ST. JOSEPH'S HOSPITAL - BREESE - Price Transparency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Site,Svc_Cd,HCPC/Cpt_Cd,CDM_Svc_Descr,Rev_Cd, Quantity/Units , Hopsital_Cdm_Chg , Self_Pay_Chg , Minimum_Negotiated_Chg , Maximum_Negotiated_Chg ," 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 ," ESSENCE, L.L.P. ", FIRST HEALTH NETWORK , HEALTH ALLIANCE MEDICAL PLAN EXCHANGE ," HEALTH ALLIANCE MEDICAL PLANS, INC. ", HEALTH ALLIANCE MEDICARE , HEALTH ALLIANCE PPO , HEALTHLINK , HEALTHLINK CASINO QUEEN , HEALTHLINK PPO , HEARTLAND HOSPICE , HOPETRUST , HUMANA , HUMANA MEDICARE , ILLINOIS BREAST AND CERVICAL CANCER PROGRAM , LIVE360 HSHS HEALTHY PLAN , LIVE360 MEDICARE COST PLAN , LIVE360 NON HSHS HEALTHY PLAN , 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 , WELLFIRST , WEXFORD HEALTH SOURCES 
ST. JOSEPH'S HOSPITAL - BREESE,N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$39,336.51 ","$7,953.57 ","$196,023.83 ","$196,023.83 ","$39,336.51 ","$36,129.07 ","$76,841.34 ","$16,944.96 ","$60,517.70 ","$76,841.34 ","$60,517.70 ","$59,307.35 ","$13,065.00 ","$13,065.00 ","$59,307.35 ","$13,065.00 ","$59,307.35 ","$33,284.74 ","$60,517.70 ","$76,841.34 ","$76,841.34 ","$45,388.28 ","$30,258.85 ","$30,258.85 ","$76,841.34 ","$30,258.85 ","$41,152.04 ","$41,152.04 ","$41,152.04 ", N/A ,"$60,517.70 ","$51,440.05 ","$76,841.34 ", N/A ,"$36,129.07 ","$76,841.34 ","$25,175.36 ","$8,748.93 ","$7,953.57 ","$76,841.34 ","$48,414.16 ","$60,517.70 ","$13,065.00 ","$16,944.96 ","$54,465.93 ","$76,841.34 ","$41,152.04 ","$60,517.70 ","$60,517.70 ","$76,841.34 ","$39,336.51 ","$60,517.70 "
ST. JOSEPH'S HOSPITAL - BREESE,N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$9,948.71 ","$1,742.00 ","$50,910.43 ","$50,910.43 ","$9,948.71 ","$9,137.50 ","$20,364.17 ","$4,285.60 ","$10,954.10 ","$20,364.17 ","$10,954.10 ","$15,305.70 ","$1,742.00 ","$1,742.00 ","$15,305.70 ","$1,742.00 ","$15,305.70 ","$8,418.14 ","$15,305.70 ","$20,364.17 ","$20,364.17 ","$11,479.28 ","$7,652.85 ","$7,652.85 ","$20,364.17 ","$7,652.85 ","$15,305.70 ","$15,305.70 ","$15,305.70 ", N/A ,"$15,305.70 ","$13,009.85 ","$20,364.17 ", N/A ,"$9,137.50 ","$20,364.17 ","$6,367.17 ","$2,623.91 ","$2,385.37 ","$20,364.17 ","$12,244.56 ","$15,305.70 ","$1,742.00 ","$4,285.60 ","$13,775.13 ","$20,364.17 ","$15,305.70 ","$15,305.70 ","$15,305.70 ","$20,364.17 ","$9,948.71 ","$15,305.70 "
ST. JOSEPH'S HOSPITAL - BREESE,N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$7,445.85 ","$1,742.00 ","$38,553.03 ","$38,553.03 ","$7,445.85 ","$6,838.73 ","$15,421.21 ","$3,207.44 ","$10,954.10 ","$15,421.21 ","$10,954.10 ","$11,455.16 ","$1,742.00 ","$1,742.00 ","$11,455.16 ","$1,742.00 ","$11,455.16 ","$6,300.34 ","$11,455.16 ","$15,421.21 ","$15,421.21 ","$8,591.37 ","$5,727.58 ","$5,727.58 ","$15,421.21 ","$5,727.58 ","$11,455.16 ","$11,455.16 ","$11,455.16 ", N/A ,"$11,455.16 ","$9,736.89 ","$15,421.21 ", N/A ,"$6,838.73 ","$15,421.21 ","$4,765.35 ","$2,623.91 ","$2,385.37 ","$15,421.21 ","$9,164.13 ","$11,455.16 ","$1,742.00 ","$3,207.44 ","$10,309.64 ","$15,421.21 ","$11,455.16 ","$11,455.16 ","$11,455.16 ","$15,421.21 ","$7,445.85 ","$11,455.16 "
ST. JOSEPH'S HOSPITAL - BREESE,N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$15,401.47 ","$2,385.37 ","$77,836.58 ","$77,836.58 ","$15,401.47 ","$14,145.66 ","$30,511.94 ","$6,634.48 ","$16,431.15 ","$30,511.94 ","$16,431.15 ","$23,220.68 ","$2,613.00 ","$2,613.00 ","$23,220.68 ","$2,613.00 ","$23,220.68 ","$13,032.01 ","$23,694.57 ","$30,511.94 ","$30,511.94 ","$17,770.93 ","$11,847.29 ","$11,847.29 ","$30,511.94 ","$11,847.29 ","$23,694.57 ","$23,694.57 ","$23,694.57 ", N/A ,"$23,694.57 ","$20,140.38 ","$30,511.94 ", N/A ,"$14,145.66 ","$30,511.94 ","$9,856.94 ","$2,623.91 ","$2,385.37 ","$30,511.94 ","$18,955.66 ","$23,694.57 ","$2,613.00 ","$6,634.48 ","$21,325.11 ","$30,511.94 ","$23,694.57 ","$23,694.57 ","$23,694.57 ","$30,511.94 ","$15,401.47 ","$23,694.57 "
ST. JOSEPH'S HOSPITAL - BREESE,N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$4,438.60 ","$1,742.00 ","$23,703.70 ","$23,703.70 ","$4,438.60 ","$4,076.68 ","$9,481.48 ","$1,912.01 ","$6,828.61 ","$9,481.48 ","$6,828.61 ","$6,828.61 ","$1,742.00 ","$1,742.00 ","$6,828.61 ","$1,742.00 ","$6,828.61 ","$3,755.74 ","$6,828.61 ","$9,481.48 ","$9,481.48 ","$5,121.46 ","$3,414.31 ","$3,414.31 ","$9,481.48 ","$3,414.31 ","$6,828.61 ","$6,828.61 ","$6,828.61 ", N/A ,"$6,828.61 ","$5,804.32 ","$9,481.48 ", N/A ,"$4,076.68 ","$9,481.48 ","$2,840.70 ","$2,623.91 ","$2,385.37 ","$9,481.48 ","$5,462.89 ","$6,828.61 ","$1,742.00 ","$1,912.01 ","$6,145.75 ","$9,481.48 ","$6,828.61 ","$6,828.61 ","$6,828.61 ","$9,481.48 ","$4,438.60 ","$6,828.61 "
ST. JOSEPH'S HOSPITAL - BREESE,12000001,N/A,HC DAILY SERVICE GENERAL,120,1 ,$957.00 ,$622.05 ,$267.96 ,$957.00 , Inpatient Medicare +150% ,$622.05 ,$571.33 , Inpatient Medicare ,$267.96 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$526.35 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$717.75 ,$478.50 ,$478.50 , Inpatient Medicare ,$478.50 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,$813.45 , Inpatient Medicare , N/A ,$571.33 , Inpatient Medicare ,$398.11 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$765.00 , Inpatient Medicare +90% ,$871.00 ,$267.96 ,$861.30 , Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,$622.05 ,$957.00 
ST. JOSEPH'S HOSPITAL - BREESE,12000002,N/A,HC DAILY SERVICE SWING BED,120,1 ,$468.00 ,$304.20 ,$131.04 ,$468.00 , Inpatient Medicare +150% ,$304.20 ,$279.40 , Inpatient Medicare ,$131.04 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$257.40 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$351.00 ,$234.00 ,$234.00 , Inpatient Medicare ,$234.00 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,$397.80 , Inpatient Medicare , N/A ,$279.40 , Inpatient Medicare ,$194.69 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$374.40 , Inpatient Medicare +90% ,$871.00 ,$131.04 ,$421.20 , Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,$304.20 ,$468.00 
ST. JOSEPH'S HOSPITAL - BREESE,12000006,N/A,HC DAILY SERVICE W/TELEMETRY,120,1 ,"$2,334.00 ","$1,517.10 ",$653.52 ,"$2,334.00 ", Inpatient Medicare +150% ,"$1,517.10 ","$1,393.40 ", Inpatient Medicare ,$653.52 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,"$1,283.70 ", Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,"$1,750.50 ","$1,167.00 ","$1,167.00 ", Inpatient Medicare ,"$1,167.00 ","$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,"$1,983.90 ", Inpatient Medicare , N/A ,"$1,393.40 ", Inpatient Medicare ,$970.94 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,"$1,867.20 ", Inpatient Medicare +90% ,$871.00 ,$653.52 ,"$2,100.60 ", Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,"$1,517.10 ","$2,334.00 "
ST. JOSEPH'S HOSPITAL - BREESE,12100001,N/A,HC DAILY SERVICE,121,1 ,$929.00 ,$603.85 ,$260.12 ,$929.00 , Inpatient Medicare +150% ,$603.85 ,$554.61 , Inpatient Medicare ,$260.12 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$510.95 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$696.75 ,$464.50 ,$464.50 , Inpatient Medicare ,$464.50 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,$789.65 , Inpatient Medicare , N/A ,$554.61 , Inpatient Medicare ,$386.46 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$743.20 , Inpatient Medicare +90% ,$871.00 ,$260.12 ,$836.10 , Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,$603.85 ,$929.00 
ST. JOSEPH'S HOSPITAL - BREESE,12200001,N/A,HC DAILY SERVICE OBSTETRICS,122,1 ,$957.00 ,$622.05 ,$267.96 ,$957.00 , Inpatient Medicare +150% ,$622.05 ,$571.33 , Inpatient Medicare ,$267.96 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$526.35 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$717.75 ,$478.50 ,$478.50 , Inpatient Medicare ,$478.50 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,$813.45 , Inpatient Medicare , N/A ,$571.33 , Inpatient Medicare ,$398.11 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$765.00 , Inpatient Medicare +90% ,$871.00 ,$267.96 ,$861.30 , Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,$622.05 ,$957.00 
ST. JOSEPH'S HOSPITAL - BREESE,12300001,N/A,HC DAILY PEDIATRIC,123,1 ,$957.00 ,$622.05 ,$267.96 ,$957.00 , Inpatient Medicare +150% ,$622.05 ,$571.33 , Inpatient Medicare ,$267.96 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$526.35 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$717.75 ,$478.50 ,$478.50 , Inpatient Medicare ,$478.50 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,$813.45 , Inpatient Medicare , N/A ,$571.33 , Inpatient Medicare ,$398.11 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$765.00 , Inpatient Medicare +90% ,$871.00 ,$267.96 ,$861.30 , Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,$622.05 ,$957.00 
ST. JOSEPH'S HOSPITAL - BREESE,12500001,N/A,HC DAILY HOSPICE ACUTE CARE,125,1 ,$929.00 ,$603.85 ,$260.12 ,$929.00 , Inpatient Medicare +150% ,$603.85 ,$554.61 , Inpatient Medicare ,$260.12 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$510.95 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$696.75 ,$464.50 ,$464.50 , Inpatient Medicare ,$464.50 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,$789.65 , Inpatient Medicare , N/A ,$554.61 , Inpatient Medicare ,$386.46 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$743.20 , Inpatient Medicare +90% ,$871.00 ,$260.12 ,$836.10 , Inpatient Medicare ,"$9,287.00 ","$1,000.00 ","$1,000.00 ", Inpatient Medicare ,$603.85 ,$929.00 
ST. JOSEPH'S HOSPITAL - BREESE,17000001,N/A,HC DAILY SERVICE NURSERY,170,1 ,$683.00 ,$443.95 ,$191.24 ,$683.00 , Inpatient Medicare +150% ,$443.95 ,$407.75 , Inpatient Medicare ,$191.24 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$375.65 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$512.25 ,$341.50 ,$341.50 , Inpatient Medicare ,$341.50 ,$606.00 ,$606.00 ,$606.00 , N/A , Inpatient Medicare +150% ,$580.55 , Inpatient Medicare , N/A ,$407.75 , Inpatient Medicare ,$284.13 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$546.40 , Inpatient Medicare +90% ,$871.00 ,$191.24 ,$614.70 , Inpatient Medicare ,$606.00 ,$671.00 ,$671.00 , Inpatient Medicare ,$443.95 ,$683.00 
ST. JOSEPH'S HOSPITAL - BREESE,17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,$869.00 ,$564.85 ,$243.32 ,$869.00 , Inpatient Medicare +150% ,$564.85 ,$518.79 , Inpatient Medicare ,$243.32 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$871.00 ,$871.00 , Inpatient Medicare ,$871.00 , Inpatient Medicare +90% ,$477.95 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,$651.75 ,$434.50 ,$434.50 , Inpatient Medicare ,$434.50 ,$606.00 ,$606.00 ,$606.00 , N/A , Inpatient Medicare +150% ,$695.20 , Inpatient Medicare , N/A ,$518.79 , Inpatient Medicare ,$361.50 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,$695.20 , Inpatient Medicare +90% ,$871.00 ,$243.32 ,$782.10 , Inpatient Medicare ,$606.00 ,$671.00 ,$671.00 , Inpatient Medicare ,$564.85 ,$869.00 
ST. JOSEPH'S HOSPITAL - BREESE,17200002,N/A,HC DAILY INFANT SERVICE LEV 2,172,1 ,"$1,982.00 ","$1,288.30 ",$554.96 ,"$1,982.00 ", Inpatient Medicare +150% ,"$1,288.30 ","$1,183.25 ", Inpatient Medicare ,$554.96 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,$591.00 ,$591.00 , Inpatient Medicare ,$591.00 , Inpatient Medicare +90% ,"$1,090.10 ", Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,"$1,486.50 ",$991.00 ,$991.00 , Inpatient Medicare ,$991.00 ,$606.00 ,$606.00 ,$606.00 , N/A , Inpatient Medicare +150% ,"$1,684.70 ", Inpatient Medicare , N/A ,"$1,183.25 ", Inpatient Medicare ,$824.51 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,"$1,585.60 ", Inpatient Medicare +90% ,$591.00 ,$554.96 ,"$1,783.80 ", Inpatient Medicare ,$606.00 ,"$1,000.00 ","$1,000.00 ", Inpatient Medicare ,"$1,288.30 ","$1,982.00 "
ST. JOSEPH'S HOSPITAL - BREESE,20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$1,982.00 ","$1,288.30 ",$554.96 ,"$1,982.00 ", Inpatient Medicare +150% ,"$1,288.30 ","$1,183.25 ", Inpatient Medicare ,$554.96 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,"$1,183.00 ","$1,183.00 ", Inpatient Medicare ,"$1,183.00 ", Inpatient Medicare +90% ,"$1,090.10 ", Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,"$1,486.50 ",$991.00 ,$991.00 , Inpatient Medicare ,$991.00 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,"$1,684.70 ", Inpatient Medicare , N/A ,"$1,183.25 ", Inpatient Medicare ,$824.51 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,"$1,585.60 ", Inpatient Medicare +90% ,"$1,183.00 ",$554.96 ,"$1,783.80 ", Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,"$1,288.30 ","$1,982.00 "
ST. JOSEPH'S HOSPITAL - BREESE,20600002,N/A,HC DAILY SERVICE IMCU,206,1 ,"$1,681.00 ","$1,092.65 ",$470.68 ,"$1,681.00 ", Inpatient Medicare +150% ,"$1,092.65 ","$1,003.56 ", Inpatient Medicare ,$470.68 ,"$5,477.05 ", Inpatient Medicare ,"$5,477.05 ", Inpatient Medicare ,"$1,183.00 ","$1,183.00 ", Inpatient Medicare ,"$1,183.00 ", Inpatient Medicare +90% ,$924.55 , Inpatient Medicare +150% , Inpatient Medicare , Inpatient Medicare ,"$1,260.75 ",$840.50 ,$840.50 , Inpatient Medicare ,$840.50 ,"$9,287.00 ","$9,287.00 ","$9,287.00 ", N/A , Inpatient Medicare +150% ,"$1,428.85 ", Inpatient Medicare , N/A ,"$1,003.56 ", Inpatient Medicare ,$699.30 , Inpatient Medicaid +10% , Inpatient Medicaid , Inpatient Medicare ,"$1,344.80 ", Inpatient Medicare +90% ,"$1,183.00 ",$470.68 ,"$1,512.90 ", Inpatient Medicare ,"$9,287.00 ","$9,000.00 ","$9,000.00 ", Inpatient Medicare ,"$1,092.65 ","$1,681.00 "
ST. JOSEPH'S HOSPITAL - BREESE,26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$332.00 ,$215.80 ,$92.96 ,$504.21 ,$504.20 ,$215.80 ,$198.20 ,$201.68 ,$92.96 ,$186.25 ,$201.68 ,$218.46 ,$201.68 ,$282.20 ,$282.20 ,$201.68 ,$282.20 ,$332.00 ,$225.76 ,$504.21 ,$201.68 ,$201.68 ,$249.00 ,$235.72 ,$235.72 ,$201.68 ,$235.72 ,$272.24 ,$272.24 ,$272.24 , N/A ,$332.00 ,$282.20 ,$201.68 ,$332.00 ,$198.20 ,$201.68 ,$138.11 ,$227.81 ,$207.10 ,$201.68 ,$282.20 ,$423.54 ,$282.20 ,$92.96 ,$298.80 ,$201.68 ,$272.24 ,$280.54 ,$280.54 ,$201.68 ,$215.80 ,$332.00 
ST. JOSEPH'S HOSPITAL - BREESE,26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$55.00 ,$35.75 ,$15.40 ,$98.63 ,$98.63 ,$35.75 ,$32.84 ,$39.45 ,$15.40 ,$30.86 ,$39.45 ,$36.19 ,$39.45 ,$46.75 ,$46.75 ,$39.45 ,$46.75 ,$55.00 ,$37.40 ,$98.63 ,$39.45 ,$39.45 ,$41.25 ,$39.05 ,$39.05 ,$39.45 ,$39.05 ,$45.10 ,$45.10 ,$45.10 , N/A ,$55.00 ,$46.75 ,$39.45 ,$55.00 ,$32.84 ,$39.45 ,$22.88 ,$55.00 ,$55.00 ,$39.45 ,$46.75 ,$82.85 ,$46.75 ,$15.40 ,$49.50 ,$39.45 ,$45.10 ,$46.48 ,$46.48 ,$39.45 ,$35.75 ,$55.00 
ST. JOSEPH'S HOSPITAL - BREESE,26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$551.00 ,$358.15 ,$154.28 ,$551.00 ,$504.20 ,$358.15 ,$328.95 ,$201.68 ,$154.28 ,$309.11 ,$201.68 ,$362.56 ,$201.68 ,$468.35 ,$468.35 ,$201.68 ,$468.35 ,$383.20 ,$374.68 ,$504.21 ,$201.68 ,$201.68 ,$413.25 ,$391.21 ,$391.21 ,$201.68 ,$391.21 ,$451.82 ,$451.82 ,$451.82 , N/A ,$504.21 ,$468.35 ,$201.68 ,$551.00 ,$328.95 ,$201.68 ,$229.22 ,$227.81 ,$207.10 ,$201.68 ,$468.35 ,$423.54 ,$468.35 ,$154.28 ,$495.90 ,$201.68 ,$451.82 ,$465.60 ,$465.60 ,$201.68 ,$358.15 ,$551.00 
ST. JOSEPH'S HOSPITAL - BREESE,26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$86.00 ,$55.90 ,$24.08 ,$98.63 ,$98.63 ,$55.90 ,$51.34 ,$39.45 ,$24.08 ,$48.25 ,$39.45 ,$56.59 ,$39.45 ,$73.10 ,$73.10 ,$39.45 ,$73.10 ,$74.96 ,$58.48 ,$98.63 ,$39.45 ,$39.45 ,$64.50 ,$61.06 ,$61.06 ,$39.45 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$86.00 ,$73.10 ,$39.45 ,$86.00 ,$51.34 ,$39.45 ,$35.78 ,$86.00 ,$86.00 ,$39.45 ,$73.10 ,$82.85 ,$73.10 ,$24.08 ,$77.40 ,$39.45 ,$70.52 ,$72.67 ,$72.67 ,$39.45 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$118.00 ,$76.70 ,$33.04 ,$152.81 ,$152.80 ,$76.70 ,$70.45 ,$61.12 ,$33.04 ,$66.20 ,$61.12 ,$77.64 ,$61.12 ,$100.30 ,$100.30 ,$61.12 ,$100.30 ,$116.14 ,$80.24 ,$152.81 ,$61.12 ,$61.12 ,$88.50 ,$83.78 ,$83.78 ,$61.12 ,$83.78 ,$96.76 ,$96.76 ,$96.76 , N/A ,$118.00 ,$100.30 ,$61.12 ,$118.00 ,$70.45 ,$61.12 ,$49.09 ,$118.00 ,$118.00 ,$61.12 ,$100.30 ,$128.36 ,$100.30 ,$33.04 ,$106.20 ,$61.12 ,$96.76 ,$99.71 ,$99.71 ,$61.12 ,$76.70 ,$118.00 
ST. JOSEPH'S HOSPITAL - BREESE,26000005,96368,HC INFUS CONCURRENT,260,1 ,$118.00 ,$76.70 ,$33.04 ,$118.00 , N/A ,$76.70 ,$70.45 , N/A ,$33.04 ,$66.20 , N/A ,$77.64 , N/A ,$100.30 ,$100.30 , N/A ,$100.30 , N/A ,$80.24 , N/A , N/A , N/A ,$88.50 ,$83.78 ,$83.78 , N/A ,$83.78 ,$96.76 ,$96.76 ,$96.76 , N/A , N/A ,$100.30 , N/A ,$118.00 ,$70.45 , N/A ,$49.09 ,$118.00 ,$118.00 , N/A ,$100.30 , N/A ,$100.30 ,$33.04 ,$106.20 , N/A ,$96.76 ,$99.71 ,$99.71 , N/A ,$76.70 ,$118.00 
ST. JOSEPH'S HOSPITAL - BREESE,26000015,M0243,"HC INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB ADMINISTRATION",260,1 ,$930.00 ,$604.50 ,$207.10 ,"$1,087.20 ","$1,087.20 ",$604.50 ,$555.21 ,$434.88 ,$260.40 ,$521.73 ,$434.88 ,$611.94 ,$434.88 ,$790.50 ,$790.50 ,$434.88 ,$790.50 ,$826.27 ,$450.00 ,"$1,087.19 ",$434.88 ,$434.88 ,$697.50 ,$660.30 ,$660.30 ,$434.88 ,$660.30 ,$762.60 ,$762.60 ,$762.60 , N/A ,$930.00 ,$790.50 ,$434.88 ,$930.00 ,$555.21 ,$434.88 ,$386.88 ,$227.81 ,$207.10 ,$434.88 ,$790.50 ,$913.24 ,$790.50 ,$260.40 ,$837.00 ,$434.88 ,$762.60 ,$785.85 ,$785.85 ,$434.88 ,$604.50 ,$930.00 
ST. JOSEPH'S HOSPITAL - BREESE,26000016,M0245,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB AND ETESEVIMAB ADMINISTRATION",260,1 ,$932.25 ,$605.96 ,$207.10 ,"$1,087.20 ","$1,087.20 ",$605.96 ,$556.55 ,$434.88 ,$261.03 ,$522.99 ,$434.88 ,$613.42 ,$434.88 ,$792.41 ,$792.41 ,$434.88 ,$792.41 ,$826.27 ,$450.00 ,"$1,087.19 ",$434.88 ,$434.88 ,$699.19 ,$661.90 ,$661.90 ,$434.88 ,$661.90 ,$764.45 ,$764.45 ,$764.45 , N/A ,$932.25 ,$792.41 ,$434.88 ,$932.25 ,$556.55 ,$434.88 ,$387.82 ,$227.81 ,$207.10 ,$434.88 ,$792.41 ,$913.24 ,$792.41 ,$261.03 ,$839.03 ,$434.88 ,$764.45 ,$787.75 ,$787.75 ,$434.88 ,$605.96 ,$932.25 
ST. JOSEPH'S HOSPITAL - BREESE,26000017,M0247,"HC INTRAVENOUS INFUSION, SOTROVIMAB ADMINISTRATION",260,1 ,"$1,350.00 ",$877.50 ,$207.10 ,"$1,350.00 ","$1,087.20 ",$877.50 ,$805.95 ,$434.88 ,$378.00 ,$757.35 ,$434.88 ,$888.30 ,$434.88 ,"$1,147.50 ","$1,147.50 ",$434.88 ,"$1,147.50 ",$826.27 ,$918.00 ,"$1,087.19 ",$434.88 ,$434.88 ,"$1,012.50 ",$958.50 ,$958.50 ,$434.88 ,$958.50 ,"$1,107.00 ","$1,107.00 ","$1,107.00 ", N/A ,"$1,087.19 ","$1,147.50 ",$434.88 ,"$1,350.00 ",$805.95 ,$434.88 ,$561.60 ,$227.81 ,$207.10 ,$434.88 ,"$1,147.50 ",$913.24 ,"$1,147.50 ",$378.00 ,"$1,215.00 ",$434.88 ,"$1,107.00 ","$1,140.75 ","$1,140.75 ",$434.88 ,$877.50 ,"$1,350.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27000012,N/A,HC PAD BREAST NURSING,270,1 ,$24.00 ,$15.60 ,$6.72 ,$24.00 , N/A ,$15.60 ,$14.33 , N/A ,$6.72 ,$13.46 , N/A ,$15.79 , N/A ,$20.40 ,$20.40 , N/A ,$20.40 , N/A ,$16.32 , N/A , N/A , N/A ,$18.00 ,$17.04 ,$17.04 , N/A ,$17.04 ,$19.68 ,$19.68 ,$19.68 , N/A , N/A ,$20.40 , N/A ,$24.00 ,$14.33 , N/A ,$9.98 , N/A , N/A , N/A ,$20.40 , N/A ,$20.40 ,$6.72 ,$21.60 , N/A ,$19.68 ,$20.28 ,$20.28 , N/A ,$15.60 ,$24.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000014,N/A,HC SET CYSTO IRRIGATION TUBING,270,1 ,$19.00 ,$12.35 ,$5.32 ,$19.00 , N/A ,$12.35 ,$11.34 , N/A ,$5.32 ,$10.66 , N/A ,$12.50 , N/A ,$16.15 ,$16.15 , N/A ,$16.15 , N/A ,$12.92 , N/A , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.58 ,$15.58 ,$15.58 , N/A , N/A ,$16.15 , N/A ,$19.00 ,$11.34 , N/A ,$7.90 , N/A , N/A , N/A ,$16.15 , N/A ,$16.15 ,$5.32 ,$17.10 , N/A ,$15.58 ,$16.06 ,$16.06 , N/A ,$12.35 ,$19.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000020,N/A,HC WARMER BAIR HUGGER,270,1 ,$21.00 ,$13.65 ,$5.88 ,$21.00 , N/A ,$13.65 ,$12.54 , N/A ,$5.88 ,$11.78 , N/A ,$13.82 , N/A ,$17.85 ,$17.85 , N/A ,$17.85 , N/A ,$14.28 , N/A , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.22 ,$17.22 ,$17.22 , N/A , N/A ,$17.85 , N/A ,$21.00 ,$12.54 , N/A ,$8.74 , N/A , N/A , N/A ,$17.85 , N/A ,$17.85 ,$5.88 ,$18.90 , N/A ,$17.22 ,$17.75 ,$17.75 , N/A ,$13.65 ,$21.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000021,N/A,HC TRAY ARTHROGRAM,270,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 , N/A ,$20.80 ,$19.10 , N/A ,$8.96 ,$17.95 , N/A ,$21.06 , N/A ,$27.20 ,$27.20 , N/A ,$27.20 , N/A ,$21.76 , N/A , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.24 ,$26.24 ,$26.24 , N/A , N/A ,$27.20 , N/A ,$32.00 ,$19.10 , N/A ,$13.31 , N/A , N/A , N/A ,$27.20 , N/A ,$27.20 ,$8.96 ,$28.80 , N/A ,$26.24 ,$27.04 ,$27.04 , N/A ,$20.80 ,$32.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000055,N/A,HC MASK ANESTHESIA,270,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000073,N/A,HC DETECTOR CARBON DIOXIDE,270,1 ,$24.00 ,$15.60 ,$6.72 ,$24.00 , N/A ,$15.60 ,$14.33 , N/A ,$6.72 ,$13.46 , N/A ,$15.79 , N/A ,$20.40 ,$20.40 , N/A ,$20.40 , N/A ,$16.32 , N/A , N/A , N/A ,$18.00 ,$17.04 ,$17.04 , N/A ,$17.04 ,$19.68 ,$19.68 ,$19.68 , N/A , N/A ,$20.40 , N/A ,$24.00 ,$14.33 , N/A ,$9.98 , N/A , N/A , N/A ,$20.40 , N/A ,$20.40 ,$6.72 ,$21.60 , N/A ,$19.68 ,$20.28 ,$20.28 , N/A ,$15.60 ,$24.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000093,N/A,HC MATTRESS WARMING,270,1 ,$87.00 ,$56.55 ,$24.36 ,$87.00 , N/A ,$56.55 ,$51.94 , N/A ,$24.36 ,$48.81 , N/A ,$57.25 , N/A ,$73.95 ,$73.95 , N/A ,$73.95 , N/A ,$59.16 , N/A , N/A , N/A ,$65.25 ,$61.77 ,$61.77 , N/A ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A , N/A ,$73.95 , N/A ,$87.00 ,$51.94 , N/A ,$36.19 , N/A , N/A , N/A ,$73.95 , N/A ,$73.95 ,$24.36 ,$78.30 , N/A ,$71.34 ,$73.52 ,$73.52 , N/A ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,27000123,N/A,HC CAUTERY BATTERY,270,1 ,$17.50 ,$11.38 ,$4.90 ,$17.50 , N/A ,$11.38 ,$10.45 , N/A ,$4.90 ,$9.82 , N/A ,$11.52 , N/A ,$14.88 ,$14.88 , N/A ,$14.88 , N/A ,$11.90 , N/A , N/A , N/A ,$13.13 ,$12.43 ,$12.43 , N/A ,$12.43 ,$14.35 ,$14.35 ,$14.35 , N/A , N/A ,$14.88 , N/A ,$17.50 ,$10.45 , N/A ,$7.28 , N/A , N/A , N/A ,$14.88 , N/A ,$14.88 ,$4.90 ,$15.75 , N/A ,$14.35 ,$14.79 ,$14.79 , N/A ,$11.38 ,$17.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100021,N/A,HC CAST ARM SYNTHETIC,271,1 ,$26.00 ,$16.90 ,$7.28 ,$26.00 , N/A ,$16.90 ,$15.52 , N/A ,$7.28 ,$14.59 , N/A ,$17.11 , N/A ,$22.10 ,$22.10 , N/A ,$22.10 , N/A ,$17.68 , N/A , N/A , N/A ,$19.50 ,$18.46 ,$18.46 , N/A ,$18.46 ,$21.32 ,$21.32 ,$21.32 , N/A , N/A ,$22.10 , N/A ,$26.00 ,$15.52 , N/A ,$10.82 , N/A , N/A , N/A ,$22.10 , N/A ,$22.10 ,$7.28 ,$23.40 , N/A ,$21.32 ,$21.97 ,$21.97 , N/A ,$16.90 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100024,N/A,HC CAST LEG SYNTHETIC,271,1 ,$95.00 ,$61.75 ,$26.60 ,$95.00 , N/A ,$61.75 ,$56.72 , N/A ,$26.60 ,$53.30 , N/A ,$62.51 , N/A ,$80.75 ,$80.75 , N/A ,$80.75 , N/A ,$64.60 , N/A , N/A , N/A ,$71.25 ,$67.45 ,$67.45 , N/A ,$67.45 ,$77.90 ,$77.90 ,$77.90 , N/A , N/A ,$80.75 , N/A ,$95.00 ,$56.72 , N/A ,$39.52 , N/A , N/A , N/A ,$80.75 , N/A ,$80.75 ,$26.60 ,$85.50 , N/A ,$77.90 ,$80.28 ,$80.28 , N/A ,$61.75 ,$95.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100038,N/A,HC CPAP MASK,271,1 ,$150.00 ,$97.50 ,$42.00 ,$150.00 , N/A ,$97.50 ,$89.55 , N/A ,$42.00 ,$84.15 , N/A ,$98.70 , N/A ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$102.00 , N/A , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A , N/A ,$127.50 , N/A ,$150.00 ,$89.55 , N/A ,$62.40 , N/A , N/A , N/A ,$127.50 , N/A ,$127.50 ,$42.00 ,$135.00 , N/A ,$123.00 ,$126.75 ,$126.75 , N/A ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100096,N/A,HC NASAL PHANYNGEAL AIRWAY,271,1 ,$18.00 ,$11.70 ,$5.04 ,$18.00 , N/A ,$11.70 ,$10.75 , N/A ,$5.04 ,$10.10 , N/A ,$11.84 , N/A ,$15.30 ,$15.30 , N/A ,$15.30 , N/A ,$12.24 , N/A , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A , N/A ,$15.30 , N/A ,$18.00 ,$10.75 , N/A ,$7.49 , N/A , N/A , N/A ,$15.30 , N/A ,$15.30 ,$5.04 ,$16.20 , N/A ,$14.76 ,$15.21 ,$15.21 , N/A ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100106,N/A,HC OXYGEN DAILY,271,1 ,$375.00 ,$243.75 ,$105.00 ,$375.00 , N/A ,$243.75 ,$223.88 , N/A ,$105.00 ,$210.38 , N/A ,$246.75 , N/A ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$255.00 , N/A , N/A , N/A ,$281.25 ,$266.25 ,$266.25 , N/A ,$266.25 ,$307.50 ,$307.50 ,$307.50 , N/A , N/A ,$318.75 , N/A ,$375.00 ,$223.88 , N/A ,$156.00 , N/A , N/A , N/A ,$318.75 , N/A ,$318.75 ,$105.00 ,$337.50 , N/A ,$307.50 ,$316.88 ,$316.88 , N/A ,$243.75 ,$375.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100114,N/A,HC PEAK FLOWMETER,271,1 ,$70.00 ,$45.50 ,$19.60 ,$70.00 , N/A ,$45.50 ,$41.79 , N/A ,$19.60 ,$39.27 , N/A ,$46.06 , N/A ,$59.50 ,$59.50 , N/A ,$59.50 , N/A ,$47.60 , N/A , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A , N/A ,$59.50 , N/A ,$70.00 ,$41.79 , N/A ,$29.12 , N/A , N/A , N/A ,$59.50 , N/A ,$59.50 ,$19.60 ,$63.00 , N/A ,$57.40 ,$59.15 ,$59.15 , N/A ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100155,N/A,HC THERABAND PER FOOT,271,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100167,N/A,HC WARMING BLANKET DISPOSABLE,271,1 ,$59.00 ,$38.35 ,$16.52 ,$59.00 , N/A ,$38.35 ,$35.22 , N/A ,$16.52 ,$33.10 , N/A ,$38.82 , N/A ,$50.15 ,$50.15 , N/A ,$50.15 , N/A ,$40.12 , N/A , N/A , N/A ,$44.25 ,$41.89 ,$41.89 , N/A ,$41.89 ,$48.38 ,$48.38 ,$48.38 , N/A , N/A ,$50.15 , N/A ,$59.00 ,$35.22 , N/A ,$24.54 , N/A , N/A , N/A ,$50.15 , N/A ,$50.15 ,$16.52 ,$53.10 , N/A ,$48.38 ,$49.86 ,$49.86 , N/A ,$38.35 ,$59.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100187,N/A,HC BAG DRAINAGE,271,1 ,$21.00 ,$13.65 ,$5.88 ,$21.00 , N/A ,$13.65 ,$12.54 , N/A ,$5.88 ,$11.78 , N/A ,$13.82 , N/A ,$17.85 ,$17.85 , N/A ,$17.85 , N/A ,$14.28 , N/A , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.22 ,$17.22 ,$17.22 , N/A , N/A ,$17.85 , N/A ,$21.00 ,$12.54 , N/A ,$8.74 , N/A , N/A , N/A ,$17.85 , N/A ,$17.85 ,$5.88 ,$18.90 , N/A ,$17.22 ,$17.75 ,$17.75 , N/A ,$13.65 ,$21.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100188,N/A,HC SLING ARM,271,1 ,$105.00 ,$68.25 ,$29.40 ,$105.00 , N/A ,$68.25 ,$62.69 , N/A ,$29.40 ,$58.91 , N/A ,$69.09 , N/A ,$89.25 ,$89.25 , N/A ,$89.25 , N/A ,$71.40 , N/A , N/A , N/A ,$78.75 ,$74.55 ,$74.55 , N/A ,$74.55 ,$86.10 ,$86.10 ,$86.10 , N/A , N/A ,$89.25 , N/A ,$105.00 ,$62.69 , N/A ,$43.68 , N/A , N/A , N/A ,$89.25 , N/A ,$89.25 ,$29.40 ,$94.50 , N/A ,$86.10 ,$88.73 ,$88.73 , N/A ,$68.25 ,$105.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100197,N/A,HC ADHESIVE STOMAHESIVE,271,1 ,$70.00 ,$45.50 ,$19.60 ,$70.00 , N/A ,$45.50 ,$41.79 , N/A ,$19.60 ,$39.27 , N/A ,$46.06 , N/A ,$59.50 ,$59.50 , N/A ,$59.50 , N/A ,$47.60 , N/A , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A , N/A ,$59.50 , N/A ,$70.00 ,$41.79 , N/A ,$29.12 , N/A , N/A , N/A ,$59.50 , N/A ,$59.50 ,$19.60 ,$63.00 , N/A ,$57.40 ,$59.15 ,$59.15 , N/A ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100201,N/A,HC CANNULA NASAL OXYGEN,271,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100204,N/A,HC CIRCUIT BREATHING,271,1 ,$29.00 ,$18.85 ,$8.12 ,$29.00 , N/A ,$18.85 ,$17.31 , N/A ,$8.12 ,$16.27 , N/A ,$19.08 , N/A ,$24.65 ,$24.65 , N/A ,$24.65 , N/A ,$19.72 , N/A , N/A , N/A ,$21.75 ,$20.59 ,$20.59 , N/A ,$20.59 ,$23.78 ,$23.78 ,$23.78 , N/A , N/A ,$24.65 , N/A ,$29.00 ,$17.31 , N/A ,$12.06 , N/A , N/A , N/A ,$24.65 , N/A ,$24.65 ,$8.12 ,$26.10 , N/A ,$23.78 ,$24.51 ,$24.51 , N/A ,$18.85 ,$29.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100207,N/A,HC DRESSING BANDAGE ELASTIC,271,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100209,N/A,HC ENEMA BAG,271,1 ,$22.00 ,$14.30 ,$6.16 ,$22.00 , N/A ,$14.30 ,$13.13 , N/A ,$6.16 ,$12.34 , N/A ,$14.48 , N/A ,$18.70 ,$18.70 , N/A ,$18.70 , N/A ,$14.96 , N/A , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.04 ,$18.04 ,$18.04 , N/A , N/A ,$18.70 , N/A ,$22.00 ,$13.13 , N/A ,$9.15 , N/A , N/A , N/A ,$18.70 , N/A ,$18.70 ,$6.16 ,$19.80 , N/A ,$18.04 ,$18.59 ,$18.59 , N/A ,$14.30 ,$22.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100210,N/A,HC KIT CANISTER SUCTION,271,1 ,$21.00 ,$13.65 ,$5.88 ,$21.00 , N/A ,$13.65 ,$12.54 , N/A ,$5.88 ,$11.78 , N/A ,$13.82 , N/A ,$17.85 ,$17.85 , N/A ,$17.85 , N/A ,$14.28 , N/A , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.22 ,$17.22 ,$17.22 , N/A , N/A ,$17.85 , N/A ,$21.00 ,$12.54 , N/A ,$8.74 , N/A , N/A , N/A ,$17.85 , N/A ,$17.85 ,$5.88 ,$18.90 , N/A ,$17.22 ,$17.75 ,$17.75 , N/A ,$13.65 ,$21.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100211,N/A,HC PAD DEFIBRILLATOR,271,1 ,$183.60 ,$119.34 ,$51.41 ,$183.60 , N/A ,$119.34 ,$109.61 , N/A ,$51.41 ,$103.00 , N/A ,$120.81 , N/A ,$156.06 ,$156.06 , N/A ,$156.06 , N/A ,$124.85 , N/A , N/A , N/A ,$137.70 ,$130.36 ,$130.36 , N/A ,$130.36 ,$150.55 ,$150.55 ,$150.55 , N/A , N/A ,$156.06 , N/A ,$183.60 ,$109.61 , N/A ,$76.38 , N/A , N/A , N/A ,$156.06 , N/A ,$156.06 ,$51.41 ,$165.24 , N/A ,$150.55 ,$155.14 ,$155.14 , N/A ,$119.34 ,$183.60 
ST. JOSEPH'S HOSPITAL - BREESE,27100215,N/A,HC RESTRAINT ANY TYPE,271,1 ,$36.60 ,$23.79 ,$10.25 ,$36.60 , N/A ,$23.79 ,$21.85 , N/A ,$10.25 ,$20.53 , N/A ,$24.08 , N/A ,$31.11 ,$31.11 , N/A ,$31.11 , N/A ,$24.89 , N/A , N/A , N/A ,$27.45 ,$25.99 ,$25.99 , N/A ,$25.99 ,$30.01 ,$30.01 ,$30.01 , N/A , N/A ,$31.11 , N/A ,$36.60 ,$21.85 , N/A ,$15.23 , N/A , N/A , N/A ,$31.11 , N/A ,$31.11 ,$10.25 ,$32.94 , N/A ,$30.01 ,$30.93 ,$30.93 , N/A ,$23.79 ,$36.60 
ST. JOSEPH'S HOSPITAL - BREESE,27100216,N/A,HC SET FLUID WARMER,271,1 ,$27.00 ,$17.55 ,$7.56 ,$27.00 , N/A ,$17.55 ,$16.12 , N/A ,$7.56 ,$15.15 , N/A ,$17.77 , N/A ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$18.36 , N/A , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.14 ,$22.14 ,$22.14 , N/A , N/A ,$22.95 , N/A ,$27.00 ,$16.12 , N/A ,$11.23 , N/A , N/A , N/A ,$22.95 , N/A ,$22.95 ,$7.56 ,$24.30 , N/A ,$22.14 ,$22.82 ,$22.82 , N/A ,$17.55 ,$27.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100228,N/A,HC STOCK ANTIEMBOLISM THIGH,271,1 ,$48.00 ,$31.20 ,$13.44 ,$48.00 , N/A ,$31.20 ,$28.66 , N/A ,$13.44 ,$26.93 , N/A ,$31.58 , N/A ,$40.80 ,$40.80 , N/A ,$40.80 , N/A ,$32.64 , N/A , N/A , N/A ,$36.00 ,$34.08 ,$34.08 , N/A ,$34.08 ,$39.36 ,$39.36 ,$39.36 , N/A , N/A ,$40.80 , N/A ,$48.00 ,$28.66 , N/A ,$19.97 , N/A , N/A , N/A ,$40.80 , N/A ,$40.80 ,$13.44 ,$43.20 , N/A ,$39.36 ,$40.56 ,$40.56 , N/A ,$31.20 ,$48.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100229,N/A,HC STRAINER URINE,271,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100240,N/A,HC CAUTERY GROUNDING PAD,271,1 ,$23.00 ,$14.95 ,$6.44 ,$23.00 , N/A ,$14.95 ,$13.73 , N/A ,$6.44 ,$12.90 , N/A ,$15.13 , N/A ,$19.55 ,$19.55 , N/A ,$19.55 , N/A ,$15.64 , N/A , N/A , N/A ,$17.25 ,$16.33 ,$16.33 , N/A ,$16.33 ,$18.86 ,$18.86 ,$18.86 , N/A , N/A ,$19.55 , N/A ,$23.00 ,$13.73 , N/A ,$9.57 , N/A , N/A , N/A ,$19.55 , N/A ,$19.55 ,$6.44 ,$20.70 , N/A ,$18.86 ,$19.44 ,$19.44 , N/A ,$14.95 ,$23.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100255,N/A,HC ELECTRODE DEFIB FAST PATCH,271,1 ,$71.58 ,$46.53 ,$20.04 ,$71.58 , N/A ,$46.53 ,$42.73 , N/A ,$20.04 ,$40.16 , N/A ,$47.10 , N/A ,$60.84 ,$60.84 , N/A ,$60.84 , N/A ,$48.67 , N/A , N/A , N/A ,$53.69 ,$50.82 ,$50.82 , N/A ,$50.82 ,$58.70 ,$58.70 ,$58.70 , N/A , N/A ,$60.84 , N/A ,$71.58 ,$42.73 , N/A ,$29.78 , N/A , N/A , N/A ,$60.84 , N/A ,$60.84 ,$20.04 ,$64.42 , N/A ,$58.70 ,$60.49 ,$60.49 , N/A ,$46.53 ,$71.58 
ST. JOSEPH'S HOSPITAL - BREESE,27100256,N/A,HC ELECTRODE FETAL SCALP,271,1 ,$29.00 ,$18.85 ,$8.12 ,$29.00 , N/A ,$18.85 ,$17.31 , N/A ,$8.12 ,$16.27 , N/A ,$19.08 , N/A ,$24.65 ,$24.65 , N/A ,$24.65 , N/A ,$19.72 , N/A , N/A , N/A ,$21.75 ,$20.59 ,$20.59 , N/A ,$20.59 ,$23.78 ,$23.78 ,$23.78 , N/A , N/A ,$24.65 , N/A ,$29.00 ,$17.31 , N/A ,$12.06 , N/A , N/A , N/A ,$24.65 , N/A ,$24.65 ,$8.12 ,$26.10 , N/A ,$23.78 ,$24.51 ,$24.51 , N/A ,$18.85 ,$29.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100281,N/A,HC PACK HOT/ COLD LARGE,271,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 , N/A , N/A , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100292,E0710,HC RESTRAINTS,271,1 ,$20.13 ,$13.08 ,$5.64 ,$20.13 , N/A ,$13.08 ,$12.02 , N/A ,$5.64 ,$11.29 , N/A ,$13.25 , N/A ,$17.11 ,$17.11 , N/A ,$17.11 , N/A ,$13.69 , N/A , N/A , N/A ,$15.10 ,$14.29 ,$14.29 , N/A ,$14.29 ,$16.51 ,$16.51 ,$16.51 , N/A , N/A ,$17.11 , N/A ,$20.13 ,$12.02 , N/A ,$8.37 , N/A , N/A , N/A ,$17.11 , N/A ,$17.11 ,$5.64 ,$18.12 , N/A ,$16.51 ,$17.01 ,$17.01 , N/A ,$13.08 ,$20.13 
ST. JOSEPH'S HOSPITAL - BREESE,27100324,N/A,HC DRESSING SELF ADHESIVE ROLL,271,1 ,$13.00 ,$8.45 ,$3.64 ,$13.00 , N/A ,$8.45 ,$7.76 , N/A ,$3.64 ,$7.29 , N/A ,$8.55 , N/A ,$11.05 ,$11.05 , N/A ,$11.05 , N/A ,$8.84 , N/A , N/A , N/A ,$9.75 ,$9.23 ,$9.23 , N/A ,$9.23 ,$10.66 ,$10.66 ,$10.66 , N/A , N/A ,$11.05 , N/A ,$13.00 ,$7.76 , N/A ,$5.41 , N/A , N/A , N/A ,$11.05 , N/A ,$11.05 ,$3.64 ,$11.70 , N/A ,$10.66 ,$10.99 ,$10.99 , N/A ,$8.45 ,$13.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100325,N/A,HC SPACER MDI,271,1 ,$43.00 ,$27.95 ,$12.04 ,$43.00 , N/A ,$27.95 ,$25.67 , N/A ,$12.04 ,$24.12 , N/A ,$28.29 , N/A ,$36.55 ,$36.55 , N/A ,$36.55 , N/A ,$29.24 , N/A , N/A , N/A ,$32.25 ,$30.53 ,$30.53 , N/A ,$30.53 ,$35.26 ,$35.26 ,$35.26 , N/A , N/A ,$36.55 , N/A ,$43.00 ,$25.67 , N/A ,$17.89 , N/A , N/A , N/A ,$36.55 , N/A ,$36.55 ,$12.04 ,$38.70 , N/A ,$35.26 ,$36.34 ,$36.34 , N/A ,$27.95 ,$43.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100328,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T1,271,1 ,$175.00 ,$113.75 ,$49.00 ,$175.00 , N/A ,$113.75 ,$104.48 , N/A ,$49.00 ,$98.18 , N/A ,$115.15 , N/A ,$148.75 ,$148.75 , N/A ,$148.75 , N/A ,$119.00 , N/A , N/A , N/A ,$131.25 ,$124.25 ,$124.25 , N/A ,$124.25 ,$143.50 ,$143.50 ,$143.50 , N/A , N/A ,$148.75 , N/A ,$175.00 ,$104.48 , N/A ,$72.80 , N/A , N/A , N/A ,$148.75 , N/A ,$148.75 ,$49.00 ,$157.50 , N/A ,$143.50 ,$147.88 ,$147.88 , N/A ,$113.75 ,$175.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100329,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T2,271,1 ,$350.00 ,$227.50 ,$98.00 ,$350.00 , N/A ,$227.50 ,$208.95 , N/A ,$98.00 ,$196.35 , N/A ,$230.30 , N/A ,$297.50 ,$297.50 , N/A ,$297.50 , N/A ,$238.00 , N/A , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$287.00 ,$287.00 ,$287.00 , N/A , N/A ,$297.50 , N/A ,$350.00 ,$208.95 , N/A ,$145.60 , N/A , N/A , N/A ,$297.50 , N/A ,$297.50 ,$98.00 ,$315.00 , N/A ,$287.00 ,$295.75 ,$295.75 , N/A ,$227.50 ,$350.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100330,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T3,271,1 ,$438.00 ,$284.70 ,$122.64 ,$438.00 , N/A ,$284.70 ,$261.49 , N/A ,$122.64 ,$245.72 , N/A ,$288.20 , N/A ,$372.30 ,$372.30 , N/A ,$372.30 , N/A ,$297.84 , N/A , N/A , N/A ,$328.50 ,$310.98 ,$310.98 , N/A ,$310.98 ,$359.16 ,$359.16 ,$359.16 , N/A , N/A ,$372.30 , N/A ,$438.00 ,$261.49 , N/A ,$182.21 , N/A , N/A , N/A ,$372.30 , N/A ,$372.30 ,$122.64 ,$394.20 , N/A ,$359.16 ,$370.11 ,$370.11 , N/A ,$284.70 ,$438.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100331,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T4,271,1 ,$500.00 ,$325.00 ,$140.00 ,$500.00 , N/A ,$325.00 ,$298.50 , N/A ,$140.00 ,$280.50 , N/A ,$329.00 , N/A ,$425.00 ,$425.00 , N/A ,$425.00 , N/A ,$340.00 , N/A , N/A , N/A ,$375.00 ,$355.00 ,$355.00 , N/A ,$355.00 ,$410.00 ,$410.00 ,$410.00 , N/A , N/A ,$425.00 , N/A ,$500.00 ,$298.50 , N/A ,$208.00 , N/A , N/A , N/A ,$425.00 , N/A ,$425.00 ,$140.00 ,$450.00 , N/A ,$410.00 ,$422.50 ,$422.50 , N/A ,$325.00 ,$500.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100332,V5286,HC ALD BLUE TOOTH FM/DM RECEIVER T5,271,1 ,$550.00 ,$357.50 ,$154.00 ,$550.00 , N/A ,$357.50 ,$328.35 , N/A ,$154.00 ,$308.55 , N/A ,$361.90 , N/A ,$467.50 ,$467.50 , N/A ,$467.50 , N/A ,$374.00 , N/A , N/A , N/A ,$412.50 ,$390.50 ,$390.50 , N/A ,$390.50 ,$451.00 ,$451.00 ,$451.00 , N/A , N/A ,$467.50 , N/A ,$550.00 ,$328.35 , N/A ,$228.80 , N/A , N/A , N/A ,$467.50 , N/A ,$467.50 ,$154.00 ,$495.00 , N/A ,$451.00 ,$464.75 ,$464.75 , N/A ,$357.50 ,$550.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100333,V5290,HC ALD TRANSMITTER MICROPHONE T1,271,1 ,$175.00 ,$113.75 ,$49.00 ,$175.00 , N/A ,$113.75 ,$104.48 , N/A ,$49.00 ,$98.18 , N/A ,$115.15 , N/A ,$148.75 ,$148.75 , N/A ,$148.75 , N/A ,$119.00 , N/A , N/A , N/A ,$131.25 ,$124.25 ,$124.25 , N/A ,$124.25 ,$143.50 ,$143.50 ,$143.50 , N/A , N/A ,$148.75 , N/A ,$175.00 ,$104.48 , N/A ,$72.80 , N/A , N/A , N/A ,$148.75 , N/A ,$148.75 ,$49.00 ,$157.50 , N/A ,$143.50 ,$147.88 ,$147.88 , N/A ,$113.75 ,$175.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100334,V5290,HC ALD TRANSMITTER MICROPHONE T2,271,1 ,$700.00 ,$455.00 ,$196.00 ,$700.00 , N/A ,$455.00 ,$417.90 , N/A ,$196.00 ,$392.70 , N/A ,$460.60 , N/A ,$595.00 ,$595.00 , N/A ,$595.00 , N/A ,$476.00 , N/A , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$574.00 ,$574.00 ,$574.00 , N/A , N/A ,$595.00 , N/A ,$700.00 ,$417.90 , N/A ,$291.20 , N/A , N/A , N/A ,$595.00 , N/A ,$595.00 ,$196.00 ,$630.00 , N/A ,$574.00 ,$591.50 ,$591.50 , N/A ,$455.00 ,$700.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100335,V5290,HC ALD TRANSMITTER MICROPHONE T3,271,1 ,$875.00 ,$568.75 ,$245.00 ,$875.00 , N/A ,$568.75 ,$522.38 , N/A ,$245.00 ,$490.88 , N/A ,$575.75 , N/A ,$743.75 ,$743.75 , N/A ,$743.75 , N/A ,$595.00 , N/A , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$717.50 ,$717.50 ,$717.50 , N/A , N/A ,$743.75 , N/A ,$875.00 ,$522.38 , N/A ,$364.00 , N/A , N/A , N/A ,$743.75 , N/A ,$743.75 ,$245.00 ,$787.50 , N/A ,$717.50 ,$739.38 ,$739.38 , N/A ,$568.75 ,$875.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100336,V5290,HC ALD TRANSMITTER MICROPHONE T4,271,1 ,"$1,050.00 ",$682.50 ,$294.00 ,"$1,050.00 ", N/A ,$682.50 ,$626.85 , N/A ,$294.00 ,$589.05 , N/A ,$690.90 , N/A ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$714.00 , N/A , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$861.00 ,$861.00 ,$861.00 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ",$626.85 , N/A ,$436.80 , N/A , N/A , N/A ,$892.50 , N/A ,$892.50 ,$294.00 ,$945.00 , N/A ,$861.00 ,$887.25 ,$887.25 , N/A ,$682.50 ,"$1,050.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100337,V5290,HC ALD TRANSMITTER MICROPHONE T5,271,1 ,"$1,150.00 ",$747.50 ,$322.00 ,"$1,150.00 ", N/A ,$747.50 ,$686.55 , N/A ,$322.00 ,$645.15 , N/A ,$756.70 , N/A ,$977.50 ,$977.50 , N/A ,$977.50 , N/A ,$782.00 , N/A , N/A , N/A ,$862.50 ,$816.50 ,$816.50 , N/A ,$816.50 ,$943.00 ,$943.00 ,$943.00 , N/A , N/A ,$977.50 , N/A ,"$1,150.00 ",$686.55 , N/A ,$478.40 , N/A , N/A , N/A ,$977.50 , N/A ,$977.50 ,$322.00 ,"$1,035.00 ", N/A ,$943.00 ,$971.75 ,$971.75 , N/A ,$747.50 ,"$1,150.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100338,V5267,HC HEARING AID ACCESSORY NOS T1,271,1 ,$90.00 ,$58.50 ,$25.20 ,$90.00 , N/A ,$58.50 ,$53.73 , N/A ,$25.20 ,$50.49 , N/A ,$59.22 , N/A ,$76.50 ,$76.50 , N/A ,$76.50 , N/A ,$61.20 , N/A , N/A , N/A ,$67.50 ,$63.90 ,$63.90 , N/A ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A , N/A ,$76.50 , N/A ,$90.00 ,$53.73 , N/A ,$37.44 , N/A , N/A , N/A ,$76.50 , N/A ,$76.50 ,$25.20 ,$81.00 , N/A ,$73.80 ,$76.05 ,$76.05 , N/A ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100339,V5267,HC HEARING AID ACCESSORY NOS T2,271,1 ,$105.00 ,$68.25 ,$29.40 ,$105.00 , N/A ,$68.25 ,$62.69 , N/A ,$29.40 ,$58.91 , N/A ,$69.09 , N/A ,$89.25 ,$89.25 , N/A ,$89.25 , N/A ,$71.40 , N/A , N/A , N/A ,$78.75 ,$74.55 ,$74.55 , N/A ,$74.55 ,$86.10 ,$86.10 ,$86.10 , N/A , N/A ,$89.25 , N/A ,$105.00 ,$62.69 , N/A ,$43.68 , N/A , N/A , N/A ,$89.25 , N/A ,$89.25 ,$29.40 ,$94.50 , N/A ,$86.10 ,$88.73 ,$88.73 , N/A ,$68.25 ,$105.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100340,V5267,HC HEARING AID ACCESSORY NOS T3,271,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100341,V5267,HC HEARING AID ACCESSORY NOS T4,271,1 ,$150.00 ,$97.50 ,$42.00 ,$150.00 , N/A ,$97.50 ,$89.55 , N/A ,$42.00 ,$84.15 , N/A ,$98.70 , N/A ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$102.00 , N/A , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A , N/A ,$127.50 , N/A ,$150.00 ,$89.55 , N/A ,$62.40 , N/A , N/A , N/A ,$127.50 , N/A ,$127.50 ,$42.00 ,$135.00 , N/A ,$123.00 ,$126.75 ,$126.75 , N/A ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100342,V5267,HC HEARING AID ACCESSORY NOS T5,271,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100343,V5267,HC HEARING AID ACCESSORY NOS T6,271,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100344,V5267,HC HEARING AID ACCESSORY NOS T7,271,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 , N/A ,$195.00 ,$179.10 , N/A ,$84.00 ,$168.30 , N/A ,$197.40 , N/A ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$204.00 , N/A , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A , N/A ,$255.00 , N/A ,$300.00 ,$179.10 , N/A ,$124.80 , N/A , N/A , N/A ,$255.00 , N/A ,$255.00 ,$84.00 ,$270.00 , N/A ,$246.00 ,$253.50 ,$253.50 , N/A ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100345,V5267,HC HEARING AID ACCESSORY NOS T8,271,1 ,$350.00 ,$227.50 ,$98.00 ,$350.00 , N/A ,$227.50 ,$208.95 , N/A ,$98.00 ,$196.35 , N/A ,$230.30 , N/A ,$297.50 ,$297.50 , N/A ,$297.50 , N/A ,$238.00 , N/A , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$287.00 ,$287.00 ,$287.00 , N/A , N/A ,$297.50 , N/A ,$350.00 ,$208.95 , N/A ,$145.60 , N/A , N/A , N/A ,$297.50 , N/A ,$297.50 ,$98.00 ,$315.00 , N/A ,$287.00 ,$295.75 ,$295.75 , N/A ,$227.50 ,$350.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100346,V5267,HC HEARING AID ACCESSORY NOS T9,271,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100347,V5267,HC HEARING AID ACCESSORY NOS T10,271,1 ,$450.00 ,$292.50 ,$126.00 ,$450.00 , N/A ,$292.50 ,$268.65 , N/A ,$126.00 ,$252.45 , N/A ,$296.10 , N/A ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$306.00 , N/A , N/A , N/A ,$337.50 ,$319.50 ,$319.50 , N/A ,$319.50 ,$369.00 ,$369.00 ,$369.00 , N/A , N/A ,$382.50 , N/A ,$450.00 ,$268.65 , N/A ,$187.20 , N/A , N/A , N/A ,$382.50 , N/A ,$382.50 ,$126.00 ,$405.00 , N/A ,$369.00 ,$380.25 ,$380.25 , N/A ,$292.50 ,$450.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100348,V5267,HC HEARING AID ACCESSORY NOS T11,271,1 ,$500.00 ,$325.00 ,$140.00 ,$500.00 , N/A ,$325.00 ,$298.50 , N/A ,$140.00 ,$280.50 , N/A ,$329.00 , N/A ,$425.00 ,$425.00 , N/A ,$425.00 , N/A ,$340.00 , N/A , N/A , N/A ,$375.00 ,$355.00 ,$355.00 , N/A ,$355.00 ,$410.00 ,$410.00 ,$410.00 , N/A , N/A ,$425.00 , N/A ,$500.00 ,$298.50 , N/A ,$208.00 , N/A , N/A , N/A ,$425.00 , N/A ,$425.00 ,$140.00 ,$450.00 , N/A ,$410.00 ,$422.50 ,$422.50 , N/A ,$325.00 ,$500.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100349,V5267,HC HEARING AID ACCESSORY NOS T12,271,1 ,$550.00 ,$357.50 ,$154.00 ,$550.00 , N/A ,$357.50 ,$328.35 , N/A ,$154.00 ,$308.55 , N/A ,$361.90 , N/A ,$467.50 ,$467.50 , N/A ,$467.50 , N/A ,$374.00 , N/A , N/A , N/A ,$412.50 ,$390.50 ,$390.50 , N/A ,$390.50 ,$451.00 ,$451.00 ,$451.00 , N/A , N/A ,$467.50 , N/A ,$550.00 ,$328.35 , N/A ,$228.80 , N/A , N/A , N/A ,$467.50 , N/A ,$467.50 ,$154.00 ,$495.00 , N/A ,$451.00 ,$464.75 ,$464.75 , N/A ,$357.50 ,$550.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100350,V5267,HC HEARING AID ACCESSORY NOS T13,271,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100351,V5050,HC HEARING AID MONAURAL IN EAR T1,271,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100352,V5050,HC HEARING AID MONAURAL IN EAR T2,271,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100353,V5050,HC HEARING AID MONAURAL IN EAR T3,271,1 ,$575.00 ,$373.75 ,$161.00 ,$575.00 , N/A ,$373.75 ,$343.28 , N/A ,$161.00 ,$322.58 , N/A ,$378.35 , N/A ,$488.75 ,$488.75 , N/A ,$488.75 , N/A ,$391.00 , N/A , N/A , N/A ,$431.25 ,$408.25 ,$408.25 , N/A ,$408.25 ,$471.50 ,$471.50 ,$471.50 , N/A , N/A ,$488.75 , N/A ,$575.00 ,$343.28 , N/A ,$239.20 , N/A , N/A , N/A ,$488.75 , N/A ,$488.75 ,$161.00 ,$517.50 , N/A ,$471.50 ,$485.88 ,$485.88 , N/A ,$373.75 ,$575.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100354,V5050,HC HEARING AID MONAURAL IN EAR T4,271,1 ,$750.00 ,$487.50 ,$210.00 ,$750.00 , N/A ,$487.50 ,$447.75 , N/A ,$210.00 ,$420.75 , N/A ,$493.50 , N/A ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$510.00 , N/A , N/A , N/A ,$562.50 ,$532.50 ,$532.50 , N/A ,$532.50 ,$615.00 ,$615.00 ,$615.00 , N/A , N/A ,$637.50 , N/A ,$750.00 ,$447.75 , N/A ,$312.00 , N/A , N/A , N/A ,$637.50 , N/A ,$637.50 ,$210.00 ,$675.00 , N/A ,$615.00 ,$633.75 ,$633.75 , N/A ,$487.50 ,$750.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100355,V5050,HC HEARING AID MONAURAL IN EAR T5,271,1 ,$800.00 ,$520.00 ,$224.00 ,$800.00 , N/A ,$520.00 ,$477.60 , N/A ,$224.00 ,$448.80 , N/A ,$526.40 , N/A ,$680.00 ,$680.00 , N/A ,$680.00 , N/A ,$544.00 , N/A , N/A , N/A ,$600.00 ,$568.00 ,$568.00 , N/A ,$568.00 ,$656.00 ,$656.00 ,$656.00 , N/A , N/A ,$680.00 , N/A ,$800.00 ,$477.60 , N/A ,$332.80 , N/A , N/A , N/A ,$680.00 , N/A ,$680.00 ,$224.00 ,$720.00 , N/A ,$656.00 ,$676.00 ,$676.00 , N/A ,$520.00 ,$800.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100356,V5050,HC HEARING AID MONAURAL IN EAR T6,271,1 ,$825.00 ,$536.25 ,$231.00 ,$825.00 , N/A ,$536.25 ,$492.53 , N/A ,$231.00 ,$462.83 , N/A ,$542.85 , N/A ,$701.25 ,$701.25 , N/A ,$701.25 , N/A ,$561.00 , N/A , N/A , N/A ,$618.75 ,$585.75 ,$585.75 , N/A ,$585.75 ,$676.50 ,$676.50 ,$676.50 , N/A , N/A ,$701.25 , N/A ,$825.00 ,$492.53 , N/A ,$343.20 , N/A , N/A , N/A ,$701.25 , N/A ,$701.25 ,$231.00 ,$742.50 , N/A ,$676.50 ,$697.13 ,$697.13 , N/A ,$536.25 ,$825.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100357,V5050,HC HEARING AID MONAURAL IN EAR T7,271,1 ,$875.00 ,$568.75 ,$245.00 ,$875.00 , N/A ,$568.75 ,$522.38 , N/A ,$245.00 ,$490.88 , N/A ,$575.75 , N/A ,$743.75 ,$743.75 , N/A ,$743.75 , N/A ,$595.00 , N/A , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$717.50 ,$717.50 ,$717.50 , N/A , N/A ,$743.75 , N/A ,$875.00 ,$522.38 , N/A ,$364.00 , N/A , N/A , N/A ,$743.75 , N/A ,$743.75 ,$245.00 ,$787.50 , N/A ,$717.50 ,$739.38 ,$739.38 , N/A ,$568.75 ,$875.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100358,V5050,HC HEARING AID MONAURAL IN EAR T8,271,1 ,"$1,000.00 ",$650.00 ,$280.00 ,"$1,000.00 ", N/A ,$650.00 ,$597.00 , N/A ,$280.00 ,$561.00 , N/A ,$658.00 , N/A ,$850.00 ,$850.00 , N/A ,$850.00 , N/A ,$680.00 , N/A , N/A , N/A ,$750.00 ,$710.00 ,$710.00 , N/A ,$710.00 ,$820.00 ,$820.00 ,$820.00 , N/A , N/A ,$850.00 , N/A ,"$1,000.00 ",$597.00 , N/A ,$416.00 , N/A , N/A , N/A ,$850.00 , N/A ,$850.00 ,$280.00 ,$900.00 , N/A ,$820.00 ,$845.00 ,$845.00 , N/A ,$650.00 ,"$1,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100359,V5050,HC HEARING AID MONAURAL IN EAR T9,271,1 ,"$1,150.00 ",$747.50 ,$322.00 ,"$1,150.00 ", N/A ,$747.50 ,$686.55 , N/A ,$322.00 ,$645.15 , N/A ,$756.70 , N/A ,$977.50 ,$977.50 , N/A ,$977.50 , N/A ,$782.00 , N/A , N/A , N/A ,$862.50 ,$816.50 ,$816.50 , N/A ,$816.50 ,$943.00 ,$943.00 ,$943.00 , N/A , N/A ,$977.50 , N/A ,"$1,150.00 ",$686.55 , N/A ,$478.40 , N/A , N/A , N/A ,$977.50 , N/A ,$977.50 ,$322.00 ,"$1,035.00 ", N/A ,$943.00 ,$971.75 ,$971.75 , N/A ,$747.50 ,"$1,150.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100360,V5050,HC HEARING AID MONAURAL IN EAR T10,271,1 ,"$1,275.00 ",$828.75 ,$357.00 ,"$1,275.00 ", N/A ,$828.75 ,$761.18 , N/A ,$357.00 ,$715.28 , N/A ,$838.95 , N/A ,"$1,083.75 ","$1,083.75 ", N/A ,"$1,083.75 ", N/A ,$867.00 , N/A , N/A , N/A ,$956.25 ,$905.25 ,$905.25 , N/A ,$905.25 ,"$1,045.50 ","$1,045.50 ","$1,045.50 ", N/A , N/A ,"$1,083.75 ", N/A ,"$1,275.00 ",$761.18 , N/A ,$530.40 , N/A , N/A , N/A ,"$1,083.75 ", N/A ,"$1,083.75 ",$357.00 ,"$1,147.50 ", N/A ,"$1,045.50 ","$1,077.38 ","$1,077.38 ", N/A ,$828.75 ,"$1,275.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100361,V5050,HC HEARING AID MONAURAL IN EAR T11,271,1 ,"$1,400.00 ",$910.00 ,$392.00 ,"$1,400.00 ", N/A ,$910.00 ,$835.80 , N/A ,$392.00 ,$785.40 , N/A ,$921.20 , N/A ,"$1,190.00 ","$1,190.00 ", N/A ,"$1,190.00 ", N/A ,$952.00 , N/A , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,148.00 ","$1,148.00 ","$1,148.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ",$835.80 , N/A ,$582.40 , N/A , N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ",$392.00 ,"$1,260.00 ", N/A ,"$1,148.00 ","$1,183.00 ","$1,183.00 ", N/A ,$910.00 ,"$1,400.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100362,V5050,HC HEARING AID MONAURAL IN EAR T12,271,1 ,"$1,525.00 ",$991.25 ,$427.00 ,"$1,525.00 ", N/A ,$991.25 ,$910.43 , N/A ,$427.00 ,$855.53 , N/A ,"$1,003.45 ", N/A ,"$1,296.25 ","$1,296.25 ", N/A ,"$1,296.25 ", N/A ,"$1,037.00 ", N/A , N/A , N/A ,"$1,143.75 ","$1,082.75 ","$1,082.75 ", N/A ,"$1,082.75 ","$1,250.50 ","$1,250.50 ","$1,250.50 ", N/A , N/A ,"$1,296.25 ", N/A ,"$1,525.00 ",$910.43 , N/A ,$634.40 , N/A , N/A , N/A ,"$1,296.25 ", N/A ,"$1,296.25 ",$427.00 ,"$1,372.50 ", N/A ,"$1,250.50 ","$1,288.63 ","$1,288.63 ", N/A ,$991.25 ,"$1,525.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100363,V5050,HC HEARING AID MONAURAL IN EAR T13,271,1 ,"$1,675.00 ","$1,088.75 ",$469.00 ,"$1,675.00 ", N/A ,"$1,088.75 ",$999.98 , N/A ,$469.00 ,$939.68 , N/A ,"$1,102.15 ", N/A ,"$1,423.75 ","$1,423.75 ", N/A ,"$1,423.75 ", N/A ,"$1,139.00 ", N/A , N/A , N/A ,"$1,256.25 ","$1,189.25 ","$1,189.25 ", N/A ,"$1,189.25 ","$1,373.50 ","$1,373.50 ","$1,373.50 ", N/A , N/A ,"$1,423.75 ", N/A ,"$1,675.00 ",$999.98 , N/A ,$696.80 , N/A , N/A , N/A ,"$1,423.75 ", N/A ,"$1,423.75 ",$469.00 ,"$1,507.50 ", N/A ,"$1,373.50 ","$1,415.38 ","$1,415.38 ", N/A ,"$1,088.75 ","$1,675.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100364,V5050,HC HEARING AID MONAURAL IN EAR T14,271,1 ,"$1,875.00 ","$1,218.75 ",$525.00 ,"$1,875.00 ", N/A ,"$1,218.75 ","$1,119.38 ", N/A ,$525.00 ,"$1,051.88 ", N/A ,"$1,233.75 ", N/A ,"$1,593.75 ","$1,593.75 ", N/A ,"$1,593.75 ", N/A ,"$1,275.00 ", N/A , N/A , N/A ,"$1,406.25 ","$1,331.25 ","$1,331.25 ", N/A ,"$1,331.25 ","$1,537.50 ","$1,537.50 ","$1,537.50 ", N/A , N/A ,"$1,593.75 ", N/A ,"$1,875.00 ","$1,119.38 ", N/A ,$780.00 , N/A , N/A , N/A ,"$1,593.75 ", N/A ,"$1,593.75 ",$525.00 ,"$1,687.50 ", N/A ,"$1,537.50 ","$1,584.38 ","$1,584.38 ", N/A ,"$1,218.75 ","$1,875.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100365,V5050,HC HEARING AID MONAURAL IN EAR T15,271,1 ,"$2,225.00 ","$1,446.25 ",$623.00 ,"$2,225.00 ", N/A ,"$1,446.25 ","$1,328.33 ", N/A ,$623.00 ,"$1,248.23 ", N/A ,"$1,464.05 ", N/A ,"$1,891.25 ","$1,891.25 ", N/A ,"$1,891.25 ", N/A ,"$1,513.00 ", N/A , N/A , N/A ,"$1,668.75 ","$1,579.75 ","$1,579.75 ", N/A ,"$1,579.75 ","$1,824.50 ","$1,824.50 ","$1,824.50 ", N/A , N/A ,"$1,891.25 ", N/A ,"$2,225.00 ","$1,328.33 ", N/A ,$925.60 , N/A , N/A , N/A ,"$1,891.25 ", N/A ,"$1,891.25 ",$623.00 ,"$2,002.50 ", N/A ,"$1,824.50 ","$1,880.13 ","$1,880.13 ", N/A ,"$1,446.25 ","$2,225.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100366,V5050,HC HEARING AID MONAURAL IN EAR T16,271,1 ,"$2,350.00 ","$1,527.50 ",$658.00 ,"$2,350.00 ", N/A ,"$1,527.50 ","$1,402.95 ", N/A ,$658.00 ,"$1,318.35 ", N/A ,"$1,546.30 ", N/A ,"$1,997.50 ","$1,997.50 ", N/A ,"$1,997.50 ", N/A ,"$1,598.00 ", N/A , N/A , N/A ,"$1,762.50 ","$1,668.50 ","$1,668.50 ", N/A ,"$1,668.50 ","$1,927.00 ","$1,927.00 ","$1,927.00 ", N/A , N/A ,"$1,997.50 ", N/A ,"$2,350.00 ","$1,402.95 ", N/A ,$977.60 , N/A , N/A , N/A ,"$1,997.50 ", N/A ,"$1,997.50 ",$658.00 ,"$2,115.00 ", N/A ,"$1,927.00 ","$1,985.75 ","$1,985.75 ", N/A ,"$1,527.50 ","$2,350.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100367,V5060,HC HEARING AID MONAURAL BEHIND EAR T1,271,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100368,V5060,HC HEARING AID MONAURAL BEHIND EAR T2,271,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100369,V5060,HC HEARING AID MONAURAL BEHIND EAR T3,271,1 ,$550.00 ,$357.50 ,$154.00 ,$550.00 , N/A ,$357.50 ,$328.35 , N/A ,$154.00 ,$308.55 , N/A ,$361.90 , N/A ,$467.50 ,$467.50 , N/A ,$467.50 , N/A ,$374.00 , N/A , N/A , N/A ,$412.50 ,$390.50 ,$390.50 , N/A ,$390.50 ,$451.00 ,$451.00 ,$451.00 , N/A , N/A ,$467.50 , N/A ,$550.00 ,$328.35 , N/A ,$228.80 , N/A , N/A , N/A ,$467.50 , N/A ,$467.50 ,$154.00 ,$495.00 , N/A ,$451.00 ,$464.75 ,$464.75 , N/A ,$357.50 ,$550.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100370,V5060,HC HEARING AID MONAURAL BEHIND EAR T4,271,1 ,$575.00 ,$373.75 ,$161.00 ,$575.00 , N/A ,$373.75 ,$343.28 , N/A ,$161.00 ,$322.58 , N/A ,$378.35 , N/A ,$488.75 ,$488.75 , N/A ,$488.75 , N/A ,$391.00 , N/A , N/A , N/A ,$431.25 ,$408.25 ,$408.25 , N/A ,$408.25 ,$471.50 ,$471.50 ,$471.50 , N/A , N/A ,$488.75 , N/A ,$575.00 ,$343.28 , N/A ,$239.20 , N/A , N/A , N/A ,$488.75 , N/A ,$488.75 ,$161.00 ,$517.50 , N/A ,$471.50 ,$485.88 ,$485.88 , N/A ,$373.75 ,$575.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100371,V5060,HC HEARING AID MONAURAL BEHIND EAR T5,271,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100372,V5060,HC HEARING AID MONAURAL BEHIND EAR T6,271,1 ,$750.00 ,$487.50 ,$210.00 ,$750.00 , N/A ,$487.50 ,$447.75 , N/A ,$210.00 ,$420.75 , N/A ,$493.50 , N/A ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$510.00 , N/A , N/A , N/A ,$562.50 ,$532.50 ,$532.50 , N/A ,$532.50 ,$615.00 ,$615.00 ,$615.00 , N/A , N/A ,$637.50 , N/A ,$750.00 ,$447.75 , N/A ,$312.00 , N/A , N/A , N/A ,$637.50 , N/A ,$637.50 ,$210.00 ,$675.00 , N/A ,$615.00 ,$633.75 ,$633.75 , N/A ,$487.50 ,$750.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100373,V5060,HC HEARING AID MONAURAL BEHIND EAR T7,271,1 ,$800.00 ,$520.00 ,$224.00 ,$800.00 , N/A ,$520.00 ,$477.60 , N/A ,$224.00 ,$448.80 , N/A ,$526.40 , N/A ,$680.00 ,$680.00 , N/A ,$680.00 , N/A ,$544.00 , N/A , N/A , N/A ,$600.00 ,$568.00 ,$568.00 , N/A ,$568.00 ,$656.00 ,$656.00 ,$656.00 , N/A , N/A ,$680.00 , N/A ,$800.00 ,$477.60 , N/A ,$332.80 , N/A , N/A , N/A ,$680.00 , N/A ,$680.00 ,$224.00 ,$720.00 , N/A ,$656.00 ,$676.00 ,$676.00 , N/A ,$520.00 ,$800.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100374,V5060,HC HEARING AID MONAURAL BEHIND EAR T8,271,1 ,$825.00 ,$536.25 ,$231.00 ,$825.00 , N/A ,$536.25 ,$492.53 , N/A ,$231.00 ,$462.83 , N/A ,$542.85 , N/A ,$701.25 ,$701.25 , N/A ,$701.25 , N/A ,$561.00 , N/A , N/A , N/A ,$618.75 ,$585.75 ,$585.75 , N/A ,$585.75 ,$676.50 ,$676.50 ,$676.50 , N/A , N/A ,$701.25 , N/A ,$825.00 ,$492.53 , N/A ,$343.20 , N/A , N/A , N/A ,$701.25 , N/A ,$701.25 ,$231.00 ,$742.50 , N/A ,$676.50 ,$697.13 ,$697.13 , N/A ,$536.25 ,$825.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100375,V5060,HC HEARING AID MONAURAL BEHIND EAR T9,271,1 ,$875.00 ,$568.75 ,$245.00 ,$875.00 , N/A ,$568.75 ,$522.38 , N/A ,$245.00 ,$490.88 , N/A ,$575.75 , N/A ,$743.75 ,$743.75 , N/A ,$743.75 , N/A ,$595.00 , N/A , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$717.50 ,$717.50 ,$717.50 , N/A , N/A ,$743.75 , N/A ,$875.00 ,$522.38 , N/A ,$364.00 , N/A , N/A , N/A ,$743.75 , N/A ,$743.75 ,$245.00 ,$787.50 , N/A ,$717.50 ,$739.38 ,$739.38 , N/A ,$568.75 ,$875.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100376,V5060,HC HEARING AID MONAURAL BEHIND EAR T10,271,1 ,"$1,000.00 ",$650.00 ,$280.00 ,"$1,000.00 ", N/A ,$650.00 ,$597.00 , N/A ,$280.00 ,$561.00 , N/A ,$658.00 , N/A ,$850.00 ,$850.00 , N/A ,$850.00 , N/A ,$680.00 , N/A , N/A , N/A ,$750.00 ,$710.00 ,$710.00 , N/A ,$710.00 ,$820.00 ,$820.00 ,$820.00 , N/A , N/A ,$850.00 , N/A ,"$1,000.00 ",$597.00 , N/A ,$416.00 , N/A , N/A , N/A ,$850.00 , N/A ,$850.00 ,$280.00 ,$900.00 , N/A ,$820.00 ,$845.00 ,$845.00 , N/A ,$650.00 ,"$1,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100377,V5060,HC HEARING AID MONAURAL BEHIND EAR T11,271,1 ,"$1,150.00 ",$747.50 ,$322.00 ,"$1,150.00 ", N/A ,$747.50 ,$686.55 , N/A ,$322.00 ,$645.15 , N/A ,$756.70 , N/A ,$977.50 ,$977.50 , N/A ,$977.50 , N/A ,$782.00 , N/A , N/A , N/A ,$862.50 ,$816.50 ,$816.50 , N/A ,$816.50 ,$943.00 ,$943.00 ,$943.00 , N/A , N/A ,$977.50 , N/A ,"$1,150.00 ",$686.55 , N/A ,$478.40 , N/A , N/A , N/A ,$977.50 , N/A ,$977.50 ,$322.00 ,"$1,035.00 ", N/A ,$943.00 ,$971.75 ,$971.75 , N/A ,$747.50 ,"$1,150.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100378,V5060,HC HEARING AID MONAURAL BEHIND EAR T12,271,1 ,"$1,225.00 ",$796.25 ,$343.00 ,"$1,225.00 ", N/A ,$796.25 ,$731.33 , N/A ,$343.00 ,$687.23 , N/A ,$806.05 , N/A ,"$1,041.25 ","$1,041.25 ", N/A ,"$1,041.25 ", N/A ,$833.00 , N/A , N/A , N/A ,$918.75 ,$869.75 ,$869.75 , N/A ,$869.75 ,"$1,004.50 ","$1,004.50 ","$1,004.50 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,225.00 ",$731.33 , N/A ,$509.60 , N/A , N/A , N/A ,"$1,041.25 ", N/A ,"$1,041.25 ",$343.00 ,"$1,102.50 ", N/A ,"$1,004.50 ","$1,035.13 ","$1,035.13 ", N/A ,$796.25 ,"$1,225.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100379,V5060,HC HEARING AID MONAURAL BEHIND EAR T13,271,1 ,"$1,275.00 ",$828.75 ,$357.00 ,"$1,275.00 ", N/A ,$828.75 ,$761.18 , N/A ,$357.00 ,$715.28 , N/A ,$838.95 , N/A ,"$1,083.75 ","$1,083.75 ", N/A ,"$1,083.75 ", N/A ,$867.00 , N/A , N/A , N/A ,$956.25 ,$905.25 ,$905.25 , N/A ,$905.25 ,"$1,045.50 ","$1,045.50 ","$1,045.50 ", N/A , N/A ,"$1,083.75 ", N/A ,"$1,275.00 ",$761.18 , N/A ,$530.40 , N/A , N/A , N/A ,"$1,083.75 ", N/A ,"$1,083.75 ",$357.00 ,"$1,147.50 ", N/A ,"$1,045.50 ","$1,077.38 ","$1,077.38 ", N/A ,$828.75 ,"$1,275.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100380,V5060,HC HEARING AID MONAURAL BEHIND EAR T14,271,1 ,"$1,400.00 ",$910.00 ,$392.00 ,"$1,400.00 ", N/A ,$910.00 ,$835.80 , N/A ,$392.00 ,$785.40 , N/A ,$921.20 , N/A ,"$1,190.00 ","$1,190.00 ", N/A ,"$1,190.00 ", N/A ,$952.00 , N/A , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,148.00 ","$1,148.00 ","$1,148.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ",$835.80 , N/A ,$582.40 , N/A , N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ",$392.00 ,"$1,260.00 ", N/A ,"$1,148.00 ","$1,183.00 ","$1,183.00 ", N/A ,$910.00 ,"$1,400.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100381,V5060,HC HEARING AID MONAURAL BEHIND EAR T15,271,1 ,"$1,525.00 ",$991.25 ,$427.00 ,"$1,525.00 ", N/A ,$991.25 ,$910.43 , N/A ,$427.00 ,$855.53 , N/A ,"$1,003.45 ", N/A ,"$1,296.25 ","$1,296.25 ", N/A ,"$1,296.25 ", N/A ,"$1,037.00 ", N/A , N/A , N/A ,"$1,143.75 ","$1,082.75 ","$1,082.75 ", N/A ,"$1,082.75 ","$1,250.50 ","$1,250.50 ","$1,250.50 ", N/A , N/A ,"$1,296.25 ", N/A ,"$1,525.00 ",$910.43 , N/A ,$634.40 , N/A , N/A , N/A ,"$1,296.25 ", N/A ,"$1,296.25 ",$427.00 ,"$1,372.50 ", N/A ,"$1,250.50 ","$1,288.63 ","$1,288.63 ", N/A ,$991.25 ,"$1,525.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100382,V5060,HC HEARING AID MONAURAL BEHIND EAR T16,271,1 ,"$1,600.00 ","$1,040.00 ",$448.00 ,"$1,600.00 ", N/A ,"$1,040.00 ",$955.20 , N/A ,$448.00 ,$897.60 , N/A ,"$1,052.80 ", N/A ,"$1,360.00 ","$1,360.00 ", N/A ,"$1,360.00 ", N/A ,"$1,088.00 ", N/A , N/A , N/A ,"$1,200.00 ","$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,312.00 ","$1,312.00 ","$1,312.00 ", N/A , N/A ,"$1,360.00 ", N/A ,"$1,600.00 ",$955.20 , N/A ,$665.60 , N/A , N/A , N/A ,"$1,360.00 ", N/A ,"$1,360.00 ",$448.00 ,"$1,440.00 ", N/A ,"$1,312.00 ","$1,352.00 ","$1,352.00 ", N/A ,"$1,040.00 ","$1,600.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100383,V5130,HC HEARING AID BINAURAL IN EAR T1,470,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100384,V5130,HC HEARING AID BINAURAL IN EAR T2,470,1 ,$800.00 ,$520.00 ,$224.00 ,$800.00 , N/A ,$520.00 ,$477.60 , N/A ,$224.00 ,$448.80 , N/A ,$526.40 , N/A ,$680.00 ,$680.00 , N/A ,$680.00 , N/A ,$544.00 , N/A , N/A , N/A ,$600.00 ,$568.00 ,$568.00 , N/A ,$568.00 ,$656.00 ,$656.00 ,$656.00 , N/A , N/A ,$680.00 , N/A ,$800.00 ,$477.60 , N/A ,$332.80 , N/A , N/A , N/A ,$680.00 , N/A ,$680.00 ,$224.00 ,$720.00 , N/A ,$656.00 ,$676.00 ,$676.00 , N/A ,$520.00 ,$800.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100385,V5130,HC HEARING AID BINAURAL IN EAR T3,470,1 ,"$1,150.00 ",$747.50 ,$322.00 ,"$1,150.00 ", N/A ,$747.50 ,$686.55 , N/A ,$322.00 ,$645.15 , N/A ,$756.70 , N/A ,$977.50 ,$977.50 , N/A ,$977.50 , N/A ,$782.00 , N/A , N/A , N/A ,$862.50 ,$816.50 ,$816.50 , N/A ,$816.50 ,$943.00 ,$943.00 ,$943.00 , N/A , N/A ,$977.50 , N/A ,"$1,150.00 ",$686.55 , N/A ,$478.40 , N/A , N/A , N/A ,$977.50 , N/A ,$977.50 ,$322.00 ,"$1,035.00 ", N/A ,$943.00 ,$971.75 ,$971.75 , N/A ,$747.50 ,"$1,150.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100386,V5130,HC HEARING AID BINAURAL IN EAR T4,470,1 ,"$1,500.00 ",$975.00 ,$420.00 ,"$1,500.00 ", N/A ,$975.00 ,$895.50 , N/A ,$420.00 ,$841.50 , N/A ,$987.00 , N/A ,"$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,020.00 ", N/A , N/A , N/A ,"$1,125.00 ","$1,065.00 ","$1,065.00 ", N/A ,"$1,065.00 ","$1,230.00 ","$1,230.00 ","$1,230.00 ", N/A , N/A ,"$1,275.00 ", N/A ,"$1,500.00 ",$895.50 , N/A ,$624.00 , N/A , N/A , N/A ,"$1,275.00 ", N/A ,"$1,275.00 ",$420.00 ,"$1,350.00 ", N/A ,"$1,230.00 ","$1,267.50 ","$1,267.50 ", N/A ,$975.00 ,"$1,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100387,V5130,HC HEARING AID BINAURAL IN EAR T5,470,1 ,"$1,600.00 ","$1,040.00 ",$448.00 ,"$1,600.00 ", N/A ,"$1,040.00 ",$955.20 , N/A ,$448.00 ,$897.60 , N/A ,"$1,052.80 ", N/A ,"$1,360.00 ","$1,360.00 ", N/A ,"$1,360.00 ", N/A ,"$1,088.00 ", N/A , N/A , N/A ,"$1,200.00 ","$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,312.00 ","$1,312.00 ","$1,312.00 ", N/A , N/A ,"$1,360.00 ", N/A ,"$1,600.00 ",$955.20 , N/A ,$665.60 , N/A , N/A , N/A ,"$1,360.00 ", N/A ,"$1,360.00 ",$448.00 ,"$1,440.00 ", N/A ,"$1,312.00 ","$1,352.00 ","$1,352.00 ", N/A ,"$1,040.00 ","$1,600.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100388,V5130,HC HEARING AID BINAURAL IN EAR T6,470,1 ,"$1,650.00 ","$1,072.50 ",$462.00 ,"$1,650.00 ", N/A ,"$1,072.50 ",$985.05 , N/A ,$462.00 ,$925.65 , N/A ,"$1,085.70 ", N/A ,"$1,402.50 ","$1,402.50 ", N/A ,"$1,402.50 ", N/A ,"$1,122.00 ", N/A , N/A , N/A ,"$1,237.50 ","$1,171.50 ","$1,171.50 ", N/A ,"$1,171.50 ","$1,353.00 ","$1,353.00 ","$1,353.00 ", N/A , N/A ,"$1,402.50 ", N/A ,"$1,650.00 ",$985.05 , N/A ,$686.40 , N/A , N/A , N/A ,"$1,402.50 ", N/A ,"$1,402.50 ",$462.00 ,"$1,485.00 ", N/A ,"$1,353.00 ","$1,394.25 ","$1,394.25 ", N/A ,"$1,072.50 ","$1,650.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100389,V5130,HC HEARING AID BINAURAL IN EAR T7,470,1 ,"$1,750.00 ","$1,137.50 ",$490.00 ,"$1,750.00 ", N/A ,"$1,137.50 ","$1,044.75 ", N/A ,$490.00 ,$981.75 , N/A ,"$1,151.50 ", N/A ,"$1,487.50 ","$1,487.50 ", N/A ,"$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,435.00 ","$1,435.00 ","$1,435.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ","$1,044.75 ", N/A ,$728.00 , N/A , N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ",$490.00 ,"$1,575.00 ", N/A ,"$1,435.00 ","$1,478.75 ","$1,478.75 ", N/A ,"$1,137.50 ","$1,750.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100390,V5130,HC HEARING AID BINAURAL IN EAR T8,470,1 ,"$2,000.00 ","$1,300.00 ",$560.00 ,"$2,000.00 ", N/A ,"$1,300.00 ","$1,194.00 ", N/A ,$560.00 ,"$1,122.00 ", N/A ,"$1,316.00 ", N/A ,"$1,700.00 ","$1,700.00 ", N/A ,"$1,700.00 ", N/A ,"$1,360.00 ", N/A , N/A , N/A ,"$1,500.00 ","$1,420.00 ","$1,420.00 ", N/A ,"$1,420.00 ","$1,640.00 ","$1,640.00 ","$1,640.00 ", N/A , N/A ,"$1,700.00 ", N/A ,"$2,000.00 ","$1,194.00 ", N/A ,$832.00 , N/A , N/A , N/A ,"$1,700.00 ", N/A ,"$1,700.00 ",$560.00 ,"$1,800.00 ", N/A ,"$1,640.00 ","$1,690.00 ","$1,690.00 ", N/A ,"$1,300.00 ","$2,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100391,V5130,HC HEARING AID BINAURAL IN EAR T9,470,1 ,"$2,300.00 ","$1,495.00 ",$644.00 ,"$2,300.00 ", N/A ,"$1,495.00 ","$1,373.10 ", N/A ,$644.00 ,"$1,290.30 ", N/A ,"$1,513.40 ", N/A ,"$1,955.00 ","$1,955.00 ", N/A ,"$1,955.00 ", N/A ,"$1,564.00 ", N/A , N/A , N/A ,"$1,725.00 ","$1,633.00 ","$1,633.00 ", N/A ,"$1,633.00 ","$1,886.00 ","$1,886.00 ","$1,886.00 ", N/A , N/A ,"$1,955.00 ", N/A ,"$2,300.00 ","$1,373.10 ", N/A ,$956.80 , N/A , N/A , N/A ,"$1,955.00 ", N/A ,"$1,955.00 ",$644.00 ,"$2,070.00 ", N/A ,"$1,886.00 ","$1,943.50 ","$1,943.50 ", N/A ,"$1,495.00 ","$2,300.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100392,V5130,HC HEARING AID BINAURAL IN EAR T10,470,1 ,"$2,550.00 ","$1,657.50 ",$714.00 ,"$2,550.00 ", N/A ,"$1,657.50 ","$1,522.35 ", N/A ,$714.00 ,"$1,430.55 ", N/A ,"$1,677.90 ", N/A ,"$2,167.50 ","$2,167.50 ", N/A ,"$2,167.50 ", N/A ,"$1,734.00 ", N/A , N/A , N/A ,"$1,912.50 ","$1,810.50 ","$1,810.50 ", N/A ,"$1,810.50 ","$2,091.00 ","$2,091.00 ","$2,091.00 ", N/A , N/A ,"$2,167.50 ", N/A ,"$2,550.00 ","$1,522.35 ", N/A ,"$1,060.80 ", N/A , N/A , N/A ,"$2,167.50 ", N/A ,"$2,167.50 ",$714.00 ,"$2,295.00 ", N/A ,"$2,091.00 ","$2,154.75 ","$2,154.75 ", N/A ,"$1,657.50 ","$2,550.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100393,V5130,HC HEARING AID BINAURAL IN EAR T11,470,1 ,"$2,800.00 ","$1,820.00 ",$784.00 ,"$2,800.00 ", N/A ,"$1,820.00 ","$1,671.60 ", N/A ,$784.00 ,"$1,570.80 ", N/A ,"$1,842.40 ", N/A ,"$2,380.00 ","$2,380.00 ", N/A ,"$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,296.00 ","$2,296.00 ","$2,296.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ","$1,671.60 ", N/A ,"$1,164.80 ", N/A , N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ",$784.00 ,"$2,520.00 ", N/A ,"$2,296.00 ","$2,366.00 ","$2,366.00 ", N/A ,"$1,820.00 ","$2,800.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100394,V5130,HC HEARING AID BINAURAL IN EAR T12,470,1 ,"$3,050.00 ","$1,982.50 ",$854.00 ,"$3,050.00 ", N/A ,"$1,982.50 ","$1,820.85 ", N/A ,$854.00 ,"$1,711.05 ", N/A ,"$2,006.90 ", N/A ,"$2,592.50 ","$2,592.50 ", N/A ,"$2,592.50 ", N/A ,"$2,074.00 ", N/A , N/A , N/A ,"$2,287.50 ","$2,165.50 ","$2,165.50 ", N/A ,"$2,165.50 ","$2,501.00 ","$2,501.00 ","$2,501.00 ", N/A , N/A ,"$2,592.50 ", N/A ,"$3,050.00 ","$1,820.85 ", N/A ,"$1,268.80 ", N/A , N/A , N/A ,"$2,592.50 ", N/A ,"$2,592.50 ",$854.00 ,"$2,745.00 ", N/A ,"$2,501.00 ","$2,577.25 ","$2,577.25 ", N/A ,"$1,982.50 ","$3,050.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100395,V5130,HC HEARING AID BINAURAL IN EAR T13,470,1 ,"$3,350.00 ","$2,177.50 ",$938.00 ,"$3,350.00 ", N/A ,"$2,177.50 ","$1,999.95 ", N/A ,$938.00 ,"$1,879.35 ", N/A ,"$2,204.30 ", N/A ,"$2,847.50 ","$2,847.50 ", N/A ,"$2,847.50 ", N/A ,"$2,278.00 ", N/A , N/A , N/A ,"$2,512.50 ","$2,378.50 ","$2,378.50 ", N/A ,"$2,378.50 ","$2,747.00 ","$2,747.00 ","$2,747.00 ", N/A , N/A ,"$2,847.50 ", N/A ,"$3,350.00 ","$1,999.95 ", N/A ,"$1,393.60 ", N/A , N/A , N/A ,"$2,847.50 ", N/A ,"$2,847.50 ",$938.00 ,"$3,015.00 ", N/A ,"$2,747.00 ","$2,830.75 ","$2,830.75 ", N/A ,"$2,177.50 ","$3,350.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100396,V5130,HC HEARING AID BINAURAL IN EAR T14,470,1 ,"$3,750.00 ","$2,437.50 ","$1,050.00 ","$3,750.00 ", N/A ,"$2,437.50 ","$2,238.75 ", N/A ,"$1,050.00 ","$2,103.75 ", N/A ,"$2,467.50 ", N/A ,"$3,187.50 ","$3,187.50 ", N/A ,"$3,187.50 ", N/A ,"$2,550.00 ", N/A , N/A , N/A ,"$2,812.50 ","$2,662.50 ","$2,662.50 ", N/A ,"$2,662.50 ","$3,075.00 ","$3,075.00 ","$3,075.00 ", N/A , N/A ,"$3,187.50 ", N/A ,"$3,750.00 ","$2,238.75 ", N/A ,"$1,560.00 ", N/A , N/A , N/A ,"$3,187.50 ", N/A ,"$3,187.50 ","$1,050.00 ","$3,375.00 ", N/A ,"$3,075.00 ","$3,168.75 ","$3,168.75 ", N/A ,"$2,437.50 ","$3,750.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100397,V5130,HC HEARING AID BINAURAL IN EAR T15,470,1 ,"$4,450.00 ","$2,892.50 ","$1,246.00 ","$4,450.00 ", N/A ,"$2,892.50 ","$2,656.65 ", N/A ,"$1,246.00 ","$2,496.45 ", N/A ,"$2,928.10 ", N/A ,"$3,782.50 ","$3,782.50 ", N/A ,"$3,782.50 ", N/A ,"$3,026.00 ", N/A , N/A , N/A ,"$3,337.50 ","$3,159.50 ","$3,159.50 ", N/A ,"$3,159.50 ","$3,649.00 ","$3,649.00 ","$3,649.00 ", N/A , N/A ,"$3,782.50 ", N/A ,"$4,450.00 ","$2,656.65 ", N/A ,"$1,851.20 ", N/A , N/A , N/A ,"$3,782.50 ", N/A ,"$3,782.50 ","$1,246.00 ","$4,005.00 ", N/A ,"$3,649.00 ","$3,760.25 ","$3,760.25 ", N/A ,"$2,892.50 ","$4,450.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100398,V5130,HC HEARING AID BINAURAL IN EAR T16,470,1 ,"$4,700.00 ","$3,055.00 ","$1,316.00 ","$4,700.00 ", N/A ,"$3,055.00 ","$2,805.90 ", N/A ,"$1,316.00 ","$2,636.70 ", N/A ,"$3,092.60 ", N/A ,"$3,995.00 ","$3,995.00 ", N/A ,"$3,995.00 ", N/A ,"$3,196.00 ", N/A , N/A , N/A ,"$3,525.00 ","$3,337.00 ","$3,337.00 ", N/A ,"$3,337.00 ","$3,854.00 ","$3,854.00 ","$3,854.00 ", N/A , N/A ,"$3,995.00 ", N/A ,"$4,700.00 ","$2,805.90 ", N/A ,"$1,955.20 ", N/A , N/A , N/A ,"$3,995.00 ", N/A ,"$3,995.00 ","$1,316.00 ","$4,230.00 ", N/A ,"$3,854.00 ","$3,971.50 ","$3,971.50 ", N/A ,"$3,055.00 ","$4,700.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100399,V5140,HC HEARING AID BINAURAL BEHIND EAR T1,271,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100400,V5140,HC HEARING AID BINAURAL BEHIND EAR T2,271,1 ,$800.00 ,$520.00 ,$224.00 ,$800.00 , N/A ,$520.00 ,$477.60 , N/A ,$224.00 ,$448.80 , N/A ,$526.40 , N/A ,$680.00 ,$680.00 , N/A ,$680.00 , N/A ,$544.00 , N/A , N/A , N/A ,$600.00 ,$568.00 ,$568.00 , N/A ,$568.00 ,$656.00 ,$656.00 ,$656.00 , N/A , N/A ,$680.00 , N/A ,$800.00 ,$477.60 , N/A ,$332.80 , N/A , N/A , N/A ,$680.00 , N/A ,$680.00 ,$224.00 ,$720.00 , N/A ,$656.00 ,$676.00 ,$676.00 , N/A ,$520.00 ,$800.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100401,V5140,HC HEARING AID BINAURAL BEHIND EAR T3,271,1 ,"$1,100.00 ",$715.00 ,$308.00 ,"$1,100.00 ", N/A ,$715.00 ,$656.70 , N/A ,$308.00 ,$617.10 , N/A ,$723.80 , N/A ,$935.00 ,$935.00 , N/A ,$935.00 , N/A ,$748.00 , N/A , N/A , N/A ,$825.00 ,$781.00 ,$781.00 , N/A ,$781.00 ,$902.00 ,$902.00 ,$902.00 , N/A , N/A ,$935.00 , N/A ,"$1,100.00 ",$656.70 , N/A ,$457.60 , N/A , N/A , N/A ,$935.00 , N/A ,$935.00 ,$308.00 ,$990.00 , N/A ,$902.00 ,$929.50 ,$929.50 , N/A ,$715.00 ,"$1,100.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100402,V5140,HC HEARING AID BINAURAL BEHIND EAR T4,271,1 ,"$1,150.00 ",$747.50 ,$322.00 ,"$1,150.00 ", N/A ,$747.50 ,$686.55 , N/A ,$322.00 ,$645.15 , N/A ,$756.70 , N/A ,$977.50 ,$977.50 , N/A ,$977.50 , N/A ,$782.00 , N/A , N/A , N/A ,$862.50 ,$816.50 ,$816.50 , N/A ,$816.50 ,$943.00 ,$943.00 ,$943.00 , N/A , N/A ,$977.50 , N/A ,"$1,150.00 ",$686.55 , N/A ,$478.40 , N/A , N/A , N/A ,$977.50 , N/A ,$977.50 ,$322.00 ,"$1,035.00 ", N/A ,$943.00 ,$971.75 ,$971.75 , N/A ,$747.50 ,"$1,150.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100403,V5140,HC HEARING AID BINAURAL BEHIND EAR T5,271,1 ,"$1,200.00 ",$780.00 ,$336.00 ,"$1,200.00 ", N/A ,$780.00 ,$716.40 , N/A ,$336.00 ,$673.20 , N/A ,$789.60 , N/A ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$816.00 , N/A , N/A , N/A ,$900.00 ,$852.00 ,$852.00 , N/A ,$852.00 ,$984.00 ,$984.00 ,$984.00 , N/A , N/A ,"$1,020.00 ", N/A ,"$1,200.00 ",$716.40 , N/A ,$499.20 , N/A , N/A , N/A ,"$1,020.00 ", N/A ,"$1,020.00 ",$336.00 ,"$1,080.00 ", N/A ,$984.00 ,"$1,014.00 ","$1,014.00 ", N/A ,$780.00 ,"$1,200.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100404,V5140,HC HEARING AID BINAURAL BEHIND EAR T6,271,1 ,"$1,500.00 ",$975.00 ,$420.00 ,"$1,500.00 ", N/A ,$975.00 ,$895.50 , N/A ,$420.00 ,$841.50 , N/A ,$987.00 , N/A ,"$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,020.00 ", N/A , N/A , N/A ,"$1,125.00 ","$1,065.00 ","$1,065.00 ", N/A ,"$1,065.00 ","$1,230.00 ","$1,230.00 ","$1,230.00 ", N/A , N/A ,"$1,275.00 ", N/A ,"$1,500.00 ",$895.50 , N/A ,$624.00 , N/A , N/A , N/A ,"$1,275.00 ", N/A ,"$1,275.00 ",$420.00 ,"$1,350.00 ", N/A ,"$1,230.00 ","$1,267.50 ","$1,267.50 ", N/A ,$975.00 ,"$1,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100405,V5140,HC HEARING AID BINAURAL BEHIND EAR T7,271,1 ,"$1,600.00 ","$1,040.00 ",$448.00 ,"$1,600.00 ", N/A ,"$1,040.00 ",$955.20 , N/A ,$448.00 ,$897.60 , N/A ,"$1,052.80 ", N/A ,"$1,360.00 ","$1,360.00 ", N/A ,"$1,360.00 ", N/A ,"$1,088.00 ", N/A , N/A , N/A ,"$1,200.00 ","$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,312.00 ","$1,312.00 ","$1,312.00 ", N/A , N/A ,"$1,360.00 ", N/A ,"$1,600.00 ",$955.20 , N/A ,$665.60 , N/A , N/A , N/A ,"$1,360.00 ", N/A ,"$1,360.00 ",$448.00 ,"$1,440.00 ", N/A ,"$1,312.00 ","$1,352.00 ","$1,352.00 ", N/A ,"$1,040.00 ","$1,600.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100406,V5140,HC HEARING AID BINAURAL BEHIND EAR T8,271,1 ,"$1,650.00 ","$1,072.50 ",$462.00 ,"$1,650.00 ", N/A ,"$1,072.50 ",$985.05 , N/A ,$462.00 ,$925.65 , N/A ,"$1,085.70 ", N/A ,"$1,402.50 ","$1,402.50 ", N/A ,"$1,402.50 ", N/A ,"$1,122.00 ", N/A , N/A , N/A ,"$1,237.50 ","$1,171.50 ","$1,171.50 ", N/A ,"$1,171.50 ","$1,353.00 ","$1,353.00 ","$1,353.00 ", N/A , N/A ,"$1,402.50 ", N/A ,"$1,650.00 ",$985.05 , N/A ,$686.40 , N/A , N/A , N/A ,"$1,402.50 ", N/A ,"$1,402.50 ",$462.00 ,"$1,485.00 ", N/A ,"$1,353.00 ","$1,394.25 ","$1,394.25 ", N/A ,"$1,072.50 ","$1,650.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100407,V5140,HC HEARING AID BINAURAL BEHIND EAR T9,271,1 ,"$1,750.00 ","$1,137.50 ",$490.00 ,"$1,750.00 ", N/A ,"$1,137.50 ","$1,044.75 ", N/A ,$490.00 ,$981.75 , N/A ,"$1,151.50 ", N/A ,"$1,487.50 ","$1,487.50 ", N/A ,"$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,435.00 ","$1,435.00 ","$1,435.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ","$1,044.75 ", N/A ,$728.00 , N/A , N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ",$490.00 ,"$1,575.00 ", N/A ,"$1,435.00 ","$1,478.75 ","$1,478.75 ", N/A ,"$1,137.50 ","$1,750.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100408,V5140,HC HEARING AID BINAURAL BEHIND EAR T10,271,1 ,"$2,000.00 ","$1,300.00 ",$560.00 ,"$2,000.00 ", N/A ,"$1,300.00 ","$1,194.00 ", N/A ,$560.00 ,"$1,122.00 ", N/A ,"$1,316.00 ", N/A ,"$1,700.00 ","$1,700.00 ", N/A ,"$1,700.00 ", N/A ,"$1,360.00 ", N/A , N/A , N/A ,"$1,500.00 ","$1,420.00 ","$1,420.00 ", N/A ,"$1,420.00 ","$1,640.00 ","$1,640.00 ","$1,640.00 ", N/A , N/A ,"$1,700.00 ", N/A ,"$2,000.00 ","$1,194.00 ", N/A ,$832.00 , N/A , N/A , N/A ,"$1,700.00 ", N/A ,"$1,700.00 ",$560.00 ,"$1,800.00 ", N/A ,"$1,640.00 ","$1,690.00 ","$1,690.00 ", N/A ,"$1,300.00 ","$2,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100409,V5140,HC HEARING AID BINAURAL BEHIND EAR T11,271,1 ,"$2,300.00 ","$1,495.00 ",$644.00 ,"$2,300.00 ", N/A ,"$1,495.00 ","$1,373.10 ", N/A ,$644.00 ,"$1,290.30 ", N/A ,"$1,513.40 ", N/A ,"$1,955.00 ","$1,955.00 ", N/A ,"$1,955.00 ", N/A ,"$1,564.00 ", N/A , N/A , N/A ,"$1,725.00 ","$1,633.00 ","$1,633.00 ", N/A ,"$1,633.00 ","$1,886.00 ","$1,886.00 ","$1,886.00 ", N/A , N/A ,"$1,955.00 ", N/A ,"$2,300.00 ","$1,373.10 ", N/A ,$956.80 , N/A , N/A , N/A ,"$1,955.00 ", N/A ,"$1,955.00 ",$644.00 ,"$2,070.00 ", N/A ,"$1,886.00 ","$1,943.50 ","$1,943.50 ", N/A ,"$1,495.00 ","$2,300.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100410,V5140,HC HEARING AID BINAURAL BEHIND EAR T12,271,1 ,"$2,450.00 ","$1,592.50 ",$686.00 ,"$2,450.00 ", N/A ,"$1,592.50 ","$1,462.65 ", N/A ,$686.00 ,"$1,374.45 ", N/A ,"$1,612.10 ", N/A ,"$2,082.50 ","$2,082.50 ", N/A ,"$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,009.00 ","$2,009.00 ","$2,009.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ","$1,462.65 ", N/A ,"$1,019.20 ", N/A , N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ",$686.00 ,"$2,205.00 ", N/A ,"$2,009.00 ","$2,070.25 ","$2,070.25 ", N/A ,"$1,592.50 ","$2,450.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100411,V5140,HC HEARING AID BINAURAL BEHIND EAR T13,271,1 ,"$2,550.00 ","$1,657.50 ",$714.00 ,"$2,550.00 ", N/A ,"$1,657.50 ","$1,522.35 ", N/A ,$714.00 ,"$1,430.55 ", N/A ,"$1,677.90 ", N/A ,"$2,167.50 ","$2,167.50 ", N/A ,"$2,167.50 ", N/A ,"$1,734.00 ", N/A , N/A , N/A ,"$1,912.50 ","$1,810.50 ","$1,810.50 ", N/A ,"$1,810.50 ","$2,091.00 ","$2,091.00 ","$2,091.00 ", N/A , N/A ,"$2,167.50 ", N/A ,"$2,550.00 ","$1,522.35 ", N/A ,"$1,060.80 ", N/A , N/A , N/A ,"$2,167.50 ", N/A ,"$2,167.50 ",$714.00 ,"$2,295.00 ", N/A ,"$2,091.00 ","$2,154.75 ","$2,154.75 ", N/A ,"$1,657.50 ","$2,550.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100412,V5140,HC HEARING AID BINAURAL BEHIND EAR T14,271,1 ,"$2,800.00 ","$1,820.00 ",$784.00 ,"$2,800.00 ", N/A ,"$1,820.00 ","$1,671.60 ", N/A ,$784.00 ,"$1,570.80 ", N/A ,"$1,842.40 ", N/A ,"$2,380.00 ","$2,380.00 ", N/A ,"$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,296.00 ","$2,296.00 ","$2,296.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ","$1,671.60 ", N/A ,"$1,164.80 ", N/A , N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ",$784.00 ,"$2,520.00 ", N/A ,"$2,296.00 ","$2,366.00 ","$2,366.00 ", N/A ,"$1,820.00 ","$2,800.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100413,V5140,HC HEARING AID BINAURAL BEHIND EAR T15,271,1 ,"$3,050.00 ","$1,982.50 ",$854.00 ,"$3,050.00 ", N/A ,"$1,982.50 ","$1,820.85 ", N/A ,$854.00 ,"$1,711.05 ", N/A ,"$2,006.90 ", N/A ,"$2,592.50 ","$2,592.50 ", N/A ,"$2,592.50 ", N/A ,"$2,074.00 ", N/A , N/A , N/A ,"$2,287.50 ","$2,165.50 ","$2,165.50 ", N/A ,"$2,165.50 ","$2,501.00 ","$2,501.00 ","$2,501.00 ", N/A , N/A ,"$2,592.50 ", N/A ,"$3,050.00 ","$1,820.85 ", N/A ,"$1,268.80 ", N/A , N/A , N/A ,"$2,592.50 ", N/A ,"$2,592.50 ",$854.00 ,"$2,745.00 ", N/A ,"$2,501.00 ","$2,577.25 ","$2,577.25 ", N/A ,"$1,982.50 ","$3,050.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100414,V5140,HC HEARING AID BINAURAL BEHIND EAR T16,271,1 ,"$3,200.00 ","$2,080.00 ",$896.00 ,"$3,200.00 ", N/A ,"$2,080.00 ","$1,910.40 ", N/A ,$896.00 ,"$1,795.20 ", N/A ,"$2,105.60 ", N/A ,"$2,720.00 ","$2,720.00 ", N/A ,"$2,720.00 ", N/A ,"$2,176.00 ", N/A , N/A , N/A ,"$2,400.00 ","$2,272.00 ","$2,272.00 ", N/A ,"$2,272.00 ","$2,624.00 ","$2,624.00 ","$2,624.00 ", N/A , N/A ,"$2,720.00 ", N/A ,"$3,200.00 ","$1,910.40 ", N/A ,"$1,331.20 ", N/A , N/A , N/A ,"$2,720.00 ", N/A ,"$2,720.00 ",$896.00 ,"$2,880.00 ", N/A ,"$2,624.00 ","$2,704.00 ","$2,704.00 ", N/A ,"$2,080.00 ","$3,200.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100415,V5171,HC HEARING AID CROS MONAURAL IN EAR T1,271,1 ,$575.00 ,$373.75 ,$161.00 ,$575.00 , N/A ,$373.75 ,$343.28 , N/A ,$161.00 ,$322.58 , N/A ,$378.35 , N/A ,$488.75 ,$488.75 , N/A ,$488.75 , N/A ,$391.00 , N/A , N/A , N/A ,$431.25 ,$408.25 ,$408.25 , N/A ,$408.25 ,$471.50 ,$471.50 ,$471.50 , N/A , N/A ,$488.75 , N/A ,$575.00 ,$343.28 , N/A ,$239.20 , N/A , N/A , N/A ,$488.75 , N/A ,$488.75 ,$161.00 ,$517.50 , N/A ,$471.50 ,$485.88 ,$485.88 , N/A ,$373.75 ,$575.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100416,V5171,HC HEARING AID CROS MONAURAL IN EAR T2,271,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100417,V5171,HC HEARING AID CROS MONAURAL IN EAR T3,271,1 ,$875.00 ,$568.75 ,$245.00 ,$875.00 , N/A ,$568.75 ,$522.38 , N/A ,$245.00 ,$490.88 , N/A ,$575.75 , N/A ,$743.75 ,$743.75 , N/A ,$743.75 , N/A ,$595.00 , N/A , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$717.50 ,$717.50 ,$717.50 , N/A , N/A ,$743.75 , N/A ,$875.00 ,$522.38 , N/A ,$364.00 , N/A , N/A , N/A ,$743.75 , N/A ,$743.75 ,$245.00 ,$787.50 , N/A ,$717.50 ,$739.38 ,$739.38 , N/A ,$568.75 ,$875.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100418,V5171,HC HEARING AID CROS MONAURAL IN EAR T4,271,1 ,$925.00 ,$601.25 ,$259.00 ,$925.00 , N/A ,$601.25 ,$552.23 , N/A ,$259.00 ,$518.93 , N/A ,$608.65 , N/A ,$786.25 ,$786.25 , N/A ,$786.25 , N/A ,$629.00 , N/A , N/A , N/A ,$693.75 ,$656.75 ,$656.75 , N/A ,$656.75 ,$758.50 ,$758.50 ,$758.50 , N/A , N/A ,$786.25 , N/A ,$925.00 ,$552.23 , N/A ,$384.80 , N/A , N/A , N/A ,$786.25 , N/A ,$786.25 ,$259.00 ,$832.50 , N/A ,$758.50 ,$781.63 ,$781.63 , N/A ,$601.25 ,$925.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100431,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T1,271,1 ,$575.00 ,$373.75 ,$161.00 ,$575.00 , N/A ,$373.75 ,$343.28 , N/A ,$161.00 ,$322.58 , N/A ,$378.35 , N/A ,$488.75 ,$488.75 , N/A ,$488.75 , N/A ,$391.00 , N/A , N/A , N/A ,$431.25 ,$408.25 ,$408.25 , N/A ,$408.25 ,$471.50 ,$471.50 ,$471.50 , N/A , N/A ,$488.75 , N/A ,$575.00 ,$343.28 , N/A ,$239.20 , N/A , N/A , N/A ,$488.75 , N/A ,$488.75 ,$161.00 ,$517.50 , N/A ,$471.50 ,$485.88 ,$485.88 , N/A ,$373.75 ,$575.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100432,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T2,271,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100433,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T3,271,1 ,$875.00 ,$568.75 ,$245.00 ,$875.00 , N/A ,$568.75 ,$522.38 , N/A ,$245.00 ,$490.88 , N/A ,$575.75 , N/A ,$743.75 ,$743.75 , N/A ,$743.75 , N/A ,$595.00 , N/A , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$717.50 ,$717.50 ,$717.50 , N/A , N/A ,$743.75 , N/A ,$875.00 ,$522.38 , N/A ,$364.00 , N/A , N/A , N/A ,$743.75 , N/A ,$743.75 ,$245.00 ,$787.50 , N/A ,$717.50 ,$739.38 ,$739.38 , N/A ,$568.75 ,$875.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100434,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T4,271,1 ,$925.00 ,$601.25 ,$259.00 ,$925.00 , N/A ,$601.25 ,$552.23 , N/A ,$259.00 ,$518.93 , N/A ,$608.65 , N/A ,$786.25 ,$786.25 , N/A ,$786.25 , N/A ,$629.00 , N/A , N/A , N/A ,$693.75 ,$656.75 ,$656.75 , N/A ,$656.75 ,$758.50 ,$758.50 ,$758.50 , N/A , N/A ,$786.25 , N/A ,$925.00 ,$552.23 , N/A ,$384.80 , N/A , N/A , N/A ,$786.25 , N/A ,$786.25 ,$259.00 ,$832.50 , N/A ,$758.50 ,$781.63 ,$781.63 , N/A ,$601.25 ,$925.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100435,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T5,271,1 ,"$1,000.00 ",$650.00 ,$280.00 ,"$1,000.00 ", N/A ,$650.00 ,$597.00 , N/A ,$280.00 ,$561.00 , N/A ,$658.00 , N/A ,$850.00 ,$850.00 , N/A ,$850.00 , N/A ,$680.00 , N/A , N/A , N/A ,$750.00 ,$710.00 ,$710.00 , N/A ,$710.00 ,$820.00 ,$820.00 ,$820.00 , N/A , N/A ,$850.00 , N/A ,"$1,000.00 ",$597.00 , N/A ,$416.00 , N/A , N/A , N/A ,$850.00 , N/A ,$850.00 ,$280.00 ,$900.00 , N/A ,$820.00 ,$845.00 ,$845.00 , N/A ,$650.00 ,"$1,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100436,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T6,271,1 ,$495.00 ,$321.75 ,$138.60 ,$495.00 , N/A ,$321.75 ,$295.52 , N/A ,$138.60 ,$277.70 , N/A ,$325.71 , N/A ,$420.75 ,$420.75 , N/A ,$420.75 , N/A ,$336.60 , N/A , N/A , N/A ,$371.25 ,$351.45 ,$351.45 , N/A ,$351.45 ,$405.90 ,$405.90 ,$405.90 , N/A , N/A ,$420.75 , N/A ,$495.00 ,$295.52 , N/A ,$205.92 , N/A , N/A , N/A ,$420.75 , N/A ,$420.75 ,$138.60 ,$445.50 , N/A ,$405.90 ,$418.28 ,$418.28 , N/A ,$321.75 ,$495.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100437,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T7,271,1 ,$495.00 ,$321.75 ,$138.60 ,$495.00 , N/A ,$321.75 ,$295.52 , N/A ,$138.60 ,$277.70 , N/A ,$325.71 , N/A ,$420.75 ,$420.75 , N/A ,$420.75 , N/A ,$336.60 , N/A , N/A , N/A ,$371.25 ,$351.45 ,$351.45 , N/A ,$351.45 ,$405.90 ,$405.90 ,$405.90 , N/A , N/A ,$420.75 , N/A ,$495.00 ,$295.52 , N/A ,$205.92 , N/A , N/A , N/A ,$420.75 , N/A ,$420.75 ,$138.60 ,$445.50 , N/A ,$405.90 ,$418.28 ,$418.28 , N/A ,$321.75 ,$495.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100438,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T8,271,1 ,"$1,575.00 ","$1,023.75 ",$441.00 ,"$1,575.00 ", N/A ,"$1,023.75 ",$940.28 , N/A ,$441.00 ,$883.58 , N/A ,"$1,036.35 ", N/A ,"$1,338.75 ","$1,338.75 ", N/A ,"$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,291.50 ","$1,291.50 ","$1,291.50 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ",$940.28 , N/A ,$655.20 , N/A , N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ",$441.00 ,"$1,417.50 ", N/A ,"$1,291.50 ","$1,330.88 ","$1,330.88 ", N/A ,"$1,023.75 ","$1,575.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100439,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T9,271,1 ,"$1,750.00 ","$1,137.50 ",$490.00 ,"$1,750.00 ", N/A ,"$1,137.50 ","$1,044.75 ", N/A ,$490.00 ,$981.75 , N/A ,"$1,151.50 ", N/A ,"$1,487.50 ","$1,487.50 ", N/A ,"$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,435.00 ","$1,435.00 ","$1,435.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ","$1,044.75 ", N/A ,$728.00 , N/A , N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ",$490.00 ,"$1,575.00 ", N/A ,"$1,435.00 ","$1,478.75 ","$1,478.75 ", N/A ,"$1,137.50 ","$1,750.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100440,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T10,271,1 ,"$1,925.00 ","$1,251.25 ",$539.00 ,"$1,925.00 ", N/A ,"$1,251.25 ","$1,149.23 ", N/A ,$539.00 ,"$1,079.93 ", N/A ,"$1,266.65 ", N/A ,"$1,636.25 ","$1,636.25 ", N/A ,"$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,578.50 ","$1,578.50 ","$1,578.50 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ","$1,149.23 ", N/A ,$800.80 , N/A , N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ",$539.00 ,"$1,732.50 ", N/A ,"$1,578.50 ","$1,626.63 ","$1,626.63 ", N/A ,"$1,251.25 ","$1,925.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100441,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T11,271,1 ,"$2,100.00 ","$1,365.00 ",$588.00 ,"$2,100.00 ", N/A ,"$1,365.00 ","$1,253.70 ", N/A ,$588.00 ,"$1,178.10 ", N/A ,"$1,381.80 ", N/A ,"$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,722.00 ","$1,722.00 ","$1,722.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ","$1,253.70 ", N/A ,$873.60 , N/A , N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ",$588.00 ,"$1,890.00 ", N/A ,"$1,722.00 ","$1,774.50 ","$1,774.50 ", N/A ,"$1,365.00 ","$2,100.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100442,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T12,271,1 ,"$2,275.00 ","$1,478.75 ",$637.00 ,"$2,275.00 ", N/A ,"$1,478.75 ","$1,358.18 ", N/A ,$637.00 ,"$1,276.28 ", N/A ,"$1,496.95 ", N/A ,"$1,933.75 ","$1,933.75 ", N/A ,"$1,933.75 ", N/A ,"$1,547.00 ", N/A , N/A , N/A ,"$1,706.25 ","$1,615.25 ","$1,615.25 ", N/A ,"$1,615.25 ","$1,865.50 ","$1,865.50 ","$1,865.50 ", N/A , N/A ,"$1,933.75 ", N/A ,"$2,275.00 ","$1,358.18 ", N/A ,$946.40 , N/A , N/A , N/A ,"$1,933.75 ", N/A ,"$1,933.75 ",$637.00 ,"$2,047.50 ", N/A ,"$1,865.50 ","$1,922.38 ","$1,922.38 ", N/A ,"$1,478.75 ","$2,275.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100443,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T13,271,1 ,"$2,450.00 ","$1,592.50 ",$686.00 ,"$2,450.00 ", N/A ,"$1,592.50 ","$1,462.65 ", N/A ,$686.00 ,"$1,374.45 ", N/A ,"$1,612.10 ", N/A ,"$2,082.50 ","$2,082.50 ", N/A ,"$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,009.00 ","$2,009.00 ","$2,009.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ","$1,462.65 ", N/A ,"$1,019.20 ", N/A , N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ",$686.00 ,"$2,205.00 ", N/A ,"$2,009.00 ","$2,070.25 ","$2,070.25 ", N/A ,"$1,592.50 ","$2,450.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100444,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T14,271,1 ,"$2,625.00 ","$1,706.25 ",$735.00 ,"$2,625.00 ", N/A ,"$1,706.25 ","$1,567.13 ", N/A ,$735.00 ,"$1,472.63 ", N/A ,"$1,727.25 ", N/A ,"$2,231.25 ","$2,231.25 ", N/A ,"$2,231.25 ", N/A ,"$1,785.00 ", N/A , N/A , N/A ,"$1,968.75 ","$1,863.75 ","$1,863.75 ", N/A ,"$1,863.75 ","$2,152.50 ","$2,152.50 ","$2,152.50 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,625.00 ","$1,567.13 ", N/A ,"$1,092.00 ", N/A , N/A , N/A ,"$2,231.25 ", N/A ,"$2,231.25 ",$735.00 ,"$2,362.50 ", N/A ,"$2,152.50 ","$2,218.13 ","$2,218.13 ", N/A ,"$1,706.25 ","$2,625.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100445,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T15,271,1 ,"$2,800.00 ","$1,820.00 ",$784.00 ,"$2,800.00 ", N/A ,"$1,820.00 ","$1,671.60 ", N/A ,$784.00 ,"$1,570.80 ", N/A ,"$1,842.40 ", N/A ,"$2,380.00 ","$2,380.00 ", N/A ,"$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,296.00 ","$2,296.00 ","$2,296.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ","$1,671.60 ", N/A ,"$1,164.80 ", N/A , N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ",$784.00 ,"$2,520.00 ", N/A ,"$2,296.00 ","$2,366.00 ","$2,366.00 ", N/A ,"$1,820.00 ","$2,800.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100446,V5181,HC HEARING AID CROS MONAURAL BEHIND EAR T16,271,1 ,"$3,000.00 ","$1,950.00 ",$840.00 ,"$3,000.00 ", N/A ,"$1,950.00 ","$1,791.00 ", N/A ,$840.00 ,"$1,683.00 ", N/A ,"$1,974.00 ", N/A ,"$2,550.00 ","$2,550.00 ", N/A ,"$2,550.00 ", N/A ,"$2,040.00 ", N/A , N/A , N/A ,"$2,250.00 ","$2,130.00 ","$2,130.00 ", N/A ,"$2,130.00 ","$2,460.00 ","$2,460.00 ","$2,460.00 ", N/A , N/A ,"$2,550.00 ", N/A ,"$3,000.00 ","$1,791.00 ", N/A ,"$1,248.00 ", N/A , N/A , N/A ,"$2,550.00 ", N/A ,"$2,550.00 ",$840.00 ,"$2,700.00 ", N/A ,"$2,460.00 ","$2,535.00 ","$2,535.00 ", N/A ,"$1,950.00 ","$3,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100447,V5160,HC HEARING AID DISPENSING FEE BINAURAL,470,1 ,$495.00 ,$321.75 ,$138.60 ,$495.00 , N/A ,$321.75 ,$295.52 , N/A ,$138.60 ,$277.70 , N/A ,$325.71 , N/A ,$420.75 ,$420.75 , N/A ,$420.75 , N/A ,$336.60 , N/A , N/A , N/A ,$371.25 ,$351.45 ,$351.45 , N/A ,$351.45 ,$405.90 ,$405.90 ,$405.90 , N/A , N/A ,$420.75 , N/A ,$495.00 ,$295.52 , N/A ,$205.92 , N/A , N/A , N/A ,$420.75 , N/A ,$420.75 ,$138.60 ,$445.50 , N/A ,$405.90 ,$418.28 ,$418.28 , N/A ,$321.75 ,$495.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100448,V5200,HC HEARING AID DISPENSING FEE CROS,271,1 ,$495.00 ,$321.75 ,$138.60 ,$495.00 , N/A ,$321.75 ,$295.52 , N/A ,$138.60 ,$277.70 , N/A ,$325.71 , N/A ,$420.75 ,$420.75 , N/A ,$420.75 , N/A ,$336.60 , N/A , N/A , N/A ,$371.25 ,$351.45 ,$351.45 , N/A ,$351.45 ,$405.90 ,$405.90 ,$405.90 , N/A , N/A ,$420.75 , N/A ,$495.00 ,$295.52 , N/A ,$205.92 , N/A , N/A , N/A ,$420.75 , N/A ,$420.75 ,$138.60 ,$445.50 , N/A ,$405.90 ,$418.28 ,$418.28 , N/A ,$321.75 ,$495.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100449,V5240,HC HEARING AID DISPENSING FEE BICROS,271,1 ,$498.00 ,$323.70 ,$139.44 ,$498.00 , N/A ,$323.70 ,$297.31 , N/A ,$139.44 ,$279.38 , N/A ,$327.68 , N/A ,$423.30 ,$423.30 , N/A ,$423.30 , N/A ,$338.64 , N/A , N/A , N/A ,$373.50 ,$353.58 ,$353.58 , N/A ,$353.58 ,$408.36 ,$408.36 ,$408.36 , N/A , N/A ,$423.30 , N/A ,$498.00 ,$297.31 , N/A ,$207.17 , N/A , N/A , N/A ,$423.30 , N/A ,$423.30 ,$139.44 ,$448.20 , N/A ,$408.36 ,$420.81 ,$420.81 , N/A ,$323.70 ,$498.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100450,V5241,HC HEARING AID DISPENSING FEE MONAURAL,271,1 ,$345.00 ,$224.25 ,$96.60 ,$345.00 , N/A ,$224.25 ,$205.97 , N/A ,$96.60 ,$193.55 , N/A ,$227.01 , N/A ,$293.25 ,$293.25 , N/A ,$293.25 , N/A ,$234.60 , N/A , N/A , N/A ,$258.75 ,$244.95 ,$244.95 , N/A ,$244.95 ,$282.90 ,$282.90 ,$282.90 , N/A , N/A ,$293.25 , N/A ,$345.00 ,$205.97 , N/A ,$143.52 , N/A , N/A , N/A ,$293.25 , N/A ,$293.25 ,$96.60 ,$310.50 , N/A ,$282.90 ,$291.53 ,$291.53 , N/A ,$224.25 ,$345.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100451,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T1,271,1 ,$40.00 ,$26.00 ,$11.20 ,$40.00 , N/A ,$26.00 ,$23.88 , N/A ,$11.20 ,$22.44 , N/A ,$26.32 , N/A ,$34.00 ,$34.00 , N/A ,$34.00 , N/A ,$27.20 , N/A , N/A , N/A ,$30.00 ,$28.40 ,$28.40 , N/A ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A , N/A ,$34.00 , N/A ,$40.00 ,$23.88 , N/A ,$16.64 , N/A , N/A , N/A ,$34.00 , N/A ,$34.00 ,$11.20 ,$36.00 , N/A ,$32.80 ,$33.80 ,$33.80 , N/A ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100452,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T2,271,1 ,$50.00 ,$32.50 ,$14.00 ,$50.00 , N/A ,$32.50 ,$29.85 , N/A ,$14.00 ,$28.05 , N/A ,$32.90 , N/A ,$42.50 ,$42.50 , N/A ,$42.50 , N/A ,$34.00 , N/A , N/A , N/A ,$37.50 ,$35.50 ,$35.50 , N/A ,$35.50 ,$41.00 ,$41.00 ,$41.00 , N/A , N/A ,$42.50 , N/A ,$50.00 ,$29.85 , N/A ,$20.80 , N/A , N/A , N/A ,$42.50 , N/A ,$42.50 ,$14.00 ,$45.00 , N/A ,$41.00 ,$42.25 ,$42.25 , N/A ,$32.50 ,$50.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100453,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T3,271,1 ,$60.00 ,$39.00 ,$16.80 ,$60.00 , N/A ,$39.00 ,$35.82 , N/A ,$16.80 ,$33.66 , N/A ,$39.48 , N/A ,$51.00 ,$51.00 , N/A ,$51.00 , N/A ,$40.80 , N/A , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.20 ,$49.20 ,$49.20 , N/A , N/A ,$51.00 , N/A ,$60.00 ,$35.82 , N/A ,$24.96 , N/A , N/A , N/A ,$51.00 , N/A ,$51.00 ,$16.80 ,$54.00 , N/A ,$49.20 ,$50.70 ,$50.70 , N/A ,$39.00 ,$60.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100454,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T4,271,1 ,$70.00 ,$45.50 ,$19.60 ,$70.00 , N/A ,$45.50 ,$41.79 , N/A ,$19.60 ,$39.27 , N/A ,$46.06 , N/A ,$59.50 ,$59.50 , N/A ,$59.50 , N/A ,$47.60 , N/A , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A , N/A ,$59.50 , N/A ,$70.00 ,$41.79 , N/A ,$29.12 , N/A , N/A , N/A ,$59.50 , N/A ,$59.50 ,$19.60 ,$63.00 , N/A ,$57.40 ,$59.15 ,$59.15 , N/A ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100455,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T5,271,1 ,$80.00 ,$52.00 ,$22.40 ,$80.00 , N/A ,$52.00 ,$47.76 , N/A ,$22.40 ,$44.88 , N/A ,$52.64 , N/A ,$68.00 ,$68.00 , N/A ,$68.00 , N/A ,$54.40 , N/A , N/A , N/A ,$60.00 ,$56.80 ,$56.80 , N/A ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A , N/A ,$68.00 , N/A ,$80.00 ,$47.76 , N/A ,$33.28 , N/A , N/A , N/A ,$68.00 , N/A ,$68.00 ,$22.40 ,$72.00 , N/A ,$65.60 ,$67.60 ,$67.60 , N/A ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100456,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T6,271,1 ,$90.00 ,$58.50 ,$25.20 ,$90.00 , N/A ,$58.50 ,$53.73 , N/A ,$25.20 ,$50.49 , N/A ,$59.22 , N/A ,$76.50 ,$76.50 , N/A ,$76.50 , N/A ,$61.20 , N/A , N/A , N/A ,$67.50 ,$63.90 ,$63.90 , N/A ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A , N/A ,$76.50 , N/A ,$90.00 ,$53.73 , N/A ,$37.44 , N/A , N/A , N/A ,$76.50 , N/A ,$76.50 ,$25.20 ,$81.00 , N/A ,$73.80 ,$76.05 ,$76.05 , N/A ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100457,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T7,271,1 ,$100.00 ,$65.00 ,$28.00 ,$100.00 , N/A ,$65.00 ,$59.70 , N/A ,$28.00 ,$56.10 , N/A ,$65.80 , N/A ,$85.00 ,$85.00 , N/A ,$85.00 , N/A ,$68.00 , N/A , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A , N/A ,$85.00 , N/A ,$100.00 ,$59.70 , N/A ,$41.60 , N/A , N/A , N/A ,$85.00 , N/A ,$85.00 ,$28.00 ,$90.00 , N/A ,$82.00 ,$84.50 ,$84.50 , N/A ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100458,V5265,HC EAR MOLD/INSERT DISPOSABLE ANY TYPE T1,271,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100459,V5265,HC EAR MOLD/INSERT DISPOSABLE ANY TYPE T2,271,1 ,$7.00 ,$4.55 ,$1.96 ,$7.00 , N/A ,$4.55 ,$4.18 , N/A ,$1.96 ,$3.93 , N/A ,$4.61 , N/A ,$5.95 ,$5.95 , N/A ,$5.95 , N/A ,$4.76 , N/A , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.74 ,$5.74 ,$5.74 , N/A , N/A ,$5.95 , N/A ,$7.00 ,$4.18 , N/A ,$2.91 , N/A , N/A , N/A ,$5.95 , N/A ,$5.95 ,$1.96 ,$6.30 , N/A ,$5.74 ,$5.92 ,$5.92 , N/A ,$4.55 ,$7.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100460,V5265,HC EAR MOLD/INSERT DISPOSABLE ANY TYPE T3,271,1 ,$17.50 ,$11.38 ,$4.90 ,$17.50 , N/A ,$11.38 ,$10.45 , N/A ,$4.90 ,$9.82 , N/A ,$11.52 , N/A ,$14.88 ,$14.88 , N/A ,$14.88 , N/A ,$11.90 , N/A , N/A , N/A ,$13.13 ,$12.43 ,$12.43 , N/A ,$12.43 ,$14.35 ,$14.35 ,$14.35 , N/A , N/A ,$14.88 , N/A ,$17.50 ,$10.45 , N/A ,$7.28 , N/A , N/A , N/A ,$14.88 , N/A ,$14.88 ,$4.90 ,$15.75 , N/A ,$14.35 ,$14.79 ,$14.79 , N/A ,$11.38 ,$17.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100461,V5266,HC HEARING AID BATTERY,271,1 ,$0.60 ,$0.39 ,$0.17 ,$0.60 , N/A ,$0.39 ,$0.36 , N/A ,$0.17 ,$0.34 , N/A ,$0.39 , N/A ,$0.51 ,$0.51 , N/A ,$0.51 , N/A ,$0.41 , N/A , N/A , N/A ,$0.45 ,$0.43 ,$0.43 , N/A ,$0.43 ,$0.49 ,$0.49 ,$0.49 , N/A , N/A ,$0.51 , N/A ,$0.60 ,$0.36 , N/A ,$0.25 , N/A , N/A , N/A ,$0.51 , N/A ,$0.51 ,$0.17 ,$0.54 , N/A ,$0.49 ,$0.51 ,$0.51 , N/A ,$0.39 ,$0.60 
ST. JOSEPH'S HOSPITAL - BREESE,27100462,V5266,HC HEARING AID BATTERY RECHARGEABLE,271,1 ,$20.00 ,$13.00 ,$5.60 ,$20.00 , N/A ,$13.00 ,$11.94 , N/A ,$5.60 ,$11.22 , N/A ,$13.16 , N/A ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$13.60 , N/A , N/A , N/A ,$15.00 ,$14.20 ,$14.20 , N/A ,$14.20 ,$16.40 ,$16.40 ,$16.40 , N/A , N/A ,$17.00 , N/A ,$20.00 ,$11.94 , N/A ,$8.32 , N/A , N/A , N/A ,$17.00 , N/A ,$17.00 ,$5.60 ,$18.00 , N/A ,$16.40 ,$16.90 ,$16.90 , N/A ,$13.00 ,$20.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100463,V5275,HC EAR MOLD IMPRESSION,271,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 , N/A , N/A , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100464,V5283,HC ALD NECK LOOP INDUCTION RECEIVER,271,1 ,$80.00 ,$52.00 ,$22.40 ,$80.00 , N/A ,$52.00 ,$47.76 , N/A ,$22.40 ,$44.88 , N/A ,$52.64 , N/A ,$68.00 ,$68.00 , N/A ,$68.00 , N/A ,$54.40 , N/A , N/A , N/A ,$60.00 ,$56.80 ,$56.80 , N/A ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A , N/A ,$68.00 , N/A ,$80.00 ,$47.76 , N/A ,$33.28 , N/A , N/A , N/A ,$68.00 , N/A ,$68.00 ,$22.40 ,$72.00 , N/A ,$65.60 ,$67.60 ,$67.60 , N/A ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100465,N/A,HC HEARING SUPPLY SHIPPING T1,271,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100466,N/A,HC HEARING SUPPLY SHIPPING T2,271,1 ,$19.99 ,$12.99 ,$5.60 ,$19.99 , N/A ,$12.99 ,$11.93 , N/A ,$5.60 ,$11.21 , N/A ,$13.15 , N/A ,$16.99 ,$16.99 , N/A ,$16.99 , N/A ,$13.59 , N/A , N/A , N/A ,$14.99 ,$14.19 ,$14.19 , N/A ,$14.19 ,$16.39 ,$16.39 ,$16.39 , N/A , N/A ,$16.99 , N/A ,$19.99 ,$11.93 , N/A ,$8.32 , N/A , N/A , N/A ,$16.99 , N/A ,$16.99 ,$5.60 ,$17.99 , N/A ,$16.39 ,$16.89 ,$16.89 , N/A ,$12.99 ,$19.99 
ST. JOSEPH'S HOSPITAL - BREESE,27100467,N/A,HC HEARING SUPPLY SHIPPING T3,271,1 ,$22.00 ,$14.30 ,$6.16 ,$22.00 , N/A ,$14.30 ,$13.13 , N/A ,$6.16 ,$12.34 , N/A ,$14.48 , N/A ,$18.70 ,$18.70 , N/A ,$18.70 , N/A ,$14.96 , N/A , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.04 ,$18.04 ,$18.04 , N/A , N/A ,$18.70 , N/A ,$22.00 ,$13.13 , N/A ,$9.15 , N/A , N/A , N/A ,$18.70 , N/A ,$18.70 ,$6.16 ,$19.80 , N/A ,$18.04 ,$18.59 ,$18.59 , N/A ,$14.30 ,$22.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100468,N/A,HC HEARING SUPPLY SHIPPING T4,271,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 , N/A , N/A , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100469,V5267,HC HEARING AID SUPPLY NOS T1,271,1 ,$1.00 ,$0.65 ,$0.28 ,$1.00 , N/A ,$0.65 ,$0.60 , N/A ,$0.28 ,$0.56 , N/A ,$0.66 , N/A ,$0.85 ,$0.85 , N/A ,$0.85 , N/A ,$0.68 , N/A , N/A , N/A ,$0.75 ,$0.71 ,$0.71 , N/A ,$0.71 ,$0.82 ,$0.82 ,$0.82 , N/A , N/A ,$0.85 , N/A ,$1.00 ,$0.60 , N/A ,$0.42 , N/A , N/A , N/A ,$0.85 , N/A ,$0.85 ,$0.28 ,$0.90 , N/A ,$0.82 ,$0.85 ,$0.85 , N/A ,$0.65 ,$1.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100470,V5267,HC HEARING AID SUPPLY NOS T2,271,1 ,$3.50 ,$2.28 ,$0.98 ,$3.50 , N/A ,$2.28 ,$2.09 , N/A ,$0.98 ,$1.96 , N/A ,$2.30 , N/A ,$2.98 ,$2.98 , N/A ,$2.98 , N/A ,$2.38 , N/A , N/A , N/A ,$2.63 ,$2.49 ,$2.49 , N/A ,$2.49 ,$2.87 ,$2.87 ,$2.87 , N/A , N/A ,$2.98 , N/A ,$3.50 ,$2.09 , N/A ,$1.46 , N/A , N/A , N/A ,$2.98 , N/A ,$2.98 ,$0.98 ,$3.15 , N/A ,$2.87 ,$2.96 ,$2.96 , N/A ,$2.28 ,$3.50 
ST. JOSEPH'S HOSPITAL - BREESE,27100471,V5267,HC HEARING AID SUPPLY NOS T3,271,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100472,V5267,HC HEARING AID SUPPLY NOS T4,271,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100473,V5267,HC HEARING AID SUPPLY NOS T5,271,1 ,$10.00 ,$6.50 ,$2.80 ,$10.00 , N/A ,$6.50 ,$5.97 , N/A ,$2.80 ,$5.61 , N/A ,$6.58 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$6.80 , N/A , N/A , N/A ,$7.50 ,$7.10 ,$7.10 , N/A ,$7.10 ,$8.20 ,$8.20 ,$8.20 , N/A , N/A ,$8.50 , N/A ,$10.00 ,$5.97 , N/A ,$4.16 , N/A , N/A , N/A ,$8.50 , N/A ,$8.50 ,$2.80 ,$9.00 , N/A ,$8.20 ,$8.45 ,$8.45 , N/A ,$6.50 ,$10.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100474,V5267,HC HEARING AID SUPPLY NOS T6,271,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 , N/A , N/A , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100475,V5267,HC HEARING AID SUPPLY NOS T7,271,1 ,$35.00 ,$22.75 ,$9.80 ,$35.00 , N/A ,$22.75 ,$20.90 , N/A ,$9.80 ,$19.64 , N/A ,$23.03 , N/A ,$29.75 ,$29.75 , N/A ,$29.75 , N/A ,$23.80 , N/A , N/A , N/A ,$26.25 ,$24.85 ,$24.85 , N/A ,$24.85 ,$28.70 ,$28.70 ,$28.70 , N/A , N/A ,$29.75 , N/A ,$35.00 ,$20.90 , N/A ,$14.56 , N/A , N/A , N/A ,$29.75 , N/A ,$29.75 ,$9.80 ,$31.50 , N/A ,$28.70 ,$29.58 ,$29.58 , N/A ,$22.75 ,$35.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100476,V5267,HC HEARING AID SUPPLY NOS T8,271,1 ,$40.00 ,$26.00 ,$11.20 ,$40.00 , N/A ,$26.00 ,$23.88 , N/A ,$11.20 ,$22.44 , N/A ,$26.32 , N/A ,$34.00 ,$34.00 , N/A ,$34.00 , N/A ,$27.20 , N/A , N/A , N/A ,$30.00 ,$28.40 ,$28.40 , N/A ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A , N/A ,$34.00 , N/A ,$40.00 ,$23.88 , N/A ,$16.64 , N/A , N/A , N/A ,$34.00 , N/A ,$34.00 ,$11.20 ,$36.00 , N/A ,$32.80 ,$33.80 ,$33.80 , N/A ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100477,V5267,HC HEARING AID SUPPLY NOS T9,271,1 ,$50.00 ,$32.50 ,$14.00 ,$50.00 , N/A ,$32.50 ,$29.85 , N/A ,$14.00 ,$28.05 , N/A ,$32.90 , N/A ,$42.50 ,$42.50 , N/A ,$42.50 , N/A ,$34.00 , N/A , N/A , N/A ,$37.50 ,$35.50 ,$35.50 , N/A ,$35.50 ,$41.00 ,$41.00 ,$41.00 , N/A , N/A ,$42.50 , N/A ,$50.00 ,$29.85 , N/A ,$20.80 , N/A , N/A , N/A ,$42.50 , N/A ,$42.50 ,$14.00 ,$45.00 , N/A ,$41.00 ,$42.25 ,$42.25 , N/A ,$32.50 ,$50.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100478,V5267,HC HEARING AID SUPPLY NOS T10,271,1 ,$60.00 ,$39.00 ,$16.80 ,$60.00 , N/A ,$39.00 ,$35.82 , N/A ,$16.80 ,$33.66 , N/A ,$39.48 , N/A ,$51.00 ,$51.00 , N/A ,$51.00 , N/A ,$40.80 , N/A , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.20 ,$49.20 ,$49.20 , N/A , N/A ,$51.00 , N/A ,$60.00 ,$35.82 , N/A ,$24.96 , N/A , N/A , N/A ,$51.00 , N/A ,$51.00 ,$16.80 ,$54.00 , N/A ,$49.20 ,$50.70 ,$50.70 , N/A ,$39.00 ,$60.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100479,V5267,HC HEARING AID SUPPLY NOS T11,271,1 ,$70.00 ,$45.50 ,$19.60 ,$70.00 , N/A ,$45.50 ,$41.79 , N/A ,$19.60 ,$39.27 , N/A ,$46.06 , N/A ,$59.50 ,$59.50 , N/A ,$59.50 , N/A ,$47.60 , N/A , N/A , N/A ,$52.50 ,$49.70 ,$49.70 , N/A ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A , N/A ,$59.50 , N/A ,$70.00 ,$41.79 , N/A ,$29.12 , N/A , N/A , N/A ,$59.50 , N/A ,$59.50 ,$19.60 ,$63.00 , N/A ,$57.40 ,$59.15 ,$59.15 , N/A ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100480,V5267,HC HEARING AID SUPPLY NOS T12,271,1 ,$80.00 ,$52.00 ,$22.40 ,$80.00 , N/A ,$52.00 ,$47.76 , N/A ,$22.40 ,$44.88 , N/A ,$52.64 , N/A ,$68.00 ,$68.00 , N/A ,$68.00 , N/A ,$54.40 , N/A , N/A , N/A ,$60.00 ,$56.80 ,$56.80 , N/A ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A , N/A ,$68.00 , N/A ,$80.00 ,$47.76 , N/A ,$33.28 , N/A , N/A , N/A ,$68.00 , N/A ,$68.00 ,$22.40 ,$72.00 , N/A ,$65.60 ,$67.60 ,$67.60 , N/A ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100481,V5267,HC HEARING AID SUPPLY NOS T13,271,1 ,$90.00 ,$58.50 ,$25.20 ,$90.00 , N/A ,$58.50 ,$53.73 , N/A ,$25.20 ,$50.49 , N/A ,$59.22 , N/A ,$76.50 ,$76.50 , N/A ,$76.50 , N/A ,$61.20 , N/A , N/A , N/A ,$67.50 ,$63.90 ,$63.90 , N/A ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A , N/A ,$76.50 , N/A ,$90.00 ,$53.73 , N/A ,$37.44 , N/A , N/A , N/A ,$76.50 , N/A ,$76.50 ,$25.20 ,$81.00 , N/A ,$73.80 ,$76.05 ,$76.05 , N/A ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100484,N/A,HC ROLL CAST FIBERGLASS,271,1 ,$43.00 ,$27.95 ,$12.04 ,$43.00 , N/A ,$27.95 ,$25.67 , N/A ,$12.04 ,$24.12 , N/A ,$28.29 , N/A ,$36.55 ,$36.55 , N/A ,$36.55 , N/A ,$29.24 , N/A , N/A , N/A ,$32.25 ,$30.53 ,$30.53 , N/A ,$30.53 ,$35.26 ,$35.26 ,$35.26 , N/A , N/A ,$36.55 , N/A ,$43.00 ,$25.67 , N/A ,$17.89 , N/A , N/A , N/A ,$36.55 , N/A ,$36.55 ,$12.04 ,$38.70 , N/A ,$35.26 ,$36.34 ,$36.34 , N/A ,$27.95 ,$43.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100488,N/A,HC PAD HEATING,271,1 ,$17.00 ,$11.05 ,$4.76 ,$17.00 , N/A ,$11.05 ,$10.15 , N/A ,$4.76 ,$9.54 , N/A ,$11.19 , N/A ,$14.45 ,$14.45 , N/A ,$14.45 , N/A ,$11.56 , N/A , N/A , N/A ,$12.75 ,$12.07 ,$12.07 , N/A ,$12.07 ,$13.94 ,$13.94 ,$13.94 , N/A , N/A ,$14.45 , N/A ,$17.00 ,$10.15 , N/A ,$7.07 , N/A , N/A , N/A ,$14.45 , N/A ,$14.45 ,$4.76 ,$15.30 , N/A ,$13.94 ,$14.37 ,$14.37 , N/A ,$11.05 ,$17.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100497,N/A,HC STRAP CATHETER,271,1 ,$13.00 ,$8.45 ,$3.64 ,$13.00 , N/A ,$8.45 ,$7.76 , N/A ,$3.64 ,$7.29 , N/A ,$8.55 , N/A ,$11.05 ,$11.05 , N/A ,$11.05 , N/A ,$8.84 , N/A , N/A , N/A ,$9.75 ,$9.23 ,$9.23 , N/A ,$9.23 ,$10.66 ,$10.66 ,$10.66 , N/A , N/A ,$11.05 , N/A ,$13.00 ,$7.76 , N/A ,$5.41 , N/A , N/A , N/A ,$11.05 , N/A ,$11.05 ,$3.64 ,$11.70 , N/A ,$10.66 ,$10.99 ,$10.99 , N/A ,$8.45 ,$13.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100499,V5172,HC HEARING AID CROS MONAURAL IN CANAL T1,271,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100500,V5172,HC HEARING AID CROS MONAURAL IN CANAL T2,271,1 ,$575.00 ,$373.75 ,$161.00 ,$575.00 , N/A ,$373.75 ,$343.28 , N/A ,$161.00 ,$322.58 , N/A ,$378.35 , N/A ,$488.75 ,$488.75 , N/A ,$488.75 , N/A ,$391.00 , N/A , N/A , N/A ,$431.25 ,$408.25 ,$408.25 , N/A ,$408.25 ,$471.50 ,$471.50 ,$471.50 , N/A , N/A ,$488.75 , N/A ,$575.00 ,$343.28 , N/A ,$239.20 , N/A , N/A , N/A ,$488.75 , N/A ,$488.75 ,$161.00 ,$517.50 , N/A ,$471.50 ,$485.88 ,$485.88 , N/A ,$373.75 ,$575.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100501,V5172,HC HEARING AID CROS MONAURAL IN CANAL T3,271,1 ,$875.00 ,$568.75 ,$245.00 ,$875.00 , N/A ,$568.75 ,$522.38 , N/A ,$245.00 ,$490.88 , N/A ,$575.75 , N/A ,$743.75 ,$743.75 , N/A ,$743.75 , N/A ,$595.00 , N/A , N/A , N/A ,$656.25 ,$621.25 ,$621.25 , N/A ,$621.25 ,$717.50 ,$717.50 ,$717.50 , N/A , N/A ,$743.75 , N/A ,$875.00 ,$522.38 , N/A ,$364.00 , N/A , N/A , N/A ,$743.75 , N/A ,$743.75 ,$245.00 ,$787.50 , N/A ,$717.50 ,$739.38 ,$739.38 , N/A ,$568.75 ,$875.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100502,V5172,HC HEARING AID CROS MONAURAL IN CANAL T4,271,1 ,$925.00 ,$601.25 ,$259.00 ,$925.00 , N/A ,$601.25 ,$552.23 , N/A ,$259.00 ,$518.93 , N/A ,$608.65 , N/A ,$786.25 ,$786.25 , N/A ,$786.25 , N/A ,$629.00 , N/A , N/A , N/A ,$693.75 ,$656.75 ,$656.75 , N/A ,$656.75 ,$758.50 ,$758.50 ,$758.50 , N/A , N/A ,$786.25 , N/A ,$925.00 ,$552.23 , N/A ,$384.80 , N/A , N/A , N/A ,$786.25 , N/A ,$786.25 ,$259.00 ,$832.50 , N/A ,$758.50 ,$781.63 ,$781.63 , N/A ,$601.25 ,$925.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100503,V5172,HC HEARING AID CROS MONAURAL IN CANAL T5,271,1 ,"$1,050.00 ",$682.50 ,$294.00 ,"$1,050.00 ", N/A ,$682.50 ,$626.85 , N/A ,$294.00 ,$589.05 , N/A ,$690.90 , N/A ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$714.00 , N/A , N/A , N/A ,$787.50 ,$745.50 ,$745.50 , N/A ,$745.50 ,$861.00 ,$861.00 ,$861.00 , N/A , N/A ,$892.50 , N/A ,"$1,050.00 ",$626.85 , N/A ,$436.80 , N/A , N/A , N/A ,$892.50 , N/A ,$892.50 ,$294.00 ,$945.00 , N/A ,$861.00 ,$887.25 ,$887.25 , N/A ,$682.50 ,"$1,050.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100504,V5172,HC HEARING AID CROS MONAURAL IN CANAL T6,271,1 ,"$1,225.00 ",$796.25 ,$343.00 ,"$1,225.00 ", N/A ,$796.25 ,$731.33 , N/A ,$343.00 ,$687.23 , N/A ,$806.05 , N/A ,"$1,041.25 ","$1,041.25 ", N/A ,"$1,041.25 ", N/A ,$833.00 , N/A , N/A , N/A ,$918.75 ,$869.75 ,$869.75 , N/A ,$869.75 ,"$1,004.50 ","$1,004.50 ","$1,004.50 ", N/A , N/A ,"$1,041.25 ", N/A ,"$1,225.00 ",$731.33 , N/A ,$509.60 , N/A , N/A , N/A ,"$1,041.25 ", N/A ,"$1,041.25 ",$343.00 ,"$1,102.50 ", N/A ,"$1,004.50 ","$1,035.13 ","$1,035.13 ", N/A ,$796.25 ,"$1,225.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100505,V5172,HC HEARING AID CROS MONAURAL IN CANAL T7,271,1 ,"$1,400.00 ",$910.00 ,$392.00 ,"$1,400.00 ", N/A ,$910.00 ,$835.80 , N/A ,$392.00 ,$785.40 , N/A ,$921.20 , N/A ,"$1,190.00 ","$1,190.00 ", N/A ,"$1,190.00 ", N/A ,$952.00 , N/A , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,148.00 ","$1,148.00 ","$1,148.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ",$835.80 , N/A ,$582.40 , N/A , N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ",$392.00 ,"$1,260.00 ", N/A ,"$1,148.00 ","$1,183.00 ","$1,183.00 ", N/A ,$910.00 ,"$1,400.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100506,V5172,HC HEARING AID CROS MONAURAL IN CANAL T8,271,1 ,"$1,575.00 ","$1,023.75 ",$441.00 ,"$1,575.00 ", N/A ,"$1,023.75 ",$940.28 , N/A ,$441.00 ,$883.58 , N/A ,"$1,036.35 ", N/A ,"$1,338.75 ","$1,338.75 ", N/A ,"$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,291.50 ","$1,291.50 ","$1,291.50 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ",$940.28 , N/A ,$655.20 , N/A , N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ",$441.00 ,"$1,417.50 ", N/A ,"$1,291.50 ","$1,330.88 ","$1,330.88 ", N/A ,"$1,023.75 ","$1,575.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100507,V5172,HC HEARING AID CROS MONAURAL IN CANAL T9,271,1 ,"$1,750.00 ","$1,137.50 ",$490.00 ,"$1,750.00 ", N/A ,"$1,137.50 ","$1,044.75 ", N/A ,$490.00 ,$981.75 , N/A ,"$1,151.50 ", N/A ,"$1,487.50 ","$1,487.50 ", N/A ,"$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,435.00 ","$1,435.00 ","$1,435.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ","$1,044.75 ", N/A ,$728.00 , N/A , N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ",$490.00 ,"$1,575.00 ", N/A ,"$1,435.00 ","$1,478.75 ","$1,478.75 ", N/A ,"$1,137.50 ","$1,750.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100508,V5172,HC HEARING AID CROS MONAURAL IN CANAL T10,271,1 ,"$1,925.00 ","$1,251.25 ",$539.00 ,"$1,925.00 ", N/A ,"$1,251.25 ","$1,149.23 ", N/A ,$539.00 ,"$1,079.93 ", N/A ,"$1,266.65 ", N/A ,"$1,636.25 ","$1,636.25 ", N/A ,"$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,578.50 ","$1,578.50 ","$1,578.50 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ","$1,149.23 ", N/A ,$800.80 , N/A , N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ",$539.00 ,"$1,732.50 ", N/A ,"$1,578.50 ","$1,626.63 ","$1,626.63 ", N/A ,"$1,251.25 ","$1,925.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100509,V5172,HC HEARING AID CROS MONAURAL IN CANAL T11,271,1 ,"$2,100.00 ","$1,365.00 ",$588.00 ,"$2,100.00 ", N/A ,"$1,365.00 ","$1,253.70 ", N/A ,$588.00 ,"$1,178.10 ", N/A ,"$1,381.80 ", N/A ,"$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,428.00 ", N/A , N/A , N/A ,"$1,575.00 ","$1,491.00 ","$1,491.00 ", N/A ,"$1,491.00 ","$1,722.00 ","$1,722.00 ","$1,722.00 ", N/A , N/A ,"$1,785.00 ", N/A ,"$2,100.00 ","$1,253.70 ", N/A ,$873.60 , N/A , N/A , N/A ,"$1,785.00 ", N/A ,"$1,785.00 ",$588.00 ,"$1,890.00 ", N/A ,"$1,722.00 ","$1,774.50 ","$1,774.50 ", N/A ,"$1,365.00 ","$2,100.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100510,V5172,HC HEARING AID CROS MONAURAL IN CANAL T12,271,1 ,"$2,275.00 ","$1,478.75 ",$637.00 ,"$2,275.00 ", N/A ,"$1,478.75 ","$1,358.18 ", N/A ,$637.00 ,"$1,276.28 ", N/A ,"$1,496.95 ", N/A ,"$1,933.75 ","$1,933.75 ", N/A ,"$1,933.75 ", N/A ,"$1,547.00 ", N/A , N/A , N/A ,"$1,706.25 ","$1,615.25 ","$1,615.25 ", N/A ,"$1,615.25 ","$1,865.50 ","$1,865.50 ","$1,865.50 ", N/A , N/A ,"$1,933.75 ", N/A ,"$2,275.00 ","$1,358.18 ", N/A ,$946.40 , N/A , N/A , N/A ,"$1,933.75 ", N/A ,"$1,933.75 ",$637.00 ,"$2,047.50 ", N/A ,"$1,865.50 ","$1,922.38 ","$1,922.38 ", N/A ,"$1,478.75 ","$2,275.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100511,V5172,HC HEARING AID CROS MONAURAL IN CANAL T13,271,1 ,"$2,450.00 ","$1,592.50 ",$686.00 ,"$2,450.00 ", N/A ,"$1,592.50 ","$1,462.65 ", N/A ,$686.00 ,"$1,374.45 ", N/A ,"$1,612.10 ", N/A ,"$2,082.50 ","$2,082.50 ", N/A ,"$2,082.50 ", N/A ,"$1,666.00 ", N/A , N/A , N/A ,"$1,837.50 ","$1,739.50 ","$1,739.50 ", N/A ,"$1,739.50 ","$2,009.00 ","$2,009.00 ","$2,009.00 ", N/A , N/A ,"$2,082.50 ", N/A ,"$2,450.00 ","$1,462.65 ", N/A ,"$1,019.20 ", N/A , N/A , N/A ,"$2,082.50 ", N/A ,"$2,082.50 ",$686.00 ,"$2,205.00 ", N/A ,"$2,009.00 ","$2,070.25 ","$2,070.25 ", N/A ,"$1,592.50 ","$2,450.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100512,V5172,HC HEARING AID CROS MONAURAL IN CANAL T14,271,1 ,"$2,625.00 ","$1,706.25 ",$735.00 ,"$2,625.00 ", N/A ,"$1,706.25 ","$1,567.13 ", N/A ,$735.00 ,"$1,472.63 ", N/A ,"$1,727.25 ", N/A ,"$2,231.25 ","$2,231.25 ", N/A ,"$2,231.25 ", N/A ,"$1,785.00 ", N/A , N/A , N/A ,"$1,968.75 ","$1,863.75 ","$1,863.75 ", N/A ,"$1,863.75 ","$2,152.50 ","$2,152.50 ","$2,152.50 ", N/A , N/A ,"$2,231.25 ", N/A ,"$2,625.00 ","$1,567.13 ", N/A ,"$1,092.00 ", N/A , N/A , N/A ,"$2,231.25 ", N/A ,"$2,231.25 ",$735.00 ,"$2,362.50 ", N/A ,"$2,152.50 ","$2,218.13 ","$2,218.13 ", N/A ,"$1,706.25 ","$2,625.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100513,V5172,HC HEARING AID CROS MONAURAL IN CANAL T15,271,1 ,"$2,800.00 ","$1,820.00 ",$784.00 ,"$2,800.00 ", N/A ,"$1,820.00 ","$1,671.60 ", N/A ,$784.00 ,"$1,570.80 ", N/A ,"$1,842.40 ", N/A ,"$2,380.00 ","$2,380.00 ", N/A ,"$2,380.00 ", N/A ,"$1,904.00 ", N/A , N/A , N/A ,"$2,100.00 ","$1,988.00 ","$1,988.00 ", N/A ,"$1,988.00 ","$2,296.00 ","$2,296.00 ","$2,296.00 ", N/A , N/A ,"$2,380.00 ", N/A ,"$2,800.00 ","$1,671.60 ", N/A ,"$1,164.80 ", N/A , N/A , N/A ,"$2,380.00 ", N/A ,"$2,380.00 ",$784.00 ,"$2,520.00 ", N/A ,"$2,296.00 ","$2,366.00 ","$2,366.00 ", N/A ,"$1,820.00 ","$2,800.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100514,V5172,HC HEARING AID CROS MONAURAL IN CANAL T16,271,1 ,"$2,850.00 ","$1,852.50 ",$798.00 ,"$2,850.00 ", N/A ,"$1,852.50 ","$1,701.45 ", N/A ,$798.00 ,"$1,598.85 ", N/A ,"$1,875.30 ", N/A ,"$2,422.50 ","$2,422.50 ", N/A ,"$2,422.50 ", N/A ,"$1,938.00 ", N/A , N/A , N/A ,"$2,137.50 ","$2,023.50 ","$2,023.50 ", N/A ,"$2,023.50 ","$2,337.00 ","$2,337.00 ","$2,337.00 ", N/A , N/A ,"$2,422.50 ", N/A ,"$2,850.00 ","$1,701.45 ", N/A ,"$1,185.60 ", N/A , N/A , N/A ,"$2,422.50 ", N/A ,"$2,422.50 ",$798.00 ,"$2,565.00 ", N/A ,"$2,337.00 ","$2,408.25 ","$2,408.25 ", N/A ,"$1,852.50 ","$2,850.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100515,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T8,271,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100516,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T9,271,1 ,$130.00 ,$84.50 ,$36.40 ,$130.00 , N/A ,$84.50 ,$77.61 , N/A ,$36.40 ,$72.93 , N/A ,$85.54 , N/A ,$110.50 ,$110.50 , N/A ,$110.50 , N/A ,$88.40 , N/A , N/A , N/A ,$97.50 ,$92.30 ,$92.30 , N/A ,$92.30 ,$106.60 ,$106.60 ,$106.60 , N/A , N/A ,$110.50 , N/A ,$130.00 ,$77.61 , N/A ,$54.08 , N/A , N/A , N/A ,$110.50 , N/A ,$110.50 ,$36.40 ,$117.00 , N/A ,$106.60 ,$109.85 ,$109.85 , N/A ,$84.50 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100517,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T10,271,1 ,$140.00 ,$91.00 ,$39.20 ,$140.00 , N/A ,$91.00 ,$83.58 , N/A ,$39.20 ,$78.54 , N/A ,$92.12 , N/A ,$119.00 ,$119.00 , N/A ,$119.00 , N/A ,$95.20 , N/A , N/A , N/A ,$105.00 ,$99.40 ,$99.40 , N/A ,$99.40 ,$114.80 ,$114.80 ,$114.80 , N/A , N/A ,$119.00 , N/A ,$140.00 ,$83.58 , N/A ,$58.24 , N/A , N/A , N/A ,$119.00 , N/A ,$119.00 ,$39.20 ,$126.00 , N/A ,$114.80 ,$118.30 ,$118.30 , N/A ,$91.00 ,$140.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100518,V5264,HC EAR MOLD/INSERT NON DISPOSABLE ANY TYPE T11,271,1 ,$150.00 ,$97.50 ,$42.00 ,$150.00 , N/A ,$97.50 ,$89.55 , N/A ,$42.00 ,$84.15 , N/A ,$98.70 , N/A ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$102.00 , N/A , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A , N/A ,$127.50 , N/A ,$150.00 ,$89.55 , N/A ,$62.40 , N/A , N/A , N/A ,$127.50 , N/A ,$127.50 ,$42.00 ,$135.00 , N/A ,$123.00 ,$126.75 ,$126.75 , N/A ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100519,N/A,HC SYSTEM MONITR NOVII PTCH,271,1 ,$116.85 ,$75.95 ,$32.72 ,$116.85 , N/A ,$75.95 ,$69.76 , N/A ,$32.72 ,$65.55 , N/A ,$76.89 , N/A ,$99.32 ,$99.32 , N/A ,$99.32 , N/A ,$79.46 , N/A , N/A , N/A ,$87.64 ,$82.96 ,$82.96 , N/A ,$82.96 ,$95.82 ,$95.82 ,$95.82 , N/A , N/A ,$99.32 , N/A ,$116.85 ,$69.76 , N/A ,$48.61 , N/A , N/A , N/A ,$99.32 , N/A ,$99.32 ,$32.72 ,$105.17 , N/A ,$95.82 ,$98.74 ,$98.74 , N/A ,$75.95 ,$116.85 
ST. JOSEPH'S HOSPITAL - BREESE,27100523,N/A,HC PORT BREATHING CIRCUIT,271,1 ,$51.00 ,$33.15 ,$14.28 ,$51.00 , N/A ,$33.15 ,$30.45 , N/A ,$14.28 ,$28.61 , N/A ,$33.56 , N/A ,$43.35 ,$43.35 , N/A ,$43.35 , N/A ,$34.68 , N/A , N/A , N/A ,$38.25 ,$36.21 ,$36.21 , N/A ,$36.21 ,$41.82 ,$41.82 ,$41.82 , N/A , N/A ,$43.35 , N/A ,$51.00 ,$30.45 , N/A ,$21.22 , N/A , N/A , N/A ,$43.35 , N/A ,$43.35 ,$14.28 ,$45.90 , N/A ,$41.82 ,$43.10 ,$43.10 , N/A ,$33.15 ,$51.00 
ST. JOSEPH'S HOSPITAL - BREESE,27100524,V5140,HC HEARING AID BINAURAL BEHIND EAR T17,271,1 ,"$3,350.00 ","$2,177.50 ",$938.00 ,"$3,350.00 ", N/A ,"$2,177.50 ","$1,999.95 ", N/A ,$938.00 ,"$1,879.35 ", N/A ,"$2,204.30 ", N/A ,"$2,847.50 ","$2,847.50 ", N/A ,"$2,847.50 ", N/A ,"$2,278.00 ", N/A , N/A , N/A ,"$2,512.50 ","$2,378.50 ","$2,378.50 ", N/A ,"$2,378.50 ","$2,747.00 ","$2,747.00 ","$2,747.00 ", N/A , N/A ,"$2,847.50 ", N/A ,"$3,350.00 ","$1,999.95 ", N/A ,"$1,393.60 ", N/A , N/A , N/A ,"$2,847.50 ", N/A ,"$2,847.50 ",$938.00 ,"$3,015.00 ", N/A ,"$2,747.00 ","$2,830.75 ","$2,830.75 ", N/A ,"$2,177.50 ","$3,350.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100525,V5140,HC HEARING AID BINAURAL BEHIND EAR T18,271,1 ,"$3,500.00 ","$2,275.00 ",$980.00 ,"$3,500.00 ", N/A ,"$2,275.00 ","$2,089.50 ", N/A ,$980.00 ,"$1,963.50 ", N/A ,"$2,303.00 ", N/A ,"$2,975.00 ","$2,975.00 ", N/A ,"$2,975.00 ", N/A ,"$2,380.00 ", N/A , N/A , N/A ,"$2,625.00 ","$2,485.00 ","$2,485.00 ", N/A ,"$2,485.00 ","$2,870.00 ","$2,870.00 ","$2,870.00 ", N/A , N/A ,"$2,975.00 ", N/A ,"$3,500.00 ","$2,089.50 ", N/A ,"$1,456.00 ", N/A , N/A , N/A ,"$2,975.00 ", N/A ,"$2,975.00 ",$980.00 ,"$3,150.00 ", N/A ,"$2,870.00 ","$2,957.50 ","$2,957.50 ", N/A ,"$2,275.00 ","$3,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100526,V5140,HC HEARING AID BINAURAL BEHIND EAR T19,271,1 ,"$3,750.00 ","$2,437.50 ","$1,050.00 ","$3,750.00 ", N/A ,"$2,437.50 ","$2,238.75 ", N/A ,"$1,050.00 ","$2,103.75 ", N/A ,"$2,467.50 ", N/A ,"$3,187.50 ","$3,187.50 ", N/A ,"$3,187.50 ", N/A ,"$2,550.00 ", N/A , N/A , N/A ,"$2,812.50 ","$2,662.50 ","$2,662.50 ", N/A ,"$2,662.50 ","$3,075.00 ","$3,075.00 ","$3,075.00 ", N/A , N/A ,"$3,187.50 ", N/A ,"$3,750.00 ","$2,238.75 ", N/A ,"$1,560.00 ", N/A , N/A , N/A ,"$3,187.50 ", N/A ,"$3,187.50 ","$1,050.00 ","$3,375.00 ", N/A ,"$3,075.00 ","$3,168.75 ","$3,168.75 ", N/A ,"$2,437.50 ","$3,750.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100527,V5140,HC HEARING AID BINAURAL BEHIND EAR T20,271,1 ,"$3,850.00 ","$2,502.50 ","$1,078.00 ","$3,850.00 ", N/A ,"$2,502.50 ","$2,298.45 ", N/A ,"$1,078.00 ","$2,159.85 ", N/A ,"$2,533.30 ", N/A ,"$3,272.50 ","$3,272.50 ", N/A ,"$3,272.50 ", N/A ,"$2,618.00 ", N/A , N/A , N/A ,"$2,887.50 ","$2,733.50 ","$2,733.50 ", N/A ,"$2,733.50 ","$3,157.00 ","$3,157.00 ","$3,157.00 ", N/A , N/A ,"$3,272.50 ", N/A ,"$3,850.00 ","$2,298.45 ", N/A ,"$1,601.60 ", N/A , N/A , N/A ,"$3,272.50 ", N/A ,"$3,272.50 ","$1,078.00 ","$3,465.00 ", N/A ,"$3,157.00 ","$3,253.25 ","$3,253.25 ", N/A ,"$2,502.50 ","$3,850.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100528,V5290,HC ALD TRANSMITTER MICROPHONE T6,271,1 ,"$1,400.00 ",$910.00 ,$392.00 ,"$1,400.00 ", N/A ,$910.00 ,$835.80 , N/A ,$392.00 ,$785.40 , N/A ,$921.20 , N/A ,"$1,190.00 ","$1,190.00 ", N/A ,"$1,190.00 ", N/A ,$952.00 , N/A , N/A , N/A ,"$1,050.00 ",$994.00 ,$994.00 , N/A ,$994.00 ,"$1,148.00 ","$1,148.00 ","$1,148.00 ", N/A , N/A ,"$1,190.00 ", N/A ,"$1,400.00 ",$835.80 , N/A ,$582.40 , N/A , N/A , N/A ,"$1,190.00 ", N/A ,"$1,190.00 ",$392.00 ,"$1,260.00 ", N/A ,"$1,148.00 ","$1,183.00 ","$1,183.00 ", N/A ,$910.00 ,"$1,400.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100529,V5060,HC HEARING AID MONAURAL BEHIND EAR T17,271,1 ,"$1,675.00 ","$1,088.75 ",$469.00 ,"$1,675.00 ", N/A ,"$1,088.75 ",$999.98 , N/A ,$469.00 ,$939.68 , N/A ,"$1,102.15 ", N/A ,"$1,423.75 ","$1,423.75 ", N/A ,"$1,423.75 ", N/A ,"$1,139.00 ", N/A , N/A , N/A ,"$1,256.25 ","$1,189.25 ","$1,189.25 ", N/A ,"$1,189.25 ","$1,373.50 ","$1,373.50 ","$1,373.50 ", N/A , N/A ,"$1,423.75 ", N/A ,"$1,675.00 ",$999.98 , N/A ,$696.80 , N/A , N/A , N/A ,"$1,423.75 ", N/A ,"$1,423.75 ",$469.00 ,"$1,507.50 ", N/A ,"$1,373.50 ","$1,415.38 ","$1,415.38 ", N/A ,"$1,088.75 ","$1,675.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100530,V5060,HC HEARING AID MONAURAL BEHIND EAR T18,271,1 ,"$1,750.00 ","$1,137.50 ",$490.00 ,"$1,750.00 ", N/A ,"$1,137.50 ","$1,044.75 ", N/A ,$490.00 ,$981.75 , N/A ,"$1,151.50 ", N/A ,"$1,487.50 ","$1,487.50 ", N/A ,"$1,487.50 ", N/A ,"$1,190.00 ", N/A , N/A , N/A ,"$1,312.50 ","$1,242.50 ","$1,242.50 ", N/A ,"$1,242.50 ","$1,435.00 ","$1,435.00 ","$1,435.00 ", N/A , N/A ,"$1,487.50 ", N/A ,"$1,750.00 ","$1,044.75 ", N/A ,$728.00 , N/A , N/A , N/A ,"$1,487.50 ", N/A ,"$1,487.50 ",$490.00 ,"$1,575.00 ", N/A ,"$1,435.00 ","$1,478.75 ","$1,478.75 ", N/A ,"$1,137.50 ","$1,750.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100531,V5060,HC HEARING AID MONAURAL BEHIND EAR T19,271,1 ,"$1,575.00 ","$1,023.75 ",$441.00 ,"$1,575.00 ", N/A ,"$1,023.75 ",$940.28 , N/A ,$441.00 ,$883.58 , N/A ,"$1,036.35 ", N/A ,"$1,338.75 ","$1,338.75 ", N/A ,"$1,338.75 ", N/A ,"$1,071.00 ", N/A , N/A , N/A ,"$1,181.25 ","$1,118.25 ","$1,118.25 ", N/A ,"$1,118.25 ","$1,291.50 ","$1,291.50 ","$1,291.50 ", N/A , N/A ,"$1,338.75 ", N/A ,"$1,575.00 ",$940.28 , N/A ,$655.20 , N/A , N/A , N/A ,"$1,338.75 ", N/A ,"$1,338.75 ",$441.00 ,"$1,417.50 ", N/A ,"$1,291.50 ","$1,330.88 ","$1,330.88 ", N/A ,"$1,023.75 ","$1,575.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100532,V5060,HC HEARING AID MONAURAL BEHIND EAR T20,271,1 ,"$1,925.00 ","$1,251.25 ",$539.00 ,"$1,925.00 ", N/A ,"$1,251.25 ","$1,149.23 ", N/A ,$539.00 ,"$1,079.93 ", N/A ,"$1,266.65 ", N/A ,"$1,636.25 ","$1,636.25 ", N/A ,"$1,636.25 ", N/A ,"$1,309.00 ", N/A , N/A , N/A ,"$1,443.75 ","$1,366.75 ","$1,366.75 ", N/A ,"$1,366.75 ","$1,578.50 ","$1,578.50 ","$1,578.50 ", N/A , N/A ,"$1,636.25 ", N/A ,"$1,925.00 ","$1,149.23 ", N/A ,$800.80 , N/A , N/A , N/A ,"$1,636.25 ", N/A ,"$1,636.25 ",$539.00 ,"$1,732.50 ", N/A ,"$1,578.50 ","$1,626.63 ","$1,626.63 ", N/A ,"$1,251.25 ","$1,925.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100533,V5060,HC HEARING AID MONAURAL BEHIND EAR T21,271,1 ,"$2,325.00 ","$1,511.25 ",$651.00 ,"$2,325.00 ", N/A ,"$1,511.25 ","$1,388.03 ", N/A ,$651.00 ,"$1,304.33 ", N/A ,"$1,529.85 ", N/A ,"$1,976.25 ","$1,976.25 ", N/A ,"$1,976.25 ", N/A ,"$1,581.00 ", N/A , N/A , N/A ,"$1,743.75 ","$1,650.75 ","$1,650.75 ", N/A ,"$1,650.75 ","$1,906.50 ","$1,906.50 ","$1,906.50 ", N/A , N/A ,"$1,976.25 ", N/A ,"$2,325.00 ","$1,388.03 ", N/A ,$967.20 , N/A , N/A , N/A ,"$1,976.25 ", N/A ,"$1,976.25 ",$651.00 ,"$2,092.50 ", N/A ,"$1,906.50 ","$1,964.63 ","$1,964.63 ", N/A ,"$1,511.25 ","$2,325.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100534,V5060,HC HEARING AID MONAURAL BEHIND EAR T22,271,1 ,"$2,350.00 ","$1,527.50 ",$658.00 ,"$2,350.00 ", N/A ,"$1,527.50 ","$1,402.95 ", N/A ,$658.00 ,"$1,318.35 ", N/A ,"$1,546.30 ", N/A ,"$1,997.50 ","$1,997.50 ", N/A ,"$1,997.50 ", N/A ,"$1,598.00 ", N/A , N/A , N/A ,"$1,762.50 ","$1,668.50 ","$1,668.50 ", N/A ,"$1,668.50 ","$1,927.00 ","$1,927.00 ","$1,927.00 ", N/A , N/A ,"$1,997.50 ", N/A ,"$2,350.00 ","$1,402.95 ", N/A ,$977.60 , N/A , N/A , N/A ,"$1,997.50 ", N/A ,"$1,997.50 ",$658.00 ,"$2,115.00 ", N/A ,"$1,927.00 ","$1,985.75 ","$1,985.75 ", N/A ,"$1,527.50 ","$2,350.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100535,V5060,HC HEARING AID MONAURAL BEHIND EAR T23,271,1 ,"$2,500.00 ","$1,625.00 ",$700.00 ,"$2,500.00 ", N/A ,"$1,625.00 ","$1,492.50 ", N/A ,$700.00 ,"$1,402.50 ", N/A ,"$1,645.00 ", N/A ,"$2,125.00 ","$2,125.00 ", N/A ,"$2,125.00 ", N/A ,"$1,700.00 ", N/A , N/A , N/A ,"$1,875.00 ","$1,775.00 ","$1,775.00 ", N/A ,"$1,775.00 ","$2,050.00 ","$2,050.00 ","$2,050.00 ", N/A , N/A ,"$2,125.00 ", N/A ,"$2,500.00 ","$1,492.50 ", N/A ,"$1,040.00 ", N/A , N/A , N/A ,"$2,125.00 ", N/A ,"$2,125.00 ",$700.00 ,"$2,250.00 ", N/A ,"$2,050.00 ","$2,112.50 ","$2,112.50 ", N/A ,"$1,625.00 ","$2,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100536,V5140,HC HEARING AID BINAURAL BEHIND EAR T21,271,1 ,"$4,650.00 ","$3,022.50 ","$1,302.00 ","$4,650.00 ", N/A ,"$3,022.50 ","$2,776.05 ", N/A ,"$1,302.00 ","$2,608.65 ", N/A ,"$3,059.70 ", N/A ,"$3,952.50 ","$3,952.50 ", N/A ,"$3,952.50 ", N/A ,"$3,162.00 ", N/A , N/A , N/A ,"$3,487.50 ","$3,301.50 ","$3,301.50 ", N/A ,"$3,301.50 ","$3,813.00 ","$3,813.00 ","$3,813.00 ", N/A , N/A ,"$3,952.50 ", N/A ,"$4,650.00 ","$2,776.05 ", N/A ,"$1,934.40 ", N/A , N/A , N/A ,"$3,952.50 ", N/A ,"$3,952.50 ","$1,302.00 ","$4,185.00 ", N/A ,"$3,813.00 ","$3,929.25 ","$3,929.25 ", N/A ,"$3,022.50 ","$4,650.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100537,V5140,HC HEARING AID BINAURAL BEHIND EAR T22,271,1 ,"$4,700.00 ","$3,055.00 ","$1,316.00 ","$4,700.00 ", N/A ,"$3,055.00 ","$2,805.90 ", N/A ,"$1,316.00 ","$2,636.70 ", N/A ,"$3,092.60 ", N/A ,"$3,995.00 ","$3,995.00 ", N/A ,"$3,995.00 ", N/A ,"$3,196.00 ", N/A , N/A , N/A ,"$3,525.00 ","$3,337.00 ","$3,337.00 ", N/A ,"$3,337.00 ","$3,854.00 ","$3,854.00 ","$3,854.00 ", N/A , N/A ,"$3,995.00 ", N/A ,"$4,700.00 ","$2,805.90 ", N/A ,"$1,955.20 ", N/A , N/A , N/A ,"$3,995.00 ", N/A ,"$3,995.00 ","$1,316.00 ","$4,230.00 ", N/A ,"$3,854.00 ","$3,971.50 ","$3,971.50 ", N/A ,"$3,055.00 ","$4,700.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27100538,V5140,HC HEARING AID BINAURAL BEHIND EAR T23,271,1 ,"$5,000.00 ","$3,250.00 ","$1,400.00 ","$5,000.00 ", N/A ,"$3,250.00 ","$2,985.00 ", N/A ,"$1,400.00 ","$2,805.00 ", N/A ,"$3,290.00 ", N/A ,"$4,250.00 ","$4,250.00 ", N/A ,"$4,250.00 ", N/A ,"$3,400.00 ", N/A , N/A , N/A ,"$3,750.00 ","$3,550.00 ","$3,550.00 ", N/A ,"$3,550.00 ","$4,100.00 ","$4,100.00 ","$4,100.00 ", N/A , N/A ,"$4,250.00 ", N/A ,"$5,000.00 ","$2,985.00 ", N/A ,"$2,080.00 ", N/A , N/A , N/A ,"$4,250.00 ", N/A ,"$4,250.00 ","$1,400.00 ","$4,500.00 ", N/A ,"$4,100.00 ","$4,225.00 ","$4,225.00 ", N/A ,"$3,250.00 ","$5,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27200189,N/A,HC 12 FR ESOPHAGEAL STEHOSCOPE,272,1 ,$28.00 ,$18.20 ,$7.84 ,$28.00 , N/A ,$18.20 ,$16.72 , N/A ,$7.84 ,$15.71 , N/A ,$18.42 , N/A ,$23.80 ,$23.80 , N/A ,$23.80 , N/A ,$19.04 , N/A , N/A , N/A ,$21.00 ,$19.88 ,$19.88 , N/A ,$19.88 ,$22.96 ,$22.96 ,$22.96 , N/A , N/A ,$23.80 , N/A ,$28.00 ,$16.72 , N/A ,$11.65 , N/A , N/A , N/A ,$23.80 , N/A ,$23.80 ,$7.84 ,$25.20 , N/A ,$22.96 ,$23.66 ,$23.66 , N/A ,$18.20 ,$28.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200226,N/A,HC ADHESIVE DERMABOND,272,1 ,$79.00 ,$51.35 ,$22.12 ,$79.00 , N/A ,$51.35 ,$47.16 , N/A ,$22.12 ,$44.32 , N/A ,$51.98 , N/A ,$67.15 ,$67.15 , N/A ,$67.15 , N/A ,$53.72 , N/A , N/A , N/A ,$59.25 ,$56.09 ,$56.09 , N/A ,$56.09 ,$64.78 ,$64.78 ,$64.78 , N/A , N/A ,$67.15 , N/A ,$79.00 ,$47.16 , N/A ,$32.86 , N/A , N/A , N/A ,$67.15 , N/A ,$67.15 ,$22.12 ,$71.10 , N/A ,$64.78 ,$66.76 ,$66.76 , N/A ,$51.35 ,$79.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200240,N/A,HC AMNIOTOMY HOOK,272,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200331,N/A,HC BED SENSOR,272,1 ,$33.63 ,$21.86 ,$9.42 ,$33.63 , N/A ,$21.86 ,$20.08 , N/A ,$9.42 ,$18.87 , N/A ,$22.13 , N/A ,$28.59 ,$28.59 , N/A ,$28.59 , N/A ,$22.87 , N/A , N/A , N/A ,$25.22 ,$23.88 ,$23.88 , N/A ,$23.88 ,$27.58 ,$27.58 ,$27.58 , N/A , N/A ,$28.59 , N/A ,$33.63 ,$20.08 , N/A ,$13.99 , N/A , N/A , N/A ,$28.59 , N/A ,$28.59 ,$9.42 ,$30.27 , N/A ,$27.58 ,$28.42 ,$28.42 , N/A ,$21.86 ,$33.63 
ST. JOSEPH'S HOSPITAL - BREESE,27200338,N/A,HC BIOPSY DEVICE NEEDLE CORE,272,1 ,$139.00 ,$90.35 ,$38.92 ,$139.00 , N/A ,$90.35 ,$82.98 , N/A ,$38.92 ,$77.98 , N/A ,$91.46 , N/A ,$118.15 ,$118.15 , N/A ,$118.15 , N/A ,$94.52 , N/A , N/A , N/A ,$104.25 ,$98.69 ,$98.69 , N/A ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A , N/A ,$118.15 , N/A ,$139.00 ,$82.98 , N/A ,$57.82 , N/A , N/A , N/A ,$118.15 , N/A ,$118.15 ,$38.92 ,$125.10 , N/A ,$113.98 ,$117.46 ,$117.46 , N/A ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200571,N/A,HC BREAST PUMP KIT,272,1 ,$85.00 ,$55.25 ,$23.80 ,$85.00 , N/A ,$55.25 ,$50.75 , N/A ,$23.80 ,$47.69 , N/A ,$55.93 , N/A ,$72.25 ,$72.25 , N/A ,$72.25 , N/A ,$57.80 , N/A , N/A , N/A ,$63.75 ,$60.35 ,$60.35 , N/A ,$60.35 ,$69.70 ,$69.70 ,$69.70 , N/A , N/A ,$72.25 , N/A ,$85.00 ,$50.75 , N/A ,$35.36 , N/A , N/A , N/A ,$72.25 , N/A ,$72.25 ,$23.80 ,$76.50 , N/A ,$69.70 ,$71.83 ,$71.83 , N/A ,$55.25 ,$85.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200712,N/A,HC CATHETER PLUG,272,1 ,$26.00 ,$16.90 ,$7.28 ,$26.00 , N/A ,$16.90 ,$15.52 , N/A ,$7.28 ,$14.59 , N/A ,$17.11 , N/A ,$22.10 ,$22.10 , N/A ,$22.10 , N/A ,$17.68 , N/A , N/A , N/A ,$19.50 ,$18.46 ,$18.46 , N/A ,$18.46 ,$21.32 ,$21.32 ,$21.32 , N/A , N/A ,$22.10 , N/A ,$26.00 ,$15.52 , N/A ,$10.82 , N/A , N/A , N/A ,$22.10 , N/A ,$22.10 ,$7.28 ,$23.40 , N/A ,$21.32 ,$21.97 ,$21.97 , N/A ,$16.90 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200747,N/A,HC CATH ARGYLE THORACIC,272,1 ,$30.00 ,$19.50 ,$8.40 ,$30.00 , N/A ,$19.50 ,$17.91 , N/A ,$8.40 ,$16.83 , N/A ,$19.74 , N/A ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$20.40 , N/A , N/A , N/A ,$22.50 ,$21.30 ,$21.30 , N/A ,$21.30 ,$24.60 ,$24.60 ,$24.60 , N/A , N/A ,$25.50 , N/A ,$30.00 ,$17.91 , N/A ,$12.48 , N/A , N/A , N/A ,$25.50 , N/A ,$25.50 ,$8.40 ,$27.00 , N/A ,$24.60 ,$25.35 ,$25.35 , N/A ,$19.50 ,$30.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200828,N/A,HC CATH FOLEY TEMPERATURE PROBE 16FR,272,1 ,$108.00 ,$70.20 ,$30.24 ,$108.00 , N/A ,$70.20 ,$64.48 , N/A ,$30.24 ,$60.59 , N/A ,$71.06 , N/A ,$91.80 ,$91.80 , N/A ,$91.80 , N/A ,$73.44 , N/A , N/A , N/A ,$81.00 ,$76.68 ,$76.68 , N/A ,$76.68 ,$88.56 ,$88.56 ,$88.56 , N/A , N/A ,$91.80 , N/A ,$108.00 ,$64.48 , N/A ,$44.93 , N/A , N/A , N/A ,$91.80 , N/A ,$91.80 ,$30.24 ,$97.20 , N/A ,$88.56 ,$91.26 ,$91.26 , N/A ,$70.20 ,$108.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200832,N/A,HC CATH TRAY WITH FOLEY,272,1 ,$39.00 ,$25.35 ,$10.92 ,$39.00 , N/A ,$25.35 ,$23.28 , N/A ,$10.92 ,$21.88 , N/A ,$25.66 , N/A ,$33.15 ,$33.15 , N/A ,$33.15 , N/A ,$26.52 , N/A , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$31.98 ,$31.98 ,$31.98 , N/A , N/A ,$33.15 , N/A ,$39.00 ,$23.28 , N/A ,$16.22 , N/A , N/A , N/A ,$33.15 , N/A ,$33.15 ,$10.92 ,$35.10 , N/A ,$31.98 ,$32.96 ,$32.96 , N/A ,$25.35 ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27200849,N/A,HC CATHETER - FOLEY,272,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 , N/A , N/A , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201077,N/A,HC DIS INCENTIVE SPIROMETER,272,1 ,$97.00 ,$63.05 ,$27.16 ,$97.00 , N/A ,$63.05 ,$57.91 , N/A ,$27.16 ,$54.42 , N/A ,$63.83 , N/A ,$82.45 ,$82.45 , N/A ,$82.45 , N/A ,$65.96 , N/A , N/A , N/A ,$72.75 ,$68.87 ,$68.87 , N/A ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A , N/A ,$82.45 , N/A ,$97.00 ,$57.91 , N/A ,$40.35 , N/A , N/A , N/A ,$82.45 , N/A ,$82.45 ,$27.16 ,$87.30 , N/A ,$79.54 ,$81.97 ,$81.97 , N/A ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201083,N/A,HC DISP. OXIMETER SENSOR,272,1 ,$47.00 ,$30.55 ,$13.16 ,$47.00 , N/A ,$30.55 ,$28.06 , N/A ,$13.16 ,$26.37 , N/A ,$30.93 , N/A ,$39.95 ,$39.95 , N/A ,$39.95 , N/A ,$31.96 , N/A , N/A , N/A ,$35.25 ,$33.37 ,$33.37 , N/A ,$33.37 ,$38.54 ,$38.54 ,$38.54 , N/A , N/A ,$39.95 , N/A ,$47.00 ,$28.06 , N/A ,$19.55 , N/A , N/A , N/A ,$39.95 , N/A ,$39.95 ,$13.16 ,$42.30 , N/A ,$38.54 ,$39.72 ,$39.72 , N/A ,$30.55 ,$47.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201147,N/A,HC DRESSING ADAPTIC 3X8,272,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201148,N/A,HC DRESSING AQUACELL W/HYDROFIBER,272,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201165,N/A,HC MORGAN LENS,272,1 ,$115.20 ,$74.88 ,$32.26 ,$115.20 , N/A ,$74.88 ,$68.77 , N/A ,$32.26 ,$64.63 , N/A ,$75.80 , N/A ,$97.92 ,$97.92 , N/A ,$97.92 , N/A ,$78.34 , N/A , N/A , N/A ,$86.40 ,$81.79 ,$81.79 , N/A ,$81.79 ,$94.46 ,$94.46 ,$94.46 , N/A , N/A ,$97.92 , N/A ,$115.20 ,$68.77 , N/A ,$47.92 , N/A , N/A , N/A ,$97.92 , N/A ,$97.92 ,$32.26 ,$103.68 , N/A ,$94.46 ,$97.34 ,$97.34 , N/A ,$74.88 ,$115.20 
ST. JOSEPH'S HOSPITAL - BREESE,27201247,N/A,HC ENDOTRACH TUBE HOLDER,272,1 ,$27.00 ,$17.55 ,$7.56 ,$27.00 , N/A ,$17.55 ,$16.12 , N/A ,$7.56 ,$15.15 , N/A ,$17.77 , N/A ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$18.36 , N/A , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.14 ,$22.14 ,$22.14 , N/A , N/A ,$22.95 , N/A ,$27.00 ,$16.12 , N/A ,$11.23 , N/A , N/A , N/A ,$22.95 , N/A ,$22.95 ,$7.56 ,$24.30 , N/A ,$22.14 ,$22.82 ,$22.82 , N/A ,$17.55 ,$27.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201248,N/A,HC ENDOTRACHEAL TUBE (DUAL LUMEN),272,1 ,$19.00 ,$12.35 ,$5.32 ,$19.00 , N/A ,$12.35 ,$11.34 , N/A ,$5.32 ,$10.66 , N/A ,$12.50 , N/A ,$16.15 ,$16.15 , N/A ,$16.15 , N/A ,$12.92 , N/A , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.58 ,$15.58 ,$15.58 , N/A , N/A ,$16.15 , N/A ,$19.00 ,$11.34 , N/A ,$7.90 , N/A , N/A , N/A ,$16.15 , N/A ,$16.15 ,$5.32 ,$17.10 , N/A ,$15.58 ,$16.06 ,$16.06 , N/A ,$12.35 ,$19.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201250,N/A,HC EPIDURAL TRAY SNGL USE,272,1 ,$54.00 ,$35.10 ,$15.12 ,$54.00 , N/A ,$35.10 ,$32.24 , N/A ,$15.12 ,$30.29 , N/A ,$35.53 , N/A ,$45.90 ,$45.90 , N/A ,$45.90 , N/A ,$36.72 , N/A , N/A , N/A ,$40.50 ,$38.34 ,$38.34 , N/A ,$38.34 ,$44.28 ,$44.28 ,$44.28 , N/A , N/A ,$45.90 , N/A ,$54.00 ,$32.24 , N/A ,$22.46 , N/A , N/A , N/A ,$45.90 , N/A ,$45.90 ,$15.12 ,$48.60 , N/A ,$44.28 ,$45.63 ,$45.63 , N/A ,$35.10 ,$54.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201279,N/A,HC FECAL MANAGEMENT KIT,272,1 ,$276.00 ,$179.40 ,$77.28 ,$276.00 , N/A ,$179.40 ,$164.77 , N/A ,$77.28 ,$154.84 , N/A ,$181.61 , N/A ,$234.60 ,$234.60 , N/A ,$234.60 , N/A ,$187.68 , N/A , N/A , N/A ,$207.00 ,$195.96 ,$195.96 , N/A ,$195.96 ,$226.32 ,$226.32 ,$226.32 , N/A , N/A ,$234.60 , N/A ,$276.00 ,$164.77 , N/A ,$114.82 , N/A , N/A , N/A ,$234.60 , N/A ,$234.60 ,$77.28 ,$248.40 , N/A ,$226.32 ,$233.22 ,$233.22 , N/A ,$179.40 ,$276.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201282,N/A,HC FEEDING TUBE,272,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 , N/A ,$20.80 ,$19.10 , N/A ,$8.96 ,$17.95 , N/A ,$21.06 , N/A ,$27.20 ,$27.20 , N/A ,$27.20 , N/A ,$21.76 , N/A , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.24 ,$26.24 ,$26.24 , N/A , N/A ,$27.20 , N/A ,$32.00 ,$19.10 , N/A ,$13.31 , N/A , N/A , N/A ,$27.20 , N/A ,$27.20 ,$8.96 ,$28.80 , N/A ,$26.24 ,$27.04 ,$27.04 , N/A ,$20.80 ,$32.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201302,N/A,HC FINE MARKING PEN,272,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201521,N/A,HC KIT INTRODUCER,272,1 ,$16.00 ,$10.40 ,$4.48 ,$16.00 , N/A ,$10.40 ,$9.55 , N/A ,$4.48 ,$8.98 , N/A ,$10.53 , N/A ,$13.60 ,$13.60 , N/A ,$13.60 , N/A ,$10.88 , N/A , N/A , N/A ,$12.00 ,$11.36 ,$11.36 , N/A ,$11.36 ,$13.12 ,$13.12 ,$13.12 , N/A , N/A ,$13.60 , N/A ,$16.00 ,$9.55 , N/A ,$6.66 , N/A , N/A , N/A ,$13.60 , N/A ,$13.60 ,$4.48 ,$14.40 , N/A ,$13.12 ,$13.52 ,$13.52 , N/A ,$10.40 ,$16.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201738,N/A,HC NIPPLE SHIELD,272,1 ,$17.00 ,$11.05 ,$4.76 ,$17.00 , N/A ,$11.05 ,$10.15 , N/A ,$4.76 ,$9.54 , N/A ,$11.19 , N/A ,$14.45 ,$14.45 , N/A ,$14.45 , N/A ,$11.56 , N/A , N/A , N/A ,$12.75 ,$12.07 ,$12.07 , N/A ,$12.07 ,$13.94 ,$13.94 ,$13.94 , N/A , N/A ,$14.45 , N/A ,$17.00 ,$10.15 , N/A ,$7.07 , N/A , N/A , N/A ,$14.45 , N/A ,$14.45 ,$4.76 ,$15.30 , N/A ,$13.94 ,$14.37 ,$14.37 , N/A ,$11.05 ,$17.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201894,N/A,HC PRESSURE CATHETER IUPC,272,1 ,$172.00 ,$111.80 ,$48.16 ,$172.00 , N/A ,$111.80 ,$102.68 , N/A ,$48.16 ,$96.49 , N/A ,$113.18 , N/A ,$146.20 ,$146.20 , N/A ,$146.20 , N/A ,$116.96 , N/A , N/A , N/A ,$129.00 ,$122.12 ,$122.12 , N/A ,$122.12 ,$141.04 ,$141.04 ,$141.04 , N/A , N/A ,$146.20 , N/A ,$172.00 ,$102.68 , N/A ,$71.55 , N/A , N/A , N/A ,$146.20 , N/A ,$146.20 ,$48.16 ,$154.80 , N/A ,$141.04 ,$145.34 ,$145.34 , N/A ,$111.80 ,$172.00 
ST. JOSEPH'S HOSPITAL - BREESE,27201896,N/A,HC PREVENA INCISION SYSTEM,272,1 ,"$1,560.00 ","$1,014.00 ",$436.80 ,"$1,560.00 ", N/A ,"$1,014.00 ",$931.32 , N/A ,$436.80 ,$875.16 , N/A ,"$1,026.48 ", N/A ,"$1,326.00 ","$1,326.00 ", N/A ,"$1,326.00 ", N/A ,"$1,060.80 ", N/A , N/A , N/A ,"$1,170.00 ","$1,107.60 ","$1,107.60 ", N/A ,"$1,107.60 ","$1,279.20 ","$1,279.20 ","$1,279.20 ", N/A , N/A ,"$1,326.00 ", N/A ,"$1,560.00 ",$931.32 , N/A ,$648.96 , N/A , N/A , N/A ,"$1,326.00 ", N/A ,"$1,326.00 ",$436.80 ,"$1,404.00 ", N/A ,"$1,279.20 ","$1,318.20 ","$1,318.20 ", N/A ,"$1,014.00 ","$1,560.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27201938,N/A,HC PULSE OXIMETER PROBE DISP,272,1 ,$39.00 ,$25.35 ,$10.92 ,$39.00 , N/A ,$25.35 ,$23.28 , N/A ,$10.92 ,$21.88 , N/A ,$25.66 , N/A ,$33.15 ,$33.15 , N/A ,$33.15 , N/A ,$26.52 , N/A , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$31.98 ,$31.98 ,$31.98 , N/A , N/A ,$33.15 , N/A ,$39.00 ,$23.28 , N/A ,$16.22 , N/A , N/A , N/A ,$33.15 , N/A ,$33.15 ,$10.92 ,$35.10 , N/A ,$31.98 ,$32.96 ,$32.96 , N/A ,$25.35 ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202002,N/A,HC SCD SLEEVE KNEE,272,1 ,$110.00 ,$71.50 ,$30.80 ,$110.00 , N/A ,$71.50 ,$65.67 , N/A ,$30.80 ,$61.71 , N/A ,$72.38 , N/A ,$93.50 ,$93.50 , N/A ,$93.50 , N/A ,$74.80 , N/A , N/A , N/A ,$82.50 ,$78.10 ,$78.10 , N/A ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A , N/A ,$93.50 , N/A ,$110.00 ,$65.67 , N/A ,$45.76 , N/A , N/A , N/A ,$93.50 , N/A ,$93.50 ,$30.80 ,$99.00 , N/A ,$90.20 ,$92.95 ,$92.95 , N/A ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202120,N/A,HC STAPLER SKIN,272,1 ,$18.00 ,$11.70 ,$5.04 ,$18.00 , N/A ,$11.70 ,$10.75 , N/A ,$5.04 ,$10.10 , N/A ,$11.84 , N/A ,$15.30 ,$15.30 , N/A ,$15.30 , N/A ,$12.24 , N/A , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A , N/A ,$15.30 , N/A ,$18.00 ,$10.75 , N/A ,$7.49 , N/A , N/A , N/A ,$15.30 , N/A ,$15.30 ,$5.04 ,$16.20 , N/A ,$14.76 ,$15.21 ,$15.21 , N/A ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202600,N/A,HC SUTURE,272,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 , N/A ,$9.75 ,$8.96 , N/A ,$4.20 ,$8.42 , N/A ,$9.87 , N/A ,$12.75 ,$12.75 , N/A ,$12.75 , N/A ,$10.20 , N/A , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.30 ,$12.30 ,$12.30 , N/A , N/A ,$12.75 , N/A ,$15.00 ,$8.96 , N/A ,$6.24 , N/A , N/A , N/A ,$12.75 , N/A ,$12.75 ,$4.20 ,$13.50 , N/A ,$12.30 ,$12.68 ,$12.68 , N/A ,$9.75 ,$15.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202634,N/A,HC SYRINGE ASEPTO,272,1 ,$6.00 ,$3.90 ,$1.68 ,$6.00 , N/A ,$3.90 ,$3.58 , N/A ,$1.68 ,$3.37 , N/A ,$3.95 , N/A ,$5.10 ,$5.10 , N/A ,$5.10 , N/A ,$4.08 , N/A , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.92 ,$4.92 ,$4.92 , N/A , N/A ,$5.10 , N/A ,$6.00 ,$3.58 , N/A ,$2.50 , N/A , N/A , N/A ,$5.10 , N/A ,$5.10 ,$1.68 ,$5.40 , N/A ,$4.92 ,$5.07 ,$5.07 , N/A ,$3.90 ,$6.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202656,N/A,HC TAPE MEDIPORE 4 INCH,272,1 ,$19.00 ,$12.35 ,$5.32 ,$19.00 , N/A ,$12.35 ,$11.34 , N/A ,$5.32 ,$10.66 , N/A ,$12.50 , N/A ,$16.15 ,$16.15 , N/A ,$16.15 , N/A ,$12.92 , N/A , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.58 ,$15.58 ,$15.58 , N/A , N/A ,$16.15 , N/A ,$19.00 ,$11.34 , N/A ,$7.90 , N/A , N/A , N/A ,$16.15 , N/A ,$16.15 ,$5.32 ,$17.10 , N/A ,$15.58 ,$16.06 ,$16.06 , N/A ,$12.35 ,$19.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202665,N/A,HC THORACENTESIS TRAY,272,1 ,$167.00 ,$108.55 ,$46.76 ,$167.00 , N/A ,$108.55 ,$99.70 , N/A ,$46.76 ,$93.69 , N/A ,$109.89 , N/A ,$141.95 ,$141.95 , N/A ,$141.95 , N/A ,$113.56 , N/A , N/A , N/A ,$125.25 ,$118.57 ,$118.57 , N/A ,$118.57 ,$136.94 ,$136.94 ,$136.94 , N/A , N/A ,$141.95 , N/A ,$167.00 ,$99.70 , N/A ,$69.47 , N/A , N/A , N/A ,$141.95 , N/A ,$141.95 ,$46.76 ,$150.30 , N/A ,$136.94 ,$141.12 ,$141.12 , N/A ,$108.55 ,$167.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202743,N/A,HC TRAY CATH,272,1 ,$27.00 ,$17.55 ,$7.56 ,$27.00 , N/A ,$17.55 ,$16.12 , N/A ,$7.56 ,$15.15 , N/A ,$17.77 , N/A ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$18.36 , N/A , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.14 ,$22.14 ,$22.14 , N/A , N/A ,$22.95 , N/A ,$27.00 ,$16.12 , N/A ,$11.23 , N/A , N/A , N/A ,$22.95 , N/A ,$22.95 ,$7.56 ,$24.30 , N/A ,$22.14 ,$22.82 ,$22.82 , N/A ,$17.55 ,$27.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202759,N/A,HC TRAY EPIDURAL CONTINUOUS,272,1 ,$21.00 ,$13.65 ,$5.88 ,$21.00 , N/A ,$13.65 ,$12.54 , N/A ,$5.88 ,$11.78 , N/A ,$13.82 , N/A ,$17.85 ,$17.85 , N/A ,$17.85 , N/A ,$14.28 , N/A , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.22 ,$17.22 ,$17.22 , N/A , N/A ,$17.85 , N/A ,$21.00 ,$12.54 , N/A ,$8.74 , N/A , N/A , N/A ,$17.85 , N/A ,$17.85 ,$5.88 ,$18.90 , N/A ,$17.22 ,$17.75 ,$17.75 , N/A ,$13.65 ,$21.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202807,N/A,HC TRAY SPINAL,272,1 ,$39.00 ,$25.35 ,$10.92 ,$39.00 , N/A ,$25.35 ,$23.28 , N/A ,$10.92 ,$21.88 , N/A ,$25.66 , N/A ,$33.15 ,$33.15 , N/A ,$33.15 , N/A ,$26.52 , N/A , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$31.98 ,$31.98 ,$31.98 , N/A , N/A ,$33.15 , N/A ,$39.00 ,$23.28 , N/A ,$16.22 , N/A , N/A , N/A ,$33.15 , N/A ,$33.15 ,$10.92 ,$35.10 , N/A ,$31.98 ,$32.96 ,$32.96 , N/A ,$25.35 ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27202916,N/A,HC TUBING DISP CO2,272,1 ,$27.00 ,$17.55 ,$7.56 ,$27.00 , N/A ,$17.55 ,$16.12 , N/A ,$7.56 ,$15.15 , N/A ,$17.77 , N/A ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$18.36 , N/A , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.14 ,$22.14 ,$22.14 , N/A , N/A ,$22.95 , N/A ,$27.00 ,$16.12 , N/A ,$11.23 , N/A , N/A , N/A ,$22.95 , N/A ,$22.95 ,$7.56 ,$24.30 , N/A ,$22.14 ,$22.82 ,$22.82 , N/A ,$17.55 ,$27.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203051,N/A,HC NASAL PACKING,272,1 ,$49.11 ,$31.92 ,$13.75 ,$49.11 , N/A ,$31.92 ,$29.32 , N/A ,$13.75 ,$27.55 , N/A ,$32.31 , N/A ,$41.74 ,$41.74 , N/A ,$41.74 , N/A ,$33.39 , N/A , N/A , N/A ,$36.83 ,$34.87 ,$34.87 , N/A ,$34.87 ,$40.27 ,$40.27 ,$40.27 , N/A , N/A ,$41.74 , N/A ,$49.11 ,$29.32 , N/A ,$20.43 , N/A , N/A , N/A ,$41.74 , N/A ,$41.74 ,$13.75 ,$44.20 , N/A ,$40.27 ,$41.50 ,$41.50 , N/A ,$31.92 ,$49.11 
ST. JOSEPH'S HOSPITAL - BREESE,27203100,N/A,HC SET QUICK PRESSURE MONITOR,272,1 ,$339.00 ,$220.35 ,$94.92 ,$339.00 , N/A ,$220.35 ,$202.38 , N/A ,$94.92 ,$190.18 , N/A ,$223.06 , N/A ,$288.15 ,$288.15 , N/A ,$288.15 , N/A ,$230.52 , N/A , N/A , N/A ,$254.25 ,$240.69 ,$240.69 , N/A ,$240.69 ,$277.98 ,$277.98 ,$277.98 , N/A , N/A ,$288.15 , N/A ,$339.00 ,$202.38 , N/A ,$141.02 , N/A , N/A , N/A ,$288.15 , N/A ,$288.15 ,$94.92 ,$305.10 , N/A ,$277.98 ,$286.46 ,$286.46 , N/A ,$220.35 ,$339.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203239,N/A,HC PUTTY,272,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203255,N/A,HC CPM PADS,272,1 ,$66.00 ,$42.90 ,$18.48 ,$66.00 , N/A ,$42.90 ,$39.40 , N/A ,$18.48 ,$37.03 , N/A ,$43.43 , N/A ,$56.10 ,$56.10 , N/A ,$56.10 , N/A ,$44.88 , N/A , N/A , N/A ,$49.50 ,$46.86 ,$46.86 , N/A ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A , N/A ,$56.10 , N/A ,$66.00 ,$39.40 , N/A ,$27.46 , N/A , N/A , N/A ,$56.10 , N/A ,$56.10 ,$18.48 ,$59.40 , N/A ,$54.12 ,$55.77 ,$55.77 , N/A ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203503,N/A,HC CANNULA NASAL HEATED HI FLOW,272,1 ,$63.00 ,$40.95 ,$17.64 ,$63.00 , N/A ,$40.95 ,$37.61 , N/A ,$17.64 ,$35.34 , N/A ,$41.45 , N/A ,$53.55 ,$53.55 , N/A ,$53.55 , N/A ,$42.84 , N/A , N/A , N/A ,$47.25 ,$44.73 ,$44.73 , N/A ,$44.73 ,$51.66 ,$51.66 ,$51.66 , N/A , N/A ,$53.55 , N/A ,$63.00 ,$37.61 , N/A ,$26.21 , N/A , N/A , N/A ,$53.55 , N/A ,$53.55 ,$17.64 ,$56.70 , N/A ,$51.66 ,$53.24 ,$53.24 , N/A ,$40.95 ,$63.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203509,N/A,HC CATHETER FOLEY 3W,272,1 ,$46.00 ,$29.90 ,$12.88 ,$46.00 , N/A ,$29.90 ,$27.46 , N/A ,$12.88 ,$25.81 , N/A ,$30.27 , N/A ,$39.10 ,$39.10 , N/A ,$39.10 , N/A ,$31.28 , N/A , N/A , N/A ,$34.50 ,$32.66 ,$32.66 , N/A ,$32.66 ,$37.72 ,$37.72 ,$37.72 , N/A , N/A ,$39.10 , N/A ,$46.00 ,$27.46 , N/A ,$19.14 , N/A , N/A , N/A ,$39.10 , N/A ,$39.10 ,$12.88 ,$41.40 , N/A ,$37.72 ,$38.87 ,$38.87 , N/A ,$29.90 ,$46.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203511,N/A,HC BAG LEG URINARY,272,1 ,$14.00 ,$9.10 ,$3.92 ,$14.00 , N/A ,$9.10 ,$8.36 , N/A ,$3.92 ,$7.85 , N/A ,$9.21 , N/A ,$11.90 ,$11.90 , N/A ,$11.90 , N/A ,$9.52 , N/A , N/A , N/A ,$10.50 ,$9.94 ,$9.94 , N/A ,$9.94 ,$11.48 ,$11.48 ,$11.48 , N/A , N/A ,$11.90 , N/A ,$14.00 ,$8.36 , N/A ,$5.82 , N/A , N/A , N/A ,$11.90 , N/A ,$11.90 ,$3.92 ,$12.60 , N/A ,$11.48 ,$11.83 ,$11.83 , N/A ,$9.10 ,$14.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203518,A6222,HC DRESSING VASELINE GAUZE,623,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203521,A6234,HC DRESSING DUODERM <16 SQ CM,272,1 ,$40.00 ,$26.00 ,$11.20 ,$40.00 , N/A ,$26.00 ,$23.88 , N/A ,$11.20 ,$22.44 , N/A ,$26.32 , N/A ,$34.00 ,$34.00 , N/A ,$34.00 , N/A ,$27.20 , N/A , N/A , N/A ,$30.00 ,$28.40 ,$28.40 , N/A ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A , N/A ,$34.00 , N/A ,$40.00 ,$23.88 , N/A ,$16.64 , N/A , N/A , N/A ,$34.00 , N/A ,$34.00 ,$11.20 ,$36.00 , N/A ,$32.80 ,$33.80 ,$33.80 , N/A ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203527,A6402,HC DRESSING GAUZE,623,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203531,C1751,HC CATHETER CV TRIPLE-LUMEN,272,1 ,$255.00 ,$165.75 ,$71.40 ,$255.00 , N/A ,$165.75 ,$152.24 , N/A ,$71.40 ,$143.06 , N/A ,$167.79 , N/A ,$216.75 ,$216.75 , N/A ,$216.75 , N/A ,$173.40 , N/A , N/A , N/A ,$191.25 ,$181.05 ,$181.05 , N/A ,$181.05 ,$209.10 ,$209.10 ,$209.10 , N/A , N/A ,$216.75 , N/A ,$255.00 ,$152.24 , N/A ,$106.08 , N/A , N/A , N/A ,$216.75 , N/A ,$216.75 ,$71.40 ,$229.50 , N/A ,$209.10 ,$215.48 ,$215.48 , N/A ,$165.75 ,$255.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203532,C1751,HC CATHETER CV DUAL-LUMEN,272,1 ,$645.00 ,$419.25 ,$180.60 ,$645.00 , N/A ,$419.25 ,$385.07 , N/A ,$180.60 ,$361.85 , N/A ,$424.41 , N/A ,$548.25 ,$548.25 , N/A ,$548.25 , N/A ,$438.60 , N/A , N/A , N/A ,$483.75 ,$457.95 ,$457.95 , N/A ,$457.95 ,$528.90 ,$528.90 ,$528.90 , N/A , N/A ,$548.25 , N/A ,$645.00 ,$385.07 , N/A ,$268.32 , N/A , N/A , N/A ,$548.25 , N/A ,$548.25 ,$180.60 ,$580.50 , N/A ,$528.90 ,$545.03 ,$545.03 , N/A ,$419.25 ,$645.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203533,C1751,HC CATHETER CV SINGLE-LUMEN,272,1 ,$397.00 ,$258.05 ,$111.16 ,$397.00 , N/A ,$258.05 ,$237.01 , N/A ,$111.16 ,$222.72 , N/A ,$261.23 , N/A ,$337.45 ,$337.45 , N/A ,$337.45 , N/A ,$269.96 , N/A , N/A , N/A ,$297.75 ,$281.87 ,$281.87 , N/A ,$281.87 ,$325.54 ,$325.54 ,$325.54 , N/A , N/A ,$337.45 , N/A ,$397.00 ,$237.01 , N/A ,$165.15 , N/A , N/A , N/A ,$337.45 , N/A ,$337.45 ,$111.16 ,$357.30 , N/A ,$325.54 ,$335.47 ,$335.47 , N/A ,$258.05 ,$397.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203535,N/A,HC TRAY LUMBAR PUNCTURE,272,1 ,$66.00 ,$42.90 ,$18.48 ,$66.00 , N/A ,$42.90 ,$39.40 , N/A ,$18.48 ,$37.03 , N/A ,$43.43 , N/A ,$56.10 ,$56.10 , N/A ,$56.10 , N/A ,$44.88 , N/A , N/A , N/A ,$49.50 ,$46.86 ,$46.86 , N/A ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A , N/A ,$56.10 , N/A ,$66.00 ,$39.40 , N/A ,$27.46 , N/A , N/A , N/A ,$56.10 , N/A ,$56.10 ,$18.48 ,$59.40 , N/A ,$54.12 ,$55.77 ,$55.77 , N/A ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203537,N/A,HC CATHETER RADIAL ARTERY,272,1 ,$33.00 ,$21.45 ,$9.24 ,$33.00 , N/A ,$21.45 ,$19.70 , N/A ,$9.24 ,$18.51 , N/A ,$21.71 , N/A ,$28.05 ,$28.05 , N/A ,$28.05 , N/A ,$22.44 , N/A , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.06 ,$27.06 ,$27.06 , N/A , N/A ,$28.05 , N/A ,$33.00 ,$19.70 , N/A ,$13.73 , N/A , N/A , N/A ,$28.05 , N/A ,$28.05 ,$9.24 ,$29.70 , N/A ,$27.06 ,$27.89 ,$27.89 , N/A ,$21.45 ,$33.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203539,N/A,HC TRANSDUCER,272,1 ,$33.00 ,$21.45 ,$9.24 ,$33.00 , N/A ,$21.45 ,$19.70 , N/A ,$9.24 ,$18.51 , N/A ,$21.71 , N/A ,$28.05 ,$28.05 , N/A ,$28.05 , N/A ,$22.44 , N/A , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.06 ,$27.06 ,$27.06 , N/A , N/A ,$28.05 , N/A ,$33.00 ,$19.70 , N/A ,$13.73 , N/A , N/A , N/A ,$28.05 , N/A ,$28.05 ,$9.24 ,$29.70 , N/A ,$27.06 ,$27.89 ,$27.89 , N/A ,$21.45 ,$33.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203560,N/A,HC CATHETER IV,272,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203562,N/A,HC CATHETER SUCTION,272,1 ,$16.00 ,$10.40 ,$4.48 ,$16.00 , N/A ,$10.40 ,$9.55 , N/A ,$4.48 ,$8.98 , N/A ,$10.53 , N/A ,$13.60 ,$13.60 , N/A ,$13.60 , N/A ,$10.88 , N/A , N/A , N/A ,$12.00 ,$11.36 ,$11.36 , N/A ,$11.36 ,$13.12 ,$13.12 ,$13.12 , N/A , N/A ,$13.60 , N/A ,$16.00 ,$9.55 , N/A ,$6.66 , N/A , N/A , N/A ,$13.60 , N/A ,$13.60 ,$4.48 ,$14.40 , N/A ,$13.12 ,$13.52 ,$13.52 , N/A ,$10.40 ,$16.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203564,N/A,HC CATHETER UMBILICAL ARTERY,272,1 ,$60.00 ,$39.00 ,$16.80 ,$60.00 , N/A ,$39.00 ,$35.82 , N/A ,$16.80 ,$33.66 , N/A ,$39.48 , N/A ,$51.00 ,$51.00 , N/A ,$51.00 , N/A ,$40.80 , N/A , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.20 ,$49.20 ,$49.20 , N/A , N/A ,$51.00 , N/A ,$60.00 ,$35.82 , N/A ,$24.96 , N/A , N/A , N/A ,$51.00 , N/A ,$51.00 ,$16.80 ,$54.00 , N/A ,$49.20 ,$50.70 ,$50.70 , N/A ,$39.00 ,$60.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203572,N/A,HC DRESSING BIOPATCH,272,1 ,$18.00 ,$11.70 ,$5.04 ,$18.00 , N/A ,$11.70 ,$10.75 , N/A ,$5.04 ,$10.10 , N/A ,$11.84 , N/A ,$15.30 ,$15.30 , N/A ,$15.30 , N/A ,$12.24 , N/A , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A , N/A ,$15.30 , N/A ,$18.00 ,$10.75 , N/A ,$7.49 , N/A , N/A , N/A ,$15.30 , N/A ,$15.30 ,$5.04 ,$16.20 , N/A ,$14.76 ,$15.21 ,$15.21 , N/A ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203575,N/A,HC DRESSING TELFA,272,1 ,$6.00 ,$3.90 ,$1.68 ,$6.00 , N/A ,$3.90 ,$3.58 , N/A ,$1.68 ,$3.37 , N/A ,$3.95 , N/A ,$5.10 ,$5.10 , N/A ,$5.10 , N/A ,$4.08 , N/A , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.92 ,$4.92 ,$4.92 , N/A , N/A ,$5.10 , N/A ,$6.00 ,$3.58 , N/A ,$2.50 , N/A , N/A , N/A ,$5.10 , N/A ,$5.10 ,$1.68 ,$5.40 , N/A ,$4.92 ,$5.07 ,$5.07 , N/A ,$3.90 ,$6.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203576,N/A,HC DRESSING V.A.C.,272,1 ,$123.00 ,$79.95 ,$34.44 ,$123.00 , N/A ,$79.95 ,$73.43 , N/A ,$34.44 ,$69.00 , N/A ,$80.93 , N/A ,$104.55 ,$104.55 , N/A ,$104.55 , N/A ,$83.64 , N/A , N/A , N/A ,$92.25 ,$87.33 ,$87.33 , N/A ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A , N/A ,$104.55 , N/A ,$123.00 ,$73.43 , N/A ,$51.17 , N/A , N/A , N/A ,$104.55 , N/A ,$104.55 ,$34.44 ,$110.70 , N/A ,$100.86 ,$103.94 ,$103.94 , N/A ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203579,N/A,HC KIT CATHETER FEMALE/INFANT/CHILD,272,1 ,$21.00 ,$13.65 ,$5.88 ,$21.00 , N/A ,$13.65 ,$12.54 , N/A ,$5.88 ,$11.78 , N/A ,$13.82 , N/A ,$17.85 ,$17.85 , N/A ,$17.85 , N/A ,$14.28 , N/A , N/A , N/A ,$15.75 ,$14.91 ,$14.91 , N/A ,$14.91 ,$17.22 ,$17.22 ,$17.22 , N/A , N/A ,$17.85 , N/A ,$21.00 ,$12.54 , N/A ,$8.74 , N/A , N/A , N/A ,$17.85 , N/A ,$17.85 ,$5.88 ,$18.90 , N/A ,$17.22 ,$17.75 ,$17.75 , N/A ,$13.65 ,$21.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203586,N/A,HC SALEM SUMP,272,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203589,N/A,HC STYLET INTUBATING,272,1 ,$18.00 ,$11.70 ,$5.04 ,$18.00 , N/A ,$11.70 ,$10.75 , N/A ,$5.04 ,$10.10 , N/A ,$11.84 , N/A ,$15.30 ,$15.30 , N/A ,$15.30 , N/A ,$12.24 , N/A , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A , N/A ,$15.30 , N/A ,$18.00 ,$10.75 , N/A ,$7.49 , N/A , N/A , N/A ,$15.30 , N/A ,$15.30 ,$5.04 ,$16.20 , N/A ,$14.76 ,$15.21 ,$15.21 , N/A ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203590,N/A,HC SYRINGE PUMP SYRINGE,272,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 , N/A ,$20.80 ,$19.10 , N/A ,$8.96 ,$17.95 , N/A ,$21.06 , N/A ,$27.20 ,$27.20 , N/A ,$27.20 , N/A ,$21.76 , N/A , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.24 ,$26.24 ,$26.24 , N/A , N/A ,$27.20 , N/A ,$32.00 ,$19.10 , N/A ,$13.31 , N/A , N/A , N/A ,$27.20 , N/A ,$27.20 ,$8.96 ,$28.80 , N/A ,$26.24 ,$27.04 ,$27.04 , N/A ,$20.80 ,$32.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203597,N/A,HC TUBING ANY,272,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203689,N/A,HC COVER PROBE,272,1 ,$20.00 ,$13.00 ,$5.60 ,$20.00 , N/A ,$13.00 ,$11.94 , N/A ,$5.60 ,$11.22 , N/A ,$13.16 , N/A ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$13.60 , N/A , N/A , N/A ,$15.00 ,$14.20 ,$14.20 , N/A ,$14.20 ,$16.40 ,$16.40 ,$16.40 , N/A , N/A ,$17.00 , N/A ,$20.00 ,$11.94 , N/A ,$8.32 , N/A , N/A , N/A ,$17.00 , N/A ,$17.00 ,$5.60 ,$18.00 , N/A ,$16.40 ,$16.90 ,$16.90 , N/A ,$13.00 ,$20.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203719,C1729,HC CATHETER CENTESIS ONE STEP,272,1 ,$39.00 ,$25.35 ,$10.92 ,$39.00 , N/A ,$25.35 ,$23.28 , N/A ,$10.92 ,$21.88 , N/A ,$25.66 , N/A ,$33.15 ,$33.15 , N/A ,$33.15 , N/A ,$26.52 , N/A , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$31.98 ,$31.98 ,$31.98 , N/A , N/A ,$33.15 , N/A ,$39.00 ,$23.28 , N/A ,$16.22 , N/A , N/A , N/A ,$33.15 , N/A ,$33.15 ,$10.92 ,$35.10 , N/A ,$31.98 ,$32.96 ,$32.96 , N/A ,$25.35 ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203844,N/A,HC TRAY CHEST TUBE,272,1 ,$84.00 ,$54.60 ,$23.52 ,$84.00 , N/A ,$54.60 ,$50.15 , N/A ,$23.52 ,$47.12 , N/A ,$55.27 , N/A ,$71.40 ,$71.40 , N/A ,$71.40 , N/A ,$57.12 , N/A , N/A , N/A ,$63.00 ,$59.64 ,$59.64 , N/A ,$59.64 ,$68.88 ,$68.88 ,$68.88 , N/A , N/A ,$71.40 , N/A ,$84.00 ,$50.15 , N/A ,$34.94 , N/A , N/A , N/A ,$71.40 , N/A ,$71.40 ,$23.52 ,$75.60 , N/A ,$68.88 ,$70.98 ,$70.98 , N/A ,$54.60 ,$84.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203846,N/A,HC SYSTEM VACUUM ASSIST MUSHROOM CAP,272,1 ,$99.00 ,$64.35 ,$27.72 ,$99.00 , N/A ,$64.35 ,$59.10 , N/A ,$27.72 ,$55.54 , N/A ,$65.14 , N/A ,$84.15 ,$84.15 , N/A ,$84.15 , N/A ,$67.32 , N/A , N/A , N/A ,$74.25 ,$70.29 ,$70.29 , N/A ,$70.29 ,$81.18 ,$81.18 ,$81.18 , N/A , N/A ,$84.15 , N/A ,$99.00 ,$59.10 , N/A ,$41.18 , N/A , N/A , N/A ,$84.15 , N/A ,$84.15 ,$27.72 ,$89.10 , N/A ,$81.18 ,$83.66 ,$83.66 , N/A ,$64.35 ,$99.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203847,N/A,HC NEEDLE INTRAOSSEOUS,272,1 ,$375.00 ,$243.75 ,$105.00 ,$375.00 , N/A ,$243.75 ,$223.88 , N/A ,$105.00 ,$210.38 , N/A ,$246.75 , N/A ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$255.00 , N/A , N/A , N/A ,$281.25 ,$266.25 ,$266.25 , N/A ,$266.25 ,$307.50 ,$307.50 ,$307.50 , N/A , N/A ,$318.75 , N/A ,$375.00 ,$223.88 , N/A ,$156.00 , N/A , N/A , N/A ,$318.75 , N/A ,$318.75 ,$105.00 ,$337.50 , N/A ,$307.50 ,$316.88 ,$316.88 , N/A ,$243.75 ,$375.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203849,N/A,HC DRESSING WOUND PICO,272,1 ,$714.00 ,$464.10 ,$199.92 ,$714.00 , N/A ,$464.10 ,$426.26 , N/A ,$199.92 ,$400.55 , N/A ,$469.81 , N/A ,$606.90 ,$606.90 , N/A ,$606.90 , N/A ,$485.52 , N/A , N/A , N/A ,$535.50 ,$506.94 ,$506.94 , N/A ,$506.94 ,$585.48 ,$585.48 ,$585.48 , N/A , N/A ,$606.90 , N/A ,$714.00 ,$426.26 , N/A ,$297.02 , N/A , N/A , N/A ,$606.90 , N/A ,$606.90 ,$199.92 ,$642.60 , N/A ,$585.48 ,$603.33 ,$603.33 , N/A ,$464.10 ,$714.00 
ST. JOSEPH'S HOSPITAL - BREESE,27203871,N/A,HC NASAL RHINO ROCKET,272,1 ,$132.12 ,$85.88 ,$36.99 ,$132.12 , N/A ,$85.88 ,$78.88 , N/A ,$36.99 ,$74.12 , N/A ,$86.94 , N/A ,$112.30 ,$112.30 , N/A ,$112.30 , N/A ,$89.84 , N/A , N/A , N/A ,$99.09 ,$93.81 ,$93.81 , N/A ,$93.81 ,$108.34 ,$108.34 ,$108.34 , N/A , N/A ,$112.30 , N/A ,$132.12 ,$78.88 , N/A ,$54.96 , N/A , N/A , N/A ,$112.30 , N/A ,$112.30 ,$36.99 ,$118.91 , N/A ,$108.34 ,$111.64 ,$111.64 , N/A ,$85.88 ,$132.12 
ST. JOSEPH'S HOSPITAL - BREESE,27203875,N/A,HC SYSTEM DRESSING WOUND VAC THERAPY,272,1 ,"$1,521.00 ",$988.65 ,$425.88 ,"$1,521.00 ", N/A ,$988.65 ,$908.04 , N/A ,$425.88 ,$853.28 , N/A ,"$1,000.82 ", N/A ,"$1,292.85 ","$1,292.85 ", N/A ,"$1,292.85 ", N/A ,"$1,034.28 ", N/A , N/A , N/A ,"$1,140.75 ","$1,079.91 ","$1,079.91 ", N/A ,"$1,079.91 ","$1,247.22 ","$1,247.22 ","$1,247.22 ", N/A , N/A ,"$1,292.85 ", N/A ,"$1,521.00 ",$908.04 , N/A ,$632.74 , N/A , N/A , N/A ,"$1,292.85 ", N/A ,"$1,292.85 ",$425.88 ,"$1,368.90 ", N/A ,"$1,247.22 ","$1,285.25 ","$1,285.25 ", N/A ,$988.65 ,"$1,521.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27204583,N/A,HC LARYNGOSCOPE GLIDESCOPE,272,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204603,N/A,HC TRAY UMBILICAL CATH,272,1 ,$151.00 ,$98.15 ,$42.28 ,$151.00 , N/A ,$98.15 ,$90.15 , N/A ,$42.28 ,$84.71 , N/A ,$99.36 , N/A ,$128.35 ,$128.35 , N/A ,$128.35 , N/A ,$102.68 , N/A , N/A , N/A ,$113.25 ,$107.21 ,$107.21 , N/A ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A , N/A ,$128.35 , N/A ,$151.00 ,$90.15 , N/A ,$62.82 , N/A , N/A , N/A ,$128.35 , N/A ,$128.35 ,$42.28 ,$135.90 , N/A ,$123.82 ,$127.60 ,$127.60 , N/A ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204607,N/A,HC TUBE NASOGASTRIC,272,1 ,$6.00 ,$3.90 ,$1.68 ,$6.00 , N/A ,$3.90 ,$3.58 , N/A ,$1.68 ,$3.37 , N/A ,$3.95 , N/A ,$5.10 ,$5.10 , N/A ,$5.10 , N/A ,$4.08 , N/A , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.92 ,$4.92 ,$4.92 , N/A , N/A ,$5.10 , N/A ,$6.00 ,$3.58 , N/A ,$2.50 , N/A , N/A , N/A ,$5.10 , N/A ,$5.10 ,$1.68 ,$5.40 , N/A ,$4.92 ,$5.07 ,$5.07 , N/A ,$3.90 ,$6.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204622,N/A,HC MARKER BIOPSY SITE,272,1 ,$182.00 ,$118.30 ,$50.96 ,$182.00 , N/A ,$118.30 ,$108.65 , N/A ,$50.96 ,$102.10 , N/A ,$119.76 , N/A ,$154.70 ,$154.70 , N/A ,$154.70 , N/A ,$123.76 , N/A , N/A , N/A ,$136.50 ,$129.22 ,$129.22 , N/A ,$129.22 ,$149.24 ,$149.24 ,$149.24 , N/A , N/A ,$154.70 , N/A ,$182.00 ,$108.65 , N/A ,$75.71 , N/A , N/A , N/A ,$154.70 , N/A ,$154.70 ,$50.96 ,$163.80 , N/A ,$149.24 ,$153.79 ,$153.79 , N/A ,$118.30 ,$182.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204623,N/A,HC NEEDLE GUIDE,272,1 ,$22.00 ,$14.30 ,$6.16 ,$22.00 , N/A ,$14.30 ,$13.13 , N/A ,$6.16 ,$12.34 , N/A ,$14.48 , N/A ,$18.70 ,$18.70 , N/A ,$18.70 , N/A ,$14.96 , N/A , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.04 ,$18.04 ,$18.04 , N/A , N/A ,$18.70 , N/A ,$22.00 ,$13.13 , N/A ,$9.15 , N/A , N/A , N/A ,$18.70 , N/A ,$18.70 ,$6.16 ,$19.80 , N/A ,$18.04 ,$18.59 ,$18.59 , N/A ,$14.30 ,$22.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204624,N/A,HC DEVICE BIOPSY COAXIAL ADJUSTABLE,272,1 ,$170.22 ,$110.64 ,$47.66 ,$170.22 , N/A ,$110.64 ,$101.62 , N/A ,$47.66 ,$95.49 , N/A ,$112.00 , N/A ,$144.69 ,$144.69 , N/A ,$144.69 , N/A ,$115.75 , N/A , N/A , N/A ,$127.67 ,$120.86 ,$120.86 , N/A ,$120.86 ,$139.58 ,$139.58 ,$139.58 , N/A , N/A ,$144.69 , N/A ,$170.22 ,$101.62 , N/A ,$70.81 , N/A , N/A , N/A ,$144.69 , N/A ,$144.69 ,$47.66 ,$153.20 , N/A ,$139.58 ,$143.84 ,$143.84 , N/A ,$110.64 ,$170.22 
ST. JOSEPH'S HOSPITAL - BREESE,27204654,N/A,HC BAG RESUSCITATE INFANT,272,1 ,$33.00 ,$21.45 ,$9.24 ,$33.00 , N/A ,$21.45 ,$19.70 , N/A ,$9.24 ,$18.51 , N/A ,$21.71 , N/A ,$28.05 ,$28.05 , N/A ,$28.05 , N/A ,$22.44 , N/A , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.06 ,$27.06 ,$27.06 , N/A , N/A ,$28.05 , N/A ,$33.00 ,$19.70 , N/A ,$13.73 , N/A , N/A , N/A ,$28.05 , N/A ,$28.05 ,$9.24 ,$29.70 , N/A ,$27.06 ,$27.89 ,$27.89 , N/A ,$21.45 ,$33.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204656,N/A,HC BAG RESUSCITOR,272,1 ,$63.00 ,$40.95 ,$17.64 ,$63.00 , N/A ,$40.95 ,$37.61 , N/A ,$17.64 ,$35.34 , N/A ,$41.45 , N/A ,$53.55 ,$53.55 , N/A ,$53.55 , N/A ,$42.84 , N/A , N/A , N/A ,$47.25 ,$44.73 ,$44.73 , N/A ,$44.73 ,$51.66 ,$51.66 ,$51.66 , N/A , N/A ,$53.55 , N/A ,$63.00 ,$37.61 , N/A ,$26.21 , N/A , N/A , N/A ,$53.55 , N/A ,$53.55 ,$17.64 ,$56.70 , N/A ,$51.66 ,$53.24 ,$53.24 , N/A ,$40.95 ,$63.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204714,N/A,HC SUCTION YANKAUER,272,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204755,N/A,HC DEVICE BREAST BIOPSY,272,1 ,$587.00 ,$381.55 ,$164.36 ,$587.00 , N/A ,$381.55 ,$350.44 , N/A ,$164.36 ,$329.31 , N/A ,$386.25 , N/A ,$498.95 ,$498.95 , N/A ,$498.95 , N/A ,$399.16 , N/A , N/A , N/A ,$440.25 ,$416.77 ,$416.77 , N/A ,$416.77 ,$481.34 ,$481.34 ,$481.34 , N/A , N/A ,$498.95 , N/A ,$587.00 ,$350.44 , N/A ,$244.19 , N/A , N/A , N/A ,$498.95 , N/A ,$498.95 ,$164.36 ,$528.30 , N/A ,$481.34 ,$496.02 ,$496.02 , N/A ,$381.55 ,$587.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204760,N/A,HC BLANKET BAIR HUGGER,272,1 ,$39.00 ,$25.35 ,$10.92 ,$39.00 , N/A ,$25.35 ,$23.28 , N/A ,$10.92 ,$21.88 , N/A ,$25.66 , N/A ,$33.15 ,$33.15 , N/A ,$33.15 , N/A ,$26.52 , N/A , N/A , N/A ,$29.25 ,$27.69 ,$27.69 , N/A ,$27.69 ,$31.98 ,$31.98 ,$31.98 , N/A , N/A ,$33.15 , N/A ,$39.00 ,$23.28 , N/A ,$16.22 , N/A , N/A , N/A ,$33.15 , N/A ,$33.15 ,$10.92 ,$35.10 , N/A ,$31.98 ,$32.96 ,$32.96 , N/A ,$25.35 ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204771,N/A,HC BLADE LARYNGOSCOPE,272,1 ,$36.00 ,$23.40 ,$10.08 ,$36.00 , N/A ,$23.40 ,$21.49 , N/A ,$10.08 ,$20.20 , N/A ,$23.69 , N/A ,$30.60 ,$30.60 , N/A ,$30.60 , N/A ,$24.48 , N/A , N/A , N/A ,$27.00 ,$25.56 ,$25.56 , N/A ,$25.56 ,$29.52 ,$29.52 ,$29.52 , N/A , N/A ,$30.60 , N/A ,$36.00 ,$21.49 , N/A ,$14.98 , N/A , N/A , N/A ,$30.60 , N/A ,$30.60 ,$10.08 ,$32.40 , N/A ,$29.52 ,$30.42 ,$30.42 , N/A ,$23.40 ,$36.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204772,N/A,HC BLADE LARYNGEAL,272,1 ,$171.60 ,$111.54 ,$48.05 ,$171.60 , N/A ,$111.54 ,$102.45 , N/A ,$48.05 ,$96.27 , N/A ,$112.91 , N/A ,$145.86 ,$145.86 , N/A ,$145.86 , N/A ,$116.69 , N/A , N/A , N/A ,$128.70 ,$121.84 ,$121.84 , N/A ,$121.84 ,$140.71 ,$140.71 ,$140.71 , N/A , N/A ,$145.86 , N/A ,$171.60 ,$102.45 , N/A ,$71.39 , N/A , N/A , N/A ,$145.86 , N/A ,$145.86 ,$48.05 ,$154.44 , N/A ,$140.71 ,$145.00 ,$145.00 , N/A ,$111.54 ,$171.60 
ST. JOSEPH'S HOSPITAL - BREESE,27204821,N/A,HC CONNECTOR STRAIGHT,272,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204860,N/A,HC HEMOSTAT MATRIX,272,1 ,$952.41 ,$619.07 ,$266.67 ,$952.41 , N/A ,$619.07 ,$568.59 , N/A ,$266.67 ,$534.30 , N/A ,$626.69 , N/A ,$809.55 ,$809.55 , N/A ,$809.55 , N/A ,$647.64 , N/A , N/A , N/A ,$714.31 ,$676.21 ,$676.21 , N/A ,$676.21 ,$780.98 ,$780.98 ,$780.98 , N/A , N/A ,$809.55 , N/A ,$952.41 ,$568.59 , N/A ,$396.20 , N/A , N/A , N/A ,$809.55 , N/A ,$809.55 ,$266.67 ,$857.17 , N/A ,$780.98 ,$804.79 ,$804.79 , N/A ,$619.07 ,$952.41 
ST. JOSEPH'S HOSPITAL - BREESE,27204865,N/A,HC INTRODUCER/SHEATH,272,1 ,$42.00 ,$27.30 ,$11.76 ,$42.00 , N/A ,$27.30 ,$25.07 , N/A ,$11.76 ,$23.56 , N/A ,$27.64 , N/A ,$35.70 ,$35.70 , N/A ,$35.70 , N/A ,$28.56 , N/A , N/A , N/A ,$31.50 ,$29.82 ,$29.82 , N/A ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A , N/A ,$35.70 , N/A ,$42.00 ,$25.07 , N/A ,$17.47 , N/A , N/A , N/A ,$35.70 , N/A ,$35.70 ,$11.76 ,$37.80 , N/A ,$34.44 ,$35.49 ,$35.49 , N/A ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204869,N/A,HC IV ANGIOCATH,272,1 ,$18.00 ,$11.70 ,$5.04 ,$18.00 , N/A ,$11.70 ,$10.75 , N/A ,$5.04 ,$10.10 , N/A ,$11.84 , N/A ,$15.30 ,$15.30 , N/A ,$15.30 , N/A ,$12.24 , N/A , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A , N/A ,$15.30 , N/A ,$18.00 ,$10.75 , N/A ,$7.49 , N/A , N/A , N/A ,$15.30 , N/A ,$15.30 ,$5.04 ,$16.20 , N/A ,$14.76 ,$15.21 ,$15.21 , N/A ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204887,N/A,HC KIT CATHETER FEMALE,272,1 ,$19.20 ,$12.48 ,$5.38 ,$19.20 , N/A ,$12.48 ,$11.46 , N/A ,$5.38 ,$10.77 , N/A ,$12.63 , N/A ,$16.32 ,$16.32 , N/A ,$16.32 , N/A ,$13.06 , N/A , N/A , N/A ,$14.40 ,$13.63 ,$13.63 , N/A ,$13.63 ,$15.74 ,$15.74 ,$15.74 , N/A , N/A ,$16.32 , N/A ,$19.20 ,$11.46 , N/A ,$7.99 , N/A , N/A , N/A ,$16.32 , N/A ,$16.32 ,$5.38 ,$17.28 , N/A ,$15.74 ,$16.22 ,$16.22 , N/A ,$12.48 ,$19.20 
ST. JOSEPH'S HOSPITAL - BREESE,27204894,N/A,HC KIT CHEST TUBE INSERTION,272,1 ,$359.00 ,$233.35 ,$100.52 ,$359.00 , N/A ,$233.35 ,$214.32 , N/A ,$100.52 ,$201.40 , N/A ,$236.22 , N/A ,$305.15 ,$305.15 , N/A ,$305.15 , N/A ,$244.12 , N/A , N/A , N/A ,$269.25 ,$254.89 ,$254.89 , N/A ,$254.89 ,$294.38 ,$294.38 ,$294.38 , N/A , N/A ,$305.15 , N/A ,$359.00 ,$214.32 , N/A ,$149.34 , N/A , N/A , N/A ,$305.15 , N/A ,$305.15 ,$100.52 ,$323.10 , N/A ,$294.38 ,$303.36 ,$303.36 , N/A ,$233.35 ,$359.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204936,N/A,HC NEEDLE NERVE BLOCK ECHOGENIC,272,1 ,$33.00 ,$21.45 ,$9.24 ,$33.00 , N/A ,$21.45 ,$19.70 , N/A ,$9.24 ,$18.51 , N/A ,$21.71 , N/A ,$28.05 ,$28.05 , N/A ,$28.05 , N/A ,$22.44 , N/A , N/A , N/A ,$24.75 ,$23.43 ,$23.43 , N/A ,$23.43 ,$27.06 ,$27.06 ,$27.06 , N/A , N/A ,$28.05 , N/A ,$33.00 ,$19.70 , N/A ,$13.73 , N/A , N/A , N/A ,$28.05 , N/A ,$28.05 ,$9.24 ,$29.70 , N/A ,$27.06 ,$27.89 ,$27.89 , N/A ,$21.45 ,$33.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204937,N/A,HC NEEDLE NERVE BLOCK STIMULATING,272,1 ,$36.00 ,$23.40 ,$10.08 ,$36.00 , N/A ,$23.40 ,$21.49 , N/A ,$10.08 ,$20.20 , N/A ,$23.69 , N/A ,$30.60 ,$30.60 , N/A ,$30.60 , N/A ,$24.48 , N/A , N/A , N/A ,$27.00 ,$25.56 ,$25.56 , N/A ,$25.56 ,$29.52 ,$29.52 ,$29.52 , N/A , N/A ,$30.60 , N/A ,$36.00 ,$21.49 , N/A ,$14.98 , N/A , N/A , N/A ,$30.60 , N/A ,$30.60 ,$10.08 ,$32.40 , N/A ,$29.52 ,$30.42 ,$30.42 , N/A ,$23.40 ,$36.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204941,N/A,HC NEEDLE EPIDURAL,272,1 ,$18.00 ,$11.70 ,$5.04 ,$18.00 , N/A ,$11.70 ,$10.75 , N/A ,$5.04 ,$10.10 , N/A ,$11.84 , N/A ,$15.30 ,$15.30 , N/A ,$15.30 , N/A ,$12.24 , N/A , N/A , N/A ,$13.50 ,$12.78 ,$12.78 , N/A ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A , N/A ,$15.30 , N/A ,$18.00 ,$10.75 , N/A ,$7.49 , N/A , N/A , N/A ,$15.30 , N/A ,$15.30 ,$5.04 ,$16.20 , N/A ,$14.76 ,$15.21 ,$15.21 , N/A ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204944,N/A,HC NEEDLE SPINAL WHITACRE,272,1 ,$27.00 ,$17.55 ,$7.56 ,$27.00 , N/A ,$17.55 ,$16.12 , N/A ,$7.56 ,$15.15 , N/A ,$17.77 , N/A ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$18.36 , N/A , N/A , N/A ,$20.25 ,$19.17 ,$19.17 , N/A ,$19.17 ,$22.14 ,$22.14 ,$22.14 , N/A , N/A ,$22.95 , N/A ,$27.00 ,$16.12 , N/A ,$11.23 , N/A , N/A , N/A ,$22.95 , N/A ,$22.95 ,$7.56 ,$24.30 , N/A ,$22.14 ,$22.82 ,$22.82 , N/A ,$17.55 ,$27.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204949,N/A,HC HOLDER ENDOTRACH NEOBAR,272,1 ,$21.78 ,$14.16 ,$6.10 ,$21.78 , N/A ,$14.16 ,$13.00 , N/A ,$6.10 ,$12.22 , N/A ,$14.33 , N/A ,$18.51 ,$18.51 , N/A ,$18.51 , N/A ,$14.81 , N/A , N/A , N/A ,$16.34 ,$15.46 ,$15.46 , N/A ,$15.46 ,$17.86 ,$17.86 ,$17.86 , N/A , N/A ,$18.51 , N/A ,$21.78 ,$13.00 , N/A ,$9.06 , N/A , N/A , N/A ,$18.51 , N/A ,$18.51 ,$6.10 ,$19.60 , N/A ,$17.86 ,$18.40 ,$18.40 , N/A ,$14.16 ,$21.78 
ST. JOSEPH'S HOSPITAL - BREESE,27204966,N/A,HC OSTOMY POUCH,272,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204968,N/A,HC OSTOMY PASTE,272,1 ,$28.00 ,$18.20 ,$7.84 ,$28.00 , N/A ,$18.20 ,$16.72 , N/A ,$7.84 ,$15.71 , N/A ,$18.42 , N/A ,$23.80 ,$23.80 , N/A ,$23.80 , N/A ,$19.04 , N/A , N/A , N/A ,$21.00 ,$19.88 ,$19.88 , N/A ,$19.88 ,$22.96 ,$22.96 ,$22.96 , N/A , N/A ,$23.80 , N/A ,$28.00 ,$16.72 , N/A ,$11.65 , N/A , N/A , N/A ,$23.80 , N/A ,$23.80 ,$7.84 ,$25.20 , N/A ,$22.96 ,$23.66 ,$23.66 , N/A ,$18.20 ,$28.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204988,N/A,HC BAG INFUSION PRESSURE,272,1 ,$60.00 ,$39.00 ,$16.80 ,$60.00 , N/A ,$39.00 ,$35.82 , N/A ,$16.80 ,$33.66 , N/A ,$39.48 , N/A ,$51.00 ,$51.00 , N/A ,$51.00 , N/A ,$40.80 , N/A , N/A , N/A ,$45.00 ,$42.60 ,$42.60 , N/A ,$42.60 ,$49.20 ,$49.20 ,$49.20 , N/A , N/A ,$51.00 , N/A ,$60.00 ,$35.82 , N/A ,$24.96 , N/A , N/A , N/A ,$51.00 , N/A ,$51.00 ,$16.80 ,$54.00 , N/A ,$49.20 ,$50.70 ,$50.70 , N/A ,$39.00 ,$60.00 
ST. JOSEPH'S HOSPITAL - BREESE,27204997,N/A,HC PROTECTOR HEEL ELBOW,272,1 ,$41.73 ,$27.12 ,$11.68 ,$41.73 , N/A ,$27.12 ,$24.91 , N/A ,$11.68 ,$23.41 , N/A ,$27.46 , N/A ,$35.47 ,$35.47 , N/A ,$35.47 , N/A ,$28.38 , N/A , N/A , N/A ,$31.30 ,$29.63 ,$29.63 , N/A ,$29.63 ,$34.22 ,$34.22 ,$34.22 , N/A , N/A ,$35.47 , N/A ,$41.73 ,$24.91 , N/A ,$17.36 , N/A , N/A , N/A ,$35.47 , N/A ,$35.47 ,$11.68 ,$37.56 , N/A ,$34.22 ,$35.26 ,$35.26 , N/A ,$27.12 ,$41.73 
ST. JOSEPH'S HOSPITAL - BREESE,27204999,N/A,HC SENSOR PULSE OX,272,1 ,$42.00 ,$27.30 ,$11.76 ,$42.00 , N/A ,$27.30 ,$25.07 , N/A ,$11.76 ,$23.56 , N/A ,$27.64 , N/A ,$35.70 ,$35.70 , N/A ,$35.70 , N/A ,$28.56 , N/A , N/A , N/A ,$31.50 ,$29.82 ,$29.82 , N/A ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A , N/A ,$35.70 , N/A ,$42.00 ,$25.07 , N/A ,$17.47 , N/A , N/A , N/A ,$35.70 , N/A ,$35.70 ,$11.76 ,$37.80 , N/A ,$34.44 ,$35.49 ,$35.49 , N/A ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205016,N/A,HC SET PRESSURE MONITOR,272,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 , N/A ,$20.80 ,$19.10 , N/A ,$8.96 ,$17.95 , N/A ,$21.06 , N/A ,$27.20 ,$27.20 , N/A ,$27.20 , N/A ,$21.76 , N/A , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.24 ,$26.24 ,$26.24 , N/A , N/A ,$27.20 , N/A ,$32.00 ,$19.10 , N/A ,$13.31 , N/A , N/A , N/A ,$27.20 , N/A ,$27.20 ,$8.96 ,$28.80 , N/A ,$26.24 ,$27.04 ,$27.04 , N/A ,$20.80 ,$32.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205029,N/A,HC STATLOCK DEVICE FOLEY,272,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205046,N/A,HC SYRINGE ATOMIZER MUCOSAL,272,1 ,$26.91 ,$17.49 ,$7.53 ,$26.91 , N/A ,$17.49 ,$16.07 , N/A ,$7.53 ,$15.10 , N/A ,$17.71 , N/A ,$22.87 ,$22.87 , N/A ,$22.87 , N/A ,$18.30 , N/A , N/A , N/A ,$20.18 ,$19.11 ,$19.11 , N/A ,$19.11 ,$22.07 ,$22.07 ,$22.07 , N/A , N/A ,$22.87 , N/A ,$26.91 ,$16.07 , N/A ,$11.19 , N/A , N/A , N/A ,$22.87 , N/A ,$22.87 ,$7.53 ,$24.22 , N/A ,$22.07 ,$22.74 ,$22.74 , N/A ,$17.49 ,$26.91 
ST. JOSEPH'S HOSPITAL - BREESE,27205060,N/A,HC TRAY PICC LINE,272,1 ,$508.40 ,$330.46 ,$142.35 ,$508.40 , N/A ,$330.46 ,$303.51 , N/A ,$142.35 ,$285.21 , N/A ,$334.53 , N/A ,$432.14 ,$432.14 , N/A ,$432.14 , N/A ,$345.71 , N/A , N/A , N/A ,$381.30 ,$360.96 ,$360.96 , N/A ,$360.96 ,$416.89 ,$416.89 ,$416.89 , N/A , N/A ,$432.14 , N/A ,$508.40 ,$303.51 , N/A ,$211.49 , N/A , N/A , N/A ,$432.14 , N/A ,$432.14 ,$142.35 ,$457.56 , N/A ,$416.89 ,$429.60 ,$429.60 , N/A ,$330.46 ,$508.40 
ST. JOSEPH'S HOSPITAL - BREESE,27205063,N/A,HC TRAY SUTURE REMOVAL,272,1 ,$7.00 ,$4.55 ,$1.96 ,$7.00 , N/A ,$4.55 ,$4.18 , N/A ,$1.96 ,$3.93 , N/A ,$4.61 , N/A ,$5.95 ,$5.95 , N/A ,$5.95 , N/A ,$4.76 , N/A , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.74 ,$5.74 ,$5.74 , N/A , N/A ,$5.95 , N/A ,$7.00 ,$4.18 , N/A ,$2.91 , N/A , N/A , N/A ,$5.95 , N/A ,$5.95 ,$1.96 ,$6.30 , N/A ,$5.74 ,$5.92 ,$5.92 , N/A ,$4.55 ,$7.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205074,N/A,HC TUBE TRACH,272,1 ,$142.00 ,$92.30 ,$39.76 ,$142.00 , N/A ,$92.30 ,$84.77 , N/A ,$39.76 ,$79.66 , N/A ,$93.44 , N/A ,$120.70 ,$120.70 , N/A ,$120.70 , N/A ,$96.56 , N/A , N/A , N/A ,$106.50 ,$100.82 ,$100.82 , N/A ,$100.82 ,$116.44 ,$116.44 ,$116.44 , N/A , N/A ,$120.70 , N/A ,$142.00 ,$84.77 , N/A ,$59.07 , N/A , N/A , N/A ,$120.70 , N/A ,$120.70 ,$39.76 ,$127.80 , N/A ,$116.44 ,$119.99 ,$119.99 , N/A ,$92.30 ,$142.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205078,N/A,HC TUBE RECTAL,272,1 ,$6.00 ,$3.90 ,$1.68 ,$6.00 , N/A ,$3.90 ,$3.58 , N/A ,$1.68 ,$3.37 , N/A ,$3.95 , N/A ,$5.10 ,$5.10 , N/A ,$5.10 , N/A ,$4.08 , N/A , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.92 ,$4.92 ,$4.92 , N/A , N/A ,$5.10 , N/A ,$6.00 ,$3.58 , N/A ,$2.50 , N/A , N/A , N/A ,$5.10 , N/A ,$5.10 ,$1.68 ,$5.40 , N/A ,$4.92 ,$5.07 ,$5.07 , N/A ,$3.90 ,$6.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205086,N/A,HC CANISTER WOUND VAC,272,1 ,$69.15 ,$44.95 ,$19.36 ,$69.15 , N/A ,$44.95 ,$41.28 , N/A ,$19.36 ,$38.79 , N/A ,$45.50 , N/A ,$58.78 ,$58.78 , N/A ,$58.78 , N/A ,$47.02 , N/A , N/A , N/A ,$51.86 ,$49.10 ,$49.10 , N/A ,$49.10 ,$56.70 ,$56.70 ,$56.70 , N/A , N/A ,$58.78 , N/A ,$69.15 ,$41.28 , N/A ,$28.77 , N/A , N/A , N/A ,$58.78 , N/A ,$58.78 ,$19.36 ,$62.24 , N/A ,$56.70 ,$58.43 ,$58.43 , N/A ,$44.95 ,$69.15 
ST. JOSEPH'S HOSPITAL - BREESE,27205088,N/A,HC KIT DRESSING WOUND VAC INSTILL CASSETTE/TUBE,272,1 ,$140.25 ,$91.16 ,$39.27 ,$140.25 , N/A ,$91.16 ,$83.73 , N/A ,$39.27 ,$78.68 , N/A ,$92.28 , N/A ,$119.21 ,$119.21 , N/A ,$119.21 , N/A ,$95.37 , N/A , N/A , N/A ,$105.19 ,$99.58 ,$99.58 , N/A ,$99.58 ,$115.01 ,$115.01 ,$115.01 , N/A , N/A ,$119.21 , N/A ,$140.25 ,$83.73 , N/A ,$58.34 , N/A , N/A , N/A ,$119.21 , N/A ,$119.21 ,$39.27 ,$126.23 , N/A ,$115.01 ,$118.51 ,$118.51 , N/A ,$91.16 ,$140.25 
ST. JOSEPH'S HOSPITAL - BREESE,27205091,N/A,HC KIT DRESSING WOUND VAC PREVENA PEEL N PLACE,272,1 ,"$1,158.30 ",$752.90 ,$324.32 ,"$1,158.30 ", N/A ,$752.90 ,$691.51 , N/A ,$324.32 ,$649.81 , N/A ,$762.16 , N/A ,$984.56 ,$984.56 , N/A ,$984.56 , N/A ,$787.64 , N/A , N/A , N/A ,$868.73 ,$822.39 ,$822.39 , N/A ,$822.39 ,$949.81 ,$949.81 ,$949.81 , N/A , N/A ,$984.56 , N/A ,"$1,158.30 ",$691.51 , N/A ,$481.85 , N/A , N/A , N/A ,$984.56 , N/A ,$984.56 ,$324.32 ,"$1,042.47 ", N/A ,$949.81 ,$978.76 ,$978.76 , N/A ,$752.90 ,"$1,158.30 "
ST. JOSEPH'S HOSPITAL - BREESE,27205148,C1751,HC KIT POWER PICC,272,1 ,$798.00 ,$518.70 ,$223.44 ,$798.00 , N/A ,$518.70 ,$476.41 , N/A ,$223.44 ,$447.68 , N/A ,$525.08 , N/A ,$678.30 ,$678.30 , N/A ,$678.30 , N/A ,$542.64 , N/A , N/A , N/A ,$598.50 ,$566.58 ,$566.58 , N/A ,$566.58 ,$654.36 ,$654.36 ,$654.36 , N/A , N/A ,$678.30 , N/A ,$798.00 ,$476.41 , N/A ,$331.97 , N/A , N/A , N/A ,$678.30 , N/A ,$678.30 ,$223.44 ,$718.20 , N/A ,$654.36 ,$674.31 ,$674.31 , N/A ,$518.70 ,$798.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205182,N/A,HC NEEDLE INTRAOSSEOUS/STABILIZER KIT,272,1 ,$79.00 ,$51.35 ,$22.12 ,$79.00 , N/A ,$51.35 ,$47.16 , N/A ,$22.12 ,$44.32 , N/A ,$51.98 , N/A ,$67.15 ,$67.15 , N/A ,$67.15 , N/A ,$53.72 , N/A , N/A , N/A ,$59.25 ,$56.09 ,$56.09 , N/A ,$56.09 ,$64.78 ,$64.78 ,$64.78 , N/A , N/A ,$67.15 , N/A ,$79.00 ,$47.16 , N/A ,$32.86 , N/A , N/A , N/A ,$67.15 , N/A ,$67.15 ,$22.12 ,$71.10 , N/A ,$64.78 ,$66.76 ,$66.76 , N/A ,$51.35 ,$79.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205183,N/A,HC MASK AIRWAY DOUBLE ENTRY PORT,272,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 , N/A ,$20.80 ,$19.10 , N/A ,$8.96 ,$17.95 , N/A ,$21.06 , N/A ,$27.20 ,$27.20 , N/A ,$27.20 , N/A ,$21.76 , N/A , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.24 ,$26.24 ,$26.24 , N/A , N/A ,$27.20 , N/A ,$32.00 ,$19.10 , N/A ,$13.31 , N/A , N/A , N/A ,$27.20 , N/A ,$27.20 ,$8.96 ,$28.80 , N/A ,$26.24 ,$27.04 ,$27.04 , N/A ,$20.80 ,$32.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205253,C1729,HC SYSTEM PLUERIX DRAIN W/CATHETER,272,1 ,"$1,452.00 ",$943.80 ,$406.56 ,"$1,452.00 ", N/A ,$943.80 ,$866.84 , N/A ,$406.56 ,$814.57 , N/A ,$955.42 , N/A ,"$1,234.20 ","$1,234.20 ", N/A ,"$1,234.20 ", N/A ,$987.36 , N/A , N/A , N/A ,"$1,089.00 ","$1,030.92 ","$1,030.92 ", N/A ,"$1,030.92 ","$1,190.64 ","$1,190.64 ","$1,190.64 ", N/A , N/A ,"$1,234.20 ", N/A ,"$1,452.00 ",$866.84 , N/A ,$604.03 , N/A , N/A , N/A ,"$1,234.20 ", N/A ,"$1,234.20 ",$406.56 ,"$1,306.80 ", N/A ,"$1,190.64 ","$1,226.94 ","$1,226.94 ", N/A ,$943.80 ,"$1,452.00 "
ST. JOSEPH'S HOSPITAL - BREESE,27205262,N/A,HC BRONCHOSCOPE,272,1 ,$810.00 ,$526.50 ,$226.80 ,$810.00 , N/A ,$526.50 ,$483.57 , N/A ,$226.80 ,$454.41 , N/A ,$532.98 , N/A ,$688.50 ,$688.50 , N/A ,$688.50 , N/A ,$550.80 , N/A , N/A , N/A ,$607.50 ,$575.10 ,$575.10 , N/A ,$575.10 ,$664.20 ,$664.20 ,$664.20 , N/A , N/A ,$688.50 , N/A ,$810.00 ,$483.57 , N/A ,$336.96 , N/A , N/A , N/A ,$688.50 , N/A ,$688.50 ,$226.80 ,$729.00 , N/A ,$664.20 ,$684.45 ,$684.45 , N/A ,$526.50 ,$810.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205283,N/A,HC AIRWAY ORAL NASAL,272,1 ,$22.00 ,$14.30 ,$6.16 ,$22.00 , N/A ,$14.30 ,$13.13 , N/A ,$6.16 ,$12.34 , N/A ,$14.48 , N/A ,$18.70 ,$18.70 , N/A ,$18.70 , N/A ,$14.96 , N/A , N/A , N/A ,$16.50 ,$15.62 ,$15.62 , N/A ,$15.62 ,$18.04 ,$18.04 ,$18.04 , N/A , N/A ,$18.70 , N/A ,$22.00 ,$13.13 , N/A ,$9.15 , N/A , N/A , N/A ,$18.70 , N/A ,$18.70 ,$6.16 ,$19.80 , N/A ,$18.04 ,$18.59 ,$18.59 , N/A ,$14.30 ,$22.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205298,N/A,HC CATHETER FOLEY COUDE,272,1 ,$44.00 ,$28.60 ,$12.32 ,$44.00 , N/A ,$28.60 ,$26.27 , N/A ,$12.32 ,$24.68 , N/A ,$28.95 , N/A ,$37.40 ,$37.40 , N/A ,$37.40 , N/A ,$29.92 , N/A , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.08 ,$36.08 ,$36.08 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$26.27 , N/A ,$18.30 , N/A , N/A , N/A ,$37.40 , N/A ,$37.40 ,$12.32 ,$39.60 , N/A ,$36.08 ,$37.18 ,$37.18 , N/A ,$28.60 ,$44.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205310,N/A,HC KIT ENEMA,272,1 ,$19.00 ,$12.35 ,$5.32 ,$19.00 , N/A ,$12.35 ,$11.34 , N/A ,$5.32 ,$10.66 , N/A ,$12.50 , N/A ,$16.15 ,$16.15 , N/A ,$16.15 , N/A ,$12.92 , N/A , N/A , N/A ,$14.25 ,$13.49 ,$13.49 , N/A ,$13.49 ,$15.58 ,$15.58 ,$15.58 , N/A , N/A ,$16.15 , N/A ,$19.00 ,$11.34 , N/A ,$7.90 , N/A , N/A , N/A ,$16.15 , N/A ,$16.15 ,$5.32 ,$17.10 , N/A ,$15.58 ,$16.06 ,$16.06 , N/A ,$12.35 ,$19.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205319,C1819,HC NEEDLE KOPANS LOCAL,272,1 ,$442.44 ,$287.59 ,$123.88 ,$442.44 , N/A ,$287.59 ,$264.14 , N/A ,$123.88 ,$248.21 , N/A ,$291.13 , N/A ,$376.07 ,$376.07 , N/A ,$376.07 , N/A ,$300.86 , N/A , N/A , N/A ,$331.83 ,$314.13 ,$314.13 , N/A ,$314.13 ,$362.80 ,$362.80 ,$362.80 , N/A , N/A ,$376.07 , N/A ,$442.44 ,$264.14 , N/A ,$184.06 , N/A , N/A , N/A ,$376.07 , N/A ,$376.07 ,$123.88 ,$398.20 , N/A ,$362.80 ,$373.86 ,$373.86 , N/A ,$287.59 ,$442.44 
ST. JOSEPH'S HOSPITAL - BREESE,27205320,N/A,HC NEEDLE PORT-A-CATH,272,1 ,$9.00 ,$5.85 ,$2.52 ,$9.00 , N/A ,$5.85 ,$5.37 , N/A ,$2.52 ,$5.05 , N/A ,$5.92 , N/A ,$7.65 ,$7.65 , N/A ,$7.65 , N/A ,$6.12 , N/A , N/A , N/A ,$6.75 ,$6.39 ,$6.39 , N/A ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A , N/A ,$7.65 , N/A ,$9.00 ,$5.37 , N/A ,$3.74 , N/A , N/A , N/A ,$7.65 , N/A ,$7.65 ,$2.52 ,$8.10 , N/A ,$7.38 ,$7.61 ,$7.61 , N/A ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205324,N/A,HC PAD ABDOMNINAL,272,1 ,$6.00 ,$3.90 ,$1.68 ,$6.00 , N/A ,$3.90 ,$3.58 , N/A ,$1.68 ,$3.37 , N/A ,$3.95 , N/A ,$5.10 ,$5.10 , N/A ,$5.10 , N/A ,$4.08 , N/A , N/A , N/A ,$4.50 ,$4.26 ,$4.26 , N/A ,$4.26 ,$4.92 ,$4.92 ,$4.92 , N/A , N/A ,$5.10 , N/A ,$6.00 ,$3.58 , N/A ,$2.50 , N/A , N/A , N/A ,$5.10 , N/A ,$5.10 ,$1.68 ,$5.40 , N/A ,$4.92 ,$5.07 ,$5.07 , N/A ,$3.90 ,$6.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205326,N/A,HC SENSOR INFANT ADHESIVE,272,1 ,$30.00 ,$19.50 ,$8.40 ,$30.00 , N/A ,$19.50 ,$17.91 , N/A ,$8.40 ,$16.83 , N/A ,$19.74 , N/A ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$20.40 , N/A , N/A , N/A ,$22.50 ,$21.30 ,$21.30 , N/A ,$21.30 ,$24.60 ,$24.60 ,$24.60 , N/A , N/A ,$25.50 , N/A ,$30.00 ,$17.91 , N/A ,$12.48 , N/A , N/A , N/A ,$25.50 , N/A ,$25.50 ,$8.40 ,$27.00 , N/A ,$24.60 ,$25.35 ,$25.35 , N/A ,$19.50 ,$30.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205332,N/A,HC SYRINGE TOOMEY,272,1 ,$7.00 ,$4.55 ,$1.96 ,$7.00 , N/A ,$4.55 ,$4.18 , N/A ,$1.96 ,$3.93 , N/A ,$4.61 , N/A ,$5.95 ,$5.95 , N/A ,$5.95 , N/A ,$4.76 , N/A , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.74 ,$5.74 ,$5.74 , N/A , N/A ,$5.95 , N/A ,$7.00 ,$4.18 , N/A ,$2.91 , N/A , N/A , N/A ,$5.95 , N/A ,$5.95 ,$1.96 ,$6.30 , N/A ,$5.74 ,$5.92 ,$5.92 , N/A ,$4.55 ,$7.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205338,N/A,HC CATHETER STRAIGHT,272,1 ,$7.00 ,$4.55 ,$1.96 ,$7.00 , N/A ,$4.55 ,$4.18 , N/A ,$1.96 ,$3.93 , N/A ,$4.61 , N/A ,$5.95 ,$5.95 , N/A ,$5.95 , N/A ,$4.76 , N/A , N/A , N/A ,$5.25 ,$4.97 ,$4.97 , N/A ,$4.97 ,$5.74 ,$5.74 ,$5.74 , N/A , N/A ,$5.95 , N/A ,$7.00 ,$4.18 , N/A ,$2.91 , N/A , N/A , N/A ,$5.95 , N/A ,$5.95 ,$1.96 ,$6.30 , N/A ,$5.74 ,$5.92 ,$5.92 , N/A ,$4.55 ,$7.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205339,N/A,HC KIT DRESSING,272,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205345,N/A,HC DRESSING GAUZE STRETCH,272,1 ,$8.00 ,$5.20 ,$2.24 ,$8.00 , N/A ,$5.20 ,$4.78 , N/A ,$2.24 ,$4.49 , N/A ,$5.26 , N/A ,$6.80 ,$6.80 , N/A ,$6.80 , N/A ,$5.44 , N/A , N/A , N/A ,$6.00 ,$5.68 ,$5.68 , N/A ,$5.68 ,$6.56 ,$6.56 ,$6.56 , N/A , N/A ,$6.80 , N/A ,$8.00 ,$4.78 , N/A ,$3.33 , N/A , N/A , N/A ,$6.80 , N/A ,$6.80 ,$2.24 ,$7.20 , N/A ,$6.56 ,$6.76 ,$6.76 , N/A ,$5.20 ,$8.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205371,C1894,HC SHEATH INTRODUCER 8FR,272,1 ,$120.09 ,$78.06 ,$33.63 ,$120.09 , N/A ,$78.06 ,$71.69 , N/A ,$33.63 ,$67.37 , N/A ,$79.02 , N/A ,$102.08 ,$102.08 , N/A ,$102.08 , N/A ,$81.66 , N/A , N/A , N/A ,$90.07 ,$85.26 ,$85.26 , N/A ,$85.26 ,$98.47 ,$98.47 ,$98.47 , N/A , N/A ,$102.08 , N/A ,$120.09 ,$71.69 , N/A ,$49.96 , N/A , N/A , N/A ,$102.08 , N/A ,$102.08 ,$33.63 ,$108.08 , N/A ,$98.47 ,$101.48 ,$101.48 , N/A ,$78.06 ,$120.09 
ST. JOSEPH'S HOSPITAL - BREESE,27205378,N/A,HC MARKER BIOPSY BREAST STEREOTATIC,272,1 ,$182.00 ,$118.30 ,$50.96 ,$182.00 , N/A ,$118.30 ,$108.65 , N/A ,$50.96 ,$102.10 , N/A ,$119.76 , N/A ,$154.70 ,$154.70 , N/A ,$154.70 , N/A ,$123.76 , N/A , N/A , N/A ,$136.50 ,$129.22 ,$129.22 , N/A ,$129.22 ,$149.24 ,$149.24 ,$149.24 , N/A , N/A ,$154.70 , N/A ,$182.00 ,$108.65 , N/A ,$75.71 , N/A , N/A , N/A ,$154.70 , N/A ,$154.70 ,$50.96 ,$163.80 , N/A ,$149.24 ,$153.79 ,$153.79 , N/A ,$118.30 ,$182.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205386,N/A,HC HANDLE LARYNGEAL BLADE,272,1 ,$16.00 ,$10.40 ,$4.48 ,$16.00 , N/A ,$10.40 ,$9.55 , N/A ,$4.48 ,$8.98 , N/A ,$10.53 , N/A ,$13.60 ,$13.60 , N/A ,$13.60 , N/A ,$10.88 , N/A , N/A , N/A ,$12.00 ,$11.36 ,$11.36 , N/A ,$11.36 ,$13.12 ,$13.12 ,$13.12 , N/A , N/A ,$13.60 , N/A ,$16.00 ,$9.55 , N/A ,$6.66 , N/A , N/A , N/A ,$13.60 , N/A ,$13.60 ,$4.48 ,$14.40 , N/A ,$13.12 ,$13.52 ,$13.52 , N/A ,$10.40 ,$16.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205388,N/A,HC BLADE LARYNGOSCOPE MACINTOSH,272,1 ,$51.00 ,$33.15 ,$14.28 ,$51.00 , N/A ,$33.15 ,$30.45 , N/A ,$14.28 ,$28.61 , N/A ,$33.56 , N/A ,$43.35 ,$43.35 , N/A ,$43.35 , N/A ,$34.68 , N/A , N/A , N/A ,$38.25 ,$36.21 ,$36.21 , N/A ,$36.21 ,$41.82 ,$41.82 ,$41.82 , N/A , N/A ,$43.35 , N/A ,$51.00 ,$30.45 , N/A ,$21.22 , N/A , N/A , N/A ,$43.35 , N/A ,$43.35 ,$14.28 ,$45.90 , N/A ,$41.82 ,$43.10 ,$43.10 , N/A ,$33.15 ,$51.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205400,N/A,HC SURGICEL HEMOSTAT 4X8,272,1 ,$166.00 ,$107.90 ,$46.48 ,$166.00 , N/A ,$107.90 ,$99.10 , N/A ,$46.48 ,$93.13 , N/A ,$109.23 , N/A ,$141.10 ,$141.10 , N/A ,$141.10 , N/A ,$112.88 , N/A , N/A , N/A ,$124.50 ,$117.86 ,$117.86 , N/A ,$117.86 ,$136.12 ,$136.12 ,$136.12 , N/A , N/A ,$141.10 , N/A ,$166.00 ,$99.10 , N/A ,$69.06 , N/A , N/A , N/A ,$141.10 , N/A ,$141.10 ,$46.48 ,$149.40 , N/A ,$136.12 ,$140.27 ,$140.27 , N/A ,$107.90 ,$166.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205423,N/A,HC CANISTER WOUND VAC 150ML,272,1 ,$60.84 ,$39.55 ,$17.04 ,$60.84 , N/A ,$39.55 ,$36.32 , N/A ,$17.04 ,$34.13 , N/A ,$40.03 , N/A ,$51.71 ,$51.71 , N/A ,$51.71 , N/A ,$41.37 , N/A , N/A , N/A ,$45.63 ,$43.20 ,$43.20 , N/A ,$43.20 ,$49.89 ,$49.89 ,$49.89 , N/A , N/A ,$51.71 , N/A ,$60.84 ,$36.32 , N/A ,$25.31 , N/A , N/A , N/A ,$51.71 , N/A ,$51.71 ,$17.04 ,$54.76 , N/A ,$49.89 ,$51.41 ,$51.41 , N/A ,$39.55 ,$60.84 
ST. JOSEPH'S HOSPITAL - BREESE,27205425,N/A,HC VAPOR CLEAR FILTER,272,1 ,$28.08 ,$18.25 ,$7.86 ,$28.08 , N/A ,$18.25 ,$16.76 , N/A ,$7.86 ,$15.75 , N/A ,$18.48 , N/A ,$23.87 ,$23.87 , N/A ,$23.87 , N/A ,$19.09 , N/A , N/A , N/A ,$21.06 ,$19.94 ,$19.94 , N/A ,$19.94 ,$23.03 ,$23.03 ,$23.03 , N/A , N/A ,$23.87 , N/A ,$28.08 ,$16.76 , N/A ,$11.68 , N/A , N/A , N/A ,$23.87 , N/A ,$23.87 ,$7.86 ,$25.27 , N/A ,$23.03 ,$23.73 ,$23.73 , N/A ,$18.25 ,$28.08 
ST. JOSEPH'S HOSPITAL - BREESE,27205428,N/A,HC INFANT SUCTION DEVICE,272,1 ,$15.15 ,$9.85 ,$4.24 ,$15.15 , N/A ,$9.85 ,$9.04 , N/A ,$4.24 ,$8.50 , N/A ,$9.97 , N/A ,$12.88 ,$12.88 , N/A ,$12.88 , N/A ,$10.30 , N/A , N/A , N/A ,$11.36 ,$10.76 ,$10.76 , N/A ,$10.76 ,$12.42 ,$12.42 ,$12.42 , N/A , N/A ,$12.88 , N/A ,$15.15 ,$9.04 , N/A ,$6.30 , N/A , N/A , N/A ,$12.88 , N/A ,$12.88 ,$4.24 ,$13.64 , N/A ,$12.42 ,$12.80 ,$12.80 , N/A ,$9.85 ,$15.15 
ST. JOSEPH'S HOSPITAL - BREESE,27205429,N/A,HC BLADE LARYNGOSCOPE LATEX FREE,272,1 ,$76.00 ,$49.40 ,$21.28 ,$76.00 , N/A ,$49.40 ,$45.37 , N/A ,$21.28 ,$42.64 , N/A ,$50.01 , N/A ,$64.60 ,$64.60 , N/A ,$64.60 , N/A ,$51.68 , N/A , N/A , N/A ,$57.00 ,$53.96 ,$53.96 , N/A ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A , N/A ,$64.60 , N/A ,$76.00 ,$45.37 , N/A ,$31.62 , N/A , N/A , N/A ,$64.60 , N/A ,$64.60 ,$21.28 ,$68.40 , N/A ,$62.32 ,$64.22 ,$64.22 , N/A ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205441,N/A,HC ENVIRONMENTAL TEST KIT,272,1 ,$145.50 ,$94.58 ,$40.74 ,$145.50 , N/A ,$94.58 ,$86.86 , N/A ,$40.74 ,$81.63 , N/A ,$95.74 , N/A ,$123.68 ,$123.68 , N/A ,$123.68 , N/A ,$98.94 , N/A , N/A , N/A ,$109.13 ,$103.31 ,$103.31 , N/A ,$103.31 ,$119.31 ,$119.31 ,$119.31 , N/A , N/A ,$123.68 , N/A ,$145.50 ,$86.86 , N/A ,$60.53 , N/A , N/A , N/A ,$123.68 , N/A ,$123.68 ,$40.74 ,$130.95 , N/A ,$119.31 ,$122.95 ,$122.95 , N/A ,$94.58 ,$145.50 
ST. JOSEPH'S HOSPITAL - BREESE,27205493,N/A,HC OXYGEN REPLACEMENT PROC MODULES,272,1 ,$42.00 ,$27.30 ,$11.76 ,$42.00 , N/A ,$27.30 ,$25.07 , N/A ,$11.76 ,$23.56 , N/A ,$27.64 , N/A ,$35.70 ,$35.70 , N/A ,$35.70 , N/A ,$28.56 , N/A , N/A , N/A ,$31.50 ,$29.82 ,$29.82 , N/A ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A , N/A ,$35.70 , N/A ,$42.00 ,$25.07 , N/A ,$17.47 , N/A , N/A , N/A ,$35.70 , N/A ,$35.70 ,$11.76 ,$37.80 , N/A ,$34.44 ,$35.49 ,$35.49 , N/A ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,27205494,N/A,HC REPLACEMENT PROC MODULES,272,1 ,$142.50 ,$92.63 ,$39.90 ,$142.50 , N/A ,$92.63 ,$85.07 , N/A ,$39.90 ,$79.94 , N/A ,$93.77 , N/A ,$121.13 ,$121.13 , N/A ,$121.13 , N/A ,$96.90 , N/A , N/A , N/A ,$106.88 ,$101.18 ,$101.18 , N/A ,$101.18 ,$116.85 ,$116.85 ,$116.85 , N/A , N/A ,$121.13 , N/A ,$142.50 ,$85.07 , N/A ,$59.28 , N/A , N/A , N/A ,$121.13 , N/A ,$121.13 ,$39.90 ,$128.25 , N/A ,$116.85 ,$120.41 ,$120.41 , N/A ,$92.63 ,$142.50 
ST. JOSEPH'S HOSPITAL - BREESE,27800553,A4648,HC TISSUE MARKER IMPLANTABLE,278,1 ,$367.50 ,$238.88 ,$102.90 ,$367.50 , N/A ,$238.88 ,$219.40 , N/A ,$102.90 ,$206.17 , N/A ,$241.82 , N/A ,$312.38 ,$312.38 , N/A ,$312.38 , N/A ,$249.90 , N/A , N/A , N/A ,$275.63 ,$260.93 ,$260.93 , N/A ,$260.93 ,$301.35 ,$301.35 ,$301.35 , N/A , N/A ,$312.38 , N/A ,$367.50 ,$219.40 , N/A ,$152.88 , N/A , N/A , N/A ,$312.38 , N/A ,$312.38 ,$102.90 ,$330.75 , N/A ,$301.35 ,$310.54 ,$310.54 , N/A ,$238.88 ,$367.50 
ST. JOSEPH'S HOSPITAL - BREESE,30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$56.00 ,$36.40 ,$12.56 ,$56.00 , N/A ,$36.40 ,$33.43 , N/A ,$15.68 ,$31.42 , N/A ,$36.85 , N/A ,$47.60 ,$47.60 , N/A ,$47.60 , N/A ,$38.08 , N/A , N/A , N/A ,$42.00 ,$39.76 ,$39.76 , N/A ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A , N/A ,$47.60 , N/A ,$56.00 ,$33.43 , N/A ,$23.30 , N/A , N/A , N/A ,$47.60 , N/A ,$47.60 ,$15.68 ,$50.40 , N/A ,$45.92 ,$12.56 ,$12.56 , N/A ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000010,36415,HC VENIPUNCTURE,300,1 ,$36.00 ,$23.40 ,$1.56 ,$36.00 ,$7.50 ,$23.40 ,$21.49 ,$3.00 ,$10.08 ,$20.20 ,$3.00 ,$23.69 ,$3.00 ,$30.60 ,$30.60 ,$3.00 ,$30.60 ,$5.70 ,$24.48 ,$7.50 ,$3.00 ,$3.00 ,$27.00 , N/A , N/A ,$3.00 , N/A ,$29.52 ,$29.52 ,$29.52 , N/A ,$7.50 ,$30.60 ,$3.00 ,$3.00 ,$21.49 ,$3.00 ,$14.98 ,$1.72 ,$1.56 ,$3.00 ,$30.60 ,$6.30 ,$30.60 ,$10.08 ,$32.40 ,$3.00 ,$29.52 ,$12.00 ,$12.00 ,$3.00 ,$23.40 ,$36.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$345.00 ,$224.25 ,$32.09 ,$345.00 ,$277.93 ,$224.25 ,$205.97 ,$111.17 ,$96.60 ,$193.55 ,$111.17 ,$227.01 ,$111.17 ,$293.25 ,$293.25 ,$111.17 ,$293.25 ,$211.22 ,$234.60 ,$277.92 ,$111.17 ,$111.17 ,$258.75 ,$244.95 ,$244.95 ,$111.17 ,$244.95 ,$282.90 ,$282.90 ,$282.90 , N/A ,$277.92 ,$293.25 ,$111.17 ,$345.00 ,$205.97 ,$111.17 ,$143.52 ,$35.30 ,$32.09 ,$111.17 ,$293.25 ,$233.45 ,$293.25 ,$96.60 ,$310.50 ,$111.17 ,$282.90 , N/A , N/A ,$111.17 ,$224.25 ,$345.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000101,89051,HC CELL CT BODY FLUID W/DIFF,300,1 ,$194.00 ,$126.10 ,$5.60 ,$194.00 ,$14.00 ,$126.10 ,$115.82 ,$5.60 ,$54.32 ,$108.83 ,$5.60 ,$127.65 ,$5.60 ,$164.90 ,$164.90 ,$5.60 ,$164.90 ,$10.64 ,$131.92 ,$14.00 ,$5.60 ,$5.60 ,$145.50 ,$137.74 ,$137.74 ,$5.60 ,$137.74 ,$159.08 ,$159.08 ,$159.08 , N/A ,$14.00 ,$164.90 ,$5.60 ,$194.00 ,$115.82 ,$5.60 ,$80.70 ,$23.44 ,$21.31 ,$5.60 ,$164.90 ,$11.76 ,$164.90 ,$54.32 ,$174.60 ,$5.60 ,$159.08 ,$22.40 ,$22.40 ,$5.60 ,$126.10 ,$194.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000104,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$64.00 ,$41.60 ,$4.27 ,$64.00 ,$10.68 ,$41.60 ,$38.21 ,$4.27 ,$17.92 ,$35.90 ,$4.27 ,$42.11 ,$4.27 ,$54.40 ,$54.40 ,$4.27 ,$54.40 ,$8.11 ,$43.52 ,$10.68 ,$4.27 ,$4.27 ,$48.00 ,$45.44 ,$45.44 ,$4.27 ,$45.44 ,$52.48 ,$52.48 ,$52.48 , N/A ,$10.68 ,$54.40 ,$4.27 ,$64.00 ,$38.21 ,$4.27 ,$26.62 ,$5.09 ,$4.63 ,$4.27 ,$54.40 ,$8.97 ,$54.40 ,$17.92 ,$57.60 ,$4.27 ,$52.48 ,$17.08 ,$17.08 ,$4.27 ,$41.60 ,$64.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000105,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$74.00 ,$48.10 ,$7.33 ,$74.00 ,$18.33 ,$48.10 ,$44.18 ,$7.33 ,$20.72 ,$41.51 ,$7.33 ,$48.69 ,$7.33 ,$62.90 ,$62.90 ,$7.33 ,$62.90 ,$13.93 ,$50.32 ,$18.33 ,$7.33 ,$7.33 ,$55.50 ,$52.54 ,$52.54 ,$7.33 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$18.33 ,$62.90 ,$7.33 ,$74.00 ,$44.18 ,$7.33 ,$30.78 ,$23.44 ,$21.31 ,$7.33 ,$62.90 ,$15.39 ,$62.90 ,$20.72 ,$66.60 ,$7.33 ,$60.68 ,$29.32 ,$29.32 ,$7.33 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000112,89320,HC SEMEN ANALYSIS COMPLETE,300,1 ,$217.00 ,$141.05 ,$12.31 ,$217.00 ,$30.78 ,$141.05 ,$129.55 ,$12.31 ,$60.76 ,$121.74 ,$12.31 ,$142.79 ,$12.31 ,$184.45 ,$184.45 ,$12.31 ,$184.45 ,$23.39 ,$147.56 ,$30.78 ,$12.31 ,$12.31 ,$162.75 ,$154.07 ,$154.07 ,$12.31 ,$154.07 ,$177.94 ,$177.94 ,$177.94 , N/A ,$30.78 ,$184.45 ,$12.31 ,$217.00 ,$129.55 ,$12.31 ,$90.27 ,$23.44 ,$21.31 ,$12.31 ,$184.45 ,$25.85 ,$184.45 ,$60.76 ,$195.30 ,$12.31 ,$177.94 ,$49.24 ,$49.24 ,$12.31 ,$141.05 ,$217.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000131,G0480,HC DRUG CONFIRMATION EA PROC 1-7 CLASSES-90,301,1 ,$204.00 ,$132.60 ,$20.08 ,$286.08 ,$286.08 ,$132.60 ,$121.79 ,$114.43 ,$57.12 ,$114.44 ,$114.43 ,$134.23 ,$114.43 ,$173.40 ,$173.40 ,$114.43 ,$173.40 ,$204.00 ,$138.72 ,$286.08 ,$114.43 ,$114.43 ,$153.00 ,$144.84 ,$144.84 ,$114.43 ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A ,$204.00 ,$173.40 ,$114.43 ,$204.00 ,$121.79 ,$114.43 ,$84.86 ,$22.09 ,$20.08 ,$114.43 ,$173.40 ,$240.30 ,$173.40 ,$57.12 ,$183.60 ,$114.43 ,$167.28 ,$204.00 ,$204.00 ,$114.43 ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000213,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$146.00 ,$94.90 ,$32.09 ,$277.93 ,$277.93 ,$94.90 ,$87.16 ,$111.17 ,$40.88 ,$81.91 ,$111.17 ,$96.07 ,$111.17 ,$124.10 ,$124.10 ,$111.17 ,$124.10 ,$146.00 ,$99.28 ,$277.92 ,$111.17 ,$111.17 ,$109.50 ,$103.66 ,$103.66 ,$111.17 ,$103.66 ,$119.72 ,$119.72 ,$119.72 , N/A ,$146.00 ,$124.10 ,$111.17 ,$146.00 ,$87.16 ,$111.17 ,$60.74 ,$35.30 ,$32.09 ,$111.17 ,$124.10 ,$233.45 ,$124.10 ,$40.88 ,$131.40 ,$111.17 ,$119.72 , N/A , N/A ,$111.17 ,$94.90 ,$146.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000230,99001,HC LAB HANDLING CHARGE SPECIMEN,300,1 ,$68.00 ,$44.20 ,$19.04 ,$68.00 , N/A ,$44.20 ,$40.60 , N/A ,$19.04 ,$38.15 , N/A ,$44.74 , N/A ,$57.80 ,$57.80 , N/A ,$57.80 , N/A ,$46.24 , N/A , N/A , N/A ,$51.00 ,$48.28 ,$48.28 , N/A ,$48.28 ,$55.76 ,$55.76 ,$55.76 , N/A , N/A ,$57.80 , N/A ,$68.00 ,$40.60 , N/A ,$28.29 , N/A , N/A , N/A ,$57.80 , N/A ,$57.80 ,$19.04 ,$61.20 , N/A ,$55.76 ,$26.52 ,$26.52 , N/A ,$44.20 ,$68.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000252,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$68.00 ,$44.20 ,$12.05 ,$68.00 ,$30.13 ,$44.20 ,$40.60 ,$12.05 ,$19.04 ,$38.15 ,$12.05 ,$44.74 ,$12.05 ,$57.80 ,$57.80 ,$12.05 ,$57.80 ,$22.90 ,$46.24 ,$30.13 ,$12.05 ,$12.05 ,$51.00 ,$48.28 ,$48.28 ,$12.05 ,$48.28 ,$55.76 ,$55.76 ,$55.76 , N/A ,$30.13 ,$57.80 ,$12.05 ,$68.00 ,$40.60 ,$12.05 ,$28.29 ,$23.44 ,$21.31 ,$12.05 ,$57.80 ,$25.31 ,$57.80 ,$19.04 ,$61.20 ,$12.05 ,$55.76 ,$48.20 ,$48.20 ,$12.05 ,$44.20 ,$68.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000260,36600,HC ARTERIAL PUNCTURE,300,1 ,$313.00 ,$203.45 ,$32.09 ,$313.00 ,$277.93 ,$203.45 ,$186.86 ,$111.17 ,$87.64 ,$175.59 ,$111.17 ,$205.95 ,$111.17 ,$266.05 ,$266.05 ,$111.17 ,$266.05 ,$211.22 ,$212.84 ,$277.92 ,$111.17 ,$111.17 ,$234.75 ,$222.23 ,$222.23 ,$111.17 ,$222.23 ,$256.66 ,$256.66 ,$256.66 , N/A ,$277.92 ,$266.05 ,$111.17 ,$313.00 ,$186.86 ,$111.17 ,$130.21 ,$35.30 ,$32.09 ,$111.17 ,$266.05 ,$233.45 ,$266.05 ,$87.64 ,$281.70 ,$111.17 ,$256.66 , N/A , N/A ,$111.17 ,$203.45 ,$313.00 
ST. JOSEPH'S HOSPITAL - BREESE,30000263,N/A,HC HEALTH FAIR PULMONARY SCREEN,300,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$2.50 ,$2.50 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002012,36415,HC KIT DRAW  AND  PROCESSING,300,1 ,$36.00 ,$23.40 ,$1.56 ,$36.00 ,$7.50 ,$23.40 ,$21.49 ,$3.00 ,$10.08 ,$20.20 ,$3.00 ,$23.69 ,$3.00 ,$30.60 ,$30.60 ,$3.00 ,$30.60 ,$5.70 ,$24.48 ,$7.50 ,$3.00 ,$3.00 ,$27.00 , N/A , N/A ,$3.00 , N/A ,$29.52 ,$29.52 ,$29.52 , N/A ,$7.50 ,$30.60 ,$3.00 ,$3.00 ,$21.49 ,$3.00 ,$14.98 ,$1.72 ,$1.56 ,$3.00 ,$30.60 ,$6.30 ,$30.60 ,$10.08 ,$32.40 ,$3.00 ,$29.52 ,$12.00 ,$12.00 ,$3.00 ,$23.40 ,$36.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002015,89050,HC BODY FLUID CELL COUNT,300,1 ,$124.00 ,$80.60 ,$4.72 ,$124.00 ,$11.80 ,$80.60 ,$74.03 ,$4.72 ,$34.72 ,$69.56 ,$4.72 ,$81.59 ,$4.72 ,$105.40 ,$105.40 ,$4.72 ,$105.40 ,$8.97 ,$84.32 ,$11.80 ,$4.72 ,$4.72 ,$93.00 ,$88.04 ,$88.04 ,$4.72 ,$88.04 ,$101.68 ,$101.68 ,$101.68 , N/A ,$11.80 ,$105.40 ,$4.72 ,$124.00 ,$74.03 ,$4.72 ,$51.58 ,$23.44 ,$21.31 ,$4.72 ,$105.40 ,$9.91 ,$105.40 ,$34.72 ,$111.60 ,$4.72 ,$101.68 ,$18.88 ,$18.88 ,$4.72 ,$80.60 ,$124.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002016,89051,HC CELL CT BODY FLUID W/DIFF T2,300,1 ,$194.00 ,$126.10 ,$5.60 ,$194.00 ,$14.00 ,$126.10 ,$115.82 ,$5.60 ,$54.32 ,$108.83 ,$5.60 ,$127.65 ,$5.60 ,$164.90 ,$164.90 ,$5.60 ,$164.90 ,$10.64 ,$131.92 ,$14.00 ,$5.60 ,$5.60 ,$145.50 ,$137.74 ,$137.74 ,$5.60 ,$137.74 ,$159.08 ,$159.08 ,$159.08 , N/A ,$14.00 ,$164.90 ,$5.60 ,$194.00 ,$115.82 ,$5.60 ,$80.70 ,$23.44 ,$21.31 ,$5.60 ,$164.90 ,$11.76 ,$164.90 ,$54.32 ,$174.60 ,$5.60 ,$159.08 ,$22.40 ,$22.40 ,$5.60 ,$126.10 ,$194.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002018,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$126.00 ,$81.90 ,$7.33 ,$126.00 ,$18.33 ,$81.90 ,$75.22 ,$7.33 ,$35.28 ,$70.69 ,$7.33 ,$82.91 ,$7.33 ,$107.10 ,$107.10 ,$7.33 ,$107.10 ,$13.93 ,$85.68 ,$18.33 ,$7.33 ,$7.33 ,$94.50 ,$89.46 ,$89.46 ,$7.33 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$18.33 ,$107.10 ,$7.33 ,$126.00 ,$75.22 ,$7.33 ,$52.42 ,$23.44 ,$21.31 ,$7.33 ,$107.10 ,$15.39 ,$107.10 ,$35.28 ,$113.40 ,$7.33 ,$103.32 ,$29.32 ,$29.32 ,$7.33 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002023,G0483,HC TOX SCREEN CHAIN OF CUSTODY URINE,300,1 ,$87.00 ,$56.55 ,$20.08 ,$217.50 ,$217.50 ,$56.55 ,$51.94 ,$87.00 ,$24.36 ,$48.81 ,$87.00 ,$57.25 ,$87.00 ,$73.95 ,$73.95 ,$87.00 ,$73.95 ,$87.00 ,$59.16 ,$217.50 ,$87.00 ,$87.00 ,$65.25 ,$61.77 ,$61.77 ,$87.00 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$87.00 ,$73.95 ,$87.00 ,$87.00 ,$51.94 ,$87.00 ,$36.19 ,$22.09 ,$20.08 ,$87.00 ,$73.95 ,$182.70 ,$73.95 ,$24.36 ,$78.30 ,$87.00 ,$71.34 ,$87.00 ,$87.00 ,$87.00 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002031,36415,HC VENIPUNCTURE,300,1 ,$36.00 ,$23.40 ,$1.56 ,$36.00 ,$7.50 ,$23.40 ,$21.49 ,$3.00 ,$10.08 ,$20.20 ,$3.00 ,$23.69 ,$3.00 ,$30.60 ,$30.60 ,$3.00 ,$30.60 ,$5.70 ,$24.48 ,$7.50 ,$3.00 ,$3.00 ,$27.00 , N/A , N/A ,$3.00 , N/A ,$29.52 ,$29.52 ,$29.52 , N/A ,$7.50 ,$30.60 ,$3.00 ,$3.00 ,$21.49 ,$3.00 ,$14.98 ,$1.72 ,$1.56 ,$3.00 ,$30.60 ,$6.30 ,$30.60 ,$10.08 ,$32.40 ,$3.00 ,$29.52 ,$12.00 ,$12.00 ,$3.00 ,$23.40 ,$36.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002033,36416,HC CAPILLARY COLLECTION,300,1 ,$56.00 ,$36.40 ,$12.56 ,$56.00 , N/A ,$36.40 ,$33.43 , N/A ,$15.68 ,$31.42 , N/A ,$36.85 , N/A ,$47.60 ,$47.60 , N/A ,$47.60 , N/A ,$38.08 , N/A , N/A , N/A ,$42.00 ,$39.76 ,$39.76 , N/A ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A , N/A ,$47.60 , N/A ,$56.00 ,$33.43 , N/A ,$23.30 , N/A , N/A , N/A ,$47.60 , N/A ,$47.60 ,$15.68 ,$50.40 , N/A ,$45.92 ,$12.56 ,$12.56 , N/A ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30002040,81352,HC TP53 GENE TRGT SEQUENCE ANALYSIS-90,300,1 ,"$1,620.00 ","$1,053.00 ",$86.18 ,"$1,620.00 ",$823.78 ,"$1,053.00 ",$967.14 ,$329.51 ,$453.60 ,$908.82 ,$329.51 ,"$1,065.96 ",$329.51 ,"$1,377.00 ","$1,377.00 ",$329.51 ,"$1,377.00 ",$626.07 ,"$1,101.60 ",$823.78 ,$329.51 ,$329.51 ,"$1,215.00 ","$1,150.20 ","$1,150.20 ",$329.51 ,"$1,150.20 ","$1,328.40 ","$1,328.40 ","$1,328.40 ", N/A ,$823.78 ,"$1,377.00 ",$329.51 ,"$1,620.00 ",$967.14 ,$329.51 ,$673.92 ,$94.80 ,$86.18 ,$329.51 ,"$1,377.00 ",$691.97 ,"$1,377.00 ",$453.60 ,"$1,458.00 ",$329.51 ,"$1,328.40 ","$1,318.04 ","$1,318.04 ",$329.51 ,"$1,053.00 ","$1,620.00 "
ST. JOSEPH'S HOSPITAL - BREESE,30002042,85027,HC HEALTH FAIR HEMOGRAM,300,1 ,$5.00 ,$3.25 ,$1.40 ,$12.50 ,$12.50 ,$3.25 ,$2.99 ,$5.00 ,$1.40 ,$2.81 ,$5.00 ,$3.29 ,$5.00 ,$4.25 ,$4.25 ,$5.00 ,$4.25 ,$5.00 ,$3.40 ,$12.50 ,$5.00 ,$5.00 ,$3.75 ,$3.55 ,$3.55 ,$5.00 ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A ,$5.00 ,$4.25 ,$5.00 ,$5.00 ,$2.99 ,$5.00 ,$2.08 ,$5.00 ,$4.63 ,$5.00 ,$4.25 ,$10.50 ,$4.25 ,$1.40 ,$4.50 ,$5.00 ,$4.10 ,$5.00 ,$5.00 ,$5.00 ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$389.00 ,$252.85 ,$6.80 ,$389.00 ,$26.40 ,$252.85 ,$232.23 ,$10.56 ,$108.92 ,$218.23 ,$10.56 ,$255.96 ,$10.56 ,$330.65 ,$330.65 ,$10.56 ,$330.65 ,$20.06 ,$264.52 ,$26.40 ,$10.56 ,$10.56 ,$291.75 ,$276.19 ,$276.19 ,$10.56 ,$276.19 ,$318.98 ,$318.98 ,$318.98 , N/A ,$26.40 ,$330.65 ,$10.56 ,$10.56 ,$232.23 ,$10.56 ,$161.82 ,$7.48 ,$6.80 ,$10.56 ,$330.65 ,$22.18 ,$330.65 ,$108.92 ,$350.10 ,$10.56 ,$318.98 ,$42.24 ,$42.24 ,$10.56 ,$252.85 ,$389.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100121,80164,HC VALPROIC ACID,301,1 ,$169.00 ,$109.85 ,$8.56 ,$169.00 ,$33.85 ,$109.85 ,$100.89 ,$13.54 ,$47.32 ,$94.81 ,$13.54 ,$111.20 ,$13.54 ,$143.65 ,$143.65 ,$13.54 ,$143.65 ,$25.73 ,$114.92 ,$33.85 ,$13.54 ,$13.54 ,$126.75 ,$119.99 ,$119.99 ,$13.54 ,$119.99 ,$138.58 ,$138.58 ,$138.58 , N/A ,$33.85 ,$143.65 ,$13.54 ,$169.00 ,$100.89 ,$13.54 ,$70.30 ,$9.42 ,$8.56 ,$13.54 ,$143.65 ,$28.43 ,$143.65 ,$47.32 ,$152.10 ,$13.54 ,$138.58 ,$54.16 ,$54.16 ,$13.54 ,$109.85 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100124,80170,HC GENTAMICIN,301,1 ,$125.00 ,$81.25 ,$8.56 ,$125.00 ,$40.95 ,$81.25 ,$74.63 ,$16.38 ,$35.00 ,$70.13 ,$16.38 ,$82.25 ,$16.38 ,$106.25 ,$106.25 ,$16.38 ,$106.25 ,$31.12 ,$85.00 ,$40.95 ,$16.38 ,$16.38 ,$93.75 ,$88.75 ,$88.75 ,$16.38 ,$88.75 ,$102.50 ,$102.50 ,$102.50 , N/A ,$40.95 ,$106.25 ,$16.38 ,$125.00 ,$74.63 ,$16.38 ,$52.00 ,$9.42 ,$8.56 ,$16.38 ,$106.25 ,$34.40 ,$106.25 ,$35.00 ,$112.50 ,$16.38 ,$102.50 ,$65.52 ,$65.52 ,$16.38 ,$81.25 ,$125.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100139,80200,HC TOBRAMYCIN,301,1 ,$154.00 ,$100.10 ,$8.56 ,$154.00 ,$40.33 ,$100.10 ,$91.94 ,$16.13 ,$43.12 ,$86.39 ,$16.13 ,$101.33 ,$16.13 ,$130.90 ,$130.90 ,$16.13 ,$130.90 ,$30.65 ,$104.72 ,$40.33 ,$16.13 ,$16.13 ,$115.50 ,$109.34 ,$109.34 ,$16.13 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$40.33 ,$130.90 ,$16.13 ,$154.00 ,$91.94 ,$16.13 ,$64.06 ,$9.42 ,$8.56 ,$16.13 ,$130.90 ,$33.87 ,$130.90 ,$43.12 ,$138.60 ,$16.13 ,$126.28 ,$64.52 ,$64.52 ,$16.13 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100157,82009,HC ACETONE SERUM,301,1 ,$61.00 ,$39.65 ,$3.32 ,$61.00 ,$11.30 ,$39.65 ,$36.42 ,$4.52 ,$17.08 ,$34.22 ,$4.52 ,$40.14 ,$4.52 ,$51.85 ,$51.85 ,$4.52 ,$51.85 ,$8.59 ,$41.48 ,$11.30 ,$4.52 ,$4.52 ,$45.75 ,$43.31 ,$43.31 ,$4.52 ,$43.31 ,$50.02 ,$50.02 ,$50.02 , N/A ,$11.30 ,$51.85 ,$4.52 ,$61.00 ,$36.42 ,$4.52 ,$25.38 ,$3.65 ,$3.32 ,$4.52 ,$51.85 ,$9.49 ,$51.85 ,$17.08 ,$54.90 ,$4.52 ,$50.02 ,$18.08 ,$18.08 ,$4.52 ,$39.65 ,$61.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$96.00 ,$62.40 ,$7.46 ,$96.00 ,$20.43 ,$62.40 ,$57.31 ,$8.17 ,$26.88 ,$53.86 ,$8.17 ,$63.17 ,$8.17 ,$81.60 ,$81.60 ,$8.17 ,$81.60 ,$15.52 ,$65.28 ,$20.43 ,$8.17 ,$8.17 ,$72.00 ,$68.16 ,$68.16 ,$8.17 ,$68.16 ,$78.72 ,$78.72 ,$78.72 , N/A ,$20.43 ,$81.60 ,$8.17 ,$96.00 ,$57.31 ,$8.17 ,$39.94 ,$8.21 ,$7.46 ,$8.17 ,$81.60 ,$17.16 ,$81.60 ,$26.88 ,$86.40 ,$8.17 ,$78.72 ,$32.68 ,$32.68 ,$8.17 ,$62.40 ,$96.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100165,82040,HC ALBUMIN SERUM,301,1 ,$76.00 ,$49.40 ,$3.32 ,$76.00 ,$12.38 ,$49.40 ,$45.37 ,$4.95 ,$21.28 ,$42.64 ,$4.95 ,$50.01 ,$4.95 ,$64.60 ,$64.60 ,$4.95 ,$64.60 ,$9.41 ,$51.68 ,$12.38 ,$4.95 ,$4.95 ,$57.00 ,$53.96 ,$53.96 ,$4.95 ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A ,$12.38 ,$64.60 ,$4.95 ,$76.00 ,$45.37 ,$4.95 ,$31.62 ,$3.65 ,$3.32 ,$4.95 ,$64.60 ,$10.40 ,$64.60 ,$21.28 ,$68.40 ,$4.95 ,$62.32 ,$19.80 ,$19.80 ,$4.95 ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$119.00 ,$77.35 ,$2.66 ,$119.00 ,$14.45 ,$77.35 ,$71.04 ,$5.78 ,$33.32 ,$66.76 ,$5.78 ,$78.30 ,$5.78 ,$101.15 ,$101.15 ,$5.78 ,$101.15 ,$10.98 ,$80.92 ,$14.45 ,$5.78 ,$5.78 ,$89.25 ,$84.49 ,$84.49 ,$5.78 ,$84.49 ,$97.58 ,$97.58 ,$97.58 , N/A ,$14.45 ,$101.15 ,$5.78 ,$119.00 ,$71.04 ,$5.78 ,$49.50 ,$2.93 ,$2.66 ,$5.78 ,$101.15 ,$12.14 ,$101.15 ,$33.32 ,$107.10 ,$5.78 ,$97.58 ,$23.12 ,$23.12 ,$5.78 ,$77.35 ,$119.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100186,82140,HC AMMONIA,301,1 ,$209.00 ,$135.85 ,$7.46 ,$209.00 ,$36.43 ,$135.85 ,$124.77 ,$14.57 ,$58.52 ,$117.25 ,$14.57 ,$137.52 ,$14.57 ,$177.65 ,$177.65 ,$14.57 ,$177.65 ,$27.68 ,$142.12 ,$36.43 ,$14.57 ,$14.57 ,$156.75 ,$148.39 ,$148.39 ,$14.57 ,$148.39 ,$171.38 ,$171.38 ,$171.38 , N/A ,$36.43 ,$177.65 ,$14.57 ,$209.00 ,$124.77 ,$14.57 ,$86.94 ,$8.21 ,$7.46 ,$14.57 ,$177.65 ,$30.60 ,$177.65 ,$58.52 ,$188.10 ,$14.57 ,$171.38 ,$58.28 ,$58.28 ,$14.57 ,$135.85 ,$209.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100188,82150,HC AMYLASE,301,1 ,$126.00 ,$81.90 ,$6.48 ,$126.00 ,$16.20 ,$81.90 ,$75.22 ,$6.48 ,$35.28 ,$70.69 ,$6.48 ,$82.91 ,$6.48 ,$107.10 ,$107.10 ,$6.48 ,$107.10 ,$12.31 ,$85.68 ,$16.20 ,$6.48 ,$6.48 ,$94.50 ,$89.46 ,$89.46 ,$6.48 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$16.20 ,$107.10 ,$6.48 ,$126.00 ,$75.22 ,$6.48 ,$52.42 ,$8.21 ,$7.46 ,$6.48 ,$107.10 ,$13.61 ,$107.10 ,$35.28 ,$113.40 ,$6.48 ,$103.32 ,$25.92 ,$25.92 ,$6.48 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$58.00 ,$37.70 ,$3.32 ,$58.00 ,$12.55 ,$37.70 ,$34.63 ,$5.02 ,$16.24 ,$32.54 ,$5.02 ,$38.16 ,$5.02 ,$49.30 ,$49.30 ,$5.02 ,$49.30 ,$9.54 ,$39.44 ,$12.55 ,$5.02 ,$5.02 ,$43.50 ,$41.18 ,$41.18 ,$5.02 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$12.55 ,$49.30 ,$5.02 ,$58.00 ,$34.63 ,$5.02 ,$24.13 ,$3.65 ,$3.32 ,$5.02 ,$49.30 ,$10.54 ,$49.30 ,$16.24 ,$52.20 ,$5.02 ,$47.56 ,$20.08 ,$20.08 ,$5.02 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$81.00 ,$52.65 ,$3.32 ,$81.00 ,$12.55 ,$52.65 ,$48.36 ,$5.02 ,$22.68 ,$45.44 ,$5.02 ,$53.30 ,$5.02 ,$68.85 ,$68.85 ,$5.02 ,$68.85 ,$9.54 ,$55.08 ,$12.55 ,$5.02 ,$5.02 ,$60.75 ,$57.51 ,$57.51 ,$5.02 ,$57.51 ,$66.42 ,$66.42 ,$66.42 , N/A ,$12.55 ,$68.85 ,$5.02 ,$81.00 ,$48.36 ,$5.02 ,$33.70 ,$3.65 ,$3.32 ,$5.02 ,$68.85 ,$10.54 ,$68.85 ,$22.68 ,$72.90 ,$5.02 ,$66.42 ,$20.08 ,$20.08 ,$5.02 ,$52.65 ,$81.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100212,82306,HC VITAMIN D 25 OH,301,1 ,$97.00 ,$63.05 ,$20.08 ,$97.00 ,$74.00 ,$63.05 ,$57.91 ,$29.60 ,$27.16 ,$54.42 ,$29.60 ,$63.83 ,$29.60 ,$82.45 ,$82.45 ,$29.60 ,$82.45 ,$56.24 ,$65.96 ,$74.00 ,$29.60 ,$29.60 ,$72.75 ,$68.87 ,$68.87 ,$29.60 ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A ,$74.00 ,$82.45 ,$29.60 ,$97.00 ,$57.91 ,$29.60 ,$40.35 ,$22.09 ,$20.08 ,$29.60 ,$82.45 ,$62.16 ,$82.45 ,$27.16 ,$87.30 ,$29.60 ,$79.54 ,$97.00 ,$97.00 ,$29.60 ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100214,82310,HC CALCIUM,301,1 ,$82.00 ,$53.30 ,$3.32 ,$82.00 ,$12.90 ,$53.30 ,$48.95 ,$5.16 ,$22.96 ,$46.00 ,$5.16 ,$53.96 ,$5.16 ,$69.70 ,$69.70 ,$5.16 ,$69.70 ,$9.80 ,$55.76 ,$12.90 ,$5.16 ,$5.16 ,$61.50 ,$58.22 ,$58.22 ,$5.16 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$12.90 ,$69.70 ,$5.16 ,$82.00 ,$48.95 ,$5.16 ,$34.11 ,$3.65 ,$3.32 ,$5.16 ,$69.70 ,$10.84 ,$69.70 ,$22.96 ,$73.80 ,$5.16 ,$67.24 ,$20.64 ,$20.64 ,$5.16 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100215,82330,HC CALCIUM IONIZED,301,1 ,$56.00 ,$36.40 ,$7.46 ,$56.00 ,$34.20 ,$36.40 ,$33.43 ,$13.68 ,$15.68 ,$31.42 ,$13.68 ,$36.85 ,$13.68 ,$47.60 ,$47.60 ,$13.68 ,$47.60 ,$25.99 ,$38.08 ,$34.20 ,$13.68 ,$13.68 ,$42.00 ,$39.76 ,$39.76 ,$13.68 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$34.20 ,$47.60 ,$13.68 ,$56.00 ,$33.43 ,$13.68 ,$23.30 ,$8.21 ,$7.46 ,$13.68 ,$47.60 ,$28.73 ,$47.60 ,$15.68 ,$50.40 ,$13.68 ,$45.92 ,$54.72 ,$54.72 ,$13.68 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100222,82374,HC BICARBONATE,301,1 ,$119.00 ,$77.35 ,$3.32 ,$119.00 ,$12.20 ,$77.35 ,$71.04 ,$4.88 ,$33.32 ,$66.76 ,$4.88 ,$78.30 ,$4.88 ,$101.15 ,$101.15 ,$4.88 ,$101.15 ,$9.27 ,$80.92 ,$12.20 ,$4.88 ,$4.88 ,$89.25 ,$84.49 ,$84.49 ,$4.88 ,$84.49 ,$97.58 ,$97.58 ,$97.58 , N/A ,$12.20 ,$101.15 ,$4.88 ,$119.00 ,$71.04 ,$4.88 ,$49.50 ,$3.65 ,$3.32 ,$4.88 ,$101.15 ,$10.25 ,$101.15 ,$33.32 ,$107.10 ,$4.88 ,$97.58 ,$19.52 ,$19.52 ,$4.88 ,$77.35 ,$119.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100237,82435,HC CHLORIDE,301,1 ,$52.00 ,$33.80 ,$3.32 ,$52.00 ,$11.50 ,$33.80 ,$31.04 ,$4.60 ,$14.56 ,$29.17 ,$4.60 ,$34.22 ,$4.60 ,$44.20 ,$44.20 ,$4.60 ,$44.20 ,$8.74 ,$35.36 ,$11.50 ,$4.60 ,$4.60 ,$39.00 ,$36.92 ,$36.92 ,$4.60 ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A ,$11.50 ,$44.20 ,$4.60 ,$52.00 ,$31.04 ,$4.60 ,$21.63 ,$3.65 ,$3.32 ,$4.60 ,$44.20 ,$9.66 ,$44.20 ,$14.56 ,$46.80 ,$4.60 ,$42.64 ,$18.40 ,$18.40 ,$4.60 ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100238,82436,HC CHLORIDE URINE,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$14.38 ,$60.45 ,$55.52 ,$5.75 ,$26.04 ,$52.17 ,$5.75 ,$61.19 ,$5.75 ,$79.05 ,$79.05 ,$5.75 ,$79.05 ,$10.93 ,$63.24 ,$14.38 ,$5.75 ,$5.75 ,$69.75 ,$66.03 ,$66.03 ,$5.75 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$14.38 ,$79.05 ,$5.75 ,$93.00 ,$55.52 ,$5.75 ,$38.69 ,$3.65 ,$3.32 ,$5.75 ,$79.05 ,$12.08 ,$79.05 ,$26.04 ,$83.70 ,$5.75 ,$76.26 ,$23.00 ,$23.00 ,$5.75 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100241,82465,HC CHOLESTEROL,301,1 ,$88.00 ,$57.20 ,$3.32 ,$88.00 ,$10.88 ,$57.20 ,$52.54 ,$4.35 ,$24.64 ,$49.37 ,$4.35 ,$57.90 ,$4.35 ,$74.80 ,$74.80 ,$4.35 ,$74.80 ,$8.27 ,$59.84 ,$10.88 ,$4.35 ,$4.35 ,$66.00 ,$62.48 ,$62.48 ,$4.35 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$10.88 ,$74.80 ,$4.35 ,$88.00 ,$52.54 ,$4.35 ,$36.61 ,$3.65 ,$3.32 ,$4.35 ,$74.80 ,$9.14 ,$74.80 ,$24.64 ,$79.20 ,$4.35 ,$72.16 ,$17.40 ,$17.40 ,$4.35 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$126.00 ,$81.90 ,$3.32 ,$126.00 ,$16.28 ,$81.90 ,$75.22 ,$6.51 ,$35.28 ,$70.69 ,$6.51 ,$82.91 ,$6.51 ,$107.10 ,$107.10 ,$6.51 ,$107.10 ,$12.37 ,$85.68 ,$16.28 ,$6.51 ,$6.51 ,$94.50 ,$89.46 ,$89.46 ,$6.51 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$16.28 ,$107.10 ,$6.51 ,$126.00 ,$75.22 ,$6.51 ,$52.42 ,$3.65 ,$3.32 ,$6.51 ,$107.10 ,$13.67 ,$107.10 ,$35.28 ,$113.40 ,$6.51 ,$103.32 ,$26.04 ,$26.04 ,$6.51 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$174.00 ,$113.10 ,$7.46 ,$174.00 ,$28.88 ,$113.10 ,$103.88 ,$11.55 ,$48.72 ,$97.61 ,$11.55 ,$114.49 ,$11.55 ,$147.90 ,$147.90 ,$11.55 ,$147.90 ,$21.95 ,$118.32 ,$28.88 ,$11.55 ,$11.55 ,$130.50 ,$123.54 ,$123.54 ,$11.55 ,$123.54 ,$142.68 ,$142.68 ,$142.68 , N/A ,$28.88 ,$147.90 ,$11.55 ,$174.00 ,$103.88 ,$11.55 ,$72.38 ,$8.21 ,$7.46 ,$11.55 ,$147.90 ,$24.26 ,$147.90 ,$48.72 ,$156.60 ,$11.55 ,$142.68 ,$46.20 ,$46.20 ,$11.55 ,$113.10 ,$174.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100262,82565,HC CREATININE,301,1 ,$72.00 ,$46.80 ,$3.32 ,$72.00 ,$12.80 ,$46.80 ,$42.98 ,$5.12 ,$20.16 ,$40.39 ,$5.12 ,$47.38 ,$5.12 ,$61.20 ,$61.20 ,$5.12 ,$61.20 ,$9.73 ,$48.96 ,$12.80 ,$5.12 ,$5.12 ,$54.00 ,$51.12 ,$51.12 ,$5.12 ,$51.12 ,$59.04 ,$59.04 ,$59.04 , N/A ,$12.80 ,$61.20 ,$5.12 ,$5.12 ,$42.98 ,$5.12 ,$29.95 ,$3.65 ,$3.32 ,$5.12 ,$61.20 ,$10.75 ,$61.20 ,$20.16 ,$64.80 ,$5.12 ,$59.04 ,$20.48 ,$20.48 ,$5.12 ,$46.80 ,$72.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$97.00 ,$63.05 ,$3.32 ,$97.00 ,$12.95 ,$63.05 ,$57.91 ,$5.18 ,$27.16 ,$54.42 ,$5.18 ,$63.83 ,$5.18 ,$82.45 ,$82.45 ,$5.18 ,$82.45 ,$9.84 ,$65.96 ,$12.95 ,$5.18 ,$5.18 ,$72.75 ,$68.87 ,$68.87 ,$5.18 ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A ,$12.95 ,$82.45 ,$5.18 ,$97.00 ,$57.91 ,$5.18 ,$40.35 ,$3.65 ,$3.32 ,$5.18 ,$82.45 ,$10.88 ,$82.45 ,$27.16 ,$87.30 ,$5.18 ,$79.54 ,$20.72 ,$20.72 ,$5.18 ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100266,82575,HC CREATININE CLEARANCE,301,1 ,$40.00 ,$26.00 ,$7.46 ,$40.00 ,$23.65 ,$26.00 ,$23.88 ,$9.46 ,$11.20 ,$22.44 ,$9.46 ,$26.32 ,$9.46 ,$34.00 ,$34.00 ,$9.46 ,$34.00 ,$17.97 ,$27.20 ,$23.65 ,$9.46 ,$9.46 ,$30.00 ,$28.40 ,$28.40 ,$9.46 ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A ,$23.65 ,$34.00 ,$9.46 ,$40.00 ,$23.88 ,$9.46 ,$16.64 ,$8.21 ,$7.46 ,$9.46 ,$34.00 ,$19.87 ,$34.00 ,$11.20 ,$36.00 ,$9.46 ,$32.80 ,$37.84 ,$37.84 ,$9.46 ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$245.00 ,$159.25 ,$20.08 ,$245.00 ,$161.03 ,$159.25 ,$146.27 ,$64.41 ,$68.60 ,$137.45 ,$64.41 ,$161.21 ,$64.41 ,$208.25 ,$208.25 ,$64.41 ,$208.25 ,$122.38 ,$166.60 ,$161.03 ,$64.41 ,$64.41 ,$183.75 ,$173.95 ,$173.95 ,$64.41 ,$173.95 ,$200.90 ,$200.90 ,$200.90 , N/A ,$161.03 ,$208.25 ,$64.41 ,$245.00 ,$146.27 ,$64.41 ,$101.92 ,$22.09 ,$20.08 ,$64.41 ,$208.25 ,$135.26 ,$208.25 ,$68.60 ,$220.50 ,$64.41 ,$200.90 ,$245.00 ,$245.00 ,$64.41 ,$159.25 ,$245.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$86.00 ,$55.90 ,$3.32 ,$86.00 ,$9.83 ,$55.90 ,$51.34 ,$3.93 ,$24.08 ,$48.25 ,$3.93 ,$56.59 ,$3.93 ,$73.10 ,$73.10 ,$3.93 ,$73.10 ,$7.47 ,$58.48 ,$9.83 ,$3.93 ,$3.93 ,$64.50 ,$61.06 ,$61.06 ,$3.93 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$9.83 ,$73.10 ,$3.93 ,$86.00 ,$51.34 ,$3.93 ,$35.78 ,$3.65 ,$3.32 ,$3.93 ,$73.10 ,$8.25 ,$73.10 ,$24.08 ,$77.40 ,$3.93 ,$70.52 ,$15.72 ,$15.72 ,$3.93 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100312,82947,HC GLUCOSE,301,1 ,$86.00 ,$55.90 ,$3.32 ,$86.00 ,$9.83 ,$55.90 ,$51.34 ,$3.93 ,$24.08 ,$48.25 ,$3.93 ,$56.59 ,$3.93 ,$73.10 ,$73.10 ,$3.93 ,$73.10 ,$7.47 ,$58.48 ,$9.83 ,$3.93 ,$3.93 ,$64.50 ,$61.06 ,$61.06 ,$3.93 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$9.83 ,$73.10 ,$3.93 ,$86.00 ,$51.34 ,$3.93 ,$35.78 ,$3.65 ,$3.32 ,$3.93 ,$73.10 ,$8.25 ,$73.10 ,$24.08 ,$77.40 ,$3.93 ,$70.52 ,$15.72 ,$15.72 ,$3.93 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100313,82950,HC GLUCOSE SCREEN,301,1 ,$66.00 ,$42.90 ,$3.32 ,$66.00 ,$11.88 ,$42.90 ,$39.40 ,$4.75 ,$18.48 ,$37.03 ,$4.75 ,$43.43 ,$4.75 ,$56.10 ,$56.10 ,$4.75 ,$56.10 ,$9.03 ,$44.88 ,$11.88 ,$4.75 ,$4.75 ,$49.50 ,$46.86 ,$46.86 ,$4.75 ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A ,$11.88 ,$56.10 ,$4.75 ,$66.00 ,$39.40 ,$4.75 ,$27.46 ,$3.65 ,$3.32 ,$4.75 ,$56.10 ,$9.98 ,$56.10 ,$18.48 ,$59.40 ,$4.75 ,$54.12 ,$19.00 ,$19.00 ,$4.75 ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$121.00 ,$78.65 ,$7.46 ,$121.00 ,$32.18 ,$78.65 ,$72.24 ,$12.87 ,$33.88 ,$67.88 ,$12.87 ,$79.62 ,$12.87 ,$102.85 ,$102.85 ,$12.87 ,$102.85 ,$24.45 ,$82.28 ,$32.18 ,$12.87 ,$12.87 ,$90.75 ,$85.91 ,$85.91 ,$12.87 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$32.18 ,$102.85 ,$12.87 ,$121.00 ,$72.24 ,$12.87 ,$50.34 ,$8.21 ,$7.46 ,$12.87 ,$102.85 ,$27.03 ,$102.85 ,$33.88 ,$108.90 ,$12.87 ,$99.22 ,$51.48 ,$51.48 ,$12.87 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$38.00 ,$24.70 ,$3.92 ,$38.00 ,$9.80 ,$24.70 ,$22.69 ,$3.92 ,$10.64 ,$21.32 ,$3.92 ,$25.00 ,$3.92 ,$32.30 ,$32.30 ,$3.92 ,$32.30 ,$7.45 ,$25.84 ,$9.80 ,$3.92 ,$3.92 ,$28.50 ,$26.98 ,$26.98 ,$3.92 ,$26.98 ,$31.16 ,$31.16 ,$31.16 , N/A ,$9.80 ,$32.30 ,$3.92 ,$38.00 ,$22.69 ,$3.92 ,$15.81 ,$8.21 ,$7.46 ,$3.92 ,$32.30 ,$8.23 ,$32.30 ,$10.64 ,$34.20 ,$3.92 ,$31.16 ,$15.68 ,$15.68 ,$3.92 ,$24.70 ,$38.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$158.00 ,$102.70 ,$7.46 ,$158.00 ,$28.93 ,$102.70 ,$94.33 ,$11.57 ,$44.24 ,$88.64 ,$11.57 ,$103.96 ,$11.57 ,$134.30 ,$134.30 ,$11.57 ,$134.30 ,$21.98 ,$107.44 ,$28.93 ,$11.57 ,$11.57 ,$118.50 ,$112.18 ,$112.18 ,$11.57 ,$112.18 ,$129.56 ,$129.56 ,$129.56 , N/A ,$28.93 ,$134.30 ,$11.57 ,$158.00 ,$94.33 ,$11.57 ,$65.73 ,$8.21 ,$7.46 ,$11.57 ,$134.30 ,$24.30 ,$134.30 ,$44.24 ,$142.20 ,$11.57 ,$129.56 ,$46.28 ,$46.28 ,$11.57 ,$102.70 ,$158.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$102.00 ,$66.30 ,$3.32 ,$102.00 ,$15.10 ,$66.30 ,$60.89 ,$6.04 ,$28.56 ,$57.22 ,$6.04 ,$67.12 ,$6.04 ,$86.70 ,$86.70 ,$6.04 ,$86.70 ,$11.48 ,$69.36 ,$15.10 ,$6.04 ,$6.04 ,$76.50 ,$72.42 ,$72.42 ,$6.04 ,$72.42 ,$83.64 ,$83.64 ,$83.64 , N/A ,$15.10 ,$86.70 ,$6.04 ,$102.00 ,$60.89 ,$6.04 ,$42.43 ,$3.65 ,$3.32 ,$6.04 ,$86.70 ,$12.68 ,$86.70 ,$28.56 ,$91.80 ,$6.04 ,$83.64 ,$24.16 ,$24.16 ,$6.04 ,$66.30 ,$102.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100409,83690,HC LIPASE,301,1 ,$119.00 ,$77.35 ,$3.32 ,$119.00 ,$17.23 ,$77.35 ,$71.04 ,$6.89 ,$33.32 ,$66.76 ,$6.89 ,$78.30 ,$6.89 ,$101.15 ,$101.15 ,$6.89 ,$101.15 ,$13.09 ,$80.92 ,$17.23 ,$6.89 ,$6.89 ,$89.25 ,$84.49 ,$84.49 ,$6.89 ,$84.49 ,$97.58 ,$97.58 ,$97.58 , N/A ,$17.23 ,$101.15 ,$6.89 ,$119.00 ,$71.04 ,$6.89 ,$49.50 ,$3.65 ,$3.32 ,$6.89 ,$101.15 ,$14.47 ,$101.15 ,$33.32 ,$107.10 ,$6.89 ,$97.58 ,$27.56 ,$27.56 ,$6.89 ,$77.35 ,$119.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100415,83718,HC CHOLESTEROL HDL,301,1 ,$88.00 ,$57.20 ,$7.46 ,$88.00 ,$20.48 ,$57.20 ,$52.54 ,$8.19 ,$24.64 ,$49.37 ,$8.19 ,$57.90 ,$8.19 ,$74.80 ,$74.80 ,$8.19 ,$74.80 ,$15.56 ,$59.84 ,$20.48 ,$8.19 ,$8.19 ,$66.00 ,$62.48 ,$62.48 ,$8.19 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$20.48 ,$74.80 ,$8.19 ,$88.00 ,$52.54 ,$8.19 ,$36.61 ,$8.21 ,$7.46 ,$8.19 ,$74.80 ,$17.20 ,$74.80 ,$24.64 ,$79.20 ,$8.19 ,$72.16 ,$32.76 ,$32.76 ,$8.19 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100416,83721,HC CHOLESTEROL LDL,301,1 ,$124.00 ,$80.60 ,$7.46 ,$124.00 ,$26.25 ,$80.60 ,$74.03 ,$10.50 ,$34.72 ,$69.56 ,$10.50 ,$81.59 ,$10.50 ,$105.40 ,$105.40 ,$10.50 ,$105.40 ,$19.95 ,$84.32 ,$26.25 ,$10.50 ,$10.50 ,$93.00 ,$88.04 ,$88.04 ,$10.50 ,$88.04 ,$101.68 ,$101.68 ,$101.68 , N/A ,$26.25 ,$105.40 ,$10.50 ,$124.00 ,$74.03 ,$10.50 ,$51.58 ,$8.21 ,$7.46 ,$10.50 ,$105.40 ,$22.05 ,$105.40 ,$34.72 ,$111.60 ,$10.50 ,$101.68 ,$42.00 ,$42.00 ,$10.50 ,$80.60 ,$124.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100417,83735,HC MAGNESIUM,301,1 ,$80.00 ,$52.00 ,$3.32 ,$80.00 ,$16.75 ,$52.00 ,$47.76 ,$6.70 ,$22.40 ,$44.88 ,$6.70 ,$52.64 ,$6.70 ,$68.00 ,$68.00 ,$6.70 ,$68.00 ,$12.73 ,$54.40 ,$16.75 ,$6.70 ,$6.70 ,$60.00 ,$56.80 ,$56.80 ,$6.70 ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A ,$16.75 ,$68.00 ,$6.70 ,$80.00 ,$47.76 ,$6.70 ,$33.28 ,$3.65 ,$3.32 ,$6.70 ,$68.00 ,$14.07 ,$68.00 ,$22.40 ,$72.00 ,$6.70 ,$65.60 ,$26.80 ,$26.80 ,$6.70 ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$270.00 ,$175.50 ,$20.08 ,$270.00 ,$98.15 ,$175.50 ,$161.19 ,$39.26 ,$75.60 ,$151.47 ,$39.26 ,$177.66 ,$39.26 ,$229.50 ,$229.50 ,$39.26 ,$229.50 ,$74.59 ,$183.60 ,$98.15 ,$39.26 ,$39.26 ,$202.50 ,$191.70 ,$191.70 ,$39.26 ,$191.70 ,$221.40 ,$221.40 ,$221.40 , N/A ,$98.15 ,$229.50 ,$39.26 ,$270.00 ,$161.19 ,$39.26 ,$112.32 ,$22.09 ,$20.08 ,$39.26 ,$229.50 ,$82.45 ,$229.50 ,$75.60 ,$243.00 ,$39.26 ,$221.40 ,$157.04 ,$157.04 ,$39.26 ,$175.50 ,$270.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$102.00 ,$66.30 ,$17.46 ,$103.20 ,$103.20 ,$66.30 ,$60.89 ,$41.28 ,$28.56 ,$57.22 ,$41.28 ,$67.12 ,$41.28 ,$86.70 ,$86.70 ,$41.28 ,$86.70 ,$78.43 ,$69.36 ,$103.20 ,$41.28 ,$41.28 ,$76.50 ,$72.42 ,$72.42 ,$41.28 ,$72.42 ,$83.64 ,$83.64 ,$83.64 , N/A ,$102.00 ,$86.70 ,$41.28 ,$102.00 ,$60.89 ,$41.28 ,$42.43 ,$19.21 ,$17.46 ,$41.28 ,$86.70 ,$86.69 ,$86.70 ,$28.56 ,$91.80 ,$41.28 ,$83.64 ,$102.00 ,$102.00 ,$41.28 ,$66.30 ,$102.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100676,84030,HC NEWBORN SCREEN PKU,301,1 ,$157.00 ,$102.05 ,$3.32 ,$157.00 ,$13.75 ,$102.05 ,$93.73 ,$5.50 ,$43.96 ,$88.08 ,$5.50 ,$103.31 ,$5.50 ,$133.45 ,$133.45 ,$5.50 ,$133.45 ,$10.45 ,$106.76 ,$13.75 ,$5.50 ,$5.50 ,$117.75 ,$111.47 ,$111.47 ,$5.50 ,$111.47 ,$128.74 ,$128.74 ,$128.74 , N/A ,$13.75 ,$133.45 ,$5.50 ,$157.00 ,$93.73 ,$5.50 ,$65.31 ,$3.65 ,$3.32 ,$5.50 ,$133.45 ,$11.55 ,$133.45 ,$43.96 ,$141.30 ,$5.50 ,$128.74 ,$22.00 ,$22.00 ,$5.50 ,$102.05 ,$157.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$58.00 ,$37.70 ,$3.32 ,$58.00 ,$12.95 ,$37.70 ,$34.63 ,$5.18 ,$16.24 ,$32.54 ,$5.18 ,$38.16 ,$5.18 ,$49.30 ,$49.30 ,$5.18 ,$49.30 ,$9.84 ,$39.44 ,$12.95 ,$5.18 ,$5.18 ,$43.50 ,$41.18 ,$41.18 ,$5.18 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$12.95 ,$49.30 ,$5.18 ,$58.00 ,$34.63 ,$5.18 ,$24.13 ,$3.65 ,$3.32 ,$5.18 ,$49.30 ,$10.88 ,$49.30 ,$16.24 ,$52.20 ,$5.18 ,$47.56 ,$20.72 ,$20.72 ,$5.18 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100684,84100,HC PHOSPHORUS,301,1 ,$98.00 ,$63.70 ,$3.32 ,$98.00 ,$11.85 ,$63.70 ,$58.51 ,$4.74 ,$27.44 ,$54.98 ,$4.74 ,$64.48 ,$4.74 ,$83.30 ,$83.30 ,$4.74 ,$83.30 ,$9.01 ,$66.64 ,$11.85 ,$4.74 ,$4.74 ,$73.50 ,$69.58 ,$69.58 ,$4.74 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$11.85 ,$83.30 ,$4.74 ,$98.00 ,$58.51 ,$4.74 ,$40.77 ,$3.65 ,$3.32 ,$4.74 ,$83.30 ,$9.95 ,$83.30 ,$27.44 ,$88.20 ,$4.74 ,$80.36 ,$18.96 ,$18.96 ,$4.74 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100691,84132,HC POTASSIUM,301,1 ,$82.00 ,$53.30 ,$3.32 ,$82.00 ,$11.90 ,$53.30 ,$48.95 ,$4.76 ,$22.96 ,$46.00 ,$4.76 ,$53.96 ,$4.76 ,$69.70 ,$69.70 ,$4.76 ,$69.70 ,$9.04 ,$55.76 ,$11.90 ,$4.76 ,$4.76 ,$61.50 ,$58.22 ,$58.22 ,$4.76 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$11.90 ,$69.70 ,$4.76 ,$82.00 ,$48.95 ,$4.76 ,$34.11 ,$3.65 ,$3.32 ,$4.76 ,$69.70 ,$10.00 ,$69.70 ,$22.96 ,$73.80 ,$4.76 ,$67.24 ,$19.04 ,$19.04 ,$4.76 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100694,84133,HC POTASSIUM URINE,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$11.83 ,$60.45 ,$55.52 ,$4.73 ,$26.04 ,$52.17 ,$4.73 ,$61.19 ,$4.73 ,$79.05 ,$79.05 ,$4.73 ,$79.05 ,$8.99 ,$63.24 ,$11.83 ,$4.73 ,$4.73 ,$69.75 ,$66.03 ,$66.03 ,$4.73 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$11.83 ,$79.05 ,$4.73 ,$93.00 ,$55.52 ,$4.73 ,$38.69 ,$3.65 ,$3.32 ,$4.73 ,$79.05 ,$9.93 ,$79.05 ,$26.04 ,$83.70 ,$4.73 ,$76.26 ,$18.92 ,$18.92 ,$4.73 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100698,84153,HC PSA TOTAL,301,1 ,$176.26 ,$114.57 ,$7.46 ,$176.26 ,$45.98 ,$114.57 ,$105.23 ,$18.39 ,$49.35 ,$98.88 ,$18.39 ,$115.98 ,$18.39 ,$149.82 ,$149.82 ,$18.39 ,$149.82 ,$34.94 ,$119.86 ,$45.98 ,$18.39 ,$18.39 ,$132.20 ,$125.14 ,$125.14 ,$18.39 ,$125.14 ,$144.53 ,$144.53 ,$144.53 , N/A ,$45.98 ,$149.82 ,$18.39 ,$176.26 ,$105.23 ,$18.39 ,$73.32 ,$8.21 ,$7.46 ,$18.39 ,$149.82 ,$38.62 ,$149.82 ,$49.35 ,$158.63 ,$18.39 ,$144.53 ,$73.56 ,$73.56 ,$18.39 ,$114.57 ,$176.26 
ST. JOSEPH'S HOSPITAL - BREESE,30100700,84155,HC PROTEIN TOTAL,301,1 ,$58.00 ,$37.70 ,$3.32 ,$58.00 ,$9.18 ,$37.70 ,$34.63 ,$3.67 ,$16.24 ,$32.54 ,$3.67 ,$38.16 ,$3.67 ,$49.30 ,$49.30 ,$3.67 ,$49.30 ,$6.97 ,$39.44 ,$9.18 ,$3.67 ,$3.67 ,$43.50 ,$41.18 ,$41.18 ,$3.67 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$9.18 ,$49.30 ,$3.67 ,$58.00 ,$34.63 ,$3.67 ,$24.13 ,$3.65 ,$3.32 ,$3.67 ,$49.30 ,$7.71 ,$49.30 ,$16.24 ,$52.20 ,$3.67 ,$47.56 ,$14.68 ,$14.68 ,$3.67 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$9.18 ,$60.45 ,$55.52 ,$3.67 ,$26.04 ,$52.17 ,$3.67 ,$61.19 ,$3.67 ,$79.05 ,$79.05 ,$3.67 ,$79.05 ,$6.97 ,$63.24 ,$9.18 ,$3.67 ,$3.67 ,$69.75 ,$66.03 ,$66.03 ,$3.67 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$9.18 ,$79.05 ,$3.67 ,$93.00 ,$55.52 ,$3.67 ,$38.69 ,$3.65 ,$3.32 ,$3.67 ,$79.05 ,$7.71 ,$79.05 ,$26.04 ,$83.70 ,$3.67 ,$76.26 ,$14.68 ,$14.68 ,$3.67 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$10.00 ,$60.45 ,$55.52 ,$4.00 ,$26.04 ,$52.17 ,$4.00 ,$61.19 ,$4.00 ,$79.05 ,$79.05 ,$4.00 ,$79.05 ,$7.60 ,$63.24 ,$10.00 ,$4.00 ,$4.00 ,$69.75 ,$66.03 ,$66.03 ,$4.00 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$10.00 ,$79.05 ,$4.00 ,$93.00 ,$55.52 ,$4.00 ,$38.69 ,$3.65 ,$3.32 ,$4.00 ,$79.05 ,$8.40 ,$79.05 ,$26.04 ,$83.70 ,$4.00 ,$76.26 ,$16.00 ,$16.00 ,$4.00 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100721,84295,HC SODIUM,301,1 ,$82.00 ,$53.30 ,$3.32 ,$82.00 ,$12.03 ,$53.30 ,$48.95 ,$4.81 ,$22.96 ,$46.00 ,$4.81 ,$53.96 ,$4.81 ,$69.70 ,$69.70 ,$4.81 ,$69.70 ,$9.14 ,$55.76 ,$12.03 ,$4.81 ,$4.81 ,$61.50 ,$58.22 ,$58.22 ,$4.81 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$12.03 ,$69.70 ,$4.81 ,$82.00 ,$48.95 ,$4.81 ,$34.11 ,$3.65 ,$3.32 ,$4.81 ,$69.70 ,$10.10 ,$69.70 ,$22.96 ,$73.80 ,$4.81 ,$67.24 ,$19.24 ,$19.24 ,$4.81 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100724,84300,HC SODIUM URINE,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$12.65 ,$60.45 ,$55.52 ,$5.06 ,$26.04 ,$52.17 ,$5.06 ,$61.19 ,$5.06 ,$79.05 ,$79.05 ,$5.06 ,$79.05 ,$9.61 ,$63.24 ,$12.65 ,$5.06 ,$5.06 ,$69.75 ,$66.03 ,$66.03 ,$5.06 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$12.65 ,$79.05 ,$5.06 ,$93.00 ,$55.52 ,$5.06 ,$38.69 ,$3.65 ,$3.32 ,$5.06 ,$79.05 ,$10.63 ,$79.05 ,$26.04 ,$83.70 ,$5.06 ,$76.26 ,$20.24 ,$20.24 ,$5.06 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100740,84439,HC T4 FREE,301,1 ,$102.00 ,$66.30 ,$9.02 ,$102.00 ,$22.55 ,$66.30 ,$60.89 ,$9.02 ,$28.56 ,$57.22 ,$9.02 ,$67.12 ,$9.02 ,$86.70 ,$86.70 ,$9.02 ,$86.70 ,$17.14 ,$69.36 ,$22.55 ,$9.02 ,$9.02 ,$76.50 ,$72.42 ,$72.42 ,$9.02 ,$72.42 ,$83.64 ,$83.64 ,$83.64 , N/A ,$22.55 ,$86.70 ,$9.02 ,$102.00 ,$60.89 ,$9.02 ,$42.43 ,$11.04 ,$10.04 ,$9.02 ,$86.70 ,$18.94 ,$86.70 ,$28.56 ,$91.80 ,$9.02 ,$83.64 ,$36.08 ,$36.08 ,$9.02 ,$66.30 ,$102.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$123.00 ,$79.95 ,$10.04 ,$123.00 ,$42.00 ,$79.95 ,$73.43 ,$16.80 ,$34.44 ,$69.00 ,$16.80 ,$80.93 ,$16.80 ,$104.55 ,$104.55 ,$16.80 ,$104.55 ,$31.92 ,$83.64 ,$42.00 ,$16.80 ,$16.80 ,$92.25 ,$87.33 ,$87.33 ,$16.80 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$42.00 ,$104.55 ,$16.80 ,$123.00 ,$73.43 ,$16.80 ,$51.17 ,$11.04 ,$10.04 ,$16.80 ,$104.55 ,$35.28 ,$104.55 ,$34.44 ,$110.70 ,$16.80 ,$100.86 ,$67.20 ,$67.20 ,$16.80 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100746,84450,HC AST,301,1 ,$96.00 ,$62.40 ,$3.32 ,$96.00 ,$12.95 ,$62.40 ,$57.31 ,$5.18 ,$26.88 ,$53.86 ,$5.18 ,$63.17 ,$5.18 ,$81.60 ,$81.60 ,$5.18 ,$81.60 ,$9.84 ,$65.28 ,$12.95 ,$5.18 ,$5.18 ,$72.00 ,$68.16 ,$68.16 ,$5.18 ,$68.16 ,$78.72 ,$78.72 ,$78.72 , N/A ,$12.95 ,$81.60 ,$5.18 ,$96.00 ,$57.31 ,$5.18 ,$39.94 ,$3.65 ,$3.32 ,$5.18 ,$81.60 ,$10.88 ,$81.60 ,$26.88 ,$86.40 ,$5.18 ,$78.72 ,$20.72 ,$20.72 ,$5.18 ,$62.40 ,$96.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100747,84460,HC ALT,301,1 ,$103.00 ,$66.95 ,$3.32 ,$103.00 ,$13.25 ,$66.95 ,$61.49 ,$5.30 ,$28.84 ,$57.78 ,$5.30 ,$67.77 ,$5.30 ,$87.55 ,$87.55 ,$5.30 ,$87.55 ,$10.07 ,$70.04 ,$13.25 ,$5.30 ,$5.30 ,$77.25 ,$73.13 ,$73.13 ,$5.30 ,$73.13 ,$84.46 ,$84.46 ,$84.46 , N/A ,$13.25 ,$87.55 ,$5.30 ,$103.00 ,$61.49 ,$5.30 ,$42.85 ,$3.65 ,$3.32 ,$5.30 ,$87.55 ,$11.13 ,$87.55 ,$28.84 ,$92.70 ,$5.30 ,$84.46 ,$21.20 ,$21.20 ,$5.30 ,$66.95 ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100750,84478,HC TRIGLYCERIDES,301,1 ,$90.00 ,$58.50 ,$3.32 ,$90.00 ,$14.35 ,$58.50 ,$53.73 ,$5.74 ,$25.20 ,$50.49 ,$5.74 ,$59.22 ,$5.74 ,$76.50 ,$76.50 ,$5.74 ,$76.50 ,$10.91 ,$61.20 ,$14.35 ,$5.74 ,$5.74 ,$67.50 ,$63.90 ,$63.90 ,$5.74 ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A ,$14.35 ,$76.50 ,$5.74 ,$90.00 ,$53.73 ,$5.74 ,$37.44 ,$3.65 ,$3.32 ,$5.74 ,$76.50 ,$12.05 ,$76.50 ,$25.20 ,$81.00 ,$5.74 ,$73.80 ,$22.96 ,$22.96 ,$5.74 ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100755,84481,HC T3 FREE,301,1 ,$127.00 ,$82.55 ,$10.04 ,$127.00 ,$42.35 ,$82.55 ,$75.82 ,$16.94 ,$35.56 ,$71.25 ,$16.94 ,$83.57 ,$16.94 ,$107.95 ,$107.95 ,$16.94 ,$107.95 ,$32.19 ,$86.36 ,$42.35 ,$16.94 ,$16.94 ,$95.25 ,$90.17 ,$90.17 ,$16.94 ,$90.17 ,$104.14 ,$104.14 ,$104.14 , N/A ,$42.35 ,$107.95 ,$16.94 ,$127.00 ,$75.82 ,$16.94 ,$52.83 ,$11.04 ,$10.04 ,$16.94 ,$107.95 ,$35.57 ,$107.95 ,$35.56 ,$114.30 ,$16.94 ,$104.14 ,$67.76 ,$67.76 ,$16.94 ,$82.55 ,$127.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100758,84484,HC TROPONIN QN,301,1 ,$212.00 ,$137.80 ,$7.46 ,$212.00 ,$31.18 ,$137.80 ,$126.56 ,$12.47 ,$59.36 ,$118.93 ,$12.47 ,$139.50 ,$12.47 ,$180.20 ,$180.20 ,$12.47 ,$180.20 ,$23.69 ,$144.16 ,$31.18 ,$12.47 ,$12.47 ,$159.00 ,$150.52 ,$150.52 ,$12.47 ,$150.52 ,$173.84 ,$173.84 ,$173.84 , N/A ,$31.18 ,$180.20 ,$12.47 ,$212.00 ,$126.56 ,$12.47 ,$88.19 ,$8.21 ,$7.46 ,$12.47 ,$180.20 ,$26.19 ,$180.20 ,$59.36 ,$190.80 ,$12.47 ,$173.84 ,$49.88 ,$49.88 ,$12.47 ,$137.80 ,$212.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100761,84520,HC BUN,301,1 ,$65.00 ,$42.25 ,$3.32 ,$65.00 ,$9.88 ,$42.25 ,$38.81 ,$3.95 ,$18.20 ,$36.47 ,$3.95 ,$42.77 ,$3.95 ,$55.25 ,$55.25 ,$3.95 ,$55.25 ,$7.51 ,$44.20 ,$9.88 ,$3.95 ,$3.95 ,$48.75 ,$46.15 ,$46.15 ,$3.95 ,$46.15 ,$53.30 ,$53.30 ,$53.30 , N/A ,$9.88 ,$55.25 ,$3.95 ,$3.95 ,$38.81 ,$3.95 ,$27.04 ,$3.65 ,$3.32 ,$3.95 ,$55.25 ,$8.30 ,$55.25 ,$18.20 ,$58.50 ,$3.95 ,$53.30 ,$15.80 ,$15.80 ,$3.95 ,$42.25 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100765,84550,HC URIC ACID,301,1 ,$100.00 ,$65.00 ,$3.32 ,$100.00 ,$11.30 ,$65.00 ,$59.70 ,$4.52 ,$28.00 ,$56.10 ,$4.52 ,$65.80 ,$4.52 ,$85.00 ,$85.00 ,$4.52 ,$85.00 ,$8.59 ,$68.00 ,$11.30 ,$4.52 ,$4.52 ,$75.00 ,$71.00 ,$71.00 ,$4.52 ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A ,$11.30 ,$85.00 ,$4.52 ,$100.00 ,$59.70 ,$4.52 ,$41.60 ,$3.65 ,$3.32 ,$4.52 ,$85.00 ,$9.49 ,$85.00 ,$28.00 ,$90.00 ,$4.52 ,$82.00 ,$18.08 ,$18.08 ,$4.52 ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100802,84702,HC HCG QN,301,1 ,$193.00 ,$125.45 ,$10.04 ,$193.00 ,$37.63 ,$125.45 ,$115.22 ,$15.05 ,$54.04 ,$108.27 ,$15.05 ,$126.99 ,$15.05 ,$164.05 ,$164.05 ,$15.05 ,$164.05 ,$28.60 ,$131.24 ,$37.63 ,$15.05 ,$15.05 ,$144.75 ,$137.03 ,$137.03 ,$15.05 ,$137.03 ,$158.26 ,$158.26 ,$158.26 , N/A ,$37.63 ,$164.05 ,$15.05 ,$193.00 ,$115.22 ,$15.05 ,$80.29 ,$11.04 ,$10.04 ,$15.05 ,$164.05 ,$31.61 ,$164.05 ,$54.04 ,$173.70 ,$15.05 ,$158.26 ,$60.20 ,$60.20 ,$15.05 ,$125.45 ,$193.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100808,84703,HC HCG QL,301,1 ,$102.00 ,$66.30 ,$7.46 ,$102.00 ,$18.80 ,$66.30 ,$60.89 ,$7.52 ,$28.56 ,$57.22 ,$7.52 ,$67.12 ,$7.52 ,$86.70 ,$86.70 ,$7.52 ,$86.70 ,$14.29 ,$69.36 ,$18.80 ,$7.52 ,$7.52 ,$76.50 ,$72.42 ,$72.42 ,$7.52 ,$72.42 ,$83.64 ,$83.64 ,$83.64 , N/A ,$18.80 ,$86.70 ,$7.52 ,$102.00 ,$60.89 ,$7.52 ,$42.43 ,$8.21 ,$7.46 ,$7.52 ,$86.70 ,$15.79 ,$86.70 ,$28.56 ,$91.80 ,$7.52 ,$83.64 ,$30.08 ,$30.08 ,$7.52 ,$66.30 ,$102.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100810,88720,HC BILICHECK TEST,301,1 ,$27.00 ,$17.55 ,$3.32 ,$27.00 ,$12.55 ,$17.55 ,$16.12 ,$5.02 ,$7.56 ,$15.15 ,$5.02 ,$17.77 ,$5.02 ,$22.95 ,$22.95 ,$5.02 ,$22.95 ,$9.54 ,$18.36 ,$12.55 ,$5.02 ,$5.02 ,$20.25 ,$19.17 ,$19.17 ,$5.02 ,$19.17 ,$22.14 ,$22.14 ,$22.14 , N/A ,$12.55 ,$22.95 ,$5.02 ,$27.00 ,$16.12 ,$5.02 ,$11.23 ,$3.65 ,$3.32 ,$5.02 ,$22.95 ,$10.54 ,$22.95 ,$7.56 ,$24.30 ,$5.02 ,$22.14 ,$20.08 ,$20.08 ,$5.02 ,$17.55 ,$27.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100838,83033,HC FETAL HGB QI,301,1 ,$72.00 ,$46.80 ,$7.46 ,$72.00 ,$20.00 ,$46.80 ,$42.98 ,$8.00 ,$20.16 ,$40.39 ,$8.00 ,$47.38 ,$8.00 ,$61.20 ,$61.20 ,$8.00 ,$61.20 ,$15.20 ,$48.96 ,$20.00 ,$8.00 ,$8.00 ,$54.00 ,$51.12 ,$51.12 ,$8.00 ,$51.12 ,$59.04 ,$59.04 ,$59.04 , N/A ,$20.00 ,$61.20 ,$8.00 ,$72.00 ,$42.98 ,$8.00 ,$29.95 ,$8.21 ,$7.46 ,$8.00 ,$61.20 ,$16.80 ,$61.20 ,$20.16 ,$64.80 ,$8.00 ,$59.04 ,$32.00 ,$32.00 ,$8.00 ,$46.80 ,$72.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100845,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$42.00 ,$27.30 ,$1.68 ,$42.00 ,$12.60 ,$27.30 ,$25.07 ,$5.04 ,$11.76 ,$23.56 ,$5.04 ,$27.64 ,$5.04 ,$35.70 ,$35.70 ,$5.04 ,$35.70 ,$9.58 ,$28.56 ,$12.60 ,$5.04 ,$5.04 ,$31.50 ,$29.82 ,$29.82 ,$5.04 ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A ,$12.60 ,$35.70 ,$5.04 ,$42.00 ,$25.07 ,$5.04 ,$17.47 ,$1.85 ,$1.68 ,$5.04 ,$35.70 ,$10.58 ,$35.70 ,$11.76 ,$37.80 ,$5.04 ,$34.44 ,$20.16 ,$20.16 ,$5.04 ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,30100993,80055,HC PRENATAL PANEL,301,1 ,$352.00 ,$228.80 ,$6.80 ,$352.00 ,$119.53 ,$228.80 ,$210.14 ,$47.81 ,$98.56 ,$197.47 ,$47.81 ,$231.62 ,$47.81 ,$299.20 ,$299.20 ,$47.81 ,$299.20 ,$90.84 ,$239.36 ,$119.53 ,$47.81 ,$47.81 ,$264.00 ,$249.92 ,$249.92 ,$47.81 ,$249.92 ,$288.64 ,$288.64 ,$288.64 , N/A ,$119.53 ,$299.20 ,$47.81 ,$352.00 ,$210.14 ,$47.81 ,$146.43 ,$7.48 ,$6.80 ,$47.81 ,$299.20 ,$100.40 ,$299.20 ,$98.56 ,$316.80 ,$47.81 ,$288.64 ,$191.24 ,$191.24 ,$47.81 ,$228.80 ,$352.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101011,83630,HC LACTOFERRIN FECAL QL,301,1 ,$59.10 ,$38.42 ,$7.46 ,$59.10 ,$49.25 ,$38.42 ,$35.28 ,$19.70 ,$16.55 ,$33.16 ,$19.70 ,$38.89 ,$19.70 ,$50.24 ,$50.24 ,$19.70 ,$50.24 ,$37.43 ,$40.19 ,$49.25 ,$19.70 ,$19.70 ,$44.33 ,$41.96 ,$41.96 ,$19.70 ,$41.96 ,$48.46 ,$48.46 ,$48.46 , N/A ,$49.25 ,$50.24 ,$19.70 ,$59.10 ,$35.28 ,$19.70 ,$24.59 ,$8.21 ,$7.46 ,$19.70 ,$50.24 ,$41.37 ,$50.24 ,$16.55 ,$53.19 ,$19.70 ,$48.46 ,$59.10 ,$59.10 ,$19.70 ,$38.42 ,$59.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$223.00 ,$144.95 ,$7.46 ,$223.00 ,$48.28 ,$144.95 ,$133.13 ,$19.31 ,$62.44 ,$125.10 ,$19.31 ,$146.73 ,$19.31 ,$189.55 ,$189.55 ,$19.31 ,$189.55 ,$36.69 ,$151.64 ,$48.28 ,$19.31 ,$19.31 ,$167.25 ,$158.33 ,$158.33 ,$19.31 ,$158.33 ,$182.86 ,$182.86 ,$182.86 , N/A ,$48.28 ,$189.55 ,$19.31 ,$223.00 ,$133.13 ,$19.31 ,$92.77 ,$8.21 ,$7.46 ,$19.31 ,$189.55 ,$40.55 ,$189.55 ,$62.44 ,$200.70 ,$19.31 ,$182.86 ,$77.24 ,$77.24 ,$19.31 ,$144.95 ,$223.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101063,83519,HC ACETYLCHOLINE RECEPTR AB TIER 1-90,301,1 ,$56.00 ,$36.40 ,$6.68 ,$56.00 ,$46.00 ,$36.40 ,$33.43 ,$18.40 ,$15.68 ,$31.42 ,$18.40 ,$36.85 ,$18.40 ,$47.60 ,$47.60 ,$18.40 ,$47.60 ,$34.96 ,$38.08 ,$46.00 ,$18.40 ,$18.40 ,$42.00 ,$39.76 ,$39.76 ,$18.40 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$46.00 ,$47.60 ,$18.40 ,$56.00 ,$33.43 ,$18.40 ,$23.30 ,$7.35 ,$6.68 ,$18.40 ,$47.60 ,$38.64 ,$47.60 ,$15.68 ,$50.40 ,$18.40 ,$45.92 ,$56.00 ,$56.00 ,$18.40 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101075,80048,HC BASIC METABOLIC PANEL,301,1 ,$330.00 ,$214.50 ,$6.80 ,$330.00 ,$21.15 ,$214.50 ,$197.01 ,$8.46 ,$92.40 ,$185.13 ,$8.46 ,$217.14 ,$8.46 ,$280.50 ,$280.50 ,$8.46 ,$280.50 ,$16.07 ,$224.40 ,$21.15 ,$8.46 ,$8.46 ,$247.50 ,$234.30 ,$234.30 ,$8.46 ,$234.30 ,$270.60 ,$270.60 ,$270.60 , N/A ,$21.15 ,$280.50 ,$8.46 ,$8.46 ,$197.01 ,$8.46 ,$137.28 ,$7.48 ,$6.80 ,$8.46 ,$280.50 ,$17.77 ,$280.50 ,$92.40 ,$297.00 ,$8.46 ,$270.60 ,$33.84 ,$33.84 ,$8.46 ,$214.50 ,$330.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101078,80051,HC ELECTROLYTE PANEL,301,1 ,$243.00 ,$157.95 ,$6.80 ,$243.00 ,$17.53 ,$157.95 ,$145.07 ,$7.01 ,$68.04 ,$136.32 ,$7.01 ,$159.89 ,$7.01 ,$206.55 ,$206.55 ,$7.01 ,$206.55 ,$13.32 ,$165.24 ,$17.53 ,$7.01 ,$7.01 ,$182.25 ,$172.53 ,$172.53 ,$7.01 ,$172.53 ,$199.26 ,$199.26 ,$199.26 , N/A ,$17.53 ,$206.55 ,$7.01 ,$243.00 ,$145.07 ,$7.01 ,$101.09 ,$7.48 ,$6.80 ,$7.01 ,$206.55 ,$14.72 ,$206.55 ,$68.04 ,$218.70 ,$7.01 ,$199.26 ,$28.04 ,$28.04 ,$7.01 ,$157.95 ,$243.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101080,80053,HC COMPREHENSIVE METABOLIC PANEL,301,1 ,$389.00 ,$252.85 ,$6.80 ,$389.00 ,$26.40 ,$252.85 ,$232.23 ,$10.56 ,$108.92 ,$218.23 ,$10.56 ,$255.96 ,$10.56 ,$330.65 ,$330.65 ,$10.56 ,$330.65 ,$20.06 ,$264.52 ,$26.40 ,$10.56 ,$10.56 ,$291.75 ,$276.19 ,$276.19 ,$10.56 ,$276.19 ,$318.98 ,$318.98 ,$318.98 , N/A ,$26.40 ,$330.65 ,$10.56 ,$10.56 ,$232.23 ,$10.56 ,$161.82 ,$7.48 ,$6.80 ,$10.56 ,$330.65 ,$22.18 ,$330.65 ,$108.92 ,$350.10 ,$10.56 ,$318.98 ,$42.24 ,$42.24 ,$10.56 ,$252.85 ,$389.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101082,80061,HC LIPID PANEL,301,1 ,$296.00 ,$192.40 ,$6.80 ,$296.00 ,$33.48 ,$192.40 ,$176.71 ,$13.39 ,$82.88 ,$166.06 ,$13.39 ,$194.77 ,$13.39 ,$251.60 ,$251.60 ,$13.39 ,$251.60 ,$25.44 ,$201.28 ,$33.48 ,$13.39 ,$13.39 ,$222.00 ,$210.16 ,$210.16 ,$13.39 ,$210.16 ,$242.72 ,$242.72 ,$242.72 , N/A ,$33.48 ,$251.60 ,$13.39 ,$296.00 ,$176.71 ,$13.39 ,$123.14 ,$7.48 ,$6.80 ,$13.39 ,$251.60 ,$28.12 ,$251.60 ,$82.88 ,$266.40 ,$13.39 ,$242.72 ,$53.56 ,$53.56 ,$13.39 ,$192.40 ,$296.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101084,80069,HC RENAL PANEL,301,1 ,$274.00 ,$178.10 ,$6.80 ,$274.00 ,$21.70 ,$178.10 ,$163.58 ,$8.68 ,$76.72 ,$153.71 ,$8.68 ,$180.29 ,$8.68 ,$232.90 ,$232.90 ,$8.68 ,$232.90 ,$16.49 ,$186.32 ,$21.70 ,$8.68 ,$8.68 ,$205.50 ,$194.54 ,$194.54 ,$8.68 ,$194.54 ,$224.68 ,$224.68 ,$224.68 , N/A ,$21.70 ,$232.90 ,$8.68 ,$274.00 ,$163.58 ,$8.68 ,$113.98 ,$7.48 ,$6.80 ,$8.68 ,$232.90 ,$18.23 ,$232.90 ,$76.72 ,$246.60 ,$8.68 ,$224.68 ,$34.72 ,$34.72 ,$8.68 ,$178.10 ,$274.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101088,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$331.00 ,$215.15 ,$6.80 ,$331.00 ,$20.43 ,$215.15 ,$197.61 ,$8.17 ,$92.68 ,$185.69 ,$8.17 ,$217.80 ,$8.17 ,$281.35 ,$281.35 ,$8.17 ,$281.35 ,$15.52 ,$225.08 ,$20.43 ,$8.17 ,$8.17 ,$248.25 ,$235.01 ,$235.01 ,$8.17 ,$235.01 ,$271.42 ,$271.42 ,$271.42 , N/A ,$20.43 ,$281.35 ,$8.17 ,$331.00 ,$197.61 ,$8.17 ,$137.70 ,$7.48 ,$6.80 ,$8.17 ,$281.35 ,$17.16 ,$281.35 ,$92.68 ,$297.90 ,$8.17 ,$271.42 ,$32.68 ,$32.68 ,$8.17 ,$215.15 ,$331.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101089,80150,HC AMIKACIN - 90,301,1 ,$67.00 ,$43.55 ,$8.56 ,$67.00 ,$37.70 ,$43.55 ,$40.00 ,$15.08 ,$18.76 ,$37.59 ,$15.08 ,$44.09 ,$15.08 ,$56.95 ,$56.95 ,$15.08 ,$56.95 ,$28.65 ,$45.56 ,$37.70 ,$15.08 ,$15.08 ,$50.25 ,$47.57 ,$47.57 ,$15.08 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$37.70 ,$56.95 ,$15.08 ,$67.00 ,$40.00 ,$15.08 ,$27.87 ,$9.42 ,$8.56 ,$15.08 ,$56.95 ,$31.67 ,$56.95 ,$18.76 ,$60.30 ,$15.08 ,$54.94 ,$60.32 ,$60.32 ,$15.08 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101091,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$170.00 ,$110.50 ,$8.56 ,$170.00 ,$36.43 ,$110.50 ,$101.49 ,$14.57 ,$47.60 ,$95.37 ,$14.57 ,$111.86 ,$14.57 ,$144.50 ,$144.50 ,$14.57 ,$144.50 ,$27.68 ,$115.60 ,$36.43 ,$14.57 ,$14.57 ,$127.50 ,$120.70 ,$120.70 ,$14.57 ,$120.70 ,$139.40 ,$139.40 ,$139.40 , N/A ,$36.43 ,$144.50 ,$14.57 ,$170.00 ,$101.49 ,$14.57 ,$70.72 ,$9.42 ,$8.56 ,$14.57 ,$144.50 ,$30.60 ,$144.50 ,$47.60 ,$153.00 ,$14.57 ,$139.40 ,$58.28 ,$58.28 ,$14.57 ,$110.50 ,$170.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101093,80157,HC CARBAMAZEPINE FREE - 90,301,1 ,$90.00 ,$58.50 ,$8.56 ,$90.00 ,$33.13 ,$58.50 ,$53.73 ,$13.25 ,$25.20 ,$50.49 ,$13.25 ,$59.22 ,$13.25 ,$76.50 ,$76.50 ,$13.25 ,$76.50 ,$25.18 ,$61.20 ,$33.13 ,$13.25 ,$13.25 ,$67.50 ,$63.90 ,$63.90 ,$13.25 ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A ,$33.13 ,$76.50 ,$13.25 ,$90.00 ,$53.73 ,$13.25 ,$37.44 ,$9.42 ,$8.56 ,$13.25 ,$76.50 ,$27.83 ,$76.50 ,$25.20 ,$81.00 ,$13.25 ,$73.80 ,$53.00 ,$53.00 ,$13.25 ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101094,80158,HC CYCLOSPORINE - 90,301,1 ,$71.00 ,$46.15 ,$8.56 ,$71.00 ,$45.13 ,$46.15 ,$42.39 ,$18.05 ,$19.88 ,$39.83 ,$18.05 ,$46.72 ,$18.05 ,$60.35 ,$60.35 ,$18.05 ,$60.35 ,$34.30 ,$48.28 ,$45.13 ,$18.05 ,$18.05 ,$53.25 ,$50.41 ,$50.41 ,$18.05 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$45.13 ,$60.35 ,$18.05 ,$71.00 ,$42.39 ,$18.05 ,$29.54 ,$9.42 ,$8.56 ,$18.05 ,$60.35 ,$37.91 ,$60.35 ,$19.88 ,$63.90 ,$18.05 ,$58.22 ,$71.00 ,$71.00 ,$18.05 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101096,80162,HC DIGOXIN LEVELS,301,1 ,$143.00 ,$92.95 ,$8.56 ,$143.00 ,$33.20 ,$92.95 ,$85.37 ,$13.28 ,$40.04 ,$80.22 ,$13.28 ,$94.09 ,$13.28 ,$121.55 ,$121.55 ,$13.28 ,$121.55 ,$25.23 ,$97.24 ,$33.20 ,$13.28 ,$13.28 ,$107.25 ,$101.53 ,$101.53 ,$13.28 ,$101.53 ,$117.26 ,$117.26 ,$117.26 , N/A ,$33.20 ,$121.55 ,$13.28 ,$143.00 ,$85.37 ,$13.28 ,$59.49 ,$9.42 ,$8.56 ,$13.28 ,$121.55 ,$27.89 ,$121.55 ,$40.04 ,$128.70 ,$13.28 ,$117.26 ,$53.12 ,$53.12 ,$13.28 ,$92.95 ,$143.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101099,80168,HC ETHOSUXIMIDE - 90,301,1 ,$58.00 ,$37.70 ,$8.56 ,$58.00 ,$40.85 ,$37.70 ,$34.63 ,$16.34 ,$16.24 ,$32.54 ,$16.34 ,$38.16 ,$16.34 ,$49.30 ,$49.30 ,$16.34 ,$49.30 ,$31.05 ,$39.44 ,$40.85 ,$16.34 ,$16.34 ,$43.50 ,$41.18 ,$41.18 ,$16.34 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$40.85 ,$49.30 ,$16.34 ,$58.00 ,$34.63 ,$16.34 ,$24.13 ,$9.42 ,$8.56 ,$16.34 ,$49.30 ,$34.31 ,$49.30 ,$16.24 ,$52.20 ,$16.34 ,$47.56 ,$58.00 ,$58.00 ,$16.34 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101100,80169,HC EVEROLIMUS - 90,301,1 ,$151.00 ,$98.15 ,$8.56 ,$151.00 ,$34.33 ,$98.15 ,$90.15 ,$13.73 ,$42.28 ,$84.71 ,$13.73 ,$99.36 ,$13.73 ,$128.35 ,$128.35 ,$13.73 ,$128.35 ,$26.09 ,$102.68 ,$34.33 ,$13.73 ,$13.73 ,$113.25 ,$107.21 ,$107.21 ,$13.73 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$34.33 ,$128.35 ,$13.73 ,$151.00 ,$90.15 ,$13.73 ,$62.82 ,$9.42 ,$8.56 ,$13.73 ,$128.35 ,$28.83 ,$128.35 ,$42.28 ,$135.90 ,$13.73 ,$123.82 ,$54.92 ,$54.92 ,$13.73 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101102,80171,HC GABAPENTIN PLASMA - 90,301,1 ,$148.00 ,$96.20 ,$8.56 ,$148.00 ,$54.18 ,$96.20 ,$88.36 ,$21.67 ,$41.44 ,$83.03 ,$21.67 ,$97.38 ,$21.67 ,$125.80 ,$125.80 ,$21.67 ,$125.80 ,$41.17 ,$100.64 ,$54.18 ,$21.67 ,$21.67 ,$111.00 ,$105.08 ,$105.08 ,$21.67 ,$105.08 ,$121.36 ,$121.36 ,$121.36 , N/A ,$54.18 ,$125.80 ,$21.67 ,$148.00 ,$88.36 ,$21.67 ,$61.57 ,$9.42 ,$8.56 ,$21.67 ,$125.80 ,$45.51 ,$125.80 ,$41.44 ,$133.20 ,$21.67 ,$121.36 ,$86.68 ,$86.68 ,$21.67 ,$96.20 ,$148.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101104,80175,HC LAMOTRIGINE - 90,301,1 ,$151.00 ,$98.15 ,$8.56 ,$151.00 ,$33.13 ,$98.15 ,$90.15 ,$13.25 ,$42.28 ,$84.71 ,$13.25 ,$99.36 ,$13.25 ,$128.35 ,$128.35 ,$13.25 ,$128.35 ,$25.18 ,$102.68 ,$33.13 ,$13.25 ,$13.25 ,$113.25 ,$107.21 ,$107.21 ,$13.25 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$33.13 ,$128.35 ,$13.25 ,$151.00 ,$90.15 ,$13.25 ,$62.82 ,$9.42 ,$8.56 ,$13.25 ,$128.35 ,$27.83 ,$128.35 ,$42.28 ,$135.90 ,$13.25 ,$123.82 ,$53.00 ,$53.00 ,$13.25 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101106,80177,HC LEVETIRACETAM - 90,301,1 ,$151.00 ,$98.15 ,$8.56 ,$151.00 ,$33.13 ,$98.15 ,$90.15 ,$13.25 ,$42.28 ,$84.71 ,$13.25 ,$99.36 ,$13.25 ,$128.35 ,$128.35 ,$13.25 ,$128.35 ,$25.18 ,$102.68 ,$33.13 ,$13.25 ,$13.25 ,$113.25 ,$107.21 ,$107.21 ,$13.25 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$33.13 ,$128.35 ,$13.25 ,$151.00 ,$90.15 ,$13.25 ,$62.82 ,$9.42 ,$8.56 ,$13.25 ,$128.35 ,$27.83 ,$128.35 ,$42.28 ,$135.90 ,$13.25 ,$123.82 ,$53.00 ,$53.00 ,$13.25 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101107,80178,HC LITHIUM,301,1 ,$114.00 ,$74.10 ,$6.61 ,$114.00 ,$16.53 ,$74.10 ,$68.06 ,$6.61 ,$31.92 ,$63.95 ,$6.61 ,$75.01 ,$6.61 ,$96.90 ,$96.90 ,$6.61 ,$96.90 ,$12.56 ,$77.52 ,$16.53 ,$6.61 ,$6.61 ,$85.50 ,$80.94 ,$80.94 ,$6.61 ,$80.94 ,$93.48 ,$93.48 ,$93.48 , N/A ,$16.53 ,$96.90 ,$6.61 ,$114.00 ,$68.06 ,$6.61 ,$47.42 ,$9.42 ,$8.56 ,$6.61 ,$96.90 ,$13.88 ,$96.90 ,$31.92 ,$102.60 ,$6.61 ,$93.48 ,$26.44 ,$26.44 ,$6.61 ,$74.10 ,$114.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101109,80183,HC OXCARBAZEPINE - 90,301,1 ,$53.00 ,$34.45 ,$8.56 ,$53.00 ,$33.13 ,$34.45 ,$31.64 ,$13.25 ,$14.84 ,$29.73 ,$13.25 ,$34.87 ,$13.25 ,$45.05 ,$45.05 ,$13.25 ,$45.05 ,$25.18 ,$36.04 ,$33.13 ,$13.25 ,$13.25 ,$39.75 ,$37.63 ,$37.63 ,$13.25 ,$37.63 ,$43.46 ,$43.46 ,$43.46 , N/A ,$33.13 ,$45.05 ,$13.25 ,$53.00 ,$31.64 ,$13.25 ,$22.05 ,$9.42 ,$8.56 ,$13.25 ,$45.05 ,$27.83 ,$45.05 ,$14.84 ,$47.70 ,$13.25 ,$43.46 ,$53.00 ,$53.00 ,$13.25 ,$34.45 ,$53.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101111,80184,HC PHENOBARBITAL,301,1 ,$164.00 ,$106.60 ,$8.56 ,$164.00 ,$38.25 ,$106.60 ,$97.91 ,$15.30 ,$45.92 ,$92.00 ,$15.30 ,$107.91 ,$15.30 ,$139.40 ,$139.40 ,$15.30 ,$139.40 ,$29.07 ,$111.52 ,$38.25 ,$15.30 ,$15.30 ,$123.00 ,$116.44 ,$116.44 ,$15.30 ,$116.44 ,$134.48 ,$134.48 ,$134.48 , N/A ,$38.25 ,$139.40 ,$15.30 ,$164.00 ,$97.91 ,$15.30 ,$68.22 ,$9.42 ,$8.56 ,$15.30 ,$139.40 ,$32.13 ,$139.40 ,$45.92 ,$147.60 ,$15.30 ,$134.48 ,$61.20 ,$61.20 ,$15.30 ,$106.60 ,$164.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101112,80185,HC PHENYTOIN TOTAL,301,1 ,$156.00 ,$101.40 ,$8.56 ,$156.00 ,$33.13 ,$101.40 ,$93.13 ,$13.25 ,$43.68 ,$87.52 ,$13.25 ,$102.65 ,$13.25 ,$132.60 ,$132.60 ,$13.25 ,$132.60 ,$25.18 ,$106.08 ,$33.13 ,$13.25 ,$13.25 ,$117.00 ,$110.76 ,$110.76 ,$13.25 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$33.13 ,$132.60 ,$13.25 ,$156.00 ,$93.13 ,$13.25 ,$64.90 ,$9.42 ,$8.56 ,$13.25 ,$132.60 ,$27.83 ,$132.60 ,$43.68 ,$140.40 ,$13.25 ,$127.92 ,$53.00 ,$53.00 ,$13.25 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101114,80186,HC PHENYTOIN FREE - 90,301,1 ,$58.00 ,$37.70 ,$8.56 ,$58.00 ,$34.40 ,$37.70 ,$34.63 ,$13.76 ,$16.24 ,$32.54 ,$13.76 ,$38.16 ,$13.76 ,$49.30 ,$49.30 ,$13.76 ,$49.30 ,$26.14 ,$39.44 ,$34.40 ,$13.76 ,$13.76 ,$43.50 ,$41.18 ,$41.18 ,$13.76 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$34.40 ,$49.30 ,$13.76 ,$58.00 ,$34.63 ,$13.76 ,$24.13 ,$9.42 ,$8.56 ,$13.76 ,$49.30 ,$28.90 ,$49.30 ,$16.24 ,$52.20 ,$13.76 ,$47.56 ,$55.04 ,$55.04 ,$13.76 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101115,80188,HC PRIMIDONE - 90,301,1 ,$64.00 ,$41.60 ,$8.56 ,$64.00 ,$41.48 ,$41.60 ,$38.21 ,$16.59 ,$17.92 ,$35.90 ,$16.59 ,$42.11 ,$16.59 ,$54.40 ,$54.40 ,$16.59 ,$54.40 ,$31.52 ,$43.52 ,$41.48 ,$16.59 ,$16.59 ,$48.00 ,$45.44 ,$45.44 ,$16.59 ,$45.44 ,$52.48 ,$52.48 ,$52.48 , N/A ,$41.48 ,$54.40 ,$16.59 ,$64.00 ,$38.21 ,$16.59 ,$26.62 ,$9.42 ,$8.56 ,$16.59 ,$54.40 ,$34.84 ,$54.40 ,$17.92 ,$57.60 ,$16.59 ,$52.48 ,$64.00 ,$64.00 ,$16.59 ,$41.60 ,$64.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101116,80192,HC PROCAINEAMIDE - 90,301,1 ,$59.00 ,$38.35 ,$8.56 ,$59.00 ,$41.88 ,$38.35 ,$35.22 ,$16.75 ,$16.52 ,$33.10 ,$16.75 ,$38.82 ,$16.75 ,$50.15 ,$50.15 ,$16.75 ,$50.15 ,$31.83 ,$40.12 ,$41.88 ,$16.75 ,$16.75 ,$44.25 ,$41.89 ,$41.89 ,$16.75 ,$41.89 ,$48.38 ,$48.38 ,$48.38 , N/A ,$41.88 ,$50.15 ,$16.75 ,$59.00 ,$35.22 ,$16.75 ,$24.54 ,$9.42 ,$8.56 ,$16.75 ,$50.15 ,$35.18 ,$50.15 ,$16.52 ,$53.10 ,$16.75 ,$48.38 ,$59.00 ,$59.00 ,$16.75 ,$38.35 ,$59.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101118,80195,HC RAPAMYCIN (SIROLIMUS) - 90,301,1 ,$90.00 ,$58.50 ,$8.56 ,$90.00 ,$34.33 ,$58.50 ,$53.73 ,$13.73 ,$25.20 ,$50.49 ,$13.73 ,$59.22 ,$13.73 ,$76.50 ,$76.50 ,$13.73 ,$76.50 ,$26.09 ,$61.20 ,$34.33 ,$13.73 ,$13.73 ,$67.50 ,$63.90 ,$63.90 ,$13.73 ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A ,$34.33 ,$76.50 ,$13.73 ,$90.00 ,$53.73 ,$13.73 ,$37.44 ,$9.42 ,$8.56 ,$13.73 ,$76.50 ,$28.83 ,$76.50 ,$25.20 ,$81.00 ,$13.73 ,$73.80 ,$54.92 ,$54.92 ,$13.73 ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101119,80197,HC TACROLIMUS - 90,301,1 ,$110.00 ,$71.50 ,$8.56 ,$110.00 ,$34.33 ,$71.50 ,$65.67 ,$13.73 ,$30.80 ,$61.71 ,$13.73 ,$72.38 ,$13.73 ,$93.50 ,$93.50 ,$13.73 ,$93.50 ,$26.09 ,$74.80 ,$34.33 ,$13.73 ,$13.73 ,$82.50 ,$78.10 ,$78.10 ,$13.73 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$34.33 ,$93.50 ,$13.73 ,$110.00 ,$65.67 ,$13.73 ,$45.76 ,$9.42 ,$8.56 ,$13.73 ,$93.50 ,$28.83 ,$93.50 ,$30.80 ,$99.00 ,$13.73 ,$90.20 ,$54.92 ,$54.92 ,$13.73 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101120,80198,HC THEOPHYLLINE,301,1 ,$155.00 ,$100.75 ,$8.56 ,$155.00 ,$35.35 ,$100.75 ,$92.54 ,$14.14 ,$43.40 ,$86.96 ,$14.14 ,$101.99 ,$14.14 ,$131.75 ,$131.75 ,$14.14 ,$131.75 ,$26.87 ,$105.40 ,$35.35 ,$14.14 ,$14.14 ,$116.25 ,$110.05 ,$110.05 ,$14.14 ,$110.05 ,$127.10 ,$127.10 ,$127.10 , N/A ,$35.35 ,$131.75 ,$14.14 ,$155.00 ,$92.54 ,$14.14 ,$64.48 ,$9.42 ,$8.56 ,$14.14 ,$131.75 ,$29.69 ,$131.75 ,$43.40 ,$139.50 ,$14.14 ,$127.10 ,$56.56 ,$56.56 ,$14.14 ,$100.75 ,$155.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101124,80201,HC TOPIRAMATE - 90,301,1 ,$121.00 ,$78.65 ,$8.56 ,$121.00 ,$29.80 ,$78.65 ,$72.24 ,$11.92 ,$33.88 ,$67.88 ,$11.92 ,$79.62 ,$11.92 ,$102.85 ,$102.85 ,$11.92 ,$102.85 ,$22.65 ,$82.28 ,$29.80 ,$11.92 ,$11.92 ,$90.75 ,$85.91 ,$85.91 ,$11.92 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$29.80 ,$102.85 ,$11.92 ,$121.00 ,$72.24 ,$11.92 ,$50.34 ,$9.42 ,$8.56 ,$11.92 ,$102.85 ,$25.03 ,$102.85 ,$33.88 ,$108.90 ,$11.92 ,$99.22 ,$47.68 ,$47.68 ,$11.92 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101125,80202,HC VANCOMYCIN,301,1 ,$169.00 ,$109.85 ,$8.56 ,$169.00 ,$33.85 ,$109.85 ,$100.89 ,$13.54 ,$47.32 ,$94.81 ,$13.54 ,$111.20 ,$13.54 ,$143.65 ,$143.65 ,$13.54 ,$143.65 ,$25.73 ,$114.92 ,$33.85 ,$13.54 ,$13.54 ,$126.75 ,$119.99 ,$119.99 ,$13.54 ,$119.99 ,$138.58 ,$138.58 ,$138.58 , N/A ,$33.85 ,$143.65 ,$13.54 ,$169.00 ,$100.89 ,$13.54 ,$70.30 ,$9.42 ,$8.56 ,$13.54 ,$143.65 ,$28.43 ,$143.65 ,$47.32 ,$152.10 ,$13.54 ,$138.58 ,$54.16 ,$54.16 ,$13.54 ,$109.85 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101126,80203,HC ZONISAMIDE - 90,301,1 ,$131.00 ,$85.15 ,$8.56 ,$131.00 ,$33.13 ,$85.15 ,$78.21 ,$13.25 ,$36.68 ,$73.49 ,$13.25 ,$86.20 ,$13.25 ,$111.35 ,$111.35 ,$13.25 ,$111.35 ,$25.18 ,$89.08 ,$33.13 ,$13.25 ,$13.25 ,$98.25 ,$93.01 ,$93.01 ,$13.25 ,$93.01 ,$107.42 ,$107.42 ,$107.42 , N/A ,$33.13 ,$111.35 ,$13.25 ,$131.00 ,$78.21 ,$13.25 ,$54.50 ,$9.42 ,$8.56 ,$13.25 ,$111.35 ,$27.83 ,$111.35 ,$36.68 ,$117.90 ,$13.25 ,$107.42 ,$53.00 ,$53.00 ,$13.25 ,$85.15 ,$131.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101131,80299,HC THERAPEUTIC DRUG OTHER - 90,301,1 ,$156.00 ,$101.40 ,$8.56 ,$156.00 ,$46.60 ,$101.40 ,$93.13 ,$18.64 ,$43.68 ,$87.52 ,$18.64 ,$102.65 ,$18.64 ,$132.60 ,$132.60 ,$18.64 ,$132.60 ,$35.42 ,$106.08 ,$46.60 ,$18.64 ,$18.64 ,$117.00 ,$110.76 ,$110.76 ,$18.64 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$46.60 ,$132.60 ,$18.64 ,$156.00 ,$93.13 ,$18.64 ,$64.90 ,$9.42 ,$8.56 ,$18.64 ,$132.60 ,$39.14 ,$132.60 ,$43.68 ,$140.40 ,$18.64 ,$127.92 ,$74.56 ,$74.56 ,$18.64 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101133,80306,HC DRUG SCREEN PRESUMPTIVE INSTRMNT ASSIST DIR OPTICAL T2,301,1 ,$235.00 ,$152.75 ,$7.46 ,$235.00 ,$42.85 ,$152.75 ,$140.30 ,$17.14 ,$65.80 ,$131.84 ,$17.14 ,$154.63 ,$17.14 ,$199.75 ,$199.75 ,$17.14 ,$199.75 ,$32.57 ,$159.80 ,$42.85 ,$17.14 ,$17.14 ,$176.25 ,$166.85 ,$166.85 ,$17.14 ,$166.85 ,$192.70 ,$192.70 ,$192.70 , N/A ,$42.85 ,$199.75 ,$17.14 ,$235.00 ,$140.30 ,$17.14 ,$97.76 ,$8.21 ,$7.46 ,$17.14 ,$199.75 ,$35.99 ,$199.75 ,$65.80 ,$211.50 ,$17.14 ,$192.70 ,$68.56 ,$68.56 ,$17.14 ,$152.75 ,$235.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101137,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4,301,1 ,$340.00 ,$221.00 ,$20.08 ,$340.00 ,$155.35 ,$221.00 ,$202.98 ,$62.14 ,$95.20 ,$190.74 ,$62.14 ,$223.72 ,$62.14 ,$289.00 ,$289.00 ,$62.14 ,$289.00 ,$118.07 ,$231.20 ,$155.35 ,$62.14 ,$62.14 ,$255.00 ,$241.40 ,$241.40 ,$62.14 ,$241.40 ,$278.80 ,$278.80 ,$278.80 , N/A ,$155.35 ,$289.00 ,$62.14 ,$340.00 ,$202.98 ,$62.14 ,$141.44 ,$22.09 ,$20.08 ,$62.14 ,$289.00 ,$130.49 ,$289.00 ,$95.20 ,$306.00 ,$62.14 ,$278.80 ,$248.56 ,$248.56 ,$62.14 ,$221.00 ,$340.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101140,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T1-90,301,1 ,$31.00 ,$20.15 ,$8.68 ,$77.50 ,$77.50 ,$20.15 ,$18.51 ,$31.00 ,$8.68 ,$17.39 ,$31.00 ,$20.40 ,$31.00 ,$26.35 ,$26.35 ,$31.00 ,$26.35 ,$31.00 ,$21.08 ,$77.50 ,$31.00 ,$31.00 ,$23.25 ,$22.01 ,$22.01 ,$31.00 ,$22.01 ,$25.42 ,$25.42 ,$25.42 , N/A ,$31.00 ,$26.35 ,$31.00 ,$31.00 ,$18.51 ,$31.00 ,$12.90 ,$22.09 ,$20.08 ,$31.00 ,$26.35 ,$65.10 ,$26.35 ,$8.68 ,$27.90 ,$31.00 ,$25.42 ,$31.00 ,$31.00 ,$31.00 ,$20.15 ,$31.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101141,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T2-90,301,1 ,$160.00 ,$104.00 ,$20.08 ,$160.00 ,$155.35 ,$104.00 ,$95.52 ,$62.14 ,$44.80 ,$89.76 ,$62.14 ,$105.28 ,$62.14 ,$136.00 ,$136.00 ,$62.14 ,$136.00 ,$118.07 ,$108.80 ,$155.35 ,$62.14 ,$62.14 ,$120.00 ,$113.60 ,$113.60 ,$62.14 ,$113.60 ,$131.20 ,$131.20 ,$131.20 , N/A ,$155.35 ,$136.00 ,$62.14 ,$160.00 ,$95.52 ,$62.14 ,$66.56 ,$22.09 ,$20.08 ,$62.14 ,$136.00 ,$130.49 ,$136.00 ,$44.80 ,$144.00 ,$62.14 ,$131.20 ,$160.00 ,$160.00 ,$62.14 ,$104.00 ,$160.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101143,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4-90,301,1 ,$340.00 ,$221.00 ,$20.08 ,$340.00 ,$155.35 ,$221.00 ,$202.98 ,$62.14 ,$95.20 ,$190.74 ,$62.14 ,$223.72 ,$62.14 ,$289.00 ,$289.00 ,$62.14 ,$289.00 ,$118.07 ,$231.20 ,$155.35 ,$62.14 ,$62.14 ,$255.00 ,$241.40 ,$241.40 ,$62.14 ,$241.40 ,$278.80 ,$278.80 ,$278.80 , N/A ,$155.35 ,$289.00 ,$62.14 ,$340.00 ,$202.98 ,$62.14 ,$141.44 ,$22.09 ,$20.08 ,$62.14 ,$289.00 ,$130.49 ,$289.00 ,$95.20 ,$306.00 ,$62.14 ,$278.80 ,$248.56 ,$248.56 ,$62.14 ,$221.00 ,$340.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101146,80323,HC NICOTINE - 90,301,1 ,$84.00 ,$54.60 ,$20.08 ,$84.00 , N/A ,$54.60 ,$50.15 , N/A ,$23.52 ,$47.12 , N/A ,$55.27 , N/A ,$71.40 ,$71.40 , N/A ,$71.40 , N/A ,$57.12 , N/A , N/A , N/A ,$63.00 ,$59.64 ,$59.64 , N/A ,$59.64 ,$68.88 ,$68.88 ,$68.88 , N/A , N/A ,$71.40 , N/A ,$84.00 ,$50.15 , N/A ,$34.94 ,$22.09 ,$20.08 , N/A ,$71.40 , N/A ,$71.40 ,$23.52 ,$75.60 , N/A ,$68.88 , N/A , N/A , N/A ,$54.60 ,$84.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101147,80323,HC NICOTINE URINE - 90,301,1 ,$46.00 ,$29.90 ,$12.88 ,$46.00 , N/A ,$29.90 ,$27.46 , N/A ,$12.88 ,$25.81 , N/A ,$30.27 , N/A ,$39.10 ,$39.10 , N/A ,$39.10 , N/A ,$31.28 , N/A , N/A , N/A ,$34.50 ,$32.66 ,$32.66 , N/A ,$32.66 ,$37.72 ,$37.72 ,$37.72 , N/A , N/A ,$39.10 , N/A ,$46.00 ,$27.46 , N/A ,$19.14 ,$22.09 ,$20.08 , N/A ,$39.10 , N/A ,$39.10 ,$12.88 ,$41.40 , N/A ,$37.72 , N/A , N/A , N/A ,$29.90 ,$46.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101149,80342,HC ANTIPSYCHOTICS NOT 1-3  -90,301,1 ,$128.00 ,$83.20 ,$20.08 ,$128.00 , N/A ,$83.20 ,$76.42 , N/A ,$35.84 ,$71.81 , N/A ,$84.22 , N/A ,$108.80 ,$108.80 , N/A ,$108.80 , N/A ,$87.04 , N/A , N/A , N/A ,$96.00 ,$90.88 ,$90.88 , N/A ,$90.88 ,$104.96 ,$104.96 ,$104.96 , N/A , N/A ,$108.80 , N/A ,$128.00 ,$76.42 , N/A ,$53.25 ,$22.09 ,$20.08 , N/A ,$108.80 , N/A ,$108.80 ,$35.84 ,$115.20 , N/A ,$104.96 , N/A , N/A , N/A ,$83.20 ,$128.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101150,80346,HC BENZODIAZEPINES 1-12  -90,301,1 ,$44.00 ,$28.60 ,$12.32 ,$44.00 , N/A ,$28.60 ,$26.27 , N/A ,$12.32 ,$24.68 , N/A ,$28.95 , N/A ,$37.40 ,$37.40 , N/A ,$37.40 , N/A ,$29.92 , N/A , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.08 ,$36.08 ,$36.08 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$26.27 , N/A ,$18.30 ,$22.09 ,$20.08 , N/A ,$37.40 , N/A ,$37.40 ,$12.32 ,$39.60 , N/A ,$36.08 , N/A , N/A , N/A ,$28.60 ,$44.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101151,80349,HC CANNABINOIDS NATURAL -90,301,1 ,$52.00 ,$33.80 ,$7.46 ,$52.00 , N/A ,$33.80 ,$31.04 , N/A ,$14.56 ,$29.17 , N/A ,$34.22 , N/A ,$44.20 ,$44.20 , N/A ,$44.20 , N/A ,$35.36 , N/A , N/A , N/A ,$39.00 ,$36.92 ,$36.92 , N/A ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A , N/A ,$44.20 , N/A ,$52.00 ,$31.04 , N/A ,$21.63 ,$8.21 ,$7.46 , N/A ,$44.20 , N/A ,$44.20 ,$14.56 ,$46.80 , N/A ,$42.64 , N/A , N/A , N/A ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101153,80359,HC METHYLENEDIOXYAMPHETAMINES MDA MDEA MDMA -90,301,1 ,$214.00 ,$139.10 ,$7.46 ,$214.00 , N/A ,$139.10 ,$127.76 , N/A ,$59.92 ,$120.05 , N/A ,$140.81 , N/A ,$181.90 ,$181.90 , N/A ,$181.90 , N/A ,$145.52 , N/A , N/A , N/A ,$160.50 ,$151.94 ,$151.94 , N/A ,$151.94 ,$175.48 ,$175.48 ,$175.48 , N/A , N/A ,$181.90 , N/A ,$214.00 ,$127.76 , N/A ,$89.02 ,$8.21 ,$7.46 , N/A ,$181.90 , N/A ,$181.90 ,$59.92 ,$192.60 , N/A ,$175.48 , N/A , N/A , N/A ,$139.10 ,$214.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101154,80361,HC OPIATES 1 OR MORE -90,301,1 ,$36.00 ,$23.40 ,$10.08 ,$36.00 , N/A ,$23.40 ,$21.49 , N/A ,$10.08 ,$20.20 , N/A ,$23.69 , N/A ,$30.60 ,$30.60 , N/A ,$30.60 , N/A ,$24.48 , N/A , N/A , N/A ,$27.00 ,$25.56 ,$25.56 , N/A ,$25.56 ,$29.52 ,$29.52 ,$29.52 , N/A , N/A ,$30.60 , N/A ,$36.00 ,$21.49 , N/A ,$14.98 ,$22.09 ,$20.08 , N/A ,$30.60 , N/A ,$30.60 ,$10.08 ,$32.40 , N/A ,$29.52 , N/A , N/A , N/A ,$23.40 ,$36.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101158,82024,HC ACTH -90,301,1 ,$71.00 ,$46.15 ,$17.46 ,$96.55 ,$96.55 ,$46.15 ,$42.39 ,$38.62 ,$19.88 ,$39.83 ,$38.62 ,$46.72 ,$38.62 ,$60.35 ,$60.35 ,$38.62 ,$60.35 ,$71.00 ,$48.28 ,$96.55 ,$38.62 ,$38.62 ,$53.25 ,$50.41 ,$50.41 ,$38.62 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$71.00 ,$60.35 ,$38.62 ,$71.00 ,$42.39 ,$38.62 ,$29.54 ,$19.21 ,$17.46 ,$38.62 ,$60.35 ,$81.10 ,$60.35 ,$19.88 ,$63.90 ,$38.62 ,$58.22 ,$71.00 ,$71.00 ,$38.62 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101159,82040,HC ALBUMIN-90,301,1 ,$76.00 ,$49.40 ,$3.32 ,$76.00 ,$12.38 ,$49.40 ,$45.37 ,$4.95 ,$21.28 ,$42.64 ,$4.95 ,$50.01 ,$4.95 ,$64.60 ,$64.60 ,$4.95 ,$64.60 ,$9.41 ,$51.68 ,$12.38 ,$4.95 ,$4.95 ,$57.00 ,$53.96 ,$53.96 ,$4.95 ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A ,$12.38 ,$64.60 ,$4.95 ,$76.00 ,$45.37 ,$4.95 ,$31.62 ,$3.65 ,$3.32 ,$4.95 ,$64.60 ,$10.40 ,$64.60 ,$21.28 ,$68.40 ,$4.95 ,$62.32 ,$19.80 ,$19.80 ,$4.95 ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101160,82042,HC ALBUMIN OTHER SOURCE-90,301,1 ,$33.70 ,$21.91 ,$3.32 ,$33.70 ,$19.45 ,$21.91 ,$20.12 ,$7.78 ,$9.44 ,$18.91 ,$7.78 ,$22.17 ,$7.78 ,$28.65 ,$28.65 ,$7.78 ,$28.65 ,$14.78 ,$22.92 ,$19.45 ,$7.78 ,$7.78 ,$25.28 ,$23.93 ,$23.93 ,$7.78 ,$23.93 ,$27.63 ,$27.63 ,$27.63 , N/A ,$19.45 ,$28.65 ,$7.78 ,$33.70 ,$20.12 ,$7.78 ,$14.02 ,$3.65 ,$3.32 ,$7.78 ,$28.65 ,$16.34 ,$28.65 ,$9.44 ,$30.33 ,$7.78 ,$27.63 ,$31.12 ,$31.12 ,$7.78 ,$21.91 ,$33.70 
ST. JOSEPH'S HOSPITAL - BREESE,30101162,82085,HC ALDOLASE-90,301,1 ,$79.00 ,$51.35 ,$7.46 ,$79.00 ,$24.28 ,$51.35 ,$47.16 ,$9.71 ,$22.12 ,$44.32 ,$9.71 ,$51.98 ,$9.71 ,$67.15 ,$67.15 ,$9.71 ,$67.15 ,$18.45 ,$53.72 ,$24.28 ,$9.71 ,$9.71 ,$59.25 ,$56.09 ,$56.09 ,$9.71 ,$56.09 ,$64.78 ,$64.78 ,$64.78 , N/A ,$24.28 ,$67.15 ,$9.71 ,$79.00 ,$47.16 ,$9.71 ,$32.86 ,$8.21 ,$7.46 ,$9.71 ,$67.15 ,$20.39 ,$67.15 ,$22.12 ,$71.10 ,$9.71 ,$64.78 ,$38.84 ,$38.84 ,$9.71 ,$51.35 ,$79.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101163,82088,HC ALDOSTERONE-90,301,1 ,$124.00 ,$80.60 ,$17.46 ,$124.00 ,$101.88 ,$80.60 ,$74.03 ,$40.75 ,$34.72 ,$69.56 ,$40.75 ,$81.59 ,$40.75 ,$105.40 ,$105.40 ,$40.75 ,$105.40 ,$77.43 ,$84.32 ,$101.88 ,$40.75 ,$40.75 ,$93.00 ,$88.04 ,$88.04 ,$40.75 ,$88.04 ,$101.68 ,$101.68 ,$101.68 , N/A ,$101.88 ,$105.40 ,$40.75 ,$124.00 ,$74.03 ,$40.75 ,$51.58 ,$19.21 ,$17.46 ,$40.75 ,$105.40 ,$85.58 ,$105.40 ,$34.72 ,$111.60 ,$40.75 ,$101.68 ,$124.00 ,$124.00 ,$40.75 ,$80.60 ,$124.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101164,82103,HC ALPHA-1 ANTITRYPSIN TOTAL-90,301,1 ,$92.00 ,$59.80 ,$7.46 ,$92.00 ,$33.60 ,$59.80 ,$54.92 ,$13.44 ,$25.76 ,$51.61 ,$13.44 ,$60.54 ,$13.44 ,$78.20 ,$78.20 ,$13.44 ,$78.20 ,$25.54 ,$62.56 ,$33.60 ,$13.44 ,$13.44 ,$69.00 ,$65.32 ,$65.32 ,$13.44 ,$65.32 ,$75.44 ,$75.44 ,$75.44 , N/A ,$33.60 ,$78.20 ,$13.44 ,$92.00 ,$54.92 ,$13.44 ,$38.27 ,$8.21 ,$7.46 ,$13.44 ,$78.20 ,$28.22 ,$78.20 ,$25.76 ,$82.80 ,$13.44 ,$75.44 ,$53.76 ,$53.76 ,$13.44 ,$59.80 ,$92.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101165,82104,HC ALPHA-1 ANTITRYPSIN PHENO-90,301,1 ,$188.00 ,$122.20 ,$7.46 ,$188.00 ,$36.15 ,$122.20 ,$112.24 ,$14.46 ,$52.64 ,$105.47 ,$14.46 ,$123.70 ,$14.46 ,$159.80 ,$159.80 ,$14.46 ,$159.80 ,$27.47 ,$127.84 ,$36.15 ,$14.46 ,$14.46 ,$141.00 ,$133.48 ,$133.48 ,$14.46 ,$133.48 ,$154.16 ,$154.16 ,$154.16 , N/A ,$36.15 ,$159.80 ,$14.46 ,$188.00 ,$112.24 ,$14.46 ,$78.21 ,$8.21 ,$7.46 ,$14.46 ,$159.80 ,$30.37 ,$159.80 ,$52.64 ,$169.20 ,$14.46 ,$154.16 ,$57.84 ,$57.84 ,$14.46 ,$122.20 ,$188.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101166,82105,HC ALPHA FETOPROTEIN SERUM-90,301,1 ,$96.00 ,$62.40 ,$7.46 ,$96.00 ,$41.93 ,$62.40 ,$57.31 ,$16.77 ,$26.88 ,$53.86 ,$16.77 ,$63.17 ,$16.77 ,$81.60 ,$81.60 ,$16.77 ,$81.60 ,$31.86 ,$65.28 ,$41.93 ,$16.77 ,$16.77 ,$72.00 ,$68.16 ,$68.16 ,$16.77 ,$68.16 ,$78.72 ,$78.72 ,$78.72 , N/A ,$41.93 ,$81.60 ,$16.77 ,$96.00 ,$57.31 ,$16.77 ,$39.94 ,$8.21 ,$7.46 ,$16.77 ,$81.60 ,$35.22 ,$81.60 ,$26.88 ,$86.40 ,$16.77 ,$78.72 ,$67.08 ,$67.08 ,$16.77 ,$62.40 ,$96.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101167,82105,HC ALPHA FETOPROTEIN SERUM SINGLE-90,301,1 ,$16.00 ,$10.40 ,$4.48 ,$40.00 ,$40.00 ,$10.40 ,$9.55 ,$16.00 ,$4.48 ,$8.98 ,$16.00 ,$10.53 ,$16.00 ,$13.60 ,$13.60 ,$16.00 ,$13.60 ,$16.00 ,$10.88 ,$40.00 ,$16.00 ,$16.00 ,$12.00 ,$11.36 ,$11.36 ,$16.00 ,$11.36 ,$13.12 ,$13.12 ,$13.12 , N/A ,$16.00 ,$13.60 ,$16.00 ,$16.00 ,$9.55 ,$16.00 ,$6.66 ,$8.21 ,$7.46 ,$16.00 ,$13.60 ,$33.60 ,$13.60 ,$4.48 ,$14.40 ,$16.00 ,$13.12 ,$16.00 ,$16.00 ,$16.00 ,$10.40 ,$16.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101169,82108,HC ALUMINUM-90,301,1 ,$18.00 ,$11.70 ,$5.04 ,$45.00 ,$45.00 ,$11.70 ,$10.75 ,$18.00 ,$5.04 ,$10.10 ,$18.00 ,$11.84 ,$18.00 ,$15.30 ,$15.30 ,$18.00 ,$15.30 ,$18.00 ,$12.24 ,$45.00 ,$18.00 ,$18.00 ,$13.50 ,$12.78 ,$12.78 ,$18.00 ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A ,$18.00 ,$15.30 ,$18.00 ,$18.00 ,$10.75 ,$18.00 ,$7.49 ,$10.01 ,$9.10 ,$18.00 ,$15.30 ,$37.80 ,$15.30 ,$5.04 ,$16.20 ,$18.00 ,$14.76 ,$18.00 ,$18.00 ,$18.00 ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101172,82131,HC AMINO ACID QN SINGLE-90,301,1 ,$69.00 ,$44.85 ,$7.46 ,$69.00 ,$57.45 ,$44.85 ,$41.19 ,$22.98 ,$19.32 ,$38.71 ,$22.98 ,$45.40 ,$22.98 ,$58.65 ,$58.65 ,$22.98 ,$58.65 ,$43.66 ,$46.92 ,$57.45 ,$22.98 ,$22.98 ,$51.75 ,$48.99 ,$48.99 ,$22.98 ,$48.99 ,$56.58 ,$56.58 ,$56.58 , N/A ,$57.45 ,$58.65 ,$22.98 ,$69.00 ,$41.19 ,$22.98 ,$28.70 ,$8.21 ,$7.46 ,$22.98 ,$58.65 ,$48.26 ,$58.65 ,$19.32 ,$62.10 ,$22.98 ,$56.58 ,$69.00 ,$69.00 ,$22.98 ,$44.85 ,$69.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101175,82139,HC AMINO ACIDS 6+ QN CSF-90,301,1 ,$360.00 ,$234.00 ,$7.46 ,$360.00 ,$42.18 ,$234.00 ,$214.92 ,$16.87 ,$100.80 ,$201.96 ,$16.87 ,$236.88 ,$16.87 ,$306.00 ,$306.00 ,$16.87 ,$306.00 ,$32.05 ,$244.80 ,$42.18 ,$16.87 ,$16.87 ,$270.00 ,$255.60 ,$255.60 ,$16.87 ,$255.60 ,$295.20 ,$295.20 ,$295.20 , N/A ,$42.18 ,$306.00 ,$16.87 ,$360.00 ,$214.92 ,$16.87 ,$149.76 ,$8.21 ,$7.46 ,$16.87 ,$306.00 ,$35.43 ,$306.00 ,$100.80 ,$324.00 ,$16.87 ,$295.20 ,$67.48 ,$67.48 ,$16.87 ,$234.00 ,$360.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101176,82140,HC AMMONIA-90,301,1 ,$209.00 ,$135.85 ,$7.46 ,$209.00 ,$36.43 ,$135.85 ,$124.77 ,$14.57 ,$58.52 ,$117.25 ,$14.57 ,$137.52 ,$14.57 ,$177.65 ,$177.65 ,$14.57 ,$177.65 ,$27.68 ,$142.12 ,$36.43 ,$14.57 ,$14.57 ,$156.75 ,$148.39 ,$148.39 ,$14.57 ,$148.39 ,$171.38 ,$171.38 ,$171.38 , N/A ,$36.43 ,$177.65 ,$14.57 ,$209.00 ,$124.77 ,$14.57 ,$86.94 ,$8.21 ,$7.46 ,$14.57 ,$177.65 ,$30.60 ,$177.65 ,$58.52 ,$188.10 ,$14.57 ,$171.38 ,$58.28 ,$58.28 ,$14.57 ,$135.85 ,$209.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101177,82150,HC AMYLASE-90,301,1 ,$126.00 ,$81.90 ,$6.48 ,$126.00 ,$16.20 ,$81.90 ,$75.22 ,$6.48 ,$35.28 ,$70.69 ,$6.48 ,$82.91 ,$6.48 ,$107.10 ,$107.10 ,$6.48 ,$107.10 ,$12.31 ,$85.68 ,$16.20 ,$6.48 ,$6.48 ,$94.50 ,$89.46 ,$89.46 ,$6.48 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$16.20 ,$107.10 ,$6.48 ,$126.00 ,$75.22 ,$6.48 ,$52.42 ,$8.21 ,$7.46 ,$6.48 ,$107.10 ,$13.61 ,$107.10 ,$35.28 ,$113.40 ,$6.48 ,$103.32 ,$25.92 ,$25.92 ,$6.48 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101178,82157,HC ANDROSTENEDIONE-90,301,1 ,$110.00 ,$71.50 ,$17.46 ,$110.00 ,$73.20 ,$71.50 ,$65.67 ,$29.28 ,$30.80 ,$61.71 ,$29.28 ,$72.38 ,$29.28 ,$93.50 ,$93.50 ,$29.28 ,$93.50 ,$55.63 ,$74.80 ,$73.20 ,$29.28 ,$29.28 ,$82.50 ,$78.10 ,$78.10 ,$29.28 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$73.20 ,$93.50 ,$29.28 ,$110.00 ,$65.67 ,$29.28 ,$45.76 ,$19.21 ,$17.46 ,$29.28 ,$93.50 ,$61.49 ,$93.50 ,$30.80 ,$99.00 ,$29.28 ,$90.20 ,$110.00 ,$110.00 ,$29.28 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101179,82164,HC ANGIOTENSIN 1 ENZYME (ACE)-90,301,1 ,$97.00 ,$63.05 ,$7.46 ,$97.00 ,$36.50 ,$63.05 ,$57.91 ,$14.60 ,$27.16 ,$54.42 ,$14.60 ,$63.83 ,$14.60 ,$82.45 ,$82.45 ,$14.60 ,$82.45 ,$27.74 ,$65.96 ,$36.50 ,$14.60 ,$14.60 ,$72.75 ,$68.87 ,$68.87 ,$14.60 ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A ,$36.50 ,$82.45 ,$14.60 ,$97.00 ,$57.91 ,$14.60 ,$40.35 ,$8.21 ,$7.46 ,$14.60 ,$82.45 ,$30.66 ,$82.45 ,$27.16 ,$87.30 ,$14.60 ,$79.54 ,$58.40 ,$58.40 ,$14.60 ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101180,82172,HC APOLIPOPROTEIN SERUM-90,301,1 ,$58.00 ,$37.70 ,$7.46 ,$58.00 ,$52.73 ,$37.70 ,$34.63 ,$21.09 ,$16.24 ,$32.54 ,$21.09 ,$38.16 ,$21.09 ,$49.30 ,$49.30 ,$21.09 ,$49.30 ,$40.07 ,$39.44 ,$52.73 ,$21.09 ,$21.09 ,$43.50 ,$41.18 ,$41.18 ,$21.09 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$52.73 ,$49.30 ,$21.09 ,$58.00 ,$34.63 ,$21.09 ,$24.13 ,$8.21 ,$7.46 ,$21.09 ,$49.30 ,$44.29 ,$49.30 ,$16.24 ,$52.20 ,$21.09 ,$47.56 ,$58.00 ,$58.00 ,$21.09 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101181,82175,HC ARSENIC-90,301,1 ,$73.00 ,$47.45 ,$9.10 ,$73.00 ,$47.43 ,$47.45 ,$43.58 ,$18.97 ,$20.44 ,$40.95 ,$18.97 ,$48.03 ,$18.97 ,$62.05 ,$62.05 ,$18.97 ,$62.05 ,$36.04 ,$49.64 ,$47.43 ,$18.97 ,$18.97 ,$54.75 ,$51.83 ,$51.83 ,$18.97 ,$51.83 ,$59.86 ,$59.86 ,$59.86 , N/A ,$47.43 ,$62.05 ,$18.97 ,$73.00 ,$43.58 ,$18.97 ,$30.37 ,$10.01 ,$9.10 ,$18.97 ,$62.05 ,$39.84 ,$62.05 ,$20.44 ,$65.70 ,$18.97 ,$59.86 ,$73.00 ,$73.00 ,$18.97 ,$47.45 ,$73.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101182,82180,HC VITAMIN C (ASCORBIC ACID)-90,301,1 ,$58.00 ,$37.70 ,$7.46 ,$58.00 ,$24.73 ,$37.70 ,$34.63 ,$9.89 ,$16.24 ,$32.54 ,$9.89 ,$38.16 ,$9.89 ,$49.30 ,$49.30 ,$9.89 ,$49.30 ,$18.79 ,$39.44 ,$24.73 ,$9.89 ,$9.89 ,$43.50 ,$41.18 ,$41.18 ,$9.89 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$24.73 ,$49.30 ,$9.89 ,$58.00 ,$34.63 ,$9.89 ,$24.13 ,$8.21 ,$7.46 ,$9.89 ,$49.30 ,$20.77 ,$49.30 ,$16.24 ,$52.20 ,$9.89 ,$47.56 ,$39.56 ,$39.56 ,$9.89 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101184,82232,HC BETA 2 MICROGLOBULIN-90,301,1 ,$95.00 ,$61.75 ,$16.18 ,$95.00 ,$40.45 ,$61.75 ,$56.72 ,$16.18 ,$26.60 ,$53.30 ,$16.18 ,$62.51 ,$16.18 ,$80.75 ,$80.75 ,$16.18 ,$80.75 ,$30.74 ,$64.60 ,$40.45 ,$16.18 ,$16.18 ,$71.25 ,$67.45 ,$67.45 ,$16.18 ,$67.45 ,$77.90 ,$77.90 ,$77.90 , N/A ,$40.45 ,$80.75 ,$16.18 ,$95.00 ,$56.72 ,$16.18 ,$39.52 ,$19.21 ,$17.46 ,$16.18 ,$80.75 ,$33.98 ,$80.75 ,$26.60 ,$85.50 ,$16.18 ,$77.90 ,$64.72 ,$64.72 ,$16.18 ,$61.75 ,$95.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101185,82239,HC BILE ACID TOTAL-90,301,1 ,$19.00 ,$12.35 ,$5.32 ,$42.80 ,$42.80 ,$12.35 ,$11.34 ,$17.12 ,$5.32 ,$10.66 ,$17.12 ,$12.50 ,$17.12 ,$16.15 ,$16.15 ,$17.12 ,$16.15 ,$19.00 ,$12.92 ,$42.80 ,$17.12 ,$17.12 ,$14.25 ,$13.49 ,$13.49 ,$17.12 ,$13.49 ,$15.58 ,$15.58 ,$15.58 , N/A ,$19.00 ,$16.15 ,$17.12 ,$19.00 ,$11.34 ,$17.12 ,$7.90 ,$8.21 ,$7.46 ,$17.12 ,$16.15 ,$35.95 ,$16.15 ,$5.32 ,$17.10 ,$17.12 ,$15.58 ,$19.00 ,$19.00 ,$17.12 ,$12.35 ,$19.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101186,82247,HC BILIRUBIN TOTAL-90,301,1 ,$18.00 ,$11.70 ,$3.32 ,$18.00 ,$12.55 ,$11.70 ,$10.75 ,$5.02 ,$5.04 ,$10.10 ,$5.02 ,$11.84 ,$5.02 ,$15.30 ,$15.30 ,$5.02 ,$15.30 ,$9.54 ,$12.24 ,$12.55 ,$5.02 ,$5.02 ,$13.50 ,$12.78 ,$12.78 ,$5.02 ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A ,$12.55 ,$15.30 ,$5.02 ,$18.00 ,$10.75 ,$5.02 ,$7.49 ,$3.65 ,$3.32 ,$5.02 ,$15.30 ,$10.54 ,$15.30 ,$5.04 ,$16.20 ,$5.02 ,$14.76 ,$18.00 ,$18.00 ,$5.02 ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101191,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$47.00 ,$30.55 ,$3.32 ,$47.00 ,$13.30 ,$30.55 ,$28.06 ,$5.32 ,$13.16 ,$26.37 ,$5.32 ,$30.93 ,$5.32 ,$39.95 ,$39.95 ,$5.32 ,$39.95 ,$10.11 ,$31.96 ,$13.30 ,$5.32 ,$5.32 ,$35.25 ,$33.37 ,$33.37 ,$5.32 ,$33.37 ,$38.54 ,$38.54 ,$38.54 , N/A ,$13.30 ,$39.95 ,$5.32 ,$47.00 ,$28.06 ,$5.32 ,$19.55 ,$3.65 ,$3.32 ,$5.32 ,$39.95 ,$11.17 ,$39.95 ,$13.16 ,$42.30 ,$5.32 ,$38.54 ,$21.28 ,$21.28 ,$5.32 ,$30.55 ,$47.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101196,82300,HC CADMIUM-90,301,1 ,$67.00 ,$43.55 ,$9.10 ,$67.00 ,$59.10 ,$43.55 ,$40.00 ,$23.64 ,$18.76 ,$37.59 ,$23.64 ,$44.09 ,$23.64 ,$56.95 ,$56.95 ,$23.64 ,$56.95 ,$44.92 ,$45.56 ,$59.10 ,$23.64 ,$23.64 ,$50.25 ,$47.57 ,$47.57 ,$23.64 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$59.10 ,$56.95 ,$23.64 ,$67.00 ,$40.00 ,$23.64 ,$27.87 ,$10.01 ,$9.10 ,$23.64 ,$56.95 ,$49.64 ,$56.95 ,$18.76 ,$60.30 ,$23.64 ,$54.94 ,$67.00 ,$67.00 ,$23.64 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101197,82306,HC VITAMIN D 25 OH-90,301,1 ,$18.00 ,$11.70 ,$5.04 ,$45.00 ,$45.00 ,$11.70 ,$10.75 ,$18.00 ,$5.04 ,$10.10 ,$18.00 ,$11.84 ,$18.00 ,$15.30 ,$15.30 ,$18.00 ,$15.30 ,$18.00 ,$12.24 ,$45.00 ,$18.00 ,$18.00 ,$13.50 ,$12.78 ,$12.78 ,$18.00 ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A ,$18.00 ,$15.30 ,$18.00 ,$18.00 ,$10.75 ,$18.00 ,$7.49 ,$18.00 ,$18.00 ,$18.00 ,$15.30 ,$37.80 ,$15.30 ,$5.04 ,$16.20 ,$18.00 ,$14.76 ,$18.00 ,$18.00 ,$18.00 ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101199,82308,HC CALCITONIN-90,301,1 ,$79.00 ,$51.35 ,$17.46 ,$79.00 ,$66.98 ,$51.35 ,$47.16 ,$26.79 ,$22.12 ,$44.32 ,$26.79 ,$51.98 ,$26.79 ,$67.15 ,$67.15 ,$26.79 ,$67.15 ,$50.90 ,$53.72 ,$66.98 ,$26.79 ,$26.79 ,$59.25 ,$56.09 ,$56.09 ,$26.79 ,$56.09 ,$64.78 ,$64.78 ,$64.78 , N/A ,$66.98 ,$67.15 ,$26.79 ,$79.00 ,$47.16 ,$26.79 ,$32.86 ,$19.21 ,$17.46 ,$26.79 ,$67.15 ,$56.26 ,$67.15 ,$22.12 ,$71.10 ,$26.79 ,$64.78 ,$79.00 ,$79.00 ,$26.79 ,$51.35 ,$79.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101200,82310,HC CALCIUM-90,301,1 ,$292.00 ,$189.80 ,$3.32 ,$292.00 ,$12.90 ,$189.80 ,$174.32 ,$5.16 ,$81.76 ,$163.81 ,$5.16 ,$192.14 ,$5.16 ,$248.20 ,$248.20 ,$5.16 ,$248.20 ,$9.80 ,$198.56 ,$12.90 ,$5.16 ,$5.16 ,$219.00 ,$207.32 ,$207.32 ,$5.16 ,$207.32 ,$239.44 ,$239.44 ,$239.44 , N/A ,$12.90 ,$248.20 ,$5.16 ,$292.00 ,$174.32 ,$5.16 ,$121.47 ,$3.65 ,$3.32 ,$5.16 ,$248.20 ,$10.84 ,$248.20 ,$81.76 ,$262.80 ,$5.16 ,$239.44 ,$20.64 ,$20.64 ,$5.16 ,$189.80 ,$292.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101203,82340,HC CALCIUM URINE QN TIMED-90,301,1 ,$154.00 ,$100.10 ,$6.03 ,$154.00 ,$15.08 ,$100.10 ,$91.94 ,$6.03 ,$43.12 ,$86.39 ,$6.03 ,$101.33 ,$6.03 ,$130.90 ,$130.90 ,$6.03 ,$130.90 ,$11.46 ,$104.72 ,$15.08 ,$6.03 ,$6.03 ,$115.50 ,$109.34 ,$109.34 ,$6.03 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$15.08 ,$130.90 ,$6.03 ,$154.00 ,$91.94 ,$6.03 ,$64.06 ,$8.21 ,$7.46 ,$6.03 ,$130.90 ,$12.66 ,$130.90 ,$43.12 ,$138.60 ,$6.03 ,$126.28 ,$24.12 ,$24.12 ,$6.03 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101205,82365,HC CALCULUS ANLYS INFRARED-90,301,1 ,$82.00 ,$53.30 ,$7.46 ,$82.00 ,$32.25 ,$53.30 ,$48.95 ,$12.90 ,$22.96 ,$46.00 ,$12.90 ,$53.96 ,$12.90 ,$69.70 ,$69.70 ,$12.90 ,$69.70 ,$24.51 ,$55.76 ,$32.25 ,$12.90 ,$12.90 ,$61.50 ,$58.22 ,$58.22 ,$12.90 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$32.25 ,$69.70 ,$12.90 ,$82.00 ,$48.95 ,$12.90 ,$34.11 ,$8.21 ,$7.46 ,$12.90 ,$69.70 ,$27.09 ,$69.70 ,$22.96 ,$73.80 ,$12.90 ,$67.24 ,$51.60 ,$51.60 ,$12.90 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101207,82373,HC CARBOHY DEFICIENT TRANSFER CONGENTIAL-90,301,1 ,$146.00 ,$94.90 ,$7.46 ,$146.00 ,$45.15 ,$94.90 ,$87.16 ,$18.06 ,$40.88 ,$81.91 ,$18.06 ,$96.07 ,$18.06 ,$124.10 ,$124.10 ,$18.06 ,$124.10 ,$34.31 ,$99.28 ,$45.15 ,$18.06 ,$18.06 ,$109.50 ,$103.66 ,$103.66 ,$18.06 ,$103.66 ,$119.72 ,$119.72 ,$119.72 , N/A ,$45.15 ,$124.10 ,$18.06 ,$146.00 ,$87.16 ,$18.06 ,$60.74 ,$8.21 ,$7.46 ,$18.06 ,$124.10 ,$37.93 ,$124.10 ,$40.88 ,$131.40 ,$18.06 ,$119.72 ,$72.24 ,$72.24 ,$18.06 ,$94.90 ,$146.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101208,82378,HC CARBINOEMBRYONIC AG (CEA)-90,301,1 ,$88.00 ,$57.20 ,$7.46 ,$88.00 ,$47.40 ,$57.20 ,$52.54 ,$18.96 ,$24.64 ,$49.37 ,$18.96 ,$57.90 ,$18.96 ,$74.80 ,$74.80 ,$18.96 ,$74.80 ,$36.02 ,$59.84 ,$47.40 ,$18.96 ,$18.96 ,$66.00 ,$62.48 ,$62.48 ,$18.96 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$47.40 ,$74.80 ,$18.96 ,$88.00 ,$52.54 ,$18.96 ,$36.61 ,$8.21 ,$7.46 ,$18.96 ,$74.80 ,$39.82 ,$74.80 ,$24.64 ,$79.20 ,$18.96 ,$72.16 ,$75.84 ,$75.84 ,$18.96 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101209,82379,HC CARNITINE TOTAL AND FREE QN-90,301,1 ,$217.00 ,$141.05 ,$7.46 ,$217.00 ,$42.18 ,$141.05 ,$129.55 ,$16.87 ,$60.76 ,$121.74 ,$16.87 ,$142.79 ,$16.87 ,$184.45 ,$184.45 ,$16.87 ,$184.45 ,$32.05 ,$147.56 ,$42.18 ,$16.87 ,$16.87 ,$162.75 ,$154.07 ,$154.07 ,$16.87 ,$154.07 ,$177.94 ,$177.94 ,$177.94 , N/A ,$42.18 ,$184.45 ,$16.87 ,$217.00 ,$129.55 ,$16.87 ,$90.27 ,$8.21 ,$7.46 ,$16.87 ,$184.45 ,$35.43 ,$184.45 ,$60.76 ,$195.30 ,$16.87 ,$177.94 ,$67.48 ,$67.48 ,$16.87 ,$141.05 ,$217.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101210,82380,HC CAROTENE-90,301,1 ,$58.00 ,$37.70 ,$7.46 ,$58.00 ,$23.05 ,$37.70 ,$34.63 ,$9.22 ,$16.24 ,$32.54 ,$9.22 ,$38.16 ,$9.22 ,$49.30 ,$49.30 ,$9.22 ,$49.30 ,$17.52 ,$39.44 ,$23.05 ,$9.22 ,$9.22 ,$43.50 ,$41.18 ,$41.18 ,$9.22 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$23.05 ,$49.30 ,$9.22 ,$58.00 ,$34.63 ,$9.22 ,$24.13 ,$8.21 ,$7.46 ,$9.22 ,$49.30 ,$19.36 ,$49.30 ,$16.24 ,$52.20 ,$9.22 ,$47.56 ,$36.88 ,$36.88 ,$9.22 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101211,82384,HC CATECHOLAMINE FRACTION-90,301,1 ,$52.00 ,$33.80 ,$14.56 ,$63.13 ,$63.13 ,$33.80 ,$31.04 ,$25.25 ,$14.56 ,$29.17 ,$25.25 ,$34.22 ,$25.25 ,$44.20 ,$44.20 ,$25.25 ,$44.20 ,$47.98 ,$35.36 ,$63.13 ,$25.25 ,$25.25 ,$39.00 ,$36.92 ,$36.92 ,$25.25 ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A ,$52.00 ,$44.20 ,$25.25 ,$52.00 ,$31.04 ,$25.25 ,$21.63 ,$19.21 ,$17.46 ,$25.25 ,$44.20 ,$53.03 ,$44.20 ,$14.56 ,$46.80 ,$25.25 ,$42.64 ,$52.00 ,$52.00 ,$25.25 ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101212,82390,HC CERULOPLASMIN-90,301,1 ,$81.00 ,$52.65 ,$7.46 ,$81.00 ,$26.85 ,$52.65 ,$48.36 ,$10.74 ,$22.68 ,$45.44 ,$10.74 ,$53.30 ,$10.74 ,$68.85 ,$68.85 ,$10.74 ,$68.85 ,$20.41 ,$55.08 ,$26.85 ,$10.74 ,$10.74 ,$60.75 ,$57.51 ,$57.51 ,$10.74 ,$57.51 ,$66.42 ,$66.42 ,$66.42 , N/A ,$26.85 ,$68.85 ,$10.74 ,$81.00 ,$48.36 ,$10.74 ,$33.70 ,$8.21 ,$7.46 ,$10.74 ,$68.85 ,$22.55 ,$68.85 ,$22.68 ,$72.90 ,$10.74 ,$66.42 ,$42.96 ,$42.96 ,$10.74 ,$52.65 ,$81.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101213,82397,HC CHEMILUMINESCENT ASSAY-90,301,1 ,$154.00 ,$100.10 ,$7.46 ,$154.00 ,$35.30 ,$100.10 ,$91.94 ,$14.12 ,$43.12 ,$86.39 ,$14.12 ,$101.33 ,$14.12 ,$130.90 ,$130.90 ,$14.12 ,$130.90 ,$26.83 ,$104.72 ,$35.30 ,$14.12 ,$14.12 ,$115.50 ,$109.34 ,$109.34 ,$14.12 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$35.30 ,$130.90 ,$14.12 ,$154.00 ,$91.94 ,$14.12 ,$64.06 ,$8.21 ,$7.46 ,$14.12 ,$130.90 ,$29.65 ,$130.90 ,$43.12 ,$138.60 ,$14.12 ,$126.28 ,$56.48 ,$56.48 ,$14.12 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101215,82438,HC CHLORIDE OTHER SOURCE-90,301,1 ,$25.10 ,$16.32 ,$3.32 ,$25.10 ,$12.50 ,$16.32 ,$14.98 ,$5.00 ,$7.03 ,$14.08 ,$5.00 ,$16.52 ,$5.00 ,$21.34 ,$21.34 ,$5.00 ,$21.34 ,$9.50 ,$17.07 ,$12.50 ,$5.00 ,$5.00 ,$18.83 ,$17.82 ,$17.82 ,$5.00 ,$17.82 ,$20.58 ,$20.58 ,$20.58 , N/A ,$12.50 ,$21.34 ,$5.00 ,$25.10 ,$14.98 ,$5.00 ,$10.44 ,$3.65 ,$3.32 ,$5.00 ,$21.34 ,$10.50 ,$21.34 ,$7.03 ,$22.59 ,$5.00 ,$20.58 ,$20.00 ,$20.00 ,$5.00 ,$16.32 ,$25.10 
ST. JOSEPH'S HOSPITAL - BREESE,30101216,82480,HC CHOLINESTERASE PSEUDO-90,301,1 ,$58.00 ,$37.70 ,$7.46 ,$58.00 ,$19.68 ,$37.70 ,$34.63 ,$7.87 ,$16.24 ,$32.54 ,$7.87 ,$38.16 ,$7.87 ,$49.30 ,$49.30 ,$7.87 ,$49.30 ,$14.95 ,$39.44 ,$19.68 ,$7.87 ,$7.87 ,$43.50 ,$41.18 ,$41.18 ,$7.87 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$19.68 ,$49.30 ,$7.87 ,$58.00 ,$34.63 ,$7.87 ,$24.13 ,$8.21 ,$7.46 ,$7.87 ,$49.30 ,$16.53 ,$49.30 ,$16.24 ,$52.20 ,$7.87 ,$47.56 ,$31.48 ,$31.48 ,$7.87 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101218,82495,HC CHROMIUM SERUM-90,301,1 ,$100.00 ,$65.00 ,$9.10 ,$100.00 ,$50.70 ,$65.00 ,$59.70 ,$20.28 ,$28.00 ,$56.10 ,$20.28 ,$65.80 ,$20.28 ,$85.00 ,$85.00 ,$20.28 ,$85.00 ,$38.53 ,$68.00 ,$50.70 ,$20.28 ,$20.28 ,$75.00 ,$71.00 ,$71.00 ,$20.28 ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A ,$50.70 ,$85.00 ,$20.28 ,$100.00 ,$59.70 ,$20.28 ,$41.60 ,$10.01 ,$9.10 ,$20.28 ,$85.00 ,$42.59 ,$85.00 ,$28.00 ,$90.00 ,$20.28 ,$82.00 ,$81.12 ,$81.12 ,$20.28 ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101219,82507,HC CITRATE-90,301,1 ,$65.00 ,$42.25 ,$7.46 ,$69.50 ,$69.50 ,$42.25 ,$38.81 ,$27.80 ,$18.20 ,$36.47 ,$27.80 ,$42.77 ,$27.80 ,$55.25 ,$55.25 ,$27.80 ,$55.25 ,$52.82 ,$44.20 ,$69.50 ,$27.80 ,$27.80 ,$48.75 ,$46.15 ,$46.15 ,$27.80 ,$46.15 ,$53.30 ,$53.30 ,$53.30 , N/A ,$65.00 ,$55.25 ,$27.80 ,$65.00 ,$38.81 ,$27.80 ,$27.04 ,$8.21 ,$7.46 ,$27.80 ,$55.25 ,$58.38 ,$55.25 ,$18.20 ,$58.50 ,$27.80 ,$53.30 ,$65.00 ,$65.00 ,$27.80 ,$42.25 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101220,82523,HC COLLAGEN CROSS LINKS ANY METHOD-90,301,1 ,$141.00 ,$91.65 ,$11.51 ,$141.00 ,$46.70 ,$91.65 ,$84.18 ,$18.68 ,$39.48 ,$79.10 ,$18.68 ,$92.78 ,$18.68 ,$119.85 ,$119.85 ,$18.68 ,$119.85 ,$35.49 ,$95.88 ,$46.70 ,$18.68 ,$18.68 ,$105.75 ,$100.11 ,$100.11 ,$18.68 ,$100.11 ,$115.62 ,$115.62 ,$115.62 , N/A ,$46.70 ,$119.85 ,$18.68 ,$141.00 ,$84.18 ,$18.68 ,$58.66 ,$12.66 ,$11.51 ,$18.68 ,$119.85 ,$39.23 ,$119.85 ,$39.48 ,$126.90 ,$18.68 ,$115.62 ,$74.72 ,$74.72 ,$18.68 ,$91.65 ,$141.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101221,82525,HC COPPER-90,301,1 ,$69.00 ,$44.85 ,$9.10 ,$69.00 ,$31.03 ,$44.85 ,$41.19 ,$12.41 ,$19.32 ,$38.71 ,$12.41 ,$45.40 ,$12.41 ,$58.65 ,$58.65 ,$12.41 ,$58.65 ,$23.58 ,$46.92 ,$31.03 ,$12.41 ,$12.41 ,$51.75 ,$48.99 ,$48.99 ,$12.41 ,$48.99 ,$56.58 ,$56.58 ,$56.58 , N/A ,$31.03 ,$58.65 ,$12.41 ,$69.00 ,$41.19 ,$12.41 ,$28.70 ,$10.01 ,$9.10 ,$12.41 ,$58.65 ,$26.06 ,$58.65 ,$19.32 ,$62.10 ,$12.41 ,$56.58 ,$49.64 ,$49.64 ,$12.41 ,$44.85 ,$69.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101222,82530,HC CORTISOL FREE-90,301,1 ,$122.00 ,$79.30 ,$7.46 ,$122.00 ,$41.78 ,$79.30 ,$72.83 ,$16.71 ,$34.16 ,$68.44 ,$16.71 ,$80.28 ,$16.71 ,$103.70 ,$103.70 ,$16.71 ,$103.70 ,$31.75 ,$82.96 ,$41.78 ,$16.71 ,$16.71 ,$91.50 ,$86.62 ,$86.62 ,$16.71 ,$86.62 ,$100.04 ,$100.04 ,$100.04 , N/A ,$41.78 ,$103.70 ,$16.71 ,$122.00 ,$72.83 ,$16.71 ,$50.75 ,$8.21 ,$7.46 ,$16.71 ,$103.70 ,$35.09 ,$103.70 ,$34.16 ,$109.80 ,$16.71 ,$100.04 ,$66.84 ,$66.84 ,$16.71 ,$79.30 ,$122.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101223,82533,HC CORTISOL TOTAL-90,301,1 ,$20.00 ,$13.00 ,$5.60 ,$40.75 ,$40.75 ,$13.00 ,$11.94 ,$16.30 ,$5.60 ,$11.22 ,$16.30 ,$13.16 ,$16.30 ,$17.00 ,$17.00 ,$16.30 ,$17.00 ,$20.00 ,$13.60 ,$40.75 ,$16.30 ,$16.30 ,$15.00 ,$14.20 ,$14.20 ,$16.30 ,$14.20 ,$16.40 ,$16.40 ,$16.40 , N/A ,$20.00 ,$17.00 ,$16.30 ,$20.00 ,$11.94 ,$16.30 ,$8.32 ,$19.21 ,$17.46 ,$16.30 ,$17.00 ,$34.23 ,$17.00 ,$5.60 ,$18.00 ,$16.30 ,$16.40 ,$20.00 ,$20.00 ,$16.30 ,$13.00 ,$20.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101224,82542,HC CHROMO SPECTROMETRY -90,301,1 ,$191.00 ,$124.15 ,$7.46 ,$191.00 ,$60.23 ,$124.15 ,$114.03 ,$24.09 ,$53.48 ,$107.15 ,$24.09 ,$125.68 ,$24.09 ,$162.35 ,$162.35 ,$24.09 ,$162.35 ,$45.77 ,$129.88 ,$60.23 ,$24.09 ,$24.09 ,$143.25 ,$135.61 ,$135.61 ,$24.09 ,$135.61 ,$156.62 ,$156.62 ,$156.62 , N/A ,$60.23 ,$162.35 ,$24.09 ,$191.00 ,$114.03 ,$24.09 ,$79.46 ,$8.21 ,$7.46 ,$24.09 ,$162.35 ,$50.59 ,$162.35 ,$53.48 ,$171.90 ,$24.09 ,$156.62 ,$96.36 ,$96.36 ,$24.09 ,$124.15 ,$191.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101225,82550,HC CREATINE KINASE (CPK) TOTAL-90,301,1 ,$126.00 ,$81.90 ,$3.32 ,$126.00 ,$16.28 ,$81.90 ,$75.22 ,$6.51 ,$35.28 ,$70.69 ,$6.51 ,$82.91 ,$6.51 ,$107.10 ,$107.10 ,$6.51 ,$107.10 ,$12.37 ,$85.68 ,$16.28 ,$6.51 ,$6.51 ,$94.50 ,$89.46 ,$89.46 ,$6.51 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$16.28 ,$107.10 ,$6.51 ,$126.00 ,$75.22 ,$6.51 ,$52.42 ,$3.65 ,$3.32 ,$6.51 ,$107.10 ,$13.67 ,$107.10 ,$35.28 ,$113.40 ,$6.51 ,$103.32 ,$26.04 ,$26.04 ,$6.51 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101226,82552,HC CREATINE KINASE (CPK) ISO-90,301,1 ,$44.00 ,$28.60 ,$7.46 ,$44.00 ,$33.48 ,$28.60 ,$26.27 ,$13.39 ,$12.32 ,$24.68 ,$13.39 ,$28.95 ,$13.39 ,$37.40 ,$37.40 ,$13.39 ,$37.40 ,$25.44 ,$29.92 ,$33.48 ,$13.39 ,$13.39 ,$33.00 ,$31.24 ,$31.24 ,$13.39 ,$31.24 ,$36.08 ,$36.08 ,$36.08 , N/A ,$33.48 ,$37.40 ,$13.39 ,$44.00 ,$26.27 ,$13.39 ,$18.30 ,$8.21 ,$7.46 ,$13.39 ,$37.40 ,$28.12 ,$37.40 ,$12.32 ,$39.60 ,$13.39 ,$36.08 ,$44.00 ,$44.00 ,$13.39 ,$28.60 ,$44.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101231,82570,HC CREATININE OTH SOURCE-90,301,1 ,$27.00 ,$17.55 ,$3.32 ,$27.00 ,$12.95 ,$17.55 ,$16.12 ,$5.18 ,$7.56 ,$15.15 ,$5.18 ,$17.77 ,$5.18 ,$22.95 ,$22.95 ,$5.18 ,$22.95 ,$9.84 ,$18.36 ,$12.95 ,$5.18 ,$5.18 ,$20.25 ,$19.17 ,$19.17 ,$5.18 ,$19.17 ,$22.14 ,$22.14 ,$22.14 , N/A ,$12.95 ,$22.95 ,$5.18 ,$27.00 ,$16.12 ,$5.18 ,$11.23 ,$3.65 ,$3.32 ,$5.18 ,$22.95 ,$10.88 ,$22.95 ,$7.56 ,$24.30 ,$5.18 ,$22.14 ,$20.72 ,$20.72 ,$5.18 ,$17.55 ,$27.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101233,82595,HC CRYOGLOBULIN QL OR SQN-90,301,1 ,$95.00 ,$61.75 ,$6.47 ,$95.00 ,$16.18 ,$61.75 ,$56.72 ,$6.47 ,$26.60 ,$53.30 ,$6.47 ,$62.51 ,$6.47 ,$80.75 ,$80.75 ,$6.47 ,$80.75 ,$12.29 ,$64.60 ,$16.18 ,$6.47 ,$6.47 ,$71.25 ,$67.45 ,$67.45 ,$6.47 ,$67.45 ,$77.90 ,$77.90 ,$77.90 , N/A ,$16.18 ,$80.75 ,$6.47 ,$95.00 ,$56.72 ,$6.47 ,$39.52 ,$8.21 ,$7.46 ,$6.47 ,$80.75 ,$13.59 ,$80.75 ,$26.60 ,$85.50 ,$6.47 ,$77.90 ,$25.88 ,$25.88 ,$6.47 ,$61.75 ,$95.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101234,82600,HC CYANIDE-90,301,1 ,$71.00 ,$46.15 ,$9.10 ,$71.00 ,$48.50 ,$46.15 ,$42.39 ,$19.40 ,$19.88 ,$39.83 ,$19.40 ,$46.72 ,$19.40 ,$60.35 ,$60.35 ,$19.40 ,$60.35 ,$36.86 ,$48.28 ,$48.50 ,$19.40 ,$19.40 ,$53.25 ,$50.41 ,$50.41 ,$19.40 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$48.50 ,$60.35 ,$19.40 ,$71.00 ,$42.39 ,$19.40 ,$29.54 ,$10.01 ,$9.10 ,$19.40 ,$60.35 ,$40.74 ,$60.35 ,$19.88 ,$63.90 ,$19.40 ,$58.22 ,$71.00 ,$71.00 ,$19.40 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101236,82608,HC VITAMIN B-12 BINDING CAPACITY-90,301,1 ,$61.00 ,$39.65 ,$7.46 ,$61.00 ,$35.80 ,$39.65 ,$36.42 ,$14.32 ,$17.08 ,$34.22 ,$14.32 ,$40.14 ,$14.32 ,$51.85 ,$51.85 ,$14.32 ,$51.85 ,$27.21 ,$41.48 ,$35.80 ,$14.32 ,$14.32 ,$45.75 ,$43.31 ,$43.31 ,$14.32 ,$43.31 ,$50.02 ,$50.02 ,$50.02 , N/A ,$35.80 ,$51.85 ,$14.32 ,$61.00 ,$36.42 ,$14.32 ,$25.38 ,$8.21 ,$7.46 ,$14.32 ,$51.85 ,$30.07 ,$51.85 ,$17.08 ,$54.90 ,$14.32 ,$50.02 ,$57.28 ,$57.28 ,$14.32 ,$39.65 ,$61.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101237,82626,HC DHEA-90,301,1 ,$65.00 ,$42.25 ,$7.46 ,$65.00 ,$63.18 ,$42.25 ,$38.81 ,$25.27 ,$18.20 ,$36.47 ,$25.27 ,$42.77 ,$25.27 ,$55.25 ,$55.25 ,$25.27 ,$55.25 ,$48.01 ,$44.20 ,$63.18 ,$25.27 ,$25.27 ,$48.75 ,$46.15 ,$46.15 ,$25.27 ,$46.15 ,$53.30 ,$53.30 ,$53.30 , N/A ,$63.18 ,$55.25 ,$25.27 ,$65.00 ,$38.81 ,$25.27 ,$27.04 ,$8.21 ,$7.46 ,$25.27 ,$55.25 ,$53.07 ,$55.25 ,$18.20 ,$58.50 ,$25.27 ,$53.30 ,$65.00 ,$65.00 ,$25.27 ,$42.25 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101238,82627,HC DHEA SULFATE-90,301,1 ,$67.00 ,$43.55 ,$17.46 ,$67.00 ,$55.58 ,$43.55 ,$40.00 ,$22.23 ,$18.76 ,$37.59 ,$22.23 ,$44.09 ,$22.23 ,$56.95 ,$56.95 ,$22.23 ,$56.95 ,$42.24 ,$45.56 ,$55.58 ,$22.23 ,$22.23 ,$50.25 ,$47.57 ,$47.57 ,$22.23 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$55.58 ,$56.95 ,$22.23 ,$67.00 ,$40.00 ,$22.23 ,$27.87 ,$19.21 ,$17.46 ,$22.23 ,$56.95 ,$46.68 ,$56.95 ,$18.76 ,$60.30 ,$22.23 ,$54.94 ,$67.00 ,$67.00 ,$22.23 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101240,82652,HC VITAMIN D (1 25 DIHYDROXY)-90,301,1 ,$100.00 ,$65.00 ,$20.08 ,$100.00 ,$96.25 ,$65.00 ,$59.70 ,$38.50 ,$28.00 ,$56.10 ,$38.50 ,$65.80 ,$38.50 ,$85.00 ,$85.00 ,$38.50 ,$85.00 ,$73.15 ,$68.00 ,$96.25 ,$38.50 ,$38.50 ,$75.00 ,$71.00 ,$71.00 ,$38.50 ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A ,$96.25 ,$85.00 ,$38.50 ,$100.00 ,$59.70 ,$38.50 ,$41.60 ,$22.09 ,$20.08 ,$38.50 ,$85.00 ,$80.85 ,$85.00 ,$28.00 ,$90.00 ,$38.50 ,$82.00 ,$100.00 ,$100.00 ,$38.50 ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101241,82656,HC ELASTASE PANCREATIC EL1 FECAL QL OR SQN-90,301,1 ,$323.00 ,$209.95 ,$7.46 ,$323.00 ,$28.83 ,$209.95 ,$192.83 ,$11.53 ,$90.44 ,$181.20 ,$11.53 ,$212.53 ,$11.53 ,$274.55 ,$274.55 ,$11.53 ,$274.55 ,$21.91 ,$219.64 ,$28.83 ,$11.53 ,$11.53 ,$242.25 ,$229.33 ,$229.33 ,$11.53 ,$229.33 ,$264.86 ,$264.86 ,$264.86 , N/A ,$28.83 ,$274.55 ,$11.53 ,$323.00 ,$192.83 ,$11.53 ,$134.37 ,$8.21 ,$7.46 ,$11.53 ,$274.55 ,$24.21 ,$274.55 ,$90.44 ,$290.70 ,$11.53 ,$264.86 ,$46.12 ,$46.12 ,$11.53 ,$209.95 ,$323.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101245,82668,HC ERYTHROPOIETIN-90,301,1 ,$102.00 ,$66.30 ,$7.46 ,$102.00 ,$46.98 ,$66.30 ,$60.89 ,$18.79 ,$28.56 ,$57.22 ,$18.79 ,$67.12 ,$18.79 ,$86.70 ,$86.70 ,$18.79 ,$86.70 ,$35.70 ,$69.36 ,$46.98 ,$18.79 ,$18.79 ,$76.50 ,$72.42 ,$72.42 ,$18.79 ,$72.42 ,$83.64 ,$83.64 ,$83.64 , N/A ,$46.98 ,$86.70 ,$18.79 ,$102.00 ,$60.89 ,$18.79 ,$42.43 ,$8.21 ,$7.46 ,$18.79 ,$86.70 ,$39.46 ,$86.70 ,$28.56 ,$91.80 ,$18.79 ,$83.64 ,$75.16 ,$75.16 ,$18.79 ,$66.30 ,$102.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101246,82670,HC ESTRADIOL-90,301,1 ,$120.00 ,$78.00 ,$17.46 ,$120.00 ,$69.85 ,$78.00 ,$71.64 ,$27.94 ,$33.60 ,$67.32 ,$27.94 ,$78.96 ,$27.94 ,$102.00 ,$102.00 ,$27.94 ,$102.00 ,$53.09 ,$81.60 ,$69.85 ,$27.94 ,$27.94 ,$90.00 ,$85.20 ,$85.20 ,$27.94 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$69.85 ,$102.00 ,$27.94 ,$120.00 ,$71.64 ,$27.94 ,$49.92 ,$19.21 ,$17.46 ,$27.94 ,$102.00 ,$58.67 ,$102.00 ,$33.60 ,$108.00 ,$27.94 ,$98.40 ,$111.76 ,$111.76 ,$27.94 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101247,82670,HC ESTRADIOL FREE-90,301,1 ,$33.00 ,$21.45 ,$9.24 ,$69.85 ,$69.85 ,$21.45 ,$19.70 ,$27.94 ,$9.24 ,$18.51 ,$27.94 ,$21.71 ,$27.94 ,$28.05 ,$28.05 ,$27.94 ,$28.05 ,$33.00 ,$22.44 ,$69.85 ,$27.94 ,$27.94 ,$24.75 ,$23.43 ,$23.43 ,$27.94 ,$23.43 ,$27.06 ,$27.06 ,$27.06 , N/A ,$33.00 ,$28.05 ,$27.94 ,$33.00 ,$19.70 ,$27.94 ,$13.73 ,$19.21 ,$17.46 ,$27.94 ,$28.05 ,$58.67 ,$28.05 ,$9.24 ,$29.70 ,$27.94 ,$27.06 ,$33.00 ,$33.00 ,$27.94 ,$21.45 ,$33.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101248,82671,HC ESTROGEN FRACTIONATED-90,301,1 ,$184.00 ,$119.60 ,$17.46 ,$184.00 ,$80.75 ,$119.60 ,$109.85 ,$32.30 ,$51.52 ,$103.22 ,$32.30 ,$121.07 ,$32.30 ,$156.40 ,$156.40 ,$32.30 ,$156.40 ,$61.37 ,$125.12 ,$80.75 ,$32.30 ,$32.30 ,$138.00 ,$130.64 ,$130.64 ,$32.30 ,$130.64 ,$150.88 ,$150.88 ,$150.88 , N/A ,$80.75 ,$156.40 ,$32.30 ,$184.00 ,$109.85 ,$32.30 ,$76.54 ,$19.21 ,$17.46 ,$32.30 ,$156.40 ,$67.83 ,$156.40 ,$51.52 ,$165.60 ,$32.30 ,$150.88 ,$129.20 ,$129.20 ,$32.30 ,$119.60 ,$184.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101249,82672,HC ESTROGEN TOTAL-90,301,1 ,$79.00 ,$51.35 ,$17.46 ,$79.00 ,$54.25 ,$51.35 ,$47.16 ,$21.70 ,$22.12 ,$44.32 ,$21.70 ,$51.98 ,$21.70 ,$67.15 ,$67.15 ,$21.70 ,$67.15 ,$41.23 ,$53.72 ,$54.25 ,$21.70 ,$21.70 ,$59.25 ,$56.09 ,$56.09 ,$21.70 ,$56.09 ,$64.78 ,$64.78 ,$64.78 , N/A ,$54.25 ,$67.15 ,$21.70 ,$79.00 ,$47.16 ,$21.70 ,$32.86 ,$19.21 ,$17.46 ,$21.70 ,$67.15 ,$45.57 ,$67.15 ,$22.12 ,$71.10 ,$21.70 ,$64.78 ,$79.00 ,$79.00 ,$21.70 ,$51.35 ,$79.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101250,82677,HC ESTRIOL-90,301,1 ,$30.00 ,$19.50 ,$8.40 ,$60.45 ,$60.45 ,$19.50 ,$17.91 ,$24.18 ,$8.40 ,$16.83 ,$24.18 ,$19.74 ,$24.18 ,$25.50 ,$25.50 ,$24.18 ,$25.50 ,$30.00 ,$20.40 ,$60.45 ,$24.18 ,$24.18 ,$22.50 ,$21.30 ,$21.30 ,$24.18 ,$21.30 ,$24.60 ,$24.60 ,$24.60 , N/A ,$30.00 ,$25.50 ,$24.18 ,$30.00 ,$17.91 ,$24.18 ,$12.48 ,$19.21 ,$17.46 ,$24.18 ,$25.50 ,$50.78 ,$25.50 ,$8.40 ,$27.00 ,$24.18 ,$24.60 ,$30.00 ,$30.00 ,$24.18 ,$19.50 ,$30.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101251,82679,HC ESTRONE-90,301,1 ,$88.00 ,$57.20 ,$17.46 ,$88.00 ,$62.38 ,$57.20 ,$52.54 ,$24.95 ,$24.64 ,$49.37 ,$24.95 ,$57.90 ,$24.95 ,$74.80 ,$74.80 ,$24.95 ,$74.80 ,$47.41 ,$59.84 ,$62.38 ,$24.95 ,$24.95 ,$66.00 ,$62.48 ,$62.48 ,$24.95 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$62.38 ,$74.80 ,$24.95 ,$88.00 ,$52.54 ,$24.95 ,$36.61 ,$19.21 ,$17.46 ,$24.95 ,$74.80 ,$52.40 ,$74.80 ,$24.64 ,$79.20 ,$24.95 ,$72.16 ,$88.00 ,$88.00 ,$24.95 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101252,82693,HC ETHYLENE GLYCOL-90,301,1 ,$27.26 ,$17.72 ,$7.63 ,$37.25 ,$37.25 ,$17.72 ,$16.27 ,$14.90 ,$7.63 ,$15.29 ,$14.90 ,$17.94 ,$14.90 ,$23.17 ,$23.17 ,$14.90 ,$23.17 ,$27.26 ,$18.54 ,$37.25 ,$14.90 ,$14.90 ,$20.45 ,$19.35 ,$19.35 ,$14.90 ,$19.35 ,$22.35 ,$22.35 ,$22.35 , N/A ,$27.26 ,$23.17 ,$14.90 ,$27.26 ,$16.27 ,$14.90 ,$11.34 ,$10.01 ,$9.10 ,$14.90 ,$23.17 ,$31.29 ,$23.17 ,$7.63 ,$24.53 ,$14.90 ,$22.35 ,$27.26 ,$27.26 ,$14.90 ,$17.72 ,$27.26 
ST. JOSEPH'S HOSPITAL - BREESE,30101253,82705,HC FECAL FAT QUALITATIVE-90,301,1 ,$74.00 ,$48.10 ,$3.32 ,$74.00 ,$12.75 ,$48.10 ,$44.18 ,$5.10 ,$20.72 ,$41.51 ,$5.10 ,$48.69 ,$5.10 ,$62.90 ,$62.90 ,$5.10 ,$62.90 ,$9.69 ,$50.32 ,$12.75 ,$5.10 ,$5.10 ,$55.50 ,$52.54 ,$52.54 ,$5.10 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$12.75 ,$62.90 ,$5.10 ,$74.00 ,$44.18 ,$5.10 ,$30.78 ,$3.65 ,$3.32 ,$5.10 ,$62.90 ,$10.71 ,$62.90 ,$20.72 ,$66.60 ,$5.10 ,$60.68 ,$20.40 ,$20.40 ,$5.10 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101255,82726,HC FATTY ACIDS VERY LONG CHAIN-90,301,1 ,$649.00 ,$421.85 ,$7.46 ,$649.00 ,$49.38 ,$421.85 ,$387.45 ,$19.75 ,$181.72 ,$364.09 ,$19.75 ,$427.04 ,$19.75 ,$551.65 ,$551.65 ,$19.75 ,$551.65 ,$37.53 ,$441.32 ,$49.38 ,$19.75 ,$19.75 ,$486.75 ,$460.79 ,$460.79 ,$19.75 ,$460.79 ,$532.18 ,$532.18 ,$532.18 , N/A ,$49.38 ,$551.65 ,$19.75 ,$649.00 ,$387.45 ,$19.75 ,$269.98 ,$8.21 ,$7.46 ,$19.75 ,$551.65 ,$41.48 ,$551.65 ,$181.72 ,$584.10 ,$19.75 ,$532.18 ,$79.00 ,$79.00 ,$19.75 ,$421.85 ,$649.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101259,82747,HC FOLIC ACID RBC-90,301,1 ,$95.00 ,$61.75 ,$4.63 ,$95.00 ,$44.13 ,$61.75 ,$56.72 ,$17.65 ,$26.60 ,$53.30 ,$17.65 ,$62.51 ,$17.65 ,$80.75 ,$80.75 ,$17.65 ,$80.75 ,$33.54 ,$64.60 ,$44.13 ,$17.65 ,$17.65 ,$71.25 ,$67.45 ,$67.45 ,$17.65 ,$67.45 ,$77.90 ,$77.90 ,$77.90 , N/A ,$44.13 ,$80.75 ,$17.65 ,$95.00 ,$56.72 ,$17.65 ,$39.52 ,$5.09 ,$4.63 ,$17.65 ,$80.75 ,$37.07 ,$80.75 ,$26.60 ,$85.50 ,$17.65 ,$77.90 ,$70.60 ,$70.60 ,$17.65 ,$61.75 ,$95.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101262,82784,HC GAMMAGLOBULIN-90,301,1 ,$101.00 ,$65.65 ,$7.46 ,$101.00 ,$23.25 ,$65.65 ,$60.30 ,$9.30 ,$28.28 ,$56.66 ,$9.30 ,$66.46 ,$9.30 ,$85.85 ,$85.85 ,$9.30 ,$85.85 ,$17.67 ,$68.68 ,$23.25 ,$9.30 ,$9.30 ,$75.75 ,$71.71 ,$71.71 ,$9.30 ,$71.71 ,$82.82 ,$82.82 ,$82.82 , N/A ,$23.25 ,$85.85 ,$9.30 ,$101.00 ,$60.30 ,$9.30 ,$42.02 ,$8.21 ,$7.46 ,$9.30 ,$85.85 ,$19.53 ,$85.85 ,$28.28 ,$90.90 ,$9.30 ,$82.82 ,$37.20 ,$37.20 ,$9.30 ,$65.65 ,$101.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101263,82785,HC GAMMAGLOBULIN IGE-90,301,1 ,$126.00 ,$81.90 ,$7.46 ,$126.00 ,$41.15 ,$81.90 ,$75.22 ,$16.46 ,$35.28 ,$70.69 ,$16.46 ,$82.91 ,$16.46 ,$107.10 ,$107.10 ,$16.46 ,$107.10 ,$31.27 ,$85.68 ,$41.15 ,$16.46 ,$16.46 ,$94.50 ,$89.46 ,$89.46 ,$16.46 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$41.15 ,$107.10 ,$16.46 ,$126.00 ,$75.22 ,$16.46 ,$52.42 ,$8.21 ,$7.46 ,$16.46 ,$107.10 ,$34.57 ,$107.10 ,$35.28 ,$113.40 ,$16.46 ,$103.32 ,$65.84 ,$65.84 ,$16.46 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101265,82787,HC IMMUNOGLOBULIN SUBCLASSES-90,301,1 ,$67.00 ,$43.55 ,$8.02 ,$67.00 ,$20.05 ,$43.55 ,$40.00 ,$8.02 ,$18.76 ,$37.59 ,$8.02 ,$44.09 ,$8.02 ,$56.95 ,$56.95 ,$8.02 ,$56.95 ,$15.24 ,$45.56 ,$20.05 ,$8.02 ,$8.02 ,$50.25 ,$47.57 ,$47.57 ,$8.02 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$20.05 ,$56.95 ,$8.02 ,$67.00 ,$40.00 ,$8.02 ,$27.87 ,$12.66 ,$11.51 ,$8.02 ,$56.95 ,$16.84 ,$56.95 ,$18.76 ,$60.30 ,$8.02 ,$54.94 ,$32.08 ,$32.08 ,$8.02 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101268,82941,HC GASTRIN-90,301,1 ,$87.00 ,$56.55 ,$17.46 ,$87.00 ,$44.08 ,$56.55 ,$51.94 ,$17.63 ,$24.36 ,$48.81 ,$17.63 ,$57.25 ,$17.63 ,$73.95 ,$73.95 ,$17.63 ,$73.95 ,$33.50 ,$59.16 ,$44.08 ,$17.63 ,$17.63 ,$65.25 ,$61.77 ,$61.77 ,$17.63 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$44.08 ,$73.95 ,$17.63 ,$87.00 ,$51.94 ,$17.63 ,$36.19 ,$19.21 ,$17.46 ,$17.63 ,$73.95 ,$37.02 ,$73.95 ,$24.36 ,$78.30 ,$17.63 ,$71.34 ,$70.52 ,$70.52 ,$17.63 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101274,82955,HC G6PD ENZYME QN-90,301,1 ,$57.00 ,$37.05 ,$7.46 ,$57.00 ,$24.25 ,$37.05 ,$34.03 ,$9.70 ,$15.96 ,$31.98 ,$9.70 ,$37.51 ,$9.70 ,$48.45 ,$48.45 ,$9.70 ,$48.45 ,$18.43 ,$38.76 ,$24.25 ,$9.70 ,$9.70 ,$42.75 ,$40.47 ,$40.47 ,$9.70 ,$40.47 ,$46.74 ,$46.74 ,$46.74 , N/A ,$24.25 ,$48.45 ,$9.70 ,$57.00 ,$34.03 ,$9.70 ,$23.71 ,$8.21 ,$7.46 ,$9.70 ,$48.45 ,$20.37 ,$48.45 ,$15.96 ,$51.30 ,$9.70 ,$46.74 ,$38.80 ,$38.80 ,$9.70 ,$37.05 ,$57.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101275,82977,HC GGT/GGTP-90,301,1 ,$90.00 ,$58.50 ,$3.32 ,$90.00 ,$18.00 ,$58.50 ,$53.73 ,$7.20 ,$25.20 ,$50.49 ,$7.20 ,$59.22 ,$7.20 ,$76.50 ,$76.50 ,$7.20 ,$76.50 ,$13.68 ,$61.20 ,$18.00 ,$7.20 ,$7.20 ,$67.50 ,$63.90 ,$63.90 ,$7.20 ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A ,$18.00 ,$76.50 ,$7.20 ,$90.00 ,$53.73 ,$7.20 ,$37.44 ,$3.65 ,$3.32 ,$7.20 ,$76.50 ,$15.12 ,$76.50 ,$25.20 ,$81.00 ,$7.20 ,$73.80 ,$28.80 ,$28.80 ,$7.20 ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101276,82985,HC FRUCTOSAMINE-90,301,1 ,$9.00 ,$5.85 ,$2.52 ,$22.50 ,$22.50 ,$5.85 ,$5.37 ,$9.00 ,$2.52 ,$5.05 ,$9.00 ,$5.92 ,$9.00 ,$7.65 ,$7.65 ,$9.00 ,$7.65 ,$9.00 ,$6.12 ,$22.50 ,$9.00 ,$9.00 ,$6.75 ,$6.39 ,$6.39 ,$9.00 ,$6.39 ,$7.38 ,$7.38 ,$7.38 , N/A ,$9.00 ,$7.65 ,$9.00 ,$9.00 ,$5.37 ,$9.00 ,$3.74 ,$8.21 ,$7.46 ,$9.00 ,$7.65 ,$18.90 ,$7.65 ,$2.52 ,$8.10 ,$9.00 ,$7.38 ,$9.00 ,$9.00 ,$9.00 ,$5.85 ,$9.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101279,83003,HC GROWTH HORMONE (HGH)-90,301,1 ,$62.00 ,$40.30 ,$16.67 ,$62.00 ,$41.68 ,$40.30 ,$37.01 ,$16.67 ,$17.36 ,$34.78 ,$16.67 ,$40.80 ,$16.67 ,$52.70 ,$52.70 ,$16.67 ,$52.70 ,$31.67 ,$42.16 ,$41.68 ,$16.67 ,$16.67 ,$46.50 ,$44.02 ,$44.02 ,$16.67 ,$44.02 ,$50.84 ,$50.84 ,$50.84 , N/A ,$41.68 ,$52.70 ,$16.67 ,$62.00 ,$37.01 ,$16.67 ,$25.79 ,$19.21 ,$17.46 ,$16.67 ,$52.70 ,$35.01 ,$52.70 ,$17.36 ,$55.80 ,$16.67 ,$50.84 ,$62.00 ,$62.00 ,$16.67 ,$40.30 ,$62.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101281,83010,HC HAPTOGLOBIN-90,301,1 ,$119.00 ,$77.35 ,$7.46 ,$119.00 ,$31.45 ,$77.35 ,$71.04 ,$12.58 ,$33.32 ,$66.76 ,$12.58 ,$78.30 ,$12.58 ,$101.15 ,$101.15 ,$12.58 ,$101.15 ,$23.90 ,$80.92 ,$31.45 ,$12.58 ,$12.58 ,$89.25 ,$84.49 ,$84.49 ,$12.58 ,$84.49 ,$97.58 ,$97.58 ,$97.58 , N/A ,$31.45 ,$101.15 ,$12.58 ,$119.00 ,$71.04 ,$12.58 ,$49.50 ,$8.21 ,$7.46 ,$12.58 ,$101.15 ,$26.42 ,$101.15 ,$33.32 ,$107.10 ,$12.58 ,$97.58 ,$50.32 ,$50.32 ,$12.58 ,$77.35 ,$119.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101282,83013,HC H PYLORI BREATH TEST-90,301,1 ,$284.00 ,$184.60 ,$20.08 ,$284.00 ,$168.40 ,$184.60 ,$169.55 ,$67.36 ,$79.52 ,$159.32 ,$67.36 ,$186.87 ,$67.36 ,$241.40 ,$241.40 ,$67.36 ,$241.40 ,$127.98 ,$193.12 ,$168.40 ,$67.36 ,$67.36 ,$213.00 ,$201.64 ,$201.64 ,$67.36 ,$201.64 ,$232.88 ,$232.88 ,$232.88 , N/A ,$168.40 ,$241.40 ,$67.36 ,$284.00 ,$169.55 ,$67.36 ,$118.14 ,$22.09 ,$20.08 ,$67.36 ,$241.40 ,$141.46 ,$241.40 ,$79.52 ,$255.60 ,$67.36 ,$232.88 ,$269.44 ,$269.44 ,$67.36 ,$184.60 ,$284.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101283,83018,HC HEAVY METAL QN EACH-90,301,1 ,$134.00 ,$87.10 ,$9.10 ,$134.00 ,$54.90 ,$87.10 ,$80.00 ,$21.96 ,$37.52 ,$75.17 ,$21.96 ,$88.17 ,$21.96 ,$113.90 ,$113.90 ,$21.96 ,$113.90 ,$41.72 ,$91.12 ,$54.90 ,$21.96 ,$21.96 ,$100.50 ,$95.14 ,$95.14 ,$21.96 ,$95.14 ,$109.88 ,$109.88 ,$109.88 , N/A ,$54.90 ,$113.90 ,$21.96 ,$134.00 ,$80.00 ,$21.96 ,$55.74 ,$10.01 ,$9.10 ,$21.96 ,$113.90 ,$46.12 ,$113.90 ,$37.52 ,$120.60 ,$21.96 ,$109.88 ,$87.84 ,$87.84 ,$21.96 ,$87.10 ,$134.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101284,83020,HC HGB ELECTROPHORESIS-90,301,1 ,$63.00 ,$40.95 ,$7.46 ,$63.00 ,$32.18 ,$40.95 ,$37.61 ,$12.87 ,$17.64 ,$35.34 ,$12.87 ,$41.45 ,$12.87 ,$53.55 ,$53.55 ,$12.87 ,$53.55 ,$24.45 ,$42.84 ,$32.18 ,$12.87 ,$12.87 ,$47.25 ,$44.73 ,$44.73 ,$12.87 ,$44.73 ,$51.66 ,$51.66 ,$51.66 , N/A ,$32.18 ,$53.55 ,$12.87 ,$63.00 ,$37.61 ,$12.87 ,$26.21 ,$8.21 ,$7.46 ,$12.87 ,$53.55 ,$27.03 ,$53.55 ,$17.64 ,$56.70 ,$12.87 ,$51.66 ,$51.48 ,$51.48 ,$12.87 ,$40.95 ,$63.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101285,83021,HC HEMOGLOBIN FRACT QN-90,301,1 ,$63.00 ,$40.95 ,$7.05 ,$63.00 ,$45.15 ,$40.95 ,$37.61 ,$18.06 ,$17.64 ,$35.34 ,$18.06 ,$41.45 ,$18.06 ,$53.55 ,$53.55 ,$18.06 ,$53.55 ,$34.31 ,$42.84 ,$45.15 ,$18.06 ,$18.06 ,$47.25 ,$44.73 ,$44.73 ,$18.06 ,$44.73 ,$51.66 ,$51.66 ,$51.66 , N/A ,$45.15 ,$53.55 ,$18.06 ,$63.00 ,$37.61 ,$18.06 ,$26.21 ,$7.76 ,$7.05 ,$18.06 ,$53.55 ,$37.93 ,$53.55 ,$17.64 ,$56.70 ,$18.06 ,$51.66 ,$63.00 ,$63.00 ,$18.06 ,$40.95 ,$63.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101289,83051,HC HEMOGLOBIN PLASMA-90,301,1 ,$52.00 ,$33.80 ,$7.31 ,$52.00 ,$18.28 ,$33.80 ,$31.04 ,$7.31 ,$14.56 ,$29.17 ,$7.31 ,$34.22 ,$7.31 ,$44.20 ,$44.20 ,$7.31 ,$44.20 ,$13.89 ,$35.36 ,$18.28 ,$7.31 ,$7.31 ,$39.00 ,$36.92 ,$36.92 ,$7.31 ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A ,$18.28 ,$44.20 ,$7.31 ,$52.00 ,$31.04 ,$7.31 ,$21.63 ,$8.21 ,$7.46 ,$7.31 ,$44.20 ,$15.35 ,$44.20 ,$14.56 ,$46.80 ,$7.31 ,$42.64 ,$29.24 ,$29.24 ,$7.31 ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101292,83090,HC HOMOCYSTEINE-90,301,1 ,$107.00 ,$69.55 ,$17.46 ,$107.00 ,$44.80 ,$69.55 ,$63.88 ,$17.92 ,$29.96 ,$60.03 ,$17.92 ,$70.41 ,$17.92 ,$90.95 ,$90.95 ,$17.92 ,$90.95 ,$34.05 ,$72.76 ,$44.80 ,$17.92 ,$17.92 ,$80.25 ,$75.97 ,$75.97 ,$17.92 ,$75.97 ,$87.74 ,$87.74 ,$87.74 , N/A ,$44.80 ,$90.95 ,$17.92 ,$107.00 ,$63.88 ,$17.92 ,$44.51 ,$19.21 ,$17.46 ,$17.92 ,$90.95 ,$37.63 ,$90.95 ,$29.96 ,$96.30 ,$17.92 ,$87.74 ,$71.68 ,$71.68 ,$17.92 ,$69.55 ,$107.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101294,83497,HC HYDROXYINDOLACET 5 (HIAA)-90,301,1 ,$65.00 ,$42.25 ,$10.04 ,$65.00 ,$32.25 ,$42.25 ,$38.81 ,$12.90 ,$18.20 ,$36.47 ,$12.90 ,$42.77 ,$12.90 ,$55.25 ,$55.25 ,$12.90 ,$55.25 ,$24.51 ,$44.20 ,$32.25 ,$12.90 ,$12.90 ,$48.75 ,$46.15 ,$46.15 ,$12.90 ,$46.15 ,$53.30 ,$53.30 ,$53.30 , N/A ,$32.25 ,$55.25 ,$12.90 ,$65.00 ,$38.81 ,$12.90 ,$27.04 ,$11.04 ,$10.04 ,$12.90 ,$55.25 ,$27.09 ,$55.25 ,$18.20 ,$58.50 ,$12.90 ,$53.30 ,$51.60 ,$51.60 ,$12.90 ,$42.25 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101295,83498,HC HYDROXYPROGESTERONE 17D-90,301,1 ,$121.00 ,$78.65 ,$17.46 ,$121.00 ,$67.93 ,$78.65 ,$72.24 ,$27.17 ,$33.88 ,$67.88 ,$27.17 ,$79.62 ,$27.17 ,$102.85 ,$102.85 ,$27.17 ,$102.85 ,$51.62 ,$82.28 ,$67.93 ,$27.17 ,$27.17 ,$90.75 ,$85.91 ,$85.91 ,$27.17 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$67.93 ,$102.85 ,$27.17 ,$121.00 ,$72.24 ,$27.17 ,$50.34 ,$19.21 ,$17.46 ,$27.17 ,$102.85 ,$57.06 ,$102.85 ,$33.88 ,$108.90 ,$27.17 ,$99.22 ,$108.68 ,$108.68 ,$27.17 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101297,83516,HC MLT NON INFECT QL/SQ-90,301,1 ,$121.00 ,$78.65 ,$6.68 ,$121.00 ,$28.83 ,$78.65 ,$72.24 ,$11.53 ,$33.88 ,$67.88 ,$11.53 ,$79.62 ,$11.53 ,$102.85 ,$102.85 ,$11.53 ,$102.85 ,$21.91 ,$82.28 ,$28.83 ,$11.53 ,$11.53 ,$90.75 ,$85.91 ,$85.91 ,$11.53 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$28.83 ,$102.85 ,$11.53 ,$121.00 ,$72.24 ,$11.53 ,$50.34 ,$7.35 ,$6.68 ,$11.53 ,$102.85 ,$24.21 ,$102.85 ,$33.88 ,$108.90 ,$11.53 ,$99.22 ,$46.12 ,$46.12 ,$11.53 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101302,83519,HC QN RIA-90,301,1 ,$220.00 ,$143.00 ,$6.68 ,$220.00 ,$46.00 ,$143.00 ,$131.34 ,$18.40 ,$61.60 ,$123.42 ,$18.40 ,$144.76 ,$18.40 ,$187.00 ,$187.00 ,$18.40 ,$187.00 ,$34.96 ,$149.60 ,$46.00 ,$18.40 ,$18.40 ,$165.00 ,$156.20 ,$156.20 ,$18.40 ,$156.20 ,$180.40 ,$180.40 ,$180.40 , N/A ,$46.00 ,$187.00 ,$18.40 ,$220.00 ,$131.34 ,$18.40 ,$91.52 ,$7.35 ,$6.68 ,$18.40 ,$187.00 ,$38.64 ,$187.00 ,$61.60 ,$198.00 ,$18.40 ,$180.40 ,$73.60 ,$73.60 ,$18.40 ,$143.00 ,$220.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101303,83520,HC IMMUNOASSAY QN OTHER-90,301,1 ,$169.00 ,$109.85 ,$6.68 ,$169.00 ,$43.18 ,$109.85 ,$100.89 ,$17.27 ,$47.32 ,$94.81 ,$17.27 ,$111.20 ,$17.27 ,$143.65 ,$143.65 ,$17.27 ,$143.65 ,$32.81 ,$114.92 ,$43.18 ,$17.27 ,$17.27 ,$126.75 ,$119.99 ,$119.99 ,$17.27 ,$119.99 ,$138.58 ,$138.58 ,$138.58 , N/A ,$43.18 ,$143.65 ,$17.27 ,$169.00 ,$100.89 ,$17.27 ,$70.30 ,$7.35 ,$6.68 ,$17.27 ,$143.65 ,$36.27 ,$143.65 ,$47.32 ,$152.10 ,$17.27 ,$138.58 ,$69.08 ,$69.08 ,$17.27 ,$109.85 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101306,83520,HC IMMUNOASSAY QN ENZYME-90,301,1 ,$369.00 ,$239.85 ,$6.68 ,$369.00 ,$43.18 ,$239.85 ,$220.29 ,$17.27 ,$103.32 ,$207.01 ,$17.27 ,$242.80 ,$17.27 ,$313.65 ,$313.65 ,$17.27 ,$313.65 ,$32.81 ,$250.92 ,$43.18 ,$17.27 ,$17.27 ,$276.75 ,$261.99 ,$261.99 ,$17.27 ,$261.99 ,$302.58 ,$302.58 ,$302.58 , N/A ,$43.18 ,$313.65 ,$17.27 ,$369.00 ,$220.29 ,$17.27 ,$153.50 ,$7.35 ,$6.68 ,$17.27 ,$313.65 ,$36.27 ,$313.65 ,$103.32 ,$332.10 ,$17.27 ,$302.58 ,$69.08 ,$69.08 ,$17.27 ,$239.85 ,$369.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101307,83525,HC INSULIN TOTAL-90,301,1 ,$87.00 ,$56.55 ,$10.04 ,$87.00 ,$28.58 ,$56.55 ,$51.94 ,$11.43 ,$24.36 ,$48.81 ,$11.43 ,$57.25 ,$11.43 ,$73.95 ,$73.95 ,$11.43 ,$73.95 ,$21.72 ,$59.16 ,$28.58 ,$11.43 ,$11.43 ,$65.25 ,$61.77 ,$61.77 ,$11.43 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$28.58 ,$73.95 ,$11.43 ,$87.00 ,$51.94 ,$11.43 ,$36.19 ,$11.04 ,$10.04 ,$11.43 ,$73.95 ,$24.00 ,$73.95 ,$24.36 ,$78.30 ,$11.43 ,$71.34 ,$45.72 ,$45.72 ,$11.43 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101308,83527,HC INSULIN FREE-90,301,1 ,$26.00 ,$16.90 ,$7.28 ,$32.38 ,$32.38 ,$16.90 ,$15.52 ,$12.95 ,$7.28 ,$14.59 ,$12.95 ,$17.11 ,$12.95 ,$22.10 ,$22.10 ,$12.95 ,$22.10 ,$24.61 ,$17.68 ,$32.38 ,$12.95 ,$12.95 ,$19.50 ,$18.46 ,$18.46 ,$12.95 ,$18.46 ,$21.32 ,$21.32 ,$21.32 , N/A ,$26.00 ,$22.10 ,$12.95 ,$26.00 ,$15.52 ,$12.95 ,$10.82 ,$19.21 ,$17.46 ,$12.95 ,$22.10 ,$27.20 ,$22.10 ,$7.28 ,$23.40 ,$12.95 ,$21.32 ,$26.00 ,$26.00 ,$12.95 ,$16.90 ,$26.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101311,83605,HC LACTATE/LACTIC ACID-90,301,1 ,$23.64 ,$15.37 ,$6.62 ,$28.93 ,$28.93 ,$15.37 ,$14.11 ,$11.57 ,$6.62 ,$13.26 ,$11.57 ,$15.56 ,$11.57 ,$20.09 ,$20.09 ,$11.57 ,$20.09 ,$21.98 ,$16.08 ,$28.93 ,$11.57 ,$11.57 ,$17.73 ,$16.78 ,$16.78 ,$11.57 ,$16.78 ,$19.38 ,$19.38 ,$19.38 , N/A ,$23.64 ,$20.09 ,$11.57 ,$23.64 ,$14.11 ,$11.57 ,$9.83 ,$8.21 ,$7.46 ,$11.57 ,$20.09 ,$24.30 ,$20.09 ,$6.62 ,$21.28 ,$11.57 ,$19.38 ,$23.64 ,$23.64 ,$11.57 ,$15.37 ,$23.64 
ST. JOSEPH'S HOSPITAL - BREESE,30101312,83615,HC LACTATE DEHYDRO (LDH)-90,301,1 ,$102.00 ,$66.30 ,$3.32 ,$102.00 ,$15.10 ,$66.30 ,$60.89 ,$6.04 ,$28.56 ,$57.22 ,$6.04 ,$67.12 ,$6.04 ,$86.70 ,$86.70 ,$6.04 ,$86.70 ,$11.48 ,$69.36 ,$15.10 ,$6.04 ,$6.04 ,$76.50 ,$72.42 ,$72.42 ,$6.04 ,$72.42 ,$83.64 ,$83.64 ,$83.64 , N/A ,$15.10 ,$86.70 ,$6.04 ,$102.00 ,$60.89 ,$6.04 ,$42.43 ,$3.65 ,$3.32 ,$6.04 ,$86.70 ,$12.68 ,$86.70 ,$28.56 ,$91.80 ,$6.04 ,$83.64 ,$24.16 ,$24.16 ,$6.04 ,$66.30 ,$102.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101313,83625,HC LDH ISOENZYMES-90,301,1 ,$42.00 ,$27.30 ,$7.46 ,$42.00 ,$31.98 ,$27.30 ,$25.07 ,$12.79 ,$11.76 ,$23.56 ,$12.79 ,$27.64 ,$12.79 ,$35.70 ,$35.70 ,$12.79 ,$35.70 ,$24.30 ,$28.56 ,$31.98 ,$12.79 ,$12.79 ,$31.50 ,$29.82 ,$29.82 ,$12.79 ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A ,$31.98 ,$35.70 ,$12.79 ,$42.00 ,$25.07 ,$12.79 ,$17.47 ,$8.21 ,$7.46 ,$12.79 ,$35.70 ,$26.86 ,$35.70 ,$11.76 ,$37.80 ,$12.79 ,$34.44 ,$42.00 ,$42.00 ,$12.79 ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101316,83655,HC LEAD-90,301,1 ,$67.00 ,$43.55 ,$9.10 ,$67.00 ,$30.28 ,$43.55 ,$40.00 ,$12.11 ,$18.76 ,$37.59 ,$12.11 ,$44.09 ,$12.11 ,$56.95 ,$56.95 ,$12.11 ,$56.95 ,$23.01 ,$45.56 ,$30.28 ,$12.11 ,$12.11 ,$50.25 ,$47.57 ,$47.57 ,$12.11 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$30.28 ,$56.95 ,$12.11 ,$67.00 ,$40.00 ,$12.11 ,$27.87 ,$10.01 ,$9.10 ,$12.11 ,$56.95 ,$25.43 ,$56.95 ,$18.76 ,$60.30 ,$12.11 ,$54.94 ,$48.44 ,$48.44 ,$12.11 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101319,83695,HC LIPOPROTEIN-90,301,1 ,$74.00 ,$48.10 ,$7.46 ,$74.00 ,$35.80 ,$48.10 ,$44.18 ,$14.32 ,$20.72 ,$41.51 ,$14.32 ,$48.69 ,$14.32 ,$62.90 ,$62.90 ,$14.32 ,$62.90 ,$27.21 ,$50.32 ,$35.80 ,$14.32 ,$14.32 ,$55.50 ,$52.54 ,$52.54 ,$14.32 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$35.80 ,$62.90 ,$14.32 ,$74.00 ,$44.18 ,$14.32 ,$30.78 ,$8.21 ,$7.46 ,$14.32 ,$62.90 ,$30.07 ,$62.90 ,$20.72 ,$66.60 ,$14.32 ,$60.68 ,$57.28 ,$57.28 ,$14.32 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101325,80335,HC ANTIDEPRESSANTS TRYCLIC 1-2  -90,301,1 ,$52.00 ,$33.80 ,$14.56 ,$52.00 , N/A ,$33.80 ,$31.04 , N/A ,$14.56 ,$29.17 , N/A ,$34.22 , N/A ,$44.20 ,$44.20 , N/A ,$44.20 , N/A ,$35.36 , N/A , N/A , N/A ,$39.00 ,$36.92 ,$36.92 , N/A ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A , N/A ,$44.20 , N/A ,$52.00 ,$31.04 , N/A ,$21.63 ,$22.09 ,$20.08 , N/A ,$44.20 , N/A ,$44.20 ,$14.56 ,$46.80 , N/A ,$42.64 , N/A , N/A , N/A ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101326,83735,HC MAGNESIUM-90,301,1 ,$80.00 ,$52.00 ,$3.32 ,$80.00 ,$16.75 ,$52.00 ,$47.76 ,$6.70 ,$22.40 ,$44.88 ,$6.70 ,$52.64 ,$6.70 ,$68.00 ,$68.00 ,$6.70 ,$68.00 ,$12.73 ,$54.40 ,$16.75 ,$6.70 ,$6.70 ,$60.00 ,$56.80 ,$56.80 ,$6.70 ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A ,$16.75 ,$68.00 ,$6.70 ,$80.00 ,$47.76 ,$6.70 ,$33.28 ,$3.65 ,$3.32 ,$6.70 ,$68.00 ,$14.07 ,$68.00 ,$22.40 ,$72.00 ,$6.70 ,$65.60 ,$26.80 ,$26.80 ,$6.70 ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101327,83785,HC MANGANESE-90,301,1 ,$164.00 ,$106.60 ,$9.10 ,$164.00 ,$66.63 ,$106.60 ,$97.91 ,$26.65 ,$45.92 ,$92.00 ,$26.65 ,$107.91 ,$26.65 ,$139.40 ,$139.40 ,$26.65 ,$139.40 ,$50.64 ,$111.52 ,$66.63 ,$26.65 ,$26.65 ,$123.00 ,$116.44 ,$116.44 ,$26.65 ,$116.44 ,$134.48 ,$134.48 ,$134.48 , N/A ,$66.63 ,$139.40 ,$26.65 ,$164.00 ,$97.91 ,$26.65 ,$68.22 ,$10.01 ,$9.10 ,$26.65 ,$139.40 ,$55.97 ,$139.40 ,$45.92 ,$147.60 ,$26.65 ,$134.48 ,$106.60 ,$106.60 ,$26.65 ,$106.60 ,$164.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101328,83789,HC MASS SPEC QN EACH-90,301,1 ,$189.00 ,$122.85 ,$7.46 ,$189.00 ,$60.28 ,$122.85 ,$112.83 ,$24.11 ,$52.92 ,$106.03 ,$24.11 ,$124.36 ,$24.11 ,$160.65 ,$160.65 ,$24.11 ,$160.65 ,$45.81 ,$128.52 ,$60.28 ,$24.11 ,$24.11 ,$141.75 ,$134.19 ,$134.19 ,$24.11 ,$134.19 ,$154.98 ,$154.98 ,$154.98 , N/A ,$60.28 ,$160.65 ,$24.11 ,$189.00 ,$112.83 ,$24.11 ,$78.62 ,$8.21 ,$7.46 ,$24.11 ,$160.65 ,$50.63 ,$160.65 ,$52.92 ,$170.10 ,$24.11 ,$154.98 ,$96.44 ,$96.44 ,$24.11 ,$122.85 ,$189.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101329,83825,HC MERCURY-90,301,1 ,$82.00 ,$53.30 ,$9.10 ,$82.00 ,$40.65 ,$53.30 ,$48.95 ,$16.26 ,$22.96 ,$46.00 ,$16.26 ,$53.96 ,$16.26 ,$69.70 ,$69.70 ,$16.26 ,$69.70 ,$30.89 ,$55.76 ,$40.65 ,$16.26 ,$16.26 ,$61.50 ,$58.22 ,$58.22 ,$16.26 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$40.65 ,$69.70 ,$16.26 ,$82.00 ,$48.95 ,$16.26 ,$34.11 ,$10.01 ,$9.10 ,$16.26 ,$69.70 ,$34.15 ,$69.70 ,$22.96 ,$73.80 ,$16.26 ,$67.24 ,$65.04 ,$65.04 ,$16.26 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101330,83835,HC METANEPHRINES-90,301,1 ,$111.00 ,$72.15 ,$16.94 ,$111.00 ,$42.35 ,$72.15 ,$66.27 ,$16.94 ,$31.08 ,$62.27 ,$16.94 ,$73.04 ,$16.94 ,$94.35 ,$94.35 ,$16.94 ,$94.35 ,$32.19 ,$75.48 ,$42.35 ,$16.94 ,$16.94 ,$83.25 ,$78.81 ,$78.81 ,$16.94 ,$78.81 ,$91.02 ,$91.02 ,$91.02 , N/A ,$42.35 ,$94.35 ,$16.94 ,$111.00 ,$66.27 ,$16.94 ,$46.18 ,$19.21 ,$17.46 ,$16.94 ,$94.35 ,$35.57 ,$94.35 ,$31.08 ,$99.90 ,$16.94 ,$91.02 ,$67.76 ,$67.76 ,$16.94 ,$72.15 ,$111.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101333,83873,HC MYELIN BASIC PROTEIN (CSF)-90,301,1 ,$66.00 ,$42.90 ,$7.46 ,$66.00 ,$43.00 ,$42.90 ,$39.40 ,$17.20 ,$18.48 ,$37.03 ,$17.20 ,$43.43 ,$17.20 ,$56.10 ,$56.10 ,$17.20 ,$56.10 ,$32.68 ,$44.88 ,$43.00 ,$17.20 ,$17.20 ,$49.50 ,$46.86 ,$46.86 ,$17.20 ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A ,$43.00 ,$56.10 ,$17.20 ,$66.00 ,$39.40 ,$17.20 ,$27.46 ,$8.21 ,$7.46 ,$17.20 ,$56.10 ,$36.12 ,$56.10 ,$18.48 ,$59.40 ,$17.20 ,$54.12 ,$66.00 ,$66.00 ,$17.20 ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101334,83874,HC MYOGLOBIN-90,301,1 ,$114.00 ,$74.10 ,$7.46 ,$114.00 ,$32.30 ,$74.10 ,$68.06 ,$12.92 ,$31.92 ,$63.95 ,$12.92 ,$75.01 ,$12.92 ,$96.90 ,$96.90 ,$12.92 ,$96.90 ,$24.55 ,$77.52 ,$32.30 ,$12.92 ,$12.92 ,$85.50 ,$80.94 ,$80.94 ,$12.92 ,$80.94 ,$93.48 ,$93.48 ,$93.48 , N/A ,$32.30 ,$96.90 ,$12.92 ,$114.00 ,$68.06 ,$12.92 ,$47.42 ,$8.21 ,$7.46 ,$12.92 ,$96.90 ,$27.13 ,$96.90 ,$31.92 ,$102.60 ,$12.92 ,$93.48 ,$51.68 ,$51.68 ,$12.92 ,$74.10 ,$114.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101336,83880,HC BNP NATRIURETIC PEPTIDE-90,301,1 ,$139.00 ,$90.35 ,$20.08 ,$139.00 ,$98.15 ,$90.35 ,$82.98 ,$39.26 ,$38.92 ,$77.98 ,$39.26 ,$91.46 ,$39.26 ,$118.15 ,$118.15 ,$39.26 ,$118.15 ,$74.59 ,$94.52 ,$98.15 ,$39.26 ,$39.26 ,$104.25 ,$98.69 ,$98.69 ,$39.26 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$98.15 ,$118.15 ,$39.26 ,$139.00 ,$82.98 ,$39.26 ,$57.82 ,$22.09 ,$20.08 ,$39.26 ,$118.15 ,$82.45 ,$118.15 ,$38.92 ,$125.10 ,$39.26 ,$113.98 ,$139.00 ,$139.00 ,$39.26 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101337,83883,HC NEPHELOMETRY EA ANALYTE-90,301,1 ,$97.00 ,$63.05 ,$11.51 ,$97.00 ,$34.00 ,$63.05 ,$57.91 ,$13.60 ,$27.16 ,$54.42 ,$13.60 ,$63.83 ,$13.60 ,$82.45 ,$82.45 ,$13.60 ,$82.45 ,$25.84 ,$65.96 ,$34.00 ,$13.60 ,$13.60 ,$72.75 ,$68.87 ,$68.87 ,$13.60 ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A ,$34.00 ,$82.45 ,$13.60 ,$97.00 ,$57.91 ,$13.60 ,$40.35 ,$12.66 ,$11.51 ,$13.60 ,$82.45 ,$28.56 ,$82.45 ,$27.16 ,$87.30 ,$13.60 ,$79.54 ,$54.40 ,$54.40 ,$13.60 ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101339,83915,HC NUCLEOTIDASE 5 -90,301,1 ,$117.00 ,$76.05 ,$7.46 ,$117.00 ,$27.88 ,$76.05 ,$69.85 ,$11.15 ,$32.76 ,$65.64 ,$11.15 ,$76.99 ,$11.15 ,$99.45 ,$99.45 ,$11.15 ,$99.45 ,$21.19 ,$79.56 ,$27.88 ,$11.15 ,$11.15 ,$87.75 ,$83.07 ,$83.07 ,$11.15 ,$83.07 ,$95.94 ,$95.94 ,$95.94 , N/A ,$27.88 ,$99.45 ,$11.15 ,$117.00 ,$69.85 ,$11.15 ,$48.67 ,$8.21 ,$7.46 ,$11.15 ,$99.45 ,$23.42 ,$99.45 ,$32.76 ,$105.30 ,$11.15 ,$95.94 ,$44.60 ,$44.60 ,$11.15 ,$76.05 ,$117.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101340,83916,HC OLIGOCLONAL BANDS-90,301,1 ,$100.00 ,$65.00 ,$7.46 ,$100.00 ,$68.48 ,$65.00 ,$59.70 ,$27.39 ,$28.00 ,$56.10 ,$27.39 ,$65.80 ,$27.39 ,$85.00 ,$85.00 ,$27.39 ,$85.00 ,$52.04 ,$68.00 ,$68.48 ,$27.39 ,$27.39 ,$75.00 ,$71.00 ,$71.00 ,$27.39 ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A ,$68.48 ,$85.00 ,$27.39 ,$100.00 ,$59.70 ,$27.39 ,$41.60 ,$8.21 ,$7.46 ,$27.39 ,$85.00 ,$57.52 ,$85.00 ,$28.00 ,$90.00 ,$27.39 ,$82.00 ,$100.00 ,$100.00 ,$27.39 ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101342,83919,HC ORGANIC ACIDS QL-90,301,1 ,$231.00 ,$150.15 ,$7.46 ,$231.00 ,$41.13 ,$150.15 ,$137.91 ,$16.45 ,$64.68 ,$129.59 ,$16.45 ,$152.00 ,$16.45 ,$196.35 ,$196.35 ,$16.45 ,$196.35 ,$31.26 ,$157.08 ,$41.13 ,$16.45 ,$16.45 ,$173.25 ,$164.01 ,$164.01 ,$16.45 ,$164.01 ,$189.42 ,$189.42 ,$189.42 , N/A ,$41.13 ,$196.35 ,$16.45 ,$231.00 ,$137.91 ,$16.45 ,$96.10 ,$8.21 ,$7.46 ,$16.45 ,$196.35 ,$34.55 ,$196.35 ,$64.68 ,$207.90 ,$16.45 ,$189.42 ,$65.80 ,$65.80 ,$16.45 ,$150.15 ,$231.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101344,83937,HC OSTEOCALCIN-90,301,1 ,$91.00 ,$59.15 ,$17.46 ,$91.00 ,$74.63 ,$59.15 ,$54.33 ,$29.85 ,$25.48 ,$51.05 ,$29.85 ,$59.88 ,$29.85 ,$77.35 ,$77.35 ,$29.85 ,$77.35 ,$56.72 ,$61.88 ,$74.63 ,$29.85 ,$29.85 ,$68.25 ,$64.61 ,$64.61 ,$29.85 ,$64.61 ,$74.62 ,$74.62 ,$74.62 , N/A ,$74.63 ,$77.35 ,$29.85 ,$91.00 ,$54.33 ,$29.85 ,$37.86 ,$19.21 ,$17.46 ,$29.85 ,$77.35 ,$62.69 ,$77.35 ,$25.48 ,$81.90 ,$29.85 ,$74.62 ,$91.00 ,$91.00 ,$29.85 ,$59.15 ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101345,83945,HC OXALATE-90,301,1 ,$74.00 ,$48.10 ,$7.46 ,$74.00 ,$36.13 ,$48.10 ,$44.18 ,$14.45 ,$20.72 ,$41.51 ,$14.45 ,$48.69 ,$14.45 ,$62.90 ,$62.90 ,$14.45 ,$62.90 ,$27.46 ,$50.32 ,$36.13 ,$14.45 ,$14.45 ,$55.50 ,$52.54 ,$52.54 ,$14.45 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$36.13 ,$62.90 ,$14.45 ,$74.00 ,$44.18 ,$14.45 ,$30.78 ,$8.21 ,$7.46 ,$14.45 ,$62.90 ,$30.35 ,$62.90 ,$20.72 ,$66.60 ,$14.45 ,$60.68 ,$57.80 ,$57.80 ,$14.45 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101348,83986,HC PH BODY FLUID NOT BLOOD-90,301,1 ,$103.00 ,$66.95 ,$3.32 ,$103.00 ,$8.95 ,$66.95 ,$61.49 ,$3.58 ,$28.84 ,$57.78 ,$3.58 ,$67.77 ,$3.58 ,$87.55 ,$87.55 ,$3.58 ,$87.55 ,$6.80 ,$70.04 ,$8.95 ,$3.58 ,$3.58 ,$77.25 ,$73.13 ,$73.13 ,$3.58 ,$73.13 ,$84.46 ,$84.46 ,$84.46 , N/A ,$8.95 ,$87.55 ,$3.58 ,$103.00 ,$61.49 ,$3.58 ,$42.85 ,$3.65 ,$3.32 ,$3.58 ,$87.55 ,$7.52 ,$87.55 ,$28.84 ,$92.70 ,$3.58 ,$84.46 ,$14.32 ,$14.32 ,$3.58 ,$66.95 ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101349,83992,HC PHENCYCLIDINE (PCP)-90,301,1 ,$44.00 ,$28.60 ,$9.10 ,$44.00 , N/A ,$28.60 ,$26.27 , N/A ,$12.32 ,$24.68 , N/A ,$28.95 , N/A ,$37.40 ,$37.40 , N/A ,$37.40 , N/A ,$29.92 , N/A , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.08 ,$36.08 ,$36.08 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$26.27 , N/A ,$18.30 ,$10.01 ,$9.10 , N/A ,$37.40 , N/A ,$37.40 ,$12.32 ,$39.60 , N/A ,$36.08 ,$44.00 ,$44.00 , N/A ,$28.60 ,$44.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101351,83993,HC CALPROTECTIN STOOL-90,301,1 ,$231.00 ,$150.15 ,$7.46 ,$231.00 ,$49.08 ,$150.15 ,$137.91 ,$19.63 ,$64.68 ,$129.59 ,$19.63 ,$152.00 ,$19.63 ,$196.35 ,$196.35 ,$19.63 ,$196.35 ,$37.30 ,$157.08 ,$49.08 ,$19.63 ,$19.63 ,$173.25 ,$164.01 ,$164.01 ,$19.63 ,$164.01 ,$189.42 ,$189.42 ,$189.42 , N/A ,$49.08 ,$196.35 ,$19.63 ,$231.00 ,$137.91 ,$19.63 ,$96.10 ,$8.21 ,$7.46 ,$19.63 ,$196.35 ,$41.22 ,$196.35 ,$64.68 ,$207.90 ,$19.63 ,$189.42 ,$78.52 ,$78.52 ,$19.63 ,$150.15 ,$231.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101352,84030,HC NEWBORN SCREEN PKU-90,301,1 ,$177.00 ,$115.05 ,$3.32 ,$177.00 ,$13.75 ,$115.05 ,$105.67 ,$5.50 ,$49.56 ,$99.30 ,$5.50 ,$116.47 ,$5.50 ,$150.45 ,$150.45 ,$5.50 ,$150.45 ,$10.45 ,$120.36 ,$13.75 ,$5.50 ,$5.50 ,$132.75 ,$125.67 ,$125.67 ,$5.50 ,$125.67 ,$145.14 ,$145.14 ,$145.14 , N/A ,$13.75 ,$150.45 ,$5.50 ,$177.00 ,$105.67 ,$5.50 ,$73.63 ,$3.65 ,$3.32 ,$5.50 ,$150.45 ,$11.55 ,$150.45 ,$49.56 ,$159.30 ,$5.50 ,$145.14 ,$22.00 ,$22.00 ,$5.50 ,$115.05 ,$177.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101353,84066,HC PHOSPHATASE ACID PROSTATIC-90,301,1 ,$58.00 ,$37.70 ,$7.46 ,$58.00 ,$24.15 ,$37.70 ,$34.63 ,$9.66 ,$16.24 ,$32.54 ,$9.66 ,$38.16 ,$9.66 ,$49.30 ,$49.30 ,$9.66 ,$49.30 ,$18.35 ,$39.44 ,$24.15 ,$9.66 ,$9.66 ,$43.50 ,$41.18 ,$41.18 ,$9.66 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$24.15 ,$49.30 ,$9.66 ,$58.00 ,$34.63 ,$9.66 ,$24.13 ,$8.21 ,$7.46 ,$9.66 ,$49.30 ,$20.29 ,$49.30 ,$16.24 ,$52.20 ,$9.66 ,$47.56 ,$38.64 ,$38.64 ,$9.66 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101354,84075,HC ALKALINE PHOSPHATASE-90,301,1 ,$58.00 ,$37.70 ,$3.32 ,$58.00 ,$12.95 ,$37.70 ,$34.63 ,$5.18 ,$16.24 ,$32.54 ,$5.18 ,$38.16 ,$5.18 ,$49.30 ,$49.30 ,$5.18 ,$49.30 ,$9.84 ,$39.44 ,$12.95 ,$5.18 ,$5.18 ,$43.50 ,$41.18 ,$41.18 ,$5.18 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$12.95 ,$49.30 ,$5.18 ,$58.00 ,$34.63 ,$5.18 ,$24.13 ,$3.65 ,$3.32 ,$5.18 ,$49.30 ,$10.88 ,$49.30 ,$16.24 ,$52.20 ,$5.18 ,$47.56 ,$20.72 ,$20.72 ,$5.18 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101356,84080,HC ALK PHOS ISOENZ-90,301,1 ,$74.00 ,$48.10 ,$7.46 ,$74.00 ,$36.95 ,$48.10 ,$44.18 ,$14.78 ,$20.72 ,$41.51 ,$14.78 ,$48.69 ,$14.78 ,$62.90 ,$62.90 ,$14.78 ,$62.90 ,$28.08 ,$50.32 ,$36.95 ,$14.78 ,$14.78 ,$55.50 ,$52.54 ,$52.54 ,$14.78 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$36.95 ,$62.90 ,$14.78 ,$74.00 ,$44.18 ,$14.78 ,$30.78 ,$8.21 ,$7.46 ,$14.78 ,$62.90 ,$31.04 ,$62.90 ,$20.72 ,$66.60 ,$14.78 ,$60.68 ,$59.12 ,$59.12 ,$14.78 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101358,84105,HC PHOSPHORUS URINE-90,301,1 ,$154.00 ,$100.10 ,$3.32 ,$154.00 ,$14.45 ,$100.10 ,$91.94 ,$5.78 ,$43.12 ,$86.39 ,$5.78 ,$101.33 ,$5.78 ,$130.90 ,$130.90 ,$5.78 ,$130.90 ,$10.98 ,$104.72 ,$14.45 ,$5.78 ,$5.78 ,$115.50 ,$109.34 ,$109.34 ,$5.78 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$14.45 ,$130.90 ,$5.78 ,$154.00 ,$91.94 ,$5.78 ,$64.06 ,$3.65 ,$3.32 ,$5.78 ,$130.90 ,$12.14 ,$130.90 ,$43.12 ,$138.60 ,$5.78 ,$126.28 ,$23.12 ,$23.12 ,$5.78 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101361,84120,HC PORPHYRINS QN FRACT-90,301,1 ,$72.00 ,$46.80 ,$7.46 ,$72.00 ,$36.78 ,$46.80 ,$42.98 ,$14.71 ,$20.16 ,$40.39 ,$14.71 ,$47.38 ,$14.71 ,$61.20 ,$61.20 ,$14.71 ,$61.20 ,$27.95 ,$48.96 ,$36.78 ,$14.71 ,$14.71 ,$54.00 ,$51.12 ,$51.12 ,$14.71 ,$51.12 ,$59.04 ,$59.04 ,$59.04 , N/A ,$36.78 ,$61.20 ,$14.71 ,$72.00 ,$42.98 ,$14.71 ,$29.95 ,$8.21 ,$7.46 ,$14.71 ,$61.20 ,$30.89 ,$61.20 ,$20.16 ,$64.80 ,$14.71 ,$59.04 ,$58.84 ,$58.84 ,$14.71 ,$46.80 ,$72.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101364,84133,HC POTASSIUM URINE-90,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$11.83 ,$60.45 ,$55.52 ,$4.73 ,$26.04 ,$52.17 ,$4.73 ,$61.19 ,$4.73 ,$79.05 ,$79.05 ,$4.73 ,$79.05 ,$8.99 ,$63.24 ,$11.83 ,$4.73 ,$4.73 ,$69.75 ,$66.03 ,$66.03 ,$4.73 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$11.83 ,$79.05 ,$4.73 ,$93.00 ,$55.52 ,$4.73 ,$38.69 ,$3.65 ,$3.32 ,$4.73 ,$79.05 ,$9.93 ,$79.05 ,$26.04 ,$83.70 ,$4.73 ,$76.26 ,$18.92 ,$18.92 ,$4.73 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101365,84134,HC PREALBUMIN-90,301,1 ,$11.20 ,$7.28 ,$3.14 ,$28.00 ,$28.00 ,$7.28 ,$6.69 ,$11.20 ,$3.14 ,$6.28 ,$11.20 ,$7.37 ,$11.20 ,$9.52 ,$9.52 ,$11.20 ,$9.52 ,$11.20 ,$7.62 ,$28.00 ,$11.20 ,$11.20 ,$8.40 ,$7.95 ,$7.95 ,$11.20 ,$7.95 ,$9.18 ,$9.18 ,$9.18 , N/A ,$11.20 ,$9.52 ,$11.20 ,$11.20 ,$6.69 ,$11.20 ,$4.66 ,$8.21 ,$7.46 ,$11.20 ,$9.52 ,$23.52 ,$9.52 ,$3.14 ,$10.08 ,$11.20 ,$9.18 ,$11.20 ,$11.20 ,$11.20 ,$7.28 ,$11.20 
ST. JOSEPH'S HOSPITAL - BREESE,30101366,84140,HC PREGNENOLONE-90,301,1 ,$120.00 ,$78.00 ,$17.46 ,$120.00 ,$51.68 ,$78.00 ,$71.64 ,$20.67 ,$33.60 ,$67.32 ,$20.67 ,$78.96 ,$20.67 ,$102.00 ,$102.00 ,$20.67 ,$102.00 ,$39.27 ,$81.60 ,$51.68 ,$20.67 ,$20.67 ,$90.00 ,$85.20 ,$85.20 ,$20.67 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$51.68 ,$102.00 ,$20.67 ,$120.00 ,$71.64 ,$20.67 ,$49.92 ,$19.21 ,$17.46 ,$20.67 ,$102.00 ,$43.41 ,$102.00 ,$33.60 ,$108.00 ,$20.67 ,$98.40 ,$82.68 ,$82.68 ,$20.67 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101368,84144,HC PROGESTERONE-90,301,1 ,$154.00 ,$100.10 ,$10.04 ,$154.00 ,$52.15 ,$100.10 ,$91.94 ,$20.86 ,$43.12 ,$86.39 ,$20.86 ,$101.33 ,$20.86 ,$130.90 ,$130.90 ,$20.86 ,$130.90 ,$39.63 ,$104.72 ,$52.15 ,$20.86 ,$20.86 ,$115.50 ,$109.34 ,$109.34 ,$20.86 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$52.15 ,$130.90 ,$20.86 ,$154.00 ,$91.94 ,$20.86 ,$64.06 ,$11.04 ,$10.04 ,$20.86 ,$130.90 ,$43.81 ,$130.90 ,$43.12 ,$138.60 ,$20.86 ,$126.28 ,$83.44 ,$83.44 ,$20.86 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101370,84153,HC PSA TOTAL-90,301,1 ,$192.00 ,$124.80 ,$7.46 ,$192.00 ,$45.98 ,$124.80 ,$114.62 ,$18.39 ,$53.76 ,$107.71 ,$18.39 ,$126.34 ,$18.39 ,$163.20 ,$163.20 ,$18.39 ,$163.20 ,$34.94 ,$130.56 ,$45.98 ,$18.39 ,$18.39 ,$144.00 ,$136.32 ,$136.32 ,$18.39 ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A ,$45.98 ,$163.20 ,$18.39 ,$192.00 ,$114.62 ,$18.39 ,$79.87 ,$8.21 ,$7.46 ,$18.39 ,$163.20 ,$38.62 ,$163.20 ,$53.76 ,$172.80 ,$18.39 ,$157.44 ,$73.56 ,$73.56 ,$18.39 ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101372,84155,HC PROTEIN TOTAL-90,301,1 ,$58.00 ,$37.70 ,$3.32 ,$58.00 ,$9.18 ,$37.70 ,$34.63 ,$3.67 ,$16.24 ,$32.54 ,$3.67 ,$38.16 ,$3.67 ,$49.30 ,$49.30 ,$3.67 ,$49.30 ,$6.97 ,$39.44 ,$9.18 ,$3.67 ,$3.67 ,$43.50 ,$41.18 ,$41.18 ,$3.67 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$9.18 ,$49.30 ,$3.67 ,$58.00 ,$34.63 ,$3.67 ,$24.13 ,$3.65 ,$3.32 ,$3.67 ,$49.30 ,$7.71 ,$49.30 ,$16.24 ,$52.20 ,$3.67 ,$47.56 ,$14.68 ,$14.68 ,$3.67 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101373,84156,HC PROTEIN TOTAL URINE-90,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$9.18 ,$60.45 ,$55.52 ,$3.67 ,$26.04 ,$52.17 ,$3.67 ,$61.19 ,$3.67 ,$79.05 ,$79.05 ,$3.67 ,$79.05 ,$6.97 ,$63.24 ,$9.18 ,$3.67 ,$3.67 ,$69.75 ,$66.03 ,$66.03 ,$3.67 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$9.18 ,$79.05 ,$3.67 ,$93.00 ,$55.52 ,$3.67 ,$38.69 ,$3.65 ,$3.32 ,$3.67 ,$79.05 ,$7.71 ,$79.05 ,$26.04 ,$83.70 ,$3.67 ,$76.26 ,$14.68 ,$14.68 ,$3.67 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101374,84157,HC PROTEIN TOTAL OTH SRC-90,301,1 ,$29.56 ,$19.21 ,$3.32 ,$29.56 ,$10.00 ,$19.21 ,$17.65 ,$4.00 ,$8.28 ,$16.58 ,$4.00 ,$19.45 ,$4.00 ,$25.13 ,$25.13 ,$4.00 ,$25.13 ,$7.60 ,$20.10 ,$10.00 ,$4.00 ,$4.00 ,$22.17 ,$20.99 ,$20.99 ,$4.00 ,$20.99 ,$24.24 ,$24.24 ,$24.24 , N/A ,$10.00 ,$25.13 ,$4.00 ,$29.56 ,$17.65 ,$4.00 ,$12.30 ,$3.65 ,$3.32 ,$4.00 ,$25.13 ,$8.40 ,$25.13 ,$8.28 ,$26.60 ,$4.00 ,$24.24 ,$16.00 ,$16.00 ,$4.00 ,$19.21 ,$29.56 
ST. JOSEPH'S HOSPITAL - BREESE,30101375,84165,HC PROTEIN ELECTROPHORESIS-90,301,1 ,$62.00 ,$40.30 ,$7.46 ,$62.00 ,$26.85 ,$40.30 ,$37.01 ,$10.74 ,$17.36 ,$34.78 ,$10.74 ,$40.80 ,$10.74 ,$52.70 ,$52.70 ,$10.74 ,$52.70 ,$20.41 ,$42.16 ,$26.85 ,$10.74 ,$10.74 ,$46.50 ,$44.02 ,$44.02 ,$10.74 ,$44.02 ,$50.84 ,$50.84 ,$50.84 , N/A ,$26.85 ,$52.70 ,$10.74 ,$62.00 ,$37.01 ,$10.74 ,$25.79 ,$8.21 ,$7.46 ,$10.74 ,$52.70 ,$22.55 ,$52.70 ,$17.36 ,$55.80 ,$10.74 ,$50.84 ,$42.96 ,$42.96 ,$10.74 ,$40.30 ,$62.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101377,84166,HC PROTEIN EP OTH FLUID-90,301,1 ,$115.00 ,$74.75 ,$7.46 ,$115.00 ,$44.58 ,$74.75 ,$68.66 ,$17.83 ,$32.20 ,$64.52 ,$17.83 ,$75.67 ,$17.83 ,$97.75 ,$97.75 ,$17.83 ,$97.75 ,$33.88 ,$78.20 ,$44.58 ,$17.83 ,$17.83 ,$86.25 ,$81.65 ,$81.65 ,$17.83 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$44.58 ,$97.75 ,$17.83 ,$115.00 ,$68.66 ,$17.83 ,$47.84 ,$8.21 ,$7.46 ,$17.83 ,$97.75 ,$37.44 ,$97.75 ,$32.20 ,$103.50 ,$17.83 ,$94.30 ,$71.32 ,$71.32 ,$17.83 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101379,84181,HC PROTEIN WESTERN BLOT-90,301,1 ,$134.00 ,$87.10 ,$6.68 ,$134.00 ,$42.58 ,$87.10 ,$80.00 ,$17.03 ,$37.52 ,$75.17 ,$17.03 ,$88.17 ,$17.03 ,$113.90 ,$113.90 ,$17.03 ,$113.90 ,$32.36 ,$91.12 ,$42.58 ,$17.03 ,$17.03 ,$100.50 ,$95.14 ,$95.14 ,$17.03 ,$95.14 ,$109.88 ,$109.88 ,$109.88 , N/A ,$42.58 ,$113.90 ,$17.03 ,$134.00 ,$80.00 ,$17.03 ,$55.74 ,$7.35 ,$6.68 ,$17.03 ,$113.90 ,$35.76 ,$113.90 ,$37.52 ,$120.60 ,$17.03 ,$109.88 ,$68.12 ,$68.12 ,$17.03 ,$87.10 ,$134.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101380,84182,HC PROTEIN WEST BLOT BAND ID-90,301,1 ,$106.00 ,$68.90 ,$11.51 ,$106.00 ,$73.03 ,$68.90 ,$63.28 ,$29.21 ,$29.68 ,$59.47 ,$29.21 ,$69.75 ,$29.21 ,$90.10 ,$90.10 ,$29.21 ,$90.10 ,$55.50 ,$72.08 ,$73.03 ,$29.21 ,$29.21 ,$79.50 ,$75.26 ,$75.26 ,$29.21 ,$75.26 ,$86.92 ,$86.92 ,$86.92 , N/A ,$73.03 ,$90.10 ,$29.21 ,$106.00 ,$63.28 ,$29.21 ,$44.10 ,$12.66 ,$11.51 ,$29.21 ,$90.10 ,$61.34 ,$90.10 ,$29.68 ,$95.40 ,$29.21 ,$86.92 ,$106.00 ,$106.00 ,$29.21 ,$68.90 ,$106.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101381,84202,HC PROTOPORPHYRIN-90,301,1 ,$69.00 ,$44.85 ,$7.46 ,$69.00 ,$35.88 ,$44.85 ,$41.19 ,$14.35 ,$19.32 ,$38.71 ,$14.35 ,$45.40 ,$14.35 ,$58.65 ,$58.65 ,$14.35 ,$58.65 ,$27.27 ,$46.92 ,$35.88 ,$14.35 ,$14.35 ,$51.75 ,$48.99 ,$48.99 ,$14.35 ,$48.99 ,$56.58 ,$56.58 ,$56.58 , N/A ,$35.88 ,$58.65 ,$14.35 ,$69.00 ,$41.19 ,$14.35 ,$28.70 ,$8.21 ,$7.46 ,$14.35 ,$58.65 ,$30.14 ,$58.65 ,$19.32 ,$62.10 ,$14.35 ,$56.58 ,$57.40 ,$57.40 ,$14.35 ,$44.85 ,$69.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101382,84206,HC PROINSULIN-90,301,1 ,$100.00 ,$65.00 ,$17.46 ,$100.00 ,$66.73 ,$65.00 ,$59.70 ,$26.69 ,$28.00 ,$56.10 ,$26.69 ,$65.80 ,$26.69 ,$85.00 ,$85.00 ,$26.69 ,$85.00 ,$50.71 ,$68.00 ,$66.73 ,$26.69 ,$26.69 ,$75.00 ,$71.00 ,$71.00 ,$26.69 ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A ,$66.73 ,$85.00 ,$26.69 ,$100.00 ,$59.70 ,$26.69 ,$41.60 ,$19.21 ,$17.46 ,$26.69 ,$85.00 ,$56.05 ,$85.00 ,$28.00 ,$90.00 ,$26.69 ,$82.00 ,$100.00 ,$100.00 ,$26.69 ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101383,84207,HC VITAMIN B6-90,301,1 ,$115.00 ,$74.75 ,$7.46 ,$115.00 ,$70.25 ,$74.75 ,$68.66 ,$28.10 ,$32.20 ,$64.52 ,$28.10 ,$75.67 ,$28.10 ,$97.75 ,$97.75 ,$28.10 ,$97.75 ,$53.39 ,$78.20 ,$70.25 ,$28.10 ,$28.10 ,$86.25 ,$81.65 ,$81.65 ,$28.10 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$70.25 ,$97.75 ,$28.10 ,$115.00 ,$68.66 ,$28.10 ,$47.84 ,$8.21 ,$7.46 ,$28.10 ,$97.75 ,$59.01 ,$97.75 ,$32.20 ,$103.50 ,$28.10 ,$94.30 ,$112.40 ,$112.40 ,$28.10 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101386,84238,HC RECEPTOR ASSAY NON ENDO-90,301,1 ,$292.00 ,$189.80 ,$20.08 ,$292.00 ,$91.43 ,$189.80 ,$174.32 ,$36.57 ,$81.76 ,$163.81 ,$36.57 ,$192.14 ,$36.57 ,$248.20 ,$248.20 ,$36.57 ,$248.20 ,$69.48 ,$198.56 ,$91.43 ,$36.57 ,$36.57 ,$219.00 ,$207.32 ,$207.32 ,$36.57 ,$207.32 ,$239.44 ,$239.44 ,$239.44 , N/A ,$91.43 ,$248.20 ,$36.57 ,$292.00 ,$174.32 ,$36.57 ,$121.47 ,$22.09 ,$20.08 ,$36.57 ,$248.20 ,$76.80 ,$248.20 ,$81.76 ,$262.80 ,$36.57 ,$239.44 ,$146.28 ,$146.28 ,$36.57 ,$189.80 ,$292.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101387,84244,HC RENIN-90,301,1 ,$97.00 ,$63.05 ,$17.46 ,$97.00 ,$54.98 ,$63.05 ,$57.91 ,$21.99 ,$27.16 ,$54.42 ,$21.99 ,$63.83 ,$21.99 ,$82.45 ,$82.45 ,$21.99 ,$82.45 ,$41.78 ,$65.96 ,$54.98 ,$21.99 ,$21.99 ,$72.75 ,$68.87 ,$68.87 ,$21.99 ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A ,$54.98 ,$82.45 ,$21.99 ,$97.00 ,$57.91 ,$21.99 ,$40.35 ,$19.21 ,$17.46 ,$21.99 ,$82.45 ,$46.18 ,$82.45 ,$27.16 ,$87.30 ,$21.99 ,$79.54 ,$87.96 ,$87.96 ,$21.99 ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101388,84255,HC SELENIUM-90,301,1 ,$150.00 ,$97.50 ,$7.46 ,$150.00 ,$63.83 ,$97.50 ,$89.55 ,$25.53 ,$42.00 ,$84.15 ,$25.53 ,$98.70 ,$25.53 ,$127.50 ,$127.50 ,$25.53 ,$127.50 ,$48.51 ,$102.00 ,$63.83 ,$25.53 ,$25.53 ,$112.50 ,$106.50 ,$106.50 ,$25.53 ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A ,$63.83 ,$127.50 ,$25.53 ,$150.00 ,$89.55 ,$25.53 ,$62.40 ,$8.21 ,$7.46 ,$25.53 ,$127.50 ,$53.61 ,$127.50 ,$42.00 ,$135.00 ,$25.53 ,$123.00 ,$102.12 ,$102.12 ,$25.53 ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101389,84252,HC VITAMIN B-2 (RIBOFLAVIN)-90,301,1 ,$87.00 ,$56.55 ,$7.46 ,$87.00 ,$50.60 ,$56.55 ,$51.94 ,$20.24 ,$24.36 ,$48.81 ,$20.24 ,$57.25 ,$20.24 ,$73.95 ,$73.95 ,$20.24 ,$73.95 ,$38.46 ,$59.16 ,$50.60 ,$20.24 ,$20.24 ,$65.25 ,$61.77 ,$61.77 ,$20.24 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$50.60 ,$73.95 ,$20.24 ,$87.00 ,$51.94 ,$20.24 ,$36.19 ,$8.21 ,$7.46 ,$20.24 ,$73.95 ,$42.50 ,$73.95 ,$24.36 ,$78.30 ,$20.24 ,$71.34 ,$80.96 ,$80.96 ,$20.24 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101390,84270,HC SEX HORMONE BIND GLOB-90,301,1 ,$111.00 ,$72.15 ,$7.46 ,$111.00 ,$54.33 ,$72.15 ,$66.27 ,$21.73 ,$31.08 ,$62.27 ,$21.73 ,$73.04 ,$21.73 ,$94.35 ,$94.35 ,$21.73 ,$94.35 ,$41.29 ,$75.48 ,$54.33 ,$21.73 ,$21.73 ,$83.25 ,$78.81 ,$78.81 ,$21.73 ,$78.81 ,$91.02 ,$91.02 ,$91.02 , N/A ,$54.33 ,$94.35 ,$21.73 ,$111.00 ,$66.27 ,$21.73 ,$46.18 ,$8.21 ,$7.46 ,$21.73 ,$94.35 ,$45.63 ,$94.35 ,$31.08 ,$99.90 ,$21.73 ,$91.02 ,$86.92 ,$86.92 ,$21.73 ,$72.15 ,$111.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101392,84260,HC SEROTONIN-90,301,1 ,$72.00 ,$46.80 ,$17.46 ,$77.45 ,$77.45 ,$46.80 ,$42.98 ,$30.98 ,$20.16 ,$40.39 ,$30.98 ,$47.38 ,$30.98 ,$61.20 ,$61.20 ,$30.98 ,$61.20 ,$58.86 ,$48.96 ,$77.45 ,$30.98 ,$30.98 ,$54.00 ,$51.12 ,$51.12 ,$30.98 ,$51.12 ,$59.04 ,$59.04 ,$59.04 , N/A ,$72.00 ,$61.20 ,$30.98 ,$72.00 ,$42.98 ,$30.98 ,$29.95 ,$19.21 ,$17.46 ,$30.98 ,$61.20 ,$65.06 ,$61.20 ,$20.16 ,$64.80 ,$30.98 ,$59.04 ,$72.00 ,$72.00 ,$30.98 ,$46.80 ,$72.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101394,84300,HC SODIUM URINE-90,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$12.65 ,$60.45 ,$55.52 ,$5.06 ,$26.04 ,$52.17 ,$5.06 ,$61.19 ,$5.06 ,$79.05 ,$79.05 ,$5.06 ,$79.05 ,$9.61 ,$63.24 ,$12.65 ,$5.06 ,$5.06 ,$69.75 ,$66.03 ,$66.03 ,$5.06 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$12.65 ,$79.05 ,$5.06 ,$93.00 ,$55.52 ,$5.06 ,$38.69 ,$3.65 ,$3.32 ,$5.06 ,$79.05 ,$10.63 ,$79.05 ,$26.04 ,$83.70 ,$5.06 ,$76.26 ,$20.24 ,$20.24 ,$5.06 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101395,84302,HC SODIUM OTHER FLUID-90,301,1 ,$16.00 ,$10.40 ,$3.32 ,$16.00 ,$12.15 ,$10.40 ,$9.55 ,$4.86 ,$4.48 ,$8.98 ,$4.86 ,$10.53 ,$4.86 ,$13.60 ,$13.60 ,$4.86 ,$13.60 ,$9.23 ,$10.88 ,$12.15 ,$4.86 ,$4.86 ,$12.00 ,$11.36 ,$11.36 ,$4.86 ,$11.36 ,$13.12 ,$13.12 ,$13.12 , N/A ,$12.15 ,$13.60 ,$4.86 ,$16.00 ,$9.55 ,$4.86 ,$6.66 ,$3.65 ,$3.32 ,$4.86 ,$13.60 ,$10.21 ,$13.60 ,$4.48 ,$14.40 ,$4.86 ,$13.12 ,$16.00 ,$16.00 ,$4.86 ,$10.40 ,$16.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101396,84305,HC SOMATOMEDIN-90,301,1 ,$140.00 ,$91.00 ,$17.46 ,$140.00 ,$53.15 ,$91.00 ,$83.58 ,$21.26 ,$39.20 ,$78.54 ,$21.26 ,$92.12 ,$21.26 ,$119.00 ,$119.00 ,$21.26 ,$119.00 ,$40.39 ,$95.20 ,$53.15 ,$21.26 ,$21.26 ,$105.00 ,$99.40 ,$99.40 ,$21.26 ,$99.40 ,$114.80 ,$114.80 ,$114.80 , N/A ,$53.15 ,$119.00 ,$21.26 ,$140.00 ,$83.58 ,$21.26 ,$58.24 ,$19.21 ,$17.46 ,$21.26 ,$119.00 ,$44.65 ,$119.00 ,$39.20 ,$126.00 ,$21.26 ,$114.80 ,$85.04 ,$85.04 ,$21.26 ,$91.00 ,$140.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101398,84311,HC SPECTROPHOTOMETRY-90,301,1 ,$78.00 ,$50.70 ,$7.46 ,$78.00 ,$20.25 ,$50.70 ,$46.57 ,$8.10 ,$21.84 ,$43.76 ,$8.10 ,$51.32 ,$8.10 ,$66.30 ,$66.30 ,$8.10 ,$66.30 ,$15.39 ,$53.04 ,$20.25 ,$8.10 ,$8.10 ,$58.50 ,$55.38 ,$55.38 ,$8.10 ,$55.38 ,$63.96 ,$63.96 ,$63.96 , N/A ,$20.25 ,$66.30 ,$8.10 ,$78.00 ,$46.57 ,$8.10 ,$32.45 ,$8.21 ,$7.46 ,$8.10 ,$66.30 ,$17.01 ,$66.30 ,$21.84 ,$70.20 ,$8.10 ,$63.96 ,$32.40 ,$32.40 ,$8.10 ,$50.70 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101402,84376,HC SUGARS SINGLE QL-90,301,1 ,$4.80 ,$3.12 ,$1.34 ,$12.00 ,$12.00 ,$3.12 ,$2.87 ,$4.80 ,$1.34 ,$2.69 ,$4.80 ,$3.16 ,$4.80 ,$4.08 ,$4.08 ,$4.80 ,$4.08 ,$4.80 ,$3.26 ,$12.00 ,$4.80 ,$4.80 ,$3.60 ,$3.41 ,$3.41 ,$4.80 ,$3.41 ,$3.94 ,$3.94 ,$3.94 , N/A ,$4.80 ,$4.08 ,$4.80 ,$4.80 ,$2.87 ,$4.80 ,$2.00 ,$3.65 ,$3.32 ,$4.80 ,$4.08 ,$10.08 ,$4.08 ,$1.34 ,$4.32 ,$4.80 ,$3.94 ,$4.80 ,$4.80 ,$4.80 ,$3.12 ,$4.80 
ST. JOSEPH'S HOSPITAL - BREESE,30101405,84392,HC SULFATE URINE-90,301,1 ,$154.00 ,$100.10 ,$2.66 ,$154.00 ,$13.73 ,$100.10 ,$91.94 ,$5.49 ,$43.12 ,$86.39 ,$5.49 ,$101.33 ,$5.49 ,$130.90 ,$130.90 ,$5.49 ,$130.90 ,$10.43 ,$104.72 ,$13.73 ,$5.49 ,$5.49 ,$115.50 ,$109.34 ,$109.34 ,$5.49 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$13.73 ,$130.90 ,$5.49 ,$154.00 ,$91.94 ,$5.49 ,$64.06 ,$2.93 ,$2.66 ,$5.49 ,$130.90 ,$11.53 ,$130.90 ,$43.12 ,$138.60 ,$5.49 ,$126.28 ,$21.96 ,$21.96 ,$5.49 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101406,84402,HC TESTOSTERONE FREE-90,301,1 ,$58.00 ,$37.70 ,$16.24 ,$63.68 ,$63.68 ,$37.70 ,$34.63 ,$25.47 ,$16.24 ,$32.54 ,$25.47 ,$38.16 ,$25.47 ,$49.30 ,$49.30 ,$25.47 ,$49.30 ,$48.39 ,$39.44 ,$63.68 ,$25.47 ,$25.47 ,$43.50 ,$41.18 ,$41.18 ,$25.47 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$58.00 ,$49.30 ,$25.47 ,$58.00 ,$34.63 ,$25.47 ,$24.13 ,$19.21 ,$17.46 ,$25.47 ,$49.30 ,$53.49 ,$49.30 ,$16.24 ,$52.20 ,$25.47 ,$47.56 ,$58.00 ,$58.00 ,$25.47 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101407,84403,HC TESTOSTERONE TOTAL-90,301,1 ,$173.00 ,$112.45 ,$17.46 ,$173.00 ,$64.53 ,$112.45 ,$103.28 ,$25.81 ,$48.44 ,$97.05 ,$25.81 ,$113.83 ,$25.81 ,$147.05 ,$147.05 ,$25.81 ,$147.05 ,$49.04 ,$117.64 ,$64.53 ,$25.81 ,$25.81 ,$129.75 ,$122.83 ,$122.83 ,$25.81 ,$122.83 ,$141.86 ,$141.86 ,$141.86 , N/A ,$64.53 ,$147.05 ,$25.81 ,$173.00 ,$103.28 ,$25.81 ,$71.97 ,$19.21 ,$17.46 ,$25.81 ,$147.05 ,$54.20 ,$147.05 ,$48.44 ,$155.70 ,$25.81 ,$141.86 ,$103.24 ,$103.24 ,$25.81 ,$112.45 ,$173.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101408,84425,HC VITAMIN B1-90,301,1 ,$107.00 ,$69.55 ,$7.46 ,$107.00 ,$53.08 ,$69.55 ,$63.88 ,$21.23 ,$29.96 ,$60.03 ,$21.23 ,$70.41 ,$21.23 ,$90.95 ,$90.95 ,$21.23 ,$90.95 ,$40.34 ,$72.76 ,$53.08 ,$21.23 ,$21.23 ,$80.25 ,$75.97 ,$75.97 ,$21.23 ,$75.97 ,$87.74 ,$87.74 ,$87.74 , N/A ,$53.08 ,$90.95 ,$21.23 ,$107.00 ,$63.88 ,$21.23 ,$44.51 ,$8.21 ,$7.46 ,$21.23 ,$90.95 ,$44.58 ,$90.95 ,$29.96 ,$96.30 ,$21.23 ,$87.74 ,$84.92 ,$84.92 ,$21.23 ,$69.55 ,$107.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101409,84430,HC THIOCYANATE-90,301,1 ,$21.84 ,$14.20 ,$6.12 ,$29.08 ,$29.08 ,$14.20 ,$13.04 ,$11.63 ,$6.12 ,$12.25 ,$11.63 ,$14.37 ,$11.63 ,$18.56 ,$18.56 ,$11.63 ,$18.56 ,$21.84 ,$14.85 ,$29.08 ,$11.63 ,$11.63 ,$16.38 ,$15.51 ,$15.51 ,$11.63 ,$15.51 ,$17.91 ,$17.91 ,$17.91 , N/A ,$21.84 ,$18.56 ,$11.63 ,$21.84 ,$13.04 ,$11.63 ,$9.09 ,$10.01 ,$9.10 ,$11.63 ,$18.56 ,$24.42 ,$18.56 ,$6.12 ,$19.66 ,$11.63 ,$17.91 ,$21.84 ,$21.84 ,$11.63 ,$14.20 ,$21.84 
ST. JOSEPH'S HOSPITAL - BREESE,30101410,84432,HC THYROGLOBULIN-90,301,1 ,$57.00 ,$37.05 ,$15.96 ,$57.00 ,$40.15 ,$37.05 ,$34.03 ,$16.06 ,$15.96 ,$31.98 ,$16.06 ,$37.51 ,$16.06 ,$48.45 ,$48.45 ,$16.06 ,$48.45 ,$30.51 ,$38.76 ,$40.15 ,$16.06 ,$16.06 ,$42.75 ,$40.47 ,$40.47 ,$16.06 ,$40.47 ,$46.74 ,$46.74 ,$46.74 , N/A ,$40.15 ,$48.45 ,$16.06 ,$57.00 ,$34.03 ,$16.06 ,$23.71 ,$19.21 ,$17.46 ,$16.06 ,$48.45 ,$33.73 ,$48.45 ,$15.96 ,$51.30 ,$16.06 ,$46.74 ,$57.00 ,$57.00 ,$16.06 ,$37.05 ,$57.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101413,84439,HC T4 FREE-90,301,1 ,$23.00 ,$14.95 ,$6.44 ,$23.00 ,$22.55 ,$14.95 ,$13.73 ,$9.02 ,$6.44 ,$12.90 ,$9.02 ,$15.13 ,$9.02 ,$19.55 ,$19.55 ,$9.02 ,$19.55 ,$17.14 ,$15.64 ,$22.55 ,$9.02 ,$9.02 ,$17.25 ,$16.33 ,$16.33 ,$9.02 ,$16.33 ,$18.86 ,$18.86 ,$18.86 , N/A ,$22.55 ,$19.55 ,$9.02 ,$23.00 ,$13.73 ,$9.02 ,$9.57 ,$11.04 ,$10.04 ,$9.02 ,$19.55 ,$18.94 ,$19.55 ,$6.44 ,$20.70 ,$9.02 ,$18.86 ,$23.00 ,$23.00 ,$9.02 ,$14.95 ,$23.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101415,84442,HC THYROXINE BIND GLOB-90,301,1 ,$61.00 ,$39.65 ,$10.04 ,$61.00 ,$36.95 ,$39.65 ,$36.42 ,$14.78 ,$17.08 ,$34.22 ,$14.78 ,$40.14 ,$14.78 ,$51.85 ,$51.85 ,$14.78 ,$51.85 ,$28.08 ,$41.48 ,$36.95 ,$14.78 ,$14.78 ,$45.75 ,$43.31 ,$43.31 ,$14.78 ,$43.31 ,$50.02 ,$50.02 ,$50.02 , N/A ,$36.95 ,$51.85 ,$14.78 ,$61.00 ,$36.42 ,$14.78 ,$25.38 ,$11.04 ,$10.04 ,$14.78 ,$51.85 ,$31.04 ,$51.85 ,$17.08 ,$54.90 ,$14.78 ,$50.02 ,$59.12 ,$59.12 ,$14.78 ,$39.65 ,$61.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101417,84445,HC THYROID STIM IMMUNO GLOB-90,301,1 ,$117.00 ,$76.05 ,$17.46 ,$127.15 ,$127.15 ,$76.05 ,$69.85 ,$50.86 ,$32.76 ,$65.64 ,$50.86 ,$76.99 ,$50.86 ,$99.45 ,$99.45 ,$50.86 ,$99.45 ,$96.63 ,$79.56 ,$127.15 ,$50.86 ,$50.86 ,$87.75 ,$83.07 ,$83.07 ,$50.86 ,$83.07 ,$95.94 ,$95.94 ,$95.94 , N/A ,$117.00 ,$99.45 ,$50.86 ,$117.00 ,$69.85 ,$50.86 ,$48.67 ,$19.21 ,$17.46 ,$50.86 ,$99.45 ,$106.81 ,$99.45 ,$32.76 ,$105.30 ,$50.86 ,$95.94 ,$117.00 ,$117.00 ,$50.86 ,$76.05 ,$117.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101418,84446,HC VITAMIN E-90,301,1 ,$57.00 ,$37.05 ,$7.46 ,$57.00 ,$35.45 ,$37.05 ,$34.03 ,$14.18 ,$15.96 ,$31.98 ,$14.18 ,$37.51 ,$14.18 ,$48.45 ,$48.45 ,$14.18 ,$48.45 ,$26.94 ,$38.76 ,$35.45 ,$14.18 ,$14.18 ,$42.75 ,$40.47 ,$40.47 ,$14.18 ,$40.47 ,$46.74 ,$46.74 ,$46.74 , N/A ,$35.45 ,$48.45 ,$14.18 ,$57.00 ,$34.03 ,$14.18 ,$23.71 ,$8.21 ,$7.46 ,$14.18 ,$48.45 ,$29.78 ,$48.45 ,$15.96 ,$51.30 ,$14.18 ,$46.74 ,$56.72 ,$56.72 ,$14.18 ,$37.05 ,$57.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101419,84460,HC ALT-90,301,1 ,$37.00 ,$24.05 ,$3.32 ,$37.00 ,$13.25 ,$24.05 ,$22.09 ,$5.30 ,$10.36 ,$20.76 ,$5.30 ,$24.35 ,$5.30 ,$31.45 ,$31.45 ,$5.30 ,$31.45 ,$10.07 ,$25.16 ,$13.25 ,$5.30 ,$5.30 ,$27.75 ,$26.27 ,$26.27 ,$5.30 ,$26.27 ,$30.34 ,$30.34 ,$30.34 , N/A ,$13.25 ,$31.45 ,$5.30 ,$37.00 ,$22.09 ,$5.30 ,$15.39 ,$3.65 ,$3.32 ,$5.30 ,$31.45 ,$11.13 ,$31.45 ,$10.36 ,$33.30 ,$5.30 ,$30.34 ,$21.20 ,$21.20 ,$5.30 ,$24.05 ,$37.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101420,84466,HC TRANSFERRIN-90,301,1 ,$146.00 ,$94.90 ,$7.46 ,$146.00 ,$31.90 ,$94.90 ,$87.16 ,$12.76 ,$40.88 ,$81.91 ,$12.76 ,$96.07 ,$12.76 ,$124.10 ,$124.10 ,$12.76 ,$124.10 ,$24.24 ,$99.28 ,$31.90 ,$12.76 ,$12.76 ,$109.50 ,$103.66 ,$103.66 ,$12.76 ,$103.66 ,$119.72 ,$119.72 ,$119.72 , N/A ,$31.90 ,$124.10 ,$12.76 ,$146.00 ,$87.16 ,$12.76 ,$60.74 ,$8.21 ,$7.46 ,$12.76 ,$124.10 ,$26.80 ,$124.10 ,$40.88 ,$131.40 ,$12.76 ,$119.72 ,$51.04 ,$51.04 ,$12.76 ,$94.90 ,$146.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101421,84478,HC TRIGLYCERIDES-90,301,1 ,$86.00 ,$55.90 ,$3.32 ,$86.00 ,$14.35 ,$55.90 ,$51.34 ,$5.74 ,$24.08 ,$48.25 ,$5.74 ,$56.59 ,$5.74 ,$73.10 ,$73.10 ,$5.74 ,$73.10 ,$10.91 ,$58.48 ,$14.35 ,$5.74 ,$5.74 ,$64.50 ,$61.06 ,$61.06 ,$5.74 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$14.35 ,$73.10 ,$5.74 ,$86.00 ,$51.34 ,$5.74 ,$35.78 ,$3.65 ,$3.32 ,$5.74 ,$73.10 ,$12.05 ,$73.10 ,$24.08 ,$77.40 ,$5.74 ,$70.52 ,$22.96 ,$22.96 ,$5.74 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101422,84479,HC T3 UPTAKE-90,301,1 ,$73.00 ,$47.45 ,$6.47 ,$73.00 ,$16.18 ,$47.45 ,$43.58 ,$6.47 ,$20.44 ,$40.95 ,$6.47 ,$48.03 ,$6.47 ,$62.05 ,$62.05 ,$6.47 ,$62.05 ,$12.29 ,$49.64 ,$16.18 ,$6.47 ,$6.47 ,$54.75 ,$51.83 ,$51.83 ,$6.47 ,$51.83 ,$59.86 ,$59.86 ,$59.86 , N/A ,$16.18 ,$62.05 ,$6.47 ,$73.00 ,$43.58 ,$6.47 ,$30.37 ,$11.04 ,$10.04 ,$6.47 ,$62.05 ,$13.59 ,$62.05 ,$20.44 ,$65.70 ,$6.47 ,$59.86 ,$25.88 ,$25.88 ,$6.47 ,$47.45 ,$73.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101423,84480,HC T3 TOTAL-90,301,1 ,$134.00 ,$87.10 ,$10.04 ,$134.00 ,$35.45 ,$87.10 ,$80.00 ,$14.18 ,$37.52 ,$75.17 ,$14.18 ,$88.17 ,$14.18 ,$113.90 ,$113.90 ,$14.18 ,$113.90 ,$26.94 ,$91.12 ,$35.45 ,$14.18 ,$14.18 ,$100.50 ,$95.14 ,$95.14 ,$14.18 ,$95.14 ,$109.88 ,$109.88 ,$109.88 , N/A ,$35.45 ,$113.90 ,$14.18 ,$134.00 ,$80.00 ,$14.18 ,$55.74 ,$11.04 ,$10.04 ,$14.18 ,$113.90 ,$29.78 ,$113.90 ,$37.52 ,$120.60 ,$14.18 ,$109.88 ,$56.72 ,$56.72 ,$14.18 ,$87.10 ,$134.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101425,84482,HC T3 REVERSE-90,301,1 ,$82.00 ,$53.30 ,$10.04 ,$82.00 ,$39.40 ,$53.30 ,$48.95 ,$15.76 ,$22.96 ,$46.00 ,$15.76 ,$53.96 ,$15.76 ,$69.70 ,$69.70 ,$15.76 ,$69.70 ,$29.94 ,$55.76 ,$39.40 ,$15.76 ,$15.76 ,$61.50 ,$58.22 ,$58.22 ,$15.76 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$39.40 ,$69.70 ,$15.76 ,$82.00 ,$48.95 ,$15.76 ,$34.11 ,$11.04 ,$10.04 ,$15.76 ,$69.70 ,$33.10 ,$69.70 ,$22.96 ,$73.80 ,$15.76 ,$67.24 ,$63.04 ,$63.04 ,$15.76 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101434,84560,HC URIC ACID OTH SRC-90,301,1 ,$52.00 ,$33.80 ,$3.32 ,$52.00 ,$12.70 ,$33.80 ,$31.04 ,$5.08 ,$14.56 ,$29.17 ,$5.08 ,$34.22 ,$5.08 ,$44.20 ,$44.20 ,$5.08 ,$44.20 ,$9.65 ,$35.36 ,$12.70 ,$5.08 ,$5.08 ,$39.00 ,$36.92 ,$36.92 ,$5.08 ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A ,$12.70 ,$44.20 ,$5.08 ,$52.00 ,$31.04 ,$5.08 ,$21.63 ,$3.65 ,$3.32 ,$5.08 ,$44.20 ,$10.67 ,$44.20 ,$14.56 ,$46.80 ,$5.08 ,$42.64 ,$20.32 ,$20.32 ,$5.08 ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101435,84585,HC VANILLYLMAND AC (VMA)-90,301,1 ,$98.00 ,$63.70 ,$15.50 ,$98.00 ,$38.75 ,$63.70 ,$58.51 ,$15.50 ,$27.44 ,$54.98 ,$15.50 ,$64.48 ,$15.50 ,$83.30 ,$83.30 ,$15.50 ,$83.30 ,$29.45 ,$66.64 ,$38.75 ,$15.50 ,$15.50 ,$73.50 ,$69.58 ,$69.58 ,$15.50 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$38.75 ,$83.30 ,$15.50 ,$98.00 ,$58.51 ,$15.50 ,$40.77 ,$19.21 ,$17.46 ,$15.50 ,$83.30 ,$32.55 ,$83.30 ,$27.44 ,$88.20 ,$15.50 ,$80.36 ,$62.00 ,$62.00 ,$15.50 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101436,84586,HC VASOACTIVE INTEST PEPTIDE-90,301,1 ,$158.00 ,$102.70 ,$17.46 ,$158.00 ,$88.33 ,$102.70 ,$94.33 ,$35.33 ,$44.24 ,$88.64 ,$35.33 ,$103.96 ,$35.33 ,$134.30 ,$134.30 ,$35.33 ,$134.30 ,$67.13 ,$107.44 ,$88.33 ,$35.33 ,$35.33 ,$118.50 ,$112.18 ,$112.18 ,$35.33 ,$112.18 ,$129.56 ,$129.56 ,$129.56 , N/A ,$88.33 ,$134.30 ,$35.33 ,$158.00 ,$94.33 ,$35.33 ,$65.73 ,$19.21 ,$17.46 ,$35.33 ,$134.30 ,$74.19 ,$134.30 ,$44.24 ,$142.20 ,$35.33 ,$129.56 ,$141.32 ,$141.32 ,$35.33 ,$102.70 ,$158.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101437,84588,HC VASOPRESSIN (ADH)-90,301,1 ,$152.00 ,$98.80 ,$17.46 ,$152.00 ,$84.85 ,$98.80 ,$90.74 ,$33.94 ,$42.56 ,$85.27 ,$33.94 ,$100.02 ,$33.94 ,$129.20 ,$129.20 ,$33.94 ,$129.20 ,$64.49 ,$103.36 ,$84.85 ,$33.94 ,$33.94 ,$114.00 ,$107.92 ,$107.92 ,$33.94 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$84.85 ,$129.20 ,$33.94 ,$152.00 ,$90.74 ,$33.94 ,$63.23 ,$19.21 ,$17.46 ,$33.94 ,$129.20 ,$71.27 ,$129.20 ,$42.56 ,$136.80 ,$33.94 ,$124.64 ,$135.76 ,$135.76 ,$33.94 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101438,84590,HC VITAMIN A-90,301,1 ,$67.00 ,$43.55 ,$7.46 ,$67.00 ,$29.03 ,$43.55 ,$40.00 ,$11.61 ,$18.76 ,$37.59 ,$11.61 ,$44.09 ,$11.61 ,$56.95 ,$56.95 ,$11.61 ,$56.95 ,$22.06 ,$45.56 ,$29.03 ,$11.61 ,$11.61 ,$50.25 ,$47.57 ,$47.57 ,$11.61 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$29.03 ,$56.95 ,$11.61 ,$67.00 ,$40.00 ,$11.61 ,$27.87 ,$8.21 ,$7.46 ,$11.61 ,$56.95 ,$24.38 ,$56.95 ,$18.76 ,$60.30 ,$11.61 ,$54.94 ,$46.44 ,$46.44 ,$11.61 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101439,84591,HC VITAMIN A OTHER-90,301,1 ,$123.30 ,$80.15 ,$8.56 ,$123.30 ,$42.65 ,$80.15 ,$73.61 ,$17.06 ,$34.52 ,$69.17 ,$17.06 ,$81.13 ,$17.06 ,$104.81 ,$104.81 ,$17.06 ,$104.81 ,$32.41 ,$83.84 ,$42.65 ,$17.06 ,$17.06 ,$92.48 ,$87.54 ,$87.54 ,$17.06 ,$87.54 ,$101.11 ,$101.11 ,$101.11 , N/A ,$42.65 ,$104.81 ,$17.06 ,$123.30 ,$73.61 ,$17.06 ,$51.29 ,$9.42 ,$8.56 ,$17.06 ,$104.81 ,$35.83 ,$104.81 ,$34.52 ,$110.97 ,$17.06 ,$101.11 ,$68.24 ,$68.24 ,$17.06 ,$80.15 ,$123.30 
ST. JOSEPH'S HOSPITAL - BREESE,30101440,84597,HC VITAMIN K-90,301,1 ,$107.00 ,$69.55 ,$7.46 ,$107.00 ,$34.30 ,$69.55 ,$63.88 ,$13.72 ,$29.96 ,$60.03 ,$13.72 ,$70.41 ,$13.72 ,$90.95 ,$90.95 ,$13.72 ,$90.95 ,$26.07 ,$72.76 ,$34.30 ,$13.72 ,$13.72 ,$80.25 ,$75.97 ,$75.97 ,$13.72 ,$75.97 ,$87.74 ,$87.74 ,$87.74 , N/A ,$34.30 ,$90.95 ,$13.72 ,$107.00 ,$63.88 ,$13.72 ,$44.51 ,$8.21 ,$7.46 ,$13.72 ,$90.95 ,$28.81 ,$90.95 ,$29.96 ,$96.30 ,$13.72 ,$87.74 ,$54.88 ,$54.88 ,$13.72 ,$69.55 ,$107.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101441,84600,HC VOLATILES-90,301,1 ,$58.00 ,$37.70 ,$7.46 ,$58.00 ,$42.78 ,$37.70 ,$34.63 ,$17.11 ,$16.24 ,$32.54 ,$17.11 ,$38.16 ,$17.11 ,$49.30 ,$49.30 ,$17.11 ,$49.30 ,$32.51 ,$39.44 ,$42.78 ,$17.11 ,$17.11 ,$43.50 ,$41.18 ,$41.18 ,$17.11 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$42.78 ,$49.30 ,$17.11 ,$58.00 ,$34.63 ,$17.11 ,$24.13 ,$8.21 ,$7.46 ,$17.11 ,$49.30 ,$35.93 ,$49.30 ,$16.24 ,$52.20 ,$17.11 ,$47.56 ,$58.00 ,$58.00 ,$17.11 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101442,84630,HC ZINC-90,301,1 ,$82.00 ,$53.30 ,$9.10 ,$82.00 ,$28.48 ,$53.30 ,$48.95 ,$11.39 ,$22.96 ,$46.00 ,$11.39 ,$53.96 ,$11.39 ,$69.70 ,$69.70 ,$11.39 ,$69.70 ,$21.64 ,$55.76 ,$28.48 ,$11.39 ,$11.39 ,$61.50 ,$58.22 ,$58.22 ,$11.39 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$28.48 ,$69.70 ,$11.39 ,$82.00 ,$48.95 ,$11.39 ,$34.11 ,$10.01 ,$9.10 ,$11.39 ,$69.70 ,$23.92 ,$69.70 ,$22.96 ,$73.80 ,$11.39 ,$67.24 ,$45.56 ,$45.56 ,$11.39 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101443,84681,HC C PEPTIDE-90,301,1 ,$92.00 ,$59.80 ,$7.46 ,$92.00 ,$52.03 ,$59.80 ,$54.92 ,$20.81 ,$25.76 ,$51.61 ,$20.81 ,$60.54 ,$20.81 ,$78.20 ,$78.20 ,$20.81 ,$78.20 ,$39.54 ,$62.56 ,$52.03 ,$20.81 ,$20.81 ,$69.00 ,$65.32 ,$65.32 ,$20.81 ,$65.32 ,$75.44 ,$75.44 ,$75.44 , N/A ,$52.03 ,$78.20 ,$20.81 ,$92.00 ,$54.92 ,$20.81 ,$38.27 ,$8.21 ,$7.46 ,$20.81 ,$78.20 ,$43.70 ,$78.20 ,$25.76 ,$82.80 ,$20.81 ,$75.44 ,$83.24 ,$83.24 ,$20.81 ,$59.80 ,$92.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101444,84702,HC HCG QN-90,301,1 ,$193.00 ,$125.45 ,$10.04 ,$193.00 ,$37.63 ,$125.45 ,$115.22 ,$15.05 ,$54.04 ,$108.27 ,$15.05 ,$126.99 ,$15.05 ,$164.05 ,$164.05 ,$15.05 ,$164.05 ,$28.60 ,$131.24 ,$37.63 ,$15.05 ,$15.05 ,$144.75 ,$137.03 ,$137.03 ,$15.05 ,$137.03 ,$158.26 ,$158.26 ,$158.26 , N/A ,$37.63 ,$164.05 ,$15.05 ,$193.00 ,$115.22 ,$15.05 ,$80.29 ,$11.04 ,$10.04 ,$15.05 ,$164.05 ,$31.61 ,$164.05 ,$54.04 ,$173.70 ,$15.05 ,$158.26 ,$60.20 ,$60.20 ,$15.05 ,$125.45 ,$193.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101455,G0480,HC DRUG SCRN DEFNT 1-7 CLS T1-90,301,1 ,$56.00 ,$36.40 ,$15.68 ,$140.00 ,$140.00 ,$36.40 ,$33.43 ,$56.00 ,$15.68 ,$31.42 ,$56.00 ,$36.85 ,$56.00 ,$47.60 ,$47.60 ,$56.00 ,$47.60 ,$56.00 ,$38.08 ,$140.00 ,$56.00 ,$56.00 ,$42.00 ,$39.76 ,$39.76 ,$56.00 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$56.00 ,$47.60 ,$56.00 ,$56.00 ,$33.43 ,$56.00 ,$23.30 ,$22.09 ,$20.08 ,$56.00 ,$47.60 ,$117.60 ,$47.60 ,$15.68 ,$50.40 ,$56.00 ,$45.92 ,$56.00 ,$56.00 ,$56.00 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101456,G0480,HC DRUG SCRN DEFNT 1-7 CLS T2-90,301,1 ,$137.00 ,$89.05 ,$20.08 ,$286.08 ,$286.08 ,$89.05 ,$81.79 ,$114.43 ,$38.36 ,$76.86 ,$114.43 ,$90.15 ,$114.43 ,$116.45 ,$116.45 ,$114.43 ,$116.45 ,$137.00 ,$93.16 ,$286.08 ,$114.43 ,$114.43 ,$102.75 ,$97.27 ,$97.27 ,$114.43 ,$97.27 ,$112.34 ,$112.34 ,$112.34 , N/A ,$137.00 ,$116.45 ,$114.43 ,$137.00 ,$81.79 ,$114.43 ,$56.99 ,$22.09 ,$20.08 ,$114.43 ,$116.45 ,$240.30 ,$116.45 ,$38.36 ,$123.30 ,$114.43 ,$112.34 ,$137.00 ,$137.00 ,$114.43 ,$89.05 ,$137.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101457,G0480,HC DRUG SCRN DEFNT 1-7 CLS T3-90,301,1 ,$220.00 ,$143.00 ,$20.08 ,$286.08 ,$286.08 ,$143.00 ,$131.34 ,$114.43 ,$61.60 ,$123.42 ,$114.43 ,$144.76 ,$114.43 ,$187.00 ,$187.00 ,$114.43 ,$187.00 ,$217.42 ,$149.60 ,$286.08 ,$114.43 ,$114.43 ,$165.00 ,$156.20 ,$156.20 ,$114.43 ,$156.20 ,$180.40 ,$180.40 ,$180.40 , N/A ,$220.00 ,$187.00 ,$114.43 ,$220.00 ,$131.34 ,$114.43 ,$91.52 ,$22.09 ,$20.08 ,$114.43 ,$187.00 ,$240.30 ,$187.00 ,$61.60 ,$198.00 ,$114.43 ,$180.40 ,$220.00 ,$220.00 ,$114.43 ,$143.00 ,$220.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101463,G0483,HC DRUG SCRN DEFINT 22+ CLASS-90,301,1 ,$244.00 ,$158.60 ,$20.08 ,$610.00 ,$610.00 ,$158.60 ,$145.67 ,$244.00 ,$68.32 ,$136.88 ,$244.00 ,$160.55 ,$244.00 ,$207.40 ,$207.40 ,$244.00 ,$207.40 ,$244.00 ,$165.92 ,$610.00 ,$244.00 ,$244.00 ,$183.00 ,$173.24 ,$173.24 ,$244.00 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$244.00 ,$244.00 ,$145.67 ,$244.00 ,$101.50 ,$22.09 ,$20.08 ,$244.00 ,$207.40 ,$512.40 ,$207.40 ,$68.32 ,$219.60 ,$244.00 ,$200.08 ,$244.00 ,$244.00 ,$244.00 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101464,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$46.00 ,$29.90 ,$3.32 ,$46.00 ,$10.58 ,$29.90 ,$27.46 ,$4.23 ,$12.88 ,$25.81 ,$4.23 ,$30.27 ,$4.23 ,$39.10 ,$39.10 ,$4.23 ,$39.10 ,$8.04 ,$31.28 ,$10.58 ,$4.23 ,$4.23 ,$34.50 ,$32.66 ,$32.66 ,$4.23 ,$32.66 ,$37.72 ,$37.72 ,$37.72 , N/A ,$10.58 ,$39.10 ,$4.23 ,$46.00 ,$27.46 ,$4.23 ,$19.14 ,$3.65 ,$3.32 ,$4.23 ,$39.10 ,$8.88 ,$39.10 ,$12.88 ,$41.40 ,$4.23 ,$37.72 ,$16.92 ,$16.92 ,$4.23 ,$29.90 ,$46.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101465,83921,HC ORGANIC ACIDS QN SINGLE-90,301,1 ,$183.00 ,$118.95 ,$7.46 ,$183.00 ,$53.03 ,$118.95 ,$109.25 ,$21.21 ,$51.24 ,$102.66 ,$21.21 ,$120.41 ,$21.21 ,$155.55 ,$155.55 ,$21.21 ,$155.55 ,$40.30 ,$124.44 ,$53.03 ,$21.21 ,$21.21 ,$137.25 ,$129.93 ,$129.93 ,$21.21 ,$129.93 ,$150.06 ,$150.06 ,$150.06 , N/A ,$53.03 ,$155.55 ,$21.21 ,$183.00 ,$109.25 ,$21.21 ,$76.13 ,$8.21 ,$7.46 ,$21.21 ,$155.55 ,$44.54 ,$155.55 ,$51.24 ,$164.70 ,$21.21 ,$150.06 ,$84.84 ,$84.84 ,$21.21 ,$118.95 ,$183.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101473,80339,HC ANTIEPILIPTICS NOS 1-3 -90,301,1 ,$75.00 ,$48.75 ,$20.08 ,$75.00 , N/A ,$48.75 ,$44.78 , N/A ,$21.00 ,$42.08 , N/A ,$49.35 , N/A ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$51.00 , N/A , N/A , N/A ,$56.25 ,$53.25 ,$53.25 , N/A ,$53.25 ,$61.50 ,$61.50 ,$61.50 , N/A , N/A ,$63.75 , N/A ,$75.00 ,$44.78 , N/A ,$31.20 ,$22.09 ,$20.08 , N/A ,$63.75 , N/A ,$63.75 ,$21.00 ,$67.50 , N/A ,$61.50 , N/A , N/A , N/A ,$48.75 ,$75.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101476,82610,HC CYSTATIN C -90,301,1 ,$141.00 ,$91.65 ,$7.46 ,$141.00 ,$46.30 ,$91.65 ,$84.18 ,$18.52 ,$39.48 ,$79.10 ,$18.52 ,$92.78 ,$18.52 ,$119.85 ,$119.85 ,$18.52 ,$119.85 ,$35.19 ,$95.88 ,$46.30 ,$18.52 ,$18.52 ,$105.75 ,$100.11 ,$100.11 ,$18.52 ,$100.11 ,$115.62 ,$115.62 ,$115.62 , N/A ,$46.30 ,$119.85 ,$18.52 ,$141.00 ,$84.18 ,$18.52 ,$58.66 ,$8.21 ,$7.46 ,$18.52 ,$119.85 ,$38.89 ,$119.85 ,$39.48 ,$126.90 ,$18.52 ,$115.62 ,$74.08 ,$74.08 ,$18.52 ,$91.65 ,$141.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101477,83519,HC QN RIA MUSK-90,301,1 ,"$1,920.00 ","$1,248.00 ",$6.68 ,"$1,920.00 ",$46.00 ,"$1,248.00 ","$1,146.24 ",$18.40 ,$537.60 ,"$1,077.12 ",$18.40 ,"$1,263.36 ",$18.40 ,"$1,632.00 ","$1,632.00 ",$18.40 ,"$1,632.00 ",$34.96 ,"$1,305.60 ",$46.00 ,$18.40 ,$18.40 ,"$1,440.00 ","$1,363.20 ","$1,363.20 ",$18.40 ,"$1,363.20 ","$1,574.40 ","$1,574.40 ","$1,574.40 ", N/A ,$46.00 ,"$1,632.00 ",$18.40 ,"$1,920.00 ","$1,146.24 ",$18.40 ,$798.72 ,$7.35 ,$6.68 ,$18.40 ,"$1,632.00 ",$38.64 ,"$1,632.00 ",$537.60 ,"$1,728.00 ",$18.40 ,"$1,574.40 ",$73.60 ,$73.60 ,$18.40 ,"$1,248.00 ","$1,920.00 "
ST. JOSEPH'S HOSPITAL - BREESE,30101478,82800,HC BLOOD GAS PH,301,1 ,$217.00 ,$141.05 ,$7.46 ,$217.00 ,$27.50 ,$141.05 ,$129.55 ,$11.00 ,$60.76 ,$121.74 ,$11.00 ,$142.79 ,$11.00 ,$184.45 ,$184.45 ,$11.00 ,$184.45 ,$20.90 ,$147.56 ,$27.50 ,$11.00 ,$11.00 ,$162.75 ,$154.07 ,$154.07 ,$11.00 ,$154.07 ,$177.94 ,$177.94 ,$177.94 , N/A ,$27.50 ,$184.45 ,$11.00 ,$217.00 ,$129.55 ,$11.00 ,$90.27 ,$8.21 ,$7.46 ,$11.00 ,$184.45 ,$23.10 ,$184.45 ,$60.76 ,$195.30 ,$11.00 ,$177.94 ,$44.00 ,$44.00 ,$11.00 ,$141.05 ,$217.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101479,82803,HC BLOOD GAS PH PO2  AND /OR PCO2,301,1 ,$223.00 ,$144.95 ,$7.46 ,$223.00 ,$65.18 ,$144.95 ,$133.13 ,$26.07 ,$62.44 ,$125.10 ,$26.07 ,$146.73 ,$26.07 ,$189.55 ,$189.55 ,$26.07 ,$189.55 ,$49.53 ,$151.64 ,$65.18 ,$26.07 ,$26.07 ,$167.25 ,$158.33 ,$158.33 ,$26.07 ,$158.33 ,$182.86 ,$182.86 ,$182.86 , N/A ,$65.18 ,$189.55 ,$26.07 ,$223.00 ,$133.13 ,$26.07 ,$92.77 ,$8.21 ,$7.46 ,$26.07 ,$189.55 ,$54.75 ,$189.55 ,$62.44 ,$200.70 ,$26.07 ,$182.86 ,$104.28 ,$104.28 ,$26.07 ,$144.95 ,$223.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101480,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$431.00 ,$280.15 ,$7.46 ,$431.00 ,$196.93 ,$280.15 ,$257.31 ,$78.77 ,$120.68 ,$241.79 ,$78.77 ,$283.60 ,$78.77 ,$366.35 ,$366.35 ,$78.77 ,$366.35 ,$149.66 ,$293.08 ,$196.93 ,$78.77 ,$78.77 ,$323.25 ,$306.01 ,$306.01 ,$78.77 ,$306.01 ,$353.42 ,$353.42 ,$353.42 , N/A ,$196.93 ,$366.35 ,$78.77 ,$431.00 ,$257.31 ,$78.77 ,$179.30 ,$8.21 ,$7.46 ,$78.77 ,$366.35 ,$165.42 ,$366.35 ,$120.68 ,$387.90 ,$78.77 ,$353.42 ,$315.08 ,$315.08 ,$78.77 ,$280.15 ,$431.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101486,82375,HC CARBON MONOXIDE QN,301,1 ,$223.00 ,$144.95 ,$7.46 ,$223.00 ,$30.80 ,$144.95 ,$133.13 ,$12.32 ,$62.44 ,$125.10 ,$12.32 ,$146.73 ,$12.32 ,$189.55 ,$189.55 ,$12.32 ,$189.55 ,$23.41 ,$151.64 ,$30.80 ,$12.32 ,$12.32 ,$167.25 ,$158.33 ,$158.33 ,$12.32 ,$158.33 ,$182.86 ,$182.86 ,$182.86 , N/A ,$30.80 ,$189.55 ,$12.32 ,$223.00 ,$133.13 ,$12.32 ,$92.77 ,$8.21 ,$7.46 ,$12.32 ,$189.55 ,$25.87 ,$189.55 ,$62.44 ,$200.70 ,$12.32 ,$182.86 ,$49.28 ,$49.28 ,$12.32 ,$144.95 ,$223.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101497,80373,HC TRAMADOL-90,301,1 ,$52.00 ,$33.80 ,$7.46 ,$52.00 , N/A ,$33.80 ,$31.04 , N/A ,$14.56 ,$29.17 , N/A ,$34.22 , N/A ,$44.20 ,$44.20 , N/A ,$44.20 , N/A ,$35.36 , N/A , N/A , N/A ,$39.00 ,$36.92 ,$36.92 , N/A ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A , N/A ,$44.20 , N/A ,$52.00 ,$31.04 , N/A ,$21.63 ,$8.21 ,$7.46 , N/A ,$44.20 , N/A ,$44.20 ,$14.56 ,$46.80 , N/A ,$42.64 , N/A , N/A , N/A ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101509,82330,HC CALCIUM IONIZED STAT -90,301,1 ,$95.00 ,$61.75 ,$7.46 ,$95.00 ,$34.20 ,$61.75 ,$56.72 ,$13.68 ,$26.60 ,$53.30 ,$13.68 ,$62.51 ,$13.68 ,$80.75 ,$80.75 ,$13.68 ,$80.75 ,$25.99 ,$64.60 ,$34.20 ,$13.68 ,$13.68 ,$71.25 ,$67.45 ,$67.45 ,$13.68 ,$67.45 ,$77.90 ,$77.90 ,$77.90 , N/A ,$34.20 ,$80.75 ,$13.68 ,$95.00 ,$56.72 ,$13.68 ,$39.52 ,$8.21 ,$7.46 ,$13.68 ,$80.75 ,$28.73 ,$80.75 ,$26.60 ,$85.50 ,$13.68 ,$77.90 ,$54.72 ,$54.72 ,$13.68 ,$61.75 ,$95.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101511,80345,HC BARBITURATE -90,301,1 ,$44.00 ,$28.60 ,$7.46 ,$44.00 , N/A ,$28.60 ,$26.27 , N/A ,$12.32 ,$24.68 , N/A ,$28.95 , N/A ,$37.40 ,$37.40 , N/A ,$37.40 , N/A ,$29.92 , N/A , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.08 ,$36.08 ,$36.08 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$26.27 , N/A ,$18.30 ,$8.21 ,$7.46 , N/A ,$37.40 , N/A ,$37.40 ,$12.32 ,$39.60 , N/A ,$36.08 , N/A , N/A , N/A ,$28.60 ,$44.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101512,80324,HC AMPHETAMINE 1-2 -90,301,1 ,$44.00 ,$28.60 ,$12.32 ,$44.00 , N/A ,$28.60 ,$26.27 , N/A ,$12.32 ,$24.68 , N/A ,$28.95 , N/A ,$37.40 ,$37.40 , N/A ,$37.40 , N/A ,$29.92 , N/A , N/A , N/A ,$33.00 ,$31.24 ,$31.24 , N/A ,$31.24 ,$36.08 ,$36.08 ,$36.08 , N/A , N/A ,$37.40 , N/A ,$44.00 ,$26.27 , N/A ,$18.30 ,$22.09 ,$20.08 , N/A ,$37.40 , N/A ,$37.40 ,$12.32 ,$39.60 , N/A ,$36.08 , N/A , N/A , N/A ,$28.60 ,$44.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101516,80321,HC ALCOHOL BIOMARKERS 1-2 - 90,301,1 ,$193.00 ,$125.45 ,$20.08 ,$193.00 , N/A ,$125.45 ,$115.22 , N/A ,$54.04 ,$108.27 , N/A ,$126.99 , N/A ,$164.05 ,$164.05 , N/A ,$164.05 , N/A ,$131.24 , N/A , N/A , N/A ,$144.75 ,$137.03 ,$137.03 , N/A ,$137.03 ,$158.26 ,$158.26 ,$158.26 , N/A , N/A ,$164.05 , N/A ,$193.00 ,$115.22 , N/A ,$80.29 ,$22.09 ,$20.08 , N/A ,$164.05 , N/A ,$164.05 ,$54.04 ,$173.70 , N/A ,$158.26 , N/A , N/A , N/A ,$125.45 ,$193.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101525,82465,HC CHOLESTEROL -90,301,1 ,$37.00 ,$24.05 ,$3.32 ,$37.00 ,$10.88 ,$24.05 ,$22.09 ,$4.35 ,$10.36 ,$20.76 ,$4.35 ,$24.35 ,$4.35 ,$31.45 ,$31.45 ,$4.35 ,$31.45 ,$8.27 ,$25.16 ,$10.88 ,$4.35 ,$4.35 ,$27.75 ,$26.27 ,$26.27 ,$4.35 ,$26.27 ,$30.34 ,$30.34 ,$30.34 , N/A ,$10.88 ,$31.45 ,$4.35 ,$37.00 ,$22.09 ,$4.35 ,$15.39 ,$3.65 ,$3.32 ,$4.35 ,$31.45 ,$9.14 ,$31.45 ,$10.36 ,$33.30 ,$4.35 ,$30.34 ,$17.40 ,$17.40 ,$4.35 ,$24.05 ,$37.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101526,82947,HC GLUCOSE -90,301,1 ,$37.00 ,$24.05 ,$3.32 ,$37.00 ,$9.83 ,$24.05 ,$22.09 ,$3.93 ,$10.36 ,$20.76 ,$3.93 ,$24.35 ,$3.93 ,$31.45 ,$31.45 ,$3.93 ,$31.45 ,$7.47 ,$25.16 ,$9.83 ,$3.93 ,$3.93 ,$27.75 ,$26.27 ,$26.27 ,$3.93 ,$26.27 ,$30.34 ,$30.34 ,$30.34 , N/A ,$9.83 ,$31.45 ,$3.93 ,$37.00 ,$22.09 ,$3.93 ,$15.39 ,$3.65 ,$3.32 ,$3.93 ,$31.45 ,$8.25 ,$31.45 ,$10.36 ,$33.30 ,$3.93 ,$30.34 ,$15.72 ,$15.72 ,$3.93 ,$24.05 ,$37.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101527,84450,HC AST -90,301,1 ,$37.00 ,$24.05 ,$3.32 ,$37.00 ,$12.95 ,$24.05 ,$22.09 ,$5.18 ,$10.36 ,$20.76 ,$5.18 ,$24.35 ,$5.18 ,$31.45 ,$31.45 ,$5.18 ,$31.45 ,$9.84 ,$25.16 ,$12.95 ,$5.18 ,$5.18 ,$27.75 ,$26.27 ,$26.27 ,$5.18 ,$26.27 ,$30.34 ,$30.34 ,$30.34 , N/A ,$12.95 ,$31.45 ,$5.18 ,$37.00 ,$22.09 ,$5.18 ,$15.39 ,$3.65 ,$3.32 ,$5.18 ,$31.45 ,$10.88 ,$31.45 ,$10.36 ,$33.30 ,$5.18 ,$30.34 ,$20.72 ,$20.72 ,$5.18 ,$24.05 ,$37.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101529,82725,HC FATTY ACIDS NONESTERIFIED-90,301,1 ,$147.00 ,$95.55 ,$7.46 ,$147.00 ,$46.93 ,$95.55 ,$87.76 ,$18.77 ,$41.16 ,$82.47 ,$18.77 ,$96.73 ,$18.77 ,$124.95 ,$124.95 ,$18.77 ,$124.95 ,$35.66 ,$99.96 ,$46.93 ,$18.77 ,$18.77 ,$110.25 ,$104.37 ,$104.37 ,$18.77 ,$104.37 ,$120.54 ,$120.54 ,$120.54 , N/A ,$46.93 ,$124.95 ,$18.77 ,$147.00 ,$87.76 ,$18.77 ,$61.15 ,$8.21 ,$7.46 ,$18.77 ,$124.95 ,$39.42 ,$124.95 ,$41.16 ,$132.30 ,$18.77 ,$120.54 ,$75.08 ,$75.08 ,$18.77 ,$95.55 ,$147.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101534,80377,HC PANEL HYPOGLYCEMIC QL-90,301,1 ,$185.00 ,$120.25 ,$20.08 ,$185.00 , N/A ,$120.25 ,$110.45 , N/A ,$51.80 ,$103.79 , N/A ,$121.73 , N/A ,$157.25 ,$157.25 , N/A ,$157.25 , N/A ,$125.80 , N/A , N/A , N/A ,$138.75 ,$131.35 ,$131.35 , N/A ,$131.35 ,$151.70 ,$151.70 ,$151.70 , N/A , N/A ,$157.25 , N/A ,$185.00 ,$110.45 , N/A ,$76.96 ,$22.09 ,$20.08 , N/A ,$157.25 , N/A ,$157.25 ,$51.80 ,$166.50 , N/A ,$151.70 , N/A , N/A , N/A ,$120.25 ,$185.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101538,83491,HC CORTICOSTEROIDS 17D -90,301,1 ,$65.00 ,$42.25 ,$17.46 ,$65.00 ,$44.75 ,$42.25 ,$38.81 ,$17.90 ,$18.20 ,$36.47 ,$17.90 ,$42.77 ,$17.90 ,$55.25 ,$55.25 ,$17.90 ,$55.25 ,$34.01 ,$44.20 ,$44.75 ,$17.90 ,$17.90 ,$48.75 ,$46.15 ,$46.15 ,$17.90 ,$46.15 ,$53.30 ,$53.30 ,$53.30 , N/A ,$44.75 ,$55.25 ,$17.90 ,$65.00 ,$38.81 ,$17.90 ,$27.04 ,$19.21 ,$17.46 ,$17.90 ,$55.25 ,$37.59 ,$55.25 ,$18.20 ,$58.50 ,$17.90 ,$53.30 ,$65.00 ,$65.00 ,$17.90 ,$42.25 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101540,84163,HC PLASMA PROTEIN-A PREGNANCY ASSOCIATED-90,301,1 ,$164.00 ,$106.60 ,$7.46 ,$164.00 ,$37.63 ,$106.60 ,$97.91 ,$15.05 ,$45.92 ,$92.00 ,$15.05 ,$107.91 ,$15.05 ,$139.40 ,$139.40 ,$15.05 ,$139.40 ,$28.60 ,$111.52 ,$37.63 ,$15.05 ,$15.05 ,$123.00 ,$116.44 ,$116.44 ,$15.05 ,$116.44 ,$134.48 ,$134.48 ,$134.48 , N/A ,$37.63 ,$139.40 ,$15.05 ,$164.00 ,$97.91 ,$15.05 ,$68.22 ,$8.21 ,$7.46 ,$15.05 ,$139.40 ,$31.61 ,$139.40 ,$45.92 ,$147.60 ,$15.05 ,$134.48 ,$60.20 ,$60.20 ,$15.05 ,$106.60 ,$164.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101543,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$775.00 ,$503.75 ,$6.80 ,$775.00 ,$119.08 ,$503.75 ,$462.68 ,$47.63 ,$217.00 ,$434.78 ,$47.63 ,$509.95 ,$47.63 ,$658.75 ,$658.75 ,$47.63 ,$658.75 ,$90.50 ,$527.00 ,$119.08 ,$47.63 ,$47.63 ,$581.25 ,$550.25 ,$550.25 ,$47.63 ,$550.25 ,$635.50 ,$635.50 ,$635.50 , N/A ,$119.08 ,$658.75 ,$47.63 ,$775.00 ,$462.68 ,$47.63 ,$322.40 ,$7.48 ,$6.80 ,$47.63 ,$658.75 ,$100.02 ,$658.75 ,$217.00 ,$697.50 ,$47.63 ,$635.50 ,$190.52 ,$190.52 ,$47.63 ,$503.75 ,$775.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101545,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$170.00 ,$110.50 ,$8.56 ,$170.00 ,$36.43 ,$110.50 ,$101.49 ,$14.57 ,$47.60 ,$95.37 ,$14.57 ,$111.86 ,$14.57 ,$144.50 ,$144.50 ,$14.57 ,$144.50 ,$27.68 ,$115.60 ,$36.43 ,$14.57 ,$14.57 ,$127.50 ,$120.70 ,$120.70 ,$14.57 ,$120.70 ,$139.40 ,$139.40 ,$139.40 , N/A ,$36.43 ,$144.50 ,$14.57 ,$170.00 ,$101.49 ,$14.57 ,$70.72 ,$9.42 ,$8.56 ,$14.57 ,$144.50 ,$30.60 ,$144.50 ,$47.60 ,$153.00 ,$14.57 ,$139.40 ,$58.28 ,$58.28 ,$14.57 ,$110.50 ,$170.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101546,80164,HC VALPROCIC ACID,301,1 ,$169.00 ,$109.85 ,$8.56 ,$169.00 ,$33.85 ,$109.85 ,$100.89 ,$13.54 ,$47.32 ,$94.81 ,$13.54 ,$111.20 ,$13.54 ,$143.65 ,$143.65 ,$13.54 ,$143.65 ,$25.73 ,$114.92 ,$33.85 ,$13.54 ,$13.54 ,$126.75 ,$119.99 ,$119.99 ,$13.54 ,$119.99 ,$138.58 ,$138.58 ,$138.58 , N/A ,$33.85 ,$143.65 ,$13.54 ,$169.00 ,$100.89 ,$13.54 ,$70.30 ,$9.42 ,$8.56 ,$13.54 ,$143.65 ,$28.43 ,$143.65 ,$47.32 ,$152.10 ,$13.54 ,$138.58 ,$54.16 ,$54.16 ,$13.54 ,$109.85 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101548,80178,HC LITHIUM,301,1 ,$114.00 ,$74.10 ,$6.61 ,$114.00 ,$16.53 ,$74.10 ,$68.06 ,$6.61 ,$31.92 ,$63.95 ,$6.61 ,$75.01 ,$6.61 ,$96.90 ,$96.90 ,$6.61 ,$96.90 ,$12.56 ,$77.52 ,$16.53 ,$6.61 ,$6.61 ,$85.50 ,$80.94 ,$80.94 ,$6.61 ,$80.94 ,$93.48 ,$93.48 ,$93.48 , N/A ,$16.53 ,$96.90 ,$6.61 ,$114.00 ,$68.06 ,$6.61 ,$47.42 ,$9.42 ,$8.56 ,$6.61 ,$96.90 ,$13.88 ,$96.90 ,$31.92 ,$102.60 ,$6.61 ,$93.48 ,$26.44 ,$26.44 ,$6.61 ,$74.10 ,$114.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101549,80184,HC PHENOBARBITAL,301,1 ,$164.00 ,$106.60 ,$8.56 ,$164.00 ,$38.25 ,$106.60 ,$97.91 ,$15.30 ,$45.92 ,$92.00 ,$15.30 ,$107.91 ,$15.30 ,$139.40 ,$139.40 ,$15.30 ,$139.40 ,$29.07 ,$111.52 ,$38.25 ,$15.30 ,$15.30 ,$123.00 ,$116.44 ,$116.44 ,$15.30 ,$116.44 ,$134.48 ,$134.48 ,$134.48 , N/A ,$38.25 ,$139.40 ,$15.30 ,$164.00 ,$97.91 ,$15.30 ,$68.22 ,$9.42 ,$8.56 ,$15.30 ,$139.40 ,$32.13 ,$139.40 ,$45.92 ,$147.60 ,$15.30 ,$134.48 ,$61.20 ,$61.20 ,$15.30 ,$106.60 ,$164.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101551,80198,HC THEOPHYLLINE,301,1 ,$155.00 ,$100.75 ,$8.56 ,$155.00 ,$35.35 ,$100.75 ,$92.54 ,$14.14 ,$43.40 ,$86.96 ,$14.14 ,$101.99 ,$14.14 ,$131.75 ,$131.75 ,$14.14 ,$131.75 ,$26.87 ,$105.40 ,$35.35 ,$14.14 ,$14.14 ,$116.25 ,$110.05 ,$110.05 ,$14.14 ,$110.05 ,$127.10 ,$127.10 ,$127.10 , N/A ,$35.35 ,$131.75 ,$14.14 ,$155.00 ,$92.54 ,$14.14 ,$64.48 ,$9.42 ,$8.56 ,$14.14 ,$131.75 ,$29.69 ,$131.75 ,$43.40 ,$139.50 ,$14.14 ,$127.10 ,$56.56 ,$56.56 ,$14.14 ,$100.75 ,$155.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101552,80200,HC TOBRAMYCIN,301,1 ,$154.00 ,$100.10 ,$8.56 ,$154.00 ,$40.33 ,$100.10 ,$91.94 ,$16.13 ,$43.12 ,$86.39 ,$16.13 ,$101.33 ,$16.13 ,$130.90 ,$130.90 ,$16.13 ,$130.90 ,$30.65 ,$104.72 ,$40.33 ,$16.13 ,$16.13 ,$115.50 ,$109.34 ,$109.34 ,$16.13 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$40.33 ,$130.90 ,$16.13 ,$154.00 ,$91.94 ,$16.13 ,$64.06 ,$9.42 ,$8.56 ,$16.13 ,$130.90 ,$33.87 ,$130.90 ,$43.12 ,$138.60 ,$16.13 ,$126.28 ,$64.52 ,$64.52 ,$16.13 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101555,81479,HC IDH GENE MUTATION ASSAY - 90,301,1 ,$632.00 ,$410.80 ,$26.47 ,$632.00 , N/A ,$410.80 ,$377.30 ,$189.60 ,$176.96 ,$354.55 , N/A ,$415.86 , N/A ,$537.20 ,$537.20 , N/A ,$537.20 ,$284.40 ,$429.76 ,$442.40 , N/A , N/A ,$474.00 ,$448.72 ,$448.72 , N/A ,$448.72 ,$518.24 ,$518.24 ,$518.24 , N/A , N/A ,$537.20 , N/A ,$632.00 ,$377.30 , N/A ,$262.91 ,$29.12 ,$26.47 , N/A ,$537.20 ,$379.20 ,$537.20 ,$176.96 ,$568.80 , N/A ,$518.24 ,$316.00 ,$316.00 , N/A ,$410.80 ,$632.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101556,82042,HC ALBUMIN OTHER SOURCE,301,1 ,$35.00 ,$22.75 ,$3.32 ,$35.00 ,$19.45 ,$22.75 ,$20.90 ,$7.78 ,$9.80 ,$19.64 ,$7.78 ,$23.03 ,$7.78 ,$29.75 ,$29.75 ,$7.78 ,$29.75 ,$14.78 ,$23.80 ,$19.45 ,$7.78 ,$7.78 ,$26.25 ,$24.85 ,$24.85 ,$7.78 ,$24.85 ,$28.70 ,$28.70 ,$28.70 , N/A ,$19.45 ,$29.75 ,$7.78 ,$35.00 ,$20.90 ,$7.78 ,$14.56 ,$3.65 ,$3.32 ,$7.78 ,$29.75 ,$16.34 ,$29.75 ,$9.80 ,$31.50 ,$7.78 ,$28.70 ,$31.12 ,$31.12 ,$7.78 ,$22.75 ,$35.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101558,82105,HC ALPHA FETOPROTEIN SERUM,301,1 ,$83.00 ,$53.95 ,$7.46 ,$83.00 ,$41.93 ,$53.95 ,$49.55 ,$16.77 ,$23.24 ,$46.56 ,$16.77 ,$54.61 ,$16.77 ,$70.55 ,$70.55 ,$16.77 ,$70.55 ,$31.86 ,$56.44 ,$41.93 ,$16.77 ,$16.77 ,$62.25 ,$58.93 ,$58.93 ,$16.77 ,$58.93 ,$68.06 ,$68.06 ,$68.06 , N/A ,$41.93 ,$70.55 ,$16.77 ,$83.00 ,$49.55 ,$16.77 ,$34.53 ,$8.21 ,$7.46 ,$16.77 ,$70.55 ,$35.22 ,$70.55 ,$23.24 ,$74.70 ,$16.77 ,$68.06 ,$67.08 ,$67.08 ,$16.77 ,$53.95 ,$83.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101559,82150,HC AMYLASE,301,1 ,$110.00 ,$71.50 ,$6.48 ,$110.00 ,$16.20 ,$71.50 ,$65.67 ,$6.48 ,$30.80 ,$61.71 ,$6.48 ,$72.38 ,$6.48 ,$93.50 ,$93.50 ,$6.48 ,$93.50 ,$12.31 ,$74.80 ,$16.20 ,$6.48 ,$6.48 ,$82.50 ,$78.10 ,$78.10 ,$6.48 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$16.20 ,$93.50 ,$6.48 ,$110.00 ,$65.67 ,$6.48 ,$45.76 ,$8.21 ,$7.46 ,$6.48 ,$93.50 ,$13.61 ,$93.50 ,$30.80 ,$99.00 ,$6.48 ,$90.20 ,$25.92 ,$25.92 ,$6.48 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101561,82247,HC BILIRUBIN TOTAL,301,1 ,$51.00 ,$33.15 ,$3.32 ,$51.00 ,$12.55 ,$33.15 ,$30.45 ,$5.02 ,$14.28 ,$28.61 ,$5.02 ,$33.56 ,$5.02 ,$43.35 ,$43.35 ,$5.02 ,$43.35 ,$9.54 ,$34.68 ,$12.55 ,$5.02 ,$5.02 ,$38.25 ,$36.21 ,$36.21 ,$5.02 ,$36.21 ,$41.82 ,$41.82 ,$41.82 , N/A ,$12.55 ,$43.35 ,$5.02 ,$51.00 ,$30.45 ,$5.02 ,$21.22 ,$3.65 ,$3.32 ,$5.02 ,$43.35 ,$10.54 ,$43.35 ,$14.28 ,$45.90 ,$5.02 ,$41.82 ,$20.08 ,$20.08 ,$5.02 ,$33.15 ,$51.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101562,82248,HC BILIRUBIN DIRECT T1,301,1 ,$70.00 ,$45.50 ,$3.32 ,$70.00 ,$12.55 ,$45.50 ,$41.79 ,$5.02 ,$19.60 ,$39.27 ,$5.02 ,$46.06 ,$5.02 ,$59.50 ,$59.50 ,$5.02 ,$59.50 ,$9.54 ,$47.60 ,$12.55 ,$5.02 ,$5.02 ,$52.50 ,$49.70 ,$49.70 ,$5.02 ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A ,$12.55 ,$59.50 ,$5.02 ,$70.00 ,$41.79 ,$5.02 ,$29.12 ,$3.65 ,$3.32 ,$5.02 ,$59.50 ,$10.54 ,$59.50 ,$19.60 ,$63.00 ,$5.02 ,$57.40 ,$20.08 ,$20.08 ,$5.02 ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101565,82310,HC CALCIUM,301,1 ,$71.00 ,$46.15 ,$3.32 ,$71.00 ,$12.90 ,$46.15 ,$42.39 ,$5.16 ,$19.88 ,$39.83 ,$5.16 ,$46.72 ,$5.16 ,$60.35 ,$60.35 ,$5.16 ,$60.35 ,$9.80 ,$48.28 ,$12.90 ,$5.16 ,$5.16 ,$53.25 ,$50.41 ,$50.41 ,$5.16 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$12.90 ,$60.35 ,$5.16 ,$71.00 ,$42.39 ,$5.16 ,$29.54 ,$3.65 ,$3.32 ,$5.16 ,$60.35 ,$10.84 ,$60.35 ,$19.88 ,$63.90 ,$5.16 ,$58.22 ,$20.64 ,$20.64 ,$5.16 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101566,82340,HC CALCIUM URINE QN TIMED,301,1 ,$154.00 ,$100.10 ,$6.03 ,$154.00 ,$15.08 ,$100.10 ,$91.94 ,$6.03 ,$43.12 ,$86.39 ,$6.03 ,$101.33 ,$6.03 ,$130.90 ,$130.90 ,$6.03 ,$130.90 ,$11.46 ,$104.72 ,$15.08 ,$6.03 ,$6.03 ,$115.50 ,$109.34 ,$109.34 ,$6.03 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$15.08 ,$130.90 ,$6.03 ,$154.00 ,$91.94 ,$6.03 ,$64.06 ,$8.21 ,$7.46 ,$6.03 ,$130.90 ,$12.66 ,$130.90 ,$43.12 ,$138.60 ,$6.03 ,$126.28 ,$24.12 ,$24.12 ,$6.03 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101568,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$77.00 ,$50.05 ,$7.46 ,$77.00 ,$47.40 ,$50.05 ,$45.97 ,$18.96 ,$21.56 ,$43.20 ,$18.96 ,$50.67 ,$18.96 ,$65.45 ,$65.45 ,$18.96 ,$65.45 ,$36.02 ,$52.36 ,$47.40 ,$18.96 ,$18.96 ,$57.75 ,$54.67 ,$54.67 ,$18.96 ,$54.67 ,$63.14 ,$63.14 ,$63.14 , N/A ,$47.40 ,$65.45 ,$18.96 ,$77.00 ,$45.97 ,$18.96 ,$32.03 ,$8.21 ,$7.46 ,$18.96 ,$65.45 ,$39.82 ,$65.45 ,$21.56 ,$69.30 ,$18.96 ,$63.14 ,$75.84 ,$75.84 ,$18.96 ,$50.05 ,$77.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101569,82436,HC CHLORIDE URINE,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$14.38 ,$60.45 ,$55.52 ,$5.75 ,$26.04 ,$52.17 ,$5.75 ,$61.19 ,$5.75 ,$79.05 ,$79.05 ,$5.75 ,$79.05 ,$10.93 ,$63.24 ,$14.38 ,$5.75 ,$5.75 ,$69.75 ,$66.03 ,$66.03 ,$5.75 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$14.38 ,$79.05 ,$5.75 ,$93.00 ,$55.52 ,$5.75 ,$38.69 ,$3.65 ,$3.32 ,$5.75 ,$79.05 ,$12.08 ,$79.05 ,$26.04 ,$83.70 ,$5.75 ,$76.26 ,$23.00 ,$23.00 ,$5.75 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101570,82465,HC CHOLESTEROL,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$10.88 ,$60.45 ,$55.52 ,$4.35 ,$26.04 ,$52.17 ,$4.35 ,$61.19 ,$4.35 ,$79.05 ,$79.05 ,$4.35 ,$79.05 ,$8.27 ,$63.24 ,$10.88 ,$4.35 ,$4.35 ,$69.75 ,$66.03 ,$66.03 ,$4.35 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$10.88 ,$79.05 ,$4.35 ,$93.00 ,$55.52 ,$4.35 ,$38.69 ,$3.65 ,$3.32 ,$4.35 ,$79.05 ,$9.14 ,$79.05 ,$26.04 ,$83.70 ,$4.35 ,$76.26 ,$17.40 ,$17.40 ,$4.35 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101571,82533,HC CORTISOL TOTAL,301,1 ,$92.00 ,$59.80 ,$16.30 ,$92.00 ,$40.75 ,$59.80 ,$54.92 ,$16.30 ,$25.76 ,$51.61 ,$16.30 ,$60.54 ,$16.30 ,$78.20 ,$78.20 ,$16.30 ,$78.20 ,$30.97 ,$62.56 ,$40.75 ,$16.30 ,$16.30 ,$69.00 ,$65.32 ,$65.32 ,$16.30 ,$65.32 ,$75.44 ,$75.44 ,$75.44 , N/A ,$40.75 ,$78.20 ,$16.30 ,$92.00 ,$54.92 ,$16.30 ,$38.27 ,$19.21 ,$17.46 ,$16.30 ,$78.20 ,$34.23 ,$78.20 ,$25.76 ,$82.80 ,$16.30 ,$75.44 ,$65.20 ,$65.20 ,$16.30 ,$59.80 ,$92.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101572,82570,HC CREATININE OTH SOURCE,301,1 ,$85.00 ,$55.25 ,$3.32 ,$85.00 ,$12.95 ,$55.25 ,$50.75 ,$5.18 ,$23.80 ,$47.69 ,$5.18 ,$55.93 ,$5.18 ,$72.25 ,$72.25 ,$5.18 ,$72.25 ,$9.84 ,$57.80 ,$12.95 ,$5.18 ,$5.18 ,$63.75 ,$60.35 ,$60.35 ,$5.18 ,$60.35 ,$69.70 ,$69.70 ,$69.70 , N/A ,$12.95 ,$72.25 ,$5.18 ,$85.00 ,$50.75 ,$5.18 ,$35.36 ,$3.65 ,$3.32 ,$5.18 ,$72.25 ,$10.88 ,$72.25 ,$23.80 ,$76.50 ,$5.18 ,$69.70 ,$20.72 ,$20.72 ,$5.18 ,$55.25 ,$85.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101573,82607,HC VITAMIN B12,301,1 ,$111.00 ,$72.15 ,$10.04 ,$111.00 ,$37.70 ,$72.15 ,$66.27 ,$15.08 ,$31.08 ,$62.27 ,$15.08 ,$73.04 ,$15.08 ,$94.35 ,$94.35 ,$15.08 ,$94.35 ,$28.65 ,$75.48 ,$37.70 ,$15.08 ,$15.08 ,$83.25 ,$78.81 ,$78.81 ,$15.08 ,$78.81 ,$91.02 ,$91.02 ,$91.02 , N/A ,$37.70 ,$94.35 ,$15.08 ,$111.00 ,$66.27 ,$15.08 ,$46.18 ,$11.04 ,$10.04 ,$15.08 ,$94.35 ,$31.67 ,$94.35 ,$31.08 ,$99.90 ,$15.08 ,$91.02 ,$60.32 ,$60.32 ,$15.08 ,$72.15 ,$111.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101575,82728,HC FERRITIN,301,1 ,$127.00 ,$82.55 ,$7.46 ,$127.00 ,$34.08 ,$82.55 ,$75.82 ,$13.63 ,$35.56 ,$71.25 ,$13.63 ,$83.57 ,$13.63 ,$107.95 ,$107.95 ,$13.63 ,$107.95 ,$25.90 ,$86.36 ,$34.08 ,$13.63 ,$13.63 ,$95.25 ,$90.17 ,$90.17 ,$13.63 ,$90.17 ,$104.14 ,$104.14 ,$104.14 , N/A ,$34.08 ,$107.95 ,$13.63 ,$127.00 ,$75.82 ,$13.63 ,$52.83 ,$8.21 ,$7.46 ,$13.63 ,$107.95 ,$28.62 ,$107.95 ,$35.56 ,$114.30 ,$13.63 ,$104.14 ,$54.52 ,$54.52 ,$13.63 ,$82.55 ,$127.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101576,82731,HC FETAL FIBRONECTIN,301,1 ,$433.00 ,$281.45 ,$20.08 ,$433.00 ,$161.03 ,$281.45 ,$258.50 ,$64.41 ,$121.24 ,$242.91 ,$64.41 ,$284.91 ,$64.41 ,$368.05 ,$368.05 ,$64.41 ,$368.05 ,$122.38 ,$294.44 ,$161.03 ,$64.41 ,$64.41 ,$324.75 ,$307.43 ,$307.43 ,$64.41 ,$307.43 ,$355.06 ,$355.06 ,$355.06 , N/A ,$161.03 ,$368.05 ,$64.41 ,$433.00 ,$258.50 ,$64.41 ,$180.13 ,$22.09 ,$20.08 ,$64.41 ,$368.05 ,$135.26 ,$368.05 ,$121.24 ,$389.70 ,$64.41 ,$355.06 ,$257.64 ,$257.64 ,$64.41 ,$281.45 ,$433.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101577,82746,HC FOLIC ACID SERUM,301,1 ,$127.00 ,$82.55 ,$7.46 ,$127.00 ,$36.75 ,$82.55 ,$75.82 ,$14.70 ,$35.56 ,$71.25 ,$14.70 ,$83.57 ,$14.70 ,$107.95 ,$107.95 ,$14.70 ,$107.95 ,$27.93 ,$86.36 ,$36.75 ,$14.70 ,$14.70 ,$95.25 ,$90.17 ,$90.17 ,$14.70 ,$90.17 ,$104.14 ,$104.14 ,$104.14 , N/A ,$36.75 ,$107.95 ,$14.70 ,$127.00 ,$75.82 ,$14.70 ,$52.83 ,$8.21 ,$7.46 ,$14.70 ,$107.95 ,$30.87 ,$107.95 ,$35.56 ,$114.30 ,$14.70 ,$104.14 ,$58.80 ,$58.80 ,$14.70 ,$82.55 ,$127.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101581,82945,HC GLUCOSE BODY FLUID,301,1 ,$75.00 ,$48.75 ,$3.32 ,$75.00 ,$9.83 ,$48.75 ,$44.78 ,$3.93 ,$21.00 ,$42.08 ,$3.93 ,$49.35 ,$3.93 ,$63.75 ,$63.75 ,$3.93 ,$63.75 ,$7.47 ,$51.00 ,$9.83 ,$3.93 ,$3.93 ,$56.25 ,$53.25 ,$53.25 ,$3.93 ,$53.25 ,$61.50 ,$61.50 ,$61.50 , N/A ,$9.83 ,$63.75 ,$3.93 ,$75.00 ,$44.78 ,$3.93 ,$31.20 ,$3.65 ,$3.32 ,$3.93 ,$63.75 ,$8.25 ,$63.75 ,$21.00 ,$67.50 ,$3.93 ,$61.50 ,$15.72 ,$15.72 ,$3.93 ,$48.75 ,$75.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101584,82977,HC GGT / GGTP,301,1 ,$115.00 ,$74.75 ,$3.32 ,$115.00 ,$18.00 ,$74.75 ,$68.66 ,$7.20 ,$32.20 ,$64.52 ,$7.20 ,$75.67 ,$7.20 ,$97.75 ,$97.75 ,$7.20 ,$97.75 ,$13.68 ,$78.20 ,$18.00 ,$7.20 ,$7.20 ,$86.25 ,$81.65 ,$81.65 ,$7.20 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$18.00 ,$97.75 ,$7.20 ,$115.00 ,$68.66 ,$7.20 ,$47.84 ,$3.65 ,$3.32 ,$7.20 ,$97.75 ,$15.12 ,$97.75 ,$32.20 ,$103.50 ,$7.20 ,$94.30 ,$28.80 ,$28.80 ,$7.20 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101585,83001,HC FSH,301,1 ,$139.00 ,$90.35 ,$17.46 ,$139.00 ,$46.45 ,$90.35 ,$82.98 ,$18.58 ,$38.92 ,$77.98 ,$18.58 ,$91.46 ,$18.58 ,$118.15 ,$118.15 ,$18.58 ,$118.15 ,$35.30 ,$94.52 ,$46.45 ,$18.58 ,$18.58 ,$104.25 ,$98.69 ,$98.69 ,$18.58 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$46.45 ,$118.15 ,$18.58 ,$139.00 ,$82.98 ,$18.58 ,$57.82 ,$19.21 ,$17.46 ,$18.58 ,$118.15 ,$39.02 ,$118.15 ,$38.92 ,$125.10 ,$18.58 ,$113.98 ,$74.32 ,$74.32 ,$18.58 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101586,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$139.00 ,$90.35 ,$17.46 ,$139.00 ,$46.30 ,$90.35 ,$82.98 ,$18.52 ,$38.92 ,$77.98 ,$18.52 ,$91.46 ,$18.52 ,$118.15 ,$118.15 ,$18.52 ,$118.15 ,$35.19 ,$94.52 ,$46.30 ,$18.52 ,$18.52 ,$104.25 ,$98.69 ,$98.69 ,$18.52 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$46.30 ,$118.15 ,$18.52 ,$139.00 ,$82.98 ,$18.52 ,$57.82 ,$19.21 ,$17.46 ,$18.52 ,$118.15 ,$38.89 ,$118.15 ,$38.92 ,$125.10 ,$18.52 ,$113.98 ,$74.08 ,$74.08 ,$18.52 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101587,83010,HC HAPTOGLOBIN,301,1 ,$82.00 ,$53.30 ,$7.46 ,$82.00 ,$31.45 ,$53.30 ,$48.95 ,$12.58 ,$22.96 ,$46.00 ,$12.58 ,$53.96 ,$12.58 ,$69.70 ,$69.70 ,$12.58 ,$69.70 ,$23.90 ,$55.76 ,$31.45 ,$12.58 ,$12.58 ,$61.50 ,$58.22 ,$58.22 ,$12.58 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$31.45 ,$69.70 ,$12.58 ,$82.00 ,$48.95 ,$12.58 ,$34.11 ,$8.21 ,$7.46 ,$12.58 ,$69.70 ,$26.42 ,$69.70 ,$22.96 ,$73.80 ,$12.58 ,$67.24 ,$50.32 ,$50.32 ,$12.58 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101590,83036,HC GLYCOSYLATED HGB,301,1 ,$124.00 ,$80.60 ,$7.46 ,$124.00 ,$24.28 ,$80.60 ,$74.03 ,$9.71 ,$34.72 ,$69.56 ,$9.71 ,$81.59 ,$9.71 ,$105.40 ,$105.40 ,$9.71 ,$105.40 ,$18.45 ,$84.32 ,$24.28 ,$9.71 ,$9.71 ,$93.00 ,$88.04 ,$88.04 ,$9.71 ,$88.04 ,$101.68 ,$101.68 ,$101.68 , N/A ,$24.28 ,$105.40 ,$9.71 ,$124.00 ,$74.03 ,$9.71 ,$51.58 ,$8.21 ,$7.46 ,$9.71 ,$105.40 ,$20.39 ,$105.40 ,$34.72 ,$111.60 ,$9.71 ,$101.68 ,$38.84 ,$38.84 ,$9.71 ,$80.60 ,$124.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101592,83540,HC IRON TOTAL,301,1 ,$105.00 ,$68.25 ,$3.32 ,$105.00 ,$16.18 ,$68.25 ,$62.69 ,$6.47 ,$29.40 ,$58.91 ,$6.47 ,$69.09 ,$6.47 ,$89.25 ,$89.25 ,$6.47 ,$89.25 ,$12.29 ,$71.40 ,$16.18 ,$6.47 ,$6.47 ,$78.75 ,$74.55 ,$74.55 ,$6.47 ,$74.55 ,$86.10 ,$86.10 ,$86.10 , N/A ,$16.18 ,$89.25 ,$6.47 ,$105.00 ,$62.69 ,$6.47 ,$43.68 ,$3.65 ,$3.32 ,$6.47 ,$89.25 ,$13.59 ,$89.25 ,$29.40 ,$94.50 ,$6.47 ,$86.10 ,$25.88 ,$25.88 ,$6.47 ,$68.25 ,$105.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101593,83550,HC IRON BINDING CAPACITY,301,1 ,$139.00 ,$90.35 ,$7.46 ,$139.00 ,$21.85 ,$90.35 ,$82.98 ,$8.74 ,$38.92 ,$77.98 ,$8.74 ,$91.46 ,$8.74 ,$118.15 ,$118.15 ,$8.74 ,$118.15 ,$16.61 ,$94.52 ,$21.85 ,$8.74 ,$8.74 ,$104.25 ,$98.69 ,$98.69 ,$8.74 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$21.85 ,$118.15 ,$8.74 ,$139.00 ,$82.98 ,$8.74 ,$57.82 ,$8.21 ,$7.46 ,$8.74 ,$118.15 ,$18.35 ,$118.15 ,$38.92 ,$125.10 ,$8.74 ,$113.98 ,$34.96 ,$34.96 ,$8.74 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$89.00 ,$57.85 ,$3.32 ,$89.00 ,$15.10 ,$57.85 ,$53.13 ,$6.04 ,$24.92 ,$49.93 ,$6.04 ,$58.56 ,$6.04 ,$75.65 ,$75.65 ,$6.04 ,$75.65 ,$11.48 ,$60.52 ,$15.10 ,$6.04 ,$6.04 ,$66.75 ,$63.19 ,$63.19 ,$6.04 ,$63.19 ,$72.98 ,$72.98 ,$72.98 , N/A ,$15.10 ,$75.65 ,$6.04 ,$89.00 ,$53.13 ,$6.04 ,$37.02 ,$3.65 ,$3.32 ,$6.04 ,$75.65 ,$12.68 ,$75.65 ,$24.92 ,$80.10 ,$6.04 ,$72.98 ,$24.16 ,$24.16 ,$6.04 ,$57.85 ,$89.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101595,83690,HC LIPASE,301,1 ,$103.00 ,$66.95 ,$3.32 ,$103.00 ,$17.23 ,$66.95 ,$61.49 ,$6.89 ,$28.84 ,$57.78 ,$6.89 ,$67.77 ,$6.89 ,$87.55 ,$87.55 ,$6.89 ,$87.55 ,$13.09 ,$70.04 ,$17.23 ,$6.89 ,$6.89 ,$77.25 ,$73.13 ,$73.13 ,$6.89 ,$73.13 ,$84.46 ,$84.46 ,$84.46 , N/A ,$17.23 ,$87.55 ,$6.89 ,$103.00 ,$61.49 ,$6.89 ,$42.85 ,$3.65 ,$3.32 ,$6.89 ,$87.55 ,$14.47 ,$87.55 ,$28.84 ,$92.70 ,$6.89 ,$84.46 ,$27.56 ,$27.56 ,$6.89 ,$66.95 ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101598,83930,HC OSMOLALITY BLOOD,301,1 ,$56.00 ,$36.40 ,$3.32 ,$56.00 ,$16.53 ,$36.40 ,$33.43 ,$6.61 ,$15.68 ,$31.42 ,$6.61 ,$36.85 ,$6.61 ,$47.60 ,$47.60 ,$6.61 ,$47.60 ,$12.56 ,$38.08 ,$16.53 ,$6.61 ,$6.61 ,$42.00 ,$39.76 ,$39.76 ,$6.61 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$16.53 ,$47.60 ,$6.61 ,$56.00 ,$33.43 ,$6.61 ,$23.30 ,$3.65 ,$3.32 ,$6.61 ,$47.60 ,$13.88 ,$47.60 ,$15.68 ,$50.40 ,$6.61 ,$45.92 ,$26.44 ,$26.44 ,$6.61 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101599,83935,HC OSMOLALITY URINE,301,1 ,$74.00 ,$48.10 ,$3.32 ,$74.00 ,$17.05 ,$48.10 ,$44.18 ,$6.82 ,$20.72 ,$41.51 ,$6.82 ,$48.69 ,$6.82 ,$62.90 ,$62.90 ,$6.82 ,$62.90 ,$12.96 ,$50.32 ,$17.05 ,$6.82 ,$6.82 ,$55.50 ,$52.54 ,$52.54 ,$6.82 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$17.05 ,$62.90 ,$6.82 ,$74.00 ,$44.18 ,$6.82 ,$30.78 ,$3.65 ,$3.32 ,$6.82 ,$62.90 ,$14.32 ,$62.90 ,$20.72 ,$66.60 ,$6.82 ,$60.68 ,$27.28 ,$27.28 ,$6.82 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101600,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$93.00 ,$60.45 ,$17.46 ,$103.20 ,$103.20 ,$60.45 ,$55.52 ,$41.28 ,$26.04 ,$52.17 ,$41.28 ,$61.19 ,$41.28 ,$79.05 ,$79.05 ,$41.28 ,$79.05 ,$78.43 ,$63.24 ,$103.20 ,$41.28 ,$41.28 ,$69.75 ,$66.03 ,$66.03 ,$41.28 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$93.00 ,$79.05 ,$41.28 ,$93.00 ,$55.52 ,$41.28 ,$38.69 ,$19.21 ,$17.46 ,$41.28 ,$79.05 ,$86.69 ,$79.05 ,$26.04 ,$83.70 ,$41.28 ,$76.26 ,$93.00 ,$93.00 ,$41.28 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101601,84075,HC ALKALINE PHOSPHATASE,301,1 ,$51.00 ,$33.15 ,$3.32 ,$51.00 ,$12.95 ,$33.15 ,$30.45 ,$5.18 ,$14.28 ,$28.61 ,$5.18 ,$33.56 ,$5.18 ,$43.35 ,$43.35 ,$5.18 ,$43.35 ,$9.84 ,$34.68 ,$12.95 ,$5.18 ,$5.18 ,$38.25 ,$36.21 ,$36.21 ,$5.18 ,$36.21 ,$41.82 ,$41.82 ,$41.82 , N/A ,$12.95 ,$43.35 ,$5.18 ,$51.00 ,$30.45 ,$5.18 ,$21.22 ,$3.65 ,$3.32 ,$5.18 ,$43.35 ,$10.88 ,$43.35 ,$14.28 ,$45.90 ,$5.18 ,$41.82 ,$20.72 ,$20.72 ,$5.18 ,$33.15 ,$51.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101602,84105,HC PHOSPHORUS UR,301,1 ,$154.00 ,$100.10 ,$3.32 ,$154.00 ,$14.45 ,$100.10 ,$91.94 ,$5.78 ,$43.12 ,$86.39 ,$5.78 ,$101.33 ,$5.78 ,$130.90 ,$130.90 ,$5.78 ,$130.90 ,$10.98 ,$104.72 ,$14.45 ,$5.78 ,$5.78 ,$115.50 ,$109.34 ,$109.34 ,$5.78 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$14.45 ,$130.90 ,$5.78 ,$154.00 ,$91.94 ,$5.78 ,$64.06 ,$3.65 ,$3.32 ,$5.78 ,$130.90 ,$12.14 ,$130.90 ,$43.12 ,$138.60 ,$5.78 ,$126.28 ,$23.12 ,$23.12 ,$5.78 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101603,84112,HC EVAL C/V AMNIOTIC FLD QL EA,301,1 ,$215.00 ,$139.75 ,$20.08 ,$245.28 ,$245.28 ,$139.75 ,$128.36 ,$98.11 ,$60.20 ,$120.62 ,$98.11 ,$141.47 ,$98.11 ,$182.75 ,$182.75 ,$98.11 ,$182.75 ,$186.41 ,$146.20 ,$245.28 ,$98.11 ,$98.11 ,$161.25 ,$152.65 ,$152.65 ,$98.11 ,$152.65 ,$176.30 ,$176.30 ,$176.30 , N/A ,$215.00 ,$182.75 ,$98.11 ,$215.00 ,$128.36 ,$98.11 ,$89.44 ,$22.09 ,$20.08 ,$98.11 ,$182.75 ,$206.03 ,$182.75 ,$60.20 ,$193.50 ,$98.11 ,$176.30 ,$215.00 ,$215.00 ,$98.11 ,$139.75 ,$215.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101604,84133,HC POTASSIUM UR,301,1 ,$81.00 ,$52.65 ,$3.32 ,$81.00 ,$11.83 ,$52.65 ,$48.36 ,$4.73 ,$22.68 ,$45.44 ,$4.73 ,$53.30 ,$4.73 ,$68.85 ,$68.85 ,$4.73 ,$68.85 ,$8.99 ,$55.08 ,$11.83 ,$4.73 ,$4.73 ,$60.75 ,$57.51 ,$57.51 ,$4.73 ,$57.51 ,$66.42 ,$66.42 ,$66.42 , N/A ,$11.83 ,$68.85 ,$4.73 ,$81.00 ,$48.36 ,$4.73 ,$33.70 ,$3.65 ,$3.32 ,$4.73 ,$68.85 ,$9.93 ,$68.85 ,$22.68 ,$72.90 ,$4.73 ,$66.42 ,$18.92 ,$18.92 ,$4.73 ,$52.65 ,$81.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101605,84134,HC PREALBUMIN,301,1 ,$154.00 ,$100.10 ,$7.46 ,$154.00 ,$36.48 ,$100.10 ,$91.94 ,$14.59 ,$43.12 ,$86.39 ,$14.59 ,$101.33 ,$14.59 ,$130.90 ,$130.90 ,$14.59 ,$130.90 ,$27.72 ,$104.72 ,$36.48 ,$14.59 ,$14.59 ,$115.50 ,$109.34 ,$109.34 ,$14.59 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$36.48 ,$130.90 ,$14.59 ,$154.00 ,$91.94 ,$14.59 ,$64.06 ,$8.21 ,$7.46 ,$14.59 ,$130.90 ,$30.64 ,$130.90 ,$43.12 ,$138.60 ,$14.59 ,$126.28 ,$58.36 ,$58.36 ,$14.59 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101607,84145,HC PROCALCITONIN (PCT),301,1 ,$88.00 ,$57.20 ,$17.46 ,$88.00 ,$68.05 ,$57.20 ,$52.54 ,$27.22 ,$24.64 ,$49.37 ,$27.22 ,$57.90 ,$27.22 ,$74.80 ,$74.80 ,$27.22 ,$74.80 ,$51.72 ,$59.84 ,$68.05 ,$27.22 ,$27.22 ,$66.00 ,$62.48 ,$62.48 ,$27.22 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$68.05 ,$74.80 ,$27.22 ,$88.00 ,$52.54 ,$27.22 ,$36.61 ,$19.21 ,$17.46 ,$27.22 ,$74.80 ,$57.16 ,$74.80 ,$24.64 ,$79.20 ,$27.22 ,$72.16 ,$88.00 ,$88.00 ,$27.22 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101608,84146,HC PROLACTIN,301,1 ,$87.00 ,$56.55 ,$17.46 ,$87.00 ,$48.45 ,$56.55 ,$51.94 ,$19.38 ,$24.36 ,$48.81 ,$19.38 ,$57.25 ,$19.38 ,$73.95 ,$73.95 ,$19.38 ,$73.95 ,$36.82 ,$59.16 ,$48.45 ,$19.38 ,$19.38 ,$65.25 ,$61.77 ,$61.77 ,$19.38 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$48.45 ,$73.95 ,$19.38 ,$87.00 ,$51.94 ,$19.38 ,$36.19 ,$19.21 ,$17.46 ,$19.38 ,$73.95 ,$40.70 ,$73.95 ,$24.36 ,$78.30 ,$19.38 ,$71.34 ,$77.52 ,$77.52 ,$19.38 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101609,84153,HC PSA TOTAL,301,1 ,$192.00 ,$124.80 ,$7.46 ,$192.00 ,$45.98 ,$124.80 ,$114.62 ,$18.39 ,$53.76 ,$107.71 ,$18.39 ,$126.34 ,$18.39 ,$163.20 ,$163.20 ,$18.39 ,$163.20 ,$34.94 ,$130.56 ,$45.98 ,$18.39 ,$18.39 ,$144.00 ,$136.32 ,$136.32 ,$18.39 ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A ,$45.98 ,$163.20 ,$18.39 ,$192.00 ,$114.62 ,$18.39 ,$79.87 ,$8.21 ,$7.46 ,$18.39 ,$163.20 ,$38.62 ,$163.20 ,$53.76 ,$172.80 ,$18.39 ,$157.44 ,$73.56 ,$73.56 ,$18.39 ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101610,84154,HC PSA FREE,301,1 ,$126.00 ,$81.90 ,$7.46 ,$126.00 ,$45.98 ,$81.90 ,$75.22 ,$18.39 ,$35.28 ,$70.69 ,$18.39 ,$82.91 ,$18.39 ,$107.10 ,$107.10 ,$18.39 ,$107.10 ,$34.94 ,$85.68 ,$45.98 ,$18.39 ,$18.39 ,$94.50 ,$89.46 ,$89.46 ,$18.39 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$45.98 ,$107.10 ,$18.39 ,$126.00 ,$75.22 ,$18.39 ,$52.42 ,$8.21 ,$7.46 ,$18.39 ,$107.10 ,$38.62 ,$107.10 ,$35.28 ,$113.40 ,$18.39 ,$103.32 ,$73.56 ,$73.56 ,$18.39 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101613,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$81.00 ,$52.65 ,$3.32 ,$81.00 ,$10.00 ,$52.65 ,$48.36 ,$4.00 ,$22.68 ,$45.44 ,$4.00 ,$53.30 ,$4.00 ,$68.85 ,$68.85 ,$4.00 ,$68.85 ,$7.60 ,$55.08 ,$10.00 ,$4.00 ,$4.00 ,$60.75 ,$57.51 ,$57.51 ,$4.00 ,$57.51 ,$66.42 ,$66.42 ,$66.42 , N/A ,$10.00 ,$68.85 ,$4.00 ,$81.00 ,$48.36 ,$4.00 ,$33.70 ,$3.65 ,$3.32 ,$4.00 ,$68.85 ,$8.40 ,$68.85 ,$22.68 ,$72.90 ,$4.00 ,$66.42 ,$16.00 ,$16.00 ,$4.00 ,$52.65 ,$81.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101617,84300,HC SODIUM URINE,301,1 ,$93.00 ,$60.45 ,$3.32 ,$93.00 ,$12.65 ,$60.45 ,$55.52 ,$5.06 ,$26.04 ,$52.17 ,$5.06 ,$61.19 ,$5.06 ,$79.05 ,$79.05 ,$5.06 ,$79.05 ,$9.61 ,$63.24 ,$12.65 ,$5.06 ,$5.06 ,$69.75 ,$66.03 ,$66.03 ,$5.06 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$12.65 ,$79.05 ,$5.06 ,$93.00 ,$55.52 ,$5.06 ,$38.69 ,$3.65 ,$3.32 ,$5.06 ,$79.05 ,$10.63 ,$79.05 ,$26.04 ,$83.70 ,$5.06 ,$76.26 ,$20.24 ,$20.24 ,$5.06 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101618,84302,HC SODIUM OTHER FLUID,301,1 ,$14.00 ,$9.10 ,$3.32 ,$14.00 ,$12.15 ,$9.10 ,$8.36 ,$4.86 ,$3.92 ,$7.85 ,$4.86 ,$9.21 ,$4.86 ,$11.90 ,$11.90 ,$4.86 ,$11.90 ,$9.23 ,$9.52 ,$12.15 ,$4.86 ,$4.86 ,$10.50 ,$9.94 ,$9.94 ,$4.86 ,$9.94 ,$11.48 ,$11.48 ,$11.48 , N/A ,$12.15 ,$11.90 ,$4.86 ,$14.00 ,$8.36 ,$4.86 ,$5.82 ,$3.65 ,$3.32 ,$4.86 ,$11.90 ,$10.21 ,$11.90 ,$3.92 ,$12.60 ,$4.86 ,$11.48 ,$14.00 ,$14.00 ,$4.86 ,$9.10 ,$14.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101620,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$98.00 ,$63.70 ,$6.87 ,$98.00 ,$17.18 ,$63.70 ,$58.51 ,$6.87 ,$27.44 ,$54.98 ,$6.87 ,$64.48 ,$6.87 ,$83.30 ,$83.30 ,$6.87 ,$83.30 ,$13.05 ,$66.64 ,$17.18 ,$6.87 ,$6.87 ,$73.50 ,$69.58 ,$69.58 ,$6.87 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$17.18 ,$83.30 ,$6.87 ,$98.00 ,$58.51 ,$6.87 ,$40.77 ,$11.04 ,$10.04 ,$6.87 ,$83.30 ,$14.43 ,$83.30 ,$27.44 ,$88.20 ,$6.87 ,$80.36 ,$27.48 ,$27.48 ,$6.87 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101621,84450,HC AST,301,1 ,$83.00 ,$53.95 ,$3.32 ,$83.00 ,$12.95 ,$53.95 ,$49.55 ,$5.18 ,$23.24 ,$46.56 ,$5.18 ,$54.61 ,$5.18 ,$70.55 ,$70.55 ,$5.18 ,$70.55 ,$9.84 ,$56.44 ,$12.95 ,$5.18 ,$5.18 ,$62.25 ,$58.93 ,$58.93 ,$5.18 ,$58.93 ,$68.06 ,$68.06 ,$68.06 , N/A ,$12.95 ,$70.55 ,$5.18 ,$83.00 ,$49.55 ,$5.18 ,$34.53 ,$3.65 ,$3.32 ,$5.18 ,$70.55 ,$10.88 ,$70.55 ,$23.24 ,$74.70 ,$5.18 ,$68.06 ,$20.72 ,$20.72 ,$5.18 ,$53.95 ,$83.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101622,84466,HC TRANSFERRIN,301,1 ,$88.00 ,$57.20 ,$7.46 ,$88.00 ,$31.90 ,$57.20 ,$52.54 ,$12.76 ,$24.64 ,$49.37 ,$12.76 ,$57.90 ,$12.76 ,$74.80 ,$74.80 ,$12.76 ,$74.80 ,$24.24 ,$59.84 ,$31.90 ,$12.76 ,$12.76 ,$66.00 ,$62.48 ,$62.48 ,$12.76 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$31.90 ,$74.80 ,$12.76 ,$88.00 ,$52.54 ,$12.76 ,$36.61 ,$8.21 ,$7.46 ,$12.76 ,$74.80 ,$26.80 ,$74.80 ,$24.64 ,$79.20 ,$12.76 ,$72.16 ,$51.04 ,$51.04 ,$12.76 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101623,84478,HC TRIGLYCERIDES,301,1 ,$78.00 ,$50.70 ,$3.32 ,$78.00 ,$14.35 ,$50.70 ,$46.57 ,$5.74 ,$21.84 ,$43.76 ,$5.74 ,$51.32 ,$5.74 ,$66.30 ,$66.30 ,$5.74 ,$66.30 ,$10.91 ,$53.04 ,$14.35 ,$5.74 ,$5.74 ,$58.50 ,$55.38 ,$55.38 ,$5.74 ,$55.38 ,$63.96 ,$63.96 ,$63.96 , N/A ,$14.35 ,$66.30 ,$5.74 ,$78.00 ,$46.57 ,$5.74 ,$32.45 ,$3.65 ,$3.32 ,$5.74 ,$66.30 ,$12.05 ,$66.30 ,$21.84 ,$70.20 ,$5.74 ,$63.96 ,$22.96 ,$22.96 ,$5.74 ,$50.70 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101626,84520,HC BUN,301,1 ,$56.00 ,$36.40 ,$3.32 ,$56.00 ,$9.88 ,$36.40 ,$33.43 ,$3.95 ,$15.68 ,$31.42 ,$3.95 ,$36.85 ,$3.95 ,$47.60 ,$47.60 ,$3.95 ,$47.60 ,$7.51 ,$38.08 ,$9.88 ,$3.95 ,$3.95 ,$42.00 ,$39.76 ,$39.76 ,$3.95 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$9.88 ,$47.60 ,$3.95 ,$3.95 ,$33.43 ,$3.95 ,$23.30 ,$3.65 ,$3.32 ,$3.95 ,$47.60 ,$8.30 ,$47.60 ,$15.68 ,$50.40 ,$3.95 ,$45.92 ,$15.80 ,$15.80 ,$3.95 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101627,84540,HC UREA URINE,301,1 ,$103.00 ,$66.95 ,$3.32 ,$103.00 ,$13.90 ,$66.95 ,$61.49 ,$5.56 ,$28.84 ,$57.78 ,$5.56 ,$67.77 ,$5.56 ,$87.55 ,$87.55 ,$5.56 ,$87.55 ,$10.56 ,$70.04 ,$13.90 ,$5.56 ,$5.56 ,$77.25 ,$73.13 ,$73.13 ,$5.56 ,$73.13 ,$84.46 ,$84.46 ,$84.46 , N/A ,$13.90 ,$87.55 ,$5.56 ,$103.00 ,$61.49 ,$5.56 ,$42.85 ,$3.65 ,$3.32 ,$5.56 ,$87.55 ,$11.68 ,$87.55 ,$28.84 ,$92.70 ,$5.56 ,$84.46 ,$22.24 ,$22.24 ,$5.56 ,$66.95 ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101628,84560,HC URIC ACID OTH SRC,301,1 ,$52.00 ,$33.80 ,$3.32 ,$52.00 ,$12.70 ,$33.80 ,$31.04 ,$5.08 ,$14.56 ,$29.17 ,$5.08 ,$34.22 ,$5.08 ,$44.20 ,$44.20 ,$5.08 ,$44.20 ,$9.65 ,$35.36 ,$12.70 ,$5.08 ,$5.08 ,$39.00 ,$36.92 ,$36.92 ,$5.08 ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A ,$12.70 ,$44.20 ,$5.08 ,$52.00 ,$31.04 ,$5.08 ,$21.63 ,$3.65 ,$3.32 ,$5.08 ,$44.20 ,$10.67 ,$44.20 ,$14.56 ,$46.80 ,$5.08 ,$42.64 ,$20.32 ,$20.32 ,$5.08 ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101630,84702,HC HCG QN,301,1 ,$168.00 ,$109.20 ,$10.04 ,$168.00 ,$37.63 ,$109.20 ,$100.30 ,$15.05 ,$47.04 ,$94.25 ,$15.05 ,$110.54 ,$15.05 ,$142.80 ,$142.80 ,$15.05 ,$142.80 ,$28.60 ,$114.24 ,$37.63 ,$15.05 ,$15.05 ,$126.00 ,$119.28 ,$119.28 ,$15.05 ,$119.28 ,$137.76 ,$137.76 ,$137.76 , N/A ,$37.63 ,$142.80 ,$15.05 ,$168.00 ,$100.30 ,$15.05 ,$69.89 ,$11.04 ,$10.04 ,$15.05 ,$142.80 ,$31.61 ,$142.80 ,$47.04 ,$151.20 ,$15.05 ,$137.76 ,$60.20 ,$60.20 ,$15.05 ,$109.20 ,$168.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101633,83070,HC HEMOSIDERIN QL - 90,301,1 ,$46.00 ,$29.90 ,$4.75 ,$46.00 ,$11.88 ,$29.90 ,$27.46 ,$4.75 ,$12.88 ,$25.81 ,$4.75 ,$30.27 ,$4.75 ,$39.10 ,$39.10 ,$4.75 ,$39.10 ,$9.03 ,$31.28 ,$11.88 ,$4.75 ,$4.75 ,$34.50 ,$32.66 ,$32.66 ,$4.75 ,$32.66 ,$37.72 ,$37.72 ,$37.72 , N/A ,$11.88 ,$39.10 ,$4.75 ,$46.00 ,$27.46 ,$4.75 ,$19.14 ,$8.21 ,$7.46 ,$4.75 ,$39.10 ,$9.98 ,$39.10 ,$12.88 ,$41.40 ,$4.75 ,$37.72 ,$19.00 ,$19.00 ,$4.75 ,$29.90 ,$46.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101634,80348,HC BUPRENORPHINE -90,301,1 ,$76.00 ,$49.40 ,$7.46 ,$76.00 , N/A ,$49.40 ,$45.37 , N/A ,$21.28 ,$42.64 , N/A ,$50.01 , N/A ,$64.60 ,$64.60 , N/A ,$64.60 , N/A ,$51.68 , N/A , N/A , N/A ,$57.00 ,$53.96 ,$53.96 , N/A ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A , N/A ,$64.60 , N/A ,$76.00 ,$45.37 , N/A ,$31.62 ,$8.21 ,$7.46 , N/A ,$64.60 , N/A ,$64.60 ,$21.28 ,$68.40 , N/A ,$62.32 , N/A , N/A , N/A ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101636,83735,HC MAGNESIUM,301,1 ,$80.00 ,$52.00 ,$3.32 ,$80.00 ,$16.75 ,$52.00 ,$47.76 ,$6.70 ,$22.40 ,$44.88 ,$6.70 ,$52.64 ,$6.70 ,$68.00 ,$68.00 ,$6.70 ,$68.00 ,$12.73 ,$54.40 ,$16.75 ,$6.70 ,$6.70 ,$60.00 ,$56.80 ,$56.80 ,$6.70 ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A ,$16.75 ,$68.00 ,$6.70 ,$80.00 ,$47.76 ,$6.70 ,$33.28 ,$3.65 ,$3.32 ,$6.70 ,$68.00 ,$14.07 ,$68.00 ,$22.40 ,$72.00 ,$6.70 ,$65.60 ,$26.80 ,$26.80 ,$6.70 ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101638,84100,HC PHOSPHORUS,301,1 ,$98.00 ,$63.70 ,$3.32 ,$98.00 ,$11.85 ,$63.70 ,$58.51 ,$4.74 ,$27.44 ,$54.98 ,$4.74 ,$64.48 ,$4.74 ,$83.30 ,$83.30 ,$4.74 ,$83.30 ,$9.01 ,$66.64 ,$11.85 ,$4.74 ,$4.74 ,$73.50 ,$69.58 ,$69.58 ,$4.74 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$11.85 ,$83.30 ,$4.74 ,$98.00 ,$58.51 ,$4.74 ,$40.77 ,$3.65 ,$3.32 ,$4.74 ,$83.30 ,$9.95 ,$83.30 ,$27.44 ,$88.20 ,$4.74 ,$80.36 ,$18.96 ,$18.96 ,$4.74 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101642,84999,HC OSMOLALITY FECAL-90,301,1 ,$8.44 ,$5.49 ,$2.36 ,$8.44 , N/A ,$5.49 ,$5.04 ,$2.53 ,$2.36 ,$4.73 , N/A ,$5.55 , N/A ,$7.17 ,$7.17 , N/A ,$7.17 ,$3.80 ,$5.74 ,$5.91 , N/A , N/A ,$6.33 ,$5.99 ,$5.99 , N/A ,$5.99 ,$6.92 ,$6.92 ,$6.92 , N/A , N/A ,$7.17 , N/A ,$8.44 ,$5.04 , N/A ,$3.51 ,$8.21 ,$7.46 , N/A ,$7.17 ,$5.06 ,$7.17 ,$2.36 ,$7.60 , N/A ,$6.92 ,$4.22 ,$4.22 , N/A ,$5.49 ,$8.44 
ST. JOSEPH'S HOSPITAL - BREESE,30101643,81596,HC CHRONIC HEP C VIRUS ASSAYS-90,301,1 ,$612.00 ,$397.80 ,$26.47 ,$612.00 ,$180.48 ,$397.80 ,$365.36 ,$72.19 ,$171.36 ,$343.33 ,$72.19 ,$402.70 ,$72.19 ,$520.20 ,$520.20 ,$72.19 ,$520.20 ,$137.16 ,$416.16 ,$180.48 ,$72.19 ,$72.19 ,$459.00 ,$434.52 ,$434.52 ,$72.19 ,$434.52 ,$501.84 ,$501.84 ,$501.84 , N/A ,$180.48 ,$520.20 ,$72.19 ,$612.00 ,$365.36 ,$72.19 ,$254.59 ,$29.12 ,$26.47 ,$72.19 ,$520.20 ,$151.60 ,$520.20 ,$171.36 ,$550.80 ,$72.19 ,$501.84 ,$288.76 ,$288.76 ,$72.19 ,$397.80 ,$612.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101648,83664,HC LAMELLAR BODY CT,301,1 ,$29.00 ,$18.85 ,$8.12 ,$48.30 ,$48.30 ,$18.85 ,$17.31 ,$19.32 ,$8.12 ,$16.27 ,$19.32 ,$19.08 ,$19.32 ,$24.65 ,$24.65 ,$19.32 ,$24.65 ,$29.00 ,$19.72 ,$48.30 ,$19.32 ,$19.32 ,$21.75 ,$20.59 ,$20.59 ,$19.32 ,$20.59 ,$23.78 ,$23.78 ,$23.78 , N/A ,$29.00 ,$24.65 ,$19.32 ,$29.00 ,$17.31 ,$19.32 ,$12.06 ,$23.44 ,$21.31 ,$19.32 ,$24.65 ,$40.57 ,$24.65 ,$8.12 ,$26.10 ,$19.32 ,$23.78 ,$29.00 ,$29.00 ,$19.32 ,$18.85 ,$29.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101653,82642,HC DIHYDROTESTOSTERONE-90,301,1 ,$338.00 ,$219.70 ,$10.04 ,$338.00 ,$73.20 ,$219.70 ,$201.79 ,$29.28 ,$94.64 ,$189.62 ,$29.28 ,$222.40 ,$29.28 ,$287.30 ,$287.30 ,$29.28 ,$287.30 ,$55.63 ,$229.84 ,$73.20 ,$29.28 ,$29.28 ,$253.50 ,$239.98 ,$239.98 ,$29.28 ,$239.98 ,$277.16 ,$277.16 ,$277.16 , N/A ,$73.20 ,$287.30 ,$29.28 ,$338.00 ,$201.79 ,$29.28 ,$140.61 ,$11.04 ,$10.04 ,$29.28 ,$287.30 ,$61.49 ,$287.30 ,$94.64 ,$304.20 ,$29.28 ,$277.16 ,$117.12 ,$117.12 ,$29.28 ,$219.70 ,$338.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101656,83036,HC HEALTH FAIR HEMOGLOBIN A1C,301,1 ,$10.00 ,$6.50 ,$2.80 ,$24.28 ,$24.28 ,$6.50 ,$5.97 ,$9.71 ,$2.80 ,$5.61 ,$9.71 ,$6.58 ,$9.71 ,$8.50 ,$8.50 ,$9.71 ,$8.50 ,$10.00 ,$6.80 ,$24.28 ,$9.71 ,$9.71 ,$7.50 ,$7.10 ,$7.10 ,$9.71 ,$7.10 ,$8.20 ,$8.20 ,$8.20 , N/A ,$10.00 ,$8.50 ,$9.71 ,$10.00 ,$5.97 ,$9.71 ,$4.16 ,$8.21 ,$7.46 ,$9.71 ,$8.50 ,$20.39 ,$8.50 ,$2.80 ,$9.00 ,$9.71 ,$8.20 ,$10.00 ,$10.00 ,$9.71 ,$6.50 ,$10.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101657,N/A,HC HEALTH FAIR TOTAL PSA SCREEN,301,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 , N/A ,$9.75 ,$8.96 , N/A ,$4.20 ,$8.42 , N/A ,$9.87 , N/A ,$12.75 ,$12.75 , N/A ,$12.75 , N/A ,$10.20 , N/A , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.30 ,$12.30 ,$12.30 , N/A , N/A ,$12.75 , N/A ,$15.00 ,$8.96 , N/A ,$6.24 , N/A , N/A , N/A ,$12.75 , N/A ,$12.75 ,$4.20 ,$13.50 , N/A ,$12.30 ,$7.50 ,$7.50 , N/A ,$9.75 ,$15.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101658,N/A,HC HEALTH FAIR VITAMIN D 25-OH,301,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 , N/A ,$9.75 ,$8.96 , N/A ,$4.20 ,$8.42 , N/A ,$9.87 , N/A ,$12.75 ,$12.75 , N/A ,$12.75 , N/A ,$10.20 , N/A , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.30 ,$12.30 ,$12.30 , N/A , N/A ,$12.75 , N/A ,$15.00 ,$8.96 , N/A ,$6.24 , N/A , N/A , N/A ,$12.75 , N/A ,$12.75 ,$4.20 ,$13.50 , N/A ,$12.30 ,$7.50 ,$7.50 , N/A ,$9.75 ,$15.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101659,84443,HC HEALTH FAIR TSH,301,1 ,$15.00 ,$9.75 ,$4.20 ,$37.50 ,$37.50 ,$9.75 ,$8.96 ,$15.00 ,$4.20 ,$8.42 ,$15.00 ,$9.87 ,$15.00 ,$12.75 ,$12.75 ,$15.00 ,$12.75 ,$15.00 ,$10.20 ,$37.50 ,$15.00 ,$15.00 ,$11.25 ,$10.65 ,$10.65 ,$15.00 ,$10.65 ,$12.30 ,$12.30 ,$12.30 , N/A ,$15.00 ,$12.75 ,$15.00 ,$15.00 ,$8.96 ,$15.00 ,$6.24 ,$11.04 ,$10.04 ,$15.00 ,$12.75 ,$31.50 ,$12.75 ,$4.20 ,$13.50 ,$15.00 ,$12.30 ,$15.00 ,$15.00 ,$15.00 ,$9.75 ,$15.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101660,N/A,HC HEALTH FAIR LAB PANEL,301,1 ,$45.00 ,$29.25 ,$12.60 ,$45.00 , N/A ,$29.25 ,$26.87 , N/A ,$12.60 ,$25.25 , N/A ,$29.61 , N/A ,$38.25 ,$38.25 , N/A ,$38.25 , N/A ,$30.60 , N/A , N/A , N/A ,$33.75 ,$31.95 ,$31.95 , N/A ,$31.95 ,$36.90 ,$36.90 ,$36.90 , N/A , N/A ,$38.25 , N/A ,$45.00 ,$26.87 , N/A ,$18.72 , N/A , N/A , N/A ,$38.25 , N/A ,$38.25 ,$12.60 ,$40.50 , N/A ,$36.90 ,$22.50 ,$22.50 , N/A ,$29.25 ,$45.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101661,80061,HC HEALTH FAIR LIPID W/CALC LDL,301,1 ,$15.00 ,$9.75 ,$4.20 ,$33.48 ,$33.48 ,$9.75 ,$8.96 ,$13.39 ,$4.20 ,$8.42 ,$13.39 ,$9.87 ,$13.39 ,$12.75 ,$12.75 ,$13.39 ,$12.75 ,$15.00 ,$10.20 ,$33.48 ,$13.39 ,$13.39 ,$11.25 ,$10.65 ,$10.65 ,$13.39 ,$10.65 ,$12.30 ,$12.30 ,$12.30 , N/A ,$15.00 ,$12.75 ,$13.39 ,$15.00 ,$8.96 ,$13.39 ,$6.24 ,$7.48 ,$6.80 ,$13.39 ,$12.75 ,$28.12 ,$12.75 ,$4.20 ,$13.50 ,$13.39 ,$12.30 ,$15.00 ,$15.00 ,$13.39 ,$9.75 ,$15.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101662,N/A,HC HEALTH FAIR OCCULT BLOOD FECAL SCREEN,301,1 ,$15.00 ,$9.75 ,$4.20 ,$15.00 , N/A ,$9.75 ,$8.96 , N/A ,$4.20 ,$8.42 , N/A ,$9.87 , N/A ,$12.75 ,$12.75 , N/A ,$12.75 , N/A ,$10.20 , N/A , N/A , N/A ,$11.25 ,$10.65 ,$10.65 , N/A ,$10.65 ,$12.30 ,$12.30 ,$12.30 , N/A , N/A ,$12.75 , N/A ,$15.00 ,$8.96 , N/A ,$6.24 , N/A , N/A , N/A ,$12.75 , N/A ,$12.75 ,$4.20 ,$13.50 , N/A ,$12.30 ,$7.50 ,$7.50 , N/A ,$9.75 ,$15.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101663,83631,HC LACTOFERRIN FECAL QN-90,301,1 ,$242.00 ,$157.30 ,$7.46 ,$242.00 ,$49.08 ,$157.30 ,$144.47 ,$19.63 ,$67.76 ,$135.76 ,$19.63 ,$159.24 ,$19.63 ,$205.70 ,$205.70 ,$19.63 ,$205.70 ,$37.30 ,$164.56 ,$49.08 ,$19.63 ,$19.63 ,$181.50 ,$171.82 ,$171.82 ,$19.63 ,$171.82 ,$198.44 ,$198.44 ,$198.44 , N/A ,$49.08 ,$205.70 ,$19.63 ,$242.00 ,$144.47 ,$19.63 ,$100.67 ,$8.21 ,$7.46 ,$19.63 ,$205.70 ,$41.22 ,$205.70 ,$67.76 ,$217.80 ,$19.63 ,$198.44 ,$78.52 ,$78.52 ,$19.63 ,$157.30 ,$242.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101674,82978,HC GLUTATHIONE-90,301,1 ,$93.00 ,$60.45 ,$7.46 ,$93.00 ,$38.63 ,$60.45 ,$55.52 ,$15.45 ,$26.04 ,$52.17 ,$15.45 ,$61.19 ,$15.45 ,$79.05 ,$79.05 ,$15.45 ,$79.05 ,$29.36 ,$63.24 ,$38.63 ,$15.45 ,$15.45 ,$69.75 ,$66.03 ,$66.03 ,$15.45 ,$66.03 ,$76.26 ,$76.26 ,$76.26 , N/A ,$38.63 ,$79.05 ,$15.45 ,$93.00 ,$55.52 ,$15.45 ,$38.69 ,$8.21 ,$7.46 ,$15.45 ,$79.05 ,$32.45 ,$79.05 ,$26.04 ,$83.70 ,$15.45 ,$76.26 ,$61.80 ,$61.80 ,$15.45 ,$60.45 ,$93.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101678,83516,HC FLUOR AB SCR AQUAPORIN 4-90,301,1 ,$886.00 ,$575.90 ,$6.68 ,$886.00 ,$28.83 ,$575.90 ,$528.94 ,$11.53 ,$248.08 ,$497.05 ,$11.53 ,$582.99 ,$11.53 ,$753.10 ,$753.10 ,$11.53 ,$753.10 ,$21.91 ,$602.48 ,$28.83 ,$11.53 ,$11.53 ,$664.50 ,$629.06 ,$629.06 ,$11.53 ,$629.06 ,$726.52 ,$726.52 ,$726.52 , N/A ,$28.83 ,$753.10 ,$11.53 ,$886.00 ,$528.94 ,$11.53 ,$368.58 ,$7.35 ,$6.68 ,$11.53 ,$753.10 ,$24.21 ,$753.10 ,$248.08 ,$797.40 ,$11.53 ,$726.52 ,$46.12 ,$46.12 ,$11.53 ,$575.90 ,$886.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101685,80235,HC LACOSAMIDE -90,301,1 ,$147.00 ,$95.55 ,$8.56 ,$147.00 ,$67.78 ,$95.55 ,$87.76 ,$27.11 ,$41.16 ,$82.47 ,$27.11 ,$96.73 ,$27.11 ,$124.95 ,$124.95 ,$27.11 ,$124.95 ,$51.51 ,$99.96 ,$67.78 ,$27.11 ,$27.11 ,$110.25 ,$104.37 ,$104.37 ,$27.11 ,$104.37 ,$120.54 ,$120.54 ,$120.54 , N/A ,$67.78 ,$124.95 ,$27.11 ,$147.00 ,$87.76 ,$27.11 ,$61.15 ,$9.42 ,$8.56 ,$27.11 ,$124.95 ,$56.93 ,$124.95 ,$41.16 ,$132.30 ,$27.11 ,$120.54 ,$108.44 ,$108.44 ,$27.11 ,$95.55 ,$147.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101689,82565,HC CREATININE,301,1 ,$71.00 ,$46.15 ,$3.32 ,$71.00 ,$12.80 ,$46.15 ,$42.39 ,$5.12 ,$19.88 ,$39.83 ,$5.12 ,$46.72 ,$5.12 ,$60.35 ,$60.35 ,$5.12 ,$60.35 ,$9.73 ,$48.28 ,$12.80 ,$5.12 ,$5.12 ,$53.25 ,$50.41 ,$50.41 ,$5.12 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$12.80 ,$60.35 ,$5.12 ,$5.12 ,$42.39 ,$5.12 ,$29.54 ,$3.65 ,$3.32 ,$5.12 ,$60.35 ,$10.75 ,$60.35 ,$19.88 ,$63.90 ,$5.12 ,$58.22 ,$20.48 ,$20.48 ,$5.12 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101692,80366,HC DRUG SCREEN PREGABALIN-90,301,1 ,$204.00 ,$132.60 ,$7.46 ,$204.00 , N/A ,$132.60 ,$121.79 , N/A ,$57.12 ,$114.44 , N/A ,$134.23 , N/A ,$173.40 ,$173.40 , N/A ,$173.40 , N/A ,$138.72 , N/A , N/A , N/A ,$153.00 ,$144.84 ,$144.84 , N/A ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A , N/A ,$173.40 , N/A ,$204.00 ,$121.79 , N/A ,$84.86 ,$8.21 ,$7.46 , N/A ,$173.40 , N/A ,$173.40 ,$57.12 ,$183.60 , N/A ,$167.28 , N/A , N/A , N/A ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101703,80299,HC HYPOGLYCEMIC PANEL-90,301,1 ,$452.00 ,$293.80 ,$8.56 ,$452.00 ,$46.60 ,$293.80 ,$269.84 ,$18.64 ,$126.56 ,$253.57 ,$18.64 ,$297.42 ,$18.64 ,$384.20 ,$384.20 ,$18.64 ,$384.20 ,$35.42 ,$307.36 ,$46.60 ,$18.64 ,$18.64 ,$339.00 ,$320.92 ,$320.92 ,$18.64 ,$320.92 ,$370.64 ,$370.64 ,$370.64 , N/A ,$46.60 ,$384.20 ,$18.64 ,$452.00 ,$269.84 ,$18.64 ,$188.03 ,$9.42 ,$8.56 ,$18.64 ,$384.20 ,$39.14 ,$384.20 ,$126.56 ,$406.80 ,$18.64 ,$370.64 ,$74.56 ,$74.56 ,$18.64 ,$293.80 ,$452.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101706,80230,HC DRUG ASSAY INFLIXIMAB-90,301,1 ,$367.00 ,$238.55 ,$8.56 ,$367.00 ,$96.43 ,$238.55 ,$219.10 ,$38.57 ,$102.76 ,$205.89 ,$38.57 ,$241.49 ,$38.57 ,$311.95 ,$311.95 ,$38.57 ,$311.95 ,$73.28 ,$249.56 ,$96.43 ,$38.57 ,$38.57 ,$275.25 ,$260.57 ,$260.57 ,$38.57 ,$260.57 ,$300.94 ,$300.94 ,$300.94 , N/A ,$96.43 ,$311.95 ,$38.57 ,$367.00 ,$219.10 ,$38.57 ,$152.67 ,$9.42 ,$8.56 ,$38.57 ,$311.95 ,$81.00 ,$311.95 ,$102.76 ,$330.30 ,$38.57 ,$300.94 ,$154.28 ,$154.28 ,$38.57 ,$238.55 ,$367.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101714,80374,HC METHAMPHETAMINE- 90,301,1 ,$52.00 ,$33.80 ,$7.46 ,$52.00 , N/A ,$33.80 ,$31.04 , N/A ,$14.56 ,$29.17 , N/A ,$34.22 , N/A ,$44.20 ,$44.20 , N/A ,$44.20 , N/A ,$35.36 , N/A , N/A , N/A ,$39.00 ,$36.92 ,$36.92 , N/A ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A , N/A ,$44.20 , N/A ,$52.00 ,$31.04 , N/A ,$21.63 ,$8.21 ,$7.46 , N/A ,$44.20 , N/A ,$44.20 ,$14.56 ,$46.80 , N/A ,$42.64 , N/A , N/A , N/A ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101735,84146,HC PROLACTIN-90,301,1 ,$212.00 ,$137.80 ,$17.46 ,$212.00 ,$48.45 ,$137.80 ,$126.56 ,$19.38 ,$59.36 ,$118.93 ,$19.38 ,$139.50 ,$19.38 ,$180.20 ,$180.20 ,$19.38 ,$180.20 ,$36.82 ,$144.16 ,$48.45 ,$19.38 ,$19.38 ,$159.00 ,$150.52 ,$150.52 ,$19.38 ,$150.52 ,$173.84 ,$173.84 ,$173.84 , N/A ,$48.45 ,$180.20 ,$19.38 ,$212.00 ,$126.56 ,$19.38 ,$88.19 ,$19.21 ,$17.46 ,$19.38 ,$180.20 ,$40.70 ,$180.20 ,$59.36 ,$190.80 ,$19.38 ,$173.84 ,$77.52 ,$77.52 ,$19.38 ,$137.80 ,$212.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101752,83722,HC LIPOPROTEIN DIR MEAS SMALL DENSE LDL CHOLESTEROL-90,301,1 ,$37.50 ,$24.38 ,$10.50 ,$85.48 ,$85.48 ,$24.38 ,$22.39 ,$34.19 ,$10.50 ,$21.04 ,$34.19 ,$24.68 ,$34.19 ,$31.88 ,$31.88 ,$34.19 ,$31.88 ,$37.50 ,$25.50 ,$85.48 ,$34.19 ,$34.19 ,$28.13 ,$26.63 ,$26.63 ,$34.19 ,$26.63 ,$30.75 ,$30.75 ,$30.75 , N/A ,$37.50 ,$31.88 ,$34.19 ,$37.50 ,$22.39 ,$34.19 ,$15.60 ,$22.09 ,$20.08 ,$34.19 ,$31.88 ,$71.80 ,$31.88 ,$10.50 ,$33.75 ,$34.19 ,$30.75 ,$37.50 ,$37.50 ,$34.19 ,$24.38 ,$37.50 
ST. JOSEPH'S HOSPITAL - BREESE,30101770,83521,HC IMMUNOGLOBULIN LIGHT CHAINS- 90,301,1 ,$169.00 ,$109.85 ,$7.46 ,$169.00 ,$43.18 ,$109.85 ,$100.89 ,$17.27 ,$47.32 ,$94.81 ,$17.27 ,$111.20 ,$17.27 ,$143.65 ,$143.65 ,$17.27 ,$143.65 ,$32.81 ,$114.92 ,$43.18 ,$17.27 ,$17.27 ,$126.75 ,$119.99 ,$119.99 ,$17.27 ,$119.99 ,$138.58 ,$138.58 ,$138.58 , N/A ,$43.18 ,$143.65 ,$17.27 ,$169.00 ,$100.89 ,$17.27 ,$70.30 ,$8.21 ,$7.46 ,$17.27 ,$143.65 ,$36.27 ,$143.65 ,$47.32 ,$152.10 ,$17.27 ,$138.58 ,$69.08 ,$69.08 ,$17.27 ,$109.85 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101771,82653,HC EL-1 FECAL QUANTITATIVE-90,301,1 ,$323.00 ,$209.95 ,$7.46 ,$323.00 ,$57.43 ,$209.95 ,$192.83 ,$22.97 ,$90.44 ,$181.20 ,$22.97 ,$212.53 ,$22.97 ,$274.55 ,$274.55 ,$22.97 ,$274.55 ,$43.64 ,$219.64 ,$57.43 ,$22.97 ,$22.97 ,$242.25 ,$229.33 ,$229.33 ,$22.97 ,$229.33 ,$264.86 ,$264.86 ,$264.86 , N/A ,$57.43 ,$274.55 ,$22.97 ,$323.00 ,$192.83 ,$22.97 ,$134.37 ,$8.21 ,$7.46 ,$22.97 ,$274.55 ,$48.24 ,$274.55 ,$90.44 ,$290.70 ,$22.97 ,$264.86 ,$91.88 ,$91.88 ,$22.97 ,$209.95 ,$323.00 
ST. JOSEPH'S HOSPITAL - BREESE,30101774,80053,HC HEALTH FAIR COMPREHENSIVE METABOLIC PANEL,301,1 ,$10.00 ,$6.50 ,$2.80 ,$25.00 ,$25.00 ,$6.50 ,$5.97 ,$10.00 ,$2.80 ,$5.61 ,$10.00 ,$6.58 ,$10.00 ,$8.50 ,$8.50 ,$10.00 ,$8.50 ,$10.00 ,$6.80 ,$25.00 ,$10.00 ,$10.00 ,$7.50 ,$7.10 ,$7.10 ,$10.00 ,$7.10 ,$8.20 ,$8.20 ,$8.20 , N/A ,$10.00 ,$8.50 ,$10.00 ,$10.00 ,$5.97 ,$10.00 ,$4.16 ,$7.48 ,$6.80 ,$10.00 ,$8.50 ,$21.00 ,$8.50 ,$2.80 ,$9.00 ,$10.00 ,$8.20 ,$10.00 ,$10.00 ,$10.00 ,$6.50 ,$10.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200121,86060,HC ASO,302,1 ,$184.00 ,$119.60 ,$6.68 ,$184.00 ,$18.25 ,$119.60 ,$109.85 ,$7.30 ,$51.52 ,$103.22 ,$7.30 ,$121.07 ,$7.30 ,$156.40 ,$156.40 ,$7.30 ,$156.40 ,$13.87 ,$125.12 ,$18.25 ,$7.30 ,$7.30 ,$138.00 ,$130.64 ,$130.64 ,$7.30 ,$130.64 ,$150.88 ,$150.88 ,$150.88 , N/A ,$18.25 ,$156.40 ,$7.30 ,$184.00 ,$109.85 ,$7.30 ,$76.54 ,$7.35 ,$6.68 ,$7.30 ,$156.40 ,$15.33 ,$156.40 ,$51.52 ,$165.60 ,$7.30 ,$150.88 ,$29.20 ,$29.20 ,$7.30 ,$119.60 ,$184.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$144.00 ,$93.60 ,$5.18 ,$144.00 ,$12.95 ,$93.60 ,$85.97 ,$5.18 ,$40.32 ,$80.78 ,$5.18 ,$94.75 ,$5.18 ,$122.40 ,$122.40 ,$5.18 ,$122.40 ,$9.84 ,$97.92 ,$12.95 ,$5.18 ,$5.18 ,$108.00 ,$102.24 ,$102.24 ,$5.18 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$12.95 ,$122.40 ,$5.18 ,$144.00 ,$85.97 ,$5.18 ,$59.90 ,$7.35 ,$6.68 ,$5.18 ,$122.40 ,$10.88 ,$122.40 ,$40.32 ,$129.60 ,$5.18 ,$118.08 ,$20.72 ,$20.72 ,$5.18 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$185.00 ,$120.25 ,$5.18 ,$185.00 ,$12.95 ,$120.25 ,$110.45 ,$5.18 ,$51.80 ,$103.79 ,$5.18 ,$121.73 ,$5.18 ,$157.25 ,$157.25 ,$5.18 ,$157.25 ,$9.84 ,$125.80 ,$12.95 ,$5.18 ,$5.18 ,$138.75 ,$131.35 ,$131.35 ,$5.18 ,$131.35 ,$151.70 ,$151.70 ,$151.70 , N/A ,$12.95 ,$157.25 ,$5.18 ,$185.00 ,$110.45 ,$5.18 ,$76.96 ,$7.35 ,$6.68 ,$5.18 ,$157.25 ,$10.88 ,$157.25 ,$51.80 ,$166.50 ,$5.18 ,$151.70 ,$20.72 ,$20.72 ,$5.18 ,$120.25 ,$185.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200197,86430,HC RHEUMATOID FACTOR,302,1 ,$144.00 ,$93.60 ,$6.14 ,$144.00 ,$15.35 ,$93.60 ,$85.97 ,$6.14 ,$40.32 ,$80.78 ,$6.14 ,$94.75 ,$6.14 ,$122.40 ,$122.40 ,$6.14 ,$122.40 ,$11.67 ,$97.92 ,$15.35 ,$6.14 ,$6.14 ,$108.00 ,$102.24 ,$102.24 ,$6.14 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$15.35 ,$122.40 ,$6.14 ,$144.00 ,$85.97 ,$6.14 ,$59.90 ,$7.35 ,$6.68 ,$6.14 ,$122.40 ,$12.89 ,$122.40 ,$40.32 ,$129.60 ,$6.14 ,$118.08 ,$24.56 ,$24.56 ,$6.14 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200200,86580,HC SKIN TEST TB INTRADERMAL,302,1 ,$56.00 ,$36.40 ,$6.68 ,$60.90 ,$60.90 ,$36.40 ,$33.43 ,$24.36 ,$15.68 ,$31.42 ,$24.36 ,$36.85 ,$24.36 ,$47.60 ,$47.60 ,$24.36 ,$47.60 ,$46.27 ,$38.08 ,$60.89 ,$24.36 ,$24.36 ,$42.00 ,$39.76 ,$39.76 ,$24.36 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$56.00 ,$47.60 ,$24.36 ,$56.00 ,$33.43 ,$24.36 ,$23.30 ,$7.35 ,$6.68 ,$24.36 ,$47.60 ,$51.15 ,$47.60 ,$15.68 ,$50.40 ,$24.36 ,$45.92 ,$56.00 ,$56.00 ,$24.36 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200270,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$147.00 ,$95.55 ,$6.68 ,$147.00 ,$34.28 ,$95.55 ,$87.76 ,$13.71 ,$41.16 ,$82.47 ,$13.71 ,$96.73 ,$13.71 ,$124.95 ,$124.95 ,$13.71 ,$124.95 ,$26.05 ,$99.96 ,$34.28 ,$13.71 ,$13.71 ,$110.25 ,$104.37 ,$104.37 ,$13.71 ,$104.37 ,$120.54 ,$120.54 ,$120.54 , N/A ,$34.28 ,$124.95 ,$13.71 ,$147.00 ,$87.76 ,$13.71 ,$61.15 ,$7.35 ,$6.68 ,$13.71 ,$124.95 ,$28.79 ,$124.95 ,$41.16 ,$132.30 ,$13.71 ,$120.54 ,$54.84 ,$54.84 ,$13.71 ,$95.55 ,$147.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200561,86870,HC RBC AB ID PANEL,302,1 ,$226.00 ,$146.90 ,$6.68 ,$717.84 ,$717.83 ,$146.90 ,$134.92 ,$287.13 ,$63.28 ,$126.79 ,$287.13 ,$148.71 ,$226.00 ,$192.10 ,$192.10 ,$226.00 ,$192.10 ,$226.00 ,$153.68 ,$717.84 ,$287.13 ,$287.13 ,$169.50 ,$160.46 ,$160.46 ,$287.13 ,$160.46 ,$185.32 ,$185.32 ,$185.32 , N/A ,$226.00 ,$192.10 ,$287.13 ,$226.00 ,$134.92 ,$287.13 ,$94.02 ,$7.35 ,$6.68 ,$287.13 ,$192.10 ,$602.98 ,$192.10 ,$63.28 ,$203.40 ,$287.13 ,$185.32 ,$226.00 ,$226.00 ,$287.13 ,$146.90 ,$226.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200562,86880,HC COOMBS DIRECT,302,1 ,$94.00 ,$61.10 ,$6.68 ,$137.20 ,$137.20 ,$61.10 ,$56.12 ,$54.88 ,$26.32 ,$52.73 ,$54.88 ,$61.85 ,$54.88 ,$79.90 ,$79.90 ,$54.88 ,$79.90 ,$94.00 ,$63.92 ,$137.20 ,$54.88 ,$54.88 ,$70.50 ,$66.74 ,$66.74 ,$54.88 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$94.00 ,$79.90 ,$54.88 ,$94.00 ,$56.12 ,$54.88 ,$39.10 ,$7.35 ,$6.68 ,$54.88 ,$79.90 ,$115.24 ,$79.90 ,$26.32 ,$84.60 ,$54.88 ,$77.08 ,$21.56 ,$21.56 ,$54.88 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200563,86885,HC INDIRECT COOMBS,302,1 ,$94.00 ,$61.10 ,$6.68 ,$367.60 ,$367.60 ,$61.10 ,$56.12 ,$147.04 ,$26.32 ,$52.73 ,$147.04 ,$61.85 ,$94.00 ,$79.90 ,$79.90 ,$94.00 ,$79.90 ,$94.00 ,$63.92 ,$367.59 ,$147.04 ,$147.04 ,$70.50 ,$66.74 ,$66.74 ,$147.04 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$94.00 ,$79.90 ,$147.04 ,$94.00 ,$56.12 ,$147.04 ,$39.10 ,$7.35 ,$6.68 ,$147.04 ,$79.90 ,$308.78 ,$79.90 ,$26.32 ,$84.60 ,$147.04 ,$77.08 ,$22.88 ,$22.88 ,$147.04 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200564,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,"$1,472.00 ",$956.80 ,$26.96 ,"$1,472.00 ",$367.60 ,$956.80 ,$878.78 ,$147.04 ,$412.16 ,$825.79 ,$147.04 ,$968.58 ,$147.04 ,"$1,251.20 ","$1,251.20 ",$147.04 ,"$1,251.20 ",$279.37 ,"$1,000.96 ",$367.59 ,$147.04 ,$147.04 ,"$1,104.00 ","$1,045.12 ","$1,045.12 ",$147.04 ,"$1,045.12 ","$1,207.04 ","$1,207.04 ","$1,207.04 ", N/A ,$367.59 ,"$1,251.20 ",$147.04 ,"$1,472.00 ",$878.78 ,$147.04 ,$612.35 ,$29.66 ,$26.96 ,$147.04 ,"$1,251.20 ",$308.78 ,"$1,251.20 ",$412.16 ,"$1,324.80 ",$147.04 ,"$1,207.04 ",$596.64 ,$596.64 ,$147.04 ,$956.80 ,"$1,472.00 "
ST. JOSEPH'S HOSPITAL - BREESE,30200565,86900,HC BLOOD TYPING ABO,302,1 ,$71.00 ,$46.15 ,$4.14 ,$277.93 ,$277.93 ,$46.15 ,$42.39 ,$111.17 ,$19.88 ,$39.83 ,$111.17 ,$46.72 ,$71.00 ,$60.35 ,$60.35 ,$71.00 ,$60.35 ,$71.00 ,$48.28 ,$277.92 ,$111.17 ,$111.17 ,$53.25 ,$50.41 ,$50.41 ,$111.17 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$71.00 ,$60.35 ,$111.17 ,$71.00 ,$42.39 ,$111.17 ,$29.54 ,$4.55 ,$4.14 ,$111.17 ,$60.35 ,$233.45 ,$60.35 ,$19.88 ,$63.90 ,$111.17 ,$58.22 ,$11.96 ,$11.96 ,$111.17 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200566,86901,HC BLOOD TYPING RH,302,1 ,$67.00 ,$43.55 ,$4.14 ,$83.43 ,$83.43 ,$43.55 ,$40.00 ,$33.37 ,$18.76 ,$37.59 ,$33.37 ,$44.09 ,$33.37 ,$56.95 ,$56.95 ,$33.37 ,$56.95 ,$63.41 ,$45.56 ,$83.43 ,$33.37 ,$33.37 ,$50.25 ,$47.57 ,$47.57 ,$33.37 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$67.00 ,$56.95 ,$33.37 ,$67.00 ,$40.00 ,$33.37 ,$27.87 ,$4.55 ,$4.14 ,$33.37 ,$56.95 ,$70.08 ,$56.95 ,$18.76 ,$60.30 ,$33.37 ,$54.94 ,$11.96 ,$11.96 ,$33.37 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200567,86902,HC RBC AG SCR RGT SERUM,302,1 ,$110.00 ,$71.50 ,$4.14 ,$717.84 ,$717.83 ,$71.50 ,$65.67 ,$287.13 ,$30.80 ,$61.71 ,$287.13 ,$72.38 ,$110.00 ,$93.50 ,$93.50 ,$110.00 ,$93.50 ,$110.00 ,$74.80 ,$717.84 ,$287.13 ,$287.13 ,$82.50 ,$78.10 ,$78.10 ,$287.13 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$110.00 ,$93.50 ,$287.13 ,$110.00 ,$65.67 ,$287.13 ,$45.76 ,$4.55 ,$4.14 ,$287.13 ,$93.50 ,$602.98 ,$93.50 ,$30.80 ,$99.00 ,$287.13 ,$90.20 ,$25.40 ,$25.40 ,$287.13 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200569,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$160.00 ,$104.00 ,$4.14 ,$367.60 ,$367.60 ,$104.00 ,$95.52 ,$147.04 ,$44.80 ,$89.76 ,$147.04 ,$105.28 ,$147.04 ,$136.00 ,$136.00 ,$147.04 ,$136.00 ,$160.00 ,$108.80 ,$367.59 ,$147.04 ,$147.04 ,$120.00 ,$113.60 ,$113.60 ,$147.04 ,$113.60 ,$131.20 ,$131.20 ,$131.20 , N/A ,$160.00 ,$136.00 ,$147.04 ,$160.00 ,$95.52 ,$147.04 ,$66.56 ,$4.55 ,$4.14 ,$147.04 ,$136.00 ,$308.78 ,$136.00 ,$44.80 ,$144.00 ,$147.04 ,$131.20 ,$160.00 ,$160.00 ,$147.04 ,$104.00 ,$160.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200571,86922,HC CROSSMATCH AHG,302,1 ,$137.00 ,$89.05 ,$26.96 ,$367.60 ,$367.60 ,$89.05 ,$81.79 ,$147.04 ,$38.36 ,$76.86 ,$147.04 ,$90.15 ,$137.00 ,$116.45 ,$116.45 ,$137.00 ,$116.45 ,$137.00 ,$93.16 ,$367.59 ,$147.04 ,$147.04 ,$102.75 ,$97.27 ,$97.27 ,$147.04 ,$97.27 ,$112.34 ,$112.34 ,$112.34 , N/A ,$137.00 ,$116.45 ,$147.04 ,$137.00 ,$81.79 ,$147.04 ,$56.99 ,$29.66 ,$26.96 ,$147.04 ,$116.45 ,$308.78 ,$116.45 ,$38.36 ,$123.30 ,$147.04 ,$112.34 ,$137.00 ,$137.00 ,$147.04 ,$89.05 ,$137.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200844,86001,HC RAST ALLERGEN IGG QN SQ EA-90,302,1 ,$67.00 ,$43.55 ,$6.68 ,$67.00 ,$19.55 ,$43.55 ,$40.00 ,$7.82 ,$18.76 ,$37.59 ,$7.82 ,$44.09 ,$7.82 ,$56.95 ,$56.95 ,$7.82 ,$56.95 ,$14.86 ,$45.56 ,$19.55 ,$7.82 ,$7.82 ,$50.25 ,$47.57 ,$47.57 ,$7.82 ,$47.57 ,$54.94 ,$54.94 ,$54.94 , N/A ,$19.55 ,$56.95 ,$7.82 ,$67.00 ,$40.00 ,$7.82 ,$27.87 ,$7.35 ,$6.68 ,$7.82 ,$56.95 ,$16.42 ,$56.95 ,$18.76 ,$60.30 ,$7.82 ,$54.94 ,$31.28 ,$31.28 ,$7.82 ,$43.55 ,$67.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200845,86003,HC RAST ALLERGEN IGE QN SQ EA-90,302,1 ,$68.00 ,$44.20 ,$5.22 ,$68.00 ,$13.05 ,$44.20 ,$40.60 ,$5.22 ,$19.04 ,$38.15 ,$5.22 ,$44.74 ,$5.22 ,$57.80 ,$57.80 ,$5.22 ,$57.80 ,$9.92 ,$46.24 ,$13.05 ,$5.22 ,$5.22 ,$51.00 ,$48.28 ,$48.28 ,$5.22 ,$48.28 ,$55.76 ,$55.76 ,$55.76 , N/A ,$13.05 ,$57.80 ,$5.22 ,$68.00 ,$40.60 ,$5.22 ,$28.29 ,$7.35 ,$6.68 ,$5.22 ,$57.80 ,$10.96 ,$57.80 ,$19.04 ,$61.20 ,$5.22 ,$55.76 ,$20.88 ,$20.88 ,$5.22 ,$44.20 ,$68.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200847,86021,HC LEUKO AB ID-90,302,1 ,$223.00 ,$144.95 ,$6.68 ,$223.00 ,$37.63 ,$144.95 ,$133.13 ,$15.05 ,$62.44 ,$125.10 ,$15.05 ,$146.73 ,$15.05 ,$189.55 ,$189.55 ,$15.05 ,$189.55 ,$28.60 ,$151.64 ,$37.63 ,$15.05 ,$15.05 ,$167.25 ,$158.33 ,$158.33 ,$15.05 ,$158.33 ,$182.86 ,$182.86 ,$182.86 , N/A ,$37.63 ,$189.55 ,$15.05 ,$223.00 ,$133.13 ,$15.05 ,$92.77 ,$7.35 ,$6.68 ,$15.05 ,$189.55 ,$31.61 ,$189.55 ,$62.44 ,$200.70 ,$15.05 ,$182.86 ,$60.20 ,$60.20 ,$15.05 ,$144.95 ,$223.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200851,86022,HC PLATELET AB ID-90,302,1 ,$174.00 ,$113.10 ,$6.68 ,$174.00 ,$45.93 ,$113.10 ,$103.88 ,$18.37 ,$48.72 ,$97.61 ,$18.37 ,$114.49 ,$18.37 ,$147.90 ,$147.90 ,$18.37 ,$147.90 ,$34.90 ,$118.32 ,$45.93 ,$18.37 ,$18.37 ,$130.50 ,$123.54 ,$123.54 ,$18.37 ,$123.54 ,$142.68 ,$142.68 ,$142.68 , N/A ,$45.93 ,$147.90 ,$18.37 ,$174.00 ,$103.88 ,$18.37 ,$72.38 ,$7.35 ,$6.68 ,$18.37 ,$147.90 ,$38.58 ,$147.90 ,$48.72 ,$156.60 ,$18.37 ,$142.68 ,$73.48 ,$73.48 ,$18.37 ,$113.10 ,$174.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200857,86023,HC PLATELET ASSOC AB ID IGG-90,302,1 ,$126.00 ,$81.90 ,$6.68 ,$126.00 ,$31.15 ,$81.90 ,$75.22 ,$12.46 ,$35.28 ,$70.69 ,$12.46 ,$82.91 ,$12.46 ,$107.10 ,$107.10 ,$12.46 ,$107.10 ,$23.67 ,$85.68 ,$31.15 ,$12.46 ,$12.46 ,$94.50 ,$89.46 ,$89.46 ,$12.46 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$31.15 ,$107.10 ,$12.46 ,$126.00 ,$75.22 ,$12.46 ,$52.42 ,$7.35 ,$6.68 ,$12.46 ,$107.10 ,$26.17 ,$107.10 ,$35.28 ,$113.40 ,$12.46 ,$103.32 ,$49.84 ,$49.84 ,$12.46 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200858,86038,HC ANA SCREEN-90,302,1 ,$131.00 ,$85.15 ,$6.68 ,$131.00 ,$30.23 ,$85.15 ,$78.21 ,$12.09 ,$36.68 ,$73.49 ,$12.09 ,$86.20 ,$12.09 ,$111.35 ,$111.35 ,$12.09 ,$111.35 ,$22.97 ,$89.08 ,$30.23 ,$12.09 ,$12.09 ,$98.25 ,$93.01 ,$93.01 ,$12.09 ,$93.01 ,$107.42 ,$107.42 ,$107.42 , N/A ,$30.23 ,$111.35 ,$12.09 ,$131.00 ,$78.21 ,$12.09 ,$54.50 ,$7.35 ,$6.68 ,$12.09 ,$111.35 ,$25.39 ,$111.35 ,$36.68 ,$117.90 ,$12.09 ,$107.42 ,$48.36 ,$48.36 ,$12.09 ,$85.15 ,$131.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200859,86039,HC ANA TITER-90,302,1 ,$117.00 ,$76.05 ,$6.68 ,$117.00 ,$27.90 ,$76.05 ,$69.85 ,$11.16 ,$32.76 ,$65.64 ,$11.16 ,$76.99 ,$11.16 ,$99.45 ,$99.45 ,$11.16 ,$99.45 ,$21.20 ,$79.56 ,$27.90 ,$11.16 ,$11.16 ,$87.75 ,$83.07 ,$83.07 ,$11.16 ,$83.07 ,$95.94 ,$95.94 ,$95.94 , N/A ,$27.90 ,$99.45 ,$11.16 ,$117.00 ,$69.85 ,$11.16 ,$48.67 ,$7.35 ,$6.68 ,$11.16 ,$99.45 ,$23.44 ,$99.45 ,$32.76 ,$105.30 ,$11.16 ,$95.94 ,$44.64 ,$44.64 ,$11.16 ,$76.05 ,$117.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200860,86060,HC ASO-90,302,1 ,$10.50 ,$6.83 ,$2.94 ,$18.25 ,$18.25 ,$6.83 ,$6.27 ,$7.30 ,$2.94 ,$5.89 ,$7.30 ,$6.91 ,$7.30 ,$8.93 ,$8.93 ,$7.30 ,$8.93 ,$10.50 ,$7.14 ,$18.25 ,$7.30 ,$7.30 ,$7.88 ,$7.46 ,$7.46 ,$7.30 ,$7.46 ,$8.61 ,$8.61 ,$8.61 , N/A ,$10.50 ,$8.93 ,$7.30 ,$10.50 ,$6.27 ,$7.30 ,$4.37 ,$7.35 ,$6.68 ,$7.30 ,$8.93 ,$15.33 ,$8.93 ,$2.94 ,$9.45 ,$7.30 ,$8.61 ,$10.50 ,$10.50 ,$7.30 ,$6.83 ,$10.50 
ST. JOSEPH'S HOSPITAL - BREESE,30200863,86141,HC C-REACTIVE PROTEIN (HS)-90,302,1 ,$176.00 ,$114.40 ,$6.68 ,$176.00 ,$32.38 ,$114.40 ,$105.07 ,$12.95 ,$49.28 ,$98.74 ,$12.95 ,$115.81 ,$12.95 ,$149.60 ,$149.60 ,$12.95 ,$149.60 ,$24.61 ,$119.68 ,$32.38 ,$12.95 ,$12.95 ,$132.00 ,$124.96 ,$124.96 ,$12.95 ,$124.96 ,$144.32 ,$144.32 ,$144.32 , N/A ,$32.38 ,$149.60 ,$12.95 ,$176.00 ,$105.07 ,$12.95 ,$73.22 ,$7.35 ,$6.68 ,$12.95 ,$149.60 ,$27.20 ,$149.60 ,$49.28 ,$158.40 ,$12.95 ,$144.32 ,$51.80 ,$51.80 ,$12.95 ,$114.40 ,$176.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200864,86146,HC BETA 2 GLYCO AB-90,302,1 ,$94.00 ,$61.10 ,$7.46 ,$94.00 ,$63.63 ,$61.10 ,$56.12 ,$25.45 ,$26.32 ,$52.73 ,$25.45 ,$61.85 ,$25.45 ,$79.90 ,$79.90 ,$25.45 ,$79.90 ,$48.36 ,$63.92 ,$63.63 ,$25.45 ,$25.45 ,$70.50 ,$66.74 ,$66.74 ,$25.45 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$63.63 ,$79.90 ,$25.45 ,$94.00 ,$56.12 ,$25.45 ,$39.10 ,$8.21 ,$7.46 ,$25.45 ,$79.90 ,$53.45 ,$79.90 ,$26.32 ,$84.60 ,$25.45 ,$77.08 ,$94.00 ,$94.00 ,$25.45 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200865,86147,HC CARDIOLIPIN AB EA-90,302,1 ,$156.00 ,$101.40 ,$11.51 ,$156.00 ,$63.63 ,$101.40 ,$93.13 ,$25.45 ,$43.68 ,$87.52 ,$25.45 ,$102.65 ,$25.45 ,$132.60 ,$132.60 ,$25.45 ,$132.60 ,$48.36 ,$106.08 ,$63.63 ,$25.45 ,$25.45 ,$117.00 ,$110.76 ,$110.76 ,$25.45 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$63.63 ,$132.60 ,$25.45 ,$156.00 ,$93.13 ,$25.45 ,$64.90 ,$12.66 ,$11.51 ,$25.45 ,$132.60 ,$53.45 ,$132.60 ,$43.68 ,$140.40 ,$25.45 ,$127.92 ,$101.80 ,$101.80 ,$25.45 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200866,86148,HC ANTI-PHOSPHATIDYLSERINE AB-90,302,1 ,$60.00 ,$39.00 ,$7.46 ,$60.00 ,$40.18 ,$39.00 ,$35.82 ,$16.07 ,$16.80 ,$33.66 ,$16.07 ,$39.48 ,$16.07 ,$51.00 ,$51.00 ,$16.07 ,$51.00 ,$30.53 ,$40.80 ,$40.18 ,$16.07 ,$16.07 ,$45.00 ,$42.60 ,$42.60 ,$16.07 ,$42.60 ,$49.20 ,$49.20 ,$49.20 , N/A ,$40.18 ,$51.00 ,$16.07 ,$60.00 ,$35.82 ,$16.07 ,$24.96 ,$8.21 ,$7.46 ,$16.07 ,$51.00 ,$33.75 ,$51.00 ,$16.80 ,$54.00 ,$16.07 ,$49.20 ,$60.00 ,$60.00 ,$16.07 ,$39.00 ,$60.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200868,86157,HC COLD AGGLUTININ TITER-90,302,1 ,$221.00 ,$143.65 ,$6.68 ,$221.00 ,$20.15 ,$143.65 ,$131.94 ,$8.06 ,$61.88 ,$123.98 ,$8.06 ,$145.42 ,$8.06 ,$187.85 ,$187.85 ,$8.06 ,$187.85 ,$15.31 ,$150.28 ,$20.15 ,$8.06 ,$8.06 ,$165.75 ,$156.91 ,$156.91 ,$8.06 ,$156.91 ,$181.22 ,$181.22 ,$181.22 , N/A ,$20.15 ,$187.85 ,$8.06 ,$221.00 ,$131.94 ,$8.06 ,$91.94 ,$7.35 ,$6.68 ,$8.06 ,$187.85 ,$16.93 ,$187.85 ,$61.88 ,$198.90 ,$8.06 ,$181.22 ,$32.24 ,$32.24 ,$8.06 ,$143.65 ,$221.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200869,86160,HC COMPLEMENT AG EA-90,302,1 ,$162.00 ,$105.30 ,$6.68 ,$162.00 ,$30.00 ,$105.30 ,$96.71 ,$12.00 ,$45.36 ,$90.88 ,$12.00 ,$106.60 ,$12.00 ,$137.70 ,$137.70 ,$12.00 ,$137.70 ,$22.80 ,$110.16 ,$30.00 ,$12.00 ,$12.00 ,$121.50 ,$115.02 ,$115.02 ,$12.00 ,$115.02 ,$132.84 ,$132.84 ,$132.84 , N/A ,$30.00 ,$137.70 ,$12.00 ,$162.00 ,$96.71 ,$12.00 ,$67.39 ,$7.35 ,$6.68 ,$12.00 ,$137.70 ,$25.20 ,$137.70 ,$45.36 ,$145.80 ,$12.00 ,$132.84 ,$48.00 ,$48.00 ,$12.00 ,$105.30 ,$162.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200870,86161,HC C1 ESTERASE INHIBITOR-90,302,1 ,$112.00 ,$72.80 ,$6.68 ,$112.00 ,$30.00 ,$72.80 ,$66.86 ,$12.00 ,$31.36 ,$62.83 ,$12.00 ,$73.70 ,$12.00 ,$95.20 ,$95.20 ,$12.00 ,$95.20 ,$22.80 ,$76.16 ,$30.00 ,$12.00 ,$12.00 ,$84.00 ,$79.52 ,$79.52 ,$12.00 ,$79.52 ,$91.84 ,$91.84 ,$91.84 , N/A ,$30.00 ,$95.20 ,$12.00 ,$112.00 ,$66.86 ,$12.00 ,$46.59 ,$7.35 ,$6.68 ,$12.00 ,$95.20 ,$25.20 ,$95.20 ,$31.36 ,$100.80 ,$12.00 ,$91.84 ,$48.00 ,$48.00 ,$12.00 ,$72.80 ,$112.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200871,86162,HC COMPLEMENT TOTAL-90,302,1 ,$159.00 ,$103.35 ,$6.68 ,$159.00 ,$50.80 ,$103.35 ,$94.92 ,$20.32 ,$44.52 ,$89.20 ,$20.32 ,$104.62 ,$20.32 ,$135.15 ,$135.15 ,$20.32 ,$135.15 ,$38.61 ,$108.12 ,$50.80 ,$20.32 ,$20.32 ,$119.25 ,$112.89 ,$112.89 ,$20.32 ,$112.89 ,$130.38 ,$130.38 ,$130.38 , N/A ,$50.80 ,$135.15 ,$20.32 ,$159.00 ,$94.92 ,$20.32 ,$66.14 ,$7.35 ,$6.68 ,$20.32 ,$135.15 ,$42.67 ,$135.15 ,$44.52 ,$143.10 ,$20.32 ,$130.38 ,$81.28 ,$81.28 ,$20.32 ,$103.35 ,$159.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200873,86200,HC CCP AB-90,302,1 ,$216.00 ,$140.40 ,$6.68 ,$216.00 ,$32.38 ,$140.40 ,$128.95 ,$12.95 ,$60.48 ,$121.18 ,$12.95 ,$142.13 ,$12.95 ,$183.60 ,$183.60 ,$12.95 ,$183.60 ,$24.61 ,$146.88 ,$32.38 ,$12.95 ,$12.95 ,$162.00 ,$153.36 ,$153.36 ,$12.95 ,$153.36 ,$177.12 ,$177.12 ,$177.12 , N/A ,$32.38 ,$183.60 ,$12.95 ,$216.00 ,$128.95 ,$12.95 ,$89.86 ,$7.35 ,$6.68 ,$12.95 ,$183.60 ,$27.20 ,$183.60 ,$60.48 ,$194.40 ,$12.95 ,$177.12 ,$51.80 ,$51.80 ,$12.95 ,$140.40 ,$216.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200874,86215,HC DEOXYRIBONUCLEASE AB-90,302,1 ,$139.00 ,$90.35 ,$6.68 ,$139.00 ,$33.13 ,$90.35 ,$82.98 ,$13.25 ,$38.92 ,$77.98 ,$13.25 ,$91.46 ,$13.25 ,$118.15 ,$118.15 ,$13.25 ,$118.15 ,$25.18 ,$94.52 ,$33.13 ,$13.25 ,$13.25 ,$104.25 ,$98.69 ,$98.69 ,$13.25 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$33.13 ,$118.15 ,$13.25 ,$139.00 ,$82.98 ,$13.25 ,$57.82 ,$7.35 ,$6.68 ,$13.25 ,$118.15 ,$27.83 ,$118.15 ,$38.92 ,$125.10 ,$13.25 ,$113.98 ,$53.00 ,$53.00 ,$13.25 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200875,86225,HC DNA DOUBLE STRAND AB-90,302,1 ,$145.00 ,$94.25 ,$6.68 ,$145.00 ,$34.35 ,$94.25 ,$86.57 ,$13.74 ,$40.60 ,$81.35 ,$13.74 ,$95.41 ,$13.74 ,$123.25 ,$123.25 ,$13.74 ,$123.25 ,$26.11 ,$98.60 ,$34.35 ,$13.74 ,$13.74 ,$108.75 ,$102.95 ,$102.95 ,$13.74 ,$102.95 ,$118.90 ,$118.90 ,$118.90 , N/A ,$34.35 ,$123.25 ,$13.74 ,$145.00 ,$86.57 ,$13.74 ,$60.32 ,$7.35 ,$6.68 ,$13.74 ,$123.25 ,$28.85 ,$123.25 ,$40.60 ,$130.50 ,$13.74 ,$118.90 ,$54.96 ,$54.96 ,$13.74 ,$94.25 ,$145.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200877,86235,HC ENA AB-90,302,1 ,$154.00 ,$100.10 ,$11.51 ,$154.00 ,$44.83 ,$100.10 ,$91.94 ,$17.93 ,$43.12 ,$86.39 ,$17.93 ,$101.33 ,$17.93 ,$130.90 ,$130.90 ,$17.93 ,$130.90 ,$34.07 ,$104.72 ,$44.83 ,$17.93 ,$17.93 ,$115.50 ,$109.34 ,$109.34 ,$17.93 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$44.83 ,$130.90 ,$17.93 ,$154.00 ,$91.94 ,$17.93 ,$64.06 ,$12.66 ,$11.51 ,$17.93 ,$130.90 ,$37.65 ,$130.90 ,$43.12 ,$138.60 ,$17.93 ,$126.28 ,$71.72 ,$71.72 ,$17.93 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200878,86255,HC FLUOR AB SCR-90,302,1 ,$184.00 ,$119.60 ,$11.51 ,$184.00 ,$30.13 ,$119.60 ,$109.85 ,$12.05 ,$51.52 ,$103.22 ,$12.05 ,$121.07 ,$12.05 ,$156.40 ,$156.40 ,$12.05 ,$156.40 ,$22.90 ,$125.12 ,$30.13 ,$12.05 ,$12.05 ,$138.00 ,$130.64 ,$130.64 ,$12.05 ,$130.64 ,$150.88 ,$150.88 ,$150.88 , N/A ,$30.13 ,$156.40 ,$12.05 ,$184.00 ,$109.85 ,$12.05 ,$76.54 ,$12.66 ,$11.51 ,$12.05 ,$156.40 ,$25.31 ,$156.40 ,$51.52 ,$165.60 ,$12.05 ,$150.88 ,$48.20 ,$48.20 ,$12.05 ,$119.60 ,$184.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200879,86256,HC FLUOR AB TITER-90,302,1 ,$56.00 ,$36.40 ,$11.51 ,$56.00 ,$30.13 ,$36.40 ,$33.43 ,$12.05 ,$15.68 ,$31.42 ,$12.05 ,$36.85 ,$12.05 ,$47.60 ,$47.60 ,$12.05 ,$47.60 ,$22.90 ,$38.08 ,$30.13 ,$12.05 ,$12.05 ,$42.00 ,$39.76 ,$39.76 ,$12.05 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$30.13 ,$47.60 ,$12.05 ,$56.00 ,$33.43 ,$12.05 ,$23.30 ,$12.66 ,$11.51 ,$12.05 ,$47.60 ,$25.31 ,$47.60 ,$15.68 ,$50.40 ,$12.05 ,$45.92 ,$48.20 ,$48.20 ,$12.05 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200880,86300,HC TUMOR AG CA 15-3 (27.29)-90,302,1 ,$179.00 ,$116.35 ,$17.70 ,$179.00 ,$52.03 ,$116.35 ,$106.86 ,$20.81 ,$50.12 ,$100.42 ,$20.81 ,$117.78 ,$20.81 ,$152.15 ,$152.15 ,$20.81 ,$152.15 ,$39.54 ,$121.72 ,$52.03 ,$20.81 ,$20.81 ,$134.25 ,$127.09 ,$127.09 ,$20.81 ,$127.09 ,$146.78 ,$146.78 ,$146.78 , N/A ,$52.03 ,$152.15 ,$20.81 ,$179.00 ,$106.86 ,$20.81 ,$74.46 ,$19.47 ,$17.70 ,$20.81 ,$152.15 ,$43.70 ,$152.15 ,$50.12 ,$161.10 ,$20.81 ,$146.78 ,$83.24 ,$83.24 ,$20.81 ,$116.35 ,$179.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200881,86301,HC TUMOR AG CA 19-9  -90,302,1 ,$174.00 ,$113.10 ,$17.70 ,$174.00 ,$52.03 ,$113.10 ,$103.88 ,$20.81 ,$48.72 ,$97.61 ,$20.81 ,$114.49 ,$20.81 ,$147.90 ,$147.90 ,$20.81 ,$147.90 ,$39.54 ,$118.32 ,$52.03 ,$20.81 ,$20.81 ,$130.50 ,$123.54 ,$123.54 ,$20.81 ,$123.54 ,$142.68 ,$142.68 ,$142.68 , N/A ,$52.03 ,$147.90 ,$20.81 ,$174.00 ,$103.88 ,$20.81 ,$72.38 ,$19.47 ,$17.70 ,$20.81 ,$147.90 ,$43.70 ,$147.90 ,$48.72 ,$156.60 ,$20.81 ,$142.68 ,$83.24 ,$83.24 ,$20.81 ,$113.10 ,$174.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200882,86304,HC TUMOR AG CA 125 -90,302,1 ,$55.00 ,$35.75 ,$15.40 ,$55.00 ,$52.03 ,$35.75 ,$32.84 ,$20.81 ,$15.40 ,$30.86 ,$20.81 ,$36.19 ,$20.81 ,$46.75 ,$46.75 ,$20.81 ,$46.75 ,$39.54 ,$37.40 ,$52.03 ,$20.81 ,$20.81 ,$41.25 ,$39.05 ,$39.05 ,$20.81 ,$39.05 ,$45.10 ,$45.10 ,$45.10 , N/A ,$52.03 ,$46.75 ,$20.81 ,$55.00 ,$32.84 ,$20.81 ,$22.88 ,$19.47 ,$17.70 ,$20.81 ,$46.75 ,$43.70 ,$46.75 ,$15.40 ,$49.50 ,$20.81 ,$45.10 ,$55.00 ,$55.00 ,$20.81 ,$35.75 ,$55.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200883,86305,HC HE4 OVARIAN CANCER-90,302,1 ,$591.00 ,$384.15 ,$17.70 ,$591.00 ,$52.03 ,$384.15 ,$352.83 ,$20.81 ,$165.48 ,$331.55 ,$20.81 ,$388.88 ,$20.81 ,$502.35 ,$502.35 ,$20.81 ,$502.35 ,$39.54 ,$401.88 ,$52.03 ,$20.81 ,$20.81 ,$443.25 ,$419.61 ,$419.61 ,$20.81 ,$419.61 ,$484.62 ,$484.62 ,$484.62 , N/A ,$52.03 ,$502.35 ,$20.81 ,$591.00 ,$352.83 ,$20.81 ,$245.86 ,$19.47 ,$17.70 ,$20.81 ,$502.35 ,$43.70 ,$502.35 ,$165.48 ,$531.90 ,$20.81 ,$484.62 ,$83.24 ,$83.24 ,$20.81 ,$384.15 ,$591.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200886,86632,HC CHLAMYDIA AB IGM-90,302,1 ,$161.00 ,$104.65 ,$5.33 ,$161.00 ,$31.70 ,$104.65 ,$96.12 ,$12.68 ,$45.08 ,$90.32 ,$12.68 ,$105.94 ,$12.68 ,$136.85 ,$136.85 ,$12.68 ,$136.85 ,$24.09 ,$109.48 ,$31.70 ,$12.68 ,$12.68 ,$120.75 ,$114.31 ,$114.31 ,$12.68 ,$114.31 ,$132.02 ,$132.02 ,$132.02 , N/A ,$31.70 ,$136.85 ,$12.68 ,$161.00 ,$96.12 ,$12.68 ,$66.98 ,$5.86 ,$5.33 ,$12.68 ,$136.85 ,$26.63 ,$136.85 ,$45.08 ,$144.90 ,$12.68 ,$132.02 ,$50.72 ,$50.72 ,$12.68 ,$104.65 ,$161.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200887,86635,HC COCCIDIOIDES AB-90,302,1 ,$131.00 ,$85.15 ,$11.47 ,$131.00 ,$28.68 ,$85.15 ,$78.21 ,$11.47 ,$36.68 ,$73.49 ,$11.47 ,$86.20 ,$11.47 ,$111.35 ,$111.35 ,$11.47 ,$111.35 ,$21.79 ,$89.08 ,$28.68 ,$11.47 ,$11.47 ,$98.25 ,$93.01 ,$93.01 ,$11.47 ,$93.01 ,$107.42 ,$107.42 ,$107.42 , N/A ,$28.68 ,$111.35 ,$11.47 ,$131.00 ,$78.21 ,$11.47 ,$54.50 ,$12.66 ,$11.51 ,$11.47 ,$111.35 ,$24.09 ,$111.35 ,$36.68 ,$117.90 ,$11.47 ,$107.42 ,$45.88 ,$45.88 ,$11.47 ,$85.15 ,$131.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200889,86641,HC CRYPTOCOCCAL AB-90,302,1 ,$20.44 ,$13.29 ,$5.72 ,$36.03 ,$36.03 ,$13.29 ,$12.20 ,$14.41 ,$5.72 ,$11.47 ,$14.41 ,$13.45 ,$14.41 ,$17.37 ,$17.37 ,$14.41 ,$17.37 ,$20.44 ,$13.90 ,$36.03 ,$14.41 ,$14.41 ,$15.33 ,$14.51 ,$14.51 ,$14.41 ,$14.51 ,$16.76 ,$16.76 ,$16.76 , N/A ,$20.44 ,$17.37 ,$14.41 ,$20.44 ,$12.20 ,$14.41 ,$8.50 ,$12.66 ,$11.51 ,$14.41 ,$17.37 ,$30.26 ,$17.37 ,$5.72 ,$18.40 ,$14.41 ,$16.76 ,$20.44 ,$20.44 ,$14.41 ,$13.29 ,$20.44 
ST. JOSEPH'S HOSPITAL - BREESE,30200890,86644,HC CMV AB-90,302,1 ,$156.00 ,$101.40 ,$11.51 ,$156.00 ,$35.98 ,$101.40 ,$93.13 ,$14.39 ,$43.68 ,$87.52 ,$14.39 ,$102.65 ,$14.39 ,$132.60 ,$132.60 ,$14.39 ,$132.60 ,$27.34 ,$106.08 ,$35.98 ,$14.39 ,$14.39 ,$117.00 ,$110.76 ,$110.76 ,$14.39 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$35.98 ,$132.60 ,$14.39 ,$156.00 ,$93.13 ,$14.39 ,$64.90 ,$12.66 ,$11.51 ,$14.39 ,$132.60 ,$30.22 ,$132.60 ,$43.68 ,$140.40 ,$14.39 ,$127.92 ,$57.56 ,$57.56 ,$14.39 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200891,86645,HC CMV AB IGM-90,302,1 ,$110.00 ,$71.50 ,$11.51 ,$110.00 ,$42.13 ,$71.50 ,$65.67 ,$16.85 ,$30.80 ,$61.71 ,$16.85 ,$72.38 ,$16.85 ,$93.50 ,$93.50 ,$16.85 ,$93.50 ,$32.02 ,$74.80 ,$42.13 ,$16.85 ,$16.85 ,$82.50 ,$78.10 ,$78.10 ,$16.85 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$42.13 ,$93.50 ,$16.85 ,$110.00 ,$65.67 ,$16.85 ,$45.76 ,$12.66 ,$11.51 ,$16.85 ,$93.50 ,$35.39 ,$93.50 ,$30.80 ,$99.00 ,$16.85 ,$90.20 ,$67.40 ,$67.40 ,$16.85 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200892,86648,HC DIPTHERIA-90,302,1 ,$183.00 ,$118.95 ,$11.51 ,$183.00 ,$38.03 ,$118.95 ,$109.25 ,$15.21 ,$51.24 ,$102.66 ,$15.21 ,$120.41 ,$15.21 ,$155.55 ,$155.55 ,$15.21 ,$155.55 ,$28.90 ,$124.44 ,$38.03 ,$15.21 ,$15.21 ,$137.25 ,$129.93 ,$129.93 ,$15.21 ,$129.93 ,$150.06 ,$150.06 ,$150.06 , N/A ,$38.03 ,$155.55 ,$15.21 ,$183.00 ,$109.25 ,$15.21 ,$76.13 ,$12.66 ,$11.51 ,$15.21 ,$155.55 ,$31.94 ,$155.55 ,$51.24 ,$164.70 ,$15.21 ,$150.06 ,$60.84 ,$60.84 ,$15.21 ,$118.95 ,$183.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200897,86658,HC ENTEROVIRUS AB-90,302,1 ,$31.00 ,$20.15 ,$8.68 ,$32.58 ,$32.58 ,$20.15 ,$18.51 ,$13.03 ,$8.68 ,$17.39 ,$13.03 ,$20.40 ,$13.03 ,$26.35 ,$26.35 ,$13.03 ,$26.35 ,$24.76 ,$21.08 ,$32.58 ,$13.03 ,$13.03 ,$23.25 ,$22.01 ,$22.01 ,$13.03 ,$22.01 ,$25.42 ,$25.42 ,$25.42 , N/A ,$31.00 ,$26.35 ,$13.03 ,$31.00 ,$18.51 ,$13.03 ,$12.90 ,$12.66 ,$11.51 ,$13.03 ,$26.35 ,$27.36 ,$26.35 ,$8.68 ,$27.90 ,$13.03 ,$25.42 ,$31.00 ,$31.00 ,$13.03 ,$20.15 ,$31.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200898,86663,HC EBV EARLY AG-90,302,1 ,$94.00 ,$61.10 ,$11.51 ,$94.00 ,$32.80 ,$61.10 ,$56.12 ,$13.12 ,$26.32 ,$52.73 ,$13.12 ,$61.85 ,$13.12 ,$79.90 ,$79.90 ,$13.12 ,$79.90 ,$24.93 ,$63.92 ,$32.80 ,$13.12 ,$13.12 ,$70.50 ,$66.74 ,$66.74 ,$13.12 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$32.80 ,$79.90 ,$13.12 ,$94.00 ,$56.12 ,$13.12 ,$39.10 ,$12.66 ,$11.51 ,$13.12 ,$79.90 ,$27.55 ,$79.90 ,$26.32 ,$84.60 ,$13.12 ,$77.08 ,$52.48 ,$52.48 ,$13.12 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200899,86664,HC EBV NUCLEAR AG-90,302,1 ,$64.00 ,$41.60 ,$11.51 ,$64.00 ,$38.23 ,$41.60 ,$38.21 ,$15.29 ,$17.92 ,$35.90 ,$15.29 ,$42.11 ,$15.29 ,$54.40 ,$54.40 ,$15.29 ,$54.40 ,$29.05 ,$43.52 ,$38.23 ,$15.29 ,$15.29 ,$48.00 ,$45.44 ,$45.44 ,$15.29 ,$45.44 ,$52.48 ,$52.48 ,$52.48 , N/A ,$38.23 ,$54.40 ,$15.29 ,$64.00 ,$38.21 ,$15.29 ,$26.62 ,$12.66 ,$11.51 ,$15.29 ,$54.40 ,$32.11 ,$54.40 ,$17.92 ,$57.60 ,$15.29 ,$52.48 ,$61.16 ,$61.16 ,$15.29 ,$41.60 ,$64.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200900,86665,HC EBV VIRAL CAP-90,302,1 ,$79.00 ,$51.35 ,$11.51 ,$79.00 ,$45.35 ,$51.35 ,$47.16 ,$18.14 ,$22.12 ,$44.32 ,$18.14 ,$51.98 ,$18.14 ,$67.15 ,$67.15 ,$18.14 ,$67.15 ,$34.47 ,$53.72 ,$45.35 ,$18.14 ,$18.14 ,$59.25 ,$56.09 ,$56.09 ,$18.14 ,$56.09 ,$64.78 ,$64.78 ,$64.78 , N/A ,$45.35 ,$67.15 ,$18.14 ,$79.00 ,$47.16 ,$18.14 ,$32.86 ,$12.66 ,$11.51 ,$18.14 ,$67.15 ,$38.09 ,$67.15 ,$22.12 ,$71.10 ,$18.14 ,$64.78 ,$72.56 ,$72.56 ,$18.14 ,$51.35 ,$79.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200901,86666,HC EHRLICHIA AB-90,302,1 ,$151.00 ,$98.15 ,$10.18 ,$151.00 ,$25.45 ,$98.15 ,$90.15 ,$10.18 ,$42.28 ,$84.71 ,$10.18 ,$99.36 ,$10.18 ,$128.35 ,$128.35 ,$10.18 ,$128.35 ,$19.34 ,$102.68 ,$25.45 ,$10.18 ,$10.18 ,$113.25 ,$107.21 ,$107.21 ,$10.18 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$25.45 ,$128.35 ,$10.18 ,$151.00 ,$90.15 ,$10.18 ,$62.82 ,$12.66 ,$11.51 ,$10.18 ,$128.35 ,$21.38 ,$128.35 ,$42.28 ,$135.90 ,$10.18 ,$123.82 ,$40.72 ,$40.72 ,$10.18 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200902,86668,HC FRANCISELLA AB-90,302,1 ,$184.00 ,$119.60 ,$11.51 ,$184.00 ,$35.40 ,$119.60 ,$109.85 ,$14.16 ,$51.52 ,$103.22 ,$14.16 ,$121.07 ,$14.16 ,$156.40 ,$156.40 ,$14.16 ,$156.40 ,$26.90 ,$125.12 ,$35.40 ,$14.16 ,$14.16 ,$138.00 ,$130.64 ,$130.64 ,$14.16 ,$130.64 ,$150.88 ,$150.88 ,$150.88 , N/A ,$35.40 ,$156.40 ,$14.16 ,$184.00 ,$109.85 ,$14.16 ,$76.54 ,$12.66 ,$11.51 ,$14.16 ,$156.40 ,$29.74 ,$156.40 ,$51.52 ,$165.60 ,$14.16 ,$150.88 ,$56.64 ,$56.64 ,$14.16 ,$119.60 ,$184.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200903,86671,HC FUNGUS AB NOS-90,302,1 ,$156.00 ,$101.40 ,$6.68 ,$156.00 ,$30.63 ,$101.40 ,$93.13 ,$12.25 ,$43.68 ,$87.52 ,$12.25 ,$102.65 ,$12.25 ,$132.60 ,$132.60 ,$12.25 ,$132.60 ,$23.28 ,$106.08 ,$30.63 ,$12.25 ,$12.25 ,$117.00 ,$110.76 ,$110.76 ,$12.25 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$30.63 ,$132.60 ,$12.25 ,$156.00 ,$93.13 ,$12.25 ,$64.90 ,$7.35 ,$6.68 ,$12.25 ,$132.60 ,$25.73 ,$132.60 ,$43.68 ,$140.40 ,$12.25 ,$127.92 ,$49.00 ,$49.00 ,$12.25 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200906,86682,HC HELMINTH ANTIBODY-90,302,1 ,$94.00 ,$61.10 ,$6.68 ,$94.00 ,$32.53 ,$61.10 ,$56.12 ,$13.01 ,$26.32 ,$52.73 ,$13.01 ,$61.85 ,$13.01 ,$79.90 ,$79.90 ,$13.01 ,$79.90 ,$24.72 ,$63.92 ,$32.53 ,$13.01 ,$13.01 ,$70.50 ,$66.74 ,$66.74 ,$13.01 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$32.53 ,$79.90 ,$13.01 ,$94.00 ,$56.12 ,$13.01 ,$39.10 ,$7.35 ,$6.68 ,$13.01 ,$79.90 ,$27.32 ,$79.90 ,$26.32 ,$84.60 ,$13.01 ,$77.08 ,$52.04 ,$52.04 ,$13.01 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200907,86684,HC HAEMOPHILUS INFLUENZA AB-90,302,1 ,$183.00 ,$118.95 ,$6.68 ,$183.00 ,$39.60 ,$118.95 ,$109.25 ,$15.84 ,$51.24 ,$102.66 ,$15.84 ,$120.41 ,$15.84 ,$155.55 ,$155.55 ,$15.84 ,$155.55 ,$30.10 ,$124.44 ,$39.60 ,$15.84 ,$15.84 ,$137.25 ,$129.93 ,$129.93 ,$15.84 ,$129.93 ,$150.06 ,$150.06 ,$150.06 , N/A ,$39.60 ,$155.55 ,$15.84 ,$183.00 ,$109.25 ,$15.84 ,$76.13 ,$7.35 ,$6.68 ,$15.84 ,$155.55 ,$33.26 ,$155.55 ,$51.24 ,$164.70 ,$15.84 ,$150.06 ,$63.36 ,$63.36 ,$15.84 ,$118.95 ,$183.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200909,86689,HC HTLV OR HIV AB CONF-90,302,1 ,$124.00 ,$80.60 ,$11.51 ,$124.00 ,$48.38 ,$80.60 ,$74.03 ,$19.35 ,$34.72 ,$69.56 ,$19.35 ,$81.59 ,$19.35 ,$105.40 ,$105.40 ,$19.35 ,$105.40 ,$36.77 ,$84.32 ,$48.38 ,$19.35 ,$19.35 ,$93.00 ,$88.04 ,$88.04 ,$19.35 ,$88.04 ,$101.68 ,$101.68 ,$101.68 , N/A ,$48.38 ,$105.40 ,$19.35 ,$124.00 ,$74.03 ,$19.35 ,$51.58 ,$12.66 ,$11.51 ,$19.35 ,$105.40 ,$40.64 ,$105.40 ,$34.72 ,$111.60 ,$19.35 ,$101.68 ,$77.40 ,$77.40 ,$19.35 ,$80.60 ,$124.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200910,86692,HC HEPATITIS D AB-90,302,1 ,$22.94 ,$14.91 ,$6.42 ,$42.90 ,$42.90 ,$14.91 ,$13.70 ,$17.16 ,$6.42 ,$12.87 ,$17.16 ,$15.09 ,$17.16 ,$19.50 ,$19.50 ,$17.16 ,$19.50 ,$22.94 ,$15.60 ,$42.90 ,$17.16 ,$17.16 ,$17.21 ,$16.29 ,$16.29 ,$17.16 ,$16.29 ,$18.81 ,$18.81 ,$18.81 , N/A ,$22.94 ,$19.50 ,$17.16 ,$22.94 ,$13.70 ,$17.16 ,$9.54 ,$7.35 ,$6.68 ,$17.16 ,$19.50 ,$36.04 ,$19.50 ,$6.42 ,$20.65 ,$17.16 ,$18.81 ,$22.94 ,$22.94 ,$17.16 ,$14.91 ,$22.94 
ST. JOSEPH'S HOSPITAL - BREESE,30200912,86695,HC HERPES SIMPLEX AB I-90,302,1 ,$87.00 ,$56.55 ,$11.51 ,$87.00 ,$32.98 ,$56.55 ,$51.94 ,$13.19 ,$24.36 ,$48.81 ,$13.19 ,$57.25 ,$13.19 ,$73.95 ,$73.95 ,$13.19 ,$73.95 ,$25.06 ,$59.16 ,$32.98 ,$13.19 ,$13.19 ,$65.25 ,$61.77 ,$61.77 ,$13.19 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$32.98 ,$73.95 ,$13.19 ,$87.00 ,$51.94 ,$13.19 ,$36.19 ,$12.66 ,$11.51 ,$13.19 ,$73.95 ,$27.70 ,$73.95 ,$24.36 ,$78.30 ,$13.19 ,$71.34 ,$52.76 ,$52.76 ,$13.19 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200913,86696,HC HERPES SIMPLEX AB II-90,302,1 ,$118.00 ,$76.70 ,$6.68 ,$118.00 ,$48.38 ,$76.70 ,$70.45 ,$19.35 ,$33.04 ,$66.20 ,$19.35 ,$77.64 ,$19.35 ,$100.30 ,$100.30 ,$19.35 ,$100.30 ,$36.77 ,$80.24 ,$48.38 ,$19.35 ,$19.35 ,$88.50 ,$83.78 ,$83.78 ,$19.35 ,$83.78 ,$96.76 ,$96.76 ,$96.76 , N/A ,$48.38 ,$100.30 ,$19.35 ,$118.00 ,$70.45 ,$19.35 ,$49.09 ,$7.35 ,$6.68 ,$19.35 ,$100.30 ,$40.64 ,$100.30 ,$33.04 ,$106.20 ,$19.35 ,$96.76 ,$77.40 ,$77.40 ,$19.35 ,$76.70 ,$118.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200914,86698,HC HISTOPLASMA AB-90,302,1 ,$124.00 ,$80.60 ,$11.51 ,$124.00 ,$34.48 ,$80.60 ,$74.03 ,$13.79 ,$34.72 ,$69.56 ,$13.79 ,$81.59 ,$13.79 ,$105.40 ,$105.40 ,$13.79 ,$105.40 ,$26.20 ,$84.32 ,$34.48 ,$13.79 ,$13.79 ,$93.00 ,$88.04 ,$88.04 ,$13.79 ,$88.04 ,$101.68 ,$101.68 ,$101.68 , N/A ,$34.48 ,$105.40 ,$13.79 ,$124.00 ,$74.03 ,$13.79 ,$51.58 ,$12.66 ,$11.51 ,$13.79 ,$105.40 ,$28.96 ,$105.40 ,$34.72 ,$111.60 ,$13.79 ,$101.68 ,$55.16 ,$55.16 ,$13.79 ,$80.60 ,$124.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200915,86701,HC HIV-1 AB-90,302,1 ,$50.00 ,$32.50 ,$6.68 ,$50.00 ,$22.23 ,$32.50 ,$29.85 ,$8.89 ,$14.00 ,$28.05 ,$8.89 ,$32.90 ,$8.89 ,$42.50 ,$42.50 ,$8.89 ,$42.50 ,$16.89 ,$34.00 ,$22.23 ,$8.89 ,$8.89 ,$37.50 ,$35.50 ,$35.50 ,$8.89 ,$35.50 ,$41.00 ,$41.00 ,$41.00 , N/A ,$22.23 ,$42.50 ,$8.89 ,$50.00 ,$29.85 ,$8.89 ,$20.80 ,$7.35 ,$6.68 ,$8.89 ,$42.50 ,$18.67 ,$42.50 ,$14.00 ,$45.00 ,$8.89 ,$41.00 ,$35.56 ,$35.56 ,$8.89 ,$32.50 ,$50.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200918,86702,HC HIV-2 AB-90,302,1 ,$50.00 ,$32.50 ,$6.68 ,$50.00 ,$33.80 ,$32.50 ,$29.85 ,$13.52 ,$14.00 ,$28.05 ,$13.52 ,$32.90 ,$13.52 ,$42.50 ,$42.50 ,$13.52 ,$42.50 ,$25.69 ,$34.00 ,$33.80 ,$13.52 ,$13.52 ,$37.50 ,$35.50 ,$35.50 ,$13.52 ,$35.50 ,$41.00 ,$41.00 ,$41.00 , N/A ,$33.80 ,$42.50 ,$13.52 ,$50.00 ,$29.85 ,$13.52 ,$20.80 ,$7.35 ,$6.68 ,$13.52 ,$42.50 ,$28.39 ,$42.50 ,$14.00 ,$45.00 ,$13.52 ,$41.00 ,$50.00 ,$50.00 ,$13.52 ,$32.50 ,$50.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200923,86707,HC HEP B E AB-90,302,1 ,$78.00 ,$50.70 ,$6.68 ,$78.00 ,$28.93 ,$50.70 ,$46.57 ,$11.57 ,$21.84 ,$43.76 ,$11.57 ,$51.32 ,$11.57 ,$66.30 ,$66.30 ,$11.57 ,$66.30 ,$21.98 ,$53.04 ,$28.93 ,$11.57 ,$11.57 ,$58.50 ,$55.38 ,$55.38 ,$11.57 ,$55.38 ,$63.96 ,$63.96 ,$63.96 , N/A ,$28.93 ,$66.30 ,$11.57 ,$78.00 ,$46.57 ,$11.57 ,$32.45 ,$7.35 ,$6.68 ,$11.57 ,$66.30 ,$24.30 ,$66.30 ,$21.84 ,$70.20 ,$11.57 ,$63.96 ,$46.28 ,$46.28 ,$11.57 ,$50.70 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200924,86708,HC HEP A AB TOTAL-90,302,1 ,$205.00 ,$133.25 ,$6.68 ,$205.00 ,$30.98 ,$133.25 ,$122.39 ,$12.39 ,$57.40 ,$115.01 ,$12.39 ,$134.89 ,$12.39 ,$174.25 ,$174.25 ,$12.39 ,$174.25 ,$23.54 ,$139.40 ,$30.98 ,$12.39 ,$12.39 ,$153.75 ,$145.55 ,$145.55 ,$12.39 ,$145.55 ,$168.10 ,$168.10 ,$168.10 , N/A ,$30.98 ,$174.25 ,$12.39 ,$205.00 ,$122.39 ,$12.39 ,$85.28 ,$7.35 ,$6.68 ,$12.39 ,$174.25 ,$26.02 ,$174.25 ,$57.40 ,$184.50 ,$12.39 ,$168.10 ,$49.56 ,$49.56 ,$12.39 ,$133.25 ,$205.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200926,86710,HC INFLUENZA AB-90,302,1 ,$145.00 ,$94.25 ,$6.68 ,$145.00 ,$33.88 ,$94.25 ,$86.57 ,$13.55 ,$40.60 ,$81.35 ,$13.55 ,$95.41 ,$13.55 ,$123.25 ,$123.25 ,$13.55 ,$123.25 ,$25.75 ,$98.60 ,$33.88 ,$13.55 ,$13.55 ,$108.75 ,$102.95 ,$102.95 ,$13.55 ,$102.95 ,$118.90 ,$118.90 ,$118.90 , N/A ,$33.88 ,$123.25 ,$13.55 ,$145.00 ,$86.57 ,$13.55 ,$60.32 ,$7.35 ,$6.68 ,$13.55 ,$123.25 ,$28.46 ,$123.25 ,$40.60 ,$130.50 ,$13.55 ,$118.90 ,$54.20 ,$54.20 ,$13.55 ,$94.25 ,$145.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200927,86713,HC LEGIONELLA AB-90,302,1 ,$86.00 ,$55.90 ,$11.51 ,$86.00 ,$38.25 ,$55.90 ,$51.34 ,$15.30 ,$24.08 ,$48.25 ,$15.30 ,$56.59 ,$15.30 ,$73.10 ,$73.10 ,$15.30 ,$73.10 ,$29.07 ,$58.48 ,$38.25 ,$15.30 ,$15.30 ,$64.50 ,$61.06 ,$61.06 ,$15.30 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$38.25 ,$73.10 ,$15.30 ,$86.00 ,$51.34 ,$15.30 ,$35.78 ,$12.66 ,$11.51 ,$15.30 ,$73.10 ,$32.13 ,$73.10 ,$24.08 ,$77.40 ,$15.30 ,$70.52 ,$61.20 ,$61.20 ,$15.30 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200931,86735,HC MUMPS AB-90,302,1 ,$126.00 ,$81.90 ,$6.68 ,$126.00 ,$32.63 ,$81.90 ,$75.22 ,$13.05 ,$35.28 ,$70.69 ,$13.05 ,$82.91 ,$13.05 ,$107.10 ,$107.10 ,$13.05 ,$107.10 ,$24.80 ,$85.68 ,$32.63 ,$13.05 ,$13.05 ,$94.50 ,$89.46 ,$89.46 ,$13.05 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$32.63 ,$107.10 ,$13.05 ,$126.00 ,$75.22 ,$13.05 ,$52.42 ,$7.35 ,$6.68 ,$13.05 ,$107.10 ,$27.41 ,$107.10 ,$35.28 ,$113.40 ,$13.05 ,$103.32 ,$52.20 ,$52.20 ,$13.05 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200932,86738,HC MYCOPLASMA AB-90,302,1 ,$126.00 ,$81.90 ,$11.51 ,$126.00 ,$33.10 ,$81.90 ,$75.22 ,$13.24 ,$35.28 ,$70.69 ,$13.24 ,$82.91 ,$13.24 ,$107.10 ,$107.10 ,$13.24 ,$107.10 ,$25.16 ,$85.68 ,$33.10 ,$13.24 ,$13.24 ,$94.50 ,$89.46 ,$89.46 ,$13.24 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$33.10 ,$107.10 ,$13.24 ,$126.00 ,$75.22 ,$13.24 ,$52.42 ,$12.66 ,$11.51 ,$13.24 ,$107.10 ,$27.80 ,$107.10 ,$35.28 ,$113.40 ,$13.24 ,$103.32 ,$52.96 ,$52.96 ,$13.24 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200935,86747,HC PARVOVIRUS AB-90,302,1 ,$139.00 ,$90.35 ,$11.51 ,$139.00 ,$37.58 ,$90.35 ,$82.98 ,$15.03 ,$38.92 ,$77.98 ,$15.03 ,$91.46 ,$15.03 ,$118.15 ,$118.15 ,$15.03 ,$118.15 ,$28.56 ,$94.52 ,$37.58 ,$15.03 ,$15.03 ,$104.25 ,$98.69 ,$98.69 ,$15.03 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$37.58 ,$118.15 ,$15.03 ,$139.00 ,$82.98 ,$15.03 ,$57.82 ,$12.66 ,$11.51 ,$15.03 ,$118.15 ,$31.56 ,$118.15 ,$38.92 ,$125.10 ,$15.03 ,$113.98 ,$60.12 ,$60.12 ,$15.03 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200937,86753,HC PROTOZOA AB-90,302,1 ,$118.00 ,$76.70 ,$6.68 ,$118.00 ,$30.98 ,$76.70 ,$70.45 ,$12.39 ,$33.04 ,$66.20 ,$12.39 ,$77.64 ,$12.39 ,$100.30 ,$100.30 ,$12.39 ,$100.30 ,$23.54 ,$80.24 ,$30.98 ,$12.39 ,$12.39 ,$88.50 ,$83.78 ,$83.78 ,$12.39 ,$83.78 ,$96.76 ,$96.76 ,$96.76 , N/A ,$30.98 ,$100.30 ,$12.39 ,$118.00 ,$70.45 ,$12.39 ,$49.09 ,$7.35 ,$6.68 ,$12.39 ,$100.30 ,$26.02 ,$100.30 ,$33.04 ,$106.20 ,$12.39 ,$96.76 ,$49.56 ,$49.56 ,$12.39 ,$76.70 ,$118.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200939,86757,HC RICKETTSIA AB-90,302,1 ,$59.00 ,$38.35 ,$11.51 ,$59.00 ,$48.38 ,$38.35 ,$35.22 ,$19.35 ,$16.52 ,$33.10 ,$19.35 ,$38.82 ,$19.35 ,$50.15 ,$50.15 ,$19.35 ,$50.15 ,$36.77 ,$40.12 ,$48.38 ,$19.35 ,$19.35 ,$44.25 ,$41.89 ,$41.89 ,$19.35 ,$41.89 ,$48.38 ,$48.38 ,$48.38 , N/A ,$48.38 ,$50.15 ,$19.35 ,$59.00 ,$35.22 ,$19.35 ,$24.54 ,$12.66 ,$11.51 ,$19.35 ,$50.15 ,$40.64 ,$50.15 ,$16.52 ,$53.10 ,$19.35 ,$48.38 ,$59.00 ,$59.00 ,$19.35 ,$38.35 ,$59.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200941,86765,HC RUBEOLA AB-90,302,1 ,$122.00 ,$79.30 ,$6.68 ,$122.00 ,$32.20 ,$79.30 ,$72.83 ,$12.88 ,$34.16 ,$68.44 ,$12.88 ,$80.28 ,$12.88 ,$103.70 ,$103.70 ,$12.88 ,$103.70 ,$24.47 ,$82.96 ,$32.20 ,$12.88 ,$12.88 ,$91.50 ,$86.62 ,$86.62 ,$12.88 ,$86.62 ,$100.04 ,$100.04 ,$100.04 , N/A ,$32.20 ,$103.70 ,$12.88 ,$122.00 ,$72.83 ,$12.88 ,$50.75 ,$7.35 ,$6.68 ,$12.88 ,$103.70 ,$27.05 ,$103.70 ,$34.16 ,$109.80 ,$12.88 ,$100.04 ,$51.52 ,$51.52 ,$12.88 ,$79.30 ,$122.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200943,86774,HC TETANUS AB-90,302,1 ,$132.00 ,$85.80 ,$11.51 ,$132.00 ,$37.00 ,$85.80 ,$78.80 ,$14.80 ,$36.96 ,$74.05 ,$14.80 ,$86.86 ,$14.80 ,$112.20 ,$112.20 ,$14.80 ,$112.20 ,$28.12 ,$89.76 ,$37.00 ,$14.80 ,$14.80 ,$99.00 ,$93.72 ,$93.72 ,$14.80 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$37.00 ,$112.20 ,$14.80 ,$132.00 ,$78.80 ,$14.80 ,$54.91 ,$12.66 ,$11.51 ,$14.80 ,$112.20 ,$31.08 ,$112.20 ,$36.96 ,$118.80 ,$14.80 ,$108.24 ,$59.20 ,$59.20 ,$14.80 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200944,86777,HC TOXOPLASMA AB-90,302,1 ,$115.00 ,$74.75 ,$11.51 ,$115.00 ,$35.98 ,$74.75 ,$68.66 ,$14.39 ,$32.20 ,$64.52 ,$14.39 ,$75.67 ,$14.39 ,$97.75 ,$97.75 ,$14.39 ,$97.75 ,$27.34 ,$78.20 ,$35.98 ,$14.39 ,$14.39 ,$86.25 ,$81.65 ,$81.65 ,$14.39 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$35.98 ,$97.75 ,$14.39 ,$115.00 ,$68.66 ,$14.39 ,$47.84 ,$12.66 ,$11.51 ,$14.39 ,$97.75 ,$30.22 ,$97.75 ,$32.20 ,$103.50 ,$14.39 ,$94.30 ,$57.56 ,$57.56 ,$14.39 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200945,86778,HC TOXOPLASMA AB IGM-90,302,1 ,$115.00 ,$74.75 ,$11.51 ,$115.00 ,$36.03 ,$74.75 ,$68.66 ,$14.41 ,$32.20 ,$64.52 ,$14.41 ,$75.67 ,$14.41 ,$97.75 ,$97.75 ,$14.41 ,$97.75 ,$27.38 ,$78.20 ,$36.03 ,$14.41 ,$14.41 ,$86.25 ,$81.65 ,$81.65 ,$14.41 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$36.03 ,$97.75 ,$14.41 ,$115.00 ,$68.66 ,$14.41 ,$47.84 ,$12.66 ,$11.51 ,$14.41 ,$97.75 ,$30.26 ,$97.75 ,$32.20 ,$103.50 ,$14.41 ,$94.30 ,$57.64 ,$57.64 ,$14.41 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200946,86780,HC TREPONEMA P AB CONFIRM-90,302,1 ,$95.00 ,$61.75 ,$11.51 ,$95.00 ,$33.10 ,$61.75 ,$56.72 ,$13.24 ,$26.60 ,$53.30 ,$13.24 ,$62.51 ,$13.24 ,$80.75 ,$80.75 ,$13.24 ,$80.75 ,$25.16 ,$64.60 ,$33.10 ,$13.24 ,$13.24 ,$71.25 ,$67.45 ,$67.45 ,$13.24 ,$67.45 ,$77.90 ,$77.90 ,$77.90 , N/A ,$33.10 ,$80.75 ,$13.24 ,$95.00 ,$56.72 ,$13.24 ,$39.52 ,$12.66 ,$11.51 ,$13.24 ,$80.75 ,$27.80 ,$80.75 ,$26.60 ,$85.50 ,$13.24 ,$77.90 ,$52.96 ,$52.96 ,$13.24 ,$61.75 ,$95.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200947,86784,HC TRICHANELLA AB-90,302,1 ,$76.00 ,$49.40 ,$11.51 ,$76.00 ,$31.40 ,$49.40 ,$45.37 ,$12.56 ,$21.28 ,$42.64 ,$12.56 ,$50.01 ,$12.56 ,$64.60 ,$64.60 ,$12.56 ,$64.60 ,$23.86 ,$51.68 ,$31.40 ,$12.56 ,$12.56 ,$57.00 ,$53.96 ,$53.96 ,$12.56 ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A ,$31.40 ,$64.60 ,$12.56 ,$76.00 ,$45.37 ,$12.56 ,$31.62 ,$12.66 ,$11.51 ,$12.56 ,$64.60 ,$26.38 ,$64.60 ,$21.28 ,$68.40 ,$12.56 ,$62.32 ,$50.24 ,$50.24 ,$12.56 ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200948,86787,HC VARICELLA ZOSTER AB-90,302,1 ,$146.00 ,$94.90 ,$6.68 ,$146.00 ,$32.20 ,$94.90 ,$87.16 ,$12.88 ,$40.88 ,$81.91 ,$12.88 ,$96.07 ,$12.88 ,$124.10 ,$124.10 ,$12.88 ,$124.10 ,$24.47 ,$99.28 ,$32.20 ,$12.88 ,$12.88 ,$109.50 ,$103.66 ,$103.66 ,$12.88 ,$103.66 ,$119.72 ,$119.72 ,$119.72 , N/A ,$32.20 ,$124.10 ,$12.88 ,$146.00 ,$87.16 ,$12.88 ,$60.74 ,$7.35 ,$6.68 ,$12.88 ,$124.10 ,$27.05 ,$124.10 ,$40.88 ,$131.40 ,$12.88 ,$119.72 ,$51.52 ,$51.52 ,$12.88 ,$94.90 ,$146.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200951,86790,HC VIRUS AB NOT SPECIFIED-90,302,1 ,$118.00 ,$76.70 ,$6.68 ,$118.00 ,$32.20 ,$76.70 ,$70.45 ,$12.88 ,$33.04 ,$66.20 ,$12.88 ,$77.64 ,$12.88 ,$100.30 ,$100.30 ,$12.88 ,$100.30 ,$24.47 ,$80.24 ,$32.20 ,$12.88 ,$12.88 ,$88.50 ,$83.78 ,$83.78 ,$12.88 ,$83.78 ,$96.76 ,$96.76 ,$96.76 , N/A ,$32.20 ,$100.30 ,$12.88 ,$118.00 ,$70.45 ,$12.88 ,$49.09 ,$7.35 ,$6.68 ,$12.88 ,$100.30 ,$27.05 ,$100.30 ,$33.04 ,$106.20 ,$12.88 ,$96.76 ,$51.52 ,$51.52 ,$12.88 ,$76.70 ,$118.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200953,86800,HC THYROGLOBULIN AB-90,302,1 ,$151.00 ,$98.15 ,$15.91 ,$151.00 ,$39.78 ,$98.15 ,$90.15 ,$15.91 ,$42.28 ,$84.71 ,$15.91 ,$99.36 ,$15.91 ,$128.35 ,$128.35 ,$15.91 ,$128.35 ,$30.23 ,$102.68 ,$39.78 ,$15.91 ,$15.91 ,$113.25 ,$107.21 ,$107.21 ,$15.91 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$39.78 ,$128.35 ,$15.91 ,$151.00 ,$90.15 ,$15.91 ,$62.82 ,$19.21 ,$17.46 ,$15.91 ,$128.35 ,$33.41 ,$128.35 ,$42.28 ,$135.90 ,$15.91 ,$123.82 ,$63.64 ,$63.64 ,$15.91 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200954,86803,HC HEP C AB-90,302,1 ,$10.00 ,$6.50 ,$2.80 ,$25.00 ,$25.00 ,$6.50 ,$5.97 ,$10.00 ,$2.80 ,$5.61 ,$10.00 ,$6.58 ,$10.00 ,$8.50 ,$8.50 ,$10.00 ,$8.50 ,$10.00 ,$6.80 ,$25.00 ,$10.00 ,$10.00 ,$7.50 ,$7.10 ,$7.10 ,$10.00 ,$7.10 ,$8.20 ,$8.20 ,$8.20 , N/A ,$10.00 ,$8.50 ,$10.00 ,$10.00 ,$5.97 ,$10.00 ,$4.16 ,$10.00 ,$10.00 ,$10.00 ,$8.50 ,$21.00 ,$8.50 ,$2.80 ,$9.00 ,$10.00 ,$8.20 ,$10.00 ,$10.00 ,$10.00 ,$6.50 ,$10.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200960,86812,HC HLA TYPING SINGLE A/B/C-90,302,1 ,$189.00 ,$122.85 ,$25.81 ,$189.00 ,$64.53 ,$122.85 ,$112.83 ,$25.81 ,$52.92 ,$106.03 ,$25.81 ,$124.36 ,$25.81 ,$160.65 ,$160.65 ,$25.81 ,$160.65 ,$49.04 ,$128.52 ,$64.53 ,$25.81 ,$25.81 ,$141.75 ,$134.19 ,$134.19 ,$25.81 ,$134.19 ,$154.98 ,$154.98 ,$154.98 , N/A ,$64.53 ,$160.65 ,$25.81 ,$189.00 ,$112.83 ,$25.81 ,$78.62 ,$29.66 ,$26.96 ,$25.81 ,$160.65 ,$54.20 ,$160.65 ,$52.92 ,$170.10 ,$25.81 ,$154.98 ,$103.24 ,$103.24 ,$25.81 ,$122.85 ,$189.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200966,86850,HC AB SCREEN-90,302,1 ,$101.00 ,$65.65 ,$6.68 ,$122.48 ,$122.48 ,$65.65 ,$60.30 ,$48.99 ,$28.28 ,$56.66 ,$48.99 ,$66.46 ,$48.99 ,$85.85 ,$85.85 ,$48.99 ,$85.85 ,$93.08 ,$68.68 ,$122.48 ,$48.99 ,$48.99 ,$75.75 ,$71.71 ,$71.71 ,$48.99 ,$71.71 ,$82.82 ,$82.82 ,$82.82 , N/A ,$101.00 ,$85.85 ,$48.99 ,$101.00 ,$60.30 ,$48.99 ,$42.02 ,$7.35 ,$6.68 ,$48.99 ,$85.85 ,$102.88 ,$85.85 ,$28.28 ,$90.90 ,$48.99 ,$82.82 ,$39.08 ,$39.08 ,$48.99 ,$65.65 ,$101.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200970,86860,HC ELUTION-90,302,1 ,$244.00 ,$158.60 ,$6.68 ,$367.60 ,$367.60 ,$158.60 ,$145.67 ,$147.04 ,$68.32 ,$136.88 ,$147.04 ,$160.55 ,$147.04 ,$207.40 ,$207.40 ,$147.04 ,$207.40 ,$244.00 ,$165.92 ,$367.59 ,$147.04 ,$147.04 ,$183.00 ,$173.24 ,$173.24 ,$147.04 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$147.04 ,$244.00 ,$145.67 ,$147.04 ,$101.50 ,$7.35 ,$6.68 ,$147.04 ,$207.40 ,$308.78 ,$207.40 ,$68.32 ,$219.60 ,$147.04 ,$200.08 ,$244.00 ,$244.00 ,$147.04 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200974,86870,HC RBC AB ID PANEL-90,302,1 ,$200.00 ,$130.00 ,$6.68 ,$717.84 ,$717.83 ,$130.00 ,$119.40 ,$287.13 ,$56.00 ,$112.20 ,$287.13 ,$131.60 ,$200.00 ,$170.00 ,$170.00 ,$200.00 ,$170.00 ,$200.00 ,$136.00 ,$717.84 ,$287.13 ,$287.13 ,$150.00 ,$142.00 ,$142.00 ,$287.13 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$200.00 ,$170.00 ,$287.13 ,$200.00 ,$119.40 ,$287.13 ,$83.20 ,$7.35 ,$6.68 ,$287.13 ,$170.00 ,$602.98 ,$170.00 ,$56.00 ,$180.00 ,$287.13 ,$164.00 ,$200.00 ,$200.00 ,$287.13 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200976,86880,HC COOMBS DIRECT-90,302,1 ,$94.00 ,$61.10 ,$6.68 ,$137.20 ,$137.20 ,$61.10 ,$56.12 ,$54.88 ,$26.32 ,$52.73 ,$54.88 ,$61.85 ,$54.88 ,$79.90 ,$79.90 ,$54.88 ,$79.90 ,$94.00 ,$63.92 ,$137.20 ,$54.88 ,$54.88 ,$70.50 ,$66.74 ,$66.74 ,$54.88 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$94.00 ,$79.90 ,$54.88 ,$94.00 ,$56.12 ,$54.88 ,$39.10 ,$7.35 ,$6.68 ,$54.88 ,$79.90 ,$115.24 ,$79.90 ,$26.32 ,$84.60 ,$54.88 ,$77.08 ,$21.56 ,$21.56 ,$54.88 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200978,86886,HC INDIRECT TITER-90,302,1 ,$223.00 ,$144.95 ,$6.68 ,$367.60 ,$367.60 ,$144.95 ,$133.13 ,$147.04 ,$62.44 ,$125.10 ,$147.04 ,$146.73 ,$147.04 ,$189.55 ,$189.55 ,$147.04 ,$189.55 ,$223.00 ,$151.64 ,$367.59 ,$147.04 ,$147.04 ,$167.25 ,$158.33 ,$158.33 ,$147.04 ,$158.33 ,$182.86 ,$182.86 ,$182.86 , N/A ,$223.00 ,$189.55 ,$147.04 ,$223.00 ,$133.13 ,$147.04 ,$92.77 ,$7.35 ,$6.68 ,$147.04 ,$189.55 ,$308.78 ,$189.55 ,$62.44 ,$200.70 ,$147.04 ,$182.86 ,$20.72 ,$20.72 ,$147.04 ,$144.95 ,$223.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200981,86900,HC BLOOD TYPING ABO-90,302,1 ,$76.00 ,$49.40 ,$4.14 ,$277.93 ,$277.93 ,$49.40 ,$45.37 ,$111.17 ,$21.28 ,$42.64 ,$111.17 ,$50.01 ,$76.00 ,$64.60 ,$64.60 ,$76.00 ,$64.60 ,$76.00 ,$51.68 ,$277.92 ,$111.17 ,$111.17 ,$57.00 ,$53.96 ,$53.96 ,$111.17 ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A ,$76.00 ,$64.60 ,$111.17 ,$76.00 ,$45.37 ,$111.17 ,$31.62 ,$4.55 ,$4.14 ,$111.17 ,$64.60 ,$233.45 ,$64.60 ,$21.28 ,$68.40 ,$111.17 ,$62.32 ,$11.96 ,$11.96 ,$111.17 ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200983,86901,HC BLOOD TYPING RH-90,302,1 ,$76.00 ,$49.40 ,$4.14 ,$83.43 ,$83.43 ,$49.40 ,$45.37 ,$33.37 ,$21.28 ,$42.64 ,$33.37 ,$50.01 ,$33.37 ,$64.60 ,$64.60 ,$33.37 ,$64.60 ,$63.41 ,$51.68 ,$83.43 ,$33.37 ,$33.37 ,$57.00 ,$53.96 ,$53.96 ,$33.37 ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A ,$76.00 ,$64.60 ,$33.37 ,$76.00 ,$45.37 ,$33.37 ,$31.62 ,$4.55 ,$4.14 ,$33.37 ,$64.60 ,$70.08 ,$64.60 ,$21.28 ,$68.40 ,$33.37 ,$62.32 ,$11.96 ,$11.96 ,$33.37 ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200989,86902,HC RBC AG SCR RGT SERUM-90,302,1 ,$101.00 ,$65.65 ,$4.14 ,$717.84 ,$717.83 ,$65.65 ,$60.30 ,$287.13 ,$28.28 ,$56.66 ,$287.13 ,$66.46 ,$101.00 ,$85.85 ,$85.85 ,$101.00 ,$85.85 ,$101.00 ,$68.68 ,$717.84 ,$287.13 ,$287.13 ,$75.75 ,$71.71 ,$71.71 ,$287.13 ,$71.71 ,$82.82 ,$82.82 ,$82.82 , N/A ,$101.00 ,$85.85 ,$287.13 ,$101.00 ,$60.30 ,$287.13 ,$42.02 ,$4.55 ,$4.14 ,$287.13 ,$85.85 ,$602.98 ,$85.85 ,$28.28 ,$90.90 ,$287.13 ,$82.82 ,$25.40 ,$25.40 ,$287.13 ,$65.65 ,$101.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200990,86904,HC RBC AG SCR PAT SERUM-90,302,1 ,$77.00 ,$50.05 ,$4.14 ,$83.43 ,$83.43 ,$50.05 ,$45.97 ,$33.37 ,$21.56 ,$43.20 ,$33.37 ,$50.67 ,$33.37 ,$65.45 ,$65.45 ,$33.37 ,$65.45 ,$63.41 ,$52.36 ,$83.43 ,$33.37 ,$33.37 ,$57.75 ,$54.67 ,$54.67 ,$33.37 ,$54.67 ,$63.14 ,$63.14 ,$63.14 , N/A ,$77.00 ,$65.45 ,$33.37 ,$77.00 ,$45.97 ,$33.37 ,$32.03 ,$4.55 ,$4.14 ,$33.37 ,$65.45 ,$70.08 ,$65.45 ,$21.56 ,$69.30 ,$33.37 ,$63.14 ,$65.36 ,$65.36 ,$33.37 ,$50.05 ,$77.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200997,86905,HC RBC AG TYPING NON ABO/RH-90,302,1 ,$101.00 ,$65.65 ,$4.14 ,$717.84 ,$717.83 ,$65.65 ,$60.30 ,$287.13 ,$28.28 ,$56.66 ,$287.13 ,$66.46 ,$101.00 ,$85.85 ,$85.85 ,$101.00 ,$85.85 ,$101.00 ,$68.68 ,$717.84 ,$287.13 ,$287.13 ,$75.75 ,$71.71 ,$71.71 ,$287.13 ,$71.71 ,$82.82 ,$82.82 ,$82.82 , N/A ,$101.00 ,$85.85 ,$287.13 ,$101.00 ,$60.30 ,$287.13 ,$42.02 ,$4.55 ,$4.14 ,$287.13 ,$85.85 ,$602.98 ,$85.85 ,$28.28 ,$90.90 ,$287.13 ,$82.82 ,$15.32 ,$15.32 ,$287.13 ,$65.65 ,$101.00 
ST. JOSEPH'S HOSPITAL - BREESE,30200998,86906,HC RH PHENOTYPE COMPLETE-90,302,1 ,$115.00 ,$74.75 ,$4.14 ,$115.00 ,$83.43 ,$74.75 ,$68.66 ,$33.37 ,$32.20 ,$64.52 ,$33.37 ,$75.67 ,$33.37 ,$97.75 ,$97.75 ,$33.37 ,$97.75 ,$63.41 ,$78.20 ,$83.43 ,$33.37 ,$33.37 ,$86.25 ,$81.65 ,$81.65 ,$33.37 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$83.43 ,$97.75 ,$33.37 ,$115.00 ,$68.66 ,$33.37 ,$47.84 ,$4.55 ,$4.14 ,$33.37 ,$97.75 ,$70.08 ,$97.75 ,$32.20 ,$103.50 ,$33.37 ,$94.30 ,$31.00 ,$31.00 ,$33.37 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201003,86970,HC RBC PRETREAT CHEM-90,302,1 ,$205.00 ,$133.25 ,$26.96 ,$205.00 ,$83.43 ,$133.25 ,$122.39 ,$33.37 ,$57.40 ,$115.01 ,$33.37 ,$134.89 ,$33.37 ,$174.25 ,$174.25 ,$33.37 ,$174.25 ,$63.41 ,$139.40 ,$83.43 ,$33.37 ,$33.37 ,$153.75 ,$145.55 ,$145.55 ,$33.37 ,$145.55 ,$168.10 ,$168.10 ,$168.10 , N/A ,$83.43 ,$174.25 ,$33.37 ,$205.00 ,$122.39 ,$33.37 ,$85.28 ,$29.66 ,$26.96 ,$33.37 ,$174.25 ,$70.08 ,$174.25 ,$57.40 ,$184.50 ,$33.37 ,$168.10 ,$135.36 ,$135.36 ,$33.37 ,$133.25 ,$205.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201005,86971,HC RBC PRETREAT ENZYME-90,302,1 ,$101.00 ,$65.65 ,$26.96 ,$717.84 ,$717.83 ,$65.65 ,$60.30 ,$287.13 ,$28.28 ,$56.66 ,$287.13 ,$66.46 ,$101.00 ,$85.85 ,$85.85 ,$101.00 ,$85.85 ,$101.00 ,$68.68 ,$717.84 ,$287.13 ,$287.13 ,$75.75 ,$71.71 ,$71.71 ,$287.13 ,$71.71 ,$82.82 ,$82.82 ,$82.82 , N/A ,$101.00 ,$85.85 ,$287.13 ,$101.00 ,$60.30 ,$287.13 ,$42.02 ,$29.66 ,$26.96 ,$287.13 ,$85.85 ,$602.98 ,$85.85 ,$28.28 ,$90.90 ,$287.13 ,$82.82 ,$101.00 ,$101.00 ,$287.13 ,$65.65 ,$101.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201007,86972,HC RBC PRETREAT DENSITY SEP-90,302,1 ,$115.00 ,$74.75 ,$26.96 ,$367.60 ,$367.60 ,$74.75 ,$68.66 ,$147.04 ,$32.20 ,$64.52 ,$147.04 ,$75.67 ,$115.00 ,$97.75 ,$97.75 ,$115.00 ,$97.75 ,$115.00 ,$78.20 ,$367.59 ,$147.04 ,$147.04 ,$86.25 ,$81.65 ,$81.65 ,$147.04 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$115.00 ,$97.75 ,$147.04 ,$115.00 ,$68.66 ,$147.04 ,$47.84 ,$29.66 ,$26.96 ,$147.04 ,$97.75 ,$308.78 ,$97.75 ,$32.20 ,$103.50 ,$147.04 ,$94.30 ,$115.00 ,$115.00 ,$147.04 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201009,86975,HC INCUBATION OF SERUM W/DRUG-90,302,1 ,$166.00 ,$107.90 ,$26.96 ,$668.93 ,$668.93 ,$107.90 ,$99.10 ,$267.57 ,$46.48 ,$93.13 ,$267.57 ,$109.23 ,$166.00 ,$141.10 ,$141.10 ,$166.00 ,$141.10 ,$166.00 ,$112.88 ,$668.92 ,$267.57 ,$267.57 ,$124.50 ,$117.86 ,$117.86 ,$267.57 ,$117.86 ,$136.12 ,$136.12 ,$136.12 , N/A ,$166.00 ,$141.10 ,$267.57 ,$166.00 ,$99.10 ,$267.57 ,$69.06 ,$29.66 ,$26.96 ,$267.57 ,$141.10 ,$561.89 ,$141.10 ,$46.48 ,$149.40 ,$267.57 ,$136.12 ,$166.00 ,$166.00 ,$267.57 ,$107.90 ,$166.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201011,86976,HC RBC PRETREAT SERUM DIL-90,302,1 ,$38.00 ,$24.70 ,$10.64 ,$60.90 ,$60.90 ,$24.70 ,$22.69 ,$24.36 ,$10.64 ,$21.32 ,$24.36 ,$25.00 ,$24.36 ,$32.30 ,$32.30 ,$24.36 ,$32.30 ,$38.00 ,$25.84 ,$60.89 ,$24.36 ,$24.36 ,$28.50 ,$26.98 ,$26.98 ,$24.36 ,$26.98 ,$31.16 ,$31.16 ,$31.16 , N/A ,$38.00 ,$32.30 ,$24.36 ,$38.00 ,$22.69 ,$24.36 ,$15.81 ,$29.66 ,$26.96 ,$24.36 ,$32.30 ,$51.15 ,$32.30 ,$10.64 ,$34.20 ,$24.36 ,$31.16 ,$38.00 ,$38.00 ,$24.36 ,$24.70 ,$38.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201016,86977,HC RBC PRETREAT NEUTRAL SERUM INHIBIT-90,302,1 ,$168.00 ,$109.20 ,$26.96 ,$367.60 ,$367.60 ,$109.20 ,$100.30 ,$147.04 ,$47.04 ,$94.25 ,$147.04 ,$110.54 ,$147.04 ,$142.80 ,$142.80 ,$147.04 ,$142.80 ,$168.00 ,$114.24 ,$367.59 ,$147.04 ,$147.04 ,$126.00 ,$119.28 ,$119.28 ,$147.04 ,$119.28 ,$137.76 ,$137.76 ,$137.76 , N/A ,$168.00 ,$142.80 ,$147.04 ,$168.00 ,$100.30 ,$147.04 ,$69.89 ,$29.66 ,$26.96 ,$147.04 ,$142.80 ,$308.78 ,$142.80 ,$47.04 ,$151.20 ,$147.04 ,$137.76 ,$168.00 ,$168.00 ,$147.04 ,$109.20 ,$168.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201020,86978,HC RBC PRETREAT ABSOR-90,302,1 ,$193.00 ,$125.45 ,$4.14 ,$193.00 ,$83.43 ,$125.45 ,$115.22 ,$33.37 ,$54.04 ,$108.27 ,$33.37 ,$126.99 ,$33.37 ,$164.05 ,$164.05 ,$33.37 ,$164.05 ,$63.41 ,$131.24 ,$83.43 ,$33.37 ,$33.37 ,$144.75 ,$137.03 ,$137.03 ,$33.37 ,$137.03 ,$158.26 ,$158.26 ,$158.26 , N/A ,$83.43 ,$164.05 ,$33.37 ,$193.00 ,$115.22 ,$33.37 ,$80.29 ,$4.55 ,$4.14 ,$33.37 ,$164.05 ,$70.08 ,$164.05 ,$54.04 ,$173.70 ,$33.37 ,$158.26 ,$135.36 ,$135.36 ,$33.37 ,$125.45 ,$193.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201022,87801,HC INFECT MLT  ORG AMP-90,302,1 ,$190.00 ,$123.50 ,$5.33 ,$190.00 ,$175.50 ,$123.50 ,$113.43 ,$70.20 ,$53.20 ,$106.59 ,$70.20 ,$125.02 ,$70.20 ,$161.50 ,$161.50 ,$70.20 ,$161.50 ,$133.38 ,$129.20 ,$175.50 ,$70.20 ,$70.20 ,$142.50 ,$134.90 ,$134.90 ,$70.20 ,$134.90 ,$155.80 ,$155.80 ,$155.80 , N/A ,$175.50 ,$161.50 ,$70.20 ,$190.00 ,$113.43 ,$70.20 ,$79.04 ,$5.86 ,$5.33 ,$70.20 ,$161.50 ,$147.42 ,$161.50 ,$53.20 ,$171.00 ,$70.20 ,$155.80 ,$190.00 ,$190.00 ,$70.20 ,$123.50 ,$190.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201025,86316,HC TUMOR AG OTHER AG QN-90,302,1 ,$323.00 ,$209.95 ,$7.46 ,$323.00 ,$52.03 ,$209.95 ,$192.83 ,$20.81 ,$90.44 ,$181.20 ,$20.81 ,$212.53 ,$20.81 ,$274.55 ,$274.55 ,$20.81 ,$274.55 ,$39.54 ,$219.64 ,$52.03 ,$20.81 ,$20.81 ,$242.25 ,$229.33 ,$229.33 ,$20.81 ,$229.33 ,$264.86 ,$264.86 ,$264.86 , N/A ,$52.03 ,$274.55 ,$20.81 ,$323.00 ,$192.83 ,$20.81 ,$134.37 ,$8.21 ,$7.46 ,$20.81 ,$274.55 ,$43.70 ,$274.55 ,$90.44 ,$290.70 ,$20.81 ,$264.86 ,$83.24 ,$83.24 ,$20.81 ,$209.95 ,$323.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201026,86317,HC INFECTIOUS AB QN-90,302,1 ,$273.70 ,$177.91 ,$11.51 ,$273.70 ,$37.48 ,$177.91 ,$163.40 ,$14.99 ,$76.64 ,$153.55 ,$14.99 ,$180.09 ,$14.99 ,$232.65 ,$232.65 ,$14.99 ,$232.65 ,$28.48 ,$186.12 ,$37.48 ,$14.99 ,$14.99 ,$205.28 ,$194.33 ,$194.33 ,$14.99 ,$194.33 ,$224.43 ,$224.43 ,$224.43 , N/A ,$37.48 ,$232.65 ,$14.99 ,$273.70 ,$163.40 ,$14.99 ,$113.86 ,$12.66 ,$11.51 ,$14.99 ,$232.65 ,$31.48 ,$232.65 ,$76.64 ,$246.33 ,$14.99 ,$224.43 ,$59.96 ,$59.96 ,$14.99 ,$177.91 ,$273.70 
ST. JOSEPH'S HOSPITAL - BREESE,30201029,86331,HC IMMUNODIFF EL EA AG AB QL-90,302,1 ,$40.00 ,$26.00 ,$11.20 ,$40.00 ,$29.95 ,$26.00 ,$23.88 ,$11.98 ,$11.20 ,$22.44 ,$11.98 ,$26.32 ,$11.98 ,$34.00 ,$34.00 ,$11.98 ,$34.00 ,$22.76 ,$27.20 ,$29.95 ,$11.98 ,$11.98 ,$30.00 ,$28.40 ,$28.40 ,$11.98 ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A ,$29.95 ,$34.00 ,$11.98 ,$40.00 ,$23.88 ,$11.98 ,$16.64 ,$12.66 ,$11.51 ,$11.98 ,$34.00 ,$25.16 ,$34.00 ,$11.20 ,$36.00 ,$11.98 ,$32.80 ,$40.00 ,$40.00 ,$11.98 ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201030,86332,HC IMMUNE COMPLEX ASSAY-90,302,1 ,$52.00 ,$33.80 ,$11.51 ,$60.93 ,$60.93 ,$33.80 ,$31.04 ,$24.37 ,$14.56 ,$29.17 ,$24.37 ,$34.22 ,$24.37 ,$44.20 ,$44.20 ,$24.37 ,$44.20 ,$46.30 ,$35.36 ,$60.93 ,$24.37 ,$24.37 ,$39.00 ,$36.92 ,$36.92 ,$24.37 ,$36.92 ,$42.64 ,$42.64 ,$42.64 , N/A ,$52.00 ,$44.20 ,$24.37 ,$52.00 ,$31.04 ,$24.37 ,$21.63 ,$12.66 ,$11.51 ,$24.37 ,$44.20 ,$51.18 ,$44.20 ,$14.56 ,$46.80 ,$24.37 ,$42.64 ,$52.00 ,$52.00 ,$24.37 ,$33.80 ,$52.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201031,86334,HC IMMUNOFIX ELECTRO SERUM -90,302,1 ,$145.00 ,$94.25 ,$11.51 ,$145.00 ,$55.85 ,$94.25 ,$86.57 ,$22.34 ,$40.60 ,$81.35 ,$22.34 ,$95.41 ,$22.34 ,$123.25 ,$123.25 ,$22.34 ,$123.25 ,$42.45 ,$98.60 ,$55.85 ,$22.34 ,$22.34 ,$108.75 ,$102.95 ,$102.95 ,$22.34 ,$102.95 ,$118.90 ,$118.90 ,$118.90 , N/A ,$55.85 ,$123.25 ,$22.34 ,$145.00 ,$86.57 ,$22.34 ,$60.32 ,$12.66 ,$11.51 ,$22.34 ,$123.25 ,$46.91 ,$123.25 ,$40.60 ,$130.50 ,$22.34 ,$118.90 ,$89.36 ,$89.36 ,$22.34 ,$94.25 ,$145.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201032,86335,HC IMMUNOFIX ELECTRO OTH-90,302,1 ,$137.00 ,$89.05 ,$11.51 ,$137.00 ,$73.38 ,$89.05 ,$81.79 ,$29.35 ,$38.36 ,$76.86 ,$29.35 ,$90.15 ,$29.35 ,$116.45 ,$116.45 ,$29.35 ,$116.45 ,$55.77 ,$93.16 ,$73.38 ,$29.35 ,$29.35 ,$102.75 ,$97.27 ,$97.27 ,$29.35 ,$97.27 ,$112.34 ,$112.34 ,$112.34 , N/A ,$73.38 ,$116.45 ,$29.35 ,$137.00 ,$81.79 ,$29.35 ,$56.99 ,$12.66 ,$11.51 ,$29.35 ,$116.45 ,$61.64 ,$116.45 ,$38.36 ,$123.30 ,$29.35 ,$112.34 ,$117.40 ,$117.40 ,$29.35 ,$89.05 ,$137.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201033,86336,HC INHIBIN A-90,302,1 ,$156.00 ,$101.40 ,$7.46 ,$156.00 ,$38.98 ,$101.40 ,$93.13 ,$15.59 ,$43.68 ,$87.52 ,$15.59 ,$102.65 ,$15.59 ,$132.60 ,$132.60 ,$15.59 ,$132.60 ,$29.62 ,$106.08 ,$38.98 ,$15.59 ,$15.59 ,$117.00 ,$110.76 ,$110.76 ,$15.59 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$38.98 ,$132.60 ,$15.59 ,$156.00 ,$93.13 ,$15.59 ,$64.90 ,$8.21 ,$7.46 ,$15.59 ,$132.60 ,$32.74 ,$132.60 ,$43.68 ,$140.40 ,$15.59 ,$127.92 ,$62.36 ,$62.36 ,$15.59 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201034,86337,HC INSULIN AB-90,302,1 ,$154.00 ,$100.10 ,$17.46 ,$154.00 ,$53.53 ,$100.10 ,$91.94 ,$21.41 ,$43.12 ,$86.39 ,$21.41 ,$101.33 ,$21.41 ,$130.90 ,$130.90 ,$21.41 ,$130.90 ,$40.68 ,$104.72 ,$53.53 ,$21.41 ,$21.41 ,$115.50 ,$109.34 ,$109.34 ,$21.41 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$53.53 ,$130.90 ,$21.41 ,$154.00 ,$91.94 ,$21.41 ,$64.06 ,$19.21 ,$17.46 ,$21.41 ,$130.90 ,$44.96 ,$130.90 ,$43.12 ,$138.60 ,$21.41 ,$126.28 ,$85.64 ,$85.64 ,$21.41 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201035,86340,HC INTRINSIC FACTOR AB-90,302,1 ,$97.00 ,$63.05 ,$15.08 ,$97.00 ,$37.70 ,$63.05 ,$57.91 ,$15.08 ,$27.16 ,$54.42 ,$15.08 ,$63.83 ,$15.08 ,$82.45 ,$82.45 ,$15.08 ,$82.45 ,$28.65 ,$65.96 ,$37.70 ,$15.08 ,$15.08 ,$72.75 ,$68.87 ,$68.87 ,$15.08 ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A ,$37.70 ,$82.45 ,$15.08 ,$97.00 ,$57.91 ,$15.08 ,$40.35 ,$19.21 ,$17.46 ,$15.08 ,$82.45 ,$31.67 ,$82.45 ,$27.16 ,$87.30 ,$15.08 ,$79.54 ,$60.32 ,$60.32 ,$15.08 ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201036,86341,HC ISLET CELL AB-90,302,1 ,$213.00 ,$138.45 ,$11.51 ,$213.00 ,$58.93 ,$138.45 ,$127.16 ,$23.57 ,$59.64 ,$119.49 ,$23.57 ,$140.15 ,$23.57 ,$181.05 ,$181.05 ,$23.57 ,$181.05 ,$44.78 ,$144.84 ,$58.93 ,$23.57 ,$23.57 ,$159.75 ,$151.23 ,$151.23 ,$23.57 ,$151.23 ,$174.66 ,$174.66 ,$174.66 , N/A ,$58.93 ,$181.05 ,$23.57 ,$213.00 ,$127.16 ,$23.57 ,$88.61 ,$12.66 ,$11.51 ,$23.57 ,$181.05 ,$49.50 ,$181.05 ,$59.64 ,$191.70 ,$23.57 ,$174.66 ,$94.28 ,$94.28 ,$23.57 ,$138.45 ,$213.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201037,86343,HC LEUKOCYTE HISTAMINE RELEASE-90,302,1 ,$304.00 ,$197.60 ,$11.51 ,$304.00 ,$31.15 ,$197.60 ,$181.49 ,$12.46 ,$85.12 ,$170.54 ,$12.46 ,$200.03 ,$12.46 ,$258.40 ,$258.40 ,$12.46 ,$258.40 ,$23.67 ,$206.72 ,$31.15 ,$12.46 ,$12.46 ,$228.00 ,$215.84 ,$215.84 ,$12.46 ,$215.84 ,$249.28 ,$249.28 ,$249.28 , N/A ,$31.15 ,$258.40 ,$12.46 ,$304.00 ,$181.49 ,$12.46 ,$126.46 ,$12.66 ,$11.51 ,$12.46 ,$258.40 ,$26.17 ,$258.40 ,$85.12 ,$273.60 ,$12.46 ,$249.28 ,$49.84 ,$49.84 ,$12.46 ,$197.60 ,$304.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201040,86355,HC B CELLS TOTAL COUNT-90,302,1 ,$206.00 ,$133.90 ,$11.51 ,$206.00 ,$94.33 ,$133.90 ,$122.98 ,$37.73 ,$57.68 ,$115.57 ,$37.73 ,$135.55 ,$37.73 ,$175.10 ,$175.10 ,$37.73 ,$175.10 ,$71.69 ,$140.08 ,$94.33 ,$37.73 ,$37.73 ,$154.50 ,$146.26 ,$146.26 ,$37.73 ,$146.26 ,$168.92 ,$168.92 ,$168.92 , N/A ,$94.33 ,$175.10 ,$37.73 ,$206.00 ,$122.98 ,$37.73 ,$85.70 ,$12.66 ,$11.51 ,$37.73 ,$175.10 ,$79.23 ,$175.10 ,$57.68 ,$185.40 ,$37.73 ,$168.92 ,$150.92 ,$150.92 ,$37.73 ,$133.90 ,$206.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201042,86357,HC CD8 TOTAL COUNT-90,302,1 ,$201.00 ,$130.65 ,$11.51 ,$201.00 ,$94.33 ,$130.65 ,$120.00 ,$37.73 ,$56.28 ,$112.76 ,$37.73 ,$132.26 ,$37.73 ,$170.85 ,$170.85 ,$37.73 ,$170.85 ,$71.69 ,$136.68 ,$94.33 ,$37.73 ,$37.73 ,$150.75 ,$142.71 ,$142.71 ,$37.73 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$94.33 ,$170.85 ,$37.73 ,$201.00 ,$120.00 ,$37.73 ,$83.62 ,$12.66 ,$11.51 ,$37.73 ,$170.85 ,$79.23 ,$170.85 ,$56.28 ,$180.90 ,$37.73 ,$164.82 ,$150.92 ,$150.92 ,$37.73 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201043,86359,HC T CELLS TOTAL COUNT-90,302,1 ,$201.00 ,$130.65 ,$11.51 ,$201.00 ,$94.33 ,$130.65 ,$120.00 ,$37.73 ,$56.28 ,$112.76 ,$37.73 ,$132.26 ,$37.73 ,$170.85 ,$170.85 ,$37.73 ,$170.85 ,$71.69 ,$136.68 ,$94.33 ,$37.73 ,$37.73 ,$150.75 ,$142.71 ,$142.71 ,$37.73 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$94.33 ,$170.85 ,$37.73 ,$201.00 ,$120.00 ,$37.73 ,$83.62 ,$12.66 ,$11.51 ,$37.73 ,$170.85 ,$79.23 ,$170.85 ,$56.28 ,$180.90 ,$37.73 ,$164.82 ,$150.92 ,$150.92 ,$37.73 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201045,86360,HC ABS T CELLS CD4 CD8 RATIO-90,302,1 ,$212.00 ,$137.80 ,$11.51 ,$212.00 ,$117.45 ,$137.80 ,$126.56 ,$46.98 ,$59.36 ,$118.93 ,$46.98 ,$139.50 ,$46.98 ,$180.20 ,$180.20 ,$46.98 ,$180.20 ,$89.26 ,$144.16 ,$117.45 ,$46.98 ,$46.98 ,$159.00 ,$150.52 ,$150.52 ,$46.98 ,$150.52 ,$173.84 ,$173.84 ,$173.84 , N/A ,$117.45 ,$180.20 ,$46.98 ,$212.00 ,$126.56 ,$46.98 ,$88.19 ,$12.66 ,$11.51 ,$46.98 ,$180.20 ,$98.66 ,$180.20 ,$59.36 ,$190.80 ,$46.98 ,$173.84 ,$187.92 ,$187.92 ,$46.98 ,$137.80 ,$212.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201047,86376,HC MICROSOMAL AB-90,302,1 ,$152.00 ,$98.80 ,$14.55 ,$152.00 ,$36.38 ,$98.80 ,$90.74 ,$14.55 ,$42.56 ,$85.27 ,$14.55 ,$100.02 ,$14.55 ,$129.20 ,$129.20 ,$14.55 ,$129.20 ,$27.65 ,$103.36 ,$36.38 ,$14.55 ,$14.55 ,$114.00 ,$107.92 ,$107.92 ,$14.55 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$36.38 ,$129.20 ,$14.55 ,$152.00 ,$90.74 ,$14.55 ,$63.23 ,$19.21 ,$17.46 ,$14.55 ,$129.20 ,$30.56 ,$129.20 ,$42.56 ,$136.80 ,$14.55 ,$124.64 ,$58.20 ,$58.20 ,$14.55 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201048,86382,HC NEUTRALIZATION TEST VIRAL-90,302,1 ,$216.00 ,$140.40 ,$11.51 ,$216.00 ,$42.28 ,$140.40 ,$128.95 ,$16.91 ,$60.48 ,$121.18 ,$16.91 ,$142.13 ,$16.91 ,$183.60 ,$183.60 ,$16.91 ,$183.60 ,$32.13 ,$146.88 ,$42.28 ,$16.91 ,$16.91 ,$162.00 ,$153.36 ,$153.36 ,$16.91 ,$153.36 ,$177.12 ,$177.12 ,$177.12 , N/A ,$42.28 ,$183.60 ,$16.91 ,$216.00 ,$128.95 ,$16.91 ,$89.86 ,$12.66 ,$11.51 ,$16.91 ,$183.60 ,$35.51 ,$183.60 ,$60.48 ,$194.40 ,$16.91 ,$177.12 ,$67.64 ,$67.64 ,$16.91 ,$140.40 ,$216.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201052,86431,HC RHEUMATOID FACTOR QN-90,302,1 ,$4.80 ,$3.12 ,$1.34 ,$12.00 ,$12.00 ,$3.12 ,$2.87 ,$4.80 ,$1.34 ,$2.69 ,$4.80 ,$3.16 ,$4.80 ,$4.08 ,$4.08 ,$4.80 ,$4.08 ,$4.80 ,$3.26 ,$12.00 ,$4.80 ,$4.80 ,$3.60 ,$3.41 ,$3.41 ,$4.80 ,$3.41 ,$3.94 ,$3.94 ,$3.94 , N/A ,$4.80 ,$4.08 ,$4.80 ,$4.80 ,$2.87 ,$4.80 ,$2.00 ,$4.80 ,$4.80 ,$4.80 ,$4.08 ,$10.08 ,$4.08 ,$1.34 ,$4.32 ,$4.80 ,$3.94 ,$4.80 ,$4.80 ,$4.80 ,$3.12 ,$4.80 
ST. JOSEPH'S HOSPITAL - BREESE,30201053,86480,HC TB QUANTIFERON GOLD-90,302,1 ,$373.00 ,$242.45 ,$11.51 ,$373.00 ,$154.95 ,$242.45 ,$222.68 ,$61.98 ,$104.44 ,$209.25 ,$61.98 ,$245.43 ,$61.98 ,$317.05 ,$317.05 ,$61.98 ,$317.05 ,$117.76 ,$253.64 ,$154.95 ,$61.98 ,$61.98 ,$279.75 ,$264.83 ,$264.83 ,$61.98 ,$264.83 ,$305.86 ,$305.86 ,$305.86 , N/A ,$154.95 ,$317.05 ,$61.98 ,$373.00 ,$222.68 ,$61.98 ,$155.17 ,$12.66 ,$11.51 ,$61.98 ,$317.05 ,$130.16 ,$317.05 ,$104.44 ,$335.70 ,$61.98 ,$305.86 ,$247.92 ,$247.92 ,$61.98 ,$242.45 ,$373.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201054,86592,HC SYPHILIS VDRL RPR QL-90,302,1 ,$140.00 ,$91.00 ,$4.27 ,$140.00 ,$10.68 ,$91.00 ,$83.58 ,$4.27 ,$39.20 ,$78.54 ,$4.27 ,$92.12 ,$4.27 ,$119.00 ,$119.00 ,$4.27 ,$119.00 ,$8.11 ,$95.20 ,$10.68 ,$4.27 ,$4.27 ,$105.00 ,$99.40 ,$99.40 ,$4.27 ,$99.40 ,$114.80 ,$114.80 ,$114.80 , N/A ,$10.68 ,$119.00 ,$4.27 ,$140.00 ,$83.58 ,$4.27 ,$58.24 ,$7.35 ,$6.68 ,$4.27 ,$119.00 ,$8.97 ,$119.00 ,$39.20 ,$126.00 ,$4.27 ,$114.80 ,$17.08 ,$17.08 ,$4.27 ,$91.00 ,$140.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201055,86603,HC ADENOVIRUS AB-90,302,1 ,$97.00 ,$63.05 ,$11.51 ,$97.00 ,$32.18 ,$63.05 ,$57.91 ,$12.87 ,$27.16 ,$54.42 ,$12.87 ,$63.83 ,$12.87 ,$82.45 ,$82.45 ,$12.87 ,$82.45 ,$24.45 ,$65.96 ,$32.18 ,$12.87 ,$12.87 ,$72.75 ,$68.87 ,$68.87 ,$12.87 ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A ,$32.18 ,$82.45 ,$12.87 ,$97.00 ,$57.91 ,$12.87 ,$40.35 ,$12.66 ,$11.51 ,$12.87 ,$82.45 ,$27.03 ,$82.45 ,$27.16 ,$87.30 ,$12.87 ,$79.54 ,$51.48 ,$51.48 ,$12.87 ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201056,86606,HC ASPERGILLUS AB-90,302,1 ,$112.00 ,$72.80 ,$11.51 ,$112.00 ,$37.63 ,$72.80 ,$66.86 ,$15.05 ,$31.36 ,$62.83 ,$15.05 ,$73.70 ,$15.05 ,$95.20 ,$95.20 ,$15.05 ,$95.20 ,$28.60 ,$76.16 ,$37.63 ,$15.05 ,$15.05 ,$84.00 ,$79.52 ,$79.52 ,$15.05 ,$79.52 ,$91.84 ,$91.84 ,$91.84 , N/A ,$37.63 ,$95.20 ,$15.05 ,$112.00 ,$66.86 ,$15.05 ,$46.59 ,$12.66 ,$11.51 ,$15.05 ,$95.20 ,$31.61 ,$95.20 ,$31.36 ,$100.80 ,$15.05 ,$91.84 ,$60.20 ,$60.20 ,$15.05 ,$72.80 ,$112.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201057,86609,HC BACTERIUM AB NOS-90,302,1 ,$90.00 ,$58.50 ,$12.88 ,$90.00 ,$32.20 ,$58.50 ,$53.73 ,$12.88 ,$25.20 ,$50.49 ,$12.88 ,$59.22 ,$12.88 ,$76.50 ,$76.50 ,$12.88 ,$76.50 ,$24.47 ,$61.20 ,$32.20 ,$12.88 ,$12.88 ,$67.50 ,$63.90 ,$63.90 ,$12.88 ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A ,$32.20 ,$76.50 ,$12.88 ,$90.00 ,$53.73 ,$12.88 ,$37.44 ,$19.47 ,$17.70 ,$12.88 ,$76.50 ,$27.05 ,$76.50 ,$25.20 ,$81.00 ,$12.88 ,$73.80 ,$51.52 ,$51.52 ,$12.88 ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201058,86611,HC BARTONELLA SCREEN AB-90,302,1 ,$76.00 ,$49.40 ,$10.18 ,$76.00 ,$25.45 ,$49.40 ,$45.37 ,$10.18 ,$21.28 ,$42.64 ,$10.18 ,$50.01 ,$10.18 ,$64.60 ,$64.60 ,$10.18 ,$64.60 ,$19.34 ,$51.68 ,$25.45 ,$10.18 ,$10.18 ,$57.00 ,$53.96 ,$53.96 ,$10.18 ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A ,$25.45 ,$64.60 ,$10.18 ,$76.00 ,$45.37 ,$10.18 ,$31.62 ,$12.66 ,$11.51 ,$10.18 ,$64.60 ,$21.38 ,$64.60 ,$21.28 ,$68.40 ,$10.18 ,$62.32 ,$40.72 ,$40.72 ,$10.18 ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201060,86612,HC BLASTOMYCES AB-90,302,1 ,$71.00 ,$46.15 ,$11.51 ,$71.00 ,$32.25 ,$46.15 ,$42.39 ,$12.90 ,$19.88 ,$39.83 ,$12.90 ,$46.72 ,$12.90 ,$60.35 ,$60.35 ,$12.90 ,$60.35 ,$24.51 ,$48.28 ,$32.25 ,$12.90 ,$12.90 ,$53.25 ,$50.41 ,$50.41 ,$12.90 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$32.25 ,$60.35 ,$12.90 ,$71.00 ,$42.39 ,$12.90 ,$29.54 ,$12.66 ,$11.51 ,$12.90 ,$60.35 ,$27.09 ,$60.35 ,$19.88 ,$63.90 ,$12.90 ,$58.22 ,$51.60 ,$51.60 ,$12.90 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201061,86615,HC BORDETELLA AB-90,302,1 ,$107.00 ,$69.55 ,$11.51 ,$107.00 ,$32.98 ,$69.55 ,$63.88 ,$13.19 ,$29.96 ,$60.03 ,$13.19 ,$70.41 ,$13.19 ,$90.95 ,$90.95 ,$13.19 ,$90.95 ,$25.06 ,$72.76 ,$32.98 ,$13.19 ,$13.19 ,$80.25 ,$75.97 ,$75.97 ,$13.19 ,$75.97 ,$87.74 ,$87.74 ,$87.74 , N/A ,$32.98 ,$90.95 ,$13.19 ,$107.00 ,$63.88 ,$13.19 ,$44.51 ,$12.66 ,$11.51 ,$13.19 ,$90.95 ,$27.70 ,$90.95 ,$29.96 ,$96.30 ,$13.19 ,$87.74 ,$52.76 ,$52.76 ,$13.19 ,$69.55 ,$107.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201062,86617,HC LYME DISEASE AB CONFIRM-90,302,1 ,$131.00 ,$85.15 ,$11.51 ,$131.00 ,$38.73 ,$85.15 ,$78.21 ,$15.49 ,$36.68 ,$73.49 ,$15.49 ,$86.20 ,$15.49 ,$111.35 ,$111.35 ,$15.49 ,$111.35 ,$29.43 ,$89.08 ,$38.73 ,$15.49 ,$15.49 ,$98.25 ,$93.01 ,$93.01 ,$15.49 ,$93.01 ,$107.42 ,$107.42 ,$107.42 , N/A ,$38.73 ,$111.35 ,$15.49 ,$131.00 ,$78.21 ,$15.49 ,$54.50 ,$12.66 ,$11.51 ,$15.49 ,$111.35 ,$32.53 ,$111.35 ,$36.68 ,$117.90 ,$15.49 ,$107.42 ,$61.96 ,$61.96 ,$15.49 ,$85.15 ,$131.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201063,86618,HC LYME AB-90,302,1 ,$146.00 ,$94.90 ,$11.51 ,$146.00 ,$42.58 ,$94.90 ,$87.16 ,$17.03 ,$40.88 ,$81.91 ,$17.03 ,$96.07 ,$17.03 ,$124.10 ,$124.10 ,$17.03 ,$124.10 ,$32.36 ,$99.28 ,$42.58 ,$17.03 ,$17.03 ,$109.50 ,$103.66 ,$103.66 ,$17.03 ,$103.66 ,$119.72 ,$119.72 ,$119.72 , N/A ,$42.58 ,$124.10 ,$17.03 ,$146.00 ,$87.16 ,$17.03 ,$60.74 ,$12.66 ,$11.51 ,$17.03 ,$124.10 ,$35.76 ,$124.10 ,$40.88 ,$131.40 ,$17.03 ,$119.72 ,$68.12 ,$68.12 ,$17.03 ,$94.90 ,$146.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201064,86619,HC BORRELIA AB-90,302,1 ,$144.20 ,$93.73 ,$11.51 ,$144.20 ,$33.45 ,$93.73 ,$86.09 ,$13.38 ,$40.38 ,$80.90 ,$13.38 ,$94.88 ,$13.38 ,$122.57 ,$122.57 ,$13.38 ,$122.57 ,$25.42 ,$98.06 ,$33.45 ,$13.38 ,$13.38 ,$108.15 ,$102.38 ,$102.38 ,$13.38 ,$102.38 ,$118.24 ,$118.24 ,$118.24 , N/A ,$33.45 ,$122.57 ,$13.38 ,$144.20 ,$86.09 ,$13.38 ,$59.99 ,$12.66 ,$11.51 ,$13.38 ,$122.57 ,$28.10 ,$122.57 ,$40.38 ,$129.78 ,$13.38 ,$118.24 ,$53.52 ,$53.52 ,$13.38 ,$93.73 ,$144.20 
ST. JOSEPH'S HOSPITAL - BREESE,30201065,86622,HC BRUCELLA AB-90,302,1 ,$94.00 ,$61.10 ,$8.93 ,$94.00 ,$22.33 ,$61.10 ,$56.12 ,$8.93 ,$26.32 ,$52.73 ,$8.93 ,$61.85 ,$8.93 ,$79.90 ,$79.90 ,$8.93 ,$79.90 ,$16.97 ,$63.92 ,$22.33 ,$8.93 ,$8.93 ,$70.50 ,$66.74 ,$66.74 ,$8.93 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$22.33 ,$79.90 ,$8.93 ,$94.00 ,$56.12 ,$8.93 ,$39.10 ,$12.66 ,$11.51 ,$8.93 ,$79.90 ,$18.75 ,$79.90 ,$26.32 ,$84.60 ,$8.93 ,$77.08 ,$35.72 ,$35.72 ,$8.93 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201067,86631,HC CHLAMYDIA AB-90,302,1 ,$102.00 ,$66.30 ,$5.33 ,$102.00 ,$29.55 ,$66.30 ,$60.89 ,$11.82 ,$28.56 ,$57.22 ,$11.82 ,$67.12 ,$11.82 ,$86.70 ,$86.70 ,$11.82 ,$86.70 ,$22.46 ,$69.36 ,$29.55 ,$11.82 ,$11.82 ,$76.50 ,$72.42 ,$72.42 ,$11.82 ,$72.42 ,$83.64 ,$83.64 ,$83.64 , N/A ,$29.55 ,$86.70 ,$11.82 ,$102.00 ,$60.89 ,$11.82 ,$42.43 ,$5.86 ,$5.33 ,$11.82 ,$86.70 ,$24.82 ,$86.70 ,$28.56 ,$91.80 ,$11.82 ,$83.64 ,$47.28 ,$47.28 ,$11.82 ,$66.30 ,$102.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201079,86711,HC AB JOHN CUNNINGHAM VIRUS-90,302,1 ,"$2,726.00 ","$1,771.90 ",$6.68 ,"$2,726.00 ",$42.23 ,"$1,771.90 ","$1,627.42 ",$16.89 ,$763.28 ,"$1,529.29 ",$16.89 ,"$1,793.71 ",$16.89 ,"$2,317.10 ","$2,317.10 ",$16.89 ,"$2,317.10 ",$32.09 ,"$1,853.68 ",$42.23 ,$16.89 ,$16.89 ,"$2,044.50 ","$1,935.46 ","$1,935.46 ",$16.89 ,"$1,935.46 ","$2,235.32 ","$2,235.32 ","$2,235.32 ", N/A ,$42.23 ,"$2,317.10 ",$16.89 ,"$2,726.00 ","$1,627.42 ",$16.89 ,"$1,134.02 ",$7.35 ,$6.68 ,$16.89 ,"$2,317.10 ",$35.47 ,"$2,317.10 ",$763.28 ,"$2,453.40 ",$16.89 ,"$2,235.32 ",$67.56 ,$67.56 ,$16.89 ,"$1,771.90 ","$2,726.00 "
ST. JOSEPH'S HOSPITAL - BREESE,30201088,86008,HC ALLERGEN IGE QN/SEMI-QN RECOMB/COMP EA-90,302,1 ,$10.00 ,$6.50 ,$2.80 ,$25.00 ,$25.00 ,$6.50 ,$5.97 ,$10.00 ,$2.80 ,$5.61 ,$10.00 ,$6.58 ,$10.00 ,$8.50 ,$8.50 ,$10.00 ,$8.50 ,$10.00 ,$6.80 ,$25.00 ,$10.00 ,$10.00 ,$7.50 ,$7.10 ,$7.10 ,$10.00 ,$7.10 ,$8.20 ,$8.20 ,$8.20 , N/A ,$10.00 ,$8.50 ,$10.00 ,$10.00 ,$5.97 ,$10.00 ,$4.16 ,$7.35 ,$6.68 ,$10.00 ,$8.50 ,$21.00 ,$8.50 ,$2.80 ,$9.00 ,$10.00 ,$8.20 ,$10.00 ,$10.00 ,$10.00 ,$6.50 ,$10.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201092,86593,HC SYPHILIS VDRL RPR QN-90,302,1 ,$2.62 ,$1.70 ,$0.73 ,$6.55 ,$6.55 ,$1.70 ,$1.56 ,$2.62 ,$0.73 ,$1.47 ,$2.62 ,$1.72 ,$2.62 ,$2.23 ,$2.23 ,$2.62 ,$2.23 ,$2.62 ,$1.78 ,$6.55 ,$2.62 ,$2.62 ,$1.97 ,$1.86 ,$1.86 ,$2.62 ,$1.86 ,$2.15 ,$2.15 ,$2.15 , N/A ,$2.62 ,$2.23 ,$2.62 ,$2.62 ,$1.56 ,$2.62 ,$1.09 ,$2.62 ,$2.62 ,$2.62 ,$2.23 ,$5.50 ,$2.23 ,$0.73 ,$2.36 ,$2.62 ,$2.15 ,$2.62 ,$2.62 ,$2.62 ,$1.70 ,$2.62 
ST. JOSEPH'S HOSPITAL - BREESE,30201096,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$176.00 ,$114.40 ,$6.68 ,$176.00 ,$32.38 ,$114.40 ,$105.07 ,$12.95 ,$49.28 ,$98.74 ,$12.95 ,$115.81 ,$12.95 ,$149.60 ,$149.60 ,$12.95 ,$149.60 ,$24.61 ,$119.68 ,$32.38 ,$12.95 ,$12.95 ,$132.00 ,$124.96 ,$124.96 ,$12.95 ,$124.96 ,$144.32 ,$144.32 ,$144.32 , N/A ,$32.38 ,$149.60 ,$12.95 ,$176.00 ,$105.07 ,$12.95 ,$73.22 ,$7.35 ,$6.68 ,$12.95 ,$149.60 ,$27.20 ,$149.60 ,$49.28 ,$158.40 ,$12.95 ,$144.32 ,$51.80 ,$51.80 ,$12.95 ,$114.40 ,$176.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201107,86403,HC PARTICLE AGG SCREEN,302,1 ,$124.00 ,$80.60 ,$6.68 ,$124.00 ,$28.85 ,$80.60 ,$74.03 ,$11.54 ,$34.72 ,$69.56 ,$11.54 ,$81.59 ,$11.54 ,$105.40 ,$105.40 ,$11.54 ,$105.40 ,$21.93 ,$84.32 ,$28.85 ,$11.54 ,$11.54 ,$93.00 ,$88.04 ,$88.04 ,$11.54 ,$88.04 ,$101.68 ,$101.68 ,$101.68 , N/A ,$28.85 ,$105.40 ,$11.54 ,$124.00 ,$74.03 ,$11.54 ,$51.58 ,$7.35 ,$6.68 ,$11.54 ,$105.40 ,$24.23 ,$105.40 ,$34.72 ,$111.60 ,$11.54 ,$101.68 ,$46.16 ,$46.16 ,$11.54 ,$80.60 ,$124.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201108,86431,HC RHEUMATOID FACTOR QN,302,1 ,$85.00 ,$55.25 ,$5.67 ,$85.00 ,$14.18 ,$55.25 ,$50.75 ,$5.67 ,$23.80 ,$47.69 ,$5.67 ,$55.93 ,$5.67 ,$72.25 ,$72.25 ,$5.67 ,$72.25 ,$10.77 ,$57.80 ,$14.18 ,$5.67 ,$5.67 ,$63.75 ,$60.35 ,$60.35 ,$5.67 ,$60.35 ,$69.70 ,$69.70 ,$69.70 , N/A ,$14.18 ,$72.25 ,$5.67 ,$85.00 ,$50.75 ,$5.67 ,$35.36 ,$7.35 ,$6.68 ,$5.67 ,$72.25 ,$11.91 ,$72.25 ,$23.80 ,$76.50 ,$5.67 ,$69.70 ,$22.68 ,$22.68 ,$5.67 ,$55.25 ,$85.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201110,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$140.00 ,$91.00 ,$4.27 ,$140.00 ,$10.68 ,$91.00 ,$83.58 ,$4.27 ,$39.20 ,$78.54 ,$4.27 ,$92.12 ,$4.27 ,$119.00 ,$119.00 ,$4.27 ,$119.00 ,$8.11 ,$95.20 ,$10.68 ,$4.27 ,$4.27 ,$105.00 ,$99.40 ,$99.40 ,$4.27 ,$99.40 ,$114.80 ,$114.80 ,$114.80 , N/A ,$10.68 ,$119.00 ,$4.27 ,$140.00 ,$83.58 ,$4.27 ,$58.24 ,$7.35 ,$6.68 ,$4.27 ,$119.00 ,$8.97 ,$119.00 ,$39.20 ,$126.00 ,$4.27 ,$114.80 ,$17.08 ,$17.08 ,$4.27 ,$91.00 ,$140.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201121,86704,HC HEP CORE AB,302,1 ,$192.00 ,$124.80 ,$6.68 ,$192.00 ,$30.13 ,$124.80 ,$114.62 ,$12.05 ,$53.76 ,$107.71 ,$12.05 ,$126.34 ,$12.05 ,$163.20 ,$163.20 ,$12.05 ,$163.20 ,$22.90 ,$130.56 ,$30.13 ,$12.05 ,$12.05 ,$144.00 ,$136.32 ,$136.32 ,$12.05 ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A ,$30.13 ,$163.20 ,$12.05 ,$192.00 ,$114.62 ,$12.05 ,$79.87 ,$7.35 ,$6.68 ,$12.05 ,$163.20 ,$25.31 ,$163.20 ,$53.76 ,$172.80 ,$12.05 ,$157.44 ,$48.20 ,$48.20 ,$12.05 ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201122,86705,HC HEP B CORE IGM,302,1 ,$185.00 ,$120.25 ,$6.68 ,$185.00 ,$29.43 ,$120.25 ,$110.45 ,$11.77 ,$51.80 ,$103.79 ,$11.77 ,$121.73 ,$11.77 ,$157.25 ,$157.25 ,$11.77 ,$157.25 ,$22.36 ,$125.80 ,$29.43 ,$11.77 ,$11.77 ,$138.75 ,$131.35 ,$131.35 ,$11.77 ,$131.35 ,$151.70 ,$151.70 ,$151.70 , N/A ,$29.43 ,$157.25 ,$11.77 ,$185.00 ,$110.45 ,$11.77 ,$76.96 ,$7.35 ,$6.68 ,$11.77 ,$157.25 ,$24.72 ,$157.25 ,$51.80 ,$166.50 ,$11.77 ,$151.70 ,$47.08 ,$47.08 ,$11.77 ,$120.25 ,$185.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201123,86706,HC HEP B SURFACE AB,302,1 ,$177.00 ,$115.05 ,$6.68 ,$177.00 ,$26.85 ,$115.05 ,$105.67 ,$10.74 ,$49.56 ,$99.30 ,$10.74 ,$116.47 ,$10.74 ,$150.45 ,$150.45 ,$10.74 ,$150.45 ,$20.41 ,$120.36 ,$26.85 ,$10.74 ,$10.74 ,$132.75 ,$125.67 ,$125.67 ,$10.74 ,$125.67 ,$145.14 ,$145.14 ,$145.14 , N/A ,$26.85 ,$150.45 ,$10.74 ,$177.00 ,$105.67 ,$10.74 ,$73.63 ,$7.35 ,$6.68 ,$10.74 ,$150.45 ,$22.55 ,$150.45 ,$49.56 ,$159.30 ,$10.74 ,$145.14 ,$42.96 ,$42.96 ,$10.74 ,$115.05 ,$177.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201125,86709,HC HEP A AB (HAAB) IGM,302,1 ,$192.00 ,$124.80 ,$6.68 ,$192.00 ,$28.15 ,$124.80 ,$114.62 ,$11.26 ,$53.76 ,$107.71 ,$11.26 ,$126.34 ,$11.26 ,$163.20 ,$163.20 ,$11.26 ,$163.20 ,$21.39 ,$130.56 ,$28.15 ,$11.26 ,$11.26 ,$144.00 ,$136.32 ,$136.32 ,$11.26 ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A ,$28.15 ,$163.20 ,$11.26 ,$192.00 ,$114.62 ,$11.26 ,$79.87 ,$7.35 ,$6.68 ,$11.26 ,$163.20 ,$23.65 ,$163.20 ,$53.76 ,$172.80 ,$11.26 ,$157.44 ,$45.04 ,$45.04 ,$11.26 ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201127,86762,HC RUBELLA AB,302,1 ,$83.00 ,$53.95 ,$6.68 ,$83.00 ,$35.98 ,$53.95 ,$49.55 ,$14.39 ,$23.24 ,$46.56 ,$14.39 ,$54.61 ,$14.39 ,$70.55 ,$70.55 ,$14.39 ,$70.55 ,$27.34 ,$56.44 ,$35.98 ,$14.39 ,$14.39 ,$62.25 ,$58.93 ,$58.93 ,$14.39 ,$58.93 ,$68.06 ,$68.06 ,$68.06 , N/A ,$35.98 ,$70.55 ,$14.39 ,$83.00 ,$49.55 ,$14.39 ,$34.53 ,$7.35 ,$6.68 ,$14.39 ,$70.55 ,$30.22 ,$70.55 ,$23.24 ,$74.70 ,$14.39 ,$68.06 ,$57.56 ,$57.56 ,$14.39 ,$53.95 ,$83.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201132,86803,HC HEP C AB,302,1 ,$201.00 ,$130.65 ,$11.51 ,$201.00 ,$35.68 ,$130.65 ,$120.00 ,$14.27 ,$56.28 ,$112.76 ,$14.27 ,$132.26 ,$14.27 ,$170.85 ,$170.85 ,$14.27 ,$170.85 ,$27.11 ,$136.68 ,$35.68 ,$14.27 ,$14.27 ,$150.75 ,$142.71 ,$142.71 ,$14.27 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$35.68 ,$170.85 ,$14.27 ,$201.00 ,$120.00 ,$14.27 ,$83.62 ,$12.66 ,$11.51 ,$14.27 ,$170.85 ,$29.97 ,$170.85 ,$56.28 ,$180.90 ,$14.27 ,$164.82 ,$57.08 ,$57.08 ,$14.27 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201133,86885,HC INDIRECT COOMBS-90,302,1 ,$94.00 ,$61.10 ,$6.68 ,$367.60 ,$367.60 ,$61.10 ,$56.12 ,$147.04 ,$26.32 ,$52.73 ,$147.04 ,$61.85 ,$94.00 ,$79.90 ,$79.90 ,$94.00 ,$79.90 ,$94.00 ,$63.92 ,$367.59 ,$147.04 ,$147.04 ,$70.50 ,$66.74 ,$66.74 ,$147.04 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$94.00 ,$79.90 ,$147.04 ,$94.00 ,$56.12 ,$147.04 ,$39.10 ,$7.35 ,$6.68 ,$147.04 ,$79.90 ,$308.78 ,$79.90 ,$26.32 ,$84.60 ,$147.04 ,$77.08 ,$22.88 ,$22.88 ,$147.04 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201135,86902,HC RBC AG SCR RGT SERUM T2-90,302,1 ,$177.00 ,$115.05 ,$4.14 ,$717.84 ,$717.83 ,$115.05 ,$105.67 ,$287.13 ,$49.56 ,$99.30 ,$287.13 ,$116.47 ,$177.00 ,$150.45 ,$150.45 ,$177.00 ,$150.45 ,$177.00 ,$120.36 ,$717.84 ,$287.13 ,$287.13 ,$132.75 ,$125.67 ,$125.67 ,$287.13 ,$125.67 ,$145.14 ,$145.14 ,$145.14 , N/A ,$177.00 ,$150.45 ,$287.13 ,$177.00 ,$105.67 ,$287.13 ,$73.63 ,$4.55 ,$4.14 ,$287.13 ,$150.45 ,$602.98 ,$150.45 ,$49.56 ,$159.30 ,$287.13 ,$145.14 ,$25.40 ,$25.40 ,$287.13 ,$115.05 ,$177.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201136,86902,HC RBC AG SCR RGT SERUM T3-90,302,1 ,$228.00 ,$148.20 ,$4.14 ,$717.84 ,$717.83 ,$148.20 ,$136.12 ,$287.13 ,$63.84 ,$127.91 ,$287.13 ,$150.02 ,$228.00 ,$193.80 ,$193.80 ,$228.00 ,$193.80 ,$228.00 ,$155.04 ,$717.84 ,$287.13 ,$287.13 ,$171.00 ,$161.88 ,$161.88 ,$287.13 ,$161.88 ,$186.96 ,$186.96 ,$186.96 , N/A ,$228.00 ,$193.80 ,$287.13 ,$228.00 ,$136.12 ,$287.13 ,$94.85 ,$4.55 ,$4.14 ,$287.13 ,$193.80 ,$602.98 ,$193.80 ,$63.84 ,$205.20 ,$287.13 ,$186.96 ,$25.40 ,$25.40 ,$287.13 ,$148.20 ,$228.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201137,86902,HC RBC AG SCR RGT SERUM T4-90,302,1 ,$281.00 ,$182.65 ,$4.14 ,$717.84 ,$717.83 ,$182.65 ,$167.76 ,$287.13 ,$78.68 ,$157.64 ,$287.13 ,$184.90 ,$281.00 ,$238.85 ,$238.85 ,$281.00 ,$238.85 ,$281.00 ,$191.08 ,$717.84 ,$287.13 ,$287.13 ,$210.75 ,$199.51 ,$199.51 ,$287.13 ,$199.51 ,$230.42 ,$230.42 ,$230.42 , N/A ,$281.00 ,$238.85 ,$287.13 ,$281.00 ,$167.76 ,$287.13 ,$116.90 ,$4.55 ,$4.14 ,$287.13 ,$238.85 ,$602.98 ,$238.85 ,$78.68 ,$252.90 ,$287.13 ,$230.42 ,$25.40 ,$25.40 ,$287.13 ,$182.65 ,$281.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201139,86905,HC RBC AG TYPING NON ABO/RH T2-90,302,1 ,$177.00 ,$115.05 ,$4.14 ,$717.84 ,$717.83 ,$115.05 ,$105.67 ,$287.13 ,$49.56 ,$99.30 ,$287.13 ,$116.47 ,$177.00 ,$150.45 ,$150.45 ,$177.00 ,$150.45 ,$177.00 ,$120.36 ,$717.84 ,$287.13 ,$287.13 ,$132.75 ,$125.67 ,$125.67 ,$287.13 ,$125.67 ,$145.14 ,$145.14 ,$145.14 , N/A ,$177.00 ,$150.45 ,$287.13 ,$177.00 ,$105.67 ,$287.13 ,$73.63 ,$4.55 ,$4.14 ,$287.13 ,$150.45 ,$602.98 ,$150.45 ,$49.56 ,$159.30 ,$287.13 ,$145.14 ,$15.32 ,$15.32 ,$287.13 ,$115.05 ,$177.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201140,86905,HC RBC AG TYPING NON ABO/RH T3-90,302,1 ,$228.00 ,$148.20 ,$4.14 ,$717.84 ,$717.83 ,$148.20 ,$136.12 ,$287.13 ,$63.84 ,$127.91 ,$287.13 ,$150.02 ,$228.00 ,$193.80 ,$193.80 ,$228.00 ,$193.80 ,$228.00 ,$155.04 ,$717.84 ,$287.13 ,$287.13 ,$171.00 ,$161.88 ,$161.88 ,$287.13 ,$161.88 ,$186.96 ,$186.96 ,$186.96 , N/A ,$228.00 ,$193.80 ,$287.13 ,$228.00 ,$136.12 ,$287.13 ,$94.85 ,$4.55 ,$4.14 ,$287.13 ,$193.80 ,$602.98 ,$193.80 ,$63.84 ,$205.20 ,$287.13 ,$186.96 ,$15.32 ,$15.32 ,$287.13 ,$148.20 ,$228.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201141,86905,HC RBC AG TYPING NON ABO/RH T4-90,302,1 ,$281.00 ,$182.65 ,$4.14 ,$717.84 ,$717.83 ,$182.65 ,$167.76 ,$287.13 ,$78.68 ,$157.64 ,$287.13 ,$184.90 ,$281.00 ,$238.85 ,$238.85 ,$281.00 ,$238.85 ,$281.00 ,$191.08 ,$717.84 ,$287.13 ,$287.13 ,$210.75 ,$199.51 ,$199.51 ,$287.13 ,$199.51 ,$230.42 ,$230.42 ,$230.42 , N/A ,$281.00 ,$238.85 ,$287.13 ,$281.00 ,$167.76 ,$287.13 ,$116.90 ,$4.55 ,$4.14 ,$287.13 ,$238.85 ,$602.98 ,$238.85 ,$78.68 ,$252.90 ,$287.13 ,$230.42 ,$15.32 ,$15.32 ,$287.13 ,$182.65 ,$281.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201148,83986,HC PH BODY FLUID,302,1 ,$90.00 ,$58.50 ,$3.32 ,$90.00 ,$8.95 ,$58.50 ,$53.73 ,$3.58 ,$25.20 ,$50.49 ,$3.58 ,$59.22 ,$3.58 ,$76.50 ,$76.50 ,$3.58 ,$76.50 ,$6.80 ,$61.20 ,$8.95 ,$3.58 ,$3.58 ,$67.50 ,$63.90 ,$63.90 ,$3.58 ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A ,$8.95 ,$76.50 ,$3.58 ,$90.00 ,$53.73 ,$3.58 ,$37.44 ,$3.65 ,$3.32 ,$3.58 ,$76.50 ,$7.52 ,$76.50 ,$25.20 ,$81.00 ,$3.58 ,$73.80 ,$14.32 ,$14.32 ,$3.58 ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201152,86255,HC FLUOR AB SCR AQUAPORIN-90,302,1 ,$974.00 ,$633.10 ,$11.51 ,$974.00 ,$30.13 ,$633.10 ,$581.48 ,$12.05 ,$272.72 ,$546.41 ,$12.05 ,$640.89 ,$12.05 ,$827.90 ,$827.90 ,$12.05 ,$827.90 ,$22.90 ,$662.32 ,$30.13 ,$12.05 ,$12.05 ,$730.50 ,$691.54 ,$691.54 ,$12.05 ,$691.54 ,$798.68 ,$798.68 ,$798.68 , N/A ,$30.13 ,$827.90 ,$12.05 ,$974.00 ,$581.48 ,$12.05 ,$405.18 ,$12.66 ,$11.51 ,$12.05 ,$827.90 ,$25.31 ,$827.90 ,$272.72 ,$876.60 ,$12.05 ,$798.68 ,$48.20 ,$48.20 ,$12.05 ,$633.10 ,$974.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201157,86255,HC FLUOR AB SCR PARANEOPLASTIC-90,302,1 ,$12.56 ,$8.16 ,$3.52 ,$30.13 ,$30.13 ,$8.16 ,$7.50 ,$12.05 ,$3.52 ,$7.05 ,$12.05 ,$8.26 ,$12.05 ,$10.68 ,$10.68 ,$12.05 ,$10.68 ,$12.56 ,$8.54 ,$30.13 ,$12.05 ,$12.05 ,$9.42 ,$8.92 ,$8.92 ,$12.05 ,$8.92 ,$10.30 ,$10.30 ,$10.30 , N/A ,$12.56 ,$10.68 ,$12.05 ,$12.56 ,$7.50 ,$12.05 ,$5.23 ,$12.56 ,$11.51 ,$12.05 ,$10.68 ,$25.31 ,$10.68 ,$3.52 ,$11.30 ,$12.05 ,$10.30 ,$12.56 ,$12.56 ,$12.05 ,$8.16 ,$12.56 
ST. JOSEPH'S HOSPITAL - BREESE,30201170,86481,HC TB ANTIGEN RESPONSE GAMMA INTER T-CELL SUSP-90,302,1 ,$84.00 ,$54.60 ,$11.51 ,$210.00 ,$210.00 ,$54.60 ,$50.15 ,$84.00 ,$23.52 ,$47.12 ,$84.00 ,$55.27 ,$84.00 ,$71.40 ,$71.40 ,$84.00 ,$71.40 ,$84.00 ,$57.12 ,$210.00 ,$84.00 ,$84.00 ,$63.00 ,$59.64 ,$59.64 ,$84.00 ,$59.64 ,$68.88 ,$68.88 ,$68.88 , N/A ,$84.00 ,$71.40 ,$84.00 ,$84.00 ,$50.15 ,$84.00 ,$34.94 ,$12.66 ,$11.51 ,$84.00 ,$71.40 ,$176.40 ,$71.40 ,$23.52 ,$75.60 ,$84.00 ,$68.88 ,$84.00 ,$84.00 ,$84.00 ,$54.60 ,$84.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201186,86628,HC ANTIBODY CANDIDA-90,302,1 ,$202.00 ,$131.30 ,$5.33 ,$202.00 ,$30.03 ,$131.30 ,$120.59 ,$12.01 ,$56.56 ,$113.32 ,$12.01 ,$132.92 ,$12.01 ,$171.70 ,$171.70 ,$12.01 ,$171.70 ,$22.82 ,$137.36 ,$30.03 ,$12.01 ,$12.01 ,$151.50 ,$143.42 ,$143.42 ,$12.01 ,$143.42 ,$165.64 ,$165.64 ,$165.64 , N/A ,$30.03 ,$171.70 ,$12.01 ,$202.00 ,$120.59 ,$12.01 ,$84.03 ,$5.86 ,$5.33 ,$12.01 ,$171.70 ,$25.22 ,$171.70 ,$56.56 ,$181.80 ,$12.01 ,$165.64 ,$48.04 ,$48.04 ,$12.01 ,$131.30 ,$202.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201187,86308,HC HETEROPHILE SCR MONO-90,302,1 ,$10.08 ,$6.55 ,$2.82 ,$12.95 ,$12.95 ,$6.55 ,$6.02 ,$5.18 ,$2.82 ,$5.65 ,$5.18 ,$6.63 ,$5.18 ,$8.57 ,$8.57 ,$5.18 ,$8.57 ,$9.84 ,$6.85 ,$12.95 ,$5.18 ,$5.18 ,$7.56 ,$7.16 ,$7.16 ,$5.18 ,$7.16 ,$8.27 ,$8.27 ,$8.27 , N/A ,$10.08 ,$8.57 ,$5.18 ,$10.08 ,$6.02 ,$5.18 ,$4.19 ,$7.35 ,$6.68 ,$5.18 ,$8.57 ,$10.88 ,$8.57 ,$2.82 ,$9.07 ,$5.18 ,$8.27 ,$10.08 ,$10.08 ,$5.18 ,$6.55 ,$10.08 
ST. JOSEPH'S HOSPITAL - BREESE,30201188,81380,HC HLA I TYPING 1 LOCUS HR-90,302,1 ,$300.00 ,$195.00 ,$84.00 ,$443.13 ,$443.13 ,$195.00 ,$179.10 ,$177.25 ,$84.00 ,$168.30 ,$177.25 ,$197.40 ,$177.25 ,$255.00 ,$255.00 ,$177.25 ,$255.00 ,$300.00 ,$204.00 ,$443.13 ,$177.25 ,$177.25 ,$225.00 ,$213.00 ,$213.00 ,$177.25 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$300.00 ,$255.00 ,$177.25 ,$300.00 ,$179.10 ,$177.25 ,$124.80 ,$94.80 ,$86.18 ,$177.25 ,$255.00 ,$372.23 ,$255.00 ,$84.00 ,$270.00 ,$177.25 ,$246.00 ,$300.00 ,$300.00 ,$177.25 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201189,86015,HC ACTIN SMOOTH MUSC ANTIBODY- 90,302,1 ,$121.00 ,$78.65 ,$6.68 ,$121.00 ,$28.83 ,$78.65 ,$72.24 ,$11.53 ,$33.88 ,$67.88 ,$11.53 ,$79.62 ,$11.53 ,$102.85 ,$102.85 ,$11.53 ,$102.85 ,$21.91 ,$82.28 ,$28.83 ,$11.53 ,$11.53 ,$90.75 ,$85.91 ,$85.91 ,$11.53 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$28.83 ,$102.85 ,$11.53 ,$121.00 ,$72.24 ,$11.53 ,$50.34 ,$7.35 ,$6.68 ,$11.53 ,$102.85 ,$24.21 ,$102.85 ,$33.88 ,$108.90 ,$11.53 ,$99.22 ,$46.12 ,$46.12 ,$11.53 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201190,86036,HC ANTINEUTROPHIL CYTO ANTB SCREEN- 90,302,1 ,$223.00 ,$144.95 ,$6.68 ,$223.00 ,$30.13 ,$144.95 ,$133.13 ,$12.05 ,$62.44 ,$125.10 ,$12.05 ,$146.73 ,$12.05 ,$189.55 ,$189.55 ,$12.05 ,$189.55 ,$22.90 ,$151.64 ,$30.13 ,$12.05 ,$12.05 ,$167.25 ,$158.33 ,$158.33 ,$12.05 ,$158.33 ,$182.86 ,$182.86 ,$182.86 , N/A ,$30.13 ,$189.55 ,$12.05 ,$223.00 ,$133.13 ,$12.05 ,$92.77 ,$7.35 ,$6.68 ,$12.05 ,$189.55 ,$25.31 ,$189.55 ,$62.44 ,$200.70 ,$12.05 ,$182.86 ,$48.20 ,$48.20 ,$12.05 ,$144.95 ,$223.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201191,86037,HC ANTINEUTROPHIL CYTOPLASMIC ANTIBODY TITER- 90,302,1 ,$56.00 ,$36.40 ,$6.68 ,$56.00 ,$30.13 ,$36.40 ,$33.43 ,$12.05 ,$15.68 ,$31.42 ,$12.05 ,$36.85 ,$12.05 ,$47.60 ,$47.60 ,$12.05 ,$47.60 ,$22.90 ,$38.08 ,$30.13 ,$12.05 ,$12.05 ,$42.00 ,$39.76 ,$39.76 ,$12.05 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$30.13 ,$47.60 ,$12.05 ,$56.00 ,$33.43 ,$12.05 ,$23.30 ,$7.35 ,$6.68 ,$12.05 ,$47.60 ,$25.31 ,$47.60 ,$15.68 ,$50.40 ,$12.05 ,$45.92 ,$48.20 ,$48.20 ,$12.05 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201192,86364,HC TISS TRANSGLUTAMINASE EA IMMUNO- 90,302,1 ,$121.00 ,$78.65 ,$6.68 ,$121.00 ,$28.83 ,$78.65 ,$72.24 ,$11.53 ,$33.88 ,$67.88 ,$11.53 ,$79.62 ,$11.53 ,$102.85 ,$102.85 ,$11.53 ,$102.85 ,$21.91 ,$82.28 ,$28.83 ,$11.53 ,$11.53 ,$90.75 ,$85.91 ,$85.91 ,$11.53 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$28.83 ,$102.85 ,$11.53 ,$121.00 ,$72.24 ,$11.53 ,$50.34 ,$7.35 ,$6.68 ,$11.53 ,$102.85 ,$24.21 ,$102.85 ,$33.88 ,$108.90 ,$11.53 ,$99.22 ,$46.12 ,$46.12 ,$11.53 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201193,86231,HC EMA EACH IG CLASS- 90,302,1 ,$184.00 ,$119.60 ,$6.68 ,$184.00 ,$30.23 ,$119.60 ,$109.85 ,$12.09 ,$51.52 ,$103.22 ,$12.09 ,$121.07 ,$12.09 ,$156.40 ,$156.40 ,$12.09 ,$156.40 ,$22.97 ,$125.12 ,$30.23 ,$12.09 ,$12.09 ,$138.00 ,$130.64 ,$130.64 ,$12.09 ,$130.64 ,$150.88 ,$150.88 ,$150.88 , N/A ,$30.23 ,$156.40 ,$12.09 ,$184.00 ,$109.85 ,$12.09 ,$76.54 ,$7.35 ,$6.68 ,$12.09 ,$156.40 ,$25.39 ,$156.40 ,$51.52 ,$165.60 ,$12.09 ,$150.88 ,$48.36 ,$48.36 ,$12.09 ,$119.60 ,$184.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201194,86258,HC GLIADIN ANTIBODY EA- 90,302,1 ,$121.00 ,$78.65 ,$6.68 ,$121.00 ,$28.83 ,$78.65 ,$72.24 ,$11.53 ,$33.88 ,$67.88 ,$11.53 ,$79.62 ,$11.53 ,$102.85 ,$102.85 ,$11.53 ,$102.85 ,$21.91 ,$82.28 ,$28.83 ,$11.53 ,$11.53 ,$90.75 ,$85.91 ,$85.91 ,$11.53 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$28.83 ,$102.85 ,$11.53 ,$121.00 ,$72.24 ,$11.53 ,$50.34 ,$7.35 ,$6.68 ,$11.53 ,$102.85 ,$24.21 ,$102.85 ,$33.88 ,$108.90 ,$11.53 ,$99.22 ,$46.12 ,$46.12 ,$11.53 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30201195,86381,HC MITOCHONDRIAL ANTIBODY- 90,302,1 ,$184.00 ,$119.60 ,$6.68 ,$184.00 ,$63.63 ,$119.60 ,$109.85 ,$25.45 ,$51.52 ,$103.22 ,$25.45 ,$121.07 ,$25.45 ,$156.40 ,$156.40 ,$25.45 ,$156.40 ,$48.36 ,$125.12 ,$63.63 ,$25.45 ,$25.45 ,$138.00 ,$130.64 ,$130.64 ,$25.45 ,$130.64 ,$150.88 ,$150.88 ,$150.88 , N/A ,$63.63 ,$156.40 ,$25.45 ,$184.00 ,$109.85 ,$25.45 ,$76.54 ,$7.35 ,$6.68 ,$25.45 ,$156.40 ,$53.45 ,$156.40 ,$51.52 ,$165.60 ,$25.45 ,$150.88 ,$101.80 ,$101.80 ,$25.45 ,$119.60 ,$184.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$57.00 ,$37.05 ,$3.80 ,$57.00 ,$9.50 ,$37.05 ,$34.03 ,$3.80 ,$15.96 ,$31.98 ,$3.80 ,$37.51 ,$3.80 ,$48.45 ,$48.45 ,$3.80 ,$48.45 ,$7.22 ,$38.76 ,$9.50 ,$3.80 ,$3.80 ,$42.75 ,$40.47 ,$40.47 ,$3.80 ,$40.47 ,$46.74 ,$46.74 ,$46.74 , N/A ,$9.50 ,$48.45 ,$3.80 ,$57.00 ,$34.03 ,$3.80 ,$23.71 ,$5.09 ,$4.63 ,$3.80 ,$48.45 ,$7.98 ,$48.45 ,$15.96 ,$51.30 ,$3.80 ,$46.74 ,$15.20 ,$15.20 ,$3.80 ,$37.05 ,$57.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500104,85014,HC HEMATOCRIT,305,1 ,$42.00 ,$27.30 ,$2.37 ,$42.00 ,$5.93 ,$27.30 ,$25.07 ,$2.37 ,$11.76 ,$23.56 ,$2.37 ,$27.64 ,$2.37 ,$35.70 ,$35.70 ,$2.37 ,$35.70 ,$4.50 ,$28.56 ,$5.93 ,$2.37 ,$2.37 ,$31.50 ,$29.82 ,$29.82 ,$2.37 ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A ,$5.93 ,$35.70 ,$2.37 ,$2.37 ,$25.07 ,$2.37 ,$17.47 ,$5.09 ,$4.63 ,$2.37 ,$35.70 ,$4.98 ,$35.70 ,$11.76 ,$37.80 ,$2.37 ,$34.44 ,$9.48 ,$9.48 ,$2.37 ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500106,85018,HC HGB,305,1 ,$42.00 ,$27.30 ,$2.37 ,$42.00 ,$5.93 ,$27.30 ,$25.07 ,$2.37 ,$11.76 ,$23.56 ,$2.37 ,$27.64 ,$2.37 ,$35.70 ,$35.70 ,$2.37 ,$35.70 ,$4.50 ,$28.56 ,$5.93 ,$2.37 ,$2.37 ,$31.50 ,$29.82 ,$29.82 ,$2.37 ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A ,$5.93 ,$35.70 ,$2.37 ,$2.37 ,$25.07 ,$2.37 ,$17.47 ,$5.09 ,$4.63 ,$2.37 ,$35.70 ,$4.98 ,$35.70 ,$11.76 ,$37.80 ,$2.37 ,$34.44 ,$9.48 ,$9.48 ,$2.37 ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$147.00 ,$95.55 ,$4.63 ,$147.00 ,$19.43 ,$95.55 ,$87.76 ,$7.77 ,$41.16 ,$82.47 ,$7.77 ,$96.73 ,$7.77 ,$124.95 ,$124.95 ,$7.77 ,$124.95 ,$14.76 ,$99.96 ,$19.43 ,$7.77 ,$7.77 ,$110.25 ,$104.37 ,$104.37 ,$7.77 ,$104.37 ,$120.54 ,$120.54 ,$120.54 , N/A ,$19.43 ,$124.95 ,$7.77 ,$7.77 ,$87.76 ,$7.77 ,$61.15 ,$5.09 ,$4.63 ,$7.77 ,$124.95 ,$16.32 ,$124.95 ,$41.16 ,$132.30 ,$7.77 ,$120.54 ,$31.08 ,$31.08 ,$7.77 ,$95.55 ,$147.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500108,85027,HC CBC W/O DIFF,305,1 ,$139.00 ,$90.35 ,$4.63 ,$139.00 ,$16.18 ,$90.35 ,$82.98 ,$6.47 ,$38.92 ,$77.98 ,$6.47 ,$91.46 ,$6.47 ,$118.15 ,$118.15 ,$6.47 ,$118.15 ,$12.29 ,$94.52 ,$16.18 ,$6.47 ,$6.47 ,$104.25 ,$98.69 ,$98.69 ,$6.47 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$16.18 ,$118.15 ,$6.47 ,$6.47 ,$82.98 ,$6.47 ,$57.82 ,$5.09 ,$4.63 ,$6.47 ,$118.15 ,$13.59 ,$118.15 ,$38.92 ,$125.10 ,$6.47 ,$113.98 ,$25.88 ,$25.88 ,$6.47 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500111,85045,HC RETIC COUNT AUTO,305,1 ,$71.00 ,$46.15 ,$3.99 ,$71.00 ,$9.98 ,$46.15 ,$42.39 ,$3.99 ,$19.88 ,$39.83 ,$3.99 ,$46.72 ,$3.99 ,$60.35 ,$60.35 ,$3.99 ,$60.35 ,$7.58 ,$48.28 ,$9.98 ,$3.99 ,$3.99 ,$53.25 ,$50.41 ,$50.41 ,$3.99 ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A ,$9.98 ,$60.35 ,$3.99 ,$71.00 ,$42.39 ,$3.99 ,$29.54 ,$5.09 ,$4.63 ,$3.99 ,$60.35 ,$8.38 ,$60.35 ,$19.88 ,$63.90 ,$3.99 ,$58.22 ,$15.96 ,$15.96 ,$3.99 ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$60.00 ,$39.00 ,$2.54 ,$60.00 ,$6.35 ,$39.00 ,$35.82 ,$2.54 ,$16.80 ,$33.66 ,$2.54 ,$39.48 ,$2.54 ,$51.00 ,$51.00 ,$2.54 ,$51.00 ,$4.83 ,$40.80 ,$6.35 ,$2.54 ,$2.54 ,$45.00 ,$42.60 ,$42.60 ,$2.54 ,$42.60 ,$49.20 ,$49.20 ,$49.20 , N/A ,$6.35 ,$51.00 ,$2.54 ,$60.00 ,$35.82 ,$2.54 ,$24.96 ,$5.09 ,$4.63 ,$2.54 ,$51.00 ,$5.33 ,$51.00 ,$16.80 ,$54.00 ,$2.54 ,$49.20 ,$10.16 ,$10.16 ,$2.54 ,$39.00 ,$60.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$75.00 ,$48.75 ,$4.48 ,$75.00 ,$11.20 ,$48.75 ,$44.78 ,$4.48 ,$21.00 ,$42.08 ,$4.48 ,$49.35 ,$4.48 ,$63.75 ,$63.75 ,$4.48 ,$63.75 ,$8.51 ,$51.00 ,$11.20 ,$4.48 ,$4.48 ,$56.25 ,$53.25 ,$53.25 ,$4.48 ,$53.25 ,$61.50 ,$61.50 ,$61.50 , N/A ,$11.20 ,$63.75 ,$4.48 ,$75.00 ,$44.78 ,$4.48 ,$31.20 ,$5.09 ,$4.63 ,$4.48 ,$63.75 ,$9.41 ,$63.75 ,$21.00 ,$67.50 ,$4.48 ,$61.50 ,$17.92 ,$17.92 ,$4.48 ,$48.75 ,$75.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500175,85379,HC D DIMER QN,305,1 ,$210.00 ,$136.50 ,$8.03 ,$210.00 ,$25.45 ,$136.50 ,$125.37 ,$10.18 ,$58.80 ,$117.81 ,$10.18 ,$138.18 ,$10.18 ,$178.50 ,$178.50 ,$10.18 ,$178.50 ,$19.34 ,$142.80 ,$25.45 ,$10.18 ,$10.18 ,$157.50 ,$149.10 ,$149.10 ,$10.18 ,$149.10 ,$172.20 ,$172.20 ,$172.20 , N/A ,$25.45 ,$178.50 ,$10.18 ,$210.00 ,$125.37 ,$10.18 ,$87.36 ,$8.83 ,$8.03 ,$10.18 ,$178.50 ,$21.38 ,$178.50 ,$58.80 ,$189.00 ,$10.18 ,$172.20 ,$40.72 ,$40.72 ,$10.18 ,$136.50 ,$210.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500176,85384,HC FIBRINOGEN,305,1 ,$29.16 ,$18.95 ,$2.70 ,$29.16 ,$24.30 ,$18.95 ,$17.41 ,$9.72 ,$8.16 ,$16.36 ,$9.72 ,$19.19 ,$9.72 ,$24.79 ,$24.79 ,$9.72 ,$24.79 ,$18.47 ,$19.83 ,$24.30 ,$9.72 ,$9.72 ,$21.87 ,$20.70 ,$20.70 ,$9.72 ,$20.70 ,$23.91 ,$23.91 ,$23.91 , N/A ,$24.30 ,$24.79 ,$9.72 ,$29.16 ,$17.41 ,$9.72 ,$12.13 ,$2.97 ,$2.70 ,$9.72 ,$24.79 ,$20.41 ,$24.79 ,$8.16 ,$26.24 ,$9.72 ,$23.91 ,$29.16 ,$29.16 ,$9.72 ,$18.95 ,$29.16 
ST. JOSEPH'S HOSPITAL - BREESE,30500179,85385,HC FIBRINOGEN AG,305,1 ,$142.00 ,$92.30 ,$2.70 ,$142.00 ,$36.15 ,$92.30 ,$84.77 ,$14.46 ,$39.76 ,$79.66 ,$14.46 ,$93.44 ,$14.46 ,$120.70 ,$120.70 ,$14.46 ,$120.70 ,$27.47 ,$96.56 ,$36.15 ,$14.46 ,$14.46 ,$106.50 ,$100.82 ,$100.82 ,$14.46 ,$100.82 ,$116.44 ,$116.44 ,$116.44 , N/A ,$36.15 ,$120.70 ,$14.46 ,$142.00 ,$84.77 ,$14.46 ,$59.07 ,$2.97 ,$2.70 ,$14.46 ,$120.70 ,$30.37 ,$120.70 ,$39.76 ,$127.80 ,$14.46 ,$116.44 ,$57.84 ,$57.84 ,$14.46 ,$92.30 ,$142.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500187,85520,HC HEPARIN ASSAY,305,1 ,$191.00 ,$124.15 ,$8.03 ,$191.00 ,$32.73 ,$124.15 ,$114.03 ,$13.09 ,$53.48 ,$107.15 ,$13.09 ,$125.68 ,$13.09 ,$162.35 ,$162.35 ,$13.09 ,$162.35 ,$24.87 ,$129.88 ,$32.73 ,$13.09 ,$13.09 ,$143.25 ,$135.61 ,$135.61 ,$13.09 ,$135.61 ,$156.62 ,$156.62 ,$156.62 , N/A ,$32.73 ,$162.35 ,$13.09 ,$191.00 ,$114.03 ,$13.09 ,$79.46 ,$8.83 ,$8.03 ,$13.09 ,$162.35 ,$27.49 ,$162.35 ,$53.48 ,$171.90 ,$13.09 ,$156.62 ,$52.36 ,$52.36 ,$13.09 ,$124.15 ,$191.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$74.00 ,$48.10 ,$2.70 ,$74.00 ,$10.73 ,$48.10 ,$44.18 ,$4.29 ,$20.72 ,$41.51 ,$4.29 ,$48.69 ,$4.29 ,$62.90 ,$62.90 ,$4.29 ,$62.90 ,$8.15 ,$50.32 ,$10.73 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$44.18 ,$4.29 ,$30.78 ,$2.97 ,$2.70 ,$4.29 ,$62.90 ,$9.01 ,$62.90 ,$20.72 ,$66.60 ,$4.29 ,$60.68 ,$17.16 ,$17.16 ,$4.29 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500205,85652,HC SED RATE AUTO,305,1 ,$80.00 ,$52.00 ,$2.70 ,$80.00 ,$6.75 ,$52.00 ,$47.76 ,$2.70 ,$22.40 ,$44.88 ,$2.70 ,$52.64 ,$2.70 ,$68.00 ,$68.00 ,$2.70 ,$68.00 ,$5.13 ,$54.40 ,$6.75 ,$2.70 ,$2.70 ,$60.00 ,$56.80 ,$56.80 ,$2.70 ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A ,$6.75 ,$68.00 ,$2.70 ,$80.00 ,$47.76 ,$2.70 ,$33.28 ,$5.09 ,$4.63 ,$2.70 ,$68.00 ,$5.67 ,$68.00 ,$22.40 ,$72.00 ,$2.70 ,$65.60 ,$10.80 ,$10.80 ,$2.70 ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500211,85730,HC PTT,305,1 ,$105.00 ,$68.25 ,$2.70 ,$105.00 ,$15.03 ,$68.25 ,$62.69 ,$6.01 ,$29.40 ,$58.91 ,$6.01 ,$69.09 ,$6.01 ,$89.25 ,$89.25 ,$6.01 ,$89.25 ,$11.42 ,$71.40 ,$15.03 ,$6.01 ,$6.01 ,$78.75 ,$74.55 ,$74.55 ,$6.01 ,$74.55 ,$86.10 ,$86.10 ,$86.10 , N/A ,$15.03 ,$89.25 ,$6.01 ,$105.00 ,$62.69 ,$6.01 ,$43.68 ,$2.97 ,$2.70 ,$6.01 ,$89.25 ,$12.62 ,$89.25 ,$29.40 ,$94.50 ,$6.01 ,$86.10 ,$24.04 ,$24.04 ,$6.01 ,$68.25 ,$105.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500217,85810,HC VISCOSITY,305,1 ,$58.00 ,$37.70 ,$7.05 ,$58.00 ,$29.18 ,$37.70 ,$34.63 ,$11.67 ,$16.24 ,$32.54 ,$11.67 ,$38.16 ,$11.67 ,$49.30 ,$49.30 ,$11.67 ,$49.30 ,$22.17 ,$39.44 ,$29.18 ,$11.67 ,$11.67 ,$43.50 ,$41.18 ,$41.18 ,$11.67 ,$41.18 ,$47.56 ,$47.56 ,$47.56 , N/A ,$29.18 ,$49.30 ,$11.67 ,$58.00 ,$34.63 ,$11.67 ,$24.13 ,$7.76 ,$7.05 ,$11.67 ,$49.30 ,$24.51 ,$49.30 ,$16.24 ,$52.20 ,$11.67 ,$47.56 ,$46.68 ,$46.68 ,$11.67 ,$37.70 ,$58.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500234,85014,HC HEMATOCRIT-90,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$5.93 ,$24.70 ,$22.69 ,$2.37 ,$10.64 ,$21.32 ,$2.37 ,$25.00 ,$2.37 ,$32.30 ,$32.30 ,$2.37 ,$32.30 ,$4.50 ,$25.84 ,$5.93 ,$2.37 ,$2.37 ,$28.50 ,$26.98 ,$26.98 ,$2.37 ,$26.98 ,$31.16 ,$31.16 ,$31.16 , N/A ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$22.69 ,$2.37 ,$15.81 ,$5.09 ,$4.63 ,$2.37 ,$32.30 ,$4.98 ,$32.30 ,$10.64 ,$34.20 ,$2.37 ,$31.16 ,$9.48 ,$9.48 ,$2.37 ,$24.70 ,$38.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500238,85018,HC HGB-90,305,1 ,$38.00 ,$24.70 ,$2.37 ,$38.00 ,$5.93 ,$24.70 ,$22.69 ,$2.37 ,$10.64 ,$21.32 ,$2.37 ,$25.00 ,$2.37 ,$32.30 ,$32.30 ,$2.37 ,$32.30 ,$4.50 ,$25.84 ,$5.93 ,$2.37 ,$2.37 ,$28.50 ,$26.98 ,$26.98 ,$2.37 ,$26.98 ,$31.16 ,$31.16 ,$31.16 , N/A ,$5.93 ,$32.30 ,$2.37 ,$2.37 ,$22.69 ,$2.37 ,$15.81 ,$5.09 ,$4.63 ,$2.37 ,$32.30 ,$4.98 ,$32.30 ,$10.64 ,$34.20 ,$2.37 ,$31.16 ,$9.48 ,$9.48 ,$2.37 ,$24.70 ,$38.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500244,85041,HC BLOOD COUNT RBC AUTO-90,305,1 ,$29.00 ,$18.85 ,$3.02 ,$29.00 ,$7.55 ,$18.85 ,$17.31 ,$3.02 ,$8.12 ,$16.27 ,$3.02 ,$19.08 ,$3.02 ,$24.65 ,$24.65 ,$3.02 ,$24.65 ,$5.74 ,$19.72 ,$7.55 ,$3.02 ,$3.02 ,$21.75 ,$20.59 ,$20.59 ,$3.02 ,$20.59 ,$23.78 ,$23.78 ,$23.78 , N/A ,$7.55 ,$24.65 ,$3.02 ,$29.00 ,$17.31 ,$3.02 ,$12.06 ,$5.09 ,$4.63 ,$3.02 ,$24.65 ,$6.34 ,$24.65 ,$8.12 ,$26.10 ,$3.02 ,$23.78 ,$12.08 ,$12.08 ,$3.02 ,$18.85 ,$29.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500247,85097,HC BONE MARROW SMEAR INTERP,305,1 ,$73.00 ,$47.45 ,$20.44 ,"$1,615.20 ","$1,615.20 ",$47.45 ,$43.58 ,$646.08 ,$20.44 ,$40.95 ,$646.08 ,$48.03 ,$73.00 ,$62.05 ,$62.05 ,$73.00 ,$62.05 ,$73.00 ,$49.64 ,"$1,615.20 ",$646.08 ,$646.08 ,$54.75 ,$51.83 ,$51.83 ,$646.08 ,$51.83 ,$59.86 ,$59.86 ,$59.86 , N/A ,$73.00 ,$62.05 ,$646.08 ,$73.00 ,$43.58 ,$646.08 ,$30.37 ,$23.44 ,$21.31 ,$646.08 ,$62.05 ,"$1,356.77 ",$62.05 ,$20.44 ,$65.70 ,$646.08 ,$59.86 ,$73.00 ,$73.00 ,$646.08 ,$47.45 ,$73.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500249,85210,HC FACTOR II-90,305,1 ,$151.00 ,$98.15 ,$2.70 ,$151.00 ,$32.45 ,$98.15 ,$90.15 ,$12.98 ,$42.28 ,$84.71 ,$12.98 ,$99.36 ,$12.98 ,$128.35 ,$128.35 ,$12.98 ,$128.35 ,$24.66 ,$102.68 ,$32.45 ,$12.98 ,$12.98 ,$113.25 ,$107.21 ,$107.21 ,$12.98 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$32.45 ,$128.35 ,$12.98 ,$151.00 ,$90.15 ,$12.98 ,$62.82 ,$2.97 ,$2.70 ,$12.98 ,$128.35 ,$27.26 ,$128.35 ,$42.28 ,$135.90 ,$12.98 ,$123.82 ,$51.92 ,$51.92 ,$12.98 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500250,85220,HC FACTOR V-90,305,1 ,$151.00 ,$98.15 ,$8.03 ,$151.00 ,$44.13 ,$98.15 ,$90.15 ,$17.65 ,$42.28 ,$84.71 ,$17.65 ,$99.36 ,$17.65 ,$128.35 ,$128.35 ,$17.65 ,$128.35 ,$33.54 ,$102.68 ,$44.13 ,$17.65 ,$17.65 ,$113.25 ,$107.21 ,$107.21 ,$17.65 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$44.13 ,$128.35 ,$17.65 ,$151.00 ,$90.15 ,$17.65 ,$62.82 ,$8.83 ,$8.03 ,$17.65 ,$128.35 ,$37.07 ,$128.35 ,$42.28 ,$135.90 ,$17.65 ,$123.82 ,$70.60 ,$70.60 ,$17.65 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500251,85230,HC FACTOR VII-90,305,1 ,$145.00 ,$94.25 ,$8.03 ,$145.00 ,$44.75 ,$94.25 ,$86.57 ,$17.90 ,$40.60 ,$81.35 ,$17.90 ,$95.41 ,$17.90 ,$123.25 ,$123.25 ,$17.90 ,$123.25 ,$34.01 ,$98.60 ,$44.75 ,$17.90 ,$17.90 ,$108.75 ,$102.95 ,$102.95 ,$17.90 ,$102.95 ,$118.90 ,$118.90 ,$118.90 , N/A ,$44.75 ,$123.25 ,$17.90 ,$145.00 ,$86.57 ,$17.90 ,$60.32 ,$8.83 ,$8.03 ,$17.90 ,$123.25 ,$37.59 ,$123.25 ,$40.60 ,$130.50 ,$17.90 ,$118.90 ,$71.60 ,$71.60 ,$17.90 ,$94.25 ,$145.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500252,85240,HC FACTOR VIII AHG-90,305,1 ,$167.00 ,$108.55 ,$8.03 ,$167.00 ,$44.75 ,$108.55 ,$99.70 ,$17.90 ,$46.76 ,$93.69 ,$17.90 ,$109.89 ,$17.90 ,$141.95 ,$141.95 ,$17.90 ,$141.95 ,$34.01 ,$113.56 ,$44.75 ,$17.90 ,$17.90 ,$125.25 ,$118.57 ,$118.57 ,$17.90 ,$118.57 ,$136.94 ,$136.94 ,$136.94 , N/A ,$44.75 ,$141.95 ,$17.90 ,$167.00 ,$99.70 ,$17.90 ,$69.47 ,$8.83 ,$8.03 ,$17.90 ,$141.95 ,$37.59 ,$141.95 ,$46.76 ,$150.30 ,$17.90 ,$136.94 ,$71.60 ,$71.60 ,$17.90 ,$108.55 ,$167.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500253,85245,HC FACTOR VIII VW RISTO-90,305,1 ,$81.00 ,$52.65 ,$8.03 ,$81.00 ,$57.35 ,$52.65 ,$48.36 ,$22.94 ,$22.68 ,$45.44 ,$22.94 ,$53.30 ,$22.94 ,$68.85 ,$68.85 ,$22.94 ,$68.85 ,$43.59 ,$55.08 ,$57.35 ,$22.94 ,$22.94 ,$60.75 ,$57.51 ,$57.51 ,$22.94 ,$57.51 ,$66.42 ,$66.42 ,$66.42 , N/A ,$57.35 ,$68.85 ,$22.94 ,$81.00 ,$48.36 ,$22.94 ,$33.70 ,$8.83 ,$8.03 ,$22.94 ,$68.85 ,$48.17 ,$68.85 ,$22.68 ,$72.90 ,$22.94 ,$66.42 ,$81.00 ,$81.00 ,$22.94 ,$52.65 ,$81.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500254,85246,HC FACTOR VIII VW AG-90,305,1 ,$152.00 ,$98.80 ,$8.03 ,$152.00 ,$57.35 ,$98.80 ,$90.74 ,$22.94 ,$42.56 ,$85.27 ,$22.94 ,$100.02 ,$22.94 ,$129.20 ,$129.20 ,$22.94 ,$129.20 ,$43.59 ,$103.36 ,$57.35 ,$22.94 ,$22.94 ,$114.00 ,$107.92 ,$107.92 ,$22.94 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$57.35 ,$129.20 ,$22.94 ,$152.00 ,$90.74 ,$22.94 ,$63.23 ,$8.83 ,$8.03 ,$22.94 ,$129.20 ,$48.17 ,$129.20 ,$42.56 ,$136.80 ,$22.94 ,$124.64 ,$91.76 ,$91.76 ,$22.94 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500255,85247,HC FACTOR VW MULTIM ANALY-90,305,1 ,$122.00 ,$79.30 ,$8.03 ,$122.00 ,$57.35 ,$79.30 ,$72.83 ,$22.94 ,$34.16 ,$68.44 ,$22.94 ,$80.28 ,$22.94 ,$103.70 ,$103.70 ,$22.94 ,$103.70 ,$43.59 ,$82.96 ,$57.35 ,$22.94 ,$22.94 ,$91.50 ,$86.62 ,$86.62 ,$22.94 ,$86.62 ,$100.04 ,$100.04 ,$100.04 , N/A ,$57.35 ,$103.70 ,$22.94 ,$122.00 ,$72.83 ,$22.94 ,$50.75 ,$8.83 ,$8.03 ,$22.94 ,$103.70 ,$48.17 ,$103.70 ,$34.16 ,$109.80 ,$22.94 ,$100.04 ,$91.76 ,$91.76 ,$22.94 ,$79.30 ,$122.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500256,85250,HC FACTOR IX-90,305,1 ,$133.00 ,$86.45 ,$8.03 ,$133.00 ,$47.60 ,$86.45 ,$79.40 ,$19.04 ,$37.24 ,$74.61 ,$19.04 ,$87.51 ,$19.04 ,$113.05 ,$113.05 ,$19.04 ,$113.05 ,$36.18 ,$90.44 ,$47.60 ,$19.04 ,$19.04 ,$99.75 ,$94.43 ,$94.43 ,$19.04 ,$94.43 ,$109.06 ,$109.06 ,$109.06 , N/A ,$47.60 ,$113.05 ,$19.04 ,$133.00 ,$79.40 ,$19.04 ,$55.33 ,$8.83 ,$8.03 ,$19.04 ,$113.05 ,$39.98 ,$113.05 ,$37.24 ,$119.70 ,$19.04 ,$109.06 ,$76.16 ,$76.16 ,$19.04 ,$86.45 ,$133.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500257,85260,HC FACTOR X-90,305,1 ,$151.00 ,$98.15 ,$8.03 ,$151.00 ,$44.75 ,$98.15 ,$90.15 ,$17.90 ,$42.28 ,$84.71 ,$17.90 ,$99.36 ,$17.90 ,$128.35 ,$128.35 ,$17.90 ,$128.35 ,$34.01 ,$102.68 ,$44.75 ,$17.90 ,$17.90 ,$113.25 ,$107.21 ,$107.21 ,$17.90 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$44.75 ,$128.35 ,$17.90 ,$151.00 ,$90.15 ,$17.90 ,$62.82 ,$8.83 ,$8.03 ,$17.90 ,$128.35 ,$37.59 ,$128.35 ,$42.28 ,$135.90 ,$17.90 ,$123.82 ,$71.60 ,$71.60 ,$17.90 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500258,85270,HC FACTOR XI-90,305,1 ,$52.06 ,$33.84 ,$8.03 ,$52.06 ,$44.75 ,$33.84 ,$31.08 ,$17.90 ,$14.58 ,$29.21 ,$17.90 ,$34.26 ,$17.90 ,$44.25 ,$44.25 ,$17.90 ,$44.25 ,$34.01 ,$35.40 ,$44.75 ,$17.90 ,$17.90 ,$39.05 ,$36.96 ,$36.96 ,$17.90 ,$36.96 ,$42.69 ,$42.69 ,$42.69 , N/A ,$44.75 ,$44.25 ,$17.90 ,$52.06 ,$31.08 ,$17.90 ,$21.66 ,$8.83 ,$8.03 ,$17.90 ,$44.25 ,$37.59 ,$44.25 ,$14.58 ,$46.85 ,$17.90 ,$42.69 ,$52.06 ,$52.06 ,$17.90 ,$33.84 ,$52.06 
ST. JOSEPH'S HOSPITAL - BREESE,30500259,85280,HC FACTOR XI-90,305,1 ,$52.06 ,$33.84 ,$8.03 ,$52.06 ,$48.38 ,$33.84 ,$31.08 ,$19.35 ,$14.58 ,$29.21 ,$19.35 ,$34.26 ,$19.35 ,$44.25 ,$44.25 ,$19.35 ,$44.25 ,$36.77 ,$35.40 ,$48.38 ,$19.35 ,$19.35 ,$39.05 ,$36.96 ,$36.96 ,$19.35 ,$36.96 ,$42.69 ,$42.69 ,$42.69 , N/A ,$48.38 ,$44.25 ,$19.35 ,$52.06 ,$31.08 ,$19.35 ,$21.66 ,$8.83 ,$8.03 ,$19.35 ,$44.25 ,$40.64 ,$44.25 ,$14.58 ,$46.85 ,$19.35 ,$42.69 ,$52.06 ,$52.06 ,$19.35 ,$33.84 ,$52.06 
ST. JOSEPH'S HOSPITAL - BREESE,30500261,85300,HC ANTITHROMBIN III ACT-90,305,1 ,$177.00 ,$115.05 ,$8.03 ,$177.00 ,$29.63 ,$115.05 ,$105.67 ,$11.85 ,$49.56 ,$99.30 ,$11.85 ,$116.47 ,$11.85 ,$150.45 ,$150.45 ,$11.85 ,$150.45 ,$22.52 ,$120.36 ,$29.63 ,$11.85 ,$11.85 ,$132.75 ,$125.67 ,$125.67 ,$11.85 ,$125.67 ,$145.14 ,$145.14 ,$145.14 , N/A ,$29.63 ,$150.45 ,$11.85 ,$177.00 ,$105.67 ,$11.85 ,$73.63 ,$8.83 ,$8.03 ,$11.85 ,$150.45 ,$24.89 ,$150.45 ,$49.56 ,$159.30 ,$11.85 ,$145.14 ,$47.40 ,$47.40 ,$11.85 ,$115.05 ,$177.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500262,85301,HC ANTITHROMBIN III AG-90,305,1 ,$53.00 ,$34.45 ,$8.03 ,$53.00 ,$27.03 ,$34.45 ,$31.64 ,$10.81 ,$14.84 ,$29.73 ,$10.81 ,$34.87 ,$10.81 ,$45.05 ,$45.05 ,$10.81 ,$45.05 ,$20.54 ,$36.04 ,$27.03 ,$10.81 ,$10.81 ,$39.75 ,$37.63 ,$37.63 ,$10.81 ,$37.63 ,$43.46 ,$43.46 ,$43.46 , N/A ,$27.03 ,$45.05 ,$10.81 ,$53.00 ,$31.64 ,$10.81 ,$22.05 ,$8.83 ,$8.03 ,$10.81 ,$45.05 ,$22.70 ,$45.05 ,$14.84 ,$47.70 ,$10.81 ,$43.46 ,$43.24 ,$43.24 ,$10.81 ,$34.45 ,$53.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500263,85302,HC PROTEIN C AG-90,305,1 ,$130.00 ,$84.50 ,$8.03 ,$130.00 ,$30.03 ,$84.50 ,$77.61 ,$12.01 ,$36.40 ,$72.93 ,$12.01 ,$85.54 ,$12.01 ,$110.50 ,$110.50 ,$12.01 ,$110.50 ,$22.82 ,$88.40 ,$30.03 ,$12.01 ,$12.01 ,$97.50 ,$92.30 ,$92.30 ,$12.01 ,$92.30 ,$106.60 ,$106.60 ,$106.60 , N/A ,$30.03 ,$110.50 ,$12.01 ,$130.00 ,$77.61 ,$12.01 ,$54.08 ,$8.83 ,$8.03 ,$12.01 ,$110.50 ,$25.22 ,$110.50 ,$36.40 ,$117.00 ,$12.01 ,$106.60 ,$48.04 ,$48.04 ,$12.01 ,$84.50 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500264,85303,HC PROTEIN C ACTIVITY-90,305,1 ,$215.00 ,$139.75 ,$8.03 ,$215.00 ,$34.60 ,$139.75 ,$128.36 ,$13.84 ,$60.20 ,$120.62 ,$13.84 ,$141.47 ,$13.84 ,$182.75 ,$182.75 ,$13.84 ,$182.75 ,$26.30 ,$146.20 ,$34.60 ,$13.84 ,$13.84 ,$161.25 ,$152.65 ,$152.65 ,$13.84 ,$152.65 ,$176.30 ,$176.30 ,$176.30 , N/A ,$34.60 ,$182.75 ,$13.84 ,$215.00 ,$128.36 ,$13.84 ,$89.44 ,$8.83 ,$8.03 ,$13.84 ,$182.75 ,$29.06 ,$182.75 ,$60.20 ,$193.50 ,$13.84 ,$176.30 ,$55.36 ,$55.36 ,$13.84 ,$139.75 ,$215.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500265,85305,HC PROTEIN S TOTAL-90,305,1 ,$37.00 ,$24.05 ,$8.03 ,$37.00 ,$29.03 ,$24.05 ,$22.09 ,$11.61 ,$10.36 ,$20.76 ,$11.61 ,$24.35 ,$11.61 ,$31.45 ,$31.45 ,$11.61 ,$31.45 ,$22.06 ,$25.16 ,$29.03 ,$11.61 ,$11.61 ,$27.75 ,$26.27 ,$26.27 ,$11.61 ,$26.27 ,$30.34 ,$30.34 ,$30.34 , N/A ,$29.03 ,$31.45 ,$11.61 ,$37.00 ,$22.09 ,$11.61 ,$15.39 ,$8.83 ,$8.03 ,$11.61 ,$31.45 ,$24.38 ,$31.45 ,$10.36 ,$33.30 ,$11.61 ,$30.34 ,$37.00 ,$37.00 ,$11.61 ,$24.05 ,$37.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500266,85306,HC PROTEIN S FREE-90,305,1 ,$201.00 ,$130.65 ,$8.03 ,$201.00 ,$38.30 ,$130.65 ,$120.00 ,$15.32 ,$56.28 ,$112.76 ,$15.32 ,$132.26 ,$15.32 ,$170.85 ,$170.85 ,$15.32 ,$170.85 ,$29.11 ,$136.68 ,$38.30 ,$15.32 ,$15.32 ,$150.75 ,$142.71 ,$142.71 ,$15.32 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$38.30 ,$170.85 ,$15.32 ,$201.00 ,$120.00 ,$15.32 ,$83.62 ,$8.83 ,$8.03 ,$15.32 ,$170.85 ,$32.17 ,$170.85 ,$56.28 ,$180.90 ,$15.32 ,$164.82 ,$61.28 ,$61.28 ,$15.32 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500267,85307,HC ACTIVATED PROTEIN C RESIST-90,305,1 ,$139.00 ,$90.35 ,$7.46 ,$139.00 ,$38.30 ,$90.35 ,$82.98 ,$15.32 ,$38.92 ,$77.98 ,$15.32 ,$91.46 ,$15.32 ,$118.15 ,$118.15 ,$15.32 ,$118.15 ,$29.11 ,$94.52 ,$38.30 ,$15.32 ,$15.32 ,$104.25 ,$98.69 ,$98.69 ,$15.32 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$38.30 ,$118.15 ,$15.32 ,$139.00 ,$82.98 ,$15.32 ,$57.82 ,$8.21 ,$7.46 ,$15.32 ,$118.15 ,$32.17 ,$118.15 ,$38.92 ,$125.10 ,$15.32 ,$113.98 ,$61.28 ,$61.28 ,$15.32 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500277,85415,HC PLASMINGEN ACTIVATOR INHIB-90,305,1 ,$216.00 ,$140.40 ,$8.03 ,$216.00 ,$42.98 ,$140.40 ,$128.95 ,$17.19 ,$60.48 ,$121.18 ,$17.19 ,$142.13 ,$17.19 ,$183.60 ,$183.60 ,$17.19 ,$183.60 ,$32.66 ,$146.88 ,$42.98 ,$17.19 ,$17.19 ,$162.00 ,$153.36 ,$153.36 ,$17.19 ,$153.36 ,$177.12 ,$177.12 ,$177.12 , N/A ,$42.98 ,$183.60 ,$17.19 ,$216.00 ,$128.95 ,$17.19 ,$89.86 ,$8.83 ,$8.03 ,$17.19 ,$183.60 ,$36.10 ,$183.60 ,$60.48 ,$194.40 ,$17.19 ,$177.12 ,$68.76 ,$68.76 ,$17.19 ,$140.40 ,$216.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500278,85420,HC PLASMINOGEN ACTIVITY-90,305,1 ,$90.00 ,$58.50 ,$6.53 ,$90.00 ,$16.33 ,$58.50 ,$53.73 ,$6.53 ,$25.20 ,$50.49 ,$6.53 ,$59.22 ,$6.53 ,$76.50 ,$76.50 ,$6.53 ,$76.50 ,$12.41 ,$61.20 ,$16.33 ,$6.53 ,$6.53 ,$67.50 ,$63.90 ,$63.90 ,$6.53 ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A ,$16.33 ,$76.50 ,$6.53 ,$90.00 ,$53.73 ,$6.53 ,$37.44 ,$8.83 ,$8.03 ,$6.53 ,$76.50 ,$13.71 ,$76.50 ,$25.20 ,$81.00 ,$6.53 ,$73.80 ,$26.12 ,$26.12 ,$6.53 ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500287,85549,HC MURAMIDASE-90,305,1 ,$70.00 ,$45.50 ,$7.46 ,$70.00 ,$46.88 ,$45.50 ,$41.79 ,$18.75 ,$19.60 ,$39.27 ,$18.75 ,$46.06 ,$18.75 ,$59.50 ,$59.50 ,$18.75 ,$59.50 ,$35.63 ,$47.60 ,$46.88 ,$18.75 ,$18.75 ,$52.50 ,$49.70 ,$49.70 ,$18.75 ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A ,$46.88 ,$59.50 ,$18.75 ,$70.00 ,$41.79 ,$18.75 ,$29.12 ,$8.21 ,$7.46 ,$18.75 ,$59.50 ,$39.38 ,$59.50 ,$19.60 ,$63.00 ,$18.75 ,$57.40 ,$70.00 ,$70.00 ,$18.75 ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500289,85597,HC PLATELET NEUTRALIZATION-90,305,1 ,$40.00 ,$26.00 ,$8.03 ,$44.95 ,$44.95 ,$26.00 ,$23.88 ,$17.98 ,$11.20 ,$22.44 ,$17.98 ,$26.32 ,$17.98 ,$34.00 ,$34.00 ,$17.98 ,$34.00 ,$34.16 ,$27.20 ,$44.95 ,$17.98 ,$17.98 ,$30.00 ,$28.40 ,$28.40 ,$17.98 ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A ,$40.00 ,$34.00 ,$17.98 ,$40.00 ,$23.88 ,$17.98 ,$16.64 ,$8.83 ,$8.03 ,$17.98 ,$34.00 ,$37.76 ,$34.00 ,$11.20 ,$36.00 ,$17.98 ,$32.80 ,$40.00 ,$40.00 ,$17.98 ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500297,85613,HC RUSSELL VIPER VENOM SCR T1-90,305,1 ,$66.00 ,$42.90 ,$8.03 ,$66.00 ,$23.95 ,$42.90 ,$39.40 ,$9.58 ,$18.48 ,$37.03 ,$9.58 ,$43.43 ,$9.58 ,$56.10 ,$56.10 ,$9.58 ,$56.10 ,$18.20 ,$44.88 ,$23.95 ,$9.58 ,$9.58 ,$49.50 ,$46.86 ,$46.86 ,$9.58 ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A ,$23.95 ,$56.10 ,$9.58 ,$66.00 ,$39.40 ,$9.58 ,$27.46 ,$8.83 ,$8.03 ,$9.58 ,$56.10 ,$20.12 ,$56.10 ,$18.48 ,$59.40 ,$9.58 ,$54.12 ,$38.32 ,$38.32 ,$9.58 ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500304,85670,HC THROMBIN TIME PLASMA-90,305,1 ,$54.00 ,$35.10 ,$2.70 ,$54.00 ,$14.43 ,$35.10 ,$32.24 ,$5.77 ,$15.12 ,$30.29 ,$5.77 ,$35.53 ,$5.77 ,$45.90 ,$45.90 ,$5.77 ,$45.90 ,$10.96 ,$36.72 ,$14.43 ,$5.77 ,$5.77 ,$40.50 ,$38.34 ,$38.34 ,$5.77 ,$38.34 ,$44.28 ,$44.28 ,$44.28 , N/A ,$14.43 ,$45.90 ,$5.77 ,$54.00 ,$32.24 ,$5.77 ,$22.46 ,$2.97 ,$2.70 ,$5.77 ,$45.90 ,$12.12 ,$45.90 ,$15.12 ,$48.60 ,$5.77 ,$44.28 ,$23.08 ,$23.08 ,$5.77 ,$35.10 ,$54.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500305,85730,HC PTT-90,305,1 ,$105.00 ,$68.25 ,$2.70 ,$105.00 ,$15.03 ,$68.25 ,$62.69 ,$6.01 ,$29.40 ,$58.91 ,$6.01 ,$69.09 ,$6.01 ,$89.25 ,$89.25 ,$6.01 ,$89.25 ,$11.42 ,$71.40 ,$15.03 ,$6.01 ,$6.01 ,$78.75 ,$74.55 ,$74.55 ,$6.01 ,$74.55 ,$86.10 ,$86.10 ,$86.10 , N/A ,$15.03 ,$89.25 ,$6.01 ,$105.00 ,$62.69 ,$6.01 ,$43.68 ,$2.97 ,$2.70 ,$6.01 ,$89.25 ,$12.62 ,$89.25 ,$29.40 ,$94.50 ,$6.01 ,$86.10 ,$24.04 ,$24.04 ,$6.01 ,$68.25 ,$105.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500310,85810,HC VISCOSITY-90,305,1 ,$51.00 ,$33.15 ,$7.05 ,$51.00 ,$29.18 ,$33.15 ,$30.45 ,$11.67 ,$14.28 ,$28.61 ,$11.67 ,$33.56 ,$11.67 ,$43.35 ,$43.35 ,$11.67 ,$43.35 ,$22.17 ,$34.68 ,$29.18 ,$11.67 ,$11.67 ,$38.25 ,$36.21 ,$36.21 ,$11.67 ,$36.21 ,$41.82 ,$41.82 ,$41.82 , N/A ,$29.18 ,$43.35 ,$11.67 ,$51.00 ,$30.45 ,$11.67 ,$21.22 ,$7.76 ,$7.05 ,$11.67 ,$43.35 ,$24.51 ,$43.35 ,$14.28 ,$45.90 ,$11.67 ,$41.82 ,$46.68 ,$46.68 ,$11.67 ,$33.15 ,$51.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500324,85009,HC BLOOD COUNT MAN DIFF WBC BUFFY COAT,305,1 ,$77.00 ,$50.05 ,$4.63 ,$77.00 ,$12.68 ,$50.05 ,$45.97 ,$5.07 ,$21.56 ,$43.20 ,$5.07 ,$50.67 ,$5.07 ,$65.45 ,$65.45 ,$5.07 ,$65.45 ,$9.63 ,$52.36 ,$12.68 ,$5.07 ,$5.07 ,$57.75 ,$54.67 ,$54.67 ,$5.07 ,$54.67 ,$63.14 ,$63.14 ,$63.14 , N/A ,$12.68 ,$65.45 ,$5.07 ,$77.00 ,$45.97 ,$5.07 ,$32.03 ,$5.09 ,$4.63 ,$5.07 ,$65.45 ,$10.65 ,$65.45 ,$21.56 ,$69.30 ,$5.07 ,$63.14 ,$20.28 ,$20.28 ,$5.07 ,$50.05 ,$77.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500327,85041,HC BLOOD COUNT RBS AUTO,305,1 ,$29.00 ,$18.85 ,$3.02 ,$29.00 ,$7.55 ,$18.85 ,$17.31 ,$3.02 ,$8.12 ,$16.27 ,$3.02 ,$19.08 ,$3.02 ,$24.65 ,$24.65 ,$3.02 ,$24.65 ,$5.74 ,$19.72 ,$7.55 ,$3.02 ,$3.02 ,$21.75 ,$20.59 ,$20.59 ,$3.02 ,$20.59 ,$23.78 ,$23.78 ,$23.78 , N/A ,$7.55 ,$24.65 ,$3.02 ,$29.00 ,$17.31 ,$3.02 ,$12.06 ,$5.09 ,$4.63 ,$3.02 ,$24.65 ,$6.34 ,$24.65 ,$8.12 ,$26.10 ,$3.02 ,$23.78 ,$12.08 ,$12.08 ,$3.02 ,$18.85 ,$29.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500341,85046,HC BLOOD COUNT RETICULOCYTES AUTO,305,1 ,$16.71 ,$10.86 ,$4.63 ,$16.71 ,$13.93 ,$10.86 ,$9.98 ,$5.57 ,$4.68 ,$9.37 ,$5.57 ,$11.00 ,$5.57 ,$14.20 ,$14.20 ,$5.57 ,$14.20 ,$10.58 ,$11.36 ,$13.93 ,$5.57 ,$5.57 ,$12.53 ,$11.86 ,$11.86 ,$5.57 ,$11.86 ,$13.70 ,$13.70 ,$13.70 , N/A ,$13.93 ,$14.20 ,$5.57 ,$16.71 ,$9.98 ,$5.57 ,$6.95 ,$5.09 ,$4.63 ,$5.57 ,$14.20 ,$11.70 ,$14.20 ,$4.68 ,$15.04 ,$5.57 ,$13.70 ,$16.71 ,$16.71 ,$5.57 ,$10.86 ,$16.71 
ST. JOSEPH'S HOSPITAL - BREESE,30500345,85610,HC PROTHROMBIN TIME (PT)-QW,305,1 ,$74.00 ,$48.10 ,$2.70 ,$74.00 ,$10.73 ,$48.10 ,$44.18 ,$4.29 ,$20.72 ,$41.51 ,$4.29 ,$48.69 ,$4.29 ,$62.90 ,$62.90 ,$4.29 ,$62.90 ,$8.15 ,$50.32 ,$10.73 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$44.18 ,$4.29 ,$30.78 ,$2.97 ,$2.70 ,$4.29 ,$62.90 ,$9.01 ,$62.90 ,$20.72 ,$66.60 ,$4.29 ,$60.68 ,$17.16 ,$17.16 ,$4.29 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500831,85384,HC FIBRINOGEN,305,1 ,$158.00 ,$102.70 ,$2.70 ,$158.00 ,$24.30 ,$102.70 ,$94.33 ,$9.72 ,$44.24 ,$88.64 ,$9.72 ,$103.96 ,$9.72 ,$134.30 ,$134.30 ,$9.72 ,$134.30 ,$18.47 ,$107.44 ,$24.30 ,$9.72 ,$9.72 ,$118.50 ,$112.18 ,$112.18 ,$9.72 ,$112.18 ,$129.56 ,$129.56 ,$129.56 , N/A ,$24.30 ,$134.30 ,$9.72 ,$158.00 ,$94.33 ,$9.72 ,$65.73 ,$2.97 ,$2.70 ,$9.72 ,$134.30 ,$20.41 ,$134.30 ,$44.24 ,$142.20 ,$9.72 ,$129.56 ,$38.88 ,$38.88 ,$9.72 ,$102.70 ,$158.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500832,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$242.00 ,$157.30 ,$7.05 ,$242.00 ,$19.33 ,$157.30 ,$144.47 ,$7.73 ,$67.76 ,$135.76 ,$7.73 ,$159.24 ,$7.73 ,$205.70 ,$205.70 ,$7.73 ,$205.70 ,$14.69 ,$164.56 ,$19.33 ,$7.73 ,$7.73 ,$181.50 ,$171.82 ,$171.82 ,$7.73 ,$171.82 ,$198.44 ,$198.44 ,$198.44 , N/A ,$19.33 ,$205.70 ,$7.73 ,$242.00 ,$144.47 ,$7.73 ,$100.67 ,$7.76 ,$7.05 ,$7.73 ,$205.70 ,$16.23 ,$205.70 ,$67.76 ,$217.80 ,$7.73 ,$198.44 ,$30.92 ,$30.92 ,$7.73 ,$157.30 ,$242.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500833,85520,HC HEPARIN ASSAY,305,1 ,$166.00 ,$107.90 ,$8.03 ,$166.00 ,$32.73 ,$107.90 ,$99.10 ,$13.09 ,$46.48 ,$93.13 ,$13.09 ,$109.23 ,$13.09 ,$141.10 ,$141.10 ,$13.09 ,$141.10 ,$24.87 ,$112.88 ,$32.73 ,$13.09 ,$13.09 ,$124.50 ,$117.86 ,$117.86 ,$13.09 ,$117.86 ,$136.12 ,$136.12 ,$136.12 , N/A ,$32.73 ,$141.10 ,$13.09 ,$166.00 ,$99.10 ,$13.09 ,$69.06 ,$8.83 ,$8.03 ,$13.09 ,$141.10 ,$27.49 ,$141.10 ,$46.48 ,$149.40 ,$13.09 ,$136.12 ,$52.36 ,$52.36 ,$13.09 ,$107.90 ,$166.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500835,85576,HC PLATELET AGGREGATION EA-90,305,1 ,$87.00 ,$56.55 ,$8.03 ,$87.00 ,$62.28 ,$56.55 ,$51.94 ,$24.91 ,$24.36 ,$48.81 ,$24.91 ,$57.25 ,$24.91 ,$73.95 ,$73.95 ,$24.91 ,$73.95 ,$47.33 ,$59.16 ,$62.28 ,$24.91 ,$24.91 ,$65.25 ,$61.77 ,$61.77 ,$24.91 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$62.28 ,$73.95 ,$24.91 ,$87.00 ,$51.94 ,$24.91 ,$36.19 ,$8.83 ,$8.03 ,$24.91 ,$73.95 ,$52.31 ,$73.95 ,$24.36 ,$78.30 ,$24.91 ,$71.34 ,$87.00 ,$87.00 ,$24.91 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500836,85610,HC PROTHROMBIN TIME (PT),305,1 ,$74.00 ,$48.10 ,$2.70 ,$74.00 ,$10.73 ,$48.10 ,$44.18 ,$4.29 ,$20.72 ,$41.51 ,$4.29 ,$48.69 ,$4.29 ,$62.90 ,$62.90 ,$4.29 ,$62.90 ,$8.15 ,$50.32 ,$10.73 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$44.18 ,$4.29 ,$30.78 ,$2.97 ,$2.70 ,$4.29 ,$62.90 ,$9.01 ,$62.90 ,$20.72 ,$66.60 ,$4.29 ,$60.68 ,$17.16 ,$17.16 ,$4.29 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500837,85610,HC PROTHROMBIN TIME (PT)-QW,305,1 ,$74.00 ,$48.10 ,$2.70 ,$74.00 ,$10.73 ,$48.10 ,$44.18 ,$4.29 ,$20.72 ,$41.51 ,$4.29 ,$48.69 ,$4.29 ,$62.90 ,$62.90 ,$4.29 ,$62.90 ,$8.15 ,$50.32 ,$10.73 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$44.18 ,$4.29 ,$30.78 ,$2.97 ,$2.70 ,$4.29 ,$62.90 ,$9.01 ,$62.90 ,$20.72 ,$66.60 ,$4.29 ,$60.68 ,$17.16 ,$17.16 ,$4.29 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500838,85730,HC PARTIAL THROMBO TIME (PTT),305,1 ,$91.00 ,$59.15 ,$2.70 ,$91.00 ,$15.03 ,$59.15 ,$54.33 ,$6.01 ,$25.48 ,$51.05 ,$6.01 ,$59.88 ,$6.01 ,$77.35 ,$77.35 ,$6.01 ,$77.35 ,$11.42 ,$61.88 ,$15.03 ,$6.01 ,$6.01 ,$68.25 ,$64.61 ,$64.61 ,$6.01 ,$64.61 ,$74.62 ,$74.62 ,$74.62 , N/A ,$15.03 ,$77.35 ,$6.01 ,$91.00 ,$54.33 ,$6.01 ,$37.86 ,$2.97 ,$2.70 ,$6.01 ,$77.35 ,$12.62 ,$77.35 ,$25.48 ,$81.90 ,$6.01 ,$74.62 ,$24.04 ,$24.04 ,$6.01 ,$59.15 ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500842,85660,HC SICKLE CELL RBC,305,1 ,$56.00 ,$36.40 ,$4.63 ,$56.00 ,$13.78 ,$36.40 ,$33.43 ,$5.51 ,$15.68 ,$31.42 ,$5.51 ,$36.85 ,$5.51 ,$47.60 ,$47.60 ,$5.51 ,$47.60 ,$10.47 ,$38.08 ,$13.78 ,$5.51 ,$5.51 ,$42.00 ,$39.76 ,$39.76 ,$5.51 ,$39.76 ,$45.92 ,$45.92 ,$45.92 , N/A ,$13.78 ,$47.60 ,$5.51 ,$56.00 ,$33.43 ,$5.51 ,$23.30 ,$5.09 ,$4.63 ,$5.51 ,$47.60 ,$11.57 ,$47.60 ,$15.68 ,$50.40 ,$5.51 ,$45.92 ,$22.04 ,$22.04 ,$5.51 ,$36.40 ,$56.00 
ST. JOSEPH'S HOSPITAL - BREESE,30500846,85610,HC PROTHROMBIN TIME (PT)-QW,305,1 ,$74.00 ,$48.10 ,$2.70 ,$74.00 ,$10.73 ,$48.10 ,$44.18 ,$4.29 ,$20.72 ,$41.51 ,$4.29 ,$48.69 ,$4.29 ,$62.90 ,$62.90 ,$4.29 ,$62.90 ,$8.15 ,$50.32 ,$10.73 ,$4.29 ,$4.29 ,$55.50 ,$52.54 ,$52.54 ,$4.29 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$10.73 ,$62.90 ,$4.29 ,$74.00 ,$44.18 ,$4.29 ,$30.78 ,$2.97 ,$2.70 ,$4.29 ,$62.90 ,$9.01 ,$62.90 ,$20.72 ,$66.60 ,$4.29 ,$60.68 ,$17.16 ,$17.16 ,$4.29 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,30530232,85049,HC PLATELET COUNT AUTO-90,305,1 ,$13.44 ,$8.74 ,$3.76 ,$13.44 ,$11.20 ,$8.74 ,$8.02 ,$4.48 ,$3.76 ,$7.54 ,$4.48 ,$8.84 ,$4.48 ,$11.42 ,$11.42 ,$4.48 ,$11.42 ,$8.51 ,$9.14 ,$11.20 ,$4.48 ,$4.48 ,$10.08 ,$9.54 ,$9.54 ,$4.48 ,$9.54 ,$11.02 ,$11.02 ,$11.02 , N/A ,$11.20 ,$11.42 ,$4.48 ,$13.44 ,$8.02 ,$4.48 ,$5.59 ,$5.09 ,$4.63 ,$4.48 ,$11.42 ,$9.41 ,$11.42 ,$3.76 ,$12.10 ,$4.48 ,$11.02 ,$13.44 ,$13.44 ,$4.48 ,$8.74 ,$13.44 
ST. JOSEPH'S HOSPITAL - BREESE,30600102,87040,HC BLOOD CULTURE,306,1 ,$362.00 ,$235.30 ,$10.32 ,$362.00 ,$25.80 ,$235.30 ,$216.11 ,$10.32 ,$101.36 ,$203.08 ,$10.32 ,$238.20 ,$10.32 ,$307.70 ,$307.70 ,$10.32 ,$307.70 ,$19.61 ,$246.16 ,$25.80 ,$10.32 ,$10.32 ,$271.50 ,$257.02 ,$257.02 ,$10.32 ,$257.02 ,$296.84 ,$296.84 ,$296.84 , N/A ,$25.80 ,$307.70 ,$10.32 ,$362.00 ,$216.11 ,$10.32 ,$150.59 ,$19.47 ,$17.70 ,$10.32 ,$307.70 ,$21.67 ,$307.70 ,$101.36 ,$325.80 ,$10.32 ,$296.84 ,$41.28 ,$41.28 ,$10.32 ,$235.30 ,$362.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600163,87172,HC PINWORM EXAM,306,1 ,$110.00 ,$71.50 ,$4.27 ,$110.00 ,$10.68 ,$71.50 ,$65.67 ,$4.27 ,$30.80 ,$61.71 ,$4.27 ,$72.38 ,$4.27 ,$93.50 ,$93.50 ,$4.27 ,$93.50 ,$8.11 ,$74.80 ,$10.68 ,$4.27 ,$4.27 ,$82.50 ,$78.10 ,$78.10 ,$4.27 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$10.68 ,$93.50 ,$4.27 ,$110.00 ,$65.67 ,$4.27 ,$45.76 ,$5.86 ,$5.33 ,$4.27 ,$93.50 ,$8.97 ,$93.50 ,$30.80 ,$99.00 ,$4.27 ,$90.20 ,$17.08 ,$17.08 ,$4.27 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$130.00 ,$84.50 ,$4.27 ,$130.00 ,$10.68 ,$84.50 ,$77.61 ,$4.27 ,$36.40 ,$72.93 ,$4.27 ,$85.54 ,$4.27 ,$110.50 ,$110.50 ,$4.27 ,$110.50 ,$8.11 ,$88.40 ,$10.68 ,$4.27 ,$4.27 ,$97.50 ,$92.30 ,$92.30 ,$4.27 ,$92.30 ,$106.60 ,$106.60 ,$106.60 , N/A ,$10.68 ,$110.50 ,$4.27 ,$130.00 ,$77.61 ,$4.27 ,$54.08 ,$5.86 ,$5.33 ,$4.27 ,$110.50 ,$8.97 ,$110.50 ,$36.40 ,$117.00 ,$4.27 ,$106.60 ,$17.08 ,$17.08 ,$4.27 ,$84.50 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600183,87210,HC SMEAR WET MOUNT,306,1 ,$137.00 ,$89.05 ,$5.33 ,$137.00 ,$14.55 ,$89.05 ,$81.79 ,$5.82 ,$38.36 ,$76.86 ,$5.82 ,$90.15 ,$5.82 ,$116.45 ,$116.45 ,$5.82 ,$116.45 ,$11.06 ,$93.16 ,$14.55 ,$5.82 ,$5.82 ,$102.75 ,$97.27 ,$97.27 ,$5.82 ,$97.27 ,$112.34 ,$112.34 ,$112.34 , N/A ,$14.55 ,$116.45 ,$5.82 ,$137.00 ,$81.79 ,$5.82 ,$56.99 ,$5.86 ,$5.33 ,$5.82 ,$116.45 ,$12.22 ,$116.45 ,$38.36 ,$123.30 ,$5.82 ,$112.34 ,$23.28 ,$23.28 ,$5.82 ,$89.05 ,$137.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600185,87220,HC TISSUE KOH PREP,306,1 ,$122.00 ,$79.30 ,$4.27 ,$122.00 ,$10.68 ,$79.30 ,$72.83 ,$4.27 ,$34.16 ,$68.44 ,$4.27 ,$80.28 ,$4.27 ,$103.70 ,$103.70 ,$4.27 ,$103.70 ,$8.11 ,$82.96 ,$10.68 ,$4.27 ,$4.27 ,$91.50 ,$86.62 ,$86.62 ,$4.27 ,$86.62 ,$100.04 ,$100.04 ,$100.04 , N/A ,$10.68 ,$103.70 ,$4.27 ,$122.00 ,$72.83 ,$4.27 ,$50.75 ,$5.86 ,$5.33 ,$4.27 ,$103.70 ,$8.97 ,$103.70 ,$34.16 ,$109.80 ,$4.27 ,$100.04 ,$17.08 ,$17.08 ,$4.27 ,$79.30 ,$122.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$35.94 ,$23.36 ,$6.68 ,$35.94 ,$29.95 ,$23.36 ,$21.46 ,$11.98 ,$10.06 ,$20.16 ,$11.98 ,$23.65 ,$11.98 ,$30.55 ,$30.55 ,$11.98 ,$30.55 ,$22.76 ,$24.44 ,$29.95 ,$11.98 ,$11.98 ,$26.96 ,$25.52 ,$25.52 ,$11.98 ,$25.52 ,$29.47 ,$29.47 ,$29.47 , N/A ,$29.95 ,$30.55 ,$11.98 ,$35.94 ,$21.46 ,$11.98 ,$14.95 ,$7.35 ,$6.68 ,$11.98 ,$30.55 ,$25.16 ,$30.55 ,$10.06 ,$32.35 ,$11.98 ,$29.47 ,$35.94 ,$35.94 ,$11.98 ,$23.36 ,$35.94 
ST. JOSEPH'S HOSPITAL - BREESE,30600269,87807,HC QL RSV,306,1 ,$170.00 ,$110.50 ,$5.33 ,$170.00 ,$32.75 ,$110.50 ,$101.49 ,$13.10 ,$47.60 ,$95.37 ,$13.10 ,$111.86 ,$13.10 ,$144.50 ,$144.50 ,$13.10 ,$144.50 ,$24.89 ,$115.60 ,$32.75 ,$13.10 ,$13.10 ,$127.50 ,$120.70 ,$120.70 ,$13.10 ,$120.70 ,$139.40 ,$139.40 ,$139.40 , N/A ,$32.75 ,$144.50 ,$13.10 ,$170.00 ,$101.49 ,$13.10 ,$70.72 ,$5.86 ,$5.33 ,$13.10 ,$144.50 ,$27.51 ,$144.50 ,$47.60 ,$153.00 ,$13.10 ,$139.40 ,$52.40 ,$52.40 ,$13.10 ,$110.50 ,$170.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600270,87880,HC OPTICAL STREP,306,1 ,$120.00 ,$78.00 ,$5.33 ,$120.00 ,$41.33 ,$78.00 ,$71.64 ,$16.53 ,$33.60 ,$67.32 ,$16.53 ,$78.96 ,$16.53 ,$102.00 ,$102.00 ,$16.53 ,$102.00 ,$31.41 ,$81.60 ,$41.33 ,$16.53 ,$16.53 ,$90.00 ,$85.20 ,$85.20 ,$16.53 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$41.33 ,$102.00 ,$16.53 ,$120.00 ,$71.64 ,$16.53 ,$49.92 ,$5.86 ,$5.33 ,$16.53 ,$102.00 ,$34.71 ,$102.00 ,$33.60 ,$108.00 ,$16.53 ,$98.40 ,$66.12 ,$66.12 ,$16.53 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600271,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$434.00 ,$282.10 ,$5.33 ,$434.00 ,$40.18 ,$282.10 ,$259.10 ,$16.07 ,$121.52 ,$243.47 ,$16.07 ,$285.57 ,$16.07 ,$368.90 ,$368.90 ,$16.07 ,$368.90 ,$30.53 ,$295.12 ,$40.18 ,$16.07 ,$16.07 ,$325.50 ,$308.14 ,$308.14 ,$16.07 ,$308.14 ,$355.88 ,$355.88 ,$355.88 , N/A ,$40.18 ,$368.90 ,$16.07 ,$434.00 ,$259.10 ,$16.07 ,$180.54 ,$5.86 ,$5.33 ,$16.07 ,$368.90 ,$33.75 ,$368.90 ,$121.52 ,$390.60 ,$16.07 ,$355.88 ,$64.28 ,$64.28 ,$16.07 ,$282.10 ,$434.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600283,87804,HC QL INFLUENZA A/B,306,1 ,$221.00 ,$143.65 ,$5.33 ,$221.00 ,$41.38 ,$143.65 ,$131.94 ,$16.55 ,$61.88 ,$123.98 ,$16.55 ,$145.42 ,$16.55 ,$187.85 ,$187.85 ,$16.55 ,$187.85 ,$31.45 ,$150.28 ,$41.38 ,$16.55 ,$16.55 ,$165.75 ,$156.91 ,$156.91 ,$16.55 ,$156.91 ,$181.22 ,$181.22 ,$181.22 , N/A ,$41.38 ,$187.85 ,$16.55 ,$221.00 ,$131.94 ,$16.55 ,$91.94 ,$5.86 ,$5.33 ,$16.55 ,$187.85 ,$34.76 ,$187.85 ,$61.88 ,$198.90 ,$16.55 ,$181.22 ,$66.20 ,$66.20 ,$16.55 ,$143.65 ,$221.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600318,87449,HC EIA QL MLT AG INF,306,1 ,$35.94 ,$23.36 ,$6.68 ,$35.94 ,$29.95 ,$23.36 ,$21.46 ,$11.98 ,$10.06 ,$20.16 ,$11.98 ,$23.65 ,$11.98 ,$30.55 ,$30.55 ,$11.98 ,$30.55 ,$22.76 ,$24.44 ,$29.95 ,$11.98 ,$11.98 ,$26.96 ,$25.52 ,$25.52 ,$11.98 ,$25.52 ,$29.47 ,$29.47 ,$29.47 , N/A ,$29.95 ,$30.55 ,$11.98 ,$35.94 ,$21.46 ,$11.98 ,$14.95 ,$7.35 ,$6.68 ,$11.98 ,$30.55 ,$25.16 ,$30.55 ,$10.06 ,$32.35 ,$11.98 ,$29.47 ,$35.94 ,$35.94 ,$11.98 ,$23.36 ,$35.94 
ST. JOSEPH'S HOSPITAL - BREESE,30600353,87015,HC CONCENTRATION INFECTIOUS AGENT-90,306,1 ,$70.00 ,$45.50 ,$5.33 ,$70.00 ,$16.70 ,$45.50 ,$41.79 ,$6.68 ,$19.60 ,$39.27 ,$6.68 ,$46.06 ,$6.68 ,$59.50 ,$59.50 ,$6.68 ,$59.50 ,$12.69 ,$47.60 ,$16.70 ,$6.68 ,$6.68 ,$52.50 ,$49.70 ,$49.70 ,$6.68 ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A ,$16.70 ,$59.50 ,$6.68 ,$70.00 ,$41.79 ,$6.68 ,$29.12 ,$5.86 ,$5.33 ,$6.68 ,$59.50 ,$14.03 ,$59.50 ,$19.60 ,$63.00 ,$6.68 ,$57.40 ,$26.72 ,$26.72 ,$6.68 ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600359,87081,HC CULTURE SCR PRESUMP PATHOGENS-90,306,1 ,$187.00 ,$121.55 ,$5.33 ,$187.00 ,$16.58 ,$121.55 ,$111.64 ,$6.63 ,$52.36 ,$104.91 ,$6.63 ,$123.05 ,$6.63 ,$158.95 ,$158.95 ,$6.63 ,$158.95 ,$12.60 ,$127.16 ,$16.58 ,$6.63 ,$6.63 ,$140.25 ,$132.77 ,$132.77 ,$6.63 ,$132.77 ,$153.34 ,$153.34 ,$153.34 , N/A ,$16.58 ,$158.95 ,$6.63 ,$187.00 ,$111.64 ,$6.63 ,$77.79 ,$5.86 ,$5.33 ,$6.63 ,$158.95 ,$13.92 ,$158.95 ,$52.36 ,$168.30 ,$6.63 ,$153.34 ,$26.52 ,$26.52 ,$6.63 ,$121.55 ,$187.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600361,87081,HC CULTURE SCR PRESUMP PATHOGENS T2,306,1 ,$187.00 ,$121.55 ,$5.33 ,$187.00 ,$16.58 ,$121.55 ,$111.64 ,$6.63 ,$52.36 ,$104.91 ,$6.63 ,$123.05 ,$6.63 ,$158.95 ,$158.95 ,$6.63 ,$158.95 ,$12.60 ,$127.16 ,$16.58 ,$6.63 ,$6.63 ,$140.25 ,$132.77 ,$132.77 ,$6.63 ,$132.77 ,$153.34 ,$153.34 ,$153.34 , N/A ,$16.58 ,$158.95 ,$6.63 ,$187.00 ,$111.64 ,$6.63 ,$77.79 ,$5.86 ,$5.33 ,$6.63 ,$158.95 ,$13.92 ,$158.95 ,$52.36 ,$168.30 ,$6.63 ,$153.34 ,$26.52 ,$26.52 ,$6.63 ,$121.55 ,$187.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600363,87103,HC CULTURE FUNGUS BLOOD-90,306,1 ,$22.00 ,$14.30 ,$6.16 ,$51.15 ,$51.15 ,$14.30 ,$13.13 ,$20.46 ,$6.16 ,$12.34 ,$20.46 ,$14.48 ,$20.46 ,$18.70 ,$18.70 ,$20.46 ,$18.70 ,$22.00 ,$14.96 ,$51.15 ,$20.46 ,$20.46 ,$16.50 ,$15.62 ,$15.62 ,$20.46 ,$15.62 ,$18.04 ,$18.04 ,$18.04 , N/A ,$22.00 ,$18.70 ,$20.46 ,$22.00 ,$13.13 ,$20.46 ,$9.15 ,$19.47 ,$17.70 ,$20.46 ,$18.70 ,$42.97 ,$18.70 ,$6.16 ,$19.80 ,$20.46 ,$18.04 ,$22.00 ,$22.00 ,$20.46 ,$14.30 ,$22.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600364,87106,HC CULTURE FUNGUS ID YEAST-90,306,1 ,$99.00 ,$64.35 ,$5.33 ,$99.00 ,$25.80 ,$64.35 ,$59.10 ,$10.32 ,$27.72 ,$55.54 ,$10.32 ,$65.14 ,$10.32 ,$84.15 ,$84.15 ,$10.32 ,$84.15 ,$19.61 ,$67.32 ,$25.80 ,$10.32 ,$10.32 ,$74.25 ,$70.29 ,$70.29 ,$10.32 ,$70.29 ,$81.18 ,$81.18 ,$81.18 , N/A ,$25.80 ,$84.15 ,$10.32 ,$99.00 ,$59.10 ,$10.32 ,$41.18 ,$5.86 ,$5.33 ,$10.32 ,$84.15 ,$21.67 ,$84.15 ,$27.72 ,$89.10 ,$10.32 ,$81.18 ,$41.28 ,$41.28 ,$10.32 ,$64.35 ,$99.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600365,87107,HC CULTURE FUNGUS ID MOLD-90,306,1 ,$18.00 ,$11.70 ,$5.04 ,$25.80 ,$25.80 ,$11.70 ,$10.75 ,$10.32 ,$5.04 ,$10.10 ,$10.32 ,$11.84 ,$10.32 ,$15.30 ,$15.30 ,$10.32 ,$15.30 ,$18.00 ,$12.24 ,$25.80 ,$10.32 ,$10.32 ,$13.50 ,$12.78 ,$12.78 ,$10.32 ,$12.78 ,$14.76 ,$14.76 ,$14.76 , N/A ,$18.00 ,$15.30 ,$10.32 ,$18.00 ,$10.75 ,$10.32 ,$7.49 ,$18.00 ,$17.70 ,$10.32 ,$15.30 ,$21.67 ,$15.30 ,$5.04 ,$16.20 ,$10.32 ,$14.76 ,$18.00 ,$18.00 ,$10.32 ,$11.70 ,$18.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600366,87109,HC CULTURE MYCOPLASMA-90,306,1 ,$163.00 ,$105.95 ,$15.39 ,$163.00 ,$38.48 ,$105.95 ,$97.31 ,$15.39 ,$45.64 ,$91.44 ,$15.39 ,$107.25 ,$15.39 ,$138.55 ,$138.55 ,$15.39 ,$138.55 ,$29.24 ,$110.84 ,$38.48 ,$15.39 ,$15.39 ,$122.25 ,$115.73 ,$115.73 ,$15.39 ,$115.73 ,$133.66 ,$133.66 ,$133.66 , N/A ,$38.48 ,$138.55 ,$15.39 ,$163.00 ,$97.31 ,$15.39 ,$67.81 ,$19.47 ,$17.70 ,$15.39 ,$138.55 ,$32.32 ,$138.55 ,$45.64 ,$146.70 ,$15.39 ,$133.66 ,$61.56 ,$61.56 ,$15.39 ,$105.95 ,$163.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600367,87110,HC CULTURE CHLAMYDIA-90,306,1 ,$148.00 ,$96.20 ,$5.33 ,$148.00 ,$49.00 ,$96.20 ,$88.36 ,$19.60 ,$41.44 ,$83.03 ,$19.60 ,$97.38 ,$19.60 ,$125.80 ,$125.80 ,$19.60 ,$125.80 ,$37.24 ,$100.64 ,$49.00 ,$19.60 ,$19.60 ,$111.00 ,$105.08 ,$105.08 ,$19.60 ,$105.08 ,$121.36 ,$121.36 ,$121.36 , N/A ,$49.00 ,$125.80 ,$19.60 ,$148.00 ,$88.36 ,$19.60 ,$61.57 ,$5.86 ,$5.33 ,$19.60 ,$125.80 ,$41.16 ,$125.80 ,$41.44 ,$133.20 ,$19.60 ,$121.36 ,$78.40 ,$78.40 ,$19.60 ,$96.20 ,$148.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600368,87116,HC CULTURE AFB/TB/MYCOBACT-90,306,1 ,$110.00 ,$71.50 ,$10.80 ,$110.00 ,$27.00 ,$71.50 ,$65.67 ,$10.80 ,$30.80 ,$61.71 ,$10.80 ,$72.38 ,$10.80 ,$93.50 ,$93.50 ,$10.80 ,$93.50 ,$20.52 ,$74.80 ,$27.00 ,$10.80 ,$10.80 ,$82.50 ,$78.10 ,$78.10 ,$10.80 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$27.00 ,$93.50 ,$10.80 ,$110.00 ,$65.67 ,$10.80 ,$45.76 ,$19.47 ,$17.70 ,$10.80 ,$93.50 ,$22.68 ,$93.50 ,$30.80 ,$99.00 ,$10.80 ,$90.20 ,$43.20 ,$43.20 ,$10.80 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600369,87118,HC CULTURE MYCOBACTERIA ID-90,306,1 ,$104.00 ,$67.60 ,$14.61 ,$104.00 ,$36.53 ,$67.60 ,$62.09 ,$14.61 ,$29.12 ,$58.34 ,$14.61 ,$68.43 ,$14.61 ,$88.40 ,$88.40 ,$14.61 ,$88.40 ,$27.76 ,$70.72 ,$36.53 ,$14.61 ,$14.61 ,$78.00 ,$73.84 ,$73.84 ,$14.61 ,$73.84 ,$85.28 ,$85.28 ,$85.28 , N/A ,$36.53 ,$88.40 ,$14.61 ,$104.00 ,$62.09 ,$14.61 ,$43.26 ,$19.47 ,$17.70 ,$14.61 ,$88.40 ,$30.68 ,$88.40 ,$29.12 ,$93.60 ,$14.61 ,$85.28 ,$58.44 ,$58.44 ,$14.61 ,$67.60 ,$104.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600370,87140,HC CULTURE TYPE IF EA ANTISERUM-90,306,1 ,$53.00 ,$34.45 ,$5.57 ,$53.00 ,$13.93 ,$34.45 ,$31.64 ,$5.57 ,$14.84 ,$29.73 ,$5.57 ,$34.87 ,$5.57 ,$45.05 ,$45.05 ,$5.57 ,$45.05 ,$10.58 ,$36.04 ,$13.93 ,$5.57 ,$5.57 ,$39.75 ,$37.63 ,$37.63 ,$5.57 ,$37.63 ,$43.46 ,$43.46 ,$43.46 , N/A ,$13.93 ,$45.05 ,$5.57 ,$53.00 ,$31.64 ,$5.57 ,$22.05 ,$19.47 ,$17.70 ,$5.57 ,$45.05 ,$11.70 ,$45.05 ,$14.84 ,$47.70 ,$5.57 ,$43.46 ,$22.28 ,$22.28 ,$5.57 ,$34.45 ,$53.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600375,87149,HC CULTURE TYPING ID NUCLEIC ACID-90,306,1 ,$115.00 ,$74.75 ,$5.33 ,$115.00 ,$50.13 ,$74.75 ,$68.66 ,$20.05 ,$32.20 ,$64.52 ,$20.05 ,$75.67 ,$20.05 ,$97.75 ,$97.75 ,$20.05 ,$97.75 ,$38.10 ,$78.20 ,$50.13 ,$20.05 ,$20.05 ,$86.25 ,$81.65 ,$81.65 ,$20.05 ,$81.65 ,$94.30 ,$94.30 ,$94.30 , N/A ,$50.13 ,$97.75 ,$20.05 ,$115.00 ,$68.66 ,$20.05 ,$47.84 ,$5.86 ,$5.33 ,$20.05 ,$97.75 ,$42.11 ,$97.75 ,$32.20 ,$103.50 ,$20.05 ,$94.30 ,$80.20 ,$80.20 ,$20.05 ,$74.75 ,$115.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600380,87177,HC SMEAR OVA PARASITE CONC/ID-90,306,1 ,$227.00 ,$147.55 ,$5.33 ,$227.00 ,$22.25 ,$147.55 ,$135.52 ,$8.90 ,$63.56 ,$127.35 ,$8.90 ,$149.37 ,$8.90 ,$192.95 ,$192.95 ,$8.90 ,$192.95 ,$16.91 ,$154.36 ,$22.25 ,$8.90 ,$8.90 ,$170.25 ,$161.17 ,$161.17 ,$8.90 ,$161.17 ,$186.14 ,$186.14 ,$186.14 , N/A ,$22.25 ,$192.95 ,$8.90 ,$227.00 ,$135.52 ,$8.90 ,$94.43 ,$5.86 ,$5.33 ,$8.90 ,$192.95 ,$18.69 ,$192.95 ,$63.56 ,$204.30 ,$8.90 ,$186.14 ,$35.60 ,$35.60 ,$8.90 ,$147.55 ,$227.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600388,87186,HC SENSITIVITY MIC INIT PLATE-90,306,1 ,$322.00 ,$209.30 ,$5.33 ,$322.00 ,$21.63 ,$209.30 ,$192.23 ,$8.65 ,$90.16 ,$180.64 ,$8.65 ,$211.88 ,$8.65 ,$273.70 ,$273.70 ,$8.65 ,$273.70 ,$16.44 ,$218.96 ,$21.63 ,$8.65 ,$8.65 ,$241.50 ,$228.62 ,$228.62 ,$8.65 ,$228.62 ,$264.04 ,$264.04 ,$264.04 , N/A ,$21.63 ,$273.70 ,$8.65 ,$322.00 ,$192.23 ,$8.65 ,$133.95 ,$5.86 ,$5.33 ,$8.65 ,$273.70 ,$18.17 ,$273.70 ,$90.16 ,$289.80 ,$8.65 ,$264.04 ,$34.60 ,$34.60 ,$8.65 ,$209.30 ,$322.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600395,87206,HC SMEAR ACID FAST/FLUOR-90,306,1 ,$112.00 ,$72.80 ,$5.33 ,$112.00 ,$13.48 ,$72.80 ,$66.86 ,$5.39 ,$31.36 ,$62.83 ,$5.39 ,$73.70 ,$5.39 ,$95.20 ,$95.20 ,$5.39 ,$95.20 ,$10.24 ,$76.16 ,$13.48 ,$5.39 ,$5.39 ,$84.00 ,$79.52 ,$79.52 ,$5.39 ,$79.52 ,$91.84 ,$91.84 ,$91.84 , N/A ,$13.48 ,$95.20 ,$5.39 ,$112.00 ,$66.86 ,$5.39 ,$46.59 ,$5.86 ,$5.33 ,$5.39 ,$95.20 ,$11.32 ,$95.20 ,$31.36 ,$100.80 ,$5.39 ,$91.84 ,$21.56 ,$21.56 ,$5.39 ,$72.80 ,$112.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600397,87207,HC SPECIAL STAIN INCL BODIES/PARASITES-90,306,1 ,$116.00 ,$75.40 ,$5.33 ,$116.00 ,$14.98 ,$75.40 ,$69.25 ,$5.99 ,$32.48 ,$65.08 ,$5.99 ,$76.33 ,$5.99 ,$98.60 ,$98.60 ,$5.99 ,$98.60 ,$11.38 ,$78.88 ,$14.98 ,$5.99 ,$5.99 ,$87.00 ,$82.36 ,$82.36 ,$5.99 ,$82.36 ,$95.12 ,$95.12 ,$95.12 , N/A ,$14.98 ,$98.60 ,$5.99 ,$116.00 ,$69.25 ,$5.99 ,$48.26 ,$5.86 ,$5.33 ,$5.99 ,$98.60 ,$12.58 ,$98.60 ,$32.48 ,$104.40 ,$5.99 ,$95.12 ,$23.96 ,$23.96 ,$5.99 ,$75.40 ,$116.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600399,87209,HC OVA  AND  PARASITE W/STAIN-90,306,1 ,$145.00 ,$94.25 ,$17.70 ,$145.00 ,$44.95 ,$94.25 ,$86.57 ,$17.98 ,$40.60 ,$81.35 ,$17.98 ,$95.41 ,$17.98 ,$123.25 ,$123.25 ,$17.98 ,$123.25 ,$34.16 ,$98.60 ,$44.95 ,$17.98 ,$17.98 ,$108.75 ,$102.95 ,$102.95 ,$17.98 ,$102.95 ,$118.90 ,$118.90 ,$118.90 , N/A ,$44.95 ,$123.25 ,$17.98 ,$145.00 ,$86.57 ,$17.98 ,$60.32 ,$19.47 ,$17.70 ,$17.98 ,$123.25 ,$37.76 ,$123.25 ,$40.60 ,$130.50 ,$17.98 ,$118.90 ,$71.92 ,$71.92 ,$17.98 ,$94.25 ,$145.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600402,87252,HC CULTURE VIRUS ID TISSUE-90,306,1 ,$187.00 ,$121.55 ,$17.70 ,$187.00 ,$65.18 ,$121.55 ,$111.64 ,$26.07 ,$52.36 ,$104.91 ,$26.07 ,$123.05 ,$26.07 ,$158.95 ,$158.95 ,$26.07 ,$158.95 ,$49.53 ,$127.16 ,$65.18 ,$26.07 ,$26.07 ,$140.25 ,$132.77 ,$132.77 ,$26.07 ,$132.77 ,$153.34 ,$153.34 ,$153.34 , N/A ,$65.18 ,$158.95 ,$26.07 ,$187.00 ,$111.64 ,$26.07 ,$77.79 ,$19.47 ,$17.70 ,$26.07 ,$158.95 ,$54.75 ,$158.95 ,$52.36 ,$168.30 ,$26.07 ,$153.34 ,$104.28 ,$104.28 ,$26.07 ,$121.55 ,$187.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600405,87254,HC VIRUS ISOL SHELL ID-90,306,1 ,$130.00 ,$84.50 ,$17.70 ,$130.00 ,$48.90 ,$84.50 ,$77.61 ,$19.56 ,$36.40 ,$72.93 ,$19.56 ,$85.54 ,$19.56 ,$110.50 ,$110.50 ,$19.56 ,$110.50 ,$37.16 ,$88.40 ,$48.90 ,$19.56 ,$19.56 ,$97.50 ,$92.30 ,$92.30 ,$19.56 ,$92.30 ,$106.60 ,$106.60 ,$106.60 , N/A ,$48.90 ,$110.50 ,$19.56 ,$130.00 ,$77.61 ,$19.56 ,$54.08 ,$19.47 ,$17.70 ,$19.56 ,$110.50 ,$41.08 ,$110.50 ,$36.40 ,$117.00 ,$19.56 ,$106.60 ,$78.24 ,$78.24 ,$19.56 ,$84.50 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600407,87260,HC IF ADENOVIRUS AG-90,306,1 ,$238.00 ,$154.70 ,$6.68 ,$238.00 ,$36.08 ,$154.70 ,$142.09 ,$14.43 ,$66.64 ,$133.52 ,$14.43 ,$156.60 ,$14.43 ,$202.30 ,$202.30 ,$14.43 ,$202.30 ,$27.42 ,$161.84 ,$36.08 ,$14.43 ,$14.43 ,$178.50 ,$168.98 ,$168.98 ,$14.43 ,$168.98 ,$195.16 ,$195.16 ,$195.16 , N/A ,$36.08 ,$202.30 ,$14.43 ,$238.00 ,$142.09 ,$14.43 ,$99.01 ,$7.35 ,$6.68 ,$14.43 ,$202.30 ,$30.30 ,$202.30 ,$66.64 ,$214.20 ,$14.43 ,$195.16 ,$57.72 ,$57.72 ,$14.43 ,$154.70 ,$238.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600413,87290,HC IF VARICELLA ZOETER AG-90,306,1 ,$32.43 ,$21.08 ,$6.68 ,$33.55 ,$33.55 ,$21.08 ,$19.36 ,$13.42 ,$9.08 ,$18.19 ,$13.42 ,$21.34 ,$13.42 ,$27.57 ,$27.57 ,$13.42 ,$27.57 ,$25.50 ,$22.05 ,$33.55 ,$13.42 ,$13.42 ,$24.32 ,$23.03 ,$23.03 ,$13.42 ,$23.03 ,$26.59 ,$26.59 ,$26.59 , N/A ,$32.43 ,$27.57 ,$13.42 ,$32.43 ,$19.36 ,$13.42 ,$13.49 ,$7.35 ,$6.68 ,$13.42 ,$27.57 ,$28.18 ,$27.57 ,$9.08 ,$29.19 ,$13.42 ,$26.59 ,$32.43 ,$32.43 ,$13.42 ,$21.08 ,$32.43 
ST. JOSEPH'S HOSPITAL - BREESE,30600414,87299,HC ANTIBODY DETECT IF NOS-90,306,1 ,$84.50 ,$54.93 ,$6.68 ,$84.50 ,$40.25 ,$54.93 ,$50.45 ,$16.10 ,$23.66 ,$47.40 ,$16.10 ,$55.60 ,$16.10 ,$71.83 ,$71.83 ,$16.10 ,$71.83 ,$30.59 ,$57.46 ,$40.25 ,$16.10 ,$16.10 ,$63.38 ,$60.00 ,$60.00 ,$16.10 ,$60.00 ,$69.29 ,$69.29 ,$69.29 , N/A ,$40.25 ,$71.83 ,$16.10 ,$84.50 ,$50.45 ,$16.10 ,$35.15 ,$7.35 ,$6.68 ,$16.10 ,$71.83 ,$33.81 ,$71.83 ,$23.66 ,$76.05 ,$16.10 ,$69.29 ,$64.40 ,$64.40 ,$16.10 ,$54.93 ,$84.50 
ST. JOSEPH'S HOSPITAL - BREESE,30600418,87328,HC EIA QL CRYPTOSPORIDIUM AG-90,306,1 ,$205.00 ,$133.25 ,$6.68 ,$205.00 ,$34.55 ,$133.25 ,$122.39 ,$13.82 ,$57.40 ,$115.01 ,$13.82 ,$134.89 ,$13.82 ,$174.25 ,$174.25 ,$13.82 ,$174.25 ,$26.26 ,$139.40 ,$34.55 ,$13.82 ,$13.82 ,$153.75 ,$145.55 ,$145.55 ,$13.82 ,$145.55 ,$168.10 ,$168.10 ,$168.10 , N/A ,$34.55 ,$174.25 ,$13.82 ,$205.00 ,$122.39 ,$13.82 ,$85.28 ,$7.35 ,$6.68 ,$13.82 ,$174.25 ,$29.02 ,$174.25 ,$57.40 ,$184.50 ,$13.82 ,$168.10 ,$55.28 ,$55.28 ,$13.82 ,$133.25 ,$205.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600419,87338,HC EIA QL H PYLORI AG STOOL-90,306,1 ,$331.00 ,$215.15 ,$6.68 ,$331.00 ,$35.95 ,$215.15 ,$197.61 ,$14.38 ,$92.68 ,$185.69 ,$14.38 ,$217.80 ,$14.38 ,$281.35 ,$281.35 ,$14.38 ,$281.35 ,$27.32 ,$225.08 ,$35.95 ,$14.38 ,$14.38 ,$248.25 ,$235.01 ,$235.01 ,$14.38 ,$235.01 ,$271.42 ,$271.42 ,$271.42 , N/A ,$35.95 ,$281.35 ,$14.38 ,$331.00 ,$197.61 ,$14.38 ,$137.70 ,$7.35 ,$6.68 ,$14.38 ,$281.35 ,$30.20 ,$281.35 ,$92.68 ,$297.90 ,$14.38 ,$271.42 ,$57.52 ,$57.52 ,$14.38 ,$215.15 ,$331.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600424,87350,HC HEPATITIS BE AG QL-90,306,1 ,$139.00 ,$90.35 ,$6.68 ,$139.00 ,$28.83 ,$90.35 ,$82.98 ,$11.53 ,$38.92 ,$77.98 ,$11.53 ,$91.46 ,$11.53 ,$118.15 ,$118.15 ,$11.53 ,$118.15 ,$21.91 ,$94.52 ,$28.83 ,$11.53 ,$11.53 ,$104.25 ,$98.69 ,$98.69 ,$11.53 ,$98.69 ,$113.98 ,$113.98 ,$113.98 , N/A ,$28.83 ,$118.15 ,$11.53 ,$139.00 ,$82.98 ,$11.53 ,$57.82 ,$7.35 ,$6.68 ,$11.53 ,$118.15 ,$24.21 ,$118.15 ,$38.92 ,$125.10 ,$11.53 ,$113.98 ,$46.12 ,$46.12 ,$11.53 ,$90.35 ,$139.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600426,87385,HC EIA QL HISTOPLASMA AG-90,306,1 ,$408.00 ,$265.20 ,$6.68 ,$408.00 ,$33.13 ,$265.20 ,$243.58 ,$13.25 ,$114.24 ,$228.89 ,$13.25 ,$268.46 ,$13.25 ,$346.80 ,$346.80 ,$13.25 ,$346.80 ,$25.18 ,$277.44 ,$33.13 ,$13.25 ,$13.25 ,$306.00 ,$289.68 ,$289.68 ,$13.25 ,$289.68 ,$334.56 ,$334.56 ,$334.56 , N/A ,$33.13 ,$346.80 ,$13.25 ,$408.00 ,$243.58 ,$13.25 ,$169.73 ,$7.35 ,$6.68 ,$13.25 ,$346.80 ,$27.83 ,$346.80 ,$114.24 ,$367.20 ,$13.25 ,$334.56 ,$53.00 ,$53.00 ,$13.25 ,$265.20 ,$408.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600432,87449,HC EIA QL MLT AG INF-90,306,1 ,$412.00 ,$267.80 ,$6.68 ,$412.00 ,$29.95 ,$267.80 ,$245.96 ,$11.98 ,$115.36 ,$231.13 ,$11.98 ,$271.10 ,$11.98 ,$350.20 ,$350.20 ,$11.98 ,$350.20 ,$22.76 ,$280.16 ,$29.95 ,$11.98 ,$11.98 ,$309.00 ,$292.52 ,$292.52 ,$11.98 ,$292.52 ,$337.84 ,$337.84 ,$337.84 , N/A ,$29.95 ,$350.20 ,$11.98 ,$412.00 ,$245.96 ,$11.98 ,$171.39 ,$7.35 ,$6.68 ,$11.98 ,$350.20 ,$25.16 ,$350.20 ,$115.36 ,$370.80 ,$11.98 ,$337.84 ,$47.92 ,$47.92 ,$11.98 ,$267.80 ,$412.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600438,87491,HC CHLAMYDIA TRACH AMP-90,306,1 ,$301.00 ,$195.65 ,$6.68 ,$301.00 ,$87.73 ,$195.65 ,$179.70 ,$35.09 ,$84.28 ,$168.86 ,$35.09 ,$198.06 ,$35.09 ,$255.85 ,$255.85 ,$35.09 ,$255.85 ,$66.67 ,$204.68 ,$87.73 ,$35.09 ,$35.09 ,$225.75 ,$213.71 ,$213.71 ,$35.09 ,$213.71 ,$246.82 ,$246.82 ,$246.82 , N/A ,$87.73 ,$255.85 ,$35.09 ,$301.00 ,$179.70 ,$35.09 ,$125.22 ,$7.35 ,$6.68 ,$35.09 ,$255.85 ,$73.69 ,$255.85 ,$84.28 ,$270.90 ,$35.09 ,$246.82 ,$140.36 ,$140.36 ,$35.09 ,$195.65 ,$301.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600439,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$152.00 ,$98.80 ,$6.68 ,$152.00 ,$87.73 ,$98.80 ,$90.74 ,$35.09 ,$42.56 ,$85.27 ,$35.09 ,$100.02 ,$35.09 ,$129.20 ,$129.20 ,$35.09 ,$129.20 ,$66.67 ,$103.36 ,$87.73 ,$35.09 ,$35.09 ,$114.00 ,$107.92 ,$107.92 ,$35.09 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$87.73 ,$129.20 ,$35.09 ,$152.00 ,$90.74 ,$35.09 ,$63.23 ,$7.35 ,$6.68 ,$35.09 ,$129.20 ,$73.69 ,$129.20 ,$42.56 ,$136.80 ,$35.09 ,$124.64 ,$140.36 ,$140.36 ,$35.09 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600441,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$268.00 ,$174.20 ,$6.68 ,$268.00 ,$93.18 ,$174.20 ,$160.00 ,$37.27 ,$75.04 ,$150.35 ,$37.27 ,$176.34 ,$37.27 ,$227.80 ,$227.80 ,$37.27 ,$227.80 ,$70.81 ,$182.24 ,$93.18 ,$37.27 ,$37.27 ,$201.00 ,$190.28 ,$190.28 ,$37.27 ,$190.28 ,$219.76 ,$219.76 ,$219.76 , N/A ,$93.18 ,$227.80 ,$37.27 ,$268.00 ,$160.00 ,$37.27 ,$111.49 ,$7.35 ,$6.68 ,$37.27 ,$227.80 ,$78.27 ,$227.80 ,$75.04 ,$241.20 ,$37.27 ,$219.76 ,$149.08 ,$149.08 ,$37.27 ,$174.20 ,$268.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600442,87496,HC INFECT AMP (CMV) MENI-90,306,1 ,$736.00 ,$478.40 ,$17.70 ,$736.00 ,$87.73 ,$478.40 ,$439.39 ,$35.09 ,$206.08 ,$412.90 ,$35.09 ,$484.29 ,$35.09 ,$625.60 ,$625.60 ,$35.09 ,$625.60 ,$66.67 ,$500.48 ,$87.73 ,$35.09 ,$35.09 ,$552.00 ,$522.56 ,$522.56 ,$35.09 ,$522.56 ,$603.52 ,$603.52 ,$603.52 , N/A ,$87.73 ,$625.60 ,$35.09 ,$736.00 ,$439.39 ,$35.09 ,$306.18 ,$19.47 ,$17.70 ,$35.09 ,$625.60 ,$73.69 ,$625.60 ,$206.08 ,$662.40 ,$35.09 ,$603.52 ,$140.36 ,$140.36 ,$35.09 ,$478.40 ,$736.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600443,87497,HC CMV QN-90,306,1 ,$542.00 ,$352.30 ,$17.70 ,$542.00 ,$107.10 ,$352.30 ,$323.57 ,$42.84 ,$151.76 ,$304.06 ,$42.84 ,$356.64 ,$42.84 ,$460.70 ,$460.70 ,$42.84 ,$460.70 ,$81.40 ,$368.56 ,$107.10 ,$42.84 ,$42.84 ,$406.50 ,$384.82 ,$384.82 ,$42.84 ,$384.82 ,$444.44 ,$444.44 ,$444.44 , N/A ,$107.10 ,$460.70 ,$42.84 ,$542.00 ,$323.57 ,$42.84 ,$225.47 ,$19.47 ,$17.70 ,$42.84 ,$460.70 ,$89.96 ,$460.70 ,$151.76 ,$487.80 ,$42.84 ,$444.44 ,$171.36 ,$171.36 ,$42.84 ,$352.30 ,$542.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600444,87498,HC ENTEROVIRUS AMP PROBE-90,306,1 ,$190.00 ,$123.50 ,$17.70 ,$190.00 ,$87.73 ,$123.50 ,$113.43 ,$35.09 ,$53.20 ,$106.59 ,$35.09 ,$125.02 ,$35.09 ,$161.50 ,$161.50 ,$35.09 ,$161.50 ,$66.67 ,$129.20 ,$87.73 ,$35.09 ,$35.09 ,$142.50 ,$134.90 ,$134.90 ,$35.09 ,$134.90 ,$155.80 ,$155.80 ,$155.80 , N/A ,$87.73 ,$161.50 ,$35.09 ,$190.00 ,$113.43 ,$35.09 ,$79.04 ,$19.47 ,$17.70 ,$35.09 ,$161.50 ,$73.69 ,$161.50 ,$53.20 ,$171.00 ,$35.09 ,$155.80 ,$140.36 ,$140.36 ,$35.09 ,$123.50 ,$190.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600446,87502,HC INFLUENZA VIRUS MULTIPLE DNA/RNA-90,306,1 ,$572.00 ,$371.80 ,$11.51 ,$572.00 ,$239.50 ,$371.80 ,$341.48 ,$95.80 ,$160.16 ,$320.89 ,$95.80 ,$376.38 ,$95.80 ,$486.20 ,$486.20 ,$95.80 ,$486.20 ,$182.02 ,$388.96 ,$239.50 ,$95.80 ,$95.80 ,$429.00 ,$406.12 ,$406.12 ,$95.80 ,$406.12 ,$469.04 ,$469.04 ,$469.04 , N/A ,$239.50 ,$486.20 ,$95.80 ,$572.00 ,$341.48 ,$95.80 ,$237.95 ,$12.66 ,$11.51 ,$95.80 ,$486.20 ,$201.18 ,$486.20 ,$160.16 ,$514.80 ,$95.80 ,$469.04 ,$383.20 ,$383.20 ,$95.80 ,$371.80 ,$572.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600448,87517,HC HEPATITIS B QN-90,306,1 ,$408.00 ,$265.20 ,$17.70 ,$408.00 ,$107.10 ,$265.20 ,$243.58 ,$42.84 ,$114.24 ,$228.89 ,$42.84 ,$268.46 ,$42.84 ,$346.80 ,$346.80 ,$42.84 ,$346.80 ,$81.40 ,$277.44 ,$107.10 ,$42.84 ,$42.84 ,$306.00 ,$289.68 ,$289.68 ,$42.84 ,$289.68 ,$334.56 ,$334.56 ,$334.56 , N/A ,$107.10 ,$346.80 ,$42.84 ,$408.00 ,$243.58 ,$42.84 ,$169.73 ,$19.47 ,$17.70 ,$42.84 ,$346.80 ,$89.96 ,$346.80 ,$114.24 ,$367.20 ,$42.84 ,$334.56 ,$171.36 ,$171.36 ,$42.84 ,$265.20 ,$408.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600451,87522,HC HEPATITIS C QN-90,306,1 ,$729.00 ,$473.85 ,$17.70 ,$729.00 ,$107.10 ,$473.85 ,$435.21 ,$42.84 ,$204.12 ,$408.97 ,$42.84 ,$479.68 ,$42.84 ,$619.65 ,$619.65 ,$42.84 ,$619.65 ,$81.40 ,$495.72 ,$107.10 ,$42.84 ,$42.84 ,$546.75 ,$517.59 ,$517.59 ,$42.84 ,$517.59 ,$597.78 ,$597.78 ,$597.78 , N/A ,$107.10 ,$619.65 ,$42.84 ,$729.00 ,$435.21 ,$42.84 ,$303.26 ,$19.47 ,$17.70 ,$42.84 ,$619.65 ,$89.96 ,$619.65 ,$204.12 ,$656.10 ,$42.84 ,$597.78 ,$171.36 ,$171.36 ,$42.84 ,$473.85 ,$729.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600453,87529,HC HERPES SIMPLEX AMP-90,306,1 ,$704.00 ,$457.60 ,$17.70 ,$704.00 ,$87.73 ,$457.60 ,$420.29 ,$35.09 ,$197.12 ,$394.94 ,$35.09 ,$463.23 ,$35.09 ,$598.40 ,$598.40 ,$35.09 ,$598.40 ,$66.67 ,$478.72 ,$87.73 ,$35.09 ,$35.09 ,$528.00 ,$499.84 ,$499.84 ,$35.09 ,$499.84 ,$577.28 ,$577.28 ,$577.28 , N/A ,$87.73 ,$598.40 ,$35.09 ,$704.00 ,$420.29 ,$35.09 ,$292.86 ,$19.47 ,$17.70 ,$35.09 ,$598.40 ,$73.69 ,$598.40 ,$197.12 ,$633.60 ,$35.09 ,$577.28 ,$140.36 ,$140.36 ,$35.09 ,$457.60 ,$704.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600454,87530,HC HSV QUANT-90,306,1 ,$380.00 ,$247.00 ,$17.70 ,$380.00 ,$107.10 ,$247.00 ,$226.86 ,$42.84 ,$106.40 ,$213.18 ,$42.84 ,$250.04 ,$42.84 ,$323.00 ,$323.00 ,$42.84 ,$323.00 ,$81.40 ,$258.40 ,$107.10 ,$42.84 ,$42.84 ,$285.00 ,$269.80 ,$269.80 ,$42.84 ,$269.80 ,$311.60 ,$311.60 ,$311.60 , N/A ,$107.10 ,$323.00 ,$42.84 ,$380.00 ,$226.86 ,$42.84 ,$158.08 ,$19.47 ,$17.70 ,$42.84 ,$323.00 ,$89.96 ,$323.00 ,$106.40 ,$342.00 ,$42.84 ,$311.60 ,$171.36 ,$171.36 ,$42.84 ,$247.00 ,$380.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600456,87535,HC PROBE HIV-1 AMP-90,306,1 ,$330.00 ,$214.50 ,$17.70 ,$330.00 ,$87.73 ,$214.50 ,$197.01 ,$35.09 ,$92.40 ,$185.13 ,$35.09 ,$217.14 ,$35.09 ,$280.50 ,$280.50 ,$35.09 ,$280.50 ,$66.67 ,$224.40 ,$87.73 ,$35.09 ,$35.09 ,$247.50 ,$234.30 ,$234.30 ,$35.09 ,$234.30 ,$270.60 ,$270.60 ,$270.60 , N/A ,$87.73 ,$280.50 ,$35.09 ,$330.00 ,$197.01 ,$35.09 ,$137.28 ,$19.47 ,$17.70 ,$35.09 ,$280.50 ,$73.69 ,$280.50 ,$92.40 ,$297.00 ,$35.09 ,$270.60 ,$140.36 ,$140.36 ,$35.09 ,$214.50 ,$330.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600458,87536,HC HIV-1 QN-90,306,1 ,$381.00 ,$247.65 ,$17.70 ,$381.00 ,$212.75 ,$247.65 ,$227.46 ,$85.10 ,$106.68 ,$213.74 ,$85.10 ,$250.70 ,$85.10 ,$323.85 ,$323.85 ,$85.10 ,$323.85 ,$161.69 ,$259.08 ,$212.75 ,$85.10 ,$85.10 ,$285.75 ,$270.51 ,$270.51 ,$85.10 ,$270.51 ,$312.42 ,$312.42 ,$312.42 , N/A ,$212.75 ,$323.85 ,$85.10 ,$381.00 ,$227.46 ,$85.10 ,$158.50 ,$19.47 ,$17.70 ,$85.10 ,$323.85 ,$178.71 ,$323.85 ,$106.68 ,$342.90 ,$85.10 ,$312.42 ,$340.40 ,$340.40 ,$85.10 ,$247.65 ,$381.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600460,87591,HC NEISSERIA AMP-90,306,1 ,$251.00 ,$163.15 ,$17.70 ,$251.00 ,$87.73 ,$163.15 ,$149.85 ,$35.09 ,$70.28 ,$140.81 ,$35.09 ,$165.16 ,$35.09 ,$213.35 ,$213.35 ,$35.09 ,$213.35 ,$66.67 ,$170.68 ,$87.73 ,$35.09 ,$35.09 ,$188.25 ,$178.21 ,$178.21 ,$35.09 ,$178.21 ,$205.82 ,$205.82 ,$205.82 , N/A ,$87.73 ,$213.35 ,$35.09 ,$251.00 ,$149.85 ,$35.09 ,$104.42 ,$19.47 ,$17.70 ,$35.09 ,$213.35 ,$73.69 ,$213.35 ,$70.28 ,$225.90 ,$35.09 ,$205.82 ,$140.36 ,$140.36 ,$35.09 ,$163.15 ,$251.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600462,87624,HC HPV AMP HIGH RISK ALL OTHERS-90,306,1 ,$284.00 ,$184.60 ,$17.70 ,$284.00 ,$87.73 ,$184.60 ,$169.55 ,$35.09 ,$79.52 ,$159.32 ,$35.09 ,$186.87 ,$35.09 ,$241.40 ,$241.40 ,$35.09 ,$241.40 ,$66.67 ,$193.12 ,$87.73 ,$35.09 ,$35.09 ,$213.00 ,$201.64 ,$201.64 ,$35.09 ,$201.64 ,$232.88 ,$232.88 ,$232.88 , N/A ,$87.73 ,$241.40 ,$35.09 ,$35.09 ,$169.55 ,$35.09 ,$118.14 ,$19.47 ,$17.70 ,$35.09 ,$241.40 ,$73.69 ,$241.40 ,$79.52 ,$255.60 ,$35.09 ,$232.88 ,$140.36 ,$140.36 ,$35.09 ,$184.60 ,$284.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600463,87625,HC HPV GENOTYPE 16 18/45-90,306,1 ,$258.00 ,$167.70 ,$17.70 ,$258.00 ,$101.38 ,$167.70 ,$154.03 ,$40.55 ,$72.24 ,$144.74 ,$40.55 ,$169.76 ,$40.55 ,$219.30 ,$219.30 ,$40.55 ,$219.30 ,$77.05 ,$175.44 ,$101.38 ,$40.55 ,$40.55 ,$193.50 ,$183.18 ,$183.18 ,$40.55 ,$183.18 ,$211.56 ,$211.56 ,$211.56 , N/A ,$101.38 ,$219.30 ,$40.55 ,$40.55 ,$154.03 ,$40.55 ,$107.33 ,$19.47 ,$17.70 ,$40.55 ,$219.30 ,$85.16 ,$219.30 ,$72.24 ,$232.20 ,$40.55 ,$211.56 ,$162.20 ,$162.20 ,$40.55 ,$167.70 ,$258.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600467,87651,HC INFECT AMP (GRP A STREP),306,1 ,$230.00 ,$149.50 ,$17.70 ,$230.00 ,$87.73 ,$149.50 ,$137.31 ,$35.09 ,$64.40 ,$129.03 ,$35.09 ,$151.34 ,$35.09 ,$195.50 ,$195.50 ,$35.09 ,$195.50 ,$66.67 ,$156.40 ,$87.73 ,$35.09 ,$35.09 ,$172.50 ,$163.30 ,$163.30 ,$35.09 ,$163.30 ,$188.60 ,$188.60 ,$188.60 , N/A ,$87.73 ,$195.50 ,$35.09 ,$230.00 ,$137.31 ,$35.09 ,$95.68 ,$19.47 ,$17.70 ,$35.09 ,$195.50 ,$73.69 ,$195.50 ,$64.40 ,$207.00 ,$35.09 ,$188.60 ,$140.36 ,$140.36 ,$35.09 ,$149.50 ,$230.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600468,87653,HC INFECT AMP (GRP B STREP),306,1 ,$230.00 ,$149.50 ,$17.70 ,$230.00 ,$87.73 ,$149.50 ,$137.31 ,$35.09 ,$64.40 ,$129.03 ,$35.09 ,$151.34 ,$35.09 ,$195.50 ,$195.50 ,$35.09 ,$195.50 ,$66.67 ,$156.40 ,$87.73 ,$35.09 ,$35.09 ,$172.50 ,$163.30 ,$163.30 ,$35.09 ,$163.30 ,$188.60 ,$188.60 ,$188.60 , N/A ,$87.73 ,$195.50 ,$35.09 ,$230.00 ,$137.31 ,$35.09 ,$95.68 ,$19.47 ,$17.70 ,$35.09 ,$195.50 ,$73.69 ,$195.50 ,$64.40 ,$207.00 ,$35.09 ,$188.60 ,$140.36 ,$140.36 ,$35.09 ,$149.50 ,$230.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600469,87661,HC TRICHOMONAS VAG AMP PROBE-90,306,1 ,$252.00 ,$163.80 ,$17.70 ,$252.00 ,$87.73 ,$163.80 ,$150.44 ,$35.09 ,$70.56 ,$141.37 ,$35.09 ,$165.82 ,$35.09 ,$214.20 ,$214.20 ,$35.09 ,$214.20 ,$66.67 ,$171.36 ,$87.73 ,$35.09 ,$35.09 ,$189.00 ,$178.92 ,$178.92 ,$35.09 ,$178.92 ,$206.64 ,$206.64 ,$206.64 , N/A ,$87.73 ,$214.20 ,$35.09 ,$252.00 ,$150.44 ,$35.09 ,$104.83 ,$19.47 ,$17.70 ,$35.09 ,$214.20 ,$73.69 ,$214.20 ,$70.56 ,$226.80 ,$35.09 ,$206.64 ,$140.36 ,$140.36 ,$35.09 ,$163.80 ,$252.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600471,87798,HC INFECT AMP-90,306,1 ,$585.00 ,$380.25 ,$17.70 ,$585.00 ,$87.73 ,$380.25 ,$349.25 ,$35.09 ,$163.80 ,$328.19 ,$35.09 ,$384.93 ,$35.09 ,$497.25 ,$497.25 ,$35.09 ,$497.25 ,$66.67 ,$397.80 ,$87.73 ,$35.09 ,$35.09 ,$438.75 ,$415.35 ,$415.35 ,$35.09 ,$415.35 ,$479.70 ,$479.70 ,$479.70 , N/A ,$87.73 ,$497.25 ,$35.09 ,$585.00 ,$349.25 ,$35.09 ,$243.36 ,$19.47 ,$17.70 ,$35.09 ,$497.25 ,$73.69 ,$497.25 ,$163.80 ,$526.50 ,$35.09 ,$479.70 ,$140.36 ,$140.36 ,$35.09 ,$380.25 ,$585.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600475,87798,HC PROBE VZV DNA QUAL RT PCR-90,306,1 ,$200.00 ,$130.00 ,$17.70 ,$200.00 ,$87.73 ,$130.00 ,$119.40 ,$35.09 ,$56.00 ,$112.20 ,$35.09 ,$131.60 ,$35.09 ,$170.00 ,$170.00 ,$35.09 ,$170.00 ,$66.67 ,$136.00 ,$87.73 ,$35.09 ,$35.09 ,$150.00 ,$142.00 ,$142.00 ,$35.09 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$87.73 ,$170.00 ,$35.09 ,$200.00 ,$119.40 ,$35.09 ,$83.20 ,$19.47 ,$17.70 ,$35.09 ,$170.00 ,$73.69 ,$170.00 ,$56.00 ,$180.00 ,$35.09 ,$164.00 ,$140.36 ,$140.36 ,$35.09 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600478,87799,HC INFECT AGENT QN-90,306,1 ,$468.00 ,$304.20 ,$17.70 ,$468.00 ,$107.10 ,$304.20 ,$279.40 ,$42.84 ,$131.04 ,$262.55 ,$42.84 ,$307.94 ,$42.84 ,$397.80 ,$397.80 ,$42.84 ,$397.80 ,$81.40 ,$318.24 ,$107.10 ,$42.84 ,$42.84 ,$351.00 ,$332.28 ,$332.28 ,$42.84 ,$332.28 ,$383.76 ,$383.76 ,$383.76 , N/A ,$107.10 ,$397.80 ,$42.84 ,$468.00 ,$279.40 ,$42.84 ,$194.69 ,$19.47 ,$17.70 ,$42.84 ,$397.80 ,$89.96 ,$397.80 ,$131.04 ,$421.20 ,$42.84 ,$383.76 ,$171.36 ,$171.36 ,$42.84 ,$304.20 ,$468.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600483,87902,HC GENTOYPE HEP C-90,306,1 ,$720.00 ,$468.00 ,$17.70 ,$720.00 ,$643.63 ,$468.00 ,$429.84 ,$257.45 ,$201.60 ,$403.92 ,$257.45 ,$473.76 ,$257.45 ,$612.00 ,$612.00 ,$257.45 ,$612.00 ,$489.16 ,$489.60 ,$643.63 ,$257.45 ,$257.45 ,$540.00 ,$511.20 ,$511.20 ,$257.45 ,$511.20 ,$590.40 ,$590.40 ,$590.40 , N/A ,$643.63 ,$612.00 ,$257.45 ,$720.00 ,$429.84 ,$257.45 ,$299.52 ,$19.47 ,$17.70 ,$257.45 ,$612.00 ,$540.65 ,$612.00 ,$201.60 ,$648.00 ,$257.45 ,$590.40 ,$720.00 ,$720.00 ,$257.45 ,$468.00 ,$720.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600503,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB-90,306,1 ,$46.00 ,$29.90 ,$6.68 ,$60.20 ,$60.20 ,$29.90 ,$27.46 ,$24.08 ,$12.88 ,$25.81 ,$24.08 ,$30.27 ,$24.08 ,$39.10 ,$39.10 ,$24.08 ,$39.10 ,$45.75 ,$31.28 ,$60.20 ,$24.08 ,$24.08 ,$34.50 ,$32.66 ,$32.66 ,$24.08 ,$32.66 ,$37.72 ,$37.72 ,$37.72 , N/A ,$46.00 ,$39.10 ,$24.08 ,$46.00 ,$27.46 ,$24.08 ,$19.14 ,$7.35 ,$6.68 ,$24.08 ,$39.10 ,$50.57 ,$39.10 ,$12.88 ,$41.40 ,$24.08 ,$37.72 ,$46.00 ,$46.00 ,$24.08 ,$29.90 ,$46.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600516,87040,HC BACTERIA BLOOD CULTURE T1,306,1 ,$362.00 ,$235.30 ,$10.32 ,$362.00 ,$25.80 ,$235.30 ,$216.11 ,$10.32 ,$101.36 ,$203.08 ,$10.32 ,$238.20 ,$10.32 ,$307.70 ,$307.70 ,$10.32 ,$307.70 ,$19.61 ,$246.16 ,$25.80 ,$10.32 ,$10.32 ,$271.50 ,$257.02 ,$257.02 ,$10.32 ,$257.02 ,$296.84 ,$296.84 ,$296.84 , N/A ,$25.80 ,$307.70 ,$10.32 ,$362.00 ,$216.11 ,$10.32 ,$150.59 ,$19.47 ,$17.70 ,$10.32 ,$307.70 ,$21.67 ,$307.70 ,$101.36 ,$325.80 ,$10.32 ,$296.84 ,$41.28 ,$41.28 ,$10.32 ,$235.30 ,$362.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600517,87045,HC STOOL CULTURE,306,1 ,$166.00 ,$107.90 ,$5.33 ,$166.00 ,$23.60 ,$107.90 ,$99.10 ,$9.44 ,$46.48 ,$93.13 ,$9.44 ,$109.23 ,$9.44 ,$141.10 ,$141.10 ,$9.44 ,$141.10 ,$17.94 ,$112.88 ,$23.60 ,$9.44 ,$9.44 ,$124.50 ,$117.86 ,$117.86 ,$9.44 ,$117.86 ,$136.12 ,$136.12 ,$136.12 , N/A ,$23.60 ,$141.10 ,$9.44 ,$166.00 ,$99.10 ,$9.44 ,$69.06 ,$5.86 ,$5.33 ,$9.44 ,$141.10 ,$19.82 ,$141.10 ,$46.48 ,$149.40 ,$9.44 ,$136.12 ,$37.76 ,$37.76 ,$9.44 ,$107.90 ,$166.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600518,87046,HC STOOL CULTURE OTH SRC,306,1 ,$130.00 ,$84.50 ,$5.33 ,$130.00 ,$23.60 ,$84.50 ,$77.61 ,$9.44 ,$36.40 ,$72.93 ,$9.44 ,$85.54 ,$9.44 ,$110.50 ,$110.50 ,$9.44 ,$110.50 ,$17.94 ,$88.40 ,$23.60 ,$9.44 ,$9.44 ,$97.50 ,$92.30 ,$92.30 ,$9.44 ,$92.30 ,$106.60 ,$106.60 ,$106.60 , N/A ,$23.60 ,$110.50 ,$9.44 ,$130.00 ,$77.61 ,$9.44 ,$54.08 ,$5.86 ,$5.33 ,$9.44 ,$110.50 ,$19.82 ,$110.50 ,$36.40 ,$117.00 ,$9.44 ,$106.60 ,$37.76 ,$37.76 ,$9.44 ,$84.50 ,$130.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600519,87070,HC BODY FLUID CULTURE,306,1 ,$41.00 ,$26.65 ,$5.33 ,$41.00 ,$21.55 ,$26.65 ,$24.48 ,$8.62 ,$11.48 ,$23.00 ,$8.62 ,$26.98 ,$8.62 ,$34.85 ,$34.85 ,$8.62 ,$34.85 ,$16.38 ,$27.88 ,$21.55 ,$8.62 ,$8.62 ,$30.75 ,$29.11 ,$29.11 ,$8.62 ,$29.11 ,$33.62 ,$33.62 ,$33.62 , N/A ,$21.55 ,$34.85 ,$8.62 ,$41.00 ,$24.48 ,$8.62 ,$17.06 ,$5.86 ,$5.33 ,$8.62 ,$34.85 ,$18.10 ,$34.85 ,$11.48 ,$36.90 ,$8.62 ,$33.62 ,$34.48 ,$34.48 ,$8.62 ,$26.65 ,$41.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600520,87071,HC CULTURE AEROBIC OTH QN,306,1 ,$218.00 ,$141.70 ,$5.33 ,$218.00 ,$24.73 ,$141.70 ,$130.15 ,$9.89 ,$61.04 ,$122.30 ,$9.89 ,$143.44 ,$9.89 ,$185.30 ,$185.30 ,$9.89 ,$185.30 ,$18.79 ,$148.24 ,$24.73 ,$9.89 ,$9.89 ,$163.50 ,$154.78 ,$154.78 ,$9.89 ,$154.78 ,$178.76 ,$178.76 ,$178.76 , N/A ,$24.73 ,$185.30 ,$9.89 ,$218.00 ,$130.15 ,$9.89 ,$90.69 ,$5.86 ,$5.33 ,$9.89 ,$185.30 ,$20.77 ,$185.30 ,$61.04 ,$196.20 ,$9.89 ,$178.76 ,$39.56 ,$39.56 ,$9.89 ,$141.70 ,$218.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600521,87073,HC CULTURE ANAEROBIC OTHER SOURCE QN,306,1 ,$246.00 ,$159.90 ,$9.66 ,$246.00 ,$24.15 ,$159.90 ,$146.86 ,$9.66 ,$68.88 ,$138.01 ,$9.66 ,$161.87 ,$9.66 ,$209.10 ,$209.10 ,$9.66 ,$209.10 ,$18.35 ,$167.28 ,$24.15 ,$9.66 ,$9.66 ,$184.50 ,$174.66 ,$174.66 ,$9.66 ,$174.66 ,$201.72 ,$201.72 ,$201.72 , N/A ,$24.15 ,$209.10 ,$9.66 ,$246.00 ,$146.86 ,$9.66 ,$102.34 ,$19.47 ,$17.70 ,$9.66 ,$209.10 ,$20.29 ,$209.10 ,$68.88 ,$221.40 ,$9.66 ,$201.72 ,$38.64 ,$38.64 ,$9.66 ,$159.90 ,$246.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600522,87075,HC CULTURE ANAEROBIC,306,1 ,$244.00 ,$158.60 ,$5.33 ,$244.00 ,$23.68 ,$158.60 ,$145.67 ,$9.47 ,$68.32 ,$136.88 ,$9.47 ,$160.55 ,$9.47 ,$207.40 ,$207.40 ,$9.47 ,$207.40 ,$17.99 ,$165.92 ,$23.68 ,$9.47 ,$9.47 ,$183.00 ,$173.24 ,$173.24 ,$9.47 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$23.68 ,$207.40 ,$9.47 ,$244.00 ,$145.67 ,$9.47 ,$101.50 ,$5.86 ,$5.33 ,$9.47 ,$207.40 ,$19.89 ,$207.40 ,$68.32 ,$219.60 ,$9.47 ,$200.08 ,$37.88 ,$37.88 ,$9.47 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600523,87076,HC CULTURE ANAEROBIC ID,306,1 ,$192.00 ,$124.80 ,$5.33 ,$192.00 ,$20.20 ,$124.80 ,$114.62 ,$8.08 ,$53.76 ,$107.71 ,$8.08 ,$126.34 ,$8.08 ,$163.20 ,$163.20 ,$8.08 ,$163.20 ,$15.35 ,$130.56 ,$20.20 ,$8.08 ,$8.08 ,$144.00 ,$136.32 ,$136.32 ,$8.08 ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A ,$20.20 ,$163.20 ,$8.08 ,$192.00 ,$114.62 ,$8.08 ,$79.87 ,$5.86 ,$5.33 ,$8.08 ,$163.20 ,$16.97 ,$163.20 ,$53.76 ,$172.80 ,$8.08 ,$157.44 ,$32.32 ,$32.32 ,$8.08 ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600524,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$169.00 ,$109.85 ,$5.33 ,$169.00 ,$20.20 ,$109.85 ,$100.89 ,$8.08 ,$47.32 ,$94.81 ,$8.08 ,$111.20 ,$8.08 ,$143.65 ,$143.65 ,$8.08 ,$143.65 ,$15.35 ,$114.92 ,$20.20 ,$8.08 ,$8.08 ,$126.75 ,$119.99 ,$119.99 ,$8.08 ,$119.99 ,$138.58 ,$138.58 ,$138.58 , N/A ,$20.20 ,$143.65 ,$8.08 ,$169.00 ,$100.89 ,$8.08 ,$70.30 ,$5.86 ,$5.33 ,$8.08 ,$143.65 ,$16.97 ,$143.65 ,$47.32 ,$152.10 ,$8.08 ,$138.58 ,$32.32 ,$32.32 ,$8.08 ,$109.85 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600525,87081,HC CULTURE SCR PRESUMP PATHOGENS,306,1 ,$187.00 ,$121.55 ,$5.33 ,$187.00 ,$16.58 ,$121.55 ,$111.64 ,$6.63 ,$52.36 ,$104.91 ,$6.63 ,$123.05 ,$6.63 ,$158.95 ,$158.95 ,$6.63 ,$158.95 ,$12.60 ,$127.16 ,$16.58 ,$6.63 ,$6.63 ,$140.25 ,$132.77 ,$132.77 ,$6.63 ,$132.77 ,$153.34 ,$153.34 ,$153.34 , N/A ,$16.58 ,$158.95 ,$6.63 ,$187.00 ,$111.64 ,$6.63 ,$77.79 ,$5.86 ,$5.33 ,$6.63 ,$158.95 ,$13.92 ,$158.95 ,$52.36 ,$168.30 ,$6.63 ,$153.34 ,$26.52 ,$26.52 ,$6.63 ,$121.55 ,$187.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600526,87081,HC CULTURE SCR PRESUMP PATHOGENS,306,1 ,$187.00 ,$121.55 ,$5.33 ,$187.00 ,$16.58 ,$121.55 ,$111.64 ,$6.63 ,$52.36 ,$104.91 ,$6.63 ,$123.05 ,$6.63 ,$158.95 ,$158.95 ,$6.63 ,$158.95 ,$12.60 ,$127.16 ,$16.58 ,$6.63 ,$6.63 ,$140.25 ,$132.77 ,$132.77 ,$6.63 ,$132.77 ,$153.34 ,$153.34 ,$153.34 , N/A ,$16.58 ,$158.95 ,$6.63 ,$187.00 ,$111.64 ,$6.63 ,$77.79 ,$5.86 ,$5.33 ,$6.63 ,$158.95 ,$13.92 ,$158.95 ,$52.36 ,$168.30 ,$6.63 ,$153.34 ,$26.52 ,$26.52 ,$6.63 ,$121.55 ,$187.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600527,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$214.00 ,$139.10 ,$5.33 ,$214.00 ,$20.18 ,$139.10 ,$127.76 ,$8.07 ,$59.92 ,$120.05 ,$8.07 ,$140.81 ,$8.07 ,$181.90 ,$181.90 ,$8.07 ,$181.90 ,$15.33 ,$145.52 ,$20.18 ,$8.07 ,$8.07 ,$160.50 ,$151.94 ,$151.94 ,$8.07 ,$151.94 ,$175.48 ,$175.48 ,$175.48 , N/A ,$20.18 ,$181.90 ,$8.07 ,$214.00 ,$127.76 ,$8.07 ,$89.02 ,$5.86 ,$5.33 ,$8.07 ,$181.90 ,$16.95 ,$181.90 ,$59.92 ,$192.60 ,$8.07 ,$175.48 ,$32.28 ,$32.28 ,$8.07 ,$139.10 ,$214.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600528,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$121.00 ,$78.65 ,$5.33 ,$121.00 ,$20.23 ,$78.65 ,$72.24 ,$8.09 ,$33.88 ,$67.88 ,$8.09 ,$79.62 ,$8.09 ,$102.85 ,$102.85 ,$8.09 ,$102.85 ,$15.37 ,$82.28 ,$20.23 ,$8.09 ,$8.09 ,$90.75 ,$85.91 ,$85.91 ,$8.09 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$20.23 ,$102.85 ,$8.09 ,$121.00 ,$72.24 ,$8.09 ,$50.34 ,$5.86 ,$5.33 ,$8.09 ,$102.85 ,$16.99 ,$102.85 ,$33.88 ,$108.90 ,$8.09 ,$99.22 ,$32.36 ,$32.36 ,$8.09 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600529,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL -90,306,1 ,$83.00 ,$53.95 ,$5.33 ,$83.00 ,$19.28 ,$53.95 ,$49.55 ,$7.71 ,$23.24 ,$46.56 ,$7.71 ,$54.61 ,$7.71 ,$70.55 ,$70.55 ,$7.71 ,$70.55 ,$14.65 ,$56.44 ,$19.28 ,$7.71 ,$7.71 ,$62.25 ,$58.93 ,$58.93 ,$7.71 ,$58.93 ,$68.06 ,$68.06 ,$68.06 , N/A ,$19.28 ,$70.55 ,$7.71 ,$83.00 ,$49.55 ,$7.71 ,$34.53 ,$5.86 ,$5.33 ,$7.71 ,$70.55 ,$16.19 ,$70.55 ,$23.24 ,$74.70 ,$7.71 ,$68.06 ,$30.84 ,$30.84 ,$7.71 ,$53.95 ,$83.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600531,87102,HC CULTURE FUNGUS OTHER,306,1 ,$258.00 ,$167.70 ,$5.33 ,$258.00 ,$21.03 ,$167.70 ,$154.03 ,$8.41 ,$72.24 ,$144.74 ,$8.41 ,$169.76 ,$8.41 ,$219.30 ,$219.30 ,$8.41 ,$219.30 ,$15.98 ,$175.44 ,$21.03 ,$8.41 ,$8.41 ,$193.50 ,$183.18 ,$183.18 ,$8.41 ,$183.18 ,$211.56 ,$211.56 ,$211.56 , N/A ,$21.03 ,$219.30 ,$8.41 ,$258.00 ,$154.03 ,$8.41 ,$107.33 ,$5.86 ,$5.33 ,$8.41 ,$219.30 ,$17.66 ,$219.30 ,$72.24 ,$232.20 ,$8.41 ,$211.56 ,$33.64 ,$33.64 ,$8.41 ,$167.70 ,$258.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600533,87106,HC CULTURE FUNGUS ID YEAST,306,1 ,$201.00 ,$130.65 ,$5.33 ,$201.00 ,$25.80 ,$130.65 ,$120.00 ,$10.32 ,$56.28 ,$112.76 ,$10.32 ,$132.26 ,$10.32 ,$170.85 ,$170.85 ,$10.32 ,$170.85 ,$19.61 ,$136.68 ,$25.80 ,$10.32 ,$10.32 ,$150.75 ,$142.71 ,$142.71 ,$10.32 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$25.80 ,$170.85 ,$10.32 ,$201.00 ,$120.00 ,$10.32 ,$83.62 ,$5.86 ,$5.33 ,$10.32 ,$170.85 ,$21.67 ,$170.85 ,$56.28 ,$180.90 ,$10.32 ,$164.82 ,$41.28 ,$41.28 ,$10.32 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600536,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$215.00 ,$139.75 ,$5.18 ,$215.00 ,$12.95 ,$139.75 ,$128.36 ,$5.18 ,$60.20 ,$120.62 ,$5.18 ,$141.47 ,$5.18 ,$182.75 ,$182.75 ,$5.18 ,$182.75 ,$9.84 ,$146.20 ,$12.95 ,$5.18 ,$5.18 ,$161.25 ,$152.65 ,$152.65 ,$5.18 ,$152.65 ,$176.30 ,$176.30 ,$176.30 , N/A ,$12.95 ,$182.75 ,$5.18 ,$215.00 ,$128.36 ,$5.18 ,$89.44 ,$5.86 ,$5.33 ,$5.18 ,$182.75 ,$10.88 ,$182.75 ,$60.20 ,$193.50 ,$5.18 ,$176.30 ,$20.72 ,$20.72 ,$5.18 ,$139.75 ,$215.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600537,87149,HC CULTURE TYPING ID NUCLEIC ACID,306,1 ,$94.00 ,$61.10 ,$5.33 ,$94.00 ,$50.13 ,$61.10 ,$56.12 ,$20.05 ,$26.32 ,$52.73 ,$20.05 ,$61.85 ,$20.05 ,$79.90 ,$79.90 ,$20.05 ,$79.90 ,$38.10 ,$63.92 ,$50.13 ,$20.05 ,$20.05 ,$70.50 ,$66.74 ,$66.74 ,$20.05 ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A ,$50.13 ,$79.90 ,$20.05 ,$94.00 ,$56.12 ,$20.05 ,$39.10 ,$5.86 ,$5.33 ,$20.05 ,$79.90 ,$42.11 ,$79.90 ,$26.32 ,$84.60 ,$20.05 ,$77.08 ,$80.20 ,$80.20 ,$20.05 ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600541,87172,HC PINWORM EXAM,306,1 ,$80.00 ,$52.00 ,$4.27 ,$80.00 ,$10.68 ,$52.00 ,$47.76 ,$4.27 ,$22.40 ,$44.88 ,$4.27 ,$52.64 ,$4.27 ,$68.00 ,$68.00 ,$4.27 ,$68.00 ,$8.11 ,$54.40 ,$10.68 ,$4.27 ,$4.27 ,$60.00 ,$56.80 ,$56.80 ,$4.27 ,$56.80 ,$65.60 ,$65.60 ,$65.60 , N/A ,$10.68 ,$68.00 ,$4.27 ,$80.00 ,$47.76 ,$4.27 ,$33.28 ,$5.86 ,$5.33 ,$4.27 ,$68.00 ,$8.97 ,$68.00 ,$22.40 ,$72.00 ,$4.27 ,$65.60 ,$17.08 ,$17.08 ,$4.27 ,$52.00 ,$80.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600542,87176,HC HOMOGENIZATION TISSUE,306,1 ,$92.00 ,$59.80 ,$5.33 ,$92.00 ,$14.70 ,$59.80 ,$54.92 ,$5.88 ,$25.76 ,$51.61 ,$5.88 ,$60.54 ,$5.88 ,$78.20 ,$78.20 ,$5.88 ,$78.20 ,$11.17 ,$62.56 ,$14.70 ,$5.88 ,$5.88 ,$69.00 ,$65.32 ,$65.32 ,$5.88 ,$65.32 ,$75.44 ,$75.44 ,$75.44 , N/A ,$14.70 ,$78.20 ,$5.88 ,$92.00 ,$54.92 ,$5.88 ,$38.27 ,$5.86 ,$5.33 ,$5.88 ,$78.20 ,$12.35 ,$78.20 ,$25.76 ,$82.80 ,$5.88 ,$75.44 ,$23.52 ,$23.52 ,$5.88 ,$59.80 ,$92.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600544,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$33.00 ,$21.45 ,$4.75 ,$33.00 ,$11.88 ,$21.45 ,$19.70 ,$4.75 ,$9.24 ,$18.51 ,$4.75 ,$21.71 ,$4.75 ,$28.05 ,$28.05 ,$4.75 ,$28.05 ,$9.03 ,$22.44 ,$11.88 ,$4.75 ,$4.75 ,$24.75 ,$23.43 ,$23.43 ,$4.75 ,$23.43 ,$27.06 ,$27.06 ,$27.06 , N/A ,$11.88 ,$28.05 ,$4.75 ,$33.00 ,$19.70 ,$4.75 ,$13.73 ,$5.86 ,$5.33 ,$4.75 ,$28.05 ,$9.98 ,$28.05 ,$9.24 ,$29.70 ,$4.75 ,$27.06 ,$19.00 ,$19.00 ,$4.75 ,$21.45 ,$33.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600545,87184,HC SENSITIVITY DISK KB,306,1 ,$117.00 ,$76.05 ,$5.33 ,$117.00 ,$18.70 ,$76.05 ,$69.85 ,$7.48 ,$32.76 ,$65.64 ,$7.48 ,$76.99 ,$7.48 ,$99.45 ,$99.45 ,$7.48 ,$99.45 ,$14.21 ,$79.56 ,$18.70 ,$7.48 ,$7.48 ,$87.75 ,$83.07 ,$83.07 ,$7.48 ,$83.07 ,$95.94 ,$95.94 ,$95.94 , N/A ,$18.70 ,$99.45 ,$7.48 ,$117.00 ,$69.85 ,$7.48 ,$48.67 ,$5.86 ,$5.33 ,$7.48 ,$99.45 ,$15.71 ,$99.45 ,$32.76 ,$105.30 ,$7.48 ,$95.94 ,$29.92 ,$29.92 ,$7.48 ,$76.05 ,$117.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600546,87185,HC BETA LACTAMASE,306,1 ,$23.00 ,$14.95 ,$4.75 ,$23.00 ,$11.88 ,$14.95 ,$13.73 ,$4.75 ,$6.44 ,$12.90 ,$4.75 ,$15.13 ,$4.75 ,$19.55 ,$19.55 ,$4.75 ,$19.55 ,$9.03 ,$15.64 ,$11.88 ,$4.75 ,$4.75 ,$17.25 ,$16.33 ,$16.33 ,$4.75 ,$16.33 ,$18.86 ,$18.86 ,$18.86 , N/A ,$11.88 ,$19.55 ,$4.75 ,$23.00 ,$13.73 ,$4.75 ,$9.57 ,$5.86 ,$5.33 ,$4.75 ,$19.55 ,$9.98 ,$19.55 ,$6.44 ,$20.70 ,$4.75 ,$18.86 ,$19.00 ,$19.00 ,$4.75 ,$14.95 ,$23.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600547,87186,HC SENSITIVITY MIC,306,1 ,$238.00 ,$154.70 ,$5.33 ,$238.00 ,$21.63 ,$154.70 ,$142.09 ,$8.65 ,$66.64 ,$133.52 ,$8.65 ,$156.60 ,$8.65 ,$202.30 ,$202.30 ,$8.65 ,$202.30 ,$16.44 ,$161.84 ,$21.63 ,$8.65 ,$8.65 ,$178.50 ,$168.98 ,$168.98 ,$8.65 ,$168.98 ,$195.16 ,$195.16 ,$195.16 , N/A ,$21.63 ,$202.30 ,$8.65 ,$238.00 ,$142.09 ,$8.65 ,$99.01 ,$5.86 ,$5.33 ,$8.65 ,$202.30 ,$18.17 ,$202.30 ,$66.64 ,$214.20 ,$8.65 ,$195.16 ,$34.60 ,$34.60 ,$8.65 ,$154.70 ,$238.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600551,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$113.00 ,$73.45 ,$4.27 ,$113.00 ,$10.68 ,$73.45 ,$67.46 ,$4.27 ,$31.64 ,$63.39 ,$4.27 ,$74.35 ,$4.27 ,$96.05 ,$96.05 ,$4.27 ,$96.05 ,$8.11 ,$76.84 ,$10.68 ,$4.27 ,$4.27 ,$84.75 ,$80.23 ,$80.23 ,$4.27 ,$80.23 ,$92.66 ,$92.66 ,$92.66 , N/A ,$10.68 ,$96.05 ,$4.27 ,$113.00 ,$67.46 ,$4.27 ,$47.01 ,$5.86 ,$5.33 ,$4.27 ,$96.05 ,$8.97 ,$96.05 ,$31.64 ,$101.70 ,$4.27 ,$92.66 ,$17.08 ,$17.08 ,$4.27 ,$73.45 ,$113.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600552,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$98.00 ,$63.70 ,$5.33 ,$98.00 ,$13.48 ,$63.70 ,$58.51 ,$5.39 ,$27.44 ,$54.98 ,$5.39 ,$64.48 ,$5.39 ,$83.30 ,$83.30 ,$5.39 ,$83.30 ,$10.24 ,$66.64 ,$13.48 ,$5.39 ,$5.39 ,$73.50 ,$69.58 ,$69.58 ,$5.39 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$13.48 ,$83.30 ,$5.39 ,$98.00 ,$58.51 ,$5.39 ,$40.77 ,$5.86 ,$5.33 ,$5.39 ,$83.30 ,$11.32 ,$83.30 ,$27.44 ,$88.20 ,$5.39 ,$80.36 ,$21.56 ,$21.56 ,$5.39 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600555,87255,HC VIRUS ID NON-IMMUNOLOGIC OTHER THAN CYTOPATHIC-90,306,1 ,$181.00 ,$117.65 ,$17.70 ,$181.00 ,$84.65 ,$117.65 ,$108.06 ,$33.86 ,$50.68 ,$101.54 ,$33.86 ,$119.10 ,$33.86 ,$153.85 ,$153.85 ,$33.86 ,$153.85 ,$64.33 ,$123.08 ,$84.65 ,$33.86 ,$33.86 ,$135.75 ,$128.51 ,$128.51 ,$33.86 ,$128.51 ,$148.42 ,$148.42 ,$148.42 , N/A ,$84.65 ,$153.85 ,$33.86 ,$181.00 ,$108.06 ,$33.86 ,$75.30 ,$19.47 ,$17.70 ,$33.86 ,$153.85 ,$71.11 ,$153.85 ,$50.68 ,$162.90 ,$33.86 ,$148.42 ,$135.44 ,$135.44 ,$33.86 ,$117.65 ,$181.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600556,87327,HC EIA QL CRYPTOCOCCUS AG,306,1 ,$144.00 ,$93.60 ,$6.68 ,$144.00 ,$33.55 ,$93.60 ,$85.97 ,$13.42 ,$40.32 ,$80.78 ,$13.42 ,$94.75 ,$13.42 ,$122.40 ,$122.40 ,$13.42 ,$122.40 ,$25.50 ,$97.92 ,$33.55 ,$13.42 ,$13.42 ,$108.00 ,$102.24 ,$102.24 ,$13.42 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$33.55 ,$122.40 ,$13.42 ,$144.00 ,$85.97 ,$13.42 ,$59.90 ,$7.35 ,$6.68 ,$13.42 ,$122.40 ,$28.18 ,$122.40 ,$40.32 ,$129.60 ,$13.42 ,$118.08 ,$53.68 ,$53.68 ,$13.42 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600557,87329,HC EIA QL GIARDIA AG,306,1 ,$166.00 ,$107.90 ,$6.68 ,$166.00 ,$29.95 ,$107.90 ,$99.10 ,$11.98 ,$46.48 ,$93.13 ,$11.98 ,$109.23 ,$11.98 ,$141.10 ,$141.10 ,$11.98 ,$141.10 ,$22.76 ,$112.88 ,$29.95 ,$11.98 ,$11.98 ,$124.50 ,$117.86 ,$117.86 ,$11.98 ,$117.86 ,$136.12 ,$136.12 ,$136.12 , N/A ,$29.95 ,$141.10 ,$11.98 ,$166.00 ,$99.10 ,$11.98 ,$69.06 ,$7.35 ,$6.68 ,$11.98 ,$141.10 ,$25.16 ,$141.10 ,$46.48 ,$149.40 ,$11.98 ,$136.12 ,$47.92 ,$47.92 ,$11.98 ,$107.90 ,$166.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600559,87340,HC EIA QL HEPATITIS B AG,306,1 ,$227.00 ,$147.55 ,$6.68 ,$227.00 ,$25.83 ,$147.55 ,$135.52 ,$10.33 ,$63.56 ,$127.35 ,$10.33 ,$149.37 ,$10.33 ,$192.95 ,$192.95 ,$10.33 ,$192.95 ,$19.63 ,$154.36 ,$25.83 ,$10.33 ,$10.33 ,$170.25 ,$161.17 ,$161.17 ,$10.33 ,$161.17 ,$186.14 ,$186.14 ,$186.14 , N/A ,$25.83 ,$192.95 ,$10.33 ,$227.00 ,$135.52 ,$10.33 ,$94.43 ,$7.35 ,$6.68 ,$10.33 ,$192.95 ,$21.69 ,$192.95 ,$63.56 ,$204.30 ,$10.33 ,$186.14 ,$41.32 ,$41.32 ,$10.33 ,$147.55 ,$227.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600560,87341,HC EIA QL HEPATITIS B AG NEUT,306,1 ,$213.00 ,$138.45 ,$6.68 ,$213.00 ,$25.83 ,$138.45 ,$127.16 ,$10.33 ,$59.64 ,$119.49 ,$10.33 ,$140.15 ,$10.33 ,$181.05 ,$181.05 ,$10.33 ,$181.05 ,$19.63 ,$144.84 ,$25.83 ,$10.33 ,$10.33 ,$159.75 ,$151.23 ,$151.23 ,$10.33 ,$151.23 ,$174.66 ,$174.66 ,$174.66 , N/A ,$25.83 ,$181.05 ,$10.33 ,$213.00 ,$127.16 ,$10.33 ,$88.61 ,$7.35 ,$6.68 ,$10.33 ,$181.05 ,$21.69 ,$181.05 ,$59.64 ,$191.70 ,$10.33 ,$174.66 ,$41.32 ,$41.32 ,$10.33 ,$138.45 ,$213.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600561,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$232.00 ,$150.80 ,$6.68 ,$232.00 ,$60.20 ,$150.80 ,$138.50 ,$24.08 ,$64.96 ,$130.15 ,$24.08 ,$152.66 ,$24.08 ,$197.20 ,$197.20 ,$24.08 ,$197.20 ,$45.75 ,$157.76 ,$60.20 ,$24.08 ,$24.08 ,$174.00 ,$164.72 ,$164.72 ,$24.08 ,$164.72 ,$190.24 ,$190.24 ,$190.24 , N/A ,$60.20 ,$197.20 ,$24.08 ,$232.00 ,$138.50 ,$24.08 ,$96.51 ,$7.35 ,$6.68 ,$24.08 ,$197.20 ,$50.57 ,$197.20 ,$64.96 ,$208.80 ,$24.08 ,$190.24 ,$96.32 ,$96.32 ,$24.08 ,$150.80 ,$232.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600562,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$371.00 ,$241.15 ,$6.68 ,$371.00 ,$29.95 ,$241.15 ,$221.49 ,$11.98 ,$103.88 ,$208.13 ,$11.98 ,$244.12 ,$11.98 ,$315.35 ,$315.35 ,$11.98 ,$315.35 ,$22.76 ,$252.28 ,$29.95 ,$11.98 ,$11.98 ,$278.25 ,$263.41 ,$263.41 ,$11.98 ,$263.41 ,$304.22 ,$304.22 ,$304.22 , N/A ,$29.95 ,$315.35 ,$11.98 ,$371.00 ,$221.49 ,$11.98 ,$154.34 ,$7.35 ,$6.68 ,$11.98 ,$315.35 ,$25.16 ,$315.35 ,$103.88 ,$333.90 ,$11.98 ,$304.22 ,$47.92 ,$47.92 ,$11.98 ,$241.15 ,$371.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600563,87427,HC SHIGELLA LIKE TOXIN AG,306,1 ,$175.00 ,$113.75 ,$6.68 ,$175.00 ,$29.95 ,$113.75 ,$104.48 ,$11.98 ,$49.00 ,$98.18 ,$11.98 ,$115.15 ,$11.98 ,$148.75 ,$148.75 ,$11.98 ,$148.75 ,$22.76 ,$119.00 ,$29.95 ,$11.98 ,$11.98 ,$131.25 ,$124.25 ,$124.25 ,$11.98 ,$124.25 ,$143.50 ,$143.50 ,$143.50 , N/A ,$29.95 ,$148.75 ,$11.98 ,$175.00 ,$104.48 ,$11.98 ,$72.80 ,$7.35 ,$6.68 ,$11.98 ,$148.75 ,$25.16 ,$148.75 ,$49.00 ,$157.50 ,$11.98 ,$143.50 ,$47.92 ,$47.92 ,$11.98 ,$113.75 ,$175.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600567,87483,HC INFECT AMP CNS DNA/RNA 14 TARGETS,306,1 ,$746.00 ,$484.90 ,$17.70 ,"$1,041.95 ","$1,041.95 ",$484.90 ,$445.36 ,$416.78 ,$208.88 ,$418.51 ,$416.78 ,$490.87 ,$416.78 ,$634.10 ,$634.10 ,$416.78 ,$634.10 ,$746.00 ,$507.28 ,"$1,041.95 ",$416.78 ,$416.78 ,$559.50 ,$529.66 ,$529.66 ,$416.78 ,$529.66 ,$611.72 ,$611.72 ,$611.72 , N/A ,$746.00 ,$634.10 ,$416.78 ,$746.00 ,$445.36 ,$416.78 ,$310.34 ,$19.47 ,$17.70 ,$416.78 ,$634.10 ,$875.24 ,$634.10 ,$208.88 ,$671.40 ,$416.78 ,$611.72 ,$746.00 ,$746.00 ,$416.78 ,$484.90 ,$746.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600568,87486,HC CHLAMYDIA PNEUM AMP PROBE,306,1 ,$121.00 ,$78.65 ,$17.70 ,$121.00 ,$87.73 ,$78.65 ,$72.24 ,$35.09 ,$33.88 ,$67.88 ,$35.09 ,$79.62 ,$35.09 ,$102.85 ,$102.85 ,$35.09 ,$102.85 ,$66.67 ,$82.28 ,$87.73 ,$35.09 ,$35.09 ,$90.75 ,$85.91 ,$85.91 ,$35.09 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$87.73 ,$102.85 ,$35.09 ,$121.00 ,$72.24 ,$35.09 ,$50.34 ,$19.47 ,$17.70 ,$35.09 ,$102.85 ,$73.69 ,$102.85 ,$33.88 ,$108.90 ,$35.09 ,$99.22 ,$121.00 ,$121.00 ,$35.09 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600570,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$152.00 ,$98.80 ,$6.68 ,$152.00 ,$87.73 ,$98.80 ,$90.74 ,$35.09 ,$42.56 ,$85.27 ,$35.09 ,$100.02 ,$35.09 ,$129.20 ,$129.20 ,$35.09 ,$129.20 ,$66.67 ,$103.36 ,$87.73 ,$35.09 ,$35.09 ,$114.00 ,$107.92 ,$107.92 ,$35.09 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$87.73 ,$129.20 ,$35.09 ,$152.00 ,$90.74 ,$35.09 ,$63.23 ,$7.35 ,$6.68 ,$35.09 ,$129.20 ,$73.69 ,$129.20 ,$42.56 ,$136.80 ,$35.09 ,$124.64 ,$140.36 ,$140.36 ,$35.09 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600571,87507,HC IF AG DNA/RNA PROBE TQ 12-25 TARGETS,306,1 ,$791.00 ,$514.15 ,$17.70 ,"$1,041.95 ","$1,041.95 ",$514.15 ,$472.23 ,$416.78 ,$221.48 ,$443.75 ,$416.78 ,$520.48 ,$416.78 ,$672.35 ,$672.35 ,$416.78 ,$672.35 ,$791.00 ,$537.88 ,"$1,041.95 ",$416.78 ,$416.78 ,$593.25 ,$561.61 ,$561.61 ,$416.78 ,$561.61 ,$648.62 ,$648.62 ,$648.62 , N/A ,$791.00 ,$672.35 ,$416.78 ,$791.00 ,$472.23 ,$416.78 ,$329.06 ,$19.47 ,$17.70 ,$416.78 ,$672.35 ,$875.24 ,$672.35 ,$221.48 ,$711.90 ,$416.78 ,$648.62 ,$791.00 ,$791.00 ,$416.78 ,$514.15 ,$791.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600573,87581,HC IF AG PROBE MYCOPLASMA PNEUMONIAE,306,1 ,$531.00 ,$345.15 ,$17.70 ,$531.00 ,$87.73 ,$345.15 ,$317.01 ,$35.09 ,$148.68 ,$297.89 ,$35.09 ,$349.40 ,$35.09 ,$451.35 ,$451.35 ,$35.09 ,$451.35 ,$66.67 ,$361.08 ,$87.73 ,$35.09 ,$35.09 ,$398.25 ,$377.01 ,$377.01 ,$35.09 ,$377.01 ,$435.42 ,$435.42 ,$435.42 , N/A ,$87.73 ,$451.35 ,$35.09 ,$531.00 ,$317.01 ,$35.09 ,$220.90 ,$19.47 ,$17.70 ,$35.09 ,$451.35 ,$73.69 ,$451.35 ,$148.68 ,$477.90 ,$35.09 ,$435.42 ,$140.36 ,$140.36 ,$35.09 ,$345.15 ,$531.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600575,87591,HC NEISSERIA AMP,306,1 ,$152.00 ,$98.80 ,$17.70 ,$152.00 ,$87.73 ,$98.80 ,$90.74 ,$35.09 ,$42.56 ,$85.27 ,$35.09 ,$100.02 ,$35.09 ,$129.20 ,$129.20 ,$35.09 ,$129.20 ,$66.67 ,$103.36 ,$87.73 ,$35.09 ,$35.09 ,$114.00 ,$107.92 ,$107.92 ,$35.09 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$87.73 ,$129.20 ,$35.09 ,$152.00 ,$90.74 ,$35.09 ,$63.23 ,$19.47 ,$17.70 ,$35.09 ,$129.20 ,$73.69 ,$129.20 ,$42.56 ,$136.80 ,$35.09 ,$124.64 ,$140.36 ,$140.36 ,$35.09 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600577,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,"$1,438.00 ",$934.70 ,$17.70 ,"$1,438.00 ","$1,041.95 ",$934.70 ,$858.49 ,$416.78 ,$402.64 ,$806.72 ,$416.78 ,$946.20 ,$416.78 ,"$1,222.30 ","$1,222.30 ",$416.78 ,"$1,222.30 ",$791.88 ,$977.84 ,"$1,041.95 ",$416.78 ,$416.78 ,"$1,078.50 ","$1,020.98 ","$1,020.98 ",$416.78 ,"$1,020.98 ","$1,179.16 ","$1,179.16 ","$1,179.16 ", N/A ,"$1,041.95 ","$1,222.30 ",$416.78 ,"$1,438.00 ",$858.49 ,$416.78 ,$598.21 ,$19.47 ,$17.70 ,$416.78 ,"$1,222.30 ",$875.24 ,"$1,222.30 ",$402.64 ,"$1,294.20 ",$416.78 ,"$1,179.16 ","$1,438.00 ","$1,438.00 ",$416.78 ,$934.70 ,"$1,438.00 "
ST. JOSEPH'S HOSPITAL - BREESE,30600579,87653,HC INFECT AMP (GRP B STREP),306,1 ,$78.00 ,$50.70 ,$17.70 ,$87.73 ,$87.73 ,$50.70 ,$46.57 ,$35.09 ,$21.84 ,$43.76 ,$35.09 ,$51.32 ,$35.09 ,$66.30 ,$66.30 ,$35.09 ,$66.30 ,$66.67 ,$53.04 ,$87.73 ,$35.09 ,$35.09 ,$58.50 ,$55.38 ,$55.38 ,$35.09 ,$55.38 ,$63.96 ,$63.96 ,$63.96 , N/A ,$78.00 ,$66.30 ,$35.09 ,$78.00 ,$46.57 ,$35.09 ,$32.45 ,$19.47 ,$17.70 ,$35.09 ,$66.30 ,$73.69 ,$66.30 ,$21.84 ,$70.20 ,$35.09 ,$63.96 ,$78.00 ,$78.00 ,$35.09 ,$50.70 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600581,87798,HC INFECT AMP,306,1 ,$508.00 ,$330.20 ,$17.70 ,$508.00 ,$87.73 ,$330.20 ,$303.28 ,$35.09 ,$142.24 ,$284.99 ,$35.09 ,$334.26 ,$35.09 ,$431.80 ,$431.80 ,$35.09 ,$431.80 ,$66.67 ,$345.44 ,$87.73 ,$35.09 ,$35.09 ,$381.00 ,$360.68 ,$360.68 ,$35.09 ,$360.68 ,$416.56 ,$416.56 ,$416.56 , N/A ,$87.73 ,$431.80 ,$35.09 ,$508.00 ,$303.28 ,$35.09 ,$211.33 ,$19.47 ,$17.70 ,$35.09 ,$431.80 ,$73.69 ,$431.80 ,$142.24 ,$457.20 ,$35.09 ,$416.56 ,$140.36 ,$140.36 ,$35.09 ,$330.20 ,$508.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600583,87808,HC TRICHOMONAS VAGINITIS OPTICAL,306,1 ,$192.00 ,$124.80 ,$5.33 ,$192.00 ,$38.23 ,$124.80 ,$114.62 ,$15.29 ,$53.76 ,$107.71 ,$15.29 ,$126.34 ,$15.29 ,$163.20 ,$163.20 ,$15.29 ,$163.20 ,$29.05 ,$130.56 ,$38.23 ,$15.29 ,$15.29 ,$144.00 ,$136.32 ,$136.32 ,$15.29 ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A ,$38.23 ,$163.20 ,$15.29 ,$192.00 ,$114.62 ,$15.29 ,$79.87 ,$5.86 ,$5.33 ,$15.29 ,$163.20 ,$32.11 ,$163.20 ,$53.76 ,$172.80 ,$15.29 ,$157.44 ,$61.16 ,$61.16 ,$15.29 ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600590,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$140.00 ,$91.00 ,$6.68 ,$140.00 ,$34.55 ,$91.00 ,$83.58 ,$13.82 ,$39.20 ,$78.54 ,$13.82 ,$92.12 ,$13.82 ,$119.00 ,$119.00 ,$13.82 ,$119.00 ,$26.26 ,$95.20 ,$34.55 ,$13.82 ,$13.82 ,$105.00 ,$99.40 ,$99.40 ,$13.82 ,$99.40 ,$114.80 ,$114.80 ,$114.80 , N/A ,$34.55 ,$119.00 ,$13.82 ,$140.00 ,$83.58 ,$13.82 ,$58.24 ,$7.35 ,$6.68 ,$13.82 ,$119.00 ,$29.02 ,$119.00 ,$39.20 ,$126.00 ,$13.82 ,$114.80 ,$55.28 ,$55.28 ,$13.82 ,$91.00 ,$140.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600592,87486,HC CHLAMYDIA PNEUM AMP PROBE-90,306,1 ,$270.00 ,$175.50 ,$17.70 ,$270.00 ,$87.73 ,$175.50 ,$161.19 ,$35.09 ,$75.60 ,$151.47 ,$35.09 ,$177.66 ,$35.09 ,$229.50 ,$229.50 ,$35.09 ,$229.50 ,$66.67 ,$183.60 ,$87.73 ,$35.09 ,$35.09 ,$202.50 ,$191.70 ,$191.70 ,$35.09 ,$191.70 ,$221.40 ,$221.40 ,$221.40 , N/A ,$87.73 ,$229.50 ,$35.09 ,$270.00 ,$161.19 ,$35.09 ,$112.32 ,$19.47 ,$17.70 ,$35.09 ,$229.50 ,$73.69 ,$229.50 ,$75.60 ,$243.00 ,$35.09 ,$221.40 ,$140.36 ,$140.36 ,$35.09 ,$175.50 ,$270.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600593,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$434.00 ,$282.10 ,$5.33 ,$434.00 ,$40.18 ,$282.10 ,$259.10 ,$16.07 ,$121.52 ,$243.47 ,$16.07 ,$285.57 ,$16.07 ,$368.90 ,$368.90 ,$16.07 ,$368.90 ,$30.53 ,$295.12 ,$40.18 ,$16.07 ,$16.07 ,$325.50 ,$308.14 ,$308.14 ,$16.07 ,$308.14 ,$355.88 ,$355.88 ,$355.88 , N/A ,$40.18 ,$368.90 ,$16.07 ,$434.00 ,$259.10 ,$16.07 ,$180.54 ,$5.86 ,$5.33 ,$16.07 ,$368.90 ,$33.75 ,$368.90 ,$121.52 ,$390.60 ,$16.07 ,$355.88 ,$64.28 ,$64.28 ,$16.07 ,$282.10 ,$434.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600607,87661,HC TRICHOMONAS BAG AMP PROBE,306,1 ,$33.00 ,$21.45 ,$9.24 ,$82.50 ,$82.50 ,$21.45 ,$19.70 ,$33.00 ,$9.24 ,$18.51 ,$33.00 ,$21.71 ,$33.00 ,$28.05 ,$28.05 ,$33.00 ,$28.05 ,$33.00 ,$22.44 ,$82.50 ,$33.00 ,$33.00 ,$24.75 ,$23.43 ,$23.43 ,$33.00 ,$23.43 ,$27.06 ,$27.06 ,$27.06 , N/A ,$33.00 ,$28.05 ,$33.00 ,$33.00 ,$19.70 ,$33.00 ,$13.73 ,$19.47 ,$17.70 ,$33.00 ,$28.05 ,$69.30 ,$28.05 ,$9.24 ,$29.70 ,$33.00 ,$27.06 ,$33.00 ,$33.00 ,$33.00 ,$21.45 ,$33.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600610,87632,HC RESP VIRUS AMP 6-11 TARGETS-90,306,1 ,"$2,313.00 ","$1,503.45 ",$17.70 ,"$2,313.00 ",$545.15 ,"$1,503.45 ","$1,380.86 ",$218.06 ,$647.64 ,"$1,297.59 ",$218.06 ,"$1,521.95 ",$218.06 ,"$1,966.05 ","$1,966.05 ",$218.06 ,"$1,966.05 ",$414.31 ,"$1,572.84 ",$545.15 ,$218.06 ,$218.06 ,"$1,734.75 ","$1,642.23 ","$1,642.23 ",$218.06 ,"$1,642.23 ","$1,896.66 ","$1,896.66 ","$1,896.66 ", N/A ,$545.15 ,"$1,966.05 ",$218.06 ,"$2,313.00 ","$1,380.86 ",$218.06 ,$962.21 ,$19.47 ,$17.70 ,$218.06 ,"$1,966.05 ",$457.93 ,"$1,966.05 ",$647.64 ,"$2,081.70 ",$218.06 ,"$1,896.66 ",$872.24 ,$872.24 ,$218.06 ,"$1,503.45 ","$2,313.00 "
ST. JOSEPH'S HOSPITAL - BREESE,30600611,87512,HC G VAGINALIS DNA SCREEN QN-90,306,1 ,$557.00 ,$362.05 ,$17.70 ,$557.00 ,$104.40 ,$362.05 ,$332.53 ,$41.76 ,$155.96 ,$312.48 ,$41.76 ,$366.51 ,$41.76 ,$473.45 ,$473.45 ,$41.76 ,$473.45 ,$79.34 ,$378.76 ,$104.40 ,$41.76 ,$41.76 ,$417.75 ,$395.47 ,$395.47 ,$41.76 ,$395.47 ,$456.74 ,$456.74 ,$456.74 , N/A ,$104.40 ,$473.45 ,$41.76 ,$557.00 ,$332.53 ,$41.76 ,$231.71 ,$19.47 ,$17.70 ,$41.76 ,$473.45 ,$87.70 ,$473.45 ,$155.96 ,$501.30 ,$41.76 ,$456.74 ,$167.04 ,$167.04 ,$41.76 ,$362.05 ,$557.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600614,87220,HC TISSUE KOH PREP,306,1 ,$70.00 ,$45.50 ,$4.27 ,$70.00 ,$10.68 ,$45.50 ,$41.79 ,$4.27 ,$19.60 ,$39.27 ,$4.27 ,$46.06 ,$4.27 ,$59.50 ,$59.50 ,$4.27 ,$59.50 ,$8.11 ,$47.60 ,$10.68 ,$4.27 ,$4.27 ,$52.50 ,$49.70 ,$49.70 ,$4.27 ,$49.70 ,$57.40 ,$57.40 ,$57.40 , N/A ,$10.68 ,$59.50 ,$4.27 ,$70.00 ,$41.79 ,$4.27 ,$29.12 ,$5.86 ,$5.33 ,$4.27 ,$59.50 ,$8.97 ,$59.50 ,$19.60 ,$63.00 ,$4.27 ,$57.40 ,$17.08 ,$17.08 ,$4.27 ,$45.50 ,$70.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600619,87481,HC CANDIDA SPECIES DNA/RNA AMP PROBE TECH-90,306,1 ,$253.00 ,$164.45 ,$6.68 ,$253.00 ,$87.73 ,$164.45 ,$151.04 ,$35.09 ,$70.84 ,$141.93 ,$35.09 ,$166.47 ,$35.09 ,$215.05 ,$215.05 ,$35.09 ,$215.05 ,$66.67 ,$172.04 ,$87.73 ,$35.09 ,$35.09 ,$189.75 ,$179.63 ,$179.63 ,$35.09 ,$179.63 ,$207.46 ,$207.46 ,$207.46 , N/A ,$87.73 ,$215.05 ,$35.09 ,$253.00 ,$151.04 ,$35.09 ,$105.25 ,$7.35 ,$6.68 ,$35.09 ,$215.05 ,$73.69 ,$215.05 ,$70.84 ,$227.70 ,$35.09 ,$207.46 ,$140.36 ,$140.36 ,$35.09 ,$164.45 ,$253.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600623,87635,HC COVID-19 LAB TEST CDC-90,306,1 ,$458.00 ,$297.70 ,$17.70 ,$458.00 ,$128.28 ,$297.70 ,$273.43 ,$51.31 ,$128.24 ,$256.94 ,$51.31 ,$301.36 ,$51.31 ,$389.30 ,$389.30 ,$51.31 ,$389.30 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$343.50 ,$325.18 ,$325.18 ,$51.31 ,$325.18 ,$375.56 ,$375.56 ,$375.56 , N/A ,$128.28 ,$389.30 ,$51.31 ,$51.31 ,$273.43 ,$51.31 ,$190.53 ,$19.47 ,$17.70 ,$51.31 ,$389.30 ,$107.75 ,$389.30 ,$128.24 ,$412.20 ,$51.31 ,$375.56 ,$205.24 ,$205.24 ,$51.31 ,$297.70 ,$458.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600636,87811,HC COVID ANTIGEN TEST,306,1 ,$125.00 ,$81.25 ,$5.33 ,$125.00 ,$103.45 ,$81.25 ,$74.63 ,$41.38 ,$35.00 ,$70.13 ,$41.38 ,$82.25 ,$41.38 ,$106.25 ,$106.25 ,$41.38 ,$106.25 ,$78.62 ,$41.38 ,$103.45 ,$41.38 ,$41.38 ,$93.75 ,$88.75 ,$88.75 ,$41.38 ,$88.75 ,$102.50 ,$102.50 ,$102.50 , N/A ,$103.45 ,$106.25 ,$41.38 ,$125.00 ,$74.63 ,$41.38 ,$52.00 ,$5.86 ,$5.33 ,$41.38 ,$106.25 ,$86.90 ,$106.25 ,$35.00 ,$112.50 ,$41.38 ,$102.50 ,$125.00 ,$125.00 ,$41.38 ,$81.25 ,$125.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600637,87635,HC COVID-19 LAB PCR TEST,306,1 ,$458.00 ,$297.70 ,$17.70 ,$458.00 ,$128.28 ,$297.70 ,$273.43 ,$51.31 ,$128.24 ,$256.94 ,$51.31 ,$301.36 ,$51.31 ,$389.30 ,$389.30 ,$51.31 ,$389.30 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$343.50 ,$325.18 ,$325.18 ,$51.31 ,$325.18 ,$375.56 ,$375.56 ,$375.56 , N/A ,$128.28 ,$389.30 ,$51.31 ,$51.31 ,$273.43 ,$51.31 ,$190.53 ,$19.47 ,$17.70 ,$51.31 ,$389.30 ,$107.75 ,$389.30 ,$128.24 ,$412.20 ,$51.31 ,$375.56 ,$205.24 ,$205.24 ,$51.31 ,$297.70 ,$458.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600638,87635,HC COVID-19 LAB TEST - 2 DAY COMPLETION - 90,306,1 ,$86.00 ,$55.90 ,$17.70 ,$128.28 ,$128.28 ,$55.90 ,$51.34 ,$51.31 ,$24.08 ,$48.25 ,$51.31 ,$56.59 ,$51.31 ,$73.10 ,$73.10 ,$51.31 ,$73.10 ,$86.00 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$64.50 ,$61.06 ,$61.06 ,$51.31 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$86.00 ,$73.10 ,$51.31 ,$51.31 ,$51.34 ,$51.31 ,$35.78 ,$19.47 ,$17.70 ,$51.31 ,$73.10 ,$107.75 ,$73.10 ,$24.08 ,$77.40 ,$51.31 ,$70.52 ,$86.00 ,$86.00 ,$51.31 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30600639,87150,HC ID NUCLEAR ACID PROBE - 90,306,1 ,$121.00 ,$78.65 ,$5.33 ,$121.00 ,$87.73 ,$78.65 ,$72.24 ,$35.09 ,$33.88 ,$67.88 ,$35.09 ,$79.62 ,$35.09 ,$102.85 ,$102.85 ,$35.09 ,$102.85 ,$66.67 ,$82.28 ,$87.73 ,$35.09 ,$35.09 ,$90.75 ,$85.91 ,$85.91 ,$35.09 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$87.73 ,$102.85 ,$35.09 ,$121.00 ,$72.24 ,$35.09 ,$50.34 ,$5.86 ,$5.33 ,$35.09 ,$102.85 ,$73.69 ,$102.85 ,$33.88 ,$108.90 ,$35.09 ,$99.22 ,$121.00 ,$121.00 ,$35.09 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,30682010,87635,HC COVID-19 LAB TEST NON-CDC-90,306,1 ,$458.00 ,$297.70 ,$17.70 ,$458.00 ,$128.28 ,$297.70 ,$273.43 ,$51.31 ,$128.24 ,$256.94 ,$51.31 ,$301.36 ,$51.31 ,$389.30 ,$389.30 ,$51.31 ,$389.30 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$343.50 ,$325.18 ,$325.18 ,$51.31 ,$325.18 ,$375.56 ,$375.56 ,$375.56 , N/A ,$128.28 ,$389.30 ,$51.31 ,$51.31 ,$273.43 ,$51.31 ,$190.53 ,$19.47 ,$17.70 ,$51.31 ,$389.30 ,$107.75 ,$389.30 ,$128.24 ,$412.20 ,$51.31 ,$375.56 ,$205.24 ,$205.24 ,$51.31 ,$297.70 ,$458.00 
ST. JOSEPH'S HOSPITAL - BREESE,30682012,87635,HC COVID-19 LAB TEST,306,1 ,$458.00 ,$297.70 ,$17.70 ,$458.00 ,$128.28 ,$297.70 ,$273.43 ,$51.31 ,$128.24 ,$256.94 ,$51.31 ,$301.36 ,$51.31 ,$389.30 ,$389.30 ,$51.31 ,$389.30 ,$97.49 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$343.50 ,$325.18 ,$325.18 ,$51.31 ,$325.18 ,$375.56 ,$375.56 ,$375.56 , N/A ,$128.28 ,$389.30 ,$51.31 ,$51.31 ,$273.43 ,$51.31 ,$190.53 ,$19.47 ,$17.70 ,$51.31 ,$389.30 ,$107.75 ,$389.30 ,$128.24 ,$412.20 ,$51.31 ,$375.56 ,$205.24 ,$205.24 ,$51.31 ,$297.70 ,$458.00 
ST. JOSEPH'S HOSPITAL - BREESE,30682015,86769,HC SARS-COV-2 COVID-19 ANTIBODY-90,306,1 ,$260.00 ,$169.00 ,$6.68 ,$260.00 ,$105.33 ,$169.00 ,$155.22 ,$42.13 ,$72.80 ,$145.86 ,$42.13 ,$171.08 ,$42.13 ,$221.00 ,$221.00 ,$42.13 ,$221.00 ,$80.05 ,$42.13 ,$105.33 ,$42.13 ,$42.13 ,$195.00 ,$184.60 ,$184.60 ,$42.13 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$105.33 ,$221.00 ,$42.13 ,$260.00 ,$155.22 ,$42.13 ,$108.16 ,$7.35 ,$6.68 ,$42.13 ,$221.00 ,$88.47 ,$221.00 ,$72.80 ,$234.00 ,$42.13 ,$213.20 ,$168.52 ,$168.52 ,$42.13 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,30682023,87426,HC SARS COVID ANTIGEN TEST,306,1 ,$86.00 ,$55.90 ,$5.33 ,$88.33 ,$88.33 ,$55.90 ,$51.34 ,$35.33 ,$24.08 ,$48.25 ,$35.33 ,$56.59 ,$35.33 ,$73.10 ,$73.10 ,$35.33 ,$73.10 ,$67.13 ,$45.23 ,$88.33 ,$35.33 ,$35.33 ,$64.50 ,$61.06 ,$61.06 ,$35.33 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$86.00 ,$73.10 ,$35.33 ,$37.79 ,$51.34 ,$35.33 ,$35.78 ,$5.86 ,$5.33 ,$35.33 ,$73.10 ,$74.19 ,$73.10 ,$24.08 ,$77.40 ,$35.33 ,$70.52 ,$86.00 ,$86.00 ,$35.33 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30682024,87635,HC SARS-COV-2 COVID-19 TEST,306,1 ,$86.00 ,$55.90 ,$17.70 ,$128.28 ,$128.28 ,$55.90 ,$51.34 ,$51.31 ,$24.08 ,$48.25 ,$51.31 ,$56.59 ,$51.31 ,$73.10 ,$73.10 ,$51.31 ,$73.10 ,$86.00 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$64.50 ,$61.06 ,$61.06 ,$51.31 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$86.00 ,$73.10 ,$51.31 ,$51.31 ,$51.34 ,$51.31 ,$35.78 ,$19.47 ,$17.70 ,$51.31 ,$73.10 ,$107.75 ,$73.10 ,$24.08 ,$77.40 ,$51.31 ,$70.52 ,$86.00 ,$86.00 ,$51.31 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30682025,87635,HC COVID-19 LAB TEST - 2 DAY COMPLETION,306,1 ,$86.00 ,$55.90 ,$17.70 ,$128.28 ,$128.28 ,$55.90 ,$51.34 ,$51.31 ,$24.08 ,$48.25 ,$51.31 ,$56.59 ,$51.31 ,$73.10 ,$73.10 ,$51.31 ,$73.10 ,$86.00 ,$51.31 ,$128.28 ,$51.31 ,$51.31 ,$64.50 ,$61.06 ,$61.06 ,$51.31 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$86.00 ,$73.10 ,$51.31 ,$51.31 ,$51.34 ,$51.31 ,$35.78 ,$19.47 ,$17.70 ,$51.31 ,$73.10 ,$107.75 ,$73.10 ,$24.08 ,$77.40 ,$51.31 ,$70.52 ,$86.00 ,$86.00 ,$51.31 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$133.00 ,$86.45 ,$2.66 ,$133.00 ,$7.93 ,$86.45 ,$79.40 ,$3.17 ,$37.24 ,$74.61 ,$3.17 ,$87.51 ,$3.17 ,$113.05 ,$113.05 ,$3.17 ,$113.05 ,$6.02 ,$90.44 ,$7.93 ,$3.17 ,$3.17 ,$99.75 ,$94.43 ,$94.43 ,$3.17 ,$94.43 ,$109.06 ,$109.06 ,$109.06 , N/A ,$7.93 ,$113.05 ,$3.17 ,$3.17 ,$79.40 ,$3.17 ,$55.33 ,$2.93 ,$2.66 ,$3.17 ,$113.05 ,$6.66 ,$113.05 ,$37.24 ,$119.70 ,$3.17 ,$109.06 ,$12.68 ,$12.68 ,$3.17 ,$86.45 ,$133.00 
ST. JOSEPH'S HOSPITAL - BREESE,30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$61.00 ,$39.65 ,$1.68 ,$61.00 ,$5.63 ,$39.65 ,$36.42 ,$2.25 ,$17.08 ,$34.22 ,$2.25 ,$40.14 ,$2.25 ,$51.85 ,$51.85 ,$2.25 ,$51.85 ,$4.28 ,$41.48 ,$5.63 ,$2.25 ,$2.25 ,$45.75 ,$43.31 ,$43.31 ,$2.25 ,$43.31 ,$50.02 ,$50.02 ,$50.02 , N/A ,$5.63 ,$51.85 ,$2.25 ,$61.00 ,$36.42 ,$2.25 ,$25.38 ,$1.85 ,$1.68 ,$2.25 ,$51.85 ,$4.73 ,$51.85 ,$17.08 ,$54.90 ,$2.25 ,$50.02 ,$9.00 ,$9.00 ,$2.25 ,$39.65 ,$61.00 
ST. JOSEPH'S HOSPITAL - BREESE,30700115,81015,HC URINALYSIS MICRO ONLY,307,1 ,$46.00 ,$29.90 ,$2.66 ,$46.00 ,$7.63 ,$29.90 ,$27.46 ,$3.05 ,$12.88 ,$25.81 ,$3.05 ,$30.27 ,$3.05 ,$39.10 ,$39.10 ,$3.05 ,$39.10 ,$5.80 ,$31.28 ,$7.63 ,$3.05 ,$3.05 ,$34.50 ,$32.66 ,$32.66 ,$3.05 ,$32.66 ,$37.72 ,$37.72 ,$37.72 , N/A ,$7.63 ,$39.10 ,$3.05 ,$46.00 ,$27.46 ,$3.05 ,$19.14 ,$2.93 ,$2.66 ,$3.05 ,$39.10 ,$6.41 ,$39.10 ,$12.88 ,$41.40 ,$3.05 ,$37.72 ,$12.20 ,$12.20 ,$3.05 ,$29.90 ,$46.00 
ST. JOSEPH'S HOSPITAL - BREESE,30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$122.00 ,$79.30 ,$2.66 ,$122.00 ,$21.53 ,$79.30 ,$72.83 ,$8.61 ,$34.16 ,$68.44 ,$8.61 ,$80.28 ,$8.61 ,$103.70 ,$103.70 ,$8.61 ,$103.70 ,$16.36 ,$82.96 ,$21.53 ,$8.61 ,$8.61 ,$91.50 ,$86.62 ,$86.62 ,$8.61 ,$86.62 ,$100.04 ,$100.04 ,$100.04 , N/A ,$21.53 ,$103.70 ,$8.61 ,$8.61 ,$72.83 ,$8.61 ,$50.75 ,$2.93 ,$2.66 ,$8.61 ,$103.70 ,$18.08 ,$103.70 ,$34.16 ,$109.80 ,$8.61 ,$100.04 ,$34.44 ,$34.44 ,$8.61 ,$79.30 ,$122.00 
ST. JOSEPH'S HOSPITAL - BREESE,30700117,81050,HC VOLUME MEASUREMENT URINE,307,1 ,$34.00 ,$22.10 ,$2.66 ,$34.00 ,$9.10 ,$22.10 ,$20.30 ,$3.64 ,$9.52 ,$19.07 ,$3.64 ,$22.37 ,$3.64 ,$28.90 ,$28.90 ,$3.64 ,$28.90 ,$6.92 ,$23.12 ,$9.10 ,$3.64 ,$3.64 ,$25.50 ,$24.14 ,$24.14 ,$3.64 ,$24.14 ,$27.88 ,$27.88 ,$27.88 , N/A ,$9.10 ,$28.90 ,$3.64 ,$34.00 ,$20.30 ,$3.64 ,$14.14 ,$2.93 ,$2.66 ,$3.64 ,$28.90 ,$7.64 ,$28.90 ,$9.52 ,$30.60 ,$3.64 ,$27.88 ,$14.56 ,$14.56 ,$3.64 ,$22.10 ,$34.00 
ST. JOSEPH'S HOSPITAL - BREESE,30700124,81003,HC URINALYSIS AUTO W/O MICRO -90,307,1 ,$4.00 ,$2.60 ,$1.12 ,$5.63 ,$5.63 ,$2.60 ,$2.39 ,$2.25 ,$1.12 ,$2.24 ,$2.25 ,$2.63 ,$2.25 ,$3.40 ,$3.40 ,$2.25 ,$3.40 ,$4.00 ,$2.72 ,$5.63 ,$2.25 ,$2.25 ,$3.00 ,$2.84 ,$2.84 ,$2.25 ,$2.84 ,$3.28 ,$3.28 ,$3.28 , N/A ,$4.00 ,$3.40 ,$2.25 ,$4.00 ,$2.39 ,$2.25 ,$1.66 ,$1.85 ,$1.68 ,$2.25 ,$3.40 ,$4.73 ,$3.40 ,$1.12 ,$3.60 ,$2.25 ,$3.28 ,$4.00 ,$4.00 ,$2.25 ,$2.60 ,$4.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000128,81162,HC BRCA1  AND  BRCA2 FULL SEQ/DUPE/DEL ANALYSIS -90,310,1 ,"$4,361.00 ","$2,834.65 ",$244.56 ,"$4,562.20 ","$4,562.20 ","$2,834.65 ","$2,603.52 ","$1,824.88 ","$1,221.08 ","$2,446.52 ","$1,824.88 ","$2,869.54 ","$1,824.88 ","$3,706.85 ","$3,706.85 ","$1,824.88 ","$3,706.85 ","$3,467.27 ","$2,965.48 ","$4,562.20 ","$1,824.88 ","$1,824.88 ","$3,270.75 ","$3,096.31 ","$3,096.31 ","$1,824.88 ","$3,096.31 ","$3,576.02 ","$3,576.02 ","$3,576.02 ", N/A ,"$4,361.00 ","$3,706.85 ","$1,824.88 ","$4,361.00 ","$2,603.52 ","$1,824.88 ","$1,814.18 ",$269.02 ,$244.56 ,"$1,824.88 ","$3,706.85 ","$3,832.25 ","$3,706.85 ","$1,221.08 ","$3,924.90 ","$1,824.88 ","$3,576.02 ","$4,361.00 ","$4,361.00 ","$1,824.88 ","$2,834.65 ","$4,361.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000129,81206,HC BCR/ABL1 GENE MAJOR BP QL/QN DIAG -90,310,1 ,$302.00 ,$196.30 ,$84.56 ,$409.90 ,$409.90 ,$196.30 ,$180.29 ,$163.96 ,$84.56 ,$169.42 ,$163.96 ,$198.72 ,$163.96 ,$256.70 ,$256.70 ,$163.96 ,$256.70 ,$302.00 ,$205.36 ,$409.90 ,$163.96 ,$163.96 ,$226.50 ,$214.42 ,$214.42 ,$163.96 ,$214.42 ,$247.64 ,$247.64 ,$247.64 , N/A ,$302.00 ,$256.70 ,$163.96 ,$302.00 ,$180.29 ,$163.96 ,$125.63 ,$94.80 ,$86.18 ,$163.96 ,$256.70 ,$344.32 ,$256.70 ,$84.56 ,$271.80 ,$163.96 ,$247.64 ,$302.00 ,$302.00 ,$163.96 ,$196.30 ,$302.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000131,81207,HC BCR/ABL1 GENE MINOR BP DIAG -90,310,1 ,$302.00 ,$196.30 ,$84.56 ,$362.10 ,$362.10 ,$196.30 ,$180.29 ,$144.84 ,$84.56 ,$169.42 ,$144.84 ,$198.72 ,$144.84 ,$256.70 ,$256.70 ,$144.84 ,$256.70 ,$275.20 ,$205.36 ,$362.10 ,$144.84 ,$144.84 ,$226.50 ,$214.42 ,$214.42 ,$144.84 ,$214.42 ,$247.64 ,$247.64 ,$247.64 , N/A ,$302.00 ,$256.70 ,$144.84 ,$302.00 ,$180.29 ,$144.84 ,$125.63 ,$94.80 ,$86.18 ,$144.84 ,$256.70 ,$304.16 ,$256.70 ,$84.56 ,$271.80 ,$144.84 ,$247.64 ,$302.00 ,$302.00 ,$144.84 ,$196.30 ,$302.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000134,81210,HC BRAF GENE ANALYS V600E VAR-90,310,1 ,$430.00 ,$279.50 ,$86.18 ,$438.50 ,$438.50 ,$279.50 ,$256.71 ,$175.40 ,$120.40 ,$241.23 ,$175.40 ,$282.94 ,$175.40 ,$365.50 ,$365.50 ,$175.40 ,$365.50 ,$333.26 ,$292.40 ,$438.50 ,$175.40 ,$175.40 ,$322.50 ,$305.30 ,$305.30 ,$175.40 ,$305.30 ,$352.60 ,$352.60 ,$352.60 , N/A ,$430.00 ,$365.50 ,$175.40 ,$430.00 ,$256.71 ,$175.40 ,$178.88 ,$94.80 ,$86.18 ,$175.40 ,$365.50 ,$368.34 ,$365.50 ,$120.40 ,$387.00 ,$175.40 ,$352.60 ,$430.00 ,$430.00 ,$175.40 ,$279.50 ,$430.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000137,81220,HC CYSTIC FIBROSIS GENE COMMON VARIANTS -90,310,1 ,$340.00 ,$221.00 ,$26.47 ,$850.00 ,$850.00 ,$221.00 ,$202.98 ,$340.00 ,$95.20 ,$190.74 ,$340.00 ,$223.72 ,$340.00 ,$289.00 ,$289.00 ,$340.00 ,$289.00 ,$340.00 ,$231.20 ,$850.00 ,$340.00 ,$340.00 ,$255.00 ,$241.40 ,$241.40 ,$340.00 ,$241.40 ,$278.80 ,$278.80 ,$278.80 , N/A ,$340.00 ,$289.00 ,$340.00 ,$340.00 ,$202.98 ,$340.00 ,$141.44 ,$29.12 ,$26.47 ,$340.00 ,$289.00 ,$714.00 ,$289.00 ,$95.20 ,$306.00 ,$340.00 ,$278.80 ,$340.00 ,$340.00 ,$340.00 ,$221.00 ,$340.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000139,81229,HC CYTOGENOMIC MICROARRY ASSAY-90,310,1 ,"$1,254.00 ",$815.10 ,$244.56 ,"$2,900.00 ","$2,900.00 ",$815.10 ,$748.64 ,"$1,160.00 ",$351.12 ,$703.49 ,"$1,160.00 ",$825.13 ,"$1,160.00 ","$1,065.90 ","$1,065.90 ","$1,160.00 ","$1,065.90 ","$1,254.00 ",$852.72 ,"$2,900.00 ","$1,160.00 ","$1,160.00 ",$940.50 ,$890.34 ,$890.34 ,"$1,160.00 ",$890.34 ,"$1,028.28 ","$1,028.28 ","$1,028.28 ", N/A ,"$1,254.00 ","$1,065.90 ","$1,160.00 ","$1,254.00 ",$748.64 ,"$1,160.00 ",$521.66 ,$269.02 ,$244.56 ,"$1,160.00 ","$1,065.90 ","$2,436.00 ","$1,065.90 ",$351.12 ,"$1,128.60 ","$1,160.00 ","$1,028.28 ","$1,254.00 ","$1,254.00 ","$1,160.00 ",$815.10 ,"$1,254.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000140,81225,HC CYP2C19 GENE ANYL COMMON VARIANTS-90,310,1 ,$874.08 ,$568.15 ,$86.18 ,$874.08 ,$728.40 ,$568.15 ,$521.83 ,$291.36 ,$244.74 ,$490.36 ,$291.36 ,$575.14 ,$291.36 ,$742.97 ,$742.97 ,$291.36 ,$742.97 ,$553.58 ,$594.37 ,$728.40 ,$291.36 ,$291.36 ,$655.56 ,$620.60 ,$620.60 ,$291.36 ,$620.60 ,$716.75 ,$716.75 ,$716.75 , N/A ,$728.40 ,$742.97 ,$291.36 ,$874.08 ,$521.83 ,$291.36 ,$363.62 ,$94.80 ,$86.18 ,$291.36 ,$742.97 ,$611.86 ,$742.97 ,$244.74 ,$786.67 ,$291.36 ,$716.75 ,$874.08 ,$874.08 ,$291.36 ,$568.15 ,$874.08 
ST. JOSEPH'S HOSPITAL - BREESE,31000143,81240,HC F2 GENE ANAL 20210G A VAR -90,310,1 ,$494.00 ,$321.10 ,$26.47 ,$494.00 ,$164.23 ,$321.10 ,$294.92 ,$65.69 ,$138.32 ,$277.13 ,$65.69 ,$325.05 ,$65.69 ,$419.90 ,$419.90 ,$65.69 ,$419.90 ,$124.81 ,$335.92 ,$164.23 ,$65.69 ,$65.69 ,$370.50 ,$350.74 ,$350.74 ,$65.69 ,$350.74 ,$405.08 ,$405.08 ,$405.08 , N/A ,$164.23 ,$419.90 ,$65.69 ,$494.00 ,$294.92 ,$65.69 ,$205.50 ,$29.12 ,$26.47 ,$65.69 ,$419.90 ,$137.95 ,$419.90 ,$138.32 ,$444.60 ,$65.69 ,$405.08 ,$262.76 ,$262.76 ,$65.69 ,$321.10 ,$494.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000145,81241,HC F5 GENE ANAL LEIDEN VAR -90,310,1 ,$169.00 ,$109.85 ,$26.47 ,$183.43 ,$183.43 ,$109.85 ,$100.89 ,$73.37 ,$47.32 ,$94.81 ,$73.37 ,$111.20 ,$73.37 ,$143.65 ,$143.65 ,$73.37 ,$143.65 ,$139.40 ,$114.92 ,$183.43 ,$73.37 ,$73.37 ,$126.75 ,$119.99 ,$119.99 ,$73.37 ,$119.99 ,$138.58 ,$138.58 ,$138.58 , N/A ,$169.00 ,$143.65 ,$73.37 ,$169.00 ,$100.89 ,$73.37 ,$70.30 ,$29.12 ,$26.47 ,$73.37 ,$143.65 ,$154.08 ,$143.65 ,$47.32 ,$152.10 ,$73.37 ,$138.58 ,$169.00 ,$169.00 ,$73.37 ,$109.85 ,$169.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000146,81243,HC FMR1 GENE DETECTION -90,310,1 ,$434.00 ,$282.10 ,$26.47 ,$434.00 , N/A ,$282.10 ,$259.10 ,$130.20 ,$121.52 ,$243.47 , N/A ,$285.57 , N/A ,$368.90 ,$368.90 , N/A ,$368.90 ,$195.30 ,$295.12 ,$303.80 , N/A , N/A ,$325.50 ,$308.14 ,$308.14 , N/A ,$308.14 ,$355.88 ,$355.88 ,$355.88 , N/A , N/A ,$368.90 , N/A ,$434.00 ,$259.10 , N/A ,$180.54 ,$29.12 ,$26.47 , N/A ,$368.90 ,$260.40 ,$368.90 ,$121.52 ,$390.60 , N/A ,$355.88 ,$228.16 ,$228.16 , N/A ,$282.10 ,$434.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000147,81244,HC FMR1 GENE CHARACTERIZATION - 90,310,1 ,$227.00 ,$147.55 ,$26.47 ,$227.00 ,$112.23 ,$147.55 ,$135.52 ,$44.89 ,$63.56 ,$127.35 ,$44.89 ,$149.37 ,$44.89 ,$192.95 ,$192.95 ,$44.89 ,$192.95 ,$85.29 ,$154.36 ,$112.23 ,$44.89 ,$44.89 ,$170.25 ,$161.17 ,$161.17 ,$44.89 ,$161.17 ,$186.14 ,$186.14 ,$186.14 , N/A ,$112.23 ,$192.95 ,$44.89 ,$227.00 ,$135.52 ,$44.89 ,$94.43 ,$29.12 ,$26.47 ,$44.89 ,$192.95 ,$94.27 ,$192.95 ,$63.56 ,$204.30 ,$44.89 ,$186.14 ,$179.56 ,$179.56 ,$44.89 ,$147.55 ,$227.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000149,81256,HC HFE GENE ANALYSIS -90,310,1 ,$434.00 ,$282.10 ,$26.47 ,$434.00 ,$163.40 ,$282.10 ,$259.10 ,$65.36 ,$121.52 ,$243.47 ,$65.36 ,$285.57 ,$65.36 ,$368.90 ,$368.90 ,$65.36 ,$368.90 ,$124.18 ,$295.12 ,$163.40 ,$65.36 ,$65.36 ,$325.50 ,$308.14 ,$308.14 ,$65.36 ,$308.14 ,$355.88 ,$355.88 ,$355.88 , N/A ,$163.40 ,$368.90 ,$65.36 ,$434.00 ,$259.10 ,$65.36 ,$180.54 ,$29.12 ,$26.47 ,$65.36 ,$368.90 ,$137.26 ,$368.90 ,$121.52 ,$390.60 ,$65.36 ,$355.88 ,$261.44 ,$261.44 ,$65.36 ,$282.10 ,$434.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000151,81261,HC IGH GENE ANALYSIS REARRANGEMENT AMP-90,310,1 ,"$1,229.00 ",$798.85 ,$86.18 ,"$1,229.00 ",$494.98 ,$798.85 ,$733.71 ,$197.99 ,$344.12 ,$689.47 ,$197.99 ,$808.68 ,$197.99 ,"$1,044.65 ","$1,044.65 ",$197.99 ,"$1,044.65 ",$376.18 ,$835.72 ,$494.98 ,$197.99 ,$197.99 ,$921.75 ,$872.59 ,$872.59 ,$197.99 ,$872.59 ,"$1,007.78 ","$1,007.78 ","$1,007.78 ", N/A ,$494.98 ,"$1,044.65 ",$197.99 ,"$1,229.00 ",$733.71 ,$197.99 ,$511.26 ,$94.80 ,$86.18 ,$197.99 ,"$1,044.65 ",$415.78 ,"$1,044.65 ",$344.12 ,"$1,106.10 ",$197.99 ,"$1,007.78 ",$791.96 ,$791.96 ,$197.99 ,$798.85 ,"$1,229.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000153,81264,HC IGK GENE REARRANGE ANALYSIS-90,310,1 ,"$1,219.00 ",$792.35 ,$86.18 ,"$1,219.00 ",$431.83 ,$792.35 ,$727.74 ,$172.73 ,$341.32 ,$683.86 ,$172.73 ,$802.10 ,$172.73 ,"$1,036.15 ","$1,036.15 ",$172.73 ,"$1,036.15 ",$328.19 ,$828.92 ,$431.83 ,$172.73 ,$172.73 ,$914.25 ,$865.49 ,$865.49 ,$172.73 ,$865.49 ,$999.58 ,$999.58 ,$999.58 , N/A ,$431.83 ,"$1,036.15 ",$172.73 ,"$1,219.00 ",$727.74 ,$172.73 ,$507.10 ,$94.80 ,$86.18 ,$172.73 ,"$1,036.15 ",$362.73 ,"$1,036.15 ",$341.32 ,"$1,097.10 ",$172.73 ,$999.58 ,$690.92 ,$690.92 ,$172.73 ,$792.35 ,"$1,219.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000154,81270,HC JAK2 GENE ANALYSIS-90,310,1 ,$414.00 ,$269.10 ,$26.47 ,$414.00 ,$229.15 ,$269.10 ,$247.16 ,$91.66 ,$115.92 ,$232.25 ,$91.66 ,$272.41 ,$91.66 ,$351.90 ,$351.90 ,$91.66 ,$351.90 ,$174.15 ,$281.52 ,$229.15 ,$91.66 ,$91.66 ,$310.50 ,$293.94 ,$293.94 ,$91.66 ,$293.94 ,$339.48 ,$339.48 ,$339.48 , N/A ,$229.15 ,$351.90 ,$91.66 ,$414.00 ,$247.16 ,$91.66 ,$172.22 ,$29.12 ,$26.47 ,$91.66 ,$351.90 ,$192.49 ,$351.90 ,$115.92 ,$372.60 ,$91.66 ,$339.48 ,$366.64 ,$366.64 ,$91.66 ,$269.10 ,$414.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000157,81291,HC MTHFR GENE ANALYSIS-90,310,1 ,$381.00 ,$247.65 ,$26.47 ,$381.00 ,$163.35 ,$247.65 ,$227.46 ,$65.34 ,$106.68 ,$213.74 ,$65.34 ,$250.70 ,$65.34 ,$323.85 ,$323.85 ,$65.34 ,$323.85 ,$124.15 ,$259.08 ,$163.35 ,$65.34 ,$65.34 ,$285.75 ,$270.51 ,$270.51 ,$65.34 ,$270.51 ,$312.42 ,$312.42 ,$312.42 , N/A ,$163.35 ,$323.85 ,$65.34 ,$381.00 ,$227.46 ,$65.34 ,$158.50 ,$29.12 ,$26.47 ,$65.34 ,$323.85 ,$137.21 ,$323.85 ,$106.68 ,$342.90 ,$65.34 ,$312.42 ,$261.36 ,$261.36 ,$65.34 ,$247.65 ,$381.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000163,81301,HC MICROSATELLITE INSTAB ANALYSIS-90,310,1 ,"$1,049.00 ",$681.85 ,$86.18 ,"$1,049.00 ",$871.40 ,$681.85 ,$626.25 ,$348.56 ,$293.72 ,$588.49 ,$348.56 ,$690.24 ,$348.56 ,$891.65 ,$891.65 ,$348.56 ,$891.65 ,$662.26 ,$713.32 ,$871.40 ,$348.56 ,$348.56 ,$786.75 ,$744.79 ,$744.79 ,$348.56 ,$744.79 ,$860.18 ,$860.18 ,$860.18 , N/A ,$871.40 ,$891.65 ,$348.56 ,"$1,049.00 ",$626.25 ,$348.56 ,$436.38 ,$94.80 ,$86.18 ,$348.56 ,$891.65 ,$731.98 ,$891.65 ,$293.72 ,$944.10 ,$348.56 ,$860.18 ,"$1,049.00 ","$1,049.00 ",$348.56 ,$681.85 ,"$1,049.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000172,81340,HC TRB GENE ANALYSIS-90,310,1 ,"$1,204.00 ",$782.60 ,$86.18 ,"$1,204.00 ",$522.30 ,$782.60 ,$718.79 ,$208.92 ,$337.12 ,$675.44 ,$208.92 ,$792.23 ,$208.92 ,"$1,023.40 ","$1,023.40 ",$208.92 ,"$1,023.40 ",$396.95 ,$818.72 ,$522.30 ,$208.92 ,$208.92 ,$903.00 ,$854.84 ,$854.84 ,$208.92 ,$854.84 ,$987.28 ,$987.28 ,$987.28 , N/A ,$522.30 ,"$1,023.40 ",$208.92 ,"$1,204.00 ",$718.79 ,$208.92 ,$500.86 ,$94.80 ,$86.18 ,$208.92 ,"$1,023.40 ",$438.73 ,"$1,023.40 ",$337.12 ,"$1,083.60 ",$208.92 ,$987.28 ,$835.68 ,$835.68 ,$208.92 ,$782.60 ,"$1,204.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000173,81342,HC TRB GENE ANALYSIS DIRECT PROBE-90,310,1 ,$645.00 ,$419.25 ,$86.18 ,$645.00 ,$503.75 ,$419.25 ,$385.07 ,$201.50 ,$180.60 ,$361.85 ,$201.50 ,$424.41 ,$201.50 ,$548.25 ,$548.25 ,$201.50 ,$548.25 ,$382.85 ,$438.60 ,$503.75 ,$201.50 ,$201.50 ,$483.75 ,$457.95 ,$457.95 ,$201.50 ,$457.95 ,$528.90 ,$528.90 ,$528.90 , N/A ,$503.75 ,$548.25 ,$201.50 ,$645.00 ,$385.07 ,$201.50 ,$268.32 ,$94.80 ,$86.18 ,$201.50 ,$548.25 ,$423.15 ,$548.25 ,$180.60 ,$580.50 ,$201.50 ,$528.90 ,$645.00 ,$645.00 ,$201.50 ,$419.25 ,$645.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000174,81372,HC CLASS 1 TYPING COMPLETE LOW RESOLUTION-90,310,1 ,$757.00 ,$492.05 ,$86.18 ,"$1,008.98 ","$1,008.98 ",$492.05 ,$451.93 ,$403.59 ,$211.96 ,$424.68 ,$403.59 ,$498.11 ,$403.59 ,$643.45 ,$643.45 ,$403.59 ,$643.45 ,$757.00 ,$514.76 ,"$1,008.98 ",$403.59 ,$403.59 ,$567.75 ,$537.47 ,$537.47 ,$403.59 ,$537.47 ,$620.74 ,$620.74 ,$620.74 , N/A ,$757.00 ,$643.45 ,$403.59 ,$757.00 ,$451.93 ,$403.59 ,$314.91 ,$94.80 ,$86.18 ,$403.59 ,$643.45 ,$847.54 ,$643.45 ,$211.96 ,$681.30 ,$403.59 ,$620.74 ,$757.00 ,$757.00 ,$403.59 ,$492.05 ,$757.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000178,81377,HC HLA CLASS 2 TYPE 1 AG EQV LR-90,310,1 ,$902.00 ,$586.30 ,$26.47 ,$902.00 ,$236.85 ,$586.30 ,$538.49 ,$94.74 ,$252.56 ,$506.02 ,$94.74 ,$593.52 ,$94.74 ,$766.70 ,$766.70 ,$94.74 ,$766.70 ,$180.01 ,$613.36 ,$236.85 ,$94.74 ,$94.74 ,$676.50 ,$640.42 ,$640.42 ,$94.74 ,$640.42 ,$739.64 ,$739.64 ,$739.64 , N/A ,$236.85 ,$766.70 ,$94.74 ,$902.00 ,$538.49 ,$94.74 ,$375.23 ,$29.12 ,$26.47 ,$94.74 ,$766.70 ,$198.95 ,$766.70 ,$252.56 ,$811.80 ,$94.74 ,$739.64 ,$378.96 ,$378.96 ,$94.74 ,$586.30 ,$902.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000179,81381,HC HLA 1 TYPE 1 ALLELE HIGH RESOLUTION -90,310,1 ,$509.70 ,$331.31 ,$26.47 ,$509.70 ,$424.75 ,$331.31 ,$304.29 ,$169.90 ,$142.72 ,$285.94 ,$169.90 ,$335.38 ,$169.90 ,$433.25 ,$433.25 ,$169.90 ,$433.25 ,$322.81 ,$346.60 ,$424.75 ,$169.90 ,$169.90 ,$382.28 ,$361.89 ,$361.89 ,$169.90 ,$361.89 ,$417.95 ,$417.95 ,$417.95 , N/A ,$424.75 ,$433.25 ,$169.90 ,$509.70 ,$304.29 ,$169.90 ,$212.04 ,$29.12 ,$26.47 ,$169.90 ,$433.25 ,$356.79 ,$433.25 ,$142.72 ,$458.73 ,$169.90 ,$417.95 ,$509.70 ,$509.70 ,$169.90 ,$331.31 ,$509.70 
ST. JOSEPH'S HOSPITAL - BREESE,31000180,81383,HC HLA 2 TYPE 1 ALLELE HIGH RESOLUTION -90,310,1 ,$902.00 ,$586.30 ,$26.47 ,$902.00 ,$272.83 ,$586.30 ,$538.49 ,$109.13 ,$252.56 ,$506.02 ,$109.13 ,$593.52 ,$109.13 ,$766.70 ,$766.70 ,$109.13 ,$766.70 ,$207.35 ,$613.36 ,$272.83 ,$109.13 ,$109.13 ,$676.50 ,$640.42 ,$640.42 ,$109.13 ,$640.42 ,$739.64 ,$739.64 ,$739.64 , N/A ,$272.83 ,$766.70 ,$109.13 ,$902.00 ,$538.49 ,$109.13 ,$375.23 ,$29.12 ,$26.47 ,$109.13 ,$766.70 ,$229.17 ,$766.70 ,$252.56 ,$811.80 ,$109.13 ,$739.64 ,$436.52 ,$436.52 ,$109.13 ,$586.30 ,$902.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000181,81400,HC MOLECULAR PATH PROC LEVEL 1-90,310,1 ,$494.00 ,$321.10 ,$26.47 ,$494.00 ,$159.90 ,$321.10 ,$294.92 ,$63.96 ,$138.32 ,$277.13 ,$63.96 ,$325.05 ,$63.96 ,$419.90 ,$419.90 ,$63.96 ,$419.90 ,$121.52 ,$335.92 ,$159.90 ,$63.96 ,$63.96 ,$370.50 ,$350.74 ,$350.74 ,$63.96 ,$350.74 ,$405.08 ,$405.08 ,$405.08 , N/A ,$159.90 ,$419.90 ,$63.96 ,$494.00 ,$294.92 ,$63.96 ,$205.50 ,$29.12 ,$26.47 ,$63.96 ,$419.90 ,$134.32 ,$419.90 ,$138.32 ,$444.60 ,$63.96 ,$405.08 ,$255.84 ,$255.84 ,$63.96 ,$321.10 ,$494.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000183,81401,HC MOLECULAR PATH PROC LEVEL 2-90,310,1 ,$867.00 ,$563.55 ,$26.47 ,$867.00 , N/A ,$563.55 ,$517.60 ,$260.10 ,$242.76 ,$486.39 , N/A ,$570.49 , N/A ,$736.95 ,$736.95 , N/A ,$736.95 ,$390.15 ,$589.56 ,$606.90 , N/A , N/A ,$650.25 ,$615.57 ,$615.57 , N/A ,$615.57 ,$710.94 ,$710.94 ,$710.94 , N/A , N/A ,$736.95 , N/A ,$867.00 ,$517.60 , N/A ,$360.67 ,$29.12 ,$26.47 , N/A ,$736.95 ,$520.20 ,$736.95 ,$242.76 ,$780.30 , N/A ,$710.94 ,$548.00 ,$548.00 , N/A ,$563.55 ,$867.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000184,81403,HC MOLECULAR PATH PROC LEVEL 4-90,310,1 ,"$1,125.00 ",$731.25 ,$26.47 ,"$1,125.00 ", N/A ,$731.25 ,$671.63 ,$337.50 ,$315.00 ,$631.13 , N/A ,$740.25 , N/A ,$956.25 ,$956.25 , N/A ,$956.25 ,$506.25 ,$765.00 ,$787.50 , N/A , N/A ,$843.75 ,$798.75 ,$798.75 , N/A ,$798.75 ,$922.50 ,$922.50 ,$922.50 , N/A , N/A ,$956.25 , N/A ,"$1,125.00 ",$671.63 , N/A ,$468.00 ,$29.12 ,$26.47 , N/A ,$956.25 ,$675.00 ,$956.25 ,$315.00 ,"$1,012.50 ", N/A ,$922.50 ,$740.80 ,$740.80 , N/A ,$731.25 ,"$1,125.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000205,81219,HC CALR GENE ANALYSIS EXON 9-90,310,1 ,"$1,078.00 ",$700.70 ,$86.18 ,"$1,078.00 ",$304.08 ,$700.70 ,$643.57 ,$121.63 ,$301.84 ,$604.76 ,$121.63 ,$709.32 ,$121.63 ,$916.30 ,$916.30 ,$121.63 ,$916.30 ,$231.10 ,$733.04 ,$304.08 ,$121.63 ,$121.63 ,$808.50 ,$765.38 ,$765.38 ,$121.63 ,$765.38 ,$883.96 ,$883.96 ,$883.96 , N/A ,$304.08 ,$916.30 ,$121.63 ,"$1,078.00 ",$643.57 ,$121.63 ,$448.45 ,$94.80 ,$86.18 ,$121.63 ,$916.30 ,$255.42 ,$916.30 ,$301.84 ,$970.20 ,$121.63 ,$883.96 ,$486.52 ,$486.52 ,$121.63 ,$700.70 ,"$1,078.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000208,81402,HC MOLECULAR PATHOLOGY PROC LEVEL 3-90,310,1 ,$564.00 ,$366.60 ,$26.47 ,$564.00 , N/A ,$366.60 ,$336.71 ,$169.20 ,$157.92 ,$316.40 , N/A ,$371.11 , N/A ,$479.40 ,$479.40 , N/A ,$479.40 ,$253.80 ,$383.52 ,$394.80 , N/A , N/A ,$423.00 ,$400.44 ,$400.44 , N/A ,$400.44 ,$462.48 ,$462.48 ,$462.48 , N/A , N/A ,$479.40 , N/A ,$564.00 ,$336.71 , N/A ,$234.62 ,$29.12 ,$26.47 , N/A ,$479.40 ,$338.40 ,$479.40 ,$157.92 ,$507.60 , N/A ,$462.48 ,$564.00 ,$564.00 , N/A ,$366.60 ,$564.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000209,81232,HC DPYD GENE ANALYSIS COMMON VARIANT-90,310,1 ,$524.43 ,$340.88 ,$86.18 ,$524.43 ,$437.03 ,$340.88 ,$313.08 ,$174.81 ,$146.84 ,$294.21 ,$174.81 ,$345.07 ,$174.81 ,$445.77 ,$445.77 ,$174.81 ,$445.77 ,$332.14 ,$356.61 ,$437.03 ,$174.81 ,$174.81 ,$393.32 ,$372.35 ,$372.35 ,$174.81 ,$372.35 ,$430.03 ,$430.03 ,$430.03 , N/A ,$437.03 ,$445.77 ,$174.81 ,$524.43 ,$313.08 ,$174.81 ,$218.16 ,$94.80 ,$86.18 ,$174.81 ,$445.77 ,$367.10 ,$445.77 ,$146.84 ,$471.99 ,$174.81 ,$430.03 ,$524.43 ,$524.43 ,$174.81 ,$340.88 ,$524.43 
ST. JOSEPH'S HOSPITAL - BREESE,31000214,88285,HC CHROMOSOME ADDL CELLS COUNTED EA STUDY-90,310,1 ,$76.00 ,$49.40 ,$21.28 ,$76.00 ,$67.28 ,$49.40 ,$45.37 ,$26.91 ,$21.28 ,$42.64 ,$26.91 ,$50.01 ,$26.91 ,$64.60 ,$64.60 ,$26.91 ,$64.60 ,$51.13 ,$51.68 ,$67.28 ,$26.91 ,$26.91 ,$57.00 ,$53.96 ,$53.96 ,$26.91 ,$53.96 ,$62.32 ,$62.32 ,$62.32 , N/A ,$67.28 ,$64.60 ,$26.91 ,$76.00 ,$45.37 ,$26.91 ,$31.62 ,$29.12 ,$26.47 ,$26.91 ,$64.60 ,$56.51 ,$64.60 ,$21.28 ,$68.40 ,$26.91 ,$62.32 ,$76.00 ,$76.00 ,$26.91 ,$49.40 ,$76.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000215,81364,HC HBB FULL GENE SEQUENCE-90,310,1 ,$907.40 ,$589.81 ,$86.18 ,$907.40 ,$811.45 ,$589.81 ,$541.72 ,$324.58 ,$254.07 ,$509.05 ,$324.58 ,$597.07 ,$324.58 ,$771.29 ,$771.29 ,$324.58 ,$771.29 ,$616.70 ,$617.03 ,$811.45 ,$324.58 ,$324.58 ,$680.55 ,$644.25 ,$644.25 ,$324.58 ,$644.25 ,$744.07 ,$744.07 ,$744.07 , N/A ,$811.45 ,$771.29 ,$324.58 ,$907.40 ,$541.72 ,$324.58 ,$377.48 ,$94.80 ,$86.18 ,$324.58 ,$771.29 ,$681.62 ,$771.29 ,$254.07 ,$816.66 ,$324.58 ,$744.07 ,$907.40 ,$907.40 ,$324.58 ,$589.81 ,$907.40 
ST. JOSEPH'S HOSPITAL - BREESE,31000224,81335,HC TPMT GENE ANALYSIS COMMON VARIANTS-90,310,1 ,$414.00 ,$269.10 ,$86.18 ,$437.03 ,$437.03 ,$269.10 ,$247.16 ,$174.81 ,$115.92 ,$232.25 ,$174.81 ,$272.41 ,$174.81 ,$351.90 ,$351.90 ,$174.81 ,$351.90 ,$332.14 ,$281.52 ,$437.03 ,$174.81 ,$174.81 ,$310.50 ,$293.94 ,$293.94 ,$174.81 ,$293.94 ,$339.48 ,$339.48 ,$339.48 , N/A ,$414.00 ,$351.90 ,$174.81 ,$414.00 ,$247.16 ,$174.81 ,$172.22 ,$94.80 ,$86.18 ,$174.81 ,$351.90 ,$367.10 ,$351.90 ,$115.92 ,$372.60 ,$174.81 ,$339.48 ,$414.00 ,$414.00 ,$174.81 ,$269.10 ,$414.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000226,81450,HC TARGET GENOMIC SEQ ANALYSIS HEMATOLYMPHOID 5-50 GENES-90,310,1 ,"$5,980.00 ","$3,887.00 ",$86.18 ,"$5,980.00 ","$1,898.83 ","$3,887.00 ","$3,570.06 ",$759.53 ,"$1,674.40 ","$3,354.78 ",$759.53 ,"$3,934.84 ",$759.53 ,"$5,083.00 ","$5,083.00 ",$759.53 ,"$5,083.00 ","$1,443.11 ","$4,066.40 ","$1,898.83 ",$759.53 ,$759.53 ,"$4,485.00 ","$4,245.80 ","$4,245.80 ",$759.53 ,"$4,245.80 ","$4,903.60 ","$4,903.60 ","$4,903.60 ", N/A ,"$1,898.83 ","$5,083.00 ",$759.53 ,"$5,980.00 ","$3,570.06 ",$759.53 ,"$2,487.68 ",$94.80 ,$86.18 ,$759.53 ,"$5,083.00 ","$1,595.01 ","$5,083.00 ","$1,674.40 ","$5,382.00 ",$759.53 ,"$4,903.60 ","$3,038.12 ","$3,038.12 ",$759.53 ,"$3,887.00 ","$5,980.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31000228,81350,HC UGT1A1 GENE ANALYSIS COM VARIANTS-90,310,1 ,$702.00 ,$456.30 ,$26.47 ,$702.00 ,$585.00 ,$456.30 ,$419.09 ,$234.00 ,$196.56 ,$393.82 ,$234.00 ,$461.92 ,$234.00 ,$596.70 ,$596.70 ,$234.00 ,$596.70 ,$444.60 ,$477.36 ,$585.00 ,$234.00 ,$234.00 ,$526.50 ,$498.42 ,$498.42 ,$234.00 ,$498.42 ,$575.64 ,$575.64 ,$575.64 , N/A ,$585.00 ,$596.70 ,$234.00 ,$702.00 ,$419.09 ,$234.00 ,$292.03 ,$29.12 ,$26.47 ,$234.00 ,$596.70 ,$491.40 ,$596.70 ,$196.56 ,$631.80 ,$234.00 ,$575.64 ,$702.00 ,$702.00 ,$234.00 ,$456.30 ,$702.00 
ST. JOSEPH'S HOSPITAL - BREESE,31000248,81226,HC CYP2D6 GENE COM VARIANTS-90,310,1 ,"$1,352.73 ",$879.27 ,$244.56 ,"$1,352.73 ","$1,127.28 ",$879.27 ,$807.58 ,$450.91 ,$378.76 ,$758.88 ,$450.91 ,$890.10 ,$450.91 ,"$1,149.82 ","$1,149.82 ",$450.91 ,"$1,149.82 ",$856.73 ,$919.86 ,"$1,127.28 ",$450.91 ,$450.91 ,"$1,014.55 ",$960.44 ,$960.44 ,$450.91 ,$960.44 ,"$1,109.24 ","$1,109.24 ","$1,109.24 ", N/A ,"$1,127.28 ","$1,149.82 ",$450.91 ,"$1,352.73 ",$807.58 ,$450.91 ,$562.74 ,$269.02 ,$244.56 ,$450.91 ,"$1,149.82 ",$946.91 ,"$1,149.82 ",$378.76 ,"$1,217.46 ",$450.91 ,"$1,109.24 ","$1,352.73 ","$1,352.73 ",$450.91 ,$879.27 ,"$1,352.73 "
ST. JOSEPH'S HOSPITAL - BREESE,31000261,81227,HC CYP2C9 GENE COM VARIANTS-90,310,1 ,$524.43 ,$340.88 ,$86.18 ,$524.43 ,$437.03 ,$340.88 ,$313.08 ,$174.81 ,$146.84 ,$294.21 ,$174.81 ,$345.07 ,$174.81 ,$445.77 ,$445.77 ,$174.81 ,$445.77 ,$332.14 ,$356.61 ,$437.03 ,$174.81 ,$174.81 ,$393.32 ,$372.35 ,$372.35 ,$174.81 ,$372.35 ,$430.03 ,$430.03 ,$430.03 , N/A ,$437.03 ,$445.77 ,$174.81 ,$524.43 ,$313.08 ,$174.81 ,$218.16 ,$94.80 ,$86.18 ,$174.81 ,$445.77 ,$367.10 ,$445.77 ,$146.84 ,$471.99 ,$174.81 ,$430.03 ,$524.43 ,$524.43 ,$174.81 ,$340.88 ,$524.43 
ST. JOSEPH'S HOSPITAL - BREESE,31000262,81230,HC CYP3A4 GENE COM VARIANTS-90,310,1 ,$524.43 ,$340.88 ,$26.47 ,$524.43 ,$437.03 ,$340.88 ,$313.08 ,$174.81 ,$146.84 ,$294.21 ,$174.81 ,$345.07 ,$174.81 ,$445.77 ,$445.77 ,$174.81 ,$445.77 ,$332.14 ,$356.61 ,$437.03 ,$174.81 ,$174.81 ,$393.32 ,$372.35 ,$372.35 ,$174.81 ,$372.35 ,$430.03 ,$430.03 ,$430.03 , N/A ,$437.03 ,$445.77 ,$174.81 ,$524.43 ,$313.08 ,$174.81 ,$218.16 ,$29.12 ,$26.47 ,$174.81 ,$445.77 ,$367.10 ,$445.77 ,$146.84 ,$471.99 ,$174.81 ,$430.03 ,$524.43 ,$524.43 ,$174.81 ,$340.88 ,$524.43 
ST. JOSEPH'S HOSPITAL - BREESE,31000263,81231,HC CYP3A5 GENE COM VARIANTS-90,310,1 ,$524.43 ,$340.88 ,$86.18 ,$524.43 ,$437.03 ,$340.88 ,$313.08 ,$174.81 ,$146.84 ,$294.21 ,$174.81 ,$345.07 ,$174.81 ,$445.77 ,$445.77 ,$174.81 ,$445.77 ,$332.14 ,$356.61 ,$437.03 ,$174.81 ,$174.81 ,$393.32 ,$372.35 ,$372.35 ,$174.81 ,$372.35 ,$430.03 ,$430.03 ,$430.03 , N/A ,$437.03 ,$445.77 ,$174.81 ,$524.43 ,$313.08 ,$174.81 ,$218.16 ,$94.80 ,$86.18 ,$174.81 ,$445.77 ,$367.10 ,$445.77 ,$146.84 ,$471.99 ,$174.81 ,$430.03 ,$524.43 ,$524.43 ,$174.81 ,$340.88 ,$524.43 
ST. JOSEPH'S HOSPITAL - BREESE,31000266,81355,HC VKORC1 GENE ANALYSIS COMMON VARIANTS-90,310,1 ,$264.60 ,$171.99 ,$26.47 ,$264.60 ,$220.50 ,$171.99 ,$157.97 ,$88.20 ,$74.09 ,$148.44 ,$88.20 ,$174.11 ,$88.20 ,$224.91 ,$224.91 ,$88.20 ,$224.91 ,$167.58 ,$179.93 ,$220.50 ,$88.20 ,$88.20 ,$198.45 ,$187.87 ,$187.87 ,$88.20 ,$187.87 ,$216.97 ,$216.97 ,$216.97 , N/A ,$220.50 ,$224.91 ,$88.20 ,$264.60 ,$157.97 ,$88.20 ,$110.07 ,$29.12 ,$26.47 ,$88.20 ,$224.91 ,$185.22 ,$224.91 ,$74.09 ,$238.14 ,$88.20 ,$216.97 ,$264.60 ,$264.60 ,$88.20 ,$171.99 ,$264.60 
ST. JOSEPH'S HOSPITAL - BREESE,31000267,81247,HC G6PD GENE ANALYSIS COMMON VARIANT-90,310,1 ,$524.43 ,$340.88 ,$86.18 ,$524.43 ,$437.03 ,$340.88 ,$313.08 ,$174.81 ,$146.84 ,$294.21 ,$174.81 ,$345.07 ,$174.81 ,$445.77 ,$445.77 ,$174.81 ,$445.77 ,$332.14 ,$356.61 ,$437.03 ,$174.81 ,$174.81 ,$393.32 ,$372.35 ,$372.35 ,$174.81 ,$372.35 ,$430.03 ,$430.03 ,$430.03 , N/A ,$437.03 ,$445.77 ,$174.81 ,$524.43 ,$313.08 ,$174.81 ,$218.16 ,$94.80 ,$86.18 ,$174.81 ,$445.77 ,$367.10 ,$445.77 ,$146.84 ,$471.99 ,$174.81 ,$430.03 ,$524.43 ,$524.43 ,$174.81 ,$340.88 ,$524.43 
ST. JOSEPH'S HOSPITAL - BREESE,31000268,81306,HC NUDT15 GENE COMMON VARIANTS-90,310,1 ,$874.08 ,$568.15 ,$86.18 ,$874.08 ,$728.40 ,$568.15 ,$521.83 ,$291.36 ,$244.74 ,$490.36 ,$291.36 ,$575.14 ,$291.36 ,$742.97 ,$742.97 ,$291.36 ,$742.97 ,$553.58 ,$594.37 ,$728.40 ,$291.36 ,$291.36 ,$655.56 ,$620.60 ,$620.60 ,$291.36 ,$620.60 ,$716.75 ,$716.75 ,$716.75 , N/A ,$728.40 ,$742.97 ,$291.36 ,$874.08 ,$521.83 ,$291.36 ,$363.62 ,$94.80 ,$86.18 ,$291.36 ,$742.97 ,$611.86 ,$742.97 ,$244.74 ,$786.67 ,$291.36 ,$716.75 ,$874.08 ,$874.08 ,$291.36 ,$568.15 ,$874.08 
ST. JOSEPH'S HOSPITAL - BREESE,31000269,81328,HC SLCO1B1 GENE COMMON VARIANTS-90,310,1 ,$524.43 ,$340.88 ,$86.18 ,$524.43 ,$437.03 ,$340.88 ,$313.08 ,$174.81 ,$146.84 ,$294.21 ,$174.81 ,$345.07 ,$174.81 ,$445.77 ,$445.77 ,$174.81 ,$445.77 ,$332.14 ,$356.61 ,$437.03 ,$174.81 ,$174.81 ,$393.32 ,$372.35 ,$372.35 ,$174.81 ,$372.35 ,$430.03 ,$430.03 ,$430.03 , N/A ,$437.03 ,$445.77 ,$174.81 ,$524.43 ,$313.08 ,$174.81 ,$218.16 ,$94.80 ,$86.18 ,$174.81 ,$445.77 ,$367.10 ,$445.77 ,$146.84 ,$471.99 ,$174.81 ,$430.03 ,$524.43 ,$524.43 ,$174.81 ,$340.88 ,$524.43 
ST. JOSEPH'S HOSPITAL - BREESE,31000280,81403,HC MOLECULAR PATHOLOGY PROC LEVEL 4-90,310,1 ,$574.00 ,$373.10 ,$26.47 ,$574.00 , N/A ,$373.10 ,$342.68 ,$172.20 ,$160.72 ,$322.01 , N/A ,$377.69 , N/A ,$487.90 ,$487.90 , N/A ,$487.90 ,$258.30 ,$390.32 ,$401.80 , N/A , N/A ,$430.50 ,$407.54 ,$407.54 , N/A ,$407.54 ,$470.68 ,$470.68 ,$470.68 , N/A , N/A ,$487.90 , N/A ,$574.00 ,$342.68 , N/A ,$238.78 ,$29.12 ,$26.47 , N/A ,$487.90 ,$344.40 ,$487.90 ,$160.72 ,$516.60 , N/A ,$470.68 ,$574.00 ,$574.00 , N/A ,$373.10 ,$574.00 
ST. JOSEPH'S HOSPITAL - BREESE,31040111,81162,HC BRCA1 AND 2 GEN FULL SEQ DUP/DEL-90,310,1 ,$52.60 ,$34.19 ,$14.73 ,$131.50 ,$131.50 ,$34.19 ,$31.40 ,$52.60 ,$14.73 ,$29.51 ,$52.60 ,$34.61 ,$52.60 ,$44.71 ,$44.71 ,$52.60 ,$44.71 ,$52.60 ,$35.77 ,$131.50 ,$52.60 ,$52.60 ,$39.45 ,$37.35 ,$37.35 ,$52.60 ,$37.35 ,$43.13 ,$43.13 ,$43.13 , N/A ,$52.60 ,$44.71 ,$52.60 ,$52.60 ,$31.40 ,$52.60 ,$21.88 ,$52.60 ,$52.60 ,$52.60 ,$44.71 ,$110.46 ,$44.71 ,$14.73 ,$47.34 ,$52.60 ,$43.13 ,$52.60 ,$52.60 ,$52.60 ,$34.19 ,$52.60 
ST. JOSEPH'S HOSPITAL - BREESE,31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$133.00 ,$86.45 ,$21.31 ,$133.00 ,$83.43 ,$86.45 ,$79.40 ,$33.37 ,$37.24 ,$74.61 ,$33.37 ,$87.51 ,$33.37 ,$113.05 ,$113.05 ,$33.37 ,$113.05 ,$63.41 ,$90.44 ,$83.43 ,$33.37 ,$33.37 ,$99.75 ,$94.43 ,$94.43 ,$33.37 ,$94.43 ,$109.06 ,$109.06 ,$109.06 , N/A ,$83.43 ,$113.05 ,$33.37 ,$133.00 ,$79.40 ,$33.37 ,$55.33 ,$23.44 ,$21.31 ,$33.37 ,$113.05 ,$70.08 ,$113.05 ,$37.24 ,$119.70 ,$33.37 ,$109.06 ,$133.00 ,$133.00 ,$33.37 ,$86.45 ,$133.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$142.00 ,$92.30 ,$23.44 ,$142.00 ,$122.48 ,$92.30 ,$84.77 ,$48.99 ,$39.76 ,$79.66 ,$48.99 ,$93.44 ,$48.99 ,$120.70 ,$120.70 ,$48.99 ,$120.70 ,$93.08 ,$96.56 ,$122.48 ,$48.99 ,$48.99 ,$106.50 ,$100.82 ,$100.82 ,$48.99 ,$100.82 ,$116.44 ,$116.44 ,$116.44 , N/A ,$122.48 ,$120.70 ,$48.99 ,$142.00 ,$84.77 ,$48.99 ,$59.07 ,$25.78 ,$23.44 ,$48.99 ,$120.70 ,$102.88 ,$120.70 ,$39.76 ,$127.80 ,$48.99 ,$116.44 ,$142.00 ,$142.00 ,$48.99 ,$92.30 ,$142.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100107,88142,HC THINPREP PAP,311,1 ,$174.00 ,$113.10 ,$15.45 ,$174.00 ,$50.65 ,$113.10 ,$103.88 ,$20.26 ,$48.72 ,$97.61 ,$20.26 ,$114.49 ,$20.26 ,$147.90 ,$147.90 ,$20.26 ,$147.90 ,$38.49 ,$118.32 ,$50.65 ,$20.26 ,$20.26 ,$130.50 ,$123.54 ,$123.54 ,$20.26 ,$123.54 ,$142.68 ,$142.68 ,$142.68 , N/A ,$50.65 ,$147.90 ,$20.26 ,$20.26 ,$103.88 ,$20.26 ,$72.38 ,$17.00 ,$15.45 ,$20.26 ,$147.90 ,$42.55 ,$147.90 ,$48.72 ,$156.60 ,$20.26 ,$142.68 ,$81.04 ,$81.04 ,$20.26 ,$113.10 ,$174.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$114.00 ,$74.10 ,$21.31 ,$114.00 ,$60.90 ,$74.10 ,$68.06 ,$24.36 ,$31.92 ,$63.95 ,$24.36 ,$75.01 ,$24.36 ,$96.90 ,$96.90 ,$24.36 ,$96.90 ,$46.27 ,$77.52 ,$60.89 ,$24.36 ,$24.36 ,$85.50 ,$80.94 ,$80.94 ,$24.36 ,$80.94 ,$93.48 ,$93.48 ,$93.48 , N/A ,$60.89 ,$96.90 ,$24.36 ,$114.00 ,$68.06 ,$24.36 ,$47.42 ,$23.44 ,$21.31 ,$24.36 ,$96.90 ,$51.15 ,$96.90 ,$31.92 ,$102.60 ,$24.36 ,$93.48 ,$98.68 ,$98.68 ,$24.36 ,$74.10 ,$114.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100113,88164,HC CYTOPATH SCR BETHESDA,311,1 ,$159.00 ,$103.35 ,$15.15 ,$159.00 ,$39.80 ,$103.35 ,$94.92 ,$15.92 ,$44.52 ,$89.20 ,$15.92 ,$104.62 ,$15.92 ,$135.15 ,$135.15 ,$15.92 ,$135.15 ,$30.25 ,$108.12 ,$39.80 ,$15.92 ,$15.92 ,$119.25 ,$112.89 ,$112.89 ,$15.92 ,$112.89 ,$130.38 ,$130.38 ,$130.38 , N/A ,$39.80 ,$135.15 ,$15.92 ,$15.15 ,$94.92 ,$15.92 ,$66.14 ,$17.00 ,$15.45 ,$15.92 ,$135.15 ,$33.43 ,$135.15 ,$44.52 ,$143.10 ,$15.92 ,$130.38 ,$60.60 ,$60.60 ,$15.92 ,$103.35 ,$159.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$236.00 ,$153.40 ,$21.31 ,$236.00 ,$122.48 ,$153.40 ,$140.89 ,$48.99 ,$66.08 ,$132.40 ,$48.99 ,$155.29 ,$48.99 ,$200.60 ,$200.60 ,$48.99 ,$200.60 ,$93.08 ,$160.48 ,$122.48 ,$48.99 ,$48.99 ,$177.00 ,$167.56 ,$167.56 ,$48.99 ,$167.56 ,$193.52 ,$193.52 ,$193.52 , N/A ,$122.48 ,$200.60 ,$48.99 ,$89.83 ,$140.89 ,$48.99 ,$98.18 ,$23.44 ,$21.31 ,$48.99 ,$200.60 ,$102.88 ,$200.60 ,$66.08 ,$212.40 ,$48.99 ,$193.52 ,$199.04 ,$199.04 ,$48.99 ,$153.40 ,$236.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100240,88161,HC CYTOPATH SMEAR OTHER SOURCE W/PREP,311,1 ,$151.00 ,$98.15 ,$21.31 ,$151.00 ,$60.90 ,$98.15 ,$90.15 ,$24.36 ,$42.28 ,$84.71 ,$24.36 ,$99.36 ,$24.36 ,$128.35 ,$128.35 ,$24.36 ,$128.35 ,$46.27 ,$102.68 ,$60.89 ,$24.36 ,$24.36 ,$113.25 ,$107.21 ,$107.21 ,$24.36 ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A ,$60.89 ,$128.35 ,$24.36 ,$151.00 ,$90.15 ,$24.36 ,$62.82 ,$23.44 ,$21.31 ,$24.36 ,$128.35 ,$51.15 ,$128.35 ,$42.28 ,$135.90 ,$24.36 ,$123.82 ,$98.68 ,$98.68 ,$24.36 ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100244,88184,HC FLOW CYTO 1ST MARKER-90,311,1 ,$197.00 ,$128.05 ,$23.44 ,$717.84 ,$717.83 ,$128.05 ,$117.61 ,$287.13 ,$55.16 ,$110.52 ,$287.13 ,$129.63 ,$197.00 ,$167.45 ,$167.45 ,$197.00 ,$167.45 ,$197.00 ,$133.96 ,$717.84 ,$287.13 ,$287.13 ,$147.75 ,$139.87 ,$139.87 ,$287.13 ,$139.87 ,$161.54 ,$161.54 ,$161.54 , N/A ,$197.00 ,$167.45 ,$287.13 ,$197.00 ,$117.61 ,$287.13 ,$81.95 ,$25.78 ,$23.44 ,$287.13 ,$167.45 ,$602.98 ,$167.45 ,$55.16 ,$177.30 ,$287.13 ,$161.54 ,$197.00 ,$197.00 ,$287.13 ,$128.05 ,$197.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100246,88185,HC FLOW CYTO EA ADD MARKER-90,311,1 ,$740.00 ,$481.00 ,$23.44 ,$740.00 , N/A ,$481.00 ,$441.78 , N/A ,$207.20 ,$415.14 , N/A ,$486.92 , N/A ,$629.00 ,$629.00 , N/A ,$629.00 , N/A ,$503.20 , N/A , N/A , N/A ,$555.00 ,$525.40 ,$525.40 , N/A ,$525.40 ,$606.80 ,$606.80 ,$606.80 , N/A , N/A ,$629.00 , N/A ,$740.00 ,$441.78 , N/A ,$307.84 ,$25.78 ,$23.44 , N/A ,$629.00 , N/A ,$629.00 ,$207.20 ,$666.00 , N/A ,$606.80 ,$92.12 ,$92.12 , N/A ,$481.00 ,$740.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100251,88230,HC TISSUE CULT NONNEO LYMPHOCYTE-90,311,1 ,$485.00 ,$315.25 ,$23.44 ,$485.00 ,$291.23 ,$315.25 ,$289.55 ,$116.49 ,$135.80 ,$272.09 ,$116.49 ,$319.13 ,$116.49 ,$412.25 ,$412.25 ,$116.49 ,$412.25 ,$221.33 ,$329.80 ,$291.23 ,$116.49 ,$116.49 ,$363.75 ,$344.35 ,$344.35 ,$116.49 ,$344.35 ,$397.70 ,$397.70 ,$397.70 , N/A ,$291.23 ,$412.25 ,$116.49 ,$485.00 ,$289.55 ,$116.49 ,$201.76 ,$25.78 ,$23.44 ,$116.49 ,$412.25 ,$244.63 ,$412.25 ,$135.80 ,$436.50 ,$116.49 ,$397.70 ,$465.96 ,$465.96 ,$116.49 ,$315.25 ,$485.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100252,88233,HC TISSUE CULT SKIN/OTH SOLID-90,311,1 ,$851.00 ,$553.15 ,$23.44 ,$851.00 ,$351.83 ,$553.15 ,$508.05 ,$140.73 ,$238.28 ,$477.41 ,$140.73 ,$559.96 ,$140.73 ,$723.35 ,$723.35 ,$140.73 ,$723.35 ,$267.39 ,$578.68 ,$351.83 ,$140.73 ,$140.73 ,$638.25 ,$604.21 ,$604.21 ,$140.73 ,$604.21 ,$697.82 ,$697.82 ,$697.82 , N/A ,$351.83 ,$723.35 ,$140.73 ,$851.00 ,$508.05 ,$140.73 ,$354.02 ,$25.78 ,$23.44 ,$140.73 ,$723.35 ,$295.53 ,$723.35 ,$238.28 ,$765.90 ,$140.73 ,$697.82 ,$562.92 ,$562.92 ,$140.73 ,$553.15 ,$851.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100255,88237,HC TISSUE CULT BONE/BLD-90,311,1 ,$851.00 ,$553.15 ,$23.44 ,$851.00 ,$359.38 ,$553.15 ,$508.05 ,$143.75 ,$238.28 ,$477.41 ,$143.75 ,$559.96 ,$143.75 ,$723.35 ,$723.35 ,$143.75 ,$723.35 ,$273.13 ,$578.68 ,$359.38 ,$143.75 ,$143.75 ,$638.25 ,$604.21 ,$604.21 ,$143.75 ,$604.21 ,$697.82 ,$697.82 ,$697.82 , N/A ,$359.38 ,$723.35 ,$143.75 ,$851.00 ,$508.05 ,$143.75 ,$354.02 ,$25.78 ,$23.44 ,$143.75 ,$723.35 ,$301.88 ,$723.35 ,$238.28 ,$765.90 ,$143.75 ,$697.82 ,$575.00 ,$575.00 ,$143.75 ,$553.15 ,$851.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100257,88262,HC CHROM COUNT 15-20/2-90,311,1 ,$642.00 ,$417.30 ,$26.47 ,$642.00 ,$313.73 ,$417.30 ,$383.27 ,$125.49 ,$179.76 ,$360.16 ,$125.49 ,$422.44 ,$125.49 ,$545.70 ,$545.70 ,$125.49 ,$545.70 ,$238.43 ,$436.56 ,$313.73 ,$125.49 ,$125.49 ,$481.50 ,$455.82 ,$455.82 ,$125.49 ,$455.82 ,$526.44 ,$526.44 ,$526.44 , N/A ,$313.73 ,$545.70 ,$125.49 ,$642.00 ,$383.27 ,$125.49 ,$267.07 ,$29.12 ,$26.47 ,$125.49 ,$545.70 ,$263.53 ,$545.70 ,$179.76 ,$577.80 ,$125.49 ,$526.44 ,$501.96 ,$501.96 ,$125.49 ,$417.30 ,$642.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100258,88264,HC CHROM ANLYS ANALYZE 20-90,311,1 ,$380.00 ,$247.00 ,$26.47 ,$380.00 ,$361.53 ,$247.00 ,$226.86 ,$144.61 ,$106.40 ,$213.18 ,$144.61 ,$250.04 ,$144.61 ,$323.00 ,$323.00 ,$144.61 ,$323.00 ,$274.76 ,$258.40 ,$361.53 ,$144.61 ,$144.61 ,$285.00 ,$269.80 ,$269.80 ,$144.61 ,$269.80 ,$311.60 ,$311.60 ,$311.60 , N/A ,$361.53 ,$323.00 ,$144.61 ,$380.00 ,$226.86 ,$144.61 ,$158.08 ,$29.12 ,$26.47 ,$144.61 ,$323.00 ,$303.68 ,$323.00 ,$106.40 ,$342.00 ,$144.61 ,$311.60 ,$380.00 ,$380.00 ,$144.61 ,$247.00 ,$380.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100261,88271,HC MCG DNA PROBE(FISH)-90,311,1 ,$168.00 ,$109.20 ,$21.42 ,$168.00 ,$53.55 ,$109.20 ,$100.30 ,$21.42 ,$47.04 ,$94.25 ,$21.42 ,$110.54 ,$21.42 ,$142.80 ,$142.80 ,$21.42 ,$142.80 ,$40.70 ,$114.24 ,$53.55 ,$21.42 ,$21.42 ,$126.00 ,$119.28 ,$119.28 ,$21.42 ,$119.28 ,$137.76 ,$137.76 ,$137.76 , N/A ,$53.55 ,$142.80 ,$21.42 ,$168.00 ,$100.30 ,$21.42 ,$69.89 ,$29.12 ,$26.47 ,$21.42 ,$142.80 ,$44.98 ,$142.80 ,$47.04 ,$151.20 ,$21.42 ,$137.76 ,$85.68 ,$85.68 ,$21.42 ,$109.20 ,$168.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100269,88275,HC MCG INTERPH INSITU 100 -90,311,1 ,$252.00 ,$163.80 ,$26.47 ,$252.00 ,$127.98 ,$163.80 ,$150.44 ,$51.19 ,$70.56 ,$141.37 ,$51.19 ,$165.82 ,$51.19 ,$214.20 ,$214.20 ,$51.19 ,$214.20 ,$97.26 ,$171.36 ,$127.98 ,$51.19 ,$51.19 ,$189.00 ,$178.92 ,$178.92 ,$51.19 ,$178.92 ,$206.64 ,$206.64 ,$206.64 , N/A ,$127.98 ,$214.20 ,$51.19 ,$252.00 ,$150.44 ,$51.19 ,$104.83 ,$29.12 ,$26.47 ,$51.19 ,$214.20 ,$107.50 ,$214.20 ,$70.56 ,$226.80 ,$51.19 ,$206.64 ,$204.76 ,$204.76 ,$51.19 ,$163.80 ,$252.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100270,88275,HC MCG INTERPH INSITU FISH 100-90,311,1 ,$252.00 ,$163.80 ,$26.47 ,$252.00 ,$127.98 ,$163.80 ,$150.44 ,$51.19 ,$70.56 ,$141.37 ,$51.19 ,$165.82 ,$51.19 ,$214.20 ,$214.20 ,$51.19 ,$214.20 ,$97.26 ,$171.36 ,$127.98 ,$51.19 ,$51.19 ,$189.00 ,$178.92 ,$178.92 ,$51.19 ,$178.92 ,$206.64 ,$206.64 ,$206.64 , N/A ,$127.98 ,$214.20 ,$51.19 ,$252.00 ,$150.44 ,$51.19 ,$104.83 ,$29.12 ,$26.47 ,$51.19 ,$214.20 ,$107.50 ,$214.20 ,$70.56 ,$226.80 ,$51.19 ,$206.64 ,$204.76 ,$204.76 ,$51.19 ,$163.80 ,$252.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100273,88280,HC CHROM ADDL KARYO-90,311,1 ,$104.00 ,$67.60 ,$26.47 ,$104.00 ,$83.68 ,$67.60 ,$62.09 ,$33.47 ,$29.12 ,$58.34 ,$33.47 ,$68.43 ,$33.47 ,$88.40 ,$88.40 ,$33.47 ,$88.40 ,$63.59 ,$70.72 ,$83.68 ,$33.47 ,$33.47 ,$78.00 ,$73.84 ,$73.84 ,$33.47 ,$73.84 ,$85.28 ,$85.28 ,$85.28 , N/A ,$83.68 ,$88.40 ,$33.47 ,$104.00 ,$62.09 ,$33.47 ,$43.26 ,$29.12 ,$26.47 ,$33.47 ,$88.40 ,$70.29 ,$88.40 ,$29.12 ,$93.60 ,$33.47 ,$85.28 ,$104.00 ,$104.00 ,$33.47 ,$67.60 ,$104.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100274,88289,HC CHROM ADDL HIGH RES-90,311,1 ,$138.00 ,$89.70 ,$26.47 ,$138.00 ,$86.08 ,$89.70 ,$82.39 ,$34.43 ,$38.64 ,$77.42 ,$34.43 ,$90.80 ,$34.43 ,$117.30 ,$117.30 ,$34.43 ,$117.30 ,$65.42 ,$93.84 ,$86.08 ,$34.43 ,$34.43 ,$103.50 ,$97.98 ,$97.98 ,$34.43 ,$97.98 ,$113.16 ,$113.16 ,$113.16 , N/A ,$86.08 ,$117.30 ,$34.43 ,$138.00 ,$82.39 ,$34.43 ,$57.41 ,$29.12 ,$26.47 ,$34.43 ,$117.30 ,$72.30 ,$117.30 ,$38.64 ,$124.20 ,$34.43 ,$113.16 ,$137.72 ,$137.72 ,$34.43 ,$89.70 ,$138.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100275,88291,HC INTERPRETATION-90,311,1 ,$69.00 ,$44.85 ,$19.32 ,$69.00 , N/A ,$44.85 ,$41.19 , N/A ,$19.32 ,$38.71 , N/A ,$45.40 , N/A ,$58.65 ,$58.65 , N/A ,$58.65 , N/A ,$46.92 , N/A , N/A , N/A ,$51.75 ,$48.99 ,$48.99 , N/A ,$48.99 ,$56.58 ,$56.58 ,$56.58 , N/A , N/A ,$58.65 , N/A ,$69.00 ,$41.19 , N/A ,$28.70 ,$29.12 ,$26.47 , N/A ,$58.65 , N/A ,$58.65 ,$19.32 ,$62.10 , N/A ,$56.58 ,$69.00 ,$69.00 , N/A ,$44.85 ,$69.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100283,88120,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC-90,311,1 ,$422.00 ,$274.30 ,$23.44 ,$422.00 ,$367.60 ,$274.30 ,$251.93 ,$147.04 ,$118.16 ,$236.74 ,$147.04 ,$277.68 ,$147.04 ,$358.70 ,$358.70 ,$147.04 ,$358.70 ,$279.37 ,$286.96 ,$367.59 ,$147.04 ,$147.04 ,$316.50 ,$299.62 ,$299.62 ,$147.04 ,$299.62 ,$346.04 ,$346.04 ,$346.04 , N/A ,$367.59 ,$358.70 ,$147.04 ,$422.00 ,$251.93 ,$147.04 ,$175.55 ,$25.78 ,$23.44 ,$147.04 ,$358.70 ,$308.78 ,$358.70 ,$118.16 ,$379.80 ,$147.04 ,$346.04 ,$422.00 ,$422.00 ,$147.04 ,$274.30 ,$422.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100310,88121,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC COMP ASSIST-90,311,1 ,$400.00 ,$260.00 ,$23.44 ,$717.84 ,$717.83 ,$260.00 ,$238.80 ,$287.13 ,$112.00 ,$224.40 ,$287.13 ,$263.20 ,$287.13 ,$340.00 ,$340.00 ,$287.13 ,$340.00 ,$400.00 ,$272.00 ,$717.84 ,$287.13 ,$287.13 ,$300.00 ,$284.00 ,$284.00 ,$287.13 ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A ,$400.00 ,$340.00 ,$287.13 ,$400.00 ,$238.80 ,$287.13 ,$166.40 ,$25.78 ,$23.44 ,$287.13 ,$340.00 ,$602.98 ,$340.00 ,$112.00 ,$360.00 ,$287.13 ,$328.00 ,$400.00 ,$400.00 ,$287.13 ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100311,88182,HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS -90,311,1 ,$622.00 ,$404.30 ,$23.44 ,$622.00 ,$122.48 ,$404.30 ,$371.33 ,$48.99 ,$174.16 ,$348.94 ,$48.99 ,$409.28 ,$48.99 ,$528.70 ,$528.70 ,$48.99 ,$528.70 ,$93.08 ,$422.96 ,$122.48 ,$48.99 ,$48.99 ,$466.50 ,$441.62 ,$441.62 ,$48.99 ,$441.62 ,$510.04 ,$510.04 ,$510.04 , N/A ,$122.48 ,$528.70 ,$48.99 ,$622.00 ,$371.33 ,$48.99 ,$258.75 ,$25.78 ,$23.44 ,$48.99 ,$528.70 ,$102.88 ,$528.70 ,$174.16 ,$559.80 ,$48.99 ,$510.04 ,$199.04 ,$199.04 ,$48.99 ,$404.30 ,$622.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100312,88189,HC FLOW CYTO INT >16 MARKERS-90,311,1 ,$662.00 ,$430.30 ,$21.31 ,$662.00 , N/A ,$430.30 ,$395.21 , N/A ,$185.36 ,$371.38 , N/A ,$435.60 , N/A ,$562.70 ,$562.70 , N/A ,$562.70 , N/A ,$450.16 , N/A , N/A , N/A ,$496.50 ,$470.02 ,$470.02 , N/A ,$470.02 ,$542.84 ,$542.84 ,$542.84 , N/A , N/A ,$562.70 , N/A ,$662.00 ,$395.21 , N/A ,$275.39 ,$23.44 ,$21.31 , N/A ,$562.70 , N/A ,$562.70 ,$185.36 ,$595.80 , N/A ,$542.84 ,$340.56 ,$340.56 , N/A ,$430.30 ,$662.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100318,88185,HC FLOW CYTO EA ADD MARKER OVER 24 - 90,311,1 ,$200.00 ,$130.00 ,$23.44 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 ,$25.78 ,$23.44 , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$92.12 ,$92.12 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,31100320,88261,"HC CHROMOSOME ANALYSIS 5 CELLS, 1 KARYOTYPE-90",311,1 ,$380.00 ,$247.00 ,$26.47 ,$660.85 ,$660.85 ,$247.00 ,$226.86 ,$264.34 ,$106.40 ,$213.18 ,$264.34 ,$250.04 ,$264.34 ,$323.00 ,$323.00 ,$264.34 ,$323.00 ,$380.00 ,$258.40 ,$660.85 ,$264.34 ,$264.34 ,$285.00 ,$269.80 ,$269.80 ,$264.34 ,$269.80 ,$311.60 ,$311.60 ,$311.60 , N/A ,$380.00 ,$323.00 ,$264.34 ,$380.00 ,$226.86 ,$264.34 ,$158.08 ,$29.12 ,$26.47 ,$264.34 ,$323.00 ,$555.11 ,$323.00 ,$106.40 ,$342.00 ,$264.34 ,$311.60 ,$380.00 ,$380.00 ,$264.34 ,$247.00 ,$380.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$156.00 ,$101.40 ,$21.31 ,$156.00 ,$60.90 ,$101.40 ,$93.13 ,$24.36 ,$43.68 ,$87.52 ,$24.36 ,$102.65 ,$24.36 ,$132.60 ,$132.60 ,$24.36 ,$132.60 ,$46.27 ,$106.08 ,$60.89 ,$24.36 ,$24.36 ,$117.00 ,$110.76 ,$110.76 ,$24.36 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$60.89 ,$132.60 ,$24.36 ,$156.00 ,$93.13 ,$24.36 ,$64.90 ,$23.44 ,$21.31 ,$24.36 ,$132.60 ,$51.15 ,$132.60 ,$43.68 ,$140.40 ,$24.36 ,$127.92 ,$98.68 ,$98.68 ,$24.36 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$297.00 ,$193.05 ,$21.31 ,$297.00 ,$60.90 ,$193.05 ,$177.31 ,$24.36 ,$83.16 ,$166.62 ,$24.36 ,$195.43 ,$24.36 ,$252.45 ,$252.45 ,$24.36 ,$252.45 ,$46.27 ,$201.96 ,$60.89 ,$24.36 ,$24.36 ,$222.75 ,$210.87 ,$210.87 ,$24.36 ,$210.87 ,$243.54 ,$243.54 ,$243.54 , N/A ,$60.89 ,$252.45 ,$24.36 ,$297.00 ,$177.31 ,$24.36 ,$123.55 ,$23.44 ,$21.31 ,$24.36 ,$252.45 ,$51.15 ,$252.45 ,$83.16 ,$267.30 ,$24.36 ,$243.54 ,$98.68 ,$98.68 ,$24.36 ,$193.05 ,$297.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$369.00 ,$239.85 ,$21.31 ,$369.00 ,$122.48 ,$239.85 ,$220.29 ,$48.99 ,$103.32 ,$207.01 ,$48.99 ,$242.80 ,$48.99 ,$313.65 ,$313.65 ,$48.99 ,$313.65 ,$93.08 ,$250.92 ,$122.48 ,$48.99 ,$48.99 ,$276.75 ,$261.99 ,$261.99 ,$48.99 ,$261.99 ,$302.58 ,$302.58 ,$302.58 , N/A ,$122.48 ,$313.65 ,$48.99 ,$369.00 ,$220.29 ,$48.99 ,$153.50 ,$23.44 ,$21.31 ,$48.99 ,$313.65 ,$102.88 ,$313.65 ,$103.32 ,$332.10 ,$48.99 ,$302.58 ,$199.04 ,$199.04 ,$48.99 ,$239.85 ,$369.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$468.00 ,$304.20 ,$21.31 ,$468.00 ,$122.48 ,$304.20 ,$279.40 ,$48.99 ,$131.04 ,$262.55 ,$48.99 ,$307.94 ,$48.99 ,$397.80 ,$397.80 ,$48.99 ,$397.80 ,$93.08 ,$318.24 ,$122.48 ,$48.99 ,$48.99 ,$351.00 ,$332.28 ,$332.28 ,$48.99 ,$332.28 ,$383.76 ,$383.76 ,$383.76 , N/A ,$122.48 ,$397.80 ,$48.99 ,$35.62 ,$279.40 ,$48.99 ,$194.69 ,$23.44 ,$21.31 ,$48.99 ,$397.80 ,$102.88 ,$397.80 ,$131.04 ,$421.20 ,$48.99 ,$383.76 ,$199.04 ,$199.04 ,$48.99 ,$304.20 ,$468.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200110,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,$851.00 ,$553.15 ,$23.44 ,$851.00 ,$717.83 ,$553.15 ,$508.05 ,$287.13 ,$238.28 ,$477.41 ,$287.13 ,$559.96 ,$287.13 ,$723.35 ,$723.35 ,$287.13 ,$723.35 ,$545.56 ,$578.68 ,$717.84 ,$287.13 ,$287.13 ,$638.25 ,$604.21 ,$604.21 ,$287.13 ,$604.21 ,$697.82 ,$697.82 ,$697.82 , N/A ,$717.84 ,$723.35 ,$287.13 ,$217.17 ,$508.05 ,$287.13 ,$354.02 ,$25.78 ,$23.44 ,$287.13 ,$723.35 ,$602.98 ,$723.35 ,$238.28 ,$765.90 ,$287.13 ,$697.82 ,$851.00 ,$851.00 ,$287.13 ,$553.15 ,$851.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200113,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,"$1,050.00 ",$682.50 ,$23.44 ,"$1,615.20 ","$1,615.20 ",$682.50 ,$626.85 ,$646.08 ,$294.00 ,$589.05 ,$646.08 ,$690.90 ,$646.08 ,$892.50 ,$892.50 ,$646.08 ,$892.50 ,"$1,050.00 ",$714.00 ,"$1,615.20 ",$646.08 ,$646.08 ,$787.50 ,$745.50 ,$745.50 ,$646.08 ,$745.50 ,$861.00 ,$861.00 ,$861.00 , N/A ,"$1,050.00 ",$892.50 ,$646.08 ,"$1,050.00 ",$626.85 ,$646.08 ,$436.80 ,$25.78 ,$23.44 ,$646.08 ,$892.50 ,"$1,356.77 ",$892.50 ,$294.00 ,$945.00 ,$646.08 ,$861.00 ,"$1,050.00 ","$1,050.00 ",$646.08 ,$682.50 ,"$1,050.00 "
ST. JOSEPH'S HOSPITAL - BREESE,31200116,88311,HC DECALCIFICATION,312,1 ,$63.00 ,$40.95 ,$17.64 ,$63.00 , N/A ,$40.95 ,$37.61 , N/A ,$17.64 ,$35.34 , N/A ,$41.45 , N/A ,$53.55 ,$53.55 , N/A ,$53.55 , N/A ,$42.84 , N/A , N/A , N/A ,$47.25 ,$44.73 ,$44.73 , N/A ,$44.73 ,$51.66 ,$51.66 ,$51.66 , N/A , N/A ,$53.55 , N/A ,$63.00 ,$37.61 , N/A ,$26.21 ,$23.44 ,$21.31 , N/A ,$53.55 , N/A ,$53.55 ,$17.64 ,$56.70 , N/A ,$51.66 ,$34.88 ,$34.88 , N/A ,$40.95 ,$63.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200123,88312,HC SPECIAL STAIN I,312,1 ,$163.00 ,$105.95 ,$21.31 ,$163.00 ,$122.48 ,$105.95 ,$97.31 ,$48.99 ,$45.64 ,$91.44 ,$48.99 ,$107.25 ,$48.99 ,$138.55 ,$138.55 ,$48.99 ,$138.55 ,$93.08 ,$110.84 ,$122.48 ,$48.99 ,$48.99 ,$122.25 ,$115.73 ,$115.73 ,$48.99 ,$115.73 ,$133.66 ,$133.66 ,$133.66 , N/A ,$122.48 ,$138.55 ,$48.99 ,$163.00 ,$97.31 ,$48.99 ,$67.81 ,$23.44 ,$21.31 ,$48.99 ,$138.55 ,$102.88 ,$138.55 ,$45.64 ,$146.70 ,$48.99 ,$133.66 ,$163.00 ,$163.00 ,$48.99 ,$105.95 ,$163.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200125,88313,HC SPECIAL STAIN II,312,1 ,$282.00 ,$183.30 ,$21.31 ,$282.00 ,$83.43 ,$183.30 ,$168.35 ,$33.37 ,$78.96 ,$158.20 ,$33.37 ,$185.56 ,$33.37 ,$239.70 ,$239.70 ,$33.37 ,$239.70 ,$63.41 ,$191.76 ,$83.43 ,$33.37 ,$33.37 ,$211.50 ,$200.22 ,$200.22 ,$33.37 ,$200.22 ,$231.24 ,$231.24 ,$231.24 , N/A ,$83.43 ,$239.70 ,$33.37 ,$282.00 ,$168.35 ,$33.37 ,$117.31 ,$23.44 ,$21.31 ,$33.37 ,$239.70 ,$70.08 ,$239.70 ,$78.96 ,$253.80 ,$33.37 ,$231.24 ,$135.36 ,$135.36 ,$33.37 ,$183.30 ,$282.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200159,88321,HC CONSULT REFERRED SLIDES,312,1 ,$98.00 ,$63.70 ,$21.31 ,$98.00 ,$83.43 ,$63.70 ,$58.51 ,$33.37 ,$27.44 ,$54.98 ,$33.37 ,$64.48 ,$33.37 ,$83.30 ,$83.30 ,$33.37 ,$83.30 ,$63.41 ,$66.64 ,$83.43 ,$33.37 ,$33.37 ,$73.50 ,$69.58 ,$69.58 ,$33.37 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$83.43 ,$83.30 ,$33.37 ,$98.00 ,$58.51 ,$33.37 ,$40.77 ,$23.44 ,$21.31 ,$33.37 ,$83.30 ,$70.08 ,$83.30 ,$27.44 ,$88.20 ,$33.37 ,$80.36 ,$98.00 ,$98.00 ,$33.37 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200171,88325,HC CONSULT PATH REV/REP,312,1 ,$98.00 ,$63.70 ,$21.31 ,$367.60 ,$367.60 ,$63.70 ,$58.51 ,$147.04 ,$27.44 ,$54.98 ,$147.04 ,$64.48 ,$98.00 ,$83.30 ,$83.30 ,$98.00 ,$83.30 ,$98.00 ,$66.64 ,$367.59 ,$147.04 ,$147.04 ,$73.50 ,$69.58 ,$69.58 ,$147.04 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$98.00 ,$83.30 ,$147.04 ,$98.00 ,$58.51 ,$147.04 ,$40.77 ,$23.44 ,$21.31 ,$147.04 ,$83.30 ,$308.78 ,$83.30 ,$27.44 ,$88.20 ,$147.04 ,$80.36 ,$98.00 ,$98.00 ,$147.04 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200172,88329,HC CONSULT PATH SURGERY,312,1 ,$87.00 ,$56.55 ,$21.31 ,$87.00 ,$83.43 ,$56.55 ,$51.94 ,$33.37 ,$24.36 ,$48.81 ,$33.37 ,$57.25 ,$33.37 ,$73.95 ,$73.95 ,$33.37 ,$73.95 ,$63.41 ,$59.16 ,$83.43 ,$33.37 ,$33.37 ,$65.25 ,$61.77 ,$61.77 ,$33.37 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$83.43 ,$73.95 ,$33.37 ,$87.00 ,$51.94 ,$33.37 ,$36.19 ,$23.44 ,$21.31 ,$33.37 ,$73.95 ,$70.08 ,$73.95 ,$24.36 ,$78.30 ,$33.37 ,$71.34 ,$87.00 ,$87.00 ,$33.37 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$243.00 ,$157.95 ,$21.31 ,$367.60 ,$367.60 ,$157.95 ,$145.07 ,$147.04 ,$68.04 ,$136.32 ,$147.04 ,$159.89 ,$147.04 ,$206.55 ,$206.55 ,$147.04 ,$206.55 ,$243.00 ,$165.24 ,$367.59 ,$147.04 ,$147.04 ,$182.25 ,$172.53 ,$172.53 ,$147.04 ,$172.53 ,$199.26 ,$199.26 ,$199.26 , N/A ,$243.00 ,$206.55 ,$147.04 ,$44.37 ,$145.07 ,$147.04 ,$101.09 ,$23.44 ,$21.31 ,$147.04 ,$206.55 ,$308.78 ,$206.55 ,$68.04 ,$218.70 ,$147.04 ,$199.26 ,$243.00 ,$243.00 ,$147.04 ,$157.95 ,$243.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$164.00 ,$106.60 ,$21.31 ,$164.00 , N/A ,$106.60 ,$97.91 , N/A ,$45.92 ,$92.00 , N/A ,$107.91 , N/A ,$139.40 ,$139.40 , N/A ,$139.40 , N/A ,$111.52 , N/A , N/A , N/A ,$123.00 ,$116.44 ,$116.44 , N/A ,$116.44 ,$134.48 ,$134.48 ,$134.48 , N/A , N/A ,$139.40 , N/A ,$25.42 ,$97.91 , N/A ,$68.22 ,$23.44 ,$21.31 , N/A ,$139.40 , N/A ,$139.40 ,$45.92 ,$147.60 , N/A ,$134.48 ,$96.32 ,$96.32 , N/A ,$106.60 ,$164.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$408.00 ,$265.20 ,$23.44 ,$408.00 ,$367.60 ,$265.20 ,$243.58 ,$147.04 ,$114.24 ,$228.89 ,$147.04 ,$268.46 ,$147.04 ,$346.80 ,$346.80 ,$147.04 ,$346.80 ,$279.37 ,$277.44 ,$367.59 ,$147.04 ,$147.04 ,$306.00 ,$289.68 ,$289.68 ,$147.04 ,$289.68 ,$334.56 ,$334.56 ,$334.56 , N/A ,$367.59 ,$346.80 ,$147.04 ,$86.62 ,$243.58 ,$147.04 ,$169.73 ,$25.78 ,$23.44 ,$147.04 ,$346.80 ,$308.78 ,$346.80 ,$114.24 ,$367.20 ,$147.04 ,$334.56 ,$408.00 ,$408.00 ,$147.04 ,$265.20 ,$408.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$349.00 ,$226.85 ,$21.31 ,$367.60 ,$367.60 ,$226.85 ,$208.35 ,$147.04 ,$97.72 ,$195.79 ,$147.04 ,$229.64 ,$147.04 ,$296.65 ,$296.65 ,$147.04 ,$296.65 ,$279.37 ,$237.32 ,$367.59 ,$147.04 ,$147.04 ,$261.75 ,$247.79 ,$247.79 ,$147.04 ,$247.79 ,$286.18 ,$286.18 ,$286.18 , N/A ,$349.00 ,$296.65 ,$147.04 ,$74.24 ,$208.35 ,$147.04 ,$145.18 ,$23.44 ,$21.31 ,$147.04 ,$296.65 ,$308.78 ,$296.65 ,$97.72 ,$314.10 ,$147.04 ,$286.18 ,$349.00 ,$349.00 ,$147.04 ,$226.85 ,$349.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200249,88344,HC IMMUNOHISTOCHEM EA AB STAIN,312,1 ,$701.00 ,$455.65 ,$21.31 ,$717.84 ,$717.83 ,$455.65 ,$418.50 ,$287.13 ,$196.28 ,$393.26 ,$287.13 ,$461.26 ,$287.13 ,$595.85 ,$595.85 ,$287.13 ,$595.85 ,$545.56 ,$476.68 ,$717.84 ,$287.13 ,$287.13 ,$525.75 ,$497.71 ,$497.71 ,$287.13 ,$497.71 ,$574.82 ,$574.82 ,$574.82 , N/A ,$701.00 ,$595.85 ,$287.13 ,$701.00 ,$418.50 ,$287.13 ,$291.62 ,$23.44 ,$21.31 ,$287.13 ,$595.85 ,$602.98 ,$595.85 ,$196.28 ,$630.90 ,$287.13 ,$574.82 ,$701.00 ,$701.00 ,$287.13 ,$455.65 ,$701.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200261,88321,HC CONSULT REFERRED SLIDES-90,312,1 ,$400.00 ,$260.00 ,$21.31 ,$400.00 ,$83.43 ,$260.00 ,$238.80 ,$33.37 ,$112.00 ,$224.40 ,$33.37 ,$263.20 ,$33.37 ,$340.00 ,$340.00 ,$33.37 ,$340.00 ,$63.41 ,$272.00 ,$83.43 ,$33.37 ,$33.37 ,$300.00 ,$284.00 ,$284.00 ,$33.37 ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A ,$83.43 ,$340.00 ,$33.37 ,$400.00 ,$238.80 ,$33.37 ,$166.40 ,$23.44 ,$21.31 ,$33.37 ,$340.00 ,$70.08 ,$340.00 ,$112.00 ,$360.00 ,$33.37 ,$328.00 ,$135.36 ,$135.36 ,$33.37 ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200265,88341,HC IMMUNOHISOCHEM EA AD SGL STN-90,312,1 ,$100.00 ,$65.00 ,$21.31 ,$100.00 , N/A ,$65.00 ,$59.70 , N/A ,$28.00 ,$56.10 , N/A ,$65.80 , N/A ,$85.00 ,$85.00 , N/A ,$85.00 , N/A ,$68.00 , N/A , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A , N/A ,$85.00 , N/A ,$68.12 ,$59.70 , N/A ,$41.60 ,$23.44 ,$21.31 , N/A ,$85.00 , N/A ,$85.00 ,$28.00 ,$90.00 , N/A ,$82.00 ,$100.00 ,$100.00 , N/A ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200266,88341,HC IMMUNOHISOCHEMIS EA AD SGL STN,312,1 ,$334.00 ,$217.10 ,$21.31 ,$334.00 , N/A ,$217.10 ,$199.40 , N/A ,$93.52 ,$187.37 , N/A ,$219.77 , N/A ,$283.90 ,$283.90 , N/A ,$283.90 , N/A ,$227.12 , N/A , N/A , N/A ,$250.50 ,$237.14 ,$237.14 , N/A ,$237.14 ,$273.88 ,$273.88 ,$273.88 , N/A , N/A ,$283.90 , N/A ,$68.12 ,$199.40 , N/A ,$138.94 ,$23.44 ,$21.31 , N/A ,$283.90 , N/A ,$283.90 ,$93.52 ,$300.60 , N/A ,$273.88 ,$261.00 ,$261.00 , N/A ,$217.10 ,$334.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200269,88342,HC IMMUNOHISOCHEMISTR EA AB INIT-90,312,1 ,$100.00 ,$65.00 ,$21.31 ,$367.60 ,$367.60 ,$65.00 ,$59.70 ,$147.04 ,$28.00 ,$56.10 ,$147.04 ,$65.80 ,$100.00 ,$85.00 ,$85.00 ,$100.00 ,$85.00 ,$100.00 ,$68.00 ,$367.59 ,$147.04 ,$147.04 ,$75.00 ,$71.00 ,$71.00 ,$147.04 ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A ,$100.00 ,$85.00 ,$147.04 ,$74.24 ,$59.70 ,$147.04 ,$41.60 ,$23.44 ,$21.31 ,$147.04 ,$85.00 ,$308.78 ,$85.00 ,$28.00 ,$90.00 ,$147.04 ,$82.00 ,$100.00 ,$100.00 ,$147.04 ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200275,88360,HC MORPHO ANLYS TUMOR MAN-90,312,1 ,$566.00 ,$367.90 ,$23.44 ,$566.00 ,$367.60 ,$367.90 ,$337.90 ,$147.04 ,$158.48 ,$317.53 ,$147.04 ,$372.43 ,$147.04 ,$481.10 ,$481.10 ,$147.04 ,$481.10 ,$279.37 ,$384.88 ,$367.59 ,$147.04 ,$147.04 ,$424.50 ,$401.86 ,$401.86 ,$147.04 ,$401.86 ,$464.12 ,$464.12 ,$464.12 , N/A ,$367.59 ,$481.10 ,$147.04 ,$86.62 ,$337.90 ,$147.04 ,$235.46 ,$25.78 ,$23.44 ,$147.04 ,$481.10 ,$308.78 ,$481.10 ,$158.48 ,$509.40 ,$147.04 ,$464.12 ,$566.00 ,$566.00 ,$147.04 ,$367.90 ,$566.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200276,88361,HC MORPHO ANLYS COMP ASSIST-90,312,1 ,$398.00 ,$258.70 ,$23.44 ,$717.84 ,$717.83 ,$258.70 ,$237.61 ,$287.13 ,$111.44 ,$223.28 ,$287.13 ,$261.88 ,$287.13 ,$338.30 ,$338.30 ,$287.13 ,$338.30 ,$398.00 ,$270.64 ,$717.84 ,$287.13 ,$287.13 ,$298.50 ,$282.58 ,$282.58 ,$287.13 ,$282.58 ,$326.36 ,$326.36 ,$326.36 , N/A ,$398.00 ,$338.30 ,$287.13 ,$84.07 ,$237.61 ,$287.13 ,$165.57 ,$25.78 ,$23.44 ,$287.13 ,$338.30 ,$602.98 ,$338.30 ,$111.44 ,$358.20 ,$287.13 ,$326.36 ,$398.00 ,$398.00 ,$287.13 ,$258.70 ,$398.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200278,88364,HC IN SITU HYBRID(FISH) EA ADL-90,312,1 ,$380.00 ,$247.00 ,$21.31 ,$380.00 , N/A ,$247.00 ,$226.86 , N/A ,$106.40 ,$213.18 , N/A ,$250.04 , N/A ,$323.00 ,$323.00 , N/A ,$323.00 , N/A ,$258.40 , N/A , N/A , N/A ,$285.00 ,$269.80 ,$269.80 , N/A ,$269.80 ,$311.60 ,$311.60 ,$311.60 , N/A , N/A ,$323.00 , N/A ,$380.00 ,$226.86 , N/A ,$158.08 ,$23.44 ,$21.31 , N/A ,$323.00 , N/A ,$323.00 ,$106.40 ,$342.00 , N/A ,$311.60 ,$380.00 ,$380.00 , N/A ,$247.00 ,$380.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200279,88365,HC IN SITU HYBRID (FISH)-90,312,1 ,$723.00 ,$469.95 ,$21.31 ,$723.00 ,$367.60 ,$469.95 ,$431.63 ,$147.04 ,$202.44 ,$405.60 ,$147.04 ,$475.73 ,$147.04 ,$614.55 ,$614.55 ,$147.04 ,$614.55 ,$279.37 ,$491.64 ,$367.59 ,$147.04 ,$147.04 ,$542.25 ,$513.33 ,$513.33 ,$147.04 ,$513.33 ,$592.86 ,$592.86 ,$592.86 , N/A ,$367.59 ,$614.55 ,$147.04 ,$723.00 ,$431.63 ,$147.04 ,$300.77 ,$23.44 ,$21.31 ,$147.04 ,$614.55 ,$308.78 ,$614.55 ,$202.44 ,$650.70 ,$147.04 ,$592.86 ,$596.64 ,$596.64 ,$147.04 ,$469.95 ,$723.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200280,88367,HC FISH HER-2NEU-90,312,1 ,$480.00 ,$312.00 ,$23.44 ,$717.84 ,$717.83 ,$312.00 ,$286.56 ,$287.13 ,$134.40 ,$269.28 ,$287.13 ,$315.84 ,$287.13 ,$408.00 ,$408.00 ,$287.13 ,$408.00 ,$480.00 ,$326.40 ,$717.84 ,$287.13 ,$287.13 ,$360.00 ,$340.80 ,$340.80 ,$287.13 ,$340.80 ,$393.60 ,$393.60 ,$393.60 , N/A ,$480.00 ,$408.00 ,$287.13 ,$480.00 ,$286.56 ,$287.13 ,$199.68 ,$25.78 ,$23.44 ,$287.13 ,$408.00 ,$602.98 ,$408.00 ,$134.40 ,$432.00 ,$287.13 ,$393.60 ,$480.00 ,$480.00 ,$287.13 ,$312.00 ,$480.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200282,88373,HC MORPH ANLY AUTO EA ADDL-90,312,1 ,$503.00 ,$326.95 ,$23.44 ,$503.00 , N/A ,$326.95 ,$300.29 , N/A ,$140.84 ,$282.18 , N/A ,$330.97 , N/A ,$427.55 ,$427.55 , N/A ,$427.55 , N/A ,$342.04 , N/A , N/A , N/A ,$377.25 ,$357.13 ,$357.13 , N/A ,$357.13 ,$412.46 ,$412.46 ,$412.46 , N/A , N/A ,$427.55 , N/A ,$503.00 ,$300.29 , N/A ,$209.25 ,$25.78 ,$23.44 , N/A ,$427.55 , N/A ,$427.55 ,$140.84 ,$452.70 , N/A ,$412.46 ,$188.44 ,$188.44 , N/A ,$326.95 ,$503.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200283,88374,HC MORPH ANLY AUTO EA MULTIPLX-90,312,1 ,$503.00 ,$326.95 ,$23.44 ,$503.00 ,$367.60 ,$326.95 ,$300.29 ,$147.04 ,$140.84 ,$282.18 ,$147.04 ,$330.97 ,$147.04 ,$427.55 ,$427.55 ,$147.04 ,$427.55 ,$279.37 ,$342.04 ,$367.59 ,$147.04 ,$147.04 ,$377.25 ,$357.13 ,$357.13 ,$147.04 ,$357.13 ,$412.46 ,$412.46 ,$412.46 , N/A ,$367.59 ,$427.55 ,$147.04 ,$503.00 ,$300.29 ,$147.04 ,$209.25 ,$25.78 ,$23.44 ,$147.04 ,$427.55 ,$308.78 ,$427.55 ,$140.84 ,$452.70 ,$147.04 ,$412.46 ,$503.00 ,$503.00 ,$147.04 ,$326.95 ,$503.00 
ST. JOSEPH'S HOSPITAL - BREESE,31200284,88377,HC MORPH ANLZ INST HYB EA MTPL-90,312,1 ,$730.00 ,$474.50 ,$23.44 ,$730.00 ,$367.60 ,$474.50 ,$435.81 ,$147.04 ,$204.40 ,$409.53 ,$147.04 ,$480.34 ,$147.04 ,$620.50 ,$620.50 ,$147.04 ,$620.50 ,$279.37 ,$496.40 ,$367.59 ,$147.04 ,$147.04 ,$547.50 ,$518.30 ,$518.30 ,$147.04 ,$518.30 ,$598.60 ,$598.60 ,$598.60 , N/A ,$367.59 ,$620.50 ,$147.04 ,$730.00 ,$435.81 ,$147.04 ,$303.68 ,$25.78 ,$23.44 ,$147.04 ,$620.50 ,$308.78 ,$620.50 ,$204.40 ,$657.00 ,$147.04 ,$598.60 ,$596.64 ,$596.64 ,$147.04 ,$474.50 ,$730.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000005,22512,HC VERTEBROPLASTY INJ PERC ADDL,320,1 ,"$9,692.00 ","$6,299.80 ","$2,713.76 ","$9,692.00 ", N/A ,"$6,299.80 ","$5,786.12 ", N/A ,"$2,713.76 ","$5,437.21 ", N/A ,"$6,377.34 ", N/A ,"$8,238.20 ","$8,238.20 ", N/A ,"$8,238.20 ", N/A ,"$6,590.56 ", N/A , N/A , N/A ,"$7,269.00 ","$6,881.32 ","$6,881.32 ", N/A ,"$6,881.32 ","$7,947.44 ","$7,947.44 ","$7,947.44 ", N/A , N/A ,"$8,238.20 ", N/A ,"$9,692.00 ","$5,786.12 ", N/A ,"$4,031.87 ","$3,570.18 ","$3,245.62 ", N/A ,"$8,238.20 ", N/A ,"$8,238.20 ","$2,713.76 ","$8,722.80 ", N/A ,"$7,947.44 ","$8,189.74 ","$8,189.74 ", N/A ,"$6,299.80 ","$9,692.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$371.00 ,$241.15 ,$103.88 ,$371.00 , N/A ,$241.15 ,$221.49 , N/A ,$103.88 ,$208.13 , N/A ,$244.12 , N/A ,$315.35 ,$315.35 , N/A ,$315.35 , N/A ,$252.28 , N/A , N/A , N/A ,$278.25 ,$263.41 ,$263.41 , N/A ,$263.41 ,$304.22 ,$304.22 ,$304.22 , N/A , N/A ,$315.35 , N/A ,$371.00 ,$221.49 , N/A ,$154.34 , N/A , N/A , N/A ,$315.35 , N/A ,$315.35 ,$103.88 ,$333.90 , N/A ,$304.22 ,$313.50 ,$313.50 , N/A ,$241.15 ,$371.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$247.00 ,$160.55 ,$69.16 ,$247.00 , N/A ,$160.55 ,$147.46 , N/A ,$69.16 ,$138.57 , N/A ,$162.53 , N/A ,$209.95 ,$209.95 , N/A ,$209.95 , N/A ,$167.96 , N/A , N/A , N/A ,$185.25 ,$175.37 ,$175.37 , N/A ,$175.37 ,$202.54 ,$202.54 ,$202.54 , N/A , N/A ,$209.95 , N/A ,$247.00 ,$147.46 , N/A ,$102.75 , N/A , N/A , N/A ,$209.95 , N/A ,$209.95 ,$69.16 ,$222.30 , N/A ,$202.54 ,$208.72 ,$208.72 , N/A ,$160.55 ,$247.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$262.00 ,$170.30 ,$73.36 ,$262.00 , N/A ,$170.30 ,$156.41 , N/A ,$73.36 ,$146.98 , N/A ,$172.40 , N/A ,$222.70 ,$222.70 , N/A ,$222.70 , N/A ,$178.16 , N/A , N/A , N/A ,$196.50 ,$186.02 ,$186.02 , N/A ,$186.02 ,$214.84 ,$214.84 ,$214.84 , N/A , N/A ,$222.70 , N/A ,$262.00 ,$156.41 , N/A ,$108.99 , N/A , N/A , N/A ,$222.70 , N/A ,$222.70 ,$73.36 ,$235.80 , N/A ,$214.84 ,$221.39 ,$221.39 , N/A ,$170.30 ,$262.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$423.00 ,$274.95 ,$118.44 ,$423.00 , N/A ,$274.95 ,$252.53 , N/A ,$118.44 ,$237.30 , N/A ,$278.33 , N/A ,$359.55 ,$359.55 , N/A ,$359.55 , N/A ,$287.64 , N/A , N/A , N/A ,$317.25 ,$300.33 ,$300.33 , N/A ,$300.33 ,$346.86 ,$346.86 ,$346.86 , N/A , N/A ,$359.55 , N/A ,$423.00 ,$252.53 , N/A ,$175.97 ,$379.18 ,$344.71 , N/A ,$359.55 , N/A ,$359.55 ,$118.44 ,$380.70 , N/A ,$346.86 ,$357.44 ,$357.44 , N/A ,$274.95 ,$423.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$282.00 ,$183.30 ,$78.96 ,$282.00 , N/A ,$183.30 ,$168.35 , N/A ,$78.96 ,$158.20 , N/A ,$185.56 , N/A ,$239.70 ,$239.70 , N/A ,$239.70 , N/A ,$191.76 , N/A , N/A , N/A ,$211.50 ,$200.22 ,$200.22 , N/A ,$200.22 ,$231.24 ,$231.24 ,$231.24 , N/A , N/A ,$239.70 , N/A ,$282.00 ,$168.35 , N/A ,$117.31 ,$252.78 ,$229.80 , N/A ,$239.70 , N/A ,$239.70 ,$78.96 ,$253.80 , N/A ,$231.24 ,$238.29 ,$238.29 , N/A ,$183.30 ,$282.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$331.00 ,$215.15 ,$92.68 ,$331.00 , N/A ,$215.15 ,$197.61 , N/A ,$92.68 ,$185.69 , N/A ,$217.80 , N/A ,$281.35 ,$281.35 , N/A ,$281.35 , N/A ,$225.08 , N/A , N/A , N/A ,$248.25 ,$235.01 ,$235.01 , N/A ,$235.01 ,$271.42 ,$271.42 ,$271.42 , N/A , N/A ,$281.35 , N/A ,$331.00 ,$197.61 , N/A ,$137.70 ,$252.78 ,$229.80 , N/A ,$281.35 , N/A ,$281.35 ,$92.68 ,$297.90 , N/A ,$271.42 ,$279.70 ,$279.70 , N/A ,$215.15 ,$331.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$201.00 ,$130.65 ,$56.28 ,$201.00 , N/A ,$130.65 ,$120.00 , N/A ,$56.28 ,$112.76 , N/A ,$132.26 , N/A ,$170.85 ,$170.85 , N/A ,$170.85 , N/A ,$136.68 , N/A , N/A , N/A ,$150.75 ,$142.71 ,$142.71 , N/A ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A , N/A ,$170.85 , N/A ,$201.00 ,$120.00 , N/A ,$83.62 , N/A , N/A , N/A ,$170.85 , N/A ,$170.85 ,$56.28 ,$180.90 , N/A ,$164.82 ,$169.85 ,$169.85 , N/A ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$231.00 ,$150.15 ,$64.68 ,$231.00 , N/A ,$150.15 ,$137.91 , N/A ,$64.68 ,$129.59 , N/A ,$152.00 , N/A ,$196.35 ,$196.35 , N/A ,$196.35 , N/A ,$157.08 , N/A , N/A , N/A ,$173.25 ,$164.01 ,$164.01 , N/A ,$164.01 ,$189.42 ,$189.42 ,$189.42 , N/A , N/A ,$196.35 , N/A ,$231.00 ,$137.91 , N/A ,$96.10 ,$231.00 ,$229.80 , N/A ,$196.35 , N/A ,$196.35 ,$64.68 ,$207.90 , N/A ,$189.42 ,$195.20 ,$195.20 , N/A ,$150.15 ,$231.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$4,676.00 ","$3,039.40 ",$457.93 ,"$4,676.00 ","$3,465.88 ","$3,039.40 ","$2,791.57 ","$1,386.35 ","$1,309.28 ","$2,623.24 ","$1,386.35 ","$3,076.81 ","$1,386.35 ","$3,974.60 ","$3,974.60 ","$1,386.35 ","$3,974.60 ","$2,634.07 ","$3,179.68 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$3,507.00 ","$3,319.96 ","$3,319.96 ","$1,386.35 ","$3,319.96 ","$3,834.32 ","$3,834.32 ","$3,834.32 ", N/A ,"$3,465.89 ","$3,974.60 ","$1,386.35 ","$4,676.00 ","$2,791.57 ","$1,386.35 ","$1,945.22 ",$503.72 ,$457.93 ,"$1,386.35 ","$3,974.60 ","$2,911.34 ","$3,974.60 ","$1,309.28 ","$4,208.40 ","$1,386.35 ","$3,834.32 ","$3,951.22 ","$3,951.22 ","$1,386.35 ","$3,039.40 ","$4,676.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000029,36410,HC VENIPUNCTURE > AGE 3 REQUIR MD,361,1 ,$157.00 ,$102.05 ,$32.09 ,$157.00 , N/A ,$102.05 ,$93.73 , N/A ,$43.96 ,$88.08 , N/A ,$103.31 , N/A ,$133.45 ,$133.45 , N/A ,$133.45 , N/A ,$106.76 , N/A , N/A , N/A ,$117.75 ,$111.47 ,$111.47 , N/A ,$111.47 ,$128.74 ,$128.74 ,$128.74 , N/A , N/A ,$133.45 , N/A ,$157.00 ,$93.73 , N/A ,$65.31 ,$35.30 ,$32.09 , N/A ,$133.45 , N/A ,$133.45 ,$43.96 ,$141.30 , N/A ,$128.74 ,$132.67 ,$132.67 , N/A ,$102.05 ,$157.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$532.00 ,$345.80 ,$148.96 ,$532.00 ,$504.20 ,$345.80 ,$317.60 ,$201.68 ,$148.96 ,$298.45 ,$201.68 ,$350.06 ,$201.68 ,$452.20 ,$452.20 ,$201.68 ,$452.20 ,$383.20 ,$361.76 ,$504.21 ,$201.68 ,$201.68 ,$399.00 ,$377.72 ,$377.72 ,$201.68 ,$377.72 ,$436.24 ,$436.24 ,$436.24 , N/A ,$504.21 ,$452.20 ,$201.68 ,$532.00 ,$317.60 ,$201.68 ,$221.31 ,$532.00 ,$532.00 ,$201.68 ,$452.20 ,$423.54 ,$452.20 ,$148.96 ,$478.80 ,$201.68 ,$436.24 ,$449.54 ,$449.54 ,$201.68 ,$345.80 ,$532.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$2,428.80 ","$1,578.72 ",$398.59 ,"$2,428.80 ","$1,994.33 ","$1,578.72 ","$1,449.99 ",$797.73 ,$680.06 ,"$1,362.56 ",$797.73 ,"$1,598.15 ",$797.73 ,"$2,064.48 ","$2,064.48 ",$797.73 ,"$2,064.48 ","$1,515.69 ","$1,651.58 ","$1,994.33 ",$797.73 ,$797.73 ,"$1,821.60 ","$1,724.45 ","$1,724.45 ",$797.73 ,"$1,724.45 ","$1,991.62 ","$1,991.62 ","$1,991.62 ", N/A ,"$1,994.33 ","$2,064.48 ",$797.73 ,"$2,428.80 ","$1,449.99 ",$797.73 ,"$1,010.38 ",$438.45 ,$398.59 ,$797.73 ,"$2,064.48 ","$1,675.23 ","$2,064.48 ",$680.06 ,"$2,185.92 ",$797.73 ,"$1,991.62 ","$2,052.34 ","$2,052.34 ",$797.73 ,"$1,578.72 ","$2,428.80 "
ST. JOSEPH'S HOSPITAL - BREESE,32000085,51600,HC INJ CYSTOGRAM,320,1 ,"$1,046.62 ",$680.30 ,$229.80 ,"$1,046.62 ", N/A ,$680.30 ,$624.83 , N/A ,$293.05 ,$587.15 , N/A ,$688.68 , N/A ,$889.63 ,$889.63 , N/A ,$889.63 , N/A ,$711.70 , N/A , N/A , N/A ,$784.97 ,$743.10 ,$743.10 , N/A ,$743.10 ,$858.23 ,$858.23 ,$858.23 , N/A , N/A ,$889.63 , N/A ,"$1,046.62 ",$624.83 , N/A ,$435.39 ,$252.78 ,$229.80 , N/A ,$889.63 , N/A ,$889.63 ,$293.05 ,$941.96 , N/A ,$858.23 ,$884.39 ,$884.39 , N/A ,$680.30 ,"$1,046.62 "
ST. JOSEPH'S HOSPITAL - BREESE,32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,$296.00 ,$192.40 ,$82.88 ,$296.00 , N/A ,$192.40 ,$176.71 , N/A ,$82.88 ,$166.06 , N/A ,$194.77 , N/A ,$251.60 ,$251.60 , N/A ,$251.60 , N/A ,$201.28 , N/A , N/A , N/A ,$222.00 ,$210.16 ,$210.16 , N/A ,$210.16 ,$242.72 ,$242.72 ,$242.72 , N/A , N/A ,$251.60 , N/A ,$296.00 ,$176.71 , N/A ,$123.14 ,$252.78 ,$229.80 , N/A ,$251.60 , N/A ,$251.60 ,$82.88 ,$266.40 , N/A ,$242.72 ,$250.12 ,$250.12 , N/A ,$192.40 ,$296.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$675.00 ,$438.75 ,$55.26 ,$675.00 ,$199.38 ,$438.75 ,$402.98 ,$79.75 ,$189.00 ,$378.68 ,$79.75 ,$444.15 ,$79.75 ,$573.75 ,$573.75 ,$79.75 ,$573.75 ,$151.52 ,$459.00 ,$199.36 ,$79.75 ,$79.75 ,$506.25 ,$479.25 ,$479.25 ,$79.75 ,$479.25 ,$553.50 ,$553.50 ,$553.50 , N/A ,$199.36 ,$573.75 ,$79.75 ,$675.00 ,$402.98 ,$79.75 ,$280.80 ,$60.79 ,$55.26 ,$79.75 ,$573.75 ,$167.46 ,$573.75 ,$189.00 ,$607.50 ,$79.75 ,$553.50 ,$570.38 ,$570.38 ,$79.75 ,$438.75 ,$675.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$451.00 ,$293.15 ,$36.84 ,$451.00 ,$199.38 ,$293.15 ,$269.25 ,$79.75 ,$126.28 ,$253.01 ,$79.75 ,$296.76 ,$79.75 ,$383.35 ,$383.35 ,$79.75 ,$383.35 ,$151.52 ,$306.68 ,$199.36 ,$79.75 ,$79.75 ,$338.25 ,$320.21 ,$320.21 ,$79.75 ,$320.21 ,$369.82 ,$369.82 ,$369.82 , N/A ,$199.36 ,$383.35 ,$79.75 ,$451.00 ,$269.25 ,$79.75 ,$187.62 ,$40.52 ,$36.84 ,$79.75 ,$383.35 ,$167.46 ,$383.35 ,$126.28 ,$405.90 ,$79.75 ,$369.82 ,$381.10 ,$381.10 ,$79.75 ,$293.15 ,$451.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$615.00 ,$399.75 ,$36.84 ,$615.00 ,$268.33 ,$399.75 ,$367.16 ,$107.33 ,$172.20 ,$345.02 ,$107.33 ,$404.67 ,$107.33 ,$522.75 ,$522.75 ,$107.33 ,$522.75 ,$203.93 ,$418.20 ,$268.33 ,$107.33 ,$107.33 ,$461.25 ,$436.65 ,$436.65 ,$107.33 ,$436.65 ,$504.30 ,$504.30 ,$504.30 , N/A ,$268.33 ,$522.75 ,$107.33 ,$615.00 ,$367.16 ,$107.33 ,$255.84 ,$40.52 ,$36.84 ,$107.33 ,$522.75 ,$225.40 ,$522.75 ,$172.20 ,$553.50 ,$107.33 ,$504.30 ,$519.68 ,$519.68 ,$107.33 ,$399.75 ,$615.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$661.00 ,$429.65 ,$36.84 ,$661.00 ,$268.33 ,$429.65 ,$394.62 ,$107.33 ,$185.08 ,$370.82 ,$107.33 ,$434.94 ,$107.33 ,$561.85 ,$561.85 ,$107.33 ,$561.85 ,$203.93 ,$449.48 ,$268.33 ,$107.33 ,$107.33 ,$495.75 ,$469.31 ,$469.31 ,$107.33 ,$469.31 ,$542.02 ,$542.02 ,$542.02 , N/A ,$268.33 ,$561.85 ,$107.33 ,$661.00 ,$394.62 ,$107.33 ,$274.98 ,$40.52 ,$36.84 ,$107.33 ,$561.85 ,$225.40 ,$561.85 ,$185.08 ,$594.90 ,$107.33 ,$542.02 ,$558.55 ,$558.55 ,$107.33 ,$429.65 ,$661.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$992.00 ,$644.80 ,$55.26 ,$992.00 ,$268.33 ,$644.80 ,$592.22 ,$107.33 ,$277.76 ,$556.51 ,$107.33 ,$652.74 ,$107.33 ,$843.20 ,$843.20 ,$107.33 ,$843.20 ,$203.93 ,$674.56 ,$268.33 ,$107.33 ,$107.33 ,$744.00 ,$704.32 ,$704.32 ,$107.33 ,$704.32 ,$813.44 ,$813.44 ,$813.44 , N/A ,$268.33 ,$843.20 ,$107.33 ,$992.00 ,$592.22 ,$107.33 ,$412.67 ,$60.79 ,$55.26 ,$107.33 ,$843.20 ,$225.40 ,$843.20 ,$277.76 ,$892.80 ,$107.33 ,$813.44 ,$838.24 ,$838.24 ,$107.33 ,$644.80 ,$992.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$695.00 ,$451.75 ,$36.84 ,$695.00 ,$268.33 ,$451.75 ,$414.92 ,$107.33 ,$194.60 ,$389.90 ,$107.33 ,$457.31 ,$107.33 ,$590.75 ,$590.75 ,$107.33 ,$590.75 ,$203.93 ,$472.60 ,$268.33 ,$107.33 ,$107.33 ,$521.25 ,$493.45 ,$493.45 ,$107.33 ,$493.45 ,$569.90 ,$569.90 ,$569.90 , N/A ,$268.33 ,$590.75 ,$107.33 ,$695.00 ,$414.92 ,$107.33 ,$289.12 ,$40.52 ,$36.84 ,$107.33 ,$590.75 ,$225.40 ,$590.75 ,$194.60 ,$625.50 ,$107.33 ,$569.90 ,$587.28 ,$587.28 ,$107.33 ,$451.75 ,$695.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$509.00 ,$330.85 ,$36.84 ,$509.00 ,$199.38 ,$330.85 ,$303.87 ,$79.75 ,$142.52 ,$285.55 ,$79.75 ,$334.92 ,$79.75 ,$432.65 ,$432.65 ,$79.75 ,$432.65 ,$151.52 ,$346.12 ,$199.36 ,$79.75 ,$79.75 ,$381.75 ,$361.39 ,$361.39 ,$79.75 ,$361.39 ,$417.38 ,$417.38 ,$417.38 , N/A ,$199.36 ,$432.65 ,$79.75 ,$509.00 ,$303.87 ,$79.75 ,$211.74 ,$40.52 ,$36.84 ,$79.75 ,$432.65 ,$167.46 ,$432.65 ,$142.52 ,$458.10 ,$79.75 ,$417.38 ,$430.11 ,$430.11 ,$79.75 ,$330.85 ,$509.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$562.00 ,$365.30 ,$36.84 ,$562.00 ,$268.33 ,$365.30 ,$335.51 ,$107.33 ,$157.36 ,$315.28 ,$107.33 ,$369.80 ,$107.33 ,$477.70 ,$477.70 ,$107.33 ,$477.70 ,$203.93 ,$382.16 ,$268.33 ,$107.33 ,$107.33 ,$421.50 ,$399.02 ,$399.02 ,$107.33 ,$399.02 ,$460.84 ,$460.84 ,$460.84 , N/A ,$268.33 ,$477.70 ,$107.33 ,$562.00 ,$335.51 ,$107.33 ,$233.79 ,$40.52 ,$36.84 ,$107.33 ,$477.70 ,$225.40 ,$477.70 ,$157.36 ,$505.80 ,$107.33 ,$460.84 ,$474.89 ,$474.89 ,$107.33 ,$365.30 ,$562.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$736.00 ,$478.40 ,$36.84 ,$736.00 ,$199.38 ,$478.40 ,$439.39 ,$79.75 ,$206.08 ,$412.90 ,$79.75 ,$484.29 ,$79.75 ,$625.60 ,$625.60 ,$79.75 ,$625.60 ,$151.52 ,$500.48 ,$199.36 ,$79.75 ,$79.75 ,$552.00 ,$522.56 ,$522.56 ,$79.75 ,$522.56 ,$603.52 ,$603.52 ,$603.52 , N/A ,$199.36 ,$625.60 ,$79.75 ,$736.00 ,$439.39 ,$79.75 ,$306.18 ,$40.52 ,$36.84 ,$79.75 ,$625.60 ,$167.46 ,$625.60 ,$206.08 ,$662.40 ,$79.75 ,$603.52 ,$621.92 ,$621.92 ,$79.75 ,$478.40 ,$736.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$567.00 ,$368.55 ,$36.84 ,$567.00 ,$268.33 ,$368.55 ,$338.50 ,$107.33 ,$158.76 ,$318.09 ,$107.33 ,$373.09 ,$107.33 ,$481.95 ,$481.95 ,$107.33 ,$481.95 ,$203.93 ,$385.56 ,$268.33 ,$107.33 ,$107.33 ,$425.25 ,$402.57 ,$402.57 ,$107.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$268.33 ,$481.95 ,$107.33 ,$567.00 ,$338.50 ,$107.33 ,$235.87 ,$40.52 ,$36.84 ,$107.33 ,$481.95 ,$225.40 ,$481.95 ,$158.76 ,$510.30 ,$107.33 ,$464.94 ,$479.12 ,$479.12 ,$107.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$834.00 ,$542.10 ,$36.84 ,$834.00 ,$268.33 ,$542.10 ,$497.90 ,$107.33 ,$233.52 ,$467.87 ,$107.33 ,$548.77 ,$107.33 ,$708.90 ,$708.90 ,$107.33 ,$708.90 ,$203.93 ,$567.12 ,$268.33 ,$107.33 ,$107.33 ,$625.50 ,$592.14 ,$592.14 ,$107.33 ,$592.14 ,$683.88 ,$683.88 ,$683.88 , N/A ,$268.33 ,$708.90 ,$107.33 ,$834.00 ,$497.90 ,$107.33 ,$346.94 ,$40.52 ,$36.84 ,$107.33 ,$708.90 ,$225.40 ,$708.90 ,$233.52 ,$750.60 ,$107.33 ,$683.88 ,$704.73 ,$704.73 ,$107.33 ,$542.10 ,$834.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$388.00 ,$252.20 ,$36.84 ,$388.00 ,$199.38 ,$252.20 ,$231.64 ,$79.75 ,$108.64 ,$217.67 ,$79.75 ,$255.30 ,$79.75 ,$329.80 ,$329.80 ,$79.75 ,$329.80 ,$151.52 ,$263.84 ,$199.36 ,$79.75 ,$79.75 ,$291.00 ,$275.48 ,$275.48 ,$79.75 ,$275.48 ,$318.16 ,$318.16 ,$318.16 , N/A ,$199.36 ,$329.80 ,$79.75 ,$388.00 ,$231.64 ,$79.75 ,$161.41 ,$40.52 ,$36.84 ,$79.75 ,$329.80 ,$167.46 ,$329.80 ,$108.64 ,$349.20 ,$79.75 ,$318.16 ,$327.86 ,$327.86 ,$79.75 ,$252.20 ,$388.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000114,70336,HC MRI TMJ,320,1 ,"$3,089.00 ","$2,007.85 ",$154.77 ,"$3,089.00 ",$567.13 ,"$2,007.85 ","$1,844.13 ",$226.85 ,$864.92 ,"$1,732.93 ",$226.85 ,"$2,032.56 ",$226.85 ,"$2,625.65 ","$2,625.65 ",$226.85 ,"$2,625.65 ",$431.02 ,"$2,100.52 ",$567.13 ,$226.85 ,$226.85 ,"$2,316.75 ","$2,193.19 ","$2,193.19 ",$226.85 ,"$2,193.19 ","$2,532.98 ","$2,532.98 ","$2,532.98 ", N/A ,$567.13 ,"$2,625.65 ",$226.85 ,"$3,089.00 ","$1,844.13 ",$226.85 ,"$1,285.02 ",$170.25 ,$154.77 ,$226.85 ,"$2,625.65 ",$476.39 ,"$2,625.65 ",$864.92 ,"$2,780.10 ",$226.85 ,"$2,532.98 ","$2,610.21 ","$2,610.21 ",$226.85 ,"$2,007.85 ","$3,089.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$403.00 ,$261.95 ,$36.84 ,$403.00 ,$199.38 ,$261.95 ,$240.59 ,$79.75 ,$112.84 ,$226.08 ,$79.75 ,$265.17 ,$79.75 ,$342.55 ,$342.55 ,$79.75 ,$342.55 ,$151.52 ,$274.04 ,$199.36 ,$79.75 ,$79.75 ,$302.25 ,$286.13 ,$286.13 ,$79.75 ,$286.13 ,$330.46 ,$330.46 ,$330.46 , N/A ,$199.36 ,$342.55 ,$79.75 ,$403.00 ,$240.59 ,$79.75 ,$167.65 ,$40.52 ,$36.84 ,$79.75 ,$342.55 ,$167.46 ,$342.55 ,$112.84 ,$362.70 ,$79.75 ,$330.46 ,$340.54 ,$340.54 ,$79.75 ,$261.95 ,$403.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000121,71045,HC XR CHEST 1V,320,1 ,$431.00 ,$280.15 ,$18.14 ,$431.00 ,$199.38 ,$280.15 ,$257.31 ,$79.75 ,$120.68 ,$241.79 ,$79.75 ,$283.60 ,$79.75 ,$366.35 ,$366.35 ,$79.75 ,$366.35 ,$151.52 ,$293.08 ,$199.36 ,$79.75 ,$79.75 ,$323.25 ,$306.01 ,$306.01 ,$79.75 ,$306.01 ,$353.42 ,$353.42 ,$353.42 , N/A ,$199.36 ,$366.35 ,$79.75 ,$18.14 ,$257.31 ,$79.75 ,$179.30 ,$40.52 ,$36.84 ,$79.75 ,$366.35 ,$167.46 ,$366.35 ,$120.68 ,$387.90 ,$79.75 ,$353.42 ,$364.20 ,$364.20 ,$79.75 ,$280.15 ,$431.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000127,71046,HC XR CHEST 2V,320,1 ,$592.00 ,$384.80 ,$24.70 ,$592.00 ,$199.38 ,$384.80 ,$353.42 ,$79.75 ,$165.76 ,$332.11 ,$79.75 ,$389.54 ,$79.75 ,$503.20 ,$503.20 ,$79.75 ,$503.20 ,$151.52 ,$402.56 ,$199.36 ,$79.75 ,$79.75 ,$444.00 ,$420.32 ,$420.32 ,$79.75 ,$420.32 ,$485.44 ,$485.44 ,$485.44 , N/A ,$199.36 ,$503.20 ,$79.75 ,$24.70 ,$353.42 ,$79.75 ,$246.27 ,$40.52 ,$36.84 ,$79.75 ,$503.20 ,$167.46 ,$503.20 ,$165.76 ,$532.80 ,$79.75 ,$485.44 ,$500.24 ,$500.24 ,$79.75 ,$384.80 ,$592.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$656.00 ,$426.40 ,$36.84 ,$656.00 ,$199.38 ,$426.40 ,$391.63 ,$79.75 ,$183.68 ,$368.02 ,$79.75 ,$431.65 ,$79.75 ,$557.60 ,$557.60 ,$79.75 ,$557.60 ,$151.52 ,$446.08 ,$199.36 ,$79.75 ,$79.75 ,$492.00 ,$465.76 ,$465.76 ,$79.75 ,$465.76 ,$537.92 ,$537.92 ,$537.92 , N/A ,$199.36 ,$557.60 ,$79.75 ,$656.00 ,$391.63 ,$79.75 ,$272.90 ,$40.52 ,$36.84 ,$79.75 ,$557.60 ,$167.46 ,$557.60 ,$183.68 ,$590.40 ,$79.75 ,$537.92 ,$554.32 ,$554.32 ,$79.75 ,$426.40 ,$656.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000131,71048,HC XR CHEST PA/LAT W/OBLIQUES,320,1 ,$656.00 ,$426.40 ,$36.84 ,$656.00 ,$268.33 ,$426.40 ,$391.63 ,$107.33 ,$183.68 ,$368.02 ,$107.33 ,$431.65 ,$107.33 ,$557.60 ,$557.60 ,$107.33 ,$557.60 ,$203.93 ,$446.08 ,$268.33 ,$107.33 ,$107.33 ,$492.00 ,$465.76 ,$465.76 ,$107.33 ,$465.76 ,$537.92 ,$537.92 ,$537.92 , N/A ,$268.33 ,$557.60 ,$107.33 ,$656.00 ,$391.63 ,$107.33 ,$272.90 ,$40.52 ,$36.84 ,$107.33 ,$557.60 ,$225.40 ,$557.60 ,$183.68 ,$590.40 ,$107.33 ,$537.92 ,$554.32 ,$554.32 ,$107.33 ,$426.40 ,$656.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000133,71048,HC XR CHEST 4+V,320,1 ,$656.00 ,$426.40 ,$36.84 ,$656.00 ,$268.33 ,$426.40 ,$391.63 ,$107.33 ,$183.68 ,$368.02 ,$107.33 ,$431.65 ,$107.33 ,$557.60 ,$557.60 ,$107.33 ,$557.60 ,$203.93 ,$446.08 ,$268.33 ,$107.33 ,$107.33 ,$492.00 ,$465.76 ,$465.76 ,$107.33 ,$465.76 ,$537.92 ,$537.92 ,$537.92 , N/A ,$268.33 ,$557.60 ,$107.33 ,$656.00 ,$391.63 ,$107.33 ,$272.90 ,$40.52 ,$36.84 ,$107.33 ,$557.60 ,$225.40 ,$557.60 ,$183.68 ,$590.40 ,$107.33 ,$537.92 ,$554.32 ,$554.32 ,$107.33 ,$426.40 ,$656.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$592.00 ,$384.80 ,$24.70 ,$592.00 ,$199.38 ,$384.80 ,$353.42 ,$79.75 ,$165.76 ,$332.11 ,$79.75 ,$389.54 ,$79.75 ,$503.20 ,$503.20 ,$79.75 ,$503.20 ,$151.52 ,$402.56 ,$199.36 ,$79.75 ,$79.75 ,$444.00 ,$420.32 ,$420.32 ,$79.75 ,$420.32 ,$485.44 ,$485.44 ,$485.44 , N/A ,$199.36 ,$503.20 ,$79.75 ,$24.70 ,$353.42 ,$79.75 ,$246.27 ,$40.52 ,$36.84 ,$79.75 ,$503.20 ,$167.46 ,$503.20 ,$165.76 ,$532.80 ,$79.75 ,$485.44 ,$500.24 ,$500.24 ,$79.75 ,$384.80 ,$592.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000137,71100,HC XR RIBS 2V UNI,320,1 ,$509.00 ,$330.85 ,$36.84 ,$509.00 ,$199.38 ,$330.85 ,$303.87 ,$79.75 ,$142.52 ,$285.55 ,$79.75 ,$334.92 ,$79.75 ,$432.65 ,$432.65 ,$79.75 ,$432.65 ,$151.52 ,$346.12 ,$199.36 ,$79.75 ,$79.75 ,$381.75 ,$361.39 ,$361.39 ,$79.75 ,$361.39 ,$417.38 ,$417.38 ,$417.38 , N/A ,$199.36 ,$432.65 ,$79.75 ,$509.00 ,$303.87 ,$79.75 ,$211.74 ,$40.52 ,$36.84 ,$79.75 ,$432.65 ,$167.46 ,$432.65 ,$142.52 ,$458.10 ,$79.75 ,$417.38 ,$430.11 ,$430.11 ,$79.75 ,$330.85 ,$509.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$341.00 ,$221.65 ,$36.84 ,$341.00 ,$268.33 ,$221.65 ,$203.58 ,$107.33 ,$95.48 ,$191.30 ,$107.33 ,$224.38 ,$107.33 ,$289.85 ,$289.85 ,$107.33 ,$289.85 ,$203.93 ,$231.88 ,$268.33 ,$107.33 ,$107.33 ,$255.75 ,$242.11 ,$242.11 ,$107.33 ,$242.11 ,$279.62 ,$279.62 ,$279.62 , N/A ,$268.33 ,$289.85 ,$107.33 ,$341.00 ,$203.58 ,$107.33 ,$141.86 ,$40.52 ,$36.84 ,$107.33 ,$289.85 ,$225.40 ,$289.85 ,$95.48 ,$306.90 ,$107.33 ,$279.62 ,$288.15 ,$288.15 ,$107.33 ,$221.65 ,$341.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$786.00 ,$510.90 ,$36.84 ,$786.00 ,$268.33 ,$510.90 ,$469.24 ,$107.33 ,$220.08 ,$440.95 ,$107.33 ,$517.19 ,$107.33 ,$668.10 ,$668.10 ,$107.33 ,$668.10 ,$203.93 ,$534.48 ,$268.33 ,$107.33 ,$107.33 ,$589.50 ,$558.06 ,$558.06 ,$107.33 ,$558.06 ,$644.52 ,$644.52 ,$644.52 , N/A ,$268.33 ,$668.10 ,$107.33 ,$786.00 ,$469.24 ,$107.33 ,$326.98 ,$40.52 ,$36.84 ,$107.33 ,$668.10 ,$225.40 ,$668.10 ,$220.08 ,$707.40 ,$107.33 ,$644.52 ,$664.17 ,$664.17 ,$107.33 ,$510.90 ,$786.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$342.00 ,$222.30 ,$36.84 ,$342.00 ,$268.33 ,$222.30 ,$204.17 ,$107.33 ,$95.76 ,$191.86 ,$107.33 ,$225.04 ,$107.33 ,$290.70 ,$290.70 ,$107.33 ,$290.70 ,$203.93 ,$232.56 ,$268.33 ,$107.33 ,$107.33 ,$256.50 ,$242.82 ,$242.82 ,$107.33 ,$242.82 ,$280.44 ,$280.44 ,$280.44 , N/A ,$268.33 ,$290.70 ,$107.33 ,$342.00 ,$204.17 ,$107.33 ,$142.27 ,$40.52 ,$36.84 ,$107.33 ,$290.70 ,$225.40 ,$290.70 ,$95.76 ,$307.80 ,$107.33 ,$280.44 ,$288.99 ,$288.99 ,$107.33 ,$222.30 ,$342.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000141,71120,HC XR STERNUM 2+V,320,1 ,$539.00 ,$350.35 ,$36.84 ,$539.00 ,$199.38 ,$350.35 ,$321.78 ,$79.75 ,$150.92 ,$302.38 ,$79.75 ,$354.66 ,$79.75 ,$458.15 ,$458.15 ,$79.75 ,$458.15 ,$151.52 ,$366.52 ,$199.36 ,$79.75 ,$79.75 ,$404.25 ,$382.69 ,$382.69 ,$79.75 ,$382.69 ,$441.98 ,$441.98 ,$441.98 , N/A ,$199.36 ,$458.15 ,$79.75 ,$539.00 ,$321.78 ,$79.75 ,$224.22 ,$40.52 ,$36.84 ,$79.75 ,$458.15 ,$167.46 ,$458.15 ,$150.92 ,$485.10 ,$79.75 ,$441.98 ,$455.46 ,$455.46 ,$79.75 ,$350.35 ,$539.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$323.00 ,$209.95 ,$36.84 ,$323.00 ,$199.38 ,$209.95 ,$192.83 ,$79.75 ,$90.44 ,$181.20 ,$79.75 ,$212.53 ,$79.75 ,$274.55 ,$274.55 ,$79.75 ,$274.55 ,$151.52 ,$219.64 ,$199.36 ,$79.75 ,$79.75 ,$242.25 ,$229.33 ,$229.33 ,$79.75 ,$229.33 ,$264.86 ,$264.86 ,$264.86 , N/A ,$199.36 ,$274.55 ,$79.75 ,$323.00 ,$192.83 ,$79.75 ,$134.37 ,$40.52 ,$36.84 ,$79.75 ,$274.55 ,$167.46 ,$274.55 ,$90.44 ,$290.70 ,$79.75 ,$264.86 ,$272.94 ,$272.94 ,$79.75 ,$209.95 ,$323.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$3,154.00 ","$2,050.10 ",$91.91 ,"$3,154.00 ",$268.33 ,"$2,050.10 ","$1,882.94 ",$107.33 ,$883.12 ,"$1,769.39 ",$107.33 ,"$2,075.33 ",$107.33 ,"$2,680.90 ","$2,680.90 ",$107.33 ,"$2,680.90 ",$203.93 ,"$2,144.72 ",$268.33 ,$107.33 ,$107.33 ,"$2,365.50 ","$2,239.34 ","$2,239.34 ",$107.33 ,"$2,239.34 ","$2,586.28 ","$2,586.28 ","$2,586.28 ", N/A ,$268.33 ,"$2,680.90 ",$107.33 ,"$3,154.00 ","$1,882.94 ",$107.33 ,"$1,312.06 ",$101.10 ,$91.91 ,$107.33 ,"$2,680.90 ",$225.40 ,"$2,680.90 ",$883.12 ,"$2,838.60 ",$107.33 ,"$2,586.28 ","$2,665.13 ","$2,665.13 ",$107.33 ,"$2,050.10 ","$3,154.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$3,915.00 ","$2,544.75 ",$91.91 ,"$3,915.00 ",$440.25 ,"$2,544.75 ","$2,337.26 ",$176.10 ,"$1,096.20 ","$2,196.32 ",$176.10 ,"$2,576.07 ",$176.10 ,"$3,327.75 ","$3,327.75 ",$176.10 ,"$3,327.75 ",$334.60 ,"$2,662.20 ",$440.26 ,$176.10 ,$176.10 ,"$2,936.25 ","$2,779.65 ","$2,779.65 ",$176.10 ,"$2,779.65 ","$3,210.30 ","$3,210.30 ","$3,210.30 ", N/A ,$440.26 ,"$3,327.75 ",$176.10 ,"$3,915.00 ","$2,337.26 ",$176.10 ,"$1,628.64 ",$101.10 ,$91.91 ,$176.10 ,"$3,327.75 ",$369.82 ,"$3,327.75 ","$1,096.20 ","$3,523.50 ",$176.10 ,"$3,210.30 ","$3,308.18 ","$3,308.18 ",$176.10 ,"$2,544.75 ","$3,915.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$4,177.00 ","$2,715.05 ",$91.91 ,"$4,177.00 ",$440.25 ,"$2,715.05 ","$2,493.67 ",$176.10 ,"$1,169.56 ","$2,343.30 ",$176.10 ,"$2,748.47 ",$176.10 ,"$3,550.45 ","$3,550.45 ",$176.10 ,"$3,550.45 ",$334.60 ,"$2,840.36 ",$440.26 ,$176.10 ,$176.10 ,"$3,132.75 ","$2,965.67 ","$2,965.67 ",$176.10 ,"$2,965.67 ","$3,425.14 ","$3,425.14 ","$3,425.14 ", N/A ,$440.26 ,"$3,550.45 ",$176.10 ,"$4,177.00 ","$2,493.67 ",$176.10 ,"$1,737.63 ",$101.10 ,$91.91 ,$176.10 ,"$3,550.45 ",$369.82 ,"$3,550.45 ","$1,169.56 ","$3,759.30 ",$176.10 ,"$3,425.14 ","$3,529.57 ","$3,529.57 ",$176.10 ,"$2,715.05 ","$4,177.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$3,377.00 ","$2,195.05 ",$176.10 ,"$3,377.00 ",$440.25 ,"$2,195.05 ","$2,016.07 ",$176.10 ,$945.56 ,"$1,894.50 ",$176.10 ,"$2,222.07 ",$176.10 ,"$2,870.45 ","$2,870.45 ",$176.10 ,"$2,870.45 ",$334.60 ,"$2,296.36 ",$440.26 ,$176.10 ,$176.10 ,"$2,532.75 ","$2,397.67 ","$2,397.67 ",$176.10 ,"$2,397.67 ","$2,769.14 ","$2,769.14 ","$2,769.14 ", N/A ,$440.26 ,"$2,870.45 ",$176.10 ,"$3,377.00 ","$2,016.07 ",$176.10 ,"$1,404.83 ",$228.49 ,$207.72 ,$176.10 ,"$2,870.45 ",$369.82 ,"$2,870.45 ",$945.56 ,"$3,039.30 ",$176.10 ,"$2,769.14 ","$2,853.57 ","$2,853.57 ",$176.10 ,"$2,195.05 ","$3,377.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,460.00 ","$2,249.00 ",$226.85 ,"$3,460.00 ",$567.13 ,"$2,249.00 ","$2,065.62 ",$226.85 ,$968.80 ,"$1,941.06 ",$226.85 ,"$2,276.68 ",$226.85 ,"$2,941.00 ","$2,941.00 ",$226.85 ,"$2,941.00 ",$431.02 ,"$2,352.80 ",$567.13 ,$226.85 ,$226.85 ,"$2,595.00 ","$2,456.60 ","$2,456.60 ",$226.85 ,"$2,456.60 ","$2,837.20 ","$2,837.20 ","$2,837.20 ", N/A ,$567.13 ,"$2,941.00 ",$226.85 ,"$3,460.00 ","$2,065.62 ",$226.85 ,"$1,439.36 ",$346.76 ,$315.24 ,$226.85 ,"$2,941.00 ",$476.39 ,"$2,941.00 ",$968.80 ,"$3,114.00 ",$226.85 ,"$2,837.20 ","$2,923.70 ","$2,923.70 ",$226.85 ,"$2,249.00 ","$3,460.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,979.00 ","$2,586.35 ",$315.24 ,"$3,979.00 ","$1,763.33 ","$2,586.35 ","$2,375.46 ",$705.33 ,"$1,114.12 ","$2,232.22 ",$705.33 ,"$2,618.18 ",$705.33 ,"$3,382.15 ","$3,382.15 ",$705.33 ,"$3,382.15 ","$1,340.13 ","$2,705.72 ","$1,763.33 ",$705.33 ,$705.33 ,"$2,984.25 ","$2,825.09 ","$2,825.09 ",$705.33 ,"$2,825.09 ","$3,262.78 ","$3,262.78 ","$3,262.78 ", N/A ,"$1,763.33 ","$3,382.15 ",$705.33 ,"$3,979.00 ","$2,375.46 ",$705.33 ,"$1,655.26 ",$346.76 ,$315.24 ,$705.33 ,"$3,382.15 ","$1,481.19 ","$3,382.15 ","$1,114.12 ","$3,581.10 ",$705.33 ,"$3,262.78 ","$3,362.26 ","$3,362.26 ",$705.33 ,"$2,586.35 ","$3,979.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$506.00 ,$328.90 ,$36.84 ,$506.00 ,$199.38 ,$328.90 ,$302.08 ,$79.75 ,$141.68 ,$283.87 ,$79.75 ,$332.95 ,$79.75 ,$430.10 ,$430.10 ,$79.75 ,$430.10 ,$151.52 ,$344.08 ,$199.36 ,$79.75 ,$79.75 ,$379.50 ,$359.26 ,$359.26 ,$79.75 ,$359.26 ,$414.92 ,$414.92 ,$414.92 , N/A ,$199.36 ,$430.10 ,$79.75 ,$506.00 ,$302.08 ,$79.75 ,$210.50 ,$40.52 ,$36.84 ,$79.75 ,$430.10 ,$167.46 ,$430.10 ,$141.68 ,$455.40 ,$79.75 ,$414.92 ,$427.57 ,$427.57 ,$79.75 ,$328.90 ,$506.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$615.00 ,$399.75 ,$36.84 ,$615.00 ,$199.38 ,$399.75 ,$367.16 ,$79.75 ,$172.20 ,$345.02 ,$79.75 ,$404.67 ,$79.75 ,$522.75 ,$522.75 ,$79.75 ,$522.75 ,$151.52 ,$418.20 ,$199.36 ,$79.75 ,$79.75 ,$461.25 ,$436.65 ,$436.65 ,$79.75 ,$436.65 ,$504.30 ,$504.30 ,$504.30 , N/A ,$199.36 ,$522.75 ,$79.75 ,$615.00 ,$367.16 ,$79.75 ,$255.84 ,$40.52 ,$36.84 ,$79.75 ,$522.75 ,$167.46 ,$522.75 ,$172.20 ,$553.50 ,$79.75 ,$504.30 ,$519.68 ,$519.68 ,$79.75 ,$399.75 ,$615.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$769.00 ,$499.85 ,$36.84 ,$769.00 ,$268.33 ,$499.85 ,$459.09 ,$107.33 ,$215.32 ,$431.41 ,$107.33 ,$506.00 ,$107.33 ,$653.65 ,$653.65 ,$107.33 ,$653.65 ,$203.93 ,$522.92 ,$268.33 ,$107.33 ,$107.33 ,$576.75 ,$545.99 ,$545.99 ,$107.33 ,$545.99 ,$630.58 ,$630.58 ,$630.58 , N/A ,$268.33 ,$653.65 ,$107.33 ,$769.00 ,$459.09 ,$107.33 ,$319.90 ,$40.52 ,$36.84 ,$107.33 ,$653.65 ,$225.40 ,$653.65 ,$215.32 ,$692.10 ,$107.33 ,$630.58 ,$649.81 ,$649.81 ,$107.33 ,$499.85 ,$769.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,"$1,155.00 ",$750.75 ,$36.84 ,"$1,155.00 ",$268.33 ,$750.75 ,$689.54 ,$107.33 ,$323.40 ,$647.96 ,$107.33 ,$759.99 ,$107.33 ,$981.75 ,$981.75 ,$107.33 ,$981.75 ,$203.93 ,$785.40 ,$268.33 ,$107.33 ,$107.33 ,$866.25 ,$820.05 ,$820.05 ,$107.33 ,$820.05 ,$947.10 ,$947.10 ,$947.10 , N/A ,$268.33 ,$981.75 ,$107.33 ,"$1,155.00 ",$689.54 ,$107.33 ,$480.48 ,$40.52 ,$36.84 ,$107.33 ,$981.75 ,$225.40 ,$981.75 ,$323.40 ,"$1,039.50 ",$107.33 ,$947.10 ,$975.98 ,$975.98 ,$107.33 ,$750.75 ,"$1,155.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000172,72070,HC XR T-SPINE 2V,320,1 ,$385.00 ,$250.25 ,$36.84 ,$385.00 ,$268.33 ,$250.25 ,$229.85 ,$107.33 ,$107.80 ,$215.99 ,$107.33 ,$253.33 ,$107.33 ,$327.25 ,$327.25 ,$107.33 ,$327.25 ,$203.93 ,$261.80 ,$268.33 ,$107.33 ,$107.33 ,$288.75 ,$273.35 ,$273.35 ,$107.33 ,$273.35 ,$315.70 ,$315.70 ,$315.70 , N/A ,$268.33 ,$327.25 ,$107.33 ,$385.00 ,$229.85 ,$107.33 ,$160.16 ,$40.52 ,$36.84 ,$107.33 ,$327.25 ,$225.40 ,$327.25 ,$107.80 ,$346.50 ,$107.33 ,$315.70 ,$325.33 ,$325.33 ,$107.33 ,$250.25 ,$385.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000174,72072,HC XR T-SPINE 3V,320,1 ,$706.00 ,$458.90 ,$36.84 ,$706.00 ,$268.33 ,$458.90 ,$421.48 ,$107.33 ,$197.68 ,$396.07 ,$107.33 ,$464.55 ,$107.33 ,$600.10 ,$600.10 ,$107.33 ,$600.10 ,$203.93 ,$480.08 ,$268.33 ,$107.33 ,$107.33 ,$529.50 ,$501.26 ,$501.26 ,$107.33 ,$501.26 ,$578.92 ,$578.92 ,$578.92 , N/A ,$268.33 ,$600.10 ,$107.33 ,$706.00 ,$421.48 ,$107.33 ,$293.70 ,$40.52 ,$36.84 ,$107.33 ,$600.10 ,$225.40 ,$600.10 ,$197.68 ,$635.40 ,$107.33 ,$578.92 ,$596.57 ,$596.57 ,$107.33 ,$458.90 ,$706.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$750.00 ,$487.50 ,$36.84 ,$750.00 ,$268.33 ,$487.50 ,$447.75 ,$107.33 ,$210.00 ,$420.75 ,$107.33 ,$493.50 ,$107.33 ,$637.50 ,$637.50 ,$107.33 ,$637.50 ,$203.93 ,$510.00 ,$268.33 ,$107.33 ,$107.33 ,$562.50 ,$532.50 ,$532.50 ,$107.33 ,$532.50 ,$615.00 ,$615.00 ,$615.00 , N/A ,$268.33 ,$637.50 ,$107.33 ,$750.00 ,$447.75 ,$107.33 ,$312.00 ,$40.52 ,$36.84 ,$107.33 ,$637.50 ,$225.40 ,$637.50 ,$210.00 ,$675.00 ,$107.33 ,$615.00 ,$633.75 ,$633.75 ,$107.33 ,$487.50 ,$750.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000181,72110,HC XR L-SPINE 4+V,320,1 ,"$1,007.00 ",$654.55 ,$36.84 ,"$1,007.00 ",$268.33 ,$654.55 ,$601.18 ,$107.33 ,$281.96 ,$564.93 ,$107.33 ,$662.61 ,$107.33 ,$855.95 ,$855.95 ,$107.33 ,$855.95 ,$203.93 ,$684.76 ,$268.33 ,$107.33 ,$107.33 ,$755.25 ,$714.97 ,$714.97 ,$107.33 ,$714.97 ,$825.74 ,$825.74 ,$825.74 , N/A ,$268.33 ,$855.95 ,$107.33 ,"$1,007.00 ",$601.18 ,$107.33 ,$418.91 ,$40.52 ,$36.84 ,$107.33 ,$855.95 ,$225.40 ,$855.95 ,$281.96 ,$906.30 ,$107.33 ,$825.74 ,$850.92 ,$850.92 ,$107.33 ,$654.55 ,"$1,007.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000183,72120,HC XR L-SPINE BENDING ONLY MIN 4V,320,1 ,$423.00 ,$274.95 ,$36.84 ,$423.00 ,$268.33 ,$274.95 ,$252.53 ,$107.33 ,$118.44 ,$237.30 ,$107.33 ,$278.33 ,$107.33 ,$359.55 ,$359.55 ,$107.33 ,$359.55 ,$203.93 ,$287.64 ,$268.33 ,$107.33 ,$107.33 ,$317.25 ,$300.33 ,$300.33 ,$107.33 ,$300.33 ,$346.86 ,$346.86 ,$346.86 , N/A ,$268.33 ,$359.55 ,$107.33 ,$423.00 ,$252.53 ,$107.33 ,$175.97 ,$40.52 ,$36.84 ,$107.33 ,$359.55 ,$225.40 ,$359.55 ,$118.44 ,$380.70 ,$107.33 ,$346.86 ,$357.44 ,$357.44 ,$107.33 ,$274.95 ,$423.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,"$1,203.00 ",$781.95 ,$36.84 ,"$1,203.00 ",$268.33 ,$781.95 ,$718.19 ,$107.33 ,$336.84 ,$674.88 ,$107.33 ,$791.57 ,$107.33 ,"$1,022.55 ","$1,022.55 ",$107.33 ,"$1,022.55 ",$203.93 ,$818.04 ,$268.33 ,$107.33 ,$107.33 ,$902.25 ,$854.13 ,$854.13 ,$107.33 ,$854.13 ,$986.46 ,$986.46 ,$986.46 , N/A ,$268.33 ,"$1,022.55 ",$107.33 ,"$1,203.00 ",$718.19 ,$107.33 ,$500.45 ,$40.52 ,$36.84 ,$107.33 ,"$1,022.55 ",$225.40 ,"$1,022.55 ",$336.84 ,"$1,082.70 ",$107.33 ,$986.46 ,"$1,016.54 ","$1,016.54 ",$107.33 ,$781.95 ,"$1,203.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000186,72170,HC XR PELVIS 1-2V,320,1 ,$501.00 ,$325.65 ,$36.84 ,$501.00 ,$268.33 ,$325.65 ,$299.10 ,$107.33 ,$140.28 ,$281.06 ,$107.33 ,$329.66 ,$107.33 ,$425.85 ,$425.85 ,$107.33 ,$425.85 ,$203.93 ,$340.68 ,$268.33 ,$107.33 ,$107.33 ,$375.75 ,$355.71 ,$355.71 ,$107.33 ,$355.71 ,$410.82 ,$410.82 ,$410.82 , N/A ,$268.33 ,$425.85 ,$107.33 ,$501.00 ,$299.10 ,$107.33 ,$208.42 ,$40.52 ,$36.84 ,$107.33 ,$425.85 ,$225.40 ,$425.85 ,$140.28 ,$450.90 ,$107.33 ,$410.82 ,$423.35 ,$423.35 ,$107.33 ,$325.65 ,$501.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$546.00 ,$354.90 ,$36.84 ,$546.00 ,$268.33 ,$354.90 ,$325.96 ,$107.33 ,$152.88 ,$306.31 ,$107.33 ,$359.27 ,$107.33 ,$464.10 ,$464.10 ,$107.33 ,$464.10 ,$203.93 ,$371.28 ,$268.33 ,$107.33 ,$107.33 ,$409.50 ,$387.66 ,$387.66 ,$107.33 ,$387.66 ,$447.72 ,$447.72 ,$447.72 , N/A ,$268.33 ,$464.10 ,$107.33 ,$546.00 ,$325.96 ,$107.33 ,$227.14 ,$40.52 ,$36.84 ,$107.33 ,$464.10 ,$225.40 ,$464.10 ,$152.88 ,$491.40 ,$107.33 ,$447.72 ,$461.37 ,$461.37 ,$107.33 ,$354.90 ,$546.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$539.00 ,$350.35 ,$36.84 ,$539.00 ,$199.38 ,$350.35 ,$321.78 ,$79.75 ,$150.92 ,$302.38 ,$79.75 ,$354.66 ,$79.75 ,$458.15 ,$458.15 ,$79.75 ,$458.15 ,$151.52 ,$366.52 ,$199.36 ,$79.75 ,$79.75 ,$404.25 ,$382.69 ,$382.69 ,$79.75 ,$382.69 ,$441.98 ,$441.98 ,$441.98 , N/A ,$199.36 ,$458.15 ,$79.75 ,$539.00 ,$321.78 ,$79.75 ,$224.22 ,$40.52 ,$36.84 ,$79.75 ,$458.15 ,$167.46 ,$458.15 ,$150.92 ,$485.10 ,$79.75 ,$441.98 ,$455.46 ,$455.46 ,$79.75 ,$350.35 ,$539.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000201,73000,HC XRAY CLAVICLE,320,1 ,$409.00 ,$265.85 ,$36.84 ,$409.00 ,$199.38 ,$265.85 ,$244.17 ,$79.75 ,$114.52 ,$229.45 ,$79.75 ,$269.12 ,$79.75 ,$347.65 ,$347.65 ,$79.75 ,$347.65 ,$151.52 ,$278.12 ,$199.36 ,$79.75 ,$79.75 ,$306.75 ,$290.39 ,$290.39 ,$79.75 ,$290.39 ,$335.38 ,$335.38 ,$335.38 , N/A ,$199.36 ,$347.65 ,$79.75 ,$409.00 ,$244.17 ,$79.75 ,$170.14 ,$40.52 ,$36.84 ,$79.75 ,$347.65 ,$167.46 ,$347.65 ,$114.52 ,$368.10 ,$79.75 ,$335.38 ,$345.61 ,$345.61 ,$79.75 ,$265.85 ,$409.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000204,73010,HC XRAY SCAPULA,320,1 ,$409.00 ,$265.85 ,$36.84 ,$409.00 ,$268.33 ,$265.85 ,$244.17 ,$107.33 ,$114.52 ,$229.45 ,$107.33 ,$269.12 ,$107.33 ,$347.65 ,$347.65 ,$107.33 ,$347.65 ,$203.93 ,$278.12 ,$268.33 ,$107.33 ,$107.33 ,$306.75 ,$290.39 ,$290.39 ,$107.33 ,$290.39 ,$335.38 ,$335.38 ,$335.38 , N/A ,$268.33 ,$347.65 ,$107.33 ,$409.00 ,$244.17 ,$107.33 ,$170.14 ,$40.52 ,$36.84 ,$107.33 ,$347.65 ,$225.40 ,$347.65 ,$114.52 ,$368.10 ,$107.33 ,$335.38 ,$345.61 ,$345.61 ,$107.33 ,$265.85 ,$409.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$399.00 ,$259.35 ,$36.84 ,$399.00 ,$199.38 ,$259.35 ,$238.20 ,$79.75 ,$111.72 ,$223.84 ,$79.75 ,$262.54 ,$79.75 ,$339.15 ,$339.15 ,$79.75 ,$339.15 ,$151.52 ,$271.32 ,$199.36 ,$79.75 ,$79.75 ,$299.25 ,$283.29 ,$283.29 ,$79.75 ,$283.29 ,$327.18 ,$327.18 ,$327.18 , N/A ,$199.36 ,$339.15 ,$79.75 ,$399.00 ,$238.20 ,$79.75 ,$165.98 ,$40.52 ,$36.84 ,$79.75 ,$339.15 ,$167.46 ,$339.15 ,$111.72 ,$359.10 ,$79.75 ,$327.18 ,$337.16 ,$337.16 ,$79.75 ,$259.35 ,$399.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$562.00 ,$365.30 ,$36.84 ,$562.00 ,$199.38 ,$365.30 ,$335.51 ,$79.75 ,$157.36 ,$315.28 ,$79.75 ,$369.80 ,$79.75 ,$477.70 ,$477.70 ,$79.75 ,$477.70 ,$151.52 ,$382.16 ,$199.36 ,$79.75 ,$79.75 ,$421.50 ,$399.02 ,$399.02 ,$79.75 ,$399.02 ,$460.84 ,$460.84 ,$460.84 , N/A ,$199.36 ,$477.70 ,$79.75 ,$562.00 ,$335.51 ,$79.75 ,$233.79 ,$40.52 ,$36.84 ,$79.75 ,$477.70 ,$167.46 ,$477.70 ,$157.36 ,$505.80 ,$79.75 ,$460.84 ,$474.89 ,$474.89 ,$79.75 ,$365.30 ,$562.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,705.00 ","$1,108.25 ",$209.93 ,"$1,705.00 ",$907.63 ,"$1,108.25 ","$1,017.89 ",$363.05 ,$477.40 ,$956.51 ,$363.05 ,"$1,121.89 ",$363.05 ,"$1,449.25 ","$1,449.25 ",$363.05 ,"$1,449.25 ",$689.79 ,"$1,159.40 ",$907.62 ,$363.05 ,$363.05 ,"$1,278.75 ","$1,210.55 ","$1,210.55 ",$363.05 ,"$1,210.55 ","$1,398.10 ","$1,398.10 ","$1,398.10 ", N/A ,$907.62 ,"$1,449.25 ",$363.05 ,"$1,705.00 ","$1,017.89 ",$363.05 ,$709.28 ,$230.92 ,$209.93 ,$363.05 ,"$1,449.25 ",$762.40 ,"$1,449.25 ",$477.40 ,"$1,534.50 ",$363.05 ,"$1,398.10 ","$1,440.73 ","$1,440.73 ",$363.05 ,"$1,108.25 ","$1,705.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$356.00 ,$231.40 ,$36.84 ,$356.00 ,$199.38 ,$231.40 ,$212.53 ,$79.75 ,$99.68 ,$199.72 ,$79.75 ,$234.25 ,$79.75 ,$302.60 ,$302.60 ,$79.75 ,$302.60 ,$151.52 ,$242.08 ,$199.36 ,$79.75 ,$79.75 ,$267.00 ,$252.76 ,$252.76 ,$79.75 ,$252.76 ,$291.92 ,$291.92 ,$291.92 , N/A ,$199.36 ,$302.60 ,$79.75 ,$356.00 ,$212.53 ,$79.75 ,$148.10 ,$40.52 ,$36.84 ,$79.75 ,$302.60 ,$167.46 ,$302.60 ,$99.68 ,$320.40 ,$79.75 ,$291.92 ,$300.82 ,$300.82 ,$79.75 ,$231.40 ,$356.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$494.00 ,$321.10 ,$36.84 ,$494.00 ,$199.38 ,$321.10 ,$294.92 ,$79.75 ,$138.32 ,$277.13 ,$79.75 ,$325.05 ,$79.75 ,$419.90 ,$419.90 ,$79.75 ,$419.90 ,$151.52 ,$335.92 ,$199.36 ,$79.75 ,$79.75 ,$370.50 ,$350.74 ,$350.74 ,$79.75 ,$350.74 ,$405.08 ,$405.08 ,$405.08 , N/A ,$199.36 ,$419.90 ,$79.75 ,$494.00 ,$294.92 ,$79.75 ,$205.50 ,$40.52 ,$36.84 ,$79.75 ,$419.90 ,$167.46 ,$419.90 ,$138.32 ,$444.60 ,$79.75 ,$405.08 ,$417.43 ,$417.43 ,$79.75 ,$321.10 ,$494.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$421.00 ,$273.65 ,$36.84 ,$421.00 ,$199.38 ,$273.65 ,$251.34 ,$79.75 ,$117.88 ,$236.18 ,$79.75 ,$277.02 ,$79.75 ,$357.85 ,$357.85 ,$79.75 ,$357.85 ,$151.52 ,$286.28 ,$199.36 ,$79.75 ,$79.75 ,$315.75 ,$298.91 ,$298.91 ,$79.75 ,$298.91 ,$345.22 ,$345.22 ,$345.22 , N/A ,$199.36 ,$357.85 ,$79.75 ,$421.00 ,$251.34 ,$79.75 ,$175.14 ,$40.52 ,$36.84 ,$79.75 ,$357.85 ,$167.46 ,$357.85 ,$117.88 ,$378.90 ,$79.75 ,$345.22 ,$355.75 ,$355.75 ,$79.75 ,$273.65 ,$421.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$524.00 ,$340.60 ,$36.84 ,$524.00 ,$199.38 ,$340.60 ,$312.83 ,$79.75 ,$146.72 ,$293.96 ,$79.75 ,$344.79 ,$79.75 ,$445.40 ,$445.40 ,$79.75 ,$445.40 ,$151.52 ,$356.32 ,$199.36 ,$79.75 ,$79.75 ,$393.00 ,$372.04 ,$372.04 ,$79.75 ,$372.04 ,$429.68 ,$429.68 ,$429.68 , N/A ,$199.36 ,$445.40 ,$79.75 ,$524.00 ,$312.83 ,$79.75 ,$217.98 ,$40.52 ,$36.84 ,$79.75 ,$445.40 ,$167.46 ,$445.40 ,$146.72 ,$471.60 ,$79.75 ,$429.68 ,$442.78 ,$442.78 ,$79.75 ,$340.60 ,$524.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,"$1,429.00 ",$928.85 ,$209.93 ,"$1,429.00 ",$907.63 ,$928.85 ,$853.11 ,$363.05 ,$400.12 ,$801.67 ,$363.05 ,$940.28 ,$363.05 ,"$1,214.65 ","$1,214.65 ",$363.05 ,"$1,214.65 ",$689.79 ,$971.72 ,$907.62 ,$363.05 ,$363.05 ,"$1,071.75 ","$1,014.59 ","$1,014.59 ",$363.05 ,"$1,014.59 ","$1,171.78 ","$1,171.78 ","$1,171.78 ", N/A ,$907.62 ,"$1,214.65 ",$363.05 ,"$1,429.00 ",$853.11 ,$363.05 ,$594.46 ,$230.92 ,$209.93 ,$363.05 ,"$1,214.65 ",$762.40 ,"$1,214.65 ",$400.12 ,"$1,286.10 ",$363.05 ,"$1,171.78 ","$1,207.51 ","$1,207.51 ",$363.05 ,$928.85 ,"$1,429.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$462.00 ,$300.30 ,$36.84 ,$462.00 ,$199.38 ,$300.30 ,$275.81 ,$79.75 ,$129.36 ,$259.18 ,$79.75 ,$304.00 ,$79.75 ,$392.70 ,$392.70 ,$79.75 ,$392.70 ,$151.52 ,$314.16 ,$199.36 ,$79.75 ,$79.75 ,$346.50 ,$328.02 ,$328.02 ,$79.75 ,$328.02 ,$378.84 ,$378.84 ,$378.84 , N/A ,$199.36 ,$392.70 ,$79.75 ,$462.00 ,$275.81 ,$79.75 ,$192.19 ,$40.52 ,$36.84 ,$79.75 ,$392.70 ,$167.46 ,$392.70 ,$129.36 ,$415.80 ,$79.75 ,$378.84 ,$390.39 ,$390.39 ,$79.75 ,$300.30 ,$462.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$436.00 ,$283.40 ,$36.84 ,$436.00 ,$268.33 ,$283.40 ,$260.29 ,$107.33 ,$122.08 ,$244.60 ,$107.33 ,$286.89 ,$107.33 ,$370.60 ,$370.60 ,$107.33 ,$370.60 ,$203.93 ,$296.48 ,$268.33 ,$107.33 ,$107.33 ,$327.00 ,$309.56 ,$309.56 ,$107.33 ,$309.56 ,$357.52 ,$357.52 ,$357.52 , N/A ,$268.33 ,$370.60 ,$107.33 ,$436.00 ,$260.29 ,$107.33 ,$181.38 ,$40.52 ,$36.84 ,$107.33 ,$370.60 ,$225.40 ,$370.60 ,$122.08 ,$392.40 ,$107.33 ,$357.52 ,$368.42 ,$368.42 ,$107.33 ,$283.40 ,$436.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$409.00 ,$265.85 ,$36.84 ,$409.00 ,$199.38 ,$265.85 ,$244.17 ,$79.75 ,$114.52 ,$229.45 ,$79.75 ,$269.12 ,$79.75 ,$347.65 ,$347.65 ,$79.75 ,$347.65 ,$151.52 ,$278.12 ,$199.36 ,$79.75 ,$79.75 ,$306.75 ,$290.39 ,$290.39 ,$79.75 ,$290.39 ,$335.38 ,$335.38 ,$335.38 , N/A ,$199.36 ,$347.65 ,$79.75 ,$409.00 ,$244.17 ,$79.75 ,$170.14 ,$40.52 ,$36.84 ,$79.75 ,$347.65 ,$167.46 ,$347.65 ,$114.52 ,$368.10 ,$79.75 ,$335.38 ,$345.61 ,$345.61 ,$79.75 ,$265.85 ,$409.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$505.00 ,$328.25 ,$36.84 ,$505.00 ,$199.38 ,$328.25 ,$301.49 ,$79.75 ,$141.40 ,$283.31 ,$79.75 ,$332.29 ,$79.75 ,$429.25 ,$429.25 ,$79.75 ,$429.25 ,$151.52 ,$343.40 ,$199.36 ,$79.75 ,$79.75 ,$378.75 ,$358.55 ,$358.55 ,$79.75 ,$358.55 ,$414.10 ,$414.10 ,$414.10 , N/A ,$199.36 ,$429.25 ,$79.75 ,$505.00 ,$301.49 ,$79.75 ,$210.08 ,$40.52 ,$36.84 ,$79.75 ,$429.25 ,$167.46 ,$429.25 ,$141.40 ,$454.50 ,$79.75 ,$414.10 ,$426.73 ,$426.73 ,$79.75 ,$328.25 ,$505.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,"$1,454.00 ",$945.10 ,$209.93 ,"$1,454.00 ",$907.63 ,$945.10 ,$868.04 ,$363.05 ,$407.12 ,$815.69 ,$363.05 ,$956.73 ,$363.05 ,"$1,235.90 ","$1,235.90 ",$363.05 ,"$1,235.90 ",$689.79 ,$988.72 ,$907.62 ,$363.05 ,$363.05 ,"$1,090.50 ","$1,032.34 ","$1,032.34 ",$363.05 ,"$1,032.34 ","$1,192.28 ","$1,192.28 ","$1,192.28 ", N/A ,$907.62 ,"$1,235.90 ",$363.05 ,"$1,454.00 ",$868.04 ,$363.05 ,$604.86 ,$230.92 ,$209.93 ,$363.05 ,"$1,235.90 ",$762.40 ,"$1,235.90 ",$407.12 ,"$1,308.60 ",$363.05 ,"$1,192.28 ","$1,228.63 ","$1,228.63 ",$363.05 ,$945.10 ,"$1,454.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$472.00 ,$306.80 ,$36.84 ,$472.00 ,$268.33 ,$306.80 ,$281.78 ,$107.33 ,$132.16 ,$264.79 ,$107.33 ,$310.58 ,$107.33 ,$401.20 ,$401.20 ,$107.33 ,$401.20 ,$203.93 ,$320.96 ,$268.33 ,$107.33 ,$107.33 ,$354.00 ,$335.12 ,$335.12 ,$107.33 ,$335.12 ,$387.04 ,$387.04 ,$387.04 , N/A ,$268.33 ,$401.20 ,$107.33 ,$472.00 ,$281.78 ,$107.33 ,$196.35 ,$40.52 ,$36.84 ,$107.33 ,$401.20 ,$225.40 ,$401.20 ,$132.16 ,$424.80 ,$107.33 ,$387.04 ,$398.84 ,$398.84 ,$107.33 ,$306.80 ,$472.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$487.00 ,$316.55 ,$36.84 ,$487.00 ,$199.38 ,$316.55 ,$290.74 ,$79.75 ,$136.36 ,$273.21 ,$79.75 ,$320.45 ,$79.75 ,$413.95 ,$413.95 ,$79.75 ,$413.95 ,$151.52 ,$331.16 ,$199.36 ,$79.75 ,$79.75 ,$365.25 ,$345.77 ,$345.77 ,$79.75 ,$345.77 ,$399.34 ,$399.34 ,$399.34 , N/A ,$199.36 ,$413.95 ,$79.75 ,$487.00 ,$290.74 ,$79.75 ,$202.59 ,$40.52 ,$36.84 ,$79.75 ,$413.95 ,$167.46 ,$413.95 ,$136.36 ,$438.30 ,$79.75 ,$399.34 ,$411.52 ,$411.52 ,$79.75 ,$316.55 ,$487.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$949.00 ,$616.85 ,$55.26 ,$949.00 ,$199.38 ,$616.85 ,$566.55 ,$79.75 ,$265.72 ,$532.39 ,$79.75 ,$624.44 ,$79.75 ,$806.65 ,$806.65 ,$79.75 ,$806.65 ,$151.52 ,$645.32 ,$199.36 ,$79.75 ,$79.75 ,$711.75 ,$673.79 ,$673.79 ,$79.75 ,$673.79 ,$778.18 ,$778.18 ,$778.18 , N/A ,$199.36 ,$806.65 ,$79.75 ,$949.00 ,$566.55 ,$79.75 ,$394.78 ,$60.79 ,$55.26 ,$79.75 ,$806.65 ,$167.46 ,$806.65 ,$265.72 ,$854.10 ,$79.75 ,$778.18 ,$801.91 ,$801.91 ,$79.75 ,$616.85 ,$949.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$633.00 ,$411.45 ,$36.84 ,$633.00 ,$199.38 ,$411.45 ,$377.90 ,$79.75 ,$177.24 ,$355.11 ,$79.75 ,$416.51 ,$79.75 ,$538.05 ,$538.05 ,$79.75 ,$538.05 ,$151.52 ,$430.44 ,$199.36 ,$79.75 ,$79.75 ,$474.75 ,$449.43 ,$449.43 ,$79.75 ,$449.43 ,$519.06 ,$519.06 ,$519.06 , N/A ,$199.36 ,$538.05 ,$79.75 ,$633.00 ,$377.90 ,$79.75 ,$263.33 ,$40.52 ,$36.84 ,$79.75 ,$538.05 ,$167.46 ,$538.05 ,$177.24 ,$569.70 ,$79.75 ,$519.06 ,$534.89 ,$534.89 ,$79.75 ,$411.45 ,$633.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,500.00 ",$975.00 ,$209.93 ,"$1,500.00 ",$907.63 ,$975.00 ,$895.50 ,$363.05 ,$420.00 ,$841.50 ,$363.05 ,$987.00 ,$363.05 ,"$1,275.00 ","$1,275.00 ",$363.05 ,"$1,275.00 ",$689.79 ,"$1,020.00 ",$907.62 ,$363.05 ,$363.05 ,"$1,125.00 ","$1,065.00 ","$1,065.00 ",$363.05 ,"$1,065.00 ","$1,230.00 ","$1,230.00 ","$1,230.00 ", N/A ,$907.62 ,"$1,275.00 ",$363.05 ,"$1,500.00 ",$895.50 ,$363.05 ,$624.00 ,$230.92 ,$209.93 ,$363.05 ,"$1,275.00 ",$762.40 ,"$1,275.00 ",$420.00 ,"$1,350.00 ",$363.05 ,"$1,230.00 ","$1,267.50 ","$1,267.50 ",$363.05 ,$975.00 ,"$1,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$494.00 ,$321.10 ,$36.84 ,$494.00 ,$199.38 ,$321.10 ,$294.92 ,$79.75 ,$138.32 ,$277.13 ,$79.75 ,$325.05 ,$79.75 ,$419.90 ,$419.90 ,$79.75 ,$419.90 ,$151.52 ,$335.92 ,$199.36 ,$79.75 ,$79.75 ,$370.50 ,$350.74 ,$350.74 ,$79.75 ,$350.74 ,$405.08 ,$405.08 ,$405.08 , N/A ,$199.36 ,$419.90 ,$79.75 ,$494.00 ,$294.92 ,$79.75 ,$205.50 ,$40.52 ,$36.84 ,$79.75 ,$419.90 ,$167.46 ,$419.90 ,$138.32 ,$444.60 ,$79.75 ,$405.08 ,$417.43 ,$417.43 ,$79.75 ,$321.10 ,$494.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$598.00 ,$388.70 ,$36.84 ,$598.00 ,$199.38 ,$388.70 ,$357.01 ,$79.75 ,$167.44 ,$335.48 ,$79.75 ,$393.48 ,$79.75 ,$508.30 ,$508.30 ,$79.75 ,$508.30 ,$151.52 ,$406.64 ,$199.36 ,$79.75 ,$79.75 ,$448.50 ,$424.58 ,$424.58 ,$79.75 ,$424.58 ,$490.36 ,$490.36 ,$490.36 , N/A ,$199.36 ,$508.30 ,$79.75 ,$598.00 ,$357.01 ,$79.75 ,$248.77 ,$40.52 ,$36.84 ,$79.75 ,$508.30 ,$167.46 ,$508.30 ,$167.44 ,$538.20 ,$79.75 ,$490.36 ,$505.31 ,$505.31 ,$79.75 ,$388.70 ,$598.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$619.00 ,$402.35 ,$36.84 ,$619.00 ,$268.33 ,$402.35 ,$369.54 ,$107.33 ,$173.32 ,$347.26 ,$107.33 ,$407.30 ,$107.33 ,$526.15 ,$526.15 ,$107.33 ,$526.15 ,$203.93 ,$420.92 ,$268.33 ,$107.33 ,$107.33 ,$464.25 ,$439.49 ,$439.49 ,$107.33 ,$439.49 ,$507.58 ,$507.58 ,$507.58 , N/A ,$268.33 ,$526.15 ,$107.33 ,$619.00 ,$369.54 ,$107.33 ,$257.50 ,$40.52 ,$36.84 ,$107.33 ,$526.15 ,$225.40 ,$526.15 ,$173.32 ,$557.10 ,$107.33 ,$507.58 ,$523.06 ,$523.06 ,$107.33 ,$402.35 ,$619.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000267,73565,HC XR KNEE STAND,320,1 ,$845.00 ,$549.25 ,$36.84 ,$845.00 ,$199.38 ,$549.25 ,$504.47 ,$79.75 ,$236.60 ,$474.05 ,$79.75 ,$556.01 ,$79.75 ,$718.25 ,$718.25 ,$79.75 ,$718.25 ,$151.52 ,$574.60 ,$199.36 ,$79.75 ,$79.75 ,$633.75 ,$599.95 ,$599.95 ,$79.75 ,$599.95 ,$692.90 ,$692.90 ,$692.90 , N/A ,$199.36 ,$718.25 ,$79.75 ,$845.00 ,$504.47 ,$79.75 ,$351.52 ,$40.52 ,$36.84 ,$79.75 ,$718.25 ,$167.46 ,$718.25 ,$236.60 ,$760.50 ,$79.75 ,$692.90 ,$714.03 ,$714.03 ,$79.75 ,$549.25 ,$845.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,454.00 ",$945.10 ,$209.93 ,"$1,454.00 ",$907.63 ,$945.10 ,$868.04 ,$363.05 ,$407.12 ,$815.69 ,$363.05 ,$956.73 ,$363.05 ,"$1,235.90 ","$1,235.90 ",$363.05 ,"$1,235.90 ",$689.79 ,$988.72 ,$907.62 ,$363.05 ,$363.05 ,"$1,090.50 ","$1,032.34 ","$1,032.34 ",$363.05 ,"$1,032.34 ","$1,192.28 ","$1,192.28 ","$1,192.28 ", N/A ,$907.62 ,"$1,235.90 ",$363.05 ,"$1,454.00 ",$868.04 ,$363.05 ,$604.86 ,$230.92 ,$209.93 ,$363.05 ,"$1,235.90 ",$762.40 ,"$1,235.90 ",$407.12 ,"$1,308.60 ",$363.05 ,"$1,192.28 ","$1,228.63 ","$1,228.63 ",$363.05 ,$945.10 ,"$1,454.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$534.00 ,$347.10 ,$36.84 ,$534.00 ,$199.38 ,$347.10 ,$318.80 ,$79.75 ,$149.52 ,$299.57 ,$79.75 ,$351.37 ,$79.75 ,$453.90 ,$453.90 ,$79.75 ,$453.90 ,$151.52 ,$363.12 ,$199.36 ,$79.75 ,$79.75 ,$400.50 ,$379.14 ,$379.14 ,$79.75 ,$379.14 ,$437.88 ,$437.88 ,$437.88 , N/A ,$199.36 ,$453.90 ,$79.75 ,$534.00 ,$318.80 ,$79.75 ,$222.14 ,$40.52 ,$36.84 ,$79.75 ,$453.90 ,$167.46 ,$453.90 ,$149.52 ,$480.60 ,$79.75 ,$437.88 ,$451.23 ,$451.23 ,$79.75 ,$347.10 ,$534.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$401.00 ,$260.65 ,$36.84 ,$401.00 ,$199.38 ,$260.65 ,$239.40 ,$79.75 ,$112.28 ,$224.96 ,$79.75 ,$263.86 ,$79.75 ,$340.85 ,$340.85 ,$79.75 ,$340.85 ,$151.52 ,$272.68 ,$199.36 ,$79.75 ,$79.75 ,$300.75 ,$284.71 ,$284.71 ,$79.75 ,$284.71 ,$328.82 ,$328.82 ,$328.82 , N/A ,$199.36 ,$340.85 ,$79.75 ,$401.00 ,$239.40 ,$79.75 ,$166.82 ,$40.52 ,$36.84 ,$79.75 ,$340.85 ,$167.46 ,$340.85 ,$112.28 ,$360.90 ,$79.75 ,$328.82 ,$338.85 ,$338.85 ,$79.75 ,$260.65 ,$401.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$421.00 ,$273.65 ,$36.84 ,$421.00 ,$199.38 ,$273.65 ,$251.34 ,$79.75 ,$117.88 ,$236.18 ,$79.75 ,$277.02 ,$79.75 ,$357.85 ,$357.85 ,$79.75 ,$357.85 ,$151.52 ,$286.28 ,$199.36 ,$79.75 ,$79.75 ,$315.75 ,$298.91 ,$298.91 ,$79.75 ,$298.91 ,$345.22 ,$345.22 ,$345.22 , N/A ,$199.36 ,$357.85 ,$79.75 ,$421.00 ,$251.34 ,$79.75 ,$175.14 ,$40.52 ,$36.84 ,$79.75 ,$357.85 ,$167.46 ,$357.85 ,$117.88 ,$378.90 ,$79.75 ,$345.22 ,$355.75 ,$355.75 ,$79.75 ,$273.65 ,$421.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$562.00 ,$365.30 ,$36.84 ,$562.00 ,$199.38 ,$365.30 ,$335.51 ,$79.75 ,$157.36 ,$315.28 ,$79.75 ,$369.80 ,$79.75 ,$477.70 ,$477.70 ,$79.75 ,$477.70 ,$151.52 ,$382.16 ,$199.36 ,$79.75 ,$79.75 ,$421.50 ,$399.02 ,$399.02 ,$79.75 ,$399.02 ,$460.84 ,$460.84 ,$460.84 , N/A ,$199.36 ,$477.70 ,$79.75 ,$562.00 ,$335.51 ,$79.75 ,$233.79 ,$40.52 ,$36.84 ,$79.75 ,$477.70 ,$167.46 ,$477.70 ,$157.36 ,$505.80 ,$79.75 ,$460.84 ,$474.89 ,$474.89 ,$79.75 ,$365.30 ,$562.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,381.00 ",$897.65 ,$209.93 ,"$1,381.00 ",$907.63 ,$897.65 ,$824.46 ,$363.05 ,$386.68 ,$774.74 ,$363.05 ,$908.70 ,$363.05 ,"$1,173.85 ","$1,173.85 ",$363.05 ,"$1,173.85 ",$689.79 ,$939.08 ,$907.62 ,$363.05 ,$363.05 ,"$1,035.75 ",$980.51 ,$980.51 ,$363.05 ,$980.51 ,"$1,132.42 ","$1,132.42 ","$1,132.42 ", N/A ,$907.62 ,"$1,173.85 ",$363.05 ,"$1,381.00 ",$824.46 ,$363.05 ,$574.50 ,$230.92 ,$209.93 ,$363.05 ,"$1,173.85 ",$762.40 ,"$1,173.85 ",$386.68 ,"$1,242.90 ",$363.05 ,"$1,132.42 ","$1,166.95 ","$1,166.95 ",$363.05 ,$897.65 ,"$1,381.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$421.00 ,$273.65 ,$36.84 ,$421.00 ,$199.38 ,$273.65 ,$251.34 ,$79.75 ,$117.88 ,$236.18 ,$79.75 ,$277.02 ,$79.75 ,$357.85 ,$357.85 ,$79.75 ,$357.85 ,$151.52 ,$286.28 ,$199.36 ,$79.75 ,$79.75 ,$315.75 ,$298.91 ,$298.91 ,$79.75 ,$298.91 ,$345.22 ,$345.22 ,$345.22 , N/A ,$199.36 ,$357.85 ,$79.75 ,$421.00 ,$251.34 ,$79.75 ,$175.14 ,$40.52 ,$36.84 ,$79.75 ,$357.85 ,$167.46 ,$357.85 ,$117.88 ,$378.90 ,$79.75 ,$345.22 ,$355.75 ,$355.75 ,$79.75 ,$273.65 ,$421.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$534.00 ,$347.10 ,$36.84 ,$534.00 ,$199.38 ,$347.10 ,$318.80 ,$79.75 ,$149.52 ,$299.57 ,$79.75 ,$351.37 ,$79.75 ,$453.90 ,$453.90 ,$79.75 ,$453.90 ,$151.52 ,$363.12 ,$199.36 ,$79.75 ,$79.75 ,$400.50 ,$379.14 ,$379.14 ,$79.75 ,$379.14 ,$437.88 ,$437.88 ,$437.88 , N/A ,$199.36 ,$453.90 ,$79.75 ,$534.00 ,$318.80 ,$79.75 ,$222.14 ,$40.52 ,$36.84 ,$79.75 ,$453.90 ,$167.46 ,$453.90 ,$149.52 ,$480.60 ,$79.75 ,$437.88 ,$451.23 ,$451.23 ,$79.75 ,$347.10 ,$534.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$409.00 ,$265.85 ,$36.84 ,$409.00 ,$199.38 ,$265.85 ,$244.17 ,$79.75 ,$114.52 ,$229.45 ,$79.75 ,$269.12 ,$79.75 ,$347.65 ,$347.65 ,$79.75 ,$347.65 ,$151.52 ,$278.12 ,$199.36 ,$79.75 ,$79.75 ,$306.75 ,$290.39 ,$290.39 ,$79.75 ,$290.39 ,$335.38 ,$335.38 ,$335.38 , N/A ,$199.36 ,$347.65 ,$79.75 ,$409.00 ,$244.17 ,$79.75 ,$170.14 ,$40.52 ,$36.84 ,$79.75 ,$347.65 ,$167.46 ,$347.65 ,$114.52 ,$368.10 ,$79.75 ,$335.38 ,$345.61 ,$345.61 ,$79.75 ,$265.85 ,$409.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$351.00 ,$228.15 ,$36.84 ,$351.00 ,$199.38 ,$228.15 ,$209.55 ,$79.75 ,$98.28 ,$196.91 ,$79.75 ,$230.96 ,$79.75 ,$298.35 ,$298.35 ,$79.75 ,$298.35 ,$151.52 ,$238.68 ,$199.36 ,$79.75 ,$79.75 ,$263.25 ,$249.21 ,$249.21 ,$79.75 ,$249.21 ,$287.82 ,$287.82 ,$287.82 , N/A ,$199.36 ,$298.35 ,$79.75 ,$351.00 ,$209.55 ,$79.75 ,$146.02 ,$40.52 ,$36.84 ,$79.75 ,$298.35 ,$167.46 ,$298.35 ,$98.28 ,$315.90 ,$79.75 ,$287.82 ,$296.60 ,$296.60 ,$79.75 ,$228.15 ,$351.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$530.00 ,$344.50 ,$55.26 ,$530.00 ,$199.38 ,$344.50 ,$316.41 ,$79.75 ,$148.40 ,$297.33 ,$79.75 ,$348.74 ,$79.75 ,$450.50 ,$450.50 ,$79.75 ,$450.50 ,$151.52 ,$360.40 ,$199.36 ,$79.75 ,$79.75 ,$397.50 ,$376.30 ,$376.30 ,$79.75 ,$376.30 ,$434.60 ,$434.60 ,$434.60 , N/A ,$199.36 ,$450.50 ,$79.75 ,$530.00 ,$316.41 ,$79.75 ,$220.48 ,$60.79 ,$55.26 ,$79.75 ,$450.50 ,$167.46 ,$450.50 ,$148.40 ,$477.00 ,$79.75 ,$434.60 ,$447.85 ,$447.85 ,$79.75 ,$344.50 ,$530.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$490.00 ,$318.50 ,$36.84 ,$490.00 ,$199.38 ,$318.50 ,$292.53 ,$79.75 ,$137.20 ,$274.89 ,$79.75 ,$322.42 ,$79.75 ,$416.50 ,$416.50 ,$79.75 ,$416.50 ,$151.52 ,$333.20 ,$199.36 ,$79.75 ,$79.75 ,$367.50 ,$347.90 ,$347.90 ,$79.75 ,$347.90 ,$401.80 ,$401.80 ,$401.80 , N/A ,$199.36 ,$416.50 ,$79.75 ,$490.00 ,$292.53 ,$79.75 ,$203.84 ,$40.52 ,$36.84 ,$79.75 ,$416.50 ,$167.46 ,$416.50 ,$137.20 ,$441.00 ,$79.75 ,$401.80 ,$414.05 ,$414.05 ,$79.75 ,$318.50 ,$490.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$713.00 ,$463.45 ,$36.84 ,$713.00 ,$268.33 ,$463.45 ,$425.66 ,$107.33 ,$199.64 ,$399.99 ,$107.33 ,$469.15 ,$107.33 ,$606.05 ,$606.05 ,$107.33 ,$606.05 ,$203.93 ,$484.84 ,$268.33 ,$107.33 ,$107.33 ,$534.75 ,$506.23 ,$506.23 ,$107.33 ,$506.23 ,$584.66 ,$584.66 ,$584.66 , N/A ,$268.33 ,$606.05 ,$107.33 ,$713.00 ,$425.66 ,$107.33 ,$296.61 ,$40.52 ,$36.84 ,$107.33 ,$606.05 ,$225.40 ,$606.05 ,$199.64 ,$641.70 ,$107.33 ,$584.66 ,$602.49 ,$602.49 ,$107.33 ,$463.45 ,$713.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,"$1,169.00 ",$759.85 ,$36.84 ,"$1,169.00 ",$268.33 ,$759.85 ,$697.89 ,$107.33 ,$327.32 ,$655.81 ,$107.33 ,$769.20 ,$107.33 ,$993.65 ,$993.65 ,$107.33 ,$993.65 ,$203.93 ,$794.92 ,$268.33 ,$107.33 ,$107.33 ,$876.75 ,$829.99 ,$829.99 ,$107.33 ,$829.99 ,$958.58 ,$958.58 ,$958.58 , N/A ,$268.33 ,$993.65 ,$107.33 ,"$1,169.00 ",$697.89 ,$107.33 ,$486.30 ,$40.52 ,$36.84 ,$107.33 ,$993.65 ,$225.40 ,$993.65 ,$327.32 ,"$1,052.10 ",$107.33 ,$958.58 ,$987.81 ,$987.81 ,$107.33 ,$759.85 ,"$1,169.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$726.00 ,$471.90 ,$36.84 ,$726.00 ,$440.25 ,$471.90 ,$433.42 ,$176.10 ,$203.28 ,$407.29 ,$176.10 ,$477.71 ,$176.10 ,$617.10 ,$617.10 ,$176.10 ,$617.10 ,$334.60 ,$493.68 ,$440.26 ,$176.10 ,$176.10 ,$544.50 ,$515.46 ,$515.46 ,$176.10 ,$515.46 ,$595.32 ,$595.32 ,$595.32 , N/A ,$440.26 ,$617.10 ,$176.10 ,$726.00 ,$433.42 ,$176.10 ,$302.02 ,$40.52 ,$36.84 ,$176.10 ,$617.10 ,$369.82 ,$617.10 ,$203.28 ,$653.40 ,$176.10 ,$595.32 ,$613.47 ,$613.47 ,$176.10 ,$471.90 ,$726.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$804.00 ,$522.60 ,$81.01 ,$804.00 ,$440.25 ,$522.60 ,$479.99 ,$176.10 ,$225.12 ,$451.04 ,$176.10 ,$529.03 ,$176.10 ,$683.40 ,$683.40 ,$176.10 ,$683.40 ,$334.60 ,$546.72 ,$440.26 ,$176.10 ,$176.10 ,$603.00 ,$570.84 ,$570.84 ,$176.10 ,$570.84 ,$659.28 ,$659.28 ,$659.28 , N/A ,$440.26 ,$683.40 ,$176.10 ,$804.00 ,$479.99 ,$176.10 ,$334.46 ,$89.11 ,$81.01 ,$176.10 ,$683.40 ,$369.82 ,$683.40 ,$225.12 ,$723.60 ,$176.10 ,$659.28 ,$679.38 ,$679.38 ,$176.10 ,$522.60 ,$804.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,"$1,284.00 ",$834.60 ,$81.01 ,"$1,284.00 ",$440.25 ,$834.60 ,$766.55 ,$176.10 ,$359.52 ,$720.32 ,$176.10 ,$844.87 ,$176.10 ,"$1,091.40 ","$1,091.40 ",$176.10 ,"$1,091.40 ",$334.60 ,$873.12 ,$440.26 ,$176.10 ,$176.10 ,$963.00 ,$911.64 ,$911.64 ,$176.10 ,$911.64 ,"$1,052.88 ","$1,052.88 ","$1,052.88 ", N/A ,$440.26 ,"$1,091.40 ",$176.10 ,"$1,284.00 ",$766.55 ,$176.10 ,$534.14 ,$89.11 ,$81.01 ,$176.10 ,"$1,091.40 ",$369.82 ,"$1,091.40 ",$359.52 ,"$1,155.60 ",$176.10 ,"$1,052.88 ","$1,084.98 ","$1,084.98 ",$176.10 ,$834.60 ,"$1,284.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,"$1,433.00 ",$931.45 ,$81.01 ,"$1,433.00 ",$440.25 ,$931.45 ,$855.50 ,$176.10 ,$401.24 ,$803.91 ,$176.10 ,$942.91 ,$176.10 ,"$1,218.05 ","$1,218.05 ",$176.10 ,"$1,218.05 ",$334.60 ,$974.44 ,$440.26 ,$176.10 ,$176.10 ,"$1,074.75 ","$1,017.43 ","$1,017.43 ",$176.10 ,"$1,017.43 ","$1,175.06 ","$1,175.06 ","$1,175.06 ", N/A ,$440.26 ,"$1,218.05 ",$176.10 ,"$1,433.00 ",$855.50 ,$176.10 ,$596.13 ,$89.11 ,$81.01 ,$176.10 ,"$1,218.05 ",$369.82 ,"$1,218.05 ",$401.24 ,"$1,289.70 ",$176.10 ,"$1,175.06 ","$1,210.89 ","$1,210.89 ",$176.10 ,$931.45 ,"$1,433.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,"$1,433.00 ",$931.45 ,$81.01 ,"$1,433.00 ",$440.25 ,$931.45 ,$855.50 ,$176.10 ,$401.24 ,$803.91 ,$176.10 ,$942.91 ,$176.10 ,"$1,218.05 ","$1,218.05 ",$176.10 ,"$1,218.05 ",$334.60 ,$974.44 ,$440.26 ,$176.10 ,$176.10 ,"$1,074.75 ","$1,017.43 ","$1,017.43 ",$176.10 ,"$1,017.43 ","$1,175.06 ","$1,175.06 ","$1,175.06 ", N/A ,$440.26 ,"$1,218.05 ",$176.10 ,"$1,433.00 ",$855.50 ,$176.10 ,$596.13 ,$89.11 ,$81.01 ,$176.10 ,"$1,218.05 ",$369.82 ,"$1,218.05 ",$401.24 ,"$1,289.70 ",$176.10 ,"$1,175.06 ","$1,210.89 ","$1,210.89 ",$176.10 ,$931.45 ,"$1,433.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$804.00 ,$522.60 ,$81.01 ,$804.00 ,$440.25 ,$522.60 ,$479.99 ,$176.10 ,$225.12 ,$451.04 ,$176.10 ,$529.03 ,$176.10 ,$683.40 ,$683.40 ,$176.10 ,$683.40 ,$334.60 ,$546.72 ,$440.26 ,$176.10 ,$176.10 ,$603.00 ,$570.84 ,$570.84 ,$176.10 ,$570.84 ,$659.28 ,$659.28 ,$659.28 , N/A ,$440.26 ,$683.40 ,$176.10 ,$804.00 ,$479.99 ,$176.10 ,$334.46 ,$89.11 ,$81.01 ,$176.10 ,$683.40 ,$369.82 ,$683.40 ,$225.12 ,$723.60 ,$176.10 ,$659.28 ,$679.38 ,$679.38 ,$176.10 ,$522.60 ,$804.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000315,74270,HC XRAY COLON BARIUM,320,1 ,"$1,470.00 ",$955.50 ,$81.01 ,"$1,470.00 ",$440.25 ,$955.50 ,$877.59 ,$176.10 ,$411.60 ,$824.67 ,$176.10 ,$967.26 ,$176.10 ,"$1,249.50 ","$1,249.50 ",$176.10 ,"$1,249.50 ",$334.60 ,$999.60 ,$440.26 ,$176.10 ,$176.10 ,"$1,102.50 ","$1,043.70 ","$1,043.70 ",$176.10 ,"$1,043.70 ","$1,205.40 ","$1,205.40 ","$1,205.40 ", N/A ,$440.26 ,"$1,249.50 ",$176.10 ,"$1,470.00 ",$877.59 ,$176.10 ,$611.52 ,$89.11 ,$81.01 ,$176.10 ,"$1,249.50 ",$369.82 ,"$1,249.50 ",$411.60 ,"$1,323.00 ",$176.10 ,"$1,205.40 ","$1,242.15 ","$1,242.15 ",$176.10 ,$955.50 ,"$1,470.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,"$1,470.00 ",$955.50 ,$81.01 ,"$1,470.00 ",$440.25 ,$955.50 ,$877.59 ,$176.10 ,$411.60 ,$824.67 ,$176.10 ,$967.26 ,$176.10 ,"$1,249.50 ","$1,249.50 ",$176.10 ,"$1,249.50 ",$334.60 ,$999.60 ,$440.26 ,$176.10 ,$176.10 ,"$1,102.50 ","$1,043.70 ","$1,043.70 ",$176.10 ,"$1,043.70 ","$1,205.40 ","$1,205.40 ","$1,205.40 ", N/A ,$440.26 ,"$1,249.50 ",$176.10 ,"$1,470.00 ",$877.59 ,$176.10 ,$611.52 ,$89.11 ,$81.01 ,$176.10 ,"$1,249.50 ",$369.82 ,"$1,249.50 ",$411.60 ,"$1,323.00 ",$176.10 ,"$1,205.40 ","$1,242.15 ","$1,242.15 ",$176.10 ,$955.50 ,"$1,470.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,"$1,470.00 ",$955.50 ,$81.01 ,"$1,470.00 ",$440.25 ,$955.50 ,$877.59 ,$176.10 ,$411.60 ,$824.67 ,$176.10 ,$967.26 ,$176.10 ,"$1,249.50 ","$1,249.50 ",$176.10 ,"$1,249.50 ",$334.60 ,$999.60 ,$440.26 ,$176.10 ,$176.10 ,"$1,102.50 ","$1,043.70 ","$1,043.70 ",$176.10 ,"$1,043.70 ","$1,205.40 ","$1,205.40 ","$1,205.40 ", N/A ,$440.26 ,"$1,249.50 ",$176.10 ,"$1,470.00 ",$877.59 ,$176.10 ,$611.52 ,$89.11 ,$81.01 ,$176.10 ,"$1,249.50 ",$369.82 ,"$1,249.50 ",$411.60 ,"$1,323.00 ",$176.10 ,"$1,205.40 ","$1,242.15 ","$1,242.15 ",$176.10 ,$955.50 ,"$1,470.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000320,74280,HC XRAY COLON BARIUM AIR CONTRAST,320,1 ,"$1,661.00 ","$1,079.65 ",$81.01 ,"$1,661.00 ",$440.25 ,"$1,079.65 ",$991.62 ,$176.10 ,$465.08 ,$931.82 ,$176.10 ,"$1,092.94 ",$176.10 ,"$1,411.85 ","$1,411.85 ",$176.10 ,"$1,411.85 ",$334.60 ,"$1,129.48 ",$440.26 ,$176.10 ,$176.10 ,"$1,245.75 ","$1,179.31 ","$1,179.31 ",$176.10 ,"$1,179.31 ","$1,362.02 ","$1,362.02 ","$1,362.02 ", N/A ,$440.26 ,"$1,411.85 ",$176.10 ,"$1,661.00 ",$991.62 ,$176.10 ,$690.98 ,$89.11 ,$81.01 ,$176.10 ,"$1,411.85 ",$369.82 ,"$1,411.85 ",$465.08 ,"$1,494.90 ",$176.10 ,"$1,362.02 ","$1,403.55 ","$1,403.55 ",$176.10 ,"$1,079.65 ","$1,661.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$961.00 ,$624.65 ,$209.93 ,$961.00 , N/A ,$624.65 ,$573.72 , N/A ,$269.08 ,$539.12 , N/A ,$632.34 , N/A ,$816.85 ,$816.85 , N/A ,$816.85 , N/A ,$653.48 , N/A , N/A , N/A ,$720.75 ,$682.31 ,$682.31 , N/A ,$682.31 ,$788.02 ,$788.02 ,$788.02 , N/A , N/A ,$816.85 , N/A ,$961.00 ,$573.72 , N/A ,$399.78 ,$230.92 ,$209.93 , N/A ,$816.85 , N/A ,$816.85 ,$269.08 ,$864.90 , N/A ,$788.02 ,$812.05 ,$812.05 , N/A ,$624.65 ,$961.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000324,74301,HC CHOLANGIOGRAPHY OPERATIVE ADDL,320,1 ,$321.00 ,$208.65 ,$89.88 ,$321.00 , N/A ,$208.65 ,$191.64 , N/A ,$89.88 ,$180.08 , N/A ,$211.22 , N/A ,$272.85 ,$272.85 , N/A ,$272.85 , N/A ,$218.28 , N/A , N/A , N/A ,$240.75 ,$227.91 ,$227.91 , N/A ,$227.91 ,$263.22 ,$263.22 ,$263.22 , N/A , N/A ,$272.85 , N/A ,$321.00 ,$191.64 , N/A ,$133.54 ,$230.92 ,$209.93 , N/A ,$272.85 , N/A ,$272.85 ,$89.88 ,$288.90 , N/A ,$263.22 ,$271.25 ,$271.25 , N/A ,$208.65 ,$321.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000325,47531,HC XRAY CHOLANGIOGRAM THRU CATH,320,1 ,"$1,502.00 ",$976.30 ,$81.01 ,"$7,841.66 ","$7,841.65 ",$976.30 ,$896.69 ,"$3,136.66 ",$420.56 ,$842.62 ,"$3,136.66 ",$988.32 ,"$1,502.00 ","$1,276.70 ","$1,276.70 ","$1,502.00 ","$1,276.70 ","$1,502.00 ","$1,021.36 ","$7,841.66 ","$3,136.66 ","$3,136.66 ","$1,126.50 ","$1,066.42 ","$1,066.42 ","$3,136.66 ","$1,066.42 ","$1,231.64 ","$1,231.64 ","$1,231.64 ", N/A ,"$1,502.00 ","$1,276.70 ","$3,136.66 ","$1,502.00 ",$896.69 ,"$3,136.66 ",$624.83 ,$89.11 ,$81.01 ,"$3,136.66 ","$1,276.70 ","$6,586.99 ","$1,276.70 ",$420.56 ,"$1,351.80 ","$3,136.66 ","$1,231.64 ","$1,269.19 ","$1,269.19 ","$3,136.66 ",$976.30 ,"$1,502.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000335,74400,HC XRAY IVP W OR W/O TOMO,320,1 ,"$1,526.00 ",$991.90 ,$176.10 ,"$1,526.00 ",$440.25 ,$991.90 ,$911.02 ,$176.10 ,$427.28 ,$856.09 ,$176.10 ,"$1,004.11 ",$176.10 ,"$1,297.10 ","$1,297.10 ",$176.10 ,"$1,297.10 ",$334.60 ,"$1,037.68 ",$440.26 ,$176.10 ,$176.10 ,"$1,144.50 ","$1,083.46 ","$1,083.46 ",$176.10 ,"$1,083.46 ","$1,251.32 ","$1,251.32 ","$1,251.32 ", N/A ,$440.26 ,"$1,297.10 ",$176.10 ,"$1,526.00 ",$911.02 ,$176.10 ,$634.82 ,$252.78 ,$229.80 ,$176.10 ,"$1,297.10 ",$369.82 ,"$1,297.10 ",$427.28 ,"$1,373.40 ",$176.10 ,"$1,251.32 ","$1,289.47 ","$1,289.47 ",$176.10 ,$991.90 ,"$1,526.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,$960.00 ,$624.00 ,$209.93 ,$960.00 ,$907.63 ,$624.00 ,$573.12 ,$363.05 ,$268.80 ,$538.56 ,$363.05 ,$631.68 ,$363.05 ,$816.00 ,$816.00 ,$363.05 ,$816.00 ,$689.79 ,$652.80 ,$907.62 ,$363.05 ,$363.05 ,$720.00 ,$681.60 ,$681.60 ,$363.05 ,$681.60 ,$787.20 ,$787.20 ,$787.20 , N/A ,$907.62 ,$816.00 ,$363.05 ,$960.00 ,$573.12 ,$363.05 ,$399.36 ,$230.92 ,$209.93 ,$363.05 ,$816.00 ,$762.40 ,$816.00 ,$268.80 ,$864.00 ,$363.05 ,$787.20 ,$811.20 ,$811.20 ,$363.05 ,$624.00 ,$960.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,"$1,350.00 ",$877.50 ,$209.93 ,"$1,350.00 ",$567.13 ,$877.50 ,$805.95 ,$226.85 ,$378.00 ,$757.35 ,$226.85 ,$888.30 ,$226.85 ,"$1,147.50 ","$1,147.50 ",$226.85 ,"$1,147.50 ",$431.02 ,$918.00 ,$567.13 ,$226.85 ,$226.85 ,"$1,012.50 ",$958.50 ,$958.50 ,$226.85 ,$958.50 ,"$1,107.00 ","$1,107.00 ","$1,107.00 ", N/A ,$567.13 ,"$1,147.50 ",$226.85 ,"$1,350.00 ",$805.95 ,$226.85 ,$561.60 ,$230.92 ,$209.93 ,$226.85 ,"$1,147.50 ",$476.39 ,"$1,147.50 ",$378.00 ,"$1,215.00 ",$226.85 ,"$1,107.00 ","$1,140.75 ","$1,140.75 ",$226.85 ,$877.50 ,"$1,350.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$910.00 ,$591.50 ,$209.93 ,$910.00 ,$567.13 ,$591.50 ,$543.27 ,$226.85 ,$254.80 ,$510.51 ,$226.85 ,$598.78 ,$226.85 ,$773.50 ,$773.50 ,$226.85 ,$773.50 ,$431.02 ,$618.80 ,$567.13 ,$226.85 ,$226.85 ,$682.50 ,$646.10 ,$646.10 ,$226.85 ,$646.10 ,$746.20 ,$746.20 ,$746.20 , N/A ,$567.13 ,$773.50 ,$226.85 ,$910.00 ,$543.27 ,$226.85 ,$378.56 ,$230.92 ,$209.93 ,$226.85 ,$773.50 ,$476.39 ,$773.50 ,$254.80 ,$819.00 ,$226.85 ,$746.20 ,$768.95 ,$768.95 ,$226.85 ,$591.50 ,$910.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$1,691.00 ","$1,099.15 ",$209.93 ,"$1,691.00 ", N/A ,"$1,099.15 ","$1,009.53 ", N/A ,$473.48 ,$948.65 , N/A ,"$1,112.68 ", N/A ,"$1,437.35 ","$1,437.35 ", N/A ,"$1,437.35 ", N/A ,"$1,149.88 ", N/A , N/A , N/A ,"$1,268.25 ","$1,200.61 ","$1,200.61 ", N/A ,"$1,200.61 ","$1,386.62 ","$1,386.62 ","$1,386.62 ", N/A , N/A ,"$1,437.35 ", N/A ,"$1,691.00 ","$1,009.53 ", N/A ,$703.46 ,$230.92 ,$209.93 , N/A ,"$1,437.35 ", N/A ,"$1,437.35 ",$473.48 ,"$1,521.90 ", N/A ,"$1,386.62 ","$1,428.90 ","$1,428.90 ", N/A ,"$1,099.15 ","$1,691.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$672.00 ,$436.80 ,$36.84 ,$672.00 ,$567.13 ,$436.80 ,$401.18 ,$226.85 ,$188.16 ,$376.99 ,$226.85 ,$442.18 ,$226.85 ,$571.20 ,$571.20 ,$226.85 ,$571.20 ,$431.02 ,$456.96 ,$567.13 ,$226.85 ,$226.85 ,$504.00 ,$477.12 ,$477.12 ,$226.85 ,$477.12 ,$551.04 ,$551.04 ,$551.04 , N/A ,$567.13 ,$571.20 ,$226.85 ,$672.00 ,$401.18 ,$226.85 ,$279.55 ,$40.52 ,$36.84 ,$226.85 ,$571.20 ,$476.39 ,$571.20 ,$188.16 ,$604.80 ,$226.85 ,$551.04 ,$567.84 ,$567.84 ,$226.85 ,$436.80 ,$672.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000464,76010,HC BABYGRAM,320,1 ,$472.00 ,$306.80 ,$36.84 ,$472.00 ,$199.38 ,$306.80 ,$281.78 ,$79.75 ,$132.16 ,$264.79 ,$79.75 ,$310.58 ,$79.75 ,$401.20 ,$401.20 ,$79.75 ,$401.20 ,$151.52 ,$320.96 ,$199.36 ,$79.75 ,$79.75 ,$354.00 ,$335.12 ,$335.12 ,$79.75 ,$335.12 ,$387.04 ,$387.04 ,$387.04 , N/A ,$199.36 ,$401.20 ,$79.75 ,$472.00 ,$281.78 ,$79.75 ,$196.35 ,$40.52 ,$36.84 ,$79.75 ,$401.20 ,$167.46 ,$401.20 ,$132.16 ,$424.80 ,$79.75 ,$387.04 ,$398.84 ,$398.84 ,$79.75 ,$306.80 ,$472.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$468.00 ,$304.20 ,$28.70 ,"$1,190.93 ","$1,190.93 ",$304.20 ,$279.40 ,$476.37 ,$131.04 ,$262.55 ,$476.37 ,$307.94 ,$468.00 ,$397.80 ,$397.80 ,$468.00 ,$397.80 ,$468.00 ,$318.24 ,"$1,190.92 ",$476.37 ,$476.37 ,$351.00 ,$332.28 ,$332.28 ,$476.37 ,$332.28 ,$383.76 ,$383.76 ,$383.76 , N/A ,$468.00 ,$397.80 ,$476.37 ,$28.70 ,$279.40 ,$476.37 ,$194.69 ,$40.52 ,$36.84 ,$476.37 ,$397.80 ,"$1,000.37 ",$397.80 ,$131.04 ,$421.20 ,$476.37 ,$383.76 ,$395.46 ,$395.46 ,$476.37 ,$304.20 ,$468.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,"$1,284.00 ",$834.60 ,$209.93 ,"$1,284.00 ", N/A ,$834.60 ,$766.55 , N/A ,$359.52 ,$720.32 , N/A ,$844.87 , N/A ,"$1,091.40 ","$1,091.40 ", N/A ,"$1,091.40 ", N/A ,$873.12 , N/A , N/A , N/A ,$963.00 ,$911.64 ,$911.64 , N/A ,$911.64 ,"$1,052.88 ","$1,052.88 ","$1,052.88 ", N/A , N/A ,"$1,091.40 ", N/A ,"$1,284.00 ",$766.55 , N/A ,$534.14 ,$230.92 ,$209.93 , N/A ,"$1,091.40 ", N/A ,"$1,091.40 ",$359.52 ,"$1,155.60 ", N/A ,"$1,052.88 ","$1,084.98 ","$1,084.98 ", N/A ,$834.60 ,"$1,284.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$807.00 ,$524.55 ,$209.93 ,$807.00 , N/A ,$524.55 ,$481.78 , N/A ,$225.96 ,$452.73 , N/A ,$531.01 , N/A ,$685.95 ,$685.95 , N/A ,$685.95 , N/A ,$548.76 , N/A , N/A , N/A ,$605.25 ,$572.97 ,$572.97 , N/A ,$572.97 ,$661.74 ,$661.74 ,$661.74 , N/A , N/A ,$685.95 , N/A ,$807.00 ,$481.78 , N/A ,$335.71 ,$230.92 ,$209.93 , N/A ,$685.95 , N/A ,$685.95 ,$225.96 ,$726.30 , N/A ,$661.74 ,$681.92 ,$681.92 , N/A ,$524.55 ,$807.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$5,721.00 ","$3,718.65 ",$619.99 ,"$5,721.00 ","$3,467.90 ","$3,718.65 ","$3,415.44 ","$1,387.16 ","$1,601.88 ","$3,209.48 ","$1,387.16 ","$3,764.42 ","$1,387.16 ","$4,862.85 ","$4,862.85 ","$1,387.16 ","$4,862.85 ","$2,635.59 ","$3,890.28 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$4,290.75 ","$4,061.91 ","$4,061.91 ","$1,387.16 ","$4,061.91 ","$4,691.22 ","$4,691.22 ","$4,691.22 ", N/A ,"$3,467.89 ","$4,862.85 ","$1,387.16 ",$619.99 ,"$3,415.44 ","$1,387.16 ","$2,379.94 ",$897.59 ,$815.99 ,"$1,387.16 ","$4,862.85 ","$2,913.03 ","$4,862.85 ","$1,601.88 ","$5,148.90 ","$1,387.16 ","$4,691.22 ","$4,834.25 ","$4,834.25 ","$1,387.16 ","$3,718.65 ","$5,721.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,"$1,996.00 ","$1,297.40 ",$79.05 ,"$1,996.00 ","$1,533.75 ","$1,297.40 ","$1,191.61 ",$613.50 ,$558.88 ,"$1,119.76 ",$613.50 ,"$1,313.37 ",$613.50 ,"$1,696.60 ","$1,696.60 ",$613.50 ,"$1,696.60 ","$1,165.65 ","$1,357.28 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,497.00 ","$1,417.16 ","$1,417.16 ",$613.50 ,"$1,417.16 ","$1,636.72 ","$1,636.72 ","$1,636.72 ", N/A ,"$1,533.75 ","$1,696.60 ",$613.50 ,$266.06 ,"$1,191.61 ",$613.50 ,$830.34 ,$86.96 ,$79.05 ,$613.50 ,"$1,696.60 ","$1,288.35 ","$1,696.60 ",$558.88 ,"$1,796.40 ",$613.50 ,"$1,636.72 ","$1,686.62 ","$1,686.62 ",$613.50 ,"$1,297.40 ","$1,996.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,"$2,993.00 ","$1,945.45 ",$118.57 ,"$2,993.00 ","$1,533.75 ","$1,945.45 ","$1,786.82 ",$613.50 ,$838.04 ,"$1,679.07 ",$613.50 ,"$1,969.39 ",$613.50 ,"$2,544.05 ","$2,544.05 ",$613.50 ,"$2,544.05 ","$1,165.65 ","$2,035.24 ","$1,533.75 ",$613.50 ,$613.50 ,"$2,244.75 ","$2,125.03 ","$2,125.03 ",$613.50 ,"$2,125.03 ","$2,454.26 ","$2,454.26 ","$2,454.26 ", N/A ,"$1,533.75 ","$2,544.05 ",$613.50 ,$266.06 ,"$1,786.82 ",$613.50 ,"$1,245.09 ",$130.43 ,$118.57 ,$613.50 ,"$2,544.05 ","$1,288.35 ","$2,544.05 ",$838.04 ,"$2,693.70 ",$613.50 ,"$2,454.26 ","$2,529.09 ","$2,529.09 ",$613.50 ,"$1,945.45 ","$2,993.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000490,77053,HC GALACTOGRAM SINGLE DUCT,320,1 ,$676.00 ,$439.40 ,$40.72 ,$676.00 ,$567.13 ,$439.40 ,$403.57 ,$226.85 ,$189.28 ,$379.24 ,$226.85 ,$444.81 ,$226.85 ,$574.60 ,$574.60 ,$226.85 ,$574.60 ,$431.02 ,$459.68 ,$567.13 ,$226.85 ,$226.85 ,$507.00 ,$479.96 ,$479.96 ,$226.85 ,$479.96 ,$554.32 ,$554.32 ,$554.32 , N/A ,$567.13 ,$574.60 ,$226.85 ,$40.72 ,$403.57 ,$226.85 ,$281.22 ,$230.92 ,$209.93 ,$226.85 ,$574.60 ,$476.39 ,$574.60 ,$189.28 ,$608.40 ,$226.85 ,$554.32 ,$571.22 ,$571.22 ,$226.85 ,$439.40 ,$676.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$795.00 ,$516.75 ,$36.84 ,$795.00 ,$268.33 ,$516.75 ,$474.62 ,$107.33 ,$222.60 ,$446.00 ,$107.33 ,$523.11 ,$107.33 ,$675.75 ,$675.75 ,$107.33 ,$675.75 ,$203.93 ,$540.60 ,$268.33 ,$107.33 ,$107.33 ,$596.25 ,$564.45 ,$564.45 ,$107.33 ,$564.45 ,$651.90 ,$651.90 ,$651.90 , N/A ,$268.33 ,$675.75 ,$107.33 ,$795.00 ,$474.62 ,$107.33 ,$330.72 ,$40.52 ,$36.84 ,$107.33 ,$675.75 ,$225.40 ,$675.75 ,$222.60 ,$715.50 ,$107.33 ,$651.90 ,$671.78 ,$671.78 ,$107.33 ,$516.75 ,$795.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,"$1,071.00 ",$696.15 ,$36.84 ,"$1,071.00 ",$268.33 ,$696.15 ,$639.39 ,$107.33 ,$299.88 ,$600.83 ,$107.33 ,$704.72 ,$107.33 ,$910.35 ,$910.35 ,$107.33 ,$910.35 ,$203.93 ,$728.28 ,$268.33 ,$107.33 ,$107.33 ,$803.25 ,$760.41 ,$760.41 ,$107.33 ,$760.41 ,$878.22 ,$878.22 ,$878.22 , N/A ,$268.33 ,$910.35 ,$107.33 ,"$1,071.00 ",$639.39 ,$107.33 ,$445.54 ,$40.52 ,$36.84 ,$107.33 ,$910.35 ,$225.40 ,$910.35 ,$299.88 ,$963.90 ,$107.33 ,$878.22 ,$905.00 ,$905.00 ,$107.33 ,$696.15 ,"$1,071.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$855.00 ,$555.75 ,$36.84 ,$855.00 ,$268.33 ,$555.75 ,$510.44 ,$107.33 ,$239.40 ,$479.66 ,$107.33 ,$562.59 ,$107.33 ,$726.75 ,$726.75 ,$107.33 ,$726.75 ,$203.93 ,$581.40 ,$268.33 ,$107.33 ,$107.33 ,$641.25 ,$607.05 ,$607.05 ,$107.33 ,$607.05 ,$701.10 ,$701.10 ,$701.10 , N/A ,$268.33 ,$726.75 ,$107.33 ,$855.00 ,$510.44 ,$107.33 ,$355.68 ,$40.52 ,$36.84 ,$107.33 ,$726.75 ,$225.40 ,$726.75 ,$239.40 ,$769.50 ,$107.33 ,$701.10 ,$722.48 ,$722.48 ,$107.33 ,$555.75 ,$855.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000496,77080,HC BONE DENSITY DXA,320,1 ,$506.00 ,$328.90 ,$58.19 ,$506.00 ,$268.33 ,$328.90 ,$302.08 ,$107.33 ,$141.68 ,$283.87 ,$107.33 ,$332.95 ,$107.33 ,$430.10 ,$430.10 ,$107.33 ,$430.10 ,$203.93 ,$344.08 ,$268.33 ,$107.33 ,$107.33 ,$379.50 ,$359.26 ,$359.26 ,$107.33 ,$359.26 ,$414.92 ,$414.92 ,$414.92 , N/A ,$268.33 ,$430.10 ,$107.33 ,$506.00 ,$302.08 ,$107.33 ,$210.50 ,$64.01 ,$58.19 ,$107.33 ,$430.10 ,$225.40 ,$430.10 ,$141.68 ,$455.40 ,$107.33 ,$414.92 ,$427.57 ,$427.57 ,$107.33 ,$328.90 ,$506.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$423.00 ,$274.95 ,$58.19 ,$423.00 ,$199.38 ,$274.95 ,$252.53 ,$79.75 ,$118.44 ,$237.30 ,$79.75 ,$278.33 ,$79.75 ,$359.55 ,$359.55 ,$79.75 ,$359.55 ,$151.52 ,$287.64 ,$199.36 ,$79.75 ,$79.75 ,$317.25 ,$300.33 ,$300.33 ,$79.75 ,$300.33 ,$346.86 ,$346.86 ,$346.86 , N/A ,$199.36 ,$359.55 ,$79.75 ,$423.00 ,$252.53 ,$79.75 ,$175.97 ,$64.01 ,$58.19 ,$79.75 ,$359.55 ,$167.46 ,$359.55 ,$118.44 ,$380.70 ,$79.75 ,$346.86 ,$357.44 ,$357.44 ,$79.75 ,$274.95 ,$423.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000498,77086,HC BONE DENSITY VERTEB FX ASSEMT,320,1 ,$330.00 ,$214.50 ,$58.19 ,$330.00 ,$199.38 ,$214.50 ,$197.01 ,$79.75 ,$92.40 ,$185.13 ,$79.75 ,$217.14 ,$79.75 ,$280.50 ,$280.50 ,$79.75 ,$280.50 ,$151.52 ,$224.40 ,$199.36 ,$79.75 ,$79.75 ,$247.50 ,$234.30 ,$234.30 ,$79.75 ,$234.30 ,$270.60 ,$270.60 ,$270.60 , N/A ,$199.36 ,$280.50 ,$79.75 ,$330.00 ,$197.01 ,$79.75 ,$137.28 ,$64.01 ,$58.19 ,$79.75 ,$280.50 ,$167.46 ,$280.50 ,$92.40 ,$297.00 ,$79.75 ,$270.60 ,$278.85 ,$278.85 ,$79.75 ,$214.50 ,$330.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$672.00 ,$436.80 ,$36.84 ,$672.00 ,$567.13 ,$436.80 ,$401.18 ,$226.85 ,$188.16 ,$376.99 ,$226.85 ,$442.18 ,$226.85 ,$571.20 ,$571.20 ,$226.85 ,$571.20 ,$431.02 ,$456.96 ,$567.13 ,$226.85 ,$226.85 ,$504.00 ,$477.12 ,$477.12 ,$226.85 ,$477.12 ,$551.04 ,$551.04 ,$551.04 , N/A ,$567.13 ,$571.20 ,$226.85 ,$672.00 ,$401.18 ,$226.85 ,$279.55 ,$40.52 ,$36.84 ,$226.85 ,$571.20 ,$476.39 ,$571.20 ,$188.16 ,$604.80 ,$226.85 ,$551.04 ,$567.84 ,$567.84 ,$226.85 ,$436.80 ,$672.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$750.00 ,$487.50 ,$210.00 ,$750.00 ,$643.95 ,$487.50 ,$447.75 ,$257.58 ,$210.00 ,$420.75 ,$257.58 ,$493.50 ,$257.58 ,$637.50 ,$637.50 ,$257.58 ,$637.50 ,$489.39 ,$510.00 ,$643.94 ,$257.58 ,$257.58 ,$562.50 ,$532.50 ,$532.50 ,$257.58 ,$532.50 ,$615.00 ,$615.00 ,$615.00 , N/A ,$643.94 ,$637.50 ,$257.58 ,$750.00 ,$447.75 ,$257.58 ,$312.00 ,$235.70 ,$214.27 ,$257.58 ,$637.50 ,$540.91 ,$637.50 ,$210.00 ,$675.00 ,$257.58 ,$615.00 ,$633.75 ,$633.75 ,$257.58 ,$487.50 ,$750.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000509,77072,HC BONE AGE STUDIES,320,1 ,$505.00 ,$328.25 ,$36.84 ,$505.00 ,$268.33 ,$328.25 ,$301.49 ,$107.33 ,$141.40 ,$283.31 ,$107.33 ,$332.29 ,$107.33 ,$429.25 ,$429.25 ,$107.33 ,$429.25 ,$203.93 ,$343.40 ,$268.33 ,$107.33 ,$107.33 ,$378.75 ,$358.55 ,$358.55 ,$107.33 ,$358.55 ,$414.10 ,$414.10 ,$414.10 , N/A ,$268.33 ,$429.25 ,$107.33 ,$505.00 ,$301.49 ,$107.33 ,$210.08 ,$40.52 ,$36.84 ,$107.33 ,$429.25 ,$225.40 ,$429.25 ,$141.40 ,$454.50 ,$107.33 ,$414.10 ,$426.73 ,$426.73 ,$107.33 ,$328.25 ,$505.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,$728.00 ,$473.20 ,$203.84 ,"$1,332.25 ","$1,332.25 ",$473.20 ,$434.62 ,$532.90 ,$203.84 ,$408.41 ,$532.90 ,$479.02 ,$532.90 ,$618.80 ,$618.80 ,$532.90 ,$618.80 ,$728.00 ,$495.04 ,"$1,332.24 ",$532.90 ,$532.90 ,$546.00 ,$516.88 ,$516.88 ,$532.90 ,$516.88 ,$596.96 ,$596.96 ,$596.96 , N/A ,$728.00 ,$618.80 ,$532.90 ,$728.00 ,$434.62 ,$532.90 ,$302.85 ,$503.72 ,$457.93 ,$532.90 ,$618.80 ,"$1,119.08 ",$618.80 ,$203.84 ,$655.20 ,$532.90 ,$596.96 ,$615.16 ,$615.16 ,$532.90 ,$473.20 ,$728.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,$831.00 ,$540.15 ,$232.68 ,"$1,332.25 ","$1,332.25 ",$540.15 ,$496.11 ,$532.90 ,$232.68 ,$466.19 ,$532.90 ,$546.80 ,$532.90 ,$706.35 ,$706.35 ,$532.90 ,$706.35 ,$831.00 ,$565.08 ,"$1,332.24 ",$532.90 ,$532.90 ,$623.25 ,$590.01 ,$590.01 ,$532.90 ,$590.01 ,$681.42 ,$681.42 ,$681.42 , N/A ,$831.00 ,$706.35 ,$532.90 ,$831.00 ,$496.11 ,$532.90 ,$345.70 ,$503.72 ,$457.93 ,$532.90 ,$706.35 ,"$1,119.08 ",$706.35 ,$232.68 ,$747.90 ,$532.90 ,$681.42 ,$702.20 ,$702.20 ,$532.90 ,$540.15 ,$831.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000543,72074,HC XR T-SPINE 4 + VIEWS,320,1 ,$823.00 ,$534.95 ,$36.84 ,$823.00 ,$268.33 ,$534.95 ,$491.33 ,$107.33 ,$230.44 ,$461.70 ,$107.33 ,$541.53 ,$107.33 ,$699.55 ,$699.55 ,$107.33 ,$699.55 ,$203.93 ,$559.64 ,$268.33 ,$107.33 ,$107.33 ,$617.25 ,$584.33 ,$584.33 ,$107.33 ,$584.33 ,$674.86 ,$674.86 ,$674.86 , N/A ,$268.33 ,$699.55 ,$107.33 ,$823.00 ,$491.33 ,$107.33 ,$342.37 ,$40.52 ,$36.84 ,$107.33 ,$699.55 ,$225.40 ,$699.55 ,$230.44 ,$740.70 ,$107.33 ,$674.86 ,$695.44 ,$695.44 ,$107.33 ,$534.95 ,$823.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000552,70100,HC XR MANDIBLE <3V,320,1 ,$246.00 ,$159.90 ,$36.84 ,$246.00 ,$199.38 ,$159.90 ,$146.86 ,$79.75 ,$68.88 ,$138.01 ,$79.75 ,$161.87 ,$79.75 ,$209.10 ,$209.10 ,$79.75 ,$209.10 ,$151.52 ,$167.28 ,$199.36 ,$79.75 ,$79.75 ,$184.50 ,$174.66 ,$174.66 ,$79.75 ,$174.66 ,$201.72 ,$201.72 ,$201.72 , N/A ,$199.36 ,$209.10 ,$79.75 ,$246.00 ,$146.86 ,$79.75 ,$102.34 ,$40.52 ,$36.84 ,$79.75 ,$209.10 ,$167.46 ,$209.10 ,$68.88 ,$221.40 ,$79.75 ,$201.72 ,$207.87 ,$207.87 ,$79.75 ,$159.90 ,$246.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$246.00 ,$159.90 ,$36.84 ,$246.00 ,$199.38 ,$159.90 ,$146.86 ,$79.75 ,$68.88 ,$138.01 ,$79.75 ,$161.87 ,$79.75 ,$209.10 ,$209.10 ,$79.75 ,$209.10 ,$151.52 ,$167.28 ,$199.36 ,$79.75 ,$79.75 ,$184.50 ,$174.66 ,$174.66 ,$79.75 ,$174.66 ,$201.72 ,$201.72 ,$201.72 , N/A ,$199.36 ,$209.10 ,$79.75 ,$246.00 ,$146.86 ,$79.75 ,$102.34 ,$40.52 ,$36.84 ,$79.75 ,$209.10 ,$167.46 ,$209.10 ,$68.88 ,$221.40 ,$79.75 ,$201.72 ,$207.87 ,$207.87 ,$79.75 ,$159.90 ,$246.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$257.00 ,$167.05 ,$36.84 ,$257.00 ,$199.38 ,$167.05 ,$153.43 ,$79.75 ,$71.96 ,$144.18 ,$79.75 ,$169.11 ,$79.75 ,$218.45 ,$218.45 ,$79.75 ,$218.45 ,$151.52 ,$174.76 ,$199.36 ,$79.75 ,$79.75 ,$192.75 ,$182.47 ,$182.47 ,$79.75 ,$182.47 ,$210.74 ,$210.74 ,$210.74 , N/A ,$199.36 ,$218.45 ,$79.75 ,$257.00 ,$153.43 ,$79.75 ,$106.91 ,$40.52 ,$36.84 ,$79.75 ,$218.45 ,$167.46 ,$218.45 ,$71.96 ,$231.30 ,$79.75 ,$210.74 ,$217.17 ,$217.17 ,$79.75 ,$167.05 ,$257.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$257.00 ,$167.05 ,$36.84 ,$268.33 ,$268.33 ,$167.05 ,$153.43 ,$107.33 ,$71.96 ,$144.18 ,$107.33 ,$169.11 ,$107.33 ,$218.45 ,$218.45 ,$107.33 ,$218.45 ,$203.93 ,$174.76 ,$268.33 ,$107.33 ,$107.33 ,$192.75 ,$182.47 ,$182.47 ,$107.33 ,$182.47 ,$210.74 ,$210.74 ,$210.74 , N/A ,$257.00 ,$218.45 ,$107.33 ,$257.00 ,$153.43 ,$107.33 ,$106.91 ,$40.52 ,$36.84 ,$107.33 ,$218.45 ,$225.40 ,$218.45 ,$71.96 ,$231.30 ,$107.33 ,$210.74 ,$217.17 ,$217.17 ,$107.33 ,$167.05 ,$257.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$257.00 ,$167.05 ,$36.84 ,$257.00 ,$199.38 ,$167.05 ,$153.43 ,$79.75 ,$71.96 ,$144.18 ,$79.75 ,$169.11 ,$79.75 ,$218.45 ,$218.45 ,$79.75 ,$218.45 ,$151.52 ,$174.76 ,$199.36 ,$79.75 ,$79.75 ,$192.75 ,$182.47 ,$182.47 ,$79.75 ,$182.47 ,$210.74 ,$210.74 ,$210.74 , N/A ,$199.36 ,$218.45 ,$79.75 ,$257.00 ,$153.43 ,$79.75 ,$106.91 ,$40.52 ,$36.84 ,$79.75 ,$218.45 ,$167.46 ,$218.45 ,$71.96 ,$231.30 ,$79.75 ,$210.74 ,$217.17 ,$217.17 ,$79.75 ,$167.05 ,$257.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$257.00 ,$167.05 ,$36.84 ,$257.00 ,$199.38 ,$167.05 ,$153.43 ,$79.75 ,$71.96 ,$144.18 ,$79.75 ,$169.11 ,$79.75 ,$218.45 ,$218.45 ,$79.75 ,$218.45 ,$151.52 ,$174.76 ,$199.36 ,$79.75 ,$79.75 ,$192.75 ,$182.47 ,$182.47 ,$79.75 ,$182.47 ,$210.74 ,$210.74 ,$210.74 , N/A ,$199.36 ,$218.45 ,$79.75 ,$257.00 ,$153.43 ,$79.75 ,$106.91 ,$40.52 ,$36.84 ,$79.75 ,$218.45 ,$167.46 ,$218.45 ,$71.96 ,$231.30 ,$79.75 ,$210.74 ,$217.17 ,$217.17 ,$79.75 ,$167.05 ,$257.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$331.00 ,$215.15 ,$36.84 ,$331.00 ,$268.33 ,$215.15 ,$197.61 ,$107.33 ,$92.68 ,$185.69 ,$107.33 ,$217.80 ,$107.33 ,$281.35 ,$281.35 ,$107.33 ,$281.35 ,$203.93 ,$225.08 ,$268.33 ,$107.33 ,$107.33 ,$248.25 ,$235.01 ,$235.01 ,$107.33 ,$235.01 ,$271.42 ,$271.42 ,$271.42 , N/A ,$268.33 ,$281.35 ,$107.33 ,$331.00 ,$197.61 ,$107.33 ,$137.70 ,$40.52 ,$36.84 ,$107.33 ,$281.35 ,$225.40 ,$281.35 ,$92.68 ,$297.90 ,$107.33 ,$271.42 ,$279.70 ,$279.70 ,$107.33 ,$215.15 ,$331.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$348.00 ,$226.20 ,$36.84 ,$348.00 ,$268.33 ,$226.20 ,$207.76 ,$107.33 ,$97.44 ,$195.23 ,$107.33 ,$228.98 ,$107.33 ,$295.80 ,$295.80 ,$107.33 ,$295.80 ,$203.93 ,$236.64 ,$268.33 ,$107.33 ,$107.33 ,$261.00 ,$247.08 ,$247.08 ,$107.33 ,$247.08 ,$285.36 ,$285.36 ,$285.36 , N/A ,$268.33 ,$295.80 ,$107.33 ,$348.00 ,$207.76 ,$107.33 ,$144.77 ,$40.52 ,$36.84 ,$107.33 ,$295.80 ,$225.40 ,$295.80 ,$97.44 ,$313.20 ,$107.33 ,$285.36 ,$294.06 ,$294.06 ,$107.33 ,$226.20 ,$348.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$342.00 ,$222.30 ,$36.84 ,$342.00 ,$268.33 ,$222.30 ,$204.17 ,$107.33 ,$95.76 ,$191.86 ,$107.33 ,$225.04 ,$107.33 ,$290.70 ,$290.70 ,$107.33 ,$290.70 ,$203.93 ,$232.56 ,$268.33 ,$107.33 ,$107.33 ,$256.50 ,$242.82 ,$242.82 ,$107.33 ,$242.82 ,$280.44 ,$280.44 ,$280.44 , N/A ,$268.33 ,$290.70 ,$107.33 ,$342.00 ,$204.17 ,$107.33 ,$142.27 ,$40.52 ,$36.84 ,$107.33 ,$290.70 ,$225.40 ,$290.70 ,$95.76 ,$307.80 ,$107.33 ,$280.44 ,$288.99 ,$288.99 ,$107.33 ,$222.30 ,$342.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$336.00 ,$218.40 ,$36.84 ,$336.00 ,$268.33 ,$218.40 ,$200.59 ,$107.33 ,$94.08 ,$188.50 ,$107.33 ,$221.09 ,$107.33 ,$285.60 ,$285.60 ,$107.33 ,$285.60 ,$203.93 ,$228.48 ,$268.33 ,$107.33 ,$107.33 ,$252.00 ,$238.56 ,$238.56 ,$107.33 ,$238.56 ,$275.52 ,$275.52 ,$275.52 , N/A ,$268.33 ,$285.60 ,$107.33 ,$336.00 ,$200.59 ,$107.33 ,$139.78 ,$40.52 ,$36.84 ,$107.33 ,$285.60 ,$225.40 ,$285.60 ,$94.08 ,$302.40 ,$107.33 ,$275.52 ,$283.92 ,$283.92 ,$107.33 ,$218.40 ,$336.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$280.00 ,$182.00 ,$55.26 ,$280.00 ,$199.38 ,$182.00 ,$167.16 ,$79.75 ,$78.40 ,$157.08 ,$79.75 ,$184.24 ,$79.75 ,$238.00 ,$238.00 ,$79.75 ,$238.00 ,$151.52 ,$190.40 ,$199.36 ,$79.75 ,$79.75 ,$210.00 ,$198.80 ,$198.80 ,$79.75 ,$198.80 ,$229.60 ,$229.60 ,$229.60 , N/A ,$199.36 ,$238.00 ,$79.75 ,$280.00 ,$167.16 ,$79.75 ,$116.48 ,$60.79 ,$55.26 ,$79.75 ,$238.00 ,$167.46 ,$238.00 ,$78.40 ,$252.00 ,$79.75 ,$229.60 ,$236.60 ,$236.60 ,$79.75 ,$182.00 ,$280.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$185.00 ,$120.25 ,$36.84 ,$199.38 ,$199.38 ,$120.25 ,$110.45 ,$79.75 ,$51.80 ,$103.79 ,$79.75 ,$121.73 ,$79.75 ,$157.25 ,$157.25 ,$79.75 ,$157.25 ,$151.52 ,$125.80 ,$199.36 ,$79.75 ,$79.75 ,$138.75 ,$131.35 ,$131.35 ,$79.75 ,$131.35 ,$151.70 ,$151.70 ,$151.70 , N/A ,$185.00 ,$157.25 ,$79.75 ,$185.00 ,$110.45 ,$79.75 ,$76.96 ,$40.52 ,$36.84 ,$79.75 ,$157.25 ,$167.46 ,$157.25 ,$51.80 ,$166.50 ,$79.75 ,$151.70 ,$156.33 ,$156.33 ,$79.75 ,$120.25 ,$185.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$257.00 ,$167.05 ,$36.84 ,$257.00 ,$199.38 ,$167.05 ,$153.43 ,$79.75 ,$71.96 ,$144.18 ,$79.75 ,$169.11 ,$79.75 ,$218.45 ,$218.45 ,$79.75 ,$218.45 ,$151.52 ,$174.76 ,$199.36 ,$79.75 ,$79.75 ,$192.75 ,$182.47 ,$182.47 ,$79.75 ,$182.47 ,$210.74 ,$210.74 ,$210.74 , N/A ,$199.36 ,$218.45 ,$79.75 ,$257.00 ,$153.43 ,$79.75 ,$106.91 ,$40.52 ,$36.84 ,$79.75 ,$218.45 ,$167.46 ,$218.45 ,$71.96 ,$231.30 ,$79.75 ,$210.74 ,$217.17 ,$217.17 ,$79.75 ,$167.05 ,$257.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000583,72200,HC XR SACROILIC JOINT <3VIEWS,320,1 ,$289.00 ,$187.85 ,$36.84 ,$289.00 ,$268.33 ,$187.85 ,$172.53 ,$107.33 ,$80.92 ,$162.13 ,$107.33 ,$190.16 ,$107.33 ,$245.65 ,$245.65 ,$107.33 ,$245.65 ,$203.93 ,$196.52 ,$268.33 ,$107.33 ,$107.33 ,$216.75 ,$205.19 ,$205.19 ,$107.33 ,$205.19 ,$236.98 ,$236.98 ,$236.98 , N/A ,$268.33 ,$245.65 ,$107.33 ,$289.00 ,$172.53 ,$107.33 ,$120.22 ,$40.52 ,$36.84 ,$107.33 ,$245.65 ,$225.40 ,$245.65 ,$80.92 ,$260.10 ,$107.33 ,$236.98 ,$244.21 ,$244.21 ,$107.33 ,$187.85 ,$289.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000589,74019,HC XR ABDOMEN 2V,320,1 ,$713.00 ,$463.45 ,$36.84 ,$713.00 ,$268.33 ,$463.45 ,$425.66 ,$107.33 ,$199.64 ,$399.99 ,$107.33 ,$469.15 ,$107.33 ,$606.05 ,$606.05 ,$107.33 ,$606.05 ,$203.93 ,$484.84 ,$268.33 ,$107.33 ,$107.33 ,$534.75 ,$506.23 ,$506.23 ,$107.33 ,$506.23 ,$584.66 ,$584.66 ,$584.66 , N/A ,$268.33 ,$606.05 ,$107.33 ,$713.00 ,$425.66 ,$107.33 ,$296.61 ,$40.52 ,$36.84 ,$107.33 ,$606.05 ,$225.40 ,$606.05 ,$199.64 ,$641.70 ,$107.33 ,$584.66 ,$602.49 ,$602.49 ,$107.33 ,$463.45 ,$713.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000595,76000,HC FLUOROSCOPY >1HR,320,1 ,$672.00 ,$436.80 ,$36.84 ,$672.00 ,$567.13 ,$436.80 ,$401.18 ,$226.85 ,$188.16 ,$376.99 ,$226.85 ,$442.18 ,$226.85 ,$571.20 ,$571.20 ,$226.85 ,$571.20 ,$431.02 ,$456.96 ,$567.13 ,$226.85 ,$226.85 ,$504.00 ,$477.12 ,$477.12 ,$226.85 ,$477.12 ,$551.04 ,$551.04 ,$551.04 , N/A ,$567.13 ,$571.20 ,$226.85 ,$672.00 ,$401.18 ,$226.85 ,$279.55 ,$40.52 ,$36.84 ,$226.85 ,$571.20 ,$476.39 ,$571.20 ,$188.16 ,$604.80 ,$226.85 ,$551.04 ,$567.84 ,$567.84 ,$226.85 ,$436.80 ,$672.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000610,N/A,HC HEALTH FAIR BONE DENSITY,320,1 ,$5.00 ,$3.25 ,$1.40 ,$5.00 , N/A ,$3.25 ,$2.99 , N/A ,$1.40 ,$2.81 , N/A ,$3.29 , N/A ,$4.25 ,$4.25 , N/A ,$4.25 , N/A ,$3.40 , N/A , N/A , N/A ,$3.75 ,$3.55 ,$3.55 , N/A ,$3.55 ,$4.10 ,$4.10 ,$4.10 , N/A , N/A ,$4.25 , N/A ,$5.00 ,$2.99 , N/A ,$2.08 , N/A , N/A , N/A ,$4.25 , N/A ,$4.25 ,$1.40 ,$4.50 , N/A ,$4.10 ,$4.23 ,$4.23 , N/A ,$3.25 ,$5.00 
ST. JOSEPH'S HOSPITAL - BREESE,32000611,G1004,HC RAD AUC CDSM NATL DECISION SUPPORT COMPANY,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,"$1,284.00 ",$834.60 ,$36.84 ,"$1,284.00 ", N/A ,$834.60 ,$766.55 , N/A ,$359.52 ,$720.32 , N/A ,$844.87 , N/A ,"$1,091.40 ","$1,091.40 ", N/A ,"$1,091.40 ", N/A ,$873.12 , N/A , N/A , N/A ,$963.00 ,$911.64 ,$911.64 , N/A ,$911.64 ,"$1,052.88 ","$1,052.88 ","$1,052.88 ", N/A , N/A ,"$1,091.40 ", N/A ,"$1,284.00 ",$766.55 , N/A ,$534.14 ,$40.52 ,$36.84 , N/A ,"$1,091.40 ", N/A ,"$1,091.40 ",$359.52 ,"$1,155.60 ", N/A ,"$1,052.88 ","$1,084.98 ","$1,084.98 ", N/A ,$834.60 ,"$1,284.00 "
ST. JOSEPH'S HOSPITAL - BREESE,32000613,G1002,HC RAD AUC CDSM MEDCURRENT,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000614,G1003,HC RAD AUC CDSM MEDICALIS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000615,G1005,HC RAD AUC CDSM NATIONAL IMAGING ASSOCIATES,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000616,G1006,HC RAD AUC CDSM TEST APPROPRIATE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000617,G1007,HC RAD AUC CDSM AIM SPECIALTY HEALTH,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000618,G1008,HC RAD AUC CDSM CRANBERRY PEAK,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000619,G1009,HC RAD AUC CDSM SAGE HEALTH MGMT SOLUTIONS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000620,G1010,HC RAD AUC CDSM STANSON,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000621,G1011,HC RAD AUC CDSM QUALIFIED TOOL NOS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,32000623,G1001,HC RAD AUC CDSM EVICORE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,33500002,96401,HC CHEMO SQ/IM NON ANTI-NEOPLAST,335,1 ,$201.00 ,$130.65 ,$56.28 ,$201.00 ,$152.80 ,$130.65 ,$120.00 ,$61.12 ,$56.28 ,$112.76 ,$61.12 ,$132.26 ,$61.12 ,$170.85 ,$170.85 ,$61.12 ,$170.85 ,$116.14 ,$136.68 ,$152.81 ,$61.12 ,$61.12 ,$150.75 ,$142.71 ,$142.71 ,$61.12 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$152.81 ,$170.85 ,$61.12 ,$201.00 ,$120.00 ,$61.12 ,$83.62 , N/A , N/A ,$61.12 ,$170.85 ,$128.36 ,$170.85 ,$56.28 ,$180.90 ,$61.12 ,$164.82 ,$169.85 ,$169.85 ,$61.12 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$531.00 ,$345.15 ,$148.68 ,$531.00 ,$504.20 ,$345.15 ,$317.01 ,$201.68 ,$148.68 ,$297.89 ,$201.68 ,$349.40 ,$201.68 ,$451.35 ,$451.35 ,$201.68 ,$451.35 ,$383.20 ,$361.08 ,$504.21 ,$201.68 ,$201.68 ,$398.25 ,$377.01 ,$377.01 ,$201.68 ,$377.01 ,$435.42 ,$435.42 ,$435.42 , N/A ,$504.21 ,$451.35 ,$201.68 ,$531.00 ,$317.01 ,$201.68 ,$220.90 , N/A , N/A ,$201.68 ,$451.35 ,$423.54 ,$451.35 ,$148.68 ,$477.90 ,$201.68 ,$435.42 ,$448.70 ,$448.70 ,$201.68 ,$345.15 ,$531.00 
ST. JOSEPH'S HOSPITAL - BREESE,33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$348.00 ,$226.20 ,$97.44 ,$785.88 ,$785.88 ,$226.20 ,$207.76 ,$314.35 ,$97.44 ,$195.23 ,$314.35 ,$228.98 ,$314.35 ,$295.80 ,$295.80 ,$314.35 ,$295.80 ,$348.00 ,$236.64 ,$785.87 ,$314.35 ,$314.35 ,$261.00 ,$247.08 ,$247.08 ,$314.35 ,$247.08 ,$285.36 ,$285.36 ,$285.36 , N/A ,$348.00 ,$295.80 ,$314.35 ,$348.00 ,$207.76 ,$314.35 ,$144.77 ,$227.81 ,$207.10 ,$314.35 ,$295.80 ,$660.13 ,$295.80 ,$97.44 ,$313.20 ,$314.35 ,$285.36 ,$294.06 ,$294.06 ,$314.35 ,$226.20 ,$348.00 
ST. JOSEPH'S HOSPITAL - BREESE,33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$126.00 ,$81.90 ,$35.28 ,$152.81 ,$152.80 ,$81.90 ,$75.22 ,$61.12 ,$35.28 ,$70.69 ,$61.12 ,$82.91 ,$61.12 ,$107.10 ,$107.10 ,$61.12 ,$107.10 ,$116.14 ,$85.68 ,$152.81 ,$61.12 ,$61.12 ,$94.50 ,$89.46 ,$89.46 ,$61.12 ,$89.46 ,$103.32 ,$103.32 ,$103.32 , N/A ,$126.00 ,$107.10 ,$61.12 ,$126.00 ,$75.22 ,$61.12 ,$52.42 ,$126.00 ,$126.00 ,$61.12 ,$107.10 ,$128.36 ,$107.10 ,$35.28 ,$113.40 ,$61.12 ,$103.32 ,$106.47 ,$106.47 ,$61.12 ,$81.90 ,$126.00 
ST. JOSEPH'S HOSPITAL - BREESE,33500013,96402,HC CHEMOTHERAPY INJECTION-HORMONAL ANTI-NEO,335,1 ,$170.00 ,$110.50 ,$47.60 ,$170.00 ,$152.80 ,$110.50 ,$101.49 ,$61.12 ,$47.60 ,$95.37 ,$61.12 ,$111.86 ,$61.12 ,$144.50 ,$144.50 ,$61.12 ,$144.50 ,$116.14 ,$115.60 ,$152.81 ,$61.12 ,$61.12 ,$127.50 ,$120.70 ,$120.70 ,$61.12 ,$120.70 ,$139.40 ,$139.40 ,$139.40 , N/A ,$152.81 ,$144.50 ,$61.12 ,$170.00 ,$101.49 ,$61.12 ,$70.72 , N/A , N/A ,$61.12 ,$144.50 ,$128.36 ,$144.50 ,$47.60 ,$153.00 ,$61.12 ,$139.40 ,$143.65 ,$143.65 ,$61.12 ,$110.50 ,$170.00 
ST. JOSEPH'S HOSPITAL - BREESE,34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$965.00 ,$627.25 ,$270.20 ,$965.00 ,$929.10 ,$627.25 ,$576.11 ,$371.64 ,$270.20 ,$541.37 ,$371.64 ,$634.97 ,$371.64 ,$820.25 ,$820.25 ,$371.64 ,$820.25 ,$706.11 ,$656.20 ,$929.10 ,$371.64 ,$371.64 ,$723.75 ,$685.15 ,$685.15 ,$371.64 ,$685.15 ,$791.30 ,$791.30 ,$791.30 , N/A ,$929.10 ,$820.25 ,$371.64 ,$965.00 ,$576.11 ,$371.64 ,$401.44 ,$306.43 ,$278.57 ,$371.64 ,$820.25 ,$780.44 ,$820.25 ,$270.20 ,$868.50 ,$371.64 ,$791.30 ,$815.43 ,$815.43 ,$371.64 ,$627.25 ,$965.00 
ST. JOSEPH'S HOSPITAL - BREESE,34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,579.00 ","$1,026.35 ",$278.57 ,"$1,579.00 ",$929.10 ,"$1,026.35 ",$942.66 ,$371.64 ,$442.12 ,$885.82 ,$371.64 ,"$1,038.98 ",$371.64 ,"$1,342.15 ","$1,342.15 ",$371.64 ,"$1,342.15 ",$706.11 ,"$1,073.72 ",$929.10 ,$371.64 ,$371.64 ,"$1,184.25 ","$1,121.09 ","$1,121.09 ",$371.64 ,"$1,121.09 ","$1,294.78 ","$1,294.78 ","$1,294.78 ", N/A ,$929.10 ,"$1,342.15 ",$371.64 ,"$1,579.00 ",$942.66 ,$371.64 ,$656.86 ,$306.43 ,$278.57 ,$371.64 ,"$1,342.15 ",$780.44 ,"$1,342.15 ",$442.12 ,"$1,421.10 ",$371.64 ,"$1,294.78 ","$1,334.26 ","$1,334.26 ",$371.64 ,"$1,026.35 ","$1,579.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000006,78013,HC NM THYROID SCAN,340,1 ,$759.00 ,$493.35 ,$212.52 ,$929.10 ,$929.10 ,$493.35 ,$453.12 ,$371.64 ,$212.52 ,$425.80 ,$371.64 ,$499.42 ,$371.64 ,$645.15 ,$645.15 ,$371.64 ,$645.15 ,$706.11 ,$516.12 ,$929.10 ,$371.64 ,$371.64 ,$569.25 ,$538.89 ,$538.89 ,$371.64 ,$538.89 ,$622.38 ,$622.38 ,$622.38 , N/A ,$759.00 ,$645.15 ,$371.64 ,$759.00 ,$453.12 ,$371.64 ,$315.74 ,$306.43 ,$278.57 ,$371.64 ,$645.15 ,$780.44 ,$645.15 ,$212.52 ,$683.10 ,$371.64 ,$622.38 ,$641.36 ,$641.36 ,$371.64 ,$493.35 ,$759.00 
ST. JOSEPH'S HOSPITAL - BREESE,34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$2,096.00 ","$1,362.40 ",$248.61 ,"$2,096.00 ",$929.10 ,"$1,362.40 ","$1,251.31 ",$371.64 ,$586.88 ,"$1,175.86 ",$371.64 ,"$1,379.17 ",$371.64 ,"$1,781.60 ","$1,781.60 ",$371.64 ,"$1,781.60 ",$706.11 ,"$1,425.28 ",$929.10 ,$371.64 ,$371.64 ,"$1,572.00 ","$1,488.16 ","$1,488.16 ",$371.64 ,"$1,488.16 ","$1,718.72 ","$1,718.72 ","$1,718.72 ", N/A ,$929.10 ,"$1,781.60 ",$371.64 ,"$2,096.00 ","$1,251.31 ",$371.64 ,$871.94 ,$273.47 ,$248.61 ,$371.64 ,"$1,781.60 ",$780.44 ,"$1,781.60 ",$586.88 ,"$1,886.40 ",$371.64 ,"$1,718.72 ","$1,771.12 ","$1,771.12 ",$371.64 ,"$1,362.40 ","$2,096.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$3,742.00 ","$2,432.30 ",$278.57 ,"$3,742.00 ","$1,206.13 ","$2,432.30 ","$2,233.97 ",$482.45 ,"$1,047.76 ","$2,099.26 ",$482.45 ,"$2,462.24 ",$482.45 ,"$3,180.70 ","$3,180.70 ",$482.45 ,"$3,180.70 ",$916.65 ,"$2,544.56 ","$1,206.12 ",$482.45 ,$482.45 ,"$2,806.50 ","$2,656.82 ","$2,656.82 ",$482.45 ,"$2,656.82 ","$3,068.44 ","$3,068.44 ","$3,068.44 ", N/A ,"$1,206.12 ","$3,180.70 ",$482.45 ,"$3,742.00 ","$2,233.97 ",$482.45 ,"$1,556.67 ",$306.43 ,$278.57 ,$482.45 ,"$3,180.70 ","$1,013.14 ","$3,180.70 ","$1,047.76 ","$3,367.80 ",$482.45 ,"$3,068.44 ","$3,161.99 ","$3,161.99 ",$482.45 ,"$2,432.30 ","$3,742.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,679.00 ","$1,091.35 ",$248.61 ,"$1,679.00 ",$929.10 ,"$1,091.35 ","$1,002.36 ",$371.64 ,$470.12 ,$941.92 ,$371.64 ,"$1,104.78 ",$371.64 ,"$1,427.15 ","$1,427.15 ",$371.64 ,"$1,427.15 ",$706.11 ,"$1,141.72 ",$929.10 ,$371.64 ,$371.64 ,"$1,259.25 ","$1,192.09 ","$1,192.09 ",$371.64 ,"$1,192.09 ","$1,376.78 ","$1,376.78 ","$1,376.78 ", N/A ,$929.10 ,"$1,427.15 ",$371.64 ,"$1,679.00 ","$1,002.36 ",$371.64 ,$698.46 ,$273.47 ,$248.61 ,$371.64 ,"$1,427.15 ",$780.44 ,"$1,427.15 ",$470.12 ,"$1,511.10 ",$371.64 ,"$1,376.78 ","$1,418.76 ","$1,418.76 ",$371.64 ,"$1,091.35 ","$1,679.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$2,889.00 ","$1,877.85 ",$278.57 ,"$2,889.00 ",$929.10 ,"$1,877.85 ","$1,724.73 ",$371.64 ,$808.92 ,"$1,620.73 ",$371.64 ,"$1,900.96 ",$371.64 ,"$2,455.65 ","$2,455.65 ",$371.64 ,"$2,455.65 ",$706.11 ,"$1,964.52 ",$929.10 ,$371.64 ,$371.64 ,"$2,166.75 ","$2,051.19 ","$2,051.19 ",$371.64 ,"$2,051.19 ","$2,368.98 ","$2,368.98 ","$2,368.98 ", N/A ,$929.10 ,"$2,455.65 ",$371.64 ,"$2,889.00 ","$1,724.73 ",$371.64 ,"$1,201.82 ",$306.43 ,$278.57 ,$371.64 ,"$2,455.65 ",$780.44 ,"$2,455.65 ",$808.92 ,"$2,600.10 ",$371.64 ,"$2,368.98 ","$2,441.21 ","$2,441.21 ",$371.64 ,"$1,877.85 ","$2,889.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$2,537.00 ","$1,649.05 ",$278.57 ,"$2,537.00 ",$929.10 ,"$1,649.05 ","$1,514.59 ",$371.64 ,$710.36 ,"$1,423.26 ",$371.64 ,"$1,669.35 ",$371.64 ,"$2,156.45 ","$2,156.45 ",$371.64 ,"$2,156.45 ",$706.11 ,"$1,725.16 ",$929.10 ,$371.64 ,$371.64 ,"$1,902.75 ","$1,801.27 ","$1,801.27 ",$371.64 ,"$1,801.27 ","$2,080.34 ","$2,080.34 ","$2,080.34 ", N/A ,$929.10 ,"$2,156.45 ",$371.64 ,"$2,537.00 ","$1,514.59 ",$371.64 ,"$1,055.39 ",$306.43 ,$278.57 ,$371.64 ,"$2,156.45 ",$780.44 ,"$2,156.45 ",$710.36 ,"$2,283.30 ",$371.64 ,"$2,080.34 ","$2,143.77 ","$2,143.77 ",$371.64 ,"$1,649.05 ","$2,537.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000027,78278,HC GI BLEED SCAN,340,1 ,"$1,780.00 ","$1,157.00 ",$278.57 ,"$1,780.00 ",$929.10 ,"$1,157.00 ","$1,062.66 ",$371.64 ,$498.40 ,$998.58 ,$371.64 ,"$1,171.24 ",$371.64 ,"$1,513.00 ","$1,513.00 ",$371.64 ,"$1,513.00 ",$706.11 ,"$1,210.40 ",$929.10 ,$371.64 ,$371.64 ,"$1,335.00 ","$1,263.80 ","$1,263.80 ",$371.64 ,"$1,263.80 ","$1,459.60 ","$1,459.60 ","$1,459.60 ", N/A ,$929.10 ,"$1,513.00 ",$371.64 ,"$1,780.00 ","$1,062.66 ",$371.64 ,$740.48 ,$306.43 ,$278.57 ,$371.64 ,"$1,513.00 ",$780.44 ,"$1,513.00 ",$498.40 ,"$1,602.00 ",$371.64 ,"$1,459.60 ","$1,504.10 ","$1,504.10 ",$371.64 ,"$1,157.00 ","$1,780.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,811.00 ","$1,177.15 ",$248.61 ,"$1,811.00 ",$929.10 ,"$1,177.15 ","$1,081.17 ",$371.64 ,$507.08 ,"$1,015.97 ",$371.64 ,"$1,191.64 ",$371.64 ,"$1,539.35 ","$1,539.35 ",$371.64 ,"$1,539.35 ",$706.11 ,"$1,231.48 ",$929.10 ,$371.64 ,$371.64 ,"$1,358.25 ","$1,285.81 ","$1,285.81 ",$371.64 ,"$1,285.81 ","$1,485.02 ","$1,485.02 ","$1,485.02 ", N/A ,$929.10 ,"$1,539.35 ",$371.64 ,"$1,811.00 ","$1,081.17 ",$371.64 ,$753.38 ,$273.47 ,$248.61 ,$371.64 ,"$1,539.35 ",$780.44 ,"$1,539.35 ",$507.08 ,"$1,629.90 ",$371.64 ,"$1,485.02 ","$1,530.30 ","$1,530.30 ",$371.64 ,"$1,177.15 ","$1,811.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,909.00 ","$1,240.85 ",$248.61 ,"$1,909.00 ",$929.10 ,"$1,240.85 ","$1,139.67 ",$371.64 ,$534.52 ,"$1,070.95 ",$371.64 ,"$1,256.12 ",$371.64 ,"$1,622.65 ","$1,622.65 ",$371.64 ,"$1,622.65 ",$706.11 ,"$1,298.12 ",$929.10 ,$371.64 ,$371.64 ,"$1,431.75 ","$1,355.39 ","$1,355.39 ",$371.64 ,"$1,355.39 ","$1,565.38 ","$1,565.38 ","$1,565.38 ", N/A ,$929.10 ,"$1,622.65 ",$371.64 ,"$1,909.00 ","$1,139.67 ",$371.64 ,$794.14 ,$273.47 ,$248.61 ,$371.64 ,"$1,622.65 ",$780.44 ,"$1,622.65 ",$534.52 ,"$1,718.10 ",$371.64 ,"$1,565.38 ","$1,613.11 ","$1,613.11 ",$371.64 ,"$1,240.85 ","$1,909.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000030,78305,HC BONE SCAN MULTIPLE,340,1 ,"$1,238.00 ",$804.70 ,$248.61 ,"$1,238.00 ",$929.10 ,$804.70 ,$739.09 ,$371.64 ,$346.64 ,$694.52 ,$371.64 ,$814.60 ,$371.64 ,"$1,052.30 ","$1,052.30 ",$371.64 ,"$1,052.30 ",$706.11 ,$841.84 ,$929.10 ,$371.64 ,$371.64 ,$928.50 ,$878.98 ,$878.98 ,$371.64 ,$878.98 ,"$1,015.16 ","$1,015.16 ","$1,015.16 ", N/A ,$929.10 ,"$1,052.30 ",$371.64 ,"$1,238.00 ",$739.09 ,$371.64 ,$515.01 ,$273.47 ,$248.61 ,$371.64 ,"$1,052.30 ",$780.44 ,"$1,052.30 ",$346.64 ,"$1,114.20 ",$371.64 ,"$1,015.16 ","$1,046.11 ","$1,046.11 ",$371.64 ,$804.70 ,"$1,238.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$2,966.00 ","$1,927.90 ",$248.61 ,"$2,966.00 ",$929.10 ,"$1,927.90 ","$1,770.70 ",$371.64 ,$830.48 ,"$1,663.93 ",$371.64 ,"$1,951.63 ",$371.64 ,"$2,521.10 ","$2,521.10 ",$371.64 ,"$2,521.10 ",$706.11 ,"$2,016.88 ",$929.10 ,$371.64 ,$371.64 ,"$2,224.50 ","$2,105.86 ","$2,105.86 ",$371.64 ,"$2,105.86 ","$2,432.12 ","$2,432.12 ","$2,432.12 ", N/A ,$929.10 ,"$2,521.10 ",$371.64 ,"$2,966.00 ","$1,770.70 ",$371.64 ,"$1,233.86 ",$273.47 ,$248.61 ,$371.64 ,"$2,521.10 ",$780.44 ,"$2,521.10 ",$830.48 ,"$2,669.40 ",$371.64 ,"$2,432.12 ","$2,506.27 ","$2,506.27 ",$371.64 ,"$1,927.90 ","$2,966.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000032,78315,HC BONE SCAN FLOW WHOLE BODY STATICS,340,1 ,"$3,116.00 ","$2,025.40 ",$248.61 ,"$3,116.00 ",$929.10 ,"$2,025.40 ","$1,860.25 ",$371.64 ,$872.48 ,"$1,748.08 ",$371.64 ,"$2,050.33 ",$371.64 ,"$2,648.60 ","$2,648.60 ",$371.64 ,"$2,648.60 ",$706.11 ,"$2,118.88 ",$929.10 ,$371.64 ,$371.64 ,"$2,337.00 ","$2,212.36 ","$2,212.36 ",$371.64 ,"$2,212.36 ","$2,555.12 ","$2,555.12 ","$2,555.12 ", N/A ,$929.10 ,"$2,648.60 ",$371.64 ,"$3,116.00 ","$1,860.25 ",$371.64 ,"$1,296.26 ",$273.47 ,$248.61 ,$371.64 ,"$2,648.60 ",$780.44 ,"$2,648.60 ",$872.48 ,"$2,804.40 ",$371.64 ,"$2,555.12 ","$2,633.02 ","$2,633.02 ",$371.64 ,"$2,025.40 ","$3,116.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$3,116.00 ","$2,025.40 ",$248.61 ,"$3,116.00 ",$929.10 ,"$2,025.40 ","$1,860.25 ",$371.64 ,$872.48 ,"$1,748.08 ",$371.64 ,"$2,050.33 ",$371.64 ,"$2,648.60 ","$2,648.60 ",$371.64 ,"$2,648.60 ",$706.11 ,"$2,118.88 ",$929.10 ,$371.64 ,$371.64 ,"$2,337.00 ","$2,212.36 ","$2,212.36 ",$371.64 ,"$2,212.36 ","$2,555.12 ","$2,555.12 ","$2,555.12 ", N/A ,$929.10 ,"$2,648.60 ",$371.64 ,"$3,116.00 ","$1,860.25 ",$371.64 ,"$1,296.26 ",$273.47 ,$248.61 ,$371.64 ,"$2,648.60 ",$780.44 ,"$2,648.60 ",$872.48 ,"$2,804.40 ",$371.64 ,"$2,555.12 ","$2,633.02 ","$2,633.02 ",$371.64 ,"$2,025.40 ","$3,116.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$1,641.00 ","$1,066.65 ",$278.57 ,"$3,220.85 ","$3,220.85 ","$1,066.65 ",$979.68 ,"$1,288.34 ",$459.48 ,$920.60 ,"$1,288.34 ","$1,079.78 ","$1,288.34 ","$1,394.85 ","$1,394.85 ","$1,288.34 ","$1,394.85 ","$1,641.00 ","$1,115.88 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,230.75 ","$1,165.11 ","$1,165.11 ","$1,288.34 ","$1,165.11 ","$1,345.62 ","$1,345.62 ","$1,345.62 ", N/A ,"$1,641.00 ","$1,394.85 ","$1,288.34 ","$1,641.00 ",$979.68 ,"$1,288.34 ",$682.66 ,$306.43 ,$278.57 ,"$1,288.34 ","$1,394.85 ","$2,705.50 ","$1,394.85 ",$459.48 ,"$1,476.90 ","$1,288.34 ","$1,345.62 ","$1,386.65 ","$1,386.65 ","$1,288.34 ","$1,066.65 ","$1,641.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$5,000.00 ","$3,250.00 ",$609.92 ,"$5,000.00 ","$3,220.85 ","$3,250.00 ","$2,985.00 ","$1,288.34 ","$1,400.00 ","$2,805.00 ","$1,288.34 ","$3,290.00 ","$1,288.34 ","$4,250.00 ","$4,250.00 ","$1,288.34 ","$4,250.00 ","$2,447.84 ","$3,400.00 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$3,750.00 ","$3,550.00 ","$3,550.00 ","$1,288.34 ","$3,550.00 ","$4,100.00 ","$4,100.00 ","$4,100.00 ", N/A ,"$3,220.84 ","$4,250.00 ","$1,288.34 ","$5,000.00 ","$2,985.00 ","$1,288.34 ","$2,080.00 ",$670.91 ,$609.92 ,"$1,288.34 ","$4,250.00 ","$2,705.50 ","$4,250.00 ","$1,400.00 ","$4,500.00 ","$1,288.34 ","$4,100.00 ","$4,225.00 ","$4,225.00 ","$1,288.34 ","$3,250.00 ","$5,000.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000044,78472,HC MUGA RESTING SGL,340,1 ,"$2,463.00 ","$1,600.95 ",$248.61 ,"$2,463.00 ",$929.10 ,"$1,600.95 ","$1,470.41 ",$371.64 ,$689.64 ,"$1,381.74 ",$371.64 ,"$1,620.65 ",$371.64 ,"$2,093.55 ","$2,093.55 ",$371.64 ,"$2,093.55 ",$706.11 ,"$1,674.84 ",$929.10 ,$371.64 ,$371.64 ,"$1,847.25 ","$1,748.73 ","$1,748.73 ",$371.64 ,"$1,748.73 ","$2,019.66 ","$2,019.66 ","$2,019.66 ", N/A ,$929.10 ,"$2,093.55 ",$371.64 ,"$2,463.00 ","$1,470.41 ",$371.64 ,"$1,024.61 ",$273.47 ,$248.61 ,$371.64 ,"$2,093.55 ",$780.44 ,"$2,093.55 ",$689.64 ,"$2,216.70 ",$371.64 ,"$2,019.66 ","$2,081.24 ","$2,081.24 ",$371.64 ,"$1,600.95 ","$2,463.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000047,78580,HC LUNG PERFUS,340,1 ,"$2,639.00 ","$1,715.35 ",$278.57 ,"$2,639.00 ",$929.10 ,"$1,715.35 ","$1,575.48 ",$371.64 ,$738.92 ,"$1,480.48 ",$371.64 ,"$1,736.46 ",$371.64 ,"$2,243.15 ","$2,243.15 ",$371.64 ,"$2,243.15 ",$706.11 ,"$1,794.52 ",$929.10 ,$371.64 ,$371.64 ,"$1,979.25 ","$1,873.69 ","$1,873.69 ",$371.64 ,"$1,873.69 ","$2,163.98 ","$2,163.98 ","$2,163.98 ", N/A ,$929.10 ,"$2,243.15 ",$371.64 ,"$2,639.00 ","$1,575.48 ",$371.64 ,"$1,097.82 ",$306.43 ,$278.57 ,$371.64 ,"$2,243.15 ",$780.44 ,"$2,243.15 ",$738.92 ,"$2,375.10 ",$371.64 ,"$2,163.98 ","$2,229.96 ","$2,229.96 ",$371.64 ,"$1,715.35 ","$2,639.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$3,847.00 ","$2,500.55 ",$278.57 ,"$3,847.00 ","$1,206.13 ","$2,500.55 ","$2,296.66 ",$482.45 ,"$1,077.16 ","$2,158.17 ",$482.45 ,"$2,531.33 ",$482.45 ,"$3,269.95 ","$3,269.95 ",$482.45 ,"$3,269.95 ",$916.65 ,"$2,615.96 ","$1,206.12 ",$482.45 ,$482.45 ,"$2,885.25 ","$2,731.37 ","$2,731.37 ",$482.45 ,"$2,731.37 ","$3,154.54 ","$3,154.54 ","$3,154.54 ", N/A ,"$1,206.12 ","$3,269.95 ",$482.45 ,"$3,847.00 ","$2,296.66 ",$482.45 ,"$1,600.35 ",$306.43 ,$278.57 ,$482.45 ,"$3,269.95 ","$1,013.14 ","$3,269.95 ","$1,077.16 ","$3,462.30 ",$482.45 ,"$3,154.54 ","$3,250.72 ","$3,250.72 ",$482.45 ,"$2,500.55 ","$3,847.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000061,78701,HC KIDNEY SCAN W/FLOW,340,1 ,$705.00 ,$458.25 ,$197.40 ,$929.10 ,$929.10 ,$458.25 ,$420.89 ,$371.64 ,$197.40 ,$395.51 ,$371.64 ,$463.89 ,$371.64 ,$599.25 ,$599.25 ,$371.64 ,$599.25 ,$705.00 ,$479.40 ,$929.10 ,$371.64 ,$371.64 ,$528.75 ,$500.55 ,$500.55 ,$371.64 ,$500.55 ,$578.10 ,$578.10 ,$578.10 , N/A ,$705.00 ,$599.25 ,$371.64 ,$705.00 ,$420.89 ,$371.64 ,$293.28 ,$273.47 ,$248.61 ,$371.64 ,$599.25 ,$780.44 ,$599.25 ,$197.40 ,$634.50 ,$371.64 ,$578.10 ,$595.73 ,$595.73 ,$371.64 ,$458.25 ,$705.00 
ST. JOSEPH'S HOSPITAL - BREESE,34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$1,195.00 ",$776.75 ,$248.61 ,"$1,206.13 ","$1,206.13 ",$776.75 ,$713.42 ,$482.45 ,$334.60 ,$670.40 ,$482.45 ,$786.31 ,$482.45 ,"$1,015.75 ","$1,015.75 ",$482.45 ,"$1,015.75 ",$916.65 ,$812.60 ,"$1,206.12 ",$482.45 ,$482.45 ,$896.25 ,$848.45 ,$848.45 ,$482.45 ,$848.45 ,$979.90 ,$979.90 ,$979.90 , N/A ,"$1,195.00 ","$1,015.75 ",$482.45 ,"$1,195.00 ",$713.42 ,$482.45 ,$497.12 ,$273.47 ,$248.61 ,$482.45 ,"$1,015.75 ","$1,013.14 ","$1,015.75 ",$334.60 ,"$1,075.50 ",$482.45 ,$979.90 ,"$1,009.78 ","$1,009.78 ",$482.45 ,$776.75 ,"$1,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$1,353.06 ",$879.49 ,$248.61 ,"$1,353.06 ","$1,206.13 ",$879.49 ,$807.78 ,$482.45 ,$378.86 ,$759.07 ,$482.45 ,$890.31 ,$482.45 ,"$1,150.10 ","$1,150.10 ",$482.45 ,"$1,150.10 ",$916.65 ,$920.08 ,"$1,206.12 ",$482.45 ,$482.45 ,"$1,014.80 ",$960.67 ,$960.67 ,$482.45 ,$960.67 ,"$1,109.51 ","$1,109.51 ","$1,109.51 ", N/A ,"$1,206.12 ","$1,150.10 ",$482.45 ,"$1,353.06 ",$807.78 ,$482.45 ,$562.87 ,$273.47 ,$248.61 ,$482.45 ,"$1,150.10 ","$1,013.14 ","$1,150.10 ",$378.86 ,"$1,217.75 ",$482.45 ,"$1,109.51 ","$1,143.34 ","$1,143.34 ",$482.45 ,$879.49 ,"$1,353.06 "
ST. JOSEPH'S HOSPITAL - BREESE,34000065,78709,HC KIDNEY W AND W/O PHARM INTERVEN,340,1 ,"$1,517.00 ",$986.05 ,$248.61 ,"$1,517.00 ","$1,206.13 ",$986.05 ,$905.65 ,$482.45 ,$424.76 ,$851.04 ,$482.45 ,$998.19 ,$482.45 ,"$1,289.45 ","$1,289.45 ",$482.45 ,"$1,289.45 ",$916.65 ,"$1,031.56 ","$1,206.12 ",$482.45 ,$482.45 ,"$1,137.75 ","$1,077.07 ","$1,077.07 ",$482.45 ,"$1,077.07 ","$1,243.94 ","$1,243.94 ","$1,243.94 ", N/A ,"$1,206.12 ","$1,289.45 ",$482.45 ,"$1,517.00 ",$905.65 ,$482.45 ,$631.07 ,$273.47 ,$248.61 ,$482.45 ,"$1,289.45 ","$1,013.14 ","$1,289.45 ",$424.76 ,"$1,365.30 ",$482.45 ,"$1,243.94 ","$1,281.87 ","$1,281.87 ",$482.45 ,$986.05 ,"$1,517.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000068,78800,HC TUMOR LOCAL LIMITED,340,1 ,"$1,238.00 ",$804.70 ,$278.57 ,"$1,238.00 ",$929.10 ,$804.70 ,$739.09 ,$371.64 ,$346.64 ,$694.52 ,$371.64 ,$814.60 ,$371.64 ,"$1,052.30 ","$1,052.30 ",$371.64 ,"$1,052.30 ",$706.11 ,$841.84 ,$929.10 ,$371.64 ,$371.64 ,$928.50 ,$878.98 ,$878.98 ,$371.64 ,$878.98 ,"$1,015.16 ","$1,015.16 ","$1,015.16 ", N/A ,$929.10 ,"$1,052.30 ",$371.64 ,"$1,238.00 ",$739.09 ,$371.64 ,$515.01 ,$306.43 ,$278.57 ,$371.64 ,"$1,052.30 ",$780.44 ,"$1,052.30 ",$346.64 ,"$1,114.20 ",$371.64 ,"$1,015.16 ","$1,046.11 ","$1,046.11 ",$371.64 ,$804.70 ,"$1,238.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000069,78801,HC TUMOR LOCAL MULTIPLE,340,1 ,"$1,238.00 ",$804.70 ,$278.57 ,"$1,238.00 ",$929.10 ,$804.70 ,$739.09 ,$371.64 ,$346.64 ,$694.52 ,$371.64 ,$814.60 ,$371.64 ,"$1,052.30 ","$1,052.30 ",$371.64 ,"$1,052.30 ",$706.11 ,$841.84 ,$929.10 ,$371.64 ,$371.64 ,$928.50 ,$878.98 ,$878.98 ,$371.64 ,$878.98 ,"$1,015.16 ","$1,015.16 ","$1,015.16 ", N/A ,$929.10 ,"$1,052.30 ",$371.64 ,"$1,238.00 ",$739.09 ,$371.64 ,$515.01 ,$306.43 ,$278.57 ,$371.64 ,"$1,052.30 ",$780.44 ,"$1,052.30 ",$346.64 ,"$1,114.20 ",$371.64 ,"$1,015.16 ","$1,046.11 ","$1,046.11 ",$371.64 ,$804.70 ,"$1,238.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$4,305.00 ","$2,798.25 ",$609.92 ,"$4,305.00 ","$3,220.85 ","$2,798.25 ","$2,570.09 ","$1,288.34 ","$1,205.40 ","$2,415.11 ","$1,288.34 ","$2,832.69 ","$1,288.34 ","$3,659.25 ","$3,659.25 ","$1,288.34 ","$3,659.25 ","$2,447.84 ","$2,927.40 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$3,228.75 ","$3,056.55 ","$3,056.55 ","$1,288.34 ","$3,056.55 ","$3,530.10 ","$3,530.10 ","$3,530.10 ", N/A ,"$3,220.84 ","$3,659.25 ","$1,288.34 ","$4,305.00 ","$2,570.09 ","$1,288.34 ","$1,790.88 ",$670.91 ,$609.92 ,"$1,288.34 ","$3,659.25 ","$2,705.50 ","$3,659.25 ","$1,205.40 ","$3,874.50 ","$1,288.34 ","$3,530.10 ","$3,637.73 ","$3,637.73 ","$1,288.34 ","$2,798.25 ","$4,305.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$1,595.00 ","$1,036.75 ",$446.60 ,"$3,220.85 ","$3,220.85 ","$1,036.75 ",$952.22 ,"$1,288.34 ",$446.60 ,$894.80 ,"$1,288.34 ","$1,049.51 ","$1,288.34 ","$1,355.75 ","$1,355.75 ","$1,288.34 ","$1,355.75 ","$1,595.00 ","$1,084.60 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,196.25 ","$1,132.45 ","$1,132.45 ","$1,288.34 ","$1,132.45 ","$1,307.90 ","$1,307.90 ","$1,307.90 ", N/A ,"$1,595.00 ","$1,355.75 ","$1,288.34 ","$1,595.00 ",$952.22 ,"$1,288.34 ",$663.52 ,$670.91 ,$609.92 ,"$1,288.34 ","$1,355.75 ","$2,705.50 ","$1,355.75 ",$446.60 ,"$1,435.50 ","$1,288.34 ","$1,307.90 ","$1,347.78 ","$1,347.78 ","$1,288.34 ","$1,036.75 ","$1,595.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000072,78803,HC TUMOR IMAGING (SPECT) MIBG,340,1 ,"$1,595.00 ","$1,036.75 ",$446.60 ,"$3,220.85 ","$3,220.85 ","$1,036.75 ",$952.22 ,"$1,288.34 ",$446.60 ,$894.80 ,"$1,288.34 ","$1,049.51 ","$1,288.34 ","$1,355.75 ","$1,355.75 ","$1,288.34 ","$1,355.75 ","$1,595.00 ","$1,084.60 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,196.25 ","$1,132.45 ","$1,132.45 ","$1,288.34 ","$1,132.45 ","$1,307.90 ","$1,307.90 ","$1,307.90 ", N/A ,"$1,595.00 ","$1,355.75 ","$1,288.34 ","$1,595.00 ",$952.22 ,"$1,288.34 ",$663.52 ,$670.91 ,$609.92 ,"$1,288.34 ","$1,355.75 ","$2,705.50 ","$1,355.75 ",$446.60 ,"$1,435.50 ","$1,288.34 ","$1,307.90 ","$1,347.78 ","$1,347.78 ","$1,288.34 ","$1,036.75 ","$1,595.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000073,78803,HC TUMOR IMAGING (SPECT) GALLIUM,340,1 ,"$1,595.00 ","$1,036.75 ",$446.60 ,"$3,220.85 ","$3,220.85 ","$1,036.75 ",$952.22 ,"$1,288.34 ",$446.60 ,$894.80 ,"$1,288.34 ","$1,049.51 ","$1,288.34 ","$1,355.75 ","$1,355.75 ","$1,288.34 ","$1,355.75 ","$1,595.00 ","$1,084.60 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,196.25 ","$1,132.45 ","$1,132.45 ","$1,288.34 ","$1,132.45 ","$1,307.90 ","$1,307.90 ","$1,307.90 ", N/A ,"$1,595.00 ","$1,355.75 ","$1,288.34 ","$1,595.00 ",$952.22 ,"$1,288.34 ",$663.52 ,$670.91 ,$609.92 ,"$1,288.34 ","$1,355.75 ","$2,705.50 ","$1,355.75 ",$446.60 ,"$1,435.50 ","$1,288.34 ","$1,307.90 ","$1,347.78 ","$1,347.78 ","$1,288.34 ","$1,036.75 ","$1,595.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000074,78803,HC TUMOR IMAGING (SPECT) NON GATED,340,1 ,"$1,595.00 ","$1,036.75 ",$446.60 ,"$3,220.85 ","$3,220.85 ","$1,036.75 ",$952.22 ,"$1,288.34 ",$446.60 ,$894.80 ,"$1,288.34 ","$1,049.51 ","$1,288.34 ","$1,355.75 ","$1,355.75 ","$1,288.34 ","$1,355.75 ","$1,595.00 ","$1,084.60 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,196.25 ","$1,132.45 ","$1,132.45 ","$1,288.34 ","$1,132.45 ","$1,307.90 ","$1,307.90 ","$1,307.90 ", N/A ,"$1,595.00 ","$1,355.75 ","$1,288.34 ","$1,595.00 ",$952.22 ,"$1,288.34 ",$663.52 ,$670.91 ,$609.92 ,"$1,288.34 ","$1,355.75 ","$2,705.50 ","$1,355.75 ",$446.60 ,"$1,435.50 ","$1,288.34 ","$1,307.90 ","$1,347.78 ","$1,347.78 ","$1,288.34 ","$1,036.75 ","$1,595.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000075,78803,HC TUMOR IMAGING (SPECT) OCTREO,340,1 ,"$1,595.00 ","$1,036.75 ",$446.60 ,"$3,220.85 ","$3,220.85 ","$1,036.75 ",$952.22 ,"$1,288.34 ",$446.60 ,$894.80 ,"$1,288.34 ","$1,049.51 ","$1,288.34 ","$1,355.75 ","$1,355.75 ","$1,288.34 ","$1,355.75 ","$1,595.00 ","$1,084.60 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,196.25 ","$1,132.45 ","$1,132.45 ","$1,288.34 ","$1,132.45 ","$1,307.90 ","$1,307.90 ","$1,307.90 ", N/A ,"$1,595.00 ","$1,355.75 ","$1,288.34 ","$1,595.00 ",$952.22 ,"$1,288.34 ",$663.52 ,$670.91 ,$609.92 ,"$1,288.34 ","$1,355.75 ","$2,705.50 ","$1,355.75 ",$446.60 ,"$1,435.50 ","$1,288.34 ","$1,307.90 ","$1,347.78 ","$1,347.78 ","$1,288.34 ","$1,036.75 ","$1,595.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000076,78803,HC TUMOR IMAGING (SPECT) PARATHYROID,340,1 ,"$1,595.00 ","$1,036.75 ",$446.60 ,"$3,220.85 ","$3,220.85 ","$1,036.75 ",$952.22 ,"$1,288.34 ",$446.60 ,$894.80 ,"$1,288.34 ","$1,049.51 ","$1,288.34 ","$1,355.75 ","$1,355.75 ","$1,288.34 ","$1,355.75 ","$1,595.00 ","$1,084.60 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$1,196.25 ","$1,132.45 ","$1,132.45 ","$1,288.34 ","$1,132.45 ","$1,307.90 ","$1,307.90 ","$1,307.90 ", N/A ,"$1,595.00 ","$1,355.75 ","$1,288.34 ","$1,595.00 ",$952.22 ,"$1,288.34 ",$663.52 ,$670.91 ,$609.92 ,"$1,288.34 ","$1,355.75 ","$2,705.50 ","$1,355.75 ",$446.60 ,"$1,435.50 ","$1,288.34 ","$1,307.90 ","$1,347.78 ","$1,347.78 ","$1,288.34 ","$1,036.75 ","$1,595.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000090,78597,HC PULM PERF DIFF W/IMG,340,1 ,"$1,936.00 ","$1,258.40 ",$278.57 ,"$1,936.00 ",$929.10 ,"$1,258.40 ","$1,155.79 ",$371.64 ,$542.08 ,"$1,086.10 ",$371.64 ,"$1,273.89 ",$371.64 ,"$1,645.60 ","$1,645.60 ",$371.64 ,"$1,645.60 ",$706.11 ,"$1,316.48 ",$929.10 ,$371.64 ,$371.64 ,"$1,452.00 ","$1,374.56 ","$1,374.56 ",$371.64 ,"$1,374.56 ","$1,587.52 ","$1,587.52 ","$1,587.52 ", N/A ,$929.10 ,"$1,645.60 ",$371.64 ,"$1,936.00 ","$1,155.79 ",$371.64 ,$805.38 ,$306.43 ,$278.57 ,$371.64 ,"$1,645.60 ",$780.44 ,"$1,645.60 ",$542.08 ,"$1,742.40 ",$371.64 ,"$1,587.52 ","$1,635.92 ","$1,635.92 ",$371.64 ,"$1,258.40 ","$1,936.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$3,071.00 ","$1,996.15 ",$278.57 ,"$3,071.00 ","$1,206.13 ","$1,996.15 ","$1,833.39 ",$482.45 ,$859.88 ,"$1,722.83 ",$482.45 ,"$2,020.72 ",$482.45 ,"$2,610.35 ","$2,610.35 ",$482.45 ,"$2,610.35 ",$916.65 ,"$2,088.28 ","$1,206.12 ",$482.45 ,$482.45 ,"$2,303.25 ","$2,180.41 ","$2,180.41 ",$482.45 ,"$2,180.41 ","$2,518.22 ","$2,518.22 ","$2,518.22 ", N/A ,"$1,206.12 ","$2,610.35 ",$482.45 ,"$3,071.00 ","$1,833.39 ",$482.45 ,"$1,277.54 ",$306.43 ,$278.57 ,$482.45 ,"$2,610.35 ","$1,013.14 ","$2,610.35 ",$859.88 ,"$2,763.90 ",$482.45 ,"$2,518.22 ","$2,595.00 ","$2,595.00 ",$482.45 ,"$1,996.15 ","$3,071.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34100007,A9538,HC NM PYROPHOSPHATE 99M VIAL,343,1 ,$152.00 ,$98.80 ,$42.56 ,$152.00 , N/A ,$98.80 ,$90.74 , N/A ,$42.56 ,$85.27 , N/A ,$100.02 , N/A ,$129.20 ,$129.20 , N/A ,$129.20 , N/A ,$103.36 , N/A , N/A , N/A ,$114.00 ,$107.92 ,$107.92 , N/A ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A , N/A ,$129.20 , N/A ,$152.00 ,$90.74 , N/A ,$63.23 , N/A , N/A , N/A ,$129.20 , N/A ,$129.20 ,$42.56 ,$136.80 , N/A ,$124.64 ,$128.44 ,$128.44 , N/A ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,34100033,78831,HC TUMOR LOCAL SPECT MULT AREA 1 DAY OR SGL AREA W/MULT DAYS,341,1 ,"$4,305.00 ","$2,798.25 ",$609.92 ,"$4,305.00 ","$3,220.85 ","$2,798.25 ","$2,570.09 ","$1,288.34 ","$1,205.40 ","$2,415.11 ","$1,288.34 ","$2,832.69 ","$1,288.34 ","$3,659.25 ","$3,659.25 ","$1,288.34 ","$3,659.25 ","$2,447.84 ","$2,927.40 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$3,228.75 ","$3,056.55 ","$3,056.55 ","$1,288.34 ","$3,056.55 ","$3,530.10 ","$3,530.10 ","$3,530.10 ", N/A ,"$3,220.84 ","$3,659.25 ","$1,288.34 ","$4,305.00 ","$2,570.09 ","$1,288.34 ","$1,790.88 ",$670.91 ,$609.92 ,"$1,288.34 ","$3,659.25 ","$2,705.50 ","$3,659.25 ","$1,205.40 ","$3,874.50 ","$1,288.34 ","$3,530.10 ","$3,637.73 ","$3,637.73 ","$1,288.34 ","$2,798.25 ","$4,305.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34100034,78830,HC TUMOR IMAGING SPECT W/CT SGL AREA 1 DAY,341,1 ,"$4,305.00 ","$2,798.25 ",$609.92 ,"$4,305.00 ","$3,220.85 ","$2,798.25 ","$2,570.09 ","$1,288.34 ","$1,205.40 ","$2,415.11 ","$1,288.34 ","$2,832.69 ","$1,288.34 ","$3,659.25 ","$3,659.25 ","$1,288.34 ","$3,659.25 ","$2,447.84 ","$2,927.40 ","$3,220.84 ","$1,288.34 ","$1,288.34 ","$3,228.75 ","$3,056.55 ","$3,056.55 ","$1,288.34 ","$3,056.55 ","$3,530.10 ","$3,530.10 ","$3,530.10 ", N/A ,"$3,220.84 ","$3,659.25 ","$1,288.34 ","$4,305.00 ","$2,570.09 ","$1,288.34 ","$1,790.88 ",$670.91 ,$609.92 ,"$1,288.34 ","$3,659.25 ","$2,705.50 ","$3,659.25 ","$1,205.40 ","$3,874.50 ","$1,288.34 ","$3,530.10 ","$3,637.73 ","$3,637.73 ","$1,288.34 ","$2,798.25 ","$4,305.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$375.00 ,$243.75 ,$105.00 ,$375.00 , N/A ,$243.75 ,$223.88 , N/A ,$105.00 ,$210.38 , N/A ,$246.75 , N/A ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$255.00 , N/A , N/A , N/A ,$281.25 ,$266.25 ,$266.25 , N/A ,$266.25 ,$307.50 ,$307.50 ,$307.50 , N/A , N/A ,$318.75 , N/A ,$375.00 ,$223.88 , N/A ,$156.00 , N/A , N/A , N/A ,$318.75 , N/A ,$318.75 ,$105.00 ,$337.50 , N/A ,$307.50 ,$316.88 ,$316.88 , N/A ,$243.75 ,$375.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$570.00 ,$370.50 ,$159.60 ,$570.00 , N/A ,$370.50 ,$340.29 , N/A ,$159.60 ,$319.77 , N/A ,$375.06 , N/A ,$484.50 ,$484.50 , N/A ,$484.50 , N/A ,$387.60 , N/A , N/A , N/A ,$427.50 ,$404.70 ,$404.70 , N/A ,$404.70 ,$467.40 ,$467.40 ,$467.40 , N/A , N/A ,$484.50 , N/A ,$570.00 ,$340.29 , N/A ,$237.12 , N/A , N/A , N/A ,$484.50 , N/A ,$484.50 ,$159.60 ,$513.00 , N/A ,$467.40 ,$481.65 ,$481.65 , N/A ,$370.50 ,$570.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300006,A9505,HC DIAGNUCLIDE THALL 201 PER MCI,343,1 ,$87.00 ,$56.55 ,$24.36 ,$87.00 , N/A ,$56.55 ,$51.94 , N/A ,$24.36 ,$48.81 , N/A ,$57.25 , N/A ,$73.95 ,$73.95 , N/A ,$73.95 , N/A ,$59.16 , N/A , N/A , N/A ,$65.25 ,$61.77 ,$61.77 , N/A ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A , N/A ,$73.95 , N/A ,$87.00 ,$51.94 , N/A ,$36.19 , N/A , N/A , N/A ,$73.95 , N/A ,$73.95 ,$24.36 ,$78.30 , N/A ,$71.34 ,$73.52 ,$73.52 , N/A ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300009,A9512,HC TECHNETIUM TC99 PERTECH PER MCI,343,1 ,$100.00 ,$65.00 ,$28.00 ,$100.00 , N/A ,$65.00 ,$59.70 , N/A ,$28.00 ,$56.10 , N/A ,$65.80 , N/A ,$85.00 ,$85.00 , N/A ,$85.00 , N/A ,$68.00 , N/A , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A , N/A ,$85.00 , N/A ,$100.00 ,$59.70 , N/A ,$41.60 , N/A , N/A , N/A ,$85.00 , N/A ,$85.00 ,$28.00 ,$90.00 , N/A ,$82.00 ,$84.50 ,$84.50 , N/A ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$212.00 ,$137.80 ,$59.36 ,$212.00 , N/A ,$137.80 ,$126.56 , N/A ,$59.36 ,$118.93 , N/A ,$139.50 , N/A ,$180.20 ,$180.20 , N/A ,$180.20 , N/A ,$144.16 , N/A , N/A , N/A ,$159.00 ,$150.52 ,$150.52 , N/A ,$150.52 ,$173.84 ,$173.84 ,$173.84 , N/A , N/A ,$180.20 , N/A ,$212.00 ,$126.56 , N/A ,$88.19 , N/A , N/A , N/A ,$180.20 , N/A ,$180.20 ,$59.36 ,$190.80 , N/A ,$173.84 ,$179.14 ,$179.14 , N/A ,$137.80 ,$212.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300012,A9521,HC DIAGNUCLIDE CERETEC,343,1 ,"$2,742.00 ","$1,782.30 ",$767.76 ,"$2,742.00 ", N/A ,"$1,782.30 ","$1,636.97 ", N/A ,$767.76 ,"$1,538.26 ", N/A ,"$1,804.24 ", N/A ,"$2,330.70 ","$2,330.70 ", N/A ,"$2,330.70 ", N/A ,"$1,864.56 ", N/A , N/A , N/A ,"$2,056.50 ","$1,946.82 ","$1,946.82 ", N/A ,"$1,946.82 ","$2,248.44 ","$2,248.44 ","$2,248.44 ", N/A , N/A ,"$2,330.70 ", N/A ,"$2,742.00 ","$1,636.97 ", N/A ,"$1,140.67 ", N/A , N/A , N/A ,"$2,330.70 ", N/A ,"$2,330.70 ",$767.76 ,"$2,467.80 ", N/A ,"$2,248.44 ","$2,316.99 ","$2,316.99 ", N/A ,"$1,782.30 ","$2,742.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$161.00 ,$104.65 ,$45.08 ,$161.00 , N/A ,$104.65 ,$96.12 , N/A ,$45.08 ,$90.32 , N/A ,$105.94 , N/A ,$136.85 ,$136.85 , N/A ,$136.85 , N/A ,$109.48 , N/A , N/A , N/A ,$120.75 ,$114.31 ,$114.31 , N/A ,$114.31 ,$132.02 ,$132.02 ,$132.02 , N/A , N/A ,$136.85 , N/A ,$161.00 ,$96.12 , N/A ,$66.98 , N/A , N/A , N/A ,$136.85 , N/A ,$136.85 ,$45.08 ,$144.90 , N/A ,$132.02 ,$136.05 ,$136.05 , N/A ,$104.65 ,$161.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$292.00 ,$189.80 ,$81.76 ,$292.00 , N/A ,$189.80 ,$174.32 , N/A ,$81.76 ,$163.81 , N/A ,$192.14 , N/A ,$248.20 ,$248.20 , N/A ,$248.20 , N/A ,$198.56 , N/A , N/A , N/A ,$219.00 ,$207.32 ,$207.32 , N/A ,$207.32 ,$239.44 ,$239.44 ,$239.44 , N/A , N/A ,$248.20 , N/A ,$292.00 ,$174.32 , N/A ,$121.47 , N/A , N/A , N/A ,$248.20 , N/A ,$248.20 ,$81.76 ,$262.80 , N/A ,$239.44 ,$246.74 ,$246.74 , N/A ,$189.80 ,$292.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$125.00 ,$81.25 ,$35.00 ,$125.00 , N/A ,$81.25 ,$74.63 , N/A ,$35.00 ,$70.13 , N/A ,$82.25 , N/A ,$106.25 ,$106.25 , N/A ,$106.25 , N/A ,$85.00 , N/A , N/A , N/A ,$93.75 ,$88.75 ,$88.75 , N/A ,$88.75 ,$102.50 ,$102.50 ,$102.50 , N/A , N/A ,$106.25 , N/A ,$125.00 ,$74.63 , N/A ,$52.00 , N/A , N/A , N/A ,$106.25 , N/A ,$106.25 ,$35.00 ,$112.50 , N/A ,$102.50 ,$105.63 ,$105.63 , N/A ,$81.25 ,$125.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$161.00 ,$104.65 ,$45.08 ,$161.00 , N/A ,$104.65 ,$96.12 , N/A ,$45.08 ,$90.32 , N/A ,$105.94 , N/A ,$136.85 ,$136.85 , N/A ,$136.85 , N/A ,$109.48 , N/A , N/A , N/A ,$120.75 ,$114.31 ,$114.31 , N/A ,$114.31 ,$132.02 ,$132.02 ,$132.02 , N/A , N/A ,$136.85 , N/A ,$161.00 ,$96.12 , N/A ,$66.98 , N/A , N/A , N/A ,$136.85 , N/A ,$136.85 ,$45.08 ,$144.90 , N/A ,$132.02 ,$136.05 ,$136.05 , N/A ,$104.65 ,$161.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$1,287.00 ",$836.55 ,$360.36 ,"$1,287.00 ", N/A ,$836.55 ,$768.34 , N/A ,$360.36 ,$722.01 , N/A ,$846.85 , N/A ,"$1,093.95 ","$1,093.95 ", N/A ,"$1,093.95 ", N/A ,$875.16 , N/A , N/A , N/A ,$965.25 ,$913.77 ,$913.77 , N/A ,$913.77 ,"$1,055.34 ","$1,055.34 ","$1,055.34 ", N/A , N/A ,"$1,093.95 ", N/A ,"$1,287.00 ",$768.34 , N/A ,$535.39 , N/A , N/A , N/A ,"$1,093.95 ", N/A ,"$1,093.95 ",$360.36 ,"$1,158.30 ", N/A ,"$1,055.34 ","$1,087.52 ","$1,087.52 ", N/A ,$836.55 ,"$1,287.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34300031,A9556,HC DIAGNUCLIDE GA67 PER MCI,343,1 ,$252.00 ,$163.80 ,$70.56 ,$252.00 , N/A ,$163.80 ,$150.44 , N/A ,$70.56 ,$141.37 , N/A ,$165.82 , N/A ,$214.20 ,$214.20 , N/A ,$214.20 , N/A ,$171.36 , N/A , N/A , N/A ,$189.00 ,$178.92 ,$178.92 , N/A ,$178.92 ,$206.64 ,$206.64 ,$206.64 , N/A , N/A ,$214.20 , N/A ,$252.00 ,$150.44 , N/A ,$104.83 , N/A , N/A , N/A ,$214.20 , N/A ,$214.20 ,$70.56 ,$226.80 , N/A ,$206.64 ,$212.94 ,$212.94 , N/A ,$163.80 ,$252.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300033,A9558,HC DIAGNUCLIDE XE133 10 MCI,343,1 ,$142.00 ,$92.30 ,$39.76 ,$142.00 , N/A ,$92.30 ,$84.77 , N/A ,$39.76 ,$79.66 , N/A ,$93.44 , N/A ,$120.70 ,$120.70 , N/A ,$120.70 , N/A ,$96.56 , N/A , N/A , N/A ,$106.50 ,$100.82 ,$100.82 , N/A ,$100.82 ,$116.44 ,$116.44 ,$116.44 , N/A , N/A ,$120.70 , N/A ,$142.00 ,$84.77 , N/A ,$59.07 , N/A , N/A , N/A ,$120.70 , N/A ,$120.70 ,$39.76 ,$127.80 , N/A ,$116.44 ,$119.99 ,$119.99 , N/A ,$92.30 ,$142.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$372.00 ,$241.80 ,$104.16 ,$372.00 , N/A ,$241.80 ,$222.08 , N/A ,$104.16 ,$208.69 , N/A ,$244.78 , N/A ,$316.20 ,$316.20 , N/A ,$316.20 , N/A ,$252.96 , N/A , N/A , N/A ,$279.00 ,$264.12 ,$264.12 , N/A ,$264.12 ,$305.04 ,$305.04 ,$305.04 , N/A , N/A ,$316.20 , N/A ,$372.00 ,$222.08 , N/A ,$154.75 , N/A , N/A , N/A ,$316.20 , N/A ,$316.20 ,$104.16 ,$334.80 , N/A ,$305.04 ,$314.34 ,$314.34 , N/A ,$241.80 ,$372.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,$740.00 ,$481.00 ,$207.20 ,$740.00 , N/A ,$481.00 ,$441.78 , N/A ,$207.20 ,$415.14 , N/A ,$486.92 , N/A ,$629.00 ,$629.00 , N/A ,$629.00 , N/A ,$503.20 , N/A , N/A , N/A ,$555.00 ,$525.40 ,$525.40 , N/A ,$525.40 ,$606.80 ,$606.80 ,$606.80 , N/A , N/A ,$629.00 , N/A ,$740.00 ,$441.78 , N/A ,$307.84 , N/A , N/A , N/A ,$629.00 , N/A ,$629.00 ,$207.20 ,$666.00 , N/A ,$606.80 ,$625.30 ,$625.30 , N/A ,$481.00 ,$740.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$312.00 ,$202.80 ,$87.36 ,$312.00 , N/A ,$202.80 ,$186.26 , N/A ,$87.36 ,$175.03 , N/A ,$205.30 , N/A ,$265.20 ,$265.20 , N/A ,$265.20 , N/A ,$212.16 , N/A , N/A , N/A ,$234.00 ,$221.52 ,$221.52 , N/A ,$221.52 ,$255.84 ,$255.84 ,$255.84 , N/A , N/A ,$265.20 , N/A ,$312.00 ,$186.26 , N/A ,$129.79 ,$99.40 ,$90.36 , N/A ,$265.20 , N/A ,$265.20 ,$87.36 ,$280.80 , N/A ,$255.84 ,$263.64 ,$263.64 , N/A ,$202.80 ,$312.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300057,A9569,HC TC99M EXAMETAZIME CERETEC DX PER DOSE,343,1 ,"$2,449.00 ","$1,591.85 ",$685.72 ,"$2,449.00 ", N/A ,"$1,591.85 ","$1,462.05 ", N/A ,$685.72 ,"$1,373.89 ", N/A ,"$1,611.44 ", N/A ,"$2,081.65 ","$2,081.65 ", N/A ,"$2,081.65 ", N/A ,"$1,665.32 ", N/A , N/A , N/A ,"$1,836.75 ","$1,738.79 ","$1,738.79 ", N/A ,"$1,738.79 ","$2,008.18 ","$2,008.18 ","$2,008.18 ", N/A , N/A ,"$2,081.65 ", N/A ,"$2,449.00 ","$1,462.05 ", N/A ,"$1,018.78 ", N/A , N/A , N/A ,"$2,081.65 ", N/A ,"$2,081.65 ",$685.72 ,"$2,204.10 ", N/A ,"$2,008.18 ","$2,069.41 ","$2,069.41 ", N/A ,"$1,591.85 ","$2,449.00 "
ST. JOSEPH'S HOSPITAL - BREESE,34300060,A9520,HC DIAGNUCLIDE TC-99 TILMANOCEPT DIAG UP TO 0.5 MCI,343,1 ,$411.00 ,$267.15 ,$115.08 ,$411.00 , N/A ,$267.15 ,$245.37 , N/A ,$115.08 ,$230.57 , N/A ,$270.44 , N/A ,$349.35 ,$349.35 , N/A ,$349.35 , N/A ,$279.48 , N/A , N/A , N/A ,$308.25 ,$291.81 ,$291.81 , N/A ,$291.81 ,$337.02 ,$337.02 ,$337.02 , N/A , N/A ,$349.35 , N/A ,$411.00 ,$245.37 , N/A ,$170.98 , N/A , N/A , N/A ,$349.35 , N/A ,$349.35 ,$115.08 ,$369.90 , N/A ,$337.02 ,$347.30 ,$347.30 , N/A ,$267.15 ,$411.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300067,A9561,HC DIAGNUCLIDE TC-99 OXIDRONATE PER STUDY UP TO 30MCI,343,1 ,$97.00 ,$63.05 ,$27.16 ,$97.00 , N/A ,$63.05 ,$57.91 , N/A ,$27.16 ,$54.42 , N/A ,$63.83 , N/A ,$82.45 ,$82.45 , N/A ,$82.45 , N/A ,$65.96 , N/A , N/A , N/A ,$72.75 ,$68.87 ,$68.87 , N/A ,$68.87 ,$79.54 ,$79.54 ,$79.54 , N/A , N/A ,$82.45 , N/A ,$97.00 ,$57.91 , N/A ,$40.35 , N/A , N/A , N/A ,$82.45 , N/A ,$82.45 ,$27.16 ,$87.30 , N/A ,$79.54 ,$81.97 ,$81.97 , N/A ,$63.05 ,$97.00 
ST. JOSEPH'S HOSPITAL - BREESE,34300072,A9595,"HC PIFLUFOLASTAT F-18, DIAGNOSTIC, 1 MILLICURIE",343,1 ,"$1,579.00 ","$1,026.35 ",$442.12 ,"$1,579.00 ","$1,354.45 ","$1,026.35 ",$942.66 ,$541.78 ,$442.12 ,$885.82 ,$541.78 ,"$1,038.98 ",$541.78 ,"$1,342.15 ","$1,342.15 ",$541.78 ,"$1,342.15 ","$1,029.38 ","$1,073.72 ","$1,354.45 ",$541.78 ,$541.78 ,"$1,184.25 ","$1,121.09 ","$1,121.09 ",$541.78 ,"$1,121.09 ","$1,294.78 ","$1,294.78 ","$1,294.78 ", N/A ,"$1,354.45 ","$1,342.15 ",$541.78 ,"$1,579.00 ",$942.66 ,$541.78 ,$656.86 , N/A , N/A ,$541.78 ,"$1,342.15 ","$1,137.73 ","$1,342.15 ",$442.12 ,"$1,421.10 ",$541.78 ,"$1,294.78 ","$1,334.26 ","$1,334.26 ",$541.78 ,"$1,026.35 ","$1,579.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000006,21550,HC BX TISSUE NECK/THORAX,350,1 ,"$3,900.00 ","$2,535.00 ",$426.58 ,"$3,900.00 ","$3,467.90 ","$2,535.00 ","$2,328.30 ","$1,387.16 ","$1,092.00 ","$2,187.90 ","$1,387.16 ","$2,566.20 ","$1,387.16 ","$3,315.00 ","$3,315.00 ","$1,387.16 ","$3,315.00 ","$2,635.59 ","$2,652.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$2,925.00 ","$2,769.00 ","$2,769.00 ","$1,387.16 ","$2,769.00 ","$3,198.00 ","$3,198.00 ","$3,198.00 ", N/A ,"$3,467.89 ","$3,315.00 ","$1,387.16 ","$3,900.00 ","$2,328.30 ","$1,387.16 ","$1,622.40 ",$469.24 ,$426.58 ,"$1,387.16 ","$3,315.00 ","$2,913.03 ","$3,315.00 ","$1,092.00 ","$3,510.00 ","$1,387.16 ","$3,198.00 ","$3,295.50 ","$3,295.50 ","$1,387.16 ","$2,535.00 ","$3,900.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,"$1,644.00 ","$1,068.60 ",$402.65 ,"$1,644.00 ","$1,533.75 ","$1,068.60 ",$981.47 ,$613.50 ,$460.32 ,$922.28 ,$613.50 ,"$1,081.75 ",$613.50 ,"$1,397.40 ","$1,397.40 ",$613.50 ,"$1,397.40 ","$1,165.65 ","$1,117.92 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,233.00 ","$1,167.24 ","$1,167.24 ",$613.50 ,"$1,167.24 ","$1,348.08 ","$1,348.08 ","$1,348.08 ", N/A ,"$1,533.75 ","$1,397.40 ",$613.50 ,"$1,644.00 ",$981.47 ,$613.50 ,$683.90 ,$442.92 ,$402.65 ,$613.50 ,"$1,397.40 ","$1,288.35 ","$1,397.40 ",$460.32 ,"$1,479.60 ",$613.50 ,"$1,348.08 ","$1,389.18 ","$1,389.18 ",$613.50 ,"$1,068.60 ","$1,644.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$2,159.00 ","$1,403.35 ",$107.33 ,"$2,159.00 ",$268.33 ,"$1,403.35 ","$1,288.92 ",$107.33 ,$604.52 ,"$1,211.20 ",$107.33 ,"$1,420.62 ",$107.33 ,"$1,835.15 ","$1,835.15 ",$107.33 ,"$1,835.15 ",$203.93 ,"$1,468.12 ",$268.33 ,$107.33 ,$107.33 ,"$1,619.25 ","$1,532.89 ","$1,532.89 ",$107.33 ,"$1,532.89 ","$1,770.38 ","$1,770.38 ","$1,770.38 ", N/A ,$268.33 ,"$1,835.15 ",$107.33 ,"$2,159.00 ","$1,288.92 ",$107.33 ,$898.14 ,$208.07 ,$189.15 ,$107.33 ,"$1,835.15 ",$225.40 ,"$1,835.15 ",$604.52 ,"$1,943.10 ",$107.33 ,"$1,770.38 ","$1,824.36 ","$1,824.36 ",$107.33 ,"$1,403.35 ","$2,159.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,609.00 ","$1,695.85 ",$176.10 ,"$2,609.00 ",$440.25 ,"$1,695.85 ","$1,557.57 ",$176.10 ,$730.52 ,"$1,463.65 ",$176.10 ,"$1,716.72 ",$176.10 ,"$2,217.65 ","$2,217.65 ",$176.10 ,"$2,217.65 ",$334.60 ,"$1,774.12 ",$440.26 ,$176.10 ,$176.10 ,"$1,956.75 ","$1,852.39 ","$1,852.39 ",$176.10 ,"$1,852.39 ","$2,139.38 ","$2,139.38 ","$2,139.38 ", N/A ,$440.26 ,"$2,217.65 ",$176.10 ,"$2,609.00 ","$1,557.57 ",$176.10 ,"$1,085.34 ",$208.07 ,$189.15 ,$176.10 ,"$2,217.65 ",$369.82 ,"$2,217.65 ",$730.52 ,"$2,348.10 ",$176.10 ,"$2,139.38 ","$2,204.61 ","$2,204.61 ",$176.10 ,"$1,695.85 ","$2,609.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$3,154.00 ","$2,050.10 ",$176.10 ,"$3,154.00 ",$440.25 ,"$2,050.10 ","$1,882.94 ",$176.10 ,$883.12 ,"$1,769.39 ",$176.10 ,"$2,075.33 ",$176.10 ,"$2,680.90 ","$2,680.90 ",$176.10 ,"$2,680.90 ",$334.60 ,"$2,144.72 ",$440.26 ,$176.10 ,$176.10 ,"$2,365.50 ","$2,239.34 ","$2,239.34 ",$176.10 ,"$2,239.34 ","$2,586.28 ","$2,586.28 ","$2,586.28 ", N/A ,$440.26 ,"$2,680.90 ",$176.10 ,"$3,154.00 ","$1,882.94 ",$176.10 ,"$1,312.06 ",$208.07 ,$189.15 ,$176.10 ,"$2,680.90 ",$369.82 ,"$2,680.90 ",$883.12 ,"$2,838.60 ",$176.10 ,"$2,586.28 ","$2,665.13 ","$2,665.13 ",$176.10 ,"$2,050.10 ","$3,154.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$1,997.00 ","$1,298.05 ",$91.91 ,"$1,997.00 ",$268.33 ,"$1,298.05 ","$1,192.21 ",$107.33 ,$559.16 ,"$1,120.32 ",$107.33 ,"$1,314.03 ",$107.33 ,"$1,697.45 ","$1,697.45 ",$107.33 ,"$1,697.45 ",$203.93 ,"$1,357.96 ",$268.33 ,$107.33 ,$107.33 ,"$1,497.75 ","$1,417.87 ","$1,417.87 ",$107.33 ,"$1,417.87 ","$1,637.54 ","$1,637.54 ","$1,637.54 ", N/A ,$268.33 ,"$1,697.45 ",$107.33 ,"$1,997.00 ","$1,192.21 ",$107.33 ,$830.75 ,$101.10 ,$91.91 ,$107.33 ,"$1,697.45 ",$225.40 ,"$1,697.45 ",$559.16 ,"$1,797.30 ",$107.33 ,"$1,637.54 ","$1,687.47 ","$1,687.47 ",$107.33 ,"$1,298.05 ","$1,997.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,243.00 ","$1,457.95 ",$91.91 ,"$2,243.00 ",$440.25 ,"$1,457.95 ","$1,339.07 ",$176.10 ,$628.04 ,"$1,258.32 ",$176.10 ,"$1,475.89 ",$176.10 ,"$1,906.55 ","$1,906.55 ",$176.10 ,"$1,906.55 ",$334.60 ,"$1,525.24 ",$440.26 ,$176.10 ,$176.10 ,"$1,682.25 ","$1,592.53 ","$1,592.53 ",$176.10 ,"$1,592.53 ","$1,839.26 ","$1,839.26 ","$1,839.26 ", N/A ,$440.26 ,"$1,906.55 ",$176.10 ,"$2,243.00 ","$1,339.07 ",$176.10 ,$933.09 ,$101.10 ,$91.91 ,$176.10 ,"$1,906.55 ",$369.82 ,"$1,906.55 ",$628.04 ,"$2,018.70 ",$176.10 ,"$1,839.26 ","$1,895.34 ","$1,895.34 ",$176.10 ,"$1,457.95 ","$2,243.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$2,489.00 ","$1,617.85 ",$91.91 ,"$2,489.00 ",$440.25 ,"$1,617.85 ","$1,485.93 ",$176.10 ,$696.92 ,"$1,396.33 ",$176.10 ,"$1,637.76 ",$176.10 ,"$2,115.65 ","$2,115.65 ",$176.10 ,"$2,115.65 ",$334.60 ,"$1,692.52 ",$440.26 ,$176.10 ,$176.10 ,"$1,866.75 ","$1,767.19 ","$1,767.19 ",$176.10 ,"$1,767.19 ","$2,040.98 ","$2,040.98 ","$2,040.98 ", N/A ,$440.26 ,"$2,115.65 ",$176.10 ,"$2,489.00 ","$1,485.93 ",$176.10 ,"$1,035.42 ",$101.10 ,$91.91 ,$176.10 ,"$2,115.65 ",$369.82 ,"$2,115.65 ",$696.92 ,"$2,240.10 ",$176.10 ,"$2,040.98 ","$2,103.21 ","$2,103.21 ",$176.10 ,"$1,617.85 ","$2,489.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$2,188.00 ","$1,422.20 ",$91.91 ,"$2,188.00 ",$268.33 ,"$1,422.20 ","$1,306.24 ",$107.33 ,$612.64 ,"$1,227.47 ",$107.33 ,"$1,439.70 ",$107.33 ,"$1,859.80 ","$1,859.80 ",$107.33 ,"$1,859.80 ",$203.93 ,"$1,487.84 ",$268.33 ,$107.33 ,$107.33 ,"$1,641.00 ","$1,553.48 ","$1,553.48 ",$107.33 ,"$1,553.48 ","$1,794.16 ","$1,794.16 ","$1,794.16 ", N/A ,$268.33 ,"$1,859.80 ",$107.33 ,"$2,188.00 ","$1,306.24 ",$107.33 ,$910.21 ,$101.10 ,$91.91 ,$107.33 ,"$1,859.80 ",$225.40 ,"$1,859.80 ",$612.64 ,"$1,969.20 ",$107.33 ,"$1,794.16 ","$1,848.86 ","$1,848.86 ",$107.33 ,"$1,422.20 ","$2,188.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,434.00 ","$1,582.10 ",$91.91 ,"$2,434.00 ",$440.25 ,"$1,582.10 ","$1,453.10 ",$176.10 ,$681.52 ,"$1,365.47 ",$176.10 ,"$1,601.57 ",$176.10 ,"$2,068.90 ","$2,068.90 ",$176.10 ,"$2,068.90 ",$334.60 ,"$1,655.12 ",$440.26 ,$176.10 ,$176.10 ,"$1,825.50 ","$1,728.14 ","$1,728.14 ",$176.10 ,"$1,728.14 ","$1,995.88 ","$1,995.88 ","$1,995.88 ", N/A ,$440.26 ,"$2,068.90 ",$176.10 ,"$2,434.00 ","$1,453.10 ",$176.10 ,"$1,012.54 ",$101.10 ,$91.91 ,$176.10 ,"$2,068.90 ",$369.82 ,"$2,068.90 ",$681.52 ,"$2,190.60 ",$176.10 ,"$1,995.88 ","$2,056.73 ","$2,056.73 ",$176.10 ,"$1,582.10 ","$2,434.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,680.00 ","$1,742.00 ",$91.91 ,"$2,680.00 ",$440.25 ,"$1,742.00 ","$1,599.96 ",$176.10 ,$750.40 ,"$1,503.48 ",$176.10 ,"$1,763.44 ",$176.10 ,"$2,278.00 ","$2,278.00 ",$176.10 ,"$2,278.00 ",$334.60 ,"$1,822.40 ",$440.26 ,$176.10 ,$176.10 ,"$2,010.00 ","$1,902.80 ","$1,902.80 ",$176.10 ,"$1,902.80 ","$2,197.60 ","$2,197.60 ","$2,197.60 ", N/A ,$440.26 ,"$2,278.00 ",$176.10 ,"$2,680.00 ","$1,599.96 ",$176.10 ,"$1,114.88 ",$101.10 ,$91.91 ,$176.10 ,"$2,278.00 ",$369.82 ,"$2,278.00 ",$750.40 ,"$2,412.00 ",$176.10 ,"$2,197.60 ","$2,264.60 ","$2,264.60 ",$176.10 ,"$1,742.00 ","$2,680.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$2,075.00 ","$1,348.75 ",$91.91 ,"$2,075.00 ",$268.33 ,"$1,348.75 ","$1,238.78 ",$107.33 ,$581.00 ,"$1,164.08 ",$107.33 ,"$1,365.35 ",$107.33 ,"$1,763.75 ","$1,763.75 ",$107.33 ,"$1,763.75 ",$203.93 ,"$1,411.00 ",$268.33 ,$107.33 ,$107.33 ,"$1,556.25 ","$1,473.25 ","$1,473.25 ",$107.33 ,"$1,473.25 ","$1,701.50 ","$1,701.50 ","$1,701.50 ", N/A ,$268.33 ,"$1,763.75 ",$107.33 ,"$2,075.00 ","$1,238.78 ",$107.33 ,$863.20 ,$101.10 ,$91.91 ,$107.33 ,"$1,763.75 ",$225.40 ,"$1,763.75 ",$581.00 ,"$1,867.50 ",$107.33 ,"$1,701.50 ","$1,753.38 ","$1,753.38 ",$107.33 ,"$1,348.75 ","$2,075.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,564.00 ","$1,666.60 ",$91.91 ,"$2,564.00 ",$440.25 ,"$1,666.60 ","$1,530.71 ",$176.10 ,$717.92 ,"$1,438.40 ",$176.10 ,"$1,687.11 ",$176.10 ,"$2,179.40 ","$2,179.40 ",$176.10 ,"$2,179.40 ",$334.60 ,"$1,743.52 ",$440.26 ,$176.10 ,$176.10 ,"$1,923.00 ","$1,820.44 ","$1,820.44 ",$176.10 ,"$1,820.44 ","$2,102.48 ","$2,102.48 ","$2,102.48 ", N/A ,$440.26 ,"$2,179.40 ",$176.10 ,"$2,564.00 ","$1,530.71 ",$176.10 ,"$1,066.62 ",$101.10 ,$91.91 ,$176.10 ,"$2,179.40 ",$369.82 ,"$2,179.40 ",$717.92 ,"$2,307.60 ",$176.10 ,"$2,102.48 ","$2,166.58 ","$2,166.58 ",$176.10 ,"$1,666.60 ","$2,564.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$2,891.00 ","$1,879.15 ",$91.91 ,"$2,891.00 ",$440.25 ,"$1,879.15 ","$1,725.93 ",$176.10 ,$809.48 ,"$1,621.85 ",$176.10 ,"$1,902.28 ",$176.10 ,"$2,457.35 ","$2,457.35 ",$176.10 ,"$2,457.35 ",$334.60 ,"$1,965.88 ",$440.26 ,$176.10 ,$176.10 ,"$2,168.25 ","$2,052.61 ","$2,052.61 ",$176.10 ,"$2,052.61 ","$2,370.62 ","$2,370.62 ","$2,370.62 ", N/A ,$440.26 ,"$2,457.35 ",$176.10 ,"$2,891.00 ","$1,725.93 ",$176.10 ,"$1,202.66 ",$101.10 ,$91.91 ,$176.10 ,"$2,457.35 ",$369.82 ,"$2,457.35 ",$809.48 ,"$2,601.90 ",$176.10 ,"$2,370.62 ","$2,442.90 ","$2,442.90 ",$176.10 ,"$1,879.15 ","$2,891.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$2,609.00 ","$1,695.85 ",$176.10 ,"$2,609.00 ",$440.25 ,"$1,695.85 ","$1,557.57 ",$176.10 ,$730.52 ,"$1,463.65 ",$176.10 ,"$1,716.72 ",$176.10 ,"$2,217.65 ","$2,217.65 ",$176.10 ,"$2,217.65 ",$334.60 ,"$1,774.12 ",$440.26 ,$176.10 ,$176.10 ,"$1,956.75 ","$1,852.39 ","$1,852.39 ",$176.10 ,"$1,852.39 ","$2,139.38 ","$2,139.38 ","$2,139.38 ", N/A ,$440.26 ,"$2,217.65 ",$176.10 ,"$2,609.00 ","$1,557.57 ",$176.10 ,"$1,085.34 ",$266.49 ,$242.26 ,$176.10 ,"$2,217.65 ",$369.82 ,"$2,217.65 ",$730.52 ,"$2,348.10 ",$176.10 ,"$2,139.38 ","$2,204.61 ","$2,204.61 ",$176.10 ,"$1,695.85 ","$2,609.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$2,891.00 ","$1,879.15 ",$91.91 ,"$2,891.00 ",$440.25 ,"$1,879.15 ","$1,725.93 ",$176.10 ,$809.48 ,"$1,621.85 ",$176.10 ,"$1,902.28 ",$176.10 ,"$2,457.35 ","$2,457.35 ",$176.10 ,"$2,457.35 ",$334.60 ,"$1,965.88 ",$440.26 ,$176.10 ,$176.10 ,"$2,168.25 ","$2,052.61 ","$2,052.61 ",$176.10 ,"$2,052.61 ","$2,370.62 ","$2,370.62 ","$2,370.62 ", N/A ,$440.26 ,"$2,457.35 ",$176.10 ,"$2,891.00 ","$1,725.93 ",$176.10 ,"$1,202.66 ",$101.10 ,$91.91 ,$176.10 ,"$2,457.35 ",$369.82 ,"$2,457.35 ",$809.48 ,"$2,601.90 ",$176.10 ,"$2,370.62 ","$2,442.90 ","$2,442.90 ",$176.10 ,"$1,879.15 ","$2,891.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,485.00 ","$2,265.25 ",$226.85 ,"$3,485.00 ",$567.13 ,"$2,265.25 ","$2,080.55 ",$226.85 ,$975.80 ,"$1,955.09 ",$226.85 ,"$2,293.13 ",$226.85 ,"$2,962.25 ","$2,962.25 ",$226.85 ,"$2,962.25 ",$431.02 ,"$2,369.80 ",$567.13 ,$226.85 ,$226.85 ,"$2,613.75 ","$2,474.35 ","$2,474.35 ",$226.85 ,"$2,474.35 ","$2,857.70 ","$2,857.70 ","$2,857.70 ", N/A ,$567.13 ,"$2,962.25 ",$226.85 ,"$3,485.00 ","$2,080.55 ",$226.85 ,"$1,449.76 ",$252.24 ,$229.31 ,$226.85 ,"$2,962.25 ",$476.39 ,"$2,962.25 ",$975.80 ,"$3,136.50 ",$226.85 ,"$2,857.70 ","$2,944.83 ","$2,944.83 ",$226.85 ,"$2,265.25 ","$3,485.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$3,642.00 ","$2,367.30 ",$104.33 ,"$3,642.00 ",$268.33 ,"$2,367.30 ","$2,174.27 ",$107.33 ,"$1,019.76 ","$2,043.16 ",$107.33 ,"$2,396.44 ",$107.33 ,"$3,095.70 ","$3,095.70 ",$107.33 ,"$3,095.70 ",$203.93 ,"$2,476.56 ",$268.33 ,$107.33 ,$107.33 ,"$2,731.50 ","$2,585.82 ","$2,585.82 ",$107.33 ,"$2,585.82 ","$2,986.44 ","$2,986.44 ","$2,986.44 ", N/A ,$268.33 ,"$3,095.70 ",$107.33 ,"$3,642.00 ","$2,174.27 ",$107.33 ,"$1,515.07 ",$114.76 ,$104.33 ,$107.33 ,"$3,095.70 ",$225.40 ,"$3,095.70 ","$1,019.76 ","$3,277.80 ",$107.33 ,"$2,986.44 ","$3,077.49 ","$3,077.49 ",$107.33 ,"$2,367.30 ","$3,642.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$1,128.00 ",$733.20 ,$104.33 ,"$1,128.00 ",$907.63 ,$733.20 ,$673.42 ,$363.05 ,$315.84 ,$632.81 ,$363.05 ,$742.22 ,$363.05 ,$958.80 ,$958.80 ,$363.05 ,$958.80 ,$689.79 ,$767.04 ,$907.62 ,$363.05 ,$363.05 ,$846.00 ,$800.88 ,$800.88 ,$363.05 ,$800.88 ,$924.96 ,$924.96 ,$924.96 , N/A ,$907.62 ,$958.80 ,$363.05 ,"$1,128.00 ",$673.42 ,$363.05 ,$469.25 ,$114.76 ,$104.33 ,$363.05 ,$958.80 ,$762.40 ,$958.80 ,$315.84 ,"$1,015.20 ",$363.05 ,$924.96 ,$953.16 ,$953.16 ,$363.05 ,$733.20 ,"$1,128.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$3,607.00 ","$2,344.55 ",$104.33 ,"$3,607.00 ",$268.33 ,"$2,344.55 ","$2,153.38 ",$107.33 ,"$1,009.96 ","$2,023.53 ",$107.33 ,"$2,373.41 ",$107.33 ,"$3,065.95 ","$3,065.95 ",$107.33 ,"$3,065.95 ",$203.93 ,"$2,452.76 ",$268.33 ,$107.33 ,$107.33 ,"$2,705.25 ","$2,560.97 ","$2,560.97 ",$107.33 ,"$2,560.97 ","$2,957.74 ","$2,957.74 ","$2,957.74 ", N/A ,$268.33 ,"$3,065.95 ",$107.33 ,"$3,607.00 ","$2,153.38 ",$107.33 ,"$1,500.51 ",$114.76 ,$104.33 ,$107.33 ,"$3,065.95 ",$225.40 ,"$3,065.95 ","$1,009.96 ","$3,246.30 ",$107.33 ,"$2,957.74 ","$3,047.92 ","$3,047.92 ",$107.33 ,"$2,344.55 ","$3,607.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$4,145.00 ","$2,694.25 ",$104.33 ,"$4,145.00 ",$440.25 ,"$2,694.25 ","$2,474.57 ",$176.10 ,"$1,160.60 ","$2,325.35 ",$176.10 ,"$2,727.41 ",$176.10 ,"$3,523.25 ","$3,523.25 ",$176.10 ,"$3,523.25 ",$334.60 ,"$2,818.60 ",$440.26 ,$176.10 ,$176.10 ,"$3,108.75 ","$2,942.95 ","$2,942.95 ",$176.10 ,"$2,942.95 ","$3,398.90 ","$3,398.90 ","$3,398.90 ", N/A ,$440.26 ,"$3,523.25 ",$176.10 ,"$4,145.00 ","$2,474.57 ",$176.10 ,"$1,724.32 ",$114.76 ,$104.33 ,$176.10 ,"$3,523.25 ",$369.82 ,"$3,523.25 ","$1,160.60 ","$3,730.50 ",$176.10 ,"$3,398.90 ","$3,502.53 ","$3,502.53 ",$176.10 ,"$2,694.25 ","$4,145.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$4,506.00 ","$2,928.90 ",$104.33 ,"$4,506.00 ",$440.25 ,"$2,928.90 ","$2,690.08 ",$176.10 ,"$1,261.68 ","$2,527.87 ",$176.10 ,"$2,964.95 ",$176.10 ,"$3,830.10 ","$3,830.10 ",$176.10 ,"$3,830.10 ",$334.60 ,"$3,064.08 ",$440.26 ,$176.10 ,$176.10 ,"$3,379.50 ","$3,199.26 ","$3,199.26 ",$176.10 ,"$3,199.26 ","$3,694.92 ","$3,694.92 ","$3,694.92 ", N/A ,$440.26 ,"$3,830.10 ",$176.10 ,"$4,506.00 ","$2,690.08 ",$176.10 ,"$1,874.50 ",$114.76 ,$104.33 ,$176.10 ,"$3,830.10 ",$369.82 ,"$3,830.10 ","$1,261.68 ","$4,055.40 ",$176.10 ,"$3,694.92 ","$3,807.57 ","$3,807.57 ",$176.10 ,"$2,928.90 ","$4,506.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$3,673.00 ","$2,387.45 ",$104.33 ,"$3,673.00 ",$268.33 ,"$2,387.45 ","$2,192.78 ",$107.33 ,"$1,028.44 ","$2,060.55 ",$107.33 ,"$2,416.83 ",$107.33 ,"$3,122.05 ","$3,122.05 ",$107.33 ,"$3,122.05 ",$203.93 ,"$2,497.64 ",$268.33 ,$107.33 ,$107.33 ,"$2,754.75 ","$2,607.83 ","$2,607.83 ",$107.33 ,"$2,607.83 ","$3,011.86 ","$3,011.86 ","$3,011.86 ", N/A ,$268.33 ,"$3,122.05 ",$107.33 ,"$3,673.00 ","$2,192.78 ",$107.33 ,"$1,527.97 ",$114.76 ,$104.33 ,$107.33 ,"$3,122.05 ",$225.40 ,"$3,122.05 ","$1,028.44 ","$3,305.70 ",$107.33 ,"$3,011.86 ","$3,103.69 ","$3,103.69 ",$107.33 ,"$2,387.45 ","$3,673.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$4,145.00 ","$2,694.25 ",$104.33 ,"$4,145.00 ",$907.63 ,"$2,694.25 ","$2,474.57 ",$363.05 ,"$1,160.60 ","$2,325.35 ",$363.05 ,"$2,727.41 ",$363.05 ,"$3,523.25 ","$3,523.25 ",$363.05 ,"$3,523.25 ",$689.79 ,"$2,818.60 ",$907.62 ,$363.05 ,$363.05 ,"$3,108.75 ","$2,942.95 ","$2,942.95 ",$363.05 ,"$2,942.95 ","$3,398.90 ","$3,398.90 ","$3,398.90 ", N/A ,$907.62 ,"$3,523.25 ",$363.05 ,"$4,145.00 ","$2,474.57 ",$363.05 ,"$1,724.32 ",$114.76 ,$104.33 ,$363.05 ,"$3,523.25 ",$762.40 ,"$3,523.25 ","$1,160.60 ","$3,730.50 ",$363.05 ,"$3,398.90 ","$3,502.53 ","$3,502.53 ",$363.05 ,"$2,694.25 ","$4,145.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$4,309.00 ","$2,800.85 ",$104.33 ,"$4,309.00 ",$440.25 ,"$2,800.85 ","$2,572.47 ",$176.10 ,"$1,206.52 ","$2,417.35 ",$176.10 ,"$2,835.32 ",$176.10 ,"$3,662.65 ","$3,662.65 ",$176.10 ,"$3,662.65 ",$334.60 ,"$2,930.12 ",$440.26 ,$176.10 ,$176.10 ,"$3,231.75 ","$3,059.39 ","$3,059.39 ",$176.10 ,"$3,059.39 ","$3,533.38 ","$3,533.38 ","$3,533.38 ", N/A ,$440.26 ,"$3,662.65 ",$176.10 ,"$4,309.00 ","$2,572.47 ",$176.10 ,"$1,792.54 ",$114.76 ,$104.33 ,$176.10 ,"$3,662.65 ",$369.82 ,"$3,662.65 ","$1,206.52 ","$3,878.10 ",$176.10 ,"$3,533.38 ","$3,641.11 ","$3,641.11 ",$176.10 ,"$2,800.85 ","$4,309.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$3,500.00 ","$2,275.00 ",$176.10 ,"$3,500.00 ",$440.25 ,"$2,275.00 ","$2,089.50 ",$176.10 ,$980.00 ,"$1,963.50 ",$176.10 ,"$2,303.00 ",$176.10 ,"$2,975.00 ","$2,975.00 ",$176.10 ,"$2,975.00 ",$334.60 ,"$2,380.00 ",$440.26 ,$176.10 ,$176.10 ,"$2,625.00 ","$2,485.00 ","$2,485.00 ",$176.10 ,"$2,485.00 ","$2,870.00 ","$2,870.00 ","$2,870.00 ", N/A ,$440.26 ,"$2,975.00 ",$176.10 ,"$3,500.00 ","$2,089.50 ",$176.10 ,"$1,456.00 ",$228.49 ,$207.72 ,$176.10 ,"$2,975.00 ",$369.82 ,"$2,975.00 ",$980.00 ,"$3,150.00 ",$176.10 ,"$2,870.00 ","$2,957.50 ","$2,957.50 ",$176.10 ,"$2,275.00 ","$3,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$2,934.00 ","$1,907.10 ",$107.33 ,"$2,934.00 ",$268.33 ,"$1,907.10 ","$1,751.60 ",$107.33 ,$821.52 ,"$1,645.97 ",$107.33 ,"$1,930.57 ",$107.33 ,"$2,493.90 ","$2,493.90 ",$107.33 ,"$2,493.90 ",$203.93 ,"$1,995.12 ",$268.33 ,$107.33 ,$107.33 ,"$2,200.50 ","$2,083.14 ","$2,083.14 ",$107.33 ,"$2,083.14 ","$2,405.88 ","$2,405.88 ","$2,405.88 ", N/A ,$268.33 ,"$2,493.90 ",$107.33 ,"$2,934.00 ","$1,751.60 ",$107.33 ,"$1,220.54 ",$228.71 ,$207.92 ,$107.33 ,"$2,493.90 ",$225.40 ,"$2,493.90 ",$821.52 ,"$2,640.60 ",$107.33 ,"$2,405.88 ","$2,479.23 ","$2,479.23 ",$107.33 ,"$1,907.10 ","$2,934.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$3,218.00 ","$2,091.70 ",$176.10 ,"$3,218.00 ",$440.25 ,"$2,091.70 ","$1,921.15 ",$176.10 ,$901.04 ,"$1,805.30 ",$176.10 ,"$2,117.44 ",$176.10 ,"$2,735.30 ","$2,735.30 ",$176.10 ,"$2,735.30 ",$334.60 ,"$2,188.24 ",$440.26 ,$176.10 ,$176.10 ,"$2,413.50 ","$2,284.78 ","$2,284.78 ",$176.10 ,"$2,284.78 ","$2,638.76 ","$2,638.76 ","$2,638.76 ", N/A ,$440.26 ,"$2,735.30 ",$176.10 ,"$3,218.00 ","$1,921.15 ",$176.10 ,"$1,338.69 ",$228.71 ,$207.92 ,$176.10 ,"$2,735.30 ",$369.82 ,"$2,735.30 ",$901.04 ,"$2,896.20 ",$176.10 ,"$2,638.76 ","$2,719.21 ","$2,719.21 ",$176.10 ,"$2,091.70 ","$3,218.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$3,500.00 ","$2,275.00 ",$176.10 ,"$3,500.00 ",$440.25 ,"$2,275.00 ","$2,089.50 ",$176.10 ,$980.00 ,"$1,963.50 ",$176.10 ,"$2,303.00 ",$176.10 ,"$2,975.00 ","$2,975.00 ",$176.10 ,"$2,975.00 ",$334.60 ,"$2,380.00 ",$440.26 ,$176.10 ,$176.10 ,"$2,625.00 ","$2,485.00 ","$2,485.00 ",$176.10 ,"$2,485.00 ","$2,870.00 ","$2,870.00 ","$2,870.00 ", N/A ,$440.26 ,"$2,975.00 ",$176.10 ,"$3,500.00 ","$2,089.50 ",$176.10 ,"$1,456.00 ",$228.71 ,$207.92 ,$176.10 ,"$2,975.00 ",$369.82 ,"$2,975.00 ",$980.00 ,"$3,150.00 ",$176.10 ,"$2,870.00 ","$2,957.50 ","$2,957.50 ",$176.10 ,"$2,275.00 ","$3,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$2,483.00 ","$1,613.95 ",$91.91 ,"$2,483.00 ",$268.33 ,"$1,613.95 ","$1,482.35 ",$107.33 ,$695.24 ,"$1,392.96 ",$107.33 ,"$1,633.81 ",$107.33 ,"$2,110.55 ","$2,110.55 ",$107.33 ,"$2,110.55 ",$203.93 ,"$1,688.44 ",$268.33 ,$107.33 ,$107.33 ,"$1,862.25 ","$1,762.93 ","$1,762.93 ",$107.33 ,"$1,762.93 ","$2,036.06 ","$2,036.06 ","$2,036.06 ", N/A ,$268.33 ,"$2,110.55 ",$107.33 ,"$2,483.00 ","$1,482.35 ",$107.33 ,"$1,032.93 ",$101.10 ,$91.91 ,$107.33 ,"$2,110.55 ",$225.40 ,"$2,110.55 ",$695.24 ,"$2,234.70 ",$107.33 ,"$2,036.06 ","$2,098.14 ","$2,098.14 ",$107.33 ,"$1,613.95 ","$2,483.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,611.00 ","$1,697.15 ",$91.91 ,"$2,611.00 ",$907.63 ,"$1,697.15 ","$1,558.77 ",$363.05 ,$731.08 ,"$1,464.77 ",$363.05 ,"$1,718.04 ",$363.05 ,"$2,219.35 ","$2,219.35 ",$363.05 ,"$2,219.35 ",$689.79 ,"$1,775.48 ",$907.62 ,$363.05 ,$363.05 ,"$1,958.25 ","$1,853.81 ","$1,853.81 ",$363.05 ,"$1,853.81 ","$2,141.02 ","$2,141.02 ","$2,141.02 ", N/A ,$907.62 ,"$2,219.35 ",$363.05 ,"$2,611.00 ","$1,558.77 ",$363.05 ,"$1,086.18 ",$101.10 ,$91.91 ,$363.05 ,"$2,219.35 ",$762.40 ,"$2,219.35 ",$731.08 ,"$2,349.90 ",$363.05 ,"$2,141.02 ","$2,206.30 ","$2,206.30 ",$363.05 ,"$1,697.15 ","$2,611.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$3,156.00 ","$2,051.40 ",$91.91 ,"$3,156.00 ",$440.25 ,"$2,051.40 ","$1,884.13 ",$176.10 ,$883.68 ,"$1,770.52 ",$176.10 ,"$2,076.65 ",$176.10 ,"$2,682.60 ","$2,682.60 ",$176.10 ,"$2,682.60 ",$334.60 ,"$2,146.08 ",$440.26 ,$176.10 ,$176.10 ,"$2,367.00 ","$2,240.76 ","$2,240.76 ",$176.10 ,"$2,240.76 ","$2,587.92 ","$2,587.92 ","$2,587.92 ", N/A ,$440.26 ,"$2,682.60 ",$176.10 ,"$3,156.00 ","$1,884.13 ",$176.10 ,"$1,312.90 ",$101.10 ,$91.91 ,$176.10 ,"$2,682.60 ",$369.82 ,"$2,682.60 ",$883.68 ,"$2,840.40 ",$176.10 ,"$2,587.92 ","$2,666.82 ","$2,666.82 ",$176.10 ,"$2,051.40 ","$3,156.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$3,156.00 ","$2,051.40 ",$176.10 ,"$3,156.00 ",$440.25 ,"$2,051.40 ","$1,884.13 ",$176.10 ,$883.68 ,"$1,770.52 ",$176.10 ,"$2,076.65 ",$176.10 ,"$2,682.60 ","$2,682.60 ",$176.10 ,"$2,682.60 ",$334.60 ,"$2,146.08 ",$440.26 ,$176.10 ,$176.10 ,"$2,367.00 ","$2,240.76 ","$2,240.76 ",$176.10 ,"$2,240.76 ","$2,587.92 ","$2,587.92 ","$2,587.92 ", N/A ,$440.26 ,"$2,682.60 ",$176.10 ,"$3,156.00 ","$1,884.13 ",$176.10 ,"$1,312.90 ",$228.49 ,$207.72 ,$176.10 ,"$2,682.60 ",$369.82 ,"$2,682.60 ",$883.68 ,"$2,840.40 ",$176.10 ,"$2,587.92 ","$2,666.82 ","$2,666.82 ",$176.10 ,"$2,051.40 ","$3,156.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$2,483.00 ","$1,613.95 ",$91.91 ,"$2,483.00 ",$268.33 ,"$1,613.95 ","$1,482.35 ",$107.33 ,$695.24 ,"$1,392.96 ",$107.33 ,"$1,633.81 ",$107.33 ,"$2,110.55 ","$2,110.55 ",$107.33 ,"$2,110.55 ",$203.93 ,"$1,688.44 ",$268.33 ,$107.33 ,$107.33 ,"$1,862.25 ","$1,762.93 ","$1,762.93 ",$107.33 ,"$1,762.93 ","$2,036.06 ","$2,036.06 ","$2,036.06 ", N/A ,$268.33 ,"$2,110.55 ",$107.33 ,"$2,483.00 ","$1,482.35 ",$107.33 ,"$1,032.93 ",$101.10 ,$91.91 ,$107.33 ,"$2,110.55 ",$225.40 ,"$2,110.55 ",$695.24 ,"$2,234.70 ",$107.33 ,"$2,036.06 ","$2,098.14 ","$2,098.14 ",$107.33 ,"$1,613.95 ","$2,483.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,611.00 ","$1,697.15 ",$91.91 ,"$2,611.00 ",$440.25 ,"$1,697.15 ","$1,558.77 ",$176.10 ,$731.08 ,"$1,464.77 ",$176.10 ,"$1,718.04 ",$176.10 ,"$2,219.35 ","$2,219.35 ",$176.10 ,"$2,219.35 ",$334.60 ,"$1,775.48 ",$440.26 ,$176.10 ,$176.10 ,"$1,958.25 ","$1,853.81 ","$1,853.81 ",$176.10 ,"$1,853.81 ","$2,141.02 ","$2,141.02 ","$2,141.02 ", N/A ,$440.26 ,"$2,219.35 ",$176.10 ,"$2,611.00 ","$1,558.77 ",$176.10 ,"$1,086.18 ",$101.10 ,$91.91 ,$176.10 ,"$2,219.35 ",$369.82 ,"$2,219.35 ",$731.08 ,"$2,349.90 ",$176.10 ,"$2,141.02 ","$2,206.30 ","$2,206.30 ",$176.10 ,"$1,697.15 ","$2,611.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$3,051.00 ","$1,983.15 ",$91.91 ,"$3,051.00 ",$440.25 ,"$1,983.15 ","$1,821.45 ",$176.10 ,$854.28 ,"$1,711.61 ",$176.10 ,"$2,007.56 ",$176.10 ,"$2,593.35 ","$2,593.35 ",$176.10 ,"$2,593.35 ",$334.60 ,"$2,074.68 ",$440.26 ,$176.10 ,$176.10 ,"$2,288.25 ","$2,166.21 ","$2,166.21 ",$176.10 ,"$2,166.21 ","$2,501.82 ","$2,501.82 ","$2,501.82 ", N/A ,$440.26 ,"$2,593.35 ",$176.10 ,"$3,051.00 ","$1,821.45 ",$176.10 ,"$1,269.22 ",$101.10 ,$91.91 ,$176.10 ,"$2,593.35 ",$369.82 ,"$2,593.35 ",$854.28 ,"$2,745.90 ",$176.10 ,"$2,501.82 ","$2,578.10 ","$2,578.10 ",$176.10 ,"$1,983.15 ","$3,051.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$3,119.00 ","$2,027.35 ",$176.10 ,"$3,119.00 ",$440.25 ,"$2,027.35 ","$1,862.04 ",$176.10 ,$873.32 ,"$1,749.76 ",$176.10 ,"$2,052.30 ",$176.10 ,"$2,651.15 ","$2,651.15 ",$176.10 ,"$2,651.15 ",$334.60 ,"$2,120.92 ",$440.26 ,$176.10 ,$176.10 ,"$2,339.25 ","$2,214.49 ","$2,214.49 ",$176.10 ,"$2,214.49 ","$2,557.58 ","$2,557.58 ","$2,557.58 ", N/A ,$440.26 ,"$2,651.15 ",$176.10 ,"$3,119.00 ","$1,862.04 ",$176.10 ,"$1,297.50 ",$228.49 ,$207.72 ,$176.10 ,"$2,651.15 ",$369.82 ,"$2,651.15 ",$873.32 ,"$2,807.10 ",$176.10 ,"$2,557.58 ","$2,635.56 ","$2,635.56 ",$176.10 ,"$2,027.35 ","$3,119.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$4,679.00 ","$3,041.35 ",$311.58 ,"$4,679.00 ","$1,072.85 ","$3,041.35 ","$2,793.36 ",$429.14 ,"$1,310.12 ","$2,624.92 ",$429.14 ,"$3,078.78 ",$429.14 ,"$3,977.15 ","$3,977.15 ",$429.14 ,"$3,977.15 ",$815.37 ,"$3,181.72 ","$1,072.86 ",$429.14 ,$429.14 ,"$3,509.25 ","$3,322.09 ","$3,322.09 ",$429.14 ,"$3,322.09 ","$3,836.78 ","$3,836.78 ","$3,836.78 ", N/A ,"$1,072.86 ","$3,977.15 ",$429.14 ,"$4,679.00 ","$2,793.36 ",$429.14 ,"$1,946.46 ",$342.74 ,$311.58 ,$429.14 ,"$3,977.15 ",$901.20 ,"$3,977.15 ","$1,310.12 ","$4,211.10 ",$429.14 ,"$3,836.78 ","$3,953.76 ","$3,953.76 ",$429.14 ,"$3,041.35 ","$4,679.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$3,308.00 ","$2,150.20 ",$107.33 ,"$3,308.00 ",$268.33 ,"$2,150.20 ","$1,974.88 ",$107.33 ,$926.24 ,"$1,855.79 ",$107.33 ,"$2,176.66 ",$107.33 ,"$2,811.80 ","$2,811.80 ",$107.33 ,"$2,811.80 ",$203.93 ,"$2,249.44 ",$268.33 ,$107.33 ,$107.33 ,"$2,481.00 ","$2,348.68 ","$2,348.68 ",$107.33 ,"$2,348.68 ","$2,712.56 ","$2,712.56 ","$2,712.56 ", N/A ,$268.33 ,"$2,811.80 ",$107.33 ,"$3,308.00 ","$1,974.88 ",$107.33 ,"$1,376.13 ",$228.71 ,$207.92 ,$107.33 ,"$2,811.80 ",$225.40 ,"$2,811.80 ",$926.24 ,"$2,977.20 ",$107.33 ,"$2,712.56 ","$2,795.26 ","$2,795.26 ",$107.33 ,"$2,150.20 ","$3,308.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$3,739.00 ","$2,430.35 ",$176.10 ,"$3,739.00 ",$440.25 ,"$2,430.35 ","$2,232.18 ",$176.10 ,"$1,046.92 ","$2,097.58 ",$176.10 ,"$2,460.26 ",$176.10 ,"$3,178.15 ","$3,178.15 ",$176.10 ,"$3,178.15 ",$334.60 ,"$2,542.52 ",$440.26 ,$176.10 ,$176.10 ,"$2,804.25 ","$2,654.69 ","$2,654.69 ",$176.10 ,"$2,654.69 ","$3,065.98 ","$3,065.98 ","$3,065.98 ", N/A ,$440.26 ,"$3,178.15 ",$176.10 ,"$3,739.00 ","$2,232.18 ",$176.10 ,"$1,555.42 ",$228.71 ,$207.92 ,$176.10 ,"$3,178.15 ",$369.82 ,"$3,178.15 ","$1,046.92 ","$3,365.10 ",$176.10 ,"$3,065.98 ","$3,159.46 ","$3,159.46 ",$176.10 ,"$2,430.35 ","$3,739.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$4,573.00 ","$2,972.45 ",$176.10 ,"$4,573.00 ",$440.25 ,"$2,972.45 ","$2,730.08 ",$176.10 ,"$1,280.44 ","$2,565.45 ",$176.10 ,"$3,009.03 ",$176.10 ,"$3,887.05 ","$3,887.05 ",$176.10 ,"$3,887.05 ",$334.60 ,"$3,109.64 ",$440.26 ,$176.10 ,$176.10 ,"$3,429.75 ","$3,246.83 ","$3,246.83 ",$176.10 ,"$3,246.83 ","$3,749.86 ","$3,749.86 ","$3,749.86 ", N/A ,$440.26 ,"$3,887.05 ",$176.10 ,"$4,573.00 ","$2,730.08 ",$176.10 ,"$1,902.37 ",$228.71 ,$207.92 ,$176.10 ,"$3,887.05 ",$369.82 ,"$3,887.05 ","$1,280.44 ","$4,115.70 ",$176.10 ,"$3,749.86 ","$3,864.19 ","$3,864.19 ",$176.10 ,"$2,972.45 ","$4,573.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,301.00 ","$2,145.65 ",$176.10 ,"$3,301.00 ",$440.25 ,"$2,145.65 ","$1,970.70 ",$176.10 ,$924.28 ,"$1,851.86 ",$176.10 ,"$2,172.06 ",$176.10 ,"$2,805.85 ","$2,805.85 ",$176.10 ,"$2,805.85 ",$334.60 ,"$2,244.68 ",$440.26 ,$176.10 ,$176.10 ,"$2,475.75 ","$2,343.71 ","$2,343.71 ",$176.10 ,"$2,343.71 ","$2,706.82 ","$2,706.82 ","$2,706.82 ", N/A ,$440.26 ,"$2,805.85 ",$176.10 ,"$3,301.00 ","$1,970.70 ",$176.10 ,"$1,373.22 ",$228.49 ,$207.72 ,$176.10 ,"$2,805.85 ",$369.82 ,"$2,805.85 ",$924.28 ,"$2,970.90 ",$176.10 ,"$2,706.82 ","$2,789.35 ","$2,789.35 ",$176.10 ,"$2,145.65 ","$3,301.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$5,136.00 ","$3,338.40 ",$207.92 ,"$5,136.00 ",$567.13 ,"$3,338.40 ","$3,066.19 ",$226.85 ,"$1,438.08 ","$2,881.30 ",$226.85 ,"$3,379.49 ",$226.85 ,"$4,365.60 ","$4,365.60 ",$226.85 ,"$4,365.60 ",$431.02 ,"$3,492.48 ",$567.13 ,$226.85 ,$226.85 ,"$3,852.00 ","$3,646.56 ","$3,646.56 ",$226.85 ,"$3,646.56 ","$4,211.52 ","$4,211.52 ","$4,211.52 ", N/A ,$567.13 ,"$4,365.60 ",$226.85 ,"$5,136.00 ","$3,066.19 ",$226.85 ,"$2,136.58 ",$228.71 ,$207.92 ,$226.85 ,"$4,365.60 ",$476.39 ,"$4,365.60 ","$1,438.08 ","$4,622.40 ",$226.85 ,"$4,211.52 ","$4,339.92 ","$4,339.92 ",$226.85 ,"$3,338.40 ","$5,136.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$5,294.00 ","$3,441.10 ",$207.92 ,"$5,294.00 ",$907.63 ,"$3,441.10 ","$3,160.52 ",$363.05 ,"$1,482.32 ","$2,969.93 ",$363.05 ,"$3,483.45 ",$363.05 ,"$4,499.90 ","$4,499.90 ",$363.05 ,"$4,499.90 ",$689.79 ,"$3,599.92 ",$907.62 ,$363.05 ,$363.05 ,"$3,970.50 ","$3,758.74 ","$3,758.74 ",$363.05 ,"$3,758.74 ","$4,341.08 ","$4,341.08 ","$4,341.08 ", N/A ,$907.62 ,"$4,499.90 ",$363.05 ,"$5,294.00 ","$3,160.52 ",$363.05 ,"$2,202.30 ",$228.71 ,$207.92 ,$363.05 ,"$4,499.90 ",$762.40 ,"$4,499.90 ","$1,482.32 ","$4,764.60 ",$363.05 ,"$4,341.08 ","$4,473.43 ","$4,473.43 ",$363.05 ,"$3,441.10 ","$5,294.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$6,352.00 ","$4,128.80 ",$207.92 ,"$6,352.00 ",$907.63 ,"$4,128.80 ","$3,792.14 ",$363.05 ,"$1,778.56 ","$3,563.47 ",$363.05 ,"$4,179.62 ",$363.05 ,"$5,399.20 ","$5,399.20 ",$363.05 ,"$5,399.20 ",$689.79 ,"$4,319.36 ",$907.62 ,$363.05 ,$363.05 ,"$4,764.00 ","$4,509.92 ","$4,509.92 ",$363.05 ,"$4,509.92 ","$5,208.64 ","$5,208.64 ","$5,208.64 ", N/A ,$907.62 ,"$5,399.20 ",$363.05 ,"$6,352.00 ","$3,792.14 ",$363.05 ,"$2,642.43 ",$228.71 ,$207.92 ,$363.05 ,"$5,399.20 ",$762.40 ,"$5,399.20 ","$1,778.56 ","$5,716.80 ",$363.05 ,"$5,208.64 ","$5,367.44 ","$5,367.44 ",$363.05 ,"$4,128.80 ","$6,352.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,$101.00 ,$65.65 ,$28.28 ,$199.38 ,$199.38 ,$65.65 ,$60.30 ,$79.75 ,$28.28 ,$56.66 ,$79.75 ,$66.46 ,$79.75 ,$85.85 ,$85.85 ,$79.75 ,$85.85 ,$101.00 ,$68.68 ,$199.36 ,$79.75 ,$79.75 ,$75.75 ,$71.71 ,$71.71 ,$79.75 ,$71.71 ,$82.82 ,$82.82 ,$82.82 , N/A ,$101.00 ,$85.85 ,$79.75 ,$101.00 ,$60.30 ,$79.75 ,$42.02 , N/A , N/A ,$79.75 ,$85.85 ,$167.46 ,$85.85 ,$28.28 ,$90.90 ,$79.75 ,$82.82 ,$85.35 ,$85.35 ,$79.75 ,$65.65 ,$101.00 
ST. JOSEPH'S HOSPITAL - BREESE,35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$3,013.00 ","$1,958.45 ",$176.10 ,"$3,013.00 ",$440.25 ,"$1,958.45 ","$1,798.76 ",$176.10 ,$843.64 ,"$1,690.29 ",$176.10 ,"$1,982.55 ",$176.10 ,"$2,561.05 ","$2,561.05 ",$176.10 ,"$2,561.05 ",$334.60 ,"$2,048.84 ",$440.26 ,$176.10 ,$176.10 ,"$2,259.75 ","$2,139.23 ","$2,139.23 ",$176.10 ,"$2,139.23 ","$2,470.66 ","$2,470.66 ","$2,470.66 ", N/A ,$440.26 ,"$2,561.05 ",$176.10 ,"$3,013.00 ","$1,798.76 ",$176.10 ,"$1,253.41 ",$228.49 ,$207.72 ,$176.10 ,"$2,561.05 ",$369.82 ,"$2,561.05 ",$843.64 ,"$2,711.70 ",$176.10 ,"$2,470.66 ","$2,545.99 ","$2,545.99 ",$176.10 ,"$1,958.45 ","$3,013.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,"$2,675.00 ","$1,738.75 ",$79.75 ,"$2,675.00 ",$199.38 ,"$1,738.75 ","$1,596.98 ",$79.75 ,$749.00 ,"$1,500.68 ",$79.75 ,"$1,760.15 ",$79.75 ,"$2,273.75 ","$2,273.75 ",$79.75 ,"$2,273.75 ",$151.52 ,"$1,819.00 ",$199.36 ,$79.75 ,$79.75 ,"$2,006.25 ","$1,899.25 ","$1,899.25 ",$79.75 ,"$1,899.25 ","$2,193.50 ","$2,193.50 ","$2,193.50 ", N/A ,$199.36 ,"$2,273.75 ",$79.75 ,"$2,675.00 ","$1,596.98 ",$79.75 ,"$1,112.80 ",$101.10 ,$91.91 ,$79.75 ,"$2,273.75 ",$167.46 ,"$2,273.75 ",$749.00 ,"$2,407.50 ",$79.75 ,"$2,193.50 ","$2,260.38 ","$2,260.38 ",$79.75 ,"$1,738.75 ","$2,675.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$5,568.00 ","$3,619.20 ",$207.92 ,"$5,568.00 ",$907.63 ,"$3,619.20 ","$3,324.10 ",$363.05 ,"$1,559.04 ","$3,123.65 ",$363.05 ,"$3,663.74 ",$363.05 ,"$4,732.80 ","$4,732.80 ",$363.05 ,"$4,732.80 ",$689.79 ,"$3,786.24 ",$907.62 ,$363.05 ,$363.05 ,"$4,176.00 ","$3,953.28 ","$3,953.28 ",$363.05 ,"$3,953.28 ","$4,565.76 ","$4,565.76 ","$4,565.76 ", N/A ,$907.62 ,"$4,732.80 ",$363.05 ,"$5,568.00 ","$3,324.10 ",$363.05 ,"$2,316.29 ",$228.71 ,$207.92 ,$363.05 ,"$4,732.80 ",$762.40 ,"$4,732.80 ","$1,559.04 ","$5,011.20 ",$363.05 ,"$4,565.76 ","$4,704.96 ","$4,704.96 ",$363.05 ,"$3,619.20 ","$5,568.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000135,22513,HC VERTEBROPLASTY INJ PERC THOR  KYPHOPLASTY,350,1 ,"$19,721.00 ","$12,818.65 ","$5,521.88 ","$19,721.00 ","$15,438.00 ","$12,818.65 ","$11,773.44 ","$6,175.20 ","$5,521.88 ","$11,063.48 ","$6,175.20 ","$12,976.42 ","$6,175.20 ","$16,762.85 ","$16,762.85 ","$6,175.20 ","$16,762.85 ","$11,732.88 ","$13,410.28 ","$15,438.00 ","$6,175.20 ","$6,175.20 ","$14,790.75 ","$14,001.91 ","$14,001.91 ","$6,175.20 ","$14,001.91 ","$16,171.22 ","$16,171.22 ","$16,171.22 ", N/A ,"$15,438.00 ","$16,762.85 ","$6,175.20 ","$19,721.00 ","$11,773.44 ","$6,175.20 ","$8,203.94 ","$9,064.39 ","$8,240.35 ","$6,175.20 ","$16,762.85 ","$12,967.92 ","$16,762.85 ","$5,521.88 ","$17,748.90 ","$6,175.20 ","$16,171.22 ","$16,664.25 ","$16,664.25 ","$6,175.20 ","$12,818.65 ","$19,721.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000136,22514,HC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,350,1 ,"$19,721.00 ","$12,818.65 ","$5,521.88 ","$19,721.00 ","$15,438.00 ","$12,818.65 ","$11,773.44 ","$6,175.20 ","$5,521.88 ","$11,063.48 ","$6,175.20 ","$12,976.42 ","$6,175.20 ","$16,762.85 ","$16,762.85 ","$6,175.20 ","$16,762.85 ","$11,732.88 ","$13,410.28 ","$15,438.00 ","$6,175.20 ","$6,175.20 ","$14,790.75 ","$14,001.91 ","$14,001.91 ","$6,175.20 ","$14,001.91 ","$16,171.22 ","$16,171.22 ","$16,171.22 ", N/A ,"$15,438.00 ","$16,762.85 ","$6,175.20 ","$19,721.00 ","$11,773.44 ","$6,175.20 ","$8,203.94 ","$9,064.39 ","$8,240.35 ","$6,175.20 ","$16,762.85 ","$12,967.92 ","$16,762.85 ","$5,521.88 ","$17,748.90 ","$6,175.20 ","$16,171.22 ","$16,664.25 ","$16,664.25 ","$6,175.20 ","$12,818.65 ","$19,721.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000137,22515,HC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,350,1 ,"$16,151.00 ","$10,498.15 ","$4,522.28 ","$16,151.00 ", N/A ,"$10,498.15 ","$9,642.15 ", N/A ,"$4,522.28 ","$9,060.71 ", N/A ,"$10,627.36 ", N/A ,"$13,728.35 ","$13,728.35 ", N/A ,"$13,728.35 ", N/A ,"$10,982.68 ", N/A , N/A , N/A ,"$12,113.25 ","$11,467.21 ","$11,467.21 ", N/A ,"$11,467.21 ","$13,243.82 ","$13,243.82 ","$13,243.82 ", N/A , N/A ,"$13,728.35 ", N/A ,"$16,151.00 ","$9,642.15 ", N/A ,"$6,718.82 ","$9,064.39 ","$8,240.35 ", N/A ,"$13,728.35 ", N/A ,"$13,728.35 ","$4,522.28 ","$14,535.90 ", N/A ,"$13,243.82 ","$13,647.60 ","$13,647.60 ", N/A ,"$10,498.15 ","$16,151.00 "
ST. JOSEPH'S HOSPITAL - BREESE,35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,$235.00 ,$152.75 ,$65.80 ,$268.33 ,$268.33 ,$152.75 ,$140.30 ,$107.33 ,$65.80 ,$131.84 ,$107.33 ,$154.63 ,$107.33 ,$199.75 ,$199.75 ,$107.33 ,$199.75 ,$203.93 ,$159.80 ,$268.33 ,$107.33 ,$107.33 ,$176.25 ,$166.85 ,$166.85 ,$107.33 ,$166.85 ,$192.70 ,$192.70 ,$192.70 , N/A ,$235.00 ,$199.75 ,$107.33 ,$235.00 ,$140.30 ,$107.33 ,$97.76 ,$101.10 ,$91.91 ,$107.33 ,$199.75 ,$225.40 ,$199.75 ,$65.80 ,$211.50 ,$107.33 ,$192.70 ,$198.58 ,$198.58 ,$107.33 ,$152.75 ,$235.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$420.00 ,$273.00 ,$117.60 ,$442.60 ,$442.60 ,$273.00 ,$250.74 ,$177.04 ,$117.60 ,$235.62 ,$177.04 ,$276.36 ,$177.04 ,$357.00 ,$357.00 ,$177.04 ,$357.00 ,$336.38 ,$285.60 ,$442.60 ,$177.04 ,$177.04 ,$315.00 ,$298.20 ,$298.20 ,$177.04 ,$298.20 ,$344.40 ,$344.40 ,$344.40 , N/A ,$420.00 ,$357.00 ,$177.04 ,$420.00 ,$250.74 ,$177.04 ,$174.72 ,$218.80 ,$198.91 ,$177.04 ,$357.00 ,$371.78 ,$357.00 ,$117.60 ,$378.00 ,$177.04 ,$344.40 ,$354.90 ,$354.90 ,$177.04 ,$273.00 ,$420.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$816.00 ,$530.40 ,$198.91 ,$851.90 ,$851.90 ,$530.40 ,$487.15 ,$340.76 ,$228.48 ,$457.78 ,$340.76 ,$536.93 ,$340.76 ,$693.60 ,$693.60 ,$340.76 ,$693.60 ,$647.44 ,$554.88 ,$851.90 ,$340.76 ,$340.76 ,$612.00 ,$579.36 ,$579.36 ,$340.76 ,$579.36 ,$669.12 ,$669.12 ,$669.12 , N/A ,$816.00 ,$693.60 ,$340.76 ,$816.00 ,$487.15 ,$340.76 ,$339.46 ,$218.80 ,$198.91 ,$340.76 ,$693.60 ,$715.59 ,$693.60 ,$228.48 ,$734.40 ,$340.76 ,$669.12 ,$689.52 ,$689.52 ,$340.76 ,$530.40 ,$816.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000078,19000,HC ASP CYST BREAST,360,1 ,$813.00 ,$528.45 ,$177.68 ,"$1,533.75 ","$1,533.75 ",$528.45 ,$485.36 ,$613.50 ,$227.64 ,$456.09 ,$613.50 ,$534.95 ,$613.50 ,$691.05 ,$691.05 ,$613.50 ,$691.05 ,$813.00 ,$552.84 ,"$1,533.75 ",$613.50 ,$613.50 ,$609.75 ,$577.23 ,$577.23 ,$613.50 ,$577.23 ,$666.66 ,$666.66 ,$666.66 , N/A ,$813.00 ,$691.05 ,$613.50 ,$177.68 ,$485.36 ,$613.50 ,$338.21 ,$442.92 ,$402.65 ,$613.50 ,$691.05 ,"$1,288.35 ",$691.05 ,$227.64 ,$731.70 ,$613.50 ,$666.66 ,$686.99 ,$686.99 ,$613.50 ,$528.45 ,$813.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$669.00 ,$434.85 ,$29.74 ,$669.00 , N/A ,$434.85 ,$399.39 , N/A ,$187.32 ,$375.31 , N/A ,$440.20 , N/A ,$568.65 ,$568.65 , N/A ,$568.65 , N/A ,$454.92 , N/A , N/A , N/A ,$501.75 ,$474.99 ,$474.99 , N/A ,$474.99 ,$548.58 ,$548.58 ,$548.58 , N/A , N/A ,$568.65 , N/A ,$29.74 ,$399.39 , N/A ,$278.30 ,$442.92 ,$402.65 , N/A ,$568.65 , N/A ,$568.65 ,$187.32 ,$602.10 , N/A ,$548.58 ,$565.31 ,$565.31 , N/A ,$434.85 ,$669.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$398.00 ,$258.70 ,$111.44 ,$398.00 , N/A ,$258.70 ,$237.61 , N/A ,$111.44 ,$223.28 , N/A ,$261.88 , N/A ,$338.30 ,$338.30 , N/A ,$338.30 , N/A ,$270.64 , N/A , N/A , N/A ,$298.50 ,$282.58 ,$282.58 , N/A ,$282.58 ,$326.36 ,$326.36 ,$326.36 , N/A , N/A ,$338.30 , N/A ,$398.00 ,$237.61 , N/A ,$165.57 , N/A , N/A , N/A ,$338.30 , N/A ,$338.30 ,$111.44 ,$358.20 , N/A ,$326.36 ,$336.31 ,$336.31 , N/A ,$258.70 ,$398.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$597.00 ,$388.05 ,$167.16 ,$597.00 , N/A ,$388.05 ,$356.41 , N/A ,$167.16 ,$334.92 , N/A ,$392.83 , N/A ,$507.45 ,$507.45 , N/A ,$507.45 , N/A ,$405.96 , N/A , N/A , N/A ,$447.75 ,$423.87 ,$423.87 , N/A ,$423.87 ,$489.54 ,$489.54 ,$489.54 , N/A , N/A ,$507.45 , N/A ,$597.00 ,$356.41 , N/A ,$248.35 , N/A , N/A , N/A ,$507.45 , N/A ,$507.45 ,$167.16 ,$537.30 , N/A ,$489.54 ,$504.47 ,$504.47 , N/A ,$388.05 ,$597.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$6,603.00 ","$4,291.95 ",$620.94 ,"$6,603.00 ","$5,843.93 ","$4,291.95 ","$3,941.99 ","$2,337.57 ","$1,848.84 ","$3,704.28 ","$2,337.57 ","$4,344.77 ","$2,337.57 ","$1,935.00 ","$1,935.00 ","$2,337.57 ","$1,935.00 ","$4,441.38 ","$4,490.04 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$4,952.25 ","$4,688.13 ","$4,688.13 ","$2,337.57 ","$4,688.13 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$5,843.93 ","$5,612.55 ","$2,337.57 ",$620.94 ,"$3,941.99 ","$2,337.57 ","$2,746.85 ","$1,346.39 ","$1,223.99 ","$2,337.57 ","$5,612.55 ","$4,908.90 ","$1,935.00 ","$1,848.84 ","$5,942.70 ","$2,337.57 ","$3,038.00 ","$5,579.54 ","$5,579.54 ","$2,337.57 ","$4,291.95 ","$6,603.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,402.00 ","$2,861.30 ",$620.94 ,"$4,402.00 ","$3,467.90 ","$2,861.30 ","$2,627.99 ","$1,387.16 ","$1,232.56 ","$2,469.52 ","$1,387.16 ","$2,896.52 ","$1,387.16 ","$1,935.00 ","$1,935.00 ","$1,387.16 ","$1,935.00 ","$2,635.59 ","$2,993.36 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$3,301.50 ","$3,125.42 ","$3,125.42 ","$1,387.16 ","$3,125.42 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,467.89 ","$3,741.70 ","$1,387.16 ",$620.94 ,"$2,627.99 ","$1,387.16 ","$1,831.23 ",$897.59 ,$815.99 ,"$1,387.16 ","$3,741.70 ","$2,913.03 ","$1,935.00 ","$1,232.56 ","$3,961.80 ","$1,387.16 ","$3,038.00 ","$3,719.69 ","$3,719.69 ","$1,387.16 ","$2,861.30 ","$4,402.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,996.00 ","$1,297.40 ",$79.05 ,"$1,996.00 ","$1,533.75 ","$1,297.40 ","$1,191.61 ",$613.50 ,$558.88 ,"$1,119.76 ",$613.50 ,"$1,313.37 ",$613.50 ,"$1,696.60 ","$1,696.60 ",$613.50 ,"$1,696.60 ","$1,165.65 ","$1,357.28 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,497.00 ","$1,417.16 ","$1,417.16 ",$613.50 ,"$1,417.16 ","$1,636.72 ","$1,636.72 ","$1,636.72 ", N/A ,"$1,533.75 ","$1,696.60 ",$613.50 ,$464.28 ,"$1,191.61 ",$613.50 ,$830.34 ,$86.96 ,$79.05 ,$613.50 ,"$1,696.60 ","$1,288.35 ","$1,696.60 ",$558.88 ,"$1,796.40 ",$613.50 ,"$1,636.72 ","$1,686.62 ","$1,686.62 ",$613.50 ,"$1,297.40 ","$1,996.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$2,993.00 ","$1,945.45 ",$118.57 ,"$2,993.00 ","$1,533.75 ","$1,945.45 ","$1,786.82 ",$613.50 ,$838.04 ,"$1,679.07 ",$613.50 ,"$1,969.39 ",$613.50 ,"$1,935.00 ","$1,935.00 ",$613.50 ,"$1,935.00 ","$1,165.65 ","$2,035.24 ","$1,533.75 ",$613.50 ,$613.50 ,"$2,244.75 ","$2,125.03 ","$2,125.03 ",$613.50 ,"$2,125.03 ","$2,454.26 ","$2,454.26 ","$2,454.26 ", N/A ,"$1,533.75 ","$2,544.05 ",$613.50 ,$464.28 ,"$1,786.82 ",$613.50 ,"$1,245.09 ",$130.43 ,$118.57 ,$613.50 ,"$2,544.05 ","$1,288.35 ","$1,935.00 ",$838.04 ,"$2,693.70 ",$613.50 ,"$2,454.26 ","$2,529.09 ","$2,529.09 ",$613.50 ,"$1,945.45 ","$2,993.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$4,006.50 ","$2,604.23 ",$402.65 ,"$4,006.50 ","$3,467.90 ","$2,604.23 ","$2,391.88 ","$1,387.16 ","$1,121.82 ","$2,247.65 ","$1,387.16 ","$2,636.28 ","$1,387.16 ","$1,935.00 ","$1,935.00 ","$1,387.16 ","$1,935.00 ","$2,635.59 ","$2,724.42 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$3,004.88 ","$2,844.62 ","$2,844.62 ","$1,387.16 ","$2,844.62 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,467.89 ","$3,405.53 ","$1,387.16 ","$4,006.50 ","$2,391.88 ","$1,387.16 ","$1,666.70 ",$442.92 ,$402.65 ,"$1,387.16 ","$3,405.53 ","$2,913.03 ","$1,935.00 ","$1,121.82 ","$3,605.85 ","$1,387.16 ","$3,038.00 ","$3,385.49 ","$3,385.49 ","$1,387.16 ","$2,604.23 ","$4,006.50 "
ST. JOSEPH'S HOSPITAL - BREESE,36000101,29085,HC CAST APPL; HAND AND FOREARM,360,1 ,$283.00 ,$183.95 ,$79.24 ,$348.23 ,$348.23 ,$183.95 ,$168.95 ,$139.29 ,$79.24 ,$158.76 ,$139.29 ,$186.21 ,$139.29 ,$240.55 ,$240.55 ,$139.29 ,$240.55 ,$264.64 ,$192.44 ,$348.22 ,$139.29 ,$139.29 ,$212.25 ,$200.93 ,$200.93 ,$139.29 ,$200.93 ,$232.06 ,$232.06 ,$232.06 , N/A ,$283.00 ,$240.55 ,$139.29 ,$283.00 ,$168.95 ,$139.29 ,$117.73 ,$236.74 ,$215.22 ,$139.29 ,$240.55 ,$292.50 ,$240.55 ,$79.24 ,$254.70 ,$139.29 ,$232.06 ,$239.14 ,$239.14 ,$139.29 ,$183.95 ,$283.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,"$2,284.00 ","$1,484.60 ",$494.86 ,"$2,284.00 ", N/A ,"$1,484.60 ","$1,363.55 ", N/A ,$639.52 ,"$1,281.32 ", N/A ,"$1,502.87 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,553.12 ", N/A , N/A , N/A ,"$1,713.00 ","$1,621.64 ","$1,621.64 ", N/A ,"$1,621.64 ","$1,872.88 ","$1,872.88 ","$1,872.88 ", N/A , N/A ,"$1,941.40 ", N/A ,$494.86 ,"$1,363.55 ", N/A ,$950.14 ,$897.59 ,$815.99 , N/A ,"$1,941.40 ", N/A ,"$1,935.00 ",$639.52 ,"$2,055.60 ", N/A ,"$1,872.88 ","$1,929.98 ","$1,929.98 ", N/A ,"$1,484.60 ","$2,284.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,"$3,426.00 ","$2,226.90 ",$494.86 ,"$3,426.00 ", N/A ,"$2,226.90 ","$2,045.32 ", N/A ,$959.28 ,"$1,921.99 ", N/A ,"$2,254.31 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$2,329.68 ", N/A , N/A , N/A ,"$2,569.50 ","$2,432.46 ","$2,432.46 ", N/A ,"$2,432.46 ","$2,809.32 ","$2,809.32 ","$2,809.32 ", N/A , N/A ,"$2,912.10 ", N/A ,$494.86 ,"$2,045.32 ", N/A ,"$1,425.22 ",$897.59 ,$815.99 , N/A ,"$2,912.10 ", N/A ,"$1,935.00 ",$959.28 ,"$3,083.40 ", N/A ,"$2,809.32 ","$2,894.97 ","$2,894.97 ", N/A ,"$2,226.90 ","$3,426.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,"$1,625.00 ","$1,056.25 ",$455.00 ,"$1,625.00 ", N/A ,"$1,056.25 ",$970.13 , N/A ,$455.00 ,$911.63 , N/A ,"$1,069.25 ", N/A ,"$1,381.25 ","$1,381.25 ", N/A ,"$1,381.25 ", N/A ,"$1,105.00 ", N/A , N/A , N/A ,"$1,218.75 ","$1,153.75 ","$1,153.75 ", N/A ,"$1,153.75 ","$1,332.50 ","$1,332.50 ","$1,332.50 ", N/A , N/A ,"$1,381.25 ", N/A ,$485.95 ,$970.13 , N/A ,$676.00 ,$897.59 ,$815.99 , N/A ,"$1,381.25 ", N/A ,"$1,381.25 ",$455.00 ,"$1,462.50 ", N/A ,"$1,332.50 ","$1,373.13 ","$1,373.13 ", N/A ,"$1,056.25 ","$1,625.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,"$2,438.00 ","$1,584.70 ",$485.95 ,"$2,438.00 ", N/A ,"$1,584.70 ","$1,455.49 ", N/A ,$682.64 ,"$1,367.72 ", N/A ,"$1,604.20 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,657.84 ", N/A , N/A , N/A ,"$1,828.50 ","$1,730.98 ","$1,730.98 ", N/A ,"$1,730.98 ","$1,999.16 ","$1,999.16 ","$1,999.16 ", N/A , N/A ,"$2,072.30 ", N/A ,$485.95 ,"$1,455.49 ", N/A ,"$1,014.21 ",$897.59 ,$815.99 , N/A ,"$2,072.30 ", N/A ,"$1,935.00 ",$682.64 ,"$2,194.20 ", N/A ,"$1,999.16 ","$2,060.11 ","$2,060.11 ", N/A ,"$1,584.70 ","$2,438.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$703.00 ,$456.95 ,$79.05 ,$703.00 , N/A ,$456.95 ,$419.69 , N/A ,$196.84 ,$394.38 , N/A ,$462.57 , N/A ,$597.55 ,$597.55 , N/A ,$597.55 , N/A ,$478.04 , N/A , N/A , N/A ,$527.25 ,$499.13 ,$499.13 , N/A ,$499.13 ,$576.46 ,$576.46 ,$576.46 , N/A , N/A ,$597.55 , N/A ,$189.78 ,$419.69 , N/A ,$292.45 ,$86.96 ,$79.05 , N/A ,$597.55 , N/A ,$597.55 ,$196.84 ,$632.70 , N/A ,$576.46 ,$594.04 ,$594.04 , N/A ,$456.95 ,$703.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,"$1,055.00 ",$685.75 ,$79.05 ,"$1,055.00 ", N/A ,$685.75 ,$629.84 , N/A ,$295.40 ,$591.86 , N/A ,$694.19 , N/A ,$896.75 ,$896.75 , N/A ,$896.75 , N/A ,$717.40 , N/A , N/A , N/A ,$791.25 ,$749.05 ,$749.05 , N/A ,$749.05 ,$865.10 ,$865.10 ,$865.10 , N/A , N/A ,$896.75 , N/A ,$189.78 ,$629.84 , N/A ,$438.88 ,$86.96 ,$79.05 , N/A ,$896.75 , N/A ,$896.75 ,$295.40 ,$949.50 , N/A ,$865.10 ,$891.48 ,$891.48 , N/A ,$685.75 ,"$1,055.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,$703.00 ,$456.95 ,$79.05 ,$703.00 , N/A ,$456.95 ,$419.69 , N/A ,$196.84 ,$394.38 , N/A ,$462.57 , N/A ,$597.55 ,$597.55 , N/A ,$597.55 , N/A ,$478.04 , N/A , N/A , N/A ,$527.25 ,$499.13 ,$499.13 , N/A ,$499.13 ,$576.46 ,$576.46 ,$576.46 , N/A , N/A ,$597.55 , N/A ,$391.77 ,$419.69 , N/A ,$292.45 ,$86.96 ,$79.05 , N/A ,$597.55 , N/A ,$597.55 ,$196.84 ,$632.70 , N/A ,$576.46 ,$594.04 ,$594.04 , N/A ,$456.95 ,$703.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,"$1,055.00 ",$685.75 ,$79.05 ,"$1,055.00 ", N/A ,$685.75 ,$629.84 , N/A ,$295.40 ,$591.86 , N/A ,$694.19 , N/A ,$896.75 ,$896.75 , N/A ,$896.75 , N/A ,$717.40 , N/A , N/A , N/A ,$791.25 ,$749.05 ,$749.05 , N/A ,$749.05 ,$865.10 ,$865.10 ,$865.10 , N/A , N/A ,$896.75 , N/A ,$391.77 ,$629.84 , N/A ,$438.88 ,$86.96 ,$79.05 , N/A ,$896.75 , N/A ,$896.75 ,$295.40 ,$949.50 , N/A ,$865.10 ,$891.48 ,$891.48 , N/A ,$685.75 ,"$1,055.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$2,176.00 ","$1,414.40 ",$609.28 ,"$7,055.60 ","$7,055.60 ","$1,414.40 ","$1,299.07 ","$2,822.24 ",$609.28 ,"$1,220.74 ","$2,822.24 ","$1,431.81 ","$2,176.00 ","$1,849.60 ","$1,849.60 ","$2,176.00 ","$1,849.60 ","$2,176.00 ","$1,479.68 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$1,632.00 ","$1,544.96 ","$1,544.96 ","$2,822.24 ","$1,544.96 ","$1,784.32 ","$1,784.32 ","$1,784.32 ", N/A ,"$2,176.00 ","$1,849.60 ","$2,822.24 ","$2,176.00 ","$1,299.07 ","$2,822.24 ",$905.22 ,"$1,239.40 ","$1,126.73 ","$2,822.24 ","$1,849.60 ","$5,926.70 ","$1,849.60 ",$609.28 ,"$1,958.40 ","$2,822.24 ","$1,784.32 ","$1,838.72 ","$1,838.72 ","$2,822.24 ","$1,414.40 ","$2,176.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$2,174.00 ","$1,413.10 ",$327.99 ,"$3,465.89 ","$3,465.88 ","$1,413.10 ","$1,297.88 ","$1,386.35 ",$608.72 ,"$1,219.61 ","$1,386.35 ","$1,430.49 ","$1,386.35 ","$1,847.90 ","$1,847.90 ","$1,386.35 ","$1,847.90 ","$2,174.00 ","$1,478.32 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$1,630.50 ","$1,543.54 ","$1,543.54 ","$1,386.35 ","$1,543.54 ","$1,782.68 ","$1,782.68 ","$1,782.68 ", N/A ,"$2,174.00 ","$1,847.90 ","$1,386.35 ","$2,174.00 ","$1,297.88 ","$1,386.35 ",$904.38 ,$360.79 ,$327.99 ,"$1,386.35 ","$1,847.90 ","$2,911.34 ","$1,847.90 ",$608.72 ,"$1,956.60 ","$1,386.35 ","$1,782.68 ","$1,837.03 ","$1,837.03 ","$1,386.35 ","$1,413.10 ","$2,174.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,$229.00 ,$148.85 ,$64.12 ,"$1,332.25 ","$1,332.25 ",$148.85 ,$136.71 ,$532.90 ,$64.12 ,$128.47 ,$532.90 ,$150.68 ,$229.00 ,$194.65 ,$194.65 ,$229.00 ,$194.65 ,$229.00 ,$155.72 ,"$1,332.24 ",$532.90 ,$532.90 ,$171.75 ,$162.59 ,$162.59 ,$532.90 ,$162.59 ,$187.78 ,$187.78 ,$187.78 , N/A ,$229.00 ,$194.65 ,$532.90 ,$229.00 ,$136.71 ,$532.90 ,$95.26 ,$103.27 ,$93.88 ,$532.90 ,$194.65 ,"$1,119.08 ",$194.65 ,$64.12 ,$206.10 ,$532.90 ,$187.78 ,$193.51 ,$193.51 ,$532.90 ,$148.85 ,$229.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,"$1,226.00 ",$796.90 ,$343.28 ,"$1,226.00 ", N/A ,$796.90 ,$731.92 , N/A ,$343.28 ,$687.79 , N/A ,$806.71 , N/A ,"$1,042.10 ","$1,042.10 ", N/A ,"$1,042.10 ", N/A ,$833.68 , N/A , N/A , N/A ,$919.50 ,$870.46 ,$870.46 , N/A ,$870.46 ,"$1,005.32 ","$1,005.32 ","$1,005.32 ", N/A , N/A ,"$1,042.10 ", N/A ,"$1,226.00 ",$731.92 , N/A ,$510.02 ,"$1,226.00 ","$1,226.00 ", N/A ,"$1,042.10 ", N/A ,"$1,042.10 ",$343.28 ,"$1,103.40 ", N/A ,"$1,005.32 ","$1,035.97 ","$1,035.97 ", N/A ,$796.90 ,"$1,226.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,"$3,901.00 ","$2,535.65 ",$402.65 ,"$3,901.00 ","$3,467.90 ","$2,535.65 ","$2,328.90 ","$1,387.16 ","$1,092.28 ","$2,188.46 ","$1,387.16 ","$2,566.86 ","$1,387.16 ","$1,935.00 ","$1,935.00 ","$1,387.16 ","$1,935.00 ","$2,635.59 ","$2,652.68 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$2,925.75 ","$2,769.71 ","$2,769.71 ","$1,387.16 ","$2,769.71 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,467.89 ","$3,315.85 ","$1,387.16 ","$3,901.00 ","$2,328.90 ","$1,387.16 ","$1,622.82 ",$442.92 ,$402.65 ,"$1,387.16 ","$3,315.85 ","$2,913.03 ","$1,935.00 ","$1,092.28 ","$3,510.90 ","$1,387.16 ","$3,038.00 ","$3,296.35 ","$3,296.35 ","$1,387.16 ","$2,535.65 ","$3,901.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$3,900.00 ","$2,535.00 ",$426.58 ,"$3,900.00 ","$3,467.90 ","$2,535.00 ","$2,328.30 ","$1,387.16 ","$1,092.00 ","$2,187.90 ","$1,387.16 ","$2,566.20 ","$1,387.16 ","$1,935.00 ","$1,935.00 ","$1,387.16 ","$1,935.00 ","$2,635.59 ","$2,652.00 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$2,925.00 ","$2,769.00 ","$2,769.00 ","$1,387.16 ","$2,769.00 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,467.89 ","$3,315.00 ","$1,387.16 ","$3,900.00 ","$2,328.30 ","$1,387.16 ","$1,622.40 ",$469.24 ,$426.58 ,"$1,387.16 ","$3,315.00 ","$2,913.03 ","$1,935.00 ","$1,092.00 ","$3,510.00 ","$1,387.16 ","$3,038.00 ","$3,295.50 ","$3,295.50 ","$1,387.16 ","$2,535.00 ","$3,900.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,"$1,073.85 ",$698.00 ,$300.68 ,"$1,073.85 ",$929.10 ,$698.00 ,$641.09 ,$371.64 ,$300.68 ,$602.43 ,$371.64 ,$706.59 ,$371.64 ,$912.77 ,$912.77 ,$371.64 ,$912.77 ,$706.11 ,$730.22 ,$929.10 ,$371.64 ,$371.64 ,$805.39 ,$762.43 ,$762.43 ,$371.64 ,$762.43 ,$880.56 ,$880.56 ,$880.56 , N/A ,$929.10 ,$912.77 ,$371.64 ,"$1,073.85 ",$641.09 ,$371.64 ,$446.72 , N/A , N/A ,$371.64 ,$912.77 ,$780.44 ,$912.77 ,$300.68 ,$966.47 ,$371.64 ,$880.56 ,$907.40 ,$907.40 ,$371.64 ,$698.00 ,"$1,073.85 "
ST. JOSEPH'S HOSPITAL - BREESE,36000187,54150,HC CIRCUMCISION OP,360,1 ,"$5,105.61 ","$3,318.65 ",$992.24 ,"$5,105.61 ","$4,413.08 ","$3,318.65 ","$3,048.05 ","$1,765.23 ","$1,429.57 ","$2,864.25 ","$1,765.23 ","$3,359.49 ","$1,765.23 ","$1,935.00 ","$1,935.00 ","$1,765.23 ","$1,935.00 ","$3,353.94 ","$3,471.81 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$3,829.21 ","$3,624.98 ","$3,624.98 ","$1,765.23 ","$3,624.98 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,413.08 ","$4,339.77 ","$1,765.23 ","$5,105.61 ","$3,048.05 ","$1,765.23 ","$2,123.93 ","$1,091.46 ",$992.24 ,"$1,765.23 ","$4,339.77 ","$3,706.99 ","$1,935.00 ","$1,429.57 ","$4,595.05 ","$1,765.23 ","$3,038.00 ","$4,314.24 ","$4,314.24 ","$1,765.23 ","$3,318.65 ","$5,105.61 "
ST. JOSEPH'S HOSPITAL - BREESE,36000194,62270,HC LUMBAR PUNCTURE,360,1 ,$590.00 ,$383.50 ,$165.20 ,"$1,565.08 ","$1,565.08 ",$383.50 ,$352.23 ,$626.03 ,$165.20 ,$330.99 ,$626.03 ,$388.22 ,$590.00 ,$501.50 ,$501.50 ,$590.00 ,$501.50 ,$590.00 ,$401.20 ,"$1,565.07 ",$626.03 ,$626.03 ,$442.50 ,$418.90 ,$418.90 ,$626.03 ,$418.90 ,$483.80 ,$483.80 ,$483.80 , N/A ,$590.00 ,$501.50 ,$626.03 ,$590.00 ,$352.23 ,$626.03 ,$245.44 ,$376.20 ,$342.00 ,$626.03 ,$501.50 ,"$1,314.66 ",$501.50 ,$165.20 ,$531.00 ,$626.03 ,$483.80 ,$498.55 ,$498.55 ,$626.03 ,$383.50 ,$590.00 
ST. JOSEPH'S HOSPITAL - BREESE,36000334,63650,HC IMPLANT NEUROELECTRODES,360,1 ,"$20,398.00 ","$13,258.70 ","$1,935.00 ","$20,398.00 ","$15,192.80 ","$13,258.70 ","$12,177.61 ","$6,077.12 ","$5,711.44 ","$11,443.28 ","$6,077.12 ","$13,421.88 ","$6,077.12 ","$1,935.00 ","$1,935.00 ","$6,077.12 ","$1,935.00 ","$11,546.54 ","$13,870.64 ","$15,192.81 ","$6,077.12 ","$6,077.12 ","$15,298.50 ","$14,482.58 ","$14,482.58 ","$6,077.12 ","$14,482.58 ","$16,726.36 ","$16,726.36 ","$16,726.36 ", N/A ,"$15,192.81 ","$17,338.30 ","$6,077.12 ","$20,398.00 ","$12,177.61 ","$6,077.12 ","$8,485.57 ","$3,570.18 ","$3,245.62 ","$6,077.12 ","$17,338.30 ","$12,761.96 ","$1,935.00 ","$5,711.44 ","$18,358.20 ","$6,077.12 ","$16,726.36 ","$17,236.31 ","$17,236.31 ","$6,077.12 ","$13,258.70 ","$20,398.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000397,27301,HC I AND D ABSC/BURSA THIGH/KNEE,360,1 ,"$6,648.00 ","$4,321.20 ",$693.76 ,"$6,648.00 ","$5,843.93 ","$4,321.20 ","$3,968.86 ","$2,337.57 ","$1,861.44 ","$3,729.53 ","$2,337.57 ","$4,374.38 ","$2,337.57 ","$1,935.00 ","$1,935.00 ","$2,337.57 ","$1,935.00 ","$4,441.38 ","$4,520.64 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$4,986.00 ","$4,720.08 ","$4,720.08 ","$2,337.57 ","$4,720.08 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$5,843.93 ","$5,650.80 ","$2,337.57 ","$6,648.00 ","$3,968.86 ","$2,337.57 ","$2,765.57 ",$763.14 ,$693.76 ,"$2,337.57 ","$5,650.80 ","$4,908.90 ","$1,935.00 ","$1,861.44 ","$5,983.20 ","$2,337.57 ","$3,038.00 ","$5,617.56 ","$5,617.56 ","$2,337.57 ","$4,321.20 ","$6,648.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000420,26735,HC TX FX OPEN SHAFT FINGER/THUMB W/INT FIX EACH,360,1 ,"$7,848.00 ","$5,101.20 ","$1,935.00 ","$7,848.00 ","$6,979.95 ","$5,101.20 ","$4,685.26 ","$2,791.98 ","$2,197.44 ","$4,402.73 ","$2,791.98 ","$5,163.98 ","$2,791.98 ","$1,935.00 ","$1,935.00 ","$2,791.98 ","$1,935.00 ","$5,304.75 ","$5,336.64 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$5,886.00 ","$5,572.08 ","$5,572.08 ","$2,791.98 ","$5,572.08 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$6,979.94 ","$6,670.80 ","$2,791.98 ","$7,848.00 ","$4,685.26 ","$2,791.98 ","$3,264.77 ","$3,263.67 ","$2,966.97 ","$2,791.98 ","$6,670.80 ","$5,863.15 ","$1,935.00 ","$2,197.44 ","$7,063.20 ","$2,791.98 ","$3,038.00 ","$6,631.56 ","$6,631.56 ","$2,791.98 ","$5,101.20 ","$7,848.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36000755,41018,HC I AND D MASTICATOR SPACE,360,1 ,"$4,058.37 ","$2,637.94 ",$847.14 ,"$4,058.37 ","$3,334.08 ","$2,637.94 ","$2,422.85 ","$1,333.63 ","$1,136.34 ","$2,276.75 ","$1,333.63 ","$2,670.41 ","$1,333.63 ","$1,935.00 ","$1,935.00 ","$1,333.63 ","$1,935.00 ","$2,533.89 ","$2,759.69 ","$3,334.07 ","$1,333.63 ","$1,333.63 ","$3,043.78 ","$2,881.44 ","$2,881.44 ","$1,333.63 ","$2,881.44 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,334.07 ","$3,449.61 ","$1,333.63 ","$4,058.37 ","$2,422.85 ","$1,333.63 ","$1,688.28 ",$931.85 ,$847.14 ,"$1,333.63 ","$3,449.61 ","$2,800.62 ","$1,935.00 ","$1,136.34 ","$3,652.53 ","$1,333.63 ","$3,038.00 ","$3,429.32 ","$3,429.32 ","$1,333.63 ","$2,637.94 ","$4,058.37 "
ST. JOSEPH'S HOSPITAL - BREESE,36000758,43460,HC PRESSURE TREATMENT ESOPHAGUS,360,1 ,"$1,569.12 ","$1,019.93 ",$439.35 ,"$1,569.12 ", N/A ,"$1,019.93 ",$936.76 , N/A ,$439.35 ,$880.28 , N/A ,"$1,032.48 ", N/A ,"$1,333.75 ","$1,333.75 ", N/A ,"$1,333.75 ", N/A ,"$1,067.00 ", N/A , N/A , N/A ,"$1,176.84 ","$1,114.08 ","$1,114.08 ", N/A ,"$1,114.08 ","$1,286.68 ","$1,286.68 ","$1,286.68 ", N/A , N/A ,"$1,333.75 ", N/A ,"$1,569.12 ",$936.76 , N/A ,$652.75 , N/A , N/A , N/A ,"$1,333.75 ", N/A ,"$1,333.75 ",$439.35 ,"$1,412.21 ", N/A ,"$1,286.68 ","$1,325.91 ","$1,325.91 ", N/A ,"$1,019.93 ","$1,569.12 "
ST. JOSEPH'S HOSPITAL - BREESE,36000761,54115,HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE,360,1 ,"$6,748.71 ","$4,386.66 ","$1,583.59 ","$6,748.71 ","$5,843.93 ","$4,386.66 ","$4,028.98 ","$2,337.57 ","$1,889.64 ","$3,786.03 ","$2,337.57 ","$4,440.65 ","$2,337.57 ","$1,935.00 ","$1,935.00 ","$2,337.57 ","$1,935.00 ","$4,441.38 ","$4,589.12 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$5,061.53 ","$4,791.58 ","$4,791.58 ","$2,337.57 ","$4,791.58 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$5,843.93 ","$5,736.40 ","$2,337.57 ","$6,748.71 ","$4,028.98 ","$2,337.57 ","$2,807.46 ","$1,741.95 ","$1,583.59 ","$2,337.57 ","$5,736.40 ","$4,908.90 ","$1,935.00 ","$1,889.64 ","$6,073.84 ","$2,337.57 ","$3,038.00 ","$5,702.66 ","$5,702.66 ","$2,337.57 ","$4,386.66 ","$6,748.71 "
ST. JOSEPH'S HOSPITAL - BREESE,36060014,N/A,HC OR LEVEL 1 ADDL 15MIN,360,1 ,$797.00 ,$518.05 ,$223.16 ,$797.00 , N/A ,$518.05 ,$475.81 , N/A ,$223.16 ,$447.12 , N/A ,$524.43 , N/A ,$677.45 ,$677.45 , N/A ,$677.45 , N/A ,$541.96 , N/A , N/A , N/A ,$597.75 ,$565.87 ,$565.87 , N/A ,$565.87 ,$653.54 ,$653.54 ,$653.54 , N/A , N/A ,$677.45 , N/A ,$797.00 ,$475.81 , N/A ,$331.55 , N/A , N/A , N/A ,$677.45 , N/A ,$677.45 ,$223.16 ,$717.30 , N/A ,$653.54 ,$673.47 ,$673.47 , N/A ,$518.05 ,$797.00 
ST. JOSEPH'S HOSPITAL - BREESE,36060016,N/A,HC OR LEVEL 2 ADDL 15MIN,360,1 ,$908.00 ,$590.20 ,$254.24 ,$908.00 , N/A ,$590.20 ,$542.08 , N/A ,$254.24 ,$509.39 , N/A ,$597.46 , N/A ,$771.80 ,$771.80 , N/A ,$771.80 , N/A ,$617.44 , N/A , N/A , N/A ,$681.00 ,$644.68 ,$644.68 , N/A ,$644.68 ,$744.56 ,$744.56 ,$744.56 , N/A , N/A ,$771.80 , N/A ,$908.00 ,$542.08 , N/A ,$377.73 , N/A , N/A , N/A ,$771.80 , N/A ,$771.80 ,$254.24 ,$817.20 , N/A ,$744.56 ,$767.26 ,$767.26 , N/A ,$590.20 ,$908.00 
ST. JOSEPH'S HOSPITAL - BREESE,36060018,N/A,HC OR LEVEL 3 ADDL 15MIN,360,1 ,"$1,058.00 ",$687.70 ,$296.24 ,"$1,058.00 ", N/A ,$687.70 ,$631.63 , N/A ,$296.24 ,$593.54 , N/A ,$696.16 , N/A ,$899.30 ,$899.30 , N/A ,$899.30 , N/A ,$719.44 , N/A , N/A , N/A ,$793.50 ,$751.18 ,$751.18 , N/A ,$751.18 ,$867.56 ,$867.56 ,$867.56 , N/A , N/A ,$899.30 , N/A ,"$1,058.00 ",$631.63 , N/A ,$440.13 , N/A , N/A , N/A ,$899.30 , N/A ,$899.30 ,$296.24 ,$952.20 , N/A ,$867.56 ,$894.01 ,$894.01 , N/A ,$687.70 ,"$1,058.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060020,N/A,HC OR LEVEL 4 ADDL 15MIN,360,1 ,"$1,196.00 ",$777.40 ,$334.88 ,"$1,196.00 ", N/A ,$777.40 ,$714.01 , N/A ,$334.88 ,$670.96 , N/A ,$786.97 , N/A ,"$1,016.60 ","$1,016.60 ", N/A ,"$1,016.60 ", N/A ,$813.28 , N/A , N/A , N/A ,$897.00 ,$849.16 ,$849.16 , N/A ,$849.16 ,$980.72 ,$980.72 ,$980.72 , N/A , N/A ,"$1,016.60 ", N/A ,"$1,196.00 ",$714.01 , N/A ,$497.54 , N/A , N/A , N/A ,"$1,016.60 ", N/A ,"$1,016.60 ",$334.88 ,"$1,076.40 ", N/A ,$980.72 ,"$1,010.62 ","$1,010.62 ", N/A ,$777.40 ,"$1,196.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060022,N/A,HC OR LEVEL 5 ADDL 15MIN,360,1 ,"$1,333.00 ",$866.45 ,$373.24 ,"$1,333.00 ", N/A ,$866.45 ,$795.80 , N/A ,$373.24 ,$747.81 , N/A ,$877.11 , N/A ,"$1,133.05 ","$1,133.05 ", N/A ,"$1,133.05 ", N/A ,$906.44 , N/A , N/A , N/A ,$999.75 ,$946.43 ,$946.43 , N/A ,$946.43 ,"$1,093.06 ","$1,093.06 ","$1,093.06 ", N/A , N/A ,"$1,133.05 ", N/A ,"$1,333.00 ",$795.80 , N/A ,$554.53 , N/A , N/A , N/A ,"$1,133.05 ", N/A ,"$1,133.05 ",$373.24 ,"$1,199.70 ", N/A ,"$1,093.06 ","$1,126.39 ","$1,126.39 ", N/A ,$866.45 ,"$1,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060025,N/A,HC OR LEVEL 1 INITIAL 30MIN,360,1 ,"$2,459.00 ","$1,598.35 ",$688.52 ,"$2,459.00 ", N/A ,"$1,598.35 ","$1,468.02 ", N/A ,$688.52 ,"$1,379.50 ", N/A ,"$1,618.02 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,672.12 ", N/A , N/A , N/A ,"$1,844.25 ","$1,745.89 ","$1,745.89 ", N/A ,"$1,745.89 ","$2,016.38 ","$2,016.38 ","$2,016.38 ", N/A , N/A ,"$2,090.15 ", N/A ,"$2,459.00 ","$1,468.02 ", N/A ,"$1,022.94 ", N/A , N/A , N/A ,"$2,090.15 ", N/A ,"$1,935.00 ",$688.52 ,"$2,213.10 ", N/A ,"$2,016.38 ","$2,077.86 ","$2,077.86 ", N/A ,"$1,598.35 ","$2,459.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060026,N/A,HC OR LEVEL 2 INITIAL 30MIN,360,1 ,"$4,234.00 ","$2,752.10 ","$1,185.52 ","$4,234.00 ", N/A ,"$2,752.10 ","$2,527.70 ", N/A ,"$1,185.52 ","$2,375.27 ", N/A ,"$2,785.97 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$2,879.12 ", N/A , N/A , N/A ,"$3,175.50 ","$3,006.14 ","$3,006.14 ", N/A ,"$3,006.14 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$3,598.90 ", N/A ,"$4,234.00 ","$2,527.70 ", N/A ,"$1,761.34 ", N/A , N/A , N/A ,"$3,598.90 ", N/A ,"$1,935.00 ","$1,185.52 ","$3,810.60 ", N/A ,"$3,038.00 ","$3,577.73 ","$3,577.73 ", N/A ,"$2,752.10 ","$4,234.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060027,N/A,HC OR LEVEL 3 INITIAL 30MIN,360,1 ,"$5,508.00 ","$3,580.20 ","$1,542.24 ","$5,508.00 ", N/A ,"$3,580.20 ","$3,288.28 ", N/A ,"$1,542.24 ","$3,089.99 ", N/A ,"$3,624.26 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$3,745.44 ", N/A , N/A , N/A ,"$4,131.00 ","$3,910.68 ","$3,910.68 ", N/A ,"$3,910.68 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,681.80 ", N/A ,"$5,508.00 ","$3,288.28 ", N/A ,"$2,291.33 ", N/A , N/A , N/A ,"$4,681.80 ", N/A ,"$1,935.00 ","$1,542.24 ","$4,957.20 ", N/A ,"$3,038.00 ","$4,654.26 ","$4,654.26 ", N/A ,"$3,580.20 ","$5,508.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060028,N/A,HC OR LEVEL 4 INITIAL 30MIN,360,1 ,"$5,763.00 ","$3,745.95 ","$1,613.64 ","$5,763.00 ", N/A ,"$3,745.95 ","$3,440.51 ", N/A ,"$1,613.64 ","$3,233.04 ", N/A ,"$3,792.05 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$3,918.84 ", N/A , N/A , N/A ,"$4,322.25 ","$4,091.73 ","$4,091.73 ", N/A ,"$4,091.73 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,898.55 ", N/A ,"$5,763.00 ","$3,440.51 ", N/A ,"$2,397.41 ", N/A , N/A , N/A ,"$4,898.55 ", N/A ,"$1,935.00 ","$1,613.64 ","$5,186.70 ", N/A ,"$3,038.00 ","$4,869.74 ","$4,869.74 ", N/A ,"$3,745.95 ","$5,763.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36060029,N/A,HC OR LEVEL 5 INITIAL 30MIN,360,1 ,"$6,050.00 ","$3,932.50 ","$1,694.00 ","$6,050.00 ", N/A ,"$3,932.50 ","$3,611.85 ", N/A ,"$1,694.00 ","$3,394.05 ", N/A ,"$3,980.90 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$4,114.00 ", N/A , N/A , N/A ,"$4,537.50 ","$4,295.50 ","$4,295.50 ", N/A ,"$4,295.50 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$5,142.50 ", N/A ,"$6,050.00 ","$3,611.85 ", N/A ,"$2,516.80 ", N/A , N/A , N/A ,"$5,142.50 ", N/A ,"$1,935.00 ","$1,694.00 ","$5,445.00 ", N/A ,"$3,038.00 ","$5,112.25 ","$5,112.25 ", N/A ,"$3,932.50 ","$6,050.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,$703.00 ,$456.95 ,$196.84 ,$703.00 ,$643.95 ,$456.95 ,$419.69 ,$257.58 ,$196.84 ,$394.38 ,$257.58 ,$462.57 ,$257.58 ,$597.55 ,$597.55 ,$257.58 ,$597.55 ,$489.39 ,$478.04 ,$643.94 ,$257.58 ,$257.58 ,$527.25 ,$499.13 ,$499.13 ,$257.58 ,$499.13 ,$576.46 ,$576.46 ,$576.46 , N/A ,$643.94 ,$597.55 ,$257.58 ,$703.00 ,$419.69 ,$257.58 ,$292.45 ,$320.22 ,$291.11 ,$257.58 ,$597.55 ,$540.91 ,$597.55 ,$196.84 ,$632.70 ,$257.58 ,$576.46 ,$594.04 ,$594.04 ,$257.58 ,$456.95 ,$703.00 
ST. JOSEPH'S HOSPITAL - BREESE,36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,"$2,307.00 ","$1,499.55 ",$291.11 ,"$2,307.00 ","$2,028.93 ","$1,499.55 ","$1,377.28 ",$811.57 ,$645.96 ,"$1,294.23 ",$811.57 ,"$1,518.01 ",$811.57 ,"$1,935.00 ","$1,935.00 ",$811.57 ,"$1,935.00 ","$1,541.99 ","$1,568.76 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$811.57 ,"$1,637.97 ","$1,891.74 ","$1,891.74 ","$1,891.74 ", N/A ,"$2,028.93 ","$1,960.95 ",$811.57 ,"$2,307.00 ","$1,377.28 ",$811.57 ,$959.71 ,$320.22 ,$291.11 ,$811.57 ,"$1,960.95 ","$1,704.30 ","$1,935.00 ",$645.96 ,"$2,076.30 ",$811.57 ,"$1,891.74 ","$1,949.42 ","$1,949.42 ",$811.57 ,"$1,499.55 ","$2,307.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100015,11010,HC DEBRID/REMOVE FOREIGN BODY SKIN/SUBQ TISSUE,361,1 ,"$1,645.00 ","$1,069.25 ",$460.60 ,"$1,645.00 ","$1,533.75 ","$1,069.25 ",$982.07 ,$613.50 ,$460.60 ,$922.85 ,$613.50 ,"$1,082.41 ",$613.50 ,"$1,398.25 ","$1,398.25 ",$613.50 ,"$1,398.25 ","$1,165.65 ","$1,118.60 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,233.75 ","$1,167.95 ","$1,167.95 ",$613.50 ,"$1,167.95 ","$1,348.90 ","$1,348.90 ","$1,348.90 ", N/A ,"$1,533.75 ","$1,398.25 ",$613.50 ,"$1,645.00 ",$982.07 ,$613.50 ,$684.32 ,$938.48 ,$853.16 ,$613.50 ,"$1,398.25 ","$1,288.35 ","$1,398.25 ",$460.60 ,"$1,480.50 ",$613.50 ,"$1,348.90 ","$1,390.03 ","$1,390.03 ",$613.50 ,"$1,069.25 ","$1,645.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100026,36510,HC UMBILICAL CATHETER INSERTION NEWBORN,361,1 ,$820.00 ,$533.00 ,$229.60 ,$820.00 , N/A ,$533.00 ,$489.54 , N/A ,$229.60 ,$460.02 , N/A ,$539.56 , N/A ,$697.00 ,$697.00 , N/A ,$697.00 , N/A ,$557.60 , N/A , N/A , N/A ,$615.00 ,$582.20 ,$582.20 , N/A ,$582.20 ,$672.40 ,$672.40 ,$672.40 , N/A , N/A ,$697.00 , N/A ,$820.00 ,$489.54 , N/A ,$341.12 , N/A , N/A , N/A ,$697.00 , N/A ,$697.00 ,$229.60 ,$738.00 , N/A ,$672.40 ,$692.90 ,$692.90 , N/A ,$533.00 ,$820.00 
ST. JOSEPH'S HOSPITAL - BREESE,36100034,55876,HC PLACE DEVICE/MARKER PROSTATE,361,1 ,"$4,106.00 ","$2,668.90 ",$968.27 ,"$4,106.00 ","$3,112.35 ","$2,668.90 ","$2,451.28 ","$1,244.94 ","$1,149.68 ","$2,303.47 ","$1,244.94 ","$2,701.75 ","$1,244.94 ","$1,935.00 ","$1,935.00 ","$1,244.94 ","$1,935.00 ","$2,365.39 ","$2,792.08 ","$3,112.36 ","$1,244.94 ","$1,244.94 ","$3,079.50 ","$2,915.26 ","$2,915.26 ","$1,244.94 ","$2,915.26 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,112.36 ","$3,490.10 ","$1,244.94 ","$4,106.00 ","$2,451.28 ","$1,244.94 ","$1,708.10 ","$1,065.10 ",$968.27 ,"$1,244.94 ","$3,490.10 ","$2,614.38 ","$1,935.00 ","$1,149.68 ","$3,695.40 ","$1,244.94 ","$3,038.00 ","$3,469.57 ","$3,469.57 ","$1,244.94 ","$2,668.90 ","$4,106.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100044,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-BIL,361,1 ,$843.00 ,$547.95 ,$236.04 ,$965.91 ,$965.90 ,$547.95 ,$503.27 ,$386.36 ,$236.04 ,$472.92 ,$386.36 ,$554.69 ,$386.36 ,$716.55 ,$716.55 ,$386.36 ,$716.55 ,$734.09 ,$573.24 ,$965.91 ,$386.36 ,$386.36 ,$632.25 ,$598.53 ,$598.53 ,$386.36 ,$598.53 ,$691.26 ,$691.26 ,$691.26 , N/A ,$843.00 ,$716.55 ,$386.36 ,$843.00 ,$503.27 ,$386.36 ,$350.69 ,$353.55 ,$321.41 ,$386.36 ,$716.55 ,$811.37 ,$716.55 ,$236.04 ,$758.70 ,$386.36 ,$691.26 ,$712.34 ,$712.34 ,$386.36 ,$547.95 ,$843.00 
ST. JOSEPH'S HOSPITAL - BREESE,36100067,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,361,1 ,$562.00 ,$365.30 ,$157.36 ,$643.95 ,$643.95 ,$365.30 ,$335.51 ,$257.58 ,$157.36 ,$315.28 ,$257.58 ,$369.80 ,$257.58 ,$477.70 ,$477.70 ,$257.58 ,$477.70 ,$489.39 ,$382.16 ,$643.94 ,$257.58 ,$257.58 ,$421.50 ,$399.02 ,$399.02 ,$257.58 ,$399.02 ,$460.84 ,$460.84 ,$460.84 , N/A ,$562.00 ,$477.70 ,$257.58 ,$562.00 ,$335.51 ,$257.58 ,$233.79 ,$235.70 ,$214.27 ,$257.58 ,$477.70 ,$540.91 ,$477.70 ,$157.36 ,$505.80 ,$257.58 ,$460.84 ,$474.89 ,$474.89 ,$257.58 ,$365.30 ,$562.00 
ST. JOSEPH'S HOSPITAL - BREESE,36100068,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,361,1 ,$562.00 ,$365.30 ,$157.36 ,$643.95 ,$643.95 ,$365.30 ,$335.51 ,$257.58 ,$157.36 ,$315.28 ,$257.58 ,$369.80 ,$257.58 ,$477.70 ,$477.70 ,$257.58 ,$477.70 ,$489.39 ,$382.16 ,$643.94 ,$257.58 ,$257.58 ,$421.50 ,$399.02 ,$399.02 ,$257.58 ,$399.02 ,$460.84 ,$460.84 ,$460.84 , N/A ,$562.00 ,$477.70 ,$257.58 ,$562.00 ,$335.51 ,$257.58 ,$233.79 ,$235.70 ,$214.27 ,$257.58 ,$477.70 ,$540.91 ,$477.70 ,$157.36 ,$505.80 ,$257.58 ,$460.84 ,$474.89 ,$474.89 ,$257.58 ,$365.30 ,$562.00 
ST. JOSEPH'S HOSPITAL - BREESE,36100093,N/A,HC CENTRAL LINE INSERTION,361,1 ,"$2,696.00 ","$1,752.40 ",$754.88 ,"$2,696.00 ", N/A ,"$1,752.40 ","$1,609.51 ", N/A ,$754.88 ,"$1,512.46 ", N/A ,"$1,773.97 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,833.28 ", N/A , N/A , N/A ,"$2,022.00 ","$1,914.16 ","$1,914.16 ", N/A ,"$1,914.16 ","$2,210.72 ","$2,210.72 ","$2,210.72 ", N/A , N/A ,"$2,291.60 ", N/A ,"$2,696.00 ","$1,609.51 ", N/A ,"$1,121.54 ", N/A , N/A , N/A ,"$2,291.60 ", N/A ,"$1,935.00 ",$754.88 ,"$2,426.40 ", N/A ,"$2,210.72 ","$2,278.12 ","$2,278.12 ", N/A ,"$1,752.40 ","$2,696.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,725.00 ","$1,121.25 ",$291.11 ,"$1,725.00 ","$1,565.08 ","$1,121.25 ","$1,029.83 ",$626.03 ,$483.00 ,$967.73 ,$626.03 ,"$1,135.05 ",$626.03 ,"$1,466.25 ","$1,466.25 ",$626.03 ,"$1,466.25 ","$1,189.46 ","$1,173.00 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,293.75 ","$1,224.75 ","$1,224.75 ",$626.03 ,"$1,224.75 ","$1,414.50 ","$1,414.50 ","$1,414.50 ", N/A ,"$1,565.07 ","$1,466.25 ",$626.03 ,"$1,725.00 ","$1,029.83 ",$626.03 ,$717.60 ,$320.22 ,$291.11 ,$626.03 ,"$1,466.25 ","$1,314.66 ","$1,466.25 ",$483.00 ,"$1,552.50 ",$626.03 ,"$1,414.50 ","$1,457.63 ","$1,457.63 ",$626.03 ,"$1,121.25 ","$1,725.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$1,792.00 ","$1,164.80 ",$291.11 ,"$1,792.00 ","$1,565.08 ","$1,164.80 ","$1,069.82 ",$626.03 ,$501.76 ,"$1,005.31 ",$626.03 ,"$1,179.14 ",$626.03 ,"$1,523.20 ","$1,523.20 ",$626.03 ,"$1,523.20 ","$1,189.46 ","$1,218.56 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,344.00 ","$1,272.32 ","$1,272.32 ",$626.03 ,"$1,272.32 ","$1,469.44 ","$1,469.44 ","$1,469.44 ", N/A ,"$1,565.07 ","$1,523.20 ",$626.03 ,"$1,792.00 ","$1,069.82 ",$626.03 ,$745.47 ,$320.22 ,$291.11 ,$626.03 ,"$1,523.20 ","$1,314.66 ","$1,523.20 ",$501.76 ,"$1,612.80 ",$626.03 ,"$1,469.44 ","$1,514.24 ","$1,514.24 ",$626.03 ,"$1,164.80 ","$1,792.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$1,792.00 ","$1,164.80 ",$291.11 ,"$1,792.00 ","$1,565.08 ","$1,164.80 ","$1,069.82 ",$626.03 ,$501.76 ,"$1,005.31 ",$626.03 ,"$1,179.14 ",$626.03 ,"$1,523.20 ","$1,523.20 ",$626.03 ,"$1,523.20 ","$1,189.46 ","$1,218.56 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,344.00 ","$1,272.32 ","$1,272.32 ",$626.03 ,"$1,272.32 ","$1,469.44 ","$1,469.44 ","$1,469.44 ", N/A ,"$1,565.07 ","$1,523.20 ",$626.03 ,"$1,792.00 ","$1,069.82 ",$626.03 ,$745.47 ,$320.22 ,$291.11 ,$626.03 ,"$1,523.20 ","$1,314.66 ","$1,523.20 ",$501.76 ,"$1,612.80 ",$626.03 ,"$1,469.44 ","$1,514.24 ","$1,514.24 ",$626.03 ,"$1,164.80 ","$1,792.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$3,244.00 ","$2,108.60 ",$527.96 ,"$3,244.00 ","$2,028.93 ","$2,108.60 ","$1,936.67 ",$811.57 ,$908.32 ,"$1,819.88 ",$811.57 ,"$2,134.55 ",$811.57 ,"$1,935.00 ","$1,935.00 ",$811.57 ,"$1,935.00 ","$1,541.99 ","$2,205.92 ","$2,028.93 ",$811.57 ,$811.57 ,"$2,433.00 ","$2,303.24 ","$2,303.24 ",$811.57 ,"$2,303.24 ","$2,660.08 ","$2,660.08 ","$2,660.08 ", N/A ,"$2,028.93 ","$2,757.40 ",$811.57 ,"$3,244.00 ","$1,936.67 ",$811.57 ,"$1,349.50 ",$580.76 ,$527.96 ,$811.57 ,"$2,757.40 ","$1,704.30 ","$1,935.00 ",$908.32 ,"$2,919.60 ",$811.57 ,"$2,660.08 ","$2,741.18 ","$2,741.18 ",$811.57 ,"$2,108.60 ","$3,244.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100119,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-BIL,361,1 ,"$5,473.00 ","$3,557.45 ",$791.94 ,"$5,473.00 ", N/A ,"$3,557.45 ","$3,267.38 ", N/A ,"$1,532.44 ","$3,070.35 ", N/A ,"$3,601.23 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$3,721.64 ", N/A , N/A , N/A ,"$4,104.75 ","$3,885.83 ","$3,885.83 ", N/A ,"$3,885.83 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,652.05 ", N/A ,"$5,473.00 ","$3,267.38 ", N/A ,"$2,276.77 ",$871.13 ,$791.94 , N/A ,"$4,652.05 ", N/A ,"$1,935.00 ","$1,532.44 ","$4,925.70 ", N/A ,"$3,038.00 ","$4,624.69 ","$4,624.69 ", N/A ,"$3,557.45 ","$5,473.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100120,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-LT,361,1 ,"$3,649.00 ","$2,371.85 ",$527.96 ,"$3,649.00 ", N/A ,"$2,371.85 ","$2,178.45 ", N/A ,"$1,021.72 ","$2,047.09 ", N/A ,"$2,401.04 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$2,481.32 ", N/A , N/A , N/A ,"$2,736.75 ","$2,590.79 ","$2,590.79 ", N/A ,"$2,590.79 ","$2,992.18 ","$2,992.18 ","$2,992.18 ", N/A , N/A ,"$3,101.65 ", N/A ,"$3,649.00 ","$2,178.45 ", N/A ,"$1,517.98 ",$580.76 ,$527.96 , N/A ,"$3,101.65 ", N/A ,"$1,935.00 ","$1,021.72 ","$3,284.10 ", N/A ,"$2,992.18 ","$3,083.41 ","$3,083.41 ", N/A ,"$2,371.85 ","$3,649.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100121,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-RT,361,1 ,"$3,649.00 ","$2,371.85 ",$527.96 ,"$3,649.00 ", N/A ,"$2,371.85 ","$2,178.45 ", N/A ,"$1,021.72 ","$2,047.09 ", N/A ,"$2,401.04 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$2,481.32 ", N/A , N/A , N/A ,"$2,736.75 ","$2,590.79 ","$2,590.79 ", N/A ,"$2,590.79 ","$2,992.18 ","$2,992.18 ","$2,992.18 ", N/A , N/A ,"$3,101.65 ", N/A ,"$3,649.00 ","$2,178.45 ", N/A ,"$1,517.98 ",$580.76 ,$527.96 , N/A ,"$3,101.65 ", N/A ,"$1,935.00 ","$1,021.72 ","$3,284.10 ", N/A ,"$2,992.18 ","$3,083.41 ","$3,083.41 ", N/A ,"$2,371.85 ","$3,649.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100122,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-BIL,361,1 ,"$8,503.00 ","$5,526.95 ",$791.94 ,"$8,503.00 ","$4,327.80 ","$5,526.95 ","$5,076.29 ","$1,731.12 ","$2,380.84 ","$4,770.18 ","$1,731.12 ","$5,594.97 ","$1,731.12 ","$1,935.00 ","$1,935.00 ","$1,731.12 ","$1,935.00 ","$3,289.12 ","$5,782.04 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$6,377.25 ","$6,037.13 ","$6,037.13 ","$1,731.12 ","$6,037.13 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,327.80 ","$7,227.55 ","$1,731.12 ","$8,503.00 ","$5,076.29 ","$1,731.12 ","$3,537.25 ",$871.13 ,$791.94 ,"$1,731.12 ","$7,227.55 ","$3,635.35 ","$1,935.00 ","$2,380.84 ","$7,652.70 ","$1,731.12 ","$3,038.00 ","$7,185.04 ","$7,185.04 ","$1,731.12 ","$5,526.95 ","$8,503.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100123,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-LT,361,1 ,"$5,668.00 ","$3,684.20 ",$527.96 ,"$5,668.00 ","$4,327.80 ","$3,684.20 ","$3,383.80 ","$1,731.12 ","$1,587.04 ","$3,179.75 ","$1,731.12 ","$3,729.54 ","$1,731.12 ","$1,935.00 ","$1,935.00 ","$1,731.12 ","$1,935.00 ","$3,289.12 ","$3,854.24 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$4,251.00 ","$4,024.28 ","$4,024.28 ","$1,731.12 ","$4,024.28 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,327.80 ","$4,817.80 ","$1,731.12 ","$5,668.00 ","$3,383.80 ","$1,731.12 ","$2,357.89 ",$580.76 ,$527.96 ,"$1,731.12 ","$4,817.80 ","$3,635.35 ","$1,935.00 ","$1,587.04 ","$5,101.20 ","$1,731.12 ","$3,038.00 ","$4,789.46 ","$4,789.46 ","$1,731.12 ","$3,684.20 ","$5,668.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100124,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-RT,361,1 ,"$5,668.00 ","$3,684.20 ",$527.96 ,"$5,668.00 ","$4,327.80 ","$3,684.20 ","$3,383.80 ","$1,731.12 ","$1,587.04 ","$3,179.75 ","$1,731.12 ","$3,729.54 ","$1,731.12 ","$1,935.00 ","$1,935.00 ","$1,731.12 ","$1,935.00 ","$3,289.12 ","$3,854.24 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$4,251.00 ","$4,024.28 ","$4,024.28 ","$1,731.12 ","$4,024.28 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,327.80 ","$4,817.80 ","$1,731.12 ","$5,668.00 ","$3,383.80 ","$1,731.12 ","$2,357.89 ",$580.76 ,$527.96 ,"$1,731.12 ","$4,817.80 ","$3,635.35 ","$1,935.00 ","$1,587.04 ","$5,101.20 ","$1,731.12 ","$3,038.00 ","$4,789.46 ","$4,789.46 ","$1,731.12 ","$3,684.20 ","$5,668.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100125,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-BIL,361,1 ,"$5,747.00 ","$3,735.55 ",$791.94 ,"$5,747.00 ", N/A ,"$3,735.55 ","$3,430.96 ", N/A ,"$1,609.16 ","$3,224.07 ", N/A ,"$3,781.53 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$3,907.96 ", N/A , N/A , N/A ,"$4,310.25 ","$4,080.37 ","$4,080.37 ", N/A ,"$4,080.37 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,884.95 ", N/A ,"$5,747.00 ","$3,430.96 ", N/A ,"$2,390.75 ",$871.13 ,$791.94 , N/A ,"$4,884.95 ", N/A ,"$1,935.00 ","$1,609.16 ","$5,172.30 ", N/A ,"$3,038.00 ","$4,856.22 ","$4,856.22 ", N/A ,"$3,735.55 ","$5,747.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100126,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-LT,361,1 ,"$3,831.00 ","$2,490.15 ",$527.96 ,"$3,831.00 ", N/A ,"$2,490.15 ","$2,287.11 ", N/A ,"$1,072.68 ","$2,149.19 ", N/A ,"$2,520.80 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$2,605.08 ", N/A , N/A , N/A ,"$2,873.25 ","$2,720.01 ","$2,720.01 ", N/A ,"$2,720.01 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$3,256.35 ", N/A ,"$3,831.00 ","$2,287.11 ", N/A ,"$1,593.70 ",$580.76 ,$527.96 , N/A ,"$3,256.35 ", N/A ,"$1,935.00 ","$1,072.68 ","$3,447.90 ", N/A ,"$3,038.00 ","$3,237.20 ","$3,237.20 ", N/A ,"$2,490.15 ","$3,831.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100127,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-RT,361,1 ,"$3,831.00 ","$2,490.15 ",$527.96 ,"$3,831.00 ", N/A ,"$2,490.15 ","$2,287.11 ", N/A ,"$1,072.68 ","$2,149.19 ", N/A ,"$2,520.80 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$2,605.08 ", N/A , N/A , N/A ,"$2,873.25 ","$2,720.01 ","$2,720.01 ", N/A ,"$2,720.01 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$3,256.35 ", N/A ,"$3,831.00 ","$2,287.11 ", N/A ,"$1,593.70 ",$580.76 ,$527.96 , N/A ,"$3,256.35 ", N/A ,"$1,935.00 ","$1,072.68 ","$3,447.90 ", N/A ,"$3,038.00 ","$3,237.20 ","$3,237.20 ", N/A ,"$2,490.15 ","$3,831.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100128,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-BIL,361,1 ,"$8,503.00 ","$5,526.95 ",$791.94 ,"$8,503.00 ","$4,327.80 ","$5,526.95 ","$5,076.29 ","$1,731.12 ","$2,380.84 ","$4,770.18 ","$1,731.12 ","$5,594.97 ","$1,731.12 ","$1,935.00 ","$1,935.00 ","$1,731.12 ","$1,935.00 ","$3,289.12 ","$5,782.04 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$6,377.25 ","$6,037.13 ","$6,037.13 ","$1,731.12 ","$6,037.13 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,327.80 ","$7,227.55 ","$1,731.12 ","$8,503.00 ","$5,076.29 ","$1,731.12 ","$3,537.25 ",$871.13 ,$791.94 ,"$1,731.12 ","$7,227.55 ","$3,635.35 ","$1,935.00 ","$2,380.84 ","$7,652.70 ","$1,731.12 ","$3,038.00 ","$7,185.04 ","$7,185.04 ","$1,731.12 ","$5,526.95 ","$8,503.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100129,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-LT,361,1 ,"$5,668.00 ","$3,684.20 ",$527.96 ,"$5,668.00 ","$4,327.80 ","$3,684.20 ","$3,383.80 ","$1,731.12 ","$1,587.04 ","$3,179.75 ","$1,731.12 ","$3,729.54 ","$1,731.12 ","$1,935.00 ","$1,935.00 ","$1,731.12 ","$1,935.00 ","$3,289.12 ","$3,854.24 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$4,251.00 ","$4,024.28 ","$4,024.28 ","$1,731.12 ","$4,024.28 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,327.80 ","$4,817.80 ","$1,731.12 ","$5,668.00 ","$3,383.80 ","$1,731.12 ","$2,357.89 ",$580.76 ,$527.96 ,"$1,731.12 ","$4,817.80 ","$3,635.35 ","$1,935.00 ","$1,587.04 ","$5,101.20 ","$1,731.12 ","$3,038.00 ","$4,789.46 ","$4,789.46 ","$1,731.12 ","$3,684.20 ","$5,668.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100130,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-RT,361,1 ,"$5,668.00 ","$3,684.20 ",$527.96 ,"$5,668.00 ","$4,327.80 ","$3,684.20 ","$3,383.80 ","$1,731.12 ","$1,587.04 ","$3,179.75 ","$1,731.12 ","$3,729.54 ","$1,731.12 ","$1,935.00 ","$1,935.00 ","$1,731.12 ","$1,935.00 ","$3,289.12 ","$3,854.24 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$4,251.00 ","$4,024.28 ","$4,024.28 ","$1,731.12 ","$4,024.28 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,327.80 ","$4,817.80 ","$1,731.12 ","$5,668.00 ","$3,383.80 ","$1,731.12 ","$2,357.89 ",$580.76 ,$527.96 ,"$1,731.12 ","$4,817.80 ","$3,635.35 ","$1,935.00 ","$1,587.04 ","$5,101.20 ","$1,731.12 ","$3,038.00 ","$4,789.46 ","$4,789.46 ","$1,731.12 ","$3,684.20 ","$5,668.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100131,64640,HC DESTROY NERVE PERIPHERAL-BIL,361,1 ,"$3,492.00 ","$2,269.80 ",$791.94 ,"$3,492.00 ","$3,043.40 ","$2,269.80 ","$2,084.72 ","$1,217.36 ",$977.76 ,"$1,959.01 ","$1,217.36 ","$2,297.74 ","$1,217.36 ","$1,935.00 ","$1,935.00 ","$1,217.36 ","$1,935.00 ","$2,312.98 ","$2,374.56 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$2,619.00 ","$2,479.32 ","$2,479.32 ","$1,217.36 ","$2,479.32 ","$2,863.44 ","$2,863.44 ","$2,863.44 ", N/A ,"$3,043.40 ","$2,968.20 ","$1,217.36 ","$3,492.00 ","$2,084.72 ","$1,217.36 ","$1,452.67 ",$871.13 ,$791.94 ,"$1,217.36 ","$2,968.20 ","$2,556.46 ","$1,935.00 ",$977.76 ,"$3,142.80 ","$1,217.36 ","$2,863.44 ","$2,950.74 ","$2,950.74 ","$1,217.36 ","$2,269.80 ","$3,492.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100132,64640,HC DESTROY NERVE PERIPHERAL-LT,361,1 ,"$2,328.00 ","$1,513.20 ",$527.96 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,935.00 ","$1,935.00 ",$811.57 ,"$1,935.00 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,935.00 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ","$1,967.16 ","$1,967.16 ",$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100133,64640,HC DESTROY NERVE PERIPHERAL-RT,361,1 ,"$2,328.00 ","$1,513.20 ",$527.96 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,935.00 ","$1,935.00 ",$811.57 ,"$1,935.00 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,935.00 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ","$1,967.16 ","$1,967.16 ",$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100156,38222,HC BONE MARROW ASPIRATION (BX/ASP SAME SITE),361,1 ,"$3,901.00 ","$2,535.65 ",$402.65 ,"$5,843.93 ","$5,843.93 ","$2,535.65 ","$2,328.90 ","$2,337.57 ","$1,092.28 ","$2,188.46 ","$2,337.57 ","$2,566.86 ","$2,337.57 ","$1,935.00 ","$1,935.00 ","$2,337.57 ","$1,935.00 ","$3,901.00 ","$2,652.68 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$2,925.75 ","$2,769.71 ","$2,769.71 ","$2,337.57 ","$2,769.71 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,901.00 ","$3,315.85 ","$2,337.57 ","$3,901.00 ","$2,328.90 ","$2,337.57 ","$1,622.82 ",$442.92 ,$402.65 ,"$2,337.57 ","$3,315.85 ","$4,908.90 ","$1,935.00 ","$1,092.28 ","$3,510.90 ","$2,337.57 ","$3,038.00 ","$3,296.35 ","$3,296.35 ","$2,337.57 ","$2,535.65 ","$3,901.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100189,64415,HC INTRASCALENE BLOCK SINGLE,361,1 ,"$3,244.00 ","$2,108.60 ",$291.11 ,"$3,244.00 ","$2,028.93 ","$2,108.60 ","$1,936.67 ",$811.57 ,$908.32 ,"$1,819.88 ",$811.57 ,"$2,134.55 ",$811.57 ,"$1,935.00 ","$1,935.00 ",$811.57 ,"$1,935.00 ","$1,541.99 ","$2,205.92 ","$2,028.93 ",$811.57 ,$811.57 ,"$2,433.00 ","$2,303.24 ","$2,303.24 ",$811.57 ,"$2,303.24 ","$2,660.08 ","$2,660.08 ","$2,660.08 ", N/A ,"$2,028.93 ","$2,757.40 ",$811.57 ,"$3,244.00 ","$1,936.67 ",$811.57 ,"$1,349.50 ",$320.22 ,$291.11 ,$811.57 ,"$2,757.40 ","$1,704.30 ","$1,935.00 ",$908.32 ,"$2,919.60 ",$811.57 ,"$2,660.08 ","$2,741.18 ","$2,741.18 ",$811.57 ,"$2,108.60 ","$3,244.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100196,64447,HC FEMORAL NERVE BLOCK SINGLE,361,1 ,"$2,307.00 ","$1,499.55 ",$291.11 ,"$2,307.00 ","$1,565.08 ","$1,499.55 ","$1,377.28 ",$626.03 ,$645.96 ,"$1,294.23 ",$626.03 ,"$1,518.01 ",$626.03 ,"$1,935.00 ","$1,935.00 ",$626.03 ,"$1,935.00 ","$1,189.46 ","$1,568.76 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$626.03 ,"$1,637.97 ","$1,891.74 ","$1,891.74 ","$1,891.74 ", N/A ,"$1,565.07 ","$1,960.95 ",$626.03 ,"$2,307.00 ","$1,377.28 ",$626.03 ,$959.71 ,$320.22 ,$291.11 ,$626.03 ,"$1,960.95 ","$1,314.66 ","$1,935.00 ",$645.96 ,"$2,076.30 ",$626.03 ,"$1,891.74 ","$1,949.42 ","$1,949.42 ",$626.03 ,"$1,499.55 ","$2,307.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100197,64450,HC INJ ANES NERVE PERIPHERAL,361,1 ,"$1,797.00 ","$1,168.05 ",$291.11 ,"$1,797.00 ","$1,565.08 ","$1,168.05 ","$1,072.81 ",$626.03 ,$503.16 ,"$1,008.12 ",$626.03 ,"$1,182.43 ",$626.03 ,"$1,527.45 ","$1,527.45 ",$626.03 ,"$1,527.45 ","$1,189.46 ","$1,221.96 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$626.03 ,"$1,275.87 ","$1,473.54 ","$1,473.54 ","$1,473.54 ", N/A ,"$1,565.07 ","$1,527.45 ",$626.03 ,"$1,797.00 ","$1,072.81 ",$626.03 ,$747.55 ,$320.22 ,$291.11 ,$626.03 ,"$1,527.45 ","$1,314.66 ","$1,527.45 ",$503.16 ,"$1,617.30 ",$626.03 ,"$1,473.54 ","$1,518.47 ","$1,518.47 ",$626.03 ,"$1,168.05 ","$1,797.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100198,64480,HC INJ TRANSF CERV/THORACIC ADDL-LT,361,1 ,"$2,471.00 ","$1,606.15 ",$527.96 ,"$2,471.00 ", N/A ,"$1,606.15 ","$1,475.19 ", N/A ,$691.88 ,"$1,386.23 ", N/A ,"$1,625.92 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,680.28 ", N/A , N/A , N/A ,"$1,853.25 ","$1,754.41 ","$1,754.41 ", N/A ,"$1,754.41 ","$2,026.22 ","$2,026.22 ","$2,026.22 ", N/A , N/A ,"$2,100.35 ", N/A ,"$2,471.00 ","$1,475.19 ", N/A ,"$1,027.94 ",$580.76 ,$527.96 , N/A ,"$2,100.35 ", N/A ,"$1,935.00 ",$691.88 ,"$2,223.90 ", N/A ,"$2,026.22 ","$2,088.00 ","$2,088.00 ", N/A ,"$1,606.15 ","$2,471.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100199,64480,HC INJ TRANSF CERV/THORACIC ADDL-RT,361,1 ,"$2,471.00 ","$1,606.15 ",$527.96 ,"$2,471.00 ", N/A ,"$1,606.15 ","$1,475.19 ", N/A ,$691.88 ,"$1,386.23 ", N/A ,"$1,625.92 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,680.28 ", N/A , N/A , N/A ,"$1,853.25 ","$1,754.41 ","$1,754.41 ", N/A ,"$1,754.41 ","$2,026.22 ","$2,026.22 ","$2,026.22 ", N/A , N/A ,"$2,100.35 ", N/A ,"$2,471.00 ","$1,475.19 ", N/A ,"$1,027.94 ",$580.76 ,$527.96 , N/A ,"$2,100.35 ", N/A ,"$1,935.00 ",$691.88 ,"$2,223.90 ", N/A ,"$2,026.22 ","$2,088.00 ","$2,088.00 ", N/A ,"$1,606.15 ","$2,471.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100200,64480,HC INJ TRANSF CERV/THORACIC ADDL,361,1 ,"$2,471.00 ","$1,606.15 ",$527.96 ,"$2,471.00 ", N/A ,"$1,606.15 ","$1,475.19 ", N/A ,$691.88 ,"$1,386.23 ", N/A ,"$1,625.92 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,680.28 ", N/A , N/A , N/A ,"$1,853.25 ","$1,754.41 ","$1,754.41 ", N/A ,"$1,754.41 ","$2,026.22 ","$2,026.22 ","$2,026.22 ", N/A , N/A ,"$2,100.35 ", N/A ,"$2,471.00 ","$1,475.19 ", N/A ,"$1,027.94 ",$580.76 ,$527.96 , N/A ,"$2,100.35 ", N/A ,"$1,935.00 ",$691.88 ,"$2,223.90 ", N/A ,"$2,026.22 ","$2,088.00 ","$2,088.00 ", N/A ,"$1,606.15 ","$2,471.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,$371.00 ,$241.15 ,$103.88 ,"$1,533.75 ","$1,533.75 ",$241.15 ,$221.49 ,$613.50 ,$103.88 ,$208.13 ,$613.50 ,$244.12 ,$371.00 ,$315.35 ,$315.35 ,$371.00 ,$315.35 ,$371.00 ,$252.28 ,"$1,533.75 ",$613.50 ,$613.50 ,$278.25 ,$263.41 ,$263.41 ,$613.50 ,$263.41 ,$304.22 ,$304.22 ,$304.22 , N/A ,$371.00 ,$315.35 ,$613.50 ,$148.00 ,$221.49 ,$613.50 ,$154.34 ,$371.00 ,$371.00 ,$613.50 ,$315.35 ,"$1,288.35 ",$315.35 ,$103.88 ,$333.90 ,$613.50 ,$304.22 ,$313.50 ,$313.50 ,$613.50 ,$241.15 ,$371.00 
ST. JOSEPH'S HOSPITAL - BREESE,36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$371.00 ,$241.15 ,$66.21 ,$371.00 , N/A ,$241.15 ,$221.49 , N/A ,$103.88 ,$208.13 , N/A ,$244.12 , N/A ,$315.35 ,$315.35 , N/A ,$315.35 , N/A ,$252.28 , N/A , N/A , N/A ,$278.25 ,$263.41 ,$263.41 , N/A ,$263.41 ,$304.22 ,$304.22 ,$304.22 , N/A , N/A ,$315.35 , N/A ,$66.21 ,$221.49 , N/A ,$154.34 ,$371.00 ,$371.00 , N/A ,$315.35 , N/A ,$315.35 ,$103.88 ,$333.90 , N/A ,$304.22 ,$313.50 ,$313.50 , N/A ,$241.15 ,$371.00 
ST. JOSEPH'S HOSPITAL - BREESE,36100268,11004,HC DEBRIDEMENT GENITALIA  AND  PERINEUM,361,1 ,"$1,792.00 ","$1,164.80 ",$501.76 ,"$1,792.00 ", N/A ,"$1,164.80 ","$1,069.82 ", N/A ,$501.76 ,"$1,005.31 ", N/A ,"$1,179.14 ", N/A ,"$1,523.20 ","$1,523.20 ", N/A ,"$1,523.20 ", N/A ,"$1,218.56 ", N/A , N/A , N/A ,"$1,344.00 ","$1,272.32 ","$1,272.32 ", N/A ,"$1,272.32 ","$1,469.44 ","$1,469.44 ","$1,469.44 ", N/A , N/A ,"$1,523.20 ", N/A ,"$1,792.00 ","$1,069.82 ", N/A ,$745.47 ,$871.86 ,$792.60 , N/A ,"$1,523.20 ", N/A ,"$1,523.20 ",$501.76 ,"$1,612.80 ", N/A ,"$1,469.44 ","$1,514.24 ","$1,514.24 ", N/A ,"$1,164.80 ","$1,792.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100269,11005,HC DEBRIDEMENT NSTI ABDOMINAL WALL,361,1 ,"$2,500.00 ","$1,625.00 ",$700.00 ,"$2,500.00 ", N/A ,"$1,625.00 ","$1,492.50 ", N/A ,$700.00 ,"$1,402.50 ", N/A ,"$1,645.00 ", N/A ,"$1,935.00 ","$1,935.00 ", N/A ,"$1,935.00 ", N/A ,"$1,700.00 ", N/A , N/A , N/A ,"$1,875.00 ","$1,775.00 ","$1,775.00 ", N/A ,"$1,775.00 ","$2,050.00 ","$2,050.00 ","$2,050.00 ", N/A , N/A ,"$2,125.00 ", N/A ,"$2,500.00 ","$1,492.50 ", N/A ,"$1,040.00 ",$871.86 ,$792.60 , N/A ,"$2,125.00 ", N/A ,"$1,935.00 ",$700.00 ,"$2,250.00 ", N/A ,"$2,050.00 ","$2,112.50 ","$2,112.50 ", N/A ,"$1,625.00 ","$2,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100274,64624,HC DESTRUST NEUROLYTIC AGENT GENICULAR NERVE W/IMG GUID,361,1 ,"$4,929.00 ","$3,203.85 ",$527.96 ,"$4,929.00 ","$4,327.80 ","$3,203.85 ","$2,942.61 ","$1,731.12 ","$1,380.12 ","$2,765.17 ","$1,731.12 ","$3,243.28 ","$1,731.12 ","$1,935.00 ","$1,935.00 ","$1,731.12 ","$1,935.00 ","$3,289.12 ","$3,351.72 ","$4,327.80 ","$1,731.12 ","$1,731.12 ","$3,696.75 ","$3,499.59 ","$3,499.59 ","$1,731.12 ","$3,499.59 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$4,327.80 ","$4,189.65 ","$1,731.12 ","$4,929.00 ","$2,942.61 ","$1,731.12 ","$2,050.46 ",$580.76 ,$527.96 ,"$1,731.12 ","$4,189.65 ","$3,635.35 ","$1,935.00 ","$1,380.12 ","$4,436.10 ","$1,731.12 ","$3,038.00 ","$4,165.01 ","$4,165.01 ","$1,731.12 ","$3,203.85 ","$4,929.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100281,32408,HC CORE NDL BX LUNG/MEDIASTINUM PERQ W IMG,361,1 ,"$4,006.00 ","$2,603.90 ",$457.93 ,"$4,006.00 ","$3,467.90 ","$2,603.90 ","$2,391.58 ","$1,387.16 ","$1,121.68 ","$2,247.37 ","$1,387.16 ","$2,635.95 ","$1,387.16 ","$1,935.00 ","$1,935.00 ","$1,387.16 ","$1,935.00 ","$2,635.59 ","$2,724.08 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$3,004.50 ","$2,844.26 ","$2,844.26 ","$1,387.16 ","$2,844.26 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A ,"$3,467.89 ","$3,405.10 ","$1,387.16 ","$4,006.00 ","$2,391.58 ","$1,387.16 ","$1,666.50 ",$503.72 ,$457.93 ,"$1,387.16 ","$3,405.10 ","$2,913.03 ","$1,935.00 ","$1,121.68 ","$3,605.40 ","$1,387.16 ","$3,038.00 ","$3,385.07 ","$3,385.07 ","$1,387.16 ","$2,603.90 ","$4,006.00 "
ST. JOSEPH'S HOSPITAL - BREESE,36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,$238.00 ,$154.70 ,$66.64 ,"$4,413.08 ","$4,413.08 ",$154.70 ,$142.09 ,"$1,765.23 ",$66.64 ,$133.52 ,"$1,765.23 ",$156.60 ,$238.00 ,$202.30 ,$202.30 ,$238.00 ,$202.30 ,$238.00 ,$161.84 ,"$4,413.08 ","$1,765.23 ","$1,765.23 ",$178.50 ,$168.98 ,$168.98 ,"$1,765.23 ",$168.98 ,$195.16 ,$195.16 ,$195.16 , N/A ,$238.00 ,$202.30 ,"$1,765.23 ",$238.00 ,$142.09 ,"$1,765.23 ",$99.01 , N/A , N/A ,"$1,765.23 ",$202.30 ,"$3,706.99 ",$202.30 ,$66.64 ,$214.20 ,"$1,765.23 ",$195.16 ,$238.00 ,$238.00 ,"$1,765.23 ",$154.70 ,$238.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,$591.00 ,$384.15 ,$165.48 ,$591.00 ,$521.45 ,$384.15 ,$352.83 ,$208.58 ,$165.48 ,$331.55 ,$208.58 ,$388.88 ,$208.58 ,$502.35 ,$502.35 ,$208.58 ,$502.35 ,$396.30 ,$401.88 ,$521.44 ,$208.58 ,$208.58 ,$443.25 ,$419.61 ,$419.61 ,$208.58 ,$419.61 ,$484.62 ,$484.62 ,$484.62 , N/A ,$521.44 ,$502.35 ,$208.58 ,$591.00 ,$352.83 ,$208.58 ,$245.86 ,$491.82 ,$447.11 ,$208.58 ,$502.35 ,$438.01 ,$502.35 ,$165.48 ,$531.90 ,$208.58 ,$484.62 ,$499.40 ,$499.40 ,$208.58 ,$384.15 ,$591.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$223.00 ,$144.95 ,$15.61 ,$223.00 , N/A ,$144.95 ,$133.13 , N/A ,$62.44 ,$125.10 , N/A ,$146.73 , N/A ,$189.55 ,$189.55 , N/A ,$189.55 , N/A ,$151.64 , N/A , N/A , N/A ,$167.25 ,$158.33 ,$158.33 , N/A ,$158.33 ,$182.86 ,$182.86 ,$182.86 , N/A , N/A ,$189.55 , N/A ,$223.00 ,$133.13 , N/A ,$92.77 ,$17.17 ,$15.61 , N/A ,$189.55 , N/A ,$189.55 ,$62.44 ,$200.70 , N/A ,$182.86 ,$188.44 ,$188.44 , N/A ,$144.95 ,$223.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$197.00 ,$128.05 ,$15.61 ,$197.00 , N/A ,$128.05 ,$117.61 , N/A ,$55.16 ,$110.52 , N/A ,$129.63 , N/A ,$167.45 ,$167.45 , N/A ,$167.45 , N/A ,$133.96 , N/A , N/A , N/A ,$147.75 ,$139.87 ,$139.87 , N/A ,$139.87 ,$161.54 ,$161.54 ,$161.54 , N/A , N/A ,$167.45 , N/A ,$197.00 ,$117.61 , N/A ,$81.95 ,$17.17 ,$15.61 , N/A ,$167.45 , N/A ,$167.45 ,$55.16 ,$177.30 , N/A ,$161.54 ,$166.47 ,$166.47 , N/A ,$128.05 ,$197.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000061,N/A,HC ANESTHESIA GENERAL INITIAL 15MIN,370,1 ,$456.00 ,$296.40 ,$127.68 ,$456.00 , N/A ,$296.40 ,$272.23 , N/A ,$127.68 ,$255.82 , N/A ,$300.05 , N/A ,$387.60 ,$387.60 , N/A ,$387.60 , N/A ,$310.08 , N/A , N/A , N/A ,$342.00 ,$323.76 ,$323.76 , N/A ,$323.76 ,$373.92 ,$373.92 ,$373.92 , N/A , N/A ,$387.60 , N/A ,$456.00 ,$272.23 , N/A ,$189.70 , N/A , N/A , N/A ,$387.60 , N/A ,$387.60 ,$127.68 ,$410.40 , N/A ,$373.92 ,$385.32 ,$385.32 , N/A ,$296.40 ,$456.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000062,N/A,HC ANESTHESIA GENERAL ADDL 15MIN,370,1 ,$286.00 ,$185.90 ,$80.08 ,$286.00 , N/A ,$185.90 ,$170.74 , N/A ,$80.08 ,$160.45 , N/A ,$188.19 , N/A ,$243.10 ,$243.10 , N/A ,$243.10 , N/A ,$194.48 , N/A , N/A , N/A ,$214.50 ,$203.06 ,$203.06 , N/A ,$203.06 ,$234.52 ,$234.52 ,$234.52 , N/A , N/A ,$243.10 , N/A ,$286.00 ,$170.74 , N/A ,$118.98 , N/A , N/A , N/A ,$243.10 , N/A ,$243.10 ,$80.08 ,$257.40 , N/A ,$234.52 ,$241.67 ,$241.67 , N/A ,$185.90 ,$286.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000063,N/A,HC ANESTHESIA REGIONAL BLOCK INITIAL 15MIN,370,1 ,$478.00 ,$310.70 ,$133.84 ,$478.00 , N/A ,$310.70 ,$285.37 , N/A ,$133.84 ,$268.16 , N/A ,$314.52 , N/A ,$406.30 ,$406.30 , N/A ,$406.30 , N/A ,$325.04 , N/A , N/A , N/A ,$358.50 ,$339.38 ,$339.38 , N/A ,$339.38 ,$391.96 ,$391.96 ,$391.96 , N/A , N/A ,$406.30 , N/A ,$478.00 ,$285.37 , N/A ,$198.85 , N/A , N/A , N/A ,$406.30 , N/A ,$406.30 ,$133.84 ,$430.20 , N/A ,$391.96 ,$403.91 ,$403.91 , N/A ,$310.70 ,$478.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000064,N/A,HC ANESTHESIA REGIONAL BLOCK ADDL 15MIN,370,1 ,$273.00 ,$177.45 ,$76.44 ,$273.00 , N/A ,$177.45 ,$162.98 , N/A ,$76.44 ,$153.15 , N/A ,$179.63 , N/A ,$232.05 ,$232.05 , N/A ,$232.05 , N/A ,$185.64 , N/A , N/A , N/A ,$204.75 ,$193.83 ,$193.83 , N/A ,$193.83 ,$223.86 ,$223.86 ,$223.86 , N/A , N/A ,$232.05 , N/A ,$273.00 ,$162.98 , N/A ,$113.57 , N/A , N/A , N/A ,$232.05 , N/A ,$232.05 ,$76.44 ,$245.70 , N/A ,$223.86 ,$230.69 ,$230.69 , N/A ,$177.45 ,$273.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$842.00 ,$547.30 ,$15.61 ,$842.00 , N/A ,$547.30 ,$502.67 , N/A ,$235.76 ,$472.36 , N/A ,$554.04 , N/A ,$715.70 ,$715.70 , N/A ,$715.70 , N/A ,$572.56 , N/A , N/A , N/A ,$631.50 ,$597.82 ,$597.82 , N/A ,$597.82 ,$690.44 ,$690.44 ,$690.44 , N/A , N/A ,$715.70 , N/A ,$842.00 ,$502.67 , N/A ,$350.27 ,$17.17 ,$15.61 , N/A ,$715.70 , N/A ,$715.70 ,$235.76 ,$757.80 , N/A ,$690.44 ,$711.49 ,$711.49 , N/A ,$547.30 ,$842.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$842.00 ,$547.30 ,$15.61 ,$842.00 , N/A ,$547.30 ,$502.67 , N/A ,$235.76 ,$472.36 , N/A ,$554.04 , N/A ,$715.70 ,$715.70 , N/A ,$715.70 , N/A ,$572.56 , N/A , N/A , N/A ,$631.50 ,$597.82 ,$597.82 , N/A ,$597.82 ,$690.44 ,$690.44 ,$690.44 , N/A , N/A ,$715.70 , N/A ,$842.00 ,$502.67 , N/A ,$350.27 ,$17.17 ,$15.61 , N/A ,$715.70 , N/A ,$715.70 ,$235.76 ,$757.80 , N/A ,$690.44 ,$711.49 ,$711.49 , N/A ,$547.30 ,$842.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000074,99155,HC MODERATE SEDATION DIFF PHY <5YR 1ST 15MIN,370,1 ,$868.00 ,$564.20 ,$15.61 ,$868.00 , N/A ,$564.20 ,$518.20 , N/A ,$243.04 ,$486.95 , N/A ,$571.14 , N/A ,$737.80 ,$737.80 , N/A ,$737.80 , N/A ,$590.24 , N/A , N/A , N/A ,$651.00 ,$616.28 ,$616.28 , N/A ,$616.28 ,$711.76 ,$711.76 ,$711.76 , N/A , N/A ,$737.80 , N/A ,$868.00 ,$518.20 , N/A ,$361.09 ,$17.17 ,$15.61 , N/A ,$737.80 , N/A ,$737.80 ,$243.04 ,$781.20 , N/A ,$711.76 ,$733.46 ,$733.46 , N/A ,$564.20 ,$868.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,$868.00 ,$564.20 ,$15.61 ,$868.00 , N/A ,$564.20 ,$518.20 , N/A ,$243.04 ,$486.95 , N/A ,$571.14 , N/A ,$737.80 ,$737.80 , N/A ,$737.80 , N/A ,$590.24 , N/A , N/A , N/A ,$651.00 ,$616.28 ,$616.28 , N/A ,$616.28 ,$711.76 ,$711.76 ,$711.76 , N/A , N/A ,$737.80 , N/A ,$200.00 ,$518.20 , N/A ,$361.09 ,$17.17 ,$15.61 , N/A ,$737.80 , N/A ,$737.80 ,$243.04 ,$781.20 , N/A ,$711.76 ,$733.46 ,$733.46 , N/A ,$564.20 ,$868.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000076,N/A,HC MONITORED ANESTHESIA INITIAL 15 MINS,370,1 ,$455.00 ,$295.75 ,$127.40 ,$455.00 , N/A ,$295.75 ,$271.64 , N/A ,$127.40 ,$255.26 , N/A ,$299.39 , N/A ,$386.75 ,$386.75 , N/A ,$386.75 , N/A ,$309.40 , N/A , N/A , N/A ,$341.25 ,$323.05 ,$323.05 , N/A ,$323.05 ,$373.10 ,$373.10 ,$373.10 , N/A , N/A ,$386.75 , N/A ,$455.00 ,$271.64 , N/A ,$189.28 , N/A , N/A , N/A ,$386.75 , N/A ,$386.75 ,$127.40 ,$409.50 , N/A ,$373.10 ,$384.48 ,$384.48 , N/A ,$295.75 ,$455.00 
ST. JOSEPH'S HOSPITAL - BREESE,37000077,N/A,HC MONITORED ANESTHESIA ADDL 15 MINS,370,1 ,$259.00 ,$168.35 ,$72.52 ,$259.00 , N/A ,$168.35 ,$154.62 , N/A ,$72.52 ,$145.30 , N/A ,$170.42 , N/A ,$220.15 ,$220.15 , N/A ,$220.15 , N/A ,$176.12 , N/A , N/A , N/A ,$194.25 ,$183.89 ,$183.89 , N/A ,$183.89 ,$212.38 ,$212.38 ,$212.38 , N/A , N/A ,$220.15 , N/A ,$259.00 ,$154.62 , N/A ,$107.74 , N/A , N/A , N/A ,$220.15 , N/A ,$220.15 ,$72.52 ,$233.10 , N/A ,$212.38 ,$218.86 ,$218.86 , N/A ,$168.35 ,$259.00 
ST. JOSEPH'S HOSPITAL - BREESE,37001000,1967,HC EPIDURAL/SPINAL FOR LABOR,370,1 ,$827.10 ,$537.62 ,$231.59 ,$827.10 , N/A ,$537.62 ,$493.78 , N/A ,$231.59 ,$464.00 , N/A ,$544.23 , N/A ,$703.04 ,$703.04 , N/A ,$703.04 , N/A ,$562.43 , N/A , N/A , N/A ,$620.33 ,$587.24 ,$587.24 , N/A ,$587.24 ,$678.22 ,$678.22 ,$678.22 , N/A , N/A ,$703.04 , N/A ,$827.10 ,$493.78 , N/A ,$344.07 , N/A , N/A , N/A ,$703.04 , N/A ,$703.04 ,$231.59 ,$744.39 , N/A ,$678.22 ,$698.90 ,$698.90 , N/A ,$537.62 ,$827.10 
ST. JOSEPH'S HOSPITAL - BREESE,37080000,64447,HC FEMORAL NERVE BLOCK SINGLE,360,1 ,"$2,307.00 ","$1,499.55 ",$291.11 ,"$2,307.00 ","$1,565.08 ","$1,499.55 ","$1,377.28 ",$626.03 ,$645.96 ,"$1,294.23 ",$626.03 ,"$1,518.01 ",$626.03 ,"$1,935.00 ","$1,935.00 ",$626.03 ,"$1,935.00 ","$1,189.46 ","$1,568.76 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$626.03 ,"$1,637.97 ","$1,891.74 ","$1,891.74 ","$1,891.74 ", N/A ,"$1,565.07 ","$1,960.95 ",$626.03 ,"$2,307.00 ","$1,377.28 ",$626.03 ,$959.71 ,$320.22 ,$291.11 ,$626.03 ,"$1,960.95 ","$1,314.66 ","$1,935.00 ",$645.96 ,"$2,076.30 ",$626.03 ,"$1,891.74 ","$1,949.42 ","$1,949.42 ",$626.03 ,"$1,499.55 ","$2,307.00 "
ST. JOSEPH'S HOSPITAL - BREESE,39000143,86945,HC BLOOD PRODUCT IRRADIATION,390,1 ,$85.00 ,$55.25 ,$4.14 ,$85.00 ,$83.43 ,$55.25 ,$50.75 ,$33.37 ,$23.80 ,$47.69 ,$33.37 ,$55.93 ,$33.37 ,$72.25 ,$72.25 ,$33.37 ,$72.25 ,$63.41 ,$57.80 ,$83.43 ,$33.37 ,$33.37 ,$63.75 ,$60.35 ,$60.35 ,$33.37 ,$60.35 ,$69.70 ,$69.70 ,$69.70 , N/A ,$83.43 ,$72.25 ,$33.37 ,$85.00 ,$50.75 ,$33.37 ,$35.36 ,$4.55 ,$4.14 ,$33.37 ,$72.25 ,$70.08 ,$72.25 ,$23.80 ,$76.50 ,$33.37 ,$69.70 ,$71.83 ,$71.83 ,$33.37 ,$55.25 ,$85.00 
ST. JOSEPH'S HOSPITAL - BREESE,39000148,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$186.00 ,$120.90 ,$52.08 ,$211.00 ,$211.00 ,$120.90 ,$111.04 ,$84.40 ,$52.08 ,$104.35 ,$84.40 ,$122.39 ,$84.40 ,$158.10 ,$158.10 ,$84.40 ,$158.10 ,$160.36 ,$126.48 ,$211.00 ,$84.40 ,$84.40 ,$139.50 ,$132.06 ,$132.06 ,$84.40 ,$132.06 ,$152.52 ,$152.52 ,$152.52 , N/A ,$186.00 ,$158.10 ,$84.40 ,$186.00 ,$111.04 ,$84.40 ,$77.38 ,$186.00 ,$186.00 ,$84.40 ,$158.10 ,$177.24 ,$158.10 ,$52.08 ,$167.40 ,$84.40 ,$152.52 ,$157.17 ,$157.17 ,$84.40 ,$120.90 ,$186.00 
ST. JOSEPH'S HOSPITAL - BREESE,39000151,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,"$1,141.00 ",$741.65 ,$153.07 ,"$1,141.00 ",$382.68 ,$741.65 ,$681.18 ,$153.07 ,$319.48 ,$640.10 ,$153.07 ,$750.78 ,$153.07 ,$969.85 ,$969.85 ,$153.07 ,$969.85 ,$290.83 ,$775.88 ,$382.68 ,$153.07 ,$153.07 ,$855.75 ,$810.11 ,$810.11 ,$153.07 ,$810.11 ,$935.62 ,$935.62 ,$935.62 , N/A ,$382.68 ,$969.85 ,$153.07 ,"$1,141.00 ",$681.18 ,$153.07 ,$474.66 ,$483.35 ,$439.41 ,$153.07 ,$969.85 ,$321.45 ,$969.85 ,$319.48 ,"$1,026.90 ",$153.07 ,$935.62 ,$964.15 ,$964.15 ,$153.07 ,$741.65 ,"$1,141.00 "
ST. JOSEPH'S HOSPITAL - BREESE,39000152,P9033,HC PLATELETS L/R IRR EA,390,1 ,"$1,041.00 ",$676.65 ,$217.66 ,"$1,041.00 ",$544.15 ,$676.65 ,$621.48 ,$217.66 ,$291.48 ,$584.00 ,$217.66 ,$684.98 ,$217.66 ,$884.85 ,$884.85 ,$217.66 ,$884.85 ,$413.55 ,$707.88 ,$544.15 ,$217.66 ,$217.66 ,$780.75 ,$739.11 ,$739.11 ,$217.66 ,$739.11 ,$853.62 ,$853.62 ,$853.62 , N/A ,$544.15 ,$884.85 ,$217.66 ,"$1,041.00 ",$621.48 ,$217.66 ,$433.06 ,$483.35 ,$439.41 ,$217.66 ,$884.85 ,$457.09 ,$884.85 ,$291.48 ,$936.90 ,$217.66 ,$853.62 ,$879.65 ,$879.65 ,$217.66 ,$676.65 ,"$1,041.00 "
ST. JOSEPH'S HOSPITAL - BREESE,39000162,P9012,HC CRYOPRECIPITATE EA UNIT T1,390,1 ,$187.00 ,$121.55 ,$52.36 ,$203.83 ,$203.83 ,$121.55 ,$111.64 ,$81.53 ,$52.36 ,$104.91 ,$81.53 ,$123.05 ,$81.53 ,$158.95 ,$158.95 ,$81.53 ,$158.95 ,$154.91 ,$127.16 ,$203.83 ,$81.53 ,$81.53 ,$140.25 ,$132.77 ,$132.77 ,$81.53 ,$132.77 ,$153.34 ,$153.34 ,$153.34 , N/A ,$187.00 ,$158.95 ,$81.53 ,$187.00 ,$111.64 ,$81.53 ,$77.79 ,$187.00 ,$187.00 ,$81.53 ,$158.95 ,$171.21 ,$158.95 ,$52.36 ,$168.30 ,$81.53 ,$153.34 ,$158.02 ,$158.02 ,$81.53 ,$121.55 ,$187.00 
ST. JOSEPH'S HOSPITAL - BREESE,39000164,P9016,HC RED CELLS L/R EA T1,390,1 ,$650.00 ,$422.50 ,$182.00 ,$650.00 ,$480.98 ,$422.50 ,$388.05 ,$192.39 ,$182.00 ,$364.65 ,$192.39 ,$427.70 ,$192.39 ,$552.50 ,$552.50 ,$192.39 ,$552.50 ,$365.54 ,$442.00 ,$480.98 ,$192.39 ,$192.39 ,$487.50 ,$461.50 ,$461.50 ,$192.39 ,$461.50 ,$533.00 ,$533.00 ,$533.00 , N/A ,$480.98 ,$552.50 ,$192.39 ,$650.00 ,$388.05 ,$192.39 ,$270.40 ,$483.35 ,$439.41 ,$192.39 ,$552.50 ,$404.02 ,$552.50 ,$182.00 ,$585.00 ,$192.39 ,$533.00 ,$549.25 ,$549.25 ,$192.39 ,$422.50 ,$650.00 
ST. JOSEPH'S HOSPITAL - BREESE,39000173,P9035,HC PLATELETS PHER L/R EA T1,390,1 ,"$1,256.00 ",$816.40 ,$351.68 ,"$1,256.00 ","$1,242.28 ",$816.40 ,$749.83 ,$496.91 ,$351.68 ,$704.62 ,$496.91 ,$826.45 ,$496.91 ,"$1,067.60 ","$1,067.60 ",$496.91 ,"$1,067.60 ",$944.13 ,$854.08 ,"$1,242.28 ",$496.91 ,$496.91 ,$942.00 ,$891.76 ,$891.76 ,$496.91 ,$891.76 ,"$1,029.92 ","$1,029.92 ","$1,029.92 ", N/A ,"$1,242.28 ","$1,067.60 ",$496.91 ,"$1,256.00 ",$749.83 ,$496.91 ,$522.50 ,$483.35 ,$439.41 ,$496.91 ,"$1,067.60 ","$1,043.51 ","$1,067.60 ",$351.68 ,"$1,130.40 ",$496.91 ,"$1,029.92 ","$1,061.32 ","$1,061.32 ",$496.91 ,$816.40 ,"$1,256.00 "
ST. JOSEPH'S HOSPITAL - BREESE,39000179,P9037,HC PLATELETS PHER L/R IRR EA T1,390,1 ,"$1,145.00 ",$744.25 ,$320.60 ,"$1,575.80 ","$1,575.80 ",$744.25 ,$683.57 ,$630.32 ,$320.60 ,$642.35 ,$630.32 ,$753.41 ,$630.32 ,$973.25 ,$973.25 ,$630.32 ,$973.25 ,"$1,145.00 ",$778.60 ,"$1,575.80 ",$630.32 ,$630.32 ,$858.75 ,$812.95 ,$812.95 ,$630.32 ,$812.95 ,$938.90 ,$938.90 ,$938.90 , N/A ,"$1,145.00 ",$973.25 ,$630.32 ,"$1,145.00 ",$683.57 ,$630.32 ,$476.32 ,$483.35 ,$439.41 ,$630.32 ,$973.25 ,"$1,323.67 ",$973.25 ,$320.60 ,"$1,030.50 ",$630.32 ,$938.90 ,$967.53 ,$967.53 ,$630.32 ,$744.25 ,"$1,145.00 "
ST. JOSEPH'S HOSPITAL - BREESE,39000187,P9040,HC RED CELLS L/R IRR EA T1,390,1 ,$708.00 ,$460.20 ,$198.24 ,$708.00 ,$665.08 ,$460.20 ,$422.68 ,$266.03 ,$198.24 ,$397.19 ,$266.03 ,$465.86 ,$266.03 ,$601.80 ,$601.80 ,$266.03 ,$601.80 ,$505.46 ,$481.44 ,$665.08 ,$266.03 ,$266.03 ,$531.00 ,$502.68 ,$502.68 ,$266.03 ,$502.68 ,$580.56 ,$580.56 ,$580.56 , N/A ,$665.08 ,$601.80 ,$266.03 ,$708.00 ,$422.68 ,$266.03 ,$294.53 ,$483.35 ,$439.41 ,$266.03 ,$601.80 ,$558.66 ,$601.80 ,$198.24 ,$637.20 ,$266.03 ,$580.56 ,$598.26 ,$598.26 ,$266.03 ,$460.20 ,$708.00 
ST. JOSEPH'S HOSPITAL - BREESE,39000198,P9058,HC RBC LEUKORED CMV NEG IRRAD,390,1 ,$494.00 ,$321.10 ,$138.32 ,$622.48 ,$622.48 ,$321.10 ,$294.92 ,$248.99 ,$138.32 ,$277.13 ,$248.99 ,$325.05 ,$248.99 ,$419.90 ,$419.90 ,$248.99 ,$419.90 ,$473.08 ,$335.92 ,$622.48 ,$248.99 ,$248.99 ,$370.50 ,$350.74 ,$350.74 ,$248.99 ,$350.74 ,$405.08 ,$405.08 ,$405.08 , N/A ,$494.00 ,$419.90 ,$248.99 ,$494.00 ,$294.92 ,$248.99 ,$205.50 ,$483.35 ,$439.41 ,$248.99 ,$419.90 ,$522.88 ,$419.90 ,$138.32 ,$444.60 ,$248.99 ,$405.08 ,$417.43 ,$417.43 ,$248.99 ,$321.10 ,$494.00 
ST. JOSEPH'S HOSPITAL - BREESE,39000205,P9073,HC PLATELETS PHERESIS PATH REDUCED EA UN T1,390,1 ,"$1,138.00 ",$739.70 ,$318.64 ,"$1,490.33 ","$1,490.33 ",$739.70 ,$679.39 ,$596.13 ,$318.64 ,$638.42 ,$596.13 ,$748.80 ,$596.13 ,$967.30 ,$967.30 ,$596.13 ,$967.30 ,"$1,132.65 ",$773.84 ,"$1,490.33 ",$596.13 ,$596.13 ,$853.50 ,$807.98 ,$807.98 ,$596.13 ,$807.98 ,$933.16 ,$933.16 ,$933.16 , N/A ,"$1,138.00 ",$967.30 ,$596.13 ,"$1,138.00 ",$679.39 ,$596.13 ,$473.41 ,$483.35 ,$439.41 ,$596.13 ,$967.30 ,"$1,251.87 ",$967.30 ,$318.64 ,"$1,024.20 ",$596.13 ,$933.16 ,$961.61 ,$961.61 ,$596.13 ,$739.70 ,"$1,138.00 "
ST. JOSEPH'S HOSPITAL - BREESE,39000212,P9053,HC PLATELETS LEUKOCUTES RED CMV NEG IRR,390,1 ,"$1,194.00 ",$776.10 ,$334.32 ,"$1,194.00 ","$1,141.78 ",$776.10 ,$712.82 ,$456.71 ,$334.32 ,$669.83 ,$456.71 ,$785.65 ,$456.71 ,"$1,014.90 ","$1,014.90 ",$456.71 ,"$1,014.90 ",$867.75 ,$811.92 ,"$1,141.78 ",$456.71 ,$456.71 ,$895.50 ,$847.74 ,$847.74 ,$456.71 ,$847.74 ,$979.08 ,$979.08 ,$979.08 , N/A ,"$1,141.78 ","$1,014.90 ",$456.71 ,"$1,194.00 ",$712.82 ,$456.71 ,$496.70 ,$483.35 ,$439.41 ,$456.71 ,"$1,014.90 ",$959.09 ,"$1,014.90 ",$334.32 ,"$1,074.60 ",$456.71 ,$979.08 ,"$1,008.93 ","$1,008.93 ",$456.71 ,$776.10 ,"$1,194.00 "
ST. JOSEPH'S HOSPITAL - BREESE,39100001,36430,HC BLOOD PROD ADMIN,391,1 ,$876.00 ,$569.40 ,$245.28 ,$978.28 ,$978.28 ,$569.40 ,$522.97 ,$391.31 ,$245.28 ,$491.44 ,$391.31 ,$576.41 ,$391.31 ,$744.60 ,$744.60 ,$391.31 ,$744.60 ,$743.49 ,$595.68 ,$978.28 ,$391.31 ,$391.31 ,$657.00 ,$621.96 ,$621.96 ,$391.31 ,$621.96 ,$718.32 ,$718.32 ,$718.32 , N/A ,$876.00 ,$744.60 ,$391.31 ,$876.00 ,$522.97 ,$391.31 ,$364.42 ,$483.35 ,$439.41 ,$391.31 ,$744.60 ,$821.75 ,$744.60 ,$245.28 ,$788.40 ,$391.31 ,$718.32 ,$740.22 ,$740.22 ,$391.31 ,$569.40 ,$876.00 
ST. JOSEPH'S HOSPITAL - BREESE,40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$514.00 ,$334.10 ,$45.73 ,$514.00 ,$272.83 ,$334.10 ,$306.86 ,$109.13 ,$143.92 ,$288.35 ,$109.13 ,$338.21 ,$109.13 ,$436.90 ,$436.90 ,$109.13 ,$436.90 ,$207.35 ,$349.52 ,$272.83 ,$109.13 ,$109.13 ,$385.50 ,$364.94 ,$364.94 ,$109.13 ,$364.94 ,$421.48 ,$421.48 ,$421.48 , N/A ,$272.83 ,$436.90 ,$109.13 ,$122.32 ,$306.86 ,$109.13 ,$213.82 ,$50.30 ,$45.73 ,$109.13 ,$436.90 ,$229.17 ,$436.90 ,$143.92 ,$462.60 ,$109.13 ,$421.48 ,$434.33 ,$434.33 ,$109.13 ,$334.10 ,$514.00 
ST. JOSEPH'S HOSPITAL - BREESE,40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$514.00 ,$334.10 ,$45.73 ,$514.00 ,$272.83 ,$334.10 ,$306.86 ,$109.13 ,$143.92 ,$288.35 ,$109.13 ,$338.21 ,$109.13 ,$436.90 ,$436.90 ,$109.13 ,$436.90 ,$207.35 ,$349.52 ,$272.83 ,$109.13 ,$109.13 ,$385.50 ,$364.94 ,$364.94 ,$109.13 ,$364.94 ,$421.48 ,$421.48 ,$421.48 , N/A ,$272.83 ,$436.90 ,$109.13 ,$122.32 ,$306.86 ,$109.13 ,$213.82 ,$50.30 ,$45.73 ,$109.13 ,$436.90 ,$229.17 ,$436.90 ,$143.92 ,$462.60 ,$109.13 ,$421.48 ,$434.33 ,$434.33 ,$109.13 ,$334.10 ,$514.00 
ST. JOSEPH'S HOSPITAL - BREESE,40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$514.00 ,$334.10 ,$45.73 ,$514.00 ,$272.83 ,$334.10 ,$306.86 ,$109.13 ,$143.92 ,$288.35 ,$109.13 ,$338.21 ,$109.13 ,$436.90 ,$436.90 ,$109.13 ,$436.90 ,$207.35 ,$349.52 ,$272.83 ,$109.13 ,$109.13 ,$385.50 ,$364.94 ,$364.94 ,$109.13 ,$364.94 ,$421.48 ,$421.48 ,$421.48 , N/A ,$272.83 ,$436.90 ,$109.13 ,$122.32 ,$306.86 ,$109.13 ,$213.82 ,$50.30 ,$45.73 ,$109.13 ,$436.90 ,$229.17 ,$436.90 ,$143.92 ,$462.60 ,$109.13 ,$421.48 ,$434.33 ,$434.33 ,$109.13 ,$334.10 ,$514.00 
ST. JOSEPH'S HOSPITAL - BREESE,40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$292.00 ,$189.80 ,$45.73 ,$292.00 ,$214.15 ,$189.80 ,$174.32 ,$85.66 ,$81.76 ,$163.81 ,$85.66 ,$192.14 ,$85.66 ,$248.20 ,$248.20 ,$85.66 ,$248.20 ,$162.75 ,$198.56 ,$214.15 ,$85.66 ,$85.66 ,$219.00 ,$207.32 ,$207.32 ,$85.66 ,$207.32 ,$239.44 ,$239.44 ,$239.44 , N/A ,$214.15 ,$248.20 ,$85.66 ,$95.73 ,$174.32 ,$85.66 ,$121.47 ,$50.30 ,$45.73 ,$85.66 ,$248.20 ,$179.89 ,$248.20 ,$81.76 ,$262.80 ,$85.66 ,$239.44 ,$246.74 ,$246.74 ,$85.66 ,$189.80 ,$292.00 
ST. JOSEPH'S HOSPITAL - BREESE,40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$292.00 ,$189.80 ,$45.73 ,$292.00 ,$214.15 ,$189.80 ,$174.32 ,$85.66 ,$81.76 ,$163.81 ,$85.66 ,$192.14 ,$85.66 ,$248.20 ,$248.20 ,$85.66 ,$248.20 ,$162.75 ,$198.56 ,$214.15 ,$85.66 ,$85.66 ,$219.00 ,$207.32 ,$207.32 ,$85.66 ,$207.32 ,$239.44 ,$239.44 ,$239.44 , N/A ,$214.15 ,$248.20 ,$85.66 ,$95.73 ,$174.32 ,$85.66 ,$121.47 ,$50.30 ,$45.73 ,$85.66 ,$248.20 ,$179.89 ,$248.20 ,$81.76 ,$262.80 ,$85.66 ,$239.44 ,$246.74 ,$246.74 ,$85.66 ,$189.80 ,$292.00 
ST. JOSEPH'S HOSPITAL - BREESE,40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$292.00 ,$189.80 ,$45.73 ,$292.00 ,$214.15 ,$189.80 ,$174.32 ,$85.66 ,$81.76 ,$163.81 ,$85.66 ,$192.14 ,$85.66 ,$248.20 ,$248.20 ,$85.66 ,$248.20 ,$162.75 ,$198.56 ,$214.15 ,$85.66 ,$85.66 ,$219.00 ,$207.32 ,$207.32 ,$85.66 ,$207.32 ,$239.44 ,$239.44 ,$239.44 , N/A ,$214.15 ,$248.20 ,$85.66 ,$95.73 ,$174.32 ,$85.66 ,$121.47 ,$50.30 ,$45.73 ,$85.66 ,$248.20 ,$179.89 ,$248.20 ,$81.76 ,$262.80 ,$85.66 ,$239.44 ,$246.74 ,$246.74 ,$85.66 ,$189.80 ,$292.00 
ST. JOSEPH'S HOSPITAL - BREESE,40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$103.00 ,$66.95 ,$22.82 ,$103.00 ,$57.05 ,$66.95 ,$61.49 ,$22.82 ,$28.84 ,$57.78 ,$22.82 ,$67.77 ,$22.82 ,$87.55 ,$87.55 ,$22.82 ,$87.55 ,$43.36 ,$70.04 ,$57.05 ,$22.82 ,$22.82 ,$77.25 ,$73.13 ,$73.13 ,$22.82 ,$73.13 ,$84.46 ,$84.46 ,$84.46 , N/A ,$57.05 ,$87.55 ,$22.82 ,$26.59 ,$61.49 ,$22.82 ,$42.85 ,$50.30 ,$45.73 ,$22.82 ,$87.55 ,$47.92 ,$87.55 ,$28.84 ,$92.70 ,$22.82 ,$84.46 ,$87.04 ,$87.04 ,$22.82 ,$66.95 ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200007,51798,HC US BLADDER SCAN,402,1 ,$177.00 ,$115.05 ,$49.56 ,$177.00 ,$137.20 ,$115.05 ,$105.67 ,$54.88 ,$49.56 ,$99.30 ,$54.88 ,$116.47 ,$54.88 ,$150.45 ,$150.45 ,$54.88 ,$150.45 ,$104.27 ,$120.36 ,$137.20 ,$54.88 ,$54.88 ,$132.75 ,$125.67 ,$125.67 ,$54.88 ,$125.67 ,$145.14 ,$145.14 ,$145.14 , N/A ,$137.20 ,$150.45 ,$54.88 ,$177.00 ,$105.67 ,$54.88 ,$73.63 ,$86.96 ,$79.05 ,$54.88 ,$150.45 ,$115.24 ,$150.45 ,$49.56 ,$159.30 ,$54.88 ,$145.14 ,$149.57 ,$149.57 ,$54.88 ,$115.05 ,$177.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200010,59000,HC AMNIOCENTESIS DIAGNOSTIC,402,1 ,$582.00 ,$378.30 ,$162.96 ,"$1,562.55 ","$1,562.55 ",$378.30 ,$347.45 ,$625.02 ,$162.96 ,$326.50 ,$625.02 ,$382.96 ,$582.00 ,$494.70 ,$494.70 ,$582.00 ,$494.70 ,$582.00 ,$395.76 ,"$1,562.54 ",$625.02 ,$625.02 ,$436.50 ,$413.22 ,$413.22 ,$625.02 ,$413.22 ,$477.24 ,$477.24 ,$477.24 , N/A ,$582.00 ,$494.70 ,$625.02 ,$582.00 ,$347.45 ,$625.02 ,$242.11 , N/A , N/A ,$625.02 ,$494.70 ,"$1,312.53 ",$494.70 ,$162.96 ,$523.80 ,$625.02 ,$477.24 ,$491.79 ,$491.79 ,$625.02 ,$378.30 ,$582.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200012,76506,HC US ENCEPHALOGRAM,402,1 ,$788.00 ,$512.20 ,$100.68 ,$788.00 ,$268.33 ,$512.20 ,$470.44 ,$107.33 ,$220.64 ,$442.07 ,$107.33 ,$518.50 ,$107.33 ,$669.80 ,$669.80 ,$107.33 ,$669.80 ,$203.93 ,$535.84 ,$268.33 ,$107.33 ,$107.33 ,$591.00 ,$559.48 ,$559.48 ,$107.33 ,$559.48 ,$646.16 ,$646.16 ,$646.16 , N/A ,$268.33 ,$669.80 ,$107.33 ,$788.00 ,$470.44 ,$107.33 ,$327.81 ,$110.75 ,$100.68 ,$107.33 ,$669.80 ,$225.40 ,$669.80 ,$220.64 ,$709.20 ,$107.33 ,$646.16 ,$665.86 ,$665.86 ,$107.33 ,$512.20 ,$788.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,"$1,261.00 ",$819.65 ,$100.68 ,"$1,261.00 ",$268.33 ,$819.65 ,$752.82 ,$107.33 ,$353.08 ,$707.42 ,$107.33 ,$829.74 ,$107.33 ,"$1,071.85 ","$1,071.85 ",$107.33 ,"$1,071.85 ",$203.93 ,$857.48 ,$268.33 ,$107.33 ,$107.33 ,$945.75 ,$895.31 ,$895.31 ,$107.33 ,$895.31 ,"$1,034.02 ","$1,034.02 ","$1,034.02 ", N/A ,$268.33 ,"$1,071.85 ",$107.33 ,"$1,261.00 ",$752.82 ,$107.33 ,$524.58 ,$110.75 ,$100.68 ,$107.33 ,"$1,071.85 ",$225.40 ,"$1,071.85 ",$353.08 ,"$1,134.90 ",$107.33 ,"$1,034.02 ","$1,065.55 ","$1,065.55 ",$107.33 ,$819.65 ,"$1,261.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200014,76604,HC US CHEST,402,1 ,$709.00 ,$460.85 ,$100.68 ,$709.00 ,$268.33 ,$460.85 ,$423.27 ,$107.33 ,$198.52 ,$397.75 ,$107.33 ,$466.52 ,$107.33 ,$602.65 ,$602.65 ,$107.33 ,$602.65 ,$203.93 ,$482.12 ,$268.33 ,$107.33 ,$107.33 ,$531.75 ,$503.39 ,$503.39 ,$107.33 ,$503.39 ,$581.38 ,$581.38 ,$581.38 , N/A ,$268.33 ,$602.65 ,$107.33 ,$709.00 ,$423.27 ,$107.33 ,$294.94 ,$110.75 ,$100.68 ,$107.33 ,$602.65 ,$225.40 ,$602.65 ,$198.52 ,$638.10 ,$107.33 ,$581.38 ,$599.11 ,$599.11 ,$107.33 ,$460.85 ,$709.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200015,76641,HC US BREAST COMPLETE,402,1 ,"$1,543.00 ","$1,002.95 ",$76.42 ,"$1,543.00 ",$268.33 ,"$1,002.95 ",$921.17 ,$107.33 ,$432.04 ,$865.62 ,$107.33 ,"$1,015.29 ",$107.33 ,"$1,311.55 ","$1,311.55 ",$107.33 ,"$1,311.55 ",$203.93 ,"$1,049.24 ",$268.33 ,$107.33 ,$107.33 ,"$1,157.25 ","$1,095.53 ","$1,095.53 ",$107.33 ,"$1,095.53 ","$1,265.26 ","$1,265.26 ","$1,265.26 ", N/A ,$268.33 ,"$1,311.55 ",$107.33 ,$76.42 ,$921.17 ,$107.33 ,$641.89 ,$166.12 ,$151.02 ,$107.33 ,"$1,311.55 ",$225.40 ,"$1,311.55 ",$432.04 ,"$1,388.70 ",$107.33 ,"$1,265.26 ","$1,303.84 ","$1,303.84 ",$107.33 ,"$1,002.95 ","$1,543.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200015,76641,HC US BREAST COMPLETE,402,1 ,"$1,028.00 ",$668.20 ,$76.42 ,"$1,028.00 ",$268.33 ,$668.20 ,$613.72 ,$107.33 ,$287.84 ,$576.71 ,$107.33 ,$676.42 ,$107.33 ,$873.80 ,$873.80 ,$107.33 ,$873.80 ,$203.93 ,$699.04 ,$268.33 ,$107.33 ,$107.33 ,$771.00 ,$729.88 ,$729.88 ,$107.33 ,$729.88 ,$842.96 ,$842.96 ,$842.96 , N/A ,$268.33 ,$873.80 ,$107.33 ,$76.42 ,$613.72 ,$107.33 ,$427.65 ,$110.75 ,$100.68 ,$107.33 ,$873.80 ,$225.40 ,$873.80 ,$287.84 ,$925.20 ,$107.33 ,$842.96 ,$868.66 ,$868.66 ,$107.33 ,$668.20 ,"$1,028.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200016,76642,HC US BREAST LIMITED,402,1 ,$515.00 ,$334.75 ,$58.57 ,$515.00 ,$199.38 ,$334.75 ,$307.46 ,$79.75 ,$144.20 ,$288.92 ,$79.75 ,$338.87 ,$79.75 ,$437.75 ,$437.75 ,$79.75 ,$437.75 ,$151.52 ,$350.20 ,$199.36 ,$79.75 ,$79.75 ,$386.25 ,$365.65 ,$365.65 ,$79.75 ,$365.65 ,$422.30 ,$422.30 ,$422.30 , N/A ,$199.36 ,$437.75 ,$79.75 ,$58.57 ,$307.46 ,$79.75 ,$214.24 ,$110.75 ,$100.68 ,$79.75 ,$437.75 ,$167.46 ,$437.75 ,$144.20 ,$463.50 ,$79.75 ,$422.30 ,$435.18 ,$435.18 ,$79.75 ,$334.75 ,$515.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200016,76642,HC US BREAST LIMITED,402,1 ,$771.00 ,$501.15 ,$58.57 ,$771.00 ,$199.38 ,$501.15 ,$460.29 ,$79.75 ,$215.88 ,$432.53 ,$79.75 ,$507.32 ,$79.75 ,$655.35 ,$655.35 ,$79.75 ,$655.35 ,$151.52 ,$524.28 ,$199.36 ,$79.75 ,$79.75 ,$578.25 ,$547.41 ,$547.41 ,$79.75 ,$547.41 ,$632.22 ,$632.22 ,$632.22 , N/A ,$199.36 ,$655.35 ,$79.75 ,$58.57 ,$460.29 ,$79.75 ,$320.74 ,$166.12 ,$151.02 ,$79.75 ,$655.35 ,$167.46 ,$655.35 ,$215.88 ,$693.90 ,$79.75 ,$632.22 ,$651.50 ,$651.50 ,$79.75 ,$501.15 ,$771.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,673.00 ","$1,087.45 ",$100.68 ,"$1,673.00 ",$268.33 ,"$1,087.45 ",$998.78 ,$107.33 ,$468.44 ,$938.55 ,$107.33 ,"$1,100.83 ",$107.33 ,"$1,422.05 ","$1,422.05 ",$107.33 ,"$1,422.05 ",$203.93 ,"$1,137.64 ",$268.33 ,$107.33 ,$107.33 ,"$1,254.75 ","$1,187.83 ","$1,187.83 ",$107.33 ,"$1,187.83 ","$1,371.86 ","$1,371.86 ","$1,371.86 ", N/A ,$268.33 ,"$1,422.05 ",$107.33 ,"$1,673.00 ",$998.78 ,$107.33 ,$695.97 ,$110.75 ,$100.68 ,$107.33 ,"$1,422.05 ",$225.40 ,"$1,422.05 ",$468.44 ,"$1,505.70 ",$107.33 ,"$1,371.86 ","$1,413.69 ","$1,413.69 ",$107.33 ,"$1,087.45 ","$1,673.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200018,76705,HC US ABDOMEN LTD,402,1 ,"$1,394.00 ",$906.10 ,$100.68 ,"$1,394.00 ",$268.33 ,$906.10 ,$832.22 ,$107.33 ,$390.32 ,$782.03 ,$107.33 ,$917.25 ,$107.33 ,"$1,184.90 ","$1,184.90 ",$107.33 ,"$1,184.90 ",$203.93 ,$947.92 ,$268.33 ,$107.33 ,$107.33 ,"$1,045.50 ",$989.74 ,$989.74 ,$107.33 ,$989.74 ,"$1,143.08 ","$1,143.08 ","$1,143.08 ", N/A ,$268.33 ,"$1,184.90 ",$107.33 ,"$1,394.00 ",$832.22 ,$107.33 ,$579.90 ,$110.75 ,$100.68 ,$107.33 ,"$1,184.90 ",$225.40 ,"$1,184.90 ",$390.32 ,"$1,254.60 ",$107.33 ,"$1,143.08 ","$1,177.93 ","$1,177.93 ",$107.33 ,$906.10 ,"$1,394.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200019,76770,HC US RETROPERITIONEAL,402,1 ,"$1,153.00 ",$749.45 ,$100.68 ,"$1,153.00 ",$268.33 ,$749.45 ,$688.34 ,$107.33 ,$322.84 ,$646.83 ,$107.33 ,$758.67 ,$107.33 ,$980.05 ,$980.05 ,$107.33 ,$980.05 ,$203.93 ,$784.04 ,$268.33 ,$107.33 ,$107.33 ,$864.75 ,$818.63 ,$818.63 ,$107.33 ,$818.63 ,$945.46 ,$945.46 ,$945.46 , N/A ,$268.33 ,$980.05 ,$107.33 ,"$1,153.00 ",$688.34 ,$107.33 ,$479.65 ,$110.75 ,$100.68 ,$107.33 ,$980.05 ,$225.40 ,$980.05 ,$322.84 ,"$1,037.70 ",$107.33 ,$945.46 ,$974.29 ,$974.29 ,$107.33 ,$749.45 ,"$1,153.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,"$1,045.00 ",$679.25 ,$100.68 ,"$1,045.00 ",$268.33 ,$679.25 ,$623.87 ,$107.33 ,$292.60 ,$586.25 ,$107.33 ,$687.61 ,$107.33 ,$888.25 ,$888.25 ,$107.33 ,$888.25 ,$203.93 ,$710.60 ,$268.33 ,$107.33 ,$107.33 ,$783.75 ,$741.95 ,$741.95 ,$107.33 ,$741.95 ,$856.90 ,$856.90 ,$856.90 , N/A ,$268.33 ,$888.25 ,$107.33 ,"$1,045.00 ",$623.87 ,$107.33 ,$434.72 ,$110.75 ,$100.68 ,$107.33 ,$888.25 ,$225.40 ,$888.25 ,$292.60 ,$940.50 ,$107.33 ,$856.90 ,$883.03 ,$883.03 ,$107.33 ,$679.25 ,"$1,045.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200022,76800,HC US SPINAL CANAL  AND  CONTENTS,402,1 ,$358.00 ,$232.70 ,$100.24 ,$358.00 ,$268.33 ,$232.70 ,$213.73 ,$107.33 ,$100.24 ,$200.84 ,$107.33 ,$235.56 ,$107.33 ,$304.30 ,$304.30 ,$107.33 ,$304.30 ,$203.93 ,$243.44 ,$268.33 ,$107.33 ,$107.33 ,$268.50 ,$254.18 ,$254.18 ,$107.33 ,$254.18 ,$293.56 ,$293.56 ,$293.56 , N/A ,$268.33 ,$304.30 ,$107.33 ,$358.00 ,$213.73 ,$107.33 ,$148.93 ,$110.75 ,$100.68 ,$107.33 ,$304.30 ,$225.40 ,$304.30 ,$100.24 ,$322.20 ,$107.33 ,$293.56 ,$302.51 ,$302.51 ,$107.33 ,$232.70 ,$358.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,"$1,245.00 ",$809.25 ,$107.33 ,"$1,245.00 ",$268.33 ,$809.25 ,$743.27 ,$107.33 ,$348.60 ,$698.45 ,$107.33 ,$819.21 ,$107.33 ,"$1,058.25 ","$1,058.25 ",$107.33 ,"$1,058.25 ",$203.93 ,$846.60 ,$268.33 ,$107.33 ,$107.33 ,$933.75 ,$883.95 ,$883.95 ,$107.33 ,$883.95 ,"$1,020.90 ","$1,020.90 ","$1,020.90 ", N/A ,$268.33 ,"$1,058.25 ",$107.33 ,"$1,245.00 ",$743.27 ,$107.33 ,$517.92 , N/A , N/A ,$107.33 ,"$1,058.25 ",$225.40 ,"$1,058.25 ",$348.60 ,"$1,120.50 ",$107.33 ,"$1,020.90 ","$1,052.03 ","$1,052.03 ",$107.33 ,$809.25 ,"$1,245.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$571.00 ,$371.15 ,$159.88 ,$571.00 , N/A ,$371.15 ,$340.89 , N/A ,$159.88 ,$320.33 , N/A ,$375.72 , N/A ,$485.35 ,$485.35 , N/A ,$485.35 , N/A ,$388.28 , N/A , N/A , N/A ,$428.25 ,$405.41 ,$405.41 , N/A ,$405.41 ,$468.22 ,$468.22 ,$468.22 , N/A , N/A ,$485.35 , N/A ,$571.00 ,$340.89 , N/A ,$237.54 , N/A , N/A , N/A ,$485.35 , N/A ,$485.35 ,$159.88 ,$513.90 , N/A ,$468.22 ,$482.50 ,$482.50 , N/A ,$371.15 ,$571.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,"$1,341.00 ",$871.65 ,$107.33 ,"$1,341.00 ",$268.33 ,$871.65 ,$800.58 ,$107.33 ,$375.48 ,$752.30 ,$107.33 ,$882.38 ,$107.33 ,"$1,139.85 ","$1,139.85 ",$107.33 ,"$1,139.85 ",$203.93 ,$911.88 ,$268.33 ,$107.33 ,$107.33 ,"$1,005.75 ",$952.11 ,$952.11 ,$107.33 ,$952.11 ,"$1,099.62 ","$1,099.62 ","$1,099.62 ", N/A ,$268.33 ,"$1,139.85 ",$107.33 ,"$1,341.00 ",$800.58 ,$107.33 ,$557.86 , N/A , N/A ,$107.33 ,"$1,139.85 ",$225.40 ,"$1,139.85 ",$375.48 ,"$1,206.90 ",$107.33 ,"$1,099.62 ","$1,133.15 ","$1,133.15 ",$107.33 ,$871.65 ,"$1,341.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,"$1,140.00 ",$741.00 ,$319.20 ,"$1,140.00 ", N/A ,$741.00 ,$680.58 , N/A ,$319.20 ,$639.54 , N/A ,$750.12 , N/A ,$969.00 ,$969.00 , N/A ,$969.00 , N/A ,$775.20 , N/A , N/A , N/A ,$855.00 ,$809.40 ,$809.40 , N/A ,$809.40 ,$934.80 ,$934.80 ,$934.80 , N/A , N/A ,$969.00 , N/A ,"$1,140.00 ",$680.58 , N/A ,$474.24 , N/A , N/A , N/A ,$969.00 , N/A ,$969.00 ,$319.20 ,"$1,026.00 ", N/A ,$934.80 ,$963.30 ,$963.30 , N/A ,$741.00 ,"$1,140.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,"$1,513.00 ",$983.45 ,$226.85 ,"$1,513.00 ",$567.13 ,$983.45 ,$903.26 ,$226.85 ,$423.64 ,$848.79 ,$226.85 ,$995.55 ,$226.85 ,"$1,286.05 ","$1,286.05 ",$226.85 ,"$1,286.05 ",$431.02 ,"$1,028.84 ",$567.13 ,$226.85 ,$226.85 ,"$1,134.75 ","$1,074.23 ","$1,074.23 ",$226.85 ,"$1,074.23 ","$1,240.66 ","$1,240.66 ","$1,240.66 ", N/A ,$567.13 ,"$1,286.05 ",$226.85 ,"$1,513.00 ",$903.26 ,$226.85 ,$629.41 , N/A , N/A ,$226.85 ,"$1,286.05 ",$476.39 ,"$1,286.05 ",$423.64 ,"$1,361.70 ",$226.85 ,"$1,240.66 ","$1,278.49 ","$1,278.49 ",$226.85 ,$983.45 ,"$1,513.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200029,76812,HC US PREGNANCY DETAILED ADDL,402,1 ,$696.00 ,$452.40 ,$194.88 ,$696.00 , N/A ,$452.40 ,$415.51 , N/A ,$194.88 ,$390.46 , N/A ,$457.97 , N/A ,$591.60 ,$591.60 , N/A ,$591.60 , N/A ,$473.28 , N/A , N/A , N/A ,$522.00 ,$494.16 ,$494.16 , N/A ,$494.16 ,$570.72 ,$570.72 ,$570.72 , N/A , N/A ,$591.60 , N/A ,$696.00 ,$415.51 , N/A ,$289.54 , N/A , N/A , N/A ,$591.60 , N/A ,$591.60 ,$194.88 ,$626.40 , N/A ,$570.72 ,$588.12 ,$588.12 , N/A ,$452.40 ,$696.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,"$1,173.00 ",$762.45 ,$107.33 ,"$1,173.00 ",$268.33 ,$762.45 ,$700.28 ,$107.33 ,$328.44 ,$658.05 ,$107.33 ,$771.83 ,$107.33 ,$997.05 ,$997.05 ,$107.33 ,$997.05 ,$203.93 ,$797.64 ,$268.33 ,$107.33 ,$107.33 ,$879.75 ,$832.83 ,$832.83 ,$107.33 ,$832.83 ,$961.86 ,$961.86 ,$961.86 , N/A ,$268.33 ,$997.05 ,$107.33 ,"$1,173.00 ",$700.28 ,$107.33 ,$487.97 , N/A , N/A ,$107.33 ,$997.05 ,$225.40 ,$997.05 ,$328.44 ,"$1,055.70 ",$107.33 ,$961.86 ,$991.19 ,$991.19 ,$107.33 ,$762.45 ,"$1,173.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200031,76815,HC US FETAL HEART BEAT,402,1 ,"$1,104.00 ",$717.60 ,$107.33 ,"$1,104.00 ",$268.33 ,$717.60 ,$659.09 ,$107.33 ,$309.12 ,$619.34 ,$107.33 ,$726.43 ,$107.33 ,$938.40 ,$938.40 ,$107.33 ,$938.40 ,$203.93 ,$750.72 ,$268.33 ,$107.33 ,$107.33 ,$828.00 ,$783.84 ,$783.84 ,$107.33 ,$783.84 ,$905.28 ,$905.28 ,$905.28 , N/A ,$268.33 ,$938.40 ,$107.33 ,"$1,104.00 ",$659.09 ,$107.33 ,$459.26 , N/A , N/A ,$107.33 ,$938.40 ,$225.40 ,$938.40 ,$309.12 ,$993.60 ,$107.33 ,$905.28 ,$932.88 ,$932.88 ,$107.33 ,$717.60 ,"$1,104.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,"$1,128.00 ",$733.20 ,$107.33 ,"$1,128.00 ",$268.33 ,$733.20 ,$673.42 ,$107.33 ,$315.84 ,$632.81 ,$107.33 ,$742.22 ,$107.33 ,$958.80 ,$958.80 ,$107.33 ,$958.80 ,$203.93 ,$767.04 ,$268.33 ,$107.33 ,$107.33 ,$846.00 ,$800.88 ,$800.88 ,$107.33 ,$800.88 ,$924.96 ,$924.96 ,$924.96 , N/A ,$268.33 ,$958.80 ,$107.33 ,"$1,128.00 ",$673.42 ,$107.33 ,$469.25 , N/A , N/A ,$107.33 ,$958.80 ,$225.40 ,$958.80 ,$315.84 ,"$1,015.20 ",$107.33 ,$924.96 ,$953.16 ,$953.16 ,$107.33 ,$733.20 ,"$1,128.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200033,76818,HC US FETAL BIO PROFILE W/NST,402,1 ,"$1,901.00 ","$1,235.65 ",$107.33 ,"$1,901.00 ",$268.33 ,"$1,235.65 ","$1,134.90 ",$107.33 ,$532.28 ,"$1,066.46 ",$107.33 ,"$1,250.86 ",$107.33 ,"$1,615.85 ","$1,615.85 ",$107.33 ,"$1,615.85 ",$203.93 ,"$1,292.68 ",$268.33 ,$107.33 ,$107.33 ,"$1,425.75 ","$1,349.71 ","$1,349.71 ",$107.33 ,"$1,349.71 ","$1,558.82 ","$1,558.82 ","$1,558.82 ", N/A ,$268.33 ,"$1,615.85 ",$107.33 ,"$1,901.00 ","$1,134.90 ",$107.33 ,$790.82 , N/A , N/A ,$107.33 ,"$1,615.85 ",$225.40 ,"$1,615.85 ",$532.28 ,"$1,710.90 ",$107.33 ,"$1,558.82 ","$1,606.35 ","$1,606.35 ",$107.33 ,"$1,235.65 ","$1,901.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,"$1,457.00 ",$947.05 ,$107.33 ,"$1,457.00 ",$268.33 ,$947.05 ,$869.83 ,$107.33 ,$407.96 ,$817.38 ,$107.33 ,$958.71 ,$107.33 ,"$1,238.45 ","$1,238.45 ",$107.33 ,"$1,238.45 ",$203.93 ,$990.76 ,$268.33 ,$107.33 ,$107.33 ,"$1,092.75 ","$1,034.47 ","$1,034.47 ",$107.33 ,"$1,034.47 ","$1,194.74 ","$1,194.74 ","$1,194.74 ", N/A ,$268.33 ,"$1,238.45 ",$107.33 ,"$1,457.00 ",$869.83 ,$107.33 ,$606.11 , N/A , N/A ,$107.33 ,"$1,238.45 ",$225.40 ,"$1,238.45 ",$407.96 ,"$1,311.30 ",$107.33 ,"$1,194.74 ","$1,231.17 ","$1,231.17 ",$107.33 ,$947.05 ,"$1,457.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200035,76819,HC US FETAL BIO PROFILE W/O NST EA ADDN,402,1 ,$310.29 ,$201.69 ,$86.88 ,$310.29 ,$268.33 ,$201.69 ,$185.24 ,$107.33 ,$86.88 ,$174.07 ,$107.33 ,$204.17 ,$107.33 ,$263.75 ,$263.75 ,$107.33 ,$263.75 ,$203.93 ,$211.00 ,$268.33 ,$107.33 ,$107.33 ,$232.72 ,$220.31 ,$220.31 ,$107.33 ,$220.31 ,$254.44 ,$254.44 ,$254.44 , N/A ,$268.33 ,$263.75 ,$107.33 ,$310.29 ,$185.24 ,$107.33 ,$129.08 , N/A , N/A ,$107.33 ,$263.75 ,$225.40 ,$263.75 ,$86.88 ,$279.26 ,$107.33 ,$254.44 ,$262.20 ,$262.20 ,$107.33 ,$201.69 ,$310.29 
ST. JOSEPH'S HOSPITAL - BREESE,40200036,76820,HC US FETAL DOPLR VELO UMB,402,1 ,$592.00 ,$384.80 ,$107.33 ,$592.00 ,$268.33 ,$384.80 ,$353.42 ,$107.33 ,$165.76 ,$332.11 ,$107.33 ,$389.54 ,$107.33 ,$503.20 ,$503.20 ,$107.33 ,$503.20 ,$203.93 ,$402.56 ,$268.33 ,$107.33 ,$107.33 ,$444.00 ,$420.32 ,$420.32 ,$107.33 ,$420.32 ,$485.44 ,$485.44 ,$485.44 , N/A ,$268.33 ,$503.20 ,$107.33 ,$592.00 ,$353.42 ,$107.33 ,$246.27 , N/A , N/A ,$107.33 ,$503.20 ,$225.40 ,$503.20 ,$165.76 ,$532.80 ,$107.33 ,$485.44 ,$500.24 ,$500.24 ,$107.33 ,$384.80 ,$592.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200037,76821,HC US FETL DOPLR VELOCIMERTY,402,1 ,$310.29 ,$201.69 ,$86.88 ,$310.29 ,$268.33 ,$201.69 ,$185.24 ,$107.33 ,$86.88 ,$174.07 ,$107.33 ,$204.17 ,$107.33 ,$263.75 ,$263.75 ,$107.33 ,$263.75 ,$203.93 ,$211.00 ,$268.33 ,$107.33 ,$107.33 ,$232.72 ,$220.31 ,$220.31 ,$107.33 ,$220.31 ,$254.44 ,$254.44 ,$254.44 , N/A ,$268.33 ,$263.75 ,$107.33 ,$310.29 ,$185.24 ,$107.33 ,$129.08 , N/A , N/A ,$107.33 ,$263.75 ,$225.40 ,$263.75 ,$86.88 ,$279.26 ,$107.33 ,$254.44 ,$262.20 ,$262.20 ,$107.33 ,$201.69 ,$310.29 
ST. JOSEPH'S HOSPITAL - BREESE,40200038,76830,HC US TRANSVAGINAL,402,1 ,$996.00 ,$647.40 ,$100.68 ,$996.00 ,$268.33 ,$647.40 ,$594.61 ,$107.33 ,$278.88 ,$558.76 ,$107.33 ,$655.37 ,$107.33 ,$846.60 ,$846.60 ,$107.33 ,$846.60 ,$203.93 ,$677.28 ,$268.33 ,$107.33 ,$107.33 ,$747.00 ,$707.16 ,$707.16 ,$107.33 ,$707.16 ,$816.72 ,$816.72 ,$816.72 , N/A ,$268.33 ,$846.60 ,$107.33 ,$996.00 ,$594.61 ,$107.33 ,$414.34 ,$110.75 ,$100.68 ,$107.33 ,$846.60 ,$225.40 ,$846.60 ,$278.88 ,$896.40 ,$107.33 ,$816.72 ,$841.62 ,$841.62 ,$107.33 ,$647.40 ,$996.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200039,76831,HC US HYSTEROSONOGRAM,402,1 ,"$1,174.00 ",$763.10 ,$226.85 ,"$1,174.00 ",$567.13 ,$763.10 ,$700.88 ,$226.85 ,$328.72 ,$658.61 ,$226.85 ,$772.49 ,$226.85 ,$997.90 ,$997.90 ,$226.85 ,$997.90 ,$431.02 ,$798.32 ,$567.13 ,$226.85 ,$226.85 ,$880.50 ,$833.54 ,$833.54 ,$226.85 ,$833.54 ,$962.68 ,$962.68 ,$962.68 , N/A ,$567.13 ,$997.90 ,$226.85 ,"$1,174.00 ",$700.88 ,$226.85 ,$488.38 ,$252.78 ,$229.80 ,$226.85 ,$997.90 ,$476.39 ,$997.90 ,$328.72 ,"$1,056.60 ",$226.85 ,$962.68 ,$992.03 ,$992.03 ,$226.85 ,$763.10 ,"$1,174.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200040,76856,HC US PELVIS NON OB,402,1 ,"$1,468.00 ",$954.20 ,$81.89 ,"$1,468.00 ",$268.33 ,$954.20 ,$876.40 ,$107.33 ,$411.04 ,$823.55 ,$107.33 ,$965.94 ,$107.33 ,"$1,247.80 ","$1,247.80 ",$107.33 ,"$1,247.80 ",$203.93 ,$998.24 ,$268.33 ,$107.33 ,$107.33 ,"$1,101.00 ","$1,042.28 ","$1,042.28 ",$107.33 ,"$1,042.28 ","$1,203.76 ","$1,203.76 ","$1,203.76 ", N/A ,$268.33 ,"$1,247.80 ",$107.33 ,$81.89 ,$876.40 ,$107.33 ,$610.69 ,$110.75 ,$100.68 ,$107.33 ,"$1,247.80 ",$225.40 ,"$1,247.80 ",$411.04 ,"$1,321.20 ",$107.33 ,"$1,203.76 ","$1,240.46 ","$1,240.46 ",$107.33 ,$954.20 ,"$1,468.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$668.00 ,$434.20 ,$100.68 ,$668.00 ,$268.33 ,$434.20 ,$398.80 ,$107.33 ,$187.04 ,$374.75 ,$107.33 ,$439.54 ,$107.33 ,$567.80 ,$567.80 ,$107.33 ,$567.80 ,$203.93 ,$454.24 ,$268.33 ,$107.33 ,$107.33 ,$501.00 ,$474.28 ,$474.28 ,$107.33 ,$474.28 ,$547.76 ,$547.76 ,$547.76 , N/A ,$268.33 ,$567.80 ,$107.33 ,$668.00 ,$398.80 ,$107.33 ,$277.89 ,$110.75 ,$100.68 ,$107.33 ,$567.80 ,$225.40 ,$567.80 ,$187.04 ,$601.20 ,$107.33 ,$547.76 ,$564.46 ,$564.46 ,$107.33 ,$434.20 ,$668.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200042,76870,HC US SCROTUM,402,1 ,"$1,173.00 ",$762.45 ,$100.68 ,"$1,173.00 ",$268.33 ,$762.45 ,$700.28 ,$107.33 ,$328.44 ,$658.05 ,$107.33 ,$771.83 ,$107.33 ,$997.05 ,$997.05 ,$107.33 ,$997.05 ,$203.93 ,$797.64 ,$268.33 ,$107.33 ,$107.33 ,$879.75 ,$832.83 ,$832.83 ,$107.33 ,$832.83 ,$961.86 ,$961.86 ,$961.86 , N/A ,$268.33 ,$997.05 ,$107.33 ,"$1,173.00 ",$700.28 ,$107.33 ,$487.97 ,$110.75 ,$100.68 ,$107.33 ,$997.05 ,$225.40 ,$997.05 ,$328.44 ,"$1,055.70 ",$107.33 ,$961.86 ,$991.19 ,$991.19 ,$107.33 ,$762.45 ,"$1,173.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200043,76872,HC ULTRA BX PROS,402,1 ,"$1,029.00 ",$668.85 ,$100.68 ,"$1,029.00 ",$268.33 ,$668.85 ,$614.31 ,$107.33 ,$288.12 ,$577.27 ,$107.33 ,$677.08 ,$107.33 ,$874.65 ,$874.65 ,$107.33 ,$874.65 ,$203.93 ,$699.72 ,$268.33 ,$107.33 ,$107.33 ,$771.75 ,$730.59 ,$730.59 ,$107.33 ,$730.59 ,$843.78 ,$843.78 ,$843.78 , N/A ,$268.33 ,$874.65 ,$107.33 ,"$1,029.00 ",$614.31 ,$107.33 ,$428.06 ,$110.75 ,$100.68 ,$107.33 ,$874.65 ,$225.40 ,$874.65 ,$288.12 ,$926.10 ,$107.33 ,$843.78 ,$869.51 ,$869.51 ,$107.33 ,$668.85 ,"$1,029.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$862.00 ,$560.30 ,$100.68 ,$862.00 ,$268.33 ,$560.30 ,$514.61 ,$107.33 ,$241.36 ,$483.58 ,$107.33 ,$567.20 ,$107.33 ,$732.70 ,$732.70 ,$107.33 ,$732.70 ,$203.93 ,$586.16 ,$268.33 ,$107.33 ,$107.33 ,$646.50 ,$612.02 ,$612.02 ,$107.33 ,$612.02 ,$706.84 ,$706.84 ,$706.84 , N/A ,$268.33 ,$732.70 ,$107.33 ,$862.00 ,$514.61 ,$107.33 ,$358.59 ,$110.75 ,$100.68 ,$107.33 ,$732.70 ,$225.40 ,$732.70 ,$241.36 ,$775.80 ,$107.33 ,$706.84 ,$728.39 ,$728.39 ,$107.33 ,$560.30 ,$862.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$734.00 ,$477.10 ,$100.68 ,$734.00 ,$268.33 ,$477.10 ,$438.20 ,$107.33 ,$205.52 ,$411.77 ,$107.33 ,$482.97 ,$107.33 ,$623.90 ,$623.90 ,$107.33 ,$623.90 ,$203.93 ,$499.12 ,$268.33 ,$107.33 ,$107.33 ,$550.50 ,$521.14 ,$521.14 ,$107.33 ,$521.14 ,$601.88 ,$601.88 ,$601.88 , N/A ,$268.33 ,$623.90 ,$107.33 ,$734.00 ,$438.20 ,$107.33 ,$305.34 ,$110.75 ,$100.68 ,$107.33 ,$623.90 ,$225.40 ,$623.90 ,$205.52 ,$660.60 ,$107.33 ,$601.88 ,$620.23 ,$620.23 ,$107.33 ,$477.10 ,$734.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200048,76885,HC US HIPS INFANT DYNAMIC,402,1 ,$567.00 ,$368.55 ,$79.75 ,$567.00 ,$199.38 ,$368.55 ,$338.50 ,$79.75 ,$158.76 ,$318.09 ,$79.75 ,$373.09 ,$79.75 ,$481.95 ,$481.95 ,$79.75 ,$481.95 ,$151.52 ,$385.56 ,$199.36 ,$79.75 ,$79.75 ,$425.25 ,$402.57 ,$402.57 ,$79.75 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$199.36 ,$481.95 ,$79.75 ,$567.00 ,$338.50 ,$79.75 ,$235.87 , N/A , N/A ,$79.75 ,$481.95 ,$167.46 ,$481.95 ,$158.76 ,$510.30 ,$79.75 ,$464.94 ,$479.12 ,$479.12 ,$79.75 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$775.00 ,$503.75 ,$73.47 ,$775.00 , N/A ,$503.75 ,$462.68 , N/A ,$217.00 ,$434.78 , N/A ,$509.95 , N/A ,$658.75 ,$658.75 , N/A ,$658.75 , N/A ,$527.00 , N/A , N/A , N/A ,$581.25 ,$550.25 ,$550.25 , N/A ,$550.25 ,$635.50 ,$635.50 ,$635.50 , N/A , N/A ,$658.75 , N/A ,$775.00 ,$462.68 , N/A ,$322.40 ,$80.82 ,$73.47 , N/A ,$658.75 , N/A ,$658.75 ,$217.00 ,$697.50 , N/A ,$635.50 ,$654.88 ,$654.88 , N/A ,$503.75 ,$775.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,359.00 ",$883.35 ,$29.07 ,"$1,359.00 ", N/A ,$883.35 ,$811.32 , N/A ,$380.52 ,$762.40 , N/A ,$894.22 , N/A ,"$1,155.15 ","$1,155.15 ", N/A ,"$1,155.15 ", N/A ,$924.12 , N/A , N/A , N/A ,"$1,019.25 ",$964.89 ,$964.89 , N/A ,$964.89 ,"$1,114.38 ","$1,114.38 ","$1,114.38 ", N/A , N/A ,"$1,155.15 ", N/A ,$29.07 ,$811.32 , N/A ,$565.34 ,$80.82 ,$73.47 , N/A ,"$1,155.15 ", N/A ,"$1,155.15 ",$380.52 ,"$1,223.10 ", N/A ,"$1,114.38 ","$1,148.36 ","$1,148.36 ", N/A ,$883.35 ,"$1,359.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200059,76946,HC US GUIDED AMNIOCENTESIS,402,1 ,$620.00 ,$403.00 ,$73.47 ,$620.00 , N/A ,$403.00 ,$370.14 , N/A ,$173.60 ,$347.82 , N/A ,$407.96 , N/A ,$527.00 ,$527.00 , N/A ,$527.00 , N/A ,$421.60 , N/A , N/A , N/A ,$465.00 ,$440.20 ,$440.20 , N/A ,$440.20 ,$508.40 ,$508.40 ,$508.40 , N/A , N/A ,$527.00 , N/A ,$620.00 ,$370.14 , N/A ,$257.92 ,$80.82 ,$73.47 , N/A ,$527.00 , N/A ,$527.00 ,$173.60 ,$558.00 , N/A ,$508.40 ,$523.90 ,$523.90 , N/A ,$403.00 ,$620.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200062,76998,HC US INTRAOPERATIVE,402,1 ,$906.00 ,$588.90 ,$73.47 ,$906.00 , N/A ,$588.90 ,$540.88 , N/A ,$253.68 ,$508.27 , N/A ,$596.15 , N/A ,$770.10 ,$770.10 , N/A ,$770.10 , N/A ,$616.08 , N/A , N/A , N/A ,$679.50 ,$643.26 ,$643.26 , N/A ,$643.26 ,$742.92 ,$742.92 ,$742.92 , N/A , N/A ,$770.10 , N/A ,$906.00 ,$540.88 , N/A ,$376.90 ,$80.82 ,$73.47 , N/A ,$770.10 , N/A ,$770.10 ,$253.68 ,$815.40 , N/A ,$742.92 ,$765.57 ,$765.57 , N/A ,$588.90 ,$906.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,$735.00 ,$477.75 ,$100.68 ,$735.00 ,$567.13 ,$477.75 ,$438.80 ,$226.85 ,$205.80 ,$412.34 ,$226.85 ,$483.63 ,$226.85 ,$624.75 ,$624.75 ,$226.85 ,$624.75 ,$431.02 ,$499.80 ,$567.13 ,$226.85 ,$226.85 ,$551.25 ,$521.85 ,$521.85 ,$226.85 ,$521.85 ,$602.70 ,$602.70 ,$602.70 , N/A ,$567.13 ,$624.75 ,$226.85 ,$735.00 ,$438.80 ,$226.85 ,$305.76 ,$110.75 ,$100.68 ,$226.85 ,$624.75 ,$476.39 ,$624.75 ,$205.80 ,$661.50 ,$226.85 ,$602.70 ,$621.08 ,$621.08 ,$226.85 ,$477.75 ,$735.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200068,93976,HC DUPLEX ABD/PEL/RETRO LTD,402,1 ,"$1,025.00 ",$666.25 ,$100.68 ,"$1,025.00 ",$268.33 ,$666.25 ,$611.93 ,$107.33 ,$287.00 ,$575.03 ,$107.33 ,$674.45 ,$107.33 ,$871.25 ,$871.25 ,$107.33 ,$871.25 ,$203.93 ,$697.00 ,$268.33 ,$107.33 ,$107.33 ,$768.75 ,$727.75 ,$727.75 ,$107.33 ,$727.75 ,$840.50 ,$840.50 ,$840.50 , N/A ,$268.33 ,$871.25 ,$107.33 ,"$1,025.00 ",$611.93 ,$107.33 ,$426.40 ,$110.75 ,$100.68 ,$107.33 ,$871.25 ,$225.40 ,$871.25 ,$287.00 ,$922.50 ,$107.33 ,$840.50 ,$866.13 ,$866.13 ,$107.33 ,$666.25 ,"$1,025.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,025.00 ",$666.25 ,$100.68 ,"$1,025.00 ",$268.33 ,$666.25 ,$611.93 ,$107.33 ,$287.00 ,$575.03 ,$107.33 ,$674.45 ,$107.33 ,$871.25 ,$871.25 ,$107.33 ,$871.25 ,$203.93 ,$697.00 ,$268.33 ,$107.33 ,$107.33 ,$768.75 ,$727.75 ,$727.75 ,$107.33 ,$727.75 ,$840.50 ,$840.50 ,$840.50 , N/A ,$268.33 ,$871.25 ,$107.33 ,"$1,025.00 ",$611.93 ,$107.33 ,$426.40 ,$110.75 ,$100.68 ,$107.33 ,$871.25 ,$225.40 ,$871.25 ,$287.00 ,$922.50 ,$107.33 ,$840.50 ,$866.13 ,$866.13 ,$107.33 ,$666.25 ,"$1,025.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,921,1 ,"$1,500.00 ",$975.00 ,$100.68 ,"$1,500.00 ",$567.13 ,$975.00 ,$895.50 ,$226.85 ,$420.00 ,$841.50 ,$226.85 ,$987.00 ,$226.85 ,"$1,275.00 ","$1,275.00 ",$226.85 ,"$1,275.00 ",$431.02 ,"$1,020.00 ",$567.13 ,$226.85 ,$226.85 ,"$1,125.00 ","$1,065.00 ","$1,065.00 ",$226.85 ,"$1,065.00 ","$1,230.00 ","$1,230.00 ","$1,230.00 ", N/A ,$567.13 ,"$1,275.00 ",$226.85 ,"$1,500.00 ",$895.50 ,$226.85 ,$624.00 ,$110.75 ,$100.68 ,$226.85 ,"$1,275.00 ",$476.39 ,"$1,275.00 ",$420.00 ,"$1,350.00 ",$226.85 ,"$1,230.00 ","$1,267.50 ","$1,267.50 ",$226.85 ,$975.00 ,"$1,500.00 "
ST. JOSEPH'S HOSPITAL - BREESE,40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,$355.00 ,$230.75 ,$99.40 ,$355.00 ,$268.33 ,$230.75 ,$211.94 ,$107.33 ,$99.40 ,$199.16 ,$107.33 ,$233.59 ,$107.33 ,$301.75 ,$301.75 ,$107.33 ,$301.75 ,$203.93 ,$241.40 ,$268.33 ,$107.33 ,$107.33 ,$266.25 ,$252.05 ,$252.05 ,$107.33 ,$252.05 ,$291.10 ,$291.10 ,$291.10 , N/A ,$268.33 ,$301.75 ,$107.33 ,$355.00 ,$211.94 ,$107.33 ,$147.68 ,$110.75 ,$100.68 ,$107.33 ,$301.75 ,$225.40 ,$301.75 ,$99.40 ,$319.50 ,$107.33 ,$291.10 ,$299.98 ,$299.98 ,$107.33 ,$230.75 ,$355.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200075,76706,HC US AORTA (SCREENING),402,1 ,$970.00 ,$630.50 ,$100.68 ,$970.00 ,$268.33 ,$630.50 ,$579.09 ,$107.33 ,$271.60 ,$544.17 ,$107.33 ,$638.26 ,$107.33 ,$824.50 ,$824.50 ,$107.33 ,$824.50 ,$203.93 ,$659.60 ,$268.33 ,$107.33 ,$107.33 ,$727.50 ,$688.70 ,$688.70 ,$107.33 ,$688.70 ,$795.40 ,$795.40 ,$795.40 , N/A ,$268.33 ,$824.50 ,$107.33 ,$970.00 ,$579.09 ,$107.33 ,$403.52 ,$110.75 ,$100.68 ,$107.33 ,$824.50 ,$225.40 ,$824.50 ,$271.60 ,$873.00 ,$107.33 ,$795.40 ,$819.65 ,$819.65 ,$107.33 ,$630.50 ,$970.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200091,76886,HC US HIPS INFANT STATIC,402,1 ,$504.00 ,$327.60 ,$79.75 ,$504.00 ,$199.38 ,$327.60 ,$300.89 ,$79.75 ,$141.12 ,$282.74 ,$79.75 ,$331.63 ,$79.75 ,$428.40 ,$428.40 ,$79.75 ,$428.40 ,$151.52 ,$342.72 ,$199.36 ,$79.75 ,$79.75 ,$378.00 ,$357.84 ,$357.84 ,$79.75 ,$357.84 ,$413.28 ,$413.28 ,$413.28 , N/A ,$199.36 ,$428.40 ,$79.75 ,$504.00 ,$300.89 ,$79.75 ,$209.66 , N/A , N/A ,$79.75 ,$428.40 ,$167.46 ,$428.40 ,$141.12 ,$453.60 ,$79.75 ,$413.28 ,$425.88 ,$425.88 ,$79.75 ,$327.60 ,$504.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200092,76813,HC US FETAL NUCHAL TRANSLUCENCY SNG,402,1 ,$742.00 ,$482.30 ,$65.16 ,$742.00 ,$268.33 ,$482.30 ,$442.97 ,$107.33 ,$207.76 ,$416.26 ,$107.33 ,$488.24 ,$107.33 ,$630.70 ,$630.70 ,$107.33 ,$630.70 ,$203.93 ,$504.56 ,$268.33 ,$107.33 ,$107.33 ,$556.50 ,$526.82 ,$526.82 ,$107.33 ,$526.82 ,$608.44 ,$608.44 ,$608.44 , N/A ,$268.33 ,$630.70 ,$107.33 ,$742.00 ,$442.97 ,$107.33 ,$308.67 ,$71.68 ,$65.16 ,$107.33 ,$630.70 ,$225.40 ,$630.70 ,$207.76 ,$667.80 ,$107.33 ,$608.44 ,$626.99 ,$626.99 ,$107.33 ,$482.30 ,$742.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200093,76814,HC US FETAL NUCHAL TRANSLUCENCY ADDL,402,1 ,$336.00 ,$218.40 ,$65.16 ,$336.00 , N/A ,$218.40 ,$200.59 , N/A ,$94.08 ,$188.50 , N/A ,$221.09 , N/A ,$285.60 ,$285.60 , N/A ,$285.60 , N/A ,$228.48 , N/A , N/A , N/A ,$252.00 ,$238.56 ,$238.56 , N/A ,$238.56 ,$275.52 ,$275.52 ,$275.52 , N/A , N/A ,$285.60 , N/A ,$336.00 ,$200.59 , N/A ,$139.78 ,$71.68 ,$65.16 , N/A ,$285.60 , N/A ,$285.60 ,$94.08 ,$302.40 , N/A ,$275.52 ,$283.92 ,$283.92 , N/A ,$218.40 ,$336.00 
ST. JOSEPH'S HOSPITAL - BREESE,40200094,76818,HC US FETAL BIO PROFILE W/NST EA ADDN,402,1 ,$326.91 ,$212.49 ,$91.53 ,$326.91 ,$268.33 ,$212.49 ,$195.17 ,$107.33 ,$91.53 ,$183.40 ,$107.33 ,$215.11 ,$107.33 ,$277.87 ,$277.87 ,$107.33 ,$277.87 ,$203.93 ,$222.30 ,$268.33 ,$107.33 ,$107.33 ,$245.18 ,$232.11 ,$232.11 ,$107.33 ,$232.11 ,$268.07 ,$268.07 ,$268.07 , N/A ,$268.33 ,$277.87 ,$107.33 ,$326.91 ,$195.17 ,$107.33 ,$135.99 , N/A , N/A ,$107.33 ,$277.87 ,$225.40 ,$277.87 ,$91.53 ,$294.22 ,$107.33 ,$268.07 ,$276.24 ,$276.24 ,$107.33 ,$212.49 ,$326.91 
ST. JOSEPH'S HOSPITAL - BREESE,40200097,76816,HC US OB GROWTH FOLLOWUP EA ADDN,402,1 ,$310.29 ,$201.69 ,$86.88 ,$310.29 ,$268.33 ,$201.69 ,$185.24 ,$107.33 ,$86.88 ,$174.07 ,$107.33 ,$204.17 ,$107.33 ,$263.75 ,$263.75 ,$107.33 ,$263.75 ,$203.93 ,$211.00 ,$268.33 ,$107.33 ,$107.33 ,$232.72 ,$220.31 ,$220.31 ,$107.33 ,$220.31 ,$254.44 ,$254.44 ,$254.44 , N/A ,$268.33 ,$263.75 ,$107.33 ,$310.29 ,$185.24 ,$107.33 ,$129.08 , N/A , N/A ,$107.33 ,$263.75 ,$225.40 ,$263.75 ,$86.88 ,$279.26 ,$107.33 ,$254.44 ,$262.20 ,$262.20 ,$107.33 ,$201.69 ,$310.29 
ST. JOSEPH'S HOSPITAL - BREESE,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$420.00 ,$273.00 ,$22.87 ,$420.00 ,$225.55 ,$273.00 ,$250.74 ,$90.22 ,$117.60 ,$235.62 ,$90.22 ,$276.36 ,$90.22 ,$357.00 ,$357.00 ,$90.22 ,$357.00 ,$171.42 ,$285.60 ,$225.55 ,$90.22 ,$90.22 ,$315.00 ,$298.20 ,$298.20 ,$90.22 ,$298.20 ,$344.40 ,$344.40 ,$344.40 , N/A ,$225.55 ,$357.00 ,$90.22 ,$101.20 ,$250.74 ,$90.22 ,$174.72 ,$25.16 ,$22.87 ,$90.22 ,$357.00 ,$189.46 ,$357.00 ,$117.60 ,$378.00 ,$90.22 ,$344.40 ,$354.90 ,$354.90 ,$90.22 ,$273.00 ,$420.00 
ST. JOSEPH'S HOSPITAL - BREESE,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$420.00 ,$273.00 ,$22.87 ,$420.00 ,$225.55 ,$273.00 ,$250.74 ,$90.22 ,$117.60 ,$235.62 ,$90.22 ,$276.36 ,$90.22 ,$357.00 ,$357.00 ,$90.22 ,$357.00 ,$171.42 ,$285.60 ,$225.55 ,$90.22 ,$90.22 ,$315.00 ,$298.20 ,$298.20 ,$90.22 ,$298.20 ,$344.40 ,$344.40 ,$344.40 , N/A ,$225.55 ,$357.00 ,$90.22 ,$101.20 ,$250.74 ,$90.22 ,$174.72 ,$25.16 ,$22.87 ,$90.22 ,$357.00 ,$189.46 ,$357.00 ,$117.60 ,$378.00 ,$90.22 ,$344.40 ,$354.90 ,$354.90 ,$90.22 ,$273.00 ,$420.00 
ST. JOSEPH'S HOSPITAL - BREESE,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$420.00 ,$273.00 ,$22.87 ,$420.00 ,$225.55 ,$273.00 ,$250.74 ,$90.22 ,$117.60 ,$235.62 ,$90.22 ,$276.36 ,$90.22 ,$357.00 ,$357.00 ,$90.22 ,$357.00 ,$171.42 ,$285.60 ,$225.55 ,$90.22 ,$90.22 ,$315.00 ,$298.20 ,$298.20 ,$90.22 ,$298.20 ,$344.40 ,$344.40 ,$344.40 , N/A ,$225.55 ,$357.00 ,$90.22 ,$101.20 ,$250.74 ,$90.22 ,$174.72 ,$25.16 ,$22.87 ,$90.22 ,$357.00 ,$189.46 ,$357.00 ,$117.60 ,$378.00 ,$90.22 ,$344.40 ,$354.90 ,$354.90 ,$90.22 ,$273.00 ,$420.00 
ST. JOSEPH'S HOSPITAL - BREESE,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$420.00 ,$273.00 ,$22.87 ,$420.00 ,$225.55 ,$273.00 ,$250.74 ,$90.22 ,$117.60 ,$235.62 ,$90.22 ,$276.36 ,$90.22 ,$357.00 ,$357.00 ,$90.22 ,$357.00 ,$171.42 ,$285.60 ,$225.55 ,$90.22 ,$90.22 ,$315.00 ,$298.20 ,$298.20 ,$90.22 ,$298.20 ,$344.40 ,$344.40 ,$344.40 , N/A ,$225.55 ,$357.00 ,$90.22 ,$101.20 ,$250.74 ,$90.22 ,$174.72 ,$25.16 ,$22.87 ,$90.22 ,$357.00 ,$189.46 ,$357.00 ,$117.60 ,$378.00 ,$90.22 ,$344.40 ,$354.90 ,$354.90 ,$90.22 ,$273.00 ,$420.00 
ST. JOSEPH'S HOSPITAL - BREESE,40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$103.00 ,$66.95 ,$22.82 ,$103.00 ,$57.05 ,$66.95 ,$61.49 ,$22.82 ,$28.84 ,$57.78 ,$22.82 ,$67.77 ,$22.82 ,$87.55 ,$87.55 ,$22.82 ,$87.55 ,$43.36 ,$70.04 ,$57.05 ,$22.82 ,$22.82 ,$77.25 ,$73.13 ,$73.13 ,$22.82 ,$73.13 ,$84.46 ,$84.46 ,$84.46 , N/A ,$57.05 ,$87.55 ,$22.82 ,$26.59 ,$61.49 ,$22.82 ,$42.85 ,$50.30 ,$45.73 ,$22.82 ,$87.55 ,$47.92 ,$87.55 ,$28.84 ,$92.70 ,$22.82 ,$84.46 ,$87.04 ,$87.04 ,$22.82 ,$66.95 ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,40300007,77063,HC SCREEN DIG BREAST TOMO BIL-52,403,1 ,$103.00 ,$66.95 ,$22.82 ,$103.00 ,$57.05 ,$66.95 ,$61.49 ,$22.82 ,$28.84 ,$57.78 ,$22.82 ,$67.77 ,$22.82 ,$87.55 ,$87.55 ,$22.82 ,$87.55 ,$43.36 ,$70.04 ,$57.05 ,$22.82 ,$22.82 ,$77.25 ,$73.13 ,$73.13 ,$22.82 ,$73.13 ,$84.46 ,$84.46 ,$84.46 , N/A ,$57.05 ,$87.55 ,$22.82 ,$26.59 ,$61.49 ,$22.82 ,$42.85 ,$25.16 ,$22.87 ,$22.82 ,$87.55 ,$47.92 ,$87.55 ,$28.84 ,$92.70 ,$22.82 ,$84.46 ,$87.04 ,$87.04 ,$22.82 ,$66.95 ,$103.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000005,92950,HC CPR,480,1 ,$849.00 ,$551.85 ,$237.72 ,$849.00 ,$652.30 ,$551.85 ,$506.85 ,$260.92 ,$237.72 ,$476.29 ,$260.92 ,$558.64 ,$260.92 ,$721.65 ,$721.65 ,$260.92 ,$721.65 ,$495.74 ,$577.32 ,$652.29 ,$260.92 ,$260.92 ,$636.75 ,$602.79 ,$602.79 ,$260.92 ,$602.79 ,$696.18 ,$696.18 ,$696.18 , N/A ,$652.29 ,$721.65 ,$260.92 ,$849.00 ,$506.85 ,$260.92 ,$353.18 ,$491.82 ,$447.11 ,$260.92 ,$721.65 ,$547.92 ,$721.65 ,$237.72 ,$764.10 ,$260.92 ,$696.18 ,$717.41 ,$717.41 ,$260.92 ,$551.85 ,$849.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,"$1,023.00 ",$664.95 ,$286.44 ,"$1,200.73 ","$1,200.73 ",$664.95 ,$610.73 ,$480.29 ,$286.44 ,$573.90 ,$480.29 ,$673.13 ,$480.29 ,$869.55 ,$869.55 ,$480.29 ,$869.55 ,$912.54 ,$695.64 ,"$1,200.71 ",$480.29 ,$480.29 ,$767.25 ,$726.33 ,$726.33 ,$480.29 ,$726.33 ,$838.86 ,$838.86 ,$838.86 , N/A ,"$1,023.00 ",$869.55 ,$480.29 ,"$1,023.00 ",$610.73 ,$480.29 ,$425.57 ,$533.25 ,$484.77 ,$480.29 ,$869.55 ,"$1,008.60 ",$869.55 ,$286.44 ,$920.70 ,$480.29 ,$838.86 ,$864.44 ,$864.44 ,$480.29 ,$664.95 ,"$1,023.00 "
ST. JOSEPH'S HOSPITAL - BREESE,41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000015,94002,HC VENT NEONATAL INTL DAY,410,1 ,"$1,023.00 ",$664.95 ,$286.44 ,"$1,200.73 ","$1,200.73 ",$664.95 ,$610.73 ,$480.29 ,$286.44 ,$573.90 ,$480.29 ,$673.13 ,$480.29 ,$869.55 ,$869.55 ,$480.29 ,$869.55 ,$912.54 ,$695.64 ,"$1,200.71 ",$480.29 ,$480.29 ,$767.25 ,$726.33 ,$726.33 ,$480.29 ,$726.33 ,$838.86 ,$838.86 ,$838.86 , N/A ,"$1,023.00 ",$869.55 ,$480.29 ,"$1,023.00 ",$610.73 ,$480.29 ,$425.57 ,$533.25 ,$484.77 ,$480.29 ,$869.55 ,"$1,008.60 ",$869.55 ,$286.44 ,$920.70 ,$480.29 ,$838.86 ,$864.44 ,$864.44 ,$480.29 ,$664.95 ,"$1,023.00 "
ST. JOSEPH'S HOSPITAL - BREESE,41000016,94660,HC VENT NONINVAS NEO INTL DAY,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$865.00 ,$562.25 ,$242.20 ,"$1,200.73 ","$1,200.73 ",$562.25 ,$516.41 ,$480.29 ,$242.20 ,$485.27 ,$480.29 ,$569.17 ,$480.29 ,$735.25 ,$735.25 ,$480.29 ,$735.25 ,$865.00 ,$588.20 ,"$1,200.71 ",$480.29 ,$480.29 ,$648.75 ,$614.15 ,$614.15 ,$480.29 ,$614.15 ,$709.30 ,$709.30 ,$709.30 , N/A ,$865.00 ,$735.25 ,$480.29 ,$865.00 ,$516.41 ,$480.29 ,$359.84 ,$533.25 ,$484.77 ,$480.29 ,$735.25 ,"$1,008.60 ",$735.25 ,$242.20 ,$778.50 ,$480.29 ,$709.30 ,$730.93 ,$730.93 ,$480.29 ,$562.25 ,$865.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000033,94660,HC VENT NONINVAS PEDS SUBQ DAY,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$123.00 ,$79.95 ,$34.44 ,$463.28 ,$463.28 ,$79.95 ,$73.43 ,$185.31 ,$34.44 ,$69.00 ,$185.31 ,$80.93 ,$123.00 ,$104.55 ,$104.55 ,$123.00 ,$104.55 ,$123.00 ,$83.64 ,$463.28 ,$185.31 ,$185.31 ,$92.25 ,$87.33 ,$87.33 ,$185.31 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$123.00 ,$104.55 ,$185.31 ,$123.00 ,$73.43 ,$185.31 ,$51.17 ,$123.00 ,$123.00 ,$185.31 ,$104.55 ,$389.16 ,$104.55 ,$34.44 ,$110.70 ,$185.31 ,$100.86 ,$103.94 ,$103.94 ,$185.31 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000037,94640,HC INCENTIVE SPIROMETER TRT,410,1 ,$123.00 ,$79.95 ,$34.44 ,$463.28 ,$463.28 ,$79.95 ,$73.43 ,$185.31 ,$34.44 ,$69.00 ,$185.31 ,$80.93 ,$123.00 ,$104.55 ,$104.55 ,$123.00 ,$104.55 ,$123.00 ,$83.64 ,$463.28 ,$185.31 ,$185.31 ,$92.25 ,$87.33 ,$87.33 ,$185.31 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$123.00 ,$104.55 ,$185.31 ,$123.00 ,$73.43 ,$185.31 ,$51.17 ,$123.00 ,$123.00 ,$185.31 ,$104.55 ,$389.16 ,$104.55 ,$34.44 ,$110.70 ,$185.31 ,$100.86 ,$103.94 ,$103.94 ,$185.31 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$123.00 ,$79.95 ,$34.44 ,$463.28 ,$463.28 ,$79.95 ,$73.43 ,$185.31 ,$34.44 ,$69.00 ,$185.31 ,$80.93 ,$123.00 ,$104.55 ,$104.55 ,$123.00 ,$104.55 ,$123.00 ,$83.64 ,$463.28 ,$185.31 ,$185.31 ,$92.25 ,$87.33 ,$87.33 ,$185.31 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$123.00 ,$104.55 ,$185.31 ,$123.00 ,$73.43 ,$185.31 ,$51.17 ,$123.00 ,$123.00 ,$185.31 ,$104.55 ,$389.16 ,$104.55 ,$34.44 ,$110.70 ,$185.31 ,$100.86 ,$103.94 ,$103.94 ,$185.31 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$123.00 ,$79.95 ,$34.44 ,$463.28 ,$463.28 ,$79.95 ,$73.43 ,$185.31 ,$34.44 ,$69.00 ,$185.31 ,$80.93 ,$123.00 ,$104.55 ,$104.55 ,$123.00 ,$104.55 ,$123.00 ,$83.64 ,$463.28 ,$185.31 ,$185.31 ,$92.25 ,$87.33 ,$87.33 ,$185.31 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$123.00 ,$104.55 ,$185.31 ,$123.00 ,$73.43 ,$185.31 ,$51.17 ,$123.00 ,$123.00 ,$185.31 ,$104.55 ,$389.16 ,$104.55 ,$34.44 ,$110.70 ,$185.31 ,$100.86 ,$103.94 ,$103.94 ,$185.31 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$322.00 ,$209.30 ,$49.50 ,$322.00 ,$277.93 ,$209.30 ,$192.23 ,$111.17 ,$90.16 ,$180.64 ,$111.17 ,$211.88 ,$111.17 ,$273.70 ,$273.70 ,$111.17 ,$273.70 ,$211.22 ,$218.96 ,$277.92 ,$111.17 ,$111.17 ,$241.50 ,$228.62 ,$228.62 ,$111.17 ,$228.62 ,$264.04 ,$264.04 ,$264.04 , N/A ,$277.92 ,$273.70 ,$111.17 ,$322.00 ,$192.23 ,$111.17 ,$133.95 ,$54.45 ,$49.50 ,$111.17 ,$273.70 ,$233.45 ,$273.70 ,$90.16 ,$289.80 ,$111.17 ,$264.04 ,$272.09 ,$272.09 ,$111.17 ,$209.30 ,$322.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$308.00 ,$200.20 ,$49.50 ,$308.00 , N/A ,$200.20 ,$183.88 , N/A ,$86.24 ,$172.79 , N/A ,$202.66 , N/A ,$261.80 ,$261.80 , N/A ,$261.80 , N/A ,$209.44 , N/A , N/A , N/A ,$231.00 ,$218.68 ,$218.68 , N/A ,$218.68 ,$252.56 ,$252.56 ,$252.56 , N/A , N/A ,$261.80 , N/A ,$308.00 ,$183.88 , N/A ,$128.13 ,$54.45 ,$49.50 , N/A ,$261.80 , N/A ,$261.80 ,$86.24 ,$277.20 , N/A ,$252.56 ,$260.26 ,$260.26 , N/A ,$200.20 ,$308.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000052,94660,HC CPAP,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000053,94660,HC CPAP DAILY EST PT,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$39.00 ,$25.35 ,$10.92 ,$463.28 ,$463.28 ,$25.35 ,$23.28 ,$185.31 ,$10.92 ,$21.88 ,$185.31 ,$25.66 ,$39.00 ,$33.15 ,$33.15 ,$39.00 ,$33.15 ,$39.00 ,$26.52 ,$463.28 ,$185.31 ,$185.31 ,$29.25 ,$27.69 ,$27.69 ,$185.31 ,$27.69 ,$31.98 ,$31.98 ,$31.98 , N/A ,$39.00 ,$33.15 ,$185.31 ,$39.00 ,$23.28 ,$185.31 ,$16.22 ,$26.28 ,$23.89 ,$185.31 ,$33.15 ,$389.16 ,$33.15 ,$10.92 ,$35.10 ,$185.31 ,$31.98 ,$32.96 ,$32.96 ,$185.31 ,$25.35 ,$39.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$78.00 ,$50.70 ,$21.84 ,$277.93 ,$277.93 ,$50.70 ,$46.57 ,$111.17 ,$21.84 ,$43.76 ,$111.17 ,$51.32 ,$78.00 ,$66.30 ,$66.30 ,$78.00 ,$66.30 ,$78.00 ,$53.04 ,$277.92 ,$111.17 ,$111.17 ,$58.50 ,$55.38 ,$55.38 ,$111.17 ,$55.38 ,$63.96 ,$63.96 ,$63.96 , N/A ,$78.00 ,$66.30 ,$111.17 ,$78.00 ,$46.57 ,$111.17 ,$32.45 ,$78.00 ,$78.00 ,$111.17 ,$66.30 ,$233.45 ,$66.30 ,$21.84 ,$70.20 ,$111.17 ,$63.96 ,$65.91 ,$65.91 ,$111.17 ,$50.70 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$78.00 ,$50.70 ,$21.84 ,$277.93 ,$277.93 ,$50.70 ,$46.57 ,$111.17 ,$21.84 ,$43.76 ,$111.17 ,$51.32 ,$78.00 ,$66.30 ,$66.30 ,$78.00 ,$66.30 ,$78.00 ,$53.04 ,$277.92 ,$111.17 ,$111.17 ,$58.50 ,$55.38 ,$55.38 ,$111.17 ,$55.38 ,$63.96 ,$63.96 ,$63.96 , N/A ,$78.00 ,$66.30 ,$111.17 ,$78.00 ,$46.57 ,$111.17 ,$32.45 ,$78.00 ,$78.00 ,$111.17 ,$66.30 ,$233.45 ,$66.30 ,$21.84 ,$70.20 ,$111.17 ,$63.96 ,$65.91 ,$65.91 ,$111.17 ,$50.70 ,$78.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$66.00 ,$42.90 ,$18.48 ,$277.93 ,$277.93 ,$42.90 ,$39.40 ,$111.17 ,$18.48 ,$37.03 ,$111.17 ,$43.43 ,$66.00 ,$56.10 ,$56.10 ,$66.00 ,$56.10 ,$66.00 ,$44.88 ,$277.92 ,$111.17 ,$111.17 ,$49.50 ,$46.86 ,$46.86 ,$111.17 ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A ,$66.00 ,$56.10 ,$111.17 ,$66.00 ,$39.40 ,$111.17 ,$27.46 ,$66.00 ,$66.00 ,$111.17 ,$56.10 ,$233.45 ,$56.10 ,$18.48 ,$59.40 ,$111.17 ,$54.12 ,$55.77 ,$55.77 ,$111.17 ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$66.00 ,$42.90 ,$18.48 ,$277.93 ,$277.93 ,$42.90 ,$39.40 ,$111.17 ,$18.48 ,$37.03 ,$111.17 ,$43.43 ,$66.00 ,$56.10 ,$56.10 ,$66.00 ,$56.10 ,$66.00 ,$44.88 ,$277.92 ,$111.17 ,$111.17 ,$49.50 ,$46.86 ,$46.86 ,$111.17 ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A ,$66.00 ,$56.10 ,$111.17 ,$66.00 ,$39.40 ,$111.17 ,$27.46 ,$66.00 ,$66.00 ,$111.17 ,$56.10 ,$233.45 ,$56.10 ,$18.48 ,$59.40 ,$111.17 ,$54.12 ,$55.77 ,$55.77 ,$111.17 ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$66.00 ,$42.90 ,$18.48 ,$66.00 ,$60.90 ,$42.90 ,$39.40 ,$24.36 ,$18.48 ,$37.03 ,$24.36 ,$43.43 ,$24.36 ,$56.10 ,$56.10 ,$24.36 ,$56.10 ,$46.27 ,$44.88 ,$60.89 ,$24.36 ,$24.36 ,$49.50 ,$46.86 ,$46.86 ,$24.36 ,$46.86 ,$54.12 ,$54.12 ,$54.12 , N/A ,$60.89 ,$56.10 ,$24.36 ,$66.00 ,$39.40 ,$24.36 ,$27.46 ,$66.00 ,$66.00 ,$24.36 ,$56.10 ,$51.15 ,$56.10 ,$18.48 ,$59.40 ,$24.36 ,$54.12 ,$55.77 ,$55.77 ,$24.36 ,$42.90 ,$66.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000069,G0238,HC RESP THRP FUNCTION,410,1 ,$74.00 ,$48.10 ,$20.72 ,$74.00 ,$60.90 ,$48.10 ,$44.18 ,$24.36 ,$20.72 ,$41.51 ,$24.36 ,$48.69 ,$24.36 ,$62.90 ,$62.90 ,$24.36 ,$62.90 ,$46.27 ,$50.32 ,$60.89 ,$24.36 ,$24.36 ,$55.50 ,$52.54 ,$52.54 ,$24.36 ,$52.54 ,$60.68 ,$60.68 ,$60.68 , N/A ,$60.89 ,$62.90 ,$24.36 ,$74.00 ,$44.18 ,$24.36 ,$30.78 ,$74.00 ,$74.00 ,$24.36 ,$62.90 ,$51.15 ,$62.90 ,$20.72 ,$66.60 ,$24.36 ,$60.68 ,$62.53 ,$62.53 ,$24.36 ,$48.10 ,$74.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$96.00 ,$62.40 ,$1.56 ,$96.00 ,$83.43 ,$62.40 ,$57.31 ,$33.37 ,$26.88 ,$53.86 ,$33.37 ,$63.17 ,$33.37 ,$81.60 ,$81.60 ,$33.37 ,$81.60 ,$63.41 ,$65.28 ,$83.43 ,$33.37 ,$33.37 ,$72.00 ,$68.16 ,$68.16 ,$33.37 ,$68.16 ,$78.72 ,$78.72 ,$78.72 , N/A ,$83.43 ,$81.60 ,$33.37 ,$96.00 ,$57.31 ,$33.37 ,$39.94 ,$1.72 ,$1.56 ,$33.37 ,$81.60 ,$70.08 ,$81.60 ,$26.88 ,$86.40 ,$33.37 ,$78.72 ,$81.12 ,$81.12 ,$33.37 ,$62.40 ,$96.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000073,94660,HC VENT NONINVAS NEON SUBQ DAY,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000076,94640,HC NEBULIZER SUBSQ,410,1 ,$123.00 ,$79.95 ,$34.44 ,$463.28 ,$463.28 ,$79.95 ,$73.43 ,$185.31 ,$34.44 ,$69.00 ,$185.31 ,$80.93 ,$123.00 ,$104.55 ,$104.55 ,$123.00 ,$104.55 ,$123.00 ,$83.64 ,$463.28 ,$185.31 ,$185.31 ,$92.25 ,$87.33 ,$87.33 ,$185.31 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$123.00 ,$104.55 ,$185.31 ,$123.00 ,$73.43 ,$185.31 ,$51.17 ,$123.00 ,$123.00 ,$185.31 ,$104.55 ,$389.16 ,$104.55 ,$34.44 ,$110.70 ,$185.31 ,$100.86 ,$103.94 ,$103.94 ,$185.31 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000077,94762,HC PULSE OX PER DAY,410,1 ,$602.00 ,$391.30 ,$49.50 ,$602.00 ,$344.13 ,$391.30 ,$359.39 ,$137.65 ,$168.56 ,$337.72 ,$137.65 ,$396.12 ,$137.65 ,$511.70 ,$511.70 ,$137.65 ,$511.70 ,$261.53 ,$409.36 ,$344.11 ,$137.65 ,$137.65 ,$451.50 ,$427.42 ,$427.42 ,$137.65 ,$427.42 ,$493.64 ,$493.64 ,$493.64 , N/A ,$344.11 ,$511.70 ,$137.65 ,$602.00 ,$359.39 ,$137.65 ,$250.43 ,$54.45 ,$49.50 ,$137.65 ,$511.70 ,$289.05 ,$511.70 ,$168.56 ,$541.80 ,$137.65 ,$493.64 ,$508.69 ,$508.69 ,$137.65 ,$391.30 ,$602.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$449.00 ,$291.85 ,$125.72 ,$463.28 ,$463.28 ,$291.85 ,$268.05 ,$185.31 ,$125.72 ,$251.89 ,$185.31 ,$295.44 ,$185.31 ,$381.65 ,$381.65 ,$185.31 ,$381.65 ,$352.09 ,$305.32 ,$463.28 ,$185.31 ,$185.31 ,$336.75 ,$318.79 ,$318.79 ,$185.31 ,$318.79 ,$368.18 ,$368.18 ,$368.18 , N/A ,$449.00 ,$381.65 ,$185.31 ,$449.00 ,$268.05 ,$185.31 ,$186.78 ,$449.00 ,$449.00 ,$185.31 ,$381.65 ,$389.16 ,$381.65 ,$125.72 ,$404.10 ,$185.31 ,$368.18 ,$379.41 ,$379.41 ,$185.31 ,$291.85 ,$449.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$123.00 ,$79.95 ,$34.44 ,$463.28 ,$463.28 ,$79.95 ,$73.43 ,$185.31 ,$34.44 ,$69.00 ,$185.31 ,$80.93 ,$123.00 ,$104.55 ,$104.55 ,$123.00 ,$104.55 ,$123.00 ,$83.64 ,$463.28 ,$185.31 ,$185.31 ,$92.25 ,$87.33 ,$87.33 ,$185.31 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$123.00 ,$104.55 ,$185.31 ,$123.00 ,$73.43 ,$185.31 ,$51.17 ,$123.00 ,$123.00 ,$185.31 ,$104.55 ,$389.16 ,$104.55 ,$34.44 ,$110.70 ,$185.31 ,$100.86 ,$103.94 ,$103.94 ,$185.31 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,41000092,94640,HC AEROSOL INHALATION SUBSQ,410,1 ,$123.00 ,$79.95 ,$34.44 ,$463.28 ,$463.28 ,$79.95 ,$73.43 ,$185.31 ,$34.44 ,$69.00 ,$185.31 ,$80.93 ,$123.00 ,$104.55 ,$104.55 ,$123.00 ,$104.55 ,$123.00 ,$83.64 ,$463.28 ,$185.31 ,$185.31 ,$92.25 ,$87.33 ,$87.33 ,$185.31 ,$87.33 ,$100.86 ,$100.86 ,$100.86 , N/A ,$123.00 ,$104.55 ,$185.31 ,$123.00 ,$73.43 ,$185.31 ,$51.17 ,$123.00 ,$123.00 ,$185.31 ,$104.55 ,$389.16 ,$104.55 ,$34.44 ,$110.70 ,$185.31 ,$100.86 ,$103.94 ,$103.94 ,$185.31 ,$79.95 ,$123.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000006,G0283,HC APPL NEUROSTIMULATOR TRANSCUT,420,1 ,$116.00 ,$75.40 ,$12.35 ,$116.00 ,$30.88 ,$75.40 ,$69.25 ,$12.35 ,$32.48 ,$65.08 ,$12.35 ,$76.33 ,$12.35 ,$98.60 ,$98.60 ,$12.35 ,$98.60 ,$23.47 ,$78.88 ,$30.88 ,$12.35 ,$12.35 ,$87.00 ,$82.36 ,$82.36 ,$12.35 ,$82.36 ,$95.12 ,$95.12 ,$95.12 , N/A ,$30.88 ,$98.60 ,$12.35 ,$116.00 ,$69.25 ,$12.35 ,$48.26 ,$20.11 ,$18.28 ,$12.35 ,$98.60 ,$25.94 ,$98.60 ,$32.48 ,$104.40 ,$12.35 ,$95.12 ,$98.02 ,$98.02 ,$12.35 ,$75.40 ,$116.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$200.00 ,$130.00 ,$14.77 ,$200.00 ,$36.93 ,$130.00 ,$119.40 ,$14.77 ,$56.00 ,$112.20 ,$14.77 ,$131.60 ,$14.77 ,$170.00 ,$170.00 ,$14.77 ,$170.00 ,$28.06 ,$136.00 ,$36.93 ,$14.77 ,$14.77 ,$150.00 ,$142.00 ,$142.00 ,$14.77 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$36.93 ,$170.00 ,$14.77 ,$200.00 ,$119.40 ,$14.77 ,$83.20 ,$200.00 ,$200.00 ,$14.77 ,$170.00 ,$31.02 ,$170.00 ,$56.00 ,$180.00 ,$14.77 ,$164.00 ,$169.00 ,$169.00 ,$14.77 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$278.00 ,$180.70 ,$19.68 ,$278.00 ,$49.20 ,$180.70 ,$165.97 ,$19.68 ,$77.84 ,$155.96 ,$19.68 ,$182.92 ,$19.68 ,$236.30 ,$236.30 ,$19.68 ,$236.30 ,$37.39 ,$189.04 ,$49.20 ,$19.68 ,$19.68 ,$208.50 ,$197.38 ,$197.38 ,$19.68 ,$197.38 ,$227.96 ,$227.96 ,$227.96 , N/A ,$49.20 ,$236.30 ,$19.68 ,$278.00 ,$165.97 ,$19.68 ,$115.65 ,$246.07 ,$223.70 ,$19.68 ,$236.30 ,$41.33 ,$236.30 ,$77.84 ,$250.20 ,$19.68 ,$227.96 ,$234.91 ,$234.91 ,$19.68 ,$180.70 ,$278.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$200.00 ,$130.00 ,$14.36 ,$200.00 ,$35.90 ,$130.00 ,$119.40 ,$14.36 ,$56.00 ,$112.20 ,$14.36 ,$131.60 ,$14.36 ,$170.00 ,$170.00 ,$14.36 ,$170.00 ,$27.28 ,$136.00 ,$35.90 ,$14.36 ,$14.36 ,$150.00 ,$142.00 ,$142.00 ,$14.36 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$35.90 ,$170.00 ,$14.36 ,$200.00 ,$119.40 ,$14.36 ,$83.20 ,$200.00 ,$200.00 ,$14.36 ,$170.00 ,$30.16 ,$170.00 ,$56.00 ,$180.00 ,$14.36 ,$164.00 ,$169.00 ,$169.00 ,$14.36 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$161.00 ,$104.65 ,$29.76 ,$161.00 ,$74.40 ,$104.65 ,$96.12 ,$29.76 ,$45.08 ,$90.32 ,$29.76 ,$105.94 ,$29.76 ,$136.85 ,$136.85 ,$29.76 ,$136.85 ,$56.54 ,$109.48 ,$74.40 ,$29.76 ,$29.76 ,$120.75 ,$114.31 ,$114.31 ,$29.76 ,$114.31 ,$132.02 ,$132.02 ,$132.02 , N/A ,$74.40 ,$136.85 ,$29.76 ,$161.00 ,$96.12 ,$29.76 ,$66.98 ,$161.00 ,$161.00 ,$29.76 ,$136.85 ,$62.50 ,$136.85 ,$45.08 ,$144.90 ,$29.76 ,$132.02 ,$136.05 ,$136.05 ,$29.76 ,$104.65 ,$161.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$180.00 ,$117.00 ,$34.43 ,$180.00 ,$86.08 ,$117.00 ,$107.46 ,$34.43 ,$50.40 ,$100.98 ,$34.43 ,$118.44 ,$34.43 ,$153.00 ,$153.00 ,$34.43 ,$153.00 ,$65.42 ,$122.40 ,$86.08 ,$34.43 ,$34.43 ,$135.00 ,$127.80 ,$127.80 ,$34.43 ,$127.80 ,$147.60 ,$147.60 ,$147.60 , N/A ,$86.08 ,$153.00 ,$34.43 ,$180.00 ,$107.46 ,$34.43 ,$74.88 ,$180.00 ,$180.00 ,$34.43 ,$153.00 ,$72.30 ,$153.00 ,$50.40 ,$162.00 ,$34.43 ,$147.60 ,$152.10 ,$152.10 ,$34.43 ,$117.00 ,$180.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$163.00 ,$105.95 ,$29.76 ,$163.00 ,$74.40 ,$105.95 ,$97.31 ,$29.76 ,$45.64 ,$91.44 ,$29.76 ,$107.25 ,$29.76 ,$138.55 ,$138.55 ,$29.76 ,$138.55 ,$56.54 ,$110.84 ,$74.40 ,$29.76 ,$29.76 ,$122.25 ,$115.73 ,$115.73 ,$29.76 ,$115.73 ,$133.66 ,$133.66 ,$133.66 , N/A ,$74.40 ,$138.55 ,$29.76 ,$163.00 ,$97.31 ,$29.76 ,$67.81 ,$163.00 ,$163.00 ,$29.76 ,$138.55 ,$62.50 ,$138.55 ,$45.64 ,$146.70 ,$29.76 ,$133.66 ,$137.74 ,$137.74 ,$29.76 ,$105.95 ,$163.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$178.00 ,$115.70 ,$29.64 ,$178.00 ,$74.10 ,$115.70 ,$106.27 ,$29.64 ,$49.84 ,$99.86 ,$29.64 ,$117.12 ,$29.64 ,$151.30 ,$151.30 ,$29.64 ,$151.30 ,$56.32 ,$121.04 ,$74.10 ,$29.64 ,$29.64 ,$133.50 ,$126.38 ,$126.38 ,$29.64 ,$126.38 ,$145.96 ,$145.96 ,$145.96 , N/A ,$74.10 ,$151.30 ,$29.64 ,$178.00 ,$106.27 ,$29.64 ,$74.05 ,$178.00 ,$178.00 ,$29.64 ,$151.30 ,$62.24 ,$151.30 ,$49.84 ,$160.20 ,$29.64 ,$145.96 ,$150.41 ,$150.41 ,$29.64 ,$115.70 ,$178.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$161.00 ,$104.65 ,$27.44 ,$161.00 ,$68.60 ,$104.65 ,$96.12 ,$27.44 ,$45.08 ,$90.32 ,$27.44 ,$105.94 ,$27.44 ,$136.85 ,$136.85 ,$27.44 ,$136.85 ,$52.14 ,$109.48 ,$68.60 ,$27.44 ,$27.44 ,$120.75 ,$114.31 ,$114.31 ,$27.44 ,$114.31 ,$132.02 ,$132.02 ,$132.02 , N/A ,$68.60 ,$136.85 ,$27.44 ,$161.00 ,$96.12 ,$27.44 ,$66.98 ,$161.00 ,$161.00 ,$27.44 ,$136.85 ,$57.62 ,$136.85 ,$45.08 ,$144.90 ,$27.44 ,$132.02 ,$136.05 ,$136.05 ,$27.44 ,$104.65 ,$161.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$148.00 ,$96.20 ,$37.24 ,$148.00 ,$93.10 ,$96.20 ,$88.36 ,$37.24 ,$41.44 ,$83.03 ,$37.24 ,$97.38 ,$37.24 ,$125.80 ,$125.80 ,$37.24 ,$125.80 ,$70.76 ,$100.64 ,$93.10 ,$37.24 ,$37.24 ,$111.00 ,$105.08 ,$105.08 ,$37.24 ,$105.08 ,$121.36 ,$121.36 ,$121.36 , N/A ,$93.10 ,$125.80 ,$37.24 ,$148.00 ,$88.36 ,$37.24 ,$61.57 ,$148.00 ,$148.00 ,$37.24 ,$125.80 ,$78.20 ,$125.80 ,$41.44 ,$133.20 ,$37.24 ,$121.36 ,$125.06 ,$125.06 ,$37.24 ,$96.20 ,$148.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$168.00 ,$109.20 ,$33.67 ,$168.00 ,$84.18 ,$109.20 ,$100.30 ,$33.67 ,$47.04 ,$94.25 ,$33.67 ,$110.54 ,$33.67 ,$142.80 ,$142.80 ,$33.67 ,$142.80 ,$63.97 ,$114.24 ,$84.18 ,$33.67 ,$33.67 ,$126.00 ,$119.28 ,$119.28 ,$33.67 ,$119.28 ,$137.76 ,$137.76 ,$137.76 , N/A ,$84.18 ,$142.80 ,$33.67 ,$168.00 ,$100.30 ,$33.67 ,$69.89 ,$168.00 ,$168.00 ,$33.67 ,$142.80 ,$70.71 ,$142.80 ,$47.04 ,$151.20 ,$33.67 ,$137.76 ,$141.96 ,$141.96 ,$33.67 ,$109.20 ,$168.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000094,97761,HC PROSTHETIC TRAINING EA 15 MIN,420,1 ,$171.00 ,$111.15 ,$41.60 ,$171.00 ,$104.00 ,$111.15 ,$102.09 ,$41.60 ,$47.88 ,$95.93 ,$41.60 ,$112.52 ,$41.60 ,$145.35 ,$145.35 ,$41.60 ,$145.35 ,$79.04 ,$116.28 ,$104.00 ,$41.60 ,$41.60 ,$128.25 ,$121.41 ,$121.41 ,$41.60 ,$121.41 ,$140.22 ,$140.22 ,$140.22 , N/A ,$104.00 ,$145.35 ,$41.60 ,$171.00 ,$102.09 ,$41.60 ,$71.14 ,$171.00 ,$171.00 ,$41.60 ,$145.35 ,$87.36 ,$145.35 ,$47.88 ,$153.90 ,$41.60 ,$140.22 ,$144.50 ,$144.50 ,$41.60 ,$111.15 ,$171.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000160,97113,HC THERAPEUTIC ACT W/AQUA,420,1 ,$212.00 ,$137.80 ,$36.99 ,$212.00 ,$92.48 ,$137.80 ,$126.56 ,$36.99 ,$59.36 ,$118.93 ,$36.99 ,$139.50 ,$36.99 ,$180.20 ,$180.20 ,$36.99 ,$180.20 ,$70.28 ,$144.16 ,$92.48 ,$36.99 ,$36.99 ,$159.00 ,$150.52 ,$150.52 ,$36.99 ,$150.52 ,$173.84 ,$173.84 ,$173.84 , N/A ,$92.48 ,$180.20 ,$36.99 ,$212.00 ,$126.56 ,$36.99 ,$88.19 ,$212.00 ,$212.00 ,$36.99 ,$180.20 ,$77.68 ,$180.20 ,$59.36 ,$190.80 ,$36.99 ,$173.84 ,$179.14 ,$179.14 ,$36.99 ,$137.80 ,$212.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000161,97024,HC DIATHERMY,420,1 ,$152.00 ,$98.80 ,$7.22 ,$152.00 ,$18.05 ,$98.80 ,$90.74 ,$7.22 ,$42.56 ,$85.27 ,$7.22 ,$100.02 ,$7.22 ,$129.20 ,$129.20 ,$7.22 ,$129.20 ,$13.72 ,$103.36 ,$18.05 ,$7.22 ,$7.22 ,$114.00 ,$107.92 ,$107.92 ,$7.22 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$18.05 ,$129.20 ,$7.22 ,$152.00 ,$90.74 ,$7.22 ,$63.23 ,$20.11 ,$18.28 ,$7.22 ,$129.20 ,$15.16 ,$129.20 ,$42.56 ,$136.80 ,$7.22 ,$124.64 ,$128.44 ,$128.44 ,$7.22 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000206,G0283,HC ELECT STIM (UNATTEND) OTHER 15MIN,420,1 ,$116.00 ,$75.40 ,$12.35 ,$116.00 ,$30.88 ,$75.40 ,$69.25 ,$12.35 ,$32.48 ,$65.08 ,$12.35 ,$76.33 ,$12.35 ,$98.60 ,$98.60 ,$12.35 ,$98.60 ,$23.47 ,$78.88 ,$30.88 ,$12.35 ,$12.35 ,$87.00 ,$82.36 ,$82.36 ,$12.35 ,$82.36 ,$95.12 ,$95.12 ,$95.12 , N/A ,$30.88 ,$98.60 ,$12.35 ,$116.00 ,$69.25 ,$12.35 ,$48.26 ,$20.11 ,$18.28 ,$12.35 ,$98.60 ,$25.94 ,$98.60 ,$32.48 ,$104.40 ,$12.35 ,$95.12 ,$98.02 ,$98.02 ,$12.35 ,$75.40 ,$116.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000207,G0283,HC ELECT STIM (UNATTEND) OTHER 30MIN,420,1 ,$116.00 ,$75.40 ,$12.35 ,$116.00 ,$30.88 ,$75.40 ,$69.25 ,$12.35 ,$32.48 ,$65.08 ,$12.35 ,$76.33 ,$12.35 ,$98.60 ,$98.60 ,$12.35 ,$98.60 ,$23.47 ,$78.88 ,$30.88 ,$12.35 ,$12.35 ,$87.00 ,$82.36 ,$82.36 ,$12.35 ,$82.36 ,$95.12 ,$95.12 ,$95.12 , N/A ,$30.88 ,$98.60 ,$12.35 ,$116.00 ,$69.25 ,$12.35 ,$48.26 ,$20.11 ,$18.28 ,$12.35 ,$98.60 ,$25.94 ,$98.60 ,$32.48 ,$104.40 ,$12.35 ,$95.12 ,$98.02 ,$98.02 ,$12.35 ,$75.40 ,$116.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000208,G0283,HC ELECT STIM (UNATTEND) OTHER 45MIN,420,1 ,$116.00 ,$75.40 ,$12.35 ,$116.00 ,$30.88 ,$75.40 ,$69.25 ,$12.35 ,$32.48 ,$65.08 ,$12.35 ,$76.33 ,$12.35 ,$98.60 ,$98.60 ,$12.35 ,$98.60 ,$23.47 ,$78.88 ,$30.88 ,$12.35 ,$12.35 ,$87.00 ,$82.36 ,$82.36 ,$12.35 ,$82.36 ,$95.12 ,$95.12 ,$95.12 , N/A ,$30.88 ,$98.60 ,$12.35 ,$116.00 ,$69.25 ,$12.35 ,$48.26 ,$20.11 ,$18.28 ,$12.35 ,$98.60 ,$25.94 ,$98.60 ,$32.48 ,$104.40 ,$12.35 ,$95.12 ,$98.02 ,$98.02 ,$12.35 ,$75.40 ,$116.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000209,G0283,HC ELECT STIM (UNATTEND) OTHER 60MIN,420,1 ,$116.00 ,$75.40 ,$12.35 ,$116.00 ,$30.88 ,$75.40 ,$69.25 ,$12.35 ,$32.48 ,$65.08 ,$12.35 ,$76.33 ,$12.35 ,$98.60 ,$98.60 ,$12.35 ,$98.60 ,$23.47 ,$78.88 ,$30.88 ,$12.35 ,$12.35 ,$87.00 ,$82.36 ,$82.36 ,$12.35 ,$82.36 ,$95.12 ,$95.12 ,$95.12 , N/A ,$30.88 ,$98.60 ,$12.35 ,$116.00 ,$69.25 ,$12.35 ,$48.26 ,$20.11 ,$18.28 ,$12.35 ,$98.60 ,$25.94 ,$98.60 ,$32.48 ,$104.40 ,$12.35 ,$95.12 ,$98.02 ,$98.02 ,$12.35 ,$75.40 ,$116.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000210,97016,HC APPLY VASOPNEUMATIC DEVICE 15MIN,420,1 ,$178.00 ,$115.70 ,$12.02 ,$178.00 ,$30.05 ,$115.70 ,$106.27 ,$12.02 ,$49.84 ,$99.86 ,$12.02 ,$117.12 ,$12.02 ,$151.30 ,$151.30 ,$12.02 ,$151.30 ,$22.84 ,$121.04 ,$30.05 ,$12.02 ,$12.02 ,$133.50 ,$126.38 ,$126.38 ,$12.02 ,$126.38 ,$145.96 ,$145.96 ,$145.96 , N/A ,$30.05 ,$151.30 ,$12.02 ,$178.00 ,$106.27 ,$12.02 ,$74.05 ,$20.11 ,$18.28 ,$12.02 ,$151.30 ,$25.24 ,$151.30 ,$49.84 ,$160.20 ,$12.02 ,$145.96 ,$150.41 ,$150.41 ,$12.02 ,$115.70 ,$178.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000211,97016,HC APPLY VASOPNEUMATIC DEVICE 30MIN,420,1 ,$178.00 ,$115.70 ,$12.02 ,$178.00 ,$30.05 ,$115.70 ,$106.27 ,$12.02 ,$49.84 ,$99.86 ,$12.02 ,$117.12 ,$12.02 ,$151.30 ,$151.30 ,$12.02 ,$151.30 ,$22.84 ,$121.04 ,$30.05 ,$12.02 ,$12.02 ,$133.50 ,$126.38 ,$126.38 ,$12.02 ,$126.38 ,$145.96 ,$145.96 ,$145.96 , N/A ,$30.05 ,$151.30 ,$12.02 ,$178.00 ,$106.27 ,$12.02 ,$74.05 ,$20.11 ,$18.28 ,$12.02 ,$151.30 ,$25.24 ,$151.30 ,$49.84 ,$160.20 ,$12.02 ,$145.96 ,$150.41 ,$150.41 ,$12.02 ,$115.70 ,$178.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000212,97016,HC APPLY VASOPNEUMATIC DEVICE 45MIN,420,1 ,$178.00 ,$115.70 ,$12.02 ,$178.00 ,$30.05 ,$115.70 ,$106.27 ,$12.02 ,$49.84 ,$99.86 ,$12.02 ,$117.12 ,$12.02 ,$151.30 ,$151.30 ,$12.02 ,$151.30 ,$22.84 ,$121.04 ,$30.05 ,$12.02 ,$12.02 ,$133.50 ,$126.38 ,$126.38 ,$12.02 ,$126.38 ,$145.96 ,$145.96 ,$145.96 , N/A ,$30.05 ,$151.30 ,$12.02 ,$178.00 ,$106.27 ,$12.02 ,$74.05 ,$20.11 ,$18.28 ,$12.02 ,$151.30 ,$25.24 ,$151.30 ,$49.84 ,$160.20 ,$12.02 ,$145.96 ,$150.41 ,$150.41 ,$12.02 ,$115.70 ,$178.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000213,97016,HC APPLY VASOPNEUMATIC DEVICE 60MIN,420,1 ,$178.00 ,$115.70 ,$12.02 ,$178.00 ,$30.05 ,$115.70 ,$106.27 ,$12.02 ,$49.84 ,$99.86 ,$12.02 ,$117.12 ,$12.02 ,$151.30 ,$151.30 ,$12.02 ,$151.30 ,$22.84 ,$121.04 ,$30.05 ,$12.02 ,$12.02 ,$133.50 ,$126.38 ,$126.38 ,$12.02 ,$126.38 ,$145.96 ,$145.96 ,$145.96 , N/A ,$30.05 ,$151.30 ,$12.02 ,$178.00 ,$106.27 ,$12.02 ,$74.05 ,$20.11 ,$18.28 ,$12.02 ,$151.30 ,$25.24 ,$151.30 ,$49.84 ,$160.20 ,$12.02 ,$145.96 ,$150.41 ,$150.41 ,$12.02 ,$115.70 ,$178.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000214,97012,HC TRACTION MECHANICAL APPL 15 MIN,420,1 ,$170.00 ,$110.50 ,$14.44 ,$170.00 ,$36.10 ,$110.50 ,$101.49 ,$14.44 ,$47.60 ,$95.37 ,$14.44 ,$111.86 ,$14.44 ,$144.50 ,$144.50 ,$14.44 ,$144.50 ,$27.44 ,$115.60 ,$36.10 ,$14.44 ,$14.44 ,$127.50 ,$120.70 ,$120.70 ,$14.44 ,$120.70 ,$139.40 ,$139.40 ,$139.40 , N/A ,$36.10 ,$144.50 ,$14.44 ,$170.00 ,$101.49 ,$14.44 ,$70.72 ,$20.11 ,$18.28 ,$14.44 ,$144.50 ,$30.32 ,$144.50 ,$47.60 ,$153.00 ,$14.44 ,$139.40 ,$143.65 ,$143.65 ,$14.44 ,$110.50 ,$170.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000215,97012,HC TRACTION MECHANICAL APPL 30 MIN,420,1 ,$170.00 ,$110.50 ,$14.44 ,$170.00 ,$36.10 ,$110.50 ,$101.49 ,$14.44 ,$47.60 ,$95.37 ,$14.44 ,$111.86 ,$14.44 ,$144.50 ,$144.50 ,$14.44 ,$144.50 ,$27.44 ,$115.60 ,$36.10 ,$14.44 ,$14.44 ,$127.50 ,$120.70 ,$120.70 ,$14.44 ,$120.70 ,$139.40 ,$139.40 ,$139.40 , N/A ,$36.10 ,$144.50 ,$14.44 ,$170.00 ,$101.49 ,$14.44 ,$70.72 ,$20.11 ,$18.28 ,$14.44 ,$144.50 ,$30.32 ,$144.50 ,$47.60 ,$153.00 ,$14.44 ,$139.40 ,$143.65 ,$143.65 ,$14.44 ,$110.50 ,$170.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000267,N/A,HC THERAPY ASSESSMENT - SELF PAY,420,1 ,$125.00 ,$81.25 ,$35.00 ,$125.00 , N/A ,$81.25 ,$74.63 , N/A ,$35.00 ,$70.13 , N/A ,$82.25 , N/A ,$106.25 ,$106.25 , N/A ,$106.25 , N/A ,$85.00 , N/A , N/A , N/A ,$93.75 ,$88.75 ,$88.75 , N/A ,$88.75 ,$102.50 ,$102.50 ,$102.50 , N/A , N/A ,$106.25 , N/A ,$125.00 ,$74.63 , N/A ,$52.00 , N/A , N/A , N/A ,$106.25 , N/A ,$106.25 ,$35.00 ,$112.50 , N/A ,$102.50 ,$105.63 ,$105.63 , N/A ,$81.25 ,$125.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000268,N/A,HC THERAPY TREATMENT 30MIN - SELF PAY,420,1 ,$75.00 ,$48.75 ,$21.00 ,$75.00 , N/A ,$48.75 ,$44.78 , N/A ,$21.00 ,$42.08 , N/A ,$49.35 , N/A ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$51.00 , N/A , N/A , N/A ,$56.25 ,$53.25 ,$53.25 , N/A ,$53.25 ,$61.50 ,$61.50 ,$61.50 , N/A , N/A ,$63.75 , N/A ,$75.00 ,$44.78 , N/A ,$31.20 , N/A , N/A , N/A ,$63.75 , N/A ,$63.75 ,$21.00 ,$67.50 , N/A ,$61.50 ,$63.38 ,$63.38 , N/A ,$48.75 ,$75.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000269,N/A,HC THERAPY GROUP - SELF PAY,420,1 ,$30.00 ,$19.50 ,$8.40 ,$30.00 , N/A ,$19.50 ,$17.91 , N/A ,$8.40 ,$16.83 , N/A ,$19.74 , N/A ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$20.40 , N/A , N/A , N/A ,$22.50 ,$21.30 ,$21.30 , N/A ,$21.30 ,$24.60 ,$24.60 ,$24.60 , N/A , N/A ,$25.50 , N/A ,$30.00 ,$17.91 , N/A ,$12.48 , N/A , N/A , N/A ,$25.50 , N/A ,$25.50 ,$8.40 ,$27.00 , N/A ,$24.60 ,$25.35 ,$25.35 , N/A ,$19.50 ,$30.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000270,20560,HC NEEDLE INSERTION W/O INJ 1-2 MUSC SELF PAY,420,1 ,$30.00 ,$19.50 ,$8.40 ,$60.90 ,$60.90 ,$19.50 ,$17.91 ,$24.36 ,$8.40 ,$16.83 ,$24.36 ,$19.74 ,$24.36 ,$25.50 ,$25.50 ,$24.36 ,$25.50 ,$30.00 ,$20.40 ,$60.89 ,$24.36 ,$24.36 ,$22.50 ,$21.30 ,$21.30 ,$24.36 ,$21.30 ,$24.60 ,$24.60 ,$24.60 , N/A ,$30.00 ,$25.50 ,$24.36 ,$30.00 ,$17.91 ,$24.36 ,$12.48 ,$20.11 ,$18.28 ,$24.36 ,$25.50 ,$51.15 ,$25.50 ,$8.40 ,$27.00 ,$24.36 ,$24.60 ,$25.35 ,$25.35 ,$24.36 ,$19.50 ,$30.00 
ST. JOSEPH'S HOSPITAL - BREESE,42000271,20561,HC NEEDLE INSERTION W/O INJ 3+ MUSC SELF PAY,420,1 ,$40.00 ,$26.00 ,$11.20 ,$60.90 ,$60.90 ,$26.00 ,$23.88 ,$24.36 ,$11.20 ,$22.44 ,$24.36 ,$26.32 ,$24.36 ,$34.00 ,$34.00 ,$24.36 ,$34.00 ,$40.00 ,$27.20 ,$60.89 ,$24.36 ,$24.36 ,$30.00 ,$28.40 ,$28.40 ,$24.36 ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A ,$40.00 ,$34.00 ,$24.36 ,$40.00 ,$23.88 ,$24.36 ,$16.64 ,$20.11 ,$18.28 ,$24.36 ,$34.00 ,$51.15 ,$34.00 ,$11.20 ,$36.00 ,$24.36 ,$32.80 ,$33.80 ,$33.80 ,$24.36 ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400047,97161,HC PT EVAL LOW COMPLEXITY 75MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400048,97161,HC PT EVAL LOW COMPLEXITY 90MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400049,97161,HC PT EVAL LOW COMPLEXITY 105MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400050,97161,HC PT EVAL LOW COMPLEXITY 120MIN,424,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 ,$244.00 ,$223.70 ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400059,97162,HC PT EVAL MOD COMPLEXITY 75MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400060,97162,HC PT EVAL MOD COMPLEXITY 90MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400061,97162,HC PT EVAL MOD COMPLEXITY 105MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400062,97162,HC PT EVAL MOD COMPLEXITY 120MIN,424,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 ,$246.07 ,$223.70 ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400071,97163,HC PT EVAL HIGH COMPLEXITY 75MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400072,97163,HC PT EVAL HIGH COMPLEXITY 90MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400073,97163,HC PT EVAL HIGH COMPLEXITY 105MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400074,97163,HC PT EVAL HIGH COMPLEXITY 120MIN,424,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 ,$246.07 ,$223.70 ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$165.00 ,$107.25 ,$46.20 ,$173.55 ,$173.55 ,$107.25 ,$98.51 ,$69.42 ,$46.20 ,$92.57 ,$69.42 ,$108.57 ,$69.42 ,$140.25 ,$140.25 ,$69.42 ,$140.25 ,$131.90 ,$112.20 ,$173.55 ,$69.42 ,$69.42 ,$123.75 ,$117.15 ,$117.15 ,$69.42 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.42 ,$165.00 ,$98.51 ,$69.42 ,$68.64 ,$165.00 ,$165.00 ,$69.42 ,$140.25 ,$145.78 ,$140.25 ,$46.20 ,$148.50 ,$69.42 ,$135.30 ,$139.43 ,$139.43 ,$69.42 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$165.00 ,$107.25 ,$46.20 ,$173.55 ,$173.55 ,$107.25 ,$98.51 ,$69.42 ,$46.20 ,$92.57 ,$69.42 ,$108.57 ,$69.42 ,$140.25 ,$140.25 ,$69.42 ,$140.25 ,$131.90 ,$112.20 ,$173.55 ,$69.42 ,$69.42 ,$123.75 ,$117.15 ,$117.15 ,$69.42 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.42 ,$165.00 ,$98.51 ,$69.42 ,$68.64 ,$165.00 ,$165.00 ,$69.42 ,$140.25 ,$145.78 ,$140.25 ,$46.20 ,$148.50 ,$69.42 ,$135.30 ,$139.43 ,$139.43 ,$69.42 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$165.00 ,$107.25 ,$46.20 ,$173.55 ,$173.55 ,$107.25 ,$98.51 ,$69.42 ,$46.20 ,$92.57 ,$69.42 ,$108.57 ,$69.42 ,$140.25 ,$140.25 ,$69.42 ,$140.25 ,$131.90 ,$112.20 ,$173.55 ,$69.42 ,$69.42 ,$123.75 ,$117.15 ,$117.15 ,$69.42 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.42 ,$165.00 ,$98.51 ,$69.42 ,$68.64 ,$165.00 ,$165.00 ,$69.42 ,$140.25 ,$145.78 ,$140.25 ,$46.20 ,$148.50 ,$69.42 ,$135.30 ,$139.43 ,$139.43 ,$69.42 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$165.00 ,$107.25 ,$46.20 ,$173.55 ,$173.55 ,$107.25 ,$98.51 ,$69.42 ,$46.20 ,$92.57 ,$69.42 ,$108.57 ,$69.42 ,$140.25 ,$140.25 ,$69.42 ,$140.25 ,$131.90 ,$112.20 ,$173.55 ,$69.42 ,$69.42 ,$123.75 ,$117.15 ,$117.15 ,$69.42 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.42 ,$165.00 ,$98.51 ,$69.42 ,$68.64 ,$165.00 ,$165.00 ,$69.42 ,$140.25 ,$145.78 ,$140.25 ,$46.20 ,$148.50 ,$69.42 ,$135.30 ,$139.43 ,$139.43 ,$69.42 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000015,97533,HC PERCEPTUAL ACTIVITY EA 15 MIN,430,1 ,$121.00 ,$78.65 ,$33.88 ,$159.33 ,$159.33 ,$78.65 ,$72.24 ,$63.73 ,$33.88 ,$67.88 ,$63.73 ,$79.62 ,$63.73 ,$102.85 ,$102.85 ,$63.73 ,$102.85 ,$121.00 ,$82.28 ,$159.33 ,$63.73 ,$63.73 ,$90.75 ,$85.91 ,$85.91 ,$63.73 ,$85.91 ,$99.22 ,$99.22 ,$99.22 , N/A ,$121.00 ,$102.85 ,$63.73 ,$121.00 ,$72.24 ,$63.73 ,$50.34 ,$121.00 ,$121.00 ,$63.73 ,$102.85 ,$133.83 ,$102.85 ,$33.88 ,$108.90 ,$63.73 ,$99.22 ,$102.25 ,$102.25 ,$63.73 ,$78.65 ,$121.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$110.00 ,$71.50 ,$30.80 ,$110.00 ,$82.55 ,$71.50 ,$65.67 ,$33.02 ,$30.80 ,$61.71 ,$33.02 ,$72.38 ,$33.02 ,$93.50 ,$93.50 ,$33.02 ,$93.50 ,$62.74 ,$74.80 ,$82.55 ,$33.02 ,$33.02 ,$82.50 ,$78.10 ,$78.10 ,$33.02 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$82.55 ,$93.50 ,$33.02 ,$110.00 ,$65.67 ,$33.02 ,$45.76 ,$110.00 ,$110.00 ,$33.02 ,$93.50 ,$69.34 ,$93.50 ,$30.80 ,$99.00 ,$33.02 ,$90.20 ,$92.95 ,$92.95 ,$33.02 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$171.00 ,$111.15 ,$47.88 ,$171.00 ,$121.10 ,$111.15 ,$102.09 ,$48.44 ,$47.88 ,$95.93 ,$48.44 ,$112.52 ,$48.44 ,$145.35 ,$145.35 ,$48.44 ,$145.35 ,$92.04 ,$116.28 ,$121.10 ,$48.44 ,$48.44 ,$128.25 ,$121.41 ,$121.41 ,$48.44 ,$121.41 ,$140.22 ,$140.22 ,$140.22 , N/A ,$121.10 ,$145.35 ,$48.44 ,$171.00 ,$102.09 ,$48.44 ,$71.14 ,$171.00 ,$171.00 ,$48.44 ,$145.35 ,$101.72 ,$145.35 ,$47.88 ,$153.90 ,$48.44 ,$140.22 ,$144.50 ,$144.50 ,$48.44 ,$111.15 ,$171.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000035,97545,HC WORK HARDENING/CONDITIONING FIRST 2 HRS,430,1 ,$486.00 ,$315.90 ,$136.08 ,$486.00 , N/A ,$315.90 ,$290.14 , N/A ,$136.08 ,$272.65 , N/A ,$319.79 , N/A ,$413.10 ,$413.10 , N/A ,$413.10 , N/A ,$330.48 , N/A , N/A , N/A ,$364.50 ,$345.06 ,$345.06 , N/A ,$345.06 ,$398.52 ,$398.52 ,$398.52 , N/A , N/A ,$413.10 , N/A ,$486.00 ,$290.14 , N/A ,$202.18 ,$246.07 ,$223.70 , N/A ,$413.10 , N/A ,$413.10 ,$136.08 ,$437.40 , N/A ,$398.52 ,$410.67 ,$410.67 , N/A ,$315.90 ,$486.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000036,97546,HC WORK HARDENING/CONDITIONINS ADD 1 HOUR,430,1 ,$149.00 ,$96.85 ,$41.72 ,$149.00 , N/A ,$96.85 ,$88.95 , N/A ,$41.72 ,$83.59 , N/A ,$98.04 , N/A ,$126.65 ,$126.65 , N/A ,$126.65 , N/A ,$101.32 , N/A , N/A , N/A ,$111.75 ,$105.79 ,$105.79 , N/A ,$105.79 ,$122.18 ,$122.18 ,$122.18 , N/A , N/A ,$126.65 , N/A ,$149.00 ,$88.95 , N/A ,$61.98 ,$149.00 ,$149.00 , N/A ,$126.65 , N/A ,$126.65 ,$41.72 ,$134.10 , N/A ,$122.18 ,$125.91 ,$125.91 , N/A ,$96.85 ,$149.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000038,97018,HC PARAFFIN BATH THERAPY 15MIN,430,1 ,$137.00 ,$89.05 ,$5.91 ,$137.00 ,$14.78 ,$89.05 ,$81.79 ,$5.91 ,$38.36 ,$76.86 ,$5.91 ,$90.15 ,$5.91 ,$116.45 ,$116.45 ,$5.91 ,$116.45 ,$11.23 ,$93.16 ,$14.78 ,$5.91 ,$5.91 ,$102.75 ,$97.27 ,$97.27 ,$5.91 ,$97.27 ,$112.34 ,$112.34 ,$112.34 , N/A ,$14.78 ,$116.45 ,$5.91 ,$137.00 ,$81.79 ,$5.91 ,$56.99 ,$20.11 ,$18.28 ,$5.91 ,$116.45 ,$12.41 ,$116.45 ,$38.36 ,$123.30 ,$5.91 ,$112.34 ,$115.77 ,$115.77 ,$5.91 ,$89.05 ,$137.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000039,97018,HC PARAFFIN BATH THERAPY 30MIN,430,1 ,$137.00 ,$89.05 ,$5.91 ,$137.00 ,$14.78 ,$89.05 ,$81.79 ,$5.91 ,$38.36 ,$76.86 ,$5.91 ,$90.15 ,$5.91 ,$116.45 ,$116.45 ,$5.91 ,$116.45 ,$11.23 ,$93.16 ,$14.78 ,$5.91 ,$5.91 ,$102.75 ,$97.27 ,$97.27 ,$5.91 ,$97.27 ,$112.34 ,$112.34 ,$112.34 , N/A ,$14.78 ,$116.45 ,$5.91 ,$137.00 ,$81.79 ,$5.91 ,$56.99 ,$20.11 ,$18.28 ,$5.91 ,$116.45 ,$12.41 ,$116.45 ,$38.36 ,$123.30 ,$5.91 ,$112.34 ,$115.77 ,$115.77 ,$5.91 ,$89.05 ,$137.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000049,95852,HC RANGE OF MOTION TESTING HAND,430,1 ,$40.00 ,$26.00 ,$11.20 ,$42.75 ,$42.75 ,$26.00 ,$23.88 ,$17.10 ,$11.20 ,$22.44 ,$17.10 ,$26.32 ,$17.10 ,$34.00 ,$34.00 ,$17.10 ,$34.00 ,$32.49 ,$27.20 ,$42.75 ,$17.10 ,$17.10 ,$30.00 ,$28.40 ,$28.40 ,$17.10 ,$28.40 ,$32.80 ,$32.80 ,$32.80 , N/A ,$40.00 ,$34.00 ,$17.10 ,$40.00 ,$23.88 ,$17.10 ,$16.64 , N/A , N/A ,$17.10 ,$34.00 ,$35.91 ,$34.00 ,$11.20 ,$36.00 ,$17.10 ,$32.80 ,$33.80 ,$33.80 ,$17.10 ,$26.00 ,$40.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$89.00 ,$57.85 ,$18.28 ,$89.00 ,$58.35 ,$57.85 ,$53.13 ,$23.34 ,$24.92 ,$49.93 ,$23.34 ,$58.56 ,$23.34 ,$75.65 ,$75.65 ,$23.34 ,$75.65 ,$44.35 ,$60.52 ,$58.35 ,$23.34 ,$23.34 ,$66.75 ,$63.19 ,$63.19 ,$23.34 ,$63.19 ,$72.98 ,$72.98 ,$72.98 , N/A ,$58.35 ,$75.65 ,$23.34 ,$89.00 ,$53.13 ,$23.34 ,$37.02 ,$20.11 ,$18.28 ,$23.34 ,$75.65 ,$49.01 ,$75.65 ,$24.92 ,$80.10 ,$23.34 ,$72.98 ,$75.21 ,$75.21 ,$23.34 ,$57.85 ,$89.00 
ST. JOSEPH'S HOSPITAL - BREESE,43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$89.00 ,$57.85 ,$18.28 ,$89.00 ,$56.63 ,$57.85 ,$53.13 ,$22.65 ,$24.92 ,$49.93 ,$22.65 ,$58.56 ,$22.65 ,$75.65 ,$75.65 ,$22.65 ,$75.65 ,$43.04 ,$60.52 ,$56.63 ,$22.65 ,$22.65 ,$66.75 ,$63.19 ,$63.19 ,$22.65 ,$63.19 ,$72.98 ,$72.98 ,$72.98 , N/A ,$56.63 ,$75.65 ,$22.65 ,$89.00 ,$53.13 ,$22.65 ,$37.02 ,$20.11 ,$18.28 ,$22.65 ,$75.65 ,$47.57 ,$75.65 ,$24.92 ,$80.10 ,$22.65 ,$72.98 ,$75.21 ,$75.21 ,$22.65 ,$57.85 ,$89.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400038,97165,HC OT EVAL LOW COMPLEXITY 75MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400039,97165,HC OT EVAL LOW COMPLEXITY 90MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400040,97165,HC OT EVAL LOW COMPLEXITY 105MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400041,97165,HC OT EVAL LOW COMPLEXITY 120MIN,434,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 ,$244.00 ,$244.00 ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400050,97166,HC OT EVAL MOD COMPLEXITY 75MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400051,97166,HC OT EVAL MOD COMPLEXITY 90MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400052,97166,HC OT EVAL MOD COMPLEXITY 105MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400053,97166,HC OT EVAL MOD COMPLEXITY 120MIN,434,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 ,$300.00 ,$300.00 ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400062,97167,HC OT EVAL HIGH COMPLEXITY 75MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400063,97167,HC OT EVAL HIGH COMPLEXITY 90MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400064,97167,HC OT EVAL HIGH COMPLEXITY 105MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400065,97167,HC OT EVAL HIGH COMPLEXITY 120MIN,434,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 ,$391.44 ,$355.85 ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$165.00 ,$107.25 ,$46.20 ,$174.38 ,$174.38 ,$107.25 ,$98.51 ,$69.75 ,$46.20 ,$92.57 ,$69.75 ,$108.57 ,$69.75 ,$140.25 ,$140.25 ,$69.75 ,$140.25 ,$132.53 ,$112.20 ,$174.38 ,$69.75 ,$69.75 ,$123.75 ,$117.15 ,$117.15 ,$69.75 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.75 ,$165.00 ,$98.51 ,$69.75 ,$68.64 ,$165.00 ,$165.00 ,$69.75 ,$140.25 ,$146.48 ,$140.25 ,$46.20 ,$148.50 ,$69.75 ,$135.30 ,$139.43 ,$139.43 ,$69.75 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$165.00 ,$107.25 ,$46.20 ,$174.38 ,$174.38 ,$107.25 ,$98.51 ,$69.75 ,$46.20 ,$92.57 ,$69.75 ,$108.57 ,$69.75 ,$140.25 ,$140.25 ,$69.75 ,$140.25 ,$132.53 ,$112.20 ,$174.38 ,$69.75 ,$69.75 ,$123.75 ,$117.15 ,$117.15 ,$69.75 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.75 ,$165.00 ,$98.51 ,$69.75 ,$68.64 ,$165.00 ,$165.00 ,$69.75 ,$140.25 ,$146.48 ,$140.25 ,$46.20 ,$148.50 ,$69.75 ,$135.30 ,$139.43 ,$139.43 ,$69.75 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$165.00 ,$107.25 ,$46.20 ,$174.38 ,$174.38 ,$107.25 ,$98.51 ,$69.75 ,$46.20 ,$92.57 ,$69.75 ,$108.57 ,$69.75 ,$140.25 ,$140.25 ,$69.75 ,$140.25 ,$132.53 ,$112.20 ,$174.38 ,$69.75 ,$69.75 ,$123.75 ,$117.15 ,$117.15 ,$69.75 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.75 ,$165.00 ,$98.51 ,$69.75 ,$68.64 ,$165.00 ,$165.00 ,$69.75 ,$140.25 ,$146.48 ,$140.25 ,$46.20 ,$148.50 ,$69.75 ,$135.30 ,$139.43 ,$139.43 ,$69.75 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$165.00 ,$107.25 ,$46.20 ,$174.38 ,$174.38 ,$107.25 ,$98.51 ,$69.75 ,$46.20 ,$92.57 ,$69.75 ,$108.57 ,$69.75 ,$140.25 ,$140.25 ,$69.75 ,$140.25 ,$132.53 ,$112.20 ,$174.38 ,$69.75 ,$69.75 ,$123.75 ,$117.15 ,$117.15 ,$69.75 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.75 ,$165.00 ,$98.51 ,$69.75 ,$68.64 ,$165.00 ,$165.00 ,$69.75 ,$140.25 ,$146.48 ,$140.25 ,$46.20 ,$148.50 ,$69.75 ,$135.30 ,$139.43 ,$139.43 ,$69.75 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 ,$132.00 ,$132.00 ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 ,$132.00 ,$132.00 ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 ,$132.00 ,$132.00 ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 ,$132.00 ,$132.00 ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$144.00 ,$93.60 ,$40.32 ,$214.40 ,$214.40 ,$93.60 ,$85.97 ,$85.76 ,$40.32 ,$80.78 ,$85.76 ,$94.75 ,$85.76 ,$122.40 ,$122.40 ,$85.76 ,$122.40 ,$144.00 ,$97.92 ,$214.40 ,$85.76 ,$85.76 ,$108.00 ,$102.24 ,$102.24 ,$85.76 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$144.00 ,$122.40 ,$85.76 ,$144.00 ,$85.97 ,$85.76 ,$59.90 ,$144.00 ,$144.00 ,$85.76 ,$122.40 ,$180.10 ,$122.40 ,$40.32 ,$129.60 ,$85.76 ,$118.08 ,$121.68 ,$121.68 ,$85.76 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$144.00 ,$93.60 ,$40.32 ,$214.40 ,$214.40 ,$93.60 ,$85.97 ,$85.76 ,$40.32 ,$80.78 ,$85.76 ,$94.75 ,$85.76 ,$122.40 ,$122.40 ,$85.76 ,$122.40 ,$144.00 ,$97.92 ,$214.40 ,$85.76 ,$85.76 ,$108.00 ,$102.24 ,$102.24 ,$85.76 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$144.00 ,$122.40 ,$85.76 ,$144.00 ,$85.97 ,$85.76 ,$59.90 ,$144.00 ,$144.00 ,$85.76 ,$122.40 ,$180.10 ,$122.40 ,$40.32 ,$129.60 ,$85.76 ,$118.08 ,$121.68 ,$121.68 ,$85.76 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$144.00 ,$93.60 ,$40.32 ,$214.40 ,$214.40 ,$93.60 ,$85.97 ,$85.76 ,$40.32 ,$80.78 ,$85.76 ,$94.75 ,$85.76 ,$122.40 ,$122.40 ,$85.76 ,$122.40 ,$144.00 ,$97.92 ,$214.40 ,$85.76 ,$85.76 ,$108.00 ,$102.24 ,$102.24 ,$85.76 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$144.00 ,$122.40 ,$85.76 ,$144.00 ,$85.97 ,$85.76 ,$59.90 ,$144.00 ,$144.00 ,$85.76 ,$122.40 ,$180.10 ,$122.40 ,$40.32 ,$129.60 ,$85.76 ,$118.08 ,$121.68 ,$121.68 ,$85.76 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$144.00 ,$93.60 ,$40.32 ,$214.40 ,$214.40 ,$93.60 ,$85.97 ,$85.76 ,$40.32 ,$80.78 ,$85.76 ,$94.75 ,$85.76 ,$122.40 ,$122.40 ,$85.76 ,$122.40 ,$144.00 ,$97.92 ,$214.40 ,$85.76 ,$85.76 ,$108.00 ,$102.24 ,$102.24 ,$85.76 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$144.00 ,$122.40 ,$85.76 ,$144.00 ,$85.97 ,$85.76 ,$59.90 ,$144.00 ,$144.00 ,$85.76 ,$122.40 ,$180.10 ,$122.40 ,$40.32 ,$129.60 ,$85.76 ,$118.08 ,$121.68 ,$121.68 ,$85.76 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$260.00 ,$216.25 ,$169.00 ,$155.22 ,$86.50 ,$72.80 ,$145.86 ,$86.50 ,$171.08 ,$86.50 ,$221.00 ,$221.00 ,$86.50 ,$221.00 ,$164.35 ,$176.80 ,$216.25 ,$86.50 ,$86.50 ,$195.00 ,$184.60 ,$184.60 ,$86.50 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$216.25 ,$221.00 ,$86.50 ,$260.00 ,$155.22 ,$86.50 ,$108.16 ,$181.89 ,$165.35 ,$86.50 ,$221.00 ,$181.65 ,$221.00 ,$72.80 ,$234.00 ,$86.50 ,$213.20 ,$219.70 ,$219.70 ,$86.50 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$260.00 ,$216.25 ,$169.00 ,$155.22 ,$86.50 ,$72.80 ,$145.86 ,$86.50 ,$171.08 ,$86.50 ,$221.00 ,$221.00 ,$86.50 ,$221.00 ,$164.35 ,$176.80 ,$216.25 ,$86.50 ,$86.50 ,$195.00 ,$184.60 ,$184.60 ,$86.50 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$216.25 ,$221.00 ,$86.50 ,$260.00 ,$155.22 ,$86.50 ,$108.16 ,$181.89 ,$165.35 ,$86.50 ,$221.00 ,$181.65 ,$221.00 ,$72.80 ,$234.00 ,$86.50 ,$213.20 ,$219.70 ,$219.70 ,$86.50 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$260.00 ,$216.25 ,$169.00 ,$155.22 ,$86.50 ,$72.80 ,$145.86 ,$86.50 ,$171.08 ,$86.50 ,$221.00 ,$221.00 ,$86.50 ,$221.00 ,$164.35 ,$176.80 ,$216.25 ,$86.50 ,$86.50 ,$195.00 ,$184.60 ,$184.60 ,$86.50 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$216.25 ,$221.00 ,$86.50 ,$260.00 ,$155.22 ,$86.50 ,$108.16 ,$181.89 ,$165.35 ,$86.50 ,$221.00 ,$181.65 ,$221.00 ,$72.80 ,$234.00 ,$86.50 ,$213.20 ,$219.70 ,$219.70 ,$86.50 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$260.00 ,$216.25 ,$169.00 ,$155.22 ,$86.50 ,$72.80 ,$145.86 ,$86.50 ,$171.08 ,$86.50 ,$221.00 ,$221.00 ,$86.50 ,$221.00 ,$164.35 ,$176.80 ,$216.25 ,$86.50 ,$86.50 ,$195.00 ,$184.60 ,$184.60 ,$86.50 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$216.25 ,$221.00 ,$86.50 ,$260.00 ,$155.22 ,$86.50 ,$108.16 ,$181.89 ,$165.35 ,$86.50 ,$221.00 ,$181.65 ,$221.00 ,$72.80 ,$234.00 ,$86.50 ,$213.20 ,$219.70 ,$219.70 ,$86.50 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$489.00 ,$317.85 ,$36.84 ,$489.00 ,$233.18 ,$317.85 ,$291.93 ,$93.27 ,$136.92 ,$274.33 ,$93.27 ,$321.76 ,$93.27 ,$415.65 ,$415.65 ,$93.27 ,$415.65 ,$177.21 ,$332.52 ,$233.18 ,$93.27 ,$93.27 ,$366.75 ,$347.19 ,$347.19 ,$93.27 ,$347.19 ,$400.98 ,$400.98 ,$400.98 , N/A ,$233.18 ,$415.65 ,$93.27 ,$489.00 ,$291.93 ,$93.27 ,$203.42 ,$40.52 ,$36.84 ,$93.27 ,$415.65 ,$195.87 ,$415.65 ,$136.92 ,$440.10 ,$93.27 ,$400.98 ,$413.21 ,$413.21 ,$93.27 ,$317.85 ,$489.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400040,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN,444,1 ,$256.00 ,$166.40 ,$71.68 ,$336.30 ,$336.30 ,$166.40 ,$152.83 ,$134.52 ,$71.68 ,$143.62 ,$134.52 ,$168.45 ,$134.52 ,$217.60 ,$217.60 ,$134.52 ,$217.60 ,$255.59 ,$174.08 ,$336.30 ,$134.52 ,$134.52 ,$192.00 ,$181.76 ,$181.76 ,$134.52 ,$181.76 ,$209.92 ,$209.92 ,$209.92 , N/A ,$256.00 ,$217.60 ,$134.52 ,$256.00 ,$152.83 ,$134.52 ,$106.50 ,$181.89 ,$165.35 ,$134.52 ,$217.60 ,$282.49 ,$217.60 ,$71.68 ,$230.40 ,$134.52 ,$209.92 ,$216.32 ,$216.32 ,$134.52 ,$166.40 ,$256.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$571.95 ,$571.95 ,$169.00 ,$155.22 ,$228.78 ,$72.80 ,$145.86 ,$228.78 ,$171.08 ,$228.78 ,$221.00 ,$221.00 ,$228.78 ,$221.00 ,$260.00 ,$176.80 ,$571.95 ,$228.78 ,$228.78 ,$195.00 ,$184.60 ,$184.60 ,$228.78 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$228.78 ,$260.00 ,$155.22 ,$228.78 ,$108.16 ,$181.89 ,$165.35 ,$228.78 ,$221.00 ,$480.44 ,$221.00 ,$72.80 ,$234.00 ,$228.78 ,$213.20 ,$219.70 ,$219.70 ,$228.78 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400043,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 15MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$279.28 ,$279.28 ,$169.00 ,$155.22 ,$111.71 ,$72.80 ,$145.86 ,$111.71 ,$171.08 ,$111.71 ,$221.00 ,$221.00 ,$111.71 ,$221.00 ,$212.25 ,$176.80 ,$279.28 ,$111.71 ,$111.71 ,$195.00 ,$184.60 ,$184.60 ,$111.71 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$111.71 ,$260.00 ,$155.22 ,$111.71 ,$108.16 ,$181.89 ,$165.35 ,$111.71 ,$221.00 ,$234.59 ,$221.00 ,$72.80 ,$234.00 ,$111.71 ,$213.20 ,$219.70 ,$219.70 ,$111.71 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$256.00 ,$166.40 ,$71.68 ,$336.30 ,$336.30 ,$166.40 ,$152.83 ,$134.52 ,$71.68 ,$143.62 ,$134.52 ,$168.45 ,$134.52 ,$217.60 ,$217.60 ,$134.52 ,$217.60 ,$255.59 ,$174.08 ,$336.30 ,$134.52 ,$134.52 ,$192.00 ,$181.76 ,$181.76 ,$134.52 ,$181.76 ,$209.92 ,$209.92 ,$209.92 , N/A ,$256.00 ,$217.60 ,$134.52 ,$256.00 ,$152.83 ,$134.52 ,$106.50 ,$181.89 ,$165.35 ,$134.52 ,$217.60 ,$282.49 ,$217.60 ,$71.68 ,$230.40 ,$134.52 ,$209.92 ,$216.32 ,$216.32 ,$134.52 ,$166.40 ,$256.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$256.00 ,$166.40 ,$71.68 ,$336.30 ,$336.30 ,$166.40 ,$152.83 ,$134.52 ,$71.68 ,$143.62 ,$134.52 ,$168.45 ,$134.52 ,$217.60 ,$217.60 ,$134.52 ,$217.60 ,$255.59 ,$174.08 ,$336.30 ,$134.52 ,$134.52 ,$192.00 ,$181.76 ,$181.76 ,$134.52 ,$181.76 ,$209.92 ,$209.92 ,$209.92 , N/A ,$256.00 ,$217.60 ,$134.52 ,$256.00 ,$152.83 ,$134.52 ,$106.50 ,$181.89 ,$165.35 ,$134.52 ,$217.60 ,$282.49 ,$217.60 ,$71.68 ,$230.40 ,$134.52 ,$209.92 ,$216.32 ,$216.32 ,$134.52 ,$166.40 ,$256.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$571.95 ,$571.95 ,$169.00 ,$155.22 ,$228.78 ,$72.80 ,$145.86 ,$228.78 ,$171.08 ,$228.78 ,$221.00 ,$221.00 ,$228.78 ,$221.00 ,$260.00 ,$176.80 ,$571.95 ,$228.78 ,$228.78 ,$195.00 ,$184.60 ,$184.60 ,$228.78 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$228.78 ,$260.00 ,$155.22 ,$228.78 ,$108.16 ,$181.89 ,$165.35 ,$228.78 ,$221.00 ,$480.44 ,$221.00 ,$72.80 ,$234.00 ,$228.78 ,$213.20 ,$219.70 ,$219.70 ,$228.78 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$571.95 ,$571.95 ,$169.00 ,$155.22 ,$228.78 ,$72.80 ,$145.86 ,$228.78 ,$171.08 ,$228.78 ,$221.00 ,$221.00 ,$228.78 ,$221.00 ,$260.00 ,$176.80 ,$571.95 ,$228.78 ,$228.78 ,$195.00 ,$184.60 ,$184.60 ,$228.78 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$228.78 ,$260.00 ,$155.22 ,$228.78 ,$108.16 ,$181.89 ,$165.35 ,$228.78 ,$221.00 ,$480.44 ,$221.00 ,$72.80 ,$234.00 ,$228.78 ,$213.20 ,$219.70 ,$219.70 ,$228.78 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$571.95 ,$571.95 ,$169.00 ,$155.22 ,$228.78 ,$72.80 ,$145.86 ,$228.78 ,$171.08 ,$228.78 ,$221.00 ,$221.00 ,$228.78 ,$221.00 ,$260.00 ,$176.80 ,$571.95 ,$228.78 ,$228.78 ,$195.00 ,$184.60 ,$184.60 ,$228.78 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$228.78 ,$260.00 ,$155.22 ,$228.78 ,$108.16 ,$181.89 ,$165.35 ,$228.78 ,$221.00 ,$480.44 ,$221.00 ,$72.80 ,$234.00 ,$228.78 ,$213.20 ,$219.70 ,$219.70 ,$228.78 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$279.28 ,$279.28 ,$169.00 ,$155.22 ,$111.71 ,$72.80 ,$145.86 ,$111.71 ,$171.08 ,$111.71 ,$221.00 ,$221.00 ,$111.71 ,$221.00 ,$212.25 ,$176.80 ,$279.28 ,$111.71 ,$111.71 ,$195.00 ,$184.60 ,$184.60 ,$111.71 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$111.71 ,$260.00 ,$155.22 ,$111.71 ,$108.16 ,$181.89 ,$165.35 ,$111.71 ,$221.00 ,$234.59 ,$221.00 ,$72.80 ,$234.00 ,$111.71 ,$213.20 ,$219.70 ,$219.70 ,$111.71 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$279.28 ,$279.28 ,$169.00 ,$155.22 ,$111.71 ,$72.80 ,$145.86 ,$111.71 ,$171.08 ,$111.71 ,$221.00 ,$221.00 ,$111.71 ,$221.00 ,$212.25 ,$176.80 ,$279.28 ,$111.71 ,$111.71 ,$195.00 ,$184.60 ,$184.60 ,$111.71 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$111.71 ,$260.00 ,$155.22 ,$111.71 ,$108.16 ,$181.89 ,$165.35 ,$111.71 ,$221.00 ,$234.59 ,$221.00 ,$72.80 ,$234.00 ,$111.71 ,$213.20 ,$219.70 ,$219.70 ,$111.71 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$260.00 ,$169.00 ,$72.80 ,$279.28 ,$279.28 ,$169.00 ,$155.22 ,$111.71 ,$72.80 ,$145.86 ,$111.71 ,$171.08 ,$111.71 ,$221.00 ,$221.00 ,$111.71 ,$221.00 ,$212.25 ,$176.80 ,$279.28 ,$111.71 ,$111.71 ,$195.00 ,$184.60 ,$184.60 ,$111.71 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$111.71 ,$260.00 ,$155.22 ,$111.71 ,$108.16 ,$181.89 ,$165.35 ,$111.71 ,$221.00 ,$234.59 ,$221.00 ,$72.80 ,$234.00 ,$111.71 ,$213.20 ,$219.70 ,$219.70 ,$111.71 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$816.00 ,$530.40 ,$228.48 ,$851.90 ,$851.90 ,$530.40 ,$487.15 ,$340.76 ,$228.48 ,$457.78 ,$340.76 ,$536.93 ,$340.76 ,$693.60 ,$693.60 ,$340.76 ,$693.60 ,$647.44 ,$554.88 ,$851.90 ,$340.76 ,$340.76 ,$612.00 ,$579.36 ,$579.36 ,$340.76 ,$579.36 ,$669.12 ,$669.12 ,$669.12 , N/A ,$816.00 ,$693.60 ,$340.76 ,$816.00 ,$487.15 ,$340.76 ,$339.46 , N/A , N/A ,$340.76 ,$693.60 ,$715.59 ,$693.60 ,$228.48 ,$734.40 ,$340.76 ,$669.12 ,$325.00 ,$325.00 ,$340.76 ,$530.40 ,$816.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$816.00 ,$530.40 ,$228.48 ,"$1,533.75 ","$1,533.75 ",$530.40 ,$487.15 ,$613.50 ,$228.48 ,$457.78 ,$613.50 ,$536.93 ,$613.50 ,$693.60 ,$693.60 ,$613.50 ,$693.60 ,$816.00 ,$554.88 ,"$1,533.75 ",$613.50 ,$613.50 ,$612.00 ,$579.36 ,$579.36 ,$613.50 ,$579.36 ,$669.12 ,$669.12 ,$669.12 , N/A ,$816.00 ,$693.60 ,$613.50 ,$816.00 ,$487.15 ,$613.50 ,$339.46 , N/A , N/A ,$613.50 ,$693.60 ,"$1,288.35 ",$693.60 ,$228.48 ,$734.40 ,$613.50 ,$669.12 ,$325.00 ,$325.00 ,$613.50 ,$530.40 ,$816.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000004,10081,HC I AND D CYST PILONIDAL CPLX,450,1 ,"$1,749.00 ","$1,136.85 ",$325.00 ,"$1,749.00 ","$1,533.75 ","$1,136.85 ","$1,044.15 ",$613.50 ,$489.72 ,$981.19 ,$613.50 ,"$1,150.84 ",$613.50 ,"$1,486.65 ","$1,486.65 ",$613.50 ,"$1,486.65 ","$1,165.65 ","$1,189.32 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,311.75 ","$1,241.79 ","$1,241.79 ",$613.50 ,"$1,241.79 ","$1,434.18 ","$1,434.18 ","$1,434.18 ", N/A ,"$1,533.75 ","$1,486.65 ",$613.50 ,"$1,749.00 ","$1,044.15 ",$613.50 ,$727.58 , N/A , N/A ,$613.50 ,"$1,486.65 ","$1,288.35 ","$1,486.65 ",$489.72 ,"$1,574.10 ",$613.50 ,"$1,434.18 ",$325.00 ,$325.00 ,$613.50 ,"$1,136.85 ","$1,749.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$806.00 ,$523.90 ,$225.68 ,$851.90 ,$851.90 ,$523.90 ,$481.18 ,$340.76 ,$225.68 ,$452.17 ,$340.76 ,$530.35 ,$340.76 ,$685.10 ,$685.10 ,$340.76 ,$685.10 ,$647.44 ,$548.08 ,$851.90 ,$340.76 ,$340.76 ,$604.50 ,$572.26 ,$572.26 ,$340.76 ,$572.26 ,$660.92 ,$660.92 ,$660.92 , N/A ,$806.00 ,$685.10 ,$340.76 ,$806.00 ,$481.18 ,$340.76 ,$335.30 , N/A , N/A ,$340.76 ,$685.10 ,$715.59 ,$685.10 ,$225.68 ,$725.40 ,$340.76 ,$660.92 ,$325.00 ,$325.00 ,$340.76 ,$523.90 ,$806.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$422.00 ,$274.30 ,$118.16 ,$442.60 ,$442.60 ,$274.30 ,$251.93 ,$177.04 ,$118.16 ,$236.74 ,$177.04 ,$277.68 ,$177.04 ,$358.70 ,$358.70 ,$177.04 ,$358.70 ,$336.38 ,$286.96 ,$442.60 ,$177.04 ,$177.04 ,$316.50 ,$299.62 ,$299.62 ,$177.04 ,$299.62 ,$346.04 ,$346.04 ,$346.04 , N/A ,$422.00 ,$358.70 ,$177.04 ,$422.00 ,$251.93 ,$177.04 ,$175.55 , N/A , N/A ,$177.04 ,$358.70 ,$371.78 ,$358.70 ,$118.16 ,$379.80 ,$177.04 ,$346.04 ,$325.00 ,$325.00 ,$177.04 ,$274.30 ,$422.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000010,11732,HC AVULSION NAIL PL PT/CO EA ADDL FAC,450,1 ,$182.00 ,$118.30 ,$50.96 ,$182.00 , N/A ,$118.30 ,$108.65 , N/A ,$50.96 ,$102.10 , N/A ,$119.76 , N/A ,$154.70 ,$154.70 , N/A ,$154.70 , N/A ,$123.76 , N/A , N/A , N/A ,$136.50 ,$129.22 ,$129.22 , N/A ,$129.22 ,$149.24 ,$149.24 ,$149.24 , N/A , N/A ,$154.70 , N/A ,$182.00 ,$108.65 , N/A ,$75.71 , N/A , N/A , N/A ,$154.70 , N/A ,$154.70 ,$50.96 ,$163.80 , N/A ,$149.24 ,$182.00 ,$182.00 , N/A ,$118.30 ,$182.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$187.00 ,$121.55 ,$52.36 ,$277.93 ,$277.93 ,$121.55 ,$111.64 ,$111.17 ,$52.36 ,$104.91 ,$111.17 ,$123.05 ,$111.17 ,$158.95 ,$158.95 ,$111.17 ,$158.95 ,$187.00 ,$127.16 ,$277.92 ,$111.17 ,$111.17 ,$140.25 ,$132.77 ,$132.77 ,$111.17 ,$132.77 ,$153.34 ,$153.34 ,$153.34 , N/A ,$187.00 ,$158.95 ,$111.17 ,$187.00 ,$111.64 ,$111.17 ,$77.79 , N/A , N/A ,$111.17 ,$158.95 ,$233.45 ,$158.95 ,$52.36 ,$168.30 ,$111.17 ,$153.34 ,$187.00 ,$187.00 ,$111.17 ,$121.55 ,$187.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000012,11760,HC REPAIR NAIL BED,450,1 ,"$1,440.00 ",$936.00 ,$325.00 ,"$1,440.00 ","$1,290.85 ",$936.00 ,$859.68 ,$516.34 ,$403.20 ,$807.84 ,$516.34 ,$947.52 ,$516.34 ,"$1,224.00 ","$1,224.00 ",$516.34 ,"$1,224.00 ",$981.05 ,$979.20 ,"$1,290.85 ",$516.34 ,$516.34 ,"$1,080.00 ","$1,022.40 ","$1,022.40 ",$516.34 ,"$1,022.40 ","$1,180.80 ","$1,180.80 ","$1,180.80 ", N/A ,"$1,290.85 ","$1,224.00 ",$516.34 ,"$1,440.00 ",$859.68 ,$516.34 ,$599.04 , N/A , N/A ,$516.34 ,"$1,224.00 ","$1,084.31 ","$1,224.00 ",$403.20 ,"$1,296.00 ",$516.34 ,"$1,180.80 ",$325.00 ,$325.00 ,$516.34 ,$936.00 ,"$1,440.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,$304.00 ,$197.60 ,$85.12 ,$851.90 ,$851.90 ,$197.60 ,$181.49 ,$340.76 ,$85.12 ,$170.54 ,$340.76 ,$200.03 ,$304.00 ,$258.40 ,$258.40 ,$304.00 ,$258.40 ,$304.00 ,$206.72 ,$851.90 ,$340.76 ,$340.76 ,$228.00 ,$215.84 ,$215.84 ,$340.76 ,$215.84 ,$249.28 ,$249.28 ,$249.28 , N/A ,$304.00 ,$258.40 ,$340.76 ,$304.00 ,$181.49 ,$340.76 ,$126.46 , N/A , N/A ,$340.76 ,$258.40 ,$715.59 ,$258.40 ,$85.12 ,$273.60 ,$340.76 ,$249.28 ,$304.00 ,$304.00 ,$340.76 ,$197.60 ,$304.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$306.00 ,$198.90 ,$85.68 ,$442.60 ,$442.60 ,$198.90 ,$182.68 ,$177.04 ,$85.68 ,$171.67 ,$177.04 ,$201.35 ,$177.04 ,$260.10 ,$260.10 ,$177.04 ,$260.10 ,$306.00 ,$208.08 ,$442.60 ,$177.04 ,$177.04 ,$229.50 ,$217.26 ,$217.26 ,$177.04 ,$217.26 ,$250.92 ,$250.92 ,$250.92 , N/A ,$306.00 ,$260.10 ,$177.04 ,$306.00 ,$182.68 ,$177.04 ,$127.30 , N/A , N/A ,$177.04 ,$260.10 ,$371.78 ,$260.10 ,$85.68 ,$275.40 ,$177.04 ,$250.92 ,$306.00 ,$306.00 ,$177.04 ,$198.90 ,$306.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$313.00 ,$203.45 ,$87.64 ,$442.60 ,$442.60 ,$203.45 ,$186.86 ,$177.04 ,$87.64 ,$175.59 ,$177.04 ,$205.95 ,$177.04 ,$266.05 ,$266.05 ,$177.04 ,$266.05 ,$313.00 ,$212.84 ,$442.60 ,$177.04 ,$177.04 ,$234.75 ,$222.23 ,$222.23 ,$177.04 ,$222.23 ,$256.66 ,$256.66 ,$256.66 , N/A ,$313.00 ,$266.05 ,$177.04 ,$313.00 ,$186.86 ,$177.04 ,$130.21 , N/A , N/A ,$177.04 ,$266.05 ,$371.78 ,$266.05 ,$87.64 ,$281.70 ,$177.04 ,$256.66 ,$313.00 ,$313.00 ,$177.04 ,$203.45 ,$313.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$317.00 ,$206.05 ,$88.76 ,$442.60 ,$442.60 ,$206.05 ,$189.25 ,$177.04 ,$88.76 ,$177.84 ,$177.04 ,$208.59 ,$177.04 ,$269.45 ,$269.45 ,$177.04 ,$269.45 ,$317.00 ,$215.56 ,$442.60 ,$177.04 ,$177.04 ,$237.75 ,$225.07 ,$225.07 ,$177.04 ,$225.07 ,$259.94 ,$259.94 ,$259.94 , N/A ,$317.00 ,$269.45 ,$177.04 ,$317.00 ,$189.25 ,$177.04 ,$131.87 , N/A , N/A ,$177.04 ,$269.45 ,$371.78 ,$269.45 ,$88.76 ,$285.30 ,$177.04 ,$259.94 ,$317.00 ,$317.00 ,$177.04 ,$206.05 ,$317.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$324.00 ,$210.60 ,$90.72 ,$851.90 ,$851.90 ,$210.60 ,$193.43 ,$340.76 ,$90.72 ,$181.76 ,$340.76 ,$213.19 ,$324.00 ,$275.40 ,$275.40 ,$324.00 ,$275.40 ,$324.00 ,$220.32 ,$851.90 ,$340.76 ,$340.76 ,$243.00 ,$230.04 ,$230.04 ,$340.76 ,$230.04 ,$265.68 ,$265.68 ,$265.68 , N/A ,$324.00 ,$275.40 ,$340.76 ,$324.00 ,$193.43 ,$340.76 ,$134.78 , N/A , N/A ,$340.76 ,$275.40 ,$715.59 ,$275.40 ,$90.72 ,$291.60 ,$340.76 ,$265.68 ,$324.00 ,$324.00 ,$340.76 ,$210.60 ,$324.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$329.00 ,$213.85 ,$92.12 ,$851.90 ,$851.90 ,$213.85 ,$196.41 ,$340.76 ,$92.12 ,$184.57 ,$340.76 ,$216.48 ,$329.00 ,$279.65 ,$279.65 ,$329.00 ,$279.65 ,$329.00 ,$223.72 ,$851.90 ,$340.76 ,$340.76 ,$246.75 ,$233.59 ,$233.59 ,$340.76 ,$233.59 ,$269.78 ,$269.78 ,$269.78 , N/A ,$329.00 ,$279.65 ,$340.76 ,$329.00 ,$196.41 ,$340.76 ,$136.86 , N/A , N/A ,$340.76 ,$279.65 ,$715.59 ,$279.65 ,$92.12 ,$296.10 ,$340.76 ,$269.78 ,$325.00 ,$325.00 ,$340.76 ,$213.85 ,$329.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$335.00 ,$217.75 ,$93.80 ,$442.60 ,$442.60 ,$217.75 ,$200.00 ,$177.04 ,$93.80 ,$187.94 ,$177.04 ,$220.43 ,$177.04 ,$284.75 ,$284.75 ,$177.04 ,$284.75 ,$335.00 ,$227.80 ,$442.60 ,$177.04 ,$177.04 ,$251.25 ,$237.85 ,$237.85 ,$177.04 ,$237.85 ,$274.70 ,$274.70 ,$274.70 , N/A ,$335.00 ,$284.75 ,$177.04 ,$335.00 ,$200.00 ,$177.04 ,$139.36 , N/A , N/A ,$177.04 ,$284.75 ,$371.78 ,$284.75 ,$93.80 ,$301.50 ,$177.04 ,$274.70 ,$325.00 ,$325.00 ,$177.04 ,$217.75 ,$335.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$306.00 ,$198.90 ,$85.68 ,$442.60 ,$442.60 ,$198.90 ,$182.68 ,$177.04 ,$85.68 ,$171.67 ,$177.04 ,$201.35 ,$177.04 ,$260.10 ,$260.10 ,$177.04 ,$260.10 ,$306.00 ,$208.08 ,$442.60 ,$177.04 ,$177.04 ,$229.50 ,$217.26 ,$217.26 ,$177.04 ,$217.26 ,$250.92 ,$250.92 ,$250.92 , N/A ,$306.00 ,$260.10 ,$177.04 ,$306.00 ,$182.68 ,$177.04 ,$127.30 , N/A , N/A ,$177.04 ,$260.10 ,$371.78 ,$260.10 ,$85.68 ,$275.40 ,$177.04 ,$250.92 ,$306.00 ,$306.00 ,$177.04 ,$198.90 ,$306.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$313.00 ,$203.45 ,$87.64 ,$442.60 ,$442.60 ,$203.45 ,$186.86 ,$177.04 ,$87.64 ,$175.59 ,$177.04 ,$205.95 ,$177.04 ,$266.05 ,$266.05 ,$177.04 ,$266.05 ,$313.00 ,$212.84 ,$442.60 ,$177.04 ,$177.04 ,$234.75 ,$222.23 ,$222.23 ,$177.04 ,$222.23 ,$256.66 ,$256.66 ,$256.66 , N/A ,$313.00 ,$266.05 ,$177.04 ,$313.00 ,$186.86 ,$177.04 ,$130.21 , N/A , N/A ,$177.04 ,$266.05 ,$371.78 ,$266.05 ,$87.64 ,$281.70 ,$177.04 ,$256.66 ,$313.00 ,$313.00 ,$177.04 ,$203.45 ,$313.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$317.00 ,$206.05 ,$88.76 ,$442.60 ,$442.60 ,$206.05 ,$189.25 ,$177.04 ,$88.76 ,$177.84 ,$177.04 ,$208.59 ,$177.04 ,$269.45 ,$269.45 ,$177.04 ,$269.45 ,$317.00 ,$215.56 ,$442.60 ,$177.04 ,$177.04 ,$237.75 ,$225.07 ,$225.07 ,$177.04 ,$225.07 ,$259.94 ,$259.94 ,$259.94 , N/A ,$317.00 ,$269.45 ,$177.04 ,$317.00 ,$189.25 ,$177.04 ,$131.87 , N/A , N/A ,$177.04 ,$269.45 ,$371.78 ,$269.45 ,$88.76 ,$285.30 ,$177.04 ,$259.94 ,$317.00 ,$317.00 ,$177.04 ,$206.05 ,$317.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$324.00 ,$210.60 ,$90.72 ,$442.60 ,$442.60 ,$210.60 ,$193.43 ,$177.04 ,$90.72 ,$181.76 ,$177.04 ,$213.19 ,$177.04 ,$275.40 ,$275.40 ,$177.04 ,$275.40 ,$324.00 ,$220.32 ,$442.60 ,$177.04 ,$177.04 ,$243.00 ,$230.04 ,$230.04 ,$177.04 ,$230.04 ,$265.68 ,$265.68 ,$265.68 , N/A ,$324.00 ,$275.40 ,$177.04 ,$324.00 ,$193.43 ,$177.04 ,$134.78 , N/A , N/A ,$177.04 ,$275.40 ,$371.78 ,$275.40 ,$90.72 ,$291.60 ,$177.04 ,$265.68 ,$324.00 ,$324.00 ,$177.04 ,$210.60 ,$324.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$329.00 ,$213.85 ,$92.12 ,$851.90 ,$851.90 ,$213.85 ,$196.41 ,$340.76 ,$92.12 ,$184.57 ,$340.76 ,$216.48 ,$329.00 ,$279.65 ,$279.65 ,$329.00 ,$279.65 ,$329.00 ,$223.72 ,$851.90 ,$340.76 ,$340.76 ,$246.75 ,$233.59 ,$233.59 ,$340.76 ,$233.59 ,$269.78 ,$269.78 ,$269.78 , N/A ,$329.00 ,$279.65 ,$340.76 ,$329.00 ,$196.41 ,$340.76 ,$136.86 , N/A , N/A ,$340.76 ,$279.65 ,$715.59 ,$279.65 ,$92.12 ,$296.10 ,$340.76 ,$269.78 ,$325.00 ,$325.00 ,$340.76 ,$213.85 ,$329.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000025,12017,HC SIMP F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$335.00 ,$217.75 ,$93.80 ,$851.90 ,$851.90 ,$217.75 ,$200.00 ,$340.76 ,$93.80 ,$187.94 ,$340.76 ,$220.43 ,$335.00 ,$284.75 ,$284.75 ,$335.00 ,$284.75 ,$335.00 ,$227.80 ,$851.90 ,$340.76 ,$340.76 ,$251.25 ,$237.85 ,$237.85 ,$340.76 ,$237.85 ,$274.70 ,$274.70 ,$274.70 , N/A ,$335.00 ,$284.75 ,$340.76 ,$335.00 ,$200.00 ,$340.76 ,$139.36 , N/A , N/A ,$340.76 ,$284.75 ,$715.59 ,$284.75 ,$93.80 ,$301.50 ,$340.76 ,$274.70 ,$325.00 ,$325.00 ,$340.76 ,$217.75 ,$335.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000026,12018,HC SIMP F/E/E/N/L/MM OVER 30CM,450,1 ,$340.00 ,$221.00 ,$95.20 ,$442.60 ,$442.60 ,$221.00 ,$202.98 ,$177.04 ,$95.20 ,$190.74 ,$177.04 ,$223.72 ,$177.04 ,$289.00 ,$289.00 ,$177.04 ,$289.00 ,$336.38 ,$231.20 ,$442.60 ,$177.04 ,$177.04 ,$255.00 ,$241.40 ,$241.40 ,$177.04 ,$241.40 ,$278.80 ,$278.80 ,$278.80 , N/A ,$340.00 ,$289.00 ,$177.04 ,$340.00 ,$202.98 ,$177.04 ,$141.44 , N/A , N/A ,$177.04 ,$289.00 ,$371.78 ,$289.00 ,$95.20 ,$306.00 ,$177.04 ,$278.80 ,$325.00 ,$325.00 ,$177.04 ,$221.00 ,$340.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$383.00 ,$248.95 ,$107.24 ,$851.90 ,$851.90 ,$248.95 ,$228.65 ,$340.76 ,$107.24 ,$214.86 ,$340.76 ,$252.01 ,$340.76 ,$325.55 ,$325.55 ,$340.76 ,$325.55 ,$383.00 ,$260.44 ,$851.90 ,$340.76 ,$340.76 ,$287.25 ,$271.93 ,$271.93 ,$340.76 ,$271.93 ,$314.06 ,$314.06 ,$314.06 , N/A ,$383.00 ,$325.55 ,$340.76 ,$383.00 ,$228.65 ,$340.76 ,$159.33 , N/A , N/A ,$340.76 ,$325.55 ,$715.59 ,$325.55 ,$107.24 ,$344.70 ,$340.76 ,$314.06 ,$325.00 ,$325.00 ,$340.76 ,$248.95 ,$383.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$388.00 ,$252.20 ,$108.64 ,$851.90 ,$851.90 ,$252.20 ,$231.64 ,$340.76 ,$108.64 ,$217.67 ,$340.76 ,$255.30 ,$340.76 ,$329.80 ,$329.80 ,$340.76 ,$329.80 ,$388.00 ,$263.84 ,$851.90 ,$340.76 ,$340.76 ,$291.00 ,$275.48 ,$275.48 ,$340.76 ,$275.48 ,$318.16 ,$318.16 ,$318.16 , N/A ,$388.00 ,$329.80 ,$340.76 ,$388.00 ,$231.64 ,$340.76 ,$161.41 , N/A , N/A ,$340.76 ,$329.80 ,$715.59 ,$329.80 ,$108.64 ,$349.20 ,$340.76 ,$318.16 ,$325.00 ,$325.00 ,$340.76 ,$252.20 ,$388.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$394.00 ,$256.10 ,$110.32 ,$851.90 ,$851.90 ,$256.10 ,$235.22 ,$340.76 ,$110.32 ,$221.03 ,$340.76 ,$259.25 ,$340.76 ,$334.90 ,$334.90 ,$340.76 ,$334.90 ,$394.00 ,$267.92 ,$851.90 ,$340.76 ,$340.76 ,$295.50 ,$279.74 ,$279.74 ,$340.76 ,$279.74 ,$323.08 ,$323.08 ,$323.08 , N/A ,$394.00 ,$334.90 ,$340.76 ,$394.00 ,$235.22 ,$340.76 ,$163.90 , N/A , N/A ,$340.76 ,$334.90 ,$715.59 ,$334.90 ,$110.32 ,$354.60 ,$340.76 ,$323.08 ,$325.00 ,$325.00 ,$340.76 ,$256.10 ,$394.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,$399.00 ,$259.35 ,$111.72 ,$851.90 ,$851.90 ,$259.35 ,$238.20 ,$340.76 ,$111.72 ,$223.84 ,$340.76 ,$262.54 ,$340.76 ,$339.15 ,$339.15 ,$340.76 ,$339.15 ,$399.00 ,$271.32 ,$851.90 ,$340.76 ,$340.76 ,$299.25 ,$283.29 ,$283.29 ,$340.76 ,$283.29 ,$327.18 ,$327.18 ,$327.18 , N/A ,$399.00 ,$339.15 ,$340.76 ,$399.00 ,$238.20 ,$340.76 ,$165.98 , N/A , N/A ,$340.76 ,$339.15 ,$715.59 ,$339.15 ,$111.72 ,$359.10 ,$340.76 ,$327.18 ,$325.00 ,$325.00 ,$340.76 ,$259.35 ,$399.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,$405.00 ,$263.25 ,$113.40 ,"$1,290.85 ","$1,290.85 ",$263.25 ,$241.79 ,$516.34 ,$113.40 ,$227.21 ,$516.34 ,$266.49 ,$405.00 ,$344.25 ,$344.25 ,$405.00 ,$344.25 ,$405.00 ,$275.40 ,"$1,290.85 ",$516.34 ,$516.34 ,$303.75 ,$287.55 ,$287.55 ,$516.34 ,$287.55 ,$332.10 ,$332.10 ,$332.10 , N/A ,$405.00 ,$344.25 ,$516.34 ,$405.00 ,$241.79 ,$516.34 ,$168.48 , N/A , N/A ,$516.34 ,$344.25 ,"$1,084.31 ",$344.25 ,$113.40 ,$364.50 ,$516.34 ,$332.10 ,$325.00 ,$325.00 ,$516.34 ,$263.25 ,$405.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000034,12037,HC INTRM S/A/T/EXT OVER 30CM,450,1 ,$411.00 ,$267.15 ,$115.08 ,"$4,221.50 ","$4,221.50 ",$267.15 ,$245.37 ,"$1,688.60 ",$115.08 ,$230.57 ,"$1,688.60 ",$270.44 ,$411.00 ,$349.35 ,$349.35 ,$411.00 ,$349.35 ,$411.00 ,$279.48 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ",$308.25 ,$291.81 ,$291.81 ,"$1,688.60 ",$291.81 ,$337.02 ,$337.02 ,$337.02 , N/A ,$411.00 ,$349.35 ,"$1,688.60 ",$411.00 ,$245.37 ,"$1,688.60 ",$170.98 , N/A , N/A ,"$1,688.60 ",$349.35 ,"$3,546.05 ",$349.35 ,$115.08 ,$369.90 ,"$1,688.60 ",$337.02 ,$325.00 ,$325.00 ,"$1,688.60 ",$267.15 ,$411.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$383.00 ,$248.95 ,$107.24 ,$851.90 ,$851.90 ,$248.95 ,$228.65 ,$340.76 ,$107.24 ,$214.86 ,$340.76 ,$252.01 ,$340.76 ,$325.55 ,$325.55 ,$340.76 ,$325.55 ,$383.00 ,$260.44 ,$851.90 ,$340.76 ,$340.76 ,$287.25 ,$271.93 ,$271.93 ,$340.76 ,$271.93 ,$314.06 ,$314.06 ,$314.06 , N/A ,$383.00 ,$325.55 ,$340.76 ,$383.00 ,$228.65 ,$340.76 ,$159.33 , N/A , N/A ,$340.76 ,$325.55 ,$715.59 ,$325.55 ,$107.24 ,$344.70 ,$340.76 ,$314.06 ,$325.00 ,$325.00 ,$340.76 ,$248.95 ,$383.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$388.00 ,$252.20 ,$108.64 ,$851.90 ,$851.90 ,$252.20 ,$231.64 ,$340.76 ,$108.64 ,$217.67 ,$340.76 ,$255.30 ,$340.76 ,$329.80 ,$329.80 ,$340.76 ,$329.80 ,$388.00 ,$263.84 ,$851.90 ,$340.76 ,$340.76 ,$291.00 ,$275.48 ,$275.48 ,$340.76 ,$275.48 ,$318.16 ,$318.16 ,$318.16 , N/A ,$388.00 ,$329.80 ,$340.76 ,$388.00 ,$231.64 ,$340.76 ,$161.41 , N/A , N/A ,$340.76 ,$329.80 ,$715.59 ,$329.80 ,$108.64 ,$349.20 ,$340.76 ,$318.16 ,$325.00 ,$325.00 ,$340.76 ,$252.20 ,$388.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$394.00 ,$256.10 ,$110.32 ,"$1,290.85 ","$1,290.85 ",$256.10 ,$235.22 ,$516.34 ,$110.32 ,$221.03 ,$516.34 ,$259.25 ,$394.00 ,$334.90 ,$334.90 ,$394.00 ,$334.90 ,$394.00 ,$267.92 ,"$1,290.85 ",$516.34 ,$516.34 ,$295.50 ,$279.74 ,$279.74 ,$516.34 ,$279.74 ,$323.08 ,$323.08 ,$323.08 , N/A ,$394.00 ,$334.90 ,$516.34 ,$394.00 ,$235.22 ,$516.34 ,$163.90 , N/A , N/A ,$516.34 ,$334.90 ,"$1,084.31 ",$334.90 ,$110.32 ,$354.60 ,$516.34 ,$323.08 ,$325.00 ,$325.00 ,$516.34 ,$256.10 ,$394.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,$399.00 ,$259.35 ,$111.72 ,"$1,290.85 ","$1,290.85 ",$259.35 ,$238.20 ,$516.34 ,$111.72 ,$223.84 ,$516.34 ,$262.54 ,$399.00 ,$339.15 ,$339.15 ,$399.00 ,$339.15 ,$399.00 ,$271.32 ,"$1,290.85 ",$516.34 ,$516.34 ,$299.25 ,$283.29 ,$283.29 ,$516.34 ,$283.29 ,$327.18 ,$327.18 ,$327.18 , N/A ,$399.00 ,$339.15 ,$516.34 ,$399.00 ,$238.20 ,$516.34 ,$165.98 , N/A , N/A ,$516.34 ,$339.15 ,"$1,084.31 ",$339.15 ,$111.72 ,$359.10 ,$516.34 ,$327.18 ,$325.00 ,$325.00 ,$516.34 ,$259.35 ,$399.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,$405.00 ,$263.25 ,$113.40 ,"$1,290.85 ","$1,290.85 ",$263.25 ,$241.79 ,$516.34 ,$113.40 ,$227.21 ,$516.34 ,$266.49 ,$405.00 ,$344.25 ,$344.25 ,$405.00 ,$344.25 ,$405.00 ,$275.40 ,"$1,290.85 ",$516.34 ,$516.34 ,$303.75 ,$287.55 ,$287.55 ,$516.34 ,$287.55 ,$332.10 ,$332.10 ,$332.10 , N/A ,$405.00 ,$344.25 ,$516.34 ,$405.00 ,$241.79 ,$516.34 ,$168.48 , N/A , N/A ,$516.34 ,$344.25 ,"$1,084.31 ",$344.25 ,$113.40 ,$364.50 ,$516.34 ,$332.10 ,$325.00 ,$325.00 ,$516.34 ,$263.25 ,$405.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000040,12047,HC INTRM N/H/F/GEN OVER 30CM,450,1 ,$411.00 ,$267.15 ,$115.08 ,"$4,221.50 ","$4,221.50 ",$267.15 ,$245.37 ,"$1,688.60 ",$115.08 ,$230.57 ,"$1,688.60 ",$270.44 ,$411.00 ,$349.35 ,$349.35 ,$411.00 ,$349.35 ,$411.00 ,$279.48 ,"$4,221.49 ","$1,688.60 ","$1,688.60 ",$308.25 ,$291.81 ,$291.81 ,"$1,688.60 ",$291.81 ,$337.02 ,$337.02 ,$337.02 , N/A ,$411.00 ,$349.35 ,"$1,688.60 ",$411.00 ,$245.37 ,"$1,688.60 ",$170.98 , N/A , N/A ,"$1,688.60 ",$349.35 ,"$3,546.05 ",$349.35 ,$115.08 ,$369.90 ,"$1,688.60 ",$337.02 ,$325.00 ,$325.00 ,"$1,688.60 ",$267.15 ,$411.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$420.00 ,$273.00 ,$117.60 ,$851.90 ,$851.90 ,$273.00 ,$250.74 ,$340.76 ,$117.60 ,$235.62 ,$340.76 ,$276.36 ,$340.76 ,$357.00 ,$357.00 ,$340.76 ,$357.00 ,$420.00 ,$285.60 ,$851.90 ,$340.76 ,$340.76 ,$315.00 ,$298.20 ,$298.20 ,$340.76 ,$298.20 ,$344.40 ,$344.40 ,$344.40 , N/A ,$420.00 ,$357.00 ,$340.76 ,$420.00 ,$250.74 ,$340.76 ,$174.72 , N/A , N/A ,$340.76 ,$357.00 ,$715.59 ,$357.00 ,$117.60 ,$378.00 ,$340.76 ,$344.40 ,$325.00 ,$325.00 ,$340.76 ,$273.00 ,$420.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$423.00 ,$274.95 ,$118.44 ,$851.90 ,$851.90 ,$274.95 ,$252.53 ,$340.76 ,$118.44 ,$237.30 ,$340.76 ,$278.33 ,$340.76 ,$359.55 ,$359.55 ,$340.76 ,$359.55 ,$423.00 ,$287.64 ,$851.90 ,$340.76 ,$340.76 ,$317.25 ,$300.33 ,$300.33 ,$340.76 ,$300.33 ,$346.86 ,$346.86 ,$346.86 , N/A ,$423.00 ,$359.55 ,$340.76 ,$423.00 ,$252.53 ,$340.76 ,$175.97 , N/A , N/A ,$340.76 ,$359.55 ,$715.59 ,$359.55 ,$118.44 ,$380.70 ,$340.76 ,$346.86 ,$325.00 ,$325.00 ,$340.76 ,$274.95 ,$423.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$444.00 ,$288.60 ,$124.32 ,$851.90 ,$851.90 ,$288.60 ,$265.07 ,$340.76 ,$124.32 ,$249.08 ,$340.76 ,$292.15 ,$340.76 ,$377.40 ,$377.40 ,$340.76 ,$377.40 ,$444.00 ,$301.92 ,$851.90 ,$340.76 ,$340.76 ,$333.00 ,$315.24 ,$315.24 ,$340.76 ,$315.24 ,$364.08 ,$364.08 ,$364.08 , N/A ,$444.00 ,$377.40 ,$340.76 ,$444.00 ,$265.07 ,$340.76 ,$184.70 , N/A , N/A ,$340.76 ,$377.40 ,$715.59 ,$377.40 ,$124.32 ,$399.60 ,$340.76 ,$364.08 ,$325.00 ,$325.00 ,$340.76 ,$288.60 ,$444.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,$466.00 ,$302.90 ,$130.48 ,$851.90 ,$851.90 ,$302.90 ,$278.20 ,$340.76 ,$130.48 ,$261.43 ,$340.76 ,$306.63 ,$340.76 ,$396.10 ,$396.10 ,$340.76 ,$396.10 ,$466.00 ,$316.88 ,$851.90 ,$340.76 ,$340.76 ,$349.50 ,$330.86 ,$330.86 ,$340.76 ,$330.86 ,$382.12 ,$382.12 ,$382.12 , N/A ,$466.00 ,$396.10 ,$340.76 ,$466.00 ,$278.20 ,$340.76 ,$193.86 , N/A , N/A ,$340.76 ,$396.10 ,$715.59 ,$396.10 ,$130.48 ,$419.40 ,$340.76 ,$382.12 ,$325.00 ,$325.00 ,$340.76 ,$302.90 ,$466.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000045,12055,HC INTRM F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$489.00 ,$317.85 ,$136.92 ,$851.90 ,$851.90 ,$317.85 ,$291.93 ,$340.76 ,$136.92 ,$274.33 ,$340.76 ,$321.76 ,$340.76 ,$415.65 ,$415.65 ,$340.76 ,$415.65 ,$489.00 ,$332.52 ,$851.90 ,$340.76 ,$340.76 ,$366.75 ,$347.19 ,$347.19 ,$340.76 ,$347.19 ,$400.98 ,$400.98 ,$400.98 , N/A ,$489.00 ,$415.65 ,$340.76 ,$489.00 ,$291.93 ,$340.76 ,$203.42 , N/A , N/A ,$340.76 ,$415.65 ,$715.59 ,$415.65 ,$136.92 ,$440.10 ,$340.76 ,$400.98 ,$325.00 ,$325.00 ,$340.76 ,$317.85 ,$489.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000046,12056,HC INTRM F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$513.00 ,$333.45 ,$143.64 ,$851.90 ,$851.90 ,$333.45 ,$306.26 ,$340.76 ,$143.64 ,$287.79 ,$340.76 ,$337.55 ,$340.76 ,$436.05 ,$436.05 ,$340.76 ,$436.05 ,$513.00 ,$348.84 ,$851.90 ,$340.76 ,$340.76 ,$384.75 ,$364.23 ,$364.23 ,$340.76 ,$364.23 ,$420.66 ,$420.66 ,$420.66 , N/A ,$513.00 ,$436.05 ,$340.76 ,$513.00 ,$306.26 ,$340.76 ,$213.41 , N/A , N/A ,$340.76 ,$436.05 ,$715.59 ,$436.05 ,$143.64 ,$461.70 ,$340.76 ,$420.66 ,$325.00 ,$325.00 ,$340.76 ,$333.45 ,$513.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000047,12057,HC INTRM F/E/E/N/L/MM OVER 30.0CM,450,1 ,$538.00 ,$349.70 ,$150.64 ,$851.90 ,$851.90 ,$349.70 ,$321.19 ,$340.76 ,$150.64 ,$301.82 ,$340.76 ,$354.00 ,$340.76 ,$457.30 ,$457.30 ,$340.76 ,$457.30 ,$538.00 ,$365.84 ,$851.90 ,$340.76 ,$340.76 ,$403.50 ,$381.98 ,$381.98 ,$340.76 ,$381.98 ,$441.16 ,$441.16 ,$441.16 , N/A ,$538.00 ,$457.30 ,$340.76 ,$538.00 ,$321.19 ,$340.76 ,$223.81 , N/A , N/A ,$340.76 ,$457.30 ,$715.59 ,$457.30 ,$150.64 ,$484.20 ,$340.76 ,$441.16 ,$325.00 ,$325.00 ,$340.76 ,$349.70 ,$538.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,$466.00 ,$302.90 ,$130.48 ,"$1,290.85 ","$1,290.85 ",$302.90 ,$278.20 ,$516.34 ,$130.48 ,$261.43 ,$516.34 ,$306.63 ,$466.00 ,$396.10 ,$396.10 ,$466.00 ,$396.10 ,$466.00 ,$316.88 ,"$1,290.85 ",$516.34 ,$516.34 ,$349.50 ,$330.86 ,$330.86 ,$516.34 ,$330.86 ,$382.12 ,$382.12 ,$382.12 , N/A ,$466.00 ,$396.10 ,$516.34 ,$466.00 ,$278.20 ,$516.34 ,$193.86 , N/A , N/A ,$516.34 ,$396.10 ,"$1,084.31 ",$396.10 ,$130.48 ,$419.40 ,$516.34 ,$382.12 ,$325.00 ,$325.00 ,$516.34 ,$302.90 ,$466.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,$511.00 ,$332.15 ,$143.08 ,"$1,290.85 ","$1,290.85 ",$332.15 ,$305.07 ,$516.34 ,$143.08 ,$286.67 ,$516.34 ,$336.24 ,$511.00 ,$434.35 ,$434.35 ,$511.00 ,$434.35 ,$511.00 ,$347.48 ,"$1,290.85 ",$516.34 ,$516.34 ,$383.25 ,$362.81 ,$362.81 ,$516.34 ,$362.81 ,$419.02 ,$419.02 ,$419.02 , N/A ,$511.00 ,$434.35 ,$516.34 ,$511.00 ,$305.07 ,$516.34 ,$212.58 , N/A , N/A ,$516.34 ,$434.35 ,"$1,084.31 ",$434.35 ,$143.08 ,$459.90 ,$516.34 ,$419.02 ,$325.00 ,$325.00 ,$516.34 ,$332.15 ,$511.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000050,13102,HC CMPLX TRUNK EA ADDL 5 CM OR LESS,450,1 ,$466.00 ,$302.90 ,$130.48 ,$466.00 , N/A ,$302.90 ,$278.20 , N/A ,$130.48 ,$261.43 , N/A ,$306.63 , N/A ,$396.10 ,$396.10 , N/A ,$396.10 , N/A ,$316.88 , N/A , N/A , N/A ,$349.50 ,$330.86 ,$330.86 , N/A ,$330.86 ,$382.12 ,$382.12 ,$382.12 , N/A , N/A ,$396.10 , N/A ,$466.00 ,$278.20 , N/A ,$193.86 , N/A , N/A , N/A ,$396.10 , N/A ,$396.10 ,$130.48 ,$419.40 , N/A ,$382.12 ,$325.00 ,$325.00 , N/A ,$302.90 ,$466.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,$385.00 ,$250.25 ,$107.80 ,"$1,290.85 ","$1,290.85 ",$250.25 ,$229.85 ,$516.34 ,$107.80 ,$215.99 ,$516.34 ,$253.33 ,$385.00 ,$327.25 ,$327.25 ,$385.00 ,$327.25 ,$385.00 ,$261.80 ,"$1,290.85 ",$516.34 ,$516.34 ,$288.75 ,$273.35 ,$273.35 ,$516.34 ,$273.35 ,$315.70 ,$315.70 ,$315.70 , N/A ,$385.00 ,$327.25 ,$516.34 ,$385.00 ,$229.85 ,$516.34 ,$160.16 , N/A , N/A ,$516.34 ,$327.25 ,"$1,084.31 ",$327.25 ,$107.80 ,$346.50 ,$516.34 ,$315.70 ,$325.00 ,$325.00 ,$516.34 ,$250.25 ,$385.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,$423.00 ,$274.95 ,$118.44 ,"$1,290.85 ","$1,290.85 ",$274.95 ,$252.53 ,$516.34 ,$118.44 ,$237.30 ,$516.34 ,$278.33 ,$423.00 ,$359.55 ,$359.55 ,$423.00 ,$359.55 ,$423.00 ,$287.64 ,"$1,290.85 ",$516.34 ,$516.34 ,$317.25 ,$300.33 ,$300.33 ,$516.34 ,$300.33 ,$346.86 ,$346.86 ,$346.86 , N/A ,$423.00 ,$359.55 ,$516.34 ,$423.00 ,$252.53 ,$516.34 ,$175.97 , N/A , N/A ,$516.34 ,$359.55 ,"$1,084.31 ",$359.55 ,$118.44 ,$380.70 ,$516.34 ,$346.86 ,$325.00 ,$325.00 ,$516.34 ,$274.95 ,$423.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000053,13122,HC CMPLX S/A/L EA ADDL 5 CM OR LESS,450,1 ,$385.00 ,$250.25 ,$107.80 ,$385.00 , N/A ,$250.25 ,$229.85 , N/A ,$107.80 ,$215.99 , N/A ,$253.33 , N/A ,$327.25 ,$327.25 , N/A ,$327.25 , N/A ,$261.80 , N/A , N/A , N/A ,$288.75 ,$273.35 ,$273.35 , N/A ,$273.35 ,$315.70 ,$315.70 ,$315.70 , N/A , N/A ,$327.25 , N/A ,$385.00 ,$229.85 , N/A ,$160.16 , N/A , N/A , N/A ,$327.25 , N/A ,$327.25 ,$107.80 ,$346.50 , N/A ,$315.70 ,$325.00 ,$325.00 , N/A ,$250.25 ,$385.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000054,13131,HC CMPLX F/C/C/M/N/A/G/H/F 1.1-2.5 CM,450,1 ,$509.00 ,$330.85 ,$142.52 ,$851.90 ,$851.90 ,$330.85 ,$303.87 ,$340.76 ,$142.52 ,$285.55 ,$340.76 ,$334.92 ,$340.76 ,$432.65 ,$432.65 ,$340.76 ,$432.65 ,$509.00 ,$346.12 ,$851.90 ,$340.76 ,$340.76 ,$381.75 ,$361.39 ,$361.39 ,$340.76 ,$361.39 ,$417.38 ,$417.38 ,$417.38 , N/A ,$509.00 ,$432.65 ,$340.76 ,$509.00 ,$303.87 ,$340.76 ,$211.74 , N/A , N/A ,$340.76 ,$432.65 ,$715.59 ,$432.65 ,$142.52 ,$458.10 ,$340.76 ,$417.38 ,$325.00 ,$325.00 ,$340.76 ,$330.85 ,$509.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000055,13132,HC CMPLX F/C/C/M/N/A/G/H/F 2.6-7.5 CM,450,1 ,$560.00 ,$364.00 ,$156.80 ,"$1,290.85 ","$1,290.85 ",$364.00 ,$334.32 ,$516.34 ,$156.80 ,$314.16 ,$516.34 ,$368.48 ,$516.34 ,$476.00 ,$476.00 ,$516.34 ,$476.00 ,$560.00 ,$380.80 ,"$1,290.85 ",$516.34 ,$516.34 ,$420.00 ,$397.60 ,$397.60 ,$516.34 ,$397.60 ,$459.20 ,$459.20 ,$459.20 , N/A ,$560.00 ,$476.00 ,$516.34 ,$560.00 ,$334.32 ,$516.34 ,$232.96 , N/A , N/A ,$516.34 ,$476.00 ,"$1,084.31 ",$476.00 ,$156.80 ,$504.00 ,$516.34 ,$459.20 ,$325.00 ,$325.00 ,$516.34 ,$364.00 ,$560.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000056,13133,HC CMPLX F/C/C/M/N/A/G/H/F EA ADDL 5 CM OR LESS,450,1 ,$466.00 ,$302.90 ,$130.48 ,$466.00 , N/A ,$302.90 ,$278.20 , N/A ,$130.48 ,$261.43 , N/A ,$306.63 , N/A ,$396.10 ,$396.10 , N/A ,$396.10 , N/A ,$316.88 , N/A , N/A , N/A ,$349.50 ,$330.86 ,$330.86 , N/A ,$330.86 ,$382.12 ,$382.12 ,$382.12 , N/A , N/A ,$396.10 , N/A ,$466.00 ,$278.20 , N/A ,$193.86 , N/A , N/A , N/A ,$396.10 , N/A ,$396.10 ,$130.48 ,$419.40 , N/A ,$382.12 ,$325.00 ,$325.00 , N/A ,$302.90 ,$466.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,$511.00 ,$332.15 ,$143.08 ,"$1,290.85 ","$1,290.85 ",$332.15 ,$305.07 ,$516.34 ,$143.08 ,$286.67 ,$516.34 ,$336.24 ,$511.00 ,$434.35 ,$434.35 ,$511.00 ,$434.35 ,$511.00 ,$347.48 ,"$1,290.85 ",$516.34 ,$516.34 ,$383.25 ,$362.81 ,$362.81 ,$516.34 ,$362.81 ,$419.02 ,$419.02 ,$419.02 , N/A ,$511.00 ,$434.35 ,$516.34 ,$511.00 ,$305.07 ,$516.34 ,$212.58 , N/A , N/A ,$516.34 ,$434.35 ,"$1,084.31 ",$434.35 ,$143.08 ,$459.90 ,$516.34 ,$419.02 ,$325.00 ,$325.00 ,$516.34 ,$332.15 ,$511.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,$511.00 ,$332.15 ,$143.08 ,"$1,290.85 ","$1,290.85 ",$332.15 ,$305.07 ,$516.34 ,$143.08 ,$286.67 ,$516.34 ,$336.24 ,$511.00 ,$434.35 ,$434.35 ,$511.00 ,$434.35 ,$511.00 ,$347.48 ,"$1,290.85 ",$516.34 ,$516.34 ,$383.25 ,$362.81 ,$362.81 ,$516.34 ,$362.81 ,$419.02 ,$419.02 ,$419.02 , N/A ,$511.00 ,$434.35 ,$516.34 ,$511.00 ,$305.07 ,$516.34 ,$212.58 , N/A , N/A ,$516.34 ,$434.35 ,"$1,084.31 ",$434.35 ,$143.08 ,$459.90 ,$516.34 ,$419.02 ,$325.00 ,$325.00 ,$516.34 ,$332.15 ,$511.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000060,13153,HC CMPLX E/N/E/L EA ADDL 5 CM OR LESS,450,1 ,$466.00 ,$302.90 ,$130.48 ,$466.00 , N/A ,$302.90 ,$278.20 , N/A ,$130.48 ,$261.43 , N/A ,$306.63 , N/A ,$396.10 ,$396.10 , N/A ,$396.10 , N/A ,$316.88 , N/A , N/A , N/A ,$349.50 ,$330.86 ,$330.86 , N/A ,$330.86 ,$382.12 ,$382.12 ,$382.12 , N/A , N/A ,$396.10 , N/A ,$466.00 ,$278.20 , N/A ,$193.86 , N/A , N/A , N/A ,$396.10 , N/A ,$396.10 ,$130.48 ,$419.40 , N/A ,$382.12 ,$325.00 ,$325.00 , N/A ,$302.90 ,$466.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$386.00 ,$250.90 ,$108.08 ,$442.60 ,$442.60 ,$250.90 ,$230.44 ,$177.04 ,$108.08 ,$216.55 ,$177.04 ,$253.99 ,$177.04 ,$328.10 ,$328.10 ,$177.04 ,$328.10 ,$336.38 ,$262.48 ,$442.60 ,$177.04 ,$177.04 ,$289.50 ,$274.06 ,$274.06 ,$177.04 ,$274.06 ,$316.52 ,$316.52 ,$316.52 , N/A ,$386.00 ,$328.10 ,$177.04 ,$386.00 ,$230.44 ,$177.04 ,$160.58 , N/A , N/A ,$177.04 ,$328.10 ,$371.78 ,$328.10 ,$108.08 ,$347.40 ,$177.04 ,$316.52 ,$325.00 ,$325.00 ,$177.04 ,$250.90 ,$386.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$386.00 ,$250.90 ,$108.08 ,$442.60 ,$442.60 ,$250.90 ,$230.44 ,$177.04 ,$108.08 ,$216.55 ,$177.04 ,$253.99 ,$177.04 ,$328.10 ,$328.10 ,$177.04 ,$328.10 ,$336.38 ,$262.48 ,$442.60 ,$177.04 ,$177.04 ,$289.50 ,$274.06 ,$274.06 ,$177.04 ,$274.06 ,$316.52 ,$316.52 ,$316.52 , N/A ,$386.00 ,$328.10 ,$177.04 ,$386.00 ,$230.44 ,$177.04 ,$160.58 , N/A , N/A ,$177.04 ,$328.10 ,$371.78 ,$328.10 ,$108.08 ,$347.40 ,$177.04 ,$316.52 ,$325.00 ,$325.00 ,$177.04 ,$250.90 ,$386.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$406.00 ,$263.90 ,$113.68 ,$442.60 ,$442.60 ,$263.90 ,$242.38 ,$177.04 ,$113.68 ,$227.77 ,$177.04 ,$267.15 ,$177.04 ,$345.10 ,$345.10 ,$177.04 ,$345.10 ,$336.38 ,$276.08 ,$442.60 ,$177.04 ,$177.04 ,$304.50 ,$288.26 ,$288.26 ,$177.04 ,$288.26 ,$332.92 ,$332.92 ,$332.92 , N/A ,$406.00 ,$345.10 ,$177.04 ,$406.00 ,$242.38 ,$177.04 ,$168.90 , N/A , N/A ,$177.04 ,$345.10 ,$371.78 ,$345.10 ,$113.68 ,$365.40 ,$177.04 ,$332.92 ,$325.00 ,$325.00 ,$177.04 ,$263.90 ,$406.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$427.00 ,$277.55 ,$119.56 ,$851.90 ,$851.90 ,$277.55 ,$254.92 ,$340.76 ,$119.56 ,$239.55 ,$340.76 ,$280.97 ,$340.76 ,$362.95 ,$362.95 ,$340.76 ,$362.95 ,$427.00 ,$290.36 ,$851.90 ,$340.76 ,$340.76 ,$320.25 ,$303.17 ,$303.17 ,$340.76 ,$303.17 ,$350.14 ,$350.14 ,$350.14 , N/A ,$427.00 ,$362.95 ,$340.76 ,$427.00 ,$254.92 ,$340.76 ,$177.63 , N/A , N/A ,$340.76 ,$362.95 ,$715.59 ,$362.95 ,$119.56 ,$384.30 ,$340.76 ,$350.14 ,$325.00 ,$325.00 ,$340.76 ,$277.55 ,$427.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,$501.00 ,$325.65 ,$140.28 ,$501.00 ,$442.60 ,$325.65 ,$299.10 ,$177.04 ,$140.28 ,$281.06 ,$177.04 ,$329.66 ,$177.04 ,$425.85 ,$425.85 ,$177.04 ,$425.85 ,$336.38 ,$340.68 ,$442.60 ,$177.04 ,$177.04 ,$375.75 ,$355.71 ,$355.71 ,$177.04 ,$355.71 ,$410.82 ,$410.82 ,$410.82 , N/A ,$442.60 ,$425.85 ,$177.04 ,$501.00 ,$299.10 ,$177.04 ,$208.42 , N/A , N/A ,$177.04 ,$425.85 ,$371.78 ,$425.85 ,$140.28 ,$450.90 ,$177.04 ,$410.82 ,$325.00 ,$325.00 ,$177.04 ,$325.65 ,$501.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$340.00 ,$221.00 ,$95.20 ,$643.95 ,$643.95 ,$221.00 ,$202.98 ,$257.58 ,$95.20 ,$190.74 ,$257.58 ,$223.72 ,$257.58 ,$289.00 ,$289.00 ,$257.58 ,$289.00 ,$340.00 ,$231.20 ,$643.94 ,$257.58 ,$257.58 ,$255.00 ,$241.40 ,$241.40 ,$257.58 ,$241.40 ,$278.80 ,$278.80 ,$278.80 , N/A ,$340.00 ,$289.00 ,$257.58 ,$340.00 ,$202.98 ,$257.58 ,$141.44 , N/A , N/A ,$257.58 ,$289.00 ,$540.91 ,$289.00 ,$95.20 ,$306.00 ,$257.58 ,$278.80 ,$325.00 ,$325.00 ,$257.58 ,$221.00 ,$340.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$511.00 ,$332.15 ,$143.08 ,$965.91 ,$965.90 ,$332.15 ,$305.07 ,$386.36 ,$143.08 ,$286.67 ,$386.36 ,$336.24 ,$386.36 ,$434.35 ,$434.35 ,$386.36 ,$434.35 ,$511.00 ,$347.48 ,$965.91 ,$386.36 ,$386.36 ,$383.25 ,$362.81 ,$362.81 ,$386.36 ,$362.81 ,$419.02 ,$419.02 ,$419.02 , N/A ,$511.00 ,$434.35 ,$386.36 ,$511.00 ,$305.07 ,$386.36 ,$212.58 , N/A , N/A ,$386.36 ,$434.35 ,$811.37 ,$434.35 ,$143.08 ,$459.90 ,$386.36 ,$419.02 ,$325.00 ,$325.00 ,$386.36 ,$332.15 ,$511.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$591.00 ,$384.15 ,$165.48 ,$965.91 ,$965.90 ,$384.15 ,$352.83 ,$386.36 ,$165.48 ,$331.55 ,$386.36 ,$388.88 ,$386.36 ,$502.35 ,$502.35 ,$386.36 ,$502.35 ,$591.00 ,$401.88 ,$965.91 ,$386.36 ,$386.36 ,$443.25 ,$419.61 ,$419.61 ,$386.36 ,$419.61 ,$484.62 ,$484.62 ,$484.62 , N/A ,$591.00 ,$502.35 ,$386.36 ,$591.00 ,$352.83 ,$386.36 ,$245.86 , N/A , N/A ,$386.36 ,$502.35 ,$811.37 ,$502.35 ,$165.48 ,$531.90 ,$386.36 ,$484.62 ,$325.00 ,$325.00 ,$386.36 ,$384.15 ,$591.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$394.00 ,$256.10 ,$110.32 ,$643.95 ,$643.95 ,$256.10 ,$235.22 ,$257.58 ,$110.32 ,$221.03 ,$257.58 ,$259.25 ,$257.58 ,$334.90 ,$334.90 ,$257.58 ,$334.90 ,$394.00 ,$267.92 ,$643.94 ,$257.58 ,$257.58 ,$295.50 ,$279.74 ,$279.74 ,$257.58 ,$279.74 ,$323.08 ,$323.08 ,$323.08 , N/A ,$394.00 ,$334.90 ,$257.58 ,$394.00 ,$235.22 ,$257.58 ,$163.90 , N/A , N/A ,$257.58 ,$334.90 ,$540.91 ,$334.90 ,$110.32 ,$354.60 ,$257.58 ,$323.08 ,$325.00 ,$325.00 ,$257.58 ,$256.10 ,$394.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$562.00 ,$365.30 ,$157.36 ,$643.95 ,$643.95 ,$365.30 ,$335.51 ,$257.58 ,$157.36 ,$315.28 ,$257.58 ,$369.80 ,$257.58 ,$477.70 ,$477.70 ,$257.58 ,$477.70 ,$489.39 ,$382.16 ,$643.94 ,$257.58 ,$257.58 ,$421.50 ,$399.02 ,$399.02 ,$257.58 ,$399.02 ,$460.84 ,$460.84 ,$460.84 , N/A ,$562.00 ,$477.70 ,$257.58 ,$562.00 ,$335.51 ,$257.58 ,$233.79 , N/A , N/A ,$257.58 ,$477.70 ,$540.91 ,$477.70 ,$157.36 ,$505.80 ,$257.58 ,$460.84 ,$325.00 ,$325.00 ,$257.58 ,$365.30 ,$562.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$843.00 ,$547.95 ,$236.04 ,$965.91 ,$965.90 ,$547.95 ,$503.27 ,$386.36 ,$236.04 ,$472.92 ,$386.36 ,$554.69 ,$386.36 ,$716.55 ,$716.55 ,$386.36 ,$716.55 ,$734.09 ,$573.24 ,$965.91 ,$386.36 ,$386.36 ,$632.25 ,$598.53 ,$598.53 ,$386.36 ,$598.53 ,$691.26 ,$691.26 ,$691.26 , N/A ,$843.00 ,$716.55 ,$386.36 ,$843.00 ,$503.27 ,$386.36 ,$350.69 , N/A , N/A ,$386.36 ,$716.55 ,$811.37 ,$716.55 ,$236.04 ,$758.70 ,$386.36 ,$691.26 ,$325.00 ,$325.00 ,$386.36 ,$547.95 ,$843.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000073,20950,HC MONT INTST FLD PRS COMP SYNDR,450,1 ,$208.00 ,$135.20 ,$58.24 ,"$1,533.75 ","$1,533.75 ",$135.20 ,$124.18 ,$613.50 ,$58.24 ,$116.69 ,$613.50 ,$136.86 ,$208.00 ,$176.80 ,$176.80 ,$208.00 ,$176.80 ,$208.00 ,$141.44 ,"$1,533.75 ",$613.50 ,$613.50 ,$156.00 ,$147.68 ,$147.68 ,$613.50 ,$147.68 ,$170.56 ,$170.56 ,$170.56 , N/A ,$208.00 ,$176.80 ,$613.50 ,$208.00 ,$124.18 ,$613.50 ,$86.53 , N/A , N/A ,$613.50 ,$176.80 ,"$1,288.35 ",$176.80 ,$58.24 ,$187.20 ,$613.50 ,$170.56 ,$208.00 ,$208.00 ,$613.50 ,$135.20 ,$208.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,$330.00 ,$214.50 ,$92.40 ,$508.00 ,$508.00 ,$214.50 ,$197.01 ,$203.20 ,$92.40 ,$185.13 ,$203.20 ,$217.14 ,$203.20 ,$280.50 ,$280.50 ,$203.20 ,$280.50 ,$330.00 ,$224.40 ,$508.00 ,$203.20 ,$203.20 ,$247.50 ,$234.30 ,$234.30 ,$203.20 ,$234.30 ,$270.60 ,$270.60 ,$270.60 , N/A ,$330.00 ,$280.50 ,$203.20 ,$330.00 ,$197.01 ,$203.20 ,$137.28 , N/A , N/A ,$203.20 ,$280.50 ,$426.72 ,$280.50 ,$92.40 ,$297.00 ,$203.20 ,$270.60 ,$325.00 ,$325.00 ,$203.20 ,$214.50 ,$330.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000075,23655,HC TX DISL SHLDR W/MAN/ANES CLS,450,1 ,"$1,297.00 ",$843.05 ,$325.00 ,"$3,432.95 ","$3,432.95 ",$843.05 ,$774.31 ,"$1,373.18 ",$363.16 ,$727.62 ,"$1,373.18 ",$853.43 ,"$1,297.00 ","$1,102.45 ","$1,102.45 ","$1,297.00 ","$1,102.45 ","$1,297.00 ",$881.96 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ",$972.75 ,$920.87 ,$920.87 ,"$1,373.18 ",$920.87 ,"$1,063.54 ","$1,063.54 ","$1,063.54 ", N/A ,"$1,297.00 ","$1,102.45 ","$1,373.18 ","$1,297.00 ",$774.31 ,"$1,373.18 ",$539.55 , N/A , N/A ,"$1,373.18 ","$1,102.45 ","$2,883.67 ","$1,102.45 ",$363.16 ,"$1,167.30 ","$1,373.18 ","$1,063.54 ",$325.00 ,$325.00 ,"$1,373.18 ",$843.05 ,"$1,297.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$491.00 ,$319.15 ,$137.48 ,$508.00 ,$508.00 ,$319.15 ,$293.13 ,$203.20 ,$137.48 ,$275.45 ,$203.20 ,$323.08 ,$203.20 ,$417.35 ,$417.35 ,$203.20 ,$417.35 ,$386.08 ,$333.88 ,$508.00 ,$203.20 ,$203.20 ,$368.25 ,$348.61 ,$348.61 ,$203.20 ,$348.61 ,$402.62 ,$402.62 ,$402.62 , N/A ,$491.00 ,$417.35 ,$203.20 ,$491.00 ,$293.13 ,$203.20 ,$204.26 , N/A , N/A ,$203.20 ,$417.35 ,$426.72 ,$417.35 ,$137.48 ,$441.90 ,$203.20 ,$402.62 ,$325.00 ,$325.00 ,$203.20 ,$319.15 ,$491.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$737.00 ,$479.05 ,$206.36 ,$762.00 ,$762.00 ,$479.05 ,$439.99 ,$304.80 ,$206.36 ,$413.46 ,$304.80 ,$484.95 ,$304.80 ,$626.45 ,$626.45 ,$304.80 ,$626.45 ,$579.12 ,$501.16 ,$762.00 ,$304.80 ,$304.80 ,$552.75 ,$523.27 ,$523.27 ,$304.80 ,$523.27 ,$604.34 ,$604.34 ,$604.34 , N/A ,$737.00 ,$626.45 ,$304.80 ,$737.00 ,$439.99 ,$304.80 ,$306.59 , N/A , N/A ,$304.80 ,$626.45 ,$640.08 ,$626.45 ,$206.36 ,$663.30 ,$304.80 ,$604.34 ,$325.00 ,$325.00 ,$304.80 ,$479.05 ,$737.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$276.00 ,$179.40 ,$77.28 ,$508.00 ,$508.00 ,$179.40 ,$164.77 ,$203.20 ,$77.28 ,$154.84 ,$203.20 ,$181.61 ,$203.20 ,$234.60 ,$234.60 ,$203.20 ,$234.60 ,$276.00 ,$187.68 ,$508.00 ,$203.20 ,$203.20 ,$207.00 ,$195.96 ,$195.96 ,$203.20 ,$195.96 ,$226.32 ,$226.32 ,$226.32 , N/A ,$276.00 ,$234.60 ,$203.20 ,$276.00 ,$164.77 ,$203.20 ,$114.82 , N/A , N/A ,$203.20 ,$234.60 ,$426.72 ,$234.60 ,$77.28 ,$248.40 ,$203.20 ,$226.32 ,$276.00 ,$276.00 ,$203.20 ,$179.40 ,$276.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$414.00 ,$269.10 ,$115.92 ,$762.00 ,$762.00 ,$269.10 ,$247.16 ,$304.80 ,$115.92 ,$232.25 ,$304.80 ,$272.41 ,$304.80 ,$351.90 ,$351.90 ,$304.80 ,$351.90 ,$414.00 ,$281.52 ,$762.00 ,$304.80 ,$304.80 ,$310.50 ,$293.94 ,$293.94 ,$304.80 ,$293.94 ,$339.48 ,$339.48 ,$339.48 , N/A ,$414.00 ,$351.90 ,$304.80 ,$414.00 ,$247.16 ,$304.80 ,$172.22 , N/A , N/A ,$304.80 ,$351.90 ,$640.08 ,$351.90 ,$115.92 ,$372.60 ,$304.80 ,$339.48 ,$325.00 ,$325.00 ,$304.80 ,$269.10 ,$414.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000081,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP,450,1 ,"$3,918.00 ","$2,546.70 ",$325.00 ,"$3,918.00 ","$3,432.95 ","$2,546.70 ","$2,339.05 ","$1,373.18 ","$1,097.04 ","$2,198.00 ","$1,373.18 ","$2,578.04 ","$1,373.18 ","$3,330.30 ","$3,330.30 ","$1,373.18 ","$3,330.30 ","$2,609.04 ","$2,664.24 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,373.18 ","$2,781.78 ","$3,212.76 ","$3,212.76 ","$3,212.76 ", N/A ,"$3,432.94 ","$3,330.30 ","$1,373.18 ","$3,918.00 ","$2,339.05 ","$1,373.18 ","$1,629.89 ", N/A , N/A ,"$1,373.18 ","$3,330.30 ","$2,883.67 ","$3,330.30 ","$1,097.04 ","$3,526.20 ","$1,373.18 ","$3,212.76 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,546.70 ","$3,918.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$553.00 ,$359.45 ,$154.84 ,"$3,432.95 ","$3,432.95 ",$359.45 ,$330.14 ,"$1,373.18 ",$154.84 ,$310.23 ,"$1,373.18 ",$363.87 ,$553.00 ,$470.05 ,$470.05 ,$553.00 ,$470.05 ,$553.00 ,$376.04 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ",$414.75 ,$392.63 ,$392.63 ,"$1,373.18 ",$392.63 ,$453.46 ,$453.46 ,$453.46 , N/A ,$553.00 ,$470.05 ,"$1,373.18 ",$553.00 ,$330.14 ,"$1,373.18 ",$230.05 , N/A , N/A ,"$1,373.18 ",$470.05 ,"$2,883.67 ",$470.05 ,$154.84 ,$497.70 ,"$1,373.18 ",$453.46 ,$325.00 ,$325.00 ,"$1,373.18 ",$359.45 ,$553.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$829.00 ,$538.85 ,$232.12 ,"$3,432.95 ","$3,432.95 ",$538.85 ,$494.91 ,"$1,373.18 ",$232.12 ,$465.07 ,"$1,373.18 ",$545.48 ,$829.00 ,$704.65 ,$704.65 ,$829.00 ,$704.65 ,$829.00 ,$563.72 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ",$621.75 ,$588.59 ,$588.59 ,"$1,373.18 ",$588.59 ,$679.78 ,$679.78 ,$679.78 , N/A ,$829.00 ,$704.65 ,"$1,373.18 ",$829.00 ,$494.91 ,"$1,373.18 ",$344.86 , N/A , N/A ,"$1,373.18 ",$704.65 ,"$2,883.67 ",$704.65 ,$232.12 ,$746.10 ,"$1,373.18 ",$679.78 ,$325.00 ,$325.00 ,"$1,373.18 ",$538.85 ,$829.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000084,26011,HC DRAIN ABSC FINGER COMPLCD,450,1 ,"$4,006.50 ","$2,604.23 ",$325.00 ,"$4,006.50 ","$3,467.90 ","$2,604.23 ","$2,391.88 ","$1,387.16 ","$1,121.82 ","$2,247.65 ","$1,387.16 ","$2,636.28 ","$1,387.16 ","$3,405.53 ","$3,405.53 ","$1,387.16 ","$3,405.53 ","$2,635.59 ","$2,724.42 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$3,004.88 ","$2,844.62 ","$2,844.62 ","$1,387.16 ","$2,844.62 ","$3,285.33 ","$3,285.33 ","$3,285.33 ", N/A ,"$3,467.89 ","$3,405.53 ","$1,387.16 ","$4,006.50 ","$2,391.88 ","$1,387.16 ","$1,666.70 ", N/A , N/A ,"$1,387.16 ","$3,405.53 ","$2,913.03 ","$3,405.53 ","$1,121.82 ","$3,605.85 ","$1,387.16 ","$3,285.33 ",$325.00 ,$325.00 ,"$1,387.16 ","$2,604.23 ","$4,006.50 "
ST. JOSEPH'S HOSPITAL - BREESE,45000087,26725,HC TX FX PHALANX PROX W/MAN CLS,450,1 ,$848.00 ,$551.20 ,$203.20 ,$848.00 ,$508.00 ,$551.20 ,$506.26 ,$203.20 ,$237.44 ,$475.73 ,$203.20 ,$557.98 ,$203.20 ,$720.80 ,$720.80 ,$203.20 ,$720.80 ,$386.08 ,$576.64 ,$508.00 ,$203.20 ,$203.20 ,$636.00 ,$602.08 ,$602.08 ,$203.20 ,$602.08 ,$695.36 ,$695.36 ,$695.36 , N/A ,$508.00 ,$720.80 ,$203.20 ,$848.00 ,$506.26 ,$203.20 ,$352.77 , N/A , N/A ,$203.20 ,$720.80 ,$426.72 ,$720.80 ,$237.44 ,$763.20 ,$203.20 ,$695.36 ,$325.00 ,$325.00 ,$203.20 ,$551.20 ,$848.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000088,26742,HC TX FX (M-P)(I-P) JT W/MAN,450,1 ,"$3,918.00 ","$2,546.70 ",$325.00 ,"$3,918.00 ","$3,432.95 ","$2,546.70 ","$2,339.05 ","$1,373.18 ","$1,097.04 ","$2,198.00 ","$1,373.18 ","$2,578.04 ","$1,373.18 ","$3,330.30 ","$3,330.30 ","$1,373.18 ","$3,330.30 ","$2,609.04 ","$2,664.24 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,373.18 ","$2,781.78 ","$3,212.76 ","$3,212.76 ","$3,212.76 ", N/A ,"$3,432.94 ","$3,330.30 ","$1,373.18 ","$3,918.00 ","$2,339.05 ","$1,373.18 ","$1,629.89 ", N/A , N/A ,"$1,373.18 ","$3,330.30 ","$2,883.67 ","$3,330.30 ","$1,097.04 ","$3,526.20 ","$1,373.18 ","$3,212.76 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,546.70 ","$3,918.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000089,26755,HC TX FX PHALANX DIST W/MAN CLS,450,1 ,$848.00 ,$551.20 ,$203.20 ,$848.00 ,$508.00 ,$551.20 ,$506.26 ,$203.20 ,$237.44 ,$475.73 ,$203.20 ,$557.98 ,$203.20 ,$720.80 ,$720.80 ,$203.20 ,$720.80 ,$386.08 ,$576.64 ,$508.00 ,$203.20 ,$203.20 ,$636.00 ,$602.08 ,$602.08 ,$203.20 ,$602.08 ,$695.36 ,$695.36 ,$695.36 , N/A ,$508.00 ,$720.80 ,$203.20 ,$848.00 ,$506.26 ,$203.20 ,$352.77 , N/A , N/A ,$203.20 ,$720.80 ,$426.72 ,$720.80 ,$237.44 ,$763.20 ,$203.20 ,$695.36 ,$325.00 ,$325.00 ,$203.20 ,$551.20 ,$848.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$649.00 ,$421.85 ,$181.72 ,$649.00 ,$508.00 ,$421.85 ,$387.45 ,$203.20 ,$181.72 ,$364.09 ,$203.20 ,$427.04 ,$203.20 ,$551.65 ,$551.65 ,$203.20 ,$551.65 ,$386.08 ,$441.32 ,$508.00 ,$203.20 ,$203.20 ,$486.75 ,$460.79 ,$460.79 ,$203.20 ,$460.79 ,$532.18 ,$532.18 ,$532.18 , N/A ,$508.00 ,$551.65 ,$203.20 ,$649.00 ,$387.45 ,$203.20 ,$269.98 , N/A , N/A ,$203.20 ,$551.65 ,$426.72 ,$551.65 ,$181.72 ,$584.10 ,$203.20 ,$532.18 ,$325.00 ,$325.00 ,$203.20 ,$421.85 ,$649.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$7,848.00 ","$5,101.20 ",$325.00 ,"$7,848.00 ","$6,979.95 ","$5,101.20 ","$4,685.26 ","$2,791.98 ","$2,197.44 ","$4,402.73 ","$2,791.98 ","$5,163.98 ","$2,791.98 ","$6,670.80 ","$6,670.80 ","$2,791.98 ","$6,670.80 ","$5,304.75 ","$5,336.64 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$5,886.00 ","$5,572.08 ","$5,572.08 ","$2,791.98 ","$5,572.08 ","$6,435.36 ","$6,435.36 ","$6,435.36 ", N/A ,"$6,979.94 ","$6,670.80 ","$2,791.98 ","$7,848.00 ","$4,685.26 ","$2,791.98 ","$3,264.77 ", N/A , N/A ,"$2,791.98 ","$6,670.80 ","$5,863.15 ","$6,670.80 ","$2,197.44 ","$7,063.20 ","$2,791.98 ","$6,435.36 ",$325.00 ,$325.00 ,"$2,791.98 ","$5,101.20 ","$7,848.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000092,27250,HC TX DISCL HIP CLOSED W/O ANES,450,1 ,$616.00 ,$400.40 ,$172.48 ,$616.00 ,$508.00 ,$400.40 ,$367.75 ,$203.20 ,$172.48 ,$345.58 ,$203.20 ,$405.33 ,$203.20 ,$523.60 ,$523.60 ,$203.20 ,$523.60 ,$386.08 ,$418.88 ,$508.00 ,$203.20 ,$203.20 ,$462.00 ,$437.36 ,$437.36 ,$203.20 ,$437.36 ,$505.12 ,$505.12 ,$505.12 , N/A ,$508.00 ,$523.60 ,$203.20 ,$616.00 ,$367.75 ,$203.20 ,$256.26 , N/A , N/A ,$203.20 ,$523.60 ,$426.72 ,$523.60 ,$172.48 ,$554.40 ,$203.20 ,$505.12 ,$325.00 ,$325.00 ,$203.20 ,$400.40 ,$616.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$941.00 ,$611.65 ,$203.20 ,$941.00 ,$508.00 ,$611.65 ,$561.78 ,$203.20 ,$263.48 ,$527.90 ,$203.20 ,$619.18 ,$203.20 ,$799.85 ,$799.85 ,$203.20 ,$799.85 ,$386.08 ,$639.88 ,$508.00 ,$203.20 ,$203.20 ,$705.75 ,$668.11 ,$668.11 ,$203.20 ,$668.11 ,$771.62 ,$771.62 ,$771.62 , N/A ,$508.00 ,$799.85 ,$203.20 ,$941.00 ,$561.78 ,$203.20 ,$391.46 , N/A , N/A ,$203.20 ,$799.85 ,$426.72 ,$799.85 ,$263.48 ,$846.90 ,$203.20 ,$771.62 ,$325.00 ,$325.00 ,$203.20 ,$611.65 ,$941.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$356.00 ,$231.40 ,$99.68 ,$508.00 ,$508.00 ,$231.40 ,$212.53 ,$203.20 ,$99.68 ,$199.72 ,$203.20 ,$234.25 ,$203.20 ,$302.60 ,$302.60 ,$203.20 ,$302.60 ,$356.00 ,$242.08 ,$508.00 ,$203.20 ,$203.20 ,$267.00 ,$252.76 ,$252.76 ,$203.20 ,$252.76 ,$291.92 ,$291.92 ,$291.92 , N/A ,$356.00 ,$302.60 ,$203.20 ,$356.00 ,$212.53 ,$203.20 ,$148.10 , N/A , N/A ,$203.20 ,$302.60 ,$426.72 ,$302.60 ,$99.68 ,$320.40 ,$203.20 ,$291.92 ,$325.00 ,$325.00 ,$203.20 ,$231.40 ,$356.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$536.00 ,$348.40 ,$150.08 ,$762.00 ,$762.00 ,$348.40 ,$319.99 ,$304.80 ,$150.08 ,$300.70 ,$304.80 ,$352.69 ,$304.80 ,$455.60 ,$455.60 ,$304.80 ,$455.60 ,$536.00 ,$364.48 ,$762.00 ,$304.80 ,$304.80 ,$402.00 ,$380.56 ,$380.56 ,$304.80 ,$380.56 ,$439.52 ,$439.52 ,$439.52 , N/A ,$536.00 ,$455.60 ,$304.80 ,$536.00 ,$319.99 ,$304.80 ,$222.98 , N/A , N/A ,$304.80 ,$455.60 ,$640.08 ,$455.60 ,$150.08 ,$482.40 ,$304.80 ,$439.52 ,$325.00 ,$325.00 ,$304.80 ,$348.40 ,$536.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000098,29065,HC APPL CAST ARM LONG,450,1 ,$743.00 ,$482.95 ,$208.04 ,$743.00 ,$594.60 ,$482.95 ,$443.57 ,$237.84 ,$208.04 ,$416.82 ,$237.84 ,$488.89 ,$237.84 ,$631.55 ,$631.55 ,$237.84 ,$631.55 ,$451.89 ,$505.24 ,$594.59 ,$237.84 ,$237.84 ,$557.25 ,$527.53 ,$527.53 ,$237.84 ,$527.53 ,$609.26 ,$609.26 ,$609.26 , N/A ,$594.59 ,$631.55 ,$237.84 ,$743.00 ,$443.57 ,$237.84 ,$309.09 , N/A , N/A ,$237.84 ,$631.55 ,$499.45 ,$631.55 ,$208.04 ,$668.70 ,$237.84 ,$609.26 ,$325.00 ,$325.00 ,$237.84 ,$482.95 ,$743.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,$743.00 ,$482.95 ,$208.04 ,$743.00 ,$594.60 ,$482.95 ,$443.57 ,$237.84 ,$208.04 ,$416.82 ,$237.84 ,$488.89 ,$237.84 ,$631.55 ,$631.55 ,$237.84 ,$631.55 ,$451.89 ,$505.24 ,$594.59 ,$237.84 ,$237.84 ,$557.25 ,$527.53 ,$527.53 ,$237.84 ,$527.53 ,$609.26 ,$609.26 ,$609.26 , N/A ,$594.59 ,$631.55 ,$237.84 ,$743.00 ,$443.57 ,$237.84 ,$309.09 , N/A , N/A ,$237.84 ,$631.55 ,$499.45 ,$631.55 ,$208.04 ,$668.70 ,$237.84 ,$609.26 ,$325.00 ,$325.00 ,$237.84 ,$482.95 ,$743.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$427.00 ,$277.55 ,$119.56 ,$427.00 ,$348.23 ,$277.55 ,$254.92 ,$139.29 ,$119.56 ,$239.55 ,$139.29 ,$280.97 ,$139.29 ,$362.95 ,$362.95 ,$139.29 ,$362.95 ,$264.64 ,$290.36 ,$348.22 ,$139.29 ,$139.29 ,$320.25 ,$303.17 ,$303.17 ,$139.29 ,$303.17 ,$350.14 ,$350.14 ,$350.14 , N/A ,$348.22 ,$362.95 ,$139.29 ,$427.00 ,$254.92 ,$139.29 ,$177.63 , N/A , N/A ,$139.29 ,$362.95 ,$292.50 ,$362.95 ,$119.56 ,$384.30 ,$139.29 ,$350.14 ,$325.00 ,$325.00 ,$139.29 ,$277.55 ,$427.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$327.00 ,$212.55 ,$91.56 ,$327.00 ,$277.93 ,$212.55 ,$195.22 ,$111.17 ,$91.56 ,$183.45 ,$111.17 ,$215.17 ,$111.17 ,$277.95 ,$277.95 ,$111.17 ,$277.95 ,$211.22 ,$222.36 ,$277.92 ,$111.17 ,$111.17 ,$245.25 ,$232.17 ,$232.17 ,$111.17 ,$232.17 ,$268.14 ,$268.14 ,$268.14 , N/A ,$277.92 ,$277.95 ,$111.17 ,$327.00 ,$195.22 ,$111.17 ,$136.03 , N/A , N/A ,$111.17 ,$277.95 ,$233.45 ,$277.95 ,$91.56 ,$294.30 ,$111.17 ,$268.14 ,$325.00 ,$325.00 ,$111.17 ,$212.55 ,$327.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$189.00 ,$122.85 ,$52.92 ,$277.93 ,$277.93 ,$122.85 ,$112.83 ,$111.17 ,$52.92 ,$106.03 ,$111.17 ,$124.36 ,$111.17 ,$160.65 ,$160.65 ,$111.17 ,$160.65 ,$189.00 ,$128.52 ,$277.92 ,$111.17 ,$111.17 ,$141.75 ,$134.19 ,$134.19 ,$111.17 ,$134.19 ,$154.98 ,$154.98 ,$154.98 , N/A ,$189.00 ,$160.65 ,$111.17 ,$189.00 ,$112.83 ,$111.17 ,$78.62 , N/A , N/A ,$111.17 ,$160.65 ,$233.45 ,$160.65 ,$52.92 ,$170.10 ,$111.17 ,$154.98 ,$189.00 ,$189.00 ,$111.17 ,$122.85 ,$189.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$200.00 ,$130.00 ,$56.00 ,$277.93 ,$277.93 ,$130.00 ,$119.40 ,$111.17 ,$56.00 ,$112.20 ,$111.17 ,$131.60 ,$111.17 ,$170.00 ,$170.00 ,$111.17 ,$170.00 ,$200.00 ,$136.00 ,$277.92 ,$111.17 ,$111.17 ,$150.00 ,$142.00 ,$142.00 ,$111.17 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$200.00 ,$170.00 ,$111.17 ,$200.00 ,$119.40 ,$111.17 ,$83.20 , N/A , N/A ,$111.17 ,$170.00 ,$233.45 ,$170.00 ,$56.00 ,$180.00 ,$111.17 ,$164.00 ,$200.00 ,$200.00 ,$111.17 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000105,29240,HC STRAPPING SHLDR,450,1 ,$200.00 ,$130.00 ,$56.00 ,$277.93 ,$277.93 ,$130.00 ,$119.40 ,$111.17 ,$56.00 ,$112.20 ,$111.17 ,$131.60 ,$111.17 ,$170.00 ,$170.00 ,$111.17 ,$170.00 ,$200.00 ,$136.00 ,$277.92 ,$111.17 ,$111.17 ,$150.00 ,$142.00 ,$142.00 ,$111.17 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$200.00 ,$170.00 ,$111.17 ,$200.00 ,$119.40 ,$111.17 ,$83.20 , N/A , N/A ,$111.17 ,$170.00 ,$233.45 ,$170.00 ,$56.00 ,$180.00 ,$111.17 ,$164.00 ,$200.00 ,$200.00 ,$111.17 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$743.00 ,$482.95 ,$208.04 ,$743.00 ,$594.60 ,$482.95 ,$443.57 ,$237.84 ,$208.04 ,$416.82 ,$237.84 ,$488.89 ,$237.84 ,$631.55 ,$631.55 ,$237.84 ,$631.55 ,$451.89 ,$505.24 ,$594.59 ,$237.84 ,$237.84 ,$557.25 ,$527.53 ,$527.53 ,$237.84 ,$527.53 ,$609.26 ,$609.26 ,$609.26 , N/A ,$594.59 ,$631.55 ,$237.84 ,$743.00 ,$443.57 ,$237.84 ,$309.09 , N/A , N/A ,$237.84 ,$631.55 ,$499.45 ,$631.55 ,$208.04 ,$668.70 ,$237.84 ,$609.26 ,$325.00 ,$325.00 ,$237.84 ,$482.95 ,$743.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$427.00 ,$277.55 ,$119.56 ,$427.00 ,$348.23 ,$277.55 ,$254.92 ,$139.29 ,$119.56 ,$239.55 ,$139.29 ,$280.97 ,$139.29 ,$362.95 ,$362.95 ,$139.29 ,$362.95 ,$264.64 ,$290.36 ,$348.22 ,$139.29 ,$139.29 ,$320.25 ,$303.17 ,$303.17 ,$139.29 ,$303.17 ,$350.14 ,$350.14 ,$350.14 , N/A ,$348.22 ,$362.95 ,$139.29 ,$427.00 ,$254.92 ,$139.29 ,$177.63 , N/A , N/A ,$139.29 ,$362.95 ,$292.50 ,$362.95 ,$119.56 ,$384.30 ,$139.29 ,$350.14 ,$325.00 ,$325.00 ,$139.29 ,$277.55 ,$427.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$427.00 ,$277.55 ,$119.56 ,$427.00 ,$348.23 ,$277.55 ,$254.92 ,$139.29 ,$119.56 ,$239.55 ,$139.29 ,$280.97 ,$139.29 ,$362.95 ,$362.95 ,$139.29 ,$362.95 ,$264.64 ,$290.36 ,$348.22 ,$139.29 ,$139.29 ,$320.25 ,$303.17 ,$303.17 ,$139.29 ,$303.17 ,$350.14 ,$350.14 ,$350.14 , N/A ,$348.22 ,$362.95 ,$139.29 ,$427.00 ,$254.92 ,$139.29 ,$177.63 , N/A , N/A ,$139.29 ,$362.95 ,$292.50 ,$362.95 ,$119.56 ,$384.30 ,$139.29 ,$350.14 ,$325.00 ,$325.00 ,$139.29 ,$277.55 ,$427.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000110,30300,HC REM FB INTRANASAL,450,1 ,$327.00 ,$212.55 ,$91.56 ,$327.00 ,$277.93 ,$212.55 ,$195.22 ,$111.17 ,$91.56 ,$183.45 ,$111.17 ,$215.17 ,$111.17 ,$277.95 ,$277.95 ,$111.17 ,$277.95 ,$211.22 ,$222.36 ,$277.92 ,$111.17 ,$111.17 ,$245.25 ,$232.17 ,$232.17 ,$111.17 ,$232.17 ,$268.14 ,$268.14 ,$268.14 , N/A ,$277.92 ,$277.95 ,$111.17 ,$327.00 ,$195.22 ,$111.17 ,$136.03 , N/A , N/A ,$111.17 ,$277.95 ,$233.45 ,$277.95 ,$91.56 ,$294.30 ,$111.17 ,$268.14 ,$325.00 ,$325.00 ,$111.17 ,$212.55 ,$327.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$327.00 ,$212.55 ,$91.56 ,$327.00 ,$277.93 ,$212.55 ,$195.22 ,$111.17 ,$91.56 ,$183.45 ,$111.17 ,$215.17 ,$111.17 ,$277.95 ,$277.95 ,$111.17 ,$277.95 ,$211.22 ,$222.36 ,$277.92 ,$111.17 ,$111.17 ,$245.25 ,$232.17 ,$232.17 ,$111.17 ,$232.17 ,$268.14 ,$268.14 ,$268.14 , N/A ,$277.92 ,$277.95 ,$111.17 ,$327.00 ,$195.22 ,$111.17 ,$136.03 , N/A , N/A ,$111.17 ,$277.95 ,$233.45 ,$277.95 ,$91.56 ,$294.30 ,$111.17 ,$268.14 ,$325.00 ,$325.00 ,$111.17 ,$212.55 ,$327.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$490.00 ,$318.50 ,$111.17 ,$490.00 ,$277.93 ,$318.50 ,$292.53 ,$111.17 ,$137.20 ,$274.89 ,$111.17 ,$322.42 ,$111.17 ,$416.50 ,$416.50 ,$111.17 ,$416.50 ,$211.22 ,$333.20 ,$277.92 ,$111.17 ,$111.17 ,$367.50 ,$347.90 ,$347.90 ,$111.17 ,$347.90 ,$401.80 ,$401.80 ,$401.80 , N/A ,$277.92 ,$416.50 ,$111.17 ,$490.00 ,$292.53 ,$111.17 ,$203.84 , N/A , N/A ,$111.17 ,$416.50 ,$233.45 ,$416.50 ,$137.20 ,$441.00 ,$111.17 ,$401.80 ,$325.00 ,$325.00 ,$111.17 ,$318.50 ,$490.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$462.00 ,$300.30 ,$111.17 ,$462.00 ,$277.93 ,$300.30 ,$275.81 ,$111.17 ,$129.36 ,$259.18 ,$111.17 ,$304.00 ,$111.17 ,$392.70 ,$392.70 ,$111.17 ,$392.70 ,$211.22 ,$314.16 ,$277.92 ,$111.17 ,$111.17 ,$346.50 ,$328.02 ,$328.02 ,$111.17 ,$328.02 ,$378.84 ,$378.84 ,$378.84 , N/A ,$277.92 ,$392.70 ,$111.17 ,$462.00 ,$275.81 ,$111.17 ,$192.19 , N/A , N/A ,$111.17 ,$392.70 ,$233.45 ,$392.70 ,$129.36 ,$415.80 ,$111.17 ,$378.84 ,$325.00 ,$325.00 ,$111.17 ,$300.30 ,$462.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$810.66 ,$526.93 ,$226.98 ,$810.66 ,$668.93 ,$526.93 ,$483.96 ,$267.57 ,$226.98 ,$454.78 ,$267.57 ,$533.41 ,$267.57 ,$689.06 ,$689.06 ,$267.57 ,$689.06 ,$508.38 ,$551.25 ,$668.92 ,$267.57 ,$267.57 ,$608.00 ,$575.57 ,$575.57 ,$267.57 ,$575.57 ,$664.74 ,$664.74 ,$664.74 , N/A ,$668.92 ,$689.06 ,$267.57 ,$810.66 ,$483.96 ,$267.57 ,$337.23 , N/A , N/A ,$267.57 ,$689.06 ,$561.89 ,$689.06 ,$226.98 ,$729.59 ,$267.57 ,$664.74 ,$325.00 ,$325.00 ,$267.57 ,$526.93 ,$810.66 
ST. JOSEPH'S HOSPITAL - BREESE,45000136,40800,HC DRAINAGE MOUTH LESION,450,1 ,"$1,749.00 ","$1,136.85 ",$325.00 ,"$1,749.00 ","$1,533.75 ","$1,136.85 ","$1,044.15 ",$613.50 ,$489.72 ,$981.19 ,$613.50 ,"$1,150.84 ",$613.50 ,"$1,486.65 ","$1,486.65 ",$613.50 ,"$1,486.65 ","$1,165.65 ","$1,189.32 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,311.75 ","$1,241.79 ","$1,241.79 ",$613.50 ,"$1,241.79 ","$1,434.18 ","$1,434.18 ","$1,434.18 ", N/A ,"$1,533.75 ","$1,486.65 ",$613.50 ,"$1,749.00 ","$1,044.15 ",$613.50 ,$727.58 , N/A , N/A ,$613.50 ,"$1,486.65 ","$1,288.35 ","$1,486.65 ",$489.72 ,"$1,574.10 ",$613.50 ,"$1,434.18 ",$325.00 ,$325.00 ,$613.50 ,"$1,136.85 ","$1,749.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000137,40830,HC LAC REPAIR VESTIBULE MOUTH 2.5 CM OR LESS,450,1 ,$584.00 ,$379.60 ,$163.52 ,$584.00 ,$521.45 ,$379.60 ,$348.65 ,$208.58 ,$163.52 ,$327.62 ,$208.58 ,$384.27 ,$208.58 ,$496.40 ,$496.40 ,$208.58 ,$496.40 ,$396.30 ,$397.12 ,$521.44 ,$208.58 ,$208.58 ,$438.00 ,$414.64 ,$414.64 ,$208.58 ,$414.64 ,$478.88 ,$478.88 ,$478.88 , N/A ,$521.44 ,$496.40 ,$208.58 ,$584.00 ,$348.65 ,$208.58 ,$242.94 , N/A , N/A ,$208.58 ,$496.40 ,$438.01 ,$496.40 ,$163.52 ,$525.60 ,$208.58 ,$478.88 ,$325.00 ,$325.00 ,$208.58 ,$379.60 ,$584.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$283.00 ,$183.95 ,$79.24 ,$668.93 ,$668.93 ,$183.95 ,$168.95 ,$267.57 ,$79.24 ,$158.76 ,$267.57 ,$186.21 ,$267.57 ,$240.55 ,$240.55 ,$267.57 ,$240.55 ,$283.00 ,$192.44 ,$668.92 ,$267.57 ,$267.57 ,$212.25 ,$200.93 ,$200.93 ,$267.57 ,$200.93 ,$232.06 ,$232.06 ,$232.06 , N/A ,$283.00 ,$240.55 ,$267.57 ,$283.00 ,$168.95 ,$267.57 ,$117.73 , N/A , N/A ,$267.57 ,$240.55 ,$561.89 ,$240.55 ,$79.24 ,$254.70 ,$267.57 ,$232.06 ,$283.00 ,$283.00 ,$267.57 ,$183.95 ,$283.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$319.00 ,$207.35 ,$89.32 ,$319.00 ,$277.93 ,$207.35 ,$190.44 ,$111.17 ,$89.32 ,$178.96 ,$111.17 ,$209.90 ,$111.17 ,$271.15 ,$271.15 ,$111.17 ,$271.15 ,$211.22 ,$216.92 ,$277.92 ,$111.17 ,$111.17 ,$239.25 ,$226.49 ,$226.49 ,$111.17 ,$226.49 ,$261.58 ,$261.58 ,$261.58 , N/A ,$277.92 ,$271.15 ,$111.17 ,$319.00 ,$190.44 ,$111.17 ,$132.70 , N/A , N/A ,$111.17 ,$271.15 ,$233.45 ,$271.15 ,$89.32 ,$287.10 ,$111.17 ,$261.58 ,$319.00 ,$319.00 ,$111.17 ,$207.35 ,$319.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000146,46040,HC INCISION RECTAL ABSCESS,450,1 ,"$2,879.00 ","$1,871.35 ",$325.00 ,"$2,879.00 ","$2,555.83 ","$1,871.35 ","$1,718.76 ","$1,022.33 ",$806.12 ,"$1,615.12 ","$1,022.33 ","$1,894.38 ","$1,022.33 ","$2,447.15 ","$2,447.15 ","$1,022.33 ","$2,447.15 ","$1,942.43 ","$1,957.72 ","$2,555.83 ","$1,022.33 ","$1,022.33 ","$2,159.25 ","$2,044.09 ","$2,044.09 ","$1,022.33 ","$2,044.09 ","$2,360.78 ","$2,360.78 ","$2,360.78 ", N/A ,"$2,555.83 ","$2,447.15 ","$1,022.33 ","$2,879.00 ","$1,718.76 ","$1,022.33 ","$1,197.66 ", N/A , N/A ,"$1,022.33 ","$2,447.15 ","$2,146.90 ","$2,447.15 ",$806.12 ,"$2,591.10 ","$1,022.33 ","$2,360.78 ",$325.00 ,$325.00 ,"$1,022.33 ","$1,871.35 ","$2,879.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$2,115.00 ","$1,374.75 ",$325.00 ,"$2,115.00 ","$1,955.93 ","$1,374.75 ","$1,262.66 ",$782.37 ,$592.20 ,"$1,186.52 ",$782.37 ,"$1,391.67 ",$782.37 ,"$1,797.75 ","$1,797.75 ",$782.37 ,"$1,797.75 ","$1,486.51 ","$1,438.20 ","$1,955.93 ",$782.37 ,$782.37 ,"$1,586.25 ","$1,501.65 ","$1,501.65 ",$782.37 ,"$1,501.65 ","$1,734.30 ","$1,734.30 ","$1,734.30 ", N/A ,"$1,955.93 ","$1,797.75 ",$782.37 ,"$2,115.00 ","$1,262.66 ",$782.37 ,$879.84 , N/A , N/A ,$782.37 ,"$1,797.75 ","$1,642.98 ","$1,797.75 ",$592.20 ,"$1,903.50 ",$782.37 ,"$1,734.30 ",$325.00 ,$325.00 ,$782.37 ,"$1,374.75 ","$2,115.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$798.42 ,$518.97 ,$223.56 ,$798.42 ,$655.88 ,$518.97 ,$476.66 ,$262.35 ,$223.56 ,$447.91 ,$262.35 ,$525.36 ,$262.35 ,$678.66 ,$678.66 ,$262.35 ,$678.66 ,$498.46 ,$542.93 ,$655.86 ,$262.35 ,$262.35 ,$598.82 ,$566.88 ,$566.88 ,$262.35 ,$566.88 ,$654.70 ,$654.70 ,$654.70 , N/A ,$655.86 ,$678.66 ,$262.35 ,$798.42 ,$476.66 ,$262.35 ,$332.14 , N/A , N/A ,$262.35 ,$678.66 ,$550.92 ,$678.66 ,$223.56 ,$718.58 ,$262.35 ,$654.70 ,$325.00 ,$325.00 ,$262.35 ,$518.97 ,$798.42 
ST. JOSEPH'S HOSPITAL - BREESE,45000149,46320,HC EXCISION THROMBOSED HEMORRHOID; EXTERNAL,450,1 ,"$5,584.00 ","$3,629.60 ",$325.00 ,"$5,584.00 ","$2,555.83 ","$3,629.60 ","$3,333.65 ","$1,022.33 ","$1,563.52 ","$3,132.62 ","$1,022.33 ","$3,674.27 ","$1,022.33 ","$4,746.40 ","$4,746.40 ","$1,022.33 ","$4,746.40 ","$1,942.43 ","$3,797.12 ","$2,555.83 ","$1,022.33 ","$1,022.33 ","$4,188.00 ","$3,964.64 ","$3,964.64 ","$1,022.33 ","$3,964.64 ","$4,578.88 ","$4,578.88 ","$4,578.88 ", N/A ,"$2,555.83 ","$4,746.40 ","$1,022.33 ","$5,584.00 ","$3,333.65 ","$1,022.33 ","$2,322.94 ", N/A , N/A ,"$1,022.33 ","$4,746.40 ","$2,146.90 ","$4,746.40 ","$1,563.52 ","$5,025.60 ","$1,022.33 ","$4,578.88 ",$325.00 ,$325.00 ,"$1,022.33 ","$3,629.60 ","$5,584.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$430.00 ,$279.50 ,$120.40 ,$655.88 ,$655.88 ,$279.50 ,$256.71 ,$262.35 ,$120.40 ,$241.23 ,$262.35 ,$282.94 ,$262.35 ,$365.50 ,$365.50 ,$262.35 ,$365.50 ,$430.00 ,$292.40 ,$655.86 ,$262.35 ,$262.35 ,$322.50 ,$305.30 ,$305.30 ,$262.35 ,$305.30 ,$352.60 ,$352.60 ,$352.60 , N/A ,$430.00 ,$365.50 ,$262.35 ,$430.00 ,$256.71 ,$262.35 ,$178.88 , N/A , N/A ,$262.35 ,$365.50 ,$550.92 ,$365.50 ,$120.40 ,$387.00 ,$262.35 ,$352.60 ,$325.00 ,$325.00 ,$262.35 ,$279.50 ,$430.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,$757.83 ,$492.59 ,$212.19 ,$757.83 ,$655.88 ,$492.59 ,$452.42 ,$262.35 ,$212.19 ,$425.14 ,$262.35 ,$498.65 ,$262.35 ,$644.16 ,$644.16 ,$262.35 ,$644.16 ,$498.46 ,$515.32 ,$655.86 ,$262.35 ,$262.35 ,$568.37 ,$538.06 ,$538.06 ,$262.35 ,$538.06 ,$621.42 ,$621.42 ,$621.42 , N/A ,$655.86 ,$644.16 ,$262.35 ,$757.83 ,$452.42 ,$262.35 ,$315.26 , N/A , N/A ,$262.35 ,$644.16 ,$550.92 ,$644.16 ,$212.19 ,$682.05 ,$262.35 ,$621.42 ,$325.00 ,$325.00 ,$262.35 ,$492.59 ,$757.83 
ST. JOSEPH'S HOSPITAL - BREESE,45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,$657.00 ,$427.05 ,$183.96 ,$657.00 ,$655.88 ,$427.05 ,$392.23 ,$262.35 ,$183.96 ,$368.58 ,$262.35 ,$432.31 ,$262.35 ,$558.45 ,$558.45 ,$262.35 ,$558.45 ,$498.46 ,$446.76 ,$655.86 ,$262.35 ,$262.35 ,$492.75 ,$466.47 ,$466.47 ,$262.35 ,$466.47 ,$538.74 ,$538.74 ,$538.74 , N/A ,$655.86 ,$558.45 ,$262.35 ,$657.00 ,$392.23 ,$262.35 ,$273.31 , N/A , N/A ,$262.35 ,$558.45 ,$550.92 ,$558.45 ,$183.96 ,$591.30 ,$262.35 ,$538.74 ,$325.00 ,$325.00 ,$262.35 ,$427.05 ,$657.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000161,54700,HC I AND D EPIDIDYMIS TESTIS OR SCROTAL SPACE,450,1 ,"$5,079.00 ","$3,301.35 ",$325.00 ,"$5,079.00 ","$4,413.08 ","$3,301.35 ","$3,032.16 ","$1,765.23 ","$1,422.12 ","$2,849.32 ","$1,765.23 ","$3,341.98 ","$1,765.23 ","$4,317.15 ","$4,317.15 ","$1,765.23 ","$4,317.15 ","$3,353.94 ","$3,453.72 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$3,809.25 ","$3,606.09 ","$3,606.09 ","$1,765.23 ","$3,606.09 ","$4,164.78 ","$4,164.78 ","$4,164.78 ", N/A ,"$4,413.08 ","$4,317.15 ","$1,765.23 ","$5,079.00 ","$3,032.16 ","$1,765.23 ","$2,112.86 ", N/A , N/A ,"$1,765.23 ","$4,317.15 ","$3,706.99 ","$4,317.15 ","$1,422.12 ","$4,571.10 ","$1,765.23 ","$4,164.78 ",$325.00 ,$325.00 ,"$1,765.23 ","$3,301.35 ","$5,079.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$146.00 ,$94.90 ,$40.88 ,$695.13 ,$695.13 ,$94.90 ,$87.16 ,$278.05 ,$40.88 ,$81.91 ,$278.05 ,$96.07 ,$146.00 ,$124.10 ,$124.10 ,$146.00 ,$124.10 ,$146.00 ,$99.28 ,$695.13 ,$278.05 ,$278.05 ,$109.50 ,$103.66 ,$103.66 ,$278.05 ,$103.66 ,$119.72 ,$119.72 ,$119.72 , N/A ,$146.00 ,$124.10 ,$278.05 ,$146.00 ,$87.16 ,$278.05 ,$60.74 , N/A , N/A ,$278.05 ,$124.10 ,$583.91 ,$124.10 ,$40.88 ,$131.40 ,$278.05 ,$119.72 ,$146.00 ,$146.00 ,$278.05 ,$94.90 ,$146.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$393.00 ,$255.45 ,$110.04 ,$419.90 ,$419.90 ,$255.45 ,$234.62 ,$167.96 ,$110.04 ,$220.47 ,$167.96 ,$258.59 ,$167.96 ,$334.05 ,$334.05 ,$167.96 ,$334.05 ,$319.12 ,$267.24 ,$419.89 ,$167.96 ,$167.96 ,$294.75 ,$279.03 ,$279.03 ,$167.96 ,$279.03 ,$322.26 ,$322.26 ,$322.26 , N/A ,$393.00 ,$334.05 ,$167.96 ,$393.00 ,$234.62 ,$167.96 ,$163.49 , N/A , N/A ,$167.96 ,$334.05 ,$352.71 ,$334.05 ,$110.04 ,$353.70 ,$167.96 ,$322.26 ,$325.00 ,$325.00 ,$167.96 ,$255.45 ,$393.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$376.00 ,$244.40 ,$105.28 ,$643.95 ,$643.95 ,$244.40 ,$224.47 ,$257.58 ,$105.28 ,$210.94 ,$257.58 ,$247.41 ,$257.58 ,$319.60 ,$319.60 ,$257.58 ,$319.60 ,$376.00 ,$255.68 ,$643.94 ,$257.58 ,$257.58 ,$282.00 ,$266.96 ,$266.96 ,$257.58 ,$266.96 ,$308.32 ,$308.32 ,$308.32 , N/A ,$376.00 ,$319.60 ,$257.58 ,$376.00 ,$224.47 ,$257.58 ,$156.42 , N/A , N/A ,$257.58 ,$319.60 ,$540.91 ,$319.60 ,$105.28 ,$338.40 ,$257.58 ,$308.32 ,$325.00 ,$325.00 ,$257.58 ,$244.40 ,$376.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,"$1,797.00 ","$1,168.05 ",$325.00 ,"$1,797.00 ","$1,565.08 ","$1,168.05 ","$1,072.81 ",$626.03 ,$503.16 ,"$1,008.12 ",$626.03 ,"$1,182.43 ",$626.03 ,"$1,527.45 ","$1,527.45 ",$626.03 ,"$1,527.45 ","$1,189.46 ","$1,221.96 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$626.03 ,"$1,275.87 ","$1,473.54 ","$1,473.54 ","$1,473.54 ", N/A ,"$1,565.07 ","$1,527.45 ",$626.03 ,"$1,797.00 ","$1,072.81 ",$626.03 ,$747.55 , N/A , N/A ,$626.03 ,"$1,527.45 ","$1,314.66 ","$1,527.45 ",$503.16 ,"$1,617.30 ",$626.03 ,"$1,473.54 ",$325.00 ,$325.00 ,$626.03 ,"$1,168.05 ","$1,797.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$378.00 ,$245.70 ,$105.84 ,$378.00 ,$277.93 ,$245.70 ,$225.67 ,$111.17 ,$105.84 ,$212.06 ,$111.17 ,$248.72 ,$111.17 ,$321.30 ,$321.30 ,$111.17 ,$321.30 ,$211.22 ,$257.04 ,$277.92 ,$111.17 ,$111.17 ,$283.50 ,$268.38 ,$268.38 ,$111.17 ,$268.38 ,$309.96 ,$309.96 ,$309.96 , N/A ,$277.92 ,$321.30 ,$111.17 ,$378.00 ,$225.67 ,$111.17 ,$157.25 , N/A , N/A ,$111.17 ,$321.30 ,$233.45 ,$321.30 ,$105.84 ,$340.20 ,$111.17 ,$309.96 ,$325.00 ,$325.00 ,$111.17 ,$245.70 ,$378.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$378.00 ,$245.70 ,$105.84 ,$668.93 ,$668.93 ,$245.70 ,$225.67 ,$267.57 ,$105.84 ,$212.06 ,$267.57 ,$248.72 ,$267.57 ,$321.30 ,$321.30 ,$267.57 ,$321.30 ,$378.00 ,$257.04 ,$668.92 ,$267.57 ,$267.57 ,$283.50 ,$268.38 ,$268.38 ,$267.57 ,$268.38 ,$309.96 ,$309.96 ,$309.96 , N/A ,$378.00 ,$321.30 ,$267.57 ,$378.00 ,$225.67 ,$267.57 ,$157.25 , N/A , N/A ,$267.57 ,$321.30 ,$561.89 ,$321.30 ,$105.84 ,$340.20 ,$267.57 ,$309.96 ,$325.00 ,$325.00 ,$267.57 ,$245.70 ,$378.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$432.00 ,$280.80 ,$120.96 ,$644.74 ,$644.73 ,$280.80 ,$257.90 ,$257.89 ,$120.96 ,$242.35 ,$257.89 ,$284.26 ,$257.89 ,$367.20 ,$367.20 ,$257.89 ,$367.20 ,$432.00 ,$293.76 ,$644.74 ,$257.89 ,$257.89 ,$324.00 ,$306.72 ,$306.72 ,$257.89 ,$306.72 ,$354.24 ,$354.24 ,$354.24 , N/A ,$432.00 ,$367.20 ,$257.89 ,$432.00 ,$257.90 ,$257.89 ,$179.71 , N/A , N/A ,$257.89 ,$367.20 ,$541.58 ,$367.20 ,$120.96 ,$388.80 ,$257.89 ,$354.24 ,$325.00 ,$325.00 ,$257.89 ,$280.80 ,$432.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$647.00 ,$420.55 ,$181.16 ,$967.11 ,$967.10 ,$420.55 ,$386.26 ,$386.84 ,$181.16 ,$362.97 ,$386.84 ,$425.73 ,$386.84 ,$549.95 ,$549.95 ,$386.84 ,$549.95 ,$647.00 ,$439.96 ,$967.11 ,$386.84 ,$386.84 ,$485.25 ,$459.37 ,$459.37 ,$386.84 ,$459.37 ,$530.54 ,$530.54 ,$530.54 , N/A ,$647.00 ,$549.95 ,$386.84 ,$647.00 ,$386.26 ,$386.84 ,$269.15 , N/A , N/A ,$386.84 ,$549.95 ,$812.37 ,$549.95 ,$181.16 ,$582.30 ,$386.84 ,$530.54 ,$325.00 ,$325.00 ,$386.84 ,$420.55 ,$647.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,"$1,080.00 ",$702.00 ,$257.89 ,"$1,080.00 ",$644.73 ,$702.00 ,$644.76 ,$257.89 ,$302.40 ,$605.88 ,$257.89 ,$710.64 ,$257.89 ,$918.00 ,$918.00 ,$257.89 ,$918.00 ,$490.00 ,$734.40 ,$644.74 ,$257.89 ,$257.89 ,$810.00 ,$766.80 ,$766.80 ,$257.89 ,$766.80 ,$885.60 ,$885.60 ,$885.60 , N/A ,$644.74 ,$918.00 ,$257.89 ,"$1,080.00 ",$644.76 ,$257.89 ,$449.28 , N/A , N/A ,$257.89 ,$918.00 ,$541.58 ,$918.00 ,$302.40 ,$972.00 ,$257.89 ,$885.60 ,$325.00 ,$325.00 ,$257.89 ,$702.00 ,"$1,080.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000179,69000,HC DRAIN ABSC/HEMA EAR EXT SMP,450,1 ,"$1,749.00 ","$1,136.85 ",$325.00 ,"$1,749.00 ","$1,533.75 ","$1,136.85 ","$1,044.15 ",$613.50 ,$489.72 ,$981.19 ,$613.50 ,"$1,150.84 ",$613.50 ,"$1,486.65 ","$1,486.65 ",$613.50 ,"$1,486.65 ","$1,165.65 ","$1,189.32 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,311.75 ","$1,241.79 ","$1,241.79 ",$613.50 ,"$1,241.79 ","$1,434.18 ","$1,434.18 ","$1,434.18 ", N/A ,"$1,533.75 ","$1,486.65 ",$613.50 ,"$1,749.00 ","$1,044.15 ",$613.50 ,$727.58 , N/A , N/A ,$613.50 ,"$1,486.65 ","$1,288.35 ","$1,486.65 ",$489.72 ,"$1,574.10 ",$613.50 ,"$1,434.18 ",$325.00 ,$325.00 ,$613.50 ,"$1,136.85 ","$1,749.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000181,69200,HC FB REMOVAL EAR,450,1 ,$324.00 ,$210.60 ,$90.72 ,$324.00 ,$277.93 ,$210.60 ,$193.43 ,$111.17 ,$90.72 ,$181.76 ,$111.17 ,$213.19 ,$111.17 ,$275.40 ,$275.40 ,$111.17 ,$275.40 ,$211.22 ,$220.32 ,$277.92 ,$111.17 ,$111.17 ,$243.00 ,$230.04 ,$230.04 ,$111.17 ,$230.04 ,$265.68 ,$265.68 ,$265.68 , N/A ,$277.92 ,$275.40 ,$111.17 ,$324.00 ,$193.43 ,$111.17 ,$134.78 , N/A , N/A ,$111.17 ,$275.40 ,$233.45 ,$275.40 ,$90.72 ,$291.60 ,$111.17 ,$265.68 ,$324.00 ,$324.00 ,$111.17 ,$210.60 ,$324.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000181,69200,HC FB REMOVAL EAR,450,1 ,$216.00 ,$140.40 ,$60.48 ,$277.93 ,$277.93 ,$140.40 ,$128.95 ,$111.17 ,$60.48 ,$121.18 ,$111.17 ,$142.13 ,$111.17 ,$183.60 ,$183.60 ,$111.17 ,$183.60 ,$211.22 ,$146.88 ,$277.92 ,$111.17 ,$111.17 ,$162.00 ,$153.36 ,$153.36 ,$111.17 ,$153.36 ,$177.12 ,$177.12 ,$177.12 , N/A ,$216.00 ,$183.60 ,$111.17 ,$216.00 ,$128.95 ,$111.17 ,$89.86 , N/A , N/A ,$111.17 ,$183.60 ,$233.45 ,$183.60 ,$60.48 ,$194.40 ,$111.17 ,$177.12 ,$216.00 ,$216.00 ,$111.17 ,$140.40 ,$216.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$222.00 ,$144.30 ,$54.88 ,$222.00 ,$137.20 ,$144.30 ,$132.53 ,$54.88 ,$62.16 ,$124.54 ,$54.88 ,$146.08 ,$54.88 ,$188.70 ,$188.70 ,$54.88 ,$188.70 ,$104.27 ,$150.96 ,$137.20 ,$54.88 ,$54.88 ,$166.50 ,$157.62 ,$157.62 ,$54.88 ,$157.62 ,$182.04 ,$182.04 ,$182.04 , N/A ,$137.20 ,$188.70 ,$54.88 ,$222.00 ,$132.53 ,$54.88 ,$92.35 , N/A , N/A ,$54.88 ,$188.70 ,$115.24 ,$188.70 ,$62.16 ,$199.80 ,$54.88 ,$182.04 ,$222.00 ,$222.00 ,$54.88 ,$144.30 ,$222.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000188,99281,HC ER LEVEL 1,450,1 ,$367.00 ,$238.55 ,$71.51 ,$367.00 ,$178.78 ,$238.55 ,$219.10 ,$71.51 ,$102.76 ,$205.89 ,$71.51 ,$241.49 ,$71.51 ,$311.95 ,$311.95 ,$71.51 ,$311.95 ,$135.87 ,$249.56 ,$178.78 ,$71.51 ,$71.51 ,$275.25 ,$260.57 ,$260.57 ,$71.51 ,$260.57 ,$300.94 ,$300.94 ,$300.94 , N/A ,$178.78 ,$311.95 ,$71.51 ,$367.00 ,$219.10 ,$71.51 ,$152.67 , N/A , N/A ,$71.51 ,$311.95 ,$150.17 ,$311.95 ,$102.76 ,$330.30 ,$71.51 ,$300.94 ,$325.00 ,$325.00 ,$71.51 ,$238.55 ,$367.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000189,99282,HC ER LEVEL 2,450,1 ,$547.00 ,$355.55 ,$129.50 ,$547.00 ,$323.75 ,$355.55 ,$326.56 ,$129.50 ,$153.16 ,$306.87 ,$129.50 ,$359.93 ,$129.50 ,$464.95 ,$464.95 ,$129.50 ,$464.95 ,$246.05 ,$371.96 ,$323.74 ,$129.50 ,$129.50 ,$410.25 ,$388.37 ,$388.37 ,$129.50 ,$388.37 ,$448.54 ,$448.54 ,$448.54 , N/A ,$323.74 ,$464.95 ,$129.50 ,$547.00 ,$326.56 ,$129.50 ,$227.55 , N/A , N/A ,$129.50 ,$464.95 ,$271.95 ,$464.95 ,$153.16 ,$492.30 ,$129.50 ,$448.54 ,$547.00 ,$547.00 ,$129.50 ,$355.55 ,$547.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000190,99283,HC ER LEVEL 3,450,1 ,$802.00 ,$521.30 ,$224.56 ,$802.00 ,$570.38 ,$521.30 ,$478.79 ,$228.15 ,$224.56 ,$449.92 ,$228.15 ,$527.72 ,$228.15 ,$681.70 ,$681.70 ,$228.15 ,$681.70 ,$433.49 ,$545.36 ,$570.38 ,$228.15 ,$228.15 ,$601.50 ,$569.42 ,$569.42 ,$228.15 ,$569.42 ,$657.64 ,$657.64 ,$657.64 , N/A ,$570.38 ,$681.70 ,$228.15 ,$802.00 ,$478.79 ,$228.15 ,$333.63 , N/A , N/A ,$228.15 ,$681.70 ,$479.12 ,$681.70 ,$224.56 ,$721.80 ,$228.15 ,$657.64 ,$802.00 ,$802.00 ,$228.15 ,$521.30 ,$802.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000191,99284,HC ER LEVEL 4,450,1 ,"$1,226.00 ",$796.90 ,$93.06 ,"$1,226.00 ",$896.60 ,$796.90 ,$731.92 ,$358.64 ,$343.28 ,$687.79 ,$358.64 ,$806.71 ,$358.64 ,"$1,042.10 ","$1,042.10 ",$358.64 ,"$1,042.10 ",$681.41 ,$833.68 ,$896.59 ,$358.64 ,$358.64 ,$919.50 ,$870.46 ,$870.46 ,$358.64 ,$870.46 ,"$1,005.32 ","$1,005.32 ","$1,005.32 ", N/A ,$896.59 ,"$1,042.10 ",$358.64 ,"$1,226.00 ",$731.92 ,$358.64 ,$510.02 ,$102.37 ,$93.06 ,$358.64 ,"$1,042.10 ",$753.13 ,"$1,042.10 ",$343.28 ,"$1,103.40 ",$358.64 ,"$1,005.32 ","$1,226.00 ","$1,226.00 ",$358.64 ,$796.90 ,"$1,226.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000192,99285,HC ER LEVEL 5,450,1 ,"$1,769.00 ","$1,149.85 ",$93.06 ,"$1,769.00 ","$1,286.95 ","$1,149.85 ","$1,056.09 ",$514.78 ,$495.32 ,$992.41 ,$514.78 ,"$1,164.00 ",$514.78 ,"$1,503.65 ","$1,503.65 ",$514.78 ,"$1,503.65 ",$978.07 ,"$1,202.92 ","$1,286.94 ",$514.78 ,$514.78 ,"$1,326.75 ","$1,255.99 ","$1,255.99 ",$514.78 ,"$1,255.99 ","$1,450.58 ","$1,450.58 ","$1,450.58 ", N/A ,"$1,286.94 ","$1,503.65 ",$514.78 ,"$1,769.00 ","$1,056.09 ",$514.78 ,$735.90 ,$102.37 ,$93.06 ,$514.78 ,"$1,503.65 ","$1,081.03 ","$1,503.65 ",$495.32 ,"$1,592.10 ",$514.78 ,"$1,450.58 ","$1,769.00 ","$1,769.00 ",$514.78 ,"$1,149.85 ","$1,769.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$2,249.00 ","$1,461.85 ",$93.06 ,"$2,249.00 ","$1,835.90 ","$1,461.85 ","$1,342.65 ",$734.36 ,$629.72 ,"$1,261.69 ",$734.36 ,"$1,479.84 ",$734.36 ,"$1,911.65 ","$1,911.65 ",$734.36 ,"$1,911.65 ","$1,395.28 ","$1,529.32 ","$1,835.89 ",$734.36 ,$734.36 ,"$1,686.75 ","$1,596.79 ","$1,596.79 ",$734.36 ,"$1,596.79 ","$1,844.18 ","$1,844.18 ","$1,844.18 ", N/A ,"$1,835.89 ","$1,911.65 ",$734.36 ,"$2,249.00 ","$1,342.65 ",$734.36 ,$935.58 ,$102.37 ,$93.06 ,$734.36 ,"$1,911.65 ","$1,542.15 ","$1,911.65 ",$629.72 ,"$2,024.10 ",$734.36 ,"$1,844.18 ","$2,249.00 ","$2,249.00 ",$734.36 ,"$1,461.85 ","$2,249.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$919.00 ,$597.35 ,$257.32 ,$919.00 , N/A ,$597.35 ,$548.64 , N/A ,$257.32 ,$515.56 , N/A ,$604.70 , N/A ,$781.15 ,$781.15 , N/A ,$781.15 , N/A ,$624.92 , N/A , N/A , N/A ,$689.25 ,$652.49 ,$652.49 , N/A ,$652.49 ,$753.58 ,$753.58 ,$753.58 , N/A , N/A ,$781.15 , N/A ,$919.00 ,$548.64 , N/A ,$382.30 , N/A , N/A , N/A ,$781.15 , N/A ,$781.15 ,$257.32 ,$827.10 , N/A ,$753.58 ,$325.00 ,$325.00 , N/A ,$597.35 ,$919.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,"$3,886.00 ","$2,525.90 ",$325.00 ,"$3,886.00 ","$3,432.95 ","$2,525.90 ","$2,319.94 ","$1,373.18 ","$1,088.08 ","$2,180.05 ","$1,373.18 ","$2,556.99 ","$1,373.18 ","$3,303.10 ","$3,303.10 ","$1,373.18 ","$3,303.10 ","$2,609.04 ","$2,642.48 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,914.50 ","$2,759.06 ","$2,759.06 ","$1,373.18 ","$2,759.06 ","$3,186.52 ","$3,186.52 ","$3,186.52 ", N/A ,"$3,432.94 ","$3,303.10 ","$1,373.18 ","$3,886.00 ","$2,319.94 ","$1,373.18 ","$1,616.58 ", N/A , N/A ,"$1,373.18 ","$3,303.10 ","$2,883.67 ","$3,303.10 ","$1,088.08 ","$3,497.40 ","$1,373.18 ","$3,186.52 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,525.90 ","$3,886.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000197,26700,HC TX DISL (M-P) W/O ANES CLS,450,1 ,$848.00 ,$551.20 ,$203.20 ,$848.00 ,$508.00 ,$551.20 ,$506.26 ,$203.20 ,$237.44 ,$475.73 ,$203.20 ,$557.98 ,$203.20 ,$720.80 ,$720.80 ,$203.20 ,$720.80 ,$386.08 ,$576.64 ,$508.00 ,$203.20 ,$203.20 ,$636.00 ,$602.08 ,$602.08 ,$203.20 ,$602.08 ,$695.36 ,$695.36 ,$695.36 , N/A ,$508.00 ,$720.80 ,$203.20 ,$848.00 ,$506.26 ,$203.20 ,$352.77 , N/A , N/A ,$203.20 ,$720.80 ,$426.72 ,$720.80 ,$237.44 ,$763.20 ,$203.20 ,$695.36 ,$325.00 ,$325.00 ,$203.20 ,$551.20 ,$848.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$422.00 ,$274.30 ,$118.16 ,$508.00 ,$508.00 ,$274.30 ,$251.93 ,$203.20 ,$118.16 ,$236.74 ,$203.20 ,$277.68 ,$203.20 ,$358.70 ,$358.70 ,$203.20 ,$358.70 ,$386.08 ,$286.96 ,$508.00 ,$203.20 ,$203.20 ,$316.50 ,$299.62 ,$299.62 ,$203.20 ,$299.62 ,$346.04 ,$346.04 ,$346.04 , N/A ,$422.00 ,$358.70 ,$203.20 ,$422.00 ,$251.93 ,$203.20 ,$175.55 , N/A , N/A ,$203.20 ,$358.70 ,$426.72 ,$358.70 ,$118.16 ,$379.80 ,$203.20 ,$346.04 ,$325.00 ,$325.00 ,$203.20 ,$274.30 ,$422.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$634.00 ,$412.10 ,$177.52 ,$762.00 ,$762.00 ,$412.10 ,$378.50 ,$304.80 ,$177.52 ,$355.67 ,$304.80 ,$417.17 ,$304.80 ,$538.90 ,$538.90 ,$304.80 ,$538.90 ,$579.12 ,$431.12 ,$762.00 ,$304.80 ,$304.80 ,$475.50 ,$450.14 ,$450.14 ,$304.80 ,$450.14 ,$519.88 ,$519.88 ,$519.88 , N/A ,$634.00 ,$538.90 ,$304.80 ,$634.00 ,$378.50 ,$304.80 ,$263.74 , N/A , N/A ,$304.80 ,$538.90 ,$640.08 ,$538.90 ,$177.52 ,$570.60 ,$304.80 ,$519.88 ,$325.00 ,$325.00 ,$304.80 ,$412.10 ,$634.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000200,35206,HC RPR VESSEL EXTREM UPR,450,1 ,"$6,250.00 ","$4,062.50 ",$325.00 ,"$7,055.60 ","$7,055.60 ","$4,062.50 ","$3,731.25 ","$2,822.24 ","$1,750.00 ","$3,506.25 ","$2,822.24 ","$4,112.50 ","$2,822.24 ","$5,312.50 ","$5,312.50 ","$2,822.24 ","$5,312.50 ","$5,362.25 ","$4,250.00 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$4,687.50 ","$4,437.50 ","$4,437.50 ","$2,822.24 ","$4,437.50 ","$5,125.00 ","$5,125.00 ","$5,125.00 ", N/A ,"$6,250.00 ","$5,312.50 ","$2,822.24 ","$6,250.00 ","$3,731.25 ","$2,822.24 ","$2,600.00 ", N/A , N/A ,"$2,822.24 ","$5,312.50 ","$5,926.70 ","$5,312.50 ","$1,750.00 ","$5,625.00 ","$2,822.24 ","$5,125.00 ",$325.00 ,$325.00 ,"$2,822.24 ","$4,062.50 ","$6,250.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000203,27840,HC TX DISL ANKE W/O ANES CLS,450,1 ,$451.00 ,$293.15 ,$126.28 ,$508.00 ,$508.00 ,$293.15 ,$269.25 ,$203.20 ,$126.28 ,$253.01 ,$203.20 ,$296.76 ,$203.20 ,$383.35 ,$383.35 ,$203.20 ,$383.35 ,$386.08 ,$306.68 ,$508.00 ,$203.20 ,$203.20 ,$338.25 ,$320.21 ,$320.21 ,$203.20 ,$320.21 ,$369.82 ,$369.82 ,$369.82 , N/A ,$451.00 ,$383.35 ,$203.20 ,$451.00 ,$269.25 ,$203.20 ,$187.62 , N/A , N/A ,$203.20 ,$383.35 ,$426.72 ,$383.35 ,$126.28 ,$405.90 ,$203.20 ,$369.82 ,$325.00 ,$325.00 ,$203.20 ,$293.15 ,$451.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,"$4,006.50 ","$2,604.23 ",$325.00 ,"$4,006.50 ","$3,467.90 ","$2,604.23 ","$2,391.88 ","$1,387.16 ","$1,121.82 ","$2,247.65 ","$1,387.16 ","$2,636.28 ","$1,387.16 ","$3,405.53 ","$3,405.53 ","$1,387.16 ","$3,405.53 ","$2,635.59 ","$2,724.42 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$3,004.88 ","$2,844.62 ","$2,844.62 ","$1,387.16 ","$2,844.62 ","$3,285.33 ","$3,285.33 ","$3,285.33 ", N/A ,"$3,467.89 ","$3,405.53 ","$1,387.16 ","$4,006.50 ","$2,391.88 ","$1,387.16 ","$1,666.70 ", N/A , N/A ,"$1,387.16 ","$3,405.53 ","$2,913.03 ","$3,405.53 ","$1,121.82 ","$3,605.85 ","$1,387.16 ","$3,285.33 ",$325.00 ,$325.00 ,"$1,387.16 ","$2,604.23 ","$4,006.50 "
ST. JOSEPH'S HOSPITAL - BREESE,45000207,49084,HC PERITONEAL LAVAGE,450,1 ,$299.00 ,$194.35 ,$83.72 ,"$1,994.33 ","$1,994.33 ",$194.35 ,$178.50 ,$797.73 ,$83.72 ,$167.74 ,$797.73 ,$196.74 ,$299.00 ,$254.15 ,$254.15 ,$299.00 ,$254.15 ,$299.00 ,$203.32 ,"$1,994.33 ",$797.73 ,$797.73 ,$224.25 ,$212.29 ,$212.29 ,$797.73 ,$212.29 ,$245.18 ,$245.18 ,$245.18 , N/A ,$299.00 ,$254.15 ,$797.73 ,$299.00 ,$178.50 ,$797.73 ,$124.38 , N/A , N/A ,$797.73 ,$254.15 ,"$1,675.23 ",$254.15 ,$83.72 ,$269.10 ,$797.73 ,$245.18 ,$299.00 ,$299.00 ,$797.73 ,$194.35 ,$299.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000212,25690,HC CLSD WRIST DISLOC,450,1 ,"$3,964.77 ","$2,577.10 ",$325.00 ,"$3,964.77 ","$3,432.95 ","$2,577.10 ","$2,366.97 ","$1,373.18 ","$1,110.14 ","$2,224.24 ","$1,373.18 ","$2,608.82 ","$1,373.18 ","$3,370.05 ","$3,370.05 ","$1,373.18 ","$3,370.05 ","$2,609.04 ","$2,696.04 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,973.58 ","$2,814.99 ","$2,814.99 ","$1,373.18 ","$2,814.99 ","$3,251.11 ","$3,251.11 ","$3,251.11 ", N/A ,"$3,432.94 ","$3,370.05 ","$1,373.18 ","$3,964.77 ","$2,366.97 ","$1,373.18 ","$1,649.34 ", N/A , N/A ,"$1,373.18 ","$3,370.05 ","$2,883.67 ","$3,370.05 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,251.11 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,577.10 ","$3,964.77 "
ST. JOSEPH'S HOSPITAL - BREESE,45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$841.00 ,$546.65 ,$235.48 ,$841.00 ,$785.88 ,$546.65 ,$502.08 ,$314.35 ,$235.48 ,$471.80 ,$314.35 ,$553.38 ,$314.35 ,$714.85 ,$714.85 ,$314.35 ,$714.85 ,$597.26 ,$571.88 ,$785.87 ,$314.35 ,$314.35 ,$630.75 ,$597.11 ,$597.11 ,$314.35 ,$597.11 ,$689.62 ,$689.62 ,$689.62 , N/A ,$785.87 ,$714.85 ,$314.35 ,$841.00 ,$502.08 ,$314.35 ,$349.86 , N/A , N/A ,$314.35 ,$714.85 ,$660.13 ,$714.85 ,$235.48 ,$756.90 ,$314.35 ,$689.62 ,$325.00 ,$325.00 ,$314.35 ,$546.65 ,$841.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000215,27786,HC DIST FIB FX W/O MANIP,450,1 ,$358.00 ,$232.70 ,$100.24 ,$508.00 ,$508.00 ,$232.70 ,$213.73 ,$203.20 ,$100.24 ,$200.84 ,$203.20 ,$235.56 ,$203.20 ,$304.30 ,$304.30 ,$203.20 ,$304.30 ,$358.00 ,$243.44 ,$508.00 ,$203.20 ,$203.20 ,$268.50 ,$254.18 ,$254.18 ,$203.20 ,$254.18 ,$293.56 ,$293.56 ,$293.56 , N/A ,$358.00 ,$304.30 ,$203.20 ,$358.00 ,$213.73 ,$203.20 ,$148.93 , N/A , N/A ,$203.20 ,$304.30 ,$426.72 ,$304.30 ,$100.24 ,$322.20 ,$203.20 ,$293.56 ,$325.00 ,$325.00 ,$203.20 ,$232.70 ,$358.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000215,27786,HC DIST FIB FX W/O MANIP,450,1 ,$537.00 ,$349.05 ,$150.36 ,$762.00 ,$762.00 ,$349.05 ,$320.59 ,$304.80 ,$150.36 ,$301.26 ,$304.80 ,$353.35 ,$304.80 ,$456.45 ,$456.45 ,$304.80 ,$456.45 ,$537.00 ,$365.16 ,$762.00 ,$304.80 ,$304.80 ,$402.75 ,$381.27 ,$381.27 ,$304.80 ,$381.27 ,$440.34 ,$440.34 ,$440.34 , N/A ,$537.00 ,$456.45 ,$304.80 ,$537.00 ,$320.59 ,$304.80 ,$223.39 , N/A , N/A ,$304.80 ,$456.45 ,$640.08 ,$456.45 ,$150.36 ,$483.30 ,$304.80 ,$440.34 ,$325.00 ,$325.00 ,$304.80 ,$349.05 ,$537.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000216,41899,HC DENTOALVEOLAR STRUCT PROC,450,1 ,$741.00 ,$481.65 ,$207.48 ,$741.00 ,$521.45 ,$481.65 ,$442.38 ,$208.58 ,$207.48 ,$415.70 ,$208.58 ,$487.58 ,$208.58 ,$629.85 ,$629.85 ,$208.58 ,$629.85 ,$396.30 ,$503.88 ,$521.44 ,$208.58 ,$208.58 ,$555.75 ,$526.11 ,$526.11 ,$208.58 ,$526.11 ,$607.62 ,$607.62 ,$607.62 , N/A ,$521.44 ,$629.85 ,$208.58 ,$741.00 ,$442.38 ,$208.58 ,$308.26 , N/A , N/A ,$208.58 ,$629.85 ,$438.01 ,$629.85 ,$207.48 ,$666.90 ,$208.58 ,$607.62 ,$325.00 ,$325.00 ,$208.58 ,$481.65 ,$741.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$4,045.47 ","$2,629.56 ",$325.00 ,"$4,045.47 ","$3,432.95 ","$2,629.56 ","$2,415.15 ","$1,373.18 ","$1,132.73 ","$2,269.51 ","$1,373.18 ","$2,661.92 ","$1,373.18 ","$3,438.65 ","$3,438.65 ","$1,373.18 ","$3,438.65 ","$2,609.04 ","$2,750.92 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$3,034.10 ","$2,872.28 ","$2,872.28 ","$1,373.18 ","$2,872.28 ","$3,317.29 ","$3,317.29 ","$3,317.29 ", N/A ,"$3,432.94 ","$3,438.65 ","$1,373.18 ","$4,045.47 ","$2,415.15 ","$1,373.18 ","$1,682.92 ", N/A , N/A ,"$1,373.18 ","$3,438.65 ","$2,883.67 ","$3,438.65 ","$1,132.73 ","$3,640.92 ","$1,373.18 ","$3,317.29 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,629.56 ","$4,045.47 "
ST. JOSEPH'S HOSPITAL - BREESE,45000221,10121,HC RM FB SUBQ W/INC COMPL,450,1 ,"$5,054.00 ","$3,285.10 ",$325.00 ,"$5,054.00 ","$3,467.90 ","$3,285.10 ","$3,017.24 ","$1,387.16 ","$1,415.12 ","$2,835.29 ","$1,387.16 ","$3,325.53 ","$1,387.16 ","$4,295.90 ","$4,295.90 ","$1,387.16 ","$4,295.90 ","$2,635.59 ","$3,436.72 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$3,790.50 ","$3,588.34 ","$3,588.34 ","$1,387.16 ","$3,588.34 ","$4,144.28 ","$4,144.28 ","$4,144.28 ", N/A ,"$3,467.89 ","$4,295.90 ","$1,387.16 ","$5,054.00 ","$3,017.24 ","$1,387.16 ","$2,102.46 ", N/A , N/A ,"$1,387.16 ","$4,295.90 ","$2,913.03 ","$4,295.90 ","$1,415.12 ","$4,548.60 ","$1,387.16 ","$4,144.28 ",$325.00 ,$325.00 ,"$1,387.16 ","$3,285.10 ","$5,054.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000227,25600,HC CLSD DIS.RADIUS W/O MANIP,450,1 ,$587.13 ,$381.63 ,$164.40 ,$587.13 ,$508.00 ,$381.63 ,$350.52 ,$203.20 ,$164.40 ,$329.38 ,$203.20 ,$386.33 ,$203.20 ,$499.06 ,$499.06 ,$203.20 ,$499.06 ,$386.08 ,$399.25 ,$508.00 ,$203.20 ,$203.20 ,$440.35 ,$416.86 ,$416.86 ,$203.20 ,$416.86 ,$481.45 ,$481.45 ,$481.45 , N/A ,$508.00 ,$499.06 ,$203.20 ,$587.13 ,$350.52 ,$203.20 ,$244.25 , N/A , N/A ,$203.20 ,$499.06 ,$426.72 ,$499.06 ,$164.40 ,$528.42 ,$203.20 ,$481.45 ,$325.00 ,$325.00 ,$203.20 ,$381.63 ,$587.13 
ST. JOSEPH'S HOSPITAL - BREESE,45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$848.00 ,$551.20 ,$203.20 ,$848.00 ,$508.00 ,$551.20 ,$506.26 ,$203.20 ,$237.44 ,$475.73 ,$203.20 ,$557.98 ,$203.20 ,$720.80 ,$720.80 ,$203.20 ,$720.80 ,$386.08 ,$576.64 ,$508.00 ,$203.20 ,$203.20 ,$636.00 ,$602.08 ,$602.08 ,$203.20 ,$602.08 ,$695.36 ,$695.36 ,$695.36 , N/A ,$508.00 ,$720.80 ,$203.20 ,$848.00 ,$506.26 ,$203.20 ,$352.77 , N/A , N/A ,$203.20 ,$720.80 ,$426.72 ,$720.80 ,$237.44 ,$763.20 ,$203.20 ,$695.36 ,$325.00 ,$325.00 ,$203.20 ,$551.20 ,$848.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000231,25505,HC RADIUS FX W MANIP,450,1 ,"$3,683.00 ","$2,393.95 ",$325.00 ,"$3,683.00 ","$3,432.95 ","$2,393.95 ","$2,198.75 ","$1,373.18 ","$1,031.24 ","$2,066.16 ","$1,373.18 ","$2,423.41 ","$1,373.18 ","$3,130.55 ","$3,130.55 ","$1,373.18 ","$3,130.55 ","$2,609.04 ","$2,504.44 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,762.25 ","$2,614.93 ","$2,614.93 ","$1,373.18 ","$2,614.93 ","$3,020.06 ","$3,020.06 ","$3,020.06 ", N/A ,"$3,432.94 ","$3,130.55 ","$1,373.18 ","$3,683.00 ","$2,198.75 ","$1,373.18 ","$1,532.13 ", N/A , N/A ,"$1,373.18 ","$3,130.55 ","$2,883.67 ","$3,130.55 ","$1,031.24 ","$3,314.70 ","$1,373.18 ","$3,020.06 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,393.95 ","$3,683.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000235,28470,HC CLSD METATARSAL W/O MANIP,450,1 ,$331.00 ,$215.15 ,$92.68 ,$508.00 ,$508.00 ,$215.15 ,$197.61 ,$203.20 ,$92.68 ,$185.69 ,$203.20 ,$217.80 ,$203.20 ,$281.35 ,$281.35 ,$203.20 ,$281.35 ,$331.00 ,$225.08 ,$508.00 ,$203.20 ,$203.20 ,$248.25 ,$235.01 ,$235.01 ,$203.20 ,$235.01 ,$271.42 ,$271.42 ,$271.42 , N/A ,$331.00 ,$281.35 ,$203.20 ,$331.00 ,$197.61 ,$203.20 ,$137.70 , N/A , N/A ,$203.20 ,$281.35 ,$426.72 ,$281.35 ,$92.68 ,$297.90 ,$203.20 ,$271.42 ,$325.00 ,$325.00 ,$203.20 ,$215.15 ,$331.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000246,24505,HC HUMERAL CLOSED RED FX,450,1 ,$642.00 ,$417.30 ,$179.76 ,"$3,432.95 ","$3,432.95 ",$417.30 ,$383.27 ,"$1,373.18 ",$179.76 ,$360.16 ,"$1,373.18 ",$422.44 ,$642.00 ,$545.70 ,$545.70 ,$642.00 ,$545.70 ,$642.00 ,$436.56 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ",$481.50 ,$455.82 ,$455.82 ,"$1,373.18 ",$455.82 ,$526.44 ,$526.44 ,$526.44 , N/A ,$642.00 ,$545.70 ,"$1,373.18 ",$642.00 ,$383.27 ,"$1,373.18 ",$267.07 , N/A , N/A ,"$1,373.18 ",$545.70 ,"$2,883.67 ",$545.70 ,$179.76 ,$577.80 ,"$1,373.18 ",$526.44 ,$325.00 ,$325.00 ,"$1,373.18 ",$417.30 ,$642.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$347.00 ,$225.55 ,$97.16 ,$508.00 ,$508.00 ,$225.55 ,$207.16 ,$203.20 ,$97.16 ,$194.67 ,$203.20 ,$228.33 ,$203.20 ,$294.95 ,$294.95 ,$203.20 ,$294.95 ,$347.00 ,$235.96 ,$508.00 ,$203.20 ,$203.20 ,$260.25 ,$246.37 ,$246.37 ,$203.20 ,$246.37 ,$284.54 ,$284.54 ,$284.54 , N/A ,$347.00 ,$294.95 ,$203.20 ,$347.00 ,$207.16 ,$203.20 ,$144.35 , N/A , N/A ,$203.20 ,$294.95 ,$426.72 ,$294.95 ,$97.16 ,$312.30 ,$203.20 ,$284.54 ,$325.00 ,$325.00 ,$203.20 ,$225.55 ,$347.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000249,28515,HC TOE FX W/MANIP,450,1 ,$639.00 ,$415.35 ,$178.92 ,$639.00 ,$508.00 ,$415.35 ,$381.48 ,$203.20 ,$178.92 ,$358.48 ,$203.20 ,$420.46 ,$203.20 ,$543.15 ,$543.15 ,$203.20 ,$543.15 ,$386.08 ,$434.52 ,$508.00 ,$203.20 ,$203.20 ,$479.25 ,$453.69 ,$453.69 ,$203.20 ,$453.69 ,$523.98 ,$523.98 ,$523.98 , N/A ,$508.00 ,$543.15 ,$203.20 ,$639.00 ,$381.48 ,$203.20 ,$265.82 , N/A , N/A ,$203.20 ,$543.15 ,$426.72 ,$543.15 ,$178.92 ,$575.10 ,$203.20 ,$523.98 ,$325.00 ,$325.00 ,$203.20 ,$415.35 ,$639.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000258,29345,HC LONG LEG CAST,450,1 ,$743.00 ,$482.95 ,$208.04 ,$743.00 ,$594.60 ,$482.95 ,$443.57 ,$237.84 ,$208.04 ,$416.82 ,$237.84 ,$488.89 ,$237.84 ,$631.55 ,$631.55 ,$237.84 ,$631.55 ,$451.89 ,$505.24 ,$594.59 ,$237.84 ,$237.84 ,$557.25 ,$527.53 ,$527.53 ,$237.84 ,$527.53 ,$609.26 ,$609.26 ,$609.26 , N/A ,$594.59 ,$631.55 ,$237.84 ,$743.00 ,$443.57 ,$237.84 ,$309.09 , N/A , N/A ,$237.84 ,$631.55 ,$499.45 ,$631.55 ,$208.04 ,$668.70 ,$237.84 ,$609.26 ,$325.00 ,$325.00 ,$237.84 ,$482.95 ,$743.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,$639.00 ,$415.35 ,$178.92 ,$639.00 ,$508.00 ,$415.35 ,$381.48 ,$203.20 ,$178.92 ,$358.48 ,$203.20 ,$420.46 ,$203.20 ,$543.15 ,$543.15 ,$203.20 ,$543.15 ,$386.08 ,$434.52 ,$508.00 ,$203.20 ,$203.20 ,$479.25 ,$453.69 ,$453.69 ,$203.20 ,$453.69 ,$523.98 ,$523.98 ,$523.98 , N/A ,$508.00 ,$543.15 ,$203.20 ,$639.00 ,$381.48 ,$203.20 ,$265.82 , N/A , N/A ,$203.20 ,$543.15 ,$426.72 ,$543.15 ,$178.92 ,$575.10 ,$203.20 ,$523.98 ,$325.00 ,$325.00 ,$203.20 ,$415.35 ,$639.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,$743.70 ,$483.41 ,$208.24 ,$743.70 ,$643.95 ,$483.41 ,$443.99 ,$257.58 ,$208.24 ,$417.22 ,$257.58 ,$489.35 ,$257.58 ,$632.15 ,$632.15 ,$257.58 ,$632.15 ,$489.39 ,$505.72 ,$643.94 ,$257.58 ,$257.58 ,$557.78 ,$528.03 ,$528.03 ,$257.58 ,$528.03 ,$609.83 ,$609.83 ,$609.83 , N/A ,$643.94 ,$632.15 ,$257.58 ,$743.70 ,$443.99 ,$257.58 ,$309.38 , N/A , N/A ,$257.58 ,$632.15 ,$540.91 ,$632.15 ,$208.24 ,$669.33 ,$257.58 ,$609.83 ,$325.00 ,$325.00 ,$257.58 ,$483.41 ,$743.70 
ST. JOSEPH'S HOSPITAL - BREESE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$156.00 ,$101.40 ,$43.68 ,$156.00 ,$137.20 ,$101.40 ,$93.13 ,$54.88 ,$43.68 ,$87.52 ,$54.88 ,$102.65 ,$54.88 ,$132.60 ,$132.60 ,$54.88 ,$132.60 ,$104.27 ,$106.08 ,$137.20 ,$54.88 ,$54.88 ,$117.00 ,$110.76 ,$110.76 ,$54.88 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$137.20 ,$132.60 ,$54.88 ,$156.00 ,$93.13 ,$54.88 ,$64.90 , N/A , N/A ,$54.88 ,$132.60 ,$115.24 ,$132.60 ,$43.68 ,$140.40 ,$54.88 ,$127.92 ,$156.00 ,$156.00 ,$54.88 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$234.00 ,$152.10 ,$54.88 ,$234.00 ,$137.20 ,$152.10 ,$139.70 ,$54.88 ,$65.52 ,$131.27 ,$54.88 ,$153.97 ,$54.88 ,$198.90 ,$198.90 ,$54.88 ,$198.90 ,$104.27 ,$159.12 ,$137.20 ,$54.88 ,$54.88 ,$175.50 ,$166.14 ,$166.14 ,$54.88 ,$166.14 ,$191.88 ,$191.88 ,$191.88 , N/A ,$137.20 ,$198.90 ,$54.88 ,$234.00 ,$139.70 ,$54.88 ,$97.34 , N/A , N/A ,$54.88 ,$198.90 ,$115.24 ,$198.90 ,$65.52 ,$210.60 ,$54.88 ,$191.88 ,$234.00 ,$234.00 ,$54.88 ,$152.10 ,$234.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000293,11440,HC EXCISION LESION BENIGN FACE/EAR<0.5CM,450,1 ,"$1,644.00 ","$1,068.60 ",$325.00 ,"$1,644.00 ","$1,533.75 ","$1,068.60 ",$981.47 ,$613.50 ,$460.32 ,$922.28 ,$613.50 ,"$1,081.75 ",$613.50 ,"$1,397.40 ","$1,397.40 ",$613.50 ,"$1,397.40 ","$1,165.65 ","$1,117.92 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,233.00 ","$1,167.24 ","$1,167.24 ",$613.50 ,"$1,167.24 ","$1,348.08 ","$1,348.08 ","$1,348.08 ", N/A ,"$1,533.75 ","$1,397.40 ",$613.50 ,"$1,644.00 ",$981.47 ,$613.50 ,$683.90 , N/A , N/A ,$613.50 ,"$1,397.40 ","$1,288.35 ","$1,397.40 ",$460.32 ,"$1,479.60 ",$613.50 ,"$1,348.08 ",$325.00 ,$325.00 ,$613.50 ,"$1,068.60 ","$1,644.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000301,24200,HC REMOVE FOREIGN BODY UPPER ARM/ELBOW SUBQ,450,1 ,"$1,717.00 ","$1,116.05 ",$325.00 ,"$3,467.90 ","$3,467.90 ","$1,116.05 ","$1,025.05 ","$1,387.16 ",$480.76 ,$963.24 ,"$1,387.16 ","$1,129.79 ","$1,387.16 ","$1,459.45 ","$1,459.45 ","$1,387.16 ","$1,459.45 ","$1,717.00 ","$1,167.56 ","$3,467.89 ","$1,387.16 ","$1,387.16 ","$1,287.75 ","$1,219.07 ","$1,219.07 ","$1,387.16 ","$1,219.07 ","$1,407.94 ","$1,407.94 ","$1,407.94 ", N/A ,"$1,717.00 ","$1,459.45 ","$1,387.16 ","$1,717.00 ","$1,025.05 ","$1,387.16 ",$714.27 , N/A , N/A ,"$1,387.16 ","$1,459.45 ","$2,913.03 ","$1,459.45 ",$480.76 ,"$1,545.30 ","$1,387.16 ","$1,407.94 ",$325.00 ,$325.00 ,"$1,387.16 ","$1,116.05 ","$1,717.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000302,24565,HC CLOSED TX HUMERUS EPICONDYLR FX W/MANIP,450,1 ,$417.00 ,$271.05 ,$116.76 ,"$3,432.95 ","$3,432.95 ",$271.05 ,$248.95 ,"$1,373.18 ",$116.76 ,$233.94 ,"$1,373.18 ",$274.39 ,$417.00 ,$354.45 ,$354.45 ,$417.00 ,$354.45 ,$417.00 ,$283.56 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ",$312.75 ,$296.07 ,$296.07 ,"$1,373.18 ",$296.07 ,$341.94 ,$341.94 ,$341.94 , N/A ,$417.00 ,$354.45 ,"$1,373.18 ",$417.00 ,$248.95 ,"$1,373.18 ",$173.47 , N/A , N/A ,"$1,373.18 ",$354.45 ,"$2,883.67 ",$354.45 ,$116.76 ,$375.30 ,"$1,373.18 ",$341.94 ,$325.00 ,$325.00 ,"$1,373.18 ",$271.05 ,$417.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$618.57 ,$402.07 ,$173.20 ,$618.57 ,$508.00 ,$402.07 ,$369.29 ,$203.20 ,$173.20 ,$347.02 ,$203.20 ,$407.02 ,$203.20 ,$525.78 ,$525.78 ,$203.20 ,$525.78 ,$386.08 ,$420.63 ,$508.00 ,$203.20 ,$203.20 ,$463.93 ,$439.18 ,$439.18 ,$203.20 ,$439.18 ,$507.23 ,$507.23 ,$507.23 , N/A ,$508.00 ,$525.78 ,$203.20 ,$618.57 ,$369.29 ,$203.20 ,$257.33 , N/A , N/A ,$203.20 ,$525.78 ,$426.72 ,$525.78 ,$173.20 ,$556.71 ,$203.20 ,$507.23 ,$325.00 ,$325.00 ,$203.20 ,$402.07 ,$618.57 
ST. JOSEPH'S HOSPITAL - BREESE,45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$493.17 ,$320.56 ,$138.09 ,$493.17 ,$405.73 ,$320.56 ,$294.42 ,$162.29 ,$138.09 ,$276.67 ,$162.29 ,$324.51 ,$162.29 ,$419.19 ,$419.19 ,$162.29 ,$419.19 ,$308.35 ,$335.36 ,$405.72 ,$162.29 ,$162.29 ,$369.88 ,$350.15 ,$350.15 ,$162.29 ,$350.15 ,$404.40 ,$404.40 ,$404.40 , N/A ,$405.72 ,$419.19 ,$162.29 ,$493.17 ,$294.42 ,$162.29 ,$205.16 , N/A , N/A ,$162.29 ,$419.19 ,$340.81 ,$419.19 ,$138.09 ,$443.85 ,$162.29 ,$404.40 ,$325.00 ,$325.00 ,$162.29 ,$320.56 ,$493.17 
ST. JOSEPH'S HOSPITAL - BREESE,45000325,24655,HC CLOSED TX FX RADIAL HEAD/NECK W/MANIP,450,1 ,"$3,918.00 ","$2,546.70 ",$325.00 ,"$3,918.00 ","$3,432.95 ","$2,546.70 ","$2,339.05 ","$1,373.18 ","$1,097.04 ","$2,198.00 ","$1,373.18 ","$2,578.04 ","$1,373.18 ","$3,330.30 ","$3,330.30 ","$1,373.18 ","$3,330.30 ","$2,609.04 ","$2,664.24 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,373.18 ","$2,781.78 ","$3,212.76 ","$3,212.76 ","$3,212.76 ", N/A ,"$3,432.94 ","$3,330.30 ","$1,373.18 ","$3,918.00 ","$2,339.05 ","$1,373.18 ","$1,629.89 ", N/A , N/A ,"$1,373.18 ","$3,330.30 ","$2,883.67 ","$3,330.30 ","$1,097.04 ","$3,526.20 ","$1,373.18 ","$3,212.76 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,546.70 ","$3,918.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000327,26765,HC TX FX OPEN FINGER/THUMB W/INT FIX EACH,450,1 ,"$5,200.00 ","$3,380.00 ",$325.00 ,"$6,979.95 ","$6,979.95 ","$3,380.00 ","$3,104.40 ","$2,791.98 ","$1,456.00 ","$2,917.20 ","$2,791.98 ","$3,421.60 ","$2,791.98 ","$4,420.00 ","$4,420.00 ","$2,791.98 ","$4,420.00 ","$5,200.00 ","$3,536.00 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$3,900.00 ","$3,692.00 ","$3,692.00 ","$2,791.98 ","$3,692.00 ","$4,264.00 ","$4,264.00 ","$4,264.00 ", N/A ,"$5,200.00 ","$4,420.00 ","$2,791.98 ","$5,200.00 ","$3,104.40 ","$2,791.98 ","$2,163.20 ", N/A , N/A ,"$2,791.98 ","$4,420.00 ","$5,863.15 ","$4,420.00 ","$1,456.00 ","$4,680.00 ","$2,791.98 ","$4,264.00 ",$325.00 ,$325.00 ,"$2,791.98 ","$3,380.00 ","$5,200.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,$848.00 ,$551.20 ,$203.20 ,$848.00 ,$508.00 ,$551.20 ,$506.26 ,$203.20 ,$237.44 ,$475.73 ,$203.20 ,$557.98 ,$203.20 ,$720.80 ,$720.80 ,$203.20 ,$720.80 ,$386.08 ,$576.64 ,$508.00 ,$203.20 ,$203.20 ,$636.00 ,$602.08 ,$602.08 ,$203.20 ,$602.08 ,$695.36 ,$695.36 ,$695.36 , N/A ,$508.00 ,$720.80 ,$203.20 ,$848.00 ,$506.26 ,$203.20 ,$352.77 , N/A , N/A ,$203.20 ,$720.80 ,$426.72 ,$720.80 ,$237.44 ,$763.20 ,$203.20 ,$695.36 ,$325.00 ,$325.00 ,$203.20 ,$551.20 ,$848.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000329,27752,HC CLSD TX FX TIBIAL SHAFT W/MANIP,450,1 ,"$4,066.00 ","$2,642.90 ",$325.00 ,"$4,066.00 ","$3,432.95 ","$2,642.90 ","$2,427.40 ","$1,373.18 ","$1,138.48 ","$2,281.03 ","$1,373.18 ","$2,675.43 ","$1,373.18 ","$3,456.10 ","$3,456.10 ","$1,373.18 ","$3,456.10 ","$2,609.04 ","$2,764.88 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$3,049.50 ","$2,886.86 ","$2,886.86 ","$1,373.18 ","$2,886.86 ","$3,334.12 ","$3,334.12 ","$3,334.12 ", N/A ,"$3,432.94 ","$3,456.10 ","$1,373.18 ","$4,066.00 ","$2,427.40 ","$1,373.18 ","$1,691.46 ", N/A , N/A ,"$1,373.18 ","$3,456.10 ","$2,883.67 ","$3,456.10 ","$1,138.48 ","$3,659.40 ","$1,373.18 ","$3,334.12 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,642.90 ","$4,066.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$872.00 ,$566.80 ,$244.16 ,$872.00 ,$762.00 ,$566.80 ,$520.58 ,$304.80 ,$244.16 ,$489.19 ,$304.80 ,$573.78 ,$304.80 ,$741.20 ,$741.20 ,$304.80 ,$741.20 ,$579.12 ,$592.96 ,$762.00 ,$304.80 ,$304.80 ,$654.00 ,$619.12 ,$619.12 ,$304.80 ,$619.12 ,$715.04 ,$715.04 ,$715.04 , N/A ,$762.00 ,$741.20 ,$304.80 ,$872.00 ,$520.58 ,$304.80 ,$362.75 , N/A , N/A ,$304.80 ,$741.20 ,$640.08 ,$741.20 ,$244.16 ,$784.80 ,$304.80 ,$715.04 ,$325.00 ,$325.00 ,$304.80 ,$566.80 ,$872.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$581.00 ,$377.65 ,$162.68 ,$581.00 ,$508.00 ,$377.65 ,$346.86 ,$203.20 ,$162.68 ,$325.94 ,$203.20 ,$382.30 ,$203.20 ,$493.85 ,$493.85 ,$203.20 ,$493.85 ,$386.08 ,$395.08 ,$508.00 ,$203.20 ,$203.20 ,$435.75 ,$412.51 ,$412.51 ,$203.20 ,$412.51 ,$476.42 ,$476.42 ,$476.42 , N/A ,$508.00 ,$493.85 ,$203.20 ,$581.00 ,$346.86 ,$203.20 ,$241.70 , N/A , N/A ,$203.20 ,$493.85 ,$426.72 ,$493.85 ,$162.68 ,$522.90 ,$203.20 ,$476.42 ,$325.00 ,$325.00 ,$203.20 ,$377.65 ,$581.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000335,29530,HC STRAPPING KNEE,450,1 ,$200.00 ,$130.00 ,$56.00 ,$277.93 ,$277.93 ,$130.00 ,$119.40 ,$111.17 ,$56.00 ,$112.20 ,$111.17 ,$131.60 ,$111.17 ,$170.00 ,$170.00 ,$111.17 ,$170.00 ,$200.00 ,$136.00 ,$277.92 ,$111.17 ,$111.17 ,$150.00 ,$142.00 ,$142.00 ,$111.17 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$200.00 ,$170.00 ,$111.17 ,$200.00 ,$119.40 ,$111.17 ,$83.20 , N/A , N/A ,$111.17 ,$170.00 ,$233.45 ,$170.00 ,$56.00 ,$180.00 ,$111.17 ,$164.00 ,$200.00 ,$200.00 ,$111.17 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000346,23625,HC CLOSED TX GR TUBER HUM FX W/MANIP,450,1 ,"$3,965.00 ","$2,577.25 ",$325.00 ,"$3,965.00 ","$3,432.95 ","$2,577.25 ","$2,367.11 ","$1,373.18 ","$1,110.20 ","$2,224.37 ","$1,373.18 ","$2,608.97 ","$1,373.18 ","$3,370.25 ","$3,370.25 ","$1,373.18 ","$3,370.25 ","$2,609.04 ","$2,696.20 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,973.75 ","$2,815.15 ","$2,815.15 ","$1,373.18 ","$2,815.15 ","$3,251.30 ","$3,251.30 ","$3,251.30 ", N/A ,"$3,432.94 ","$3,370.25 ","$1,373.18 ","$3,965.00 ","$2,367.11 ","$1,373.18 ","$1,649.44 ", N/A , N/A ,"$1,373.18 ","$3,370.25 ","$2,883.67 ","$3,370.25 ","$1,110.20 ","$3,568.50 ","$1,373.18 ","$3,251.30 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,577.25 ","$3,965.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000431,32551,HC TUBE THORACOSTOMY-LT,450,1 ,"$4,676.00 ","$3,039.40 ",$325.00 ,"$4,676.00 ","$3,465.88 ","$3,039.40 ","$2,791.57 ","$1,386.35 ","$1,309.28 ","$2,623.24 ","$1,386.35 ","$3,076.81 ","$1,386.35 ","$3,974.60 ","$3,974.60 ","$1,386.35 ","$3,974.60 ","$2,634.07 ","$3,179.68 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$3,507.00 ","$3,319.96 ","$3,319.96 ","$1,386.35 ","$3,319.96 ","$3,834.32 ","$3,834.32 ","$3,834.32 ", N/A ,"$3,465.89 ","$3,974.60 ","$1,386.35 ","$4,676.00 ","$2,791.57 ","$1,386.35 ","$1,945.22 ", N/A , N/A ,"$1,386.35 ","$3,974.60 ","$2,911.34 ","$3,974.60 ","$1,309.28 ","$4,208.40 ","$1,386.35 ","$3,834.32 ",$325.00 ,$325.00 ,"$1,386.35 ","$3,039.40 ","$4,676.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000432,32551,HC TUBE THORACOSTOMY-RT,450,1 ,"$4,676.00 ","$3,039.40 ",$325.00 ,"$4,676.00 ","$3,465.88 ","$3,039.40 ","$2,791.57 ","$1,386.35 ","$1,309.28 ","$2,623.24 ","$1,386.35 ","$3,076.81 ","$1,386.35 ","$3,974.60 ","$3,974.60 ","$1,386.35 ","$3,974.60 ","$2,634.07 ","$3,179.68 ","$3,465.89 ","$1,386.35 ","$1,386.35 ","$3,507.00 ","$3,319.96 ","$3,319.96 ","$1,386.35 ","$3,319.96 ","$3,834.32 ","$3,834.32 ","$3,834.32 ", N/A ,"$3,465.89 ","$3,974.60 ","$1,386.35 ","$4,676.00 ","$2,791.57 ","$1,386.35 ","$1,945.22 ", N/A , N/A ,"$1,386.35 ","$3,974.60 ","$2,911.34 ","$3,974.60 ","$1,309.28 ","$4,208.40 ","$1,386.35 ","$3,834.32 ",$325.00 ,$325.00 ,"$1,386.35 ","$3,039.40 ","$4,676.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000439,64450,HC INJ ANES OTHER THAN PERIPHERAL-LT,450,1 ,"$1,797.00 ","$1,168.05 ",$325.00 ,"$1,797.00 ","$1,565.08 ","$1,168.05 ","$1,072.81 ",$626.03 ,$503.16 ,"$1,008.12 ",$626.03 ,"$1,182.43 ",$626.03 ,"$1,527.45 ","$1,527.45 ",$626.03 ,"$1,527.45 ","$1,189.46 ","$1,221.96 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$626.03 ,"$1,275.87 ","$1,473.54 ","$1,473.54 ","$1,473.54 ", N/A ,"$1,565.07 ","$1,527.45 ",$626.03 ,"$1,797.00 ","$1,072.81 ",$626.03 ,$747.55 , N/A , N/A ,$626.03 ,"$1,527.45 ","$1,314.66 ","$1,527.45 ",$503.16 ,"$1,617.30 ",$626.03 ,"$1,473.54 ",$325.00 ,$325.00 ,$626.03 ,"$1,168.05 ","$1,797.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000440,64450,HC INJ ANES OTHER THAN PERIPHERAL-RT,450,1 ,"$1,797.00 ","$1,168.05 ",$325.00 ,"$1,797.00 ","$1,565.08 ","$1,168.05 ","$1,072.81 ",$626.03 ,$503.16 ,"$1,008.12 ",$626.03 ,"$1,182.43 ",$626.03 ,"$1,527.45 ","$1,527.45 ",$626.03 ,"$1,527.45 ","$1,189.46 ","$1,221.96 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,347.75 ","$1,275.87 ","$1,275.87 ",$626.03 ,"$1,275.87 ","$1,473.54 ","$1,473.54 ","$1,473.54 ", N/A ,"$1,565.07 ","$1,527.45 ",$626.03 ,"$1,797.00 ","$1,072.81 ",$626.03 ,$747.55 , N/A , N/A ,$626.03 ,"$1,527.45 ","$1,314.66 ","$1,527.45 ",$503.16 ,"$1,617.30 ",$626.03 ,"$1,473.54 ",$325.00 ,$325.00 ,$626.03 ,"$1,168.05 ","$1,797.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000451,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-LT,450,1 ,"$1,749.00 ","$1,136.85 ",$325.00 ,"$1,749.00 ","$1,533.75 ","$1,136.85 ","$1,044.15 ",$613.50 ,$489.72 ,$981.19 ,$613.50 ,"$1,150.84 ",$613.50 ,"$1,486.65 ","$1,486.65 ",$613.50 ,"$1,486.65 ","$1,165.65 ","$1,189.32 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,311.75 ","$1,241.79 ","$1,241.79 ",$613.50 ,"$1,241.79 ","$1,434.18 ","$1,434.18 ","$1,434.18 ", N/A ,"$1,533.75 ","$1,486.65 ",$613.50 ,"$1,749.00 ","$1,044.15 ",$613.50 ,$727.58 , N/A , N/A ,$613.50 ,"$1,486.65 ","$1,288.35 ","$1,486.65 ",$489.72 ,"$1,574.10 ",$613.50 ,"$1,434.18 ",$325.00 ,$325.00 ,$613.50 ,"$1,136.85 ","$1,749.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000452,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-RT,450,1 ,"$1,749.00 ","$1,136.85 ",$325.00 ,"$1,749.00 ","$1,533.75 ","$1,136.85 ","$1,044.15 ",$613.50 ,$489.72 ,$981.19 ,$613.50 ,"$1,150.84 ",$613.50 ,"$1,486.65 ","$1,486.65 ",$613.50 ,"$1,486.65 ","$1,165.65 ","$1,189.32 ","$1,533.75 ",$613.50 ,$613.50 ,"$1,311.75 ","$1,241.79 ","$1,241.79 ",$613.50 ,"$1,241.79 ","$1,434.18 ","$1,434.18 ","$1,434.18 ", N/A ,"$1,533.75 ","$1,486.65 ",$613.50 ,"$1,749.00 ","$1,044.15 ",$613.50 ,$727.58 , N/A , N/A ,$613.50 ,"$1,486.65 ","$1,288.35 ","$1,486.65 ",$489.72 ,"$1,574.10 ",$613.50 ,"$1,434.18 ",$325.00 ,$325.00 ,$613.50 ,"$1,136.85 ","$1,749.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000467,27842,HC CLOSED TX ANKLE DISLOC W/ANESTH W/W/O FIXATION,450,1 ,"$1,282.00 ",$833.30 ,$325.00 ,"$3,432.95 ","$3,432.95 ",$833.30 ,$765.35 ,"$1,373.18 ",$358.96 ,$719.20 ,"$1,373.18 ",$843.56 ,"$1,282.00 ","$1,089.70 ","$1,089.70 ","$1,282.00 ","$1,089.70 ","$1,282.00 ",$871.76 ,"$3,432.94 ","$1,373.18 ","$1,373.18 ",$961.50 ,$910.22 ,$910.22 ,"$1,373.18 ",$910.22 ,"$1,051.24 ","$1,051.24 ","$1,051.24 ", N/A ,"$1,282.00 ","$1,089.70 ","$1,373.18 ","$1,282.00 ",$765.35 ,"$1,373.18 ",$533.31 , N/A , N/A ,"$1,373.18 ","$1,089.70 ","$2,883.67 ","$1,089.70 ",$358.96 ,"$1,153.80 ","$1,373.18 ","$1,051.24 ",$325.00 ,$325.00 ,"$1,373.18 ",$833.30 ,"$1,282.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000493,36600,HC ARTERIAL PUNCTURE,450,1 ,$313.00 ,$203.45 ,$87.64 ,$313.00 ,$277.93 ,$203.45 ,$186.86 ,$111.17 ,$87.64 ,$175.59 ,$111.17 ,$205.95 ,$111.17 ,$266.05 ,$266.05 ,$111.17 ,$266.05 ,$211.22 ,$212.84 ,$277.92 ,$111.17 ,$111.17 ,$234.75 ,$222.23 ,$222.23 ,$111.17 ,$222.23 ,$256.66 ,$256.66 ,$256.66 , N/A ,$277.92 ,$266.05 ,$111.17 ,$313.00 ,$186.86 ,$111.17 ,$130.21 , N/A , N/A ,$111.17 ,$266.05 ,$233.45 ,$266.05 ,$87.64 ,$281.70 ,$111.17 ,$256.66 ,$313.00 ,$313.00 ,$111.17 ,$203.45 ,$313.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000497,27086,HC REMOVE FB PELVIS/HIP SUBQ TISSUE,450,1 ,"$5,054.00 ","$3,285.10 ",$325.00 ,"$5,843.93 ","$5,843.93 ","$3,285.10 ","$3,017.24 ","$2,337.57 ","$1,415.12 ","$2,835.29 ","$2,337.57 ","$3,325.53 ","$2,337.57 ","$4,295.90 ","$4,295.90 ","$2,337.57 ","$4,295.90 ","$4,441.38 ","$3,436.72 ","$5,843.93 ","$2,337.57 ","$2,337.57 ","$3,790.50 ","$3,588.34 ","$3,588.34 ","$2,337.57 ","$3,588.34 ","$4,144.28 ","$4,144.28 ","$4,144.28 ", N/A ,"$5,054.00 ","$4,295.90 ","$2,337.57 ","$5,054.00 ","$3,017.24 ","$2,337.57 ","$2,102.46 ", N/A , N/A ,"$2,337.57 ","$4,295.90 ","$4,908.90 ","$4,295.90 ","$1,415.12 ","$4,548.60 ","$2,337.57 ","$4,144.28 ",$325.00 ,$325.00 ,"$2,337.57 ","$3,285.10 ","$5,054.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000515,32551,HC TUBE THORACOSTOMY-BIL,450,1 ,"$7,014.00 ","$4,559.10 ",$325.00 ,"$7,055.60 ","$7,055.60 ","$4,559.10 ","$4,187.36 ","$2,822.24 ","$1,963.92 ","$3,934.85 ","$2,822.24 ","$4,615.21 ","$2,822.24 ","$5,961.90 ","$5,961.90 ","$2,822.24 ","$5,961.90 ","$5,362.25 ","$4,769.52 ","$7,055.60 ","$2,822.24 ","$2,822.24 ","$5,260.50 ","$4,979.94 ","$4,979.94 ","$2,822.24 ","$4,979.94 ","$5,751.48 ","$5,751.48 ","$5,751.48 ", N/A ,"$7,014.00 ","$5,961.90 ","$2,822.24 ","$7,014.00 ","$4,187.36 ","$2,822.24 ","$2,917.82 ", N/A , N/A ,"$2,822.24 ","$5,961.90 ","$5,926.70 ","$5,961.90 ","$1,963.92 ","$6,312.60 ","$2,822.24 ","$5,751.48 ",$325.00 ,$325.00 ,"$2,822.24 ","$4,559.10 ","$7,014.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45000516,26775,HC TX DISLOC I-P JOINT W/ANES/MAN,450,1 ,$743.00 ,$482.95 ,$208.04 ,$743.00 ,$594.60 ,$482.95 ,$443.57 ,$237.84 ,$208.04 ,$416.82 ,$237.84 ,$488.89 ,$237.84 ,$631.55 ,$631.55 ,$237.84 ,$631.55 ,$451.89 ,$505.24 ,$594.59 ,$237.84 ,$237.84 ,$557.25 ,$527.53 ,$527.53 ,$237.84 ,$527.53 ,$609.26 ,$609.26 ,$609.26 , N/A ,$594.59 ,$631.55 ,$237.84 ,$743.00 ,$443.57 ,$237.84 ,$309.09 , N/A , N/A ,$237.84 ,$631.55 ,$499.45 ,$631.55 ,$208.04 ,$668.70 ,$237.84 ,$609.26 ,$325.00 ,$325.00 ,$237.84 ,$482.95 ,$743.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000518,27200,HC TX FX COCCYGEAL CLOSED,450,1 ,$616.00 ,$400.40 ,$172.48 ,$616.00 ,$508.00 ,$400.40 ,$367.75 ,$203.20 ,$172.48 ,$345.58 ,$203.20 ,$405.33 ,$203.20 ,$523.60 ,$523.60 ,$203.20 ,$523.60 ,$386.08 ,$418.88 ,$508.00 ,$203.20 ,$203.20 ,$462.00 ,$437.36 ,$437.36 ,$203.20 ,$437.36 ,$505.12 ,$505.12 ,$505.12 , N/A ,$508.00 ,$523.60 ,$203.20 ,$616.00 ,$367.75 ,$203.20 ,$256.26 , N/A , N/A ,$203.20 ,$523.60 ,$426.72 ,$523.60 ,$172.48 ,$554.40 ,$203.20 ,$505.12 ,$325.00 ,$325.00 ,$203.20 ,$400.40 ,$616.00 
ST. JOSEPH'S HOSPITAL - BREESE,45000548,29425,HC APPLY SHORT LEG CAST WALKING,450,1 ,$743.00 ,$482.95 ,$208.04 ,$743.00 ,$594.60 ,$482.95 ,$443.57 ,$237.84 ,$208.04 ,$416.82 ,$237.84 ,$488.89 ,$237.84 ,$631.55 ,$631.55 ,$237.84 ,$631.55 ,$451.89 ,$505.24 ,$594.59 ,$237.84 ,$237.84 ,$557.25 ,$527.53 ,$527.53 ,$237.84 ,$527.53 ,$609.26 ,$609.26 ,$609.26 , N/A ,$594.59 ,$631.55 ,$237.84 ,$743.00 ,$443.57 ,$237.84 ,$309.09 , N/A , N/A ,$237.84 ,$631.55 ,$499.45 ,$631.55 ,$208.04 ,$668.70 ,$237.84 ,$609.26 ,$325.00 ,$325.00 ,$237.84 ,$482.95 ,$743.00 
ST. JOSEPH'S HOSPITAL - BREESE,45001165,45915,HC REMOVE IMPACTED FECAL/FB W/ANES,450,1 ,"$3,110.88 ","$2,022.07 ",$325.00 ,"$3,110.88 ","$2,555.83 ","$2,022.07 ","$1,857.20 ","$1,022.33 ",$871.05 ,"$1,745.20 ","$1,022.33 ","$2,046.96 ","$1,022.33 ","$2,644.25 ","$2,644.25 ","$1,022.33 ","$2,644.25 ","$1,942.43 ","$2,115.40 ","$2,555.83 ","$1,022.33 ","$1,022.33 ","$2,333.16 ","$2,208.72 ","$2,208.72 ","$1,022.33 ","$2,208.72 ","$2,550.92 ","$2,550.92 ","$2,550.92 ", N/A ,"$2,555.83 ","$2,644.25 ","$1,022.33 ","$3,110.88 ","$1,857.20 ","$1,022.33 ","$1,294.13 ", N/A , N/A ,"$1,022.33 ","$2,644.25 ","$2,146.90 ","$2,644.25 ",$871.05 ,"$2,799.79 ","$1,022.33 ","$2,550.92 ",$325.00 ,$325.00 ,"$1,022.33 ","$2,022.07 ","$3,110.88 "
ST. JOSEPH'S HOSPITAL - BREESE,45001168,52281,HC CYSTOURETHROSCOPY W/CALIBRATION/DILATION,450,1 ,"$5,105.61 ","$3,318.65 ",$325.00 ,"$5,105.61 ","$4,413.08 ","$3,318.65 ","$3,048.05 ","$1,765.23 ","$1,429.57 ","$2,864.25 ","$1,765.23 ","$3,359.49 ","$1,765.23 ","$4,339.77 ","$4,339.77 ","$1,765.23 ","$4,339.77 ","$3,353.94 ","$3,471.81 ","$4,413.08 ","$1,765.23 ","$1,765.23 ","$3,829.21 ","$3,624.98 ","$3,624.98 ","$1,765.23 ","$3,624.98 ","$4,186.60 ","$4,186.60 ","$4,186.60 ", N/A ,"$4,413.08 ","$4,339.77 ","$1,765.23 ","$5,105.61 ","$3,048.05 ","$1,765.23 ","$2,123.93 ", N/A , N/A ,"$1,765.23 ","$4,339.77 ","$3,706.99 ","$4,339.77 ","$1,429.57 ","$4,595.05 ","$1,765.23 ","$4,186.60 ",$325.00 ,$325.00 ,"$1,765.23 ","$3,318.65 ","$5,105.61 "
ST. JOSEPH'S HOSPITAL - BREESE,45001169,54235,HC INJ PENILE W/RX AGENT,450,1 ,$757.83 ,$492.59 ,$212.19 ,$757.83 ,$655.88 ,$492.59 ,$452.42 ,$262.35 ,$212.19 ,$425.14 ,$262.35 ,$498.65 ,$262.35 ,$644.16 ,$644.16 ,$262.35 ,$644.16 ,$498.46 ,$515.32 ,$655.86 ,$262.35 ,$262.35 ,$568.37 ,$538.06 ,$538.06 ,$262.35 ,$538.06 ,$621.42 ,$621.42 ,$621.42 , N/A ,$655.86 ,$644.16 ,$262.35 ,$757.83 ,$452.42 ,$262.35 ,$315.26 , N/A , N/A ,$262.35 ,$644.16 ,$550.92 ,$644.16 ,$212.19 ,$682.05 ,$262.35 ,$621.42 ,$325.00 ,$325.00 ,$262.35 ,$492.59 ,$757.83 
ST. JOSEPH'S HOSPITAL - BREESE,45001272,23665,HC TX FX DISLOC SHOULDER HUMERW/MANIP,450,1 ,"$3,964.77 ","$2,577.10 ",$325.00 ,"$3,964.77 ","$3,432.95 ","$2,577.10 ","$2,366.97 ","$1,373.18 ","$1,110.14 ","$2,224.24 ","$1,373.18 ","$2,608.82 ","$1,373.18 ","$3,370.05 ","$3,370.05 ","$1,373.18 ","$3,370.05 ","$2,609.04 ","$2,696.04 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,973.58 ","$2,814.99 ","$2,814.99 ","$1,373.18 ","$2,814.99 ","$3,251.11 ","$3,251.11 ","$3,251.11 ", N/A ,"$3,432.94 ","$3,370.05 ","$1,373.18 ","$3,964.77 ","$2,366.97 ","$1,373.18 ","$1,649.34 ", N/A , N/A ,"$1,373.18 ","$3,370.05 ","$2,883.67 ","$3,370.05 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,251.11 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,577.10 ","$3,964.77 "
ST. JOSEPH'S HOSPITAL - BREESE,45001273,23675,HC TX FX DISLOC SHOULDER W/PROX HUM W/MANIP,450,1 ,"$3,886.00 ","$2,525.90 ",$325.00 ,"$3,886.00 ","$3,432.95 ","$2,525.90 ","$2,319.94 ","$1,373.18 ","$1,088.08 ","$2,180.05 ","$1,373.18 ","$2,556.99 ","$1,373.18 ","$3,303.10 ","$3,303.10 ","$1,373.18 ","$3,303.10 ","$2,609.04 ","$2,642.48 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,914.50 ","$2,759.06 ","$2,759.06 ","$1,373.18 ","$2,759.06 ","$3,186.52 ","$3,186.52 ","$3,186.52 ", N/A ,"$3,432.94 ","$3,303.10 ","$1,373.18 ","$3,886.00 ","$2,319.94 ","$1,373.18 ","$1,616.58 ", N/A , N/A ,"$1,373.18 ","$3,303.10 ","$2,883.67 ","$3,303.10 ","$1,088.08 ","$3,497.40 ","$1,373.18 ","$3,186.52 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,525.90 ","$3,886.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001277,24577,HC TX FX HUMERUS CONDYLAR W/MANIP CLOSED,450,1 ,"$3,965.00 ","$2,577.25 ",$325.00 ,"$3,965.00 ","$3,432.95 ","$2,577.25 ","$2,367.11 ","$1,373.18 ","$1,110.20 ","$2,224.37 ","$1,373.18 ","$2,608.97 ","$1,373.18 ","$3,370.25 ","$3,370.25 ","$1,373.18 ","$3,370.25 ","$2,609.04 ","$2,696.20 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,973.75 ","$2,815.15 ","$2,815.15 ","$1,373.18 ","$2,815.15 ","$3,251.30 ","$3,251.30 ","$3,251.30 ", N/A ,"$3,432.94 ","$3,370.25 ","$1,373.18 ","$3,965.00 ","$2,367.11 ","$1,373.18 ","$1,649.44 ", N/A , N/A ,"$1,373.18 ","$3,370.25 ","$2,883.67 ","$3,370.25 ","$1,110.20 ","$3,568.50 ","$1,373.18 ","$3,251.30 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,577.25 ","$3,965.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001278,24675,HC TX FX CLOSED ULNA PROXIMAL W/MANIP,450,1 ,"$3,918.00 ","$2,546.70 ",$325.00 ,"$3,918.00 ","$3,432.95 ","$2,546.70 ","$2,339.05 ","$1,373.18 ","$1,097.04 ","$2,198.00 ","$1,373.18 ","$2,578.04 ","$1,373.18 ","$3,330.30 ","$3,330.30 ","$1,373.18 ","$3,330.30 ","$2,609.04 ","$2,664.24 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,938.50 ","$2,781.78 ","$2,781.78 ","$1,373.18 ","$2,781.78 ","$3,212.76 ","$3,212.76 ","$3,212.76 ", N/A ,"$3,432.94 ","$3,330.30 ","$1,373.18 ","$3,918.00 ","$2,339.05 ","$1,373.18 ","$1,629.89 ", N/A , N/A ,"$1,373.18 ","$3,330.30 ","$2,883.67 ","$3,330.30 ","$1,097.04 ","$3,526.20 ","$1,373.18 ","$3,212.76 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,546.70 ","$3,918.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$4,704.00 ","$3,057.60 ",$325.00 ,"$4,704.00 ","$3,432.95 ","$3,057.60 ","$2,808.29 ","$1,373.18 ","$1,317.12 ","$2,638.94 ","$1,373.18 ","$3,095.23 ","$1,373.18 ","$3,998.40 ","$3,998.40 ","$1,373.18 ","$3,998.40 ","$2,609.04 ","$3,198.72 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$3,528.00 ","$3,339.84 ","$3,339.84 ","$1,373.18 ","$3,339.84 ","$3,857.28 ","$3,857.28 ","$3,857.28 ", N/A ,"$3,432.94 ","$3,998.40 ","$1,373.18 ","$4,704.00 ","$2,808.29 ","$1,373.18 ","$1,956.86 ", N/A , N/A ,"$1,373.18 ","$3,998.40 ","$2,883.67 ","$3,998.40 ","$1,317.12 ","$4,233.60 ","$1,373.18 ","$3,857.28 ",$325.00 ,$325.00 ,"$1,373.18 ","$3,057.60 ","$4,704.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001291,27502,HC TX FX FEMUR W/MAN W/W/O TRACTION,450,1 ,"$4,468.00 ","$2,904.20 ",$325.00 ,"$4,468.00 ","$3,432.95 ","$2,904.20 ","$2,667.40 ","$1,373.18 ","$1,251.04 ","$2,506.55 ","$1,373.18 ","$2,939.94 ","$1,373.18 ","$3,797.80 ","$3,797.80 ","$1,373.18 ","$3,797.80 ","$2,609.04 ","$3,038.24 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$3,351.00 ","$3,172.28 ","$3,172.28 ","$1,373.18 ","$3,172.28 ","$3,663.76 ","$3,663.76 ","$3,663.76 ", N/A ,"$3,432.94 ","$3,797.80 ","$1,373.18 ","$4,468.00 ","$2,667.40 ","$1,373.18 ","$1,858.69 ", N/A , N/A ,"$1,373.18 ","$3,797.80 ","$2,883.67 ","$3,797.80 ","$1,251.04 ","$4,021.20 ","$1,373.18 ","$3,663.76 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,904.20 ","$4,468.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001296,27762,HC TX FX CLOSED MEDIAL MALLEOLUS W/MANIP,450,1 ,"$3,964.77 ","$2,577.10 ",$325.00 ,"$3,964.77 ","$3,432.95 ","$2,577.10 ","$2,366.97 ","$1,373.18 ","$1,110.14 ","$2,224.24 ","$1,373.18 ","$2,608.82 ","$1,373.18 ","$3,370.05 ","$3,370.05 ","$1,373.18 ","$3,370.05 ","$2,609.04 ","$2,696.04 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$2,973.58 ","$2,814.99 ","$2,814.99 ","$1,373.18 ","$2,814.99 ","$3,251.11 ","$3,251.11 ","$3,251.11 ", N/A ,"$3,432.94 ","$3,370.05 ","$1,373.18 ","$3,964.77 ","$2,366.97 ","$1,373.18 ","$1,649.34 ", N/A , N/A ,"$1,373.18 ","$3,370.05 ","$2,883.67 ","$3,370.05 ","$1,110.14 ","$3,568.29 ","$1,373.18 ","$3,251.11 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,577.10 ","$3,964.77 "
ST. JOSEPH'S HOSPITAL - BREESE,45001298,27816,HC TX FX CLOSED TRIMALLEOLAR ANKLE W/O MANIP,450,1 ,$587.00 ,$381.55 ,$164.36 ,$587.00 ,$508.00 ,$381.55 ,$350.44 ,$203.20 ,$164.36 ,$329.31 ,$203.20 ,$386.25 ,$203.20 ,$498.95 ,$498.95 ,$203.20 ,$498.95 ,$386.08 ,$399.16 ,$508.00 ,$203.20 ,$203.20 ,$440.25 ,$416.77 ,$416.77 ,$203.20 ,$416.77 ,$481.34 ,$481.34 ,$481.34 , N/A ,$508.00 ,$498.95 ,$203.20 ,$587.00 ,$350.44 ,$203.20 ,$244.19 , N/A , N/A ,$203.20 ,$498.95 ,$426.72 ,$498.95 ,$164.36 ,$528.30 ,$203.20 ,$481.34 ,$325.00 ,$325.00 ,$203.20 ,$381.55 ,$587.00 
ST. JOSEPH'S HOSPITAL - BREESE,45001317,67935,HC REPAIR EYELID WOUND FULL THICKNESS,450,1 ,"$6,380.00 ","$4,147.00 ",$325.00 ,"$6,380.00 ","$4,932.05 ","$4,147.00 ","$3,808.86 ","$1,972.82 ","$1,786.40 ","$3,579.18 ","$1,972.82 ","$4,198.04 ","$1,972.82 ","$5,423.00 ","$5,423.00 ","$1,972.82 ","$5,423.00 ","$3,748.37 ","$4,338.40 ","$4,932.06 ","$1,972.82 ","$1,972.82 ","$4,785.00 ","$4,529.80 ","$4,529.80 ","$1,972.82 ","$4,529.80 ","$5,231.60 ","$5,231.60 ","$5,231.60 ", N/A ,"$4,932.06 ","$5,423.00 ","$1,972.82 ","$6,380.00 ","$3,808.86 ","$1,972.82 ","$2,654.08 ", N/A , N/A ,"$1,972.82 ","$5,423.00 ","$4,142.93 ","$5,423.00 ","$1,786.40 ","$5,742.00 ","$1,972.82 ","$5,231.60 ",$325.00 ,$325.00 ,"$1,972.82 ","$4,147.00 ","$6,380.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001329,41005,HC I AND D INTRAORAL LESION,450,1 ,$387.00 ,$251.55 ,$108.36 ,$521.45 ,$521.45 ,$251.55 ,$231.04 ,$208.58 ,$108.36 ,$217.11 ,$208.58 ,$254.65 ,$208.58 ,$328.95 ,$328.95 ,$208.58 ,$328.95 ,$387.00 ,$263.16 ,$521.44 ,$208.58 ,$208.58 ,$290.25 ,$274.77 ,$274.77 ,$208.58 ,$274.77 ,$317.34 ,$317.34 ,$317.34 , N/A ,$387.00 ,$328.95 ,$208.58 ,$387.00 ,$231.04 ,$208.58 ,$160.99 , N/A , N/A ,$208.58 ,$328.95 ,$438.01 ,$328.95 ,$108.36 ,$348.30 ,$208.58 ,$317.34 ,$325.00 ,$325.00 ,$208.58 ,$251.55 ,$387.00 
ST. JOSEPH'S HOSPITAL - BREESE,45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$657.00 ,$427.05 ,$183.96 ,$657.00 ,$655.88 ,$427.05 ,$392.23 ,$262.35 ,$183.96 ,$368.58 ,$262.35 ,$432.31 ,$262.35 ,$558.45 ,$558.45 ,$262.35 ,$558.45 ,$498.46 ,$446.76 ,$655.86 ,$262.35 ,$262.35 ,$492.75 ,$466.47 ,$466.47 ,$262.35 ,$466.47 ,$538.74 ,$538.74 ,$538.74 , N/A ,$655.86 ,$558.45 ,$262.35 ,$657.00 ,$392.23 ,$262.35 ,$273.31 , N/A , N/A ,$262.35 ,$558.45 ,$550.92 ,$558.45 ,$183.96 ,$591.30 ,$262.35 ,$538.74 ,$325.00 ,$325.00 ,$262.35 ,$427.05 ,$657.00 
ST. JOSEPH'S HOSPITAL - BREESE,45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,$657.00 ,$427.05 ,$183.96 ,$657.00 ,$655.88 ,$427.05 ,$392.23 ,$262.35 ,$183.96 ,$368.58 ,$262.35 ,$432.31 ,$262.35 ,$558.45 ,$558.45 ,$262.35 ,$558.45 ,$498.46 ,$446.76 ,$655.86 ,$262.35 ,$262.35 ,$492.75 ,$466.47 ,$466.47 ,$262.35 ,$466.47 ,$538.74 ,$538.74 ,$538.74 , N/A ,$655.86 ,$558.45 ,$262.35 ,$657.00 ,$392.23 ,$262.35 ,$273.31 , N/A , N/A ,$262.35 ,$558.45 ,$550.92 ,$558.45 ,$183.96 ,$591.30 ,$262.35 ,$538.74 ,$325.00 ,$325.00 ,$262.35 ,$427.05 ,$657.00 
ST. JOSEPH'S HOSPITAL - BREESE,45001341,42720,HC I AND D ABSCESS PHARYNGEAL INTRAORAL APPROACH,450,1 ,"$7,858.00 ","$5,107.70 ",$325.00 ,"$7,858.00 ","$6,742.70 ","$5,107.70 ","$4,691.23 ","$2,697.08 ","$2,200.24 ","$4,408.34 ","$2,697.08 ","$5,170.56 ","$2,697.08 ","$6,679.30 ","$6,679.30 ","$2,697.08 ","$6,679.30 ","$5,124.46 ","$5,343.44 ","$6,742.71 ","$2,697.08 ","$2,697.08 ","$5,893.50 ","$5,579.18 ","$5,579.18 ","$2,697.08 ","$5,579.18 ","$6,443.56 ","$6,443.56 ","$6,443.56 ", N/A ,"$6,742.71 ","$6,679.30 ","$2,697.08 ","$7,858.00 ","$4,691.23 ","$2,697.08 ","$3,268.93 ", N/A , N/A ,"$2,697.08 ","$6,679.30 ","$5,663.88 ","$6,679.30 ","$2,200.24 ","$7,072.20 ","$2,697.08 ","$6,443.56 ",$325.00 ,$325.00 ,"$2,697.08 ","$5,107.70 ","$7,858.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001347,27503,HC CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,450,1 ,"$4,468.00 ","$2,904.20 ",$325.00 ,"$4,468.00 ","$3,432.95 ","$2,904.20 ","$2,667.40 ","$1,373.18 ","$1,251.04 ","$2,506.55 ","$1,373.18 ","$2,939.94 ","$1,373.18 ","$3,797.80 ","$3,797.80 ","$1,373.18 ","$3,797.80 ","$2,609.04 ","$3,038.24 ","$3,432.94 ","$1,373.18 ","$1,373.18 ","$3,351.00 ","$3,172.28 ","$3,172.28 ","$1,373.18 ","$3,172.28 ","$3,663.76 ","$3,663.76 ","$3,663.76 ", N/A ,"$3,432.94 ","$3,797.80 ","$1,373.18 ","$4,468.00 ","$2,667.40 ","$1,373.18 ","$1,858.69 ", N/A , N/A ,"$1,373.18 ","$3,797.80 ","$2,883.67 ","$3,797.80 ","$1,251.04 ","$4,021.20 ","$1,373.18 ","$3,663.76 ",$325.00 ,$325.00 ,"$1,373.18 ","$2,904.20 ","$4,468.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001350,P9612,HC STRAIGHT CATH FOR URINE SPECIMEN,450,1 ,$201.00 ,$130.65 ,$3.00 ,$201.00 ,$7.50 ,$130.65 ,$120.00 ,$3.00 ,$56.28 ,$112.76 ,$3.00 ,$132.26 ,$3.00 ,$170.85 ,$170.85 ,$3.00 ,$170.85 ,$5.70 ,$136.68 ,$7.50 ,$3.00 ,$3.00 ,$150.75 ,$142.71 ,$142.71 ,$3.00 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$7.50 ,$170.85 ,$3.00 ,$201.00 ,$120.00 ,$3.00 ,$83.62 , N/A , N/A ,$3.00 ,$170.85 ,$6.30 ,$170.85 ,$56.28 ,$180.90 ,$3.00 ,$164.82 ,$201.00 ,$201.00 ,$3.00 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,45001352,26545,HC RECONSTRUCT FINGER JOINT,450,1 ,"$7,847.00 ","$5,100.55 ",$325.00 ,"$7,847.00 ","$6,979.95 ","$5,100.55 ","$4,684.66 ","$2,791.98 ","$2,197.16 ","$4,402.17 ","$2,791.98 ","$5,163.33 ","$2,791.98 ","$6,669.95 ","$6,669.95 ","$2,791.98 ","$6,669.95 ","$5,304.75 ","$5,335.96 ","$6,979.94 ","$2,791.98 ","$2,791.98 ","$5,885.25 ","$5,571.37 ","$5,571.37 ","$2,791.98 ","$5,571.37 ","$6,434.54 ","$6,434.54 ","$6,434.54 ", N/A ,"$6,979.94 ","$6,669.95 ","$2,791.98 ","$7,847.00 ","$4,684.66 ","$2,791.98 ","$3,264.35 ", N/A , N/A ,"$2,791.98 ","$6,669.95 ","$5,863.15 ","$6,669.95 ","$2,197.16 ","$7,062.30 ","$2,791.98 ","$6,434.54 ",$325.00 ,$325.00 ,"$2,791.98 ","$5,100.55 ","$7,847.00 "
ST. JOSEPH'S HOSPITAL - BREESE,45001355,25660,HC CLTX RDCRPL/INTERCARPL DISLC 1 >BONES W MAN,450,1 ,$587.13 ,$381.63 ,$164.40 ,$587.13 ,$508.00 ,$381.63 ,$350.52 ,$203.20 ,$164.40 ,$329.38 ,$203.20 ,$386.33 ,$203.20 ,$499.06 ,$499.06 ,$203.20 ,$499.06 ,$386.08 ,$399.25 ,$508.00 ,$203.20 ,$203.20 ,$440.35 ,$416.86 ,$416.86 ,$203.20 ,$416.86 ,$481.45 ,$481.45 ,$481.45 , N/A ,$508.00 ,$499.06 ,$203.20 ,$587.13 ,$350.52 ,$203.20 ,$244.25 , N/A , N/A ,$203.20 ,$499.06 ,$426.72 ,$499.06 ,$164.40 ,$528.42 ,$203.20 ,$481.45 ,$325.00 ,$325.00 ,$203.20 ,$381.63 ,$587.13 
ST. JOSEPH'S HOSPITAL - BREESE,45001360,31577,HC LARYNGOSCOPY FLX RMVL FOREIGN BODY(S),450,1 ,"$1,072.14 ",$696.89 ,$300.20 ,"$1,072.14 ",$926.43 ,$696.89 ,$640.07 ,$370.57 ,$300.20 ,$601.47 ,$370.57 ,$705.47 ,$370.57 ,$911.32 ,$911.32 ,$370.57 ,$911.32 ,$704.08 ,$729.06 ,$926.42 ,$370.57 ,$370.57 ,$804.11 ,$761.22 ,$761.22 ,$370.57 ,$761.22 ,$879.15 ,$879.15 ,$879.15 , N/A ,$926.42 ,$911.32 ,$370.57 ,"$1,072.14 ",$640.07 ,$370.57 ,$446.01 , N/A , N/A ,$370.57 ,$911.32 ,$778.19 ,$911.32 ,$300.20 ,$964.93 ,$370.57 ,$879.15 ,$325.00 ,$325.00 ,$370.57 ,$696.89 ,"$1,072.14 "
ST. JOSEPH'S HOSPITAL - BREESE,46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$326.00 ,$211.90 ,$49.50 ,$344.13 ,$344.13 ,$211.90 ,$194.62 ,$137.65 ,$91.28 ,$182.89 ,$137.65 ,$214.51 ,$137.65 ,$277.10 ,$277.10 ,$137.65 ,$277.10 ,$261.53 ,$221.68 ,$344.11 ,$137.65 ,$137.65 ,$244.50 ,$231.46 ,$231.46 ,$137.65 ,$231.46 ,$267.32 ,$267.32 ,$267.32 , N/A ,$326.00 ,$277.10 ,$137.65 ,$326.00 ,$194.62 ,$137.65 ,$135.62 ,$54.45 ,$49.50 ,$137.65 ,$277.10 ,$289.05 ,$277.10 ,$91.28 ,$293.40 ,$137.65 ,$267.32 ,$275.47 ,$275.47 ,$137.65 ,$211.90 ,$326.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$702.00 ,$456.30 ,$49.50 ,$702.00 ,$652.30 ,$456.30 ,$419.09 ,$260.92 ,$196.56 ,$393.82 ,$260.92 ,$461.92 ,$260.92 ,$596.70 ,$596.70 ,$260.92 ,$596.70 ,$495.74 ,$477.36 ,$652.29 ,$260.92 ,$260.92 ,$526.50 ,$498.42 ,$498.42 ,$260.92 ,$498.42 ,$575.64 ,$575.64 ,$575.64 , N/A ,$652.29 ,$596.70 ,$260.92 ,$702.00 ,$419.09 ,$260.92 ,$292.03 ,$54.45 ,$49.50 ,$260.92 ,$596.70 ,$547.92 ,$596.70 ,$196.56 ,$631.80 ,$260.92 ,$575.64 ,$593.19 ,$593.19 ,$260.92 ,$456.30 ,$702.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,$553.00 ,$359.45 ,$151.25 ,$652.30 ,$652.30 ,$359.45 ,$330.14 ,$260.92 ,$154.84 ,$310.23 ,$260.92 ,$363.87 ,$260.92 ,$470.05 ,$470.05 ,$260.92 ,$470.05 ,$495.74 ,$376.04 ,$652.29 ,$260.92 ,$260.92 ,$414.75 ,$392.63 ,$392.63 ,$260.92 ,$392.63 ,$453.46 ,$453.46 ,$453.46 , N/A ,$553.00 ,$470.05 ,$260.92 ,$553.00 ,$330.14 ,$260.92 ,$230.05 ,$166.38 ,$151.25 ,$260.92 ,$470.05 ,$547.92 ,$470.05 ,$154.84 ,$497.70 ,$260.92 ,$453.46 ,$467.29 ,$467.29 ,$260.92 ,$359.45 ,$553.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000007,94150,HC VITAL CAPACITY TOTAL,460,1 ,$85.00 ,$55.25 ,$23.80 ,$344.13 ,$344.13 ,$55.25 ,$50.75 ,$137.65 ,$23.80 ,$47.69 ,$137.65 ,$55.93 ,$85.00 ,$72.25 ,$72.25 ,$85.00 ,$72.25 ,$85.00 ,$57.80 ,$344.11 ,$137.65 ,$137.65 ,$63.75 ,$60.35 ,$60.35 ,$137.65 ,$60.35 ,$69.70 ,$69.70 ,$69.70 , N/A ,$85.00 ,$72.25 ,$137.65 ,$85.00 ,$50.75 ,$137.65 ,$35.36 ,$54.45 ,$49.50 ,$137.65 ,$72.25 ,$289.05 ,$72.25 ,$23.80 ,$76.50 ,$137.65 ,$69.70 ,$71.83 ,$71.83 ,$137.65 ,$55.25 ,$85.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000012,94728,HC AIRFLOW RESISTANCE,460,1 ,$328.00 ,$213.20 ,$49.50 ,$652.30 ,$652.30 ,$213.20 ,$195.82 ,$260.92 ,$91.84 ,$184.01 ,$260.92 ,$215.82 ,$260.92 ,$278.80 ,$278.80 ,$260.92 ,$278.80 ,$328.00 ,$223.04 ,$652.29 ,$260.92 ,$260.92 ,$246.00 ,$232.88 ,$232.88 ,$260.92 ,$232.88 ,$268.96 ,$268.96 ,$268.96 , N/A ,$328.00 ,$278.80 ,$260.92 ,$328.00 ,$195.82 ,$260.92 ,$136.45 ,$54.45 ,$49.50 ,$260.92 ,$278.80 ,$547.92 ,$278.80 ,$91.84 ,$295.20 ,$260.92 ,$268.96 ,$277.16 ,$277.16 ,$260.92 ,$213.20 ,$328.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000013,94726,HC PLETHYSMOGRAPHY,460,1 ,$821.00 ,$533.65 ,$49.50 ,$821.00 ,$652.30 ,$533.65 ,$490.14 ,$260.92 ,$229.88 ,$460.58 ,$260.92 ,$540.22 ,$260.92 ,$697.85 ,$697.85 ,$260.92 ,$697.85 ,$495.74 ,$558.28 ,$652.29 ,$260.92 ,$260.92 ,$615.75 ,$582.91 ,$582.91 ,$260.92 ,$582.91 ,$673.22 ,$673.22 ,$673.22 , N/A ,$652.29 ,$697.85 ,$260.92 ,$821.00 ,$490.14 ,$260.92 ,$341.54 ,$54.45 ,$49.50 ,$260.92 ,$697.85 ,$547.92 ,$697.85 ,$229.88 ,$738.90 ,$260.92 ,$673.22 ,$693.75 ,$693.75 ,$260.92 ,$533.65 ,$821.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000014,94618,HC WALK TEST 6 MIN,460,1 ,$323.00 ,$209.95 ,$90.44 ,$323.00 ,$277.93 ,$209.95 ,$192.83 ,$111.17 ,$90.44 ,$181.20 ,$111.17 ,$212.53 ,$111.17 ,$274.55 ,$274.55 ,$111.17 ,$274.55 ,$211.22 ,$219.64 ,$277.92 ,$111.17 ,$111.17 ,$242.25 ,$229.33 ,$229.33 ,$111.17 ,$229.33 ,$264.86 ,$264.86 ,$264.86 , N/A ,$277.92 ,$274.55 ,$111.17 ,$323.00 ,$192.83 ,$111.17 ,$134.37 ,$166.38 ,$151.25 ,$111.17 ,$274.55 ,$233.45 ,$274.55 ,$90.44 ,$290.70 ,$111.17 ,$264.86 ,$272.94 ,$272.94 ,$111.17 ,$209.95 ,$323.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$363.00 ,$235.95 ,$49.50 ,$363.00 , N/A ,$235.95 ,$216.71 , N/A ,$101.64 ,$203.64 , N/A ,$238.85 , N/A ,$308.55 ,$308.55 , N/A ,$308.55 , N/A ,$246.84 , N/A , N/A , N/A ,$272.25 ,$257.73 ,$257.73 , N/A ,$257.73 ,$297.66 ,$297.66 ,$297.66 , N/A , N/A ,$308.55 , N/A ,$363.00 ,$216.71 , N/A ,$151.01 ,$54.45 ,$49.50 , N/A ,$308.55 , N/A ,$308.55 ,$101.64 ,$326.70 , N/A ,$297.66 ,$306.74 ,$306.74 , N/A ,$235.95 ,$363.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000021,94760,HC PULSE OX SINGLE,460,1 ,$83.00 ,$53.95 ,$23.24 ,$83.00 , N/A ,$53.95 ,$49.55 , N/A ,$23.24 ,$46.56 , N/A ,$54.61 , N/A ,$70.55 ,$70.55 , N/A ,$70.55 , N/A ,$56.44 , N/A , N/A , N/A ,$62.25 ,$58.93 ,$58.93 , N/A ,$58.93 ,$68.06 ,$68.06 ,$68.06 , N/A , N/A ,$70.55 , N/A ,$83.00 ,$49.55 , N/A ,$34.53 , N/A , N/A , N/A ,$70.55 , N/A ,$70.55 ,$23.24 ,$74.70 , N/A ,$68.06 ,$70.14 ,$70.14 , N/A ,$53.95 ,$83.00 
ST. JOSEPH'S HOSPITAL - BREESE,46000022,94200,HC MAXIMAL VOL VENTILATION,942,1 ,$177.00 ,$115.05 ,$49.56 ,$177.00 ,$137.20 ,$115.05 ,$105.67 ,$54.88 ,$49.56 ,$99.30 ,$54.88 ,$116.47 ,$54.88 ,$150.45 ,$150.45 ,$54.88 ,$150.45 ,$104.27 ,$120.36 ,$137.20 ,$54.88 ,$54.88 ,$132.75 ,$125.67 ,$125.67 ,$54.88 ,$125.67 ,$145.14 ,$145.14 ,$145.14 , N/A ,$137.20 ,$150.45 ,$54.88 ,$177.00 ,$105.67 ,$54.88 ,$73.63 , N/A , N/A ,$54.88 ,$150.45 ,$115.24 ,$150.45 ,$49.56 ,$159.30 ,$54.88 ,$145.14 ,$149.57 ,$149.57 ,$54.88 ,$115.05 ,$177.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000001,92587,HC DISTORTION EVOKED POTENT LTD,470,1 ,$277.00 ,$180.05 ,$77.56 ,$652.30 ,$652.30 ,$180.05 ,$165.37 ,$260.92 ,$77.56 ,$155.40 ,$260.92 ,$182.27 ,$260.92 ,$235.45 ,$235.45 ,$260.92 ,$235.45 ,$277.00 ,$188.36 ,$652.29 ,$260.92 ,$260.92 ,$207.75 ,$196.67 ,$196.67 ,$260.92 ,$196.67 ,$227.14 ,$227.14 ,$227.14 , N/A ,$277.00 ,$235.45 ,$260.92 ,$277.00 ,$165.37 ,$260.92 ,$115.23 ,$158.81 ,$144.37 ,$260.92 ,$235.45 ,$547.92 ,$235.45 ,$77.56 ,$249.30 ,$260.92 ,$227.14 ,$234.07 ,$234.07 ,$260.92 ,$180.05 ,$277.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000003,92586,HC NEWBORN HEARING SCREENING,470,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000014,V5014,HC REPROGRAM HEARING AID W/O WARRANTY,470,1 ,$72.00 ,$46.80 ,$20.16 ,$72.00 , N/A ,$46.80 ,$42.98 , N/A ,$20.16 ,$40.39 , N/A ,$47.38 , N/A ,$61.20 ,$61.20 , N/A ,$61.20 , N/A ,$48.96 , N/A , N/A , N/A ,$54.00 ,$51.12 ,$51.12 , N/A ,$51.12 ,$59.04 ,$59.04 ,$59.04 , N/A , N/A ,$61.20 , N/A ,$72.00 ,$42.98 , N/A ,$29.95 ,$72.00 ,$72.00 , N/A ,$61.20 , N/A ,$61.20 ,$20.16 ,$64.80 , N/A ,$59.04 ,$60.84 ,$60.84 , N/A ,$46.80 ,$72.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000015,V5014,HC REPAIR HEARING AID T1,470,1 ,$1.00 ,$0.65 ,$0.28 ,$1.00 , N/A ,$0.65 ,$0.60 , N/A ,$0.28 ,$0.56 , N/A ,$0.66 , N/A ,$0.85 ,$0.85 , N/A ,$0.85 , N/A ,$0.68 , N/A , N/A , N/A ,$0.75 ,$0.71 ,$0.71 , N/A ,$0.71 ,$0.82 ,$0.82 ,$0.82 , N/A , N/A ,$0.85 , N/A ,$1.00 ,$0.60 , N/A ,$0.42 ,$1.00 ,$1.00 , N/A ,$0.85 , N/A ,$0.85 ,$0.28 ,$0.90 , N/A ,$0.82 ,$0.85 ,$0.85 , N/A ,$0.65 ,$1.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000016,V5014,HC REPAIR HEARING AID T2,470,1 ,$10.00 ,$6.50 ,$2.80 ,$10.00 , N/A ,$6.50 ,$5.97 , N/A ,$2.80 ,$5.61 , N/A ,$6.58 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$6.80 , N/A , N/A , N/A ,$7.50 ,$7.10 ,$7.10 , N/A ,$7.10 ,$8.20 ,$8.20 ,$8.20 , N/A , N/A ,$8.50 , N/A ,$10.00 ,$5.97 , N/A ,$4.16 ,$10.00 ,$10.00 , N/A ,$8.50 , N/A ,$8.50 ,$2.80 ,$9.00 , N/A ,$8.20 ,$8.45 ,$8.45 , N/A ,$6.50 ,$10.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000017,V5014,HC REPAIR HEARING AID T3,470,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 ,$25.00 ,$25.00 , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000018,V5014,HC REPAIR HEARING AID T4,470,1 ,$50.00 ,$32.50 ,$14.00 ,$50.00 , N/A ,$32.50 ,$29.85 , N/A ,$14.00 ,$28.05 , N/A ,$32.90 , N/A ,$42.50 ,$42.50 , N/A ,$42.50 , N/A ,$34.00 , N/A , N/A , N/A ,$37.50 ,$35.50 ,$35.50 , N/A ,$35.50 ,$41.00 ,$41.00 ,$41.00 , N/A , N/A ,$42.50 , N/A ,$50.00 ,$29.85 , N/A ,$20.80 ,$50.00 ,$50.00 , N/A ,$42.50 , N/A ,$42.50 ,$14.00 ,$45.00 , N/A ,$41.00 ,$42.25 ,$42.25 , N/A ,$32.50 ,$50.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000019,V5014,HC REPAIR HEARING AID T5,470,1 ,$75.00 ,$48.75 ,$21.00 ,$75.00 , N/A ,$48.75 ,$44.78 , N/A ,$21.00 ,$42.08 , N/A ,$49.35 , N/A ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$51.00 , N/A , N/A , N/A ,$56.25 ,$53.25 ,$53.25 , N/A ,$53.25 ,$61.50 ,$61.50 ,$61.50 , N/A , N/A ,$63.75 , N/A ,$75.00 ,$44.78 , N/A ,$31.20 ,$75.00 ,$75.00 , N/A ,$63.75 , N/A ,$63.75 ,$21.00 ,$67.50 , N/A ,$61.50 ,$63.38 ,$63.38 , N/A ,$48.75 ,$75.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000020,V5014,HC REPAIR HEARING AID T6,470,1 ,$100.00 ,$65.00 ,$28.00 ,$100.00 , N/A ,$65.00 ,$59.70 , N/A ,$28.00 ,$56.10 , N/A ,$65.80 , N/A ,$85.00 ,$85.00 , N/A ,$85.00 , N/A ,$68.00 , N/A , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A , N/A ,$85.00 , N/A ,$100.00 ,$59.70 , N/A ,$41.60 ,$100.00 ,$91.38 , N/A ,$85.00 , N/A ,$85.00 ,$28.00 ,$90.00 , N/A ,$82.00 ,$84.50 ,$84.50 , N/A ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000021,V5014,HC REPAIR HEARING AID T7,470,1 ,$175.00 ,$113.75 ,$49.00 ,$175.00 , N/A ,$113.75 ,$104.48 , N/A ,$49.00 ,$98.18 , N/A ,$115.15 , N/A ,$148.75 ,$148.75 , N/A ,$148.75 , N/A ,$119.00 , N/A , N/A , N/A ,$131.25 ,$124.25 ,$124.25 , N/A ,$124.25 ,$143.50 ,$143.50 ,$143.50 , N/A , N/A ,$148.75 , N/A ,$175.00 ,$104.48 , N/A ,$72.80 ,$100.52 ,$91.38 , N/A ,$148.75 , N/A ,$148.75 ,$49.00 ,$157.50 , N/A ,$143.50 ,$147.88 ,$147.88 , N/A ,$113.75 ,$175.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000022,V5014,HC REPAIR HEARING AID T8,470,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 ,$100.52 ,$91.38 , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000023,V5014,HC REPAIR HEARING AID T9,470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 ,$100.52 ,$91.38 , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000024,V5014,HC REPAIR HEARING AID T10,470,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 , N/A ,$195.00 ,$179.10 , N/A ,$84.00 ,$168.30 , N/A ,$197.40 , N/A ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$204.00 , N/A , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A , N/A ,$255.00 , N/A ,$300.00 ,$179.10 , N/A ,$124.80 ,$100.52 ,$91.38 , N/A ,$255.00 , N/A ,$255.00 ,$84.00 ,$270.00 , N/A ,$246.00 ,$253.50 ,$253.50 , N/A ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000025,V5014,HC REPAIR HEARING AID T11,470,1 ,$350.00 ,$227.50 ,$91.38 ,$350.00 , N/A ,$227.50 ,$208.95 , N/A ,$98.00 ,$196.35 , N/A ,$230.30 , N/A ,$297.50 ,$297.50 , N/A ,$297.50 , N/A ,$238.00 , N/A , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$287.00 ,$287.00 ,$287.00 , N/A , N/A ,$297.50 , N/A ,$350.00 ,$208.95 , N/A ,$145.60 ,$100.52 ,$91.38 , N/A ,$297.50 , N/A ,$297.50 ,$98.00 ,$315.00 , N/A ,$287.00 ,$295.75 ,$295.75 , N/A ,$227.50 ,$350.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000026,V5014,HC REPAIR HEARING AID T12,470,1 ,$400.00 ,$260.00 ,$91.38 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 ,$100.52 ,$91.38 , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000027,V5014,HC REPAIR HEARING AID T13,470,1 ,$450.00 ,$292.50 ,$91.38 ,$450.00 , N/A ,$292.50 ,$268.65 , N/A ,$126.00 ,$252.45 , N/A ,$296.10 , N/A ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$306.00 , N/A , N/A , N/A ,$337.50 ,$319.50 ,$319.50 , N/A ,$319.50 ,$369.00 ,$369.00 ,$369.00 , N/A , N/A ,$382.50 , N/A ,$450.00 ,$268.65 , N/A ,$187.20 ,$100.52 ,$91.38 , N/A ,$382.50 , N/A ,$382.50 ,$126.00 ,$405.00 , N/A ,$369.00 ,$380.25 ,$380.25 , N/A ,$292.50 ,$450.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000028,V5010,HC HEARING AID ASSESSMENT,470,1 ,$214.00 ,$139.10 ,$59.92 ,$214.00 , N/A ,$139.10 ,$127.76 , N/A ,$59.92 ,$120.05 , N/A ,$140.81 , N/A ,$181.90 ,$181.90 , N/A ,$181.90 , N/A ,$145.52 , N/A , N/A , N/A ,$160.50 ,$151.94 ,$151.94 , N/A ,$151.94 ,$175.48 ,$175.48 ,$175.48 , N/A , N/A ,$181.90 , N/A ,$214.00 ,$127.76 , N/A ,$89.02 ,$100.52 ,$91.38 , N/A ,$181.90 , N/A ,$181.90 ,$59.92 ,$192.60 , N/A ,$175.48 ,$180.83 ,$180.83 , N/A ,$139.10 ,$214.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000029,V5011,HC HEARING AID FITTING/CHECK,470,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 ,$25.00 ,$25.00 , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000030,V5020,HC CONFORMITY EVAL,470,1 ,$72.00 ,$46.80 ,$20.16 ,$72.00 , N/A ,$46.80 ,$42.98 , N/A ,$20.16 ,$40.39 , N/A ,$47.38 , N/A ,$61.20 ,$61.20 , N/A ,$61.20 , N/A ,$48.96 , N/A , N/A , N/A ,$54.00 ,$51.12 ,$51.12 , N/A ,$51.12 ,$59.04 ,$59.04 ,$59.04 , N/A , N/A ,$61.20 , N/A ,$72.00 ,$42.98 , N/A ,$29.95 ,$72.00 ,$72.00 , N/A ,$61.20 , N/A ,$61.20 ,$20.16 ,$64.80 , N/A ,$59.04 ,$60.84 ,$60.84 , N/A ,$46.80 ,$72.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000031,V5299,HC WARRANTY TIER 1,470,1 ,$100.00 ,$65.00 ,$28.00 ,$100.00 , N/A ,$65.00 ,$59.70 , N/A ,$28.00 ,$56.10 , N/A ,$65.80 , N/A ,$85.00 ,$85.00 , N/A ,$85.00 , N/A ,$68.00 , N/A , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A , N/A ,$85.00 , N/A ,$100.00 ,$59.70 , N/A ,$41.60 , N/A , N/A , N/A ,$85.00 , N/A ,$85.00 ,$28.00 ,$90.00 , N/A ,$82.00 ,$84.50 ,$84.50 , N/A ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000032,V5299,HC WARRANTY TIER 2,470,1 ,$150.00 ,$97.50 ,$42.00 ,$150.00 , N/A ,$97.50 ,$89.55 , N/A ,$42.00 ,$84.15 , N/A ,$98.70 , N/A ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$102.00 , N/A , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A , N/A ,$127.50 , N/A ,$150.00 ,$89.55 , N/A ,$62.40 , N/A , N/A , N/A ,$127.50 , N/A ,$127.50 ,$42.00 ,$135.00 , N/A ,$123.00 ,$126.75 ,$126.75 , N/A ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000033,V5299,HC WARRANTY TIER 3,470,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000034,V5299,HC WARRANTY TIER 4,470,1 ,$230.00 ,$149.50 ,$64.40 ,$230.00 , N/A ,$149.50 ,$137.31 , N/A ,$64.40 ,$129.03 , N/A ,$151.34 , N/A ,$195.50 ,$195.50 , N/A ,$195.50 , N/A ,$156.40 , N/A , N/A , N/A ,$172.50 ,$163.30 ,$163.30 , N/A ,$163.30 ,$188.60 ,$188.60 ,$188.60 , N/A , N/A ,$195.50 , N/A ,$230.00 ,$137.31 , N/A ,$95.68 , N/A , N/A , N/A ,$195.50 , N/A ,$195.50 ,$64.40 ,$207.00 , N/A ,$188.60 ,$194.35 ,$194.35 , N/A ,$149.50 ,$230.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000035,V5299,HC WARRANTY TIER 5,470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000036,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 500-600,470,1 ,$292.00 ,$189.80 ,$81.76 ,$292.00 , N/A ,$189.80 ,$174.32 , N/A ,$81.76 ,$163.81 , N/A ,$192.14 , N/A ,$248.20 ,$248.20 , N/A ,$248.20 , N/A ,$198.56 , N/A , N/A , N/A ,$219.00 ,$207.32 ,$207.32 , N/A ,$207.32 ,$239.44 ,$239.44 ,$239.44 , N/A , N/A ,$248.20 , N/A ,$292.00 ,$174.32 , N/A ,$121.47 , N/A , N/A , N/A ,$248.20 , N/A ,$248.20 ,$81.76 ,$262.80 , N/A ,$239.44 ,$246.74 ,$246.74 , N/A ,$189.80 ,$292.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000037,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 600-700,470,1 ,$341.00 ,$221.65 ,$95.48 ,$341.00 , N/A ,$221.65 ,$203.58 , N/A ,$95.48 ,$191.30 , N/A ,$224.38 , N/A ,$289.85 ,$289.85 , N/A ,$289.85 , N/A ,$231.88 , N/A , N/A , N/A ,$255.75 ,$242.11 ,$242.11 , N/A ,$242.11 ,$279.62 ,$279.62 ,$279.62 , N/A , N/A ,$289.85 , N/A ,$341.00 ,$203.58 , N/A ,$141.86 , N/A , N/A , N/A ,$289.85 , N/A ,$289.85 ,$95.48 ,$306.90 , N/A ,$279.62 ,$288.15 ,$288.15 , N/A ,$221.65 ,$341.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000038,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 700-800,470,1 ,$385.00 ,$250.25 ,$107.80 ,$385.00 , N/A ,$250.25 ,$229.85 , N/A ,$107.80 ,$215.99 , N/A ,$253.33 , N/A ,$327.25 ,$327.25 , N/A ,$327.25 , N/A ,$261.80 , N/A , N/A , N/A ,$288.75 ,$273.35 ,$273.35 , N/A ,$273.35 ,$315.70 ,$315.70 ,$315.70 , N/A , N/A ,$327.25 , N/A ,$385.00 ,$229.85 , N/A ,$160.16 , N/A , N/A , N/A ,$327.25 , N/A ,$327.25 ,$107.80 ,$346.50 , N/A ,$315.70 ,$325.33 ,$325.33 , N/A ,$250.25 ,$385.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000039,V5299,HC HEARING AID FLEX SOFTWARE UPGRADE 800-PRO,470,1 ,$770.00 ,$500.50 ,$215.60 ,$770.00 , N/A ,$500.50 ,$459.69 , N/A ,$215.60 ,$431.97 , N/A ,$506.66 , N/A ,$654.50 ,$654.50 , N/A ,$654.50 , N/A ,$523.60 , N/A , N/A , N/A ,$577.50 ,$546.70 ,$546.70 , N/A ,$546.70 ,$631.40 ,$631.40 ,$631.40 , N/A , N/A ,$654.50 , N/A ,$770.00 ,$459.69 , N/A ,$320.32 , N/A , N/A , N/A ,$654.50 , N/A ,$654.50 ,$215.60 ,$693.00 , N/A ,$631.40 ,$650.65 ,$650.65 , N/A ,$500.50 ,$770.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000040,V5299,HC WARRANTY DEDUCTIBLE T1,470,1 ,$150.00 ,$97.50 ,$42.00 ,$150.00 , N/A ,$97.50 ,$89.55 , N/A ,$42.00 ,$84.15 , N/A ,$98.70 , N/A ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$102.00 , N/A , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A , N/A ,$127.50 , N/A ,$150.00 ,$89.55 , N/A ,$62.40 , N/A , N/A , N/A ,$127.50 , N/A ,$127.50 ,$42.00 ,$135.00 , N/A ,$123.00 ,$126.75 ,$126.75 , N/A ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000041,V5299,HC WARRANTY DEDUCTIBLE T2,470,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000042,V5299,HC WARRANTY DEDUCTIBLE T3,470,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 , N/A ,$195.00 ,$179.10 , N/A ,$84.00 ,$168.30 , N/A ,$197.40 , N/A ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$204.00 , N/A , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A , N/A ,$255.00 , N/A ,$300.00 ,$179.10 , N/A ,$124.80 , N/A , N/A , N/A ,$255.00 , N/A ,$255.00 ,$84.00 ,$270.00 , N/A ,$246.00 ,$253.50 ,$253.50 , N/A ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000043,V5299,HC WARRANTY DEDUCTIBLE T4,470,1 ,$325.00 ,$211.25 ,$91.00 ,$325.00 , N/A ,$211.25 ,$194.03 , N/A ,$91.00 ,$182.33 , N/A ,$213.85 , N/A ,$276.25 ,$276.25 , N/A ,$276.25 , N/A ,$221.00 , N/A , N/A , N/A ,$243.75 ,$230.75 ,$230.75 , N/A ,$230.75 ,$266.50 ,$266.50 ,$266.50 , N/A , N/A ,$276.25 , N/A ,$325.00 ,$194.03 , N/A ,$135.20 , N/A , N/A , N/A ,$276.25 , N/A ,$276.25 ,$91.00 ,$292.50 , N/A ,$266.50 ,$274.63 ,$274.63 , N/A ,$211.25 ,$325.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000044,V5299,HC WARRANTY DEDUCTIBLE T5,470,1 ,$350.00 ,$227.50 ,$98.00 ,$350.00 , N/A ,$227.50 ,$208.95 , N/A ,$98.00 ,$196.35 , N/A ,$230.30 , N/A ,$297.50 ,$297.50 , N/A ,$297.50 , N/A ,$238.00 , N/A , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$287.00 ,$287.00 ,$287.00 , N/A , N/A ,$297.50 , N/A ,$350.00 ,$208.95 , N/A ,$145.60 , N/A , N/A , N/A ,$297.50 , N/A ,$297.50 ,$98.00 ,$315.00 , N/A ,$287.00 ,$295.75 ,$295.75 , N/A ,$227.50 ,$350.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000045,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - STARKEY (2017  AND  EARLIER),470,1 ,$185.00 ,$120.25 ,$51.80 ,$185.00 , N/A ,$120.25 ,$110.45 , N/A ,$51.80 ,$103.79 , N/A ,$121.73 , N/A ,$157.25 ,$157.25 , N/A ,$157.25 , N/A ,$125.80 , N/A , N/A , N/A ,$138.75 ,$131.35 ,$131.35 , N/A ,$131.35 ,$151.70 ,$151.70 ,$151.70 , N/A , N/A ,$157.25 , N/A ,$185.00 ,$110.45 , N/A ,$76.96 , N/A , N/A , N/A ,$157.25 , N/A ,$157.25 ,$51.80 ,$166.50 , N/A ,$151.70 ,$156.33 ,$156.33 , N/A ,$120.25 ,$185.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000046,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - SIGNIA TIER 1,470,1 ,$210.00 ,$136.50 ,$58.80 ,$210.00 , N/A ,$136.50 ,$125.37 , N/A ,$58.80 ,$117.81 , N/A ,$138.18 , N/A ,$178.50 ,$178.50 , N/A ,$178.50 , N/A ,$142.80 , N/A , N/A , N/A ,$157.50 ,$149.10 ,$149.10 , N/A ,$149.10 ,$172.20 ,$172.20 ,$172.20 , N/A , N/A ,$178.50 , N/A ,$210.00 ,$125.37 , N/A ,$87.36 , N/A , N/A , N/A ,$178.50 , N/A ,$178.50 ,$58.80 ,$189.00 , N/A ,$172.20 ,$177.45 ,$177.45 , N/A ,$136.50 ,$210.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000047,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - PHONAK,470,1 ,$245.00 ,$159.25 ,$68.60 ,$245.00 , N/A ,$159.25 ,$146.27 , N/A ,$68.60 ,$137.45 , N/A ,$161.21 , N/A ,$208.25 ,$208.25 , N/A ,$208.25 , N/A ,$166.60 , N/A , N/A , N/A ,$183.75 ,$173.95 ,$173.95 , N/A ,$173.95 ,$200.90 ,$200.90 ,$200.90 , N/A , N/A ,$208.25 , N/A ,$245.00 ,$146.27 , N/A ,$101.92 , N/A , N/A , N/A ,$208.25 , N/A ,$208.25 ,$68.60 ,$220.50 , N/A ,$200.90 ,$207.03 ,$207.03 , N/A ,$159.25 ,$245.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000048,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - UNITRON,470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000049,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - WIDEX,470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000050,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - SIGNIA TIER 2,470,1 ,$260.00 ,$169.00 ,$72.80 ,$260.00 , N/A ,$169.00 ,$155.22 , N/A ,$72.80 ,$145.86 , N/A ,$171.08 , N/A ,$221.00 ,$221.00 , N/A ,$221.00 , N/A ,$176.80 , N/A , N/A , N/A ,$195.00 ,$184.60 ,$184.60 , N/A ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A , N/A ,$221.00 , N/A ,$260.00 ,$155.22 , N/A ,$108.16 , N/A , N/A , N/A ,$221.00 , N/A ,$221.00 ,$72.80 ,$234.00 , N/A ,$213.20 ,$219.70 ,$219.70 , N/A ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000051,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - STARKEY (2018  AND  LATER),470,1 ,$270.00 ,$175.50 ,$75.60 ,$270.00 , N/A ,$175.50 ,$161.19 , N/A ,$75.60 ,$151.47 , N/A ,$177.66 , N/A ,$229.50 ,$229.50 , N/A ,$229.50 , N/A ,$183.60 , N/A , N/A , N/A ,$202.50 ,$191.70 ,$191.70 , N/A ,$191.70 ,$221.40 ,$221.40 ,$221.40 , N/A , N/A ,$229.50 , N/A ,$270.00 ,$161.19 , N/A ,$112.32 , N/A , N/A , N/A ,$229.50 , N/A ,$229.50 ,$75.60 ,$243.00 , N/A ,$221.40 ,$228.15 ,$228.15 , N/A ,$175.50 ,$270.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000052,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - OTICON,470,1 ,$275.00 ,$178.75 ,$77.00 ,$275.00 , N/A ,$178.75 ,$164.18 , N/A ,$77.00 ,$154.28 , N/A ,$180.95 , N/A ,$233.75 ,$233.75 , N/A ,$233.75 , N/A ,$187.00 , N/A , N/A , N/A ,$206.25 ,$195.25 ,$195.25 , N/A ,$195.25 ,$225.50 ,$225.50 ,$225.50 , N/A , N/A ,$233.75 , N/A ,$275.00 ,$164.18 , N/A ,$114.40 , N/A , N/A , N/A ,$233.75 , N/A ,$233.75 ,$77.00 ,$247.50 , N/A ,$225.50 ,$232.38 ,$232.38 , N/A ,$178.75 ,$275.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000053,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - RESOUND,470,1 ,$285.00 ,$185.25 ,$79.80 ,$285.00 , N/A ,$185.25 ,$170.15 , N/A ,$79.80 ,$159.89 , N/A ,$187.53 , N/A ,$242.25 ,$242.25 , N/A ,$242.25 , N/A ,$193.80 , N/A , N/A , N/A ,$213.75 ,$202.35 ,$202.35 , N/A ,$202.35 ,$233.70 ,$233.70 ,$233.70 , N/A , N/A ,$242.25 , N/A ,$285.00 ,$170.15 , N/A ,$118.56 , N/A , N/A , N/A ,$242.25 , N/A ,$242.25 ,$79.80 ,$256.50 , N/A ,$233.70 ,$240.83 ,$240.83 , N/A ,$185.25 ,$285.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000055,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - REXTON,470,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 , N/A ,$195.00 ,$179.10 , N/A ,$84.00 ,$168.30 , N/A ,$197.40 , N/A ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$204.00 , N/A , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A , N/A ,$255.00 , N/A ,$300.00 ,$179.10 , N/A ,$124.80 , N/A , N/A , N/A ,$255.00 , N/A ,$255.00 ,$84.00 ,$270.00 , N/A ,$246.00 ,$253.50 ,$253.50 , N/A ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000056,N/A,HC AMPLIFON LOSS  AND  DAMAGE DED - SIGNIA TIER 3,470,1 ,$320.00 ,$208.00 ,$89.60 ,$320.00 , N/A ,$208.00 ,$191.04 , N/A ,$89.60 ,$179.52 , N/A ,$210.56 , N/A ,$272.00 ,$272.00 , N/A ,$272.00 , N/A ,$217.60 , N/A , N/A , N/A ,$240.00 ,$227.20 ,$227.20 , N/A ,$227.20 ,$262.40 ,$262.40 ,$262.40 , N/A , N/A ,$272.00 , N/A ,$320.00 ,$191.04 , N/A ,$133.12 , N/A , N/A , N/A ,$272.00 , N/A ,$272.00 ,$89.60 ,$288.00 , N/A ,$262.40 ,$270.40 ,$270.40 , N/A ,$208.00 ,$320.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000057,N/A,HC AMPLIFON HEARING AIDS - BASIC,470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000058,N/A,HC AMPLIFON HEARING AIDS - WC BASIC,470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000059,N/A,HC AMPLIFON HEARING AIDS - PLUS,470,1 ,$275.00 ,$178.75 ,$77.00 ,$275.00 , N/A ,$178.75 ,$164.18 , N/A ,$77.00 ,$154.28 , N/A ,$180.95 , N/A ,$233.75 ,$233.75 , N/A ,$233.75 , N/A ,$187.00 , N/A , N/A , N/A ,$206.25 ,$195.25 ,$195.25 , N/A ,$195.25 ,$225.50 ,$225.50 ,$225.50 , N/A , N/A ,$233.75 , N/A ,$275.00 ,$164.18 , N/A ,$114.40 , N/A , N/A , N/A ,$233.75 , N/A ,$233.75 ,$77.00 ,$247.50 , N/A ,$225.50 ,$232.38 ,$232.38 , N/A ,$178.75 ,$275.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000060,N/A,HC AMPLIFON HEARING AIDS - WC CROS,470,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 , N/A ,$195.00 ,$179.10 , N/A ,$84.00 ,$168.30 , N/A ,$197.40 , N/A ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$204.00 , N/A , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A , N/A ,$255.00 , N/A ,$300.00 ,$179.10 , N/A ,$124.80 , N/A , N/A , N/A ,$255.00 , N/A ,$255.00 ,$84.00 ,$270.00 , N/A ,$246.00 ,$253.50 ,$253.50 , N/A ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000061,N/A,HC AMPLIFON HEARING AIDS - CROS,470,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 , N/A ,$195.00 ,$179.10 , N/A ,$84.00 ,$168.30 , N/A ,$197.40 , N/A ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$204.00 , N/A , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A , N/A ,$255.00 , N/A ,$300.00 ,$179.10 , N/A ,$124.80 , N/A , N/A , N/A ,$255.00 , N/A ,$255.00 ,$84.00 ,$270.00 , N/A ,$246.00 ,$253.50 ,$253.50 , N/A ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000062,N/A,HC AMPLIFON HEARING AIDS - WC PLUS,470,1 ,$350.00 ,$227.50 ,$98.00 ,$350.00 , N/A ,$227.50 ,$208.95 , N/A ,$98.00 ,$196.35 , N/A ,$230.30 , N/A ,$297.50 ,$297.50 , N/A ,$297.50 , N/A ,$238.00 , N/A , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$287.00 ,$287.00 ,$287.00 , N/A , N/A ,$297.50 , N/A ,$350.00 ,$208.95 , N/A ,$145.60 , N/A , N/A , N/A ,$297.50 , N/A ,$297.50 ,$98.00 ,$315.00 , N/A ,$287.00 ,$295.75 ,$295.75 , N/A ,$227.50 ,$350.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000063,N/A,HC AMPLIFON HEARING AIDS - ADVANTAGE,470,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000064,N/A,HC AMPLIFON HEARING AIDS - PREMIER,470,1 ,$750.00 ,$487.50 ,$210.00 ,$750.00 , N/A ,$487.50 ,$447.75 , N/A ,$210.00 ,$420.75 , N/A ,$493.50 , N/A ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$510.00 , N/A , N/A , N/A ,$562.50 ,$532.50 ,$532.50 , N/A ,$532.50 ,$615.00 ,$615.00 ,$615.00 , N/A , N/A ,$637.50 , N/A ,$750.00 ,$447.75 , N/A ,$312.00 , N/A , N/A , N/A ,$637.50 , N/A ,$637.50 ,$210.00 ,$675.00 , N/A ,$615.00 ,$633.75 ,$633.75 , N/A ,$487.50 ,$750.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000065,N/A,HC AMPLIFON HEARING AIDS - SIGNATURE,470,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000066,N/A,HC AMPLIFON HEARING AIDS - WC PREMIER,470,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000067,N/A,HC AMPLIFON HEARING AIDS - WC SIGNATURE,470,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000068,N/A,HC AMPLIFON HEARING AIDS - WC ADVANTAGE,470,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000069,N/A,HC UHC RETURN UNRESPONSIVE PATIENT,470,1 ,$150.00 ,$97.50 ,$42.00 ,$150.00 , N/A ,$97.50 ,$89.55 , N/A ,$42.00 ,$84.15 , N/A ,$98.70 , N/A ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$102.00 , N/A , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A , N/A ,$127.50 , N/A ,$150.00 ,$89.55 , N/A ,$62.40 , N/A , N/A , N/A ,$127.50 , N/A ,$127.50 ,$42.00 ,$135.00 , N/A ,$123.00 ,$126.75 ,$126.75 , N/A ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000070,N/A,HC UHC LOSS  AND  DAMAGE 3 YR WARRANTY,470,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000071,N/A,HC UHC LOSS  AND  DAMAGE FITTING FEE,470,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000072,N/A,HC UHC PRO FEE - EARMOLDS W/O HA PURCHASE,470,1 ,$10.00 ,$6.50 ,$2.80 ,$10.00 , N/A ,$6.50 ,$5.97 , N/A ,$2.80 ,$5.61 , N/A ,$6.58 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$6.80 , N/A , N/A , N/A ,$7.50 ,$7.10 ,$7.10 , N/A ,$7.10 ,$8.20 ,$8.20 ,$8.20 , N/A , N/A ,$8.50 , N/A ,$10.00 ,$5.97 , N/A ,$4.16 , N/A , N/A , N/A ,$8.50 , N/A ,$8.50 ,$2.80 ,$9.00 , N/A ,$8.20 ,$8.45 ,$8.45 , N/A ,$6.50 ,$10.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000073,N/A,HC UHC PRO FEE - FM RECEIVERS,470,1 ,$75.00 ,$48.75 ,$21.00 ,$75.00 , N/A ,$48.75 ,$44.78 , N/A ,$21.00 ,$42.08 , N/A ,$49.35 , N/A ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$51.00 , N/A , N/A , N/A ,$56.25 ,$53.25 ,$53.25 , N/A ,$53.25 ,$61.50 ,$61.50 ,$61.50 , N/A , N/A ,$63.75 , N/A ,$75.00 ,$44.78 , N/A ,$31.20 , N/A , N/A , N/A ,$63.75 , N/A ,$63.75 ,$21.00 ,$67.50 , N/A ,$61.50 ,$63.38 ,$63.38 , N/A ,$48.75 ,$75.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000074,N/A,HC UHC PRO FEE - FM TRANSMITTERS,470,1 ,$100.00 ,$65.00 ,$28.00 ,$100.00 , N/A ,$65.00 ,$59.70 , N/A ,$28.00 ,$56.10 , N/A ,$65.80 , N/A ,$85.00 ,$85.00 , N/A ,$85.00 , N/A ,$68.00 , N/A , N/A , N/A ,$75.00 ,$71.00 ,$71.00 , N/A ,$71.00 ,$82.00 ,$82.00 ,$82.00 , N/A , N/A ,$85.00 , N/A ,$100.00 ,$59.70 , N/A ,$41.60 , N/A , N/A , N/A ,$85.00 , N/A ,$85.00 ,$28.00 ,$90.00 , N/A ,$82.00 ,$84.50 ,$84.50 , N/A ,$65.00 ,$100.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000075,N/A,HC UHCPRO FEE - RETURN/CREDIT W/O REORDER,470,1 ,$150.00 ,$97.50 ,$42.00 ,$150.00 , N/A ,$97.50 ,$89.55 , N/A ,$42.00 ,$84.15 , N/A ,$98.70 , N/A ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$102.00 , N/A , N/A , N/A ,$112.50 ,$106.50 ,$106.50 , N/A ,$106.50 ,$123.00 ,$123.00 ,$123.00 , N/A , N/A ,$127.50 , N/A ,$150.00 ,$89.55 , N/A ,$62.40 , N/A , N/A , N/A ,$127.50 , N/A ,$127.50 ,$42.00 ,$135.00 , N/A ,$123.00 ,$126.75 ,$126.75 , N/A ,$97.50 ,$150.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000076,N/A,HC UHC PRO FEE - CROS,470,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000077,N/A,HC UHC PRO FEE - LOSS  AND  DAMANGE,470,1 ,$200.00 ,$130.00 ,$56.00 ,$200.00 , N/A ,$130.00 ,$119.40 , N/A ,$56.00 ,$112.20 , N/A ,$131.60 , N/A ,$170.00 ,$170.00 , N/A ,$170.00 , N/A ,$136.00 , N/A , N/A , N/A ,$150.00 ,$142.00 ,$142.00 , N/A ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A , N/A ,$170.00 , N/A ,$200.00 ,$119.40 , N/A ,$83.20 , N/A , N/A , N/A ,$170.00 , N/A ,$170.00 ,$56.00 ,$180.00 , N/A ,$164.00 ,$169.00 ,$169.00 , N/A ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000078,N/A,HC UHC PRO FEE - ENTRY,470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000079,N/A,HC UHC PRO FEE - AMPLIFY VISTA 610,470,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 , N/A ,$195.00 ,$179.10 , N/A ,$84.00 ,$168.30 , N/A ,$197.40 , N/A ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$204.00 , N/A , N/A , N/A ,$225.00 ,$213.00 ,$213.00 , N/A ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A , N/A ,$255.00 , N/A ,$300.00 ,$179.10 , N/A ,$124.80 , N/A , N/A , N/A ,$255.00 , N/A ,$255.00 ,$84.00 ,$270.00 , N/A ,$246.00 ,$253.50 ,$253.50 , N/A ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000080,N/A,HC UHC PRO FEE - ESSENTIAL,470,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000081,N/A,HC UHC PRO FEE - AMPLIFY VISTA 810,470,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000082,N/A,HC UHC PRO FEE - STANDARD,470,1 ,$500.00 ,$325.00 ,$140.00 ,$500.00 , N/A ,$325.00 ,$298.50 , N/A ,$140.00 ,$280.50 , N/A ,$329.00 , N/A ,$425.00 ,$425.00 , N/A ,$425.00 , N/A ,$340.00 , N/A , N/A , N/A ,$375.00 ,$355.00 ,$355.00 , N/A ,$355.00 ,$410.00 ,$410.00 ,$410.00 , N/A , N/A ,$425.00 , N/A ,$500.00 ,$298.50 , N/A ,$208.00 , N/A , N/A , N/A ,$425.00 , N/A ,$425.00 ,$140.00 ,$450.00 , N/A ,$410.00 ,$422.50 ,$422.50 , N/A ,$325.00 ,$500.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000084,N/A,HC UHC PRO FEE - LYRIC (PER YEAR),470,1 ,$600.00 ,$390.00 ,$168.00 ,$600.00 , N/A ,$390.00 ,$358.20 , N/A ,$168.00 ,$336.60 , N/A ,$394.80 , N/A ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$408.00 , N/A , N/A , N/A ,$450.00 ,$426.00 ,$426.00 , N/A ,$426.00 ,$492.00 ,$492.00 ,$492.00 , N/A , N/A ,$510.00 , N/A ,$600.00 ,$358.20 , N/A ,$249.60 , N/A , N/A , N/A ,$510.00 , N/A ,$510.00 ,$168.00 ,$540.00 , N/A ,$492.00 ,$507.00 ,$507.00 , N/A ,$390.00 ,$600.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000085,N/A,HC UHC PRO FEE - PREMIER,470,1 ,$700.00 ,$455.00 ,$196.00 ,$700.00 , N/A ,$455.00 ,$417.90 , N/A ,$196.00 ,$392.70 , N/A ,$460.60 , N/A ,$595.00 ,$595.00 , N/A ,$595.00 , N/A ,$476.00 , N/A , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$574.00 ,$574.00 ,$574.00 , N/A , N/A ,$595.00 , N/A ,$700.00 ,$417.90 , N/A ,$291.20 , N/A , N/A , N/A ,$595.00 , N/A ,$595.00 ,$196.00 ,$630.00 , N/A ,$574.00 ,$591.50 ,$591.50 , N/A ,$455.00 ,$700.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000086,N/A,HC UHC AUDIENT PROGRAM - ENTRY (MONAURAL  AND  BINAURAL),470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000087,N/A,HC UHC AUDIENT PROGRAM - ALL OTHERS (BINAURAL),470,1 ,$350.00 ,$227.50 ,$98.00 ,$350.00 , N/A ,$227.50 ,$208.95 , N/A ,$98.00 ,$196.35 , N/A ,$230.30 , N/A ,$297.50 ,$297.50 , N/A ,$297.50 , N/A ,$238.00 , N/A , N/A , N/A ,$262.50 ,$248.50 ,$248.50 , N/A ,$248.50 ,$287.00 ,$287.00 ,$287.00 , N/A , N/A ,$297.50 , N/A ,$350.00 ,$208.95 , N/A ,$145.60 , N/A , N/A , N/A ,$297.50 , N/A ,$297.50 ,$98.00 ,$315.00 , N/A ,$287.00 ,$295.75 ,$295.75 , N/A ,$227.50 ,$350.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000088,N/A,HC UHC AUDIENT PROGRAM - ALL OTHERS (MONAURAL),470,1 ,$250.00 ,$162.50 ,$70.00 ,$250.00 , N/A ,$162.50 ,$149.25 , N/A ,$70.00 ,$140.25 , N/A ,$164.50 , N/A ,$212.50 ,$212.50 , N/A ,$212.50 , N/A ,$170.00 , N/A , N/A , N/A ,$187.50 ,$177.50 ,$177.50 , N/A ,$177.50 ,$205.00 ,$205.00 ,$205.00 , N/A , N/A ,$212.50 , N/A ,$250.00 ,$149.25 , N/A ,$104.00 , N/A , N/A , N/A ,$212.50 , N/A ,$212.50 ,$70.00 ,$225.00 , N/A ,$205.00 ,$211.25 ,$211.25 , N/A ,$162.50 ,$250.00 
ST. JOSEPH'S HOSPITAL - BREESE,47000089,N/A,HC UHC TESTING  AND  EVAL - PURETONE THRESHOLD W/O HA PURCHASE,470,1 ,$20.00 ,$13.00 ,$5.60 ,$20.00 , N/A ,$13.00 ,$11.94 , N/A ,$5.60 ,$11.22 , N/A ,$13.16 , N/A ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$13.60 , N/A , N/A , N/A ,$15.00 ,$14.20 ,$14.20 , N/A ,$14.20 ,$16.40 ,$16.40 ,$16.40 , N/A , N/A ,$17.00 , N/A ,$20.00 ,$11.94 , N/A ,$8.32 , N/A , N/A , N/A ,$17.00 , N/A ,$17.00 ,$5.60 ,$18.00 , N/A ,$16.40 ,$16.90 ,$16.90 , N/A ,$13.00 ,$20.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100001,92550,HC AUD TYMPAN/REFLEX THRESHOLD MEASURE,471,1 ,$134.00 ,$87.10 ,$37.52 ,$344.13 ,$344.13 ,$87.10 ,$80.00 ,$137.65 ,$37.52 ,$75.17 ,$137.65 ,$88.17 ,$134.00 ,$113.90 ,$113.90 ,$134.00 ,$113.90 ,$134.00 ,$91.12 ,$344.11 ,$137.65 ,$137.65 ,$100.50 ,$95.14 ,$95.14 ,$137.65 ,$95.14 ,$109.88 ,$109.88 ,$109.88 , N/A ,$134.00 ,$113.90 ,$137.65 ,$134.00 ,$80.00 ,$137.65 ,$55.74 ,$134.00 ,$134.00 ,$137.65 ,$113.90 ,$289.05 ,$113.90 ,$37.52 ,$120.60 ,$137.65 ,$109.88 ,$113.23 ,$113.23 ,$137.65 ,$87.10 ,$134.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100003,92567,HC TYMPANOMETRY IMPED TEST,471,1 ,$156.00 ,$101.40 ,$33.37 ,$156.00 ,$83.43 ,$101.40 ,$93.13 ,$33.37 ,$43.68 ,$87.52 ,$33.37 ,$102.65 ,$33.37 ,$132.60 ,$132.60 ,$33.37 ,$132.60 ,$63.41 ,$106.08 ,$83.43 ,$33.37 ,$33.37 ,$117.00 ,$110.76 ,$110.76 ,$33.37 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$83.43 ,$132.60 ,$33.37 ,$156.00 ,$93.13 ,$33.37 ,$64.90 ,$100.52 ,$91.38 ,$33.37 ,$132.60 ,$70.08 ,$132.60 ,$43.68 ,$140.40 ,$33.37 ,$127.92 ,$131.82 ,$131.82 ,$33.37 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100006,92557,HC AUD COMPREHENSIVE AUDIO,471,1 ,$375.00 ,$243.75 ,$91.38 ,$375.00 ,$344.13 ,$243.75 ,$223.88 ,$137.65 ,$105.00 ,$210.38 ,$137.65 ,$246.75 ,$137.65 ,$318.75 ,$318.75 ,$137.65 ,$318.75 ,$261.53 ,$255.00 ,$344.11 ,$137.65 ,$137.65 ,$281.25 ,$266.25 ,$266.25 ,$137.65 ,$266.25 ,$307.50 ,$307.50 ,$307.50 , N/A ,$344.11 ,$318.75 ,$137.65 ,$375.00 ,$223.88 ,$137.65 ,$156.00 ,$100.52 ,$91.38 ,$137.65 ,$318.75 ,$289.05 ,$318.75 ,$105.00 ,$337.50 ,$137.65 ,$307.50 ,$316.88 ,$316.88 ,$137.65 ,$243.75 ,$375.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100007,92582,HC AUD CONDITION PLAY AUDIOMETRY,471,1 ,$185.00 ,$120.25 ,$51.80 ,$344.13 ,$344.13 ,$120.25 ,$110.45 ,$137.65 ,$51.80 ,$103.79 ,$137.65 ,$121.73 ,$137.65 ,$157.25 ,$157.25 ,$137.65 ,$157.25 ,$185.00 ,$125.80 ,$344.11 ,$137.65 ,$137.65 ,$138.75 ,$131.35 ,$131.35 ,$137.65 ,$131.35 ,$151.70 ,$151.70 ,$151.70 , N/A ,$185.00 ,$157.25 ,$137.65 ,$185.00 ,$110.45 ,$137.65 ,$76.96 ,$86.96 ,$79.05 ,$137.65 ,$157.25 ,$289.05 ,$157.25 ,$51.80 ,$166.50 ,$137.65 ,$151.70 ,$156.33 ,$156.33 ,$137.65 ,$120.25 ,$185.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100008,92588,HC AUD EVOKED OTOACOUS EMISSIONS COMP EVAL,471,1 ,$120.00 ,$78.00 ,$33.60 ,$652.30 ,$652.30 ,$78.00 ,$71.64 ,$260.92 ,$33.60 ,$67.32 ,$260.92 ,$78.96 ,$120.00 ,$102.00 ,$102.00 ,$120.00 ,$102.00 ,$120.00 ,$81.60 ,$652.29 ,$260.92 ,$260.92 ,$90.00 ,$85.20 ,$85.20 ,$260.92 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$120.00 ,$102.00 ,$260.92 ,$120.00 ,$71.64 ,$260.92 ,$49.92 ,$120.00 ,$120.00 ,$260.92 ,$102.00 ,$547.92 ,$102.00 ,$33.60 ,$108.00 ,$260.92 ,$98.40 ,$101.40 ,$101.40 ,$260.92 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100009,92558,HC AUD EVOKED OTOACOUS EMISSIONS SCREENING,471,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 ,$100.52 ,$91.38 , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100011,92553,HC AUD PURE TONE AIR  AND  BONE,471,1 ,$305.00 ,$198.25 ,$85.40 ,$344.13 ,$344.13 ,$198.25 ,$182.09 ,$137.65 ,$85.40 ,$171.11 ,$137.65 ,$200.69 ,$137.65 ,$259.25 ,$259.25 ,$137.65 ,$259.25 ,$261.53 ,$207.40 ,$344.11 ,$137.65 ,$137.65 ,$228.75 ,$216.55 ,$216.55 ,$137.65 ,$216.55 ,$250.10 ,$250.10 ,$250.10 , N/A ,$305.00 ,$259.25 ,$137.65 ,$305.00 ,$182.09 ,$137.65 ,$126.88 ,$100.52 ,$91.38 ,$137.65 ,$259.25 ,$289.05 ,$259.25 ,$85.40 ,$274.50 ,$137.65 ,$250.10 ,$257.73 ,$257.73 ,$137.65 ,$198.25 ,$305.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100012,92553,HC AUD PURE TONE AIR  AND  BONE -52,471,1 ,$305.00 ,$198.25 ,$45.69 ,$305.00 ,$172.05 ,$198.25 ,$182.09 ,$68.82 ,$85.40 ,$171.11 ,$68.82 ,$200.69 ,$68.82 ,$259.25 ,$259.25 ,$68.82 ,$259.25 ,$130.76 ,$207.40 ,$172.06 ,$68.82 ,$68.82 ,$228.75 ,$216.55 ,$216.55 ,$68.82 ,$216.55 ,$250.10 ,$250.10 ,$250.10 , N/A ,$172.06 ,$259.25 ,$68.82 ,$305.00 ,$182.09 ,$68.82 ,$126.88 ,$50.26 ,$45.69 ,$68.82 ,$259.25 ,$144.53 ,$259.25 ,$85.40 ,$274.50 ,$68.82 ,$250.10 ,$257.73 ,$257.73 ,$68.82 ,$198.25 ,$305.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100013,92552,HC AUD PURE TONE AIR ONLY,471,1 ,$88.00 ,$57.20 ,$24.64 ,$277.93 ,$277.93 ,$57.20 ,$52.54 ,$111.17 ,$24.64 ,$49.37 ,$111.17 ,$57.90 ,$88.00 ,$74.80 ,$74.80 ,$88.00 ,$74.80 ,$88.00 ,$59.84 ,$277.92 ,$111.17 ,$111.17 ,$66.00 ,$62.48 ,$62.48 ,$111.17 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$88.00 ,$74.80 ,$111.17 ,$88.00 ,$52.54 ,$111.17 ,$36.61 ,$88.00 ,$88.00 ,$111.17 ,$74.80 ,$233.45 ,$74.80 ,$24.64 ,$79.20 ,$111.17 ,$72.16 ,$74.36 ,$74.36 ,$111.17 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100014,92583,HC AUD SELECT PICTURE AUDIOMETRY,471,1 ,$119.00 ,$77.35 ,$33.32 ,$137.20 ,$137.20 ,$77.35 ,$71.04 ,$54.88 ,$33.32 ,$66.76 ,$54.88 ,$78.30 ,$54.88 ,$101.15 ,$101.15 ,$54.88 ,$101.15 ,$104.27 ,$80.92 ,$137.20 ,$54.88 ,$54.88 ,$89.25 ,$84.49 ,$84.49 ,$54.88 ,$84.49 ,$97.58 ,$97.58 ,$97.58 , N/A ,$119.00 ,$101.15 ,$54.88 ,$119.00 ,$71.04 ,$54.88 ,$49.50 ,$86.96 ,$79.05 ,$54.88 ,$101.15 ,$115.24 ,$101.15 ,$33.32 ,$107.10 ,$54.88 ,$97.58 ,$100.56 ,$100.56 ,$54.88 ,$77.35 ,$119.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100015,92555,HC AUD SPEECH THRESHOLD,471,1 ,$87.00 ,$56.55 ,$24.36 ,$87.00 ,$83.43 ,$56.55 ,$51.94 ,$33.37 ,$24.36 ,$48.81 ,$33.37 ,$57.25 ,$33.37 ,$73.95 ,$73.95 ,$33.37 ,$73.95 ,$63.41 ,$59.16 ,$83.43 ,$33.37 ,$33.37 ,$65.25 ,$61.77 ,$61.77 ,$33.37 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$83.43 ,$73.95 ,$33.37 ,$87.00 ,$51.94 ,$33.37 ,$36.19 ,$87.00 ,$87.00 ,$33.37 ,$73.95 ,$70.08 ,$73.95 ,$24.36 ,$78.30 ,$33.37 ,$71.34 ,$73.52 ,$73.52 ,$33.37 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100016,92556,HC AUD SPEECH THRESHOLD W/SPEECH RECOGNITION,471,1 ,$156.00 ,$101.40 ,$43.68 ,$156.00 ,$137.20 ,$101.40 ,$93.13 ,$54.88 ,$43.68 ,$87.52 ,$54.88 ,$102.65 ,$54.88 ,$132.60 ,$132.60 ,$54.88 ,$132.60 ,$104.27 ,$106.08 ,$137.20 ,$54.88 ,$54.88 ,$117.00 ,$110.76 ,$110.76 ,$54.88 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$137.20 ,$132.60 ,$54.88 ,$156.00 ,$93.13 ,$54.88 ,$64.90 ,$100.52 ,$91.38 ,$54.88 ,$132.60 ,$115.24 ,$132.60 ,$43.68 ,$140.40 ,$54.88 ,$127.92 ,$131.82 ,$131.82 ,$54.88 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100017,92579,HC AUD VISUAL REINFORCEMENT AUDIOMETRY,471,1 ,$204.00 ,$132.60 ,$57.12 ,$344.13 ,$344.13 ,$132.60 ,$121.79 ,$137.65 ,$57.12 ,$114.44 ,$137.65 ,$134.23 ,$137.65 ,$173.40 ,$173.40 ,$137.65 ,$173.40 ,$204.00 ,$138.72 ,$344.11 ,$137.65 ,$137.65 ,$153.00 ,$144.84 ,$144.84 ,$137.65 ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A ,$204.00 ,$173.40 ,$137.65 ,$204.00 ,$121.79 ,$137.65 ,$84.86 ,$100.52 ,$91.38 ,$137.65 ,$173.40 ,$289.05 ,$173.40 ,$57.12 ,$183.60 ,$137.65 ,$167.28 ,$172.38 ,$172.38 ,$137.65 ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100019,92537,HC CALORIC VESTIBULAR TEST W/REC BILAT BITHERMAL,471,1 ,$561.00 ,$364.65 ,$137.65 ,$561.00 ,$344.13 ,$364.65 ,$334.92 ,$137.65 ,$157.08 ,$314.72 ,$137.65 ,$369.14 ,$137.65 ,$476.85 ,$476.85 ,$137.65 ,$476.85 ,$261.53 ,$381.48 ,$344.11 ,$137.65 ,$137.65 ,$420.75 ,$398.31 ,$398.31 ,$137.65 ,$398.31 ,$460.02 ,$460.02 ,$460.02 , N/A ,$344.11 ,$476.85 ,$137.65 ,$561.00 ,$334.92 ,$137.65 ,$233.38 ,$158.81 ,$144.37 ,$137.65 ,$476.85 ,$289.05 ,$476.85 ,$157.08 ,$504.90 ,$137.65 ,$460.02 ,$474.05 ,$474.05 ,$137.65 ,$364.65 ,$561.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100020,92538,HC CALORIC VESTIBULAR TEST W/REC BILAT MONOTHERMAL,471,1 ,$561.00 ,$364.65 ,$137.65 ,$561.00 ,$344.13 ,$364.65 ,$334.92 ,$137.65 ,$157.08 ,$314.72 ,$137.65 ,$369.14 ,$137.65 ,$476.85 ,$476.85 ,$137.65 ,$476.85 ,$261.53 ,$381.48 ,$344.11 ,$137.65 ,$137.65 ,$420.75 ,$398.31 ,$398.31 ,$137.65 ,$398.31 ,$460.02 ,$460.02 ,$460.02 , N/A ,$344.11 ,$476.85 ,$137.65 ,$561.00 ,$334.92 ,$137.65 ,$233.38 ,$158.81 ,$144.37 ,$137.65 ,$476.85 ,$289.05 ,$476.85 ,$157.08 ,$504.90 ,$137.65 ,$460.02 ,$474.05 ,$474.05 ,$137.65 ,$364.65 ,$561.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100021,92540,HC BASIC VESTIBULAR EVAL,471,1 ,$828.00 ,$538.20 ,$137.65 ,$828.00 ,$344.13 ,$538.20 ,$494.32 ,$137.65 ,$231.84 ,$464.51 ,$137.65 ,$544.82 ,$137.65 ,$703.80 ,$703.80 ,$137.65 ,$703.80 ,$261.53 ,$563.04 ,$344.11 ,$137.65 ,$137.65 ,$621.00 ,$587.88 ,$587.88 ,$137.65 ,$587.88 ,$678.96 ,$678.96 ,$678.96 , N/A ,$344.11 ,$703.80 ,$137.65 ,$828.00 ,$494.32 ,$137.65 ,$344.45 ,$158.81 ,$144.37 ,$137.65 ,$703.80 ,$289.05 ,$703.80 ,$231.84 ,$745.20 ,$137.65 ,$678.96 ,$699.66 ,$699.66 ,$137.65 ,$538.20 ,$828.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100023,92542,HC POSITIONAL NYSTAGMUS TEST W/RECORDING,471,1 ,$311.00 ,$202.15 ,$79.05 ,$311.00 ,$277.93 ,$202.15 ,$185.67 ,$111.17 ,$87.08 ,$174.47 ,$111.17 ,$204.64 ,$111.17 ,$264.35 ,$264.35 ,$111.17 ,$264.35 ,$211.22 ,$211.48 ,$277.92 ,$111.17 ,$111.17 ,$233.25 ,$220.81 ,$220.81 ,$111.17 ,$220.81 ,$255.02 ,$255.02 ,$255.02 , N/A ,$277.92 ,$264.35 ,$111.17 ,$311.00 ,$185.67 ,$111.17 ,$129.38 ,$86.96 ,$79.05 ,$111.17 ,$264.35 ,$233.45 ,$264.35 ,$87.08 ,$279.90 ,$111.17 ,$255.02 ,$262.80 ,$262.80 ,$111.17 ,$202.15 ,$311.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100038,92592,HC HEARING AID CHECK MONAURAL,471,1 ,$68.00 ,$44.20 ,$19.04 ,$68.00 , N/A ,$44.20 ,$40.60 , N/A ,$19.04 ,$38.15 , N/A ,$44.74 , N/A ,$57.80 ,$57.80 , N/A ,$57.80 , N/A ,$46.24 , N/A , N/A , N/A ,$51.00 ,$48.28 ,$48.28 , N/A ,$48.28 ,$55.76 ,$55.76 ,$55.76 , N/A , N/A ,$57.80 , N/A ,$68.00 ,$40.60 , N/A ,$28.29 ,$68.00 ,$68.00 , N/A ,$57.80 , N/A ,$57.80 ,$19.04 ,$61.20 , N/A ,$55.76 ,$57.46 ,$57.46 , N/A ,$44.20 ,$68.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100039,92591,HC HEARING AID EXAM BINAURAL,471,1 ,$211.00 ,$137.15 ,$59.08 ,$211.00 , N/A ,$137.15 ,$125.97 , N/A ,$59.08 ,$118.37 , N/A ,$138.84 , N/A ,$179.35 ,$179.35 , N/A ,$179.35 , N/A ,$143.48 , N/A , N/A , N/A ,$158.25 ,$149.81 ,$149.81 , N/A ,$149.81 ,$173.02 ,$173.02 ,$173.02 , N/A , N/A ,$179.35 , N/A ,$211.00 ,$125.97 , N/A ,$87.78 ,$100.52 ,$91.38 , N/A ,$179.35 , N/A ,$179.35 ,$59.08 ,$189.90 , N/A ,$173.02 ,$178.30 ,$178.30 , N/A ,$137.15 ,$211.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100040,92590,HC HEARING AID EXAM MONAURAL,471,1 ,$206.00 ,$133.90 ,$57.68 ,$206.00 , N/A ,$133.90 ,$122.98 , N/A ,$57.68 ,$115.57 , N/A ,$135.55 , N/A ,$175.10 ,$175.10 , N/A ,$175.10 , N/A ,$140.08 , N/A , N/A , N/A ,$154.50 ,$146.26 ,$146.26 , N/A ,$146.26 ,$168.92 ,$168.92 ,$168.92 , N/A , N/A ,$175.10 , N/A ,$206.00 ,$122.98 , N/A ,$85.70 ,$100.52 ,$91.38 , N/A ,$175.10 , N/A ,$175.10 ,$57.68 ,$185.40 , N/A ,$168.92 ,$174.07 ,$174.07 , N/A ,$133.90 ,$206.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100041,92555,HC AUD SPEECH THRESHOLD -52,471,1 ,$87.00 ,$56.55 ,$16.69 ,$87.00 ,$41.73 ,$56.55 ,$51.94 ,$16.69 ,$24.36 ,$48.81 ,$16.69 ,$57.25 ,$16.69 ,$73.95 ,$73.95 ,$16.69 ,$73.95 ,$31.70 ,$59.16 ,$41.71 ,$16.69 ,$16.69 ,$65.25 ,$61.77 ,$61.77 ,$16.69 ,$61.77 ,$71.34 ,$71.34 ,$71.34 , N/A ,$41.71 ,$73.95 ,$16.69 ,$87.00 ,$51.94 ,$16.69 ,$36.19 ,$50.26 ,$45.69 ,$16.69 ,$73.95 ,$35.04 ,$73.95 ,$24.36 ,$78.30 ,$16.69 ,$71.34 ,$73.52 ,$73.52 ,$16.69 ,$56.55 ,$87.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100042,92567,HC TYMPANOMETRY IMPED TEST -52,471,1 ,$156.00 ,$101.40 ,$16.69 ,$156.00 ,$41.73 ,$101.40 ,$93.13 ,$16.69 ,$43.68 ,$87.52 ,$16.69 ,$102.65 ,$16.69 ,$132.60 ,$132.60 ,$16.69 ,$132.60 ,$31.70 ,$106.08 ,$41.71 ,$16.69 ,$16.69 ,$117.00 ,$110.76 ,$110.76 ,$16.69 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$41.71 ,$132.60 ,$16.69 ,$156.00 ,$93.13 ,$16.69 ,$64.90 ,$50.26 ,$45.69 ,$16.69 ,$132.60 ,$35.04 ,$132.60 ,$43.68 ,$140.40 ,$16.69 ,$127.92 ,$131.82 ,$131.82 ,$16.69 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100043,92552,HC AUD PURE TONE AIR ONLY -52,471,1 ,$88.00 ,$57.20 ,$24.64 ,$138.96 ,$138.95 ,$57.20 ,$52.54 ,$55.58 ,$24.64 ,$49.37 ,$55.58 ,$57.90 ,$55.58 ,$74.80 ,$74.80 ,$55.58 ,$74.80 ,$88.00 ,$59.84 ,$138.96 ,$55.58 ,$55.58 ,$66.00 ,$62.48 ,$62.48 ,$55.58 ,$62.48 ,$72.16 ,$72.16 ,$72.16 , N/A ,$88.00 ,$74.80 ,$55.58 ,$88.00 ,$52.54 ,$55.58 ,$36.61 ,$50.26 ,$45.69 ,$55.58 ,$74.80 ,$116.72 ,$74.80 ,$24.64 ,$79.20 ,$55.58 ,$72.16 ,$74.36 ,$74.36 ,$55.58 ,$57.20 ,$88.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100044,92556,HC AUD SPEECH THRESHOLD W/SPEECH RECOGNITION -52,471,1 ,$156.00 ,$101.40 ,$27.44 ,$156.00 ,$68.60 ,$101.40 ,$93.13 ,$27.44 ,$43.68 ,$87.52 ,$27.44 ,$102.65 ,$27.44 ,$132.60 ,$132.60 ,$27.44 ,$132.60 ,$52.13 ,$106.08 ,$68.60 ,$27.44 ,$27.44 ,$117.00 ,$110.76 ,$110.76 ,$27.44 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$68.60 ,$132.60 ,$27.44 ,$156.00 ,$93.13 ,$27.44 ,$64.90 ,$50.26 ,$45.69 ,$27.44 ,$132.60 ,$57.62 ,$132.60 ,$43.68 ,$140.40 ,$27.44 ,$127.92 ,$131.82 ,$131.82 ,$27.44 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100046,92540,HC BASIC VESTIBULAR EVAL -52,471,1 ,$828.00 ,$538.20 ,$68.82 ,$828.00 ,$172.05 ,$538.20 ,$494.32 ,$68.82 ,$231.84 ,$464.51 ,$68.82 ,$544.82 ,$68.82 ,$703.80 ,$703.80 ,$68.82 ,$703.80 ,$130.76 ,$563.04 ,$172.06 ,$68.82 ,$68.82 ,$621.00 ,$587.88 ,$587.88 ,$68.82 ,$587.88 ,$678.96 ,$678.96 ,$678.96 , N/A ,$172.06 ,$703.80 ,$68.82 ,$828.00 ,$494.32 ,$68.82 ,$344.45 ,$79.40 ,$72.18 ,$68.82 ,$703.80 ,$144.53 ,$703.80 ,$231.84 ,$745.20 ,$68.82 ,$678.96 ,$699.66 ,$699.66 ,$68.82 ,$538.20 ,$828.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100047,V5008,HC HEARING SCREENING,471,1 ,$71.00 ,$46.15 ,$19.88 ,$71.00 , N/A ,$46.15 ,$42.39 , N/A ,$19.88 ,$39.83 , N/A ,$46.72 , N/A ,$60.35 ,$60.35 , N/A ,$60.35 , N/A ,$48.28 , N/A , N/A , N/A ,$53.25 ,$50.41 ,$50.41 , N/A ,$50.41 ,$58.22 ,$58.22 ,$58.22 , N/A , N/A ,$60.35 , N/A ,$71.00 ,$42.39 , N/A ,$29.54 ,$71.00 ,$71.00 , N/A ,$60.35 , N/A ,$60.35 ,$19.88 ,$63.90 , N/A ,$58.22 ,$60.00 ,$60.00 , N/A ,$46.15 ,$71.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100048,92587,HC DISTORTION AUDITORY EVOKED POTENT LTD-52,471,1 ,$277.00 ,$180.05 ,$72.18 ,$326.15 ,$326.15 ,$180.05 ,$165.37 ,$130.46 ,$77.56 ,$155.40 ,$130.46 ,$182.27 ,$130.46 ,$235.45 ,$235.45 ,$130.46 ,$235.45 ,$247.87 ,$188.36 ,$326.15 ,$130.46 ,$130.46 ,$207.75 ,$196.67 ,$196.67 ,$130.46 ,$196.67 ,$227.14 ,$227.14 ,$227.14 , N/A ,$277.00 ,$235.45 ,$130.46 ,$277.00 ,$165.37 ,$130.46 ,$115.23 ,$79.40 ,$72.18 ,$130.46 ,$235.45 ,$273.96 ,$235.45 ,$77.56 ,$249.30 ,$130.46 ,$227.14 ,$234.07 ,$234.07 ,$130.46 ,$180.05 ,$277.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100049,92588,HC AUD EVOKED OTOACOUS EMISSIONS COMP EVAL-52,471,1 ,$120.00 ,$78.00 ,$33.60 ,$326.15 ,$326.15 ,$78.00 ,$71.64 ,$130.46 ,$33.60 ,$67.32 ,$130.46 ,$78.96 ,$120.00 ,$102.00 ,$102.00 ,$120.00 ,$102.00 ,$120.00 ,$81.60 ,$326.15 ,$130.46 ,$130.46 ,$90.00 ,$85.20 ,$85.20 ,$130.46 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$120.00 ,$102.00 ,$130.46 ,$120.00 ,$71.64 ,$130.46 ,$49.92 ,$79.40 ,$72.18 ,$130.46 ,$102.00 ,$273.96 ,$102.00 ,$33.60 ,$108.00 ,$130.46 ,$98.40 ,$101.40 ,$101.40 ,$130.46 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100050,92557,HC AUD COMPREHENSIVE AUDIO-52,471,1 ,$375.00 ,$243.75 ,$45.69 ,$375.00 ,$172.05 ,$243.75 ,$223.88 ,$68.82 ,$105.00 ,$210.38 ,$68.82 ,$246.75 ,$68.82 ,$318.75 ,$318.75 ,$68.82 ,$318.75 ,$130.76 ,$255.00 ,$172.06 ,$68.82 ,$68.82 ,$281.25 ,$266.25 ,$266.25 ,$68.82 ,$266.25 ,$307.50 ,$307.50 ,$307.50 , N/A ,$172.06 ,$318.75 ,$68.82 ,$375.00 ,$223.88 ,$68.82 ,$156.00 ,$50.26 ,$45.69 ,$68.82 ,$318.75 ,$144.53 ,$318.75 ,$105.00 ,$337.50 ,$68.82 ,$307.50 ,$316.88 ,$316.88 ,$68.82 ,$243.75 ,$375.00 
ST. JOSEPH'S HOSPITAL - BREESE,47100051,92570,HC AUD ACOUSTIC REFLEX DECAY-52,471,1 ,$46.00 ,$29.90 ,$12.88 ,$172.06 ,$172.05 ,$29.90 ,$27.46 ,$68.82 ,$12.88 ,$25.81 ,$68.82 ,$30.27 ,$46.00 ,$39.10 ,$39.10 ,$46.00 ,$39.10 ,$46.00 ,$31.28 ,$172.06 ,$68.82 ,$68.82 ,$34.50 ,$32.66 ,$32.66 ,$68.82 ,$32.66 ,$37.72 ,$37.72 ,$37.72 , N/A ,$46.00 ,$39.10 ,$68.82 ,$46.00 ,$27.46 ,$68.82 ,$19.14 ,$43.47 ,$39.52 ,$68.82 ,$39.10 ,$144.53 ,$39.10 ,$12.88 ,$41.40 ,$68.82 ,$37.72 ,$38.87 ,$38.87 ,$68.82 ,$29.90 ,$46.00 
ST. JOSEPH'S HOSPITAL - BREESE,48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,$981.00 ,$637.65 ,$274.68 ,"$1,384.58 ","$1,384.58 ",$637.65 ,$585.66 ,$553.83 ,$274.68 ,$550.34 ,$553.83 ,$645.50 ,$553.83 ,$833.85 ,$833.85 ,$553.83 ,$833.85 ,$981.00 ,$667.08 ,"$1,384.58 ",$553.83 ,$553.83 ,$735.75 ,$696.51 ,$696.51 ,$553.83 ,$696.51 ,$804.42 ,$804.42 ,$804.42 , N/A ,$981.00 ,$833.85 ,$553.83 ,$981.00 ,$585.66 ,$553.83 ,$408.10 ,$443.64 ,$403.31 ,$553.83 ,$833.85 ,"$1,163.05 ",$833.85 ,$274.68 ,$882.90 ,$553.83 ,$804.42 ,$828.95 ,$828.95 ,$553.83 ,$637.65 ,$981.00 
ST. JOSEPH'S HOSPITAL - BREESE,48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$158.49 ,$103.02 ,$44.38 ,$158.49 ,$137.20 ,$103.02 ,$94.62 ,$54.88 ,$44.38 ,$88.91 ,$54.88 ,$104.29 ,$54.88 ,$134.72 ,$134.72 ,$54.88 ,$134.72 ,$104.27 ,$107.77 ,$137.20 ,$54.88 ,$54.88 ,$118.87 ,$112.53 ,$112.53 ,$54.88 ,$112.53 ,$129.96 ,$129.96 ,$129.96 , N/A ,$137.20 ,$134.72 ,$54.88 ,$158.49 ,$94.62 ,$54.88 ,$65.93 ,$158.49 ,$158.49 ,$54.88 ,$134.72 ,$115.24 ,$134.72 ,$44.38 ,$142.64 ,$54.88 ,$129.96 ,$133.92 ,$133.92 ,$54.88 ,$103.02 ,$158.49 
ST. JOSEPH'S HOSPITAL - BREESE,48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,402.00 ",$911.30 ,$202.06 ,"$1,402.00 ",$652.30 ,$911.30 ,$836.99 ,$260.92 ,$392.56 ,$786.52 ,$260.92 ,$922.52 ,$260.92 ,"$1,191.70 ","$1,191.70 ",$260.92 ,"$1,191.70 ",$495.74 ,$953.36 ,$652.29 ,$260.92 ,$260.92 ,"$1,051.50 ",$995.42 ,$995.42 ,$260.92 ,$995.42 ,"$1,149.64 ","$1,149.64 ","$1,149.64 ", N/A ,$652.29 ,"$1,191.70 ",$260.92 ,"$1,402.00 ",$836.99 ,$260.92 ,$583.23 ,$222.27 ,$202.06 ,$260.92 ,"$1,191.70 ",$547.92 ,"$1,191.70 ",$392.56 ,"$1,261.80 ",$260.92 ,"$1,149.64 ","$1,184.69 ","$1,184.69 ",$260.92 ,$911.30 ,"$1,402.00 "
ST. JOSEPH'S HOSPITAL - BREESE,48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$1,664.00 ","$1,081.60 ",$321.14 ,"$1,664.00 ","$1,190.93 ","$1,081.60 ",$993.41 ,$476.37 ,$465.92 ,$933.50 ,$476.37 ,"$1,094.91 ",$476.37 ,"$1,414.40 ","$1,414.40 ",$476.37 ,"$1,414.40 ",$905.10 ,"$1,131.52 ","$1,190.92 ",$476.37 ,$476.37 ,"$1,248.00 ","$1,181.44 ","$1,181.44 ",$476.37 ,"$1,181.44 ","$1,364.48 ","$1,364.48 ","$1,364.48 ", N/A ,"$1,190.92 ","$1,414.40 ",$476.37 ,"$1,664.00 ",$993.41 ,$476.37 ,$692.22 ,$353.25 ,$321.14 ,$476.37 ,"$1,414.40 ","$1,000.37 ","$1,414.40 ",$465.92 ,"$1,497.60 ",$476.37 ,"$1,364.48 ","$1,406.08 ","$1,406.08 ",$476.37 ,"$1,081.60 ","$1,664.00 "
ST. JOSEPH'S HOSPITAL - BREESE,48300001,93307,HC ECHOCARDIOGRAM 2D W/O DOP,483,1 ,$605.00 ,$393.25 ,$169.40 ,$605.00 ,$567.13 ,$393.25 ,$361.19 ,$226.85 ,$169.40 ,$339.41 ,$226.85 ,$398.09 ,$226.85 ,$514.25 ,$514.25 ,$226.85 ,$514.25 ,$431.02 ,$411.40 ,$567.13 ,$226.85 ,$226.85 ,$453.75 ,$429.55 ,$429.55 ,$226.85 ,$429.55 ,$496.10 ,$496.10 ,$496.10 , N/A ,$567.13 ,$514.25 ,$226.85 ,$605.00 ,$361.19 ,$226.85 ,$251.68 ,$353.25 ,$321.14 ,$226.85 ,$514.25 ,$476.39 ,$514.25 ,$169.40 ,$544.50 ,$226.85 ,$496.10 ,$511.23 ,$511.23 ,$226.85 ,$393.25 ,$605.00 
ST. JOSEPH'S HOSPITAL - BREESE,48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$452.00 ,$293.80 ,$126.56 ,$567.13 ,$567.13 ,$293.80 ,$269.84 ,$226.85 ,$126.56 ,$253.57 ,$226.85 ,$297.42 ,$226.85 ,$384.20 ,$384.20 ,$226.85 ,$384.20 ,$431.02 ,$307.36 ,$567.13 ,$226.85 ,$226.85 ,$339.00 ,$320.92 ,$320.92 ,$226.85 ,$320.92 ,$370.64 ,$370.64 ,$370.64 , N/A ,$452.00 ,$384.20 ,$226.85 ,$452.00 ,$269.84 ,$226.85 ,$188.03 ,$353.25 ,$321.14 ,$226.85 ,$384.20 ,$476.39 ,$384.20 ,$126.56 ,$406.80 ,$226.85 ,$370.64 ,$381.94 ,$381.94 ,$226.85 ,$293.80 ,$452.00 
ST. JOSEPH'S HOSPITAL - BREESE,48300005,93320,HC ECHO DOPPLER,483,1 ,$442.00 ,$287.30 ,$123.76 ,$442.00 , N/A ,$287.30 ,$263.87 , N/A ,$123.76 ,$247.96 , N/A ,$290.84 , N/A ,$375.70 ,$375.70 , N/A ,$375.70 , N/A ,$300.56 , N/A , N/A , N/A ,$331.50 ,$313.82 ,$313.82 , N/A ,$313.82 ,$362.44 ,$362.44 ,$362.44 , N/A , N/A ,$375.70 , N/A ,$442.00 ,$263.87 , N/A ,$183.87 ,$353.25 ,$321.14 , N/A ,$375.70 , N/A ,$375.70 ,$123.76 ,$397.80 , N/A ,$362.44 ,$373.49 ,$373.49 , N/A ,$287.30 ,$442.00 
ST. JOSEPH'S HOSPITAL - BREESE,48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$263.00 ,$170.95 ,$73.64 ,$263.00 , N/A ,$170.95 ,$157.01 , N/A ,$73.64 ,$147.54 , N/A ,$173.05 , N/A ,$223.55 ,$223.55 , N/A ,$223.55 , N/A ,$178.84 , N/A , N/A , N/A ,$197.25 ,$186.73 ,$186.73 , N/A ,$186.73 ,$215.66 ,$215.66 ,$215.66 , N/A , N/A ,$223.55 , N/A ,$263.00 ,$157.01 , N/A ,$109.41 ,$263.00 ,$263.00 , N/A ,$223.55 , N/A ,$223.55 ,$73.64 ,$236.70 , N/A ,$215.66 ,$222.24 ,$222.24 , N/A ,$170.95 ,$263.00 
ST. JOSEPH'S HOSPITAL - BREESE,48300007,93350,HC ECHO REST  AND  STRESS W/PF,483,1 ,"$1,958.00 ","$1,272.70 ",$321.14 ,"$1,958.00 ","$1,190.93 ","$1,272.70 ","$1,168.93 ",$476.37 ,$548.24 ,"$1,098.44 ",$476.37 ,"$1,288.36 ",$476.37 ,"$1,664.30 ","$1,664.30 ",$476.37 ,"$1,664.30 ",$905.10 ,"$1,331.44 ","$1,190.92 ",$476.37 ,$476.37 ,"$1,468.50 ","$1,390.18 ","$1,390.18 ",$476.37 ,"$1,390.18 ","$1,605.56 ","$1,605.56 ","$1,605.56 ", N/A ,"$1,190.92 ","$1,664.30 ",$476.37 ,"$1,958.00 ","$1,168.93 ",$476.37 ,$814.53 ,$353.25 ,$321.14 ,$476.37 ,"$1,664.30 ","$1,000.37 ","$1,664.30 ",$548.24 ,"$1,762.20 ",$476.37 ,"$1,605.56 ","$1,654.51 ","$1,654.51 ",$476.37 ,"$1,272.70 ","$1,958.00 "
ST. JOSEPH'S HOSPITAL - BREESE,48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$253.00 ,$164.45 ,$70.84 ,$253.00 , N/A ,$164.45 ,$151.04 , N/A ,$70.84 ,$141.93 , N/A ,$166.47 , N/A ,$215.05 ,$215.05 , N/A ,$215.05 , N/A ,$172.04 , N/A , N/A , N/A ,$189.75 ,$179.63 ,$179.63 , N/A ,$179.63 ,$207.46 ,$207.46 ,$207.46 , N/A , N/A ,$215.05 , N/A ,$253.00 ,$151.04 , N/A ,$105.25 ,$253.00 ,$253.00 , N/A ,$215.05 , N/A ,$215.05 ,$70.84 ,$227.70 , N/A ,$207.46 ,$213.79 ,$213.79 , N/A ,$164.45 ,$253.00 
ST. JOSEPH'S HOSPITAL - BREESE,48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$1,095.00 ",$711.75 ,$306.60 ,"$1,095.00 ",$907.63 ,$711.75 ,$653.72 ,$363.05 ,$306.60 ,$614.30 ,$363.05 ,$720.51 ,$363.05 ,$930.75 ,$930.75 ,$363.05 ,$930.75 ,$689.79 ,$744.60 ,$907.62 ,$363.05 ,$363.05 ,$821.25 ,$777.45 ,$777.45 ,$363.05 ,$777.45 ,$897.90 ,$897.90 ,$897.90 , N/A ,$907.62 ,$930.75 ,$363.05 ,"$1,095.00 ",$653.72 ,$363.05 ,$455.52 ,$353.25 ,$321.14 ,$363.05 ,$930.75 ,$762.40 ,$930.75 ,$306.60 ,$985.50 ,$363.05 ,$897.90 ,$925.28 ,$925.28 ,$363.05 ,$711.75 ,"$1,095.00 "
ST. JOSEPH'S HOSPITAL - BREESE,48300018,C8928,HC ECHO TTE 2D STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$1,965.00 ","$1,277.25 ",$321.14 ,"$1,965.00 ","$1,763.33 ","$1,277.25 ","$1,173.11 ",$705.33 ,$550.20 ,"$1,102.37 ",$705.33 ,"$1,292.97 ",$705.33 ,"$1,670.25 ","$1,670.25 ",$705.33 ,"$1,670.25 ","$1,340.13 ","$1,336.20 ","$1,763.33 ",$705.33 ,$705.33 ,"$1,473.75 ","$1,395.15 ","$1,395.15 ",$705.33 ,"$1,395.15 ","$1,611.30 ","$1,611.30 ","$1,611.30 ", N/A ,"$1,763.33 ","$1,670.25 ",$705.33 ,"$1,965.00 ","$1,173.11 ",$705.33 ,$817.44 ,$353.25 ,$321.14 ,$705.33 ,"$1,670.25 ","$1,481.19 ","$1,670.25 ",$550.20 ,"$1,768.50 ",$705.33 ,"$1,611.30 ","$1,660.43 ","$1,660.43 ",$705.33 ,"$1,277.25 ","$1,965.00 "
ST. JOSEPH'S HOSPITAL - BREESE,48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$2,103.00 ","$1,366.95 ",$321.14 ,"$2,103.00 ","$1,763.33 ","$1,366.95 ","$1,255.49 ",$705.33 ,$588.84 ,"$1,179.78 ",$705.33 ,"$1,383.77 ",$705.33 ,"$1,787.55 ","$1,787.55 ",$705.33 ,"$1,787.55 ","$1,340.13 ","$1,430.04 ","$1,763.33 ",$705.33 ,$705.33 ,"$1,577.25 ","$1,493.13 ","$1,493.13 ",$705.33 ,"$1,493.13 ","$1,724.46 ","$1,724.46 ","$1,724.46 ", N/A ,"$1,763.33 ","$1,787.55 ",$705.33 ,"$2,103.00 ","$1,255.49 ",$705.33 ,$874.85 ,$353.25 ,$321.14 ,$705.33 ,"$1,787.55 ","$1,481.19 ","$1,787.55 ",$588.84 ,"$1,892.70 ",$705.33 ,"$1,724.46 ","$1,777.04 ","$1,777.04 ",$705.33 ,"$1,366.95 ","$2,103.00 "
ST. JOSEPH'S HOSPITAL - BREESE,48300020,C8930,HC ECHO TTE 2D REST/STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$1,965.00 ","$1,277.25 ",$321.14 ,"$1,965.00 ","$1,763.33 ","$1,277.25 ","$1,173.11 ",$705.33 ,$550.20 ,"$1,102.37 ",$705.33 ,"$1,292.97 ",$705.33 ,"$1,670.25 ","$1,670.25 ",$705.33 ,"$1,670.25 ","$1,340.13 ","$1,336.20 ","$1,763.33 ",$705.33 ,$705.33 ,"$1,473.75 ","$1,395.15 ","$1,395.15 ",$705.33 ,"$1,395.15 ","$1,611.30 ","$1,611.30 ","$1,611.30 ", N/A ,"$1,763.33 ","$1,670.25 ",$705.33 ,"$1,965.00 ","$1,173.11 ",$705.33 ,$817.44 ,$353.25 ,$321.14 ,$705.33 ,"$1,670.25 ","$1,481.19 ","$1,670.25 ",$550.20 ,"$1,768.50 ",$705.33 ,"$1,611.30 ","$1,660.43 ","$1,660.43 ",$705.33 ,"$1,277.25 ","$1,965.00 "
ST. JOSEPH'S HOSPITAL - BREESE,51000002,95117,HC ALLERGY SHOTS 2 OR MORE,510,1 ,$82.00 ,$53.30 ,$16.27 ,$98.63 ,$98.63 ,$53.30 ,$48.95 ,$39.45 ,$22.96 ,$46.00 ,$39.45 ,$53.96 ,$39.45 ,$69.70 ,$69.70 ,$39.45 ,$69.70 ,$74.96 ,$55.76 ,$98.63 ,$39.45 ,$39.45 ,$61.50 ,$58.22 ,$58.22 ,$39.45 ,$58.22 ,$67.24 ,$67.24 ,$67.24 , N/A ,$82.00 ,$69.70 ,$39.45 ,$82.00 ,$48.95 ,$39.45 ,$34.11 ,$17.90 ,$16.27 ,$39.45 ,$69.70 ,$82.85 ,$69.70 ,$22.96 ,$73.80 ,$39.45 ,$67.24 ,$82.00 ,$82.00 ,$39.45 ,$53.30 ,$82.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,$806.00 ,$523.90 ,$125.00 ,$851.90 ,$851.90 ,$523.90 ,$481.18 ,$340.76 ,$225.68 ,$452.17 ,$340.76 ,$530.35 ,$340.76 ,$685.10 ,$685.10 ,$340.76 ,$685.10 ,$647.44 ,$548.08 ,$851.90 ,$340.76 ,$340.76 ,$604.50 ,$572.26 ,$572.26 ,$340.76 ,$572.26 ,$660.92 ,$660.92 ,$660.92 , N/A ,$806.00 ,$685.10 ,$340.76 ,$806.00 ,$481.18 ,$340.76 ,$335.30 ,$223.26 ,$202.96 ,$340.76 ,$685.10 ,$715.59 ,$685.10 ,$225.68 ,$725.40 ,$340.76 ,$660.92 ,$125.00 ,$125.00 ,$340.76 ,$523.90 ,$806.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000014,11056,HC PARING LESN BENIGN 2-4 FAC,510,1 ,$511.29 ,$332.34 ,$125.00 ,$511.29 ,$442.60 ,$332.34 ,$305.24 ,$177.04 ,$143.16 ,$286.83 ,$177.04 ,$336.43 ,$177.04 ,$434.60 ,$434.60 ,$177.04 ,$434.60 ,$336.38 ,$347.68 ,$442.60 ,$177.04 ,$177.04 ,$383.47 ,$363.02 ,$363.02 ,$177.04 ,$363.02 ,$419.26 ,$419.26 ,$419.26 , N/A ,$442.60 ,$434.60 ,$177.04 ,$511.29 ,$305.24 ,$177.04 ,$212.70 ,$223.26 ,$202.96 ,$177.04 ,$434.60 ,$371.78 ,$434.60 ,$143.16 ,$460.16 ,$177.04 ,$419.26 ,$125.00 ,$125.00 ,$177.04 ,$332.34 ,$511.29 
ST. JOSEPH'S HOSPITAL - BREESE,51000023,11720,HC DEBR NAIL(S) UP TO 5,510,1 ,$200.00 ,$130.00 ,$54.30 ,$200.00 ,$137.20 ,$130.00 ,$119.40 ,$54.88 ,$56.00 ,$112.20 ,$54.88 ,$131.60 ,$54.88 ,$170.00 ,$170.00 ,$54.88 ,$170.00 ,$104.27 ,$136.00 ,$137.20 ,$54.88 ,$54.88 ,$150.00 ,$142.00 ,$142.00 ,$54.88 ,$142.00 ,$164.00 ,$164.00 ,$164.00 , N/A ,$137.20 ,$170.00 ,$54.88 ,$200.00 ,$119.40 ,$54.88 ,$83.20 ,$59.73 ,$54.30 ,$54.88 ,$170.00 ,$115.24 ,$170.00 ,$56.00 ,$180.00 ,$54.88 ,$164.00 ,$125.00 ,$125.00 ,$54.88 ,$130.00 ,$200.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000024,11721,HC DEBR NAIL(S) 6 OR MORE,510,1 ,$327.00 ,$212.55 ,$54.30 ,$327.00 ,$137.20 ,$212.55 ,$195.22 ,$54.88 ,$91.56 ,$183.45 ,$54.88 ,$215.17 ,$54.88 ,$277.95 ,$277.95 ,$54.88 ,$277.95 ,$104.27 ,$222.36 ,$137.20 ,$54.88 ,$54.88 ,$245.25 ,$232.17 ,$232.17 ,$54.88 ,$232.17 ,$268.14 ,$268.14 ,$268.14 , N/A ,$137.20 ,$277.95 ,$54.88 ,$327.00 ,$195.22 ,$54.88 ,$136.03 ,$59.73 ,$54.30 ,$54.88 ,$277.95 ,$115.24 ,$277.95 ,$91.56 ,$294.30 ,$54.88 ,$268.14 ,$125.00 ,$125.00 ,$54.88 ,$212.55 ,$327.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,$846.00 ,$549.90 ,$125.00 ,$851.90 ,$851.90 ,$549.90 ,$505.06 ,$340.76 ,$236.88 ,$474.61 ,$340.76 ,$556.67 ,$340.76 ,$719.10 ,$719.10 ,$340.76 ,$719.10 ,$647.44 ,$575.28 ,$851.90 ,$340.76 ,$340.76 ,$634.50 ,$600.66 ,$600.66 ,$340.76 ,$600.66 ,$693.72 ,$693.72 ,$693.72 , N/A ,$846.00 ,$719.10 ,$340.76 ,$846.00 ,$505.06 ,$340.76 ,$351.94 ,$469.24 ,$426.58 ,$340.76 ,$719.10 ,$715.59 ,$719.10 ,$236.88 ,$761.40 ,$340.76 ,$693.72 ,$125.00 ,$125.00 ,$340.76 ,$549.90 ,$846.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$330.00 ,$214.50 ,$79.05 ,$785.88 ,$785.88 ,$214.50 ,$197.01 ,$314.35 ,$92.40 ,$185.13 ,$314.35 ,$217.14 ,$314.35 ,$280.50 ,$280.50 ,$314.35 ,$280.50 ,$330.00 ,$224.40 ,$785.87 ,$314.35 ,$314.35 ,$247.50 ,$234.30 ,$234.30 ,$314.35 ,$234.30 ,$270.60 ,$270.60 ,$270.60 , N/A ,$330.00 ,$280.50 ,$314.35 ,$330.00 ,$197.01 ,$314.35 ,$137.28 ,$86.96 ,$79.05 ,$314.35 ,$280.50 ,$660.13 ,$280.50 ,$92.40 ,$297.00 ,$314.35 ,$270.60 ,$125.00 ,$125.00 ,$314.35 ,$214.50 ,$330.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000053,29580,HC APPLY UNNA BOOT,510,1 ,$427.00 ,$277.55 ,$119.56 ,$427.00 ,$348.23 ,$277.55 ,$254.92 ,$139.29 ,$119.56 ,$239.55 ,$139.29 ,$280.97 ,$139.29 ,$362.95 ,$362.95 ,$139.29 ,$362.95 ,$264.64 ,$290.36 ,$348.22 ,$139.29 ,$139.29 ,$320.25 ,$303.17 ,$303.17 ,$139.29 ,$303.17 ,$350.14 ,$350.14 ,$350.14 , N/A ,$348.22 ,$362.95 ,$139.29 ,$427.00 ,$254.92 ,$139.29 ,$177.63 ,$183.50 ,$166.82 ,$139.29 ,$362.95 ,$292.50 ,$362.95 ,$119.56 ,$384.30 ,$139.29 ,$350.14 ,$125.00 ,$125.00 ,$139.29 ,$277.55 ,$427.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$55.00 ,$35.75 ,$15.40 ,$152.81 ,$152.80 ,$35.75 ,$32.84 ,$61.12 ,$15.40 ,$30.86 ,$61.12 ,$36.19 ,$55.00 ,$46.75 ,$46.75 ,$55.00 ,$46.75 ,$55.00 ,$37.40 ,$152.81 ,$61.12 ,$61.12 ,$41.25 ,$39.05 ,$39.05 ,$61.12 ,$39.05 ,$45.10 ,$45.10 ,$45.10 , N/A ,$55.00 ,$46.75 ,$61.12 ,$55.00 ,$32.84 ,$61.12 ,$22.88 , N/A , N/A ,$61.12 ,$46.75 ,$128.36 ,$46.75 ,$15.40 ,$49.50 ,$61.12 ,$45.10 ,$46.48 ,$46.48 ,$61.12 ,$35.75 ,$55.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$156.00 ,$101.40 ,$43.68 ,$504.21 ,$504.20 ,$101.40 ,$93.13 ,$201.68 ,$43.68 ,$87.52 ,$201.68 ,$102.65 ,$156.00 ,$132.60 ,$132.60 ,$156.00 ,$132.60 ,$156.00 ,$106.08 ,$504.21 ,$201.68 ,$201.68 ,$117.00 ,$110.76 ,$110.76 ,$201.68 ,$110.76 ,$127.92 ,$127.92 ,$127.92 , N/A ,$156.00 ,$132.60 ,$201.68 ,$156.00 ,$93.13 ,$201.68 ,$64.90 , N/A , N/A ,$201.68 ,$132.60 ,$423.54 ,$132.60 ,$43.68 ,$140.40 ,$201.68 ,$127.92 ,$131.82 ,$131.82 ,$201.68 ,$101.40 ,$156.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$86.00 ,$55.90 ,$24.08 ,$98.63 ,$98.63 ,$55.90 ,$51.34 ,$39.45 ,$24.08 ,$48.25 ,$39.45 ,$56.59 ,$39.45 ,$73.10 ,$73.10 ,$39.45 ,$73.10 ,$74.96 ,$58.48 ,$98.63 ,$39.45 ,$39.45 ,$64.50 ,$61.06 ,$61.06 ,$39.45 ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A ,$86.00 ,$73.10 ,$39.45 ,$86.00 ,$51.34 ,$39.45 ,$35.78 , N/A , N/A ,$39.45 ,$73.10 ,$82.85 ,$73.10 ,$24.08 ,$77.40 ,$39.45 ,$70.52 ,$72.67 ,$72.67 ,$39.45 ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$86.00 ,$55.90 ,$24.08 ,$86.00 , N/A ,$55.90 ,$51.34 , N/A ,$24.08 ,$48.25 , N/A ,$56.59 , N/A ,$73.10 ,$73.10 , N/A ,$73.10 , N/A ,$58.48 , N/A , N/A , N/A ,$64.50 ,$61.06 ,$61.06 , N/A ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A , N/A ,$73.10 , N/A ,$86.00 ,$51.34 , N/A ,$35.78 , N/A , N/A , N/A ,$73.10 , N/A ,$73.10 ,$24.08 ,$77.40 , N/A ,$70.52 ,$72.67 ,$72.67 , N/A ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$152.00 ,$98.80 ,$42.56 ,$152.00 ,$137.20 ,$98.80 ,$90.74 ,$54.88 ,$42.56 ,$85.27 ,$54.88 ,$100.02 ,$54.88 ,$129.20 ,$129.20 ,$54.88 ,$129.20 ,$104.27 ,$103.36 ,$137.20 ,$54.88 ,$54.88 ,$114.00 ,$107.92 ,$107.92 ,$54.88 ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A ,$137.20 ,$129.20 ,$54.88 ,$152.00 ,$90.74 ,$54.88 ,$63.23 ,$86.96 ,$79.05 ,$54.88 ,$129.20 ,$115.24 ,$129.20 ,$42.56 ,$136.80 ,$54.88 ,$124.64 ,$125.00 ,$125.00 ,$54.88 ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$144.00 ,$93.60 ,$40.32 ,$144.00 , N/A ,$93.60 ,$85.97 , N/A ,$40.32 ,$80.78 , N/A ,$94.75 , N/A ,$122.40 ,$122.40 , N/A ,$122.40 , N/A ,$97.92 , N/A , N/A , N/A ,$108.00 ,$102.24 ,$102.24 , N/A ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A , N/A ,$122.40 , N/A ,$78.75 ,$85.97 , N/A ,$59.90 ,$102.37 ,$93.06 , N/A ,$122.40 , N/A ,$122.40 ,$40.32 ,$129.60 , N/A ,$118.08 ,$125.00 ,$125.00 , N/A ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$337.00 ,$219.05 ,$93.06 ,$337.00 , N/A ,$219.05 ,$201.19 , N/A ,$94.36 ,$189.06 , N/A ,$221.75 , N/A ,$286.45 ,$286.45 , N/A ,$286.45 , N/A ,$229.16 , N/A , N/A , N/A ,$252.75 ,$239.27 ,$239.27 , N/A ,$239.27 ,$276.34 ,$276.34 ,$276.34 , N/A , N/A ,$286.45 , N/A ,$121.24 ,$201.19 , N/A ,$140.19 ,$102.37 ,$93.06 , N/A ,$286.45 , N/A ,$286.45 ,$94.36 ,$303.30 , N/A ,$276.34 ,$125.00 ,$125.00 , N/A ,$219.05 ,$337.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000109,99204,HC CLINIC VISIT COMPLEX NEW,510,1 ,$210.00 ,$136.50 ,$58.80 ,$210.00 , N/A ,$136.50 ,$125.37 , N/A ,$58.80 ,$117.81 , N/A ,$138.18 , N/A ,$178.50 ,$178.50 , N/A ,$178.50 , N/A ,$142.80 , N/A , N/A , N/A ,$157.50 ,$149.10 ,$149.10 , N/A ,$149.10 ,$172.20 ,$172.20 ,$172.20 , N/A , N/A ,$178.50 , N/A ,$181.05 ,$125.37 , N/A ,$87.36 ,$102.37 ,$93.06 , N/A ,$178.50 , N/A ,$178.50 ,$58.80 ,$189.00 , N/A ,$172.20 ,$125.00 ,$125.00 , N/A ,$136.50 ,$210.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000113,99205,HC CLINIC VISIT COMPREH NEW,510,1 ,$541.00 ,$351.65 ,$93.06 ,$541.00 , N/A ,$351.65 ,$322.98 , N/A ,$151.48 ,$303.50 , N/A ,$355.98 , N/A ,$459.85 ,$459.85 , N/A ,$459.85 , N/A ,$367.88 , N/A , N/A , N/A ,$405.75 ,$384.11 ,$384.11 , N/A ,$384.11 ,$443.62 ,$443.62 ,$443.62 , N/A , N/A ,$459.85 , N/A ,$239.15 ,$322.98 , N/A ,$225.06 ,$102.37 ,$93.06 , N/A ,$459.85 , N/A ,$459.85 ,$151.48 ,$486.90 , N/A ,$443.62 ,$125.00 ,$125.00 , N/A ,$351.65 ,$541.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$188.00 ,$122.20 ,$52.64 ,$188.00 , N/A ,$122.20 ,$112.24 , N/A ,$52.64 ,$105.47 , N/A ,$123.70 , N/A ,$159.80 ,$159.80 , N/A ,$159.80 , N/A ,$127.84 , N/A , N/A , N/A ,$141.00 ,$133.48 ,$133.48 , N/A ,$133.48 ,$154.16 ,$154.16 ,$154.16 , N/A , N/A ,$159.80 , N/A ,$188.00 ,$112.24 , N/A ,$78.21 ,$102.37 ,$93.06 , N/A ,$159.80 , N/A ,$159.80 ,$52.64 ,$169.20 , N/A ,$154.16 ,$125.00 ,$125.00 , N/A ,$122.20 ,$188.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$213.00 ,$138.45 ,$59.64 ,$213.00 , N/A ,$138.45 ,$127.16 , N/A ,$59.64 ,$119.49 , N/A ,$140.15 , N/A ,$181.05 ,$181.05 , N/A ,$181.05 , N/A ,$144.84 , N/A , N/A , N/A ,$159.75 ,$151.23 ,$151.23 , N/A ,$151.23 ,$174.66 ,$174.66 ,$174.66 , N/A , N/A ,$181.05 , N/A ,$60.02 ,$127.16 , N/A ,$88.61 ,$102.37 ,$93.06 , N/A ,$181.05 , N/A ,$181.05 ,$59.64 ,$191.70 , N/A ,$174.66 ,$125.00 ,$125.00 , N/A ,$138.45 ,$213.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$239.00 ,$155.35 ,$66.92 ,$239.00 , N/A ,$155.35 ,$142.68 , N/A ,$66.92 ,$134.08 , N/A ,$157.26 , N/A ,$203.15 ,$203.15 , N/A ,$203.15 , N/A ,$162.52 , N/A , N/A , N/A ,$179.25 ,$169.69 ,$169.69 , N/A ,$169.69 ,$195.98 ,$195.98 ,$195.98 , N/A , N/A ,$203.15 , N/A ,$97.92 ,$142.68 , N/A ,$99.42 ,$102.37 ,$93.06 , N/A ,$203.15 , N/A ,$203.15 ,$66.92 ,$215.10 , N/A ,$195.98 ,$125.00 ,$125.00 , N/A ,$155.35 ,$239.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$304.00 ,$197.60 ,$85.12 ,$304.00 , N/A ,$197.60 ,$181.49 , N/A ,$85.12 ,$170.54 , N/A ,$200.03 , N/A ,$258.40 ,$258.40 , N/A ,$258.40 , N/A ,$206.72 , N/A , N/A , N/A ,$228.00 ,$215.84 ,$215.84 , N/A ,$215.84 ,$249.28 ,$249.28 ,$249.28 , N/A , N/A ,$258.40 , N/A ,$304.00 ,$181.49 , N/A ,$126.46 ,$102.37 ,$93.06 , N/A ,$258.40 , N/A ,$258.40 ,$85.12 ,$273.60 , N/A ,$249.28 ,$125.00 ,$125.00 , N/A ,$197.60 ,$304.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$380.00 ,$247.00 ,$93.06 ,$380.00 , N/A ,$247.00 ,$226.86 , N/A ,$106.40 ,$213.18 , N/A ,$250.04 , N/A ,$323.00 ,$323.00 , N/A ,$323.00 , N/A ,$258.40 , N/A , N/A , N/A ,$285.00 ,$269.80 ,$269.80 , N/A ,$269.80 ,$311.60 ,$311.60 ,$311.60 , N/A , N/A ,$323.00 , N/A ,$380.00 ,$226.86 , N/A ,$158.08 ,$102.37 ,$93.06 , N/A ,$323.00 , N/A ,$323.00 ,$106.40 ,$342.00 , N/A ,$311.60 ,$125.00 ,$125.00 , N/A ,$247.00 ,$380.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$201.00 ,$130.65 ,$3.00 ,$201.00 ,$7.50 ,$130.65 ,$120.00 ,$3.00 ,$56.28 ,$112.76 ,$3.00 ,$132.26 ,$3.00 ,$170.85 ,$170.85 ,$3.00 ,$170.85 ,$5.70 ,$136.68 ,$7.50 ,$3.00 ,$3.00 ,$150.75 ,$142.71 ,$142.71 ,$3.00 ,$142.71 ,$164.82 ,$164.82 ,$164.82 , N/A ,$7.50 ,$170.85 ,$3.00 ,$201.00 ,$120.00 ,$3.00 ,$83.62 , N/A , N/A ,$3.00 ,$170.85 ,$6.30 ,$170.85 ,$56.28 ,$180.90 ,$3.00 ,$164.82 ,$12.00 ,$12.00 ,$3.00 ,$130.65 ,$201.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$196.00 ,$127.40 ,$54.88 ,$277.93 ,$277.93 ,$127.40 ,$117.01 ,$111.17 ,$54.88 ,$109.96 ,$111.17 ,$128.97 ,$111.17 ,$166.60 ,$166.60 ,$111.17 ,$166.60 ,$196.00 ,$133.28 ,$277.92 ,$111.17 ,$111.17 ,$147.00 ,$139.16 ,$139.16 ,$111.17 ,$139.16 ,$160.72 ,$160.72 ,$160.72 , N/A ,$196.00 ,$166.60 ,$111.17 ,$196.00 ,$117.01 ,$111.17 ,$81.54 ,$86.96 ,$79.05 ,$111.17 ,$166.60 ,$233.45 ,$166.60 ,$54.88 ,$176.40 ,$111.17 ,$160.72 ,$125.00 ,$125.00 ,$111.17 ,$127.40 ,$196.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000172,51702,HC CATH BLADDER SMP,510,1 ,$214.00 ,$139.10 ,$59.92 ,$277.93 ,$277.93 ,$139.10 ,$127.76 ,$111.17 ,$59.92 ,$120.05 ,$111.17 ,$140.81 ,$111.17 ,$181.90 ,$181.90 ,$111.17 ,$181.90 ,$211.22 ,$145.52 ,$277.92 ,$111.17 ,$111.17 ,$160.50 ,$151.94 ,$151.94 ,$111.17 ,$151.94 ,$175.48 ,$175.48 ,$175.48 , N/A ,$214.00 ,$181.90 ,$111.17 ,$214.00 ,$127.76 ,$111.17 ,$89.02 ,$86.96 ,$79.05 ,$111.17 ,$181.90 ,$233.45 ,$181.90 ,$59.92 ,$192.60 ,$111.17 ,$175.48 ,$125.00 ,$125.00 ,$111.17 ,$139.10 ,$214.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000173,51703,HC CATH BLADDER CPLX,510,1 ,$397.00 ,$258.05 ,$79.05 ,$397.00 ,$344.13 ,$258.05 ,$237.01 ,$137.65 ,$111.16 ,$222.72 ,$137.65 ,$261.23 ,$137.65 ,$337.45 ,$337.45 ,$137.65 ,$337.45 ,$261.53 ,$269.96 ,$344.11 ,$137.65 ,$137.65 ,$297.75 ,$281.87 ,$281.87 ,$137.65 ,$281.87 ,$325.54 ,$325.54 ,$325.54 , N/A ,$344.11 ,$337.45 ,$137.65 ,$397.00 ,$237.01 ,$137.65 ,$165.15 ,$86.96 ,$79.05 ,$137.65 ,$337.45 ,$289.05 ,$337.45 ,$111.16 ,$357.30 ,$137.65 ,$325.54 ,$125.00 ,$125.00 ,$137.65 ,$258.05 ,$397.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000175,94780,HC CARSEAT ANALYSIS FIRST 60MIN,510,1 ,$154.00 ,$100.10 ,$33.37 ,$154.00 ,$83.43 ,$100.10 ,$91.94 ,$33.37 ,$43.12 ,$86.39 ,$33.37 ,$101.33 ,$33.37 ,$130.90 ,$130.90 ,$33.37 ,$130.90 ,$63.41 ,$104.72 ,$83.43 ,$33.37 ,$33.37 ,$115.50 ,$109.34 ,$109.34 ,$33.37 ,$109.34 ,$126.28 ,$126.28 ,$126.28 , N/A ,$83.43 ,$130.90 ,$33.37 ,$154.00 ,$91.94 ,$33.37 ,$64.06 ,$54.45 ,$49.50 ,$33.37 ,$130.90 ,$70.08 ,$130.90 ,$43.12 ,$138.60 ,$33.37 ,$126.28 ,$125.00 ,$125.00 ,$33.37 ,$100.10 ,$154.00 
ST. JOSEPH'S HOSPITAL - BREESE,51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$1,636.68 ","$1,063.84 ",$125.00 ,"$1,636.68 ","$1,417.95 ","$1,063.84 ",$977.10 ,$567.18 ,$458.27 ,$918.18 ,$567.18 ,"$1,076.94 ",$567.18 ,"$1,391.18 ","$1,391.18 ",$567.18 ,"$1,391.18 ","$1,077.65 ","$1,112.94 ","$1,417.96 ",$567.18 ,$567.18 ,"$1,227.51 ","$1,162.04 ","$1,162.04 ",$567.18 ,"$1,162.04 ","$1,342.08 ","$1,342.08 ","$1,342.08 ", N/A ,"$1,417.96 ","$1,391.18 ",$567.18 ,"$1,636.68 ",$977.10 ,$567.18 ,$680.86 ,$790.36 ,$718.51 ,$567.18 ,"$1,391.18 ","$1,191.09 ","$1,391.18 ",$458.27 ,"$1,473.01 ",$567.18 ,"$1,342.08 ",$125.00 ,$125.00 ,$567.18 ,"$1,063.84 ","$1,636.68 "
ST. JOSEPH'S HOSPITAL - BREESE,51000320,94781,HC CARSEAT ANALYSIS  EA ADDN 30MIN,510,1 ,$90.00 ,$58.50 ,$25.20 ,$90.00 , N/A ,$58.50 ,$53.73 , N/A ,$25.20 ,$50.49 , N/A ,$59.22 , N/A ,$76.50 ,$76.50 , N/A ,$76.50 , N/A ,$61.20 , N/A , N/A , N/A ,$67.50 ,$63.90 ,$63.90 , N/A ,$63.90 ,$73.80 ,$73.80 ,$73.80 , N/A , N/A ,$76.50 , N/A ,$90.00 ,$53.73 , N/A ,$37.44 ,$54.45 ,$49.50 , N/A ,$76.50 , N/A ,$76.50 ,$25.20 ,$81.00 , N/A ,$73.80 ,$90.00 ,$90.00 , N/A ,$58.50 ,$90.00 
ST. JOSEPH'S HOSPITAL - BREESE,51001010,99215,HC CLINIC VISIT - MEMORY INITIAL,510,1 ,$380.00 ,$247.00 ,$93.06 ,$380.00 , N/A ,$247.00 ,$226.86 , N/A ,$106.40 ,$213.18 , N/A ,$250.04 , N/A ,$323.00 ,$323.00 , N/A ,$323.00 , N/A ,$258.40 , N/A , N/A , N/A ,$285.00 ,$269.80 ,$269.80 , N/A ,$269.80 ,$311.60 ,$311.60 ,$311.60 , N/A , N/A ,$323.00 , N/A ,$380.00 ,$226.86 , N/A ,$158.08 ,$102.37 ,$93.06 , N/A ,$323.00 , N/A ,$323.00 ,$106.40 ,$342.00 , N/A ,$311.60 ,$125.00 ,$125.00 , N/A ,$247.00 ,$380.00 
ST. JOSEPH'S HOSPITAL - BREESE,51001012,95115,HC ALLERGY SHOTS ONE INJECTION,510,1 ,$54.00 ,$35.10 ,$15.12 ,$98.63 ,$98.63 ,$35.10 ,$32.24 ,$39.45 ,$15.12 ,$30.29 ,$39.45 ,$35.53 ,$39.45 ,$45.90 ,$45.90 ,$39.45 ,$45.90 ,$54.00 ,$36.72 ,$98.63 ,$39.45 ,$39.45 ,$40.50 ,$38.34 ,$38.34 ,$39.45 ,$38.34 ,$44.28 ,$44.28 ,$44.28 , N/A ,$54.00 ,$45.90 ,$39.45 ,$54.00 ,$32.24 ,$39.45 ,$22.46 ,$17.90 ,$16.27 ,$39.45 ,$45.90 ,$82.85 ,$45.90 ,$15.12 ,$48.60 ,$39.45 ,$44.28 ,$54.00 ,$54.00 ,$39.45 ,$35.10 ,$54.00 
ST. JOSEPH'S HOSPITAL - BREESE,51070001,98960,HC EDUCATION SELF MGNT NON PHY HLTCARE PROF,510,1 ,$91.00 ,$59.15 ,$23.89 ,$91.00 , N/A ,$59.15 ,$54.33 , N/A ,$25.48 ,$51.05 , N/A ,$59.88 , N/A ,$77.35 ,$77.35 , N/A ,$77.35 , N/A ,$61.88 , N/A , N/A , N/A ,$68.25 ,$64.61 ,$64.61 , N/A ,$64.61 ,$74.62 ,$74.62 ,$74.62 , N/A , N/A ,$77.35 , N/A ,$91.00 ,$54.33 , N/A ,$37.86 ,$26.28 ,$23.89 , N/A ,$77.35 , N/A ,$77.35 ,$25.48 ,$81.90 , N/A ,$74.62 ,$91.00 ,$91.00 , N/A ,$59.15 ,$91.00 
ST. JOSEPH'S HOSPITAL - BREESE,61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$5,235.00 ","$3,402.75 ",$229.31 ,"$5,235.00 ",$907.63 ,"$3,402.75 ","$3,125.30 ",$363.05 ,"$1,465.80 ","$2,936.84 ",$363.05 ,"$3,444.63 ",$363.05 ,"$4,449.75 ","$4,449.75 ",$363.05 ,"$4,449.75 ",$689.79 ,"$3,559.80 ",$907.62 ,$363.05 ,$363.05 ,"$3,926.25 ","$3,716.85 ","$3,716.85 ",$363.05 ,"$3,716.85 ","$4,292.70 ","$4,292.70 ","$4,292.70 ", N/A ,$907.62 ,"$4,449.75 ",$363.05 ,"$5,235.00 ","$3,125.30 ",$363.05 ,"$2,177.76 ",$252.24 ,$229.31 ,$363.05 ,"$4,449.75 ",$762.40 ,"$4,449.75 ","$1,465.80 ","$4,711.50 ",$363.05 ,"$4,292.70 ","$4,423.58 ","$4,423.58 ",$363.05 ,"$3,402.75 ","$5,235.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,574.00 ","$2,323.10 ",$226.85 ,"$3,574.00 ",$567.13 ,"$2,323.10 ","$2,133.68 ",$226.85 ,"$1,000.72 ","$2,005.01 ",$226.85 ,"$2,351.69 ",$226.85 ,"$3,037.90 ","$3,037.90 ",$226.85 ,"$3,037.90 ",$431.02 ,"$2,430.32 ",$567.13 ,$226.85 ,$226.85 ,"$2,680.50 ","$2,537.54 ","$2,537.54 ",$226.85 ,"$2,537.54 ","$2,930.68 ","$2,930.68 ","$2,930.68 ", N/A ,$567.13 ,"$3,037.90 ",$226.85 ,"$3,574.00 ","$2,133.68 ",$226.85 ,"$1,486.78 ",$308.81 ,$280.74 ,$226.85 ,"$3,037.90 ",$476.39 ,"$3,037.90 ","$1,000.72 ","$3,216.60 ",$226.85 ,"$2,930.68 ","$3,020.03 ","$3,020.03 ",$226.85 ,"$2,323.10 ","$3,574.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$3,755.00 ","$2,440.75 ",$280.74 ,"$3,755.00 ",$907.63 ,"$2,440.75 ","$2,241.74 ",$363.05 ,"$1,051.40 ","$2,106.56 ",$363.05 ,"$2,470.79 ",$363.05 ,"$3,191.75 ","$3,191.75 ",$363.05 ,"$3,191.75 ",$689.79 ,"$2,553.40 ",$907.62 ,$363.05 ,$363.05 ,"$2,816.25 ","$2,666.05 ","$2,666.05 ",$363.05 ,"$2,666.05 ","$3,079.10 ","$3,079.10 ","$3,079.10 ", N/A ,$907.62 ,"$3,191.75 ",$363.05 ,"$3,755.00 ","$2,241.74 ",$363.05 ,"$1,562.08 ",$308.81 ,$280.74 ,$363.05 ,"$3,191.75 ",$762.40 ,"$3,191.75 ","$1,051.40 ","$3,379.50 ",$363.05 ,"$3,079.10 ","$3,172.98 ","$3,172.98 ",$363.05 ,"$2,440.75 ","$3,755.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$3,698.00 ","$2,403.70 ",$280.74 ,"$3,698.00 ",$907.63 ,"$2,403.70 ","$2,207.71 ",$363.05 ,"$1,035.44 ","$2,074.58 ",$363.05 ,"$2,433.28 ",$363.05 ,"$3,143.30 ","$3,143.30 ",$363.05 ,"$3,143.30 ",$689.79 ,"$2,514.64 ",$907.62 ,$363.05 ,$363.05 ,"$2,773.50 ","$2,625.58 ","$2,625.58 ",$363.05 ,"$2,625.58 ","$3,032.36 ","$3,032.36 ","$3,032.36 ", N/A ,$907.62 ,"$3,143.30 ",$363.05 ,"$3,698.00 ","$2,207.71 ",$363.05 ,"$1,538.37 ",$308.81 ,$280.74 ,$363.05 ,"$3,143.30 ",$762.40 ,"$3,143.30 ","$1,035.44 ","$3,328.20 ",$363.05 ,"$3,032.36 ","$3,124.81 ","$3,124.81 ",$363.05 ,"$2,403.70 ","$3,698.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$3,752.00 ","$2,438.80 ",$226.85 ,"$3,752.00 ",$567.13 ,"$2,438.80 ","$2,239.94 ",$226.85 ,"$1,050.56 ","$2,104.87 ",$226.85 ,"$2,468.82 ",$226.85 ,"$3,189.20 ","$3,189.20 ",$226.85 ,"$3,189.20 ",$431.02 ,"$2,551.36 ",$567.13 ,$226.85 ,$226.85 ,"$2,814.00 ","$2,663.92 ","$2,663.92 ",$226.85 ,"$2,663.92 ","$3,076.64 ","$3,076.64 ","$3,076.64 ", N/A ,$567.13 ,"$3,189.20 ",$226.85 ,"$3,752.00 ","$2,239.94 ",$226.85 ,"$1,560.83 ",$308.81 ,$280.74 ,$226.85 ,"$3,189.20 ",$476.39 ,"$3,189.20 ","$1,050.56 ","$3,376.80 ",$226.85 ,"$3,076.64 ","$3,170.44 ","$3,170.44 ",$226.85 ,"$2,438.80 ","$3,752.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$4,005.00 ","$2,603.25 ",$280.74 ,"$4,005.00 ",$907.63 ,"$2,603.25 ","$2,390.99 ",$363.05 ,"$1,121.40 ","$2,246.81 ",$363.05 ,"$2,635.29 ",$363.05 ,"$3,404.25 ","$3,404.25 ",$363.05 ,"$3,404.25 ",$689.79 ,"$2,723.40 ",$907.62 ,$363.05 ,$363.05 ,"$3,003.75 ","$2,843.55 ","$2,843.55 ",$363.05 ,"$2,843.55 ","$3,284.10 ","$3,284.10 ","$3,284.10 ", N/A ,$907.62 ,"$3,404.25 ",$363.05 ,"$4,005.00 ","$2,390.99 ",$363.05 ,"$1,666.08 ",$308.81 ,$280.74 ,$363.05 ,"$3,404.25 ",$762.40 ,"$3,404.25 ","$1,121.40 ","$3,604.50 ",$363.05 ,"$3,284.10 ","$3,384.23 ","$3,384.23 ",$363.05 ,"$2,603.25 ","$4,005.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$4,258.00 ","$2,767.70 ",$280.74 ,"$4,258.00 ",$907.63 ,"$2,767.70 ","$2,542.03 ",$363.05 ,"$1,192.24 ","$2,388.74 ",$363.05 ,"$2,801.76 ",$363.05 ,"$3,619.30 ","$3,619.30 ",$363.05 ,"$3,619.30 ",$689.79 ,"$2,895.44 ",$907.62 ,$363.05 ,$363.05 ,"$3,193.50 ","$3,023.18 ","$3,023.18 ",$363.05 ,"$3,023.18 ","$3,491.56 ","$3,491.56 ","$3,491.56 ", N/A ,$907.62 ,"$3,619.30 ",$363.05 ,"$4,258.00 ","$2,542.03 ",$363.05 ,"$1,771.33 ",$308.81 ,$280.74 ,$363.05 ,"$3,619.30 ",$762.40 ,"$3,619.30 ","$1,192.24 ","$3,832.20 ",$363.05 ,"$3,491.56 ","$3,598.01 ","$3,598.01 ",$363.05 ,"$2,767.70 ","$4,258.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,843.00 ","$2,497.95 ",$226.85 ,"$3,843.00 ",$567.13 ,"$2,497.95 ","$2,294.27 ",$226.85 ,"$1,076.04 ","$2,155.92 ",$226.85 ,"$2,528.69 ",$226.85 ,"$3,266.55 ","$3,266.55 ",$226.85 ,"$3,266.55 ",$431.02 ,"$2,613.24 ",$567.13 ,$226.85 ,$226.85 ,"$2,882.25 ","$2,728.53 ","$2,728.53 ",$226.85 ,"$2,728.53 ","$3,151.26 ","$3,151.26 ","$3,151.26 ", N/A ,$567.13 ,"$3,266.55 ",$226.85 ,"$3,843.00 ","$2,294.27 ",$226.85 ,"$1,598.69 ",$282.62 ,$256.93 ,$226.85 ,"$3,266.55 ",$476.39 ,"$3,266.55 ","$1,076.04 ","$3,458.70 ",$226.85 ,"$3,151.26 ","$3,247.34 ","$3,247.34 ",$226.85 ,"$2,497.95 ","$3,843.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$4,470.00 ","$2,905.50 ",$256.93 ,"$4,470.00 ",$907.63 ,"$2,905.50 ","$2,668.59 ",$363.05 ,"$1,251.60 ","$2,507.67 ",$363.05 ,"$2,941.26 ",$363.05 ,"$3,799.50 ","$3,799.50 ",$363.05 ,"$3,799.50 ",$689.79 ,"$3,039.60 ",$907.62 ,$363.05 ,$363.05 ,"$3,352.50 ","$3,173.70 ","$3,173.70 ",$363.05 ,"$3,173.70 ","$3,665.40 ","$3,665.40 ","$3,665.40 ", N/A ,$907.62 ,"$3,799.50 ",$363.05 ,"$4,470.00 ","$2,668.59 ",$363.05 ,"$1,859.52 ",$282.62 ,$256.93 ,$363.05 ,"$3,799.50 ",$762.40 ,"$3,799.50 ","$1,251.60 ","$4,023.00 ",$363.05 ,"$3,665.40 ","$3,777.15 ","$3,777.15 ",$363.05 ,"$2,905.50 ","$4,470.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$5,114.00 ","$3,324.10 ",$256.93 ,"$5,114.00 ",$907.63 ,"$3,324.10 ","$3,053.06 ",$363.05 ,"$1,431.92 ","$2,868.95 ",$363.05 ,"$3,365.01 ",$363.05 ,"$4,346.90 ","$4,346.90 ",$363.05 ,"$4,346.90 ",$689.79 ,"$3,477.52 ",$907.62 ,$363.05 ,$363.05 ,"$3,835.50 ","$3,630.94 ","$3,630.94 ",$363.05 ,"$3,630.94 ","$4,193.48 ","$4,193.48 ","$4,193.48 ", N/A ,$907.62 ,"$4,346.90 ",$363.05 ,"$5,114.00 ","$3,053.06 ",$363.05 ,"$2,127.42 ",$282.62 ,$256.93 ,$363.05 ,"$4,346.90 ",$762.40 ,"$4,346.90 ","$1,431.92 ","$4,602.60 ",$363.05 ,"$4,193.48 ","$4,321.33 ","$4,321.33 ",$363.05 ,"$3,324.10 ","$5,114.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$3,757.00 ","$2,442.05 ",$185.30 ,"$3,757.00 ",$567.13 ,"$2,442.05 ","$2,242.93 ",$226.85 ,"$1,051.96 ","$2,107.68 ",$226.85 ,"$2,472.11 ",$226.85 ,"$3,193.45 ","$3,193.45 ",$226.85 ,"$3,193.45 ",$431.02 ,"$2,554.76 ",$567.13 ,$226.85 ,$226.85 ,"$2,817.75 ","$2,667.47 ","$2,667.47 ",$226.85 ,"$2,667.47 ","$3,080.74 ","$3,080.74 ","$3,080.74 ", N/A ,$567.13 ,"$3,193.45 ",$226.85 ,"$3,757.00 ","$2,242.93 ",$226.85 ,"$1,562.91 ",$203.83 ,$185.30 ,$226.85 ,"$3,193.45 ",$476.39 ,"$3,193.45 ","$1,051.96 ","$3,381.30 ",$226.85 ,"$3,080.74 ","$3,174.67 ","$3,174.67 ",$226.85 ,"$2,442.05 ","$3,757.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$4,478.00 ","$2,910.70 ",$185.30 ,"$4,478.00 ",$907.63 ,"$2,910.70 ","$2,673.37 ",$363.05 ,"$1,253.84 ","$2,512.16 ",$363.05 ,"$2,946.52 ",$363.05 ,"$3,806.30 ","$3,806.30 ",$363.05 ,"$3,806.30 ",$689.79 ,"$3,045.04 ",$907.62 ,$363.05 ,$363.05 ,"$3,358.50 ","$3,179.38 ","$3,179.38 ",$363.05 ,"$3,179.38 ","$3,671.96 ","$3,671.96 ","$3,671.96 ", N/A ,$907.62 ,"$3,806.30 ",$363.05 ,"$4,478.00 ","$2,673.37 ",$363.05 ,"$1,862.85 ",$203.83 ,$185.30 ,$363.05 ,"$3,806.30 ",$762.40 ,"$3,806.30 ","$1,253.84 ","$4,030.20 ",$363.05 ,"$3,671.96 ","$3,783.91 ","$3,783.91 ",$363.05 ,"$2,910.70 ","$4,478.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$3,662.00 ","$2,380.30 ",$185.30 ,"$3,662.00 ",$567.13 ,"$2,380.30 ","$2,186.21 ",$226.85 ,"$1,025.36 ","$2,054.38 ",$226.85 ,"$2,409.60 ",$226.85 ,"$3,112.70 ","$3,112.70 ",$226.85 ,"$3,112.70 ",$431.02 ,"$2,490.16 ",$567.13 ,$226.85 ,$226.85 ,"$2,746.50 ","$2,600.02 ","$2,600.02 ",$226.85 ,"$2,600.02 ","$3,002.84 ","$3,002.84 ","$3,002.84 ", N/A ,$567.13 ,"$3,112.70 ",$226.85 ,"$3,662.00 ","$2,186.21 ",$226.85 ,"$1,523.39 ",$203.83 ,$185.30 ,$226.85 ,"$3,112.70 ",$476.39 ,"$3,112.70 ","$1,025.36 ","$3,295.80 ",$226.85 ,"$3,002.84 ","$3,094.39 ","$3,094.39 ",$226.85 ,"$2,380.30 ","$3,662.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$4,126.00 ","$2,681.90 ",$185.30 ,"$4,126.00 ",$907.63 ,"$2,681.90 ","$2,463.22 ",$363.05 ,"$1,155.28 ","$2,314.69 ",$363.05 ,"$2,714.91 ",$363.05 ,"$3,507.10 ","$3,507.10 ",$363.05 ,"$3,507.10 ",$689.79 ,"$2,805.68 ",$907.62 ,$363.05 ,$363.05 ,"$3,094.50 ","$2,929.46 ","$2,929.46 ",$363.05 ,"$2,929.46 ","$3,383.32 ","$3,383.32 ","$3,383.32 ", N/A ,$907.62 ,"$3,507.10 ",$363.05 ,"$4,126.00 ","$2,463.22 ",$363.05 ,"$1,716.42 ",$203.83 ,$185.30 ,$363.05 ,"$3,507.10 ",$762.40 ,"$3,507.10 ","$1,155.28 ","$3,713.40 ",$363.05 ,"$3,383.32 ","$3,486.47 ","$3,486.47 ",$363.05 ,"$2,681.90 ","$4,126.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$3,689.00 ","$2,397.85 ",$185.30 ,"$3,689.00 ",$567.13 ,"$2,397.85 ","$2,202.33 ",$226.85 ,"$1,032.92 ","$2,069.53 ",$226.85 ,"$2,427.36 ",$226.85 ,"$3,135.65 ","$3,135.65 ",$226.85 ,"$3,135.65 ",$431.02 ,"$2,508.52 ",$567.13 ,$226.85 ,$226.85 ,"$2,766.75 ","$2,619.19 ","$2,619.19 ",$226.85 ,"$2,619.19 ","$3,024.98 ","$3,024.98 ","$3,024.98 ", N/A ,$567.13 ,"$3,135.65 ",$226.85 ,"$3,689.00 ","$2,202.33 ",$226.85 ,"$1,534.62 ",$203.83 ,$185.30 ,$226.85 ,"$3,135.65 ",$476.39 ,"$3,135.65 ","$1,032.92 ","$3,320.10 ",$226.85 ,"$3,024.98 ","$3,117.21 ","$3,117.21 ",$226.85 ,"$2,397.85 ","$3,689.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$4,156.00 ","$2,701.40 ",$185.30 ,"$4,156.00 ",$907.63 ,"$2,701.40 ","$2,481.13 ",$363.05 ,"$1,163.68 ","$2,331.52 ",$363.05 ,"$2,734.65 ",$363.05 ,"$3,532.60 ","$3,532.60 ",$363.05 ,"$3,532.60 ",$689.79 ,"$2,826.08 ",$907.62 ,$363.05 ,$363.05 ,"$3,117.00 ","$2,950.76 ","$2,950.76 ",$363.05 ,"$2,950.76 ","$3,407.92 ","$3,407.92 ","$3,407.92 ", N/A ,$907.62 ,"$3,532.60 ",$363.05 ,"$4,156.00 ","$2,481.13 ",$363.05 ,"$1,728.90 ",$203.83 ,$185.30 ,$363.05 ,"$3,532.60 ",$762.40 ,"$3,532.60 ","$1,163.68 ","$3,740.40 ",$363.05 ,"$3,407.92 ","$3,511.82 ","$3,511.82 ",$363.05 ,"$2,701.40 ","$4,156.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$5,024.00 ","$3,265.60 ",$185.30 ,"$5,024.00 ",$907.63 ,"$3,265.60 ","$2,999.33 ",$363.05 ,"$1,406.72 ","$2,818.46 ",$363.05 ,"$3,305.79 ",$363.05 ,"$4,270.40 ","$4,270.40 ",$363.05 ,"$4,270.40 ",$689.79 ,"$3,416.32 ",$907.62 ,$363.05 ,$363.05 ,"$3,768.00 ","$3,567.04 ","$3,567.04 ",$363.05 ,"$3,567.04 ","$4,119.68 ","$4,119.68 ","$4,119.68 ", N/A ,$907.62 ,"$4,270.40 ",$363.05 ,"$5,024.00 ","$2,999.33 ",$363.05 ,"$2,089.98 ",$203.83 ,$185.30 ,$363.05 ,"$4,270.40 ",$762.40 ,"$4,270.40 ","$1,406.72 ","$4,521.60 ",$363.05 ,"$4,119.68 ","$4,245.28 ","$4,245.28 ",$363.05 ,"$3,265.60 ","$5,024.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$5,055.00 ","$3,285.75 ",$185.30 ,"$5,055.00 ",$907.63 ,"$3,285.75 ","$3,017.84 ",$363.05 ,"$1,415.40 ","$2,835.86 ",$363.05 ,"$3,326.19 ",$363.05 ,"$4,296.75 ","$4,296.75 ",$363.05 ,"$4,296.75 ",$689.79 ,"$3,437.40 ",$907.62 ,$363.05 ,$363.05 ,"$3,791.25 ","$3,589.05 ","$3,589.05 ",$363.05 ,"$3,589.05 ","$4,145.10 ","$4,145.10 ","$4,145.10 ", N/A ,$907.62 ,"$4,296.75 ",$363.05 ,"$5,055.00 ","$3,017.84 ",$363.05 ,"$2,102.88 ",$203.83 ,$185.30 ,$363.05 ,"$4,296.75 ",$762.40 ,"$4,296.75 ","$1,415.40 ","$4,549.50 ",$363.05 ,"$4,145.10 ","$4,271.48 ","$4,271.48 ",$363.05 ,"$3,285.75 ","$5,055.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$5,011.00 ","$3,257.15 ",$185.30 ,"$5,011.00 ",$907.63 ,"$3,257.15 ","$2,991.57 ",$363.05 ,"$1,403.08 ","$2,811.17 ",$363.05 ,"$3,297.24 ",$363.05 ,"$4,259.35 ","$4,259.35 ",$363.05 ,"$4,259.35 ",$689.79 ,"$3,407.48 ",$907.62 ,$363.05 ,$363.05 ,"$3,758.25 ","$3,557.81 ","$3,557.81 ",$363.05 ,"$3,557.81 ","$4,109.02 ","$4,109.02 ","$4,109.02 ", N/A ,$907.62 ,"$4,259.35 ",$363.05 ,"$5,011.00 ","$2,991.57 ",$363.05 ,"$2,084.58 ",$203.83 ,$185.30 ,$363.05 ,"$4,259.35 ",$762.40 ,"$4,259.35 ","$1,403.08 ","$4,509.90 ",$363.05 ,"$4,109.02 ","$4,234.30 ","$4,234.30 ",$363.05 ,"$3,257.15 ","$5,011.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$3,476.00 ","$2,259.40 ",$226.85 ,"$3,476.00 ",$567.13 ,"$2,259.40 ","$2,075.17 ",$226.85 ,$973.28 ,"$1,950.04 ",$226.85 ,"$2,287.21 ",$226.85 ,"$2,954.60 ","$2,954.60 ",$226.85 ,"$2,954.60 ",$431.02 ,"$2,363.68 ",$567.13 ,$226.85 ,$226.85 ,"$2,607.00 ","$2,467.96 ","$2,467.96 ",$226.85 ,"$2,467.96 ","$2,850.32 ","$2,850.32 ","$2,850.32 ", N/A ,$567.13 ,"$2,954.60 ",$226.85 ,"$3,476.00 ","$2,075.17 ",$226.85 ,"$1,446.02 ",$252.24 ,$229.31 ,$226.85 ,"$2,954.60 ",$476.39 ,"$2,954.60 ",$973.28 ,"$3,128.40 ",$226.85 ,"$2,850.32 ","$2,937.22 ","$2,937.22 ",$226.85 ,"$2,259.40 ","$3,476.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$4,058.00 ","$2,637.70 ",$229.31 ,"$4,058.00 ",$907.63 ,"$2,637.70 ","$2,422.63 ",$363.05 ,"$1,136.24 ","$2,276.54 ",$363.05 ,"$2,670.16 ",$363.05 ,"$3,449.30 ","$3,449.30 ",$363.05 ,"$3,449.30 ",$689.79 ,"$2,759.44 ",$907.62 ,$363.05 ,$363.05 ,"$3,043.50 ","$2,881.18 ","$2,881.18 ",$363.05 ,"$2,881.18 ","$3,327.56 ","$3,327.56 ","$3,327.56 ", N/A ,$907.62 ,"$3,449.30 ",$363.05 ,"$4,058.00 ","$2,422.63 ",$363.05 ,"$1,688.13 ",$252.24 ,$229.31 ,$363.05 ,"$3,449.30 ",$762.40 ,"$3,449.30 ","$1,136.24 ","$3,652.20 ",$363.05 ,"$3,327.56 ","$3,429.01 ","$3,429.01 ",$363.05 ,"$2,637.70 ","$4,058.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$4,776.00 ","$3,104.40 ",$229.31 ,"$4,776.00 ",$907.63 ,"$3,104.40 ","$2,851.27 ",$363.05 ,"$1,337.28 ","$2,679.34 ",$363.05 ,"$3,142.61 ",$363.05 ,"$4,059.60 ","$4,059.60 ",$363.05 ,"$4,059.60 ",$689.79 ,"$3,247.68 ",$907.62 ,$363.05 ,$363.05 ,"$3,582.00 ","$3,390.96 ","$3,390.96 ",$363.05 ,"$3,390.96 ","$3,916.32 ","$3,916.32 ","$3,916.32 ", N/A ,$907.62 ,"$4,059.60 ",$363.05 ,"$4,776.00 ","$2,851.27 ",$363.05 ,"$1,986.82 ",$252.24 ,$229.31 ,$363.05 ,"$4,059.60 ",$762.40 ,"$4,059.60 ","$1,337.28 ","$4,298.40 ",$363.05 ,"$3,916.32 ","$4,035.72 ","$4,035.72 ",$363.05 ,"$3,104.40 ","$4,776.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$3,771.00 ","$2,451.15 ",$226.85 ,"$3,771.00 ",$567.13 ,"$2,451.15 ","$2,251.29 ",$226.85 ,"$1,055.88 ","$2,115.53 ",$226.85 ,"$2,481.32 ",$226.85 ,"$3,205.35 ","$3,205.35 ",$226.85 ,"$3,205.35 ",$431.02 ,"$2,564.28 ",$567.13 ,$226.85 ,$226.85 ,"$2,828.25 ","$2,677.41 ","$2,677.41 ",$226.85 ,"$2,677.41 ","$3,092.22 ","$3,092.22 ","$3,092.22 ", N/A ,$567.13 ,"$3,205.35 ",$226.85 ,"$3,771.00 ","$2,251.29 ",$226.85 ,"$1,568.74 ",$252.24 ,$229.31 ,$226.85 ,"$3,205.35 ",$476.39 ,"$3,205.35 ","$1,055.88 ","$3,393.90 ",$226.85 ,"$3,092.22 ","$3,186.50 ","$3,186.50 ",$226.85 ,"$2,451.15 ","$3,771.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$4,133.00 ","$2,686.45 ",$229.31 ,"$4,133.00 ",$907.63 ,"$2,686.45 ","$2,467.40 ",$363.05 ,"$1,157.24 ","$2,318.61 ",$363.05 ,"$2,719.51 ",$363.05 ,"$3,513.05 ","$3,513.05 ",$363.05 ,"$3,513.05 ",$689.79 ,"$2,810.44 ",$907.62 ,$363.05 ,$363.05 ,"$3,099.75 ","$2,934.43 ","$2,934.43 ",$363.05 ,"$2,934.43 ","$3,389.06 ","$3,389.06 ","$3,389.06 ", N/A ,$907.62 ,"$3,513.05 ",$363.05 ,"$4,133.00 ","$2,467.40 ",$363.05 ,"$1,719.33 ",$252.24 ,$229.31 ,$363.05 ,"$3,513.05 ",$762.40 ,"$3,513.05 ","$1,157.24 ","$3,719.70 ",$363.05 ,"$3,389.06 ","$3,492.39 ","$3,492.39 ",$363.05 ,"$2,686.45 ","$4,133.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$4,827.00 ","$3,137.55 ",$229.31 ,"$4,827.00 ",$907.63 ,"$3,137.55 ","$2,881.72 ",$363.05 ,"$1,351.56 ","$2,707.95 ",$363.05 ,"$3,176.17 ",$363.05 ,"$4,102.95 ","$4,102.95 ",$363.05 ,"$4,102.95 ",$689.79 ,"$3,282.36 ",$907.62 ,$363.05 ,$363.05 ,"$3,620.25 ","$3,427.17 ","$3,427.17 ",$363.05 ,"$3,427.17 ","$3,958.14 ","$3,958.14 ","$3,958.14 ", N/A ,$907.62 ,"$4,102.95 ",$363.05 ,"$4,827.00 ","$2,881.72 ",$363.05 ,"$2,008.03 ",$252.24 ,$229.31 ,$363.05 ,"$4,102.95 ",$762.40 ,"$4,102.95 ","$1,351.56 ","$4,344.30 ",$363.05 ,"$3,958.14 ","$4,078.82 ","$4,078.82 ",$363.05 ,"$3,137.55 ","$4,827.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$3,771.00 ","$2,451.15 ",$154.77 ,"$3,771.00 ",$567.13 ,"$2,451.15 ","$2,251.29 ",$226.85 ,"$1,055.88 ","$2,115.53 ",$226.85 ,"$2,481.32 ",$226.85 ,"$3,205.35 ","$3,205.35 ",$226.85 ,"$3,205.35 ",$431.02 ,"$2,564.28 ",$567.13 ,$226.85 ,$226.85 ,"$2,828.25 ","$2,677.41 ","$2,677.41 ",$226.85 ,"$2,677.41 ","$3,092.22 ","$3,092.22 ","$3,092.22 ", N/A ,$567.13 ,"$3,205.35 ",$226.85 ,"$3,771.00 ","$2,251.29 ",$226.85 ,"$1,568.74 ",$170.25 ,$154.77 ,$226.85 ,"$3,205.35 ",$476.39 ,"$3,205.35 ","$1,055.88 ","$3,393.90 ",$226.85 ,"$3,092.22 ","$3,186.50 ","$3,186.50 ",$226.85 ,"$2,451.15 ","$3,771.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$4,238.00 ","$2,754.70 ",$154.77 ,"$4,238.00 ","$1,763.33 ","$2,754.70 ","$2,530.09 ",$705.33 ,"$1,186.64 ","$2,377.52 ",$705.33 ,"$2,788.60 ",$705.33 ,"$3,602.30 ","$3,602.30 ",$705.33 ,"$3,602.30 ","$1,340.13 ","$2,881.84 ","$1,763.33 ",$705.33 ,$705.33 ,"$3,178.50 ","$3,008.98 ","$3,008.98 ",$705.33 ,"$3,008.98 ","$3,475.16 ","$3,475.16 ","$3,475.16 ", N/A ,"$1,763.33 ","$3,602.30 ",$705.33 ,"$4,238.00 ","$2,530.09 ",$705.33 ,"$1,763.01 ",$170.25 ,$154.77 ,$705.33 ,"$3,602.30 ","$1,481.19 ","$3,602.30 ","$1,186.64 ","$3,814.20 ",$705.33 ,"$3,475.16 ","$3,581.11 ","$3,581.11 ",$705.33 ,"$2,754.70 ","$4,238.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,827.00 ","$3,137.55 ",$154.77 ,"$4,827.00 ",$907.63 ,"$3,137.55 ","$2,881.72 ",$363.05 ,"$1,351.56 ","$2,707.95 ",$363.05 ,"$3,176.17 ",$363.05 ,"$4,102.95 ","$4,102.95 ",$363.05 ,"$4,102.95 ",$689.79 ,"$3,282.36 ",$907.62 ,$363.05 ,$363.05 ,"$3,620.25 ","$3,427.17 ","$3,427.17 ",$363.05 ,"$3,427.17 ","$3,958.14 ","$3,958.14 ","$3,958.14 ", N/A ,$907.62 ,"$4,102.95 ",$363.05 ,"$4,827.00 ","$2,881.72 ",$363.05 ,"$2,008.03 ",$170.25 ,$154.77 ,$363.05 ,"$4,102.95 ",$762.40 ,"$4,102.95 ","$1,351.56 ","$4,344.30 ",$363.05 ,"$3,958.14 ","$4,078.82 ","$4,078.82 ",$363.05 ,"$3,137.55 ","$4,827.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$3,771.00 ","$2,451.15 ",$226.85 ,"$3,771.00 ",$567.13 ,"$2,451.15 ","$2,251.29 ",$226.85 ,"$1,055.88 ","$2,115.53 ",$226.85 ,"$2,481.32 ",$226.85 ,"$3,205.35 ","$3,205.35 ",$226.85 ,"$3,205.35 ",$431.02 ,"$2,564.28 ",$567.13 ,$226.85 ,$226.85 ,"$2,828.25 ","$2,677.41 ","$2,677.41 ",$226.85 ,"$2,677.41 ","$3,092.22 ","$3,092.22 ","$3,092.22 ", N/A ,$567.13 ,"$3,205.35 ",$226.85 ,"$3,771.00 ","$2,251.29 ",$226.85 ,"$1,568.74 ",$252.24 ,$229.31 ,$226.85 ,"$3,205.35 ",$476.39 ,"$3,205.35 ","$1,055.88 ","$3,393.90 ",$226.85 ,"$3,092.22 ","$3,186.50 ","$3,186.50 ",$226.85 ,"$2,451.15 ","$3,771.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$4,121.00 ","$2,678.65 ",$229.31 ,"$4,121.00 ",$907.63 ,"$2,678.65 ","$2,460.24 ",$363.05 ,"$1,153.88 ","$2,311.88 ",$363.05 ,"$2,711.62 ",$363.05 ,"$3,502.85 ","$3,502.85 ",$363.05 ,"$3,502.85 ",$689.79 ,"$2,802.28 ",$907.62 ,$363.05 ,$363.05 ,"$3,090.75 ","$2,925.91 ","$2,925.91 ",$363.05 ,"$2,925.91 ","$3,379.22 ","$3,379.22 ","$3,379.22 ", N/A ,$907.62 ,"$3,502.85 ",$363.05 ,"$4,121.00 ","$2,460.24 ",$363.05 ,"$1,714.34 ",$252.24 ,$229.31 ,$363.05 ,"$3,502.85 ",$762.40 ,"$3,502.85 ","$1,153.88 ","$3,708.90 ",$363.05 ,"$3,379.22 ","$3,482.25 ","$3,482.25 ",$363.05 ,"$2,678.65 ","$4,121.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$4,827.00 ","$3,137.55 ",$229.31 ,"$4,827.00 ",$907.63 ,"$3,137.55 ","$2,881.72 ",$363.05 ,"$1,351.56 ","$2,707.95 ",$363.05 ,"$3,176.17 ",$363.05 ,"$4,102.95 ","$4,102.95 ",$363.05 ,"$4,102.95 ",$689.79 ,"$3,282.36 ",$907.62 ,$363.05 ,$363.05 ,"$3,620.25 ","$3,427.17 ","$3,427.17 ",$363.05 ,"$3,427.17 ","$3,958.14 ","$3,958.14 ","$3,958.14 ", N/A ,$907.62 ,"$4,102.95 ",$363.05 ,"$4,827.00 ","$2,881.72 ",$363.05 ,"$2,008.03 ",$252.24 ,$229.31 ,$363.05 ,"$4,102.95 ",$762.40 ,"$4,102.95 ","$1,351.56 ","$4,344.30 ",$363.05 ,"$3,958.14 ","$4,078.82 ","$4,078.82 ",$363.05 ,"$3,137.55 ","$4,827.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$3,771.00 ","$2,451.15 ",$154.77 ,"$3,771.00 ",$567.13 ,"$2,451.15 ","$2,251.29 ",$226.85 ,"$1,055.88 ","$2,115.53 ",$226.85 ,"$2,481.32 ",$226.85 ,"$3,205.35 ","$3,205.35 ",$226.85 ,"$3,205.35 ",$431.02 ,"$2,564.28 ",$567.13 ,$226.85 ,$226.85 ,"$2,828.25 ","$2,677.41 ","$2,677.41 ",$226.85 ,"$2,677.41 ","$3,092.22 ","$3,092.22 ","$3,092.22 ", N/A ,$567.13 ,"$3,205.35 ",$226.85 ,"$3,771.00 ","$2,251.29 ",$226.85 ,"$1,568.74 ",$170.25 ,$154.77 ,$226.85 ,"$3,205.35 ",$476.39 ,"$3,205.35 ","$1,055.88 ","$3,393.90 ",$226.85 ,"$3,092.22 ","$3,186.50 ","$3,186.50 ",$226.85 ,"$2,451.15 ","$3,771.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$4,121.00 ","$2,678.65 ",$154.77 ,"$4,121.00 ","$1,763.33 ","$2,678.65 ","$2,460.24 ",$705.33 ,"$1,153.88 ","$2,311.88 ",$705.33 ,"$2,711.62 ",$705.33 ,"$3,502.85 ","$3,502.85 ",$705.33 ,"$3,502.85 ","$1,340.13 ","$2,802.28 ","$1,763.33 ",$705.33 ,$705.33 ,"$3,090.75 ","$2,925.91 ","$2,925.91 ",$705.33 ,"$2,925.91 ","$3,379.22 ","$3,379.22 ","$3,379.22 ", N/A ,"$1,763.33 ","$3,502.85 ",$705.33 ,"$4,121.00 ","$2,460.24 ",$705.33 ,"$1,714.34 ",$170.25 ,$154.77 ,$705.33 ,"$3,502.85 ","$1,481.19 ","$3,502.85 ","$1,153.88 ","$3,708.90 ",$705.33 ,"$3,379.22 ","$3,482.25 ","$3,482.25 ",$705.33 ,"$2,678.65 ","$4,121.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,827.00 ","$3,137.55 ",$154.77 ,"$4,827.00 ",$907.63 ,"$3,137.55 ","$2,881.72 ",$363.05 ,"$1,351.56 ","$2,707.95 ",$363.05 ,"$3,176.17 ",$363.05 ,"$4,102.95 ","$4,102.95 ",$363.05 ,"$4,102.95 ",$689.79 ,"$3,282.36 ",$907.62 ,$363.05 ,$363.05 ,"$3,620.25 ","$3,427.17 ","$3,427.17 ",$363.05 ,"$3,427.17 ","$3,958.14 ","$3,958.14 ","$3,958.14 ", N/A ,$907.62 ,"$4,102.95 ",$363.05 ,"$4,827.00 ","$2,881.72 ",$363.05 ,"$2,008.03 ",$170.25 ,$154.77 ,$363.05 ,"$4,102.95 ",$762.40 ,"$4,102.95 ","$1,351.56 ","$4,344.30 ",$363.05 ,"$3,958.14 ","$4,078.82 ","$4,078.82 ",$363.05 ,"$3,137.55 ","$4,827.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,698.00 ","$2,403.70 ",$226.85 ,"$3,698.00 ",$567.13 ,"$2,403.70 ","$2,207.71 ",$226.85 ,"$1,035.44 ","$2,074.58 ",$226.85 ,"$2,433.28 ",$226.85 ,"$3,143.30 ","$3,143.30 ",$226.85 ,"$3,143.30 ",$431.02 ,"$2,514.64 ",$567.13 ,$226.85 ,$226.85 ,"$2,773.50 ","$2,625.58 ","$2,625.58 ",$226.85 ,"$2,625.58 ","$3,032.36 ","$3,032.36 ","$3,032.36 ", N/A ,$567.13 ,"$3,143.30 ",$226.85 ,"$3,698.00 ","$2,207.71 ",$226.85 ,"$1,538.37 ",$302.32 ,$274.84 ,$226.85 ,"$3,143.30 ",$476.39 ,"$3,143.30 ","$1,035.44 ","$3,328.20 ",$226.85 ,"$3,032.36 ","$3,124.81 ","$3,124.81 ",$226.85 ,"$2,403.70 ","$3,698.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$4,163.00 ","$2,705.95 ",$274.84 ,"$4,163.00 ",$907.63 ,"$2,705.95 ","$2,485.31 ",$363.05 ,"$1,165.64 ","$2,335.44 ",$363.05 ,"$2,739.25 ",$363.05 ,"$3,538.55 ","$3,538.55 ",$363.05 ,"$3,538.55 ",$689.79 ,"$2,830.84 ",$907.62 ,$363.05 ,$363.05 ,"$3,122.25 ","$2,955.73 ","$2,955.73 ",$363.05 ,"$2,955.73 ","$3,413.66 ","$3,413.66 ","$3,413.66 ", N/A ,$907.62 ,"$3,538.55 ",$363.05 ,"$4,163.00 ","$2,485.31 ",$363.05 ,"$1,731.81 ",$302.32 ,$274.84 ,$363.05 ,"$3,538.55 ",$762.40 ,"$3,538.55 ","$1,165.64 ","$3,746.70 ",$363.05 ,"$3,413.66 ","$3,517.74 ","$3,517.74 ",$363.05 ,"$2,705.95 ","$4,163.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$4,789.00 ","$3,112.85 ",$274.84 ,"$4,789.00 ",$907.63 ,"$3,112.85 ","$2,859.03 ",$363.05 ,"$1,340.92 ","$2,686.63 ",$363.05 ,"$3,151.16 ",$363.05 ,"$4,070.65 ","$4,070.65 ",$363.05 ,"$4,070.65 ",$689.79 ,"$3,256.52 ",$907.62 ,$363.05 ,$363.05 ,"$3,591.75 ","$3,400.19 ","$3,400.19 ",$363.05 ,"$3,400.19 ","$3,926.98 ","$3,926.98 ","$3,926.98 ", N/A ,$907.62 ,"$4,070.65 ",$363.05 ,"$4,789.00 ","$2,859.03 ",$363.05 ,"$1,992.22 ",$302.32 ,$274.84 ,$363.05 ,"$4,070.65 ",$762.40 ,"$4,070.65 ","$1,340.92 ","$4,310.10 ",$363.05 ,"$3,926.98 ","$4,046.71 ","$4,046.71 ",$363.05 ,"$3,112.85 ","$4,789.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000050,C8937,HC MRI BREAST CAD,610,1 ,$151.00 ,$98.15 ,$42.28 ,$151.00 , N/A ,$98.15 ,$90.15 , N/A ,$42.28 ,$84.71 , N/A ,$99.36 , N/A ,$128.35 ,$128.35 , N/A ,$128.35 , N/A ,$102.68 , N/A , N/A , N/A ,$113.25 ,$107.21 ,$107.21 , N/A ,$107.21 ,$123.82 ,$123.82 ,$123.82 , N/A , N/A ,$128.35 , N/A ,$151.00 ,$90.15 , N/A ,$62.82 , N/A , N/A , N/A ,$128.35 , N/A ,$128.35 ,$42.28 ,$135.90 , N/A ,$123.82 ,$127.60 ,$127.60 , N/A ,$98.15 ,$151.00 
ST. JOSEPH'S HOSPITAL - BREESE,61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,684.00 ","$2,394.60 ",$296.52 ,"$3,684.00 ",$907.63 ,"$2,394.60 ","$2,199.35 ",$363.05 ,"$1,031.52 ","$2,066.72 ",$363.05 ,"$2,424.07 ",$363.05 ,"$3,131.40 ","$3,131.40 ",$363.05 ,"$3,131.40 ",$689.79 ,"$2,505.12 ",$907.62 ,$363.05 ,$363.05 ,"$2,763.00 ","$2,615.64 ","$2,615.64 ",$363.05 ,"$2,615.64 ","$3,020.88 ","$3,020.88 ","$3,020.88 ", N/A ,$907.62 ,"$3,131.40 ",$363.05 ,"$3,684.00 ","$2,199.35 ",$363.05 ,"$1,532.54 ",$326.17 ,$296.52 ,$363.05 ,"$3,131.40 ",$762.40 ,"$3,131.40 ","$1,031.52 ","$3,315.60 ",$363.05 ,"$3,020.88 ","$3,112.98 ","$3,112.98 ",$363.05 ,"$2,394.60 ","$3,684.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$3,460.00 ","$2,249.00 ",$226.85 ,"$3,460.00 ",$567.13 ,"$2,249.00 ","$2,065.62 ",$226.85 ,$968.80 ,"$1,941.06 ",$226.85 ,"$2,276.68 ",$226.85 ,"$2,941.00 ","$2,941.00 ",$226.85 ,"$2,941.00 ",$431.02 ,"$2,352.80 ",$567.13 ,$226.85 ,$226.85 ,"$2,595.00 ","$2,456.60 ","$2,456.60 ",$226.85 ,"$2,456.60 ","$2,837.20 ","$2,837.20 ","$2,837.20 ", N/A ,$567.13 ,"$2,941.00 ",$226.85 ,"$3,460.00 ","$2,065.62 ",$226.85 ,"$1,439.36 ",$326.17 ,$296.52 ,$226.85 ,"$2,941.00 ",$476.39 ,"$2,941.00 ",$968.80 ,"$3,114.00 ",$226.85 ,"$2,837.20 ","$2,923.70 ","$2,923.70 ",$226.85 ,"$2,249.00 ","$3,460.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$3,908.00 ","$2,540.20 ",$296.52 ,"$3,908.00 ",$907.63 ,"$2,540.20 ","$2,333.08 ",$363.05 ,"$1,094.24 ","$2,192.39 ",$363.05 ,"$2,571.46 ",$363.05 ,"$3,321.80 ","$3,321.80 ",$363.05 ,"$3,321.80 ",$689.79 ,"$2,657.44 ",$907.62 ,$363.05 ,$363.05 ,"$2,931.00 ","$2,774.68 ","$2,774.68 ",$363.05 ,"$2,774.68 ","$3,204.56 ","$3,204.56 ","$3,204.56 ", N/A ,$907.62 ,"$3,321.80 ",$363.05 ,"$3,908.00 ","$2,333.08 ",$363.05 ,"$1,625.73 ",$326.17 ,$296.52 ,$363.05 ,"$3,321.80 ",$762.40 ,"$3,321.80 ","$1,094.24 ","$3,517.20 ",$363.05 ,"$3,204.56 ","$3,302.26 ","$3,302.26 ",$363.05 ,"$2,540.20 ","$3,908.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000054,C8903,HC MRI BREAST UNI W/CONTRAST,610,1 ,"$3,089.00 ","$2,007.85 ",$176.10 ,"$3,089.00 ",$440.25 ,"$2,007.85 ","$1,844.13 ",$176.10 ,$864.92 ,"$1,732.93 ",$176.10 ,"$2,032.56 ",$176.10 ,"$2,625.65 ","$2,625.65 ",$176.10 ,"$2,625.65 ",$334.60 ,"$2,100.52 ",$440.26 ,$176.10 ,$176.10 ,"$2,316.75 ","$2,193.19 ","$2,193.19 ",$176.10 ,"$2,193.19 ","$2,532.98 ","$2,532.98 ","$2,532.98 ", N/A ,$440.26 ,"$2,625.65 ",$176.10 ,"$3,089.00 ","$1,844.13 ",$176.10 ,"$1,285.02 ",$252.24 ,$229.31 ,$176.10 ,"$2,625.65 ",$369.82 ,"$2,625.65 ",$864.92 ,"$2,780.10 ",$176.10 ,"$2,532.98 ","$2,610.21 ","$2,610.21 ",$176.10 ,"$2,007.85 ","$3,089.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$4,429.00 ","$2,878.85 ",$229.31 ,"$4,429.00 ",$907.63 ,"$2,878.85 ","$2,644.11 ",$363.05 ,"$1,240.12 ","$2,484.67 ",$363.05 ,"$2,914.28 ",$363.05 ,"$3,764.65 ","$3,764.65 ",$363.05 ,"$3,764.65 ",$689.79 ,"$3,011.72 ",$907.62 ,$363.05 ,$363.05 ,"$3,321.75 ","$3,144.59 ","$3,144.59 ",$363.05 ,"$3,144.59 ","$3,631.78 ","$3,631.78 ","$3,631.78 ", N/A ,$907.62 ,"$3,764.65 ",$363.05 ,"$4,429.00 ","$2,644.11 ",$363.05 ,"$1,842.46 ",$252.24 ,$229.31 ,$363.05 ,"$3,764.65 ",$762.40 ,"$3,764.65 ","$1,240.12 ","$3,986.10 ",$363.05 ,"$3,631.78 ","$3,742.51 ","$3,742.51 ",$363.05 ,"$2,878.85 ","$4,429.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$3,811.00 ","$2,477.15 ",$260.82 ,"$3,811.00 ",$907.63 ,"$2,477.15 ","$2,275.17 ",$363.05 ,"$1,067.08 ","$2,137.97 ",$363.05 ,"$2,507.64 ",$363.05 ,"$3,239.35 ","$3,239.35 ",$363.05 ,"$3,239.35 ",$689.79 ,"$2,591.48 ",$907.62 ,$363.05 ,$363.05 ,"$2,858.25 ","$2,705.81 ","$2,705.81 ",$363.05 ,"$2,705.81 ","$3,125.02 ","$3,125.02 ","$3,125.02 ", N/A ,$907.62 ,"$3,239.35 ",$363.05 ,"$3,811.00 ","$2,275.17 ",$363.05 ,"$1,585.38 ",$286.90 ,$260.82 ,$363.05 ,"$3,239.35 ",$762.40 ,"$3,239.35 ","$1,067.08 ","$3,429.90 ",$363.05 ,"$3,125.02 ","$3,220.30 ","$3,220.30 ",$363.05 ,"$2,477.15 ","$3,811.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000061,C8910,HC MRA CHEST W/O CONTRAST,610,1 ,"$3,460.00 ","$2,249.00 ",$226.85 ,"$3,460.00 ",$567.13 ,"$2,249.00 ","$2,065.62 ",$226.85 ,$968.80 ,"$1,941.06 ",$226.85 ,"$2,276.68 ",$226.85 ,"$2,941.00 ","$2,941.00 ",$226.85 ,"$2,941.00 ",$431.02 ,"$2,352.80 ",$567.13 ,$226.85 ,$226.85 ,"$2,595.00 ","$2,456.60 ","$2,456.60 ",$226.85 ,"$2,456.60 ","$2,837.20 ","$2,837.20 ","$2,837.20 ", N/A ,$567.13 ,"$2,941.00 ",$226.85 ,"$3,460.00 ","$2,065.62 ",$226.85 ,"$1,439.36 ",$286.90 ,$260.82 ,$226.85 ,"$2,941.00 ",$476.39 ,"$2,941.00 ",$968.80 ,"$3,114.00 ",$226.85 ,"$2,837.20 ","$2,923.70 ","$2,923.70 ",$226.85 ,"$2,249.00 ","$3,460.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000062,C8911,HC MRA CHEST W AND W/O CONTRAST,610,1 ,"$4,218.00 ","$2,741.70 ",$260.82 ,"$4,218.00 ",$907.63 ,"$2,741.70 ","$2,518.15 ",$363.05 ,"$1,181.04 ","$2,366.30 ",$363.05 ,"$2,775.44 ",$363.05 ,"$3,585.30 ","$3,585.30 ",$363.05 ,"$3,585.30 ",$689.79 ,"$2,868.24 ",$907.62 ,$363.05 ,$363.05 ,"$3,163.50 ","$2,994.78 ","$2,994.78 ",$363.05 ,"$2,994.78 ","$3,458.76 ","$3,458.76 ","$3,458.76 ", N/A ,$907.62 ,"$3,585.30 ",$363.05 ,"$4,218.00 ","$2,518.15 ",$363.05 ,"$1,754.69 ",$286.90 ,$260.82 ,$363.05 ,"$3,585.30 ",$762.40 ,"$3,585.30 ","$1,181.04 ","$3,796.20 ",$363.05 ,"$3,458.76 ","$3,564.21 ","$3,564.21 ",$363.05 ,"$2,741.70 ","$4,218.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000064,C8913,HC MRA LWR EXT W/O CON,610,1 ,"$3,460.00 ","$2,249.00 ",$226.85 ,"$3,460.00 ",$567.13 ,"$2,249.00 ","$2,065.62 ",$226.85 ,$968.80 ,"$1,941.06 ",$226.85 ,"$2,276.68 ",$226.85 ,"$2,941.00 ","$2,941.00 ",$226.85 ,"$2,941.00 ",$431.02 ,"$2,352.80 ",$567.13 ,$226.85 ,$226.85 ,"$2,595.00 ","$2,456.60 ","$2,456.60 ",$226.85 ,"$2,456.60 ","$2,837.20 ","$2,837.20 ","$2,837.20 ", N/A ,$567.13 ,"$2,941.00 ",$226.85 ,"$3,460.00 ","$2,065.62 ",$226.85 ,"$1,439.36 ",$326.17 ,$296.52 ,$226.85 ,"$2,941.00 ",$476.39 ,"$2,941.00 ",$968.80 ,"$3,114.00 ",$226.85 ,"$2,837.20 ","$2,923.70 ","$2,923.70 ",$226.85 ,"$2,249.00 ","$3,460.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$3,927.00 ","$2,552.55 ",$296.52 ,"$3,927.00 ",$907.63 ,"$2,552.55 ","$2,344.42 ",$363.05 ,"$1,099.56 ","$2,203.05 ",$363.05 ,"$2,583.97 ",$363.05 ,"$3,337.95 ","$3,337.95 ",$363.05 ,"$3,337.95 ",$689.79 ,"$2,670.36 ",$907.62 ,$363.05 ,$363.05 ,"$2,945.25 ","$2,788.17 ","$2,788.17 ",$363.05 ,"$2,788.17 ","$3,220.14 ","$3,220.14 ","$3,220.14 ", N/A ,$907.62 ,"$3,337.95 ",$363.05 ,"$3,927.00 ","$2,344.42 ",$363.05 ,"$1,633.63 ",$326.17 ,$296.52 ,$363.05 ,"$3,337.95 ",$762.40 ,"$3,337.95 ","$1,099.56 ","$3,534.30 ",$363.05 ,"$3,220.14 ","$3,318.32 ","$3,318.32 ",$363.05 ,"$2,552.55 ","$3,927.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000070,C8920,HC MRA PELVIS W AND W/O CONTRAST,610,1 ,"$4,429.00 ","$2,878.85 ",$296.52 ,"$4,429.00 ",$907.63 ,"$2,878.85 ","$2,644.11 ",$363.05 ,"$1,240.12 ","$2,484.67 ",$363.05 ,"$2,914.28 ",$363.05 ,"$3,764.65 ","$3,764.65 ",$363.05 ,"$3,764.65 ",$689.79 ,"$3,011.72 ",$907.62 ,$363.05 ,$363.05 ,"$3,321.75 ","$3,144.59 ","$3,144.59 ",$363.05 ,"$3,144.59 ","$3,631.78 ","$3,631.78 ","$3,631.78 ", N/A ,$907.62 ,"$3,764.65 ",$363.05 ,"$4,429.00 ","$2,644.11 ",$363.05 ,"$1,842.46 ",$326.17 ,$296.52 ,$363.05 ,"$3,764.65 ",$762.40 ,"$3,764.65 ","$1,240.12 ","$3,986.10 ",$363.05 ,"$3,631.78 ","$3,742.51 ","$3,742.51 ",$363.05 ,"$2,878.85 ","$4,429.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$5,114.00 ","$3,324.10 ",$256.93 ,"$5,114.00 ",$907.63 ,"$3,324.10 ","$3,053.06 ",$363.05 ,"$1,431.92 ","$2,868.95 ",$363.05 ,"$3,365.01 ",$363.05 ,"$4,346.90 ","$4,346.90 ",$363.05 ,"$4,346.90 ",$689.79 ,"$3,477.52 ",$907.62 ,$363.05 ,$363.05 ,"$3,835.50 ","$3,630.94 ","$3,630.94 ",$363.05 ,"$3,630.94 ","$4,193.48 ","$4,193.48 ","$4,193.48 ", N/A ,$907.62 ,"$4,346.90 ",$363.05 ,"$5,114.00 ","$3,053.06 ",$363.05 ,"$2,127.42 ",$282.62 ,$256.93 ,$363.05 ,"$4,346.90 ",$762.40 ,"$4,346.90 ","$1,431.92 ","$4,602.60 ",$363.05 ,"$4,193.48 ","$4,321.33 ","$4,321.33 ",$363.05 ,"$3,324.10 ","$5,114.00 "
ST. JOSEPH'S HOSPITAL - BREESE,61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$4,091.00 ","$2,659.15 ",$229.31 ,"$4,091.00 ",$907.63 ,"$2,659.15 ","$2,442.33 ",$363.05 ,"$1,145.48 ","$2,295.05 ",$363.05 ,"$2,691.88 ",$363.05 ,"$3,477.35 ","$3,477.35 ",$363.05 ,"$3,477.35 ",$689.79 ,"$2,781.88 ",$907.62 ,$363.05 ,$363.05 ,"$3,068.25 ","$2,904.61 ","$2,904.61 ",$363.05 ,"$2,904.61 ","$3,354.62 ","$3,354.62 ","$3,354.62 ", N/A ,$907.62 ,"$3,477.35 ",$363.05 ,"$4,091.00 ","$2,442.33 ",$363.05 ,"$1,701.86 ",$252.24 ,$229.31 ,$363.05 ,"$3,477.35 ",$762.40 ,"$3,477.35 ","$1,145.48 ","$3,681.90 ",$363.05 ,"$3,354.62 ","$3,456.90 ","$3,456.90 ",$363.05 ,"$2,659.15 ","$4,091.00 "
ST. JOSEPH'S HOSPITAL - BREESE,63600019,M1145,"HC MFN DRUG ADD-ON, PER DOSE",636,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,71000221,N/A,HC C-SECTION RECOVERY 30 MIN,710,1 ,"$1,376.00 ",$894.40 ,$385.28 ,"$1,376.00 ", N/A ,$894.40 ,$821.47 , N/A ,$385.28 ,$771.94 , N/A ,$905.41 , N/A ,"$1,169.60 ","$1,169.60 ", N/A ,"$1,169.60 ", N/A ,$935.68 , N/A , N/A , N/A ,"$1,032.00 ",$976.96 ,$976.96 , N/A ,$976.96 ,"$1,128.32 ","$1,128.32 ","$1,128.32 ", N/A , N/A ,"$1,169.60 ", N/A ,"$1,376.00 ",$821.47 , N/A ,$572.42 , N/A , N/A , N/A ,"$1,169.60 ", N/A ,"$1,169.60 ",$385.28 ,"$1,238.40 ", N/A ,"$1,128.32 ","$1,162.72 ","$1,162.72 ", N/A ,$894.40 ,"$1,376.00 "
ST. JOSEPH'S HOSPITAL - BREESE,71000230,N/A,HC PHASE II RECOVERY 15 MIN,710,1 ,$167.00 ,$108.55 ,$46.76 ,$167.00 , N/A ,$108.55 ,$99.70 , N/A ,$46.76 ,$93.69 , N/A ,$109.89 , N/A ,$141.95 ,$141.95 , N/A ,$141.95 , N/A ,$113.56 , N/A , N/A , N/A ,$125.25 ,$118.57 ,$118.57 , N/A ,$118.57 ,$136.94 ,$136.94 ,$136.94 , N/A , N/A ,$141.95 , N/A ,$167.00 ,$99.70 , N/A ,$69.47 , N/A , N/A , N/A ,$141.95 , N/A ,$141.95 ,$46.76 ,$150.30 , N/A ,$136.94 ,$141.12 ,$141.12 , N/A ,$108.55 ,$167.00 
ST. JOSEPH'S HOSPITAL - BREESE,71000231,N/A,HC RECOVERY <75 MIN,710,1 ,$895.00 ,$581.75 ,$250.60 ,$895.00 , N/A ,$581.75 ,$534.32 , N/A ,$250.60 ,$502.10 , N/A ,$588.91 , N/A ,$760.75 ,$760.75 , N/A ,$760.75 , N/A ,$608.60 , N/A , N/A , N/A ,$671.25 ,$635.45 ,$635.45 , N/A ,$635.45 ,$733.90 ,$733.90 ,$733.90 , N/A , N/A ,$760.75 , N/A ,$895.00 ,$534.32 , N/A ,$372.32 , N/A , N/A , N/A ,$760.75 , N/A ,$760.75 ,$250.60 ,$805.50 , N/A ,$733.90 ,$756.28 ,$756.28 , N/A ,$581.75 ,$895.00 
ST. JOSEPH'S HOSPITAL - BREESE,71000232,N/A,HC RECOVERY >75 MIN,710,1 ,$175.00 ,$113.75 ,$49.00 ,$175.00 , N/A ,$113.75 ,$104.48 , N/A ,$49.00 ,$98.18 , N/A ,$115.15 , N/A ,$148.75 ,$148.75 , N/A ,$148.75 , N/A ,$119.00 , N/A , N/A , N/A ,$131.25 ,$124.25 ,$124.25 , N/A ,$124.25 ,$143.50 ,$143.50 ,$143.50 , N/A , N/A ,$148.75 , N/A ,$175.00 ,$104.48 , N/A ,$72.80 , N/A , N/A , N/A ,$148.75 , N/A ,$148.75 ,$49.00 ,$157.50 , N/A ,$143.50 ,$147.88 ,$147.88 , N/A ,$113.75 ,$175.00 
ST. JOSEPH'S HOSPITAL - BREESE,71000233,N/A,HC PHASE I RECOVERY 30 MIN,710,1 ,"$1,279.00 ",$831.35 ,$358.12 ,"$1,279.00 ", N/A ,$831.35 ,$763.56 , N/A ,$358.12 ,$717.52 , N/A ,$841.58 , N/A ,"$1,087.15 ","$1,087.15 ", N/A ,"$1,087.15 ", N/A ,$869.72 , N/A , N/A , N/A ,$959.25 ,$908.09 ,$908.09 , N/A ,$908.09 ,"$1,048.78 ","$1,048.78 ","$1,048.78 ", N/A , N/A ,"$1,087.15 ", N/A ,"$1,279.00 ",$763.56 , N/A ,$532.06 , N/A , N/A , N/A ,"$1,087.15 ", N/A ,"$1,087.15 ",$358.12 ,"$1,151.10 ", N/A ,"$1,048.78 ","$1,080.76 ","$1,080.76 ", N/A ,$831.35 ,"$1,279.00 "
ST. JOSEPH'S HOSPITAL - BREESE,71000234,N/A,HC PHASE I RECOVERY 15 MIN,710,1 ,$247.00 ,$160.55 ,$69.16 ,$247.00 , N/A ,$160.55 ,$147.46 , N/A ,$69.16 ,$138.57 , N/A ,$162.53 , N/A ,$209.95 ,$209.95 , N/A ,$209.95 , N/A ,$167.96 , N/A , N/A , N/A ,$185.25 ,$175.37 ,$175.37 , N/A ,$175.37 ,$202.54 ,$202.54 ,$202.54 , N/A , N/A ,$209.95 , N/A ,$247.00 ,$147.46 , N/A ,$102.75 , N/A , N/A , N/A ,$209.95 , N/A ,$209.95 ,$69.16 ,$222.30 , N/A ,$202.54 ,$208.72 ,$208.72 , N/A ,$160.55 ,$247.00 
ST. JOSEPH'S HOSPITAL - BREESE,71000252,N/A,HC RECOVERY EXTENDED INIT HR,710,1 ,$42.00 ,$27.30 ,$11.76 ,$42.00 , N/A ,$27.30 ,$25.07 , N/A ,$11.76 ,$23.56 , N/A ,$27.64 , N/A ,$35.70 ,$35.70 , N/A ,$35.70 , N/A ,$28.56 , N/A , N/A , N/A ,$31.50 ,$29.82 ,$29.82 , N/A ,$29.82 ,$34.44 ,$34.44 ,$34.44 , N/A , N/A ,$35.70 , N/A ,$42.00 ,$25.07 , N/A ,$17.47 , N/A , N/A , N/A ,$35.70 , N/A ,$35.70 ,$11.76 ,$37.80 , N/A ,$34.44 ,$35.49 ,$35.49 , N/A ,$27.30 ,$42.00 
ST. JOSEPH'S HOSPITAL - BREESE,71000253,N/A,HC RECOVERY EXTENDED ADDL HR,710,1 ,$38.00 ,$24.70 ,$10.64 ,$38.00 , N/A ,$24.70 ,$22.69 , N/A ,$10.64 ,$21.32 , N/A ,$25.00 , N/A ,$32.30 ,$32.30 , N/A ,$32.30 , N/A ,$25.84 , N/A , N/A , N/A ,$28.50 ,$26.98 ,$26.98 , N/A ,$26.98 ,$31.16 ,$31.16 ,$31.16 , N/A , N/A ,$32.30 , N/A ,$38.00 ,$22.69 , N/A ,$15.81 , N/A , N/A , N/A ,$32.30 , N/A ,$32.30 ,$10.64 ,$34.20 , N/A ,$31.16 ,$32.11 ,$32.11 , N/A ,$24.70 ,$38.00 
ST. JOSEPH'S HOSPITAL - BREESE,71000256,N/A,HC C-SECTION RECOVERY ADDL 15MIN,710,1 ,$262.00 ,$170.30 ,$73.36 ,$262.00 , N/A ,$170.30 ,$156.41 , N/A ,$73.36 ,$146.98 , N/A ,$172.40 , N/A ,$222.70 ,$222.70 , N/A ,$222.70 , N/A ,$178.16 , N/A , N/A , N/A ,$196.50 ,$186.02 ,$186.02 , N/A ,$186.02 ,$214.84 ,$214.84 ,$214.84 , N/A , N/A ,$222.70 , N/A ,$262.00 ,$156.41 , N/A ,$108.99 , N/A , N/A , N/A ,$222.70 , N/A ,$222.70 ,$73.36 ,$235.80 , N/A ,$214.84 ,$221.39 ,$221.39 , N/A ,$170.30 ,$262.00 
ST. JOSEPH'S HOSPITAL - BREESE,72000008,59412,HC EXTERNAL CEPHALIC VERSION,720,1 ,$806.00 ,$523.90 ,$225.68 ,"$6,466.58 ","$6,466.58 ",$523.90 ,$481.18 ,"$2,586.63 ",$225.68 ,$452.17 ,"$2,586.63 ",$530.35 ,$806.00 ,$685.10 ,$685.10 ,$806.00 ,$685.10 ,$806.00 ,$548.08 ,"$6,466.58 ","$2,586.63 ","$2,586.63 ",$604.50 ,$572.26 ,$572.26 ,"$2,586.63 ",$572.26 ,$660.92 ,$660.92 ,$660.92 , N/A ,$806.00 ,$685.10 ,"$2,586.63 ",$806.00 ,$481.18 ,"$2,586.63 ",$335.30 , N/A , N/A ,"$2,586.63 ",$685.10 ,"$5,431.93 ",$685.10 ,$225.68 ,$725.40 ,"$2,586.63 ",$660.92 ,$681.07 ,$681.07 ,"$2,586.63 ",$523.90 ,$806.00 
ST. JOSEPH'S HOSPITAL - BREESE,72000013,N/A,HC DELIVERY COMPLICATED,720,1 ,"$3,448.00 ","$2,241.20 ",$965.44 ,"$3,448.00 ", N/A ,"$2,241.20 ","$2,058.46 ", N/A ,$965.44 ,"$1,934.33 ", N/A ,"$2,268.78 ", N/A ,"$2,930.80 ","$2,930.80 ", N/A ,"$2,930.80 ", N/A ,"$2,344.64 ", N/A , N/A , N/A ,"$2,586.00 ","$2,448.08 ","$2,448.08 ", N/A ,"$2,448.08 ","$2,827.36 ","$2,827.36 ","$2,827.36 ", N/A , N/A ,"$2,930.80 ", N/A ,"$3,448.00 ","$2,058.46 ", N/A ,"$1,434.37 ", N/A , N/A , N/A ,"$2,930.80 ", N/A ,"$2,930.80 ",$965.44 ,"$3,103.20 ", N/A ,"$2,827.36 ","$2,913.56 ","$2,913.56 ", N/A ,"$2,241.20 ","$3,448.00 "
ST. JOSEPH'S HOSPITAL - BREESE,72100005,N/A,HC LABOR PER HR,721,1 ,$131.00 ,$85.15 ,$36.68 ,$131.00 , N/A ,$85.15 ,$78.21 , N/A ,$36.68 ,$73.49 , N/A ,$86.20 , N/A ,$111.35 ,$111.35 , N/A ,$111.35 , N/A ,$89.08 , N/A , N/A , N/A ,$98.25 ,$93.01 ,$93.01 , N/A ,$93.01 ,$107.42 ,$107.42 ,$107.42 , N/A , N/A ,$111.35 , N/A ,$131.00 ,$78.21 , N/A ,$54.50 , N/A , N/A , N/A ,$111.35 , N/A ,$111.35 ,$36.68 ,$117.90 , N/A ,$107.42 ,$110.70 ,$110.70 , N/A ,$85.15 ,$131.00 
ST. JOSEPH'S HOSPITAL - BREESE,72200009,N/A,HC DELIVERY,722,1 ,"$3,105.00 ","$2,018.25 ",$869.40 ,"$3,105.00 ", N/A ,"$2,018.25 ","$1,853.69 ", N/A ,$869.40 ,"$1,741.91 ", N/A ,"$2,043.09 ", N/A ,"$2,639.25 ","$2,639.25 ", N/A ,"$2,639.25 ", N/A ,"$2,111.40 ", N/A , N/A , N/A ,"$2,328.75 ","$2,204.55 ","$2,204.55 ", N/A ,"$2,204.55 ","$2,546.10 ","$2,546.10 ","$2,546.10 ", N/A , N/A ,"$2,639.25 ", N/A ,"$3,105.00 ","$1,853.69 ", N/A ,"$1,291.68 ", N/A , N/A , N/A ,"$2,639.25 ", N/A ,"$2,639.25 ",$869.40 ,"$2,794.50 ", N/A ,"$2,546.10 ","$2,623.73 ","$2,623.73 ", N/A ,"$2,018.25 ","$3,105.00 "
ST. JOSEPH'S HOSPITAL - BREESE,72200014,N/A,HC C-SECTION,722,1 ,"$8,077.00 ","$5,250.05 ","$2,261.56 ","$8,077.00 ", N/A ,"$5,250.05 ","$4,821.97 ", N/A ,"$2,261.56 ","$4,531.20 ", N/A ,"$5,314.67 ", N/A ,"$6,865.45 ","$6,865.45 ", N/A ,"$6,865.45 ", N/A ,"$5,492.36 ", N/A , N/A , N/A ,"$6,057.75 ","$5,734.67 ","$5,734.67 ", N/A ,"$5,734.67 ","$6,623.14 ","$6,623.14 ","$6,623.14 ", N/A , N/A ,"$6,865.45 ", N/A ,"$8,077.00 ","$4,821.97 ", N/A ,"$3,360.03 ", N/A , N/A , N/A ,"$6,865.45 ", N/A ,"$6,865.45 ","$2,261.56 ","$7,269.30 ", N/A ,"$6,623.14 ","$6,825.07 ","$6,825.07 ", N/A ,"$5,250.05 ","$8,077.00 "
ST. JOSEPH'S HOSPITAL - BREESE,72200015,N/A,HC C-SECTION COMPLICATED,722,1 ,"$8,780.00 ","$5,707.00 ","$2,458.40 ","$8,780.00 ", N/A ,"$5,707.00 ","$5,241.66 ", N/A ,"$2,458.40 ","$4,925.58 ", N/A ,"$5,777.24 ", N/A ,"$7,463.00 ","$7,463.00 ", N/A ,"$7,463.00 ", N/A ,"$5,970.40 ", N/A , N/A , N/A ,"$6,585.00 ","$6,233.80 ","$6,233.80 ", N/A ,"$6,233.80 ","$7,199.60 ","$7,199.60 ","$7,199.60 ", N/A , N/A ,"$7,463.00 ", N/A ,"$8,780.00 ","$5,241.66 ", N/A ,"$3,652.48 ", N/A , N/A , N/A ,"$7,463.00 ", N/A ,"$7,463.00 ","$2,458.40 ","$7,902.00 ", N/A ,"$7,199.60 ","$7,419.10 ","$7,419.10 ", N/A ,"$5,707.00 ","$8,780.00 "
ST. JOSEPH'S HOSPITAL - BREESE,72300002,54160,HC CIRCUMCISION,723,1 ,$467.00 ,$303.55 ,$130.76 ,"$1,417.96 ","$1,417.95 ",$303.55 ,$278.80 ,$567.18 ,$130.76 ,$261.99 ,$567.18 ,$307.29 ,$467.00 ,$396.95 ,$396.95 ,$467.00 ,$396.95 ,$467.00 ,$317.56 ,"$1,417.96 ",$567.18 ,$567.18 ,$350.25 ,$331.57 ,$331.57 ,$567.18 ,$331.57 ,$382.94 ,$382.94 ,$382.94 , N/A ,$467.00 ,$396.95 ,$567.18 ,$467.00 ,$278.80 ,$567.18 ,$194.27 , N/A , N/A ,$567.18 ,$396.95 ,"$1,191.09 ",$396.95 ,$130.76 ,$420.30 ,$567.18 ,$382.94 ,$394.62 ,$394.62 ,$567.18 ,$303.55 ,$467.00 
ST. JOSEPH'S HOSPITAL - BREESE,73000002,93005,HC EKG,730,1 ,$354.00 ,$230.10 ,$17.05 ,$354.00 ,$137.20 ,$230.10 ,$211.34 ,$54.88 ,$99.12 ,$198.59 ,$54.88 ,$232.93 ,$54.88 ,$300.90 ,$300.90 ,$54.88 ,$300.90 ,$104.27 ,$240.72 ,$137.20 ,$54.88 ,$54.88 ,$265.50 ,$251.34 ,$251.34 ,$54.88 ,$251.34 ,$290.28 ,$290.28 ,$290.28 , N/A ,$137.20 ,$300.90 ,$54.88 ,$354.00 ,$211.34 ,$54.88 ,$147.26 ,$18.76 ,$17.05 ,$54.88 ,$300.90 ,$115.24 ,$300.90 ,$99.12 ,$318.60 ,$54.88 ,$290.28 ,$299.13 ,$299.13 ,$54.88 ,$230.10 ,$354.00 
ST. JOSEPH'S HOSPITAL - BREESE,73000003,93041,HC EKG RHYTHM STRIP TRACING,730,1 ,$273.00 ,$177.45 ,$17.05 ,$273.00 ,$137.20 ,$177.45 ,$162.98 ,$54.88 ,$76.44 ,$153.15 ,$54.88 ,$179.63 ,$54.88 ,$232.05 ,$232.05 ,$54.88 ,$232.05 ,$104.27 ,$185.64 ,$137.20 ,$54.88 ,$54.88 ,$204.75 ,$193.83 ,$193.83 ,$54.88 ,$193.83 ,$223.86 ,$223.86 ,$223.86 , N/A ,$137.20 ,$232.05 ,$54.88 ,$273.00 ,$162.98 ,$54.88 ,$113.57 ,$18.76 ,$17.05 ,$54.88 ,$232.05 ,$115.24 ,$232.05 ,$76.44 ,$245.70 ,$54.88 ,$223.86 ,$230.69 ,$230.69 ,$54.88 ,$177.45 ,$273.00 
ST. JOSEPH'S HOSPITAL - BREESE,73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$758.00 ,$492.70 ,$45.73 ,$758.00 ,$277.93 ,$492.70 ,$452.53 ,$111.17 ,$212.24 ,$425.24 ,$111.17 ,$498.76 ,$111.17 ,$644.30 ,$644.30 ,$111.17 ,$644.30 ,$211.22 ,$515.44 ,$277.92 ,$111.17 ,$111.17 ,$568.50 ,$538.18 ,$538.18 ,$111.17 ,$538.18 ,$621.56 ,$621.56 ,$621.56 , N/A ,$277.92 ,$644.30 ,$111.17 ,$758.00 ,$452.53 ,$111.17 ,$315.33 ,$50.30 ,$45.73 ,$111.17 ,$644.30 ,$233.45 ,$644.30 ,$212.24 ,$682.20 ,$111.17 ,$621.56 ,$640.51 ,$640.51 ,$111.17 ,$492.70 ,$758.00 
ST. JOSEPH'S HOSPITAL - BREESE,73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,$704.00 ,$457.60 ,$45.73 ,$704.00 ,$277.93 ,$457.60 ,$420.29 ,$111.17 ,$197.12 ,$394.94 ,$111.17 ,$463.23 ,$111.17 ,$598.40 ,$598.40 ,$111.17 ,$598.40 ,$211.22 ,$478.72 ,$277.92 ,$111.17 ,$111.17 ,$528.00 ,$499.84 ,$499.84 ,$111.17 ,$499.84 ,$577.28 ,$577.28 ,$577.28 , N/A ,$277.92 ,$598.40 ,$111.17 ,$704.00 ,$420.29 ,$111.17 ,$292.86 ,$50.30 ,$45.73 ,$111.17 ,$598.40 ,$233.45 ,$598.40 ,$197.12 ,$633.60 ,$111.17 ,$577.28 ,$594.88 ,$594.88 ,$111.17 ,$457.60 ,$704.00 
ST. JOSEPH'S HOSPITAL - BREESE,73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$574.00 ,$373.10 ,$36.71 ,$574.00 ,$91.78 ,$373.10 ,$342.68 ,$36.71 ,$160.72 ,$322.01 ,$36.71 ,$377.69 ,$36.71 ,$487.90 ,$487.90 ,$36.71 ,$487.90 ,$69.75 ,$390.32 ,$91.78 ,$36.71 ,$36.71 ,$430.50 ,$407.54 ,$407.54 ,$36.71 ,$407.54 ,$470.68 ,$470.68 ,$470.68 , N/A ,$91.78 ,$487.90 ,$36.71 ,$574.00 ,$342.68 ,$36.71 ,$238.78 ,$50.30 ,$45.73 ,$36.71 ,$487.90 ,$77.09 ,$487.90 ,$160.72 ,$516.60 ,$36.71 ,$470.68 ,$485.03 ,$485.03 ,$36.71 ,$373.10 ,$574.00 
ST. JOSEPH'S HOSPITAL - BREESE,73100005,93271,HC CARDIAC EVENT MONITOR,731,1 ,$676.00 ,$439.40 ,$93.88 ,$676.00 ,$247.43 ,$439.40 ,$403.57 ,$98.97 ,$189.28 ,$379.24 ,$98.97 ,$444.81 ,$98.97 ,$574.60 ,$574.60 ,$98.97 ,$574.60 ,$188.05 ,$459.68 ,$247.44 ,$98.97 ,$98.97 ,$507.00 ,$479.96 ,$479.96 ,$98.97 ,$479.96 ,$554.32 ,$554.32 ,$554.32 , N/A ,$247.44 ,$574.60 ,$98.97 ,$676.00 ,$403.57 ,$98.97 ,$281.22 ,$103.27 ,$93.88 ,$98.97 ,$574.60 ,$207.85 ,$574.60 ,$189.28 ,$608.40 ,$98.97 ,$554.32 ,$571.22 ,$571.22 ,$98.97 ,$439.40 ,$676.00 
ST. JOSEPH'S HOSPITAL - BREESE,74000003,95806,HC SLEEP STUDY UNATTENDED,740,1 ,"$1,225.00 ",$796.25 ,$137.65 ,"$1,225.00 ",$344.13 ,$796.25 ,$731.33 ,$137.65 ,$343.00 ,$687.23 ,$137.65 ,$806.05 ,$137.65 ,"$1,041.25 ","$1,041.25 ",$137.65 ,"$1,041.25 ",$261.53 ,$833.00 ,$344.11 ,$137.65 ,$137.65 ,$918.75 ,$869.75 ,$869.75 ,$137.65 ,$869.75 ,"$1,004.50 ","$1,004.50 ","$1,004.50 ", N/A ,$344.11 ,"$1,041.25 ",$137.65 ,"$1,225.00 ",$731.33 ,$137.65 ,$509.60 ,$558.71 ,$507.92 ,$137.65 ,"$1,041.25 ",$289.05 ,"$1,041.25 ",$343.00 ,"$1,102.50 ",$137.65 ,"$1,004.50 ",$850.00 ,$850.00 ,$137.65 ,$796.25 ,"$1,225.00 "
ST. JOSEPH'S HOSPITAL - BREESE,74000006,95810,HC SLEEP STUDY,740,1 ,"$5,242.00 ","$3,407.30 ",$507.92 ,"$5,242.00 ","$2,267.55 ","$3,407.30 ","$3,129.47 ",$907.02 ,"$1,467.76 ","$2,940.76 ",$907.02 ,"$3,449.24 ",$907.02 ,"$4,455.70 ","$4,455.70 ",$907.02 ,"$4,455.70 ","$1,723.35 ","$3,564.56 ","$2,267.56 ",$907.02 ,$907.02 ,"$3,931.50 ","$3,721.82 ","$3,721.82 ",$907.02 ,"$3,721.82 ","$4,298.44 ","$4,298.44 ","$4,298.44 ", N/A ,"$2,267.56 ","$4,455.70 ",$907.02 ,"$5,242.00 ","$3,129.47 ",$907.02 ,"$2,180.67 ",$558.71 ,$507.92 ,$907.02 ,"$4,455.70 ","$1,904.75 ","$4,455.70 ","$1,467.76 ","$4,717.80 ",$907.02 ,"$4,298.44 ","$3,250.00 ","$3,250.00 ",$907.02 ,"$3,407.30 ","$5,242.00 "
ST. JOSEPH'S HOSPITAL - BREESE,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$5,931.00 ","$3,855.15 ",$507.92 ,"$5,931.00 ","$2,267.55 ","$3,855.15 ","$3,540.81 ",$907.02 ,"$1,660.68 ","$3,327.29 ",$907.02 ,"$3,902.60 ",$907.02 ,"$5,041.35 ","$5,041.35 ",$907.02 ,"$5,041.35 ","$1,723.35 ","$4,033.08 ","$2,267.56 ",$907.02 ,$907.02 ,"$4,448.25 ","$4,211.01 ","$4,211.01 ",$907.02 ,"$4,211.01 ","$4,863.42 ","$4,863.42 ","$4,863.42 ", N/A ,"$2,267.56 ","$5,041.35 ",$907.02 ,"$5,931.00 ","$3,540.81 ",$907.02 ,"$2,467.30 ",$558.71 ,$507.92 ,$907.02 ,"$5,041.35 ","$1,904.75 ","$5,041.35 ","$1,660.68 ","$5,337.90 ",$907.02 ,"$4,863.42 ","$3,250.00 ","$3,250.00 ",$907.02 ,"$3,855.15 ","$5,931.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$1,213.00 ",$788.45 ,$339.64 ,"$1,994.33 ","$1,994.33 ",$788.45 ,$724.16 ,$797.73 ,$339.64 ,$680.49 ,$797.73 ,$798.15 ,$797.73 ,"$1,031.05 ","$1,031.05 ",$797.73 ,"$1,031.05 ","$1,213.00 ",$824.84 ,"$1,994.33 ",$797.73 ,$797.73 ,$909.75 ,$861.23 ,$861.23 ,$797.73 ,$861.23 ,$994.66 ,$994.66 ,$994.66 , N/A ,"$1,213.00 ","$1,031.05 ",$797.73 ,"$1,213.00 ",$724.16 ,$797.73 ,$504.61 ,$503.72 ,$457.93 ,$797.73 ,"$1,031.05 ","$1,675.23 ","$1,031.05 ",$339.64 ,"$1,091.70 ",$797.73 ,$994.66 ,"$1,024.99 ","$1,024.99 ",$797.73 ,$788.45 ,"$1,213.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,$653.00 ,$424.45 ,$182.84 ,"$1,994.33 ","$1,994.33 ",$424.45 ,$389.84 ,$797.73 ,$182.84 ,$366.33 ,$797.73 ,$429.67 ,$653.00 ,$555.05 ,$555.05 ,$653.00 ,$555.05 ,$653.00 ,$444.04 ,"$1,994.33 ",$797.73 ,$797.73 ,$489.75 ,$463.63 ,$463.63 ,$797.73 ,$463.63 ,$535.46 ,$535.46 ,$535.46 , N/A ,$653.00 ,$555.05 ,$797.73 ,$653.00 ,$389.84 ,$797.73 ,$271.65 ,$503.72 ,$457.93 ,$797.73 ,$555.05 ,"$1,675.23 ",$555.05 ,$182.84 ,$587.70 ,$797.73 ,$535.46 ,$551.79 ,$551.79 ,$797.73 ,$424.45 ,$653.00 
ST. JOSEPH'S HOSPITAL - BREESE,75001071,N/A,HC EGD W/BALLOON DILAT >30MM - 43233,750,1 ,"$4,857.00 ","$3,157.05 ","$1,359.96 ","$4,857.00 ", N/A ,"$3,157.05 ","$2,899.63 ", N/A ,"$1,359.96 ","$2,724.78 ", N/A ,"$3,195.91 ", N/A ,"$4,128.45 ","$4,128.45 ", N/A ,"$4,128.45 ", N/A ,"$3,302.76 ", N/A , N/A , N/A ,"$3,642.75 ","$3,448.47 ","$3,448.47 ", N/A ,"$3,448.47 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,128.45 ", N/A ,"$4,857.00 ","$2,899.63 ", N/A ,"$2,020.51 ", N/A , N/A , N/A ,"$4,128.45 ", N/A ,"$4,128.45 ","$1,359.96 ","$4,371.30 ", N/A ,"$3,038.00 ","$4,104.17 ","$4,104.17 ", N/A ,"$3,157.05 ","$4,857.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001072,N/A,HC EGD W/BRUSH/WASH - 43235,750,1 ,"$3,002.00 ","$1,951.30 ",$840.56 ,"$3,002.00 ", N/A ,"$1,951.30 ","$1,792.19 ", N/A ,$840.56 ,"$1,684.12 ", N/A ,"$1,975.32 ", N/A ,"$2,551.70 ","$2,551.70 ", N/A ,"$2,551.70 ", N/A ,"$2,041.36 ", N/A , N/A , N/A ,"$2,251.50 ","$2,131.42 ","$2,131.42 ", N/A ,"$2,131.42 ","$2,461.64 ","$2,461.64 ","$2,461.64 ", N/A , N/A ,"$2,551.70 ", N/A ,"$3,002.00 ","$1,792.19 ", N/A ,"$1,248.83 ", N/A , N/A , N/A ,"$2,551.70 ", N/A ,"$2,551.70 ",$840.56 ,"$2,701.80 ", N/A ,"$2,461.64 ","$2,536.69 ","$2,536.69 ", N/A ,"$1,951.30 ","$3,002.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001073,N/A,HC EGD W/SUBMUCOSAL INJ - 43236,750,1 ,"$2,546.00 ","$1,654.90 ",$712.88 ,"$2,546.00 ", N/A ,"$1,654.90 ","$1,519.96 ", N/A ,$712.88 ,"$1,428.31 ", N/A ,"$1,675.27 ", N/A ,"$2,164.10 ","$2,164.10 ", N/A ,"$2,164.10 ", N/A ,"$1,731.28 ", N/A , N/A , N/A ,"$1,909.50 ","$1,807.66 ","$1,807.66 ", N/A ,"$1,807.66 ","$2,087.72 ","$2,087.72 ","$2,087.72 ", N/A , N/A ,"$2,164.10 ", N/A ,"$2,546.00 ","$1,519.96 ", N/A ,"$1,059.14 ", N/A , N/A , N/A ,"$2,164.10 ", N/A ,"$2,164.10 ",$712.88 ,"$2,291.40 ", N/A ,"$2,087.72 ","$2,151.37 ","$2,151.37 ", N/A ,"$1,654.90 ","$2,546.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001076,N/A,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001081,N/A,HC EGD W/DILAT STRICTURE - 43245,750,1 ,"$4,783.00 ","$3,108.95 ","$1,339.24 ","$4,783.00 ", N/A ,"$3,108.95 ","$2,855.45 ", N/A ,"$1,339.24 ","$2,683.26 ", N/A ,"$3,147.21 ", N/A ,"$4,065.55 ","$4,065.55 ", N/A ,"$4,065.55 ", N/A ,"$3,252.44 ", N/A , N/A , N/A ,"$3,587.25 ","$3,395.93 ","$3,395.93 ", N/A ,"$3,395.93 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,065.55 ", N/A ,"$4,783.00 ","$2,855.45 ", N/A ,"$1,989.73 ", N/A , N/A , N/A ,"$4,065.55 ", N/A ,"$4,065.55 ","$1,339.24 ","$4,304.70 ", N/A ,"$3,038.00 ","$4,041.64 ","$4,041.64 ", N/A ,"$3,108.95 ","$4,783.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001082,N/A,HC EGD W/PLACEMENT G-TUBE - 43246,750,1 ,"$4,857.00 ","$3,157.05 ","$1,359.96 ","$4,857.00 ", N/A ,"$3,157.05 ","$2,899.63 ", N/A ,"$1,359.96 ","$2,724.78 ", N/A ,"$3,195.91 ", N/A ,"$4,128.45 ","$4,128.45 ", N/A ,"$4,128.45 ", N/A ,"$3,302.76 ", N/A , N/A , N/A ,"$3,642.75 ","$3,448.47 ","$3,448.47 ", N/A ,"$3,448.47 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,128.45 ", N/A ,"$4,857.00 ","$2,899.63 ", N/A ,"$2,020.51 ", N/A , N/A , N/A ,"$4,128.45 ", N/A ,"$4,128.45 ","$1,359.96 ","$4,371.30 ", N/A ,"$3,038.00 ","$4,104.17 ","$4,104.17 ", N/A ,"$3,157.05 ","$4,857.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001083,N/A,HC EGD W/FB REMOVAL - 43247,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001084,N/A,HC EGD W/INSERT GUIDEWIRE - 43248,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001085,N/A,HC EGD W/BALLOON DILAT <30MM - 43249,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001086,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY - 43250,750,1 ,"$5,094.00 ","$3,311.10 ","$1,426.32 ","$5,094.00 ", N/A ,"$3,311.10 ","$3,041.12 ", N/A ,"$1,426.32 ","$2,857.73 ", N/A ,"$3,351.85 ", N/A ,"$4,329.90 ","$4,329.90 ", N/A ,"$4,329.90 ", N/A ,"$3,463.92 ", N/A , N/A , N/A ,"$3,820.50 ","$3,616.74 ","$3,616.74 ", N/A ,"$3,616.74 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,329.90 ", N/A ,"$5,094.00 ","$3,041.12 ", N/A ,"$2,119.10 ", N/A , N/A , N/A ,"$4,329.90 ", N/A ,"$4,329.90 ","$1,426.32 ","$4,584.60 ", N/A ,"$3,038.00 ","$4,304.43 ","$4,304.43 ", N/A ,"$3,311.10 ","$5,094.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001087,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH - 43251,750,1 ,"$5,094.00 ","$3,311.10 ","$1,426.32 ","$5,094.00 ", N/A ,"$3,311.10 ","$3,041.12 ", N/A ,"$1,426.32 ","$2,857.73 ", N/A ,"$3,351.85 ", N/A ,"$4,329.90 ","$4,329.90 ", N/A ,"$4,329.90 ", N/A ,"$3,463.92 ", N/A , N/A , N/A ,"$3,820.50 ","$3,616.74 ","$3,616.74 ", N/A ,"$3,616.74 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,329.90 ", N/A ,"$5,094.00 ","$3,041.12 ", N/A ,"$2,119.10 ", N/A , N/A , N/A ,"$4,329.90 ", N/A ,"$4,329.90 ","$1,426.32 ","$4,584.60 ", N/A ,"$3,038.00 ","$4,304.43 ","$4,304.43 ", N/A ,"$3,311.10 ","$5,094.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001090,N/A,HC EGD W/CONTROL BLEEDING - 43255,750,1 ,"$5,004.00 ","$3,252.60 ","$1,401.12 ","$5,004.00 ", N/A ,"$3,252.60 ","$2,987.39 ", N/A ,"$1,401.12 ","$2,807.24 ", N/A ,"$3,292.63 ", N/A ,"$4,253.40 ","$4,253.40 ", N/A ,"$4,253.40 ", N/A ,"$3,402.72 ", N/A , N/A , N/A ,"$3,753.00 ","$3,552.84 ","$3,552.84 ", N/A ,"$3,552.84 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,253.40 ", N/A ,"$5,004.00 ","$2,987.39 ", N/A ,"$2,081.66 ", N/A , N/A , N/A ,"$4,253.40 ", N/A ,"$4,253.40 ","$1,401.12 ","$4,503.60 ", N/A ,"$3,038.00 ","$4,228.38 ","$4,228.38 ", N/A ,"$3,252.60 ","$5,004.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001096,N/A,HC ERCP W/SPHINCTEROTOMY - 43262,750,1 ,"$8,772.66 ","$5,702.23 ","$2,456.34 ","$8,772.66 ", N/A ,"$5,702.23 ","$5,237.28 ", N/A ,"$2,456.34 ","$4,921.46 ", N/A ,"$5,772.41 ", N/A ,"$7,456.76 ","$7,456.76 ", N/A ,"$7,456.76 ", N/A ,"$5,965.41 ", N/A , N/A , N/A ,"$6,579.50 ","$6,228.59 ","$6,228.59 ", N/A ,"$6,228.59 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$7,456.76 ", N/A ,"$8,772.66 ","$5,237.28 ", N/A ,"$3,649.43 ", N/A , N/A , N/A ,"$7,456.76 ", N/A ,"$7,456.76 ","$2,456.34 ","$7,895.39 ", N/A ,"$3,038.00 ","$7,412.90 ","$7,412.90 ", N/A ,"$5,702.23 ","$8,772.66 "
ST. JOSEPH'S HOSPITAL - BREESE,75001097,N/A,HC ERCP W/SPHINCTER PRESSURE MEASUREMENT - 43263,750,1 ,"$5,275.00 ","$3,428.75 ","$1,477.00 ","$5,275.00 ", N/A ,"$3,428.75 ","$3,149.18 ", N/A ,"$1,477.00 ","$2,959.28 ", N/A ,"$3,470.95 ", N/A ,"$4,483.75 ","$4,483.75 ", N/A ,"$4,483.75 ", N/A ,"$3,587.00 ", N/A , N/A , N/A ,"$3,956.25 ","$3,745.25 ","$3,745.25 ", N/A ,"$3,745.25 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,483.75 ", N/A ,"$5,275.00 ","$3,149.18 ", N/A ,"$2,194.40 ", N/A , N/A , N/A ,"$4,483.75 ", N/A ,"$4,483.75 ","$1,477.00 ","$4,747.50 ", N/A ,"$3,038.00 ","$4,457.38 ","$4,457.38 ", N/A ,"$3,428.75 ","$5,275.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001098,N/A,HC ERCP W/STONE REMOVAL DUCT - 43264,750,1 ,"$9,527.00 ","$6,192.55 ","$2,667.56 ","$9,527.00 ", N/A ,"$6,192.55 ","$5,687.62 ", N/A ,"$2,667.56 ","$5,344.65 ", N/A ,"$6,268.77 ", N/A ,"$8,097.95 ","$8,097.95 ", N/A ,"$8,097.95 ", N/A ,"$6,478.36 ", N/A , N/A , N/A ,"$7,145.25 ","$6,764.17 ","$6,764.17 ", N/A ,"$6,764.17 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$8,097.95 ", N/A ,"$9,527.00 ","$5,687.62 ", N/A ,"$3,963.23 ", N/A , N/A , N/A ,"$8,097.95 ", N/A ,"$8,097.95 ","$2,667.56 ","$8,574.30 ", N/A ,"$3,038.00 ","$8,050.32 ","$8,050.32 ", N/A ,"$6,192.55 ","$9,527.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001099,N/A,HC ERCP W/LITHOTRIPSY - 43265,750,1 ,"$15,165.00 ","$9,857.25 ","$3,038.00 ","$15,165.00 ", N/A ,"$9,857.25 ","$9,053.51 ", N/A ,"$4,246.20 ","$8,507.57 ", N/A ,"$9,978.57 ", N/A ,"$12,890.25 ","$12,890.25 ", N/A ,"$12,890.25 ", N/A ,"$10,312.20 ", N/A , N/A , N/A ,"$11,373.75 ","$10,767.15 ","$10,767.15 ", N/A ,"$10,767.15 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$12,890.25 ", N/A ,"$15,165.00 ","$9,053.51 ", N/A ,"$6,308.64 ", N/A , N/A , N/A ,"$12,890.25 ", N/A ,"$12,890.25 ","$4,246.20 ","$13,648.50 ", N/A ,"$3,038.00 ","$12,814.43 ","$12,814.43 ", N/A ,"$9,857.25 ","$15,165.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001100,N/A,HC ERCP W/STENT PLACEMENT DUCT - 43274,750,1 ,"$15,165.00 ","$9,857.25 ","$3,038.00 ","$15,165.00 ", N/A ,"$9,857.25 ","$9,053.51 ", N/A ,"$4,246.20 ","$8,507.57 ", N/A ,"$9,978.57 ", N/A ,"$12,890.25 ","$12,890.25 ", N/A ,"$12,890.25 ", N/A ,"$10,312.20 ", N/A , N/A , N/A ,"$11,373.75 ","$10,767.15 ","$10,767.15 ", N/A ,"$10,767.15 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$12,890.25 ", N/A ,"$15,165.00 ","$9,053.51 ", N/A ,"$6,308.64 ", N/A , N/A , N/A ,"$12,890.25 ", N/A ,"$12,890.25 ","$4,246.20 ","$13,648.50 ", N/A ,"$3,038.00 ","$12,814.43 ","$12,814.43 ", N/A ,"$9,857.25 ","$15,165.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001101,N/A,HC ERCP W/FB OR STENT REMOVAL DUCT - 43275,750,1 ,"$9,527.00 ","$6,192.55 ","$2,667.56 ","$9,527.00 ", N/A ,"$6,192.55 ","$5,687.62 ", N/A ,"$2,667.56 ","$5,344.65 ", N/A ,"$6,268.77 ", N/A ,"$8,097.95 ","$8,097.95 ", N/A ,"$8,097.95 ", N/A ,"$6,478.36 ", N/A , N/A , N/A ,"$7,145.25 ","$6,764.17 ","$6,764.17 ", N/A ,"$6,764.17 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$8,097.95 ", N/A ,"$9,527.00 ","$5,687.62 ", N/A ,"$3,963.23 ", N/A , N/A , N/A ,"$8,097.95 ", N/A ,"$8,097.95 ","$2,667.56 ","$8,574.30 ", N/A ,"$3,038.00 ","$8,050.32 ","$8,050.32 ", N/A ,"$6,192.55 ","$9,527.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001102,N/A,HC ERCP W/REM/EXCHG STENT W/DILAT  AND  WIRE EA - 43276,750,1 ,"$15,165.00 ","$9,857.25 ","$3,038.00 ","$15,165.00 ", N/A ,"$9,857.25 ","$9,053.51 ", N/A ,"$4,246.20 ","$8,507.57 ", N/A ,"$9,978.57 ", N/A ,"$12,890.25 ","$12,890.25 ", N/A ,"$12,890.25 ", N/A ,"$10,312.20 ", N/A , N/A , N/A ,"$11,373.75 ","$10,767.15 ","$10,767.15 ", N/A ,"$10,767.15 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$12,890.25 ", N/A ,"$15,165.00 ","$9,053.51 ", N/A ,"$6,308.64 ", N/A , N/A , N/A ,"$12,890.25 ", N/A ,"$12,890.25 ","$4,246.20 ","$13,648.50 ", N/A ,"$3,038.00 ","$12,814.43 ","$12,814.43 ", N/A ,"$9,857.25 ","$15,165.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001103,N/A,HC ERCP W/BALL DILAT DUCT/AMPULLA EA -43277,750,1 ,"$9,527.00 ","$6,192.55 ","$2,667.56 ","$9,527.00 ", N/A ,"$6,192.55 ","$5,687.62 ", N/A ,"$2,667.56 ","$5,344.65 ", N/A ,"$6,268.77 ", N/A ,"$8,097.95 ","$8,097.95 ", N/A ,"$8,097.95 ", N/A ,"$6,478.36 ", N/A , N/A , N/A ,"$7,145.25 ","$6,764.17 ","$6,764.17 ", N/A ,"$6,764.17 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$8,097.95 ", N/A ,"$9,527.00 ","$5,687.62 ", N/A ,"$3,963.23 ", N/A , N/A , N/A ,"$8,097.95 ", N/A ,"$8,097.95 ","$2,667.56 ","$8,574.30 ", N/A ,"$3,038.00 ","$8,050.32 ","$8,050.32 ", N/A ,"$6,192.55 ","$9,527.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001106,N/A,HC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS - 43450,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001109,N/A,HC GASTROSTOMY TUBE PLACE OPEN - 43832,750,1 ,"$3,028.00 ","$1,968.20 ",$847.84 ,"$3,028.00 ", N/A ,"$1,968.20 ","$1,807.72 ", N/A ,$847.84 ,"$1,698.71 ", N/A ,"$1,992.42 ", N/A ,"$2,573.80 ","$2,573.80 ", N/A ,"$2,573.80 ", N/A ,"$2,059.04 ", N/A , N/A , N/A ,"$2,271.00 ","$2,149.88 ","$2,149.88 ", N/A ,"$2,149.88 ","$2,482.96 ","$2,482.96 ","$2,482.96 ", N/A , N/A ,"$2,573.80 ", N/A ,"$3,028.00 ","$1,807.72 ", N/A ,"$1,259.65 ", N/A , N/A , N/A ,"$2,573.80 ", N/A ,"$2,573.80 ",$847.84 ,"$2,725.20 ", N/A ,"$2,482.96 ","$2,558.66 ","$2,558.66 ", N/A ,"$1,968.20 ","$3,028.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001125,N/A,HC COLONOSCOPY STOMA DX W/BRUSH/WASH - 44388,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001126,N/A,HC COLONOSCOPY STOMA W/BX SGL/MULT - 44389,750,1 ,"$3,119.88 ","$2,027.92 ",$873.57 ,"$3,119.88 ", N/A ,"$2,027.92 ","$1,862.57 ", N/A ,$873.57 ,"$1,750.25 ", N/A ,"$2,052.88 ", N/A ,"$2,651.90 ","$2,651.90 ", N/A ,"$2,651.90 ", N/A ,"$2,121.52 ", N/A , N/A , N/A ,"$2,339.91 ","$2,215.11 ","$2,215.11 ", N/A ,"$2,215.11 ","$2,558.30 ","$2,558.30 ","$2,558.30 ", N/A , N/A ,"$2,651.90 ", N/A ,"$3,119.88 ","$1,862.57 ", N/A ,"$1,297.87 ", N/A , N/A , N/A ,"$2,651.90 ", N/A ,"$2,651.90 ",$873.57 ,"$2,807.89 ", N/A ,"$2,558.30 ","$2,636.30 ","$2,636.30 ", N/A ,"$2,027.92 ","$3,119.88 "
ST. JOSEPH'S HOSPITAL - BREESE,75001128,N/A,HC COLONOSCOPY STOMA W/CONTROL BLEEDING - 44391,750,1 ,"$3,254.00 ","$2,115.10 ",$911.12 ,"$3,254.00 ", N/A ,"$2,115.10 ","$1,942.64 ", N/A ,$911.12 ,"$1,825.49 ", N/A ,"$2,141.13 ", N/A ,"$2,765.90 ","$2,765.90 ", N/A ,"$2,765.90 ", N/A ,"$2,212.72 ", N/A , N/A , N/A ,"$2,440.50 ","$2,310.34 ","$2,310.34 ", N/A ,"$2,310.34 ","$2,668.28 ","$2,668.28 ","$2,668.28 ", N/A , N/A ,"$2,765.90 ", N/A ,"$3,254.00 ","$1,942.64 ", N/A ,"$1,353.66 ", N/A , N/A , N/A ,"$2,765.90 ", N/A ,"$2,765.90 ",$911.12 ,"$2,928.60 ", N/A ,"$2,668.28 ","$2,749.63 ","$2,749.63 ", N/A ,"$2,115.10 ","$3,254.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001129,N/A,HC COLONOSCOPY STOMA W/REM TUMOR HOT BX - 44392,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001139,N/A,HC PROCTOSIGMOIDOSCOPY RIGID DX W/W/O SPECIMEN - 45300,750,1 ,"$2,475.00 ","$1,608.75 ",$693.00 ,"$2,475.00 ", N/A ,"$1,608.75 ","$1,477.58 ", N/A ,$693.00 ,"$1,388.48 ", N/A ,"$1,628.55 ", N/A ,"$2,103.75 ","$2,103.75 ", N/A ,"$2,103.75 ", N/A ,"$1,683.00 ", N/A , N/A , N/A ,"$1,856.25 ","$1,757.25 ","$1,757.25 ", N/A ,"$1,757.25 ","$2,029.50 ","$2,029.50 ","$2,029.50 ", N/A , N/A ,"$2,103.75 ", N/A ,"$2,475.00 ","$1,477.58 ", N/A ,"$1,029.60 ", N/A , N/A , N/A ,"$2,103.75 ", N/A ,"$2,103.75 ",$693.00 ,"$2,227.50 ", N/A ,"$2,029.50 ","$2,091.38 ","$2,091.38 ", N/A ,"$1,608.75 ","$2,475.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001142,N/A,HC SIGMOIDOSCOPY DX W/BRUSH/WASH - 45330,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001143,N/A,HC SIGMOIDOSCOPY W/BIOPSY SGL/MULT -45331,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001144,N/A,HC SIGMOIDOSCOPY W/FB REMOVAL -45332,750,1 ,"$2,952.78 ","$1,919.31 ",$826.78 ,"$2,952.78 ", N/A ,"$1,919.31 ","$1,762.81 ", N/A ,$826.78 ,"$1,656.51 ", N/A ,"$1,942.93 ", N/A ,"$2,509.86 ","$2,509.86 ", N/A ,"$2,509.86 ", N/A ,"$2,007.89 ", N/A , N/A , N/A ,"$2,214.59 ","$2,096.47 ","$2,096.47 ", N/A ,"$2,096.47 ","$2,421.28 ","$2,421.28 ","$2,421.28 ", N/A , N/A ,"$2,509.86 ", N/A ,"$2,952.78 ","$1,762.81 ", N/A ,"$1,228.36 ", N/A , N/A , N/A ,"$2,509.86 ", N/A ,"$2,509.86 ",$826.78 ,"$2,657.50 ", N/A ,"$2,421.28 ","$2,495.10 ","$2,495.10 ", N/A ,"$1,919.31 ","$2,952.78 "
ST. JOSEPH'S HOSPITAL - BREESE,75001145,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN  HOT BIOPSY -45333,750,1 ,"$2,259.96 ","$1,468.97 ",$632.79 ,"$2,259.96 ", N/A ,"$1,468.97 ","$1,349.20 ", N/A ,$632.79 ,"$1,267.84 ", N/A ,"$1,487.05 ", N/A ,"$1,920.97 ","$1,920.97 ", N/A ,"$1,920.97 ", N/A ,"$1,536.77 ", N/A , N/A , N/A ,"$1,694.97 ","$1,604.57 ","$1,604.57 ", N/A ,"$1,604.57 ","$1,853.17 ","$1,853.17 ","$1,853.17 ", N/A , N/A ,"$1,920.97 ", N/A ,"$2,259.96 ","$1,349.20 ", N/A ,$940.14 , N/A , N/A , N/A ,"$1,920.97 ", N/A ,"$1,920.97 ",$632.79 ,"$2,033.96 ", N/A ,"$1,853.17 ","$1,909.67 ","$1,909.67 ", N/A ,"$1,468.97 ","$2,259.96 "
ST. JOSEPH'S HOSPITAL - BREESE,75001146,N/A,HC SIGMOIDOSCOPY W/CONTROL BLEEDING - 45334,750,1 ,"$3,110.88 ","$2,022.07 ",$871.05 ,"$3,110.88 ", N/A ,"$2,022.07 ","$1,857.20 ", N/A ,$871.05 ,"$1,745.20 ", N/A ,"$2,046.96 ", N/A ,"$2,644.25 ","$2,644.25 ", N/A ,"$2,644.25 ", N/A ,"$2,115.40 ", N/A , N/A , N/A ,"$2,333.16 ","$2,208.72 ","$2,208.72 ", N/A ,"$2,208.72 ","$2,550.92 ","$2,550.92 ","$2,550.92 ", N/A , N/A ,"$2,644.25 ", N/A ,"$3,110.88 ","$1,857.20 ", N/A ,"$1,294.13 ", N/A , N/A , N/A ,"$2,644.25 ", N/A ,"$2,644.25 ",$871.05 ,"$2,799.79 ", N/A ,"$2,550.92 ","$2,628.69 ","$2,628.69 ", N/A ,"$2,022.07 ","$3,110.88 "
ST. JOSEPH'S HOSPITAL - BREESE,75001147,N/A,HC SIGMOIDOSCOPY W/SUBMUCOSAL INJ - 45335,750,1 ,"$2,359.00 ","$1,533.35 ",$660.52 ,"$2,359.00 ", N/A ,"$1,533.35 ","$1,408.32 ", N/A ,$660.52 ,"$1,323.40 ", N/A ,"$1,552.22 ", N/A ,"$2,005.15 ","$2,005.15 ", N/A ,"$2,005.15 ", N/A ,"$1,604.12 ", N/A , N/A , N/A ,"$1,769.25 ","$1,674.89 ","$1,674.89 ", N/A ,"$1,674.89 ","$1,934.38 ","$1,934.38 ","$1,934.38 ", N/A , N/A ,"$2,005.15 ", N/A ,"$2,359.00 ","$1,408.32 ", N/A ,$981.34 , N/A , N/A , N/A ,"$2,005.15 ", N/A ,"$2,005.15 ",$660.52 ,"$2,123.10 ", N/A ,"$1,934.38 ","$1,993.36 ","$1,993.36 ", N/A ,"$1,533.35 ","$2,359.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001149,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45338,750,1 ,"$3,109.00 ","$2,020.85 ",$870.52 ,"$3,109.00 ", N/A ,"$2,020.85 ","$1,856.07 ", N/A ,$870.52 ,"$1,744.15 ", N/A ,"$2,045.72 ", N/A ,"$2,642.65 ","$2,642.65 ", N/A ,"$2,642.65 ", N/A ,"$2,114.12 ", N/A , N/A , N/A ,"$2,331.75 ","$2,207.39 ","$2,207.39 ", N/A ,"$2,207.39 ","$2,549.38 ","$2,549.38 ","$2,549.38 ", N/A , N/A ,"$2,642.65 ", N/A ,"$3,109.00 ","$1,856.07 ", N/A ,"$1,293.34 ", N/A , N/A , N/A ,"$2,642.65 ", N/A ,"$2,642.65 ",$870.52 ,"$2,798.10 ", N/A ,"$2,549.38 ","$2,627.11 ","$2,627.11 ", N/A ,"$2,020.85 ","$3,109.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001155,N/A,HC SIGMOIDOSCOPY W/ENDO MUCOSAL RESECTION - 45349,750,1 ,"$7,258.00 ","$4,717.70 ","$2,032.24 ","$7,258.00 ", N/A ,"$4,717.70 ","$4,333.03 ", N/A ,"$2,032.24 ","$4,071.74 ", N/A ,"$4,775.76 ", N/A ,"$6,169.30 ","$6,169.30 ", N/A ,"$6,169.30 ", N/A ,"$4,935.44 ", N/A , N/A , N/A ,"$5,443.50 ","$5,153.18 ","$5,153.18 ", N/A ,"$5,153.18 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$6,169.30 ", N/A ,"$7,258.00 ","$4,333.03 ", N/A ,"$3,019.33 ", N/A , N/A , N/A ,"$6,169.30 ", N/A ,"$6,169.30 ","$2,032.24 ","$6,532.20 ", N/A ,"$3,038.00 ","$6,133.01 ","$6,133.01 ", N/A ,"$4,717.70 ","$7,258.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001156,N/A,HC SIGMOIDOSCOPY W/BAND LIGATION - 45350,750,1 ,"$3,304.00 ","$2,147.60 ",$925.12 ,"$3,304.00 ", N/A ,"$2,147.60 ","$1,972.49 ", N/A ,$925.12 ,"$1,853.54 ", N/A ,"$2,174.03 ", N/A ,"$2,808.40 ","$2,808.40 ", N/A ,"$2,808.40 ", N/A ,"$2,246.72 ", N/A , N/A , N/A ,"$2,478.00 ","$2,345.84 ","$2,345.84 ", N/A ,"$2,345.84 ","$2,709.28 ","$2,709.28 ","$2,709.28 ", N/A , N/A ,"$2,808.40 ", N/A ,"$3,304.00 ","$1,972.49 ", N/A ,"$1,374.46 ", N/A , N/A , N/A ,"$2,808.40 ", N/A ,"$2,808.40 ",$925.12 ,"$2,973.60 ", N/A ,"$2,709.28 ","$2,791.88 ","$2,791.88 ", N/A ,"$2,147.60 ","$3,304.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001157,N/A,HC COLONOSCOPY DX W/SPECIMEN BRUSH/WASH - 45378,750,1 ,"$3,002.00 ","$1,951.30 ",$840.56 ,"$3,002.00 ", N/A ,"$1,951.30 ","$1,792.19 ", N/A ,$840.56 ,"$1,684.12 ", N/A ,"$1,975.32 ", N/A ,"$2,551.70 ","$2,551.70 ", N/A ,"$2,551.70 ", N/A ,"$2,041.36 ", N/A , N/A , N/A ,"$2,251.50 ","$2,131.42 ","$2,131.42 ", N/A ,"$2,131.42 ","$2,461.64 ","$2,461.64 ","$2,461.64 ", N/A , N/A ,"$2,551.70 ", N/A ,"$3,002.00 ","$1,792.19 ", N/A ,"$1,248.83 ", N/A , N/A , N/A ,"$2,551.70 ", N/A ,"$2,551.70 ",$840.56 ,"$2,701.80 ", N/A ,"$2,461.64 ","$2,536.69 ","$2,536.69 ", N/A ,"$1,951.30 ","$3,002.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001159,N/A,HC COLONOSCOPY W/BIOPSY SGL/MULT - 45380,750,1 ,"$3,333.00 ","$2,166.45 ",$933.24 ,"$3,333.00 ", N/A ,"$2,166.45 ","$1,989.80 ", N/A ,$933.24 ,"$1,869.81 ", N/A ,"$2,193.11 ", N/A ,"$2,833.05 ","$2,833.05 ", N/A ,"$2,833.05 ", N/A ,"$2,266.44 ", N/A , N/A , N/A ,"$2,499.75 ","$2,366.43 ","$2,366.43 ", N/A ,"$2,366.43 ","$2,733.06 ","$2,733.06 ","$2,733.06 ", N/A , N/A ,"$2,833.05 ", N/A ,"$3,333.00 ","$1,989.80 ", N/A ,"$1,386.53 ", N/A , N/A , N/A ,"$2,833.05 ", N/A ,"$2,833.05 ",$933.24 ,"$2,999.70 ", N/A ,"$2,733.06 ","$2,816.39 ","$2,816.39 ", N/A ,"$2,166.45 ","$3,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001160,N/A,HC COLONOSCOPY W/SUBMUCOSAL INJ - 45381,750,1 ,"$3,333.00 ","$2,166.45 ",$933.24 ,"$3,333.00 ", N/A ,"$2,166.45 ","$1,989.80 ", N/A ,$933.24 ,"$1,869.81 ", N/A ,"$2,193.11 ", N/A ,"$2,833.05 ","$2,833.05 ", N/A ,"$2,833.05 ", N/A ,"$2,266.44 ", N/A , N/A , N/A ,"$2,499.75 ","$2,366.43 ","$2,366.43 ", N/A ,"$2,366.43 ","$2,733.06 ","$2,733.06 ","$2,733.06 ", N/A , N/A ,"$2,833.05 ", N/A ,"$3,333.00 ","$1,989.80 ", N/A ,"$1,386.53 ", N/A , N/A , N/A ,"$2,833.05 ", N/A ,"$2,833.05 ",$933.24 ,"$2,999.70 ", N/A ,"$2,733.06 ","$2,816.39 ","$2,816.39 ", N/A ,"$2,166.45 ","$3,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001161,N/A,HC COLONOSCOPY W/CONTROL BLEEDING - 45382,750,1 ,"$3,333.00 ","$2,166.45 ",$933.24 ,"$3,333.00 ", N/A ,"$2,166.45 ","$1,989.80 ", N/A ,$933.24 ,"$1,869.81 ", N/A ,"$2,193.11 ", N/A ,"$2,833.05 ","$2,833.05 ", N/A ,"$2,833.05 ", N/A ,"$2,266.44 ", N/A , N/A , N/A ,"$2,499.75 ","$2,366.43 ","$2,366.43 ", N/A ,"$2,366.43 ","$2,733.06 ","$2,733.06 ","$2,733.06 ", N/A , N/A ,"$2,833.05 ", N/A ,"$3,333.00 ","$1,989.80 ", N/A ,"$1,386.53 ", N/A , N/A , N/A ,"$2,833.05 ", N/A ,"$2,833.05 ",$933.24 ,"$2,999.70 ", N/A ,"$2,733.06 ","$2,816.39 ","$2,816.39 ", N/A ,"$2,166.45 ","$3,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001162,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 45384,750,1 ,"$3,333.00 ","$2,166.45 ",$933.24 ,"$3,333.00 ", N/A ,"$2,166.45 ","$1,989.80 ", N/A ,$933.24 ,"$1,869.81 ", N/A ,"$2,193.11 ", N/A ,"$2,833.05 ","$2,833.05 ", N/A ,"$2,833.05 ", N/A ,"$2,266.44 ", N/A , N/A , N/A ,"$2,499.75 ","$2,366.43 ","$2,366.43 ", N/A ,"$2,366.43 ","$2,733.06 ","$2,733.06 ","$2,733.06 ", N/A , N/A ,"$2,833.05 ", N/A ,"$3,333.00 ","$1,989.80 ", N/A ,"$1,386.53 ", N/A , N/A , N/A ,"$2,833.05 ", N/A ,"$2,833.05 ",$933.24 ,"$2,999.70 ", N/A ,"$2,733.06 ","$2,816.39 ","$2,816.39 ", N/A ,"$2,166.45 ","$3,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001163,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45385,750,1 ,"$3,333.00 ","$2,166.45 ",$933.24 ,"$3,333.00 ", N/A ,"$2,166.45 ","$1,989.80 ", N/A ,$933.24 ,"$1,869.81 ", N/A ,"$2,193.11 ", N/A ,"$2,833.05 ","$2,833.05 ", N/A ,"$2,833.05 ", N/A ,"$2,266.44 ", N/A , N/A , N/A ,"$2,499.75 ","$2,366.43 ","$2,366.43 ", N/A ,"$2,366.43 ","$2,733.06 ","$2,733.06 ","$2,733.06 ", N/A , N/A ,"$2,833.05 ", N/A ,"$3,333.00 ","$1,989.80 ", N/A ,"$1,386.53 ", N/A , N/A , N/A ,"$2,833.05 ", N/A ,"$2,833.05 ",$933.24 ,"$2,999.70 ", N/A ,"$2,733.06 ","$2,816.39 ","$2,816.39 ", N/A ,"$2,166.45 ","$3,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001164,N/A,HC COLONOSCOPY W/BALLOON DILATION - 45386,750,1 ,"$3,333.00 ","$2,166.45 ",$933.24 ,"$3,333.00 ", N/A ,"$2,166.45 ","$1,989.80 ", N/A ,$933.24 ,"$1,869.81 ", N/A ,"$2,193.11 ", N/A ,"$2,833.05 ","$2,833.05 ", N/A ,"$2,833.05 ", N/A ,"$2,266.44 ", N/A , N/A , N/A ,"$2,499.75 ","$2,366.43 ","$2,366.43 ", N/A ,"$2,366.43 ","$2,733.06 ","$2,733.06 ","$2,733.06 ", N/A , N/A ,"$2,833.05 ", N/A ,"$3,333.00 ","$1,989.80 ", N/A ,"$1,386.53 ", N/A , N/A , N/A ,"$2,833.05 ", N/A ,"$2,833.05 ",$933.24 ,"$2,999.70 ", N/A ,"$2,733.06 ","$2,816.39 ","$2,816.39 ", N/A ,"$2,166.45 ","$3,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001165,N/A,HC COLONOSCOPY W/ABLATION TUMOR - 45388,750,1 ,"$3,109.00 ","$2,020.85 ",$870.52 ,"$3,109.00 ", N/A ,"$2,020.85 ","$1,856.07 ", N/A ,$870.52 ,"$1,744.15 ", N/A ,"$2,045.72 ", N/A ,"$2,642.65 ","$2,642.65 ", N/A ,"$2,642.65 ", N/A ,"$2,114.12 ", N/A , N/A , N/A ,"$2,331.75 ","$2,207.39 ","$2,207.39 ", N/A ,"$2,207.39 ","$2,549.38 ","$2,549.38 ","$2,549.38 ", N/A , N/A ,"$2,642.65 ", N/A ,"$3,109.00 ","$1,856.07 ", N/A ,"$1,293.34 ", N/A , N/A , N/A ,"$2,642.65 ", N/A ,"$2,642.65 ",$870.52 ,"$2,798.10 ", N/A ,"$2,549.38 ","$2,627.11 ","$2,627.11 ", N/A ,"$2,020.85 ","$3,109.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001167,N/A,HC COLONOSCOPY W/MUCOSAL RESECTION - 45390,750,1 ,"$7,258.00 ","$4,717.70 ","$2,032.24 ","$7,258.00 ", N/A ,"$4,717.70 ","$4,333.03 ", N/A ,"$2,032.24 ","$4,071.74 ", N/A ,"$4,775.76 ", N/A ,"$6,169.30 ","$6,169.30 ", N/A ,"$6,169.30 ", N/A ,"$4,935.44 ", N/A , N/A , N/A ,"$5,443.50 ","$5,153.18 ","$5,153.18 ", N/A ,"$5,153.18 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$6,169.30 ", N/A ,"$7,258.00 ","$4,333.03 ", N/A ,"$3,019.33 ", N/A , N/A , N/A ,"$6,169.30 ", N/A ,"$6,169.30 ","$2,032.24 ","$6,532.20 ", N/A ,"$3,038.00 ","$6,133.01 ","$6,133.01 ", N/A ,"$4,717.70 ","$7,258.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001171,N/A,HC COLONOSCOPY W/BAND LIGATION - 45398,750,1 ,"$3,333.00 ","$2,166.45 ",$933.24 ,"$3,333.00 ", N/A ,"$2,166.45 ","$1,989.80 ", N/A ,$933.24 ,"$1,869.81 ", N/A ,"$2,193.11 ", N/A ,"$2,833.05 ","$2,833.05 ", N/A ,"$2,833.05 ", N/A ,"$2,266.44 ", N/A , N/A , N/A ,"$2,499.75 ","$2,366.43 ","$2,366.43 ", N/A ,"$2,366.43 ","$2,733.06 ","$2,733.06 ","$2,733.06 ", N/A , N/A ,"$2,833.05 ", N/A ,"$3,333.00 ","$1,989.80 ", N/A ,"$1,386.53 ", N/A , N/A , N/A ,"$2,833.05 ", N/A ,"$2,833.05 ",$933.24 ,"$2,999.70 ", N/A ,"$2,733.06 ","$2,816.39 ","$2,816.39 ", N/A ,"$2,166.45 ","$3,333.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001173,N/A,HC HERMORRHOIDECTOMY INTERNAL W/LIGATION - 46221,750,1 ,"$2,138.00 ","$1,389.70 ",$598.64 ,"$2,138.00 ", N/A ,"$1,389.70 ","$1,276.39 ", N/A ,$598.64 ,"$1,199.42 ", N/A ,"$1,406.80 ", N/A ,"$1,817.30 ","$1,817.30 ", N/A ,"$1,817.30 ", N/A ,"$1,453.84 ", N/A , N/A , N/A ,"$1,603.50 ","$1,517.98 ","$1,517.98 ", N/A ,"$1,517.98 ","$1,753.16 ","$1,753.16 ","$1,753.16 ", N/A , N/A ,"$1,817.30 ", N/A ,"$2,138.00 ","$1,276.39 ", N/A ,$889.41 , N/A , N/A , N/A ,"$1,817.30 ", N/A ,"$1,817.30 ",$598.64 ,"$1,924.20 ", N/A ,"$1,753.16 ","$1,806.61 ","$1,806.61 ", N/A ,"$1,389.70 ","$2,138.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001174,N/A,HC ANOSCOPY DX W/SPECIMEN -46600,750,1 ,"$2,195.00 ","$1,426.75 ",$614.60 ,"$2,195.00 ", N/A ,"$1,426.75 ","$1,310.42 ", N/A ,$614.60 ,"$1,231.40 ", N/A ,"$1,444.31 ", N/A ,"$1,865.75 ","$1,865.75 ", N/A ,"$1,865.75 ", N/A ,"$1,492.60 ", N/A , N/A , N/A ,"$1,646.25 ","$1,558.45 ","$1,558.45 ", N/A ,"$1,558.45 ","$1,799.90 ","$1,799.90 ","$1,799.90 ", N/A , N/A ,"$1,865.75 ", N/A ,"$2,195.00 ","$1,310.42 ", N/A ,$913.12 , N/A , N/A , N/A ,"$1,865.75 ", N/A ,"$1,865.75 ",$614.60 ,"$1,975.50 ", N/A ,"$1,799.90 ","$1,854.78 ","$1,854.78 ", N/A ,"$1,426.75 ","$2,195.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001176,N/A,HC ANOSCOPY W/BIOPSY SGL/MULT - 46606,750,1 ,"$2,952.78 ","$1,919.31 ",$826.78 ,"$2,952.78 ", N/A ,"$1,919.31 ","$1,762.81 ", N/A ,$826.78 ,"$1,656.51 ", N/A ,"$1,942.93 ", N/A ,"$2,509.86 ","$2,509.86 ", N/A ,"$2,509.86 ", N/A ,"$2,007.89 ", N/A , N/A , N/A ,"$2,214.59 ","$2,096.47 ","$2,096.47 ", N/A ,"$2,096.47 ","$2,421.28 ","$2,421.28 ","$2,421.28 ", N/A , N/A ,"$2,509.86 ", N/A ,"$2,952.78 ","$1,762.81 ", N/A ,"$1,228.36 ", N/A , N/A , N/A ,"$2,509.86 ", N/A ,"$2,509.86 ",$826.78 ,"$2,657.50 ", N/A ,"$2,421.28 ","$2,495.10 ","$2,495.10 ", N/A ,"$1,919.31 ","$2,952.78 "
ST. JOSEPH'S HOSPITAL - BREESE,75001177,N/A,HC ANOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 46610,750,1 ,"$7,258.00 ","$4,717.70 ","$2,032.24 ","$7,258.00 ", N/A ,"$4,717.70 ","$4,333.03 ", N/A ,"$2,032.24 ","$4,071.74 ", N/A ,"$4,775.76 ", N/A ,"$6,169.30 ","$6,169.30 ", N/A ,"$6,169.30 ", N/A ,"$4,935.44 ", N/A , N/A , N/A ,"$5,443.50 ","$5,153.18 ","$5,153.18 ", N/A ,"$5,153.18 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$6,169.30 ", N/A ,"$7,258.00 ","$4,333.03 ", N/A ,"$3,019.33 ", N/A , N/A , N/A ,"$6,169.30 ", N/A ,"$6,169.30 ","$2,032.24 ","$6,532.20 ", N/A ,"$3,038.00 ","$6,133.01 ","$6,133.01 ", N/A ,"$4,717.70 ","$7,258.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001178,N/A,HC EXCISION ANAL LESIONS SIMPLE - 46922,750,1 ,"$4,857.00 ","$3,157.05 ","$1,359.96 ","$4,857.00 ", N/A ,"$3,157.05 ","$2,899.63 ", N/A ,"$1,359.96 ","$2,724.78 ", N/A ,"$3,195.91 ", N/A ,"$4,128.45 ","$4,128.45 ", N/A ,"$4,128.45 ", N/A ,"$3,302.76 ", N/A , N/A , N/A ,"$3,642.75 ","$3,448.47 ","$3,448.47 ", N/A ,"$3,448.47 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$4,128.45 ", N/A ,"$4,857.00 ","$2,899.63 ", N/A ,"$2,020.51 ", N/A , N/A , N/A ,"$4,128.45 ", N/A ,"$4,128.45 ","$1,359.96 ","$4,371.30 ", N/A ,"$3,038.00 ","$4,104.17 ","$4,104.17 ", N/A ,"$3,157.05 ","$4,857.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001179,N/A,HC LAP CHOLECYSTECTOMY W/CHOLANG - 47563,750,1 ,"$15,048.00 ","$9,781.20 ","$3,038.00 ","$15,048.00 ", N/A ,"$9,781.20 ","$8,983.66 ", N/A ,"$4,213.44 ","$8,441.93 ", N/A ,"$9,901.58 ", N/A ,"$12,790.80 ","$12,790.80 ", N/A ,"$12,790.80 ", N/A ,"$10,232.64 ", N/A , N/A , N/A ,"$11,286.00 ","$10,684.08 ","$10,684.08 ", N/A ,"$10,684.08 ","$3,038.00 ","$3,038.00 ","$3,038.00 ", N/A , N/A ,"$12,790.80 ", N/A ,"$15,048.00 ","$8,983.66 ", N/A ,"$6,259.97 ", N/A , N/A , N/A ,"$12,790.80 ", N/A ,"$12,790.80 ","$4,213.44 ","$13,543.20 ", N/A ,"$3,038.00 ","$12,715.56 ","$12,715.56 ", N/A ,"$9,781.20 ","$15,048.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001202,N/A,HC REPLACE GASTRO TUBE PERC - 43762,750,1 ,$781.00 ,$507.65 ,$218.68 ,$781.00 , N/A ,$507.65 ,$466.26 , N/A ,$218.68 ,$438.14 , N/A ,$513.90 , N/A ,$663.85 ,$663.85 , N/A ,$663.85 , N/A ,$531.08 , N/A , N/A , N/A ,$585.75 ,$554.51 ,$554.51 , N/A ,$554.51 ,$640.42 ,$640.42 ,$640.42 , N/A , N/A ,$663.85 , N/A ,$781.00 ,$466.26 , N/A ,$324.90 , N/A , N/A , N/A ,$663.85 , N/A ,$663.85 ,$218.68 ,$702.90 , N/A ,$640.42 ,$659.95 ,$659.95 , N/A ,$507.65 ,$781.00 
ST. JOSEPH'S HOSPITAL - BREESE,75001203,N/A,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT - 43763,750,1 ,$781.00 ,$507.65 ,$218.68 ,$781.00 , N/A ,$507.65 ,$466.26 , N/A ,$218.68 ,$438.14 , N/A ,$513.90 , N/A ,$663.85 ,$663.85 , N/A ,$663.85 , N/A ,$531.08 , N/A , N/A , N/A ,$585.75 ,$554.51 ,$554.51 , N/A ,$554.51 ,$640.42 ,$640.42 ,$640.42 , N/A , N/A ,$663.85 , N/A ,$781.00 ,$466.26 , N/A ,$324.90 , N/A , N/A , N/A ,$663.85 , N/A ,$663.85 ,$218.68 ,$702.90 , N/A ,$640.42 ,$659.95 ,$659.95 , N/A ,$507.65 ,$781.00 
ST. JOSEPH'S HOSPITAL - BREESE,75001204,N/A,HC REMOVE G TUBE W/ANESTHESIA - 43999,750,1 ,"$2,568.00 ","$1,669.20 ",$719.04 ,"$2,568.00 ", N/A ,"$1,669.20 ","$1,533.10 ", N/A ,$719.04 ,"$1,440.65 ", N/A ,"$1,689.74 ", N/A ,"$2,182.80 ","$2,182.80 ", N/A ,"$2,182.80 ", N/A ,"$1,746.24 ", N/A , N/A , N/A ,"$1,926.00 ","$1,823.28 ","$1,823.28 ", N/A ,"$1,823.28 ","$2,105.76 ","$2,105.76 ","$2,105.76 ", N/A , N/A ,"$2,182.80 ", N/A ,"$2,568.00 ","$1,533.10 ", N/A ,"$1,068.29 ", N/A , N/A , N/A ,"$2,182.80 ", N/A ,"$2,182.80 ",$719.04 ,"$2,311.20 ", N/A ,"$2,105.76 ","$2,169.96 ","$2,169.96 ", N/A ,"$1,669.20 ","$2,568.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001212,N/A,HC CHEMODENERVATION INTERNAL ANAL SPHINCTER - 46505,750,1 ,"$3,254.00 ","$2,115.10 ",$911.12 ,"$3,254.00 ", N/A ,"$2,115.10 ","$1,942.64 ", N/A ,$911.12 ,"$1,825.49 ", N/A ,"$2,141.13 ", N/A ,"$2,765.90 ","$2,765.90 ", N/A ,"$2,765.90 ", N/A ,"$2,212.72 ", N/A , N/A , N/A ,"$2,440.50 ","$2,310.34 ","$2,310.34 ", N/A ,"$2,310.34 ","$2,668.28 ","$2,668.28 ","$2,668.28 ", N/A , N/A ,"$2,765.90 ", N/A ,"$3,254.00 ","$1,942.64 ", N/A ,"$1,353.66 ", N/A , N/A , N/A ,"$2,765.90 ", N/A ,"$2,765.90 ",$911.12 ,"$2,928.60 ", N/A ,"$2,668.28 ","$2,749.63 ","$2,749.63 ", N/A ,"$2,115.10 ","$3,254.00 "
ST. JOSEPH'S HOSPITAL - BREESE,75001216,46220,HC ANAL EXT TAG/PAPILLA,750,1 ,"$2,952.78 ","$1,919.31 ",$434.20 ,"$2,952.78 ","$2,555.83 ","$1,919.31 ","$1,762.81 ","$1,022.33 ",$826.78 ,"$1,656.51 ","$1,022.33 ","$1,942.93 ","$1,022.33 ","$2,509.86 ","$2,509.86 ","$1,022.33 ","$2,509.86 ","$1,942.43 ","$2,007.89 ","$2,555.83 ","$1,022.33 ","$1,022.33 ","$2,214.59 ","$2,096.47 ","$2,096.47 ","$1,022.33 ","$2,096.47 ","$2,421.28 ","$2,421.28 ","$2,421.28 ", N/A ,"$2,555.83 ","$2,509.86 ","$1,022.33 ","$2,952.78 ","$1,762.81 ","$1,022.33 ","$1,228.36 ",$477.62 ,$434.20 ,"$1,022.33 ","$2,509.86 ","$2,146.90 ","$2,509.86 ",$826.78 ,"$2,657.50 ","$1,022.33 ","$2,421.28 ","$2,495.10 ","$2,495.10 ","$1,022.33 ","$1,919.31 ","$2,952.78 "
ST. JOSEPH'S HOSPITAL - BREESE,75001223,N/A,HC SMALL BOWEL ENDOSCOPY- 44378,750,1 ,"$1,913.40 ","$1,243.71 ",$535.75 ,"$1,913.40 ", N/A ,"$1,243.71 ","$1,142.30 ", N/A ,$535.75 ,"$1,073.42 ", N/A ,"$1,259.02 ", N/A ,"$1,626.39 ","$1,626.39 ", N/A ,"$1,626.39 ", N/A ,"$1,301.11 ", N/A , N/A , N/A ,"$1,435.05 ","$1,358.51 ","$1,358.51 ", N/A ,"$1,358.51 ","$1,568.99 ","$1,568.99 ","$1,568.99 ", N/A , N/A ,"$1,626.39 ", N/A ,"$1,913.40 ","$1,142.30 ", N/A ,$795.97 , N/A , N/A , N/A ,"$1,626.39 ", N/A ,"$1,626.39 ",$535.75 ,"$1,722.06 ", N/A ,"$1,568.99 ","$1,616.82 ","$1,616.82 ", N/A ,"$1,243.71 ","$1,913.40 "
ST. JOSEPH'S HOSPITAL - BREESE,76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,$973.00 ,$632.45 ,$272.44 ,"$1,565.08 ","$1,565.08 ",$632.45 ,$580.88 ,$626.03 ,$272.44 ,$545.85 ,$626.03 ,$640.23 ,$626.03 ,$827.05 ,$827.05 ,$626.03 ,$827.05 ,$973.00 ,$661.64 ,"$1,565.07 ",$626.03 ,$626.03 ,$729.75 ,$690.83 ,$690.83 ,$626.03 ,$690.83 ,$797.86 ,$797.86 ,$797.86 , N/A ,$973.00 ,$827.05 ,$626.03 ,$973.00 ,$580.88 ,$626.03 ,$404.77 ,$580.76 ,$527.96 ,$626.03 ,$827.05 ,"$1,314.66 ",$827.05 ,$272.44 ,$875.70 ,$626.03 ,$797.86 ,$822.19 ,$822.19 ,$626.03 ,$632.45 ,$973.00 
ST. JOSEPH'S HOSPITAL - BREESE,76100006,64447,HC INJ ANES NERVE FEMORAL SINGLE-BI,761,1 ,"$3,460.00 ","$2,249.00 ",$240.00 ,"$3,460.00 ","$2,347.60 ","$2,249.00 ","$2,065.62 ",$939.04 ,$968.80 ,"$1,941.06 ",$939.04 ,"$2,276.68 ",$939.04 ,"$2,941.00 ","$2,941.00 ",$939.04 ,"$2,941.00 ","$1,784.18 ","$2,352.80 ","$2,347.61 ",$939.04 ,$939.04 ,"$2,595.00 ","$2,456.60 ","$2,456.60 ",$939.04 ,"$2,456.60 ","$2,837.20 ","$2,837.20 ","$2,837.20 ", N/A ,"$2,347.61 ","$2,941.00 ",$939.04 ,"$3,460.00 ","$2,065.62 ",$939.04 ,"$1,439.36 ",$480.33 ,$436.66 ,$939.04 ,"$2,941.00 ","$1,971.99 ","$2,941.00 ",$968.80 ,"$3,114.00 ",$939.04 ,"$2,837.20 ",$240.00 ,$240.00 ,$939.04 ,"$2,249.00 ","$3,460.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100007,64447,HC INJ ANES NERVE FEMORAL SINGLE-LT,761,1 ,"$2,307.00 ","$1,499.55 ",$240.00 ,"$2,307.00 ","$1,565.08 ","$1,499.55 ","$1,377.28 ",$626.03 ,$645.96 ,"$1,294.23 ",$626.03 ,"$1,518.01 ",$626.03 ,"$1,960.95 ","$1,960.95 ",$626.03 ,"$1,960.95 ","$1,189.46 ","$1,568.76 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$626.03 ,"$1,637.97 ","$1,891.74 ","$1,891.74 ","$1,891.74 ", N/A ,"$1,565.07 ","$1,960.95 ",$626.03 ,"$2,307.00 ","$1,377.28 ",$626.03 ,$959.71 ,$320.22 ,$291.11 ,$626.03 ,"$1,960.95 ","$1,314.66 ","$1,960.95 ",$645.96 ,"$2,076.30 ",$626.03 ,"$1,891.74 ",$240.00 ,$240.00 ,$626.03 ,"$1,499.55 ","$2,307.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100008,64447,HC INJ ANES NERVE FEMORAL SINGLE-RT,761,1 ,"$2,307.00 ","$1,499.55 ",$240.00 ,"$2,307.00 ","$1,565.08 ","$1,499.55 ","$1,377.28 ",$626.03 ,$645.96 ,"$1,294.23 ",$626.03 ,"$1,518.01 ",$626.03 ,"$1,960.95 ","$1,960.95 ",$626.03 ,"$1,960.95 ","$1,189.46 ","$1,568.76 ","$1,565.07 ",$626.03 ,$626.03 ,"$1,730.25 ","$1,637.97 ","$1,637.97 ",$626.03 ,"$1,637.97 ","$1,891.74 ","$1,891.74 ","$1,891.74 ", N/A ,"$1,565.07 ","$1,960.95 ",$626.03 ,"$2,307.00 ","$1,377.28 ",$626.03 ,$959.71 ,$320.22 ,$291.11 ,$626.03 ,"$1,960.95 ","$1,314.66 ","$1,960.95 ",$645.96 ,"$2,076.30 ",$626.03 ,"$1,891.74 ",$240.00 ,$240.00 ,$626.03 ,"$1,499.55 ","$2,307.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100021,64484,HC INJ EPID LUMBAR/SACRAL ADDL,761,1 ,"$2,392.00 ","$1,554.80 ",$240.00 ,"$2,392.00 ", N/A ,"$1,554.80 ","$1,428.02 ", N/A ,$669.76 ,"$1,341.91 ", N/A ,"$1,573.94 ", N/A ,"$2,033.20 ","$2,033.20 ", N/A ,"$2,033.20 ", N/A ,"$1,626.56 ", N/A , N/A , N/A ,"$1,794.00 ","$1,698.32 ","$1,698.32 ", N/A ,"$1,698.32 ","$1,961.44 ","$1,961.44 ","$1,961.44 ", N/A , N/A ,"$2,033.20 ", N/A ,"$2,392.00 ","$1,428.02 ", N/A ,$995.07 ,$580.76 ,$527.96 , N/A ,"$2,033.20 ", N/A ,"$2,033.20 ",$669.76 ,"$2,152.80 ", N/A ,"$1,961.44 ",$240.00 ,$240.00 , N/A ,"$1,554.80 ","$2,392.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100024,64483,HC INJ EPID LUMBAR/SACRAL SGL-BI,761,1 ,"$3,492.00 ","$2,269.80 ",$240.00 ,"$3,492.00 ","$3,043.40 ","$2,269.80 ","$2,084.72 ","$1,217.36 ",$977.76 ,"$1,959.01 ","$1,217.36 ","$2,297.74 ","$1,217.36 ","$2,968.20 ","$2,968.20 ","$1,217.36 ","$2,968.20 ","$2,312.98 ","$2,374.56 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$2,619.00 ","$2,479.32 ","$2,479.32 ","$1,217.36 ","$2,479.32 ","$2,863.44 ","$2,863.44 ","$2,863.44 ", N/A ,"$3,043.40 ","$2,968.20 ","$1,217.36 ","$3,492.00 ","$2,084.72 ","$1,217.36 ","$1,452.67 ",$871.13 ,$791.94 ,"$1,217.36 ","$2,968.20 ","$2,556.46 ","$2,968.20 ",$977.76 ,"$3,142.80 ","$1,217.36 ","$2,863.44 ",$240.00 ,$240.00 ,"$1,217.36 ","$2,269.80 ","$3,492.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100025,64483,HC INJ EPID LUMBAR/SACRAL SGL-LT,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,978.80 ","$1,978.80 ",$811.57 ,"$1,978.80 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,978.80 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ",$240.00 ,$240.00 ,$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100026,64483,HC INJ EPID LUMBAR/SACRAL SGL-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,978.80 ","$1,978.80 ",$811.57 ,"$1,978.80 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,978.80 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ",$240.00 ,$240.00 ,$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100027,64479,HC INJ EPIDURAL CREV/THOR SGL-BI,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$3,043.40 ","$3,043.40 ","$1,513.20 ","$1,389.82 ","$1,217.36 ",$651.84 ,"$1,306.01 ","$1,217.36 ","$1,531.82 ","$1,217.36 ","$1,978.80 ","$1,978.80 ","$1,217.36 ","$1,978.80 ","$2,312.98 ","$1,583.04 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,746.00 ","$1,652.88 ","$1,652.88 ","$1,217.36 ","$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,328.00 ","$1,978.80 ","$1,217.36 ","$2,328.00 ","$1,389.82 ","$1,217.36 ",$968.45 ,$871.13 ,$791.94 ,"$1,217.36 ","$1,978.80 ","$2,556.46 ","$1,978.80 ",$651.84 ,"$2,095.20 ","$1,217.36 ","$1,908.96 ",$240.00 ,$240.00 ,"$1,217.36 ","$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100028,64479,HC INJ EPIDURAL CREV/THOR SGL-LT,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,978.80 ","$1,978.80 ",$811.57 ,"$1,978.80 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,978.80 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ",$240.00 ,$240.00 ,$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100029,64479,HC INJ EPIDURAL CREV/THOR SGL-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,978.80 ","$1,978.80 ",$811.57 ,"$1,978.80 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,978.80 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ",$240.00 ,$240.00 ,$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100032,64490,HC INJ PARAVERT F JNT C/T 1 LV-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,978.80 ","$1,978.80 ",$811.57 ,"$1,978.80 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,978.80 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ",$240.00 ,$240.00 ,$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100033,64491,HC INJ PARAVERT F JNT C/T 2 LV,761,1 ,"$2,036.00 ","$1,323.40 ",$240.00 ,"$2,036.00 ", N/A ,"$1,323.40 ","$1,215.49 ", N/A ,$570.08 ,"$1,142.20 ", N/A ,"$1,339.69 ", N/A ,"$1,730.60 ","$1,730.60 ", N/A ,"$1,730.60 ", N/A ,"$1,384.48 ", N/A , N/A , N/A ,"$1,527.00 ","$1,445.56 ","$1,445.56 ", N/A ,"$1,445.56 ","$1,669.52 ","$1,669.52 ","$1,669.52 ", N/A , N/A ,"$1,730.60 ", N/A ,"$2,036.00 ","$1,215.49 ", N/A ,$846.98 ,$580.76 ,$527.96 , N/A ,"$1,730.60 ", N/A ,"$1,730.60 ",$570.08 ,"$1,832.40 ", N/A ,"$1,669.52 ",$240.00 ,$240.00 , N/A ,"$1,323.40 ","$2,036.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100034,64491,HC INJ PARAVERT F JNT C/T 2 LV-LT,761,1 ,"$2,036.00 ","$1,323.40 ",$240.00 ,"$2,036.00 ", N/A ,"$1,323.40 ","$1,215.49 ", N/A ,$570.08 ,"$1,142.20 ", N/A ,"$1,339.69 ", N/A ,"$1,730.60 ","$1,730.60 ", N/A ,"$1,730.60 ", N/A ,"$1,384.48 ", N/A , N/A , N/A ,"$1,527.00 ","$1,445.56 ","$1,445.56 ", N/A ,"$1,445.56 ","$1,669.52 ","$1,669.52 ","$1,669.52 ", N/A , N/A ,"$1,730.60 ", N/A ,"$2,036.00 ","$1,215.49 ", N/A ,$846.98 ,$580.76 ,$527.96 , N/A ,"$1,730.60 ", N/A ,"$1,730.60 ",$570.08 ,"$1,832.40 ", N/A ,"$1,669.52 ",$240.00 ,$240.00 , N/A ,"$1,323.40 ","$2,036.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100035,64491,HC INJ PARAVERT F JNT C/T 2 LV-RT,761,1 ,"$2,036.00 ","$1,323.40 ",$240.00 ,"$2,036.00 ", N/A ,"$1,323.40 ","$1,215.49 ", N/A ,$570.08 ,"$1,142.20 ", N/A ,"$1,339.69 ", N/A ,"$1,730.60 ","$1,730.60 ", N/A ,"$1,730.60 ", N/A ,"$1,384.48 ", N/A , N/A , N/A ,"$1,527.00 ","$1,445.56 ","$1,445.56 ", N/A ,"$1,445.56 ","$1,669.52 ","$1,669.52 ","$1,669.52 ", N/A , N/A ,"$1,730.60 ", N/A ,"$2,036.00 ","$1,215.49 ", N/A ,$846.98 ,$580.76 ,$527.96 , N/A ,"$1,730.60 ", N/A ,"$1,730.60 ",$570.08 ,"$1,832.40 ", N/A ,"$1,669.52 ",$240.00 ,$240.00 , N/A ,"$1,323.40 ","$2,036.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100036,64492,HC INJ PARAVERT F JNT C/T 3 LV,761,1 ,"$2,227.00 ","$1,447.55 ",$240.00 ,"$2,227.00 ", N/A ,"$1,447.55 ","$1,329.52 ", N/A ,$623.56 ,"$1,249.35 ", N/A ,"$1,465.37 ", N/A ,"$1,892.95 ","$1,892.95 ", N/A ,"$1,892.95 ", N/A ,"$1,514.36 ", N/A , N/A , N/A ,"$1,670.25 ","$1,581.17 ","$1,581.17 ", N/A ,"$1,581.17 ","$1,826.14 ","$1,826.14 ","$1,826.14 ", N/A , N/A ,"$1,892.95 ", N/A ,"$2,227.00 ","$1,329.52 ", N/A ,$926.43 ,$580.76 ,$527.96 , N/A ,"$1,892.95 ", N/A ,"$1,892.95 ",$623.56 ,"$2,004.30 ", N/A ,"$1,826.14 ",$240.00 ,$240.00 , N/A ,"$1,447.55 ","$2,227.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100037,64492,HC INJ PARAVERT F JNT C/T 3 LV-LT,761,1 ,"$2,227.00 ","$1,447.55 ",$240.00 ,"$2,227.00 ", N/A ,"$1,447.55 ","$1,329.52 ", N/A ,$623.56 ,"$1,249.35 ", N/A ,"$1,465.37 ", N/A ,"$1,892.95 ","$1,892.95 ", N/A ,"$1,892.95 ", N/A ,"$1,514.36 ", N/A , N/A , N/A ,"$1,670.25 ","$1,581.17 ","$1,581.17 ", N/A ,"$1,581.17 ","$1,826.14 ","$1,826.14 ","$1,826.14 ", N/A , N/A ,"$1,892.95 ", N/A ,"$2,227.00 ","$1,329.52 ", N/A ,$926.43 ,$580.76 ,$527.96 , N/A ,"$1,892.95 ", N/A ,"$1,892.95 ",$623.56 ,"$2,004.30 ", N/A ,"$1,826.14 ",$240.00 ,$240.00 , N/A ,"$1,447.55 ","$2,227.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100038,64492,HC INJ PARAVERT F JNT C/T 3 LV-RT,761,1 ,"$2,227.00 ","$1,447.55 ",$240.00 ,"$2,227.00 ", N/A ,"$1,447.55 ","$1,329.52 ", N/A ,$623.56 ,"$1,249.35 ", N/A ,"$1,465.37 ", N/A ,"$1,892.95 ","$1,892.95 ", N/A ,"$1,892.95 ", N/A ,"$1,514.36 ", N/A , N/A , N/A ,"$1,670.25 ","$1,581.17 ","$1,581.17 ", N/A ,"$1,581.17 ","$1,826.14 ","$1,826.14 ","$1,826.14 ", N/A , N/A ,"$1,892.95 ", N/A ,"$2,227.00 ","$1,329.52 ", N/A ,$926.43 ,$580.76 ,$527.96 , N/A ,"$1,892.95 ", N/A ,"$1,892.95 ",$623.56 ,"$2,004.30 ", N/A ,"$1,826.14 ",$240.00 ,$240.00 , N/A ,"$1,447.55 ","$2,227.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100039,64493,HC INJ PARAVERT F JNT L/S 1 LV-BI,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$3,043.40 ","$3,043.40 ","$1,513.20 ","$1,389.82 ","$1,217.36 ",$651.84 ,"$1,306.01 ","$1,217.36 ","$1,531.82 ","$1,217.36 ","$1,978.80 ","$1,978.80 ","$1,217.36 ","$1,978.80 ","$2,312.98 ","$1,583.04 ","$3,043.40 ","$1,217.36 ","$1,217.36 ","$1,746.00 ","$1,652.88 ","$1,652.88 ","$1,217.36 ","$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,328.00 ","$1,978.80 ","$1,217.36 ","$2,328.00 ","$1,389.82 ","$1,217.36 ",$968.45 ,$871.13 ,$791.94 ,"$1,217.36 ","$1,978.80 ","$2,556.46 ","$1,978.80 ",$651.84 ,"$2,095.20 ","$1,217.36 ","$1,908.96 ",$240.00 ,$240.00 ,"$1,217.36 ","$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100040,64493,HC INJ PARAVERT F JNT L/S 1 LV-LT,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,978.80 ","$1,978.80 ",$811.57 ,"$1,978.80 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,978.80 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ",$240.00 ,$240.00 ,$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100041,64493,HC INJ PARAVERT F JNT L/S 1 LV-RT,761,1 ,"$2,328.00 ","$1,513.20 ",$240.00 ,"$2,328.00 ","$2,028.93 ","$1,513.20 ","$1,389.82 ",$811.57 ,$651.84 ,"$1,306.01 ",$811.57 ,"$1,531.82 ",$811.57 ,"$1,978.80 ","$1,978.80 ",$811.57 ,"$1,978.80 ","$1,541.99 ","$1,583.04 ","$2,028.93 ",$811.57 ,$811.57 ,"$1,746.00 ","$1,652.88 ","$1,652.88 ",$811.57 ,"$1,652.88 ","$1,908.96 ","$1,908.96 ","$1,908.96 ", N/A ,"$2,028.93 ","$1,978.80 ",$811.57 ,"$2,328.00 ","$1,389.82 ",$811.57 ,$968.45 ,$580.76 ,$527.96 ,$811.57 ,"$1,978.80 ","$1,704.30 ","$1,978.80 ",$651.84 ,"$2,095.20 ",$811.57 ,"$1,908.96 ",$240.00 ,$240.00 ,$811.57 ,"$1,513.20 ","$2,328.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100042,64494,HC INJ PARAVERT F JNT L/S 2 LV,761,1 ,"$2,016.00 ","$1,310.40 ",$240.00 ,"$2,016.00 ", N/A ,"$1,310.40 ","$1,203.55 ", N/A ,$564.48 ,"$1,130.98 ", N/A ,"$1,326.53 ", N/A ,"$1,713.60 ","$1,713.60 ", N/A ,"$1,713.60 ", N/A ,"$1,370.88 ", N/A , N/A , N/A ,"$1,512.00 ","$1,431.36 ","$1,431.36 ", N/A ,"$1,431.36 ","$1,653.12 ","$1,653.12 ","$1,653.12 ", N/A , N/A ,"$1,713.60 ", N/A ,"$2,016.00 ","$1,203.55 ", N/A ,$838.66 ,$580.76 ,$527.96 , N/A ,"$1,713.60 ", N/A ,"$1,713.60 ",$564.48 ,"$1,814.40 ", N/A ,"$1,653.12 ",$240.00 ,$240.00 , N/A ,"$1,310.40 ","$2,016.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100043,64494,HC INJ PARAVERT F JNT L/S 2 LV-LT,761,1 ,"$2,016.00 ","$1,310.40 ",$240.00 ,"$2,016.00 ", N/A ,"$1,310.40 ","$1,203.55 ", N/A ,$564.48 ,"$1,130.98 ", N/A ,"$1,326.53 ", N/A ,"$1,713.60 ","$1,713.60 ", N/A ,"$1,713.60 ", N/A ,"$1,370.88 ", N/A , N/A , N/A ,"$1,512.00 ","$1,431.36 ","$1,431.36 ", N/A ,"$1,431.36 ","$1,653.12 ","$1,653.12 ","$1,653.12 ", N/A , N/A ,"$1,713.60 ", N/A ,"$2,016.00 ","$1,203.55 ", N/A ,$838.66 ,$580.76 ,$527.96 , N/A ,"$1,713.60 ", N/A ,"$1,713.60 ",$564.48 ,"$1,814.40 ", N/A ,"$1,653.12 ",$240.00 ,$240.00 , N/A ,"$1,310.40 ","$2,016.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100044,64494,HC INJ PARAVERT F JNT L/S 2 LV-RT,761,1 ,"$2,016.00 ","$1,310.40 ",$240.00 ,"$2,016.00 ", N/A ,"$1,310.40 ","$1,203.55 ", N/A ,$564.48 ,"$1,130.98 ", N/A ,"$1,326.53 ", N/A ,"$1,713.60 ","$1,713.60 ", N/A ,"$1,713.60 ", N/A ,"$1,370.88 ", N/A , N/A , N/A ,"$1,512.00 ","$1,431.36 ","$1,431.36 ", N/A ,"$1,431.36 ","$1,653.12 ","$1,653.12 ","$1,653.12 ", N/A , N/A ,"$1,713.60 ", N/A ,"$2,016.00 ","$1,203.55 ", N/A ,$838.66 ,$580.76 ,$527.96 , N/A ,"$1,713.60 ", N/A ,"$1,713.60 ",$564.48 ,"$1,814.40 ", N/A ,"$1,653.12 ",$240.00 ,$240.00 , N/A ,"$1,310.40 ","$2,016.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100045,64495,HC INJ PARAVRT F JNT L/S 3+ LV,761,1 ,"$1,878.00 ","$1,220.70 ",$240.00 ,"$1,878.00 ", N/A ,"$1,220.70 ","$1,121.17 ", N/A ,$525.84 ,"$1,053.56 ", N/A ,"$1,235.72 ", N/A ,"$1,596.30 ","$1,596.30 ", N/A ,"$1,596.30 ", N/A ,"$1,277.04 ", N/A , N/A , N/A ,"$1,408.50 ","$1,333.38 ","$1,333.38 ", N/A ,"$1,333.38 ","$1,539.96 ","$1,539.96 ","$1,539.96 ", N/A , N/A ,"$1,596.30 ", N/A ,"$1,878.00 ","$1,121.17 ", N/A ,$781.25 ,$580.76 ,$527.96 , N/A ,"$1,596.30 ", N/A ,"$1,596.30 ",$525.84 ,"$1,690.20 ", N/A ,"$1,539.96 ",$240.00 ,$240.00 , N/A ,"$1,220.70 ","$1,878.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100046,64495,HC INJ PARAVRT F JNT L/S 3+ LV-LT,761,1 ,"$1,878.00 ","$1,220.70 ",$240.00 ,"$1,878.00 ", N/A ,"$1,220.70 ","$1,121.17 ", N/A ,$525.84 ,"$1,053.56 ", N/A ,"$1,235.72 ", N/A ,"$1,596.30 ","$1,596.30 ", N/A ,"$1,596.30 ", N/A ,"$1,277.04 ", N/A , N/A , N/A ,"$1,408.50 ","$1,333.38 ","$1,333.38 ", N/A ,"$1,333.38 ","$1,539.96 ","$1,539.96 ","$1,539.96 ", N/A , N/A ,"$1,596.30 ", N/A ,"$1,878.00 ","$1,121.17 ", N/A ,$781.25 ,$580.76 ,$527.96 , N/A ,"$1,596.30 ", N/A ,"$1,596.30 ",$525.84 ,"$1,690.20 ", N/A ,"$1,539.96 ",$240.00 ,$240.00 , N/A ,"$1,220.70 ","$1,878.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76100047,64495,HC INJ PARAVRT F JNT L/S 3+ LV-RT,761,1 ,"$1,878.00 ","$1,220.70 ",$240.00 ,"$1,878.00 ", N/A ,"$1,220.70 ","$1,121.17 ", N/A ,$525.84 ,"$1,053.56 ", N/A ,"$1,235.72 ", N/A ,"$1,596.30 ","$1,596.30 ", N/A ,"$1,596.30 ", N/A ,"$1,277.04 ", N/A , N/A , N/A ,"$1,408.50 ","$1,333.38 ","$1,333.38 ", N/A ,"$1,333.38 ","$1,539.96 ","$1,539.96 ","$1,539.96 ", N/A , N/A ,"$1,596.30 ", N/A ,"$1,878.00 ","$1,121.17 ", N/A ,$781.25 ,$580.76 ,$527.96 , N/A ,"$1,596.30 ", N/A ,"$1,596.30 ",$525.84 ,"$1,690.20 ", N/A ,"$1,539.96 ",$240.00 ,$240.00 , N/A ,"$1,220.70 ","$1,878.00 "
ST. JOSEPH'S HOSPITAL - BREESE,76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$146.00 ,$94.90 ,$40.88 ,$146.00 , N/A ,$94.90 ,$87.16 , N/A ,$40.88 ,$81.91 , N/A ,$96.07 , N/A ,$124.10 ,$124.10 , N/A ,$124.10 , N/A ,$99.28 , N/A , N/A , N/A ,$109.50 ,$103.66 ,$103.66 , N/A ,$103.66 ,$119.72 ,$119.72 ,$119.72 , N/A , N/A ,$124.10 , N/A ,$146.00 ,$87.16 , N/A ,$60.74 , N/A , N/A , N/A ,$124.10 , N/A ,$124.10 ,$40.88 ,$131.40 , N/A ,$119.72 ,$123.37 ,$123.37 , N/A ,$94.90 ,$146.00 
ST. JOSEPH'S HOSPITAL - BREESE,76200009,G0378,HC OBSERVATION HOURLY,762,1 ,$65.00 ,$42.25 ,$18.20 ,$65.00 , N/A ,$42.25 ,$38.81 , N/A ,$18.20 ,$36.47 , N/A ,$42.77 , N/A ,$55.25 ,$55.25 , N/A ,$55.25 , N/A ,$44.20 , N/A , N/A , N/A ,$48.75 ,$46.15 ,$46.15 , N/A ,$46.15 ,$53.30 ,$53.30 ,$53.30 , N/A , N/A ,$55.25 , N/A ,$65.00 ,$38.81 , N/A ,$27.04 , N/A , N/A , N/A ,$55.25 , N/A ,$55.25 ,$18.20 ,$58.50 , N/A ,$53.30 ,$54.93 ,$54.93 , N/A ,$42.25 ,$65.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$51.00 ,$33.15 ,$14.28 ,$152.81 ,$152.80 ,$33.15 ,$30.45 ,$61.12 ,$14.28 ,$28.61 ,$61.12 ,$33.56 ,$51.00 ,$43.35 ,$43.35 ,$51.00 ,$43.35 ,$51.00 ,$34.68 ,$152.81 ,$61.12 ,$61.12 ,$38.25 ,$36.21 ,$36.21 ,$61.12 ,$36.21 ,$41.82 ,$41.82 ,$41.82 , N/A ,$51.00 ,$43.35 ,$61.12 ,$51.00 ,$30.45 ,$61.12 ,$21.22 , N/A , N/A ,$61.12 ,$43.35 ,$128.36 ,$43.35 ,$14.28 ,$45.90 ,$61.12 ,$41.82 ,$43.10 ,$43.10 ,$61.12 ,$33.15 ,$51.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$69.00 ,$44.85 ,$19.32 ,$69.00 , N/A ,$44.85 ,$41.19 , N/A ,$19.32 ,$38.71 , N/A ,$45.40 , N/A ,$58.65 ,$58.65 , N/A ,$58.65 , N/A ,$46.92 , N/A , N/A , N/A ,$51.75 ,$48.99 ,$48.99 , N/A ,$48.99 ,$56.58 ,$56.58 ,$56.58 , N/A , N/A ,$58.65 , N/A ,$69.00 ,$41.19 , N/A ,$28.70 , N/A , N/A , N/A ,$58.65 , N/A ,$58.65 ,$19.32 ,$62.10 , N/A ,$56.58 ,$58.31 ,$58.31 , N/A ,$44.85 ,$69.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$48.00 ,$31.20 ,$13.44 ,$98.63 ,$98.63 ,$31.20 ,$28.66 ,$39.45 ,$13.44 ,$26.93 ,$39.45 ,$31.58 ,$39.45 ,$40.80 ,$40.80 ,$39.45 ,$40.80 ,$48.00 ,$32.64 ,$98.63 ,$39.45 ,$39.45 ,$36.00 ,$34.08 ,$34.08 ,$39.45 ,$34.08 ,$39.36 ,$39.36 ,$39.36 , N/A ,$48.00 ,$40.80 ,$39.45 ,$48.00 ,$28.66 ,$39.45 ,$19.97 , N/A , N/A ,$39.45 ,$40.80 ,$82.85 ,$40.80 ,$13.44 ,$43.20 ,$39.45 ,$39.36 ,$40.56 ,$40.56 ,$39.45 ,$31.20 ,$48.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$48.00 ,$31.20 ,$13.44 ,$98.63 ,$98.63 ,$31.20 ,$28.66 ,$39.45 ,$13.44 ,$26.93 ,$39.45 ,$31.58 ,$39.45 ,$40.80 ,$40.80 ,$39.45 ,$40.80 ,$48.00 ,$32.64 ,$98.63 ,$39.45 ,$39.45 ,$36.00 ,$34.08 ,$34.08 ,$39.45 ,$34.08 ,$39.36 ,$39.36 ,$39.36 , N/A ,$48.00 ,$40.80 ,$39.45 ,$48.00 ,$28.66 ,$39.45 ,$19.97 , N/A , N/A ,$39.45 ,$40.80 ,$82.85 ,$40.80 ,$13.44 ,$43.20 ,$39.45 ,$39.36 ,$40.56 ,$40.56 ,$39.45 ,$31.20 ,$48.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$48.00 ,$31.20 ,$13.44 ,$98.63 ,$98.63 ,$31.20 ,$28.66 ,$39.45 ,$13.44 ,$26.93 ,$39.45 ,$31.58 ,$39.45 ,$40.80 ,$40.80 ,$39.45 ,$40.80 ,$48.00 ,$32.64 ,$98.63 ,$39.45 ,$39.45 ,$36.00 ,$34.08 ,$34.08 ,$39.45 ,$34.08 ,$39.36 ,$39.36 ,$39.36 , N/A ,$48.00 ,$40.80 ,$39.45 ,$48.00 ,$28.66 ,$39.45 ,$19.97 , N/A , N/A ,$39.45 ,$40.80 ,$82.85 ,$40.80 ,$13.44 ,$43.20 ,$39.45 ,$39.36 ,$40.56 ,$40.56 ,$39.45 ,$31.20 ,$48.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100008,N/A,HC HEALTH FAIR INFLUENZA VACCINE,771,1 ,$25.00 ,$16.25 ,$7.00 ,$25.00 , N/A ,$16.25 ,$14.93 , N/A ,$7.00 ,$14.03 , N/A ,$16.45 , N/A ,$21.25 ,$21.25 , N/A ,$21.25 , N/A ,$17.00 , N/A , N/A , N/A ,$18.75 ,$17.75 ,$17.75 , N/A ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A , N/A ,$21.25 , N/A ,$25.00 ,$14.93 , N/A ,$10.40 , N/A , N/A , N/A ,$21.25 , N/A ,$21.25 ,$7.00 ,$22.50 , N/A ,$20.50 ,$21.13 ,$21.13 , N/A ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100009,0001A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$40.00 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100010,0002A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$40.00 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100011,0011A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$40.00 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100012,0012A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5M SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$40.00 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100013,0021A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$40.00 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100014,0022A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$40.00 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100015,0031A,HC ADMINISTRATION SARS-COV-2 VACCINE AD26 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$40.00 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100016,0041A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML FIRST DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100017,0042A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML SECOND DOSE,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 , N/A ,$78.00 ,$71.64 , N/A ,$33.60 ,$67.32 , N/A ,$78.96 , N/A ,$102.00 ,$102.00 , N/A ,$102.00 , N/A ,$81.60 , N/A , N/A , N/A ,$90.00 ,$85.20 ,$85.20 , N/A ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A , N/A ,$102.00 , N/A ,$120.00 ,$71.64 , N/A ,$49.92 , N/A , N/A , N/A ,$102.00 , N/A ,$102.00 ,$33.60 ,$108.00 , N/A ,$98.40 ,$101.40 ,$101.40 , N/A ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100018,0003A,HC ADM SARSCOV2 30MCG/0.3ML 3RD - PFIZER,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$81.60 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100019,0013A,HC ADM SARSCOV2 100MCG/0.5ML 3RD - MODERNA,771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$81.60 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100025,0064A,"HC ADMIN SARS-COV-2 VACCINE 50MCG/0.25ML, BOOSTER DOSE",771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$81.60 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,77100028,0034A,"HC ADMIN SARS-COV-2 VACCINE JOHNSON  AND  JOHNSON, BOOSTER DOSE",771,1 ,$120.00 ,$78.00 ,$33.60 ,$120.00 ,$96.53 ,$78.00 ,$71.64 ,$38.61 ,$33.60 ,$67.32 ,$38.61 ,$78.96 ,$38.61 ,$102.00 ,$102.00 ,$38.61 ,$102.00 ,$73.36 ,$81.60 ,$96.53 ,$38.61 ,$38.61 ,$90.00 ,$85.20 ,$85.20 ,$38.61 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$96.53 ,$102.00 ,$38.61 ,$120.00 ,$71.64 ,$38.61 ,$49.92 , N/A , N/A ,$38.61 ,$102.00 ,$81.09 ,$102.00 ,$33.60 ,$108.00 ,$38.61 ,$98.40 ,$101.40 ,$101.40 ,$38.61 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$98.00 ,$63.70 ,$9.67 ,$98.00 ,$68.98 ,$63.70 ,$58.51 ,$27.59 ,$27.44 ,$54.98 ,$27.59 ,$64.48 ,$27.59 ,$83.30 ,$83.30 ,$27.59 ,$83.30 ,$52.42 ,$66.64 ,$68.98 ,$27.59 ,$27.59 ,$73.50 ,$69.58 ,$69.58 ,$27.59 ,$69.58 ,$80.36 ,$80.36 ,$80.36 , N/A ,$68.98 ,$83.30 ,$27.59 ,$98.00 ,$58.51 ,$27.59 ,$40.77 ,$10.64 ,$9.67 ,$27.59 ,$83.30 ,$57.94 ,$83.30 ,$27.44 ,$88.20 ,$27.59 ,$80.36 ,$82.81 ,$82.81 ,$27.59 ,$63.70 ,$98.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000003,97110,HC THERA EXER; EA 15 MIN - 95,780,1 ,$161.00 ,$104.65 ,$29.76 ,$161.00 ,$74.40 ,$104.65 ,$96.12 ,$29.76 ,$45.08 ,$90.32 ,$29.76 ,$105.94 ,$29.76 ,$136.85 ,$136.85 ,$29.76 ,$136.85 ,$56.54 ,$109.48 ,$74.40 ,$29.76 ,$29.76 ,$120.75 ,$114.31 ,$114.31 ,$29.76 ,$114.31 ,$132.02 ,$132.02 ,$132.02 , N/A ,$74.40 ,$136.85 ,$29.76 ,$161.00 ,$96.12 ,$29.76 ,$66.98 , N/A , N/A ,$29.76 ,$136.85 ,$62.50 ,$136.85 ,$45.08 ,$144.90 ,$29.76 ,$132.02 ,$136.05 ,$136.05 ,$29.76 ,$104.65 ,$161.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000004,97112,HC NEUROMUSCULAR RE ED EA 15 MIN - 95,780,1 ,$180.00 ,$117.00 ,$34.43 ,$180.00 ,$86.08 ,$117.00 ,$107.46 ,$34.43 ,$50.40 ,$100.98 ,$34.43 ,$118.44 ,$34.43 ,$153.00 ,$153.00 ,$34.43 ,$153.00 ,$65.42 ,$122.40 ,$86.08 ,$34.43 ,$34.43 ,$135.00 ,$127.80 ,$127.80 ,$34.43 ,$127.80 ,$147.60 ,$147.60 ,$147.60 , N/A ,$86.08 ,$153.00 ,$34.43 ,$180.00 ,$107.46 ,$34.43 ,$74.88 , N/A , N/A ,$34.43 ,$153.00 ,$72.30 ,$153.00 ,$50.40 ,$162.00 ,$34.43 ,$147.60 ,$152.10 ,$152.10 ,$34.43 ,$117.00 ,$180.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000005,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN - 95,780,1 ,$148.00 ,$96.20 ,$37.24 ,$148.00 ,$93.10 ,$96.20 ,$88.36 ,$37.24 ,$41.44 ,$83.03 ,$37.24 ,$97.38 ,$37.24 ,$125.80 ,$125.80 ,$37.24 ,$125.80 ,$70.76 ,$100.64 ,$93.10 ,$37.24 ,$37.24 ,$111.00 ,$105.08 ,$105.08 ,$37.24 ,$105.08 ,$121.36 ,$121.36 ,$121.36 , N/A ,$93.10 ,$125.80 ,$37.24 ,$148.00 ,$88.36 ,$37.24 ,$61.57 , N/A , N/A ,$37.24 ,$125.80 ,$78.20 ,$125.80 ,$41.44 ,$133.20 ,$37.24 ,$121.36 ,$125.06 ,$125.06 ,$37.24 ,$96.20 ,$148.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000006,97535,HC SELF CARE ADL TRAINING EA 15 MIN - 95,780,1 ,$110.00 ,$71.50 ,$30.80 ,$110.00 ,$82.55 ,$71.50 ,$65.67 ,$33.02 ,$30.80 ,$61.71 ,$33.02 ,$72.38 ,$33.02 ,$93.50 ,$93.50 ,$33.02 ,$93.50 ,$62.74 ,$74.80 ,$82.55 ,$33.02 ,$33.02 ,$82.50 ,$78.10 ,$78.10 ,$33.02 ,$78.10 ,$90.20 ,$90.20 ,$90.20 , N/A ,$82.55 ,$93.50 ,$33.02 ,$110.00 ,$65.67 ,$33.02 ,$45.76 , N/A , N/A ,$33.02 ,$93.50 ,$69.34 ,$93.50 ,$30.80 ,$99.00 ,$33.02 ,$90.20 ,$92.95 ,$92.95 ,$33.02 ,$71.50 ,$110.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000007,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN - 95,780,1 ,$89.00 ,$57.85 ,$23.34 ,$89.00 ,$58.35 ,$57.85 ,$53.13 ,$23.34 ,$24.92 ,$49.93 ,$23.34 ,$58.56 ,$23.34 ,$75.65 ,$75.65 ,$23.34 ,$75.65 ,$44.35 ,$60.52 ,$58.35 ,$23.34 ,$23.34 ,$66.75 ,$63.19 ,$63.19 ,$23.34 ,$63.19 ,$72.98 ,$72.98 ,$72.98 , N/A ,$58.35 ,$75.65 ,$23.34 ,$89.00 ,$53.13 ,$23.34 ,$37.02 , N/A , N/A ,$23.34 ,$75.65 ,$49.01 ,$75.65 ,$24.92 ,$80.10 ,$23.34 ,$72.98 ,$75.21 ,$75.21 ,$23.34 ,$57.85 ,$89.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000008,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN - 95,780,1 ,$89.00 ,$57.85 ,$22.65 ,$89.00 ,$56.63 ,$57.85 ,$53.13 ,$22.65 ,$24.92 ,$49.93 ,$22.65 ,$58.56 ,$22.65 ,$75.65 ,$75.65 ,$22.65 ,$75.65 ,$43.04 ,$60.52 ,$56.63 ,$22.65 ,$22.65 ,$66.75 ,$63.19 ,$63.19 ,$22.65 ,$63.19 ,$72.98 ,$72.98 ,$72.98 , N/A ,$56.63 ,$75.65 ,$22.65 ,$89.00 ,$53.13 ,$22.65 ,$37.02 , N/A , N/A ,$22.65 ,$75.65 ,$47.57 ,$75.65 ,$24.92 ,$80.10 ,$22.65 ,$72.98 ,$75.21 ,$75.21 ,$22.65 ,$57.85 ,$89.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000009,97161,HC PT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$244.00 ,$158.60 ,$68.32 ,$253.33 ,$253.33 ,$158.60 ,$145.67 ,$101.33 ,$68.32 ,$136.88 ,$101.33 ,$160.55 ,$101.33 ,$207.40 ,$207.40 ,$101.33 ,$207.40 ,$192.53 ,$165.92 ,$253.33 ,$101.33 ,$101.33 ,$183.00 ,$173.24 ,$173.24 ,$101.33 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.33 ,$244.00 ,$145.67 ,$101.33 ,$101.50 , N/A , N/A ,$101.33 ,$207.40 ,$212.79 ,$207.40 ,$68.32 ,$219.60 ,$101.33 ,$200.08 ,$206.18 ,$206.18 ,$101.33 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000010,97162,HC PT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$271.00 ,$176.15 ,$75.88 ,$271.00 ,$253.33 ,$176.15 ,$161.79 ,$101.33 ,$75.88 ,$152.03 ,$101.33 ,$178.32 ,$101.33 ,$230.35 ,$230.35 ,$101.33 ,$230.35 ,$192.53 ,$184.28 ,$253.33 ,$101.33 ,$101.33 ,$203.25 ,$192.41 ,$192.41 ,$101.33 ,$192.41 ,$222.22 ,$222.22 ,$222.22 , N/A ,$253.33 ,$230.35 ,$101.33 ,$271.00 ,$161.79 ,$101.33 ,$112.74 , N/A , N/A ,$101.33 ,$230.35 ,$212.79 ,$230.35 ,$75.88 ,$243.90 ,$101.33 ,$222.22 ,$229.00 ,$229.00 ,$101.33 ,$176.15 ,$271.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000011,97163,HC PT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$567.00 ,$368.55 ,$101.33 ,$567.00 ,$253.33 ,$368.55 ,$338.50 ,$101.33 ,$158.76 ,$318.09 ,$101.33 ,$373.09 ,$101.33 ,$481.95 ,$481.95 ,$101.33 ,$481.95 ,$192.53 ,$385.56 ,$253.33 ,$101.33 ,$101.33 ,$425.25 ,$402.57 ,$402.57 ,$101.33 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$253.33 ,$481.95 ,$101.33 ,$567.00 ,$338.50 ,$101.33 ,$235.87 , N/A , N/A ,$101.33 ,$481.95 ,$212.79 ,$481.95 ,$158.76 ,$510.30 ,$101.33 ,$464.94 ,$479.12 ,$479.12 ,$101.33 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000012,97164,HC PT RE-EVAL 15 MIN - 95,780,1 ,$165.00 ,$107.25 ,$46.20 ,$173.55 ,$173.55 ,$107.25 ,$98.51 ,$69.42 ,$46.20 ,$92.57 ,$69.42 ,$108.57 ,$69.42 ,$140.25 ,$140.25 ,$69.42 ,$140.25 ,$131.90 ,$112.20 ,$173.55 ,$69.42 ,$69.42 ,$123.75 ,$117.15 ,$117.15 ,$69.42 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.42 ,$165.00 ,$98.51 ,$69.42 ,$68.64 , N/A , N/A ,$69.42 ,$140.25 ,$145.78 ,$140.25 ,$46.20 ,$148.50 ,$69.42 ,$135.30 ,$139.43 ,$139.43 ,$69.42 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000013,97165,HC OT EVAL LOW COMPLEXITY 30 MIN - 95,780,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 , N/A , N/A ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000014,97116,HC AMBULATION GAIT TRAIN EA 15 MIN - 95,780,1 ,$163.00 ,$105.95 ,$29.76 ,$163.00 ,$74.40 ,$105.95 ,$97.31 ,$29.76 ,$45.64 ,$91.44 ,$29.76 ,$107.25 ,$29.76 ,$138.55 ,$138.55 ,$29.76 ,$138.55 ,$56.54 ,$110.84 ,$74.40 ,$29.76 ,$29.76 ,$122.25 ,$115.73 ,$115.73 ,$29.76 ,$115.73 ,$133.66 ,$133.66 ,$133.66 , N/A ,$74.40 ,$138.55 ,$29.76 ,$163.00 ,$97.31 ,$29.76 ,$67.81 , N/A , N/A ,$29.76 ,$138.55 ,$62.50 ,$138.55 ,$45.64 ,$146.70 ,$29.76 ,$133.66 ,$137.74 ,$137.74 ,$29.76 ,$105.95 ,$163.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000015,97167,HC OT EVAL HIGH COMPLEXITY 60 MIN - 95,780,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 , N/A , N/A ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000016,97168,HC OT RE-EVAL 30 MIN - 95,780,1 ,$165.00 ,$107.25 ,$46.20 ,$174.38 ,$174.38 ,$107.25 ,$98.51 ,$69.75 ,$46.20 ,$92.57 ,$69.75 ,$108.57 ,$69.75 ,$140.25 ,$140.25 ,$69.75 ,$140.25 ,$132.53 ,$112.20 ,$174.38 ,$69.75 ,$69.75 ,$123.75 ,$117.15 ,$117.15 ,$69.75 ,$117.15 ,$135.30 ,$135.30 ,$135.30 , N/A ,$165.00 ,$140.25 ,$69.75 ,$165.00 ,$98.51 ,$69.75 ,$68.64 , N/A , N/A ,$69.75 ,$140.25 ,$146.48 ,$140.25 ,$46.20 ,$148.50 ,$69.75 ,$135.30 ,$139.43 ,$139.43 ,$69.75 ,$107.25 ,$165.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000017,92507,HC SPEECH THERAPY TREATMENT 15 MIN - 95,780,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 , N/A , N/A ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000018,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN - 95,780,1 ,$256.00 ,$166.40 ,$71.68 ,$336.30 ,$336.30 ,$166.40 ,$152.83 ,$134.52 ,$71.68 ,$143.62 ,$134.52 ,$168.45 ,$134.52 ,$217.60 ,$217.60 ,$134.52 ,$217.60 ,$255.59 ,$174.08 ,$336.30 ,$134.52 ,$134.52 ,$192.00 ,$181.76 ,$181.76 ,$134.52 ,$181.76 ,$209.92 ,$209.92 ,$209.92 , N/A ,$256.00 ,$217.60 ,$134.52 ,$256.00 ,$152.83 ,$134.52 ,$106.50 , N/A , N/A ,$134.52 ,$217.60 ,$282.49 ,$217.60 ,$71.68 ,$230.40 ,$134.52 ,$209.92 ,$216.32 ,$216.32 ,$134.52 ,$166.40 ,$256.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000019,92526,HC DYSPHAGIA TREATMENT 15 MIN - 95,780,1 ,$144.00 ,$93.60 ,$40.32 ,$214.40 ,$214.40 ,$93.60 ,$85.97 ,$85.76 ,$40.32 ,$80.78 ,$85.76 ,$94.75 ,$85.76 ,$122.40 ,$122.40 ,$85.76 ,$122.40 ,$144.00 ,$97.92 ,$214.40 ,$85.76 ,$85.76 ,$108.00 ,$102.24 ,$102.24 ,$85.76 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$144.00 ,$122.40 ,$85.76 ,$144.00 ,$85.97 ,$85.76 ,$59.90 , N/A , N/A ,$85.76 ,$122.40 ,$180.10 ,$122.40 ,$40.32 ,$129.60 ,$85.76 ,$118.08 ,$121.68 ,$121.68 ,$85.76 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000024,90832,PC THERAPY INDIVIDUAL PSYCH 30 MIN - 95,780,1 ,$120.00 ,$78.00 ,$33.60 ,$329.78 ,$329.78 ,$78.00 ,$71.64 ,$131.91 ,$33.60 ,$67.32 ,$131.91 ,$78.96 ,$120.00 ,$102.00 ,$102.00 ,$120.00 ,$102.00 ,$120.00 ,$81.60 ,$329.78 ,$131.91 ,$131.91 ,$90.00 ,$85.20 ,$85.20 ,$131.91 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$120.00 ,$102.00 ,$131.91 ,$120.00 ,$71.64 ,$131.91 ,$49.92 , N/A , N/A ,$131.91 ,$102.00 ,$277.01 ,$102.00 ,$33.60 ,$108.00 ,$131.91 ,$98.40 ,$101.40 ,$101.40 ,$131.91 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000026,90834,PC THERAPY INDIVIDUAL PSYCH 45 MIN - 95,961,1 ,$181.00 ,$117.65 ,$50.68 ,$329.78 ,$329.78 ,$117.65 ,$108.06 ,$131.91 ,$50.68 ,$101.54 ,$131.91 ,$119.10 ,$131.91 ,$153.85 ,$153.85 ,$131.91 ,$153.85 ,$181.00 ,$123.08 ,$329.78 ,$131.91 ,$131.91 ,$135.75 ,$128.51 ,$128.51 ,$131.91 ,$128.51 ,$148.42 ,$148.42 ,$148.42 , N/A ,$181.00 ,$153.85 ,$131.91 ,$181.00 ,$108.06 ,$131.91 ,$117.14 ,$107.95 ,$98.14 ,$131.91 ,$153.85 ,$277.01 ,$153.85 ,$50.68 ,$162.90 ,$131.91 ,$148.42 , N/A , N/A ,$131.91 ,$117.65 ,$181.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000028,90837,PC THERAPY INDIVIDUAL PSYCH 60 MIN - 95,961,1 ,$204.00 ,$132.60 ,$57.12 ,$329.78 ,$329.78 ,$132.60 ,$121.79 ,$131.91 ,$57.12 ,$114.44 ,$131.91 ,$134.23 ,$131.91 ,$173.40 ,$173.40 ,$131.91 ,$173.40 ,$204.00 ,$138.72 ,$329.78 ,$131.91 ,$131.91 ,$153.00 ,$144.84 ,$144.84 ,$131.91 ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A ,$204.00 ,$173.40 ,$131.91 ,$204.00 ,$121.79 ,$131.91 ,$175.12 ,$107.95 ,$98.14 ,$131.91 ,$173.40 ,$277.01 ,$173.40 ,$57.12 ,$183.60 ,$131.91 ,$167.28 , N/A , N/A ,$131.91 ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000198,92526,PC DYSPHAGIA TREATMENT 30 MIN - 95,780,1 ,$144.00 ,$93.60 ,$40.32 ,$214.40 ,$214.40 ,$93.60 ,$85.97 ,$85.76 ,$40.32 ,$80.78 ,$85.76 ,$94.75 ,$85.76 ,$122.40 ,$122.40 ,$85.76 ,$122.40 ,$144.00 ,$97.92 ,$214.40 ,$85.76 ,$85.76 ,$108.00 ,$102.24 ,$102.24 ,$85.76 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$144.00 ,$122.40 ,$85.76 ,$144.00 ,$85.97 ,$85.76 ,$59.90 , N/A , N/A ,$85.76 ,$122.40 ,$180.10 ,$122.40 ,$40.32 ,$129.60 ,$85.76 ,$118.08 ,$121.68 ,$121.68 ,$85.76 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000199,92526,PC DYSPHAGIA TREATMENT 45 MIN - 95,780,1 ,$144.00 ,$93.60 ,$40.32 ,$214.40 ,$214.40 ,$93.60 ,$85.97 ,$85.76 ,$40.32 ,$80.78 ,$85.76 ,$94.75 ,$85.76 ,$122.40 ,$122.40 ,$85.76 ,$122.40 ,$144.00 ,$97.92 ,$214.40 ,$85.76 ,$85.76 ,$108.00 ,$102.24 ,$102.24 ,$85.76 ,$102.24 ,$118.08 ,$118.08 ,$118.08 , N/A ,$144.00 ,$122.40 ,$85.76 ,$144.00 ,$85.97 ,$85.76 ,$59.90 , N/A , N/A ,$85.76 ,$122.40 ,$180.10 ,$122.40 ,$40.32 ,$129.60 ,$85.76 ,$118.08 ,$121.68 ,$121.68 ,$85.76 ,$93.60 ,$144.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000201,92507,HC SPEECH THERAPY TREATMENT 30 MIN - 95,780,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 , N/A , N/A ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000202,92507,PC SPEECH THERAPY TREATMENT 45 MIN - 95,780,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 , N/A , N/A ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000203,92507,PC SPEECH THERAPY TREATMENT 60 MIN - 95,780,1 ,$132.00 ,$85.80 ,$36.96 ,$193.83 ,$193.83 ,$85.80 ,$78.80 ,$77.53 ,$36.96 ,$74.05 ,$77.53 ,$86.86 ,$77.53 ,$112.20 ,$112.20 ,$77.53 ,$112.20 ,$132.00 ,$89.76 ,$193.83 ,$77.53 ,$77.53 ,$99.00 ,$93.72 ,$93.72 ,$77.53 ,$93.72 ,$108.24 ,$108.24 ,$108.24 , N/A ,$132.00 ,$112.20 ,$77.53 ,$132.00 ,$78.80 ,$77.53 ,$54.91 , N/A , N/A ,$77.53 ,$112.20 ,$162.81 ,$112.20 ,$36.96 ,$118.80 ,$77.53 ,$108.24 ,$111.54 ,$111.54 ,$77.53 ,$85.80 ,$132.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000204,92521,PC EVALUATION OF SPEECH FLUENCY 30 MIN - 95,780,1 ,$256.00 ,$166.40 ,$71.68 ,$336.30 ,$336.30 ,$166.40 ,$152.83 ,$134.52 ,$71.68 ,$143.62 ,$134.52 ,$168.45 ,$134.52 ,$217.60 ,$217.60 ,$134.52 ,$217.60 ,$255.59 ,$174.08 ,$336.30 ,$134.52 ,$134.52 ,$192.00 ,$181.76 ,$181.76 ,$134.52 ,$181.76 ,$209.92 ,$209.92 ,$209.92 , N/A ,$256.00 ,$217.60 ,$134.52 ,$256.00 ,$152.83 ,$134.52 ,$106.50 , N/A , N/A ,$134.52 ,$217.60 ,$282.49 ,$217.60 ,$71.68 ,$230.40 ,$134.52 ,$209.92 ,$216.32 ,$216.32 ,$134.52 ,$166.40 ,$256.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000205,92521,PC EVALUATION OF SPEECH FLUENCY 45 MIN - 95,780,1 ,$256.00 ,$166.40 ,$71.68 ,$336.30 ,$336.30 ,$166.40 ,$152.83 ,$134.52 ,$71.68 ,$143.62 ,$134.52 ,$168.45 ,$134.52 ,$217.60 ,$217.60 ,$134.52 ,$217.60 ,$255.59 ,$174.08 ,$336.30 ,$134.52 ,$134.52 ,$192.00 ,$181.76 ,$181.76 ,$134.52 ,$181.76 ,$209.92 ,$209.92 ,$209.92 , N/A ,$256.00 ,$217.60 ,$134.52 ,$256.00 ,$152.83 ,$134.52 ,$106.50 , N/A , N/A ,$134.52 ,$217.60 ,$282.49 ,$217.60 ,$71.68 ,$230.40 ,$134.52 ,$209.92 ,$216.32 ,$216.32 ,$134.52 ,$166.40 ,$256.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000206,92521,PC EVALUATION OF SPEECH FLUENCY 60 MIN - 95,780,1 ,$256.00 ,$166.40 ,$71.68 ,$336.30 ,$336.30 ,$166.40 ,$152.83 ,$134.52 ,$71.68 ,$143.62 ,$134.52 ,$168.45 ,$134.52 ,$217.60 ,$217.60 ,$134.52 ,$217.60 ,$255.59 ,$174.08 ,$336.30 ,$134.52 ,$134.52 ,$192.00 ,$181.76 ,$181.76 ,$134.52 ,$181.76 ,$209.92 ,$209.92 ,$209.92 , N/A ,$256.00 ,$217.60 ,$134.52 ,$256.00 ,$152.83 ,$134.52 ,$106.50 , N/A , N/A ,$134.52 ,$217.60 ,$282.49 ,$217.60 ,$71.68 ,$230.40 ,$134.52 ,$209.92 ,$216.32 ,$216.32 ,$134.52 ,$166.40 ,$256.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000207,97165,PC OT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 , N/A , N/A ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000208,97165,PC OT EVAL LOW COMPLEXITY 45 MIN - 95,780,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 , N/A , N/A ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000209,97165,PC OT EVAL LOW COMPLEXITY 60 MIN - 95,780,1 ,$244.00 ,$158.60 ,$68.32 ,$254.95 ,$254.95 ,$158.60 ,$145.67 ,$101.98 ,$68.32 ,$136.88 ,$101.98 ,$160.55 ,$101.98 ,$207.40 ,$207.40 ,$101.98 ,$207.40 ,$193.76 ,$165.92 ,$254.95 ,$101.98 ,$101.98 ,$183.00 ,$173.24 ,$173.24 ,$101.98 ,$173.24 ,$200.08 ,$200.08 ,$200.08 , N/A ,$244.00 ,$207.40 ,$101.98 ,$244.00 ,$145.67 ,$101.98 ,$101.50 , N/A , N/A ,$101.98 ,$207.40 ,$214.16 ,$207.40 ,$68.32 ,$219.60 ,$101.98 ,$200.08 ,$206.18 ,$206.18 ,$101.98 ,$158.60 ,$244.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000210,97166,PC OT EVAL MOD COMPLEXITY 15 MIN - 95,780,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 , N/A , N/A ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000211,97166,HC OT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 , N/A , N/A ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000212,97166,PC OT EVAL MOD COMPLEXITY 60 MIN - 95,780,1 ,$300.00 ,$195.00 ,$84.00 ,$300.00 ,$254.95 ,$195.00 ,$179.10 ,$101.98 ,$84.00 ,$168.30 ,$101.98 ,$197.40 ,$101.98 ,$255.00 ,$255.00 ,$101.98 ,$255.00 ,$193.76 ,$204.00 ,$254.95 ,$101.98 ,$101.98 ,$225.00 ,$213.00 ,$213.00 ,$101.98 ,$213.00 ,$246.00 ,$246.00 ,$246.00 , N/A ,$254.95 ,$255.00 ,$101.98 ,$300.00 ,$179.10 ,$101.98 ,$124.80 , N/A , N/A ,$101.98 ,$255.00 ,$214.16 ,$255.00 ,$84.00 ,$270.00 ,$101.98 ,$246.00 ,$253.50 ,$253.50 ,$101.98 ,$195.00 ,$300.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000213,97167,PC OT EVAL HIGH COMPLEXITY 15 MIN - 95,780,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 , N/A , N/A ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000214,97167,PC OT EVAL HIGH COMPLEXITY 30 MIN - 95,961,1 ,$500.00 ,$325.00 ,$101.98 ,$500.00 ,$254.95 ,$325.00 ,$298.50 ,$101.98 ,$140.00 ,$280.50 ,$101.98 ,$329.00 ,$101.98 ,$425.00 ,$425.00 ,$101.98 ,$425.00 ,$193.76 ,$340.00 ,$254.95 ,$101.98 ,$101.98 ,$375.00 ,$355.00 ,$355.00 ,$101.98 ,$355.00 ,$410.00 ,$410.00 ,$410.00 , N/A ,$254.95 ,$425.00 ,$101.98 ,$500.00 ,$298.50 ,$101.98 ,$115.83 ,$391.44 ,$355.85 ,$101.98 ,$425.00 ,$214.16 ,$425.00 ,$140.00 ,$450.00 ,$101.98 ,$410.00 , N/A , N/A ,$101.98 ,$325.00 ,$500.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000215,97167,PC OT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$567.00 ,$368.55 ,$101.98 ,$567.00 ,$254.95 ,$368.55 ,$338.50 ,$101.98 ,$158.76 ,$318.09 ,$101.98 ,$373.09 ,$101.98 ,$481.95 ,$481.95 ,$101.98 ,$481.95 ,$193.76 ,$385.56 ,$254.95 ,$101.98 ,$101.98 ,$425.25 ,$402.57 ,$402.57 ,$101.98 ,$402.57 ,$464.94 ,$464.94 ,$464.94 , N/A ,$254.95 ,$481.95 ,$101.98 ,$567.00 ,$338.50 ,$101.98 ,$235.87 , N/A , N/A ,$101.98 ,$481.95 ,$214.16 ,$481.95 ,$158.76 ,$510.30 ,$101.98 ,$464.94 ,$479.12 ,$479.12 ,$101.98 ,$368.55 ,$567.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000216,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 30 MIN - 95,780,1 ,$260.00 ,$169.00 ,$72.80 ,$571.95 ,$571.95 ,$169.00 ,$155.22 ,$228.78 ,$72.80 ,$145.86 ,$228.78 ,$171.08 ,$228.78 ,$221.00 ,$221.00 ,$228.78 ,$221.00 ,$260.00 ,$176.80 ,$571.95 ,$228.78 ,$228.78 ,$195.00 ,$184.60 ,$184.60 ,$228.78 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$228.78 ,$260.00 ,$155.22 ,$228.78 ,$108.16 , N/A , N/A ,$228.78 ,$221.00 ,$480.44 ,$221.00 ,$72.80 ,$234.00 ,$228.78 ,$213.20 ,$219.70 ,$219.70 ,$228.78 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000217,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 45 MIN - 95,780,1 ,$260.00 ,$169.00 ,$72.80 ,$571.95 ,$571.95 ,$169.00 ,$155.22 ,$228.78 ,$72.80 ,$145.86 ,$228.78 ,$171.08 ,$228.78 ,$221.00 ,$221.00 ,$228.78 ,$221.00 ,$260.00 ,$176.80 ,$571.95 ,$228.78 ,$228.78 ,$195.00 ,$184.60 ,$184.60 ,$228.78 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$228.78 ,$260.00 ,$155.22 ,$228.78 ,$108.16 , N/A , N/A ,$228.78 ,$221.00 ,$480.44 ,$221.00 ,$72.80 ,$234.00 ,$228.78 ,$213.20 ,$219.70 ,$219.70 ,$228.78 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000218,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60 MIN - 95,780,1 ,$260.00 ,$169.00 ,$72.80 ,$571.95 ,$571.95 ,$169.00 ,$155.22 ,$228.78 ,$72.80 ,$145.86 ,$228.78 ,$171.08 ,$228.78 ,$221.00 ,$221.00 ,$228.78 ,$221.00 ,$260.00 ,$176.80 ,$571.95 ,$228.78 ,$228.78 ,$195.00 ,$184.60 ,$184.60 ,$228.78 ,$184.60 ,$213.20 ,$213.20 ,$213.20 , N/A ,$260.00 ,$221.00 ,$228.78 ,$260.00 ,$155.22 ,$228.78 ,$108.16 , N/A , N/A ,$228.78 ,$221.00 ,$480.44 ,$221.00 ,$72.80 ,$234.00 ,$228.78 ,$213.20 ,$219.70 ,$219.70 ,$228.78 ,$169.00 ,$260.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000221,90832,HC THERAPY INDIVIDUAL PSYCH 30 MIN-95,780,1 ,$120.00 ,$78.00 ,$33.60 ,$329.78 ,$329.78 ,$78.00 ,$71.64 ,$131.91 ,$33.60 ,$67.32 ,$131.91 ,$78.96 ,$120.00 ,$102.00 ,$102.00 ,$120.00 ,$102.00 ,$120.00 ,$81.60 ,$329.78 ,$131.91 ,$131.91 ,$90.00 ,$85.20 ,$85.20 ,$131.91 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$120.00 ,$102.00 ,$131.91 ,$120.00 ,$71.64 ,$131.91 ,$49.92 , N/A , N/A ,$131.91 ,$102.00 ,$277.01 ,$102.00 ,$33.60 ,$108.00 ,$131.91 ,$98.40 ,$101.40 ,$101.40 ,$131.91 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000222,90834,HC THERAPY INDIVIDUAL PSYCH 45 MIN-95,780,1 ,$181.00 ,$117.65 ,$50.68 ,$329.78 ,$329.78 ,$117.65 ,$108.06 ,$131.91 ,$50.68 ,$101.54 ,$131.91 ,$119.10 ,$131.91 ,$153.85 ,$153.85 ,$131.91 ,$153.85 ,$181.00 ,$123.08 ,$329.78 ,$131.91 ,$131.91 ,$135.75 ,$128.51 ,$128.51 ,$131.91 ,$128.51 ,$148.42 ,$148.42 ,$148.42 , N/A ,$181.00 ,$153.85 ,$131.91 ,$181.00 ,$108.06 ,$131.91 ,$75.30 , N/A , N/A ,$131.91 ,$153.85 ,$277.01 ,$153.85 ,$50.68 ,$162.90 ,$131.91 ,$148.42 ,$152.95 ,$152.95 ,$131.91 ,$117.65 ,$181.00 
ST. JOSEPH'S HOSPITAL - BREESE,78000223,90837,HC THERAPY INDIVIDUAL PSYCH 60 MIN-95,780,1 ,$204.00 ,$132.60 ,$57.12 ,$329.78 ,$329.78 ,$132.60 ,$121.79 ,$131.91 ,$57.12 ,$114.44 ,$131.91 ,$134.23 ,$131.91 ,$173.40 ,$173.40 ,$131.91 ,$173.40 ,$204.00 ,$138.72 ,$329.78 ,$131.91 ,$131.91 ,$153.00 ,$144.84 ,$144.84 ,$131.91 ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A ,$204.00 ,$173.40 ,$131.91 ,$204.00 ,$121.79 ,$131.91 ,$84.86 , N/A , N/A ,$131.91 ,$173.40 ,$277.01 ,$173.40 ,$57.12 ,$183.60 ,$131.91 ,$167.28 ,$172.38 ,$172.38 ,$131.91 ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,91400004,90832,HC THERAPY INDIVIDUAL PSYCH 30MIN,914,1 ,$120.00 ,$78.00 ,$33.60 ,$329.78 ,$329.78 ,$78.00 ,$71.64 ,$131.91 ,$33.60 ,$67.32 ,$131.91 ,$78.96 ,$120.00 ,$102.00 ,$102.00 ,$120.00 ,$102.00 ,$120.00 ,$81.60 ,$329.78 ,$131.91 ,$131.91 ,$90.00 ,$85.20 ,$85.20 ,$131.91 ,$85.20 ,$98.40 ,$98.40 ,$98.40 , N/A ,$120.00 ,$102.00 ,$131.91 ,$120.00 ,$71.64 ,$131.91 ,$49.92 ,$107.78 ,$97.98 ,$131.91 ,$102.00 ,$277.01 ,$102.00 ,$33.60 ,$108.00 ,$131.91 ,$98.40 , N/A , N/A ,$131.91 ,$78.00 ,$120.00 
ST. JOSEPH'S HOSPITAL - BREESE,91400007,90834,HC THERAPY INDIVIDUAL PSYCH 45MIN,914,1 ,$181.00 ,$117.65 ,$50.68 ,$329.78 ,$329.78 ,$117.65 ,$108.06 ,$131.91 ,$50.68 ,$101.54 ,$131.91 ,$119.10 ,$131.91 ,$153.85 ,$153.85 ,$131.91 ,$153.85 ,$181.00 ,$123.08 ,$329.78 ,$131.91 ,$131.91 ,$135.75 ,$128.51 ,$128.51 ,$131.91 ,$128.51 ,$148.42 ,$148.42 ,$148.42 , N/A ,$181.00 ,$153.85 ,$131.91 ,$181.00 ,$108.06 ,$131.91 ,$75.30 ,$107.95 ,$98.14 ,$131.91 ,$153.85 ,$277.01 ,$153.85 ,$50.68 ,$162.90 ,$131.91 ,$148.42 , N/A , N/A ,$131.91 ,$117.65 ,$181.00 
ST. JOSEPH'S HOSPITAL - BREESE,91400012,90837,HC THERAPY INDIVIDUAL PSYCH 60MIN,914,1 ,$204.00 ,$132.60 ,$57.12 ,$329.78 ,$329.78 ,$132.60 ,$121.79 ,$131.91 ,$57.12 ,$114.44 ,$131.91 ,$134.23 ,$131.91 ,$173.40 ,$173.40 ,$131.91 ,$173.40 ,$204.00 ,$138.72 ,$329.78 ,$131.91 ,$131.91 ,$153.00 ,$144.84 ,$144.84 ,$131.91 ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A ,$204.00 ,$173.40 ,$131.91 ,$204.00 ,$121.79 ,$131.91 ,$84.86 ,$107.95 ,$98.14 ,$131.91 ,$173.40 ,$277.01 ,$173.40 ,$57.12 ,$183.60 ,$131.91 ,$167.28 , N/A , N/A ,$131.91 ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,91600005,90846,HC THERAPY FAMILY PSYCH W/O PATIENT 50 MIN,916,1 ,$204.00 ,$132.60 ,$57.12 ,$329.78 ,$329.78 ,$132.60 ,$121.79 ,$131.91 ,$57.12 ,$114.44 ,$131.91 ,$134.23 ,$131.91 ,$173.40 ,$173.40 ,$131.91 ,$173.40 ,$204.00 ,$138.72 ,$329.78 ,$131.91 ,$131.91 ,$153.00 ,$144.84 ,$144.84 ,$131.91 ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A ,$204.00 ,$173.40 ,$131.91 ,$204.00 ,$121.79 ,$131.91 ,$84.86 ,$113.82 ,$103.47 ,$131.91 ,$173.40 ,$277.01 ,$173.40 ,$57.12 ,$183.60 ,$131.91 ,$167.28 , N/A , N/A ,$131.91 ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,91600006,90847,HC THERAPY FAMILY PSYCH W/PATIENT 50 MIN,916,1 ,$181.00 ,$117.65 ,$50.68 ,$329.78 ,$329.78 ,$117.65 ,$108.06 ,$131.91 ,$50.68 ,$101.54 ,$131.91 ,$119.10 ,$131.91 ,$153.85 ,$153.85 ,$131.91 ,$153.85 ,$181.00 ,$123.08 ,$329.78 ,$131.91 ,$131.91 ,$135.75 ,$128.51 ,$128.51 ,$131.91 ,$128.51 ,$148.42 ,$148.42 ,$148.42 , N/A ,$181.00 ,$153.85 ,$131.91 ,$181.00 ,$108.06 ,$131.91 ,$75.30 ,$113.82 ,$103.47 ,$131.91 ,$153.85 ,$277.01 ,$153.85 ,$50.68 ,$162.90 ,$131.91 ,$148.42 , N/A , N/A ,$131.91 ,$117.65 ,$181.00 
ST. JOSEPH'S HOSPITAL - BREESE,91600007,90853,HC THERAPY GROUP PSYCH,916,1 ,$181.00 ,$117.65 ,$50.68 ,$184.43 ,$184.43 ,$117.65 ,$108.06 ,$73.77 ,$50.68 ,$101.54 ,$73.77 ,$119.10 ,$73.77 ,$153.85 ,$153.85 ,$73.77 ,$153.85 ,$140.16 ,$123.08 ,$184.42 ,$73.77 ,$73.77 ,$135.75 ,$128.51 ,$128.51 ,$73.77 ,$128.51 ,$148.42 ,$148.42 ,$148.42 , N/A ,$181.00 ,$153.85 ,$73.77 ,$181.00 ,$108.06 ,$73.77 ,$75.30 ,$153.08 ,$139.16 ,$73.77 ,$153.85 ,$154.92 ,$153.85 ,$50.68 ,$162.90 ,$73.77 ,$148.42 , N/A , N/A ,$73.77 ,$117.65 ,$181.00 
ST. JOSEPH'S HOSPITAL - BREESE,91800006,96116,HC NEUROPSYCH STATUS EXAM MD/QHCP INIT HOUR,918,1 ,$399.00 ,$259.35 ,$111.72 ,$641.88 ,$641.88 ,$259.35 ,$238.20 ,$256.75 ,$111.72 ,$223.84 ,$256.75 ,$262.54 ,$256.75 ,$339.15 ,$339.15 ,$256.75 ,$339.15 ,$399.00 ,$271.32 ,$641.87 ,$256.75 ,$256.75 ,$299.25 ,$283.29 ,$283.29 ,$256.75 ,$283.29 ,$327.18 ,$327.18 ,$327.18 , N/A ,$399.00 ,$339.15 ,$256.75 ,$399.00 ,$238.20 ,$256.75 ,$165.98 ,$399.00 ,$399.00 ,$256.75 ,$339.15 ,$539.17 ,$339.15 ,$111.72 ,$359.10 ,$256.75 ,$327.18 ,$337.16 ,$337.16 ,$256.75 ,$259.35 ,$399.00 
ST. JOSEPH'S HOSPITAL - BREESE,91800007,96121,HC NEUROPSYCH STATUS EXAM MD/QHCP ADDL HOUR,918,1 ,$399.00 ,$259.35 ,$111.72 ,$399.00 , N/A ,$259.35 ,$238.20 , N/A ,$111.72 ,$223.84 , N/A ,$262.54 , N/A ,$339.15 ,$339.15 , N/A ,$339.15 , N/A ,$271.32 , N/A , N/A , N/A ,$299.25 ,$283.29 ,$283.29 , N/A ,$283.29 ,$327.18 ,$327.18 ,$327.18 , N/A , N/A ,$339.15 , N/A ,$399.00 ,$238.20 , N/A ,$165.98 ,$399.00 ,$399.00 , N/A ,$339.15 , N/A ,$339.15 ,$111.72 ,$359.10 , N/A ,$327.18 ,$337.16 ,$337.16 , N/A ,$259.35 ,$399.00 
ST. JOSEPH'S HOSPITAL - BREESE,92000001,59020,HC TEST STRESS FETAL,920,1 ,$374.00 ,$243.10 ,$104.72 ,$419.90 ,$419.90 ,$243.10 ,$223.28 ,$167.96 ,$104.72 ,$209.81 ,$167.96 ,$246.09 ,$167.96 ,$317.90 ,$317.90 ,$167.96 ,$317.90 ,$319.12 ,$254.32 ,$419.89 ,$167.96 ,$167.96 ,$280.50 ,$265.54 ,$265.54 ,$167.96 ,$265.54 ,$306.68 ,$306.68 ,$306.68 , N/A ,$374.00 ,$317.90 ,$167.96 ,$374.00 ,$223.28 ,$167.96 ,$155.58 , N/A , N/A ,$167.96 ,$317.90 ,$352.71 ,$317.90 ,$104.72 ,$336.60 ,$167.96 ,$306.68 ,$316.03 ,$316.03 ,$167.96 ,$243.10 ,$374.00 
ST. JOSEPH'S HOSPITAL - BREESE,92000002,59025,HC TEST NON STRESS FETAL,920,1 ,$492.00 ,$319.80 ,$137.76 ,$492.00 ,$419.90 ,$319.80 ,$293.72 ,$167.96 ,$137.76 ,$276.01 ,$167.96 ,$323.74 ,$167.96 ,$418.20 ,$418.20 ,$167.96 ,$418.20 ,$319.12 ,$334.56 ,$419.89 ,$167.96 ,$167.96 ,$369.00 ,$349.32 ,$349.32 ,$167.96 ,$349.32 ,$403.44 ,$403.44 ,$403.44 , N/A ,$419.89 ,$418.20 ,$167.96 ,$492.00 ,$293.72 ,$167.96 ,$204.67 , N/A , N/A ,$167.96 ,$418.20 ,$352.71 ,$418.20 ,$137.76 ,$442.80 ,$167.96 ,$403.44 ,$415.74 ,$415.74 ,$167.96 ,$319.80 ,$492.00 
ST. JOSEPH'S HOSPITAL - BREESE,92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$1,354.00 ",$880.10 ,$100.68 ,"$1,354.00 ",$567.13 ,$880.10 ,$808.34 ,$226.85 ,$379.12 ,$759.59 ,$226.85 ,$890.93 ,$226.85 ,"$1,150.90 ","$1,150.90 ",$226.85 ,"$1,150.90 ",$431.02 ,$920.72 ,$567.13 ,$226.85 ,$226.85 ,"$1,015.50 ",$961.34 ,$961.34 ,$226.85 ,$961.34 ,"$1,110.28 ","$1,110.28 ","$1,110.28 ", N/A ,$567.13 ,"$1,150.90 ",$226.85 ,"$1,354.00 ",$808.34 ,$226.85 ,$563.26 ,$110.75 ,$100.68 ,$226.85 ,"$1,150.90 ",$476.39 ,"$1,150.90 ",$379.12 ,"$1,218.60 ",$226.85 ,"$1,110.28 ","$1,144.13 ","$1,144.13 ",$226.85 ,$880.10 ,"$1,354.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$606.00 ,$393.90 ,$93.88 ,$606.00 ,$277.93 ,$393.90 ,$361.78 ,$111.17 ,$169.68 ,$339.97 ,$111.17 ,$398.75 ,$111.17 ,$515.10 ,$515.10 ,$111.17 ,$515.10 ,$211.22 ,$412.08 ,$277.92 ,$111.17 ,$111.17 ,$454.50 ,$430.26 ,$430.26 ,$111.17 ,$430.26 ,$496.92 ,$496.92 ,$496.92 , N/A ,$277.92 ,$515.10 ,$111.17 ,$606.00 ,$361.78 ,$111.17 ,$252.10 ,$103.27 ,$93.88 ,$111.17 ,$515.10 ,$233.45 ,$515.10 ,$169.68 ,$545.40 ,$111.17 ,$496.92 ,$512.07 ,$512.07 ,$111.17 ,$393.90 ,$606.00 
ST. JOSEPH'S HOSPITAL - BREESE,92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,560.00 ","$1,014.00 ",$93.88 ,"$1,560.00 ",$344.13 ,"$1,014.00 ",$931.32 ,$137.65 ,$436.80 ,$875.16 ,$137.65 ,"$1,026.48 ",$137.65 ,"$1,326.00 ","$1,326.00 ",$137.65 ,"$1,326.00 ",$261.53 ,"$1,060.80 ",$344.11 ,$137.65 ,$137.65 ,"$1,170.00 ","$1,107.60 ","$1,107.60 ",$137.65 ,"$1,107.60 ","$1,279.20 ","$1,279.20 ","$1,279.20 ", N/A ,$344.11 ,"$1,326.00 ",$137.65 ,"$1,560.00 ",$931.32 ,$137.65 ,$648.96 ,$103.27 ,$93.88 ,$137.65 ,"$1,326.00 ",$289.05 ,"$1,326.00 ",$436.80 ,"$1,404.00 ",$137.65 ,"$1,279.20 ","$1,318.20 ","$1,318.20 ",$137.65 ,"$1,014.00 ","$1,560.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$1,096.00 ",$712.40 ,$93.88 ,"$1,096.00 ",$652.30 ,$712.40 ,$654.31 ,$260.92 ,$306.88 ,$614.86 ,$260.92 ,$721.17 ,$260.92 ,$931.60 ,$931.60 ,$260.92 ,$931.60 ,$495.74 ,$745.28 ,$652.29 ,$260.92 ,$260.92 ,$822.00 ,$778.16 ,$778.16 ,$260.92 ,$778.16 ,$898.72 ,$898.72 ,$898.72 , N/A ,$652.29 ,$931.60 ,$260.92 ,"$1,096.00 ",$654.31 ,$260.92 ,$455.94 ,$103.27 ,$93.88 ,$260.92 ,$931.60 ,$547.92 ,$931.60 ,$306.88 ,$986.40 ,$260.92 ,$898.72 ,$926.12 ,$926.12 ,$260.92 ,$712.40 ,"$1,096.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$2,526.00 ","$1,641.90 ",$132.52 ,"$2,526.00 ",$567.13 ,"$1,641.90 ","$1,508.02 ",$226.85 ,$707.28 ,"$1,417.09 ",$226.85 ,"$1,662.11 ",$226.85 ,"$2,147.10 ","$2,147.10 ",$226.85 ,"$2,147.10 ",$431.02 ,"$1,717.68 ",$567.13 ,$226.85 ,$226.85 ,"$1,894.50 ","$1,793.46 ","$1,793.46 ",$226.85 ,"$1,793.46 ","$2,071.32 ","$2,071.32 ","$2,071.32 ", N/A ,$567.13 ,"$2,147.10 ",$226.85 ,"$2,526.00 ","$1,508.02 ",$226.85 ,"$1,050.82 ",$145.77 ,$132.52 ,$226.85 ,"$2,147.10 ",$476.39 ,"$2,147.10 ",$707.28 ,"$2,273.40 ",$226.85 ,"$2,071.32 ","$2,134.47 ","$2,134.47 ",$226.85 ,"$1,641.90 ","$2,526.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,"$1,834.00 ","$1,192.10 ",$107.33 ,"$1,834.00 ",$268.33 ,"$1,192.10 ","$1,094.90 ",$107.33 ,$513.52 ,"$1,028.87 ",$107.33 ,"$1,206.77 ",$107.33 ,"$1,558.90 ","$1,558.90 ",$107.33 ,"$1,558.90 ",$203.93 ,"$1,247.12 ",$268.33 ,$107.33 ,$107.33 ,"$1,375.50 ","$1,302.14 ","$1,302.14 ",$107.33 ,"$1,302.14 ","$1,503.88 ","$1,503.88 ","$1,503.88 ", N/A ,$268.33 ,"$1,558.90 ",$107.33 ,"$1,834.00 ","$1,094.90 ",$107.33 ,$762.94 ,$145.77 ,$132.52 ,$107.33 ,"$1,558.90 ",$225.40 ,"$1,558.90 ",$513.52 ,"$1,650.60 ",$107.33 ,"$1,503.88 ","$1,549.73 ","$1,549.73 ",$107.33 ,"$1,192.10 ","$1,834.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$2,861.00 ","$1,859.65 ",$100.68 ,"$2,861.00 ",$567.13 ,"$1,859.65 ","$1,708.02 ",$226.85 ,$801.08 ,"$1,605.02 ",$226.85 ,"$1,882.54 ",$226.85 ,"$2,431.85 ","$2,431.85 ",$226.85 ,"$2,431.85 ",$431.02 ,"$1,945.48 ",$567.13 ,$226.85 ,$226.85 ,"$2,145.75 ","$2,031.31 ","$2,031.31 ",$226.85 ,"$2,031.31 ","$2,346.02 ","$2,346.02 ","$2,346.02 ", N/A ,$567.13 ,"$2,431.85 ",$226.85 ,"$2,861.00 ","$1,708.02 ",$226.85 ,"$1,190.18 ",$110.75 ,$100.68 ,$226.85 ,"$2,431.85 ",$476.39 ,"$2,431.85 ",$801.08 ,"$2,574.90 ",$226.85 ,"$2,346.02 ","$2,417.55 ","$2,417.55 ",$226.85 ,"$1,859.65 ","$2,861.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,"$1,486.00 ",$965.90 ,$100.68 ,"$1,486.00 ",$268.33 ,$965.90 ,$887.14 ,$107.33 ,$416.08 ,$833.65 ,$107.33 ,$977.79 ,$107.33 ,"$1,263.10 ","$1,263.10 ",$107.33 ,"$1,263.10 ",$203.93 ,"$1,010.48 ",$268.33 ,$107.33 ,$107.33 ,"$1,114.50 ","$1,055.06 ","$1,055.06 ",$107.33 ,"$1,055.06 ","$1,218.52 ","$1,218.52 ","$1,218.52 ", N/A ,$268.33 ,"$1,263.10 ",$107.33 ,"$1,486.00 ",$887.14 ,$107.33 ,$618.18 ,$110.75 ,$100.68 ,$107.33 ,"$1,263.10 ",$225.40 ,"$1,263.10 ",$416.08 ,"$1,337.40 ",$107.33 ,"$1,218.52 ","$1,255.67 ","$1,255.67 ",$107.33 ,$965.90 ,"$1,486.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$2,526.00 ","$1,641.90 ",$132.52 ,"$2,526.00 ",$567.13 ,"$1,641.90 ","$1,508.02 ",$226.85 ,$707.28 ,"$1,417.09 ",$226.85 ,"$1,662.11 ",$226.85 ,"$2,147.10 ","$2,147.10 ",$226.85 ,"$2,147.10 ",$431.02 ,"$1,717.68 ",$567.13 ,$226.85 ,$226.85 ,"$1,894.50 ","$1,793.46 ","$1,793.46 ",$226.85 ,"$1,793.46 ","$2,071.32 ","$2,071.32 ","$2,071.32 ", N/A ,$567.13 ,"$2,147.10 ",$226.85 ,"$2,526.00 ","$1,508.02 ",$226.85 ,"$1,050.82 ",$145.77 ,$132.52 ,$226.85 ,"$2,147.10 ",$476.39 ,"$2,147.10 ",$707.28 ,"$2,273.40 ",$226.85 ,"$2,071.32 ","$2,134.47 ","$2,134.47 ",$226.85 ,"$1,641.90 ","$2,526.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,"$1,527.00 ",$992.55 ,$107.33 ,"$1,527.00 ",$268.33 ,$992.55 ,$911.62 ,$107.33 ,$427.56 ,$856.65 ,$107.33 ,"$1,004.77 ",$107.33 ,"$1,297.95 ","$1,297.95 ",$107.33 ,"$1,297.95 ",$203.93 ,"$1,038.36 ",$268.33 ,$107.33 ,$107.33 ,"$1,145.25 ","$1,084.17 ","$1,084.17 ",$107.33 ,"$1,084.17 ","$1,252.14 ","$1,252.14 ","$1,252.14 ", N/A ,$268.33 ,"$1,297.95 ",$107.33 ,"$1,527.00 ",$911.62 ,$107.33 ,$635.23 ,$145.77 ,$132.52 ,$107.33 ,"$1,297.95 ",$225.40 ,"$1,297.95 ",$427.56 ,"$1,374.30 ",$107.33 ,"$1,252.14 ","$1,290.32 ","$1,290.32 ",$107.33 ,$992.55 ,"$1,527.00 "
ST. JOSEPH'S HOSPITAL - BREESE,92100049,93923,HC RESTING ARTERIAL EXTREMITY COMP -52,921,1 ,"$1,560.00 ","$1,014.00 ",$46.94 ,"$1,560.00 ",$172.05 ,"$1,014.00 ",$931.32 ,$68.82 ,$436.80 ,$875.16 ,$68.82 ,"$1,026.48 ",$68.82 ,"$1,326.00 ","$1,326.00 ",$68.82 ,"$1,326.00 ",$130.76 ,"$1,060.80 ",$172.06 ,$68.82 ,$68.82 ,"$1,170.00 ","$1,107.60 ","$1,107.60 ",$68.82 ,"$1,107.60 ","$1,279.20 ","$1,279.20 ","$1,279.20 ", N/A ,$172.06 ,"$1,326.00 ",$68.82 ,"$1,560.00 ",$931.32 ,$68.82 ,$648.96 ,$51.63 ,$46.94 ,$68.82 ,"$1,326.00 ",$144.53 ,"$1,326.00 ",$436.80 ,"$1,404.00 ",$68.82 ,"$1,279.20 ","$1,318.20 ","$1,318.20 ",$68.82 ,"$1,014.00 ","$1,560.00 "
ST. JOSEPH'S HOSPITAL - BREESE,94000110,99195,HC THERAPEUTIC PHLEBOTOMY,940,1 ,$158.00 ,$102.70 ,$44.24 ,$277.93 ,$277.93 ,$102.70 ,$94.33 ,$111.17 ,$44.24 ,$88.64 ,$111.17 ,$103.96 ,$111.17 ,$134.30 ,$134.30 ,$111.17 ,$134.30 ,$158.00 ,$107.44 ,$277.92 ,$111.17 ,$111.17 ,$118.50 ,$112.18 ,$112.18 ,$111.17 ,$112.18 ,$129.56 ,$129.56 ,$129.56 , N/A ,$158.00 ,$134.30 ,$111.17 ,$158.00 ,$94.33 ,$111.17 ,$65.73 ,$64.50 ,$58.64 ,$111.17 ,$134.30 ,$233.45 ,$134.30 ,$44.24 ,$142.20 ,$111.17 ,$129.56 ,$133.51 ,$133.51 ,$111.17 ,$102.70 ,$158.00 
ST. JOSEPH'S HOSPITAL - BREESE,94000114,20560,HC NEEDLE INSERTION W/O INJECTION 1-2 MUSCLES,940,1 ,$0.01 ,$0.01 ,$0.01 ,$60.90 ,$60.90 ,$0.01 ,$0.01 ,$24.36 , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$24.36 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$24.36 , N/A ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$51.15 ,$0.01 , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,94000115,20561,HC NEEDLE INSERTION W/O INJECTION 3+ MUSCLES,940,1 ,$0.01 ,$0.01 ,$0.01 ,$60.90 ,$60.90 ,$0.01 ,$0.01 ,$24.36 , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$60.89 ,$24.36 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$24.36 , N/A ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$51.15 ,$0.01 , N/A ,$0.01 ,$24.36 ,$0.01 ,$0.01 ,$0.01 ,$24.36 ,$0.01 ,$0.01 
ST. JOSEPH'S HOSPITAL - BREESE,94000118,N/A,HC CASH-BASED THERAPIES GENERIC PACKAGE #1,940,1 ,$400.00 ,$260.00 ,$112.00 ,$400.00 , N/A ,$260.00 ,$238.80 , N/A ,$112.00 ,$224.40 , N/A ,$263.20 , N/A ,$340.00 ,$340.00 , N/A ,$340.00 , N/A ,$272.00 , N/A , N/A , N/A ,$300.00 ,$284.00 ,$284.00 , N/A ,$284.00 ,$328.00 ,$328.00 ,$328.00 , N/A , N/A ,$340.00 , N/A ,$400.00 ,$238.80 , N/A ,$166.40 , N/A , N/A , N/A ,$340.00 , N/A ,$340.00 ,$112.00 ,$360.00 , N/A ,$328.00 ,$338.00 ,$338.00 , N/A ,$260.00 ,$400.00 
ST. JOSEPH'S HOSPITAL - BREESE,94000119,N/A,HC CASH-BASED THERAPIES GENERIC PACKAGE #2,940,1 ,$700.00 ,$455.00 ,$196.00 ,$700.00 , N/A ,$455.00 ,$417.90 , N/A ,$196.00 ,$392.70 , N/A ,$460.60 , N/A ,$595.00 ,$595.00 , N/A ,$595.00 , N/A ,$476.00 , N/A , N/A , N/A ,$525.00 ,$497.00 ,$497.00 , N/A ,$497.00 ,$574.00 ,$574.00 ,$574.00 , N/A , N/A ,$595.00 , N/A ,$700.00 ,$417.90 , N/A ,$291.20 , N/A , N/A , N/A ,$595.00 , N/A ,$595.00 ,$196.00 ,$630.00 , N/A ,$574.00 ,$591.50 ,$591.50 , N/A ,$455.00 ,$700.00 
ST. JOSEPH'S HOSPITAL - BREESE,94200005,97802,HC NUTRITION THRPY EVAL 15 MIN,942,1 ,$25.00 ,$16.25 ,$7.00 ,$91.93 ,$62.50 ,$16.25 ,$14.93 ,$36.77 ,$7.00 ,$14.03 ,$36.77 ,$16.45 ,$25.00 ,$21.25 ,$21.25 ,$25.00 ,$21.25 ,$25.00 ,$17.00 ,$91.93 ,$36.77 ,$36.77 ,$18.75 ,$17.75 ,$17.75 ,$36.77 ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A ,$25.00 ,$21.25 ,$36.77 ,$25.00 ,$14.93 ,$36.77 ,$10.40 , N/A , N/A ,$36.77 ,$21.25 ,$77.22 ,$21.25 ,$7.00 ,$22.50 ,$36.77 ,$20.50 ,$21.13 ,$21.13 ,$36.77 ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,94200006,97803,HC NUTRITION THRPY RE-EVAL 15 MIN,942,1 ,$25.00 ,$16.25 ,$7.00 ,$80.10 ,$62.50 ,$16.25 ,$14.93 ,$32.04 ,$7.00 ,$14.03 ,$32.04 ,$16.45 ,$25.00 ,$21.25 ,$21.25 ,$25.00 ,$21.25 ,$25.00 ,$17.00 ,$80.10 ,$32.04 ,$32.04 ,$18.75 ,$17.75 ,$17.75 ,$32.04 ,$17.75 ,$20.50 ,$20.50 ,$20.50 , N/A ,$25.00 ,$21.25 ,$32.04 ,$25.00 ,$14.93 ,$32.04 ,$10.40 , N/A , N/A ,$32.04 ,$21.25 ,$67.28 ,$21.25 ,$7.00 ,$22.50 ,$32.04 ,$20.50 ,$21.13 ,$21.13 ,$32.04 ,$16.25 ,$25.00 
ST. JOSEPH'S HOSPITAL - BREESE,94200007,97804,HC MNT GROUP INIT 30 MIN,942,1 ,$53.00 ,$34.45 ,$14.49 ,$53.00 ,$36.23 ,$34.45 ,$31.64 ,$17.05 ,$14.84 ,$29.73 ,$17.05 ,$34.87 ,$14.49 ,$45.05 ,$45.05 ,$14.49 ,$45.05 ,$32.40 ,$36.04 ,$42.63 ,$17.05 ,$17.05 ,$39.75 ,$37.63 ,$37.63 ,$17.05 ,$37.63 ,$43.46 ,$43.46 ,$43.46 , N/A ,$14.49 ,$45.05 ,$17.05 ,$53.00 ,$31.64 ,$17.05 ,$22.05 , N/A , N/A ,$17.05 ,$45.05 ,$35.81 ,$45.05 ,$14.84 ,$47.70 ,$17.05 ,$43.46 ,$44.79 ,$44.79 ,$17.05 ,$34.45 ,$53.00 
ST. JOSEPH'S HOSPITAL - BREESE,94200011,G0108,HC DIABETES SELF MGT ED 30 MIN,942,1 ,$77.00 ,$50.05 ,$21.56 ,$139.65 ,$139.65 ,$50.05 ,$45.97 ,$55.86 ,$21.56 ,$43.20 ,$55.86 ,$50.67 ,$55.86 ,$65.45 ,$65.45 ,$55.86 ,$65.45 ,$77.00 ,$52.36 ,$139.65 ,$55.86 ,$55.86 ,$57.75 ,$54.67 ,$54.67 ,$55.86 ,$54.67 ,$63.14 ,$63.14 ,$63.14 , N/A ,$77.00 ,$65.45 ,$55.86 ,$77.00 ,$45.97 ,$55.86 ,$32.03 , N/A , N/A ,$55.86 ,$65.45 ,$117.31 ,$65.45 ,$21.56 ,$69.30 ,$55.86 ,$63.14 ,$65.07 ,$65.07 ,$55.86 ,$50.05 ,$77.00 
ST. JOSEPH'S HOSPITAL - BREESE,94200013,G0109,HC DIABETES SELF MGT GROUP 30MIN,942,1 ,$105.00 ,$68.25 ,$15.75 ,$105.00 ,$39.38 ,$68.25 ,$62.69 ,$15.75 ,$29.40 ,$58.91 ,$15.75 ,$69.09 ,$15.75 ,$89.25 ,$89.25 ,$15.75 ,$89.25 ,$29.93 ,$71.40 ,$39.38 ,$15.75 ,$15.75 ,$78.75 ,$74.55 ,$74.55 ,$15.75 ,$74.55 ,$86.10 ,$86.10 ,$86.10 , N/A ,$39.38 ,$89.25 ,$15.75 ,$105.00 ,$62.69 ,$15.75 ,$43.68 , N/A , N/A ,$15.75 ,$89.25 ,$33.08 ,$89.25 ,$29.40 ,$94.50 ,$15.75 ,$86.10 ,$88.73 ,$88.73 ,$15.75 ,$68.25 ,$105.00 
ST. JOSEPH'S HOSPITAL - BREESE,94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$188.00 ,$122.20 ,$52.64 ,$286.10 ,$286.10 ,$122.20 ,$112.24 ,$114.44 ,$52.64 ,$105.47 ,$114.44 ,$123.70 ,$114.44 ,$159.80 ,$159.80 ,$114.44 ,$159.80 ,$188.00 ,$127.84 ,$286.10 ,$114.44 ,$114.44 ,$141.00 ,$133.48 ,$133.48 ,$114.44 ,$133.48 ,$154.16 ,$154.16 ,$154.16 , N/A ,$188.00 ,$159.80 ,$114.44 ,$188.00 ,$112.24 ,$114.44 ,$78.21 , N/A , N/A ,$114.44 ,$159.80 ,$240.32 ,$159.80 ,$52.64 ,$169.20 ,$114.44 ,$154.16 ,$158.86 ,$158.86 ,$114.44 ,$122.20 ,$188.00 
ST. JOSEPH'S HOSPITAL - BREESE,94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$163.00 ,$105.95 ,$45.64 ,$286.10 ,$286.10 ,$105.95 ,$97.31 ,$114.44 ,$45.64 ,$91.44 ,$114.44 ,$107.25 ,$114.44 ,$138.55 ,$138.55 ,$114.44 ,$138.55 ,$163.00 ,$110.84 ,$286.10 ,$114.44 ,$114.44 ,$122.25 ,$115.73 ,$115.73 ,$114.44 ,$115.73 ,$133.66 ,$133.66 ,$133.66 , N/A ,$163.00 ,$138.55 ,$114.44 ,$163.00 ,$97.31 ,$114.44 ,$67.81 , N/A , N/A ,$114.44 ,$138.55 ,$240.32 ,$138.55 ,$45.64 ,$146.70 ,$114.44 ,$133.66 ,$137.74 ,$137.74 ,$114.44 ,$105.95 ,$163.00 
ST. JOSEPH'S HOSPITAL - BREESE,94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$163.00 ,$105.95 ,$45.64 ,$286.10 ,$286.10 ,$105.95 ,$97.31 ,$114.44 ,$45.64 ,$91.44 ,$114.44 ,$107.25 ,$114.44 ,$138.55 ,$138.55 ,$114.44 ,$138.55 ,$163.00 ,$110.84 ,$286.10 ,$114.44 ,$114.44 ,$122.25 ,$115.73 ,$115.73 ,$114.44 ,$115.73 ,$133.66 ,$133.66 ,$133.66 , N/A ,$163.00 ,$138.55 ,$114.44 ,$163.00 ,$97.31 ,$114.44 ,$67.81 , N/A , N/A ,$114.44 ,$138.55 ,$240.32 ,$138.55 ,$45.64 ,$146.70 ,$114.44 ,$133.66 ,$137.74 ,$137.74 ,$114.44 ,$105.95 ,$163.00 
ST. JOSEPH'S HOSPITAL - BREESE,94300019,N/A,HC CARDIAC REHAB PHASE 3 FULL MONTH,943,1 ,$32.00 ,$20.80 ,$8.96 ,$32.00 , N/A ,$20.80 ,$19.10 , N/A ,$8.96 ,$17.95 , N/A ,$21.06 , N/A ,$27.20 ,$27.20 , N/A ,$27.20 , N/A ,$21.76 , N/A , N/A , N/A ,$24.00 ,$22.72 ,$22.72 , N/A ,$22.72 ,$26.24 ,$26.24 ,$26.24 , N/A , N/A ,$27.20 , N/A ,$32.00 ,$19.10 , N/A ,$13.31 , N/A , N/A , N/A ,$27.20 , N/A ,$27.20 ,$8.96 ,$28.80 , N/A ,$26.24 ,$27.04 ,$27.04 , N/A ,$20.80 ,$32.00 
ST. JOSEPH'S HOSPITAL - BREESE,94300022,N/A,HC CARDIAC REHAB 4 EXERCISE MONTHLY,943,1 ,$94.00 ,$61.10 ,$26.32 ,$94.00 , N/A ,$61.10 ,$56.12 , N/A ,$26.32 ,$52.73 , N/A ,$61.85 , N/A ,$79.90 ,$79.90 , N/A ,$79.90 , N/A ,$63.92 , N/A , N/A , N/A ,$70.50 ,$66.74 ,$66.74 , N/A ,$66.74 ,$77.08 ,$77.08 ,$77.08 , N/A , N/A ,$79.90 , N/A ,$94.00 ,$56.12 , N/A ,$39.10 , N/A , N/A , N/A ,$79.90 , N/A ,$79.90 ,$26.32 ,$84.60 , N/A ,$77.08 ,$79.43 ,$79.43 , N/A ,$61.10 ,$94.00 
ST. JOSEPH'S HOSPITAL - BREESE,94800001,94625,HC PHY/QHP OP PULM RHB W/O MNTR,948,1 ,$164.64 ,$107.02 ,$46.10 ,$164.64 ,$137.20 ,$107.02 ,$98.29 ,$54.88 ,$46.10 ,$92.36 ,$54.88 ,$108.33 ,$54.88 ,$139.94 ,$139.94 ,$54.88 ,$139.94 ,$104.27 ,$111.96 ,$137.20 ,$54.88 ,$54.88 ,$123.48 ,$116.89 ,$116.89 ,$54.88 ,$116.89 ,$135.00 ,$135.00 ,$135.00 , N/A ,$137.20 ,$139.94 ,$54.88 ,$164.64 ,$98.29 ,$54.88 ,$68.49 , N/A , N/A ,$54.88 ,$139.94 ,$115.24 ,$139.94 ,$46.10 ,$148.18 ,$54.88 ,$135.00 ,$139.12 ,$139.12 ,$54.88 ,$107.02 ,$164.64 
ST. JOSEPH'S HOSPITAL - BREESE,94800002,94626,HC PHY/QHP OP PULM RHB W/MNTR,948,1 ,$164.64 ,$107.02 ,$46.10 ,$164.64 ,$137.20 ,$107.02 ,$98.29 ,$54.88 ,$46.10 ,$92.36 ,$54.88 ,$108.33 ,$54.88 ,$139.94 ,$139.94 ,$54.88 ,$139.94 ,$104.27 ,$111.96 ,$137.20 ,$54.88 ,$54.88 ,$123.48 ,$116.89 ,$116.89 ,$54.88 ,$116.89 ,$135.00 ,$135.00 ,$135.00 , N/A ,$137.20 ,$139.94 ,$54.88 ,$164.64 ,$98.29 ,$54.88 ,$68.49 , N/A , N/A ,$54.88 ,$139.94 ,$115.24 ,$139.94 ,$46.10 ,$148.18 ,$54.88 ,$135.00 ,$139.12 ,$139.12 ,$54.88 ,$107.02 ,$164.64 
ST. JOSEPH'S HOSPITAL - BREESE,96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$37.47 ,$24.36 ,$10.49 ,$37.47 , N/A ,$24.36 ,$22.37 , N/A ,$10.49 ,$21.02 , N/A ,$24.66 , N/A ,$31.85 ,$31.85 , N/A ,$31.85 , N/A ,$25.48 , N/A , N/A , N/A ,$28.10 ,$26.60 ,$26.60 , N/A ,$26.60 ,$30.73 ,$30.73 ,$30.73 , N/A , N/A ,$31.85 , N/A ,$37.47 ,$22.37 , N/A ,$15.49 , N/A , N/A , N/A ,$31.85 , N/A ,$31.85 ,$10.49 ,$33.72 , N/A ,$30.73 , N/A , N/A , N/A ,$24.36 ,$37.47 
ST. JOSEPH'S HOSPITAL - BREESE,96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$66.27 ,$43.08 ,$18.56 ,$66.27 , N/A ,$43.08 ,$39.56 , N/A ,$18.56 ,$37.18 , N/A ,$43.61 , N/A ,$56.33 ,$56.33 , N/A ,$56.33 , N/A ,$45.06 , N/A , N/A , N/A ,$49.70 ,$47.05 ,$47.05 , N/A ,$47.05 ,$54.34 ,$54.34 ,$54.34 , N/A , N/A ,$56.33 , N/A ,$66.27 ,$39.56 , N/A ,$27.35 , N/A , N/A , N/A ,$56.33 , N/A ,$56.33 ,$18.56 ,$59.64 , N/A ,$54.34 , N/A , N/A , N/A ,$43.08 ,$66.27 
ST. JOSEPH'S HOSPITAL - BREESE,96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$103.74 ,$67.43 ,$29.05 ,$103.74 , N/A ,$67.43 ,$61.93 , N/A ,$29.05 ,$58.20 , N/A ,$68.26 , N/A ,$88.18 ,$88.18 , N/A ,$88.18 , N/A ,$70.54 , N/A , N/A , N/A ,$77.81 ,$73.66 ,$73.66 , N/A ,$73.66 ,$85.07 ,$85.07 ,$85.07 , N/A , N/A ,$88.18 , N/A ,$103.74 ,$61.93 , N/A ,$42.42 , N/A , N/A , N/A ,$88.18 , N/A ,$88.18 ,$29.05 ,$93.37 , N/A ,$85.07 , N/A , N/A , N/A ,$67.43 ,$103.74 
ST. JOSEPH'S HOSPITAL - BREESE,97500073,43239,PC EGD W/BIOPSY SGL/MULT,975,1 ,$456.00 ,$296.40 ,$127.68 ,"$1,994.33 ","$1,994.33 ",$296.40 ,$272.23 ,$797.73 ,$127.68 ,$255.82 ,$797.73 ,$300.05 ,$456.00 ,$387.60 ,$387.60 ,$456.00 ,$387.60 ,$456.00 ,$310.08 ,"$1,994.33 ",$797.73 ,$797.73 ,$342.00 ,$323.76 ,$323.76 ,$797.73 ,$323.76 ,$373.92 ,$373.92 ,$373.92 , N/A ,$456.00 ,$387.60 ,$797.73 ,$456.00 ,$272.23 ,$797.73 ,$243.06 ,$456.00 ,$456.00 ,$797.73 ,$387.60 ,"$1,675.23 ",$387.60 ,$127.68 ,$410.40 ,$797.73 ,$373.92 , N/A , N/A ,$797.73 ,$296.40 ,$456.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500074,45380,PC COLONOSCOPY W/BIOPSY SGL/MULT,975,1 ,$666.00 ,$432.90 ,$186.48 ,"$2,555.83 ","$2,555.83 ",$432.90 ,$397.60 ,"$1,022.33 ",$186.48 ,$373.63 ,"$1,022.33 ",$438.23 ,$666.00 ,$566.10 ,$566.10 ,$666.00 ,$566.10 ,$666.00 ,$452.88 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$499.50 ,$472.86 ,$472.86 ,"$1,022.33 ",$472.86 ,$546.12 ,$546.12 ,$546.12 , N/A ,$666.00 ,$566.10 ,"$1,022.33 ",$666.00 ,$397.60 ,"$1,022.33 ",$353.25 ,$494.16 ,$449.24 ,"$1,022.33 ",$566.10 ,"$2,146.90 ",$566.10 ,$186.48 ,$599.40 ,"$1,022.33 ",$546.12 , N/A , N/A ,"$1,022.33 ",$432.90 ,$666.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500075,43450,PC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS,975,1 ,$261.00 ,$169.65 ,$73.08 ,"$1,994.33 ","$1,994.33 ",$169.65 ,$155.82 ,$797.73 ,$73.08 ,$146.42 ,$797.73 ,$171.74 ,$261.00 ,$221.85 ,$221.85 ,$261.00 ,$221.85 ,$261.00 ,$177.48 ,"$1,994.33 ",$797.73 ,$797.73 ,$195.75 ,$185.31 ,$185.31 ,$797.73 ,$185.31 ,$214.02 ,$214.02 ,$214.02 , N/A ,$261.00 ,$221.85 ,$797.73 ,$261.00 ,$155.82 ,$797.73 ,$137.36 ,$261.00 ,$261.00 ,$797.73 ,$221.85 ,"$1,675.23 ",$221.85 ,$73.08 ,$234.90 ,$797.73 ,$214.02 , N/A , N/A ,$797.73 ,$169.65 ,$261.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500076,45378,PC COLONSCOPY DX W/SPECIMEN BRUSH/WASH,975,1 ,$205.00 ,$133.25 ,$57.40 ,"$1,955.93 ","$1,955.93 ",$133.25 ,$122.39 ,$782.37 ,$57.40 ,$115.01 ,$782.37 ,$134.89 ,$205.00 ,$174.25 ,$174.25 ,$205.00 ,$174.25 ,$205.00 ,$139.40 ,"$1,955.93 ",$782.37 ,$782.37 ,$153.75 ,$145.55 ,$145.55 ,$782.37 ,$145.55 ,$168.10 ,$168.10 ,$168.10 , N/A ,$205.00 ,$174.25 ,$782.37 ,$205.00 ,$122.39 ,$782.37 ,$205.00 ,$205.00 ,$205.00 ,$782.37 ,$174.25 ,"$1,642.98 ",$174.25 ,$57.40 ,$184.50 ,$782.37 ,$168.10 , N/A , N/A ,$782.37 ,$133.25 ,$205.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500077,45385,PC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH,975,1 ,$843.00 ,$547.95 ,$236.04 ,"$2,555.83 ","$2,555.83 ",$547.95 ,$503.27 ,"$1,022.33 ",$236.04 ,$472.92 ,"$1,022.33 ",$554.69 ,$843.00 ,$716.55 ,$716.55 ,$843.00 ,$716.55 ,$843.00 ,$573.24 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$632.25 ,$598.53 ,$598.53 ,"$1,022.33 ",$598.53 ,$691.26 ,$691.26 ,$691.26 , N/A ,$843.00 ,$716.55 ,"$1,022.33 ",$843.00 ,$503.27 ,"$1,022.33 ",$448.68 ,$607.98 ,$552.71 ,"$1,022.33 ",$716.55 ,"$2,146.90 ",$716.55 ,$236.04 ,$758.70 ,"$1,022.33 ",$691.26 , N/A , N/A ,"$1,022.33 ",$547.95 ,$843.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500078,G0105,PC COLONSCOPY CANCER SCREENING HIGH RISK,975,1 ,$204.00 ,$132.60 ,$57.12 ,"$1,955.93 ","$1,955.93 ",$132.60 ,$121.79 ,$782.37 ,$57.12 ,$114.44 ,$782.37 ,$134.23 ,$204.00 ,$173.40 ,$173.40 ,$204.00 ,$173.40 ,$204.00 ,$138.72 ,"$1,955.93 ",$782.37 ,$782.37 ,$153.00 ,$144.84 ,$144.84 ,$782.37 ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A ,$204.00 ,$173.40 ,$782.37 ,$204.00 ,$121.79 ,$782.37 ,$204.00 ,$204.00 ,$204.00 ,$782.37 ,$173.40 ,"$1,642.98 ",$173.40 ,$57.12 ,$183.60 ,$782.37 ,$167.28 , N/A , N/A ,$782.37 ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500079,G0121,PC COLONSCOPY CANCER SCREENING NOT HIGH RISK,975,1 ,$183.00 ,$118.95 ,$51.24 ,"$1,955.93 ","$1,955.93 ",$118.95 ,$109.25 ,$782.37 ,$51.24 ,$102.66 ,$782.37 ,$120.41 ,$183.00 ,$155.55 ,$155.55 ,$183.00 ,$155.55 ,$183.00 ,$124.44 ,"$1,955.93 ",$782.37 ,$782.37 ,$137.25 ,$129.93 ,$129.93 ,$782.37 ,$129.93 ,$150.06 ,$150.06 ,$150.06 , N/A ,$183.00 ,$155.55 ,$782.37 ,$183.00 ,$109.25 ,$782.37 ,$183.00 ,$183.00 ,$183.00 ,$782.37 ,$155.55 ,"$1,642.98 ",$155.55 ,$51.24 ,$164.70 ,$782.37 ,$150.06 , N/A , N/A ,$782.37 ,$118.95 ,$183.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500080,43249,PC EGD W/BALLOON DILAT <30MM,975,1 ,$504.00 ,$327.60 ,$141.12 ,"$4,003.21 ","$4,003.20 ",$327.60 ,$300.89 ,"$1,601.28 ",$141.12 ,$282.74 ,"$1,601.28 ",$331.63 ,$504.00 ,$428.40 ,$428.40 ,$504.00 ,$428.40 ,$504.00 ,$342.72 ,"$4,003.21 ","$1,601.28 ","$1,601.28 ",$378.00 ,$357.84 ,$357.84 ,"$1,601.28 ",$357.84 ,$413.28 ,$413.28 ,$413.28 , N/A ,$504.00 ,$428.40 ,"$1,601.28 ",$504.00 ,$300.89 ,"$1,601.28 ",$269.37 ,$504.00 ,$504.00 ,"$1,601.28 ",$428.40 ,"$3,362.69 ",$428.40 ,$141.12 ,$453.60 ,"$1,601.28 ",$413.28 , N/A , N/A ,"$1,601.28 ",$327.60 ,$504.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500081,43235,PC EGD W/BRUSH/WASH,975,1 ,$468.00 ,$304.20 ,$131.04 ,"$1,994.33 ","$1,994.33 ",$304.20 ,$279.40 ,$797.73 ,$131.04 ,$262.55 ,$797.73 ,$307.94 ,$468.00 ,$397.80 ,$397.80 ,$468.00 ,$397.80 ,$468.00 ,$318.24 ,"$1,994.33 ",$797.73 ,$797.73 ,$351.00 ,$332.28 ,$332.28 ,$797.73 ,$332.28 ,$383.76 ,$383.76 ,$383.76 , N/A ,$468.00 ,$397.80 ,$797.73 ,$468.00 ,$279.40 ,$797.73 ,$215.69 ,$468.00 ,$468.00 ,$797.73 ,$397.80 ,"$1,675.23 ",$397.80 ,$131.04 ,$421.20 ,$797.73 ,$383.76 , N/A , N/A ,$797.73 ,$304.20 ,$468.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500082,43251,PC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH,975,1 ,$651.00 ,$423.15 ,$182.28 ,"$4,003.21 ","$4,003.20 ",$423.15 ,$388.65 ,"$1,601.28 ",$182.28 ,$365.21 ,"$1,601.28 ",$428.36 ,$651.00 ,$553.35 ,$553.35 ,$651.00 ,$553.35 ,$651.00 ,$442.68 ,"$4,003.21 ","$1,601.28 ","$1,601.28 ",$488.25 ,$462.21 ,$462.21 ,"$1,601.28 ",$462.21 ,$533.82 ,$533.82 ,$533.82 , N/A ,$651.00 ,$553.35 ,"$1,601.28 ",$651.00 ,$388.65 ,"$1,601.28 ",$345.25 ,$651.00 ,$651.00 ,"$1,601.28 ",$553.35 ,"$3,362.69 ",$553.35 ,$182.28 ,$585.90 ,"$1,601.28 ",$533.82 , N/A , N/A ,"$1,601.28 ",$423.15 ,$651.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500083,43250,PC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY,975,1 ,$570.00 ,$370.50 ,$159.60 ,"$4,003.21 ","$4,003.20 ",$370.50 ,$340.29 ,"$1,601.28 ",$159.60 ,$319.77 ,"$1,601.28 ",$375.06 ,$570.00 ,$484.50 ,$484.50 ,$570.00 ,$484.50 ,$570.00 ,$387.60 ,"$4,003.21 ","$1,601.28 ","$1,601.28 ",$427.50 ,$404.70 ,$404.70 ,"$1,601.28 ",$404.70 ,$467.40 ,$467.40 ,$467.40 , N/A ,$570.00 ,$484.50 ,"$1,601.28 ",$570.00 ,$340.29 ,"$1,601.28 ",$302.60 ,$570.00 ,$570.00 ,"$1,601.28 ",$484.50 ,"$3,362.69 ",$484.50 ,$159.60 ,$513.00 ,"$1,601.28 ",$467.40 , N/A , N/A ,"$1,601.28 ",$370.50 ,$570.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500084,45386,PC COLONOSCOPY W/BALLOON DILATION,975,1 ,$702.00 ,$456.30 ,$196.56 ,"$2,555.83 ","$2,555.83 ",$456.30 ,$419.09 ,"$1,022.33 ",$196.56 ,$393.82 ,"$1,022.33 ",$461.92 ,$702.00 ,$596.70 ,$596.70 ,$702.00 ,$596.70 ,$702.00 ,$477.36 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$526.50 ,$498.42 ,$498.42 ,"$1,022.33 ",$498.42 ,$575.64 ,$575.64 ,$575.64 , N/A ,$702.00 ,$596.70 ,"$1,022.33 ",$702.00 ,$419.09 ,"$1,022.33 ",$372.97 ,$607.98 ,$552.71 ,"$1,022.33 ",$596.70 ,"$2,146.90 ",$596.70 ,$196.56 ,$631.80 ,"$1,022.33 ",$575.64 , N/A , N/A ,"$1,022.33 ",$456.30 ,$702.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500085,45381,PC COLONSCOPY W/SUBMUCOSAL INJ,975,1 ,$666.00 ,$432.90 ,$186.48 ,"$2,555.83 ","$2,555.83 ",$432.90 ,$397.60 ,"$1,022.33 ",$186.48 ,$373.63 ,"$1,022.33 ",$438.23 ,$666.00 ,$566.10 ,$566.10 ,$666.00 ,$566.10 ,$666.00 ,$452.88 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$499.50 ,$472.86 ,$472.86 ,"$1,022.33 ",$472.86 ,$546.12 ,$546.12 ,$546.12 , N/A ,$666.00 ,$566.10 ,"$1,022.33 ",$666.00 ,$397.60 ,"$1,022.33 ",$353.25 ,$607.98 ,$552.71 ,"$1,022.33 ",$566.10 ,"$2,146.90 ",$566.10 ,$186.48 ,$599.40 ,"$1,022.33 ",$546.12 , N/A , N/A ,"$1,022.33 ",$432.90 ,$666.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500086,45382,PC COLONSCOPY W/CONTROL BLEEDING,975,1 ,$858.00 ,$557.70 ,$240.24 ,"$2,555.83 ","$2,555.83 ",$557.70 ,$512.23 ,"$1,022.33 ",$240.24 ,$481.34 ,"$1,022.33 ",$564.56 ,$858.00 ,$729.30 ,$729.30 ,$858.00 ,$729.30 ,$858.00 ,$583.44 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$643.50 ,$609.18 ,$609.18 ,"$1,022.33 ",$609.18 ,$703.56 ,$703.56 ,$703.56 , N/A ,$858.00 ,$729.30 ,"$1,022.33 ",$858.00 ,$512.23 ,"$1,022.33 ",$456.34 ,$607.98 ,$552.71 ,"$1,022.33 ",$729.30 ,"$2,146.90 ",$729.30 ,$240.24 ,$772.20 ,"$1,022.33 ",$703.56 , N/A , N/A ,"$1,022.33 ",$557.70 ,$858.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500087,43233,PC EGD W/BALLOON DILAT >30MM,975,1 ,$762.00 ,$495.30 ,$213.36 ,"$4,003.21 ","$4,003.20 ",$495.30 ,$454.91 ,"$1,601.28 ",$213.36 ,$427.48 ,"$1,601.28 ",$501.40 ,$762.00 ,$647.70 ,$647.70 ,$762.00 ,$647.70 ,$762.00 ,$518.16 ,"$4,003.21 ","$1,601.28 ","$1,601.28 ",$571.50 ,$541.02 ,$541.02 ,"$1,601.28 ",$541.02 ,$624.84 ,$624.84 ,$624.84 , N/A ,$762.00 ,$647.70 ,"$1,601.28 ",$762.00 ,$454.91 ,"$1,601.28 ",$405.63 ,$762.00 ,$715.11 ,"$1,601.28 ",$647.70 ,"$3,362.69 ",$647.70 ,$213.36 ,$685.80 ,"$1,601.28 ",$624.84 , N/A , N/A ,"$1,601.28 ",$495.30 ,$762.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500088,45398,PC COLONOSCOPY W/BAND LIGATION,975,1 ,"$1,296.00 ",$842.40 ,$362.88 ,"$2,555.83 ","$2,555.83 ",$842.40 ,$773.71 ,"$1,022.33 ",$362.88 ,$727.06 ,"$1,022.33 ",$852.77 ,"$1,022.33 ","$1,101.60 ","$1,101.60 ","$1,022.33 ","$1,101.60 ","$1,296.00 ",$881.28 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$972.00 ,$920.16 ,$920.16 ,"$1,022.33 ",$920.16 ,"$1,062.72 ","$1,062.72 ","$1,062.72 ", N/A ,"$1,296.00 ","$1,101.60 ","$1,022.33 ","$1,296.00 ",$773.71 ,"$1,022.33 ",$419.06 ,$607.98 ,$552.71 ,"$1,022.33 ","$1,101.60 ","$2,146.90 ","$1,101.60 ",$362.88 ,"$1,166.40 ","$1,022.33 ","$1,062.72 ", N/A , N/A ,"$1,022.33 ",$842.40 ,"$1,296.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500089,43247,PC EGD W/FB REMOVAL,975,1 ,$718.00 ,$466.70 ,$201.04 ,"$1,994.33 ","$1,994.33 ",$466.70 ,$428.65 ,$797.73 ,$201.04 ,$402.80 ,$797.73 ,$472.44 ,$718.00 ,$610.30 ,$610.30 ,$718.00 ,$610.30 ,$718.00 ,$488.24 ,"$1,994.33 ",$797.73 ,$797.73 ,$538.50 ,$509.78 ,$509.78 ,$797.73 ,$509.78 ,$588.76 ,$588.76 ,$588.76 , N/A ,$718.00 ,$610.30 ,$797.73 ,$718.00 ,$428.65 ,$797.73 ,$311.91 ,$718.00 ,$715.11 ,$797.73 ,$610.30 ,"$1,675.23 ",$610.30 ,$201.04 ,$646.20 ,$797.73 ,$588.76 , N/A , N/A ,$797.73 ,$466.70 ,$718.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500090,43236,PC EGD W/SUBMUCOSAL INJ,975,1 ,"$1,253.00 ",$814.45 ,$242.89 ,"$1,994.33 ","$1,994.33 ",$814.45 ,$748.04 ,$797.73 ,$350.84 ,$702.93 ,$797.73 ,$824.47 ,$797.73 ,"$1,065.05 ","$1,065.05 ",$797.73 ,"$1,065.05 ","$1,253.00 ",$852.04 ,"$1,994.33 ",$797.73 ,$797.73 ,$939.75 ,$889.63 ,$889.63 ,$797.73 ,$889.63 ,"$1,027.46 ","$1,027.46 ","$1,027.46 ", N/A ,"$1,253.00 ","$1,065.05 ",$797.73 ,"$1,253.00 ",$748.04 ,$797.73 ,$242.89 ,$786.62 ,$715.11 ,$797.73 ,"$1,065.05 ","$1,675.23 ","$1,065.05 ",$350.84 ,"$1,127.70 ",$797.73 ,"$1,027.46 ", N/A , N/A ,$797.73 ,$814.45 ,"$1,253.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500091,43248,PC EGD W/DILAT ESOPH GD WIRE,975,1 ,$480.00 ,$312.00 ,$134.40 ,"$1,994.33 ","$1,994.33 ",$312.00 ,$286.56 ,$797.73 ,$134.40 ,$269.28 ,$797.73 ,$315.84 ,$480.00 ,$408.00 ,$408.00 ,$480.00 ,$408.00 ,$480.00 ,$326.40 ,"$1,994.33 ",$797.73 ,$797.73 ,$360.00 ,$340.80 ,$340.80 ,$797.73 ,$340.80 ,$393.60 ,$393.60 ,$393.60 , N/A ,$480.00 ,$408.00 ,$797.73 ,$480.00 ,$286.56 ,$797.73 ,$291.16 ,$480.00 ,$480.00 ,$797.73 ,$408.00 ,"$1,675.23 ",$408.00 ,$134.40 ,$432.00 ,$797.73 ,$393.60 , N/A , N/A ,$797.73 ,$312.00 ,$480.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500092,43220,PC ESOPHAGOSC W/BALLOON,975,1 ,$387.00 ,$251.55 ,$108.36 ,"$4,003.21 ","$4,003.20 ",$251.55 ,$231.04 ,"$1,601.28 ",$108.36 ,$217.11 ,"$1,601.28 ",$254.65 ,$387.00 ,$328.95 ,$328.95 ,$387.00 ,$328.95 ,$387.00 ,$263.16 ,"$4,003.21 ","$1,601.28 ","$1,601.28 ",$290.25 ,$274.77 ,$274.77 ,"$1,601.28 ",$274.77 ,$317.34 ,$317.34 ,$317.34 , N/A ,$387.00 ,$328.95 ,"$1,601.28 ",$387.00 ,$231.04 ,"$1,601.28 ",$207.30 ,$387.00 ,$387.00 ,"$1,601.28 ",$328.95 ,"$3,362.69 ",$328.95 ,$108.36 ,$348.30 ,"$1,601.28 ",$317.34 , N/A , N/A ,"$1,601.28 ",$251.55 ,$387.00 
ST. JOSEPH'S HOSPITAL - BREESE,97500093,43264,PC ERCP W/REMOVE CALCULUS,975,1 ,"$1,843.00 ","$1,197.95 ",$516.04 ,"$7,567.88 ","$7,567.88 ","$1,197.95 ","$1,100.27 ","$3,027.15 ",$516.04 ,"$1,033.92 ","$3,027.15 ","$1,212.69 ","$1,843.00 ","$1,566.55 ","$1,566.55 ","$1,843.00 ","$1,566.55 ","$1,843.00 ","$1,253.24 ","$7,567.87 ","$3,027.15 ","$3,027.15 ","$1,382.25 ","$1,308.53 ","$1,308.53 ","$3,027.15 ","$1,308.53 ","$1,511.26 ","$1,511.26 ","$1,511.26 ", N/A ,"$1,843.00 ","$1,566.55 ","$3,027.15 ","$1,843.00 ","$1,100.27 ","$3,027.15 ",$639.85 ,"$1,663.43 ","$1,512.21 ","$3,027.15 ","$1,566.55 ","$6,357.01 ","$1,566.55 ",$516.04 ,"$1,658.70 ","$3,027.15 ","$1,511.26 ", N/A , N/A ,"$3,027.15 ","$1,197.95 ","$1,843.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500094,43275,PC ERCP W/REM FB STENT DUCT,975,1 ,"$1,455.00 ",$945.75 ,$407.40 ,"$7,567.88 ","$7,567.88 ",$945.75 ,$868.64 ,"$3,027.15 ",$407.40 ,$816.26 ,"$3,027.15 ",$957.39 ,"$1,455.00 ","$1,236.75 ","$1,236.75 ","$1,455.00 ","$1,236.75 ","$1,455.00 ",$989.40 ,"$7,567.87 ","$3,027.15 ","$3,027.15 ","$1,091.25 ","$1,033.05 ","$1,033.05 ","$3,027.15 ","$1,033.05 ","$1,193.10 ","$1,193.10 ","$1,193.10 ", N/A ,"$1,455.00 ","$1,236.75 ","$3,027.15 ","$1,455.00 ",$868.64 ,"$3,027.15 ",$662.85 ,"$1,455.00 ","$1,455.00 ","$3,027.15 ","$1,236.75 ","$6,357.01 ","$1,236.75 ",$407.40 ,"$1,309.50 ","$3,027.15 ","$1,193.10 ", N/A , N/A ,"$3,027.15 ",$945.75 ,"$1,455.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500095,45384,PC COLONOSCOPY FLEX W/REM FORCEP,975,1 ,$708.42 ,$460.47 ,$198.36 ,"$2,555.83 ","$2,555.83 ",$460.47 ,$422.93 ,"$1,022.33 ",$198.36 ,$397.42 ,"$1,022.33 ",$466.14 ,$708.42 ,$602.16 ,$602.16 ,$708.42 ,$602.16 ,$708.42 ,$481.73 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$531.32 ,$502.98 ,$502.98 ,"$1,022.33 ",$502.98 ,$580.90 ,$580.90 ,$580.90 , N/A ,$708.42 ,$602.16 ,"$1,022.33 ",$708.42 ,$422.93 ,"$1,022.33 ",$404.33 ,$607.98 ,$552.71 ,"$1,022.33 ",$602.16 ,"$2,146.90 ",$602.16 ,$198.36 ,$637.58 ,"$1,022.33 ",$580.90 , N/A , N/A ,"$1,022.33 ",$460.47 ,$708.42 
ST. JOSEPH'S HOSPITAL - BREESE,97500096,43274,PC ERCP W/STENT PLACEMENT DUCT,975,1 ,"$1,764.00 ","$1,146.60 ",$493.92 ,"$12,406.43 ","$12,406.43 ","$1,146.60 ","$1,053.11 ","$4,962.57 ",$493.92 ,$989.60 ,"$4,962.57 ","$1,160.71 ","$1,764.00 ","$1,499.40 ","$1,499.40 ","$1,764.00 ","$1,499.40 ","$1,764.00 ","$1,199.52 ","$12,406.41 ","$4,962.57 ","$4,962.57 ","$1,323.00 ","$1,252.44 ","$1,252.44 ","$4,962.57 ","$1,252.44 ","$1,446.48 ","$1,446.48 ","$1,446.48 ", N/A ,"$1,764.00 ","$1,499.40 ","$4,962.57 ","$1,764.00 ","$1,053.11 ","$4,962.57 ",$815.69 ,"$1,663.43 ","$1,512.21 ","$4,962.57 ","$1,499.40 ","$10,421.39 ","$1,499.40 ",$493.92 ,"$1,587.60 ","$4,962.57 ","$1,446.48 ", N/A , N/A ,"$4,962.57 ","$1,146.60 ","$1,764.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500097,43276,PC ERCP W/REM/EXCHG STENT W/DILAT  AND  WIRE EA,975,1 ,"$1,835.00 ","$1,192.75 ",$513.80 ,"$12,406.43 ","$12,406.43 ","$1,192.75 ","$1,095.50 ","$4,962.57 ",$513.80 ,"$1,029.44 ","$4,962.57 ","$1,207.43 ","$1,835.00 ","$1,559.75 ","$1,559.75 ","$1,835.00 ","$1,559.75 ","$1,835.00 ","$1,247.80 ","$12,406.41 ","$4,962.57 ","$4,962.57 ","$1,376.25 ","$1,302.85 ","$1,302.85 ","$4,962.57 ","$1,302.85 ","$1,504.70 ","$1,504.70 ","$1,504.70 ", N/A ,"$1,835.00 ","$1,559.75 ","$4,962.57 ","$1,835.00 ","$1,095.50 ","$4,962.57 ",$848.46 ,"$1,663.43 ","$1,512.21 ","$4,962.57 ","$1,559.75 ","$10,421.39 ","$1,559.75 ",$513.80 ,"$1,651.50 ","$4,962.57 ","$1,504.70 ", N/A , N/A ,"$4,962.57 ","$1,192.75 ","$1,835.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500098,43275,PC ERCP W/FB OR STENT REMOVAL DUCT,975,1 ,"$1,455.00 ",$945.75 ,$407.40 ,"$7,567.88 ","$7,567.88 ",$945.75 ,$868.64 ,"$3,027.15 ",$407.40 ,$816.26 ,"$3,027.15 ",$957.39 ,"$1,455.00 ","$1,236.75 ","$1,236.75 ","$1,455.00 ","$1,236.75 ","$1,455.00 ",$989.40 ,"$7,567.87 ","$3,027.15 ","$3,027.15 ","$1,091.25 ","$1,033.05 ","$1,033.05 ","$3,027.15 ","$1,033.05 ","$1,193.10 ","$1,193.10 ","$1,193.10 ", N/A ,"$1,455.00 ","$1,236.75 ","$3,027.15 ","$1,455.00 ",$868.64 ,"$3,027.15 ",$662.85 ,"$1,455.00 ","$1,455.00 ","$3,027.15 ","$1,236.75 ","$6,357.01 ","$1,236.75 ",$407.40 ,"$1,309.50 ","$3,027.15 ","$1,193.10 ", N/A , N/A ,"$3,027.15 ",$945.75 ,"$1,455.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500099,43265,PC ERCP W/LITHOTRIPSY,975,1 ,"$1,933.00 ","$1,256.45 ",$541.24 ,"$12,406.43 ","$12,406.43 ","$1,256.45 ","$1,154.00 ","$4,962.57 ",$541.24 ,"$1,084.41 ","$4,962.57 ","$1,271.91 ","$1,933.00 ","$1,643.05 ","$1,643.05 ","$1,933.00 ","$1,643.05 ","$1,933.00 ","$1,314.44 ","$12,406.41 ","$4,962.57 ","$4,962.57 ","$1,449.75 ","$1,372.43 ","$1,372.43 ","$4,962.57 ","$1,372.43 ","$1,585.06 ","$1,585.06 ","$1,585.06 ", N/A ,"$1,933.00 ","$1,643.05 ","$4,962.57 ","$1,933.00 ","$1,154.00 ","$4,962.57 ",$763.69 ,"$1,663.43 ","$1,512.21 ","$4,962.57 ","$1,643.05 ","$10,421.39 ","$1,643.05 ",$541.24 ,"$1,739.70 ","$4,962.57 ","$1,585.06 ", N/A , N/A ,"$4,962.57 ","$1,256.45 ","$1,933.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500100,43263,PC ERCP W/SPHINCTER PRESSURE MEASUREMENT,975,1 ,"$1,414.00 ",$919.10 ,$395.92 ,"$7,567.88 ","$7,567.88 ",$919.10 ,$844.16 ,"$3,027.15 ",$395.92 ,$793.25 ,"$3,027.15 ",$930.41 ,"$1,414.00 ","$1,201.90 ","$1,201.90 ","$1,414.00 ","$1,201.90 ","$1,414.00 ",$961.52 ,"$7,567.87 ","$3,027.15 ","$3,027.15 ","$1,060.50 ","$1,003.94 ","$1,003.94 ","$3,027.15 ","$1,003.94 ","$1,159.48 ","$1,159.48 ","$1,159.48 ", N/A ,"$1,414.00 ","$1,201.90 ","$3,027.15 ","$1,414.00 ",$844.16 ,"$3,027.15 ",$628.25 ,"$1,414.00 ","$1,414.00 ","$3,027.15 ","$1,201.90 ","$6,357.01 ","$1,201.90 ",$395.92 ,"$1,272.60 ","$3,027.15 ","$1,159.48 ", N/A , N/A ,"$3,027.15 ",$919.10 ,"$1,414.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500101,43277,PC ERCP W/BALL DILAT DUCT/AMPULLA EA,975,1 ,"$1,463.00 ",$950.95 ,$409.64 ,"$7,567.88 ","$7,567.88 ",$950.95 ,$873.41 ,"$3,027.15 ",$409.64 ,$820.74 ,"$3,027.15 ",$962.65 ,"$1,463.00 ","$1,243.55 ","$1,243.55 ","$1,463.00 ","$1,243.55 ","$1,463.00 ",$994.84 ,"$7,567.87 ","$3,027.15 ","$3,027.15 ","$1,097.25 ","$1,038.73 ","$1,038.73 ","$3,027.15 ","$1,038.73 ","$1,199.66 ","$1,199.66 ","$1,199.66 ", N/A ,"$1,463.00 ","$1,243.55 ","$3,027.15 ","$1,463.00 ",$873.41 ,"$3,027.15 ",$666.46 ,"$1,463.00 ","$1,463.00 ","$3,027.15 ","$1,243.55 ","$6,357.01 ","$1,243.55 ",$409.64 ,"$1,316.70 ","$3,027.15 ","$1,199.66 ", N/A , N/A ,"$3,027.15 ",$950.95 ,"$1,463.00 "
ST. JOSEPH'S HOSPITAL - BREESE,97500102,43245,PC EGD DILATE STRICTURE,975,1 ,$544.14 ,$353.69 ,$152.36 ,"$4,003.21 ","$4,003.20 ",$353.69 ,$324.85 ,"$1,601.28 ",$152.36 ,$305.26 ,"$1,601.28 ",$358.04 ,$544.14 ,$462.52 ,$462.52 ,$544.14 ,$462.52 ,$544.14 ,$370.02 ,"$4,003.21 ","$1,601.28 ","$1,601.28 ",$408.11 ,$386.34 ,$386.34 ,"$1,601.28 ",$386.34 ,$446.19 ,$446.19 ,$446.19 , N/A ,$544.14 ,$462.52 ,"$1,601.28 ",$544.14 ,$324.85 ,"$1,601.28 ",$310.58 ,$544.14 ,$544.14 ,"$1,601.28 ",$462.52 ,"$3,362.69 ",$462.52 ,$152.36 ,$489.73 ,"$1,601.28 ",$446.19 , N/A , N/A ,"$1,601.28 ",$353.69 ,$544.14 
ST. JOSEPH'S HOSPITAL - BREESE,97500103,45390,PC COLONOSCOPY W/RESECTION,975,1 ,"$1,037.40 ",$674.31 ,$290.47 ,"$6,021.28 ","$6,021.28 ",$674.31 ,$619.33 ,"$2,408.51 ",$290.47 ,$581.98 ,"$2,408.51 ",$682.61 ,"$1,037.40 ",$881.79 ,$881.79 ,"$1,037.40 ",$881.79 ,"$1,037.40 ",$705.43 ,"$6,021.28 ","$2,408.51 ","$2,408.51 ",$778.05 ,$736.55 ,$736.55 ,"$2,408.51 ",$736.55 ,$850.67 ,$850.67 ,$850.67 , N/A ,"$1,037.40 ",$881.79 ,"$2,408.51 ","$1,037.40 ",$619.33 ,"$2,408.51 ",$584.99 ,$607.98 ,$552.71 ,"$2,408.51 ",$881.79 ,"$5,057.88 ",$881.79 ,$290.47 ,$933.66 ,"$2,408.51 ",$850.67 , N/A , N/A ,"$2,408.51 ",$674.31 ,"$1,037.40 "
ST. JOSEPH'S HOSPITAL - BREESE,98180092,20600,PC DRAIN/INJECT SMALL JOINT/BURSA,981,1 ,$117.24 ,$76.21 ,$32.83 ,$643.95 ,$643.95 ,$76.21 ,$69.99 ,$257.58 ,$32.83 ,$65.77 ,$257.58 ,$77.14 ,$117.24 ,$99.65 ,$99.65 ,$117.24 ,$99.65 ,$117.24 ,$79.72 ,$643.94 ,$257.58 ,$257.58 ,$87.93 ,$83.24 ,$83.24 ,$257.58 ,$83.24 ,$96.14 ,$96.14 ,$96.14 , N/A ,$117.24 ,$99.65 ,$257.58 ,$117.24 ,$69.99 ,$257.58 ,$63.84 ,$117.24 ,$117.24 ,$257.58 ,$99.65 ,$540.91 ,$99.65 ,$32.83 ,$105.52 ,$257.58 ,$96.14 , N/A , N/A ,$257.58 ,$76.21 ,$117.24 
ST. JOSEPH'S HOSPITAL - BREESE,98180093,20605,PC DRAIN/INJECT MEDIUM JOINT/BURSA,981,1 ,$121.41 ,$78.92 ,$33.99 ,$643.95 ,$643.95 ,$78.92 ,$72.48 ,$257.58 ,$33.99 ,$68.11 ,$257.58 ,$79.89 ,$121.41 ,$103.20 ,$103.20 ,$121.41 ,$103.20 ,$121.41 ,$82.56 ,$643.94 ,$257.58 ,$257.58 ,$91.06 ,$86.20 ,$86.20 ,$257.58 ,$86.20 ,$99.56 ,$99.56 ,$99.56 , N/A ,$121.41 ,$103.20 ,$257.58 ,$121.41 ,$72.48 ,$257.58 ,$66.21 ,$121.41 ,$121.41 ,$257.58 ,$103.20 ,$540.91 ,$103.20 ,$33.99 ,$109.27 ,$257.58 ,$99.56 , N/A , N/A ,$257.58 ,$78.92 ,$121.41 
ST. JOSEPH'S HOSPITAL - BREESE,98180094,20610,PC DRAIN/INJECT LARGE JOINT/BURSA,981,1 ,$149.01 ,$96.86 ,$41.72 ,$643.95 ,$643.95 ,$96.86 ,$88.96 ,$257.58 ,$41.72 ,$83.59 ,$257.58 ,$98.05 ,$149.01 ,$126.66 ,$126.66 ,$149.01 ,$126.66 ,$149.01 ,$101.33 ,$643.94 ,$257.58 ,$257.58 ,$111.76 ,$105.80 ,$105.80 ,$257.58 ,$105.80 ,$122.19 ,$122.19 ,$122.19 , N/A ,$149.01 ,$126.66 ,$257.58 ,$149.01 ,$88.96 ,$257.58 ,$80.88 ,$149.01 ,$149.01 ,$257.58 ,$126.66 ,$540.91 ,$126.66 ,$41.72 ,$134.11 ,$257.58 ,$122.19 , N/A , N/A ,$257.58 ,$96.86 ,$149.01 
ST. JOSEPH'S HOSPITAL - BREESE,98180506,20550,PC INJ SINGLE TENDON/LIGAMENT,981,1 ,$126.90 ,$82.49 ,$35.53 ,$643.95 ,$643.95 ,$82.49 ,$75.76 ,$257.58 ,$35.53 ,$71.19 ,$257.58 ,$83.50 ,$126.90 ,$107.87 ,$107.87 ,$126.90 ,$107.87 ,$126.90 ,$86.29 ,$643.94 ,$257.58 ,$257.58 ,$95.18 ,$90.10 ,$90.10 ,$257.58 ,$90.10 ,$104.06 ,$104.06 ,$104.06 , N/A ,$126.90 ,$107.87 ,$257.58 ,$126.90 ,$75.76 ,$257.58 ,$69.40 ,$126.90 ,$126.90 ,$257.58 ,$107.87 ,$540.91 ,$107.87 ,$35.53 ,$114.21 ,$257.58 ,$104.06 , N/A , N/A ,$257.58 ,$82.49 ,$126.90 
ST. JOSEPH'S HOSPITAL - BREESE,98180507,20552,PC INJ TRIGGER PT 1-2 MUSCLE,981,1 ,$124.35 ,$80.83 ,$34.82 ,$643.95 ,$643.95 ,$80.83 ,$74.24 ,$257.58 ,$34.82 ,$69.76 ,$257.58 ,$81.82 ,$124.35 ,$105.70 ,$105.70 ,$124.35 ,$105.70 ,$124.35 ,$84.56 ,$643.94 ,$257.58 ,$257.58 ,$93.26 ,$88.29 ,$88.29 ,$257.58 ,$88.29 ,$101.97 ,$101.97 ,$101.97 , N/A ,$124.35 ,$105.70 ,$257.58 ,$124.35 ,$74.24 ,$257.58 ,$67.80 ,$124.35 ,$124.35 ,$257.58 ,$105.70 ,$540.91 ,$105.70 ,$34.82 ,$111.92 ,$257.58 ,$101.97 , N/A , N/A ,$257.58 ,$80.83 ,$124.35 
ST. JOSEPH'S HOSPITAL - BREESE,98180508,20553,PC INJ TRIGGER PT 3+ MUSCLE,981,1 ,$139.11 ,$90.42 ,$38.95 ,$643.95 ,$643.95 ,$90.42 ,$83.05 ,$257.58 ,$38.95 ,$78.04 ,$257.58 ,$91.53 ,$139.11 ,$118.24 ,$118.24 ,$139.11 ,$118.24 ,$139.11 ,$94.59 ,$643.94 ,$257.58 ,$257.58 ,$104.33 ,$98.77 ,$98.77 ,$257.58 ,$98.77 ,$114.07 ,$114.07 ,$114.07 , N/A ,$139.11 ,$118.24 ,$257.58 ,$139.11 ,$83.05 ,$257.58 ,$76.19 ,$139.11 ,$139.11 ,$257.58 ,$118.24 ,$540.91 ,$118.24 ,$38.95 ,$125.20 ,$257.58 ,$114.07 , N/A , N/A ,$257.58 ,$90.42 ,$139.11 
ST. JOSEPH'S HOSPITAL - BREESE,98180552,45330,PC SIGMOIDOSCOPY FLEXIBLE DIAG,981,1 ,$174.00 ,$113.10 ,$48.72 ,"$1,955.93 ","$1,955.93 ",$113.10 ,$103.88 ,$782.37 ,$48.72 ,$97.61 ,$782.37 ,$114.49 ,$174.00 ,$147.90 ,$147.90 ,$174.00 ,$147.90 ,$174.00 ,$118.32 ,"$1,955.93 ",$782.37 ,$782.37 ,$130.50 ,$123.54 ,$123.54 ,$782.37 ,$123.54 ,$142.68 ,$142.68 ,$142.68 , N/A ,$174.00 ,$147.90 ,$782.37 ,$174.00 ,$103.88 ,$782.37 ,$97.38 ,$174.00 ,$174.00 ,$782.37 ,$147.90 ,"$1,642.98 ",$147.90 ,$48.72 ,$156.60 ,$782.37 ,$142.68 , N/A , N/A ,$782.37 ,$113.10 ,$174.00 
ST. JOSEPH'S HOSPITAL - BREESE,98180592,64405,PC INJ ANES NERVE OCCIPITAL,981,1 ,$180.90 ,$117.59 ,$50.65 ,$643.95 ,$643.95 ,$117.59 ,$108.00 ,$257.58 ,$50.65 ,$101.48 ,$257.58 ,$119.03 ,$180.90 ,$153.77 ,$153.77 ,$180.90 ,$153.77 ,$180.90 ,$123.01 ,$643.94 ,$257.58 ,$257.58 ,$135.68 ,$128.44 ,$128.44 ,$257.58 ,$128.44 ,$148.34 ,$148.34 ,$148.34 , N/A ,$180.90 ,$153.77 ,$257.58 ,$180.90 ,$108.00 ,$257.58 ,$96.23 ,$180.90 ,$180.90 ,$257.58 ,$153.77 ,$540.91 ,$153.77 ,$50.65 ,$162.81 ,$257.58 ,$148.34 , N/A , N/A ,$257.58 ,$117.59 ,$180.90 
ST. JOSEPH'S HOSPITAL - BREESE,98180621,20600,PC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-LT,981,1 ,$117.24 ,$76.21 ,$32.83 ,$643.95 ,$643.95 ,$76.21 ,$69.99 ,$257.58 ,$32.83 ,$65.77 ,$257.58 ,$77.14 ,$117.24 ,$99.65 ,$99.65 ,$117.24 ,$99.65 ,$117.24 ,$79.72 ,$643.94 ,$257.58 ,$257.58 ,$87.93 ,$83.24 ,$83.24 ,$257.58 ,$83.24 ,$96.14 ,$96.14 ,$96.14 , N/A ,$117.24 ,$99.65 ,$257.58 ,$117.24 ,$69.99 ,$257.58 ,$63.84 ,$117.24 ,$117.24 ,$257.58 ,$99.65 ,$540.91 ,$99.65 ,$32.83 ,$105.52 ,$257.58 ,$96.14 , N/A , N/A ,$257.58 ,$76.21 ,$117.24 
ST. JOSEPH'S HOSPITAL - BREESE,98180622,20600,PC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-RT,981,1 ,$117.24 ,$76.21 ,$32.83 ,$643.95 ,$643.95 ,$76.21 ,$69.99 ,$257.58 ,$32.83 ,$65.77 ,$257.58 ,$77.14 ,$117.24 ,$99.65 ,$99.65 ,$117.24 ,$99.65 ,$117.24 ,$79.72 ,$643.94 ,$257.58 ,$257.58 ,$87.93 ,$83.24 ,$83.24 ,$257.58 ,$83.24 ,$96.14 ,$96.14 ,$96.14 , N/A ,$117.24 ,$99.65 ,$257.58 ,$117.24 ,$69.99 ,$257.58 ,$63.84 ,$117.24 ,$117.24 ,$257.58 ,$99.65 ,$540.91 ,$99.65 ,$32.83 ,$105.52 ,$257.58 ,$96.14 , N/A , N/A ,$257.58 ,$76.21 ,$117.24 
ST. JOSEPH'S HOSPITAL - BREESE,98180623,20605,PC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-LT,981,1 ,$121.41 ,$78.92 ,$33.99 ,$643.95 ,$643.95 ,$78.92 ,$72.48 ,$257.58 ,$33.99 ,$68.11 ,$257.58 ,$79.89 ,$121.41 ,$103.20 ,$103.20 ,$121.41 ,$103.20 ,$121.41 ,$82.56 ,$643.94 ,$257.58 ,$257.58 ,$91.06 ,$86.20 ,$86.20 ,$257.58 ,$86.20 ,$99.56 ,$99.56 ,$99.56 , N/A ,$121.41 ,$103.20 ,$257.58 ,$121.41 ,$72.48 ,$257.58 ,$66.21 ,$121.41 ,$121.41 ,$257.58 ,$103.20 ,$540.91 ,$103.20 ,$33.99 ,$109.27 ,$257.58 ,$99.56 , N/A , N/A ,$257.58 ,$78.92 ,$121.41 
ST. JOSEPH'S HOSPITAL - BREESE,98180624,20605,PC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-RT,981,1 ,$121.41 ,$78.92 ,$33.99 ,$643.95 ,$643.95 ,$78.92 ,$72.48 ,$257.58 ,$33.99 ,$68.11 ,$257.58 ,$79.89 ,$121.41 ,$103.20 ,$103.20 ,$121.41 ,$103.20 ,$121.41 ,$82.56 ,$643.94 ,$257.58 ,$257.58 ,$91.06 ,$86.20 ,$86.20 ,$257.58 ,$86.20 ,$99.56 ,$99.56 ,$99.56 , N/A ,$121.41 ,$103.20 ,$257.58 ,$121.41 ,$72.48 ,$257.58 ,$66.21 ,$121.41 ,$121.41 ,$257.58 ,$103.20 ,$540.91 ,$103.20 ,$33.99 ,$109.27 ,$257.58 ,$99.56 , N/A , N/A ,$257.58 ,$78.92 ,$121.41 
ST. JOSEPH'S HOSPITAL - BREESE,98180625,20610,PC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,981,1 ,$149.01 ,$96.86 ,$41.72 ,$643.95 ,$643.95 ,$96.86 ,$88.96 ,$257.58 ,$41.72 ,$83.59 ,$257.58 ,$98.05 ,$149.01 ,$126.66 ,$126.66 ,$149.01 ,$126.66 ,$149.01 ,$101.33 ,$643.94 ,$257.58 ,$257.58 ,$111.76 ,$105.80 ,$105.80 ,$257.58 ,$105.80 ,$122.19 ,$122.19 ,$122.19 , N/A ,$149.01 ,$126.66 ,$257.58 ,$149.01 ,$88.96 ,$257.58 ,$80.88 ,$149.01 ,$149.01 ,$257.58 ,$126.66 ,$540.91 ,$126.66 ,$41.72 ,$134.11 ,$257.58 ,$122.19 , N/A , N/A ,$257.58 ,$96.86 ,$149.01 
ST. JOSEPH'S HOSPITAL - BREESE,98180626,20610,PC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,981,1 ,$149.01 ,$96.86 ,$41.72 ,$643.95 ,$643.95 ,$96.86 ,$88.96 ,$257.58 ,$41.72 ,$83.59 ,$257.58 ,$98.05 ,$149.01 ,$126.66 ,$126.66 ,$149.01 ,$126.66 ,$149.01 ,$101.33 ,$643.94 ,$257.58 ,$257.58 ,$111.76 ,$105.80 ,$105.80 ,$257.58 ,$105.80 ,$122.19 ,$122.19 ,$122.19 , N/A ,$149.01 ,$126.66 ,$257.58 ,$149.01 ,$88.96 ,$257.58 ,$80.88 ,$149.01 ,$149.01 ,$257.58 ,$126.66 ,$540.91 ,$126.66 ,$41.72 ,$134.11 ,$257.58 ,$122.19 , N/A , N/A ,$257.58 ,$96.86 ,$149.01 
ST. JOSEPH'S HOSPITAL - BREESE,98180665,64450,PC INJ ANES OTHER THAN PERIPHERAL-LT,981,1 ,$137.07 ,$89.10 ,$38.38 ,"$1,565.08 ","$1,565.08 ",$89.10 ,$81.83 ,$626.03 ,$38.38 ,$76.90 ,$626.03 ,$90.19 ,$137.07 ,$116.51 ,$116.51 ,$137.07 ,$116.51 ,$137.07 ,$93.21 ,"$1,565.07 ",$626.03 ,$626.03 ,$102.80 ,$97.32 ,$97.32 ,$626.03 ,$97.32 ,$112.40 ,$112.40 ,$112.40 , N/A ,$137.07 ,$116.51 ,$626.03 ,$137.07 ,$81.83 ,$626.03 ,$75.06 ,$137.07 ,$137.07 ,$626.03 ,$116.51 ,"$1,314.66 ",$116.51 ,$38.38 ,$123.36 ,$626.03 ,$112.40 , N/A , N/A ,$626.03 ,$89.10 ,$137.07 
ST. JOSEPH'S HOSPITAL - BREESE,98180666,64450,PC INJ ANES OTHER THAN PERIPHERAL-RT,981,1 ,$137.07 ,$89.10 ,$38.38 ,"$1,565.08 ","$1,565.08 ",$89.10 ,$81.83 ,$626.03 ,$38.38 ,$76.90 ,$626.03 ,$90.19 ,$137.07 ,$116.51 ,$116.51 ,$137.07 ,$116.51 ,$137.07 ,$93.21 ,"$1,565.07 ",$626.03 ,$626.03 ,$102.80 ,$97.32 ,$97.32 ,$626.03 ,$97.32 ,$112.40 ,$112.40 ,$112.40 , N/A ,$137.07 ,$116.51 ,$626.03 ,$137.07 ,$81.83 ,$626.03 ,$75.06 ,$137.07 ,$137.07 ,$626.03 ,$116.51 ,"$1,314.66 ",$116.51 ,$38.38 ,$123.36 ,$626.03 ,$112.40 , N/A , N/A ,$626.03 ,$89.10 ,$137.07 
ST. JOSEPH'S HOSPITAL - BREESE,98180871,62323,PC INJ INTRLAMNR LUM/SAC W/GUIDE,981,1 ,$316.59 ,$205.78 ,$88.65 ,"$1,565.08 ","$1,565.08 ",$205.78 ,$189.00 ,$626.03 ,$88.65 ,$177.61 ,$626.03 ,$208.32 ,$316.59 ,$269.10 ,$269.10 ,$316.59 ,$269.10 ,$316.59 ,$215.28 ,"$1,565.07 ",$626.03 ,$626.03 ,$237.44 ,$224.78 ,$224.78 ,$626.03 ,$224.78 ,$259.60 ,$259.60 ,$259.60 , N/A ,$316.59 ,$269.10 ,$626.03 ,$316.59 ,$189.00 ,$626.03 ,$174.32 ,$316.59 ,$291.11 ,$626.03 ,$269.10 ,"$1,314.66 ",$269.10 ,$88.65 ,$284.93 ,$626.03 ,$259.60 , N/A , N/A ,$626.03 ,$205.78 ,$316.59 
ST. JOSEPH'S HOSPITAL - BREESE,98180975,20551,PC INJECTION SINGLE TENDON ORIGIN/INSERTION,981,1 ,$138.12 ,$89.78 ,$38.67 ,$643.95 ,$643.95 ,$89.78 ,$82.46 ,$257.58 ,$38.67 ,$77.49 ,$257.58 ,$90.88 ,$138.12 ,$117.40 ,$117.40 ,$138.12 ,$117.40 ,$138.12 ,$93.92 ,$643.94 ,$257.58 ,$257.58 ,$103.59 ,$98.07 ,$98.07 ,$257.58 ,$98.07 ,$113.26 ,$113.26 ,$113.26 , N/A ,$138.12 ,$117.40 ,$257.58 ,$138.12 ,$82.46 ,$257.58 ,$70.53 ,$138.12 ,$138.12 ,$257.58 ,$117.40 ,$540.91 ,$117.40 ,$38.67 ,$124.31 ,$257.58 ,$113.26 , N/A , N/A ,$257.58 ,$89.78 ,$138.12 
ST. JOSEPH'S HOSPITAL - BREESE,98180976,20606,PC ARTHROCENTESIS ASPIR AND /INJ INTERM JT/BURS W/US,981,1 ,$169.71 ,$110.31 ,$47.52 ,"$1,565.08 ","$1,565.08 ",$110.31 ,$101.32 ,$626.03 ,$47.52 ,$95.21 ,$626.03 ,$111.67 ,$169.71 ,$144.25 ,$144.25 ,$169.71 ,$144.25 ,$169.71 ,$115.40 ,"$1,565.07 ",$626.03 ,$626.03 ,$127.28 ,$120.49 ,$120.49 ,$626.03 ,$120.49 ,$139.16 ,$139.16 ,$139.16 , N/A ,$169.71 ,$144.25 ,$626.03 ,$169.71 ,$101.32 ,$626.03 ,$93.12 ,$169.71 ,$169.71 ,$626.03 ,$144.25 ,"$1,314.66 ",$144.25 ,$47.52 ,$152.74 ,$626.03 ,$139.16 , N/A , N/A ,$626.03 ,$110.31 ,$169.71 
ST. JOSEPH'S HOSPITAL - BREESE,98180977,20611,PC ARTHROCENTESIS ASPIR AND /INJ MAJOR JT/BURSA W/US,981,1 ,$193.35 ,$125.68 ,$54.14 ,$643.95 ,$643.95 ,$125.68 ,$115.43 ,$257.58 ,$54.14 ,$108.47 ,$257.58 ,$127.22 ,$193.35 ,$164.35 ,$164.35 ,$193.35 ,$164.35 ,$193.35 ,$131.48 ,$643.94 ,$257.58 ,$257.58 ,$145.01 ,$137.28 ,$137.28 ,$257.58 ,$137.28 ,$158.55 ,$158.55 ,$158.55 , N/A ,$193.35 ,$164.35 ,$257.58 ,$193.35 ,$115.43 ,$257.58 ,$105.87 ,$193.35 ,$193.35 ,$257.58 ,$164.35 ,$540.91 ,$164.35 ,$54.14 ,$174.02 ,$257.58 ,$158.55 , N/A , N/A ,$257.58 ,$125.68 ,$193.35 
ST. JOSEPH'S HOSPITAL - BREESE,98200002,99202,PC CLINIC VISIT LIMITED NEW PRO,982,1 ,$158.46 ,$103.00 ,$44.37 ,$158.46 , N/A ,$103.00 ,$94.60 , N/A ,$44.37 ,$88.90 , N/A ,$104.27 , N/A ,$134.69 ,$134.69 , N/A ,$134.69 , N/A ,$107.75 , N/A , N/A , N/A ,$118.85 ,$112.51 ,$112.51 , N/A ,$112.51 ,$129.94 ,$129.94 ,$129.94 , N/A , N/A ,$134.69 , N/A ,$78.75 ,$94.60 , N/A ,$65.28 ,$102.37 ,$93.06 , N/A ,$134.69 , N/A ,$134.69 ,$44.37 ,$142.61 , N/A ,$129.94 , N/A , N/A , N/A ,$103.00 ,$158.46 
ST. JOSEPH'S HOSPITAL - BREESE,98200003,99203,PC CLINIC VISIT INTERM NEW PRO,982,1 ,$236.91 ,$153.99 ,$66.33 ,$236.91 , N/A ,$153.99 ,$141.44 , N/A ,$66.33 ,$132.91 , N/A ,$155.89 , N/A ,$201.37 ,$201.37 , N/A ,$201.37 , N/A ,$161.10 , N/A , N/A , N/A ,$177.68 ,$168.21 ,$168.21 , N/A ,$168.21 ,$194.27 ,$194.27 ,$194.27 , N/A , N/A ,$201.37 , N/A ,$121.24 ,$141.44 , N/A ,$97.74 ,$102.37 ,$93.06 , N/A ,$201.37 , N/A ,$201.37 ,$66.33 ,$213.22 , N/A ,$194.27 , N/A , N/A , N/A ,$153.99 ,$236.91 
ST. JOSEPH'S HOSPITAL - BREESE,98200004,99204,PC CLINIC VISIT COMPLEX NEW PRO,982,1 ,$405.00 ,$263.25 ,$93.06 ,$405.00 , N/A ,$263.25 ,$241.79 , N/A ,$113.40 ,$227.21 , N/A ,$266.49 , N/A ,$344.25 ,$344.25 , N/A ,$344.25 , N/A ,$275.40 , N/A , N/A , N/A ,$303.75 ,$287.55 ,$287.55 , N/A ,$287.55 ,$332.10 ,$332.10 ,$332.10 , N/A , N/A ,$344.25 , N/A ,$181.05 ,$241.79 , N/A ,$167.14 ,$102.37 ,$93.06 , N/A ,$344.25 , N/A ,$344.25 ,$113.40 ,$364.50 , N/A ,$332.10 , N/A , N/A , N/A ,$263.25 ,$405.00 
ST. JOSEPH'S HOSPITAL - BREESE,98200005,99205,PC CLINIC VISIT COMPREH NEW PRO,982,1 ,$528.30 ,$343.40 ,$93.06 ,$528.30 , N/A ,$343.40 ,$315.40 , N/A ,$147.92 ,$296.38 , N/A ,$347.62 , N/A ,$449.06 ,$449.06 , N/A ,$449.06 , N/A ,$359.24 , N/A , N/A , N/A ,$396.23 ,$375.09 ,$375.09 , N/A ,$375.09 ,$433.21 ,$433.21 ,$433.21 , N/A , N/A ,$449.06 , N/A ,$239.15 ,$315.40 , N/A ,$218.17 ,$102.37 ,$93.06 , N/A ,$449.06 , N/A ,$449.06 ,$147.92 ,$475.47 , N/A ,$433.21 , N/A , N/A , N/A ,$343.40 ,$528.30 
ST. JOSEPH'S HOSPITAL - BREESE,98200006,99211,PC CLINIC VISIT BRIEF EST PRO,982,1 ,$28.35 ,$18.43 ,$7.94 ,$28.35 , N/A ,$18.43 ,$16.93 , N/A ,$7.94 ,$15.90 , N/A ,$18.65 , N/A ,$24.10 ,$24.10 , N/A ,$24.10 , N/A ,$19.28 , N/A , N/A , N/A ,$21.26 ,$20.13 ,$20.13 , N/A ,$20.13 ,$23.25 ,$23.25 ,$23.25 , N/A , N/A ,$24.10 , N/A ,$28.35 ,$16.93 , N/A ,$11.83 ,$28.35 ,$28.35 , N/A ,$24.10 , N/A ,$24.10 ,$7.94 ,$25.52 , N/A ,$23.25 , N/A , N/A , N/A ,$18.43 ,$28.35 
ST. JOSEPH'S HOSPITAL - BREESE,98200007,99212,PC CLINIC VISIT LIMIT EST PRO,982,1 ,$81.27 ,$52.83 ,$22.76 ,$81.27 , N/A ,$52.83 ,$48.52 , N/A ,$22.76 ,$45.59 , N/A ,$53.48 , N/A ,$69.08 ,$69.08 , N/A ,$69.08 , N/A ,$55.26 , N/A , N/A , N/A ,$60.95 ,$57.70 ,$57.70 , N/A ,$57.70 ,$66.64 ,$66.64 ,$66.64 , N/A , N/A ,$69.08 , N/A ,$60.02 ,$48.52 , N/A ,$33.40 ,$81.27 ,$81.27 , N/A ,$69.08 , N/A ,$69.08 ,$22.76 ,$73.14 , N/A ,$66.64 , N/A , N/A , N/A ,$52.83 ,$81.27 
ST. JOSEPH'S HOSPITAL - BREESE,98200008,99213,PC CLINIC VISIT INTERM EST PRO,982,1 ,$157.17 ,$102.16 ,$44.01 ,$157.17 , N/A ,$102.16 ,$93.83 , N/A ,$44.01 ,$88.17 , N/A ,$103.42 , N/A ,$133.59 ,$133.59 , N/A ,$133.59 , N/A ,$106.88 , N/A , N/A , N/A ,$117.88 ,$111.59 ,$111.59 , N/A ,$111.59 ,$128.88 ,$128.88 ,$128.88 , N/A , N/A ,$133.59 , N/A ,$97.92 ,$93.83 , N/A ,$66.15 ,$102.37 ,$93.06 , N/A ,$133.59 , N/A ,$133.59 ,$44.01 ,$141.45 , N/A ,$128.88 , N/A , N/A , N/A ,$102.16 ,$157.17 
ST. JOSEPH'S HOSPITAL - BREESE,98200009,99214,PC CLINIC VISIT COMPLX EST PRO,982,1 ,$244.83 ,$159.14 ,$68.55 ,$244.83 , N/A ,$159.14 ,$146.16 , N/A ,$68.55 ,$137.35 , N/A ,$161.10 , N/A ,$208.11 ,$208.11 , N/A ,$208.11 , N/A ,$166.48 , N/A , N/A , N/A ,$183.62 ,$173.83 ,$173.83 , N/A ,$173.83 ,$200.76 ,$200.76 ,$200.76 , N/A , N/A ,$208.11 , N/A ,$244.83 ,$146.16 , N/A ,$101.60 ,$102.37 ,$93.06 , N/A ,$208.11 , N/A ,$208.11 ,$68.55 ,$220.35 , N/A ,$200.76 , N/A , N/A , N/A ,$159.14 ,$244.83 
ST. JOSEPH'S HOSPITAL - BREESE,98200010,99215,PC CLINIC VISIT COMPRH EST PRO,982,1 ,$345.33 ,$224.46 ,$93.06 ,$345.33 , N/A ,$224.46 ,$206.16 , N/A ,$96.69 ,$193.73 , N/A ,$227.23 , N/A ,$293.53 ,$293.53 , N/A ,$293.53 , N/A ,$234.82 , N/A , N/A , N/A ,$259.00 ,$245.18 ,$245.18 , N/A ,$245.18 ,$283.17 ,$283.17 ,$283.17 , N/A , N/A ,$293.53 , N/A ,$345.33 ,$206.16 , N/A ,$143.41 ,$102.37 ,$93.06 , N/A ,$293.53 , N/A ,$293.53 ,$96.69 ,$310.80 , N/A ,$283.17 , N/A , N/A , N/A ,$224.46 ,$345.33 
ST. JOSEPH'S HOSPITAL - BREESE,98200028,22512,PC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL,982,1 ,$675.18 ,$438.87 ,$189.05 ,$675.18 , N/A ,$438.87 ,$403.08 , N/A ,$189.05 ,$378.78 , N/A ,$444.27 , N/A ,$573.90 ,$573.90 , N/A ,$573.90 , N/A ,$459.12 , N/A , N/A , N/A ,$506.39 ,$479.38 ,$479.38 , N/A ,$479.38 ,$553.65 ,$553.65 ,$553.65 , N/A , N/A ,$573.90 , N/A ,$675.18 ,$403.08 , N/A ,$367.40 ,$675.18 ,$675.18 , N/A ,$573.90 , N/A ,$573.90 ,$189.05 ,$607.66 , N/A ,$553.65 , N/A , N/A , N/A ,$438.87 ,$675.18 
ST. JOSEPH'S HOSPITAL - BREESE,98200029,22513,PC VERTEBROPLASTY INJ PERC THOR KYPHOPLASTY,982,1 ,"$1,683.99 ","$1,094.59 ",$471.52 ,"$15,438.00 ","$15,438.00 ","$1,094.59 ","$1,005.34 ","$6,175.20 ",$471.52 ,$944.72 ,"$6,175.20 ","$1,108.07 ","$1,683.99 ","$1,431.39 ","$1,431.39 ","$1,683.99 ","$1,431.39 ","$1,683.99 ","$1,145.11 ","$15,438.00 ","$6,175.20 ","$6,175.20 ","$1,262.99 ","$1,195.63 ","$1,195.63 ","$6,175.20 ","$1,195.63 ","$1,380.87 ","$1,380.87 ","$1,380.87 ", N/A ,"$1,683.99 ","$1,431.39 ","$6,175.20 ","$1,683.99 ","$1,005.34 ","$6,175.20 ",$909.77 ,"$1,683.99 ","$1,683.99 ","$6,175.20 ","$1,431.39 ","$12,967.92 ","$1,431.39 ",$471.52 ,"$1,515.59 ","$6,175.20 ","$1,380.87 ", N/A , N/A ,"$6,175.20 ","$1,094.59 ","$1,683.99 "
ST. JOSEPH'S HOSPITAL - BREESE,98200030,22514,PC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,982,1 ,"$1,569.96 ","$1,020.47 ",$439.59 ,"$15,438.00 ","$15,438.00 ","$1,020.47 ",$937.27 ,"$6,175.20 ",$439.59 ,$880.75 ,"$6,175.20 ","$1,033.03 ","$1,569.96 ","$1,334.47 ","$1,334.47 ","$1,569.96 ","$1,334.47 ","$1,569.96 ","$1,067.57 ","$15,438.00 ","$6,175.20 ","$6,175.20 ","$1,177.47 ","$1,114.67 ","$1,114.67 ","$6,175.20 ","$1,114.67 ","$1,287.37 ","$1,287.37 ","$1,287.37 ", N/A ,"$1,569.96 ","$1,334.47 ","$6,175.20 ","$1,569.96 ",$937.27 ,"$6,175.20 ",$848.02 ,"$1,569.96 ","$1,569.96 ","$6,175.20 ","$1,334.47 ","$12,967.92 ","$1,334.47 ",$439.59 ,"$1,412.96 ","$6,175.20 ","$1,287.37 ", N/A , N/A ,"$6,175.20 ","$1,020.47 ","$1,569.96 "
ST. JOSEPH'S HOSPITAL - BREESE,98200031,22515,PC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,982,1 ,$735.03 ,$477.77 ,$205.81 ,$735.03 , N/A ,$477.77 ,$438.81 , N/A ,$205.81 ,$412.35 , N/A ,$483.65 , N/A ,$624.78 ,$624.78 , N/A ,$624.78 , N/A ,$499.82 , N/A , N/A , N/A ,$551.27 ,$521.87 ,$521.87 , N/A ,$521.87 ,$602.72 ,$602.72 ,$602.72 , N/A , N/A ,$624.78 , N/A ,$735.03 ,$438.81 , N/A ,$395.01 ,$735.03 ,$735.03 , N/A ,$624.78 , N/A ,$624.78 ,$205.81 ,$661.53 , N/A ,$602.72 , N/A , N/A , N/A ,$477.77 ,$735.03 
ST. JOSEPH'S HOSPITAL - BREESE,98200032,63650,PC IMPLANT NEUROELECTRODES,982,1 ,"$1,320.09 ",$858.06 ,$369.63 ,"$15,192.81 ","$15,192.80 ",$858.06 ,$788.09 ,"$6,077.12 ",$369.63 ,$740.57 ,"$6,077.12 ",$868.62 ,"$1,320.09 ","$1,122.08 ","$1,122.08 ","$1,320.09 ","$1,122.08 ","$1,320.09 ",$897.66 ,"$15,192.81 ","$6,077.12 ","$6,077.12 ",$990.07 ,$937.26 ,$937.26 ,"$6,077.12 ",$937.26 ,"$1,082.47 ","$1,082.47 ","$1,082.47 ", N/A ,"$1,320.09 ","$1,122.08 ","$6,077.12 ","$1,320.09 ",$788.09 ,"$6,077.12 ",$725.61 ,"$1,320.09 ","$1,320.09 ","$6,077.12 ","$1,122.08 ","$12,761.96 ","$1,122.08 ",$369.63 ,"$1,188.08 ","$6,077.12 ","$1,082.47 ", N/A , N/A ,"$6,077.12 ",$858.06 ,"$1,320.09 "
ST. JOSEPH'S HOSPITAL - BREESE,98200033,64479,PC INJ EPIDURAL CREV/THOR SGL-BI,982,1 ,$415.35 ,$269.98 ,$116.30 ,"$2,028.93 ","$2,028.93 ",$269.98 ,$247.96 ,$811.57 ,$116.30 ,$233.01 ,$811.57 ,$273.30 ,$415.35 ,$353.05 ,$353.05 ,$415.35 ,$353.05 ,$415.35 ,$282.44 ,"$2,028.93 ",$811.57 ,$811.57 ,$311.51 ,$294.90 ,$294.90 ,$811.57 ,$294.90 ,$340.59 ,$340.59 ,$340.59 , N/A ,$415.35 ,$353.05 ,$811.57 ,$415.35 ,$247.96 ,$811.57 ,$229.06 ,$415.35 ,$415.35 ,$811.57 ,$353.05 ,"$1,704.30 ",$353.05 ,$116.30 ,$373.82 ,$811.57 ,$340.59 , N/A , N/A ,$811.57 ,$269.98 ,$415.35 
ST. JOSEPH'S HOSPITAL - BREESE,98200034,64479,PC INJ EPIDURAL CREV/THOR SGL-LT,982,1 ,$415.35 ,$269.98 ,$116.30 ,"$2,028.93 ","$2,028.93 ",$269.98 ,$247.96 ,$811.57 ,$116.30 ,$233.01 ,$811.57 ,$273.30 ,$415.35 ,$353.05 ,$353.05 ,$415.35 ,$353.05 ,$415.35 ,$282.44 ,"$2,028.93 ",$811.57 ,$811.57 ,$311.51 ,$294.90 ,$294.90 ,$811.57 ,$294.90 ,$340.59 ,$340.59 ,$340.59 , N/A ,$415.35 ,$353.05 ,$811.57 ,$415.35 ,$247.96 ,$811.57 ,$229.06 ,$415.35 ,$415.35 ,$811.57 ,$353.05 ,"$1,704.30 ",$353.05 ,$116.30 ,$373.82 ,$811.57 ,$340.59 , N/A , N/A ,$811.57 ,$269.98 ,$415.35 
ST. JOSEPH'S HOSPITAL - BREESE,98200035,64479,PC INJ EPIDURAL CREV/THOR SGL-RT,982,1 ,$415.35 ,$269.98 ,$116.30 ,"$2,028.93 ","$2,028.93 ",$269.98 ,$247.96 ,$811.57 ,$116.30 ,$233.01 ,$811.57 ,$273.30 ,$415.35 ,$353.05 ,$353.05 ,$415.35 ,$353.05 ,$415.35 ,$282.44 ,"$2,028.93 ",$811.57 ,$811.57 ,$311.51 ,$294.90 ,$294.90 ,$811.57 ,$294.90 ,$340.59 ,$340.59 ,$340.59 , N/A ,$415.35 ,$353.05 ,$811.57 ,$415.35 ,$247.96 ,$811.57 ,$229.06 ,$415.35 ,$415.35 ,$811.57 ,$353.05 ,"$1,704.30 ",$353.05 ,$116.30 ,$373.82 ,$811.57 ,$340.59 , N/A , N/A ,$811.57 ,$269.98 ,$415.35 
ST. JOSEPH'S HOSPITAL - BREESE,98200036,64480,PC INJ TRANSF CERV/THORACIC ADDL-LT,982,1 ,$200.22 ,$130.14 ,$56.06 ,$200.22 , N/A ,$130.14 ,$119.53 , N/A ,$56.06 ,$112.32 , N/A ,$131.74 , N/A ,$170.19 ,$170.19 , N/A ,$170.19 , N/A ,$136.15 , N/A , N/A , N/A ,$150.17 ,$142.16 ,$142.16 , N/A ,$142.16 ,$164.18 ,$164.18 ,$164.18 , N/A , N/A ,$170.19 , N/A ,$200.22 ,$119.53 , N/A ,$110.17 ,$200.22 ,$200.22 , N/A ,$170.19 , N/A ,$170.19 ,$56.06 ,$180.20 , N/A ,$164.18 , N/A , N/A , N/A ,$130.14 ,$200.22 
ST. JOSEPH'S HOSPITAL - BREESE,98200037,64480,PC INJ TRANSF CERV/THORACIC ADDL-RT,982,1 ,$200.22 ,$130.14 ,$56.06 ,$200.22 , N/A ,$130.14 ,$119.53 , N/A ,$56.06 ,$112.32 , N/A ,$131.74 , N/A ,$170.19 ,$170.19 , N/A ,$170.19 , N/A ,$136.15 , N/A , N/A , N/A ,$150.17 ,$142.16 ,$142.16 , N/A ,$142.16 ,$164.18 ,$164.18 ,$164.18 , N/A , N/A ,$170.19 , N/A ,$200.22 ,$119.53 , N/A ,$110.17 ,$200.22 ,$200.22 , N/A ,$170.19 , N/A ,$170.19 ,$56.06 ,$180.20 , N/A ,$164.18 , N/A , N/A , N/A ,$130.14 ,$200.22 
ST. JOSEPH'S HOSPITAL - BREESE,98200038,64483,PC INJ EPID LUMBAR/SACRAL SGL-BI,982,1 ,$352.74 ,$229.28 ,$98.77 ,"$2,028.93 ","$2,028.93 ",$229.28 ,$210.59 ,$811.57 ,$98.77 ,$197.89 ,$811.57 ,$232.10 ,$352.74 ,$299.83 ,$299.83 ,$352.74 ,$299.83 ,$352.74 ,$239.86 ,"$2,028.93 ",$811.57 ,$811.57 ,$264.56 ,$250.45 ,$250.45 ,$811.57 ,$250.45 ,$289.25 ,$289.25 ,$289.25 , N/A ,$352.74 ,$299.83 ,$811.57 ,$352.74 ,$210.59 ,$811.57 ,$194.65 ,$352.74 ,$352.74 ,$811.57 ,$299.83 ,"$1,704.30 ",$299.83 ,$98.77 ,$317.47 ,$811.57 ,$289.25 , N/A , N/A ,$811.57 ,$229.28 ,$352.74 
ST. JOSEPH'S HOSPITAL - BREESE,98200039,64483,PC INJ EPID LUMBAR/SACRAL SGL-LT,982,1 ,$352.74 ,$229.28 ,$98.77 ,"$2,028.93 ","$2,028.93 ",$229.28 ,$210.59 ,$811.57 ,$98.77 ,$197.89 ,$811.57 ,$232.10 ,$352.74 ,$299.83 ,$299.83 ,$352.74 ,$299.83 ,$352.74 ,$239.86 ,"$2,028.93 ",$811.57 ,$811.57 ,$264.56 ,$250.45 ,$250.45 ,$811.57 ,$250.45 ,$289.25 ,$289.25 ,$289.25 , N/A ,$352.74 ,$299.83 ,$811.57 ,$352.74 ,$210.59 ,$811.57 ,$194.65 ,$352.74 ,$352.74 ,$811.57 ,$299.83 ,"$1,704.30 ",$299.83 ,$98.77 ,$317.47 ,$811.57 ,$289.25 , N/A , N/A ,$811.57 ,$229.28 ,$352.74 
ST. JOSEPH'S HOSPITAL - BREESE,98200040,64483,PC INJ EPID LUMBAR/SACRAL SGL-RT,982,1 ,$352.74 ,$229.28 ,$98.77 ,"$2,028.93 ","$2,028.93 ",$229.28 ,$210.59 ,$811.57 ,$98.77 ,$197.89 ,$811.57 ,$232.10 ,$352.74 ,$299.83 ,$299.83 ,$352.74 ,$299.83 ,$352.74 ,$239.86 ,"$2,028.93 ",$811.57 ,$811.57 ,$264.56 ,$250.45 ,$250.45 ,$811.57 ,$250.45 ,$289.25 ,$289.25 ,$289.25 , N/A ,$352.74 ,$299.83 ,$811.57 ,$352.74 ,$210.59 ,$811.57 ,$194.65 ,$352.74 ,$352.74 ,$811.57 ,$299.83 ,"$1,704.30 ",$299.83 ,$98.77 ,$317.47 ,$811.57 ,$289.25 , N/A , N/A ,$811.57 ,$229.28 ,$352.74 
ST. JOSEPH'S HOSPITAL - BREESE,98200041,64484,PC INJ EPID LUMBAR/SACRAL ADDL-LT,982,1 ,$165.99 ,$107.89 ,$46.48 ,$165.99 , N/A ,$107.89 ,$99.10 , N/A ,$46.48 ,$93.12 , N/A ,$109.22 , N/A ,$141.09 ,$141.09 , N/A ,$141.09 , N/A ,$112.87 , N/A , N/A , N/A ,$124.49 ,$117.85 ,$117.85 , N/A ,$117.85 ,$136.11 ,$136.11 ,$136.11 , N/A , N/A ,$141.09 , N/A ,$165.99 ,$99.10 , N/A ,$91.64 ,$165.99 ,$165.99 , N/A ,$141.09 , N/A ,$141.09 ,$46.48 ,$149.39 , N/A ,$136.11 , N/A , N/A , N/A ,$107.89 ,$165.99 
ST. JOSEPH'S HOSPITAL - BREESE,98200042,64484,PC INJ EPID LUMBAR/SACRAL ADDL-RT,982,1 ,$165.99 ,$107.89 ,$46.48 ,$165.99 , N/A ,$107.89 ,$99.10 , N/A ,$46.48 ,$93.12 , N/A ,$109.22 , N/A ,$141.09 ,$141.09 , N/A ,$141.09 , N/A ,$112.87 , N/A , N/A , N/A ,$124.49 ,$117.85 ,$117.85 , N/A ,$117.85 ,$136.11 ,$136.11 ,$136.11 , N/A , N/A ,$141.09 , N/A ,$165.99 ,$99.10 , N/A ,$91.64 ,$165.99 ,$165.99 , N/A ,$141.09 , N/A ,$141.09 ,$46.48 ,$149.39 , N/A ,$136.11 , N/A , N/A , N/A ,$107.89 ,$165.99 
ST. JOSEPH'S HOSPITAL - BREESE,98200043,64490,PC INJ PARAVERT F JNT C/T 1 LV-BI,982,1 ,$335.01 ,$217.76 ,$93.80 ,"$2,028.93 ","$2,028.93 ",$217.76 ,$200.00 ,$811.57 ,$93.80 ,$187.94 ,$811.57 ,$220.44 ,$335.01 ,$284.76 ,$284.76 ,$335.01 ,$284.76 ,$335.01 ,$227.81 ,"$2,028.93 ",$811.57 ,$811.57 ,$251.26 ,$237.86 ,$237.86 ,$811.57 ,$237.86 ,$274.71 ,$274.71 ,$274.71 , N/A ,$335.01 ,$284.76 ,$811.57 ,$335.01 ,$200.00 ,$811.57 ,$184.61 ,$335.01 ,$335.01 ,$811.57 ,$284.76 ,"$1,704.30 ",$284.76 ,$93.80 ,$301.51 ,$811.57 ,$274.71 , N/A , N/A ,$811.57 ,$217.76 ,$335.01 
ST. JOSEPH'S HOSPITAL - BREESE,98200044,64490,PC INJ PARAVERT F JNT C/T 1 LV-RT,982,1 ,$335.01 ,$217.76 ,$93.80 ,"$2,028.93 ","$2,028.93 ",$217.76 ,$200.00 ,$811.57 ,$93.80 ,$187.94 ,$811.57 ,$220.44 ,$335.01 ,$284.76 ,$284.76 ,$335.01 ,$284.76 ,$335.01 ,$227.81 ,"$2,028.93 ",$811.57 ,$811.57 ,$251.26 ,$237.86 ,$237.86 ,$811.57 ,$237.86 ,$274.71 ,$274.71 ,$274.71 , N/A ,$335.01 ,$284.76 ,$811.57 ,$335.01 ,$200.00 ,$811.57 ,$184.61 ,$335.01 ,$335.01 ,$811.57 ,$284.76 ,"$1,704.30 ",$284.76 ,$93.80 ,$301.51 ,$811.57 ,$274.71 , N/A , N/A ,$811.57 ,$217.76 ,$335.01 
ST. JOSEPH'S HOSPITAL - BREESE,98200045,64490,PC INJ PARAVERT F JNT C/T 1 LV-LT,982,1 ,$335.01 ,$217.76 ,$93.80 ,"$2,028.93 ","$2,028.93 ",$217.76 ,$200.00 ,$811.57 ,$93.80 ,$187.94 ,$811.57 ,$220.44 ,$335.01 ,$284.76 ,$284.76 ,$335.01 ,$284.76 ,$335.01 ,$227.81 ,"$2,028.93 ",$811.57 ,$811.57 ,$251.26 ,$237.86 ,$237.86 ,$811.57 ,$237.86 ,$274.71 ,$274.71 ,$274.71 , N/A ,$335.01 ,$284.76 ,$811.57 ,$335.01 ,$200.00 ,$811.57 ,$184.61 ,$335.01 ,$335.01 ,$811.57 ,$284.76 ,"$1,704.30 ",$284.76 ,$93.80 ,$301.51 ,$811.57 ,$274.71 , N/A , N/A ,$811.57 ,$217.76 ,$335.01 
ST. JOSEPH'S HOSPITAL - BREESE,98200046,64491,PC INJ PARAVERT F JNT C/T 2 LV-LT,982,1 ,$192.00 ,$124.80 ,$53.76 ,$192.00 , N/A ,$124.80 ,$114.62 , N/A ,$53.76 ,$107.71 , N/A ,$126.34 , N/A ,$163.20 ,$163.20 , N/A ,$163.20 , N/A ,$130.56 , N/A , N/A , N/A ,$144.00 ,$136.32 ,$136.32 , N/A ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A , N/A ,$163.20 , N/A ,$192.00 ,$114.62 , N/A ,$105.83 ,$192.00 ,$192.00 , N/A ,$163.20 , N/A ,$163.20 ,$53.76 ,$172.80 , N/A ,$157.44 , N/A , N/A , N/A ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,98200047,64491,PC INJ PARAVERT F JNT C/T 2 LV-RT,982,1 ,$192.00 ,$124.80 ,$53.76 ,$192.00 , N/A ,$124.80 ,$114.62 , N/A ,$53.76 ,$107.71 , N/A ,$126.34 , N/A ,$163.20 ,$163.20 , N/A ,$163.20 , N/A ,$130.56 , N/A , N/A , N/A ,$144.00 ,$136.32 ,$136.32 , N/A ,$136.32 ,$157.44 ,$157.44 ,$157.44 , N/A , N/A ,$163.20 , N/A ,$192.00 ,$114.62 , N/A ,$105.83 ,$192.00 ,$192.00 , N/A ,$163.20 , N/A ,$163.20 ,$53.76 ,$172.80 , N/A ,$157.44 , N/A , N/A , N/A ,$124.80 ,$192.00 
ST. JOSEPH'S HOSPITAL - BREESE,98200048,64492,PC INJ PARAVERT F JNT C/T 3 LV-LT,982,1 ,$194.04 ,$126.13 ,$54.33 ,$194.04 , N/A ,$126.13 ,$115.84 , N/A ,$54.33 ,$108.86 , N/A ,$127.68 , N/A ,$164.93 ,$164.93 , N/A ,$164.93 , N/A ,$131.95 , N/A , N/A , N/A ,$145.53 ,$137.77 ,$137.77 , N/A ,$137.77 ,$159.11 ,$159.11 ,$159.11 , N/A , N/A ,$164.93 , N/A ,$194.04 ,$115.84 , N/A ,$106.96 ,$194.04 ,$194.04 , N/A ,$164.93 , N/A ,$164.93 ,$54.33 ,$174.64 , N/A ,$159.11 , N/A , N/A , N/A ,$126.13 ,$194.04 
ST. JOSEPH'S HOSPITAL - BREESE,98200049,64492,PC INJ PARAVERT F JNT C/T 3 LV-RT,982,1 ,$194.04 ,$126.13 ,$54.33 ,$194.04 , N/A ,$126.13 ,$115.84 , N/A ,$54.33 ,$108.86 , N/A ,$127.68 , N/A ,$164.93 ,$164.93 , N/A ,$164.93 , N/A ,$131.95 , N/A , N/A , N/A ,$145.53 ,$137.77 ,$137.77 , N/A ,$137.77 ,$159.11 ,$159.11 ,$159.11 , N/A , N/A ,$164.93 , N/A ,$194.04 ,$115.84 , N/A ,$106.96 ,$194.04 ,$194.04 , N/A ,$164.93 , N/A ,$164.93 ,$54.33 ,$174.64 , N/A ,$159.11 , N/A , N/A , N/A ,$126.13 ,$194.04 
ST. JOSEPH'S HOSPITAL - BREESE,98200050,64493,PC INJ PARAVERT F JNT L/S 1 LV-BI,982,1 ,$282.24 ,$183.46 ,$79.03 ,"$2,028.93 ", N/A ,$183.46 ,$168.50 , N/A ,$79.03 ,$158.34 , N/A ,$185.71 ,$282.24 ,$239.90 ,$239.90 ,$282.24 ,$239.90 ,$282.24 ,$191.92 ,"$2,028.93 ", N/A , N/A ,$211.68 ,$200.39 ,$200.39 , N/A ,$200.39 ,$231.44 ,$231.44 ,$231.44 , N/A , N/A ,$239.90 , N/A ,$282.24 ,$168.50 , N/A ,$156.16 ,$282.24 ,$282.24 , N/A ,$239.90 ,"$1,704.30 ",$239.90 ,$79.03 ,$254.02 , N/A ,$231.44 , N/A , N/A , N/A ,$183.46 ,$282.24 
ST. JOSEPH'S HOSPITAL - BREESE,98200051,64493,PC INJ PARAVERT F JNT L/S 1 LV-LT,982,1 ,$282.24 ,$183.46 ,$79.03 ,"$2,028.93 ","$2,028.93 ",$183.46 ,$168.50 ,$811.57 ,$79.03 ,$158.34 ,$811.57 ,$185.71 ,$282.24 ,$239.90 ,$239.90 ,$282.24 ,$239.90 ,$282.24 ,$191.92 ,"$2,028.93 ",$811.57 ,$811.57 ,$211.68 ,$200.39 ,$200.39 ,$811.57 ,$200.39 ,$231.44 ,$231.44 ,$231.44 , N/A ,$282.24 ,$239.90 ,$811.57 ,$282.24 ,$168.50 ,$811.57 ,$156.16 ,$282.24 ,$282.24 ,$811.57 ,$239.90 ,"$1,704.30 ",$239.90 ,$79.03 ,$254.02 ,$811.57 ,$231.44 , N/A , N/A ,$811.57 ,$183.46 ,$282.24 
ST. JOSEPH'S HOSPITAL - BREESE,98200052,64493,PC INJ PARAVERT F JNT L/S 1 LV-RT,982,1 ,$282.24 ,$183.46 ,$79.03 ,"$2,028.93 ","$2,028.93 ",$183.46 ,$168.50 ,$811.57 ,$79.03 ,$158.34 ,$811.57 ,$185.71 ,$282.24 ,$239.90 ,$239.90 ,$282.24 ,$239.90 ,$282.24 ,$191.92 ,"$2,028.93 ",$811.57 ,$811.57 ,$211.68 ,$200.39 ,$200.39 ,$811.57 ,$200.39 ,$231.44 ,$231.44 ,$231.44 , N/A ,$282.24 ,$239.90 ,$811.57 ,$282.24 ,$168.50 ,$811.57 ,$156.16 ,$282.24 ,$282.24 ,$811.57 ,$239.90 ,"$1,704.30 ",$239.90 ,$79.03 ,$254.02 ,$811.57 ,$231.44 , N/A , N/A ,$811.57 ,$183.46 ,$282.24 
ST. JOSEPH'S HOSPITAL - BREESE,98200053,64494,PC INJ PARAVERT F JNT L/S 2 LV-LT,982,1 ,$164.97 ,$107.23 ,$46.19 ,$164.97 , N/A ,$107.23 ,$98.49 , N/A ,$46.19 ,$92.55 , N/A ,$108.55 , N/A ,$140.22 ,$140.22 , N/A ,$140.22 , N/A ,$112.18 , N/A , N/A , N/A ,$123.73 ,$117.13 ,$117.13 , N/A ,$117.13 ,$135.28 ,$135.28 ,$135.28 , N/A , N/A ,$140.22 , N/A ,$164.97 ,$98.49 , N/A ,$91.07 ,$164.97 ,$164.97 , N/A ,$140.22 , N/A ,$140.22 ,$46.19 ,$148.47 , N/A ,$135.28 , N/A , N/A , N/A ,$107.23 ,$164.97 
ST. JOSEPH'S HOSPITAL - BREESE,98200054,64494,PC INJ PARAVERT F JNT L/S 2 LV-RT,982,1 ,$164.97 ,$107.23 ,$46.19 ,$164.97 , N/A ,$107.23 ,$98.49 , N/A ,$46.19 ,$92.55 , N/A ,$108.55 , N/A ,$140.22 ,$140.22 , N/A ,$140.22 , N/A ,$112.18 , N/A , N/A , N/A ,$123.73 ,$117.13 ,$117.13 , N/A ,$117.13 ,$135.28 ,$135.28 ,$135.28 , N/A , N/A ,$140.22 , N/A ,$164.97 ,$98.49 , N/A ,$91.07 ,$164.97 ,$164.97 , N/A ,$140.22 , N/A ,$140.22 ,$46.19 ,$148.47 , N/A ,$135.28 , N/A , N/A , N/A ,$107.23 ,$164.97 
ST. JOSEPH'S HOSPITAL - BREESE,98200055,64495,PC INJ PARAVRT F JNT L/S 3+ LV-LT,982,1 ,$167.00 ,$108.55 ,$46.76 ,$167.00 , N/A ,$108.55 ,$99.70 , N/A ,$46.76 ,$93.69 , N/A ,$109.89 , N/A ,$141.95 ,$141.95 , N/A ,$141.95 , N/A ,$113.56 , N/A , N/A , N/A ,$125.25 ,$118.57 ,$118.57 , N/A ,$118.57 ,$136.94 ,$136.94 ,$136.94 , N/A , N/A ,$141.95 , N/A ,$167.00 ,$99.70 , N/A ,$92.21 ,$167.00 ,$167.00 , N/A ,$141.95 , N/A ,$141.95 ,$46.76 ,$150.30 , N/A ,$136.94 , N/A , N/A , N/A ,$108.55 ,$167.00 
ST. JOSEPH'S HOSPITAL - BREESE,98200056,64495,PC INJ PARAVRT F JNT L/S 3+ LV-RT,982,1 ,$167.00 ,$108.55 ,$46.76 ,$167.00 , N/A ,$108.55 ,$99.70 , N/A ,$46.76 ,$93.69 , N/A ,$109.89 , N/A ,$141.95 ,$141.95 , N/A ,$141.95 , N/A ,$113.56 , N/A , N/A , N/A ,$125.25 ,$118.57 ,$118.57 , N/A ,$118.57 ,$136.94 ,$136.94 ,$136.94 , N/A , N/A ,$141.95 , N/A ,$167.00 ,$99.70 , N/A ,$92.21 ,$167.00 ,$167.00 , N/A ,$141.95 , N/A ,$141.95 ,$46.76 ,$150.30 , N/A ,$136.94 , N/A , N/A , N/A ,$108.55 ,$167.00 
ST. JOSEPH'S HOSPITAL - BREESE,98200057,64633,PC DESTROY NERVE CERVICAL/THORACIC SGL-BIL,982,1 ,$710.64 ,$461.92 ,$198.98 ,"$4,327.80 ","$4,327.80 ",$461.92 ,$424.25 ,"$1,731.12 ",$198.98 ,$398.67 ,"$1,731.12 ",$467.60 ,$710.64 ,$604.04 ,$604.04 ,$710.64 ,$604.04 ,$710.64 ,$483.24 ,"$4,327.80 ","$1,731.12 ","$1,731.12 ",$532.98 ,$504.55 ,$504.55 ,"$1,731.12 ",$504.55 ,$582.72 ,$582.72 ,$582.72 , N/A ,$710.64 ,$604.04 ,"$1,731.12 ",$710.64 ,$424.25 ,"$1,731.12 ",$391.94 ,$580.76 ,$527.96 ,"$1,731.12 ",$604.04 ,"$3,635.35 ",$604.04 ,$198.98 ,$639.58 ,"$1,731.12 ",$582.72 , N/A , N/A ,"$1,731.12 ",$461.92 ,$710.64 
ST. JOSEPH'S HOSPITAL - BREESE,98200058,64633,PC DESTROY NERVE CERVICAL/THORACIC SGL-LT,982,1 ,$710.64 ,$461.92 ,$198.98 ,"$4,327.80 ","$4,327.80 ",$461.92 ,$424.25 ,"$1,731.12 ",$198.98 ,$398.67 ,"$1,731.12 ",$467.60 ,$710.64 ,$604.04 ,$604.04 ,$710.64 ,$604.04 ,$710.64 ,$483.24 ,"$4,327.80 ","$1,731.12 ","$1,731.12 ",$532.98 ,$504.55 ,$504.55 ,"$1,731.12 ",$504.55 ,$582.72 ,$582.72 ,$582.72 , N/A ,$710.64 ,$604.04 ,"$1,731.12 ",$710.64 ,$424.25 ,"$1,731.12 ",$391.94 ,$580.76 ,$527.96 ,"$1,731.12 ",$604.04 ,"$3,635.35 ",$604.04 ,$198.98 ,$639.58 ,"$1,731.12 ",$582.72 , N/A , N/A ,"$1,731.12 ",$461.92 ,$710.64 
ST. JOSEPH'S HOSPITAL - BREESE,98200059,64633,PC DESTROY NERVE CERVICAL/THORACIC SGL-RT,982,1 ,$710.64 ,$461.92 ,$198.98 ,"$4,327.80 ","$4,327.80 ",$461.92 ,$424.25 ,"$1,731.12 ",$198.98 ,$398.67 ,"$1,731.12 ",$467.60 ,$710.64 ,$604.04 ,$604.04 ,$710.64 ,$604.04 ,$710.64 ,$483.24 ,"$4,327.80 ","$1,731.12 ","$1,731.12 ",$532.98 ,$504.55 ,$504.55 ,"$1,731.12 ",$504.55 ,$582.72 ,$582.72 ,$582.72 , N/A ,$710.64 ,$604.04 ,"$1,731.12 ",$710.64 ,$424.25 ,"$1,731.12 ",$391.94 ,$580.76 ,$527.96 ,"$1,731.12 ",$604.04 ,"$3,635.35 ",$604.04 ,$198.98 ,$639.58 ,"$1,731.12 ",$582.72 , N/A , N/A ,"$1,731.12 ",$461.92 ,$710.64 
ST. JOSEPH'S HOSPITAL - BREESE,98200060,64634,PC DESTROY NERVE CERVICAL/THORACIC EA ADDL-BIL,982,1 ,$217.17 ,$141.16 ,$60.81 ,$217.17 , N/A ,$141.16 ,$129.65 , N/A ,$60.81 ,$121.83 , N/A ,$142.90 , N/A ,$184.59 ,$184.59 , N/A ,$184.59 , N/A ,$147.68 , N/A , N/A , N/A ,$162.88 ,$154.19 ,$154.19 , N/A ,$154.19 ,$178.08 ,$178.08 ,$178.08 , N/A , N/A ,$184.59 , N/A ,$217.17 ,$129.65 , N/A ,$119.85 ,$217.17 ,$217.17 , N/A ,$184.59 , N/A ,$184.59 ,$60.81 ,$195.45 , N/A ,$178.08 , N/A , N/A , N/A ,$141.16 ,$217.17 
ST. JOSEPH'S HOSPITAL - BREESE,98200061,64634,PC DESTROY NERVE CERVICAL/THORACIC EA ADDL-LT,982,1 ,$217.17 ,$141.16 ,$60.81 ,$217.17 , N/A ,$141.16 ,$129.65 , N/A ,$60.81 ,$121.83 , N/A ,$142.90 , N/A ,$184.59 ,$184.59 , N/A ,$184.59 , N/A ,$147.68 , N/A , N/A , N/A ,$162.88 ,$154.19 ,$154.19 , N/A ,$154.19 ,$178.08 ,$178.08 ,$178.08 , N/A , N/A ,$184.59 , N/A ,$217.17 ,$129.65 , N/A ,$119.85 ,$217.17 ,$217.17 , N/A ,$184.59 , N/A ,$184.59 ,$60.81 ,$195.45 , N/A ,$178.08 , N/A , N/A , N/A ,$141.16 ,$217.17 
ST. JOSEPH'S HOSPITAL - BREESE,98200062,64634,PC DESTROY NERVE CERVICAL/THORACIC EA ADDL-RT,982,1 ,$217.17 ,$141.16 ,$60.81 ,$217.17 , N/A ,$141.16 ,$129.65 , N/A ,$60.81 ,$121.83 , N/A ,$142.90 , N/A ,$184.59 ,$184.59 , N/A ,$184.59 , N/A ,$147.68 , N/A , N/A , N/A ,$162.88 ,$154.19 ,$154.19 , N/A ,$154.19 ,$178.08 ,$178.08 ,$178.08 , N/A , N/A ,$184.59 , N/A ,$217.17 ,$129.65 , N/A ,$119.85 ,$217.17 ,$217.17 , N/A ,$184.59 , N/A ,$184.59 ,$60.81 ,$195.45 , N/A ,$178.08 , N/A , N/A , N/A ,$141.16 ,$217.17 
ST. JOSEPH'S HOSPITAL - BREESE,98200063,64635,PC DESTROY NERVE LUMBAR/SACRAL SGL-BIL,982,1 ,$699.45 ,$454.64 ,$195.85 ,"$4,327.80 ","$4,327.80 ",$454.64 ,$417.57 ,"$1,731.12 ",$195.85 ,$392.39 ,"$1,731.12 ",$460.24 ,$699.45 ,$594.53 ,$594.53 ,$699.45 ,$594.53 ,$699.45 ,$475.63 ,"$4,327.80 ","$1,731.12 ","$1,731.12 ",$524.59 ,$496.61 ,$496.61 ,"$1,731.12 ",$496.61 ,$573.55 ,$573.55 ,$573.55 , N/A ,$699.45 ,$594.53 ,"$1,731.12 ",$699.45 ,$417.57 ,"$1,731.12 ",$386.19 ,$580.76 ,$527.96 ,"$1,731.12 ",$594.53 ,"$3,635.35 ",$594.53 ,$195.85 ,$629.51 ,"$1,731.12 ",$573.55 , N/A , N/A ,"$1,731.12 ",$454.64 ,$699.45 
ST. JOSEPH'S HOSPITAL - BREESE,98200064,64635,PC DESTROY NERVE LUMBAR/SACRAL SGL-LT,982,1 ,$699.45 ,$454.64 ,$195.85 ,"$4,327.80 ","$4,327.80 ",$454.64 ,$417.57 ,"$1,731.12 ",$195.85 ,$392.39 ,"$1,731.12 ",$460.24 ,$699.45 ,$594.53 ,$594.53 ,$699.45 ,$594.53 ,$699.45 ,$475.63 ,"$4,327.80 ","$1,731.12 ","$1,731.12 ",$524.59 ,$496.61 ,$496.61 ,"$1,731.12 ",$496.61 ,$573.55 ,$573.55 ,$573.55 , N/A ,$699.45 ,$594.53 ,"$1,731.12 ",$699.45 ,$417.57 ,"$1,731.12 ",$386.19 ,$580.76 ,$527.96 ,"$1,731.12 ",$594.53 ,"$3,635.35 ",$594.53 ,$195.85 ,$629.51 ,"$1,731.12 ",$573.55 , N/A , N/A ,"$1,731.12 ",$454.64 ,$699.45 
ST. JOSEPH'S HOSPITAL - BREESE,98200065,64635,PC DESTROY NERVE LUMBAR/SACRAL SGL-RT,982,1 ,$699.45 ,$454.64 ,$195.85 ,"$4,327.80 ","$4,327.80 ",$454.64 ,$417.57 ,"$1,731.12 ",$195.85 ,$392.39 ,"$1,731.12 ",$460.24 ,$699.45 ,$594.53 ,$594.53 ,$699.45 ,$594.53 ,$699.45 ,$475.63 ,"$4,327.80 ","$1,731.12 ","$1,731.12 ",$524.59 ,$496.61 ,$496.61 ,"$1,731.12 ",$496.61 ,$573.55 ,$573.55 ,$573.55 , N/A ,$699.45 ,$594.53 ,"$1,731.12 ",$699.45 ,$417.57 ,"$1,731.12 ",$386.19 ,$580.76 ,$527.96 ,"$1,731.12 ",$594.53 ,"$3,635.35 ",$594.53 ,$195.85 ,$629.51 ,"$1,731.12 ",$573.55 , N/A , N/A ,"$1,731.12 ",$454.64 ,$699.45 
ST. JOSEPH'S HOSPITAL - BREESE,98200066,64636,PC DESTROY NERVE LUMBAR/SACRAL EA ADDL-BIL,982,1 ,$190.98 ,$124.14 ,$53.47 ,$190.98 , N/A ,$124.14 ,$114.02 , N/A ,$53.47 ,$107.14 , N/A ,$125.66 , N/A ,$162.33 ,$162.33 , N/A ,$162.33 , N/A ,$129.87 , N/A , N/A , N/A ,$143.24 ,$135.60 ,$135.60 , N/A ,$135.60 ,$156.60 ,$156.60 ,$156.60 , N/A , N/A ,$162.33 , N/A ,$190.98 ,$114.02 , N/A ,$105.27 ,$190.98 ,$190.98 , N/A ,$162.33 , N/A ,$162.33 ,$53.47 ,$171.88 , N/A ,$156.60 , N/A , N/A , N/A ,$124.14 ,$190.98 
ST. JOSEPH'S HOSPITAL - BREESE,98200067,64636,PC DESTROY NERVE LUMBAR/SACRAL EA ADDL-LT,982,1 ,$190.98 ,$124.14 ,$53.47 ,$190.98 , N/A ,$124.14 ,$114.02 , N/A ,$53.47 ,$107.14 , N/A ,$125.66 , N/A ,$162.33 ,$162.33 , N/A ,$162.33 , N/A ,$129.87 , N/A , N/A , N/A ,$143.24 ,$135.60 ,$135.60 , N/A ,$135.60 ,$156.60 ,$156.60 ,$156.60 , N/A , N/A ,$162.33 , N/A ,$190.98 ,$114.02 , N/A ,$105.27 ,$190.98 ,$190.98 , N/A ,$162.33 , N/A ,$162.33 ,$53.47 ,$171.88 , N/A ,$156.60 , N/A , N/A , N/A ,$124.14 ,$190.98 
ST. JOSEPH'S HOSPITAL - BREESE,98200068,64636,PC DESTROY NERVE LUMBAR/SACRAL EA ADDL-RT,982,1 ,$190.98 ,$124.14 ,$53.47 ,$190.98 , N/A ,$124.14 ,$114.02 , N/A ,$53.47 ,$107.14 , N/A ,$125.66 , N/A ,$162.33 ,$162.33 , N/A ,$162.33 , N/A ,$129.87 , N/A , N/A , N/A ,$143.24 ,$135.60 ,$135.60 , N/A ,$135.60 ,$156.60 ,$156.60 ,$156.60 , N/A , N/A ,$162.33 , N/A ,$190.98 ,$114.02 , N/A ,$105.27 ,$190.98 ,$190.98 , N/A ,$162.33 , N/A ,$162.33 ,$53.47 ,$171.88 , N/A ,$156.60 , N/A , N/A , N/A ,$124.14 ,$190.98 
ST. JOSEPH'S HOSPITAL - BREESE,98200069,64640,PC DESTROY NERVE PERIPHERAL-BIL,982,1 ,$370.50 ,$240.83 ,$103.74 ,"$2,028.93 ","$2,028.93 ",$240.83 ,$221.19 ,$811.57 ,$103.74 ,$207.85 ,$811.57 ,$243.79 ,$370.50 ,$314.93 ,$314.93 ,$370.50 ,$314.93 ,$370.50 ,$251.94 ,"$2,028.93 ",$811.57 ,$811.57 ,$277.88 ,$263.06 ,$263.06 ,$811.57 ,$263.06 ,$303.81 ,$303.81 ,$303.81 , N/A ,$370.50 ,$314.93 ,$811.57 ,$370.50 ,$221.19 ,$811.57 ,$204.68 ,$370.50 ,$370.50 ,$811.57 ,$314.93 ,"$1,704.30 ",$314.93 ,$103.74 ,$333.45 ,$811.57 ,$303.81 , N/A , N/A ,$811.57 ,$240.83 ,$370.50 
ST. JOSEPH'S HOSPITAL - BREESE,98200070,64640,PC DESTROY NERVE PERIPHERAL-LT,982,1 ,$370.50 ,$240.83 ,$103.74 ,"$2,028.93 ","$2,028.93 ",$240.83 ,$221.19 ,$811.57 ,$103.74 ,$207.85 ,$811.57 ,$243.79 ,$370.50 ,$314.93 ,$314.93 ,$370.50 ,$314.93 ,$370.50 ,$251.94 ,"$2,028.93 ",$811.57 ,$811.57 ,$277.88 ,$263.06 ,$263.06 ,$811.57 ,$263.06 ,$303.81 ,$303.81 ,$303.81 , N/A ,$370.50 ,$314.93 ,$811.57 ,$370.50 ,$221.19 ,$811.57 ,$204.68 ,$370.50 ,$370.50 ,$811.57 ,$314.93 ,"$1,704.30 ",$314.93 ,$103.74 ,$333.45 ,$811.57 ,$303.81 , N/A , N/A ,$811.57 ,$240.83 ,$370.50 
ST. JOSEPH'S HOSPITAL - BREESE,98200071,64640,PC DESTROY NERVE PERIPHERAL-RT,982,1 ,$370.50 ,$240.83 ,$103.74 ,"$2,028.93 ","$2,028.93 ",$240.83 ,$221.19 ,$811.57 ,$103.74 ,$207.85 ,$811.57 ,$243.79 ,$370.50 ,$314.93 ,$314.93 ,$370.50 ,$314.93 ,$370.50 ,$251.94 ,"$2,028.93 ",$811.57 ,$811.57 ,$277.88 ,$263.06 ,$263.06 ,$811.57 ,$263.06 ,$303.81 ,$303.81 ,$303.81 , N/A ,$370.50 ,$314.93 ,$811.57 ,$370.50 ,$221.19 ,$811.57 ,$204.68 ,$370.50 ,$370.50 ,$811.57 ,$314.93 ,"$1,704.30 ",$314.93 ,$103.74 ,$333.45 ,$811.57 ,$303.81 , N/A , N/A ,$811.57 ,$240.83 ,$370.50 
ST. JOSEPH'S HOSPITAL - BREESE,98500000,93010,PC EKG INTER AND REPORT PRO,985,1 ,$51.00 ,$33.15 ,$14.28 ,$51.00 , N/A ,$33.15 ,$30.45 , N/A ,$14.28 ,$28.61 , N/A ,$33.56 , N/A ,$43.35 ,$43.35 , N/A ,$43.35 , N/A ,$34.68 , N/A , N/A , N/A ,$38.25 ,$36.21 ,$36.21 , N/A ,$36.21 ,$41.82 ,$41.82 ,$41.82 , N/A , N/A ,$43.35 , N/A ,$51.00 ,$30.45 , N/A ,$15.74 ,$18.76 ,$17.05 , N/A ,$43.35 , N/A ,$43.35 ,$14.28 ,$45.90 , N/A ,$41.82 , N/A , N/A , N/A ,$33.15 ,$51.00 
ST. JOSEPH'S HOSPITAL - BREESE,98500015,45334,PC SIGMOIDOSCOPY W/CONTROL BLEEDING,985,1 ,$350.19 ,$227.62 ,$98.05 ,"$2,555.83 ","$2,555.83 ",$227.62 ,$209.06 ,"$1,022.33 ",$98.05 ,$196.46 ,"$1,022.33 ",$230.43 ,$350.19 ,$297.66 ,$297.66 ,$350.19 ,$297.66 ,$350.19 ,$238.13 ,"$2,555.83 ","$1,022.33 ","$1,022.33 ",$262.64 ,$248.63 ,$248.63 ,"$1,022.33 ",$248.63 ,$287.16 ,$287.16 ,$287.16 , N/A ,$350.19 ,$297.66 ,"$1,022.33 ",$350.19 ,$209.06 ,"$1,022.33 ",$205.65 ,$350.19 ,$350.19 ,"$1,022.33 ",$297.66 ,"$2,146.90 ",$297.66 ,$98.05 ,$315.17 ,"$1,022.33 ",$287.16 , N/A , N/A ,"$1,022.33 ",$227.62 ,$350.19 
ST. JOSEPH'S HOSPITAL - BREESE,98880000,99251,PC INPATIENT CONSULTATION 1 LIMITED 20MIN,988,1 ,$86.00 ,$55.90 ,$24.08 ,$86.00 , N/A ,$55.90 ,$51.34 , N/A ,$24.08 ,$48.25 , N/A ,$56.59 , N/A ,$73.10 ,$73.10 , N/A ,$73.10 , N/A ,$58.48 , N/A , N/A , N/A ,$64.50 ,$61.06 ,$61.06 , N/A ,$61.06 ,$70.52 ,$70.52 ,$70.52 , N/A , N/A ,$73.10 , N/A ,$86.00 ,$51.34 , N/A ,$64.70 , N/A , N/A , N/A ,$73.10 , N/A ,$73.10 ,$24.08 ,$77.40 , N/A ,$70.52 , N/A , N/A , N/A ,$55.90 ,$86.00 
ST. JOSEPH'S HOSPITAL - BREESE,98880001,99252,PC INPATIENT CONSULTATION 2 LOW 40MIN,988,1 ,$152.00 ,$98.80 ,$42.56 ,$152.00 , N/A ,$98.80 ,$90.74 , N/A ,$42.56 ,$85.27 , N/A ,$100.02 , N/A ,$129.20 ,$129.20 , N/A ,$129.20 , N/A ,$103.36 , N/A , N/A , N/A ,$114.00 ,$107.92 ,$107.92 , N/A ,$107.92 ,$124.64 ,$124.64 ,$124.64 , N/A , N/A ,$129.20 , N/A ,$152.00 ,$90.74 , N/A ,$97.37 , N/A , N/A , N/A ,$129.20 , N/A ,$129.20 ,$42.56 ,$136.80 , N/A ,$124.64 , N/A , N/A , N/A ,$98.80 ,$152.00 
ST. JOSEPH'S HOSPITAL - BREESE,98880002,99253,PC INPATIENT CONSULTATION 3 MOD 55MIN,988,1 ,$204.00 ,$132.60 ,$57.12 ,$204.00 , N/A ,$132.60 ,$121.79 , N/A ,$57.12 ,$114.44 , N/A ,$134.23 , N/A ,$173.40 ,$173.40 , N/A ,$173.40 , N/A ,$138.72 , N/A , N/A , N/A ,$153.00 ,$144.84 ,$144.84 , N/A ,$144.84 ,$167.28 ,$167.28 ,$167.28 , N/A , N/A ,$173.40 , N/A ,$204.00 ,$121.79 , N/A ,$150.34 , N/A , N/A , N/A ,$173.40 , N/A ,$173.40 ,$57.12 ,$183.60 , N/A ,$167.28 , N/A , N/A , N/A ,$132.60 ,$204.00 
ST. JOSEPH'S HOSPITAL - BREESE,98880003,99254,PC INPATIENT CONSULTATION 4 MOD-HIGH 80MIN,988,1 ,$298.00 ,$193.70 ,$83.44 ,$298.00 , N/A ,$193.70 ,$177.91 , N/A ,$83.44 ,$167.18 , N/A ,$196.08 , N/A ,$253.30 ,$253.30 , N/A ,$253.30 , N/A ,$202.64 , N/A , N/A , N/A ,$223.50 ,$211.58 ,$211.58 , N/A ,$211.58 ,$244.36 ,$244.36 ,$244.36 , N/A , N/A ,$253.30 , N/A ,$298.00 ,$177.91 , N/A ,$218.93 , N/A , N/A , N/A ,$253.30 , N/A ,$253.30 ,$83.44 ,$268.20 , N/A ,$244.36 , N/A , N/A , N/A ,$193.70 ,$298.00 
ST. JOSEPH'S HOSPITAL - BREESE,98880004,99255,PC INPATIENT CONSULTATION 5 HIGH 110MIN,988,1 ,$345.00 ,$224.25 ,$96.60 ,$345.00 , N/A ,$224.25 ,$205.97 , N/A ,$96.60 ,$193.55 , N/A ,$227.01 , N/A ,$293.25 ,$293.25 , N/A ,$293.25 , N/A ,$234.60 , N/A , N/A , N/A ,$258.75 ,$244.95 ,$244.95 , N/A ,$244.95 ,$282.90 ,$282.90 ,$282.90 , N/A , N/A ,$293.25 , N/A ,$345.00 ,$205.97 , N/A ,$263.38 , N/A , N/A , N/A ,$293.25 , N/A ,$293.25 ,$96.60 ,$310.50 , N/A ,$282.90 , N/A , N/A , N/A ,$224.25 ,$345.00