.60 ","$5,346.60 ","$5,346.60 ","$7,035.00 ", N/A ,"$5,979.75 ","$7,035.00 ","$4,572.75 ","$2,822.24 ","$7,035.00 ","$3,939.60 ","$2,822.24 ","$1,850.21 ", N/A ,"$6,139.39 ","$5,860.32 ","$2,963.35 ","$5,628.00 ","$6,350.04 ","$3,172.79 ","$1,969.80 ","$6,331.50 ","$2,822.24 ","$5,346.60 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,376.80 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,48100010,33216,HC INS ELECTRODE SGL CHAMBER 33216,481,1 ,"$20,802.00 ","$13,521.30 ","$2,986.93 ","$20,802.00 ","$20,108.50 ","$5,000.00 ","$11,649.12 ","$8,043.40 ","$5,824.56 ","$4,859.14 ","$8,043.40 ","$5,584.90 ","$8,043.40 ","$6,645.60 ","$6,645.60 ","$8,043.40 ","$6,645.60 ","$15,282.47 ","$10,401.00 ","$20,108.51 ","$8,043.40 ","$8,043.40 ","$8,204.27 ","$15,601.50 ","$12,481.20 ","$12,481.20 ","$8,043.40 ","$12,481.20 ","$15,809.52 ","$15,809.52 ","$15,809.52 ","$20,802.00 ", N/A ,"$17,681.70 ","$20,108.51 ","$13,521.30 ","$8,043.40 ","$20,802.00 ","$11,649.12 ","$8,043.40 ","$5,470.93 ", N/A ,"$3,285.62 ","$3,136.28 ","$8,445.57 ","$16,641.60 ","$18,097.66 ","$6,645.60 ","$5,824.56 ","$18,721.80 ","$8,043.40 ","$15,809.52 ","$4,800.00 ","$4,800.00 ","$8,043.40 ","$4,800.00 ","$9,984.96 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100011,33217,HC INS ELECTRODE DUAL CHAMBER 33217,481,1 ,"$20,802.00 ","$13,521.30 ","$2,986.93 ","$20,802.00 ","$20,108.50 ","$5,000.00 ","$11,649.12 ","$8,043.40 ","$5,824.56 ","$4,859.14 ","$8,043.40 ","$5,584.90 ","$8,043.40 ","$6,645.60 ","$6,645.60 ","$8,043.40 ","$6,645.60 ","$15,282.47 ","$10,401.00 ","$20,108.51 ","$8,043.40 ","$8,043.40 ","$8,204.27 ","$15,601.50 ","$12,481.20 ","$12,481.20 ","$8,043.40 ","$12,481.20 ","$15,809.52 ","$15,809.52 ","$15,809.52 ","$20,802.00 ", N/A ,"$17,681.70 ","$20,108.51 ","$13,521.30 ","$8,043.40 ","$20,802.00 ","$11,649.12 ","$8,043.40 ","$5,470.93 ", N/A ,"$3,285.62 ","$3,136.28 ","$8,445.57 ","$16,641.60 ","$18,097.66 ","$6,645.60 ","$5,824.56 ","$18,721.80 ","$8,043.40 ","$15,809.52 ","$4,800.00 ","$4,800.00 ","$8,043.40 ","$4,800.00 ","$9,984.96 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100012,33222,HC REVISE PACEMAKER POCKET 33222,481,1 ,"$4,425.00 ","$2,876.25 ","$1,163.78 ","$4,425.00 ","$4,221.50 ","$3,200.00 ","$2,478.00 ","$1,688.60 ","$1,239.00 ","$1,495.65 ","$1,688.60 ","$1,721.33 ","$1,688.60 ","$1,995.68 ","$1,995.68 ","$1,688.60 ","$1,995.68 ","$3,208.33 ","$2,212.50 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$3,318.75 ","$2,655.00 ","$2,655.00 ","$1,688.60 ","$2,655.00 ","$3,363.00 ","$3,363.00 ","$3,363.00 ","$4,425.00 ", N/A ,"$3,761.25 ","$4,221.49 ","$2,876.25 ","$1,688.60 ","$4,425.00 ","$2,478.00 ","$1,688.60 ","$1,163.78 ", N/A ,"$1,848.13 ","$1,764.13 ","$1,773.03 ","$3,540.00 ","$3,799.34 ","$1,995.68 ","$1,239.00 ","$3,982.50 ","$1,688.60 ","$3,363.00 ","$1,890.00 ","$1,890.00 ","$1,688.60 ","$1,890.00 ","$2,124.00 ","$1,680.12 "
ST. ELIZABETH'S HOSPITAL,48100013,33223,HC REVISE C-D POCKET 33223,481,1 ,"$4,425.00 ","$2,876.25 ","$1,163.78 ","$4,425.00 ","$4,221.50 ","$3,200.00 ","$2,478.00 ","$1,688.60 ","$1,239.00 ","$1,495.65 ","$1,688.60 ","$1,721.33 ","$1,688.60 ","$1,995.68 ","$1,995.68 ","$1,688.60 ","$1,995.68 ","$3,208.33 ","$2,212.50 ","$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,722.37 ","$3,318.75 ","$2,655.00 ","$2,655.00 ","$1,688.60 ","$2,655.00 ","$3,363.00 ","$3,363.00 ","$3,363.00 ","$4,425.00 ", N/A ,"$3,761.25 ","$4,221.49 ","$2,876.25 ","$1,688.60 ","$4,425.00 ","$2,478.00 ","$1,688.60 ","$1,163.78 ", N/A ,"$1,848.13 ","$1,764.13 ","$1,773.03 ","$3,540.00 ","$3,799.34 ","$1,995.68 ","$1,239.00 ","$3,982.50 ","$1,688.60 ","$3,363.00 ","$1,890.00 ","$1,890.00 ","$1,688.60 ","$1,890.00 ","$2,124.00 ","$1,680.12 "
ST. ELIZABETH'S HOSPITAL,48100014,33224,HC INSERT LV PACING ELECTRODE 33224,481,1 ,"$27,510.00 ","$17,881.50 ","$4,200.00 ","$27,510.00 ","$25,627.60 ","$4,200.00 ","$15,405.60 ","$10,251.04 ","$7,702.80 ","$4,859.14 ","$10,251.04 ","$5,584.90 ","$10,251.04 ","$6,645.60 ","$6,645.60 ","$10,251.04 ","$6,645.60 ","$19,476.98 ","$13,755.00 ","$25,627.61 ","$10,251.04 ","$10,251.04 ","$10,456.06 ","$20,632.50 ","$16,506.00 ","$16,506.00 ","$10,251.04 ","$16,506.00 ","$20,907.60 ","$20,907.60 ","$20,907.60 ","$27,510.00 ", N/A ,"$23,383.50 ","$25,627.61 ","$17,881.50 ","$10,251.04 ","$27,510.00 ","$15,405.60 ","$10,251.04 ","$7,235.13 ", N/A ,"$11,318.77 ","$10,804.28 ","$10,763.59 ","$22,008.00 ","$23,064.84 ","$6,645.60 ","$7,702.80 ","$24,759.00 ","$10,251.04 ","$20,907.60 ","$22,140.00 ","$22,140.00 ","$10,251.04 ","$22,140.00 ","$13,204.80 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100015,33225,HC INS LV PACING ELCT W/C-D/PACE 33225,481,1 ,"$4,028.00 ","$2,618.20 ","$1,059.36 ","$4,028.00 ", N/A ,"$4,028.00 ","$2,255.68 ", N/A ,"$1,127.84 ","$1,361.46 ", N/A ,"$1,566.89 ", N/A ,"$1,816.63 ","$1,816.63 ", N/A ,"$1,816.63 ", N/A ,"$2,014.00 ", N/A , N/A , N/A , N/A ,"$3,021.00 ","$2,416.80 ","$2,416.80 ", N/A ,"$2,416.80 ","$3,061.28 ","$3,061.28 ","$3,061.28 ","$4,028.00 ", N/A ,"$3,423.80 ", N/A ,"$2,618.20 ", N/A ,"$4,028.00 ","$2,255.68 ", N/A ,"$1,059.36 ", N/A , N/A , N/A , N/A ,"$3,222.40 ", N/A ,"$1,816.63 ","$1,127.84 ","$3,625.20 ", N/A ,"$3,061.28 ","$4,028.00 ","$4,028.00 ", N/A ,"$4,028.00 ","$1,933.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100016,33226,HC REPOSITION LV ELECTRODE 33226,481,1 ,"$7,035.00 ","$4,572.75 ","$1,850.21 ","$7,055.60 ","$7,055.60 ","$4,200.00 ","$3,939.60 ","$2,822.24 ","$1,969.80 ","$2,377.83 ","$2,822.24 ","$2,736.62 ","$2,822.24 ","$3,172.79 ","$3,172.79 ","$2,822.24 ","$3,172.79 ","$5,362.25 ","$3,517.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,276.25 ","$4,221.00 ","$4,221.00 ","$2,822.24 ","$4,221.00 ","$5,346.60 ","$5,346.60 ","$5,346.60 ","$7,035.00 ", N/A ,"$5,979.75 ","$7,035.00 ","$4,572.75 ","$2,822.24 ","$7,035.00 ","$3,939.60 ","$2,822.24 ","$1,850.21 ", N/A ,"$6,139.39 ","$5,860.32 ","$2,963.35 ","$5,628.00 ","$6,350.04 ","$3,172.79 ","$1,969.80 ","$6,331.50 ","$2,822.24 ","$5,346.60 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,376.80 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,48100017,33233,HC REMOVE PPM 33233,481,1 ,"$20,802.00 ","$13,521.30 ","$3,200.00 ","$20,802.00 ","$20,108.50 ","$3,200.00 ","$11,649.12 ","$8,043.40 ","$5,824.56 ","$4,859.14 ","$8,043.40 ","$5,584.90 ","$8,043.40 ","$6,645.60 ","$6,645.60 ","$8,043.40 ","$6,645.60 ","$15,282.47 ","$10,401.00 ","$20,108.51 ","$8,043.40 ","$8,043.40 ","$8,204.27 ","$15,601.50 ","$12,481.20 ","$12,481.20 ","$8,043.40 ","$12,481.20 ","$15,809.52 ","$15,809.52 ","$15,809.52 ","$20,802.00 ", N/A ,"$17,681.70 ","$20,108.51 ","$13,521.30 ","$8,043.40 ","$20,802.00 ","$11,649.12 ","$8,043.40 ","$5,470.93 ", N/A ,"$6,139.39 ","$5,860.32 ","$8,445.57 ","$16,641.60 ","$18,097.66 ","$6,645.60 ","$5,824.56 ","$18,721.80 ","$8,043.40 ","$15,809.52 ","$3,600.00 ","$3,600.00 ","$8,043.40 ","$3,600.00 ","$9,984.96 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,48100018,33234,HC REMOVE ELECTRODE SGL 33234,481,1 ,"$8,094.00 ","$5,261.10 ","$2,128.72 ","$8,487.15 ","$8,487.15 ","$5,000.00 ","$4,532.64 ","$3,394.86 ","$2,266.32 ","$2,735.77 ","$3,394.86 ","$3,148.57 ","$3,394.86 ","$3,650.39 ","$3,650.39 ","$3,394.86 ","$3,650.39 ","$6,450.23 ","$4,047.00 ","$8,487.14 ","$3,394.86 ","$3,394.86 ","$3,462.75 ","$6,070.50 ","$4,856.40 ","$4,856.40 ","$3,394.86 ","$4,856.40 ","$6,151.44 ","$6,151.44 ","$6,151.44 ","$8,094.00 ", N/A ,"$6,879.90 ","$8,094.00 ","$5,261.10 ","$3,394.86 ","$8,094.00 ","$4,532.64 ","$3,394.86 ","$2,128.72 ", N/A ,"$6,139.39 ","$5,860.32 ","$3,564.60 ","$6,475.20 ","$7,638.43 ","$3,650.39 ","$2,266.32 ","$7,284.60 ","$3,394.86 ","$6,151.44 ","$3,600.00 ","$3,600.00 ","$3,394.86 ","$3,600.00 ","$3,885.12 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,48100019,33235,HC REMOVE ELECTRODE DUAL 33235,481,1 ,"$8,094.00 ","$5,261.10 ","$2,128.72 ","$8,487.15 ","$8,487.15 ","$5,000.00 ","$4,532.64 ","$3,394.86 ","$2,266.32 ","$2,735.77 ","$3,394.86 ","$3,148.57 ","$3,394.86 ","$3,650.39 ","$3,650.39 ","$3,394.86 ","$3,650.39 ","$6,450.23 ","$4,047.00 ","$8,487.14 ","$3,394.86 ","$3,394.86 ","$3,462.75 ","$6,070.50 ","$4,856.40 ","$4,856.40 ","$3,394.86 ","$4,856.40 ","$6,151.44 ","$6,151.44 ","$6,151.44 ","$8,094.00 ", N/A ,"$6,879.90 ","$8,094.00 ","$5,261.10 ","$3,394.86 ","$8,094.00 ","$4,532.64 ","$3,394.86 ","$2,128.72 ", N/A ,"$6,139.39 ","$5,860.32 ","$3,564.60 ","$6,475.20 ","$7,638.43 ","$3,650.39 ","$2,266.32 ","$7,284.60 ","$3,394.86 ","$6,151.44 ","$3,600.00 ","$3,600.00 ","$3,394.86 ","$3,600.00 ","$3,885.12 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,48100020,33240,HC INSERT SGL/DUAL CHAMBER C-D 33240,481,1 ,"$62,394.00 ","$40,556.10 ","$12,000.00 ","$62,394.00 ","$56,835.28 ","$12,000.00 ","$34,940.64 ","$22,734.11 ","$17,470.32 ","$21,089.17 ","$22,734.11 ","$24,271.27 ","$22,734.11 ","$28,139.69 ","$28,139.69 ","$22,734.11 ","$28,139.69 ","$43,194.80 ","$31,197.00 ","$56,835.27 ","$22,734.11 ","$22,734.11 ","$23,188.79 ","$46,795.50 ","$37,436.40 ","$37,436.40 ","$22,734.11 ","$37,436.40 ","$47,419.44 ","$47,419.44 ","$47,419.44 ","$62,394.00 ", N/A ,"$53,034.90 ","$56,835.27 ","$40,556.10 ","$22,734.11 ","$62,394.00 ","$34,940.64 ","$22,734.11 ","$16,409.62 ", N/A ,"$24,331.36 ","$23,225.39 ","$23,870.82 ","$49,915.20 ","$51,151.74 ","$28,139.69 ","$17,470.32 ","$56,154.60 ","$22,734.11 ","$47,419.44 ","$22,140.00 ","$22,140.00 ","$22,734.11 ","$22,140.00 ","$29,949.12 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100022,33241,HC REMOVE C-D PULSE GENERATOR 33241,481,1 ,"$8,094.00 ","$5,261.10 ","$2,128.72 ","$8,487.15 ","$8,487.15 ","$5,000.00 ","$4,532.64 ","$3,394.86 ","$2,266.32 ","$2,735.77 ","$3,394.86 ","$3,148.57 ","$3,394.86 ","$3,650.39 ","$3,650.39 ","$3,394.86 ","$3,650.39 ","$6,450.23 ","$4,047.00 ","$8,487.14 ","$3,394.86 ","$3,394.86 ","$3,462.75 ","$6,070.50 ","$4,856.40 ","$4,856.40 ","$3,394.86 ","$4,856.40 ","$6,151.44 ","$6,151.44 ","$6,151.44 ","$8,094.00 ", N/A ,"$6,879.90 ","$8,094.00 ","$5,261.10 ","$3,394.86 ","$8,094.00 ","$4,532.64 ","$3,394.86 ","$2,128.72 ", N/A ,"$6,139.39 ","$5,860.32 ","$3,564.60 ","$6,475.20 ","$7,638.43 ","$3,650.39 ","$2,266.32 ","$7,284.60 ","$3,394.86 ","$6,151.44 ","$3,600.00 ","$3,600.00 ","$3,394.86 ","$3,600.00 ","$3,885.12 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,48100023,33244,HC REMOVE C-D ELECTRODES 33244,481,1 ,"$8,094.00 ","$5,261.10 ","$2,128.72 ","$8,487.15 ","$8,487.15 ","$5,000.00 ","$4,532.64 ","$3,394.86 ","$2,266.32 ","$2,735.77 ","$3,394.86 ","$3,148.57 ","$3,394.86 ","$3,650.39 ","$3,650.39 ","$3,394.86 ","$3,650.39 ","$6,450.23 ","$4,047.00 ","$8,487.14 ","$3,394.86 ","$3,394.86 ","$3,462.75 ","$6,070.50 ","$4,856.40 ","$4,856.40 ","$3,394.86 ","$4,856.40 ","$6,151.44 ","$6,151.44 ","$6,151.44 ","$8,094.00 ", N/A ,"$6,879.90 ","$8,094.00 ","$5,261.10 ","$3,394.86 ","$8,094.00 ","$4,532.64 ","$3,394.86 ","$2,128.72 ", N/A ,"$6,139.39 ","$5,860.32 ","$3,564.60 ","$6,475.20 ","$7,638.43 ","$3,650.39 ","$2,266.32 ","$7,284.60 ","$3,394.86 ","$6,151.44 ","$3,600.00 ","$3,600.00 ","$3,394.86 ","$3,600.00 ","$3,885.12 ","$5,581.26 "
ST. ELIZABETH'S HOSPITAL,48100024,33249,HC INS/REPOS DEFIB LEAD/GEN 33249,481,1 ,"$87,375.00 ","$56,793.75 ","$12,000.00 ","$87,375.00 ","$80,959.05 ","$12,000.00 ","$48,930.00 ","$32,383.62 ","$24,465.00 ","$29,532.75 ","$32,383.62 ","$33,988.88 ","$32,383.62 ","$39,406.13 ","$39,406.13 ","$32,383.62 ","$39,406.13 ","$61,528.88 ","$43,687.50 ","$80,959.05 ","$32,383.62 ","$32,383.62 ","$33,031.29 ","$65,531.25 ","$52,425.00 ","$52,425.00 ","$32,383.62 ","$52,425.00 ","$66,405.00 ","$66,405.00 ","$66,405.00 ","$87,375.00 ", N/A ,"$74,268.75 ","$80,959.05 ","$56,793.75 ","$32,383.62 ","$87,375.00 ","$48,930.00 ","$32,383.62 ","$22,979.63 ", N/A ,"$24,331.36 ","$23,225.39 ","$34,002.80 ","$69,900.00 ","$72,863.14 ","$39,406.13 ","$24,465.00 ","$78,637.50 ","$32,383.62 ","$66,405.00 ","$22,140.00 ","$22,140.00 ","$32,383.62 ","$22,140.00 ","$41,940.00 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100028,33285,HC IMPLANT CARDIAC EVENT RECORDER,481,1 ,"$20,802.00 ","$13,521.30 ","$2,125.00 ","$20,802.00 ","$20,108.50 ","$2,125.00 ","$11,649.12 ","$8,043.40 ","$5,824.56 ","$4,859.14 ","$8,043.40 ","$5,584.90 ","$8,043.40 ","$6,645.60 ","$6,645.60 ","$8,043.40 ","$6,645.60 ","$15,282.47 ","$10,401.00 ","$20,108.51 ","$8,043.40 ","$8,043.40 ","$8,204.27 ","$15,601.50 ","$12,481.20 ","$12,481.20 ","$8,043.40 ","$12,481.20 ","$15,809.52 ","$15,809.52 ","$15,809.52 ","$20,802.00 ", N/A ,"$17,681.70 ","$20,108.51 ","$13,521.30 ","$8,043.40 ","$20,802.00 ","$11,649.12 ","$8,043.40 ","$5,470.93 ", N/A ,"$4,198.04 ","$4,007.22 ","$8,445.57 ","$16,641.60 ","$18,097.66 ","$6,645.60 ","$5,824.56 ","$18,721.80 ","$8,043.40 ","$15,809.52 ","$5,500.00 ","$5,500.00 ","$8,043.40 ","$5,500.00 ","$9,984.96 ","$3,816.40 "
ST. ELIZABETH'S HOSPITAL,48100029,33286,HC REMOVE CARDIAC EVENT RECORDER,481,1 ,"$1,078.00 ",$700.70 ,$283.51 ,"$1,533.75 ","$1,533.75 ","$1,078.00 ",$603.68 ,$613.50 ,$301.84 ,$364.36 ,$613.50 ,$419.34 ,$613.50 ,$486.18 ,$486.18 ,$613.50 ,$486.18 ,"$1,078.00 ",$539.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$625.77 ,$808.50 ,$646.80 ,$646.80 ,$613.50 ,$646.80 ,$819.28 ,$819.28 ,$819.28 ,"$1,078.00 ", N/A ,$916.30 ,"$1,078.00 ",$700.70 ,$613.50 ,"$1,078.00 ",$603.68 ,$613.50 ,$283.51 , N/A ,$679.51 ,$648.63 ,$644.18 ,$862.40 ,"$1,380.37 ",$486.18 ,$301.84 ,$970.20 ,$613.50 ,$819.28 ,"$1,078.00 ","$1,078.00 ",$613.50 ,"$1,078.00 ",$517.44 ,$617.74 
ST. ELIZABETH'S HOSPITAL,48100030,33967,HC IABP INSERTION 33967,481,1 ,"$3,036.00 ","$1,973.40 ",$798.47 ,"$3,036.00 ", N/A ,"$3,036.00 ","$1,700.16 ", N/A ,$850.08 ,"$1,026.17 ", N/A ,"$1,181.00 ", N/A ,"$1,369.24 ","$1,369.24 ", N/A ,"$1,369.24 ", N/A ,"$1,518.00 ", N/A , N/A , N/A , N/A ,"$2,277.00 ","$1,821.60 ","$1,821.60 ", N/A ,"$1,821.60 ","$2,307.36 ","$2,307.36 ","$2,307.36 ","$3,036.00 ", N/A ,"$2,580.60 ", N/A ,"$1,973.40 ", N/A ,"$3,036.00 ","$1,700.16 ", N/A ,$798.47 , N/A , N/A , N/A , N/A ,"$2,428.80 ", N/A ,"$1,369.24 ",$850.08 ,"$2,732.40 ", N/A ,"$2,307.36 ","$3,036.00 ","$3,036.00 ", N/A ,"$3,036.00 ","$1,457.28 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100039,36010,HC INTRO CATH VENA CAVA SUP/IN,481,1 ,"$3,500.00 ","$2,275.00 ",$920.00 ,"$3,500.00 ", N/A ,"$2,125.00 ","$1,960.00 ", N/A ,$980.00 ,"$1,183.00 ", N/A ,"$1,361.50 ", N/A ,"$1,578.50 ","$1,578.50 ", N/A ,"$1,578.50 ", N/A ,"$1,750.00 ", N/A , N/A , N/A , N/A ,"$2,625.00 ","$2,100.00 ","$2,100.00 ", N/A ,"$2,100.00 ","$2,660.00 ","$2,660.00 ","$2,660.00 ","$3,500.00 ", N/A ,"$2,975.00 ", N/A ,"$2,275.00 ", N/A ,"$3,500.00 ","$1,960.00 ", N/A ,$920.50 , N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$2,800.00 ", N/A ,"$1,578.50 ",$980.00 ,"$3,150.00 ", N/A ,"$2,660.00 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,680.00 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100040,36011,"HC CATH PLCMT VENOUS, 1ST ORDER",481,1 ,"$1,110.00 ",$721.50 ,$291.93 ,"$2,565.01 ", N/A ,"$1,110.00 ",$621.60 , N/A ,$310.80 ,$375.18 , N/A ,$431.79 , N/A ,$500.61 ,$500.61 , N/A ,$500.61 , N/A ,$555.00 , N/A , N/A , N/A , N/A ,$832.50 ,$666.00 ,$666.00 , N/A ,$666.00 ,$843.60 ,$843.60 ,$843.60 ,"$1,110.00 ", N/A ,$943.50 , N/A ,$721.50 , N/A ,"$1,110.00 ",$621.60 , N/A ,$291.93 , N/A ,"$1,110.00 ","$1,110.00 ", N/A ,$888.00 , N/A ,$500.61 ,$310.80 ,$999.00 , N/A ,$843.60 ,$920.00 ,$920.00 , N/A ,$920.00 ,$532.80 ,"$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100041,36012,"HC CATH PLCMT VENOUS, 2ND ORDER",481,1 ,"$1,977.00 ","$1,285.05 ",$519.95 ,"$3,847.52 ", N/A ,"$1,977.00 ","$1,107.12 ", N/A ,$553.56 ,$668.23 , N/A ,$769.05 , N/A ,$891.63 ,$891.63 , N/A ,$891.63 , N/A ,$988.50 , N/A , N/A , N/A , N/A ,"$1,482.75 ","$1,186.20 ","$1,186.20 ", N/A ,"$1,186.20 ","$1,502.52 ","$1,502.52 ","$1,502.52 ","$1,977.00 ", N/A ,"$1,680.45 ", N/A ,"$1,285.05 ", N/A ,"$1,977.00 ","$1,107.12 ", N/A ,$519.95 , N/A ,"$1,977.00 ","$1,977.00 ", N/A ,"$1,581.60 ", N/A ,$891.63 ,$553.56 ,"$1,779.30 ", N/A ,"$1,502.52 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ",$948.96 ,"$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100041,36012,"HC CATH PLCMT VENOUS, 2ND ORDER",481,1 ,"$1,394.00 ",$906.10 ,$366.62 ,"$2,565.01 ", N/A ,"$1,394.00 ",$780.64 , N/A ,$390.32 ,$471.17 , N/A ,$542.27 , N/A ,$628.69 ,$628.69 , N/A ,$628.69 , N/A ,$697.00 , N/A , N/A , N/A , N/A ,"$1,045.50 ",$836.40 ,$836.40 , N/A ,$836.40 ,"$1,059.44 ","$1,059.44 ","$1,059.44 ","$1,394.00 ", N/A ,"$1,184.90 ", N/A ,$906.10 , N/A ,"$1,394.00 ",$780.64 , N/A ,$366.62 , N/A ,"$1,394.00 ","$1,394.00 ", N/A ,"$1,115.20 ", N/A ,$628.69 ,$390.32 ,"$1,254.60 ", N/A ,"$1,059.44 ",$920.00 ,$920.00 , N/A ,$920.00 ,$669.12 ,"$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100042,36013,HC INTRO CATH ARTERY HEART/PULM,481,1 ,"$2,400.00 ","$1,560.00 ",$631.20 ,"$2,565.01 ", N/A ,"$2,125.00 ","$1,344.00 ", N/A ,$672.00 ,"$2,400.00 ", N/A ,$933.60 , N/A ,"$1,082.40 ","$1,082.40 ", N/A ,"$1,082.40 ", N/A ,"$1,200.00 ", N/A , N/A , N/A , N/A ,"$1,800.00 ","$1,440.00 ","$1,440.00 ", N/A ,"$1,440.00 ","$1,824.00 ","$1,824.00 ","$1,824.00 ","$2,400.00 ", N/A ,"$2,040.00 ", N/A ,"$1,560.00 ", N/A ,"$2,400.00 ","$1,344.00 ", N/A ,$631.20 , N/A ,"$2,400.00 ","$2,400.00 ", N/A ,"$1,920.00 ", N/A ,"$1,082.40 ",$672.00 ,"$2,160.00 ", N/A ,"$1,824.00 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,152.00 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100047,36140,HC INTRO NDL/CATH ARTERY EXTREM 36140,481,1 ,"$3,216.00 ","$2,090.40 ",$845.81 ,"$3,216.00 ", N/A ,"$2,125.00 ","$1,800.96 ", N/A ,$900.48 ,"$1,087.01 ", N/A ,"$1,251.02 ", N/A ,"$1,450.42 ","$1,450.42 ", N/A ,"$1,450.42 ", N/A ,"$1,608.00 ", N/A , N/A , N/A , N/A ,"$2,412.00 ","$1,929.60 ","$1,929.60 ", N/A ,"$1,929.60 ","$2,444.16 ","$2,444.16 ","$2,444.16 ","$3,216.00 ", N/A ,"$2,733.60 ", N/A ,"$2,090.40 ", N/A ,"$3,216.00 ","$1,800.96 ", N/A ,$845.81 , N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$2,572.80 ", N/A ,"$1,450.42 ",$900.48 ,"$2,894.40 ", N/A ,"$2,444.16 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,543.68 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100051,36200,HC INTRO CATH AORTA 36200,481,1 ,"$4,322.00 ","$2,809.30 ",$920.00 ,"$4,322.00 ", N/A ,"$3,200.00 ","$2,420.32 ", N/A ,"$1,210.16 ","$1,460.84 ", N/A ,"$1,681.26 ", N/A ,"$1,949.22 ","$1,949.22 ", N/A ,"$1,949.22 ", N/A ,"$2,161.00 ", N/A , N/A , N/A , N/A ,"$3,241.50 ","$2,593.20 ","$2,593.20 ", N/A ,"$2,593.20 ","$3,284.72 ","$3,284.72 ","$3,284.72 ","$4,322.00 ", N/A ,"$3,673.70 ", N/A ,"$2,809.30 ", N/A ,"$4,322.00 ","$2,420.32 ", N/A ,"$1,136.69 ", N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$3,457.60 ", N/A ,"$1,949.22 ","$1,210.16 ","$3,889.80 ", N/A ,"$3,284.72 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$2,074.56 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100052,36215,HC PLACE CATH THOR/BRAC 1ST ORDER 36215,481,1 ,"$3,487.00 ","$2,266.55 ",$917.08 ,"$3,487.00 ", N/A ,"$3,200.00 ","$1,952.72 ", N/A ,$976.36 ,"$1,178.61 ", N/A ,"$1,356.44 ", N/A ,"$1,572.64 ","$1,572.64 ", N/A ,"$1,572.64 ", N/A ,"$1,743.50 ", N/A , N/A , N/A , N/A ,"$2,615.25 ","$2,092.20 ","$2,092.20 ", N/A ,"$2,092.20 ","$2,650.12 ","$2,650.12 ","$2,650.12 ","$3,487.00 ", N/A ,"$2,963.95 ", N/A ,"$2,266.55 ", N/A ,"$3,487.00 ","$1,952.72 ", N/A ,$917.08 , N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$2,789.60 ", N/A ,"$1,572.64 ",$976.36 ,"$3,138.30 ", N/A ,"$2,650.12 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,673.76 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100053,36216,HC PL CATH THOR/BRAC 2ND ORDER 36216,481,1 ,"$3,210.00 ","$2,086.50 ",$844.23 ,"$3,210.00 ", N/A ,"$3,200.00 ","$1,797.60 ", N/A ,$898.80 ,"$1,084.98 ", N/A ,"$1,248.69 ", N/A ,"$1,447.71 ","$1,447.71 ", N/A ,"$1,447.71 ", N/A ,"$1,605.00 ", N/A , N/A , N/A , N/A ,"$2,407.50 ","$1,926.00 ","$1,926.00 ", N/A ,"$1,926.00 ","$2,439.60 ","$2,439.60 ","$2,439.60 ","$3,210.00 ", N/A ,"$2,728.50 ", N/A ,"$2,086.50 ", N/A ,"$3,210.00 ","$1,797.60 ", N/A ,$844.23 , N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$2,568.00 ", N/A ,"$1,447.71 ",$898.80 ,"$2,889.00 ", N/A ,"$2,439.60 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,540.80 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100054,36217,HC PL CATH THOR/BRAC 3RD ORDER 36217,481,1 ,"$2,096.00 ","$1,362.40 ",$551.25 ,"$2,565.01 ", N/A ,"$2,096.00 ","$1,173.76 ", N/A ,$586.88 ,$708.45 , N/A ,$815.34 , N/A ,$945.30 ,$945.30 , N/A ,$945.30 , N/A ,"$1,048.00 ", N/A , N/A , N/A , N/A ,"$1,572.00 ","$1,257.60 ","$1,257.60 ", N/A ,"$1,257.60 ","$1,592.96 ","$1,592.96 ","$1,592.96 ","$2,096.00 ", N/A ,"$1,781.60 ", N/A ,"$1,362.40 ", N/A ,"$2,096.00 ","$1,173.76 ", N/A ,$551.25 , N/A ,"$2,096.00 ","$2,096.00 ", N/A ,"$1,676.80 ", N/A ,$945.30 ,$586.88 ,"$1,886.40 ", N/A ,"$1,592.96 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,006.08 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100056,36245,HC ABD 1ST ORDER 36245,481,1 ,"$5,728.00 ","$3,723.20 ","$1,380.00 ","$5,728.00 ", N/A ,"$4,800.00 ","$3,207.68 ", N/A ,"$1,603.84 ","$1,936.06 ", N/A ,"$2,228.19 ", N/A ,"$2,583.33 ","$2,583.33 ", N/A ,"$2,583.33 ", N/A ,"$2,864.00 ", N/A , N/A , N/A , N/A ,"$4,296.00 ","$3,436.80 ","$3,436.80 ", N/A ,"$3,436.80 ","$4,353.28 ","$4,353.28 ","$4,353.28 ","$5,728.00 ", N/A ,"$4,868.80 ", N/A ,"$3,723.20 ", N/A ,"$5,728.00 ","$3,207.68 ", N/A ,"$1,506.46 ", N/A ,"$4,232.27 ","$4,039.90 ", N/A ,"$4,582.40 ", N/A ,"$2,583.33 ","$1,603.84 ","$5,155.20 ", N/A ,"$4,353.28 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$2,749.44 ","$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100056,36245,HC ABD 1ST ORDER 36245,481,1 ,"$3,819.00 ","$2,482.35 ",$920.00 ,"$3,819.00 ", N/A ,"$3,200.00 ","$2,138.64 ", N/A ,"$1,069.32 ","$1,290.82 ", N/A ,"$1,485.59 ", N/A ,"$1,722.37 ","$1,722.37 ", N/A ,"$1,722.37 ", N/A ,"$1,909.50 ", N/A , N/A , N/A , N/A ,"$2,864.25 ","$2,291.40 ","$2,291.40 ", N/A ,"$2,291.40 ","$2,902.44 ","$2,902.44 ","$2,902.44 ","$3,819.00 ", N/A ,"$3,246.15 ", N/A ,"$2,482.35 ", N/A ,"$3,819.00 ","$2,138.64 ", N/A ,"$1,004.40 ", N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$3,055.20 ", N/A ,"$1,722.37 ","$1,069.32 ","$3,437.10 ", N/A ,"$2,902.44 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,833.12 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100057,36246,HC ABD INITIAL 2ND ORDER 36246,481,1 ,"$5,488.00 ","$3,567.20 ","$1,380.00 ","$5,488.00 ", N/A ,"$4,800.00 ","$3,073.28 ", N/A ,"$1,536.64 ","$1,854.94 ", N/A ,"$2,134.83 ", N/A ,"$2,475.09 ","$2,475.09 ", N/A ,"$2,475.09 ", N/A ,"$2,744.00 ", N/A , N/A , N/A , N/A ,"$4,116.00 ","$3,292.80 ","$3,292.80 ", N/A ,"$3,292.80 ","$4,170.88 ","$4,170.88 ","$4,170.88 ","$5,488.00 ", N/A ,"$4,664.80 ", N/A ,"$3,567.20 ", N/A ,"$5,488.00 ","$3,073.28 ", N/A ,"$1,443.34 ", N/A ,"$4,232.27 ","$4,039.90 ", N/A ,"$4,390.40 ", N/A ,"$2,475.09 ","$1,536.64 ","$4,939.20 ", N/A ,"$4,170.88 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$2,634.24 ","$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100057,36246,HC ABD INITIAL 2ND ORDER 36246,481,1 ,"$3,659.00 ","$2,378.35 ",$920.00 ,"$3,659.00 ", N/A ,"$3,200.00 ","$2,049.04 ", N/A ,"$1,024.52 ","$1,236.74 ", N/A ,"$1,423.35 ", N/A ,"$1,650.21 ","$1,650.21 ", N/A ,"$1,650.21 ", N/A ,"$1,829.50 ", N/A , N/A , N/A , N/A ,"$2,744.25 ","$2,195.40 ","$2,195.40 ", N/A ,"$2,195.40 ","$2,780.84 ","$2,780.84 ","$2,780.84 ","$3,659.00 ", N/A ,"$3,110.15 ", N/A ,"$2,378.35 ", N/A ,"$3,659.00 ","$2,049.04 ", N/A ,$962.32 , N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$2,927.20 ", N/A ,"$1,650.21 ","$1,024.52 ","$3,293.10 ", N/A ,"$2,780.84 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,756.32 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100058,36247,HC ABD INT 3RD/PLUS ORDER 36247,481,1 ,"$4,092.00 ","$2,659.80 ",$920.00 ,"$4,092.00 ", N/A ,"$3,200.00 ","$2,291.52 ", N/A ,"$1,145.76 ","$1,383.10 ", N/A ,"$1,591.79 ", N/A ,"$1,845.49 ","$1,845.49 ", N/A ,"$1,845.49 ", N/A ,"$2,046.00 ", N/A , N/A , N/A , N/A ,"$3,069.00 ","$2,455.20 ","$2,455.20 ", N/A ,"$2,455.20 ","$3,109.92 ","$3,109.92 ","$3,109.92 ","$4,092.00 ", N/A ,"$3,478.20 ", N/A ,"$2,659.80 ", N/A ,"$4,092.00 ","$2,291.52 ", N/A ,"$1,076.20 ", N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$3,273.60 ", N/A ,"$1,845.49 ","$1,145.76 ","$3,682.80 ", N/A ,"$3,109.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,964.16 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100059,36248,HC ABD ADDL 2ND/PLUS ORDER 36248,481,1 ,"$1,943.00 ","$1,262.95 ",$511.01 ,"$2,565.01 ", N/A ,"$1,943.00 ","$1,088.08 ", N/A ,$544.04 ,$656.73 , N/A ,$755.83 , N/A ,$876.29 ,$876.29 , N/A ,$876.29 , N/A ,$971.50 , N/A , N/A , N/A , N/A ,"$1,457.25 ","$1,165.80 ","$1,165.80 ", N/A ,"$1,165.80 ","$1,476.68 ","$1,476.68 ","$1,476.68 ","$1,943.00 ", N/A ,"$1,651.55 ", N/A ,"$1,262.95 ", N/A ,"$1,943.00 ","$1,088.08 ", N/A ,$511.01 , N/A ,"$1,943.00 ","$1,943.00 ", N/A ,"$1,554.40 ", N/A ,$876.29 ,$544.04 ,"$1,748.70 ", N/A ,"$1,476.68 ",$920.00 ,$920.00 , N/A ,$920.00 ,$932.64 ,"$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100060,37184,HC PERIPH THROMBECK ONLY W/TPA 37184,481,1 ,"$20,616.00 ","$13,400.40 ","$2,986.93 ","$24,756.83 ","$24,756.83 ","$5,500.00 ","$11,544.96 ","$9,902.73 ","$5,772.48 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$10,308.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$15,462.00 ","$12,369.60 ","$12,369.60 ","$9,902.73 ","$12,369.60 ","$15,668.16 ","$15,668.16 ","$15,668.16 ","$20,616.00 ", N/A ,"$17,523.60 ","$20,616.00 ","$13,400.40 ","$9,902.73 ","$20,616.00 ","$11,544.96 ","$9,902.73 ","$5,422.01 ", N/A ,"$3,285.62 ","$3,136.28 ","$10,397.87 ","$16,492.80 ","$22,281.13 ","$6,645.60 ","$5,772.48 ","$18,554.40 ","$9,902.73 ","$15,668.16 ","$4,800.00 ","$4,800.00 ","$9,902.73 ","$4,800.00 ","$9,895.68 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100061,37185,HC PRIM PERC THROMB EA ADDL 37185,481,1 ,"$6,159.00 ","$4,003.35 ",$920.00 ,"$6,159.00 ", N/A ,"$3,200.00 ","$3,449.04 ", N/A ,"$1,724.52 ","$2,081.74 ", N/A ,"$2,395.85 ", N/A ,"$2,777.71 ","$2,777.71 ", N/A ,"$2,777.71 ", N/A ,"$3,079.50 ", N/A , N/A , N/A , N/A ,"$4,619.25 ","$3,695.40 ","$3,695.40 ", N/A ,"$3,695.40 ","$4,680.84 ","$4,680.84 ","$4,680.84 ","$6,159.00 ", N/A ,"$5,235.15 ", N/A ,"$4,003.35 ", N/A ,"$6,159.00 ","$3,449.04 ", N/A ,"$1,619.82 ", N/A ,"$3,285.62 ","$3,136.28 ", N/A ,"$4,927.20 ", N/A ,"$2,777.71 ","$1,724.52 ","$5,543.10 ", N/A ,"$4,680.84 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$2,956.32 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100062,37186,HC SEC PERC THROMB EA VESSEL ADDL 37186,481,1 ,"$6,477.00 ","$4,210.05 ",$920.00 ,"$6,477.00 ", N/A ,"$2,125.00 ","$3,627.12 ", N/A ,"$1,813.56 ","$2,189.23 ", N/A ,"$2,519.55 ", N/A ,"$2,921.13 ","$2,921.13 ", N/A ,"$2,921.13 ", N/A ,"$3,238.50 ", N/A , N/A , N/A , N/A ,"$4,857.75 ","$3,886.20 ","$3,886.20 ", N/A ,"$3,886.20 ","$4,922.52 ","$4,922.52 ","$4,922.52 ","$6,477.00 ", N/A ,"$5,505.45 ", N/A ,"$4,210.05 ", N/A ,"$6,477.00 ","$3,627.12 ", N/A ,"$1,703.45 ", N/A ,"$3,285.62 ","$3,136.28 ", N/A ,"$5,181.60 ", N/A ,"$2,921.13 ","$1,813.56 ","$5,829.30 ", N/A ,"$4,922.52 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,108.96 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100063,37187,HC PRIMARY VENOUS THROMBECTOMY,481,1 ,"$20,616.00 ","$13,400.40 ","$2,986.93 ","$24,756.83 ","$24,756.83 ","$5,500.00 ","$11,544.96 ","$9,902.73 ","$5,772.48 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$10,308.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$15,462.00 ","$12,369.60 ","$12,369.60 ","$9,902.73 ","$12,369.60 ","$15,668.16 ","$15,668.16 ","$15,668.16 ","$20,616.00 ", N/A ,"$17,523.60 ","$20,616.00 ","$13,400.40 ","$9,902.73 ","$20,616.00 ","$11,544.96 ","$9,902.73 ","$5,422.01 ", N/A ,"$3,285.62 ","$3,136.28 ","$10,397.87 ","$16,492.80 ","$22,281.13 ","$6,645.60 ","$5,772.48 ","$18,554.40 ","$9,902.73 ","$15,668.16 ","$4,800.00 ","$4,800.00 ","$9,902.73 ","$4,800.00 ","$9,895.68 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100064,37188,HC SUBSEQUENT VENOUS THROMBECTOMY,481,1 ,"$7,312.00 ","$4,752.80 ","$1,923.06 ","$7,312.00 ","$7,055.60 ","$5,500.00 ","$4,094.72 ","$2,822.24 ","$2,047.36 ","$2,471.46 ","$2,822.24 ","$2,844.37 ","$2,822.24 ","$3,297.71 ","$3,297.71 ","$2,822.24 ","$3,297.71 ","$5,362.25 ","$3,656.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,484.00 ","$4,387.20 ","$4,387.20 ","$2,822.24 ","$4,387.20 ","$5,557.12 ","$5,557.12 ","$5,557.12 ","$7,312.00 ", N/A ,"$6,215.20 ","$7,055.60 ","$4,752.80 ","$2,822.24 ","$7,312.00 ","$4,094.72 ","$2,822.24 ","$1,923.06 ", N/A ,"$3,285.62 ","$3,136.28 ","$2,963.35 ","$5,849.60 ","$6,350.04 ","$3,297.71 ","$2,047.36 ","$6,580.80 ","$2,822.24 ","$5,557.12 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,509.76 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100065,37200,HC BIOPSY TRANSCATHETER,481,1 ,"$12,157.00 ","$7,902.05 ",$583.08 ,"$12,157.00 ","$11,753.38 ","$5,000.00 ","$6,807.92 ","$4,701.35 ","$3,403.96 ","$4,109.07 ","$4,701.35 ","$4,729.07 ","$4,701.35 ","$5,482.81 ","$5,482.81 ","$4,701.35 ","$5,482.81 ","$8,932.56 ","$6,078.50 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$9,117.75 ","$7,294.20 ","$7,294.20 ","$4,701.35 ","$7,294.20 ","$9,239.32 ","$9,239.32 ","$9,239.32 ","$12,157.00 ", N/A ,"$10,333.45 ","$11,753.37 ","$7,902.05 ","$4,701.35 ","$12,157.00 ","$6,807.92 ","$4,701.35 ","$3,197.29 ", N/A ,$641.39 ,$612.23 ,"$4,936.42 ","$9,725.60 ","$10,578.04 ","$5,482.81 ","$3,403.96 ","$10,941.30 ","$4,701.35 ","$9,239.32 ","$4,800.00 ","$4,800.00 ","$4,701.35 ","$4,800.00 ","$5,835.36 ",$583.08 
ST. ELIZABETH'S HOSPITAL,48100069,37241,HC OCCL/EMBOL TRANSCATH PERC 37241,481,1 ,"$11,976.00 ","$7,784.40 ","$3,149.69 ","$24,756.83 ","$24,756.83 ","$4,200.00 ","$6,706.56 ","$9,902.73 ","$3,353.28 ","$4,047.89 ","$9,902.73 ","$4,658.66 ","$9,902.73 ","$5,401.18 ","$5,401.18 ","$9,902.73 ","$5,401.18 ","$11,976.00 ","$5,988.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$8,982.00 ","$7,185.60 ","$7,185.60 ","$9,902.73 ","$7,185.60 ","$9,101.76 ","$9,101.76 ","$9,101.76 ","$11,976.00 ", N/A ,"$10,179.60 ","$11,976.00 ","$7,784.40 ","$9,902.73 ","$11,976.00 ","$6,706.56 ","$9,902.73 ","$3,149.69 ", N/A ,"$11,318.77 ","$10,804.28 ","$10,397.87 ","$9,580.80 ","$22,281.13 ","$5,401.18 ","$3,353.28 ","$10,778.40 ","$9,902.73 ","$9,101.76 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$5,748.48 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100070,37236,HC PL STENT INTRAVAS PERC INIT 37236,481,1 ,"$29,661.00 ","$19,279.65 ","$4,200.00 ","$29,661.00 ","$24,756.83 ","$4,200.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$14,237.28 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100071,37237,HC PLACE STENT PERC ADDL 37237,481,1 ,"$7,763.00 ","$5,045.95 ","$2,041.67 ","$7,763.00 ", N/A ,"$2,125.00 ","$4,347.28 ", N/A ,"$2,173.64 ","$2,623.89 ", N/A ,"$3,019.81 ", N/A ,"$3,501.11 ","$3,501.11 ", N/A ,"$3,501.11 ", N/A ,"$3,881.50 ", N/A , N/A , N/A , N/A ,"$5,822.25 ","$4,657.80 ","$4,657.80 ", N/A ,"$4,657.80 ","$5,899.88 ","$5,899.88 ","$5,899.88 ","$7,763.00 ", N/A ,"$6,598.55 ", N/A ,"$5,045.95 ", N/A ,"$7,763.00 ","$4,347.28 ", N/A ,"$2,041.67 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$6,210.40 ", N/A ,"$3,501.11 ","$2,173.64 ","$6,986.70 ", N/A ,"$5,899.88 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$3,726.24 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100076,37215,HC PL STENT TRNSCATH CAROT ART W/ 37215,481,1 ,"$18,885.00 ","$12,275.25 ","$1,635.00 ","$18,885.00 ", N/A ,"$4,200.00 ","$10,575.60 ", N/A ,"$5,287.80 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$9,442.50 ", N/A , N/A , N/A , N/A ,"$14,163.75 ","$11,331.00 ","$11,331.00 ", N/A ,"$11,331.00 ","$14,352.60 ","$14,352.60 ","$14,352.60 ","$18,885.00 ", N/A ,"$16,052.25 ", N/A ,"$12,275.25 ", N/A ,"$18,885.00 ","$10,575.60 ", N/A ,"$4,966.76 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$15,108.00 ", N/A ,"$6,645.60 ","$5,287.80 ","$16,996.50 ", N/A ,"$14,352.60 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$9,064.80 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$12,633.00 ","$8,211.45 ","$3,322.48 ","$12,633.00 ","$12,215.85 ","$5,000.00 ","$7,074.48 ","$4,886.34 ","$3,537.24 ","$4,269.95 ","$4,886.34 ","$4,914.24 ","$4,886.34 ","$5,697.48 ","$5,697.48 ","$4,886.34 ","$5,697.48 ","$9,284.05 ","$6,316.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$9,474.75 ","$7,579.80 ","$7,579.80 ","$4,886.34 ","$7,579.80 ","$9,601.08 ","$9,601.08 ","$9,601.08 ","$12,633.00 ", N/A ,"$10,738.05 ","$12,215.86 ","$8,211.45 ","$4,886.34 ","$12,633.00 ","$7,074.48 ","$4,886.34 ","$3,322.48 ", N/A ,"$5,217.83 ","$4,980.65 ","$5,130.66 ","$10,106.40 ","$10,994.27 ","$5,697.48 ","$3,537.24 ","$11,369.70 ","$4,886.34 ","$9,601.08 ","$4,800.00 ","$4,800.00 ","$4,886.34 ","$4,800.00 ","$6,063.84 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$18,228.00 ","$11,848.20 ","$4,743.48 ","$24,756.83 ","$24,756.83 ","$5,000.00 ","$10,207.68 ","$9,902.73 ","$5,103.84 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,228.00 ","$9,114.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$13,671.00 ","$10,936.80 ","$10,936.80 ","$9,902.73 ","$10,936.80 ","$13,853.28 ","$13,853.28 ","$13,853.28 ","$18,228.00 ", N/A ,"$15,493.80 ","$18,228.00 ","$11,848.20 ","$9,902.73 ","$18,228.00 ","$10,207.68 ","$9,902.73 ","$4,793.96 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$14,582.40 ","$22,281.13 ","$6,645.60 ","$5,103.84 ","$16,405.20 ","$9,902.73 ","$13,853.28 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$8,749.44 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100079,37222,HC RVC EN PRC ICA W/ANG EA AD VS 37222,481,1 ,"$15,220.00 ","$9,893.00 ","$2,125.00 ","$15,220.00 ", N/A ,"$2,125.00 ","$8,523.20 ", N/A ,"$4,261.60 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$7,610.00 ", N/A , N/A , N/A , N/A ,"$11,415.00 ","$9,132.00 ","$9,132.00 ", N/A ,"$9,132.00 ","$11,567.20 ","$11,567.20 ","$11,567.20 ","$15,220.00 ", N/A ,"$12,937.00 ", N/A ,"$9,893.00 ", N/A ,"$15,220.00 ","$8,523.20 ", N/A ,"$4,002.86 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$12,176.00 ", N/A ,"$6,645.60 ","$4,261.60 ","$13,698.00 ", N/A ,"$11,567.20 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$7,305.60 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100080,37223,HC RVC EN PRC ICA W/TRN ST AD VS 37223,481,1 ,"$26,766.00 ","$17,397.90 ","$2,125.00 ","$26,766.00 ", N/A ,"$2,125.00 ","$14,988.96 ", N/A ,"$7,494.48 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$13,383.00 ", N/A , N/A , N/A , N/A ,"$20,074.50 ","$16,059.60 ","$16,059.60 ", N/A ,"$16,059.60 ","$20,342.16 ","$20,342.16 ","$20,342.16 ","$26,766.00 ", N/A ,"$22,751.10 ", N/A ,"$17,397.90 ", N/A ,"$26,766.00 ","$14,988.96 ", N/A ,"$7,039.46 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$21,412.80 ", N/A ,"$6,645.60 ","$7,494.48 ","$24,089.40 ", N/A ,"$20,342.16 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$12,847.68 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$32,606.00 ","$21,193.90 ","$4,743.48 ","$32,606.00 ","$12,215.85 ","$5,000.00 ","$18,259.36 ","$4,886.34 ","$9,129.68 ","$11,020.83 ","$4,886.34 ","$12,683.73 ","$4,886.34 ","$6,645.60 ","$6,645.60 ","$4,886.34 ","$6,645.60 ","$9,284.05 ","$16,303.00 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$24,454.50 ","$19,563.60 ","$19,563.60 ","$4,886.34 ","$19,563.60 ","$24,780.56 ","$24,780.56 ","$24,780.56 ","$32,606.00 ", N/A ,"$27,715.10 ","$12,215.86 ","$21,193.90 ","$4,886.34 ","$32,606.00 ","$18,259.36 ","$4,886.34 ","$8,575.38 ", N/A ,"$5,217.83 ","$4,980.65 ","$5,130.66 ","$26,084.80 ","$10,994.27 ","$6,645.60 ","$9,129.68 ","$29,345.40 ","$4,886.34 ","$24,780.56 ","$4,800.00 ","$4,800.00 ","$4,886.34 ","$4,800.00 ","$15,650.88 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100082,37225,HC RVC EN PRC F/P W/ANT INT VSL 37225,481,1 ,"$50,446.00 ","$32,789.90 ","$4,743.48 ","$50,446.00 ","$24,756.83 ","$5,000.00 ","$28,249.76 ","$9,902.73 ","$14,124.88 ","$17,050.75 ","$9,902.73 ","$19,623.49 ","$9,902.73 ","$22,751.15 ","$22,751.15 ","$9,902.73 ","$22,751.15 ","$18,815.18 ","$25,223.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$37,834.50 ","$30,267.60 ","$30,267.60 ","$9,902.73 ","$30,267.60 ","$38,338.96 ","$38,338.96 ","$38,338.96 ","$50,446.00 ", N/A ,"$42,879.10 ","$24,756.81 ","$32,789.90 ","$9,902.73 ","$50,446.00 ","$28,249.76 ","$9,902.73 ","$13,267.30 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$40,356.80 ","$22,281.13 ","$22,751.15 ","$14,124.88 ","$45,401.40 ","$9,902.73 ","$38,338.96 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$24,214.08 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$31,985.00 ","$20,790.25 ","$4,743.48 ","$31,985.00 ","$24,756.83 ","$5,000.00 ","$17,911.60 ","$9,902.73 ","$8,955.80 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$15,992.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$23,988.75 ","$19,191.00 ","$19,191.00 ","$9,902.73 ","$19,191.00 ","$24,308.60 ","$24,308.60 ","$24,308.60 ","$31,985.00 ", N/A ,"$27,187.25 ","$24,756.81 ","$20,790.25 ","$9,902.73 ","$31,985.00 ","$17,911.60 ","$9,902.73 ","$8,412.06 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$25,588.00 ","$22,281.13 ","$6,645.60 ","$8,955.80 ","$28,786.50 ","$9,902.73 ","$24,308.60 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$15,352.80 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100084,37227,HC RVC EN PRC F/P W/AN/TR ST INT 37227,481,1 ,"$60,576.00 ","$39,374.40 ","$4,743.48 ","$60,576.00 ","$39,583.70 ","$5,000.00 ","$33,922.56 ","$15,833.48 ","$16,961.28 ","$20,474.69 ","$15,833.48 ","$23,564.06 ","$15,833.48 ","$27,319.78 ","$27,319.78 ","$15,833.48 ","$27,319.78 ","$30,083.61 ","$30,288.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$45,432.00 ","$36,345.60 ","$36,345.60 ","$15,833.48 ","$36,345.60 ","$46,037.76 ","$46,037.76 ","$46,037.76 ","$60,576.00 ", N/A ,"$51,489.60 ","$39,583.69 ","$39,374.40 ","$15,833.48 ","$60,576.00 ","$33,922.56 ","$15,833.48 ","$15,931.49 ", N/A ,"$5,217.83 ","$4,980.65 ","$16,625.15 ","$48,460.80 ","$35,625.33 ","$27,319.78 ","$16,961.28 ","$54,518.40 ","$15,833.48 ","$46,037.76 ","$7,500.00 ","$7,500.00 ","$15,833.48 ","$7,500.00 ","$29,076.48 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$33,073.00 ","$21,497.45 ","$4,743.48 ","$33,073.00 ","$24,756.83 ","$5,000.00 ","$18,520.88 ","$9,902.73 ","$9,260.44 ","$11,178.67 ","$9,902.73 ","$12,865.40 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$16,536.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$24,804.75 ","$19,843.80 ","$19,843.80 ","$9,902.73 ","$19,843.80 ","$25,135.48 ","$25,135.48 ","$25,135.48 ","$33,073.00 ", N/A ,"$28,112.05 ","$24,756.81 ","$21,497.45 ","$9,902.73 ","$33,073.00 ","$18,520.88 ","$9,902.73 ","$8,698.20 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$26,458.40 ","$22,281.13 ","$6,645.60 ","$9,260.44 ","$29,765.70 ","$9,902.73 ","$25,135.48 ","$4,800.00 ","$4,800.00 ","$9,902.73 ","$4,800.00 ","$15,875.04 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100086,37229,HC RVC EN PRC T/P W/ANT INT VSL 37229,481,1 ,"$51,613.00 ","$33,548.45 ","$4,743.48 ","$51,613.00 ","$39,583.70 ","$5,000.00 ","$28,903.28 ","$15,833.48 ","$14,451.64 ","$17,445.19 ","$15,833.48 ","$20,077.46 ","$15,833.48 ","$23,277.46 ","$23,277.46 ","$15,833.48 ","$23,277.46 ","$30,083.61 ","$25,806.50 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$38,709.75 ","$30,967.80 ","$30,967.80 ","$15,833.48 ","$30,967.80 ","$39,225.88 ","$39,225.88 ","$39,225.88 ","$51,613.00 ", N/A ,"$43,871.05 ","$39,583.69 ","$33,548.45 ","$15,833.48 ","$51,613.00 ","$28,903.28 ","$15,833.48 ","$13,574.22 ", N/A ,"$5,217.83 ","$4,980.65 ","$16,625.15 ","$41,290.40 ","$35,625.33 ","$23,277.46 ","$14,451.64 ","$46,451.70 ","$15,833.48 ","$39,225.88 ","$5,500.00 ","$5,500.00 ","$15,833.48 ","$5,500.00 ","$24,774.24 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100087,37230,HC RVC EN PRC T/P W/TRN SNT IN VS 37230,481,1 ,"$43,113.00 ","$28,023.45 ","$4,743.48 ","$43,113.00 ","$39,583.70 ","$5,000.00 ","$24,143.28 ","$15,833.48 ","$12,071.64 ","$14,572.19 ","$15,833.48 ","$16,770.96 ","$15,833.48 ","$19,443.96 ","$19,443.96 ","$15,833.48 ","$19,443.96 ","$30,083.61 ","$21,556.50 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$32,334.75 ","$25,867.80 ","$25,867.80 ","$15,833.48 ","$25,867.80 ","$32,765.88 ","$32,765.88 ","$32,765.88 ","$43,113.00 ", N/A ,"$36,646.05 ","$39,583.69 ","$28,023.45 ","$15,833.48 ","$43,113.00 ","$24,143.28 ","$15,833.48 ","$11,338.72 ", N/A ,"$5,217.83 ","$4,980.65 ","$16,625.15 ","$34,490.40 ","$35,625.33 ","$19,443.96 ","$12,071.64 ","$38,801.70 ","$15,833.48 ","$32,765.88 ","$5,500.00 ","$5,500.00 ","$15,833.48 ","$5,500.00 ","$20,694.24 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100088,37231,HC RVC EN PRC T/P W/AN/TR ST IN V 37231,481,1 ,"$61,652.00 ","$40,073.80 ","$4,743.48 ","$61,652.00 ","$39,583.70 ","$5,000.00 ","$34,525.12 ","$15,833.48 ","$17,262.56 ","$20,838.38 ","$15,833.48 ","$23,982.63 ","$15,833.48 ","$27,805.05 ","$27,805.05 ","$15,833.48 ","$27,805.05 ","$30,083.61 ","$30,826.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$46,239.00 ","$36,991.20 ","$36,991.20 ","$15,833.48 ","$36,991.20 ","$46,855.52 ","$46,855.52 ","$46,855.52 ","$61,652.00 ", N/A ,"$52,404.20 ","$39,583.69 ","$40,073.80 ","$15,833.48 ","$61,652.00 ","$34,525.12 ","$15,833.48 ","$16,214.48 ", N/A ,"$5,217.83 ","$4,980.65 ","$16,625.15 ","$49,321.60 ","$35,625.33 ","$27,805.05 ","$17,262.56 ","$55,486.80 ","$15,833.48 ","$46,855.52 ","$7,500.00 ","$7,500.00 ","$15,833.48 ","$7,500.00 ","$29,592.96 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100089,37232,HC RVC EN PRC T/P W/ANG EA AD VS 37232,481,1 ,"$29,760.00 ","$19,344.00 ","$2,125.00 ","$29,760.00 ", N/A ,"$2,125.00 ","$16,665.60 ", N/A ,"$8,332.80 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$14,880.00 ", N/A , N/A , N/A , N/A ,"$22,320.00 ","$17,856.00 ","$17,856.00 ", N/A ,"$17,856.00 ","$22,617.60 ","$22,617.60 ","$22,617.60 ","$29,760.00 ", N/A ,"$25,296.00 ", N/A ,"$19,344.00 ", N/A ,"$29,760.00 ","$16,665.60 ", N/A ,"$7,826.88 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$23,808.00 ", N/A ,"$6,645.60 ","$8,332.80 ","$26,784.00 ", N/A ,"$22,617.60 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$14,284.80 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100090,37233,HC RVC EN PRC T/P W/ANT EA AD VS 37233,481,1 ,"$24,077.00 ","$15,650.05 ","$2,125.00 ","$24,077.00 ", N/A ,"$2,125.00 ","$13,483.12 ", N/A ,"$6,741.56 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$12,038.50 ", N/A , N/A , N/A , N/A ,"$18,057.75 ","$14,446.20 ","$14,446.20 ", N/A ,"$14,446.20 ","$18,298.52 ","$18,298.52 ","$18,298.52 ","$24,077.00 ", N/A ,"$20,465.45 ", N/A ,"$15,650.05 ", N/A ,"$24,077.00 ","$13,483.12 ", N/A ,"$6,332.25 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$19,261.60 ", N/A ,"$6,645.60 ","$6,741.56 ","$21,669.30 ", N/A ,"$18,298.52 ","$5,500.00 ","$5,500.00 ", N/A ,"$5,500.00 ","$11,556.96 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100091,37234,HC RVC EN PRC T/P W/TRN SNT EA VS 37234,481,1 ,"$25,723.00 ","$16,719.95 ","$2,125.00 ","$25,723.00 ", N/A ,"$2,125.00 ","$14,404.88 ", N/A ,"$7,202.44 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$12,861.50 ", N/A , N/A , N/A , N/A ,"$19,292.25 ","$15,433.80 ","$15,433.80 ", N/A ,"$15,433.80 ","$19,549.48 ","$19,549.48 ","$19,549.48 ","$25,723.00 ", N/A ,"$21,864.55 ", N/A ,"$16,719.95 ", N/A ,"$25,723.00 ","$14,404.88 ", N/A ,"$6,765.15 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$20,578.40 ", N/A ,"$6,645.60 ","$7,202.44 ","$23,150.70 ", N/A ,"$19,549.48 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$12,347.04 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100092,37235,HC RVC EN PRC T/P W/AN/TR ST AD V 37235,481,1 ,"$39,508.00 ","$25,680.20 ","$2,125.00 ","$39,508.00 ", N/A ,"$2,125.00 ","$22,124.48 ", N/A ,"$11,062.24 ","$13,353.70 ", N/A ,"$15,368.61 ", N/A ,"$17,818.11 ","$17,818.11 ", N/A ,"$17,818.11 ", N/A ,"$19,754.00 ", N/A , N/A , N/A , N/A ,"$29,631.00 ","$23,704.80 ","$23,704.80 ", N/A ,"$23,704.80 ","$30,026.08 ","$30,026.08 ","$30,026.08 ","$39,508.00 ", N/A ,"$33,581.80 ", N/A ,"$25,680.20 ", N/A ,"$39,508.00 ","$22,124.48 ", N/A ,"$10,390.60 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$31,606.40 ", N/A ,"$17,818.11 ","$11,062.24 ","$35,557.20 ", N/A ,"$30,026.08 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$18,963.84 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100093,37252,HC US VASCULAR NON-CORONARY INIT 37252,481,1 ,$103.00 ,$66.95 ,$27.09 ,$145.80 , N/A ,$103.00 ,$57.68 , N/A ,$28.84 ,$34.81 , N/A ,$40.07 , N/A ,$46.45 ,$46.45 , N/A ,$46.45 , N/A ,$51.50 , N/A , N/A , N/A , N/A ,$77.25 ,$61.80 ,$61.80 , N/A ,$61.80 , N/A , N/A , N/A ,$103.00 , N/A ,$87.55 , N/A ,$66.95 , N/A ,$103.00 ,$57.68 , N/A ,$27.09 , N/A ,$103.00 ,$103.00 , N/A ,$82.40 , N/A ,$46.45 ,$28.84 ,$92.70 , N/A , N/A ,$103.00 ,$103.00 , N/A ,$103.00 ,$49.44 ,$145.80 
ST. ELIZABETH'S HOSPITAL,48100094,37253,HC US VASCULAR NON-CORON ADDL EA 37253,481,1 ,$82.00 ,$53.30 ,$21.57 ,$145.80 , N/A ,$82.00 ,$45.92 , N/A ,$22.96 ,$27.72 , N/A ,$31.90 , N/A ,$36.98 ,$36.98 , N/A ,$36.98 , N/A ,$41.00 , N/A , N/A , N/A , N/A ,$61.50 ,$49.20 ,$49.20 , N/A ,$49.20 , N/A , N/A , N/A ,$82.00 , N/A ,$69.70 , N/A ,$53.30 , N/A ,$82.00 ,$45.92 , N/A ,$21.57 , N/A ,$82.00 ,$82.00 , N/A ,$65.60 , N/A ,$36.98 ,$22.96 ,$73.80 , N/A , N/A ,$82.00 ,$82.00 , N/A ,$82.00 ,$39.36 ,$145.80 
ST. ELIZABETH'S HOSPITAL,48100096,92973,HC PTC TRANSLUM CORONARY THROMB 92973,481,1 ,$835.00 ,$542.75 ,$219.61 ,$835.00 , N/A ,$384.10 ,$467.60 , N/A ,$233.80 ,$282.23 , N/A ,$344.02 , N/A ,$376.59 ,$376.59 , N/A ,$376.59 , N/A ,$417.50 , N/A , N/A , N/A , N/A ,$626.25 ,$501.00 ,$501.00 , N/A ,$501.00 ,$634.60 ,$634.60 ,$634.60 ,$835.00 , N/A ,$709.75 , N/A ,$542.75 , N/A ,$835.00 ,$467.60 , N/A ,$219.61 , N/A , N/A , N/A , N/A ,$668.00 , N/A ,$376.59 ,$233.80 ,$751.50 , N/A ,$634.60 ,$835.00 ,$835.00 , N/A ,$835.00 ,$400.80 , N/A 
ST. ELIZABETH'S HOSPITAL,48100097,92978,HC INTRAVASCULAR ULTRSOUND INTIAL 92978,481,1 ,"$6,648.00 ","$4,321.20 ",$920.00 ,"$6,648.00 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,861.44 ","$2,247.02 ", N/A ,"$2,738.98 ", N/A ,"$2,998.25 ","$2,998.25 ", N/A ,"$2,998.25 ", N/A ,"$3,324.00 ", N/A , N/A , N/A , N/A ,"$4,986.00 ","$3,988.80 ","$3,988.80 ", N/A ,"$3,988.80 ","$5,052.48 ","$5,052.48 ","$5,052.48 ","$6,648.00 ", N/A ,"$5,650.80 ", N/A ,"$4,321.20 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,748.42 ", N/A , N/A , N/A , N/A ,"$5,318.40 ", N/A ,"$2,998.25 ","$1,861.44 ","$5,983.20 ", N/A ,"$5,052.48 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,191.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100098,92979,HC INTRAVASCULAR ULTRSOUND EA ADD 92979,481,1 ,"$8,042.00 ","$5,227.30 ",$920.00 ,"$8,042.00 ", N/A ,"$7,500.00 ","$4,503.52 ", N/A ,"$2,251.76 ","$2,718.20 ", N/A ,"$1,442.87 ", N/A ,"$3,626.94 ","$3,626.94 ", N/A ,"$3,626.94 ", N/A ,"$4,021.00 ", N/A , N/A , N/A , N/A ,"$6,031.50 ","$4,825.20 ","$4,825.20 ", N/A ,"$4,825.20 ","$6,111.92 ","$6,111.92 ","$6,111.92 ","$8,042.00 ", N/A ,"$6,835.70 ", N/A ,"$5,227.30 ", N/A ,"$8,042.00 ","$4,503.52 ", N/A ,"$2,115.05 ", N/A , N/A , N/A , N/A ,"$6,433.60 ", N/A ,"$3,626.94 ","$2,251.76 ","$7,237.80 ", N/A ,"$6,111.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,860.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100103,92986,HC VALVULOPLASTY AORTIC VALVE 92986,481,1 ,"$14,349.00 ","$9,326.85 ","$3,773.79 ","$14,349.00 ","$12,215.85 ","$7,500.00 ","$8,035.44 ","$4,886.34 ","$4,017.72 ","$4,849.96 ","$4,886.34 ","$5,911.79 ","$4,886.34 ","$6,471.40 ","$6,471.40 ","$4,886.34 ","$6,471.40 ","$9,284.05 ","$7,174.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,761.75 ","$8,609.40 ","$8,609.40 ","$4,886.34 ","$8,609.40 ","$10,905.24 ","$10,905.24 ","$10,905.24 ","$14,349.00 ", N/A ,"$12,196.65 ","$12,215.86 ","$9,326.85 ","$4,886.34 ","$14,349.00 ","$8,035.44 ","$4,886.34 ","$3,773.79 ", N/A ,"$9,066.65 ","$8,654.53 ","$5,130.66 ","$11,479.20 ","$10,994.27 ","$6,471.40 ","$4,017.72 ","$12,914.10 ","$4,886.34 ","$10,905.24 ","$4,800.00 ","$4,800.00 ","$4,886.34 ","$4,800.00 ","$6,887.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100104,92987,HC VALVULOPLASTY MITRAL VALVE 92987,481,1 ,"$29,661.00 ","$19,279.65 ","$4,800.00 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$12,220.33 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$4,800.00 ","$4,800.00 ","$9,902.73 ","$4,800.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100107,93451,HC CATH RIGHT HEART 93451,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$6,072.48 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100108,93452,HC LHC ONLY NO COROS 93452,481,1 ,"$8,440.00 ","$5,486.00 ","$2,219.72 ","$8,440.00 ","$7,147.03 ","$3,882.40 ","$4,726.40 ","$2,858.81 ","$2,363.20 ","$6,072.48 ","$2,858.81 ","$3,283.16 ","$2,858.81 ","$3,806.44 ","$3,806.44 ","$2,858.81 ","$3,806.44 ","$5,431.75 ","$4,220.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$6,330.00 ","$5,064.00 ","$5,064.00 ","$2,858.81 ","$5,064.00 ","$6,414.40 ","$6,414.40 ","$6,414.40 ","$8,440.00 ", N/A ,"$7,174.00 ","$7,147.04 ","$5,486.00 ","$2,858.81 ","$8,440.00 ","$4,726.40 ","$2,858.81 ","$2,219.72 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,752.00 ","$6,432.33 ","$3,806.44 ","$2,363.20 ","$7,596.00 ","$2,858.81 ","$6,414.40 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$4,051.20 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100109,93453,HC RHC/LHC ONLY/NO CORS 93453,481,1 ,"$7,940.00 ","$5,161.00 ","$2,088.22 ","$7,940.00 ","$7,147.03 ","$3,652.40 ","$4,446.40 ","$2,858.81 ","$2,223.20 ","$6,072.48 ","$2,858.81 ","$3,088.66 ","$2,858.81 ","$3,580.94 ","$3,580.94 ","$2,858.81 ","$3,580.94 ","$5,431.75 ","$3,970.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,955.00 ","$4,764.00 ","$4,764.00 ","$2,858.81 ","$4,764.00 ","$6,034.40 ","$6,034.40 ","$6,034.40 ","$7,940.00 ", N/A ,"$6,749.00 ","$7,147.04 ","$5,161.00 ","$2,858.81 ","$7,940.00 ","$4,446.40 ","$2,858.81 ","$2,088.22 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,352.00 ","$6,432.33 ","$3,580.94 ","$2,223.20 ","$7,146.00 ","$2,858.81 ","$6,034.40 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,811.20 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100110,93454,HC CORONARY ANGIO ONLY/NO LV 93454,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$2,683.04 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100111,93455,HC CORO ANGIO  AND  GRAFTS ONLY NO LV 93455,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$2,683.04 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100112,93456,HC RHC CORONARY ANGIO/NO LV 93456,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$6,072.48 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100113,93457,HC RHC CORO ANGIO  AND  GRAFTS/NO LV 93457,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$6,072.48 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100114,93458,HC CORONARY ANGIO WITH LV 93458,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$6,072.48 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100115,93459,HC CORONARY ANGIO W GRAFTS AND LV 93459,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$6,072.48 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100116,93460,HC RHC/LHC/CORONAY ANGIO AND LV 93460,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$6,072.48 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100117,93461,HC RHC/LHC/CORON ANGIO GRAFTS  AND LV 93461,481,1 ,"$7,938.00 ","$5,159.70 ","$2,087.69 ","$7,938.00 ","$7,147.03 ","$3,651.48 ","$4,445.28 ","$2,858.81 ","$2,222.64 ","$6,072.48 ","$2,858.81 ","$3,087.88 ","$2,858.81 ","$3,580.04 ","$3,580.04 ","$2,858.81 ","$3,580.04 ","$5,431.75 ","$3,969.00 ","$7,147.04 ","$2,858.81 ","$2,858.81 ","$2,915.99 ","$5,953.50 ","$4,762.80 ","$4,762.80 ","$2,858.81 ","$4,762.80 ","$6,032.88 ","$6,032.88 ","$6,032.88 ","$7,938.00 ", N/A ,"$6,747.30 ","$7,147.04 ","$5,159.70 ","$2,858.81 ","$7,938.00 ","$4,445.28 ","$2,858.81 ","$2,087.69 ", N/A ,"$2,568.96 ","$2,452.19 ","$3,001.75 ","$6,350.40 ","$6,432.33 ","$3,580.04 ","$2,222.64 ","$7,144.20 ","$2,858.81 ","$6,032.88 ","$7,600.00 ","$7,600.00 ","$2,858.81 ","$7,600.00 ","$3,810.24 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100118,93463,HC NITRIC OXIDE STUDY 93463,481,1 ,"$14,997.00 ","$9,748.05 ",$920.00 ,"$14,997.00 ", N/A ,"$6,898.62 ","$8,398.32 ", N/A ,"$4,199.16 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$7,498.50 ", N/A , N/A , N/A , N/A ,"$11,247.75 ","$8,998.20 ","$8,998.20 ", N/A ,"$8,998.20 ","$10,816.00 ","$10,816.00 ","$10,816.00 ","$14,997.00 ", N/A ,"$12,747.45 ", N/A ,"$9,748.05 ", N/A ,"$14,997.00 ","$8,398.32 ", N/A ,"$3,944.21 ", N/A , N/A , N/A , N/A ,"$11,997.60 ", N/A ,"$6,645.60 ","$4,199.16 ","$13,497.30 ", N/A ,"$9,734.00 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$7,198.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100119,93567,HC AORTAGRAM 93567,481,1 ,"$1,212.00 ",$787.80 ,$318.76 ,"$1,212.00 ", N/A ,$557.52 ,$678.72 , N/A ,$339.36 ,$409.66 , N/A ,$471.47 , N/A ,$546.61 ,$546.61 , N/A ,$546.61 , N/A ,$606.00 , N/A , N/A , N/A , N/A ,$909.00 ,$727.20 ,$727.20 , N/A ,$727.20 ,$921.12 ,$921.12 ,$921.12 ,"$1,212.00 ", N/A ,"$1,030.20 ", N/A ,$787.80 , N/A ,"$1,212.00 ",$678.72 , N/A ,$318.76 , N/A , N/A , N/A , N/A ,$969.60 , N/A ,$546.61 ,$339.36 ,"$1,090.80 ", N/A ,$921.12 ,$920.00 ,$920.00 , N/A ,$920.00 ,$581.76 , N/A 
ST. ELIZABETH'S HOSPITAL,48100120,93571,HC INTRAVASC DOPP COLOR FLOW INIT 93571,481,1 ,"$9,449.00 ","$6,141.85 ",$920.00 ,"$9,449.00 ", N/A ,"$4,346.54 ","$5,291.44 ", N/A ,"$2,645.72 ","$3,193.76 ", N/A ,"$2,833.04 ", N/A ,"$4,261.50 ","$4,261.50 ", N/A ,"$4,261.50 ", N/A ,"$4,724.50 ", N/A , N/A , N/A , N/A ,"$7,086.75 ","$5,669.40 ","$5,669.40 ", N/A ,"$5,669.40 ","$7,181.24 ","$7,181.24 ","$7,181.24 ","$9,449.00 ", N/A ,"$8,031.65 ", N/A ,"$6,141.85 ", N/A ,"$9,449.00 ","$5,291.44 ", N/A ,"$2,485.09 ", N/A , N/A , N/A , N/A ,"$7,559.20 ", N/A ,"$4,261.50 ","$2,645.72 ","$8,504.10 ", N/A ,"$7,181.24 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$4,535.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100121,93572,HC INTRAVASC DOPP COLOR FLOW ADDL 93572,481,1 ,"$1,424.00 ",$925.60 ,$374.51 ,"$1,424.00 ", N/A ,$655.04 ,$797.44 , N/A ,$398.72 ,$481.31 , N/A ,$586.69 , N/A ,$642.22 ,$642.22 , N/A ,$642.22 , N/A ,$712.00 , N/A , N/A , N/A , N/A ,"$1,068.00 ",$854.40 ,$854.40 , N/A ,$854.40 ,"$1,082.24 ","$1,082.24 ","$1,082.24 ","$1,424.00 ", N/A ,"$1,210.40 ", N/A ,$925.60 , N/A ,"$1,424.00 ",$797.44 , N/A ,$374.51 , N/A , N/A , N/A , N/A ,"$1,139.20 ", N/A ,$642.22 ,$398.72 ,"$1,281.60 ", N/A ,"$1,082.24 ",$920.00 ,$920.00 , N/A ,$920.00 ,$683.52 , N/A 
ST. ELIZABETH'S HOSPITAL,48100122,93580,HC PTC W/IMPLNT ATRIAL 93580,481,1 ,"$22,000.00 ","$14,300.00 ","$4,859.14 ","$39,583.70 ","$39,583.70 ","$7,000.00 ","$12,320.00 ","$15,833.48 ","$6,160.00 ","$4,859.14 ","$15,833.48 ","$9,064.00 ","$15,833.48 ","$6,645.60 ","$6,645.60 ","$15,833.48 ","$6,645.60 ","$22,000.00 ","$11,000.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$16,500.00 ","$13,200.00 ","$13,200.00 ","$15,833.48 ","$13,200.00 ","$16,720.00 ","$16,720.00 ","$16,720.00 ","$22,000.00 ", N/A ,"$18,700.00 ","$22,000.00 ","$14,300.00 ","$15,833.48 ","$22,000.00 ","$12,320.00 ","$15,833.48 ","$5,786.00 ", N/A ,"$11,318.77 ","$10,804.28 ","$16,625.15 ","$17,600.00 ","$35,625.33 ","$6,645.60 ","$6,160.00 ","$19,800.00 ","$15,833.48 ","$16,720.00 ","$6,000.00 ","$6,000.00 ","$15,833.48 ","$6,000.00 ","$10,560.00 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100125,93609,HC TACHYCARDIA SITE MAPPING 93609,481,1 ,"$5,609.00 ","$3,645.85 ","$1,475.17 ","$11,484.15 ", N/A ,"$5,609.00 ","$3,141.04 ", N/A ,"$1,570.52 ","$1,895.84 ", N/A ,"$1,736.53 ", N/A ,"$2,529.66 ","$2,529.66 ", N/A ,"$2,529.66 ", N/A ,"$2,804.50 ", N/A , N/A , N/A , N/A ,"$4,206.75 ","$3,365.40 ","$3,365.40 ", N/A ,"$3,365.40 ","$4,262.84 ","$4,262.84 ","$4,262.84 ","$5,609.00 ", N/A ,"$4,767.65 ", N/A ,"$3,645.85 ", N/A ,"$5,609.00 ","$3,141.04 ", N/A ,"$1,475.17 ", N/A ,"$5,609.00 ","$5,609.00 ", N/A ,"$4,487.20 ", N/A ,"$2,529.66 ","$1,570.52 ","$5,048.10 ", N/A ,"$4,262.84 ","$5,609.00 ","$5,609.00 ", N/A ,"$5,609.00 ","$2,692.32 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100127,93613,HC EP INTRACARDIAC 3-D MAPPING 93613,481,1 ,"$8,624.00 ","$5,605.60 ","$2,268.11 ","$11,484.15 ", N/A ,"$7,500.00 ","$4,829.44 ", N/A ,"$2,414.72 ","$2,914.91 ", N/A ,"$3,553.09 ", N/A ,"$3,889.42 ","$3,889.42 ", N/A ,"$3,889.42 ", N/A ,"$4,312.00 ", N/A , N/A , N/A , N/A ,"$6,468.00 ","$5,174.40 ","$5,174.40 ", N/A ,"$5,174.40 ","$6,554.24 ","$6,554.24 ","$6,554.24 ","$8,624.00 ", N/A ,"$7,330.40 ", N/A ,"$5,605.60 ", N/A ,"$8,624.00 ","$4,829.44 ", N/A ,"$2,268.11 ", N/A ,"$8,624.00 ","$8,624.00 ", N/A ,"$6,899.20 ", N/A ,"$3,889.42 ","$2,414.72 ","$7,761.60 ", N/A ,"$6,554.24 ","$8,624.00 ","$8,624.00 ", N/A ,"$8,624.00 ","$4,139.52 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100129,93620,HC EP COMPREHENSIVE W/ ARRHYTHMIA 93620,481,1 ,"$14,997.00 ","$9,748.05 ","$3,352.95 ","$14,997.00 ","$14,981.38 ","$12,000.00 ","$8,398.32 ","$5,992.55 ","$4,199.16 ","$4,859.14 ","$5,992.55 ","$3,352.95 ","$5,992.55 ","$6,645.60 ","$6,645.60 ","$5,992.55 ","$6,645.60 ","$11,385.85 ","$7,498.50 ","$14,981.38 ","$5,992.55 ","$5,992.55 ","$6,112.40 ","$11,247.75 ","$8,998.20 ","$8,998.20 ","$5,992.55 ","$8,998.20 ","$11,397.72 ","$11,397.72 ","$11,397.72 ","$14,997.00 ", N/A ,"$12,747.45 ","$14,981.38 ","$9,748.05 ","$5,992.55 ","$14,997.00 ","$8,398.32 ","$5,992.55 ","$3,944.21 ", N/A ,"$12,632.57 ","$12,058.36 ","$6,292.18 ","$11,997.60 ","$13,483.24 ","$6,645.60 ","$4,199.16 ","$13,497.30 ","$5,992.55 ","$11,397.72 ","$4,800.00 ","$4,800.00 ","$5,992.55 ","$4,800.00 ","$7,198.56 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100130,93621,HC EP COMPREHENSIVE W/LT ATRIUM 93621,481,1 ,"$8,990.00 ","$5,843.50 ",$629.39 ,"$11,484.15 ", N/A ,"$8,990.00 ","$5,034.40 ", N/A ,"$2,517.20 ","$3,038.62 ", N/A ,$629.39 , N/A ,"$4,054.49 ","$4,054.49 ", N/A ,"$4,054.49 ", N/A ,"$4,495.00 ", N/A , N/A , N/A , N/A ,"$6,742.50 ","$5,394.00 ","$5,394.00 ", N/A ,"$5,394.00 ","$6,832.40 ","$6,832.40 ","$6,832.40 ","$8,990.00 ", N/A ,"$7,641.50 ", N/A ,"$5,843.50 ", N/A ,"$8,990.00 ","$5,034.40 ", N/A ,"$2,364.37 ", N/A ,"$8,990.00 ","$8,990.00 ", N/A ,"$7,192.00 ", N/A ,"$4,054.49 ","$2,517.20 ","$8,091.00 ", N/A ,"$6,832.40 ","$8,990.00 ","$8,990.00 ", N/A ,"$8,990.00 ","$4,315.20 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100131,93622,HC EP COMPREHENSIVE W/LT VENTRIC 93622,481,1 ,"$1,327.00 ",$862.55 ,$349.00 ,"$11,484.15 ", N/A ,"$1,327.00 ",$743.12 , N/A ,$371.56 ,$448.53 , N/A ,$546.72 , N/A ,$598.48 ,$598.48 , N/A ,$598.48 , N/A ,$663.50 , N/A , N/A , N/A , N/A ,$995.25 ,$796.20 ,$796.20 , N/A ,$796.20 ,"$1,008.52 ","$1,008.52 ","$1,008.52 ","$1,327.00 ", N/A ,"$1,127.95 ", N/A ,$862.55 , N/A ,"$1,327.00 ",$743.12 , N/A ,$349.00 , N/A ,"$1,327.00 ","$1,327.00 ", N/A ,"$1,061.60 ", N/A ,$598.48 ,$371.56 ,"$1,194.30 ", N/A ,"$1,008.52 ","$1,327.00 ","$1,327.00 ", N/A ,"$1,327.00 ",$636.96 ,"$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100132,93623,HC EP IV DRUG INFUSION PACING 93623,481,1 ,"$6,479.00 ","$4,211.35 ",$849.75 ,"$11,484.15 ", N/A ,"$6,479.00 ","$3,628.24 ", N/A ,"$1,814.12 ","$2,189.90 ", N/A ,$849.75 , N/A ,"$2,922.03 ","$2,922.03 ", N/A ,"$2,922.03 ", N/A ,"$3,239.50 ", N/A , N/A , N/A , N/A ,"$4,859.25 ","$3,887.40 ","$3,887.40 ", N/A ,"$3,887.40 ","$4,924.04 ","$4,924.04 ","$4,924.04 ","$6,479.00 ", N/A ,"$5,507.15 ", N/A ,"$4,211.35 ", N/A ,"$6,479.00 ","$3,628.24 ", N/A ,"$1,703.98 ", N/A ,"$6,479.00 ","$6,479.00 ", N/A ,"$5,183.20 ", N/A ,"$2,922.03 ","$1,814.12 ","$5,831.10 ", N/A ,"$4,924.04 ","$6,479.00 ","$6,479.00 ", N/A ,"$6,479.00 ","$3,109.92 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100133,93641,HC EP EVAL CARDIO/DEFIB GENERATOR 93641,481,1 ,"$2,178.00 ","$1,415.70 ",$242.82 ,"$2,178.00 ", N/A ,"$2,178.00 ","$1,219.68 ", N/A ,$609.84 ,$736.16 , N/A ,$897.34 , N/A ,$982.28 ,$982.28 , N/A ,$982.28 , N/A ,"$1,089.00 ", N/A , N/A , N/A , N/A ,"$1,633.50 ","$1,306.80 ","$1,306.80 ", N/A ,"$1,306.80 ","$1,655.28 ","$1,655.28 ","$1,655.28 ","$2,178.00 ", N/A ,"$1,851.30 ", N/A ,"$1,415.70 ", N/A ,"$2,178.00 ","$1,219.68 ", N/A ,$572.81 , N/A ,$267.10 ,$254.96 , N/A ,"$1,742.40 ", N/A ,$982.28 ,$609.84 ,"$1,960.20 ", N/A ,"$1,655.28 ","$2,178.00 ","$2,178.00 ", N/A ,"$2,178.00 ","$1,045.44 ",$242.82 
ST. ELIZABETH'S HOSPITAL,48100135,93642,HC EP EVAL CARDIO/DEFIB SGL/DUAL 93642,481,1 ,"$3,295.00 ","$2,141.75 ",$242.82 ,"$3,295.00 ","$2,745.18 ","$3,295.00 ","$1,845.20 ","$1,098.07 ",$922.60 ,"$1,113.71 ","$1,098.07 ","$1,255.54 ","$1,098.07 ","$1,486.05 ","$1,486.05 ","$1,098.07 ","$1,486.05 ","$2,086.33 ","$1,647.50 ","$2,745.18 ","$1,098.07 ","$1,098.07 ","$1,120.03 ","$2,471.25 ","$1,977.00 ","$1,977.00 ","$1,098.07 ","$1,977.00 ","$2,504.20 ","$2,504.20 ","$2,504.20 ","$3,295.00 ", N/A ,"$2,800.75 ","$2,745.18 ","$2,141.75 ","$1,098.07 ","$3,295.00 ","$1,845.20 ","$1,098.07 ",$866.59 , N/A ,$267.10 ,$254.96 ,"$1,152.97 ","$2,636.00 ","$2,470.66 ","$1,486.05 ",$922.60 ,"$2,965.50 ","$1,098.07 ","$2,504.20 ","$3,295.00 ","$3,295.00 ","$1,098.07 ","$3,295.00 ","$1,581.60 ",$242.82 
ST. ELIZABETH'S HOSPITAL,48100136,93650,HC ABLATION ATRIOVENTRICULAR FNCT 93650,481,1 ,"$14,997.00 ","$9,748.05 ","$3,944.21 ","$14,997.00 ","$14,981.38 ","$12,000.00 ","$8,398.32 ","$5,992.55 ","$4,199.16 ","$4,859.14 ","$5,992.55 ","$6,178.76 ","$5,992.55 ","$6,645.60 ","$6,645.60 ","$5,992.55 ","$6,645.60 ","$11,385.85 ","$7,498.50 ","$14,981.38 ","$5,992.55 ","$5,992.55 ","$6,112.40 ","$11,247.75 ","$8,998.20 ","$8,998.20 ","$5,992.55 ","$8,998.20 ","$11,397.72 ","$11,397.72 ","$11,397.72 ","$14,997.00 ", N/A ,"$12,747.45 ","$14,981.38 ","$9,748.05 ","$5,992.55 ","$14,997.00 ","$8,398.32 ","$5,992.55 ","$3,944.21 ", N/A ,"$12,632.57 ","$12,058.36 ","$6,292.18 ","$11,997.60 ","$13,483.24 ","$6,645.60 ","$4,199.16 ","$13,497.30 ","$5,992.55 ","$11,397.72 ","$14,500.00 ","$14,500.00 ","$5,992.55 ","$14,500.00 ","$7,198.56 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100139,93660,HC TILT TABLE EVALUATION 93660,481,1 ,"$1,254.00 ",$815.10 ,$135.95 ,"$1,254.00 ","$1,203.10 ",$576.84 ,$702.24 ,$481.24 ,$351.12 ,$423.85 ,$481.24 ,$516.65 ,$481.24 ,$565.55 ,$565.55 ,$481.24 ,$565.55 ,$914.36 ,$627.00 ,"$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,$940.50 ,$752.40 ,$752.40 ,$481.24 ,$752.40 ,$953.04 ,$953.04 ,$953.04 ,"$1,254.00 ", N/A ,"$1,065.90 ","$1,203.10 ",$815.10 ,$481.24 ,"$1,254.00 ",$702.24 ,$481.24 ,$329.80 , N/A ,$149.55 ,$142.75 ,$505.30 ,"$1,003.20 ","$1,082.79 ",$565.55 ,$351.12 ,"$1,128.60 ",$481.24 ,$953.04 ,$920.00 ,$920.00 ,$481.24 ,$920.00 ,$601.92 ,$135.95 
ST. ELIZABETH'S HOSPITAL,48100140,93662,HC EP INTRACARDIAC ECHO INTERVENT 93662,481,1 ,"$6,659.00 ","$4,328.35 ",$750.15 ,"$6,659.00 ", N/A ,"$6,659.00 ","$3,729.04 ", N/A ,"$1,864.52 ","$2,250.74 ", N/A ,$750.15 , N/A ,"$3,003.21 ","$3,003.21 ", N/A ,"$3,003.21 ", N/A ,"$3,329.50 ", N/A , N/A , N/A , N/A ,"$4,994.25 ","$3,995.40 ","$3,995.40 ", N/A ,"$3,995.40 ","$5,060.84 ","$5,060.84 ","$5,060.84 ","$6,659.00 ", N/A ,"$5,660.15 ", N/A ,"$4,328.35 ", N/A ,"$6,659.00 ","$3,729.04 ", N/A ,"$1,751.32 ", N/A , N/A , N/A , N/A ,"$5,327.20 ", N/A ,"$3,003.21 ","$1,864.52 ","$5,993.10 ", N/A ,"$5,060.84 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,196.32 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100150,93503,HC PLACEMENT SWANZ GAN CATH MONIT 93503,481,1 ,"$2,775.00 ","$1,803.75 ",$729.83 ,"$3,465.89 ","$3,465.88 ","$1,276.50 ","$1,554.00 ","$1,386.35 ",$777.00 ,$937.95 ,"$1,386.35 ","$1,143.30 ","$1,386.35 ","$1,251.53 ","$1,251.53 ","$1,386.35 ","$1,251.53 ","$2,634.07 ","$1,387.50 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$2,081.25 ","$1,665.00 ","$1,665.00 ","$1,386.35 ","$1,665.00 ","$2,109.00 ","$2,109.00 ","$2,109.00 ","$2,775.00 ", N/A ,"$2,358.75 ","$2,775.00 ","$1,803.75 ","$1,386.35 ","$2,775.00 ","$1,554.00 ","$1,386.35 ",$729.83 , N/A ,"$1,794.80 ","$1,713.22 ","$1,455.67 ","$2,220.00 ","$3,119.30 ","$1,251.53 ",$777.00 ,"$2,497.50 ","$1,386.35 ","$2,109.00 ","$1,500.00 ","$1,500.00 ","$1,386.35 ","$1,500.00 ","$1,332.00 ","$1,631.64 "
ST. ELIZABETH'S HOSPITAL,48100151,33227,HC REM/REPL PCMKR PUL GEN SGL 33227,481,1 ,"$20,802.00 ","$13,521.30 ","$4,200.00 ","$20,802.00 ","$20,108.50 ","$4,200.00 ","$11,649.12 ","$8,043.40 ","$5,824.56 ","$4,859.14 ","$8,043.40 ","$5,584.90 ","$8,043.40 ","$6,645.60 ","$6,645.60 ","$8,043.40 ","$6,645.60 ","$15,282.47 ","$10,401.00 ","$20,108.51 ","$8,043.40 ","$8,043.40 ","$8,204.27 ","$15,601.50 ","$12,481.20 ","$12,481.20 ","$8,043.40 ","$12,481.20 ","$15,809.52 ","$15,809.52 ","$15,809.52 ","$20,802.00 ", N/A ,"$17,681.70 ","$20,108.51 ","$13,521.30 ","$8,043.40 ","$20,802.00 ","$11,649.12 ","$8,043.40 ","$5,470.93 ", N/A ,"$8,482.36 ","$8,096.80 ","$8,445.57 ","$16,641.60 ","$18,097.66 ","$6,645.60 ","$5,824.56 ","$18,721.80 ","$8,043.40 ","$15,809.52 ","$20,802.00 ","$20,802.00 ","$8,043.40 ","$20,802.00 ","$9,984.96 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100152,33228,HC REM/REPL PCMKR PUL GEN DUAL 33228,481,1 ,"$27,510.00 ","$17,881.50 ","$4,200.00 ","$27,510.00 ","$25,627.60 ","$4,200.00 ","$15,405.60 ","$10,251.04 ","$7,702.80 ","$4,859.14 ","$10,251.04 ","$5,584.90 ","$10,251.04 ","$6,645.60 ","$6,645.60 ","$10,251.04 ","$6,645.60 ","$19,476.98 ","$13,755.00 ","$25,627.61 ","$10,251.04 ","$10,251.04 ","$10,456.06 ","$20,632.50 ","$16,506.00 ","$16,506.00 ","$10,251.04 ","$16,506.00 ","$20,907.60 ","$20,907.60 ","$20,907.60 ","$27,510.00 ", N/A ,"$23,383.50 ","$25,627.61 ","$17,881.50 ","$10,251.04 ","$27,510.00 ","$15,405.60 ","$10,251.04 ","$7,235.13 ", N/A ,"$8,482.36 ","$8,096.80 ","$10,763.59 ","$22,008.00 ","$23,064.84 ","$6,645.60 ","$7,702.80 ","$24,759.00 ","$10,251.04 ","$20,907.60 ","$22,140.00 ","$22,140.00 ","$10,251.04 ","$22,140.00 ","$13,204.80 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100153,33229,HC REM/REPL PCMKR PUL GEN MULT 33229,481,1 ,"$49,356.00 ","$32,081.40 ","$4,200.00 ","$49,356.00 ","$45,902.88 ","$4,200.00 ","$27,639.36 ","$18,361.15 ","$13,819.68 ","$16,682.33 ","$18,361.15 ","$19,199.48 ","$18,361.15 ","$22,259.56 ","$22,259.56 ","$18,361.15 ","$22,259.56 ","$34,886.18 ","$24,678.00 ","$45,902.87 ","$18,361.15 ","$18,361.15 ","$18,728.37 ","$37,017.00 ","$29,613.60 ","$29,613.60 ","$18,361.15 ","$29,613.60 ","$37,510.56 ","$37,510.56 ","$37,510.56 ","$49,356.00 ", N/A ,"$41,952.60 ","$45,902.87 ","$32,081.40 ","$18,361.15 ","$49,356.00 ","$27,639.36 ","$18,361.15 ","$12,980.63 ", N/A ,"$8,482.36 ","$8,096.80 ","$19,279.21 ","$39,484.80 ","$41,312.59 ","$22,259.56 ","$13,819.68 ","$44,420.40 ","$18,361.15 ","$37,510.56 ","$22,140.00 ","$22,140.00 ","$18,361.15 ","$22,140.00 ","$23,690.88 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100154,33262,HC REM/REPL DEFIB PUL GEN SGL 33262,481,1 ,"$62,394.00 ","$40,556.10 ","$4,200.00 ","$62,394.00 ","$56,835.28 ","$4,200.00 ","$34,940.64 ","$22,734.11 ","$17,470.32 ","$21,089.17 ","$22,734.11 ","$24,271.27 ","$22,734.11 ","$28,139.69 ","$28,139.69 ","$22,734.11 ","$28,139.69 ","$43,194.80 ","$31,197.00 ","$56,835.27 ","$22,734.11 ","$22,734.11 ","$23,188.79 ","$46,795.50 ","$37,436.40 ","$37,436.40 ","$22,734.11 ","$37,436.40 ","$47,419.44 ","$47,419.44 ","$47,419.44 ","$62,394.00 ", N/A ,"$53,034.90 ","$56,835.27 ","$40,556.10 ","$22,734.11 ","$62,394.00 ","$34,940.64 ","$22,734.11 ","$16,409.62 ", N/A ,"$24,331.36 ","$23,225.39 ","$23,870.82 ","$49,915.20 ","$51,151.74 ","$28,139.69 ","$17,470.32 ","$56,154.60 ","$22,734.11 ","$47,419.44 ","$22,140.00 ","$22,140.00 ","$22,734.11 ","$22,140.00 ","$29,949.12 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100155,33263,HC REM/REPL DEFIB PUL GEN DUAL 33263,481,1 ,"$62,394.00 ","$40,556.10 ","$4,200.00 ","$62,394.00 ","$56,835.28 ","$4,200.00 ","$34,940.64 ","$22,734.11 ","$17,470.32 ","$21,089.17 ","$22,734.11 ","$24,271.27 ","$22,734.11 ","$28,139.69 ","$28,139.69 ","$22,734.11 ","$28,139.69 ","$43,194.80 ","$31,197.00 ","$56,835.27 ","$22,734.11 ","$22,734.11 ","$23,188.79 ","$46,795.50 ","$37,436.40 ","$37,436.40 ","$22,734.11 ","$37,436.40 ","$47,419.44 ","$47,419.44 ","$47,419.44 ","$62,394.00 ", N/A ,"$53,034.90 ","$56,835.27 ","$40,556.10 ","$22,734.11 ","$62,394.00 ","$34,940.64 ","$22,734.11 ","$16,409.62 ", N/A ,"$24,331.36 ","$23,225.39 ","$23,870.82 ","$49,915.20 ","$51,151.74 ","$28,139.69 ","$17,470.32 ","$56,154.60 ","$22,734.11 ","$47,419.44 ","$22,140.00 ","$22,140.00 ","$22,734.11 ","$22,140.00 ","$29,949.12 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100156,33264,HC REM/REPL DEFIB PUL GEN MULT 33264,481,1 ,"$87,375.00 ","$56,793.75 ","$4,200.00 ","$87,375.00 ","$80,959.05 ","$4,200.00 ","$48,930.00 ","$32,383.62 ","$24,465.00 ","$29,532.75 ","$32,383.62 ","$33,988.88 ","$32,383.62 ","$39,406.13 ","$39,406.13 ","$32,383.62 ","$39,406.13 ","$61,528.88 ","$43,687.50 ","$80,959.05 ","$32,383.62 ","$32,383.62 ","$33,031.29 ","$65,531.25 ","$52,425.00 ","$52,425.00 ","$32,383.62 ","$52,425.00 ","$66,405.00 ","$66,405.00 ","$66,405.00 ","$87,375.00 ", N/A ,"$74,268.75 ","$80,959.05 ","$56,793.75 ","$32,383.62 ","$87,375.00 ","$48,930.00 ","$32,383.62 ","$22,979.63 ", N/A ,"$24,331.36 ","$23,225.39 ","$34,002.80 ","$69,900.00 ","$72,863.14 ","$39,406.13 ","$24,465.00 ","$78,637.50 ","$32,383.62 ","$66,405.00 ","$22,140.00 ","$22,140.00 ","$32,383.62 ","$22,140.00 ","$41,940.00 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100160,33270,HC INS/REP SUBQ DEFIBRILLATOR 33270,481,1 ,"$45,848.00 ","$29,801.20 ","$4,200.00 ","$80,959.05 ","$80,959.05 ","$4,200.00 ","$25,674.88 ","$32,383.62 ","$12,837.44 ","$15,496.62 ","$32,383.62 ","$17,834.87 ","$32,383.62 ","$20,677.45 ","$20,677.45 ","$32,383.62 ","$20,677.45 ","$45,848.00 ","$22,924.00 ","$80,959.05 ","$32,383.62 ","$32,383.62 ","$33,031.29 ","$34,386.00 ","$27,508.80 ","$27,508.80 ","$32,383.62 ","$27,508.80 ","$34,844.48 ","$34,844.48 ","$34,844.48 ","$45,848.00 ", N/A ,"$38,970.80 ","$45,848.00 ","$29,801.20 ","$32,383.62 ","$45,848.00 ","$25,674.88 ","$32,383.62 ","$12,058.02 ", N/A ,"$24,331.36 ","$23,225.39 ","$34,002.80 ","$36,678.40 ","$72,863.14 ","$20,677.45 ","$12,837.44 ","$41,263.20 ","$32,383.62 ","$34,844.48 ","$22,140.00 ","$22,140.00 ","$32,383.62 ","$22,140.00 ","$22,007.04 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100165,93462,HC LHC TRANSEPTAL PUNCTURE 93462,481,1 ,"$9,260.00 ","$6,019.00 ",$920.00 ,"$9,260.00 ", N/A ,"$4,259.60 ","$5,185.60 ", N/A ,"$2,592.80 ","$3,129.88 ", N/A ,"$3,602.14 ", N/A ,"$4,176.26 ","$4,176.26 ", N/A ,"$4,176.26 ", N/A ,"$4,630.00 ", N/A , N/A , N/A , N/A ,"$6,945.00 ","$5,556.00 ","$5,556.00 ", N/A ,"$5,556.00 ","$7,037.60 ","$7,037.60 ","$7,037.60 ","$9,260.00 ", N/A ,"$7,871.00 ", N/A ,"$6,019.00 ", N/A ,"$9,260.00 ","$5,185.60 ", N/A ,"$2,435.38 ", N/A ,"$2,568.96 ","$2,452.19 ", N/A ,"$7,408.00 ", N/A ,"$4,176.26 ","$2,592.80 ","$8,334.00 ", N/A ,"$7,037.60 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$4,444.80 ","$2,335.42 "
ST. ELIZABETH'S HOSPITAL,48100171,36253,HC PLC CATH RENAL ANGIO 1< UNI,481,1 ,"$3,257.00 ","$2,117.05 ",$856.59 ,"$11,753.38 ","$11,753.38 ","$3,200.00 ","$1,823.92 ","$4,701.35 ",$911.96 ,"$1,100.87 ","$4,701.35 ","$1,266.97 ","$3,257.00 ","$1,468.91 ","$1,468.91 ","$3,257.00 ","$1,468.91 ","$3,257.00 ","$1,628.50 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$3,257.00 ","$2,442.75 ","$1,954.20 ","$1,954.20 ","$4,701.35 ","$1,954.20 ","$2,475.32 ","$2,475.32 ","$2,475.32 ","$3,257.00 ", N/A ,"$2,768.45 ","$3,257.00 ","$2,117.05 ","$4,701.35 ","$3,257.00 ","$1,823.92 ","$4,701.35 ",$856.59 , N/A ,"$2,821.51 ","$2,693.26 ","$4,936.42 ","$2,605.60 ","$10,578.04 ","$1,468.91 ",$911.96 ,"$2,931.30 ","$4,701.35 ","$2,475.32 ","$3,257.00 ","$3,257.00 ","$3,257.00 ","$3,257.00 ","$1,563.36 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100172,36254,HC PLC CATH RENAL ANGIO 1< BIL,481,1 ,"$8,990.00 ","$5,843.50 ","$2,364.37 ","$8,990.00 ","$7,055.60 ","$3,200.00 ","$5,034.40 ","$2,822.24 ","$2,517.20 ","$3,038.62 ","$2,822.24 ","$3,497.11 ","$2,822.24 ","$4,054.49 ","$4,054.49 ","$2,822.24 ","$4,054.49 ","$5,362.25 ","$4,495.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$6,742.50 ","$5,394.00 ","$5,394.00 ","$2,822.24 ","$5,394.00 ","$6,832.40 ","$6,832.40 ","$6,832.40 ","$8,990.00 ", N/A ,"$7,641.50 ","$7,055.60 ","$5,843.50 ","$2,822.24 ","$8,990.00 ","$5,034.40 ","$2,822.24 ","$2,364.37 ", N/A ,"$2,821.51 ","$2,693.26 ","$2,963.35 ","$7,192.00 ","$6,350.04 ","$4,054.49 ","$2,517.20 ","$8,091.00 ","$2,822.24 ","$6,832.40 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$4,315.20 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100173,37193,HC FILTER REMOVAL,481,1 ,"$10,833.00 ","$7,041.45 ","$2,822.24 ","$10,833.00 ","$7,055.60 ","$4,200.00 ","$6,066.48 ","$2,822.24 ","$3,033.24 ","$3,661.55 ","$2,822.24 ","$4,214.04 ","$2,822.24 ","$4,885.68 ","$4,885.68 ","$2,822.24 ","$4,885.68 ","$5,362.25 ","$5,416.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$8,124.75 ","$6,499.80 ","$6,499.80 ","$2,822.24 ","$6,499.80 ","$8,233.08 ","$8,233.08 ","$8,233.08 ","$10,833.00 ", N/A ,"$9,208.05 ","$7,055.60 ","$7,041.45 ","$2,822.24 ","$10,833.00 ","$6,066.48 ","$2,822.24 ","$2,849.08 ", N/A ,"$3,285.62 ","$3,136.28 ","$2,963.35 ","$8,666.40 ","$6,350.04 ","$4,885.68 ","$3,033.24 ","$9,749.70 ","$2,822.24 ","$8,233.08 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$5,199.84 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100174,33230,HC INS DEFIB PULSE GEN W/EST DUAL,481,1 ,"$62,394.00 ","$40,556.10 ","$4,200.00 ","$62,394.00 ","$56,835.28 ","$4,200.00 ","$34,940.64 ","$22,734.11 ","$17,470.32 ","$21,089.17 ","$22,734.11 ","$24,271.27 ","$22,734.11 ","$28,139.69 ","$28,139.69 ","$22,734.11 ","$28,139.69 ","$43,194.80 ","$31,197.00 ","$56,835.27 ","$22,734.11 ","$22,734.11 ","$23,188.79 ","$46,795.50 ","$37,436.40 ","$37,436.40 ","$22,734.11 ","$37,436.40 ","$47,419.44 ","$47,419.44 ","$47,419.44 ","$62,394.00 ", N/A ,"$53,034.90 ","$56,835.27 ","$40,556.10 ","$22,734.11 ","$62,394.00 ","$34,940.64 ","$22,734.11 ","$16,409.62 ", N/A ,"$24,331.36 ","$23,225.39 ","$23,870.82 ","$49,915.20 ","$51,151.74 ","$28,139.69 ","$17,470.32 ","$56,154.60 ","$22,734.11 ","$47,419.44 ","$22,140.00 ","$22,140.00 ","$22,734.11 ","$22,140.00 ","$29,949.12 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100175,33231,HC INS DEFIB PULSE GEN W/EST MULT,481,1 ,"$87,375.00 ","$56,793.75 ","$4,200.00 ","$87,375.00 ","$80,959.05 ","$4,200.00 ","$48,930.00 ","$32,383.62 ","$24,465.00 ","$29,532.75 ","$32,383.62 ","$33,988.88 ","$32,383.62 ","$39,406.13 ","$39,406.13 ","$32,383.62 ","$39,406.13 ","$61,528.88 ","$43,687.50 ","$80,959.05 ","$32,383.62 ","$32,383.62 ","$33,031.29 ","$65,531.25 ","$52,425.00 ","$52,425.00 ","$32,383.62 ","$52,425.00 ","$66,405.00 ","$66,405.00 ","$66,405.00 ","$87,375.00 ", N/A ,"$74,268.75 ","$80,959.05 ","$56,793.75 ","$32,383.62 ","$87,375.00 ","$48,930.00 ","$32,383.62 ","$22,979.63 ", N/A ,"$24,331.36 ","$23,225.39 ","$34,002.80 ","$69,900.00 ","$72,863.14 ","$39,406.13 ","$24,465.00 ","$78,637.50 ","$32,383.62 ","$66,405.00 ","$22,140.00 ","$22,140.00 ","$32,383.62 ","$22,140.00 ","$41,940.00 ","$22,119.42 "
ST. ELIZABETH'S HOSPITAL,48100176,37216,HC PL STENT TRNSCATH CAROT ART W/O,481,1 ,"$10,724.00 ","$6,970.60 ","$1,635.00 ","$10,724.00 ", N/A ,"$4,200.00 ","$6,005.44 ", N/A ,"$3,002.72 ","$3,624.71 ", N/A ,"$4,171.64 ", N/A ,"$4,836.52 ","$4,836.52 ", N/A ,"$4,836.52 ", N/A ,"$5,362.00 ", N/A , N/A , N/A , N/A ,"$8,043.00 ","$6,434.40 ","$6,434.40 ", N/A ,"$6,434.40 ","$8,150.24 ","$8,150.24 ","$8,150.24 ","$10,724.00 ", N/A ,"$9,115.40 ", N/A ,"$6,970.60 ", N/A ,"$10,724.00 ","$6,005.44 ", N/A ,"$2,820.41 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$8,579.20 ", N/A ,"$4,836.52 ","$3,002.72 ","$9,651.60 ", N/A ,"$8,150.24 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$5,147.52 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100181,37212,HC VENOUS THROMBOLYSIS; INIT DAY 37212,481,1 ,"$5,124.00 ","$3,330.60 ","$1,347.61 ","$7,055.60 ","$7,055.60 ","$2,125.00 ","$2,869.44 ","$2,822.24 ","$1,434.72 ","$1,731.91 ","$2,822.24 ","$1,993.24 ","$2,822.24 ","$2,310.92 ","$2,310.92 ","$2,822.24 ","$2,310.92 ","$5,124.00 ","$2,562.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$3,843.00 ","$3,074.40 ","$3,074.40 ","$2,822.24 ","$3,074.40 ","$3,894.24 ","$3,894.24 ","$3,894.24 ","$5,124.00 ", N/A ,"$4,355.40 ","$5,124.00 ","$3,330.60 ","$2,822.24 ","$5,124.00 ","$2,869.44 ","$2,822.24 ","$1,347.61 ", N/A ,"$3,285.62 ","$3,136.28 ","$2,963.35 ","$4,099.20 ","$6,350.04 ","$2,310.92 ","$1,434.72 ","$4,611.60 ","$2,822.24 ","$3,894.24 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$2,459.52 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100182,37214,HC THROMBO CESS/CLOS; SUBSQ DAY 37214,481,1 ,"$7,434.00 ","$4,832.10 ","$1,500.00 ","$7,434.00 ","$7,055.60 ","$4,200.00 ","$4,163.04 ","$2,822.24 ","$2,081.52 ","$2,512.69 ","$2,822.24 ","$2,891.83 ","$2,822.24 ","$3,352.73 ","$3,352.73 ","$2,822.24 ","$3,352.73 ","$5,362.25 ","$3,717.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,575.50 ","$4,460.40 ","$4,460.40 ","$2,822.24 ","$4,460.40 ","$5,649.84 ","$5,649.84 ","$5,649.84 ","$7,434.00 ", N/A ,"$6,318.90 ","$7,055.60 ","$4,832.10 ","$2,822.24 ","$7,434.00 ","$4,163.04 ","$2,822.24 ","$1,955.14 ", N/A ,"$3,285.62 ","$3,136.28 ","$2,963.35 ","$5,947.20 ","$6,350.04 ","$3,352.73 ","$2,081.52 ","$6,690.60 ","$2,822.24 ","$5,649.84 ","$1,500.00 ","$1,500.00 ","$2,822.24 ","$1,500.00 ","$3,568.32 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100183,36225,HC CATH PLCMT SEL SUBCL/INOM VERTEB UNI 36225,481,1 ,"$6,022.00 ","$3,914.30 ","$1,583.79 ","$7,055.60 ","$7,055.60 ","$3,200.00 ","$3,372.32 ","$2,822.24 ","$1,686.16 ","$2,035.44 ","$2,822.24 ","$2,342.56 ","$2,822.24 ","$2,715.92 ","$2,715.92 ","$2,822.24 ","$2,715.92 ","$5,362.25 ","$3,011.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$4,516.50 ","$3,613.20 ","$3,613.20 ","$2,822.24 ","$3,613.20 ","$4,576.72 ","$4,576.72 ","$4,576.72 ","$6,022.00 ", N/A ,"$5,118.70 ","$6,022.00 ","$3,914.30 ","$2,822.24 ","$6,022.00 ","$3,372.32 ","$2,822.24 ","$1,583.79 ", N/A ,"$2,821.51 ","$2,693.26 ","$2,963.35 ","$4,817.60 ","$6,350.04 ","$2,715.92 ","$1,686.16 ","$5,419.80 ","$2,822.24 ","$4,576.72 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$2,890.56 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100184,36228,HC CATH PLCMT SEL EA INTRACRN BRANCH UNI 36228,481,1 ,"$4,819.00 ","$3,132.35 ",$920.00 ,"$4,819.00 ", N/A ,"$2,125.00 ","$2,698.64 ", N/A ,"$1,349.32 ","$1,628.82 ", N/A ,"$1,874.59 ", N/A ,"$2,173.37 ","$2,173.37 ", N/A ,"$2,173.37 ", N/A ,"$2,409.50 ", N/A , N/A , N/A , N/A ,"$3,614.25 ","$2,891.40 ","$2,891.40 ", N/A ,"$2,891.40 ","$3,662.44 ","$3,662.44 ","$3,662.44 ","$4,819.00 ", N/A ,"$4,096.15 ", N/A ,"$3,132.35 ", N/A ,"$4,819.00 ","$2,698.64 ", N/A ,"$1,267.40 ", N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$3,855.20 ", N/A ,"$2,173.37 ","$1,349.32 ","$4,337.10 ", N/A ,"$3,662.44 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$2,313.12 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100185,37211,HC ARTRL THROMBOLYSIS; INIT DAY 37211,481,1 ,"$9,678.00 ","$6,290.70 ","$2,125.00 ","$11,753.38 ","$11,753.38 ","$2,125.00 ","$5,419.68 ","$4,701.35 ","$2,709.84 ","$3,271.16 ","$4,701.35 ","$3,764.74 ","$4,701.35 ","$4,364.78 ","$4,364.78 ","$4,701.35 ","$4,364.78 ","$8,932.56 ","$4,839.00 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$7,258.50 ","$5,806.80 ","$5,806.80 ","$4,701.35 ","$5,806.80 ","$7,355.28 ","$7,355.28 ","$7,355.28 ","$9,678.00 ", N/A ,"$8,226.30 ","$9,678.00 ","$6,290.70 ","$4,701.35 ","$9,678.00 ","$5,419.68 ","$4,701.35 ","$2,545.31 ", N/A ,"$3,285.62 ","$3,136.28 ","$4,936.42 ","$7,742.40 ","$10,578.04 ","$4,364.78 ","$2,709.84 ","$8,710.20 ","$4,701.35 ","$7,355.28 ","$4,800.00 ","$4,800.00 ","$4,701.35 ","$4,800.00 ","$4,645.44 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100186,37213,HC ARTRL/VENOUS THROMBOLYSIS; SUBSQ DAY 37213,481,1 ,"$2,919.00 ","$1,897.35 ",$767.70 ,"$7,055.60 ","$7,055.60 ","$2,919.00 ","$1,634.64 ","$2,822.24 ",$817.32 ,$986.62 ,"$2,822.24 ","$1,135.49 ","$2,822.24 ","$1,316.47 ","$1,316.47 ","$2,822.24 ","$1,316.47 ","$2,919.00 ","$1,459.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$2,189.25 ","$1,751.40 ","$1,751.40 ","$2,822.24 ","$1,751.40 ","$2,218.44 ","$2,218.44 ","$2,218.44 ","$2,919.00 ", N/A ,"$2,481.15 ","$2,919.00 ","$1,897.35 ","$2,822.24 ","$2,919.00 ","$1,634.64 ","$2,822.24 ",$767.70 , N/A ,"$2,919.00 ","$2,919.00 ","$2,963.35 ","$2,335.20 ","$6,350.04 ","$1,316.47 ",$817.32 ,"$2,627.10 ","$2,822.24 ","$2,218.44 ","$1,500.00 ","$1,500.00 ","$2,822.24 ","$1,500.00 ","$1,401.12 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100187,37197,HC TRANSCATH RETRVAL FOREIGN BODY 37197,481,1 ,"$7,317.00 ","$4,756.05 ","$1,924.37 ","$7,317.00 ","$7,055.60 ","$4,200.00 ","$4,097.52 ","$2,822.24 ","$2,048.76 ","$2,473.15 ","$2,822.24 ","$2,846.31 ","$2,822.24 ","$3,299.97 ","$3,299.97 ","$2,822.24 ","$3,299.97 ","$5,362.25 ","$3,658.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,487.75 ","$4,390.20 ","$4,390.20 ","$2,822.24 ","$4,390.20 ","$5,560.92 ","$5,560.92 ","$5,560.92 ","$7,317.00 ", N/A ,"$6,219.45 ","$7,055.60 ","$4,756.05 ","$2,822.24 ","$7,317.00 ","$4,097.52 ","$2,822.24 ","$1,924.37 ", N/A ,"$5,217.83 ","$4,980.65 ","$2,963.35 ","$5,853.60 ","$6,350.04 ","$3,299.97 ","$2,048.76 ","$6,585.30 ","$2,822.24 ","$5,560.92 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,512.16 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100188,36221,HC CATH PLCMT NON SEL THORAC AORTA 36221,481,1 ,"$5,847.00 ","$3,800.55 ","$1,537.76 ","$7,055.60 ","$7,055.60 ","$3,200.00 ","$3,274.32 ","$2,822.24 ","$1,637.16 ","$1,976.29 ","$2,822.24 ","$2,274.48 ","$2,822.24 ","$2,637.00 ","$2,637.00 ","$2,822.24 ","$2,637.00 ","$5,362.25 ","$2,923.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$4,385.25 ","$3,508.20 ","$3,508.20 ","$2,822.24 ","$3,508.20 ","$4,443.72 ","$4,443.72 ","$4,443.72 ","$5,847.00 ", N/A ,"$4,969.95 ","$5,847.00 ","$3,800.55 ","$2,822.24 ","$5,847.00 ","$3,274.32 ","$2,822.24 ","$1,537.76 ", N/A ,"$2,821.51 ","$2,693.26 ","$2,963.35 ","$4,677.60 ","$6,350.04 ","$2,637.00 ","$1,637.16 ","$5,262.30 ","$2,822.24 ","$4,443.72 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$2,806.56 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$6,022.00 ","$3,914.30 ","$1,583.79 ","$7,055.60 ","$7,055.60 ","$3,200.00 ","$3,372.32 ","$2,822.24 ","$1,686.16 ","$2,035.44 ","$2,822.24 ","$2,342.56 ","$2,822.24 ","$2,715.92 ","$2,715.92 ","$2,822.24 ","$2,715.92 ","$5,362.25 ","$3,011.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$4,516.50 ","$3,613.20 ","$3,613.20 ","$2,822.24 ","$3,613.20 ","$4,576.72 ","$4,576.72 ","$4,576.72 ","$6,022.00 ", N/A ,"$5,118.70 ","$6,022.00 ","$3,914.30 ","$2,822.24 ","$6,022.00 ","$3,372.32 ","$2,822.24 ","$1,583.79 ", N/A ,"$2,821.51 ","$2,693.26 ","$2,963.35 ","$4,817.60 ","$6,350.04 ","$2,715.92 ","$1,686.16 ","$5,419.80 ","$2,822.24 ","$4,576.72 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$2,890.56 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100190,36223,HC CATH PLCMT SEL COM CAR/INOM INTRACRN UNI 36223,481,1 ,"$12,426.00 ","$8,076.90 ","$2,565.01 ","$12,426.00 ","$11,753.38 ","$3,200.00 ","$6,958.56 ","$4,701.35 ","$3,479.28 ","$4,199.99 ","$4,701.35 ","$4,833.71 ","$4,701.35 ","$5,604.13 ","$5,604.13 ","$4,701.35 ","$5,604.13 ","$8,932.56 ","$6,213.00 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$9,319.50 ","$7,455.60 ","$7,455.60 ","$4,701.35 ","$7,455.60 ","$9,443.76 ","$9,443.76 ","$9,443.76 ","$12,426.00 ", N/A ,"$10,562.10 ","$11,753.37 ","$8,076.90 ","$4,701.35 ","$12,426.00 ","$6,958.56 ","$4,701.35 ","$3,268.04 ", N/A ,"$2,821.51 ","$2,693.26 ","$4,936.42 ","$9,940.80 ","$10,578.04 ","$5,604.13 ","$3,479.28 ","$11,183.40 ","$4,701.35 ","$9,443.76 ","$4,800.00 ","$4,800.00 ","$4,701.35 ","$4,800.00 ","$5,964.48 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100191,36224,HC CATH PLCMT SEL INTERNAL CAR UNI 36224,481,1 ,"$12,426.00 ","$8,076.90 ","$2,565.01 ","$12,426.00 ","$11,753.38 ","$4,200.00 ","$6,958.56 ","$4,701.35 ","$3,479.28 ","$4,199.99 ","$4,701.35 ","$4,833.71 ","$4,701.35 ","$5,604.13 ","$5,604.13 ","$4,701.35 ","$5,604.13 ","$8,932.56 ","$6,213.00 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$9,319.50 ","$7,455.60 ","$7,455.60 ","$4,701.35 ","$7,455.60 ","$9,443.76 ","$9,443.76 ","$9,443.76 ","$12,426.00 ", N/A ,"$10,562.10 ","$11,753.37 ","$8,076.90 ","$4,701.35 ","$12,426.00 ","$6,958.56 ","$4,701.35 ","$3,268.04 ", N/A ,"$2,821.51 ","$2,693.26 ","$4,936.42 ","$9,940.80 ","$10,578.04 ","$5,604.13 ","$3,479.28 ","$11,183.40 ","$4,701.35 ","$9,443.76 ","$4,800.00 ","$4,800.00 ","$4,701.35 ","$4,800.00 ","$5,964.48 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100192,36226,HC CATH PLCMT SEL VERTEBRAL UNI 36226,481,1 ,"$12,426.00 ","$8,076.90 ","$2,565.01 ","$12,426.00 ","$11,753.38 ","$4,200.00 ","$6,958.56 ","$4,701.35 ","$3,479.28 ","$4,199.99 ","$4,701.35 ","$4,833.71 ","$4,701.35 ","$5,604.13 ","$5,604.13 ","$4,701.35 ","$5,604.13 ","$8,932.56 ","$6,213.00 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$9,319.50 ","$7,455.60 ","$7,455.60 ","$4,701.35 ","$7,455.60 ","$9,443.76 ","$9,443.76 ","$9,443.76 ","$12,426.00 ", N/A ,"$10,562.10 ","$11,753.37 ","$8,076.90 ","$4,701.35 ","$12,426.00 ","$6,958.56 ","$4,701.35 ","$3,268.04 ", N/A ,"$2,821.51 ","$2,693.26 ","$4,936.42 ","$9,940.80 ","$10,578.04 ","$5,604.13 ","$3,479.28 ","$11,183.40 ","$4,701.35 ","$9,443.76 ","$4,800.00 ","$4,800.00 ","$4,701.35 ","$4,800.00 ","$5,964.48 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100193,36227,HC CATH PLCMT SEL EXTERNAL CAR UNI 36227,481,1 ,"$10,034.00 ","$6,522.10 ",$920.00 ,"$10,034.00 ", N/A ,"$2,125.00 ","$5,619.04 ", N/A ,"$2,809.52 ","$3,391.49 ", N/A ,"$3,903.23 ", N/A ,"$4,525.33 ","$4,525.33 ", N/A ,"$4,525.33 ", N/A ,"$5,017.00 ", N/A , N/A , N/A , N/A ,"$7,525.50 ","$6,020.40 ","$6,020.40 ", N/A ,"$6,020.40 ","$7,625.84 ","$7,625.84 ","$7,625.84 ","$10,034.00 ", N/A ,"$8,528.90 ", N/A ,"$6,522.10 ", N/A ,"$10,034.00 ","$5,619.04 ", N/A ,"$2,638.94 ", N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$8,027.20 ", N/A ,"$4,525.33 ","$2,809.52 ","$9,030.60 ", N/A ,"$7,625.84 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$4,816.32 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100213,93653,HC EP STUDY PLUS SVT ABLATION 93653,481,1 ,"$52,251.00 ","$33,963.15 ","$11,484.15 ","$52,888.88 ","$52,888.88 ","$12,000.00 ","$29,260.56 ","$21,155.55 ","$14,630.28 ","$17,660.84 ","$21,155.55 ","$20,325.64 ","$21,155.55 ","$23,565.20 ","$23,565.20 ","$21,155.55 ","$23,565.20 ","$40,195.54 ","$26,125.50 ","$52,888.87 ","$21,155.55 ","$21,155.55 ","$21,578.66 ","$39,188.25 ","$31,350.60 ","$31,350.60 ","$21,155.55 ","$31,350.60 ","$39,710.76 ","$39,710.76 ","$39,710.76 ","$52,251.00 ", N/A ,"$44,413.35 ","$52,251.00 ","$33,963.15 ","$21,155.55 ","$52,251.00 ","$29,260.56 ","$21,155.55 ","$13,742.01 ", N/A ,"$12,632.57 ","$12,058.36 ","$22,213.33 ","$41,800.80 ","$47,599.98 ","$23,565.20 ","$14,630.28 ","$47,025.90 ","$21,155.55 ","$39,710.76 ","$14,500.00 ","$14,500.00 ","$21,155.55 ","$14,500.00 ","$25,080.48 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100214,93654,HC EP STUDY PLUS VT ABLATION 93654,481,1 ,"$20,071.00 ","$13,046.15 ","$4,859.14 ","$52,888.88 ","$52,888.88 ","$12,000.00 ","$11,239.76 ","$21,155.55 ","$5,619.88 ","$4,859.14 ","$21,155.55 ","$8,269.25 ","$20,071.00 ","$6,645.60 ","$6,645.60 ","$20,071.00 ","$6,645.60 ","$20,071.00 ","$10,035.50 ","$52,888.87 ","$21,155.55 ","$21,155.55 ","$20,071.00 ","$15,053.25 ","$12,042.60 ","$12,042.60 ","$21,155.55 ","$12,042.60 ","$15,253.96 ","$15,253.96 ","$15,253.96 ","$20,071.00 ", N/A ,"$17,060.35 ","$20,071.00 ","$13,046.15 ","$21,155.55 ","$20,071.00 ","$11,239.76 ","$21,155.55 ","$5,278.67 ", N/A ,"$12,632.57 ","$12,058.36 ","$22,213.33 ","$16,056.80 ","$47,599.98 ","$6,645.60 ","$5,619.88 ","$18,063.90 ","$21,155.55 ","$15,253.96 ","$14,500.00 ","$14,500.00 ","$20,071.00 ","$14,500.00 ","$9,634.08 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100215,93655,HC ADD ON ABLAT POST ABLAT ORIG RHYTHM 93655,481,1 ,"$7,362.00 ","$4,785.30 ","$1,936.21 ","$11,484.15 ", N/A ,"$2,125.00 ","$4,122.72 ", N/A ,"$2,061.36 ","$2,488.36 ", N/A ,"$2,863.82 ", N/A ,"$3,320.26 ","$3,320.26 ", N/A ,"$3,320.26 ", N/A ,"$3,681.00 ", N/A , N/A , N/A , N/A ,"$5,521.50 ","$4,417.20 ","$4,417.20 ", N/A ,"$4,417.20 ","$5,595.12 ","$5,595.12 ","$5,595.12 ","$7,362.00 ", N/A ,"$6,257.70 ", N/A ,"$4,785.30 ", N/A ,"$7,362.00 ","$4,122.72 ", N/A ,"$1,936.21 ", N/A ,"$7,362.00 ","$7,362.00 ", N/A ,"$5,889.60 ", N/A ,"$3,320.26 ","$2,061.36 ","$6,625.80 ", N/A ,"$5,595.12 ","$7,362.00 ","$7,362.00 ", N/A ,"$7,362.00 ","$3,533.76 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100216,93656,HC EP STUDY PLUS AFIB ABLATION 93656,481,1 ,"$52,251.00 ","$33,963.15 ","$11,484.15 ","$52,888.88 ","$52,888.88 ","$12,000.00 ","$29,260.56 ","$21,155.55 ","$14,630.28 ","$17,660.84 ","$21,155.55 ","$20,325.64 ","$21,155.55 ","$23,565.20 ","$23,565.20 ","$21,155.55 ","$23,565.20 ","$40,195.54 ","$26,125.50 ","$52,888.87 ","$21,155.55 ","$21,155.55 ","$21,578.66 ","$39,188.25 ","$31,350.60 ","$31,350.60 ","$21,155.55 ","$31,350.60 ","$39,710.76 ","$39,710.76 ","$39,710.76 ","$52,251.00 ", N/A ,"$44,413.35 ","$52,251.00 ","$33,963.15 ","$21,155.55 ","$52,251.00 ","$29,260.56 ","$21,155.55 ","$13,742.01 ", N/A ,"$12,632.57 ","$12,058.36 ","$22,213.33 ","$41,800.80 ","$47,599.98 ","$23,565.20 ","$14,630.28 ","$47,025.90 ","$21,155.55 ","$39,710.76 ","$14,500.00 ","$14,500.00 ","$21,155.55 ","$14,500.00 ","$25,080.48 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100217,93657,HC ADD ON AFIB ABLAT POST COMPL PVI 93657,481,1 ,"$11,569.00 ","$7,519.85 ","$2,125.00 ","$11,569.00 ", N/A ,"$2,125.00 ","$6,478.64 ", N/A ,"$3,239.32 ","$3,910.32 ", N/A ,"$4,500.34 ", N/A ,"$5,217.62 ","$5,217.62 ", N/A ,"$5,217.62 ", N/A ,"$5,784.50 ", N/A , N/A , N/A , N/A ,"$8,676.75 ","$6,941.40 ","$6,941.40 ", N/A ,"$6,941.40 ","$8,792.44 ","$8,792.44 ","$8,792.44 ","$11,569.00 ", N/A ,"$9,833.65 ", N/A ,"$7,519.85 ", N/A ,"$11,569.00 ","$6,478.64 ", N/A ,"$3,042.65 ", N/A ,"$11,569.00 ","$11,569.00 ", N/A ,"$9,255.20 ", N/A ,"$5,217.62 ","$3,239.32 ","$10,412.10 ", N/A ,"$8,792.44 ","$11,569.00 ","$11,569.00 ", N/A ,"$11,569.00 ","$5,553.12 ","$11,484.15 "
ST. ELIZABETH'S HOSPITAL,48100227,93286,HC PRE OR POST PACEMAKER EVAL 93286,481,1 ,$140.00 ,$91.00 ,$36.82 ,$140.00 , N/A ,$64.40 ,$78.40 , N/A ,$39.20 ,$47.32 , N/A ,$57.68 , N/A ,$63.14 ,$63.14 , N/A ,$63.14 , N/A ,$70.00 , N/A , N/A , N/A , N/A ,$105.00 ,$84.00 ,$84.00 , N/A ,$84.00 ,$106.40 ,$106.40 ,$106.40 ,$140.00 , N/A ,$119.00 , N/A ,$91.00 , N/A ,$140.00 ,$78.40 , N/A ,$36.82 , N/A , N/A , N/A , N/A ,$112.00 , N/A ,$63.14 ,$39.20 ,$126.00 , N/A ,$106.40 , N/A , N/A , N/A , N/A ,$67.20 , N/A 
ST. ELIZABETH'S HOSPITAL,48100230,37241,HC VENOUS EMBO FOR VEIN MALFORMATION 37241,481,1 ,"$11,976.00 ","$7,784.40 ","$3,149.69 ","$24,756.83 ","$24,756.83 ","$4,200.00 ","$6,706.56 ","$9,902.73 ","$3,353.28 ","$4,047.89 ","$9,902.73 ","$4,658.66 ","$9,902.73 ","$5,401.18 ","$5,401.18 ","$9,902.73 ","$5,401.18 ","$11,976.00 ","$5,988.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$8,982.00 ","$7,185.60 ","$7,185.60 ","$9,902.73 ","$7,185.60 ","$9,101.76 ","$9,101.76 ","$9,101.76 ","$11,976.00 ", N/A ,"$10,179.60 ","$11,976.00 ","$7,784.40 ","$9,902.73 ","$11,976.00 ","$6,706.56 ","$9,902.73 ","$3,149.69 ", N/A ,"$11,318.77 ","$10,804.28 ","$10,397.87 ","$9,580.80 ","$22,281.13 ","$5,401.18 ","$3,353.28 ","$10,778.40 ","$9,902.73 ","$9,101.76 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$5,748.48 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100231,37242,HC ARTERIAL EMBO FOR AVM ANER PRE/PST AAA 37242,481,1 ,"$11,976.00 ","$7,784.40 ","$3,149.69 ","$24,756.83 ","$24,756.83 ","$4,200.00 ","$6,706.56 ","$9,902.73 ","$3,353.28 ","$4,047.89 ","$9,902.73 ","$4,658.66 ","$9,902.73 ","$5,401.18 ","$5,401.18 ","$9,902.73 ","$5,401.18 ","$11,976.00 ","$5,988.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$8,982.00 ","$7,185.60 ","$7,185.60 ","$9,902.73 ","$7,185.60 ","$9,101.76 ","$9,101.76 ","$9,101.76 ","$11,976.00 ", N/A ,"$10,179.60 ","$11,976.00 ","$7,784.40 ","$9,902.73 ","$11,976.00 ","$6,706.56 ","$9,902.73 ","$3,149.69 ", N/A ,"$11,318.77 ","$10,804.28 ","$10,397.87 ","$9,580.80 ","$22,281.13 ","$5,401.18 ","$3,353.28 ","$10,778.40 ","$9,902.73 ","$9,101.76 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$5,748.48 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100232,37243,HC EMBOLIZATION OF TUMOR UFE CHEMO 37243,481,1 ,"$11,976.00 ","$7,784.40 ","$3,149.69 ","$24,756.83 ","$24,756.83 ","$4,200.00 ","$6,706.56 ","$9,902.73 ","$3,353.28 ","$4,047.89 ","$9,902.73 ","$4,658.66 ","$9,902.73 ","$5,401.18 ","$5,401.18 ","$9,902.73 ","$5,401.18 ","$11,976.00 ","$5,988.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$8,982.00 ","$7,185.60 ","$7,185.60 ","$9,902.73 ","$7,185.60 ", N/A , N/A , N/A ,"$11,976.00 ", N/A ,"$10,179.60 ","$11,976.00 ","$7,784.40 ","$9,902.73 ","$11,976.00 ","$6,706.56 ","$9,902.73 ","$3,149.69 ", N/A ,"$11,318.77 ","$10,804.28 ","$10,397.87 ","$9,580.80 ","$22,281.13 ","$5,401.18 ","$3,353.28 ","$10,778.40 ","$9,902.73 ", N/A ,"$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$5,748.48 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100233,37244,HC EMBOLIZATION FOR HEMORRAGE ART/VEN 37244,481,1 ,"$11,976.00 ","$7,784.40 ","$3,149.69 ","$24,756.83 ","$24,756.83 ","$4,200.00 ","$6,706.56 ","$9,902.73 ","$3,353.28 ","$4,047.89 ","$9,902.73 ","$4,658.66 ","$9,902.73 ","$5,401.18 ","$5,401.18 ","$9,902.73 ","$5,401.18 ","$11,976.00 ","$5,988.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$8,982.00 ","$7,185.60 ","$7,185.60 ","$9,902.73 ","$7,185.60 ", N/A , N/A , N/A ,"$11,976.00 ", N/A ,"$10,179.60 ","$11,976.00 ","$7,784.40 ","$9,902.73 ","$11,976.00 ","$6,706.56 ","$9,902.73 ","$3,149.69 ", N/A ,"$11,318.77 ","$10,804.28 ","$10,397.87 ","$9,580.80 ","$22,281.13 ","$5,401.18 ","$3,353.28 ","$10,778.40 ","$9,902.73 ", N/A ,"$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$5,748.48 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100234,37236,HC STENT INIT ARTERY UPPER EXT VISCERAL 37236,481,1 ,"$29,661.00 ","$19,279.65 ","$4,200.00 ","$29,661.00 ","$24,756.83 ","$4,200.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$14,237.28 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100235,37237,HC STENT ADDN ARTERY UPPER EXT VISERAL 37237,481,1 ,"$7,763.00 ","$5,045.95 ","$2,041.67 ","$7,763.00 ", N/A ,"$2,125.00 ","$4,347.28 ", N/A ,"$2,173.64 ","$2,623.89 ", N/A ,"$3,019.81 ", N/A ,"$3,501.11 ","$3,501.11 ", N/A ,"$3,501.11 ", N/A ,"$3,881.50 ", N/A , N/A , N/A , N/A ,"$5,822.25 ","$4,657.80 ","$4,657.80 ", N/A ,"$4,657.80 ","$5,899.88 ","$5,899.88 ","$5,899.88 ","$7,763.00 ", N/A ,"$6,598.55 ", N/A ,"$5,045.95 ", N/A ,"$7,763.00 ","$4,347.28 ", N/A ,"$2,041.67 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$6,210.40 ", N/A ,"$3,501.11 ","$2,173.64 ","$6,986.70 ", N/A ,"$5,899.88 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$3,726.24 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100236,37238,HC STENT INIT VENOUS UPPER EXT VISERAL 37238,481,1 ,"$29,661.00 ","$19,279.65 ","$4,200.00 ","$29,661.00 ","$24,756.83 ","$4,200.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$14,237.28 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100237,37239,HC STENT ADDN VENOUS UPPER EXT VISERAL 37239,481,1 ,"$9,047.00 ","$5,880.55 ","$2,125.00 ","$9,047.00 ", N/A ,"$2,125.00 ","$5,066.32 ", N/A ,"$2,533.16 ","$3,057.89 ", N/A ,"$3,519.28 ", N/A ,"$4,080.20 ","$4,080.20 ", N/A ,"$4,080.20 ", N/A ,"$4,523.50 ", N/A , N/A , N/A , N/A ,"$6,785.25 ","$5,428.20 ","$5,428.20 ", N/A ,"$5,428.20 ","$6,875.72 ","$6,875.72 ","$6,875.72 ","$9,047.00 ", N/A ,"$7,689.95 ", N/A ,"$5,880.55 ", N/A ,"$9,047.00 ","$5,066.32 ", N/A ,"$2,379.36 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$7,237.60 ", N/A ,"$4,080.20 ","$2,533.16 ","$8,142.30 ", N/A ,"$6,875.72 ","$4,800.00 ","$4,800.00 ", N/A ,"$4,800.00 ","$4,342.56 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100241,33361,HC REPL TAVR W/PRO PERC FEM ART,481,1 ,"$21,400.00 ","$13,910.00 ","$1,635.00 ","$21,400.00 ", N/A ,"$7,500.00 ","$11,984.00 ", N/A ,"$5,992.00 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$10,700.00 ", N/A , N/A , N/A , N/A ,"$16,050.00 ","$12,840.00 ","$12,840.00 ", N/A ,"$12,840.00 ","$16,264.00 ","$16,264.00 ","$16,264.00 ","$21,400.00 ", N/A ,"$18,190.00 ", N/A ,"$13,910.00 ", N/A ,"$21,400.00 ","$11,984.00 ", N/A ,"$5,628.20 ", N/A , N/A , N/A , N/A ,"$17,120.00 ", N/A ,"$6,645.60 ","$5,992.00 ","$19,260.00 ", N/A ,"$16,264.00 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$10,272.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100250,33418,HC RPR TRNSCTH MITRL VLV INT PROS,481,1 ,"$34,881.62 ","$22,673.05 ","$1,635.00 ","$34,881.62 ", N/A ,"$7,500.00 ","$19,533.71 ", N/A ,"$9,766.85 ","$11,789.99 ", N/A ,"$13,568.95 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$17,440.81 ", N/A , N/A , N/A , N/A ,"$26,161.22 ","$20,928.97 ","$20,928.97 ", N/A ,"$20,928.97 ","$26,510.03 ","$26,510.03 ","$26,510.03 ","$34,881.62 ", N/A ,"$29,649.38 ", N/A ,"$22,673.05 ", N/A ,"$34,881.62 ","$19,533.71 ", N/A ,"$9,173.87 ", N/A , N/A , N/A , N/A ,"$27,905.30 ", N/A ,"$6,645.60 ","$9,766.85 ","$31,393.46 ", N/A ,"$26,510.03 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$16,743.18 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100251,33419,HC RPR TRNSCTH MITRL VLV SUB PROS,481,1 ,"$17,440.81 ","$11,336.53 ",$920.00 ,"$17,440.81 ", N/A ,"$7,500.00 ","$9,766.85 ", N/A ,"$4,883.43 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$8,720.41 ", N/A , N/A , N/A , N/A ,"$13,080.61 ","$10,464.49 ","$10,464.49 ", N/A ,"$10,464.49 ","$13,255.02 ","$13,255.02 ","$13,255.02 ","$17,440.81 ", N/A ,"$14,824.69 ", N/A ,"$11,336.53 ", N/A ,"$17,440.81 ","$9,766.85 ", N/A ,"$4,586.93 ", N/A , N/A , N/A , N/A ,"$13,952.65 ", N/A ,"$6,645.60 ","$4,883.43 ","$15,696.73 ", N/A ,"$13,255.02 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$8,371.59 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100263,36902,HC INTRO CATH/CIRCUIT W/ANGIO 36902,481,1 ,"$13,590.00 ","$8,833.50 ","$3,574.17 ","$13,590.00 ","$12,215.85 ","$12,000.00 ","$7,610.40 ","$4,886.34 ","$3,805.20 ","$4,593.42 ","$4,886.34 ","$5,286.51 ","$4,886.34 ","$6,129.09 ","$6,129.09 ","$4,886.34 ","$6,129.09 ","$9,284.05 ","$6,795.00 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,192.50 ","$8,154.00 ","$8,154.00 ","$4,886.34 ","$8,154.00 ","$10,328.40 ","$10,328.40 ","$10,328.40 ","$13,590.00 ", N/A ,"$11,551.50 ","$12,215.86 ","$8,833.50 ","$4,886.34 ","$13,590.00 ","$7,610.40 ","$4,886.34 ","$3,574.17 ", N/A ,"$5,217.83 ","$4,980.65 ","$5,130.66 ","$10,872.00 ","$10,994.27 ","$6,129.09 ","$3,805.20 ","$12,231.00 ","$4,886.34 ","$10,328.40 ","$4,800.00 ","$4,800.00 ","$4,886.34 ","$4,800.00 ","$6,523.20 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100264,36905,HC THROMBECTOMY/INFUS CIRCUIT W/ANGIO 36905,481,1 ,"$21,880.00 ","$14,222.00 ","$4,743.48 ","$24,756.83 ","$24,756.83 ","$12,000.00 ","$12,252.80 ","$9,902.73 ","$6,126.40 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$10,940.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$16,410.00 ","$13,128.00 ","$13,128.00 ","$9,902.73 ","$13,128.00 ","$16,628.80 ","$16,628.80 ","$16,628.80 ","$21,880.00 ", N/A ,"$18,598.00 ","$21,880.00 ","$14,222.00 ","$9,902.73 ","$21,880.00 ","$12,252.80 ","$9,902.73 ","$5,754.44 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$17,504.00 ","$22,281.13 ","$6,645.60 ","$6,126.40 ","$19,692.00 ","$9,902.73 ","$16,628.80 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$10,502.40 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100265,36907,HC ANGIOPLASTY CTR DIALYSIS SEGMENT 36907,481,1 ,"$2,947.00 ","$1,915.55 ",$775.06 ,"$4,743.48 ", N/A ,"$2,125.00 ","$1,650.32 ", N/A ,$825.16 ,$996.09 , N/A ,"$1,146.38 ", N/A ,"$1,329.10 ","$1,329.10 ", N/A ,"$1,329.10 ", N/A ,"$1,473.50 ", N/A , N/A , N/A , N/A ,"$2,210.25 ","$1,768.20 ","$1,768.20 ", N/A ,"$1,768.20 ","$2,239.72 ","$2,239.72 ","$2,239.72 ","$2,947.00 ", N/A ,"$2,504.95 ", N/A ,"$1,915.55 ", N/A ,"$2,947.00 ","$1,650.32 ", N/A ,$775.06 , N/A ,"$2,947.00 ","$2,947.00 ", N/A ,"$2,357.60 ", N/A ,"$1,329.10 ",$825.16 ,"$2,652.30 ", N/A ,"$2,239.72 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,414.56 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100266,37246,HC ANGIOPLASTY TRANLUM BALN INIT ARTERY 37246,481,1 ,"$13,590.00 ","$8,833.50 ","$3,574.17 ","$13,590.00 ","$12,215.85 ","$12,000.00 ","$7,610.40 ","$4,886.34 ","$3,805.20 ","$4,593.42 ","$4,886.34 ","$5,286.51 ","$4,886.34 ","$6,129.09 ","$6,129.09 ","$4,886.34 ","$6,129.09 ","$9,284.05 ","$6,795.00 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,192.50 ","$8,154.00 ","$8,154.00 ","$4,886.34 ","$8,154.00 ", N/A , N/A , N/A ,"$13,590.00 ", N/A ,"$11,551.50 ","$12,215.86 ","$8,833.50 ","$4,886.34 ","$13,590.00 ","$7,610.40 ","$4,886.34 ","$3,574.17 ", N/A ,"$5,217.83 ","$4,980.65 ","$5,130.66 ","$10,872.00 ","$10,994.27 ","$6,129.09 ","$3,805.20 ","$12,231.00 ","$4,886.34 ", N/A ,"$4,800.00 ","$4,800.00 ","$4,886.34 ","$4,800.00 ","$6,523.20 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100267,37247,HC ANGIOPLASTY TRANLUM BALN ADDL ARTERY 37247,481,1 ,"$12,041.00 ","$7,826.65 ",$920.00 ,"$12,041.00 ", N/A ,"$2,125.00 ","$6,742.96 ", N/A ,"$3,371.48 ","$4,069.86 ", N/A ,"$4,683.95 ", N/A ,"$5,430.49 ","$5,430.49 ", N/A ,"$5,430.49 ", N/A ,"$6,020.50 ", N/A , N/A , N/A , N/A ,"$9,030.75 ","$7,224.60 ","$7,224.60 ", N/A ,"$7,224.60 ", N/A , N/A , N/A ,"$12,041.00 ", N/A ,"$10,234.85 ", N/A ,"$7,826.65 ", N/A ,"$12,041.00 ","$6,742.96 ", N/A ,"$3,166.78 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$9,632.80 ", N/A ,"$5,430.49 ","$3,371.48 ","$10,836.90 ", N/A , N/A ,$920.00 ,$920.00 , N/A ,$920.00 ,"$5,779.68 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100268,37248,HC ANGIOPLASTY TRANLUM BALN INIT VEIN 37248,481,1 ,"$12,041.00 ","$7,826.65 ","$3,166.78 ","$12,215.86 ","$12,215.85 ","$12,000.00 ","$6,742.96 ","$4,886.34 ","$3,371.48 ","$4,069.86 ","$4,886.34 ","$4,683.95 ","$4,886.34 ","$5,430.49 ","$5,430.49 ","$4,886.34 ","$5,430.49 ","$9,284.05 ","$6,020.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$9,030.75 ","$7,224.60 ","$7,224.60 ","$4,886.34 ","$7,224.60 ", N/A , N/A , N/A ,"$12,041.00 ", N/A ,"$10,234.85 ","$12,041.00 ","$7,826.65 ","$4,886.34 ","$12,041.00 ","$6,742.96 ","$4,886.34 ","$3,166.78 ", N/A ,"$5,217.83 ","$4,980.65 ","$5,130.66 ","$9,632.80 ","$10,994.27 ","$5,430.49 ","$3,371.48 ","$10,836.90 ","$4,886.34 ", N/A ,"$4,800.00 ","$4,800.00 ","$4,886.34 ","$4,800.00 ","$5,779.68 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100269,37249,HC ANGIOPLASTY TRANLUM BALN ADDL VEIN 37249,481,1 ,"$10,791.00 ","$7,014.15 ",$920.00 ,"$10,791.00 ", N/A ,"$2,125.00 ","$6,042.96 ", N/A ,"$3,021.48 ","$3,647.36 ", N/A ,"$4,197.70 ", N/A ,"$4,866.74 ","$4,866.74 ", N/A ,"$4,866.74 ", N/A ,"$5,395.50 ", N/A , N/A , N/A , N/A ,"$8,093.25 ","$6,474.60 ","$6,474.60 ", N/A ,"$6,474.60 ", N/A , N/A , N/A ,"$10,791.00 ", N/A ,"$9,172.35 ", N/A ,"$7,014.15 ", N/A ,"$10,791.00 ","$6,042.96 ", N/A ,"$2,838.03 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$8,632.80 ", N/A ,"$4,866.74 ","$3,021.48 ","$9,711.90 ", N/A , N/A ,$920.00 ,$920.00 , N/A ,$920.00 ,"$5,179.68 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100270,36908,HC PLACE STENT CENTRAL DIAL SEGMENT 36908,481,1 ,"$9,895.00 ","$6,431.75 ",$920.00 ,"$9,895.00 ", N/A ,"$2,125.00 ","$5,541.20 ", N/A ,"$2,770.60 ","$3,344.51 ", N/A ,"$3,849.16 ", N/A ,"$4,462.65 ","$4,462.65 ", N/A ,"$4,462.65 ", N/A ,"$4,947.50 ", N/A , N/A , N/A , N/A ,"$7,421.25 ","$5,937.00 ","$5,937.00 ", N/A ,"$5,937.00 ","$7,520.20 ","$7,520.20 ","$7,520.20 ","$9,895.00 ", N/A ,"$8,410.75 ", N/A ,"$6,431.75 ", N/A ,"$9,895.00 ","$5,541.20 ", N/A ,"$2,602.39 ", N/A ,"$5,217.83 ","$4,980.65 ", N/A ,"$7,916.00 ", N/A ,"$4,462.65 ","$2,770.60 ","$8,905.50 ", N/A ,"$7,520.20 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$4,749.60 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100271,36909,HC DIAL CIRCUIT VASC EMBOL/OCCUL 36909,481,1 ,"$14,461.00 ","$9,399.65 ",$920.00 ,"$14,461.00 ", N/A ,"$2,125.00 ","$8,098.16 ", N/A ,"$4,049.08 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,521.91 ","$6,521.91 ", N/A ,"$6,521.91 ", N/A ,"$7,230.50 ", N/A , N/A , N/A , N/A ,"$10,845.75 ","$8,676.60 ","$8,676.60 ", N/A ,"$8,676.60 ","$10,990.36 ","$10,990.36 ","$10,990.36 ","$14,461.00 ", N/A ,"$12,291.85 ", N/A ,"$9,399.65 ", N/A ,"$14,461.00 ","$8,098.16 ", N/A ,"$3,803.24 ", N/A ,"$4,198.04 ","$4,007.22 ", N/A ,"$11,568.80 ", N/A ,"$6,521.91 ","$4,049.08 ","$13,014.90 ", N/A ,"$10,990.36 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$6,941.28 ","$3,816.40 "
ST. ELIZABETH'S HOSPITAL,48100272,36901,HC INTRO CATH DIALYSIS CIRCUIT 36901,481,1 ,"$2,947.00 ","$1,915.55 ",$775.06 ,"$3,465.89 ","$3,465.88 ","$2,125.00 ","$1,650.32 ","$1,386.35 ",$825.16 ,$996.09 ,"$1,386.35 ","$1,146.38 ","$1,386.35 ","$1,329.10 ","$1,329.10 ","$1,386.35 ","$1,329.10 ","$2,634.07 ","$1,473.50 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,414.08 ","$2,210.25 ","$1,768.20 ","$1,768.20 ","$1,386.35 ","$1,768.20 ","$2,239.72 ","$2,239.72 ","$2,239.72 ","$2,947.00 ", N/A ,"$2,504.95 ","$2,947.00 ","$1,915.55 ","$1,386.35 ","$2,947.00 ","$1,650.32 ","$1,386.35 ",$775.06 , N/A ,"$2,947.00 ","$2,947.00 ","$1,455.67 ","$2,357.60 ","$3,119.30 ","$1,329.10 ",$825.16 ,"$2,652.30 ","$1,386.35 ","$2,239.72 ","$1,890.00 ","$1,890.00 ","$1,386.35 ","$1,890.00 ","$1,414.56 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100273,36903,HC INTRO CATH/CIRCUIT W/STENT 36903,481,1 ,"$20,158.00 ","$13,102.70 ","$4,743.48 ","$24,756.83 ","$24,756.83 ","$12,000.00 ","$11,288.48 ","$9,902.73 ","$5,644.24 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$10,079.00 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$15,118.50 ","$12,094.80 ","$12,094.80 ","$9,902.73 ","$12,094.80 ","$15,320.08 ","$15,320.08 ","$15,320.08 ","$20,158.00 ", N/A ,"$17,134.30 ","$20,158.00 ","$13,102.70 ","$9,902.73 ","$20,158.00 ","$11,288.48 ","$9,902.73 ","$5,301.55 ", N/A ,"$5,217.83 ","$4,980.65 ","$10,397.87 ","$16,126.40 ","$22,281.13 ","$6,645.60 ","$5,644.24 ","$18,142.20 ","$9,902.73 ","$15,320.08 ","$5,500.00 ","$5,500.00 ","$9,902.73 ","$5,500.00 ","$9,675.84 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100274,36904,HC THROMBECTOMY/INFUS DIALYSIS CIRCUIT 36904,481,1 ,"$10,791.00 ","$7,014.15 ","$2,838.03 ","$12,215.86 ","$12,215.85 ","$5,500.00 ","$6,042.96 ","$4,886.34 ","$3,021.48 ","$3,647.36 ","$4,886.34 ","$4,197.70 ","$4,886.34 ","$4,866.74 ","$4,866.74 ","$4,886.34 ","$4,866.74 ","$9,284.05 ","$5,395.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$8,093.25 ","$6,474.60 ","$6,474.60 ","$4,886.34 ","$6,474.60 ","$8,201.16 ","$8,201.16 ","$8,201.16 ","$10,791.00 ", N/A ,"$9,172.35 ","$10,791.00 ","$7,014.15 ","$4,886.34 ","$10,791.00 ","$6,042.96 ","$4,886.34 ","$2,838.03 ", N/A ,"$5,217.83 ","$4,980.65 ","$5,130.66 ","$8,632.80 ","$10,994.27 ","$4,866.74 ","$3,021.48 ","$9,711.90 ","$4,886.34 ","$8,201.16 ","$4,800.00 ","$4,800.00 ","$4,886.34 ","$4,800.00 ","$5,179.68 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100275,36906,HC THROMBECTOMY/INFUS CIRCUIT W/STENT 36906,481,1 ,"$21,794.00 ","$14,166.10 ","$4,743.48 ","$39,583.70 ","$39,583.70 ","$12,000.00 ","$12,204.64 ","$15,833.48 ","$6,102.32 ","$4,859.14 ","$15,833.48 ","$5,584.90 ","$15,833.48 ","$6,645.60 ","$6,645.60 ","$15,833.48 ","$6,645.60 ","$21,794.00 ","$10,897.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$16,345.50 ","$13,076.40 ","$13,076.40 ","$15,833.48 ","$13,076.40 ","$16,563.44 ","$16,563.44 ","$16,563.44 ","$21,794.00 ", N/A ,"$18,524.90 ","$21,794.00 ","$14,166.10 ","$15,833.48 ","$21,794.00 ","$12,204.64 ","$15,833.48 ","$5,731.82 ", N/A ,"$5,217.83 ","$4,980.65 ","$16,625.15 ","$17,435.20 ","$35,625.33 ","$6,645.60 ","$6,102.32 ","$19,614.60 ","$15,833.48 ","$16,563.44 ","$7,500.00 ","$7,500.00 ","$15,833.48 ","$7,500.00 ","$10,461.12 ","$4,743.48 "
ST. ELIZABETH'S HOSPITAL,48100276,93505,HC BIOPSY ENDOMYOCARDIAL,481,1 ,"$7,035.00 ","$4,572.75 ",$663.14 ,"$7,055.60 ","$7,055.60 ","$3,236.10 ","$3,939.60 ","$2,822.24 ","$1,969.80 ","$2,377.83 ","$2,822.24 ","$2,898.42 ","$2,822.24 ","$3,172.79 ","$3,172.79 ","$2,822.24 ","$3,172.79 ","$5,362.25 ","$3,517.50 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$5,276.25 ","$4,221.00 ","$4,221.00 ","$2,822.24 ","$4,221.00 ","$5,346.60 ","$5,346.60 ","$5,346.60 ","$7,035.00 ", N/A ,"$5,979.75 ","$7,035.00 ","$4,572.75 ","$2,822.24 ","$7,035.00 ","$3,939.60 ","$2,822.24 ","$1,850.21 ", N/A ,$729.45 ,$696.30 ,"$2,963.35 ","$5,628.00 ","$6,350.04 ","$3,172.79 ","$1,969.80 ","$6,331.50 ","$2,822.24 ","$5,346.60 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,376.80 ",$663.14 
ST. ELIZABETH'S HOSPITAL,48100277,93288,HC INTERROG DEVICE EVAL PACEMAKER SYSTEM,481,1 ,$140.00 ,$91.00 ,$36.71 ,$140.00 ,$91.78 ,$64.40 ,$78.40 ,$36.71 ,$39.20 ,$47.32 ,$36.71 ,$57.68 ,$36.71 ,$63.14 ,$63.14 ,$36.71 ,$63.14 ,$69.75 ,$70.00 ,$91.78 ,$36.71 ,$36.71 ,$37.45 ,$105.00 ,$84.00 ,$84.00 ,$36.71 ,$84.00 ,$106.40 ,$106.40 ,$106.40 ,$140.00 , N/A ,$119.00 ,$91.78 ,$91.00 ,$36.71 ,$140.00 ,$78.40 ,$36.71 ,$36.82 , N/A ,$44.58 ,$42.56 ,$38.55 ,$112.00 ,$82.60 ,$63.14 ,$39.20 ,$126.00 ,$36.71 ,$106.40 , N/A , N/A ,$36.71 , N/A ,$67.20 ,$40.53 
ST. ELIZABETH'S HOSPITAL,48100278,93571,HC INTRVASC DOPP COLOR FLOW INIT VSL-LC,480,1 ,"$9,449.00 ","$6,141.85 ",$97.21 ,"$9,449.00 ", N/A ,"$4,346.54 ","$5,291.44 ", N/A ,"$2,645.72 ","$2,833.04 ", N/A ,"$2,833.04 ", N/A ,"$4,261.50 ","$4,261.50 ", N/A ,$97.21 , N/A ,"$4,724.50 ", N/A , N/A , N/A , N/A ,"$7,086.75 ","$5,669.40 ","$5,669.40 ", N/A ,"$5,669.40 ","$7,181.24 ","$7,181.24 ","$7,181.24 ","$9,449.00 ", N/A ,"$8,031.65 ", N/A ,"$6,141.85 ", N/A ,"$9,449.00 ","$5,291.44 ", N/A ,"$2,485.09 ", N/A , N/A , N/A , N/A ,"$7,559.20 ", N/A ,"$4,261.50 ","$2,645.72 ","$8,504.10 ", N/A ,"$7,181.24 ","$2,670.00 ","$2,670.00 ", N/A ,"$2,670.00 ","$4,535.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100279,93571,HC INTRVASC DOPP COLOR FLOW INIT VSL-LD,480,1 ,"$9,449.00 ","$6,141.85 ",$97.21 ,"$9,449.00 ", N/A ,"$4,346.54 ","$5,291.44 ", N/A ,"$2,645.72 ","$2,833.04 ", N/A ,"$2,833.04 ", N/A ,"$4,261.50 ","$4,261.50 ", N/A ,$97.21 , N/A ,"$4,724.50 ", N/A , N/A , N/A , N/A ,"$7,086.75 ","$5,669.40 ","$5,669.40 ", N/A ,"$5,669.40 ","$7,181.24 ","$7,181.24 ","$7,181.24 ","$9,449.00 ", N/A ,"$8,031.65 ", N/A ,"$6,141.85 ", N/A ,"$9,449.00 ","$5,291.44 ", N/A ,"$2,485.09 ", N/A , N/A , N/A , N/A ,"$7,559.20 ", N/A ,"$4,261.50 ","$2,645.72 ","$8,504.10 ", N/A ,"$7,181.24 ","$2,670.00 ","$2,670.00 ", N/A ,"$2,670.00 ","$4,535.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100280,93571,HC INTRVASC DOPP COLOR FLOW INIT VSL-LM,480,1 ,"$9,449.00 ","$6,141.85 ",$97.21 ,"$9,449.00 ", N/A ,"$4,346.54 ","$5,291.44 ", N/A ,"$2,645.72 ","$2,833.04 ", N/A ,"$2,833.04 ", N/A ,"$4,261.50 ","$4,261.50 ", N/A ,$97.21 , N/A ,"$4,724.50 ", N/A , N/A , N/A , N/A ,"$7,086.75 ","$5,669.40 ","$5,669.40 ", N/A ,"$5,669.40 ","$7,181.24 ","$7,181.24 ","$7,181.24 ","$9,449.00 ", N/A ,"$8,031.65 ", N/A ,"$6,141.85 ", N/A ,"$9,449.00 ","$5,291.44 ", N/A ,"$2,485.09 ", N/A , N/A , N/A , N/A ,"$7,559.20 ", N/A ,"$4,261.50 ","$2,645.72 ","$8,504.10 ", N/A ,"$7,181.24 ","$2,670.00 ","$2,670.00 ", N/A ,"$2,670.00 ","$4,535.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100281,93571,HC INTRVASC DOPP COLOR FLOW INIT VSL-RC,480,1 ,"$9,449.00 ","$6,141.85 ",$97.21 ,"$9,449.00 ", N/A ,"$4,346.54 ","$5,291.44 ", N/A ,"$2,645.72 ","$2,833.04 ", N/A ,"$2,833.04 ", N/A ,"$4,261.50 ","$4,261.50 ", N/A ,$97.21 , N/A ,"$4,724.50 ", N/A , N/A , N/A , N/A ,"$7,086.75 ","$5,669.40 ","$5,669.40 ", N/A ,"$5,669.40 ","$7,181.24 ","$7,181.24 ","$7,181.24 ","$9,449.00 ", N/A ,"$8,031.65 ", N/A ,"$6,141.85 ", N/A ,"$9,449.00 ","$5,291.44 ", N/A ,"$2,485.09 ", N/A , N/A , N/A , N/A ,"$7,559.20 ", N/A ,"$4,261.50 ","$2,645.72 ","$8,504.10 ", N/A ,"$7,181.24 ","$2,670.00 ","$2,670.00 ", N/A ,"$2,670.00 ","$4,535.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100282,93571,HC INTRVASC DOPP COLOR FLOW INIT VSL-RI,480,1 ,"$9,449.00 ","$6,141.85 ",$97.21 ,"$9,449.00 ", N/A ,"$4,346.54 ","$5,291.44 ", N/A ,"$2,645.72 ","$2,833.04 ", N/A ,"$2,833.04 ", N/A ,"$4,261.50 ","$4,261.50 ", N/A ,$97.21 , N/A ,"$4,724.50 ", N/A , N/A , N/A , N/A ,"$7,086.75 ","$5,669.40 ","$5,669.40 ", N/A ,"$5,669.40 ","$7,181.24 ","$7,181.24 ","$7,181.24 ","$9,449.00 ", N/A ,"$8,031.65 ", N/A ,"$6,141.85 ", N/A ,"$9,449.00 ","$5,291.44 ", N/A ,"$2,485.09 ", N/A , N/A , N/A , N/A ,"$7,559.20 ", N/A ,"$4,261.50 ","$2,645.72 ","$8,504.10 ", N/A ,"$7,181.24 ","$2,670.00 ","$2,670.00 ", N/A ,"$2,670.00 ","$4,535.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100283,93572,HC INTRVASC DOPP COLOR FLOW ADDL VSL-LC,481,1 ,"$1,424.00 ",$925.60 ,$374.51 ,"$1,424.00 ", N/A ,$655.04 ,$797.44 , N/A ,$398.72 ,$481.31 , N/A ,$586.69 , N/A ,$642.22 ,$642.22 , N/A ,$642.22 , N/A ,$712.00 , N/A , N/A , N/A , N/A ,"$1,068.00 ",$854.40 ,$854.40 , N/A ,$854.40 ,"$1,082.24 ","$1,082.24 ","$1,082.24 ","$1,424.00 ", N/A ,"$1,210.40 ", N/A ,$925.60 , N/A ,"$1,424.00 ",$797.44 , N/A ,$374.51 , N/A , N/A , N/A , N/A ,"$1,139.20 ", N/A ,$642.22 ,$398.72 ,"$1,281.60 ", N/A ,"$1,082.24 ",$920.00 ,$920.00 , N/A ,$920.00 ,$683.52 , N/A 
ST. ELIZABETH'S HOSPITAL,48100284,93572,HC INTRVASC DOPP COLOR FLOW ADDL VSL-LD,481,1 ,"$1,424.00 ",$925.60 ,$374.51 ,"$1,424.00 ", N/A ,$655.04 ,$797.44 , N/A ,$398.72 ,$481.31 , N/A ,$586.69 , N/A ,$642.22 ,$642.22 , N/A ,$642.22 , N/A ,$712.00 , N/A , N/A , N/A , N/A ,"$1,068.00 ",$854.40 ,$854.40 , N/A ,$854.40 ,"$1,082.24 ","$1,082.24 ","$1,082.24 ","$1,424.00 ", N/A ,"$1,210.40 ", N/A ,$925.60 , N/A ,"$1,424.00 ",$797.44 , N/A ,$374.51 , N/A , N/A , N/A , N/A ,"$1,139.20 ", N/A ,$642.22 ,$398.72 ,"$1,281.60 ", N/A ,"$1,082.24 ",$920.00 ,$920.00 , N/A ,$920.00 ,$683.52 , N/A 
ST. ELIZABETH'S HOSPITAL,48100285,93572,HC INTRVASC DOPP COLOR FLOW ADDL VSL-LM,481,1 ,"$1,424.00 ",$925.60 ,$374.51 ,"$1,424.00 ", N/A ,$655.04 ,$797.44 , N/A ,$398.72 ,$481.31 , N/A ,$586.69 , N/A ,$642.22 ,$642.22 , N/A ,$642.22 , N/A ,$712.00 , N/A , N/A , N/A , N/A ,"$1,068.00 ",$854.40 ,$854.40 , N/A ,$854.40 ,"$1,082.24 ","$1,082.24 ","$1,082.24 ","$1,424.00 ", N/A ,"$1,210.40 ", N/A ,$925.60 , N/A ,"$1,424.00 ",$797.44 , N/A ,$374.51 , N/A , N/A , N/A , N/A ,"$1,139.20 ", N/A ,$642.22 ,$398.72 ,"$1,281.60 ", N/A ,"$1,082.24 ",$920.00 ,$920.00 , N/A ,$920.00 ,$683.52 , N/A 
ST. ELIZABETH'S HOSPITAL,48100286,93572,HC INTRVASC DOPP COLOR FLOW ADDL VSL-RC,481,1 ,"$1,424.00 ",$925.60 ,$374.51 ,"$1,424.00 ", N/A ,$655.04 ,$797.44 , N/A ,$398.72 ,$481.31 , N/A ,$586.69 , N/A ,$642.22 ,$642.22 , N/A ,$642.22 , N/A ,$712.00 , N/A , N/A , N/A , N/A ,"$1,068.00 ",$854.40 ,$854.40 , N/A ,$854.40 ,"$1,082.24 ","$1,082.24 ","$1,082.24 ","$1,424.00 ", N/A ,"$1,210.40 ", N/A ,$925.60 , N/A ,"$1,424.00 ",$797.44 , N/A ,$374.51 , N/A , N/A , N/A , N/A ,"$1,139.20 ", N/A ,$642.22 ,$398.72 ,"$1,281.60 ", N/A ,"$1,082.24 ",$920.00 ,$920.00 , N/A ,$920.00 ,$683.52 , N/A 
ST. ELIZABETH'S HOSPITAL,48100287,93572,HC INTRVASC DOPP COLOR FLOW ADDL VSL-RI,481,1 ,"$1,424.00 ",$925.60 ,$374.51 ,"$1,424.00 ", N/A ,$655.04 ,$797.44 , N/A ,$398.72 ,$481.31 , N/A ,$586.69 , N/A ,$642.22 ,$642.22 , N/A ,$642.22 , N/A ,$712.00 , N/A , N/A , N/A , N/A ,"$1,068.00 ",$854.40 ,$854.40 , N/A ,$854.40 ,"$1,082.24 ","$1,082.24 ","$1,082.24 ","$1,424.00 ", N/A ,"$1,210.40 ", N/A ,$925.60 , N/A ,"$1,424.00 ",$797.44 , N/A ,$374.51 , N/A , N/A , N/A , N/A ,"$1,139.20 ", N/A ,$642.22 ,$398.72 ,"$1,281.60 ", N/A ,"$1,082.24 ",$920.00 ,$920.00 , N/A ,$920.00 ,$683.52 , N/A 
ST. ELIZABETH'S HOSPITAL,48100288,C9600,HC PLACE PERC COR STENT DRUG ELUT SINGLE-LC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100289,C9600,HC PLACE PERC COR STENT DRUG ELUT SINGLE-LD,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100290,C9600,HC PLACE PERC COR STENT DRUG ELUT SINGLE-LM,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100291,C9600,HC PLACE PERC COR STENT DRUG ELUT SINGLE-RC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100292,C9600,HC PLACE PERC COR STENT DRUG ELUT SINGLE-RI,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100293,C9601,HC PLACE PERC COR STENT DRUG ELUT EA ADDL-LC,481,1 ,"$8,928.00 ","$5,803.20 ","$2,348.06 ","$8,928.00 ", N/A ,"$7,500.00 ","$4,999.68 ", N/A ,"$2,499.84 ","$3,017.66 ", N/A ,"$3,472.99 ", N/A ,"$4,026.53 ","$4,026.53 ", N/A ,"$4,026.53 ", N/A ,"$4,464.00 ", N/A , N/A , N/A , N/A ,"$6,696.00 ","$5,356.80 ","$5,356.80 ", N/A ,"$5,356.80 ","$6,785.28 ","$6,785.28 ","$6,785.28 ","$8,928.00 ", N/A ,"$7,588.80 ", N/A ,"$5,803.20 ", N/A ,"$8,928.00 ","$4,999.68 ", N/A ,"$2,348.06 ", N/A ,"$8,928.00 ","$8,654.53 ", N/A ,"$7,142.40 ", N/A ,"$4,026.53 ","$2,499.84 ","$8,035.20 ", N/A ,"$6,785.28 ","$8,928.00 ","$8,928.00 ", N/A ,"$8,928.00 ","$4,285.44 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100294,C9601,HC PLACE PERC COR STENT DRUG ELUT EA ADDL-LD,481,1 ,"$8,928.00 ","$5,803.20 ","$2,348.06 ","$8,928.00 ", N/A ,"$7,500.00 ","$4,999.68 ", N/A ,"$2,499.84 ","$3,017.66 ", N/A ,"$3,472.99 ", N/A ,"$4,026.53 ","$4,026.53 ", N/A ,"$4,026.53 ", N/A ,"$4,464.00 ", N/A , N/A , N/A , N/A ,"$6,696.00 ","$5,356.80 ","$5,356.80 ", N/A ,"$5,356.80 ","$6,785.28 ","$6,785.28 ","$6,785.28 ","$8,928.00 ", N/A ,"$7,588.80 ", N/A ,"$5,803.20 ", N/A ,"$8,928.00 ","$4,999.68 ", N/A ,"$2,348.06 ", N/A ,"$8,928.00 ","$8,654.53 ", N/A ,"$7,142.40 ", N/A ,"$4,026.53 ","$2,499.84 ","$8,035.20 ", N/A ,"$6,785.28 ","$8,928.00 ","$8,928.00 ", N/A ,"$8,928.00 ","$4,285.44 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100295,C9601,HC PLACE PERC COR STENT DRUG ELUT EA ADDL-LM,481,1 ,"$8,928.00 ","$5,803.20 ","$2,348.06 ","$8,928.00 ", N/A ,"$7,500.00 ","$4,999.68 ", N/A ,"$2,499.84 ","$3,017.66 ", N/A ,"$3,472.99 ", N/A ,"$4,026.53 ","$4,026.53 ", N/A ,"$4,026.53 ", N/A ,"$4,464.00 ", N/A , N/A , N/A , N/A ,"$6,696.00 ","$5,356.80 ","$5,356.80 ", N/A ,"$5,356.80 ","$6,785.28 ","$6,785.28 ","$6,785.28 ","$8,928.00 ", N/A ,"$7,588.80 ", N/A ,"$5,803.20 ", N/A ,"$8,928.00 ","$4,999.68 ", N/A ,"$2,348.06 ", N/A ,"$8,928.00 ","$8,654.53 ", N/A ,"$7,142.40 ", N/A ,"$4,026.53 ","$2,499.84 ","$8,035.20 ", N/A ,"$6,785.28 ","$8,928.00 ","$8,928.00 ", N/A ,"$8,928.00 ","$4,285.44 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100296,C9601,HC PLACE PERC COR STENT DRUG ELUT EA ADDL-RC,481,1 ,"$8,928.00 ","$5,803.20 ","$2,348.06 ","$8,928.00 ", N/A ,"$7,500.00 ","$4,999.68 ", N/A ,"$2,499.84 ","$3,017.66 ", N/A ,"$3,472.99 ", N/A ,"$4,026.53 ","$4,026.53 ", N/A ,"$4,026.53 ", N/A ,"$4,464.00 ", N/A , N/A , N/A , N/A ,"$6,696.00 ","$5,356.80 ","$5,356.80 ", N/A ,"$5,356.80 ","$6,785.28 ","$6,785.28 ","$6,785.28 ","$8,928.00 ", N/A ,"$7,588.80 ", N/A ,"$5,803.20 ", N/A ,"$8,928.00 ","$4,999.68 ", N/A ,"$2,348.06 ", N/A ,"$8,928.00 ","$8,654.53 ", N/A ,"$7,142.40 ", N/A ,"$4,026.53 ","$2,499.84 ","$8,035.20 ", N/A ,"$6,785.28 ","$8,928.00 ","$8,928.00 ", N/A ,"$8,928.00 ","$4,285.44 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100297,C9601,HC PLACE PERC COR STENT DRUG ELUT EA ADDL-RI,481,1 ,"$8,928.00 ","$5,803.20 ","$2,348.06 ","$8,928.00 ", N/A ,"$7,500.00 ","$4,999.68 ", N/A ,"$2,499.84 ","$3,017.66 ", N/A ,"$3,472.99 ", N/A ,"$4,026.53 ","$4,026.53 ", N/A ,"$4,026.53 ", N/A ,"$4,464.00 ", N/A , N/A , N/A , N/A ,"$6,696.00 ","$5,356.80 ","$5,356.80 ", N/A ,"$5,356.80 ","$6,785.28 ","$6,785.28 ","$6,785.28 ","$8,928.00 ", N/A ,"$7,588.80 ", N/A ,"$5,803.20 ", N/A ,"$8,928.00 ","$4,999.68 ", N/A ,"$2,348.06 ", N/A ,"$8,928.00 ","$8,654.53 ", N/A ,"$7,142.40 ", N/A ,"$4,026.53 ","$2,499.84 ","$8,035.20 ", N/A ,"$6,785.28 ","$8,928.00 ","$8,928.00 ", N/A ,"$8,928.00 ","$4,285.44 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100298,92943,HC PERC TRANSL REVASC OCCL SGL VSL-LC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100299,92943,HC PERC TRANSL REVASC OCCL SGL VSL-LD,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100300,92943,HC PERC TRANSL REVASC OCCL SGL VSL-LM,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100301,92943,HC PERC TRANSL REVASC OCCL SGL VSL-RC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100302,92943,HC PERC TRANSL REVASC OCCL SGL VSL-RI,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100303,92944,HC PERC TRANSL REVASC OCCL EA ADL-LC,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100304,92944,HC PERC TRANSL REVASC OCCL EA ADL-LD,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100305,92944,HC PERC TRANSL REVASC OCCL EA ADL-LM,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100306,92944,HC PERC TRANSL REVASC OCCL EA ADL-RC,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100307,92944,HC PERC TRANSL REVASC OCCL EA ADL-RI,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100308,92937,HC PERC TRANSL REVASC GRAFT SGL VSL-LC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100309,92937,HC PERC TRANSL REVASC GRAFT SGL VSL-LD,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100310,92937,HC PERC TRANSL REVASC GRAFT SGL VSL-LM,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100311,92937,HC PERC TRANSL REVASC GRAFT SGL VSL-RC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100312,92937,HC PERC TRANSL REVASC GRAFT SGL VSL-RI,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100313,92938,HC PERC TRANSL REVASC GRAFT EA AD-LC,481,1 ,"$8,929.00 ","$5,803.85 ","$2,348.33 ","$8,929.00 ", N/A ,"$7,500.00 ","$5,000.24 ", N/A ,"$2,500.12 ","$3,018.00 ", N/A ,"$3,473.38 ", N/A ,"$4,026.98 ","$4,026.98 ", N/A ,"$4,026.98 ", N/A ,"$4,464.50 ", N/A , N/A , N/A , N/A ,"$6,696.75 ","$5,357.40 ","$5,357.40 ", N/A ,"$5,357.40 ","$6,786.04 ","$6,786.04 ","$6,786.04 ","$8,929.00 ", N/A ,"$7,589.65 ", N/A ,"$5,803.85 ", N/A ,"$8,929.00 ","$5,000.24 ", N/A ,"$2,348.33 ", N/A ,"$8,929.00 ","$8,654.53 ", N/A ,"$7,143.20 ", N/A ,"$4,026.98 ","$2,500.12 ","$8,036.10 ", N/A ,"$6,786.04 ","$8,929.00 ","$8,929.00 ", N/A ,"$8,929.00 ","$4,285.92 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100314,92938,HC PERC TRANSL REVASC GRAFT EA AD-LD,481,1 ,"$8,929.00 ","$5,803.85 ","$2,348.33 ","$8,929.00 ", N/A ,"$7,500.00 ","$5,000.24 ", N/A ,"$2,500.12 ","$3,018.00 ", N/A ,"$3,473.38 ", N/A ,"$4,026.98 ","$4,026.98 ", N/A ,"$4,026.98 ", N/A ,"$4,464.50 ", N/A , N/A , N/A , N/A ,"$6,696.75 ","$5,357.40 ","$5,357.40 ", N/A ,"$5,357.40 ","$6,786.04 ","$6,786.04 ","$6,786.04 ","$8,929.00 ", N/A ,"$7,589.65 ", N/A ,"$5,803.85 ", N/A ,"$8,929.00 ","$5,000.24 ", N/A ,"$2,348.33 ", N/A ,"$8,929.00 ","$8,654.53 ", N/A ,"$7,143.20 ", N/A ,"$4,026.98 ","$2,500.12 ","$8,036.10 ", N/A ,"$6,786.04 ","$8,929.00 ","$8,929.00 ", N/A ,"$8,929.00 ","$4,285.92 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100315,92938,HC PERC TRANSL REVASC GRAFT EA AD-LM,481,1 ,"$8,929.00 ","$5,803.85 ","$2,348.33 ","$8,929.00 ", N/A ,"$7,500.00 ","$5,000.24 ", N/A ,"$2,500.12 ","$3,018.00 ", N/A ,"$3,473.38 ", N/A ,"$4,026.98 ","$4,026.98 ", N/A ,"$4,026.98 ", N/A ,"$4,464.50 ", N/A , N/A , N/A , N/A ,"$6,696.75 ","$5,357.40 ","$5,357.40 ", N/A ,"$5,357.40 ","$6,786.04 ","$6,786.04 ","$6,786.04 ","$8,929.00 ", N/A ,"$7,589.65 ", N/A ,"$5,803.85 ", N/A ,"$8,929.00 ","$5,000.24 ", N/A ,"$2,348.33 ", N/A ,"$8,929.00 ","$8,654.53 ", N/A ,"$7,143.20 ", N/A ,"$4,026.98 ","$2,500.12 ","$8,036.10 ", N/A ,"$6,786.04 ","$8,929.00 ","$8,929.00 ", N/A ,"$8,929.00 ","$4,285.92 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100316,92938,HC PERC TRANSL REVASC GRAFT EA AD-RC,481,1 ,"$8,929.00 ","$5,803.85 ","$2,348.33 ","$8,929.00 ", N/A ,"$7,500.00 ","$5,000.24 ", N/A ,"$2,500.12 ","$3,018.00 ", N/A ,"$3,473.38 ", N/A ,"$4,026.98 ","$4,026.98 ", N/A ,"$4,026.98 ", N/A ,"$4,464.50 ", N/A , N/A , N/A , N/A ,"$6,696.75 ","$5,357.40 ","$5,357.40 ", N/A ,"$5,357.40 ","$6,786.04 ","$6,786.04 ","$6,786.04 ","$8,929.00 ", N/A ,"$7,589.65 ", N/A ,"$5,803.85 ", N/A ,"$8,929.00 ","$5,000.24 ", N/A ,"$2,348.33 ", N/A ,"$8,929.00 ","$8,654.53 ", N/A ,"$7,143.20 ", N/A ,"$4,026.98 ","$2,500.12 ","$8,036.10 ", N/A ,"$6,786.04 ","$8,929.00 ","$8,929.00 ", N/A ,"$8,929.00 ","$4,285.92 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100317,92938,HC PERC TRANSL REVASC GRAFT EA AD-RI,481,1 ,"$8,929.00 ","$5,803.85 ","$2,348.33 ","$8,929.00 ", N/A ,"$7,500.00 ","$5,000.24 ", N/A ,"$2,500.12 ","$3,018.00 ", N/A ,"$3,473.38 ", N/A ,"$4,026.98 ","$4,026.98 ", N/A ,"$4,026.98 ", N/A ,"$4,464.50 ", N/A , N/A , N/A , N/A ,"$6,696.75 ","$5,357.40 ","$5,357.40 ", N/A ,"$5,357.40 ","$6,786.04 ","$6,786.04 ","$6,786.04 ","$8,929.00 ", N/A ,"$7,589.65 ", N/A ,"$5,803.85 ", N/A ,"$8,929.00 ","$5,000.24 ", N/A ,"$2,348.33 ", N/A ,"$8,929.00 ","$8,654.53 ", N/A ,"$7,143.20 ", N/A ,"$4,026.98 ","$2,500.12 ","$8,036.10 ", N/A ,"$6,786.04 ","$8,929.00 ","$8,929.00 ", N/A ,"$8,929.00 ","$4,285.92 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100318,92941,HC PERC TRANSL REVASC OCCL/INFARC SGL VSL-LC,481,1 ,"$14,724.00 ","$9,570.60 ","$3,872.41 ","$14,724.00 ", N/A ,"$7,500.00 ","$8,245.44 ", N/A ,"$4,122.72 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,640.52 ","$6,640.52 ", N/A ,"$6,640.52 ", N/A ,"$7,362.00 ", N/A , N/A , N/A , N/A ,"$11,043.00 ","$8,834.40 ","$8,834.40 ", N/A ,"$8,834.40 ","$11,190.24 ","$11,190.24 ","$11,190.24 ","$14,724.00 ", N/A ,"$12,515.40 ", N/A ,"$9,570.60 ", N/A ,"$14,724.00 ","$8,245.44 ", N/A ,"$3,872.41 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$11,779.20 ", N/A ,"$6,640.52 ","$4,122.72 ","$13,251.60 ", N/A ,"$11,190.24 ","$14,724.00 ","$14,724.00 ", N/A ,"$14,724.00 ","$7,067.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100319,92941,HC PERC TRANSL REVASC OCCL/INFARC SGL VSL-LD,481,1 ,"$14,724.00 ","$9,570.60 ","$3,872.41 ","$14,724.00 ", N/A ,"$7,500.00 ","$8,245.44 ", N/A ,"$4,122.72 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,640.52 ","$6,640.52 ", N/A ,"$6,640.52 ", N/A ,"$7,362.00 ", N/A , N/A , N/A , N/A ,"$11,043.00 ","$8,834.40 ","$8,834.40 ", N/A ,"$8,834.40 ","$11,190.24 ","$11,190.24 ","$11,190.24 ","$14,724.00 ", N/A ,"$12,515.40 ", N/A ,"$9,570.60 ", N/A ,"$14,724.00 ","$8,245.44 ", N/A ,"$3,872.41 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$11,779.20 ", N/A ,"$6,640.52 ","$4,122.72 ","$13,251.60 ", N/A ,"$11,190.24 ","$14,724.00 ","$14,724.00 ", N/A ,"$14,724.00 ","$7,067.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100320,92941,HC PERC TRANSL REVASC OCCL/INFARC SGL VSL-LM,481,1 ,"$14,724.00 ","$9,570.60 ","$3,872.41 ","$14,724.00 ", N/A ,"$7,500.00 ","$8,245.44 ", N/A ,"$4,122.72 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,640.52 ","$6,640.52 ", N/A ,"$6,640.52 ", N/A ,"$7,362.00 ", N/A , N/A , N/A , N/A ,"$11,043.00 ","$8,834.40 ","$8,834.40 ", N/A ,"$8,834.40 ","$11,190.24 ","$11,190.24 ","$11,190.24 ","$14,724.00 ", N/A ,"$12,515.40 ", N/A ,"$9,570.60 ", N/A ,"$14,724.00 ","$8,245.44 ", N/A ,"$3,872.41 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$11,779.20 ", N/A ,"$6,640.52 ","$4,122.72 ","$13,251.60 ", N/A ,"$11,190.24 ","$14,724.00 ","$14,724.00 ", N/A ,"$14,724.00 ","$7,067.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100321,92941,HC PERC TRANSL REVASC OCCL/INFARC SGL VSL-RC,481,1 ,"$14,724.00 ","$9,570.60 ","$3,872.41 ","$14,724.00 ", N/A ,"$7,500.00 ","$8,245.44 ", N/A ,"$4,122.72 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,640.52 ","$6,640.52 ", N/A ,"$6,640.52 ", N/A ,"$7,362.00 ", N/A , N/A , N/A , N/A ,"$11,043.00 ","$8,834.40 ","$8,834.40 ", N/A ,"$8,834.40 ","$11,190.24 ","$11,190.24 ","$11,190.24 ","$14,724.00 ", N/A ,"$12,515.40 ", N/A ,"$9,570.60 ", N/A ,"$14,724.00 ","$8,245.44 ", N/A ,"$3,872.41 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$11,779.20 ", N/A ,"$6,640.52 ","$4,122.72 ","$13,251.60 ", N/A ,"$11,190.24 ","$14,724.00 ","$14,724.00 ", N/A ,"$14,724.00 ","$7,067.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100322,92941,HC PERC TRANSL REVASC OCCL/INFARC SGL VSL-RI,481,1 ,"$14,724.00 ","$9,570.60 ","$3,872.41 ","$14,724.00 ", N/A ,"$7,500.00 ","$8,245.44 ", N/A ,"$4,122.72 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,640.52 ","$6,640.52 ", N/A ,"$6,640.52 ", N/A ,"$7,362.00 ", N/A , N/A , N/A , N/A ,"$11,043.00 ","$8,834.40 ","$8,834.40 ", N/A ,"$8,834.40 ","$11,190.24 ","$11,190.24 ","$11,190.24 ","$14,724.00 ", N/A ,"$12,515.40 ", N/A ,"$9,570.60 ", N/A ,"$14,724.00 ","$8,245.44 ", N/A ,"$3,872.41 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$11,779.20 ", N/A ,"$6,640.52 ","$4,122.72 ","$13,251.60 ", N/A ,"$11,190.24 ","$14,724.00 ","$14,724.00 ", N/A ,"$14,724.00 ","$7,067.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100323,36245,HC PLACE CATH ABD/PEL 1ST ORDER-BI,360,1 ,"$5,728.00 ","$3,723.20 ","$1,380.00 ","$5,728.00 ", N/A ,"$4,800.00 ","$3,207.68 ", N/A ,"$1,603.84 ","$1,936.06 ", N/A ,"$2,228.19 ", N/A ,"$2,583.33 ","$2,583.33 ", N/A ,"$2,583.33 ", N/A ,"$2,864.00 ", N/A , N/A , N/A , N/A ,"$4,296.00 ","$3,436.80 ","$3,436.80 ", N/A ,"$3,436.80 ","$4,353.28 ","$4,353.28 ","$4,353.28 ","$5,728.00 ", N/A ,"$4,868.80 ", N/A ,"$3,723.20 ", N/A ,"$5,728.00 ","$3,207.68 ", N/A ,"$1,506.46 ", N/A ,"$4,232.27 ","$4,039.90 ", N/A ,"$4,582.40 ", N/A ,"$2,583.33 ","$1,603.84 ","$5,155.20 ", N/A ,"$4,353.28 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$2,749.44 ","$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100324,36245,HC PLACE CATH ABD/PEL 1ST ORDER-LT,360,1 ,"$3,819.00 ","$2,482.35 ",$920.00 ,"$3,819.00 ", N/A ,"$3,200.00 ","$2,138.64 ", N/A ,"$1,069.32 ","$1,290.82 ", N/A ,"$1,485.59 ", N/A ,"$1,722.37 ","$1,722.37 ", N/A ,"$1,722.37 ", N/A ,"$1,909.50 ", N/A , N/A , N/A , N/A ,"$2,864.25 ","$2,291.40 ","$2,291.40 ", N/A ,"$2,291.40 ","$2,902.44 ","$2,902.44 ","$2,902.44 ","$3,819.00 ", N/A ,"$3,246.15 ", N/A ,"$2,482.35 ", N/A ,"$3,819.00 ","$2,138.64 ", N/A ,"$1,004.40 ", N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$3,055.20 ", N/A ,"$1,722.37 ","$1,069.32 ","$3,437.10 ", N/A ,"$2,902.44 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,833.12 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100325,36245,HC PLACE CATH ABD/PEL 1ST ORDER-RT,360,1 ,"$3,819.00 ","$2,482.35 ",$920.00 ,"$3,819.00 ", N/A ,"$3,200.00 ","$2,138.64 ", N/A ,"$1,069.32 ","$1,290.82 ", N/A ,"$1,485.59 ", N/A ,"$1,722.37 ","$1,722.37 ", N/A ,"$1,722.37 ", N/A ,"$1,909.50 ", N/A , N/A , N/A , N/A ,"$2,864.25 ","$2,291.40 ","$2,291.40 ", N/A ,"$2,291.40 ","$2,902.44 ","$2,902.44 ","$2,902.44 ","$3,819.00 ", N/A ,"$3,246.15 ", N/A ,"$2,482.35 ", N/A ,"$3,819.00 ","$2,138.64 ", N/A ,"$1,004.40 ", N/A ,"$2,821.51 ","$2,693.26 ", N/A ,"$3,055.20 ", N/A ,"$1,722.37 ","$1,069.32 ","$3,437.10 ", N/A ,"$2,902.44 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,833.12 ","$2,565.01 "
ST. ELIZABETH'S HOSPITAL,48100326,92928,HC PLACE PERC INTRACOR STENT SGL-LC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100327,92928,HC PLACE PERC INTRACOR STENT SGL-LD,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100328,92928,HC PLACE PERC INTRACOR STENT SGL-LM,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100329,92928,HC PLACE PERC INTRACOR STENT SGL-RC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100330,92928,HC PLACE PERC INTRACOR STENT SGL-RI,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100331,92929,HC PLACE PERC INTRACOR STENT EA AD-LC,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100332,92929,HC PLACE PERC INTRACOR STENT EA AD-LD,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100333,92929,HC PLACE PERC INTRACOR STENT EA AD-LM,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100334,92929,HC PLACE PERC INTRACOR STENT EA AD-RC,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100335,92929,HC PLACE PERC INTRACOR STENT EA AD-RI,481,1 ,"$8,669.00 ","$5,634.85 ","$2,279.95 ","$8,669.00 ", N/A ,"$7,500.00 ","$4,854.64 ", N/A ,"$2,427.32 ","$2,930.12 ", N/A ,"$3,372.24 ", N/A ,"$3,909.72 ","$3,909.72 ", N/A ,"$3,909.72 ", N/A ,"$4,334.50 ", N/A , N/A , N/A , N/A ,"$6,501.75 ","$5,201.40 ","$5,201.40 ", N/A ,"$5,201.40 ","$6,588.44 ","$6,588.44 ","$6,588.44 ","$8,669.00 ", N/A ,"$7,368.65 ", N/A ,"$5,634.85 ", N/A ,"$8,669.00 ","$4,854.64 ", N/A ,"$2,279.95 ", N/A ,"$8,669.00 ","$8,654.53 ", N/A ,"$6,935.20 ", N/A ,"$3,909.72 ","$2,427.32 ","$7,802.10 ", N/A ,"$6,588.44 ","$8,669.00 ","$8,669.00 ", N/A ,"$8,669.00 ","$4,161.12 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100336,C9602,HC PERC TRN ATHR DRUG ELUT STENT SGL-LC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100337,C9602,HC PERC TRN ATHR DRUG ELUT STENT SGL-LD,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100338,C9602,HC PERC TRN ATHR DRUG ELUT STENT SGL-LM,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100339,C9602,HC PERC TRN ATHR DRUG ELUT STENT SGL-RC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100340,C9602,HC PERC TRN ATHR DRUG ELUT STENT SGL-RI,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100341,C9603,HC PERC TRN ATHR DRUG ELUT STENT EA AD-LC,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100342,C9603,HC PERC TRN ATHR DRUG ELUT STENT EA AD-LD,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100343,C9603,HC PERC TRN ATHR DRUG ELUT STENT EA AD-LM,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100344,C9603,HC PERC TRN ATHR DRUG ELUT STENT EA AD-RC,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100345,C9603,HC PERC TRN ATHR DRUG ELUT STENT EA AD-RI,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100346,C9604,HC PERC RVSC CABG COR GRFT STENT DRG ELUT SGL-LC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100347,C9604,HC PERC RVSC CABG COR GRFT STENT DRG ELUT SGL-LD,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100348,C9604,HC PERC RVSC CABG COR GRFT STENT DRG ELUT SGL-LM,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100349,C9604,HC PERC RVSC CABG COR GRFT STENT DRG ELUT SGL-RC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100350,C9604,HC PERC RVSC CABG COR GRFT STENT DRG ELUT SGL-RI,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,142.00 ","$22,142.00 ","$9,902.73 ","$22,142.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100351,C9605,HC PERC RVSC CABG COR GRFT STENT DRG ELUT EA ADL-LC,481,1 ,"$15,472.00 ","$10,056.80 ","$4,069.14 ","$15,472.00 ", N/A ,"$7,500.00 ","$8,664.32 ", N/A ,"$4,332.16 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$7,736.00 ", N/A , N/A , N/A , N/A ,"$11,604.00 ","$9,283.20 ","$9,283.20 ", N/A ,"$9,283.20 ","$11,758.72 ","$11,758.72 ","$11,758.72 ","$15,472.00 ", N/A ,"$13,151.20 ", N/A ,"$10,056.80 ", N/A ,"$15,472.00 ","$8,664.32 ", N/A ,"$4,069.14 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$12,377.60 ", N/A ,"$6,645.60 ","$4,332.16 ","$13,924.80 ", N/A ,"$11,758.72 ","$15,472.00 ","$15,472.00 ", N/A ,"$15,472.00 ","$7,426.56 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100352,C9605,HC PERC RVSC CABG COR GRFT STENT DRG ELUT EA ADL-LD,481,1 ,"$15,472.00 ","$10,056.80 ","$4,069.14 ","$15,472.00 ", N/A ,"$7,500.00 ","$8,664.32 ", N/A ,"$4,332.16 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$7,736.00 ", N/A , N/A , N/A , N/A ,"$11,604.00 ","$9,283.20 ","$9,283.20 ", N/A ,"$9,283.20 ","$11,758.72 ","$11,758.72 ","$11,758.72 ","$15,472.00 ", N/A ,"$13,151.20 ", N/A ,"$10,056.80 ", N/A ,"$15,472.00 ","$8,664.32 ", N/A ,"$4,069.14 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$12,377.60 ", N/A ,"$6,645.60 ","$4,332.16 ","$13,924.80 ", N/A ,"$11,758.72 ","$15,472.00 ","$15,472.00 ", N/A ,"$15,472.00 ","$7,426.56 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100353,C9605,HC PERC RVSC CABG COR GRFT STENT DRG ELUT EA ADL-LM,481,1 ,"$15,472.00 ","$10,056.80 ","$4,069.14 ","$15,472.00 ", N/A ,"$7,500.00 ","$8,664.32 ", N/A ,"$4,332.16 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$7,736.00 ", N/A , N/A , N/A , N/A ,"$11,604.00 ","$9,283.20 ","$9,283.20 ", N/A ,"$9,283.20 ","$11,758.72 ","$11,758.72 ","$11,758.72 ","$15,472.00 ", N/A ,"$13,151.20 ", N/A ,"$10,056.80 ", N/A ,"$15,472.00 ","$8,664.32 ", N/A ,"$4,069.14 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$12,377.60 ", N/A ,"$6,645.60 ","$4,332.16 ","$13,924.80 ", N/A ,"$11,758.72 ","$15,472.00 ","$15,472.00 ", N/A ,"$15,472.00 ","$7,426.56 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100354,C9605,HC PERC RVSC CABG COR GRFT STENT DRG ELUT EA ADL-RC,481,1 ,"$15,472.00 ","$10,056.80 ","$4,069.14 ","$15,472.00 ", N/A ,"$7,500.00 ","$8,664.32 ", N/A ,"$4,332.16 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$7,736.00 ", N/A , N/A , N/A , N/A ,"$11,604.00 ","$9,283.20 ","$9,283.20 ", N/A ,"$9,283.20 ","$11,758.72 ","$11,758.72 ","$11,758.72 ","$15,472.00 ", N/A ,"$13,151.20 ", N/A ,"$10,056.80 ", N/A ,"$15,472.00 ","$8,664.32 ", N/A ,"$4,069.14 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$12,377.60 ", N/A ,"$6,645.60 ","$4,332.16 ","$13,924.80 ", N/A ,"$11,758.72 ","$15,472.00 ","$15,472.00 ", N/A ,"$15,472.00 ","$7,426.56 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100355,C9605,HC PERC RVSC CABG COR GRFT STENT DRG ELUT EA ADL-RI,481,1 ,"$15,472.00 ","$10,056.80 ","$4,069.14 ","$15,472.00 ", N/A ,"$7,500.00 ","$8,664.32 ", N/A ,"$4,332.16 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$7,736.00 ", N/A , N/A , N/A , N/A ,"$11,604.00 ","$9,283.20 ","$9,283.20 ", N/A ,"$9,283.20 ","$11,758.72 ","$11,758.72 ","$11,758.72 ","$15,472.00 ", N/A ,"$13,151.20 ", N/A ,"$10,056.80 ", N/A ,"$15,472.00 ","$8,664.32 ", N/A ,"$4,069.14 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$12,377.60 ", N/A ,"$6,645.60 ","$4,332.16 ","$13,924.80 ", N/A ,"$11,758.72 ","$15,472.00 ","$15,472.00 ", N/A ,"$15,472.00 ","$7,426.56 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100356,C9607,HC PERC REVASC COR OCCL STENT DRG ELUT SGL-LC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100357,C9607,HC PERC REVASC COR OCCL STENT DRG ELUT SGL-LD,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100358,C9607,HC PERC REVASC COR OCCL STENT DRG ELUT SGL-LM,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100359,C9607,HC PERC REVASC COR OCCL STENT DRG ELUT SGL-RC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100360,C9607,HC PERC REVASC COR OCCL STENT DRG ELUT SGL-RI,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,142.00 ","$22,142.00 ","$15,833.48 ","$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100361,C9608,HC PERC REVASC COR OCCL STENT DRG ELUT EA ADL-LC,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100362,C9608,HC PERC REVASC COR OCCL STENT DRG ELUT EA ADL-LD,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100363,C9608,HC PERC REVASC COR OCCL STENT DRG ELUT EA ADL-LM,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100364,C9608,HC PERC REVASC COR OCCL STENT DRG ELUT EA ADL-RC,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100365,C9608,HC PERC REVASC COR OCCL STENT DRG ELUT EA ADL-RI,481,1 ,"$8,256.00 ","$5,366.40 ","$2,171.33 ","$8,256.00 ", N/A ,"$7,500.00 ","$4,623.36 ", N/A ,"$2,311.68 ","$2,790.53 ", N/A ,"$3,211.58 ", N/A ,"$3,723.46 ","$3,723.46 ", N/A ,"$3,723.46 ", N/A ,"$4,128.00 ", N/A , N/A , N/A , N/A ,"$6,192.00 ","$4,953.60 ","$4,953.60 ", N/A ,"$4,953.60 ","$6,274.56 ","$6,274.56 ","$6,274.56 ","$8,256.00 ", N/A ,"$7,017.60 ", N/A ,"$5,366.40 ", N/A ,"$8,256.00 ","$4,623.36 ", N/A ,"$2,171.33 ", N/A ,"$8,256.00 ","$8,256.00 ", N/A ,"$6,604.80 ", N/A ,"$3,723.46 ","$2,311.68 ","$7,430.40 ", N/A ,"$6,274.56 ","$8,256.00 ","$8,256.00 ", N/A ,"$8,256.00 ","$3,962.88 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100366,C9606,HC PERC REVASC COR STENT DRG ELUT W/AMI-LC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ", N/A ,"$7,500.00 ","$25,317.60 ", N/A ,"$12,658.80 ","$15,280.98 ", N/A ,"$17,586.69 ", N/A ,"$20,389.71 ","$20,389.71 ", N/A ,"$20,389.71 ", N/A ,"$22,605.00 ", N/A , N/A , N/A , N/A ,"$33,907.50 ","$27,126.00 ","$27,126.00 ", N/A ,"$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ", N/A ,"$29,386.50 ", N/A ,"$45,210.00 ","$25,317.60 ", N/A ,"$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$36,168.00 ", N/A ,"$20,389.71 ","$12,658.80 ","$40,689.00 ", N/A ,"$34,359.60 ","$22,142.00 ","$22,142.00 ", N/A ,"$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100367,C9606,HC PERC REVASC COR STENT DRG ELUT W/AMI-LD,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ", N/A ,"$7,500.00 ","$25,317.60 ", N/A ,"$12,658.80 ","$15,280.98 ", N/A ,"$17,586.69 ", N/A ,"$20,389.71 ","$20,389.71 ", N/A ,"$20,389.71 ", N/A ,"$22,605.00 ", N/A , N/A , N/A , N/A ,"$33,907.50 ","$27,126.00 ","$27,126.00 ", N/A ,"$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ", N/A ,"$29,386.50 ", N/A ,"$45,210.00 ","$25,317.60 ", N/A ,"$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$36,168.00 ", N/A ,"$20,389.71 ","$12,658.80 ","$40,689.00 ", N/A ,"$34,359.60 ","$22,142.00 ","$22,142.00 ", N/A ,"$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100368,C9606,HC PERC REVASC COR STENT DRG ELUT W/AMI-LM,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ", N/A ,"$7,500.00 ","$25,317.60 ", N/A ,"$12,658.80 ","$15,280.98 ", N/A ,"$17,586.69 ", N/A ,"$20,389.71 ","$20,389.71 ", N/A ,"$20,389.71 ", N/A ,"$22,605.00 ", N/A , N/A , N/A , N/A ,"$33,907.50 ","$27,126.00 ","$27,126.00 ", N/A ,"$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ", N/A ,"$29,386.50 ", N/A ,"$45,210.00 ","$25,317.60 ", N/A ,"$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$36,168.00 ", N/A ,"$20,389.71 ","$12,658.80 ","$40,689.00 ", N/A ,"$34,359.60 ","$22,142.00 ","$22,142.00 ", N/A ,"$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100369,C9606,HC PERC REVASC COR STENT DRG ELUT W/AMI-RC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ", N/A ,"$7,500.00 ","$25,317.60 ", N/A ,"$12,658.80 ","$15,280.98 ", N/A ,"$17,586.69 ", N/A ,"$20,389.71 ","$20,389.71 ", N/A ,"$20,389.71 ", N/A ,"$22,605.00 ", N/A , N/A , N/A , N/A ,"$33,907.50 ","$27,126.00 ","$27,126.00 ", N/A ,"$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ", N/A ,"$29,386.50 ", N/A ,"$45,210.00 ","$25,317.60 ", N/A ,"$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$36,168.00 ", N/A ,"$20,389.71 ","$12,658.80 ","$40,689.00 ", N/A ,"$34,359.60 ","$22,142.00 ","$22,142.00 ", N/A ,"$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100370,C9606,HC PERC REVASC COR STENT DRG ELUT W/AMI-RI,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ", N/A ,"$7,500.00 ","$25,317.60 ", N/A ,"$12,658.80 ","$15,280.98 ", N/A ,"$17,586.69 ", N/A ,"$20,389.71 ","$20,389.71 ", N/A ,"$20,389.71 ", N/A ,"$22,605.00 ", N/A , N/A , N/A , N/A ,"$33,907.50 ","$27,126.00 ","$27,126.00 ", N/A ,"$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ", N/A ,"$29,386.50 ", N/A ,"$45,210.00 ","$25,317.60 ", N/A ,"$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$36,168.00 ", N/A ,"$20,389.71 ","$12,658.80 ","$40,689.00 ", N/A ,"$34,359.60 ","$22,142.00 ","$22,142.00 ", N/A ,"$22,142.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100371,92924,HC PERC TRN ARTHR W/COR ANGIO SGL-LC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100372,92924,HC PERC TRN ARTHR W/COR ANGIO SGL-LD,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100373,92924,HC PERC TRN ARTHR W/COR ANGIO SGL-LM,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100374,92924,HC PERC TRN ARTHR W/COR ANGIO SGL-RC,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100375,92924,HC PERC TRN ARTHR W/COR ANGIO SGL-RI,481,1 ,"$29,661.00 ","$19,279.65 ","$4,859.14 ","$29,661.00 ","$24,756.83 ","$7,500.00 ","$16,610.16 ","$9,902.73 ","$8,305.08 ","$4,859.14 ","$9,902.73 ","$5,584.90 ","$9,902.73 ","$6,645.60 ","$6,645.60 ","$9,902.73 ","$6,645.60 ","$18,815.18 ","$14,830.50 ","$24,756.81 ","$9,902.73 ","$9,902.73 ","$10,100.78 ","$22,245.75 ","$17,796.60 ","$17,796.60 ","$9,902.73 ","$17,796.60 ","$22,542.36 ","$22,542.36 ","$22,542.36 ","$29,661.00 ", N/A ,"$25,211.85 ","$24,756.81 ","$19,279.65 ","$9,902.73 ","$29,661.00 ","$16,610.16 ","$9,902.73 ","$7,800.84 ", N/A ,"$9,066.65 ","$8,654.53 ","$10,397.87 ","$23,728.80 ","$22,281.13 ","$6,645.60 ","$8,305.08 ","$26,694.90 ","$9,902.73 ","$22,542.36 ","$22,140.00 ","$22,140.00 ","$9,902.73 ","$22,140.00 ","$14,237.28 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100376,92925,HC PERC TRN ARTHR W/COR ANGIO EA ADL-LC,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100377,92925,HC PERC TRN ARTHR W/COR ANGIO EA ADL-LD,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100378,92925,HC PERC TRN ARTHR W/COR ANGIO EA ADL-LM,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100379,92925,HC PERC TRN ARTHR W/COR ANGIO EA ADL-RC,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100380,92925,HC PERC TRN ARTHR W/COR ANGIO EA ADL-RI,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100381,92933,HC PERC TRN ARTHR W/INTRA STENT ANGIO SGL-LC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,140.00 ","$22,140.00 ","$15,833.48 ","$22,140.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100382,92933,HC PERC TRN ARTHR W/INTRA STENT ANGIO SGL-LD,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,140.00 ","$22,140.00 ","$15,833.48 ","$22,140.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100383,92933,HC PERC TRN ARTHR W/INTRA STENT ANGIO SGL-LM,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,140.00 ","$22,140.00 ","$15,833.48 ","$22,140.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100384,92933,HC PERC TRN ARTHR W/INTRA STENT ANGIO SGL-RC,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,140.00 ","$22,140.00 ","$15,833.48 ","$22,140.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100385,92933,HC PERC TRN ARTHR W/INTRA STENT ANGIO SGL-RI,481,1 ,"$45,210.00 ","$29,386.50 ","$7,500.00 ","$45,210.00 ","$39,583.70 ","$7,500.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$9,066.65 ","$8,654.53 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$22,140.00 ","$22,140.00 ","$15,833.48 ","$22,140.00 ","$21,700.80 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100386,92934,HC PERC TRN ARTHR W/INTRA STENT ANGIO EA ADL-LC,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100387,92934,HC PERC TRN ARTHR W/INTRA STENT ANGIO EA ADL-LD,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100388,92934,HC PERC TRN ARTHR W/INTRA STENT ANGIO EA ADL-LM,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100389,92934,HC PERC TRN ARTHR W/INTRA STENT ANGIO EA ADL-RC,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100390,92934,HC PERC TRN ARTHR W/INTRA STENT ANGIO EA ADL-RI,481,1 ,"$11,007.00 ","$7,154.55 ","$2,894.84 ","$11,007.00 ", N/A ,"$7,500.00 ","$6,163.92 ", N/A ,"$3,081.96 ","$3,720.37 ", N/A ,"$4,281.72 ", N/A ,"$4,964.16 ","$4,964.16 ", N/A ,"$4,964.16 ", N/A ,"$5,503.50 ", N/A , N/A , N/A , N/A ,"$8,255.25 ","$6,604.20 ","$6,604.20 ", N/A ,"$6,604.20 ","$8,365.32 ","$8,365.32 ","$8,365.32 ","$11,007.00 ", N/A ,"$9,355.95 ", N/A ,"$7,154.55 ", N/A ,"$11,007.00 ","$6,163.92 ", N/A ,"$2,894.84 ", N/A ,"$9,066.65 ","$8,654.53 ", N/A ,"$8,805.60 ", N/A ,"$4,964.16 ","$3,081.96 ","$9,906.30 ", N/A ,"$8,365.32 ","$11,007.00 ","$11,007.00 ", N/A ,"$11,007.00 ","$5,283.36 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100391,92973,HC PERC TRANSLUM THROMBECTOMY -LC,481,1 ,$835.00 ,$542.75 ,$219.61 ,$835.00 , N/A ,$384.10 ,$467.60 , N/A ,$233.80 ,$282.23 , N/A ,$344.02 , N/A ,$376.59 ,$376.59 , N/A ,$376.59 , N/A ,$417.50 , N/A , N/A , N/A , N/A ,$626.25 ,$501.00 ,$501.00 , N/A ,$501.00 ,$634.60 ,$634.60 ,$634.60 ,$835.00 , N/A ,$709.75 , N/A ,$542.75 , N/A ,$835.00 ,$467.60 , N/A ,$219.61 , N/A , N/A , N/A , N/A ,$668.00 , N/A ,$376.59 ,$233.80 ,$751.50 , N/A ,$634.60 ,$835.00 ,$835.00 , N/A ,$835.00 ,$400.80 , N/A 
ST. ELIZABETH'S HOSPITAL,48100392,92973,HC PERC TRANSLUM THROMBECTOMY -LD,481,1 ,$835.00 ,$542.75 ,$219.61 ,$835.00 , N/A ,$384.10 ,$467.60 , N/A ,$233.80 ,$282.23 , N/A ,$344.02 , N/A ,$376.59 ,$376.59 , N/A ,$376.59 , N/A ,$417.50 , N/A , N/A , N/A , N/A ,$626.25 ,$501.00 ,$501.00 , N/A ,$501.00 ,$634.60 ,$634.60 ,$634.60 ,$835.00 , N/A ,$709.75 , N/A ,$542.75 , N/A ,$835.00 ,$467.60 , N/A ,$219.61 , N/A , N/A , N/A , N/A ,$668.00 , N/A ,$376.59 ,$233.80 ,$751.50 , N/A ,$634.60 ,$835.00 ,$835.00 , N/A ,$835.00 ,$400.80 , N/A 
ST. ELIZABETH'S HOSPITAL,48100393,92973,HC PERC TRANSLUM THROMBECTOMY -LM,481,1 ,$835.00 ,$542.75 ,$219.61 ,$835.00 , N/A ,$384.10 ,$467.60 , N/A ,$233.80 ,$282.23 , N/A ,$344.02 , N/A ,$376.59 ,$376.59 , N/A ,$376.59 , N/A ,$417.50 , N/A , N/A , N/A , N/A ,$626.25 ,$501.00 ,$501.00 , N/A ,$501.00 ,$634.60 ,$634.60 ,$634.60 ,$835.00 , N/A ,$709.75 , N/A ,$542.75 , N/A ,$835.00 ,$467.60 , N/A ,$219.61 , N/A , N/A , N/A , N/A ,$668.00 , N/A ,$376.59 ,$233.80 ,$751.50 , N/A ,$634.60 ,$835.00 ,$835.00 , N/A ,$835.00 ,$400.80 , N/A 
ST. ELIZABETH'S HOSPITAL,48100394,92973,HC PERC TRANSLUM THROMBECTOMY -RC,481,1 ,$835.00 ,$542.75 ,$219.61 ,$835.00 , N/A ,$384.10 ,$467.60 , N/A ,$233.80 ,$282.23 , N/A ,$344.02 , N/A ,$376.59 ,$376.59 , N/A ,$376.59 , N/A ,$417.50 , N/A , N/A , N/A , N/A ,$626.25 ,$501.00 ,$501.00 , N/A ,$501.00 ,$634.60 ,$634.60 ,$634.60 ,$835.00 , N/A ,$709.75 , N/A ,$542.75 , N/A ,$835.00 ,$467.60 , N/A ,$219.61 , N/A , N/A , N/A , N/A ,$668.00 , N/A ,$376.59 ,$233.80 ,$751.50 , N/A ,$634.60 ,$835.00 ,$835.00 , N/A ,$835.00 ,$400.80 , N/A 
ST. ELIZABETH'S HOSPITAL,48100395,92973,HC PERC TRANSLUM THROMBECTOMY -RI,481,1 ,$835.00 ,$542.75 ,$219.61 ,$835.00 , N/A ,$384.10 ,$467.60 , N/A ,$233.80 ,$282.23 , N/A ,$344.02 , N/A ,$376.59 ,$376.59 , N/A ,$376.59 , N/A ,$417.50 , N/A , N/A , N/A , N/A ,$626.25 ,$501.00 ,$501.00 , N/A ,$501.00 ,$634.60 ,$634.60 ,$634.60 ,$835.00 , N/A ,$709.75 , N/A ,$542.75 , N/A ,$835.00 ,$467.60 , N/A ,$219.61 , N/A , N/A , N/A , N/A ,$668.00 , N/A ,$376.59 ,$233.80 ,$751.50 , N/A ,$634.60 ,$835.00 ,$835.00 , N/A ,$835.00 ,$400.80 , N/A 
ST. ELIZABETH'S HOSPITAL,48100396,92920,HC PERC TRANSLUM COR ANGIO SGL-LC,481,1 ,"$14,349.00 ","$9,326.85 ","$3,773.79 ","$14,349.00 ","$12,215.85 ","$7,500.00 ","$8,035.44 ","$4,886.34 ","$4,017.72 ","$4,849.96 ","$4,886.34 ","$5,581.76 ","$4,886.34 ","$6,471.40 ","$6,471.40 ","$4,886.34 ","$6,471.40 ","$9,284.05 ","$7,174.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,761.75 ","$8,609.40 ","$8,609.40 ","$4,886.34 ","$8,609.40 ","$10,905.24 ","$10,905.24 ","$10,905.24 ","$14,349.00 ", N/A ,"$12,196.65 ","$12,215.86 ","$9,326.85 ","$4,886.34 ","$14,349.00 ","$8,035.44 ","$4,886.34 ","$3,773.79 ", N/A ,"$9,066.65 ","$8,654.53 ","$5,130.66 ","$11,479.20 ","$10,994.27 ","$6,471.40 ","$4,017.72 ","$12,914.10 ","$4,886.34 ","$10,905.24 ","$14,349.00 ","$14,349.00 ","$4,886.34 ","$14,349.00 ","$6,887.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100397,92920,HC PERC TRANSLUM COR ANGIO SGL-LD,481,1 ,"$14,349.00 ","$9,326.85 ","$3,773.79 ","$14,349.00 ","$12,215.85 ","$7,500.00 ","$8,035.44 ","$4,886.34 ","$4,017.72 ","$4,849.96 ","$4,886.34 ","$5,581.76 ","$4,886.34 ","$6,471.40 ","$6,471.40 ","$4,886.34 ","$6,471.40 ","$9,284.05 ","$7,174.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,761.75 ","$8,609.40 ","$8,609.40 ","$4,886.34 ","$8,609.40 ","$10,905.24 ","$10,905.24 ","$10,905.24 ","$14,349.00 ", N/A ,"$12,196.65 ","$12,215.86 ","$9,326.85 ","$4,886.34 ","$14,349.00 ","$8,035.44 ","$4,886.34 ","$3,773.79 ", N/A ,"$9,066.65 ","$8,654.53 ","$5,130.66 ","$11,479.20 ","$10,994.27 ","$6,471.40 ","$4,017.72 ","$12,914.10 ","$4,886.34 ","$10,905.24 ","$14,349.00 ","$14,349.00 ","$4,886.34 ","$14,349.00 ","$6,887.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100398,92920,HC PERC TRANSLUM COR ANGIO SGL-LM,481,1 ,"$14,349.00 ","$9,326.85 ","$3,773.79 ","$14,349.00 ","$12,215.85 ","$7,500.00 ","$8,035.44 ","$4,886.34 ","$4,017.72 ","$4,849.96 ","$4,886.34 ","$5,581.76 ","$4,886.34 ","$6,471.40 ","$6,471.40 ","$4,886.34 ","$6,471.40 ","$9,284.05 ","$7,174.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,761.75 ","$8,609.40 ","$8,609.40 ","$4,886.34 ","$8,609.40 ","$10,905.24 ","$10,905.24 ","$10,905.24 ","$14,349.00 ", N/A ,"$12,196.65 ","$12,215.86 ","$9,326.85 ","$4,886.34 ","$14,349.00 ","$8,035.44 ","$4,886.34 ","$3,773.79 ", N/A ,"$9,066.65 ","$8,654.53 ","$5,130.66 ","$11,479.20 ","$10,994.27 ","$6,471.40 ","$4,017.72 ","$12,914.10 ","$4,886.34 ","$10,905.24 ","$14,349.00 ","$14,349.00 ","$4,886.34 ","$14,349.00 ","$6,887.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100399,92920,HC PERC TRANSLUM COR ANGIO SGL-RC,481,1 ,"$14,349.00 ","$9,326.85 ","$3,773.79 ","$14,349.00 ","$12,215.85 ","$7,500.00 ","$8,035.44 ","$4,886.34 ","$4,017.72 ","$4,849.96 ","$4,886.34 ","$5,581.76 ","$4,886.34 ","$6,471.40 ","$6,471.40 ","$4,886.34 ","$6,471.40 ","$9,284.05 ","$7,174.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,761.75 ","$8,609.40 ","$8,609.40 ","$4,886.34 ","$8,609.40 ","$10,905.24 ","$10,905.24 ","$10,905.24 ","$14,349.00 ", N/A ,"$12,196.65 ","$12,215.86 ","$9,326.85 ","$4,886.34 ","$14,349.00 ","$8,035.44 ","$4,886.34 ","$3,773.79 ", N/A ,"$9,066.65 ","$8,654.53 ","$5,130.66 ","$11,479.20 ","$10,994.27 ","$6,471.40 ","$4,017.72 ","$12,914.10 ","$4,886.34 ","$10,905.24 ","$14,349.00 ","$14,349.00 ","$4,886.34 ","$14,349.00 ","$6,887.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100400,92920,HC PERC TRANSLUM COR ANGIO SGL-RI,481,1 ,"$14,349.00 ","$9,326.85 ","$3,773.79 ","$14,349.00 ","$12,215.85 ","$7,500.00 ","$8,035.44 ","$4,886.34 ","$4,017.72 ","$4,849.96 ","$4,886.34 ","$5,581.76 ","$4,886.34 ","$6,471.40 ","$6,471.40 ","$4,886.34 ","$6,471.40 ","$9,284.05 ","$7,174.50 ","$12,215.86 ","$4,886.34 ","$4,886.34 ","$4,984.07 ","$10,761.75 ","$8,609.40 ","$8,609.40 ","$4,886.34 ","$8,609.40 ","$10,905.24 ","$10,905.24 ","$10,905.24 ","$14,349.00 ", N/A ,"$12,196.65 ","$12,215.86 ","$9,326.85 ","$4,886.34 ","$14,349.00 ","$8,035.44 ","$4,886.34 ","$3,773.79 ", N/A ,"$9,066.65 ","$8,654.53 ","$5,130.66 ","$11,479.20 ","$10,994.27 ","$6,471.40 ","$4,017.72 ","$12,914.10 ","$4,886.34 ","$10,905.24 ","$14,349.00 ","$14,349.00 ","$4,886.34 ","$14,349.00 ","$6,887.52 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100401,92921,HC PERC TRANSLUM COR ANGIO EA AD-LC,481,1 ,"$6,087.00 ","$3,956.55 ","$1,600.88 ","$8,242.41 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,704.36 ","$2,057.41 ", N/A ,"$2,367.84 ", N/A ,"$2,745.24 ","$2,745.24 ", N/A ,"$2,745.24 ", N/A ,"$3,043.50 ", N/A , N/A , N/A , N/A ,"$4,565.25 ","$3,652.20 ","$3,652.20 ", N/A ,"$3,652.20 ","$4,626.12 ","$4,626.12 ","$4,626.12 ","$6,087.00 ", N/A ,"$5,173.95 ", N/A ,"$3,956.55 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,600.88 ", N/A ,"$6,087.00 ","$6,087.00 ", N/A ,"$4,869.60 ", N/A ,"$2,745.24 ","$1,704.36 ","$5,478.30 ", N/A ,"$4,626.12 ","$6,087.00 ","$6,087.00 ", N/A ,"$6,087.00 ","$2,921.76 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100402,92921,HC PERC TRANSLUM COR ANGIO EA AD-LD,481,1 ,"$6,087.00 ","$3,956.55 ","$1,600.88 ","$8,242.41 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,704.36 ","$2,057.41 ", N/A ,"$2,367.84 ", N/A ,"$2,745.24 ","$2,745.24 ", N/A ,"$2,745.24 ", N/A ,"$3,043.50 ", N/A , N/A , N/A , N/A ,"$4,565.25 ","$3,652.20 ","$3,652.20 ", N/A ,"$3,652.20 ","$4,626.12 ","$4,626.12 ","$4,626.12 ","$6,087.00 ", N/A ,"$5,173.95 ", N/A ,"$3,956.55 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,600.88 ", N/A ,"$6,087.00 ","$6,087.00 ", N/A ,"$4,869.60 ", N/A ,"$2,745.24 ","$1,704.36 ","$5,478.30 ", N/A ,"$4,626.12 ","$6,087.00 ","$6,087.00 ", N/A ,"$6,087.00 ","$2,921.76 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100403,92921,HC PERC TRANSLUM COR ANGIO EA AD-LM,481,1 ,"$6,087.00 ","$3,956.55 ","$1,600.88 ","$8,242.41 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,704.36 ","$2,057.41 ", N/A ,"$2,367.84 ", N/A ,"$2,745.24 ","$2,745.24 ", N/A ,"$2,745.24 ", N/A ,"$3,043.50 ", N/A , N/A , N/A , N/A ,"$4,565.25 ","$3,652.20 ","$3,652.20 ", N/A ,"$3,652.20 ","$4,626.12 ","$4,626.12 ","$4,626.12 ","$6,087.00 ", N/A ,"$5,173.95 ", N/A ,"$3,956.55 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,600.88 ", N/A ,"$6,087.00 ","$6,087.00 ", N/A ,"$4,869.60 ", N/A ,"$2,745.24 ","$1,704.36 ","$5,478.30 ", N/A ,"$4,626.12 ","$6,087.00 ","$6,087.00 ", N/A ,"$6,087.00 ","$2,921.76 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100404,92921,HC PERC TRANSLUM COR ANGIO EA AD-RC,481,1 ,"$6,087.00 ","$3,956.55 ","$1,600.88 ","$8,242.41 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,704.36 ","$2,057.41 ", N/A ,"$2,367.84 ", N/A ,"$2,745.24 ","$2,745.24 ", N/A ,"$2,745.24 ", N/A ,"$3,043.50 ", N/A , N/A , N/A , N/A ,"$4,565.25 ","$3,652.20 ","$3,652.20 ", N/A ,"$3,652.20 ","$4,626.12 ","$4,626.12 ","$4,626.12 ","$6,087.00 ", N/A ,"$5,173.95 ", N/A ,"$3,956.55 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,600.88 ", N/A ,"$6,087.00 ","$6,087.00 ", N/A ,"$4,869.60 ", N/A ,"$2,745.24 ","$1,704.36 ","$5,478.30 ", N/A ,"$4,626.12 ","$6,087.00 ","$6,087.00 ", N/A ,"$6,087.00 ","$2,921.76 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100405,92921,HC PERC TRANSLUM COR ANGIO EA AD-RI,481,1 ,"$6,087.00 ","$3,956.55 ","$1,600.88 ","$8,242.41 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,704.36 ","$2,057.41 ", N/A ,"$2,367.84 ", N/A ,"$2,745.24 ","$2,745.24 ", N/A ,"$2,745.24 ", N/A ,"$3,043.50 ", N/A , N/A , N/A , N/A ,"$4,565.25 ","$3,652.20 ","$3,652.20 ", N/A ,"$3,652.20 ","$4,626.12 ","$4,626.12 ","$4,626.12 ","$6,087.00 ", N/A ,"$5,173.95 ", N/A ,"$3,956.55 ", N/A ,"$6,087.00 ","$3,408.72 ", N/A ,"$1,600.88 ", N/A ,"$6,087.00 ","$6,087.00 ", N/A ,"$4,869.60 ", N/A ,"$2,745.24 ","$1,704.36 ","$5,478.30 ", N/A ,"$4,626.12 ","$6,087.00 ","$6,087.00 ", N/A ,"$6,087.00 ","$2,921.76 ","$8,242.41 "
ST. ELIZABETH'S HOSPITAL,48100406,92978,HC US IVUS/OCT  S AND I INIT VESSEL-LC,481,1 ,"$6,648.00 ","$4,321.20 ",$920.00 ,"$6,648.00 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,861.44 ","$2,247.02 ", N/A ,"$2,738.98 ", N/A ,"$2,998.25 ","$2,998.25 ", N/A ,"$2,998.25 ", N/A ,"$3,324.00 ", N/A , N/A , N/A , N/A ,"$4,986.00 ","$3,988.80 ","$3,988.80 ", N/A ,"$3,988.80 ","$5,052.48 ","$5,052.48 ","$5,052.48 ","$6,648.00 ", N/A ,"$5,650.80 ", N/A ,"$4,321.20 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,748.42 ", N/A , N/A , N/A , N/A ,"$5,318.40 ", N/A ,"$2,998.25 ","$1,861.44 ","$5,983.20 ", N/A ,"$5,052.48 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,191.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100407,92978,HC US IVUS/OCT S AND I INIT VESSEL-LD,481,1 ,"$6,648.00 ","$4,321.20 ",$920.00 ,"$6,648.00 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,861.44 ","$2,247.02 ", N/A ,"$2,738.98 ", N/A ,"$2,998.25 ","$2,998.25 ", N/A ,"$2,998.25 ", N/A ,"$3,324.00 ", N/A , N/A , N/A , N/A ,"$4,986.00 ","$3,988.80 ","$3,988.80 ", N/A ,"$3,988.80 ","$5,052.48 ","$5,052.48 ","$5,052.48 ","$6,648.00 ", N/A ,"$5,650.80 ", N/A ,"$4,321.20 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,748.42 ", N/A , N/A , N/A , N/A ,"$5,318.40 ", N/A ,"$2,998.25 ","$1,861.44 ","$5,983.20 ", N/A ,"$5,052.48 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,191.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100408,92978,HC US IVUS/OCT S AND I INIT VESSEL-LM,481,1 ,"$6,648.00 ","$4,321.20 ",$920.00 ,"$6,648.00 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,861.44 ","$2,247.02 ", N/A ,"$2,738.98 ", N/A ,"$2,998.25 ","$2,998.25 ", N/A ,"$2,998.25 ", N/A ,"$3,324.00 ", N/A , N/A , N/A , N/A ,"$4,986.00 ","$3,988.80 ","$3,988.80 ", N/A ,"$3,988.80 ","$5,052.48 ","$5,052.48 ","$5,052.48 ","$6,648.00 ", N/A ,"$5,650.80 ", N/A ,"$4,321.20 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,748.42 ", N/A , N/A , N/A , N/A ,"$5,318.40 ", N/A ,"$2,998.25 ","$1,861.44 ","$5,983.20 ", N/A ,"$5,052.48 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,191.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100409,92978,HC US IVUS/OCT S AND I INIT VESSEL-RC,481,1 ,"$6,648.00 ","$4,321.20 ",$920.00 ,"$6,648.00 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,861.44 ","$2,247.02 ", N/A ,"$2,738.98 ", N/A ,"$2,998.25 ","$2,998.25 ", N/A ,"$2,998.25 ", N/A ,"$3,324.00 ", N/A , N/A , N/A , N/A ,"$4,986.00 ","$3,988.80 ","$3,988.80 ", N/A ,"$3,988.80 ","$5,052.48 ","$5,052.48 ","$5,052.48 ","$6,648.00 ", N/A ,"$5,650.80 ", N/A ,"$4,321.20 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,748.42 ", N/A , N/A , N/A , N/A ,"$5,318.40 ", N/A ,"$2,998.25 ","$1,861.44 ","$5,983.20 ", N/A ,"$5,052.48 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,191.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100410,92978,HC US IVUS/OCT S AND I INIT VESSEL-RI,481,1 ,"$6,648.00 ","$4,321.20 ",$920.00 ,"$6,648.00 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,861.44 ","$2,247.02 ", N/A ,"$2,738.98 ", N/A ,"$2,998.25 ","$2,998.25 ", N/A ,"$2,998.25 ", N/A ,"$3,324.00 ", N/A , N/A , N/A , N/A ,"$4,986.00 ","$3,988.80 ","$3,988.80 ", N/A ,"$3,988.80 ","$5,052.48 ","$5,052.48 ","$5,052.48 ","$6,648.00 ", N/A ,"$5,650.80 ", N/A ,"$4,321.20 ", N/A ,"$6,648.00 ","$3,722.88 ", N/A ,"$1,748.42 ", N/A , N/A , N/A , N/A ,"$5,318.40 ", N/A ,"$2,998.25 ","$1,861.44 ","$5,983.20 ", N/A ,"$5,052.48 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,191.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100411,92979,HC US IVUS/OCT S AND I VESSEL EA ADL-LC,481,1 ,"$8,042.00 ","$5,227.30 ",$920.00 ,"$8,042.00 ", N/A ,"$7,500.00 ","$4,503.52 ", N/A ,"$2,251.76 ","$2,718.20 ", N/A ,"$1,442.87 ", N/A ,"$3,626.94 ","$3,626.94 ", N/A ,"$3,626.94 ", N/A ,"$4,021.00 ", N/A , N/A , N/A , N/A ,"$6,031.50 ","$4,825.20 ","$4,825.20 ", N/A ,"$4,825.20 ","$6,111.92 ","$6,111.92 ","$6,111.92 ","$8,042.00 ", N/A ,"$6,835.70 ", N/A ,"$5,227.30 ", N/A ,"$8,042.00 ","$4,503.52 ", N/A ,"$2,115.05 ", N/A , N/A , N/A , N/A ,"$6,433.60 ", N/A ,"$3,626.94 ","$2,251.76 ","$7,237.80 ", N/A ,"$6,111.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,860.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100412,92979,HC US IVUS/OCT S AND I VESSEL EA ADL-LD,481,1 ,"$8,042.00 ","$5,227.30 ",$920.00 ,"$8,042.00 ", N/A ,"$7,500.00 ","$4,503.52 ", N/A ,"$2,251.76 ","$2,718.20 ", N/A ,"$1,442.87 ", N/A ,"$3,626.94 ","$3,626.94 ", N/A ,"$3,626.94 ", N/A ,"$4,021.00 ", N/A , N/A , N/A , N/A ,"$6,031.50 ","$4,825.20 ","$4,825.20 ", N/A ,"$4,825.20 ","$6,111.92 ","$6,111.92 ","$6,111.92 ","$8,042.00 ", N/A ,"$6,835.70 ", N/A ,"$5,227.30 ", N/A ,"$8,042.00 ","$4,503.52 ", N/A ,"$2,115.05 ", N/A , N/A , N/A , N/A ,"$6,433.60 ", N/A ,"$3,626.94 ","$2,251.76 ","$7,237.80 ", N/A ,"$6,111.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,860.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100413,92979,HC US IVUS/OCT S AND I VESSEL EA ADL-LM,481,1 ,"$8,042.00 ","$5,227.30 ",$920.00 ,"$8,042.00 ", N/A ,"$7,500.00 ","$4,503.52 ", N/A ,"$2,251.76 ","$2,718.20 ", N/A ,"$1,442.87 ", N/A ,"$3,626.94 ","$3,626.94 ", N/A ,"$3,626.94 ", N/A ,"$4,021.00 ", N/A , N/A , N/A , N/A ,"$6,031.50 ","$4,825.20 ","$4,825.20 ", N/A ,"$4,825.20 ","$6,111.92 ","$6,111.92 ","$6,111.92 ","$8,042.00 ", N/A ,"$6,835.70 ", N/A ,"$5,227.30 ", N/A ,"$8,042.00 ","$4,503.52 ", N/A ,"$2,115.05 ", N/A , N/A , N/A , N/A ,"$6,433.60 ", N/A ,"$3,626.94 ","$2,251.76 ","$7,237.80 ", N/A ,"$6,111.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,860.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100414,92979,HC US IVUS/OCT S AND I VESSEL EA ADL-RC,481,1 ,"$8,042.00 ","$5,227.30 ",$920.00 ,"$8,042.00 ", N/A ,"$7,500.00 ","$4,503.52 ", N/A ,"$2,251.76 ","$2,718.20 ", N/A ,"$1,442.87 ", N/A ,"$3,626.94 ","$3,626.94 ", N/A ,"$3,626.94 ", N/A ,"$4,021.00 ", N/A , N/A , N/A , N/A ,"$6,031.50 ","$4,825.20 ","$4,825.20 ", N/A ,"$4,825.20 ","$6,111.92 ","$6,111.92 ","$6,111.92 ","$8,042.00 ", N/A ,"$6,835.70 ", N/A ,"$5,227.30 ", N/A ,"$8,042.00 ","$4,503.52 ", N/A ,"$2,115.05 ", N/A , N/A , N/A , N/A ,"$6,433.60 ", N/A ,"$3,626.94 ","$2,251.76 ","$7,237.80 ", N/A ,"$6,111.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,860.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100415,92979,HC US IVUS/OCT S AND I VESSEL EA ADL-RI,481,1 ,"$8,042.00 ","$5,227.30 ",$920.00 ,"$8,042.00 ", N/A ,"$7,500.00 ","$4,503.52 ", N/A ,"$2,251.76 ","$2,718.20 ", N/A ,"$1,442.87 ", N/A ,"$3,626.94 ","$3,626.94 ", N/A ,"$3,626.94 ", N/A ,"$4,021.00 ", N/A , N/A , N/A , N/A ,"$6,031.50 ","$4,825.20 ","$4,825.20 ", N/A ,"$4,825.20 ","$6,111.92 ","$6,111.92 ","$6,111.92 ","$8,042.00 ", N/A ,"$6,835.70 ", N/A ,"$5,227.30 ", N/A ,"$8,042.00 ","$4,503.52 ", N/A ,"$2,115.05 ", N/A , N/A , N/A , N/A ,"$6,433.60 ", N/A ,"$3,626.94 ","$2,251.76 ","$7,237.80 ", N/A ,"$6,111.92 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$3,860.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100416,93592,HC TRANSCATH PERQ AORTIC ADDL,481,1 ,"$10,672.00 ","$6,936.80 ",$920.00 ,"$10,672.00 ", N/A ,"$2,125.00 ","$5,976.32 ", N/A ,"$2,988.16 ","$3,607.14 ", N/A ,"$4,151.41 ", N/A ,"$4,813.07 ","$4,813.07 ", N/A ,"$4,813.07 ", N/A ,"$5,336.00 ", N/A , N/A , N/A , N/A ,"$8,004.00 ","$6,403.20 ","$6,403.20 ", N/A ,"$6,403.20 ","$8,110.72 ","$8,110.72 ","$8,110.72 ","$10,672.00 ", N/A ,"$9,071.20 ", N/A ,"$6,936.80 ", N/A ,"$10,672.00 ","$5,976.32 ", N/A ,"$2,806.74 ", N/A ,"$10,672.00 ","$10,672.00 ", N/A ,"$8,537.60 ", N/A ,"$4,813.07 ","$2,988.16 ","$9,604.80 ", N/A ,"$8,110.72 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$5,122.56 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100417,93591,HC TRANSCATH PERQ AORTIC INIT,481,1 ,"$45,210.00 ","$29,386.50 ","$7,000.00 ","$45,210.00 ","$39,583.70 ","$7,000.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$11,318.77 ","$10,804.28 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$7,500.00 ","$7,500.00 ","$15,833.48 ","$7,500.00 ","$21,700.80 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100418,93571,HC INTRAVASC DOPP COLOR FLOW INIT 93571 -74,480,1 ,"$9,449.00 ","$6,141.85 ",$97.21 ,"$9,449.00 ", N/A ,"$4,346.54 ","$5,291.44 ", N/A ,"$2,645.72 ","$2,833.04 ", N/A ,"$2,833.04 ", N/A ,"$4,261.50 ","$4,261.50 ", N/A ,$97.21 , N/A ,"$4,724.50 ", N/A , N/A , N/A , N/A ,"$7,086.75 ","$5,669.40 ","$5,669.40 ", N/A ,"$5,669.40 ","$7,181.24 ","$7,181.24 ","$7,181.24 ","$9,449.00 ", N/A ,"$8,031.65 ", N/A ,"$6,141.85 ", N/A ,"$9,449.00 ","$5,291.44 ", N/A ,"$2,485.09 ", N/A , N/A , N/A , N/A ,"$7,559.20 ", N/A ,"$4,261.50 ","$2,645.72 ","$8,504.10 ", N/A ,"$7,181.24 ","$2,670.00 ","$2,670.00 ", N/A ,"$2,670.00 ","$4,535.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100430,33340,HC LAA PERC CLOSURE W/ENDOCARDIAL IMPLANT S AND I,481,1 ,"$22,000.00 ","$14,300.00 ","$1,635.00 ","$22,000.00 ", N/A ,"$7,500.00 ","$12,320.00 ", N/A ,"$6,160.00 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$11,000.00 ", N/A , N/A , N/A , N/A ,"$16,500.00 ","$13,200.00 ","$13,200.00 ", N/A ,"$13,200.00 ","$16,720.00 ","$16,720.00 ","$16,720.00 ","$22,000.00 ", N/A ,"$18,700.00 ", N/A ,"$14,300.00 ", N/A ,"$22,000.00 ","$12,320.00 ", N/A ,"$5,786.00 ", N/A , N/A , N/A , N/A ,"$17,600.00 ", N/A ,"$6,645.60 ","$6,160.00 ","$19,800.00 ", N/A ,"$16,720.00 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$10,560.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100438,33992,HC REMOVE VAD SEPARATE SESSION,481,1 ,"$4,975.00 ","$3,233.75 ","$1,308.43 ","$4,975.00 ", N/A ,"$4,975.00 ","$2,786.00 ", N/A ,"$1,393.00 ","$1,681.55 ", N/A ,"$1,935.28 ", N/A ,"$2,243.73 ","$2,243.73 ", N/A ,"$2,243.73 ", N/A ,"$2,487.50 ", N/A , N/A , N/A , N/A ,"$3,731.25 ","$2,985.00 ","$2,985.00 ", N/A ,"$2,985.00 ","$3,781.00 ","$3,781.00 ","$3,781.00 ","$4,975.00 ", N/A ,"$4,228.75 ", N/A ,"$3,233.75 ", N/A ,"$4,975.00 ","$2,786.00 ", N/A ,"$1,308.43 ", N/A , N/A , N/A , N/A ,"$3,980.00 ", N/A ,"$2,243.73 ","$1,393.00 ","$4,477.50 ", N/A ,"$3,781.00 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$2,388.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,48100448,36223,HC CATH PLCMT SEL COM CAR/INOM INTRACRN-BIL,481,1 ,"$18,639.00 ","$12,115.35 ","$3,847.52 ","$18,639.00 ","$11,753.38 ","$4,800.00 ","$10,437.84 ","$4,701.35 ","$5,218.92 ","$4,859.14 ","$4,701.35 ","$5,584.90 ","$4,701.35 ","$6,645.60 ","$6,645.60 ","$4,701.35 ","$6,645.60 ","$8,932.56 ","$9,319.50 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$13,979.25 ","$11,183.40 ","$11,183.40 ","$4,701.35 ","$11,183.40 ","$14,165.64 ","$14,165.64 ","$14,165.64 ","$18,639.00 ", N/A ,"$15,843.15 ","$11,753.37 ","$12,115.35 ","$4,701.35 ","$18,639.00 ","$10,437.84 ","$4,701.35 ","$4,902.06 ", N/A ,"$4,232.27 ","$4,039.90 ","$4,936.42 ","$14,911.20 ","$10,578.04 ","$6,645.60 ","$5,218.92 ","$16,775.10 ","$4,701.35 ","$14,165.64 ","$7,200.00 ","$7,200.00 ","$4,701.35 ","$7,200.00 ","$8,946.72 ","$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100449,36224,HC CATH PLCMT SEL INTERNAL CARTOID-BIL,481,1 ,"$16,839.00 ","$10,945.35 ","$3,847.52 ","$16,839.00 ","$11,753.38 ","$6,300.00 ","$9,429.84 ","$4,701.35 ","$4,714.92 ","$4,859.14 ","$4,701.35 ","$5,584.90 ","$4,701.35 ","$6,645.60 ","$6,645.60 ","$4,701.35 ","$6,645.60 ","$8,932.56 ","$8,419.50 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$12,629.25 ","$10,103.40 ","$10,103.40 ","$4,701.35 ","$10,103.40 ","$12,797.64 ","$12,797.64 ","$12,797.64 ","$16,839.00 ", N/A ,"$14,313.15 ","$11,753.37 ","$10,945.35 ","$4,701.35 ","$16,839.00 ","$9,429.84 ","$4,701.35 ","$4,428.66 ", N/A ,"$4,232.27 ","$4,039.90 ","$4,936.42 ","$13,471.20 ","$10,578.04 ","$6,645.60 ","$4,714.92 ","$15,155.10 ","$4,701.35 ","$12,797.64 ","$7,200.00 ","$7,200.00 ","$4,701.35 ","$7,200.00 ","$8,082.72 ","$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100451,36226,HC CATH PLCMT SEL VERTEBRAL-BIL,481,1 ,"$16,839.00 ","$10,945.35 ","$3,847.52 ","$16,839.00 ","$11,753.38 ","$6,300.00 ","$9,429.84 ","$4,701.35 ","$4,714.92 ","$4,859.14 ","$4,701.35 ","$5,584.90 ","$4,701.35 ","$6,645.60 ","$6,645.60 ","$4,701.35 ","$6,645.60 ","$8,932.56 ","$8,419.50 ","$11,753.37 ","$4,701.35 ","$4,701.35 ","$4,795.38 ","$12,629.25 ","$10,103.40 ","$10,103.40 ","$4,701.35 ","$10,103.40 ","$12,797.64 ","$12,797.64 ","$12,797.64 ","$16,839.00 ", N/A ,"$14,313.15 ","$11,753.37 ","$10,945.35 ","$4,701.35 ","$16,839.00 ","$9,429.84 ","$4,701.35 ","$4,428.66 ", N/A ,"$4,232.27 ","$4,039.90 ","$4,936.42 ","$13,471.20 ","$10,578.04 ","$6,645.60 ","$4,714.92 ","$15,155.10 ","$4,701.35 ","$12,797.64 ","$7,200.00 ","$7,200.00 ","$4,701.35 ","$7,200.00 ","$8,082.72 ","$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100452,36227,HC CATH PLCMT SEL EXTERNAL CARTOID-BIL,481,1 ,"$16,839.00 ","$10,945.35 ","$1,380.00 ","$16,839.00 ", N/A ,"$3,187.50 ","$9,429.84 ", N/A ,"$4,714.92 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$8,419.50 ", N/A , N/A , N/A , N/A ,"$12,629.25 ","$10,103.40 ","$10,103.40 ", N/A ,"$10,103.40 ","$12,797.64 ","$12,797.64 ","$12,797.64 ","$16,839.00 ", N/A ,"$14,313.15 ", N/A ,"$10,945.35 ", N/A ,"$16,839.00 ","$9,429.84 ", N/A ,"$4,428.66 ", N/A ,"$4,232.27 ","$4,039.90 ", N/A ,"$13,471.20 ", N/A ,"$6,645.60 ","$4,714.92 ","$15,155.10 ", N/A ,"$12,797.64 ","$1,380.00 ","$1,380.00 ", N/A ,"$1,380.00 ","$8,082.72 ","$3,847.52 "
ST. ELIZABETH'S HOSPITAL,48100482,33289,HC CATHERIZATION RIGHT HEART W/SENSOR PULM ARTERY,481,1 ,"$92,076.00 ","$59,849.40 ","$6,500.00 ","$92,076.00 ","$71,095.83 ","$42,354.96 ","$51,562.56 ","$28,438.33 ","$25,781.28 ","$31,121.69 ","$28,438.33 ","$35,817.56 ","$28,438.33 ","$41,526.28 ","$41,526.28 ","$28,438.33 ","$41,526.28 ","$54,032.82 ","$46,038.00 ","$71,095.82 ","$28,438.33 ","$28,438.33 ","$29,007.09 ","$69,057.00 ","$55,245.60 ","$55,245.60 ","$28,438.33 ","$55,245.60 ","$69,977.76 ","$69,977.76 ","$69,977.76 ","$92,076.00 ", N/A ,"$78,264.60 ","$71,095.82 ","$59,849.40 ","$28,438.33 ","$92,076.00 ","$51,562.56 ","$28,438.33 ","$24,215.99 ", N/A ,"$11,318.77 ","$10,804.28 ","$29,860.25 ","$73,660.80 ","$63,986.24 ","$41,526.28 ","$25,781.28 ","$82,868.40 ","$28,438.33 ","$69,977.76 ","$6,500.00 ","$6,500.00 ","$28,438.33 ","$6,500.00 ","$44,196.48 ","$10,289.79 "
ST. ELIZABETH'S HOSPITAL,48100484,33274,HC TRANSCATH INS/REPLC VENTRIC PACEMAKER LEADLESS W/GUIDE,481,1 ,"$45,210.00 ","$29,386.50 ","$5,000.00 ","$45,210.00 ","$39,583.70 ","$5,000.00 ","$25,317.60 ","$15,833.48 ","$12,658.80 ","$15,280.98 ","$15,833.48 ","$17,586.69 ","$15,833.48 ","$20,389.71 ","$20,389.71 ","$15,833.48 ","$20,389.71 ","$30,083.61 ","$22,605.00 ","$39,583.69 ","$15,833.48 ","$15,833.48 ","$16,150.15 ","$33,907.50 ","$27,126.00 ","$27,126.00 ","$15,833.48 ","$27,126.00 ","$34,359.60 ","$34,359.60 ","$34,359.60 ","$45,210.00 ", N/A ,"$38,428.50 ","$39,583.69 ","$29,386.50 ","$15,833.48 ","$45,210.00 ","$25,317.60 ","$15,833.48 ","$11,890.23 ", N/A ,"$8,482.36 ","$8,096.80 ","$16,625.15 ","$36,168.00 ","$35,625.33 ","$20,389.71 ","$12,658.80 ","$40,689.00 ","$15,833.48 ","$34,359.60 ","$7,500.00 ","$7,500.00 ","$15,833.48 ","$7,500.00 ","$21,700.80 ","$7,711.24 "
ST. ELIZABETH'S HOSPITAL,48100485,33275,HC TRANSCATH REMOVE VENTRIC PACEMAKER LEADLESS,481,1 ,"$8,090.00 ","$5,258.50 ","$2,127.67 ","$8,090.00 ","$7,055.60 ","$5,000.00 ","$4,530.40 ","$2,822.24 ","$2,265.20 ","$2,734.42 ","$2,822.24 ","$3,147.01 ","$2,822.24 ","$3,648.59 ","$3,648.59 ","$2,822.24 ","$3,648.59 ","$5,362.25 ","$4,045.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$2,878.68 ","$6,067.50 ","$4,854.00 ","$4,854.00 ","$2,822.24 ","$4,854.00 ","$6,148.40 ","$6,148.40 ","$6,148.40 ","$8,090.00 ", N/A ,"$6,876.50 ","$7,055.60 ","$5,258.50 ","$2,822.24 ","$8,090.00 ","$4,530.40 ","$2,822.24 ","$2,127.67 ", N/A ,"$3,285.62 ","$3,136.28 ","$2,963.35 ","$6,472.00 ","$6,350.04 ","$3,648.59 ","$2,265.20 ","$7,281.00 ","$2,822.24 ","$6,148.40 ","$3,600.00 ","$3,600.00 ","$2,822.24 ","$3,600.00 ","$3,883.20 ","$2,986.93 "
ST. ELIZABETH'S HOSPITAL,48100497,93583,HC TRANSCATH PERQ SEPTAL REDUCTION,481,1 ,"$17,000.00 ","$11,050.00 ","$1,635.00 ","$17,000.00 ", N/A ,"$7,000.00 ","$9,520.00 ", N/A ,"$4,760.00 ","$4,859.14 ", N/A ,"$5,584.90 ", N/A ,"$6,645.60 ","$6,645.60 ", N/A ,"$6,645.60 ", N/A ,"$8,500.00 ", N/A , N/A , N/A , N/A ,"$12,750.00 ","$10,200.00 ","$10,200.00 ", N/A ,"$10,200.00 ","$12,920.00 ","$12,920.00 ","$12,920.00 ","$17,000.00 ", N/A ,"$14,450.00 ", N/A ,"$11,050.00 ", N/A ,"$17,000.00 ","$9,520.00 ", N/A ,"$4,471.00 ", N/A , N/A , N/A , N/A ,"$13,600.00 ", N/A ,"$6,645.60 ","$4,760.00 ","$15,300.00 ", N/A ,"$12,920.00 ","$1,635.00 ","$1,635.00 ", N/A ,"$1,635.00 ","$8,160.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,474.00 ",$958.10 ,$43.00 ,"$1,474.00 ",$652.30 ,$678.04 ,$825.44 ,$260.92 ,$412.72 ,$482.89 ,$260.92 ,$482.89 ,$260.92 ,$664.77 ,$664.77 ,$260.92 ,$43.00 ,$495.74 ,$737.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,"$1,105.50 ",$884.40 ,$884.40 ,$260.92 ,$884.40 ,"$1,120.24 ","$1,120.24 ","$1,120.24 ","$1,474.00 ", N/A ,"$1,252.90 ",$652.29 ,$958.10 ,$260.92 ,"$1,474.00 ",$825.44 ,$260.92 ,$387.66 , N/A ,$321.87 ,$307.24 ,$273.97 ,"$1,179.20 ",$587.06 ,$664.77 ,$412.72 ,"$1,326.60 ",$260.92 ,"$1,120.24 ","$1,200.00 ","$1,200.00 ",$260.92 ,"$1,200.00 ",$707.52 ,$292.61 
ST. ELIZABETH'S HOSPITAL,48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$6,041.00 ","$3,926.65 ",$159.14 ,"$6,041.00 ","$1,190.93 ","$2,778.86 ","$3,382.96 ",$476.37 ,"$1,691.48 ","$1,913.32 ",$476.37 ,"$1,913.32 ",$476.37 ,"$2,724.49 ","$2,724.49 ",$476.37 ,$159.14 ,$905.10 ,"$3,020.50 ","$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,"$4,530.75 ","$3,624.60 ","$3,624.60 ",$476.37 ,"$3,624.60 ","$4,591.16 ","$4,591.16 ","$4,591.16 ","$6,041.00 ", N/A ,"$5,134.85 ","$1,190.92 ","$3,926.65 ",$476.37 ,"$6,041.00 ","$3,382.96 ",$476.37 ,"$1,588.78 ", N/A ,$511.57 ,$488.31 ,$500.19 ,"$4,832.80 ","$1,071.82 ","$2,724.49 ","$1,691.48 ","$5,436.90 ",$476.37 ,"$4,591.16 ","$2,900.00 ","$2,900.00 ",$476.37 ,"$2,900.00 ","$2,899.68 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300001,93307,HC ECHOCARDIOGRAM 2D W/O DOP,483,1 ,"$4,397.00 ","$2,858.05 ",$117.16 ,"$4,397.00 ",$567.13 ,"$2,022.62 ","$2,462.32 ",$226.85 ,"$1,231.16 ","$1,366.26 ",$226.85 ,"$1,366.26 ",$226.85 ,"$1,983.05 ","$1,983.05 ",$226.85 ,$117.16 ,$431.02 ,"$2,198.50 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$3,297.75 ","$2,638.20 ","$2,638.20 ",$226.85 ,"$2,638.20 ","$3,341.72 ","$3,341.72 ","$3,341.72 ","$4,397.00 ", N/A ,"$3,737.45 ",$567.13 ,"$2,858.05 ",$226.85 ,"$4,397.00 ","$2,462.32 ",$226.85 ,"$1,156.41 ", N/A ,$511.57 ,$488.31 ,$238.19 ,"$3,517.60 ",$510.41 ,"$1,983.05 ","$1,231.16 ","$3,957.30 ",$226.85 ,"$3,341.72 ","$2,900.00 ","$2,900.00 ",$226.85 ,"$2,900.00 ","$2,110.56 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,"$2,004.00 ","$1,302.60 ",$90.36 ,"$2,004.00 ",$567.13 ,$921.84 ,"$1,122.24 ",$226.85 ,$561.12 ,$707.41 ,$226.85 ,$825.65 ,$226.85 ,$903.80 ,$903.80 ,$226.85 ,$90.36 ,$431.02 ,"$1,002.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,503.00 ","$1,202.40 ","$1,202.40 ",$226.85 ,"$1,202.40 ","$1,523.04 ","$1,523.04 ","$1,523.04 ","$2,004.00 ", N/A ,"$1,703.40 ",$567.13 ,"$1,302.60 ",$226.85 ,"$2,004.00 ","$1,122.24 ",$226.85 ,$527.05 , N/A ,$511.57 ,$488.31 ,$238.19 ,"$1,603.20 ",$510.41 ,$903.80 ,$561.12 ,"$1,803.60 ",$226.85 ,"$1,523.04 ","$2,004.00 ","$2,004.00 ",$226.85 ,"$2,004.00 ",$961.92 ,$465.06 
ST. ELIZABETH'S HOSPITAL,48300003,93312,HC ECHO TEE CMPL W/PF,483,1 ,"$6,247.00 ","$4,060.55 ",$163.61 ,"$6,247.00 ","$1,190.93 ","$2,873.62 ","$3,498.32 ",$476.37 ,"$1,749.16 ","$1,942.95 ",$476.37 ,"$1,942.95 ",$476.37 ,"$2,817.40 ","$2,817.40 ",$476.37 ,$163.61 ,$905.10 ,"$3,123.50 ","$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,"$4,685.25 ","$3,748.20 ","$3,748.20 ",$476.37 ,"$3,748.20 ","$4,747.72 ","$4,747.72 ","$4,747.72 ","$6,247.00 ", N/A ,"$5,309.95 ","$1,190.92 ","$4,060.55 ",$476.37 ,"$6,247.00 ","$3,498.32 ",$476.37 ,"$1,642.96 ", N/A ,$511.57 ,$488.31 ,$500.19 ,"$4,997.60 ","$1,071.82 ","$2,817.40 ","$1,749.16 ","$5,622.30 ",$476.37 ,"$4,747.72 ","$2,900.00 ","$2,900.00 ",$476.37 ,"$2,900.00 ","$2,998.56 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300005,93320,HC ECHO DOPPLER,483,1 ,"$1,498.00 ",$973.70 ,$41.46 ,"$1,498.00 ", N/A ,$689.08 ,$838.88 , N/A ,$419.44 ,$503.31 , N/A ,$503.31 , N/A ,$675.60 ,$675.60 , N/A ,$41.46 , N/A ,$749.00 , N/A , N/A , N/A , N/A ,"$1,123.50 ",$898.80 ,$898.80 , N/A ,$898.80 ,"$1,138.48 ","$1,138.48 ","$1,138.48 ","$1,498.00 ", N/A ,"$1,273.30 ", N/A ,$973.70 , N/A ,"$1,498.00 ",$838.88 , N/A ,$393.97 , N/A ,$511.57 ,$488.31 , N/A ,"$1,198.40 ", N/A ,$675.60 ,$419.44 ,"$1,348.20 ", N/A ,"$1,138.48 ","$1,498.00 ","$1,498.00 ", N/A ,"$1,498.00 ",$719.04 ,$465.06 
ST. ELIZABETH'S HOSPITAL,48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,"$1,395.00 ",$906.75 ,$25.26 ,"$1,395.00 ", N/A ,$641.70 ,$781.20 , N/A ,$390.60 ,$315.82 , N/A ,$315.82 , N/A ,$629.15 ,$629.15 , N/A ,$25.26 , N/A ,$697.50 , N/A , N/A , N/A , N/A ,"$1,046.25 ",$837.00 ,$837.00 , N/A ,$837.00 ,"$1,060.20 ","$1,060.20 ","$1,060.20 ","$1,395.00 ", N/A ,"$1,185.75 ", N/A ,$906.75 , N/A ,"$1,395.00 ",$781.20 , N/A ,$366.89 , N/A ,$511.57 ,$488.31 , N/A ,"$1,116.00 ", N/A ,$629.15 ,$390.60 ,"$1,255.50 ", N/A ,"$1,060.20 ","$1,395.00 ","$1,395.00 ", N/A ,"$1,395.00 ",$669.60 ,$465.06 
ST. ELIZABETH'S HOSPITAL,48300008,93303,HC ECHO PEDS CONGENITAL,483,1 ,"$4,135.00 ","$2,687.75 ",$199.06 ,"$4,135.00 ","$1,190.93 ","$1,902.10 ","$2,315.60 ",$476.37 ,"$1,157.80 ","$1,459.66 ",$476.37 ,"$1,703.62 ",$476.37 ,"$1,864.89 ","$1,864.89 ",$476.37 ,$199.06 ,$905.10 ,"$2,067.50 ","$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,"$3,101.25 ","$2,481.00 ","$2,481.00 ",$476.37 ,"$2,481.00 ","$3,142.60 ","$3,142.60 ","$3,142.60 ","$4,135.00 ", N/A ,"$3,514.75 ","$1,190.92 ","$2,687.75 ",$476.37 ,"$4,135.00 ","$2,315.60 ",$476.37 ,"$1,087.51 ", N/A ,$511.57 ,$488.31 ,$500.19 ,"$3,308.00 ","$1,071.82 ","$1,864.89 ","$1,157.80 ","$3,721.50 ",$476.37 ,"$3,142.60 ","$2,900.00 ","$2,900.00 ",$476.37 ,"$2,900.00 ","$1,984.80 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300009,93304,HC ECHO PEDS CONGENITAL LMTD,483,1 ,"$2,141.00 ","$1,391.65 ",$149.35 ,"$2,141.00 ","$1,190.93 ",$984.86 ,"$1,198.96 ",$476.37 ,$599.48 ,$755.77 ,$476.37 ,$882.09 ,$476.37 ,$965.59 ,$965.59 ,$476.37 ,$149.35 ,$905.10 ,"$1,070.50 ","$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,"$1,605.75 ","$1,284.60 ","$1,284.60 ",$476.37 ,"$1,284.60 ","$1,627.16 ","$1,627.16 ","$1,627.16 ","$2,141.00 ", N/A ,"$1,819.85 ","$1,190.92 ","$1,391.65 ",$476.37 ,"$2,141.00 ","$1,198.96 ",$476.37 ,$563.08 , N/A ,$511.57 ,$488.31 ,$500.19 ,"$1,712.80 ","$1,071.82 ",$965.59 ,$599.48 ,"$1,926.90 ",$476.37 ,"$1,627.16 ","$2,141.00 ","$2,141.00 ",$476.37 ,"$2,141.00 ","$1,027.68 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,"$1,340.00 ",$871.00 ,$22.41 ,"$1,340.00 ", N/A ,$616.40 ,$750.40 , N/A ,$375.20 ,$281.29 , N/A ,$281.29 , N/A ,$604.34 ,$604.34 , N/A ,$22.41 , N/A ,$670.00 , N/A , N/A , N/A , N/A ,"$1,005.00 ",$804.00 ,$804.00 , N/A ,$804.00 ,"$1,018.40 ","$1,018.40 ","$1,018.40 ","$1,340.00 ", N/A ,"$1,139.00 ", N/A ,$871.00 , N/A ,"$1,340.00 ",$750.40 , N/A ,$352.42 , N/A ,$511.57 ,$488.31 , N/A ,"$1,072.00 ", N/A ,$604.34 ,$375.20 ,"$1,206.00 ", N/A ,"$1,018.40 ","$1,340.00 ","$1,340.00 ", N/A ,"$1,340.00 ",$643.20 ,$465.06 
ST. ELIZABETH'S HOSPITAL,48300011,93351,HC ECHO 2D STRESS CONT MONITORING,483,1 ,"$5,322.00 ","$3,459.30 ",$186.24 ,"$5,322.00 ","$1,190.93 ","$2,448.12 ","$2,980.32 ",$476.37 ,"$1,490.16 ","$1,878.67 ",$476.37 ,"$2,192.66 ",$476.37 ,"$2,400.22 ","$2,400.22 ",$476.37 ,$186.24 ,$905.10 ,"$2,661.00 ","$1,190.92 ",$476.37 ,$476.37 ,$485.89 ,"$3,991.50 ","$3,193.20 ","$3,193.20 ",$476.37 ,"$3,193.20 ","$4,044.72 ","$4,044.72 ","$4,044.72 ","$5,322.00 ", N/A ,"$4,523.70 ","$1,190.92 ","$3,459.30 ",$476.37 ,"$5,322.00 ","$2,980.32 ",$476.37 ,"$1,399.69 ", N/A ,$511.57 ,$488.31 ,$500.19 ,"$4,257.60 ","$1,071.82 ","$2,400.22 ","$1,490.16 ","$4,789.80 ",$476.37 ,"$4,044.72 ","$2,900.00 ","$2,900.00 ",$476.37 ,"$2,900.00 ","$2,554.56 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300013,C8921,HC ECHO TTE CONGENTIAL W/W/O CONT  AND  W/CONT COMPL,483,1 ,"$4,674.00 ","$3,038.10 ",$465.06 ,"$4,674.00 ","$1,763.33 ","$2,150.04 ","$2,617.44 ",$705.33 ,"$1,308.72 ","$1,579.81 ",$705.33 ,"$1,818.19 ",$705.33 ,"$2,107.97 ","$2,107.97 ",$705.33 ,"$3,038.10 ","$1,340.13 ","$2,337.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,505.50 ","$2,804.40 ","$2,804.40 ",$705.33 ,"$2,804.40 ","$3,552.24 ","$3,552.24 ","$3,552.24 ","$4,674.00 ", N/A ,"$3,972.90 ","$1,763.33 ","$3,038.10 ",$705.33 ,"$4,674.00 ","$2,617.44 ",$705.33 ,"$1,229.26 ", N/A ,$511.57 ,$488.31 ,$740.60 ,"$3,739.20 ","$1,586.99 ","$2,107.97 ","$1,308.72 ","$4,206.60 ",$705.33 ,"$3,552.24 ","$2,900.00 ","$2,900.00 ",$705.33 ,"$2,900.00 ","$2,243.52 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300014,C8922,HC ECHO TTE CONGENTIAL W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$3,323.00 ","$2,159.95 ",$465.06 ,"$3,323.00 ","$1,763.33 ","$1,528.58 ","$1,860.88 ",$705.33 ,$930.44 ,"$1,123.17 ",$705.33 ,"$1,292.65 ",$705.33 ,"$1,498.67 ","$1,498.67 ",$705.33 ,"$2,159.95 ","$1,340.13 ","$1,661.50 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$2,492.25 ","$1,993.80 ","$1,993.80 ",$705.33 ,"$1,993.80 ","$2,525.48 ","$2,525.48 ","$2,525.48 ","$3,323.00 ", N/A ,"$2,824.55 ","$1,763.33 ","$2,159.95 ",$705.33 ,"$3,323.00 ","$1,860.88 ",$705.33 ,$873.95 , N/A ,$511.57 ,$488.31 ,$740.60 ,"$2,658.40 ","$1,586.99 ","$1,498.67 ",$930.44 ,"$2,990.70 ",$705.33 ,"$2,525.48 ","$2,900.00 ","$2,900.00 ",$705.33 ,"$2,900.00 ","$1,595.04 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300015,C8923,HC ECHO TTE W/W/O CONT  AND  W/CONT COMPL,483,1 ,"$4,345.00 ","$2,824.25 ",$465.06 ,"$4,345.00 ","$1,763.33 ","$1,998.70 ","$2,433.20 ",$705.33 ,"$1,216.60 ","$1,468.61 ",$705.33 ,"$1,690.21 ",$705.33 ,"$1,959.60 ","$1,959.60 ",$705.33 ,"$2,824.25 ","$1,340.13 ","$2,172.50 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,258.75 ","$2,607.00 ","$2,607.00 ",$705.33 ,"$2,607.00 ","$3,302.20 ","$3,302.20 ","$3,302.20 ","$4,345.00 ", N/A ,"$3,693.25 ","$1,763.33 ","$2,824.25 ",$705.33 ,"$4,345.00 ","$2,433.20 ",$705.33 ,"$1,142.74 ", N/A ,$511.57 ,$488.31 ,$740.60 ,"$3,476.00 ","$1,586.99 ","$1,959.60 ","$1,216.60 ","$3,910.50 ",$705.33 ,"$3,302.20 ","$2,900.00 ","$2,900.00 ",$705.33 ,"$2,900.00 ","$2,085.60 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$3,102.00 ","$2,016.30 ",$363.05 ,"$3,102.00 ",$907.63 ,"$1,426.92 ","$1,737.12 ",$363.05 ,$868.56 ,"$1,048.48 ",$363.05 ,"$1,206.68 ",$363.05 ,"$1,399.00 ","$1,399.00 ",$363.05 ,"$2,016.30 ",$689.79 ,"$1,551.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,326.50 ","$1,861.20 ","$1,861.20 ",$363.05 ,"$1,861.20 ","$2,357.52 ","$2,357.52 ","$2,357.52 ","$3,102.00 ", N/A ,"$2,636.70 ",$907.62 ,"$2,016.30 ",$363.05 ,"$3,102.00 ","$1,737.12 ",$363.05 ,$815.83 , N/A ,$511.57 ,$488.31 ,$381.20 ,"$2,481.60 ",$816.86 ,"$1,399.00 ",$868.56 ,"$2,791.80 ",$363.05 ,"$2,357.52 ","$2,900.00 ","$2,900.00 ",$363.05 ,"$2,900.00 ","$1,488.96 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300018,C8928,HC ECHO TTE 2D STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$5,000.00 ","$3,250.00 ",$465.06 ,"$5,000.00 ","$1,763.33 ","$2,300.00 ","$2,800.00 ",$705.33 ,"$1,400.00 ","$1,690.00 ",$705.33 ,"$1,945.00 ",$705.33 ,"$2,255.00 ","$2,255.00 ",$705.33 ,"$3,250.00 ","$1,340.13 ","$2,500.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,750.00 ","$3,000.00 ","$3,000.00 ",$705.33 ,"$3,000.00 ","$3,800.00 ","$3,800.00 ","$3,800.00 ","$5,000.00 ", N/A ,"$4,250.00 ","$1,763.33 ","$3,250.00 ",$705.33 ,"$5,000.00 ","$2,800.00 ",$705.33 ,"$1,315.00 ", N/A ,$511.57 ,$488.31 ,$740.60 ,"$4,000.00 ","$1,586.99 ","$2,255.00 ","$1,400.00 ","$4,500.00 ",$705.33 ,"$3,800.00 ","$2,900.00 ","$2,900.00 ",$705.33 ,"$2,900.00 ","$2,400.00 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$5,695.00 ","$3,701.75 ",$465.06 ,"$5,695.00 ","$1,763.33 ","$2,619.70 ","$3,189.20 ",$705.33 ,"$1,594.60 ","$1,924.91 ",$705.33 ,"$2,215.36 ",$705.33 ,"$2,568.45 ","$2,568.45 ",$705.33 ,"$3,701.75 ","$1,340.13 ","$2,847.50 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$4,271.25 ","$3,417.00 ","$3,417.00 ",$705.33 ,"$3,417.00 ","$4,328.20 ","$4,328.20 ","$4,328.20 ","$5,695.00 ", N/A ,"$4,840.75 ","$1,763.33 ","$3,701.75 ",$705.33 ,"$5,695.00 ","$3,189.20 ",$705.33 ,"$1,497.79 ", N/A ,$511.57 ,$488.31 ,$740.60 ,"$4,556.00 ","$1,586.99 ","$2,568.45 ","$1,594.60 ","$5,125.50 ",$705.33 ,"$4,328.20 ","$2,900.00 ","$2,900.00 ",$705.33 ,"$2,900.00 ","$2,733.60 ",$465.06 
ST. ELIZABETH'S HOSPITAL,48300020,C8930,HC ECHO TTE 2D REST/STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$5,322.00 ","$3,459.30 ",$465.06 ,"$5,322.00 ","$1,763.33 ","$2,448.12 ","$2,980.32 ",$705.33 ,"$1,490.16 ","$1,798.84 ",$705.33 ,"$2,070.26 ",$705.33 ,"$2,400.22 ","$2,400.22 ",$705.33 ,"$3,459.30 ","$1,340.13 ","$2,661.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,991.50 ","$3,193.20 ","$3,193.20 ",$705.33 ,"$3,193.20 ","$4,044.72 ","$4,044.72 ","$4,044.72 ","$5,322.00 ", N/A ,"$4,523.70 ","$1,763.33 ","$3,459.30 ",$705.33 ,"$5,322.00 ","$2,980.32 ",$705.33 ,"$1,399.69 ", N/A ,$511.57 ,$488.31 ,$740.60 ,"$4,257.60 ","$1,586.99 ","$2,400.22 ","$1,490.16 ","$4,789.80 ",$705.33 ,"$4,044.72 ","$2,900.00 ","$2,900.00 ",$705.33 ,"$2,900.00 ","$2,554.56 ",$465.06 
ST. ELIZABETH'S HOSPITAL,51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,"$2,040.00 ","$1,326.00 ",$77.99 ,"$2,040.00 ",$851.90 ,$938.40 ,"$1,142.40 ",$340.76 ,$571.20 ,$689.52 ,$340.76 ,$793.56 ,$340.76 ,$920.04 ,$920.04 ,$340.76 ,$77.99 ,$647.44 , N/A ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,530.00 ","$1,224.00 ","$1,224.00 ",$340.76 ,"$1,224.00 ","$1,550.40 ","$1,550.40 ","$1,550.40 ","$2,040.00 ", N/A ,"$1,734.00 ",$851.90 ,"$1,326.00 ",$340.76 ,"$2,040.00 ","$1,142.40 ",$340.76 ,$536.52 , N/A ,$323.31 ,$308.62 ,$357.80 ,"$1,632.00 ",$766.71 ,$920.04 ,$571.20 ,"$1,836.00 ",$340.76 ,"$1,550.40 ",$275.00 ,$275.00 ,$340.76 ,$275.00 ,$979.20 ,$293.92 
ST. ELIZABETH'S HOSPITAL,51000006,11043,HC DEBR SKIN/SUBQ TISSUE/MUSCLE FAC,510,1 ,"$2,040.00 ","$1,326.00 ",$203.30 ,"$2,040.00 ","$1,290.85 ",$938.40 ,"$1,142.40 ",$516.34 ,$571.20 ,$689.52 ,$516.34 ,$793.56 ,$516.34 ,$920.04 ,$920.04 ,$516.34 ,$203.30 ,$981.05 , N/A ,"$1,290.85 ",$516.34 ,$516.34 ,$526.67 ,"$1,530.00 ","$1,224.00 ","$1,224.00 ",$516.34 ,"$1,224.00 ","$1,550.40 ","$1,550.40 ","$1,550.40 ","$2,040.00 ", N/A ,"$1,734.00 ","$1,290.85 ","$1,326.00 ",$516.34 ,"$2,040.00 ","$1,142.40 ",$516.34 ,$536.52 , N/A ,$879.58 ,$839.60 ,$542.16 ,"$1,632.00 ","$1,161.77 ",$920.04 ,$571.20 ,"$1,836.00 ",$516.34 ,"$1,550.40 ",$275.00 ,$275.00 ,$516.34 ,$275.00 ,$979.20 ,$799.62 
ST. ELIZABETH'S HOSPITAL,51000007,11044,HC DEBR SKIN/SUB TIS/MUS/BONE INT 20 FAC,510,1 ,"$7,330.00 ","$4,764.50 ",$275.00 ,"$7,330.00 ","$3,467.90 ","$3,371.80 ","$4,104.80 ","$1,387.16 ","$2,052.40 ","$2,477.54 ","$1,387.16 ","$2,851.37 ","$1,387.16 ","$3,305.83 ","$3,305.83 ","$1,387.16 ",$299.45 ,"$2,635.59 ", N/A ,"$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,414.90 ","$5,497.50 ","$4,398.00 ","$4,398.00 ","$1,387.16 ","$4,398.00 ","$5,570.80 ","$5,570.80 ","$5,570.80 ","$7,330.00 ", N/A ,"$6,230.50 ","$3,467.89 ","$4,764.50 ","$1,387.16 ","$7,330.00 ","$4,104.80 ","$1,387.16 ","$1,927.79 ", N/A ,"$1,262.55 ","$1,205.16 ","$1,456.52 ","$5,864.00 ","$3,121.10 ","$3,305.83 ","$2,052.40 ","$6,597.00 ","$1,387.16 ","$5,570.80 ",$275.00 ,$275.00 ,"$1,387.16 ",$275.00 ,"$3,518.40 ","$1,147.77 "
ST. ELIZABETH'S HOSPITAL,51000009,11045,HC DEBR SKIN/SUBQ TIS EA ADL 20CM FAC,510,1 ,"$2,148.00 ","$1,396.20 ",$35.43 ,"$2,148.00 ", N/A ,$988.08 ,"$1,202.88 ", N/A ,$601.44 ,$726.02 , N/A ,$835.57 , N/A ,$968.75 ,$968.75 , N/A ,$35.43 , N/A , N/A , N/A , N/A , N/A , N/A ,"$1,611.00 ","$1,288.80 ","$1,288.80 ", N/A ,"$1,288.80 ","$1,632.48 ","$1,632.48 ","$1,632.48 ","$2,148.00 ", N/A ,"$1,825.80 ", N/A ,"$1,396.20 ", N/A ,"$2,148.00 ","$1,202.88 ", N/A ,$564.92 , N/A ,$879.58 ,$839.60 , N/A ,"$1,718.40 ", N/A ,$968.75 ,$601.44 ,"$1,933.20 ", N/A ,"$1,632.48 ",$275.00 ,$275.00 , N/A ,$275.00 ,"$1,031.04 ",$799.62 
ST. ELIZABETH'S HOSPITAL,51000010,11046,HC DEBR SKIN/SUBQ MUS/FAS ADL 20C FAC,510,1 ,"$1,877.00 ","$1,220.05 ",$75.23 ,"$1,877.00 ", N/A ,$863.42 ,"$1,051.12 ", N/A ,$525.56 ,$634.43 , N/A ,$730.15 , N/A ,$846.53 ,$846.53 , N/A ,$75.23 , N/A , N/A , N/A , N/A , N/A , N/A ,"$1,407.75 ","$1,126.20 ","$1,126.20 ", N/A ,"$1,126.20 ","$1,426.52 ","$1,426.52 ","$1,426.52 ","$1,877.00 ", N/A ,"$1,595.45 ", N/A ,"$1,220.05 ", N/A ,"$1,877.00 ","$1,051.12 ", N/A ,$493.65 , N/A ,$879.58 ,$839.60 , N/A ,"$1,501.60 ", N/A ,$846.53 ,$525.56 ,"$1,689.30 ", N/A ,"$1,426.52 ",$275.00 ,$275.00 , N/A ,$275.00 ,$900.96 ,$799.62 
ST. ELIZABETH'S HOSPITAL,51000011,11047,HC DEBR SKIN/SUB TIS/MUS/BN ADL 20C FAC,510,1 ,"$5,046.00 ","$3,279.90 ",$131.23 ,"$5,046.00 ", N/A ,"$2,321.16 ","$2,825.76 ", N/A ,"$1,412.88 ","$1,705.55 ", N/A ,"$1,962.89 ", N/A ,"$2,275.75 ","$2,275.75 ", N/A ,$131.23 , N/A , N/A , N/A , N/A , N/A , N/A ,"$3,784.50 ","$3,027.60 ","$3,027.60 ", N/A ,"$3,027.60 ","$3,834.96 ","$3,834.96 ","$3,834.96 ","$5,046.00 ", N/A ,"$4,289.10 ", N/A ,"$3,279.90 ", N/A ,"$5,046.00 ","$2,825.76 ", N/A ,"$1,327.10 ", N/A ,"$1,262.55 ","$1,205.16 ", N/A ,"$4,036.80 ", N/A ,"$2,275.75 ","$1,412.88 ","$4,541.40 ", N/A ,"$3,834.96 ",$275.00 ,$275.00 , N/A ,$275.00 ,"$2,422.08 ","$1,147.77 "
ST. ELIZABETH'S HOSPITAL,51000012,11055,HC PARING LESN BENIGN 1 FAC,510,1 ,$625.00 ,$406.25 ,$21.28 ,$625.00 ,$442.60 ,$287.50 ,$350.00 ,$177.04 ,$175.00 ,$211.25 ,$177.04 ,$243.13 ,$177.04 ,$281.88 ,$281.88 ,$177.04 ,$21.28 ,$336.38 , N/A ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$468.75 ,$375.00 ,$375.00 ,$177.04 ,$375.00 ,$475.00 ,$475.00 ,$475.00 ,$625.00 , N/A ,$531.25 ,$442.60 ,$406.25 ,$177.04 ,$625.00 ,$350.00 ,$177.04 ,$164.38 , N/A ,$323.31 ,$308.62 ,$185.89 ,$500.00 ,$398.34 ,$281.88 ,$175.00 ,$562.50 ,$177.04 ,$475.00 ,$275.00 ,$275.00 ,$177.04 ,$275.00 ,$300.00 ,$293.92 
ST. ELIZABETH'S HOSPITAL,51000014,11056,HC PARING LESN BENIGN 2-4 FAC,510,1 ,$738.00 ,$479.70 ,$28.99 ,$738.00 ,$442.60 ,$339.48 ,$413.28 ,$177.04 ,$206.64 ,$249.44 ,$177.04 ,$287.08 ,$177.04 ,$332.84 ,$332.84 ,$177.04 ,$28.99 ,$336.38 , N/A ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$553.50 ,$442.80 ,$442.80 ,$177.04 ,$442.80 ,$560.88 ,$560.88 ,$560.88 ,$738.00 , N/A ,$627.30 ,$442.60 ,$479.70 ,$177.04 ,$738.00 ,$413.28 ,$177.04 ,$194.09 , N/A ,$323.31 ,$308.62 ,$185.89 ,$590.40 ,$398.34 ,$332.84 ,$206.64 ,$664.20 ,$177.04 ,$560.88 ,$275.00 ,$275.00 ,$177.04 ,$275.00 ,$354.24 ,$293.92 
ST. ELIZABETH'S HOSPITAL,51000021,11719,HC TRIM NAILS NONDYSTROPHIC FAC,510,1 ,$221.00 ,$143.65 ,$9.70 ,$221.00 ,$137.20 ,$101.66 ,$123.76 ,$54.88 ,$61.88 ,$74.70 ,$54.88 ,$85.97 ,$54.88 ,$99.67 ,$99.67 ,$54.88 ,$9.70 ,$104.27 , N/A ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$165.75 ,$132.60 ,$132.60 ,$54.88 ,$132.60 ,$167.96 ,$167.96 ,$167.96 ,$221.00 , N/A ,$187.85 ,$137.20 ,$143.65 ,$54.88 ,$221.00 ,$123.76 ,$54.88 ,$58.12 , N/A ,$86.49 ,$82.56 ,$57.62 ,$176.80 ,$123.48 ,$99.67 ,$61.88 ,$198.90 ,$54.88 ,$167.96 ,$221.00 ,$221.00 ,$54.88 ,$221.00 ,$106.08 ,$78.63 
ST. ELIZABETH'S HOSPITAL,51000023,11720,HC DEBR NAIL(S) UP TO 5,510,1 ,$433.00 ,$281.45 ,$19.58 ,$433.00 ,$137.20 ,$199.18 ,$242.48 ,$54.88 ,$121.24 ,$146.35 ,$54.88 ,$168.44 ,$54.88 ,$195.28 ,$195.28 ,$54.88 ,$19.58 ,$104.27 , N/A ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$324.75 ,$259.80 ,$259.80 ,$54.88 ,$259.80 ,$329.08 ,$329.08 ,$329.08 ,$433.00 , N/A ,$368.05 ,$137.20 ,$281.45 ,$54.88 ,$433.00 ,$242.48 ,$54.88 ,$113.88 , N/A ,$86.49 ,$82.56 ,$57.62 ,$346.40 ,$123.48 ,$195.28 ,$121.24 ,$389.70 ,$54.88 ,$329.08 ,$275.00 ,$275.00 ,$54.88 ,$275.00 ,$207.84 ,$78.63 
ST. ELIZABETH'S HOSPITAL,51000024,11721,HC DEBR NAIL(S) 6 OR MORE,510,1 ,$599.00 ,$389.35 ,$31.13 ,$599.00 ,$137.20 ,$275.54 ,$335.44 ,$54.88 ,$167.72 ,$202.46 ,$54.88 ,$233.01 ,$54.88 ,$270.15 ,$270.15 ,$54.88 ,$31.13 ,$104.27 , N/A ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$449.25 ,$359.40 ,$359.40 ,$54.88 ,$359.40 ,$455.24 ,$455.24 ,$455.24 ,$599.00 , N/A ,$509.15 ,$137.20 ,$389.35 ,$54.88 ,$599.00 ,$335.44 ,$54.88 ,$157.54 , N/A ,$86.49 ,$82.56 ,$57.62 ,$479.20 ,$123.48 ,$270.15 ,$167.72 ,$539.10 ,$54.88 ,$455.24 ,$275.00 ,$275.00 ,$54.88 ,$275.00 ,$287.52 ,$78.63 
ST. ELIZABETH'S HOSPITAL,51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,"$1,906.00 ","$1,238.90 ",$128.73 ,"$1,906.00 ",$851.90 ,$876.76 ,"$1,067.36 ",$340.76 ,$533.68 ,$644.23 ,$340.76 ,$741.43 ,$340.76 ,$859.61 ,$859.61 ,$340.76 ,$128.73 ,$647.44 , N/A ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,"$1,429.50 ","$1,143.60 ","$1,143.60 ",$340.76 ,"$1,143.60 ","$1,448.56 ","$1,448.56 ","$1,448.56 ","$1,906.00 ", N/A ,"$1,620.10 ",$851.90 ,"$1,238.90 ",$340.76 ,"$1,906.00 ","$1,067.36 ",$340.76 ,$501.28 , N/A ,$679.51 ,$648.63 ,$357.80 ,"$1,524.80 ",$766.71 ,$859.61 ,$533.68 ,"$1,715.40 ",$340.76 ,"$1,448.56 ",$275.00 ,$275.00 ,$340.76 ,$275.00 ,$914.88 ,$617.74 
ST. ELIZABETH'S HOSPITAL,51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,"$1,358.00 ",$882.70 ,$40.15 ,"$1,358.00 ",$785.88 ,$624.68 ,$760.48 ,$314.35 ,$380.24 ,$459.00 ,$314.35 ,$528.26 ,$314.35 ,$612.46 ,$612.46 ,$314.35 ,$40.15 ,$597.26 , N/A ,$785.87 ,$314.35 ,$314.35 ,$320.63 ,"$1,018.50 ",$814.80 ,$814.80 ,$314.35 ,$814.80 ,"$1,032.08 ","$1,032.08 ","$1,032.08 ","$1,358.00 ", N/A ,"$1,154.30 ",$785.87 ,$882.70 ,$314.35 ,"$1,358.00 ",$760.48 ,$314.35 ,$357.15 , N/A ,$125.92 ,$120.19 ,$330.07 ,"$1,086.40 ",$707.28 ,$612.46 ,$380.24 ,"$1,222.20 ",$314.35 ,"$1,032.08 ",$275.00 ,$275.00 ,$314.35 ,$275.00 ,$651.84 ,$114.47 
ST. ELIZABETH'S HOSPITAL,51000051,20240,HC BX BN OPEN-SUPERFICIAL,510,1 ,"$6,346.00 ","$4,124.90 ",$185.30 ,"$6,346.00 ","$5,843.93 ","$2,919.16 ","$3,553.76 ","$2,337.57 ","$1,776.88 ","$2,144.95 ","$2,337.57 ","$2,468.59 ","$2,337.57 ","$2,862.05 ","$2,862.05 ","$2,337.57 ",$185.30 ,"$4,441.38 ", N/A ,"$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$4,759.50 ","$3,807.60 ","$3,807.60 ","$2,337.57 ","$3,807.60 ","$4,822.96 ","$4,822.96 ","$4,822.96 ","$6,346.00 ", N/A ,"$5,394.10 ","$5,843.93 ","$4,124.90 ","$2,337.57 ","$6,346.00 ","$3,553.76 ","$2,337.57 ","$1,669.00 ", N/A ,"$1,359.03 ","$1,297.25 ","$2,454.45 ","$5,076.80 ","$5,259.53 ","$2,862.05 ","$1,776.88 ","$5,711.40 ","$2,337.57 ","$4,822.96 ",$275.00 ,$275.00 ,"$2,337.57 ",$275.00 ,"$3,046.08 ","$1,235.48 "
ST. ELIZABETH'S HOSPITAL,51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$172.00 ,$111.80 ,$17.85 ,$172.00 ,$152.80 ,$79.12 ,$96.32 ,$61.12 ,$48.16 ,$60.72 ,$61.12 ,$70.86 ,$61.12 ,$77.57 ,$77.57 ,$61.12 ,$17.85 ,$116.14 ,$86.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$129.00 ,$103.20 ,$103.20 ,$61.12 ,$103.20 ,$130.72 ,$130.72 ,$130.72 ,$172.00 , N/A ,$146.20 ,$152.81 ,$111.80 ,$61.12 ,$172.00 ,$96.32 ,$61.12 ,$45.24 , N/A , N/A , N/A ,$64.18 ,$137.60 ,$137.53 ,$77.57 ,$48.16 ,$154.80 ,$61.12 ,$130.72 ,$111.80 ,$111.80 ,$61.12 ,$111.80 ,$82.56 , N/A 
ST. ELIZABETH'S HOSPITAL,51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$392.00 ,$254.80 ,$48.34 ,$504.21 ,$504.20 ,$180.32 ,$219.52 ,$201.68 ,$109.76 ,$138.38 ,$201.68 ,$161.50 ,$201.68 ,$176.79 ,$176.79 ,$201.68 ,$48.34 ,$383.20 ,$196.00 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$294.00 ,$235.20 ,$235.20 ,$201.68 ,$235.20 ,$297.92 ,$297.92 ,$297.92 ,$392.00 , N/A ,$333.20 ,$392.00 ,$254.80 ,$201.68 ,$392.00 ,$219.52 ,$201.68 ,$103.10 , N/A , N/A , N/A ,$211.76 ,$313.60 ,$453.79 ,$176.79 ,$109.76 ,$352.80 ,$201.68 ,$297.92 ,$254.80 ,$254.80 ,$201.68 ,$254.80 ,$188.16 , N/A 
ST. ELIZABETH'S HOSPITAL,51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$313.00 ,$203.45 ,$19.71 ,$313.00 ,$98.63 ,$143.98 ,$175.28 ,$39.45 ,$87.64 ,$110.49 ,$39.45 ,$128.96 ,$39.45 ,$141.16 ,$141.16 ,$39.45 ,$19.71 ,$74.96 ,$156.50 ,$98.63 ,$39.45 ,$39.45 ,$40.24 ,$234.75 ,$187.80 ,$187.80 ,$39.45 ,$187.80 ,$237.88 ,$237.88 ,$237.88 ,$313.00 , N/A ,$266.05 ,$98.63 ,$203.45 ,$39.45 ,$313.00 ,$175.28 ,$39.45 ,$82.32 , N/A , N/A , N/A ,$41.42 ,$250.40 ,$88.77 ,$141.16 ,$87.64 ,$281.70 ,$39.45 ,$237.88 ,$203.45 ,$203.45 ,$39.45 ,$203.45 ,$150.24 , N/A 
ST. ELIZABETH'S HOSPITAL,51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$348.00 ,$226.20 ,$91.52 ,$348.00 , N/A ,$160.08 ,$194.88 , N/A ,$97.44 ,$122.84 , N/A ,$143.38 , N/A ,$156.95 ,$156.95 , N/A ,$226.20 , N/A ,$174.00 , N/A , N/A , N/A , N/A ,$261.00 ,$208.80 ,$208.80 , N/A ,$208.80 ,$264.48 ,$264.48 ,$264.48 ,$348.00 , N/A ,$295.80 , N/A ,$226.20 , N/A ,$348.00 ,$194.88 , N/A ,$91.52 , N/A , N/A , N/A , N/A ,$278.40 , N/A ,$156.95 ,$97.44 ,$313.20 , N/A ,$264.48 ,$226.20 ,$226.20 , N/A ,$226.20 ,$167.04 , N/A 
ST. ELIZABETH'S HOSPITAL,51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$385.00 ,$250.25 ,$32.91 ,$385.00 ,$137.20 ,$177.10 ,$215.60 ,$54.88 ,$107.80 ,$135.91 ,$54.88 ,$158.62 ,$54.88 ,$173.64 ,$173.64 ,$54.88 ,$32.91 ,$104.27 , N/A ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$288.75 ,$231.00 ,$231.00 ,$54.88 ,$231.00 ,$292.60 ,$292.60 ,$292.60 ,$385.00 , N/A ,$327.25 ,$137.20 ,$250.25 ,$54.88 ,$385.00 ,$215.60 ,$54.88 ,$101.26 , N/A ,$125.92 ,$120.19 ,$57.62 ,$308.00 ,$123.48 ,$173.64 ,$107.80 ,$346.50 ,$54.88 ,$292.60 ,$275.00 ,$275.00 ,$54.88 ,$275.00 ,$184.80 ,$114.47 
ST. ELIZABETH'S HOSPITAL,51000072,97597,HC DEBR SKIN PART THICKNESS <20CM FAC,510,1 ,$810.00 ,$526.50 ,$47.30 ,$810.00 ,$442.60 ,$372.60 ,$453.60 ,$177.04 ,$226.80 ,$191.98 ,$177.04 ,$191.98 ,$177.04 ,$365.31 ,$365.31 ,$177.04 ,$47.30 ,$336.38 , N/A ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$607.50 ,$486.00 ,$486.00 ,$177.04 ,$486.00 ,$615.60 ,$615.60 ,$615.60 ,$810.00 , N/A ,$688.50 ,$442.60 ,$526.50 ,$177.04 ,$810.00 ,$453.60 ,$177.04 ,$213.03 , N/A ,$125.92 ,$120.19 ,$185.89 ,$648.00 ,$398.34 ,$365.31 ,$226.80 ,$729.00 ,$177.04 ,$615.60 ,$275.00 ,$275.00 ,$177.04 ,$275.00 ,$388.80 ,$114.47 
ST. ELIZABETH'S HOSPITAL,51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$306.00 ,$198.90 ,$63.40 ,$306.00 , N/A ,$140.76 ,$171.36 , N/A ,$85.68 ,$108.02 , N/A ,$126.07 , N/A ,$138.01 ,$138.01 , N/A ,$63.40 , N/A , N/A , N/A , N/A , N/A , N/A ,$229.50 ,$183.60 ,$183.60 , N/A ,$183.60 ,$232.56 ,$232.56 ,$232.56 ,$306.00 , N/A ,$260.10 , N/A ,$198.90 , N/A ,$78.75 ,$171.36 , N/A ,$80.48 , N/A ,$148.24 ,$141.50 , N/A ,$244.80 , N/A ,$138.01 ,$85.68 ,$275.40 , N/A ,$232.56 ,$275.00 ,$275.00 , N/A ,$275.00 ,$146.88 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$370.00 ,$240.50 ,$97.31 ,$370.00 , N/A ,$170.20 ,$207.20 , N/A ,$103.60 ,$130.61 , N/A ,$152.44 , N/A ,$166.87 ,$166.87 , N/A ,$108.73 , N/A , N/A , N/A , N/A , N/A , N/A ,$277.50 ,$222.00 ,$222.00 , N/A ,$222.00 ,$281.20 ,$281.20 ,$281.20 ,$370.00 , N/A ,$314.50 , N/A ,$240.50 , N/A ,$121.24 ,$207.20 , N/A ,$97.31 , N/A ,$148.24 ,$141.50 , N/A ,$296.00 , N/A ,$166.87 ,$103.60 ,$333.00 , N/A ,$281.20 ,$275.00 ,$275.00 , N/A ,$275.00 ,$177.60 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000109,99204,HC CLINIC VISIT COMPLEX NEW,510,1 ,$523.00 ,$339.95 ,$134.76 ,$523.00 , N/A ,$240.58 ,$292.88 , N/A ,$146.44 ,$184.62 , N/A ,$215.48 , N/A ,$235.87 ,$235.87 , N/A ,$174.95 , N/A , N/A , N/A , N/A , N/A , N/A ,$392.25 ,$313.80 ,$313.80 , N/A ,$313.80 ,$397.48 ,$397.48 ,$397.48 ,$523.00 , N/A ,$444.55 , N/A ,$339.95 , N/A ,$181.05 ,$292.88 , N/A ,$137.55 , N/A ,$148.24 ,$141.50 , N/A ,$418.40 , N/A ,$235.87 ,$146.44 ,$470.70 , N/A ,$397.48 ,$275.00 ,$275.00 , N/A ,$275.00 ,$251.04 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000113,99205,HC CLINIC VISIT COMPREH NEW,510,1 ,$590.00 ,$383.50 ,$134.76 ,$590.00 , N/A ,$271.40 ,$330.40 , N/A ,$165.20 ,$208.27 , N/A ,$243.08 , N/A ,$266.09 ,$266.09 , N/A ,$237.15 , N/A , N/A , N/A , N/A , N/A , N/A ,$442.50 ,$354.00 ,$354.00 , N/A ,$354.00 ,$448.40 ,$448.40 ,$448.40 ,$590.00 , N/A ,$501.50 , N/A ,$383.50 , N/A ,$239.15 ,$330.40 , N/A ,$155.17 , N/A ,$148.24 ,$141.50 , N/A ,$472.00 , N/A ,$266.09 ,$165.20 ,$531.00 , N/A ,$448.40 ,$275.00 ,$275.00 , N/A ,$275.00 ,$283.20 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$218.00 ,$141.70 ,$11.36 ,$218.00 , N/A ,$100.28 ,$122.08 , N/A ,$61.04 ,$76.95 , N/A ,$87.81 , N/A ,$98.32 ,$98.32 , N/A ,$11.36 , N/A , N/A , N/A , N/A , N/A , N/A ,$163.50 ,$130.80 ,$130.80 , N/A ,$130.80 ,$165.68 ,$165.68 ,$165.68 ,$218.00 , N/A ,$185.30 , N/A ,$141.70 , N/A ,$218.00 ,$122.08 , N/A ,$57.33 , N/A ,$148.24 ,$141.50 , N/A ,$174.40 , N/A ,$98.32 ,$61.04 ,$196.20 , N/A ,$165.68 ,$218.00 ,$218.00 , N/A ,$218.00 ,$104.64 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$264.00 ,$171.60 ,$47.13 ,$264.00 , N/A ,$121.44 ,$147.84 , N/A ,$73.92 ,$93.19 , N/A ,$108.77 , N/A ,$119.06 ,$119.06 , N/A ,$47.13 , N/A , N/A , N/A , N/A , N/A , N/A ,$198.00 ,$158.40 ,$158.40 , N/A ,$158.40 ,$200.64 ,$200.64 ,$200.64 ,$264.00 , N/A ,$224.40 , N/A ,$171.60 , N/A ,$60.02 ,$147.84 , N/A ,$69.43 , N/A ,$148.24 ,$141.50 , N/A ,$211.20 , N/A ,$119.06 ,$73.92 ,$237.60 , N/A ,$200.64 ,$264.00 ,$264.00 , N/A ,$264.00 ,$126.72 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$318.00 ,$206.70 ,$83.63 ,$318.00 , N/A ,$146.28 ,$178.08 , N/A ,$89.04 ,$112.25 , N/A ,$131.02 , N/A ,$143.42 ,$143.42 , N/A ,$85.84 , N/A , N/A , N/A , N/A , N/A , N/A ,$238.50 ,$190.80 ,$190.80 , N/A ,$190.80 ,$241.68 ,$241.68 ,$241.68 ,$318.00 , N/A ,$270.30 , N/A ,$206.70 , N/A ,$97.92 ,$178.08 , N/A ,$83.63 , N/A ,$148.24 ,$141.50 , N/A ,$254.40 , N/A ,$143.42 ,$89.04 ,$286.20 , N/A ,$241.68 ,$275.00 ,$275.00 , N/A ,$275.00 ,$152.64 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$459.00 ,$298.35 ,$120.72 ,$459.00 , N/A ,$211.14 ,$257.04 , N/A ,$128.52 ,$162.03 , N/A ,$189.11 , N/A ,$207.01 ,$207.01 , N/A ,$125.09 , N/A , N/A , N/A , N/A , N/A , N/A ,$344.25 ,$275.40 ,$275.40 , N/A ,$275.40 ,$348.84 ,$348.84 ,$348.84 ,$459.00 , N/A ,$390.15 , N/A ,$298.35 , N/A ,$459.00 ,$257.04 , N/A ,$120.72 , N/A ,$148.24 ,$141.50 , N/A ,$367.20 , N/A ,$207.01 ,$128.52 ,$413.10 , N/A ,$348.84 ,$275.00 ,$275.00 , N/A ,$275.00 ,$220.32 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$563.00 ,$365.95 ,$134.76 ,$563.00 , N/A ,$258.98 ,$315.28 , N/A ,$157.64 ,$198.74 , N/A ,$231.96 , N/A ,$253.91 ,$253.91 , N/A ,$186.74 , N/A , N/A , N/A , N/A , N/A , N/A ,$422.25 ,$337.80 ,$337.80 , N/A ,$337.80 ,$427.88 ,$427.88 ,$427.88 ,$563.00 , N/A ,$478.55 , N/A ,$365.95 , N/A ,$563.00 ,$315.28 , N/A ,$148.07 , N/A ,$148.24 ,$141.50 , N/A ,$450.40 , N/A ,$253.91 ,$157.64 ,$506.70 , N/A ,$427.88 ,$275.00 ,$275.00 , N/A ,$275.00 ,$270.24 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$161.00 ,$104.65 ,$3.00 ,$161.00 ,$7.50 ,$74.06 ,$90.16 ,$3.00 ,$45.08 ,$18.21 ,$3.00 ,$18.21 ,$3.00 ,$72.61 ,$72.61 ,$3.00 ,$3.75 ,$5.70 ,$5.03 ,$7.50 ,$3.00 ,$3.00 ,$3.06 ,$120.75 ,$96.60 ,$96.60 ,$3.00 ,$96.60 ,$3.90 ,$3.90 ,$3.90 ,$161.00 , N/A ,$136.85 ,$7.50 ,$104.65 ,$3.00 ,$161.00 ,$90.16 ,$3.00 ,$42.34 , N/A , N/A , N/A ,$3.15 ,$128.80 ,$6.75 ,$72.61 ,$45.08 ,$144.90 ,$3.00 ,$3.90 ,$6.00 ,$6.00 ,$3.00 ,$6.00 ,$77.28 , N/A 
ST. ELIZABETH'S HOSPITAL,51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$742.00 ,$482.30 ,$34.71 ,$742.00 ,$277.93 ,$341.32 ,$415.52 ,$111.17 ,$207.76 ,$250.80 ,$111.17 ,$288.64 ,$111.17 ,$334.64 ,$334.64 ,$111.17 ,$34.71 ,$211.22 , N/A ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$556.50 ,$445.20 ,$445.20 ,$111.17 ,$445.20 ,$563.92 ,$563.92 ,$563.92 ,$742.00 , N/A ,$630.70 ,$277.92 ,$482.30 ,$111.17 ,$742.00 ,$415.52 ,$111.17 ,$195.15 , N/A ,$125.92 ,$120.19 ,$116.73 ,$593.60 ,$250.12 ,$334.64 ,$207.76 ,$667.80 ,$111.17 ,$563.92 ,$275.00 ,$275.00 ,$111.17 ,$275.00 ,$356.16 ,$114.47 
ST. ELIZABETH'S HOSPITAL,51000172,51702,HC CATH BLADDER SMP,510,1 ,$554.00 ,$360.10 ,$33.99 ,$554.00 ,$277.93 ,$254.84 ,$310.24 ,$111.17 ,$155.12 ,$187.25 ,$111.17 ,$215.51 ,$111.17 ,$249.85 ,$249.85 ,$111.17 ,$33.99 ,$211.22 , N/A ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$415.50 ,$332.40 ,$332.40 ,$111.17 ,$332.40 ,$421.04 ,$421.04 ,$421.04 ,$554.00 , N/A ,$470.90 ,$277.92 ,$360.10 ,$111.17 ,$554.00 ,$310.24 ,$111.17 ,$145.70 , N/A ,$125.92 ,$120.19 ,$116.73 ,$443.20 ,$250.12 ,$249.85 ,$155.12 ,$498.60 ,$111.17 ,$421.04 ,$275.00 ,$275.00 ,$111.17 ,$275.00 ,$265.92 ,$114.47 
ST. ELIZABETH'S HOSPITAL,51000173,51703,HC CATH BLADDER CPLX,510,1 ,$638.00 ,$414.70 ,$100.88 ,$638.00 ,$344.13 ,$293.48 ,$357.28 ,$137.65 ,$178.64 ,$215.64 ,$137.65 ,$248.18 ,$137.65 ,$287.74 ,$287.74 ,$137.65 ,$100.88 ,$261.53 , N/A ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$478.50 ,$382.80 ,$382.80 ,$137.65 ,$382.80 ,$484.88 ,$484.88 ,$484.88 ,$638.00 , N/A ,$542.30 ,$344.11 ,$414.70 ,$137.65 ,$638.00 ,$357.28 ,$137.65 ,$167.79 , N/A ,$125.92 ,$120.19 ,$144.53 ,$510.40 ,$309.70 ,$287.74 ,$178.64 ,$574.20 ,$137.65 ,$484.88 ,$275.00 ,$275.00 ,$137.65 ,$275.00 ,$306.24 ,$114.47 
ST. ELIZABETH'S HOSPITAL,51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$1,636.68 ","$1,063.84 ",$105.51 ,"$1,636.68 ","$1,417.95 ",$752.87 ,$916.54 ,$567.18 ,$458.27 ,$553.20 ,$567.18 ,$636.67 ,$567.18 ,$738.14 ,$738.14 ,$567.18 ,$105.51 ,"$1,077.65 ", N/A ,"$1,417.96 ",$567.18 ,$567.18 ,$578.53 ,"$1,227.51 ",$982.01 ,$982.01 ,$567.18 ,$982.01 ,"$1,243.88 ","$1,243.88 ","$1,243.88 ","$1,636.68 ", N/A ,"$1,391.18 ","$1,417.96 ","$1,063.84 ",$567.18 ,"$1,636.68 ",$916.54 ,$567.18 ,$430.45 , N/A ,"$1,144.54 ","$1,092.51 ",$595.54 ,"$1,309.34 ","$1,276.16 ",$738.14 ,$458.27 ,"$1,473.01 ",$567.18 ,"$1,243.88 ",$275.00 ,$275.00 ,$567.18 ,$275.00 ,$785.61 ,"$1,040.49 "
ST. ELIZABETH'S HOSPITAL,51000225,56605,HC BX VULVA/PERINEUM ONE LESION,510,1 ,"$1,840.38 ","$1,196.25 ",$79.66 ,"$1,840.38 ","$1,562.55 ",$846.57 ,"$1,030.61 ",$625.02 ,$515.31 ,$622.05 ,$625.02 ,$715.91 ,$625.02 ,$830.01 ,$830.01 ,$625.02 ,$79.66 ,"$1,187.53 ", N/A ,"$1,562.54 ",$625.02 ,$625.02 ,$637.52 ,"$1,380.29 ","$1,104.23 ","$1,104.23 ",$625.02 ,"$1,104.23 ","$1,398.69 ","$1,398.69 ","$1,398.69 ","$1,840.38 ", N/A ,"$1,564.32 ","$1,562.54 ","$1,196.25 ",$625.02 ,"$1,840.38 ","$1,030.61 ",$625.02 ,$484.02 , N/A ,$679.51 ,$648.63 ,$656.27 ,"$1,472.30 ","$1,406.29 ",$830.01 ,$515.31 ,"$1,656.34 ",$625.02 ,"$1,398.69 ",$275.00 ,$275.00 ,$625.02 ,$275.00 ,$883.38 ,$617.74 
ST. ELIZABETH'S HOSPITAL,51000315,38222,HC BM ASPIRATION (BX/ASP SAME SITE),360,1 ,"$8,348.00 ","$5,426.20 ",$583.08 ,"$8,348.00 ","$5,843.93 ","$2,125.00 ","$4,674.88 ","$2,337.57 ","$2,337.44 ","$2,821.62 ","$2,337.57 ","$3,247.37 ","$2,337.57 ","$3,764.95 ","$3,764.95 ","$2,337.57 ","$3,764.95 ","$4,441.38 ","$4,174.00 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,384.32 ","$6,261.00 ","$5,008.80 ","$5,008.80 ","$2,337.57 ","$5,008.80 ","$6,344.48 ","$6,344.48 ","$6,344.48 ","$8,348.00 ", N/A ,"$7,095.80 ","$5,843.93 ","$5,426.20 ","$2,337.57 ","$8,348.00 ","$4,674.88 ","$2,337.57 ","$2,195.52 ", N/A ,$641.39 ,$612.23 ,"$2,454.45 ","$6,678.40 ","$5,259.53 ","$3,764.95 ","$2,337.44 ","$7,513.20 ","$2,337.57 ","$6,344.48 ","$1,890.00 ","$1,890.00 ","$2,337.57 ","$1,890.00 ","$4,007.04 ",$583.08 
ST. ELIZABETH'S HOSPITAL,51000325,15271,HC APL SKIN SUB TAL<100 INT 25CM,761,1 ,"$1,159.00 ",$753.35 ,$110.85 ,"$4,221.50 ","$4,221.50 ",$533.14 ,$649.04 ,"$1,688.60 ",$324.52 ,$391.74 ,"$1,688.60 ",$450.85 ,"$1,159.00 ",$522.71 ,$522.71 ,"$1,159.00 ",$110.85 ,"$1,159.00 ",$579.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,159.00 ",$869.25 ,$695.40 ,$695.40 ,"$1,688.60 ",$695.40 ,$880.84 ,$880.84 ,$880.84 ,"$1,159.00 ", N/A ,$985.15 ,"$1,159.00 ",$753.35 ,"$1,688.60 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$304.82 , N/A ,"$1,159.00 ","$1,159.00 ","$1,773.03 ",$927.20 ,"$3,799.34 ",$522.71 ,$324.52 ,"$1,043.10 ","$1,688.60 ",$880.84 ,"$1,159.00 ","$1,159.00 ","$1,159.00 ","$1,159.00 ",$556.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,51000326,15272,HC APL SKIN SUB TAL<100 ADL 25CM,761,1 ,$415.00 ,$269.75 ,$24.20 ,"$1,518.42 ", N/A ,$190.90 ,$232.40 , N/A ,$116.20 ,$140.27 , N/A ,$161.44 , N/A ,$187.17 ,$187.17 , N/A ,$24.20 , N/A ,$207.50 , N/A , N/A , N/A , N/A ,$311.25 ,$249.00 ,$249.00 , N/A ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 , N/A ,$269.75 , N/A ,$415.00 ,$232.40 , N/A ,$109.15 , N/A ,$415.00 ,$415.00 , N/A ,$332.00 , N/A ,$187.17 ,$116.20 ,$373.50 , N/A ,$315.40 ,$415.00 ,$415.00 , N/A ,$415.00 ,$199.20 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,51000328,15274,HC APL SKIN SUB TAL>100 ADL 100CM,761,1 ,"$1,124.00 ",$730.60 ,$62.21 ,"$1,518.42 ", N/A ,$517.04 ,$629.44 , N/A ,$314.72 ,$379.91 , N/A ,$437.24 , N/A ,$506.92 ,$506.92 , N/A ,$62.21 , N/A ,$562.00 , N/A , N/A , N/A , N/A ,$843.00 ,$674.40 ,$674.40 , N/A ,$674.40 ,$854.24 ,$854.24 ,$854.24 ,"$1,124.00 ", N/A ,$955.40 , N/A ,$730.60 , N/A ,"$1,124.00 ",$629.44 , N/A ,$295.61 , N/A ,"$1,124.00 ","$1,124.00 ", N/A ,$899.20 , N/A ,$506.92 ,$314.72 ,"$1,011.60 ", N/A ,$854.24 ,"$1,124.00 ","$1,124.00 ", N/A ,"$1,124.00 ",$539.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,51000329,15275,HC APL SKIN SUB OTH<100 INT 25CM,761,1 ,"$1,159.00 ",$753.35 ,$122.46 ,"$4,221.50 ","$4,221.50 ",$533.14 ,$649.04 ,"$1,688.60 ",$324.52 ,$391.74 ,"$1,688.60 ",$450.85 ,"$1,159.00 ",$522.71 ,$522.71 ,"$1,159.00 ",$122.46 ,"$1,159.00 ",$579.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,159.00 ",$869.25 ,$695.40 ,$695.40 ,"$1,688.60 ",$695.40 ,$880.84 ,$880.84 ,$880.84 ,"$1,159.00 ", N/A ,$985.15 ,"$1,159.00 ",$753.35 ,"$1,688.60 ","$1,159.00 ",$649.04 ,"$1,688.60 ",$304.82 , N/A ,"$1,159.00 ","$1,159.00 ","$1,773.03 ",$927.20 ,"$3,799.34 ",$522.71 ,$324.52 ,"$1,043.10 ","$1,688.60 ",$880.84 ,"$1,159.00 ","$1,159.00 ","$1,159.00 ","$1,159.00 ",$556.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,51000330,15276,HC APL SKIN SUB OTH<100 ADL 25CM,761,1 ,$415.00 ,$269.75 ,$34.30 ,"$1,518.42 ", N/A ,$190.90 ,$232.40 , N/A ,$116.20 ,$140.27 , N/A ,$161.44 , N/A ,$187.17 ,$187.17 , N/A ,$34.30 , N/A ,$207.50 , N/A , N/A , N/A , N/A ,$311.25 ,$249.00 ,$249.00 , N/A ,$249.00 ,$315.40 ,$315.40 ,$315.40 ,$415.00 , N/A ,$352.75 , N/A ,$269.75 , N/A ,$415.00 ,$232.40 , N/A ,$109.15 , N/A ,$415.00 ,$415.00 , N/A ,$332.00 , N/A ,$187.17 ,$116.20 ,$373.50 , N/A ,$315.40 ,$415.00 ,$415.00 , N/A ,$415.00 ,$199.20 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,51000331,15277,HC APL SKIN SUB OTH>100 INT 100CM,761,1 ,"$1,713.00 ","$1,113.45 ",$302.90 ,"$4,221.50 ","$4,221.50 ",$787.98 ,$959.28 ,"$1,688.60 ",$479.64 ,$578.99 ,"$1,688.60 ",$666.36 ,"$1,688.60 ",$772.56 ,$772.56 ,"$1,688.60 ",$302.90 ,"$1,713.00 ",$856.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ","$1,713.00 ","$1,284.75 ","$1,027.80 ","$1,027.80 ","$1,688.60 ","$1,027.80 ","$1,301.88 ","$1,301.88 ","$1,301.88 ","$1,713.00 ", N/A ,"$1,456.05 ","$1,713.00 ","$1,113.45 ","$1,688.60 ","$1,713.00 ",$959.28 ,"$1,688.60 ",$450.52 , N/A ,"$1,670.26 ","$1,594.34 ","$1,773.03 ","$1,370.40 ","$3,799.34 ",$772.56 ,$479.64 ,"$1,541.70 ","$1,688.60 ","$1,301.88 ","$1,305.00 ","$1,305.00 ","$1,688.60 ","$1,305.00 ",$822.24 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,51000332,15278,HC APL SKIN SUB OTH>100 ADL 100CM,761,1 ,"$1,124.00 ",$730.60 ,$76.78 ,"$1,518.42 ", N/A ,$517.04 ,$629.44 , N/A ,$314.72 ,$379.91 , N/A ,$437.24 , N/A ,$506.92 ,$506.92 , N/A ,$76.78 , N/A ,$562.00 , N/A , N/A , N/A , N/A ,$843.00 ,$674.40 ,$674.40 , N/A ,$674.40 ,$854.24 ,$854.24 ,$854.24 ,"$1,124.00 ", N/A ,$955.40 , N/A ,$730.60 , N/A ,"$1,124.00 ",$629.44 , N/A ,$295.61 , N/A ,"$1,124.00 ","$1,124.00 ", N/A ,$899.20 , N/A ,$506.92 ,$314.72 ,"$1,011.60 ", N/A ,$854.24 ,"$1,124.00 ","$1,124.00 ", N/A ,"$1,124.00 ",$539.52 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,51000352,11057,HC PARING LESN BENIGN >4 FAC,510,1 ,$851.00 ,$553.15 ,$37.41 ,$851.00 ,$442.60 ,$391.46 ,$476.56 ,$177.04 ,$238.28 ,$287.64 ,$177.04 ,$331.04 ,$177.04 ,$383.80 ,$383.80 ,$177.04 ,$37.41 ,$336.38 , N/A ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$638.25 ,$510.60 ,$510.60 ,$177.04 ,$510.60 ,$646.76 ,$646.76 ,$646.76 ,$851.00 , N/A ,$723.35 ,$442.60 ,$553.15 ,$177.04 ,$851.00 ,$476.56 ,$177.04 ,$223.81 , N/A ,$323.31 ,$308.62 ,$185.89 ,$680.80 ,$398.34 ,$383.80 ,$238.28 ,$765.90 ,$177.04 ,$646.76 ,$275.00 ,$275.00 ,$177.04 ,$275.00 ,$408.48 ,$293.92 
ST. ELIZABETH'S HOSPITAL,51000400,29580,HC APPLY UNNA BOOT BILAT FAC,510,1 ,"$1,153.00 ",$749.45 ,$36.06 ,"$1,153.00 ",$522.33 ,$530.38 ,$645.68 ,$208.93 ,$322.84 ,$389.69 ,$208.93 ,$389.69 ,$208.93 ,$520.00 ,$520.00 ,$208.93 ,$36.06 ,$396.97 , N/A ,$522.32 ,$208.93 ,$208.93 ,$213.11 ,$864.75 ,$691.80 ,$691.80 ,$208.93 ,$691.80 ,$876.28 ,$876.28 ,$876.28 ,"$1,153.00 ", N/A ,$980.05 ,$522.32 ,$749.45 ,$208.93 ,"$1,153.00 ",$645.68 ,$208.93 ,$303.24 , N/A ,$398.61 ,$380.49 ,$219.38 ,$922.40 ,$470.09 ,$520.00 ,$322.84 ,"$1,037.70 ",$208.93 ,$876.28 ,$275.00 ,$275.00 ,$208.93 ,$275.00 ,$553.44 ,$362.37 
ST. ELIZABETH'S HOSPITAL,51000401,29581,HC APPLY MULTI COMP LWR LEG BIL FAC,510,1 ,"$1,153.00 ",$749.45 ,$34.73 ,"$1,153.00 ",$522.33 ,$530.38 ,$645.68 ,$208.93 ,$322.84 ,$389.71 ,$208.93 ,$448.52 ,$208.93 ,$520.00 ,$520.00 ,$208.93 ,$34.73 ,$396.97 , N/A ,$522.32 ,$208.93 ,$208.93 ,$213.11 ,$864.75 ,$691.80 ,$691.80 ,$208.93 ,$691.80 ,$876.28 ,$876.28 ,$876.28 ,"$1,153.00 ", N/A ,$980.05 ,$522.32 ,$749.45 ,$208.93 ,"$1,153.00 ",$645.68 ,$208.93 ,$303.24 , N/A ,$398.61 ,$380.49 ,$219.38 ,$922.40 ,$470.09 ,$520.00 ,$322.84 ,"$1,037.70 ",$208.93 ,$876.28 ,$275.00 ,$275.00 ,$208.93 ,$275.00 ,$553.44 ,$362.37 
ST. ELIZABETH'S HOSPITAL,51000407,11200,HC REMOVAL SKIN TAG LESIONS <=15 FAC,510,1 ,"$1,035.00 ",$672.75 ,$95.33 ,"$1,035.00 ",$442.60 ,$476.10 ,$579.60 ,$177.04 ,$289.80 ,$349.83 ,$177.04 ,$402.62 ,$177.04 ,$466.79 ,$466.79 ,$177.04 ,$95.33 ,$336.38 , N/A ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$776.25 ,$621.00 ,$621.00 ,$177.04 ,$621.00 ,$786.60 ,$786.60 ,$786.60 ,"$1,035.00 ", N/A ,$879.75 ,$442.60 ,$672.75 ,$177.04 ,"$1,035.00 ",$579.60 ,$177.04 ,$272.21 , N/A ,$323.31 ,$308.62 ,$185.89 ,$828.00 ,$398.34 ,$466.79 ,$289.80 ,$931.50 ,$177.04 ,$786.60 ,$275.00 ,$275.00 ,$177.04 ,$275.00 ,$496.80 ,$293.92 
ST. ELIZABETH'S HOSPITAL,51000407,11200,HC REMOVAL SKIN TAG LESIONS <=15 FAC,510,1 ,$690.00 ,$448.50 ,$95.33 ,$690.00 ,$442.60 ,$317.40 ,$386.40 ,$177.04 ,$193.20 ,$233.22 ,$177.04 ,$268.41 ,$177.04 ,$311.19 ,$311.19 ,$177.04 ,$95.33 ,$336.38 , N/A ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$517.50 ,$414.00 ,$414.00 ,$177.04 ,$414.00 ,$524.40 ,$524.40 ,$524.40 ,$690.00 , N/A ,$586.50 ,$442.60 ,$448.50 ,$177.04 ,$690.00 ,$386.40 ,$177.04 ,$181.47 , N/A ,$323.31 ,$308.62 ,$185.89 ,$552.00 ,$398.34 ,$311.19 ,$193.20 ,$621.00 ,$177.04 ,$524.40 ,$275.00 ,$275.00 ,$177.04 ,$275.00 ,$331.20 ,$293.92 
ST. ELIZABETH'S HOSPITAL,51000436,99241,HC OFFICE CONSULT NEW/ESTAB PT 15 MIN,510,1 ,$103.00 ,$66.95 ,$27.09 ,$134.76 , N/A ,$47.38 ,$57.68 , N/A ,$28.84 ,$36.36 , N/A ,$42.44 , N/A ,$46.45 ,$46.45 , N/A ,$66.95 , N/A , N/A , N/A , N/A , N/A , N/A ,$77.25 ,$61.80 ,$61.80 , N/A ,$61.80 ,$78.28 ,$78.28 ,$78.28 ,$103.00 , N/A ,$87.55 , N/A ,$66.95 , N/A ,$103.00 ,$57.68 , N/A ,$27.09 , N/A ,$103.00 ,$103.00 , N/A ,$82.40 , N/A ,$46.45 ,$28.84 ,$92.70 , N/A ,$78.28 ,$103.00 ,$103.00 , N/A ,$103.00 ,$49.44 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000437,99242,HC OFFICE CONSULT NEW/ESTAB PT 30 MIN,510,1 ,$217.00 ,$141.05 ,$57.07 ,$217.00 , N/A ,$99.82 ,$121.52 , N/A ,$60.76 ,$76.60 , N/A ,$89.40 , N/A ,$97.87 ,$97.87 , N/A ,$141.05 , N/A , N/A , N/A , N/A , N/A , N/A ,$162.75 ,$130.20 ,$130.20 , N/A ,$130.20 ,$164.92 ,$164.92 ,$164.92 ,$217.00 , N/A ,$184.45 , N/A ,$141.05 , N/A ,$217.00 ,$121.52 , N/A ,$57.07 , N/A ,$148.24 ,$141.50 , N/A ,$173.60 , N/A ,$97.87 ,$60.76 ,$195.30 , N/A ,$164.92 ,$217.00 ,$217.00 , N/A ,$217.00 ,$104.16 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000438,99243,HC OFFICE CONSULT NEW/ESTAB PT 40 MIN,510,1 ,$304.00 ,$197.60 ,$79.95 ,$304.00 , N/A ,$139.84 ,$170.24 , N/A ,$85.12 ,$107.31 , N/A ,$125.25 , N/A ,$137.10 ,$137.10 , N/A ,$197.60 , N/A , N/A , N/A , N/A , N/A , N/A ,$228.00 ,$182.40 ,$182.40 , N/A ,$182.40 ,$231.04 ,$231.04 ,$231.04 ,$304.00 , N/A ,$258.40 , N/A ,$197.60 , N/A ,$304.00 ,$170.24 , N/A ,$79.95 , N/A ,$148.24 ,$141.50 , N/A ,$243.20 , N/A ,$137.10 ,$85.12 ,$273.60 , N/A ,$231.04 ,$275.00 ,$275.00 , N/A ,$275.00 ,$145.92 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000439,99244,HC OFFICE CONSULT NEW/ESTAB PT 60 MIN,510,1 ,$490.00 ,$318.50 ,$128.87 ,$490.00 , N/A ,$225.40 ,$274.40 , N/A ,$137.20 ,$172.97 , N/A ,$201.88 , N/A ,$220.99 ,$220.99 , N/A ,$318.50 , N/A , N/A , N/A , N/A , N/A , N/A ,$367.50 ,$294.00 ,$294.00 , N/A ,$294.00 ,$372.40 ,$372.40 ,$372.40 ,$490.00 , N/A ,$416.50 , N/A ,$318.50 , N/A ,$490.00 ,$274.40 , N/A ,$128.87 , N/A ,$148.24 ,$141.50 , N/A ,$392.00 , N/A ,$220.99 ,$137.20 ,$441.00 , N/A ,$372.40 ,$275.00 ,$275.00 , N/A ,$275.00 ,$235.20 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000443,G0463,HC HOSPITAL OUTPT CLINIC VISIT FOR ASSESSMENT  AND  MANAGEMENT OF A PATIENT,510,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$292.85 ,$155.48 ,$189.28 ,$117.14 ,$94.64 ,$114.24 ,$117.14 ,$131.48 ,$117.14 ,$152.44 ,$152.44 ,$117.14 ,$219.70 ,$222.57 , N/A ,$292.85 ,$117.14 ,$117.14 ,$119.48 ,$253.50 ,$202.80 ,$202.80 ,$117.14 ,$202.80 ,$256.88 ,$256.88 ,$256.88 ,$338.00 , N/A ,$287.30 ,$292.85 ,$219.70 ,$117.14 ,$338.00 ,$189.28 ,$117.14 ,$88.89 , N/A ,$148.24 ,$141.50 ,$123.00 ,$270.40 ,$263.57 ,$152.44 ,$94.64 ,$304.20 ,$117.14 ,$256.88 ,$275.00 ,$275.00 ,$117.14 ,$275.00 ,$162.24 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000464,99202,HC CLINIC VISIT LIMITED NEW -25,510,1 ,$306.00 ,$198.90 ,$63.40 ,$306.00 , N/A ,$140.76 ,$171.36 , N/A ,$85.68 ,$108.02 , N/A ,$126.07 , N/A ,$138.01 ,$138.01 , N/A ,$63.40 , N/A , N/A , N/A , N/A , N/A , N/A ,$229.50 ,$183.60 ,$183.60 , N/A ,$183.60 ,$232.56 ,$232.56 ,$232.56 ,$306.00 , N/A ,$260.10 , N/A ,$198.90 , N/A ,$78.75 ,$171.36 , N/A ,$80.48 , N/A ,$148.24 ,$141.50 , N/A ,$244.80 , N/A ,$138.01 ,$85.68 ,$275.40 , N/A ,$232.56 ,$275.00 ,$275.00 , N/A ,$275.00 ,$146.88 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000465,99203,HC CLINIC VISIT INTERM NEW -25,510,1 ,$370.00 ,$240.50 ,$97.31 ,$370.00 , N/A ,$170.20 ,$207.20 , N/A ,$103.60 ,$130.61 , N/A ,$152.44 , N/A ,$166.87 ,$166.87 , N/A ,$108.73 , N/A , N/A , N/A , N/A , N/A , N/A ,$277.50 ,$222.00 ,$222.00 , N/A ,$222.00 ,$281.20 ,$281.20 ,$281.20 ,$370.00 , N/A ,$314.50 , N/A ,$240.50 , N/A ,$121.24 ,$207.20 , N/A ,$97.31 , N/A ,$148.24 ,$141.50 , N/A ,$296.00 , N/A ,$166.87 ,$103.60 ,$333.00 , N/A ,$281.20 ,$275.00 ,$275.00 , N/A ,$275.00 ,$177.60 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000466,99204,HC CLINIC VISIT COMPLEX NEW -25,510,1 ,$523.00 ,$339.95 ,$134.76 ,$523.00 , N/A ,$240.58 ,$292.88 , N/A ,$146.44 ,$184.62 , N/A ,$215.48 , N/A ,$235.87 ,$235.87 , N/A ,$174.95 , N/A , N/A , N/A , N/A , N/A , N/A ,$392.25 ,$313.80 ,$313.80 , N/A ,$313.80 ,$397.48 ,$397.48 ,$397.48 ,$523.00 , N/A ,$444.55 , N/A ,$339.95 , N/A ,$181.05 ,$292.88 , N/A ,$137.55 , N/A ,$148.24 ,$141.50 , N/A ,$418.40 , N/A ,$235.87 ,$146.44 ,$470.70 , N/A ,$397.48 ,$275.00 ,$275.00 , N/A ,$275.00 ,$251.04 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000467,99205,HC CLINIC VISIT COMPREH NEW -25,510,1 ,$590.00 ,$383.50 ,$134.76 ,$590.00 , N/A ,$271.40 ,$330.40 , N/A ,$165.20 ,$208.27 , N/A ,$243.08 , N/A ,$266.09 ,$266.09 , N/A ,$237.15 , N/A , N/A , N/A , N/A , N/A , N/A ,$442.50 ,$354.00 ,$354.00 , N/A ,$354.00 ,$448.40 ,$448.40 ,$448.40 ,$590.00 , N/A ,$501.50 , N/A ,$383.50 , N/A ,$239.15 ,$330.40 , N/A ,$155.17 , N/A ,$148.24 ,$141.50 , N/A ,$472.00 , N/A ,$266.09 ,$165.20 ,$531.00 , N/A ,$448.40 ,$275.00 ,$275.00 , N/A ,$275.00 ,$283.20 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000468,99211,HC CLINIC VISIT BRIEF ESTAB -25,510,1 ,$218.00 ,$141.70 ,$11.36 ,$218.00 , N/A ,$100.28 ,$122.08 , N/A ,$61.04 ,$76.95 , N/A ,$87.81 , N/A ,$98.32 ,$98.32 , N/A ,$11.36 , N/A , N/A , N/A , N/A , N/A , N/A ,$163.50 ,$130.80 ,$130.80 , N/A ,$130.80 ,$165.68 ,$165.68 ,$165.68 ,$218.00 , N/A ,$185.30 , N/A ,$141.70 , N/A ,$218.00 ,$122.08 , N/A ,$57.33 , N/A ,$148.24 ,$141.50 , N/A ,$174.40 , N/A ,$98.32 ,$61.04 ,$196.20 , N/A ,$165.68 ,$218.00 ,$218.00 , N/A ,$218.00 ,$104.64 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000469,99212,HC CLINIC VISIT LIMITED ESTAB -25,510,1 ,$264.00 ,$171.60 ,$47.13 ,$264.00 , N/A ,$121.44 ,$147.84 , N/A ,$73.92 ,$93.19 , N/A ,$108.77 , N/A ,$119.06 ,$119.06 , N/A ,$47.13 , N/A , N/A , N/A , N/A , N/A , N/A ,$198.00 ,$158.40 ,$158.40 , N/A ,$158.40 ,$200.64 ,$200.64 ,$200.64 ,$264.00 , N/A ,$224.40 , N/A ,$171.60 , N/A ,$60.02 ,$147.84 , N/A ,$69.43 , N/A ,$148.24 ,$141.50 , N/A ,$211.20 , N/A ,$119.06 ,$73.92 ,$237.60 , N/A ,$200.64 ,$264.00 ,$264.00 , N/A ,$264.00 ,$126.72 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000470,99213,HC CLINIC VISIT INTERM EST -25,510,1 ,$318.00 ,$206.70 ,$83.63 ,$318.00 , N/A ,$146.28 ,$178.08 , N/A ,$89.04 ,$112.25 , N/A ,$131.02 , N/A ,$143.42 ,$143.42 , N/A ,$85.84 , N/A , N/A , N/A , N/A , N/A , N/A ,$238.50 ,$190.80 ,$190.80 , N/A ,$190.80 ,$241.68 ,$241.68 ,$241.68 ,$318.00 , N/A ,$270.30 , N/A ,$206.70 , N/A ,$97.92 ,$178.08 , N/A ,$83.63 , N/A ,$148.24 ,$141.50 , N/A ,$254.40 , N/A ,$143.42 ,$89.04 ,$286.20 , N/A ,$241.68 ,$275.00 ,$275.00 , N/A ,$275.00 ,$152.64 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000471,99214,HC CLINIC VISIT COMPLEX EST -25,510,1 ,$459.00 ,$298.35 ,$120.72 ,$459.00 , N/A ,$211.14 ,$257.04 , N/A ,$128.52 ,$162.03 , N/A ,$189.11 , N/A ,$207.01 ,$207.01 , N/A ,$125.09 , N/A , N/A , N/A , N/A , N/A , N/A ,$344.25 ,$275.40 ,$275.40 , N/A ,$275.40 ,$348.84 ,$348.84 ,$348.84 ,$459.00 , N/A ,$390.15 , N/A ,$298.35 , N/A ,$459.00 ,$257.04 , N/A ,$120.72 , N/A ,$148.24 ,$141.50 , N/A ,$367.20 , N/A ,$207.01 ,$128.52 ,$413.10 , N/A ,$348.84 ,$275.00 ,$275.00 , N/A ,$275.00 ,$220.32 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51000472,99215,HC CLINIC VISIT COMPREH EST -25,510,1 ,$563.00 ,$365.95 ,$134.76 ,$563.00 , N/A ,$258.98 ,$315.28 , N/A ,$157.64 ,$198.74 , N/A ,$231.96 , N/A ,$253.91 ,$253.91 , N/A ,$186.74 , N/A , N/A , N/A , N/A , N/A , N/A ,$422.25 ,$337.80 ,$337.80 , N/A ,$337.80 ,$427.88 ,$427.88 ,$427.88 ,$563.00 , N/A ,$478.55 , N/A ,$365.95 , N/A ,$563.00 ,$315.28 , N/A ,$148.07 , N/A ,$148.24 ,$141.50 , N/A ,$450.40 , N/A ,$253.91 ,$157.64 ,$506.70 , N/A ,$427.88 ,$275.00 ,$275.00 , N/A ,$275.00 ,$270.24 ,$134.76 
ST. ELIZABETH'S HOSPITAL,51070001,98960,HC EDUCATION SELF MGNT NON PHY HLTCARE PROF,510,1 ,$92.00 ,$59.80 ,$24.20 ,$92.00 , N/A ,$42.32 ,$51.52 , N/A ,$25.76 ,$32.48 , N/A ,$37.90 , N/A ,$41.49 ,$41.49 , N/A ,$59.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$69.00 ,$55.20 ,$55.20 , N/A ,$55.20 ,$69.92 ,$69.92 ,$69.92 ,$92.00 , N/A ,$78.20 , N/A ,$59.80 , N/A ,$92.00 ,$51.52 , N/A ,$24.20 , N/A ,$38.06 ,$36.33 , N/A ,$73.60 , N/A ,$41.49 ,$25.76 ,$82.80 , N/A ,$69.92 ,$92.00 ,$92.00 , N/A ,$92.00 ,$44.16 ,$34.60 
ST. ELIZABETH'S HOSPITAL,51100000,62370,HC ELEC ANLYS REPRGRMING/REFILL SPINAL INF PUMP PHYSICIAN,511,1 ,$808.00 ,$525.20 ,$60.38 ,$808.00 ,$672.98 ,$371.68 ,$452.48 ,$269.19 ,$226.24 ,$273.10 ,$269.19 ,$314.31 ,$269.19 ,$364.41 ,$364.41 ,$269.19 ,$60.38 ,$511.46 , N/A ,$672.97 ,$269.19 ,$269.19 ,$274.57 ,$606.00 ,$484.80 ,$484.80 ,$269.19 ,$484.80 ,$614.08 ,$614.08 ,$614.08 ,$808.00 , N/A ,$686.80 ,$672.97 ,$525.20 ,$269.19 ,$808.00 ,$452.48 ,$269.19 ,$212.50 , N/A ,$267.10 ,$254.96 ,$282.65 ,$646.40 ,$605.68 ,$364.41 ,$226.24 ,$727.20 ,$269.19 ,$614.08 ,$275.00 ,$275.00 ,$269.19 ,$275.00 ,$387.84 ,$242.82 
ST. ELIZABETH'S HOSPITAL,61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$3,973.00 ","$2,582.45 ",$314.60 ,"$3,973.00 ",$907.63 ,"$1,100.00 ","$2,224.88 ",$363.05 ,"$1,112.44 ","$1,402.47 ",$363.05 ,"$1,636.88 ",$363.05 ,"$1,791.82 ","$1,791.82 ",$363.05 ,$314.60 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,979.75 ","$2,383.80 ","$2,383.80 ",$363.05 ,"$2,383.80 ",$404.21 ,$404.21 ,$404.21 ,"$3,973.00 ", N/A ,"$3,377.05 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,973.00 ","$2,224.88 ",$363.05 ,"$1,044.90 ", N/A ,$365.28 ,$348.67 ,$381.20 ,"$3,178.40 ",$816.86 ,"$1,791.82 ","$1,112.44 ","$3,575.70 ",$363.05 ,$404.21 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,907.04 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$2,329.00 ","$1,513.85 ",$206.40 ,"$2,329.00 ",$567.13 ,"$1,100.00 ","$1,304.24 ",$226.85 ,$652.12 ,$822.14 ,$226.85 ,$959.55 ,$226.85 ,"$1,050.38 ","$1,050.38 ",$226.85 ,$206.40 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,746.75 ","$1,397.40 ","$1,397.40 ",$226.85 ,"$1,397.40 ",$304.85 ,$304.85 ,$304.85 ,"$2,329.00 ", N/A ,"$1,979.65 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,329.00 ","$1,304.24 ",$226.85 ,$612.53 , N/A ,$447.21 ,$426.88 ,$238.19 ,"$1,863.20 ",$510.41 ,"$1,050.38 ",$652.12 ,"$2,096.10 ",$226.85 ,$304.85 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,117.92 ",$406.55 
ST. ELIZABETH'S HOSPITAL,61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$2,445.00 ","$1,589.25 ",$221.89 ,"$2,445.00 ",$907.63 ,"$1,100.00 ","$1,369.20 ",$363.05 ,$684.60 ,$863.09 ,$363.05 ,"$1,007.34 ",$363.05 ,"$1,102.70 ","$1,102.70 ",$363.05 ,$221.89 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,833.75 ","$1,467.00 ","$1,467.00 ",$363.05 ,"$1,467.00 ",$301.88 ,$301.88 ,$301.88 ,"$2,445.00 ", N/A ,"$2,078.25 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,445.00 ","$1,369.20 ",$363.05 ,$643.04 , N/A ,$447.21 ,$426.88 ,$381.20 ,"$1,956.00 ",$816.86 ,"$1,102.70 ",$684.60 ,"$2,200.50 ",$363.05 ,$301.88 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,173.60 ",$406.55 
ST. ELIZABETH'S HOSPITAL,61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$2,562.00 ","$1,665.30 ",$337.01 ,"$2,562.00 ",$907.63 ,"$1,100.00 ","$1,434.72 ",$363.05 ,$717.36 ,$904.39 ,$363.05 ,"$1,055.54 ",$363.05 ,"$1,155.46 ","$1,155.46 ",$363.05 ,$337.01 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,921.50 ","$1,537.20 ","$1,537.20 ",$363.05 ,"$1,537.20 ",$467.46 ,$467.46 ,$467.46 ,"$2,562.00 ", N/A ,"$2,177.70 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,562.00 ","$1,434.72 ",$363.05 ,$673.81 , N/A ,$447.21 ,$426.88 ,$381.20 ,"$2,049.60 ",$816.86 ,"$1,155.46 ",$717.36 ,"$2,305.80 ",$363.05 ,$467.46 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,229.76 ",$406.55 
ST. ELIZABETH'S HOSPITAL,61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$2,324.00 ","$1,510.60 ",$207.21 ,"$2,324.00 ",$567.13 ,"$1,100.00 ","$1,301.44 ",$226.85 ,$650.72 ,$820.37 ,$226.85 ,$957.49 ,$226.85 ,"$1,048.12 ","$1,048.12 ",$226.85 ,$207.21 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,743.00 ","$1,394.40 ","$1,394.40 ",$226.85 ,"$1,394.40 ",$306.35 ,$306.35 ,$306.35 ,"$2,324.00 ", N/A ,"$1,975.40 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,324.00 ","$1,301.44 ",$226.85 ,$611.21 , N/A ,$447.21 ,$426.88 ,$238.19 ,"$1,859.20 ",$510.41 ,"$1,048.12 ",$650.72 ,"$2,091.60 ",$226.85 ,$306.35 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,115.52 ",$406.55 
ST. ELIZABETH'S HOSPITAL,61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$2,557.00 ","$1,662.05 ",$228.41 ,"$2,557.00 ",$907.63 ,"$1,100.00 ","$1,431.92 ",$363.05 ,$715.96 ,$902.62 ,$363.05 ,"$1,053.48 ",$363.05 ,"$1,153.21 ","$1,153.21 ",$363.05 ,$228.41 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,917.75 ","$1,534.20 ","$1,534.20 ",$363.05 ,"$1,534.20 ",$324.23 ,$324.23 ,$324.23 ,"$2,557.00 ", N/A ,"$2,173.45 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,557.00 ","$1,431.92 ",$363.05 ,$672.49 , N/A ,$447.21 ,$426.88 ,$381.20 ,"$2,045.60 ",$816.86 ,"$1,153.21 ",$715.96 ,"$2,301.30 ",$363.05 ,$324.23 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,227.36 ",$406.55 
ST. ELIZABETH'S HOSPITAL,61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$2,936.00 ","$1,908.40 ",$339.05 ,"$2,936.00 ",$907.63 ,"$1,100.00 ","$1,644.16 ",$363.05 ,$822.08 ,"$1,036.41 ",$363.05 ,"$1,209.63 ",$363.05 ,"$1,324.14 ","$1,324.14 ",$363.05 ,$339.05 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,202.00 ","$1,761.60 ","$1,761.60 ",$363.05 ,"$1,761.60 ",$470.45 ,$470.45 ,$470.45 ,"$2,936.00 ", N/A ,"$2,495.60 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,936.00 ","$1,644.16 ",$363.05 ,$772.17 , N/A ,$447.21 ,$426.88 ,$381.20 ,"$2,348.80 ",$816.86 ,"$1,324.14 ",$822.08 ,"$2,642.40 ",$363.05 ,$470.45 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,409.28 ",$406.55 
ST. ELIZABETH'S HOSPITAL,61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,866.00 ","$2,512.90 ",$165.25 ,"$3,866.00 ",$567.13 ,"$1,100.00 ","$2,164.96 ",$226.85 ,"$1,082.48 ","$1,364.70 ",$226.85 ,"$1,592.79 ",$226.85 ,"$1,743.57 ","$1,743.57 ",$226.85 ,$165.25 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,899.50 ","$2,319.60 ","$2,319.60 ",$226.85 ,"$2,319.60 ",$212.30 ,$212.30 ,$212.30 ,"$3,866.00 ", N/A ,"$3,286.10 ",$567.13 ,"$1,708.00 ",$226.85 ,"$3,866.00 ","$2,164.96 ",$226.85 ,"$1,016.76 ", N/A ,$409.28 ,$390.67 ,$238.19 ,"$3,092.80 ",$510.41 ,"$1,743.57 ","$1,082.48 ","$3,479.40 ",$226.85 ,$212.30 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,855.68 ",$372.07 
ST. ELIZABETH'S HOSPITAL,61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$5,276.00 ","$3,429.40 ",$243.89 ,"$5,276.00 ",$907.63 ,"$1,100.00 ","$2,954.56 ",$363.05 ,"$1,477.28 ","$1,862.43 ",$363.05 ,"$2,173.71 ",$363.05 ,"$2,379.48 ","$2,379.48 ",$363.05 ,$243.89 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,957.00 ","$3,165.60 ","$3,165.60 ",$363.05 ,"$3,165.60 ",$314.30 ,$314.30 ,$314.30 ,"$5,276.00 ", N/A ,"$4,484.60 ",$907.62 ,"$1,708.00 ",$363.05 ,"$5,276.00 ","$2,954.56 ",$363.05 ,"$1,387.59 ", N/A ,$409.28 ,$390.67 ,$381.20 ,"$4,220.80 ",$816.86 ,"$2,379.48 ","$1,477.28 ","$4,748.40 ",$363.05 ,$314.30 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,532.48 ",$372.07 
ST. ELIZABETH'S HOSPITAL,61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$5,398.00 ","$3,508.70 ",$277.93 ,"$5,398.00 ",$907.63 ,"$1,100.00 ","$3,022.88 ",$363.05 ,"$1,511.44 ","$1,905.49 ",$363.05 ,"$2,223.98 ",$363.05 ,"$2,434.50 ","$2,434.50 ",$363.05 ,$277.93 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$4,048.50 ","$3,238.80 ","$3,238.80 ",$363.05 ,"$3,238.80 ",$358.01 ,$358.01 ,$358.01 ,"$5,398.00 ", N/A ,"$4,588.30 ",$907.62 ,"$1,708.00 ",$363.05 ,"$5,398.00 ","$3,022.88 ",$363.05 ,"$1,419.67 ", N/A ,$409.28 ,$390.67 ,$381.20 ,"$4,318.40 ",$816.86 ,"$2,434.50 ","$1,511.44 ","$4,858.20 ",$363.05 ,$358.01 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,591.04 ",$372.07 
ST. ELIZABETH'S HOSPITAL,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$2,197.00 ","$1,428.05 ",$159.14 ,"$2,197.00 ",$567.13 ,"$1,100.00 ","$1,230.32 ",$226.85 ,$615.16 ,$775.54 ,$226.85 ,$905.16 ,$226.85 ,$990.85 ,$990.85 ,$226.85 ,$159.14 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,647.75 ","$1,318.20 ","$1,318.20 ",$226.85 ,"$1,318.20 ",$203.85 ,$203.85 ,$203.85 ,"$2,197.00 ", N/A ,"$1,867.45 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,197.00 ","$1,230.32 ",$226.85 ,$577.81 , N/A ,$295.17 ,$281.76 ,$238.19 ,"$1,757.60 ",$510.41 ,$990.85 ,$615.16 ,"$1,977.30 ",$226.85 ,$203.85 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,054.56 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$2,197.00 ","$1,428.05 ",$159.14 ,"$2,197.00 ",$567.13 ,"$1,100.00 ","$1,230.32 ",$226.85 ,$615.16 ,$775.54 ,$226.85 ,$905.16 ,$226.85 ,$990.85 ,$990.85 ,$226.85 ,$159.14 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,647.75 ","$1,318.20 ","$1,318.20 ",$226.85 ,"$1,318.20 ",$203.85 ,$203.85 ,$203.85 ,"$2,197.00 ", N/A ,"$1,867.45 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,197.00 ","$1,230.32 ",$226.85 ,$577.81 , N/A ,$295.17 ,$281.76 ,$238.19 ,"$1,757.60 ",$510.41 ,$990.85 ,$615.16 ,"$1,977.30 ",$226.85 ,$203.85 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,054.56 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$4,434.00 ","$2,882.10 ",$251.64 ,"$4,434.00 ",$907.63 ,"$1,100.00 ","$2,483.04 ",$363.05 ,"$1,241.52 ","$1,565.20 ",$363.05 ,"$1,826.81 ",$363.05 ,"$1,999.73 ","$1,999.73 ",$363.05 ,$251.64 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,325.50 ","$2,660.40 ","$2,660.40 ",$363.05 ,"$2,660.40 ",$322.25 ,$322.25 ,$322.25 ,"$4,434.00 ", N/A ,"$3,768.90 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,434.00 ","$2,483.04 ",$363.05 ,"$1,166.14 ", N/A ,$295.17 ,$281.76 ,$381.20 ,"$3,547.20 ",$816.86 ,"$1,999.73 ","$1,241.52 ","$3,990.60 ",$363.05 ,$322.25 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,128.32 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,496.00 ","$1,622.40 ",$159.14 ,"$2,496.00 ",$567.13 ,"$1,100.00 ","$1,397.76 ",$226.85 ,$698.88 ,$881.09 ,$226.85 ,"$1,028.35 ",$226.85 ,"$1,125.70 ","$1,125.70 ",$226.85 ,$159.14 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,872.00 ","$1,497.60 ","$1,497.60 ",$226.85 ,"$1,497.60 ",$204.35 ,$204.35 ,$204.35 ,"$2,496.00 ", N/A ,"$2,121.60 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,496.00 ","$1,397.76 ",$226.85 ,$656.45 , N/A ,$295.17 ,$281.76 ,$238.19 ,"$1,996.80 ",$510.41 ,"$1,125.70 ",$698.88 ,"$2,246.40 ",$226.85 ,$204.35 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,198.08 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,496.00 ","$1,622.40 ",$159.14 ,"$2,496.00 ",$567.13 ,"$1,100.00 ","$1,397.76 ",$226.85 ,$698.88 ,$881.09 ,$226.85 ,"$1,028.35 ",$226.85 ,"$1,125.70 ","$1,125.70 ",$226.85 ,$159.14 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,872.00 ","$1,497.60 ","$1,497.60 ",$226.85 ,"$1,497.60 ",$204.35 ,$204.35 ,$204.35 ,"$2,496.00 ", N/A ,"$2,121.60 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,496.00 ","$1,397.76 ",$226.85 ,$656.45 , N/A ,$295.17 ,$281.76 ,$238.19 ,"$1,996.80 ",$510.41 ,"$1,125.70 ",$698.88 ,"$2,246.40 ",$226.85 ,$204.35 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,198.08 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$5,224.00 ","$3,395.60 ",$248.38 ,"$5,224.00 ",$907.63 ,"$1,100.00 ","$2,925.44 ",$363.05 ,"$1,462.72 ","$1,844.07 ",$363.05 ,"$2,152.29 ",$363.05 ,"$2,356.02 ","$2,356.02 ",$363.05 ,$248.38 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,918.00 ","$3,134.40 ","$3,134.40 ",$363.05 ,"$3,134.40 ",$320.25 ,$320.25 ,$320.25 ,"$5,224.00 ", N/A ,"$4,440.40 ",$907.62 ,"$1,708.00 ",$363.05 ,"$5,224.00 ","$2,925.44 ",$363.05 ,"$1,373.91 ", N/A ,$295.17 ,$281.76 ,$381.20 ,"$4,179.20 ",$816.86 ,"$2,356.02 ","$1,462.72 ","$4,701.60 ",$363.05 ,$320.25 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,507.52 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$2,496.00 ","$1,622.40 ",$159.54 ,"$2,496.00 ",$567.13 ,"$1,100.00 ","$1,397.76 ",$226.85 ,$698.88 ,$881.09 ,$226.85 ,"$1,028.35 ",$226.85 ,"$1,125.70 ","$1,125.70 ",$226.85 ,$159.54 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,872.00 ","$1,497.60 ","$1,497.60 ",$226.85 ,"$1,497.60 ",$204.35 ,$204.35 ,$204.35 ,"$2,496.00 ", N/A ,"$2,121.60 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,496.00 ","$1,397.76 ",$226.85 ,$656.45 , N/A ,$295.17 ,$281.76 ,$238.19 ,"$1,996.80 ",$510.41 ,"$1,125.70 ",$698.88 ,"$2,246.40 ",$226.85 ,$204.35 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,198.08 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$2,496.00 ","$1,622.40 ",$159.54 ,"$2,496.00 ",$567.13 ,"$1,100.00 ","$1,397.76 ",$226.85 ,$698.88 ,$881.09 ,$226.85 ,"$1,028.35 ",$226.85 ,"$1,125.70 ","$1,125.70 ",$226.85 ,$159.54 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,872.00 ","$1,497.60 ","$1,497.60 ",$226.85 ,"$1,497.60 ",$204.35 ,$204.35 ,$204.35 ,"$2,496.00 ", N/A ,"$2,121.60 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,496.00 ","$1,397.76 ",$226.85 ,$656.45 , N/A ,$295.17 ,$281.76 ,$238.19 ,"$1,996.80 ",$510.41 ,"$1,125.70 ",$698.88 ,"$2,246.40 ",$226.85 ,$204.35 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,198.08 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$5,224.00 ","$3,395.60 ",$245.53 ,"$5,224.00 ",$907.63 ,"$1,100.00 ","$2,925.44 ",$363.05 ,"$1,462.72 ","$1,844.07 ",$363.05 ,"$2,152.29 ",$363.05 ,"$2,356.02 ","$2,356.02 ",$363.05 ,$245.53 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,918.00 ","$3,134.40 ","$3,134.40 ",$363.05 ,"$3,134.40 ",$316.77 ,$316.77 ,$316.77 ,"$5,224.00 ", N/A ,"$4,440.40 ",$907.62 ,"$1,708.00 ",$363.05 ,"$5,224.00 ","$2,925.44 ",$363.05 ,"$1,373.91 ", N/A ,$295.17 ,$281.76 ,$381.20 ,"$4,179.20 ",$816.86 ,"$2,356.02 ","$1,462.72 ","$4,701.60 ",$363.05 ,$316.77 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,507.52 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$4,548.00 ","$2,956.20 ",$268.34 ,"$4,548.00 ",$907.63 ,"$1,100.00 ","$2,546.88 ",$363.05 ,"$1,273.44 ","$1,605.44 ",$363.05 ,"$1,873.78 ",$363.05 ,"$2,051.15 ","$2,051.15 ",$363.05 ,$279.75 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,411.00 ","$2,728.80 ","$2,728.80 ",$363.05 ,"$2,728.80 ",$361.49 ,$361.49 ,$361.49 ,"$4,548.00 ", N/A ,"$3,865.80 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,548.00 ","$2,546.88 ",$363.05 ,"$1,196.12 ", N/A ,$295.17 ,$281.76 ,$381.20 ,"$3,638.40 ",$816.86 ,"$2,051.15 ","$1,273.44 ","$4,093.20 ",$363.05 ,$361.49 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,183.04 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$5,353.00 ","$3,479.45 ",$268.34 ,"$5,353.00 ",$907.63 ,"$1,100.00 ","$2,997.68 ",$363.05 ,"$1,498.84 ","$1,889.61 ",$363.05 ,"$2,205.44 ",$363.05 ,"$2,414.20 ","$2,414.20 ",$363.05 ,$280.16 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$4,014.75 ","$3,211.80 ","$3,211.80 ",$363.05 ,"$3,211.80 ",$362.97 ,$362.97 ,$362.97 ,"$5,353.00 ", N/A ,"$4,550.05 ",$907.62 ,"$1,708.00 ",$363.05 ,"$5,353.00 ","$2,997.68 ",$363.05 ,"$1,407.84 ", N/A ,$295.17 ,$281.76 ,$381.20 ,"$4,282.40 ",$816.86 ,"$2,414.20 ","$1,498.84 ","$4,817.70 ",$363.05 ,$362.97 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,569.44 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$6,351.00 ","$4,128.15 ",$268.34 ,"$6,351.00 ",$907.63 ,"$1,100.00 ","$3,556.56 ",$363.05 ,"$1,778.28 ","$2,241.90 ",$363.05 ,"$2,616.61 ",$363.05 ,"$2,864.30 ","$2,864.30 ",$363.05 ,$278.53 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$4,763.25 ","$3,810.60 ","$3,810.60 ",$363.05 ,"$3,810.60 ",$360.50 ,$360.50 ,$360.50 ,"$6,351.00 ", N/A ,"$5,398.35 ",$907.62 ,"$1,708.00 ",$363.05 ,"$6,351.00 ","$3,556.56 ",$363.05 ,"$1,670.31 ", N/A ,$295.17 ,$281.76 ,$381.20 ,"$5,080.80 ",$816.86 ,"$2,864.30 ","$1,778.28 ","$5,715.90 ",$363.05 ,$360.50 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$3,048.48 ",$268.34 
ST. ELIZABETH'S HOSPITAL,61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$4,331.00 ","$2,815.15 ",$212.11 ,"$4,331.00 ",$567.13 ,"$1,100.00 ","$2,425.36 ",$226.85 ,"$1,212.68 ","$1,528.84 ",$226.85 ,"$1,784.37 ",$226.85 ,"$1,953.28 ","$1,953.28 ",$226.85 ,$212.11 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$3,248.25 ","$2,598.60 ","$2,598.60 ",$226.85 ,"$2,598.60 ",$275.39 ,$275.39 ,$275.39 ,"$4,331.00 ", N/A ,"$3,681.35 ",$567.13 ,"$1,708.00 ",$226.85 ,"$4,331.00 ","$2,425.36 ",$226.85 ,"$1,139.05 ", N/A ,$365.28 ,$348.67 ,$238.19 ,"$3,464.80 ",$510.41 ,"$1,953.28 ","$1,212.68 ","$3,897.90 ",$226.85 ,$275.39 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$2,078.88 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$4,466.00 ","$2,902.90 ",$247.56 ,"$4,466.00 ",$907.63 ,"$1,100.00 ","$2,500.96 ",$363.05 ,"$1,250.48 ","$1,576.50 ",$363.05 ,"$1,839.99 ",$363.05 ,"$2,014.17 ","$2,014.17 ",$363.05 ,$247.56 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,349.50 ","$2,679.60 ","$2,679.60 ",$363.05 ,"$2,679.60 ",$319.76 ,$319.76 ,$319.76 ,"$4,466.00 ", N/A ,"$3,796.10 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,466.00 ","$2,500.96 ",$363.05 ,"$1,174.56 ", N/A ,$365.28 ,$348.67 ,$381.20 ,"$3,572.80 ",$816.86 ,"$2,014.17 ","$1,250.48 ","$4,019.40 ",$363.05 ,$319.76 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,143.68 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$4,805.00 ","$3,123.25 ",$310.53 ,"$4,805.00 ",$907.63 ,"$1,100.00 ","$2,690.80 ",$363.05 ,"$1,345.40 ","$1,696.17 ",$363.05 ,"$1,979.66 ",$363.05 ,"$2,167.06 ","$2,167.06 ",$363.05 ,$310.53 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,603.75 ","$2,883.00 ","$2,883.00 ",$363.05 ,"$2,883.00 ",$403.22 ,$403.22 ,$403.22 ,"$4,805.00 ", N/A ,"$4,084.25 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,805.00 ","$2,690.80 ",$363.05 ,"$1,263.72 ", N/A ,$365.28 ,$348.67 ,$381.20 ,"$3,844.00 ",$816.86 ,"$2,167.06 ","$1,345.40 ","$4,324.50 ",$363.05 ,$403.22 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,306.40 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$2,978.00 ","$1,935.70 ",$226.85 ,"$2,978.00 ",$567.13 ,"$1,100.00 ","$1,667.68 ",$226.85 ,$833.84 ,"$1,051.23 ",$226.85 ,"$1,226.94 ",$226.85 ,"$1,343.08 ","$1,343.08 ",$226.85 ,$315.61 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,233.50 ","$1,786.80 ","$1,786.80 ",$226.85 ,"$1,786.80 ",$318.27 ,$318.27 ,$318.27 ,"$2,978.00 ", N/A ,"$2,531.30 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,978.00 ","$1,667.68 ",$226.85 ,$783.21 , N/A ,$365.28 ,$348.67 ,$238.19 ,"$2,382.40 ",$510.41 ,"$1,343.08 ",$833.84 ,"$2,680.20 ",$226.85 ,$318.27 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,429.44 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$3,384.00 ","$2,199.60 ",$332.07 ,"$3,384.00 ",$907.63 ,"$1,100.00 ","$1,895.04 ",$363.05 ,$947.52 ,"$1,194.55 ",$363.05 ,"$1,394.21 ",$363.05 ,"$1,526.18 ","$1,526.18 ",$363.05 ,$335.58 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,538.00 ","$2,030.40 ","$2,030.40 ",$363.05 ,"$2,030.40 ",$437.49 ,$437.49 ,$437.49 ,"$3,384.00 ", N/A ,"$2,876.40 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,384.00 ","$1,895.04 ",$363.05 ,$889.99 , N/A ,$365.28 ,$348.67 ,$381.20 ,"$2,707.20 ",$816.86 ,"$1,526.18 ",$947.52 ,"$3,045.60 ",$363.05 ,$437.49 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,624.32 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$3,790.00 ","$2,463.50 ",$332.07 ,"$3,790.00 ",$907.63 ,"$1,100.00 ","$2,122.40 ",$363.05 ,"$1,061.20 ","$1,337.87 ",$363.05 ,"$1,561.48 ",$363.05 ,"$1,709.29 ","$1,709.29 ",$363.05 ,$409.95 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,842.50 ","$2,274.00 ","$2,274.00 ",$363.05 ,"$2,274.00 ",$531.89 ,$531.89 ,$531.89 ,"$3,790.00 ", N/A ,"$3,221.50 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,790.00 ","$2,122.40 ",$363.05 ,$996.77 , N/A ,$365.28 ,$348.67 ,$381.20 ,"$3,032.00 ",$816.86 ,"$1,709.29 ","$1,061.20 ","$3,411.00 ",$363.05 ,$531.89 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,819.20 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$3,837.00 ","$2,494.05 ",$180.33 ,"$3,837.00 ",$567.13 ,"$1,100.00 ","$2,148.72 ",$226.85 ,"$1,074.36 ","$1,354.46 ",$226.85 ,"$1,580.84 ",$226.85 ,"$1,730.49 ","$1,730.49 ",$226.85 ,$180.33 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,877.75 ","$2,302.20 ","$2,302.20 ",$226.85 ,"$2,302.20 ",$230.33 ,$230.33 ,$230.33 ,"$3,837.00 ", N/A ,"$3,261.45 ",$567.13 ,"$1,708.00 ",$226.85 ,"$3,837.00 ","$2,148.72 ",$226.85 ,"$1,009.13 ", N/A ,$246.54 ,$235.34 ,$238.19 ,"$3,069.60 ",$510.41 ,"$1,730.49 ","$1,074.36 ","$3,453.30 ",$226.85 ,$230.33 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,841.76 ",$224.13 
ST. ELIZABETH'S HOSPITAL,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$4,466.00 ","$2,902.90 ",$224.13 ,"$4,466.00 ","$1,763.33 ","$1,100.00 ","$2,500.96 ",$705.33 ,"$1,250.48 ","$1,576.50 ",$705.33 ,"$1,839.99 ",$705.33 ,"$2,014.17 ","$2,014.17 ",$705.33 ,$312.76 ,"$1,340.13 ","$1,493.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,349.50 ","$2,679.60 ","$2,679.60 ",$705.33 ,"$2,679.60 ",$405.21 ,$405.21 ,$405.21 ,"$4,466.00 ", N/A ,"$3,796.10 ","$1,763.33 ","$1,708.00 ",$705.33 ,"$4,466.00 ","$2,500.96 ",$705.33 ,"$1,174.56 ", N/A ,$246.54 ,$235.34 ,$740.60 ,"$3,572.80 ","$1,586.99 ","$2,014.17 ","$1,250.48 ","$4,019.40 ",$705.33 ,$405.21 ,"$1,700.00 ","$1,700.00 ",$705.33 ,"$1,700.00 ","$2,143.68 ",$224.13 
ST. ELIZABETH'S HOSPITAL,61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,737.00 ","$3,079.05 ",$224.13 ,"$4,737.00 ",$907.63 ,"$1,100.00 ","$2,652.72 ",$363.05 ,"$1,326.36 ","$1,672.16 ",$363.05 ,"$1,951.64 ",$363.05 ,"$2,136.39 ","$2,136.39 ",$363.05 ,$380.61 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,552.75 ","$2,842.20 ","$2,842.20 ",$363.05 ,"$2,842.20 ",$493.64 ,$493.64 ,$493.64 ,"$4,737.00 ", N/A ,"$4,026.45 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,737.00 ","$2,652.72 ",$363.05 ,"$1,245.83 ", N/A ,$246.54 ,$235.34 ,$381.20 ,"$3,789.60 ",$816.86 ,"$2,136.39 ","$1,326.36 ","$4,263.30 ",$363.05 ,$493.64 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,273.76 ",$224.13 
ST. ELIZABETH'S HOSPITAL,61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$3,289.00 ","$2,137.85 ",$210.48 ,"$3,289.00 ",$567.13 ,"$1,100.00 ","$1,841.84 ",$226.85 ,$920.92 ,"$1,161.02 ",$226.85 ,"$1,355.07 ",$226.85 ,"$1,483.34 ","$1,483.34 ",$226.85 ,$210.48 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,466.75 ","$1,973.40 ","$1,973.40 ",$226.85 ,"$1,973.40 ",$271.91 ,$271.91 ,$271.91 ,"$3,289.00 ", N/A ,"$2,795.65 ",$567.13 ,"$1,708.00 ",$226.85 ,"$3,289.00 ","$1,841.84 ",$226.85 ,$865.01 , N/A ,$365.28 ,$348.67 ,$238.19 ,"$2,631.20 ",$510.41 ,"$1,483.34 ",$920.92 ,"$2,960.10 ",$226.85 ,$271.91 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,578.72 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$3,451.00 ","$2,243.15 ",$245.53 ,"$3,451.00 ",$907.63 ,"$1,100.00 ","$1,932.56 ",$363.05 ,$966.28 ,"$1,218.20 ",$363.05 ,"$1,421.81 ",$363.05 ,"$1,556.40 ","$1,556.40 ",$363.05 ,$245.53 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,588.25 ","$2,070.60 ","$2,070.60 ",$363.05 ,"$2,070.60 ",$319.76 ,$319.76 ,$319.76 ,"$3,451.00 ", N/A ,"$2,933.35 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,451.00 ","$1,932.56 ",$363.05 ,$907.61 , N/A ,$365.28 ,$348.67 ,$381.20 ,"$2,760.80 ",$816.86 ,"$1,556.40 ",$966.28 ,"$3,105.90 ",$363.05 ,$319.76 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,656.48 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$3,560.00 ","$2,314.00 ",$313.38 ,"$3,560.00 ",$907.63 ,"$1,100.00 ","$1,993.60 ",$363.05 ,$996.80 ,"$1,256.68 ",$363.05 ,"$1,466.72 ",$363.05 ,"$1,605.56 ","$1,605.56 ",$363.05 ,$313.38 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,670.00 ","$2,136.00 ","$2,136.00 ",$363.05 ,"$2,136.00 ",$405.71 ,$405.71 ,$405.71 ,"$3,560.00 ", N/A ,"$3,026.00 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,560.00 ","$1,993.60 ",$363.05 ,$936.28 , N/A ,$365.28 ,$348.67 ,$381.20 ,"$2,848.00 ",$816.86 ,"$1,605.56 ",$996.80 ,"$3,204.00 ",$363.05 ,$405.71 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,708.80 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$3,953.00 ","$2,569.45 ",$179.91 ,"$3,953.00 ",$567.13 ,"$1,100.00 ","$2,213.68 ",$226.85 ,"$1,106.84 ","$1,395.41 ",$226.85 ,"$1,628.64 ",$226.85 ,"$1,782.80 ","$1,782.80 ",$226.85 ,$179.91 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,964.75 ","$2,371.80 ","$2,371.80 ",$226.85 ,"$2,371.80 ",$230.33 ,$230.33 ,$230.33 ,"$3,953.00 ", N/A ,"$3,360.05 ",$567.13 ,"$1,708.00 ",$226.85 ,"$3,953.00 ","$2,213.68 ",$226.85 ,"$1,039.64 ", N/A ,$246.54 ,$235.34 ,$238.19 ,"$3,162.40 ",$510.41 ,"$1,782.80 ","$1,106.84 ","$3,557.70 ",$226.85 ,$230.33 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,897.44 ",$224.13 
ST. ELIZABETH'S HOSPITAL,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$4,663.00 ","$3,030.95 ",$224.13 ,"$4,663.00 ","$1,763.33 ","$1,100.00 ","$2,611.28 ",$705.33 ,"$1,305.64 ","$1,646.04 ",$705.33 ,"$1,921.16 ",$705.33 ,"$2,103.01 ","$2,103.01 ",$705.33 ,$313.58 ,"$1,340.13 ","$1,493.00 ","$1,763.33 ",$705.33 ,$705.33 ,$719.44 ,"$3,497.25 ","$2,797.80 ","$2,797.80 ",$705.33 ,"$2,797.80 ",$407.69 ,$407.69 ,$407.69 ,"$4,663.00 ", N/A ,"$3,963.55 ","$1,763.33 ","$1,708.00 ",$705.33 ,"$4,663.00 ","$2,611.28 ",$705.33 ,"$1,226.37 ", N/A ,$246.54 ,$235.34 ,$740.60 ,"$3,730.40 ","$1,586.99 ","$2,103.01 ","$1,305.64 ","$4,196.70 ",$705.33 ,$407.69 ,"$1,700.00 ","$1,700.00 ",$705.33 ,"$1,700.00 ","$2,238.24 ",$224.13 
ST. ELIZABETH'S HOSPITAL,61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,805.00 ","$3,123.25 ",$224.13 ,"$4,805.00 ",$907.63 ,"$1,100.00 ","$2,690.80 ",$363.05 ,"$1,345.40 ","$1,696.17 ",$363.05 ,"$1,979.66 ",$363.05 ,"$2,167.06 ","$2,167.06 ",$363.05 ,$379.39 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,603.75 ","$2,883.00 ","$2,883.00 ",$363.05 ,"$2,883.00 ",$492.65 ,$492.65 ,$492.65 ,"$4,805.00 ", N/A ,"$4,084.25 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,805.00 ","$2,690.80 ",$363.05 ,"$1,263.72 ", N/A ,$246.54 ,$235.34 ,$381.20 ,"$3,844.00 ",$816.86 ,"$2,167.06 ","$1,345.40 ","$4,324.50 ",$363.05 ,$492.65 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,306.40 ",$224.13 
ST. ELIZABETH'S HOSPITAL,61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,808.00 ","$2,475.20 ",$166.98 ,"$3,808.00 ",$567.13 ,"$1,100.00 ","$2,132.48 ",$226.85 ,"$1,066.24 ","$1,344.22 ",$226.85 ,"$1,568.90 ",$226.85 ,"$1,717.41 ","$1,717.41 ",$226.85 ,$166.98 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,856.00 ","$2,284.80 ","$2,284.80 ",$226.85 ,"$2,284.80 ",$238.62 ,$238.62 ,$238.62 ,"$3,808.00 ", N/A ,"$3,236.80 ",$567.13 ,"$1,708.00 ",$226.85 ,"$3,808.00 ","$2,132.48 ",$226.85 ,"$1,001.50 ", N/A ,$437.80 ,$417.90 ,$238.19 ,"$3,046.40 ",$510.41 ,"$1,717.41 ","$1,066.24 ","$3,427.20 ",$226.85 ,$238.62 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,827.84 ",$398.00 
ST. ELIZABETH'S HOSPITAL,61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$4,017.00 ","$2,611.05 ",$291.16 ,"$4,017.00 ",$907.63 ,"$1,100.00 ","$2,249.52 ",$363.05 ,"$1,124.76 ","$1,418.00 ",$363.05 ,"$1,655.00 ",$363.05 ,"$1,811.67 ","$1,811.67 ",$363.05 ,$291.16 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,012.75 ","$2,410.20 ","$2,410.20 ",$363.05 ,"$2,410.20 ",$379.86 ,$379.86 ,$379.86 ,"$4,017.00 ", N/A ,"$3,414.45 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,017.00 ","$2,249.52 ",$363.05 ,"$1,056.47 ", N/A ,$437.80 ,$417.90 ,$381.20 ,"$3,213.60 ",$816.86 ,"$1,811.67 ","$1,124.76 ","$3,615.30 ",$363.05 ,$379.86 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,928.16 ",$398.00 
ST. ELIZABETH'S HOSPITAL,61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$4,387.00 ","$2,851.55 ",$311.75 ,"$4,387.00 ",$907.63 ,"$1,100.00 ","$2,456.72 ",$363.05 ,"$1,228.36 ","$1,548.61 ",$363.05 ,"$1,807.44 ",$363.05 ,"$1,978.54 ","$1,978.54 ",$363.05 ,$311.75 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,290.25 ","$2,632.20 ","$2,632.20 ",$363.05 ,"$2,632.20 ",$403.71 ,$403.71 ,$403.71 ,"$4,387.00 ", N/A ,"$3,728.95 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,387.00 ","$2,456.72 ",$363.05 ,"$1,153.78 ", N/A ,$437.80 ,$417.90 ,$381.20 ,"$3,509.60 ",$816.86 ,"$1,978.54 ","$1,228.36 ","$3,948.30 ",$363.05 ,$403.71 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,105.76 ",$398.00 
ST. ELIZABETH'S HOSPITAL,61000043,76390,HC MRI SPECTROSCOPY,610,1 ,"$3,866.00 ","$2,512.90 ",$79.75 ,"$3,866.00 ",$199.38 ,"$1,100.00 ","$2,164.96 ",$79.75 ,"$1,082.48 ","$1,364.70 ",$79.75 ,"$1,592.79 ",$79.75 ,"$1,743.57 ","$1,743.57 ",$79.75 ,"$2,512.90 ",$151.52 ,"$1,493.00 ",$199.36 ,$79.75 ,$79.75 ,$81.34 ,"$2,899.50 ","$2,319.60 ","$2,319.60 ",$79.75 ,"$2,319.60 ","$2,706.20 ","$2,706.20 ","$2,706.20 ","$3,866.00 ", N/A ,"$3,286.10 ",$199.36 ,"$1,708.00 ",$79.75 ,"$3,866.00 ","$2,164.96 ",$79.75 ,"$1,016.76 ", N/A ,$365.28 ,$348.67 ,$83.74 ,"$3,092.80 ",$179.43 ,"$1,743.57 ","$1,082.48 ","$3,479.40 ",$79.75 ,"$2,706.20 ","$1,700.00 ","$1,700.00 ",$79.75 ,"$1,700.00 ","$1,855.68 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000050,C8937,HC MRI BREAST CAD,610,1 ,$147.00 ,$95.55 ,$38.66 ,$147.00 , N/A ,$67.62 ,$82.32 , N/A ,$41.16 ,$49.69 , N/A ,$57.18 , N/A ,$66.30 ,$66.30 , N/A ,$95.55 , N/A ,$147.00 , N/A , N/A , N/A , N/A ,$110.25 ,$88.20 ,$88.20 , N/A ,$88.20 ,$102.90 ,$102.90 ,$102.90 ,$147.00 , N/A ,$124.95 , N/A ,$147.00 , N/A ,$147.00 ,$82.32 , N/A ,$38.66 , N/A , N/A , N/A , N/A ,$117.60 , N/A ,$66.30 ,$41.16 ,$132.30 , N/A ,$102.90 ,$147.00 ,$147.00 , N/A ,$147.00 ,$70.56 , N/A 
ST. ELIZABETH'S HOSPITAL,61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$2,308.00 ","$1,500.20 ",$363.05 ,"$2,308.00 ",$907.63 ,"$1,100.00 ","$1,292.48 ",$363.05 ,$646.24 ,$780.10 ,$363.05 ,$897.81 ,$363.05 ,"$1,040.91 ","$1,040.91 ",$363.05 ,"$1,500.20 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,731.00 ","$1,384.80 ","$1,384.80 ",$363.05 ,"$1,384.80 ","$1,615.60 ","$1,615.60 ","$1,615.60 ","$2,308.00 ", N/A ,"$1,961.80 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,308.00 ","$1,292.48 ",$363.05 ,$607.00 , N/A ,$472.33 ,$450.86 ,$381.20 ,"$1,846.40 ",$816.86 ,"$1,040.91 ",$646.24 ,"$2,077.20 ",$363.05 ,"$1,615.60 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,107.84 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$1,848.00 ","$1,201.20 ",$226.85 ,"$1,848.00 ",$567.13 ,"$1,100.00 ","$1,034.88 ",$226.85 ,$517.44 ,$624.62 ,$226.85 ,$718.87 ,$226.85 ,$833.45 ,$833.45 ,$226.85 ,"$1,201.20 ",$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,386.00 ","$1,108.80 ","$1,108.80 ",$226.85 ,"$1,108.80 ","$1,293.60 ","$1,293.60 ","$1,293.60 ","$1,848.00 ", N/A ,"$1,570.80 ",$567.13 ,"$1,708.00 ",$226.85 ,"$1,848.00 ","$1,034.88 ",$226.85 ,$486.02 , N/A ,$472.33 ,$450.86 ,$238.19 ,"$1,478.40 ",$510.41 ,$833.45 ,$517.44 ,"$1,663.20 ",$226.85 ,"$1,293.60 ","$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ",$887.04 ,$429.39 
ST. ELIZABETH'S HOSPITAL,61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$3,981.00 ","$2,587.65 ",$363.05 ,"$3,981.00 ",$907.63 ,"$1,100.00 ","$2,229.36 ",$363.05 ,"$1,114.68 ","$1,345.58 ",$363.05 ,"$1,548.61 ",$363.05 ,"$1,795.43 ","$1,795.43 ",$363.05 ,"$2,587.65 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,985.75 ","$2,388.60 ","$2,388.60 ",$363.05 ,"$2,388.60 ","$2,786.70 ","$2,786.70 ","$2,786.70 ","$3,981.00 ", N/A ,"$3,383.85 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,981.00 ","$2,229.36 ",$363.05 ,"$1,047.00 ", N/A ,$472.33 ,$450.86 ,$381.20 ,"$3,184.80 ",$816.86 ,"$1,795.43 ","$1,114.68 ","$3,582.90 ",$363.05 ,"$2,786.70 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,910.88 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000054,C8903,HC MRI BREAST UNI W/CONTRAST,610,1 ,"$2,384.00 ","$1,549.60 ",$176.10 ,"$2,384.00 ",$440.25 ,"$1,100.00 ","$1,335.04 ",$176.10 ,$667.52 ,$805.79 ,$176.10 ,$927.38 ,$176.10 ,"$1,075.18 ","$1,075.18 ",$176.10 ,"$1,549.60 ",$334.60 ,"$1,493.00 ",$440.26 ,$176.10 ,$176.10 ,$179.63 ,"$1,788.00 ","$1,430.40 ","$1,430.40 ",$176.10 ,"$1,430.40 ","$1,668.80 ","$1,668.80 ","$1,668.80 ","$2,384.00 ", N/A ,"$2,026.40 ",$440.26 ,"$1,708.00 ",$176.10 ,"$2,384.00 ","$1,335.04 ",$176.10 ,$626.99 , N/A ,$365.28 ,$348.67 ,$184.91 ,"$1,907.20 ",$396.23 ,"$1,075.18 ",$667.52 ,"$2,145.60 ",$176.10 ,"$1,668.80 ","$1,700.00 ","$1,700.00 ",$176.10 ,"$1,700.00 ","$1,144.32 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000055,77046,HC MRI BREAST UNI W/O CON,610,1 ,"$2,305.00 ","$1,498.25 ",$180.53 ,"$2,305.00 ",$567.13 ,"$1,100.00 ","$1,290.80 ",$226.85 ,$645.40 ,$779.09 ,$226.85 ,$896.65 ,$226.85 ,"$1,039.56 ","$1,039.56 ",$226.85 ,$190.51 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,728.75 ","$1,383.00 ","$1,383.00 ",$226.85 ,"$1,383.00 ",$246.57 ,$246.57 ,$246.57 ,"$2,305.00 ", N/A ,"$1,959.25 ",$567.13 ,"$1,708.00 ",$226.85 ,$180.53 ,"$1,290.80 ",$226.85 ,$606.22 , N/A ,$365.28 ,$348.67 ,$238.19 ,"$1,844.00 ",$510.41 ,"$1,039.56 ",$645.40 ,"$2,074.50 ",$226.85 ,$246.57 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,106.40 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000056,C8905,HC MRI BREAST UNI W AND W/O CONTRAST,610,1 ,"$2,844.00 ","$1,848.60 ",$332.07 ,"$2,844.00 ",$907.63 ,"$1,100.00 ","$1,592.64 ",$363.05 ,$796.32 ,$961.27 ,$363.05 ,"$1,106.32 ",$363.05 ,"$1,282.64 ","$1,282.64 ",$363.05 ,"$1,848.60 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,133.00 ","$1,706.40 ","$1,706.40 ",$363.05 ,"$1,706.40 ","$1,990.80 ","$1,990.80 ","$1,990.80 ","$2,844.00 ", N/A ,"$2,417.40 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,844.00 ","$1,592.64 ",$363.05 ,$747.97 , N/A ,$365.28 ,$348.67 ,$381.20 ,"$2,275.20 ",$816.86 ,"$1,282.64 ",$796.32 ,"$2,559.60 ",$363.05 ,"$1,990.80 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,365.12 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000057,C8906,HC MRI BREAST BIL W/CONTRAST,610,1 ,"$3,578.00 ","$2,325.70 ",$332.07 ,"$3,578.00 ",$907.63 ,"$1,100.00 ","$2,003.68 ",$363.05 ,"$1,001.84 ","$1,209.36 ",$363.05 ,"$1,391.84 ",$363.05 ,"$1,613.68 ","$1,613.68 ",$363.05 ,"$2,325.70 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,683.50 ","$2,146.80 ","$2,146.80 ",$363.05 ,"$2,146.80 ","$2,504.60 ","$2,504.60 ","$2,504.60 ","$3,578.00 ", N/A ,"$3,041.30 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,578.00 ","$2,003.68 ",$363.05 ,$941.01 , N/A ,$365.28 ,$348.67 ,$381.20 ,"$2,862.40 ",$816.86 ,"$1,613.68 ","$1,001.84 ","$3,220.20 ",$363.05 ,"$2,504.60 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,717.44 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000058,77047,HC MRI BREAST BI W/O CON,610,1 ,"$4,221.00 ","$2,743.65 ",$179.80 ,"$4,221.00 ",$567.13 ,"$1,100.00 ","$2,363.76 ",$226.85 ,"$1,181.88 ","$1,426.70 ",$226.85 ,"$1,641.97 ",$226.85 ,"$1,903.67 ","$1,903.67 ",$226.85 ,$189.70 ,$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$3,165.75 ","$2,532.60 ","$2,532.60 ",$226.85 ,"$2,532.60 ",$245.09 ,$245.09 ,$245.09 ,"$4,221.00 ", N/A ,"$3,587.85 ",$567.13 ,"$1,708.00 ",$226.85 ,$179.80 ,"$2,363.76 ",$226.85 ,"$1,110.12 ", N/A ,$365.28 ,$348.67 ,$238.19 ,"$3,376.80 ",$510.41 ,"$1,903.67 ","$1,181.88 ","$3,798.90 ",$226.85 ,$245.09 ,"$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$2,026.08 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$4,478.00 ","$2,910.70 ",$332.07 ,"$4,478.00 ",$907.63 ,"$1,100.00 ","$2,507.68 ",$363.05 ,"$1,253.84 ","$1,513.56 ",$363.05 ,"$1,741.94 ",$363.05 ,"$2,019.58 ","$2,019.58 ",$363.05 ,"$2,910.70 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,358.50 ","$2,686.80 ","$2,686.80 ",$363.05 ,"$2,686.80 ","$3,134.60 ","$3,134.60 ","$3,134.60 ","$4,478.00 ", N/A ,"$3,806.30 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,478.00 ","$2,507.68 ",$363.05 ,"$1,177.71 ", N/A ,$365.28 ,$348.67 ,$381.20 ,"$3,582.40 ",$816.86 ,"$2,019.58 ","$1,253.84 ","$4,030.20 ",$363.05 ,"$3,134.60 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,149.44 ",$332.07 
ST. ELIZABETH'S HOSPITAL,61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$2,183.00 ","$1,418.95 ",$363.05 ,"$2,183.00 ",$907.63 ,"$1,100.00 ","$1,222.48 ",$363.05 ,$611.24 ,$737.85 ,$363.05 ,$849.19 ,$363.05 ,$984.53 ,$984.53 ,$363.05 ,"$1,418.95 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,637.25 ","$1,309.80 ","$1,309.80 ",$363.05 ,"$1,309.80 ","$1,528.10 ","$1,528.10 ","$1,528.10 ","$2,183.00 ", N/A ,"$1,855.55 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,183.00 ","$1,222.48 ",$363.05 ,$574.13 , N/A ,$415.48 ,$396.60 ,$381.20 ,"$1,746.40 ",$816.86 ,$984.53 ,$611.24 ,"$1,964.70 ",$363.05 ,"$1,528.10 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,047.84 ",$377.71 
ST. ELIZABETH'S HOSPITAL,61000061,C8910,HC MRA CHEST W/O CONTRAST,610,1 ,"$1,748.00 ","$1,136.20 ",$226.85 ,"$1,748.00 ",$567.13 ,"$1,100.00 ",$978.88 ,$226.85 ,$489.44 ,$590.82 ,$226.85 ,$679.97 ,$226.85 ,$788.35 ,$788.35 ,$226.85 ,"$1,136.20 ",$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,311.00 ","$1,048.80 ","$1,048.80 ",$226.85 ,"$1,048.80 ","$1,223.60 ","$1,223.60 ","$1,223.60 ","$1,748.00 ", N/A ,"$1,485.80 ",$567.13 ,"$1,708.00 ",$226.85 ,"$1,748.00 ",$978.88 ,$226.85 ,$459.72 , N/A ,$415.48 ,$396.60 ,$238.19 ,"$1,398.40 ",$510.41 ,$788.35 ,$489.44 ,"$1,573.20 ",$226.85 ,"$1,223.60 ","$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ",$839.04 ,$377.71 
ST. ELIZABETH'S HOSPITAL,61000062,C8911,HC MRA CHEST W AND W/O CONTRAST,610,1 ,"$3,083.00 ","$2,003.95 ",$363.05 ,"$3,083.00 ",$907.63 ,"$1,100.00 ","$1,726.48 ",$363.05 ,$863.24 ,"$1,042.05 ",$363.05 ,"$1,199.29 ",$363.05 ,"$1,390.43 ","$1,390.43 ",$363.05 ,"$2,003.95 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,312.25 ","$1,849.80 ","$1,849.80 ",$363.05 ,"$1,849.80 ","$2,158.10 ","$2,158.10 ","$2,158.10 ","$3,083.00 ", N/A ,"$2,620.55 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,083.00 ","$1,726.48 ",$363.05 ,$810.83 , N/A ,$415.48 ,$396.60 ,$381.20 ,"$2,466.40 ",$816.86 ,"$1,390.43 ",$863.24 ,"$2,774.70 ",$363.05 ,"$2,158.10 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,479.84 ",$377.71 
ST. ELIZABETH'S HOSPITAL,61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$4,396.00 ","$2,857.40 ",$363.05 ,"$4,396.00 ",$907.63 ,"$1,100.00 ","$2,461.76 ",$363.05 ,"$1,230.88 ","$1,485.85 ",$363.05 ,"$1,710.04 ",$363.05 ,"$1,982.60 ","$1,982.60 ",$363.05 ,"$2,857.40 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,297.00 ","$2,637.60 ","$2,637.60 ",$363.05 ,"$2,637.60 ","$3,077.20 ","$3,077.20 ","$3,077.20 ","$4,396.00 ", N/A ,"$3,736.60 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,396.00 ","$2,461.76 ",$363.05 ,"$1,156.15 ", N/A ,$472.33 ,$450.86 ,$381.20 ,"$3,516.80 ",$816.86 ,"$1,982.60 ","$1,230.88 ","$3,956.40 ",$363.05 ,"$3,077.20 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,110.08 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$3,099.00 ","$2,014.35 ",$363.05 ,"$3,099.00 ",$907.63 ,"$1,100.00 ","$1,735.44 ",$363.05 ,$867.72 ,"$1,047.46 ",$363.05 ,"$1,205.51 ",$363.05 ,"$1,397.65 ","$1,397.65 ",$363.05 ,"$2,014.35 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,324.25 ","$1,859.40 ","$1,859.40 ",$363.05 ,"$1,859.40 ","$2,169.30 ","$2,169.30 ","$2,169.30 ","$3,099.00 ", N/A ,"$2,634.15 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,099.00 ","$1,735.44 ",$363.05 ,$815.04 , N/A ,$472.33 ,$450.86 ,$381.20 ,"$2,479.20 ",$816.86 ,"$1,397.65 ",$867.72 ,"$2,789.10 ",$363.05 ,"$2,169.30 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,487.52 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000064,C8913,HC MRA LWR EXT W/O CON,610,1 ,"$2,953.00 ","$1,919.45 ",$226.85 ,"$2,953.00 ",$567.13 ,"$1,100.00 ","$1,653.68 ",$226.85 ,$826.84 ,$998.11 ,$226.85 ,"$1,148.72 ",$226.85 ,"$1,331.80 ","$1,331.80 ",$226.85 ,"$1,919.45 ",$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,214.75 ","$1,771.80 ","$1,771.80 ",$226.85 ,"$1,771.80 ","$2,067.10 ","$2,067.10 ","$2,067.10 ","$2,953.00 ", N/A ,"$2,510.05 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,953.00 ","$1,653.68 ",$226.85 ,$776.64 , N/A ,$472.33 ,$450.86 ,$238.19 ,"$2,362.40 ",$510.41 ,"$1,331.80 ",$826.84 ,"$2,657.70 ",$226.85 ,"$2,067.10 ","$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,417.44 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000064,C8913,HC MRA LWR EXT W/O CON,610,1 ,"$4,189.00 ","$2,722.85 ",$226.85 ,"$4,189.00 ",$567.13 ,"$1,100.00 ","$2,345.84 ",$226.85 ,"$1,172.92 ","$1,415.88 ",$226.85 ,"$1,629.52 ",$226.85 ,"$1,889.24 ","$1,889.24 ",$226.85 ,"$2,722.85 ",$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$3,141.75 ","$2,513.40 ","$2,513.40 ",$226.85 ,"$2,513.40 ","$2,932.30 ","$2,932.30 ","$2,932.30 ","$4,189.00 ", N/A ,"$3,560.65 ",$567.13 ,"$1,708.00 ",$226.85 ,"$4,189.00 ","$2,345.84 ",$226.85 ,"$1,101.71 ", N/A ,$472.33 ,$450.86 ,$238.19 ,"$3,351.20 ",$510.41 ,"$1,889.24 ","$1,172.92 ","$3,770.10 ",$226.85 ,"$2,932.30 ","$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$2,010.72 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$5,994.00 ","$3,896.10 ",$363.05 ,"$5,994.00 ",$907.63 ,"$1,100.00 ","$3,356.64 ",$363.05 ,"$1,678.32 ","$2,025.97 ",$363.05 ,"$2,331.67 ",$363.05 ,"$2,703.29 ","$2,703.29 ",$363.05 ,"$3,896.10 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$4,495.50 ","$3,596.40 ","$3,596.40 ",$363.05 ,"$3,596.40 ","$4,195.80 ","$4,195.80 ","$4,195.80 ","$5,994.00 ", N/A ,"$5,094.90 ",$907.62 ,"$1,708.00 ",$363.05 ,"$5,994.00 ","$3,356.64 ",$363.05 ,"$1,576.42 ", N/A ,$472.33 ,$450.86 ,$381.20 ,"$4,795.20 ",$816.86 ,"$2,703.29 ","$1,678.32 ","$5,394.60 ",$363.05 ,"$4,195.80 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,877.12 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$4,221.00 ","$2,743.65 ",$363.05 ,"$4,221.00 ",$907.63 ,"$1,100.00 ","$2,363.76 ",$363.05 ,"$1,181.88 ","$1,426.70 ",$363.05 ,"$1,641.97 ",$363.05 ,"$1,903.67 ","$1,903.67 ",$363.05 ,"$2,743.65 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$3,165.75 ","$2,532.60 ","$2,532.60 ",$363.05 ,"$2,532.60 ","$2,954.70 ","$2,954.70 ","$2,954.70 ","$4,221.00 ", N/A ,"$3,587.85 ",$907.62 ,"$1,708.00 ",$363.05 ,"$4,221.00 ","$2,363.76 ",$363.05 ,"$1,110.12 ", N/A ,$472.33 ,$450.86 ,$381.20 ,"$3,376.80 ",$816.86 ,"$1,903.67 ","$1,181.88 ","$3,798.90 ",$363.05 ,"$2,954.70 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,026.08 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000068,C8918,HC MRA PELVIS W/CON,610,1 ,"$3,232.00 ","$2,100.80 ",$363.05 ,"$3,232.00 ",$907.63 ,"$1,100.00 ","$1,809.92 ",$363.05 ,$904.96 ,"$1,092.42 ",$363.05 ,"$1,257.25 ",$363.05 ,"$1,457.63 ","$1,457.63 ",$363.05 ,"$2,100.80 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,424.00 ","$1,939.20 ","$1,939.20 ",$363.05 ,"$1,939.20 ","$2,262.40 ","$2,262.40 ","$2,262.40 ","$3,232.00 ", N/A ,"$2,747.20 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,232.00 ","$1,809.92 ",$363.05 ,$850.02 , N/A ,$472.33 ,$450.86 ,$381.20 ,"$2,585.60 ",$816.86 ,"$1,457.63 ",$904.96 ,"$2,908.80 ",$363.05 ,"$2,262.40 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,551.36 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000069,C8919,HC MRA PELVIS W/O CON,610,1 ,"$2,694.00 ","$1,751.10 ",$226.85 ,"$2,694.00 ",$567.13 ,"$1,100.00 ","$1,508.64 ",$226.85 ,$754.32 ,$910.57 ,$226.85 ,"$1,047.97 ",$226.85 ,"$1,214.99 ","$1,214.99 ",$226.85 ,"$1,751.10 ",$431.02 ,"$1,493.00 ",$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,020.50 ","$1,616.40 ","$1,616.40 ",$226.85 ,"$1,616.40 ","$1,885.80 ","$1,885.80 ","$1,885.80 ","$2,694.00 ", N/A ,"$2,289.90 ",$567.13 ,"$1,708.00 ",$226.85 ,"$2,694.00 ","$1,508.64 ",$226.85 ,$708.52 , N/A ,$472.33 ,$450.86 ,$238.19 ,"$2,155.20 ",$510.41 ,"$1,214.99 ",$754.32 ,"$2,424.60 ",$226.85 ,"$1,885.80 ","$1,700.00 ","$1,700.00 ",$226.85 ,"$1,700.00 ","$1,293.12 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000070,C8920,HC MRA PELVIS W AND W/O CONTRAST,610,1 ,"$3,945.00 ","$2,564.25 ",$363.05 ,"$3,945.00 ",$907.63 ,"$1,100.00 ","$2,209.20 ",$363.05 ,"$1,104.60 ","$1,333.41 ",$363.05 ,"$1,534.61 ",$363.05 ,"$1,779.20 ","$1,779.20 ",$363.05 ,"$2,564.25 ",$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$2,958.75 ","$2,367.00 ","$2,367.00 ",$363.05 ,"$2,367.00 ","$2,761.50 ","$2,761.50 ","$2,761.50 ","$3,945.00 ", N/A ,"$3,353.25 ",$907.62 ,"$1,708.00 ",$363.05 ,"$3,945.00 ","$2,209.20 ",$363.05 ,"$1,037.54 ", N/A ,$472.33 ,$450.86 ,$381.20 ,"$3,156.00 ",$816.86 ,"$1,779.20 ","$1,104.60 ","$3,550.50 ",$363.05 ,"$2,761.50 ","$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,893.60 ",$429.39 
ST. ELIZABETH'S HOSPITAL,61000071,C8934,HC MRA UPPR EXT W/CONTRAST,610,1 ,$908.00 ,$590.20 ,$238.80 ,$908.00 ,$907.63 ,$908.00 ,$508.48 ,$363.05 ,$254.24 ,$306.90 ,$363.05 ,$353.21 ,$363.05 ,$409.51 ,$409.51 ,$363.05 ,$590.20 ,$689.79 ,$908.00 ,$907.62 ,$363.05 ,$363.05 ,$370.31 ,$681.00 ,$544.80 ,$544.80 ,$363.05 ,$544.80 ,$635.60 ,$635.60 ,$635.60 ,$908.00 , N/A ,$771.80 ,$907.62 ,$908.00 ,$363.05 ,$908.00 ,$508.48 ,$363.05 ,$238.80 , N/A ,$472.33 ,$450.86 ,$381.20 ,$726.40 ,$816.86 ,$409.51 ,$254.24 ,$817.20 ,$363.05 ,$635.60 ,$908.00 ,$908.00 ,$363.05 ,$908.00 ,$435.84 ,$429.39 
ST. ELIZABETH'S HOSPITAL,61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$5,398.00 ","$3,508.70 ",$277.93 ,"$5,398.00 ",$907.63 ,"$1,100.00 ","$3,022.88 ",$363.05 ,"$1,511.44 ","$1,905.49 ",$363.05 ,"$2,223.98 ",$363.05 ,"$2,434.50 ","$2,434.50 ",$363.05 ,$277.93 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$4,048.50 ","$3,238.80 ","$3,238.80 ",$363.05 ,"$3,238.80 ",$358.01 ,$358.01 ,$358.01 ,"$5,398.00 ", N/A ,"$4,588.30 ",$907.62 ,"$1,708.00 ",$363.05 ,"$5,398.00 ","$3,022.88 ",$363.05 ,"$1,419.67 ", N/A ,$409.28 ,$390.67 ,$381.20 ,"$4,318.40 ",$816.86 ,"$2,434.50 ","$1,511.44 ","$4,858.20 ",$363.05 ,$358.01 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$2,591.04 ",$372.07 
ST. ELIZABETH'S HOSPITAL,61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$2,628.00 ","$1,708.20 ",$253.26 ,"$2,628.00 ",$907.63 ,"$1,100.00 ","$1,471.68 ",$363.05 ,$735.84 ,$927.68 ,$363.05 ,"$1,082.74 ",$363.05 ,"$1,185.23 ","$1,185.23 ",$363.05 ,$253.26 ,$689.79 ,"$1,493.00 ",$907.62 ,$363.05 ,$363.05 ,$370.31 ,"$1,971.00 ","$1,576.80 ","$1,576.80 ",$363.05 ,"$1,576.80 ",$327.21 ,$327.21 ,$327.21 ,"$2,628.00 ", N/A ,"$2,233.80 ",$907.62 ,"$1,708.00 ",$363.05 ,"$2,628.00 ","$1,471.68 ",$363.05 ,$691.16 , N/A ,$365.28 ,$348.67 ,$381.20 ,"$2,102.40 ",$816.86 ,"$1,185.23 ",$735.84 ,"$2,365.20 ",$363.05 ,$327.21 ,"$1,700.00 ","$1,700.00 ",$363.05 ,"$1,700.00 ","$1,261.44 ",$332.07 
ST. ELIZABETH'S HOSPITAL,62100027,C2627,HC CATH SUPRAPUBIC-SYSTOSCOPIC,621,1 ,$267.42 ,$173.82 ,$70.33 ,$267.42 , N/A ,$123.01 ,$149.76 , N/A ,$74.88 ,$90.39 , N/A ,$104.03 , N/A ,$120.61 ,$120.61 , N/A ,$173.82 , N/A ,$133.71 , N/A , N/A , N/A , N/A ,$200.57 ,$160.45 ,$160.45 , N/A ,$160.45 ,$203.24 ,$203.24 ,$203.24 ,$267.42 , N/A ,$227.31 , N/A ,$173.82 , N/A ,$267.42 ,$149.76 , N/A ,$70.33 , N/A , N/A , N/A , N/A ,$213.94 , N/A ,$120.61 ,$74.88 ,$240.68 , N/A ,$203.24 ,$173.82 ,$173.82 , N/A ,$173.82 ,$128.36 , N/A 
ST. ELIZABETH'S HOSPITAL,62100073,C1757,HC CATHETER INFUSION/ASPIRATION,621,1 ,"$1,218.72 ",$792.17 ,$320.52 ,"$1,218.72 ", N/A ,$560.61 ,$682.48 , N/A ,$341.24 ,$411.93 , N/A ,$474.08 , N/A ,$549.64 ,$549.64 , N/A ,$792.17 , N/A ,$609.36 , N/A , N/A , N/A , N/A ,$914.04 ,$731.23 ,$731.23 , N/A ,$731.23 ,$926.23 ,$926.23 ,$926.23 ,"$1,218.72 ", N/A ,"$1,035.91 ", N/A ,$792.17 , N/A ,"$1,218.72 ",$682.48 , N/A ,$320.52 , N/A , N/A , N/A , N/A ,$974.98 , N/A ,$549.64 ,$341.24 ,"$1,096.85 ", N/A ,$926.23 ,$792.17 ,$792.17 , N/A ,$792.17 ,$584.99 , N/A 
ST. ELIZABETH'S HOSPITAL,62300002,A6441,HC BANDAGE PADDING >3 = <5 IN PER YD T1,623,1 ,$13.14 ,$8.54 ,$3.46 ,$13.14 , N/A ,$6.04 ,$7.36 , N/A ,$3.68 ,$4.64 , N/A ,$5.15 , N/A ,$5.93 ,$5.93 , N/A ,$8.54 , N/A ,$6.57 , N/A , N/A , N/A , N/A ,$9.86 ,$7.88 ,$7.88 , N/A ,$7.88 ,$9.99 ,$9.99 ,$9.99 ,$13.14 , N/A ,$11.17 , N/A ,$8.54 , N/A ,$13.14 ,$7.36 , N/A ,$3.46 , N/A , N/A , N/A , N/A ,$10.51 , N/A ,$5.93 ,$3.68 ,$11.83 , N/A ,$9.99 ,$8.54 ,$8.54 , N/A ,$8.54 ,$6.31 , N/A 
ST. ELIZABETH'S HOSPITAL,62300023,A6211,HC DRESSING FOAM W/O BORDER >48 SQ IN,623,1 ,$146.00 ,$94.90 ,$38.40 ,$146.00 , N/A ,$67.16 ,$81.76 , N/A ,$40.88 ,$51.54 , N/A ,$60.15 , N/A ,$65.85 ,$65.85 , N/A ,$94.90 , N/A ,$73.00 , N/A , N/A , N/A , N/A ,$109.50 ,$87.60 ,$87.60 , N/A ,$87.60 ,$110.96 ,$110.96 ,$110.96 ,$146.00 , N/A ,$124.10 , N/A ,$94.90 , N/A ,$146.00 ,$81.76 , N/A ,$38.40 , N/A , N/A , N/A , N/A ,$116.80 , N/A ,$65.85 ,$40.88 ,$131.40 , N/A ,$110.96 ,$94.90 ,$94.90 , N/A ,$94.90 ,$70.08 , N/A 
ST. ELIZABETH'S HOSPITAL,62300028,A6243,HC DRESSING HYDROGEL >16=<48 SQ IN,623,1 ,$55.00 ,$35.75 ,$14.47 ,$55.00 , N/A ,$25.30 ,$30.80 , N/A ,$15.40 ,$19.42 , N/A ,$22.66 , N/A ,$24.81 ,$24.81 , N/A ,$35.75 , N/A ,$27.50 , N/A , N/A , N/A , N/A ,$41.25 ,$33.00 ,$33.00 , N/A ,$33.00 ,$41.80 ,$41.80 ,$41.80 ,$55.00 , N/A ,$46.75 , N/A ,$35.75 , N/A ,$55.00 ,$30.80 , N/A ,$14.47 , N/A , N/A , N/A , N/A ,$44.00 , N/A ,$24.81 ,$15.40 ,$49.50 , N/A ,$41.80 ,$35.75 ,$35.75 , N/A ,$35.75 ,$26.40 , N/A 
ST. ELIZABETH'S HOSPITAL,63600009,Q4186,HC EPIFIX PER SQ CM,636,1 ,$857.86 ,$557.61 ,$223.04 ,$857.86 , N/A ,$223.04 ,$480.40 , N/A ,$240.20 ,$289.96 , N/A ,$333.71 , N/A ,$386.89 ,$386.89 , N/A ,$386.89 , N/A ,$428.93 , N/A , N/A , N/A , N/A ,$643.40 ,$514.72 ,$514.72 , N/A ,$514.72 ,$651.97 ,$651.97 ,$651.97 ,$857.86 , N/A ,$729.18 , N/A ,$557.61 , N/A ,$857.86 ,$480.40 , N/A ,$225.62 , N/A ,$487.21 ,$465.07 , N/A ,$686.29 , N/A ,$386.89 ,$240.20 ,$772.07 , N/A ,$651.97 ,$254.61 ,$254.61 , N/A ,$254.61 ,$411.77 ,$442.92 
ST. ELIZABETH'S HOSPITAL,63600019,M1145,"HC MFN DRUG ADD-ON, PER DOSE",636,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A , N/A , N/A , N/A 
ST. ELIZABETH'S HOSPITAL,63600124,Q9967,HC CONTRAST ISOVUE 300 PER ML,636,1 ,$450.00 ,$292.50 ,$3.63 ,$450.00 , N/A , N/A ,$252.00 , N/A ,$126.00 ,$3.63 , N/A ,$3.63 , N/A ,$202.95 ,$202.95 , N/A ,$202.95 , N/A , N/A , N/A , N/A , N/A , N/A ,$337.50 ,$270.00 ,$270.00 , N/A ,$270.00 ,$342.00 ,$342.00 ,$342.00 ,$450.00 , N/A ,$382.50 , N/A ,$292.50 , N/A ,$450.00 ,$252.00 , N/A ,$118.35 , N/A , N/A , N/A , N/A ,$360.00 , N/A ,$202.95 ,$126.00 ,$405.00 , N/A ,$342.00 , N/A , N/A , N/A , N/A ,$216.00 , N/A 
ST. ELIZABETH'S HOSPITAL,63600183,Q4196,HC PURAPLY ANTIMICROBIAL PER SQ CENTIMETER USED - JC,636,1 ,$336.00 ,$218.40 ,$87.36 ,$442.92 , N/A ,$87.36 ,$188.16 , N/A ,$94.08 ,$113.57 , N/A ,$130.70 , N/A ,$151.54 ,$151.54 , N/A ,$151.54 , N/A ,$168.00 , N/A , N/A , N/A , N/A ,$252.00 ,$201.60 ,$201.60 , N/A ,$201.60 ,$255.36 ,$255.36 ,$255.36 ,$336.00 , N/A ,$285.60 , N/A ,$218.40 , N/A ,$336.00 ,$188.16 , N/A ,$88.37 , N/A ,$336.00 ,$336.00 , N/A ,$268.80 , N/A ,$151.54 ,$94.08 ,$302.40 , N/A ,$255.36 ,$182.57 ,$182.57 , N/A ,$182.57 ,$161.28 ,$442.92 
ST. ELIZABETH'S HOSPITAL,63600184,Q4196,HC PURAPLY ANTIMICROBIAL PER SQ CENTIMETER WASTED - JW,636,1 ,$336.00 ,$218.40 ,$87.36 ,$442.92 , N/A ,$87.36 ,$188.16 , N/A ,$94.08 ,$113.57 , N/A ,$130.70 , N/A ,$151.54 ,$151.54 , N/A ,$151.54 , N/A ,$168.00 , N/A , N/A , N/A , N/A ,$252.00 ,$201.60 ,$201.60 , N/A ,$201.60 ,$255.36 ,$255.36 ,$255.36 ,$336.00 , N/A ,$285.60 , N/A ,$218.40 , N/A ,$336.00 ,$188.16 , N/A ,$88.37 , N/A ,$336.00 ,$336.00 , N/A ,$268.80 , N/A ,$151.54 ,$94.08 ,$302.40 , N/A ,$255.36 ,$182.57 ,$182.57 , N/A ,$182.57 ,$161.28 ,$442.92 
ST. ELIZABETH'S HOSPITAL,63600190,Q4160,HC NUSHIELD PER SQ CM,636,1 ,$693.15 ,$450.55 ,$158.30 ,$693.15 , N/A ,$180.22 ,$388.16 , N/A ,$194.08 ,$234.28 , N/A ,$269.64 , N/A ,$312.61 ,$312.61 , N/A ,$312.61 , N/A ,$346.58 , N/A , N/A , N/A , N/A ,$519.86 ,$415.89 ,$415.89 , N/A ,$415.89 ,$526.79 ,$526.79 ,$526.79 ,$693.15 , N/A ,$589.18 , N/A ,$450.55 , N/A ,$693.15 ,$388.16 , N/A ,$182.30 , N/A ,$487.21 ,$465.07 , N/A ,$554.52 , N/A ,$312.61 ,$194.08 ,$623.84 , N/A ,$526.79 ,$158.30 ,$158.30 , N/A ,$158.30 ,$332.71 ,$442.92 
ST. ELIZABETH'S HOSPITAL,63600195,Q4110,"HC PRIMATRIX, PER SQ CM USED - JC",636,1 ,$104.00 ,$67.60 ,$27.04 ,$442.92 , N/A ,$27.04 ,$58.24 , N/A ,$29.12 ,$36.71 , N/A ,$42.85 , N/A ,$46.90 ,$46.90 , N/A ,$46.90 , N/A ,$52.00 , N/A , N/A , N/A , N/A ,$78.00 ,$62.40 ,$62.40 , N/A ,$62.40 ,$79.04 ,$79.04 ,$79.04 ,$104.00 , N/A ,$88.40 , N/A ,$67.60 , N/A ,$104.00 ,$58.24 , N/A ,$27.35 , N/A ,$104.00 ,$104.00 , N/A ,$83.20 , N/A ,$46.90 ,$29.12 ,$93.60 , N/A ,$79.04 ,$70.46 ,$70.46 , N/A ,$70.46 ,$49.92 ,$442.92 
ST. ELIZABETH'S HOSPITAL,63600196,Q4110,"HC PRIMATRIX, PER SQ CM WASTED - JW",636,1 ,$104.00 ,$67.60 ,$27.04 ,$442.92 , N/A ,$27.04 ,$58.24 , N/A ,$29.12 ,$36.71 , N/A ,$42.85 , N/A ,$46.90 ,$46.90 , N/A ,$46.90 , N/A ,$52.00 , N/A , N/A , N/A , N/A ,$78.00 ,$62.40 ,$62.40 , N/A ,$62.40 ,$79.04 ,$79.04 ,$79.04 ,$104.00 , N/A ,$88.40 , N/A ,$67.60 , N/A ,$104.00 ,$58.24 , N/A ,$27.35 , N/A ,$104.00 ,$104.00 , N/A ,$83.20 , N/A ,$46.90 ,$29.12 ,$93.60 , N/A ,$79.04 ,$70.46 ,$70.46 , N/A ,$70.46 ,$49.92 ,$442.92 
ST. ELIZABETH'S HOSPITAL,71000230,N/A,HC PHASE II RECOVERY 15 MIN,710,1 ,$770.00 ,$500.50 ,$202.51 ,$770.00 , N/A ,$354.20 ,$431.20 , N/A ,$215.60 ,$260.26 , N/A ,$299.53 , N/A ,$347.27 ,$347.27 , N/A ,$347.27 , N/A ,$385.00 , N/A , N/A , N/A , N/A ,$577.50 ,$462.00 ,$462.00 , N/A ,$462.00 ,$585.20 ,$585.20 ,$585.20 ,$770.00 , N/A ,$654.50 , N/A ,$500.50 , N/A ,$770.00 ,$431.20 , N/A ,$202.51 , N/A , N/A , N/A , N/A ,$616.00 , N/A ,$347.27 ,$215.60 ,$693.00 , N/A ,$585.20 ,$500.50 ,$500.50 , N/A ,$500.50 ,$369.60 , N/A 
ST. ELIZABETH'S HOSPITAL,71000231,N/A,HC RECOVERY <75 MIN,710,1 ,$965.00 ,$627.25 ,$253.80 ,$965.00 , N/A ,$443.90 ,$540.40 , N/A ,$270.20 ,$326.17 , N/A ,$375.39 , N/A ,$435.22 ,$435.22 , N/A ,$435.22 , N/A ,$482.50 , N/A , N/A , N/A , N/A ,$723.75 ,$579.00 ,$579.00 , N/A ,$579.00 ,$733.40 ,$733.40 ,$733.40 ,$965.00 , N/A ,$820.25 , N/A ,$627.25 , N/A ,$965.00 ,$540.40 , N/A ,$253.80 , N/A , N/A , N/A , N/A ,$772.00 , N/A ,$435.22 ,$270.20 ,$868.50 , N/A ,$733.40 ,$627.25 ,$627.25 , N/A ,$627.25 ,$463.20 , N/A 
ST. ELIZABETH'S HOSPITAL,71000232,N/A,HC RECOVERY >75 MIN,710,1 ,$189.00 ,$122.85 ,$49.71 ,$189.00 , N/A ,$86.94 ,$105.84 , N/A ,$52.92 ,$63.88 , N/A ,$73.52 , N/A ,$85.24 ,$85.24 , N/A ,$85.24 , N/A ,$94.50 , N/A , N/A , N/A , N/A ,$141.75 ,$113.40 ,$113.40 , N/A ,$113.40 ,$143.64 ,$143.64 ,$143.64 ,$189.00 , N/A ,$160.65 , N/A ,$122.85 , N/A ,$189.00 ,$105.84 , N/A ,$49.71 , N/A , N/A , N/A , N/A ,$151.20 , N/A ,$85.24 ,$52.92 ,$170.10 , N/A ,$143.64 ,$122.85 ,$122.85 , N/A ,$122.85 ,$90.72 , N/A 
ST. ELIZABETH'S HOSPITAL,71000233,N/A,HC PHASE I RECOVERY 30 MIN,710,1 ,$872.00 ,$566.80 ,$229.34 ,$872.00 , N/A ,$401.12 ,$488.32 , N/A ,$244.16 ,$294.74 , N/A ,$339.21 , N/A ,$393.27 ,$393.27 , N/A ,$393.27 , N/A ,$436.00 , N/A , N/A , N/A , N/A ,$654.00 ,$523.20 ,$523.20 , N/A ,$523.20 ,$662.72 ,$662.72 ,$662.72 ,$872.00 , N/A ,$741.20 , N/A ,$566.80 , N/A ,$872.00 ,$488.32 , N/A ,$229.34 , N/A , N/A , N/A , N/A ,$697.60 , N/A ,$393.27 ,$244.16 ,$784.80 , N/A ,$662.72 ,$566.80 ,$566.80 , N/A ,$566.80 ,$418.56 , N/A 
ST. ELIZABETH'S HOSPITAL,71000234,N/A,HC PHASE I RECOVERY 15 MIN,710,1 ,$314.00 ,$204.10 ,$82.58 ,$314.00 , N/A ,$144.44 ,$175.84 , N/A ,$87.92 ,$106.13 , N/A ,$122.15 , N/A ,$141.61 ,$141.61 , N/A ,$141.61 , N/A ,$157.00 , N/A , N/A , N/A , N/A ,$235.50 ,$188.40 ,$188.40 , N/A ,$188.40 ,$238.64 ,$238.64 ,$238.64 ,$314.00 , N/A ,$266.90 , N/A ,$204.10 , N/A ,$314.00 ,$175.84 , N/A ,$82.58 , N/A , N/A , N/A , N/A ,$251.20 , N/A ,$141.61 ,$87.92 ,$282.60 , N/A ,$238.64 ,$204.10 ,$204.10 , N/A ,$204.10 ,$150.72 , N/A 
ST. ELIZABETH'S HOSPITAL,72000007,59200,HC INSERT DILATOR CERVICAL,720,1 ,$664.00 ,$431.60 ,$62.20 ,$695.13 ,$695.13 ,$305.44 ,$371.84 ,$278.05 ,$185.92 ,$224.43 ,$278.05 ,$258.30 ,$278.05 ,$299.46 ,$299.46 ,$278.05 ,$62.20 ,$528.30 ,$332.00 ,$695.13 ,$278.05 ,$278.05 ,$283.61 ,$498.00 ,$398.40 ,$398.40 ,$278.05 ,$398.40 ,$504.64 ,$504.64 ,$504.64 ,$664.00 , N/A ,$564.40 ,$664.00 ,$431.60 ,$278.05 ,$664.00 ,$371.84 ,$278.05 ,$174.63 , N/A ,$258.09 ,$246.36 ,$291.95 ,$531.20 ,$625.61 ,$299.46 ,$185.92 ,$597.60 ,$278.05 ,$504.64 ,$664.00 ,$664.00 ,$278.05 ,$664.00 ,$318.72 ,$234.63 
ST. ELIZABETH'S HOSPITAL,72000008,59412,HC EXTERNAL CEPHALIC VERSION,720,1 ,"$3,208.00 ","$2,085.20 ",$143.31 ,"$6,466.58 ","$6,466.58 ","$1,475.68 ","$1,796.48 ","$2,586.63 ",$898.24 ,"$1,084.30 ","$2,586.63 ","$1,247.91 ","$2,586.63 ","$1,446.81 ","$1,446.81 ","$2,586.63 ",$143.31 ,"$3,208.00 ","$1,604.00 ","$6,466.58 ","$2,586.63 ","$2,586.63 ","$2,638.37 ","$2,406.00 ","$1,924.80 ","$1,924.80 ","$2,586.63 ","$1,924.80 ","$2,438.08 ","$2,438.08 ","$2,438.08 ","$3,208.00 ", N/A ,"$2,726.80 ","$3,208.00 ","$2,085.20 ","$2,586.63 ","$3,208.00 ","$1,796.48 ","$2,586.63 ",$843.70 , N/A , N/A , N/A ,"$2,715.96 ","$2,566.40 ","$5,819.92 ","$1,446.81 ",$898.24 ,"$2,887.20 ","$2,586.63 ","$2,438.08 ","$2,440.00 ","$2,440.00 ","$2,586.63 ","$2,440.00 ","$1,539.84 ", N/A 
ST. ELIZABETH'S HOSPITAL,72000013,N/A,HC DELIVERY COMPLICATED,720,1 ,"$2,997.00 ","$1,948.05 ",$788.21 ,"$2,997.00 ", N/A ,"$1,378.62 ","$1,678.32 ", N/A ,$839.16 ,"$1,012.99 ", N/A ,"$1,165.83 ", N/A ,"$1,351.65 ","$1,351.65 ", N/A ,"$1,948.05 ", N/A ,"$1,498.50 ", N/A , N/A , N/A , N/A ,"$2,247.75 ","$1,798.20 ","$1,798.20 ", N/A ,"$1,798.20 ","$2,277.72 ","$2,277.72 ","$2,277.72 ","$2,997.00 ", N/A ,"$2,547.45 ", N/A ,"$1,948.05 ", N/A ,"$2,997.00 ","$1,678.32 ", N/A ,$788.21 , N/A , N/A , N/A , N/A ,"$2,397.60 ", N/A ,"$1,351.65 ",$839.16 ,"$2,697.30 ", N/A ,"$2,277.72 ","$2,440.00 ","$2,440.00 ", N/A ,"$2,440.00 ","$1,438.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,72000018,N/A,HC DELIVERY OUTSIDE,720,1 ,"$1,543.00 ","$1,002.95 ",$405.81 ,"$1,543.00 ", N/A ,$709.78 ,$864.08 , N/A ,$432.04 ,$521.53 , N/A ,$600.23 , N/A ,$695.89 ,$695.89 , N/A ,"$1,002.95 ", N/A ,$771.50 , N/A , N/A , N/A , N/A ,"$1,157.25 ",$925.80 ,$925.80 , N/A ,$925.80 ,"$1,172.68 ","$1,172.68 ","$1,172.68 ","$1,543.00 ", N/A ,"$1,311.55 ", N/A ,"$1,002.95 ", N/A ,"$1,543.00 ",$864.08 , N/A ,$405.81 , N/A , N/A , N/A , N/A ,"$1,234.40 ", N/A ,$695.89 ,$432.04 ,"$1,388.70 ", N/A ,"$1,172.68 ","$1,543.00 ","$1,543.00 ", N/A ,"$1,543.00 ",$740.64 , N/A 
ST. ELIZABETH'S HOSPITAL,72000019,N/A,HC C-SECTION LEVEL 1,722,1 ,"$3,556.00 ","$2,311.40 ",$935.23 ,"$3,556.00 ", N/A ,"$1,635.76 ","$1,991.36 ", N/A ,$995.68 ,"$1,201.93 ", N/A ,"$1,383.28 ", N/A ,"$1,603.76 ","$1,603.76 ", N/A ,"$2,311.40 ", N/A ,"$1,778.00 ", N/A , N/A , N/A , N/A ,"$2,667.00 ","$2,133.60 ","$2,133.60 ", N/A ,"$2,133.60 ","$2,702.56 ","$2,702.56 ","$2,702.56 ","$3,556.00 ", N/A ,"$3,022.60 ", N/A ,"$2,311.40 ", N/A ,"$3,556.00 ","$1,991.36 ", N/A ,$935.23 , N/A , N/A , N/A , N/A ,"$2,844.80 ", N/A ,"$1,603.76 ",$995.68 ,"$3,200.40 ", N/A ,"$2,702.56 ","$2,440.00 ","$2,440.00 ", N/A ,"$2,440.00 ","$1,706.88 ", N/A 
ST. ELIZABETH'S HOSPITAL,72000020,N/A,HC C-SECTION LEVEL 2,722,1 ,"$3,831.00 ","$2,490.15 ","$1,007.55 ","$3,831.00 ", N/A ,"$1,762.26 ","$2,145.36 ", N/A ,"$1,072.68 ","$1,294.88 ", N/A ,"$1,490.26 ", N/A ,"$1,727.78 ","$1,727.78 ", N/A ,"$2,490.15 ", N/A ,"$1,915.50 ", N/A , N/A , N/A , N/A ,"$2,873.25 ","$2,298.60 ","$2,298.60 ", N/A ,"$2,298.60 ","$2,911.56 ","$2,911.56 ","$2,911.56 ","$3,831.00 ", N/A ,"$3,256.35 ", N/A ,"$2,490.15 ", N/A ,"$3,831.00 ","$2,145.36 ", N/A ,"$1,007.55 ", N/A , N/A , N/A , N/A ,"$3,064.80 ", N/A ,"$1,727.78 ","$1,072.68 ","$3,447.90 ", N/A ,"$2,911.56 ","$2,440.00 ","$2,440.00 ", N/A ,"$2,440.00 ","$1,838.88 ", N/A 
ST. ELIZABETH'S HOSPITAL,72100008,N/A,HC LABOR LEVEL 1,721,1 ,$555.00 ,$360.75 ,$145.97 ,$555.00 , N/A ,$255.30 ,$310.80 , N/A ,$155.40 ,$187.59 , N/A ,$215.90 , N/A ,$250.31 ,$250.31 , N/A ,$360.75 , N/A ,$277.50 , N/A , N/A , N/A , N/A ,$416.25 ,$333.00 ,$333.00 , N/A ,$333.00 ,$421.80 ,$421.80 ,$421.80 ,$555.00 , N/A ,$471.75 , N/A ,$360.75 , N/A ,$555.00 ,$310.80 , N/A ,$145.97 , N/A , N/A , N/A , N/A ,$444.00 , N/A ,$250.31 ,$155.40 ,$499.50 , N/A ,$421.80 ,$555.00 ,$555.00 , N/A ,$555.00 ,$266.40 , N/A 
ST. ELIZABETH'S HOSPITAL,72100009,N/A,HC LABOR LEVEL 2,721,1 ,$832.00 ,$540.80 ,$218.82 ,$832.00 , N/A ,$382.72 ,$465.92 , N/A ,$232.96 ,$281.22 , N/A ,$323.65 , N/A ,$375.23 ,$375.23 , N/A ,$540.80 , N/A ,$416.00 , N/A , N/A , N/A , N/A ,$624.00 ,$499.20 ,$499.20 , N/A ,$499.20 ,$632.32 ,$632.32 ,$632.32 ,$832.00 , N/A ,$707.20 , N/A ,$540.80 , N/A ,$832.00 ,$465.92 , N/A ,$218.82 , N/A , N/A , N/A , N/A ,$665.60 , N/A ,$375.23 ,$232.96 ,$748.80 , N/A ,$632.32 ,$832.00 ,$832.00 , N/A ,$832.00 ,$399.36 , N/A 
ST. ELIZABETH'S HOSPITAL,72100010,N/A,HC LABOR LEVEL 3,721,1 ,"$1,221.00 ",$793.65 ,$321.12 ,"$1,221.00 ", N/A ,$561.66 ,$683.76 , N/A ,$341.88 ,$412.70 , N/A ,$474.97 , N/A ,$550.67 ,$550.67 , N/A ,$793.65 , N/A ,$610.50 , N/A , N/A , N/A , N/A ,$915.75 ,$732.60 ,$732.60 , N/A ,$732.60 ,$927.96 ,$927.96 ,$927.96 ,"$1,221.00 ", N/A ,"$1,037.85 ", N/A ,$793.65 , N/A ,"$1,221.00 ",$683.76 , N/A ,$321.12 , N/A , N/A , N/A , N/A ,$976.80 , N/A ,$550.67 ,$341.88 ,"$1,098.90 ", N/A ,$927.96 ,"$1,221.00 ","$1,221.00 ", N/A ,"$1,221.00 ",$586.08 , N/A 
ST. ELIZABETH'S HOSPITAL,72100011,N/A,HC LABOR LEVEL 4,721,1 ,"$1,498.00 ",$973.70 ,$393.97 ,"$1,498.00 ", N/A ,$689.08 ,$838.88 , N/A ,$419.44 ,$506.32 , N/A ,$582.72 , N/A ,$675.60 ,$675.60 , N/A ,$973.70 , N/A ,$749.00 , N/A , N/A , N/A , N/A ,"$1,123.50 ",$898.80 ,$898.80 , N/A ,$898.80 ,"$1,138.48 ","$1,138.48 ","$1,138.48 ","$1,498.00 ", N/A ,"$1,273.30 ", N/A ,$973.70 , N/A ,"$1,498.00 ",$838.88 , N/A ,$393.97 , N/A , N/A , N/A , N/A ,"$1,198.40 ", N/A ,$675.60 ,$419.44 ,"$1,348.20 ", N/A ,"$1,138.48 ","$1,498.00 ","$1,498.00 ", N/A ,"$1,498.00 ",$719.04 , N/A 
ST. ELIZABETH'S HOSPITAL,72200009,N/A,HC DELIVERY,722,1 ,"$1,980.00 ","$1,287.00 ",$520.74 ,"$1,980.00 ", N/A ,$910.80 ,"$1,108.80 ", N/A ,$554.40 ,$669.24 , N/A ,$770.22 , N/A ,$892.98 ,$892.98 , N/A ,"$1,287.00 ", N/A ,$990.00 , N/A , N/A , N/A , N/A ,"$1,485.00 ","$1,188.00 ","$1,188.00 ", N/A ,"$1,188.00 ","$1,504.80 ","$1,504.80 ","$1,504.80 ","$1,980.00 ", N/A ,"$1,683.00 ", N/A ,"$1,287.00 ", N/A ,"$1,980.00 ","$1,108.80 ", N/A ,$520.74 , N/A , N/A , N/A , N/A ,"$1,584.00 ", N/A ,$892.98 ,$554.40 ,"$1,782.00 ", N/A ,"$1,504.80 ","$1,980.00 ","$1,980.00 ", N/A ,"$1,980.00 ",$950.40 , N/A 
ST. ELIZABETH'S HOSPITAL,72300002,54160,HC CIRCUMCISION,723,1 ,$526.00 ,$341.90 ,$138.34 ,"$1,417.96 ","$1,417.95 ",$241.96 ,$294.56 ,$567.18 ,$147.28 ,$177.79 ,$567.18 ,$204.61 ,$526.00 ,$237.23 ,$237.23 ,$526.00 ,$188.55 ,$526.00 ,$263.00 ,"$1,417.96 ",$567.18 ,$567.18 ,$526.00 ,$394.50 ,$315.60 ,$315.60 ,$567.18 ,$315.60 ,$399.76 ,$399.76 ,$399.76 ,$526.00 , N/A ,$447.10 ,$526.00 ,$341.90 ,$567.18 ,$526.00 ,$294.56 ,$567.18 ,$138.34 , N/A , N/A , N/A ,$595.54 ,$420.80 ,"$1,276.16 ",$237.23 ,$147.28 ,$473.40 ,$567.18 ,$399.76 ,$341.90 ,$341.90 ,$526.00 ,$341.90 ,$252.48 , N/A 
ST. ELIZABETH'S HOSPITAL,73000002,93005,HC EKG,730,1 ,$428.00 ,$278.20 ,$7.65 ,$428.00 ,$137.20 ,$196.88 ,$239.68 ,$54.88 ,$119.84 ,$122.67 ,$54.88 ,$122.67 ,$54.88 ,$193.03 ,$193.03 ,$54.88 ,$7.65 ,$104.27 ,$214.00 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$321.00 ,$256.80 ,$256.80 ,$54.88 ,$256.80 ,$325.28 ,$325.28 ,$325.28 ,$428.00 , N/A ,$363.80 ,$137.20 ,$278.20 ,$54.88 ,$428.00 ,$239.68 ,$54.88 ,$112.56 , N/A ,$27.16 ,$25.92 ,$57.62 ,$342.40 ,$123.48 ,$193.03 ,$119.84 ,$385.20 ,$54.88 ,$325.28 ,$355.00 ,$355.00 ,$54.88 ,$355.00 ,$205.44 ,$24.69 
ST. ELIZABETH'S HOSPITAL,74000002,95805,HC MULTIPLE SLEEP LATENCY,740,1 ,"$3,925.00 ","$2,551.25 ",$437.49 ,"$3,925.00 ","$1,203.10 ","$1,805.50 ","$2,198.00 ",$481.24 ,"$1,099.00 ","$1,385.53 ",$481.24 ,"$1,617.10 ",$481.24 ,"$1,770.18 ","$1,770.18 ",$481.24 ,$437.49 ,$914.36 ,"$1,962.50 ","$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$2,943.75 ","$2,355.00 ","$2,355.00 ",$481.24 ,"$2,355.00 ","$2,983.00 ","$2,983.00 ","$2,983.00 ","$3,925.00 ", N/A ,"$3,336.25 ","$1,203.10 ","$2,551.25 ",$481.24 ,"$3,925.00 ","$2,198.00 ",$481.24 ,"$1,032.28 ", N/A ,$809.08 ,$772.31 ,$505.30 ,"$3,140.00 ","$1,082.79 ","$1,770.18 ","$1,099.00 ","$3,532.50 ",$481.24 ,"$2,983.00 ","$2,508.00 ","$2,508.00 ",$481.24 ,"$2,508.00 ","$1,884.00 ",$735.53 
ST. ELIZABETH'S HOSPITAL,74000006,95810,HC SLEEP STUDY,740,1 ,"$5,540.00 ","$3,601.00 ",$593.88 ,"$5,540.00 ","$2,267.55 ","$2,548.40 ","$3,102.40 ",$907.02 ,"$1,551.20 ","$1,955.62 ",$907.02 ,"$2,282.48 ",$907.02 ,"$2,498.54 ","$2,498.54 ",$907.02 ,$593.88 ,"$1,723.35 ","$2,770.00 ","$2,267.56 ",$907.02 ,$907.02 ,$925.16 ,"$4,155.00 ","$3,324.00 ","$3,324.00 ",$907.02 ,"$3,324.00 ","$4,210.40 ","$4,210.40 ","$4,210.40 ","$5,540.00 ", N/A ,"$4,709.00 ","$2,267.56 ","$3,601.00 ",$907.02 ,"$5,540.00 ","$3,102.40 ",$907.02 ,"$1,457.02 ", N/A ,$809.08 ,$772.31 ,$952.37 ,"$4,432.00 ","$2,040.80 ","$2,498.54 ","$1,551.20 ","$4,986.00 ",$907.02 ,"$4,210.40 ","$2,508.00 ","$2,508.00 ",$907.02 ,"$2,508.00 ","$2,659.20 ",$735.53 
ST. ELIZABETH'S HOSPITAL,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$8,019.00 ","$5,212.35 ",$621.08 ,"$8,019.00 ","$2,267.55 ","$3,688.74 ","$4,490.64 ",$907.02 ,"$2,245.32 ","$2,830.71 ",$907.02 ,"$3,303.83 ",$907.02 ,"$3,616.57 ","$3,616.57 ",$907.02 ,$621.08 ,"$1,723.35 ","$4,009.50 ","$2,267.56 ",$907.02 ,$907.02 ,$925.16 ,"$6,014.25 ","$4,811.40 ","$4,811.40 ",$907.02 ,"$4,811.40 ","$6,094.44 ","$6,094.44 ","$6,094.44 ","$8,019.00 ", N/A ,"$6,816.15 ","$2,267.56 ","$5,212.35 ",$907.02 ,"$8,019.00 ","$4,490.64 ",$907.02 ,"$2,109.00 ", N/A ,$809.08 ,$772.31 ,$952.37 ,"$6,415.20 ","$2,040.80 ","$3,616.57 ","$2,245.32 ","$7,217.10 ",$907.02 ,"$6,094.44 ","$2,508.00 ","$2,508.00 ",$907.02 ,"$2,508.00 ","$3,849.12 ",$735.53 
ST. ELIZABETH'S HOSPITAL,74000014,95816,HC EEG AWAKE/DROWSY,740,1 ,"$1,309.00 ",$850.85 ,$248.22 ,"$1,309.00 ",$652.30 ,$602.14 ,$733.04 ,$260.92 ,$366.52 ,$462.08 ,$260.92 ,$539.31 ,$260.92 ,$590.36 ,$590.36 ,$260.92 ,$395.69 ,$495.74 ,$654.50 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$981.75 ,$785.40 ,$785.40 ,$260.92 ,$785.40 ,$994.84 ,$994.84 ,$994.84 ,"$1,309.00 ", N/A ,"$1,112.65 ",$652.29 ,$850.85 ,$260.92 ,"$1,309.00 ",$733.04 ,$260.92 ,$344.27 , N/A ,$273.04 ,$260.63 ,$273.97 ,"$1,047.20 ",$587.06 ,$590.36 ,$366.52 ,"$1,178.10 ",$260.92 ,$994.84 ,$620.00 ,$620.00 ,$260.92 ,$620.00 ,$628.32 ,$248.22 
ST. ELIZABETH'S HOSPITAL,74000016,95819,HC EEG AWAKE/ASLEEP,740,1 ,$941.00 ,$611.65 ,$247.48 ,$941.00 ,$652.30 ,$432.86 ,$526.96 ,$260.92 ,$263.48 ,$332.17 ,$260.92 ,$387.69 ,$260.92 ,$424.39 ,$424.39 ,$260.92 ,$475.88 ,$495.74 ,$470.50 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$705.75 ,$564.60 ,$564.60 ,$260.92 ,$564.60 ,$715.16 ,$715.16 ,$715.16 ,$941.00 , N/A ,$799.85 ,$652.29 ,$611.65 ,$260.92 ,$941.00 ,$526.96 ,$260.92 ,$247.48 , N/A ,$273.04 ,$260.63 ,$273.97 ,$752.80 ,$587.06 ,$424.39 ,$263.48 ,$846.90 ,$260.92 ,$715.16 ,$620.00 ,$620.00 ,$260.92 ,$620.00 ,$451.68 ,$248.22 
ST. ELIZABETH'S HOSPITAL,74000023,95928,HC TCMEP UPPER LIMBS,740,1 ,"$1,162.00 ",$755.30 ,$193.36 ,"$2,267.56 ","$2,267.55 ",$534.52 ,$650.72 ,$907.02 ,$325.36 ,$410.19 ,$907.02 ,$478.74 ,$907.02 ,$524.06 ,$524.06 ,$907.02 ,$193.36 ,"$1,162.00 ",$581.00 ,"$2,267.56 ",$907.02 ,$907.02 ,$925.16 ,$871.50 ,$697.20 ,$697.20 ,$907.02 ,$697.20 ,$883.12 ,$883.12 ,$883.12 ,"$1,162.00 ", N/A ,$987.70 ,"$1,162.00 ",$755.30 ,$907.02 ,"$1,162.00 ",$650.72 ,$907.02 ,$305.61 , N/A ,$346.21 ,$330.48 ,$952.37 ,$929.60 ,"$2,040.80 ",$524.06 ,$325.36 ,"$1,045.80 ",$907.02 ,$883.12 ,$620.00 ,$620.00 ,$907.02 ,$620.00 ,$557.76 ,$314.74 
ST. ELIZABETH'S HOSPITAL,74000024,95929,HC TCMEP LWR LIMBS,740,1 ,"$1,162.00 ",$755.30 ,$201.51 ,"$1,203.10 ","$1,203.10 ",$534.52 ,$650.72 ,$481.24 ,$325.36 ,$410.19 ,$481.24 ,$478.74 ,$481.24 ,$524.06 ,$524.06 ,$481.24 ,$201.51 ,$914.36 ,$581.00 ,"$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,$871.50 ,$697.20 ,$697.20 ,$481.24 ,$697.20 ,$883.12 ,$883.12 ,$883.12 ,"$1,162.00 ", N/A ,$987.70 ,"$1,162.00 ",$755.30 ,$481.24 ,"$1,162.00 ",$650.72 ,$481.24 ,$305.61 , N/A ,$346.21 ,$330.48 ,$505.30 ,$929.60 ,"$1,082.79 ",$524.06 ,$325.36 ,"$1,045.80 ",$481.24 ,$883.12 ,$620.00 ,$620.00 ,$481.24 ,$620.00 ,$557.76 ,$314.74 
ST. ELIZABETH'S HOSPITAL,74000025,95937,HC NEUROMUSCULAR JUNCTION TEST,740,1 ,$581.00 ,$377.65 ,$89.14 ,$581.00 ,$344.13 ,$267.26 ,$325.36 ,$137.65 ,$162.68 ,$205.09 ,$137.65 ,$239.37 ,$137.65 ,$262.03 ,$262.03 ,$137.65 ,$89.14 ,$261.53 ,$290.50 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$435.75 ,$348.60 ,$348.60 ,$137.65 ,$348.60 ,$441.56 ,$441.56 ,$441.56 ,$581.00 , N/A ,$493.85 ,$344.11 ,$377.65 ,$137.65 ,$581.00 ,$325.36 ,$137.65 ,$152.80 , N/A ,$346.21 ,$330.48 ,$144.53 ,$464.80 ,$309.70 ,$262.03 ,$162.68 ,$522.90 ,$137.65 ,$441.56 ,$581.00 ,$581.00 ,$137.65 ,$581.00 ,$278.88 ,$314.74 
ST. ELIZABETH'S HOSPITAL,74000033,95939,HC TCMEP UPPER AND LOWER,740,1 ,"$2,249.00 ","$1,461.85 ",$314.74 ,"$2,267.56 ","$2,267.55 ","$1,034.54 ","$1,259.44 ",$907.02 ,$629.72 ,$760.16 ,$907.02 ,$874.86 ,$907.02 ,"$1,014.30 ","$1,014.30 ",$907.02 ,$523.95 ,"$1,723.35 ","$1,124.50 ","$2,267.56 ",$907.02 ,$907.02 ,$925.16 ,"$1,686.75 ","$1,349.40 ","$1,349.40 ",$907.02 ,"$1,349.40 ","$1,709.24 ","$1,709.24 ","$1,709.24 ","$2,249.00 ", N/A ,"$1,911.65 ","$2,249.00 ","$1,461.85 ",$907.02 ,"$2,249.00 ","$1,259.44 ",$907.02 ,$591.49 , N/A ,$346.21 ,$330.48 ,$952.37 ,"$1,799.20 ","$2,040.80 ","$1,014.30 ",$629.72 ,"$2,024.10 ",$907.02 ,"$1,709.24 ",$620.00 ,$620.00 ,$907.02 ,$620.00 ,"$1,079.52 ",$314.74 
ST. ELIZABETH'S HOSPITAL,74000035,G0399,HC SLEEP STUDY HOME ADULT,740,1 ,"$1,040.00 ",$676.00 ,$114.47 ,"$1,040.00 ",$344.13 ,$478.40 ,$582.40 ,$137.65 ,$291.20 ,$351.52 ,$137.65 ,$404.56 ,$137.65 ,$469.04 ,$469.04 ,$137.65 ,$676.00 ,$261.53 ,$520.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$780.00 ,$624.00 ,$624.00 ,$137.65 ,$624.00 ,$790.40 ,$790.40 ,$790.40 ,"$1,040.00 ", N/A ,$884.00 ,$344.11 ,$676.00 ,$137.65 ,"$1,040.00 ",$582.40 ,$137.65 ,$273.52 , N/A ,$125.92 ,$120.19 ,$144.53 ,$832.00 ,$309.70 ,$469.04 ,$291.20 ,$936.00 ,$137.65 ,$790.40 ,"$1,040.00 ","$1,040.00 ",$137.65 ,"$1,040.00 ",$499.20 ,$114.47 
ST. ELIZABETH'S HOSPITAL,74000045,95810,HC SLEEP STUDY PSG 4+ PARAMETERS >6YRS -52,740,1 ,"$5,540.00 ","$3,601.00 ",$367.77 ,"$5,540.00 ","$1,133.78 ","$2,548.40 ","$3,102.40 ",$453.51 ,"$1,551.20 ","$1,955.62 ",$453.51 ,"$2,282.48 ",$453.51 ,"$2,498.54 ","$2,498.54 ",$453.51 ,$593.88 ,$861.67 ,"$2,770.00 ","$1,133.78 ",$453.51 ,$453.51 ,$462.58 ,"$4,155.00 ","$3,324.00 ","$3,324.00 ",$453.51 ,"$3,324.00 ","$4,210.40 ","$4,210.40 ","$4,210.40 ","$5,540.00 ", N/A ,"$4,709.00 ","$1,133.78 ","$3,601.00 ",$453.51 ,"$5,540.00 ","$3,102.40 ",$453.51 ,"$1,457.02 ", N/A ,$404.55 ,$386.16 ,$476.19 ,"$4,432.00 ","$1,020.40 ","$2,498.54 ","$1,551.20 ","$4,986.00 ",$453.51 ,"$4,210.40 ","$2,508.00 ","$2,508.00 ",$453.51 ,"$2,508.00 ","$2,659.20 ",$367.77 
ST. ELIZABETH'S HOSPITAL,74000046,95811,HC SLEEP STUDY PSG 4+ PARAMTRS W/CPAP >6YR-52,740,1 ,"$8,019.00 ","$5,212.35 ",$367.77 ,"$8,019.00 ","$1,133.78 ","$3,688.74 ","$4,490.64 ",$453.51 ,"$2,245.32 ","$2,830.71 ",$453.51 ,"$3,303.83 ",$453.51 ,"$3,616.57 ","$3,616.57 ",$453.51 ,$621.08 ,$861.67 ,"$4,009.50 ","$1,133.78 ",$453.51 ,$453.51 ,$462.58 ,"$6,014.25 ","$4,811.40 ","$4,811.40 ",$453.51 ,"$4,811.40 ","$6,094.44 ","$6,094.44 ","$6,094.44 ","$8,019.00 ", N/A ,"$6,816.15 ","$1,133.78 ","$5,212.35 ",$453.51 ,"$8,019.00 ","$4,490.64 ",$453.51 ,"$2,109.00 ", N/A ,$404.55 ,$386.16 ,$476.19 ,"$6,415.20 ","$1,020.40 ","$3,616.57 ","$2,245.32 ","$7,217.10 ",$453.51 ,"$6,094.44 ","$2,508.00 ","$2,508.00 ",$453.51 ,"$2,508.00 ","$3,849.12 ",$367.77 
ST. ELIZABETH'S HOSPITAL,75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$2,400.00 ","$1,560.00 ",$631.20 ,"$2,400.00 ","$1,994.33 ","$2,400.00 ","$1,344.00 ",$797.73 ,$672.00 ,$811.20 ,$797.73 ,$933.60 ,$797.73 ,"$1,082.40 ","$1,082.40 ",$797.73 ,"$1,082.40 ","$1,515.69 ","$1,200.00 ","$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$1,800.00 ","$1,440.00 ","$1,440.00 ",$797.73 ,"$1,440.00 ","$1,824.00 ","$1,824.00 ","$1,824.00 ","$2,400.00 ", N/A ,"$2,040.00 ","$1,994.33 ","$1,560.00 ",$797.73 ,"$2,400.00 ","$1,344.00 ",$797.73 ,$631.20 , N/A ,$729.45 ,$696.30 ,$837.62 ,"$1,920.00 ","$1,794.89 ","$1,082.40 ",$672.00 ,"$2,160.00 ",$797.73 ,"$1,824.00 ","$1,890.00 ","$1,890.00 ",$797.73 ,"$1,890.00 ","$1,152.00 ",$663.14 
ST. ELIZABETH'S HOSPITAL,75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,"$1,614.00 ","$1,049.10 ",$424.48 ,"$1,994.33 ","$1,994.33 ","$1,614.00 ",$903.84 ,$797.73 ,$451.92 ,$545.53 ,$797.73 ,$627.85 ,$797.73 ,$727.91 ,$727.91 ,$797.73 ,$727.91 ,"$1,515.69 ",$807.00 ,"$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$1,210.50 ",$968.40 ,$968.40 ,$797.73 ,$968.40 ,"$1,226.64 ","$1,226.64 ","$1,226.64 ","$1,614.00 ", N/A ,"$1,371.90 ","$1,614.00 ","$1,049.10 ",$797.73 ,"$1,614.00 ",$903.84 ,$797.73 ,$424.48 , N/A ,$729.45 ,$696.30 ,$837.62 ,"$1,291.20 ","$1,794.89 ",$727.91 ,$451.92 ,"$1,452.60 ",$797.73 ,"$1,226.64 ","$1,614.00 ","$1,614.00 ",$797.73 ,"$1,614.00 ",$774.72 ,$663.14 
ST. ELIZABETH'S HOSPITAL,75001007,91010,HC MOTILITY STUDY ESOPHAGEAL,750,1 ,"$1,388.97 ",$902.83 ,$365.30 ,"$1,388.97 ","$1,203.10 ","$1,388.97 ",$777.82 ,$481.24 ,$388.91 ,$490.31 ,$481.24 ,$572.26 ,$481.24 ,$626.43 ,$626.43 ,$481.24 ,$626.43 ,$914.36 ,$694.49 ,"$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$1,041.73 ",$833.38 ,$833.38 ,$481.24 ,$833.38 ,"$1,055.62 ","$1,055.62 ","$1,055.62 ","$1,388.97 ", N/A ,"$1,180.62 ","$1,203.10 ",$902.83 ,$481.24 ,"$1,388.97 ",$777.82 ,$481.24 ,$365.30 , N/A ,$634.93 ,$606.07 ,$505.30 ,"$1,111.18 ","$1,082.79 ",$626.43 ,$388.91 ,"$1,250.07 ",$481.24 ,"$1,055.62 ",$920.00 ,$920.00 ,$481.24 ,$920.00 ,$666.71 ,$577.21 
ST. ELIZABETH'S HOSPITAL,75001055,N/A,HC BRONCHOSCOPY DX W/WASHING -31622,750,1 ,"$4,267.00 ","$2,773.55 ","$1,122.22 ","$4,267.00 ", N/A ,"$1,962.82 ","$2,389.52 ", N/A ,"$1,194.76 ","$1,442.25 ", N/A ,"$1,659.86 ", N/A ,"$1,924.42 ","$1,924.42 ", N/A ,"$1,924.42 ", N/A ,"$2,133.50 ", N/A , N/A , N/A , N/A ,"$3,200.25 ","$2,560.20 ","$2,560.20 ", N/A ,"$2,560.20 ","$3,242.92 ","$3,242.92 ","$3,242.92 ","$4,267.00 ", N/A ,"$3,626.95 ", N/A ,"$2,773.55 ", N/A ,"$4,267.00 ","$2,389.52 ", N/A ,"$1,122.22 ", N/A , N/A , N/A , N/A ,"$3,413.60 ", N/A ,"$1,924.42 ","$1,194.76 ","$3,840.30 ", N/A ,"$3,242.92 ", N/A , N/A , N/A , N/A ,"$2,048.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001056,N/A,HC BRONCHOSCOPY W/BRUSHING -31623,750,1 ,"$3,772.00 ","$2,451.80 ",$992.04 ,"$3,772.00 ", N/A ,"$1,735.12 ","$2,112.32 ", N/A ,"$1,056.16 ","$1,274.94 ", N/A ,"$1,467.31 ", N/A ,"$1,701.17 ","$1,701.17 ", N/A ,"$1,701.17 ", N/A ,"$1,886.00 ", N/A , N/A , N/A , N/A ,"$2,829.00 ","$2,263.20 ","$2,263.20 ", N/A ,"$2,263.20 ","$2,866.72 ","$2,866.72 ","$2,866.72 ","$3,772.00 ", N/A ,"$3,206.20 ", N/A ,"$2,451.80 ", N/A ,"$3,772.00 ","$2,112.32 ", N/A ,$992.04 , N/A , N/A , N/A , N/A ,"$3,017.60 ", N/A ,"$1,701.17 ","$1,056.16 ","$3,394.80 ", N/A ,"$2,866.72 ", N/A , N/A , N/A , N/A ,"$1,810.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001057,N/A,HC BRONCHOSCOPY W/ALVEOLAR LAVAGE -31624,750,1 ,"$3,862.00 ","$2,510.30 ","$1,015.71 ","$3,862.00 ", N/A ,"$1,776.52 ","$2,162.72 ", N/A ,"$1,081.36 ","$1,305.36 ", N/A ,"$1,502.32 ", N/A ,"$1,741.76 ","$1,741.76 ", N/A ,"$1,741.76 ", N/A ,"$1,931.00 ", N/A , N/A , N/A , N/A ,"$2,896.50 ","$2,317.20 ","$2,317.20 ", N/A ,"$2,317.20 ","$2,935.12 ","$2,935.12 ","$2,935.12 ","$3,862.00 ", N/A ,"$3,282.70 ", N/A ,"$2,510.30 ", N/A ,"$3,862.00 ","$2,162.72 ", N/A ,"$1,015.71 ", N/A , N/A , N/A , N/A ,"$3,089.60 ", N/A ,"$1,741.76 ","$1,081.36 ","$3,475.80 ", N/A ,"$2,935.12 ", N/A , N/A , N/A , N/A ,"$1,853.76 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001058,N/A,HC BRONCHOSCOPY W/BIOPSY - 31625,750,1 ,"$4,071.00 ","$2,646.15 ","$1,070.67 ","$4,071.00 ", N/A ,"$1,872.66 ","$2,279.76 ", N/A ,"$1,139.88 ","$1,376.00 ", N/A ,"$1,583.62 ", N/A ,"$1,836.02 ","$1,836.02 ", N/A ,"$1,836.02 ", N/A ,"$2,035.50 ", N/A , N/A , N/A , N/A ,"$3,053.25 ","$2,442.60 ","$2,442.60 ", N/A ,"$2,442.60 ","$3,093.96 ","$3,093.96 ","$3,093.96 ","$4,071.00 ", N/A ,"$3,460.35 ", N/A ,"$2,646.15 ", N/A ,"$4,071.00 ","$2,279.76 ", N/A ,"$1,070.67 ", N/A , N/A , N/A , N/A ,"$3,256.80 ", N/A ,"$1,836.02 ","$1,139.88 ","$3,663.90 ", N/A ,"$3,093.96 ", N/A , N/A , N/A , N/A ,"$1,954.08 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001059,N/A,HC BRONCHOSCOPY W/LUNG BIOPSY SGL - 31628,750,1 ,"$3,412.00 ","$2,217.80 ",$897.36 ,"$3,412.00 ", N/A ,"$1,569.52 ","$1,910.72 ", N/A ,$955.36 ,"$1,153.26 ", N/A ,"$1,327.27 ", N/A ,"$1,538.81 ","$1,538.81 ", N/A ,"$1,538.81 ", N/A ,"$1,706.00 ", N/A , N/A , N/A , N/A ,"$2,559.00 ","$2,047.20 ","$2,047.20 ", N/A ,"$2,047.20 ","$2,593.12 ","$2,593.12 ","$2,593.12 ","$3,412.00 ", N/A ,"$2,900.20 ", N/A ,"$2,217.80 ", N/A ,"$3,412.00 ","$1,910.72 ", N/A ,$897.36 , N/A , N/A , N/A , N/A ,"$2,729.60 ", N/A ,"$1,538.81 ",$955.36 ,"$3,070.80 ", N/A ,"$2,593.12 ", N/A , N/A , N/A , N/A ,"$1,637.76 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001060,N/A,HC BRONCHOSCOPY W/NEEDLE ASPIRATION BIOPSY - 31629,750,1 ,"$3,521.00 ","$2,288.65 ",$926.02 ,"$3,521.00 ", N/A ,"$1,619.66 ","$1,971.76 ", N/A ,$985.88 ,"$1,190.10 ", N/A ,"$1,369.67 ", N/A ,"$1,587.97 ","$1,587.97 ", N/A ,"$1,587.97 ", N/A ,"$1,760.50 ", N/A , N/A , N/A , N/A ,"$2,640.75 ","$2,112.60 ","$2,112.60 ", N/A ,"$2,112.60 ","$2,675.96 ","$2,675.96 ","$2,675.96 ","$3,521.00 ", N/A ,"$2,992.85 ", N/A ,"$2,288.65 ", N/A ,"$3,521.00 ","$1,971.76 ", N/A ,$926.02 , N/A , N/A , N/A , N/A ,"$2,816.80 ", N/A ,"$1,587.97 ",$985.88 ,"$3,168.90 ", N/A ,"$2,675.96 ", N/A , N/A , N/A , N/A ,"$1,690.08 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001062,N/A,HC ESOPHAGOSCOPY RIGID W/BRUSH/WASH - 43191,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001063,N/A,HC ESOPHAGOSCOPY RIGID W/BIOPSY - 43193,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001064,N/A,HC ESOPHAGOSCOPY RIGID W/ FB REMOVAL -43194,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001065,N/A,HC ESOPHAGOSCOPY RIGID W/BALLOON DILATION - 43195,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001066,N/A,HC ESOPHAGOSCOPY FLEXIBLE DX W/BRUSH/WASH -43200,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001067,N/A,HC ESOPHAGOSCOPY FLEXIBLE W/BIOPSY - 43202,750,1 ,"$4,688.00 ","$3,047.20 ","$1,232.94 ","$4,688.00 ", N/A ,"$2,156.48 ","$2,625.28 ", N/A ,"$1,312.64 ","$1,584.54 ", N/A ,"$1,823.63 ", N/A ,"$2,114.29 ","$2,114.29 ", N/A ,"$2,114.29 ", N/A ,"$2,344.00 ", N/A , N/A , N/A , N/A ,"$3,516.00 ","$2,812.80 ","$2,812.80 ", N/A ,"$2,812.80 ","$3,562.88 ","$3,562.88 ","$3,562.88 ","$4,688.00 ", N/A ,"$3,984.80 ", N/A ,"$3,047.20 ", N/A ,"$4,688.00 ","$2,625.28 ", N/A ,"$1,232.94 ", N/A , N/A , N/A , N/A ,"$3,750.40 ", N/A ,"$2,114.29 ","$1,312.64 ","$4,219.20 ", N/A ,"$3,562.88 ", N/A , N/A , N/A , N/A ,"$2,250.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001068,N/A,HC ESOPHAGOSCOPY FLEXIBLE W/FB REMOVAL - 43215,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001069,N/A,HC ESOPHAGOSCOPY FLEXIBLE W/BALLOON DILATION - 43220,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001070,N/A,HC ESOPHAGOSCOPY FLEXIBLE W/ENDO US EXAM - 43231,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001071,N/A,HC EGD W/BALLOON DILAT >30MM - 43233,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001072,N/A,HC EGD W/BRUSH/WASH - 43235,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001073,N/A,HC EGD W/SUBMUCOSAL INJ - 43236,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001074,N/A,HC EGD W/ENDO US EXAM LIMITED - 43237,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001075,N/A,HC EGD W/US FINE NEEDLE ASPIRATION LIMITED - 43238,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001076,N/A,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001078,N/A,HC EGD W/US FINE NEEDLE ASPIRATION - 43242,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001079,N/A,HC EGD W/SCLEROTHERAPY - 43243,750,1 ,"$4,930.00 ","$3,204.50 ","$1,296.59 ","$4,930.00 ", N/A ,"$2,267.80 ","$2,760.80 ", N/A ,"$1,380.40 ","$1,666.34 ", N/A ,"$1,917.77 ", N/A ,"$2,223.43 ","$2,223.43 ", N/A ,"$2,223.43 ", N/A ,"$2,465.00 ", N/A , N/A , N/A , N/A ,"$3,697.50 ","$2,958.00 ","$2,958.00 ", N/A ,"$2,958.00 ","$3,746.80 ","$3,746.80 ","$3,746.80 ","$4,930.00 ", N/A ,"$4,190.50 ", N/A ,"$3,204.50 ", N/A ,"$4,930.00 ","$2,760.80 ", N/A ,"$1,296.59 ", N/A , N/A , N/A , N/A ,"$3,944.00 ", N/A ,"$2,223.43 ","$1,380.40 ","$4,437.00 ", N/A ,"$3,746.80 ", N/A , N/A , N/A , N/A ,"$2,366.40 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001080,N/A,HC EGD W/BAND LIGATION - 43244,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001081,N/A,HC EGD W/DILAT STRICTURE - 43245,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001082,N/A,HC EGD W/PLACEMENT G-TUBE - 43246,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001083,N/A,HC EGD W/FB REMOVAL - 43247,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001084,N/A,HC EGD W/INSERT GUIDEWIRE - 43248,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001085,N/A,HC EGD W/BALLOON DILAT <30MM - 43249,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001086,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY - 43250,750,1 ,"$4,672.00 ","$3,036.80 ","$1,228.74 ","$4,672.00 ", N/A ,"$2,149.12 ","$2,616.32 ", N/A ,"$1,308.16 ","$1,579.14 ", N/A ,"$1,817.41 ", N/A ,"$2,107.07 ","$2,107.07 ", N/A ,"$2,107.07 ", N/A ,"$2,336.00 ", N/A , N/A , N/A , N/A ,"$3,504.00 ","$2,803.20 ","$2,803.20 ", N/A ,"$2,803.20 ","$3,550.72 ","$3,550.72 ","$3,550.72 ","$4,672.00 ", N/A ,"$3,971.20 ", N/A ,"$3,036.80 ", N/A ,"$4,672.00 ","$2,616.32 ", N/A ,"$1,228.74 ", N/A , N/A , N/A , N/A ,"$3,737.60 ", N/A ,"$2,107.07 ","$1,308.16 ","$4,204.80 ", N/A ,"$3,550.72 ", N/A , N/A , N/A , N/A ,"$2,242.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001087,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH - 43251,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001090,N/A,HC EGD W/CONTROL BLEEDING - 43255,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001091,N/A,HC EGD W/US DUODENUM/JEJUNUM - 43259,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001092,N/A,HC EGD W/STENT PLACEMENT - 43266,750,1 ,"$10,348.00 ","$6,726.20 ","$2,721.52 ","$10,348.00 ", N/A ,"$4,760.08 ","$5,794.88 ", N/A ,"$2,897.44 ","$3,497.62 ", N/A ,"$4,025.37 ", N/A ,"$4,666.95 ","$4,666.95 ", N/A ,"$4,666.95 ", N/A ,"$5,174.00 ", N/A , N/A , N/A , N/A ,"$7,761.00 ","$6,208.80 ","$6,208.80 ", N/A ,"$6,208.80 ","$7,864.48 ","$7,864.48 ","$7,864.48 ","$10,348.00 ", N/A ,"$8,795.80 ", N/A ,"$6,726.20 ", N/A ,"$10,348.00 ","$5,794.88 ", N/A ,"$2,721.52 ", N/A , N/A , N/A , N/A ,"$8,278.40 ", N/A ,"$4,666.95 ","$2,897.44 ","$9,313.20 ", N/A ,"$7,301.00 ", N/A , N/A , N/A , N/A ,"$4,967.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001093,N/A,HC EGD W/TUMOR ABLATION - 43270,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001094,N/A,HC ERCP W/BRUSH/WASH - 43260,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001095,N/A,HC ERCP W/BIOPSY SGL/MULT - 43261,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001096,N/A,HC ERCP W/SPHINCTEROTOMY - 43262,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001097,N/A,HC ERCP W/SPHINCTER PRESSURE MEASUREMENT - 43263,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001098,N/A,HC ERCP W/STONE REMOVAL DUCT - 43264,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001100,N/A,HC ERCP W/STENT PLACEMENT DUCT - 43274,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001101,N/A,HC ERCP W/FB OR STENT REMOVAL DUCT - 43275,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001102,N/A,HC ERCP W/REM/EXCHG STENT W/DILAT  AND  WIRE EA - 43276,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001103,N/A,HC ERCP W/BALL DILAT DUCT/AMPULLA EA -43277,750,1 ,"$5,176.00 ","$3,364.40 ","$1,361.29 ","$5,176.00 ", N/A ,"$2,380.96 ","$2,898.56 ", N/A ,"$1,449.28 ","$1,749.49 ", N/A ,"$2,013.46 ", N/A ,"$2,334.38 ","$2,334.38 ", N/A ,"$2,334.38 ", N/A ,"$2,588.00 ", N/A , N/A , N/A , N/A ,"$3,882.00 ","$3,105.60 ","$3,105.60 ", N/A ,"$3,105.60 ","$3,933.76 ","$3,933.76 ","$3,933.76 ","$5,176.00 ", N/A ,"$4,399.60 ", N/A ,"$3,364.40 ", N/A ,"$5,176.00 ","$2,898.56 ", N/A ,"$1,361.29 ", N/A , N/A , N/A , N/A ,"$4,140.80 ", N/A ,"$2,334.38 ","$1,449.28 ","$4,658.40 ", N/A ,"$3,933.76 ", N/A , N/A , N/A , N/A ,"$2,484.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001105,N/A,HC ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREAS - 43273,750,1 ,"$4,042.00 ","$2,627.30 ","$1,063.05 ","$4,042.00 ", N/A ,"$1,859.32 ","$2,263.52 ", N/A ,"$1,131.76 ","$1,366.20 ", N/A ,"$1,572.34 ", N/A ,"$1,822.94 ","$1,822.94 ", N/A ,"$1,822.94 ", N/A ,"$2,021.00 ", N/A , N/A , N/A , N/A ,"$3,031.50 ","$2,425.20 ","$2,425.20 ", N/A ,"$2,425.20 ","$3,071.92 ","$3,071.92 ","$3,071.92 ","$4,042.00 ", N/A ,"$3,435.70 ", N/A ,"$2,627.30 ", N/A ,"$4,042.00 ","$2,263.52 ", N/A ,"$1,063.05 ", N/A , N/A , N/A , N/A ,"$3,233.60 ", N/A ,"$1,822.94 ","$1,131.76 ","$3,637.80 ", N/A ,"$3,071.92 ", N/A , N/A , N/A , N/A ,"$1,940.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001106,N/A,HC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS - 43450,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001109,N/A,HC GASTROSTOMY TUBE PLACE OPEN - 43832,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001111,N/A,HC ENTEROSCOPY UPPER SMALL BOWEL - 44360,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001112,N/A,HC ENTEROSCOPY UPR SM BOWEL W/BIOPSY - 44361,750,1 ,"$4,895.00 ","$3,181.75 ","$1,287.39 ","$4,895.00 ", N/A ,"$2,251.70 ","$2,741.20 ", N/A ,"$1,370.60 ","$1,654.51 ", N/A ,"$1,904.16 ", N/A ,"$2,207.65 ","$2,207.65 ", N/A ,"$2,207.65 ", N/A ,"$2,447.50 ", N/A , N/A , N/A , N/A ,"$3,671.25 ","$2,937.00 ","$2,937.00 ", N/A ,"$2,937.00 ","$3,720.20 ","$3,720.20 ","$3,720.20 ","$4,895.00 ", N/A ,"$4,160.75 ", N/A ,"$3,181.75 ", N/A ,"$4,895.00 ","$2,741.20 ", N/A ,"$1,287.39 ", N/A , N/A , N/A , N/A ,"$3,916.00 ", N/A ,"$2,207.65 ","$1,370.60 ","$4,405.50 ", N/A ,"$3,720.20 ", N/A , N/A , N/A , N/A ,"$2,349.60 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001115,N/A,HC ENTEROSCOPY W/CONTROL BLEEDING - 44366,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001116,N/A,HC ENTEROSCOPY W/ABLATION - 44369,750,1 ,"$4,688.00 ","$3,047.20 ","$1,232.94 ","$4,688.00 ", N/A ,"$2,156.48 ","$2,625.28 ", N/A ,"$1,312.64 ","$1,584.54 ", N/A ,"$1,823.63 ", N/A ,"$2,114.29 ","$2,114.29 ", N/A ,"$2,114.29 ", N/A ,"$2,344.00 ", N/A , N/A , N/A , N/A ,"$3,516.00 ","$2,812.80 ","$2,812.80 ", N/A ,"$2,812.80 ","$3,562.88 ","$3,562.88 ","$3,562.88 ","$4,688.00 ", N/A ,"$3,984.80 ", N/A ,"$3,047.20 ", N/A ,"$4,688.00 ","$2,625.28 ", N/A ,"$1,232.94 ", N/A , N/A , N/A , N/A ,"$3,750.40 ", N/A ,"$2,114.29 ","$1,312.64 ","$4,219.20 ", N/A ,"$3,562.88 ", N/A , N/A , N/A , N/A ,"$2,250.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001118,N/A,HC ENTEROSCOPY W/J-TUBE PLACEMENT - 44372,750,1 ,"$4,909.00 ","$3,190.85 ","$1,291.07 ","$4,909.00 ", N/A ,"$2,258.14 ","$2,749.04 ", N/A ,"$1,374.52 ","$1,659.24 ", N/A ,"$1,909.60 ", N/A ,"$2,213.96 ","$2,213.96 ", N/A ,"$2,213.96 ", N/A ,"$2,454.50 ", N/A , N/A , N/A , N/A ,"$3,681.75 ","$2,945.40 ","$2,945.40 ", N/A ,"$2,945.40 ","$3,730.84 ","$3,730.84 ","$3,730.84 ","$4,909.00 ", N/A ,"$4,172.65 ", N/A ,"$3,190.85 ", N/A ,"$4,909.00 ","$2,749.04 ", N/A ,"$1,291.07 ", N/A , N/A , N/A , N/A ,"$3,927.20 ", N/A ,"$2,213.96 ","$1,374.52 ","$4,418.10 ", N/A ,"$3,730.84 ", N/A , N/A , N/A , N/A ,"$2,356.32 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001123,N/A,HC ENDOSCOPY POUCH DX W/BRUSH/WASH - 44385,750,1 ,"$3,528.00 ","$2,293.20 ",$927.86 ,"$3,528.00 ", N/A ,"$1,622.88 ","$1,975.68 ", N/A ,$987.84 ,"$1,192.46 ", N/A ,"$1,372.39 ", N/A ,"$1,591.13 ","$1,591.13 ", N/A ,"$1,591.13 ", N/A ,"$1,764.00 ", N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,116.80 ","$2,116.80 ", N/A ,"$2,116.80 ","$2,681.28 ","$2,681.28 ","$2,681.28 ","$3,528.00 ", N/A ,"$2,998.80 ", N/A ,"$2,293.20 ", N/A ,"$3,528.00 ","$1,975.68 ", N/A ,$927.86 , N/A , N/A , N/A , N/A ,"$2,822.40 ", N/A ,"$1,591.13 ",$987.84 ,"$3,175.20 ", N/A ,"$2,681.28 ", N/A , N/A , N/A , N/A ,"$1,693.44 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001125,N/A,HC COLONOSCOPY STOMA DX W/BRUSH/WASH - 44388,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001126,N/A,HC COLONOSCOPY STOMA W/BX SGL/MULT - 44389,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001129,N/A,HC COLONOSCOPY STOMA W/REM TUMOR HOT BX - 44392,750,1 ,"$3,023.00 ","$1,964.95 ",$795.05 ,"$3,023.00 ", N/A ,"$1,390.58 ","$1,692.88 ", N/A ,$846.44 ,"$1,021.77 ", N/A ,"$1,175.95 ", N/A ,"$1,363.37 ","$1,363.37 ", N/A ,"$1,363.37 ", N/A ,"$1,511.50 ", N/A , N/A , N/A , N/A ,"$2,267.25 ","$1,813.80 ","$1,813.80 ", N/A ,"$1,813.80 ","$2,297.48 ","$2,297.48 ","$2,297.48 ","$3,023.00 ", N/A ,"$2,569.55 ", N/A ,"$1,964.95 ", N/A ,"$3,023.00 ","$1,692.88 ", N/A ,$795.05 , N/A , N/A , N/A , N/A ,"$2,418.40 ", N/A ,"$1,363.37 ",$846.44 ,"$2,720.70 ", N/A ,"$2,297.48 ", N/A , N/A , N/A , N/A ,"$1,451.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001130,N/A,HC COLONOSCOPY STOMA W/REM TUMOR SNARE TECH - 44394,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001134,N/A,HC COLONOSCOPY STOMA W/SUBMUCOSAL INJ - 44404,750,1 ,"$3,023.00 ","$1,964.95 ",$795.05 ,"$3,023.00 ", N/A ,"$1,390.58 ","$1,692.88 ", N/A ,$846.44 ,"$1,021.77 ", N/A ,"$1,175.95 ", N/A ,"$1,363.37 ","$1,363.37 ", N/A ,"$1,363.37 ", N/A ,"$1,511.50 ", N/A , N/A , N/A , N/A ,"$2,267.25 ","$1,813.80 ","$1,813.80 ", N/A ,"$1,813.80 ","$2,297.48 ","$2,297.48 ","$2,297.48 ","$3,023.00 ", N/A ,"$2,569.55 ", N/A ,"$1,964.95 ", N/A ,"$3,023.00 ","$1,692.88 ", N/A ,$795.05 , N/A , N/A , N/A , N/A ,"$2,418.40 ", N/A ,"$1,363.37 ",$846.44 ,"$2,720.70 ", N/A ,"$2,297.48 ", N/A , N/A , N/A , N/A ,"$1,451.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001142,N/A,HC SIGMOIDOSCOPY DX W/BRUSH/WASH - 45330,750,1 ,"$2,219.00 ","$1,442.35 ",$583.60 ,"$2,219.00 ", N/A ,"$1,020.74 ","$1,242.64 ", N/A ,$621.32 ,$750.02 , N/A ,$863.19 , N/A ,"$1,000.77 ","$1,000.77 ", N/A ,"$1,000.77 ", N/A ,"$1,109.50 ", N/A , N/A , N/A , N/A ,"$1,664.25 ","$1,331.40 ","$1,331.40 ", N/A ,"$1,331.40 ","$1,686.44 ","$1,686.44 ","$1,686.44 ","$2,219.00 ", N/A ,"$1,886.15 ", N/A ,"$1,442.35 ", N/A ,"$2,219.00 ","$1,242.64 ", N/A ,$583.60 , N/A , N/A , N/A , N/A ,"$1,775.20 ", N/A ,"$1,000.77 ",$621.32 ,"$1,997.10 ", N/A ,"$1,686.44 ", N/A , N/A , N/A , N/A ,"$1,065.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001143,N/A,HC SIGMOIDOSCOPY W/BIOPSY SGL/MULT -45331,750,1 ,"$2,219.00 ","$1,442.35 ",$583.60 ,"$2,219.00 ", N/A ,"$1,020.74 ","$1,242.64 ", N/A ,$621.32 ,$750.02 , N/A ,$863.19 , N/A ,"$1,000.77 ","$1,000.77 ", N/A ,"$1,000.77 ", N/A ,"$1,109.50 ", N/A , N/A , N/A , N/A ,"$1,664.25 ","$1,331.40 ","$1,331.40 ", N/A ,"$1,331.40 ","$1,686.44 ","$1,686.44 ","$1,686.44 ","$2,219.00 ", N/A ,"$1,886.15 ", N/A ,"$1,442.35 ", N/A ,"$2,219.00 ","$1,242.64 ", N/A ,$583.60 , N/A , N/A , N/A , N/A ,"$1,775.20 ", N/A ,"$1,000.77 ",$621.32 ,"$1,997.10 ", N/A ,"$1,686.44 ", N/A , N/A , N/A , N/A ,"$1,065.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001144,N/A,HC SIGMOIDOSCOPY W/FB REMOVAL -45332,750,1 ,"$3,110.88 ","$2,022.07 ",$818.16 ,"$3,110.88 ", N/A ,"$1,431.00 ","$1,742.09 ", N/A ,$871.05 ,"$1,051.48 ", N/A ,"$1,210.13 ", N/A ,"$1,403.01 ","$1,403.01 ", N/A ,"$1,403.01 ", N/A ,"$1,555.44 ", N/A , N/A , N/A , N/A ,"$2,333.16 ","$1,866.53 ","$1,866.53 ", N/A ,"$1,866.53 ","$2,364.27 ","$2,364.27 ","$2,364.27 ","$3,110.88 ", N/A ,"$2,644.25 ", N/A ,"$2,022.07 ", N/A ,"$3,110.88 ","$1,742.09 ", N/A ,$818.16 , N/A , N/A , N/A , N/A ,"$2,488.70 ", N/A ,"$1,403.01 ",$871.05 ,"$2,799.79 ", N/A ,"$2,364.27 ", N/A , N/A , N/A , N/A ,"$1,493.22 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001145,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN  HOT BIOPSY -45333,750,1 ,"$2,500.00 ","$1,625.00 ",$657.50 ,"$2,500.00 ", N/A ,"$1,150.00 ","$1,400.00 ", N/A ,$700.00 ,$845.00 , N/A ,$972.50 , N/A ,"$1,127.50 ","$1,127.50 ", N/A ,"$1,127.50 ", N/A ,"$1,250.00 ", N/A , N/A , N/A , N/A ,"$1,875.00 ","$1,500.00 ","$1,500.00 ", N/A ,"$1,500.00 ","$1,900.00 ","$1,900.00 ","$1,900.00 ","$2,500.00 ", N/A ,"$2,125.00 ", N/A ,"$1,625.00 ", N/A ,"$2,500.00 ","$1,400.00 ", N/A ,$657.50 , N/A , N/A , N/A , N/A ,"$2,000.00 ", N/A ,"$1,127.50 ",$700.00 ,"$2,250.00 ", N/A ,"$1,900.00 ", N/A , N/A , N/A , N/A ,"$1,200.00 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001146,N/A,HC SIGMOIDOSCOPY W/CONTROL BLEEDING - 45334,750,1 ,"$3,197.00 ","$2,078.05 ",$840.81 ,"$3,197.00 ", N/A ,"$1,470.62 ","$1,790.32 ", N/A ,$895.16 ,"$1,080.59 ", N/A ,"$1,243.63 ", N/A ,"$1,441.85 ","$1,441.85 ", N/A ,"$1,441.85 ", N/A ,"$1,598.50 ", N/A , N/A , N/A , N/A ,"$2,397.75 ","$1,918.20 ","$1,918.20 ", N/A ,"$1,918.20 ","$2,429.72 ","$2,429.72 ","$2,429.72 ","$3,197.00 ", N/A ,"$2,717.45 ", N/A ,"$2,078.05 ", N/A ,"$3,197.00 ","$1,790.32 ", N/A ,$840.81 , N/A , N/A , N/A , N/A ,"$2,557.60 ", N/A ,"$1,441.85 ",$895.16 ,"$2,877.30 ", N/A ,"$2,429.72 ", N/A , N/A , N/A , N/A ,"$1,534.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001147,N/A,HC SIGMOIDOSCOPY W/SUBMUCOSAL INJ - 45335,750,1 ,"$2,219.00 ","$1,442.35 ",$583.60 ,"$2,219.00 ", N/A ,"$1,020.74 ","$1,242.64 ", N/A ,$621.32 ,$750.02 , N/A ,$863.19 , N/A ,"$1,000.77 ","$1,000.77 ", N/A ,"$1,000.77 ", N/A ,"$1,109.50 ", N/A , N/A , N/A , N/A ,"$1,664.25 ","$1,331.40 ","$1,331.40 ", N/A ,"$1,331.40 ","$1,686.44 ","$1,686.44 ","$1,686.44 ","$2,219.00 ", N/A ,"$1,886.15 ", N/A ,"$1,442.35 ", N/A ,"$2,219.00 ","$1,242.64 ", N/A ,$583.60 , N/A , N/A , N/A , N/A ,"$1,775.20 ", N/A ,"$1,000.77 ",$621.32 ,"$1,997.10 ", N/A ,"$1,686.44 ", N/A , N/A , N/A , N/A ,"$1,065.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001148,N/A,HC SIGMOIDOSCOPY W/DECOMPRESSION -45337,750,1 ,"$4,101.00 ","$2,665.65 ","$1,078.56 ","$4,101.00 ", N/A ,"$1,886.46 ","$2,296.56 ", N/A ,"$1,148.28 ","$1,386.14 ", N/A ,"$1,595.29 ", N/A ,"$1,849.55 ","$1,849.55 ", N/A ,"$1,849.55 ", N/A ,"$2,050.50 ", N/A , N/A , N/A , N/A ,"$3,075.75 ","$2,460.60 ","$2,460.60 ", N/A ,"$2,460.60 ","$3,116.76 ","$3,116.76 ","$3,116.76 ","$4,101.00 ", N/A ,"$3,485.85 ", N/A ,"$2,665.65 ", N/A ,"$4,101.00 ","$2,296.56 ", N/A ,"$1,078.56 ", N/A , N/A , N/A , N/A ,"$3,280.80 ", N/A ,"$1,849.55 ","$1,148.28 ","$3,690.90 ", N/A ,"$3,116.76 ", N/A , N/A , N/A , N/A ,"$1,968.48 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001149,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45338,750,1 ,"$3,023.00 ","$1,964.95 ",$795.05 ,"$3,023.00 ", N/A ,"$1,390.58 ","$1,692.88 ", N/A ,$846.44 ,"$1,021.77 ", N/A ,"$1,175.95 ", N/A ,"$1,363.37 ","$1,363.37 ", N/A ,"$1,363.37 ", N/A ,"$1,511.50 ", N/A , N/A , N/A , N/A ,"$2,267.25 ","$1,813.80 ","$1,813.80 ", N/A ,"$1,813.80 ","$2,297.48 ","$2,297.48 ","$2,297.48 ","$3,023.00 ", N/A ,"$2,569.55 ", N/A ,"$1,964.95 ", N/A ,"$3,023.00 ","$1,692.88 ", N/A ,$795.05 , N/A , N/A , N/A , N/A ,"$2,418.40 ", N/A ,"$1,363.37 ",$846.44 ,"$2,720.70 ", N/A ,"$2,297.48 ", N/A , N/A , N/A , N/A ,"$1,451.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001151,N/A,HC SIGMOIDOSCOPY W/ENDO US - 45341,750,1 ,"$2,219.00 ","$1,442.35 ",$583.60 ,"$2,219.00 ", N/A ,"$1,020.74 ","$1,242.64 ", N/A ,$621.32 ,$750.02 , N/A ,$863.19 , N/A ,"$1,000.77 ","$1,000.77 ", N/A ,"$1,000.77 ", N/A ,"$1,109.50 ", N/A , N/A , N/A , N/A ,"$1,664.25 ","$1,331.40 ","$1,331.40 ", N/A ,"$1,331.40 ","$1,686.44 ","$1,686.44 ","$1,686.44 ","$2,219.00 ", N/A ,"$1,886.15 ", N/A ,"$1,442.35 ", N/A ,"$2,219.00 ","$1,242.64 ", N/A ,$583.60 , N/A , N/A , N/A , N/A ,"$1,775.20 ", N/A ,"$1,000.77 ",$621.32 ,"$1,997.10 ", N/A ,"$1,686.44 ", N/A , N/A , N/A , N/A ,"$1,065.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001156,N/A,HC SIGMOIDOSCOPY W/BAND LIGATION - 45350,750,1 ,"$3,241.00 ","$2,106.65 ",$852.38 ,"$3,241.00 ", N/A ,"$1,490.86 ","$1,814.96 ", N/A ,$907.48 ,"$1,095.46 ", N/A ,"$1,260.75 ", N/A ,"$1,461.69 ","$1,461.69 ", N/A ,"$1,461.69 ", N/A ,"$1,620.50 ", N/A , N/A , N/A , N/A ,"$2,430.75 ","$1,944.60 ","$1,944.60 ", N/A ,"$1,944.60 ","$2,463.16 ","$2,463.16 ","$2,463.16 ","$3,241.00 ", N/A ,"$2,754.85 ", N/A ,"$2,106.65 ", N/A ,"$3,241.00 ","$1,814.96 ", N/A ,$852.38 , N/A , N/A , N/A , N/A ,"$2,592.80 ", N/A ,"$1,461.69 ",$907.48 ,"$2,916.90 ", N/A ,"$2,463.16 ", N/A , N/A , N/A , N/A ,"$1,555.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001157,N/A,HC COLONOSCOPY DX W/SPECIMEN BRUSH/WASH - 45378,750,1 ,"$2,715.00 ","$1,764.75 ",$714.05 ,"$2,715.00 ", N/A ,"$1,248.90 ","$1,520.40 ", N/A ,$760.20 ,$917.67 , N/A ,"$1,056.14 ", N/A ,"$1,224.47 ","$1,224.47 ", N/A ,"$1,224.47 ", N/A ,"$1,357.50 ", N/A , N/A , N/A , N/A ,"$2,036.25 ","$1,629.00 ","$1,629.00 ", N/A ,"$1,629.00 ","$2,063.40 ","$2,063.40 ","$2,063.40 ","$2,715.00 ", N/A ,"$2,307.75 ", N/A ,"$1,764.75 ", N/A ,"$2,715.00 ","$1,520.40 ", N/A ,$714.05 , N/A , N/A , N/A , N/A ,"$2,172.00 ", N/A ,"$1,224.47 ",$760.20 ,"$2,443.50 ", N/A ,"$2,063.40 ", N/A , N/A , N/A , N/A ,"$1,303.20 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001158,N/A,HC COLONOSCOPY W/FB REMOVAL - 45379,750,1 ,"$3,023.00 ","$1,964.95 ",$795.05 ,"$3,023.00 ", N/A ,"$1,390.58 ","$1,692.88 ", N/A ,$846.44 ,"$1,021.77 ", N/A ,"$1,175.95 ", N/A ,"$1,363.37 ","$1,363.37 ", N/A ,"$1,363.37 ", N/A ,"$1,511.50 ", N/A , N/A , N/A , N/A ,"$2,267.25 ","$1,813.80 ","$1,813.80 ", N/A ,"$1,813.80 ","$2,297.48 ","$2,297.48 ","$2,297.48 ","$3,023.00 ", N/A ,"$2,569.55 ", N/A ,"$1,964.95 ", N/A ,"$3,023.00 ","$1,692.88 ", N/A ,$795.05 , N/A , N/A , N/A , N/A ,"$2,418.40 ", N/A ,"$1,363.37 ",$846.44 ,"$2,720.70 ", N/A ,"$2,297.48 ", N/A , N/A , N/A , N/A ,"$1,451.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001159,N/A,HC COLONOSCOPY W/BIOPSY SGL/MULT - 45380,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001160,N/A,HC COLONOSCOPY W/SUBMUCOSAL INJ - 45381,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001161,N/A,HC COLONOSCOPY W/CONTROL BLEEDING - 45382,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001162,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 45384,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001163,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45385,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001164,N/A,HC COLONOSCOPY W/BALLOON DILATION - 45386,750,1 ,"$3,242.00 ","$2,107.30 ",$852.65 ,"$3,242.00 ", N/A ,"$1,491.32 ","$1,815.52 ", N/A ,$907.76 ,"$1,095.80 ", N/A ,"$1,261.14 ", N/A ,"$1,462.14 ","$1,462.14 ", N/A ,"$1,462.14 ", N/A ,"$1,621.00 ", N/A , N/A , N/A , N/A ,"$2,431.50 ","$1,945.20 ","$1,945.20 ", N/A ,"$1,945.20 ","$2,463.92 ","$2,463.92 ","$2,463.92 ","$3,242.00 ", N/A ,"$2,755.70 ", N/A ,"$2,107.30 ", N/A ,"$3,242.00 ","$1,815.52 ", N/A ,$852.65 , N/A , N/A , N/A , N/A ,"$2,593.60 ", N/A ,"$1,462.14 ",$907.76 ,"$2,917.80 ", N/A ,"$2,463.92 ", N/A , N/A , N/A , N/A ,"$1,556.16 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001165,N/A,HC COLONOSCOPY W/ABLATION TUMOR - 45388,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001167,N/A,HC COLONOSCOPY W/MUCOSAL RESECTION - 45390,750,1 ,"$3,529.00 ","$2,293.85 ",$928.13 ,"$3,529.00 ", N/A ,"$1,623.34 ","$1,976.24 ", N/A ,$988.12 ,"$1,192.80 ", N/A ,"$1,372.78 ", N/A ,"$1,591.58 ","$1,591.58 ", N/A ,"$1,591.58 ", N/A ,"$1,764.50 ", N/A , N/A , N/A , N/A ,"$2,646.75 ","$2,117.40 ","$2,117.40 ", N/A ,"$2,117.40 ","$2,682.04 ","$2,682.04 ","$2,682.04 ","$3,529.00 ", N/A ,"$2,999.65 ", N/A ,"$2,293.85 ", N/A ,"$3,529.00 ","$1,976.24 ", N/A ,$928.13 , N/A , N/A , N/A , N/A ,"$2,823.20 ", N/A ,"$1,591.58 ",$988.12 ,"$3,176.10 ", N/A ,"$2,682.04 ", N/A , N/A , N/A , N/A ,"$1,693.92 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001170,N/A,HC COLONOSCOPY W/DECOMPRESSION - 45393,750,1 ,"$3,241.00 ","$2,106.65 ",$852.38 ,"$3,241.00 ", N/A ,"$1,490.86 ","$1,814.96 ", N/A ,$907.48 ,"$1,095.46 ", N/A ,"$1,260.75 ", N/A ,"$1,461.69 ","$1,461.69 ", N/A ,"$1,461.69 ", N/A ,"$1,620.50 ", N/A , N/A , N/A , N/A ,"$2,430.75 ","$1,944.60 ","$1,944.60 ", N/A ,"$1,944.60 ","$2,463.16 ","$2,463.16 ","$2,463.16 ","$3,241.00 ", N/A ,"$2,754.85 ", N/A ,"$2,106.65 ", N/A ,"$3,241.00 ","$1,814.96 ", N/A ,$852.38 , N/A , N/A , N/A , N/A ,"$2,592.80 ", N/A ,"$1,461.69 ",$907.48 ,"$2,916.90 ", N/A ,"$2,463.16 ", N/A , N/A , N/A , N/A ,"$1,555.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001171,N/A,HC COLONOSCOPY W/BAND LIGATION - 45398,750,1 ,"$3,231.00 ","$2,100.15 ",$849.75 ,"$3,231.00 ", N/A ,"$1,486.26 ","$1,809.36 ", N/A ,$904.68 ,"$1,092.08 ", N/A ,"$1,256.86 ", N/A ,"$1,457.18 ","$1,457.18 ", N/A ,"$1,457.18 ", N/A ,"$1,615.50 ", N/A , N/A , N/A , N/A ,"$2,423.25 ","$1,938.60 ","$1,938.60 ", N/A ,"$1,938.60 ","$2,455.56 ","$2,455.56 ","$2,455.56 ","$3,231.00 ", N/A ,"$2,746.35 ", N/A ,"$2,100.15 ", N/A ,"$3,231.00 ","$1,809.36 ", N/A ,$849.75 , N/A , N/A , N/A , N/A ,"$2,584.80 ", N/A ,"$1,457.18 ",$904.68 ,"$2,907.90 ", N/A ,"$2,455.56 ", N/A , N/A , N/A , N/A ,"$1,550.88 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001173,N/A,HC HERMORRHOIDECTOMY INTERNAL W/LIGATION - 46221,750,1 ,"$2,406.00 ","$1,563.90 ",$632.78 ,"$2,406.00 ", N/A ,"$1,106.76 ","$1,347.36 ", N/A ,$673.68 ,$813.23 , N/A ,$935.93 , N/A ,"$1,085.11 ","$1,085.11 ", N/A ,"$1,085.11 ", N/A ,"$1,203.00 ", N/A , N/A , N/A , N/A ,"$1,804.50 ","$1,443.60 ","$1,443.60 ", N/A ,"$1,443.60 ","$1,828.56 ","$1,828.56 ","$1,828.56 ","$2,406.00 ", N/A ,"$2,045.10 ", N/A ,"$1,563.90 ", N/A ,"$2,406.00 ","$1,347.36 ", N/A ,$632.78 , N/A , N/A , N/A , N/A ,"$1,924.80 ", N/A ,"$1,085.11 ",$673.68 ,"$2,165.40 ", N/A ,"$1,828.56 ", N/A , N/A , N/A , N/A ,"$1,154.88 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001174,N/A,HC ANOSCOPY DX W/SPECIMEN -46600,750,1 ,"$1,754.00 ","$1,140.10 ",$461.30 ,"$1,754.00 ", N/A ,$806.84 ,$982.24 , N/A ,$491.12 ,$592.85 , N/A ,$682.31 , N/A ,$791.05 ,$791.05 , N/A ,$791.05 , N/A ,$877.00 , N/A , N/A , N/A , N/A ,"$1,315.50 ","$1,052.40 ","$1,052.40 ", N/A ,"$1,052.40 ","$1,333.04 ","$1,333.04 ","$1,333.04 ","$1,754.00 ", N/A ,"$1,490.90 ", N/A ,"$1,140.10 ", N/A ,"$1,754.00 ",$982.24 , N/A ,$461.30 , N/A , N/A , N/A , N/A ,"$1,403.20 ", N/A ,$791.05 ,$491.12 ,"$1,578.60 ", N/A ,"$1,333.04 ", N/A , N/A , N/A , N/A ,$841.92 , N/A 
ST. ELIZABETH'S HOSPITAL,75001180,N/A,HC PLACE GASTROSTOMY TUBE PERC W/GUID - 49440,750,1 ,"$4,672.00 ","$3,036.80 ","$1,228.74 ","$4,672.00 ", N/A ,"$2,149.12 ","$2,616.32 ", N/A ,"$1,308.16 ","$1,579.14 ", N/A ,"$1,817.41 ", N/A ,"$2,107.07 ","$2,107.07 ", N/A ,"$2,107.07 ", N/A ,"$2,336.00 ", N/A , N/A , N/A , N/A ,"$3,504.00 ","$2,803.20 ","$2,803.20 ", N/A ,"$2,803.20 ","$3,550.72 ","$3,550.72 ","$3,550.72 ","$4,672.00 ", N/A ,"$3,971.20 ", N/A ,"$3,036.80 ", N/A ,"$4,672.00 ","$2,616.32 ", N/A ,"$1,228.74 ", N/A , N/A , N/A , N/A ,"$3,737.60 ", N/A ,"$2,107.07 ","$1,308.16 ","$4,204.80 ", N/A ,"$3,550.72 ", N/A , N/A , N/A , N/A ,"$2,242.56 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001186,N/A,HC BRONCHOSCOPY NAVAGATIONAL 31627,750,1 ,"$3,794.00 ","$2,466.10 ",$997.82 ,"$3,794.00 ", N/A ,"$1,745.24 ","$2,124.64 ", N/A ,"$1,062.32 ","$1,282.37 ", N/A ,"$1,475.87 ", N/A ,"$1,711.09 ","$1,711.09 ", N/A ,"$1,711.09 ", N/A ,"$1,897.00 ", N/A , N/A , N/A , N/A ,"$2,845.50 ","$2,276.40 ","$2,276.40 ", N/A ,"$2,276.40 ","$2,883.44 ","$2,883.44 ","$2,883.44 ","$3,794.00 ", N/A ,"$3,224.90 ", N/A ,"$2,466.10 ", N/A ,"$3,794.00 ","$2,124.64 ", N/A ,$997.82 , N/A , N/A , N/A , N/A ,"$3,035.20 ", N/A ,"$1,711.09 ","$1,062.32 ","$3,414.60 ", N/A ,"$2,883.44 ", N/A , N/A , N/A , N/A ,"$1,821.12 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001187,N/A,HC BRONCHOSCOPY W/EXCISION TUMOR 31640,750,1 ,"$6,548.00 ","$4,256.20 ","$1,722.12 ","$6,548.00 ", N/A ,"$3,012.08 ","$3,666.88 ", N/A ,"$1,833.44 ","$2,213.22 ", N/A ,"$2,547.17 ", N/A ,"$2,953.15 ","$2,953.15 ", N/A ,"$2,953.15 ", N/A ,"$3,274.00 ", N/A , N/A , N/A , N/A ,"$4,911.00 ","$3,928.80 ","$3,928.80 ", N/A ,"$3,928.80 ","$4,976.48 ","$4,976.48 ","$4,976.48 ","$6,548.00 ", N/A ,"$5,565.80 ", N/A ,"$4,256.20 ", N/A ,"$6,548.00 ","$3,666.88 ", N/A ,"$1,722.12 ", N/A , N/A , N/A , N/A ,"$5,238.40 ", N/A ,"$2,953.15 ","$1,833.44 ","$5,893.20 ", N/A ,"$4,976.48 ", N/A , N/A , N/A , N/A ,"$3,143.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001188,N/A,HC BRONCHOSCOPY W/ASP TREE INITIAL 31645,750,1 ,"$3,723.00 ","$2,419.95 ",$979.15 ,"$3,723.00 ", N/A ,"$1,712.58 ","$2,084.88 ", N/A ,"$1,042.44 ","$1,258.37 ", N/A ,"$1,448.25 ", N/A ,"$1,679.07 ","$1,679.07 ", N/A ,"$1,679.07 ", N/A ,"$1,861.50 ", N/A , N/A , N/A , N/A ,"$2,792.25 ","$2,233.80 ","$2,233.80 ", N/A ,"$2,233.80 ","$2,829.48 ","$2,829.48 ","$2,829.48 ","$3,723.00 ", N/A ,"$3,164.55 ", N/A ,"$2,419.95 ", N/A ,"$3,723.00 ","$2,084.88 ", N/A ,$979.15 , N/A , N/A , N/A , N/A ,"$2,978.40 ", N/A ,"$1,679.07 ","$1,042.44 ","$3,350.70 ", N/A ,"$2,829.48 ", N/A , N/A , N/A , N/A ,"$1,787.04 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001189,N/A,HC BRONCHOSCOPY W/ASP TREE SUBSQ 31646,750,1 ,"$3,934.00 ","$2,557.10 ","$1,034.64 ","$3,934.00 ", N/A ,"$1,809.64 ","$2,203.04 ", N/A ,"$1,101.52 ","$1,329.69 ", N/A ,"$1,530.33 ", N/A ,"$1,774.23 ","$1,774.23 ", N/A ,"$1,774.23 ", N/A ,"$1,967.00 ", N/A , N/A , N/A , N/A ,"$2,950.50 ","$2,360.40 ","$2,360.40 ", N/A ,"$2,360.40 ","$2,989.84 ","$2,989.84 ","$2,989.84 ","$3,934.00 ", N/A ,"$3,343.90 ", N/A ,"$2,557.10 ", N/A ,"$3,934.00 ","$2,203.04 ", N/A ,"$1,034.64 ", N/A , N/A , N/A , N/A ,"$3,147.20 ", N/A ,"$1,774.23 ","$1,101.52 ","$3,540.60 ", N/A ,"$2,989.84 ", N/A , N/A , N/A , N/A ,"$1,888.32 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001190,N/A,HC BRONCHOSCOPY US W/GUID SAMPLING 1-2 NODES 31652,750,1 ,"$7,665.00 ","$4,982.25 ","$2,015.90 ","$7,665.00 ", N/A ,"$3,525.90 ","$4,292.40 ", N/A ,"$2,146.20 ","$2,590.77 ", N/A ,"$2,981.69 ", N/A ,"$3,456.92 ","$3,456.92 ", N/A ,"$3,456.92 ", N/A ,"$3,832.50 ", N/A , N/A , N/A , N/A ,"$5,748.75 ","$4,599.00 ","$4,599.00 ", N/A ,"$4,599.00 ","$5,825.40 ","$5,825.40 ","$5,825.40 ","$7,665.00 ", N/A ,"$6,515.25 ", N/A ,"$4,982.25 ", N/A ,"$7,665.00 ","$4,292.40 ", N/A ,"$2,015.90 ", N/A , N/A , N/A , N/A ,"$6,132.00 ", N/A ,"$3,456.92 ","$2,146.20 ","$6,898.50 ", N/A ,"$5,825.40 ", N/A , N/A , N/A , N/A ,"$3,679.20 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001191,N/A,HC BRONCHOSCOPY US W/GUID SAMPLING 3+ NODES 31653,750,1 ,"$7,665.00 ","$4,982.25 ","$2,015.90 ","$7,665.00 ", N/A ,"$3,525.90 ","$4,292.40 ", N/A ,"$2,146.20 ","$2,590.77 ", N/A ,"$2,981.69 ", N/A ,"$3,456.92 ","$3,456.92 ", N/A ,"$3,456.92 ", N/A ,"$3,832.50 ", N/A , N/A , N/A , N/A ,"$5,748.75 ","$4,599.00 ","$4,599.00 ", N/A ,"$4,599.00 ","$5,825.40 ","$5,825.40 ","$5,825.40 ","$7,665.00 ", N/A ,"$6,515.25 ", N/A ,"$4,982.25 ", N/A ,"$7,665.00 ","$4,292.40 ", N/A ,"$2,015.90 ", N/A , N/A , N/A , N/A ,"$6,132.00 ", N/A ,"$3,456.92 ","$2,146.20 ","$6,898.50 ", N/A ,"$5,825.40 ", N/A , N/A , N/A , N/A ,"$3,679.20 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001192,N/A,HC BRONCHOSCOPY US W/INTERV PERPH LESION 31654,750,1 ,"$3,832.00 ","$2,490.80 ","$1,007.82 ","$3,832.00 ", N/A ,"$1,762.72 ","$2,145.92 ", N/A ,"$1,072.96 ","$1,295.22 ", N/A ,"$1,490.65 ", N/A ,"$1,728.23 ","$1,728.23 ", N/A ,"$1,728.23 ", N/A ,"$1,916.00 ", N/A , N/A , N/A , N/A ,"$2,874.00 ","$2,299.20 ","$2,299.20 ", N/A ,"$2,299.20 ","$2,912.32 ","$2,912.32 ","$2,912.32 ","$3,832.00 ", N/A ,"$3,257.20 ", N/A ,"$2,490.80 ", N/A ,"$3,832.00 ","$2,145.92 ", N/A ,"$1,007.82 ", N/A , N/A , N/A , N/A ,"$3,065.60 ", N/A ,"$1,728.23 ","$1,072.96 ","$3,448.80 ", N/A ,"$2,912.32 ", N/A , N/A , N/A , N/A ,"$1,839.36 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001193,91035,HC ACID REFLUX TEST MUCOSAL ELECTRODE- 91035,750,1 ,"$1,388.97 ",$902.83 ,$365.30 ,"$1,388.97 ","$1,203.10 ","$1,388.97 ",$777.82 ,$481.24 ,$388.91 ,$490.31 ,$481.24 ,$572.26 ,$481.24 ,$626.43 ,$626.43 ,$481.24 ,$626.43 ,$914.36 ,$694.49 ,"$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$1,041.73 ",$833.38 ,$833.38 ,$481.24 ,$833.38 ,"$1,055.62 ","$1,055.62 ","$1,055.62 ","$1,388.97 ", N/A ,"$1,180.62 ","$1,203.10 ",$902.83 ,$481.24 ,"$1,388.97 ",$777.82 ,$481.24 ,$365.30 , N/A ,$634.93 ,$606.07 ,$505.30 ,"$1,111.18 ","$1,082.79 ",$626.43 ,$388.91 ,"$1,250.07 ",$481.24 ,"$1,055.62 ",$920.00 ,$920.00 ,$481.24 ,$920.00 ,$666.71 ,$577.21 
ST. ELIZABETH'S HOSPITAL,75001194,91038,HC ESOPHAGEAL FUNCTION IMPEDENCE EXT TEST,750,1 ,"$1,388.97 ",$902.83 ,$365.30 ,"$1,388.97 ","$1,203.10 ","$1,388.97 ",$777.82 ,$481.24 ,$388.91 ,$490.31 ,$481.24 ,$572.26 ,$481.24 ,$626.43 ,$626.43 ,$481.24 ,$626.43 ,$914.36 ,$694.49 ,"$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$1,041.73 ",$833.38 ,$833.38 ,$481.24 ,$833.38 ,"$1,055.62 ","$1,055.62 ","$1,055.62 ","$1,388.97 ", N/A ,"$1,180.62 ","$1,203.10 ",$902.83 ,$481.24 ,"$1,388.97 ",$777.82 ,$481.24 ,$365.30 , N/A ,$634.93 ,$606.07 ,$505.30 ,"$1,111.18 ","$1,082.79 ",$626.43 ,$388.91 ,"$1,250.07 ",$481.24 ,"$1,055.62 ",$920.00 ,$920.00 ,$481.24 ,$920.00 ,$666.71 ,$577.21 
ST. ELIZABETH'S HOSPITAL,75001196,91110,HC IMAGE GI TRACT ESPOH THRU ILIEM W/REPORT- 91110,750,1 ,"$2,087.00 ","$1,356.55 ",$548.88 ,"$2,189.86 ","$1,994.33 ",$960.02 ,"$1,168.72 ",$797.73 ,$584.36 ,$736.71 ,$797.73 ,$859.84 ,$797.73 ,$941.24 ,$941.24 ,$797.73 ,$941.24 ,"$1,515.69 ","$1,043.50 ","$1,994.33 ",$797.73 ,$797.73 ,$813.69 ,"$1,565.25 ","$1,252.20 ","$1,252.20 ",$797.73 ,"$1,252.20 ","$1,586.12 ","$1,586.12 ","$1,586.12 ","$2,087.00 ", N/A ,"$1,773.95 ","$1,994.33 ","$1,356.55 ",$797.73 ,"$2,087.00 ","$1,168.72 ",$797.73 ,$548.88 , N/A ,"$2,087.00 ","$2,087.00 ",$837.62 ,"$1,669.60 ","$1,794.89 ",$941.24 ,$584.36 ,"$1,878.30 ",$797.73 ,"$1,586.12 ","$1,890.00 ","$1,890.00 ",$797.73 ,"$1,890.00 ","$1,001.76 ","$2,189.86 "
ST. ELIZABETH'S HOSPITAL,75001200,G0104,HC COLONOSCOPY SCREEN W/FLEX SIGMOID - G0104,750,1 ,"$2,190.00 ","$1,423.50 ",$575.97 ,"$2,190.00 ","$1,955.93 ","$2,125.00 ","$1,226.40 ",$782.37 ,$613.20 ,$773.07 ,$782.37 ,$786.76 ,$782.37 ,$987.69 ,$987.69 ,$782.37 ,$987.69 ,"$1,486.51 ","$1,095.00 ","$1,955.93 ",$782.37 ,$782.37 ,$798.02 ,"$1,642.50 ","$1,314.00 ","$1,314.00 ",$782.37 ,"$1,314.00 ","$1,664.40 ","$1,664.40 ","$1,664.40 ","$2,190.00 ", N/A ,"$1,861.50 ","$1,955.93 ","$1,423.50 ",$782.37 ,"$2,190.00 ","$1,226.40 ",$782.37 ,$575.97 , N/A ,$691.66 ,$660.22 ,$821.49 ,"$1,752.00 ","$1,760.34 ",$987.69 ,$613.20 ,"$1,971.00 ",$782.37 ,"$1,664.40 ","$1,500.00 ","$1,500.00 ",$782.37 ,"$1,500.00 ","$1,051.20 ",$628.78 
ST. ELIZABETH'S HOSPITAL,75001209,N/A,HC HEMORRHOIDECTOMY INTERNAL W/LIGATION-46221,750,1 ,"$2,299.00 ","$1,494.35 ",$604.64 ,"$2,299.00 ", N/A ,"$1,057.54 ","$1,287.44 ", N/A ,$643.72 ,$777.06 , N/A ,$894.31 , N/A ,"$1,036.85 ","$1,036.85 ", N/A ,"$1,036.85 ", N/A ,"$1,149.50 ", N/A , N/A , N/A , N/A ,"$1,724.25 ","$1,379.40 ","$1,379.40 ", N/A ,"$1,379.40 ","$1,747.24 ","$1,747.24 ","$1,747.24 ","$2,299.00 ", N/A ,"$1,954.15 ", N/A ,"$1,494.35 ", N/A ,"$2,299.00 ","$1,287.44 ", N/A ,$604.64 , N/A , N/A , N/A , N/A ,"$1,839.20 ", N/A ,"$1,036.85 ",$643.72 ,"$2,069.10 ", N/A ,"$1,747.24 ", N/A , N/A , N/A , N/A ,"$1,103.52 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001210,N/A,HC BRONCHOSCOPY W/TUMOR DESTRUCTION - 31641,750,1 ,"$8,841.00 ","$5,746.65 ","$2,325.18 ","$8,841.00 ", N/A ,"$4,066.86 ","$4,950.96 ", N/A ,"$2,475.48 ","$2,988.26 ", N/A ,"$3,439.15 ", N/A ,"$3,987.29 ","$3,987.29 ", N/A ,"$3,987.29 ", N/A ,"$4,420.50 ", N/A , N/A , N/A , N/A ,"$6,630.75 ","$5,304.60 ","$5,304.60 ", N/A ,"$5,304.60 ","$6,719.16 ","$6,719.16 ","$6,719.16 ","$8,841.00 ", N/A ,"$7,514.85 ", N/A ,"$5,746.65 ", N/A ,"$8,841.00 ","$4,950.96 ", N/A ,"$2,325.18 ", N/A , N/A , N/A , N/A ,"$7,072.80 ", N/A ,"$3,987.29 ","$2,475.48 ","$7,956.90 ", N/A ,"$6,719.16 ", N/A , N/A , N/A , N/A ,"$4,243.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001211,N/A,HC BRONCHOSCOPY W/LAVAGE ALVEOLAR - 31624,750,1 ,"$3,313.00 ","$2,153.45 ",$871.32 ,"$3,313.00 ", N/A ,"$1,523.98 ","$1,855.28 ", N/A ,$927.64 ,"$1,119.79 ", N/A ,"$1,288.76 ", N/A ,"$1,494.16 ","$1,494.16 ", N/A ,"$1,494.16 ", N/A ,"$1,656.50 ", N/A , N/A , N/A , N/A ,"$2,484.75 ","$1,987.80 ","$1,987.80 ", N/A ,"$1,987.80 ","$2,517.88 ","$2,517.88 ","$2,517.88 ","$3,313.00 ", N/A ,"$2,816.05 ", N/A ,"$2,153.45 ", N/A ,"$3,313.00 ","$1,855.28 ", N/A ,$871.32 , N/A , N/A , N/A , N/A ,"$2,650.40 ", N/A ,"$1,494.16 ",$927.64 ,"$2,981.70 ", N/A ,"$2,517.88 ", N/A , N/A , N/A , N/A ,"$1,590.24 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001217,N/A,HC ESOPHAGOSCOPY LESION ABLATE - 43229,750,1 ,"$8,772.66 ","$5,702.23 ","$2,307.21 ","$8,772.66 ", N/A ,"$4,035.42 ","$4,912.69 ", N/A ,"$2,456.34 ","$2,965.16 ", N/A ,"$3,412.56 ", N/A ,"$3,956.47 ","$3,956.47 ", N/A ,"$3,956.47 ", N/A ,"$4,386.33 ", N/A , N/A , N/A , N/A ,"$6,579.50 ","$5,263.60 ","$5,263.60 ", N/A ,"$5,263.60 ","$6,667.22 ","$6,667.22 ","$6,667.22 ","$8,772.66 ", N/A ,"$7,456.76 ", N/A ,"$5,702.23 ", N/A ,"$8,772.66 ","$4,912.69 ", N/A ,"$2,307.21 ", N/A , N/A , N/A , N/A ,"$7,018.13 ", N/A ,"$3,956.47 ","$2,456.34 ","$7,895.39 ", N/A ,"$6,667.22 ", N/A , N/A , N/A , N/A ,"$4,210.88 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001218,N/A,HC ANOSCOPY ABLATION LESION - 46615,750,1 ,"$6,957.66 ","$4,522.48 ","$1,829.86 ","$6,957.66 ", N/A ,"$3,200.52 ","$3,896.29 ", N/A ,"$1,948.14 ","$2,351.69 ", N/A ,"$2,706.53 ", N/A ,"$3,137.90 ","$3,137.90 ", N/A ,"$3,137.90 ", N/A ,"$3,478.83 ", N/A , N/A , N/A , N/A ,"$5,218.25 ","$4,174.60 ","$4,174.60 ", N/A ,"$4,174.60 ","$5,287.82 ","$5,287.82 ","$5,287.82 ","$6,957.66 ", N/A ,"$5,914.01 ", N/A ,"$4,522.48 ", N/A ,"$6,957.66 ","$3,896.29 ", N/A ,"$1,829.86 ", N/A , N/A , N/A , N/A ,"$5,566.13 ", N/A ,"$3,137.90 ","$1,948.14 ","$6,261.89 ", N/A ,"$5,287.82 ", N/A , N/A , N/A , N/A ,"$3,339.68 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001219,N/A,"HC UNLISTED PROCEDURE, ESOPHAGUS - 43499",750,1 ,"$2,305.38 ","$1,498.50 ",$606.31 ,"$2,305.38 ", N/A ,"$1,060.47 ","$1,291.01 ", N/A ,$645.51 ,$779.22 , N/A ,$896.79 , N/A ,"$1,039.73 ","$1,039.73 ", N/A ,"$1,039.73 ", N/A ,"$1,152.69 ", N/A , N/A , N/A , N/A ,"$1,729.04 ","$1,383.23 ","$1,383.23 ", N/A ,"$1,383.23 ","$1,752.09 ","$1,752.09 ","$1,752.09 ","$2,305.38 ", N/A ,"$1,959.57 ", N/A ,"$1,498.50 ", N/A ,"$2,305.38 ","$1,291.01 ", N/A ,$606.31 , N/A , N/A , N/A , N/A ,"$1,844.30 ", N/A ,"$1,039.73 ",$645.51 ,"$2,074.84 ", N/A ,"$1,752.09 ", N/A , N/A , N/A , N/A ,"$1,106.58 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001220,96570,HC PHOTODYNMC TX 30 MIN ADD-ON,750,1 ,"$4,223.75 ","$2,745.44 ",$751.73 ,"$4,223.75 ", N/A ,"$4,223.75 ","$2,365.30 ", N/A ,"$1,182.65 ",$751.73 , N/A ,$751.73 , N/A ,"$1,904.91 ","$1,904.91 ", N/A ,"$1,904.91 ", N/A ,"$2,111.88 ", N/A , N/A , N/A , N/A ,"$3,167.81 ","$2,534.25 ","$2,534.25 ", N/A ,"$2,534.25 ","$3,210.05 ","$3,210.05 ","$3,210.05 ","$4,223.75 ", N/A ,"$3,590.19 ", N/A ,"$2,745.44 ", N/A ,"$4,223.75 ","$2,365.30 ", N/A ,"$1,110.85 ", N/A , N/A , N/A , N/A ,"$3,379.00 ", N/A ,"$1,904.91 ","$1,182.65 ","$3,801.38 ", N/A ,"$3,210.05 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$2,027.40 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001221,96571,HC PHOTODYNMC TX ADDL 15 MIN,750,1 ,"$2,111.88 ","$1,372.72 ",$425.29 ,"$2,111.88 ", N/A ,"$2,111.88 ","$1,182.65 ", N/A ,$591.33 ,$425.29 , N/A ,$425.29 , N/A ,$952.46 ,$952.46 , N/A ,$952.46 , N/A ,"$1,055.94 ", N/A , N/A , N/A , N/A ,"$1,583.91 ","$1,267.13 ","$1,267.13 ", N/A ,"$1,267.13 ","$1,605.03 ","$1,605.03 ","$1,605.03 ","$2,111.88 ", N/A ,"$1,795.10 ", N/A ,"$1,372.72 ", N/A ,"$2,111.88 ","$1,182.65 ", N/A ,$555.42 , N/A , N/A , N/A , N/A ,"$1,689.50 ", N/A ,$952.46 ,$591.33 ,"$1,900.69 ", N/A ,"$1,605.03 ",$920.00 ,$920.00 , N/A ,$920.00 ,"$1,013.70 ", N/A 
ST. ELIZABETH'S HOSPITAL,75001222,91037,HC ESOPH IMPED FUNCTION TEST,750,1 ,$753.03 ,$489.47 ,$198.05 ,$753.03 ,$652.30 ,$753.03 ,$421.70 ,$260.92 ,$210.85 ,$265.82 ,$260.92 ,$310.25 ,$260.92 ,$339.62 ,$339.62 ,$260.92 ,$339.62 ,$495.74 ,$376.52 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,$564.77 ,$451.82 ,$451.82 ,$260.92 ,$451.82 ,$572.30 ,$572.30 ,$572.30 ,$753.03 , N/A ,$640.08 ,$652.29 ,$489.47 ,$260.92 ,$753.03 ,$421.70 ,$260.92 ,$198.05 , N/A ,$634.93 ,$606.07 ,$273.97 ,$602.42 ,$587.06 ,$339.62 ,$210.85 ,$677.73 ,$260.92 ,$572.30 ,$753.03 ,$753.03 ,$260.92 ,$753.03 ,$361.45 ,$577.21 
ST. ELIZABETH'S HOSPITAL,75001223,N/A,HC SMALL BOWEL ENDOSCOPY- 44378,750,1 ,"$1,913.40 ","$1,243.71 ",$503.22 ,"$1,913.40 ", N/A ,$880.16 ,"$1,071.50 ", N/A ,$535.75 ,$646.73 , N/A ,$744.31 , N/A ,$862.94 ,$862.94 , N/A ,$862.94 , N/A ,$956.70 , N/A , N/A , N/A , N/A ,"$1,435.05 ","$1,148.04 ","$1,148.04 ", N/A ,"$1,148.04 ","$1,454.18 ","$1,454.18 ","$1,454.18 ","$1,913.40 ", N/A ,"$1,626.39 ", N/A ,"$1,243.71 ", N/A ,"$1,913.40 ","$1,071.50 ", N/A ,$503.22 , N/A , N/A , N/A , N/A ,"$1,530.72 ", N/A ,$862.94 ,$535.75 ,"$1,722.06 ", N/A ,"$1,454.18 ", N/A , N/A , N/A , N/A ,$918.43 , N/A 
ST. ELIZABETH'S HOSPITAL,76000004,31579,HC LARYNG VIDEOSTROB INITIAL,760,1 ,"$1,225.00 ",$796.25 ,$322.18 ,"$1,225.00 ",$926.43 ,$563.50 ,$686.00 ,$370.57 ,$343.00 ,$414.05 ,$370.57 ,$476.53 ,$370.57 ,$552.48 ,$552.48 ,$370.57 ,$552.48 ,$704.08 ,$612.50 ,$926.42 ,$370.57 ,$370.57 ,$377.98 ,$918.75 ,$735.00 ,$735.00 ,$370.57 ,$735.00 ,$869.75 ,$869.75 ,$869.75 ,"$1,225.00 ", N/A ,"$1,041.25 ",$926.42 ,$796.25 ,$370.57 ,"$1,225.00 ",$686.00 ,$370.57 ,$322.18 , N/A ,$425.85 ,$406.50 ,$389.10 ,$980.00 ,$833.78 ,$552.48 ,$343.00 ,"$1,102.50 ",$370.57 ,$869.75 ,$796.25 ,$796.25 ,$370.57 ,$796.25 ,$588.00 ,$387.14 
ST. ELIZABETH'S HOSPITAL,76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$1,986.00 ","$1,290.90 ",$522.32 ,"$1,986.00 ","$1,565.08 ",$913.56 ,"$1,112.16 ",$626.03 ,$556.08 ,$671.27 ,$626.03 ,$772.55 ,$626.03 ,$895.69 ,$895.69 ,$626.03 ,$895.69 ,"$1,189.46 ",$993.00 ,"$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,489.50 ","$1,191.60 ","$1,191.60 ",$626.03 ,"$1,191.60 ","$1,410.06 ","$1,410.06 ","$1,410.06 ","$1,986.00 ", N/A ,"$1,688.10 ","$1,565.07 ","$1,290.90 ",$626.03 ,"$1,986.00 ","$1,112.16 ",$626.03 ,$522.32 , N/A ,$841.01 ,$802.78 ,$657.33 ,"$1,588.80 ","$1,408.57 ",$895.69 ,$556.08 ,"$1,787.40 ",$626.03 ,"$1,410.06 ","$1,290.90 ","$1,290.90 ",$626.03 ,"$1,290.90 ",$953.28 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100004,64642,HC CHEMODENERVATION EXTREMITY 1-4 MUSCLES,761,1 ,"$2,395.00 ","$1,556.75 ",$145.85 ,"$2,395.00 ","$1,565.08 ","$1,101.70 ","$1,341.20 ",$626.03 ,$670.60 ,$809.51 ,$626.03 ,$931.66 ,$626.03 ,"$1,080.15 ","$1,080.15 ",$626.03 ,$145.85 ,"$1,189.46 ","$1,197.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,796.25 ","$1,437.00 ","$1,437.00 ",$626.03 ,"$1,437.00 ","$1,820.20 ","$1,820.20 ","$1,820.20 ","$2,395.00 ", N/A ,"$2,035.75 ","$1,565.07 ","$1,556.75 ",$626.03 ,"$2,395.00 ","$1,341.20 ",$626.03 ,$629.89 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$1,916.00 ","$1,408.57 ","$1,080.15 ",$670.60 ,"$2,155.50 ",$626.03 ,"$1,820.20 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$1,149.60 ",$421.56 
ST. ELIZABETH'S HOSPITAL,76100005,64615,HC CHEMODENERVATION FACE/NECK/SPINE MUSCLES BIL,761,1 ,"$1,163.00 ",$755.95 ,$171.63 ,"$1,163.00 ",$643.95 ,$534.98 ,$651.28 ,$257.58 ,$325.64 ,$393.09 ,$257.58 ,$452.41 ,$257.58 ,$524.51 ,$524.51 ,$257.58 ,$171.63 ,$489.39 ,$581.50 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$872.25 ,$697.80 ,$697.80 ,$257.58 ,$697.80 ,$883.88 ,$883.88 ,$883.88 ,"$1,163.00 ", N/A ,$988.55 ,$643.94 ,$755.95 ,$257.58 ,"$1,163.00 ",$651.28 ,$257.58 ,$305.87 , N/A ,$463.72 ,$442.64 ,$270.46 ,$930.40 ,$579.55 ,$524.51 ,$325.64 ,"$1,046.70 ",$257.58 ,$883.88 ,"$1,163.00 ","$1,163.00 ",$257.58 ,"$1,163.00 ",$558.24 ,$421.56 
ST. ELIZABETH'S HOSPITAL,76100006,64447,HC INJ ANES NERVE FEMORAL SINGLE-BI,761,1 ,"$3,996.00 ","$2,597.40 ",$68.31 ,"$3,996.00 ","$2,347.60 ","$1,838.16 ","$2,237.76 ",$939.04 ,"$1,118.88 ","$1,350.65 ",$939.04 ,"$1,554.44 ",$939.04 ,"$1,802.20 ","$1,802.20 ",$939.04 ,$68.31 ,"$1,784.18 ","$1,998.00 ","$2,347.61 ",$939.04 ,$939.04 ,$957.82 ,"$2,997.00 ","$2,397.60 ","$2,397.60 ",$939.04 ,"$2,397.60 ","$3,036.96 ","$3,036.96 ","$3,036.96 ","$3,996.00 ", N/A ,"$3,396.60 ","$2,347.61 ","$2,597.40 ",$939.04 ,"$3,996.00 ","$2,237.76 ",$939.04 ,"$1,050.95 ", N/A ,$695.57 ,$663.96 ,$985.99 ,"$3,196.80 ","$2,112.85 ","$1,802.20 ","$1,118.88 ","$3,596.40 ",$939.04 ,"$3,036.96 ","$1,305.00 ","$1,305.00 ",$939.04 ,"$1,305.00 ","$1,918.08 ",$632.34 
ST. ELIZABETH'S HOSPITAL,76100007,64447,HC INJ ANES NERVE FEMORAL SINGLE-LT,761,1 ,"$2,378.00 ","$1,545.70 ",$68.31 ,"$2,378.00 ","$1,565.08 ","$1,093.88 ","$1,331.68 ",$626.03 ,$665.84 ,$803.76 ,$626.03 ,$925.04 ,$626.03 ,"$1,072.48 ","$1,072.48 ",$626.03 ,$68.31 ,"$1,189.46 ","$1,189.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,783.50 ","$1,426.80 ","$1,426.80 ",$626.03 ,"$1,426.80 ","$1,807.28 ","$1,807.28 ","$1,807.28 ","$2,378.00 ", N/A ,"$2,021.30 ","$1,565.07 ","$1,545.70 ",$626.03 ,"$2,378.00 ","$1,331.68 ",$626.03 ,$625.41 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$1,902.40 ","$1,408.57 ","$1,072.48 ",$665.84 ,"$2,140.20 ",$626.03 ,"$1,807.28 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$1,141.44 ",$421.56 
ST. ELIZABETH'S HOSPITAL,76100008,64447,HC INJ ANES NERVE FEMORAL SINGLE-RT,761,1 ,"$2,378.00 ","$1,545.70 ",$68.31 ,"$2,378.00 ","$1,565.08 ","$1,093.88 ","$1,331.68 ",$626.03 ,$665.84 ,$803.76 ,$626.03 ,$925.04 ,$626.03 ,"$1,072.48 ","$1,072.48 ",$626.03 ,$68.31 ,"$1,189.46 ","$1,189.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,783.50 ","$1,426.80 ","$1,426.80 ",$626.03 ,"$1,426.80 ","$1,807.28 ","$1,807.28 ","$1,807.28 ","$2,378.00 ", N/A ,"$2,021.30 ","$1,565.07 ","$1,545.70 ",$626.03 ,"$2,378.00 ","$1,331.68 ",$626.03 ,$625.41 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$1,902.40 ","$1,408.57 ","$1,072.48 ",$665.84 ,"$2,140.20 ",$626.03 ,"$1,807.28 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$1,141.44 ",$421.56 
ST. ELIZABETH'S HOSPITAL,76100009,64425,HC INJ ANES NERVE ILIOINGUINAL-LT,761,1 ,"$2,585.00 ","$1,680.25 ",$71.23 ,"$2,585.00 ","$1,565.08 ","$1,189.10 ","$1,447.60 ",$626.03 ,$723.80 ,$873.73 ,$626.03 ,"$1,005.57 ",$626.03 ,"$1,165.84 ","$1,165.84 ",$626.03 ,$71.23 ,"$1,189.46 ","$1,292.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,938.75 ","$1,551.00 ","$1,551.00 ",$626.03 ,"$1,551.00 ","$1,964.60 ","$1,964.60 ","$1,964.60 ","$2,585.00 ", N/A ,"$2,197.25 ","$1,565.07 ","$1,680.25 ",$626.03 ,"$2,585.00 ","$1,447.60 ",$626.03 ,$679.86 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$2,068.00 ","$1,408.57 ","$1,165.84 ",$723.80 ,"$2,326.50 ",$626.03 ,"$1,964.60 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$1,240.80 ",$421.56 
ST. ELIZABETH'S HOSPITAL,76100010,64425,HC INJ ANES NERVE ILIOINGUINAL-RT,761,1 ,"$2,585.00 ","$1,680.25 ",$71.23 ,"$2,585.00 ","$1,565.08 ","$1,189.10 ","$1,447.60 ",$626.03 ,$723.80 ,$873.73 ,$626.03 ,"$1,005.57 ",$626.03 ,"$1,165.84 ","$1,165.84 ",$626.03 ,$71.23 ,"$1,189.46 ","$1,292.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$1,938.75 ","$1,551.00 ","$1,551.00 ",$626.03 ,"$1,551.00 ","$1,964.60 ","$1,964.60 ","$1,964.60 ","$2,585.00 ", N/A ,"$2,197.25 ","$1,565.07 ","$1,680.25 ",$626.03 ,"$2,585.00 ","$1,447.60 ",$626.03 ,$679.86 , N/A ,$463.72 ,$442.64 ,$657.33 ,"$2,068.00 ","$1,408.57 ","$1,165.84 ",$723.80 ,"$2,326.50 ",$626.03 ,"$1,964.60 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$1,240.80 ",$421.56 
ST. ELIZABETH'S HOSPITAL,76100011,64450,HC INJ ANES NERVE PERIPHERAL-BI,761,1 ,"$3,121.00 ","$2,028.65 ",$55.21 ,"$3,121.00 ","$2,347.60 ","$1,435.66 ","$1,747.76 ",$939.04 ,$873.88 ,"$1,054.90 ",$939.04 ,"$1,214.07 ",$939.04 ,"$1,407.57 ","$1,407.57 ",$939.04 ,$55.21 ,"$1,784.18 ","$1,560.50 ","$2,347.61 ",$939.04 ,$939.04 ,$957.82 ,"$2,340.75 ","$1,872.60 ","$1,872.60 ",$939.04 ,"$1,872.60 ","$2,371.96 ","$2,371.96 ","$2,371.96 ","$3,121.00 ", N/A ,"$2,652.85 ","$2,347.61 ","$2,028.65 ",$939.04 ,"$3,121.00 ","$1,747.76 ",$939.04 ,$820.82 , N/A ,$695.57 ,$663.96 ,$985.99 ,"$2,496.80 ","$2,112.85 ","$1,407.57 ",$873.88 ,"$2,808.90 ",$939.04 ,"$2,371.96 ","$1,305.00 ","$1,305.00 ",$939.04 ,"$1,305.00 ","$1,498.08 ",$632.34 
ST. ELIZABETH'S HOSPITAL,76100014,64999,HC INJ ANES NERVE CERVICAL PLEXUS,761,1 ,$772.00 ,$501.80 ,$203.04 ,$772.00 ,$643.95 ,$355.12 ,$432.32 ,$257.58 ,$216.16 ,$260.94 ,$257.58 ,$300.31 ,$257.58 ,$348.17 ,$348.17 ,$257.58 ,$501.80 ,$489.39 ,$386.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$579.00 ,$463.20 ,$463.20 ,$257.58 ,$463.20 ,$586.72 ,$586.72 ,$586.72 ,$772.00 , N/A ,$656.20 ,$643.94 ,$501.80 ,$257.58 ,$772.00 ,$432.32 ,$257.58 ,$203.04 , N/A ,$463.72 ,$442.64 ,$270.46 ,$617.60 ,$579.55 ,$348.17 ,$216.16 ,$694.80 ,$257.58 ,$586.72 ,$772.00 ,$772.00 ,$257.58 ,$772.00 ,$370.56 ,$421.56 
ST. ELIZABETH'S HOSPITAL,76100015,64405,HC INJ ANES NERVE GREAT OCCIPITAL-BI,761,1 ,"$3,154.00 ","$2,050.10 ",$72.46 ,"$3,154.00 ",$965.90 ,"$1,450.84 ","$1,766.24 ",$386.36 ,$883.12 ,"$1,066.05 ",$386.36 ,"$1,226.91 ",$386.36 ,"$1,422.45 ","$1,422.45 ",$386.36 ,$72.46 ,$734.09 ,"$1,577.00 ",$965.91 ,$386.36 ,$386.36 ,$394.09 ,"$2,365.50 ","$1,892.40 ","$1,892.40 ",$386.36 ,"$1,892.40 ","$2,397.04 ","$2,397.04 ","$2,397.04 ","$3,154.00 ", N/A ,"$2,680.90 ",$965.91 ,"$2,050.10 ",$386.36 ,"$3,154.00 ","$1,766.24 ",$386.36 ,$829.50 , N/A ,$695.57 ,$663.96 ,$405.68 ,"$2,523.20 ",$869.32 ,"$1,422.45 ",$883.12 ,"$2,838.60 ",$386.36 ,"$2,397.04 ","$1,305.00 ","$1,305.00 ",$386.36 ,"$1,305.00 ","$1,513.92 ",$632.34 
ST. ELIZABETH'S HOSPITAL,76100016,64405,HC INJ ANES NERVE GREAT OCCIPITAL-LT,761,1 ,"$2,104.00 ","$1,367.60 ",$72.46 ,"$2,104.00 ",$643.95 ,$967.84 ,"$1,178.24 ",$257.58 ,$589.12 ,$711.15 ,$257.58 ,$818.46 ,$257.58 ,$948.90 ,$948.90 ,$257.58 ,$72.46 ,$489.39 ,"$1,052.00 ",$643.94 ,$257.58 ,$257.58 ,$262.73 ,"$1,578.00 ","$1,262.40 ","$1,262.40 ",$257.58 ,"$1,262.40 ","$1,599.04 ","$1,599.04 ","$1,599.04 ","$2,104.00 ", N/A ,"$1,788.40 ",$643.94 ,"$1,367.60 ",$257.58 ,"$2,104.00 ","$1,178.24 ",$257.58 ,$553.35 , N/A ,$463.72 ,$442.64 ,$270.46 ,"$1,683.20 ",$579.55 ,$948.90 ,$589.12 ,"$1,893.60 ",$257.58 ,"$1,599.04 ","$1,305.00 ","$1,305.00 ",$257.58 ,"$1,305.00 ","$1,009.92 ",$421.56 
ST. ELIZABETH'S HOSPITAL,76100017,64405,HC INJ ANES NERVE GREAT OCCIPITAL-RT,761,1 ,"$2,104.00 ","$1,367.60 ",$72.46 ,"$2,104.00 ",$643.95 ,$967.84 ,"$1,178.24 ",$257.58 ,$589.12 ,$711.15 ,$257.58 ,$818.46 ,$257.58 ,$948.90 ,$948.90 ,$257.58 ,$72.46 ,$489.39 ,"$1,052.00 ",$643.94 ,$257.58 ,$257.58 ,$262.73 ,"$1,578.00 ","$1,262.40 ","$1,262.40 ",$257.58 ,"$1,262.40 ","$1,599.04 ","$1,599.04 ","$1,599.04 ","$2,104.00 ", N/A ,"$1,788.40 ",$643.94 ,"$1,367.60 ",$257.58 ,"$2,104.00 ","$1,178.24 ",$257.58 ,$553.35 , N/A ,$463.72 ,$442.64 ,$270.46 ,"$1,683.20 ",$579.55 ,$948.90 ,$589.12 ,"$1,893.60 ",$257.58 ,"$1,599.04 ","$1,305.00 ","$1,305.00 ",$257.58 ,"$1,305.00 ","$1,009.92 ",$421.56 
ST. ELIZABETH'S HOSPITAL,76100018,G0260,HC INJ ARTHROGRAM SACROILIAC-BI,761,1 ,"$5,868.00 ","$3,814.20 ",$310.29 ,"$5,868.00 ","$1,565.08 ","$2,699.28 ","$3,286.08 ",$626.03 ,"$1,643.04 ","$1,983.38 ",$626.03 ,"$2,282.65 ",$626.03 ,"$2,646.47 ","$2,646.47 ",$626.03 ,"$3,814.20 ","$1,189.46 ","$2,934.00 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$4,401.00 ","$3,520.80 ","$3,520.80 ",$626.03 ,"$3,520.80 ","$4,459.68 ","$4,459.68 ","$4,459.68 ","$5,868.00 ", N/A ,"$4,987.80 ","$1,565.07 ","$3,814.20 ",$626.03 ,"$5,868.00 ","$3,286.08 ",$626.03 ,"$1,543.28 ", N/A ,$341.32 ,$325.80 ,$657.33 ,"$4,694.40 ","$1,408.57 ","$2,646.47 ","$1,643.04 ","$5,281.20 ",$626.03 ,"$4,459.68 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$2,816.64 ",$310.29 
ST. ELIZABETH'S HOSPITAL,76100019,G0260,HC INJ ARTHROGRAM SACROILIAC-LT,761,1 ,"$3,353.00 ","$2,179.45 ",$310.29 ,"$3,353.00 ","$1,565.08 ","$1,542.38 ","$1,877.68 ",$626.03 ,$938.84 ,"$1,133.31 ",$626.03 ,"$1,304.32 ",$626.03 ,"$1,512.20 ","$1,512.20 ",$626.03 ,"$2,179.45 ","$1,189.46 ","$1,676.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,514.75 ","$2,011.80 ","$2,011.80 ",$626.03 ,"$2,011.80 ","$2,548.28 ","$2,548.28 ","$2,548.28 ","$3,353.00 ", N/A ,"$2,850.05 ","$1,565.07 ","$2,179.45 ",$626.03 ,"$3,353.00 ","$1,877.68 ",$626.03 ,$881.84 , N/A ,$341.32 ,$325.80 ,$657.33 ,"$2,682.40 ","$1,408.57 ","$1,512.20 ",$938.84 ,"$3,017.70 ",$626.03 ,"$2,548.28 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$1,609.44 ",$310.29 
ST. ELIZABETH'S HOSPITAL,76100020,G0260,HC INJ ARTHROGRAM SACROILIAC-RT,761,1 ,"$3,353.00 ","$2,179.45 ",$310.29 ,"$3,353.00 ","$1,565.08 ","$1,542.38 ","$1,877.68 ",$626.03 ,$938.84 ,"$1,133.31 ",$626.03 ,"$1,304.32 ",$626.03 ,"$1,512.20 ","$1,512.20 ",$626.03 ,"$2,179.45 ","$1,189.46 ","$1,676.50 ","$1,565.07 ",$626.03 ,$626.03 ,$638.55 ,"$2,514.75 ","$2,011.80 ","$2,011.80 ",$626.03 ,"$2,011.80 ","$2,548.28 ","$2,548.28 ","$2,548.28 ","$3,353.00 ", N/A ,"$2,850.05 ","$1,565.07 ","$2,179.45 ",$626.03 ,"$3,353.00 ","$1,877.68 ",$626.03 ,$881.84 , N/A ,$341.32 ,$325.80 ,$657.33 ,"$2,682.40 ","$1,408.57 ","$1,512.20 ",$938.84 ,"$3,017.70 ",$626.03 ,"$2,548.28 ","$1,305.00 ","$1,305.00 ",$626.03 ,"$1,305.00 ","$1,609.44 ",$310.29 
ST. ELIZABETH'S HOSPITAL,76100021,64484,HC INJ EPID LUMBAR/SACRAL ADDL,761,1 ,"$2,525.00 ","$1,641.25 ",$67.15 ,"$2,525.00 ", N/A ,"$1,161.50 ","$1,414.00 ", N/A ,$707.00 ,$853.45 , N/A ,$982.23 , N/A ,"$1,138.78 ","$1,138.78 ", N/A ,$67.15 , N/A ,"$1,262.50 ", N/A , N/A , N/A , N/A ,"$1,893.75 ","$1,515.00 ","$1,515.00 ", N/A ,"$1,515.00 ","$1,919.00 ","$1,919.00 ","$1,919.00 ","$2,525.00 ", N/A ,"$2,146.25 ", N/A ,"$1,641.25 ", N/A ,"$2,525.00 ","$1,414.00 ", N/A ,$664.08 , N/A ,$841.01 ,$802.78 , N/A ,"$2,020.00 ", N/A ,"$1,138.78 ",$707.00 ,"$2,272.50 ", N/A ,"$1,919.00 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ","$1,212.00 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100022,64484,HC INJ EPID LUMBAR/SACRAL ADDL-LT,761,1 ,"$2,525.00 ","$1,641.25 ",$67.15 ,"$2,525.00 ", N/A ,"$1,161.50 ","$1,414.00 ", N/A ,$707.00 ,$853.45 , N/A ,$982.23 , N/A ,"$1,138.78 ","$1,138.78 ", N/A ,$67.15 , N/A ,"$1,262.50 ", N/A , N/A , N/A , N/A ,"$1,893.75 ","$1,515.00 ","$1,515.00 ", N/A ,"$1,515.00 ","$1,919.00 ","$1,919.00 ","$1,919.00 ","$2,525.00 ", N/A ,"$2,146.25 ", N/A ,"$1,641.25 ", N/A ,"$2,525.00 ","$1,414.00 ", N/A ,$664.08 , N/A ,$841.01 ,$802.78 , N/A ,"$2,020.00 ", N/A ,"$1,138.78 ",$707.00 ,"$2,272.50 ", N/A ,"$1,919.00 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ","$1,212.00 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100023,64484,HC INJ EPID LUMBAR/SACRAL ADDL-RT,761,1 ,"$2,525.00 ","$1,641.25 ",$67.15 ,"$2,525.00 ", N/A ,"$1,161.50 ","$1,414.00 ", N/A ,$707.00 ,$853.45 , N/A ,$982.23 , N/A ,"$1,138.78 ","$1,138.78 ", N/A ,$67.15 , N/A ,"$1,262.50 ", N/A , N/A , N/A , N/A ,"$1,893.75 ","$1,515.00 ","$1,515.00 ", N/A ,"$1,515.00 ","$1,919.00 ","$1,919.00 ","$1,919.00 ","$2,525.00 ", N/A ,"$2,146.25 ", N/A ,"$1,641.25 ", N/A ,"$2,525.00 ","$1,414.00 ", N/A ,$664.08 , N/A ,$841.01 ,$802.78 , N/A ,"$2,020.00 ", N/A ,"$1,138.78 ",$707.00 ,"$2,272.50 ", N/A ,"$1,919.00 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ","$1,212.00 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100024,64483,HC INJ EPID LUMBAR/SACRAL SGL-BI,761,1 ,"$6,590.00 ","$4,283.50 ",$143.51 ,"$6,590.00 ","$3,043.40 ","$3,031.40 ","$3,690.40 ","$1,217.36 ","$1,845.20 ","$2,227.42 ","$1,217.36 ","$2,563.51 ","$1,217.36 ","$2,972.09 ","$2,972.09 ","$1,217.36 ",$143.51 ,"$2,312.98 ","$3,295.00 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,241.71 ","$4,942.50 ","$3,954.00 ","$3,954.00 ","$1,217.36 ","$3,954.00 ","$5,008.40 ","$5,008.40 ","$5,008.40 ","$6,590.00 ", N/A ,"$5,601.50 ","$3,043.40 ","$4,283.50 ","$1,217.36 ","$6,590.00 ","$3,690.40 ","$1,217.36 ","$1,733.17 ", N/A ,"$1,261.50 ","$1,204.16 ","$1,278.23 ","$5,272.00 ","$2,739.06 ","$2,972.09 ","$1,845.20 ","$5,931.00 ","$1,217.36 ","$5,008.40 ","$1,305.00 ","$1,305.00 ","$1,217.36 ","$1,305.00 ","$3,163.20 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,76100025,64483,HC INJ EPID LUMBAR/SACRAL SGL-LT,761,1 ,"$3,431.00 ","$2,230.15 ",$143.51 ,"$3,431.00 ","$2,028.93 ","$1,578.26 ","$1,921.36 ",$811.57 ,$960.68 ,"$1,159.68 ",$811.57 ,"$1,334.66 ",$811.57 ,"$1,547.38 ","$1,547.38 ",$811.57 ,$143.51 ,"$1,541.99 ","$1,715.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,573.25 ","$2,058.60 ","$2,058.60 ",$811.57 ,"$2,058.60 ","$2,607.56 ","$2,607.56 ","$2,607.56 ","$3,431.00 ", N/A ,"$2,916.35 ","$2,028.93 ","$2,230.15 ",$811.57 ,"$3,431.00 ","$1,921.36 ",$811.57 ,$902.35 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,744.80 ","$1,826.04 ","$1,547.38 ",$960.68 ,"$3,087.90 ",$811.57 ,"$2,607.56 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$1,646.88 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100026,64483,HC INJ EPID LUMBAR/SACRAL SGL-RT,761,1 ,"$3,431.00 ","$2,230.15 ",$143.51 ,"$3,431.00 ","$2,028.93 ","$1,578.26 ","$1,921.36 ",$811.57 ,$960.68 ,"$1,159.68 ",$811.57 ,"$1,334.66 ",$811.57 ,"$1,547.38 ","$1,547.38 ",$811.57 ,$143.51 ,"$1,541.99 ","$1,715.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,573.25 ","$2,058.60 ","$2,058.60 ",$811.57 ,"$2,058.60 ","$2,607.56 ","$2,607.56 ","$2,607.56 ","$3,431.00 ", N/A ,"$2,916.35 ","$2,028.93 ","$2,230.15 ",$811.57 ,"$3,431.00 ","$1,921.36 ",$811.57 ,$902.35 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,744.80 ","$1,826.04 ","$1,547.38 ",$960.68 ,"$3,087.90 ",$811.57 ,"$2,607.56 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$1,646.88 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100027,64479,HC INJ EPIDURAL CREV/THOR SGL-BI,761,1 ,"$5,442.00 ","$3,537.30 ",$169.06 ,"$5,442.00 ","$3,043.40 ","$2,503.32 ","$3,047.52 ","$1,217.36 ","$1,523.76 ","$1,839.40 ","$1,217.36 ","$2,116.94 ","$1,217.36 ","$2,454.34 ","$2,454.34 ","$1,217.36 ",$169.06 ,"$2,312.98 ","$2,721.00 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,241.71 ","$4,081.50 ","$3,265.20 ","$3,265.20 ","$1,217.36 ","$3,265.20 ","$4,135.92 ","$4,135.92 ","$4,135.92 ","$5,442.00 ", N/A ,"$4,625.70 ","$3,043.40 ","$3,537.30 ","$1,217.36 ","$5,442.00 ","$3,047.52 ","$1,217.36 ","$1,431.25 ", N/A ,"$1,261.50 ","$1,204.16 ","$1,278.23 ","$4,353.60 ","$2,739.06 ","$2,454.34 ","$1,523.76 ","$4,897.80 ","$1,217.36 ","$4,135.92 ","$1,305.00 ","$1,305.00 ","$1,217.36 ","$1,305.00 ","$2,612.16 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,76100028,64479,HC INJ EPIDURAL CREV/THOR SGL-LT,761,1 ,"$3,628.00 ","$2,358.20 ",$169.06 ,"$3,628.00 ","$2,028.93 ","$1,668.88 ","$2,031.68 ",$811.57 ,"$1,015.84 ","$1,226.26 ",$811.57 ,"$1,411.29 ",$811.57 ,"$1,636.23 ","$1,636.23 ",$811.57 ,$169.06 ,"$1,541.99 ","$1,814.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,721.00 ","$2,176.80 ","$2,176.80 ",$811.57 ,"$2,176.80 ","$2,757.28 ","$2,757.28 ","$2,757.28 ","$3,628.00 ", N/A ,"$3,083.80 ","$2,028.93 ","$2,358.20 ",$811.57 ,"$3,628.00 ","$2,031.68 ",$811.57 ,$954.16 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,902.40 ","$1,826.04 ","$1,636.23 ","$1,015.84 ","$3,265.20 ",$811.57 ,"$2,757.28 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$1,741.44 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100029,64479,HC INJ EPIDURAL CREV/THOR SGL-RT,761,1 ,"$3,628.00 ","$2,358.20 ",$169.06 ,"$3,628.00 ","$2,028.93 ","$1,668.88 ","$2,031.68 ",$811.57 ,"$1,015.84 ","$1,226.26 ",$811.57 ,"$1,411.29 ",$811.57 ,"$1,636.23 ","$1,636.23 ",$811.57 ,$169.06 ,"$1,541.99 ","$1,814.00 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$2,721.00 ","$2,176.80 ","$2,176.80 ",$811.57 ,"$2,176.80 ","$2,757.28 ","$2,757.28 ","$2,757.28 ","$3,628.00 ", N/A ,"$3,083.80 ","$2,028.93 ","$2,358.20 ",$811.57 ,"$3,628.00 ","$2,031.68 ",$811.57 ,$954.16 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$2,902.40 ","$1,826.04 ","$1,636.23 ","$1,015.84 ","$3,265.20 ",$811.57 ,"$2,757.28 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$1,741.44 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100030,64490,HC INJ PARAVERT F JNT C/T 1 LV-BI,761,1 ,"$6,515.00 ","$4,234.75 ",$137.11 ,"$6,515.00 ","$3,043.40 ","$2,996.90 ","$3,648.40 ","$1,217.36 ","$1,824.20 ","$2,202.07 ","$1,217.36 ","$2,534.34 ","$1,217.36 ","$2,938.27 ","$2,938.27 ","$1,217.36 ",$137.11 ,"$2,312.98 ","$3,257.50 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,241.71 ","$4,886.25 ","$3,909.00 ","$3,909.00 ","$1,217.36 ","$3,909.00 ","$4,951.40 ","$4,951.40 ","$4,951.40 ","$6,515.00 ", N/A ,"$5,537.75 ","$3,043.40 ","$4,234.75 ","$1,217.36 ","$6,515.00 ","$3,648.40 ","$1,217.36 ","$1,713.45 ", N/A ,"$1,261.50 ","$1,204.16 ","$1,278.23 ","$5,212.00 ","$2,739.06 ","$2,938.27 ","$1,824.20 ","$5,863.50 ","$1,217.36 ","$4,951.40 ","$1,305.00 ","$1,305.00 ","$1,217.36 ","$1,305.00 ","$3,127.20 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,76100031,64490,HC INJ PARAVERT F JNT C/T 1 LV-LT,761,1 ,"$4,343.00 ","$2,822.95 ",$137.11 ,"$4,343.00 ","$2,028.93 ","$1,997.78 ","$2,432.08 ",$811.57 ,"$1,216.04 ","$1,467.93 ",$811.57 ,"$1,689.43 ",$811.57 ,"$1,958.69 ","$1,958.69 ",$811.57 ,$137.11 ,"$1,541.99 ","$2,171.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$3,257.25 ","$2,605.80 ","$2,605.80 ",$811.57 ,"$2,605.80 ","$3,300.68 ","$3,300.68 ","$3,300.68 ","$4,343.00 ", N/A ,"$3,691.55 ","$2,028.93 ","$2,822.95 ",$811.57 ,"$4,343.00 ","$2,432.08 ",$811.57 ,"$1,142.21 ", N/A ,$841.01 ,$802.78 ,$852.15 ,"$3,474.40 ","$1,826.04 ","$1,958.69 ","$1,216.04 ","$3,908.70 ",$811.57 ,"$3,300.68 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$2,084.64 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100032,64490,HC INJ PARAVERT F JNT C/T 1 LV-RT,761,1 ,"$4,343.00 ","$2,822.95 ",$137.11 ,"$4,343.00 ","$2,028.93 ","$1,997.78 ","$2,432.08 ",$811.57 ,"$1,216.04 ","$1,467.93 ",$811.57 ,"$1,689.43 ",$811.57 ,"$1,958.69 ","$1,958.69 ",$811.57 ,$137.11 ,"$1,541.99 ","$2,171.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$3,257.25 ","$2,605.80 ","$2,605.80 ",$811.57 ,"$2,605.80 ","$3,300.68 ","$3,300.68 ","$3,300.68 ","$4,343.00 ", N/A ,"$3,691.55 ","$2,028.93 ","$2,822.95 ",$811.57 ,"$4,343.00 ","$2,432.08 ",$811.57 ,"$1,142.21 ", N/A ,$841.01 ,$802.78 ,$852.15 ,"$3,474.40 ","$1,826.04 ","$1,958.69 ","$1,216.04 ","$3,908.70 ",$811.57 ,"$3,300.68 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$2,084.64 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100033,64491,HC INJ PARAVERT F JNT C/T 2 LV,761,1 ,"$2,142.00 ","$1,392.30 ",$77.24 ,"$2,142.00 ", N/A ,$985.32 ,"$1,199.52 ", N/A ,$599.76 ,$724.00 , N/A ,$833.24 , N/A ,$966.04 ,$966.04 , N/A ,$77.24 , N/A ,"$1,071.00 ", N/A , N/A , N/A , N/A ,"$1,606.50 ","$1,285.20 ","$1,285.20 ", N/A ,"$1,285.20 ","$1,627.92 ","$1,627.92 ","$1,627.92 ","$2,142.00 ", N/A ,"$1,820.70 ", N/A ,"$1,392.30 ", N/A ,"$2,142.00 ","$1,199.52 ", N/A ,$563.35 , N/A ,$841.01 ,$802.78 , N/A ,"$1,713.60 ", N/A ,$966.04 ,$599.76 ,"$1,927.80 ", N/A ,"$1,627.92 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ","$1,028.16 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100034,64491,HC INJ PARAVERT F JNT C/T 2 LV-LT,761,1 ,"$2,142.00 ","$1,392.30 ",$77.24 ,"$2,142.00 ", N/A ,$985.32 ,"$1,199.52 ", N/A ,$599.76 ,$724.00 , N/A ,$833.24 , N/A ,$966.04 ,$966.04 , N/A ,$77.24 , N/A ,"$1,071.00 ", N/A , N/A , N/A , N/A ,"$1,606.50 ","$1,285.20 ","$1,285.20 ", N/A ,"$1,285.20 ","$1,627.92 ","$1,627.92 ","$1,627.92 ","$2,142.00 ", N/A ,"$1,820.70 ", N/A ,"$1,392.30 ", N/A ,"$2,142.00 ","$1,199.52 ", N/A ,$563.35 , N/A ,$841.01 ,$802.78 , N/A ,"$1,713.60 ", N/A ,$966.04 ,$599.76 ,"$1,927.80 ", N/A ,"$1,627.92 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ","$1,028.16 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100035,64491,HC INJ PARAVERT F JNT C/T 2 LV-RT,761,1 ,"$2,142.00 ","$1,392.30 ",$77.24 ,"$2,142.00 ", N/A ,$985.32 ,"$1,199.52 ", N/A ,$599.76 ,$724.00 , N/A ,$833.24 , N/A ,$966.04 ,$966.04 , N/A ,$77.24 , N/A ,"$1,071.00 ", N/A , N/A , N/A , N/A ,"$1,606.50 ","$1,285.20 ","$1,285.20 ", N/A ,"$1,285.20 ","$1,627.92 ","$1,627.92 ","$1,627.92 ","$2,142.00 ", N/A ,"$1,820.70 ", N/A ,"$1,392.30 ", N/A ,"$2,142.00 ","$1,199.52 ", N/A ,$563.35 , N/A ,$841.01 ,$802.78 , N/A ,"$1,713.60 ", N/A ,$966.04 ,$599.76 ,"$1,927.80 ", N/A ,"$1,627.92 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ","$1,028.16 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100036,64492,HC INJ PARAVERT F JNT C/T 3 LV,761,1 ,"$1,265.00 ",$822.25 ,$78.05 ,"$1,265.00 ", N/A ,$581.90 ,$708.40 , N/A ,$354.20 ,$427.57 , N/A ,$492.09 , N/A ,$570.52 ,$570.52 , N/A ,$78.05 , N/A ,$632.50 , N/A , N/A , N/A , N/A ,$948.75 ,$759.00 ,$759.00 , N/A ,$759.00 ,$961.40 ,$961.40 ,$961.40 ,"$1,265.00 ", N/A ,"$1,075.25 ", N/A ,$822.25 , N/A ,"$1,265.00 ",$708.40 , N/A ,$332.70 , N/A ,$841.01 ,$802.78 , N/A ,"$1,012.00 ", N/A ,$570.52 ,$354.20 ,"$1,138.50 ", N/A ,$961.40 ,"$1,265.00 ","$1,265.00 ", N/A ,"$1,265.00 ",$607.20 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100037,64492,HC INJ PARAVERT F JNT C/T 3 LV-LT,761,1 ,"$1,265.00 ",$822.25 ,$78.05 ,"$1,265.00 ", N/A ,$581.90 ,$708.40 , N/A ,$354.20 ,$427.57 , N/A ,$492.09 , N/A ,$570.52 ,$570.52 , N/A ,$78.05 , N/A ,$632.50 , N/A , N/A , N/A , N/A ,$948.75 ,$759.00 ,$759.00 , N/A ,$759.00 ,$961.40 ,$961.40 ,$961.40 ,"$1,265.00 ", N/A ,"$1,075.25 ", N/A ,$822.25 , N/A ,"$1,265.00 ",$708.40 , N/A ,$332.70 , N/A ,$841.01 ,$802.78 , N/A ,"$1,012.00 ", N/A ,$570.52 ,$354.20 ,"$1,138.50 ", N/A ,$961.40 ,"$1,265.00 ","$1,265.00 ", N/A ,"$1,265.00 ",$607.20 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100038,64492,HC INJ PARAVERT F JNT C/T 3 LV-RT,761,1 ,"$1,265.00 ",$822.25 ,$78.05 ,"$1,265.00 ", N/A ,$581.90 ,$708.40 , N/A ,$354.20 ,$427.57 , N/A ,$492.09 , N/A ,$570.52 ,$570.52 , N/A ,$78.05 , N/A ,$632.50 , N/A , N/A , N/A , N/A ,$948.75 ,$759.00 ,$759.00 , N/A ,$759.00 ,$961.40 ,$961.40 ,$961.40 ,"$1,265.00 ", N/A ,"$1,075.25 ", N/A ,$822.25 , N/A ,"$1,265.00 ",$708.40 , N/A ,$332.70 , N/A ,$841.01 ,$802.78 , N/A ,"$1,012.00 ", N/A ,$570.52 ,$354.20 ,"$1,138.50 ", N/A ,$961.40 ,"$1,265.00 ","$1,265.00 ", N/A ,"$1,265.00 ",$607.20 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100039,64493,HC INJ PARAVERT F JNT L/S 1 LV-BI,761,1 ,"$3,619.00 ","$2,352.35 ",$115.34 ,"$3,619.00 ","$3,043.40 ","$1,664.74 ","$2,026.64 ","$1,217.36 ","$1,013.32 ","$1,223.22 ","$1,217.36 ","$1,407.79 ","$1,217.36 ","$1,632.17 ","$1,632.17 ","$1,217.36 ",$115.34 ,"$2,312.98 ","$1,809.50 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,241.71 ","$2,714.25 ","$2,171.40 ","$2,171.40 ","$1,217.36 ","$2,171.40 ","$2,750.44 ","$2,750.44 ","$2,750.44 ","$3,619.00 ", N/A ,"$3,076.15 ","$3,043.40 ","$2,352.35 ","$1,217.36 ","$3,619.00 ","$2,026.64 ","$1,217.36 ",$951.80 , N/A ,"$1,261.50 ","$1,204.16 ","$1,278.23 ","$2,895.20 ","$2,739.06 ","$1,632.17 ","$1,013.32 ","$3,257.10 ","$1,217.36 ","$2,750.44 ","$1,305.00 ","$1,305.00 ","$1,217.36 ","$1,305.00 ","$1,737.12 ","$1,146.82 "
ST. ELIZABETH'S HOSPITAL,76100040,64493,HC INJ PARAVERT F JNT L/S 1 LV-LT,761,1 ,"$2,413.00 ","$1,568.45 ",$115.34 ,"$2,413.00 ","$2,028.93 ","$1,109.98 ","$1,351.28 ",$811.57 ,$675.64 ,$815.59 ,$811.57 ,$938.66 ,$811.57 ,"$1,088.26 ","$1,088.26 ",$811.57 ,$115.34 ,"$1,541.99 ","$1,206.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$1,809.75 ","$1,447.80 ","$1,447.80 ",$811.57 ,"$1,447.80 ","$1,833.88 ","$1,833.88 ","$1,833.88 ","$2,413.00 ", N/A ,"$2,051.05 ","$2,028.93 ","$1,568.45 ",$811.57 ,"$2,413.00 ","$1,351.28 ",$811.57 ,$634.62 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$1,930.40 ","$1,826.04 ","$1,088.26 ",$675.64 ,"$2,171.70 ",$811.57 ,"$1,833.88 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$1,158.24 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100041,64493,HC INJ PARAVERT F JNT L/S 1 LV-RT,761,1 ,"$2,413.00 ","$1,568.45 ",$115.34 ,"$2,413.00 ","$2,028.93 ","$1,109.98 ","$1,351.28 ",$811.57 ,$675.64 ,$815.59 ,$811.57 ,$938.66 ,$811.57 ,"$1,088.26 ","$1,088.26 ",$811.57 ,$115.34 ,"$1,541.99 ","$1,206.50 ","$2,028.93 ",$811.57 ,$811.57 ,$827.80 ,"$1,809.75 ","$1,447.80 ","$1,447.80 ",$811.57 ,"$1,447.80 ","$1,833.88 ","$1,833.88 ","$1,833.88 ","$2,413.00 ", N/A ,"$2,051.05 ","$2,028.93 ","$1,568.45 ",$811.57 ,"$2,413.00 ","$1,351.28 ",$811.57 ,$634.62 , N/A ,$841.01 ,$802.78 ,$852.15 ,"$1,930.40 ","$1,826.04 ","$1,088.26 ",$675.64 ,"$2,171.70 ",$811.57 ,"$1,833.88 ","$1,305.00 ","$1,305.00 ",$811.57 ,"$1,305.00 ","$1,158.24 ",$764.55 
ST. ELIZABETH'S HOSPITAL,76100042,64494,HC INJ PARAVERT F JNT L/S 2 LV,761,1 ,"$2,068.00 ","$1,344.20 ",$66.74 ,"$2,068.00 ", N/A ,$951.28 ,"$1,158.08 ", N/A ,$579.04 ,$698.98 , N/A ,$804.45 , N/A ,$932.67 ,$932.67 , N/A ,$66.74 , N/A ,"$1,034.00 ", N/A , N/A , N/A , N/A ,"$1,551.00 ","$1,240.80 ","$1,240.80 ", N/A ,"$1,240.80 ","$1,571.68 ","$1,571.68 ","$1,571.68 ","$2,068.00 ", N/A ,"$1,757.80 ", N/A ,"$1,344.20 ", N/A ,"$2,068.00 ","$1,158.08 ", N/A ,$543.88 , N/A ,$841.01 ,$802.78 , N/A ,"$1,654.40 ", N/A ,$932.67 ,$579.04 ,"$1,861.20 ", N/A ,"$1,571.68 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ",$992.64 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100043,64494,HC INJ PARAVERT F JNT L/S 2 LV-LT,761,1 ,"$2,068.00 ","$1,344.20 ",$66.74 ,"$2,068.00 ", N/A ,$951.28 ,"$1,158.08 ", N/A ,$579.04 ,$698.98 , N/A ,$804.45 , N/A ,$932.67 ,$932.67 , N/A ,$66.74 , N/A ,"$1,034.00 ", N/A , N/A , N/A , N/A ,"$1,551.00 ","$1,240.80 ","$1,240.80 ", N/A ,"$1,240.80 ","$1,571.68 ","$1,571.68 ","$1,571.68 ","$2,068.00 ", N/A ,"$1,757.80 ", N/A ,"$1,344.20 ", N/A ,"$2,068.00 ","$1,158.08 ", N/A ,$543.88 , N/A ,$841.01 ,$802.78 , N/A ,"$1,654.40 ", N/A ,$932.67 ,$579.04 ,"$1,861.20 ", N/A ,"$1,571.68 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ",$992.64 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100044,64494,HC INJ PARAVERT F JNT L/S 2 LV-RT,761,1 ,"$2,068.00 ","$1,344.20 ",$66.74 ,"$2,068.00 ", N/A ,$951.28 ,"$1,158.08 ", N/A ,$579.04 ,$698.98 , N/A ,$804.45 , N/A ,$932.67 ,$932.67 , N/A ,$66.74 , N/A ,"$1,034.00 ", N/A , N/A , N/A , N/A ,"$1,551.00 ","$1,240.80 ","$1,240.80 ", N/A ,"$1,240.80 ","$1,571.68 ","$1,571.68 ","$1,571.68 ","$2,068.00 ", N/A ,"$1,757.80 ", N/A ,"$1,344.20 ", N/A ,"$2,068.00 ","$1,158.08 ", N/A ,$543.88 , N/A ,$841.01 ,$802.78 , N/A ,"$1,654.40 ", N/A ,$932.67 ,$579.04 ,"$1,861.20 ", N/A ,"$1,571.68 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ",$992.64 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100045,64495,HC INJ PARAVRT F JNT L/S 3+ LV,761,1 ,"$2,006.00 ","$1,303.90 ",$67.56 ,"$2,006.00 ", N/A ,$922.76 ,"$1,123.36 ", N/A ,$561.68 ,$678.03 , N/A ,$780.33 , N/A ,$904.71 ,$904.71 , N/A ,$67.56 , N/A ,"$1,003.00 ", N/A , N/A , N/A , N/A ,"$1,504.50 ","$1,203.60 ","$1,203.60 ", N/A ,"$1,203.60 ","$1,524.56 ","$1,524.56 ","$1,524.56 ","$2,006.00 ", N/A ,"$1,705.10 ", N/A ,"$1,303.90 ", N/A ,"$2,006.00 ","$1,123.36 ", N/A ,$527.58 , N/A ,$841.01 ,$802.78 , N/A ,"$1,604.80 ", N/A ,$904.71 ,$561.68 ,"$1,805.40 ", N/A ,"$1,524.56 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ",$962.88 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100046,64495,HC INJ PARAVRT F JNT L/S 3+ LV-LT,761,1 ,"$2,006.00 ","$1,303.90 ",$67.56 ,"$2,006.00 ", N/A ,$922.76 ,"$1,123.36 ", N/A ,$561.68 ,$678.03 , N/A ,$780.33 , N/A ,$904.71 ,$904.71 , N/A ,$67.56 , N/A ,"$1,003.00 ", N/A , N/A , N/A , N/A ,"$1,504.50 ","$1,203.60 ","$1,203.60 ", N/A ,"$1,203.60 ","$1,524.56 ","$1,524.56 ","$1,524.56 ","$2,006.00 ", N/A ,"$1,705.10 ", N/A ,"$1,303.90 ", N/A ,"$2,006.00 ","$1,123.36 ", N/A ,$527.58 , N/A ,$841.01 ,$802.78 , N/A ,"$1,604.80 ", N/A ,$904.71 ,$561.68 ,"$1,805.40 ", N/A ,"$1,524.56 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ",$962.88 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100047,64495,HC INJ PARAVRT F JNT L/S 3+ LV-RT,761,1 ,"$2,006.00 ","$1,303.90 ",$67.56 ,"$2,006.00 ", N/A ,$922.76 ,"$1,123.36 ", N/A ,$561.68 ,$678.03 , N/A ,$780.33 , N/A ,$904.71 ,$904.71 , N/A ,$67.56 , N/A ,"$1,003.00 ", N/A , N/A , N/A , N/A ,"$1,504.50 ","$1,203.60 ","$1,203.60 ", N/A ,"$1,203.60 ","$1,524.56 ","$1,524.56 ","$1,524.56 ","$2,006.00 ", N/A ,"$1,705.10 ", N/A ,"$1,303.90 ", N/A ,"$2,006.00 ","$1,123.36 ", N/A ,$527.58 , N/A ,$841.01 ,$802.78 , N/A ,"$1,604.80 ", N/A ,$904.71 ,$561.68 ,"$1,805.40 ", N/A ,"$1,524.56 ","$1,305.00 ","$1,305.00 ", N/A ,"$1,305.00 ",$962.88 ,$764.55 
ST. ELIZABETH'S HOSPITAL,76100048,97607,HC NEG PRESS WOUND THERAPY WO DME<50CM,761,1 ,"$1,135.00 ",$737.75 ,$30.41 ,"$1,135.00 ",$851.90 ,$522.10 ,$635.60 ,$340.76 ,$317.80 ,$383.63 ,$340.76 ,$441.52 ,$340.76 ,$511.89 ,$511.89 ,$340.76 ,$30.41 ,$647.44 ,$567.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$851.25 ,$681.00 ,$681.00 ,$340.76 ,$681.00 ,$862.60 ,$862.60 ,$862.60 ,"$1,135.00 ", N/A ,$964.75 ,$851.90 ,$737.75 ,$340.76 ,"$1,135.00 ",$635.60 ,$340.76 ,$298.51 , N/A ,$303.34 ,$289.55 ,$357.80 ,$908.00 ,$766.71 ,$511.89 ,$317.80 ,"$1,021.50 ",$340.76 ,$862.60 ,"$1,135.00 ","$1,135.00 ",$340.76 ,"$1,135.00 ",$544.80 ,$275.76 
ST. ELIZABETH'S HOSPITAL,76100049,97608,HC NEG PRESS WOUND THERAPY WO DME>50CM,761,1 ,$881.00 ,$572.65 ,$34.11 ,$881.00 ,$851.90 ,$405.26 ,$493.36 ,$340.76 ,$246.68 ,$297.78 ,$340.76 ,$342.71 ,$340.76 ,$397.33 ,$397.33 ,$340.76 ,$34.11 ,$647.44 ,$440.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$660.75 ,$528.60 ,$528.60 ,$340.76 ,$528.60 ,$669.56 ,$669.56 ,$669.56 ,$881.00 , N/A ,$748.85 ,$851.90 ,$572.65 ,$340.76 ,$881.00 ,$493.36 ,$340.76 ,$231.70 , N/A ,$303.34 ,$289.55 ,$357.80 ,$704.80 ,$766.71 ,$397.33 ,$246.68 ,$792.90 ,$340.76 ,$669.56 ,$881.00 ,$881.00 ,$340.76 ,$881.00 ,$422.88 ,$275.76 
ST. ELIZABETH'S HOSPITAL,76100054,64999,HC GANGLION IMPAR BLOCK,761,1 ,$772.00 ,$501.80 ,$203.04 ,$772.00 ,$643.95 ,$355.12 ,$432.32 ,$257.58 ,$216.16 ,$260.94 ,$257.58 ,$300.31 ,$257.58 ,$348.17 ,$348.17 ,$257.58 ,$501.80 ,$489.39 ,$386.00 ,$643.94 ,$257.58 ,$257.58 ,$262.73 ,$579.00 ,$463.20 ,$463.20 ,$257.58 ,$463.20 ,$586.72 ,$586.72 ,$586.72 ,$772.00 , N/A ,$656.20 ,$643.94 ,$501.80 ,$257.58 ,$772.00 ,$432.32 ,$257.58 ,$203.04 , N/A ,$463.72 ,$442.64 ,$270.46 ,$617.60 ,$579.55 ,$348.17 ,$216.16 ,$694.80 ,$257.58 ,$586.72 ,$772.00 ,$772.00 ,$257.58 ,$772.00 ,$370.56 ,$421.56 
ST. ELIZABETH'S HOSPITAL,76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$133.00 ,$86.45 ,$34.98 ,$133.00 , N/A ,$61.18 ,$74.48 , N/A ,$37.24 ,$44.95 , N/A ,$51.74 , N/A ,$59.98 ,$59.98 , N/A ,$59.98 , N/A ,$66.50 , N/A , N/A , N/A , N/A ,$99.75 ,$79.80 ,$79.80 , N/A ,$79.80 ,$94.43 ,$94.43 ,$94.43 ,$133.00 , N/A ,$113.05 , N/A ,$86.45 , N/A ,$133.00 ,$74.48 , N/A ,$34.98 , N/A , N/A , N/A , N/A ,$106.40 , N/A ,$59.98 ,$37.24 ,$119.70 , N/A ,$94.43 ,$133.00 ,$133.00 , N/A ,$133.00 ,$63.84 , N/A 
ST. ELIZABETH'S HOSPITAL,76200009,G0378,HC OBSERVATION HOURLY,762,1 ,$133.00 ,$86.45 ,$34.98 ,$133.00 , N/A ,$61.18 ,$74.48 , N/A ,$37.24 ,$44.95 , N/A ,$51.74 , N/A ,$59.98 ,$59.98 , N/A ,$59.98 , N/A ,$66.50 , N/A , N/A , N/A , N/A ,$99.75 ,$79.80 ,$79.80 , N/A ,$79.80 ,$94.43 ,$94.43 ,$94.43 ,$133.00 , N/A ,$113.05 , N/A ,$86.45 , N/A ,$133.00 ,$74.48 , N/A ,$34.98 , N/A , N/A , N/A , N/A ,$106.40 , N/A ,$59.98 ,$37.24 ,$119.70 , N/A ,$94.43 ,$133.00 ,$133.00 , N/A ,$133.00 ,$63.84 , N/A 
ST. ELIZABETH'S HOSPITAL,76200022,G0378,HC OBSERVATION W/TELEMETRY PER HR,762,1 ,$133.00 ,$86.45 ,$34.98 ,$133.00 , N/A ,$61.18 ,$74.48 , N/A ,$37.24 ,$44.95 , N/A ,$51.74 , N/A ,$59.98 ,$59.98 , N/A ,$59.98 , N/A ,$66.50 , N/A , N/A , N/A , N/A ,$99.75 ,$79.80 ,$79.80 , N/A ,$79.80 ,$94.43 ,$94.43 ,$94.43 ,$133.00 , N/A ,$113.05 , N/A ,$86.45 , N/A ,$133.00 ,$74.48 , N/A ,$34.98 , N/A , N/A , N/A , N/A ,$106.40 , N/A ,$59.98 ,$37.24 ,$119.70 , N/A ,$94.43 ,$133.00 ,$133.00 , N/A ,$133.00 ,$63.84 , N/A 
ST. ELIZABETH'S HOSPITAL,77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$140.00 ,$91.00 ,$20.70 ,$152.81 ,$152.80 ,$64.40 ,$78.40 ,$61.12 ,$39.20 ,$49.42 ,$61.12 ,$57.68 ,$61.12 ,$63.14 ,$63.14 ,$61.12 ,$20.70 ,$116.14 ,$70.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$105.00 ,$84.00 ,$84.00 ,$61.12 ,$84.00 ,$106.40 ,$106.40 ,$106.40 ,$140.00 , N/A ,$119.00 ,$140.00 ,$91.00 ,$61.12 ,$140.00 ,$78.40 ,$61.12 ,$36.82 , N/A , N/A , N/A ,$64.18 ,$112.00 ,$137.53 ,$63.14 ,$39.20 ,$126.00 ,$61.12 ,$106.40 , N/A , N/A ,$61.12 , N/A ,$67.20 , N/A 
ST. ELIZABETH'S HOSPITAL,77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$74.00 ,$48.10 ,$15.76 ,$74.00 , N/A ,$34.04 ,$41.44 , N/A ,$20.72 ,$26.12 , N/A ,$30.49 , N/A ,$33.37 ,$33.37 , N/A ,$15.76 , N/A ,$37.00 , N/A , N/A , N/A , N/A ,$55.50 ,$44.40 ,$44.40 , N/A ,$44.40 ,$56.24 ,$56.24 ,$56.24 ,$74.00 , N/A ,$62.90 , N/A ,$48.10 , N/A ,$74.00 ,$41.44 , N/A ,$19.46 , N/A , N/A , N/A , N/A ,$59.20 , N/A ,$33.37 ,$20.72 ,$66.60 , N/A ,$56.24 , N/A , N/A , N/A , N/A ,$35.52 , N/A 
ST. ELIZABETH'S HOSPITAL,77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$70.00 ,$45.50 ,$18.41 ,$98.63 ,$98.63 ,$32.20 ,$39.20 ,$39.45 ,$19.60 ,$24.71 ,$39.45 ,$28.84 ,$39.45 ,$31.57 ,$31.57 ,$39.45 ,$45.50 ,$70.00 ,$35.00 ,$98.63 ,$39.45 ,$39.45 ,$40.24 ,$52.50 ,$42.00 ,$42.00 ,$39.45 ,$42.00 ,$53.20 ,$53.20 ,$53.20 ,$70.00 , N/A ,$59.50 ,$70.00 ,$45.50 ,$39.45 ,$70.00 ,$39.20 ,$39.45 ,$18.41 , N/A , N/A , N/A ,$41.42 ,$56.00 ,$88.77 ,$31.57 ,$19.60 ,$63.00 ,$39.45 ,$53.20 , N/A , N/A ,$39.45 , N/A ,$33.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$70.00 ,$45.50 ,$18.41 ,$98.63 ,$98.63 ,$32.20 ,$39.20 ,$39.45 ,$19.60 ,$24.71 ,$39.45 ,$28.84 ,$39.45 ,$31.57 ,$31.57 ,$39.45 ,$45.50 ,$70.00 ,$35.00 ,$98.63 ,$39.45 ,$39.45 ,$40.24 ,$52.50 ,$42.00 ,$42.00 ,$39.45 ,$42.00 ,$53.20 ,$53.20 ,$53.20 ,$70.00 , N/A ,$59.50 ,$70.00 ,$45.50 ,$39.45 ,$70.00 ,$39.20 ,$39.45 ,$18.41 , N/A , N/A , N/A ,$41.42 ,$56.00 ,$88.77 ,$31.57 ,$19.60 ,$63.00 ,$39.45 ,$53.20 , N/A , N/A ,$39.45 , N/A ,$33.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$70.00 ,$45.50 ,$18.41 ,$98.63 ,$98.63 ,$32.20 ,$39.20 ,$39.45 ,$19.60 ,$24.71 ,$39.45 ,$28.84 ,$39.45 ,$31.57 ,$31.57 ,$39.45 ,$45.50 ,$70.00 ,$35.00 ,$98.63 ,$39.45 ,$39.45 ,$40.24 ,$52.50 ,$42.00 ,$42.00 ,$39.45 ,$42.00 ,$53.20 ,$53.20 ,$53.20 ,$70.00 , N/A ,$59.50 ,$70.00 ,$45.50 ,$39.45 ,$70.00 ,$39.20 ,$39.45 ,$18.41 , N/A , N/A , N/A ,$41.42 ,$56.00 ,$88.77 ,$31.57 ,$19.60 ,$63.00 ,$39.45 ,$53.20 , N/A , N/A ,$39.45 , N/A ,$33.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100009,0001A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$55.20 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100010,0002A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$55.20 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100011,0011A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$55.20 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100012,0012A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5M SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$55.20 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100013,0021A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$70.00 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 , N/A , N/A , N/A , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100014,0022A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$70.00 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 , N/A , N/A , N/A , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100015,0031A,HC ADMINISTRATION SARS-COV-2 VACCINE AD26 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$70.00 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100016,0041A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$70.00 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 , N/A , N/A , N/A , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100017,0042A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 , N/A ,$70.00 ,$67.20 , N/A ,$33.60 ,$40.56 , N/A ,$46.68 , N/A ,$54.12 ,$54.12 , N/A ,$78.00 , N/A ,$60.00 , N/A , N/A , N/A , N/A ,$90.00 ,$72.00 ,$72.00 , N/A ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 , N/A ,$78.00 , N/A ,$120.00 ,$67.20 , N/A ,$31.56 , N/A , N/A , N/A , N/A ,$96.00 , N/A ,$54.12 ,$33.60 ,$108.00 , N/A ,$91.20 , N/A , N/A , N/A , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100018,0003A,HC ADM SARSCOV2 30MCG/0.3ML 3RD - PFIZER,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$55.20 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100019,0013A,HC ADM SARSCOV2 100MCG/0.5ML 3RD - MODERNA,771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$55.20 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100025,0064A,"HC ADMIN SARS-COV-2 VACCINE 50MCG/0.25ML, BOOSTER DOSE",771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$70.00 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,77100028,0034A,"HC ADMIN SARS-COV-2 VACCINE JOHNSON  AND  JOHNSON, BOOSTER DOSE",771,1 ,$120.00 ,$78.00 ,$31.56 ,$120.00 ,$96.53 ,$55.20 ,$67.20 ,$38.61 ,$33.60 ,$40.56 ,$38.61 ,$46.68 ,$38.61 ,$54.12 ,$54.12 ,$38.61 ,$78.00 ,$73.36 ,$60.00 ,$96.53 ,$38.61 ,$38.61 ,$39.39 ,$90.00 ,$72.00 ,$72.00 ,$38.61 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$96.53 ,$78.00 ,$38.61 ,$120.00 ,$67.20 ,$38.61 ,$31.56 , N/A , N/A , N/A ,$40.54 ,$96.00 ,$86.88 ,$54.12 ,$33.60 ,$108.00 ,$38.61 ,$91.20 , N/A , N/A ,$38.61 , N/A ,$57.60 , N/A 
ST. ELIZABETH'S HOSPITAL,78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$84.50 ,$54.93 ,$14.00 ,$84.50 ,$68.98 ,$38.87 ,$47.32 ,$27.59 ,$23.66 ,$28.56 ,$27.59 ,$32.87 ,$27.59 ,$38.11 ,$38.11 ,$27.59 ,$54.93 ,$52.42 ,$42.25 ,$68.98 ,$27.59 ,$27.59 ,$28.14 ,$63.38 ,$50.70 ,$50.70 ,$27.59 ,$50.70 ,$64.22 ,$64.22 ,$64.22 ,$84.50 , N/A ,$71.83 ,$68.98 ,$54.93 ,$27.59 ,$84.50 ,$47.32 ,$27.59 ,$22.22 , N/A ,$15.40 ,$14.70 ,$28.97 ,$67.60 ,$62.08 ,$38.11 ,$23.66 ,$76.05 ,$27.59 ,$64.22 ,$54.93 ,$54.93 ,$27.59 ,$54.93 ,$40.56 ,$14.00 
ST. ELIZABETH'S HOSPITAL,78000003,97110,HC THERA EXER; EA 15 MIN - 95,780,1 ,$155.00 ,$100.75 ,$29.76 ,$155.00 ,$74.40 ,$71.30 ,$86.80 ,$29.76 ,$43.40 ,$54.72 ,$29.76 ,$63.86 ,$29.76 ,$69.91 ,$69.91 ,$29.76 ,$37.20 ,$56.54 ,$77.50 ,$74.40 ,$29.76 ,$29.76 ,$30.36 ,$116.25 ,$93.00 ,$93.00 ,$29.76 ,$93.00 ,$117.80 ,$117.80 ,$117.80 ,$155.00 , N/A ,$131.75 ,$74.40 ,$100.75 ,$29.76 ,$155.00 ,$86.80 ,$29.76 ,$40.77 , N/A , N/A , N/A ,$31.25 ,$124.00 ,$66.96 ,$69.91 ,$43.40 ,$139.50 ,$29.76 ,$117.80 ,$100.75 ,$100.75 ,$29.76 ,$100.75 ,$74.40 , N/A 
ST. ELIZABETH'S HOSPITAL,78000004,97112,HC NEUROMUSCULAR RE ED EA 15 MIN - 95,780,1 ,$196.00 ,$127.40 ,$34.43 ,$196.00 ,$86.08 ,$90.16 ,$109.76 ,$34.43 ,$54.88 ,$69.19 ,$34.43 ,$80.75 ,$34.43 ,$88.40 ,$88.40 ,$34.43 ,$43.04 ,$65.42 ,$98.00 ,$86.08 ,$34.43 ,$34.43 ,$35.12 ,$147.00 ,$117.60 ,$117.60 ,$34.43 ,$117.60 ,$148.96 ,$148.96 ,$148.96 ,$196.00 , N/A ,$166.60 ,$86.08 ,$127.40 ,$34.43 ,$196.00 ,$109.76 ,$34.43 ,$51.55 , N/A , N/A , N/A ,$36.15 ,$156.80 ,$77.47 ,$88.40 ,$54.88 ,$176.40 ,$34.43 ,$148.96 ,$127.40 ,$127.40 ,$34.43 ,$127.40 ,$94.08 , N/A 
ST. ELIZABETH'S HOSPITAL,78000005,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN - 95,780,1 ,$160.00 ,$104.00 ,$37.24 ,$160.00 ,$93.10 ,$73.60 ,$89.60 ,$37.24 ,$44.80 ,$56.48 ,$37.24 ,$65.92 ,$37.24 ,$72.16 ,$72.16 ,$37.24 ,$46.55 ,$70.76 ,$80.00 ,$93.10 ,$37.24 ,$37.24 ,$37.98 ,$120.00 ,$96.00 ,$96.00 ,$37.24 ,$96.00 ,$121.60 ,$121.60 ,$121.60 ,$160.00 , N/A ,$136.00 ,$93.10 ,$104.00 ,$37.24 ,$160.00 ,$89.60 ,$37.24 ,$42.08 , N/A , N/A , N/A ,$39.10 ,$128.00 ,$83.79 ,$72.16 ,$44.80 ,$144.00 ,$37.24 ,$121.60 ,$104.00 ,$104.00 ,$37.24 ,$104.00 ,$76.80 , N/A 
ST. ELIZABETH'S HOSPITAL,78000006,97535,HC SELF CARE ADL TRAINING EA 15 MIN - 95,780,1 ,$132.00 ,$85.80 ,$33.02 ,$132.00 ,$82.55 ,$60.72 ,$73.92 ,$33.02 ,$36.96 ,$46.60 ,$33.02 ,$54.38 ,$33.02 ,$59.53 ,$59.53 ,$33.02 ,$41.28 ,$62.74 ,$66.00 ,$82.55 ,$33.02 ,$33.02 ,$33.68 ,$99.00 ,$79.20 ,$79.20 ,$33.02 ,$79.20 ,$100.32 ,$100.32 ,$100.32 ,$132.00 , N/A ,$112.20 ,$82.55 ,$85.80 ,$33.02 ,$132.00 ,$73.92 ,$33.02 ,$34.72 , N/A , N/A , N/A ,$34.67 ,$105.60 ,$74.30 ,$59.53 ,$36.96 ,$118.80 ,$33.02 ,$100.32 ,$85.80 ,$85.80 ,$33.02 ,$85.80 ,$63.36 , N/A 
ST. ELIZABETH'S HOSPITAL,78000007,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN - 95,780,1 ,$78.00 ,$50.70 ,$20.51 ,$78.00 ,$58.35 ,$35.88 ,$43.68 ,$23.34 ,$21.84 ,$26.36 ,$23.34 ,$30.34 ,$23.34 ,$35.18 ,$35.18 ,$23.34 ,$29.18 ,$44.35 ,$39.00 ,$58.35 ,$23.34 ,$23.34 ,$23.81 ,$58.50 ,$46.80 ,$46.80 ,$23.34 ,$46.80 ,$59.28 ,$59.28 ,$59.28 ,$78.00 , N/A ,$66.30 ,$58.35 ,$50.70 ,$23.34 ,$78.00 ,$43.68 ,$23.34 ,$20.51 , N/A , N/A , N/A ,$24.51 ,$62.40 ,$52.52 ,$35.18 ,$21.84 ,$70.20 ,$23.34 ,$59.28 ,$50.70 ,$50.70 ,$23.34 ,$50.70 ,$37.44 , N/A 
ST. ELIZABETH'S HOSPITAL,78000008,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN - 95,780,1 ,$78.00 ,$50.70 ,$20.51 ,$78.00 ,$56.63 ,$35.88 ,$43.68 ,$22.65 ,$21.84 ,$26.36 ,$22.65 ,$30.34 ,$22.65 ,$35.18 ,$35.18 ,$22.65 ,$27.90 ,$43.04 ,$39.00 ,$56.63 ,$22.65 ,$22.65 ,$23.10 ,$58.50 ,$46.80 ,$46.80 ,$22.65 ,$46.80 ,$59.28 ,$59.28 ,$59.28 ,$78.00 , N/A ,$66.30 ,$56.63 ,$50.70 ,$22.65 ,$78.00 ,$43.68 ,$22.65 ,$20.51 , N/A , N/A , N/A ,$23.78 ,$62.40 ,$50.96 ,$35.18 ,$21.84 ,$70.20 ,$22.65 ,$59.28 ,$50.70 ,$50.70 ,$22.65 ,$50.70 ,$37.44 , N/A 
ST. ELIZABETH'S HOSPITAL,78000009,97161,HC PT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$253.33 ,$155.48 ,$189.28 ,$101.33 ,$94.64 ,$119.31 ,$101.33 ,$139.26 ,$101.33 ,$152.44 ,$152.44 ,$101.33 ,$126.66 ,$192.53 ,$169.00 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$253.50 ,$202.80 ,$202.80 ,$101.33 ,$202.80 ,$256.88 ,$256.88 ,$256.88 ,$338.00 , N/A ,$287.30 ,$253.33 ,$219.70 ,$101.33 ,$338.00 ,$189.28 ,$101.33 ,$88.89 , N/A , N/A , N/A ,$106.40 ,$270.40 ,$227.99 ,$152.44 ,$94.64 ,$304.20 ,$101.33 ,$256.88 ,$219.70 ,$219.70 ,$101.33 ,$219.70 ,$162.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000010,97162,HC PT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$451.00 ,$293.15 ,$101.33 ,$451.00 ,$253.33 ,$207.46 ,$252.56 ,$101.33 ,$126.28 ,$159.20 ,$101.33 ,$185.81 ,$101.33 ,$203.40 ,$203.40 ,$101.33 ,$126.66 ,$192.53 ,$225.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$338.25 ,$270.60 ,$270.60 ,$101.33 ,$270.60 ,$342.76 ,$342.76 ,$342.76 ,$451.00 , N/A ,$383.35 ,$253.33 ,$293.15 ,$101.33 ,$451.00 ,$252.56 ,$101.33 ,$118.61 , N/A , N/A , N/A ,$106.40 ,$360.80 ,$227.99 ,$203.40 ,$126.28 ,$405.90 ,$101.33 ,$342.76 ,$293.15 ,$293.15 ,$101.33 ,$293.15 ,$216.48 , N/A 
ST. ELIZABETH'S HOSPITAL,78000011,97163,HC PT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$563.00 ,$365.95 ,$101.33 ,$563.00 ,$253.33 ,$258.98 ,$315.28 ,$101.33 ,$157.64 ,$198.74 ,$101.33 ,$231.96 ,$101.33 ,$253.91 ,$253.91 ,$101.33 ,$126.66 ,$192.53 ,$281.50 ,$253.33 ,$101.33 ,$101.33 ,$103.36 ,$422.25 ,$337.80 ,$337.80 ,$101.33 ,$337.80 ,$427.88 ,$427.88 ,$427.88 ,$563.00 , N/A ,$478.55 ,$253.33 ,$365.95 ,$101.33 ,$563.00 ,$315.28 ,$101.33 ,$148.07 , N/A , N/A , N/A ,$106.40 ,$450.40 ,$227.99 ,$253.91 ,$157.64 ,$506.70 ,$101.33 ,$427.88 ,$365.95 ,$365.95 ,$101.33 ,$365.95 ,$270.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000012,97164,HC PT RE-EVAL 15 MIN - 95,780,1 ,$221.00 ,$143.65 ,$58.12 ,$221.00 ,$173.55 ,$101.66 ,$123.76 ,$69.42 ,$61.88 ,$78.01 ,$69.42 ,$91.05 ,$69.42 ,$99.67 ,$99.67 ,$69.42 ,$86.78 ,$131.90 ,$110.50 ,$173.55 ,$69.42 ,$69.42 ,$70.81 ,$165.75 ,$132.60 ,$132.60 ,$69.42 ,$132.60 ,$167.96 ,$167.96 ,$167.96 ,$221.00 , N/A ,$187.85 ,$173.55 ,$143.65 ,$69.42 ,$221.00 ,$123.76 ,$69.42 ,$58.12 , N/A , N/A , N/A ,$72.89 ,$176.80 ,$156.20 ,$99.67 ,$61.88 ,$198.90 ,$69.42 ,$167.96 ,$143.65 ,$143.65 ,$69.42 ,$143.65 ,$106.08 , N/A 
ST. ELIZABETH'S HOSPITAL,78000013,97165,HC OT EVAL LOW COMPLEXITY 30 MIN - 95,780,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$254.95 ,$155.48 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$256.88 ,$256.88 ,$256.88 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A , N/A , N/A ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$256.88 ,$219.70 ,$219.70 ,$101.98 ,$219.70 ,$162.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000014,97116,HC AMBULATION GAIT TRAIN EA 15 MIN - 95,780,1 ,$196.00 ,$127.40 ,$29.76 ,$196.00 ,$74.40 ,$90.16 ,$109.76 ,$29.76 ,$54.88 ,$69.19 ,$29.76 ,$80.75 ,$29.76 ,$88.40 ,$88.40 ,$29.76 ,$37.20 ,$56.54 ,$98.00 ,$74.40 ,$29.76 ,$29.76 ,$30.36 ,$147.00 ,$117.60 ,$117.60 ,$29.76 ,$117.60 ,$148.96 ,$148.96 ,$148.96 ,$196.00 , N/A ,$166.60 ,$74.40 ,$127.40 ,$29.76 ,$196.00 ,$109.76 ,$29.76 ,$51.55 , N/A , N/A , N/A ,$31.25 ,$156.80 ,$66.96 ,$88.40 ,$54.88 ,$176.40 ,$29.76 ,$148.96 ,$127.40 ,$127.40 ,$29.76 ,$127.40 ,$94.08 , N/A 
ST. ELIZABETH'S HOSPITAL,78000015,97167,HC OT EVAL HIGH COMPLEXITY 60 MIN - 95,780,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$258.98 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$427.88 ,$427.88 ,$427.88 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A , N/A , N/A ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$427.88 ,$365.95 ,$365.95 ,$101.98 ,$365.95 ,$270.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000016,97168,HC OT RE-EVAL 30 MIN - 95,780,1 ,$221.00 ,$143.65 ,$58.12 ,$221.00 ,$174.38 ,$101.66 ,$123.76 ,$69.75 ,$61.88 ,$78.01 ,$69.75 ,$91.05 ,$69.75 ,$99.67 ,$99.67 ,$69.75 ,$87.19 ,$132.53 ,$110.50 ,$174.38 ,$69.75 ,$69.75 ,$71.15 ,$165.75 ,$132.60 ,$132.60 ,$69.75 ,$132.60 ,$167.96 ,$167.96 ,$167.96 ,$221.00 , N/A ,$187.85 ,$174.38 ,$143.65 ,$69.75 ,$221.00 ,$123.76 ,$69.75 ,$58.12 , N/A , N/A , N/A ,$73.24 ,$176.80 ,$156.94 ,$99.67 ,$61.88 ,$198.90 ,$69.75 ,$167.96 ,$143.65 ,$143.65 ,$69.75 ,$143.65 ,$106.08 , N/A 
ST. ELIZABETH'S HOSPITAL,78000017,92507,HC SPEECH THERAPY TREATMENT 15 MIN - 95,780,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$165.60 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$273.60 ,$273.60 ,$273.60 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A , N/A , N/A ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$273.60 ,$234.00 ,$234.00 ,$77.53 ,$234.00 ,$172.80 , N/A 
ST. ELIZABETH'S HOSPITAL,78000018,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN - 95,780,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$139.38 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$230.28 ,$230.28 ,$230.28 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A , N/A , N/A ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$230.28 ,$196.95 ,$196.95 ,$134.52 ,$196.95 ,$145.44 , N/A 
ST. ELIZABETH'S HOSPITAL,78000019,92526,HC DYSPHAGIA TREATMENT 15 MIN - 95,780,1 ,$343.00 ,$222.95 ,$85.76 ,$343.00 ,$214.40 ,$157.78 ,$192.08 ,$85.76 ,$96.04 ,$121.08 ,$85.76 ,$141.32 ,$85.76 ,$154.69 ,$154.69 ,$85.76 ,$107.20 ,$162.94 ,$171.50 ,$214.40 ,$85.76 ,$85.76 ,$87.48 ,$257.25 ,$205.80 ,$205.80 ,$85.76 ,$205.80 ,$260.68 ,$260.68 ,$260.68 ,$343.00 , N/A ,$291.55 ,$214.40 ,$222.95 ,$85.76 ,$343.00 ,$192.08 ,$85.76 ,$90.21 , N/A , N/A , N/A ,$90.05 ,$274.40 ,$192.96 ,$154.69 ,$96.04 ,$308.70 ,$85.76 ,$260.68 ,$222.95 ,$222.95 ,$85.76 ,$222.95 ,$164.64 , N/A 
ST. ELIZABETH'S HOSPITAL,78000198,92526,PC DYSPHAGIA TREATMENT 30 MIN - 95,780,1 ,$343.00 ,$222.95 ,$85.76 ,$343.00 ,$214.40 ,$157.78 ,$192.08 ,$85.76 ,$96.04 ,$121.08 ,$85.76 ,$141.32 ,$85.76 ,$154.69 ,$154.69 ,$85.76 ,$107.20 ,$162.94 ,$171.50 ,$214.40 ,$85.76 ,$85.76 ,$87.48 ,$257.25 ,$205.80 ,$205.80 ,$85.76 ,$205.80 ,$260.68 ,$260.68 ,$260.68 ,$343.00 , N/A ,$291.55 ,$214.40 ,$222.95 ,$85.76 ,$343.00 ,$192.08 ,$85.76 ,$90.21 , N/A , N/A , N/A ,$90.05 ,$274.40 ,$192.96 ,$154.69 ,$96.04 ,$308.70 ,$85.76 ,$260.68 ,$222.95 ,$222.95 ,$85.76 ,$222.95 ,$164.64 , N/A 
ST. ELIZABETH'S HOSPITAL,78000199,92526,PC DYSPHAGIA TREATMENT 45 MIN - 95,780,1 ,$343.00 ,$222.95 ,$85.76 ,$343.00 ,$214.40 ,$157.78 ,$192.08 ,$85.76 ,$96.04 ,$121.08 ,$85.76 ,$141.32 ,$85.76 ,$154.69 ,$154.69 ,$85.76 ,$107.20 ,$162.94 ,$171.50 ,$214.40 ,$85.76 ,$85.76 ,$87.48 ,$257.25 ,$205.80 ,$205.80 ,$85.76 ,$205.80 ,$260.68 ,$260.68 ,$260.68 ,$343.00 , N/A ,$291.55 ,$214.40 ,$222.95 ,$85.76 ,$343.00 ,$192.08 ,$85.76 ,$90.21 , N/A , N/A , N/A ,$90.05 ,$274.40 ,$192.96 ,$154.69 ,$96.04 ,$308.70 ,$85.76 ,$260.68 ,$222.95 ,$222.95 ,$85.76 ,$222.95 ,$164.64 , N/A 
ST. ELIZABETH'S HOSPITAL,78000201,92507,HC SPEECH THERAPY TREATMENT 30 MIN - 95,780,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$165.60 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$273.60 ,$273.60 ,$273.60 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A , N/A , N/A ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$273.60 ,$234.00 ,$234.00 ,$77.53 ,$234.00 ,$172.80 , N/A 
ST. ELIZABETH'S HOSPITAL,78000202,92507,PC SPEECH THERAPY TREATMENT 45 MIN - 95,780,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$165.60 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$273.60 ,$273.60 ,$273.60 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A , N/A , N/A ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$273.60 ,$234.00 ,$234.00 ,$77.53 ,$234.00 ,$172.80 , N/A 
ST. ELIZABETH'S HOSPITAL,78000203,92507,PC SPEECH THERAPY TREATMENT 60 MIN - 95,780,1 ,$360.00 ,$234.00 ,$77.53 ,$360.00 ,$193.83 ,$165.60 ,$201.60 ,$77.53 ,$100.80 ,$127.08 ,$77.53 ,$148.32 ,$77.53 ,$162.36 ,$162.36 ,$77.53 ,$96.91 ,$147.31 ,$180.00 ,$193.83 ,$77.53 ,$77.53 ,$79.08 ,$270.00 ,$216.00 ,$216.00 ,$77.53 ,$216.00 ,$273.60 ,$273.60 ,$273.60 ,$360.00 , N/A ,$306.00 ,$193.83 ,$234.00 ,$77.53 ,$360.00 ,$201.60 ,$77.53 ,$94.68 , N/A , N/A , N/A ,$81.41 ,$288.00 ,$174.44 ,$162.36 ,$100.80 ,$324.00 ,$77.53 ,$273.60 ,$234.00 ,$234.00 ,$77.53 ,$234.00 ,$172.80 , N/A 
ST. ELIZABETH'S HOSPITAL,78000204,92521,PC EVALUATION OF SPEECH FLUENCY 30 MIN - 95,780,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$139.38 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$230.28 ,$230.28 ,$230.28 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A , N/A , N/A ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$230.28 ,$196.95 ,$196.95 ,$134.52 ,$196.95 ,$145.44 , N/A 
ST. ELIZABETH'S HOSPITAL,78000205,92521,PC EVALUATION OF SPEECH FLUENCY 45 MIN - 95,780,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$139.38 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$230.28 ,$230.28 ,$230.28 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A , N/A , N/A ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$230.28 ,$196.95 ,$196.95 ,$134.52 ,$196.95 ,$145.44 , N/A 
ST. ELIZABETH'S HOSPITAL,78000206,92521,PC EVALUATION OF SPEECH FLUENCY 60 MIN - 95,780,1 ,$303.00 ,$196.95 ,$79.69 ,$336.30 ,$336.30 ,$139.38 ,$169.68 ,$134.52 ,$84.84 ,$106.96 ,$134.52 ,$124.84 ,$134.52 ,$136.65 ,$136.65 ,$134.52 ,$168.15 ,$255.59 ,$151.50 ,$336.30 ,$134.52 ,$134.52 ,$137.21 ,$227.25 ,$181.80 ,$181.80 ,$134.52 ,$181.80 ,$230.28 ,$230.28 ,$230.28 ,$303.00 , N/A ,$257.55 ,$303.00 ,$196.95 ,$134.52 ,$303.00 ,$169.68 ,$134.52 ,$79.69 , N/A , N/A , N/A ,$141.25 ,$242.40 ,$302.67 ,$136.65 ,$84.84 ,$272.70 ,$134.52 ,$230.28 ,$196.95 ,$196.95 ,$134.52 ,$196.95 ,$145.44 , N/A 
ST. ELIZABETH'S HOSPITAL,78000207,97165,PC OT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$254.95 ,$155.48 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$256.88 ,$256.88 ,$256.88 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A , N/A , N/A ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$256.88 ,$219.70 ,$219.70 ,$101.98 ,$219.70 ,$162.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000208,97165,PC OT EVAL LOW COMPLEXITY 45 MIN - 95,780,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$254.95 ,$155.48 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$256.88 ,$256.88 ,$256.88 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A , N/A , N/A ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$256.88 ,$219.70 ,$219.70 ,$101.98 ,$219.70 ,$162.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000209,97165,PC OT EVAL LOW COMPLEXITY 60 MIN - 95,780,1 ,$338.00 ,$219.70 ,$88.89 ,$338.00 ,$254.95 ,$155.48 ,$189.28 ,$101.98 ,$94.64 ,$119.31 ,$101.98 ,$139.26 ,$101.98 ,$152.44 ,$152.44 ,$101.98 ,$127.48 ,$193.76 ,$169.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$253.50 ,$202.80 ,$202.80 ,$101.98 ,$202.80 ,$256.88 ,$256.88 ,$256.88 ,$338.00 , N/A ,$287.30 ,$254.95 ,$219.70 ,$101.98 ,$338.00 ,$189.28 ,$101.98 ,$88.89 , N/A , N/A , N/A ,$107.08 ,$270.40 ,$229.46 ,$152.44 ,$94.64 ,$304.20 ,$101.98 ,$256.88 ,$219.70 ,$219.70 ,$101.98 ,$219.70 ,$162.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000210,97166,PC OT EVAL MOD COMPLEXITY 15 MIN - 95,780,1 ,$451.00 ,$293.15 ,$101.98 ,$451.00 ,$254.95 ,$207.46 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$342.76 ,$342.76 ,$342.76 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A , N/A , N/A ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$342.76 ,$293.15 ,$293.15 ,$101.98 ,$293.15 ,$216.48 , N/A 
ST. ELIZABETH'S HOSPITAL,78000211,97166,HC OT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$451.00 ,$293.15 ,$101.98 ,$451.00 ,$254.95 ,$207.46 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$342.76 ,$342.76 ,$342.76 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A , N/A , N/A ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$342.76 ,$293.15 ,$293.15 ,$101.98 ,$293.15 ,$216.48 , N/A 
ST. ELIZABETH'S HOSPITAL,78000212,97166,PC OT EVAL MOD COMPLEXITY 60 MIN - 95,780,1 ,$451.00 ,$293.15 ,$101.98 ,$451.00 ,$254.95 ,$207.46 ,$252.56 ,$101.98 ,$126.28 ,$159.20 ,$101.98 ,$185.81 ,$101.98 ,$203.40 ,$203.40 ,$101.98 ,$127.48 ,$193.76 ,$225.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$338.25 ,$270.60 ,$270.60 ,$101.98 ,$270.60 ,$342.76 ,$342.76 ,$342.76 ,$451.00 , N/A ,$383.35 ,$254.95 ,$293.15 ,$101.98 ,$451.00 ,$252.56 ,$101.98 ,$118.61 , N/A , N/A , N/A ,$107.08 ,$360.80 ,$229.46 ,$203.40 ,$126.28 ,$405.90 ,$101.98 ,$342.76 ,$293.15 ,$293.15 ,$101.98 ,$293.15 ,$216.48 , N/A 
ST. ELIZABETH'S HOSPITAL,78000213,97167,PC OT EVAL HIGH COMPLEXITY 15 MIN - 95,780,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$258.98 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$427.88 ,$427.88 ,$427.88 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A , N/A , N/A ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$427.88 ,$365.95 ,$365.95 ,$101.98 ,$365.95 ,$270.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000214,97167,PC OT EVAL HIGH COMPLEXITY 30 MIN - 95,961,1 ,$560.00 ,$364.00 ,$101.98 ,$560.00 ,$254.95 ,$257.60 ,$313.60 ,$101.98 ,$156.80 ,$197.68 ,$101.98 ,$230.72 ,$101.98 ,$252.56 ,$252.56 ,$101.98 ,$127.48 ,$193.76 ,$280.00 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$420.00 ,$336.00 ,$336.00 ,$101.98 ,$336.00 ,$425.60 ,$425.60 ,$425.60 ,$560.00 , N/A ,$476.00 ,$254.95 ,$364.00 ,$101.98 ,$560.00 ,$313.60 ,$101.98 ,$115.83 , N/A ,$560.00 ,$541.09 ,$107.08 ,$448.00 ,$229.46 ,$252.56 ,$156.80 ,$504.00 ,$101.98 ,$425.60 , N/A , N/A ,$101.98 , N/A ,$268.80 ,$515.32 
ST. ELIZABETH'S HOSPITAL,78000215,97167,PC OT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$563.00 ,$365.95 ,$101.98 ,$563.00 ,$254.95 ,$258.98 ,$315.28 ,$101.98 ,$157.64 ,$198.74 ,$101.98 ,$231.96 ,$101.98 ,$253.91 ,$253.91 ,$101.98 ,$127.48 ,$193.76 ,$281.50 ,$254.95 ,$101.98 ,$101.98 ,$104.02 ,$422.25 ,$337.80 ,$337.80 ,$101.98 ,$337.80 ,$427.88 ,$427.88 ,$427.88 ,$563.00 , N/A ,$478.55 ,$254.95 ,$365.95 ,$101.98 ,$563.00 ,$315.28 ,$101.98 ,$148.07 , N/A , N/A , N/A ,$107.08 ,$450.40 ,$229.46 ,$253.91 ,$157.64 ,$506.70 ,$101.98 ,$427.88 ,$365.95 ,$365.95 ,$101.98 ,$365.95 ,$270.24 , N/A 
ST. ELIZABETH'S HOSPITAL,78000216,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 30 MIN - 95,780,1 ,$512.00 ,$332.80 ,$134.66 ,$571.95 ,$571.95 ,$235.52 ,$286.72 ,$228.78 ,$143.36 ,$180.74 ,$228.78 ,$210.94 ,$228.78 ,$230.91 ,$230.91 ,$228.78 ,$285.98 ,$434.68 ,$256.00 ,$571.95 ,$228.78 ,$228.78 ,$233.36 ,$384.00 ,$307.20 ,$307.20 ,$228.78 ,$307.20 ,$389.12 ,$389.12 ,$389.12 ,$512.00 , N/A ,$435.20 ,$512.00 ,$332.80 ,$228.78 ,$512.00 ,$286.72 ,$228.78 ,$134.66 , N/A , N/A , N/A ,$240.22 ,$409.60 ,$514.76 ,$230.91 ,$143.36 ,$460.80 ,$228.78 ,$389.12 ,$332.80 ,$332.80 ,$228.78 ,$332.80 ,$245.76 , N/A 
ST. ELIZABETH'S HOSPITAL,78000217,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 45 MIN - 95,780,1 ,$512.00 ,$332.80 ,$134.66 ,$571.95 ,$571.95 ,$235.52 ,$286.72 ,$228.78 ,$143.36 ,$180.74 ,$228.78 ,$210.94 ,$228.78 ,$230.91 ,$230.91 ,$228.78 ,$285.98 ,$434.68 ,$256.00 ,$571.95 ,$228.78 ,$228.78 ,$233.36 ,$384.00 ,$307.20 ,$307.20 ,$228.78 ,$307.20 ,$389.12 ,$389.12 ,$389.12 ,$512.00 , N/A ,$435.20 ,$512.00 ,$332.80 ,$228.78 ,$512.00 ,$286.72 ,$228.78 ,$134.66 , N/A , N/A , N/A ,$240.22 ,$409.60 ,$514.76 ,$230.91 ,$143.36 ,$460.80 ,$228.78 ,$389.12 ,$332.80 ,$332.80 ,$228.78 ,$332.80 ,$245.76 , N/A 
ST. ELIZABETH'S HOSPITAL,78000218,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60 MIN - 95,780,1 ,$512.00 ,$332.80 ,$134.66 ,$571.95 ,$571.95 ,$235.52 ,$286.72 ,$228.78 ,$143.36 ,$180.74 ,$228.78 ,$210.94 ,$228.78 ,$230.91 ,$230.91 ,$228.78 ,$285.98 ,$434.68 ,$256.00 ,$571.95 ,$228.78 ,$228.78 ,$233.36 ,$384.00 ,$307.20 ,$307.20 ,$228.78 ,$307.20 ,$389.12 ,$389.12 ,$389.12 ,$512.00 , N/A ,$435.20 ,$512.00 ,$332.80 ,$228.78 ,$512.00 ,$286.72 ,$228.78 ,$134.66 , N/A , N/A , N/A ,$240.22 ,$409.60 ,$514.76 ,$230.91 ,$143.36 ,$460.80 ,$228.78 ,$389.12 ,$332.80 ,$332.80 ,$228.78 ,$332.80 ,$245.76 , N/A 
ST. ELIZABETH'S HOSPITAL,80100010,90945,HC DIALYSIS PROC OTHER THAN HEMO,801,1 ,"$1,053.00 ",$684.45 ,$276.94 ,"$1,053.00 ",$896.60 ,$484.38 ,$589.68 ,$358.64 ,$294.84 ,$371.71 ,$358.64 ,$433.84 ,$358.64 ,$474.90 ,$474.90 ,$358.64 ,$474.90 ,$681.41 ,$526.50 ,$896.59 ,$358.64 ,$358.64 ,$365.81 ,$789.75 ,$631.80 ,$631.80 ,$358.64 ,$631.80 ,$800.28 ,$800.28 ,$800.28 ,"$1,053.00 ", N/A ,$895.05 ,$896.59 ,$684.45 ,$358.64 ,"$1,053.00 ",$589.68 ,$358.64 ,$276.94 , N/A ,$993.55 ,$948.39 ,$376.57 ,$842.40 ,$806.93 ,$474.90 ,$294.84 ,$947.70 ,$358.64 ,$800.28 ,$684.45 ,$684.45 ,$358.64 ,$684.45 ,$505.44 ,$903.23 
ST. ELIZABETH'S HOSPITAL,80100011,G0257,HC HEMODIALYSIS INPATIENT,801,1 ,"$3,473.00 ","$2,257.45 ",$645.71 ,"$3,473.00 ","$1,614.28 ","$1,597.58 ","$1,944.88 ",$645.71 ,$972.44 ,"$1,173.87 ",$645.71 ,"$1,351.00 ",$645.71 ,"$1,566.32 ","$1,566.32 ",$645.71 ,"$1,566.32 ","$1,226.85 ","$1,736.50 ","$1,614.28 ",$645.71 ,$645.71 ,$658.63 ,"$2,604.75 ","$2,083.80 ","$2,083.80 ",$645.71 ,"$2,083.80 ","$2,639.48 ","$2,639.48 ","$2,639.48 ","$3,473.00 ", N/A ,"$2,952.05 ","$1,614.28 ","$2,257.45 ",$645.71 ,"$3,473.00 ","$1,944.88 ",$645.71 ,$913.40 , N/A ,"$1,000.27 ",$954.81 ,$678.00 ,"$2,778.40 ","$1,452.85 ","$1,566.32 ",$972.44 ,"$3,125.70 ",$645.71 ,"$2,639.48 ","$2,257.45 ","$2,257.45 ",$645.71 ,"$2,257.45 ","$1,667.04 ",$909.34 
ST. ELIZABETH'S HOSPITAL,82900001,G0257,HC HEMODIALYSIS OUTPATIENT,829,1 ,"$3,473.00 ","$2,257.45 ",$645.71 ,"$3,473.00 ","$1,614.28 ","$1,597.58 ","$1,944.88 ",$645.71 ,$972.44 ,"$1,173.87 ",$645.71 ,"$1,351.00 ",$645.71 ,"$1,566.32 ","$1,566.32 ",$645.71 ,"$1,566.32 ","$1,226.85 ","$1,736.50 ","$1,614.28 ",$645.71 ,$645.71 ,$658.63 ,"$2,604.75 ","$2,083.80 ","$2,083.80 ",$645.71 ,"$2,083.80 ","$2,639.48 ","$2,639.48 ","$2,639.48 ","$3,473.00 ", N/A ,"$2,952.05 ","$1,614.28 ","$2,257.45 ",$645.71 ,"$3,473.00 ","$1,944.88 ",$645.71 ,$913.40 , N/A ,"$1,000.27 ",$954.81 ,$678.00 ,"$2,778.40 ","$1,452.85 ","$1,566.32 ",$972.44 ,"$3,125.70 ",$645.71 ,"$2,639.48 ","$1,130.00 ","$1,130.00 ",$645.71 ,"$1,130.00 ","$1,667.04 ",$909.34 
ST. ELIZABETH'S HOSPITAL,90100001,90870,HC ELECTROCONVULSIVE THERAPY,901,1 ,"$1,645.00 ","$1,069.25 ",$432.64 ,"$1,645.00 ","$1,203.10 ",$756.70 ,$921.20 ,$481.24 ,$460.60 ,$580.69 ,$481.24 ,$677.74 ,$481.24 ,$741.90 ,$741.90 ,$481.24 ,$741.90 ,$914.36 ,$822.50 ,"$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$1,233.75 ",$987.00 ,$987.00 ,$481.24 ,$987.00 ,"$1,250.20 ","$1,250.20 ","$1,250.20 ","$1,645.00 ", N/A ,"$1,398.25 ","$1,203.10 ","$1,069.25 ",$481.24 ,"$1,645.00 ",$921.20 ,$481.24 ,$432.64 ,$849.87 ,$511.17 ,$487.94 ,$505.30 ,"$1,316.00 ","$1,082.79 ",$741.90 ,$460.60 ,"$1,480.50 ",$481.24 ,"$1,250.20 ", N/A , N/A ,$481.24 , N/A ,$789.60 ,$464.70 
ST. ELIZABETH'S HOSPITAL,92000001,59020,HC TEST STRESS FETAL,920,1 ,"$1,188.00 ",$772.20 ,$40.65 ,"$1,188.00 ",$419.90 ,$546.48 ,$665.28 ,$167.96 ,$332.64 ,$401.54 ,$167.96 ,$462.13 ,$167.96 ,$535.79 ,$535.79 ,$167.96 ,$40.65 ,$319.12 ,$594.00 ,$419.89 ,$167.96 ,$167.96 ,$171.32 ,$891.00 ,$712.80 ,$712.80 ,$167.96 ,$712.80 ,$902.88 ,$902.88 ,$902.88 ,"$1,188.00 ", N/A ,"$1,009.80 ",$419.89 ,$772.20 ,$167.96 ,"$1,188.00 ",$665.28 ,$167.96 ,$312.44 , N/A , N/A , N/A ,$176.36 ,$950.40 ,$377.90 ,$535.79 ,$332.64 ,"$1,069.20 ",$167.96 ,$902.88 ,$65.00 ,$65.00 ,$167.96 ,$65.00 ,$570.24 , N/A 
ST. ELIZABETH'S HOSPITAL,92000002,59025,HC TEST NON STRESS FETAL,920,1 ,"$1,446.00 ",$939.90 ,$23.95 ,"$1,446.00 ",$419.90 ,$665.16 ,$809.76 ,$167.96 ,$404.88 ,$488.75 ,$167.96 ,$562.49 ,$167.96 ,$652.15 ,$652.15 ,$167.96 ,$23.95 ,$319.12 ,$723.00 ,$419.89 ,$167.96 ,$167.96 ,$171.32 ,"$1,084.50 ",$867.60 ,$867.60 ,$167.96 ,$867.60 ,"$1,098.96 ","$1,098.96 ","$1,098.96 ","$1,446.00 ", N/A ,"$1,229.10 ",$419.89 ,$939.90 ,$167.96 ,"$1,446.00 ",$809.76 ,$167.96 ,$380.30 , N/A , N/A , N/A ,$176.36 ,"$1,156.80 ",$377.90 ,$652.15 ,$404.88 ,"$1,301.40 ",$167.96 ,"$1,098.96 ",$65.00 ,$65.00 ,$167.96 ,$65.00 ,$694.08 , N/A 
ST. ELIZABETH'S HOSPITAL,92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$3,355.00 ","$2,180.75 ",$145.80 ,"$3,355.00 ",$567.13 ,"$1,543.30 ","$1,878.80 ",$226.85 ,$939.40 ,"$1,184.32 ",$226.85 ,"$1,382.26 ",$226.85 ,"$1,513.11 ","$1,513.11 ",$226.85 ,$188.89 ,$431.02 ,$435.16 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$2,516.25 ","$2,013.00 ","$2,013.00 ",$226.85 ,"$2,013.00 ","$2,549.80 ","$2,549.80 ","$2,549.80 ","$3,355.00 ", N/A ,"$2,851.75 ",$567.13 ,"$2,180.75 ",$226.85 ,"$3,355.00 ","$1,878.80 ",$226.85 ,$882.37 , N/A ,$160.38 ,$153.09 ,$238.19 ,"$2,684.00 ",$510.41 ,"$1,513.11 ",$939.40 ,"$3,019.50 ",$226.85 ,"$2,549.80 ","$2,180.75 ","$2,180.75 ",$226.85 ,"$2,180.75 ","$1,610.40 ",$145.80 
ST. ELIZABETH'S HOSPITAL,92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,"$2,138.00 ","$1,389.70 ",$107.33 ,"$2,138.00 ",$268.33 ,$983.48 ,"$1,197.28 ",$107.33 ,$598.64 ,$754.71 ,$107.33 ,$880.86 ,$107.33 ,$964.24 ,$964.24 ,$107.33 ,$124.90 ,$203.93 ,$279.59 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,"$1,603.50 ","$1,282.80 ","$1,282.80 ",$107.33 ,"$1,282.80 ","$1,624.88 ","$1,624.88 ","$1,624.88 ","$2,138.00 ", N/A ,"$1,817.30 ",$268.33 ,"$1,389.70 ",$107.33 ,"$2,138.00 ","$1,197.28 ",$107.33 ,$562.29 , N/A ,$160.38 ,$153.09 ,$112.70 ,"$1,710.40 ",$241.50 ,$964.24 ,$598.64 ,"$1,924.20 ",$107.33 ,"$1,624.88 ","$1,389.70 ","$1,389.70 ",$107.33 ,"$1,389.70 ","$1,026.24 ",$145.80 
ST. ELIZABETH'S HOSPITAL,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,"$1,065.00 ",$692.25 ,$85.48 ,"$1,065.00 ",$277.93 ,$489.90 ,$596.40 ,$111.17 ,$298.20 ,$375.95 ,$111.17 ,$438.78 ,$111.17 ,$480.32 ,$480.32 ,$111.17 ,$85.48 ,$211.22 ,$198.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$798.75 ,$639.00 ,$639.00 ,$111.17 ,$639.00 ,$809.40 ,$809.40 ,$809.40 ,"$1,065.00 ", N/A ,$905.25 ,$277.92 ,$692.25 ,$111.17 ,"$1,065.00 ",$596.40 ,$111.17 ,$280.10 , N/A ,$149.55 ,$142.75 ,$116.73 ,$852.00 ,$250.12 ,$480.32 ,$298.20 ,$958.50 ,$111.17 ,$809.40 ,$692.25 ,$692.25 ,$111.17 ,$692.25 ,$511.20 ,$135.95 
ST. ELIZABETH'S HOSPITAL,92100011,93922,HC TCPO2 UNLIATERAL 1-2 LEVEL - 93922-52,921,1 ,"$1,065.00 ",$692.25 ,$55.58 ,"$1,065.00 ",$138.95 ,$489.90 ,$596.40 ,$55.58 ,$298.20 ,$375.95 ,$55.58 ,$438.78 ,$55.58 ,$480.32 ,$480.32 ,$55.58 ,$85.48 ,$105.61 ,$198.50 ,$138.96 ,$55.58 ,$55.58 ,$56.69 ,$798.75 ,$639.00 ,$639.00 ,$55.58 ,$639.00 ,$809.40 ,$809.40 ,$809.40 ,"$1,065.00 ", N/A ,$905.25 ,$138.96 ,$692.25 ,$55.58 ,"$1,065.00 ",$596.40 ,$55.58 ,$280.10 , N/A ,$74.78 ,$71.38 ,$58.36 ,$852.00 ,$125.06 ,$480.32 ,$298.20 ,$958.50 ,$55.58 ,$809.40 ,$692.25 ,$692.25 ,$55.58 ,$692.25 ,$511.20 ,$67.98 
ST. ELIZABETH'S HOSPITAL,92100023,93923,HC TCPO2/ABI/PPG MULT LEVELS,921,1 ,"$1,533.00 ",$996.45 ,$130.61 ,"$1,533.00 ",$344.13 ,$705.18 ,$858.48 ,$137.65 ,$429.24 ,$541.15 ,$137.65 ,$631.60 ,$137.65 ,$691.38 ,$691.38 ,$137.65 ,$130.61 ,$261.53 ,$300.66 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,"$1,149.75 ",$919.80 ,$919.80 ,$137.65 ,$919.80 ,"$1,165.08 ","$1,165.08 ","$1,165.08 ","$1,533.00 ", N/A ,"$1,303.05 ",$344.11 ,$996.45 ,$137.65 ,"$1,533.00 ",$858.48 ,$137.65 ,$403.18 , N/A ,$149.55 ,$142.75 ,$144.53 ,"$1,226.40 ",$309.70 ,$691.38 ,$429.24 ,"$1,379.70 ",$137.65 ,"$1,165.08 ",$996.45 ,$996.45 ,$137.65 ,$996.45 ,$735.84 ,$135.95 
ST. ELIZABETH'S HOSPITAL,92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,533.00 ",$996.45 ,$130.61 ,"$1,533.00 ",$344.13 ,$705.18 ,$858.48 ,$137.65 ,$429.24 ,$541.15 ,$137.65 ,$631.60 ,$137.65 ,$691.38 ,$691.38 ,$137.65 ,$130.61 ,$261.53 ,$300.66 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,"$1,149.75 ",$919.80 ,$919.80 ,$137.65 ,$919.80 ,"$1,165.08 ","$1,165.08 ","$1,165.08 ","$1,533.00 ", N/A ,"$1,303.05 ",$344.11 ,$996.45 ,$137.65 ,"$1,533.00 ",$858.48 ,$137.65 ,$403.18 , N/A ,$149.55 ,$142.75 ,$144.53 ,"$1,226.40 ",$309.70 ,$691.38 ,$429.24 ,"$1,379.70 ",$137.65 ,"$1,165.08 ",$996.45 ,$996.45 ,$137.65 ,$996.45 ,$735.84 ,$135.95 
ST. ELIZABETH'S HOSPITAL,92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,"$1,533.00 ",$996.45 ,$130.61 ,"$1,533.00 ",$344.13 ,$705.18 ,$858.48 ,$137.65 ,$429.24 ,$541.15 ,$137.65 ,$631.60 ,$137.65 ,$691.38 ,$691.38 ,$137.65 ,$130.61 ,$261.53 ,$300.66 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,"$1,149.75 ",$919.80 ,$919.80 ,$137.65 ,$919.80 ,"$1,165.08 ","$1,165.08 ","$1,165.08 ","$1,533.00 ", N/A ,"$1,303.05 ",$344.11 ,$996.45 ,$137.65 ,"$1,533.00 ",$858.48 ,$137.65 ,$403.18 , N/A ,$149.55 ,$142.75 ,$144.53 ,"$1,226.40 ",$309.70 ,$691.38 ,$429.24 ,"$1,379.70 ",$137.65 ,"$1,165.08 ",$996.45 ,$996.45 ,$137.65 ,$996.45 ,$735.84 ,$135.95 
ST. ELIZABETH'S HOSPITAL,92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$1,789.00 ","$1,162.85 ",$191.91 ,"$1,789.00 ",$567.13 ,$822.94 ,"$1,001.84 ",$226.85 ,$500.92 ,$631.52 ,$226.85 ,$737.07 ,$226.85 ,$806.84 ,$806.84 ,$226.85 ,$252.66 ,$431.02 ,$585.02 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,341.75 ","$1,073.40 ","$1,073.40 ",$226.85 ,"$1,073.40 ","$1,359.64 ","$1,359.64 ","$1,359.64 ","$1,789.00 ", N/A ,"$1,520.65 ",$567.13 ,"$1,162.85 ",$226.85 ,"$1,789.00 ","$1,001.84 ",$226.85 ,$470.51 , N/A ,$211.10 ,$201.51 ,$238.19 ,"$1,431.20 ",$510.41 ,$806.84 ,$500.92 ,"$1,610.10 ",$226.85 ,"$1,359.64 ","$1,162.85 ","$1,162.85 ",$226.85 ,"$1,162.85 ",$858.72 ,$191.91 
ST. ELIZABETH'S HOSPITAL,92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,"$1,222.00 ",$794.30 ,$107.33 ,"$1,222.00 ",$268.33 ,$562.12 ,$684.32 ,$107.33 ,$342.16 ,$431.37 ,$107.33 ,$503.46 ,$107.33 ,$551.12 ,$551.12 ,$107.33 ,$148.54 ,$203.93 ,$340.73 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$916.50 ,$733.20 ,$733.20 ,$107.33 ,$733.20 ,$928.72 ,$928.72 ,$928.72 ,"$1,222.00 ", N/A ,"$1,038.70 ",$268.33 ,$794.30 ,$107.33 ,"$1,222.00 ",$684.32 ,$107.33 ,$321.39 , N/A ,$211.10 ,$201.51 ,$112.70 ,$977.60 ,$241.50 ,$551.12 ,$342.16 ,"$1,099.80 ",$107.33 ,$928.72 ,$794.30 ,$794.30 ,$107.33 ,$794.30 ,$586.56 ,$191.91 
ST. ELIZABETH'S HOSPITAL,92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$1,754.00 ","$1,140.10 ",$145.80 ,"$1,754.00 ",$567.13 ,$806.84 ,$982.24 ,$226.85 ,$491.12 ,$619.16 ,$226.85 ,$722.65 ,$226.85 ,$791.05 ,$791.05 ,$226.85 ,$196.03 ,$431.02 ,$447.56 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,315.50 ","$1,052.40 ","$1,052.40 ",$226.85 ,"$1,052.40 ","$1,333.04 ","$1,333.04 ","$1,333.04 ","$1,754.00 ", N/A ,"$1,490.90 ",$567.13 ,"$1,140.10 ",$226.85 ,"$1,754.00 ",$982.24 ,$226.85 ,$461.30 , N/A ,$160.38 ,$153.09 ,$238.19 ,"$1,403.20 ",$510.41 ,$791.05 ,$491.12 ,"$1,578.60 ",$226.85 ,"$1,333.04 ","$1,140.10 ","$1,140.10 ",$226.85 ,"$1,140.10 ",$841.92 ,$145.80 
ST. ELIZABETH'S HOSPITAL,92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,"$1,184.00 ",$769.60 ,$107.33 ,"$1,184.00 ",$268.33 ,$544.64 ,$663.04 ,$107.33 ,$331.52 ,$417.95 ,$107.33 ,$487.81 ,$107.33 ,$533.98 ,$533.98 ,$107.33 ,$124.50 ,$203.93 ,$279.59 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$888.00 ,$710.40 ,$710.40 ,$107.33 ,$710.40 ,$899.84 ,$899.84 ,$899.84 ,"$1,184.00 ", N/A ,"$1,006.40 ",$268.33 ,$769.60 ,$107.33 ,"$1,184.00 ",$663.04 ,$107.33 ,$311.39 , N/A ,$160.38 ,$153.09 ,$112.70 ,$947.20 ,$241.50 ,$533.98 ,$331.52 ,"$1,065.60 ",$107.33 ,$899.84 ,$769.60 ,$769.60 ,$107.33 ,$769.60 ,$568.32 ,$145.80 
ST. ELIZABETH'S HOSPITAL,92100039,93931,HC DUPLEX ARTRL UPR EXT PSEUD ONLY,921,1 ,"$1,184.00 ",$769.60 ,$107.33 ,"$1,184.00 ",$268.33 ,$544.64 ,$663.04 ,$107.33 ,$331.52 ,$417.95 ,$107.33 ,$487.81 ,$107.33 ,$533.98 ,$533.98 ,$107.33 ,$124.50 ,$203.93 ,$279.59 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$888.00 ,$710.40 ,$710.40 ,$107.33 ,$710.40 ,$899.84 ,$899.84 ,$899.84 ,"$1,184.00 ", N/A ,"$1,006.40 ",$268.33 ,$769.60 ,$107.33 ,"$1,184.00 ",$663.04 ,$107.33 ,$311.39 , N/A ,$160.38 ,$153.09 ,$112.70 ,$947.20 ,$241.50 ,$533.98 ,$331.52 ,"$1,065.60 ",$107.33 ,$899.84 ,$769.60 ,$769.60 ,$107.33 ,$769.60 ,$568.32 ,$145.80 
ST. ELIZABETH'S HOSPITAL,92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$1,884.00 ","$1,224.60 ",$190.93 ,"$1,884.00 ",$567.13 ,$866.64 ,"$1,055.04 ",$226.85 ,$527.52 ,$665.05 ,$226.85 ,$776.21 ,$226.85 ,$849.68 ,$849.68 ,$226.85 ,$190.93 ,$431.02 ,$433.26 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,"$1,413.00 ","$1,130.40 ","$1,130.40 ",$226.85 ,"$1,130.40 ","$1,431.84 ","$1,431.84 ","$1,431.84 ","$1,884.00 ", N/A ,"$1,601.40 ",$567.13 ,"$1,224.60 ",$226.85 ,"$1,884.00 ","$1,055.04 ",$226.85 ,$495.49 , N/A ,$211.10 ,$201.51 ,$238.19 ,"$1,507.20 ",$510.41 ,$849.68 ,$527.52 ,"$1,695.60 ",$226.85 ,"$1,431.84 ","$1,224.60 ","$1,224.60 ",$226.85 ,"$1,224.60 ",$904.32 ,$191.91 
ST. ELIZABETH'S HOSPITAL,92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,"$1,319.00 ",$857.35 ,$107.33 ,"$1,319.00 ",$268.33 ,$606.74 ,$738.64 ,$107.33 ,$369.32 ,$465.61 ,$107.33 ,$543.43 ,$107.33 ,$594.87 ,$594.87 ,$107.33 ,$121.24 ,$203.93 ,$265.28 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$989.25 ,$791.40 ,$791.40 ,$107.33 ,$791.40 ,"$1,002.44 ","$1,002.44 ","$1,002.44 ","$1,319.00 ", N/A ,"$1,121.15 ",$268.33 ,$857.35 ,$107.33 ,"$1,319.00 ",$738.64 ,$107.33 ,$346.90 , N/A ,$211.10 ,$201.51 ,$112.70 ,"$1,055.20 ",$241.50 ,$594.87 ,$369.32 ,"$1,187.10 ",$107.33 ,"$1,002.44 ",$857.35 ,$857.35 ,$107.33 ,$857.35 ,$633.12 ,$191.91 
ST. ELIZABETH'S HOSPITAL,92100046,93990,HC DUPLEX HEMODIALYSIS ACCESS,921,1 ,$936.00 ,$608.40 ,$107.33 ,$936.00 ,$268.33 ,$430.56 ,$524.16 ,$107.33 ,$262.08 ,$330.41 ,$107.33 ,$385.63 ,$107.33 ,$422.14 ,$422.14 ,$107.33 ,$153.03 ,$203.93 ,$355.04 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$702.00 ,$561.60 ,$561.60 ,$107.33 ,$561.60 ,$711.36 ,$711.36 ,$711.36 ,$936.00 , N/A ,$795.60 ,$268.33 ,$608.40 ,$107.33 ,$936.00 ,$524.16 ,$107.33 ,$246.17 , N/A ,$160.38 ,$153.09 ,$112.70 ,$748.80 ,$241.50 ,$422.14 ,$262.08 ,$842.40 ,$107.33 ,$711.36 ,$608.40 ,$608.40 ,$107.33 ,$608.40 ,$449.28 ,$145.80 
ST. ELIZABETH'S HOSPITAL,92100049,93923,HC RESTING ARTERIAL EXTREMITY COMP -52,921,1 ,"$1,533.00 ",$996.45 ,$67.98 ,"$1,533.00 ",$172.05 ,$705.18 ,$858.48 ,$68.82 ,$429.24 ,$541.15 ,$68.82 ,$631.60 ,$68.82 ,$691.38 ,$691.38 ,$68.82 ,$130.61 ,$130.76 ,$300.66 ,$172.06 ,$68.82 ,$68.82 ,$70.20 ,"$1,149.75 ",$919.80 ,$919.80 ,$68.82 ,$919.80 ,"$1,165.08 ","$1,165.08 ","$1,165.08 ","$1,533.00 ", N/A ,"$1,303.05 ",$172.06 ,$996.45 ,$68.82 ,"$1,533.00 ",$858.48 ,$68.82 ,$403.18 , N/A ,$74.78 ,$71.38 ,$72.26 ,"$1,226.40 ",$154.85 ,$691.38 ,$429.24 ,"$1,379.70 ",$68.82 ,"$1,165.08 ",$996.45 ,$996.45 ,$68.82 ,$996.45 ,$735.84 ,$67.98 
ST. ELIZABETH'S HOSPITAL,92100053,93985,HC DUPLEX SCAN ARTERIAL/VENOUS HEMO ACCESS COMPL BILATERAL STUDY,921,1 ,$670.62 ,$435.90 ,$145.80 ,$670.62 ,$567.13 ,$308.49 ,$375.55 ,$226.85 ,$187.77 ,$226.67 ,$226.85 ,$260.87 ,$226.85 ,$302.45 ,$302.45 ,$226.85 ,$263.26 ,$431.02 ,$335.31 ,$567.13 ,$226.85 ,$226.85 ,$231.39 ,$502.97 ,$402.37 ,$402.37 ,$226.85 ,$402.37 ,$509.67 ,$509.67 ,$509.67 ,$670.62 , N/A ,$570.03 ,$567.13 ,$435.90 ,$226.85 ,$670.62 ,$375.55 ,$226.85 ,$176.37 , N/A ,$160.38 ,$153.09 ,$238.19 ,$536.50 ,$510.41 ,$302.45 ,$187.77 ,$603.56 ,$226.85 ,$509.67 ,$435.90 ,$435.90 ,$226.85 ,$435.90 ,$321.90 ,$145.80 
ST. ELIZABETH'S HOSPITAL,92100054,93986,HC DUPLEX SCAN ARTERIAL/VENOUS HEMO ACCESS COMPL UNILATERAL STUDY,921,1 ,$321.00 ,$208.65 ,$84.42 ,$321.00 ,$268.33 ,$147.66 ,$179.76 ,$107.33 ,$89.88 ,$108.50 ,$107.33 ,$124.87 ,$107.33 ,$144.77 ,$144.77 ,$107.33 ,$154.65 ,$203.93 ,$160.50 ,$268.33 ,$107.33 ,$107.33 ,$109.48 ,$240.75 ,$192.60 ,$192.60 ,$107.33 ,$192.60 ,$243.96 ,$243.96 ,$243.96 ,$321.00 , N/A ,$272.85 ,$268.33 ,$208.65 ,$107.33 ,$321.00 ,$179.76 ,$107.33 ,$84.42 , N/A ,$160.38 ,$153.09 ,$112.70 ,$256.80 ,$241.50 ,$144.77 ,$89.88 ,$288.90 ,$107.33 ,$243.96 ,$208.65 ,$208.65 ,$107.33 ,$208.65 ,$154.08 ,$145.80 
ST. ELIZABETH'S HOSPITAL,92200000,95860,HC EMG ONE EXTREMITY,922,1 ,"$1,642.00 ","$1,067.30 ",$77.74 ,"$1,642.00 ",$277.93 ,$755.32 ,$919.52 ,$111.17 ,$459.76 ,$579.63 ,$111.17 ,$676.50 ,$111.17 ,$740.54 ,$740.54 ,$111.17 ,$77.74 ,$211.22 ,$821.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,"$1,231.50 ",$985.20 ,$985.20 ,$111.17 ,$985.20 ,"$1,247.92 ","$1,247.92 ","$1,247.92 ","$1,642.00 ", N/A ,"$1,395.70 ",$277.92 ,"$1,067.30 ",$111.17 ,"$1,642.00 ",$919.52 ,$111.17 ,$431.85 , N/A ,$346.21 ,$330.48 ,$116.73 ,"$1,313.60 ",$250.12 ,$740.54 ,$459.76 ,"$1,477.80 ",$111.17 ,"$1,247.92 ","$1,067.30 ","$1,067.30 ",$111.17 ,"$1,067.30 ",$788.16 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200001,95861,HC EMG TWO EXTREMITIES,922,1 ,"$1,450.00 ",$942.50 ,$102.59 ,"$1,450.00 ",$277.93 ,$667.00 ,$812.00 ,$111.17 ,$406.00 ,$511.85 ,$111.17 ,$597.40 ,$111.17 ,$653.95 ,$653.95 ,$111.17 ,$102.59 ,$211.22 ,$725.00 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,"$1,087.50 ",$870.00 ,$870.00 ,$111.17 ,$870.00 ,"$1,102.00 ","$1,102.00 ","$1,102.00 ","$1,450.00 ", N/A ,"$1,232.50 ",$277.92 ,$942.50 ,$111.17 ,"$1,450.00 ",$812.00 ,$111.17 ,$381.35 , N/A ,$346.21 ,$330.48 ,$116.73 ,"$1,160.00 ",$250.12 ,$653.95 ,$406.00 ,"$1,305.00 ",$111.17 ,"$1,102.00 ",$942.50 ,$942.50 ,$111.17 ,$942.50 ,$696.00 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200002,95863,HC EMG THREE EXTREMITIES,922,1 ,"$3,403.00 ","$2,211.95 ",$137.65 ,"$3,403.00 ",$344.13 ,"$1,565.38 ","$1,905.68 ",$137.65 ,$952.84 ,"$1,201.26 ",$137.65 ,"$1,317.38 ",$137.65 ,"$1,534.75 ","$1,534.75 ",$137.65 ,$142.94 ,$261.53 ,"$1,701.50 ",$344.11 ,$137.65 ,$137.65 ,$140.40 ,"$2,552.25 ","$2,041.80 ","$2,041.80 ",$137.65 ,"$2,041.80 ","$2,586.28 ","$2,586.28 ","$2,586.28 ","$3,403.00 ", N/A ,"$2,892.55 ",$344.11 ,"$2,211.95 ",$137.65 ,"$3,403.00 ","$1,905.68 ",$137.65 ,$894.99 , N/A ,$346.21 ,$330.48 ,$144.53 ,"$2,722.40 ",$309.70 ,"$1,534.75 ",$952.84 ,"$3,062.70 ",$137.65 ,"$2,586.28 ","$2,211.95 ","$2,211.95 ",$137.65 ,"$2,211.95 ","$1,633.44 ",$314.74 
ST. ELIZABETH'S HOSPITAL,92200008,95925,HC SSEP UPPER LIMBS,922,1 ,"$1,501.00 ",$975.65 ,$190.73 ,"$1,501.00 ",$652.30 ,$690.46 ,$840.56 ,$260.92 ,$420.28 ,$529.85 ,$260.92 ,$618.41 ,$260.92 ,$676.95 ,$676.95 ,$260.92 ,$190.73 ,$495.74 ,$750.50 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,"$1,125.75 ",$900.60 ,$900.60 ,$260.92 ,$900.60 ,"$1,140.76 ","$1,140.76 ","$1,140.76 ","$1,501.00 ", N/A ,"$1,275.85 ",$652.29 ,$975.65 ,$260.92 ,"$1,501.00 ",$840.56 ,$260.92 ,$394.76 , N/A ,$346.21 ,$330.48 ,$273.97 ,"$1,200.80 ",$587.06 ,$676.95 ,$420.28 ,"$1,350.90 ",$260.92 ,"$1,140.76 ",$975.65 ,$975.65 ,$260.92 ,$975.65 ,$720.48 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200009,95926,HC SSEP LOWER LIMBS,922,1 ,"$1,520.00 ",$988.00 ,$161.80 ,"$1,520.00 ",$652.30 ,$699.20 ,$851.20 ,$260.92 ,$425.60 ,$536.56 ,$260.92 ,$626.24 ,$260.92 ,$685.52 ,$685.52 ,$260.92 ,$161.80 ,$495.74 ,$760.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,"$1,140.00 ",$912.00 ,$912.00 ,$260.92 ,$912.00 ,"$1,155.20 ","$1,155.20 ","$1,155.20 ","$1,520.00 ", N/A ,"$1,292.00 ",$652.29 ,$988.00 ,$260.92 ,"$1,520.00 ",$851.20 ,$260.92 ,$399.76 , N/A ,$346.21 ,$330.48 ,$273.97 ,"$1,216.00 ",$587.06 ,$685.52 ,$425.60 ,"$1,368.00 ",$260.92 ,"$1,155.20 ",$988.00 ,$988.00 ,$260.92 ,$988.00 ,$729.60 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200011,95886,HC EMG ADD ON >5 MUSCLES,922,1 ,"$1,245.00 ",$809.25 ,$67.24 ,"$1,245.00 ", N/A ,$572.70 ,$697.20 , N/A ,$348.60 ,$420.81 , N/A ,$484.31 , N/A ,$561.50 ,$561.50 , N/A ,$67.24 , N/A ,$622.50 , N/A , N/A , N/A , N/A ,$933.75 ,$747.00 ,$747.00 , N/A ,$747.00 ,$946.20 ,$946.20 ,$946.20 ,"$1,245.00 ", N/A ,"$1,058.25 ", N/A ,$809.25 , N/A ,"$1,245.00 ",$697.20 , N/A ,$327.44 , N/A ,$346.21 ,$330.48 , N/A ,$996.00 , N/A ,$561.50 ,$348.60 ,"$1,120.50 ", N/A ,$946.20 ,$809.25 ,$809.25 , N/A ,$809.25 ,$597.60 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200012,95864,HC EMG 4 EXTREMITIES,922,1 ,"$4,373.00 ","$2,842.45 ",$137.65 ,"$4,373.00 ",$344.13 ,"$2,011.58 ","$2,448.88 ",$137.65 ,"$1,224.44 ","$1,528.86 ",$137.65 ,"$1,528.86 ",$137.65 ,"$1,972.22 ","$1,972.22 ",$137.65 ,$165.34 ,$261.53 ,"$2,186.50 ",$344.11 ,$137.65 ,$137.65 ,$140.40 ,"$3,279.75 ","$2,623.80 ","$2,623.80 ",$137.65 ,"$2,623.80 ","$3,323.48 ","$3,323.48 ","$3,323.48 ","$4,373.00 ", N/A ,"$3,717.05 ",$344.11 ,"$2,842.45 ",$137.65 ,"$4,373.00 ","$2,448.88 ",$137.65 ,"$1,150.10 ", N/A ,$346.21 ,$330.48 ,$144.53 ,"$3,498.40 ",$309.70 ,"$1,972.22 ","$1,224.44 ","$3,935.70 ",$137.65 ,"$3,323.48 ","$2,842.45 ","$2,842.45 ",$137.65 ,"$2,842.45 ","$2,099.04 ",$314.74 
ST. ELIZABETH'S HOSPITAL,92200015,95938,HC SSEP UPPER AND LOWER,922,1 ,"$1,741.00 ","$1,131.65 ",$314.74 ,"$1,741.00 ","$1,203.10 ",$800.86 ,$974.96 ,$481.24 ,$487.48 ,$588.46 ,$481.24 ,$677.25 ,$481.24 ,$785.19 ,$785.19 ,$481.24 ,$386.33 ,$914.36 ,$870.50 ,"$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$1,305.75 ","$1,044.60 ","$1,044.60 ",$481.24 ,"$1,044.60 ","$1,323.16 ","$1,323.16 ","$1,323.16 ","$1,741.00 ", N/A ,"$1,479.85 ","$1,203.10 ","$1,131.65 ",$481.24 ,"$1,741.00 ",$974.96 ,$481.24 ,$457.88 , N/A ,$346.21 ,$330.48 ,$505.30 ,"$1,392.80 ","$1,082.79 ",$785.19 ,$487.48 ,"$1,566.90 ",$481.24 ,"$1,323.16 ","$1,131.65 ","$1,131.65 ",$481.24 ,"$1,131.65 ",$835.68 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200016,95885,HC EMG ADD ON <5 MUSCLES,922,1 ,"$1,051.00 ",$683.15 ,$56.24 ,"$1,051.00 ", N/A ,$483.46 ,$588.56 , N/A ,$294.28 ,$355.24 , N/A ,$408.84 , N/A ,$474.00 ,$474.00 , N/A ,$56.24 , N/A ,$525.50 , N/A , N/A , N/A , N/A ,$788.25 ,$630.60 ,$630.60 , N/A ,$630.60 ,$798.76 ,$798.76 ,$798.76 ,"$1,051.00 ", N/A ,$893.35 , N/A ,$683.15 , N/A ,"$1,051.00 ",$588.56 , N/A ,$276.41 , N/A ,$346.21 ,$330.48 , N/A ,$840.80 , N/A ,$474.00 ,$294.28 ,$945.90 , N/A ,$798.76 ,$683.15 ,$683.15 , N/A ,$683.15 ,$504.48 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200017,95887,HC EMG ADD ON CRANIAL,922,1 ,"$1,051.00 ",$683.15 ,$59.90 ,"$1,051.00 ", N/A ,$483.46 ,$588.56 , N/A ,$294.28 ,$355.24 , N/A ,$408.84 , N/A ,$474.00 ,$474.00 , N/A ,$59.90 , N/A ,$525.50 , N/A , N/A , N/A , N/A ,$788.25 ,$630.60 ,$630.60 , N/A ,$630.60 ,$798.76 ,$798.76 ,$798.76 ,"$1,051.00 ", N/A ,$893.35 , N/A ,$683.15 , N/A ,"$1,051.00 ",$588.56 , N/A ,$276.41 , N/A ,$346.21 ,$330.48 , N/A ,$840.80 , N/A ,$474.00 ,$294.28 ,$945.90 , N/A ,$798.76 ,$683.15 ,$683.15 , N/A ,$683.15 ,$504.48 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200021,95907,HC NVR CNDJ TST 1-2 STUDIES,922,1 ,$752.00 ,$488.80 ,$47.99 ,$752.00 ,$344.13 ,$345.92 ,$421.12 ,$137.65 ,$210.56 ,$254.18 ,$137.65 ,$292.53 ,$137.65 ,$339.15 ,$339.15 ,$137.65 ,$47.99 ,$261.53 ,$376.00 ,$344.11 ,$137.65 ,$137.65 ,$140.40 ,$564.00 ,$451.20 ,$451.20 ,$137.65 ,$451.20 ,$571.52 ,$571.52 ,$571.52 ,$752.00 , N/A ,$639.20 ,$344.11 ,$488.80 ,$137.65 ,$752.00 ,$421.12 ,$137.65 ,$197.78 , N/A ,$346.21 ,$330.48 ,$144.53 ,$601.60 ,$309.70 ,$339.15 ,$210.56 ,$676.80 ,$137.65 ,$571.52 ,$488.80 ,$488.80 ,$137.65 ,$488.80 ,$360.96 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200022,95908,HC NVR CNDJ TST 3-4 STUDIES,922,1 ,"$1,504.00 ",$977.60 ,$59.40 ,"$1,504.00 ",$652.30 ,$691.84 ,$842.24 ,$260.92 ,$421.12 ,$508.35 ,$260.92 ,$585.06 ,$260.92 ,$678.30 ,$678.30 ,$260.92 ,$59.40 ,$495.74 ,$752.00 ,$652.29 ,$260.92 ,$260.92 ,$266.13 ,"$1,128.00 ",$902.40 ,$902.40 ,$260.92 ,$902.40 ,"$1,143.04 ","$1,143.04 ","$1,143.04 ","$1,504.00 ", N/A ,"$1,278.40 ",$652.29 ,$977.60 ,$260.92 ,"$1,504.00 ",$842.24 ,$260.92 ,$395.55 , N/A ,$346.21 ,$330.48 ,$273.97 ,"$1,203.20 ",$587.06 ,$678.30 ,$421.12 ,"$1,353.60 ",$260.92 ,"$1,143.04 ",$977.60 ,$977.60 ,$260.92 ,$977.60 ,$721.92 ,$314.74 
ST. ELIZABETH'S HOSPITAL,92200023,95909,HC NVR CNDJ TST 5-6 STUDIES,922,1 ,"$2,256.00 ","$1,466.40 ",$71.21 ,"$2,256.00 ",$652.30 ,"$1,037.76 ","$1,263.36 ",$260.92 ,$631.68 ,$762.53 ,$260.92 ,$877.58 ,$260.92 ,"$1,017.46 ","$1,017.46 ",$260.92 ,$71.21 ,$495.74 ,"$1,128.00 ",$652.29 ,$260.92 ,$260.92 ,$266.13 ,"$1,692.00 ","$1,353.60 ","$1,353.60 ",$260.92 ,"$1,353.60 ","$1,714.56 ","$1,714.56 ","$1,714.56 ","$2,256.00 ", N/A ,"$1,917.60 ",$652.29 ,"$1,466.40 ",$260.92 ,"$2,256.00 ","$1,263.36 ",$260.92 ,$593.33 , N/A ,$346.21 ,$330.48 ,$273.97 ,"$1,804.80 ",$587.06 ,"$1,017.46 ",$631.68 ,"$2,030.40 ",$260.92 ,"$1,714.56 ","$1,466.40 ","$1,466.40 ",$260.92 ,"$1,466.40 ","$1,082.88 ",$314.74 
ST. ELIZABETH'S HOSPITAL,92200024,95910,HC NVR CNDJ TST 7-8 STUDIES,922,1 ,"$3,008.00 ","$1,955.20 ",$90.36 ,"$3,008.00 ",$652.30 ,"$1,383.68 ","$1,684.48 ",$260.92 ,$842.24 ,"$1,016.70 ",$260.92 ,"$1,170.11 ",$260.92 ,"$1,356.61 ","$1,356.61 ",$260.92 ,$90.36 ,$495.74 ,"$1,504.00 ",$652.29 ,$260.92 ,$260.92 ,$266.13 ,"$2,256.00 ","$1,804.80 ","$1,804.80 ",$260.92 ,"$1,804.80 ","$2,286.08 ","$2,286.08 ","$2,286.08 ","$3,008.00 ", N/A ,"$2,556.80 ",$652.29 ,"$1,955.20 ",$260.92 ,"$3,008.00 ","$1,684.48 ",$260.92 ,$791.10 , N/A ,$346.21 ,$330.48 ,$273.97 ,"$2,406.40 ",$587.06 ,"$1,356.61 ",$842.24 ,"$2,707.20 ",$260.92 ,"$2,286.08 ","$1,955.20 ","$1,955.20 ",$260.92 ,"$1,955.20 ","$1,443.84 ",$314.74 
ST. ELIZABETH'S HOSPITAL,92200025,95911,HC NVR CNDJ TST 9-10 STUDIES,922,1 ,"$3,760.00 ","$2,444.00 ",$103.81 ,"$3,760.00 ","$1,203.10 ","$1,729.60 ","$2,105.60 ",$481.24 ,"$1,052.80 ","$1,270.88 ",$481.24 ,"$1,462.64 ",$481.24 ,"$1,695.76 ","$1,695.76 ",$481.24 ,$103.81 ,$914.36 ,"$1,880.00 ","$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$2,820.00 ","$2,256.00 ","$2,256.00 ",$481.24 ,"$2,256.00 ","$2,857.60 ","$2,857.60 ","$2,857.60 ","$3,760.00 ", N/A ,"$3,196.00 ","$1,203.10 ","$2,444.00 ",$481.24 ,"$3,760.00 ","$2,105.60 ",$481.24 ,$988.88 , N/A ,$346.21 ,$330.48 ,$505.30 ,"$3,008.00 ","$1,082.79 ","$1,695.76 ","$1,052.80 ","$3,384.00 ",$481.24 ,"$2,857.60 ","$2,444.00 ","$2,444.00 ",$481.24 ,"$2,444.00 ","$1,804.80 ",$314.74 
ST. ELIZABETH'S HOSPITAL,92200026,95912,HC NVR CNDJ TST 11-12 STUDIES,922,1 ,"$4,512.00 ","$2,932.80 ",$116.75 ,"$4,512.00 ","$1,203.10 ","$2,075.52 ","$2,526.72 ",$481.24 ,"$1,263.36 ","$1,525.06 ",$481.24 ,"$1,755.17 ",$481.24 ,"$2,034.91 ","$2,034.91 ",$481.24 ,$116.75 ,$914.36 ,"$2,256.00 ","$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$3,384.00 ","$2,707.20 ","$2,707.20 ",$481.24 ,"$2,707.20 ","$3,429.12 ","$3,429.12 ","$3,429.12 ","$4,512.00 ", N/A ,"$3,835.20 ","$1,203.10 ","$2,932.80 ",$481.24 ,"$4,512.00 ","$2,526.72 ",$481.24 ,"$1,186.66 ", N/A ,$346.21 ,$330.48 ,$505.30 ,"$3,609.60 ","$1,082.79 ","$2,034.91 ","$1,263.36 ","$4,060.80 ",$481.24 ,"$3,429.12 ","$2,932.80 ","$2,932.80 ",$481.24 ,"$2,932.80 ","$2,165.76 ",$314.74 
ST. ELIZABETH'S HOSPITAL,92200027,95913,HC NVR CNDJ TST 13 AND > STUDIES,922,1 ,"$5,264.00 ","$3,421.60 ",$129.39 ,"$5,264.00 ","$1,203.10 ","$2,421.44 ","$2,947.84 ",$481.24 ,"$1,473.92 ","$1,779.23 ",$481.24 ,"$2,047.70 ",$481.24 ,"$2,374.06 ","$2,374.06 ",$481.24 ,$129.39 ,$914.36 ,"$2,632.00 ","$1,203.10 ",$481.24 ,$481.24 ,$490.87 ,"$3,948.00 ","$3,158.40 ","$3,158.40 ",$481.24 ,"$3,158.40 ","$4,000.64 ","$4,000.64 ","$4,000.64 ","$5,264.00 ", N/A ,"$4,474.40 ","$1,203.10 ","$3,421.60 ",$481.24 ,"$5,264.00 ","$2,947.84 ",$481.24 ,"$1,384.43 ", N/A ,$346.21 ,$330.48 ,$505.30 ,"$4,211.20 ","$1,082.79 ","$2,374.06 ","$1,473.92 ","$4,737.60 ",$481.24 ,"$4,000.64 ","$3,421.60 ","$3,421.60 ",$481.24 ,"$3,421.60 ","$2,526.72 ",$314.74 
ST. ELIZABETH'S HOSPITAL,94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$409.00 ,$265.85 ,$84.92 ,$409.00 ,$277.93 ,$188.14 ,$229.04 ,$111.17 ,$114.52 ,$144.38 ,$111.17 ,$168.51 ,$111.17 ,$184.46 ,$184.46 ,$111.17 ,$124.83 ,$211.22 ,$204.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$306.75 ,$245.40 ,$245.40 ,$111.17 ,$245.40 ,$310.84 ,$310.84 ,$310.84 ,$409.00 , N/A ,$347.65 ,$277.92 ,$265.85 ,$111.17 ,$409.00 ,$229.04 ,$111.17 ,$107.57 , N/A ,$93.41 ,$89.17 ,$116.73 ,$327.20 ,$250.12 ,$184.46 ,$114.52 ,$368.10 ,$111.17 ,$310.84 ,$265.85 ,$265.85 ,$111.17 ,$265.85 ,$196.32 ,$84.92 
ST. ELIZABETH'S HOSPITAL,94000103,E0202,HC PHOTO THERAPY INITIATE,940,1 ,$173.00 ,$112.45 ,$34.60 ,$173.00 ,$86.50 ,$79.58 ,$96.88 ,$34.60 ,$48.44 ,$58.47 ,$34.60 ,$67.30 ,$34.60 ,$78.02 ,$78.02 ,$34.60 ,$112.45 ,$65.74 ,$86.50 ,$86.50 ,$34.60 ,$34.60 ,$35.29 ,$129.75 ,$103.80 ,$103.80 ,$34.60 ,$103.80 ,$131.48 ,$131.48 ,$131.48 ,$173.00 , N/A ,$147.05 ,$86.50 ,$112.45 ,$34.60 ,$173.00 ,$96.88 ,$34.60 ,$45.50 , N/A , N/A , N/A ,$36.33 ,$138.40 ,$77.85 ,$78.02 ,$48.44 ,$155.70 ,$34.60 ,$131.48 ,$112.45 ,$112.45 ,$34.60 ,$112.45 ,$83.04 , N/A 
ST. ELIZABETH'S HOSPITAL,94000104,96372,HC INJECTION IM/SUBQ,940,1 ,$172.00 ,$111.80 ,$17.85 ,$172.00 ,$152.80 ,$79.12 ,$96.32 ,$61.12 ,$48.16 ,$60.72 ,$61.12 ,$70.86 ,$61.12 ,$77.57 ,$77.57 ,$61.12 ,$17.85 ,$116.14 ,$86.00 ,$152.81 ,$61.12 ,$61.12 ,$62.35 ,$129.00 ,$103.20 ,$103.20 ,$61.12 ,$103.20 ,$130.72 ,$130.72 ,$130.72 ,$172.00 , N/A ,$146.20 ,$152.81 ,$111.80 ,$61.12 ,$172.00 ,$96.32 ,$61.12 ,$45.24 , N/A , N/A , N/A ,$64.18 ,$137.60 ,$137.53 ,$77.57 ,$48.16 ,$154.80 ,$61.12 ,$130.72 ,$111.80 ,$111.80 ,$61.12 ,$111.80 ,$82.56 , N/A 
ST. ELIZABETH'S HOSPITAL,94000105,96374,HC INJ IV PUSH SINGL/INITIAL,940,1 ,$392.00 ,$254.80 ,$48.34 ,$504.21 ,$504.20 ,$180.32 ,$219.52 ,$201.68 ,$109.76 ,$138.38 ,$201.68 ,$161.50 ,$201.68 ,$176.79 ,$176.79 ,$201.68 ,$48.34 ,$383.20 ,$196.00 ,$504.21 ,$201.68 ,$201.68 ,$205.72 ,$294.00 ,$235.20 ,$235.20 ,$201.68 ,$235.20 ,$297.92 ,$297.92 ,$297.92 ,$392.00 , N/A ,$333.20 ,$392.00 ,$254.80 ,$201.68 ,$392.00 ,$219.52 ,$201.68 ,$103.10 , N/A , N/A , N/A ,$211.76 ,$313.60 ,$453.79 ,$176.79 ,$109.76 ,$352.80 ,$201.68 ,$297.92 ,$254.80 ,$254.80 ,$201.68 ,$254.80 ,$188.16 , N/A 
ST. ELIZABETH'S HOSPITAL,94000110,99195,HC THERAPEUTIC PHLEBOTOMY,940,1 ,$409.00 ,$265.85 ,$84.92 ,$409.00 ,$277.93 ,$188.14 ,$229.04 ,$111.17 ,$114.52 ,$144.38 ,$111.17 ,$168.51 ,$111.17 ,$184.46 ,$184.46 ,$111.17 ,$124.83 ,$211.22 ,$204.50 ,$277.92 ,$111.17 ,$111.17 ,$113.39 ,$306.75 ,$245.40 ,$245.40 ,$111.17 ,$245.40 ,$310.84 ,$310.84 ,$310.84 ,$409.00 , N/A ,$347.65 ,$277.92 ,$265.85 ,$111.17 ,$409.00 ,$229.04 ,$111.17 ,$107.57 , N/A ,$93.41 ,$89.17 ,$116.73 ,$327.20 ,$250.12 ,$184.46 ,$114.52 ,$368.10 ,$111.17 ,$310.84 ,$265.85 ,$265.85 ,$111.17 ,$265.85 ,$196.32 ,$84.92 
ST. ELIZABETH'S HOSPITAL,94000114,20560,HC NEEDLE INSERTION W/O INJECTION 1-2 MUSCLES,940,1 ,$0.01 ,$0.01 ,$0.01 ,$60.90 ,$60.90 , N/A ,$0.01 ,$24.36 , N/A , N/A ,$24.36 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$24.36 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$24.36 , N/A , N/A ,$0.01 ,$0.01 ,$25.58 ,$0.01 ,$54.80 , N/A , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$26.47 
ST. ELIZABETH'S HOSPITAL,94000115,20561,HC NEEDLE INSERTION W/O INJECTION 3+ MUSCLES,940,1 ,$0.01 ,$0.01 ,$0.01 ,$60.90 ,$60.90 , N/A ,$0.01 ,$24.36 , N/A , N/A ,$24.36 , N/A ,$0.01 , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$24.36 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$24.36 , N/A , N/A ,$0.01 ,$0.01 ,$25.58 ,$0.01 ,$54.80 , N/A , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$26.47 
ST. ELIZABETH'S HOSPITAL,94000118,N/A,HC CASH-BASED THERAPIES GENERIC PACKAGE #1,940,1 ,$400.00 ,$260.00 ,$105.20 ,$400.00 , N/A ,$184.00 ,$224.00 , N/A ,$112.00 ,$135.20 , N/A ,$155.60 , N/A ,$180.40 ,$180.40 , N/A ,$260.00 , N/A ,$200.00 , N/A , N/A , N/A , N/A ,$300.00 ,$240.00 ,$240.00 , N/A ,$240.00 ,$304.00 ,$304.00 ,$304.00 ,$400.00 , N/A ,$340.00 , N/A ,$260.00 , N/A ,$400.00 ,$224.00 , N/A ,$105.20 , N/A , N/A , N/A , N/A ,$320.00 , N/A ,$180.40 ,$112.00 ,$360.00 , N/A ,$304.00 ,$260.00 ,$260.00 , N/A ,$260.00 ,$192.00 , N/A 
ST. ELIZABETH'S HOSPITAL,94000119,N/A,HC CASH-BASED THERAPIES GENERIC PACKAGE #2,940,1 ,$600.00 ,$390.00 ,$157.80 ,$600.00 , N/A ,$276.00 ,$336.00 , N/A ,$168.00 ,$202.80 , N/A ,$233.40 , N/A ,$270.60 ,$270.60 , N/A ,$390.00 , N/A ,$300.00 , N/A , N/A , N/A , N/A ,$450.00 ,$360.00 ,$360.00 , N/A ,$360.00 ,$456.00 ,$456.00 ,$456.00 ,$600.00 , N/A ,$510.00 , N/A ,$390.00 , N/A ,$600.00 ,$336.00 , N/A ,$157.80 , N/A , N/A , N/A , N/A ,$480.00 , N/A ,$270.60 ,$168.00 ,$540.00 , N/A ,$456.00 ,$390.00 ,$390.00 , N/A ,$390.00 ,$288.00 , N/A 
ST. ELIZABETH'S HOSPITAL,94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$335.00 ,$217.75 ,$17.63 ,$335.00 ,$286.10 ,$154.10 ,$187.60 ,$114.44 ,$93.80 ,$118.26 ,$114.44 ,$138.02 ,$114.44 ,$151.09 ,$151.09 ,$114.44 ,$17.63 ,$217.43 ,$167.50 ,$286.10 ,$114.44 ,$114.44 ,$116.73 ,$251.25 ,$201.00 ,$201.00 ,$114.44 ,$201.00 ,$254.60 ,$254.60 ,$254.60 ,$335.00 , N/A ,$284.75 ,$286.10 ,$217.75 ,$114.44 ,$335.00 ,$187.60 ,$114.44 ,$88.11 , N/A , N/A , N/A ,$120.16 ,$268.00 ,$257.49 ,$151.09 ,$93.80 ,$301.50 ,$114.44 ,$254.60 ,$335.00 ,$335.00 ,$114.44 ,$335.00 ,$160.80 , N/A 
ST. ELIZABETH'S HOSPITAL,94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$335.00 ,$217.75 ,$17.63 ,$335.00 ,$286.10 ,$154.10 ,$187.60 ,$114.44 ,$93.80 ,$118.26 ,$114.44 ,$138.02 ,$114.44 ,$151.09 ,$151.09 ,$114.44 ,$17.63 ,$217.43 ,$167.50 ,$286.10 ,$114.44 ,$114.44 ,$116.73 ,$251.25 ,$201.00 ,$201.00 ,$114.44 ,$201.00 ,$254.60 ,$254.60 ,$254.60 ,$335.00 , N/A ,$284.75 ,$286.10 ,$217.75 ,$114.44 ,$335.00 ,$187.60 ,$114.44 ,$88.11 , N/A , N/A , N/A ,$120.16 ,$268.00 ,$257.49 ,$151.09 ,$93.80 ,$301.50 ,$114.44 ,$254.60 ,$335.00 ,$335.00 ,$114.44 ,$335.00 ,$160.80 , N/A 
ST. ELIZABETH'S HOSPITAL,94300019,N/A,HC CARDIAC REHAB PHASE 3 FULL MONTH,943,1 ,$326.00 ,$211.90 ,$85.74 ,$326.00 , N/A ,$149.96 ,$182.56 , N/A ,$91.28 ,$110.19 , N/A ,$126.81 , N/A ,$147.03 ,$147.03 , N/A ,$211.90 , N/A ,$163.00 , N/A , N/A , N/A , N/A ,$244.50 ,$195.60 ,$195.60 , N/A ,$195.60 ,$247.76 ,$247.76 ,$247.76 ,$326.00 , N/A ,$277.10 , N/A ,$211.90 , N/A ,$326.00 ,$182.56 , N/A ,$85.74 , N/A , N/A , N/A , N/A ,$260.80 , N/A ,$147.03 ,$91.28 ,$293.40 , N/A ,$247.76 ,$326.00 ,$326.00 , N/A ,$326.00 ,$156.48 , N/A 
ST. ELIZABETH'S HOSPITAL,94300022,N/A,HC CARDIAC REHAB 4 EXERCISE MONTHLY,943,1 ,$33.00 ,$21.45 ,$8.68 ,$33.00 , N/A ,$15.18 ,$18.48 , N/A ,$9.24 ,$11.15 , N/A ,$12.84 , N/A ,$14.88 ,$14.88 , N/A ,$21.45 , N/A ,$16.50 , N/A , N/A , N/A , N/A ,$24.75 ,$19.80 ,$19.80 , N/A ,$19.80 ,$25.08 ,$25.08 ,$25.08 ,$33.00 , N/A ,$28.05 , N/A ,$21.45 , N/A ,$33.00 ,$18.48 , N/A ,$8.68 , N/A , N/A , N/A , N/A ,$26.40 , N/A ,$14.88 ,$9.24 ,$29.70 , N/A ,$25.08 ,$33.00 ,$33.00 , N/A ,$33.00 ,$15.84 , N/A 
ST. ELIZABETH'S HOSPITAL,94300023,N/A,HC CARDIAC REHAB 4 EXERCISE SPOUSE MONTHLY,943,1 ,$23.00 ,$14.95 ,$6.05 ,$23.00 , N/A ,$10.58 ,$12.88 , N/A ,$6.44 ,$7.77 , N/A ,$8.95 , N/A ,$10.37 ,$10.37 , N/A ,$14.95 , N/A ,$11.50 , N/A , N/A , N/A , N/A ,$17.25 ,$13.80 ,$13.80 , N/A ,$13.80 ,$17.48 ,$17.48 ,$17.48 ,$23.00 , N/A ,$19.55 , N/A ,$14.95 , N/A ,$23.00 ,$12.88 , N/A ,$6.05 , N/A , N/A , N/A , N/A ,$18.40 , N/A ,$10.37 ,$6.44 ,$20.70 , N/A ,$17.48 ,$23.00 ,$23.00 , N/A ,$23.00 ,$11.04 , N/A 
ST. ELIZABETH'S HOSPITAL,94800001,94625,HC PHY/QHP OP PULM RHB W/O MNTR,948,1 ,$164.64 ,$107.02 ,$24.88 ,$164.64 ,$137.20 ,$75.73 ,$92.20 ,$54.88 ,$46.10 ,$55.65 ,$54.88 ,$64.05 ,$54.88 ,$74.25 ,$74.25 ,$54.88 ,$24.88 ,$104.27 ,$82.32 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$123.48 ,$98.78 ,$98.78 ,$54.88 ,$98.78 ,$125.13 ,$125.13 ,$125.13 ,$164.64 , N/A ,$139.94 ,$137.20 ,$107.02 ,$54.88 ,$164.64 ,$92.20 ,$54.88 ,$43.30 , N/A , N/A , N/A ,$57.62 ,$131.71 ,$123.48 ,$74.25 ,$46.10 ,$148.18 ,$54.88 ,$125.13 ,$164.64 ,$164.64 ,$54.88 ,$164.64 ,$79.03 , N/A 
ST. ELIZABETH'S HOSPITAL,94800002,94626,HC PHY/QHP OP PULM RHB W/MNTR,948,1 ,$164.64 ,$107.02 ,$34.84 ,$164.64 ,$137.20 ,$75.73 ,$92.20 ,$54.88 ,$46.10 ,$55.65 ,$54.88 ,$64.05 ,$54.88 ,$74.25 ,$74.25 ,$54.88 ,$34.84 ,$104.27 ,$82.32 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$123.48 ,$98.78 ,$98.78 ,$54.88 ,$98.78 ,$125.13 ,$125.13 ,$125.13 ,$164.64 , N/A ,$139.94 ,$137.20 ,$107.02 ,$54.88 ,$164.64 ,$92.20 ,$54.88 ,$43.30 , N/A , N/A , N/A ,$57.62 ,$131.71 ,$123.48 ,$74.25 ,$46.10 ,$148.18 ,$54.88 ,$125.13 ,$164.64 ,$164.64 ,$54.88 ,$164.64 ,$79.03 , N/A 
ST. ELIZABETH'S HOSPITAL,96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$37.47 ,$24.36 ,$10.49 ,$37.47 , N/A ,$17.24 ,$20.98 , N/A ,$10.49 ,$12.66 , N/A ,$14.58 , N/A ,$16.90 ,$16.90 , N/A ,$24.36 , N/A ,$18.74 , N/A , N/A , N/A , N/A ,$28.10 ,$22.48 ,$22.48 , N/A ,$22.48 ,$28.48 ,$28.48 ,$28.48 ,$37.47 , N/A ,$31.85 , N/A ,$24.36 , N/A ,$37.47 ,$20.98 , N/A ,$15.49 , N/A , N/A , N/A , N/A ,$29.98 , N/A ,$16.90 ,$10.49 ,$33.72 , N/A ,$28.48 , N/A , N/A , N/A , N/A ,$17.99 , N/A 
ST. ELIZABETH'S HOSPITAL,96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$66.27 ,$43.08 ,$18.56 ,$66.27 , N/A ,$30.48 ,$37.11 , N/A ,$18.56 ,$22.40 , N/A ,$25.78 , N/A ,$29.89 ,$29.89 , N/A ,$43.08 , N/A ,$33.14 , N/A , N/A , N/A , N/A ,$49.70 ,$39.76 ,$39.76 , N/A ,$39.76 ,$50.37 ,$50.37 ,$50.37 ,$66.27 , N/A ,$56.33 , N/A ,$43.08 , N/A ,$66.27 ,$37.11 , N/A ,$27.35 , N/A , N/A , N/A , N/A ,$53.02 , N/A ,$29.89 ,$18.56 ,$59.64 , N/A ,$50.37 , N/A , N/A , N/A , N/A ,$31.81 , N/A 
ST. ELIZABETH'S HOSPITAL,96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$103.74 ,$67.43 ,$29.05 ,$103.74 , N/A ,$47.72 ,$58.09 , N/A ,$29.05 ,$35.06 , N/A ,$40.35 , N/A ,$46.79 ,$46.79 , N/A ,$67.43 , N/A ,$51.87 , N/A , N/A , N/A , N/A ,$77.81 ,$62.24 ,$62.24 , N/A ,$62.24 ,$78.84 ,$78.84 ,$78.84 ,$103.74 , N/A ,$88.18 , N/A ,$67.43 , N/A ,$103.74 ,$58.09 , N/A ,$42.42 , N/A , N/A , N/A , N/A ,$82.99 , N/A ,$46.79 ,$29.05 ,$93.37 , N/A ,$78.84 , N/A , N/A , N/A , N/A ,$49.80 , N/A 
ST. ELIZABETH'S HOSPITAL,98180003,10061,PC DRAIN SKIN ABSCESS COMPLIC,981,1 ,$573.00 ,$372.45 ,$160.44 ,$851.90 ,$851.90 ,$263.58 ,$320.88 ,$340.76 ,$160.44 ,$193.67 ,$340.76 ,$222.90 ,$340.76 ,$258.42 ,$258.42 ,$340.76 ,$236.14 ,$573.00 ,$286.50 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$429.75 ,$343.80 ,$343.80 ,$340.76 ,$343.80 ,$435.48 ,$435.48 ,$435.48 ,$573.00 , N/A ,$487.05 ,$573.00 ,$372.45 ,$340.76 ,$573.00 ,$320.88 ,$340.76 ,$313.11 , N/A ,$316.84 ,$302.44 ,$357.80 ,$458.40 ,$766.71 ,$258.42 ,$160.44 ,$515.70 ,$340.76 ,$435.48 , N/A , N/A ,$340.76 , N/A ,$275.04 ,$288.04 
ST. ELIZABETH'S HOSPITAL,98180029,11750,PC REMOVAL OF NAIL BED,981,1 ,$316.00 ,$205.40 ,$88.48 ,$851.90 ,$851.90 ,$145.36 ,$176.96 ,$340.76 ,$88.48 ,$106.81 ,$340.76 ,$122.92 ,$316.00 ,$142.52 ,$142.52 ,$316.00 ,$128.73 ,$316.00 ,$158.00 ,$851.90 ,$340.76 ,$340.76 ,$316.00 ,$237.00 ,$189.60 ,$189.60 ,$340.76 ,$189.60 ,$240.16 ,$240.16 ,$240.16 ,$316.00 , N/A ,$268.60 ,$316.00 ,$205.40 ,$340.76 ,$316.00 ,$176.96 ,$340.76 ,$174.97 , N/A ,$316.00 ,$316.00 ,$357.80 ,$252.80 ,$766.71 ,$142.52 ,$88.48 ,$284.40 ,$340.76 ,$240.16 , N/A , N/A ,$316.00 , N/A ,$151.68 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98180480,11055,PC PARING LESION BENIGN SINGLE,981,1 ,$52.00 ,$33.80 ,$14.56 ,$442.60 ,$442.60 ,$23.92 ,$29.12 ,$177.04 ,$14.56 ,$17.58 ,$177.04 ,$20.23 ,$52.00 ,$23.45 ,$23.45 ,$52.00 ,$21.28 ,$52.00 ,$26.00 ,$442.60 ,$177.04 ,$177.04 ,$52.00 ,$39.00 ,$31.20 ,$31.20 ,$177.04 ,$31.20 ,$39.52 ,$39.52 ,$39.52 ,$52.00 , N/A ,$44.20 ,$52.00 ,$33.80 ,$177.04 ,$52.00 ,$29.12 ,$177.04 ,$28.37 , N/A ,$52.00 ,$52.00 ,$185.89 ,$41.60 ,$398.34 ,$23.45 ,$14.56 ,$46.80 ,$177.04 ,$39.52 , N/A , N/A ,$52.00 , N/A ,$24.96 ,$293.92 
ST. ELIZABETH'S HOSPITAL,98180481,11056,PC PARING LESION BENIGN 2-4 LESIONS,981,1 ,$76.00 ,$49.40 ,$21.28 ,$442.60 ,$442.60 ,$34.96 ,$42.56 ,$177.04 ,$21.28 ,$25.69 ,$177.04 ,$29.56 ,$76.00 ,$34.28 ,$34.28 ,$76.00 ,$28.99 ,$76.00 ,$38.00 ,$442.60 ,$177.04 ,$177.04 ,$76.00 ,$57.00 ,$45.60 ,$45.60 ,$177.04 ,$45.60 ,$57.76 ,$57.76 ,$57.76 ,$76.00 , N/A ,$64.60 ,$76.00 ,$49.40 ,$177.04 ,$76.00 ,$42.56 ,$177.04 ,$41.38 , N/A ,$76.00 ,$76.00 ,$185.89 ,$60.80 ,$398.34 ,$34.28 ,$21.28 ,$68.40 ,$177.04 ,$57.76 , N/A , N/A ,$76.00 , N/A ,$36.48 ,$293.92 
ST. ELIZABETH'S HOSPITAL,98180482,11057,PC PARING LESION BENIGN 4+ LESIONS,981,1 ,$95.00 ,$61.75 ,$26.60 ,$442.60 ,$442.60 ,$43.70 ,$53.20 ,$177.04 ,$26.60 ,$32.11 ,$177.04 ,$36.96 ,$95.00 ,$42.85 ,$42.85 ,$95.00 ,$37.41 ,$95.00 ,$47.50 ,$442.60 ,$177.04 ,$177.04 ,$95.00 ,$71.25 ,$57.00 ,$57.00 ,$177.04 ,$57.00 ,$72.20 ,$72.20 ,$72.20 ,$95.00 , N/A ,$80.75 ,$95.00 ,$61.75 ,$177.04 ,$95.00 ,$53.20 ,$177.04 ,$52.34 , N/A ,$95.00 ,$95.00 ,$185.89 ,$76.00 ,$398.34 ,$42.85 ,$26.60 ,$85.50 ,$177.04 ,$72.20 , N/A , N/A ,$95.00 , N/A ,$45.60 ,$293.92 
ST. ELIZABETH'S HOSPITAL,98180487,11402,PC EXCISION LESION BENIGN TRUNK/ARM/LEG 1.1-2.0CM,981,1 ,$358.00 ,$232.70 ,$100.24 ,"$1,533.75 ","$1,533.75 ",$164.68 ,$200.48 ,$613.50 ,$100.24 ,$121.00 ,$613.50 ,$139.26 ,$358.00 ,$161.46 ,$161.46 ,$358.00 ,$148.40 ,$358.00 ,$179.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$358.00 ,$268.50 ,$214.80 ,$214.80 ,$613.50 ,$214.80 ,$272.08 ,$272.08 ,$272.08 ,$358.00 , N/A ,$304.30 ,$358.00 ,$232.70 ,$613.50 ,$358.00 ,$200.48 ,$613.50 ,$195.88 , N/A ,$358.00 ,$358.00 ,$644.18 ,$286.40 ,"$1,380.37 ",$161.46 ,$100.24 ,$322.20 ,$613.50 ,$272.08 , N/A , N/A ,$358.00 , N/A ,$171.84 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98180488,11403,PC EXCISION LESION BENIGN TRUNK/ARM/LEG 2.1-3.0CM,981,1 ,$466.00 ,$302.90 ,$130.48 ,"$1,533.75 ","$1,533.75 ",$214.36 ,$260.96 ,$613.50 ,$130.48 ,$157.51 ,$613.50 ,$181.27 ,$466.00 ,$210.17 ,$210.17 ,$466.00 ,$189.65 ,$466.00 ,$233.00 ,"$1,533.75 ",$613.50 ,$613.50 ,$466.00 ,$349.50 ,$279.60 ,$279.60 ,$613.50 ,$279.60 ,$354.16 ,$354.16 ,$354.16 ,$466.00 , N/A ,$396.10 ,$466.00 ,$302.90 ,$613.50 ,$466.00 ,$260.96 ,$613.50 ,$253.79 , N/A ,$466.00 ,$466.00 ,$644.18 ,$372.80 ,"$1,380.37 ",$210.17 ,$130.48 ,$419.40 ,$613.50 ,$354.16 , N/A , N/A ,$466.00 , N/A ,$223.68 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98180490,11420,PC EXCISION LESION BENIGN SCALP/NECK/HAND/FEET <0.5CM,981,1 ,$254.00 ,$165.10 ,$71.12 ,"$3,467.90 ","$3,467.90 ",$116.84 ,$142.24 ,"$1,387.16 ",$71.12 ,$85.85 ,"$1,387.16 ",$98.81 ,$254.00 ,$114.55 ,$114.55 ,$254.00 ,$103.90 ,$254.00 ,$127.00 ,"$3,467.89 ","$1,387.16 ","$1,387.16 ",$254.00 ,$190.50 ,$152.40 ,$152.40 ,"$1,387.16 ",$152.40 ,$193.04 ,$193.04 ,$193.04 ,$254.00 , N/A ,$215.90 ,$254.00 ,$165.10 ,"$1,387.16 ",$254.00 ,$142.24 ,"$1,387.16 ",$139.68 , N/A ,$254.00 ,$254.00 ,"$1,456.52 ",$203.20 ,"$3,121.10 ",$114.55 ,$71.12 ,$228.60 ,"$1,387.16 ",$193.04 , N/A , N/A ,$254.00 , N/A ,$121.92 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98180497,11732,PC AVULSION NAIL PLATE EA ADDL,981,1 ,$56.00 ,$36.40 ,$15.68 ,$275.76 , N/A ,$25.76 ,$31.36 , N/A ,$15.68 ,$18.93 , N/A ,$21.78 , N/A ,$25.26 ,$25.26 , N/A ,$22.98 , N/A ,$28.00 , N/A , N/A , N/A , N/A ,$42.00 ,$33.60 ,$33.60 , N/A ,$33.60 ,$42.56 ,$42.56 ,$42.56 ,$56.00 , N/A ,$47.60 , N/A ,$36.40 , N/A ,$56.00 ,$31.36 , N/A ,$30.79 , N/A ,$56.00 ,$56.00 , N/A ,$44.80 , N/A ,$25.26 ,$15.68 ,$50.40 , N/A ,$42.56 , N/A , N/A , N/A , N/A ,$26.88 ,$275.76 
ST. ELIZABETH'S HOSPITAL,98180603,69210,PC REMOVE CERUMEN IMPACTED W/INSTRUMENT,981,1 ,$109.00 ,$70.85 ,$30.52 ,$137.20 ,$137.20 ,$50.14 ,$61.04 ,$54.88 ,$30.52 ,$36.84 ,$54.88 ,$42.40 ,$54.88 ,$49.16 ,$49.16 ,$54.88 ,$43.85 ,$104.27 ,$54.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$81.75 ,$65.40 ,$65.40 ,$54.88 ,$65.40 ,$82.84 ,$82.84 ,$82.84 ,$109.00 , N/A ,$92.65 ,$109.00 ,$70.85 ,$54.88 ,$109.00 ,$61.04 ,$54.88 ,$59.05 , N/A ,$109.00 ,$109.00 ,$57.62 ,$87.20 ,$123.48 ,$49.16 ,$30.52 ,$98.10 ,$54.88 ,$82.84 , N/A , N/A ,$54.88 , N/A ,$52.32 ,$114.47 
ST. ELIZABETH'S HOSPITAL,98180960,11105,PC BIOPSY SKIN PUNCH ADDL LESN,981,1 ,$84.00 ,$54.60 ,$23.52 ,$617.74 , N/A ,$38.64 ,$47.04 , N/A ,$23.52 ,$28.39 , N/A ,$32.68 , N/A ,$37.88 ,$37.88 , N/A ,$33.25 , N/A ,$42.00 , N/A , N/A , N/A , N/A ,$63.00 ,$50.40 ,$50.40 , N/A ,$50.40 ,$63.84 ,$63.84 ,$63.84 ,$84.00 , N/A ,$71.40 , N/A ,$54.60 , N/A ,$84.00 ,$47.04 , N/A ,$46.21 , N/A ,$84.00 ,$84.00 , N/A ,$67.20 , N/A ,$37.88 ,$23.52 ,$75.60 , N/A ,$63.84 , N/A , N/A , N/A , N/A ,$40.32 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98180963,11104,PC BIOPSY SKIN PUNCH INIT LESN,981,1 ,$155.00 ,$100.75 ,$43.40 ,$851.90 ,$851.90 ,$71.30 ,$86.80 ,$340.76 ,$43.40 ,$52.39 ,$340.76 ,$60.30 ,$155.00 ,$69.91 ,$69.91 ,$155.00 ,$60.71 ,$155.00 ,$77.50 ,$851.90 ,$340.76 ,$340.76 ,$155.00 ,$116.25 ,$93.00 ,$93.00 ,$340.76 ,$93.00 ,$117.80 ,$117.80 ,$117.80 ,$155.00 , N/A ,$131.75 ,$155.00 ,$100.75 ,$340.76 ,$155.00 ,$86.80 ,$340.76 ,$85.10 , N/A ,$155.00 ,$155.00 ,$357.80 ,$124.00 ,$766.71 ,$69.91 ,$43.40 ,$139.50 ,$340.76 ,$117.80 , N/A , N/A ,$155.00 , N/A ,$74.40 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98200002,99202,PC CLINIC VISIT LIMITED NEW PRO,982,1 ,$159.00 ,$103.35 ,$44.52 ,$159.00 , N/A ,$73.14 ,$89.04 , N/A ,$44.52 ,$56.13 , N/A ,$65.51 , N/A ,$71.71 ,$71.71 , N/A ,$63.40 , N/A ,$79.50 , N/A , N/A , N/A , N/A ,$119.25 ,$95.40 ,$95.40 , N/A ,$95.40 ,$120.84 ,$120.84 ,$120.84 ,$159.00 , N/A ,$135.15 , N/A ,$103.35 , N/A ,$78.75 ,$89.04 , N/A ,$65.28 , N/A ,$148.24 ,$141.50 , N/A ,$127.20 , N/A ,$71.71 ,$44.52 ,$143.10 , N/A ,$120.84 , N/A , N/A , N/A , N/A ,$76.32 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200003,99203,PC CLINIC VISIT INTERM NEW PRO,982,1 ,$238.00 ,$154.70 ,$66.64 ,$238.00 , N/A ,$109.48 ,$133.28 , N/A ,$66.64 ,$84.01 , N/A ,$98.06 , N/A ,$107.34 ,$107.34 , N/A ,$108.73 , N/A ,$119.00 , N/A , N/A , N/A , N/A ,$178.50 ,$142.80 ,$142.80 , N/A ,$142.80 ,$180.88 ,$180.88 ,$180.88 ,$238.00 , N/A ,$202.30 , N/A ,$154.70 , N/A ,$121.24 ,$133.28 , N/A ,$97.74 , N/A ,$148.24 ,$141.50 , N/A ,$190.40 , N/A ,$107.34 ,$66.64 ,$214.20 , N/A ,$180.88 , N/A , N/A , N/A , N/A ,$114.24 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200004,99204,PC CLINIC VISIT COMPLEX NEW PRO,982,1 ,$407.00 ,$264.55 ,$113.96 ,$407.00 , N/A ,$187.22 ,$227.92 , N/A ,$113.96 ,$143.67 , N/A ,$167.68 , N/A ,$183.56 ,$183.56 , N/A ,$174.95 , N/A ,$203.50 , N/A , N/A , N/A , N/A ,$305.25 ,$244.20 ,$244.20 , N/A ,$244.20 ,$309.32 ,$309.32 ,$309.32 ,$407.00 , N/A ,$345.95 , N/A ,$264.55 , N/A ,$181.05 ,$227.92 , N/A ,$167.14 , N/A ,$148.24 ,$141.50 , N/A ,$325.60 , N/A ,$183.56 ,$113.96 ,$366.30 , N/A ,$309.32 , N/A , N/A , N/A , N/A ,$195.36 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200005,99205,PC CLINIC VISIT COMPREH NEW PRO,982,1 ,$531.00 ,$345.15 ,$134.76 ,$531.00 , N/A ,$244.26 ,$297.36 , N/A ,$148.68 ,$187.44 , N/A ,$218.77 , N/A ,$239.48 ,$239.48 , N/A ,$237.15 , N/A ,$265.50 , N/A , N/A , N/A , N/A ,$398.25 ,$318.60 ,$318.60 , N/A ,$318.60 ,$403.56 ,$403.56 ,$403.56 ,$531.00 , N/A ,$451.35 , N/A ,$345.15 , N/A ,$239.15 ,$297.36 , N/A ,$218.17 , N/A ,$148.24 ,$141.50 , N/A ,$424.80 , N/A ,$239.48 ,$148.68 ,$477.90 , N/A ,$403.56 , N/A , N/A , N/A , N/A ,$254.88 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200006,99211,PC CLINIC VISIT BRIEF EST PRO,982,1 ,$28.00 ,$18.20 ,$7.84 ,$134.76 , N/A ,$12.88 ,$15.68 , N/A ,$7.84 ,$9.88 , N/A ,$11.54 , N/A ,$12.63 ,$12.63 , N/A ,$11.36 , N/A ,$14.00 , N/A , N/A , N/A , N/A ,$21.00 ,$16.80 ,$16.80 , N/A ,$16.80 ,$21.28 ,$21.28 ,$21.28 ,$28.00 , N/A ,$23.80 , N/A ,$18.20 , N/A ,$28.00 ,$15.68 , N/A ,$11.83 , N/A ,$28.00 ,$28.00 , N/A ,$22.40 , N/A ,$12.63 ,$7.84 ,$25.20 , N/A ,$21.28 , N/A , N/A , N/A , N/A ,$13.44 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200007,99212,PC CLINIC VISIT LIMIT EST PRO,982,1 ,$82.00 ,$53.30 ,$22.96 ,$134.76 , N/A ,$37.72 ,$45.92 , N/A ,$22.96 ,$28.95 , N/A ,$33.78 , N/A ,$36.98 ,$36.98 , N/A ,$47.13 , N/A ,$41.00 , N/A , N/A , N/A , N/A ,$61.50 ,$49.20 ,$49.20 , N/A ,$49.20 ,$62.32 ,$62.32 ,$62.32 ,$82.00 , N/A ,$69.70 , N/A ,$53.30 , N/A ,$60.02 ,$45.92 , N/A ,$33.40 , N/A ,$82.00 ,$82.00 , N/A ,$65.60 , N/A ,$36.98 ,$22.96 ,$73.80 , N/A ,$62.32 , N/A , N/A , N/A , N/A ,$39.36 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200008,99213,PC CLINIC VISIT INTERM EST PRO,982,1 ,$161.00 ,$104.65 ,$45.08 ,$161.00 , N/A ,$74.06 ,$90.16 , N/A ,$45.08 ,$56.83 , N/A ,$66.33 , N/A ,$72.61 ,$72.61 , N/A ,$85.84 , N/A ,$80.50 , N/A , N/A , N/A , N/A ,$120.75 ,$96.60 ,$96.60 , N/A ,$96.60 ,$122.36 ,$122.36 ,$122.36 ,$161.00 , N/A ,$136.85 , N/A ,$104.65 , N/A ,$97.92 ,$90.16 , N/A ,$66.15 , N/A ,$148.24 ,$141.50 , N/A ,$128.80 , N/A ,$72.61 ,$45.08 ,$144.90 , N/A ,$122.36 , N/A , N/A , N/A , N/A ,$77.28 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200009,99214,PC CLINIC VISIT COMPLX EST PRO,982,1 ,$246.00 ,$159.90 ,$68.88 ,$246.00 , N/A ,$113.16 ,$137.76 , N/A ,$68.88 ,$86.84 , N/A ,$101.35 , N/A ,$110.95 ,$110.95 , N/A ,$125.09 , N/A ,$123.00 , N/A , N/A , N/A , N/A ,$184.50 ,$147.60 ,$147.60 , N/A ,$147.60 ,$186.96 ,$186.96 ,$186.96 ,$246.00 , N/A ,$209.10 , N/A ,$159.90 , N/A ,$246.00 ,$137.76 , N/A ,$101.60 , N/A ,$148.24 ,$141.50 , N/A ,$196.80 , N/A ,$110.95 ,$68.88 ,$221.40 , N/A ,$186.96 , N/A , N/A , N/A , N/A ,$118.08 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200010,99215,PC CLINIC VISIT COMPRH EST PRO,982,1 ,$347.00 ,$225.55 ,$97.16 ,$347.00 , N/A ,$159.62 ,$194.32 , N/A ,$97.16 ,$122.49 , N/A ,$142.96 , N/A ,$156.50 ,$156.50 , N/A ,$186.74 , N/A ,$173.50 , N/A , N/A , N/A , N/A ,$260.25 ,$208.20 ,$208.20 , N/A ,$208.20 ,$263.72 ,$263.72 ,$263.72 ,$347.00 , N/A ,$294.95 , N/A ,$225.55 , N/A ,$347.00 ,$194.32 , N/A ,$143.41 , N/A ,$148.24 ,$141.50 , N/A ,$277.60 , N/A ,$156.50 ,$97.16 ,$312.30 , N/A ,$263.72 , N/A , N/A , N/A , N/A ,$166.56 ,$134.76 
ST. ELIZABETH'S HOSPITAL,98200012,93923,PC DOPPLER ARTERIAL EXTREMITY COMPLETE-26,982,1 ,$71.00 ,$46.15 ,$19.88 ,$344.13 ,$344.13 ,$32.66 ,$39.76 ,$137.65 ,$19.88 ,$25.06 ,$137.65 ,$29.25 ,$71.00 ,$32.02 ,$32.02 ,$71.00 ,$71.00 ,$71.00 ,$35.50 ,$344.11 ,$137.65 ,$137.65 ,$71.00 ,$53.25 ,$42.60 ,$42.60 ,$137.65 ,$42.60 ,$53.96 ,$53.96 ,$53.96 ,$71.00 , N/A ,$60.35 ,$71.00 ,$46.15 ,$137.65 ,$71.00 ,$39.76 ,$137.65 ,$41.78 , N/A ,$71.00 ,$71.00 ,$144.53 ,$56.80 ,$309.70 ,$32.02 ,$19.88 ,$63.90 ,$137.65 ,$53.96 , N/A , N/A ,$71.00 , N/A ,$34.08 ,$135.95 
ST. ELIZABETH'S HOSPITAL,98200013,93922,PC DOPPLER ARTERIAL EXTREMITY LIMITED,982,1 ,$41.00 ,$26.65 ,$11.48 ,$277.93 ,$277.93 ,$18.86 ,$22.96 ,$111.17 ,$11.48 ,$14.47 ,$111.17 ,$16.89 ,$41.00 ,$18.49 ,$18.49 ,$41.00 ,$41.00 ,$41.00 ,$20.50 ,$277.92 ,$111.17 ,$111.17 ,$41.00 ,$30.75 ,$24.60 ,$24.60 ,$111.17 ,$24.60 ,$31.16 ,$31.16 ,$31.16 ,$41.00 , N/A ,$34.85 ,$41.00 ,$26.65 ,$111.17 ,$41.00 ,$22.96 ,$111.17 ,$41.00 , N/A ,$41.00 ,$41.00 ,$116.73 ,$32.80 ,$250.12 ,$18.49 ,$11.48 ,$36.90 ,$111.17 ,$31.16 , N/A , N/A ,$41.00 , N/A ,$19.68 ,$135.95 
ST. ELIZABETH'S HOSPITAL,98200072,99221,HC INITIAL HOSPITAL CARE 30 MIN,982,1 ,$321.60 ,$209.04 ,$90.05 ,$321.60 , N/A ,$147.94 ,$180.10 , N/A ,$90.05 ,$113.52 , N/A ,$132.50 , N/A ,$145.04 ,$145.04 , N/A ,$129.93 , N/A ,$160.80 , N/A , N/A , N/A , N/A ,$241.20 ,$192.96 ,$192.96 , N/A ,$192.96 ,$244.42 ,$244.42 ,$244.42 ,$321.60 , N/A ,$273.36 , N/A ,$209.04 , N/A ,$321.60 ,$180.10 , N/A ,$131.76 , N/A , N/A , N/A , N/A ,$257.28 , N/A ,$145.04 ,$90.05 ,$289.44 , N/A ,$244.42 , N/A , N/A , N/A , N/A ,$154.37 , N/A 
ST. ELIZABETH'S HOSPITAL,98200073,99222,HC INITIAL HOSPITAL CARE 50 MIN,982,1 ,$431.40 ,$280.41 ,$120.79 ,$431.40 , N/A ,$198.44 ,$241.58 , N/A ,$120.79 ,$152.28 , N/A ,$177.74 , N/A ,$194.56 ,$194.56 , N/A ,$172.71 , N/A ,$215.70 , N/A , N/A , N/A , N/A ,$323.55 ,$258.84 ,$258.84 , N/A ,$258.84 ,$327.86 ,$327.86 ,$327.86 ,$431.40 , N/A ,$366.69 , N/A ,$280.41 , N/A ,$431.40 ,$241.58 , N/A ,$177.57 , N/A , N/A , N/A , N/A ,$345.12 , N/A ,$194.56 ,$120.79 ,$388.26 , N/A ,$327.86 , N/A , N/A , N/A , N/A ,$207.07 , N/A 
ST. ELIZABETH'S HOSPITAL,98200074,99223,HC INITIAL HOSPITAL CARE 70 MIN,982,1 ,$629.76 ,$409.34 ,$176.33 ,$629.76 , N/A ,$289.69 ,$352.67 , N/A ,$176.33 ,$222.31 , N/A ,$259.46 , N/A ,$284.02 ,$284.02 , N/A ,$252.20 , N/A ,$314.88 , N/A , N/A , N/A , N/A ,$472.32 ,$377.86 ,$377.86 , N/A ,$377.86 ,$478.62 ,$478.62 ,$478.62 ,$629.76 , N/A ,$535.30 , N/A ,$409.34 , N/A ,$629.76 ,$352.67 , N/A ,$260.20 , N/A , N/A , N/A , N/A ,$503.81 , N/A ,$284.02 ,$176.33 ,$566.78 , N/A ,$478.62 , N/A , N/A , N/A , N/A ,$302.28 , N/A 
ST. ELIZABETH'S HOSPITAL,98200075,99231,HC SUBSEQUENT HOPITAL CARE 15 MIN,982,1 ,$122.97 ,$79.93 ,$34.43 ,$122.97 , N/A ,$56.57 ,$68.86 , N/A ,$34.43 ,$41.56 , N/A ,$47.84 , N/A ,$55.46 ,$55.46 , N/A ,$49.73 , N/A ,$61.49 , N/A , N/A , N/A , N/A ,$92.23 ,$73.78 ,$73.78 , N/A ,$73.78 ,$93.46 ,$93.46 ,$93.46 ,$122.97 , N/A ,$104.52 , N/A ,$79.93 , N/A ,$122.97 ,$68.86 , N/A ,$50.69 , N/A , N/A , N/A , N/A ,$98.38 , N/A ,$55.46 ,$34.43 ,$110.67 , N/A ,$93.46 , N/A , N/A , N/A , N/A ,$59.03 , N/A 
ST. ELIZABETH'S HOSPITAL,98200076,99232,HC SUBSEQUENT HOPITAL CARE 25 MIN,982,1 ,$224.22 ,$145.74 ,$62.78 ,$224.22 , N/A ,$103.14 ,$125.56 , N/A ,$62.78 ,$79.15 , N/A ,$92.38 , N/A ,$101.12 ,$101.12 , N/A ,$90.54 , N/A ,$112.11 , N/A , N/A , N/A , N/A ,$168.17 ,$134.53 ,$134.53 , N/A ,$134.53 ,$170.41 ,$170.41 ,$170.41 ,$224.22 , N/A ,$190.59 , N/A ,$145.74 , N/A ,$224.22 ,$125.56 , N/A ,$92.87 , N/A , N/A , N/A , N/A ,$179.38 , N/A ,$101.12 ,$62.78 ,$201.80 , N/A ,$170.41 , N/A , N/A , N/A , N/A ,$107.63 , N/A 
ST. ELIZABETH'S HOSPITAL,98200077,99233,HC SUBSEQUENT HOPITAL CARE 35 MIN,982,1 ,$323.13 ,$210.03 ,$90.48 ,$323.13 , N/A ,$148.64 ,$180.95 , N/A ,$90.48 ,$114.06 , N/A ,$133.13 , N/A ,$145.73 ,$145.73 , N/A ,$129.99 , N/A ,$161.57 , N/A , N/A , N/A , N/A ,$242.35 ,$193.88 ,$193.88 , N/A ,$193.88 ,$245.58 ,$245.58 ,$245.58 ,$323.13 , N/A ,$274.66 , N/A ,$210.03 , N/A ,$323.13 ,$180.95 , N/A ,$133.84 , N/A , N/A , N/A , N/A ,$258.50 , N/A ,$145.73 ,$90.48 ,$290.82 , N/A ,$245.58 , N/A , N/A , N/A , N/A ,$155.10 , N/A 
ST. ELIZABETH'S HOSPITAL,98200078,99238,HC HOSPITAL DISCHARGE 30 MIN/<,982,1 ,$225.51 ,$146.58 ,$63.14 ,$225.51 , N/A ,$103.73 ,$126.29 , N/A ,$63.14 ,$79.61 , N/A ,$92.91 , N/A ,$101.71 ,$101.71 , N/A ,$90.76 , N/A ,$112.76 , N/A , N/A , N/A , N/A ,$169.13 ,$135.31 ,$135.31 , N/A ,$135.31 ,$171.39 ,$171.39 ,$171.39 ,$225.51 , N/A ,$191.68 , N/A ,$146.58 , N/A ,$225.51 ,$126.29 , N/A ,$93.29 , N/A , N/A , N/A , N/A ,$180.41 , N/A ,$101.71 ,$63.14 ,$202.96 , N/A ,$171.39 , N/A , N/A , N/A , N/A ,$108.24 , N/A 
ST. ELIZABETH'S HOSPITAL,98300001,10060,PC I AND D ABSC SMP PRO,983,1 ,$311.00 ,$202.15 ,$87.08 ,$442.60 ,$442.60 ,$143.06 ,$174.16 ,$177.04 ,$87.08 ,$105.12 ,$177.04 ,$120.98 ,$177.04 ,$140.26 ,$140.26 ,$177.04 ,$132.30 ,$311.00 ,$155.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$233.25 ,$186.60 ,$186.60 ,$177.04 ,$186.60 ,$236.36 ,$236.36 ,$236.36 ,$311.00 , N/A ,$264.35 ,$311.00 ,$202.15 ,$177.04 ,$311.00 ,$174.16 ,$177.04 ,$171.01 , N/A ,$311.00 ,$302.44 ,$185.89 ,$248.80 ,$398.34 ,$140.26 ,$87.08 ,$279.90 ,$177.04 ,$236.36 , N/A , N/A ,$177.04 , N/A ,$149.28 ,$288.04 
ST. ELIZABETH'S HOSPITAL,98300004,11042,PC DEBR SKIN/SUBQ TISS INIT 20CM PRO,983,1 ,$195.00 ,$126.75 ,$54.60 ,$851.90 ,$851.90 ,$89.70 ,$109.20 ,$340.76 ,$54.60 ,$65.91 ,$340.76 ,$75.86 ,$195.00 ,$87.95 ,$87.95 ,$195.00 ,$77.99 ,$195.00 ,$97.50 ,$851.90 ,$340.76 ,$340.76 ,$195.00 ,$146.25 ,$117.00 ,$117.00 ,$340.76 ,$117.00 ,$148.20 ,$148.20 ,$148.20 ,$195.00 , N/A ,$165.75 ,$195.00 ,$126.75 ,$340.76 ,$195.00 ,$109.20 ,$340.76 ,$106.36 , N/A ,$195.00 ,$195.00 ,$357.80 ,$156.00 ,$766.71 ,$87.95 ,$54.60 ,$175.50 ,$340.76 ,$148.20 , N/A , N/A ,$195.00 , N/A ,$93.60 ,$293.92 
ST. ELIZABETH'S HOSPITAL,98300006,11043,PC DEBR SKIN/SUBQ TISSUE/MUSCLE PRO,983,1 ,$508.00 ,$330.20 ,$142.24 ,"$1,290.85 ","$1,290.85 ",$233.68 ,$284.48 ,$516.34 ,$142.24 ,$171.70 ,$516.34 ,$197.61 ,$508.00 ,$229.11 ,$229.11 ,$508.00 ,$203.30 ,$508.00 ,$254.00 ,"$1,290.85 ",$516.34 ,$516.34 ,$508.00 ,$381.00 ,$304.80 ,$304.80 ,$516.34 ,$304.80 ,$386.08 ,$386.08 ,$386.08 ,$508.00 , N/A ,$431.80 ,$508.00 ,$330.20 ,$516.34 ,$508.00 ,$284.48 ,$516.34 ,$274.25 , N/A ,$508.00 ,$508.00 ,$542.16 ,$406.40 ,"$1,161.77 ",$229.11 ,$142.24 ,$457.20 ,$516.34 ,$386.08 , N/A , N/A ,$508.00 , N/A ,$243.84 ,$799.62 
ST. ELIZABETH'S HOSPITAL,98300008,11044,PC DEBR SKIN/SUB TIS/MUS/BONE INT 20 PRO,983,1 ,$748.00 ,$486.20 ,$209.44 ,"$3,467.90 ","$3,467.90 ",$344.08 ,$418.88 ,"$1,387.16 ",$209.44 ,$252.82 ,"$1,387.16 ",$290.97 ,$748.00 ,$337.35 ,$337.35 ,$748.00 ,$299.45 ,$748.00 ,$374.00 ,"$3,467.89 ","$1,387.16 ","$1,387.16 ",$748.00 ,$561.00 ,$448.80 ,$448.80 ,"$1,387.16 ",$448.80 ,$568.48 ,$568.48 ,$568.48 ,$748.00 , N/A ,$635.80 ,$748.00 ,$486.20 ,"$1,387.16 ",$748.00 ,$418.88 ,"$1,387.16 ",$403.60 , N/A ,$748.00 ,$748.00 ,"$1,456.52 ",$598.40 ,"$3,121.10 ",$337.35 ,$209.44 ,$673.20 ,"$1,387.16 ",$568.48 , N/A , N/A ,$748.00 , N/A ,$359.04 ,"$1,147.77 "
ST. ELIZABETH'S HOSPITAL,98300010,11045,PC DEBR SKIN/SUBQ TIS EA ADL 20CM PRO,983,1 ,$89.00 ,$57.85 ,$24.92 ,$799.62 , N/A ,$40.94 ,$49.84 , N/A ,$24.92 ,$30.08 , N/A ,$34.62 , N/A ,$40.14 ,$40.14 , N/A ,$35.43 , N/A ,$44.50 , N/A , N/A , N/A , N/A ,$66.75 ,$53.40 ,$53.40 , N/A ,$53.40 ,$67.64 ,$67.64 ,$67.64 ,$89.00 , N/A ,$75.65 , N/A ,$57.85 , N/A ,$89.00 ,$49.84 , N/A ,$47.73 , N/A ,$89.00 ,$89.00 , N/A ,$71.20 , N/A ,$40.14 ,$24.92 ,$80.10 , N/A ,$67.64 , N/A , N/A , N/A , N/A ,$42.72 ,$799.62 
ST. ELIZABETH'S HOSPITAL,98300011,11046,PC DEBR SKIN/SUBQ MUS/FAS ADL 20C PRO,983,1 ,$188.00 ,$122.20 ,$52.64 ,$799.62 , N/A ,$86.48 ,$105.28 , N/A ,$52.64 ,$63.54 , N/A ,$73.13 , N/A ,$84.79 ,$84.79 , N/A ,$75.23 , N/A ,$94.00 , N/A , N/A , N/A , N/A ,$141.00 ,$112.80 ,$112.80 , N/A ,$112.80 ,$142.88 ,$142.88 ,$142.88 ,$188.00 , N/A ,$159.80 , N/A ,$122.20 , N/A ,$188.00 ,$105.28 , N/A ,$100.31 , N/A ,$188.00 ,$188.00 , N/A ,$150.40 , N/A ,$84.79 ,$52.64 ,$169.20 , N/A ,$142.88 , N/A , N/A , N/A , N/A ,$90.24 ,$799.62 
ST. ELIZABETH'S HOSPITAL,98300012,11047,PC DEBR SKIN/SUB TIS/MUS/BN ADL 20C PRO,983,1 ,$332.00 ,$215.80 ,$92.96 ,"$1,147.77 ", N/A ,$152.72 ,$185.92 , N/A ,$92.96 ,$112.22 , N/A ,$129.15 , N/A ,$149.73 ,$149.73 , N/A ,$131.23 , N/A ,$166.00 , N/A , N/A , N/A , N/A ,$249.00 ,$199.20 ,$199.20 , N/A ,$199.20 ,$252.32 ,$252.32 ,$252.32 ,$332.00 , N/A ,$282.20 , N/A ,$215.80 , N/A ,$332.00 ,$185.92 , N/A ,$177.25 , N/A ,$332.00 ,$332.00 , N/A ,$265.60 , N/A ,$149.73 ,$92.96 ,$298.80 , N/A ,$252.32 , N/A , N/A , N/A , N/A ,$159.36 ,"$1,147.77 "
ST. ELIZABETH'S HOSPITAL,98300015,11100,PC BX LESN SKIN/SUBQ/MUCOUS SGL PRO,983,1 ,$198.00 ,$128.70 ,$55.44 ,$198.00 , N/A ,$91.08 ,$110.88 , N/A ,$55.44 ,$66.92 , N/A ,$77.02 , N/A ,$89.30 ,$89.30 , N/A ,$128.70 , N/A ,$99.00 , N/A , N/A , N/A , N/A ,$148.50 ,$118.80 ,$118.80 , N/A ,$118.80 ,$150.48 ,$150.48 ,$150.48 ,$198.00 , N/A ,$168.30 , N/A ,$128.70 , N/A ,$198.00 ,$110.88 , N/A ,$138.60 , N/A , N/A , N/A , N/A ,$158.40 , N/A ,$89.30 ,$55.44 ,$178.20 , N/A ,$150.48 , N/A , N/A , N/A , N/A ,$95.04 , N/A 
ST. ELIZABETH'S HOSPITAL,98300017,11101,PC PUNCH BIOPSY EA ADD PRO,983,1 ,$78.00 ,$50.70 ,$21.84 ,$78.00 , N/A ,$35.88 ,$43.68 , N/A ,$21.84 ,$26.36 , N/A ,$30.34 , N/A ,$35.18 ,$35.18 , N/A ,$50.70 , N/A ,$39.00 , N/A , N/A , N/A , N/A ,$58.50 ,$46.80 ,$46.80 , N/A ,$46.80 ,$59.28 ,$59.28 ,$59.28 ,$78.00 , N/A ,$66.30 , N/A ,$50.70 , N/A ,$78.00 ,$43.68 , N/A ,$54.60 , N/A , N/A , N/A , N/A ,$62.40 , N/A ,$35.18 ,$21.84 ,$70.20 , N/A ,$59.28 , N/A , N/A , N/A , N/A ,$37.44 , N/A 
ST. ELIZABETH'S HOSPITAL,98300018,11719,PC TRIM NAILS NONDYSTROPHIC PRO,983,1 ,$24.00 ,$15.60 ,$6.72 ,$137.20 ,$137.20 ,$11.04 ,$13.44 ,$54.88 ,$6.72 ,$8.11 ,$54.88 ,$9.34 ,$24.00 ,$10.82 ,$10.82 ,$24.00 ,$9.70 ,$24.00 ,$12.00 ,$137.20 ,$54.88 ,$54.88 ,$24.00 ,$18.00 ,$14.40 ,$14.40 ,$54.88 ,$14.40 ,$18.24 ,$18.24 ,$18.24 ,$24.00 , N/A ,$20.40 ,$24.00 ,$15.60 ,$54.88 ,$24.00 ,$13.44 ,$54.88 ,$13.51 , N/A ,$24.00 ,$24.00 ,$57.62 ,$19.20 ,$123.48 ,$10.82 ,$6.72 ,$21.60 ,$54.88 ,$18.24 , N/A , N/A ,$24.00 , N/A ,$11.52 ,$78.63 
ST. ELIZABETH'S HOSPITAL,98300028,16020,PC BURN DRESS  AND /OR DEBRIDE PRO <5%,983,1 ,$173.00 ,$112.45 ,$48.44 ,$442.60 ,$442.60 ,$79.58 ,$96.88 ,$177.04 ,$48.44 ,$58.47 ,$177.04 ,$67.30 ,$173.00 ,$78.02 ,$78.02 ,$173.00 ,$70.40 ,$173.00 ,$86.50 ,$442.60 ,$177.04 ,$177.04 ,$173.00 ,$129.75 ,$103.80 ,$103.80 ,$177.04 ,$103.80 ,$131.48 ,$131.48 ,$131.48 ,$173.00 , N/A ,$147.05 ,$173.00 ,$112.45 ,$177.04 ,$173.00 ,$96.88 ,$177.04 ,$93.88 , N/A ,$149.81 ,$143.00 ,$185.89 ,$138.40 ,$398.34 ,$78.02 ,$48.44 ,$155.70 ,$177.04 ,$131.48 , N/A , N/A ,$173.00 , N/A ,$83.04 ,$136.19 
ST. ELIZABETH'S HOSPITAL,98300031,17250,PC CHEM CAUTERY PRO,983,1 ,$120.00 ,$78.00 ,$33.60 ,$442.60 ,$442.60 ,$55.20 ,$67.20 ,$177.04 ,$33.60 ,$40.56 ,$177.04 ,$46.68 ,$120.00 ,$54.12 ,$54.12 ,$120.00 ,$48.88 ,$120.00 ,$60.00 ,$442.60 ,$177.04 ,$177.04 ,$120.00 ,$90.00 ,$72.00 ,$72.00 ,$177.04 ,$72.00 ,$91.20 ,$91.20 ,$91.20 ,$120.00 , N/A ,$102.00 ,$120.00 ,$78.00 ,$177.04 ,$120.00 ,$67.20 ,$177.04 ,$64.71 , N/A ,$120.00 ,$120.00 ,$185.89 ,$96.00 ,$398.34 ,$54.12 ,$33.60 ,$108.00 ,$177.04 ,$91.20 , N/A , N/A ,$120.00 , N/A ,$57.60 ,$293.92 
ST. ELIZABETH'S HOSPITAL,98300033,20220,PC BX BONE NEEDLE SUPERFIC PRO,983,1 ,$279.00 ,$181.35 ,$78.12 ,"$3,467.90 ","$3,467.90 ",$128.34 ,$156.24 ,"$1,387.16 ",$78.12 ,$94.30 ,"$1,387.16 ",$108.53 ,$279.00 ,$125.83 ,$125.83 ,$279.00 ,$112.00 ,$279.00 ,$139.50 ,"$3,467.89 ","$1,387.16 ","$1,387.16 ",$279.00 ,$209.25 ,$167.40 ,$167.40 ,"$1,387.16 ",$167.40 ,$212.04 ,$212.04 ,$212.04 ,$279.00 , N/A ,$237.15 ,$279.00 ,$181.35 ,"$1,387.16 ",$279.00 ,$156.24 ,"$1,387.16 ",$155.13 , N/A ,$279.00 ,$279.00 ,"$1,456.52 ",$223.20 ,"$3,121.10 ",$125.83 ,$78.12 ,$251.10 ,"$1,387.16 ",$212.04 , N/A , N/A ,$279.00 , N/A ,$133.92 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98300036,29580,PC UNNA BOOT APPLICATION PRO,983,1 ,$91.00 ,$59.15 ,$25.48 ,$348.23 ,$348.23 ,$41.86 ,$50.96 ,$139.29 ,$25.48 ,$32.12 ,$139.29 ,$37.49 ,$91.00 ,$41.04 ,$41.04 ,$91.00 ,$36.06 ,$91.00 ,$45.50 ,$348.22 ,$139.29 ,$139.29 ,$91.00 ,$68.25 ,$54.60 ,$54.60 ,$139.29 ,$54.60 ,$69.16 ,$69.16 ,$69.16 ,$91.00 , N/A ,$77.35 ,$91.00 ,$59.15 ,$139.29 ,$91.00 ,$50.96 ,$139.29 ,$48.95 , N/A ,$91.00 ,$91.00 ,$146.25 ,$72.80 ,$313.39 ,$41.04 ,$25.48 ,$81.90 ,$139.29 ,$69.16 , N/A , N/A ,$91.00 , N/A ,$43.68 ,$241.58 
ST. ELIZABETH'S HOSPITAL,98300038,29581,PC APPL MULTI COMP LOWER LEG PRO,983,1 ,$87.00 ,$56.55 ,$24.36 ,$348.23 ,$348.23 ,$40.02 ,$48.72 ,$139.29 ,$24.36 ,$29.41 ,$139.29 ,$33.84 ,$87.00 ,$39.24 ,$39.24 ,$87.00 ,$34.73 ,$87.00 ,$43.50 ,$348.22 ,$139.29 ,$139.29 ,$87.00 ,$65.25 ,$52.20 ,$52.20 ,$139.29 ,$52.20 ,$66.12 ,$66.12 ,$66.12 ,$87.00 , N/A ,$73.95 ,$87.00 ,$56.55 ,$139.29 ,$87.00 ,$48.72 ,$139.29 ,$48.74 , N/A ,$87.00 ,$87.00 ,$146.25 ,$69.60 ,$313.39 ,$39.24 ,$24.36 ,$78.30 ,$139.29 ,$66.12 , N/A , N/A ,$87.00 , N/A ,$41.76 ,$241.58 
ST. ELIZABETH'S HOSPITAL,98300043,97597,PC DEBR SKIN INTL 20CM PRO,983,1 ,$117.00 ,$76.05 ,$32.76 ,$442.60 ,$442.60 ,$53.82 ,$65.52 ,$177.04 ,$32.76 ,$41.30 ,$177.04 ,$48.20 ,$117.00 ,$52.77 ,$52.77 ,$117.00 ,$47.30 ,$117.00 ,$58.50 ,$442.60 ,$177.04 ,$177.04 ,$117.00 ,$87.75 ,$70.20 ,$70.20 ,$177.04 ,$70.20 ,$88.92 ,$88.92 ,$88.92 ,$117.00 , N/A ,$99.45 ,$117.00 ,$76.05 ,$177.04 ,$117.00 ,$65.52 ,$177.04 ,$64.46 , N/A ,$117.00 ,$117.00 ,$185.89 ,$93.60 ,$398.34 ,$52.77 ,$32.76 ,$105.30 ,$177.04 ,$88.92 , N/A , N/A ,$117.00 , N/A ,$56.16 ,$114.47 
ST. ELIZABETH'S HOSPITAL,98300049,97598,PC DEBR SKIN PART THICKNESS EA ADDN>20CM PRO,983,1 ,$84.00 ,$54.60 ,$23.52 ,$114.47 , N/A ,$38.64 ,$47.04 , N/A ,$23.52 ,$29.65 , N/A ,$34.61 , N/A ,$37.88 ,$37.88 , N/A ,$33.59 , N/A ,$42.00 , N/A , N/A , N/A , N/A ,$63.00 ,$50.40 ,$50.40 , N/A ,$50.40 ,$63.84 ,$63.84 ,$63.84 ,$84.00 , N/A ,$71.40 , N/A ,$54.60 , N/A ,$84.00 ,$47.04 , N/A ,$45.51 , N/A ,$84.00 ,$84.00 , N/A ,$67.20 , N/A ,$37.88 ,$23.52 ,$75.60 , N/A ,$63.84 , N/A , N/A , N/A , N/A ,$40.32 ,$114.47 
ST. ELIZABETH'S HOSPITAL,98300050,97605,PC NWPT <50 SQ CM PRO,983,1 ,$81.00 ,$52.65 ,$22.68 ,$442.60 ,$442.60 ,$37.26 ,$45.36 ,$177.04 ,$22.68 ,$28.59 ,$177.04 ,$33.37 ,$81.00 ,$36.53 ,$36.53 ,$81.00 ,$31.75 ,$81.00 ,$40.50 ,$442.60 ,$177.04 ,$177.04 ,$81.00 ,$60.75 ,$48.60 ,$48.60 ,$177.04 ,$48.60 ,$61.56 ,$61.56 ,$61.56 ,$81.00 , N/A ,$68.85 ,$81.00 ,$52.65 ,$177.04 ,$81.00 ,$45.36 ,$177.04 ,$48.48 , N/A ,$81.00 ,$81.00 ,$185.89 ,$64.80 ,$398.34 ,$36.53 ,$22.68 ,$72.90 ,$177.04 ,$61.56 , N/A , N/A ,$81.00 , N/A ,$38.88 ,$275.76 
ST. ELIZABETH'S HOSPITAL,98300051,97606,PC NWPT >50 SQ CM PRO,983,1 ,$87.00 ,$56.55 ,$24.36 ,$851.90 ,$851.90 ,$40.02 ,$48.72 ,$340.76 ,$24.36 ,$30.71 ,$340.76 ,$35.84 ,$87.00 ,$39.24 ,$39.24 ,$87.00 ,$34.73 ,$87.00 ,$43.50 ,$851.90 ,$340.76 ,$340.76 ,$87.00 ,$65.25 ,$52.20 ,$52.20 ,$340.76 ,$52.20 ,$66.12 ,$66.12 ,$66.12 ,$87.00 , N/A ,$73.95 ,$87.00 ,$56.55 ,$340.76 ,$87.00 ,$48.72 ,$340.76 ,$52.41 , N/A ,$87.00 ,$87.00 ,$357.80 ,$69.60 ,$766.71 ,$39.24 ,$24.36 ,$78.30 ,$340.76 ,$66.12 , N/A , N/A ,$87.00 , N/A ,$41.76 ,$275.76 
ST. ELIZABETH'S HOSPITAL,98300075,99183,PC HYPERBARIC 02 HSHS PRO FEE,983,1 ,$358.00 ,$232.70 ,$100.24 ,$358.00 , N/A ,$164.68 ,$200.48 , N/A ,$100.24 ,$126.37 , N/A ,$147.50 , N/A ,$161.46 ,$161.46 , N/A ,$141.03 , N/A ,$179.00 , N/A , N/A , N/A , N/A ,$268.50 ,$214.80 ,$214.80 , N/A ,$214.80 ,$272.08 ,$272.08 ,$272.08 ,$358.00 , N/A ,$304.30 , N/A ,$232.70 , N/A ,$358.00 ,$200.48 , N/A ,$209.10 , N/A , N/A , N/A , N/A ,$286.40 , N/A ,$161.46 ,$100.24 ,$322.20 , N/A ,$272.08 , N/A , N/A , N/A , N/A ,$171.84 , N/A 
ST. ELIZABETH'S HOSPITAL,98300080,15271,PC APL SKIN SUB TAL<100 INT 25CM PRO,983,1 ,$279.00 ,$181.35 ,$78.12 ,"$4,221.50 ","$4,221.50 ",$128.34 ,$156.24 ,"$1,688.60 ",$78.12 ,$94.30 ,"$1,688.60 ",$108.53 ,$279.00 ,$125.83 ,$125.83 ,$279.00 ,$110.85 ,$279.00 ,$139.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ",$279.00 ,$209.25 ,$167.40 ,$167.40 ,"$1,688.60 ",$167.40 ,$212.04 ,$212.04 ,$212.04 ,$279.00 , N/A ,$237.15 ,$279.00 ,$181.35 ,"$1,688.60 ",$279.00 ,$156.24 ,"$1,688.60 ",$150.42 , N/A ,$279.00 ,$279.00 ,"$1,773.03 ",$223.20 ,"$3,799.34 ",$125.83 ,$78.12 ,$251.10 ,"$1,688.60 ",$212.04 , N/A , N/A ,$279.00 , N/A ,$133.92 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300082,15272,PC APL SKIN SUB TAL<100 ADL 25CM PRO,983,1 ,$59.00 ,$38.35 ,$16.52 ,"$1,518.42 ", N/A ,$27.14 ,$33.04 , N/A ,$16.52 ,$19.94 , N/A ,$22.95 , N/A ,$26.61 ,$26.61 , N/A ,$24.20 , N/A ,$29.50 , N/A , N/A , N/A , N/A ,$44.25 ,$35.40 ,$35.40 , N/A ,$35.40 ,$44.84 ,$44.84 ,$44.84 ,$59.00 , N/A ,$50.15 , N/A ,$38.35 , N/A ,$59.00 ,$33.04 , N/A ,$31.61 , N/A ,$59.00 ,$59.00 , N/A ,$47.20 , N/A ,$26.61 ,$16.52 ,$53.10 , N/A ,$44.84 , N/A , N/A , N/A , N/A ,$28.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300083,15273,PC APL SKIN SUB TAL>100 INT 100CM PRO,983,1 ,$668.00 ,$434.20 ,$187.04 ,"$8,678.76 ","$8,678.75 ",$307.28 ,$374.08 ,"$3,471.50 ",$187.04 ,$225.78 ,"$3,471.50 ",$259.85 ,$668.00 ,$301.27 ,$301.27 ,$668.00 ,$266.15 ,$668.00 ,$334.00 ,"$8,678.76 ","$3,471.50 ","$3,471.50 ",$668.00 ,$501.00 ,$400.80 ,$400.80 ,"$3,471.50 ",$400.80 ,$507.68 ,$507.68 ,$507.68 ,$668.00 , N/A ,$567.80 ,$668.00 ,$434.20 ,"$3,471.50 ",$668.00 ,$374.08 ,"$3,471.50 ",$358.43 , N/A ,$668.00 ,$668.00 ,"$3,645.08 ",$534.40 ,"$7,810.88 ",$301.27 ,$187.04 ,$601.20 ,"$3,471.50 ",$507.68 , N/A , N/A ,$668.00 , N/A ,$320.64 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300085,15274,PC APL SKIN SUB TAL>100 ADL 100CM PRO,983,1 ,$153.00 ,$99.45 ,$42.84 ,"$1,518.42 ", N/A ,$70.38 ,$85.68 , N/A ,$42.84 ,$51.71 , N/A ,$59.52 , N/A ,$69.00 ,$69.00 , N/A ,$62.21 , N/A ,$76.50 , N/A , N/A , N/A , N/A ,$114.75 ,$91.80 ,$91.80 , N/A ,$91.80 ,$116.28 ,$116.28 ,$116.28 ,$153.00 , N/A ,$130.05 , N/A ,$99.45 , N/A ,$153.00 ,$85.68 , N/A ,$81.62 , N/A ,$153.00 ,$153.00 , N/A ,$122.40 , N/A ,$69.00 ,$42.84 ,$137.70 , N/A ,$116.28 , N/A , N/A , N/A , N/A ,$73.44 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300086,15275,PC APL SKIN SUB OTH<100 INT 25CM PRO,983,1 ,$308.00 ,$200.20 ,$86.24 ,"$4,221.50 ","$4,221.50 ",$141.68 ,$172.48 ,"$1,688.60 ",$86.24 ,$104.10 ,"$1,688.60 ",$119.81 ,$308.00 ,$138.91 ,$138.91 ,$308.00 ,$122.46 ,$308.00 ,$154.00 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ",$308.00 ,$231.00 ,$184.80 ,$184.80 ,"$1,688.60 ",$184.80 ,$234.08 ,$234.08 ,$234.08 ,$308.00 , N/A ,$261.80 ,$308.00 ,$200.20 ,"$1,688.60 ",$308.00 ,$172.48 ,"$1,688.60 ",$168.42 , N/A ,$308.00 ,$308.00 ,"$1,773.03 ",$246.40 ,"$3,799.34 ",$138.91 ,$86.24 ,$277.20 ,"$1,688.60 ",$234.08 , N/A , N/A ,$308.00 , N/A ,$147.84 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300088,15276,PC APL SKIN SUB OTH<100 ADL 25CM PRO,983,1 ,$87.00 ,$56.55 ,$24.36 ,"$1,518.42 ", N/A ,$40.02 ,$48.72 , N/A ,$24.36 ,$29.41 , N/A ,$33.84 , N/A ,$39.24 ,$39.24 , N/A ,$34.30 , N/A ,$43.50 , N/A , N/A , N/A , N/A ,$65.25 ,$52.20 ,$52.20 , N/A ,$52.20 ,$66.12 ,$66.12 ,$66.12 ,$87.00 , N/A ,$73.95 , N/A ,$56.55 , N/A ,$87.00 ,$48.72 , N/A ,$46.42 , N/A ,$87.00 ,$87.00 , N/A ,$69.60 , N/A ,$39.24 ,$24.36 ,$78.30 , N/A ,$66.12 , N/A , N/A , N/A , N/A ,$41.76 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300089,15277,PC APL SKIN SUB OTH>100 INT 100CM PRO,983,1 ,$759.00 ,$493.35 ,$212.52 ,"$4,221.50 ","$4,221.50 ",$349.14 ,$425.04 ,"$1,688.60 ",$212.52 ,$256.54 ,"$1,688.60 ",$295.25 ,$759.00 ,$342.31 ,$342.31 ,$759.00 ,$302.90 ,$759.00 ,$379.50 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ",$759.00 ,$569.25 ,$455.40 ,$455.40 ,"$1,688.60 ",$455.40 ,$576.84 ,$576.84 ,$576.84 ,$759.00 , N/A ,$645.15 ,$759.00 ,$493.35 ,"$1,688.60 ",$759.00 ,$425.04 ,"$1,688.60 ",$406.38 , N/A ,$759.00 ,$759.00 ,"$1,773.03 ",$607.20 ,"$3,799.34 ",$342.31 ,$212.52 ,$683.10 ,"$1,688.60 ",$576.84 , N/A , N/A ,$759.00 , N/A ,$364.32 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300091,15278,PC APL SKIN SUB OTH>100 ADL 100CM PRO,983,1 ,$194.00 ,$126.10 ,$54.32 ,"$1,518.42 ", N/A ,$89.24 ,$108.64 , N/A ,$54.32 ,$65.57 , N/A ,$75.47 , N/A ,$87.49 ,$87.49 , N/A ,$76.78 , N/A ,$97.00 , N/A , N/A , N/A , N/A ,$145.50 ,$116.40 ,$116.40 , N/A ,$116.40 ,$147.44 ,$147.44 ,$147.44 ,$194.00 , N/A ,$164.90 , N/A ,$126.10 , N/A ,$194.00 ,$108.64 , N/A ,$103.33 , N/A ,$194.00 ,$194.00 , N/A ,$155.20 , N/A ,$87.49 ,$54.32 ,$174.60 , N/A ,$147.44 , N/A , N/A , N/A , N/A ,$93.12 ,"$1,518.42 "
ST. ELIZABETH'S HOSPITAL,98300092,10140,PC I AND D HEMATOMA/SEROMA/FLUID PRO,983,1 ,$376.00 ,$244.40 ,$105.28 ,"$3,467.90 ","$3,467.90 ",$172.96 ,$210.56 ,"$1,387.16 ",$105.28 ,$127.09 ,"$1,387.16 ",$146.26 ,$376.00 ,$169.58 ,$169.58 ,$376.00 ,$151.90 ,$376.00 ,$188.00 ,"$3,467.89 ","$1,387.16 ","$1,387.16 ",$376.00 ,$282.00 ,$225.60 ,$225.60 ,"$1,387.16 ",$225.60 ,$285.76 ,$285.76 ,$285.76 ,$376.00 , N/A ,$319.60 ,$376.00 ,$244.40 ,"$1,387.16 ",$376.00 ,$210.56 ,"$1,387.16 ",$204.99 , N/A ,$376.00 ,$376.00 ,"$1,456.52 ",$300.80 ,"$3,121.10 ",$169.58 ,$105.28 ,$338.40 ,"$1,387.16 ",$285.76 , N/A , N/A ,$376.00 , N/A ,$180.48 ,"$1,004.64 "
ST. ELIZABETH'S HOSPITAL,98300093,16030,PC BURN DRESS  AND /OR DEBRIDE PRO >10%,983,1 ,$436.00 ,$283.40 ,$122.08 ,$851.90 ,$851.90 ,$200.56 ,$244.16 ,$340.76 ,$122.08 ,$147.37 ,$340.76 ,$169.60 ,$340.76 ,$196.64 ,$196.64 ,$340.76 ,$175.05 ,$436.00 ,$218.00 ,$851.90 ,$340.76 ,$340.76 ,$347.57 ,$327.00 ,$261.60 ,$261.60 ,$340.76 ,$261.60 ,$331.36 ,$331.36 ,$331.36 ,$436.00 , N/A ,$370.60 ,$436.00 ,$283.40 ,$340.76 ,$436.00 ,$244.16 ,$340.76 ,$234.51 , N/A ,$149.81 ,$143.00 ,$357.80 ,$348.80 ,$766.71 ,$196.64 ,$122.08 ,$392.40 ,$340.76 ,$331.36 , N/A , N/A ,$340.76 , N/A ,$209.28 ,$136.19 
ST. ELIZABETH'S HOSPITAL,98300094,16025,PC BURN DRESS  AND /OR DEBRIDE PRO 5-10%,983,1 ,$359.00 ,$233.35 ,$100.52 ,$442.60 ,$442.60 ,$165.14 ,$201.04 ,$177.04 ,$100.52 ,$121.34 ,$177.04 ,$139.65 ,$177.04 ,$161.91 ,$161.91 ,$177.04 ,$146.01 ,$336.38 ,$179.50 ,$442.60 ,$177.04 ,$177.04 ,$180.58 ,$269.25 ,$215.40 ,$215.40 ,$177.04 ,$215.40 ,$272.84 ,$272.84 ,$272.84 ,$359.00 , N/A ,$305.15 ,$359.00 ,$233.35 ,$177.04 ,$359.00 ,$201.04 ,$177.04 ,$193.84 , N/A ,$149.81 ,$143.00 ,$185.89 ,$287.20 ,$398.34 ,$161.91 ,$100.52 ,$323.10 ,$177.04 ,$272.84 , N/A , N/A ,$177.04 , N/A ,$172.32 ,$136.19 
ST. ELIZABETH'S HOSPITAL,98300105,96372,PC INJECTION IM/SUBQ PRO,983,1 ,$43.00 ,$27.95 ,$12.04 ,$152.81 ,$152.80 ,$19.78 ,$24.08 ,$61.12 ,$12.04 ,$15.18 ,$61.12 ,$17.72 ,$43.00 ,$19.39 ,$19.39 ,$43.00 ,$17.85 ,$43.00 ,$21.50 ,$152.81 ,$61.12 ,$61.12 ,$43.00 ,$32.25 ,$25.80 ,$25.80 ,$61.12 ,$25.80 ,$32.68 ,$32.68 ,$32.68 ,$43.00 , N/A ,$36.55 ,$43.00 ,$27.95 ,$61.12 ,$43.00 ,$24.08 ,$61.12 ,$25.48 , N/A , N/A , N/A ,$64.18 ,$34.40 ,$137.53 ,$19.39 ,$12.04 ,$38.70 ,$61.12 ,$32.68 , N/A , N/A ,$43.00 , N/A ,$20.64 , N/A 
ST. ELIZABETH'S HOSPITAL,98300124,11730,PC AVULSION NAIL PLATE SINGLE PRO,983,1 ,$174.00 ,$113.10 ,$48.72 ,$442.60 ,$442.60 ,$80.04 ,$97.44 ,$177.04 ,$48.72 ,$58.81 ,$177.04 ,$67.69 ,$174.00 ,$78.47 ,$78.47 ,$174.00 ,$69.41 ,$174.00 ,$87.00 ,$442.60 ,$177.04 ,$177.04 ,$174.00 ,$130.50 ,$104.40 ,$104.40 ,$177.04 ,$104.40 ,$132.24 ,$132.24 ,$132.24 ,$174.00 , N/A ,$147.90 ,$174.00 ,$113.10 ,$177.04 ,$174.00 ,$97.44 ,$177.04 ,$95.86 , N/A ,$174.00 ,$174.00 ,$185.89 ,$139.20 ,$398.34 ,$78.47 ,$48.72 ,$156.60 ,$177.04 ,$132.24 , N/A , N/A ,$174.00 , N/A ,$83.52 ,$275.76 
ST. ELIZABETH'S HOSPITAL,98300143,11721,PC DEBR NAIL(S) 6 OR MORE,983,1 ,$81.00 ,$52.65 ,$22.68 ,$137.20 ,$137.20 ,$37.26 ,$45.36 ,$54.88 ,$22.68 ,$27.38 ,$54.88 ,$31.51 ,$54.88 ,$36.53 ,$36.53 ,$54.88 ,$31.13 ,$81.00 ,$40.50 ,$137.20 ,$54.88 ,$54.88 ,$55.98 ,$60.75 ,$48.60 ,$48.60 ,$54.88 ,$48.60 ,$61.56 ,$61.56 ,$61.56 ,$81.00 , N/A ,$68.85 ,$81.00 ,$52.65 ,$54.88 ,$81.00 ,$45.36 ,$54.88 ,$44.42 , N/A ,$81.00 ,$81.00 ,$57.62 ,$64.80 ,$123.48 ,$36.53 ,$22.68 ,$72.90 ,$54.88 ,$61.56 , N/A , N/A ,$54.88 , N/A ,$38.88 ,$78.63 
ST. ELIZABETH'S HOSPITAL,98300144,11720,PC DEBR NAIL(S) UP TO 5,983,1 ,$47.00 ,$30.55 ,$13.16 ,$137.20 ,$137.20 ,$21.62 ,$26.32 ,$54.88 ,$13.16 ,$15.89 ,$54.88 ,$18.28 ,$47.00 ,$21.20 ,$21.20 ,$47.00 ,$19.58 ,$47.00 ,$23.50 ,$137.20 ,$54.88 ,$54.88 ,$47.00 ,$35.25 ,$28.20 ,$28.20 ,$54.88 ,$28.20 ,$35.72 ,$35.72 ,$35.72 ,$47.00 , N/A ,$39.95 ,$47.00 ,$30.55 ,$54.88 ,$47.00 ,$26.32 ,$54.88 ,$25.95 , N/A ,$47.00 ,$47.00 ,$57.62 ,$37.60 ,$123.48 ,$21.20 ,$13.16 ,$42.30 ,$54.88 ,$35.72 , N/A , N/A ,$47.00 , N/A ,$22.56 ,$78.63 
ST. ELIZABETH'S HOSPITAL,98300147,11106,PC BIOPSY SKIN INCISIONAL INIT LESN,983,1 ,$186.00 ,$120.90 ,$52.08 ,"$1,290.85 ","$1,290.85 ",$85.56 ,$104.16 ,$516.34 ,$52.08 ,$62.87 ,$516.34 ,$72.35 ,$186.00 ,$83.89 ,$83.89 ,$186.00 ,$73.60 ,$186.00 ,$93.00 ,"$1,290.85 ",$516.34 ,$516.34 ,$186.00 ,$139.50 ,$111.60 ,$111.60 ,$516.34 ,$111.60 ,$141.36 ,$141.36 ,$141.36 ,$186.00 , N/A ,$158.10 ,$186.00 ,$120.90 ,$516.34 ,$186.00 ,$104.16 ,$516.34 ,$102.45 , N/A ,$186.00 ,$186.00 ,$542.16 ,$148.80 ,"$1,161.77 ",$83.89 ,$52.08 ,$167.40 ,$516.34 ,$141.36 , N/A , N/A ,$186.00 , N/A ,$89.28 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98300150,11107,PC BIOPSY SKIN INCISIONAL ADDL LESN,983,1 ,$100.00 ,$65.00 ,$28.00 ,$617.74 , N/A ,$46.00 ,$56.00 , N/A ,$28.00 ,$33.80 , N/A ,$38.90 , N/A ,$45.10 ,$45.10 , N/A ,$40.61 , N/A ,$50.00 , N/A , N/A , N/A , N/A ,$75.00 ,$60.00 ,$60.00 , N/A ,$60.00 ,$76.00 ,$76.00 ,$76.00 ,$100.00 , N/A ,$85.00 , N/A ,$65.00 , N/A ,$100.00 ,$56.00 , N/A ,$55.17 , N/A ,$100.00 ,$100.00 , N/A ,$80.00 , N/A ,$45.10 ,$28.00 ,$90.00 , N/A ,$76.00 , N/A , N/A , N/A , N/A ,$48.00 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98300154,G8427,PC DOC MEDS VERIFIED W/PT OR RE,983,1 ,$1.00 ,$0.65 ,$0.28 ,$1.00 , N/A ,$0.46 ,$0.56 , N/A ,$0.28 ,$0.34 , N/A ,$0.39 , N/A ,$0.45 ,$0.45 , N/A ,$0.65 , N/A ,$0.50 , N/A , N/A , N/A , N/A ,$0.75 ,$0.60 ,$0.60 , N/A ,$0.60 ,$0.76 ,$0.76 ,$0.76 ,$1.00 , N/A ,$0.85 , N/A ,$0.65 , N/A ,$1.00 ,$0.56 , N/A ,$0.70 , N/A , N/A , N/A , N/A ,$0.80 , N/A ,$0.45 ,$0.28 ,$0.90 , N/A ,$0.76 , N/A , N/A , N/A , N/A ,$0.48 , N/A 
ST. ELIZABETH'S HOSPITAL,98300155,4004F,PC SCREENED TOBACCO USE  AND  REC'D TOBACCO CESSATION INTERV,983,1 ,$1.00 ,$0.65 ,$0.28 ,$1.00 , N/A ,$0.46 ,$0.56 , N/A ,$0.28 ,$0.34 , N/A ,$0.39 , N/A ,$0.45 ,$0.45 , N/A ,$0.65 , N/A ,$0.50 , N/A , N/A , N/A , N/A ,$0.75 ,$0.60 ,$0.60 , N/A ,$0.60 ,$0.76 ,$0.76 ,$0.76 ,$1.00 , N/A ,$0.85 , N/A ,$0.65 , N/A ,$1.00 ,$0.56 , N/A ,$0.70 , N/A , N/A , N/A , N/A ,$0.80 , N/A ,$0.45 ,$0.28 ,$0.90 , N/A ,$0.76 , N/A , N/A , N/A , N/A ,$0.48 , N/A 
ST. ELIZABETH'S HOSPITAL,98300156,97602,PC DEBRIDEMENT NONSELECTIVE,983,1 ,$118.00 ,$76.70 ,$33.04 ,$442.60 ,$442.60 ,$54.28 ,$66.08 ,$177.04 ,$33.04 ,$41.65 ,$177.04 ,$48.62 ,$118.00 ,$53.22 ,$53.22 ,$118.00 ,$76.70 ,$118.00 ,$59.00 ,$442.60 ,$177.04 ,$177.04 ,$118.00 ,$88.50 ,$70.80 ,$70.80 ,$177.04 ,$70.80 ,$89.68 ,$89.68 ,$89.68 ,$118.00 , N/A ,$100.30 ,$118.00 ,$76.70 ,$177.04 ,$118.00 ,$66.08 ,$177.04 ,$82.60 , N/A ,$118.00 ,$118.00 ,$185.89 ,$94.40 ,$398.34 ,$53.22 ,$33.04 ,$106.20 ,$177.04 ,$89.68 , N/A , N/A ,$118.00 , N/A ,$56.64 ,$275.76 
ST. ELIZABETH'S HOSPITAL,98300157,69100,PC BIOPSY EXTERNAL EAR,983,1 ,$153.00 ,$99.45 ,$42.84 ,$617.74 ,$521.45 ,$70.38 ,$85.68 ,$208.58 ,$42.84 ,$51.71 ,$208.58 ,$59.52 ,$153.00 ,$69.00 ,$69.00 ,$153.00 ,$60.25 ,$153.00 ,$76.50 ,$521.44 ,$208.58 ,$208.58 ,$153.00 ,$114.75 ,$91.80 ,$91.80 ,$208.58 ,$91.80 ,$116.28 ,$116.28 ,$116.28 ,$153.00 , N/A ,$130.05 ,$153.00 ,$99.45 ,$208.58 ,$153.00 ,$85.68 ,$208.58 ,$83.30 , N/A ,$153.00 ,$153.00 ,$219.01 ,$122.40 ,$469.30 ,$69.00 ,$42.84 ,$137.70 ,$208.58 ,$116.28 , N/A , N/A ,$153.00 , N/A ,$73.44 ,$617.74 
ST. ELIZABETH'S HOSPITAL,98300158,20240,PC BX BN EXCISIONAL,983,1 ,$472.00 ,$306.80 ,$132.16 ,"$5,843.93 ","$5,843.93 ",$217.12 ,$264.32 ,"$2,337.57 ",$132.16 ,$159.54 ,"$2,337.57 ",$183.61 ,$472.00 ,$212.87 ,$212.87 ,$472.00 ,$185.30 ,$472.00 ,$236.00 ,"$5,843.93 ","$2,337.57 ","$2,337.57 ",$472.00 ,$354.00 ,$283.20 ,$283.20 ,"$2,337.57 ",$283.20 ,$358.72 ,$358.72 ,$358.72 ,$472.00 , N/A ,$401.20 ,$472.00 ,$306.80 ,"$2,337.57 ",$472.00 ,$264.32 ,"$2,337.57 ",$257.34 , N/A ,$472.00 ,$472.00 ,"$2,454.45 ",$377.60 ,"$5,259.53 ",$212.87 ,$132.16 ,$424.80 ,"$2,337.57 ",$358.72 , N/A , N/A ,$472.00 , N/A ,$226.56 ,"$1,235.48 "
ST. ELIZABETH'S HOSPITAL,98500000,93010,PC EKG INTER AND REPORT PRO,985,1 ,$66.59 ,$43.28 ,$10.51 ,$66.59 , N/A ,$30.63 ,$37.29 , N/A ,$18.65 ,$23.51 , N/A ,$27.44 , N/A ,$30.03 ,$30.03 , N/A ,$10.51 , N/A ,$33.30 , N/A , N/A , N/A , N/A ,$49.94 ,$39.95 ,$39.95 , N/A ,$39.95 ,$50.61 ,$50.61 ,$50.61 ,$66.59 , N/A ,$56.60 , N/A ,$43.28 , N/A ,$66.59 ,$37.29 , N/A ,$15.74 , N/A ,$27.16 ,$25.92 , N/A ,$53.27 , N/A ,$30.03 ,$18.65 ,$59.93 , N/A ,$50.61 , N/A , N/A , N/A , N/A ,$31.96 ,$24.69 
ST. ELIZABETH'S HOSPITAL,98800024,99251,HC INPATIENT CONSULT NEW/ESTAB PT 20 MIN,988,1 ,$156.69 ,$101.85 ,$43.87 ,$156.69 , N/A ,$72.08 ,$87.75 , N/A ,$43.87 ,$55.31 , N/A ,$64.56 , N/A ,$70.67 ,$70.67 , N/A ,$101.85 , N/A ,$78.35 , N/A , N/A , N/A , N/A ,$117.52 ,$94.01 ,$94.01 , N/A ,$94.01 ,$119.08 ,$119.08 ,$119.08 ,$156.69 , N/A ,$133.19 , N/A ,$101.85 , N/A ,$156.69 ,$87.75 , N/A ,$64.70 , N/A , N/A , N/A , N/A ,$125.35 , N/A ,$70.67 ,$43.87 ,$141.02 , N/A ,$119.08 , N/A , N/A , N/A , N/A ,$75.21 , N/A 
ST. ELIZABETH'S HOSPITAL,98800025,99252,HC INPATIENT CONSULT NEW/ESTAB PT 40 MIN,988,1 ,$235.80 ,$153.27 ,$66.02 ,$235.80 , N/A ,$108.47 ,$132.05 , N/A ,$66.02 ,$83.24 , N/A ,$97.15 , N/A ,$106.35 ,$106.35 , N/A ,$153.27 , N/A ,$117.90 , N/A , N/A , N/A , N/A ,$176.85 ,$141.48 ,$141.48 , N/A ,$141.48 ,$179.21 ,$179.21 ,$179.21 ,$235.80 , N/A ,$200.43 , N/A ,$153.27 , N/A ,$235.80 ,$132.05 , N/A ,$97.37 , N/A , N/A , N/A , N/A ,$188.64 , N/A ,$106.35 ,$66.02 ,$212.22 , N/A ,$179.21 , N/A , N/A , N/A , N/A ,$113.18 , N/A 
ST. ELIZABETH'S HOSPITAL,98800026,99253,HC INPATIENT CONSULT NEW/ESTAB PT 55 MIN,988,1 ,$364.74 ,$237.08 ,$102.13 ,$364.74 , N/A ,$167.78 ,$204.25 , N/A ,$102.13 ,$128.75 , N/A ,$150.27 , N/A ,$164.50 ,$164.50 , N/A ,$237.08 , N/A ,$182.37 , N/A , N/A , N/A , N/A ,$273.56 ,$218.84 ,$218.84 , N/A ,$218.84 ,$277.20 ,$277.20 ,$277.20 ,$364.74 , N/A ,$310.03 , N/A ,$237.08 , N/A ,$364.74 ,$204.25 , N/A ,$150.34 , N/A , N/A , N/A , N/A ,$291.79 , N/A ,$164.50 ,$102.13 ,$328.27 , N/A ,$277.20 , N/A , N/A , N/A , N/A ,$175.08 , N/A 
ST. ELIZABETH'S HOSPITAL,98800027,99254,HC INPATIENT CONSULT NEW/ESTAB PT 80 MIN,988,1 ,$531.63 ,$345.56 ,$148.86 ,$531.63 , N/A ,$244.55 ,$297.71 , N/A ,$148.86 ,$187.67 , N/A ,$219.03 , N/A ,$239.77 ,$239.77 , N/A ,$345.56 , N/A ,$265.82 , N/A , N/A , N/A , N/A ,$398.72 ,$318.98 ,$318.98 , N/A ,$318.98 ,$404.04 ,$404.04 ,$404.04 ,$531.63 , N/A ,$451.89 , N/A ,$345.56 , N/A ,$531.63 ,$297.71 , N/A ,$218.93 , N/A , N/A , N/A , N/A ,$425.30 , N/A ,$239.77 ,$148.86 ,$478.47 , N/A ,$404.04 , N/A , N/A , N/A , N/A ,$255.18 , N/A 
ST. ELIZABETH'S HOSPITAL,98800028,99255,HC INPATIENT CONSULT NEW/ESTAB PT 110 MIN,988,1 ,$639.18 ,$415.47 ,$178.97 ,$639.18 , N/A ,$294.02 ,$357.94 , N/A ,$178.97 ,$225.63 , N/A ,$263.34 , N/A ,$288.27 ,$288.27 , N/A ,$415.47 , N/A ,$319.59 , N/A , N/A , N/A , N/A ,$479.39 ,$383.51 ,$383.51 , N/A ,$383.51 ,$485.78 ,$485.78 ,$485.78 ,$639.18 , N/A ,$543.30 , N/A ,$415.47 , N/A ,$639.18 ,$357.94 , N/A ,$263.38 , N/A , N/A , N/A , N/A ,$511.34 , N/A ,$288.27 ,$178.97 ,$575.26 , N/A ,$485.78 , N/A , N/A , N/A , N/A ,$306.81 , N/A 
ST. ELIZABETH'S HOSPITAL,99000002,N/A,HC BOOKS AND PAMPHLETS ALL TYPES,990,1 ,$13.00 ,$8.45 ,$3.42 ,$13.00 , N/A ,$5.98 ,$7.28 , N/A ,$3.64 ,$4.39 , N/A ,$5.06 , N/A ,$5.86 ,$5.86 , N/A ,$5.86 , N/A ,$6.50 , N/A , N/A , N/A , N/A ,$9.75 ,$7.80 ,$7.80 , N/A ,$7.80 ,$9.88 ,$9.88 ,$9.88 ,$13.00 , N/A ,$11.05 , N/A ,$8.45 , N/A ,$13.00 ,$7.28 , N/A ,$3.42 , N/A , N/A , N/A , N/A ,$10.40 , N/A ,$5.86 ,$3.64 ,$11.70 , N/A ,$9.88 , N/A , N/A , N/A , N/A ,$6.24 , N/A