ST NICHOLAS HOSPITAL - Price Transparency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Site,Svc_Cd,HCPC/Cpt_Cd,CDM_Svc_Descr,Rev_Cd, Quantity/Units , Hopsital_Cdm_Chg , Self_Pay_Chg , Minimum_Negotiated_Chg , Maximum_Negotiated_Chg , ANTEHM MEDICAID , ANTHEM , ANTHEM HMO , ANTHEM MEDICARE ADVANTAGE HMO , ARISE HEALTH PLAN , CHOICE CARE , CIGNA , COMMUNITY CARE FAMILY CARE , FIRST HEALTH NETWORK , HEALTHEOS , HEALTHSMART , HUMANA CHOICE CARE HMO , HUMANA CHOICE CARE PPO , HUMANA MEDICARE ADVANTAGE , HUMANA NATIIONAL POS HMO , HUMANA PREFERRED BHCG , INTERPLAN HEALTH GROUP , MANAGED HEALTH SERVICES MCD , MANAGED MEDICARE NO SEQUESTRATION , MEDICA MEDICARE ADVANTAGE , MOLINA MARKETPLACE , MULTIPLAN , NAPHCARE , NEHA , NETWORK HEALTH PLAN , P360 SMALL GROUP , PREVEA 360 EMPLOYEES , PREVEA 360 HSHS EMPLOYEES , PREVEA 360 NON EMPLOYEES , PREVEA HEALTH NETWORK ," PRIVATE HEALTHCARE SYSTEMS, INC ", SECURITY HEALTH PLAN , SECURITY HEALTH PLAN OF WISCONSIN , TRILOGY , TRILOGY MEDICAID , UHC ONEIDA NATION , UNITED HEALTH ALL PAYOR , UNITED HEALTH CARE MEDICARE , UNITED HEALTH CARE OPTIONS PPO , WEA INSURANCE CORPORATION , WEA INSURANCE CORPORATION                         1 , WEA INSURANCE CORPORATION                         2 , WEA TRUST PPP/TRUST PREFERRED , WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION 
ST NICHOLAS HOSPITAL - ACUTE,N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$30,258.85 ","$3,234.26 ","$63,459.93 ","$3,234.26 ","$60,517.70 ","$60,517.70 ","$63,459.93 ","$60,517.70 ","$51,440.05 ","$42,362.39 ","$3,234.26 ","$57,491.82 ","$45,993.45 ","$45,388.28 ","$60,517.70 ","$51,440.05 ","$63,459.93 ","$60,517.70 ","$60,517.70 ","$42,362.39 ","$3,234.26 ","$63,459.93 ","$62,190.73 ","$60,517.70 ","$51,440.05 ","$60,517.70 ","$55,676.28 ","$42,362.39 ","$60,517.70 ","$60,517.70 ","$36,855.28 ","$60,517.70 ","$41,817.73 ","$54,465.93 ","$42,150.58 ","$62,812.64 ","$47,808.98 ","$3,608.75 ","$60,517.70 ","$60,517.70 ","$62,190.73 ","$60,517.70 ","$43,572.74 ","$37,520.97 ","$43,572.74 ","$43,572.74 ","$48,414.16 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$7,652.85 ","$3,234.26 ","$16,209.89 ","$3,234.26 ","$15,305.70 ","$15,305.70 ","$16,049.40 ","$15,305.70 ","$13,009.85 ","$10,713.99 ","$3,234.26 ","$14,540.42 ","$11,632.33 ","$11,479.28 ","$15,305.70 ","$13,009.85 ","$16,049.40 ","$15,305.70 ","$15,305.70 ","$10,713.99 ","$3,234.26 ","$16,049.40 ","$16,049.40 ","$15,305.70 ","$13,009.85 ","$15,305.70 ","$14,081.24 ","$10,713.99 ","$15,305.70 ","$15,305.70 ","$9,321.17 ","$15,305.70 ","$10,576.24 ","$13,775.13 ","$10,660.42 ","$16,209.89 ","$12,091.50 ","$3,608.75 ","$15,305.70 ","$15,305.70 ","$16,049.40 ","$15,305.70 ","$11,020.10 ","$9,489.53 ","$11,020.10 ","$11,020.10 ","$12,244.56 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$5,727.58 ","$3,234.26 ","$12,132.22 ","$3,234.26 ","$11,455.16 ","$11,455.16 ","$12,012.10 ","$11,455.16 ","$9,736.89 ","$8,018.61 ","$3,234.26 ","$10,882.40 ","$8,705.92 ","$8,591.37 ","$11,455.16 ","$9,736.89 ","$12,012.10 ","$11,455.16 ","$11,455.16 ","$8,018.61 ","$3,234.26 ","$12,012.10 ","$12,012.10 ","$11,455.16 ","$9,736.89 ","$11,455.16 ","$10,538.75 ","$8,018.61 ","$11,455.16 ","$11,455.16 ","$6,976.19 ","$11,455.16 ","$7,915.52 ","$10,309.64 ","$7,978.52 ","$12,132.22 ","$9,049.58 ","$3,608.75 ","$11,455.16 ","$11,455.16 ","$12,012.10 ","$11,455.16 ","$8,247.72 ","$7,102.20 ","$8,247.72 ","$8,247.72 ","$9,164.13 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$11,847.29 ","$3,234.26 ","$24,846.55 ","$3,234.26 ","$23,694.57 ","$23,694.57 ","$24,846.55 ","$23,694.57 ","$20,140.38 ","$16,586.20 ","$3,234.26 ","$22,509.84 ","$18,007.87 ","$17,770.93 ","$23,694.57 ","$20,140.38 ","$24,846.55 ","$23,694.57 ","$23,694.57 ","$16,586.20 ","$3,234.26 ","$24,846.55 ","$24,349.62 ","$23,694.57 ","$20,140.38 ","$23,694.57 ","$21,799.00 ","$16,586.20 ","$23,694.57 ","$23,694.57 ","$14,429.99 ","$23,694.57 ","$16,372.95 ","$21,325.11 ","$16,503.27 ","$24,593.12 ","$18,718.71 ","$3,608.75 ","$23,694.57 ","$23,694.57 ","$24,349.62 ","$23,694.57 ","$17,060.09 ","$14,690.63 ","$17,060.09 ","$17,060.09 ","$18,955.66 "
ST NICHOLAS HOSPITAL - ACUTE,N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$3,414.31 ","$3,234.26 ","$7,232.21 ","$3,234.26 ","$6,828.61 ","$6,828.61 ","$7,160.60 ","$6,828.61 ","$5,804.32 ","$4,780.03 ","$3,234.26 ","$6,487.18 ","$5,189.74 ","$5,121.46 ","$6,828.61 ","$5,804.32 ","$7,160.60 ","$6,828.61 ","$6,828.61 ","$4,780.03 ","$3,234.26 ","$7,160.60 ","$7,160.60 ","$6,828.61 ","$5,804.32 ","$6,828.61 ","$6,282.32 ","$4,780.03 ","$6,828.61 ","$6,828.61 ","$4,158.62 ","$6,828.61 ","$4,718.57 ","$6,145.75 ","$4,756.13 ","$7,232.21 ","$5,394.60 ","$3,608.75 ","$6,828.61 ","$6,828.61 ","$7,160.60 ","$6,828.61 ","$4,916.60 ","$4,233.74 ","$4,916.60 ","$4,916.60 ","$5,462.89 "
ST NICHOLAS HOSPITAL - ACUTE,12100001,N/A,HC DAILY SERVICE,121,1 ,"$1,532.00 ",$766.00 ,$766.00 ,"$1,532.00 ", Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ","$1,302.20 ","$1,072.40 ", Inpatient Medicaid ,"$1,455.40 ","$1,164.32 ","$1,149.00 ","$15,741.00 ","$1,302.20 ", Inpatient Medicare ,"$15,741.00 ","$13,063.00 ","$1,072.40 ", Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ","$1,302.20 ", Inpatient Medicare +100% ,"$1,409.44 ","$1,072.40 ","$9,665.52 ","$9,665.52 ",$932.99 ,"$9,665.52 ","$1,058.61 ","$1,378.80 ","$1,067.04 ", Inpatient Medicaid ,"$1,210.28 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ","$1,103.04 ",$949.84 ,"$1,103.04 ","$1,103.04 ","$1,225.60 "
ST NICHOLAS HOSPITAL - ACUTE,16900000,N/A,HC DAILY SERVICE PROLONGED STAY,169,1 ,$466.00 ,$233.00 ,$233.00 ,$466.00 , Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ",$396.10 ,$326.20 , Inpatient Medicaid ,$442.70 ,$354.16 ,$349.50 ,"$15,741.00 ",$396.10 , Inpatient Medicare ,"$15,741.00 ","$13,063.00 ",$326.20 , Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ",$396.10 , Inpatient Medicare +100% ,$428.72 ,$326.20 ,"$9,665.52 ","$9,665.52 ",$283.79 ,"$9,665.52 ",$322.01 ,$419.40 ,$324.57 , Inpatient Medicaid ,$368.14 , Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$335.52 ,$288.92 ,$335.52 ,$335.52 ,$372.80 
ST NICHOLAS HOSPITAL - ACUTE,17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,"$1,190.00 ",$595.00 ,$595.00 ,"$1,190.00 ", Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ","$1,011.50 ",$833.00 , Inpatient Medicaid ,"$1,130.50 ",$904.40 ,$892.50 ,"$15,741.00 ","$1,011.50 ", Inpatient Medicare ,"$15,741.00 ","$13,063.00 ",$833.00 , Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ","$1,011.50 ", Inpatient Medicare +100% ,"$1,094.80 ",$833.00 ,"$9,665.52 ","$9,665.52 ",$724.71 ,"$9,665.52 ",$822.29 ,"$1,071.00 ",$828.84 , Inpatient Medicaid ,$940.10 , Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$856.80 ,$737.80 ,$856.80 ,$856.80 ,$952.00 
ST NICHOLAS HOSPITAL - ACUTE,17200002,N/A,HC DAILY INFANT SERVICE LEV 2,172,1 ,"$1,553.00 ",$776.50 ,$776.50 ,"$1,553.00 ", Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ","$1,320.05 ","$1,087.10 ", Inpatient Medicaid ,"$1,475.35 ","$1,180.28 ","$1,164.75 ","$15,741.00 ","$1,320.05 ", Inpatient Medicare ,"$15,741.00 ","$13,063.00 ","$1,087.10 ", Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ","$1,320.05 ", Inpatient Medicare +100% ,"$1,428.76 ","$1,087.10 ","$9,665.52 ","$9,665.52 ",$945.78 ,"$9,665.52 ","$1,073.12 ","$1,397.70 ","$1,081.66 ", Inpatient Medicaid ,"$1,226.87 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ","$1,118.16 ",$962.86 ,"$1,118.16 ","$1,118.16 ","$1,242.40 "
ST NICHOLAS HOSPITAL - ACUTE,17300002,N/A,HC DAILY INFANT SERVICE LEV 3,173,1 ,"$1,760.00 ",$880.00 ,$880.00 ,"$1,760.00 ", Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ","$1,496.00 ","$1,232.00 ", Inpatient Medicaid ,"$1,672.00 ","$1,337.60 ","$1,320.00 ","$15,741.00 ","$1,496.00 ", Inpatient Medicare ,"$15,741.00 ","$13,063.00 ","$1,232.00 ", Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ","$1,496.00 ", Inpatient Medicare +100% ,"$1,619.20 ","$1,232.00 ","$9,665.52 ","$9,665.52 ","$1,071.84 ","$9,665.52 ","$1,216.16 ","$1,584.00 ","$1,225.84 ", Inpatient Medicaid ,"$1,390.40 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ","$1,267.20 ","$1,091.20 ","$1,267.20 ","$1,267.20 ","$1,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$4,244.00 ","$2,122.00 ","$2,122.00 ","$4,244.00 ", Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ","$3,607.40 ","$2,970.80 ", Inpatient Medicaid ,"$4,031.80 ","$3,225.44 ","$3,183.00 ","$15,741.00 ","$3,607.40 ", Inpatient Medicare ,"$15,741.00 ","$13,063.00 ","$2,970.80 ", Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ","$3,607.40 ", Inpatient Medicare +100% ,"$3,904.48 ","$2,970.80 ","$9,665.52 ","$9,665.52 ","$2,584.60 ","$9,665.52 ","$2,932.60 ","$3,819.60 ","$2,955.95 ", Inpatient Medicaid ,"$3,352.76 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ","$3,055.68 ","$2,631.28 ","$3,055.68 ","$3,055.68 ","$3,395.20 "
ST NICHOLAS HOSPITAL - ACUTE,20000002,N/A,HC DAILY SERVICE CVICU,200,1 ,"$4,347.00 ","$2,173.50 ","$2,173.50 ","$4,347.00 ", Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ","$3,694.95 ","$3,042.90 ", Inpatient Medicaid ,"$4,129.65 ","$3,303.72 ","$3,260.25 ","$15,741.00 ","$3,694.95 ", Inpatient Medicare ,"$15,741.00 ","$13,063.00 ","$3,042.90 ", Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ","$3,694.95 ", Inpatient Medicare +100% ,"$3,999.24 ","$3,042.90 ","$9,665.52 ","$9,665.52 ","$2,647.32 ","$9,665.52 ","$3,003.78 ","$3,912.30 ","$3,027.69 ", Inpatient Medicaid ,"$3,434.13 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ","$3,129.84 ","$2,695.14 ","$3,129.84 ","$3,129.84 ","$3,477.60 "
ST NICHOLAS HOSPITAL - ACUTE,20600002,N/A,HC DAILY SERVICE IMCU,206,1 ,"$3,105.00 ","$1,552.50 ","$1,552.50 ","$3,105.00 ", Inpatient Medicaid ,"$18,566.00 ","$18,207.00 ", Inpatient Medicare ,"$12,283.44 ","$2,639.25 ","$2,173.50 ", Inpatient Medicaid ,"$2,949.75 ","$2,359.80 ","$2,328.75 ","$15,741.00 ","$2,639.25 ", Inpatient Medicare ,"$15,741.00 ","$13,063.00 ","$2,173.50 ", Inpatient Medicaid , Inpatient Medicare , Inpatient Medicare ,"$11,879.79 ","$2,639.25 ", Inpatient Medicare +100% ,"$2,856.60 ","$2,173.50 ","$9,665.52 ","$9,665.52 ","$1,890.95 ","$9,665.52 ","$2,145.56 ","$2,794.50 ","$2,162.63 ", Inpatient Medicaid ,"$2,452.95 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ","$2,235.60 ","$1,925.10 ","$2,235.60 ","$2,235.60 ","$2,484.00 "
ST NICHOLAS HOSPITAL - ACUTE,23300001,N/A,HC SURCHARGE ICU/HR,233,1 ,$110.00 ,$55.00 ,$46.20 ,$110.00 , N/A ,$71.16 ,$71.16 , N/A ,$66.00 ,$93.50 ,$77.00 , N/A ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 , N/A ,$71.50 , N/A ,$77.00 , N/A , N/A , N/A ,$46.20 ,$93.50 , N/A ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 , N/A ,$86.90 , N/A ,$66.00 ,$66.00 , N/A ,$66.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$448.00 ,$224.00 ,$95.17 ,$453.85 ,$95.17 ,$289.81 ,$289.81 ,$201.71 ,$268.80 ,$380.80 ,$313.60 ,$95.17 ,$425.60 ,$340.48 ,$336.00 ,$291.20 ,$380.80 ,$201.71 ,$291.20 ,$291.20 ,$313.60 ,$95.17 ,$201.71 ,$201.71 ,$188.16 ,$380.80 ,$453.85 ,$412.16 ,$313.60 ,$227.23 ,$272.70 ,$272.83 ,$272.70 ,$309.57 ,$403.20 ,$312.03 ,$203.73 ,$353.92 ,$100.88 ,$224.00 ,$224.00 ,$201.71 ,$224.00 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$358.40 
ST NICHOLAS HOSPITAL - ACUTE,26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$179.00 ,$89.50 ,$39.46 ,$179.00 ,$161.07 ,$115.80 ,$115.80 ,$39.46 ,$107.40 ,$152.15 ,$125.30 ,$161.07 ,$170.05 ,$136.04 ,$134.25 ,$116.35 ,$152.15 ,$39.46 ,$116.35 ,$116.35 ,$125.30 ,$161.07 ,$39.46 ,$39.46 ,$75.18 ,$152.15 ,$88.78 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$108.96 ,$123.69 ,$161.10 ,$124.67 ,$39.85 ,$141.41 ,$170.73 ,$89.50 ,$89.50 ,$39.46 ,$89.50 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$538.00 ,$269.00 ,$95.17 ,$538.00 ,$95.17 ,$348.03 ,$348.03 ,$201.71 ,$322.80 ,$457.30 ,$376.60 ,$95.17 ,$511.10 ,$408.88 ,$403.50 ,$349.70 ,$457.30 ,$201.71 ,$349.70 ,$349.70 ,$376.60 ,$95.17 ,$201.71 ,$201.71 ,$225.96 ,$457.30 ,$453.85 ,$494.96 ,$376.60 ,$272.87 ,$327.48 ,$327.64 ,$327.48 ,$371.76 ,$484.20 ,$374.72 ,$203.73 ,$425.02 ,$100.88 ,$269.00 ,$269.00 ,$201.71 ,$269.00 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$430.40 
ST NICHOLAS HOSPITAL - ACUTE,26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$179.00 ,$89.50 ,$39.46 ,$179.00 ,$161.07 ,$115.80 ,$115.80 ,$39.46 ,$107.40 ,$152.15 ,$125.30 ,$161.07 ,$170.05 ,$136.04 ,$134.25 ,$116.35 ,$152.15 ,$39.46 ,$116.35 ,$116.35 ,$125.30 ,$161.07 ,$39.46 ,$39.46 ,$75.18 ,$152.15 ,$88.78 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$108.96 ,$123.69 ,$161.10 ,$124.67 ,$39.85 ,$141.41 ,$170.73 ,$89.50 ,$89.50 ,$39.46 ,$89.50 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$168.00 ,$84.00 ,$61.13 ,$168.00 ,$95.17 ,$108.68 ,$108.68 ,$61.13 ,$100.80 ,$142.80 ,$117.60 ,$95.17 ,$159.60 ,$127.68 ,$126.00 ,$109.20 ,$142.80 ,$61.13 ,$109.20 ,$109.20 ,$117.60 ,$95.17 ,$61.13 ,$61.13 ,$70.56 ,$142.80 ,$137.55 ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$117.01 ,$61.74 ,$132.72 ,$100.88 ,$84.00 ,$84.00 ,$61.13 ,$84.00 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,26000005,96368,HC INFUS CONCURRENT,260,1 ,$258.00 ,$129.00 ,$95.17 ,$258.00 ,$95.17 ,$166.90 ,$166.90 , N/A ,$154.80 ,$219.30 ,$180.60 ,$95.17 ,$245.10 ,$196.08 ,$193.50 ,$167.70 ,$219.30 , N/A ,$167.70 ,$167.70 ,$180.60 ,$95.17 , N/A , N/A ,$108.36 ,$219.30 , N/A ,$237.36 ,$180.60 ,$130.86 ,$157.04 ,$157.12 ,$157.04 ,$178.28 ,$232.20 ,$179.70 , N/A ,$203.82 ,$100.88 ,$129.00 ,$129.00 , N/A ,$129.00 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,26000014,M0239,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB",260,1 ,$697.00 ,$348.50 ,$292.74 ,$697.00 ,$309.60 ,$450.89 ,$450.89 , N/A ,$418.20 ,$592.45 ,$487.90 ,$309.60 ,$662.15 ,$529.72 ,$522.75 ,$453.05 ,$592.45 , N/A ,$453.05 ,$453.05 ,$487.90 ,$309.60 , N/A , N/A ,$292.74 ,$592.45 , N/A ,$641.24 ,$487.90 ,$353.52 ,$424.26 ,$424.47 ,$424.26 ,$481.63 ,$627.30 ,$485.46 , N/A ,$550.63 ,$328.18 ,$348.50 ,$348.50 , N/A ,$348.50 ,$501.84 ,$432.14 ,$501.84 ,$501.84 ,$557.60 
ST NICHOLAS HOSPITAL - ACUTE,26000015,M0243,"HC INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB ADMINISTRATION",260,1 ,$903.00 ,$451.50 ,$379.26 ,$978.59 ,$450.00 ,$584.15 ,$584.15 ,$434.93 ,$541.80 ,$767.55 ,$632.10 ,$450.00 ,$857.85 ,$686.28 ,$677.25 ,$586.95 ,$767.55 ,$434.93 ,$586.95 ,$586.95 ,$632.10 ,$450.00 ,$434.93 ,$434.93 ,$379.26 ,$767.55 ,$978.59 ,$830.76 ,$632.10 ,$903.00 ,$903.00 ,$549.93 ,$903.00 ,$623.97 ,$812.70 ,$628.94 ,$439.28 ,$713.37 ,$477.00 ,$451.50 ,$451.50 ,$434.93 ,$451.50 ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$722.40 
ST NICHOLAS HOSPITAL - ACUTE,26000016,M0245,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB AND ETESEVIMAB ADMINISTRATION",260,1 ,$754.00 ,$377.00 ,$316.68 ,$978.59 ,$450.00 ,$487.76 ,$487.76 ,$434.93 ,$452.40 ,$640.90 ,$527.80 ,$450.00 ,$716.30 ,$573.04 ,$565.50 ,$490.10 ,$640.90 ,$434.93 ,$490.10 ,$490.10 ,$527.80 ,$450.00 ,$434.93 ,$434.93 ,$316.68 ,$640.90 ,$978.59 ,$693.68 ,$527.80 ,$754.00 ,$754.00 ,$459.19 ,$754.00 ,$521.01 ,$678.60 ,$525.16 ,$439.28 ,$595.66 ,$477.00 ,$377.00 ,$377.00 ,$434.93 ,$377.00 ,$542.88 ,$467.48 ,$542.88 ,$542.88 ,$603.20 
ST NICHOLAS HOSPITAL - ACUTE,26000017,M0247,"HC INTRAVENOUS INFUSION, SOTROVIMAB ADMINISTRATION",260,1 ,"$1,125.00 ",$562.50 ,$434.93 ,"$1,125.00 ",$450.00 ,$727.76 ,$727.76 ,$434.93 ,$675.00 ,$956.25 ,$787.50 ,$450.00 ,"$1,068.75 ",$855.00 ,$843.75 ,$731.25 ,$956.25 ,$434.93 ,$731.25 ,$731.25 ,$787.50 ,$450.00 ,$434.93 ,$434.93 ,$472.50 ,$956.25 ,$978.59 ,"$1,035.00 ",$787.50 ,"$1,125.00 ","$1,125.00 ",$685.13 ,"$1,125.00 ",$777.38 ,"$1,012.50 ",$783.56 ,$439.28 ,$888.75 ,$477.00 ,$562.50 ,$562.50 ,$434.93 ,$562.50 ,$810.00 ,$697.50 ,$810.00 ,$810.00 ,$900.00 
ST NICHOLAS HOSPITAL - ACUTE,27000013,N/A,HC PUMP BREAST,270,1 ,$71.58 ,$35.79 ,$30.06 ,$71.58 , N/A ,$46.31 ,$46.31 , N/A ,$42.95 ,$60.84 ,$50.11 , N/A ,$68.00 ,$54.40 ,$53.69 ,$46.53 ,$60.84 , N/A ,$46.53 ,$46.53 ,$50.11 , N/A , N/A , N/A ,$30.06 ,$60.84 , N/A ,$65.85 ,$50.11 ,$36.31 ,$43.57 ,$43.59 ,$43.57 ,$49.46 ,$64.42 ,$49.86 , N/A ,$56.55 , N/A ,$42.95 ,$42.95 , N/A ,$42.95 ,$51.54 ,$44.38 ,$51.54 ,$51.54 ,$57.26 
ST NICHOLAS HOSPITAL - ACUTE,27100038,N/A,HC CPAP MASK,271,1 ,$65.00 ,$32.50 ,$27.30 ,$65.00 , N/A ,$42.05 ,$42.05 , N/A ,$39.00 ,$55.25 ,$45.50 , N/A ,$61.75 ,$49.40 ,$48.75 ,$42.25 ,$55.25 , N/A ,$42.25 ,$42.25 ,$45.50 , N/A , N/A , N/A ,$27.30 ,$55.25 , N/A ,$59.80 ,$45.50 ,$32.97 ,$39.57 ,$39.59 ,$39.57 ,$44.92 ,$58.50 ,$45.27 , N/A ,$51.35 , N/A ,$39.00 ,$39.00 , N/A ,$39.00 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,27100082,N/A,HC LEV I FLUID WARMR/FILTER,271,1 ,"$2,025.00 ","$1,012.50 ",$850.50 ,"$2,025.00 ", N/A ,"$1,309.97 ","$1,309.97 ", N/A ,"$1,215.00 ","$1,721.25 ","$1,417.50 ", N/A ,"$1,923.75 ","$1,539.00 ","$1,518.75 ","$1,316.25 ","$1,721.25 ", N/A ,"$1,316.25 ","$1,316.25 ","$1,417.50 ", N/A , N/A , N/A ,$850.50 ,"$1,721.25 ", N/A ,"$1,863.00 ","$1,417.50 ","$1,027.08 ","$1,232.62 ","$1,233.23 ","$1,232.62 ","$1,399.28 ","$1,822.50 ","$1,410.41 ", N/A ,"$1,599.75 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,"$1,215.00 ","$1,458.00 ","$1,255.50 ","$1,458.00 ","$1,458.00 ","$1,620.00 "
ST NICHOLAS HOSPITAL - ACUTE,27100084,N/A,HC MEDIUM VAGINAL DILATOR,271,1 ,$41.00 ,$20.50 ,$17.22 ,$41.00 , N/A ,$26.52 ,$26.52 , N/A ,$24.60 ,$34.85 ,$28.70 , N/A ,$38.95 ,$31.16 ,$30.75 ,$26.65 ,$34.85 , N/A ,$26.65 ,$26.65 ,$28.70 , N/A , N/A , N/A ,$17.22 ,$34.85 , N/A ,$37.72 ,$28.70 ,$20.80 ,$24.96 ,$24.97 ,$24.96 ,$28.33 ,$36.90 ,$28.56 , N/A ,$32.39 , N/A ,$24.60 ,$24.60 , N/A ,$24.60 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,27100097,N/A,HC NITRIC OXIDE HR ADULT,271,1 ,$579.00 ,$289.50 ,$243.18 ,$579.00 , N/A ,$374.56 ,$374.56 , N/A ,$347.40 ,$492.15 ,$405.30 , N/A ,$550.05 ,$440.04 ,$434.25 ,$376.35 ,$492.15 , N/A ,$376.35 ,$376.35 ,$405.30 , N/A , N/A , N/A ,$243.18 ,$492.15 , N/A ,$532.68 ,$405.30 ,$293.67 ,$352.44 ,$352.61 ,$352.44 ,$400.09 ,$521.10 ,$403.27 , N/A ,$457.41 , N/A ,$347.40 ,$347.40 , N/A ,$347.40 ,$416.88 ,$358.98 ,$416.88 ,$416.88 ,$463.20 
ST NICHOLAS HOSPITAL - ACUTE,27100098,N/A,HC NITRIC OXIDE HR CARDIAC,271,1 ,$579.00 ,$289.50 ,$243.18 ,$579.00 , N/A ,$374.56 ,$374.56 , N/A ,$347.40 ,$492.15 ,$405.30 , N/A ,$550.05 ,$440.04 ,$434.25 ,$376.35 ,$492.15 , N/A ,$376.35 ,$376.35 ,$405.30 , N/A , N/A , N/A ,$243.18 ,$492.15 , N/A ,$532.68 ,$405.30 ,$293.67 ,$352.44 ,$352.61 ,$352.44 ,$400.09 ,$521.10 ,$403.27 , N/A ,$457.41 , N/A ,$347.40 ,$347.40 , N/A ,$347.40 ,$416.88 ,$358.98 ,$416.88 ,$416.88 ,$463.20 
ST NICHOLAS HOSPITAL - ACUTE,27100107,N/A,HC OXYGEN HOURLY,271,1 ,$23.00 ,$11.50 ,$9.66 ,$23.00 , N/A ,$14.88 ,$14.88 , N/A ,$13.80 ,$19.55 ,$16.10 , N/A ,$21.85 ,$17.48 ,$17.25 ,$14.95 ,$19.55 , N/A ,$14.95 ,$14.95 ,$16.10 , N/A , N/A , N/A ,$9.66 ,$19.55 , N/A ,$21.16 ,$16.10 ,$11.67 ,$14.00 ,$14.01 ,$14.00 ,$15.89 ,$20.70 ,$16.02 , N/A ,$18.17 , N/A ,$13.80 ,$13.80 , N/A ,$13.80 ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$18.40 
ST NICHOLAS HOSPITAL - ACUTE,27100113,N/A,HC PAVLIK HARNESS,271,1 ,$174.00 ,$87.00 ,$73.08 ,$174.00 , N/A ,$112.56 ,$112.56 , N/A ,$104.40 ,$147.90 ,$121.80 , N/A ,$165.30 ,$132.24 ,$130.50 ,$113.10 ,$147.90 , N/A ,$113.10 ,$113.10 ,$121.80 , N/A , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$105.91 ,$120.23 ,$156.60 ,$121.19 , N/A ,$137.46 , N/A ,$104.40 ,$104.40 , N/A ,$104.40 ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$139.20 
ST NICHOLAS HOSPITAL - ACUTE,27100126,N/A,HC SMALL VAGINAL DILATOR,271,1 ,$36.00 ,$18.00 ,$15.12 ,$36.00 , N/A ,$23.29 ,$23.29 , N/A ,$21.60 ,$30.60 ,$25.20 , N/A ,$34.20 ,$27.36 ,$27.00 ,$23.40 ,$30.60 , N/A ,$23.40 ,$23.40 ,$25.20 , N/A , N/A , N/A ,$15.12 ,$30.60 , N/A ,$33.12 ,$25.20 ,$18.26 ,$21.91 ,$21.92 ,$21.91 ,$24.88 ,$32.40 ,$25.07 , N/A ,$28.44 , N/A ,$21.60 ,$21.60 , N/A ,$21.60 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,27100148,L3908,HC SPLINT THUMB SPICA FIT AND ADJUST,274,1 ,$100.00 ,$50.00 ,$42.00 ,$171.72 , N/A , N/A , N/A ,$76.32 ,$60.00 ,$85.00 ,$70.00 , N/A ,$95.00 ,$76.00 ,$75.00 , N/A ,$85.00 ,$76.32 , N/A ,$65.00 ,$70.00 , N/A ,$76.32 ,$76.32 ,$42.00 ,$85.00 ,$171.72 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$77.08 ,$79.00 , N/A , N/A , N/A ,$76.32 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,27100258,N/A,HC KIT RT OXYGEN SUPPLY,271,1 ,$80.00 ,$40.00 ,$33.60 ,$80.00 , N/A ,$51.75 ,$51.75 , N/A ,$48.00 ,$68.00 ,$56.00 , N/A ,$76.00 ,$60.80 ,$60.00 ,$52.00 ,$68.00 , N/A ,$52.00 ,$52.00 ,$56.00 , N/A , N/A , N/A ,$33.60 ,$68.00 , N/A ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$55.72 , N/A ,$63.20 , N/A ,$48.00 ,$48.00 , N/A ,$48.00 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,27200005,B4087,HC MAGNA PORT G-TUBE SET,272,1 ,$55.00 ,$27.50 ,$23.10 ,$55.00 , N/A ,$31.30 ,$31.30 , N/A ,$33.00 ,$46.75 ,$38.50 , N/A ,$52.25 ,$41.80 ,$41.25 ,$35.75 ,$46.75 , N/A ,$35.75 ,$35.75 ,$38.50 , N/A , N/A , N/A ,$23.10 ,$46.75 ,$33.00 ,$50.60 ,$38.50 ,$27.90 ,$33.48 ,$33.50 ,$33.48 ,$38.01 ,$49.50 ,$38.31 , N/A ,$43.45 , N/A ,$33.00 ,$33.00 , N/A ,$33.00 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,27200009,C1724,HC ROTABLATOR BURR,272,1 ,"$1,805.00 ",$902.50 ,$758.10 ,"$1,805.00 ", N/A ,"$1,167.65 ","$1,167.65 ", N/A ,"$1,083.00 ","$1,534.25 ","$1,263.50 ", N/A ,"$1,714.75 ","$1,371.80 ","$1,353.75 ","$1,173.25 ","$1,534.25 ", N/A ,"$1,173.25 ","$1,173.25 ","$1,263.50 ", N/A , N/A , N/A ,$758.10 ,"$1,534.25 ", N/A ,"$1,660.60 ","$1,263.50 ",$915.50 ,"$1,098.70 ","$1,099.25 ","$1,098.70 ","$1,247.26 ","$1,624.50 ","$1,257.18 ", N/A ,"$1,425.95 ", N/A ,"$1,083.00 ","$1,083.00 ", N/A ,"$1,083.00 ","$1,299.60 ","$1,119.10 ","$1,299.60 ","$1,299.60 ","$1,444.00 "
ST NICHOLAS HOSPITAL - ACUTE,27200011,C1724,HC ROTALINK PLUS,272,1 ,"$2,302.00 ","$1,151.00 ",$966.84 ,"$2,302.00 ", N/A ,"$1,489.16 ","$1,489.16 ", N/A ,"$1,381.20 ","$1,956.70 ","$1,611.40 ", N/A ,"$2,186.90 ","$1,749.52 ","$1,726.50 ","$1,496.30 ","$1,956.70 ", N/A ,"$1,496.30 ","$1,496.30 ","$1,611.40 ", N/A , N/A , N/A ,$966.84 ,"$1,956.70 ", N/A ,"$2,117.84 ","$1,611.40 ","$1,167.57 ","$1,401.23 ","$1,401.92 ","$1,401.23 ","$1,590.68 ","$2,071.80 ","$1,603.34 ", N/A ,"$1,818.58 ", N/A ,"$1,381.20 ","$1,381.20 ", N/A ,"$1,381.20 ","$1,657.44 ","$1,427.24 ","$1,657.44 ","$1,657.44 ","$1,841.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200034,C1729,HC CATHETER DRAINAGE,272,1 ,$537.00 ,$268.50 ,$225.54 ,$537.00 , N/A ,$347.39 ,$347.39 , N/A ,$322.20 ,$456.45 ,$375.90 , N/A ,$510.15 ,$408.12 ,$402.75 ,$349.05 ,$456.45 , N/A ,$349.05 ,$349.05 ,$375.90 , N/A , N/A , N/A ,$225.54 ,$456.45 , N/A ,$494.04 ,$375.90 ,$272.37 ,$326.87 ,$327.03 ,$326.87 ,$371.07 ,$483.30 ,$374.02 , N/A ,$424.23 , N/A ,$322.20 ,$322.20 , N/A ,$322.20 ,$386.64 ,$332.94 ,$386.64 ,$386.64 ,$429.60 
ST NICHOLAS HOSPITAL - ACUTE,27200035,C1729,HC CATHETER DRAINAGE PLEUREX,272,1 ,"$1,040.00 ",$520.00 ,$436.80 ,"$1,040.00 ", N/A ,$672.78 ,$672.78 , N/A ,$624.00 ,$884.00 ,$728.00 , N/A ,$988.00 ,$790.40 ,$780.00 ,$676.00 ,$884.00 , N/A ,$676.00 ,$676.00 ,$728.00 , N/A , N/A , N/A ,$436.80 ,$884.00 , N/A ,$956.80 ,$728.00 ,$527.49 ,$633.05 ,$633.36 ,$633.05 ,$718.64 ,$936.00 ,$724.36 , N/A ,$821.60 , N/A ,$624.00 ,$624.00 , N/A ,$624.00 ,$748.80 ,$644.80 ,$748.80 ,$748.80 ,$832.00 
ST NICHOLAS HOSPITAL - ACUTE,27200044,C1729,HC STENT BILIARY PLASTIC,272,1 ,$331.00 ,$165.50 ,$139.02 ,$331.00 , N/A ,$214.12 ,$214.12 , N/A ,$198.60 ,$281.35 ,$231.70 , N/A ,$314.45 ,$251.56 ,$248.25 ,$215.15 ,$281.35 , N/A ,$215.15 ,$215.15 ,$231.70 , N/A , N/A , N/A ,$139.02 ,$281.35 , N/A ,$304.52 ,$231.70 ,$167.88 ,$201.48 ,$201.58 ,$201.48 ,$228.72 ,$297.90 ,$230.54 , N/A ,$261.49 , N/A ,$198.60 ,$198.60 , N/A ,$198.60 ,$238.32 ,$205.22 ,$238.32 ,$238.32 ,$264.80 
ST NICHOLAS HOSPITAL - ACUTE,27200050,C1732,HC RF ABLATION CATHETER,272,1 ,"$2,971.00 ","$1,485.50 ","$1,247.82 ","$2,971.00 ", N/A ,"$1,921.94 ","$1,921.94 ", N/A ,"$1,782.60 ","$2,525.35 ","$2,079.70 ", N/A ,"$2,822.45 ","$2,257.96 ","$2,228.25 ","$1,931.15 ","$2,525.35 ", N/A ,"$1,931.15 ","$1,931.15 ","$2,079.70 ", N/A , N/A , N/A ,"$1,247.82 ","$2,525.35 ", N/A ,"$2,733.32 ","$2,079.70 ","$1,506.89 ","$1,808.45 ","$1,809.34 ","$1,808.45 ","$2,052.96 ","$2,673.90 ","$2,069.30 ", N/A ,"$2,347.09 ", N/A ,"$1,782.60 ","$1,782.60 ", N/A ,"$1,782.60 ","$2,139.12 ","$1,842.02 ","$2,139.12 ","$2,139.12 ","$2,376.80 "
ST NICHOLAS HOSPITAL - ACUTE,27200052,C1730,HC QUADRIPOLAR CATHETER,272,1 ,$771.00 ,$385.50 ,$323.82 ,$771.00 , N/A ,$498.76 ,$498.76 , N/A ,$462.60 ,$655.35 ,$539.70 , N/A ,$732.45 ,$585.96 ,$578.25 ,$501.15 ,$655.35 , N/A ,$501.15 ,$501.15 ,$539.70 , N/A , N/A , N/A ,$323.82 ,$655.35 , N/A ,$709.32 ,$539.70 ,$391.05 ,$469.31 ,$469.54 ,$469.31 ,$532.76 ,$693.90 ,$537.00 , N/A ,$609.09 , N/A ,$462.60 ,$462.60 , N/A ,$462.60 ,$555.12 ,$478.02 ,$555.12 ,$555.12 ,$616.80 
ST NICHOLAS HOSPITAL - ACUTE,27200056,C1757,HC ANGIOJET CATHETER,272,1 ,"$3,412.00 ","$1,706.00 ","$1,433.04 ","$3,412.00 ", N/A ,"$2,207.22 ","$2,207.22 ", N/A ,"$2,047.20 ","$2,900.20 ","$2,388.40 ", N/A ,"$3,241.40 ","$2,593.12 ","$2,559.00 ","$2,217.80 ","$2,900.20 ", N/A ,"$2,217.80 ","$2,217.80 ","$2,388.40 ", N/A , N/A , N/A ,"$1,433.04 ","$2,900.20 ", N/A ,"$3,139.04 ","$2,388.40 ","$1,730.57 ","$2,076.88 ","$2,077.91 ","$2,076.88 ","$2,357.69 ","$3,070.80 ","$2,376.46 ", N/A ,"$2,695.48 ", N/A ,"$2,047.20 ","$2,047.20 ", N/A ,"$2,047.20 ","$2,456.64 ","$2,115.44 ","$2,456.64 ","$2,456.64 ","$2,729.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200077,C1764,HC REVEAL LOOP RECORDER,278,1 ,"$11,018.00 ","$5,509.00 ","$4,627.56 ","$11,018.00 ", N/A ,"$5,482.56 ","$5,482.56 ", N/A ,"$6,610.80 ","$9,365.30 ","$7,712.60 ", N/A ,"$10,467.10 ","$8,373.68 ","$8,263.50 ","$5,509.00 ","$9,365.30 ", N/A ,"$5,509.00 ","$7,161.70 ","$7,712.60 ", N/A , N/A , N/A ,"$4,627.56 ","$9,365.30 ", N/A ,"$10,136.56 ","$7,712.60 ","$5,588.33 ","$6,706.66 ","$6,709.96 ","$6,706.66 ","$7,613.44 ","$9,916.20 ","$7,674.04 ", N/A ,"$8,704.22 ", N/A ,"$5,509.00 ","$5,509.00 ", N/A ,"$5,509.00 ","$7,932.96 ","$6,831.16 ","$7,932.96 ","$7,932.96 ","$8,814.40 "
ST NICHOLAS HOSPITAL - ACUTE,27200117,C1769,SVG HC WAVE WIRE,272,1 ,"$1,064.00 ",$532.00 ,$446.88 ,"$1,064.00 ", N/A ,$688.30 ,$688.30 , N/A ,$638.40 ,$904.40 ,$744.80 , N/A ,"$1,010.80 ",$808.64 ,$798.00 ,$691.60 ,$904.40 , N/A ,$691.60 ,$691.60 ,$744.80 , N/A , N/A , N/A ,$446.88 ,$904.40 , N/A ,$978.88 ,$744.80 ,$539.66 ,$647.66 ,$647.98 ,$647.66 ,$735.22 ,$957.60 ,$741.08 , N/A ,$840.56 , N/A ,$638.40 ,$638.40 , N/A ,$638.40 ,$766.08 ,$659.68 ,$766.08 ,$766.08 ,$851.20 
ST NICHOLAS HOSPITAL - ACUTE,27200138,C1773,HC SNARE RETRIEVAL DEVICE,272,1 ,$532.00 ,$266.00 ,$223.44 ,$532.00 , N/A ,$344.15 ,$344.15 , N/A ,$319.20 ,$452.20 ,$372.40 , N/A ,$505.40 ,$404.32 ,$399.00 ,$345.80 ,$452.20 , N/A ,$345.80 ,$345.80 ,$372.40 , N/A , N/A , N/A ,$223.44 ,$452.20 , N/A ,$489.44 ,$372.40 ,$269.83 ,$323.83 ,$323.99 ,$323.83 ,$367.61 ,$478.80 ,$370.54 , N/A ,$420.28 , N/A ,$319.20 ,$319.20 , N/A ,$319.20 ,$383.04 ,$329.84 ,$383.04 ,$383.04 ,$425.60 
ST NICHOLAS HOSPITAL - ACUTE,27200145,C1874,HC STENT EXPANDABLE COVERED,278,1 ,"$4,622.00 ","$2,311.00 ","$1,941.24 ","$4,622.00 ", N/A ,"$2,299.91 ","$2,299.91 ", N/A ,"$2,773.20 ","$3,928.70 ","$3,235.40 ", N/A ,"$4,390.90 ","$3,512.72 ","$3,466.50 ","$2,311.00 ","$3,928.70 ", N/A ,"$2,311.00 ","$3,004.30 ","$3,235.40 ", N/A , N/A , N/A ,"$1,941.24 ","$3,928.70 ", N/A ,"$4,252.24 ","$3,235.40 ","$2,344.28 ","$2,813.41 ","$2,814.80 ","$2,813.41 ","$3,193.80 ","$4,159.80 ","$3,219.22 ", N/A ,"$3,651.38 ", N/A , N/A , N/A , N/A , N/A ,"$3,327.84 ","$2,865.64 ","$3,327.84 ","$3,327.84 ","$3,697.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200152,C1884,HC EMBOLIZATION PROTECTION SYSTEM,272,1 ,"$3,167.00 ","$1,583.50 ","$1,330.14 ","$3,167.00 ", N/A ,"$2,048.73 ","$2,048.73 ", N/A ,"$1,900.20 ","$2,691.95 ","$2,216.90 ", N/A ,"$3,008.65 ","$2,406.92 ","$2,375.25 ","$2,058.55 ","$2,691.95 ", N/A ,"$2,058.55 ","$2,058.55 ","$2,216.90 ", N/A , N/A , N/A ,"$1,330.14 ","$2,691.95 ", N/A ,"$2,913.64 ","$2,216.90 ","$1,606.30 ","$1,927.75 ","$1,928.70 ","$1,927.75 ","$2,188.40 ","$2,850.30 ","$2,205.82 ", N/A ,"$2,501.93 ", N/A ,"$1,900.20 ","$1,900.20 ", N/A ,"$1,900.20 ","$2,280.24 ","$1,963.54 ","$2,280.24 ","$2,280.24 ","$2,533.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200153,C1885,HC TURBO ELITE LASER CATH,272,1 ,"$5,337.00 ","$2,668.50 ","$2,241.54 ","$5,337.00 ", N/A ,"$3,452.51 ","$3,452.51 ", N/A ,"$3,202.20 ","$4,536.45 ","$3,735.90 ", N/A ,"$5,070.15 ","$4,056.12 ","$4,002.75 ","$3,469.05 ","$4,536.45 ", N/A ,"$3,469.05 ","$3,469.05 ","$3,735.90 ", N/A , N/A , N/A ,"$2,241.54 ","$4,536.45 ", N/A ,"$4,910.04 ","$3,735.90 ","$2,706.93 ","$3,248.63 ","$3,250.23 ","$3,248.63 ","$3,687.87 ","$4,803.30 ","$3,717.22 ", N/A ,"$4,216.23 ", N/A ,"$3,202.20 ","$3,202.20 ", N/A ,"$3,202.20 ","$3,842.64 ","$3,308.94 ","$3,842.64 ","$3,842.64 ","$4,269.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200163,C1892,HC EP PEEL AWAY SHEATH C1892,272,1 ,$140.00 ,$70.00 ,$58.80 ,$140.00 , N/A ,$90.57 ,$90.57 , N/A ,$84.00 ,$119.00 ,$98.00 , N/A ,$133.00 ,$106.40 ,$105.00 ,$91.00 ,$119.00 , N/A ,$91.00 ,$91.00 ,$98.00 , N/A , N/A , N/A ,$58.80 ,$119.00 , N/A ,$128.80 ,$98.00 ,$71.01 ,$85.22 ,$85.26 ,$85.22 ,$96.74 ,$126.00 ,$97.51 , N/A ,$110.60 , N/A ,$84.00 ,$84.00 , N/A ,$84.00 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$112.00 
ST NICHOLAS HOSPITAL - ACUTE,27200185,C1733,HC CRYOABLATION CATHETER,272,1 ,"$7,990.00 ","$3,995.00 ","$3,355.80 ","$7,990.00 ", N/A ,"$5,168.73 ","$5,168.73 ", N/A ,"$4,794.00 ","$6,791.50 ","$5,593.00 ", N/A ,"$7,590.50 ","$6,072.40 ","$5,992.50 ","$5,193.50 ","$6,791.50 ", N/A ,"$5,193.50 ","$5,193.50 ","$5,593.00 ", N/A , N/A , N/A ,"$3,355.80 ","$6,791.50 ", N/A ,"$7,350.80 ","$5,593.00 ","$4,052.53 ","$4,863.51 ","$4,865.91 ","$4,863.51 ","$5,521.09 ","$7,191.00 ","$5,565.04 ", N/A ,"$6,312.10 ", N/A ,"$4,794.00 ","$4,794.00 ", N/A ,"$4,794.00 ","$5,752.80 ","$4,953.80 ","$5,752.80 ","$5,752.80 ","$6,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,27200252,N/A,HC AORTIC EXTENDER,272,1 ,"$4,068.00 ","$2,034.00 ","$1,708.56 ","$4,068.00 ", N/A ,"$2,631.59 ","$2,631.59 ", N/A ,"$2,440.80 ","$3,457.80 ","$2,847.60 ", N/A ,"$3,864.60 ","$3,091.68 ","$3,051.00 ","$2,644.20 ","$3,457.80 ", N/A ,"$2,644.20 ","$2,644.20 ","$2,847.60 ", N/A , N/A , N/A ,"$1,708.56 ","$3,457.80 ", N/A ,"$3,742.56 ","$2,847.60 ","$2,063.29 ","$2,476.19 ","$2,477.41 ","$2,476.19 ","$2,810.99 ","$3,661.20 ","$2,833.36 ", N/A ,"$3,213.72 ", N/A ,"$2,440.80 ","$2,440.80 ", N/A ,"$2,440.80 ","$2,928.96 ","$2,522.16 ","$2,928.96 ","$2,928.96 ","$3,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,27200280,N/A,HC ASAHI CORSAIR MICROCATHETER,272,1 ,"$2,302.00 ","$1,151.00 ",$966.84 ,"$2,302.00 ", N/A ,"$1,489.16 ","$1,489.16 ", N/A ,"$1,381.20 ","$1,956.70 ","$1,611.40 ", N/A ,"$2,186.90 ","$1,749.52 ","$1,726.50 ","$1,496.30 ","$1,956.70 ", N/A ,"$1,496.30 ","$1,496.30 ","$1,611.40 ", N/A , N/A , N/A ,$966.84 ,"$1,956.70 ", N/A ,"$2,117.84 ","$1,611.40 ","$1,167.57 ","$1,401.23 ","$1,401.92 ","$1,401.23 ","$1,590.68 ","$2,071.80 ","$1,603.34 ", N/A ,"$1,818.58 ", N/A ,"$1,381.20 ","$1,381.20 ", N/A ,"$1,381.20 ","$1,657.44 ","$1,427.24 ","$1,657.44 ","$1,657.44 ","$1,841.60 "
ST NICHOLAS HOSPITAL - ACUTE,27200732,N/A,HC CAPSULE,272,1 ,$38.00 ,$19.00 ,$15.96 ,$38.00 , N/A ,$24.58 ,$24.58 , N/A ,$22.80 ,$32.30 ,$26.60 , N/A ,$36.10 ,$28.88 ,$28.50 ,$24.70 ,$32.30 , N/A ,$24.70 ,$24.70 ,$26.60 , N/A , N/A , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$26.47 , N/A ,$30.02 , N/A ,$22.80 ,$22.80 , N/A ,$22.80 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,27200781,C1730,HC CATH DECAPOLAR,272,1 ,"$1,365.00 ",$682.50 ,$573.30 ,"$1,365.00 ", N/A ,$883.02 ,$883.02 , N/A ,$819.00 ,"$1,160.25 ",$955.50 , N/A ,"$1,296.75 ","$1,037.40 ","$1,023.75 ",$887.25 ,"$1,160.25 ", N/A ,$887.25 ,$887.25 ,$955.50 , N/A , N/A , N/A ,$573.30 ,"$1,160.25 ", N/A ,"$1,255.80 ",$955.50 ,$692.33 ,$830.88 ,$831.29 ,$830.88 ,$943.22 ,"$1,228.50 ",$950.72 , N/A ,"$1,078.35 ", N/A ,$819.00 ,$819.00 , N/A ,$819.00 ,$982.80 ,$846.30 ,$982.80 ,$982.80 ,"$1,092.00 "
ST NICHOLAS HOSPITAL - ACUTE,27200828,N/A,HC CATH FOLEY TEMPERATURE PROBE 16FR,272,1 ,$122.00 ,$61.00 ,$51.24 ,$122.00 , N/A ,$78.92 ,$78.92 , N/A ,$73.20 ,$103.70 ,$85.40 , N/A ,$115.90 ,$92.72 ,$91.50 ,$79.30 ,$103.70 , N/A ,$79.30 ,$79.30 ,$85.40 , N/A , N/A , N/A ,$51.24 ,$103.70 , N/A ,$112.24 ,$85.40 ,$61.88 ,$74.26 ,$74.30 ,$74.26 ,$84.30 ,$109.80 ,$84.97 , N/A ,$96.38 , N/A ,$73.20 ,$73.20 , N/A ,$73.20 ,$87.84 ,$75.64 ,$87.84 ,$87.84 ,$97.60 
ST NICHOLAS HOSPITAL - ACUTE,27200990,N/A,HC COSCO CAR BED,272,1 ,$100.00 ,$50.00 ,$42.00 ,$100.00 , N/A ,$64.69 ,$64.69 , N/A ,$60.00 ,$85.00 ,$70.00 , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 , N/A , N/A , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 , N/A ,$79.00 , N/A ,$60.00 ,$60.00 , N/A ,$60.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,27201085,N/A,HC DISPOSABLE CLIPS USED  >4 EACH CLIP,272,1 ,$176.00 ,$88.00 ,$73.92 ,$176.00 , N/A ,$113.85 ,$113.85 , N/A ,$105.60 ,$149.60 ,$123.20 , N/A ,$167.20 ,$133.76 ,$132.00 ,$114.40 ,$149.60 , N/A ,$114.40 ,$114.40 ,$123.20 , N/A , N/A , N/A ,$73.92 ,$149.60 , N/A ,$161.92 ,$123.20 ,$89.27 ,$107.13 ,$107.18 ,$107.13 ,$121.62 ,$158.40 ,$122.58 , N/A ,$139.04 , N/A ,$105.60 ,$105.60 , N/A ,$105.60 ,$126.72 ,$109.12 ,$126.72 ,$126.72 ,$140.80 
ST NICHOLAS HOSPITAL - ACUTE,27201086,C1769,HC GUIDEWIRE,272,1 ,$291.00 ,$145.50 ,$122.22 ,$291.00 , N/A ,$188.25 ,$188.25 , N/A ,$174.60 ,$247.35 ,$203.70 , N/A ,$276.45 ,$221.16 ,$218.25 ,$189.15 ,$247.35 , N/A ,$189.15 ,$189.15 ,$203.70 , N/A , N/A , N/A ,$122.22 ,$247.35 , N/A ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$177.13 ,$201.08 ,$261.90 ,$202.68 , N/A ,$229.89 , N/A ,$174.60 ,$174.60 , N/A ,$174.60 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,27201164,N/A,HC MINNESOTA 4 LUMEN TUBE,272,1 ,$908.00 ,$454.00 ,$381.36 ,$908.00 , N/A ,$587.39 ,$587.39 , N/A ,$544.80 ,$771.80 ,$635.60 , N/A ,$862.60 ,$690.08 ,$681.00 ,$590.20 ,$771.80 , N/A ,$590.20 ,$590.20 ,$635.60 , N/A , N/A , N/A ,$381.36 ,$771.80 , N/A ,$835.36 ,$635.60 ,$460.54 ,$552.70 ,$552.97 ,$552.70 ,$627.43 ,$817.20 ,$632.42 , N/A ,$717.32 , N/A ,$544.80 ,$544.80 , N/A ,$544.80 ,$653.76 ,$562.96 ,$653.76 ,$653.76 ,$726.40 
ST NICHOLAS HOSPITAL - ACUTE,27201249,N/A,HC EPIDURAL TRAY CONTINUOUS,272,1 ,$116.00 ,$58.00 ,$48.72 ,$116.00 , N/A ,$75.04 ,$75.04 , N/A ,$69.60 ,$98.60 ,$81.20 , N/A ,$110.20 ,$88.16 ,$87.00 ,$75.40 ,$98.60 , N/A ,$75.40 ,$75.40 ,$81.20 , N/A , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$70.61 ,$80.16 ,$104.40 ,$80.79 , N/A ,$91.64 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,27201282,N/A,HC FEEDING TUBE,272,1 ,$58.00 ,$29.00 ,$24.36 ,$58.00 , N/A ,$37.52 ,$37.52 , N/A ,$34.80 ,$49.30 ,$40.60 , N/A ,$55.10 ,$44.08 ,$43.50 ,$37.70 ,$49.30 , N/A ,$37.70 ,$37.70 ,$40.60 , N/A , N/A , N/A ,$24.36 ,$49.30 , N/A ,$53.36 ,$40.60 ,$29.42 ,$35.30 ,$35.32 ,$35.30 ,$40.08 ,$52.20 ,$40.40 , N/A ,$45.82 , N/A ,$34.80 ,$34.80 , N/A ,$34.80 ,$41.76 ,$35.96 ,$41.76 ,$41.76 ,$46.40 
ST NICHOLAS HOSPITAL - ACUTE,27201340,N/A,SVG HC GELFOAM ANGIO AVITENE,272,1 ,$750.00 ,$375.00 ,$315.00 ,$750.00 , N/A ,$485.18 ,$485.18 , N/A ,$450.00 ,$637.50 ,$525.00 , N/A ,$712.50 ,$570.00 ,$562.50 ,$487.50 ,$637.50 , N/A ,$487.50 ,$487.50 ,$525.00 , N/A , N/A , N/A ,$315.00 ,$637.50 , N/A ,$690.00 ,$525.00 ,$380.40 ,$456.53 ,$456.75 ,$456.53 ,$518.25 ,$675.00 ,$522.38 , N/A ,$592.50 , N/A ,$450.00 ,$450.00 , N/A ,$450.00 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$600.00 
ST NICHOLAS HOSPITAL - ACUTE,27201423,N/A,HC HYSTEROSALPINGEOGRAM CATH,272,1 ,$152.00 ,$76.00 ,$63.84 ,$152.00 , N/A ,$98.33 ,$98.33 , N/A ,$91.20 ,$129.20 ,$106.40 , N/A ,$144.40 ,$115.52 ,$114.00 ,$98.80 ,$129.20 , N/A ,$98.80 ,$98.80 ,$106.40 , N/A , N/A , N/A ,$63.84 ,$129.20 , N/A ,$139.84 ,$106.40 ,$77.09 ,$92.52 ,$92.57 ,$92.52 ,$105.03 ,$136.80 ,$105.87 , N/A ,$120.08 , N/A ,$91.20 ,$91.20 , N/A ,$91.20 ,$109.44 ,$94.24 ,$109.44 ,$109.44 ,$121.60 
ST NICHOLAS HOSPITAL - ACUTE,27201424,N/A,HC IABP BALLOON,272,1 ,"$2,488.00 ","$1,244.00 ","$1,044.96 ","$2,488.00 ", N/A ,"$1,609.49 ","$1,609.49 ", N/A ,"$1,492.80 ","$2,114.80 ","$1,741.60 ", N/A ,"$2,363.60 ","$1,890.88 ","$1,866.00 ","$1,617.20 ","$2,114.80 ", N/A ,"$1,617.20 ","$1,617.20 ","$1,741.60 ", N/A , N/A , N/A ,"$1,044.96 ","$2,114.80 ", N/A ,"$2,288.96 ","$1,741.60 ","$1,261.91 ","$1,514.45 ","$1,515.19 ","$1,514.45 ","$1,719.21 ","$2,239.20 ","$1,732.89 ", N/A ,"$1,965.52 ", N/A ,"$1,492.80 ","$1,492.80 ", N/A ,"$1,492.80 ","$1,791.36 ","$1,542.56 ","$1,791.36 ","$1,791.36 ","$1,990.40 "
ST NICHOLAS HOSPITAL - ACUTE,27201450,N/A,HC INTRODUCER KIT,272,1 ,$186.00 ,$93.00 ,$78.12 ,$186.00 , N/A ,$120.32 ,$120.32 , N/A ,$111.60 ,$158.10 ,$130.20 , N/A ,$176.70 ,$141.36 ,$139.50 ,$120.90 ,$158.10 , N/A ,$120.90 ,$120.90 ,$130.20 , N/A , N/A , N/A ,$78.12 ,$158.10 , N/A ,$171.12 ,$130.20 ,$94.34 ,$113.22 ,$113.27 ,$113.22 ,$128.53 ,$167.40 ,$129.55 , N/A ,$146.94 , N/A ,$111.60 ,$111.60 , N/A ,$111.60 ,$133.92 ,$115.32 ,$133.92 ,$133.92 ,$148.80 
ST NICHOLAS HOSPITAL - ACUTE,27201473,N/A,SVG HC JEJUNOSTOMY TUBE,272,1 ,$291.00 ,$145.50 ,$122.22 ,$291.00 , N/A ,$188.25 ,$188.25 , N/A ,$174.60 ,$247.35 ,$203.70 , N/A ,$276.45 ,$221.16 ,$218.25 ,$189.15 ,$247.35 , N/A ,$189.15 ,$189.15 ,$203.70 , N/A , N/A , N/A ,$122.22 ,$247.35 , N/A ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$177.13 ,$201.08 ,$261.90 ,$202.68 , N/A ,$229.89 , N/A ,$174.60 ,$174.60 , N/A ,$174.60 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,27201527,N/A,HC KIT NASAL BLIMP(RHINO ROCKET),272,1 ,$87.00 ,$43.50 ,$36.54 ,$87.00 , N/A ,$56.28 ,$56.28 , N/A ,$52.20 ,$73.95 ,$60.90 , N/A ,$82.65 ,$66.12 ,$65.25 ,$56.55 ,$73.95 , N/A ,$56.55 ,$56.55 ,$60.90 , N/A , N/A , N/A ,$36.54 ,$73.95 , N/A ,$80.04 ,$60.90 ,$44.13 ,$52.96 ,$52.98 ,$52.96 ,$60.12 ,$78.30 ,$60.60 , N/A ,$68.73 , N/A ,$52.20 ,$52.20 , N/A ,$52.20 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,27201640,N/A,HC MANUAL HAND BREAST PUMP,272,1 ,$52.00 ,$26.00 ,$21.84 ,$52.00 , N/A ,$33.64 ,$33.64 , N/A ,$31.20 ,$44.20 ,$36.40 , N/A ,$49.40 ,$39.52 ,$39.00 ,$33.80 ,$44.20 , N/A ,$33.80 ,$33.80 ,$36.40 , N/A , N/A , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$31.65 ,$35.93 ,$46.80 ,$36.22 , N/A ,$41.08 , N/A ,$31.20 ,$31.20 , N/A ,$31.20 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,27201644,N/A,HC DOUBLE BREAST PUMP KT,272,1 ,$106.00 ,$53.00 ,$44.52 ,$106.00 , N/A ,$68.57 ,$68.57 , N/A ,$63.60 ,$90.10 ,$74.20 , N/A ,$100.70 ,$80.56 ,$79.50 ,$68.90 ,$90.10 , N/A ,$68.90 ,$68.90 ,$74.20 , N/A , N/A , N/A ,$44.52 ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$73.83 , N/A ,$83.74 , N/A ,$63.60 ,$63.60 , N/A ,$63.60 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,27201729,N/A,HC NEOPUFF CIRCUIT AND MASK,272,1 ,$61.00 ,$30.50 ,$25.62 ,$61.00 , N/A ,$39.46 ,$39.46 , N/A ,$36.60 ,$51.85 ,$42.70 , N/A ,$57.95 ,$46.36 ,$45.75 ,$39.65 ,$51.85 , N/A ,$39.65 ,$39.65 ,$42.70 , N/A , N/A , N/A ,$25.62 ,$51.85 , N/A ,$56.12 ,$42.70 ,$30.94 ,$37.13 ,$37.15 ,$37.13 ,$42.15 ,$54.90 ,$42.49 , N/A ,$48.19 , N/A ,$36.60 ,$36.60 , N/A ,$36.60 ,$43.92 ,$37.82 ,$43.92 ,$43.92 ,$48.80 
ST NICHOLAS HOSPITAL - ACUTE,27201768,N/A,HC OUTBACK LTD CATHETER,272,1 ,"$4,522.00 ","$2,261.00 ","$1,899.24 ","$4,522.00 ", N/A ,"$2,925.28 ","$2,925.28 ", N/A ,"$2,713.20 ","$3,843.70 ","$3,165.40 ", N/A ,"$4,295.90 ","$3,436.72 ","$3,391.50 ","$2,939.30 ","$3,843.70 ", N/A ,"$2,939.30 ","$2,939.30 ","$3,165.40 ", N/A , N/A , N/A ,"$1,899.24 ","$3,843.70 ", N/A ,"$4,160.24 ","$3,165.40 ","$2,293.56 ","$2,752.54 ","$2,753.90 ","$2,752.54 ","$3,124.70 ","$4,069.80 ","$3,149.57 ", N/A ,"$3,572.38 ", N/A ,"$2,713.20 ","$2,713.20 ", N/A ,"$2,713.20 ","$3,255.84 ","$2,803.64 ","$3,255.84 ","$3,255.84 ","$3,617.60 "
ST NICHOLAS HOSPITAL - ACUTE,27201829,N/A,HC PELVIC BINDER,272,1 ,$609.00 ,$304.50 ,$255.78 ,$609.00 , N/A ,$393.96 ,$393.96 , N/A ,$365.40 ,$517.65 ,$426.30 , N/A ,$578.55 ,$462.84 ,$456.75 ,$395.85 ,$517.65 , N/A ,$395.85 ,$395.85 ,$426.30 , N/A , N/A , N/A ,$255.78 ,$517.65 , N/A ,$560.28 ,$426.30 ,$308.88 ,$370.70 ,$370.88 ,$370.70 ,$420.82 ,$548.10 ,$424.17 , N/A ,$481.11 , N/A ,$365.40 ,$365.40 , N/A ,$365.40 ,$438.48 ,$377.58 ,$438.48 ,$438.48 ,$487.20 
ST NICHOLAS HOSPITAL - ACUTE,27202002,N/A,HC SCD SLEEVE KNEE,272,1 ,$174.00 ,$87.00 ,$73.08 ,$174.00 , N/A ,$112.56 ,$112.56 , N/A ,$104.40 ,$147.90 ,$121.80 , N/A ,$165.30 ,$132.24 ,$130.50 ,$113.10 ,$147.90 , N/A ,$113.10 ,$113.10 ,$121.80 , N/A , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$105.91 ,$120.23 ,$156.60 ,$121.19 , N/A ,$137.46 , N/A ,$104.40 ,$104.40 , N/A ,$104.40 ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$139.20 
ST NICHOLAS HOSPITAL - ACUTE,27202013,N/A,HC SEALANT FLOSEAL MATRIX,272,1 ,$294.00 ,$147.00 ,$123.48 ,$294.00 , N/A ,$190.19 ,$190.19 , N/A ,$176.40 ,$249.90 ,$205.80 , N/A ,$279.30 ,$223.44 ,$220.50 ,$191.10 ,$249.90 , N/A ,$191.10 ,$191.10 ,$205.80 , N/A , N/A , N/A ,$123.48 ,$249.90 , N/A ,$270.48 ,$205.80 ,$149.12 ,$178.96 ,$179.05 ,$178.96 ,$203.15 ,$264.60 ,$204.77 , N/A ,$232.26 , N/A ,$176.40 ,$176.40 , N/A ,$176.40 ,$211.68 ,$182.28 ,$211.68 ,$211.68 ,$235.20 
ST NICHOLAS HOSPITAL - ACUTE,27202140,N/A,HC STENT PANCREATIC PLASTIC,272,1 ,$331.00 ,$165.50 ,$139.02 ,$331.00 , N/A ,$214.12 ,$214.12 , N/A ,$198.60 ,$281.35 ,$231.70 , N/A ,$314.45 ,$251.56 ,$248.25 ,$215.15 ,$281.35 , N/A ,$215.15 ,$215.15 ,$231.70 , N/A , N/A , N/A ,$139.02 ,$281.35 , N/A ,$304.52 ,$231.70 ,$167.88 ,$201.48 ,$201.58 ,$201.48 ,$228.72 ,$297.90 ,$230.54 , N/A ,$261.49 , N/A ,$198.60 ,$198.60 , N/A ,$198.60 ,$238.32 ,$205.22 ,$238.32 ,$238.32 ,$264.80 
ST NICHOLAS HOSPITAL - ACUTE,27202180,N/A,HC SUPPLEMENTAL NURSING SYSTEM,272,1 ,$54.00 ,$27.00 ,$22.68 ,$54.00 , N/A ,$34.93 ,$34.93 , N/A ,$32.40 ,$45.90 ,$37.80 , N/A ,$51.30 ,$41.04 ,$40.50 ,$35.10 ,$45.90 , N/A ,$35.10 ,$35.10 ,$37.80 , N/A , N/A , N/A ,$22.68 ,$45.90 , N/A ,$49.68 ,$37.80 ,$27.39 ,$32.87 ,$32.89 ,$32.87 ,$37.31 ,$48.60 ,$37.61 , N/A ,$42.66 , N/A ,$32.40 ,$32.40 , N/A ,$32.40 ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$43.20 
ST NICHOLAS HOSPITAL - ACUTE,27203025,N/A,HC EMBOLIZATION COIL,272,1 ,$303.00 ,$151.50 ,$127.26 ,$303.00 , N/A ,$196.01 ,$196.01 , N/A ,$181.80 ,$257.55 ,$212.10 , N/A ,$287.85 ,$230.28 ,$227.25 ,$196.95 ,$257.55 , N/A ,$196.95 ,$196.95 ,$212.10 , N/A , N/A , N/A ,$127.26 ,$257.55 , N/A ,$278.76 ,$212.10 ,$153.68 ,$184.44 ,$184.53 ,$184.44 ,$209.37 ,$272.70 ,$211.04 , N/A ,$239.37 , N/A ,$181.80 ,$181.80 , N/A ,$181.80 ,$218.16 ,$187.86 ,$218.16 ,$218.16 ,$242.40 
ST NICHOLAS HOSPITAL - ACUTE,27203043,N/A,HC TRANSESOPHAGEAL SUPPLIES,272,1 ,$417.00 ,$208.50 ,$175.14 ,$417.00 , N/A ,$269.76 ,$269.76 , N/A ,$250.20 ,$354.45 ,$291.90 , N/A ,$396.15 ,$316.92 ,$312.75 ,$271.05 ,$354.45 , N/A ,$271.05 ,$271.05 ,$291.90 , N/A , N/A , N/A ,$175.14 ,$354.45 , N/A ,$383.64 ,$291.90 ,$211.50 ,$253.83 ,$253.95 ,$253.83 ,$288.15 ,$375.30 ,$290.44 , N/A ,$329.43 , N/A ,$250.20 ,$250.20 , N/A ,$250.20 ,$300.24 ,$258.54 ,$300.24 ,$300.24 ,$333.60 
ST NICHOLAS HOSPITAL - ACUTE,27203094,N/A,HC SPECIAL NEEDS FEEDER,272,1 ,$36.00 ,$18.00 ,$15.12 ,$36.00 , N/A ,$23.29 ,$23.29 , N/A ,$21.60 ,$30.60 ,$25.20 , N/A ,$34.20 ,$27.36 ,$27.00 ,$23.40 ,$30.60 , N/A ,$23.40 ,$23.40 ,$25.20 , N/A , N/A , N/A ,$15.12 ,$30.60 , N/A ,$33.12 ,$25.20 ,$18.26 ,$21.91 ,$21.92 ,$21.91 ,$24.88 ,$32.40 ,$25.07 , N/A ,$28.44 , N/A ,$21.60 ,$21.60 , N/A ,$21.60 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,27203112,C1885,HC TURBO TANDEM LASER CATHETER,272,1 ,"$7,859.00 ","$3,929.50 ","$3,300.78 ","$7,859.00 ", N/A ,"$5,083.99 ","$5,083.99 ", N/A ,"$4,715.40 ","$6,680.15 ","$5,501.30 ", N/A ,"$7,466.05 ","$5,972.84 ","$5,894.25 ","$5,108.35 ","$6,680.15 ", N/A ,"$5,108.35 ","$5,108.35 ","$5,501.30 ", N/A , N/A , N/A ,"$3,300.78 ","$6,680.15 ", N/A ,"$7,230.28 ","$5,501.30 ","$3,986.08 ","$4,783.77 ","$4,786.13 ","$4,783.77 ","$5,430.57 ","$7,073.10 ","$5,473.79 ", N/A ,"$6,208.61 ", N/A ,"$4,715.40 ","$4,715.40 ", N/A ,"$4,715.40 ","$5,658.48 ","$4,872.58 ","$5,658.48 ","$5,658.48 ","$6,287.20 "
ST NICHOLAS HOSPITAL - ACUTE,27203113,C1766,HC EP STEERABLE NON PEEL AWAY SHEATH C1766,272,1 ,"$2,543.00 ","$1,271.50 ","$1,068.06 ","$2,543.00 ", N/A ,"$1,645.07 ","$1,645.07 ", N/A ,"$1,525.80 ","$2,161.55 ","$1,780.10 ", N/A ,"$2,415.85 ","$1,932.68 ","$1,907.25 ","$1,652.95 ","$2,161.55 ", N/A ,"$1,652.95 ","$1,652.95 ","$1,780.10 ", N/A , N/A , N/A ,"$1,068.06 ","$2,161.55 ", N/A ,"$2,339.56 ","$1,780.10 ","$1,289.81 ","$1,547.92 ","$1,548.69 ","$1,547.92 ","$1,757.21 ","$2,288.70 ","$1,771.20 ", N/A ,"$2,008.97 ", N/A ,"$1,525.80 ","$1,525.80 ", N/A ,"$1,525.80 ","$1,830.96 ","$1,576.66 ","$1,830.96 ","$1,830.96 ","$2,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,27203115,C1731,HC HALO/LASSO CATHETER,272,1 ,"$2,774.00 ","$1,387.00 ","$1,165.08 ","$2,774.00 ", N/A ,"$1,794.50 ","$1,794.50 ", N/A ,"$1,664.40 ","$2,357.90 ","$1,941.80 ", N/A ,"$2,635.30 ","$2,108.24 ","$2,080.50 ","$1,803.10 ","$2,357.90 ", N/A ,"$1,803.10 ","$1,803.10 ","$1,941.80 ", N/A , N/A , N/A ,"$1,165.08 ","$2,357.90 ", N/A ,"$2,552.08 ","$1,941.80 ","$1,406.97 ","$1,688.53 ","$1,689.37 ","$1,688.53 ","$1,916.83 ","$2,496.60 ","$1,932.09 ", N/A ,"$2,191.46 ", N/A ,"$1,664.40 ","$1,664.40 ", N/A ,"$1,664.40 ","$1,997.28 ","$1,719.88 ","$1,997.28 ","$1,997.28 ","$2,219.20 "
ST NICHOLAS HOSPITAL - ACUTE,27203116,N/A,HC NAV-X PATCHES,272,1 ,"$2,201.00 ","$1,100.50 ",$924.42 ,"$2,201.00 ", N/A ,"$1,423.83 ","$1,423.83 ", N/A ,"$1,320.60 ","$1,870.85 ","$1,540.70 ", N/A ,"$2,090.95 ","$1,672.76 ","$1,650.75 ","$1,430.65 ","$1,870.85 ", N/A ,"$1,430.65 ","$1,430.65 ","$1,540.70 ", N/A , N/A , N/A ,$924.42 ,"$1,870.85 ", N/A ,"$2,024.92 ","$1,540.70 ","$1,116.35 ","$1,339.75 ","$1,340.41 ","$1,339.75 ","$1,520.89 ","$1,980.90 ","$1,533.00 ", N/A ,"$1,738.79 ", N/A ,"$1,320.60 ","$1,320.60 ", N/A ,"$1,320.60 ","$1,584.72 ","$1,364.62 ","$1,584.72 ","$1,584.72 ","$1,760.80 "
ST NICHOLAS HOSPITAL - ACUTE,27203169,C1769,HC TRUEPATH,272,1 ,"$4,161.00 ","$2,080.50 ","$1,747.62 ","$4,161.00 ", N/A ,"$2,691.75 ","$2,691.75 ", N/A ,"$2,496.60 ","$3,536.85 ","$2,912.70 ", N/A ,"$3,952.95 ","$3,162.36 ","$3,120.75 ","$2,704.65 ","$3,536.85 ", N/A ,"$2,704.65 ","$2,704.65 ","$2,912.70 ", N/A , N/A , N/A ,"$1,747.62 ","$3,536.85 ", N/A ,"$3,828.12 ","$2,912.70 ","$2,110.46 ","$2,532.80 ","$2,534.05 ","$2,532.80 ","$2,875.25 ","$3,744.90 ","$2,898.14 ", N/A ,"$3,287.19 ", N/A ,"$2,496.60 ","$2,496.60 ", N/A ,"$2,496.60 ","$2,995.92 ","$2,579.82 ","$2,995.92 ","$2,995.92 ","$3,328.80 "
ST NICHOLAS HOSPITAL - ACUTE,27203225,N/A,HC MRI BREAST BIOPSY KIT,272,1 ,"$1,335.00 ",$667.50 ,$560.70 ,"$1,335.00 ", N/A ,$863.61 ,$863.61 , N/A ,$801.00 ,"$1,134.75 ",$934.50 , N/A ,"$1,268.25 ","$1,014.60 ","$1,001.25 ",$867.75 ,"$1,134.75 ", N/A ,$867.75 ,$867.75 ,$934.50 , N/A , N/A , N/A ,$560.70 ,"$1,134.75 ", N/A ,"$1,228.20 ",$934.50 ,$677.11 ,$812.61 ,$813.02 ,$812.61 ,$922.49 ,"$1,201.50 ",$929.83 , N/A ,"$1,054.65 ", N/A ,$801.00 ,$801.00 , N/A ,$801.00 ,$961.20 ,$827.70 ,$961.20 ,$961.20 ,"$1,068.00 "
ST NICHOLAS HOSPITAL - ACUTE,27203287,N/A,HC MISC SUPPLY CATH LAB TIER 1,272,1 ,$116.00 ,$58.00 ,$48.72 ,$116.00 , N/A ,$75.04 ,$75.04 , N/A ,$69.60 ,$98.60 ,$81.20 , N/A ,$110.20 ,$88.16 ,$87.00 ,$75.40 ,$98.60 , N/A ,$75.40 ,$75.40 ,$81.20 , N/A , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$70.61 ,$80.16 ,$104.40 ,$80.79 , N/A ,$91.64 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,27203288,N/A,HC MISC SUPPLY CATH LAB TIER 2,272,1 ,$232.00 ,$116.00 ,$97.44 ,$232.00 , N/A ,$150.08 ,$150.08 , N/A ,$139.20 ,$197.20 ,$162.40 , N/A ,$220.40 ,$176.32 ,$174.00 ,$150.80 ,$197.20 , N/A ,$150.80 ,$150.80 ,$162.40 , N/A , N/A , N/A ,$97.44 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$141.22 ,$160.31 ,$208.80 ,$161.59 , N/A ,$183.28 , N/A ,$139.20 ,$139.20 , N/A ,$139.20 ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$185.60 
ST NICHOLAS HOSPITAL - ACUTE,27203289,N/A,HC MISC SUPPLY CATH LAB TIER 3,272,1 ,$406.00 ,$203.00 ,$170.52 ,$406.00 , N/A ,$262.64 ,$262.64 , N/A ,$243.60 ,$345.10 ,$284.20 , N/A ,$385.70 ,$308.56 ,$304.50 ,$263.90 ,$345.10 , N/A ,$263.90 ,$263.90 ,$284.20 , N/A , N/A , N/A ,$170.52 ,$345.10 , N/A ,$373.52 ,$284.20 ,$205.92 ,$247.13 ,$247.25 ,$247.13 ,$280.55 ,$365.40 ,$282.78 , N/A ,$320.74 , N/A ,$243.60 ,$243.60 , N/A ,$243.60 ,$292.32 ,$251.72 ,$292.32 ,$292.32 ,$324.80 
ST NICHOLAS HOSPITAL - ACUTE,27203292,C1732,HC THERMACOOL ABLATION CATH,272,1 ,"$3,544.00 ","$1,772.00 ","$1,488.48 ","$3,544.00 ", N/A ,"$2,292.61 ","$2,292.61 ", N/A ,"$2,126.40 ","$3,012.40 ","$2,480.80 ", N/A ,"$3,366.80 ","$2,693.44 ","$2,658.00 ","$2,303.60 ","$3,012.40 ", N/A ,"$2,303.60 ","$2,303.60 ","$2,480.80 ", N/A , N/A , N/A ,"$1,488.48 ","$3,012.40 ", N/A ,"$3,260.48 ","$2,480.80 ","$1,797.52 ","$2,157.23 ","$2,158.30 ","$2,157.23 ","$2,448.90 ","$3,189.60 ","$2,468.40 ", N/A ,"$2,799.76 ", N/A ,"$2,126.40 ","$2,126.40 ", N/A ,"$2,126.40 ","$2,551.68 ","$2,197.28 ","$2,551.68 ","$2,551.68 ","$2,835.20 "
ST NICHOLAS HOSPITAL - ACUTE,27203294,C1893,HC EP NON PEEL AWAY SHEATH C1893,272,1 ,"$2,543.00 ","$1,271.50 ","$1,068.06 ","$2,543.00 ", N/A ,"$1,645.07 ","$1,645.07 ", N/A ,"$1,525.80 ","$2,161.55 ","$1,780.10 ", N/A ,"$2,415.85 ","$1,932.68 ","$1,907.25 ","$1,652.95 ","$2,161.55 ", N/A ,"$1,652.95 ","$1,652.95 ","$1,780.10 ", N/A , N/A , N/A ,"$1,068.06 ","$2,161.55 ", N/A ,"$2,339.56 ","$1,780.10 ","$1,289.81 ","$1,547.92 ","$1,548.69 ","$1,547.92 ","$1,757.21 ","$2,288.70 ","$1,771.20 ", N/A ,"$2,008.97 ", N/A ,"$1,525.80 ","$1,525.80 ", N/A ,"$1,525.80 ","$1,830.96 ","$1,576.66 ","$1,830.96 ","$1,830.96 ","$2,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,27203400,C1725,HC BALLOON TIER 1,272,1 ,$694.00 ,$347.00 ,$291.48 ,$694.00 , N/A ,$448.95 ,$448.95 , N/A ,$416.40 ,$589.90 ,$485.80 , N/A ,$659.30 ,$527.44 ,$520.50 ,$451.10 ,$589.90 , N/A ,$451.10 ,$451.10 ,$485.80 , N/A , N/A , N/A ,$291.48 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$422.44 ,$479.55 ,$624.60 ,$483.37 , N/A ,$548.26 , N/A ,$416.40 ,$416.40 , N/A ,$416.40 ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$555.20 
ST NICHOLAS HOSPITAL - ACUTE,27203401,C1725,HC BALLOON TIER 2,272,1 ,"$1,040.00 ",$520.00 ,$436.80 ,"$1,040.00 ", N/A ,$672.78 ,$672.78 , N/A ,$624.00 ,$884.00 ,$728.00 , N/A ,$988.00 ,$790.40 ,$780.00 ,$676.00 ,$884.00 , N/A ,$676.00 ,$676.00 ,$728.00 , N/A , N/A , N/A ,$436.80 ,$884.00 , N/A ,$956.80 ,$728.00 ,$527.49 ,$633.05 ,$633.36 ,$633.05 ,$718.64 ,$936.00 ,$724.36 , N/A ,$821.60 , N/A ,$624.00 ,$624.00 , N/A ,$624.00 ,$748.80 ,$644.80 ,$748.80 ,$748.80 ,$832.00 
ST NICHOLAS HOSPITAL - ACUTE,27203402,C1725,HC BALLOON TIER 3,272,1 ,"$2,080.00 ","$1,040.00 ",$873.60 ,"$2,080.00 ", N/A ,"$1,345.55 ","$1,345.55 ", N/A ,"$1,248.00 ","$1,768.00 ","$1,456.00 ", N/A ,"$1,976.00 ","$1,580.80 ","$1,560.00 ","$1,352.00 ","$1,768.00 ", N/A ,"$1,352.00 ","$1,352.00 ","$1,456.00 ", N/A , N/A , N/A ,$873.60 ,"$1,768.00 ", N/A ,"$1,913.60 ","$1,456.00 ","$1,054.98 ","$1,266.10 ","$1,266.72 ","$1,266.10 ","$1,437.28 ","$1,872.00 ","$1,448.72 ", N/A ,"$1,643.20 ", N/A ,"$1,248.00 ","$1,248.00 ", N/A ,"$1,248.00 ","$1,497.60 ","$1,289.60 ","$1,497.60 ","$1,497.60 ","$1,664.00 "
ST NICHOLAS HOSPITAL - ACUTE,27203403,C1769,HC GUIDEWIRE TIER 1,272,1 ,$116.00 ,$58.00 ,$48.72 ,$116.00 , N/A ,$75.04 ,$75.04 , N/A ,$69.60 ,$98.60 ,$81.20 , N/A ,$110.20 ,$88.16 ,$87.00 ,$75.40 ,$98.60 , N/A ,$75.40 ,$75.40 ,$81.20 , N/A , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$70.61 ,$80.16 ,$104.40 ,$80.79 , N/A ,$91.64 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,27203404,C1769,HC GUIDEWIRE TIER 2,272,1 ,$313.00 ,$156.50 ,$131.46 ,$313.00 , N/A ,$202.48 ,$202.48 , N/A ,$187.80 ,$266.05 ,$219.10 , N/A ,$297.35 ,$237.88 ,$234.75 ,$203.45 ,$266.05 , N/A ,$203.45 ,$203.45 ,$219.10 , N/A , N/A , N/A ,$131.46 ,$266.05 , N/A ,$287.96 ,$219.10 ,$158.75 ,$190.52 ,$190.62 ,$190.52 ,$216.28 ,$281.70 ,$218.00 , N/A ,$247.27 , N/A ,$187.80 ,$187.80 , N/A ,$187.80 ,$225.36 ,$194.06 ,$225.36 ,$225.36 ,$250.40 
ST NICHOLAS HOSPITAL - ACUTE,27203405,C1769,HC GUIDEWIRE TIER 3,272,1 ,"$1,064.00 ",$532.00 ,$446.88 ,"$1,064.00 ", N/A ,$688.30 ,$688.30 , N/A ,$638.40 ,$904.40 ,$744.80 , N/A ,"$1,010.80 ",$808.64 ,$798.00 ,$691.60 ,$904.40 , N/A ,$691.60 ,$691.60 ,$744.80 , N/A , N/A , N/A ,$446.88 ,$904.40 , N/A ,$978.88 ,$744.80 ,$539.66 ,$647.66 ,$647.98 ,$647.66 ,$735.22 ,$957.60 ,$741.08 , N/A ,$840.56 , N/A ,$638.40 ,$638.40 , N/A ,$638.40 ,$766.08 ,$659.68 ,$766.08 ,$766.08 ,$851.20 
ST NICHOLAS HOSPITAL - ACUTE,27203406,C1887,HC CATHETER TIER 1,272,1 ,$59.00 ,$29.50 ,$24.78 ,$59.00 , N/A ,$38.17 ,$38.17 , N/A ,$35.40 ,$50.15 ,$41.30 , N/A ,$56.05 ,$44.84 ,$44.25 ,$38.35 ,$50.15 , N/A ,$38.35 ,$38.35 ,$41.30 , N/A , N/A , N/A ,$24.78 ,$50.15 , N/A ,$54.28 ,$41.30 ,$29.92 ,$35.91 ,$35.93 ,$35.91 ,$40.77 ,$53.10 ,$41.09 , N/A ,$46.61 , N/A ,$35.40 ,$35.40 , N/A ,$35.40 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$47.20 
ST NICHOLAS HOSPITAL - ACUTE,27203407,C1887,HC CATHETER TIER 2,272,1 ,$232.00 ,$116.00 ,$97.44 ,$232.00 , N/A ,$150.08 ,$150.08 , N/A ,$139.20 ,$197.20 ,$162.40 , N/A ,$220.40 ,$176.32 ,$174.00 ,$150.80 ,$197.20 , N/A ,$150.80 ,$150.80 ,$162.40 , N/A , N/A , N/A ,$97.44 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$141.22 ,$160.31 ,$208.80 ,$161.59 , N/A ,$183.28 , N/A ,$139.20 ,$139.20 , N/A ,$139.20 ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$185.60 
ST NICHOLAS HOSPITAL - ACUTE,27203408,C1887,HC CATHETER TIER 3,272,1 ,$464.00 ,$232.00 ,$194.88 ,$464.00 , N/A ,$300.16 ,$300.16 , N/A ,$278.40 ,$394.40 ,$324.80 , N/A ,$440.80 ,$352.64 ,$348.00 ,$301.60 ,$394.40 , N/A ,$301.60 ,$301.60 ,$324.80 , N/A , N/A , N/A ,$194.88 ,$394.40 , N/A ,$426.88 ,$324.80 ,$235.34 ,$282.44 ,$282.58 ,$282.44 ,$320.62 ,$417.60 ,$323.18 , N/A ,$366.56 , N/A ,$278.40 ,$278.40 , N/A ,$278.40 ,$334.08 ,$287.68 ,$334.08 ,$334.08 ,$371.20 
ST NICHOLAS HOSPITAL - ACUTE,27203409,C1887,HC CATHETER TIER 4,272,1 ,"$1,098.00 ",$549.00 ,$461.16 ,"$1,098.00 ", N/A ,$710.30 ,$710.30 , N/A ,$658.80 ,$933.30 ,$768.60 , N/A ,"$1,043.10 ",$834.48 ,$823.50 ,$713.70 ,$933.30 , N/A ,$713.70 ,$713.70 ,$768.60 , N/A , N/A , N/A ,$461.16 ,$933.30 , N/A ,"$1,010.16 ",$768.60 ,$556.91 ,$668.35 ,$668.68 ,$668.35 ,$758.72 ,$988.20 ,$764.76 , N/A ,$867.42 , N/A ,$658.80 ,$658.80 , N/A ,$658.80 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$878.40 
ST NICHOLAS HOSPITAL - ACUTE,27203410,C1894,HC DIAGNOSTIC SHEATH TIER 1,272,1 ,$116.00 ,$58.00 ,$48.72 ,$116.00 , N/A ,$75.04 ,$75.04 , N/A ,$69.60 ,$98.60 ,$81.20 , N/A ,$110.20 ,$88.16 ,$87.00 ,$75.40 ,$98.60 , N/A ,$75.40 ,$75.40 ,$81.20 , N/A , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$70.61 ,$80.16 ,$104.40 ,$80.79 , N/A ,$91.64 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,27203411,C1894,HC DIAGNOSTIC SHEATH TIER 2,272,1 ,$232.00 ,$116.00 ,$97.44 ,$232.00 , N/A ,$150.08 ,$150.08 , N/A ,$139.20 ,$197.20 ,$162.40 , N/A ,$220.40 ,$176.32 ,$174.00 ,$150.80 ,$197.20 , N/A ,$150.80 ,$150.80 ,$162.40 , N/A , N/A , N/A ,$97.44 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$141.22 ,$160.31 ,$208.80 ,$161.59 , N/A ,$183.28 , N/A ,$139.20 ,$139.20 , N/A ,$139.20 ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$185.60 
ST NICHOLAS HOSPITAL - ACUTE,27203412,C1894,HC DIAGNOSTIC SHEATH TIER 3,272,1 ,$694.00 ,$347.00 ,$291.48 ,$694.00 , N/A ,$448.95 ,$448.95 , N/A ,$416.40 ,$589.90 ,$485.80 , N/A ,$659.30 ,$527.44 ,$520.50 ,$451.10 ,$589.90 , N/A ,$451.10 ,$451.10 ,$485.80 , N/A , N/A , N/A ,$291.48 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$422.44 ,$479.55 ,$624.60 ,$483.37 , N/A ,$548.26 , N/A ,$416.40 ,$416.40 , N/A ,$416.40 ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$555.20 
ST NICHOLAS HOSPITAL - ACUTE,27203413,C1894,HC DIAGNOSTIC SHEATH TIER 4,272,1 ,"$1,387.00 ",$693.50 ,$582.54 ,"$1,387.00 ", N/A ,$897.25 ,$897.25 , N/A ,$832.20 ,"$1,178.95 ",$970.90 , N/A ,"$1,317.65 ","$1,054.12 ","$1,040.25 ",$901.55 ,"$1,178.95 ", N/A ,$901.55 ,$901.55 ,$970.90 , N/A , N/A , N/A ,$582.54 ,"$1,178.95 ", N/A ,"$1,276.04 ",$970.90 ,$703.49 ,$844.27 ,$844.68 ,$844.27 ,$958.42 ,"$1,248.30 ",$966.05 , N/A ,"$1,095.73 ", N/A ,$832.20 ,$832.20 , N/A ,$832.20 ,$998.64 ,$859.94 ,$998.64 ,$998.64 ,"$1,109.60 "
ST NICHOLAS HOSPITAL - ACUTE,27203414,C1725,HC POLAR CATH KIT,272,1 ,"$3,456.00 ","$1,728.00 ","$1,451.52 ","$3,456.00 ", N/A ,"$2,235.69 ","$2,235.69 ", N/A ,"$2,073.60 ","$2,937.60 ","$2,419.20 ", N/A ,"$3,283.20 ","$2,626.56 ","$2,592.00 ","$2,246.40 ","$2,937.60 ", N/A ,"$2,246.40 ","$2,246.40 ","$2,419.20 ", N/A , N/A , N/A ,"$1,451.52 ","$2,937.60 ", N/A ,"$3,179.52 ","$2,419.20 ","$1,752.88 ","$2,103.67 ","$2,104.70 ","$2,103.67 ","$2,388.10 ","$3,110.40 ","$2,407.10 ", N/A ,"$2,730.24 ", N/A ,"$2,073.60 ","$2,073.60 ", N/A ,"$2,073.60 ","$2,488.32 ","$2,142.72 ","$2,488.32 ","$2,488.32 ","$2,764.80 "
ST NICHOLAS HOSPITAL - ACUTE,27203415,C1725,HC BALLOON TIER 4,272,1 ,"$3,235.00 ","$1,617.50 ","$1,358.70 ","$3,235.00 ", N/A ,"$2,092.72 ","$2,092.72 ", N/A ,"$1,941.00 ","$2,749.75 ","$2,264.50 ", N/A ,"$3,073.25 ","$2,458.60 ","$2,426.25 ","$2,102.75 ","$2,749.75 ", N/A ,"$2,102.75 ","$2,102.75 ","$2,264.50 ", N/A , N/A , N/A ,"$1,358.70 ","$2,749.75 ", N/A ,"$2,976.20 ","$2,264.50 ","$1,640.79 ","$1,969.14 ","$1,970.12 ","$1,969.14 ","$2,235.39 ","$2,911.50 ","$2,253.18 ", N/A ,"$2,555.65 ", N/A ,"$1,941.00 ","$1,941.00 ", N/A ,"$1,941.00 ","$2,329.20 ","$2,005.70 ","$2,329.20 ","$2,329.20 ","$2,588.00 "
ST NICHOLAS HOSPITAL - ACUTE,27203503,N/A,HC CANNULA NASAL HEATED HI FLOW,272,1 ,$104.00 ,$52.00 ,$43.68 ,$104.00 , N/A ,$67.28 ,$67.28 , N/A ,$62.40 ,$88.40 ,$72.80 , N/A ,$98.80 ,$79.04 ,$78.00 ,$67.60 ,$88.40 , N/A ,$67.60 ,$67.60 ,$72.80 , N/A , N/A , N/A ,$43.68 ,$88.40 , N/A ,$95.68 ,$72.80 ,$52.75 ,$63.30 ,$63.34 ,$63.30 ,$71.86 ,$93.60 ,$72.44 , N/A ,$82.16 , N/A ,$62.40 ,$62.40 , N/A ,$62.40 ,$74.88 ,$64.48 ,$74.88 ,$74.88 ,$83.20 
ST NICHOLAS HOSPITAL - ACUTE,27205265,N/A,HC SYSTEM DIRECT VISUALIZATION SPYSCOPE,272,1 ,"$7,031.00 ","$3,515.50 ","$2,953.02 ","$7,031.00 ", N/A ,"$4,548.35 ","$4,548.35 ", N/A ,"$4,218.60 ","$5,976.35 ","$4,921.70 ", N/A ,"$6,679.45 ","$5,343.56 ","$5,273.25 ","$4,570.15 ","$5,976.35 ", N/A ,"$4,570.15 ","$4,570.15 ","$4,921.70 ", N/A , N/A , N/A ,"$2,953.02 ","$5,976.35 ", N/A ,"$6,468.52 ","$4,921.70 ","$3,566.12 ","$4,279.77 ","$4,281.88 ","$4,279.77 ","$4,858.42 ","$6,327.90 ","$4,897.09 ", N/A ,"$5,554.49 ", N/A ,"$4,218.60 ","$4,218.60 ", N/A ,"$4,218.60 ","$5,062.32 ","$4,359.22 ","$5,062.32 ","$5,062.32 ","$5,624.80 "
ST NICHOLAS HOSPITAL - ACUTE,27205430,N/A,HC NEO PUFF TUBING,272,1 ,$35.00 ,$17.50 ,$14.70 ,$35.00 , N/A ,$22.64 ,$22.64 , N/A ,$21.00 ,$29.75 ,$24.50 , N/A ,$33.25 ,$26.60 ,$26.25 ,$22.75 ,$29.75 , N/A ,$22.75 ,$22.75 ,$24.50 , N/A , N/A , N/A ,$14.70 ,$29.75 , N/A ,$32.20 ,$24.50 ,$17.75 ,$21.30 ,$21.32 ,$21.30 ,$24.19 ,$31.50 ,$24.38 , N/A ,$27.65 , N/A ,$21.00 ,$21.00 , N/A ,$21.00 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,27205487,N/A,HC BOTTLE DRAINAGE SAFETY VAC,272,1 ,$39.00 ,$19.50 ,$16.38 ,$39.00 , N/A ,$25.23 ,$25.23 , N/A ,$23.40 ,$33.15 ,$27.30 , N/A ,$37.05 ,$29.64 ,$29.25 ,$25.35 ,$33.15 , N/A ,$25.35 ,$25.35 ,$27.30 , N/A , N/A , N/A ,$16.38 ,$33.15 , N/A ,$35.88 ,$27.30 ,$19.78 ,$23.74 ,$23.75 ,$23.74 ,$26.95 ,$35.10 ,$27.16 , N/A ,$30.81 , N/A ,$23.40 ,$23.40 , N/A ,$23.40 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,27272900,S2900,HC SURGERY ROBOTIC TECHNICAL SYSTEM,272,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,27400003,L0120,HC CERVICAL COLLAR,274,1 ,$69.00 ,$34.50 ,$28.98 ,$81.27 , N/A , N/A , N/A ,$36.12 ,$41.40 ,$58.65 ,$48.30 , N/A ,$65.55 ,$52.44 ,$51.75 , N/A ,$58.65 ,$36.12 , N/A ,$44.85 ,$48.30 , N/A ,$36.12 ,$36.12 ,$28.98 ,$58.65 ,$81.27 ,$63.48 ,$48.30 ,$35.00 ,$42.00 ,$42.02 ,$42.00 ,$47.68 ,$62.10 ,$48.06 ,$36.48 ,$54.51 , N/A , N/A , N/A ,$36.12 , N/A ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,27400004,L0140,HC CERVICAL COLLAR ADJUSTABLE,274,1 ,$198.00 ,$99.00 ,$83.16 ,$202.77 , N/A , N/A , N/A ,$90.12 ,$118.80 ,$168.30 ,$138.60 , N/A ,$188.10 ,$150.48 ,$148.50 , N/A ,$168.30 ,$90.12 , N/A ,$128.70 ,$138.60 , N/A ,$90.12 ,$90.12 ,$83.16 ,$168.30 ,$202.77 ,$182.16 ,$138.60 ,$100.43 ,$120.52 ,$120.58 ,$120.52 ,$136.82 ,$178.20 ,$137.91 ,$91.02 ,$156.42 , N/A , N/A , N/A ,$90.12 , N/A ,$142.56 ,$122.76 ,$142.56 ,$142.56 ,$158.40 
ST NICHOLAS HOSPITAL - ACUTE,27400005,L0150,HC CERVICAL COLLAR-STIFF NECK,274,1 ,$127.00 ,$63.50 ,$53.34 ,$260.42 , N/A , N/A , N/A ,$115.74 ,$76.20 ,$107.95 ,$88.90 , N/A ,$120.65 ,$96.52 ,$95.25 , N/A ,$107.95 ,$115.74 , N/A ,$82.55 ,$88.90 , N/A ,$115.74 ,$115.74 ,$53.34 ,$107.95 ,$260.42 ,$116.84 ,$88.90 ,$64.41 ,$77.30 ,$77.34 ,$77.30 ,$87.76 ,$114.30 ,$88.46 ,$116.90 ,$100.33 , N/A , N/A , N/A ,$115.74 , N/A ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$101.60 
ST NICHOLAS HOSPITAL - ACUTE,27400006,L0150,HC PHILADELPHA COLLAR,274,1 ,$127.00 ,$63.50 ,$53.34 ,$260.42 , N/A , N/A , N/A ,$115.74 ,$76.20 ,$107.95 ,$88.90 , N/A ,$120.65 ,$96.52 ,$95.25 , N/A ,$107.95 ,$115.74 , N/A ,$82.55 ,$88.90 , N/A ,$115.74 ,$115.74 ,$53.34 ,$107.95 ,$260.42 ,$116.84 ,$88.90 ,$64.41 ,$77.30 ,$77.34 ,$77.30 ,$87.76 ,$114.30 ,$88.46 ,$116.90 ,$100.33 , N/A , N/A , N/A ,$115.74 , N/A ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$101.60 
ST NICHOLAS HOSPITAL - ACUTE,27400010,L0172,HC CERVICAL COLLAR TWO PIECE,274,1 ,$291.00 ,$145.50 ,$122.22 ,$399.91 , N/A , N/A , N/A ,$177.74 ,$174.60 ,$247.35 ,$203.70 , N/A ,$276.45 ,$221.16 ,$218.25 , N/A ,$247.35 ,$177.74 , N/A ,$189.15 ,$203.70 , N/A ,$177.74 ,$177.74 ,$122.22 ,$247.35 ,$399.91 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$177.13 ,$201.08 ,$261.90 ,$202.68 ,$179.52 ,$229.89 , N/A , N/A , N/A ,$177.74 , N/A ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,27400011,L0220,HC RIBBELT,274,1 ,$174.00 ,$87.00 ,$73.08 ,$323.62 , N/A , N/A , N/A ,$143.83 ,$104.40 ,$147.90 ,$121.80 , N/A ,$165.30 ,$132.24 ,$130.50 , N/A ,$147.90 ,$143.83 , N/A ,$113.10 ,$121.80 , N/A ,$143.83 ,$143.83 ,$73.08 ,$147.90 ,$323.62 ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$105.91 ,$120.23 ,$156.60 ,$121.19 ,$145.27 ,$137.46 , N/A , N/A , N/A ,$143.83 , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$139.20 
ST NICHOLAS HOSPITAL - ACUTE,27400019,L1830,HC KNEE IMMOBILIZER,274,1 ,$123.00 ,$61.50 ,$51.66 ,$185.13 , N/A , N/A , N/A ,$82.28 ,$73.80 ,$104.55 ,$86.10 , N/A ,$116.85 ,$93.48 ,$92.25 , N/A ,$104.55 ,$82.28 , N/A ,$79.95 ,$86.10 , N/A ,$82.28 ,$82.28 ,$51.66 ,$104.55 ,$185.13 ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$74.87 ,$84.99 ,$110.70 ,$85.67 ,$83.10 ,$97.17 , N/A , N/A , N/A ,$82.28 , N/A ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,27400028,L1830,HC KNEE IMMOBILIZER FIT  AND  ADJ,274,1 ,$193.00 ,$96.50 ,$81.06 ,$216.63 , N/A , N/A , N/A ,$96.28 ,$115.80 ,$164.05 ,$135.10 , N/A ,$183.35 ,$146.68 ,$144.75 , N/A ,$164.05 ,$96.28 , N/A ,$125.45 ,$135.10 , N/A ,$96.28 ,$96.28 ,$81.06 ,$164.05 ,$216.63 ,$177.56 ,$135.10 ,$97.89 ,$117.48 ,$117.54 ,$117.48 ,$133.36 ,$173.70 ,$134.42 ,$97.24 ,$152.47 , N/A , N/A , N/A ,$96.28 , N/A ,$138.96 ,$119.66 ,$138.96 ,$138.96 ,$154.40 
ST NICHOLAS HOSPITAL - ACUTE,27400035,L3650,HC CLAVICLE STRAP/FIT  AND  ADJ,274,1 ,$157.00 ,$78.50 ,$65.94 ,$195.19 , N/A , N/A , N/A ,$86.75 ,$94.20 ,$133.45 ,$109.90 , N/A ,$149.15 ,$119.32 ,$117.75 , N/A ,$133.45 ,$86.75 , N/A ,$102.05 ,$109.90 , N/A ,$86.75 ,$86.75 ,$65.94 ,$133.45 ,$195.19 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$95.57 ,$108.49 ,$141.30 ,$109.35 ,$87.62 ,$124.03 , N/A , N/A , N/A ,$86.75 , N/A ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,27400037,L4397,HC SPLINT ANKLE FOOT ORTHOSIS STATIC,274,1 ,$117.00 ,$58.50 ,$49.14 ,$371.34 , N/A , N/A , N/A ,$165.04 ,$70.20 ,$99.45 ,$81.90 , N/A ,$111.15 ,$88.92 ,$87.75 , N/A ,$99.45 ,$165.04 , N/A ,$76.05 ,$81.90 , N/A ,$165.04 ,$165.04 ,$49.14 ,$99.45 ,$371.34 ,$107.64 ,$81.90 ,$59.34 ,$71.22 ,$71.25 ,$71.22 ,$80.85 ,$105.30 ,$81.49 ,$166.69 ,$92.43 , N/A , N/A , N/A ,$165.04 , N/A ,$84.24 ,$72.54 ,$84.24 ,$84.24 ,$93.60 
ST NICHOLAS HOSPITAL - ACUTE,27400039,L3670,HC SHOULDER IMMOBILIZER FIT  AND  ADJ,274,1 ,$157.00 ,$78.50 ,$65.94 ,$267.14 , N/A , N/A , N/A ,$118.73 ,$94.20 ,$133.45 ,$109.90 , N/A ,$149.15 ,$119.32 ,$117.75 , N/A ,$133.45 ,$118.73 , N/A ,$102.05 ,$109.90 , N/A ,$118.73 ,$118.73 ,$65.94 ,$133.45 ,$267.14 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$95.57 ,$108.49 ,$141.30 ,$109.35 ,$119.92 ,$124.03 , N/A , N/A , N/A ,$118.73 , N/A ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,27400040,L3763,HC SPLINT FOREARM-STATIC,274,1 ,$752.00 ,$376.00 ,$315.84 ,"$1,631.75 ", N/A , N/A , N/A ,$725.22 ,$451.20 ,$639.20 ,$526.40 , N/A ,$714.40 ,$571.52 ,$564.00 , N/A ,$639.20 ,$725.22 , N/A ,$488.80 ,$526.40 , N/A ,$725.22 ,$725.22 ,$315.84 ,$639.20 ,"$1,631.75 ",$691.84 ,$526.40 ,$381.41 ,$457.74 ,$457.97 ,$457.74 ,$519.63 ,$676.80 ,$523.77 ,$732.47 ,$594.08 , N/A , N/A , N/A ,$725.22 , N/A ,$541.44 ,$466.24 ,$541.44 ,$541.44 ,$601.60 
ST NICHOLAS HOSPITAL - ACUTE,27400043,L3807,HC FUNCT POSITION HAND SPLT,274,1 ,$230.00 ,$115.00 ,$96.60 ,$535.64 , N/A , N/A , N/A ,$238.06 ,$138.00 ,$195.50 ,$161.00 , N/A ,$218.50 ,$174.80 ,$172.50 , N/A ,$195.50 ,$238.06 , N/A ,$149.50 ,$161.00 , N/A ,$238.06 ,$238.06 ,$96.60 ,$195.50 ,$535.64 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$240.44 ,$181.70 , N/A , N/A , N/A ,$238.06 , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,27400044,L3908,HC COCK UP WRIST SPLINT/FIT  AND  ADJ,274,1 ,$155.00 ,$77.50 ,$65.10 ,$196.47 , N/A , N/A , N/A ,$87.32 ,$93.00 ,$131.75 ,$108.50 , N/A ,$147.25 ,$117.80 ,$116.25 , N/A ,$131.75 ,$87.32 , N/A ,$100.75 ,$108.50 , N/A ,$87.32 ,$87.32 ,$65.10 ,$131.75 ,$196.47 ,$142.60 ,$108.50 ,$78.62 ,$94.35 ,$94.40 ,$94.35 ,$107.11 ,$139.50 ,$107.96 ,$88.19 ,$122.45 , N/A , N/A , N/A ,$87.32 , N/A ,$111.60 ,$96.10 ,$111.60 ,$111.60 ,$124.00 
ST NICHOLAS HOSPITAL - ACUTE,27400049,L3913,HC HAND FINGER SPLINT INCL FITTING,274,1 ,$507.00 ,$253.50 ,$212.94 ,$696.20 , N/A , N/A , N/A ,$309.42 ,$304.20 ,$430.95 ,$354.90 , N/A ,$481.65 ,$385.32 ,$380.25 , N/A ,$430.95 ,$309.42 , N/A ,$329.55 ,$354.90 , N/A ,$309.42 ,$309.42 ,$212.94 ,$430.95 ,$696.20 ,$466.44 ,$354.90 ,$257.15 ,$308.61 ,$308.76 ,$308.61 ,$350.34 ,$456.30 ,$353.13 ,$312.51 ,$400.53 , N/A , N/A , N/A ,$309.42 , N/A ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$405.60 
ST NICHOLAS HOSPITAL - ACUTE,27400051,L3919,HC SPLINT HAND STATIC,274,1 ,$285.00 ,$142.50 ,$119.70 ,$596.30 , N/A , N/A , N/A ,$265.02 ,$171.00 ,$242.25 ,$199.50 , N/A ,$270.75 ,$216.60 ,$213.75 , N/A ,$242.25 ,$265.02 , N/A ,$185.25 ,$199.50 , N/A ,$265.02 ,$265.02 ,$119.70 ,$242.25 ,$596.30 ,$262.20 ,$199.50 ,$144.55 ,$173.48 ,$173.57 ,$173.48 ,$196.94 ,$256.50 ,$198.50 ,$267.67 ,$225.15 , N/A , N/A , N/A ,$265.02 , N/A ,$205.20 ,$176.70 ,$205.20 ,$205.20 ,$228.00 
ST NICHOLAS HOSPITAL - ACUTE,27400052,L3921,HC SPLINT HAND DYNAMIC,274,1 ,$387.00 ,$193.50 ,$162.54 ,$729.32 , N/A , N/A , N/A ,$324.14 ,$232.20 ,$328.95 ,$270.90 , N/A ,$367.65 ,$294.12 ,$290.25 , N/A ,$328.95 ,$324.14 , N/A ,$251.55 ,$270.90 , N/A ,$324.14 ,$324.14 ,$162.54 ,$328.95 ,$729.32 ,$356.04 ,$270.90 ,$196.29 ,$235.57 ,$235.68 ,$235.57 ,$267.42 ,$348.30 ,$269.55 ,$327.38 ,$305.73 , N/A , N/A , N/A ,$324.14 , N/A ,$278.64 ,$239.94 ,$278.64 ,$278.64 ,$309.60 
ST NICHOLAS HOSPITAL - ACUTE,27400061,L3931,HC SPLINT DORSAL BLOCKING,274,1 ,$208.00 ,$104.00 ,$87.36 ,$453.94 , N/A , N/A , N/A ,$201.75 ,$124.80 ,$176.80 ,$145.60 , N/A ,$197.60 ,$158.08 ,$156.00 , N/A ,$176.80 ,$201.75 , N/A ,$135.20 ,$145.60 , N/A ,$201.75 ,$201.75 ,$87.36 ,$176.80 ,$453.94 ,$191.36 ,$145.60 ,$105.50 ,$126.61 ,$126.67 ,$126.61 ,$143.73 ,$187.20 ,$144.87 ,$203.77 ,$164.32 , N/A , N/A , N/A ,$201.75 , N/A ,$149.76 ,$128.96 ,$149.76 ,$149.76 ,$166.40 
ST NICHOLAS HOSPITAL - ACUTE,27400063,L4350,HC AIR CAST/FIT  AND  ADJ,274,1 ,$198.00 ,$99.00 ,$83.16 ,$272.84 , N/A , N/A , N/A ,$121.26 ,$118.80 ,$168.30 ,$138.60 , N/A ,$188.10 ,$150.48 ,$148.50 , N/A ,$168.30 ,$121.26 , N/A ,$128.70 ,$138.60 , N/A ,$121.26 ,$121.26 ,$83.16 ,$168.30 ,$272.84 ,$182.16 ,$138.60 ,$100.43 ,$120.52 ,$120.58 ,$120.52 ,$136.82 ,$178.20 ,$137.91 ,$122.47 ,$156.42 , N/A , N/A , N/A ,$121.26 , N/A ,$142.56 ,$122.76 ,$142.56 ,$142.56 ,$158.40 
ST NICHOLAS HOSPITAL - ACUTE,27400064,L4360,HC AIRWALKER SPLINT INCL FITTING,274,1 ,$522.00 ,$261.00 ,$219.24 ,$726.57 , N/A , N/A , N/A ,$322.92 ,$313.20 ,$443.70 ,$365.40 , N/A ,$495.90 ,$396.72 ,$391.50 , N/A ,$443.70 ,$322.92 , N/A ,$339.30 ,$365.40 , N/A ,$322.92 ,$322.92 ,$219.24 ,$443.70 ,$726.57 ,$480.24 ,$365.40 ,$264.76 ,$317.74 ,$317.90 ,$317.74 ,$360.70 ,$469.80 ,$363.57 ,$326.15 ,$412.38 , N/A , N/A , N/A ,$322.92 , N/A ,$375.84 ,$323.64 ,$375.84 ,$375.84 ,$417.60 
ST NICHOLAS HOSPITAL - ACUTE,27400065,L4386,HC ROM WALKER BOOT FIT  AND  ADJ,274,1 ,$324.00 ,$162.00 ,$136.08 ,$446.90 , N/A , N/A , N/A ,$198.62 ,$194.40 ,$275.40 ,$226.80 , N/A ,$307.80 ,$246.24 ,$243.00 , N/A ,$275.40 ,$198.62 , N/A ,$210.60 ,$226.80 , N/A ,$198.62 ,$198.62 ,$136.08 ,$275.40 ,$446.90 ,$298.08 ,$226.80 ,$164.33 ,$197.22 ,$197.32 ,$197.22 ,$223.88 ,$291.60 ,$225.67 ,$200.61 ,$255.96 , N/A , N/A , N/A ,$198.62 , N/A ,$233.28 ,$200.88 ,$233.28 ,$233.28 ,$259.20 
ST NICHOLAS HOSPITAL - ACUTE,27400066,L4398,HC DROP FOOT BRACE (AFO),274,1 ,$162.00 ,$81.00 ,$68.04 ,$219.58 , N/A , N/A , N/A ,$97.59 ,$97.20 ,$137.70 ,$113.40 , N/A ,$153.90 ,$123.12 ,$121.50 , N/A ,$137.70 ,$97.59 , N/A ,$105.30 ,$113.40 , N/A ,$97.59 ,$97.59 ,$68.04 ,$137.70 ,$219.58 ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$98.61 ,$111.94 ,$145.80 ,$112.83 ,$98.57 ,$127.98 , N/A , N/A , N/A ,$97.59 , N/A ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,27400069,L8501,HC PASSEY MUIR VALVE,274,1 ,$278.00 ,$139.00 ,$116.76 ,$353.63 , N/A , N/A , N/A ,$157.17 ,$166.80 ,$236.30 ,$194.60 , N/A ,$264.10 ,$211.28 ,$208.50 , N/A ,$236.30 ,$157.17 , N/A ,$180.70 ,$194.60 , N/A ,$157.17 ,$157.17 ,$116.76 ,$236.30 ,$353.63 ,$255.76 ,$194.60 ,$141.00 ,$169.22 ,$169.30 ,$169.22 ,$192.10 ,$250.20 ,$193.63 ,$158.74 ,$219.62 , N/A , N/A , N/A ,$157.17 , N/A ,$200.16 ,$172.36 ,$200.16 ,$200.16 ,$222.40 
ST NICHOLAS HOSPITAL - ACUTE,27400080,L3935,HC THUMB SPLINT FIT AND ADJUST,274,1 ,$232.00 ,$116.00 ,$97.44 ,$486.20 , N/A , N/A , N/A ,$216.09 ,$139.20 ,$197.20 ,$162.40 , N/A ,$220.40 ,$176.32 ,$174.00 , N/A ,$197.20 ,$216.09 , N/A ,$150.80 ,$162.40 , N/A ,$216.09 ,$216.09 ,$97.44 ,$197.20 ,$486.20 ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$141.22 ,$160.31 ,$208.80 ,$161.59 ,$218.25 ,$183.28 , N/A , N/A , N/A ,$216.09 , N/A ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$185.60 
ST NICHOLAS HOSPITAL - ACUTE,27400092,L3927,HC FINGER SPLINT STATIC FIT/ADJUST,274,1 ,$67.00 ,$33.50 ,$28.14 ,$90.65 , N/A , N/A , N/A ,$40.29 ,$40.20 ,$56.95 ,$46.90 , N/A ,$63.65 ,$50.92 ,$50.25 , N/A ,$56.95 ,$40.29 , N/A ,$43.55 ,$46.90 , N/A ,$40.29 ,$40.29 ,$28.14 ,$56.95 ,$90.65 ,$61.64 ,$46.90 ,$33.98 ,$40.78 ,$40.80 ,$40.78 ,$46.30 ,$60.30 ,$46.67 ,$40.69 ,$52.93 , N/A , N/A , N/A ,$40.29 , N/A ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,27400109,L3702,HC ORTHOSIS ELBOW W/O JOINTS CUSTOM,274,1 ,$476.00 ,$238.00 ,$199.92 ,$713.27 , N/A , N/A , N/A ,$317.01 ,$285.60 ,$404.60 ,$333.20 , N/A ,$452.20 ,$361.76 ,$357.00 , N/A ,$404.60 ,$317.01 , N/A ,$309.40 ,$333.20 , N/A ,$317.01 ,$317.01 ,$199.92 ,$404.60 ,$713.27 ,$437.92 ,$333.20 ,$241.43 ,$289.74 ,$289.88 ,$289.74 ,$328.92 ,$428.40 ,$331.53 ,$320.18 ,$376.04 , N/A , N/A , N/A ,$317.01 , N/A ,$342.72 ,$295.12 ,$342.72 ,$342.72 ,$380.80 
ST NICHOLAS HOSPITAL - ACUTE,27400110,L3808,HC ORTHOSIS WHFO RIGID W/O JOINTS,274,1 ,$662.00 ,$331.00 ,$278.04 ,$913.55 , N/A , N/A , N/A ,$406.02 ,$397.20 ,$562.70 ,$463.40 , N/A ,$628.90 ,$503.12 ,$496.50 , N/A ,$562.70 ,$406.02 , N/A ,$430.30 ,$463.40 , N/A ,$406.02 ,$406.02 ,$278.04 ,$562.70 ,$913.55 ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$402.96 ,$457.44 ,$595.80 ,$461.08 ,$410.08 ,$522.98 , N/A , N/A , N/A ,$406.02 , N/A ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$529.60 
ST NICHOLAS HOSPITAL - ACUTE,27400112,L3906,HC ORTHOSIS WHO GAUNTLET MOLDED CUSTOM,274,1 ,$932.00 ,$466.00 ,$391.44 ,"$1,295.24 ", N/A , N/A , N/A ,$575.66 ,$559.20 ,$792.20 ,$652.40 , N/A ,$885.40 ,$708.32 ,$699.00 , N/A ,$792.20 ,$575.66 , N/A ,$605.80 ,$652.40 , N/A ,$575.66 ,$575.66 ,$391.44 ,$792.20 ,"$1,295.24 ",$857.44 ,$652.40 ,$472.71 ,$567.31 ,$567.59 ,$567.31 ,$644.01 ,$838.80 ,$649.14 ,$581.42 ,$736.28 , N/A , N/A , N/A ,$575.66 , N/A ,$671.04 ,$577.84 ,$671.04 ,$671.04 ,$745.60 
ST NICHOLAS HOSPITAL - ACUTE,27400133,L4360,HC BOOT WALKING,274,1 ,$206.00 ,$103.00 ,$86.52 ,$584.37 , N/A , N/A , N/A ,$259.72 ,$123.60 ,$175.10 ,$144.20 , N/A ,$195.70 ,$156.56 ,$154.50 , N/A ,$175.10 ,$259.72 , N/A ,$133.90 ,$144.20 , N/A ,$259.72 ,$259.72 ,$86.52 ,$175.10 ,$584.37 ,$189.52 ,$144.20 ,$104.48 ,$125.39 ,$125.45 ,$125.39 ,$142.35 ,$185.40 ,$143.48 ,$262.32 ,$162.74 , N/A , N/A , N/A ,$259.72 , N/A ,$148.32 ,$127.72 ,$148.32 ,$148.32 ,$164.80 
ST NICHOLAS HOSPITAL - ACUTE,27400220,L3806,HC WRIST/HAND/FINGER ORTHOSIS W/JOINT CUSTOM FAB FIT AND ADJUST,274,1 ,$838.00 ,$419.00 ,$351.96 ,"$1,162.13 ", N/A , N/A , N/A ,$516.50 ,$502.80 ,$712.30 ,$586.60 , N/A ,$796.10 ,$636.88 ,$628.50 , N/A ,$712.30 ,$516.50 , N/A ,$544.70 ,$586.60 , N/A ,$516.50 ,$516.50 ,$351.96 ,$712.30 ,"$1,162.13 ",$770.96 ,$586.60 ,$425.03 ,$510.09 ,$510.34 ,$510.09 ,$579.06 ,$754.20 ,$583.67 ,$521.67 ,$662.02 , N/A , N/A , N/A ,$516.50 , N/A ,$603.36 ,$519.56 ,$603.36 ,$603.36 ,$670.40 
ST NICHOLAS HOSPITAL - ACUTE,27400221,L3809,HC WRIST/HAND/FINGER ORTHOSIS W/O JOINT PREFAB,274,1 ,$476.00 ,$238.00 ,$199.92 ,$646.34 , N/A , N/A , N/A ,$287.26 ,$285.60 ,$404.60 ,$333.20 , N/A ,$452.20 ,$361.76 ,$357.00 , N/A ,$404.60 ,$287.26 , N/A ,$309.40 ,$333.20 , N/A ,$287.26 ,$287.26 ,$199.92 ,$404.60 ,$646.34 ,$437.92 ,$333.20 ,$241.43 ,$289.74 ,$289.88 ,$289.74 ,$328.92 ,$428.40 ,$331.53 ,$290.13 ,$376.04 , N/A , N/A , N/A ,$287.26 , N/A ,$342.72 ,$295.12 ,$342.72 ,$342.72 ,$380.80 
ST NICHOLAS HOSPITAL - ACUTE,27400222,L3933,HC FINGER ORTHOSIS W/O JOINTS CUSTOM FAB FIT AND ADJUST,274,1 ,$404.00 ,$202.00 ,$169.68 ,$550.57 , N/A , N/A , N/A ,$244.70 ,$242.40 ,$343.40 ,$282.80 , N/A ,$383.80 ,$307.04 ,$303.00 , N/A ,$343.40 ,$244.70 , N/A ,$262.60 ,$282.80 , N/A ,$244.70 ,$244.70 ,$169.68 ,$343.40 ,$550.57 ,$371.68 ,$282.80 ,$204.91 ,$245.91 ,$246.04 ,$245.91 ,$279.16 ,$363.60 ,$281.39 ,$247.15 ,$319.16 , N/A , N/A , N/A ,$244.70 , N/A ,$290.88 ,$250.48 ,$290.88 ,$290.88 ,$323.20 
ST NICHOLAS HOSPITAL - ACUTE,27400223,L3807,HC RADIAL NERVE PALSY SPLINT,274,1 ,$230.00 ,$115.00 ,$96.60 ,$535.64 , N/A , N/A , N/A ,$238.06 ,$138.00 ,$195.50 ,$161.00 , N/A ,$218.50 ,$174.80 ,$172.50 , N/A ,$195.50 ,$238.06 , N/A ,$149.50 ,$161.00 , N/A ,$238.06 ,$238.06 ,$96.60 ,$195.50 ,$535.64 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$240.44 ,$181.70 , N/A , N/A , N/A ,$238.06 , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,27500020,C1898,HC MSB PACEMAKER LEAD,275,1 ,$685.00 ,$342.50 ,$287.70 ,$685.00 , N/A , N/A , N/A , N/A ,$411.00 ,$582.25 ,$479.50 , N/A ,$650.75 ,$520.60 ,$513.75 , N/A ,$582.25 , N/A , N/A ,$445.25 ,$479.50 , N/A , N/A , N/A ,$287.70 ,$582.25 , N/A ,$630.20 ,$479.50 ,$347.43 ,$416.96 ,$417.17 ,$416.96 ,$473.34 ,$616.50 ,$477.10 , N/A ,$541.15 , N/A , N/A , N/A , N/A , N/A ,$493.20 ,$424.70 ,$493.20 ,$493.20 ,$548.00 
ST NICHOLAS HOSPITAL - ACUTE,27500022,C1900,HC MSB LEAD FOR CS,275,1 ,"$3,512.00 ","$1,756.00 ","$1,475.04 ","$3,512.00 ", N/A ,"$1,747.57 ","$1,747.57 ", N/A ,"$2,107.20 ","$2,985.20 ","$2,458.40 ", N/A ,"$3,336.40 ","$2,669.12 ","$2,634.00 ","$1,756.00 ","$2,985.20 ", N/A ,"$1,756.00 ","$2,282.80 ","$2,458.40 ", N/A , N/A , N/A ,"$1,475.04 ","$2,985.20 ", N/A ,"$3,231.04 ","$2,458.40 ","$1,781.29 ","$2,137.75 ","$2,138.81 ","$2,137.75 ","$2,426.79 ","$3,160.80 ","$2,446.11 ", N/A ,"$2,774.48 ", N/A , N/A , N/A , N/A , N/A ,"$2,528.64 ","$2,177.44 ","$2,528.64 ","$2,528.64 ","$2,809.60 "
ST NICHOLAS HOSPITAL - ACUTE,27500023,C1786,HC MSB PACER SINGLE,275,1 ,"$6,031.00 ","$3,015.50 ","$2,533.02 ","$6,031.00 ", N/A ,"$3,001.03 ","$3,001.03 ", N/A ,"$3,618.60 ","$5,126.35 ","$4,221.70 ", N/A ,"$5,729.45 ","$4,583.56 ","$4,523.25 ","$3,015.50 ","$5,126.35 ", N/A ,"$3,015.50 ","$3,920.15 ","$4,221.70 ", N/A , N/A , N/A ,"$2,533.02 ","$5,126.35 ", N/A ,"$5,548.52 ","$4,221.70 ","$3,058.92 ","$3,671.07 ","$3,672.88 ","$3,671.07 ","$4,167.42 ","$5,427.90 ","$4,200.59 ", N/A ,"$4,764.49 ", N/A ,"$3,015.50 ","$3,015.50 ", N/A ,"$3,015.50 ","$4,342.32 ","$3,739.22 ","$4,342.32 ","$4,342.32 ","$4,824.80 "
ST NICHOLAS HOSPITAL - ACUTE,27500024,C1785,HC MSB PACER DUAL,275,1 ,"$8,111.00 ","$4,055.50 ","$3,406.62 ","$8,111.00 ", N/A ,"$4,036.03 ","$4,036.03 ", N/A ,"$4,866.60 ","$6,894.35 ","$5,677.70 ", N/A ,"$7,705.45 ","$6,164.36 ","$6,083.25 ","$4,055.50 ","$6,894.35 ", N/A ,"$4,055.50 ","$5,272.15 ","$5,677.70 ", N/A , N/A , N/A ,"$3,406.62 ","$6,894.35 ", N/A ,"$7,462.12 ","$5,677.70 ","$4,113.90 ","$4,937.17 ","$4,939.60 ","$4,937.17 ","$5,604.70 ","$7,299.90 ","$5,649.31 ", N/A ,"$6,407.69 ", N/A ,"$4,055.50 ","$4,055.50 ", N/A ,"$4,055.50 ","$5,839.92 ","$5,028.82 ","$5,839.92 ","$5,839.92 ","$6,488.80 "
ST NICHOLAS HOSPITAL - ACUTE,27500025,C2621,HC MSB PACER BI-V,275,1 ,"$14,142.00 ","$7,071.00 ","$5,939.64 ","$14,142.00 ", N/A ,"$7,037.06 ","$7,037.06 ", N/A ,"$8,485.20 ","$12,020.70 ","$9,899.40 ", N/A ,"$13,434.90 ","$10,747.92 ","$10,606.50 ","$7,071.00 ","$12,020.70 ", N/A ,"$7,071.00 ","$9,192.30 ","$9,899.40 ", N/A , N/A , N/A ,"$5,939.64 ","$12,020.70 ", N/A ,"$13,010.64 ","$9,899.40 ","$7,172.82 ","$8,608.24 ","$8,612.48 ","$8,608.24 ","$9,772.12 ","$12,727.80 ","$9,849.90 ", N/A ,"$11,172.18 ", N/A ,"$7,071.00 ","$7,071.00 ", N/A ,"$7,071.00 ","$10,182.24 ","$8,768.04 ","$10,182.24 ","$10,182.24 ","$11,313.60 "
ST NICHOLAS HOSPITAL - ACUTE,27500026,C1722,HC MSB ICD SINGLE,275,1 ,"$24,960.00 ","$12,480.00 ","$10,483.20 ","$24,960.00 ", N/A ,"$12,420.10 ","$12,420.10 ", N/A ,"$14,976.00 ","$21,216.00 ","$17,472.00 ", N/A ,"$23,712.00 ","$18,969.60 ","$18,720.00 ","$12,480.00 ","$21,216.00 ", N/A ,"$12,480.00 ","$16,224.00 ","$17,472.00 ", N/A , N/A , N/A ,"$10,483.20 ","$21,216.00 ", N/A ,"$22,963.20 ","$17,472.00 ","$12,659.71 ","$15,193.15 ","$15,200.64 ","$15,193.15 ","$17,247.36 ","$22,464.00 ","$17,384.64 ", N/A ,"$19,718.40 ", N/A ,"$12,480.00 ","$12,480.00 ", N/A ,"$12,480.00 ","$17,971.20 ","$15,475.20 ","$17,971.20 ","$17,971.20 ","$19,968.00 "
ST NICHOLAS HOSPITAL - ACUTE,27500027,C1721,HC MSB ICD DUAL,275,1 ,"$28,085.00 ","$14,042.50 ","$11,795.70 ","$28,085.00 ", N/A ,"$13,975.10 ","$13,975.10 ", N/A ,"$16,851.00 ","$23,872.25 ","$19,659.50 ", N/A ,"$26,680.75 ","$21,344.60 ","$21,063.75 ","$14,042.50 ","$23,872.25 ", N/A ,"$14,042.50 ","$18,255.25 ","$19,659.50 ", N/A , N/A , N/A ,"$11,795.70 ","$23,872.25 ", N/A ,"$25,838.20 ","$19,659.50 ","$14,244.71 ","$17,095.34 ","$17,103.77 ","$17,095.34 ","$19,406.74 ","$25,276.50 ","$19,561.20 ", N/A ,"$22,187.15 ", N/A ,"$14,042.50 ","$14,042.50 ", N/A ,"$14,042.50 ","$20,221.20 ","$17,412.70 ","$20,221.20 ","$20,221.20 ","$22,468.00 "
ST NICHOLAS HOSPITAL - ACUTE,27500028,C1882,HC MSB ICD BI-V,275,1 ,"$40,163.00 ","$20,081.50 ","$16,868.46 ","$40,163.00 ", N/A ,"$19,985.11 ","$19,985.11 ", N/A ,"$24,097.80 ","$34,138.55 ","$28,114.10 ", N/A ,"$38,154.85 ","$30,523.88 ","$30,122.25 ","$20,081.50 ","$34,138.55 ", N/A ,"$20,081.50 ","$26,105.95 ","$28,114.10 ", N/A , N/A , N/A ,"$16,868.46 ","$34,138.55 ", N/A ,"$36,949.96 ","$28,114.10 ","$20,370.67 ","$24,447.22 ","$24,459.27 ","$24,447.22 ","$27,752.63 ","$36,146.70 ","$27,973.53 ", N/A ,"$31,728.77 ", N/A ,"$20,081.50 ","$20,081.50 ", N/A ,"$20,081.50 ","$28,917.36 ","$24,901.06 ","$28,917.36 ","$28,917.36 ","$32,130.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500029,C1777,HC MSB ICD LEAD ENDO SINGLE C1777,275,1 ,"$7,693.00 ","$3,846.50 ","$3,231.06 ","$7,693.00 ", N/A ,"$3,828.04 ","$3,828.04 ", N/A ,"$4,615.80 ","$6,539.05 ","$5,385.10 ", N/A ,"$7,308.35 ","$5,846.68 ","$5,769.75 ","$3,846.50 ","$6,539.05 ", N/A ,"$3,846.50 ","$5,000.45 ","$5,385.10 ", N/A , N/A , N/A ,"$3,231.06 ","$6,539.05 ", N/A ,"$7,077.56 ","$5,385.10 ","$3,901.89 ","$4,682.73 ","$4,685.04 ","$4,682.73 ","$5,315.86 ","$6,923.70 ","$5,358.17 ", N/A ,"$6,077.47 ", N/A ,"$3,846.50 ","$3,846.50 ", N/A ,"$3,846.50 ","$5,538.96 ","$4,769.66 ","$5,538.96 ","$5,538.96 ","$6,154.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500030,C1895,HC MSB ICD LEAD ENDO DUAL,275,1 ,"$7,693.00 ","$3,846.50 ","$3,231.06 ","$7,693.00 ", N/A ,"$3,828.04 ","$3,828.04 ", N/A ,"$4,615.80 ","$6,539.05 ","$5,385.10 ", N/A ,"$7,308.35 ","$5,846.68 ","$5,769.75 ","$3,846.50 ","$6,539.05 ", N/A ,"$3,846.50 ","$5,000.45 ","$5,385.10 ", N/A , N/A , N/A ,"$3,231.06 ","$6,539.05 ", N/A ,"$7,077.56 ","$5,385.10 ","$3,901.89 ","$4,682.73 ","$4,685.04 ","$4,682.73 ","$5,315.86 ","$6,923.70 ","$5,358.17 ", N/A ,"$6,077.47 ", N/A ,"$3,846.50 ","$3,846.50 ", N/A ,"$3,846.50 ","$5,538.96 ","$4,769.66 ","$5,538.96 ","$5,538.96 ","$6,154.40 "
ST NICHOLAS HOSPITAL - ACUTE,27500031,C1896,HC MSB ICD LEAD NON ENDO SGL OR DUAL,275,1 ,"$27,039.00 ","$13,519.50 ","$11,356.38 ","$27,039.00 ", N/A ,"$13,454.61 ","$13,454.61 ", N/A ,"$16,223.40 ","$22,983.15 ","$18,927.30 ", N/A ,"$25,687.05 ","$20,549.64 ","$20,279.25 ","$13,519.50 ","$22,983.15 ", N/A ,"$13,519.50 ","$17,575.35 ","$18,927.30 ", N/A , N/A , N/A ,"$11,356.38 ","$22,983.15 ", N/A ,"$24,875.88 ","$18,927.30 ","$13,714.18 ","$16,458.64 ","$16,466.75 ","$16,458.64 ","$18,683.95 ","$24,335.10 ","$18,832.66 ", N/A ,"$21,360.81 ", N/A ,"$13,519.50 ","$13,519.50 ", N/A ,"$13,519.50 ","$19,468.08 ","$16,764.18 ","$19,468.08 ","$19,468.08 ","$21,631.20 "
ST NICHOLAS HOSPITAL - ACUTE,27500035,C1898,HC MSB MRI PACEMAKER LEAD C1898,275,1 ,"$2,080.00 ","$1,040.00 ",$873.60 ,"$2,080.00 ", N/A ,"$1,035.01 ","$1,035.01 ", N/A ,"$1,248.00 ","$1,768.00 ","$1,456.00 ", N/A ,"$1,976.00 ","$1,580.80 ","$1,560.00 ", N/A ,"$1,768.00 ", N/A , N/A ,"$1,352.00 ","$1,456.00 ", N/A , N/A , N/A ,$873.60 ,"$1,768.00 ", N/A ,"$1,913.60 ","$1,456.00 ","$1,054.98 ","$1,266.10 ","$1,266.72 ","$1,266.10 ","$1,437.28 ","$1,872.00 ","$1,448.72 ", N/A ,"$1,643.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,497.60 ","$1,289.60 ","$1,497.60 ","$1,497.60 ","$1,664.00 "
ST NICHOLAS HOSPITAL - ACUTE,27500036,C1786,HC MSB MRI PACER SINGLE C1786,275,1 ,"$8,320.00 ","$4,160.00 ","$3,494.40 ","$8,320.00 ", N/A ,"$4,140.03 ","$4,140.03 ", N/A ,"$4,992.00 ","$7,072.00 ","$5,824.00 ", N/A ,"$7,904.00 ","$6,323.20 ","$6,240.00 ","$4,160.00 ","$7,072.00 ", N/A ,"$4,160.00 ","$5,408.00 ","$5,824.00 ", N/A , N/A , N/A ,"$3,494.40 ","$7,072.00 ", N/A ,"$7,654.40 ","$5,824.00 ","$4,219.90 ","$5,064.38 ","$5,066.88 ","$5,064.38 ","$5,749.12 ","$7,488.00 ","$5,794.88 ", N/A ,"$6,572.80 ", N/A ,"$4,160.00 ","$4,160.00 ", N/A ,"$4,160.00 ","$5,990.40 ","$5,158.40 ","$5,990.40 ","$5,990.40 ","$6,656.00 "
ST NICHOLAS HOSPITAL - ACUTE,27500037,C1785,HC MSB MRI PACER DUAL C1785,275,1 ,"$8,320.00 ","$4,160.00 ","$3,494.40 ","$8,320.00 ", N/A ,"$4,140.03 ","$4,140.03 ", N/A ,"$4,992.00 ","$7,072.00 ","$5,824.00 ", N/A ,"$7,904.00 ","$6,323.20 ","$6,240.00 ","$4,160.00 ","$7,072.00 ", N/A ,"$4,160.00 ","$5,408.00 ","$5,824.00 ", N/A , N/A , N/A ,"$3,494.40 ","$7,072.00 ", N/A ,"$7,654.40 ","$5,824.00 ","$4,219.90 ","$5,064.38 ","$5,066.88 ","$5,064.38 ","$5,749.12 ","$7,488.00 ","$5,794.88 ", N/A ,"$6,572.80 ", N/A ,"$4,160.00 ","$4,160.00 ", N/A ,"$4,160.00 ","$5,990.40 ","$5,158.40 ","$5,990.40 ","$5,990.40 ","$6,656.00 "
ST NICHOLAS HOSPITAL - ACUTE,27500038,C1721,HC MSB MRI ICD DUAL,275,1 ,"$31,992.00 ","$15,996.00 ","$13,436.64 ","$31,992.00 ", N/A ,"$15,919.22 ","$15,919.22 ", N/A ,"$19,195.20 ","$27,193.20 ","$22,394.40 ", N/A ,"$30,392.40 ","$24,313.92 ","$23,994.00 ","$15,996.00 ","$27,193.20 ", N/A ,"$15,996.00 ","$20,794.80 ","$22,394.40 ", N/A , N/A , N/A ,"$13,436.64 ","$27,193.20 ", N/A ,"$29,432.64 ","$22,394.40 ","$16,226.34 ","$19,473.53 ","$19,483.13 ","$19,473.53 ","$22,106.47 ","$28,792.80 ","$22,282.43 ", N/A ,"$25,273.68 ", N/A ,"$15,996.00 ","$15,996.00 ", N/A ,"$15,996.00 ","$23,034.24 ","$19,835.04 ","$23,034.24 ","$23,034.24 ","$25,593.60 "
ST NICHOLAS HOSPITAL - ACUTE,27500039,C1722,HC MSB MRI ICD SINGLE,275,1 ,"$30,012.00 ","$15,006.00 ","$12,605.04 ","$30,012.00 ", N/A ,"$14,933.97 ","$14,933.97 ", N/A ,"$18,007.20 ","$25,510.20 ","$21,008.40 ", N/A ,"$28,511.40 ","$22,809.12 ","$22,509.00 ","$15,006.00 ","$25,510.20 ", N/A ,"$15,006.00 ","$19,507.80 ","$21,008.40 ", N/A , N/A , N/A ,"$12,605.04 ","$25,510.20 ", N/A ,"$27,611.04 ","$21,008.40 ","$15,222.09 ","$18,268.30 ","$18,277.31 ","$18,268.30 ","$20,738.29 ","$27,010.80 ","$20,903.36 ", N/A ,"$23,709.48 ", N/A ,"$15,006.00 ","$15,006.00 ", N/A ,"$15,006.00 ","$21,608.64 ","$18,607.44 ","$21,608.64 ","$21,608.64 ","$24,009.60 "
ST NICHOLAS HOSPITAL - ACUTE,27600001,V2785,HC CORNEA PROCESSING,276,1 ,"$5,891.00 ","$2,945.50 ",$825.93 ,"$5,891.00 ",$825.93 ,"$2,931.36 ","$2,931.36 ", N/A ,"$3,534.60 ","$5,007.35 ","$4,123.70 ",$825.93 ,"$5,596.45 ","$4,477.16 ","$4,418.25 ","$2,945.50 ","$5,007.35 ", N/A ,"$2,945.50 ","$3,829.15 ","$4,123.70 ",$825.93 , N/A , N/A ,"$2,474.22 ","$5,007.35 ", N/A ,"$5,419.72 ","$4,123.70 ","$2,987.92 ","$3,585.85 ","$3,587.62 ","$3,585.85 ","$4,070.68 ","$5,301.90 ","$4,103.08 ", N/A ,"$4,653.89 ",$875.49 ,"$2,945.50 ","$2,945.50 ", N/A ,"$2,945.50 ","$4,241.52 ","$3,652.42 ","$4,241.52 ","$4,241.52 ","$4,712.80 "
ST NICHOLAS HOSPITAL - ACUTE,27800123,C1724,HC DIAMONDBACK BURR  AND  LUBRICANT,278,1 ,"$6,548.00 ","$3,274.00 ","$2,750.16 ","$6,548.00 ", N/A ,"$3,258.28 ","$3,258.28 ", N/A ,"$3,928.80 ","$5,565.80 ","$4,583.60 ", N/A ,"$6,220.60 ","$4,976.48 ","$4,911.00 ","$3,274.00 ","$5,565.80 ", N/A ,"$3,274.00 ","$4,256.20 ","$4,583.60 ", N/A , N/A , N/A ,"$2,750.16 ","$5,565.80 ", N/A ,"$6,024.16 ","$4,583.60 ","$3,321.15 ","$3,985.77 ","$3,987.73 ","$3,985.77 ","$4,524.67 ","$5,893.20 ","$4,560.68 ", N/A ,"$5,172.92 ", N/A ,"$3,274.00 ","$3,274.00 ", N/A ,"$3,274.00 ","$4,714.56 ","$4,059.76 ","$4,714.56 ","$4,714.56 ","$5,238.40 "
ST NICHOLAS HOSPITAL - ACUTE,27800124,C1724,HC SILVERHAWK DIRECTIONAL ATHERECTOMY DEV,278,1 ,"$6,979.00 ","$3,489.50 ","$2,931.18 ","$6,979.00 ", N/A ,"$3,472.75 ","$3,472.75 ", N/A ,"$4,187.40 ","$5,932.15 ","$4,885.30 ", N/A ,"$6,630.05 ","$5,304.04 ","$5,234.25 ","$3,489.50 ","$5,932.15 ", N/A ,"$3,489.50 ","$4,536.35 ","$4,885.30 ", N/A , N/A , N/A ,"$2,931.18 ","$5,932.15 ", N/A ,"$6,420.68 ","$4,885.30 ","$3,539.75 ","$4,248.12 ","$4,250.21 ","$4,248.12 ","$4,822.49 ","$6,281.10 ","$4,860.87 ", N/A ,"$5,513.41 ", N/A ,"$3,489.50 ","$3,489.50 ", N/A ,"$3,489.50 ","$5,024.88 ","$4,326.98 ","$5,024.88 ","$5,024.88 ","$5,583.20 "
ST NICHOLAS HOSPITAL - ACUTE,27800133,C1751,HC HICKMAN,278,1 ,$925.00 ,$462.50 ,$388.50 ,$925.00 , N/A , N/A , N/A , N/A ,$555.00 ,$786.25 ,$647.50 , N/A ,$878.75 ,$703.00 ,$693.75 , N/A ,$786.25 , N/A , N/A ,$601.25 ,$647.50 , N/A , N/A , N/A ,$388.50 ,$786.25 , N/A ,$851.00 ,$647.50 ,$469.16 ,$563.05 ,$563.33 ,$563.05 ,$639.18 ,$832.50 ,$644.26 , N/A ,$730.75 , N/A , N/A , N/A , N/A , N/A ,$666.00 ,$573.50 ,$666.00 ,$666.00 ,$740.00 
ST NICHOLAS HOSPITAL - ACUTE,27800160,C1752,HC SHORT TERM DIALYSIS CATH,278,1 ,$925.00 ,$462.50 ,$388.50 ,$925.00 , N/A , N/A , N/A , N/A ,$555.00 ,$786.25 ,$647.50 , N/A ,$878.75 ,$703.00 ,$693.75 , N/A ,$786.25 , N/A , N/A ,$601.25 ,$647.50 , N/A , N/A , N/A ,$388.50 ,$786.25 , N/A ,$851.00 ,$647.50 ,$469.16 ,$563.05 ,$563.33 ,$563.05 ,$639.18 ,$832.50 ,$644.26 , N/A ,$730.75 , N/A , N/A , N/A , N/A , N/A ,$666.00 ,$573.50 ,$666.00 ,$666.00 ,$740.00 
ST NICHOLAS HOSPITAL - ACUTE,27800161,C1753,HC IVUS CATHETER,278,1 ,"$1,839.00 ",$919.50 ,$772.38 ,"$1,839.00 ", N/A ,$915.09 ,$915.09 , N/A ,"$1,103.40 ","$1,563.15 ","$1,287.30 ", N/A ,"$1,747.05 ","$1,397.64 ","$1,379.25 ", N/A ,"$1,563.15 ", N/A , N/A ,"$1,195.35 ","$1,287.30 ", N/A , N/A , N/A ,$772.38 ,"$1,563.15 ", N/A ,"$1,691.88 ","$1,287.30 ",$932.74 ,"$1,119.40 ","$1,119.95 ","$1,119.40 ","$1,270.75 ","$1,655.10 ","$1,280.86 ", N/A ,"$1,452.81 ", N/A , N/A , N/A , N/A , N/A ,"$1,324.08 ","$1,140.18 ","$1,324.08 ","$1,324.08 ","$1,471.20 "
ST NICHOLAS HOSPITAL - ACUTE,27800166,C1760,HC DEVICE VASCULAR CLOSURE,278,1 ,$515.00 ,$257.50 ,$216.30 ,$515.00 , N/A , N/A , N/A , N/A ,$309.00 ,$437.75 ,$360.50 , N/A ,$489.25 ,$391.40 ,$386.25 , N/A ,$437.75 , N/A , N/A ,$334.75 ,$360.50 , N/A , N/A , N/A ,$216.30 ,$437.75 , N/A ,$473.80 ,$360.50 ,$261.21 ,$313.48 ,$313.64 ,$313.48 ,$355.87 ,$463.50 ,$358.70 , N/A ,$406.85 , N/A , N/A , N/A , N/A , N/A ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$412.00 
ST NICHOLAS HOSPITAL - ACUTE,27800171,N/A,HC VASCULAR PLUG,278,1 ,"$1,567.00 ",$783.50 ,$658.14 ,"$1,567.00 ", N/A ,$779.74 ,$779.74 , N/A ,$940.20 ,"$1,331.95 ","$1,096.90 ", N/A ,"$1,488.65 ","$1,190.92 ","$1,175.25 ", N/A ,"$1,331.95 ", N/A , N/A ,"$1,018.55 ","$1,096.90 ", N/A , N/A , N/A ,$658.14 ,"$1,331.95 ", N/A ,"$1,441.64 ","$1,096.90 ",$794.78 ,$953.83 ,$954.30 ,$953.83 ,"$1,082.80 ","$1,410.30 ","$1,091.42 ", N/A ,"$1,237.93 ", N/A , N/A , N/A , N/A , N/A ,"$1,128.24 ",$971.54 ,"$1,128.24 ","$1,128.24 ","$1,253.60 "
ST NICHOLAS HOSPITAL - ACUTE,27800493,C1788,HC PORT,278,1 ,$925.00 ,$462.50 ,$388.50 ,$925.00 , N/A , N/A , N/A , N/A ,$555.00 ,$786.25 ,$647.50 , N/A ,$878.75 ,$703.00 ,$693.75 , N/A ,$786.25 , N/A , N/A ,$601.25 ,$647.50 , N/A , N/A , N/A ,$388.50 ,$786.25 , N/A ,$851.00 ,$647.50 ,$469.16 ,$563.05 ,$563.33 ,$563.05 ,$639.18 ,$832.50 ,$644.26 , N/A ,$730.75 , N/A , N/A , N/A , N/A , N/A ,$666.00 ,$573.50 ,$666.00 ,$666.00 ,$740.00 
ST NICHOLAS HOSPITAL - ACUTE,27800504,C1817,HC ASD/PFO OCCLUDER,278,1 ,"$12,689.00 ","$6,344.50 ","$5,329.38 ","$12,689.00 ", N/A ,"$6,314.05 ","$6,314.05 ", N/A ,"$7,613.40 ","$10,785.65 ","$8,882.30 ", N/A ,"$12,054.55 ","$9,643.64 ","$9,516.75 ","$6,344.50 ","$10,785.65 ", N/A ,"$6,344.50 ","$8,247.85 ","$8,882.30 ", N/A , N/A , N/A ,"$5,329.38 ","$10,785.65 ", N/A ,"$11,673.88 ","$8,882.30 ","$6,435.86 ","$7,723.79 ","$7,727.60 ","$7,723.79 ","$8,768.10 ","$11,420.10 ","$8,837.89 ", N/A ,"$10,024.31 ", N/A ,"$6,344.50 ","$6,344.50 ", N/A ,"$6,344.50 ","$9,136.08 ","$7,867.18 ","$9,136.08 ","$9,136.08 ","$10,151.20 "
ST NICHOLAS HOSPITAL - ACUTE,27800507,C1874,HC STENT COVERED AND DELIVERY SYSTEM,278,1 ,"$9,766.00 ","$4,883.00 ","$4,101.72 ","$9,766.00 ", N/A ,"$4,859.56 ","$4,859.56 ", N/A ,"$5,859.60 ","$8,301.10 ","$6,836.20 ", N/A ,"$9,277.70 ","$7,422.16 ","$7,324.50 ","$4,883.00 ","$8,301.10 ", N/A ,"$4,883.00 ","$6,347.90 ","$6,836.20 ", N/A , N/A , N/A ,"$4,101.72 ","$8,301.10 ", N/A ,"$8,984.72 ","$6,836.20 ","$4,953.32 ","$5,944.56 ","$5,947.49 ","$5,944.56 ","$6,748.31 ","$8,789.40 ","$6,802.02 ", N/A ,"$7,715.14 ", N/A ,"$4,883.00 ","$4,883.00 ", N/A ,"$4,883.00 ","$7,031.52 ","$6,054.92 ","$7,031.52 ","$7,031.52 ","$7,812.80 "
ST NICHOLAS HOSPITAL - ACUTE,27800515,C1874,HC WALLSTENT COVERED,278,1 ,"$5,777.00 ","$2,888.50 ","$2,426.34 ","$5,777.00 ", N/A ,"$2,874.64 ","$2,874.64 ", N/A ,"$3,466.20 ","$4,910.45 ","$4,043.90 ", N/A ,"$5,488.15 ","$4,390.52 ","$4,332.75 ","$2,888.50 ","$4,910.45 ", N/A ,"$2,888.50 ","$3,755.05 ","$4,043.90 ", N/A , N/A , N/A ,"$2,426.34 ","$4,910.45 ", N/A ,"$5,314.84 ","$4,043.90 ","$2,930.09 ","$3,516.46 ","$3,518.19 ","$3,516.46 ","$3,991.91 ","$5,199.30 ","$4,023.68 ", N/A ,"$4,563.83 ", N/A ,"$2,888.50 ","$2,888.50 ", N/A ,"$2,888.50 ","$4,159.44 ","$3,581.74 ","$4,159.44 ","$4,159.44 ","$4,621.60 "
ST NICHOLAS HOSPITAL - ACUTE,27800522,C1876,HC STENT EXPANDABLE UNCOVERED,278,1 ,"$4,622.00 ","$2,311.00 ","$1,941.24 ","$4,622.00 ", N/A ,"$2,299.91 ","$2,299.91 ", N/A ,"$2,773.20 ","$3,928.70 ","$3,235.40 ", N/A ,"$4,390.90 ","$3,512.72 ","$3,466.50 ","$2,311.00 ","$3,928.70 ", N/A ,"$2,311.00 ","$3,004.30 ","$3,235.40 ", N/A , N/A , N/A ,"$1,941.24 ","$3,928.70 ", N/A ,"$4,252.24 ","$3,235.40 ","$2,344.28 ","$2,813.41 ","$2,814.80 ","$2,813.41 ","$3,193.80 ","$4,159.80 ","$3,219.22 ", N/A ,"$3,651.38 ", N/A , N/A , N/A , N/A , N/A ,"$3,327.84 ","$2,865.64 ","$3,327.84 ","$3,327.84 ","$3,697.60 "
ST NICHOLAS HOSPITAL - ACUTE,27800542,C1876,HC URETERAL STENT,278,1 ,$324.00 ,$162.00 ,$136.08 ,$324.00 , N/A , N/A , N/A , N/A ,$194.40 ,$275.40 ,$226.80 , N/A ,$307.80 ,$246.24 ,$243.00 , N/A ,$275.40 , N/A , N/A ,$210.60 ,$226.80 , N/A , N/A , N/A ,$136.08 ,$275.40 , N/A ,$298.08 ,$226.80 ,$164.33 ,$197.22 ,$197.32 ,$197.22 ,$223.88 ,$291.60 ,$225.67 , N/A ,$255.96 , N/A , N/A , N/A , N/A , N/A ,$233.28 ,$200.88 ,$233.28 ,$233.28 ,$259.20 
ST NICHOLAS HOSPITAL - ACUTE,27800548,C1877,HC ANGIO STENT Z,278,1 ,"$1,734.00 ",$867.00 ,$728.28 ,"$1,734.00 ", N/A ,$862.84 ,$862.84 , N/A ,"$1,040.40 ","$1,473.90 ","$1,213.80 ", N/A ,"$1,647.30 ","$1,317.84 ","$1,300.50 ", N/A ,"$1,473.90 ", N/A , N/A ,"$1,127.10 ","$1,213.80 ", N/A , N/A , N/A ,$728.28 ,"$1,473.90 ", N/A ,"$1,595.28 ","$1,213.80 ",$879.48 ,"$1,055.49 ","$1,056.01 ","$1,055.49 ","$1,198.19 ","$1,560.60 ","$1,207.73 ", N/A ,"$1,369.86 ", N/A , N/A , N/A , N/A , N/A ,"$1,248.48 ","$1,075.08 ","$1,248.48 ","$1,248.48 ","$1,387.20 "
ST NICHOLAS HOSPITAL - ACUTE,27800552,A4648,HC MICROCLIP,278,1 ,$208.00 ,$104.00 ,$87.36 ,$208.00 , N/A , N/A , N/A , N/A ,$124.80 ,$176.80 ,$145.60 , N/A ,$197.60 ,$158.08 ,$156.00 , N/A ,$176.80 , N/A , N/A ,$135.20 ,$145.60 , N/A , N/A , N/A ,$87.36 ,$176.80 , N/A ,$191.36 ,$145.60 ,$105.50 ,$126.61 ,$126.67 ,$126.61 ,$143.73 ,$187.20 ,$144.87 , N/A ,$164.32 , N/A , N/A , N/A , N/A , N/A ,$149.76 ,$128.96 ,$149.76 ,$149.76 ,$166.40 
ST NICHOLAS HOSPITAL - ACUTE,27800553,A4648,HC TISSUE MARKER IMPLANTABLE,278,1 ,$208.00 ,$104.00 ,$87.36 ,$208.00 , N/A , N/A , N/A , N/A ,$124.80 ,$176.80 ,$145.60 , N/A ,$197.60 ,$158.08 ,$156.00 , N/A ,$176.80 , N/A , N/A ,$135.20 ,$145.60 , N/A , N/A , N/A ,$87.36 ,$176.80 , N/A ,$191.36 ,$145.60 ,$105.50 ,$126.61 ,$126.67 ,$126.61 ,$143.73 ,$187.20 ,$144.87 , N/A ,$164.32 , N/A , N/A , N/A , N/A , N/A ,$149.76 ,$128.96 ,$149.76 ,$149.76 ,$166.40 
ST NICHOLAS HOSPITAL - ACUTE,27800557,C1880,HC IVC FILTER,278,1 ,"$4,778.00 ","$2,389.00 ","$2,006.76 ","$4,778.00 ", N/A ,"$2,377.53 ","$2,377.53 ", N/A ,"$2,866.80 ","$4,061.30 ","$3,344.60 ", N/A ,"$4,539.10 ","$3,631.28 ","$3,583.50 ","$2,389.00 ","$4,061.30 ", N/A ,"$2,389.00 ","$3,105.70 ","$3,344.60 ", N/A , N/A , N/A ,"$2,006.76 ","$4,061.30 ", N/A ,"$4,395.76 ","$3,344.60 ","$2,423.40 ","$2,908.37 ","$2,909.80 ","$2,908.37 ","$3,301.60 ","$4,300.20 ","$3,327.88 ", N/A ,"$3,774.62 ", N/A , N/A , N/A , N/A , N/A ,"$3,440.16 ","$2,962.36 ","$3,440.16 ","$3,440.16 ","$3,822.40 "
ST NICHOLAS HOSPITAL - ACUTE,27800581,Q4110,HC SKIN SUBST PRIMATRIX PER SQCM,278,1 ,$87.00 ,$43.50 ,$36.54 ,$87.00 , N/A , N/A , N/A , N/A ,$52.20 ,$73.95 ,$60.90 , N/A ,$82.65 ,$66.12 ,$65.25 , N/A ,$73.95 , N/A , N/A ,$56.55 ,$60.90 , N/A , N/A , N/A ,$36.54 ,$73.95 , N/A ,$80.04 ,$60.90 ,$44.13 ,$52.96 ,$52.98 ,$52.96 ,$60.12 ,$78.30 ,$60.60 , N/A ,$68.73 , N/A , N/A , N/A , N/A , N/A ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,27801356,N/A,HC FEMOSTOP CATH LAB,278,1 ,$387.00 ,$193.50 ,$162.54 ,$387.00 , N/A , N/A , N/A , N/A ,$232.20 ,$328.95 ,$270.90 , N/A ,$367.65 ,$294.12 ,$290.25 , N/A ,$328.95 , N/A , N/A ,$251.55 ,$270.90 , N/A , N/A , N/A ,$162.54 ,$328.95 , N/A ,$356.04 ,$270.90 ,$196.29 ,$235.57 ,$235.68 ,$235.57 ,$267.42 ,$348.30 ,$269.55 , N/A ,$305.73 , N/A , N/A , N/A , N/A , N/A ,$278.64 ,$239.94 ,$278.64 ,$278.64 ,$309.60 
ST NICHOLAS HOSPITAL - ACUTE,27801400,Q4121,HC THERASKIN PER SQ CM,278,1 ,$79.00 ,$39.50 ,$33.18 ,$79.00 , N/A , N/A , N/A , N/A ,$47.40 ,$67.15 ,$55.30 , N/A ,$75.05 ,$60.04 ,$59.25 , N/A ,$67.15 , N/A , N/A ,$51.35 ,$55.30 , N/A , N/A , N/A ,$33.18 ,$67.15 , N/A ,$72.68 ,$55.30 ,$40.07 ,$48.09 ,$48.11 ,$48.09 ,$54.59 ,$71.10 ,$55.02 , N/A ,$62.41 , N/A , N/A , N/A , N/A , N/A ,$56.88 ,$48.98 ,$56.88 ,$56.88 ,$63.20 
ST NICHOLAS HOSPITAL - ACUTE,27801410,C1714,HC CROSSER C1714,278,1 ,"$6,749.00 ","$3,374.50 ","$2,834.58 ","$6,749.00 ", N/A ,"$3,358.30 ","$3,358.30 ", N/A ,"$4,049.40 ","$5,736.65 ","$4,724.30 ", N/A ,"$6,411.55 ","$5,129.24 ","$5,061.75 ","$3,374.50 ","$5,736.65 ", N/A ,"$3,374.50 ","$4,386.85 ","$4,724.30 ", N/A , N/A , N/A ,"$2,834.58 ","$5,736.65 ", N/A ,"$6,209.08 ","$4,724.30 ","$3,423.09 ","$4,108.12 ","$4,110.14 ","$4,108.12 ","$4,663.56 ","$6,074.10 ","$4,700.68 ", N/A ,"$5,331.71 ", N/A ,"$3,374.50 ","$3,374.50 ", N/A ,"$3,374.50 ","$4,859.28 ","$4,184.38 ","$4,859.28 ","$4,859.28 ","$5,399.20 "
ST NICHOLAS HOSPITAL - ACUTE,27801430,C2623,HC CATH TRANSLUMINAL DRUG COATED C2623,278,1 ,"$2,917.00 ","$1,458.50 ","$1,225.14 ","$2,917.00 ", N/A ,"$1,451.50 ","$1,451.50 ", N/A ,"$1,750.20 ","$2,479.45 ","$2,041.90 ", N/A ,"$2,771.15 ","$2,216.92 ","$2,187.75 ","$1,458.50 ","$2,479.45 ", N/A ,"$1,458.50 ","$1,896.05 ","$2,041.90 ", N/A , N/A , N/A ,"$1,225.14 ","$2,479.45 ", N/A ,"$2,683.64 ","$2,041.90 ","$1,479.50 ","$1,775.58 ","$1,776.45 ","$1,775.58 ","$2,015.65 ","$2,625.30 ","$2,031.69 ", N/A ,"$2,304.43 ", N/A , N/A , N/A , N/A , N/A ,"$2,100.24 ","$1,808.54 ","$2,100.24 ","$2,100.24 ","$2,333.60 "
ST NICHOLAS HOSPITAL - ACUTE,27801450,C1751,HC PICC,278,1 ,$694.00 ,$347.00 ,$291.48 ,$694.00 , N/A , N/A , N/A , N/A ,$416.40 ,$589.90 ,$485.80 , N/A ,$659.30 ,$527.44 ,$520.50 , N/A ,$589.90 , N/A , N/A ,$451.10 ,$485.80 , N/A , N/A , N/A ,$291.48 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$422.44 ,$479.55 ,$624.60 ,$483.37 , N/A ,$548.26 , N/A , N/A , N/A , N/A , N/A ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$555.20 
ST NICHOLAS HOSPITAL - ACUTE,27801451,C1874,HC COVERED STENTS TIER 1,278,1 ,"$7,628.00 ","$3,814.00 ","$3,203.76 ","$7,628.00 ", N/A ,"$3,795.69 ","$3,795.69 ", N/A ,"$4,576.80 ","$6,483.80 ","$5,339.60 ", N/A ,"$7,246.60 ","$5,797.28 ","$5,721.00 ","$3,814.00 ","$6,483.80 ", N/A ,"$3,814.00 ","$4,958.20 ","$5,339.60 ", N/A , N/A , N/A ,"$3,203.76 ","$6,483.80 ", N/A ,"$7,017.76 ","$5,339.60 ","$3,868.92 ","$4,643.16 ","$4,645.45 ","$4,643.16 ","$5,270.95 ","$6,865.20 ","$5,312.90 ", N/A ,"$6,026.12 ", N/A ,"$3,814.00 ","$3,814.00 ", N/A ,"$3,814.00 ","$5,492.16 ","$4,729.36 ","$5,492.16 ","$5,492.16 ","$6,102.40 "
ST NICHOLAS HOSPITAL - ACUTE,27801452,C1874,HC COVERED STENTS TIER 2,278,1 ,"$10,400.00 ","$5,200.00 ","$4,368.00 ","$10,400.00 ", N/A ,"$5,175.04 ","$5,175.04 ", N/A ,"$6,240.00 ","$8,840.00 ","$7,280.00 ", N/A ,"$9,880.00 ","$7,904.00 ","$7,800.00 ","$5,200.00 ","$8,840.00 ", N/A ,"$5,200.00 ","$6,760.00 ","$7,280.00 ", N/A , N/A , N/A ,"$4,368.00 ","$8,840.00 ", N/A ,"$9,568.00 ","$7,280.00 ","$5,274.88 ","$6,330.48 ","$6,333.60 ","$6,330.48 ","$7,186.40 ","$9,360.00 ","$7,243.60 ", N/A ,"$8,216.00 ", N/A ,"$5,200.00 ","$5,200.00 ", N/A ,"$5,200.00 ","$7,488.00 ","$6,448.00 ","$7,488.00 ","$7,488.00 ","$8,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,27801453,C1876,HC STENT TIER 1,278,1 ,"$1,739.00 ",$869.50 ,$730.38 ,"$1,739.00 ", N/A ,$865.33 ,$865.33 , N/A ,"$1,043.40 ","$1,478.15 ","$1,217.30 ", N/A ,"$1,652.05 ","$1,321.64 ","$1,304.25 ", N/A ,"$1,478.15 ", N/A , N/A ,"$1,130.35 ","$1,217.30 ", N/A , N/A , N/A ,$730.38 ,"$1,478.15 ", N/A ,"$1,599.88 ","$1,217.30 ",$882.02 ,"$1,058.53 ","$1,059.05 ","$1,058.53 ","$1,201.65 ","$1,565.10 ","$1,211.21 ", N/A ,"$1,373.81 ", N/A , N/A , N/A , N/A , N/A ,"$1,252.08 ","$1,078.18 ","$1,252.08 ","$1,252.08 ","$1,391.20 "
ST NICHOLAS HOSPITAL - ACUTE,27801454,C1876,HC STENT TIER 2,278,1 ,"$3,467.00 ","$1,733.50 ","$1,456.14 ","$3,467.00 ", N/A ,"$1,725.18 ","$1,725.18 ", N/A ,"$2,080.20 ","$2,946.95 ","$2,426.90 ", N/A ,"$3,293.65 ","$2,634.92 ","$2,600.25 ","$1,733.50 ","$2,946.95 ", N/A ,"$1,733.50 ","$2,253.55 ","$2,426.90 ", N/A , N/A , N/A ,"$1,456.14 ","$2,946.95 ", N/A ,"$3,189.64 ","$2,426.90 ","$1,758.46 ","$2,110.36 ","$2,111.40 ","$2,110.36 ","$2,395.70 ","$3,120.30 ","$2,414.77 ", N/A ,"$2,738.93 ", N/A , N/A , N/A , N/A , N/A ,"$2,496.24 ","$2,149.54 ","$2,496.24 ","$2,496.24 ","$2,773.60 "
ST NICHOLAS HOSPITAL - ACUTE,27801455,C1876,HC STENT TIER 3,278,1 ,"$4,223.00 ","$2,111.50 ","$1,773.66 ","$4,223.00 ", N/A ,"$2,101.36 ","$2,101.36 ", N/A ,"$2,533.80 ","$3,589.55 ","$2,956.10 ", N/A ,"$4,011.85 ","$3,209.48 ","$3,167.25 ","$2,111.50 ","$3,589.55 ", N/A ,"$2,111.50 ","$2,744.95 ","$2,956.10 ", N/A , N/A , N/A ,"$1,773.66 ","$3,589.55 ", N/A ,"$3,885.16 ","$2,956.10 ","$2,141.91 ","$2,570.54 ","$2,571.81 ","$2,570.54 ","$2,918.09 ","$3,800.70 ","$2,941.32 ", N/A ,"$3,336.17 ", N/A , N/A , N/A , N/A , N/A ,"$3,040.56 ","$2,618.26 ","$3,040.56 ","$3,040.56 ","$3,378.40 "
ST NICHOLAS HOSPITAL - ACUTE,27802177,Q4139,HC INJECT AMINO BIOMATRIX 1CC,278,1 ,$762.00 ,$381.00 ,$320.04 ,$762.00 , N/A , N/A , N/A , N/A ,$457.20 ,$647.70 ,$533.40 , N/A ,$723.90 ,$579.12 ,$571.50 , N/A ,$647.70 , N/A , N/A ,$495.30 ,$533.40 , N/A , N/A , N/A ,$320.04 ,$647.70 , N/A ,$701.04 ,$533.40 ,$386.49 ,$463.83 ,$464.06 ,$463.83 ,$526.54 ,$685.80 ,$530.73 , N/A ,$601.98 , N/A , N/A , N/A , N/A , N/A ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,27871783,C1783,"HC OCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE",278,1 ,"$3,753.00 ","$1,876.50 ","$1,576.26 ","$3,753.00 ", N/A ,"$1,867.49 ","$1,867.49 ", N/A ,"$2,251.80 ","$3,190.05 ","$2,627.10 ", N/A ,"$3,565.35 ","$2,852.28 ","$2,814.75 ","$1,876.50 ","$3,190.05 ", N/A ,"$1,876.50 ","$2,439.45 ","$2,627.10 ", N/A , N/A , N/A ,"$1,576.26 ","$3,190.05 ", N/A ,"$3,452.76 ","$2,627.10 ","$1,903.52 ","$2,284.45 ","$2,285.58 ","$2,284.45 ","$2,593.32 ","$3,377.70 ","$2,613.96 ", N/A ,"$2,964.87 ", N/A , N/A , N/A , N/A , N/A ,"$2,702.16 ","$2,326.86 ","$2,702.16 ","$2,702.16 ","$3,002.40 "
ST NICHOLAS HOSPITAL - ACUTE,30000002,N/A,HC CHEMISTRY PANEL-VET,300,1 ,$18.00 ,$9.00 ,$7.56 ,$18.00 , N/A ,$11.64 ,$11.64 , N/A ,$10.80 ,$15.30 ,$12.60 , N/A ,$17.10 ,$13.68 ,$13.50 , N/A ,$15.30 , N/A , N/A ,$11.70 ,$12.60 , N/A , N/A , N/A ,$7.56 ,$15.30 , N/A ,$16.56 ,$12.60 ,$9.13 ,$10.96 ,$10.96 ,$10.96 ,$12.44 ,$16.20 ,$12.54 , N/A ,$14.22 , N/A ,$9.00 ,$9.00 , N/A ,$9.00 ,$12.96 ,$11.16 ,$12.96 ,$12.96 ,$14.40 
ST NICHOLAS HOSPITAL - ACUTE,30000005,36415,HC BLOOD COLLECTION FOR EVIDENCE,300,1 ,$46.50 ,$23.25 ,$0.73 ,$46.50 ,$0.73 ,$8.00 ,$6.00 ,$3.00 ,$27.90 ,$39.53 ,$32.55 ,$0.73 ,$44.18 ,$35.34 ,$34.88 ,$5.10 ,$39.53 ,$3.00 ,$5.10 ,$3.00 ,$32.55 ,$0.73 ,$3.00 ,$3.00 ,$3.40 ,$39.53 ,$6.75 ,$42.78 ,$32.55 ,$10.57 ,$10.57 ,$28.32 ,$10.57 ,$32.13 ,$41.85 ,$32.39 ,$3.03 ,$36.74 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$37.20 
ST NICHOLAS HOSPITAL - ACUTE,30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$30.00 ,$15.00 ,$0.73 ,$30.00 ,$0.73 ,$8.00 ,$6.00 , N/A ,$18.00 ,$25.50 ,$21.00 ,$0.73 ,$28.50 ,$22.80 ,$22.50 ,$5.03 ,$25.50 , N/A ,$5.03 ,$2.74 ,$21.00 ,$0.73 , N/A , N/A ,$12.60 ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$18.26 ,$20.73 ,$27.00 ,$20.90 , N/A ,$23.70 ,$0.77 ,$3.47 ,$3.47 , N/A ,$3.47 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,30000010,36415,HC VENIPUNCTURE,300,1 ,$46.50 ,$23.25 ,$0.73 ,$46.50 ,$0.73 ,$8.00 ,$6.00 ,$3.00 ,$27.90 ,$39.53 ,$32.55 ,$0.73 ,$44.18 ,$35.34 ,$34.88 ,$5.10 ,$39.53 ,$3.00 ,$5.10 ,$3.00 ,$32.55 ,$0.73 ,$3.00 ,$3.00 ,$3.40 ,$39.53 ,$6.75 ,$42.78 ,$32.55 ,$10.57 ,$10.57 ,$28.32 ,$10.57 ,$32.13 ,$41.85 ,$32.39 ,$3.03 ,$36.74 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$37.20 
ST NICHOLAS HOSPITAL - ACUTE,30000011,36415,HC CATHETER COLLECTION,300,1 ,$46.50 ,$23.25 ,$0.73 ,$46.50 ,$0.73 ,$8.00 ,$6.00 ,$3.00 ,$27.90 ,$39.53 ,$32.55 ,$0.73 ,$44.18 ,$35.34 ,$34.88 ,$5.10 ,$39.53 ,$3.00 ,$5.10 ,$3.00 ,$32.55 ,$0.73 ,$3.00 ,$3.00 ,$3.40 ,$39.53 ,$6.75 ,$42.78 ,$32.55 ,$10.57 ,$10.57 ,$28.32 ,$10.57 ,$32.13 ,$41.85 ,$32.39 ,$3.03 ,$36.74 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$37.20 
ST NICHOLAS HOSPITAL - ACUTE,30000014,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$119.00 ,$59.50 ,$18.43 ,$250.16 ,$18.43 ,$76.98 ,$76.98 ,$111.18 ,$71.40 ,$101.15 ,$83.30 ,$18.43 ,$113.05 ,$90.44 ,$89.25 ,$43.40 ,$101.15 ,$111.18 ,$43.40 ,$23.75 ,$83.30 ,$18.43 ,$111.18 ,$111.18 ,$49.98 ,$101.15 ,$250.16 ,$109.48 ,$83.30 ,$119.00 ,$119.00 ,$72.47 ,$119.00 ,$82.23 ,$107.10 ,$82.88 ,$112.29 ,$94.01 ,$19.54 , N/A , N/A ,$111.18 , N/A ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$95.20 
ST NICHOLAS HOSPITAL - ACUTE,30000015,36600,HC ARTERIAL PUNCTURE,300,1 ,$65.00 ,$32.50 ,$18.43 ,$250.16 ,$18.43 ,$42.05 ,$42.05 ,$111.18 ,$39.00 ,$55.25 ,$45.50 ,$18.43 ,$61.75 ,$49.40 ,$48.75 ,$25.06 ,$55.25 ,$111.18 ,$25.06 ,$29.36 ,$45.50 ,$18.43 ,$111.18 ,$111.18 ,$27.30 ,$55.25 ,$250.16 ,$59.80 ,$45.50 ,$32.97 ,$39.57 ,$39.59 ,$39.57 ,$44.92 ,$58.50 ,$45.27 ,$112.29 ,$51.35 ,$19.54 , N/A , N/A ,$111.18 , N/A ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$129.00 ,$64.50 ,$18.43 ,$250.16 ,$18.43 ,$83.45 ,$83.45 ,$111.18 ,$77.40 ,$109.65 ,$90.30 ,$18.43 ,$122.55 ,$98.04 ,$96.75 ,$48.38 ,$109.65 ,$111.18 ,$48.38 ,$26.83 ,$90.30 ,$18.43 ,$111.18 ,$111.18 ,$54.18 ,$109.65 ,$250.16 ,$118.68 ,$90.30 ,$129.00 ,$129.00 ,$78.56 ,$129.00 ,$89.14 ,$116.10 ,$89.85 ,$112.29 ,$101.91 ,$19.54 , N/A , N/A ,$111.18 , N/A ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,30000101,89051,HC CELL CT BODY FLUID W/DIFF,300,1 ,$65.00 ,$32.50 ,$5.60 ,$65.00 ,$5.79 ,$21.42 ,$18.36 ,$5.60 ,$39.00 ,$55.25 ,$45.50 ,$5.79 ,$61.75 ,$49.40 ,$48.75 ,$9.52 ,$55.25 ,$5.60 ,$9.52 ,$5.60 ,$45.50 ,$5.79 ,$5.60 ,$5.60 ,$6.34 ,$55.25 ,$12.60 ,$59.80 ,$45.50 ,$26.45 ,$26.45 ,$39.59 ,$26.45 ,$44.92 ,$58.50 ,$45.27 ,$5.66 ,$51.35 ,$6.14 ,$6.72 ,$6.72 ,$5.60 ,$6.72 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,30000102,89051,HC CELL CT BODY FLUID W/DIFF (SYN),300,1 ,$99.00 ,$49.50 ,$5.60 ,$99.00 ,$5.79 ,$21.42 ,$18.36 ,$5.60 ,$59.40 ,$84.15 ,$69.30 ,$5.79 ,$94.05 ,$75.24 ,$74.25 ,$9.52 ,$84.15 ,$5.60 ,$9.52 ,$5.60 ,$69.30 ,$5.79 ,$5.60 ,$5.60 ,$6.34 ,$84.15 ,$12.60 ,$91.08 ,$69.30 ,$26.45 ,$26.45 ,$60.29 ,$26.45 ,$68.41 ,$89.10 ,$68.95 ,$5.66 ,$78.21 ,$6.14 ,$6.72 ,$6.72 ,$5.60 ,$6.72 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30000104,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$41.00 ,$20.50 ,$4.27 ,$41.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$24.60 ,$34.85 ,$28.70 ,$4.41 ,$38.95 ,$31.16 ,$30.75 ,$7.26 ,$34.85 ,$4.27 ,$7.26 ,$4.27 ,$28.70 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$34.85 ,$9.61 ,$37.72 ,$28.70 ,$20.50 ,$20.50 ,$24.97 ,$20.50 ,$28.33 ,$36.90 ,$28.56 ,$4.31 ,$32.39 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,30000105,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$53.00 ,$26.50 ,$7.33 ,$53.00 ,$7.57 ,$27.83 ,$23.85 ,$7.33 ,$31.80 ,$45.05 ,$37.10 ,$7.57 ,$50.35 ,$40.28 ,$39.75 ,$12.46 ,$45.05 ,$7.33 ,$12.46 ,$7.33 ,$37.10 ,$7.57 ,$7.33 ,$7.33 ,$8.30 ,$45.05 ,$16.49 ,$48.76 ,$37.10 ,$34.38 ,$34.38 ,$32.28 ,$34.38 ,$36.62 ,$47.70 ,$36.91 ,$7.40 ,$41.87 ,$8.02 ,$8.80 ,$8.80 ,$7.33 ,$8.80 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30000106,89125,HC FAT STAIN,300,1 ,$39.00 ,$19.50 ,$5.88 ,$39.00 ,$6.08 ,$20.58 ,$17.64 ,$5.88 ,$23.40 ,$33.15 ,$27.30 ,$6.08 ,$37.05 ,$29.64 ,$29.25 ,$10.00 ,$33.15 ,$5.88 ,$10.00 ,$5.88 ,$27.30 ,$6.08 ,$5.88 ,$5.88 ,$6.66 ,$33.15 ,$13.23 ,$35.88 ,$27.30 ,$20.75 ,$20.75 ,$23.75 ,$20.75 ,$26.95 ,$35.10 ,$27.16 ,$5.94 ,$30.81 ,$6.44 ,$7.06 ,$7.06 ,$5.88 ,$7.06 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30000107,89190,HC SMEAR NASAL EOSINOPHILS,300,1 ,$41.00 ,$20.50 ,$5.79 ,$41.00 ,$5.98 ,$20.27 ,$17.37 ,$5.79 ,$24.60 ,$34.85 ,$28.70 ,$5.98 ,$38.95 ,$31.16 ,$30.75 ,$9.84 ,$34.85 ,$5.79 ,$9.84 ,$5.79 ,$28.70 ,$5.98 ,$5.79 ,$5.79 ,$6.55 ,$34.85 ,$13.03 ,$37.72 ,$28.70 ,$22.83 ,$22.83 ,$24.97 ,$22.83 ,$28.33 ,$36.90 ,$28.56 ,$5.85 ,$32.39 ,$6.34 ,$6.95 ,$6.95 ,$5.79 ,$6.95 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,30000108,89220,HC SPUTUM COLLECTION,300,1 ,$97.00 ,$48.50 ,$8.63 ,$330.88 ,$8.63 ,$54.76 ,$46.94 ,$147.06 ,$58.20 ,$82.45 ,$67.90 ,$8.63 ,$92.15 ,$73.72 ,$72.75 ,$29.72 ,$82.45 ,$147.06 ,$29.72 ,$15.53 ,$67.90 ,$8.63 ,$147.06 ,$147.06 ,$40.74 ,$82.45 ,$330.88 ,$89.24 ,$67.90 ,$97.00 ,$97.00 ,$59.07 ,$97.00 ,$67.03 ,$87.30 ,$67.56 ,$148.53 ,$76.63 ,$9.15 ,$97.00 ,$97.00 ,$147.06 ,$97.00 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30000109,89230,HC SWEAT COLLECTION,300,1 ,$194.00 ,$97.00 ,$2.17 ,$194.00 ,$9.06 ,$8.89 ,$7.62 ,$49.00 ,$116.40 ,$164.90 ,$135.80 ,$9.06 ,$184.30 ,$147.44 ,$145.50 ,$3.50 ,$164.90 ,$49.00 ,$3.50 ,$2.17 ,$135.80 ,$9.06 ,$49.00 ,$49.00 ,$81.48 ,$164.90 ,$110.24 ,$178.48 ,$135.80 ,$138.86 ,$138.86 ,$118.15 ,$138.86 ,$134.05 ,$174.60 ,$135.12 ,$49.49 ,$153.26 ,$9.60 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$155.20 
ST NICHOLAS HOSPITAL - ACUTE,30000111,89310,HC SPERM COUNT,300,1 ,$286.00 ,$143.00 ,$8.61 ,$286.00 ,$8.90 ,$33.50 ,$28.71 ,$8.61 ,$171.60 ,$243.10 ,$200.20 ,$8.90 ,$271.70 ,$217.36 ,$214.50 ,$14.64 ,$243.10 ,$8.61 ,$14.64 ,$8.61 ,$200.20 ,$8.90 ,$8.61 ,$8.61 ,$9.74 ,$243.10 ,$19.37 ,$263.12 ,$200.20 ,$41.36 ,$41.36 ,$174.17 ,$41.36 ,$197.63 ,$257.40 ,$199.20 ,$8.70 ,$225.94 ,$9.43 ,$10.33 ,$10.33 ,$8.61 ,$10.33 ,$205.92 ,$177.32 ,$205.92 ,$205.92 ,$228.80 
ST NICHOLAS HOSPITAL - ACUTE,30000113,89320,HC SEMEN ANALYSIS,300,1 ,$60.00 ,$30.00 ,$12.31 ,$60.00 ,$12.72 ,$46.87 ,$40.17 ,$12.31 ,$36.00 ,$51.00 ,$42.00 ,$12.72 ,$57.00 ,$45.60 ,$45.00 ,$20.93 ,$51.00 ,$12.31 ,$20.93 ,$12.31 ,$42.00 ,$12.72 ,$12.31 ,$12.31 ,$13.93 ,$51.00 ,$27.70 ,$55.20 ,$42.00 ,$57.91 ,$57.91 ,$36.54 ,$57.91 ,$41.46 ,$54.00 ,$41.79 ,$12.43 ,$47.40 ,$13.48 ,$14.77 ,$14.77 ,$12.31 ,$14.77 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,30000114,89325,HC SPERM ANTIBODIES,300,1 ,$69.00 ,$34.50 ,$3.02 ,$69.00 ,$3.02 ,$41.51 ,$35.58 ,$10.67 ,$41.40 ,$58.65 ,$48.30 ,$3.02 ,$65.55 ,$52.44 ,$51.75 ,$18.14 ,$58.65 ,$10.67 ,$18.14 ,$10.67 ,$48.30 ,$3.02 ,$10.67 ,$10.67 ,$12.08 ,$58.65 ,$24.01 ,$63.48 ,$48.30 ,$51.29 ,$51.29 ,$42.02 ,$51.29 ,$47.68 ,$62.10 ,$48.06 ,$10.78 ,$54.51 ,$3.20 ,$12.80 ,$12.80 ,$10.67 ,$12.80 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30000115,99001,HC SPECIMEN HAND/CONVEY OTHER,300,1 ,$26.00 ,$13.00 ,$3.92 ,$26.00 ,$3.92 ,$16.82 ,$16.82 , N/A ,$15.60 ,$22.10 ,$18.20 ,$3.92 ,$24.70 ,$19.76 ,$19.50 ,$10.44 ,$22.10 , N/A ,$10.44 ,$5.69 ,$18.20 ,$3.92 , N/A , N/A ,$10.92 ,$22.10 , N/A ,$23.92 ,$18.20 ,$13.19 ,$15.83 ,$15.83 ,$15.83 ,$17.97 ,$23.40 ,$18.11 , N/A ,$20.54 ,$4.16 ,$7.37 ,$7.37 , N/A ,$7.37 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$20.80 
ST NICHOLAS HOSPITAL - ACUTE,30000116,99080,HC EMPL DRUG SCREEN COL,300,1 ,$23.00 ,$11.50 ,$9.66 ,$23.00 , N/A ,$14.88 ,$14.88 , N/A ,$13.80 ,$19.55 ,$16.10 , N/A ,$21.85 ,$17.48 ,$17.25 , N/A ,$19.55 , N/A , N/A ,$14.95 ,$16.10 , N/A , N/A , N/A ,$9.66 ,$19.55 , N/A ,$21.16 ,$16.10 ,$11.67 ,$14.00 ,$14.01 ,$14.00 ,$15.89 ,$20.70 ,$16.02 , N/A ,$18.17 , N/A , N/A , N/A , N/A , N/A ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$18.40 
ST NICHOLAS HOSPITAL - ACUTE,30000117,99080,HC LAB PROCESS FEE,300,1 ,$22.00 ,$11.00 ,$9.24 ,$22.00 , N/A ,$14.23 ,$14.23 , N/A ,$13.20 ,$18.70 ,$15.40 , N/A ,$20.90 ,$16.72 ,$16.50 , N/A ,$18.70 , N/A , N/A ,$14.30 ,$15.40 , N/A , N/A , N/A ,$9.24 ,$18.70 , N/A ,$20.24 ,$15.40 ,$11.16 ,$13.39 ,$13.40 ,$13.39 ,$15.20 ,$19.80 ,$15.32 , N/A ,$17.38 , N/A , N/A , N/A , N/A , N/A ,$15.84 ,$13.64 ,$15.84 ,$15.84 ,$17.60 
ST NICHOLAS HOSPITAL - ACUTE,30000120,80306,HC DRUG SCREEN URINE,300,1 ,$300.00 ,$150.00 ,$17.14 ,$300.00 ,$17.71 ,$59.99 ,$51.42 ,$17.14 ,$180.00 ,$255.00 ,$210.00 ,$17.71 ,$285.00 ,$228.00 ,$225.00 ,$29.14 ,$255.00 ,$17.14 ,$29.14 ,$17.14 ,$210.00 ,$17.71 ,$17.14 ,$17.14 ,$19.40 ,$255.00 ,$38.57 ,$276.00 ,$210.00 ,$60.38 ,$60.38 ,$182.70 ,$60.38 ,$207.30 ,$270.00 ,$208.95 ,$17.31 ,$237.00 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$240.00 
ST NICHOLAS HOSPITAL - ACUTE,30000121,80306,HC DRUG SCREEN SGL CLASS PRESUMPTIVE INSTRMNT,300,1 ,$300.00 ,$150.00 ,$17.14 ,$300.00 ,$17.71 ,$59.99 ,$51.42 ,$17.14 ,$180.00 ,$255.00 ,$210.00 ,$17.71 ,$285.00 ,$228.00 ,$225.00 ,$29.14 ,$255.00 ,$17.14 ,$29.14 ,$17.14 ,$210.00 ,$17.71 ,$17.14 ,$17.14 ,$19.40 ,$255.00 ,$38.57 ,$276.00 ,$210.00 ,$60.38 ,$60.38 ,$182.70 ,$60.38 ,$207.30 ,$270.00 ,$208.95 ,$17.31 ,$237.00 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$240.00 
ST NICHOLAS HOSPITAL - ACUTE,30000122,80306,HC DRUG SCREEN (FLUNITRAZEPAM),300,1 ,$330.00 ,$165.00 ,$17.14 ,$330.00 ,$17.71 ,$59.99 ,$51.42 ,$17.14 ,$198.00 ,$280.50 ,$231.00 ,$17.71 ,$313.50 ,$250.80 ,$247.50 ,$29.14 ,$280.50 ,$17.14 ,$29.14 ,$17.14 ,$231.00 ,$17.71 ,$17.14 ,$17.14 ,$19.40 ,$280.50 ,$38.57 ,$303.60 ,$231.00 ,$60.38 ,$60.38 ,$200.97 ,$60.38 ,$228.03 ,$297.00 ,$229.85 ,$17.31 ,$260.70 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$237.60 ,$204.60 ,$237.60 ,$237.60 ,$264.00 
ST NICHOLAS HOSPITAL - ACUTE,30000123,80306,HC DRUG SCREEN (HYDROXYBUTYRIC),300,1 ,$183.00 ,$91.50 ,$17.14 ,$183.00 ,$17.71 ,$59.99 ,$51.42 ,$17.14 ,$109.80 ,$155.55 ,$128.10 ,$17.71 ,$173.85 ,$139.08 ,$137.25 ,$29.14 ,$155.55 ,$17.14 ,$29.14 ,$17.14 ,$128.10 ,$17.71 ,$17.14 ,$17.14 ,$19.40 ,$155.55 ,$38.57 ,$168.36 ,$128.10 ,$60.38 ,$60.38 ,$111.45 ,$60.38 ,$126.45 ,$164.70 ,$127.46 ,$17.31 ,$144.57 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,30000124,80307,HC DRUG SCREEN MECONIUM,300,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000125,G0432,HC HIV I-II SCREEN,300,1 ,$90.00 ,$45.00 ,$2.27 ,$90.00 ,$2.27 ,$68.50 ,$58.71 ,$19.57 ,$54.00 ,$76.50 ,$63.00 ,$2.27 ,$85.50 ,$68.40 ,$67.50 ,$33.27 ,$76.50 ,$19.57 ,$33.27 ,$19.57 ,$63.00 ,$2.27 ,$19.57 ,$19.57 ,$22.15 ,$76.50 ,$44.03 ,$82.80 ,$63.00 ,$65.87 ,$65.87 ,$54.81 ,$65.87 ,$62.19 ,$81.00 ,$62.69 ,$19.77 ,$71.10 ,$2.41 ,$23.48 ,$23.48 ,$19.57 ,$23.48 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30000126,J2790,HC RH IMMUNE GLOBULIN,300,1 ,$129.00 ,$64.50 ,$26.29 ,$129.00 ,$26.29 ,$83.45 ,$83.45 , N/A ,$77.40 ,$109.65 ,$90.30 ,$26.29 ,$122.55 ,$98.04 ,$96.75 ,$129.00 ,$109.65 , N/A ,$129.00 ,$74.65 ,$90.30 ,$26.29 , N/A , N/A ,$54.18 ,$109.65 , N/A ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$78.52 ,$89.14 ,$116.10 ,$89.85 , N/A ,$101.91 ,$27.87 , N/A , N/A , N/A , N/A ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,30000200,80307,HC MECONIUM SCREEN MAYO,300,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000205,84311,HC PM SCREEN OXIDANT,300,1 ,$103.00 ,$51.50 ,$8.10 ,$103.00 ,$8.37 ,$28.35 ,$24.30 ,$8.10 ,$61.80 ,$87.55 ,$72.10 ,$8.37 ,$97.85 ,$78.28 ,$77.25 ,$13.77 ,$87.55 ,$8.10 ,$13.77 ,$8.10 ,$72.10 ,$8.37 ,$8.10 ,$8.10 ,$9.17 ,$87.55 ,$18.23 ,$94.76 ,$72.10 ,$33.61 ,$33.61 ,$62.73 ,$33.61 ,$71.17 ,$92.70 ,$71.74 ,$8.18 ,$81.37 ,$8.87 ,$9.72 ,$9.72 ,$8.10 ,$9.72 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30000206,80307,HC DRUG SCREEN PANEL 9,300,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000207,80307,HC DRUG SCREEN PANEL 20,300,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000209,G0480,HC M-PHENIDATE MET QN URINE DEFINITIVE,300,1 ,$200.00 ,$100.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$114.43 ,$140.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$139.30 ,$115.57 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000210,G0480,HC FENTANYL QN URINE DEFINITIVE,300,1 ,$200.00 ,$100.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$114.43 ,$140.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$139.30 ,$115.57 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000211,80306,HC BUPRENORPHINE SCR/QN URINE,300,1 ,$200.00 ,$100.00 ,$17.14 ,$200.00 ,$17.71 ,$59.99 ,$51.42 ,$17.14 ,$120.00 ,$170.00 ,$140.00 ,$17.71 ,$190.00 ,$152.00 ,$150.00 ,$29.14 ,$170.00 ,$17.14 ,$29.14 ,$17.14 ,$140.00 ,$17.71 ,$17.14 ,$17.14 ,$19.40 ,$170.00 ,$38.57 ,$184.00 ,$140.00 ,$60.38 ,$60.38 ,$121.80 ,$60.38 ,$138.20 ,$180.00 ,$139.30 ,$17.31 ,$158.00 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000212,G0480,HC BUPRENORPHINE QN URINE,300,1 ,$200.00 ,$100.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$114.43 ,$140.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$139.30 ,$115.57 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30000227,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$259.00 ,$129.50 ,$12.05 ,$259.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$155.40 ,$220.15 ,$181.30 ,$12.45 ,$246.05 ,$196.84 ,$194.25 ,$20.49 ,$220.15 ,$12.05 ,$20.49 ,$12.05 ,$181.30 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$220.15 ,$27.11 ,$238.28 ,$181.30 ,$57.91 ,$57.91 ,$157.73 ,$57.91 ,$178.97 ,$233.10 ,$180.39 ,$12.17 ,$204.61 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$186.48 ,$160.58 ,$186.48 ,$186.48 ,$207.20 
ST NICHOLAS HOSPITAL - ACUTE,30000229,89322,HC SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA,300,1 ,$387.00 ,$193.50 ,$15.50 ,$387.00 ,$16.02 ,$60.27 ,$51.66 ,$15.50 ,$232.20 ,$328.95 ,$270.90 ,$16.02 ,$367.65 ,$294.12 ,$290.25 ,$26.35 ,$328.95 ,$15.50 ,$26.35 ,$15.50 ,$270.90 ,$16.02 ,$15.50 ,$15.50 ,$17.54 ,$328.95 ,$34.88 ,$356.04 ,$270.90 ,$74.47 ,$74.47 ,$235.68 ,$74.47 ,$267.42 ,$348.30 ,$269.55 ,$15.66 ,$305.73 ,$16.98 ,$18.60 ,$18.60 ,$15.50 ,$18.60 ,$278.64 ,$239.94 ,$278.64 ,$278.64 ,$309.60 
ST NICHOLAS HOSPITAL - ACUTE,30000236,80307,HC DRUG SCREEN PANEL 4,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000237,80307,HC DRUG SCREEN PANEL 6,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30000463,76120,HC CINERADIOGRAPHY 76120,320,1 ,$403.00 ,$201.50 ,$17.98 ,$403.00 ,$17.98 ,$363.74 ,$323.32 ,$107.35 ,$241.80 ,$342.55 ,$282.10 ,$17.98 ,$382.85 ,$306.28 ,$302.25 ,$194.01 ,$342.55 ,$107.35 ,$194.01 ,$86.08 ,$282.10 ,$17.98 ,$107.35 ,$107.35 ,$169.26 ,$342.55 ,$241.53 ,$370.76 ,$282.10 ,$403.00 ,$403.00 ,$245.43 ,$403.00 ,$278.47 ,$362.70 ,$280.69 ,$108.42 ,$318.37 ,$19.06 ,$403.00 ,$403.00 ,$107.35 ,$403.00 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,30002038,81288,HC MLH1 GENE ANALYSIS,300,1 ,$518.00 ,$259.00 ,$164.96 ,$518.00 ,$164.96 ,$518.00 ,$518.00 ,$192.32 ,$310.80 ,$440.30 ,$362.60 ,$164.96 ,$492.10 ,$393.68 ,$388.50 ,$326.94 ,$440.30 ,$192.32 ,$326.94 ,$192.32 ,$362.60 ,$164.96 ,$192.32 ,$192.32 ,$217.67 ,$440.30 ,$432.72 ,$476.56 ,$362.60 ,$518.00 ,$518.00 ,$315.46 ,$518.00 ,$357.94 ,$466.20 ,$360.79 ,$194.24 ,$409.22 ,$174.86 ,$230.78 ,$230.78 ,$192.32 ,$230.78 ,$372.96 ,$321.16 ,$372.96 ,$372.96 ,$414.40 
ST NICHOLAS HOSPITAL - ACUTE,30100062,80307,HC AMPHET/METHAMPHET CONFIRM MEC,301,1 ,$120.00 ,$60.00 ,$60.00 ,$139.82 ,$63.40 ,$120.00 ,$120.00 ,$62.14 ,$72.00 ,$102.00 ,$84.00 ,$63.40 ,$114.00 ,$91.20 ,$90.00 ,$105.64 ,$102.00 ,$62.14 ,$105.64 ,$62.14 ,$84.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$102.00 ,$139.82 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$108.00 ,$83.58 ,$62.76 ,$94.80 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100063,80307,HC COCAINE  AND  MET CONFIRM MEC,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30100064,80307,HC OPIATE CONFIRM MEC,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30100065,80307,HC PCP CONFIRM MEC,301,1 ,$120.00 ,$60.00 ,$60.00 ,$139.82 ,$63.40 ,$120.00 ,$120.00 ,$62.14 ,$72.00 ,$102.00 ,$84.00 ,$63.40 ,$114.00 ,$91.20 ,$90.00 ,$105.64 ,$102.00 ,$62.14 ,$105.64 ,$62.14 ,$84.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$102.00 ,$139.82 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$108.00 ,$83.58 ,$62.76 ,$94.80 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100066,80307,HC THC CONFIRM MEC,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30100099,80048,HC SURGICAL VET PANEL,301,1 ,$9.00 ,$4.50 ,$4.50 ,$19.04 ,$8.74 ,$9.00 ,$9.00 ,$8.46 ,$5.40 ,$7.65 ,$6.30 ,$8.74 ,$8.55 ,$6.84 ,$6.75 ,$9.00 ,$7.65 ,$8.46 ,$9.00 ,$8.46 ,$6.30 ,$8.74 ,$8.46 ,$8.46 ,$9.00 ,$7.65 ,$19.04 ,$8.28 ,$6.30 ,$9.00 ,$9.00 ,$5.48 ,$9.00 ,$6.22 ,$8.10 ,$6.27 ,$8.54 ,$7.11 ,$9.26 ,$9.00 ,$9.00 ,$8.46 ,$9.00 ,$6.48 ,$5.58 ,$6.48 ,$6.48 ,$7.20 
ST NICHOLAS HOSPITAL - ACUTE,30100101,80048,HC BASIC METABOLIC PANEL,301,1 ,$97.00 ,$48.50 ,$8.46 ,$97.00 ,$8.74 ,$32.90 ,$28.20 ,$8.46 ,$58.20 ,$82.45 ,$67.90 ,$8.74 ,$92.15 ,$73.72 ,$72.75 ,$14.38 ,$82.45 ,$8.46 ,$14.38 ,$8.46 ,$67.90 ,$8.74 ,$8.46 ,$8.46 ,$9.58 ,$82.45 ,$19.04 ,$89.24 ,$67.90 ,$40.65 ,$40.65 ,$59.07 ,$40.65 ,$67.03 ,$87.30 ,$67.56 ,$8.54 ,$76.63 ,$9.26 ,$10.15 ,$10.15 ,$8.46 ,$10.15 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100103,80051,HC ELECTROLYTE PANEL,301,1 ,$55.00 ,$27.50 ,$7.01 ,$55.00 ,$7.24 ,$27.27 ,$23.37 ,$7.01 ,$33.00 ,$46.75 ,$38.50 ,$7.24 ,$52.25 ,$41.80 ,$41.25 ,$11.92 ,$46.75 ,$7.01 ,$11.92 ,$7.01 ,$38.50 ,$7.24 ,$7.01 ,$7.01 ,$7.93 ,$46.75 ,$15.77 ,$50.60 ,$38.50 ,$33.71 ,$33.71 ,$33.50 ,$33.71 ,$38.01 ,$49.50 ,$38.31 ,$7.08 ,$43.45 ,$7.67 ,$8.41 ,$8.41 ,$7.01 ,$8.41 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$134.00 ,$67.00 ,$10.56 ,$134.00 ,$10.91 ,$41.09 ,$35.22 ,$10.56 ,$80.40 ,$113.90 ,$93.80 ,$10.91 ,$127.30 ,$101.84 ,$100.50 ,$17.95 ,$113.90 ,$10.56 ,$17.95 ,$10.56 ,$93.80 ,$10.91 ,$10.56 ,$10.56 ,$11.95 ,$113.90 ,$23.76 ,$123.28 ,$93.80 ,$50.76 ,$50.76 ,$81.61 ,$50.76 ,$92.59 ,$120.60 ,$93.33 ,$10.67 ,$105.86 ,$11.56 ,$12.67 ,$12.67 ,$10.56 ,$12.67 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100105,80053,HC COMPREHENSIVE METABOL PANEL VET,301,1 ,$15.00 ,$7.50 ,$7.50 ,$23.76 ,$10.91 ,$15.00 ,$15.00 ,$10.56 ,$9.00 ,$12.75 ,$10.50 ,$10.91 ,$14.25 ,$11.40 ,$11.25 ,$15.00 ,$12.75 ,$10.56 ,$15.00 ,$10.56 ,$10.50 ,$10.91 ,$10.56 ,$10.56 ,$11.95 ,$12.75 ,$23.76 ,$13.80 ,$10.50 ,$15.00 ,$15.00 ,$9.14 ,$15.00 ,$10.37 ,$13.50 ,$10.45 ,$10.67 ,$11.85 ,$11.56 ,$12.67 ,$12.67 ,$10.56 ,$12.67 ,$10.80 ,$9.30 ,$10.80 ,$10.80 ,$12.00 
ST NICHOLAS HOSPITAL - ACUTE,30100106,80055,HC PRENATAL PANEL,301,1 ,$291.00 ,$145.50 ,$18.84 ,$291.00 ,$18.84 ,$185.92 ,$159.36 ,$47.81 ,$174.60 ,$247.35 ,$203.70 ,$18.84 ,$276.45 ,$221.16 ,$218.25 ,$81.28 ,$247.35 ,$47.81 ,$81.28 ,$47.81 ,$203.70 ,$18.84 ,$47.81 ,$47.81 ,$54.11 ,$247.35 ,$107.57 ,$267.72 ,$203.70 ,$226.19 ,$226.19 ,$177.22 ,$226.19 ,$201.08 ,$261.90 ,$202.68 ,$48.29 ,$229.89 ,$19.97 ,$57.37 ,$57.37 ,$47.81 ,$57.37 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30100107,80061,HC LIPID PANEL,301,1 ,$101.00 ,$50.50 ,$13.39 ,$101.00 ,$13.84 ,$52.08 ,$44.64 ,$13.39 ,$60.60 ,$85.85 ,$70.70 ,$13.84 ,$95.95 ,$76.76 ,$75.75 ,$22.76 ,$85.85 ,$13.39 ,$22.76 ,$13.39 ,$70.70 ,$13.84 ,$13.39 ,$13.39 ,$15.15 ,$85.85 ,$30.13 ,$92.92 ,$70.70 ,$64.36 ,$64.36 ,$61.51 ,$64.36 ,$69.79 ,$90.90 ,$70.35 ,$13.52 ,$79.79 ,$14.67 ,$16.07 ,$16.07 ,$13.39 ,$16.07 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100108,80069,HC RENAL PANEL,301,1 ,$112.00 ,$56.00 ,$8.68 ,$112.00 ,$8.97 ,$33.78 ,$28.95 ,$8.68 ,$67.20 ,$95.20 ,$78.40 ,$8.97 ,$106.40 ,$85.12 ,$84.00 ,$14.76 ,$95.20 ,$8.68 ,$14.76 ,$8.68 ,$78.40 ,$8.97 ,$8.68 ,$8.68 ,$9.82 ,$95.20 ,$19.53 ,$103.04 ,$78.40 ,$41.74 ,$41.74 ,$68.21 ,$41.74 ,$77.39 ,$100.80 ,$78.01 ,$8.77 ,$88.48 ,$9.51 ,$10.42 ,$10.42 ,$8.68 ,$10.42 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100109,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$358.00 ,$179.00 ,$47.63 ,$358.00 ,$49.22 ,$185.26 ,$158.79 ,$47.63 ,$214.80 ,$304.30 ,$250.60 ,$49.22 ,$340.10 ,$272.08 ,$268.50 ,$80.97 ,$304.30 ,$47.63 ,$80.97 ,$47.63 ,$250.60 ,$49.22 ,$47.63 ,$47.63 ,$53.91 ,$304.30 ,$107.17 ,$329.36 ,$250.60 ,$228.93 ,$228.93 ,$218.02 ,$228.93 ,$247.38 ,$322.20 ,$249.35 ,$48.11 ,$282.82 ,$52.17 ,$57.16 ,$57.16 ,$47.63 ,$57.16 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,30100110,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.44 ,$31.78 ,$27.24 ,$8.17 ,$46.80 ,$66.30 ,$54.60 ,$8.44 ,$74.10 ,$59.28 ,$58.50 ,$13.89 ,$66.30 ,$8.17 ,$13.89 ,$8.17 ,$54.60 ,$8.44 ,$8.17 ,$8.17 ,$9.25 ,$66.30 ,$18.38 ,$71.76 ,$54.60 ,$39.24 ,$39.24 ,$47.50 ,$39.24 ,$53.90 ,$70.20 ,$54.33 ,$8.25 ,$61.62 ,$8.95 ,$9.80 ,$9.80 ,$8.17 ,$9.80 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100111,80150,HC AMIKACIN,301,1 ,$119.00 ,$59.50 ,$15.08 ,$119.00 ,$15.58 ,$58.63 ,$50.25 ,$15.08 ,$71.40 ,$101.15 ,$83.30 ,$15.58 ,$113.05 ,$90.44 ,$89.25 ,$25.64 ,$101.15 ,$15.08 ,$25.64 ,$15.08 ,$83.30 ,$15.58 ,$15.08 ,$15.08 ,$17.07 ,$101.15 ,$33.93 ,$109.48 ,$83.30 ,$72.42 ,$72.42 ,$72.47 ,$72.42 ,$82.23 ,$107.10 ,$82.88 ,$15.23 ,$94.01 ,$16.51 ,$18.10 ,$18.10 ,$15.08 ,$18.10 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$95.20 
ST NICHOLAS HOSPITAL - ACUTE,30100112,80335,HC AMITRIPTYLINE,301,1 ,$90.00 ,$45.00 ,$3.81 ,$90.00 ,$3.81 ,$80.88 ,$69.32 , N/A ,$54.00 ,$76.50 ,$63.00 ,$3.81 ,$85.50 ,$68.40 ,$67.50 ,$38.56 ,$76.50 , N/A ,$38.56 ,$22.95 ,$63.00 ,$3.81 , N/A , N/A ,$37.80 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 , N/A ,$71.10 ,$4.04 , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100113,80346,HC LORAZEPAM,301,1 ,$106.00 ,$53.00 ,$3.81 ,$106.00 ,$3.81 ,$80.88 ,$69.32 , N/A ,$63.60 ,$90.10 ,$74.20 ,$3.81 ,$100.70 ,$80.56 ,$79.50 ,$38.56 ,$90.10 , N/A ,$38.56 ,$22.95 ,$74.20 ,$3.81 , N/A , N/A ,$44.52 ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$64.52 ,$73.25 ,$95.40 ,$73.83 , N/A ,$83.74 ,$4.04 , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,30100114,80346,HC CLONOPIN,301,1 ,$38.00 ,$19.00 ,$3.81 ,$38.00 ,$3.81 ,$38.00 ,$38.00 , N/A ,$22.80 ,$32.30 ,$26.60 ,$3.81 ,$36.10 ,$28.88 ,$28.50 ,$38.00 ,$32.30 , N/A ,$38.00 ,$22.95 ,$26.60 ,$3.81 , N/A , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$26.47 , N/A ,$30.02 ,$4.04 , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100115,80346,HC BENZODIAZEPINE GC/MS,301,1 ,$38.00 ,$19.00 ,$3.81 ,$38.00 ,$3.81 ,$38.00 ,$38.00 , N/A ,$22.80 ,$32.30 ,$26.60 ,$3.81 ,$36.10 ,$28.88 ,$28.50 ,$38.00 ,$32.30 , N/A ,$38.00 ,$22.95 ,$26.60 ,$3.81 , N/A , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$26.47 , N/A ,$30.02 ,$4.04 , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100116,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$108.00 ,$54.00 ,$14.57 ,$108.00 ,$15.06 ,$56.63 ,$48.54 ,$14.57 ,$64.80 ,$91.80 ,$75.60 ,$15.06 ,$102.60 ,$82.08 ,$81.00 ,$24.77 ,$91.80 ,$14.57 ,$24.77 ,$14.57 ,$75.60 ,$15.06 ,$14.57 ,$14.57 ,$16.49 ,$91.80 ,$32.78 ,$99.36 ,$75.60 ,$69.99 ,$69.99 ,$65.77 ,$69.99 ,$74.63 ,$97.20 ,$75.22 ,$14.72 ,$85.32 ,$15.96 ,$17.48 ,$17.48 ,$14.57 ,$17.48 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,30100117,80157,HC CARBAMAZEPINE FREE,301,1 ,$124.00 ,$62.00 ,$13.25 ,$124.00 ,$13.69 ,$51.56 ,$44.19 ,$13.25 ,$74.40 ,$105.40 ,$86.80 ,$13.69 ,$117.80 ,$94.24 ,$93.00 ,$22.53 ,$105.40 ,$13.25 ,$22.53 ,$13.25 ,$86.80 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$105.40 ,$29.81 ,$114.08 ,$86.80 ,$63.72 ,$63.72 ,$75.52 ,$63.72 ,$85.68 ,$111.60 ,$86.37 ,$13.38 ,$97.96 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$89.28 ,$76.88 ,$89.28 ,$89.28 ,$99.20 
ST NICHOLAS HOSPITAL - ACUTE,30100118,80158,HC CYCLOSPORINE,301,1 ,$90.00 ,$45.00 ,$18.05 ,$90.00 ,$18.65 ,$70.21 ,$60.18 ,$18.05 ,$54.00 ,$76.50 ,$63.00 ,$18.65 ,$85.50 ,$68.40 ,$67.50 ,$30.69 ,$76.50 ,$18.05 ,$30.69 ,$18.05 ,$63.00 ,$18.65 ,$18.05 ,$18.05 ,$20.43 ,$76.50 ,$40.61 ,$82.80 ,$63.00 ,$86.76 ,$86.76 ,$54.81 ,$86.76 ,$62.19 ,$81.00 ,$62.69 ,$18.23 ,$71.10 ,$19.77 ,$21.66 ,$21.66 ,$18.05 ,$21.66 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100119,80335,HC DESIPRAMINE,301,1 ,$42.00 ,$21.00 ,$3.81 ,$42.00 ,$3.81 ,$42.00 ,$42.00 , N/A ,$25.20 ,$35.70 ,$29.40 ,$3.81 ,$39.90 ,$31.92 ,$31.50 ,$38.56 ,$35.70 , N/A ,$38.56 ,$22.95 ,$29.40 ,$3.81 , N/A , N/A ,$17.64 ,$35.70 , N/A ,$38.64 ,$29.40 ,$21.30 ,$25.57 ,$25.58 ,$25.57 ,$29.02 ,$37.80 ,$29.25 , N/A ,$33.18 ,$4.04 , N/A , N/A , N/A , N/A ,$30.24 ,$26.04 ,$30.24 ,$30.24 ,$33.60 
ST NICHOLAS HOSPITAL - ACUTE,30100120,80162,HC DIGOXIN LEVELS,301,1 ,$142.00 ,$71.00 ,$13.28 ,$142.00 ,$13.72 ,$51.63 ,$44.25 ,$13.28 ,$85.20 ,$120.70 ,$99.40 ,$13.72 ,$134.90 ,$107.92 ,$106.50 ,$22.58 ,$120.70 ,$13.28 ,$22.58 ,$13.28 ,$99.40 ,$13.72 ,$13.28 ,$13.28 ,$15.03 ,$120.70 ,$29.88 ,$130.64 ,$99.40 ,$63.83 ,$63.83 ,$86.48 ,$63.83 ,$98.12 ,$127.80 ,$98.90 ,$13.41 ,$112.18 ,$14.54 ,$15.94 ,$15.94 ,$13.28 ,$15.94 ,$102.24 ,$88.04 ,$102.24 ,$102.24 ,$113.60 
ST NICHOLAS HOSPITAL - ACUTE,30100121,80164,HC VALPROIC ACID,301,1 ,$97.00 ,$48.50 ,$13.54 ,$97.00 ,$13.99 ,$52.68 ,$45.15 ,$13.54 ,$58.20 ,$82.45 ,$67.90 ,$13.99 ,$92.15 ,$73.72 ,$72.75 ,$23.02 ,$82.45 ,$13.54 ,$23.02 ,$13.54 ,$67.90 ,$13.99 ,$13.54 ,$13.54 ,$15.32 ,$82.45 ,$30.47 ,$89.24 ,$67.90 ,$65.13 ,$65.13 ,$59.07 ,$65.13 ,$67.03 ,$87.30 ,$67.56 ,$13.68 ,$76.63 ,$14.83 ,$16.25 ,$16.25 ,$13.54 ,$16.25 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100122,80335,HC DOXEPIN,301,1 ,$62.00 ,$31.00 ,$3.81 ,$62.00 ,$3.81 ,$62.00 ,$62.00 , N/A ,$37.20 ,$52.70 ,$43.40 ,$3.81 ,$58.90 ,$47.12 ,$46.50 ,$38.56 ,$52.70 , N/A ,$38.56 ,$22.95 ,$43.40 ,$3.81 , N/A , N/A ,$26.04 ,$52.70 , N/A ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$37.74 ,$42.84 ,$55.80 ,$43.18 , N/A ,$48.98 ,$4.04 , N/A , N/A , N/A , N/A ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30100123,80168,HC ZARONTIN,301,1 ,$119.00 ,$59.50 ,$16.34 ,$119.00 ,$16.88 ,$63.53 ,$54.45 ,$16.34 ,$71.40 ,$101.15 ,$83.30 ,$16.88 ,$113.05 ,$90.44 ,$89.25 ,$27.78 ,$101.15 ,$16.34 ,$27.78 ,$16.34 ,$83.30 ,$16.88 ,$16.34 ,$16.34 ,$18.49 ,$101.15 ,$36.77 ,$109.48 ,$83.30 ,$78.55 ,$78.55 ,$72.47 ,$78.55 ,$82.23 ,$107.10 ,$82.88 ,$16.50 ,$94.01 ,$17.89 ,$19.61 ,$19.61 ,$16.34 ,$19.61 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$95.20 
ST NICHOLAS HOSPITAL - ACUTE,30100124,80170,HC GENTAMICIN,301,1 ,$173.00 ,$86.50 ,$16.38 ,$173.00 ,$16.93 ,$63.70 ,$54.60 ,$16.38 ,$103.80 ,$147.05 ,$121.10 ,$16.93 ,$164.35 ,$131.48 ,$129.75 ,$27.85 ,$147.05 ,$16.38 ,$27.85 ,$16.38 ,$121.10 ,$16.93 ,$16.38 ,$16.38 ,$18.54 ,$147.05 ,$36.86 ,$159.16 ,$121.10 ,$78.77 ,$78.77 ,$105.36 ,$78.77 ,$119.54 ,$155.70 ,$120.49 ,$16.54 ,$136.67 ,$17.95 ,$19.66 ,$19.66 ,$16.38 ,$19.66 ,$124.56 ,$107.26 ,$124.56 ,$124.56 ,$138.40 
ST NICHOLAS HOSPITAL - ACUTE,30100125,80335,HC IMIPRAMINE,301,1 ,$65.00 ,$32.50 ,$3.81 ,$65.00 ,$3.81 ,$65.00 ,$65.00 , N/A ,$39.00 ,$55.25 ,$45.50 ,$3.81 ,$61.75 ,$49.40 ,$48.75 ,$38.56 ,$55.25 , N/A ,$38.56 ,$22.95 ,$45.50 ,$3.81 , N/A , N/A ,$27.30 ,$55.25 , N/A ,$59.80 ,$45.50 ,$32.97 ,$39.57 ,$39.59 ,$39.57 ,$44.92 ,$58.50 ,$45.27 , N/A ,$51.35 ,$4.04 , N/A , N/A , N/A , N/A ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,30100126,80176,HC LIDOCAINE,301,1 ,$194.00 ,$97.00 ,$14.69 ,$194.00 ,$15.18 ,$57.12 ,$48.96 ,$14.69 ,$116.40 ,$164.90 ,$135.80 ,$15.18 ,$184.30 ,$147.44 ,$145.50 ,$24.97 ,$164.90 ,$14.69 ,$24.97 ,$14.69 ,$135.80 ,$15.18 ,$14.69 ,$14.69 ,$16.63 ,$164.90 ,$33.05 ,$178.48 ,$135.80 ,$70.59 ,$70.59 ,$118.15 ,$70.59 ,$134.05 ,$174.60 ,$135.12 ,$14.84 ,$153.26 ,$16.09 ,$17.63 ,$17.63 ,$14.69 ,$17.63 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$155.20 
ST NICHOLAS HOSPITAL - ACUTE,30100127,80178,HC LITHIUM,301,1 ,$49.00 ,$24.50 ,$6.61 ,$49.00 ,$6.83 ,$25.73 ,$22.05 ,$6.61 ,$29.40 ,$41.65 ,$34.30 ,$6.83 ,$46.55 ,$37.24 ,$36.75 ,$11.24 ,$41.65 ,$6.61 ,$11.24 ,$6.61 ,$34.30 ,$6.83 ,$6.61 ,$6.61 ,$7.48 ,$41.65 ,$14.87 ,$45.08 ,$34.30 ,$31.77 ,$31.77 ,$29.84 ,$31.77 ,$33.86 ,$44.10 ,$34.13 ,$6.68 ,$38.71 ,$7.24 ,$7.93 ,$7.93 ,$6.61 ,$7.93 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,30100128,80335,HC NORTRIPTYLINE,301,1 ,$85.00 ,$42.50 ,$3.81 ,$85.00 ,$3.81 ,$80.88 ,$69.32 , N/A ,$51.00 ,$72.25 ,$59.50 ,$3.81 ,$80.75 ,$64.60 ,$63.75 ,$38.56 ,$72.25 , N/A ,$38.56 ,$22.95 ,$59.50 ,$3.81 , N/A , N/A ,$35.70 ,$72.25 , N/A ,$78.20 ,$59.50 ,$43.11 ,$51.74 ,$51.77 ,$51.74 ,$58.74 ,$76.50 ,$59.20 , N/A ,$67.15 ,$4.04 , N/A , N/A , N/A , N/A ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30100129,80184,HC PHENOBARBITAL,301,1 ,$97.00 ,$48.50 ,$15.30 ,$97.00 ,$15.81 ,$53.55 ,$45.90 ,$15.30 ,$58.20 ,$82.45 ,$67.90 ,$15.81 ,$92.15 ,$73.72 ,$72.75 ,$26.01 ,$82.45 ,$15.30 ,$26.01 ,$15.30 ,$67.90 ,$15.81 ,$15.30 ,$15.30 ,$17.32 ,$82.45 ,$34.43 ,$89.24 ,$67.90 ,$55.02 ,$55.02 ,$59.07 ,$55.02 ,$67.03 ,$87.30 ,$67.56 ,$15.45 ,$76.63 ,$16.76 ,$18.36 ,$18.36 ,$15.30 ,$18.36 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100130,80185,HC PHENYTOIN TOTAL,301,1 ,$97.00 ,$48.50 ,$13.25 ,$97.00 ,$13.69 ,$51.56 ,$44.19 ,$13.25 ,$58.20 ,$82.45 ,$67.90 ,$13.69 ,$92.15 ,$73.72 ,$72.75 ,$22.53 ,$82.45 ,$13.25 ,$22.53 ,$13.25 ,$67.90 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$82.45 ,$29.81 ,$89.24 ,$67.90 ,$63.72 ,$63.72 ,$59.07 ,$63.72 ,$67.03 ,$87.30 ,$67.56 ,$13.38 ,$76.63 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100131,80186,HC PHENYTOIN FREE,301,1 ,$76.00 ,$38.00 ,$13.76 ,$76.00 ,$14.22 ,$53.52 ,$45.87 ,$13.76 ,$45.60 ,$64.60 ,$53.20 ,$14.22 ,$72.20 ,$57.76 ,$57.00 ,$23.39 ,$64.60 ,$13.76 ,$23.39 ,$13.76 ,$53.20 ,$14.22 ,$13.76 ,$13.76 ,$15.57 ,$64.60 ,$30.96 ,$69.92 ,$53.20 ,$56.40 ,$56.40 ,$46.28 ,$56.40 ,$52.52 ,$68.40 ,$52.93 ,$13.90 ,$60.04 ,$15.07 ,$16.51 ,$16.51 ,$13.76 ,$16.51 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$60.80 
ST NICHOLAS HOSPITAL - ACUTE,30100132,80188,HC PRIMIDONE,301,1 ,$97.00 ,$48.50 ,$16.59 ,$97.00 ,$17.14 ,$64.54 ,$55.32 ,$16.59 ,$58.20 ,$82.45 ,$67.90 ,$17.14 ,$92.15 ,$73.72 ,$72.75 ,$28.20 ,$82.45 ,$16.59 ,$28.20 ,$16.59 ,$67.90 ,$17.14 ,$16.59 ,$16.59 ,$18.78 ,$82.45 ,$37.33 ,$89.24 ,$67.90 ,$79.75 ,$79.75 ,$59.07 ,$79.75 ,$67.03 ,$87.30 ,$67.56 ,$16.76 ,$76.63 ,$18.17 ,$19.91 ,$19.91 ,$16.59 ,$19.91 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100133,80192,HC PROCAINEAMIDE,301,1 ,$115.00 ,$57.50 ,$16.75 ,$115.00 ,$17.31 ,$65.14 ,$55.83 ,$16.75 ,$69.00 ,$97.75 ,$80.50 ,$17.31 ,$109.25 ,$87.40 ,$86.25 ,$28.48 ,$97.75 ,$16.75 ,$28.48 ,$16.75 ,$80.50 ,$17.31 ,$16.75 ,$16.75 ,$18.96 ,$97.75 ,$37.69 ,$105.80 ,$80.50 ,$80.49 ,$80.49 ,$70.04 ,$80.49 ,$79.47 ,$103.50 ,$80.10 ,$16.92 ,$90.85 ,$18.35 ,$20.10 ,$20.10 ,$16.75 ,$20.10 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30100134,80194,HC QUINIDINE,301,1 ,$110.00 ,$55.00 ,$14.60 ,$110.00 ,$15.09 ,$56.77 ,$48.66 ,$14.60 ,$66.00 ,$93.50 ,$77.00 ,$15.09 ,$104.50 ,$83.60 ,$82.50 ,$24.82 ,$93.50 ,$14.60 ,$24.82 ,$14.60 ,$77.00 ,$15.09 ,$14.60 ,$14.60 ,$16.52 ,$93.50 ,$32.85 ,$101.20 ,$77.00 ,$70.17 ,$70.17 ,$66.99 ,$70.17 ,$76.01 ,$99.00 ,$76.62 ,$14.75 ,$86.90 ,$16.00 ,$17.52 ,$17.52 ,$14.60 ,$17.52 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30100135,80195,HC RAPAMYCIN (SIROLIMUS),301,1 ,$86.00 ,$43.00 ,$13.73 ,$86.00 ,$14.19 ,$53.41 ,$45.78 ,$13.73 ,$51.60 ,$73.10 ,$60.20 ,$14.19 ,$81.70 ,$65.36 ,$64.50 ,$23.34 ,$73.10 ,$13.73 ,$23.34 ,$13.73 ,$60.20 ,$14.19 ,$13.73 ,$13.73 ,$15.54 ,$73.10 ,$30.89 ,$79.12 ,$60.20 ,$65.98 ,$65.98 ,$52.37 ,$65.98 ,$59.43 ,$77.40 ,$59.90 ,$13.87 ,$67.94 ,$15.04 ,$16.48 ,$16.48 ,$13.73 ,$16.48 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30100136,G0480,HC SALICYLATE,301,1 ,$180.00 ,$90.00 ,$63.95 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$114.43 ,$108.00 ,$153.00 ,$126.00 ,$63.95 ,$171.00 ,$136.80 ,$135.00 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$114.43 ,$126.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$162.00 ,$125.37 ,$115.57 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100137,80197,HC TACROLIMUS,301,1 ,$97.00 ,$48.50 ,$13.73 ,$97.00 ,$14.19 ,$53.41 ,$45.78 ,$13.73 ,$58.20 ,$82.45 ,$67.90 ,$14.19 ,$92.15 ,$73.72 ,$72.75 ,$23.34 ,$82.45 ,$13.73 ,$23.34 ,$13.73 ,$67.90 ,$14.19 ,$13.73 ,$13.73 ,$15.54 ,$82.45 ,$30.89 ,$89.24 ,$67.90 ,$65.98 ,$65.98 ,$59.07 ,$65.98 ,$67.03 ,$87.30 ,$67.56 ,$13.87 ,$76.63 ,$15.04 ,$16.48 ,$16.48 ,$13.73 ,$16.48 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100138,80198,HC THEOPHYLLINE,301,1 ,$86.00 ,$43.00 ,$14.14 ,$86.00 ,$14.61 ,$54.99 ,$47.13 ,$14.14 ,$51.60 ,$73.10 ,$60.20 ,$14.61 ,$81.70 ,$65.36 ,$64.50 ,$24.04 ,$73.10 ,$14.14 ,$24.04 ,$14.14 ,$60.20 ,$14.61 ,$14.14 ,$14.14 ,$16.00 ,$73.10 ,$31.82 ,$79.12 ,$60.20 ,$67.99 ,$67.99 ,$52.37 ,$67.99 ,$59.43 ,$77.40 ,$59.90 ,$14.28 ,$67.94 ,$15.49 ,$16.97 ,$16.97 ,$14.14 ,$16.97 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30100139,80200,HC TOBRAMYCIN,301,1 ,$97.00 ,$48.50 ,$16.13 ,$97.00 ,$16.67 ,$62.72 ,$53.76 ,$16.13 ,$58.20 ,$82.45 ,$67.90 ,$16.67 ,$92.15 ,$73.72 ,$72.75 ,$27.42 ,$82.45 ,$16.13 ,$27.42 ,$16.13 ,$67.90 ,$16.67 ,$16.13 ,$16.13 ,$18.26 ,$82.45 ,$36.29 ,$89.24 ,$67.90 ,$77.46 ,$77.46 ,$59.07 ,$77.46 ,$67.03 ,$87.30 ,$67.56 ,$16.29 ,$76.63 ,$17.67 ,$19.36 ,$19.36 ,$16.13 ,$19.36 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100140,80201,HC TOPIRAMATE,301,1 ,$97.00 ,$48.50 ,$11.92 ,$97.00 ,$12.32 ,$46.34 ,$39.72 ,$11.92 ,$58.20 ,$82.45 ,$67.90 ,$12.32 ,$92.15 ,$73.72 ,$72.75 ,$20.26 ,$82.45 ,$11.92 ,$20.26 ,$11.92 ,$67.90 ,$12.32 ,$11.92 ,$11.92 ,$13.49 ,$82.45 ,$26.82 ,$89.24 ,$67.90 ,$57.31 ,$57.31 ,$59.07 ,$57.31 ,$67.03 ,$87.30 ,$67.56 ,$12.04 ,$76.63 ,$13.06 ,$14.30 ,$14.30 ,$11.92 ,$14.30 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,30100141,80202,HC VANCOMYCIN,301,1 ,$119.00 ,$59.50 ,$13.54 ,$119.00 ,$13.99 ,$52.68 ,$45.15 ,$13.54 ,$71.40 ,$101.15 ,$83.30 ,$13.99 ,$113.05 ,$90.44 ,$89.25 ,$23.02 ,$101.15 ,$13.54 ,$23.02 ,$13.54 ,$83.30 ,$13.99 ,$13.54 ,$13.54 ,$15.32 ,$101.15 ,$30.47 ,$109.48 ,$83.30 ,$65.13 ,$65.13 ,$72.47 ,$65.13 ,$82.23 ,$107.10 ,$82.88 ,$13.68 ,$94.01 ,$14.83 ,$16.25 ,$16.25 ,$13.54 ,$16.25 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$95.20 
ST NICHOLAS HOSPITAL - ACUTE,30100142,80299,HC WARFARIN,301,1 ,$156.00 ,$78.00 ,$18.64 ,$156.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$93.60 ,$132.60 ,$109.20 ,$19.26 ,$148.20 ,$118.56 ,$117.00 ,$31.69 ,$132.60 ,$18.64 ,$31.69 ,$18.64 ,$109.20 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$132.60 ,$41.94 ,$143.52 ,$109.20 ,$65.80 ,$65.80 ,$95.00 ,$65.80 ,$107.80 ,$140.40 ,$108.65 ,$18.83 ,$123.24 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$112.32 ,$96.72 ,$112.32 ,$112.32 ,$124.80 
ST NICHOLAS HOSPITAL - ACUTE,30100143,80299,HC FELBAMATE,301,1 ,$162.00 ,$81.00 ,$18.64 ,$162.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$97.20 ,$137.70 ,$113.40 ,$19.26 ,$153.90 ,$123.12 ,$121.50 ,$31.69 ,$137.70 ,$18.64 ,$31.69 ,$18.64 ,$113.40 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$137.70 ,$41.94 ,$149.04 ,$113.40 ,$65.80 ,$65.80 ,$98.66 ,$65.80 ,$111.94 ,$145.80 ,$112.83 ,$18.83 ,$127.98 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,30100144,80299,HC IBUPROFEN,301,1 ,$123.00 ,$61.50 ,$18.64 ,$123.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$73.80 ,$104.55 ,$86.10 ,$19.26 ,$116.85 ,$93.48 ,$92.25 ,$31.69 ,$104.55 ,$18.64 ,$31.69 ,$18.64 ,$86.10 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$104.55 ,$41.94 ,$113.16 ,$86.10 ,$65.80 ,$65.80 ,$74.91 ,$65.80 ,$84.99 ,$110.70 ,$85.67 ,$18.83 ,$97.17 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100145,80187,HC FLECAINAIDE,301,1 ,$50.00 ,$25.00 ,$21.69 ,$61.00 ,$21.69 ,$50.00 ,$50.00 ,$27.11 ,$30.00 ,$42.50 ,$35.00 ,$21.69 ,$47.50 ,$38.00 ,$37.50 ,$46.09 ,$42.50 ,$27.11 ,$46.09 ,$27.11 ,$35.00 ,$21.69 ,$27.11 ,$27.11 ,$30.68 ,$42.50 ,$61.00 ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.83 ,$27.38 ,$39.50 ,$22.99 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30100146,80171,HC GABAPENTIN PLASMA,301,1 ,$110.00 ,$55.00 ,$14.48 ,$110.00 ,$14.48 ,$75.85 ,$65.01 ,$21.67 ,$66.00 ,$93.50 ,$77.00 ,$14.48 ,$104.50 ,$83.60 ,$82.50 ,$36.84 ,$93.50 ,$21.67 ,$36.84 ,$21.67 ,$77.00 ,$14.48 ,$21.67 ,$21.67 ,$24.53 ,$93.50 ,$48.76 ,$101.20 ,$77.00 ,$63.72 ,$63.72 ,$66.99 ,$63.72 ,$76.01 ,$99.00 ,$76.62 ,$21.89 ,$86.90 ,$15.35 ,$26.00 ,$26.00 ,$21.67 ,$26.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30100147,80175,HC LAMOTRIGINE,301,1 ,$90.00 ,$45.00 ,$13.25 ,$90.00 ,$13.69 ,$51.56 ,$44.19 ,$13.25 ,$54.00 ,$76.50 ,$63.00 ,$13.69 ,$85.50 ,$68.40 ,$67.50 ,$22.53 ,$76.50 ,$13.25 ,$22.53 ,$13.25 ,$63.00 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$76.50 ,$29.81 ,$82.80 ,$63.00 ,$63.72 ,$63.72 ,$54.81 ,$63.72 ,$62.19 ,$81.00 ,$62.69 ,$13.38 ,$71.10 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100148,80183,HC TRILEPTAL,301,1 ,$100.00 ,$50.00 ,$13.25 ,$100.00 ,$13.69 ,$51.56 ,$44.19 ,$13.25 ,$60.00 ,$85.00 ,$70.00 ,$13.69 ,$95.00 ,$76.00 ,$75.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$13.25 ,$70.00 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$63.72 ,$63.72 ,$60.90 ,$63.72 ,$69.10 ,$90.00 ,$69.65 ,$13.38 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100149,80177,HC KEPPRA,301,1 ,$110.00 ,$55.00 ,$13.25 ,$110.00 ,$13.69 ,$51.56 ,$44.19 ,$13.25 ,$66.00 ,$93.50 ,$77.00 ,$13.69 ,$104.50 ,$83.60 ,$82.50 ,$22.53 ,$93.50 ,$13.25 ,$22.53 ,$13.25 ,$77.00 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$93.50 ,$29.81 ,$101.20 ,$77.00 ,$63.72 ,$63.72 ,$66.99 ,$63.72 ,$76.01 ,$99.00 ,$76.62 ,$13.38 ,$86.90 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30100150,80203,HC ZONISAMIDE,301,1 ,$100.00 ,$50.00 ,$13.25 ,$100.00 ,$13.69 ,$51.56 ,$44.19 ,$13.25 ,$60.00 ,$85.00 ,$70.00 ,$13.69 ,$95.00 ,$76.00 ,$75.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$13.25 ,$70.00 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$63.72 ,$63.72 ,$60.90 ,$63.72 ,$69.10 ,$90.00 ,$69.65 ,$13.38 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100151,80199,HC TIAGABINE,301,1 ,$120.00 ,$60.00 ,$19.70 ,$120.00 ,$19.70 ,$94.89 ,$81.33 ,$27.11 ,$72.00 ,$102.00 ,$84.00 ,$19.70 ,$114.00 ,$91.20 ,$90.00 ,$46.09 ,$102.00 ,$27.11 ,$46.09 ,$27.11 ,$84.00 ,$19.70 ,$27.11 ,$27.11 ,$30.68 ,$102.00 ,$61.00 ,$110.40 ,$84.00 ,$86.76 ,$86.76 ,$73.08 ,$86.76 ,$82.92 ,$108.00 ,$83.58 ,$27.38 ,$94.80 ,$20.88 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100152,80299,HC TRAZODONE,301,1 ,$162.00 ,$81.00 ,$18.64 ,$162.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$97.20 ,$137.70 ,$113.40 ,$19.26 ,$153.90 ,$123.12 ,$121.50 ,$31.69 ,$137.70 ,$18.64 ,$31.69 ,$18.64 ,$113.40 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$137.70 ,$41.94 ,$149.04 ,$113.40 ,$65.80 ,$65.80 ,$98.66 ,$65.80 ,$111.94 ,$145.80 ,$112.83 ,$18.83 ,$127.98 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,30100153,80299,HC RITALIN,301,1 ,$91.00 ,$45.50 ,$18.64 ,$91.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$54.60 ,$77.35 ,$63.70 ,$19.26 ,$86.45 ,$69.16 ,$68.25 ,$31.69 ,$77.35 ,$18.64 ,$31.69 ,$18.64 ,$63.70 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$77.35 ,$41.94 ,$83.72 ,$63.70 ,$65.80 ,$65.80 ,$55.42 ,$65.80 ,$62.88 ,$81.90 ,$63.38 ,$18.83 ,$71.89 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$65.52 ,$56.42 ,$65.52 ,$65.52 ,$72.80 
ST NICHOLAS HOSPITAL - ACUTE,30100154,80299,HC AMIODARONE,301,1 ,$162.00 ,$81.00 ,$18.64 ,$162.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$97.20 ,$137.70 ,$113.40 ,$19.26 ,$153.90 ,$123.12 ,$121.50 ,$31.69 ,$137.70 ,$18.64 ,$31.69 ,$18.64 ,$113.40 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$137.70 ,$41.94 ,$149.04 ,$113.40 ,$65.80 ,$65.80 ,$98.66 ,$65.80 ,$111.94 ,$145.80 ,$112.83 ,$18.83 ,$127.98 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,30100155,81099,HC INBORN ERR METABOLISM,301,1 ,$661.00 ,$330.50 ,$0.87 ,$661.00 ,$0.87 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$0.87 ,$627.95 ,$502.36 ,$495.75 , N/A ,$561.85 , N/A , N/A , N/A ,$462.70 ,$0.87 , N/A , N/A ,$277.62 ,$561.85 ,$396.60 ,$608.12 ,$462.70 ,$335.26 ,$402.35 ,$402.55 ,$402.35 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$0.92 ,$330.50 ,$330.50 , N/A ,$330.50 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,30100156,G0480,HC ACETAMINOPHEN,301,1 ,$200.00 ,$100.00 ,$63.95 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$114.43 ,$120.00 ,$170.00 ,$140.00 ,$63.95 ,$190.00 ,$152.00 ,$150.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$114.43 ,$140.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$180.00 ,$139.30 ,$115.57 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30100157,82009,HC ACETONE SERUM,301,1 ,$48.00 ,$24.00 ,$4.52 ,$48.00 ,$4.67 ,$17.57 ,$15.06 ,$4.52 ,$28.80 ,$40.80 ,$33.60 ,$4.67 ,$45.60 ,$36.48 ,$36.00 ,$7.68 ,$40.80 ,$4.52 ,$7.68 ,$4.52 ,$33.60 ,$4.67 ,$4.52 ,$4.52 ,$5.12 ,$40.80 ,$10.17 ,$44.16 ,$33.60 ,$21.70 ,$21.70 ,$29.23 ,$21.70 ,$33.17 ,$43.20 ,$33.43 ,$4.57 ,$37.92 ,$4.95 ,$5.42 ,$5.42 ,$4.52 ,$5.42 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$55.00 ,$27.50 ,$8.17 ,$55.00 ,$8.44 ,$31.78 ,$27.24 ,$8.17 ,$33.00 ,$46.75 ,$38.50 ,$8.44 ,$52.25 ,$41.80 ,$41.25 ,$13.89 ,$46.75 ,$8.17 ,$13.89 ,$8.17 ,$38.50 ,$8.44 ,$8.17 ,$8.17 ,$9.25 ,$46.75 ,$18.38 ,$50.60 ,$38.50 ,$39.28 ,$39.28 ,$33.50 ,$39.28 ,$38.01 ,$49.50 ,$38.31 ,$8.25 ,$43.45 ,$8.95 ,$9.80 ,$9.80 ,$8.17 ,$9.80 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,30100159,82017,HC ACYLCARNITINES QN EA SPEC,301,1 ,$482.00 ,$241.00 ,$16.87 ,$482.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$289.20 ,$409.70 ,$337.40 ,$17.43 ,$457.90 ,$366.32 ,$361.50 ,$28.68 ,$409.70 ,$16.87 ,$28.68 ,$16.87 ,$337.40 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$409.70 ,$37.96 ,$443.44 ,$337.40 ,$69.25 ,$69.25 ,$293.54 ,$69.25 ,$333.06 ,$433.80 ,$335.71 ,$17.04 ,$380.78 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,30100160,82017,HC FATTY ACID OXIDATION SCREEN,301,1 ,$17.00 ,$8.50 ,$8.50 ,$37.96 ,$17.00 ,$17.00 ,$17.00 ,$16.87 ,$10.20 ,$14.45 ,$11.90 ,$17.00 ,$16.15 ,$12.92 ,$12.75 ,$17.00 ,$14.45 ,$16.87 ,$17.00 ,$16.87 ,$11.90 ,$17.00 ,$16.87 ,$16.87 ,$17.00 ,$14.45 ,$37.96 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$15.30 ,$11.84 ,$17.04 ,$13.43 ,$18.02 ,$17.00 ,$17.00 ,$16.87 ,$17.00 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,30100161,82017,HC ORGANIC ACIDEMIA SCREEN,301,1 ,$17.00 ,$8.50 ,$8.50 ,$37.96 ,$17.00 ,$17.00 ,$17.00 ,$16.87 ,$10.20 ,$14.45 ,$11.90 ,$17.00 ,$16.15 ,$12.92 ,$12.75 ,$17.00 ,$14.45 ,$16.87 ,$17.00 ,$16.87 ,$11.90 ,$17.00 ,$16.87 ,$16.87 ,$17.00 ,$14.45 ,$37.96 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$15.30 ,$11.84 ,$17.04 ,$13.43 ,$18.02 ,$17.00 ,$17.00 ,$16.87 ,$17.00 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,30100162,82017,HC ACYLCARNITINES QN PLASMA MAYO,301,1 ,$433.00 ,$216.50 ,$16.87 ,$433.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$259.80 ,$368.05 ,$303.10 ,$17.43 ,$411.35 ,$329.08 ,$324.75 ,$28.68 ,$368.05 ,$16.87 ,$28.68 ,$16.87 ,$303.10 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$368.05 ,$37.96 ,$398.36 ,$303.10 ,$69.25 ,$69.25 ,$263.70 ,$69.25 ,$299.20 ,$389.70 ,$301.58 ,$17.04 ,$342.07 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$311.76 ,$268.46 ,$311.76 ,$311.76 ,$346.40 
ST NICHOLAS HOSPITAL - ACUTE,30100163,82024,HC ACTH,301,1 ,$291.00 ,$145.50 ,$38.62 ,$291.00 ,$39.91 ,$150.19 ,$128.73 ,$38.62 ,$174.60 ,$247.35 ,$203.70 ,$39.91 ,$276.45 ,$221.16 ,$218.25 ,$65.65 ,$247.35 ,$38.62 ,$65.65 ,$38.62 ,$203.70 ,$39.91 ,$38.62 ,$38.62 ,$43.71 ,$247.35 ,$86.90 ,$267.72 ,$203.70 ,$185.64 ,$185.64 ,$177.22 ,$185.64 ,$201.08 ,$261.90 ,$202.68 ,$39.01 ,$229.89 ,$42.30 ,$46.34 ,$46.34 ,$38.62 ,$46.34 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30100164,82040,HC ALBUMIN,301,1 ,$38.00 ,$19.00 ,$4.95 ,$38.00 ,$5.11 ,$19.25 ,$16.50 ,$4.95 ,$22.80 ,$32.30 ,$26.60 ,$5.11 ,$36.10 ,$28.88 ,$28.50 ,$8.42 ,$32.30 ,$4.95 ,$8.42 ,$4.95 ,$26.60 ,$5.11 ,$4.95 ,$4.95 ,$5.60 ,$32.30 ,$11.14 ,$34.96 ,$26.60 ,$23.78 ,$23.78 ,$23.14 ,$23.78 ,$26.26 ,$34.20 ,$26.47 ,$5.00 ,$30.02 ,$5.42 ,$5.94 ,$5.94 ,$4.95 ,$5.94 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100165,82040,HC ALBUMIN SERUM,301,1 ,$38.00 ,$19.00 ,$4.95 ,$38.00 ,$5.11 ,$19.25 ,$16.50 ,$4.95 ,$22.80 ,$32.30 ,$26.60 ,$5.11 ,$36.10 ,$28.88 ,$28.50 ,$8.42 ,$32.30 ,$4.95 ,$8.42 ,$4.95 ,$26.60 ,$5.11 ,$4.95 ,$4.95 ,$5.60 ,$32.30 ,$11.14 ,$34.96 ,$26.60 ,$23.78 ,$23.78 ,$23.14 ,$23.78 ,$26.26 ,$34.20 ,$26.47 ,$5.00 ,$30.02 ,$5.42 ,$5.94 ,$5.94 ,$4.95 ,$5.94 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100166,82042,HC ALBUMIN BODY FLUID,301,1 ,$67.00 ,$33.50 ,$7.27 ,$67.00 ,$7.27 ,$27.23 ,$23.34 ,$7.78 ,$40.20 ,$56.95 ,$46.90 ,$7.27 ,$63.65 ,$50.92 ,$50.25 ,$13.23 ,$56.95 ,$7.78 ,$13.23 ,$7.78 ,$46.90 ,$7.27 ,$7.78 ,$7.78 ,$8.81 ,$56.95 ,$17.51 ,$61.64 ,$46.90 ,$24.87 ,$24.87 ,$40.80 ,$24.87 ,$46.30 ,$60.30 ,$46.67 ,$7.86 ,$52.93 ,$7.71 ,$9.34 ,$9.34 ,$7.78 ,$9.34 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100167,82042,HC ALBUMIN CSF,301,1 ,$67.00 ,$33.50 ,$7.27 ,$67.00 ,$7.27 ,$27.23 ,$23.34 ,$7.78 ,$40.20 ,$56.95 ,$46.90 ,$7.27 ,$63.65 ,$50.92 ,$50.25 ,$13.23 ,$56.95 ,$7.78 ,$13.23 ,$7.78 ,$46.90 ,$7.27 ,$7.78 ,$7.78 ,$8.81 ,$56.95 ,$17.51 ,$61.64 ,$46.90 ,$24.87 ,$24.87 ,$40.80 ,$24.87 ,$46.30 ,$60.30 ,$46.67 ,$7.86 ,$52.93 ,$7.71 ,$9.34 ,$9.34 ,$7.78 ,$9.34 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$54.00 ,$27.00 ,$5.78 ,$54.00 ,$5.97 ,$22.47 ,$19.26 ,$5.78 ,$32.40 ,$45.90 ,$37.80 ,$5.97 ,$51.30 ,$41.04 ,$40.50 ,$9.83 ,$45.90 ,$5.78 ,$9.83 ,$5.78 ,$37.80 ,$5.97 ,$5.78 ,$5.78 ,$6.54 ,$45.90 ,$13.01 ,$49.68 ,$37.80 ,$27.79 ,$27.79 ,$32.89 ,$27.79 ,$37.31 ,$48.60 ,$37.61 ,$5.84 ,$42.66 ,$6.33 ,$6.94 ,$6.94 ,$5.78 ,$6.94 ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$43.20 
ST NICHOLAS HOSPITAL - ACUTE,30100169,G0480,HC ALCOHOL (ETOH),301,1 ,$180.00 ,$90.00 ,$63.95 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$114.43 ,$108.00 ,$153.00 ,$126.00 ,$63.95 ,$171.00 ,$136.80 ,$135.00 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$114.43 ,$126.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$162.00 ,$125.37 ,$115.57 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100170,82085,HC ALDOLASE,301,1 ,$67.00 ,$33.50 ,$9.71 ,$67.00 ,$10.03 ,$37.77 ,$32.37 ,$9.71 ,$40.20 ,$56.95 ,$46.90 ,$10.03 ,$63.65 ,$50.92 ,$50.25 ,$16.51 ,$56.95 ,$9.71 ,$16.51 ,$9.71 ,$46.90 ,$10.03 ,$9.71 ,$9.71 ,$10.99 ,$56.95 ,$21.85 ,$61.64 ,$46.90 ,$46.64 ,$46.64 ,$40.80 ,$46.64 ,$46.30 ,$60.30 ,$46.67 ,$9.81 ,$52.93 ,$10.63 ,$11.65 ,$11.65 ,$9.71 ,$11.65 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100171,82088,HC ALDOSTERONE,301,1 ,$314.00 ,$157.00 ,$40.75 ,$314.00 ,$42.11 ,$158.48 ,$135.84 ,$40.75 ,$188.40 ,$266.90 ,$219.80 ,$42.11 ,$298.30 ,$238.64 ,$235.50 ,$69.28 ,$266.90 ,$40.75 ,$69.28 ,$40.75 ,$219.80 ,$42.11 ,$40.75 ,$40.75 ,$46.12 ,$266.90 ,$91.69 ,$288.88 ,$219.80 ,$195.86 ,$195.86 ,$191.23 ,$195.86 ,$216.97 ,$282.60 ,$218.70 ,$41.16 ,$248.06 ,$44.64 ,$48.90 ,$48.90 ,$40.75 ,$48.90 ,$226.08 ,$194.68 ,$226.08 ,$226.08 ,$251.20 
ST NICHOLAS HOSPITAL - ACUTE,30100172,82103,HC ALPHA-1 ANTITRYPSIN TOTAL,301,1 ,$101.00 ,$50.50 ,$13.44 ,$101.00 ,$13.89 ,$52.26 ,$44.79 ,$13.44 ,$60.60 ,$85.85 ,$70.70 ,$13.89 ,$95.95 ,$76.76 ,$75.75 ,$22.85 ,$85.85 ,$13.44 ,$22.85 ,$13.44 ,$70.70 ,$13.89 ,$13.44 ,$13.44 ,$15.21 ,$85.85 ,$30.24 ,$92.92 ,$70.70 ,$64.57 ,$64.57 ,$61.51 ,$64.57 ,$69.79 ,$90.90 ,$70.35 ,$13.57 ,$79.79 ,$14.72 ,$16.13 ,$16.13 ,$13.44 ,$16.13 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100173,82103,HC A-1 ANTITRYPSIN TOTAL,301,1 ,$101.00 ,$50.50 ,$13.44 ,$101.00 ,$13.89 ,$52.26 ,$44.79 ,$13.44 ,$60.60 ,$85.85 ,$70.70 ,$13.89 ,$95.95 ,$76.76 ,$75.75 ,$22.85 ,$85.85 ,$13.44 ,$22.85 ,$13.44 ,$70.70 ,$13.89 ,$13.44 ,$13.44 ,$15.21 ,$85.85 ,$30.24 ,$92.92 ,$70.70 ,$64.57 ,$64.57 ,$61.51 ,$64.57 ,$69.79 ,$90.90 ,$70.35 ,$13.57 ,$79.79 ,$14.72 ,$16.13 ,$16.13 ,$13.44 ,$16.13 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100174,82104,HC ANTITRYPSIN PHENO,301,1 ,$148.00 ,$74.00 ,$14.46 ,$148.00 ,$14.94 ,$56.25 ,$48.21 ,$14.46 ,$88.80 ,$125.80 ,$103.60 ,$14.94 ,$140.60 ,$112.48 ,$111.00 ,$24.58 ,$125.80 ,$14.46 ,$24.58 ,$14.46 ,$103.60 ,$14.94 ,$14.46 ,$14.46 ,$16.37 ,$125.80 ,$32.54 ,$136.16 ,$103.60 ,$69.50 ,$69.50 ,$90.13 ,$69.50 ,$102.27 ,$133.20 ,$103.08 ,$14.60 ,$116.92 ,$15.84 ,$17.35 ,$17.35 ,$14.46 ,$17.35 ,$106.56 ,$91.76 ,$106.56 ,$106.56 ,$118.40 
ST NICHOLAS HOSPITAL - ACUTE,30100175,82105,HC ALPHA FETOPROTEIN SERUM,301,1 ,$123.00 ,$61.50 ,$16.77 ,$123.00 ,$17.33 ,$65.24 ,$55.92 ,$16.77 ,$73.80 ,$104.55 ,$86.10 ,$17.33 ,$116.85 ,$93.48 ,$92.25 ,$28.51 ,$104.55 ,$16.77 ,$28.51 ,$16.77 ,$86.10 ,$17.33 ,$16.77 ,$16.77 ,$18.98 ,$104.55 ,$37.73 ,$113.16 ,$86.10 ,$80.63 ,$80.63 ,$74.91 ,$80.63 ,$84.99 ,$110.70 ,$85.67 ,$16.94 ,$97.17 ,$18.37 ,$20.12 ,$20.12 ,$16.77 ,$20.12 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100177,82105,HC QUAD AFP,301,1 ,$123.00 ,$61.50 ,$16.77 ,$123.00 ,$17.33 ,$65.24 ,$55.92 ,$16.77 ,$73.80 ,$104.55 ,$86.10 ,$17.33 ,$116.85 ,$93.48 ,$92.25 ,$28.51 ,$104.55 ,$16.77 ,$28.51 ,$16.77 ,$86.10 ,$17.33 ,$16.77 ,$16.77 ,$18.98 ,$104.55 ,$37.73 ,$113.16 ,$86.10 ,$80.63 ,$80.63 ,$74.91 ,$80.63 ,$84.99 ,$110.70 ,$85.67 ,$16.94 ,$97.17 ,$18.37 ,$20.12 ,$20.12 ,$16.77 ,$20.12 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100178,82105,HC AFP MATERNAL,301,1 ,$123.00 ,$61.50 ,$16.77 ,$123.00 ,$17.33 ,$65.24 ,$55.92 ,$16.77 ,$73.80 ,$104.55 ,$86.10 ,$17.33 ,$116.85 ,$93.48 ,$92.25 ,$28.51 ,$104.55 ,$16.77 ,$28.51 ,$16.77 ,$86.10 ,$17.33 ,$16.77 ,$16.77 ,$18.98 ,$104.55 ,$37.73 ,$113.16 ,$86.10 ,$80.63 ,$80.63 ,$74.91 ,$80.63 ,$84.99 ,$110.70 ,$85.67 ,$16.94 ,$97.17 ,$18.37 ,$20.12 ,$20.12 ,$16.77 ,$20.12 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100179,82108,HC ALUMINUM,301,1 ,$157.00 ,$78.50 ,$25.48 ,$157.00 ,$26.33 ,$99.09 ,$84.93 ,$25.48 ,$94.20 ,$133.45 ,$109.90 ,$26.33 ,$149.15 ,$119.32 ,$117.75 ,$43.32 ,$133.45 ,$25.48 ,$43.32 ,$25.48 ,$109.90 ,$26.33 ,$25.48 ,$25.48 ,$28.84 ,$133.45 ,$57.33 ,$144.44 ,$109.90 ,$122.45 ,$122.45 ,$95.61 ,$122.45 ,$108.49 ,$141.30 ,$109.35 ,$25.73 ,$124.03 ,$27.91 ,$30.58 ,$30.58 ,$25.48 ,$30.58 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30100180,82131,HC AMINO ACID QN SINGLE,301,1 ,$170.00 ,$85.00 ,$21.01 ,$170.00 ,$21.01 ,$80.43 ,$68.94 ,$22.98 ,$102.00 ,$144.50 ,$119.00 ,$21.01 ,$161.50 ,$129.20 ,$127.50 ,$39.07 ,$144.50 ,$22.98 ,$39.07 ,$22.98 ,$119.00 ,$21.01 ,$22.98 ,$22.98 ,$26.01 ,$144.50 ,$51.71 ,$156.40 ,$119.00 ,$81.06 ,$81.06 ,$103.53 ,$81.06 ,$117.47 ,$153.00 ,$118.41 ,$23.21 ,$134.30 ,$22.27 ,$27.58 ,$27.58 ,$22.98 ,$27.58 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,30100181,82131,HC CYSTINE,301,1 ,$170.00 ,$85.00 ,$21.01 ,$170.00 ,$21.01 ,$80.43 ,$68.94 ,$22.98 ,$102.00 ,$144.50 ,$119.00 ,$21.01 ,$161.50 ,$129.20 ,$127.50 ,$39.07 ,$144.50 ,$22.98 ,$39.07 ,$22.98 ,$119.00 ,$21.01 ,$22.98 ,$22.98 ,$26.01 ,$144.50 ,$51.71 ,$156.40 ,$119.00 ,$81.06 ,$81.06 ,$103.53 ,$81.06 ,$117.47 ,$153.00 ,$118.41 ,$23.21 ,$134.30 ,$22.27 ,$27.58 ,$27.58 ,$22.98 ,$27.58 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,30100182,82139,HC AMINO ACID 6+ QN PLASMA,301,1 ,"$1,120.00 ",$560.00 ,$16.87 ,"$1,120.00 ",$17.43 ,$65.59 ,$56.22 ,$16.87 ,$672.00 ,$952.00 ,$784.00 ,$17.43 ,"$1,064.00 ",$851.20 ,$840.00 ,$28.68 ,$952.00 ,$16.87 ,$28.68 ,$16.87 ,$784.00 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$952.00 ,$37.96 ,"$1,030.40 ",$784.00 ,$69.25 ,$69.25 ,$682.08 ,$69.25 ,$773.92 ,"$1,008.00 ",$780.08 ,$17.04 ,$884.80 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,30100183,82139,HC AMINO ACID 6+ QN URINE,301,1 ,$482.00 ,$241.00 ,$16.87 ,$482.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$289.20 ,$409.70 ,$337.40 ,$17.43 ,$457.90 ,$366.32 ,$361.50 ,$28.68 ,$409.70 ,$16.87 ,$28.68 ,$16.87 ,$337.40 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$409.70 ,$37.96 ,$443.44 ,$337.40 ,$69.25 ,$69.25 ,$293.54 ,$69.25 ,$333.06 ,$433.80 ,$335.71 ,$17.04 ,$380.78 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,30100184,82139,HC AMINO ACID 6+ QN SERUM,301,1 ,$702.00 ,$351.00 ,$16.87 ,$702.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$421.20 ,$596.70 ,$491.40 ,$17.43 ,$666.90 ,$533.52 ,$526.50 ,$28.68 ,$596.70 ,$16.87 ,$28.68 ,$16.87 ,$491.40 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$596.70 ,$37.96 ,$645.84 ,$491.40 ,$69.25 ,$69.25 ,$427.52 ,$69.25 ,$485.08 ,$631.80 ,$488.94 ,$17.04 ,$554.58 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$505.44 ,$435.24 ,$505.44 ,$505.44 ,$561.60 
ST NICHOLAS HOSPITAL - ACUTE,30100185,82139,HC AMINO ACID 6+ URINE,301,1 ,$747.00 ,$373.50 ,$16.87 ,$747.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$448.20 ,$634.95 ,$522.90 ,$17.43 ,$709.65 ,$567.72 ,$560.25 ,$28.68 ,$634.95 ,$16.87 ,$28.68 ,$16.87 ,$522.90 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$634.95 ,$37.96 ,$687.24 ,$522.90 ,$69.25 ,$69.25 ,$454.92 ,$69.25 ,$516.18 ,$672.30 ,$520.29 ,$17.04 ,$590.13 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$537.84 ,$463.14 ,$537.84 ,$537.84 ,$597.60 
ST NICHOLAS HOSPITAL - ACUTE,30100186,82140,HC AMMONIA,301,1 ,$112.00 ,$56.00 ,$14.57 ,$112.00 ,$15.06 ,$56.67 ,$48.57 ,$14.57 ,$67.20 ,$95.20 ,$78.40 ,$15.06 ,$106.40 ,$85.12 ,$84.00 ,$24.77 ,$95.20 ,$14.57 ,$24.77 ,$14.57 ,$78.40 ,$15.06 ,$14.57 ,$14.57 ,$16.49 ,$95.20 ,$32.78 ,$103.04 ,$78.40 ,$70.03 ,$70.03 ,$68.21 ,$70.03 ,$77.39 ,$100.80 ,$78.01 ,$14.72 ,$88.48 ,$15.96 ,$17.48 ,$17.48 ,$14.57 ,$17.48 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100187,80324,HC AMPHETAMINE,301,1 ,$46.00 ,$23.00 ,$3.81 ,$46.00 ,$3.81 ,$46.00 ,$46.00 , N/A ,$27.60 ,$39.10 ,$32.20 ,$3.81 ,$43.70 ,$34.96 ,$34.50 ,$38.56 ,$39.10 , N/A ,$38.56 ,$22.95 ,$32.20 ,$3.81 , N/A , N/A ,$19.32 ,$39.10 , N/A ,$42.32 ,$32.20 ,$23.33 ,$28.00 ,$28.01 ,$28.00 ,$31.79 ,$41.40 ,$32.04 , N/A ,$36.34 ,$4.04 , N/A , N/A , N/A , N/A ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30100188,82150,HC AMYLASE,301,1 ,$67.00 ,$33.50 ,$6.48 ,$67.00 ,$6.70 ,$25.20 ,$21.60 ,$6.48 ,$40.20 ,$56.95 ,$46.90 ,$6.70 ,$63.65 ,$50.92 ,$50.25 ,$11.02 ,$56.95 ,$6.48 ,$11.02 ,$6.48 ,$46.90 ,$6.70 ,$6.48 ,$6.48 ,$7.33 ,$56.95 ,$14.58 ,$61.64 ,$46.90 ,$31.14 ,$31.14 ,$40.80 ,$31.14 ,$46.30 ,$60.30 ,$46.67 ,$6.54 ,$52.93 ,$7.10 ,$7.78 ,$7.78 ,$6.48 ,$7.78 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100189,82157,HC ANDROSTENEDIONE,301,1 ,$224.00 ,$112.00 ,$29.28 ,$224.00 ,$30.26 ,$113.86 ,$97.59 ,$29.28 ,$134.40 ,$190.40 ,$156.80 ,$30.26 ,$212.80 ,$170.24 ,$168.00 ,$49.78 ,$190.40 ,$29.28 ,$49.78 ,$29.28 ,$156.80 ,$30.26 ,$29.28 ,$29.28 ,$33.14 ,$190.40 ,$65.88 ,$206.08 ,$156.80 ,$140.69 ,$140.69 ,$136.42 ,$140.69 ,$154.78 ,$201.60 ,$156.02 ,$29.57 ,$176.96 ,$32.08 ,$35.14 ,$35.14 ,$29.28 ,$35.14 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30100190,82164,"HC ACE, CSF",301,1 ,$112.00 ,$56.00 ,$14.60 ,$112.00 ,$15.09 ,$56.77 ,$48.66 ,$14.60 ,$67.20 ,$95.20 ,$78.40 ,$15.09 ,$106.40 ,$85.12 ,$84.00 ,$24.82 ,$95.20 ,$14.60 ,$24.82 ,$14.60 ,$78.40 ,$15.09 ,$14.60 ,$14.60 ,$16.52 ,$95.20 ,$32.85 ,$103.04 ,$78.40 ,$70.17 ,$70.17 ,$68.21 ,$70.17 ,$77.39 ,$100.80 ,$78.01 ,$14.75 ,$88.48 ,$16.00 ,$17.52 ,$17.52 ,$14.60 ,$17.52 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100191,82164,HC ANGIOTENSIN 1 ENZYME (ACE),301,1 ,$112.00 ,$56.00 ,$14.60 ,$112.00 ,$15.09 ,$56.77 ,$48.66 ,$14.60 ,$67.20 ,$95.20 ,$78.40 ,$15.09 ,$106.40 ,$85.12 ,$84.00 ,$24.82 ,$95.20 ,$14.60 ,$24.82 ,$14.60 ,$78.40 ,$15.09 ,$14.60 ,$14.60 ,$16.52 ,$95.20 ,$32.85 ,$103.04 ,$78.40 ,$70.17 ,$70.17 ,$68.21 ,$70.17 ,$77.39 ,$100.80 ,$78.01 ,$14.75 ,$88.48 ,$16.00 ,$17.52 ,$17.52 ,$14.60 ,$17.52 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100192,82172,HC APOLIPOPROTEIN SERUM,301,1 ,$101.00 ,$50.50 ,$21.09 ,$101.00 ,$21.79 ,$73.82 ,$63.27 ,$21.09 ,$60.60 ,$85.85 ,$70.70 ,$21.79 ,$95.95 ,$76.76 ,$75.75 ,$35.85 ,$85.85 ,$21.09 ,$35.85 ,$21.09 ,$70.70 ,$21.79 ,$21.09 ,$21.09 ,$23.87 ,$85.85 ,$47.45 ,$92.92 ,$70.70 ,$74.47 ,$74.47 ,$61.51 ,$74.47 ,$69.79 ,$90.90 ,$70.35 ,$21.30 ,$79.79 ,$23.10 ,$25.31 ,$25.31 ,$21.09 ,$25.31 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100193,82175,HC ARSENIC,301,1 ,$53.00 ,$26.50 ,$18.97 ,$53.00 ,$19.60 ,$53.00 ,$53.00 ,$18.97 ,$31.80 ,$45.05 ,$37.10 ,$19.60 ,$50.35 ,$40.28 ,$39.75 ,$32.25 ,$45.05 ,$18.97 ,$32.25 ,$18.97 ,$37.10 ,$19.60 ,$18.97 ,$18.97 ,$21.47 ,$45.05 ,$42.68 ,$48.76 ,$37.10 ,$53.00 ,$53.00 ,$32.28 ,$53.00 ,$36.62 ,$47.70 ,$36.91 ,$19.16 ,$41.87 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30100194,82175,HC ARSENIC BLOOD,301,1 ,$90.00 ,$45.00 ,$18.97 ,$90.00 ,$19.60 ,$73.78 ,$63.24 ,$18.97 ,$54.00 ,$76.50 ,$63.00 ,$19.60 ,$85.50 ,$68.40 ,$67.50 ,$32.25 ,$76.50 ,$18.97 ,$32.25 ,$18.97 ,$63.00 ,$19.60 ,$18.97 ,$18.97 ,$21.47 ,$76.50 ,$42.68 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$62.69 ,$19.16 ,$71.10 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100195,82175,HC ARSENIC URINE,301,1 ,$90.00 ,$45.00 ,$18.97 ,$90.00 ,$19.60 ,$73.78 ,$63.24 ,$18.97 ,$54.00 ,$76.50 ,$63.00 ,$19.60 ,$85.50 ,$68.40 ,$67.50 ,$32.25 ,$76.50 ,$18.97 ,$32.25 ,$18.97 ,$63.00 ,$19.60 ,$18.97 ,$18.97 ,$21.47 ,$76.50 ,$42.68 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$62.69 ,$19.16 ,$71.10 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100196,82175,HC ARESNIC 24 HR URINE,301,1 ,$90.00 ,$45.00 ,$18.97 ,$90.00 ,$19.60 ,$73.78 ,$63.24 ,$18.97 ,$54.00 ,$76.50 ,$63.00 ,$19.60 ,$85.50 ,$68.40 ,$67.50 ,$32.25 ,$76.50 ,$18.97 ,$32.25 ,$18.97 ,$63.00 ,$19.60 ,$18.97 ,$18.97 ,$21.47 ,$76.50 ,$42.68 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$62.69 ,$19.16 ,$71.10 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100197,82180,HC VITAMIN C (ASCORBIC ACID),301,1 ,$78.00 ,$39.00 ,$9.89 ,$78.00 ,$10.22 ,$38.43 ,$32.94 ,$9.89 ,$46.80 ,$66.30 ,$54.60 ,$10.22 ,$74.10 ,$59.28 ,$58.50 ,$16.81 ,$66.30 ,$9.89 ,$16.81 ,$9.89 ,$54.60 ,$10.22 ,$9.89 ,$9.89 ,$11.19 ,$66.30 ,$22.25 ,$71.76 ,$54.60 ,$47.48 ,$47.48 ,$47.50 ,$47.48 ,$53.90 ,$70.20 ,$54.33 ,$9.99 ,$61.62 ,$10.83 ,$11.87 ,$11.87 ,$9.89 ,$11.87 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100199,80345,HC BARBITURATE,301,1 ,$38.00 ,$19.00 ,$3.81 ,$38.00 ,$3.81 ,$38.00 ,$38.00 , N/A ,$22.80 ,$32.30 ,$26.60 ,$3.81 ,$36.10 ,$28.88 ,$28.50 ,$38.00 ,$32.30 , N/A ,$38.00 ,$22.95 ,$26.60 ,$3.81 , N/A , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$26.47 , N/A ,$30.02 ,$4.04 , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100200,G0480,HC PENTOBARB,301,1 ,$139.00 ,$69.50 ,$63.95 ,$257.47 ,$63.95 ,$139.00 ,$139.00 ,$114.43 ,$83.40 ,$118.15 ,$97.30 ,$63.95 ,$132.05 ,$105.64 ,$104.25 ,$139.00 ,$118.15 ,$114.43 ,$139.00 ,$114.43 ,$97.30 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$118.15 ,$257.47 ,$127.88 ,$97.30 ,$139.00 ,$139.00 ,$84.65 ,$139.00 ,$96.05 ,$125.10 ,$96.81 ,$115.57 ,$109.81 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$111.20 
ST NICHOLAS HOSPITAL - ACUTE,30100201,82232,HC BETA 2 MICROGLOBULIN,301,1 ,$123.00 ,$61.50 ,$16.18 ,$123.00 ,$16.72 ,$62.90 ,$53.91 ,$16.18 ,$73.80 ,$104.55 ,$86.10 ,$16.72 ,$116.85 ,$93.48 ,$92.25 ,$27.51 ,$104.55 ,$16.18 ,$27.51 ,$16.18 ,$86.10 ,$16.72 ,$16.18 ,$16.18 ,$18.31 ,$104.55 ,$36.41 ,$113.16 ,$86.10 ,$77.74 ,$77.74 ,$74.91 ,$77.74 ,$84.99 ,$110.70 ,$85.67 ,$16.34 ,$97.17 ,$17.72 ,$19.42 ,$19.42 ,$16.18 ,$19.42 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$38.00 ,$19.00 ,$4.24 ,$38.00 ,$4.24 ,$19.50 ,$16.71 ,$5.02 ,$22.80 ,$32.30 ,$26.60 ,$4.24 ,$36.10 ,$28.88 ,$28.50 ,$8.53 ,$32.30 ,$5.02 ,$8.53 ,$5.02 ,$26.60 ,$4.24 ,$5.02 ,$5.02 ,$5.68 ,$32.30 ,$11.30 ,$34.96 ,$26.60 ,$24.09 ,$24.09 ,$23.14 ,$24.09 ,$26.26 ,$34.20 ,$26.47 ,$5.07 ,$30.02 ,$4.49 ,$6.02 ,$6.02 ,$5.02 ,$6.02 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$38.00 ,$19.00 ,$4.70 ,$38.00 ,$4.70 ,$19.50 ,$16.71 ,$5.02 ,$22.80 ,$32.30 ,$26.60 ,$4.70 ,$36.10 ,$28.88 ,$28.50 ,$8.53 ,$32.30 ,$5.02 ,$8.53 ,$5.02 ,$26.60 ,$4.70 ,$5.02 ,$5.02 ,$5.68 ,$32.30 ,$11.30 ,$34.96 ,$26.60 ,$24.09 ,$24.09 ,$23.14 ,$24.09 ,$26.26 ,$34.20 ,$26.47 ,$5.07 ,$30.02 ,$4.98 ,$6.02 ,$6.02 ,$5.02 ,$6.02 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100205,82270,HC OCCULT BLOOD FECAL SCRN,301,1 ,$26.00 ,$13.00 ,$3.66 ,$26.00 ,$3.66 ,$15.33 ,$13.14 ,$4.38 ,$15.60 ,$22.10 ,$18.20 ,$3.66 ,$24.70 ,$19.76 ,$19.50 ,$7.45 ,$22.10 ,$4.38 ,$7.45 ,$4.38 ,$18.20 ,$3.66 ,$4.38 ,$4.38 ,$4.96 ,$22.10 ,$9.86 ,$23.92 ,$18.20 ,$15.64 ,$15.64 ,$15.83 ,$15.64 ,$17.97 ,$23.40 ,$18.11 ,$4.42 ,$20.54 ,$3.88 ,$5.26 ,$5.26 ,$4.38 ,$5.26 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$20.80 
ST NICHOLAS HOSPITAL - ACUTE,30100206,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$26.00 ,$13.00 ,$4.26 ,$26.00 ,$4.26 ,$18.62 ,$15.96 ,$5.32 ,$15.60 ,$22.10 ,$18.20 ,$4.26 ,$24.70 ,$19.76 ,$19.50 ,$9.04 ,$22.10 ,$5.32 ,$9.04 ,$5.32 ,$18.20 ,$4.26 ,$5.32 ,$5.32 ,$6.02 ,$22.10 ,$11.97 ,$23.92 ,$18.20 ,$15.64 ,$15.64 ,$15.83 ,$15.64 ,$17.97 ,$23.40 ,$18.11 ,$5.37 ,$20.54 ,$4.52 ,$6.38 ,$6.38 ,$5.32 ,$6.38 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$20.80 
ST NICHOLAS HOSPITAL - ACUTE,30100207,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$25.00 ,$12.50 ,$4.23 ,$25.00 ,$4.26 ,$14.81 ,$12.69 ,$4.23 ,$15.00 ,$21.25 ,$17.50 ,$4.26 ,$23.75 ,$19.00 ,$18.75 ,$7.19 ,$21.25 ,$4.23 ,$7.19 ,$4.23 ,$17.50 ,$4.26 ,$4.23 ,$4.23 ,$4.79 ,$21.25 ,$9.52 ,$23.00 ,$17.50 ,$15.64 ,$15.64 ,$15.23 ,$15.64 ,$17.28 ,$22.50 ,$17.41 ,$4.27 ,$19.75 ,$4.52 ,$5.08 ,$5.08 ,$4.23 ,$5.08 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30100208,82274,HC OCCULT BLOOD FECAL HGB,301,1 ,$123.00 ,$61.50 ,$15.92 ,$123.00 ,$16.45 ,$61.85 ,$53.01 ,$15.92 ,$73.80 ,$104.55 ,$86.10 ,$16.45 ,$116.85 ,$93.48 ,$92.25 ,$27.06 ,$104.55 ,$15.92 ,$27.06 ,$15.92 ,$86.10 ,$16.45 ,$15.92 ,$15.92 ,$18.02 ,$104.55 ,$35.82 ,$113.16 ,$86.10 ,$76.44 ,$76.44 ,$74.91 ,$76.44 ,$84.99 ,$110.70 ,$85.67 ,$16.08 ,$97.17 ,$17.44 ,$19.10 ,$19.10 ,$15.92 ,$19.10 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100209,82300,HC CADMIUM,301,1 ,$90.00 ,$45.00 ,$23.64 ,$90.00 ,$24.43 ,$90.00 ,$77.16 ,$23.64 ,$54.00 ,$76.50 ,$63.00 ,$24.43 ,$85.50 ,$68.40 ,$67.50 ,$40.19 ,$76.50 ,$23.64 ,$40.19 ,$23.64 ,$63.00 ,$24.43 ,$23.64 ,$23.64 ,$26.76 ,$76.50 ,$53.19 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$62.69 ,$23.88 ,$71.10 ,$25.90 ,$28.37 ,$28.37 ,$23.64 ,$28.37 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100210,82300,HC CADMIUM URINE,301,1 ,$90.00 ,$45.00 ,$23.64 ,$90.00 ,$24.43 ,$90.00 ,$77.16 ,$23.64 ,$54.00 ,$76.50 ,$63.00 ,$24.43 ,$85.50 ,$68.40 ,$67.50 ,$40.19 ,$76.50 ,$23.64 ,$40.19 ,$23.64 ,$63.00 ,$24.43 ,$23.64 ,$23.64 ,$26.76 ,$76.50 ,$53.19 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$62.69 ,$23.88 ,$71.10 ,$25.90 ,$28.37 ,$28.37 ,$23.64 ,$28.37 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100211,82300,HC CADMIUM 24 HR URINE,301,1 ,$90.00 ,$45.00 ,$23.64 ,$90.00 ,$24.43 ,$90.00 ,$77.16 ,$23.64 ,$54.00 ,$76.50 ,$63.00 ,$24.43 ,$85.50 ,$68.40 ,$67.50 ,$40.19 ,$76.50 ,$23.64 ,$40.19 ,$23.64 ,$63.00 ,$24.43 ,$23.64 ,$23.64 ,$26.76 ,$76.50 ,$53.19 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$81.00 ,$62.69 ,$23.88 ,$71.10 ,$25.90 ,$28.37 ,$28.37 ,$23.64 ,$28.37 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100212,82306,HC VITAMIN D 25 OH,301,1 ,$224.00 ,$112.00 ,$29.60 ,$224.00 ,$30.59 ,$115.12 ,$98.67 ,$29.60 ,$134.40 ,$190.40 ,$156.80 ,$30.59 ,$212.80 ,$170.24 ,$168.00 ,$50.32 ,$190.40 ,$29.60 ,$50.32 ,$29.60 ,$156.80 ,$30.59 ,$29.60 ,$29.60 ,$33.50 ,$190.40 ,$66.60 ,$206.08 ,$156.80 ,$142.31 ,$142.31 ,$136.42 ,$142.31 ,$154.78 ,$201.60 ,$156.02 ,$29.90 ,$176.96 ,$32.43 ,$35.52 ,$35.52 ,$29.60 ,$35.52 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30100213,82308,HC CALCITONIN,301,1 ,$157.00 ,$78.50 ,$26.79 ,$157.00 ,$27.68 ,$104.20 ,$89.31 ,$26.79 ,$94.20 ,$133.45 ,$109.90 ,$27.68 ,$149.15 ,$119.32 ,$117.75 ,$45.54 ,$133.45 ,$26.79 ,$45.54 ,$26.79 ,$109.90 ,$27.68 ,$26.79 ,$26.79 ,$30.32 ,$133.45 ,$60.28 ,$144.44 ,$109.90 ,$128.72 ,$128.72 ,$95.61 ,$128.72 ,$108.49 ,$141.30 ,$109.35 ,$27.06 ,$124.03 ,$29.34 ,$32.15 ,$32.15 ,$26.79 ,$32.15 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30100214,82310,HC CALCIUM,301,1 ,$38.00 ,$19.00 ,$5.16 ,$38.00 ,$5.33 ,$20.06 ,$17.19 ,$5.16 ,$22.80 ,$32.30 ,$26.60 ,$5.33 ,$36.10 ,$28.88 ,$28.50 ,$8.77 ,$32.30 ,$5.16 ,$8.77 ,$5.16 ,$26.60 ,$5.33 ,$5.16 ,$5.16 ,$5.84 ,$32.30 ,$11.61 ,$34.96 ,$26.60 ,$24.80 ,$24.80 ,$23.14 ,$24.80 ,$26.26 ,$34.20 ,$26.47 ,$5.21 ,$30.02 ,$5.65 ,$6.19 ,$6.19 ,$5.16 ,$6.19 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100215,82330,HC CALCIUM IONIZED,301,1 ,$101.00 ,$50.50 ,$13.68 ,$101.00 ,$14.14 ,$53.20 ,$45.60 ,$13.68 ,$60.60 ,$85.85 ,$70.70 ,$14.14 ,$95.95 ,$76.76 ,$75.75 ,$23.26 ,$85.85 ,$13.68 ,$23.26 ,$13.68 ,$70.70 ,$14.14 ,$13.68 ,$13.68 ,$15.48 ,$85.85 ,$30.78 ,$92.92 ,$70.70 ,$65.70 ,$65.70 ,$61.51 ,$65.70 ,$69.79 ,$90.90 ,$70.35 ,$13.82 ,$79.79 ,$14.99 ,$16.42 ,$16.42 ,$13.68 ,$16.42 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$46.00 ,$23.00 ,$6.03 ,$46.00 ,$6.23 ,$23.45 ,$20.10 ,$6.03 ,$27.60 ,$39.10 ,$32.20 ,$6.23 ,$43.70 ,$34.96 ,$34.50 ,$10.25 ,$39.10 ,$6.03 ,$10.25 ,$6.03 ,$32.20 ,$6.23 ,$6.03 ,$6.03 ,$6.82 ,$39.10 ,$13.57 ,$42.32 ,$32.20 ,$28.99 ,$28.99 ,$28.01 ,$28.99 ,$31.79 ,$41.40 ,$32.04 ,$6.09 ,$36.34 ,$6.60 ,$7.24 ,$7.24 ,$6.03 ,$7.24 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30100217,82360,HC CALCULUS ANALYSIS QN,301,1 ,$101.00 ,$50.50 ,$12.87 ,$101.00 ,$13.30 ,$50.05 ,$42.90 ,$12.87 ,$60.60 ,$85.85 ,$70.70 ,$13.30 ,$95.95 ,$76.76 ,$75.75 ,$21.88 ,$85.85 ,$12.87 ,$21.88 ,$12.87 ,$70.70 ,$13.30 ,$12.87 ,$12.87 ,$14.57 ,$85.85 ,$28.96 ,$92.92 ,$70.70 ,$61.86 ,$61.86 ,$61.51 ,$61.86 ,$69.79 ,$90.90 ,$70.35 ,$13.00 ,$79.79 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100218,82365,HC CALCULUS ANLYS (SA) INFRARED,301,1 ,$118.00 ,$59.00 ,$12.90 ,$118.00 ,$13.33 ,$50.16 ,$42.99 ,$12.90 ,$70.80 ,$100.30 ,$82.60 ,$13.33 ,$112.10 ,$89.68 ,$88.50 ,$21.93 ,$100.30 ,$12.90 ,$21.93 ,$12.90 ,$82.60 ,$13.33 ,$12.90 ,$12.90 ,$14.60 ,$100.30 ,$29.03 ,$108.56 ,$82.60 ,$61.96 ,$61.96 ,$71.86 ,$61.96 ,$81.54 ,$106.20 ,$82.19 ,$13.03 ,$93.22 ,$14.13 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$94.40 
ST NICHOLAS HOSPITAL - ACUTE,30100221,82373,HC CARBOHY DEFICIENT TRANSFER,301,1 ,$517.00 ,$258.50 ,$10.38 ,$517.00 ,$10.38 ,$70.21 ,$60.18 ,$18.06 ,$310.20 ,$439.45 ,$361.90 ,$10.38 ,$491.15 ,$392.92 ,$387.75 ,$30.70 ,$439.45 ,$18.06 ,$30.70 ,$18.06 ,$361.90 ,$10.38 ,$18.06 ,$18.06 ,$20.44 ,$439.45 ,$40.64 ,$475.64 ,$361.90 ,$86.76 ,$86.76 ,$314.85 ,$86.76 ,$357.25 ,$465.30 ,$360.09 ,$18.24 ,$408.43 ,$11.00 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$372.24 ,$320.54 ,$372.24 ,$372.24 ,$413.60 
ST NICHOLAS HOSPITAL - ACUTE,30100222,82374,HC BICARBONATE,301,1 ,$101.00 ,$50.50 ,$4.88 ,$101.00 ,$5.04 ,$19.01 ,$16.29 ,$4.88 ,$60.60 ,$85.85 ,$70.70 ,$5.04 ,$95.95 ,$76.76 ,$75.75 ,$8.30 ,$85.85 ,$4.88 ,$8.30 ,$4.88 ,$70.70 ,$5.04 ,$4.88 ,$4.88 ,$5.52 ,$85.85 ,$10.98 ,$92.92 ,$70.70 ,$23.50 ,$23.50 ,$61.51 ,$23.50 ,$69.79 ,$90.90 ,$70.35 ,$4.93 ,$79.79 ,$5.34 ,$5.86 ,$5.86 ,$4.88 ,$5.86 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100223,82374,HC CO2,301,1 ,$43.00 ,$21.50 ,$4.88 ,$43.00 ,$5.04 ,$19.01 ,$16.29 ,$4.88 ,$25.80 ,$36.55 ,$30.10 ,$5.04 ,$40.85 ,$32.68 ,$32.25 ,$8.30 ,$36.55 ,$4.88 ,$8.30 ,$4.88 ,$30.10 ,$5.04 ,$4.88 ,$4.88 ,$5.52 ,$36.55 ,$10.98 ,$39.56 ,$30.10 ,$23.50 ,$23.50 ,$26.19 ,$23.50 ,$29.71 ,$38.70 ,$29.95 ,$4.93 ,$33.97 ,$5.34 ,$5.86 ,$5.86 ,$4.88 ,$5.86 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,30100224,82375,HC CARBON MONOXIDE,301,1 ,$168.00 ,$84.00 ,$12.32 ,$168.00 ,$12.73 ,$47.92 ,$41.07 ,$12.32 ,$100.80 ,$142.80 ,$117.60 ,$12.73 ,$159.60 ,$127.68 ,$126.00 ,$20.94 ,$142.80 ,$12.32 ,$20.94 ,$12.32 ,$117.60 ,$12.73 ,$12.32 ,$12.32 ,$13.94 ,$142.80 ,$27.72 ,$154.56 ,$117.60 ,$59.21 ,$59.21 ,$102.31 ,$59.21 ,$116.09 ,$151.20 ,$117.01 ,$12.44 ,$132.72 ,$13.49 ,$14.78 ,$14.78 ,$12.32 ,$14.78 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100225,82375,HC CARBOXYHEMOGLOBIN,301,1 ,$168.00 ,$84.00 ,$12.32 ,$168.00 ,$12.73 ,$47.92 ,$41.07 ,$12.32 ,$100.80 ,$142.80 ,$117.60 ,$12.73 ,$159.60 ,$127.68 ,$126.00 ,$20.94 ,$142.80 ,$12.32 ,$20.94 ,$12.32 ,$117.60 ,$12.73 ,$12.32 ,$12.32 ,$13.94 ,$142.80 ,$27.72 ,$154.56 ,$117.60 ,$59.21 ,$59.21 ,$102.31 ,$59.21 ,$116.09 ,$151.20 ,$117.01 ,$12.44 ,$132.72 ,$13.49 ,$14.78 ,$14.78 ,$12.32 ,$14.78 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100226,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$146.00 ,$73.00 ,$18.96 ,$146.00 ,$19.59 ,$73.75 ,$63.21 ,$18.96 ,$87.60 ,$124.10 ,$102.20 ,$19.59 ,$138.70 ,$110.96 ,$109.50 ,$32.23 ,$124.10 ,$18.96 ,$32.23 ,$18.96 ,$102.20 ,$19.59 ,$18.96 ,$18.96 ,$21.46 ,$124.10 ,$42.66 ,$134.32 ,$102.20 ,$91.16 ,$91.16 ,$88.91 ,$91.16 ,$100.89 ,$131.40 ,$101.69 ,$19.15 ,$115.34 ,$20.77 ,$22.75 ,$22.75 ,$18.96 ,$22.75 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100227,82378,HC CEA BODY FLUID,301,1 ,$235.00 ,$117.50 ,$18.96 ,$235.00 ,$19.59 ,$73.75 ,$63.21 ,$18.96 ,$141.00 ,$199.75 ,$164.50 ,$19.59 ,$223.25 ,$178.60 ,$176.25 ,$32.23 ,$199.75 ,$18.96 ,$32.23 ,$18.96 ,$164.50 ,$19.59 ,$18.96 ,$18.96 ,$21.46 ,$199.75 ,$42.66 ,$216.20 ,$164.50 ,$91.16 ,$91.16 ,$143.12 ,$91.16 ,$162.39 ,$211.50 ,$163.68 ,$19.15 ,$185.65 ,$20.77 ,$22.75 ,$22.75 ,$18.96 ,$22.75 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,30100228,82379,HC CARNITINE URINE,301,1 ,$562.00 ,$281.00 ,$16.87 ,$562.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$337.20 ,$477.70 ,$393.40 ,$17.43 ,$533.90 ,$427.12 ,$421.50 ,$28.68 ,$477.70 ,$16.87 ,$28.68 ,$16.87 ,$393.40 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$477.70 ,$37.96 ,$517.04 ,$393.40 ,$69.25 ,$69.25 ,$342.26 ,$69.25 ,$388.34 ,$505.80 ,$391.43 ,$17.04 ,$443.98 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$404.64 ,$348.44 ,$404.64 ,$404.64 ,$449.60 
ST NICHOLAS HOSPITAL - ACUTE,30100229,82379,HC CARNITINE SERUM,301,1 ,$519.00 ,$259.50 ,$16.87 ,$519.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$311.40 ,$441.15 ,$363.30 ,$17.43 ,$493.05 ,$394.44 ,$389.25 ,$28.68 ,$441.15 ,$16.87 ,$28.68 ,$16.87 ,$363.30 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$441.15 ,$37.96 ,$477.48 ,$363.30 ,$69.25 ,$69.25 ,$316.07 ,$69.25 ,$358.63 ,$467.10 ,$361.48 ,$17.04 ,$410.01 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$373.68 ,$321.78 ,$373.68 ,$373.68 ,$415.20 
ST NICHOLAS HOSPITAL - ACUTE,30100230,82379,HC CARNITINE,301,1 ,$426.00 ,$213.00 ,$16.87 ,$426.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$255.60 ,$362.10 ,$298.20 ,$17.43 ,$404.70 ,$323.76 ,$319.50 ,$28.68 ,$362.10 ,$16.87 ,$28.68 ,$16.87 ,$298.20 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$362.10 ,$37.96 ,$391.92 ,$298.20 ,$69.25 ,$69.25 ,$259.43 ,$69.25 ,$294.37 ,$383.40 ,$296.71 ,$17.04 ,$336.54 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$340.80 
ST NICHOLAS HOSPITAL - ACUTE,30100231,82380,HC CAROTENE,301,1 ,$57.00 ,$28.50 ,$9.22 ,$57.00 ,$9.53 ,$35.88 ,$30.75 ,$9.22 ,$34.20 ,$48.45 ,$39.90 ,$9.53 ,$54.15 ,$43.32 ,$42.75 ,$15.67 ,$48.45 ,$9.22 ,$15.67 ,$9.22 ,$39.90 ,$9.53 ,$9.22 ,$9.22 ,$10.44 ,$48.45 ,$20.75 ,$52.44 ,$39.90 ,$44.31 ,$44.31 ,$34.71 ,$44.31 ,$39.39 ,$51.30 ,$39.70 ,$9.31 ,$45.03 ,$10.10 ,$11.06 ,$11.06 ,$9.22 ,$11.06 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$45.60 
ST NICHOLAS HOSPITAL - ACUTE,30100232,82384,HC CATECHOLAMINE FRACTION,301,1 ,$190.00 ,$95.00 ,$25.25 ,$190.00 ,$26.09 ,$98.21 ,$84.18 ,$25.25 ,$114.00 ,$161.50 ,$133.00 ,$26.09 ,$180.50 ,$144.40 ,$142.50 ,$42.93 ,$161.50 ,$25.25 ,$42.93 ,$25.25 ,$133.00 ,$26.09 ,$25.25 ,$25.25 ,$28.58 ,$161.50 ,$56.81 ,$174.80 ,$133.00 ,$121.35 ,$121.35 ,$115.71 ,$121.35 ,$131.29 ,$171.00 ,$132.34 ,$25.50 ,$150.10 ,$27.66 ,$30.30 ,$30.30 ,$25.25 ,$30.30 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100233,82384,HC CATECHOLAMINE RNDM URINE,301,1 ,$190.00 ,$95.00 ,$25.25 ,$190.00 ,$26.09 ,$98.21 ,$84.18 ,$25.25 ,$114.00 ,$161.50 ,$133.00 ,$26.09 ,$180.50 ,$144.40 ,$142.50 ,$42.93 ,$161.50 ,$25.25 ,$42.93 ,$25.25 ,$133.00 ,$26.09 ,$25.25 ,$25.25 ,$28.58 ,$161.50 ,$56.81 ,$174.80 ,$133.00 ,$121.35 ,$121.35 ,$115.71 ,$121.35 ,$131.29 ,$171.00 ,$132.34 ,$25.50 ,$150.10 ,$27.66 ,$30.30 ,$30.30 ,$25.25 ,$30.30 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100234,82384,HC CATECHOLAMINE PLASMA,301,1 ,$84.00 ,$42.00 ,$25.25 ,$84.00 ,$26.09 ,$84.00 ,$84.00 ,$25.25 ,$50.40 ,$71.40 ,$58.80 ,$26.09 ,$79.80 ,$63.84 ,$63.00 ,$42.93 ,$71.40 ,$25.25 ,$42.93 ,$25.25 ,$58.80 ,$26.09 ,$25.25 ,$25.25 ,$28.58 ,$71.40 ,$56.81 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$75.60 ,$58.51 ,$25.50 ,$66.36 ,$27.66 ,$30.30 ,$30.30 ,$25.25 ,$30.30 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,30100235,82390,HC CERULOPLASMIN,301,1 ,$78.00 ,$39.00 ,$10.74 ,$78.00 ,$11.10 ,$41.76 ,$35.79 ,$10.74 ,$46.80 ,$66.30 ,$54.60 ,$11.10 ,$74.10 ,$59.28 ,$58.50 ,$18.26 ,$66.30 ,$10.74 ,$18.26 ,$10.74 ,$54.60 ,$11.10 ,$10.74 ,$10.74 ,$12.16 ,$66.30 ,$24.17 ,$71.76 ,$54.60 ,$51.61 ,$51.61 ,$47.50 ,$51.61 ,$53.90 ,$70.20 ,$54.33 ,$10.85 ,$61.62 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100236,82397,HC CHEMILUMINESCENT ASSAY,301,1 ,$112.00 ,$56.00 ,$14.12 ,$112.00 ,$14.59 ,$54.92 ,$47.07 ,$14.12 ,$67.20 ,$95.20 ,$78.40 ,$14.59 ,$106.40 ,$85.12 ,$84.00 ,$24.00 ,$95.20 ,$14.12 ,$24.00 ,$14.12 ,$78.40 ,$14.59 ,$14.12 ,$14.12 ,$15.98 ,$95.20 ,$31.77 ,$103.04 ,$78.40 ,$67.88 ,$67.88 ,$68.21 ,$67.88 ,$77.39 ,$100.80 ,$78.01 ,$14.26 ,$88.48 ,$15.47 ,$16.94 ,$16.94 ,$14.12 ,$16.94 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100237,82435,HC CHLORIDE,301,1 ,$67.00 ,$33.50 ,$4.60 ,$67.00 ,$4.75 ,$17.89 ,$15.33 ,$4.60 ,$40.20 ,$56.95 ,$46.90 ,$4.75 ,$63.65 ,$50.92 ,$50.25 ,$7.82 ,$56.95 ,$4.60 ,$7.82 ,$4.60 ,$46.90 ,$4.75 ,$4.60 ,$4.60 ,$5.21 ,$56.95 ,$10.35 ,$61.64 ,$46.90 ,$22.09 ,$22.09 ,$40.80 ,$22.09 ,$46.30 ,$60.30 ,$46.67 ,$4.65 ,$52.93 ,$5.04 ,$5.52 ,$5.52 ,$4.60 ,$5.52 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100238,82436,HC CHLORIDE URINE,301,1 ,$48.00 ,$24.00 ,$5.75 ,$48.00 ,$5.94 ,$20.13 ,$17.25 ,$5.75 ,$28.80 ,$40.80 ,$33.60 ,$5.94 ,$45.60 ,$36.48 ,$36.00 ,$9.78 ,$40.80 ,$5.75 ,$9.78 ,$5.75 ,$33.60 ,$5.94 ,$5.75 ,$5.75 ,$6.51 ,$40.80 ,$12.94 ,$44.16 ,$33.60 ,$24.17 ,$24.17 ,$29.23 ,$24.17 ,$33.17 ,$43.20 ,$33.43 ,$5.81 ,$37.92 ,$6.30 ,$6.90 ,$6.90 ,$5.75 ,$6.90 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30100240,82438,HC CHLORIDE OTHER SOURCE,301,1 ,$76.00 ,$38.00 ,$5.00 ,$76.00 ,$5.17 ,$19.01 ,$16.29 ,$5.00 ,$45.60 ,$64.60 ,$53.20 ,$5.17 ,$72.20 ,$57.76 ,$57.00 ,$8.50 ,$64.60 ,$5.00 ,$8.50 ,$5.00 ,$53.20 ,$5.17 ,$5.00 ,$5.00 ,$5.66 ,$64.60 ,$11.25 ,$69.92 ,$53.20 ,$23.50 ,$23.50 ,$46.28 ,$23.50 ,$52.52 ,$68.40 ,$52.93 ,$5.05 ,$60.04 ,$5.48 ,$6.00 ,$6.00 ,$5.00 ,$6.00 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$60.80 
ST NICHOLAS HOSPITAL - ACUTE,30100241,82465,HC CHOLESTEROL,301,1 ,$56.00 ,$28.00 ,$4.35 ,$56.00 ,$4.49 ,$16.94 ,$14.52 ,$4.35 ,$33.60 ,$47.60 ,$39.20 ,$4.49 ,$53.20 ,$42.56 ,$42.00 ,$7.40 ,$47.60 ,$4.35 ,$7.40 ,$4.35 ,$39.20 ,$4.49 ,$4.35 ,$4.35 ,$4.92 ,$47.60 ,$9.79 ,$51.52 ,$39.20 ,$20.89 ,$20.89 ,$34.10 ,$20.89 ,$38.70 ,$50.40 ,$39.00 ,$4.39 ,$44.24 ,$4.76 ,$5.22 ,$5.22 ,$4.35 ,$5.22 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30100242,82542,HC CHROMATO QN SGL COLUMN,301,1 ,$157.00 ,$78.50 ,$24.09 ,$157.00 ,$24.89 ,$84.32 ,$72.27 ,$24.09 ,$94.20 ,$133.45 ,$109.90 ,$24.89 ,$149.15 ,$119.32 ,$117.75 ,$40.95 ,$133.45 ,$24.09 ,$40.95 ,$24.09 ,$109.90 ,$24.89 ,$24.09 ,$24.09 ,$27.27 ,$133.45 ,$54.20 ,$144.44 ,$109.90 ,$86.76 ,$86.76 ,$95.61 ,$86.76 ,$108.49 ,$141.30 ,$109.35 ,$24.33 ,$124.03 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30100243,80299,HC CHROMATO QN MLT COLUMN,301,1 ,$183.00 ,$91.50 ,$18.64 ,$183.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$109.80 ,$155.55 ,$128.10 ,$19.26 ,$173.85 ,$139.08 ,$137.25 ,$31.69 ,$155.55 ,$18.64 ,$31.69 ,$18.64 ,$128.10 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$155.55 ,$41.94 ,$168.36 ,$128.10 ,$65.80 ,$65.80 ,$111.45 ,$65.80 ,$126.45 ,$164.70 ,$127.46 ,$18.83 ,$144.57 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,30100244,82495,HC CHROMIUM (MAYO) SERUM,301,1 ,$268.00 ,$134.00 ,$10.23 ,$268.00 ,$10.23 ,$78.86 ,$67.59 ,$20.28 ,$160.80 ,$227.80 ,$187.60 ,$10.23 ,$254.60 ,$203.68 ,$201.00 ,$34.48 ,$227.80 ,$20.28 ,$34.48 ,$20.28 ,$187.60 ,$10.23 ,$20.28 ,$20.28 ,$22.95 ,$227.80 ,$45.63 ,$246.56 ,$187.60 ,$34.94 ,$34.94 ,$163.21 ,$34.94 ,$185.19 ,$241.20 ,$186.66 ,$20.48 ,$211.72 ,$10.84 ,$24.34 ,$24.34 ,$20.28 ,$24.34 ,$192.96 ,$166.16 ,$192.96 ,$192.96 ,$214.40 
ST NICHOLAS HOSPITAL - ACUTE,30100245,82495,HC CHROMIUM SERUM,301,1 ,$123.00 ,$61.50 ,$10.23 ,$123.00 ,$10.23 ,$78.86 ,$67.59 ,$20.28 ,$73.80 ,$104.55 ,$86.10 ,$10.23 ,$116.85 ,$93.48 ,$92.25 ,$34.48 ,$104.55 ,$20.28 ,$34.48 ,$20.28 ,$86.10 ,$10.23 ,$20.28 ,$20.28 ,$22.95 ,$104.55 ,$45.63 ,$113.16 ,$86.10 ,$34.94 ,$34.94 ,$74.91 ,$34.94 ,$84.99 ,$110.70 ,$85.67 ,$20.48 ,$97.17 ,$10.84 ,$24.34 ,$24.34 ,$20.28 ,$24.34 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100246,82507,HC CITRATE,301,1 ,$202.00 ,$101.00 ,$27.80 ,$202.00 ,$28.73 ,$108.12 ,$92.67 ,$27.80 ,$121.20 ,$171.70 ,$141.40 ,$28.73 ,$191.90 ,$153.52 ,$151.50 ,$47.26 ,$171.70 ,$27.80 ,$47.26 ,$27.80 ,$141.40 ,$28.73 ,$27.80 ,$27.80 ,$31.46 ,$171.70 ,$62.55 ,$185.84 ,$141.40 ,$133.61 ,$133.61 ,$123.02 ,$133.61 ,$139.58 ,$181.80 ,$140.69 ,$28.08 ,$159.58 ,$30.45 ,$33.36 ,$33.36 ,$27.80 ,$33.36 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30100247,80343,HC COCAINE QN,301,1 ,$36.00 ,$18.00 ,$10.05 ,$36.00 ,$10.05 ,$23.29 ,$23.29 , N/A ,$21.60 ,$30.60 ,$25.20 ,$10.05 ,$34.20 ,$27.36 ,$27.00 ,$36.00 ,$30.60 , N/A ,$36.00 ,$32.33 ,$25.20 ,$10.05 , N/A , N/A ,$15.12 ,$30.60 , N/A ,$33.12 ,$25.20 ,$18.26 ,$21.91 ,$21.92 ,$21.91 ,$24.88 ,$32.40 ,$25.07 , N/A ,$28.44 ,$10.65 , N/A , N/A , N/A , N/A ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30100248,82525,HC COPPER (MAYO) SERUM,301,1 ,$153.00 ,$76.50 ,$12.41 ,$153.00 ,$12.82 ,$48.27 ,$41.37 ,$12.41 ,$91.80 ,$130.05 ,$107.10 ,$12.82 ,$145.35 ,$116.28 ,$114.75 ,$21.10 ,$130.05 ,$12.41 ,$21.10 ,$12.41 ,$107.10 ,$12.82 ,$12.41 ,$12.41 ,$14.05 ,$130.05 ,$27.92 ,$140.76 ,$107.10 ,$49.35 ,$49.35 ,$93.18 ,$49.35 ,$105.72 ,$137.70 ,$106.56 ,$12.53 ,$120.87 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,30100249,82525,HC COPPER URINE,301,1 ,$69.00 ,$34.50 ,$12.41 ,$69.00 ,$12.82 ,$48.27 ,$41.37 ,$12.41 ,$41.40 ,$58.65 ,$48.30 ,$12.82 ,$65.55 ,$52.44 ,$51.75 ,$21.10 ,$58.65 ,$12.41 ,$21.10 ,$12.41 ,$48.30 ,$12.82 ,$12.41 ,$12.41 ,$14.05 ,$58.65 ,$27.92 ,$63.48 ,$48.30 ,$49.35 ,$49.35 ,$42.02 ,$49.35 ,$47.68 ,$62.10 ,$48.06 ,$12.53 ,$54.51 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30100250,82525,HC COPPER SERUM QCOP,301,1 ,$90.00 ,$45.00 ,$12.41 ,$90.00 ,$12.82 ,$48.27 ,$41.37 ,$12.41 ,$54.00 ,$76.50 ,$63.00 ,$12.82 ,$85.50 ,$68.40 ,$67.50 ,$21.10 ,$76.50 ,$12.41 ,$21.10 ,$12.41 ,$63.00 ,$12.82 ,$12.41 ,$12.41 ,$14.05 ,$76.50 ,$27.92 ,$82.80 ,$63.00 ,$49.35 ,$49.35 ,$54.81 ,$49.35 ,$62.19 ,$81.00 ,$62.69 ,$12.53 ,$71.10 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100251,82525,HC COPPER PLASMA,301,1 ,$120.00 ,$60.00 ,$12.41 ,$120.00 ,$12.82 ,$48.27 ,$41.37 ,$12.41 ,$72.00 ,$102.00 ,$84.00 ,$12.82 ,$114.00 ,$91.20 ,$90.00 ,$21.10 ,$102.00 ,$12.41 ,$21.10 ,$12.41 ,$84.00 ,$12.82 ,$12.41 ,$12.41 ,$14.05 ,$102.00 ,$27.92 ,$110.40 ,$84.00 ,$49.35 ,$49.35 ,$73.08 ,$49.35 ,$82.92 ,$108.00 ,$83.58 ,$12.53 ,$94.80 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100252,82525,HC COPPER,301,1 ,$67.00 ,$33.50 ,$12.41 ,$67.00 ,$12.82 ,$48.27 ,$41.37 ,$12.41 ,$40.20 ,$56.95 ,$46.90 ,$12.82 ,$63.65 ,$50.92 ,$50.25 ,$21.10 ,$56.95 ,$12.41 ,$21.10 ,$12.41 ,$46.90 ,$12.82 ,$12.41 ,$12.41 ,$14.05 ,$56.95 ,$27.92 ,$61.64 ,$46.90 ,$49.35 ,$49.35 ,$40.80 ,$49.35 ,$46.30 ,$60.30 ,$46.67 ,$12.53 ,$52.93 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100253,82530,HC CORTISOL FREE,301,1 ,$123.00 ,$61.50 ,$16.71 ,$123.00 ,$17.27 ,$65.00 ,$55.71 ,$16.71 ,$73.80 ,$104.55 ,$86.10 ,$17.27 ,$116.85 ,$93.48 ,$92.25 ,$28.41 ,$104.55 ,$16.71 ,$28.41 ,$16.71 ,$86.10 ,$17.27 ,$16.71 ,$16.71 ,$18.91 ,$104.55 ,$37.60 ,$113.16 ,$86.10 ,$80.32 ,$80.32 ,$74.91 ,$80.32 ,$84.99 ,$110.70 ,$85.67 ,$16.88 ,$97.17 ,$18.31 ,$20.05 ,$20.05 ,$16.71 ,$20.05 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100254,82533,HC CORTISOL TOTAL,301,1 ,$123.00 ,$61.50 ,$16.30 ,$123.00 ,$16.84 ,$63.39 ,$54.33 ,$16.30 ,$73.80 ,$104.55 ,$86.10 ,$16.84 ,$116.85 ,$93.48 ,$92.25 ,$27.71 ,$104.55 ,$16.30 ,$27.71 ,$16.30 ,$86.10 ,$16.84 ,$16.30 ,$16.30 ,$18.45 ,$104.55 ,$36.68 ,$113.16 ,$86.10 ,$78.34 ,$78.34 ,$74.91 ,$78.34 ,$84.99 ,$110.70 ,$85.67 ,$16.46 ,$97.17 ,$17.85 ,$19.56 ,$19.56 ,$16.30 ,$19.56 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100255,G0480,HC RISPERIDONE,301,1 ,$128.00 ,$64.00 ,$63.95 ,$257.47 ,$63.95 ,$128.00 ,$128.00 ,$114.43 ,$76.80 ,$108.80 ,$89.60 ,$63.95 ,$121.60 ,$97.28 ,$96.00 ,$128.00 ,$108.80 ,$114.43 ,$128.00 ,$114.43 ,$89.60 ,$63.95 ,$114.43 ,$114.43 ,$128.00 ,$108.80 ,$257.47 ,$117.76 ,$89.60 ,$128.00 ,$128.00 ,$77.95 ,$128.00 ,$88.45 ,$115.20 ,$89.15 ,$115.57 ,$101.12 ,$67.79 ,$128.00 ,$128.00 ,$114.43 ,$128.00 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$102.40 
ST NICHOLAS HOSPITAL - ACUTE,30100256,G0480,HC THC CONFIRMATION,301,1 ,$100.00 ,$50.00 ,$50.00 ,$225.00 ,$63.95 ,$100.00 ,$100.00 ,$100.00 ,$60.00 ,$85.00 ,$70.00 ,$63.95 ,$95.00 ,$76.00 ,$75.00 ,$100.00 ,$85.00 ,$100.00 ,$100.00 ,$100.00 ,$70.00 ,$63.95 ,$100.00 ,$100.00 ,$100.00 ,$85.00 ,$225.00 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$101.00 ,$79.00 ,$67.79 ,$100.00 ,$100.00 ,$100.00 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100257,82542,HC ACYLGYLCINES QD,301,1 ,$749.00 ,$374.50 ,$24.09 ,$749.00 ,$24.89 ,$84.32 ,$72.27 ,$24.09 ,$449.40 ,$636.65 ,$524.30 ,$24.89 ,$711.55 ,$569.24 ,$561.75 ,$40.95 ,$636.65 ,$24.09 ,$40.95 ,$24.09 ,$524.30 ,$24.89 ,$24.09 ,$24.09 ,$27.27 ,$636.65 ,$54.20 ,$689.08 ,$524.30 ,$86.76 ,$86.76 ,$456.14 ,$86.76 ,$517.56 ,$674.10 ,$521.68 ,$24.33 ,$591.71 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$539.28 ,$464.38 ,$539.28 ,$539.28 ,$599.20 
ST NICHOLAS HOSPITAL - ACUTE,30100258,82542,HC ACYLGYLCINES (MAYO) URINE,301,1 ,$641.00 ,$320.50 ,$24.09 ,$641.00 ,$24.89 ,$84.32 ,$72.27 ,$24.09 ,$384.60 ,$544.85 ,$448.70 ,$24.89 ,$608.95 ,$487.16 ,$480.75 ,$40.95 ,$544.85 ,$24.09 ,$40.95 ,$24.09 ,$448.70 ,$24.89 ,$24.09 ,$24.09 ,$27.27 ,$544.85 ,$54.20 ,$589.72 ,$448.70 ,$86.76 ,$86.76 ,$390.37 ,$86.76 ,$442.93 ,$576.90 ,$446.46 ,$24.33 ,$506.39 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$461.52 ,$397.42 ,$461.52 ,$461.52 ,$512.80 
ST NICHOLAS HOSPITAL - ACUTE,30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$52.00 ,$26.00 ,$6.51 ,$52.00 ,$6.73 ,$25.31 ,$21.69 ,$6.51 ,$31.20 ,$44.20 ,$36.40 ,$6.73 ,$49.40 ,$39.52 ,$39.00 ,$11.07 ,$44.20 ,$6.51 ,$11.07 ,$6.51 ,$36.40 ,$6.73 ,$6.51 ,$6.51 ,$7.37 ,$44.20 ,$14.65 ,$47.84 ,$36.40 ,$31.28 ,$31.28 ,$31.67 ,$31.28 ,$35.93 ,$46.80 ,$36.22 ,$6.58 ,$41.08 ,$7.13 ,$7.81 ,$7.81 ,$6.51 ,$7.81 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30100260,82552,HC CREATINE KINASE (CPK) ISO,301,1 ,$92.00 ,$46.00 ,$13.39 ,$92.00 ,$13.84 ,$52.08 ,$44.64 ,$13.39 ,$55.20 ,$78.20 ,$64.40 ,$13.84 ,$87.40 ,$69.92 ,$69.00 ,$22.76 ,$78.20 ,$13.39 ,$22.76 ,$13.39 ,$64.40 ,$13.84 ,$13.39 ,$13.39 ,$15.15 ,$78.20 ,$30.13 ,$84.64 ,$64.40 ,$64.39 ,$64.39 ,$56.03 ,$64.39 ,$63.57 ,$82.80 ,$64.08 ,$13.52 ,$72.68 ,$14.67 ,$16.07 ,$16.07 ,$13.39 ,$16.07 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$67.00 ,$33.50 ,$8.66 ,$67.00 ,$8.66 ,$44.91 ,$38.49 ,$11.55 ,$40.20 ,$56.95 ,$46.90 ,$8.66 ,$63.65 ,$50.92 ,$50.25 ,$19.64 ,$56.95 ,$11.55 ,$19.64 ,$11.55 ,$46.90 ,$8.66 ,$11.55 ,$11.55 ,$13.07 ,$56.95 ,$25.99 ,$61.64 ,$46.90 ,$29.59 ,$29.59 ,$40.80 ,$29.59 ,$46.30 ,$60.30 ,$46.67 ,$11.67 ,$52.93 ,$9.18 ,$13.86 ,$13.86 ,$11.55 ,$13.86 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100262,82565,HC CREATININE,301,1 ,$39.00 ,$19.50 ,$5.12 ,$39.00 ,$5.29 ,$19.92 ,$17.07 ,$5.12 ,$23.40 ,$33.15 ,$27.30 ,$5.29 ,$37.05 ,$29.64 ,$29.25 ,$8.70 ,$33.15 ,$5.12 ,$8.70 ,$5.12 ,$27.30 ,$5.29 ,$5.12 ,$5.12 ,$5.79 ,$33.15 ,$11.52 ,$35.88 ,$27.30 ,$24.62 ,$24.62 ,$23.75 ,$24.62 ,$26.95 ,$35.10 ,$27.16 ,$5.17 ,$30.81 ,$5.61 ,$6.14 ,$6.14 ,$5.12 ,$6.14 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100263,82570,HC CREATININE BODY FLUID,301,1 ,$39.00 ,$19.50 ,$5.18 ,$39.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$23.40 ,$33.15 ,$27.30 ,$5.35 ,$37.05 ,$29.64 ,$29.25 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$5.18 ,$27.30 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$24.87 ,$24.87 ,$23.75 ,$24.87 ,$26.95 ,$35.10 ,$27.16 ,$5.23 ,$30.81 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$39.00 ,$19.50 ,$5.18 ,$39.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$23.40 ,$33.15 ,$27.30 ,$5.35 ,$37.05 ,$29.64 ,$29.25 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$5.18 ,$27.30 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$24.87 ,$24.87 ,$23.75 ,$24.87 ,$26.95 ,$35.10 ,$27.16 ,$5.23 ,$30.81 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100265,82570,HC CREATININE STONE,301,1 ,$39.00 ,$19.50 ,$5.18 ,$39.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$23.40 ,$33.15 ,$27.30 ,$5.35 ,$37.05 ,$29.64 ,$29.25 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$5.18 ,$27.30 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$24.87 ,$24.87 ,$23.75 ,$24.87 ,$26.95 ,$35.10 ,$27.16 ,$5.23 ,$30.81 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100266,82575,HC CREATININE CLEARANCE,301,1 ,$90.00 ,$45.00 ,$9.46 ,$90.00 ,$9.78 ,$36.79 ,$31.53 ,$9.46 ,$54.00 ,$76.50 ,$63.00 ,$9.78 ,$85.50 ,$68.40 ,$67.50 ,$16.08 ,$76.50 ,$9.46 ,$16.08 ,$9.46 ,$63.00 ,$9.78 ,$9.46 ,$9.46 ,$10.71 ,$76.50 ,$21.29 ,$82.80 ,$63.00 ,$45.41 ,$45.41 ,$54.81 ,$45.41 ,$62.19 ,$81.00 ,$62.69 ,$9.55 ,$71.10 ,$10.37 ,$11.35 ,$11.35 ,$9.46 ,$11.35 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100267,82585,HC CRYOFIBRINOGEN,301,1 ,$52.00 ,$26.00 ,$9.02 ,$52.00 ,$9.02 ,$49.49 ,$42.42 ,$14.14 ,$31.20 ,$44.20 ,$36.40 ,$9.02 ,$49.40 ,$39.52 ,$39.00 ,$24.04 ,$44.20 ,$14.14 ,$24.04 ,$14.14 ,$36.40 ,$9.02 ,$14.14 ,$14.14 ,$16.00 ,$44.20 ,$31.82 ,$47.84 ,$36.40 ,$30.82 ,$30.82 ,$31.67 ,$30.82 ,$35.93 ,$46.80 ,$36.22 ,$14.28 ,$41.08 ,$9.56 ,$16.97 ,$16.97 ,$14.14 ,$16.97 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30100268,82595,HC CRYOGLOBULIN,301,1 ,$168.00 ,$84.00 ,$6.47 ,$168.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$100.80 ,$142.80 ,$117.60 ,$6.69 ,$159.60 ,$127.68 ,$126.00 ,$11.00 ,$142.80 ,$6.47 ,$11.00 ,$6.47 ,$117.60 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$142.80 ,$14.56 ,$154.56 ,$117.60 ,$31.10 ,$31.10 ,$102.31 ,$31.10 ,$116.09 ,$151.20 ,$117.01 ,$6.53 ,$132.72 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100269,82607,HC VITAMIN B12,301,1 ,$112.00 ,$56.00 ,$15.08 ,$112.00 ,$15.58 ,$58.63 ,$50.25 ,$15.08 ,$67.20 ,$95.20 ,$78.40 ,$15.58 ,$106.40 ,$85.12 ,$84.00 ,$25.64 ,$95.20 ,$15.08 ,$25.64 ,$15.08 ,$78.40 ,$15.58 ,$15.08 ,$15.08 ,$17.07 ,$95.20 ,$33.93 ,$103.04 ,$78.40 ,$72.42 ,$72.42 ,$68.21 ,$72.42 ,$77.39 ,$100.80 ,$78.01 ,$15.23 ,$88.48 ,$16.51 ,$18.10 ,$18.10 ,$15.08 ,$18.10 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100270,82626,HC DHEA,301,1 ,$190.00 ,$95.00 ,$25.27 ,$190.00 ,$26.11 ,$98.28 ,$84.24 ,$25.27 ,$114.00 ,$161.50 ,$133.00 ,$26.11 ,$180.50 ,$144.40 ,$142.50 ,$42.96 ,$161.50 ,$25.27 ,$42.96 ,$25.27 ,$133.00 ,$26.11 ,$25.27 ,$25.27 ,$28.60 ,$161.50 ,$56.86 ,$174.80 ,$133.00 ,$121.46 ,$121.46 ,$115.71 ,$121.46 ,$131.29 ,$171.00 ,$132.34 ,$25.52 ,$150.10 ,$27.68 ,$30.32 ,$30.32 ,$25.27 ,$30.32 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100271,82627,HC DHEA SULFATE,301,1 ,$168.00 ,$84.00 ,$22.23 ,$168.00 ,$22.97 ,$86.49 ,$74.13 ,$22.23 ,$100.80 ,$142.80 ,$117.60 ,$22.97 ,$159.60 ,$127.68 ,$126.00 ,$37.79 ,$142.80 ,$22.23 ,$37.79 ,$22.23 ,$117.60 ,$22.97 ,$22.23 ,$22.23 ,$25.16 ,$142.80 ,$50.02 ,$154.56 ,$117.60 ,$106.84 ,$106.84 ,$102.31 ,$106.84 ,$116.09 ,$151.20 ,$117.01 ,$22.45 ,$132.72 ,$24.35 ,$26.68 ,$26.68 ,$22.23 ,$26.68 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100272,82652,HC VITAMIN D (1 25 DIHYDROXY),301,1 ,$291.00 ,$145.50 ,$38.50 ,$291.00 ,$39.78 ,$149.73 ,$128.34 ,$38.50 ,$174.60 ,$247.35 ,$203.70 ,$39.78 ,$276.45 ,$221.16 ,$218.25 ,$65.45 ,$247.35 ,$38.50 ,$65.45 ,$38.50 ,$203.70 ,$39.78 ,$38.50 ,$38.50 ,$43.57 ,$247.35 ,$86.63 ,$267.72 ,$203.70 ,$185.04 ,$185.04 ,$177.22 ,$185.04 ,$201.08 ,$261.90 ,$202.68 ,$38.89 ,$229.89 ,$42.17 ,$46.20 ,$46.20 ,$38.50 ,$46.20 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30100273,82657,HC ENZYME ACT NONRAD SUBS,301,1 ,$258.00 ,$129.00 ,$22.17 ,$258.00 ,$22.91 ,$77.60 ,$66.51 ,$22.17 ,$154.80 ,$219.30 ,$180.60 ,$22.91 ,$245.10 ,$196.08 ,$193.50 ,$37.69 ,$219.30 ,$22.17 ,$37.69 ,$22.17 ,$180.60 ,$22.91 ,$22.17 ,$22.17 ,$25.09 ,$219.30 ,$49.88 ,$237.36 ,$180.60 ,$86.76 ,$86.76 ,$157.12 ,$86.76 ,$178.28 ,$232.20 ,$179.70 ,$22.39 ,$203.82 ,$24.28 ,$26.60 ,$26.60 ,$22.17 ,$26.60 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,30100274,82664,HC ELECTROPHORETIC TEST,301,1 ,$224.00 ,$112.00 ,$48.31 ,$224.00 ,$48.31 ,$215.25 ,$184.50 ,$61.50 ,$134.40 ,$190.40 ,$156.80 ,$48.31 ,$212.80 ,$170.24 ,$168.00 ,$104.55 ,$190.40 ,$61.50 ,$104.55 ,$61.50 ,$156.80 ,$48.31 ,$61.50 ,$61.50 ,$69.61 ,$190.40 ,$138.38 ,$206.08 ,$156.80 ,$165.10 ,$165.10 ,$136.42 ,$165.10 ,$154.78 ,$201.60 ,$156.02 ,$62.12 ,$176.96 ,$51.21 ,$73.80 ,$73.80 ,$61.50 ,$73.80 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30100275,82668,HC ERYTHROPOIETIN,301,1 ,$101.00 ,$50.50 ,$18.79 ,$101.00 ,$19.42 ,$73.08 ,$62.64 ,$18.79 ,$60.60 ,$85.85 ,$70.70 ,$19.42 ,$95.95 ,$76.76 ,$75.75 ,$31.94 ,$85.85 ,$18.79 ,$31.94 ,$18.79 ,$70.70 ,$19.42 ,$18.79 ,$18.79 ,$21.27 ,$85.85 ,$42.28 ,$92.92 ,$70.70 ,$90.35 ,$90.35 ,$61.51 ,$90.35 ,$69.79 ,$90.90 ,$70.35 ,$18.98 ,$79.79 ,$20.59 ,$22.55 ,$22.55 ,$18.79 ,$22.55 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100276,82670,HC ESTRADIOL,301,1 ,$213.00 ,$106.50 ,$27.94 ,$213.00 ,$28.87 ,$108.64 ,$93.12 ,$27.94 ,$127.80 ,$181.05 ,$149.10 ,$28.87 ,$202.35 ,$161.88 ,$159.75 ,$47.50 ,$181.05 ,$27.94 ,$47.50 ,$27.94 ,$149.10 ,$28.87 ,$27.94 ,$27.94 ,$31.62 ,$181.05 ,$62.87 ,$195.96 ,$149.10 ,$134.28 ,$134.28 ,$129.72 ,$134.28 ,$147.18 ,$191.70 ,$148.35 ,$28.22 ,$168.27 ,$30.60 ,$33.53 ,$33.53 ,$27.94 ,$33.53 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100277,82670,HC ESTRADIOL SERUM,301,1 ,$213.00 ,$106.50 ,$27.94 ,$213.00 ,$28.87 ,$108.64 ,$93.12 ,$27.94 ,$127.80 ,$181.05 ,$149.10 ,$28.87 ,$202.35 ,$161.88 ,$159.75 ,$47.50 ,$181.05 ,$27.94 ,$47.50 ,$27.94 ,$149.10 ,$28.87 ,$27.94 ,$27.94 ,$31.62 ,$181.05 ,$62.87 ,$195.96 ,$149.10 ,$134.28 ,$134.28 ,$129.72 ,$134.28 ,$147.18 ,$191.70 ,$148.35 ,$28.22 ,$168.27 ,$30.60 ,$33.53 ,$33.53 ,$27.94 ,$33.53 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100278,82672,HC ESTROGEN TOTAL,301,1 ,$168.00 ,$84.00 ,$21.70 ,$168.00 ,$22.42 ,$84.39 ,$72.33 ,$21.70 ,$100.80 ,$142.80 ,$117.60 ,$22.42 ,$159.60 ,$127.68 ,$126.00 ,$36.89 ,$142.80 ,$21.70 ,$36.89 ,$21.70 ,$117.60 ,$22.42 ,$21.70 ,$21.70 ,$24.56 ,$142.80 ,$48.83 ,$154.56 ,$117.60 ,$104.27 ,$104.27 ,$102.31 ,$104.27 ,$116.09 ,$151.20 ,$117.01 ,$21.92 ,$132.72 ,$23.77 ,$26.04 ,$26.04 ,$21.70 ,$26.04 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100279,82672,HC ESTROGEN 24HR URINE,301,1 ,$187.00 ,$93.50 ,$21.70 ,$187.00 ,$22.42 ,$84.39 ,$72.33 ,$21.70 ,$112.20 ,$158.95 ,$130.90 ,$22.42 ,$177.65 ,$142.12 ,$140.25 ,$36.89 ,$158.95 ,$21.70 ,$36.89 ,$21.70 ,$130.90 ,$22.42 ,$21.70 ,$21.70 ,$24.56 ,$158.95 ,$48.83 ,$172.04 ,$130.90 ,$104.27 ,$104.27 ,$113.88 ,$104.27 ,$129.22 ,$168.30 ,$130.25 ,$21.92 ,$147.73 ,$23.77 ,$26.04 ,$26.04 ,$21.70 ,$26.04 ,$134.64 ,$115.94 ,$134.64 ,$134.64 ,$149.60 
ST NICHOLAS HOSPITAL - ACUTE,30100280,82677,HC ESTRIOL,301,1 ,$202.00 ,$101.00 ,$24.18 ,$202.00 ,$24.99 ,$94.05 ,$80.61 ,$24.18 ,$121.20 ,$171.70 ,$141.40 ,$24.99 ,$191.90 ,$153.52 ,$151.50 ,$41.11 ,$171.70 ,$24.18 ,$41.11 ,$24.18 ,$141.40 ,$24.99 ,$24.18 ,$24.18 ,$27.37 ,$171.70 ,$54.41 ,$185.84 ,$141.40 ,$116.21 ,$116.21 ,$123.02 ,$116.21 ,$139.58 ,$181.80 ,$140.69 ,$24.42 ,$159.58 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30100281,82677,HC ESTRIOL QUAD,301,1 ,$113.00 ,$56.50 ,$24.18 ,$113.00 ,$24.99 ,$94.05 ,$80.61 ,$24.18 ,$67.80 ,$96.05 ,$79.10 ,$24.99 ,$107.35 ,$85.88 ,$84.75 ,$41.11 ,$96.05 ,$24.18 ,$41.11 ,$24.18 ,$79.10 ,$24.99 ,$24.18 ,$24.18 ,$27.37 ,$96.05 ,$54.41 ,$103.96 ,$79.10 ,$113.00 ,$113.00 ,$68.82 ,$113.00 ,$78.08 ,$101.70 ,$78.70 ,$24.42 ,$89.27 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$81.36 ,$70.06 ,$81.36 ,$81.36 ,$90.40 
ST NICHOLAS HOSPITAL - ACUTE,30100283,82677,HC ESTRIOL URINE,301,1 ,$235.00 ,$117.50 ,$24.18 ,$235.00 ,$24.99 ,$94.05 ,$80.61 ,$24.18 ,$141.00 ,$199.75 ,$164.50 ,$24.99 ,$223.25 ,$178.60 ,$176.25 ,$41.11 ,$199.75 ,$24.18 ,$41.11 ,$24.18 ,$164.50 ,$24.99 ,$24.18 ,$24.18 ,$27.37 ,$199.75 ,$54.41 ,$216.20 ,$164.50 ,$116.21 ,$116.21 ,$143.12 ,$116.21 ,$162.39 ,$211.50 ,$163.68 ,$24.42 ,$185.65 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,30100284,82677,HC ESTRIOL ASSAY,301,1 ,$142.00 ,$71.00 ,$24.18 ,$142.00 ,$24.99 ,$94.05 ,$80.61 ,$24.18 ,$85.20 ,$120.70 ,$99.40 ,$24.99 ,$134.90 ,$107.92 ,$106.50 ,$41.11 ,$120.70 ,$24.18 ,$41.11 ,$24.18 ,$99.40 ,$24.99 ,$24.18 ,$24.18 ,$27.37 ,$120.70 ,$54.41 ,$130.64 ,$99.40 ,$116.21 ,$116.21 ,$86.48 ,$116.21 ,$98.12 ,$127.80 ,$98.90 ,$24.42 ,$112.18 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$102.24 ,$88.04 ,$102.24 ,$102.24 ,$113.60 
ST NICHOLAS HOSPITAL - ACUTE,30100285,82679,HC ESTRONE,301,1 ,$183.00 ,$91.50 ,$24.95 ,$183.00 ,$25.78 ,$97.06 ,$83.19 ,$24.95 ,$109.80 ,$155.55 ,$128.10 ,$25.78 ,$173.85 ,$139.08 ,$137.25 ,$42.42 ,$155.55 ,$24.95 ,$42.42 ,$24.95 ,$128.10 ,$25.78 ,$24.95 ,$24.95 ,$28.24 ,$155.55 ,$56.14 ,$168.36 ,$128.10 ,$119.94 ,$119.94 ,$111.45 ,$119.94 ,$126.45 ,$164.70 ,$127.46 ,$25.20 ,$144.57 ,$27.33 ,$29.94 ,$29.94 ,$24.95 ,$29.94 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,30100286,82693,HC ETHYLENE GLYCOL,301,1 ,$400.00 ,$200.00 ,$7.95 ,$400.00 ,$7.95 ,$57.96 ,$49.68 ,$14.90 ,$240.00 ,$340.00 ,$280.00 ,$7.95 ,$380.00 ,$304.00 ,$300.00 ,$25.33 ,$340.00 ,$14.90 ,$25.33 ,$14.90 ,$280.00 ,$7.95 ,$14.90 ,$14.90 ,$16.86 ,$340.00 ,$33.53 ,$368.00 ,$280.00 ,$27.16 ,$27.16 ,$243.60 ,$27.16 ,$276.40 ,$360.00 ,$278.60 ,$15.05 ,$316.00 ,$8.43 ,$17.88 ,$17.88 ,$14.90 ,$17.88 ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$320.00 
ST NICHOLAS HOSPITAL - ACUTE,30100287,82710,HC FECAL FAT QN,301,1 ,$280.00 ,$140.00 ,$16.80 ,$280.00 ,$17.36 ,$65.35 ,$56.01 ,$16.80 ,$168.00 ,$238.00 ,$196.00 ,$17.36 ,$266.00 ,$212.80 ,$210.00 ,$28.56 ,$238.00 ,$16.80 ,$28.56 ,$16.80 ,$196.00 ,$17.36 ,$16.80 ,$16.80 ,$19.01 ,$238.00 ,$37.80 ,$257.60 ,$196.00 ,$80.77 ,$80.77 ,$170.52 ,$80.77 ,$193.48 ,$252.00 ,$195.02 ,$16.97 ,$221.20 ,$18.40 ,$20.16 ,$20.16 ,$16.80 ,$20.16 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,30100288,82725,HC FATTY ACIDS NONESTERIFIED,301,1 ,$157.00 ,$78.50 ,$18.72 ,$157.00 ,$18.72 ,$65.70 ,$56.31 ,$18.77 ,$94.20 ,$133.45 ,$109.90 ,$18.72 ,$149.15 ,$119.32 ,$117.75 ,$31.91 ,$133.45 ,$18.77 ,$31.91 ,$18.77 ,$109.90 ,$18.72 ,$18.77 ,$18.77 ,$21.24 ,$133.45 ,$42.23 ,$144.44 ,$109.90 ,$63.97 ,$63.97 ,$95.61 ,$63.97 ,$108.49 ,$141.30 ,$109.35 ,$18.96 ,$124.03 ,$19.84 ,$22.52 ,$22.52 ,$18.77 ,$22.52 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30100289,82726,HC VLFC FATTY ACIDS,301,1 ,$280.00 ,$140.00 ,$19.75 ,$280.00 ,$20.41 ,$70.21 ,$60.18 ,$19.75 ,$168.00 ,$238.00 ,$196.00 ,$20.41 ,$266.00 ,$212.80 ,$210.00 ,$33.58 ,$238.00 ,$19.75 ,$33.58 ,$19.75 ,$196.00 ,$20.41 ,$19.75 ,$19.75 ,$22.35 ,$238.00 ,$44.44 ,$257.60 ,$196.00 ,$86.76 ,$86.76 ,$170.52 ,$86.76 ,$193.48 ,$252.00 ,$195.02 ,$19.95 ,$221.20 ,$21.63 ,$23.70 ,$23.70 ,$19.75 ,$23.70 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,30100290,82728,HC FERRITIN,301,1 ,$101.00 ,$50.50 ,$13.63 ,$101.00 ,$14.08 ,$53.03 ,$45.45 ,$13.63 ,$60.60 ,$85.85 ,$70.70 ,$14.08 ,$95.95 ,$76.76 ,$75.75 ,$23.17 ,$85.85 ,$13.63 ,$23.17 ,$13.63 ,$70.70 ,$14.08 ,$13.63 ,$13.63 ,$15.43 ,$85.85 ,$30.67 ,$92.92 ,$70.70 ,$65.49 ,$65.49 ,$61.51 ,$65.49 ,$69.79 ,$90.90 ,$70.35 ,$13.77 ,$79.79 ,$14.92 ,$16.36 ,$16.36 ,$13.63 ,$16.36 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$493.00 ,$246.50 ,$64.41 ,$493.00 ,$66.55 ,$250.50 ,$214.71 ,$64.41 ,$295.80 ,$419.05 ,$345.10 ,$66.55 ,$468.35 ,$374.68 ,$369.75 ,$109.50 ,$419.05 ,$64.41 ,$109.50 ,$64.41 ,$345.10 ,$66.55 ,$64.41 ,$64.41 ,$72.90 ,$419.05 ,$144.92 ,$453.56 ,$345.10 ,$309.57 ,$309.57 ,$300.24 ,$309.57 ,$340.66 ,$443.70 ,$343.37 ,$65.05 ,$389.47 ,$70.54 ,$77.29 ,$77.29 ,$64.41 ,$77.29 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,30100292,82746,HC FOLIC ACID SERUM,301,1 ,$112.00 ,$56.00 ,$14.70 ,$112.00 ,$15.19 ,$57.19 ,$49.02 ,$14.70 ,$67.20 ,$95.20 ,$78.40 ,$15.19 ,$106.40 ,$85.12 ,$84.00 ,$24.99 ,$95.20 ,$14.70 ,$24.99 ,$14.70 ,$78.40 ,$15.19 ,$14.70 ,$14.70 ,$16.64 ,$95.20 ,$33.08 ,$103.04 ,$78.40 ,$70.66 ,$70.66 ,$68.21 ,$70.66 ,$77.39 ,$100.80 ,$78.01 ,$14.85 ,$88.48 ,$16.10 ,$17.64 ,$17.64 ,$14.70 ,$17.64 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100293,82747,HC FOLIC ACID RBC,301,1 ,$90.00 ,$45.00 ,$16.37 ,$90.00 ,$16.37 ,$67.38 ,$57.75 ,$17.65 ,$54.00 ,$76.50 ,$63.00 ,$16.37 ,$85.50 ,$68.40 ,$67.50 ,$30.01 ,$76.50 ,$17.65 ,$30.01 ,$17.65 ,$63.00 ,$16.37 ,$17.65 ,$17.65 ,$19.98 ,$76.50 ,$39.71 ,$82.80 ,$63.00 ,$55.94 ,$55.94 ,$54.81 ,$55.94 ,$62.19 ,$81.00 ,$62.69 ,$17.83 ,$71.10 ,$17.35 ,$21.18 ,$21.18 ,$17.65 ,$21.18 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100295,82784,HC GAMMAGLOBULIN,301,1 ,$67.00 ,$33.50 ,$9.30 ,$67.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$40.20 ,$56.95 ,$46.90 ,$9.61 ,$63.65 ,$50.92 ,$50.25 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$9.30 ,$46.90 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$44.67 ,$44.67 ,$40.80 ,$44.67 ,$46.30 ,$60.30 ,$46.67 ,$9.39 ,$52.93 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100296,82784,HC IGA (TISSUE TRNSGLT),301,1 ,$36.00 ,$18.00 ,$9.30 ,$36.00 ,$9.61 ,$36.00 ,$31.02 ,$9.30 ,$21.60 ,$30.60 ,$25.20 ,$9.61 ,$34.20 ,$27.36 ,$27.00 ,$15.81 ,$30.60 ,$9.30 ,$15.81 ,$9.30 ,$25.20 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$30.60 ,$20.93 ,$33.12 ,$25.20 ,$36.00 ,$36.00 ,$21.92 ,$36.00 ,$24.88 ,$32.40 ,$25.07 ,$9.39 ,$28.44 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30100297,82784,HC IGA (CELIAC SCRN),301,1 ,$67.00 ,$33.50 ,$9.30 ,$67.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$40.20 ,$56.95 ,$46.90 ,$9.61 ,$63.65 ,$50.92 ,$50.25 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$9.30 ,$46.90 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$44.67 ,$44.67 ,$40.80 ,$44.67 ,$46.30 ,$60.30 ,$46.67 ,$9.39 ,$52.93 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100298,82784,HC GAMMAGLOBULIN TOTAL,301,1 ,$67.00 ,$33.50 ,$9.30 ,$67.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$40.20 ,$56.95 ,$46.90 ,$9.61 ,$63.65 ,$50.92 ,$50.25 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$9.30 ,$46.90 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$44.67 ,$44.67 ,$40.80 ,$44.67 ,$46.30 ,$60.30 ,$46.67 ,$9.39 ,$52.93 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100299,82784,HC CP IGA,301,1 ,$67.00 ,$33.50 ,$9.30 ,$67.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$40.20 ,$56.95 ,$46.90 ,$9.61 ,$63.65 ,$50.92 ,$50.25 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$9.30 ,$46.90 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$44.67 ,$44.67 ,$40.80 ,$44.67 ,$46.30 ,$60.30 ,$46.67 ,$9.39 ,$52.93 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100300,82784,HC IGD SERUM,301,1 ,$71.00 ,$35.50 ,$9.30 ,$71.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$42.60 ,$60.35 ,$49.70 ,$9.61 ,$67.45 ,$53.96 ,$53.25 ,$15.81 ,$60.35 ,$9.30 ,$15.81 ,$9.30 ,$49.70 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$60.35 ,$20.93 ,$65.32 ,$49.70 ,$44.67 ,$44.67 ,$43.24 ,$44.67 ,$49.06 ,$63.90 ,$49.45 ,$9.39 ,$56.09 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$56.80 
ST NICHOLAS HOSPITAL - ACUTE,30100301,82784,HC GAMMAGLOBULIN CSF/SERUM,301,1 ,$71.00 ,$35.50 ,$9.30 ,$71.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$42.60 ,$60.35 ,$49.70 ,$9.61 ,$67.45 ,$53.96 ,$53.25 ,$15.81 ,$60.35 ,$9.30 ,$15.81 ,$9.30 ,$49.70 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$60.35 ,$20.93 ,$65.32 ,$49.70 ,$44.67 ,$44.67 ,$43.24 ,$44.67 ,$49.06 ,$63.90 ,$49.45 ,$9.39 ,$56.09 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$56.80 
ST NICHOLAS HOSPITAL - ACUTE,30100302,82785,HC GAMMAGLOBULIN IGE,301,1 ,$123.00 ,$61.50 ,$16.46 ,$123.00 ,$17.01 ,$64.02 ,$54.87 ,$16.46 ,$73.80 ,$104.55 ,$86.10 ,$17.01 ,$116.85 ,$93.48 ,$92.25 ,$27.98 ,$104.55 ,$16.46 ,$27.98 ,$16.46 ,$86.10 ,$17.01 ,$16.46 ,$16.46 ,$18.63 ,$104.55 ,$37.04 ,$113.16 ,$86.10 ,$79.15 ,$79.15 ,$74.91 ,$79.15 ,$84.99 ,$110.70 ,$85.67 ,$16.62 ,$97.17 ,$18.03 ,$19.75 ,$19.75 ,$16.46 ,$19.75 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100303,82787,HC IGG SUBCLASS1-3,301,1 ,$41.00 ,$20.50 ,$5.90 ,$41.00 ,$5.90 ,$31.19 ,$26.73 ,$8.02 ,$24.60 ,$34.85 ,$28.70 ,$5.90 ,$38.95 ,$31.16 ,$30.75 ,$13.63 ,$34.85 ,$8.02 ,$13.63 ,$8.02 ,$28.70 ,$5.90 ,$8.02 ,$8.02 ,$9.08 ,$34.85 ,$18.05 ,$37.72 ,$28.70 ,$20.15 ,$20.15 ,$24.97 ,$20.15 ,$28.33 ,$36.90 ,$28.56 ,$8.10 ,$32.39 ,$6.25 ,$9.62 ,$9.62 ,$8.02 ,$9.62 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,30100304,82787,HC IGG SUBCLASS 4,301,1 ,$41.00 ,$20.50 ,$5.90 ,$41.00 ,$5.90 ,$31.19 ,$26.73 ,$8.02 ,$24.60 ,$34.85 ,$28.70 ,$5.90 ,$38.95 ,$31.16 ,$30.75 ,$13.63 ,$34.85 ,$8.02 ,$13.63 ,$8.02 ,$28.70 ,$5.90 ,$8.02 ,$8.02 ,$9.08 ,$34.85 ,$18.05 ,$37.72 ,$28.70 ,$20.15 ,$20.15 ,$24.97 ,$20.15 ,$28.33 ,$36.90 ,$28.56 ,$8.10 ,$32.39 ,$6.25 ,$9.62 ,$9.62 ,$8.02 ,$9.62 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,30100305,82800,HC BLOOD GAS PH,301,1 ,$84.00 ,$42.00 ,$11.00 ,$84.00 ,$11.37 ,$38.50 ,$33.00 ,$11.00 ,$50.40 ,$71.40 ,$58.80 ,$11.37 ,$79.80 ,$63.84 ,$63.00 ,$18.70 ,$71.40 ,$11.00 ,$18.70 ,$11.00 ,$58.80 ,$11.37 ,$11.00 ,$11.00 ,$12.45 ,$71.40 ,$24.75 ,$77.28 ,$58.80 ,$40.65 ,$40.65 ,$51.16 ,$40.65 ,$58.04 ,$75.60 ,$58.51 ,$11.11 ,$66.36 ,$12.05 ,$13.20 ,$13.20 ,$11.00 ,$13.20 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,30100306,82803,HC BLOOD GAS PH PO2  AND /OR PCO2,301,1 ,$146.00 ,$73.00 ,$26.07 ,$146.00 ,$26.94 ,$91.25 ,$78.21 ,$26.07 ,$87.60 ,$124.10 ,$102.20 ,$26.94 ,$138.70 ,$110.96 ,$109.50 ,$44.32 ,$124.10 ,$26.07 ,$44.32 ,$26.07 ,$102.20 ,$26.94 ,$26.07 ,$26.07 ,$29.51 ,$124.10 ,$58.66 ,$134.32 ,$102.20 ,$93.00 ,$93.00 ,$88.91 ,$93.00 ,$100.89 ,$131.40 ,$101.69 ,$26.33 ,$115.34 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100307,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$213.00 ,$106.50 ,$39.91 ,$213.00 ,$39.91 ,$213.00 ,$213.00 ,$78.77 ,$127.80 ,$181.05 ,$149.10 ,$39.91 ,$202.35 ,$161.88 ,$159.75 ,$133.91 ,$181.05 ,$78.77 ,$133.91 ,$78.77 ,$149.10 ,$39.91 ,$78.77 ,$78.77 ,$89.15 ,$181.05 ,$177.23 ,$195.96 ,$149.10 ,$136.36 ,$136.36 ,$129.72 ,$136.36 ,$147.18 ,$191.70 ,$148.35 ,$79.56 ,$168.27 ,$42.30 ,$94.52 ,$94.52 ,$78.77 ,$94.52 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100308,82810,HC BLOOD GAS O2 SAT ONLY,301,1 ,$151.00 ,$75.50 ,$9.77 ,$151.00 ,$10.10 ,$34.20 ,$29.31 ,$9.77 ,$90.60 ,$128.35 ,$105.70 ,$10.10 ,$143.45 ,$114.76 ,$113.25 ,$16.61 ,$128.35 ,$9.77 ,$16.61 ,$9.77 ,$105.70 ,$10.10 ,$9.77 ,$9.77 ,$11.06 ,$128.35 ,$21.98 ,$138.92 ,$105.70 ,$41.95 ,$41.95 ,$91.96 ,$41.95 ,$104.34 ,$135.90 ,$105.17 ,$9.87 ,$119.29 ,$10.71 ,$11.72 ,$11.72 ,$9.77 ,$11.72 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$120.80 
ST NICHOLAS HOSPITAL - ACUTE,30100309,82941,HC GASTRIN,301,1 ,$101.00 ,$50.50 ,$17.63 ,$101.00 ,$18.22 ,$68.57 ,$58.77 ,$17.63 ,$60.60 ,$85.85 ,$70.70 ,$18.22 ,$95.95 ,$76.76 ,$75.75 ,$29.97 ,$85.85 ,$17.63 ,$29.97 ,$17.63 ,$70.70 ,$18.22 ,$17.63 ,$17.63 ,$19.95 ,$85.85 ,$39.67 ,$92.92 ,$70.70 ,$84.75 ,$84.75 ,$61.51 ,$84.75 ,$69.79 ,$90.90 ,$70.35 ,$17.81 ,$79.79 ,$19.31 ,$21.16 ,$21.16 ,$17.63 ,$21.16 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100310,82943,HC GLUCAGON PLASMA,301,1 ,$62.00 ,$31.00 ,$13.88 ,$62.00 ,$13.88 ,$55.58 ,$47.64 ,$14.29 ,$37.20 ,$52.70 ,$43.40 ,$13.88 ,$58.90 ,$47.12 ,$46.50 ,$24.29 ,$52.70 ,$14.29 ,$24.29 ,$14.29 ,$43.40 ,$13.88 ,$14.29 ,$14.29 ,$16.17 ,$52.70 ,$32.15 ,$57.04 ,$43.40 ,$47.41 ,$47.41 ,$37.76 ,$47.41 ,$42.84 ,$55.80 ,$43.18 ,$14.43 ,$48.98 ,$14.71 ,$17.15 ,$17.15 ,$14.29 ,$17.15 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$54.00 ,$27.00 ,$3.93 ,$54.00 ,$4.06 ,$15.30 ,$13.11 ,$3.93 ,$32.40 ,$45.90 ,$37.80 ,$4.06 ,$51.30 ,$41.04 ,$40.50 ,$6.68 ,$45.90 ,$3.93 ,$6.68 ,$3.93 ,$37.80 ,$4.06 ,$3.93 ,$3.93 ,$4.45 ,$45.90 ,$8.84 ,$49.68 ,$37.80 ,$18.88 ,$18.88 ,$32.89 ,$18.88 ,$37.31 ,$48.60 ,$37.61 ,$3.97 ,$42.66 ,$4.30 ,$4.72 ,$4.72 ,$3.93 ,$4.72 ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$43.20 
ST NICHOLAS HOSPITAL - ACUTE,30100312,82947,HC GLUCOSE,301,1 ,$30.00 ,$15.00 ,$3.93 ,$30.00 ,$4.06 ,$15.30 ,$13.11 ,$3.93 ,$18.00 ,$25.50 ,$21.00 ,$4.06 ,$28.50 ,$22.80 ,$22.50 ,$6.68 ,$25.50 ,$3.93 ,$6.68 ,$3.93 ,$21.00 ,$4.06 ,$3.93 ,$3.93 ,$4.45 ,$25.50 ,$8.84 ,$27.60 ,$21.00 ,$18.88 ,$18.88 ,$18.27 ,$18.88 ,$20.73 ,$27.00 ,$20.90 ,$3.97 ,$23.70 ,$4.30 ,$4.72 ,$4.72 ,$3.93 ,$4.72 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,30100313,82950,HC GLUCOSE SCREEN,301,1 ,$90.00 ,$45.00 ,$4.75 ,$90.00 ,$4.91 ,$18.45 ,$15.81 ,$4.75 ,$54.00 ,$76.50 ,$63.00 ,$4.91 ,$85.50 ,$68.40 ,$67.50 ,$8.08 ,$76.50 ,$4.75 ,$8.08 ,$4.75 ,$63.00 ,$4.91 ,$4.75 ,$4.75 ,$5.38 ,$76.50 ,$10.69 ,$82.80 ,$63.00 ,$22.83 ,$22.83 ,$54.81 ,$22.83 ,$62.19 ,$81.00 ,$62.69 ,$4.80 ,$71.10 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$112.00 ,$56.00 ,$12.87 ,$112.00 ,$13.30 ,$50.05 ,$42.90 ,$12.87 ,$67.20 ,$95.20 ,$78.40 ,$13.30 ,$106.40 ,$85.12 ,$84.00 ,$21.88 ,$95.20 ,$12.87 ,$21.88 ,$12.87 ,$78.40 ,$13.30 ,$12.87 ,$12.87 ,$14.57 ,$95.20 ,$28.96 ,$103.04 ,$78.40 ,$61.86 ,$61.86 ,$68.21 ,$61.86 ,$77.39 ,$100.80 ,$78.01 ,$13.00 ,$88.48 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$31.00 ,$15.50 ,$3.92 ,$31.00 ,$4.05 ,$15.26 ,$13.08 ,$3.92 ,$18.60 ,$26.35 ,$21.70 ,$4.05 ,$29.45 ,$23.56 ,$23.25 ,$6.66 ,$26.35 ,$3.92 ,$6.66 ,$3.92 ,$21.70 ,$4.05 ,$3.92 ,$3.92 ,$4.44 ,$26.35 ,$8.82 ,$28.52 ,$21.70 ,$18.85 ,$18.85 ,$18.88 ,$18.85 ,$21.42 ,$27.90 ,$21.59 ,$3.96 ,$24.49 ,$4.29 ,$4.70 ,$4.70 ,$3.92 ,$4.70 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$24.80 
ST NICHOLAS HOSPITAL - ACUTE,30100316,82955,HC G6PD ENZYME QN,301,1 ,$431.00 ,$215.50 ,$9.70 ,$431.00 ,$10.02 ,$37.70 ,$32.31 ,$9.70 ,$258.60 ,$366.35 ,$301.70 ,$10.02 ,$409.45 ,$327.56 ,$323.25 ,$16.49 ,$366.35 ,$9.70 ,$16.49 ,$9.70 ,$301.70 ,$10.02 ,$9.70 ,$9.70 ,$10.98 ,$366.35 ,$21.83 ,$396.52 ,$301.70 ,$46.57 ,$46.57 ,$262.48 ,$46.57 ,$297.82 ,$387.90 ,$300.19 ,$9.80 ,$340.49 ,$10.62 ,$11.64 ,$11.64 ,$9.70 ,$11.64 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,30100317,82955,HC GLUCOSE 6 PHOS DEHYDROGN,301,1 ,$78.00 ,$39.00 ,$9.70 ,$78.00 ,$10.02 ,$37.70 ,$32.31 ,$9.70 ,$46.80 ,$66.30 ,$54.60 ,$10.02 ,$74.10 ,$59.28 ,$58.50 ,$16.49 ,$66.30 ,$9.70 ,$16.49 ,$9.70 ,$54.60 ,$10.02 ,$9.70 ,$9.70 ,$10.98 ,$66.30 ,$21.83 ,$71.76 ,$54.60 ,$46.57 ,$46.57 ,$47.50 ,$46.57 ,$53.90 ,$70.20 ,$54.33 ,$9.80 ,$61.62 ,$10.62 ,$11.64 ,$11.64 ,$9.70 ,$11.64 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100318,82962,HC GLUCOSE BY DEVICE,301,1 ,$19.00 ,$9.50 ,$3.28 ,$19.00 ,$3.30 ,$11.48 ,$9.84 ,$3.28 ,$11.40 ,$16.15 ,$13.30 ,$3.30 ,$18.05 ,$14.44 ,$14.25 ,$5.58 ,$16.15 ,$3.28 ,$5.58 ,$3.28 ,$13.30 ,$3.30 ,$3.28 ,$3.28 ,$3.71 ,$16.15 ,$7.38 ,$17.48 ,$13.30 ,$11.27 ,$11.27 ,$11.57 ,$11.27 ,$13.13 ,$17.10 ,$13.23 ,$3.31 ,$15.01 ,$3.50 ,$3.94 ,$3.94 ,$3.28 ,$3.94 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$15.20 
ST NICHOLAS HOSPITAL - ACUTE,30100319,82977,HC GGT/GGTP,301,1 ,$55.00 ,$27.50 ,$7.20 ,$55.00 ,$7.44 ,$28.00 ,$24.00 ,$7.20 ,$33.00 ,$46.75 ,$38.50 ,$7.44 ,$52.25 ,$41.80 ,$41.25 ,$12.24 ,$46.75 ,$7.20 ,$12.24 ,$7.20 ,$38.50 ,$7.44 ,$7.20 ,$7.20 ,$8.15 ,$46.75 ,$16.20 ,$50.60 ,$38.50 ,$34.59 ,$34.59 ,$33.50 ,$34.59 ,$38.01 ,$49.50 ,$38.31 ,$7.27 ,$43.45 ,$7.89 ,$8.64 ,$8.64 ,$7.20 ,$8.64 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,30100320,82978,HC GLUTATHIONE,301,1 ,$260.00 ,$130.00 ,$15.45 ,$260.00 ,$15.96 ,$55.44 ,$47.52 ,$15.45 ,$156.00 ,$221.00 ,$182.00 ,$15.96 ,$247.00 ,$197.60 ,$195.00 ,$26.27 ,$221.00 ,$15.45 ,$26.27 ,$15.45 ,$182.00 ,$15.96 ,$15.45 ,$15.45 ,$17.49 ,$221.00 ,$34.76 ,$239.20 ,$182.00 ,$68.51 ,$68.51 ,$158.34 ,$68.51 ,$179.66 ,$234.00 ,$181.09 ,$15.60 ,$205.40 ,$16.92 ,$18.54 ,$18.54 ,$15.45 ,$18.54 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,30100321,82985,HC FRUCTOSAMINE,301,1 ,$90.00 ,$45.00 ,$16.62 ,$90.00 ,$16.62 ,$58.66 ,$50.28 ,$16.76 ,$54.00 ,$76.50 ,$63.00 ,$16.62 ,$85.50 ,$68.40 ,$67.50 ,$28.49 ,$76.50 ,$16.76 ,$28.49 ,$16.76 ,$63.00 ,$16.62 ,$16.76 ,$16.76 ,$18.97 ,$76.50 ,$37.71 ,$82.80 ,$63.00 ,$56.78 ,$56.78 ,$54.81 ,$56.78 ,$62.19 ,$81.00 ,$62.69 ,$16.93 ,$71.10 ,$17.62 ,$20.11 ,$20.11 ,$16.76 ,$20.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100323,83001,HC FSH,301,1 ,$146.00 ,$73.00 ,$18.58 ,$146.00 ,$19.20 ,$72.28 ,$61.95 ,$18.58 ,$87.60 ,$124.10 ,$102.20 ,$19.20 ,$138.70 ,$110.96 ,$109.50 ,$31.59 ,$124.10 ,$18.58 ,$31.59 ,$18.58 ,$102.20 ,$19.20 ,$18.58 ,$18.58 ,$21.03 ,$124.10 ,$41.81 ,$134.32 ,$102.20 ,$89.30 ,$89.30 ,$88.91 ,$89.30 ,$100.89 ,$131.40 ,$101.69 ,$18.77 ,$115.34 ,$20.35 ,$22.30 ,$22.30 ,$18.58 ,$22.30 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100325,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$146.00 ,$73.00 ,$18.52 ,$146.00 ,$19.14 ,$72.00 ,$61.71 ,$18.52 ,$87.60 ,$124.10 ,$102.20 ,$19.14 ,$138.70 ,$110.96 ,$109.50 ,$31.48 ,$124.10 ,$18.52 ,$31.48 ,$18.52 ,$102.20 ,$19.14 ,$18.52 ,$18.52 ,$20.96 ,$124.10 ,$41.67 ,$134.32 ,$102.20 ,$88.98 ,$88.98 ,$88.91 ,$88.98 ,$100.89 ,$131.40 ,$101.69 ,$18.71 ,$115.34 ,$20.29 ,$22.22 ,$22.22 ,$18.52 ,$22.22 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100326,83003,HC GROWTH HORMONE,301,1 ,$101.00 ,$50.50 ,$16.67 ,$101.00 ,$17.23 ,$64.82 ,$55.56 ,$16.67 ,$60.60 ,$85.85 ,$70.70 ,$17.23 ,$95.95 ,$76.76 ,$75.75 ,$28.34 ,$85.85 ,$16.67 ,$28.34 ,$16.67 ,$70.70 ,$17.23 ,$16.67 ,$16.67 ,$18.87 ,$85.85 ,$37.51 ,$92.92 ,$70.70 ,$80.17 ,$80.17 ,$61.51 ,$80.17 ,$69.79 ,$90.90 ,$70.35 ,$16.84 ,$79.79 ,$18.26 ,$20.00 ,$20.00 ,$16.67 ,$20.00 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100327,83010,HC HAPTOGLOBIN,301,1 ,$101.00 ,$50.50 ,$12.58 ,$101.00 ,$13.00 ,$48.90 ,$41.91 ,$12.58 ,$60.60 ,$85.85 ,$70.70 ,$13.00 ,$95.95 ,$76.76 ,$75.75 ,$21.39 ,$85.85 ,$12.58 ,$21.39 ,$12.58 ,$70.70 ,$13.00 ,$12.58 ,$12.58 ,$14.24 ,$85.85 ,$28.31 ,$92.92 ,$70.70 ,$60.45 ,$60.45 ,$61.51 ,$60.45 ,$69.79 ,$90.90 ,$70.35 ,$12.71 ,$79.79 ,$13.78 ,$15.10 ,$15.10 ,$12.58 ,$15.10 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100328,83018,HC HEAVY METAL EACH,301,1 ,$123.00 ,$61.50 ,$21.96 ,$123.00 ,$22.69 ,$85.44 ,$73.23 ,$21.96 ,$73.80 ,$104.55 ,$86.10 ,$22.69 ,$116.85 ,$93.48 ,$92.25 ,$37.33 ,$104.55 ,$21.96 ,$37.33 ,$21.96 ,$86.10 ,$22.69 ,$21.96 ,$21.96 ,$24.85 ,$104.55 ,$49.41 ,$113.16 ,$86.10 ,$105.54 ,$105.54 ,$74.91 ,$105.54 ,$84.99 ,$110.70 ,$85.67 ,$22.18 ,$97.17 ,$24.05 ,$26.35 ,$26.35 ,$21.96 ,$26.35 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100329,83018,HC HEAVY METAL 24HR EACH,301,1 ,$123.00 ,$61.50 ,$21.96 ,$123.00 ,$22.69 ,$85.44 ,$73.23 ,$21.96 ,$73.80 ,$104.55 ,$86.10 ,$22.69 ,$116.85 ,$93.48 ,$92.25 ,$37.33 ,$104.55 ,$21.96 ,$37.33 ,$21.96 ,$86.10 ,$22.69 ,$21.96 ,$21.96 ,$24.85 ,$104.55 ,$49.41 ,$113.16 ,$86.10 ,$105.54 ,$105.54 ,$74.91 ,$105.54 ,$84.99 ,$110.70 ,$85.67 ,$22.18 ,$97.17 ,$24.05 ,$26.35 ,$26.35 ,$21.96 ,$26.35 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100330,83020,HC HGB ELECTROPHORESIS,301,1 ,$128.00 ,$64.00 ,$6.41 ,$128.00 ,$6.41 ,$50.05 ,$42.90 ,$12.87 ,$76.80 ,$108.80 ,$89.60 ,$6.41 ,$121.60 ,$97.28 ,$96.00 ,$21.88 ,$108.80 ,$12.87 ,$21.88 ,$12.87 ,$89.60 ,$6.41 ,$12.87 ,$12.87 ,$14.57 ,$108.80 ,$28.96 ,$117.76 ,$89.60 ,$21.91 ,$21.91 ,$77.95 ,$21.91 ,$88.45 ,$115.20 ,$89.15 ,$13.00 ,$101.12 ,$6.79 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$102.40 
ST NICHOLAS HOSPITAL - ACUTE,30100331,83020,HC HGB ELECTROPHORESIS (MAYO),301,1 ,$99.00 ,$49.50 ,$6.41 ,$99.00 ,$6.41 ,$50.05 ,$42.90 ,$12.87 ,$59.40 ,$84.15 ,$69.30 ,$6.41 ,$94.05 ,$75.24 ,$74.25 ,$21.88 ,$84.15 ,$12.87 ,$21.88 ,$12.87 ,$69.30 ,$6.41 ,$12.87 ,$12.87 ,$14.57 ,$84.15 ,$28.96 ,$91.08 ,$69.30 ,$21.91 ,$21.91 ,$60.29 ,$21.91 ,$68.41 ,$89.10 ,$68.95 ,$13.00 ,$78.21 ,$6.79 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30100332,83020,HC HGB ELECTORPHORESIS (QHBCV),301,1 ,$131.00 ,$65.50 ,$6.41 ,$131.00 ,$6.41 ,$50.05 ,$42.90 ,$12.87 ,$78.60 ,$111.35 ,$91.70 ,$6.41 ,$124.45 ,$99.56 ,$98.25 ,$21.88 ,$111.35 ,$12.87 ,$21.88 ,$12.87 ,$91.70 ,$6.41 ,$12.87 ,$12.87 ,$14.57 ,$111.35 ,$28.96 ,$120.52 ,$91.70 ,$21.91 ,$21.91 ,$79.78 ,$21.91 ,$90.52 ,$117.90 ,$91.24 ,$13.00 ,$103.49 ,$6.79 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$94.32 ,$81.22 ,$94.32 ,$94.32 ,$104.80 
ST NICHOLAS HOSPITAL - ACUTE,30100334,83021,HC HEMOGLOBIN FRACT QN,301,1 ,$190.00 ,$95.00 ,$18.06 ,$190.00 ,$18.66 ,$70.21 ,$60.18 ,$18.06 ,$114.00 ,$161.50 ,$133.00 ,$18.66 ,$180.50 ,$144.40 ,$142.50 ,$30.70 ,$161.50 ,$18.06 ,$30.70 ,$18.06 ,$133.00 ,$18.66 ,$18.06 ,$18.06 ,$20.44 ,$161.50 ,$40.64 ,$174.80 ,$133.00 ,$86.76 ,$86.76 ,$115.71 ,$86.76 ,$131.29 ,$171.00 ,$132.34 ,$18.24 ,$150.10 ,$19.78 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100335,83021,HC HEMOGLOBIN FRACT QN HPLC,301,1 ,$190.00 ,$95.00 ,$18.06 ,$190.00 ,$18.66 ,$70.21 ,$60.18 ,$18.06 ,$114.00 ,$161.50 ,$133.00 ,$18.66 ,$180.50 ,$144.40 ,$142.50 ,$30.70 ,$161.50 ,$18.06 ,$30.70 ,$18.06 ,$133.00 ,$18.66 ,$18.06 ,$18.06 ,$20.44 ,$161.50 ,$40.64 ,$174.80 ,$133.00 ,$86.76 ,$86.76 ,$115.71 ,$86.76 ,$131.29 ,$171.00 ,$132.34 ,$18.24 ,$150.10 ,$19.78 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100336,83021,HC HEMOGLOBIN VARIANTS,301,1 ,$190.00 ,$95.00 ,$18.06 ,$190.00 ,$18.66 ,$70.21 ,$60.18 ,$18.06 ,$114.00 ,$161.50 ,$133.00 ,$18.66 ,$180.50 ,$144.40 ,$142.50 ,$30.70 ,$161.50 ,$18.06 ,$30.70 ,$18.06 ,$133.00 ,$18.66 ,$18.06 ,$18.06 ,$20.44 ,$161.50 ,$40.64 ,$174.80 ,$133.00 ,$86.76 ,$86.76 ,$115.71 ,$86.76 ,$131.29 ,$171.00 ,$132.34 ,$18.24 ,$150.10 ,$19.78 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$78.00 ,$39.00 ,$9.71 ,$78.00 ,$10.03 ,$37.77 ,$32.37 ,$9.71 ,$46.80 ,$66.30 ,$54.60 ,$10.03 ,$74.10 ,$59.28 ,$58.50 ,$16.51 ,$66.30 ,$9.71 ,$16.51 ,$9.71 ,$54.60 ,$10.03 ,$9.71 ,$9.71 ,$10.99 ,$66.30 ,$21.85 ,$71.76 ,$54.60 ,$46.64 ,$46.64 ,$47.50 ,$46.64 ,$53.90 ,$70.20 ,$54.33 ,$9.81 ,$61.62 ,$10.63 ,$11.65 ,$11.65 ,$9.71 ,$11.65 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100338,83050,HC METHEMOGLOBIN,301,1 ,$67.00 ,$33.50 ,$4.12 ,$67.00 ,$4.12 ,$28.70 ,$24.60 ,$8.20 ,$40.20 ,$56.95 ,$46.90 ,$4.12 ,$63.65 ,$50.92 ,$50.25 ,$13.94 ,$56.95 ,$8.20 ,$13.94 ,$8.20 ,$46.90 ,$4.12 ,$8.20 ,$8.20 ,$9.28 ,$56.95 ,$18.45 ,$61.64 ,$46.90 ,$14.09 ,$14.09 ,$40.80 ,$14.09 ,$46.30 ,$60.30 ,$46.67 ,$8.28 ,$52.93 ,$4.37 ,$9.84 ,$9.84 ,$8.20 ,$9.84 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100339,83051,HC HEMOGLOBIN PLASMA,301,1 ,$25.00 ,$12.50 ,$4.90 ,$25.00 ,$4.90 ,$25.00 ,$24.36 ,$7.31 ,$15.00 ,$21.25 ,$17.50 ,$4.90 ,$23.75 ,$19.00 ,$18.75 ,$12.43 ,$21.25 ,$7.31 ,$12.43 ,$7.31 ,$17.50 ,$4.90 ,$7.31 ,$7.31 ,$8.27 ,$21.25 ,$16.45 ,$23.00 ,$17.50 ,$16.73 ,$16.73 ,$15.23 ,$16.73 ,$17.28 ,$22.50 ,$17.41 ,$7.38 ,$19.75 ,$5.19 ,$8.77 ,$8.77 ,$7.31 ,$8.77 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30100341,83051,HC HEMOGLOBIN PLASMA,301,1 ,$25.00 ,$12.50 ,$4.90 ,$25.00 ,$4.90 ,$25.00 ,$24.36 ,$7.31 ,$15.00 ,$21.25 ,$17.50 ,$4.90 ,$23.75 ,$19.00 ,$18.75 ,$12.43 ,$21.25 ,$7.31 ,$12.43 ,$7.31 ,$17.50 ,$4.90 ,$7.31 ,$7.31 ,$8.27 ,$21.25 ,$16.45 ,$23.00 ,$17.50 ,$16.73 ,$16.73 ,$15.23 ,$16.73 ,$17.28 ,$22.50 ,$17.41 ,$7.38 ,$19.75 ,$5.19 ,$8.77 ,$8.77 ,$7.31 ,$8.77 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30100342,83051,HC HEMOGLOBIN (MAYO),301,1 ,$101.00 ,$50.50 ,$4.90 ,$101.00 ,$4.90 ,$28.42 ,$24.36 ,$7.31 ,$60.60 ,$85.85 ,$70.70 ,$4.90 ,$95.95 ,$76.76 ,$75.75 ,$12.43 ,$85.85 ,$7.31 ,$12.43 ,$7.31 ,$70.70 ,$4.90 ,$7.31 ,$7.31 ,$8.27 ,$85.85 ,$16.45 ,$92.92 ,$70.70 ,$16.73 ,$16.73 ,$61.51 ,$16.73 ,$69.79 ,$90.90 ,$70.35 ,$7.38 ,$79.79 ,$5.19 ,$8.77 ,$8.77 ,$7.31 ,$8.77 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100343,83068,HC HEMOGLOBIN UNSTABLE,301,1 ,$121.00 ,$60.50 ,$9.47 ,$121.00 ,$9.79 ,$33.15 ,$28.41 ,$9.47 ,$72.60 ,$102.85 ,$84.70 ,$9.79 ,$114.95 ,$91.96 ,$90.75 ,$16.10 ,$102.85 ,$9.47 ,$16.10 ,$9.47 ,$84.70 ,$9.79 ,$9.47 ,$9.47 ,$10.72 ,$102.85 ,$21.31 ,$111.32 ,$84.70 ,$40.65 ,$40.65 ,$73.69 ,$40.65 ,$83.61 ,$108.90 ,$84.28 ,$9.56 ,$95.59 ,$10.38 ,$11.36 ,$11.36 ,$9.47 ,$11.36 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$96.80 
ST NICHOLAS HOSPITAL - ACUTE,30100344,83070,HC HEMOSIDERIN,301,1 ,$56.00 ,$28.00 ,$4.75 ,$56.00 ,$4.91 ,$18.45 ,$15.81 ,$4.75 ,$33.60 ,$47.60 ,$39.20 ,$4.91 ,$53.20 ,$42.56 ,$42.00 ,$8.08 ,$47.60 ,$4.75 ,$8.08 ,$4.75 ,$39.20 ,$4.91 ,$4.75 ,$4.75 ,$5.38 ,$47.60 ,$10.69 ,$51.52 ,$39.20 ,$22.83 ,$22.83 ,$34.10 ,$22.83 ,$38.70 ,$50.40 ,$39.00 ,$4.80 ,$44.24 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30100345,83088,HC HISTAMINE,301,1 ,$213.00 ,$106.50 ,$29.53 ,$213.00 ,$30.51 ,$114.84 ,$98.43 ,$29.53 ,$127.80 ,$181.05 ,$149.10 ,$30.51 ,$202.35 ,$161.88 ,$159.75 ,$50.20 ,$181.05 ,$29.53 ,$50.20 ,$29.53 ,$149.10 ,$30.51 ,$29.53 ,$29.53 ,$33.42 ,$181.05 ,$66.44 ,$195.96 ,$149.10 ,$141.93 ,$141.93 ,$129.72 ,$141.93 ,$147.18 ,$191.70 ,$148.35 ,$29.83 ,$168.27 ,$32.34 ,$35.44 ,$35.44 ,$29.53 ,$35.44 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100346,83090,HC HOMOCYSTEINE,301,1 ,$134.00 ,$67.00 ,$17.92 ,$134.00 ,$18.52 ,$65.59 ,$56.22 ,$17.92 ,$80.40 ,$113.90 ,$93.80 ,$18.52 ,$127.30 ,$101.84 ,$100.50 ,$30.46 ,$113.90 ,$17.92 ,$30.46 ,$17.92 ,$93.80 ,$18.52 ,$17.92 ,$17.92 ,$20.28 ,$113.90 ,$40.32 ,$123.28 ,$93.80 ,$81.06 ,$81.06 ,$81.61 ,$81.06 ,$92.59 ,$120.60 ,$93.33 ,$18.10 ,$105.86 ,$19.63 ,$21.50 ,$21.50 ,$17.92 ,$21.50 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100347,83150,HC HOMOVANILLIC ACID (HVA24),301,1 ,$112.00 ,$56.00 ,$19.62 ,$112.00 ,$19.62 ,$78.44 ,$67.23 ,$22.41 ,$67.20 ,$95.20 ,$78.40 ,$19.62 ,$106.40 ,$85.12 ,$84.00 ,$38.10 ,$95.20 ,$22.41 ,$38.10 ,$22.41 ,$78.40 ,$19.62 ,$22.41 ,$22.41 ,$25.36 ,$95.20 ,$50.42 ,$103.04 ,$78.40 ,$67.07 ,$67.07 ,$68.21 ,$67.07 ,$77.39 ,$100.80 ,$78.01 ,$22.63 ,$88.48 ,$20.80 ,$26.89 ,$26.89 ,$22.41 ,$26.89 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100348,83150,HC HOMOVANILLIC ACID,301,1 ,$112.00 ,$56.00 ,$19.62 ,$112.00 ,$19.62 ,$78.44 ,$67.23 ,$22.41 ,$67.20 ,$95.20 ,$78.40 ,$19.62 ,$106.40 ,$85.12 ,$84.00 ,$38.10 ,$95.20 ,$22.41 ,$38.10 ,$22.41 ,$78.40 ,$19.62 ,$22.41 ,$22.41 ,$25.36 ,$95.20 ,$50.42 ,$103.04 ,$78.40 ,$67.07 ,$67.07 ,$68.21 ,$67.07 ,$77.39 ,$100.80 ,$78.01 ,$22.63 ,$88.48 ,$20.80 ,$26.89 ,$26.89 ,$22.41 ,$26.89 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100349,83491,HC CORTICOSTEROIDS 17D,301,1 ,$125.00 ,$62.50 ,$17.90 ,$125.00 ,$18.50 ,$68.15 ,$58.41 ,$17.90 ,$75.00 ,$106.25 ,$87.50 ,$18.50 ,$118.75 ,$95.00 ,$93.75 ,$30.43 ,$106.25 ,$17.90 ,$30.43 ,$17.90 ,$87.50 ,$18.50 ,$17.90 ,$17.90 ,$20.26 ,$106.25 ,$40.28 ,$115.00 ,$87.50 ,$84.19 ,$84.19 ,$76.13 ,$84.19 ,$86.38 ,$112.50 ,$87.06 ,$18.08 ,$98.75 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$100.00 
ST NICHOLAS HOSPITAL - ACUTE,30100350,83497,HC HYDROXYINDOLACET 5 (HIAA),301,1 ,$101.00 ,$50.50 ,$12.90 ,$101.00 ,$13.33 ,$50.16 ,$42.99 ,$12.90 ,$60.60 ,$85.85 ,$70.70 ,$13.33 ,$95.95 ,$76.76 ,$75.75 ,$21.93 ,$85.85 ,$12.90 ,$21.93 ,$12.90 ,$70.70 ,$13.33 ,$12.90 ,$12.90 ,$14.60 ,$85.85 ,$29.03 ,$92.92 ,$70.70 ,$61.96 ,$61.96 ,$61.51 ,$61.96 ,$69.79 ,$90.90 ,$70.35 ,$13.03 ,$79.79 ,$14.13 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100351,83497,HC HYDROXYINDOLACET 5 URINE,301,1 ,$47.00 ,$23.50 ,$12.90 ,$47.00 ,$13.33 ,$47.00 ,$42.99 ,$12.90 ,$28.20 ,$39.95 ,$32.90 ,$13.33 ,$44.65 ,$35.72 ,$35.25 ,$21.93 ,$39.95 ,$12.90 ,$21.93 ,$12.90 ,$32.90 ,$13.33 ,$12.90 ,$12.90 ,$14.60 ,$39.95 ,$29.03 ,$43.24 ,$32.90 ,$47.00 ,$47.00 ,$28.62 ,$47.00 ,$32.48 ,$42.30 ,$32.74 ,$13.03 ,$37.13 ,$14.13 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$37.60 
ST NICHOLAS HOSPITAL - ACUTE,30100352,83498,HC HYDROXYPROGESTERONE 17D,301,1 ,$213.00 ,$106.50 ,$27.17 ,$213.00 ,$28.07 ,$105.67 ,$90.57 ,$27.17 ,$127.80 ,$181.05 ,$149.10 ,$28.07 ,$202.35 ,$161.88 ,$159.75 ,$46.19 ,$181.05 ,$27.17 ,$46.19 ,$27.17 ,$149.10 ,$28.07 ,$27.17 ,$27.17 ,$30.75 ,$181.05 ,$61.13 ,$195.96 ,$149.10 ,$130.58 ,$130.58 ,$129.72 ,$130.58 ,$147.18 ,$191.70 ,$148.35 ,$27.44 ,$168.27 ,$29.75 ,$32.60 ,$32.60 ,$27.17 ,$32.60 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100354,83505,HC HYDROXYPROLIN,301,1 ,$180.00 ,$90.00 ,$24.30 ,$180.00 ,$25.11 ,$94.54 ,$81.03 ,$24.30 ,$108.00 ,$153.00 ,$126.00 ,$25.11 ,$171.00 ,$136.80 ,$135.00 ,$41.31 ,$153.00 ,$24.30 ,$41.31 ,$24.30 ,$126.00 ,$25.11 ,$24.30 ,$24.30 ,$27.50 ,$153.00 ,$54.68 ,$165.60 ,$126.00 ,$116.84 ,$116.84 ,$109.62 ,$116.84 ,$124.38 ,$162.00 ,$125.37 ,$24.54 ,$142.20 ,$26.62 ,$29.16 ,$29.16 ,$24.30 ,$29.16 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100355,83516,HC IMMUNO QL/SQ MLT,301,1 ,$90.00 ,$45.00 ,$11.53 ,$90.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$54.00 ,$76.50 ,$63.00 ,$11.91 ,$85.50 ,$68.40 ,$67.50 ,$19.60 ,$76.50 ,$11.53 ,$19.60 ,$11.53 ,$63.00 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$76.50 ,$25.94 ,$82.80 ,$63.00 ,$55.45 ,$55.45 ,$54.81 ,$55.45 ,$62.19 ,$81.00 ,$62.69 ,$11.65 ,$71.10 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100356,83516,HC ANTICARDIOPLIPIN SCREEN,301,1 ,$111.00 ,$55.50 ,$11.53 ,$111.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$66.60 ,$94.35 ,$77.70 ,$11.91 ,$105.45 ,$84.36 ,$83.25 ,$19.60 ,$94.35 ,$11.53 ,$19.60 ,$11.53 ,$77.70 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$94.35 ,$25.94 ,$102.12 ,$77.70 ,$55.45 ,$55.45 ,$67.60 ,$55.45 ,$76.70 ,$99.90 ,$77.31 ,$11.65 ,$87.69 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$88.80 
ST NICHOLAS HOSPITAL - ACUTE,30100357,83516,HC HISTONE ANTIBODY,301,1 ,$101.00 ,$50.50 ,$11.53 ,$101.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$60.60 ,$85.85 ,$70.70 ,$11.91 ,$95.95 ,$76.76 ,$75.75 ,$19.60 ,$85.85 ,$11.53 ,$19.60 ,$11.53 ,$70.70 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$85.85 ,$25.94 ,$92.92 ,$70.70 ,$55.45 ,$55.45 ,$61.51 ,$55.45 ,$69.79 ,$90.90 ,$70.35 ,$11.65 ,$79.79 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100358,83516,HC ACTIN AB,301,1 ,$80.00 ,$40.00 ,$11.53 ,$80.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$48.00 ,$68.00 ,$56.00 ,$11.91 ,$76.00 ,$60.80 ,$60.00 ,$19.60 ,$68.00 ,$11.53 ,$19.60 ,$11.53 ,$56.00 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$68.00 ,$25.94 ,$73.60 ,$56.00 ,$55.45 ,$55.45 ,$48.72 ,$55.45 ,$55.28 ,$72.00 ,$55.72 ,$11.65 ,$63.20 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,30100359,83516,HC IMMUNO QL/SQ MLT (2),301,1 ,$83.00 ,$41.50 ,$11.53 ,$83.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$49.80 ,$70.55 ,$58.10 ,$11.91 ,$78.85 ,$63.08 ,$62.25 ,$19.60 ,$70.55 ,$11.53 ,$19.60 ,$11.53 ,$58.10 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$70.55 ,$25.94 ,$76.36 ,$58.10 ,$55.45 ,$55.45 ,$50.55 ,$55.45 ,$57.35 ,$74.70 ,$57.81 ,$11.65 ,$65.57 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$66.40 
ST NICHOLAS HOSPITAL - ACUTE,30100360,83516,HC SMOOTH MUSCLE AB,301,1 ,$90.00 ,$45.00 ,$11.53 ,$90.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$54.00 ,$76.50 ,$63.00 ,$11.91 ,$85.50 ,$68.40 ,$67.50 ,$19.60 ,$76.50 ,$11.53 ,$19.60 ,$11.53 ,$63.00 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$76.50 ,$25.94 ,$82.80 ,$63.00 ,$55.45 ,$55.45 ,$54.81 ,$55.45 ,$62.19 ,$81.00 ,$62.69 ,$11.65 ,$71.10 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100361,83516,HC IMMUNO QL/SQ MLT (3),301,1 ,$101.00 ,$50.50 ,$11.53 ,$101.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$60.60 ,$85.85 ,$70.70 ,$11.91 ,$95.95 ,$76.76 ,$75.75 ,$19.60 ,$85.85 ,$11.53 ,$19.60 ,$11.53 ,$70.70 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$85.85 ,$25.94 ,$92.92 ,$70.70 ,$55.45 ,$55.45 ,$61.51 ,$55.45 ,$69.79 ,$90.90 ,$70.35 ,$11.65 ,$79.79 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100363,83519,HC ACETYLCHOLINE RECEPTR AB,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100364,83519,HC ADI LEMS AUTO AB,301,1 ,$483.00 ,$241.50 ,$18.40 ,$483.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$289.80 ,$410.55 ,$338.10 ,$19.00 ,$458.85 ,$367.08 ,$362.25 ,$31.28 ,$410.55 ,$18.40 ,$31.28 ,$18.40 ,$338.10 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$410.55 ,$41.40 ,$444.36 ,$338.10 ,$64.92 ,$64.92 ,$294.15 ,$64.92 ,$333.75 ,$434.70 ,$336.41 ,$18.58 ,$381.57 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$386.40 
ST NICHOLAS HOSPITAL - ACUTE,30100365,83519,HC GAD 65 AB,301,1 ,$103.00 ,$51.50 ,$18.40 ,$103.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$61.80 ,$87.55 ,$72.10 ,$19.00 ,$97.85 ,$78.28 ,$77.25 ,$31.28 ,$87.55 ,$18.40 ,$31.28 ,$18.40 ,$72.10 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$87.55 ,$41.40 ,$94.76 ,$72.10 ,$64.92 ,$64.92 ,$62.73 ,$64.92 ,$71.17 ,$92.70 ,$71.74 ,$18.58 ,$81.37 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30100366,86341,HC ISLET CELL AUTO AB,301,1 ,$258.00 ,$129.00 ,$19.88 ,$258.00 ,$19.88 ,$82.50 ,$70.71 ,$23.57 ,$154.80 ,$219.30 ,$180.60 ,$19.88 ,$245.10 ,$196.08 ,$193.50 ,$40.07 ,$219.30 ,$23.57 ,$40.07 ,$23.57 ,$180.60 ,$19.88 ,$23.57 ,$23.57 ,$26.68 ,$219.30 ,$53.03 ,$237.36 ,$180.60 ,$67.95 ,$67.95 ,$157.12 ,$67.95 ,$178.28 ,$232.20 ,$179.70 ,$23.81 ,$203.82 ,$21.07 ,$28.28 ,$28.28 ,$23.57 ,$28.28 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,30100367,83519,HC PTH RELATED PROTEIN,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100368,83519,HC NEOPTERIN,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100369,83519,HC IGF BINDING PROTEIN,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100370,83519,HC ACHR BINDING AB,301,1 ,$169.00 ,$84.50 ,$18.40 ,$169.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$101.40 ,$143.65 ,$118.30 ,$19.00 ,$160.55 ,$128.44 ,$126.75 ,$31.28 ,$143.65 ,$18.40 ,$31.28 ,$18.40 ,$118.30 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$143.65 ,$41.40 ,$155.48 ,$118.30 ,$64.92 ,$64.92 ,$102.92 ,$64.92 ,$116.78 ,$152.10 ,$117.71 ,$18.58 ,$133.51 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$135.20 
ST NICHOLAS HOSPITAL - ACUTE,30100371,83519,HC MUSK ANTIBODY,301,1 ,$560.00 ,$280.00 ,$18.40 ,$560.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$336.00 ,$476.00 ,$392.00 ,$19.00 ,$532.00 ,$425.60 ,$420.00 ,$31.28 ,$476.00 ,$18.40 ,$31.28 ,$18.40 ,$392.00 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$476.00 ,$41.40 ,$515.20 ,$392.00 ,$64.92 ,$64.92 ,$341.04 ,$64.92 ,$386.96 ,$504.00 ,$390.04 ,$18.58 ,$442.40 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,30100372,83519,HC ACEYTLCHOLINE RECPT AB (BK),301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100373,83519,HC ACEYTLCHOLINE RECPT AB (MD),301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100374,83519,HC IGF BINDING PROTEIN 3,301,1 ,$240.00 ,$120.00 ,$18.40 ,$240.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$144.00 ,$204.00 ,$168.00 ,$19.00 ,$228.00 ,$182.40 ,$180.00 ,$31.28 ,$204.00 ,$18.40 ,$31.28 ,$18.40 ,$168.00 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$204.00 ,$41.40 ,$220.80 ,$168.00 ,$64.92 ,$64.92 ,$146.16 ,$64.92 ,$165.84 ,$216.00 ,$167.16 ,$18.58 ,$189.60 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$172.80 ,$148.80 ,$172.80 ,$172.80 ,$192.00 
ST NICHOLAS HOSPITAL - ACUTE,30100375,80155,HC CAFFEINE,301,1 ,$180.00 ,$90.00 ,$15.44 ,$180.00 ,$15.44 ,$135.00 ,$115.71 ,$38.57 ,$108.00 ,$153.00 ,$126.00 ,$15.44 ,$171.00 ,$136.80 ,$135.00 ,$65.57 ,$153.00 ,$38.57 ,$65.57 ,$38.57 ,$126.00 ,$15.44 ,$38.57 ,$38.57 ,$43.65 ,$153.00 ,$86.78 ,$165.60 ,$126.00 ,$67.99 ,$67.99 ,$109.62 ,$67.99 ,$124.38 ,$162.00 ,$125.37 ,$38.96 ,$142.20 ,$16.37 ,$46.28 ,$46.28 ,$38.57 ,$46.28 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100376,83520,HC METHOTREXATE,301,1 ,$336.00 ,$168.00 ,$17.27 ,$336.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$201.60 ,$285.60 ,$235.20 ,$17.85 ,$319.20 ,$255.36 ,$252.00 ,$29.36 ,$285.60 ,$17.27 ,$29.36 ,$17.27 ,$235.20 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$285.60 ,$38.86 ,$309.12 ,$235.20 ,$62.21 ,$62.21 ,$204.62 ,$62.21 ,$232.18 ,$302.40 ,$234.02 ,$17.44 ,$265.44 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,30100377,83520,HC GLOMERULAR BS MEM IGG,301,1 ,$141.00 ,$70.50 ,$17.27 ,$141.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$84.60 ,$119.85 ,$98.70 ,$17.85 ,$133.95 ,$107.16 ,$105.75 ,$29.36 ,$119.85 ,$17.27 ,$29.36 ,$17.27 ,$98.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$119.85 ,$38.86 ,$129.72 ,$98.70 ,$62.21 ,$62.21 ,$85.87 ,$62.21 ,$97.43 ,$126.90 ,$98.21 ,$17.44 ,$111.39 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,30100378,83520,HC C1 ESTERASE IHHIB FUNCTN,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100379,83520,HC IMMUNOASSAY QN PROTEIN,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100380,83520,HC GASTRIC PARIETAL AB,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$59.40 ,$84.15 ,$69.30 ,$17.85 ,$94.05 ,$75.24 ,$74.25 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$17.27 ,$69.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.21 ,$62.21 ,$60.29 ,$62.21 ,$68.41 ,$89.10 ,$68.95 ,$17.44 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30100381,83520,HC C3 A,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100382,83520,HC ANTI GBM,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100383,83520,HC CITRULLINE PEPTIDE ANTIBODY,301,1 ,$160.00 ,$80.00 ,$17.27 ,$160.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$96.00 ,$136.00 ,$112.00 ,$17.85 ,$152.00 ,$121.60 ,$120.00 ,$29.36 ,$136.00 ,$17.27 ,$29.36 ,$17.27 ,$112.00 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$136.00 ,$38.86 ,$147.20 ,$112.00 ,$62.21 ,$62.21 ,$97.44 ,$62.21 ,$110.56 ,$144.00 ,$111.44 ,$17.44 ,$126.40 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100384,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100385,83520,HC CD ANTI GLIADIN,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$59.40 ,$84.15 ,$69.30 ,$17.85 ,$94.05 ,$75.24 ,$74.25 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$17.27 ,$69.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.21 ,$62.21 ,$60.29 ,$62.21 ,$68.41 ,$89.10 ,$68.95 ,$17.44 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30100386,83520,HC FIBROSPECT TIMP 1,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$59.40 ,$84.15 ,$69.30 ,$17.85 ,$94.05 ,$75.24 ,$74.25 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$17.27 ,$69.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.21 ,$62.21 ,$60.29 ,$62.21 ,$68.41 ,$89.10 ,$68.95 ,$17.44 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30100388,83520,HC CD ANTI HU TGG IGA,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$59.40 ,$84.15 ,$69.30 ,$17.85 ,$94.05 ,$75.24 ,$74.25 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$17.27 ,$69.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.21 ,$62.21 ,$60.29 ,$62.21 ,$68.41 ,$89.10 ,$68.95 ,$17.44 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30100389,83520,HC TRYPTASE,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100390,82397,HC INHIBIN B,301,1 ,$224.00 ,$112.00 ,$14.12 ,$224.00 ,$14.59 ,$54.92 ,$47.07 ,$14.12 ,$134.40 ,$190.40 ,$156.80 ,$14.59 ,$212.80 ,$170.24 ,$168.00 ,$24.00 ,$190.40 ,$14.12 ,$24.00 ,$14.12 ,$156.80 ,$14.59 ,$14.12 ,$14.12 ,$15.98 ,$190.40 ,$31.77 ,$206.08 ,$156.80 ,$67.88 ,$67.88 ,$136.42 ,$67.88 ,$154.78 ,$201.60 ,$156.02 ,$14.26 ,$176.96 ,$15.47 ,$16.94 ,$16.94 ,$14.12 ,$16.94 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30100392,83525,HC INSULIN TOTAL,301,1 ,$78.00 ,$39.00 ,$11.43 ,$78.00 ,$11.81 ,$44.45 ,$38.10 ,$11.43 ,$46.80 ,$66.30 ,$54.60 ,$11.81 ,$74.10 ,$59.28 ,$58.50 ,$19.43 ,$66.30 ,$11.43 ,$19.43 ,$11.43 ,$54.60 ,$11.81 ,$11.43 ,$11.43 ,$12.94 ,$66.30 ,$25.72 ,$71.76 ,$54.60 ,$54.92 ,$54.92 ,$47.50 ,$54.92 ,$53.90 ,$70.20 ,$54.33 ,$11.54 ,$61.62 ,$12.52 ,$13.72 ,$13.72 ,$11.43 ,$13.72 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100393,83540,HC IRON TOTAL,301,1 ,$49.00 ,$24.50 ,$6.47 ,$49.00 ,$6.69 ,$25.17 ,$21.57 ,$6.47 ,$29.40 ,$41.65 ,$34.30 ,$6.69 ,$46.55 ,$37.24 ,$36.75 ,$11.00 ,$41.65 ,$6.47 ,$11.00 ,$6.47 ,$34.30 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$41.65 ,$14.56 ,$45.08 ,$34.30 ,$31.10 ,$31.10 ,$29.84 ,$31.10 ,$33.86 ,$44.10 ,$34.13 ,$6.53 ,$38.71 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$67.00 ,$33.50 ,$8.74 ,$67.00 ,$9.03 ,$33.99 ,$29.13 ,$8.74 ,$40.20 ,$56.95 ,$46.90 ,$9.03 ,$63.65 ,$50.92 ,$50.25 ,$14.86 ,$56.95 ,$8.74 ,$14.86 ,$8.74 ,$46.90 ,$9.03 ,$8.74 ,$8.74 ,$9.89 ,$56.95 ,$19.67 ,$61.64 ,$46.90 ,$42.02 ,$42.02 ,$40.80 ,$42.02 ,$46.30 ,$60.30 ,$46.67 ,$8.83 ,$52.93 ,$9.57 ,$10.49 ,$10.49 ,$8.74 ,$10.49 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100395,83586,HC KETOSTEROIDS (17-KS),301,1 ,$92.00 ,$46.00 ,$12.80 ,$92.00 ,$13.23 ,$49.77 ,$42.66 ,$12.80 ,$55.20 ,$78.20 ,$64.40 ,$13.23 ,$87.40 ,$69.92 ,$69.00 ,$21.76 ,$78.20 ,$12.80 ,$21.76 ,$12.80 ,$64.40 ,$13.23 ,$12.80 ,$12.80 ,$14.49 ,$78.20 ,$28.80 ,$84.64 ,$64.40 ,$61.54 ,$61.54 ,$56.03 ,$61.54 ,$63.57 ,$82.80 ,$64.08 ,$12.93 ,$72.68 ,$14.02 ,$15.36 ,$15.36 ,$12.80 ,$15.36 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$90.00 ,$45.00 ,$11.57 ,$90.00 ,$11.96 ,$41.55 ,$35.61 ,$11.57 ,$54.00 ,$76.50 ,$63.00 ,$11.96 ,$85.50 ,$68.40 ,$67.50 ,$19.67 ,$76.50 ,$11.57 ,$19.67 ,$11.57 ,$63.00 ,$11.96 ,$11.57 ,$11.57 ,$13.09 ,$76.50 ,$26.03 ,$82.80 ,$63.00 ,$51.32 ,$51.32 ,$54.81 ,$51.32 ,$62.19 ,$81.00 ,$62.69 ,$11.69 ,$71.10 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$49.00 ,$24.50 ,$6.04 ,$49.00 ,$6.24 ,$23.49 ,$20.13 ,$6.04 ,$29.40 ,$41.65 ,$34.30 ,$6.24 ,$46.55 ,$37.24 ,$36.75 ,$10.27 ,$41.65 ,$6.04 ,$10.27 ,$6.04 ,$34.30 ,$6.24 ,$6.04 ,$6.04 ,$6.84 ,$41.65 ,$13.59 ,$45.08 ,$34.30 ,$28.99 ,$28.99 ,$29.84 ,$28.99 ,$33.86 ,$44.10 ,$34.13 ,$6.10 ,$38.71 ,$6.61 ,$7.25 ,$7.25 ,$6.04 ,$7.25 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,30100399,83625,HC LDH ISOENZYMES,301,1 ,$78.00 ,$39.00 ,$12.79 ,$78.00 ,$13.22 ,$49.77 ,$42.66 ,$12.79 ,$46.80 ,$66.30 ,$54.60 ,$13.22 ,$74.10 ,$59.28 ,$58.50 ,$21.74 ,$66.30 ,$12.79 ,$21.74 ,$12.79 ,$54.60 ,$13.22 ,$12.79 ,$12.79 ,$14.48 ,$66.30 ,$28.78 ,$71.76 ,$54.60 ,$61.50 ,$61.50 ,$47.50 ,$61.50 ,$53.90 ,$70.20 ,$54.33 ,$12.92 ,$61.62 ,$14.01 ,$15.35 ,$15.35 ,$12.79 ,$15.35 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100401,83655,HC LEAD,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$12.11 ,$54.00 ,$76.50 ,$63.00 ,$12.51 ,$85.50 ,$68.40 ,$67.50 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$12.11 ,$63.00 ,$12.51 ,$12.11 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.19 ,$58.19 ,$54.81 ,$58.19 ,$62.19 ,$81.00 ,$62.69 ,$12.23 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100403,83655,HC LEAD BLOOD PT DEMO,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$12.11 ,$54.00 ,$76.50 ,$63.00 ,$12.51 ,$85.50 ,$68.40 ,$67.50 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$12.11 ,$63.00 ,$12.51 ,$12.11 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.19 ,$58.19 ,$54.81 ,$58.19 ,$62.19 ,$81.00 ,$62.69 ,$12.23 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100404,83655,HC LEAD URINE,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$12.11 ,$54.00 ,$76.50 ,$63.00 ,$12.51 ,$85.50 ,$68.40 ,$67.50 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$12.11 ,$63.00 ,$12.51 ,$12.11 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.19 ,$58.19 ,$54.81 ,$58.19 ,$62.19 ,$81.00 ,$62.69 ,$12.23 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100405,83655,HC LEAD URINE UPB,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$12.11 ,$54.00 ,$76.50 ,$63.00 ,$12.51 ,$85.50 ,$68.40 ,$67.50 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$12.11 ,$63.00 ,$12.51 ,$12.11 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.19 ,$58.19 ,$54.81 ,$58.19 ,$62.19 ,$81.00 ,$62.69 ,$12.23 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100406,83655,HC LEAD 24HR URINE,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$12.11 ,$54.00 ,$76.50 ,$63.00 ,$12.51 ,$85.50 ,$68.40 ,$67.50 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$12.11 ,$63.00 ,$12.51 ,$12.11 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.19 ,$58.19 ,$54.81 ,$58.19 ,$62.19 ,$81.00 ,$62.69 ,$12.23 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100407,83655,HC LEAD (2),301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$12.11 ,$54.00 ,$76.50 ,$63.00 ,$12.51 ,$85.50 ,$68.40 ,$67.50 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$12.11 ,$63.00 ,$12.51 ,$12.11 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.19 ,$58.19 ,$54.81 ,$58.19 ,$62.19 ,$81.00 ,$62.69 ,$12.23 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100408,83663,HC FETAL LUNG MATURITY,301,1 ,$541.00 ,$270.50 ,$13.65 ,$541.00 ,$13.65 ,$73.54 ,$63.03 ,$18.91 ,$324.60 ,$459.85 ,$378.70 ,$13.65 ,$513.95 ,$411.16 ,$405.75 ,$32.15 ,$459.85 ,$18.91 ,$32.15 ,$18.91 ,$378.70 ,$13.65 ,$18.91 ,$18.91 ,$21.40 ,$459.85 ,$42.55 ,$497.72 ,$378.70 ,$90.92 ,$90.92 ,$329.47 ,$90.92 ,$373.83 ,$486.90 ,$376.81 ,$19.10 ,$427.39 ,$14.47 ,$22.69 ,$22.69 ,$18.91 ,$22.69 ,$389.52 ,$335.42 ,$389.52 ,$389.52 ,$432.80 
ST NICHOLAS HOSPITAL - ACUTE,30100409,83690,HC LIPASE,301,1 ,$78.00 ,$39.00 ,$6.89 ,$78.00 ,$7.12 ,$26.78 ,$22.95 ,$6.89 ,$46.80 ,$66.30 ,$54.60 ,$7.12 ,$74.10 ,$59.28 ,$58.50 ,$11.71 ,$66.30 ,$6.89 ,$11.71 ,$6.89 ,$54.60 ,$7.12 ,$6.89 ,$6.89 ,$7.80 ,$66.30 ,$15.50 ,$71.76 ,$54.60 ,$33.11 ,$33.11 ,$47.50 ,$33.11 ,$53.90 ,$70.20 ,$54.33 ,$6.96 ,$61.62 ,$7.55 ,$8.27 ,$8.27 ,$6.89 ,$8.27 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100410,83695,HC LIPOPROTEIN,301,1 ,$78.00 ,$39.00 ,$14.32 ,$78.00 ,$14.80 ,$50.37 ,$43.17 ,$14.32 ,$46.80 ,$66.30 ,$54.60 ,$14.80 ,$74.10 ,$59.28 ,$58.50 ,$24.34 ,$66.30 ,$14.32 ,$24.34 ,$14.32 ,$54.60 ,$14.80 ,$14.32 ,$14.32 ,$16.21 ,$66.30 ,$32.22 ,$71.76 ,$54.60 ,$62.21 ,$62.21 ,$47.50 ,$62.21 ,$53.90 ,$70.20 ,$54.33 ,$14.46 ,$61.62 ,$15.69 ,$17.18 ,$17.18 ,$14.32 ,$17.18 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100411,83701,HC VLDL,301,1 ,$184.00 ,$92.00 ,$32.56 ,$184.00 ,$32.56 ,$118.51 ,$101.58 ,$33.86 ,$110.40 ,$156.40 ,$128.80 ,$32.56 ,$174.80 ,$139.84 ,$138.00 ,$57.56 ,$156.40 ,$33.86 ,$57.56 ,$33.86 ,$128.80 ,$32.56 ,$33.86 ,$33.86 ,$38.32 ,$156.40 ,$76.19 ,$169.28 ,$128.80 ,$119.28 ,$119.28 ,$112.06 ,$119.28 ,$127.14 ,$165.60 ,$128.16 ,$34.20 ,$145.36 ,$34.51 ,$40.63 ,$40.63 ,$33.86 ,$40.63 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,30100413,83704,HC LP FRACTN ION MOBILITY,301,1 ,$246.00 ,$123.00 ,$34.19 ,$246.00 ,$35.33 ,$122.71 ,$105.18 ,$34.19 ,$147.60 ,$209.10 ,$172.20 ,$35.33 ,$233.70 ,$186.96 ,$184.50 ,$58.12 ,$209.10 ,$34.19 ,$58.12 ,$34.19 ,$172.20 ,$35.33 ,$34.19 ,$34.19 ,$38.70 ,$209.10 ,$76.93 ,$226.32 ,$172.20 ,$151.61 ,$151.61 ,$149.81 ,$151.61 ,$169.99 ,$221.40 ,$171.34 ,$34.53 ,$194.34 ,$37.45 ,$41.03 ,$41.03 ,$34.19 ,$41.03 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,30100414,83704,HC NMR LIPOPROFILE LIP,301,1 ,$129.00 ,$64.50 ,$34.19 ,$129.00 ,$35.33 ,$122.71 ,$105.18 ,$34.19 ,$77.40 ,$109.65 ,$90.30 ,$35.33 ,$122.55 ,$98.04 ,$96.75 ,$58.12 ,$109.65 ,$34.19 ,$58.12 ,$34.19 ,$90.30 ,$35.33 ,$34.19 ,$34.19 ,$38.70 ,$109.65 ,$76.93 ,$118.68 ,$90.30 ,$129.00 ,$129.00 ,$78.56 ,$129.00 ,$89.14 ,$116.10 ,$89.85 ,$34.53 ,$101.91 ,$37.45 ,$41.03 ,$41.03 ,$34.19 ,$41.03 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,30100415,83718,HC CHOLESTEROL HDL,301,1 ,$67.00 ,$33.50 ,$8.19 ,$67.00 ,$8.46 ,$31.85 ,$27.30 ,$8.19 ,$40.20 ,$56.95 ,$46.90 ,$8.46 ,$63.65 ,$50.92 ,$50.25 ,$13.92 ,$56.95 ,$8.19 ,$13.92 ,$8.19 ,$46.90 ,$8.46 ,$8.19 ,$8.19 ,$9.27 ,$56.95 ,$18.43 ,$61.64 ,$46.90 ,$39.35 ,$39.35 ,$40.80 ,$39.35 ,$46.30 ,$60.30 ,$46.67 ,$8.27 ,$52.93 ,$8.97 ,$9.83 ,$9.83 ,$8.19 ,$9.83 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100416,83721,HC CHOLESTEROL LDL,301,1 ,$78.00 ,$39.00 ,$10.50 ,$78.00 ,$10.85 ,$37.10 ,$31.80 ,$10.50 ,$46.80 ,$66.30 ,$54.60 ,$10.85 ,$74.10 ,$59.28 ,$58.50 ,$17.85 ,$66.30 ,$10.50 ,$17.85 ,$10.50 ,$54.60 ,$10.85 ,$10.50 ,$10.50 ,$11.88 ,$66.30 ,$23.63 ,$71.76 ,$54.60 ,$45.86 ,$45.86 ,$47.50 ,$45.86 ,$53.90 ,$70.20 ,$54.33 ,$10.61 ,$61.62 ,$11.50 ,$12.60 ,$12.60 ,$10.50 ,$12.60 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100417,83735,HC MAGNESIUM,301,1 ,$52.00 ,$26.00 ,$6.70 ,$52.00 ,$6.92 ,$26.04 ,$22.32 ,$6.70 ,$31.20 ,$44.20 ,$36.40 ,$6.92 ,$49.40 ,$39.52 ,$39.00 ,$11.39 ,$44.20 ,$6.70 ,$11.39 ,$6.70 ,$36.40 ,$6.92 ,$6.70 ,$6.70 ,$7.58 ,$44.20 ,$15.08 ,$47.84 ,$36.40 ,$32.20 ,$32.20 ,$31.67 ,$32.20 ,$35.93 ,$46.80 ,$36.22 ,$6.77 ,$41.08 ,$7.34 ,$8.04 ,$8.04 ,$6.70 ,$8.04 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30100418,83785,HC MANGANESE (MAYO),301,1 ,$157.00 ,$78.50 ,$26.65 ,$157.00 ,$27.54 ,$95.66 ,$81.99 ,$26.65 ,$94.20 ,$133.45 ,$109.90 ,$27.54 ,$149.15 ,$119.32 ,$117.75 ,$45.31 ,$133.45 ,$26.65 ,$45.31 ,$26.65 ,$109.90 ,$27.54 ,$26.65 ,$26.65 ,$30.16 ,$133.45 ,$59.96 ,$144.44 ,$109.90 ,$118.18 ,$118.18 ,$95.61 ,$118.18 ,$108.49 ,$141.30 ,$109.35 ,$26.92 ,$124.03 ,$29.19 ,$31.98 ,$31.98 ,$26.65 ,$31.98 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30100419,83785,HC MANGANESE,301,1 ,$157.00 ,$78.50 ,$26.65 ,$157.00 ,$27.54 ,$95.66 ,$81.99 ,$26.65 ,$94.20 ,$133.45 ,$109.90 ,$27.54 ,$149.15 ,$119.32 ,$117.75 ,$45.31 ,$133.45 ,$26.65 ,$45.31 ,$26.65 ,$109.90 ,$27.54 ,$26.65 ,$26.65 ,$30.16 ,$133.45 ,$59.96 ,$144.44 ,$109.90 ,$118.18 ,$118.18 ,$95.61 ,$118.18 ,$108.49 ,$141.30 ,$109.35 ,$26.92 ,$124.03 ,$29.19 ,$31.98 ,$31.98 ,$26.65 ,$31.98 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30100421,82542,HC BILE ACIDS,301,1 ,$314.00 ,$157.00 ,$24.09 ,$314.00 ,$24.89 ,$84.32 ,$72.27 ,$24.09 ,$188.40 ,$266.90 ,$219.80 ,$24.89 ,$298.30 ,$238.64 ,$235.50 ,$40.95 ,$266.90 ,$24.09 ,$40.95 ,$24.09 ,$219.80 ,$24.89 ,$24.09 ,$24.09 ,$27.27 ,$266.90 ,$54.20 ,$288.88 ,$219.80 ,$86.76 ,$86.76 ,$191.23 ,$86.76 ,$216.97 ,$282.60 ,$218.70 ,$24.33 ,$248.06 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$226.08 ,$194.68 ,$226.08 ,$226.08 ,$251.20 
ST NICHOLAS HOSPITAL - ACUTE,30100422,83789,HC CLOMIPRAMINE,301,1 ,$202.00 ,$101.00 ,$24.11 ,$202.00 ,$24.91 ,$84.39 ,$72.33 ,$24.11 ,$121.20 ,$171.70 ,$141.40 ,$24.91 ,$191.90 ,$153.52 ,$151.50 ,$40.99 ,$171.70 ,$24.11 ,$40.99 ,$24.11 ,$141.40 ,$24.91 ,$24.11 ,$24.11 ,$27.29 ,$171.70 ,$54.25 ,$185.84 ,$141.40 ,$86.76 ,$86.76 ,$123.02 ,$86.76 ,$139.58 ,$181.80 ,$140.69 ,$24.35 ,$159.58 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30100423,G0480,HC ETHYL GLUCUR/SULFATE,301,1 ,$180.00 ,$90.00 ,$63.95 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$114.43 ,$108.00 ,$153.00 ,$126.00 ,$63.95 ,$171.00 ,$136.80 ,$135.00 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$114.43 ,$126.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$162.00 ,$125.37 ,$115.57 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,30100424,80183,HC TRILEPTAL,301,1 ,$100.00 ,$50.00 ,$13.25 ,$100.00 ,$13.69 ,$51.56 ,$44.19 ,$13.25 ,$60.00 ,$85.00 ,$70.00 ,$13.69 ,$95.00 ,$76.00 ,$75.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$13.25 ,$70.00 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$63.72 ,$63.72 ,$60.90 ,$63.72 ,$69.10 ,$90.00 ,$69.65 ,$13.38 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100425,G0480,HC MEPROBAMATE,301,1 ,$160.00 ,$80.00 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$114.43 ,$112.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 ,$115.57 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100426,83825,HC MERCURY,301,1 ,$101.00 ,$50.50 ,$16.26 ,$101.00 ,$16.80 ,$63.21 ,$54.18 ,$16.26 ,$60.60 ,$85.85 ,$70.70 ,$16.80 ,$95.95 ,$76.76 ,$75.75 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$16.26 ,$70.70 ,$16.80 ,$16.26 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$78.13 ,$78.13 ,$61.51 ,$78.13 ,$69.79 ,$90.90 ,$70.35 ,$16.42 ,$79.79 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100427,83825,HC MERCURY URINE,301,1 ,$101.00 ,$50.50 ,$16.26 ,$101.00 ,$16.80 ,$63.21 ,$54.18 ,$16.26 ,$60.60 ,$85.85 ,$70.70 ,$16.80 ,$95.95 ,$76.76 ,$75.75 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$16.26 ,$70.70 ,$16.80 ,$16.26 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$78.13 ,$78.13 ,$61.51 ,$78.13 ,$69.79 ,$90.90 ,$70.35 ,$16.42 ,$79.79 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100428,83825,HC MERCURY BLOOD,301,1 ,$101.00 ,$50.50 ,$16.26 ,$101.00 ,$16.80 ,$63.21 ,$54.18 ,$16.26 ,$60.60 ,$85.85 ,$70.70 ,$16.80 ,$95.95 ,$76.76 ,$75.75 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$16.26 ,$70.70 ,$16.80 ,$16.26 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$78.13 ,$78.13 ,$61.51 ,$78.13 ,$69.79 ,$90.90 ,$70.35 ,$16.42 ,$79.79 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100429,83825,HC MERCURY 24HR URINE,301,1 ,$101.00 ,$50.50 ,$16.26 ,$101.00 ,$16.80 ,$63.21 ,$54.18 ,$16.26 ,$60.60 ,$85.85 ,$70.70 ,$16.80 ,$95.95 ,$76.76 ,$75.75 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$16.26 ,$70.70 ,$16.80 ,$16.26 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$78.13 ,$78.13 ,$61.51 ,$78.13 ,$69.79 ,$90.90 ,$70.35 ,$16.42 ,$79.79 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100430,83835,HC METANEPHRINES,301,1 ,$134.00 ,$67.00 ,$16.94 ,$134.00 ,$17.50 ,$65.87 ,$56.46 ,$16.94 ,$80.40 ,$113.90 ,$93.80 ,$17.50 ,$127.30 ,$101.84 ,$100.50 ,$28.80 ,$113.90 ,$16.94 ,$28.80 ,$16.94 ,$93.80 ,$17.50 ,$16.94 ,$16.94 ,$19.17 ,$113.90 ,$38.12 ,$123.28 ,$93.80 ,$81.41 ,$81.41 ,$81.61 ,$81.41 ,$92.59 ,$120.60 ,$93.33 ,$17.11 ,$105.86 ,$18.55 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100431,83835,HC METANEPHRINES PLASMA,301,1 ,$134.00 ,$67.00 ,$16.94 ,$134.00 ,$17.50 ,$65.87 ,$56.46 ,$16.94 ,$80.40 ,$113.90 ,$93.80 ,$17.50 ,$127.30 ,$101.84 ,$100.50 ,$28.80 ,$113.90 ,$16.94 ,$28.80 ,$16.94 ,$93.80 ,$17.50 ,$16.94 ,$16.94 ,$19.17 ,$113.90 ,$38.12 ,$123.28 ,$93.80 ,$81.41 ,$81.41 ,$81.61 ,$81.41 ,$92.59 ,$120.60 ,$93.33 ,$17.11 ,$105.86 ,$18.55 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100432,83835,HC METANEPHRINES RANDM URINE,301,1 ,$134.00 ,$67.00 ,$16.94 ,$134.00 ,$17.50 ,$65.87 ,$56.46 ,$16.94 ,$80.40 ,$113.90 ,$93.80 ,$17.50 ,$127.30 ,$101.84 ,$100.50 ,$28.80 ,$113.90 ,$16.94 ,$28.80 ,$16.94 ,$93.80 ,$17.50 ,$16.94 ,$16.94 ,$19.17 ,$113.90 ,$38.12 ,$123.28 ,$93.80 ,$81.41 ,$81.41 ,$81.61 ,$81.41 ,$92.59 ,$120.60 ,$93.33 ,$17.11 ,$105.86 ,$18.55 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100433,80358,HC METHADONE,301,1 ,$210.00 ,$105.00 ,$1.53 ,$210.00 ,$1.53 ,$80.88 ,$69.32 , N/A ,$126.00 ,$178.50 ,$147.00 ,$1.53 ,$199.50 ,$159.60 ,$157.50 ,$38.56 ,$178.50 , N/A ,$38.56 ,$22.95 ,$147.00 ,$1.53 , N/A , N/A ,$88.20 ,$178.50 , N/A ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 , N/A ,$165.90 ,$1.62 , N/A , N/A , N/A , N/A ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,30100434,83873,HC MYELIN BASIC PROTEIN,301,1 ,$112.00 ,$56.00 ,$17.20 ,$112.00 ,$17.77 ,$66.92 ,$57.36 ,$17.20 ,$67.20 ,$95.20 ,$78.40 ,$17.77 ,$106.40 ,$85.12 ,$84.00 ,$29.24 ,$95.20 ,$17.20 ,$29.24 ,$17.20 ,$78.40 ,$17.77 ,$17.20 ,$17.20 ,$19.47 ,$95.20 ,$38.70 ,$103.04 ,$78.40 ,$82.68 ,$82.68 ,$68.21 ,$82.68 ,$77.39 ,$100.80 ,$78.01 ,$17.37 ,$88.48 ,$18.84 ,$20.64 ,$20.64 ,$17.20 ,$20.64 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100435,83874,HC MYOGLOBIN,301,1 ,$112.00 ,$56.00 ,$12.92 ,$112.00 ,$13.35 ,$50.23 ,$43.05 ,$12.92 ,$67.20 ,$95.20 ,$78.40 ,$13.35 ,$106.40 ,$85.12 ,$84.00 ,$21.96 ,$95.20 ,$12.92 ,$21.96 ,$12.92 ,$78.40 ,$13.35 ,$12.92 ,$12.92 ,$14.62 ,$95.20 ,$29.07 ,$103.04 ,$78.40 ,$62.07 ,$62.07 ,$68.21 ,$62.07 ,$77.39 ,$100.80 ,$78.01 ,$13.05 ,$88.48 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100436,83874,HC MYOGLOBIN URINE,301,1 ,$112.00 ,$56.00 ,$12.92 ,$112.00 ,$13.35 ,$50.23 ,$43.05 ,$12.92 ,$67.20 ,$95.20 ,$78.40 ,$13.35 ,$106.40 ,$85.12 ,$84.00 ,$21.96 ,$95.20 ,$12.92 ,$21.96 ,$12.92 ,$78.40 ,$13.35 ,$12.92 ,$12.92 ,$14.62 ,$95.20 ,$29.07 ,$103.04 ,$78.40 ,$62.07 ,$62.07 ,$68.21 ,$62.07 ,$77.39 ,$100.80 ,$78.01 ,$13.05 ,$88.48 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100437,83874,HC MYOGLOBIN URINE 2,301,1 ,$112.00 ,$56.00 ,$12.92 ,$112.00 ,$13.35 ,$50.23 ,$43.05 ,$12.92 ,$67.20 ,$95.20 ,$78.40 ,$13.35 ,$106.40 ,$85.12 ,$84.00 ,$21.96 ,$95.20 ,$12.92 ,$21.96 ,$12.92 ,$78.40 ,$13.35 ,$12.92 ,$12.92 ,$14.62 ,$95.20 ,$29.07 ,$103.04 ,$78.40 ,$62.07 ,$62.07 ,$68.21 ,$62.07 ,$77.39 ,$100.80 ,$78.01 ,$13.05 ,$88.48 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$258.00 ,$129.00 ,$39.26 ,$258.00 ,$40.57 ,$137.41 ,$117.78 ,$39.26 ,$154.80 ,$219.30 ,$180.60 ,$40.57 ,$245.10 ,$196.08 ,$193.50 ,$66.74 ,$219.30 ,$39.26 ,$66.74 ,$39.26 ,$180.60 ,$40.57 ,$39.26 ,$39.26 ,$44.43 ,$219.30 ,$88.34 ,$237.36 ,$180.60 ,$163.13 ,$163.13 ,$157.12 ,$163.13 ,$178.28 ,$232.20 ,$179.70 ,$39.65 ,$203.82 ,$43.00 ,$47.11 ,$47.11 ,$39.26 ,$47.11 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,30100439,83883,HC NEPHELOMETRY EA ANALYTE,301,1 ,$101.00 ,$50.50 ,$13.60 ,$101.00 ,$14.05 ,$52.89 ,$45.33 ,$13.60 ,$60.60 ,$85.85 ,$70.70 ,$14.05 ,$95.95 ,$76.76 ,$75.75 ,$23.12 ,$85.85 ,$13.60 ,$23.12 ,$13.60 ,$70.70 ,$14.05 ,$13.60 ,$13.60 ,$15.39 ,$85.85 ,$30.60 ,$92.92 ,$70.70 ,$65.31 ,$65.31 ,$61.51 ,$65.31 ,$69.79 ,$90.90 ,$70.35 ,$13.74 ,$79.79 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100440,83883,HC NEPHELOMETRY EA AN (MAYO),301,1 ,$101.00 ,$50.50 ,$13.60 ,$101.00 ,$14.05 ,$52.89 ,$45.33 ,$13.60 ,$60.60 ,$85.85 ,$70.70 ,$14.05 ,$95.95 ,$76.76 ,$75.75 ,$23.12 ,$85.85 ,$13.60 ,$23.12 ,$13.60 ,$70.70 ,$14.05 ,$13.60 ,$13.60 ,$15.39 ,$85.85 ,$30.60 ,$92.92 ,$70.70 ,$65.31 ,$65.31 ,$61.51 ,$65.31 ,$69.79 ,$90.90 ,$70.35 ,$13.74 ,$79.79 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100441,86160,HC C1 ESTERASE INHIB PRO QU,301,1 ,$90.00 ,$45.00 ,$12.00 ,$90.00 ,$12.40 ,$46.66 ,$39.99 ,$12.00 ,$54.00 ,$76.50 ,$63.00 ,$12.40 ,$85.50 ,$68.40 ,$67.50 ,$20.40 ,$76.50 ,$12.00 ,$20.40 ,$12.00 ,$63.00 ,$12.40 ,$12.00 ,$12.00 ,$13.58 ,$76.50 ,$27.00 ,$82.80 ,$63.00 ,$57.70 ,$57.70 ,$54.81 ,$57.70 ,$62.19 ,$81.00 ,$62.69 ,$12.12 ,$71.10 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100442,83883,HC NEPHELOMETRY EA AN (FREE),301,1 ,$127.00 ,$63.50 ,$13.60 ,$127.00 ,$14.05 ,$52.89 ,$45.33 ,$13.60 ,$76.20 ,$107.95 ,$88.90 ,$14.05 ,$120.65 ,$96.52 ,$95.25 ,$23.12 ,$107.95 ,$13.60 ,$23.12 ,$13.60 ,$88.90 ,$14.05 ,$13.60 ,$13.60 ,$15.39 ,$107.95 ,$30.60 ,$116.84 ,$88.90 ,$65.31 ,$65.31 ,$77.34 ,$65.31 ,$87.76 ,$114.30 ,$88.46 ,$13.74 ,$100.33 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$101.60 
ST NICHOLAS HOSPITAL - ACUTE,30100443,83883,HC NEPHELOMETRY EA AN 2,301,1 ,$90.00 ,$45.00 ,$13.60 ,$90.00 ,$14.05 ,$52.89 ,$45.33 ,$13.60 ,$54.00 ,$76.50 ,$63.00 ,$14.05 ,$85.50 ,$68.40 ,$67.50 ,$23.12 ,$76.50 ,$13.60 ,$23.12 ,$13.60 ,$63.00 ,$14.05 ,$13.60 ,$13.60 ,$15.39 ,$76.50 ,$30.60 ,$82.80 ,$63.00 ,$65.31 ,$65.31 ,$54.81 ,$65.31 ,$62.19 ,$81.00 ,$62.69 ,$13.74 ,$71.10 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100444,G0480,HC NICOTINE,301,1 ,$63.00 ,$31.50 ,$31.50 ,$141.75 ,$63.00 ,$63.00 ,$63.00 ,$63.00 ,$37.80 ,$53.55 ,$44.10 ,$63.00 ,$59.85 ,$47.88 ,$47.25 ,$63.00 ,$53.55 ,$63.00 ,$63.00 ,$63.00 ,$44.10 ,$63.00 ,$63.00 ,$63.00 ,$63.00 ,$53.55 ,$141.75 ,$57.96 ,$44.10 ,$63.00 ,$63.00 ,$38.37 ,$63.00 ,$43.53 ,$56.70 ,$43.88 ,$63.63 ,$49.77 ,$66.78 ,$63.00 ,$63.00 ,$63.00 ,$63.00 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$50.40 
ST NICHOLAS HOSPITAL - ACUTE,30100445,G0480,HC NICOTINE W/METABOLITE,301,1 ,$120.00 ,$60.00 ,$60.00 ,$257.47 ,$63.95 ,$120.00 ,$120.00 ,$114.43 ,$72.00 ,$102.00 ,$84.00 ,$63.95 ,$114.00 ,$91.20 ,$90.00 ,$120.00 ,$102.00 ,$114.43 ,$120.00 ,$114.43 ,$84.00 ,$63.95 ,$114.43 ,$114.43 ,$120.00 ,$102.00 ,$257.47 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$108.00 ,$83.58 ,$115.57 ,$94.80 ,$67.79 ,$120.00 ,$120.00 ,$114.43 ,$120.00 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30100460,84311,HC FUNGITELL (1-3)-B-D-GLUCAN,301,1 ,$358.00 ,$179.00 ,$8.10 ,$358.00 ,$8.37 ,$28.35 ,$24.30 ,$8.10 ,$214.80 ,$304.30 ,$250.60 ,$8.37 ,$340.10 ,$272.08 ,$268.50 ,$13.77 ,$304.30 ,$8.10 ,$13.77 ,$8.10 ,$250.60 ,$8.37 ,$8.10 ,$8.10 ,$9.17 ,$304.30 ,$18.23 ,$329.36 ,$250.60 ,$33.61 ,$33.61 ,$218.02 ,$33.61 ,$247.38 ,$322.20 ,$249.35 ,$8.18 ,$282.82 ,$8.87 ,$9.72 ,$9.72 ,$8.10 ,$9.72 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,30100480,82261,HC BIOTINIDASE SERUM,301,1 ,$127.00 ,$63.50 ,$16.87 ,$127.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$76.20 ,$107.95 ,$88.90 ,$17.43 ,$120.65 ,$96.52 ,$95.25 ,$28.68 ,$107.95 ,$16.87 ,$28.68 ,$16.87 ,$88.90 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$107.95 ,$37.96 ,$116.84 ,$88.90 ,$69.25 ,$69.25 ,$77.34 ,$69.25 ,$87.76 ,$114.30 ,$88.46 ,$17.04 ,$100.33 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$101.60 
ST NICHOLAS HOSPITAL - ACUTE,30100481,82373,HC CDG SERUM,301,1 ,$183.00 ,$91.50 ,$10.38 ,$183.00 ,$10.38 ,$70.21 ,$60.18 ,$18.06 ,$109.80 ,$155.55 ,$128.10 ,$10.38 ,$173.85 ,$139.08 ,$137.25 ,$30.70 ,$155.55 ,$18.06 ,$30.70 ,$18.06 ,$128.10 ,$10.38 ,$18.06 ,$18.06 ,$20.44 ,$155.55 ,$40.64 ,$168.36 ,$128.10 ,$86.76 ,$86.76 ,$111.45 ,$86.76 ,$126.45 ,$164.70 ,$127.46 ,$18.24 ,$144.57 ,$11.00 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,30100482,82139,HC AMINO ACID QN CSF,301,1 ,$514.00 ,$257.00 ,$16.87 ,$514.00 ,$17.43 ,$65.59 ,$56.22 ,$16.87 ,$308.40 ,$436.90 ,$359.80 ,$17.43 ,$488.30 ,$390.64 ,$385.50 ,$28.68 ,$436.90 ,$16.87 ,$28.68 ,$16.87 ,$359.80 ,$17.43 ,$16.87 ,$16.87 ,$19.09 ,$436.90 ,$37.96 ,$472.88 ,$359.80 ,$69.25 ,$69.25 ,$313.03 ,$69.25 ,$355.17 ,$462.60 ,$358.00 ,$17.04 ,$406.06 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$370.08 ,$318.68 ,$370.08 ,$370.08 ,$411.20 
ST NICHOLAS HOSPITAL - ACUTE,30100483,84210,HC PYRUVIC ACID CSF,301,1 ,$103.00 ,$51.50 ,$14.48 ,$103.00 ,$14.96 ,$50.68 ,$43.44 ,$14.48 ,$61.80 ,$87.55 ,$72.10 ,$14.96 ,$97.85 ,$78.28 ,$77.25 ,$24.62 ,$87.55 ,$14.48 ,$24.62 ,$14.48 ,$72.10 ,$14.96 ,$14.48 ,$14.48 ,$16.39 ,$87.55 ,$32.58 ,$94.76 ,$72.10 ,$52.17 ,$52.17 ,$62.73 ,$52.17 ,$71.17 ,$92.70 ,$71.74 ,$14.62 ,$81.37 ,$15.86 ,$17.38 ,$17.38 ,$14.48 ,$17.38 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30100484,83605,HC LACTIC ACID CSF,301,1 ,$134.00 ,$67.00 ,$11.57 ,$134.00 ,$11.96 ,$41.55 ,$35.61 ,$11.57 ,$80.40 ,$113.90 ,$93.80 ,$11.96 ,$127.30 ,$101.84 ,$100.50 ,$19.67 ,$113.90 ,$11.57 ,$19.67 ,$11.57 ,$93.80 ,$11.96 ,$11.57 ,$11.57 ,$13.09 ,$113.90 ,$26.03 ,$123.28 ,$93.80 ,$51.32 ,$51.32 ,$81.61 ,$51.32 ,$92.59 ,$120.60 ,$93.33 ,$11.69 ,$105.86 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100485,83605,HC LACTIC ACID SPINAL FLUID,301,1 ,$134.00 ,$67.00 ,$11.57 ,$134.00 ,$11.96 ,$41.55 ,$35.61 ,$11.57 ,$80.40 ,$113.90 ,$93.80 ,$11.96 ,$127.30 ,$101.84 ,$100.50 ,$19.67 ,$113.90 ,$11.57 ,$19.67 ,$11.57 ,$93.80 ,$11.96 ,$11.57 ,$11.57 ,$13.09 ,$113.90 ,$26.03 ,$123.28 ,$93.80 ,$51.32 ,$51.32 ,$81.61 ,$51.32 ,$92.59 ,$120.60 ,$93.33 ,$11.69 ,$105.86 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100486,80165,HC VALPROIC ACID FREE,301,1 ,$72.00 ,$36.00 ,$13.54 ,$72.00 ,$13.99 ,$52.68 ,$45.15 ,$13.54 ,$43.20 ,$61.20 ,$50.40 ,$13.99 ,$68.40 ,$54.72 ,$54.00 ,$23.02 ,$61.20 ,$13.54 ,$23.02 ,$13.54 ,$50.40 ,$13.99 ,$13.54 ,$13.54 ,$15.32 ,$61.20 ,$30.47 ,$66.24 ,$50.40 ,$64.96 ,$64.96 ,$43.85 ,$64.96 ,$49.75 ,$64.80 ,$50.15 ,$13.68 ,$56.88 ,$14.83 ,$16.25 ,$16.25 ,$13.54 ,$16.25 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$57.60 
ST NICHOLAS HOSPITAL - ACUTE,30100515,82542,HC CHROMATO QN SGL 6TGN 6MMPN RBC,301,1 ,$291.00 ,$145.50 ,$24.09 ,$291.00 ,$24.89 ,$84.32 ,$72.27 ,$24.09 ,$174.60 ,$247.35 ,$203.70 ,$24.89 ,$276.45 ,$221.16 ,$218.25 ,$40.95 ,$247.35 ,$24.09 ,$40.95 ,$24.09 ,$203.70 ,$24.89 ,$24.09 ,$24.09 ,$27.27 ,$247.35 ,$54.20 ,$267.72 ,$203.70 ,$86.76 ,$86.76 ,$177.22 ,$86.76 ,$201.08 ,$261.90 ,$202.68 ,$24.33 ,$229.89 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30100660,83915,HC NUCLEOTIDASE,301,1 ,$146.00 ,$73.00 ,$11.15 ,$146.00 ,$11.52 ,$43.37 ,$37.17 ,$11.15 ,$87.60 ,$124.10 ,$102.20 ,$11.52 ,$138.70 ,$110.96 ,$109.50 ,$18.96 ,$124.10 ,$11.15 ,$18.96 ,$11.15 ,$102.20 ,$11.52 ,$11.15 ,$11.15 ,$12.62 ,$124.10 ,$25.09 ,$134.32 ,$102.20 ,$53.58 ,$53.58 ,$88.91 ,$53.58 ,$100.89 ,$131.40 ,$101.69 ,$11.26 ,$115.34 ,$12.21 ,$13.38 ,$13.38 ,$11.15 ,$13.38 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100661,83916,HC OLIGOCLONAL BANDS,301,1 ,$146.00 ,$73.00 ,$27.39 ,$146.00 ,$28.28 ,$95.87 ,$82.17 ,$27.39 ,$87.60 ,$124.10 ,$102.20 ,$28.28 ,$138.70 ,$110.96 ,$109.50 ,$46.56 ,$124.10 ,$27.39 ,$46.56 ,$27.39 ,$102.20 ,$28.28 ,$27.39 ,$27.39 ,$31.00 ,$124.10 ,$61.63 ,$134.32 ,$102.20 ,$96.62 ,$96.62 ,$88.91 ,$96.62 ,$100.89 ,$131.40 ,$101.69 ,$27.66 ,$115.34 ,$29.98 ,$32.87 ,$32.87 ,$27.39 ,$32.87 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100662,83918,HC ORGANIC ACIDS QD,301,1 ,$661.00 ,$330.50 ,$23.14 ,$661.00 ,$23.14 ,$82.60 ,$70.80 ,$23.60 ,$396.60 ,$561.85 ,$462.70 ,$23.14 ,$627.95 ,$502.36 ,$495.75 ,$40.12 ,$561.85 ,$23.60 ,$40.12 ,$23.60 ,$462.70 ,$23.14 ,$23.60 ,$23.60 ,$26.71 ,$561.85 ,$53.10 ,$608.12 ,$462.70 ,$79.08 ,$79.08 ,$402.55 ,$79.08 ,$456.75 ,$594.90 ,$460.39 ,$23.84 ,$522.19 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,30100663,83918,HC ORGANIC ACIDS QN,301,1 ,"$1,142.00 ",$571.00 ,$23.14 ,"$1,142.00 ",$23.14 ,$82.60 ,$70.80 ,$23.60 ,$685.20 ,$970.70 ,$799.40 ,$23.14 ,"$1,084.90 ",$867.92 ,$856.50 ,$40.12 ,$970.70 ,$23.60 ,$40.12 ,$23.60 ,$799.40 ,$23.14 ,$23.60 ,$23.60 ,$26.71 ,$970.70 ,$53.10 ,"$1,050.64 ",$799.40 ,$79.08 ,$79.08 ,$695.48 ,$79.08 ,$789.12 ,"$1,027.80 ",$795.40 ,$23.84 ,$902.18 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$822.24 ,$708.04 ,$822.24 ,$822.24 ,$913.60 
ST NICHOLAS HOSPITAL - ACUTE,30100664,83918,HC ORGANIC ACIDS URINE,301,1 ,"$1,185.00 ",$592.50 ,$23.14 ,"$1,185.00 ",$23.14 ,$82.60 ,$70.80 ,$23.60 ,$711.00 ,"$1,007.25 ",$829.50 ,$23.14 ,"$1,125.75 ",$900.60 ,$888.75 ,$40.12 ,"$1,007.25 ",$23.60 ,$40.12 ,$23.60 ,$829.50 ,$23.14 ,$23.60 ,$23.60 ,$26.71 ,"$1,007.25 ",$53.10 ,"$1,090.20 ",$829.50 ,$79.08 ,$79.08 ,$721.67 ,$79.08 ,$818.84 ,"$1,066.50 ",$825.35 ,$23.84 ,$936.15 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,30100665,83918,HC ACYLGLYCINE,301,1 ,$959.00 ,$479.50 ,$23.14 ,$959.00 ,$23.14 ,$82.60 ,$70.80 ,$23.60 ,$575.40 ,$815.15 ,$671.30 ,$23.14 ,$911.05 ,$728.84 ,$719.25 ,$40.12 ,$815.15 ,$23.60 ,$40.12 ,$23.60 ,$671.30 ,$23.14 ,$23.60 ,$23.60 ,$26.71 ,$815.15 ,$53.10 ,$882.28 ,$671.30 ,$79.08 ,$79.08 ,$584.03 ,$79.08 ,$662.67 ,$863.10 ,$667.94 ,$23.84 ,$757.61 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$690.48 ,$594.58 ,$690.48 ,$690.48 ,$767.20 
ST NICHOLAS HOSPITAL - ACUTE,30100666,83921,HC ORGANIC ACID SNG QN (MEHTYL),301,1 ,$123.00 ,$61.50 ,$21.21 ,$123.00 ,$21.92 ,$74.24 ,$63.63 ,$21.21 ,$73.80 ,$104.55 ,$86.10 ,$21.92 ,$116.85 ,$93.48 ,$92.25 ,$36.06 ,$104.55 ,$21.21 ,$36.06 ,$21.21 ,$86.10 ,$21.92 ,$21.21 ,$21.21 ,$24.01 ,$104.55 ,$47.72 ,$113.16 ,$86.10 ,$79.08 ,$79.08 ,$74.91 ,$79.08 ,$84.99 ,$110.70 ,$85.67 ,$21.42 ,$97.17 ,$23.24 ,$25.45 ,$25.45 ,$21.21 ,$25.45 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100667,80364,HC OPIATES EXP,301,1 ,$37.00 ,$18.50 ,$1.53 ,$37.00 ,$1.53 ,$23.94 ,$23.94 , N/A ,$22.20 ,$31.45 ,$25.90 ,$1.53 ,$35.15 ,$28.12 ,$27.75 ,$27.08 ,$31.45 , N/A ,$27.08 ,$15.93 ,$25.90 ,$1.53 , N/A , N/A ,$15.54 ,$31.45 , N/A ,$34.04 ,$25.90 ,$18.77 ,$22.52 ,$22.53 ,$22.52 ,$25.57 ,$33.30 ,$25.77 , N/A ,$29.23 ,$1.62 , N/A , N/A , N/A , N/A ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,30100668,83930,HC OSMOLALITY BLOOD,301,1 ,$50.00 ,$25.00 ,$6.61 ,$50.00 ,$6.83 ,$25.73 ,$22.05 ,$6.61 ,$30.00 ,$42.50 ,$35.00 ,$6.83 ,$47.50 ,$38.00 ,$37.50 ,$11.24 ,$42.50 ,$6.61 ,$11.24 ,$6.61 ,$35.00 ,$6.83 ,$6.61 ,$6.61 ,$7.48 ,$42.50 ,$14.87 ,$46.00 ,$35.00 ,$31.77 ,$31.77 ,$30.45 ,$31.77 ,$34.55 ,$45.00 ,$34.83 ,$6.68 ,$39.50 ,$7.24 ,$7.93 ,$7.93 ,$6.61 ,$7.93 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30100669,83935,HC OSMOLALITY URINE,301,1 ,$53.00 ,$26.50 ,$6.82 ,$53.00 ,$7.05 ,$26.50 ,$22.71 ,$6.82 ,$31.80 ,$45.05 ,$37.10 ,$7.05 ,$50.35 ,$40.28 ,$39.75 ,$11.59 ,$45.05 ,$6.82 ,$11.59 ,$6.82 ,$37.10 ,$7.05 ,$6.82 ,$6.82 ,$7.72 ,$45.05 ,$15.35 ,$48.76 ,$37.10 ,$32.76 ,$32.76 ,$32.28 ,$32.76 ,$36.62 ,$47.70 ,$36.91 ,$6.89 ,$41.87 ,$7.47 ,$8.18 ,$8.18 ,$6.82 ,$8.18 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30100670,83945,HC OXALATE,301,1 ,$60.00 ,$30.00 ,$14.45 ,$60.00 ,$14.93 ,$50.58 ,$43.35 ,$14.45 ,$36.00 ,$51.00 ,$42.00 ,$14.93 ,$57.00 ,$45.60 ,$45.00 ,$24.57 ,$51.00 ,$14.45 ,$24.57 ,$14.45 ,$42.00 ,$14.93 ,$14.45 ,$14.45 ,$16.35 ,$51.00 ,$32.51 ,$55.20 ,$42.00 ,$60.00 ,$60.00 ,$36.54 ,$60.00 ,$41.46 ,$54.00 ,$41.79 ,$14.59 ,$47.40 ,$15.83 ,$17.34 ,$17.34 ,$14.45 ,$17.34 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,30100671,83945,HC OXALATE 24 HR URINE,301,1 ,$125.00 ,$62.50 ,$14.45 ,$125.00 ,$14.93 ,$50.58 ,$43.35 ,$14.45 ,$75.00 ,$106.25 ,$87.50 ,$14.93 ,$118.75 ,$95.00 ,$93.75 ,$24.57 ,$106.25 ,$14.45 ,$24.57 ,$14.45 ,$87.50 ,$14.93 ,$14.45 ,$14.45 ,$16.35 ,$106.25 ,$32.51 ,$115.00 ,$87.50 ,$61.86 ,$61.86 ,$76.13 ,$61.86 ,$86.38 ,$112.50 ,$87.06 ,$14.59 ,$98.75 ,$15.83 ,$17.34 ,$17.34 ,$14.45 ,$17.34 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$100.00 
ST NICHOLAS HOSPITAL - ACUTE,30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$314.00 ,$157.00 ,$41.28 ,$314.00 ,$42.65 ,$160.51 ,$137.58 ,$41.28 ,$188.40 ,$266.90 ,$219.80 ,$42.65 ,$298.30 ,$238.64 ,$235.50 ,$70.18 ,$266.90 ,$41.28 ,$70.18 ,$41.28 ,$219.80 ,$42.65 ,$41.28 ,$41.28 ,$46.72 ,$266.90 ,$92.88 ,$288.88 ,$219.80 ,$198.36 ,$198.36 ,$191.23 ,$198.36 ,$216.97 ,$282.60 ,$218.70 ,$41.69 ,$248.06 ,$45.21 ,$49.54 ,$49.54 ,$41.28 ,$49.54 ,$226.08 ,$194.68 ,$226.08 ,$226.08 ,$251.20 
ST NICHOLAS HOSPITAL - ACUTE,30100673,83986,HC PH BODY FLUID,301,1 ,$27.00 ,$13.50 ,$3.58 ,$27.00 ,$3.70 ,$13.93 ,$11.94 ,$3.58 ,$16.20 ,$22.95 ,$18.90 ,$3.70 ,$25.65 ,$20.52 ,$20.25 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$3.58 ,$18.90 ,$3.70 ,$3.58 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.19 ,$17.19 ,$16.44 ,$17.19 ,$18.66 ,$24.30 ,$18.81 ,$3.62 ,$21.33 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$21.60 
ST NICHOLAS HOSPITAL - ACUTE,30100674,83986,HC PH BODY FLUID (FECES),301,1 ,$27.00 ,$13.50 ,$3.58 ,$27.00 ,$3.70 ,$13.93 ,$11.94 ,$3.58 ,$16.20 ,$22.95 ,$18.90 ,$3.70 ,$25.65 ,$20.52 ,$20.25 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$3.58 ,$18.90 ,$3.70 ,$3.58 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.19 ,$17.19 ,$16.44 ,$17.19 ,$18.66 ,$24.30 ,$18.81 ,$3.62 ,$21.33 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$21.60 
ST NICHOLAS HOSPITAL - ACUTE,30100675,83992,HC PHENCYCLIDINE (PCP),301,1 ,$112.00 ,$56.00 ,$20.67 ,$112.00 ,$20.67 ,$112.00 ,$112.00 , N/A ,$67.20 ,$95.20 ,$78.40 ,$20.67 ,$106.40 ,$85.12 ,$84.00 ,$66.49 ,$95.20 , N/A ,$66.49 ,$41.10 ,$78.40 ,$20.67 , N/A , N/A ,$47.04 ,$95.20 , N/A ,$103.04 ,$78.40 ,$70.63 ,$70.63 ,$68.21 ,$70.63 ,$77.39 ,$100.80 ,$78.01 , N/A ,$88.48 ,$21.91 ,$51.97 ,$51.97 , N/A ,$51.97 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100676,84030,HC NEWBORN SCREEN PKU,301,1 ,$213.00 ,$106.50 ,$5.50 ,$213.00 ,$5.68 ,$21.39 ,$18.33 ,$5.50 ,$127.80 ,$181.05 ,$149.10 ,$5.68 ,$202.35 ,$161.88 ,$159.75 ,$9.35 ,$181.05 ,$5.50 ,$9.35 ,$5.50 ,$149.10 ,$5.68 ,$5.50 ,$5.50 ,$6.22 ,$181.05 ,$12.38 ,$195.96 ,$149.10 ,$26.42 ,$26.42 ,$129.72 ,$26.42 ,$147.18 ,$191.70 ,$148.35 ,$5.56 ,$168.27 ,$6.02 ,$6.60 ,$6.60 ,$5.50 ,$6.60 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100677,84060,HC ACID PHOSPHATASE,301,1 ,$104.00 ,$52.00 ,$7.64 ,$104.00 ,$7.89 ,$28.74 ,$24.63 ,$7.64 ,$62.40 ,$88.40 ,$72.80 ,$7.89 ,$98.80 ,$79.04 ,$78.00 ,$12.99 ,$88.40 ,$7.64 ,$12.99 ,$7.64 ,$72.80 ,$7.89 ,$7.64 ,$7.64 ,$8.65 ,$88.40 ,$17.19 ,$95.68 ,$72.80 ,$35.51 ,$35.51 ,$63.34 ,$35.51 ,$71.86 ,$93.60 ,$72.44 ,$7.72 ,$82.16 ,$8.36 ,$9.17 ,$9.17 ,$7.64 ,$9.17 ,$74.88 ,$64.48 ,$74.88 ,$74.88 ,$83.20 
ST NICHOLAS HOSPITAL - ACUTE,30100678,84066,HC PHOSPHATASE ACID PROSTATIC,301,1 ,$112.00 ,$56.00 ,$9.66 ,$112.00 ,$9.98 ,$37.56 ,$32.19 ,$9.66 ,$67.20 ,$95.20 ,$78.40 ,$9.98 ,$106.40 ,$85.12 ,$84.00 ,$16.42 ,$95.20 ,$9.66 ,$16.42 ,$9.66 ,$78.40 ,$9.98 ,$9.66 ,$9.66 ,$10.93 ,$95.20 ,$21.74 ,$103.04 ,$78.40 ,$46.43 ,$46.43 ,$68.21 ,$46.43 ,$77.39 ,$100.80 ,$78.01 ,$9.76 ,$88.48 ,$10.58 ,$11.59 ,$11.59 ,$9.66 ,$11.59 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$28.00 ,$14.00 ,$5.18 ,$28.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$16.80 ,$23.80 ,$19.60 ,$5.35 ,$26.60 ,$21.28 ,$21.00 ,$8.81 ,$23.80 ,$5.18 ,$8.81 ,$5.18 ,$19.60 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$23.80 ,$11.66 ,$25.76 ,$19.60 ,$24.87 ,$24.87 ,$17.05 ,$24.87 ,$19.35 ,$25.20 ,$19.50 ,$5.23 ,$22.12 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$20.16 ,$17.36 ,$20.16 ,$20.16 ,$22.40 
ST NICHOLAS HOSPITAL - ACUTE,30100680,84075,HC ALKALINE PHOSPHATASE TOT,301,1 ,$40.00 ,$20.00 ,$5.18 ,$40.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$24.00 ,$34.00 ,$28.00 ,$5.35 ,$38.00 ,$30.40 ,$30.00 ,$8.81 ,$34.00 ,$5.18 ,$8.81 ,$5.18 ,$28.00 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$34.00 ,$11.66 ,$36.80 ,$28.00 ,$24.87 ,$24.87 ,$24.36 ,$24.87 ,$27.64 ,$36.00 ,$27.86 ,$5.23 ,$31.60 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30100681,84080,HC ALK PHOS ISOENZ,301,1 ,$112.00 ,$56.00 ,$14.78 ,$112.00 ,$15.27 ,$57.51 ,$49.29 ,$14.78 ,$67.20 ,$95.20 ,$78.40 ,$15.27 ,$106.40 ,$85.12 ,$84.00 ,$25.13 ,$95.20 ,$14.78 ,$25.13 ,$14.78 ,$78.40 ,$15.27 ,$14.78 ,$14.78 ,$16.73 ,$95.20 ,$33.26 ,$103.04 ,$78.40 ,$71.05 ,$71.05 ,$68.21 ,$71.05 ,$77.39 ,$100.80 ,$78.01 ,$14.93 ,$88.48 ,$16.19 ,$17.74 ,$17.74 ,$14.78 ,$17.74 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100682,84081,HC PHOSPHATIDYLYCEROL (PG),301,1 ,$436.00 ,$218.00 ,$16.52 ,$436.00 ,$17.07 ,$64.23 ,$55.05 ,$16.52 ,$261.60 ,$370.60 ,$305.20 ,$17.07 ,$414.20 ,$331.36 ,$327.00 ,$28.08 ,$370.60 ,$16.52 ,$28.08 ,$16.52 ,$305.20 ,$17.07 ,$16.52 ,$16.52 ,$18.70 ,$370.60 ,$37.17 ,$401.12 ,$305.20 ,$79.40 ,$79.40 ,$265.52 ,$79.40 ,$301.28 ,$392.40 ,$303.67 ,$16.69 ,$344.44 ,$18.09 ,$19.82 ,$19.82 ,$16.52 ,$19.82 ,$313.92 ,$270.32 ,$313.92 ,$313.92 ,$348.80 
ST NICHOLAS HOSPITAL - ACUTE,30100683,84087,HC PHOSPHATIDYLYCEROL (PG),301,1 ,$431.00 ,$215.50 ,$10.73 ,$431.00 ,$11.09 ,$40.15 ,$34.41 ,$10.73 ,$258.60 ,$366.35 ,$301.70 ,$11.09 ,$409.45 ,$327.56 ,$323.25 ,$18.24 ,$366.35 ,$10.73 ,$18.24 ,$10.73 ,$301.70 ,$11.09 ,$10.73 ,$10.73 ,$12.14 ,$366.35 ,$24.14 ,$396.52 ,$301.70 ,$49.63 ,$49.63 ,$262.48 ,$49.63 ,$297.82 ,$387.90 ,$300.19 ,$10.84 ,$340.49 ,$11.76 ,$12.88 ,$12.88 ,$10.73 ,$12.88 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,30100684,84100,HC PHOSPHORUS,301,1 ,$36.00 ,$18.00 ,$4.74 ,$36.00 ,$4.90 ,$18.45 ,$15.81 ,$4.74 ,$21.60 ,$30.60 ,$25.20 ,$4.90 ,$34.20 ,$27.36 ,$27.00 ,$8.06 ,$30.60 ,$4.74 ,$8.06 ,$4.74 ,$25.20 ,$4.90 ,$4.74 ,$4.74 ,$5.36 ,$30.60 ,$10.67 ,$33.12 ,$25.20 ,$22.76 ,$22.76 ,$21.92 ,$22.76 ,$24.88 ,$32.40 ,$25.07 ,$4.79 ,$28.44 ,$5.19 ,$5.69 ,$5.69 ,$4.74 ,$5.69 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30100685,84105,HC PHOSPHORUS URINE,301,1 ,$39.00 ,$19.50 ,$5.78 ,$39.00 ,$5.97 ,$20.23 ,$17.34 ,$5.78 ,$23.40 ,$33.15 ,$27.30 ,$5.97 ,$37.05 ,$29.64 ,$29.25 ,$9.83 ,$33.15 ,$5.78 ,$9.83 ,$5.78 ,$27.30 ,$5.97 ,$5.78 ,$5.78 ,$6.54 ,$33.15 ,$13.01 ,$35.88 ,$27.30 ,$24.87 ,$24.87 ,$23.75 ,$24.87 ,$26.95 ,$35.10 ,$27.16 ,$5.84 ,$30.81 ,$6.33 ,$6.94 ,$6.94 ,$5.78 ,$6.94 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100686,84110,HC PORPHOBILINOGEN QN,301,1 ,$62.00 ,$31.00 ,$8.44 ,$62.00 ,$8.72 ,$32.83 ,$28.14 ,$8.44 ,$37.20 ,$52.70 ,$43.40 ,$8.72 ,$58.90 ,$47.12 ,$46.50 ,$14.35 ,$52.70 ,$8.44 ,$14.35 ,$8.44 ,$43.40 ,$8.72 ,$8.44 ,$8.44 ,$9.55 ,$52.70 ,$18.99 ,$57.04 ,$43.40 ,$40.55 ,$40.55 ,$37.76 ,$40.55 ,$42.84 ,$55.80 ,$43.18 ,$8.52 ,$48.98 ,$9.24 ,$10.13 ,$10.13 ,$8.44 ,$10.13 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30100687,84110,HC PORPHOBILINOGEN QN (24),301,1 ,$67.00 ,$33.50 ,$8.44 ,$67.00 ,$8.72 ,$32.83 ,$28.14 ,$8.44 ,$40.20 ,$56.95 ,$46.90 ,$8.72 ,$63.65 ,$50.92 ,$50.25 ,$14.35 ,$56.95 ,$8.44 ,$14.35 ,$8.44 ,$46.90 ,$8.72 ,$8.44 ,$8.44 ,$9.55 ,$56.95 ,$18.99 ,$61.64 ,$46.90 ,$40.55 ,$40.55 ,$40.80 ,$40.55 ,$46.30 ,$60.30 ,$46.67 ,$8.52 ,$52.93 ,$9.24 ,$10.13 ,$10.13 ,$8.44 ,$10.13 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100688,84112,HC PLACENTAL ALPHA MICROGLOBULIN,301,1 ,$493.00 ,$246.50 ,$90.57 ,$493.00 ,$90.57 ,$343.39 ,$294.33 ,$98.11 ,$295.80 ,$419.05 ,$345.10 ,$90.57 ,$468.35 ,$374.68 ,$369.75 ,$166.79 ,$419.05 ,$98.11 ,$166.79 ,$98.11 ,$345.10 ,$90.57 ,$98.11 ,$98.11 ,$111.04 ,$419.05 ,$220.75 ,$453.56 ,$345.10 ,$309.57 ,$309.57 ,$300.24 ,$309.57 ,$340.66 ,$443.70 ,$343.37 ,$99.09 ,$389.47 ,$96.00 ,$117.73 ,$117.73 ,$98.11 ,$117.73 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,30100689,84120,HC PORPHYRINS QN FRACT,301,1 ,$134.00 ,$67.00 ,$14.71 ,$134.00 ,$15.20 ,$57.23 ,$49.05 ,$14.71 ,$80.40 ,$113.90 ,$93.80 ,$15.20 ,$127.30 ,$101.84 ,$100.50 ,$25.01 ,$113.90 ,$14.71 ,$25.01 ,$14.71 ,$93.80 ,$15.20 ,$14.71 ,$14.71 ,$16.65 ,$113.90 ,$33.10 ,$123.28 ,$93.80 ,$70.70 ,$70.70 ,$81.61 ,$70.70 ,$92.59 ,$120.60 ,$93.33 ,$14.86 ,$105.86 ,$16.11 ,$17.65 ,$17.65 ,$14.71 ,$17.65 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100690,84120,HC PORPHYRINS QN FRACT RNDM,301,1 ,$168.00 ,$84.00 ,$14.71 ,$168.00 ,$15.20 ,$57.23 ,$49.05 ,$14.71 ,$100.80 ,$142.80 ,$117.60 ,$15.20 ,$159.60 ,$127.68 ,$126.00 ,$25.01 ,$142.80 ,$14.71 ,$25.01 ,$14.71 ,$117.60 ,$15.20 ,$14.71 ,$14.71 ,$16.65 ,$142.80 ,$33.10 ,$154.56 ,$117.60 ,$70.70 ,$70.70 ,$102.31 ,$70.70 ,$116.09 ,$151.20 ,$117.01 ,$14.86 ,$132.72 ,$16.11 ,$17.65 ,$17.65 ,$14.71 ,$17.65 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100691,84132,HC POTASSIUM,301,1 ,$35.00 ,$17.50 ,$4.76 ,$35.00 ,$4.92 ,$17.89 ,$15.33 ,$4.76 ,$21.00 ,$29.75 ,$24.50 ,$4.92 ,$33.25 ,$26.60 ,$26.25 ,$8.09 ,$29.75 ,$4.76 ,$8.09 ,$4.76 ,$24.50 ,$4.92 ,$4.76 ,$4.76 ,$5.39 ,$29.75 ,$10.71 ,$32.20 ,$24.50 ,$22.09 ,$22.09 ,$21.32 ,$22.09 ,$24.19 ,$31.50 ,$24.38 ,$4.81 ,$27.65 ,$5.22 ,$5.71 ,$5.71 ,$4.76 ,$5.71 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,30100692,84132,HC POTASSIUM ABG,301,1 ,$35.00 ,$17.50 ,$4.76 ,$35.00 ,$4.92 ,$17.89 ,$15.33 ,$4.76 ,$21.00 ,$29.75 ,$24.50 ,$4.92 ,$33.25 ,$26.60 ,$26.25 ,$8.09 ,$29.75 ,$4.76 ,$8.09 ,$4.76 ,$24.50 ,$4.92 ,$4.76 ,$4.76 ,$5.39 ,$29.75 ,$10.71 ,$32.20 ,$24.50 ,$22.09 ,$22.09 ,$21.32 ,$22.09 ,$24.19 ,$31.50 ,$24.38 ,$4.81 ,$27.65 ,$5.22 ,$5.71 ,$5.71 ,$4.76 ,$5.71 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,30100693,84132,HC POTASSIUM ISTAT,301,1 ,$35.00 ,$17.50 ,$4.76 ,$35.00 ,$4.92 ,$17.89 ,$15.33 ,$4.76 ,$21.00 ,$29.75 ,$24.50 ,$4.92 ,$33.25 ,$26.60 ,$26.25 ,$8.09 ,$29.75 ,$4.76 ,$8.09 ,$4.76 ,$24.50 ,$4.92 ,$4.76 ,$4.76 ,$5.39 ,$29.75 ,$10.71 ,$32.20 ,$24.50 ,$22.09 ,$22.09 ,$21.32 ,$22.09 ,$24.19 ,$31.50 ,$24.38 ,$4.81 ,$27.65 ,$5.22 ,$5.71 ,$5.71 ,$4.76 ,$5.71 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,30100694,84133,HC POTASSIUM URINE,301,1 ,$32.00 ,$16.00 ,$4.73 ,$32.00 ,$4.89 ,$16.77 ,$14.37 ,$4.73 ,$19.20 ,$27.20 ,$22.40 ,$4.89 ,$30.40 ,$24.32 ,$24.00 ,$8.04 ,$27.20 ,$4.73 ,$8.04 ,$4.73 ,$22.40 ,$4.89 ,$4.73 ,$4.73 ,$5.35 ,$27.20 ,$10.64 ,$29.44 ,$22.40 ,$20.68 ,$20.68 ,$19.49 ,$20.68 ,$22.11 ,$28.80 ,$22.29 ,$4.78 ,$25.28 ,$5.18 ,$5.68 ,$5.68 ,$4.73 ,$5.68 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$25.60 
ST NICHOLAS HOSPITAL - ACUTE,30100695,84134,HC PREALBUMIN,301,1 ,$50.00 ,$25.00 ,$7.85 ,$50.00 ,$7.85 ,$50.00 ,$48.63 ,$14.59 ,$30.00 ,$42.50 ,$35.00 ,$7.85 ,$47.50 ,$38.00 ,$37.50 ,$24.80 ,$42.50 ,$14.59 ,$24.80 ,$14.59 ,$35.00 ,$7.85 ,$14.59 ,$14.59 ,$16.51 ,$42.50 ,$32.83 ,$46.00 ,$35.00 ,$26.84 ,$26.84 ,$30.45 ,$26.84 ,$34.55 ,$45.00 ,$34.83 ,$14.74 ,$39.50 ,$8.32 ,$17.51 ,$17.51 ,$14.59 ,$17.51 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30100696,84144,HC PROGESTERONE,301,1 ,$146.00 ,$73.00 ,$20.86 ,$146.00 ,$21.55 ,$81.13 ,$69.54 ,$20.86 ,$87.60 ,$124.10 ,$102.20 ,$21.55 ,$138.70 ,$110.96 ,$109.50 ,$35.46 ,$124.10 ,$20.86 ,$35.46 ,$20.86 ,$102.20 ,$21.55 ,$20.86 ,$20.86 ,$23.61 ,$124.10 ,$46.94 ,$134.32 ,$102.20 ,$89.40 ,$89.40 ,$88.91 ,$89.40 ,$100.89 ,$131.40 ,$101.69 ,$21.07 ,$115.34 ,$22.84 ,$25.03 ,$25.03 ,$20.86 ,$25.03 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100697,84146,HC PROLACTIN,301,1 ,$146.00 ,$73.00 ,$19.38 ,$146.00 ,$20.03 ,$75.36 ,$64.59 ,$19.38 ,$87.60 ,$124.10 ,$102.20 ,$20.03 ,$138.70 ,$110.96 ,$109.50 ,$32.95 ,$124.10 ,$19.38 ,$32.95 ,$19.38 ,$102.20 ,$20.03 ,$19.38 ,$19.38 ,$21.93 ,$124.10 ,$43.61 ,$134.32 ,$102.20 ,$93.14 ,$93.14 ,$88.91 ,$93.14 ,$100.89 ,$131.40 ,$101.69 ,$19.57 ,$115.34 ,$21.23 ,$23.26 ,$23.26 ,$19.38 ,$23.26 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100698,84153,HC PSA TOTAL,301,1 ,$146.00 ,$73.00 ,$18.39 ,$146.00 ,$19.00 ,$71.54 ,$61.32 ,$18.39 ,$87.60 ,$124.10 ,$102.20 ,$19.00 ,$138.70 ,$110.96 ,$109.50 ,$31.26 ,$124.10 ,$18.39 ,$31.26 ,$18.39 ,$102.20 ,$19.00 ,$18.39 ,$18.39 ,$20.81 ,$124.10 ,$41.38 ,$134.32 ,$102.20 ,$88.38 ,$88.38 ,$88.91 ,$88.38 ,$100.89 ,$131.40 ,$101.69 ,$18.57 ,$115.34 ,$20.14 ,$22.07 ,$22.07 ,$18.39 ,$22.07 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100699,84154,HC PSA FREE,301,1 ,$146.00 ,$73.00 ,$18.39 ,$146.00 ,$19.00 ,$71.54 ,$61.32 ,$18.39 ,$87.60 ,$124.10 ,$102.20 ,$19.00 ,$138.70 ,$110.96 ,$109.50 ,$31.26 ,$124.10 ,$18.39 ,$31.26 ,$18.39 ,$102.20 ,$19.00 ,$18.39 ,$18.39 ,$20.81 ,$124.10 ,$41.38 ,$134.32 ,$102.20 ,$88.38 ,$88.38 ,$88.91 ,$88.38 ,$100.89 ,$131.40 ,$101.69 ,$18.57 ,$115.34 ,$20.14 ,$22.07 ,$22.07 ,$18.39 ,$22.07 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100700,84155,HC PROTEIN TOTAL,301,1 ,$29.00 ,$14.50 ,$3.67 ,$29.00 ,$3.79 ,$14.25 ,$12.21 ,$3.67 ,$17.40 ,$24.65 ,$20.30 ,$3.79 ,$27.55 ,$22.04 ,$21.75 ,$6.24 ,$24.65 ,$3.67 ,$6.24 ,$3.67 ,$20.30 ,$3.79 ,$3.67 ,$3.67 ,$4.15 ,$24.65 ,$8.26 ,$26.68 ,$20.30 ,$17.61 ,$17.61 ,$17.66 ,$17.61 ,$20.04 ,$26.10 ,$20.20 ,$3.71 ,$22.91 ,$4.02 ,$4.40 ,$4.40 ,$3.67 ,$4.40 ,$20.88 ,$17.98 ,$20.88 ,$20.88 ,$23.20 
ST NICHOLAS HOSPITAL - ACUTE,30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$35.00 ,$17.50 ,$3.67 ,$35.00 ,$3.79 ,$14.25 ,$12.21 ,$3.67 ,$21.00 ,$29.75 ,$24.50 ,$3.79 ,$33.25 ,$26.60 ,$26.25 ,$6.24 ,$29.75 ,$3.67 ,$6.24 ,$3.67 ,$24.50 ,$3.79 ,$3.67 ,$3.67 ,$4.15 ,$29.75 ,$8.26 ,$32.20 ,$24.50 ,$17.61 ,$17.61 ,$21.32 ,$17.61 ,$24.19 ,$31.50 ,$24.38 ,$3.71 ,$27.65 ,$4.02 ,$4.40 ,$4.40 ,$3.67 ,$4.40 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,30100702,84156,HC PROTEIN TOTAL 24HR URINE,301,1 ,$28.00 ,$14.00 ,$3.67 ,$28.00 ,$3.79 ,$14.25 ,$12.21 ,$3.67 ,$16.80 ,$23.80 ,$19.60 ,$3.79 ,$26.60 ,$21.28 ,$21.00 ,$6.24 ,$23.80 ,$3.67 ,$6.24 ,$3.67 ,$19.60 ,$3.79 ,$3.67 ,$3.67 ,$4.15 ,$23.80 ,$8.26 ,$25.76 ,$19.60 ,$17.61 ,$17.61 ,$17.05 ,$17.61 ,$19.35 ,$25.20 ,$19.50 ,$3.71 ,$22.12 ,$4.02 ,$4.40 ,$4.40 ,$3.67 ,$4.40 ,$20.16 ,$17.36 ,$20.16 ,$20.16 ,$22.40 
ST NICHOLAS HOSPITAL - ACUTE,30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$53.00 ,$26.50 ,$4.00 ,$53.00 ,$4.13 ,$14.25 ,$12.21 ,$4.00 ,$31.80 ,$45.05 ,$37.10 ,$4.13 ,$50.35 ,$40.28 ,$39.75 ,$6.80 ,$45.05 ,$4.00 ,$6.80 ,$4.00 ,$37.10 ,$4.13 ,$4.00 ,$4.00 ,$4.53 ,$45.05 ,$9.00 ,$48.76 ,$37.10 ,$17.61 ,$17.61 ,$32.28 ,$17.61 ,$36.62 ,$47.70 ,$36.91 ,$4.04 ,$41.87 ,$4.38 ,$4.80 ,$4.80 ,$4.00 ,$4.80 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30100704,84157,HC PROTEIN TOTAL SPINAL FLUID,301,1 ,$53.00 ,$26.50 ,$4.00 ,$53.00 ,$4.13 ,$14.25 ,$12.21 ,$4.00 ,$31.80 ,$45.05 ,$37.10 ,$4.13 ,$50.35 ,$40.28 ,$39.75 ,$6.80 ,$45.05 ,$4.00 ,$6.80 ,$4.00 ,$37.10 ,$4.13 ,$4.00 ,$4.00 ,$4.53 ,$45.05 ,$9.00 ,$48.76 ,$37.10 ,$17.61 ,$17.61 ,$32.28 ,$17.61 ,$36.62 ,$47.70 ,$36.91 ,$4.04 ,$41.87 ,$4.38 ,$4.80 ,$4.80 ,$4.00 ,$4.80 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30100705,84165,HC PROTEIN ELECTROPHORESIS,301,1 ,$78.00 ,$39.00 ,$10.74 ,$78.00 ,$11.10 ,$41.76 ,$35.79 ,$10.74 ,$46.80 ,$66.30 ,$54.60 ,$11.10 ,$74.10 ,$59.28 ,$58.50 ,$18.26 ,$66.30 ,$10.74 ,$18.26 ,$10.74 ,$54.60 ,$11.10 ,$10.74 ,$10.74 ,$12.16 ,$66.30 ,$24.17 ,$71.76 ,$54.60 ,$51.61 ,$51.61 ,$47.50 ,$51.61 ,$53.90 ,$70.20 ,$54.33 ,$10.85 ,$61.62 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100706,84166,HC PROTEIN EP OTH FLUID,301,1 ,$134.00 ,$67.00 ,$17.83 ,$134.00 ,$18.42 ,$69.34 ,$59.43 ,$17.83 ,$80.40 ,$113.90 ,$93.80 ,$18.42 ,$127.30 ,$101.84 ,$100.50 ,$30.31 ,$113.90 ,$17.83 ,$30.31 ,$17.83 ,$93.80 ,$18.42 ,$17.83 ,$17.83 ,$20.18 ,$113.90 ,$40.12 ,$123.28 ,$93.80 ,$85.70 ,$85.70 ,$81.61 ,$85.70 ,$92.59 ,$120.60 ,$93.33 ,$18.01 ,$105.86 ,$19.53 ,$21.40 ,$21.40 ,$17.83 ,$21.40 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100707,84166,HC PROTEIN EP OTH FLUID SF,301,1 ,$134.00 ,$67.00 ,$17.83 ,$134.00 ,$18.42 ,$69.34 ,$59.43 ,$17.83 ,$80.40 ,$113.90 ,$93.80 ,$18.42 ,$127.30 ,$101.84 ,$100.50 ,$30.31 ,$113.90 ,$17.83 ,$30.31 ,$17.83 ,$93.80 ,$18.42 ,$17.83 ,$17.83 ,$20.18 ,$113.90 ,$40.12 ,$123.28 ,$93.80 ,$85.70 ,$85.70 ,$81.61 ,$85.70 ,$92.59 ,$120.60 ,$93.33 ,$18.01 ,$105.86 ,$19.53 ,$21.40 ,$21.40 ,$17.83 ,$21.40 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100708,84181,HC PROTEIN WESTERN BLOT,301,1 ,$159.00 ,$79.50 ,$17.03 ,$159.00 ,$17.60 ,$66.22 ,$56.76 ,$17.03 ,$95.40 ,$135.15 ,$111.30 ,$17.60 ,$151.05 ,$120.84 ,$119.25 ,$28.95 ,$135.15 ,$17.03 ,$28.95 ,$17.03 ,$111.30 ,$17.60 ,$17.03 ,$17.03 ,$19.27 ,$135.15 ,$38.32 ,$146.28 ,$111.30 ,$81.87 ,$81.87 ,$96.83 ,$81.87 ,$109.87 ,$143.10 ,$110.74 ,$17.20 ,$125.61 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$127.20 
ST NICHOLAS HOSPITAL - ACUTE,30100709,84202,HC PROTOPORPHYRIN,301,1 ,$90.00 ,$45.00 ,$14.35 ,$90.00 ,$14.83 ,$55.79 ,$47.82 ,$14.35 ,$54.00 ,$76.50 ,$63.00 ,$14.83 ,$85.50 ,$68.40 ,$67.50 ,$24.40 ,$76.50 ,$14.35 ,$24.40 ,$14.35 ,$63.00 ,$14.83 ,$14.35 ,$14.35 ,$16.24 ,$76.50 ,$32.29 ,$82.80 ,$63.00 ,$68.94 ,$68.94 ,$54.81 ,$68.94 ,$62.19 ,$81.00 ,$62.69 ,$14.49 ,$71.10 ,$15.72 ,$17.22 ,$17.22 ,$14.35 ,$17.22 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100710,84206,HC PROINSULIN,301,1 ,$291.00 ,$145.50 ,$25.05 ,$291.00 ,$25.05 ,$93.42 ,$80.07 ,$26.69 ,$174.60 ,$247.35 ,$203.70 ,$25.05 ,$276.45 ,$221.16 ,$218.25 ,$45.37 ,$247.35 ,$26.69 ,$45.37 ,$26.69 ,$203.70 ,$25.05 ,$26.69 ,$26.69 ,$30.21 ,$247.35 ,$60.05 ,$267.72 ,$203.70 ,$85.60 ,$85.60 ,$177.22 ,$85.60 ,$201.08 ,$261.90 ,$202.68 ,$26.96 ,$229.89 ,$26.55 ,$32.03 ,$32.03 ,$26.69 ,$32.03 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30100711,84207,HC VITAMIN B6,301,1 ,$213.00 ,$106.50 ,$28.10 ,$213.00 ,$29.04 ,$109.27 ,$93.66 ,$28.10 ,$127.80 ,$181.05 ,$149.10 ,$29.04 ,$202.35 ,$161.88 ,$159.75 ,$47.77 ,$181.05 ,$28.10 ,$47.77 ,$28.10 ,$149.10 ,$29.04 ,$28.10 ,$28.10 ,$31.80 ,$181.05 ,$63.23 ,$195.96 ,$149.10 ,$135.02 ,$135.02 ,$129.72 ,$135.02 ,$147.18 ,$191.70 ,$148.35 ,$28.38 ,$168.27 ,$30.78 ,$33.72 ,$33.72 ,$28.10 ,$33.72 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100712,84210,HC PYRUVATE,301,1 ,$112.00 ,$56.00 ,$14.48 ,$112.00 ,$14.96 ,$50.68 ,$43.44 ,$14.48 ,$67.20 ,$95.20 ,$78.40 ,$14.96 ,$106.40 ,$85.12 ,$84.00 ,$24.62 ,$95.20 ,$14.48 ,$24.62 ,$14.48 ,$78.40 ,$14.96 ,$14.48 ,$14.48 ,$16.39 ,$95.20 ,$32.58 ,$103.04 ,$78.40 ,$52.17 ,$52.17 ,$68.21 ,$52.17 ,$77.39 ,$100.80 ,$78.01 ,$14.62 ,$88.48 ,$15.86 ,$17.38 ,$17.38 ,$14.48 ,$17.38 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100713,84220,HC PYRUVATE KINASE,301,1 ,$227.00 ,$113.50 ,$9.44 ,$227.00 ,$9.75 ,$36.72 ,$31.47 ,$9.44 ,$136.20 ,$192.95 ,$158.90 ,$9.75 ,$215.65 ,$172.52 ,$170.25 ,$16.05 ,$192.95 ,$9.44 ,$16.05 ,$9.44 ,$158.90 ,$9.75 ,$9.44 ,$9.44 ,$10.68 ,$192.95 ,$21.24 ,$208.84 ,$158.90 ,$45.37 ,$45.37 ,$138.24 ,$45.37 ,$156.86 ,$204.30 ,$158.11 ,$9.53 ,$179.33 ,$10.34 ,$11.33 ,$11.33 ,$9.44 ,$11.33 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$181.60 
ST NICHOLAS HOSPITAL - ACUTE,30100714,84238,HC RECEPTOR ASSAY NON ENDO,301,1 ,$291.00 ,$145.50 ,$36.57 ,$291.00 ,$37.79 ,$142.21 ,$121.89 ,$36.57 ,$174.60 ,$247.35 ,$203.70 ,$37.79 ,$276.45 ,$221.16 ,$218.25 ,$62.17 ,$247.35 ,$36.57 ,$62.17 ,$36.57 ,$203.70 ,$37.79 ,$36.57 ,$36.57 ,$41.39 ,$247.35 ,$82.28 ,$267.72 ,$203.70 ,$175.74 ,$175.74 ,$177.22 ,$175.74 ,$201.08 ,$261.90 ,$202.68 ,$36.94 ,$229.89 ,$40.06 ,$43.88 ,$43.88 ,$36.57 ,$43.88 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30100715,84244,HC RENIN,301,1 ,$168.00 ,$84.00 ,$21.99 ,$168.00 ,$22.72 ,$85.54 ,$73.32 ,$21.99 ,$100.80 ,$142.80 ,$117.60 ,$22.72 ,$159.60 ,$127.68 ,$126.00 ,$37.38 ,$142.80 ,$21.99 ,$37.38 ,$21.99 ,$117.60 ,$22.72 ,$21.99 ,$21.99 ,$24.89 ,$142.80 ,$49.48 ,$154.56 ,$117.60 ,$105.71 ,$105.71 ,$102.31 ,$105.71 ,$116.09 ,$151.20 ,$117.01 ,$22.21 ,$132.72 ,$24.08 ,$26.39 ,$26.39 ,$21.99 ,$26.39 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100716,84255,HC SELENIUM (MAYO),301,1 ,$286.00 ,$143.00 ,$25.53 ,$286.00 ,$26.38 ,$99.30 ,$85.11 ,$25.53 ,$171.60 ,$243.10 ,$200.20 ,$26.38 ,$271.70 ,$217.36 ,$214.50 ,$43.40 ,$243.10 ,$25.53 ,$43.40 ,$25.53 ,$200.20 ,$26.38 ,$25.53 ,$25.53 ,$28.89 ,$243.10 ,$57.44 ,$263.12 ,$200.20 ,$122.69 ,$122.69 ,$174.17 ,$122.69 ,$197.63 ,$257.40 ,$199.20 ,$25.79 ,$225.94 ,$27.96 ,$30.64 ,$30.64 ,$25.53 ,$30.64 ,$205.92 ,$177.32 ,$205.92 ,$205.92 ,$228.80 
ST NICHOLAS HOSPITAL - ACUTE,30100717,84255,HC SELENIUM,301,1 ,$190.00 ,$95.00 ,$25.53 ,$190.00 ,$26.38 ,$99.30 ,$85.11 ,$25.53 ,$114.00 ,$161.50 ,$133.00 ,$26.38 ,$180.50 ,$144.40 ,$142.50 ,$43.40 ,$161.50 ,$25.53 ,$43.40 ,$25.53 ,$133.00 ,$26.38 ,$25.53 ,$25.53 ,$28.89 ,$161.50 ,$57.44 ,$174.80 ,$133.00 ,$122.69 ,$122.69 ,$115.71 ,$122.69 ,$131.29 ,$171.00 ,$132.34 ,$25.79 ,$150.10 ,$27.96 ,$30.64 ,$30.64 ,$25.53 ,$30.64 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100718,84260,HC SEROTONIN,301,1 ,$190.00 ,$95.00 ,$30.98 ,$190.00 ,$32.01 ,$120.51 ,$103.29 ,$30.98 ,$114.00 ,$161.50 ,$133.00 ,$32.01 ,$180.50 ,$144.40 ,$142.50 ,$52.67 ,$161.50 ,$30.98 ,$52.67 ,$30.98 ,$133.00 ,$32.01 ,$30.98 ,$30.98 ,$35.06 ,$161.50 ,$69.71 ,$174.80 ,$133.00 ,$148.87 ,$148.87 ,$115.71 ,$148.87 ,$131.29 ,$171.00 ,$132.34 ,$31.29 ,$150.10 ,$33.93 ,$37.18 ,$37.18 ,$30.98 ,$37.18 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100719,84260,HC SEROTONIN WHOLE BLOOD,301,1 ,$228.00 ,$114.00 ,$30.98 ,$228.00 ,$32.01 ,$120.51 ,$103.29 ,$30.98 ,$136.80 ,$193.80 ,$159.60 ,$32.01 ,$216.60 ,$173.28 ,$171.00 ,$52.67 ,$193.80 ,$30.98 ,$52.67 ,$30.98 ,$159.60 ,$32.01 ,$30.98 ,$30.98 ,$35.06 ,$193.80 ,$69.71 ,$209.76 ,$159.60 ,$148.87 ,$148.87 ,$138.85 ,$148.87 ,$157.55 ,$205.20 ,$158.80 ,$31.29 ,$180.12 ,$33.93 ,$37.18 ,$37.18 ,$30.98 ,$37.18 ,$164.16 ,$141.36 ,$164.16 ,$164.16 ,$182.40 
ST NICHOLAS HOSPITAL - ACUTE,30100720,84270,HC SEX HORMONE BIND GLOB,301,1 ,$168.00 ,$84.00 ,$21.73 ,$168.00 ,$22.45 ,$84.53 ,$72.45 ,$21.73 ,$100.80 ,$142.80 ,$117.60 ,$22.45 ,$159.60 ,$127.68 ,$126.00 ,$36.94 ,$142.80 ,$21.73 ,$36.94 ,$21.73 ,$117.60 ,$22.45 ,$21.73 ,$21.73 ,$24.59 ,$142.80 ,$48.89 ,$154.56 ,$117.60 ,$104.45 ,$104.45 ,$102.31 ,$104.45 ,$116.09 ,$151.20 ,$117.01 ,$21.95 ,$132.72 ,$23.80 ,$26.08 ,$26.08 ,$21.73 ,$26.08 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100721,84295,HC SODIUM,301,1 ,$24.00 ,$12.00 ,$4.81 ,$24.00 ,$4.97 ,$18.73 ,$16.05 ,$4.81 ,$14.40 ,$20.40 ,$16.80 ,$4.97 ,$22.80 ,$18.24 ,$18.00 ,$8.18 ,$20.40 ,$4.81 ,$8.18 ,$4.81 ,$16.80 ,$4.97 ,$4.81 ,$4.81 ,$5.44 ,$20.40 ,$10.82 ,$22.08 ,$16.80 ,$23.11 ,$23.11 ,$14.62 ,$23.11 ,$16.58 ,$21.60 ,$16.72 ,$4.86 ,$18.96 ,$5.27 ,$5.77 ,$5.77 ,$4.81 ,$5.77 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$19.20 
ST NICHOLAS HOSPITAL - ACUTE,30100722,84295,HC SODIUM SERUM/PLSM/WB,301,1 ,$15.00 ,$7.50 ,$4.81 ,$15.00 ,$4.97 ,$15.00 ,$15.00 ,$4.81 ,$9.00 ,$12.75 ,$10.50 ,$4.97 ,$14.25 ,$11.40 ,$11.25 ,$8.18 ,$12.75 ,$4.81 ,$8.18 ,$4.81 ,$10.50 ,$4.97 ,$4.81 ,$4.81 ,$5.44 ,$12.75 ,$10.82 ,$13.80 ,$10.50 ,$15.00 ,$15.00 ,$9.14 ,$15.00 ,$10.37 ,$13.50 ,$10.45 ,$4.86 ,$11.85 ,$5.27 ,$5.77 ,$5.77 ,$4.81 ,$5.77 ,$10.80 ,$9.30 ,$10.80 ,$10.80 ,$12.00 
ST NICHOLAS HOSPITAL - ACUTE,30100723,84295,HC SODIUM ISTAT,301,1 ,$24.00 ,$12.00 ,$4.81 ,$24.00 ,$4.97 ,$18.73 ,$16.05 ,$4.81 ,$14.40 ,$20.40 ,$16.80 ,$4.97 ,$22.80 ,$18.24 ,$18.00 ,$8.18 ,$20.40 ,$4.81 ,$8.18 ,$4.81 ,$16.80 ,$4.97 ,$4.81 ,$4.81 ,$5.44 ,$20.40 ,$10.82 ,$22.08 ,$16.80 ,$23.11 ,$23.11 ,$14.62 ,$23.11 ,$16.58 ,$21.60 ,$16.72 ,$4.86 ,$18.96 ,$5.27 ,$5.77 ,$5.77 ,$4.81 ,$5.77 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$19.20 
ST NICHOLAS HOSPITAL - ACUTE,30100724,84300,HC SODIUM URINE,301,1 ,$37.00 ,$18.50 ,$5.06 ,$37.00 ,$5.23 ,$18.90 ,$16.20 ,$5.06 ,$22.20 ,$31.45 ,$25.90 ,$5.23 ,$35.15 ,$28.12 ,$27.75 ,$8.60 ,$31.45 ,$5.06 ,$8.60 ,$5.06 ,$25.90 ,$5.23 ,$5.06 ,$5.06 ,$5.73 ,$31.45 ,$11.39 ,$34.04 ,$25.90 ,$23.39 ,$23.39 ,$22.53 ,$23.39 ,$25.57 ,$33.30 ,$25.77 ,$5.11 ,$29.23 ,$5.54 ,$6.07 ,$6.07 ,$5.06 ,$6.07 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,30100725,84302,HC SODIUM OTHER FLUID,301,1 ,$37.00 ,$18.50 ,$4.86 ,$37.00 ,$5.02 ,$18.90 ,$16.20 ,$4.86 ,$22.20 ,$31.45 ,$25.90 ,$5.02 ,$35.15 ,$28.12 ,$27.75 ,$8.26 ,$31.45 ,$4.86 ,$8.26 ,$4.86 ,$25.90 ,$5.02 ,$4.86 ,$4.86 ,$5.50 ,$31.45 ,$10.94 ,$34.04 ,$25.90 ,$23.39 ,$23.39 ,$22.53 ,$23.39 ,$25.57 ,$33.30 ,$25.77 ,$4.91 ,$29.23 ,$5.32 ,$5.83 ,$5.83 ,$4.86 ,$5.83 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,30100726,84305,HC SOMATOMEDINC,301,1 ,$168.00 ,$84.00 ,$21.26 ,$168.00 ,$21.97 ,$82.71 ,$70.89 ,$21.26 ,$100.80 ,$142.80 ,$117.60 ,$21.97 ,$159.60 ,$127.68 ,$126.00 ,$36.14 ,$142.80 ,$21.26 ,$36.14 ,$21.26 ,$117.60 ,$21.97 ,$21.26 ,$21.26 ,$24.06 ,$142.80 ,$47.84 ,$154.56 ,$117.60 ,$102.16 ,$102.16 ,$102.31 ,$102.16 ,$116.09 ,$151.20 ,$117.01 ,$21.47 ,$132.72 ,$23.29 ,$25.51 ,$25.51 ,$21.26 ,$25.51 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30100727,84311,HC SPECTROPHOTOMETRY,301,1 ,$213.00 ,$106.50 ,$8.10 ,$213.00 ,$8.37 ,$28.35 ,$24.30 ,$8.10 ,$127.80 ,$181.05 ,$149.10 ,$8.37 ,$202.35 ,$161.88 ,$159.75 ,$13.77 ,$181.05 ,$8.10 ,$13.77 ,$8.10 ,$149.10 ,$8.37 ,$8.10 ,$8.10 ,$9.17 ,$181.05 ,$18.23 ,$195.96 ,$149.10 ,$33.61 ,$33.61 ,$129.72 ,$33.61 ,$147.18 ,$191.70 ,$148.35 ,$8.18 ,$168.27 ,$8.87 ,$9.72 ,$9.72 ,$8.10 ,$9.72 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100728,84376,HC SUGARS SINGLE QL,301,1 ,$67.00 ,$33.50 ,$5.50 ,$67.00 ,$5.68 ,$21.39 ,$18.33 ,$5.50 ,$40.20 ,$56.95 ,$46.90 ,$5.68 ,$63.65 ,$50.92 ,$50.25 ,$9.35 ,$56.95 ,$5.50 ,$9.35 ,$5.50 ,$46.90 ,$5.68 ,$5.50 ,$5.50 ,$6.22 ,$56.95 ,$12.38 ,$61.64 ,$46.90 ,$26.42 ,$26.42 ,$40.80 ,$26.42 ,$46.30 ,$60.30 ,$46.67 ,$5.56 ,$52.93 ,$6.02 ,$6.60 ,$6.60 ,$5.50 ,$6.60 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100729,84376,HC SUGARS SINGLE (ACID HYDRO) QL,301,1 ,$69.00 ,$34.50 ,$5.50 ,$69.00 ,$5.68 ,$21.39 ,$18.33 ,$5.50 ,$41.40 ,$58.65 ,$48.30 ,$5.68 ,$65.55 ,$52.44 ,$51.75 ,$9.35 ,$58.65 ,$5.50 ,$9.35 ,$5.50 ,$48.30 ,$5.68 ,$5.50 ,$5.50 ,$6.22 ,$58.65 ,$12.38 ,$63.48 ,$48.30 ,$26.42 ,$26.42 ,$42.02 ,$26.42 ,$47.68 ,$62.10 ,$48.06 ,$5.56 ,$54.51 ,$6.02 ,$6.60 ,$6.60 ,$5.50 ,$6.60 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30100730,84315,HC SPEC GRAVITY NON UR,301,1 ,$16.00 ,$8.00 ,$3.28 ,$16.00 ,$3.39 ,$11.48 ,$9.84 ,$3.28 ,$9.60 ,$13.60 ,$11.20 ,$3.39 ,$15.20 ,$12.16 ,$12.00 ,$5.58 ,$13.60 ,$3.28 ,$5.58 ,$3.28 ,$11.20 ,$3.39 ,$3.28 ,$3.28 ,$3.71 ,$13.60 ,$7.38 ,$14.72 ,$11.20 ,$12.08 ,$12.08 ,$9.74 ,$12.08 ,$11.06 ,$14.40 ,$11.14 ,$3.31 ,$12.64 ,$3.59 ,$3.94 ,$3.94 ,$3.28 ,$3.94 ,$11.52 ,$9.92 ,$11.52 ,$11.52 ,$12.80 
ST NICHOLAS HOSPITAL - ACUTE,30100731,84392,HC SULFATE URINE,301,1 ,$36.00 ,$18.00 ,$5.49 ,$36.00 ,$5.67 ,$19.22 ,$16.47 ,$5.49 ,$21.60 ,$30.60 ,$25.20 ,$5.67 ,$34.20 ,$27.36 ,$27.00 ,$9.33 ,$30.60 ,$5.49 ,$9.33 ,$5.49 ,$25.20 ,$5.67 ,$5.49 ,$5.49 ,$6.21 ,$30.60 ,$12.35 ,$33.12 ,$25.20 ,$22.83 ,$22.83 ,$21.92 ,$22.83 ,$24.88 ,$32.40 ,$25.07 ,$5.54 ,$28.44 ,$6.01 ,$6.59 ,$6.59 ,$5.49 ,$6.59 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30100732,84402,HC TESTOSTERONE FREE,301,1 ,$190.00 ,$95.00 ,$25.47 ,$190.00 ,$26.32 ,$99.05 ,$84.90 ,$25.47 ,$114.00 ,$161.50 ,$133.00 ,$26.32 ,$180.50 ,$144.40 ,$142.50 ,$43.30 ,$161.50 ,$25.47 ,$43.30 ,$25.47 ,$133.00 ,$26.32 ,$25.47 ,$25.47 ,$28.83 ,$161.50 ,$57.31 ,$174.80 ,$133.00 ,$122.38 ,$122.38 ,$115.71 ,$122.38 ,$131.29 ,$171.00 ,$132.34 ,$25.72 ,$150.10 ,$27.90 ,$30.56 ,$30.56 ,$25.47 ,$30.56 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100733,84403,HC TESTOSTERONE TOTAL,301,1 ,$190.00 ,$95.00 ,$25.81 ,$190.00 ,$26.67 ,$100.38 ,$86.04 ,$25.81 ,$114.00 ,$161.50 ,$133.00 ,$26.67 ,$180.50 ,$144.40 ,$142.50 ,$43.88 ,$161.50 ,$25.81 ,$43.88 ,$25.81 ,$133.00 ,$26.67 ,$25.81 ,$25.81 ,$29.21 ,$161.50 ,$58.07 ,$174.80 ,$133.00 ,$121.14 ,$121.14 ,$115.71 ,$121.14 ,$131.29 ,$171.00 ,$132.34 ,$26.07 ,$150.10 ,$28.27 ,$30.97 ,$30.97 ,$25.81 ,$30.97 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100734,84402,HC TESTOSTERONE FREE ASSAY,301,1 ,$190.00 ,$95.00 ,$25.47 ,$190.00 ,$26.32 ,$99.05 ,$84.90 ,$25.47 ,$114.00 ,$161.50 ,$133.00 ,$26.32 ,$180.50 ,$144.40 ,$142.50 ,$43.30 ,$161.50 ,$25.47 ,$43.30 ,$25.47 ,$133.00 ,$26.32 ,$25.47 ,$25.47 ,$28.83 ,$161.50 ,$57.31 ,$174.80 ,$133.00 ,$122.38 ,$122.38 ,$115.71 ,$122.38 ,$131.29 ,$171.00 ,$132.34 ,$25.72 ,$150.10 ,$27.90 ,$30.56 ,$30.56 ,$25.47 ,$30.56 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100735,84425,HC VITAMIN B1,301,1 ,$134.00 ,$67.00 ,$21.23 ,$134.00 ,$21.94 ,$82.57 ,$70.77 ,$21.23 ,$80.40 ,$113.90 ,$93.80 ,$21.94 ,$127.30 ,$101.84 ,$100.50 ,$36.09 ,$113.90 ,$21.23 ,$36.09 ,$21.23 ,$93.80 ,$21.94 ,$21.23 ,$21.23 ,$24.03 ,$113.90 ,$47.77 ,$123.28 ,$93.80 ,$102.01 ,$102.01 ,$81.61 ,$102.01 ,$92.59 ,$120.60 ,$93.33 ,$21.44 ,$105.86 ,$23.26 ,$25.48 ,$25.48 ,$21.23 ,$25.48 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30100736,84425,HC VITAMIN B1 PLASMA,301,1 ,$221.00 ,$110.50 ,$21.23 ,$221.00 ,$21.94 ,$82.57 ,$70.77 ,$21.23 ,$132.60 ,$187.85 ,$154.70 ,$21.94 ,$209.95 ,$167.96 ,$165.75 ,$36.09 ,$187.85 ,$21.23 ,$36.09 ,$21.23 ,$154.70 ,$21.94 ,$21.23 ,$21.23 ,$24.03 ,$187.85 ,$47.77 ,$203.32 ,$154.70 ,$102.01 ,$102.01 ,$134.59 ,$102.01 ,$152.71 ,$198.90 ,$153.93 ,$21.44 ,$174.59 ,$23.26 ,$25.48 ,$25.48 ,$21.23 ,$25.48 ,$159.12 ,$137.02 ,$159.12 ,$159.12 ,$176.80 
ST NICHOLAS HOSPITAL - ACUTE,30100737,84432,HC THYROGLOBULIN,301,1 ,$123.00 ,$61.50 ,$16.06 ,$123.00 ,$16.59 ,$62.44 ,$53.52 ,$16.06 ,$73.80 ,$104.55 ,$86.10 ,$16.59 ,$116.85 ,$93.48 ,$92.25 ,$27.30 ,$104.55 ,$16.06 ,$27.30 ,$16.06 ,$86.10 ,$16.59 ,$16.06 ,$16.06 ,$18.18 ,$104.55 ,$36.14 ,$113.16 ,$86.10 ,$77.18 ,$77.18 ,$74.91 ,$77.18 ,$84.99 ,$110.70 ,$85.67 ,$16.22 ,$97.17 ,$17.59 ,$19.27 ,$19.27 ,$16.06 ,$19.27 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100738,84432,HC THYROGLOBULIN 2,301,1 ,$358.00 ,$179.00 ,$16.06 ,$358.00 ,$16.59 ,$62.44 ,$53.52 ,$16.06 ,$214.80 ,$304.30 ,$250.60 ,$16.59 ,$340.10 ,$272.08 ,$268.50 ,$27.30 ,$304.30 ,$16.06 ,$27.30 ,$16.06 ,$250.60 ,$16.59 ,$16.06 ,$16.06 ,$18.18 ,$304.30 ,$36.14 ,$329.36 ,$250.60 ,$77.18 ,$77.18 ,$218.02 ,$77.18 ,$247.38 ,$322.20 ,$249.35 ,$16.22 ,$282.82 ,$17.59 ,$19.27 ,$19.27 ,$16.06 ,$19.27 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,30100739,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$39.00 ,$19.50 ,$6.87 ,$39.00 ,$7.10 ,$26.71 ,$22.89 ,$6.87 ,$23.40 ,$33.15 ,$27.30 ,$7.10 ,$37.05 ,$29.64 ,$29.25 ,$11.68 ,$33.15 ,$6.87 ,$11.68 ,$6.87 ,$27.30 ,$7.10 ,$6.87 ,$6.87 ,$7.78 ,$33.15 ,$15.46 ,$35.88 ,$27.30 ,$33.01 ,$33.01 ,$23.75 ,$33.01 ,$26.95 ,$35.10 ,$27.16 ,$6.94 ,$30.81 ,$7.53 ,$8.24 ,$8.24 ,$6.87 ,$8.24 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100740,84439,HC T4 FREE,301,1 ,$67.00 ,$33.50 ,$9.02 ,$67.00 ,$9.32 ,$35.07 ,$30.06 ,$9.02 ,$40.20 ,$56.95 ,$46.90 ,$9.32 ,$63.65 ,$50.92 ,$50.25 ,$15.33 ,$56.95 ,$9.02 ,$15.33 ,$9.02 ,$46.90 ,$9.32 ,$9.02 ,$9.02 ,$10.21 ,$56.95 ,$20.30 ,$61.64 ,$46.90 ,$43.33 ,$43.33 ,$40.80 ,$43.33 ,$46.30 ,$60.30 ,$46.67 ,$9.11 ,$52.93 ,$9.88 ,$10.82 ,$10.82 ,$9.02 ,$10.82 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100741,84439,HC T4/T4 FREE,301,1 ,$123.00 ,$61.50 ,$9.02 ,$123.00 ,$9.32 ,$35.07 ,$30.06 ,$9.02 ,$73.80 ,$104.55 ,$86.10 ,$9.32 ,$116.85 ,$93.48 ,$92.25 ,$15.33 ,$104.55 ,$9.02 ,$15.33 ,$9.02 ,$86.10 ,$9.32 ,$9.02 ,$9.02 ,$10.21 ,$104.55 ,$20.30 ,$113.16 ,$86.10 ,$43.33 ,$43.33 ,$74.91 ,$43.33 ,$84.99 ,$110.70 ,$85.67 ,$9.11 ,$97.17 ,$9.88 ,$10.82 ,$10.82 ,$9.02 ,$10.82 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100742,84442,HC THYROXINE BIND GLOB,301,1 ,$81.00 ,$40.50 ,$14.78 ,$81.00 ,$15.27 ,$57.51 ,$49.29 ,$14.78 ,$48.60 ,$68.85 ,$56.70 ,$15.27 ,$76.95 ,$61.56 ,$60.75 ,$25.13 ,$68.85 ,$14.78 ,$25.13 ,$14.78 ,$56.70 ,$15.27 ,$14.78 ,$14.78 ,$16.73 ,$68.85 ,$33.26 ,$74.52 ,$56.70 ,$71.05 ,$71.05 ,$49.33 ,$71.05 ,$55.97 ,$72.90 ,$56.42 ,$14.93 ,$63.99 ,$16.19 ,$17.74 ,$17.74 ,$14.78 ,$17.74 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$64.80 
ST NICHOLAS HOSPITAL - ACUTE,30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$123.00 ,$61.50 ,$16.80 ,$123.00 ,$17.36 ,$65.35 ,$56.01 ,$16.80 ,$73.80 ,$104.55 ,$86.10 ,$17.36 ,$116.85 ,$93.48 ,$92.25 ,$28.56 ,$104.55 ,$16.80 ,$28.56 ,$16.80 ,$86.10 ,$17.36 ,$16.80 ,$16.80 ,$19.01 ,$104.55 ,$37.80 ,$113.16 ,$86.10 ,$80.77 ,$80.77 ,$74.91 ,$80.77 ,$84.99 ,$110.70 ,$85.67 ,$16.97 ,$97.17 ,$18.40 ,$20.16 ,$20.16 ,$16.80 ,$20.16 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100744,84445,HC THYROID STIM IMMUNO GLOB,301,1 ,$291.00 ,$145.50 ,$32.70 ,$291.00 ,$32.70 ,$197.79 ,$169.53 ,$50.86 ,$174.60 ,$247.35 ,$203.70 ,$32.70 ,$276.45 ,$221.16 ,$218.25 ,$86.46 ,$247.35 ,$50.86 ,$86.46 ,$50.86 ,$203.70 ,$32.70 ,$50.86 ,$50.86 ,$57.56 ,$247.35 ,$114.44 ,$267.72 ,$203.70 ,$111.77 ,$111.77 ,$177.22 ,$111.77 ,$201.08 ,$261.90 ,$202.68 ,$51.37 ,$229.89 ,$34.66 ,$61.03 ,$61.03 ,$50.86 ,$61.03 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30100745,84446,HC VITAMIN E,301,1 ,$112.00 ,$56.00 ,$14.18 ,$112.00 ,$14.65 ,$55.13 ,$47.25 ,$14.18 ,$67.20 ,$95.20 ,$78.40 ,$14.65 ,$106.40 ,$85.12 ,$84.00 ,$24.11 ,$95.20 ,$14.18 ,$24.11 ,$14.18 ,$78.40 ,$14.65 ,$14.18 ,$14.18 ,$16.05 ,$95.20 ,$31.91 ,$103.04 ,$78.40 ,$68.13 ,$68.13 ,$68.21 ,$68.13 ,$77.39 ,$100.80 ,$78.01 ,$14.32 ,$88.48 ,$15.53 ,$17.02 ,$17.02 ,$14.18 ,$17.02 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100746,84450,HC AST,301,1 ,$39.00 ,$19.50 ,$5.18 ,$39.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$23.40 ,$33.15 ,$27.30 ,$5.35 ,$37.05 ,$29.64 ,$29.25 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$5.18 ,$27.30 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$24.87 ,$24.87 ,$23.75 ,$24.87 ,$26.95 ,$35.10 ,$27.16 ,$5.23 ,$30.81 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100747,84460,HC ALT,301,1 ,$40.00 ,$20.00 ,$5.30 ,$40.00 ,$5.48 ,$20.62 ,$17.67 ,$5.30 ,$24.00 ,$34.00 ,$28.00 ,$5.48 ,$38.00 ,$30.40 ,$30.00 ,$9.01 ,$34.00 ,$5.30 ,$9.01 ,$5.30 ,$28.00 ,$5.48 ,$5.30 ,$5.30 ,$6.00 ,$34.00 ,$11.93 ,$36.80 ,$28.00 ,$25.43 ,$25.43 ,$24.36 ,$25.43 ,$27.64 ,$36.00 ,$27.86 ,$5.35 ,$31.60 ,$5.81 ,$6.36 ,$6.36 ,$5.30 ,$6.36 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30100748,84466,HC TRANSFERRIN,301,1 ,$54.00 ,$27.00 ,$12.76 ,$54.00 ,$13.18 ,$49.63 ,$42.54 ,$12.76 ,$32.40 ,$45.90 ,$37.80 ,$13.18 ,$51.30 ,$41.04 ,$40.50 ,$21.69 ,$45.90 ,$12.76 ,$21.69 ,$12.76 ,$37.80 ,$13.18 ,$12.76 ,$12.76 ,$14.44 ,$45.90 ,$28.71 ,$49.68 ,$37.80 ,$54.00 ,$54.00 ,$32.89 ,$54.00 ,$37.31 ,$48.60 ,$37.61 ,$12.89 ,$42.66 ,$13.97 ,$15.31 ,$15.31 ,$12.76 ,$15.31 ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$43.20 
ST NICHOLAS HOSPITAL - ACUTE,30100749,84466,HC TRANSFERRIN SERUM/IRON,301,1 ,$112.00 ,$56.00 ,$12.76 ,$112.00 ,$13.18 ,$49.63 ,$42.54 ,$12.76 ,$67.20 ,$95.20 ,$78.40 ,$13.18 ,$106.40 ,$85.12 ,$84.00 ,$21.69 ,$95.20 ,$12.76 ,$21.69 ,$12.76 ,$78.40 ,$13.18 ,$12.76 ,$12.76 ,$14.44 ,$95.20 ,$28.71 ,$103.04 ,$78.40 ,$61.36 ,$61.36 ,$68.21 ,$61.36 ,$77.39 ,$100.80 ,$78.01 ,$12.89 ,$88.48 ,$13.97 ,$15.31 ,$15.31 ,$12.76 ,$15.31 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100750,84478,HC TRIGLYCERIDES,301,1 ,$44.00 ,$22.00 ,$5.74 ,$44.00 ,$5.93 ,$22.33 ,$19.14 ,$5.74 ,$26.40 ,$37.40 ,$30.80 ,$5.93 ,$41.80 ,$33.44 ,$33.00 ,$9.76 ,$37.40 ,$5.74 ,$9.76 ,$5.74 ,$30.80 ,$5.93 ,$5.74 ,$5.74 ,$6.50 ,$37.40 ,$12.92 ,$40.48 ,$30.80 ,$27.62 ,$27.62 ,$26.80 ,$27.62 ,$30.40 ,$39.60 ,$30.65 ,$5.80 ,$34.76 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$35.20 
ST NICHOLAS HOSPITAL - ACUTE,30100751,84478,HC TRIGLYCERIDES (VAP),301,1 ,$44.00 ,$22.00 ,$5.74 ,$44.00 ,$5.93 ,$22.33 ,$19.14 ,$5.74 ,$26.40 ,$37.40 ,$30.80 ,$5.93 ,$41.80 ,$33.44 ,$33.00 ,$9.76 ,$37.40 ,$5.74 ,$9.76 ,$5.74 ,$30.80 ,$5.93 ,$5.74 ,$5.74 ,$6.50 ,$37.40 ,$12.92 ,$40.48 ,$30.80 ,$27.62 ,$27.62 ,$26.80 ,$27.62 ,$30.40 ,$39.60 ,$30.65 ,$5.80 ,$34.76 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$35.20 
ST NICHOLAS HOSPITAL - ACUTE,30100752,84478,HC TRICGLYCERIDES BODY FLUID,301,1 ,$44.00 ,$22.00 ,$5.74 ,$44.00 ,$5.93 ,$22.33 ,$19.14 ,$5.74 ,$26.40 ,$37.40 ,$30.80 ,$5.93 ,$41.80 ,$33.44 ,$33.00 ,$9.76 ,$37.40 ,$5.74 ,$9.76 ,$5.74 ,$30.80 ,$5.93 ,$5.74 ,$5.74 ,$6.50 ,$37.40 ,$12.92 ,$40.48 ,$30.80 ,$27.62 ,$27.62 ,$26.80 ,$27.62 ,$30.40 ,$39.60 ,$30.65 ,$5.80 ,$34.76 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$35.20 
ST NICHOLAS HOSPITAL - ACUTE,30100753,84479,HC T3 UPTAKE,301,1 ,$67.00 ,$33.50 ,$6.47 ,$67.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$40.20 ,$56.95 ,$46.90 ,$6.69 ,$63.65 ,$50.92 ,$50.25 ,$11.00 ,$56.95 ,$6.47 ,$11.00 ,$6.47 ,$46.90 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$56.95 ,$14.56 ,$61.64 ,$46.90 ,$31.10 ,$31.10 ,$40.80 ,$31.10 ,$46.30 ,$60.30 ,$46.67 ,$6.53 ,$52.93 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100754,84480,HC T3 TOTAL,301,1 ,$112.00 ,$56.00 ,$14.18 ,$112.00 ,$14.65 ,$55.13 ,$47.25 ,$14.18 ,$67.20 ,$95.20 ,$78.40 ,$14.65 ,$106.40 ,$85.12 ,$84.00 ,$24.11 ,$95.20 ,$14.18 ,$24.11 ,$14.18 ,$78.40 ,$14.65 ,$14.18 ,$14.18 ,$16.05 ,$95.20 ,$31.91 ,$103.04 ,$78.40 ,$68.13 ,$68.13 ,$68.21 ,$68.13 ,$77.39 ,$100.80 ,$78.01 ,$14.32 ,$88.48 ,$15.53 ,$17.02 ,$17.02 ,$14.18 ,$17.02 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100755,84481,HC T3 FREE,301,1 ,$90.00 ,$45.00 ,$16.62 ,$90.00 ,$16.62 ,$65.87 ,$56.46 ,$16.94 ,$54.00 ,$76.50 ,$63.00 ,$16.62 ,$85.50 ,$68.40 ,$67.50 ,$28.80 ,$76.50 ,$16.94 ,$28.80 ,$16.94 ,$63.00 ,$16.62 ,$16.94 ,$16.94 ,$19.17 ,$76.50 ,$38.12 ,$82.80 ,$63.00 ,$56.78 ,$56.78 ,$54.81 ,$56.78 ,$62.19 ,$81.00 ,$62.69 ,$17.11 ,$71.10 ,$17.62 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100756,84481,HC TRIIODOTHYRONINE T3 FREE,301,1 ,$178.00 ,$89.00 ,$16.62 ,$178.00 ,$16.62 ,$65.87 ,$56.46 ,$16.94 ,$106.80 ,$151.30 ,$124.60 ,$16.62 ,$169.10 ,$135.28 ,$133.50 ,$28.80 ,$151.30 ,$16.94 ,$28.80 ,$16.94 ,$124.60 ,$16.62 ,$16.94 ,$16.94 ,$19.17 ,$151.30 ,$38.12 ,$163.76 ,$124.60 ,$56.78 ,$56.78 ,$108.40 ,$56.78 ,$123.00 ,$160.20 ,$123.98 ,$17.11 ,$140.62 ,$17.62 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$128.16 ,$110.36 ,$128.16 ,$128.16 ,$142.40 
ST NICHOLAS HOSPITAL - ACUTE,30100757,84482,HC T3 REVERSE,301,1 ,$67.00 ,$33.50 ,$10.82 ,$67.00 ,$10.82 ,$61.29 ,$52.53 ,$15.76 ,$40.20 ,$56.95 ,$46.90 ,$10.82 ,$63.65 ,$50.92 ,$50.25 ,$26.79 ,$56.95 ,$15.76 ,$26.79 ,$15.76 ,$46.90 ,$10.82 ,$15.76 ,$15.76 ,$17.84 ,$56.95 ,$35.46 ,$61.64 ,$46.90 ,$36.99 ,$36.99 ,$40.80 ,$36.99 ,$46.30 ,$60.30 ,$46.67 ,$15.92 ,$52.93 ,$11.47 ,$18.91 ,$18.91 ,$15.76 ,$18.91 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100758,84484,HC TROPONIN QN,301,1 ,$101.00 ,$50.50 ,$12.47 ,$101.00 ,$12.89 ,$43.65 ,$37.41 ,$12.47 ,$60.60 ,$85.85 ,$70.70 ,$12.89 ,$95.95 ,$76.76 ,$75.75 ,$21.20 ,$85.85 ,$12.47 ,$21.20 ,$12.47 ,$70.70 ,$12.89 ,$12.47 ,$12.47 ,$14.11 ,$85.85 ,$28.06 ,$92.92 ,$70.70 ,$47.27 ,$47.27 ,$61.51 ,$47.27 ,$69.79 ,$90.90 ,$70.35 ,$12.59 ,$79.79 ,$13.66 ,$14.96 ,$14.96 ,$12.47 ,$14.96 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100759,84488,HC TRYPSIN FECES QL,301,1 ,$93.00 ,$46.50 ,$7.30 ,$93.00 ,$7.54 ,$28.39 ,$24.33 ,$7.30 ,$55.80 ,$79.05 ,$65.10 ,$7.54 ,$88.35 ,$70.68 ,$69.75 ,$12.41 ,$79.05 ,$7.30 ,$12.41 ,$7.30 ,$65.10 ,$7.54 ,$7.30 ,$7.30 ,$8.26 ,$79.05 ,$16.43 ,$85.56 ,$65.10 ,$35.09 ,$35.09 ,$56.64 ,$35.09 ,$64.26 ,$83.70 ,$64.77 ,$7.37 ,$73.47 ,$7.99 ,$8.76 ,$8.76 ,$7.30 ,$8.76 ,$66.96 ,$57.66 ,$66.96 ,$66.96 ,$74.40 
ST NICHOLAS HOSPITAL - ACUTE,30100761,84520,HC BUN,301,1 ,$30.00 ,$15.00 ,$3.95 ,$30.00 ,$4.08 ,$15.37 ,$13.17 ,$3.95 ,$18.00 ,$25.50 ,$21.00 ,$4.08 ,$28.50 ,$22.80 ,$22.50 ,$6.72 ,$25.50 ,$3.95 ,$6.72 ,$3.95 ,$21.00 ,$4.08 ,$3.95 ,$3.95 ,$4.47 ,$25.50 ,$8.89 ,$27.60 ,$21.00 ,$18.99 ,$18.99 ,$18.27 ,$18.99 ,$20.73 ,$27.00 ,$20.90 ,$3.99 ,$23.70 ,$4.32 ,$4.74 ,$4.74 ,$3.95 ,$4.74 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,30100762,84520,HC BUN BODY FLUID,301,1 ,$38.00 ,$19.00 ,$3.95 ,$38.00 ,$4.08 ,$15.37 ,$13.17 ,$3.95 ,$22.80 ,$32.30 ,$26.60 ,$4.08 ,$36.10 ,$28.88 ,$28.50 ,$6.72 ,$32.30 ,$3.95 ,$6.72 ,$3.95 ,$26.60 ,$4.08 ,$3.95 ,$3.95 ,$4.47 ,$32.30 ,$8.89 ,$34.96 ,$26.60 ,$18.99 ,$18.99 ,$23.14 ,$18.99 ,$26.26 ,$34.20 ,$26.47 ,$3.99 ,$30.02 ,$4.32 ,$4.74 ,$4.74 ,$3.95 ,$4.74 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100763,84520,HC BUN ISTAT,301,1 ,$38.00 ,$19.00 ,$3.95 ,$38.00 ,$4.08 ,$15.37 ,$13.17 ,$3.95 ,$22.80 ,$32.30 ,$26.60 ,$4.08 ,$36.10 ,$28.88 ,$28.50 ,$6.72 ,$32.30 ,$3.95 ,$6.72 ,$3.95 ,$26.60 ,$4.08 ,$3.95 ,$3.95 ,$4.47 ,$32.30 ,$8.89 ,$34.96 ,$26.60 ,$18.99 ,$18.99 ,$23.14 ,$18.99 ,$26.26 ,$34.20 ,$26.47 ,$3.99 ,$30.02 ,$4.32 ,$4.74 ,$4.74 ,$3.95 ,$4.74 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100764,84540,HC UREA URINE,301,1 ,$67.00 ,$33.50 ,$5.56 ,$67.00 ,$5.75 ,$19.46 ,$16.68 ,$5.56 ,$40.20 ,$56.95 ,$46.90 ,$5.75 ,$63.65 ,$50.92 ,$50.25 ,$9.45 ,$56.95 ,$5.56 ,$9.45 ,$5.56 ,$46.90 ,$5.75 ,$5.56 ,$5.56 ,$6.29 ,$56.95 ,$12.51 ,$61.64 ,$46.90 ,$22.83 ,$22.83 ,$40.80 ,$22.83 ,$46.30 ,$60.30 ,$46.67 ,$5.62 ,$52.93 ,$6.10 ,$6.67 ,$6.67 ,$5.56 ,$6.67 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100765,84550,HC URIC ACID,301,1 ,$38.00 ,$19.00 ,$4.52 ,$38.00 ,$4.67 ,$17.57 ,$15.06 ,$4.52 ,$22.80 ,$32.30 ,$26.60 ,$4.67 ,$36.10 ,$28.88 ,$28.50 ,$7.68 ,$32.30 ,$4.52 ,$7.68 ,$4.52 ,$26.60 ,$4.67 ,$4.52 ,$4.52 ,$5.12 ,$32.30 ,$10.17 ,$34.96 ,$26.60 ,$21.70 ,$21.70 ,$23.14 ,$21.70 ,$26.26 ,$34.20 ,$26.47 ,$4.57 ,$30.02 ,$4.95 ,$5.42 ,$5.42 ,$4.52 ,$5.42 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100766,84560,HC URIC ACID OTH SRC,301,1 ,$36.00 ,$18.00 ,$5.08 ,$36.00 ,$5.25 ,$18.45 ,$15.81 ,$5.08 ,$21.60 ,$30.60 ,$25.20 ,$5.25 ,$34.20 ,$27.36 ,$27.00 ,$8.64 ,$30.60 ,$5.08 ,$8.64 ,$5.08 ,$25.20 ,$5.25 ,$5.08 ,$5.08 ,$5.75 ,$30.60 ,$11.43 ,$33.12 ,$25.20 ,$22.83 ,$22.83 ,$21.92 ,$22.83 ,$24.88 ,$32.40 ,$25.07 ,$5.13 ,$28.44 ,$5.57 ,$6.10 ,$6.10 ,$5.08 ,$6.10 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30100767,84578,HC UROBILINOGEN,301,1 ,$25.00 ,$12.50 ,$4.47 ,$25.00 ,$4.58 ,$15.65 ,$13.41 ,$4.47 ,$15.00 ,$21.25 ,$17.50 ,$4.58 ,$23.75 ,$19.00 ,$18.75 ,$7.60 ,$21.25 ,$4.47 ,$7.60 ,$4.47 ,$17.50 ,$4.58 ,$4.47 ,$4.47 ,$5.06 ,$21.25 ,$10.06 ,$23.00 ,$17.50 ,$15.61 ,$15.61 ,$15.23 ,$15.61 ,$17.28 ,$22.50 ,$17.41 ,$4.51 ,$19.75 ,$4.85 ,$5.36 ,$5.36 ,$4.47 ,$5.36 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30100768,84585,HC VANILLYLMAND AC (VMA),301,1 ,$112.00 ,$56.00 ,$15.50 ,$112.00 ,$16.02 ,$60.27 ,$51.66 ,$15.50 ,$67.20 ,$95.20 ,$78.40 ,$16.02 ,$106.40 ,$85.12 ,$84.00 ,$26.35 ,$95.20 ,$15.50 ,$26.35 ,$15.50 ,$78.40 ,$16.02 ,$15.50 ,$15.50 ,$17.54 ,$95.20 ,$34.88 ,$103.04 ,$78.40 ,$74.47 ,$74.47 ,$68.21 ,$74.47 ,$77.39 ,$100.80 ,$78.01 ,$15.66 ,$88.48 ,$16.98 ,$18.60 ,$18.60 ,$15.50 ,$18.60 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100769,84586,HC VASOACTIVE INTEST PEPTIDE,301,1 ,$190.00 ,$95.00 ,$17.93 ,$190.00 ,$17.93 ,$137.41 ,$117.78 ,$35.33 ,$114.00 ,$161.50 ,$133.00 ,$17.93 ,$180.50 ,$144.40 ,$142.50 ,$60.06 ,$161.50 ,$35.33 ,$60.06 ,$35.33 ,$133.00 ,$17.93 ,$35.33 ,$35.33 ,$39.99 ,$161.50 ,$79.49 ,$174.80 ,$133.00 ,$61.26 ,$61.26 ,$115.71 ,$61.26 ,$131.29 ,$171.00 ,$132.34 ,$35.68 ,$150.10 ,$19.01 ,$42.40 ,$42.40 ,$35.33 ,$42.40 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30100770,84588,HC VASOPRESSIN (ADH),301,1 ,$258.00 ,$129.00 ,$33.94 ,$258.00 ,$35.07 ,$131.99 ,$113.13 ,$33.94 ,$154.80 ,$219.30 ,$180.60 ,$35.07 ,$245.10 ,$196.08 ,$193.50 ,$57.70 ,$219.30 ,$33.94 ,$57.70 ,$33.94 ,$180.60 ,$35.07 ,$33.94 ,$33.94 ,$38.41 ,$219.30 ,$76.37 ,$237.36 ,$180.60 ,$163.13 ,$163.13 ,$157.12 ,$163.13 ,$178.28 ,$232.20 ,$179.70 ,$34.28 ,$203.82 ,$37.17 ,$40.73 ,$40.73 ,$33.94 ,$40.73 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,30100771,84590,HC VITAMIN A,301,1 ,$90.00 ,$45.00 ,$11.61 ,$90.00 ,$12.00 ,$45.15 ,$38.70 ,$11.61 ,$54.00 ,$76.50 ,$63.00 ,$12.00 ,$85.50 ,$68.40 ,$67.50 ,$19.74 ,$76.50 ,$11.61 ,$19.74 ,$11.61 ,$63.00 ,$12.00 ,$11.61 ,$11.61 ,$13.14 ,$76.50 ,$26.12 ,$82.80 ,$63.00 ,$55.76 ,$55.76 ,$54.81 ,$55.76 ,$62.19 ,$81.00 ,$62.69 ,$11.73 ,$71.10 ,$12.72 ,$13.93 ,$13.93 ,$11.61 ,$13.93 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100772,84597,HC VITAMIN K,301,1 ,$392.00 ,$196.00 ,$13.72 ,$392.00 ,$14.18 ,$53.34 ,$45.72 ,$13.72 ,$235.20 ,$333.20 ,$274.40 ,$14.18 ,$372.40 ,$297.92 ,$294.00 ,$23.32 ,$333.20 ,$13.72 ,$23.32 ,$13.72 ,$274.40 ,$14.18 ,$13.72 ,$13.72 ,$15.53 ,$333.20 ,$30.87 ,$360.64 ,$274.40 ,$65.91 ,$65.91 ,$238.73 ,$65.91 ,$270.87 ,$352.80 ,$273.03 ,$13.86 ,$309.68 ,$15.03 ,$16.46 ,$16.46 ,$13.72 ,$16.46 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,30100773,80320,HC VOLATILES,301,1 ,$250.00 ,$125.00 ,$3.81 ,$250.00 ,$3.81 ,$80.88 ,$69.32 , N/A ,$150.00 ,$212.50 ,$175.00 ,$3.81 ,$237.50 ,$190.00 ,$187.50 ,$38.56 ,$212.50 , N/A ,$38.56 ,$22.95 ,$175.00 ,$3.81 , N/A , N/A ,$105.00 ,$212.50 , N/A ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$174.13 , N/A ,$197.50 ,$4.04 , N/A , N/A , N/A , N/A ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,30100774,G0480,HC VOLATILES (STAT),301,1 ,$247.00 ,$123.50 ,$63.95 ,$257.47 ,$63.95 ,$247.00 ,$247.00 ,$114.43 ,$148.20 ,$209.95 ,$172.90 ,$63.95 ,$234.65 ,$187.72 ,$185.25 ,$194.53 ,$209.95 ,$114.43 ,$194.53 ,$114.43 ,$172.90 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$209.95 ,$257.47 ,$227.24 ,$172.90 ,$247.00 ,$247.00 ,$150.42 ,$247.00 ,$170.68 ,$222.30 ,$172.04 ,$115.57 ,$195.13 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$177.84 ,$153.14 ,$177.84 ,$177.84 ,$197.60 
ST NICHOLAS HOSPITAL - ACUTE,30100775,84166,HC ELECTRPHRTC FRAC/QUNT,301,1 ,$55.00 ,$27.50 ,$17.83 ,$55.00 ,$18.42 ,$55.00 ,$55.00 ,$17.83 ,$33.00 ,$46.75 ,$38.50 ,$18.42 ,$52.25 ,$41.80 ,$41.25 ,$30.31 ,$46.75 ,$17.83 ,$30.31 ,$17.83 ,$38.50 ,$18.42 ,$17.83 ,$17.83 ,$20.18 ,$46.75 ,$40.12 ,$50.60 ,$38.50 ,$55.00 ,$55.00 ,$33.50 ,$55.00 ,$38.01 ,$49.50 ,$38.31 ,$18.01 ,$43.45 ,$19.53 ,$21.40 ,$21.40 ,$17.83 ,$21.40 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,30100776,84630,HC ZINC,301,1 ,$78.00 ,$39.00 ,$11.39 ,$78.00 ,$11.77 ,$44.28 ,$37.95 ,$11.39 ,$46.80 ,$66.30 ,$54.60 ,$11.77 ,$74.10 ,$59.28 ,$58.50 ,$19.36 ,$66.30 ,$11.39 ,$19.36 ,$11.39 ,$54.60 ,$11.77 ,$11.39 ,$11.39 ,$12.89 ,$66.30 ,$25.63 ,$71.76 ,$54.60 ,$49.81 ,$49.81 ,$47.50 ,$49.81 ,$53.90 ,$70.20 ,$54.33 ,$11.50 ,$61.62 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30100777,84630,HC ZINC (MAYO),301,1 ,$170.00 ,$85.00 ,$11.39 ,$170.00 ,$11.77 ,$44.28 ,$37.95 ,$11.39 ,$102.00 ,$144.50 ,$119.00 ,$11.77 ,$161.50 ,$129.20 ,$127.50 ,$19.36 ,$144.50 ,$11.39 ,$19.36 ,$11.39 ,$119.00 ,$11.77 ,$11.39 ,$11.39 ,$12.89 ,$144.50 ,$25.63 ,$156.40 ,$119.00 ,$49.81 ,$49.81 ,$103.53 ,$49.81 ,$117.47 ,$153.00 ,$118.41 ,$11.50 ,$134.30 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,30100778,84630,HC ZINC PLASMA,301,1 ,$34.00 ,$17.00 ,$11.39 ,$34.00 ,$11.77 ,$34.00 ,$34.00 ,$11.39 ,$20.40 ,$28.90 ,$23.80 ,$11.77 ,$32.30 ,$25.84 ,$25.50 ,$19.36 ,$28.90 ,$11.39 ,$19.36 ,$11.39 ,$23.80 ,$11.77 ,$11.39 ,$11.39 ,$12.89 ,$28.90 ,$25.63 ,$31.28 ,$23.80 ,$34.00 ,$34.00 ,$20.71 ,$34.00 ,$23.49 ,$30.60 ,$23.68 ,$11.50 ,$26.86 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$24.48 ,$21.08 ,$24.48 ,$24.48 ,$27.20 
ST NICHOLAS HOSPITAL - ACUTE,30100780,82465,HC CHOLESTEROL (LMP),301,1 ,$87.00 ,$43.50 ,$4.35 ,$87.00 ,$4.49 ,$16.94 ,$14.52 ,$4.35 ,$52.20 ,$73.95 ,$60.90 ,$4.49 ,$82.65 ,$66.12 ,$65.25 ,$7.40 ,$73.95 ,$4.35 ,$7.40 ,$4.35 ,$60.90 ,$4.49 ,$4.35 ,$4.35 ,$4.92 ,$73.95 ,$9.79 ,$80.04 ,$60.90 ,$20.89 ,$20.89 ,$52.98 ,$20.89 ,$60.12 ,$78.30 ,$60.60 ,$4.39 ,$68.73 ,$4.76 ,$5.22 ,$5.22 ,$4.35 ,$5.22 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,30100781,82542,HC ZIPRASIDONE,301,1 ,$129.00 ,$64.50 ,$24.09 ,$129.00 ,$24.89 ,$84.32 ,$72.27 ,$24.09 ,$77.40 ,$109.65 ,$90.30 ,$24.89 ,$122.55 ,$98.04 ,$96.75 ,$40.95 ,$109.65 ,$24.09 ,$40.95 ,$24.09 ,$90.30 ,$24.89 ,$24.09 ,$24.09 ,$27.27 ,$109.65 ,$54.20 ,$118.68 ,$90.30 ,$86.76 ,$86.76 ,$78.56 ,$86.76 ,$89.14 ,$116.10 ,$89.85 ,$24.33 ,$101.91 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,30100782,82664,HC CHOLESTEROL (LMP LPA),301,1 ,$224.00 ,$112.00 ,$48.31 ,$224.00 ,$48.31 ,$215.25 ,$184.50 ,$61.50 ,$134.40 ,$190.40 ,$156.80 ,$48.31 ,$212.80 ,$170.24 ,$168.00 ,$104.55 ,$190.40 ,$61.50 ,$104.55 ,$61.50 ,$156.80 ,$48.31 ,$61.50 ,$61.50 ,$69.61 ,$190.40 ,$138.38 ,$206.08 ,$156.80 ,$165.10 ,$165.10 ,$136.42 ,$165.10 ,$154.78 ,$201.60 ,$156.02 ,$62.12 ,$176.96 ,$51.21 ,$73.80 ,$73.80 ,$61.50 ,$73.80 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30100800,84478,HC TRIGLYCERIDES (LMP),301,1 ,$100.00 ,$50.00 ,$5.74 ,$100.00 ,$5.93 ,$22.33 ,$19.14 ,$5.74 ,$60.00 ,$85.00 ,$70.00 ,$5.93 ,$95.00 ,$76.00 ,$75.00 ,$9.76 ,$85.00 ,$5.74 ,$9.76 ,$5.74 ,$70.00 ,$5.93 ,$5.74 ,$5.74 ,$6.50 ,$85.00 ,$12.92 ,$92.00 ,$70.00 ,$27.62 ,$27.62 ,$60.90 ,$27.62 ,$69.10 ,$90.00 ,$69.65 ,$5.80 ,$79.00 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100801,84681,HC C PEPTIDE,301,1 ,$101.00 ,$50.50 ,$7.34 ,$101.00 ,$7.34 ,$80.96 ,$69.39 ,$20.81 ,$60.60 ,$85.85 ,$70.70 ,$7.34 ,$95.95 ,$76.76 ,$75.75 ,$35.38 ,$85.85 ,$20.81 ,$35.38 ,$20.81 ,$70.70 ,$7.34 ,$20.81 ,$20.81 ,$23.55 ,$85.85 ,$46.82 ,$92.92 ,$70.70 ,$25.08 ,$25.08 ,$61.51 ,$25.08 ,$69.79 ,$90.90 ,$70.35 ,$21.02 ,$79.79 ,$7.78 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100802,84702,HC HCG QN,301,1 ,$112.00 ,$56.00 ,$15.05 ,$112.00 ,$15.55 ,$58.56 ,$50.19 ,$15.05 ,$67.20 ,$95.20 ,$78.40 ,$15.55 ,$106.40 ,$85.12 ,$84.00 ,$25.59 ,$95.20 ,$15.05 ,$25.59 ,$15.05 ,$78.40 ,$15.55 ,$15.05 ,$15.05 ,$17.03 ,$95.20 ,$33.86 ,$103.04 ,$78.40 ,$72.35 ,$72.35 ,$68.21 ,$72.35 ,$77.39 ,$100.80 ,$78.01 ,$15.20 ,$88.48 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100803,84702,HC HCG QN (SUBUNIT),301,1 ,$20.00 ,$10.00 ,$10.00 ,$33.86 ,$15.55 ,$20.00 ,$20.00 ,$15.05 ,$12.00 ,$17.00 ,$14.00 ,$15.55 ,$19.00 ,$15.20 ,$15.00 ,$20.00 ,$17.00 ,$15.05 ,$20.00 ,$15.05 ,$14.00 ,$15.55 ,$15.05 ,$15.05 ,$17.03 ,$17.00 ,$33.86 ,$18.40 ,$14.00 ,$20.00 ,$20.00 ,$12.18 ,$20.00 ,$13.82 ,$18.00 ,$13.93 ,$15.20 ,$15.80 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$14.40 ,$12.40 ,$14.40 ,$14.40 ,$16.00 
ST NICHOLAS HOSPITAL - ACUTE,30100807,84702,HC HCG QN (BETA SUBUNIT),301,1 ,$40.00 ,$20.00 ,$15.05 ,$40.00 ,$15.55 ,$40.00 ,$40.00 ,$15.05 ,$24.00 ,$34.00 ,$28.00 ,$15.55 ,$38.00 ,$30.40 ,$30.00 ,$25.59 ,$34.00 ,$15.05 ,$25.59 ,$15.05 ,$28.00 ,$15.55 ,$15.05 ,$15.05 ,$17.03 ,$34.00 ,$33.86 ,$36.80 ,$28.00 ,$40.00 ,$40.00 ,$24.36 ,$40.00 ,$27.64 ,$36.00 ,$27.86 ,$15.20 ,$31.60 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30100808,84703,HC HCG QL,301,1 ,$67.00 ,$33.50 ,$7.52 ,$67.00 ,$7.77 ,$29.26 ,$25.08 ,$7.52 ,$40.20 ,$56.95 ,$46.90 ,$7.77 ,$63.65 ,$50.92 ,$50.25 ,$12.78 ,$56.95 ,$7.52 ,$12.78 ,$7.52 ,$46.90 ,$7.77 ,$7.52 ,$7.52 ,$8.51 ,$56.95 ,$16.92 ,$61.64 ,$46.90 ,$36.14 ,$36.14 ,$40.80 ,$36.14 ,$46.30 ,$60.30 ,$46.67 ,$7.60 ,$52.93 ,$8.24 ,$9.02 ,$9.02 ,$7.52 ,$9.02 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100809,84999,HC CHEMISTRY UNLISTED,301,1 ,$19.00 ,$9.50 ,$3.81 ,$19.00 ,$3.81 ,$12.29 ,$12.29 , N/A ,$11.40 ,$16.15 ,$13.30 ,$3.81 ,$18.05 ,$14.44 ,$14.25 , N/A ,$16.15 , N/A , N/A , N/A ,$13.30 ,$3.81 , N/A , N/A ,$7.98 ,$16.15 ,$11.40 ,$17.48 ,$13.30 ,$9.64 ,$11.57 ,$11.57 ,$11.57 ,$13.13 ,$17.10 ,$13.23 , N/A ,$15.01 ,$4.04 ,$9.50 ,$9.50 , N/A ,$9.50 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$15.20 
ST NICHOLAS HOSPITAL - ACUTE,30100810,88720,HC BILICHECK TEST,301,1 ,$38.00 ,$19.00 ,$3.63 ,$38.00 ,$3.63 ,$19.50 ,$16.71 ,$5.02 ,$22.80 ,$32.30 ,$26.60 ,$3.63 ,$36.10 ,$28.88 ,$28.50 ,$8.53 ,$32.30 ,$5.02 ,$8.53 ,$5.02 ,$26.60 ,$3.63 ,$5.02 ,$5.02 ,$5.68 ,$32.30 ,$11.30 ,$34.96 ,$26.60 ,$24.09 ,$24.09 ,$23.14 ,$24.09 ,$26.26 ,$34.20 ,$26.47 ,$5.07 ,$30.02 ,$3.85 ,$6.02 ,$6.02 ,$5.02 ,$6.02 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30100813,G0103,HC PSA ANNUAL SCREENING,301,1 ,$146.00 ,$73.00 ,$19.31 ,$146.00 ,$19.95 ,$71.54 ,$61.32 ,$19.31 ,$87.60 ,$124.10 ,$102.20 ,$19.95 ,$138.70 ,$110.96 ,$109.50 ,$32.83 ,$124.10 ,$19.31 ,$32.83 ,$19.31 ,$102.20 ,$19.95 ,$19.31 ,$19.31 ,$21.86 ,$124.10 ,$43.45 ,$134.32 ,$102.20 ,$88.38 ,$88.38 ,$88.91 ,$88.38 ,$100.89 ,$131.40 ,$101.69 ,$19.50 ,$115.34 ,$21.15 ,$23.17 ,$23.17 ,$19.31 ,$23.17 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30100815,G0123,HC PAP SMEAR THIN PREP SCREEN,311,1 ,$151.00 ,$75.50 ,$20.26 ,$151.00 ,$20.93 ,$78.79 ,$67.53 ,$20.26 ,$90.60 ,$128.35 ,$105.70 ,$20.93 ,$143.45 ,$114.76 ,$113.25 ,$34.44 ,$128.35 ,$20.26 ,$34.44 ,$20.26 ,$105.70 ,$20.93 ,$20.26 ,$20.26 ,$22.93 ,$128.35 ,$45.59 ,$138.92 ,$105.70 ,$97.36 ,$97.36 ,$91.96 ,$97.36 ,$104.34 ,$135.90 ,$105.17 ,$20.46 ,$119.29 ,$22.19 ,$24.31 ,$24.31 ,$20.26 ,$24.31 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$120.80 
ST NICHOLAS HOSPITAL - ACUTE,30100818,84182,HC PROTEIN WEST BLOT BAND ID,301,1 ,$450.00 ,$225.00 ,$25.31 ,$450.00 ,$25.31 ,$102.24 ,$87.63 ,$29.21 ,$270.00 ,$382.50 ,$315.00 ,$25.31 ,$427.50 ,$342.00 ,$337.50 ,$49.66 ,$382.50 ,$29.21 ,$49.66 ,$29.21 ,$315.00 ,$25.31 ,$29.21 ,$29.21 ,$33.06 ,$382.50 ,$65.72 ,$414.00 ,$315.00 ,$86.48 ,$86.48 ,$274.05 ,$86.48 ,$310.95 ,$405.00 ,$313.43 ,$29.50 ,$355.50 ,$26.83 ,$35.05 ,$35.05 ,$29.21 ,$35.05 ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,30100820,83664,HC LAMELLAR BODY CT,301,1 ,$164.00 ,$82.00 ,$6.82 ,$164.00 ,$6.82 ,$73.54 ,$63.03 ,$19.32 ,$98.40 ,$139.40 ,$114.80 ,$6.82 ,$155.80 ,$124.64 ,$123.00 ,$32.84 ,$139.40 ,$19.32 ,$32.84 ,$19.32 ,$114.80 ,$6.82 ,$19.32 ,$19.32 ,$21.87 ,$139.40 ,$43.47 ,$150.88 ,$114.80 ,$90.92 ,$90.92 ,$99.88 ,$90.92 ,$113.32 ,$147.60 ,$114.23 ,$19.51 ,$129.56 ,$7.23 ,$23.18 ,$23.18 ,$19.32 ,$23.18 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30100821,80159,HC CLOZAPINE,301,1 ,$100.00 ,$50.00 ,$20.15 ,$100.00 ,$20.18 ,$71.93 ,$61.65 ,$20.15 ,$60.00 ,$85.00 ,$70.00 ,$20.18 ,$95.00 ,$76.00 ,$75.00 ,$34.26 ,$85.00 ,$20.15 ,$34.26 ,$20.15 ,$70.00 ,$20.18 ,$20.15 ,$20.15 ,$22.81 ,$85.00 ,$45.34 ,$92.00 ,$70.00 ,$88.88 ,$88.88 ,$60.90 ,$88.88 ,$69.10 ,$90.00 ,$69.65 ,$20.35 ,$79.00 ,$21.39 ,$24.18 ,$24.18 ,$20.15 ,$24.18 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30100822,83701,HC VAP HRF LIPOPROTEINS,301,1 ,$184.00 ,$92.00 ,$32.56 ,$184.00 ,$32.56 ,$118.51 ,$101.58 ,$33.86 ,$110.40 ,$156.40 ,$128.80 ,$32.56 ,$174.80 ,$139.84 ,$138.00 ,$57.56 ,$156.40 ,$33.86 ,$57.56 ,$33.86 ,$128.80 ,$32.56 ,$33.86 ,$33.86 ,$38.32 ,$156.40 ,$76.19 ,$169.28 ,$128.80 ,$119.28 ,$119.28 ,$112.06 ,$119.28 ,$127.14 ,$165.60 ,$128.16 ,$34.20 ,$145.36 ,$34.51 ,$40.63 ,$40.63 ,$33.86 ,$40.63 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,30100826,84403,HC TESTOSTERONE TOTAL ASSAY,301,1 ,$188.00 ,$94.00 ,$25.81 ,$188.00 ,$26.67 ,$100.38 ,$86.04 ,$25.81 ,$112.80 ,$159.80 ,$131.60 ,$26.67 ,$178.60 ,$142.88 ,$141.00 ,$43.88 ,$159.80 ,$25.81 ,$43.88 ,$25.81 ,$131.60 ,$26.67 ,$25.81 ,$25.81 ,$29.21 ,$159.80 ,$58.07 ,$172.96 ,$131.60 ,$121.14 ,$121.14 ,$114.49 ,$121.14 ,$129.91 ,$169.20 ,$130.94 ,$26.07 ,$148.52 ,$28.27 ,$30.97 ,$30.97 ,$25.81 ,$30.97 ,$135.36 ,$116.56 ,$135.36 ,$135.36 ,$150.40 
ST NICHOLAS HOSPITAL - ACUTE,30100827,80081,HC OB PANEL WITH HIV,301,1 ,$403.00 ,$201.50 ,$74.86 ,$403.00 ,$77.35 ,$291.13 ,$249.54 ,$74.86 ,$241.80 ,$342.55 ,$282.10 ,$77.35 ,$382.85 ,$306.28 ,$302.25 ,$127.26 ,$342.55 ,$74.86 ,$127.26 ,$74.86 ,$282.10 ,$77.35 ,$74.86 ,$74.86 ,$84.73 ,$342.55 ,$168.44 ,$370.76 ,$282.10 ,$359.20 ,$359.20 ,$245.43 ,$359.20 ,$278.47 ,$362.70 ,$280.69 ,$75.61 ,$318.37 ,$81.99 ,$89.83 ,$89.83 ,$74.86 ,$89.83 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,30100830,83986,HC NITRAZINE CHECK,301,1 ,$27.00 ,$13.50 ,$3.58 ,$27.00 ,$3.70 ,$13.93 ,$11.94 ,$3.58 ,$16.20 ,$22.95 ,$18.90 ,$3.70 ,$25.65 ,$20.52 ,$20.25 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$3.58 ,$18.90 ,$3.70 ,$3.58 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.19 ,$17.19 ,$16.44 ,$17.19 ,$18.66 ,$24.30 ,$18.81 ,$3.62 ,$21.33 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$21.60 
ST NICHOLAS HOSPITAL - ACUTE,30100835,84481,HC T3 TOTAL/T3 FREE,301,1 ,$179.00 ,$89.50 ,$16.62 ,$179.00 ,$16.62 ,$65.87 ,$56.46 ,$16.94 ,$107.40 ,$152.15 ,$125.30 ,$16.62 ,$170.05 ,$136.04 ,$134.25 ,$28.80 ,$152.15 ,$16.94 ,$28.80 ,$16.94 ,$125.30 ,$16.62 ,$16.94 ,$16.94 ,$19.17 ,$152.15 ,$38.12 ,$164.68 ,$125.30 ,$56.78 ,$56.78 ,$109.01 ,$56.78 ,$123.69 ,$161.10 ,$124.67 ,$17.11 ,$141.41 ,$17.62 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,30100838,83033,HC FETAL HGB QI,301,1 ,$55.00 ,$27.50 ,$8.00 ,$55.00 ,$8.27 ,$28.00 ,$24.00 ,$8.00 ,$33.00 ,$46.75 ,$38.50 ,$8.27 ,$52.25 ,$41.80 ,$41.25 ,$13.60 ,$46.75 ,$8.00 ,$13.60 ,$8.00 ,$38.50 ,$8.27 ,$8.00 ,$8.00 ,$9.05 ,$46.75 ,$18.00 ,$50.60 ,$38.50 ,$28.64 ,$28.64 ,$33.50 ,$28.64 ,$38.01 ,$49.50 ,$38.31 ,$8.08 ,$43.45 ,$8.77 ,$9.60 ,$9.60 ,$8.00 ,$9.60 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,30100840,82306,HC VITAMIN D 25 TOTAL,301,1 ,$224.00 ,$112.00 ,$29.60 ,$224.00 ,$30.59 ,$115.12 ,$98.67 ,$29.60 ,$134.40 ,$190.40 ,$156.80 ,$30.59 ,$212.80 ,$170.24 ,$168.00 ,$50.32 ,$190.40 ,$29.60 ,$50.32 ,$29.60 ,$156.80 ,$30.59 ,$29.60 ,$29.60 ,$33.50 ,$190.40 ,$66.60 ,$206.08 ,$156.80 ,$142.31 ,$142.31 ,$136.42 ,$142.31 ,$154.78 ,$201.60 ,$156.02 ,$29.90 ,$176.96 ,$32.43 ,$35.52 ,$35.52 ,$29.60 ,$35.52 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30100845,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$17.00 ,$8.50 ,$4.45 ,$17.00 ,$4.45 ,$17.00 ,$15.12 ,$5.04 ,$10.20 ,$14.45 ,$11.90 ,$4.45 ,$16.15 ,$12.92 ,$12.75 ,$8.57 ,$14.45 ,$5.04 ,$8.57 ,$5.04 ,$11.90 ,$4.45 ,$5.04 ,$5.04 ,$5.70 ,$14.45 ,$11.34 ,$15.64 ,$11.90 ,$15.22 ,$15.22 ,$10.35 ,$15.22 ,$11.75 ,$15.30 ,$11.84 ,$5.09 ,$13.43 ,$4.72 ,$6.05 ,$6.05 ,$5.04 ,$6.05 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,30100860,84145,HC PROCALCITONIN,301,1 ,$202.00 ,$101.00 ,$27.22 ,$202.00 ,$28.13 ,$104.20 ,$89.31 ,$27.22 ,$121.20 ,$171.70 ,$141.40 ,$28.13 ,$191.90 ,$153.52 ,$151.50 ,$46.27 ,$171.70 ,$27.22 ,$46.27 ,$27.22 ,$141.40 ,$28.13 ,$27.22 ,$27.22 ,$30.81 ,$171.70 ,$61.25 ,$185.84 ,$141.40 ,$128.72 ,$128.72 ,$123.02 ,$128.72 ,$139.58 ,$181.80 ,$140.69 ,$27.49 ,$159.58 ,$29.82 ,$32.66 ,$32.66 ,$27.22 ,$32.66 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30100950,G0328,HC OCCULT BLOOD FECAL SCRN - AMB,301,1 ,$125.00 ,$62.50 ,$3.28 ,$125.00 ,$3.28 ,$63.18 ,$54.15 ,$18.05 ,$75.00 ,$106.25 ,$87.50 ,$3.28 ,$118.75 ,$95.00 ,$93.75 ,$30.69 ,$106.25 ,$18.05 ,$30.69 ,$18.05 ,$87.50 ,$3.28 ,$18.05 ,$18.05 ,$20.43 ,$106.25 ,$40.61 ,$115.00 ,$87.50 ,$76.44 ,$76.44 ,$76.13 ,$76.44 ,$86.38 ,$112.50 ,$87.06 ,$18.23 ,$98.75 ,$3.48 ,$21.66 ,$21.66 ,$18.05 ,$21.66 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$100.00 
ST NICHOLAS HOSPITAL - ACUTE,30100951,82140,HC AMMONIA-STONE,301,1 ,$112.00 ,$56.00 ,$14.57 ,$112.00 ,$15.06 ,$56.67 ,$48.57 ,$14.57 ,$67.20 ,$95.20 ,$78.40 ,$15.06 ,$106.40 ,$85.12 ,$84.00 ,$24.77 ,$95.20 ,$14.57 ,$24.77 ,$14.57 ,$78.40 ,$15.06 ,$14.57 ,$14.57 ,$16.49 ,$95.20 ,$32.78 ,$103.04 ,$78.40 ,$70.03 ,$70.03 ,$68.21 ,$70.03 ,$77.39 ,$100.80 ,$78.01 ,$14.72 ,$88.48 ,$15.96 ,$17.48 ,$17.48 ,$14.57 ,$17.48 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30100952,82340,HC CALCIUM URINE QN TIMED-STONE,301,1 ,$46.00 ,$23.00 ,$6.03 ,$46.00 ,$6.23 ,$23.45 ,$20.10 ,$6.03 ,$27.60 ,$39.10 ,$32.20 ,$6.23 ,$43.70 ,$34.96 ,$34.50 ,$10.25 ,$39.10 ,$6.03 ,$10.25 ,$6.03 ,$32.20 ,$6.23 ,$6.03 ,$6.03 ,$6.82 ,$39.10 ,$13.57 ,$42.32 ,$32.20 ,$28.99 ,$28.99 ,$28.01 ,$28.99 ,$31.79 ,$41.40 ,$32.04 ,$6.09 ,$36.34 ,$6.60 ,$7.24 ,$7.24 ,$6.03 ,$7.24 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30100953,82507,HC CITRATE-STONE,301,1 ,$202.00 ,$101.00 ,$27.80 ,$202.00 ,$28.73 ,$108.12 ,$92.67 ,$27.80 ,$121.20 ,$171.70 ,$141.40 ,$28.73 ,$191.90 ,$153.52 ,$151.50 ,$47.26 ,$171.70 ,$27.80 ,$47.26 ,$27.80 ,$141.40 ,$28.73 ,$27.80 ,$27.80 ,$31.46 ,$171.70 ,$62.55 ,$185.84 ,$141.40 ,$133.61 ,$133.61 ,$123.02 ,$133.61 ,$139.58 ,$181.80 ,$140.69 ,$28.08 ,$159.58 ,$30.45 ,$33.36 ,$33.36 ,$27.80 ,$33.36 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30100954,83735,HC MAGNESIUM-STONE,301,1 ,$52.00 ,$26.00 ,$6.70 ,$52.00 ,$6.92 ,$26.04 ,$22.32 ,$6.70 ,$31.20 ,$44.20 ,$36.40 ,$6.92 ,$49.40 ,$39.52 ,$39.00 ,$11.39 ,$44.20 ,$6.70 ,$11.39 ,$6.70 ,$36.40 ,$6.92 ,$6.70 ,$6.70 ,$7.58 ,$44.20 ,$15.08 ,$47.84 ,$36.40 ,$32.20 ,$32.20 ,$31.67 ,$32.20 ,$35.93 ,$46.80 ,$36.22 ,$6.77 ,$41.08 ,$7.34 ,$8.04 ,$8.04 ,$6.70 ,$8.04 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30100955,83945,HC OXALATE-STONE,301,1 ,$99.00 ,$49.50 ,$14.45 ,$99.00 ,$14.93 ,$50.58 ,$43.35 ,$14.45 ,$59.40 ,$84.15 ,$69.30 ,$14.93 ,$94.05 ,$75.24 ,$74.25 ,$24.57 ,$84.15 ,$14.45 ,$24.57 ,$14.45 ,$69.30 ,$14.93 ,$14.45 ,$14.45 ,$16.35 ,$84.15 ,$32.51 ,$91.08 ,$69.30 ,$61.86 ,$61.86 ,$60.29 ,$61.86 ,$68.41 ,$89.10 ,$68.95 ,$14.59 ,$78.21 ,$15.83 ,$17.34 ,$17.34 ,$14.45 ,$17.34 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30100956,83986,HC PH BODY FLUID-STONE,301,1 ,$27.00 ,$13.50 ,$3.58 ,$27.00 ,$3.70 ,$13.93 ,$11.94 ,$3.58 ,$16.20 ,$22.95 ,$18.90 ,$3.70 ,$25.65 ,$20.52 ,$20.25 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$3.58 ,$18.90 ,$3.70 ,$3.58 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.19 ,$17.19 ,$16.44 ,$17.19 ,$18.66 ,$24.30 ,$18.81 ,$3.62 ,$21.33 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$21.60 
ST NICHOLAS HOSPITAL - ACUTE,30100957,84105,HC PHOSPHORUS URINE-STONE,301,1 ,$39.00 ,$19.50 ,$5.78 ,$39.00 ,$5.97 ,$20.23 ,$17.34 ,$5.78 ,$23.40 ,$33.15 ,$27.30 ,$5.97 ,$37.05 ,$29.64 ,$29.25 ,$9.83 ,$33.15 ,$5.78 ,$9.83 ,$5.78 ,$27.30 ,$5.97 ,$5.78 ,$5.78 ,$6.54 ,$33.15 ,$13.01 ,$35.88 ,$27.30 ,$24.87 ,$24.87 ,$23.75 ,$24.87 ,$26.95 ,$35.10 ,$27.16 ,$5.84 ,$30.81 ,$6.33 ,$6.94 ,$6.94 ,$5.78 ,$6.94 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30100958,84133,HC POTASSIUM URINE-STONE,301,1 ,$32.00 ,$16.00 ,$4.73 ,$32.00 ,$4.89 ,$16.77 ,$14.37 ,$4.73 ,$19.20 ,$27.20 ,$22.40 ,$4.89 ,$30.40 ,$24.32 ,$24.00 ,$8.04 ,$27.20 ,$4.73 ,$8.04 ,$4.73 ,$22.40 ,$4.89 ,$4.73 ,$4.73 ,$5.35 ,$27.20 ,$10.64 ,$29.44 ,$22.40 ,$20.68 ,$20.68 ,$19.49 ,$20.68 ,$22.11 ,$28.80 ,$22.29 ,$4.78 ,$25.28 ,$5.18 ,$5.68 ,$5.68 ,$4.73 ,$5.68 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$25.60 
ST NICHOLAS HOSPITAL - ACUTE,30100959,84300,HC SODIUM URINE-STONE,301,1 ,$37.00 ,$18.50 ,$5.06 ,$37.00 ,$5.23 ,$18.90 ,$16.20 ,$5.06 ,$22.20 ,$31.45 ,$25.90 ,$5.23 ,$35.15 ,$28.12 ,$27.75 ,$8.60 ,$31.45 ,$5.06 ,$8.60 ,$5.06 ,$25.90 ,$5.23 ,$5.06 ,$5.06 ,$5.73 ,$31.45 ,$11.39 ,$34.04 ,$25.90 ,$23.39 ,$23.39 ,$22.53 ,$23.39 ,$25.57 ,$33.30 ,$25.77 ,$5.11 ,$29.23 ,$5.54 ,$6.07 ,$6.07 ,$5.06 ,$6.07 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,30100960,84560,HC URIC ACID OTH SOURCE-STONE,301,1 ,$36.00 ,$18.00 ,$5.08 ,$36.00 ,$5.25 ,$18.45 ,$15.81 ,$5.08 ,$21.60 ,$30.60 ,$25.20 ,$5.25 ,$34.20 ,$27.36 ,$27.00 ,$8.64 ,$30.60 ,$5.08 ,$8.64 ,$5.08 ,$25.20 ,$5.25 ,$5.08 ,$5.08 ,$5.75 ,$30.60 ,$11.43 ,$33.12 ,$25.20 ,$22.83 ,$22.83 ,$21.92 ,$22.83 ,$24.88 ,$32.40 ,$25.07 ,$5.13 ,$28.44 ,$5.57 ,$6.10 ,$6.10 ,$5.08 ,$6.10 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30100961,83993,HC CALPROTECTIN STOOL,301,1 ,$157.00 ,$78.50 ,$19.63 ,$157.00 ,$20.28 ,$76.34 ,$65.43 ,$19.63 ,$94.20 ,$133.45 ,$109.90 ,$20.28 ,$149.15 ,$119.32 ,$117.75 ,$33.37 ,$133.45 ,$19.63 ,$33.37 ,$19.63 ,$109.90 ,$20.28 ,$19.63 ,$19.63 ,$22.22 ,$133.45 ,$44.17 ,$144.44 ,$109.90 ,$94.34 ,$94.34 ,$95.61 ,$94.34 ,$108.49 ,$141.30 ,$109.35 ,$19.83 ,$124.03 ,$21.50 ,$23.56 ,$23.56 ,$19.63 ,$23.56 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30100962,82656,"HC ELASTASE,PANCREATIC EL1 FECAL QT",301,1 ,$213.00 ,$106.50 ,$11.53 ,$213.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$127.80 ,$181.05 ,$149.10 ,$11.91 ,$202.35 ,$161.88 ,$159.75 ,$19.60 ,$181.05 ,$11.53 ,$19.60 ,$11.53 ,$149.10 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$181.05 ,$25.94 ,$195.96 ,$149.10 ,$55.45 ,$55.45 ,$129.72 ,$55.45 ,$147.18 ,$191.70 ,$148.35 ,$11.65 ,$168.27 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30100965,80361,HC DIHYDROCODEINONE,301,1 ,$172.00 ,$86.00 ,$10.05 ,$172.00 ,$10.05 ,$80.88 ,$69.32 , N/A ,$103.20 ,$146.20 ,$120.40 ,$10.05 ,$163.40 ,$130.72 ,$129.00 ,$38.56 ,$146.20 , N/A ,$38.56 ,$22.95 ,$120.40 ,$10.05 , N/A , N/A ,$72.24 ,$146.20 , N/A ,$158.24 ,$120.40 ,$87.24 ,$104.70 ,$104.75 ,$104.70 ,$118.85 ,$154.80 ,$119.80 , N/A ,$135.88 ,$10.65 , N/A , N/A , N/A , N/A ,$123.84 ,$106.64 ,$123.84 ,$123.84 ,$137.60 
ST NICHOLAS HOSPITAL - ACUTE,30100966,80324,"HC AMPHETAMINE CONFIRM GC/MS,UR",301,1 ,$90.00 ,$45.00 ,$3.81 ,$90.00 ,$3.81 ,$80.88 ,$69.32 , N/A ,$54.00 ,$76.50 ,$63.00 ,$3.81 ,$85.50 ,$68.40 ,$67.50 ,$38.56 ,$76.50 , N/A ,$38.56 ,$22.95 ,$63.00 ,$3.81 , N/A , N/A ,$37.80 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 , N/A ,$71.10 ,$4.04 , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100968,83018,HC COBALT BLOOD,301,1 ,$123.00 ,$61.50 ,$21.96 ,$123.00 ,$22.69 ,$85.44 ,$73.23 ,$21.96 ,$73.80 ,$104.55 ,$86.10 ,$22.69 ,$116.85 ,$93.48 ,$92.25 ,$37.33 ,$104.55 ,$21.96 ,$37.33 ,$21.96 ,$86.10 ,$22.69 ,$21.96 ,$21.96 ,$24.85 ,$104.55 ,$49.41 ,$113.16 ,$86.10 ,$105.54 ,$105.54 ,$74.91 ,$105.54 ,$84.99 ,$110.70 ,$85.67 ,$22.18 ,$97.17 ,$24.05 ,$26.35 ,$26.35 ,$21.96 ,$26.35 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100969,82705,HC FECAL FAT QUALITATIVE,301,1 ,$35.00 ,$17.50 ,$5.10 ,$35.00 ,$5.27 ,$19.81 ,$16.98 ,$5.10 ,$21.00 ,$29.75 ,$24.50 ,$5.27 ,$33.25 ,$26.60 ,$26.25 ,$8.67 ,$29.75 ,$5.10 ,$8.67 ,$5.10 ,$24.50 ,$5.27 ,$5.10 ,$5.10 ,$5.77 ,$29.75 ,$11.48 ,$32.20 ,$24.50 ,$24.45 ,$24.45 ,$21.32 ,$24.45 ,$24.19 ,$31.50 ,$24.38 ,$5.15 ,$27.65 ,$5.59 ,$6.12 ,$6.12 ,$5.10 ,$6.12 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,30100970,80180,HC MYCOPHENOLIC ACID,301,1 ,$90.00 ,$45.00 ,$18.05 ,$90.00 ,$18.65 ,$70.21 ,$60.18 ,$18.05 ,$54.00 ,$76.50 ,$63.00 ,$18.65 ,$85.50 ,$68.40 ,$67.50 ,$30.69 ,$76.50 ,$18.05 ,$30.69 ,$18.05 ,$63.00 ,$18.65 ,$18.05 ,$18.05 ,$20.43 ,$76.50 ,$40.61 ,$82.80 ,$63.00 ,$86.76 ,$86.76 ,$54.81 ,$86.76 ,$62.19 ,$81.00 ,$62.69 ,$18.23 ,$71.10 ,$19.77 ,$21.66 ,$21.66 ,$18.05 ,$21.66 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100971,80361,HC PAIN MGMT OPIATES QN URINE,301,1 ,$25.00 ,$12.50 ,$10.05 ,$25.00 ,$10.05 ,$25.00 ,$25.00 , N/A ,$15.00 ,$21.25 ,$17.50 ,$10.05 ,$23.75 ,$19.00 ,$18.75 ,$25.00 ,$21.25 , N/A ,$25.00 ,$22.95 ,$17.50 ,$10.05 , N/A , N/A ,$10.50 ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$15.22 ,$17.28 ,$22.50 ,$17.41 , N/A ,$19.75 ,$10.65 , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30100972,G0480,HC OPIATES 1 OR MORE,301,1 ,$160.00 ,$80.00 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$114.43 ,$112.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 ,$115.57 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100973,G0480,HC PAIN MGMT BENZO QN URINE,301,1 ,$160.00 ,$80.00 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$114.43 ,$112.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 ,$115.57 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100974,83516,HC TISSUE TRANGLUTAMINASE IGG AB,301,1 ,$59.00 ,$29.50 ,$11.53 ,$59.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$35.40 ,$50.15 ,$41.30 ,$11.91 ,$56.05 ,$44.84 ,$44.25 ,$19.60 ,$50.15 ,$11.53 ,$19.60 ,$11.53 ,$41.30 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$50.15 ,$25.94 ,$54.28 ,$41.30 ,$55.45 ,$55.45 ,$35.93 ,$55.45 ,$40.77 ,$53.10 ,$41.09 ,$11.65 ,$46.61 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$47.20 
ST NICHOLAS HOSPITAL - ACUTE,30100975,82784,HC TOTAL SERUM IGA BY NEPHELP,301,1 ,$71.00 ,$35.50 ,$9.30 ,$71.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$42.60 ,$60.35 ,$49.70 ,$9.61 ,$67.45 ,$53.96 ,$53.25 ,$15.81 ,$60.35 ,$9.30 ,$15.81 ,$9.30 ,$49.70 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$60.35 ,$20.93 ,$65.32 ,$49.70 ,$44.67 ,$44.67 ,$43.24 ,$44.67 ,$49.06 ,$63.90 ,$49.45 ,$9.39 ,$56.09 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$56.80 
ST NICHOLAS HOSPITAL - ACUTE,30100976,84075,HC ALKALINE PHOSPHATASE BONE SPECIFIC,301,1 ,$31.00 ,$15.50 ,$5.18 ,$31.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$18.60 ,$26.35 ,$21.70 ,$5.35 ,$29.45 ,$23.56 ,$23.25 ,$8.81 ,$26.35 ,$5.18 ,$8.81 ,$5.18 ,$21.70 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$26.35 ,$11.66 ,$28.52 ,$21.70 ,$24.87 ,$24.87 ,$18.88 ,$24.87 ,$21.42 ,$27.90 ,$21.59 ,$5.23 ,$24.49 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$24.80 
ST NICHOLAS HOSPITAL - ACUTE,30100977,84181,HC FLUOR AB TITER,301,1 ,$60.00 ,$30.00 ,$17.03 ,$60.00 ,$17.60 ,$60.00 ,$56.76 ,$17.03 ,$36.00 ,$51.00 ,$42.00 ,$17.60 ,$57.00 ,$45.60 ,$45.00 ,$28.95 ,$51.00 ,$17.03 ,$28.95 ,$17.03 ,$42.00 ,$17.60 ,$17.03 ,$17.03 ,$19.27 ,$51.00 ,$38.32 ,$55.20 ,$42.00 ,$60.00 ,$60.00 ,$36.54 ,$60.00 ,$41.46 ,$54.00 ,$41.79 ,$17.20 ,$47.40 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,30100978,83520,HC ANTI-MULLERIAN HORMONE,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100979,G0480,HC TRAMADOL,301,1 ,$160.00 ,$80.00 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$114.43 ,$112.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 ,$115.57 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30100980,83498,HC 17 OH PROGESTERONE RESP TO ACTH,301,1 ,$199.00 ,$99.50 ,$27.17 ,$199.00 ,$28.07 ,$105.67 ,$90.57 ,$27.17 ,$119.40 ,$169.15 ,$139.30 ,$28.07 ,$189.05 ,$151.24 ,$149.25 ,$46.19 ,$169.15 ,$27.17 ,$46.19 ,$27.17 ,$139.30 ,$28.07 ,$27.17 ,$27.17 ,$30.75 ,$169.15 ,$61.13 ,$183.08 ,$139.30 ,$130.58 ,$130.58 ,$121.19 ,$130.58 ,$137.51 ,$179.10 ,$138.60 ,$27.44 ,$157.21 ,$29.75 ,$32.60 ,$32.60 ,$27.17 ,$32.60 ,$143.28 ,$123.38 ,$143.28 ,$143.28 ,$159.20 
ST NICHOLAS HOSPITAL - ACUTE,30100981,82397,HC ALPHA SUBUNIT,301,1 ,$123.00 ,$61.50 ,$14.12 ,$123.00 ,$14.59 ,$54.92 ,$47.07 ,$14.12 ,$73.80 ,$104.55 ,$86.10 ,$14.59 ,$116.85 ,$93.48 ,$92.25 ,$24.00 ,$104.55 ,$14.12 ,$24.00 ,$14.12 ,$86.10 ,$14.59 ,$14.12 ,$14.12 ,$15.98 ,$104.55 ,$31.77 ,$113.16 ,$86.10 ,$67.88 ,$67.88 ,$74.91 ,$67.88 ,$84.99 ,$110.70 ,$85.67 ,$14.26 ,$97.17 ,$15.47 ,$16.94 ,$16.94 ,$14.12 ,$16.94 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100982,82530,HC CORTISOL SALIVA 2 SAMPLES,301,1 ,$123.00 ,$61.50 ,$16.71 ,$123.00 ,$17.27 ,$65.00 ,$55.71 ,$16.71 ,$73.80 ,$104.55 ,$86.10 ,$17.27 ,$116.85 ,$93.48 ,$92.25 ,$28.41 ,$104.55 ,$16.71 ,$28.41 ,$16.71 ,$86.10 ,$17.27 ,$16.71 ,$16.71 ,$18.91 ,$104.55 ,$37.60 ,$113.16 ,$86.10 ,$80.32 ,$80.32 ,$74.91 ,$80.32 ,$84.99 ,$110.70 ,$85.67 ,$16.88 ,$97.17 ,$18.31 ,$20.05 ,$20.05 ,$16.71 ,$20.05 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100983,80299,HC DEXAMETHASONE,301,1 ,$151.00 ,$75.50 ,$18.64 ,$151.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$90.60 ,$128.35 ,$105.70 ,$19.26 ,$143.45 ,$114.76 ,$113.25 ,$31.69 ,$128.35 ,$18.64 ,$31.69 ,$18.64 ,$105.70 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$128.35 ,$41.94 ,$138.92 ,$105.70 ,$65.80 ,$65.80 ,$91.96 ,$65.80 ,$104.34 ,$135.90 ,$105.17 ,$18.83 ,$119.29 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$120.80 
ST NICHOLAS HOSPITAL - ACUTE,30100984,83789,HC IODINE 24 HOUR URINE,301,1 ,$90.00 ,$45.00 ,$24.11 ,$90.00 ,$24.91 ,$84.39 ,$72.33 ,$24.11 ,$54.00 ,$76.50 ,$63.00 ,$24.91 ,$85.50 ,$68.40 ,$67.50 ,$40.99 ,$76.50 ,$24.11 ,$40.99 ,$24.11 ,$63.00 ,$24.91 ,$24.11 ,$24.11 ,$27.29 ,$76.50 ,$54.25 ,$82.80 ,$63.00 ,$86.76 ,$86.76 ,$54.81 ,$86.76 ,$62.19 ,$81.00 ,$62.69 ,$24.35 ,$71.10 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100985,83789,HC IODINE RANDOM URINE,301,1 ,$90.00 ,$45.00 ,$24.11 ,$90.00 ,$24.91 ,$84.39 ,$72.33 ,$24.11 ,$54.00 ,$76.50 ,$63.00 ,$24.91 ,$85.50 ,$68.40 ,$67.50 ,$40.99 ,$76.50 ,$24.11 ,$40.99 ,$24.11 ,$63.00 ,$24.91 ,$24.11 ,$24.11 ,$27.29 ,$76.50 ,$54.25 ,$82.80 ,$63.00 ,$86.76 ,$86.76 ,$54.81 ,$86.76 ,$62.19 ,$81.00 ,$62.69 ,$24.35 ,$71.10 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30100986,82533,HC ACTH STIM 3 SPECIMENS,301,1 ,$123.00 ,$61.50 ,$16.30 ,$123.00 ,$16.84 ,$63.39 ,$54.33 ,$16.30 ,$73.80 ,$104.55 ,$86.10 ,$16.84 ,$116.85 ,$93.48 ,$92.25 ,$27.71 ,$104.55 ,$16.30 ,$27.71 ,$16.30 ,$86.10 ,$16.84 ,$16.30 ,$16.30 ,$18.45 ,$104.55 ,$36.68 ,$113.16 ,$86.10 ,$78.34 ,$78.34 ,$74.91 ,$78.34 ,$84.99 ,$110.70 ,$85.67 ,$16.46 ,$97.17 ,$17.85 ,$19.56 ,$19.56 ,$16.30 ,$19.56 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100987,82523,HC COLLAGEN CROSS LINKED 24 HR URINE,301,1 ,$123.00 ,$61.50 ,$14.65 ,$123.00 ,$14.65 ,$72.66 ,$62.28 ,$18.68 ,$73.80 ,$104.55 ,$86.10 ,$14.65 ,$116.85 ,$93.48 ,$92.25 ,$31.76 ,$104.55 ,$18.68 ,$31.76 ,$18.68 ,$86.10 ,$14.65 ,$18.68 ,$18.68 ,$21.14 ,$104.55 ,$42.03 ,$113.16 ,$86.10 ,$50.09 ,$50.09 ,$74.91 ,$50.09 ,$84.99 ,$110.70 ,$85.67 ,$18.87 ,$97.17 ,$15.53 ,$22.42 ,$22.42 ,$18.68 ,$22.42 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100988,84439,HC T4 FREE DIRECT DIALYSIS,301,1 ,$67.00 ,$33.50 ,$9.02 ,$67.00 ,$9.32 ,$35.07 ,$30.06 ,$9.02 ,$40.20 ,$56.95 ,$46.90 ,$9.32 ,$63.65 ,$50.92 ,$50.25 ,$15.33 ,$56.95 ,$9.02 ,$15.33 ,$9.02 ,$46.90 ,$9.32 ,$9.02 ,$9.02 ,$10.21 ,$56.95 ,$20.30 ,$61.64 ,$46.90 ,$43.33 ,$43.33 ,$40.80 ,$43.33 ,$46.30 ,$60.30 ,$46.67 ,$9.11 ,$52.93 ,$9.88 ,$10.82 ,$10.82 ,$9.02 ,$10.82 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30100989,84443,HC TSH WITH HAMA TREATMENT,301,1 ,$123.00 ,$61.50 ,$16.80 ,$123.00 ,$17.36 ,$65.35 ,$56.01 ,$16.80 ,$73.80 ,$104.55 ,$86.10 ,$17.36 ,$116.85 ,$93.48 ,$92.25 ,$28.56 ,$104.55 ,$16.80 ,$28.56 ,$16.80 ,$86.10 ,$17.36 ,$16.80 ,$16.80 ,$19.01 ,$104.55 ,$37.80 ,$113.16 ,$86.10 ,$80.77 ,$80.77 ,$74.91 ,$80.77 ,$84.99 ,$110.70 ,$85.67 ,$16.97 ,$97.17 ,$18.40 ,$20.16 ,$20.16 ,$16.80 ,$20.16 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30100990,82523,HC C TELOPEPTIDE CTX,301,1 ,$101.00 ,$50.50 ,$14.65 ,$101.00 ,$14.65 ,$72.66 ,$62.28 ,$18.68 ,$60.60 ,$85.85 ,$70.70 ,$14.65 ,$95.95 ,$76.76 ,$75.75 ,$31.76 ,$85.85 ,$18.68 ,$31.76 ,$18.68 ,$70.70 ,$14.65 ,$18.68 ,$18.68 ,$21.14 ,$85.85 ,$42.03 ,$92.92 ,$70.70 ,$50.09 ,$50.09 ,$61.51 ,$50.09 ,$69.79 ,$90.90 ,$70.35 ,$18.87 ,$79.79 ,$15.53 ,$22.42 ,$22.42 ,$18.68 ,$22.42 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100991,83519,HC THYROTROPIN BINDING INHIBITORY IG,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30100992,83519,HC TSH ANTIBODY,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30101003,82523,HC COLLAGEN CROSS LINKS ANY METHOD,301,1 ,$161.00 ,$80.50 ,$14.65 ,$161.00 ,$14.65 ,$72.66 ,$62.28 ,$18.68 ,$96.60 ,$136.85 ,$112.70 ,$14.65 ,$152.95 ,$122.36 ,$120.75 ,$31.76 ,$136.85 ,$18.68 ,$31.76 ,$18.68 ,$112.70 ,$14.65 ,$18.68 ,$18.68 ,$21.14 ,$136.85 ,$42.03 ,$148.12 ,$112.70 ,$50.09 ,$50.09 ,$98.05 ,$50.09 ,$111.25 ,$144.90 ,$112.14 ,$18.87 ,$127.19 ,$15.53 ,$22.42 ,$22.42 ,$18.68 ,$22.42 ,$115.92 ,$99.82 ,$115.92 ,$115.92 ,$128.80 
ST NICHOLAS HOSPITAL - ACUTE,30101006,82787,HC IMMUNOGLOBULIN SUBCLASSES,301,1 ,$63.00 ,$31.50 ,$5.90 ,$63.00 ,$5.90 ,$31.19 ,$26.73 ,$8.02 ,$37.80 ,$53.55 ,$44.10 ,$5.90 ,$59.85 ,$47.88 ,$47.25 ,$13.63 ,$53.55 ,$8.02 ,$13.63 ,$8.02 ,$44.10 ,$5.90 ,$8.02 ,$8.02 ,$9.08 ,$53.55 ,$18.05 ,$57.96 ,$44.10 ,$20.15 ,$20.15 ,$38.37 ,$20.15 ,$43.53 ,$56.70 ,$43.88 ,$8.10 ,$49.77 ,$6.25 ,$9.62 ,$9.62 ,$8.02 ,$9.62 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$50.40 
ST NICHOLAS HOSPITAL - ACUTE,30101010,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$157.00 ,$78.50 ,$17.27 ,$157.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$94.20 ,$133.45 ,$109.90 ,$17.85 ,$149.15 ,$119.32 ,$117.75 ,$29.36 ,$133.45 ,$17.27 ,$29.36 ,$17.27 ,$109.90 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$133.45 ,$38.86 ,$144.44 ,$109.90 ,$62.21 ,$62.21 ,$95.61 ,$62.21 ,$108.49 ,$141.30 ,$109.35 ,$17.44 ,$124.03 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$123.00 ,$61.50 ,$19.31 ,$123.00 ,$19.95 ,$71.54 ,$61.32 ,$19.31 ,$73.80 ,$104.55 ,$86.10 ,$19.95 ,$116.85 ,$93.48 ,$92.25 ,$32.83 ,$104.55 ,$19.31 ,$32.83 ,$19.31 ,$86.10 ,$19.95 ,$19.31 ,$19.31 ,$21.86 ,$104.55 ,$43.45 ,$113.16 ,$86.10 ,$88.38 ,$88.38 ,$74.91 ,$88.38 ,$84.99 ,$110.70 ,$85.67 ,$19.50 ,$97.17 ,$21.15 ,$23.17 ,$23.17 ,$19.31 ,$23.17 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30101024,G0480,HC DRUG CONFIRMATION EA PROC 1-7 CLASSES,301,1 ,$160.00 ,$80.00 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$114.43 ,$112.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 ,$115.57 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101030,80169,HC EVEROLIMUS,301,1 ,$190.00 ,$95.00 ,$13.73 ,$190.00 ,$14.19 ,$53.41 ,$45.78 ,$13.73 ,$114.00 ,$161.50 ,$133.00 ,$14.19 ,$180.50 ,$144.40 ,$142.50 ,$23.34 ,$161.50 ,$13.73 ,$23.34 ,$13.73 ,$133.00 ,$14.19 ,$13.73 ,$13.73 ,$15.54 ,$161.50 ,$30.89 ,$174.80 ,$133.00 ,$65.98 ,$65.98 ,$115.71 ,$65.98 ,$131.29 ,$171.00 ,$132.34 ,$13.87 ,$150.10 ,$15.04 ,$16.48 ,$16.48 ,$13.73 ,$16.48 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30101045,80299,HC POSACONAZOLE,301,1 ,$216.00 ,$108.00 ,$18.64 ,$216.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$129.60 ,$183.60 ,$151.20 ,$19.26 ,$205.20 ,$164.16 ,$162.00 ,$31.69 ,$183.60 ,$18.64 ,$31.69 ,$18.64 ,$151.20 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$183.60 ,$41.94 ,$198.72 ,$151.20 ,$65.80 ,$65.80 ,$131.54 ,$65.80 ,$149.26 ,$194.40 ,$150.44 ,$18.83 ,$170.64 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$172.80 
ST NICHOLAS HOSPITAL - ACUTE,30101050,82610,HC CYSTATIN C,301,1 ,$123.00 ,$61.50 ,$18.52 ,$123.00 ,$19.00 ,$64.82 ,$55.56 ,$18.52 ,$73.80 ,$104.55 ,$86.10 ,$19.00 ,$116.85 ,$93.48 ,$92.25 ,$31.48 ,$104.55 ,$18.52 ,$31.48 ,$18.52 ,$86.10 ,$19.00 ,$18.52 ,$18.52 ,$20.96 ,$104.55 ,$41.67 ,$113.16 ,$86.10 ,$65.31 ,$65.31 ,$74.91 ,$65.31 ,$84.99 ,$110.70 ,$85.67 ,$18.71 ,$97.17 ,$20.14 ,$22.22 ,$22.22 ,$18.52 ,$22.22 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30101051,83789,HC MASS/TANDEM SPEC TPMT ACTIVITY EACH SPECIMEN,301,1 ,$347.00 ,$173.50 ,$24.11 ,$347.00 ,$24.91 ,$84.39 ,$72.33 ,$24.11 ,$208.20 ,$294.95 ,$242.90 ,$24.91 ,$329.65 ,$263.72 ,$260.25 ,$40.99 ,$294.95 ,$24.11 ,$40.99 ,$24.11 ,$242.90 ,$24.91 ,$24.11 ,$24.11 ,$27.29 ,$294.95 ,$54.25 ,$319.24 ,$242.90 ,$86.76 ,$86.76 ,$211.32 ,$86.76 ,$239.78 ,$312.30 ,$241.69 ,$24.35 ,$274.13 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$277.60 
ST NICHOLAS HOSPITAL - ACUTE,30101052,82642,HC DRUG CONFIRMATION DIHYDROTESTOSTERONE LC/MS/MS,301,1 ,$179.00 ,$89.50 ,$29.28 ,$179.00 ,$30.26 ,$113.86 ,$97.59 ,$29.28 ,$107.40 ,$152.15 ,$125.30 ,$30.26 ,$170.05 ,$136.04 ,$134.25 ,$49.78 ,$152.15 ,$29.28 ,$49.78 ,$29.28 ,$125.30 ,$30.26 ,$29.28 ,$29.28 ,$33.14 ,$152.15 ,$65.88 ,$164.68 ,$125.30 ,$125.69 ,$125.69 ,$109.01 ,$125.69 ,$123.69 ,$161.10 ,$124.67 ,$29.57 ,$141.41 ,$32.08 ,$35.14 ,$35.14 ,$29.28 ,$35.14 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,30101053,80235,HC LACOSAMIDE LC/MS/MS,301,1 ,$110.00 ,$55.00 ,$21.69 ,$110.00 ,$21.69 ,$94.89 ,$81.33 ,$27.11 ,$66.00 ,$93.50 ,$77.00 ,$21.69 ,$104.50 ,$83.60 ,$82.50 ,$46.09 ,$93.50 ,$27.11 ,$46.09 ,$27.11 ,$77.00 ,$21.69 ,$27.11 ,$27.11 ,$30.68 ,$93.50 ,$61.00 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$27.38 ,$86.90 ,$22.99 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30101054,83520,HC GANGLIOSIDE GQ1B AB IGG EIA,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$60.60 ,$85.85 ,$70.70 ,$17.85 ,$95.95 ,$76.76 ,$75.75 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$17.27 ,$70.70 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$17.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30101055,83519,HC CALCIUM CHAN AB VOLTAGE-GATED,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$60.60 ,$85.85 ,$70.70 ,$19.00 ,$95.95 ,$76.76 ,$75.75 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$18.40 ,$70.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$64.92 ,$64.92 ,$61.51 ,$64.92 ,$69.79 ,$90.90 ,$70.35 ,$18.58 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30101057,84140,HC PREGNENOLONE,301,1 ,$106.00 ,$53.00 ,$20.67 ,$106.00 ,$21.36 ,$80.40 ,$68.91 ,$20.67 ,$63.60 ,$90.10 ,$74.20 ,$21.36 ,$100.70 ,$80.56 ,$79.50 ,$35.14 ,$90.10 ,$20.67 ,$35.14 ,$20.67 ,$74.20 ,$21.36 ,$20.67 ,$20.67 ,$23.39 ,$90.10 ,$46.51 ,$97.52 ,$74.20 ,$99.37 ,$99.37 ,$64.55 ,$99.37 ,$73.25 ,$95.40 ,$73.83 ,$20.88 ,$83.74 ,$22.64 ,$24.80 ,$24.80 ,$20.67 ,$24.80 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,30101058,82679,HC ESTRONE LC/MS/MS,301,1 ,$100.00 ,$50.00 ,$24.95 ,$100.00 ,$25.78 ,$97.06 ,$83.19 ,$24.95 ,$60.00 ,$85.00 ,$70.00 ,$25.78 ,$95.00 ,$76.00 ,$75.00 ,$42.42 ,$85.00 ,$24.95 ,$42.42 ,$24.95 ,$70.00 ,$25.78 ,$24.95 ,$24.95 ,$28.24 ,$85.00 ,$56.14 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$25.20 ,$79.00 ,$27.33 ,$29.94 ,$29.94 ,$24.95 ,$29.94 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,30101066,G0480,HC IF PREGABALIN,301,1 ,$282.00 ,$141.00 ,$63.95 ,$282.00 ,$63.95 ,$282.00 ,$282.00 ,$114.43 ,$169.20 ,$239.70 ,$197.40 ,$63.95 ,$267.90 ,$214.32 ,$211.50 ,$194.53 ,$239.70 ,$114.43 ,$194.53 ,$114.43 ,$197.40 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$239.70 ,$257.47 ,$259.44 ,$197.40 ,$281.60 ,$281.60 ,$171.74 ,$281.60 ,$194.86 ,$253.80 ,$196.41 ,$115.57 ,$222.78 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$203.04 ,$174.84 ,$203.04 ,$203.04 ,$225.60 
ST NICHOLAS HOSPITAL - ACUTE,30101067,G0480,HC IF MARIJUANA GC/MS URINE,301,1 ,$160.00 ,$80.00 ,$63.95 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$114.43 ,$96.00 ,$136.00 ,$112.00 ,$63.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$114.43 ,$112.00 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 ,$115.57 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30101068,84630,HC ZINC RBC,301,1 ,$80.00 ,$40.00 ,$11.39 ,$80.00 ,$11.77 ,$44.28 ,$37.95 ,$11.39 ,$48.00 ,$68.00 ,$56.00 ,$11.77 ,$76.00 ,$60.80 ,$60.00 ,$19.36 ,$68.00 ,$11.39 ,$19.36 ,$11.39 ,$56.00 ,$11.77 ,$11.39 ,$11.39 ,$12.89 ,$68.00 ,$25.63 ,$73.60 ,$56.00 ,$49.81 ,$49.81 ,$48.72 ,$49.81 ,$55.28 ,$72.00 ,$55.72 ,$11.50 ,$63.20 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,30101071,84432,HC THYROGLOBULIN MASS SPEC,301,1 ,$325.00 ,$162.50 ,$16.06 ,$325.00 ,$16.59 ,$62.44 ,$53.52 ,$16.06 ,$195.00 ,$276.25 ,$227.50 ,$16.59 ,$308.75 ,$247.00 ,$243.75 ,$27.30 ,$276.25 ,$16.06 ,$27.30 ,$16.06 ,$227.50 ,$16.59 ,$16.06 ,$16.06 ,$18.18 ,$276.25 ,$36.14 ,$299.00 ,$227.50 ,$77.18 ,$77.18 ,$197.93 ,$77.18 ,$224.58 ,$292.50 ,$226.36 ,$16.22 ,$256.75 ,$17.59 ,$19.27 ,$19.27 ,$16.06 ,$19.27 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30101127,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$165.00 ,$82.50 ,$18.64 ,$165.00 ,$19.26 ,$65.24 ,$55.92 ,$18.64 ,$99.00 ,$140.25 ,$115.50 ,$19.26 ,$156.75 ,$125.40 ,$123.75 ,$31.69 ,$140.25 ,$18.64 ,$31.69 ,$18.64 ,$115.50 ,$19.26 ,$18.64 ,$18.64 ,$21.10 ,$140.25 ,$41.94 ,$151.80 ,$115.50 ,$65.80 ,$65.80 ,$100.49 ,$65.80 ,$114.02 ,$148.50 ,$114.92 ,$18.83 ,$130.35 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$118.80 ,$102.30 ,$118.80 ,$118.80 ,$132.00 
ST NICHOLAS HOSPITAL - ACUTE,30101466,82600,HC CYANIDE BLOOD,301,1 ,$146.00 ,$73.00 ,$19.40 ,$146.00 ,$20.05 ,$75.43 ,$64.65 ,$19.40 ,$87.60 ,$124.10 ,$102.20 ,$20.05 ,$138.70 ,$110.96 ,$109.50 ,$32.98 ,$124.10 ,$19.40 ,$32.98 ,$19.40 ,$102.20 ,$20.05 ,$19.40 ,$19.40 ,$21.96 ,$124.10 ,$43.65 ,$134.32 ,$102.20 ,$93.21 ,$93.21 ,$88.91 ,$93.21 ,$100.89 ,$131.40 ,$101.69 ,$19.59 ,$115.34 ,$21.25 ,$23.28 ,$23.28 ,$19.40 ,$23.28 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30101467,84238,HC RECEPTOR ASSAY TRASFERRIN,301,1 ,$224.00 ,$112.00 ,$36.57 ,$224.00 ,$37.79 ,$142.21 ,$121.89 ,$36.57 ,$134.40 ,$190.40 ,$156.80 ,$37.79 ,$212.80 ,$170.24 ,$168.00 ,$62.17 ,$190.40 ,$36.57 ,$62.17 ,$36.57 ,$156.80 ,$37.79 ,$36.57 ,$36.57 ,$41.39 ,$190.40 ,$82.28 ,$206.08 ,$156.80 ,$175.74 ,$175.74 ,$136.42 ,$175.74 ,$154.78 ,$201.60 ,$156.02 ,$36.94 ,$176.96 ,$40.06 ,$43.88 ,$43.88 ,$36.57 ,$43.88 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30101468,83013,HC H PYLORI BREATH TEST,301,1 ,$274.00 ,$137.00 ,$67.36 ,$274.00 ,$69.60 ,$261.94 ,$224.52 ,$67.36 ,$164.40 ,$232.90 ,$191.80 ,$69.60 ,$260.30 ,$208.24 ,$205.50 ,$114.51 ,$232.90 ,$67.36 ,$114.51 ,$67.36 ,$191.80 ,$69.60 ,$67.36 ,$67.36 ,$76.24 ,$232.90 ,$151.56 ,$252.08 ,$191.80 ,$274.00 ,$274.00 ,$166.87 ,$274.00 ,$189.33 ,$246.60 ,$190.84 ,$68.03 ,$216.46 ,$73.78 ,$80.83 ,$80.83 ,$67.36 ,$80.83 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$219.20 
ST NICHOLAS HOSPITAL - ACUTE,30101469,G0481,HC DRUG SCREEN DEFINITIVE 8-14 CLASSES,301,1 ,$270.00 ,$135.00 ,$98.39 ,$352.33 ,$98.39 ,$270.00 ,$270.00 ,$156.59 ,$162.00 ,$229.50 ,$189.00 ,$98.39 ,$256.50 ,$205.20 ,$202.50 ,$266.20 ,$229.50 ,$156.59 ,$266.20 ,$156.59 ,$189.00 ,$98.39 ,$156.59 ,$156.59 ,$177.23 ,$229.50 ,$352.33 ,$248.40 ,$189.00 ,$270.00 ,$270.00 ,$164.43 ,$270.00 ,$186.57 ,$243.00 ,$188.06 ,$158.16 ,$213.30 ,$104.29 ,$187.91 ,$187.91 ,$156.59 ,$187.91 ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,30101470,G0482,HC DRUG SCREEN DEFINITIVE 15-21 CLASSES,301,1 ,$350.00 ,$175.00 ,$132.80 ,$447.17 ,$132.80 ,$350.00 ,$350.00 ,$198.74 ,$210.00 ,$297.50 ,$245.00 ,$132.80 ,$332.50 ,$266.00 ,$262.50 ,$337.86 ,$297.50 ,$198.74 ,$337.86 ,$198.74 ,$245.00 ,$132.80 ,$198.74 ,$198.74 ,$224.93 ,$297.50 ,$447.17 ,$322.00 ,$245.00 ,$350.00 ,$350.00 ,$213.15 ,$350.00 ,$241.85 ,$315.00 ,$243.78 ,$200.73 ,$276.50 ,$140.77 ,$238.49 ,$238.49 ,$198.74 ,$238.49 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,30101471,G0483,HC DRUG SCREEN DEFINITIVE 22+ CLASSES,301,1 ,$515.00 ,$257.50 ,$172.18 ,$555.57 ,$172.18 ,$515.00 ,$515.00 ,$246.92 ,$309.00 ,$437.75 ,$360.50 ,$172.18 ,$489.25 ,$391.40 ,$386.25 ,$419.76 ,$437.75 ,$246.92 ,$419.76 ,$246.92 ,$360.50 ,$172.18 ,$246.92 ,$246.92 ,$279.46 ,$437.75 ,$555.57 ,$473.80 ,$360.50 ,$515.00 ,$515.00 ,$313.64 ,$515.00 ,$355.87 ,$463.50 ,$358.70 ,$249.39 ,$406.85 ,$182.51 ,$296.30 ,$296.30 ,$246.92 ,$296.30 ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$412.00 
ST NICHOLAS HOSPITAL - ACUTE,30101501,84999,HC OSMOLALITY FECAL,301,1 ,$129.00 ,$64.50 ,$3.81 ,$129.00 ,$3.81 ,$83.45 ,$83.45 , N/A ,$77.40 ,$109.65 ,$90.30 ,$3.81 ,$122.55 ,$98.04 ,$96.75 , N/A ,$109.65 , N/A , N/A , N/A ,$90.30 ,$3.81 , N/A , N/A ,$54.18 ,$109.65 ,$77.40 ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$78.52 ,$89.14 ,$116.10 ,$89.85 , N/A ,$101.91 ,$4.04 ,$64.50 ,$64.50 , N/A ,$64.50 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,30101502,83520,HC IMMUNOASSAY QN MYELIN ASSOC GLYCOPROTEIN,301,1 ,$155.00 ,$77.50 ,$17.27 ,$155.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$93.00 ,$131.75 ,$108.50 ,$17.85 ,$147.25 ,$117.80 ,$116.25 ,$29.36 ,$131.75 ,$17.27 ,$29.36 ,$17.27 ,$108.50 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$131.75 ,$38.86 ,$142.60 ,$108.50 ,$62.21 ,$62.21 ,$94.40 ,$62.21 ,$107.11 ,$139.50 ,$107.96 ,$17.44 ,$122.45 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$111.60 ,$96.10 ,$111.60 ,$111.60 ,$124.00 
ST NICHOLAS HOSPITAL - ACUTE,30101504,80285,HC VORICONAZOLE,301,1 ,$140.00 ,$70.00 ,$21.69 ,$140.00 ,$21.69 ,$94.89 ,$81.33 ,$27.11 ,$84.00 ,$119.00 ,$98.00 ,$21.69 ,$133.00 ,$106.40 ,$105.00 ,$46.09 ,$119.00 ,$27.11 ,$46.09 ,$27.11 ,$98.00 ,$21.69 ,$27.11 ,$27.11 ,$30.68 ,$119.00 ,$61.00 ,$128.80 ,$98.00 ,$95.50 ,$95.50 ,$85.26 ,$95.50 ,$96.74 ,$126.00 ,$97.51 ,$27.38 ,$110.60 ,$22.99 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$112.00 
ST NICHOLAS HOSPITAL - ACUTE,30101506,G0483,HC DRUG SCREEN DEFINITIVE TOXICOLOGY URINE,301,1 ,"$1,000.00 ",$500.00 ,$172.18 ,"$1,000.00 ",$172.18 ,$864.22 ,$740.76 ,$246.92 ,$600.00 ,$850.00 ,$700.00 ,$172.18 ,$950.00 ,$760.00 ,$750.00 ,$419.76 ,$850.00 ,$246.92 ,$419.76 ,$246.92 ,$700.00 ,$172.18 ,$246.92 ,$246.92 ,$279.46 ,$850.00 ,$555.57 ,$920.00 ,$700.00 ,$758.17 ,$758.17 ,$609.00 ,$758.17 ,$691.00 ,$900.00 ,$696.50 ,$249.39 ,$790.00 ,$182.51 ,$296.30 ,$296.30 ,$246.92 ,$296.30 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,30101507,80307,HC DRUG SCREEN MONITOR 1 FLUID ORAL,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$62.14 ,$222.00 ,$314.50 ,$259.00 ,$63.40 ,$351.50 ,$281.20 ,$277.50 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$62.14 ,$259.00 ,$63.40 ,$62.14 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$227.74 ,$227.74 ,$225.33 ,$227.74 ,$255.67 ,$333.00 ,$257.71 ,$62.76 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30101508,G0480,HC TRICYCLIC QN URINE,301,1 ,$99.00 ,$49.50 ,$49.50 ,$222.75 ,$63.95 ,$99.00 ,$99.00 ,$99.00 ,$59.40 ,$84.15 ,$69.30 ,$63.95 ,$94.05 ,$75.24 ,$74.25 ,$99.00 ,$84.15 ,$99.00 ,$99.00 ,$99.00 ,$69.30 ,$63.95 ,$99.00 ,$99.00 ,$99.00 ,$84.15 ,$222.75 ,$91.08 ,$69.30 ,$99.00 ,$99.00 ,$60.29 ,$99.00 ,$68.41 ,$89.10 ,$68.95 ,$99.99 ,$78.21 ,$67.79 ,$99.00 ,$99.00 ,$99.00 ,$99.00 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30101519,83520,HC POLYMERASE III RNA ANTIBODY,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$59.40 ,$84.15 ,$69.30 ,$17.85 ,$94.05 ,$75.24 ,$74.25 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$17.27 ,$69.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.21 ,$62.21 ,$60.29 ,$62.21 ,$68.41 ,$89.10 ,$68.95 ,$17.44 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30101523,84181,HC NEURONAL NUCLEAR AB/WB,301,1 ,$197.00 ,$98.50 ,$17.03 ,$197.00 ,$17.60 ,$66.22 ,$56.76 ,$17.03 ,$118.20 ,$167.45 ,$137.90 ,$17.60 ,$187.15 ,$149.72 ,$147.75 ,$28.95 ,$167.45 ,$17.03 ,$28.95 ,$17.03 ,$137.90 ,$17.60 ,$17.03 ,$17.03 ,$19.27 ,$167.45 ,$38.32 ,$181.24 ,$137.90 ,$81.87 ,$81.87 ,$119.97 ,$81.87 ,$136.13 ,$177.30 ,$137.21 ,$17.20 ,$155.63 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$141.84 ,$122.14 ,$141.84 ,$141.84 ,$157.60 
ST NICHOLAS HOSPITAL - ACUTE,30101528,82657,HC ENZYME ACT NONRAD SUBS DISACCHARIDASE,301,1 ,$258.00 ,$129.00 ,$22.17 ,$258.00 ,$22.91 ,$77.60 ,$66.51 ,$22.17 ,$154.80 ,$219.30 ,$180.60 ,$22.91 ,$245.10 ,$196.08 ,$193.50 ,$37.69 ,$219.30 ,$22.17 ,$37.69 ,$22.17 ,$180.60 ,$22.91 ,$22.17 ,$22.17 ,$25.09 ,$219.30 ,$49.88 ,$237.36 ,$180.60 ,$86.76 ,$86.76 ,$157.12 ,$86.76 ,$178.28 ,$232.20 ,$179.70 ,$22.39 ,$203.82 ,$24.28 ,$26.60 ,$26.60 ,$22.17 ,$26.60 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$84.00 ,$42.00 ,$6.04 ,$84.00 ,$6.24 ,$23.49 ,$20.13 ,$6.04 ,$50.40 ,$71.40 ,$58.80 ,$6.24 ,$79.80 ,$63.84 ,$63.00 ,$10.27 ,$71.40 ,$6.04 ,$10.27 ,$6.04 ,$58.80 ,$6.24 ,$6.04 ,$6.04 ,$6.84 ,$71.40 ,$13.59 ,$77.28 ,$58.80 ,$28.99 ,$28.99 ,$51.16 ,$28.99 ,$58.04 ,$75.60 ,$58.51 ,$6.10 ,$66.36 ,$6.61 ,$7.25 ,$7.25 ,$6.04 ,$7.25 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,30101595,83690,HC LIPASE,301,1 ,$179.00 ,$89.50 ,$6.89 ,$179.00 ,$7.12 ,$26.78 ,$22.95 ,$6.89 ,$107.40 ,$152.15 ,$125.30 ,$7.12 ,$170.05 ,$136.04 ,$134.25 ,$11.71 ,$152.15 ,$6.89 ,$11.71 ,$6.89 ,$125.30 ,$7.12 ,$6.89 ,$6.89 ,$7.80 ,$152.15 ,$15.50 ,$164.68 ,$125.30 ,$33.11 ,$33.11 ,$109.01 ,$33.11 ,$123.69 ,$161.10 ,$124.67 ,$6.96 ,$141.41 ,$7.55 ,$8.27 ,$8.27 ,$6.89 ,$8.27 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,30101654,82642,HC DIHYDROTESTOSTERONE,301,1 ,$179.00 ,$89.50 ,$29.28 ,$179.00 ,$30.26 ,$113.86 ,$97.59 ,$29.28 ,$107.40 ,$152.15 ,$125.30 ,$30.26 ,$170.05 ,$136.04 ,$134.25 ,$49.78 ,$152.15 ,$29.28 ,$49.78 ,$29.28 ,$125.30 ,$30.26 ,$29.28 ,$29.28 ,$33.14 ,$152.15 ,$65.88 ,$164.68 ,$125.30 ,$125.69 ,$125.69 ,$109.01 ,$125.69 ,$123.69 ,$161.10 ,$124.67 ,$29.57 ,$141.41 ,$32.08 ,$35.14 ,$35.14 ,$29.28 ,$35.14 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,30101666,84252,HC VITAMIN B-2 (RIBOFLAVIN),301,1 ,$150.00 ,$75.00 ,$20.24 ,$150.00 ,$20.91 ,$78.72 ,$67.47 ,$20.24 ,$90.00 ,$127.50 ,$105.00 ,$20.91 ,$142.50 ,$114.00 ,$112.50 ,$34.41 ,$127.50 ,$20.24 ,$34.41 ,$20.24 ,$105.00 ,$20.91 ,$20.24 ,$20.24 ,$22.91 ,$127.50 ,$45.54 ,$138.00 ,$105.00 ,$97.26 ,$97.26 ,$91.35 ,$97.26 ,$103.65 ,$135.00 ,$104.48 ,$20.44 ,$118.50 ,$22.16 ,$24.29 ,$24.29 ,$20.24 ,$24.29 ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$120.00 
ST NICHOLAS HOSPITAL - ACUTE,30101672,84591,HC VITAMIN OTHER,301,1 ,$137.00 ,$68.50 ,$16.32 ,$137.00 ,$16.32 ,$59.71 ,$51.18 ,$17.06 ,$82.20 ,$116.45 ,$95.90 ,$16.32 ,$130.15 ,$104.12 ,$102.75 ,$29.00 ,$116.45 ,$17.06 ,$29.00 ,$17.06 ,$95.90 ,$16.32 ,$17.06 ,$17.06 ,$19.31 ,$116.45 ,$38.39 ,$126.04 ,$95.90 ,$55.76 ,$55.76 ,$83.43 ,$55.76 ,$94.67 ,$123.30 ,$95.42 ,$17.23 ,$108.23 ,$17.30 ,$20.47 ,$20.47 ,$17.06 ,$20.47 ,$98.64 ,$84.94 ,$98.64 ,$98.64 ,$109.60 
ST NICHOLAS HOSPITAL - ACUTE,30101680,83520,HC IMMUNOASSAY PROTEIN QN CSF (PRION),301,1 ,$833.00 ,$416.50 ,$17.27 ,$833.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$499.80 ,$708.05 ,$583.10 ,$17.85 ,$791.35 ,$633.08 ,$624.75 ,$29.36 ,$708.05 ,$17.27 ,$29.36 ,$17.27 ,$583.10 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$708.05 ,$38.86 ,$766.36 ,$583.10 ,$62.21 ,$62.21 ,$507.30 ,$62.21 ,$575.60 ,$749.70 ,$580.18 ,$17.44 ,$658.07 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$599.76 ,$516.46 ,$599.76 ,$599.76 ,$666.40 
ST NICHOLAS HOSPITAL - ACUTE,30101683,83519,HC IMMUNOASSAY QN CHANNEL/NEURONAL AB,301,1 ,$211.00 ,$105.50 ,$18.40 ,$211.00 ,$19.00 ,$64.40 ,$55.20 ,$18.40 ,$126.60 ,$179.35 ,$147.70 ,$19.00 ,$200.45 ,$160.36 ,$158.25 ,$31.28 ,$179.35 ,$18.40 ,$31.28 ,$18.40 ,$147.70 ,$19.00 ,$18.40 ,$18.40 ,$20.83 ,$179.35 ,$41.40 ,$194.12 ,$147.70 ,$64.92 ,$64.92 ,$128.50 ,$64.92 ,$145.80 ,$189.90 ,$146.96 ,$18.58 ,$166.69 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$151.92 ,$130.82 ,$151.92 ,$151.92 ,$168.80 
ST NICHOLAS HOSPITAL - ACUTE,30101684,83520,HC IMMUNOASSAY QN STRIATIONAL AB,301,1 ,$169.00 ,$84.50 ,$17.27 ,$169.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$101.40 ,$143.65 ,$118.30 ,$17.85 ,$160.55 ,$128.44 ,$126.75 ,$29.36 ,$143.65 ,$17.27 ,$29.36 ,$17.27 ,$118.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$143.65 ,$38.86 ,$155.48 ,$118.30 ,$62.21 ,$62.21 ,$102.92 ,$62.21 ,$116.78 ,$152.10 ,$117.71 ,$17.44 ,$133.51 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$135.20 
ST NICHOLAS HOSPITAL - ACUTE,30101707,82542,"HC IODINE, SERUM/PLASMA",301,1 ,$200.00 ,$100.00 ,$24.09 ,$200.00 ,$24.89 ,$84.32 ,$72.27 ,$24.09 ,$120.00 ,$170.00 ,$140.00 ,$24.89 ,$190.00 ,$152.00 ,$150.00 ,$40.95 ,$170.00 ,$24.09 ,$40.95 ,$24.09 ,$140.00 ,$24.89 ,$24.09 ,$24.09 ,$27.27 ,$170.00 ,$54.20 ,$184.00 ,$140.00 ,$86.76 ,$86.76 ,$121.80 ,$86.76 ,$138.20 ,$180.00 ,$139.30 ,$24.33 ,$158.00 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,30101708,G0480,HC ALCOHOL METAB WITH CONFIRM,301,1 ,$219.00 ,$109.50 ,$63.95 ,$257.47 ,$63.95 ,$219.00 ,$219.00 ,$114.43 ,$131.40 ,$186.15 ,$153.30 ,$63.95 ,$208.05 ,$166.44 ,$164.25 ,$194.53 ,$186.15 ,$114.43 ,$194.53 ,$114.43 ,$153.30 ,$63.95 ,$114.43 ,$114.43 ,$129.51 ,$186.15 ,$257.47 ,$201.48 ,$153.30 ,$219.00 ,$219.00 ,$133.37 ,$219.00 ,$151.33 ,$197.10 ,$152.53 ,$115.57 ,$173.01 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$157.68 ,$135.78 ,$157.68 ,$157.68 ,$175.20 
ST NICHOLAS HOSPITAL - ACUTE,30101721,83520,HC TSH RECEPTOR BINDING AB,301,1 ,$169.00 ,$84.50 ,$17.27 ,$169.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$101.40 ,$143.65 ,$118.30 ,$17.85 ,$160.55 ,$128.44 ,$126.75 ,$29.36 ,$143.65 ,$17.27 ,$29.36 ,$17.27 ,$118.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$143.65 ,$38.86 ,$155.48 ,$118.30 ,$62.21 ,$62.21 ,$102.92 ,$62.21 ,$116.78 ,$152.10 ,$117.71 ,$17.44 ,$133.51 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$135.20 
ST NICHOLAS HOSPITAL - ACUTE,30101737,82784,HC IMMUNOGLOBIN G,301,1 ,$39.00 ,$19.50 ,$9.30 ,$39.00 ,$9.61 ,$36.19 ,$31.02 ,$9.30 ,$23.40 ,$33.15 ,$27.30 ,$9.61 ,$37.05 ,$29.64 ,$29.25 ,$15.81 ,$33.15 ,$9.30 ,$15.81 ,$9.30 ,$27.30 ,$9.61 ,$9.30 ,$9.30 ,$10.53 ,$33.15 ,$20.93 ,$35.88 ,$27.30 ,$39.00 ,$39.00 ,$23.75 ,$39.00 ,$26.95 ,$35.10 ,$27.16 ,$9.39 ,$30.81 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30101738,G0480,HC PAIN MGMT TAPENTADOL QN -90,301,1 ,$78.00 ,$39.00 ,$39.00 ,$175.50 ,$63.95 ,$78.00 ,$78.00 ,$78.00 ,$46.80 ,$66.30 ,$54.60 ,$63.95 ,$74.10 ,$59.28 ,$58.50 ,$78.00 ,$66.30 ,$78.00 ,$78.00 ,$78.00 ,$54.60 ,$63.95 ,$78.00 ,$78.00 ,$78.00 ,$66.30 ,$175.50 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$70.20 ,$54.33 ,$78.78 ,$61.62 ,$67.79 ,$78.00 ,$78.00 ,$78.00 ,$78.00 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30101741,84545,"HC UREA NITROGEN, CLEARANCE",301,1 ,$270.00 ,$135.00 ,$7.20 ,$270.00 ,$7.44 ,$25.73 ,$22.05 ,$7.20 ,$162.00 ,$229.50 ,$189.00 ,$7.44 ,$256.50 ,$205.20 ,$202.50 ,$12.24 ,$229.50 ,$7.20 ,$12.24 ,$7.20 ,$189.00 ,$7.44 ,$7.20 ,$7.20 ,$8.15 ,$229.50 ,$16.20 ,$248.40 ,$189.00 ,$31.74 ,$31.74 ,$164.43 ,$31.74 ,$186.57 ,$243.00 ,$188.06 ,$7.27 ,$213.30 ,$7.89 ,$8.64 ,$8.64 ,$7.20 ,$8.64 ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,30101746,G0480,HC DRUG SCRN DEFINT 1-7 CLASS T1,301,1 ,$52.00 ,$26.00 ,$26.00 ,$117.00 ,$52.00 ,$52.00 ,$52.00 ,$52.00 ,$31.20 ,$44.20 ,$36.40 ,$52.00 ,$49.40 ,$39.52 ,$39.00 ,$52.00 ,$44.20 ,$52.00 ,$52.00 ,$52.00 ,$36.40 ,$52.00 ,$52.00 ,$52.00 ,$52.00 ,$44.20 ,$117.00 ,$47.84 ,$36.40 ,$52.00 ,$52.00 ,$31.67 ,$52.00 ,$35.93 ,$46.80 ,$36.22 ,$52.52 ,$41.08 ,$55.12 ,$52.00 ,$52.00 ,$52.00 ,$52.00 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30101747,80362,HC OPIOIDS  AND  OPIATE ANALOGS 1/2,301,1 ,$52.00 ,$26.00 ,$10.05 ,$52.00 ,$10.05 ,$52.00 ,$52.00 , N/A ,$31.20 ,$44.20 ,$36.40 ,$10.05 ,$49.40 ,$39.52 ,$39.00 ,$38.56 ,$44.20 , N/A ,$38.56 ,$22.95 ,$36.40 ,$10.05 , N/A , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$31.65 ,$35.93 ,$46.80 ,$36.22 , N/A ,$41.08 ,$10.65 , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30101748,80372,HC DRUG SCREENING TAPENTADOL,301,1 ,$52.00 ,$26.00 ,$1.53 ,$52.00 ,$1.53 ,$52.00 ,$52.00 , N/A ,$31.20 ,$44.20 ,$36.40 ,$1.53 ,$49.40 ,$39.52 ,$39.00 ,$38.56 ,$44.20 , N/A ,$38.56 ,$22.95 ,$36.40 ,$1.53 , N/A , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$31.65 ,$35.93 ,$46.80 ,$36.22 , N/A ,$41.08 ,$1.62 , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30101749,80355,HC DRUG SCREENING GABAPENTIN NON-BLOOD,301,1 ,$52.00 ,$26.00 ,$1.53 ,$52.00 ,$1.53 ,$52.00 ,$52.00 , N/A ,$31.20 ,$44.20 ,$36.40 ,$1.53 ,$49.40 ,$39.52 ,$39.00 ,$38.56 ,$44.20 , N/A ,$38.56 ,$22.95 ,$36.40 ,$1.53 , N/A , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$31.65 ,$35.93 ,$46.80 ,$36.22 , N/A ,$41.08 ,$1.62 , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30140436,83874,HC MYOGLOBIN URINE-REF,301,1 ,$40.14 ,$20.07 ,$12.92 ,$40.14 ,$13.35 ,$40.14 ,$40.14 ,$12.92 ,$24.08 ,$34.12 ,$28.10 ,$13.35 ,$38.13 ,$30.51 ,$30.11 ,$21.96 ,$34.12 ,$12.92 ,$21.96 ,$12.92 ,$28.10 ,$13.35 ,$12.92 ,$12.92 ,$14.62 ,$34.12 ,$29.07 ,$36.93 ,$28.10 ,$40.14 ,$40.14 ,$24.45 ,$40.14 ,$27.74 ,$36.13 ,$27.96 ,$13.05 ,$31.71 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$28.90 ,$24.89 ,$28.90 ,$28.90 ,$32.11 
ST NICHOLAS HOSPITAL - ACUTE,30182005,83520,HC INTERLEUKIN 6 (IL-6),301,1 ,$169.00 ,$84.50 ,$17.27 ,$169.00 ,$17.85 ,$60.45 ,$51.81 ,$17.27 ,$101.40 ,$143.65 ,$118.30 ,$17.85 ,$160.55 ,$128.44 ,$126.75 ,$29.36 ,$143.65 ,$17.27 ,$29.36 ,$17.27 ,$118.30 ,$17.85 ,$17.27 ,$17.27 ,$19.55 ,$143.65 ,$38.86 ,$155.48 ,$118.30 ,$62.21 ,$62.21 ,$102.92 ,$62.21 ,$116.78 ,$152.10 ,$117.71 ,$17.44 ,$133.51 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$135.20 
ST NICHOLAS HOSPITAL - ACUTE,30200101,86003,HC ALLERGEN IGE QN EA (LATEX/IGE),302,1 ,$25.00 ,$12.50 ,$4.57 ,$25.00 ,$4.57 ,$20.30 ,$17.40 ,$5.22 ,$15.00 ,$21.25 ,$17.50 ,$4.57 ,$23.75 ,$19.00 ,$18.75 ,$8.87 ,$21.25 ,$5.22 ,$8.87 ,$5.22 ,$17.50 ,$4.57 ,$5.22 ,$5.22 ,$5.91 ,$21.25 ,$11.75 ,$23.00 ,$17.50 ,$15.61 ,$15.61 ,$15.23 ,$15.61 ,$17.28 ,$22.50 ,$17.41 ,$5.27 ,$19.75 ,$4.84 ,$6.26 ,$6.26 ,$5.22 ,$6.26 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30200102,86003,HC ALLERGEN IGE QN EA,302,1 ,$16.00 ,$8.00 ,$4.57 ,$16.00 ,$4.57 ,$16.00 ,$16.00 ,$5.22 ,$9.60 ,$13.60 ,$11.20 ,$4.57 ,$15.20 ,$12.16 ,$12.00 ,$8.87 ,$13.60 ,$5.22 ,$8.87 ,$5.22 ,$11.20 ,$4.57 ,$5.22 ,$5.22 ,$5.91 ,$13.60 ,$11.75 ,$14.72 ,$11.20 ,$15.61 ,$15.61 ,$9.74 ,$15.61 ,$11.06 ,$14.40 ,$11.14 ,$5.27 ,$12.64 ,$4.84 ,$6.26 ,$6.26 ,$5.22 ,$6.26 ,$11.52 ,$9.92 ,$11.52 ,$11.52 ,$12.80 
ST NICHOLAS HOSPITAL - ACUTE,30200103,86021,HC LEUKO AB ID,302,1 ,$123.00 ,$61.50 ,$15.05 ,$123.00 ,$15.55 ,$58.56 ,$50.19 ,$15.05 ,$73.80 ,$104.55 ,$86.10 ,$15.55 ,$116.85 ,$93.48 ,$92.25 ,$25.59 ,$104.55 ,$15.05 ,$25.59 ,$15.05 ,$86.10 ,$15.55 ,$15.05 ,$15.05 ,$17.03 ,$104.55 ,$33.86 ,$113.16 ,$86.10 ,$72.35 ,$72.35 ,$74.91 ,$72.35 ,$84.99 ,$110.70 ,$85.67 ,$15.20 ,$97.17 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200105,86021,HC LEUKO AB ID (ANCA),302,1 ,$78.00 ,$39.00 ,$15.05 ,$78.00 ,$15.55 ,$58.56 ,$50.19 ,$15.05 ,$46.80 ,$66.30 ,$54.60 ,$15.55 ,$74.10 ,$59.28 ,$58.50 ,$25.59 ,$66.30 ,$15.05 ,$25.59 ,$15.05 ,$54.60 ,$15.55 ,$15.05 ,$15.05 ,$17.03 ,$66.30 ,$33.86 ,$71.76 ,$54.60 ,$72.35 ,$72.35 ,$47.50 ,$72.35 ,$53.90 ,$70.20 ,$54.33 ,$15.20 ,$61.62 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200106,86021,HC LEUKO AB ID (MYELO),302,1 ,$101.00 ,$50.50 ,$15.05 ,$101.00 ,$15.55 ,$58.56 ,$50.19 ,$15.05 ,$60.60 ,$85.85 ,$70.70 ,$15.55 ,$95.95 ,$76.76 ,$75.75 ,$25.59 ,$85.85 ,$15.05 ,$25.59 ,$15.05 ,$70.70 ,$15.55 ,$15.05 ,$15.05 ,$17.03 ,$85.85 ,$33.86 ,$92.92 ,$70.70 ,$72.35 ,$72.35 ,$61.51 ,$72.35 ,$69.79 ,$90.90 ,$70.35 ,$15.20 ,$79.79 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200107,86021,HC LEUKO AB ID (PROTEIN),302,1 ,$101.00 ,$50.50 ,$15.05 ,$101.00 ,$15.55 ,$58.56 ,$50.19 ,$15.05 ,$60.60 ,$85.85 ,$70.70 ,$15.55 ,$95.95 ,$76.76 ,$75.75 ,$25.59 ,$85.85 ,$15.05 ,$25.59 ,$15.05 ,$70.70 ,$15.55 ,$15.05 ,$15.05 ,$17.03 ,$85.85 ,$33.86 ,$92.92 ,$70.70 ,$72.35 ,$72.35 ,$61.51 ,$72.35 ,$69.79 ,$90.90 ,$70.35 ,$15.20 ,$79.79 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200108,86022,HC PLATELET AB ID (HIT),302,1 ,$202.00 ,$101.00 ,$18.37 ,$202.00 ,$18.98 ,$71.44 ,$61.23 ,$18.37 ,$121.20 ,$171.70 ,$141.40 ,$18.98 ,$191.90 ,$153.52 ,$151.50 ,$31.23 ,$171.70 ,$18.37 ,$31.23 ,$18.37 ,$141.40 ,$18.98 ,$18.37 ,$18.37 ,$20.79 ,$171.70 ,$41.33 ,$185.84 ,$141.40 ,$88.28 ,$88.28 ,$123.02 ,$88.28 ,$139.58 ,$181.80 ,$140.69 ,$18.55 ,$159.58 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30200109,86022,HC PLATELET AB ID (HEPARIN),302,1 ,$213.00 ,$106.50 ,$18.37 ,$213.00 ,$18.98 ,$71.44 ,$61.23 ,$18.37 ,$127.80 ,$181.05 ,$149.10 ,$18.98 ,$202.35 ,$161.88 ,$159.75 ,$31.23 ,$181.05 ,$18.37 ,$31.23 ,$18.37 ,$149.10 ,$18.98 ,$18.37 ,$18.37 ,$20.79 ,$181.05 ,$41.33 ,$195.96 ,$149.10 ,$88.28 ,$88.28 ,$129.72 ,$88.28 ,$147.18 ,$191.70 ,$148.35 ,$18.55 ,$168.27 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30200111,86022,HC PLATELET AB ID (SEROTONIN),302,1 ,$437.00 ,$218.50 ,$18.37 ,$437.00 ,$18.98 ,$71.44 ,$61.23 ,$18.37 ,$262.20 ,$371.45 ,$305.90 ,$18.98 ,$415.15 ,$332.12 ,$327.75 ,$31.23 ,$371.45 ,$18.37 ,$31.23 ,$18.37 ,$305.90 ,$18.98 ,$18.37 ,$18.37 ,$20.79 ,$371.45 ,$41.33 ,$402.04 ,$305.90 ,$88.28 ,$88.28 ,$266.13 ,$88.28 ,$301.97 ,$393.30 ,$304.37 ,$18.55 ,$345.23 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$349.60 
ST NICHOLAS HOSPITAL - ACUTE,30200113,86022,HC PLATELET AB-ID,302,1 ,$202.00 ,$101.00 ,$18.37 ,$202.00 ,$18.98 ,$71.44 ,$61.23 ,$18.37 ,$121.20 ,$171.70 ,$141.40 ,$18.98 ,$191.90 ,$153.52 ,$151.50 ,$31.23 ,$171.70 ,$18.37 ,$31.23 ,$18.37 ,$141.40 ,$18.98 ,$18.37 ,$18.37 ,$20.79 ,$171.70 ,$41.33 ,$185.84 ,$141.40 ,$88.28 ,$88.28 ,$123.02 ,$88.28 ,$139.58 ,$181.80 ,$140.69 ,$18.55 ,$159.58 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30200116,86022,HC PLATELET AB ID (NAT),302,1 ,$58.00 ,$29.00 ,$18.37 ,$58.00 ,$18.98 ,$58.00 ,$58.00 ,$18.37 ,$34.80 ,$49.30 ,$40.60 ,$18.98 ,$55.10 ,$44.08 ,$43.50 ,$31.23 ,$49.30 ,$18.37 ,$31.23 ,$18.37 ,$40.60 ,$18.98 ,$18.37 ,$18.37 ,$20.79 ,$49.30 ,$41.33 ,$53.36 ,$40.60 ,$58.00 ,$58.00 ,$35.32 ,$58.00 ,$40.08 ,$52.20 ,$40.40 ,$18.55 ,$45.82 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$41.76 ,$35.96 ,$41.76 ,$41.76 ,$46.40 
ST NICHOLAS HOSPITAL - ACUTE,30200117,86022,HC PLATELET AB ID (HIT2),302,1 ,$202.00 ,$101.00 ,$18.37 ,$202.00 ,$18.98 ,$71.44 ,$61.23 ,$18.37 ,$121.20 ,$171.70 ,$141.40 ,$18.98 ,$191.90 ,$153.52 ,$151.50 ,$31.23 ,$171.70 ,$18.37 ,$31.23 ,$18.37 ,$141.40 ,$18.98 ,$18.37 ,$18.37 ,$20.79 ,$171.70 ,$41.33 ,$185.84 ,$141.40 ,$88.28 ,$88.28 ,$123.02 ,$88.28 ,$139.58 ,$181.80 ,$140.69 ,$18.55 ,$159.58 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30200118,86023,HC PLATELET ASSOC AB ID IGG,302,1 ,$101.00 ,$50.50 ,$12.46 ,$101.00 ,$12.87 ,$48.44 ,$41.52 ,$12.46 ,$60.60 ,$85.85 ,$70.70 ,$12.87 ,$95.95 ,$76.76 ,$75.75 ,$21.18 ,$85.85 ,$12.46 ,$21.18 ,$12.46 ,$70.70 ,$12.87 ,$12.46 ,$12.46 ,$14.10 ,$85.85 ,$28.04 ,$92.92 ,$70.70 ,$59.88 ,$59.88 ,$61.51 ,$59.88 ,$69.79 ,$90.90 ,$70.35 ,$12.58 ,$79.79 ,$13.64 ,$14.95 ,$14.95 ,$12.46 ,$14.95 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200119,86038,HC ANA SCREEN,302,1 ,$78.00 ,$39.00 ,$12.09 ,$78.00 ,$12.49 ,$47.01 ,$40.29 ,$12.09 ,$46.80 ,$66.30 ,$54.60 ,$12.49 ,$74.10 ,$59.28 ,$58.50 ,$20.55 ,$66.30 ,$12.09 ,$20.55 ,$12.09 ,$54.60 ,$12.49 ,$12.09 ,$12.09 ,$13.68 ,$66.30 ,$27.20 ,$71.76 ,$54.60 ,$50.09 ,$50.09 ,$47.50 ,$50.09 ,$53.90 ,$70.20 ,$54.33 ,$12.21 ,$61.62 ,$13.24 ,$14.51 ,$14.51 ,$12.09 ,$14.51 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200120,86039,HC ANA TITER,302,1 ,$90.00 ,$45.00 ,$11.16 ,$90.00 ,$11.53 ,$43.40 ,$37.20 ,$11.16 ,$54.00 ,$76.50 ,$63.00 ,$11.53 ,$85.50 ,$68.40 ,$67.50 ,$18.97 ,$76.50 ,$11.16 ,$18.97 ,$11.16 ,$63.00 ,$11.53 ,$11.16 ,$11.16 ,$12.63 ,$76.50 ,$25.11 ,$82.80 ,$63.00 ,$53.65 ,$53.65 ,$54.81 ,$53.65 ,$62.19 ,$81.00 ,$62.69 ,$11.27 ,$71.10 ,$12.22 ,$13.39 ,$13.39 ,$11.16 ,$13.39 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200121,86060,HC ASO,302,1 ,$123.00 ,$61.50 ,$7.30 ,$123.00 ,$7.54 ,$28.39 ,$24.33 ,$7.30 ,$73.80 ,$104.55 ,$86.10 ,$7.54 ,$116.85 ,$93.48 ,$92.25 ,$12.41 ,$104.55 ,$7.30 ,$12.41 ,$7.30 ,$86.10 ,$7.54 ,$7.30 ,$7.30 ,$8.26 ,$104.55 ,$16.43 ,$113.16 ,$86.10 ,$35.09 ,$35.09 ,$74.91 ,$35.09 ,$84.99 ,$110.70 ,$85.67 ,$7.37 ,$97.17 ,$7.99 ,$8.76 ,$8.76 ,$7.30 ,$8.76 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200122,86063,HC ASO SCREEN,302,1 ,$105.00 ,$52.50 ,$5.77 ,$105.00 ,$5.96 ,$22.44 ,$19.23 ,$5.77 ,$63.00 ,$89.25 ,$73.50 ,$5.96 ,$99.75 ,$79.80 ,$78.75 ,$9.81 ,$89.25 ,$5.77 ,$9.81 ,$5.77 ,$73.50 ,$5.96 ,$5.77 ,$5.77 ,$6.53 ,$89.25 ,$12.98 ,$96.60 ,$73.50 ,$27.72 ,$27.72 ,$63.95 ,$27.72 ,$72.56 ,$94.50 ,$73.13 ,$5.83 ,$82.95 ,$6.32 ,$6.92 ,$6.92 ,$5.77 ,$6.92 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$45.00 ,$22.50 ,$5.18 ,$45.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$27.00 ,$38.25 ,$31.50 ,$5.35 ,$42.75 ,$34.20 ,$33.75 ,$8.81 ,$38.25 ,$5.18 ,$8.81 ,$5.18 ,$31.50 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$38.25 ,$11.66 ,$41.40 ,$31.50 ,$24.87 ,$24.87 ,$27.41 ,$24.87 ,$31.10 ,$40.50 ,$31.34 ,$5.23 ,$35.55 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,30200124,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$168.00 ,$84.00 ,$12.95 ,$168.00 ,$13.38 ,$50.37 ,$43.17 ,$12.95 ,$100.80 ,$142.80 ,$117.60 ,$13.38 ,$159.60 ,$127.68 ,$126.00 ,$22.02 ,$142.80 ,$12.95 ,$22.02 ,$12.95 ,$117.60 ,$13.38 ,$12.95 ,$12.95 ,$14.66 ,$142.80 ,$29.14 ,$154.56 ,$117.60 ,$62.21 ,$62.21 ,$102.31 ,$62.21 ,$116.09 ,$151.20 ,$117.01 ,$13.08 ,$132.72 ,$14.18 ,$15.54 ,$15.54 ,$12.95 ,$15.54 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30200125,86146,HC BETA 2 GLYCO AB,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$78.00 ,$78.00 ,$25.45 ,$46.80 ,$66.30 ,$54.60 ,$8.17 ,$74.10 ,$59.28 ,$58.50 ,$43.27 ,$66.30 ,$25.45 ,$43.27 ,$25.45 ,$54.60 ,$8.17 ,$25.45 ,$25.45 ,$28.80 ,$66.30 ,$57.26 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$25.70 ,$61.62 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200126,86147,HC CARDIOLIPIN AB EA,302,1 ,$67.00 ,$33.50 ,$8.17 ,$67.00 ,$8.17 ,$67.00 ,$67.00 ,$25.45 ,$40.20 ,$56.95 ,$46.90 ,$8.17 ,$63.65 ,$50.92 ,$50.25 ,$43.27 ,$56.95 ,$25.45 ,$43.27 ,$25.45 ,$46.90 ,$8.17 ,$25.45 ,$25.45 ,$28.80 ,$56.95 ,$57.26 ,$61.64 ,$46.90 ,$27.93 ,$27.93 ,$40.80 ,$27.93 ,$46.30 ,$60.30 ,$46.67 ,$25.70 ,$52.93 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200127,86147,HC CARDIOLIPIN AB EA (ANTI),302,1 ,$76.00 ,$38.00 ,$8.17 ,$76.00 ,$8.17 ,$76.00 ,$76.00 ,$25.45 ,$45.60 ,$64.60 ,$53.20 ,$8.17 ,$72.20 ,$57.76 ,$57.00 ,$43.27 ,$64.60 ,$25.45 ,$43.27 ,$25.45 ,$53.20 ,$8.17 ,$25.45 ,$25.45 ,$28.80 ,$64.60 ,$57.26 ,$69.92 ,$53.20 ,$27.93 ,$27.93 ,$46.28 ,$27.93 ,$52.52 ,$68.40 ,$52.93 ,$25.70 ,$60.04 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$60.80 
ST NICHOLAS HOSPITAL - ACUTE,30200128,86147,HC CARDIOLIPIN AB EA (PHOSPH),302,1 ,$76.00 ,$38.00 ,$8.17 ,$76.00 ,$8.17 ,$76.00 ,$76.00 ,$25.45 ,$45.60 ,$64.60 ,$53.20 ,$8.17 ,$72.20 ,$57.76 ,$57.00 ,$43.27 ,$64.60 ,$25.45 ,$43.27 ,$25.45 ,$53.20 ,$8.17 ,$25.45 ,$25.45 ,$28.80 ,$64.60 ,$57.26 ,$69.92 ,$53.20 ,$27.93 ,$27.93 ,$46.28 ,$27.93 ,$52.52 ,$68.40 ,$52.93 ,$25.70 ,$60.04 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$60.80 
ST NICHOLAS HOSPITAL - ACUTE,30200130,86160,HC COMPLEMENT AG EA (C3),302,1 ,$90.00 ,$45.00 ,$12.00 ,$90.00 ,$12.40 ,$46.66 ,$39.99 ,$12.00 ,$54.00 ,$76.50 ,$63.00 ,$12.40 ,$85.50 ,$68.40 ,$67.50 ,$20.40 ,$76.50 ,$12.00 ,$20.40 ,$12.00 ,$63.00 ,$12.40 ,$12.00 ,$12.00 ,$13.58 ,$76.50 ,$27.00 ,$82.80 ,$63.00 ,$57.70 ,$57.70 ,$54.81 ,$57.70 ,$62.19 ,$81.00 ,$62.69 ,$12.12 ,$71.10 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200131,86160,HC COMPLEMENT AG EA (C4),302,1 ,$90.00 ,$45.00 ,$12.00 ,$90.00 ,$12.40 ,$46.66 ,$39.99 ,$12.00 ,$54.00 ,$76.50 ,$63.00 ,$12.40 ,$85.50 ,$68.40 ,$67.50 ,$20.40 ,$76.50 ,$12.00 ,$20.40 ,$12.00 ,$63.00 ,$12.40 ,$12.00 ,$12.00 ,$13.58 ,$76.50 ,$27.00 ,$82.80 ,$63.00 ,$57.70 ,$57.70 ,$54.81 ,$57.70 ,$62.19 ,$81.00 ,$62.69 ,$12.12 ,$71.10 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200132,86160,HC COMPLEMENT AG EA,302,1 ,$179.00 ,$89.50 ,$12.00 ,$179.00 ,$12.40 ,$46.66 ,$39.99 ,$12.00 ,$107.40 ,$152.15 ,$125.30 ,$12.40 ,$170.05 ,$136.04 ,$134.25 ,$20.40 ,$152.15 ,$12.00 ,$20.40 ,$12.00 ,$125.30 ,$12.40 ,$12.00 ,$12.00 ,$13.58 ,$152.15 ,$27.00 ,$164.68 ,$125.30 ,$57.70 ,$57.70 ,$109.01 ,$57.70 ,$123.69 ,$161.10 ,$124.67 ,$12.12 ,$141.41 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,30200133,86161,HC C1 ESTERASE INHIBITOR,302,1 ,$86.00 ,$43.00 ,$12.00 ,$86.00 ,$12.40 ,$46.66 ,$39.99 ,$12.00 ,$51.60 ,$73.10 ,$60.20 ,$12.40 ,$81.70 ,$65.36 ,$64.50 ,$20.40 ,$73.10 ,$12.00 ,$20.40 ,$12.00 ,$60.20 ,$12.40 ,$12.00 ,$12.00 ,$13.58 ,$73.10 ,$27.00 ,$79.12 ,$60.20 ,$57.70 ,$57.70 ,$52.37 ,$57.70 ,$59.43 ,$77.40 ,$59.90 ,$12.12 ,$67.94 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30200134,86162,HC COMPLEMENT TOTAL,302,1 ,$146.00 ,$73.00 ,$20.32 ,$146.00 ,$21.00 ,$79.03 ,$67.74 ,$20.32 ,$87.60 ,$124.10 ,$102.20 ,$21.00 ,$138.70 ,$110.96 ,$109.50 ,$34.54 ,$124.10 ,$20.32 ,$34.54 ,$20.32 ,$102.20 ,$21.00 ,$20.32 ,$20.32 ,$23.00 ,$124.10 ,$45.72 ,$134.32 ,$102.20 ,$90.92 ,$90.92 ,$88.91 ,$90.92 ,$100.89 ,$131.40 ,$101.69 ,$20.52 ,$115.34 ,$22.26 ,$24.38 ,$24.38 ,$20.32 ,$24.38 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200135,86200,HC CCP AB,302,1 ,$101.00 ,$50.50 ,$12.95 ,$101.00 ,$13.38 ,$50.37 ,$43.17 ,$12.95 ,$60.60 ,$85.85 ,$70.70 ,$13.38 ,$95.95 ,$76.76 ,$75.75 ,$22.02 ,$85.85 ,$12.95 ,$22.02 ,$12.95 ,$70.70 ,$13.38 ,$12.95 ,$12.95 ,$14.66 ,$85.85 ,$29.14 ,$92.92 ,$70.70 ,$62.21 ,$62.21 ,$61.51 ,$62.21 ,$69.79 ,$90.90 ,$70.35 ,$13.08 ,$79.79 ,$14.18 ,$15.54 ,$15.54 ,$12.95 ,$15.54 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200136,86215,HC DEOXYRIBONUCLEASE AB,302,1 ,$78.00 ,$39.00 ,$13.25 ,$78.00 ,$13.69 ,$51.52 ,$44.16 ,$13.25 ,$46.80 ,$66.30 ,$54.60 ,$13.69 ,$74.10 ,$59.28 ,$58.50 ,$22.53 ,$66.30 ,$13.25 ,$22.53 ,$13.25 ,$54.60 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$66.30 ,$29.81 ,$71.76 ,$54.60 ,$60.38 ,$60.38 ,$47.50 ,$60.38 ,$53.90 ,$70.20 ,$54.33 ,$13.38 ,$61.62 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200137,86225,HC DNA DOUBLE STRAND AB,302,1 ,$101.00 ,$50.50 ,$13.74 ,$101.00 ,$14.20 ,$53.45 ,$45.81 ,$13.74 ,$60.60 ,$85.85 ,$70.70 ,$14.20 ,$95.95 ,$76.76 ,$75.75 ,$23.36 ,$85.85 ,$13.74 ,$23.36 ,$13.74 ,$70.70 ,$14.20 ,$13.74 ,$13.74 ,$15.55 ,$85.85 ,$30.92 ,$92.92 ,$70.70 ,$66.01 ,$66.01 ,$61.51 ,$66.01 ,$69.79 ,$90.90 ,$70.35 ,$13.88 ,$79.79 ,$15.05 ,$16.49 ,$16.49 ,$13.74 ,$16.49 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200138,86235,HC ENA AB,302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$17.93 ,$80.40 ,$113.90 ,$93.80 ,$18.53 ,$127.30 ,$101.84 ,$100.50 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$17.93 ,$93.80 ,$18.53 ,$17.93 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$86.16 ,$86.16 ,$81.61 ,$86.16 ,$92.59 ,$120.60 ,$93.33 ,$18.11 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30200139,86235,HC ENA AB (SCL70),302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$17.93 ,$80.40 ,$113.90 ,$93.80 ,$18.53 ,$127.30 ,$101.84 ,$100.50 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$17.93 ,$93.80 ,$18.53 ,$17.93 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$86.16 ,$86.16 ,$81.61 ,$86.16 ,$92.59 ,$120.60 ,$93.33 ,$18.11 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30200140,86235,HC ENA AB (JO1),302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$17.93 ,$80.40 ,$113.90 ,$93.80 ,$18.53 ,$127.30 ,$101.84 ,$100.50 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$17.93 ,$93.80 ,$18.53 ,$17.93 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$86.16 ,$86.16 ,$81.61 ,$86.16 ,$92.59 ,$120.60 ,$93.33 ,$18.11 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30200141,86235,HC ENA AB (SSA/SSB),302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$17.93 ,$80.40 ,$113.90 ,$93.80 ,$18.53 ,$127.30 ,$101.84 ,$100.50 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$17.93 ,$93.80 ,$18.53 ,$17.93 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$86.16 ,$86.16 ,$81.61 ,$86.16 ,$92.59 ,$120.60 ,$93.33 ,$18.11 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30200142,86255,HC FLUOR AB SCR (MITOCHONDRIAL),302,1 ,$56.00 ,$28.00 ,$12.05 ,$56.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$33.60 ,$47.60 ,$39.20 ,$12.45 ,$53.20 ,$42.56 ,$42.00 ,$20.49 ,$47.60 ,$12.05 ,$20.49 ,$12.05 ,$39.20 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$47.60 ,$27.11 ,$51.52 ,$39.20 ,$56.00 ,$56.00 ,$34.10 ,$56.00 ,$38.70 ,$50.40 ,$39.00 ,$12.17 ,$44.24 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200143,86255,HC FLUOR AB SCR (MUSCLE),302,1 ,$41.00 ,$20.50 ,$12.05 ,$41.00 ,$12.45 ,$41.00 ,$40.17 ,$12.05 ,$24.60 ,$34.85 ,$28.70 ,$12.45 ,$38.95 ,$31.16 ,$30.75 ,$20.49 ,$34.85 ,$12.05 ,$20.49 ,$12.05 ,$28.70 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$34.85 ,$27.11 ,$37.72 ,$28.70 ,$41.00 ,$41.00 ,$24.97 ,$41.00 ,$28.33 ,$36.90 ,$28.56 ,$12.17 ,$32.39 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,30200144,86255,HC FLUOR AB SCR (RETICULIN),302,1 ,$130.00 ,$65.00 ,$12.05 ,$130.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$78.00 ,$110.50 ,$91.00 ,$12.45 ,$123.50 ,$98.80 ,$97.50 ,$20.49 ,$110.50 ,$12.05 ,$20.49 ,$12.05 ,$91.00 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$110.50 ,$27.11 ,$119.60 ,$91.00 ,$57.91 ,$57.91 ,$79.17 ,$57.91 ,$89.83 ,$117.00 ,$90.55 ,$12.17 ,$102.70 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,30200145,86255,HC FLUOR AB SCR (MAYO),302,1 ,$167.00 ,$83.50 ,$12.05 ,$167.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$100.20 ,$141.95 ,$116.90 ,$12.45 ,$158.65 ,$126.92 ,$125.25 ,$20.49 ,$141.95 ,$12.05 ,$20.49 ,$12.05 ,$116.90 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$141.95 ,$27.11 ,$153.64 ,$116.90 ,$57.91 ,$57.91 ,$101.70 ,$57.91 ,$115.40 ,$150.30 ,$116.32 ,$12.17 ,$131.93 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$120.24 ,$103.54 ,$120.24 ,$120.24 ,$133.60 
ST NICHOLAS HOSPITAL - ACUTE,30200146,86255,HC FLUOR AB SCR (ENDOMYSIAL),302,1 ,$112.00 ,$56.00 ,$12.05 ,$112.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$67.20 ,$95.20 ,$78.40 ,$12.45 ,$106.40 ,$85.12 ,$84.00 ,$20.49 ,$95.20 ,$12.05 ,$20.49 ,$12.05 ,$78.40 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$95.20 ,$27.11 ,$103.04 ,$78.40 ,$57.91 ,$57.91 ,$68.21 ,$57.91 ,$77.39 ,$100.80 ,$78.01 ,$12.17 ,$88.48 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200147,86255,HC FLUOR AB SCR (HU AB IFA),302,1 ,$157.00 ,$78.50 ,$12.05 ,$157.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$94.20 ,$133.45 ,$109.90 ,$12.45 ,$149.15 ,$119.32 ,$117.75 ,$20.49 ,$133.45 ,$12.05 ,$20.49 ,$12.05 ,$109.90 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$133.45 ,$27.11 ,$144.44 ,$109.90 ,$57.91 ,$57.91 ,$95.61 ,$57.91 ,$108.49 ,$141.30 ,$109.35 ,$12.17 ,$124.03 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200148,86255,HC FLUOR AB SCR (PURKINJE),302,1 ,$157.00 ,$78.50 ,$12.05 ,$157.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$94.20 ,$133.45 ,$109.90 ,$12.45 ,$149.15 ,$119.32 ,$117.75 ,$20.49 ,$133.45 ,$12.05 ,$20.49 ,$12.05 ,$109.90 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$133.45 ,$27.11 ,$144.44 ,$109.90 ,$57.91 ,$57.91 ,$95.61 ,$57.91 ,$108.49 ,$141.30 ,$109.35 ,$12.17 ,$124.03 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200149,86225,HC YO AB IFA,302,1 ,$101.00 ,$50.50 ,$13.74 ,$101.00 ,$14.20 ,$53.45 ,$45.81 ,$13.74 ,$60.60 ,$85.85 ,$70.70 ,$14.20 ,$95.95 ,$76.76 ,$75.75 ,$23.36 ,$85.85 ,$13.74 ,$23.36 ,$13.74 ,$70.70 ,$14.20 ,$13.74 ,$13.74 ,$15.55 ,$85.85 ,$30.92 ,$92.92 ,$70.70 ,$66.01 ,$66.01 ,$61.51 ,$66.01 ,$69.79 ,$90.90 ,$70.35 ,$13.88 ,$79.79 ,$15.05 ,$16.49 ,$16.49 ,$13.74 ,$16.49 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200150,86256,HC FLUOR AB TITER (C ANCA),302,1 ,$90.00 ,$45.00 ,$12.05 ,$90.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$54.00 ,$76.50 ,$63.00 ,$12.45 ,$85.50 ,$68.40 ,$67.50 ,$20.49 ,$76.50 ,$12.05 ,$20.49 ,$12.05 ,$63.00 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$76.50 ,$27.11 ,$82.80 ,$63.00 ,$57.91 ,$57.91 ,$54.81 ,$57.91 ,$62.19 ,$81.00 ,$62.69 ,$12.17 ,$71.10 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200151,86256,HC FLUOR AB TITER (P ANCA),302,1 ,$90.00 ,$45.00 ,$12.05 ,$90.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$54.00 ,$76.50 ,$63.00 ,$12.45 ,$85.50 ,$68.40 ,$67.50 ,$20.49 ,$76.50 ,$12.05 ,$20.49 ,$12.05 ,$63.00 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$76.50 ,$27.11 ,$82.80 ,$63.00 ,$57.91 ,$57.91 ,$54.81 ,$57.91 ,$62.19 ,$81.00 ,$62.69 ,$12.17 ,$71.10 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200152,86256,HC FLUOR AB TITER (CAT SCRATCH),302,1 ,$65.00 ,$32.50 ,$12.05 ,$65.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$39.00 ,$55.25 ,$45.50 ,$12.45 ,$61.75 ,$49.40 ,$48.75 ,$20.49 ,$55.25 ,$12.05 ,$20.49 ,$12.05 ,$45.50 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$55.25 ,$27.11 ,$59.80 ,$45.50 ,$57.91 ,$57.91 ,$39.59 ,$57.91 ,$44.92 ,$58.50 ,$45.27 ,$12.17 ,$51.35 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,30200153,86256,HC FLUOR AB TITER (MITOCHONDRIAL),302,1 ,$92.00 ,$46.00 ,$12.05 ,$92.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$55.20 ,$78.20 ,$64.40 ,$12.45 ,$87.40 ,$69.92 ,$69.00 ,$20.49 ,$78.20 ,$12.05 ,$20.49 ,$12.05 ,$64.40 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$78.20 ,$27.11 ,$84.64 ,$64.40 ,$57.91 ,$57.91 ,$56.03 ,$57.91 ,$63.57 ,$82.80 ,$64.08 ,$12.17 ,$72.68 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30200154,86256,HC FLUOR AB TITER (ENDOMYSIAL),302,1 ,$336.00 ,$168.00 ,$12.05 ,$336.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$201.60 ,$285.60 ,$235.20 ,$12.45 ,$319.20 ,$255.36 ,$252.00 ,$20.49 ,$285.60 ,$12.05 ,$20.49 ,$12.05 ,$235.20 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$285.60 ,$27.11 ,$309.12 ,$235.20 ,$57.91 ,$57.91 ,$204.62 ,$57.91 ,$232.18 ,$302.40 ,$234.02 ,$12.17 ,$265.44 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,30200155,86256,HC FLUOR AB TITER (RETICULAN),302,1 ,$60.00 ,$30.00 ,$12.05 ,$60.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$36.00 ,$51.00 ,$42.00 ,$12.45 ,$57.00 ,$45.60 ,$45.00 ,$20.49 ,$51.00 ,$12.05 ,$20.49 ,$12.05 ,$42.00 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$51.00 ,$27.11 ,$55.20 ,$42.00 ,$57.91 ,$57.91 ,$36.54 ,$57.91 ,$41.46 ,$54.00 ,$41.79 ,$12.17 ,$47.40 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,30200156,86256,HC FLUOR AB TITER (MUSCLE),302,1 ,$103.00 ,$51.50 ,$12.05 ,$103.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$61.80 ,$87.55 ,$72.10 ,$12.45 ,$97.85 ,$78.28 ,$77.25 ,$20.49 ,$87.55 ,$12.05 ,$20.49 ,$12.05 ,$72.10 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$87.55 ,$27.11 ,$94.76 ,$72.10 ,$57.91 ,$57.91 ,$62.73 ,$57.91 ,$71.17 ,$92.70 ,$71.74 ,$12.17 ,$81.37 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30200157,82677,HC ESTRIOL SERUM,302,1 ,$114.00 ,$57.00 ,$24.18 ,$114.00 ,$24.99 ,$94.05 ,$80.61 ,$24.18 ,$68.40 ,$96.90 ,$79.80 ,$24.99 ,$108.30 ,$86.64 ,$85.50 ,$41.11 ,$96.90 ,$24.18 ,$41.11 ,$24.18 ,$79.80 ,$24.99 ,$24.18 ,$24.18 ,$27.37 ,$96.90 ,$54.41 ,$104.88 ,$79.80 ,$114.00 ,$114.00 ,$69.43 ,$114.00 ,$78.77 ,$102.60 ,$79.40 ,$24.42 ,$90.06 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$91.20 
ST NICHOLAS HOSPITAL - ACUTE,30200158,86300,HC TUMOR AG CA 15-3 (27.29),302,1 ,$157.00 ,$78.50 ,$20.81 ,$157.00 ,$21.50 ,$80.96 ,$69.39 ,$20.81 ,$94.20 ,$133.45 ,$109.90 ,$21.50 ,$149.15 ,$119.32 ,$117.75 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$20.81 ,$109.90 ,$21.50 ,$20.81 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$100.01 ,$100.01 ,$95.61 ,$100.01 ,$108.49 ,$141.30 ,$109.35 ,$21.02 ,$124.03 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200159,86300,HC TUMOR AG CA 15-3 (27.29) 2,302,1 ,$131.00 ,$65.50 ,$20.81 ,$131.00 ,$21.50 ,$80.96 ,$69.39 ,$20.81 ,$78.60 ,$111.35 ,$91.70 ,$21.50 ,$124.45 ,$99.56 ,$98.25 ,$35.38 ,$111.35 ,$20.81 ,$35.38 ,$20.81 ,$91.70 ,$21.50 ,$20.81 ,$20.81 ,$23.55 ,$111.35 ,$46.82 ,$120.52 ,$91.70 ,$100.01 ,$100.01 ,$79.78 ,$100.01 ,$90.52 ,$117.90 ,$91.24 ,$21.02 ,$103.49 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$94.32 ,$81.22 ,$94.32 ,$94.32 ,$104.80 
ST NICHOLAS HOSPITAL - ACUTE,30200160,86301,HC TUMOR AG CA 19-9,302,1 ,$157.00 ,$78.50 ,$20.81 ,$157.00 ,$21.50 ,$80.96 ,$69.39 ,$20.81 ,$94.20 ,$133.45 ,$109.90 ,$21.50 ,$149.15 ,$119.32 ,$117.75 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$20.81 ,$109.90 ,$21.50 ,$20.81 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$100.01 ,$100.01 ,$95.61 ,$100.01 ,$108.49 ,$141.30 ,$109.35 ,$21.02 ,$124.03 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200161,86301,HC TUMOR AG CA 19-9 BODY FLUID,302,1 ,$157.00 ,$78.50 ,$20.81 ,$157.00 ,$21.50 ,$80.96 ,$69.39 ,$20.81 ,$94.20 ,$133.45 ,$109.90 ,$21.50 ,$149.15 ,$119.32 ,$117.75 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$20.81 ,$109.90 ,$21.50 ,$20.81 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$100.01 ,$100.01 ,$95.61 ,$100.01 ,$108.49 ,$141.30 ,$109.35 ,$21.02 ,$124.03 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200162,86304,HC TUMOR AG CA 125,302,1 ,$157.00 ,$78.50 ,$20.81 ,$157.00 ,$21.50 ,$80.96 ,$69.39 ,$20.81 ,$94.20 ,$133.45 ,$109.90 ,$21.50 ,$149.15 ,$119.32 ,$117.75 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$20.81 ,$109.90 ,$21.50 ,$20.81 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$100.01 ,$100.01 ,$95.61 ,$100.01 ,$108.49 ,$141.30 ,$109.35 ,$21.02 ,$124.03 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$78.00 ,$39.00 ,$5.18 ,$78.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$46.80 ,$66.30 ,$54.60 ,$5.35 ,$74.10 ,$59.28 ,$58.50 ,$8.81 ,$66.30 ,$5.18 ,$8.81 ,$5.18 ,$54.60 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$66.30 ,$11.66 ,$71.76 ,$54.60 ,$24.87 ,$24.87 ,$47.50 ,$24.87 ,$53.90 ,$70.20 ,$54.33 ,$5.23 ,$61.62 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200164,86316,HC TUMOR AG OTHER AG QN,302,1 ,$168.00 ,$84.00 ,$20.81 ,$168.00 ,$21.50 ,$80.96 ,$69.39 ,$20.81 ,$100.80 ,$142.80 ,$117.60 ,$21.50 ,$159.60 ,$127.68 ,$126.00 ,$35.38 ,$142.80 ,$20.81 ,$35.38 ,$20.81 ,$117.60 ,$21.50 ,$20.81 ,$20.81 ,$23.55 ,$142.80 ,$46.82 ,$154.56 ,$117.60 ,$100.01 ,$100.01 ,$102.31 ,$100.01 ,$116.09 ,$151.20 ,$117.01 ,$21.02 ,$132.72 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30200165,86317,HC INFECTIOUS AB QN,302,1 ,$112.00 ,$56.00 ,$14.99 ,$112.00 ,$15.49 ,$58.28 ,$49.95 ,$14.99 ,$67.20 ,$95.20 ,$78.40 ,$15.49 ,$106.40 ,$85.12 ,$84.00 ,$25.48 ,$95.20 ,$14.99 ,$25.48 ,$14.99 ,$78.40 ,$15.49 ,$14.99 ,$14.99 ,$16.97 ,$95.20 ,$33.73 ,$103.04 ,$78.40 ,$72.04 ,$72.04 ,$68.21 ,$72.04 ,$77.39 ,$100.80 ,$78.01 ,$15.14 ,$88.48 ,$16.42 ,$17.99 ,$17.99 ,$14.99 ,$17.99 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200166,86318,HC INFECTIOUS AB QL,302,1 ,$134.00 ,$67.00 ,$18.09 ,$134.00 ,$18.21 ,$63.32 ,$54.27 ,$18.09 ,$80.40 ,$113.90 ,$93.80 ,$18.21 ,$127.30 ,$101.84 ,$100.50 ,$30.75 ,$113.90 ,$18.09 ,$30.75 ,$18.09 ,$93.80 ,$18.21 ,$18.09 ,$18.09 ,$20.47 ,$113.90 ,$40.70 ,$123.28 ,$93.80 ,$62.21 ,$62.21 ,$81.61 ,$62.21 ,$92.59 ,$120.60 ,$93.33 ,$18.27 ,$105.86 ,$19.30 ,$21.71 ,$21.71 ,$18.09 ,$21.71 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30200167,86331,HC IMMUNODIFF EL EA AG AB QL,302,1 ,$48.00 ,$24.00 ,$11.98 ,$48.00 ,$12.38 ,$46.59 ,$39.93 ,$11.98 ,$28.80 ,$40.80 ,$33.60 ,$12.38 ,$45.60 ,$36.48 ,$36.00 ,$20.37 ,$40.80 ,$11.98 ,$20.37 ,$11.98 ,$33.60 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$40.80 ,$26.96 ,$44.16 ,$33.60 ,$48.00 ,$48.00 ,$29.23 ,$48.00 ,$33.17 ,$43.20 ,$33.43 ,$12.10 ,$37.92 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30200168,86331,HC IMMUNODIFF EL EA AG AB QL (TEICH),302,1 ,$48.00 ,$24.00 ,$11.98 ,$48.00 ,$12.38 ,$46.59 ,$39.93 ,$11.98 ,$28.80 ,$40.80 ,$33.60 ,$12.38 ,$45.60 ,$36.48 ,$36.00 ,$20.37 ,$40.80 ,$11.98 ,$20.37 ,$11.98 ,$33.60 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$40.80 ,$26.96 ,$44.16 ,$33.60 ,$48.00 ,$48.00 ,$29.23 ,$48.00 ,$33.17 ,$43.20 ,$33.43 ,$12.10 ,$37.92 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30200169,86334,HC IMMUNOFIX ELECTRO SERUM,302,1 ,$168.00 ,$84.00 ,$22.34 ,$168.00 ,$23.08 ,$86.91 ,$74.49 ,$22.34 ,$100.80 ,$142.80 ,$117.60 ,$23.08 ,$159.60 ,$127.68 ,$126.00 ,$37.98 ,$142.80 ,$22.34 ,$37.98 ,$22.34 ,$117.60 ,$23.08 ,$22.34 ,$22.34 ,$25.28 ,$142.80 ,$50.27 ,$154.56 ,$117.60 ,$107.37 ,$107.37 ,$102.31 ,$107.37 ,$116.09 ,$151.20 ,$117.01 ,$22.56 ,$132.72 ,$24.46 ,$26.81 ,$26.81 ,$22.34 ,$26.81 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30200170,86334,HC IMMUNOFIX ELECTRO REFLEX,302,1 ,$235.00 ,$117.50 ,$22.34 ,$235.00 ,$23.08 ,$86.91 ,$74.49 ,$22.34 ,$141.00 ,$199.75 ,$164.50 ,$23.08 ,$223.25 ,$178.60 ,$176.25 ,$37.98 ,$199.75 ,$22.34 ,$37.98 ,$22.34 ,$164.50 ,$23.08 ,$22.34 ,$22.34 ,$25.28 ,$199.75 ,$50.27 ,$216.20 ,$164.50 ,$107.37 ,$107.37 ,$143.12 ,$107.37 ,$162.39 ,$211.50 ,$163.68 ,$22.56 ,$185.65 ,$24.46 ,$26.81 ,$26.81 ,$22.34 ,$26.81 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,30200171,86335,HC IMMUNOFIX ELECTRO OTH,302,1 ,$224.00 ,$112.00 ,$29.35 ,$224.00 ,$30.33 ,$114.14 ,$97.83 ,$29.35 ,$134.40 ,$190.40 ,$156.80 ,$30.33 ,$212.80 ,$170.24 ,$168.00 ,$49.90 ,$190.40 ,$29.35 ,$49.90 ,$29.35 ,$156.80 ,$30.33 ,$29.35 ,$29.35 ,$33.22 ,$190.40 ,$66.04 ,$206.08 ,$156.80 ,$141.04 ,$141.04 ,$136.42 ,$141.04 ,$154.78 ,$201.60 ,$156.02 ,$29.64 ,$176.96 ,$32.15 ,$35.22 ,$35.22 ,$29.35 ,$35.22 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30200172,86335,HC IMMUNOFIX ELECTRO OTH (TRANS),302,1 ,$224.00 ,$112.00 ,$29.35 ,$224.00 ,$30.33 ,$114.14 ,$97.83 ,$29.35 ,$134.40 ,$190.40 ,$156.80 ,$30.33 ,$212.80 ,$170.24 ,$168.00 ,$49.90 ,$190.40 ,$29.35 ,$49.90 ,$29.35 ,$156.80 ,$30.33 ,$29.35 ,$29.35 ,$33.22 ,$190.40 ,$66.04 ,$206.08 ,$156.80 ,$141.04 ,$141.04 ,$136.42 ,$141.04 ,$154.78 ,$201.60 ,$156.02 ,$29.64 ,$176.96 ,$32.15 ,$35.22 ,$35.22 ,$29.35 ,$35.22 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30200173,86336,HC INHIBIN A,302,1 ,$123.00 ,$61.50 ,$15.59 ,$123.00 ,$16.11 ,$60.62 ,$51.96 ,$15.59 ,$73.80 ,$104.55 ,$86.10 ,$16.11 ,$116.85 ,$93.48 ,$92.25 ,$26.50 ,$104.55 ,$15.59 ,$26.50 ,$15.59 ,$86.10 ,$16.11 ,$15.59 ,$15.59 ,$17.64 ,$104.55 ,$35.08 ,$113.16 ,$86.10 ,$74.89 ,$74.89 ,$74.91 ,$74.89 ,$84.99 ,$110.70 ,$85.67 ,$15.75 ,$97.17 ,$17.08 ,$18.71 ,$18.71 ,$15.59 ,$18.71 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200174,86336,HC INHIBIN A (QUAD),302,1 ,$176.00 ,$88.00 ,$15.59 ,$176.00 ,$16.11 ,$60.62 ,$51.96 ,$15.59 ,$105.60 ,$149.60 ,$123.20 ,$16.11 ,$167.20 ,$133.76 ,$132.00 ,$26.50 ,$149.60 ,$15.59 ,$26.50 ,$15.59 ,$123.20 ,$16.11 ,$15.59 ,$15.59 ,$17.64 ,$149.60 ,$35.08 ,$161.92 ,$123.20 ,$74.89 ,$74.89 ,$107.18 ,$74.89 ,$121.62 ,$158.40 ,$122.58 ,$15.75 ,$139.04 ,$17.08 ,$18.71 ,$18.71 ,$15.59 ,$18.71 ,$126.72 ,$109.12 ,$126.72 ,$126.72 ,$140.80 
ST NICHOLAS HOSPITAL - ACUTE,30200175,86337,HC INSULIN AB (HS),302,1 ,$255.00 ,$127.50 ,$21.41 ,$255.00 ,$22.12 ,$83.27 ,$71.37 ,$21.41 ,$153.00 ,$216.75 ,$178.50 ,$22.12 ,$242.25 ,$193.80 ,$191.25 ,$36.40 ,$216.75 ,$21.41 ,$36.40 ,$21.41 ,$178.50 ,$22.12 ,$21.41 ,$21.41 ,$24.23 ,$216.75 ,$48.17 ,$234.60 ,$178.50 ,$102.90 ,$102.90 ,$155.30 ,$102.90 ,$176.21 ,$229.50 ,$177.61 ,$21.62 ,$201.45 ,$23.45 ,$25.69 ,$25.69 ,$21.41 ,$25.69 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,30200176,86337,HC INSULIN AB,302,1 ,$235.00 ,$117.50 ,$21.41 ,$235.00 ,$22.12 ,$83.27 ,$71.37 ,$21.41 ,$141.00 ,$199.75 ,$164.50 ,$22.12 ,$223.25 ,$178.60 ,$176.25 ,$36.40 ,$199.75 ,$21.41 ,$36.40 ,$21.41 ,$164.50 ,$22.12 ,$21.41 ,$21.41 ,$24.23 ,$199.75 ,$48.17 ,$216.20 ,$164.50 ,$102.90 ,$102.90 ,$143.12 ,$102.90 ,$162.39 ,$211.50 ,$163.68 ,$21.62 ,$185.65 ,$23.45 ,$25.69 ,$25.69 ,$21.41 ,$25.69 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,30200177,86340,HC INTRINSIC FACTOR AB,302,1 ,$112.00 ,$56.00 ,$14.28 ,$112.00 ,$14.28 ,$58.63 ,$50.25 ,$15.08 ,$67.20 ,$95.20 ,$78.40 ,$14.28 ,$106.40 ,$85.12 ,$84.00 ,$25.64 ,$95.20 ,$15.08 ,$25.64 ,$15.08 ,$78.40 ,$14.28 ,$15.08 ,$15.08 ,$17.07 ,$95.20 ,$33.93 ,$103.04 ,$78.40 ,$48.79 ,$48.79 ,$68.21 ,$48.79 ,$77.39 ,$100.80 ,$78.01 ,$15.23 ,$88.48 ,$15.14 ,$18.10 ,$18.10 ,$15.08 ,$18.10 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200178,86341,HC ISLET CELL AB,302,1 ,$101.00 ,$50.50 ,$19.88 ,$101.00 ,$19.88 ,$82.50 ,$70.71 ,$23.57 ,$60.60 ,$85.85 ,$70.70 ,$19.88 ,$95.95 ,$76.76 ,$75.75 ,$40.07 ,$85.85 ,$23.57 ,$40.07 ,$23.57 ,$70.70 ,$19.88 ,$23.57 ,$23.57 ,$26.68 ,$85.85 ,$53.03 ,$92.92 ,$70.70 ,$67.95 ,$67.95 ,$61.51 ,$67.95 ,$69.79 ,$90.90 ,$70.35 ,$23.81 ,$79.79 ,$21.07 ,$28.28 ,$28.28 ,$23.57 ,$28.28 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200179,86355,HC B CELLS TOTAL COUNT (CD19),302,1 ,$252.00 ,$126.00 ,$37.73 ,$252.00 ,$38.99 ,$146.72 ,$125.76 ,$37.73 ,$151.20 ,$214.20 ,$176.40 ,$38.99 ,$239.40 ,$191.52 ,$189.00 ,$64.14 ,$214.20 ,$37.73 ,$64.14 ,$37.73 ,$176.40 ,$38.99 ,$37.73 ,$37.73 ,$42.70 ,$214.20 ,$84.89 ,$231.84 ,$176.40 ,$181.27 ,$181.27 ,$153.47 ,$181.27 ,$174.13 ,$226.80 ,$175.52 ,$38.11 ,$199.08 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$181.44 ,$156.24 ,$181.44 ,$181.44 ,$201.60 
ST NICHOLAS HOSPITAL - ACUTE,30200180,86355,HC B CELLS TOTAL COUNT (CD20),302,1 ,$252.00 ,$126.00 ,$37.73 ,$252.00 ,$38.99 ,$146.72 ,$125.76 ,$37.73 ,$151.20 ,$214.20 ,$176.40 ,$38.99 ,$239.40 ,$191.52 ,$189.00 ,$64.14 ,$214.20 ,$37.73 ,$64.14 ,$37.73 ,$176.40 ,$38.99 ,$37.73 ,$37.73 ,$42.70 ,$214.20 ,$84.89 ,$231.84 ,$176.40 ,$181.27 ,$181.27 ,$153.47 ,$181.27 ,$174.13 ,$226.80 ,$175.52 ,$38.11 ,$199.08 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$181.44 ,$156.24 ,$181.44 ,$181.44 ,$201.60 
ST NICHOLAS HOSPITAL - ACUTE,30200181,86355,HC B CELLS TOTAL COUNT,302,1 ,$291.00 ,$145.50 ,$37.73 ,$291.00 ,$38.99 ,$146.72 ,$125.76 ,$37.73 ,$174.60 ,$247.35 ,$203.70 ,$38.99 ,$276.45 ,$221.16 ,$218.25 ,$64.14 ,$247.35 ,$37.73 ,$64.14 ,$37.73 ,$203.70 ,$38.99 ,$37.73 ,$37.73 ,$42.70 ,$247.35 ,$84.89 ,$267.72 ,$203.70 ,$181.27 ,$181.27 ,$177.22 ,$181.27 ,$201.08 ,$261.90 ,$202.68 ,$38.11 ,$229.89 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30200182,86357,HC CD8 TOTAL COUNT,302,1 ,$291.00 ,$145.50 ,$37.73 ,$291.00 ,$38.99 ,$146.72 ,$125.76 ,$37.73 ,$174.60 ,$247.35 ,$203.70 ,$38.99 ,$276.45 ,$221.16 ,$218.25 ,$64.14 ,$247.35 ,$37.73 ,$64.14 ,$37.73 ,$203.70 ,$38.99 ,$37.73 ,$37.73 ,$42.70 ,$247.35 ,$84.89 ,$267.72 ,$203.70 ,$181.27 ,$181.27 ,$177.22 ,$181.27 ,$201.08 ,$261.90 ,$202.68 ,$38.11 ,$229.89 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30200184,86360,HC ABS T CELLS CD4 CD8 RATIO,302,1 ,$358.00 ,$179.00 ,$46.98 ,$358.00 ,$48.54 ,$182.70 ,$156.60 ,$46.98 ,$214.80 ,$304.30 ,$250.60 ,$48.54 ,$340.10 ,$272.08 ,$268.50 ,$79.87 ,$304.30 ,$46.98 ,$79.87 ,$46.98 ,$250.60 ,$48.54 ,$46.98 ,$46.98 ,$53.17 ,$304.30 ,$105.71 ,$329.36 ,$250.60 ,$225.80 ,$225.80 ,$218.02 ,$225.80 ,$247.38 ,$322.20 ,$249.35 ,$47.45 ,$282.82 ,$51.45 ,$56.38 ,$56.38 ,$46.98 ,$56.38 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,30200185,86360,HC ABS T CELLS CD4 CD8 RATIO (MARKER),302,1 ,$358.00 ,$179.00 ,$46.98 ,$358.00 ,$48.54 ,$182.70 ,$156.60 ,$46.98 ,$214.80 ,$304.30 ,$250.60 ,$48.54 ,$340.10 ,$272.08 ,$268.50 ,$79.87 ,$304.30 ,$46.98 ,$79.87 ,$46.98 ,$250.60 ,$48.54 ,$46.98 ,$46.98 ,$53.17 ,$304.30 ,$105.71 ,$329.36 ,$250.60 ,$225.80 ,$225.80 ,$218.02 ,$225.80 ,$247.38 ,$322.20 ,$249.35 ,$47.45 ,$282.82 ,$51.45 ,$56.38 ,$56.38 ,$46.98 ,$56.38 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,30200186,86360,HC ABS T CELLS CD4 CD8 RATIO (CD3),302,1 ,$358.00 ,$179.00 ,$46.98 ,$358.00 ,$48.54 ,$182.70 ,$156.60 ,$46.98 ,$214.80 ,$304.30 ,$250.60 ,$48.54 ,$340.10 ,$272.08 ,$268.50 ,$79.87 ,$304.30 ,$46.98 ,$79.87 ,$46.98 ,$250.60 ,$48.54 ,$46.98 ,$46.98 ,$53.17 ,$304.30 ,$105.71 ,$329.36 ,$250.60 ,$225.80 ,$225.80 ,$218.02 ,$225.80 ,$247.38 ,$322.20 ,$249.35 ,$47.45 ,$282.82 ,$51.45 ,$56.38 ,$56.38 ,$46.98 ,$56.38 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,30200187,86361,HC T CELLS CD4 COUNT,302,1 ,$196.00 ,$98.00 ,$26.78 ,$196.00 ,$27.67 ,$104.13 ,$89.25 ,$26.78 ,$117.60 ,$166.60 ,$137.20 ,$27.67 ,$186.20 ,$148.96 ,$147.00 ,$45.53 ,$166.60 ,$26.78 ,$45.53 ,$26.78 ,$137.20 ,$27.67 ,$26.78 ,$26.78 ,$30.31 ,$166.60 ,$60.26 ,$180.32 ,$137.20 ,$128.68 ,$128.68 ,$119.36 ,$128.68 ,$135.44 ,$176.40 ,$136.51 ,$27.05 ,$154.84 ,$29.33 ,$32.14 ,$32.14 ,$26.78 ,$32.14 ,$141.12 ,$121.52 ,$141.12 ,$141.12 ,$156.80 
ST NICHOLAS HOSPITAL - ACUTE,30200188,86376,HC MICROSOMAL AB (TPO),302,1 ,$112.00 ,$56.00 ,$14.55 ,$112.00 ,$15.03 ,$56.60 ,$48.51 ,$14.55 ,$67.20 ,$95.20 ,$78.40 ,$15.03 ,$106.40 ,$85.12 ,$84.00 ,$24.74 ,$95.20 ,$14.55 ,$24.74 ,$14.55 ,$78.40 ,$15.03 ,$14.55 ,$14.55 ,$16.47 ,$95.20 ,$32.74 ,$103.04 ,$78.40 ,$69.92 ,$69.92 ,$68.21 ,$69.92 ,$77.39 ,$100.80 ,$78.01 ,$14.70 ,$88.48 ,$15.93 ,$17.46 ,$17.46 ,$14.55 ,$17.46 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200189,86376,HC MICROSOMAL AB,302,1 ,$112.00 ,$56.00 ,$14.55 ,$112.00 ,$15.03 ,$56.60 ,$48.51 ,$14.55 ,$67.20 ,$95.20 ,$78.40 ,$15.03 ,$106.40 ,$85.12 ,$84.00 ,$24.74 ,$95.20 ,$14.55 ,$24.74 ,$14.55 ,$78.40 ,$15.03 ,$14.55 ,$14.55 ,$16.47 ,$95.20 ,$32.74 ,$103.04 ,$78.40 ,$69.92 ,$69.92 ,$68.21 ,$69.92 ,$77.39 ,$100.80 ,$78.01 ,$14.70 ,$88.48 ,$15.93 ,$17.46 ,$17.46 ,$14.55 ,$17.46 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200190,86376,HC MICROSOMAL AB (LIV/KID),302,1 ,$112.00 ,$56.00 ,$14.55 ,$112.00 ,$15.03 ,$56.60 ,$48.51 ,$14.55 ,$67.20 ,$95.20 ,$78.40 ,$15.03 ,$106.40 ,$85.12 ,$84.00 ,$24.74 ,$95.20 ,$14.55 ,$24.74 ,$14.55 ,$78.40 ,$15.03 ,$14.55 ,$14.55 ,$16.47 ,$95.20 ,$32.74 ,$103.04 ,$78.40 ,$69.92 ,$69.92 ,$68.21 ,$69.92 ,$77.39 ,$100.80 ,$78.01 ,$14.70 ,$88.48 ,$15.93 ,$17.46 ,$17.46 ,$14.55 ,$17.46 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200191,86403,HC PARTICLE AGG SCREEN,302,1 ,$103.00 ,$51.50 ,$11.54 ,$103.00 ,$11.92 ,$40.39 ,$34.62 ,$11.54 ,$61.80 ,$87.55 ,$72.10 ,$11.92 ,$97.85 ,$78.28 ,$77.25 ,$19.62 ,$87.55 ,$11.54 ,$19.62 ,$11.54 ,$72.10 ,$11.92 ,$11.54 ,$11.54 ,$13.06 ,$87.55 ,$25.97 ,$94.76 ,$72.10 ,$48.96 ,$48.96 ,$62.73 ,$48.96 ,$71.17 ,$92.70 ,$71.74 ,$11.66 ,$81.37 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30200193,86403,HC STREPTOZYME,302,1 ,$57.00 ,$28.50 ,$11.54 ,$57.00 ,$11.92 ,$40.39 ,$34.62 ,$11.54 ,$34.20 ,$48.45 ,$39.90 ,$11.92 ,$54.15 ,$43.32 ,$42.75 ,$19.62 ,$48.45 ,$11.54 ,$19.62 ,$11.54 ,$39.90 ,$11.92 ,$11.54 ,$11.54 ,$13.06 ,$48.45 ,$25.97 ,$52.44 ,$39.90 ,$48.96 ,$48.96 ,$34.71 ,$48.96 ,$39.39 ,$51.30 ,$39.70 ,$11.66 ,$45.03 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$45.60 
ST NICHOLAS HOSPITAL - ACUTE,30200194,86403,HC CRYPTOCOCCUS AB,302,1 ,$91.00 ,$45.50 ,$11.54 ,$91.00 ,$11.92 ,$40.39 ,$34.62 ,$11.54 ,$54.60 ,$77.35 ,$63.70 ,$11.92 ,$86.45 ,$69.16 ,$68.25 ,$19.62 ,$77.35 ,$11.54 ,$19.62 ,$11.54 ,$63.70 ,$11.92 ,$11.54 ,$11.54 ,$13.06 ,$77.35 ,$25.97 ,$83.72 ,$63.70 ,$48.96 ,$48.96 ,$55.42 ,$48.96 ,$62.88 ,$81.90 ,$63.38 ,$11.66 ,$71.89 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$65.52 ,$56.42 ,$65.52 ,$65.52 ,$72.80 
ST NICHOLAS HOSPITAL - ACUTE,30200195,86403,HC MAYO CRYPTOCOCCUS AG,302,1 ,$160.00 ,$80.00 ,$11.54 ,$160.00 ,$11.92 ,$40.39 ,$34.62 ,$11.54 ,$96.00 ,$136.00 ,$112.00 ,$11.92 ,$152.00 ,$121.60 ,$120.00 ,$19.62 ,$136.00 ,$11.54 ,$19.62 ,$11.54 ,$112.00 ,$11.92 ,$11.54 ,$11.54 ,$13.06 ,$136.00 ,$25.97 ,$147.20 ,$112.00 ,$48.96 ,$48.96 ,$97.44 ,$48.96 ,$110.56 ,$144.00 ,$111.44 ,$11.66 ,$126.40 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,30200196,86406,HC PARTICLE AGGLUT TITER,302,1 ,$80.00 ,$40.00 ,$9.85 ,$80.00 ,$9.85 ,$41.37 ,$35.46 ,$10.64 ,$48.00 ,$68.00 ,$56.00 ,$9.85 ,$76.00 ,$60.80 ,$60.00 ,$18.09 ,$68.00 ,$10.64 ,$18.09 ,$10.64 ,$56.00 ,$9.85 ,$10.64 ,$10.64 ,$12.04 ,$68.00 ,$23.94 ,$73.60 ,$56.00 ,$33.64 ,$33.64 ,$48.72 ,$33.64 ,$55.28 ,$72.00 ,$55.72 ,$10.75 ,$63.20 ,$10.44 ,$12.77 ,$12.77 ,$10.64 ,$12.77 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,30200197,86430,HC RHEUMATOID FACTOR,302,1 ,$47.00 ,$23.50 ,$6.14 ,$47.00 ,$6.34 ,$22.05 ,$18.90 ,$6.14 ,$28.20 ,$39.95 ,$32.90 ,$6.34 ,$44.65 ,$35.72 ,$35.25 ,$10.44 ,$39.95 ,$6.14 ,$10.44 ,$6.14 ,$32.90 ,$6.34 ,$6.14 ,$6.14 ,$6.95 ,$39.95 ,$13.82 ,$43.24 ,$32.90 ,$27.26 ,$27.26 ,$28.62 ,$27.26 ,$32.48 ,$42.30 ,$32.74 ,$6.20 ,$37.13 ,$6.72 ,$7.37 ,$7.37 ,$6.14 ,$7.37 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$37.60 
ST NICHOLAS HOSPITAL - ACUTE,30200198,86431,HC RHEUMATOID FACTOR QN,302,1 ,$44.00 ,$22.00 ,$5.67 ,$44.00 ,$5.86 ,$22.05 ,$18.90 ,$5.67 ,$26.40 ,$37.40 ,$30.80 ,$5.86 ,$41.80 ,$33.44 ,$33.00 ,$9.64 ,$37.40 ,$5.67 ,$9.64 ,$5.67 ,$30.80 ,$5.86 ,$5.67 ,$5.67 ,$6.42 ,$37.40 ,$12.76 ,$40.48 ,$30.80 ,$27.26 ,$27.26 ,$26.80 ,$27.26 ,$30.40 ,$39.60 ,$30.65 ,$5.73 ,$34.76 ,$6.21 ,$6.80 ,$6.80 ,$5.67 ,$6.80 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$35.20 
ST NICHOLAS HOSPITAL - ACUTE,30200199,86480,HC TB QUANTIFERON GOLD,302,1 ,$470.00 ,$235.00 ,$61.98 ,$470.00 ,$64.04 ,$241.05 ,$206.61 ,$61.98 ,$282.00 ,$399.50 ,$329.00 ,$64.04 ,$446.50 ,$357.20 ,$352.50 ,$105.37 ,$399.50 ,$61.98 ,$105.37 ,$61.98 ,$329.00 ,$64.04 ,$61.98 ,$61.98 ,$70.15 ,$399.50 ,$139.46 ,$432.40 ,$329.00 ,$297.87 ,$297.87 ,$286.23 ,$297.87 ,$324.77 ,$423.00 ,$327.36 ,$62.60 ,$371.30 ,$67.88 ,$74.38 ,$74.38 ,$61.98 ,$74.38 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,30200200,86580,HC SKIN TEST TB INTRADERMAL,302,1 ,$67.00 ,$33.50 ,$3.28 ,$67.00 ,$3.28 ,$28.20 ,$24.17 ,$24.36 ,$40.20 ,$56.95 ,$46.90 ,$3.28 ,$63.65 ,$50.92 ,$50.25 ,$16.80 ,$56.95 ,$24.36 ,$16.80 ,$8.68 ,$46.90 ,$3.28 ,$24.36 ,$24.36 ,$28.14 ,$56.95 ,$54.81 ,$61.64 ,$46.90 ,$47.52 ,$47.52 ,$40.80 ,$47.52 ,$46.30 ,$60.30 ,$46.67 ,$24.60 ,$52.93 ,$3.48 ,$27.59 ,$27.59 ,$24.36 ,$27.59 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200201,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$32.00 ,$16.00 ,$4.27 ,$32.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$19.20 ,$27.20 ,$22.40 ,$4.41 ,$30.40 ,$24.32 ,$24.00 ,$7.26 ,$27.20 ,$4.27 ,$7.26 ,$4.27 ,$22.40 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$27.20 ,$9.61 ,$29.44 ,$22.40 ,$20.50 ,$20.50 ,$19.49 ,$20.50 ,$22.11 ,$28.80 ,$22.29 ,$4.31 ,$25.28 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$25.60 
ST NICHOLAS HOSPITAL - ACUTE,30200203,86592,HC SYPHILIS VDRL RPR QL (CSF),302,1 ,$65.00 ,$32.50 ,$4.27 ,$65.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$39.00 ,$55.25 ,$45.50 ,$4.41 ,$61.75 ,$49.40 ,$48.75 ,$7.26 ,$55.25 ,$4.27 ,$7.26 ,$4.27 ,$45.50 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$55.25 ,$9.61 ,$59.80 ,$45.50 ,$20.50 ,$20.50 ,$39.59 ,$20.50 ,$44.92 ,$58.50 ,$45.27 ,$4.31 ,$51.35 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,30200205,86602,HC ACTINOMYCES AB,302,1 ,$103.00 ,$51.50 ,$8.17 ,$103.00 ,$8.17 ,$39.59 ,$33.93 ,$10.18 ,$61.80 ,$87.55 ,$72.10 ,$8.17 ,$97.85 ,$78.28 ,$77.25 ,$17.31 ,$87.55 ,$10.18 ,$17.31 ,$10.18 ,$72.10 ,$8.17 ,$10.18 ,$10.18 ,$11.52 ,$87.55 ,$22.91 ,$94.76 ,$72.10 ,$27.93 ,$27.93 ,$62.73 ,$27.93 ,$71.17 ,$92.70 ,$71.74 ,$10.28 ,$81.37 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30200206,86603,HC ADENOVIRUS AB,302,1 ,$59.00 ,$29.50 ,$8.17 ,$59.00 ,$8.17 ,$50.05 ,$42.90 ,$12.87 ,$35.40 ,$50.15 ,$41.30 ,$8.17 ,$56.05 ,$44.84 ,$44.25 ,$21.88 ,$50.15 ,$12.87 ,$21.88 ,$12.87 ,$41.30 ,$8.17 ,$12.87 ,$12.87 ,$14.57 ,$50.15 ,$28.96 ,$54.28 ,$41.30 ,$27.93 ,$27.93 ,$35.93 ,$27.93 ,$40.77 ,$53.10 ,$41.09 ,$13.00 ,$46.61 ,$8.66 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$47.20 
ST NICHOLAS HOSPITAL - ACUTE,30200207,86606,HC ASPERGILLUS AB,302,1 ,$68.00 ,$34.00 ,$8.17 ,$68.00 ,$8.17 ,$58.56 ,$50.19 ,$15.05 ,$40.80 ,$57.80 ,$47.60 ,$8.17 ,$64.60 ,$51.68 ,$51.00 ,$25.59 ,$57.80 ,$15.05 ,$25.59 ,$15.05 ,$47.60 ,$8.17 ,$15.05 ,$15.05 ,$17.03 ,$57.80 ,$33.86 ,$62.56 ,$47.60 ,$27.93 ,$27.93 ,$41.41 ,$27.93 ,$46.99 ,$61.20 ,$47.36 ,$15.20 ,$53.72 ,$8.66 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$54.40 
ST NICHOLAS HOSPITAL - ACUTE,30200208,86606,HC ASPERGILLUS AB (ASPER),302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$56.00 ,$50.19 ,$15.05 ,$33.60 ,$47.60 ,$39.20 ,$8.17 ,$53.20 ,$42.56 ,$42.00 ,$25.59 ,$47.60 ,$15.05 ,$25.59 ,$15.05 ,$39.20 ,$8.17 ,$15.05 ,$15.05 ,$17.03 ,$47.60 ,$33.86 ,$51.52 ,$39.20 ,$27.93 ,$27.93 ,$34.10 ,$27.93 ,$38.70 ,$50.40 ,$39.00 ,$15.20 ,$44.24 ,$8.66 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200209,86606,HC ASPERGILLUS AB (FLAV/FUM/NIGER),302,1 ,$12.00 ,$6.00 ,$6.00 ,$27.00 ,$8.17 ,$12.00 ,$12.00 ,$12.00 ,$7.20 ,$10.20 ,$8.40 ,$8.17 ,$11.40 ,$9.12 ,$9.00 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$12.00 ,$8.40 ,$8.17 ,$12.00 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$10.80 ,$8.36 ,$12.12 ,$9.48 ,$8.66 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$9.60 
ST NICHOLAS HOSPITAL - ACUTE,30200210,86606,HC ASPERGILLIS AB (HS PNEUMO),302,1 ,$30.00 ,$15.00 ,$8.17 ,$33.86 ,$8.17 ,$30.00 ,$30.00 ,$15.05 ,$18.00 ,$25.50 ,$21.00 ,$8.17 ,$28.50 ,$22.80 ,$22.50 ,$25.59 ,$25.50 ,$15.05 ,$25.59 ,$15.05 ,$21.00 ,$8.17 ,$15.05 ,$15.05 ,$17.03 ,$25.50 ,$33.86 ,$27.60 ,$21.00 ,$27.93 ,$27.93 ,$18.27 ,$27.93 ,$20.73 ,$27.00 ,$20.90 ,$15.20 ,$23.70 ,$8.66 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,30200211,86609,HC BACTERIUM AB NOS,302,1 ,$35.00 ,$17.50 ,$8.17 ,$35.00 ,$8.17 ,$35.00 ,$35.00 ,$12.88 ,$21.00 ,$29.75 ,$24.50 ,$8.17 ,$33.25 ,$26.60 ,$26.25 ,$21.90 ,$29.75 ,$12.88 ,$21.90 ,$12.88 ,$24.50 ,$8.17 ,$12.88 ,$12.88 ,$14.58 ,$29.75 ,$28.98 ,$32.20 ,$24.50 ,$27.93 ,$27.93 ,$21.32 ,$27.93 ,$24.19 ,$31.50 ,$24.38 ,$13.01 ,$27.65 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,30200212,86611,HC BARTONELLA SCREEN AB,302,1 ,$57.00 ,$28.50 ,$8.17 ,$57.00 ,$8.17 ,$39.59 ,$33.93 ,$10.18 ,$34.20 ,$48.45 ,$39.90 ,$8.17 ,$54.15 ,$43.32 ,$42.75 ,$17.31 ,$48.45 ,$10.18 ,$17.31 ,$10.18 ,$39.90 ,$8.17 ,$10.18 ,$10.18 ,$11.52 ,$48.45 ,$22.91 ,$52.44 ,$39.90 ,$27.93 ,$27.93 ,$34.71 ,$27.93 ,$39.39 ,$51.30 ,$39.70 ,$10.28 ,$45.03 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$45.60 
ST NICHOLAS HOSPITAL - ACUTE,30200213,86612,HC BLASTOMYCES AB,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$50.19 ,$43.02 ,$12.90 ,$46.80 ,$66.30 ,$54.60 ,$8.17 ,$74.10 ,$59.28 ,$58.50 ,$21.93 ,$66.30 ,$12.90 ,$21.93 ,$12.90 ,$54.60 ,$8.17 ,$12.90 ,$12.90 ,$14.60 ,$66.30 ,$29.03 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$13.03 ,$61.62 ,$8.66 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200214,86612,HC BLASTOMYCES AB (CF/ID),302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$50.19 ,$43.02 ,$12.90 ,$46.80 ,$66.30 ,$54.60 ,$8.17 ,$74.10 ,$59.28 ,$58.50 ,$21.93 ,$66.30 ,$12.90 ,$21.93 ,$12.90 ,$54.60 ,$8.17 ,$12.90 ,$12.90 ,$14.60 ,$66.30 ,$29.03 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$13.03 ,$61.62 ,$8.66 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200215,86612,HC BLASTO AB ID,302,1 ,$12.00 ,$6.00 ,$6.00 ,$27.00 ,$8.17 ,$12.00 ,$12.00 ,$12.00 ,$7.20 ,$10.20 ,$8.40 ,$8.17 ,$11.40 ,$9.12 ,$9.00 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$12.00 ,$8.40 ,$8.17 ,$12.00 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$10.80 ,$8.36 ,$12.12 ,$9.48 ,$8.66 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$9.60 
ST NICHOLAS HOSPITAL - ACUTE,30200216,86612,HC BLASTOMYCES AB (MAYO),302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$50.19 ,$43.02 ,$12.90 ,$46.80 ,$66.30 ,$54.60 ,$8.17 ,$74.10 ,$59.28 ,$58.50 ,$21.93 ,$66.30 ,$12.90 ,$21.93 ,$12.90 ,$54.60 ,$8.17 ,$12.90 ,$12.90 ,$14.60 ,$66.30 ,$29.03 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$13.03 ,$61.62 ,$8.66 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200217,86617,HC LYME DISEASE AB CONFIRM (IGG),302,1 ,$123.00 ,$61.50 ,$15.49 ,$123.00 ,$16.01 ,$60.24 ,$51.63 ,$15.49 ,$73.80 ,$104.55 ,$86.10 ,$16.01 ,$116.85 ,$93.48 ,$92.25 ,$26.33 ,$104.55 ,$15.49 ,$26.33 ,$15.49 ,$86.10 ,$16.01 ,$15.49 ,$15.49 ,$17.53 ,$104.55 ,$34.85 ,$113.16 ,$86.10 ,$74.43 ,$74.43 ,$74.91 ,$74.43 ,$84.99 ,$110.70 ,$85.67 ,$15.64 ,$97.17 ,$16.97 ,$18.59 ,$18.59 ,$15.49 ,$18.59 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200218,86617,HC LYME DISEASE AB CONFIRM (IGM),302,1 ,$123.00 ,$61.50 ,$15.49 ,$123.00 ,$16.01 ,$60.24 ,$51.63 ,$15.49 ,$73.80 ,$104.55 ,$86.10 ,$16.01 ,$116.85 ,$93.48 ,$92.25 ,$26.33 ,$104.55 ,$15.49 ,$26.33 ,$15.49 ,$86.10 ,$16.01 ,$15.49 ,$15.49 ,$17.53 ,$104.55 ,$34.85 ,$113.16 ,$86.10 ,$74.43 ,$74.43 ,$74.91 ,$74.43 ,$84.99 ,$110.70 ,$85.67 ,$15.64 ,$97.17 ,$16.97 ,$18.59 ,$18.59 ,$15.49 ,$18.59 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200219,86618,HC LYME AB,302,1 ,$134.00 ,$67.00 ,$17.03 ,$134.00 ,$17.60 ,$66.22 ,$56.76 ,$17.03 ,$80.40 ,$113.90 ,$93.80 ,$17.60 ,$127.30 ,$101.84 ,$100.50 ,$28.95 ,$113.90 ,$17.03 ,$28.95 ,$17.03 ,$93.80 ,$17.60 ,$17.03 ,$17.03 ,$19.27 ,$113.90 ,$38.32 ,$123.28 ,$93.80 ,$81.87 ,$81.87 ,$81.61 ,$81.87 ,$92.59 ,$120.60 ,$93.33 ,$17.20 ,$105.86 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30200220,86622,HC BRUCELLA AB (IGG/IGM),302,1 ,$67.00 ,$33.50 ,$8.17 ,$67.00 ,$8.17 ,$34.72 ,$29.76 ,$8.93 ,$40.20 ,$56.95 ,$46.90 ,$8.17 ,$63.65 ,$50.92 ,$50.25 ,$15.18 ,$56.95 ,$8.93 ,$15.18 ,$8.93 ,$46.90 ,$8.17 ,$8.93 ,$8.93 ,$10.11 ,$56.95 ,$20.09 ,$61.64 ,$46.90 ,$27.93 ,$27.93 ,$40.80 ,$27.93 ,$46.30 ,$60.30 ,$46.67 ,$9.02 ,$52.93 ,$8.66 ,$10.72 ,$10.72 ,$8.93 ,$10.72 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200221,86622,HC BRUCELLA AB,302,1 ,$60.00 ,$30.00 ,$8.17 ,$60.00 ,$8.17 ,$34.72 ,$29.76 ,$8.93 ,$36.00 ,$51.00 ,$42.00 ,$8.17 ,$57.00 ,$45.60 ,$45.00 ,$15.18 ,$51.00 ,$8.93 ,$15.18 ,$8.93 ,$42.00 ,$8.17 ,$8.93 ,$8.93 ,$10.11 ,$51.00 ,$20.09 ,$55.20 ,$42.00 ,$27.93 ,$27.93 ,$36.54 ,$27.93 ,$41.46 ,$54.00 ,$41.79 ,$9.02 ,$47.40 ,$8.66 ,$10.72 ,$10.72 ,$8.93 ,$10.72 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,30200222,86628,HC CANDIDA AB,302,1 ,$62.00 ,$31.00 ,$8.17 ,$62.00 ,$8.17 ,$46.69 ,$40.02 ,$12.01 ,$37.20 ,$52.70 ,$43.40 ,$8.17 ,$58.90 ,$47.12 ,$46.50 ,$20.42 ,$52.70 ,$12.01 ,$20.42 ,$12.01 ,$43.40 ,$8.17 ,$12.01 ,$12.01 ,$13.59 ,$52.70 ,$27.02 ,$57.04 ,$43.40 ,$27.93 ,$27.93 ,$37.76 ,$27.93 ,$42.84 ,$55.80 ,$43.18 ,$12.13 ,$48.98 ,$8.66 ,$14.41 ,$14.41 ,$12.01 ,$14.41 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30200223,86631,HC CHLAMYDIA AB,302,1 ,$60.00 ,$30.00 ,$8.17 ,$60.00 ,$8.17 ,$45.99 ,$39.42 ,$11.82 ,$36.00 ,$51.00 ,$42.00 ,$8.17 ,$57.00 ,$45.60 ,$45.00 ,$20.09 ,$51.00 ,$11.82 ,$20.09 ,$11.82 ,$42.00 ,$8.17 ,$11.82 ,$11.82 ,$13.38 ,$51.00 ,$26.60 ,$55.20 ,$42.00 ,$27.93 ,$27.93 ,$36.54 ,$27.93 ,$41.46 ,$54.00 ,$41.79 ,$11.94 ,$47.40 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,30200224,86631,HC CHLAMYDIA AB IGG,302,1 ,$48.00 ,$24.00 ,$8.17 ,$48.00 ,$8.17 ,$45.99 ,$39.42 ,$11.82 ,$28.80 ,$40.80 ,$33.60 ,$8.17 ,$45.60 ,$36.48 ,$36.00 ,$20.09 ,$40.80 ,$11.82 ,$20.09 ,$11.82 ,$33.60 ,$8.17 ,$11.82 ,$11.82 ,$13.38 ,$40.80 ,$26.60 ,$44.16 ,$33.60 ,$27.93 ,$27.93 ,$29.23 ,$27.93 ,$33.17 ,$43.20 ,$33.43 ,$11.94 ,$37.92 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30200225,86631,HC CHLAMYDIA AB (GRP AB),302,1 ,$146.00 ,$73.00 ,$8.17 ,$146.00 ,$8.17 ,$45.99 ,$39.42 ,$11.82 ,$87.60 ,$124.10 ,$102.20 ,$8.17 ,$138.70 ,$110.96 ,$109.50 ,$20.09 ,$124.10 ,$11.82 ,$20.09 ,$11.82 ,$102.20 ,$8.17 ,$11.82 ,$11.82 ,$13.38 ,$124.10 ,$26.60 ,$134.32 ,$102.20 ,$27.93 ,$27.93 ,$88.91 ,$27.93 ,$100.89 ,$131.40 ,$101.69 ,$11.94 ,$115.34 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200226,86631,HC CHLAMYDIA AB (PSITT IGG/IGA),302,1 ,$17.00 ,$8.50 ,$8.17 ,$26.60 ,$8.17 ,$17.00 ,$17.00 ,$11.82 ,$10.20 ,$14.45 ,$11.90 ,$8.17 ,$16.15 ,$12.92 ,$12.75 ,$17.00 ,$14.45 ,$11.82 ,$17.00 ,$11.82 ,$11.90 ,$8.17 ,$11.82 ,$11.82 ,$13.38 ,$14.45 ,$26.60 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$15.30 ,$11.84 ,$11.94 ,$13.43 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,30200227,86631,HC CHLAMYDIA AB IGG 2,302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$45.99 ,$39.42 ,$11.82 ,$33.60 ,$47.60 ,$39.20 ,$8.17 ,$53.20 ,$42.56 ,$42.00 ,$20.09 ,$47.60 ,$11.82 ,$20.09 ,$11.82 ,$39.20 ,$8.17 ,$11.82 ,$11.82 ,$13.38 ,$47.60 ,$26.60 ,$51.52 ,$39.20 ,$27.93 ,$27.93 ,$34.10 ,$27.93 ,$38.70 ,$50.40 ,$39.00 ,$11.94 ,$44.24 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200228,86632,HC CHLAMYDIA AB IGM SEROLOGY,302,1 ,$60.00 ,$30.00 ,$8.17 ,$60.00 ,$8.17 ,$49.32 ,$42.27 ,$12.68 ,$36.00 ,$51.00 ,$42.00 ,$8.17 ,$57.00 ,$45.60 ,$45.00 ,$21.56 ,$51.00 ,$12.68 ,$21.56 ,$12.68 ,$42.00 ,$8.17 ,$12.68 ,$12.68 ,$14.35 ,$51.00 ,$28.53 ,$55.20 ,$42.00 ,$27.93 ,$27.93 ,$36.54 ,$27.93 ,$41.46 ,$54.00 ,$41.79 ,$12.81 ,$47.40 ,$8.66 ,$15.22 ,$15.22 ,$12.68 ,$15.22 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$48.00 
ST NICHOLAS HOSPITAL - ACUTE,30200229,86632,HC CHLAMYDIA AB IGM PSITTACI,302,1 ,$17.00 ,$8.50 ,$8.17 ,$28.53 ,$8.17 ,$17.00 ,$17.00 ,$12.68 ,$10.20 ,$14.45 ,$11.90 ,$8.17 ,$16.15 ,$12.92 ,$12.75 ,$17.00 ,$14.45 ,$12.68 ,$17.00 ,$12.68 ,$11.90 ,$8.17 ,$12.68 ,$12.68 ,$14.35 ,$14.45 ,$28.53 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$15.30 ,$11.84 ,$12.81 ,$13.43 ,$8.66 ,$15.22 ,$15.22 ,$12.68 ,$15.22 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,30200230,86632,HC CHLAMYDIA AB IGM,302,1 ,$55.00 ,$27.50 ,$8.17 ,$55.00 ,$8.17 ,$49.32 ,$42.27 ,$12.68 ,$33.00 ,$46.75 ,$38.50 ,$8.17 ,$52.25 ,$41.80 ,$41.25 ,$21.56 ,$46.75 ,$12.68 ,$21.56 ,$12.68 ,$38.50 ,$8.17 ,$12.68 ,$12.68 ,$14.35 ,$46.75 ,$28.53 ,$50.60 ,$38.50 ,$27.93 ,$27.93 ,$33.50 ,$27.93 ,$38.01 ,$49.50 ,$38.31 ,$12.81 ,$43.45 ,$8.66 ,$15.22 ,$15.22 ,$12.68 ,$15.22 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$44.00 
ST NICHOLAS HOSPITAL - ACUTE,30200231,86635,HC COCCIDIOIDES AB,302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$44.63 ,$38.25 ,$11.47 ,$33.60 ,$47.60 ,$39.20 ,$8.17 ,$53.20 ,$42.56 ,$42.00 ,$19.50 ,$47.60 ,$11.47 ,$19.50 ,$11.47 ,$39.20 ,$8.17 ,$11.47 ,$11.47 ,$12.98 ,$47.60 ,$25.81 ,$51.52 ,$39.20 ,$27.93 ,$27.93 ,$34.10 ,$27.93 ,$38.70 ,$50.40 ,$39.00 ,$11.58 ,$44.24 ,$8.66 ,$13.76 ,$13.76 ,$11.47 ,$13.76 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200232,86635,HC COCCID AB,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$44.63 ,$38.25 ,$11.47 ,$46.80 ,$66.30 ,$54.60 ,$8.17 ,$74.10 ,$59.28 ,$58.50 ,$19.50 ,$66.30 ,$11.47 ,$19.50 ,$11.47 ,$54.60 ,$8.17 ,$11.47 ,$11.47 ,$12.98 ,$66.30 ,$25.81 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$11.58 ,$61.62 ,$8.66 ,$13.76 ,$13.76 ,$11.47 ,$13.76 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200233,86638,HC Q FEVER AB IGG,302,1 ,$72.00 ,$36.00 ,$8.17 ,$72.00 ,$8.17 ,$47.15 ,$40.41 ,$12.12 ,$43.20 ,$61.20 ,$50.40 ,$8.17 ,$68.40 ,$54.72 ,$54.00 ,$20.60 ,$61.20 ,$12.12 ,$20.60 ,$12.12 ,$50.40 ,$8.17 ,$12.12 ,$12.12 ,$13.72 ,$61.20 ,$27.27 ,$66.24 ,$50.40 ,$27.93 ,$27.93 ,$43.85 ,$27.93 ,$49.75 ,$64.80 ,$50.15 ,$12.24 ,$56.88 ,$8.66 ,$14.54 ,$14.54 ,$12.12 ,$14.54 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$57.60 
ST NICHOLAS HOSPITAL - ACUTE,30200234,86638,HC Q FEVER AB IGM,302,1 ,$72.00 ,$36.00 ,$8.17 ,$72.00 ,$8.17 ,$47.15 ,$40.41 ,$12.12 ,$43.20 ,$61.20 ,$50.40 ,$8.17 ,$68.40 ,$54.72 ,$54.00 ,$20.60 ,$61.20 ,$12.12 ,$20.60 ,$12.12 ,$50.40 ,$8.17 ,$12.12 ,$12.12 ,$13.72 ,$61.20 ,$27.27 ,$66.24 ,$50.40 ,$27.93 ,$27.93 ,$43.85 ,$27.93 ,$49.75 ,$64.80 ,$50.15 ,$12.24 ,$56.88 ,$8.66 ,$14.54 ,$14.54 ,$12.12 ,$14.54 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$57.60 
ST NICHOLAS HOSPITAL - ACUTE,30200235,86645,HC CMV AB IGM,302,1 ,$101.00 ,$50.50 ,$8.17 ,$101.00 ,$8.17 ,$65.52 ,$56.16 ,$16.85 ,$60.60 ,$85.85 ,$70.70 ,$8.17 ,$95.95 ,$76.76 ,$75.75 ,$28.65 ,$85.85 ,$16.85 ,$28.65 ,$16.85 ,$70.70 ,$8.17 ,$16.85 ,$16.85 ,$19.07 ,$85.85 ,$37.91 ,$92.92 ,$70.70 ,$27.93 ,$27.93 ,$61.51 ,$27.93 ,$69.79 ,$90.90 ,$70.35 ,$17.02 ,$79.79 ,$8.66 ,$20.22 ,$20.22 ,$16.85 ,$20.22 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200236,86651,HC ENCEPHALITIS CALIFORNIA AB,302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$51.28 ,$43.95 ,$13.19 ,$33.60 ,$47.60 ,$39.20 ,$8.17 ,$53.20 ,$42.56 ,$42.00 ,$22.42 ,$47.60 ,$13.19 ,$22.42 ,$13.19 ,$39.20 ,$8.17 ,$13.19 ,$13.19 ,$14.93 ,$47.60 ,$29.68 ,$51.52 ,$39.20 ,$27.93 ,$27.93 ,$34.10 ,$27.93 ,$38.70 ,$50.40 ,$39.00 ,$13.32 ,$44.24 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200237,86652,HC ENCEPHALITIS EQUINE AB,302,1 ,$68.00 ,$34.00 ,$8.17 ,$68.00 ,$8.17 ,$51.28 ,$43.95 ,$13.19 ,$40.80 ,$57.80 ,$47.60 ,$8.17 ,$64.60 ,$51.68 ,$51.00 ,$22.42 ,$57.80 ,$13.19 ,$22.42 ,$13.19 ,$47.60 ,$8.17 ,$13.19 ,$13.19 ,$14.93 ,$57.80 ,$29.68 ,$62.56 ,$47.60 ,$27.93 ,$27.93 ,$41.41 ,$27.93 ,$46.99 ,$61.20 ,$47.36 ,$13.32 ,$53.72 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$54.40 
ST NICHOLAS HOSPITAL - ACUTE,30200238,86653,HC ENCEPHALITIS ST LOUIS AB,302,1 ,$69.00 ,$34.50 ,$8.17 ,$69.00 ,$8.17 ,$51.28 ,$43.95 ,$13.19 ,$41.40 ,$58.65 ,$48.30 ,$8.17 ,$65.55 ,$52.44 ,$51.75 ,$22.42 ,$58.65 ,$13.19 ,$22.42 ,$13.19 ,$48.30 ,$8.17 ,$13.19 ,$13.19 ,$14.93 ,$58.65 ,$29.68 ,$63.48 ,$48.30 ,$27.93 ,$27.93 ,$42.02 ,$27.93 ,$47.68 ,$62.10 ,$48.06 ,$13.32 ,$54.51 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30200239,86654,HC ENCEPHALITIS WEST EQUINE AB,302,1 ,$68.00 ,$34.00 ,$8.17 ,$68.00 ,$8.17 ,$51.28 ,$43.95 ,$13.19 ,$40.80 ,$57.80 ,$47.60 ,$8.17 ,$64.60 ,$51.68 ,$51.00 ,$22.42 ,$57.80 ,$13.19 ,$22.42 ,$13.19 ,$47.60 ,$8.17 ,$13.19 ,$13.19 ,$14.93 ,$57.80 ,$29.68 ,$62.56 ,$47.60 ,$27.93 ,$27.93 ,$41.41 ,$27.93 ,$46.99 ,$61.20 ,$47.36 ,$13.32 ,$53.72 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$54.40 
ST NICHOLAS HOSPITAL - ACUTE,30200240,86658,HC ENTEROVIRUS A COXSACKIE,302,1 ,$67.00 ,$33.50 ,$8.17 ,$67.00 ,$8.17 ,$50.65 ,$43.41 ,$13.03 ,$40.20 ,$56.95 ,$46.90 ,$8.17 ,$63.65 ,$50.92 ,$50.25 ,$22.15 ,$56.95 ,$13.03 ,$22.15 ,$13.03 ,$46.90 ,$8.17 ,$13.03 ,$13.03 ,$14.75 ,$56.95 ,$29.32 ,$61.64 ,$46.90 ,$27.93 ,$27.93 ,$40.80 ,$27.93 ,$46.30 ,$60.30 ,$46.67 ,$13.16 ,$52.93 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200241,86658,HC ENTEROVIRUS (POLIO TYP 1),302,1 ,$146.00 ,$73.00 ,$8.17 ,$146.00 ,$8.17 ,$50.65 ,$43.41 ,$13.03 ,$87.60 ,$124.10 ,$102.20 ,$8.17 ,$138.70 ,$110.96 ,$109.50 ,$22.15 ,$124.10 ,$13.03 ,$22.15 ,$13.03 ,$102.20 ,$8.17 ,$13.03 ,$13.03 ,$14.75 ,$124.10 ,$29.32 ,$134.32 ,$102.20 ,$27.93 ,$27.93 ,$88.91 ,$27.93 ,$100.89 ,$131.40 ,$101.69 ,$13.16 ,$115.34 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200242,86658,HC ENTEROVIRUS (POLIO TYP 2),302,1 ,$47.00 ,$23.50 ,$8.17 ,$47.00 ,$8.17 ,$47.00 ,$43.41 ,$13.03 ,$28.20 ,$39.95 ,$32.90 ,$8.17 ,$44.65 ,$35.72 ,$35.25 ,$22.15 ,$39.95 ,$13.03 ,$22.15 ,$13.03 ,$32.90 ,$8.17 ,$13.03 ,$13.03 ,$14.75 ,$39.95 ,$29.32 ,$43.24 ,$32.90 ,$27.93 ,$27.93 ,$28.62 ,$27.93 ,$32.48 ,$42.30 ,$32.74 ,$13.16 ,$37.13 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$37.60 
ST NICHOLAS HOSPITAL - ACUTE,30200243,86658,HC ENTEROVIRUS (POLIO TYP 3),302,1 ,$47.00 ,$23.50 ,$8.17 ,$47.00 ,$8.17 ,$47.00 ,$43.41 ,$13.03 ,$28.20 ,$39.95 ,$32.90 ,$8.17 ,$44.65 ,$35.72 ,$35.25 ,$22.15 ,$39.95 ,$13.03 ,$22.15 ,$13.03 ,$32.90 ,$8.17 ,$13.03 ,$13.03 ,$14.75 ,$39.95 ,$29.32 ,$43.24 ,$32.90 ,$27.93 ,$27.93 ,$28.62 ,$27.93 ,$32.48 ,$42.30 ,$32.74 ,$13.16 ,$37.13 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$37.60 
ST NICHOLAS HOSPITAL - ACUTE,30200244,86663,HC EBV EARLY AG,302,1 ,$101.00 ,$50.50 ,$13.12 ,$101.00 ,$13.56 ,$51.03 ,$43.74 ,$13.12 ,$60.60 ,$85.85 ,$70.70 ,$13.56 ,$95.95 ,$76.76 ,$75.75 ,$22.30 ,$85.85 ,$13.12 ,$22.30 ,$13.12 ,$70.70 ,$13.56 ,$13.12 ,$13.12 ,$14.85 ,$85.85 ,$29.52 ,$92.92 ,$70.70 ,$63.05 ,$63.05 ,$61.51 ,$63.05 ,$69.79 ,$90.90 ,$70.35 ,$13.25 ,$79.79 ,$14.37 ,$15.74 ,$15.74 ,$13.12 ,$15.74 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200245,86664,HC EBV NUCLEAR AG,302,1 ,$112.00 ,$56.00 ,$15.29 ,$112.00 ,$15.80 ,$59.47 ,$50.97 ,$15.29 ,$67.20 ,$95.20 ,$78.40 ,$15.80 ,$106.40 ,$85.12 ,$84.00 ,$25.99 ,$95.20 ,$15.29 ,$25.99 ,$15.29 ,$78.40 ,$15.80 ,$15.29 ,$15.29 ,$17.31 ,$95.20 ,$34.40 ,$103.04 ,$78.40 ,$73.52 ,$73.52 ,$68.21 ,$73.52 ,$77.39 ,$100.80 ,$78.01 ,$15.44 ,$88.48 ,$16.75 ,$18.35 ,$18.35 ,$15.29 ,$18.35 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200246,86665,HC EBV VIRAL CAP,302,1 ,$134.00 ,$67.00 ,$18.14 ,$134.00 ,$18.74 ,$70.56 ,$60.48 ,$18.14 ,$80.40 ,$113.90 ,$93.80 ,$18.74 ,$127.30 ,$101.84 ,$100.50 ,$30.84 ,$113.90 ,$18.14 ,$30.84 ,$18.14 ,$93.80 ,$18.74 ,$18.14 ,$18.14 ,$20.53 ,$113.90 ,$40.82 ,$123.28 ,$93.80 ,$87.18 ,$87.18 ,$81.61 ,$87.18 ,$92.59 ,$120.60 ,$93.33 ,$18.32 ,$105.86 ,$19.86 ,$21.77 ,$21.77 ,$18.14 ,$21.77 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30200247,86666,HC EHRICHIA AB,302,1 ,$39.00 ,$19.50 ,$8.17 ,$39.00 ,$8.17 ,$39.00 ,$33.93 ,$10.18 ,$23.40 ,$33.15 ,$27.30 ,$8.17 ,$37.05 ,$29.64 ,$29.25 ,$17.31 ,$33.15 ,$10.18 ,$17.31 ,$10.18 ,$27.30 ,$8.17 ,$10.18 ,$10.18 ,$11.52 ,$33.15 ,$22.91 ,$35.88 ,$27.30 ,$27.93 ,$27.93 ,$23.75 ,$27.93 ,$26.95 ,$35.10 ,$27.16 ,$10.28 ,$30.81 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$31.20 
ST NICHOLAS HOSPITAL - ACUTE,30200248,86666,HC EHRICHIA AB (ANAPLASMA),302,1 ,$50.00 ,$25.00 ,$8.17 ,$50.00 ,$8.17 ,$39.59 ,$33.93 ,$10.18 ,$30.00 ,$42.50 ,$35.00 ,$8.17 ,$47.50 ,$38.00 ,$37.50 ,$17.31 ,$42.50 ,$10.18 ,$17.31 ,$10.18 ,$35.00 ,$8.17 ,$10.18 ,$10.18 ,$11.52 ,$42.50 ,$22.91 ,$46.00 ,$35.00 ,$27.93 ,$27.93 ,$30.45 ,$27.93 ,$34.55 ,$45.00 ,$34.83 ,$10.28 ,$39.50 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30200249,86668,HC FRANCISELLA AB,302,1 ,$67.00 ,$33.50 ,$14.16 ,$67.00 ,$14.63 ,$49.56 ,$42.48 ,$14.16 ,$40.20 ,$56.95 ,$46.90 ,$14.63 ,$63.65 ,$50.92 ,$50.25 ,$24.07 ,$56.95 ,$14.16 ,$24.07 ,$14.16 ,$46.90 ,$14.63 ,$14.16 ,$14.16 ,$16.03 ,$56.95 ,$31.86 ,$61.64 ,$46.90 ,$49.99 ,$49.99 ,$40.80 ,$49.99 ,$46.30 ,$60.30 ,$46.67 ,$14.30 ,$52.93 ,$15.51 ,$16.99 ,$16.99 ,$14.16 ,$16.99 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200250,86671,HC FUNGUS AB NOS,302,1 ,$52.00 ,$26.00 ,$7.15 ,$52.00 ,$7.15 ,$47.67 ,$40.86 ,$12.25 ,$31.20 ,$44.20 ,$36.40 ,$7.15 ,$49.40 ,$39.52 ,$39.00 ,$20.83 ,$44.20 ,$12.25 ,$20.83 ,$12.25 ,$36.40 ,$7.15 ,$12.25 ,$12.25 ,$13.86 ,$44.20 ,$27.56 ,$47.84 ,$36.40 ,$24.45 ,$24.45 ,$31.67 ,$24.45 ,$35.93 ,$46.80 ,$36.22 ,$12.37 ,$41.08 ,$7.58 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30200251,86677,HC H PYLORI AB,302,1 ,$90.00 ,$45.00 ,$8.17 ,$90.00 ,$8.17 ,$58.98 ,$50.55 ,$16.85 ,$54.00 ,$76.50 ,$63.00 ,$8.17 ,$85.50 ,$68.40 ,$67.50 ,$28.65 ,$76.50 ,$16.85 ,$28.65 ,$16.85 ,$63.00 ,$8.17 ,$16.85 ,$16.85 ,$19.07 ,$76.50 ,$37.91 ,$82.80 ,$63.00 ,$27.93 ,$27.93 ,$54.81 ,$27.93 ,$62.19 ,$81.00 ,$62.69 ,$17.02 ,$71.10 ,$8.66 ,$20.22 ,$20.22 ,$16.85 ,$20.22 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200252,86684,HC HAEMOPHILUS INFLUENZA AB,302,1 ,$157.00 ,$78.50 ,$15.84 ,$157.00 ,$16.37 ,$61.60 ,$52.80 ,$15.84 ,$94.20 ,$133.45 ,$109.90 ,$16.37 ,$149.15 ,$119.32 ,$117.75 ,$26.93 ,$133.45 ,$15.84 ,$26.93 ,$15.84 ,$109.90 ,$16.37 ,$15.84 ,$15.84 ,$17.93 ,$133.45 ,$35.64 ,$144.44 ,$109.90 ,$76.12 ,$76.12 ,$95.61 ,$76.12 ,$108.49 ,$141.30 ,$109.35 ,$16.00 ,$124.03 ,$17.35 ,$19.01 ,$19.01 ,$15.84 ,$19.01 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200253,86689,HC HIV WESTERN BLOT,302,1 ,$353.00 ,$176.50 ,$19.35 ,$353.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$211.80 ,$300.05 ,$247.10 ,$19.99 ,$335.35 ,$268.28 ,$264.75 ,$32.90 ,$300.05 ,$19.35 ,$32.90 ,$19.35 ,$247.10 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$300.05 ,$43.54 ,$324.76 ,$247.10 ,$93.00 ,$93.00 ,$214.98 ,$93.00 ,$243.92 ,$317.70 ,$245.86 ,$19.54 ,$278.87 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$254.16 ,$218.86 ,$254.16 ,$254.16 ,$282.40 
ST NICHOLAS HOSPITAL - ACUTE,30200254,86689,HC HIV REF WB,302,1 ,$69.00 ,$34.50 ,$19.35 ,$69.00 ,$19.99 ,$69.00 ,$64.53 ,$19.35 ,$41.40 ,$58.65 ,$48.30 ,$19.99 ,$65.55 ,$52.44 ,$51.75 ,$32.90 ,$58.65 ,$19.35 ,$32.90 ,$19.35 ,$48.30 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$58.65 ,$43.54 ,$63.48 ,$48.30 ,$69.00 ,$69.00 ,$42.02 ,$69.00 ,$47.68 ,$62.10 ,$48.06 ,$19.54 ,$54.51 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,30200255,86689,HC HTLV AB WESTERN BLOT,302,1 ,$128.00 ,$64.00 ,$19.35 ,$128.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$76.80 ,$108.80 ,$89.60 ,$19.99 ,$121.60 ,$97.28 ,$96.00 ,$32.90 ,$108.80 ,$19.35 ,$32.90 ,$19.35 ,$89.60 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$108.80 ,$43.54 ,$117.76 ,$89.60 ,$93.00 ,$93.00 ,$77.95 ,$93.00 ,$88.45 ,$115.20 ,$89.15 ,$19.54 ,$101.12 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$102.40 
ST NICHOLAS HOSPITAL - ACUTE,30200256,86689,HC HIV1 WESTERN BLOT,302,1 ,$141.00 ,$70.50 ,$19.35 ,$141.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$84.60 ,$119.85 ,$98.70 ,$19.99 ,$133.95 ,$107.16 ,$105.75 ,$32.90 ,$119.85 ,$19.35 ,$32.90 ,$19.35 ,$98.70 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$119.85 ,$43.54 ,$129.72 ,$98.70 ,$93.00 ,$93.00 ,$85.87 ,$93.00 ,$97.43 ,$126.90 ,$98.21 ,$19.54 ,$111.39 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,30200257,86689,HC HIV2 WESTERN BLOT,302,1 ,$141.00 ,$70.50 ,$19.35 ,$141.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$84.60 ,$119.85 ,$98.70 ,$19.99 ,$133.95 ,$107.16 ,$105.75 ,$32.90 ,$119.85 ,$19.35 ,$32.90 ,$19.35 ,$98.70 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$119.85 ,$43.54 ,$129.72 ,$98.70 ,$93.00 ,$93.00 ,$85.87 ,$93.00 ,$97.43 ,$126.90 ,$98.21 ,$19.54 ,$111.39 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,30200258,86692,HC HEPATITIS D AB,302,1 ,$132.00 ,$66.00 ,$17.16 ,$132.00 ,$17.73 ,$66.75 ,$57.21 ,$17.16 ,$79.20 ,$112.20 ,$92.40 ,$17.73 ,$125.40 ,$100.32 ,$99.00 ,$29.17 ,$112.20 ,$17.16 ,$29.17 ,$17.16 ,$92.40 ,$17.73 ,$17.16 ,$17.16 ,$19.42 ,$112.20 ,$38.61 ,$121.44 ,$92.40 ,$82.46 ,$82.46 ,$80.39 ,$82.46 ,$91.21 ,$118.80 ,$91.94 ,$17.33 ,$104.28 ,$18.79 ,$20.59 ,$20.59 ,$17.16 ,$20.59 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$105.60 
ST NICHOLAS HOSPITAL - ACUTE,30200259,86694,HC HERPES SIMPLEX AB,302,1 ,$111.00 ,$55.50 ,$14.39 ,$111.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$66.60 ,$94.35 ,$77.70 ,$14.87 ,$105.45 ,$84.36 ,$83.25 ,$24.46 ,$94.35 ,$14.39 ,$24.46 ,$14.39 ,$77.70 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$94.35 ,$32.38 ,$102.12 ,$77.70 ,$69.18 ,$69.18 ,$67.60 ,$69.18 ,$76.70 ,$99.90 ,$77.31 ,$14.53 ,$87.69 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$88.80 
ST NICHOLAS HOSPITAL - ACUTE,30200260,86694,HC HERPES SIMPLEX AB (IGG),302,1 ,$111.00 ,$55.50 ,$14.39 ,$111.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$66.60 ,$94.35 ,$77.70 ,$14.87 ,$105.45 ,$84.36 ,$83.25 ,$24.46 ,$94.35 ,$14.39 ,$24.46 ,$14.39 ,$77.70 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$94.35 ,$32.38 ,$102.12 ,$77.70 ,$69.18 ,$69.18 ,$67.60 ,$69.18 ,$76.70 ,$99.90 ,$77.31 ,$14.53 ,$87.69 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$88.80 
ST NICHOLAS HOSPITAL - ACUTE,30200261,86695,HC HERPES SIMPLEX AB I,302,1 ,$101.00 ,$50.50 ,$13.19 ,$101.00 ,$13.63 ,$51.28 ,$43.95 ,$13.19 ,$60.60 ,$85.85 ,$70.70 ,$13.63 ,$95.95 ,$76.76 ,$75.75 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$13.19 ,$70.70 ,$13.63 ,$13.19 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$63.41 ,$63.41 ,$61.51 ,$63.41 ,$69.79 ,$90.90 ,$70.35 ,$13.32 ,$79.79 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200262,86695,HC HERPES SIMPLEX IGG I,302,1 ,$96.00 ,$48.00 ,$13.19 ,$96.00 ,$13.63 ,$51.28 ,$43.95 ,$13.19 ,$57.60 ,$81.60 ,$67.20 ,$13.63 ,$91.20 ,$72.96 ,$72.00 ,$22.42 ,$81.60 ,$13.19 ,$22.42 ,$13.19 ,$67.20 ,$13.63 ,$13.19 ,$13.19 ,$14.93 ,$81.60 ,$29.68 ,$88.32 ,$67.20 ,$63.41 ,$63.41 ,$58.46 ,$63.41 ,$66.34 ,$86.40 ,$66.86 ,$13.32 ,$75.84 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$69.12 ,$59.52 ,$69.12 ,$69.12 ,$76.80 
ST NICHOLAS HOSPITAL - ACUTE,30200263,86696,HC HERPES SIMPLEX AB II,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$87.60 ,$124.10 ,$102.20 ,$19.99 ,$138.70 ,$110.96 ,$109.50 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$19.35 ,$102.20 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$93.00 ,$93.00 ,$88.91 ,$93.00 ,$100.89 ,$131.40 ,$101.69 ,$19.54 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200264,86696,HC HERPES SIMPLEX IGG II,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$87.60 ,$124.10 ,$102.20 ,$19.99 ,$138.70 ,$110.96 ,$109.50 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$19.35 ,$102.20 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$93.00 ,$93.00 ,$88.91 ,$93.00 ,$100.89 ,$131.40 ,$101.69 ,$19.54 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200265,86698,HC HISTOPLASMA AB,302,1 ,$78.00 ,$39.00 ,$13.79 ,$78.00 ,$14.25 ,$48.58 ,$41.64 ,$13.79 ,$46.80 ,$66.30 ,$54.60 ,$14.25 ,$74.10 ,$59.28 ,$58.50 ,$23.44 ,$66.30 ,$13.79 ,$23.44 ,$13.79 ,$54.60 ,$14.25 ,$13.79 ,$13.79 ,$15.61 ,$66.30 ,$31.03 ,$71.76 ,$54.60 ,$53.93 ,$53.93 ,$47.50 ,$53.93 ,$53.90 ,$70.20 ,$54.33 ,$13.93 ,$61.62 ,$15.11 ,$16.55 ,$16.55 ,$13.79 ,$16.55 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200266,86698,HC HISTOPLASMA AB (MAYO SCR),302,1 ,$78.00 ,$39.00 ,$13.79 ,$78.00 ,$14.25 ,$48.58 ,$41.64 ,$13.79 ,$46.80 ,$66.30 ,$54.60 ,$14.25 ,$74.10 ,$59.28 ,$58.50 ,$23.44 ,$66.30 ,$13.79 ,$23.44 ,$13.79 ,$54.60 ,$14.25 ,$13.79 ,$13.79 ,$15.61 ,$66.30 ,$31.03 ,$71.76 ,$54.60 ,$53.93 ,$53.93 ,$47.50 ,$53.93 ,$53.90 ,$70.20 ,$54.33 ,$13.93 ,$61.62 ,$15.11 ,$16.55 ,$16.55 ,$13.79 ,$16.55 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200267,86698,HC HISTOPLASMA AB (MAYO),302,1 ,$168.00 ,$84.00 ,$13.79 ,$168.00 ,$14.25 ,$48.58 ,$41.64 ,$13.79 ,$100.80 ,$142.80 ,$117.60 ,$14.25 ,$159.60 ,$127.68 ,$126.00 ,$23.44 ,$142.80 ,$13.79 ,$23.44 ,$13.79 ,$117.60 ,$14.25 ,$13.79 ,$13.79 ,$15.61 ,$142.80 ,$31.03 ,$154.56 ,$117.60 ,$53.93 ,$53.93 ,$102.31 ,$53.93 ,$116.09 ,$151.20 ,$117.01 ,$13.93 ,$132.72 ,$15.11 ,$16.55 ,$16.55 ,$13.79 ,$16.55 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30200268,86698,HC HISTOPLASMA AB (MYC),302,1 ,$12.00 ,$6.00 ,$6.00 ,$27.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$7.20 ,$10.20 ,$8.40 ,$12.00 ,$11.40 ,$9.12 ,$9.00 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$12.00 ,$8.40 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$10.80 ,$8.36 ,$12.12 ,$9.48 ,$12.72 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$9.60 
ST NICHOLAS HOSPITAL - ACUTE,30200269,86698,HC HISTOPLASMA AB (YEAST),302,1 ,$12.00 ,$6.00 ,$6.00 ,$27.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$7.20 ,$10.20 ,$8.40 ,$12.00 ,$11.40 ,$9.12 ,$9.00 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$12.00 ,$8.40 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$10.80 ,$8.36 ,$12.12 ,$9.48 ,$12.72 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$9.60 
ST NICHOLAS HOSPITAL - ACUTE,30200270,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$101.00 ,$50.50 ,$13.71 ,$101.00 ,$14.17 ,$53.31 ,$45.69 ,$13.71 ,$60.60 ,$85.85 ,$70.70 ,$14.17 ,$95.95 ,$76.76 ,$75.75 ,$23.31 ,$85.85 ,$13.71 ,$23.31 ,$13.71 ,$70.70 ,$14.17 ,$13.71 ,$13.71 ,$15.52 ,$85.85 ,$30.85 ,$92.92 ,$70.70 ,$65.87 ,$65.87 ,$61.51 ,$65.87 ,$69.79 ,$90.90 ,$70.35 ,$13.85 ,$79.79 ,$15.02 ,$16.45 ,$16.45 ,$13.71 ,$16.45 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200271,86704,HC HEP CORE AB,302,1 ,$90.00 ,$45.00 ,$12.05 ,$90.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$54.00 ,$76.50 ,$63.00 ,$12.45 ,$85.50 ,$68.40 ,$67.50 ,$20.49 ,$76.50 ,$12.05 ,$20.49 ,$12.05 ,$63.00 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$76.50 ,$27.11 ,$82.80 ,$63.00 ,$57.91 ,$57.91 ,$54.81 ,$57.91 ,$62.19 ,$81.00 ,$62.69 ,$12.17 ,$71.10 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200272,86704,HC HEP CORE AB (ATB),302,1 ,$108.00 ,$54.00 ,$12.05 ,$108.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$64.80 ,$91.80 ,$75.60 ,$12.45 ,$102.60 ,$82.08 ,$81.00 ,$20.49 ,$91.80 ,$12.05 ,$20.49 ,$12.05 ,$75.60 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$91.80 ,$27.11 ,$99.36 ,$75.60 ,$57.91 ,$57.91 ,$65.77 ,$57.91 ,$74.63 ,$97.20 ,$75.22 ,$12.17 ,$85.32 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,30200273,86706,HC HEP B SURFACE AB,302,1 ,$78.00 ,$39.00 ,$10.74 ,$78.00 ,$11.10 ,$41.76 ,$35.79 ,$10.74 ,$46.80 ,$66.30 ,$54.60 ,$11.10 ,$74.10 ,$59.28 ,$58.50 ,$18.26 ,$66.30 ,$10.74 ,$18.26 ,$10.74 ,$54.60 ,$11.10 ,$10.74 ,$10.74 ,$12.16 ,$66.30 ,$24.17 ,$71.76 ,$54.60 ,$51.61 ,$51.61 ,$47.50 ,$51.61 ,$53.90 ,$70.20 ,$54.33 ,$10.85 ,$61.62 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200274,86706,HC HEP B SURFACE AB (ATB),302,1 ,$59.00 ,$29.50 ,$10.74 ,$59.00 ,$11.10 ,$41.76 ,$35.79 ,$10.74 ,$35.40 ,$50.15 ,$41.30 ,$11.10 ,$56.05 ,$44.84 ,$44.25 ,$18.26 ,$50.15 ,$10.74 ,$18.26 ,$10.74 ,$41.30 ,$11.10 ,$10.74 ,$10.74 ,$12.16 ,$50.15 ,$24.17 ,$54.28 ,$41.30 ,$51.61 ,$51.61 ,$35.93 ,$51.61 ,$40.77 ,$53.10 ,$41.09 ,$10.85 ,$46.61 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$47.20 
ST NICHOLAS HOSPITAL - ACUTE,30200275,86707,HC HEP B E AB,302,1 ,$67.00 ,$33.50 ,$11.57 ,$67.00 ,$11.96 ,$44.98 ,$38.55 ,$11.57 ,$40.20 ,$56.95 ,$46.90 ,$11.96 ,$63.65 ,$50.92 ,$50.25 ,$19.67 ,$56.95 ,$11.57 ,$19.67 ,$11.57 ,$46.90 ,$11.96 ,$11.57 ,$11.57 ,$13.09 ,$56.95 ,$26.03 ,$61.64 ,$46.90 ,$55.59 ,$55.59 ,$40.80 ,$55.59 ,$46.30 ,$60.30 ,$46.67 ,$11.69 ,$52.93 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200276,86708,HC HEP A AB TOTAL,302,1 ,$78.00 ,$39.00 ,$12.39 ,$78.00 ,$12.80 ,$48.16 ,$41.28 ,$12.39 ,$46.80 ,$66.30 ,$54.60 ,$12.80 ,$74.10 ,$59.28 ,$58.50 ,$21.06 ,$66.30 ,$12.39 ,$21.06 ,$12.39 ,$54.60 ,$12.80 ,$12.39 ,$12.39 ,$14.02 ,$66.30 ,$27.88 ,$71.76 ,$54.60 ,$59.53 ,$59.53 ,$47.50 ,$59.53 ,$53.90 ,$70.20 ,$54.33 ,$12.51 ,$61.62 ,$13.57 ,$14.87 ,$14.87 ,$12.39 ,$14.87 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200277,86709,HC HEP A AB IGM,302,1 ,$157.00 ,$78.50 ,$11.26 ,$157.00 ,$11.63 ,$43.79 ,$37.53 ,$11.26 ,$94.20 ,$133.45 ,$109.90 ,$11.63 ,$149.15 ,$119.32 ,$117.75 ,$19.14 ,$133.45 ,$11.26 ,$19.14 ,$11.26 ,$109.90 ,$11.63 ,$11.26 ,$11.26 ,$12.74 ,$133.45 ,$25.34 ,$144.44 ,$109.90 ,$54.11 ,$54.11 ,$95.61 ,$54.11 ,$108.49 ,$141.30 ,$109.35 ,$11.37 ,$124.03 ,$12.33 ,$13.51 ,$13.51 ,$11.26 ,$13.51 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200279,86713,HC LEGIONELLA AB (PNEUM),302,1 ,$101.00 ,$50.50 ,$15.30 ,$101.00 ,$15.81 ,$59.50 ,$51.00 ,$15.30 ,$60.60 ,$85.85 ,$70.70 ,$15.81 ,$95.95 ,$76.76 ,$75.75 ,$26.01 ,$85.85 ,$15.30 ,$26.01 ,$15.30 ,$70.70 ,$15.81 ,$15.30 ,$15.30 ,$17.32 ,$85.85 ,$34.43 ,$92.92 ,$70.70 ,$73.55 ,$73.55 ,$61.51 ,$73.55 ,$69.79 ,$90.90 ,$70.35 ,$15.45 ,$79.79 ,$16.76 ,$18.36 ,$18.36 ,$15.30 ,$18.36 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200280,86713,HC LEGIONELLA AB (IGM),302,1 ,$101.00 ,$50.50 ,$15.30 ,$101.00 ,$15.81 ,$59.50 ,$51.00 ,$15.30 ,$60.60 ,$85.85 ,$70.70 ,$15.81 ,$95.95 ,$76.76 ,$75.75 ,$26.01 ,$85.85 ,$15.30 ,$26.01 ,$15.30 ,$70.70 ,$15.81 ,$15.30 ,$15.30 ,$17.32 ,$85.85 ,$34.43 ,$92.92 ,$70.70 ,$73.55 ,$73.55 ,$61.51 ,$73.55 ,$69.79 ,$90.90 ,$70.35 ,$15.45 ,$79.79 ,$16.76 ,$18.36 ,$18.36 ,$15.30 ,$18.36 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200281,86720,HC LEPTOSPIRA AB,302,1 ,$99.00 ,$49.50 ,$8.17 ,$99.00 ,$8.17 ,$56.70 ,$48.60 ,$16.20 ,$59.40 ,$84.15 ,$69.30 ,$8.17 ,$94.05 ,$75.24 ,$74.25 ,$27.54 ,$84.15 ,$16.20 ,$27.54 ,$16.20 ,$69.30 ,$8.17 ,$16.20 ,$16.20 ,$18.34 ,$84.15 ,$36.45 ,$91.08 ,$69.30 ,$27.93 ,$27.93 ,$60.29 ,$27.93 ,$68.41 ,$89.10 ,$68.95 ,$16.36 ,$78.21 ,$8.66 ,$19.44 ,$19.44 ,$16.20 ,$19.44 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,30200282,86735,HC MUMPS AB,302,1 ,$123.00 ,$61.50 ,$13.05 ,$123.00 ,$13.48 ,$50.75 ,$43.50 ,$13.05 ,$73.80 ,$104.55 ,$86.10 ,$13.48 ,$116.85 ,$93.48 ,$92.25 ,$22.19 ,$104.55 ,$13.05 ,$22.19 ,$13.05 ,$86.10 ,$13.48 ,$13.05 ,$13.05 ,$14.77 ,$104.55 ,$29.36 ,$113.16 ,$86.10 ,$62.70 ,$62.70 ,$74.91 ,$62.70 ,$84.99 ,$110.70 ,$85.67 ,$13.18 ,$97.17 ,$14.29 ,$15.66 ,$15.66 ,$13.05 ,$15.66 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200283,86735,HC MUMPS QN,302,1 ,$45.00 ,$22.50 ,$13.05 ,$45.00 ,$13.48 ,$45.00 ,$43.50 ,$13.05 ,$27.00 ,$38.25 ,$31.50 ,$13.48 ,$42.75 ,$34.20 ,$33.75 ,$22.19 ,$38.25 ,$13.05 ,$22.19 ,$13.05 ,$31.50 ,$13.48 ,$13.05 ,$13.05 ,$14.77 ,$38.25 ,$29.36 ,$41.40 ,$31.50 ,$45.00 ,$45.00 ,$27.41 ,$45.00 ,$31.10 ,$40.50 ,$31.34 ,$13.18 ,$35.55 ,$14.29 ,$15.66 ,$15.66 ,$13.05 ,$15.66 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,30200284,86738,HC MYCOPLASMA AB,302,1 ,$78.00 ,$39.00 ,$13.24 ,$78.00 ,$13.68 ,$51.49 ,$44.13 ,$13.24 ,$46.80 ,$66.30 ,$54.60 ,$13.68 ,$74.10 ,$59.28 ,$58.50 ,$22.51 ,$66.30 ,$13.24 ,$22.51 ,$13.24 ,$54.60 ,$13.68 ,$13.24 ,$13.24 ,$14.99 ,$66.30 ,$29.79 ,$71.76 ,$54.60 ,$63.65 ,$63.65 ,$47.50 ,$63.65 ,$53.90 ,$70.20 ,$54.33 ,$13.37 ,$61.62 ,$14.50 ,$15.89 ,$15.89 ,$13.24 ,$15.89 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200285,86744,HC NOCARDIA AB,302,1 ,$41.00 ,$20.50 ,$8.17 ,$41.00 ,$8.17 ,$41.00 ,$41.00 ,$15.99 ,$24.60 ,$34.85 ,$28.70 ,$8.17 ,$38.95 ,$31.16 ,$30.75 ,$27.18 ,$34.85 ,$15.99 ,$27.18 ,$15.99 ,$28.70 ,$8.17 ,$15.99 ,$15.99 ,$18.10 ,$34.85 ,$35.98 ,$37.72 ,$28.70 ,$27.93 ,$27.93 ,$24.97 ,$27.93 ,$28.33 ,$36.90 ,$28.56 ,$16.15 ,$32.39 ,$8.66 ,$19.19 ,$19.19 ,$15.99 ,$19.19 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,30200286,86747,HC PARVOVIRUS AB,302,1 ,$90.00 ,$45.00 ,$15.03 ,$90.00 ,$15.53 ,$58.45 ,$50.10 ,$15.03 ,$54.00 ,$76.50 ,$63.00 ,$15.53 ,$85.50 ,$68.40 ,$67.50 ,$25.55 ,$76.50 ,$15.03 ,$25.55 ,$15.03 ,$63.00 ,$15.53 ,$15.03 ,$15.03 ,$17.01 ,$76.50 ,$33.82 ,$82.80 ,$63.00 ,$72.25 ,$72.25 ,$54.81 ,$72.25 ,$62.19 ,$81.00 ,$62.69 ,$15.18 ,$71.10 ,$16.46 ,$18.04 ,$18.04 ,$15.03 ,$18.04 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200287,86753,HC PROTOZOA AB,302,1 ,$48.00 ,$24.00 ,$8.17 ,$48.00 ,$8.17 ,$48.00 ,$41.28 ,$12.39 ,$28.80 ,$40.80 ,$33.60 ,$8.17 ,$45.60 ,$36.48 ,$36.00 ,$21.06 ,$40.80 ,$12.39 ,$21.06 ,$12.39 ,$33.60 ,$8.17 ,$12.39 ,$12.39 ,$14.02 ,$40.80 ,$27.88 ,$44.16 ,$33.60 ,$27.93 ,$27.93 ,$29.23 ,$27.93 ,$33.17 ,$43.20 ,$33.43 ,$12.51 ,$37.92 ,$8.66 ,$14.87 ,$14.87 ,$12.39 ,$14.87 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30200288,86762,HC RUBELLA AB,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$67.20 ,$95.20 ,$78.40 ,$14.87 ,$106.40 ,$85.12 ,$84.00 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$14.39 ,$78.40 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.18 ,$69.18 ,$68.21 ,$69.18 ,$77.39 ,$100.80 ,$78.01 ,$14.53 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200289,86762,HC RUBELLA AB QN,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$67.20 ,$95.20 ,$78.40 ,$14.87 ,$106.40 ,$85.12 ,$84.00 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$14.39 ,$78.40 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.18 ,$69.18 ,$68.21 ,$69.18 ,$77.39 ,$100.80 ,$78.01 ,$14.53 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200290,86762,HC RUBELLA AB IGG/IGM,302,1 ,$116.00 ,$58.00 ,$14.39 ,$116.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$69.60 ,$98.60 ,$81.20 ,$14.87 ,$110.20 ,$88.16 ,$87.00 ,$24.46 ,$98.60 ,$14.39 ,$24.46 ,$14.39 ,$81.20 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$98.60 ,$32.38 ,$106.72 ,$81.20 ,$69.18 ,$69.18 ,$70.64 ,$69.18 ,$80.16 ,$104.40 ,$80.79 ,$14.53 ,$91.64 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,30200291,86765,HC RUBEOLA AB,302,1 ,$101.00 ,$50.50 ,$12.88 ,$101.00 ,$13.31 ,$50.09 ,$42.93 ,$12.88 ,$60.60 ,$85.85 ,$70.70 ,$13.31 ,$95.95 ,$76.76 ,$75.75 ,$21.90 ,$85.85 ,$12.88 ,$21.90 ,$12.88 ,$70.70 ,$13.31 ,$12.88 ,$12.88 ,$14.58 ,$85.85 ,$28.98 ,$92.92 ,$70.70 ,$61.93 ,$61.93 ,$61.51 ,$61.93 ,$69.79 ,$90.90 ,$70.35 ,$13.01 ,$79.79 ,$14.11 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200292,86765,HC RUBEOLA AB QN,302,1 ,$101.00 ,$50.50 ,$12.88 ,$101.00 ,$13.31 ,$50.09 ,$42.93 ,$12.88 ,$60.60 ,$85.85 ,$70.70 ,$13.31 ,$95.95 ,$76.76 ,$75.75 ,$21.90 ,$85.85 ,$12.88 ,$21.90 ,$12.88 ,$70.70 ,$13.31 ,$12.88 ,$12.88 ,$14.58 ,$85.85 ,$28.98 ,$92.92 ,$70.70 ,$61.93 ,$61.93 ,$61.51 ,$61.93 ,$69.79 ,$90.90 ,$70.35 ,$13.01 ,$79.79 ,$14.11 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200293,86765,HC RUBEOLA AB IGM,302,1 ,$142.00 ,$71.00 ,$12.88 ,$142.00 ,$13.31 ,$50.09 ,$42.93 ,$12.88 ,$85.20 ,$120.70 ,$99.40 ,$13.31 ,$134.90 ,$107.92 ,$106.50 ,$21.90 ,$120.70 ,$12.88 ,$21.90 ,$12.88 ,$99.40 ,$13.31 ,$12.88 ,$12.88 ,$14.58 ,$120.70 ,$28.98 ,$130.64 ,$99.40 ,$61.93 ,$61.93 ,$86.48 ,$61.93 ,$98.12 ,$127.80 ,$98.90 ,$13.01 ,$112.18 ,$14.11 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$102.24 ,$88.04 ,$102.24 ,$102.24 ,$113.60 
ST NICHOLAS HOSPITAL - ACUTE,30200294,86768,HC SALMONELLA,302,1 ,$75.00 ,$37.50 ,$11.50 ,$75.00 ,$11.50 ,$51.28 ,$43.95 ,$13.19 ,$45.00 ,$63.75 ,$52.50 ,$11.50 ,$71.25 ,$57.00 ,$56.25 ,$22.42 ,$63.75 ,$13.19 ,$22.42 ,$13.19 ,$52.50 ,$11.50 ,$13.19 ,$13.19 ,$14.93 ,$63.75 ,$29.68 ,$69.00 ,$52.50 ,$39.31 ,$39.31 ,$45.68 ,$39.31 ,$51.83 ,$67.50 ,$52.24 ,$13.32 ,$59.25 ,$12.19 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,30200295,86774,HC TETANUS AB,302,1 ,$112.00 ,$56.00 ,$14.80 ,$112.00 ,$15.29 ,$57.54 ,$49.32 ,$14.80 ,$67.20 ,$95.20 ,$78.40 ,$15.29 ,$106.40 ,$85.12 ,$84.00 ,$25.16 ,$95.20 ,$14.80 ,$25.16 ,$14.80 ,$78.40 ,$15.29 ,$14.80 ,$14.80 ,$16.75 ,$95.20 ,$33.30 ,$103.04 ,$78.40 ,$71.12 ,$71.12 ,$68.21 ,$71.12 ,$77.39 ,$100.80 ,$78.01 ,$14.95 ,$88.48 ,$16.21 ,$17.76 ,$17.76 ,$14.80 ,$17.76 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200296,86777,HC TOXOPLASMA AB,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$67.20 ,$95.20 ,$78.40 ,$14.87 ,$106.40 ,$85.12 ,$84.00 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$14.39 ,$78.40 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.18 ,$69.18 ,$68.21 ,$69.18 ,$77.39 ,$100.80 ,$78.01 ,$14.53 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200297,86778,HC TOXOPLASMA AB IGM,302,1 ,$101.00 ,$50.50 ,$14.41 ,$101.00 ,$14.89 ,$56.04 ,$48.03 ,$14.41 ,$60.60 ,$85.85 ,$70.70 ,$14.89 ,$95.95 ,$76.76 ,$75.75 ,$24.50 ,$85.85 ,$14.41 ,$24.50 ,$14.41 ,$70.70 ,$14.89 ,$14.41 ,$14.41 ,$16.31 ,$85.85 ,$32.42 ,$92.92 ,$70.70 ,$61.40 ,$61.40 ,$61.51 ,$61.40 ,$69.79 ,$90.90 ,$70.35 ,$14.55 ,$79.79 ,$15.78 ,$17.29 ,$17.29 ,$14.41 ,$17.29 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200298,86780,HC TREPONEMA P AB CONFIRM,302,1 ,$43.00 ,$21.50 ,$11.13 ,$43.00 ,$11.13 ,$43.00 ,$43.00 ,$13.24 ,$25.80 ,$36.55 ,$30.10 ,$11.13 ,$40.85 ,$32.68 ,$32.25 ,$22.51 ,$36.55 ,$13.24 ,$22.51 ,$13.24 ,$30.10 ,$11.13 ,$13.24 ,$13.24 ,$14.99 ,$36.55 ,$29.79 ,$39.56 ,$30.10 ,$38.04 ,$38.04 ,$26.19 ,$38.04 ,$29.71 ,$38.70 ,$29.95 ,$13.37 ,$33.97 ,$11.80 ,$15.89 ,$15.89 ,$13.24 ,$15.89 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,30200299,86787,HC VARICELLA ZOSTER ATB,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$50.09 ,$42.93 ,$12.88 ,$46.80 ,$66.30 ,$54.60 ,$8.17 ,$74.10 ,$59.28 ,$58.50 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$12.88 ,$54.60 ,$8.17 ,$12.88 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$13.01 ,$61.62 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200300,86787,HC VARICELLA ZOSTER IGM,302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$50.09 ,$42.93 ,$12.88 ,$33.60 ,$47.60 ,$39.20 ,$8.17 ,$53.20 ,$42.56 ,$42.00 ,$21.90 ,$47.60 ,$12.88 ,$21.90 ,$12.88 ,$39.20 ,$8.17 ,$12.88 ,$12.88 ,$14.58 ,$47.60 ,$28.98 ,$51.52 ,$39.20 ,$27.93 ,$27.93 ,$34.10 ,$27.93 ,$38.70 ,$50.40 ,$39.00 ,$13.01 ,$44.24 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200301,86787,HC VARICELLA ZOSTER QN,302,1 ,$45.00 ,$22.50 ,$8.17 ,$45.00 ,$8.17 ,$45.00 ,$42.93 ,$12.88 ,$27.00 ,$38.25 ,$31.50 ,$8.17 ,$42.75 ,$34.20 ,$33.75 ,$21.90 ,$38.25 ,$12.88 ,$21.90 ,$12.88 ,$31.50 ,$8.17 ,$12.88 ,$12.88 ,$14.58 ,$38.25 ,$28.98 ,$41.40 ,$31.50 ,$27.93 ,$27.93 ,$27.41 ,$27.93 ,$31.10 ,$40.50 ,$31.34 ,$13.01 ,$35.55 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,30200302,86787,HC VARICELLA ZOSTER IGG,302,1 ,$50.00 ,$25.00 ,$8.17 ,$50.00 ,$8.17 ,$50.00 ,$42.93 ,$12.88 ,$30.00 ,$42.50 ,$35.00 ,$8.17 ,$47.50 ,$38.00 ,$37.50 ,$21.90 ,$42.50 ,$12.88 ,$21.90 ,$12.88 ,$35.00 ,$8.17 ,$12.88 ,$12.88 ,$14.58 ,$42.50 ,$28.98 ,$46.00 ,$35.00 ,$27.93 ,$27.93 ,$30.45 ,$27.93 ,$34.55 ,$45.00 ,$34.83 ,$13.01 ,$39.50 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30200303,86788,HC WEST NILE VIRUS AB IGM,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$65.52 ,$56.16 ,$16.85 ,$46.80 ,$66.30 ,$54.60 ,$8.17 ,$74.10 ,$59.28 ,$58.50 ,$28.65 ,$66.30 ,$16.85 ,$28.65 ,$16.85 ,$54.60 ,$8.17 ,$16.85 ,$16.85 ,$19.07 ,$66.30 ,$37.91 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$17.02 ,$61.62 ,$8.66 ,$20.22 ,$20.22 ,$16.85 ,$20.22 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200304,86789,HC WEST NILE AB,302,1 ,$90.00 ,$45.00 ,$14.39 ,$90.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$54.00 ,$76.50 ,$63.00 ,$14.87 ,$85.50 ,$68.40 ,$67.50 ,$24.46 ,$76.50 ,$14.39 ,$24.46 ,$14.39 ,$63.00 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$76.50 ,$32.38 ,$82.80 ,$63.00 ,$69.18 ,$69.18 ,$54.81 ,$69.18 ,$62.19 ,$81.00 ,$62.69 ,$14.53 ,$71.10 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200305,86790,HC HTLV I/II AB,302,1 ,$78.00 ,$39.00 ,$3.28 ,$78.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$46.80 ,$66.30 ,$54.60 ,$3.28 ,$74.10 ,$59.28 ,$58.50 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$12.88 ,$54.60 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$13.01 ,$61.62 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200306,86790,HC HHV6 IGM/IGG,302,1 ,$78.00 ,$39.00 ,$3.28 ,$78.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$46.80 ,$66.30 ,$54.60 ,$3.28 ,$74.10 ,$59.28 ,$58.50 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$12.88 ,$54.60 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$13.01 ,$61.62 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200307,86790,HC HERPES VIRUS 7 IGM/IGG,302,1 ,$78.00 ,$39.00 ,$3.28 ,$78.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$46.80 ,$66.30 ,$54.60 ,$3.28 ,$74.10 ,$59.28 ,$58.50 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$12.88 ,$54.60 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$27.93 ,$27.93 ,$47.50 ,$27.93 ,$53.90 ,$70.20 ,$54.33 ,$13.01 ,$61.62 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200308,86790,HC HERPES VIRUS 8 IGM,302,1 ,$130.00 ,$65.00 ,$3.28 ,$130.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$78.00 ,$110.50 ,$91.00 ,$3.28 ,$123.50 ,$98.80 ,$97.50 ,$21.90 ,$110.50 ,$12.88 ,$21.90 ,$12.88 ,$91.00 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$110.50 ,$28.98 ,$119.60 ,$91.00 ,$27.93 ,$27.93 ,$79.17 ,$27.93 ,$89.83 ,$117.00 ,$90.55 ,$13.01 ,$102.70 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,30200309,86790,HC RABIES AB,302,1 ,$88.00 ,$44.00 ,$3.28 ,$88.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$52.80 ,$74.80 ,$61.60 ,$3.28 ,$83.60 ,$66.88 ,$66.00 ,$21.90 ,$74.80 ,$12.88 ,$21.90 ,$12.88 ,$61.60 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$74.80 ,$28.98 ,$80.96 ,$61.60 ,$27.93 ,$27.93 ,$53.59 ,$27.93 ,$60.81 ,$79.20 ,$61.29 ,$13.01 ,$69.52 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$63.36 ,$54.56 ,$63.36 ,$63.36 ,$70.40 
ST NICHOLAS HOSPITAL - ACUTE,30200310,86694,HC HSV IGM,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$67.20 ,$95.20 ,$78.40 ,$14.87 ,$106.40 ,$85.12 ,$84.00 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$14.39 ,$78.40 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.18 ,$69.18 ,$68.21 ,$69.18 ,$77.39 ,$100.80 ,$78.01 ,$14.53 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200312,86800,HC THYROGLOBULIN AB,302,1 ,$123.00 ,$61.50 ,$15.91 ,$123.00 ,$16.44 ,$61.85 ,$53.01 ,$15.91 ,$73.80 ,$104.55 ,$86.10 ,$16.44 ,$116.85 ,$93.48 ,$92.25 ,$27.05 ,$104.55 ,$15.91 ,$27.05 ,$15.91 ,$86.10 ,$16.44 ,$15.91 ,$15.91 ,$18.01 ,$104.55 ,$35.80 ,$113.16 ,$86.10 ,$76.44 ,$76.44 ,$74.91 ,$76.44 ,$84.99 ,$110.70 ,$85.67 ,$16.07 ,$97.17 ,$17.43 ,$19.09 ,$19.09 ,$15.91 ,$19.09 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200313,86800,HC THYROGLOBULIN ANTIBODY,302,1 ,$123.00 ,$61.50 ,$15.91 ,$123.00 ,$16.44 ,$61.85 ,$53.01 ,$15.91 ,$73.80 ,$104.55 ,$86.10 ,$16.44 ,$116.85 ,$93.48 ,$92.25 ,$27.05 ,$104.55 ,$15.91 ,$27.05 ,$15.91 ,$86.10 ,$16.44 ,$15.91 ,$15.91 ,$18.01 ,$104.55 ,$35.80 ,$113.16 ,$86.10 ,$76.44 ,$76.44 ,$74.91 ,$76.44 ,$84.99 ,$110.70 ,$85.67 ,$16.07 ,$97.17 ,$17.43 ,$19.09 ,$19.09 ,$15.91 ,$19.09 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200314,86803,HC HEP C AB,302,1 ,$112.00 ,$56.00 ,$14.27 ,$112.00 ,$14.75 ,$55.48 ,$47.55 ,$14.27 ,$67.20 ,$95.20 ,$78.40 ,$14.75 ,$106.40 ,$85.12 ,$84.00 ,$24.26 ,$95.20 ,$14.27 ,$24.26 ,$14.27 ,$78.40 ,$14.75 ,$14.27 ,$14.27 ,$16.15 ,$95.20 ,$32.11 ,$103.04 ,$78.40 ,$68.59 ,$68.59 ,$68.21 ,$68.59 ,$77.39 ,$100.80 ,$78.01 ,$14.41 ,$88.48 ,$15.64 ,$17.12 ,$17.12 ,$14.27 ,$17.12 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200316,86804,HC HEP C AB CONFIRM,302,1 ,$164.00 ,$82.00 ,$15.49 ,$164.00 ,$16.01 ,$60.24 ,$51.63 ,$15.49 ,$98.40 ,$139.40 ,$114.80 ,$16.01 ,$155.80 ,$124.64 ,$123.00 ,$26.33 ,$139.40 ,$15.49 ,$26.33 ,$15.49 ,$114.80 ,$16.01 ,$15.49 ,$15.49 ,$17.53 ,$139.40 ,$34.85 ,$150.88 ,$114.80 ,$74.43 ,$74.43 ,$99.88 ,$74.43 ,$113.32 ,$147.60 ,$114.23 ,$15.64 ,$129.56 ,$16.97 ,$18.59 ,$18.59 ,$15.49 ,$18.59 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$131.20 
ST NICHOLAS HOSPITAL - ACUTE,30200317,86807,HC CYTOTOXIC PRA STND,302,1 ,$86.00 ,$43.00 ,$43.00 ,$176.96 ,$55.65 ,$86.00 ,$86.00 ,$78.65 ,$51.60 ,$73.10 ,$60.20 ,$55.65 ,$81.70 ,$65.36 ,$64.50 ,$86.00 ,$73.10 ,$78.65 ,$86.00 ,$78.65 ,$60.20 ,$55.65 ,$78.65 ,$78.65 ,$86.00 ,$73.10 ,$176.96 ,$79.12 ,$60.20 ,$86.00 ,$86.00 ,$52.37 ,$86.00 ,$59.43 ,$77.40 ,$59.90 ,$79.44 ,$67.94 ,$58.99 ,$86.00 ,$86.00 ,$78.65 ,$86.00 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30200318,86807,HC CYTOTOXIC PRA STND SCR,302,1 ,$405.00 ,$202.50 ,$55.65 ,$405.00 ,$55.65 ,$275.28 ,$235.95 ,$78.65 ,$243.00 ,$344.25 ,$283.50 ,$55.65 ,$384.75 ,$307.80 ,$303.75 ,$133.71 ,$344.25 ,$78.65 ,$133.71 ,$78.65 ,$283.50 ,$55.65 ,$78.65 ,$78.65 ,$89.02 ,$344.25 ,$176.96 ,$372.60 ,$283.50 ,$190.19 ,$190.19 ,$246.65 ,$190.19 ,$279.86 ,$364.50 ,$282.08 ,$79.44 ,$319.95 ,$58.99 ,$94.38 ,$94.38 ,$78.65 ,$94.38 ,$291.60 ,$251.10 ,$291.60 ,$291.60 ,$324.00 
ST NICHOLAS HOSPITAL - ACUTE,30200319,86808,HC CYTOTOXIC PRA QUICK SCR,302,1 ,$62.00 ,$31.00 ,$29.68 ,$66.78 ,$30.67 ,$62.00 ,$62.00 ,$29.68 ,$37.20 ,$52.70 ,$43.40 ,$30.67 ,$58.90 ,$47.12 ,$46.50 ,$50.46 ,$52.70 ,$29.68 ,$50.46 ,$29.68 ,$43.40 ,$30.67 ,$29.68 ,$29.68 ,$33.59 ,$52.70 ,$66.78 ,$57.04 ,$43.40 ,$62.00 ,$62.00 ,$37.76 ,$62.00 ,$42.84 ,$55.80 ,$43.18 ,$29.98 ,$48.98 ,$32.51 ,$35.62 ,$35.62 ,$29.68 ,$35.62 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30200320,86808,HC CYTOTOXIC PRA QUICK (MTHD 1/2),302,1 ,$263.00 ,$131.50 ,$29.68 ,$263.00 ,$30.67 ,$115.43 ,$98.94 ,$29.68 ,$157.80 ,$223.55 ,$184.10 ,$30.67 ,$249.85 ,$199.88 ,$197.25 ,$50.46 ,$223.55 ,$29.68 ,$50.46 ,$29.68 ,$184.10 ,$30.67 ,$29.68 ,$29.68 ,$33.59 ,$223.55 ,$66.78 ,$241.96 ,$184.10 ,$142.63 ,$142.63 ,$160.17 ,$142.63 ,$181.73 ,$236.70 ,$183.18 ,$29.98 ,$207.77 ,$32.51 ,$35.62 ,$35.62 ,$29.68 ,$35.62 ,$189.36 ,$163.06 ,$189.36 ,$189.36 ,$210.40 
ST NICHOLAS HOSPITAL - ACUTE,30200321,86808,HC CYTOTOXIC PRA QUICK,302,1 ,$86.00 ,$43.00 ,$29.68 ,$86.00 ,$30.67 ,$86.00 ,$86.00 ,$29.68 ,$51.60 ,$73.10 ,$60.20 ,$30.67 ,$81.70 ,$65.36 ,$64.50 ,$50.46 ,$73.10 ,$29.68 ,$50.46 ,$29.68 ,$60.20 ,$30.67 ,$29.68 ,$29.68 ,$33.59 ,$73.10 ,$66.78 ,$79.12 ,$60.20 ,$86.00 ,$86.00 ,$52.37 ,$86.00 ,$59.43 ,$77.40 ,$59.90 ,$29.98 ,$67.94 ,$32.51 ,$35.62 ,$35.62 ,$29.68 ,$35.62 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30200322,86812,HC HLA TYPING SINGLE A/B/C,302,1 ,$235.00 ,$117.50 ,$25.81 ,$235.00 ,$26.67 ,$100.35 ,$86.01 ,$25.81 ,$141.00 ,$199.75 ,$164.50 ,$26.67 ,$223.25 ,$178.60 ,$176.25 ,$43.88 ,$199.75 ,$25.81 ,$43.88 ,$25.81 ,$164.50 ,$26.67 ,$25.81 ,$25.81 ,$29.21 ,$199.75 ,$58.07 ,$216.20 ,$164.50 ,$124.03 ,$124.03 ,$143.12 ,$124.03 ,$162.39 ,$211.50 ,$163.68 ,$26.07 ,$185.65 ,$28.27 ,$30.97 ,$30.97 ,$25.81 ,$30.97 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,30200323,86813,HC HLA TYPING MULTI A/B/C,302,1 ,$590.00 ,$295.00 ,$58.00 ,$590.00 ,$59.93 ,$225.54 ,$193.32 ,$58.00 ,$354.00 ,$501.50 ,$413.00 ,$59.93 ,$560.50 ,$448.40 ,$442.50 ,$98.60 ,$501.50 ,$58.00 ,$98.60 ,$58.00 ,$413.00 ,$59.93 ,$58.00 ,$58.00 ,$65.64 ,$501.50 ,$130.50 ,$542.80 ,$413.00 ,$278.71 ,$278.71 ,$359.31 ,$278.71 ,$407.69 ,$531.00 ,$410.94 ,$58.58 ,$466.10 ,$63.53 ,$69.60 ,$69.60 ,$58.00 ,$69.60 ,$424.80 ,$365.80 ,$424.80 ,$424.80 ,$472.00 
ST NICHOLAS HOSPITAL - ACUTE,30200324,86849,HC IMMUNOASSAY UNLISTED (LEUKO),302,1 ,$62.00 ,$31.00 ,$3.28 ,$62.00 ,$3.28 ,$40.11 ,$40.11 , N/A ,$37.20 ,$52.70 ,$43.40 ,$3.28 ,$58.90 ,$47.12 ,$46.50 , N/A ,$52.70 , N/A , N/A , N/A ,$43.40 ,$3.28 , N/A , N/A ,$26.04 ,$52.70 ,$37.20 ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$37.74 ,$42.84 ,$55.80 ,$43.18 , N/A ,$48.98 ,$3.48 ,$31.00 ,$31.00 , N/A ,$31.00 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30200325,86849,HC IMMUNOASSAY UNLISTED (ABID),302,1 ,$86.00 ,$43.00 ,$3.28 ,$86.00 ,$3.28 ,$55.63 ,$55.63 , N/A ,$51.60 ,$73.10 ,$60.20 ,$3.28 ,$81.70 ,$65.36 ,$64.50 , N/A ,$73.10 , N/A , N/A , N/A ,$60.20 ,$3.28 , N/A , N/A ,$36.12 ,$73.10 ,$51.60 ,$79.12 ,$60.20 ,$43.62 ,$52.35 ,$52.37 ,$52.35 ,$59.43 ,$77.40 ,$59.90 , N/A ,$67.94 ,$3.48 ,$43.00 ,$43.00 , N/A ,$43.00 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30200326,86849,HC IMMUNOASSAY UNLISTED,302,1 ,$161.00 ,$80.50 ,$3.28 ,$161.00 ,$3.28 ,$104.15 ,$104.15 , N/A ,$96.60 ,$136.85 ,$112.70 ,$3.28 ,$152.95 ,$122.36 ,$120.75 , N/A ,$136.85 , N/A , N/A , N/A ,$112.70 ,$3.28 , N/A , N/A ,$67.62 ,$136.85 ,$96.60 ,$148.12 ,$112.70 ,$81.66 ,$98.00 ,$98.05 ,$98.00 ,$111.25 ,$144.90 ,$112.14 , N/A ,$127.19 ,$3.48 ,$80.50 ,$80.50 , N/A ,$80.50 ,$115.92 ,$99.82 ,$115.92 ,$115.92 ,$128.80 
ST NICHOLAS HOSPITAL - ACUTE,30200327,86850,HC AB SCREEN,302,1 ,$90.00 ,$45.00 ,$5.38 ,$110.24 ,$5.38 ,$34.20 ,$29.31 ,$49.00 ,$54.00 ,$76.50 ,$63.00 ,$5.38 ,$85.50 ,$68.40 ,$67.50 ,$16.61 ,$76.50 ,$49.00 ,$16.61 ,$9.77 ,$63.00 ,$5.38 ,$49.00 ,$49.00 ,$11.06 ,$76.50 ,$110.24 ,$82.80 ,$63.00 ,$46.08 ,$46.08 ,$54.81 ,$46.08 ,$62.19 ,$81.00 ,$62.69 ,$49.49 ,$71.10 ,$5.70 ,$11.72 ,$11.72 ,$49.00 ,$11.72 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200329,86860,HC ELUTION,302,1 ,$146.00 ,$73.00 ,$8.23 ,$330.88 ,$8.23 ,$109.85 ,$94.16 ,$147.06 ,$87.60 ,$124.10 ,$102.20 ,$8.23 ,$138.70 ,$110.96 ,$109.50 ,$52.53 ,$124.10 ,$147.06 ,$52.53 ,$31.17 ,$102.20 ,$8.23 ,$147.06 ,$147.06 ,$61.32 ,$124.10 ,$330.88 ,$134.32 ,$102.20 ,$146.00 ,$146.00 ,$88.91 ,$146.00 ,$100.89 ,$131.40 ,$101.69 ,$148.53 ,$115.34 ,$8.72 ,$146.00 ,$146.00 ,$147.06 ,$146.00 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200331,86870,HC RBC AB ID PANEL,302,1 ,$269.00 ,$134.50 ,$8.23 ,$646.13 ,$8.23 ,$150.89 ,$129.34 ,$287.17 ,$161.40 ,$228.65 ,$188.30 ,$8.23 ,$255.55 ,$204.44 ,$201.75 ,$71.52 ,$228.65 ,$287.17 ,$71.52 ,$42.81 ,$188.30 ,$8.23 ,$287.17 ,$287.17 ,$112.98 ,$228.65 ,$646.13 ,$247.48 ,$188.30 ,$119.98 ,$119.98 ,$163.82 ,$119.98 ,$185.88 ,$242.10 ,$187.36 ,$290.04 ,$212.51 ,$8.72 ,$269.00 ,$269.00 ,$287.17 ,$269.00 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30200334,86880,HC COOMBS DIRECT,302,1 ,$56.00 ,$28.00 ,$5.39 ,$123.49 ,$5.57 ,$20.97 ,$17.97 ,$54.89 ,$33.60 ,$47.60 ,$39.20 ,$5.57 ,$53.20 ,$42.56 ,$42.00 ,$9.16 ,$47.60 ,$54.89 ,$9.16 ,$5.39 ,$39.20 ,$5.57 ,$54.89 ,$54.89 ,$6.10 ,$47.60 ,$123.49 ,$51.52 ,$39.20 ,$20.64 ,$20.64 ,$34.10 ,$20.64 ,$38.70 ,$50.40 ,$39.00 ,$55.44 ,$44.24 ,$5.90 ,$6.47 ,$6.47 ,$54.89 ,$6.47 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30200336,86880,HC ANTIHUMAN GLOBULIN TEST,302,1 ,$53.00 ,$26.50 ,$5.39 ,$123.49 ,$5.57 ,$20.97 ,$17.97 ,$54.89 ,$31.80 ,$45.05 ,$37.10 ,$5.57 ,$50.35 ,$40.28 ,$39.75 ,$9.16 ,$45.05 ,$54.89 ,$9.16 ,$5.39 ,$37.10 ,$5.57 ,$54.89 ,$54.89 ,$6.10 ,$45.05 ,$123.49 ,$48.76 ,$37.10 ,$20.64 ,$20.64 ,$32.28 ,$20.64 ,$36.62 ,$47.70 ,$36.91 ,$55.44 ,$41.87 ,$5.90 ,$6.47 ,$6.47 ,$54.89 ,$6.47 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30200338,86885,HC INDIRECT COOMBS,302,1 ,$80.00 ,$40.00 ,$5.72 ,$330.88 ,$5.91 ,$22.26 ,$19.08 ,$147.06 ,$48.00 ,$68.00 ,$56.00 ,$5.91 ,$76.00 ,$60.80 ,$60.00 ,$9.72 ,$68.00 ,$147.06 ,$9.72 ,$5.72 ,$56.00 ,$5.91 ,$147.06 ,$147.06 ,$6.47 ,$68.00 ,$330.88 ,$73.60 ,$56.00 ,$27.51 ,$27.51 ,$48.72 ,$27.51 ,$55.28 ,$72.00 ,$55.72 ,$148.53 ,$63.20 ,$6.26 ,$6.86 ,$6.86 ,$147.06 ,$6.86 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,30200339,86885,HC INDIRECT COOMBS (ABID),302,1 ,$11.00 ,$5.50 ,$5.50 ,$330.88 ,$5.91 ,$11.00 ,$11.00 ,$147.06 ,$6.60 ,$9.35 ,$7.70 ,$5.91 ,$10.45 ,$8.36 ,$8.25 ,$9.72 ,$9.35 ,$147.06 ,$9.72 ,$5.72 ,$7.70 ,$5.91 ,$147.06 ,$147.06 ,$6.47 ,$9.35 ,$330.88 ,$10.12 ,$7.70 ,$11.00 ,$11.00 ,$6.70 ,$11.00 ,$7.60 ,$9.90 ,$7.66 ,$148.53 ,$8.69 ,$6.26 ,$6.86 ,$6.86 ,$147.06 ,$6.86 ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$8.80 
ST NICHOLAS HOSPITAL - ACUTE,30200340,86886,HC INDIRECT TITER,302,1 ,$67.00 ,$33.50 ,$5.18 ,$330.88 ,$5.35 ,$20.13 ,$17.25 ,$147.06 ,$40.20 ,$56.95 ,$46.90 ,$5.35 ,$63.65 ,$50.92 ,$50.25 ,$8.81 ,$56.95 ,$147.06 ,$8.81 ,$5.18 ,$46.90 ,$5.35 ,$147.06 ,$147.06 ,$5.86 ,$56.95 ,$330.88 ,$61.64 ,$46.90 ,$24.87 ,$24.87 ,$40.80 ,$24.87 ,$46.30 ,$60.30 ,$46.67 ,$148.53 ,$52.93 ,$5.67 ,$6.22 ,$6.22 ,$147.06 ,$6.22 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200342,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,$381.00 ,$190.50 ,$8.35 ,$381.00 ,$8.35 ,$346.45 ,$296.95 ,$147.06 ,$228.60 ,$323.85 ,$266.70 ,$8.35 ,$361.95 ,$289.56 ,$285.75 ,$164.83 ,$323.85 ,$147.06 ,$164.83 ,$97.95 ,$266.70 ,$8.35 ,$147.06 ,$147.06 ,$160.02 ,$323.85 ,$330.88 ,$350.52 ,$266.70 ,$229.78 ,$229.78 ,$232.03 ,$229.78 ,$263.27 ,$342.90 ,$265.37 ,$148.53 ,$300.99 ,$8.85 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,30200343,86891,HC BLOOD SALVAGE AUTOLOOUS INTRA,302,1 ,$504.00 ,$252.00 ,$8.35 ,"$1,453.86 ",$8.35 ,$490.09 ,$420.08 ,$646.16 ,$302.40 ,$428.40 ,$352.80 ,$8.35 ,$478.80 ,$383.04 ,$378.00 ,$232.46 ,$428.40 ,$646.16 ,$232.46 ,$138.37 ,$352.80 ,$8.35 ,$646.16 ,$646.16 ,$211.68 ,$428.40 ,"$1,453.86 ",$463.68 ,$352.80 ,$229.78 ,$229.78 ,$306.94 ,$229.78 ,$348.26 ,$453.60 ,$351.04 ,$652.62 ,$398.16 ,$8.85 ,$504.00 ,$504.00 ,$646.16 ,$504.00 ,$362.88 ,$312.48 ,$362.88 ,$362.88 ,$403.20 
ST NICHOLAS HOSPITAL - ACUTE,30200344,86900,HC BLOOD TYPING ABO,302,1 ,$40.00 ,$20.00 ,$2.99 ,$250.16 ,$3.09 ,$11.62 ,$9.96 ,$111.18 ,$24.00 ,$34.00 ,$28.00 ,$3.09 ,$38.00 ,$30.40 ,$30.00 ,$5.08 ,$34.00 ,$111.18 ,$5.08 ,$2.99 ,$28.00 ,$3.09 ,$111.18 ,$111.18 ,$3.38 ,$34.00 ,$250.16 ,$36.80 ,$28.00 ,$13.17 ,$13.17 ,$24.36 ,$13.17 ,$27.64 ,$36.00 ,$27.86 ,$112.29 ,$31.60 ,$3.28 ,$3.59 ,$3.59 ,$111.18 ,$3.59 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30200346,86901,HC BLOOD TYPING RH,302,1 ,$44.00 ,$22.00 ,$2.99 ,$75.09 ,$3.09 ,$11.62 ,$9.96 ,$33.38 ,$26.40 ,$37.40 ,$30.80 ,$3.09 ,$41.80 ,$33.44 ,$33.00 ,$5.08 ,$37.40 ,$33.38 ,$5.08 ,$2.99 ,$30.80 ,$3.09 ,$33.38 ,$33.38 ,$3.38 ,$37.40 ,$75.09 ,$40.48 ,$30.80 ,$13.17 ,$13.17 ,$26.80 ,$13.17 ,$30.40 ,$39.60 ,$30.65 ,$33.71 ,$34.76 ,$3.28 ,$3.59 ,$3.59 ,$33.38 ,$3.59 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$35.20 
ST NICHOLAS HOSPITAL - ACUTE,30200347,86901,HC BLOOD TYPING RH (CLINIC),302,1 ,$24.00 ,$12.00 ,$2.99 ,$75.09 ,$3.09 ,$11.62 ,$9.96 ,$33.38 ,$14.40 ,$20.40 ,$16.80 ,$3.09 ,$22.80 ,$18.24 ,$18.00 ,$5.08 ,$20.40 ,$33.38 ,$5.08 ,$2.99 ,$16.80 ,$3.09 ,$33.38 ,$33.38 ,$3.38 ,$20.40 ,$75.09 ,$22.08 ,$16.80 ,$13.17 ,$13.17 ,$14.62 ,$13.17 ,$16.58 ,$21.60 ,$16.72 ,$33.71 ,$18.96 ,$3.28 ,$3.59 ,$3.59 ,$33.38 ,$3.59 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$19.20 
ST NICHOLAS HOSPITAL - ACUTE,30200349,86902,HC RBC AG SCR RGT SERUM,302,1 ,$78.00 ,$39.00 ,$5.37 ,$646.13 ,$5.37 ,$22.23 ,$19.05 ,$287.17 ,$46.80 ,$66.30 ,$54.60 ,$5.37 ,$74.10 ,$59.28 ,$58.50 ,$10.80 ,$66.30 ,$287.17 ,$10.80 ,$6.35 ,$54.60 ,$5.37 ,$287.17 ,$287.17 ,$7.19 ,$66.30 ,$646.13 ,$71.76 ,$54.60 ,$18.39 ,$18.39 ,$47.50 ,$18.39 ,$53.90 ,$70.20 ,$54.33 ,$290.04 ,$61.62 ,$5.69 ,$7.62 ,$7.62 ,$287.17 ,$7.62 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200351,86902,HC RBC AG SCR RGT SERUM TYPE UNIT,302,1 ,$67.00 ,$33.50 ,$5.37 ,$646.13 ,$5.37 ,$22.23 ,$19.05 ,$287.17 ,$40.20 ,$56.95 ,$46.90 ,$5.37 ,$63.65 ,$50.92 ,$50.25 ,$10.80 ,$56.95 ,$287.17 ,$10.80 ,$6.35 ,$46.90 ,$5.37 ,$287.17 ,$287.17 ,$7.19 ,$56.95 ,$646.13 ,$61.64 ,$46.90 ,$18.39 ,$18.39 ,$40.80 ,$18.39 ,$46.30 ,$60.30 ,$46.67 ,$290.04 ,$52.93 ,$5.69 ,$7.62 ,$7.62 ,$287.17 ,$7.62 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200352,86904,HC RBC AG SCR PAT SERUM,302,1 ,$86.00 ,$43.00 ,$13.37 ,$86.00 ,$13.37 ,$57.19 ,$49.02 ,$33.38 ,$51.60 ,$73.10 ,$60.20 ,$13.37 ,$81.70 ,$65.36 ,$64.50 ,$27.78 ,$73.10 ,$33.38 ,$27.78 ,$16.34 ,$60.20 ,$13.37 ,$33.38 ,$33.38 ,$18.49 ,$73.10 ,$75.09 ,$79.12 ,$60.20 ,$45.69 ,$45.69 ,$52.37 ,$45.69 ,$59.43 ,$77.40 ,$59.90 ,$33.71 ,$67.94 ,$14.17 ,$19.61 ,$19.61 ,$33.38 ,$19.61 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30200354,86905,HC ANTIGEN ID ONLY,302,1 ,$67.00 ,$33.50 ,$3.83 ,$646.13 ,$3.96 ,$14.88 ,$12.75 ,$287.17 ,$40.20 ,$56.95 ,$46.90 ,$3.96 ,$63.65 ,$50.92 ,$50.25 ,$6.51 ,$56.95 ,$287.17 ,$6.51 ,$3.83 ,$46.90 ,$3.96 ,$287.17 ,$287.17 ,$4.33 ,$56.95 ,$646.13 ,$61.64 ,$46.90 ,$18.39 ,$18.39 ,$40.80 ,$18.39 ,$46.30 ,$60.30 ,$46.67 ,$290.04 ,$52.93 ,$4.20 ,$4.60 ,$4.60 ,$287.17 ,$4.60 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200356,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$157.00 ,$78.50 ,$7.15 ,$330.88 ,$7.15 ,$121.92 ,$104.50 ,$147.06 ,$94.20 ,$133.45 ,$109.90 ,$7.15 ,$149.15 ,$119.32 ,$117.75 ,$58.11 ,$133.45 ,$147.06 ,$58.11 ,$34.59 ,$109.90 ,$7.15 ,$147.06 ,$147.06 ,$65.94 ,$133.45 ,$330.88 ,$144.44 ,$109.90 ,$119.98 ,$119.98 ,$95.61 ,$119.98 ,$108.49 ,$141.30 ,$109.35 ,$148.53 ,$124.03 ,$7.58 ,$157.00 ,$157.00 ,$147.06 ,$157.00 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200358,86921,HC CROSSMATCH INCUBATION,302,1 ,$123.00 ,$61.50 ,$8.23 ,$330.88 ,$8.23 ,$109.85 ,$94.16 ,$147.06 ,$73.80 ,$104.55 ,$86.10 ,$8.23 ,$116.85 ,$93.48 ,$92.25 ,$52.53 ,$104.55 ,$147.06 ,$52.53 ,$31.17 ,$86.10 ,$8.23 ,$147.06 ,$147.06 ,$51.66 ,$104.55 ,$330.88 ,$113.16 ,$86.10 ,$46.08 ,$46.08 ,$74.91 ,$46.08 ,$84.99 ,$110.70 ,$85.67 ,$148.53 ,$97.17 ,$8.72 ,$123.00 ,$123.00 ,$147.06 ,$123.00 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200360,86922,HC CROSSMATCH AHG,302,1 ,$157.00 ,$78.50 ,$8.23 ,$330.88 ,$8.23 ,$130.37 ,$111.75 ,$147.06 ,$94.20 ,$133.45 ,$109.90 ,$8.23 ,$149.15 ,$119.32 ,$117.75 ,$62.02 ,$133.45 ,$147.06 ,$62.02 ,$36.99 ,$109.90 ,$8.23 ,$147.06 ,$147.06 ,$65.94 ,$133.45 ,$330.88 ,$144.44 ,$109.90 ,$119.98 ,$119.98 ,$95.61 ,$119.98 ,$108.49 ,$141.30 ,$109.35 ,$148.53 ,$124.03 ,$8.72 ,$157.00 ,$157.00 ,$147.06 ,$157.00 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200362,86923,HC CROSSMATCH ELECTRONIC,302,1 ,$157.00 ,$78.50 ,$8.23 ,$330.88 ,$8.23 ,$97.78 ,$83.81 ,$147.06 ,$94.20 ,$133.45 ,$109.90 ,$8.23 ,$149.15 ,$119.32 ,$117.75 ,$46.38 ,$133.45 ,$147.06 ,$46.38 ,$27.74 ,$109.90 ,$8.23 ,$147.06 ,$147.06 ,$65.94 ,$133.45 ,$330.88 ,$144.44 ,$109.90 ,$119.98 ,$119.98 ,$95.61 ,$119.98 ,$108.49 ,$141.30 ,$109.35 ,$148.53 ,$124.03 ,$8.72 ,$157.00 ,$157.00 ,$147.06 ,$157.00 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200363,86927,HC FFP THAWING EACH UNIT,302,1 ,$168.00 ,$84.00 ,$8.35 ,$330.88 ,$8.35 ,$68.81 ,$58.98 ,$147.06 ,$100.80 ,$142.80 ,$117.60 ,$8.35 ,$159.60 ,$127.68 ,$126.00 ,$32.96 ,$142.80 ,$147.06 ,$32.96 ,$19.52 ,$117.60 ,$8.35 ,$147.06 ,$147.06 ,$70.56 ,$142.80 ,$330.88 ,$154.56 ,$117.60 ,$168.00 ,$168.00 ,$102.31 ,$168.00 ,$116.09 ,$151.20 ,$117.01 ,$148.53 ,$132.72 ,$8.85 ,$168.00 ,$168.00 ,$147.06 ,$168.00 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30200365,86945,HC BLOOD PRODUCT IRRADIATION,302,1 ,$115.00 ,$57.50 ,$8.35 ,$115.00 ,$8.35 ,$102.61 ,$87.95 ,$33.38 ,$69.00 ,$97.75 ,$80.50 ,$8.35 ,$109.25 ,$87.40 ,$86.25 ,$48.62 ,$97.75 ,$33.38 ,$48.62 ,$28.77 ,$80.50 ,$8.35 ,$33.38 ,$33.38 ,$48.30 ,$97.75 ,$75.09 ,$105.80 ,$80.50 ,$46.08 ,$46.08 ,$70.04 ,$46.08 ,$79.47 ,$103.50 ,$80.10 ,$33.71 ,$90.85 ,$8.85 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30200366,86950,HC WBC CONC CMV NEG,302,1 ,"$1,725.00 ",$862.50 ,$8.35 ,"$1,725.00 ",$8.35 ,$265.57 ,$227.63 ,$147.06 ,"$1,035.00 ","$1,466.25 ","$1,207.50 ",$8.35 ,"$1,638.75 ","$1,311.00 ","$1,293.75 ",$126.28 ,"$1,466.25 ",$147.06 ,$126.28 ,$75.01 ,"$1,207.50 ",$8.35 ,$147.06 ,$147.06 ,$724.50 ,"$1,466.25 ",$330.88 ,"$1,587.00 ","$1,207.50 ",$46.08 ,$46.08 ,"$1,050.53 ",$46.08 ,"$1,191.98 ","$1,552.50 ","$1,201.46 ",$148.53 ,"$1,362.75 ",$8.85 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,"$1,242.00 ","$1,069.50 ","$1,242.00 ","$1,242.00 ","$1,380.00 "
ST NICHOLAS HOSPITAL - ACUTE,30200367,86950,HC WBC CONC CMV NEG (RC),302,1 ,"$1,698.00 ",$849.00 ,$8.35 ,"$1,698.00 ",$8.35 ,$265.57 ,$227.63 ,$147.06 ,"$1,018.80 ","$1,443.30 ","$1,188.60 ",$8.35 ,"$1,613.10 ","$1,290.48 ","$1,273.50 ",$126.28 ,"$1,443.30 ",$147.06 ,$126.28 ,$75.01 ,"$1,188.60 ",$8.35 ,$147.06 ,$147.06 ,$713.16 ,"$1,443.30 ",$330.88 ,"$1,562.16 ","$1,188.60 ",$46.08 ,$46.08 ,"$1,034.08 ",$46.08 ,"$1,173.32 ","$1,528.20 ","$1,182.66 ",$148.53 ,"$1,341.42 ",$8.85 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,"$1,222.56 ","$1,052.76 ","$1,222.56 ","$1,222.56 ","$1,358.40 "
ST NICHOLAS HOSPITAL - ACUTE,30200368,86965,HC BLOOD PRODUCT POOL,302,1 ,$127.00 ,$63.50 ,$8.35 ,$330.88 ,$8.35 ,$114.68 ,$98.29 ,$147.06 ,$76.20 ,$107.95 ,$88.90 ,$8.35 ,$120.65 ,$96.52 ,$95.25 ,$54.20 ,$107.95 ,$147.06 ,$54.20 ,$32.19 ,$88.90 ,$8.35 ,$147.06 ,$147.06 ,$53.34 ,$107.95 ,$330.88 ,$116.84 ,$88.90 ,$127.00 ,$127.00 ,$77.34 ,$127.00 ,$87.76 ,$114.30 ,$88.46 ,$148.53 ,$100.33 ,$8.85 ,$127.00 ,$127.00 ,$147.06 ,$127.00 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$101.60 
ST NICHOLAS HOSPITAL - ACUTE,30200369,86970,HC RBC PRETREAT CHEM,302,1 ,$115.00 ,$57.50 ,$8.35 ,$115.00 ,$8.35 ,$102.61 ,$87.95 ,$33.38 ,$69.00 ,$97.75 ,$80.50 ,$8.35 ,$109.25 ,$87.40 ,$86.25 ,$48.62 ,$97.75 ,$33.38 ,$48.62 ,$28.77 ,$80.50 ,$8.35 ,$33.38 ,$33.38 ,$48.30 ,$97.75 ,$75.09 ,$105.80 ,$80.50 ,$115.00 ,$115.00 ,$70.04 ,$115.00 ,$79.47 ,$103.50 ,$80.10 ,$33.71 ,$90.85 ,$8.85 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30200373,86403,HC PARTICLE AGG SCREEN (HAEMOPHILUS OR NEISSERIA),302,1 ,$115.00 ,$57.50 ,$11.54 ,$115.00 ,$11.92 ,$40.39 ,$34.62 ,$11.54 ,$69.00 ,$97.75 ,$80.50 ,$11.92 ,$109.25 ,$87.40 ,$86.25 ,$19.62 ,$97.75 ,$11.54 ,$19.62 ,$11.54 ,$80.50 ,$11.92 ,$11.54 ,$11.54 ,$13.06 ,$97.75 ,$25.97 ,$105.80 ,$80.50 ,$48.96 ,$48.96 ,$70.04 ,$48.96 ,$79.47 ,$103.50 ,$80.10 ,$11.66 ,$90.85 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30200375,86880,HC C3 DIRECT COOMBS,302,1 ,$52.00 ,$26.00 ,$5.39 ,$123.49 ,$5.57 ,$20.97 ,$17.97 ,$54.89 ,$31.20 ,$44.20 ,$36.40 ,$5.57 ,$49.40 ,$39.52 ,$39.00 ,$9.16 ,$44.20 ,$54.89 ,$9.16 ,$5.39 ,$36.40 ,$5.57 ,$54.89 ,$54.89 ,$6.10 ,$44.20 ,$123.49 ,$47.84 ,$36.40 ,$20.64 ,$20.64 ,$31.67 ,$20.64 ,$35.93 ,$46.80 ,$36.22 ,$55.44 ,$41.08 ,$5.90 ,$6.47 ,$6.47 ,$54.89 ,$6.47 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30200376,86832,HC HLA AB ID CLASS I HIGH RES,302,1 ,$907.00 ,$453.50 ,$139.23 ,$907.00 ,$139.23 ,$907.00 ,$907.00 ,$323.75 ,$544.20 ,$770.95 ,$634.90 ,$139.23 ,$861.65 ,$689.32 ,$680.25 ,$550.38 ,$770.95 ,$323.75 ,$550.38 ,$323.75 ,$634.90 ,$139.23 ,$323.75 ,$323.75 ,$366.42 ,$770.95 ,$728.44 ,$834.44 ,$634.90 ,$609.73 ,$609.73 ,$552.36 ,$609.73 ,$626.74 ,$816.30 ,$631.73 ,$326.99 ,$716.53 ,$147.58 ,$388.50 ,$388.50 ,$323.75 ,$388.50 ,$653.04 ,$562.34 ,$653.04 ,$653.04 ,$725.60 
ST NICHOLAS HOSPITAL - ACUTE,30200380,86658,HC ENTEROVIRUS B COXSACKIE,302,1 ,$43.00 ,$21.50 ,$8.17 ,$43.00 ,$8.17 ,$43.00 ,$43.00 ,$13.03 ,$25.80 ,$36.55 ,$30.10 ,$8.17 ,$40.85 ,$32.68 ,$32.25 ,$22.15 ,$36.55 ,$13.03 ,$22.15 ,$13.03 ,$30.10 ,$8.17 ,$13.03 ,$13.03 ,$14.75 ,$36.55 ,$29.32 ,$39.56 ,$30.10 ,$27.93 ,$27.93 ,$26.19 ,$27.93 ,$29.71 ,$38.70 ,$29.95 ,$13.16 ,$33.97 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,30200400,86235,HC ENA AB QUEST,302,1 ,$123.00 ,$61.50 ,$17.93 ,$123.00 ,$18.53 ,$69.76 ,$59.79 ,$17.93 ,$73.80 ,$104.55 ,$86.10 ,$18.53 ,$116.85 ,$93.48 ,$92.25 ,$30.48 ,$104.55 ,$17.93 ,$30.48 ,$17.93 ,$86.10 ,$18.53 ,$17.93 ,$17.93 ,$20.29 ,$104.55 ,$40.34 ,$113.16 ,$86.10 ,$86.16 ,$86.16 ,$74.91 ,$86.16 ,$84.99 ,$110.70 ,$85.67 ,$18.11 ,$97.17 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30200448,86757,HC RICKETTSIA IGG,302,1 ,$112.00 ,$56.00 ,$19.35 ,$112.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$67.20 ,$95.20 ,$78.40 ,$19.99 ,$106.40 ,$85.12 ,$84.00 ,$32.90 ,$95.20 ,$19.35 ,$32.90 ,$19.35 ,$78.40 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$95.20 ,$43.54 ,$103.04 ,$78.40 ,$93.00 ,$93.00 ,$68.21 ,$93.00 ,$77.39 ,$100.80 ,$78.01 ,$19.54 ,$88.48 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200449,86757,HC RICKETTSIA IGM,302,1 ,$112.00 ,$56.00 ,$19.35 ,$112.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$67.20 ,$95.20 ,$78.40 ,$19.99 ,$106.40 ,$85.12 ,$84.00 ,$32.90 ,$95.20 ,$19.35 ,$32.90 ,$19.35 ,$78.40 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$95.20 ,$43.54 ,$103.04 ,$78.40 ,$93.00 ,$93.00 ,$68.21 ,$93.00 ,$77.39 ,$100.80 ,$78.01 ,$19.54 ,$88.48 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200450,86635,HC COCCID AB IGG/IGM,302,1 ,$137.00 ,$68.50 ,$8.17 ,$137.00 ,$8.17 ,$44.63 ,$38.25 ,$11.47 ,$82.20 ,$116.45 ,$95.90 ,$8.17 ,$130.15 ,$104.12 ,$102.75 ,$19.50 ,$116.45 ,$11.47 ,$19.50 ,$11.47 ,$95.90 ,$8.17 ,$11.47 ,$11.47 ,$12.98 ,$116.45 ,$25.81 ,$126.04 ,$95.90 ,$27.93 ,$27.93 ,$83.43 ,$27.93 ,$94.67 ,$123.30 ,$95.42 ,$11.58 ,$108.23 ,$8.66 ,$13.76 ,$13.76 ,$11.47 ,$13.76 ,$98.64 ,$84.94 ,$98.64 ,$98.64 ,$109.60 
ST NICHOLAS HOSPITAL - ACUTE,30200460,86038,HC ANA CENTROMERE B AB,302,1 ,$78.00 ,$39.00 ,$12.09 ,$78.00 ,$12.49 ,$47.01 ,$40.29 ,$12.09 ,$46.80 ,$66.30 ,$54.60 ,$12.49 ,$74.10 ,$59.28 ,$58.50 ,$20.55 ,$66.30 ,$12.09 ,$20.55 ,$12.09 ,$54.60 ,$12.49 ,$12.09 ,$12.09 ,$13.68 ,$66.30 ,$27.20 ,$71.76 ,$54.60 ,$50.09 ,$50.09 ,$47.50 ,$50.09 ,$53.90 ,$70.20 ,$54.33 ,$12.21 ,$61.62 ,$13.24 ,$14.51 ,$14.51 ,$12.09 ,$14.51 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30200476,86985,HC SPLITTING BLOOD PRODUCT EA,302,1 ,$84.00 ,$42.00 ,$8.35 ,$330.88 ,$8.35 ,$84.00 ,$76.57 ,$147.06 ,$50.40 ,$71.40 ,$58.80 ,$8.35 ,$79.80 ,$63.84 ,$63.00 ,$42.47 ,$71.40 ,$147.06 ,$42.47 ,$25.34 ,$58.80 ,$8.35 ,$147.06 ,$147.06 ,$35.28 ,$71.40 ,$330.88 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$75.60 ,$58.51 ,$148.53 ,$66.36 ,$8.85 ,$84.00 ,$84.00 ,$147.06 ,$84.00 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,30200477,86695,HC HSV IGM TITER TYPE I,302,1 ,$101.00 ,$50.50 ,$13.19 ,$101.00 ,$13.63 ,$51.28 ,$43.95 ,$13.19 ,$60.60 ,$85.85 ,$70.70 ,$13.63 ,$95.95 ,$76.76 ,$75.75 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$13.19 ,$70.70 ,$13.63 ,$13.19 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$63.41 ,$63.41 ,$61.51 ,$63.41 ,$69.79 ,$90.90 ,$70.35 ,$13.32 ,$79.79 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200478,86696,HC HSV IGM TITER TYPE 2,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$87.60 ,$124.10 ,$102.20 ,$19.99 ,$138.70 ,$110.96 ,$109.50 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$19.35 ,$102.20 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$93.00 ,$93.00 ,$88.91 ,$93.00 ,$100.89 ,$131.40 ,$101.69 ,$19.54 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200480,86696,HC HSV TYPE 2 AB IGG,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$87.60 ,$124.10 ,$102.20 ,$19.99 ,$138.70 ,$110.96 ,$109.50 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$19.35 ,$102.20 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$93.00 ,$93.00 ,$88.91 ,$93.00 ,$100.89 ,$131.40 ,$101.69 ,$19.54 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200481,86695,HC HSV TYPE 1 AB IGG,302,1 ,$101.00 ,$50.50 ,$13.19 ,$101.00 ,$13.63 ,$51.28 ,$43.95 ,$13.19 ,$60.60 ,$85.85 ,$70.70 ,$13.63 ,$95.95 ,$76.76 ,$75.75 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$13.19 ,$70.70 ,$13.63 ,$13.19 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$63.41 ,$63.41 ,$61.51 ,$63.41 ,$69.79 ,$90.90 ,$70.35 ,$13.32 ,$79.79 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30200482,86777,HC TOXOPLASMA AB IGG,302,1 ,$106.00 ,$53.00 ,$14.39 ,$106.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$63.60 ,$90.10 ,$74.20 ,$14.87 ,$100.70 ,$80.56 ,$79.50 ,$24.46 ,$90.10 ,$14.39 ,$24.46 ,$14.39 ,$74.20 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$90.10 ,$32.38 ,$97.52 ,$74.20 ,$69.18 ,$69.18 ,$64.55 ,$69.18 ,$73.25 ,$95.40 ,$73.83 ,$14.53 ,$83.74 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$84.80 
ST NICHOLAS HOSPITAL - ACUTE,30200483,86762,HC RUBELLA AB IGG MAYO,302,1 ,$116.00 ,$58.00 ,$14.39 ,$116.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$69.60 ,$98.60 ,$81.20 ,$14.87 ,$110.20 ,$88.16 ,$87.00 ,$24.46 ,$98.60 ,$14.39 ,$24.46 ,$14.39 ,$81.20 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$98.60 ,$32.38 ,$106.72 ,$81.20 ,$69.18 ,$69.18 ,$70.64 ,$69.18 ,$80.16 ,$104.40 ,$80.79 ,$14.53 ,$91.64 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,30200484,86644,HC CMV AB IGG,302,1 ,$110.00 ,$55.00 ,$14.39 ,$110.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$66.00 ,$93.50 ,$77.00 ,$14.87 ,$104.50 ,$83.60 ,$82.50 ,$24.46 ,$93.50 ,$14.39 ,$24.46 ,$14.39 ,$77.00 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$93.50 ,$32.38 ,$101.20 ,$77.00 ,$69.18 ,$69.18 ,$66.99 ,$69.18 ,$76.01 ,$99.00 ,$76.62 ,$14.53 ,$86.90 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,30200500,87804,HC INFLUENZA ASSAY W/OPTIC,302,1 ,$90.00 ,$45.00 ,$16.55 ,$90.00 ,$16.86 ,$57.93 ,$49.65 ,$16.55 ,$54.00 ,$76.50 ,$63.00 ,$16.86 ,$85.50 ,$68.40 ,$67.50 ,$28.14 ,$76.50 ,$16.55 ,$28.14 ,$16.55 ,$63.00 ,$16.86 ,$16.55 ,$16.55 ,$18.73 ,$76.50 ,$37.24 ,$82.80 ,$63.00 ,$57.63 ,$57.63 ,$54.81 ,$57.63 ,$62.19 ,$81.00 ,$62.69 ,$16.72 ,$71.10 ,$17.87 ,$19.86 ,$19.86 ,$16.55 ,$19.86 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200511,86226,HC DNA SINGLE STRAND AB,302,1 ,$115.00 ,$57.50 ,$12.11 ,$115.00 ,$12.51 ,$47.08 ,$40.35 ,$12.11 ,$69.00 ,$97.75 ,$80.50 ,$12.51 ,$109.25 ,$87.40 ,$86.25 ,$20.59 ,$97.75 ,$12.11 ,$20.59 ,$12.11 ,$80.50 ,$12.51 ,$12.11 ,$12.11 ,$13.71 ,$97.75 ,$27.25 ,$105.80 ,$80.50 ,$58.19 ,$58.19 ,$70.04 ,$58.19 ,$79.47 ,$103.50 ,$80.10 ,$12.23 ,$90.85 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,30200513,86256,HC FLUOR AB TITER,302,1 ,$86.00 ,$43.00 ,$12.05 ,$86.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$51.60 ,$73.10 ,$60.20 ,$12.45 ,$81.70 ,$65.36 ,$64.50 ,$20.49 ,$73.10 ,$12.05 ,$20.49 ,$12.05 ,$60.20 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$73.10 ,$27.11 ,$79.12 ,$60.20 ,$57.91 ,$57.91 ,$52.37 ,$57.91 ,$59.43 ,$77.40 ,$59.90 ,$12.17 ,$67.94 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,30200540,86701,HC HIV-1 AB,302,1 ,$90.00 ,$45.00 ,$8.89 ,$90.00 ,$9.19 ,$34.55 ,$29.61 ,$8.89 ,$54.00 ,$76.50 ,$63.00 ,$9.19 ,$85.50 ,$68.40 ,$67.50 ,$15.11 ,$76.50 ,$8.89 ,$15.11 ,$8.89 ,$63.00 ,$9.19 ,$8.89 ,$8.89 ,$10.06 ,$76.50 ,$20.00 ,$82.80 ,$63.00 ,$42.69 ,$42.69 ,$54.81 ,$42.69 ,$62.19 ,$81.00 ,$62.69 ,$8.98 ,$71.10 ,$9.74 ,$10.67 ,$10.67 ,$8.89 ,$10.67 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200541,86702,HC HIV-2 AB,302,1 ,$90.00 ,$45.00 ,$13.52 ,$90.00 ,$13.97 ,$52.57 ,$45.06 ,$13.52 ,$54.00 ,$76.50 ,$63.00 ,$13.97 ,$85.50 ,$68.40 ,$67.50 ,$22.98 ,$76.50 ,$13.52 ,$22.98 ,$13.52 ,$63.00 ,$13.97 ,$13.52 ,$13.52 ,$15.30 ,$76.50 ,$30.42 ,$82.80 ,$63.00 ,$64.96 ,$64.96 ,$54.81 ,$64.96 ,$62.19 ,$81.00 ,$62.69 ,$13.66 ,$71.10 ,$14.81 ,$16.22 ,$16.22 ,$13.52 ,$16.22 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200577,86481,HC TB ANTIGEN RESPONSE GAMMA INTER T-CELL SUSP,302,1 ,$470.00 ,$235.00 ,$90.12 ,$470.00 ,$90.12 ,$350.00 ,$300.00 ,$100.00 ,$282.00 ,$399.50 ,$329.00 ,$90.12 ,$446.50 ,$357.20 ,$352.50 ,$170.00 ,$399.50 ,$100.00 ,$170.00 ,$100.00 ,$329.00 ,$90.12 ,$100.00 ,$100.00 ,$113.18 ,$399.50 ,$225.00 ,$432.40 ,$329.00 ,$360.08 ,$360.08 ,$286.23 ,$360.08 ,$324.77 ,$423.00 ,$327.36 ,$101.00 ,$371.30 ,$95.53 ,$120.00 ,$120.00 ,$100.00 ,$120.00 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,30200582,86382,HC RABIES VACCINE RESPONSE TTR,302,1 ,$157.00 ,$78.50 ,$16.91 ,$157.00 ,$17.47 ,$65.77 ,$56.37 ,$16.91 ,$94.20 ,$133.45 ,$109.90 ,$17.47 ,$149.15 ,$119.32 ,$117.75 ,$28.75 ,$133.45 ,$16.91 ,$28.75 ,$16.91 ,$109.90 ,$17.47 ,$16.91 ,$16.91 ,$19.14 ,$133.45 ,$38.05 ,$144.44 ,$109.90 ,$81.27 ,$81.27 ,$95.61 ,$81.27 ,$108.49 ,$141.30 ,$109.35 ,$17.08 ,$124.03 ,$18.52 ,$20.29 ,$20.29 ,$16.91 ,$20.29 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30200583,86382,HC POLIOVIRUS AB NEUTRALIZATION,302,1 ,$44.00 ,$22.00 ,$16.91 ,$44.00 ,$17.47 ,$44.00 ,$44.00 ,$16.91 ,$26.40 ,$37.40 ,$30.80 ,$17.47 ,$41.80 ,$33.44 ,$33.00 ,$28.75 ,$37.40 ,$16.91 ,$28.75 ,$16.91 ,$30.80 ,$17.47 ,$16.91 ,$16.91 ,$19.14 ,$37.40 ,$38.05 ,$40.48 ,$30.80 ,$44.00 ,$44.00 ,$26.80 ,$44.00 ,$30.40 ,$39.60 ,$30.65 ,$17.08 ,$34.76 ,$18.52 ,$20.29 ,$20.29 ,$16.91 ,$20.29 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$35.20 
ST NICHOLAS HOSPITAL - ACUTE,30200584,86658,HC ENTEROVIRUS PANEL CF SERUM,302,1 ,$146.00 ,$73.00 ,$8.17 ,$146.00 ,$8.17 ,$50.65 ,$43.41 ,$13.03 ,$87.60 ,$124.10 ,$102.20 ,$8.17 ,$138.70 ,$110.96 ,$109.50 ,$22.15 ,$124.10 ,$13.03 ,$22.15 ,$13.03 ,$102.20 ,$8.17 ,$13.03 ,$13.03 ,$14.75 ,$124.10 ,$29.32 ,$134.32 ,$102.20 ,$27.93 ,$27.93 ,$88.91 ,$27.93 ,$100.89 ,$131.40 ,$101.69 ,$13.16 ,$115.34 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30200585,86800,HC THYROGLOBULIN AB CANCER MONITORING,302,1 ,$50.00 ,$25.00 ,$15.91 ,$50.00 ,$16.44 ,$50.00 ,$50.00 ,$15.91 ,$30.00 ,$42.50 ,$35.00 ,$16.44 ,$47.50 ,$38.00 ,$37.50 ,$27.05 ,$42.50 ,$15.91 ,$27.05 ,$15.91 ,$35.00 ,$16.44 ,$15.91 ,$15.91 ,$18.01 ,$42.50 ,$35.80 ,$46.00 ,$35.00 ,$50.00 ,$50.00 ,$30.45 ,$50.00 ,$34.55 ,$45.00 ,$34.83 ,$16.07 ,$39.50 ,$17.43 ,$19.09 ,$19.09 ,$15.91 ,$19.09 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30200586,86790,HC VIRUS AB DENGUE FEVER IGG/IGMA,302,1 ,$112.00 ,$56.00 ,$3.28 ,$112.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$67.20 ,$95.20 ,$78.40 ,$3.28 ,$106.40 ,$85.12 ,$84.00 ,$21.90 ,$95.20 ,$12.88 ,$21.90 ,$12.88 ,$78.40 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$95.20 ,$28.98 ,$103.04 ,$78.40 ,$27.93 ,$27.93 ,$68.21 ,$27.93 ,$77.39 ,$100.80 ,$78.01 ,$13.01 ,$88.48 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200587,86753,HC PROTOZOA AB ENTAMOEBA HISTOLYTICA IGG,302,1 ,$95.00 ,$47.50 ,$8.17 ,$95.00 ,$8.17 ,$48.16 ,$41.28 ,$12.39 ,$57.00 ,$80.75 ,$66.50 ,$8.17 ,$90.25 ,$72.20 ,$71.25 ,$21.06 ,$80.75 ,$12.39 ,$21.06 ,$12.39 ,$66.50 ,$8.17 ,$12.39 ,$12.39 ,$14.02 ,$80.75 ,$27.88 ,$87.40 ,$66.50 ,$27.93 ,$27.93 ,$57.86 ,$27.93 ,$65.65 ,$85.50 ,$66.17 ,$12.51 ,$75.05 ,$8.66 ,$14.87 ,$14.87 ,$12.39 ,$14.87 ,$68.40 ,$58.90 ,$68.40 ,$68.40 ,$76.00 
ST NICHOLAS HOSPITAL - ACUTE,30200822,86705,HC HEP B CORE IGM,302,1 ,$168.00 ,$84.00 ,$11.77 ,$168.00 ,$12.16 ,$45.78 ,$39.24 ,$11.77 ,$100.80 ,$142.80 ,$117.60 ,$12.16 ,$159.60 ,$127.68 ,$126.00 ,$20.01 ,$142.80 ,$11.77 ,$20.01 ,$11.77 ,$117.60 ,$12.16 ,$11.77 ,$11.77 ,$13.32 ,$142.80 ,$26.48 ,$154.56 ,$117.60 ,$56.61 ,$56.61 ,$102.31 ,$56.61 ,$116.09 ,$151.20 ,$117.01 ,$11.89 ,$132.72 ,$12.89 ,$14.12 ,$14.12 ,$11.77 ,$14.12 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30200824,86644,HC CMV AB,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$14.39 ,$67.20 ,$95.20 ,$78.40 ,$14.87 ,$106.40 ,$85.12 ,$84.00 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$14.39 ,$78.40 ,$14.87 ,$14.39 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.18 ,$69.18 ,$68.21 ,$69.18 ,$77.39 ,$100.80 ,$78.01 ,$14.53 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30200825,86671,HC FUNGUS AB NOS 2-REF,302,1 ,$52.00 ,$26.00 ,$7.15 ,$52.00 ,$7.15 ,$47.67 ,$40.86 ,$12.25 ,$31.20 ,$44.20 ,$36.40 ,$7.15 ,$49.40 ,$39.52 ,$39.00 ,$20.83 ,$44.20 ,$12.25 ,$20.83 ,$12.25 ,$36.40 ,$7.15 ,$12.25 ,$12.25 ,$13.86 ,$44.20 ,$27.56 ,$47.84 ,$36.40 ,$24.45 ,$24.45 ,$31.67 ,$24.45 ,$35.93 ,$46.80 ,$36.22 ,$12.37 ,$41.08 ,$7.58 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30200826,86735,HC MUMPS AB (DIAG),302,1 ,$67.00 ,$33.50 ,$13.05 ,$67.00 ,$13.48 ,$50.75 ,$43.50 ,$13.05 ,$40.20 ,$56.95 ,$46.90 ,$13.48 ,$63.65 ,$50.92 ,$50.25 ,$22.19 ,$56.95 ,$13.05 ,$22.19 ,$13.05 ,$46.90 ,$13.48 ,$13.05 ,$13.05 ,$14.77 ,$56.95 ,$29.36 ,$61.64 ,$46.90 ,$62.70 ,$62.70 ,$40.80 ,$62.70 ,$46.30 ,$60.30 ,$46.67 ,$13.18 ,$52.93 ,$14.29 ,$15.66 ,$15.66 ,$13.05 ,$15.66 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30200830,87801,HC INFECT MLT  ORG AMP,302,1 ,$538.00 ,$269.00 ,$50.62 ,$538.00 ,$50.62 ,$272.97 ,$233.97 ,$70.20 ,$322.80 ,$457.30 ,$376.60 ,$50.62 ,$511.10 ,$408.88 ,$403.50 ,$119.34 ,$457.30 ,$70.20 ,$119.34 ,$70.20 ,$376.60 ,$50.62 ,$70.20 ,$70.20 ,$79.45 ,$457.30 ,$157.95 ,$494.96 ,$376.60 ,$337.32 ,$337.32 ,$327.64 ,$337.32 ,$371.76 ,$484.20 ,$374.72 ,$70.90 ,$425.02 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$430.40 
ST NICHOLAS HOSPITAL - ACUTE,30200831,86832,HC HLA HIGH DEFINITION QL PANEL,302,1 ,$815.00 ,$407.50 ,$139.23 ,$815.00 ,$139.23 ,$815.00 ,$815.00 ,$323.75 ,$489.00 ,$692.75 ,$570.50 ,$139.23 ,$774.25 ,$619.40 ,$611.25 ,$550.38 ,$692.75 ,$323.75 ,$550.38 ,$323.75 ,$570.50 ,$139.23 ,$323.75 ,$323.75 ,$366.42 ,$692.75 ,$728.44 ,$749.80 ,$570.50 ,$609.73 ,$609.73 ,$496.34 ,$609.73 ,$563.17 ,$733.50 ,$567.65 ,$326.99 ,$643.85 ,$147.58 ,$388.50 ,$388.50 ,$323.75 ,$388.50 ,$586.80 ,$505.30 ,$586.80 ,$586.80 ,$652.00 
ST NICHOLAS HOSPITAL - ACUTE,30200832,86611,HC BARTONELLA TITER,302,1 ,$63.00 ,$31.50 ,$8.17 ,$63.00 ,$8.17 ,$39.59 ,$33.93 ,$10.18 ,$37.80 ,$53.55 ,$44.10 ,$8.17 ,$59.85 ,$47.88 ,$47.25 ,$17.31 ,$53.55 ,$10.18 ,$17.31 ,$10.18 ,$44.10 ,$8.17 ,$10.18 ,$10.18 ,$11.52 ,$53.55 ,$22.91 ,$57.96 ,$44.10 ,$27.93 ,$27.93 ,$38.37 ,$27.93 ,$43.53 ,$56.70 ,$43.88 ,$10.28 ,$49.77 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$50.40 
ST NICHOLAS HOSPITAL - ACUTE,30200833,86406,HC STREPTOZYME TITER,302,1 ,$77.00 ,$38.50 ,$9.85 ,$77.00 ,$9.85 ,$41.37 ,$35.46 ,$10.64 ,$46.20 ,$65.45 ,$53.90 ,$9.85 ,$73.15 ,$58.52 ,$57.75 ,$18.09 ,$65.45 ,$10.64 ,$18.09 ,$10.64 ,$53.90 ,$9.85 ,$10.64 ,$10.64 ,$12.04 ,$65.45 ,$23.94 ,$70.84 ,$53.90 ,$33.64 ,$33.64 ,$46.89 ,$33.64 ,$53.21 ,$69.30 ,$53.63 ,$10.75 ,$60.83 ,$10.44 ,$12.77 ,$12.77 ,$10.64 ,$12.77 ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$61.60 
ST NICHOLAS HOSPITAL - ACUTE,30200834,86648,HC DIPTHERIA,302,1 ,$90.00 ,$45.00 ,$8.17 ,$90.00 ,$8.17 ,$59.15 ,$50.70 ,$15.21 ,$54.00 ,$76.50 ,$63.00 ,$8.17 ,$85.50 ,$68.40 ,$67.50 ,$25.86 ,$76.50 ,$15.21 ,$25.86 ,$15.21 ,$63.00 ,$8.17 ,$15.21 ,$15.21 ,$17.21 ,$76.50 ,$34.22 ,$82.80 ,$63.00 ,$27.93 ,$27.93 ,$54.81 ,$27.93 ,$62.19 ,$81.00 ,$62.69 ,$15.36 ,$71.10 ,$8.66 ,$18.25 ,$18.25 ,$15.21 ,$18.25 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30200835,86790,HC HANTAVIRUS (SIN NOMBRE) ELISA,302,1 ,$68.00 ,$34.00 ,$3.28 ,$68.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$40.80 ,$57.80 ,$47.60 ,$3.28 ,$64.60 ,$51.68 ,$51.00 ,$21.90 ,$57.80 ,$12.88 ,$21.90 ,$12.88 ,$47.60 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$57.80 ,$28.98 ,$62.56 ,$47.60 ,$27.93 ,$27.93 ,$41.41 ,$27.93 ,$46.99 ,$61.20 ,$47.36 ,$13.01 ,$53.72 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$54.40 
ST NICHOLAS HOSPITAL - ACUTE,30200836,86790,HC HANTAVIRUS (SIN NOMBRE) IGG,302,1 ,$120.00 ,$60.00 ,$3.28 ,$120.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$72.00 ,$102.00 ,$84.00 ,$3.28 ,$114.00 ,$91.20 ,$90.00 ,$21.90 ,$102.00 ,$12.88 ,$21.90 ,$12.88 ,$84.00 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$102.00 ,$28.98 ,$110.40 ,$84.00 ,$27.93 ,$27.93 ,$73.08 ,$27.93 ,$82.92 ,$108.00 ,$83.58 ,$13.01 ,$94.80 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30200837,86790,HC HANTAVIRUS (SIN NOMBRE) IGM,302,1 ,$68.00 ,$34.00 ,$3.28 ,$68.00 ,$3.28 ,$50.09 ,$42.93 ,$12.88 ,$40.80 ,$57.80 ,$47.60 ,$3.28 ,$64.60 ,$51.68 ,$51.00 ,$21.90 ,$57.80 ,$12.88 ,$21.90 ,$12.88 ,$47.60 ,$3.28 ,$12.88 ,$12.88 ,$14.58 ,$57.80 ,$28.98 ,$62.56 ,$47.60 ,$27.93 ,$27.93 ,$41.41 ,$27.93 ,$46.99 ,$61.20 ,$47.36 ,$13.01 ,$53.72 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$54.40 
ST NICHOLAS HOSPITAL - ACUTE,30200841,86671,HC FUNGUS AB SACC CEREVISIAE,302,1 ,$147.00 ,$73.50 ,$7.15 ,$147.00 ,$7.15 ,$47.67 ,$40.86 ,$12.25 ,$88.20 ,$124.95 ,$102.90 ,$7.15 ,$139.65 ,$111.72 ,$110.25 ,$20.83 ,$124.95 ,$12.25 ,$20.83 ,$12.25 ,$102.90 ,$7.15 ,$12.25 ,$12.25 ,$13.86 ,$124.95 ,$27.56 ,$135.24 ,$102.90 ,$24.45 ,$24.45 ,$89.52 ,$24.45 ,$101.58 ,$132.30 ,$102.39 ,$12.37 ,$116.13 ,$7.58 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$105.84 ,$91.14 ,$105.84 ,$105.84 ,$117.60 
ST NICHOLAS HOSPITAL - ACUTE,30201069,86711,HC AB JOHN CUNNINGHAM VIRUS,302,1 ,"$1,792.00 ",$896.00 ,$15.79 ,"$1,792.00 ",$15.79 ,$59.12 ,$50.67 ,$16.89 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$15.79 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$28.71 ,"$1,523.20 ",$16.89 ,$28.71 ,$16.89 ,"$1,254.40 ",$15.79 ,$16.89 ,$16.89 ,$19.12 ,"$1,523.20 ",$38.00 ,"$1,648.64 ","$1,254.40 ",$69.18 ,$69.18 ,"$1,091.33 ",$69.18 ,"$1,238.27 ","$1,612.80 ","$1,248.13 ",$17.06 ,"$1,415.68 ",$16.74 ,$20.27 ,$20.27 ,$16.89 ,$20.27 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,30201070,86711,HC AB JOHN CUNNINGHAM VIRUS INHIBITION ASSAY,302,1 ,$702.00 ,$351.00 ,$15.79 ,$702.00 ,$15.79 ,$59.12 ,$50.67 ,$16.89 ,$421.20 ,$596.70 ,$491.40 ,$15.79 ,$666.90 ,$533.52 ,$526.50 ,$28.71 ,$596.70 ,$16.89 ,$28.71 ,$16.89 ,$491.40 ,$15.79 ,$16.89 ,$16.89 ,$19.12 ,$596.70 ,$38.00 ,$645.84 ,$491.40 ,$69.18 ,$69.18 ,$427.52 ,$69.18 ,$485.08 ,$631.80 ,$488.94 ,$17.06 ,$554.58 ,$16.74 ,$20.27 ,$20.27 ,$16.89 ,$20.27 ,$505.44 ,$435.24 ,$505.44 ,$505.44 ,$561.60 
ST NICHOLAS HOSPITAL - ACUTE,30201080,G0472,HC HEPATITIS C SCREEN HIGH RISK,302,1 ,$108.00 ,$54.00 ,$9.51 ,$108.00 ,$9.51 ,$108.00 ,$108.00 ,$46.35 ,$64.80 ,$91.80 ,$75.60 ,$9.51 ,$102.60 ,$82.08 ,$81.00 ,$78.80 ,$91.80 ,$46.35 ,$78.80 ,$46.35 ,$75.60 ,$9.51 ,$46.35 ,$46.35 ,$52.46 ,$91.80 ,$104.29 ,$99.36 ,$75.60 ,$68.48 ,$68.48 ,$65.77 ,$68.48 ,$74.63 ,$97.20 ,$75.22 ,$46.81 ,$85.32 ,$10.08 ,$55.62 ,$55.62 ,$46.35 ,$55.62 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,30201081,86695,HC HERPES SIMPLEX IGM I,302,1 ,$101.00 ,$50.50 ,$13.19 ,$101.00 ,$13.63 ,$51.28 ,$43.95 ,$13.19 ,$60.60 ,$85.85 ,$70.70 ,$13.63 ,$95.95 ,$76.76 ,$75.75 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$13.19 ,$70.70 ,$13.63 ,$13.19 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$63.41 ,$63.41 ,$61.51 ,$63.41 ,$69.79 ,$90.90 ,$70.35 ,$13.32 ,$79.79 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30201082,86696,HC HERPES SIMPLEX IGM II,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$19.35 ,$87.60 ,$124.10 ,$102.20 ,$19.99 ,$138.70 ,$110.96 ,$109.50 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$19.35 ,$102.20 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$93.00 ,$93.00 ,$88.91 ,$93.00 ,$100.89 ,$131.40 ,$101.69 ,$19.54 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30201084,86008,HC ALLERGEN IGE QN/SEMI-QN RECOMB/COMP EA,302,1 ,$37.00 ,$18.50 ,$17.71 ,$40.34 ,$17.71 ,$37.00 ,$37.00 ,$17.93 ,$22.20 ,$31.45 ,$25.90 ,$17.71 ,$35.15 ,$28.12 ,$27.75 ,$30.48 ,$31.45 ,$17.93 ,$30.48 ,$17.93 ,$25.90 ,$17.71 ,$17.93 ,$17.93 ,$20.29 ,$31.45 ,$40.34 ,$34.04 ,$25.90 ,$37.00 ,$37.00 ,$22.53 ,$37.00 ,$25.57 ,$33.30 ,$25.77 ,$18.11 ,$29.23 ,$18.77 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,30201085,86481,HC TSPOT TB AG RESPONSE GAMMA INTER T-CELL SUSP,302,1 ,$291.00 ,$145.50 ,$90.12 ,$291.00 ,$90.12 ,$291.00 ,$291.00 ,$100.00 ,$174.60 ,$247.35 ,$203.70 ,$90.12 ,$276.45 ,$221.16 ,$218.25 ,$170.00 ,$247.35 ,$100.00 ,$170.00 ,$100.00 ,$203.70 ,$90.12 ,$100.00 ,$100.00 ,$113.18 ,$247.35 ,$225.00 ,$267.72 ,$203.70 ,$291.00 ,$291.00 ,$177.22 ,$291.00 ,$201.08 ,$261.90 ,$202.68 ,$101.00 ,$229.89 ,$95.53 ,$120.00 ,$120.00 ,$100.00 ,$120.00 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30201087,86317,HC INFECTIOUS STREPTOCOCCUS PNEUMONIAE EA AB,302,1 ,$90.00 ,$45.00 ,$14.99 ,$90.00 ,$15.49 ,$58.28 ,$49.95 ,$14.99 ,$54.00 ,$76.50 ,$63.00 ,$15.49 ,$85.50 ,$68.40 ,$67.50 ,$25.48 ,$76.50 ,$14.99 ,$25.48 ,$14.99 ,$63.00 ,$15.49 ,$14.99 ,$14.99 ,$16.97 ,$76.50 ,$33.73 ,$82.80 ,$63.00 ,$72.04 ,$72.04 ,$54.81 ,$72.04 ,$62.19 ,$81.00 ,$62.69 ,$15.14 ,$71.10 ,$16.42 ,$17.99 ,$17.99 ,$14.99 ,$17.99 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30201090,86780,HC TREPONEMA P AB SCREEN,302,1 ,$43.00 ,$21.50 ,$11.13 ,$43.00 ,$11.13 ,$43.00 ,$43.00 ,$13.24 ,$25.80 ,$36.55 ,$30.10 ,$11.13 ,$40.85 ,$32.68 ,$32.25 ,$22.51 ,$36.55 ,$13.24 ,$22.51 ,$13.24 ,$30.10 ,$11.13 ,$13.24 ,$13.24 ,$14.99 ,$36.55 ,$29.79 ,$39.56 ,$30.10 ,$38.04 ,$38.04 ,$26.19 ,$38.04 ,$29.71 ,$38.70 ,$29.95 ,$13.37 ,$33.97 ,$11.80 ,$15.89 ,$15.89 ,$13.24 ,$15.89 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,30201158,86255,HC FLUOR AB SCR CYTOP/NEURONAL AB,302,1 ,$140.00 ,$70.00 ,$12.05 ,$140.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$84.00 ,$119.00 ,$98.00 ,$12.45 ,$133.00 ,$106.40 ,$105.00 ,$20.49 ,$119.00 ,$12.05 ,$20.49 ,$12.05 ,$98.00 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$119.00 ,$27.11 ,$128.80 ,$98.00 ,$57.91 ,$57.91 ,$85.26 ,$57.91 ,$96.74 ,$126.00 ,$97.51 ,$12.17 ,$110.60 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$112.00 
ST NICHOLAS HOSPITAL - ACUTE,30201159,87801,HC INFECT MLT ORG AMP BRD RAGNE BACT PCR,302,1 ,$538.00 ,$269.00 ,$50.62 ,$538.00 ,$50.62 ,$272.97 ,$233.97 ,$70.20 ,$322.80 ,$457.30 ,$376.60 ,$50.62 ,$511.10 ,$408.88 ,$403.50 ,$119.34 ,$457.30 ,$70.20 ,$119.34 ,$70.20 ,$376.60 ,$50.62 ,$70.20 ,$70.20 ,$79.45 ,$457.30 ,$157.95 ,$494.96 ,$376.60 ,$337.32 ,$337.32 ,$327.64 ,$337.32 ,$371.76 ,$484.20 ,$374.72 ,$70.90 ,$425.02 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$430.40 
ST NICHOLAS HOSPITAL - ACUTE,30201182,86255,HC FLUOR AB SCR (CRITHIDIA TITER W/REFLEX)-REF,302,1 ,$18.00 ,$9.00 ,$9.00 ,$27.11 ,$12.45 ,$18.00 ,$18.00 ,$12.05 ,$10.80 ,$15.30 ,$12.60 ,$12.45 ,$17.10 ,$13.68 ,$13.50 ,$18.00 ,$15.30 ,$12.05 ,$18.00 ,$12.05 ,$12.60 ,$12.45 ,$12.05 ,$12.05 ,$13.64 ,$15.30 ,$27.11 ,$16.56 ,$12.60 ,$18.00 ,$18.00 ,$10.96 ,$18.00 ,$12.44 ,$16.20 ,$12.54 ,$12.17 ,$14.22 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.96 ,$11.16 ,$12.96 ,$12.96 ,$14.40 
ST NICHOLAS HOSPITAL - ACUTE,30240102,86003,HC ALLERGEN IGE QN EA-REF,302,1 ,$10.10 ,$5.05 ,$4.57 ,$11.75 ,$4.57 ,$10.10 ,$10.10 ,$5.22 ,$6.06 ,$8.59 ,$7.07 ,$4.57 ,$9.60 ,$7.68 ,$7.58 ,$8.87 ,$8.59 ,$5.22 ,$8.87 ,$5.22 ,$7.07 ,$4.57 ,$5.22 ,$5.22 ,$5.91 ,$8.59 ,$11.75 ,$9.29 ,$7.07 ,$10.10 ,$10.10 ,$6.15 ,$10.10 ,$6.98 ,$9.09 ,$7.03 ,$5.27 ,$7.98 ,$4.84 ,$6.26 ,$6.26 ,$5.22 ,$6.26 ,$7.27 ,$6.26 ,$7.27 ,$7.27 ,$8.08 
ST NICHOLAS HOSPITAL - ACUTE,30240129,86157,HC COLD AGGLUTININ TITER-REF,302,1 ,$10.00 ,$5.00 ,$5.00 ,$18.14 ,$8.17 ,$10.00 ,$10.00 ,$8.06 ,$6.00 ,$8.50 ,$7.00 ,$8.17 ,$9.50 ,$7.60 ,$7.50 ,$10.00 ,$8.50 ,$8.06 ,$10.00 ,$8.06 ,$7.00 ,$8.17 ,$8.06 ,$8.06 ,$9.12 ,$8.50 ,$18.14 ,$9.20 ,$7.00 ,$10.00 ,$10.00 ,$6.09 ,$10.00 ,$6.91 ,$9.00 ,$6.97 ,$8.14 ,$7.90 ,$8.66 ,$9.67 ,$9.67 ,$8.06 ,$9.67 ,$7.20 ,$6.20 ,$7.20 ,$7.20 ,$8.00 
ST NICHOLAS HOSPITAL - ACUTE,30240192,86403,HC CRYPTOCOCAL ANTIGEN-REF,302,1 ,$20.00 ,$10.00 ,$10.00 ,$25.97 ,$11.92 ,$20.00 ,$20.00 ,$11.54 ,$12.00 ,$17.00 ,$14.00 ,$11.92 ,$19.00 ,$15.20 ,$15.00 ,$19.62 ,$17.00 ,$11.54 ,$19.62 ,$11.54 ,$14.00 ,$11.92 ,$11.54 ,$11.54 ,$13.06 ,$17.00 ,$25.97 ,$18.40 ,$14.00 ,$20.00 ,$20.00 ,$12.18 ,$20.00 ,$13.82 ,$18.00 ,$13.93 ,$11.66 ,$15.80 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$14.40 ,$12.40 ,$14.40 ,$14.40 ,$16.00 
ST NICHOLAS HOSPITAL - ACUTE,30500098,85421,HC PLASMINOGEN ANTIGENIC,305,1 ,$143.00 ,$71.50 ,$10.18 ,$143.00 ,$10.52 ,$39.62 ,$33.96 ,$10.18 ,$85.80 ,$121.55 ,$100.10 ,$10.52 ,$135.85 ,$108.68 ,$107.25 ,$17.31 ,$121.55 ,$10.18 ,$17.31 ,$10.18 ,$100.10 ,$10.52 ,$10.18 ,$10.18 ,$11.52 ,$121.55 ,$22.91 ,$131.56 ,$100.10 ,$48.96 ,$48.96 ,$87.09 ,$48.96 ,$98.81 ,$128.70 ,$99.60 ,$10.28 ,$112.97 ,$11.15 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$102.96 ,$88.66 ,$102.96 ,$102.96 ,$114.40 
ST NICHOLAS HOSPITAL - ACUTE,30500101,85002,HC BLEEDING TIME,305,1 ,$129.00 ,$64.50 ,$4.77 ,$129.00 ,$4.77 ,$17.54 ,$15.03 ,$4.82 ,$77.40 ,$109.65 ,$90.30 ,$4.77 ,$122.55 ,$98.04 ,$96.75 ,$8.19 ,$109.65 ,$4.82 ,$8.19 ,$4.82 ,$90.30 ,$4.77 ,$4.82 ,$4.82 ,$5.46 ,$109.65 ,$10.85 ,$118.68 ,$90.30 ,$16.31 ,$16.31 ,$78.56 ,$16.31 ,$89.14 ,$116.10 ,$89.85 ,$4.87 ,$101.91 ,$5.06 ,$5.78 ,$5.78 ,$4.82 ,$5.78 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,30500102,85004,HC WBC W/AUTO DIFFERENTIAL,305,1 ,$43.00 ,$21.50 ,$6.47 ,$43.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$25.80 ,$36.55 ,$30.10 ,$6.69 ,$40.85 ,$32.68 ,$32.25 ,$11.00 ,$36.55 ,$6.47 ,$11.00 ,$6.47 ,$30.10 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$36.55 ,$14.56 ,$39.56 ,$30.10 ,$31.10 ,$31.10 ,$26.19 ,$31.10 ,$29.71 ,$38.70 ,$29.95 ,$6.53 ,$33.97 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$35.00 ,$17.50 ,$3.80 ,$35.00 ,$3.93 ,$13.37 ,$11.46 ,$3.80 ,$21.00 ,$29.75 ,$24.50 ,$3.93 ,$33.25 ,$26.60 ,$26.25 ,$6.46 ,$29.75 ,$3.80 ,$6.46 ,$3.80 ,$24.50 ,$3.93 ,$3.80 ,$3.80 ,$4.30 ,$29.75 ,$8.55 ,$32.20 ,$24.50 ,$16.52 ,$16.52 ,$21.32 ,$16.52 ,$24.19 ,$31.50 ,$24.38 ,$3.84 ,$27.65 ,$4.17 ,$4.56 ,$4.56 ,$3.80 ,$4.56 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,30500104,85014,HC HEMATOCRIT,305,1 ,$18.00 ,$9.00 ,$2.37 ,$18.00 ,$2.45 ,$9.21 ,$7.89 ,$2.37 ,$10.80 ,$15.30 ,$12.60 ,$2.45 ,$17.10 ,$13.68 ,$13.50 ,$4.03 ,$15.30 ,$2.37 ,$4.03 ,$2.37 ,$12.60 ,$2.45 ,$2.37 ,$2.37 ,$2.68 ,$15.30 ,$5.33 ,$16.56 ,$12.60 ,$11.38 ,$11.38 ,$10.96 ,$11.38 ,$12.44 ,$16.20 ,$12.54 ,$2.39 ,$14.22 ,$2.60 ,$2.84 ,$2.84 ,$2.37 ,$2.84 ,$12.96 ,$11.16 ,$12.96 ,$12.96 ,$14.40 
ST NICHOLAS HOSPITAL - ACUTE,30500106,85018,HC HGB,305,1 ,$19.00 ,$9.50 ,$2.37 ,$19.00 ,$2.45 ,$9.21 ,$7.89 ,$2.37 ,$11.40 ,$16.15 ,$13.30 ,$2.45 ,$18.05 ,$14.44 ,$14.25 ,$4.03 ,$16.15 ,$2.37 ,$4.03 ,$2.37 ,$13.30 ,$2.45 ,$2.37 ,$2.37 ,$2.68 ,$16.15 ,$5.33 ,$17.48 ,$13.30 ,$11.38 ,$11.38 ,$11.57 ,$11.38 ,$13.13 ,$17.10 ,$13.23 ,$2.39 ,$15.01 ,$2.60 ,$2.84 ,$2.84 ,$2.37 ,$2.84 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$15.20 
ST NICHOLAS HOSPITAL - ACUTE,30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$67.00 ,$33.50 ,$7.77 ,$67.00 ,$8.03 ,$30.21 ,$25.89 ,$7.77 ,$40.20 ,$56.95 ,$46.90 ,$8.03 ,$63.65 ,$50.92 ,$50.25 ,$13.21 ,$56.95 ,$7.77 ,$13.21 ,$7.77 ,$46.90 ,$8.03 ,$7.77 ,$7.77 ,$8.79 ,$56.95 ,$17.48 ,$61.64 ,$46.90 ,$37.37 ,$37.37 ,$40.80 ,$37.37 ,$46.30 ,$60.30 ,$46.67 ,$7.85 ,$52.93 ,$8.51 ,$9.32 ,$9.32 ,$7.77 ,$9.32 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30500108,85027,HC CBC W/O DIFF,305,1 ,$49.00 ,$24.50 ,$6.47 ,$49.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$29.40 ,$41.65 ,$34.30 ,$6.69 ,$46.55 ,$37.24 ,$36.75 ,$11.00 ,$41.65 ,$6.47 ,$11.00 ,$6.47 ,$34.30 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$41.65 ,$14.56 ,$45.08 ,$34.30 ,$31.10 ,$31.10 ,$29.84 ,$31.10 ,$33.86 ,$44.10 ,$34.13 ,$6.53 ,$38.71 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,30500109,85027,HC HISTOGRAM,305,1 ,$49.00 ,$24.50 ,$6.47 ,$49.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$29.40 ,$41.65 ,$34.30 ,$6.69 ,$46.55 ,$37.24 ,$36.75 ,$11.00 ,$41.65 ,$6.47 ,$11.00 ,$6.47 ,$34.30 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$41.65 ,$14.56 ,$45.08 ,$34.30 ,$31.10 ,$31.10 ,$29.84 ,$31.10 ,$33.86 ,$44.10 ,$34.13 ,$6.53 ,$38.71 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,30500110,85044,HC RETIC COUNT MANUAL,305,1 ,$146.00 ,$73.00 ,$4.31 ,$146.00 ,$4.45 ,$16.77 ,$14.37 ,$4.31 ,$87.60 ,$124.10 ,$102.20 ,$4.45 ,$138.70 ,$110.96 ,$109.50 ,$7.33 ,$124.10 ,$4.31 ,$7.33 ,$4.31 ,$102.20 ,$4.45 ,$4.31 ,$4.31 ,$4.88 ,$124.10 ,$9.70 ,$134.32 ,$102.20 ,$20.68 ,$20.68 ,$88.91 ,$20.68 ,$100.89 ,$131.40 ,$101.69 ,$4.35 ,$115.34 ,$4.72 ,$5.17 ,$5.17 ,$4.31 ,$5.17 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30500111,85045,HC RETIC COUNT AUTO,305,1 ,$34.00 ,$17.00 ,$3.99 ,$34.00 ,$4.12 ,$15.54 ,$13.32 ,$3.99 ,$20.40 ,$28.90 ,$23.80 ,$4.12 ,$32.30 ,$25.84 ,$25.50 ,$6.78 ,$28.90 ,$3.99 ,$6.78 ,$3.99 ,$23.80 ,$4.12 ,$3.99 ,$3.99 ,$4.52 ,$28.90 ,$8.98 ,$31.28 ,$23.80 ,$19.20 ,$19.20 ,$20.71 ,$19.20 ,$23.49 ,$30.60 ,$23.68 ,$4.03 ,$26.86 ,$4.37 ,$4.79 ,$4.79 ,$3.99 ,$4.79 ,$24.48 ,$21.08 ,$24.48 ,$24.48 ,$27.20 
ST NICHOLAS HOSPITAL - ACUTE,30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$19.00 ,$9.50 ,$2.54 ,$19.00 ,$2.62 ,$9.87 ,$8.46 ,$2.54 ,$11.40 ,$16.15 ,$13.30 ,$2.62 ,$18.05 ,$14.44 ,$14.25 ,$4.32 ,$16.15 ,$2.54 ,$4.32 ,$2.54 ,$13.30 ,$2.62 ,$2.54 ,$2.54 ,$2.87 ,$16.15 ,$5.72 ,$17.48 ,$13.30 ,$12.19 ,$12.19 ,$11.57 ,$12.19 ,$13.13 ,$17.10 ,$13.23 ,$2.57 ,$15.01 ,$2.78 ,$3.05 ,$3.05 ,$2.54 ,$3.05 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$15.20 
ST NICHOLAS HOSPITAL - ACUTE,30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$38.00 ,$19.00 ,$4.48 ,$38.00 ,$4.63 ,$17.40 ,$14.91 ,$4.48 ,$22.80 ,$32.30 ,$26.60 ,$4.63 ,$36.10 ,$28.88 ,$28.50 ,$7.62 ,$32.30 ,$4.48 ,$7.62 ,$4.48 ,$26.60 ,$4.63 ,$4.48 ,$4.48 ,$5.07 ,$32.30 ,$10.08 ,$34.96 ,$26.60 ,$21.52 ,$21.52 ,$23.14 ,$21.52 ,$26.26 ,$34.20 ,$26.47 ,$4.52 ,$30.02 ,$4.91 ,$5.38 ,$5.38 ,$4.48 ,$5.38 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30500116,85097,HC BONE MARROW SMEAR INTERP,305,1 ,$457.00 ,$228.50 ,$12.46 ,"$1,453.86 ",$12.46 ,$172.66 ,$148.00 ,$646.16 ,$274.20 ,$388.45 ,$319.90 ,$12.46 ,$434.15 ,$347.32 ,$342.75 ,$112.69 ,$388.45 ,$646.16 ,$112.69 ,$68.41 ,$319.90 ,$12.46 ,$646.16 ,$646.16 ,$191.94 ,$388.45 ,"$1,453.86 ",$420.44 ,$319.90 ,$138.86 ,$138.86 ,$278.31 ,$138.86 ,$315.79 ,$411.30 ,$318.30 ,$652.62 ,$361.03 ,$13.21 ,$457.00 ,$457.00 ,$646.16 ,$457.00 ,$329.04 ,$283.34 ,$329.04 ,$329.04 ,$365.60 
ST NICHOLAS HOSPITAL - ACUTE,30500117,85097,HC BONE MARROW SMEAR INTERP (MAYO),305,1 ,$457.00 ,$228.50 ,$12.46 ,"$1,453.86 ",$12.46 ,$172.66 ,$148.00 ,$646.16 ,$274.20 ,$388.45 ,$319.90 ,$12.46 ,$434.15 ,$347.32 ,$342.75 ,$112.69 ,$388.45 ,$646.16 ,$112.69 ,$68.41 ,$319.90 ,$12.46 ,$646.16 ,$646.16 ,$191.94 ,$388.45 ,"$1,453.86 ",$420.44 ,$319.90 ,$138.86 ,$138.86 ,$278.31 ,$138.86 ,$315.79 ,$411.30 ,$318.30 ,$652.62 ,$361.03 ,$13.21 ,$457.00 ,$457.00 ,$646.16 ,$457.00 ,$329.04 ,$283.34 ,$329.04 ,$329.04 ,$365.60 
ST NICHOLAS HOSPITAL - ACUTE,30500119,85175,HC CLOT LYSIS TIME,305,1 ,$78.00 ,$39.00 ,$6.40 ,$78.00 ,$6.40 ,$71.30 ,$61.11 ,$20.37 ,$46.80 ,$66.30 ,$54.60 ,$6.40 ,$74.10 ,$59.28 ,$58.50 ,$34.63 ,$66.30 ,$20.37 ,$34.63 ,$20.37 ,$54.60 ,$6.40 ,$20.37 ,$20.37 ,$23.05 ,$66.30 ,$45.83 ,$71.76 ,$54.60 ,$21.88 ,$21.88 ,$47.50 ,$21.88 ,$53.90 ,$70.20 ,$54.33 ,$20.57 ,$61.62 ,$6.78 ,$24.44 ,$24.44 ,$20.37 ,$24.44 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500120,85018,HC HGB ANESTH,305,1 ,$162.00 ,$81.00 ,$2.37 ,$162.00 ,$2.45 ,$9.21 ,$7.89 ,$2.37 ,$97.20 ,$137.70 ,$113.40 ,$2.45 ,$153.90 ,$123.12 ,$121.50 ,$4.03 ,$137.70 ,$2.37 ,$4.03 ,$2.37 ,$113.40 ,$2.45 ,$2.37 ,$2.37 ,$2.68 ,$137.70 ,$5.33 ,$149.04 ,$113.40 ,$11.38 ,$11.38 ,$98.66 ,$11.38 ,$111.94 ,$145.80 ,$112.83 ,$2.39 ,$127.98 ,$2.60 ,$2.84 ,$2.84 ,$2.37 ,$2.84 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,30500121,85210,HC FACTOR II,305,1 ,$101.00 ,$50.50 ,$8.17 ,$101.00 ,$8.17 ,$50.51 ,$43.29 ,$12.98 ,$60.60 ,$85.85 ,$70.70 ,$8.17 ,$95.95 ,$76.76 ,$75.75 ,$22.07 ,$85.85 ,$12.98 ,$22.07 ,$12.98 ,$70.70 ,$8.17 ,$12.98 ,$12.98 ,$14.69 ,$85.85 ,$29.21 ,$92.92 ,$70.70 ,$27.93 ,$27.93 ,$61.51 ,$27.93 ,$69.79 ,$90.90 ,$70.35 ,$13.11 ,$79.79 ,$8.66 ,$15.58 ,$15.58 ,$12.98 ,$15.58 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30500123,85220,HC FACTOR V,305,1 ,$168.00 ,$84.00 ,$17.65 ,$168.00 ,$18.24 ,$68.64 ,$58.83 ,$17.65 ,$100.80 ,$142.80 ,$117.60 ,$18.24 ,$159.60 ,$127.68 ,$126.00 ,$30.01 ,$142.80 ,$17.65 ,$30.01 ,$17.65 ,$117.60 ,$18.24 ,$17.65 ,$17.65 ,$19.98 ,$142.80 ,$39.71 ,$154.56 ,$117.60 ,$84.79 ,$84.79 ,$102.31 ,$84.79 ,$116.09 ,$151.20 ,$117.01 ,$17.83 ,$132.72 ,$19.33 ,$21.18 ,$21.18 ,$17.65 ,$21.18 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30500125,85230,HC FACTOR VII,305,1 ,$168.00 ,$84.00 ,$17.90 ,$168.00 ,$18.50 ,$69.62 ,$59.67 ,$17.90 ,$100.80 ,$142.80 ,$117.60 ,$18.50 ,$159.60 ,$127.68 ,$126.00 ,$30.43 ,$142.80 ,$17.90 ,$30.43 ,$17.90 ,$117.60 ,$18.50 ,$17.90 ,$17.90 ,$20.26 ,$142.80 ,$40.28 ,$154.56 ,$117.60 ,$86.06 ,$86.06 ,$102.31 ,$86.06 ,$116.09 ,$151.20 ,$117.01 ,$18.08 ,$132.72 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30500126,85240,HC FACTOR VIII AHG,305,1 ,$101.00 ,$50.50 ,$9.84 ,$101.00 ,$9.84 ,$69.62 ,$59.67 ,$17.90 ,$60.60 ,$85.85 ,$70.70 ,$9.84 ,$95.95 ,$76.76 ,$75.75 ,$30.43 ,$85.85 ,$17.90 ,$30.43 ,$17.90 ,$70.70 ,$9.84 ,$17.90 ,$17.90 ,$20.26 ,$85.85 ,$40.28 ,$92.92 ,$70.70 ,$33.61 ,$33.61 ,$61.51 ,$33.61 ,$69.79 ,$90.90 ,$70.35 ,$18.08 ,$79.79 ,$10.43 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30500128,85240,HC FACTOR VIII AHG (ASSAY),305,1 ,$183.00 ,$91.50 ,$9.84 ,$183.00 ,$9.84 ,$69.62 ,$59.67 ,$17.90 ,$109.80 ,$155.55 ,$128.10 ,$9.84 ,$173.85 ,$139.08 ,$137.25 ,$30.43 ,$155.55 ,$17.90 ,$30.43 ,$17.90 ,$128.10 ,$9.84 ,$17.90 ,$17.90 ,$20.26 ,$155.55 ,$40.28 ,$168.36 ,$128.10 ,$33.61 ,$33.61 ,$111.45 ,$33.61 ,$126.45 ,$164.70 ,$127.46 ,$18.08 ,$144.57 ,$10.43 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,30500130,85245,HC FACTOR VIII VW RISTO,305,1 ,$186.00 ,$93.00 ,$22.94 ,$186.00 ,$23.70 ,$89.22 ,$76.47 ,$22.94 ,$111.60 ,$158.10 ,$130.20 ,$23.70 ,$176.70 ,$141.36 ,$139.50 ,$39.00 ,$158.10 ,$22.94 ,$39.00 ,$22.94 ,$130.20 ,$23.70 ,$22.94 ,$22.94 ,$25.96 ,$158.10 ,$51.62 ,$171.12 ,$130.20 ,$110.26 ,$110.26 ,$113.27 ,$110.26 ,$128.53 ,$167.40 ,$129.55 ,$23.17 ,$146.94 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$133.92 ,$115.32 ,$133.92 ,$133.92 ,$148.80 
ST NICHOLAS HOSPITAL - ACUTE,30500131,85245,HC FACTOR VIII VW RISTO (VW),305,1 ,$179.00 ,$89.50 ,$22.94 ,$179.00 ,$23.70 ,$89.22 ,$76.47 ,$22.94 ,$107.40 ,$152.15 ,$125.30 ,$23.70 ,$170.05 ,$136.04 ,$134.25 ,$39.00 ,$152.15 ,$22.94 ,$39.00 ,$22.94 ,$125.30 ,$23.70 ,$22.94 ,$22.94 ,$25.96 ,$152.15 ,$51.62 ,$164.68 ,$125.30 ,$110.26 ,$110.26 ,$109.01 ,$110.26 ,$123.69 ,$161.10 ,$124.67 ,$23.17 ,$141.41 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,30500132,85246,HC FACTOR VIII VW AG,305,1 ,$157.00 ,$78.50 ,$22.94 ,$157.00 ,$23.70 ,$89.22 ,$76.47 ,$22.94 ,$94.20 ,$133.45 ,$109.90 ,$23.70 ,$149.15 ,$119.32 ,$117.75 ,$39.00 ,$133.45 ,$22.94 ,$39.00 ,$22.94 ,$109.90 ,$23.70 ,$22.94 ,$22.94 ,$25.96 ,$133.45 ,$51.62 ,$144.44 ,$109.90 ,$110.26 ,$110.26 ,$95.61 ,$110.26 ,$108.49 ,$141.30 ,$109.35 ,$23.17 ,$124.03 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30500135,85246,HC FACTOR VIII VW AG (MAYO),305,1 ,$194.00 ,$97.00 ,$22.94 ,$194.00 ,$23.70 ,$89.22 ,$76.47 ,$22.94 ,$116.40 ,$164.90 ,$135.80 ,$23.70 ,$184.30 ,$147.44 ,$145.50 ,$39.00 ,$164.90 ,$22.94 ,$39.00 ,$22.94 ,$135.80 ,$23.70 ,$22.94 ,$22.94 ,$25.96 ,$164.90 ,$51.62 ,$178.48 ,$135.80 ,$110.26 ,$110.26 ,$118.15 ,$110.26 ,$134.05 ,$174.60 ,$135.12 ,$23.17 ,$153.26 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$155.20 
ST NICHOLAS HOSPITAL - ACUTE,30500136,85247,HC FACTOR VW MULTIM ANALY,305,1 ,$213.00 ,$106.50 ,$22.94 ,$213.00 ,$23.70 ,$89.22 ,$76.47 ,$22.94 ,$127.80 ,$181.05 ,$149.10 ,$23.70 ,$202.35 ,$161.88 ,$159.75 ,$39.00 ,$181.05 ,$22.94 ,$39.00 ,$22.94 ,$149.10 ,$23.70 ,$22.94 ,$22.94 ,$25.96 ,$181.05 ,$51.62 ,$195.96 ,$149.10 ,$110.26 ,$110.26 ,$129.72 ,$110.26 ,$147.18 ,$191.70 ,$148.35 ,$23.17 ,$168.27 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30500138,85250,HC FACTOR IX,305,1 ,$224.00 ,$112.00 ,$19.04 ,$224.00 ,$19.67 ,$74.06 ,$63.48 ,$19.04 ,$134.40 ,$190.40 ,$156.80 ,$19.67 ,$212.80 ,$170.24 ,$168.00 ,$32.37 ,$190.40 ,$19.04 ,$32.37 ,$19.04 ,$156.80 ,$19.67 ,$19.04 ,$19.04 ,$21.55 ,$190.40 ,$42.84 ,$206.08 ,$156.80 ,$91.48 ,$91.48 ,$136.42 ,$91.48 ,$154.78 ,$201.60 ,$156.02 ,$19.23 ,$176.96 ,$20.85 ,$22.85 ,$22.85 ,$19.04 ,$22.85 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30500140,85250,HC FACTOR IX (ASSAY),305,1 ,$222.00 ,$111.00 ,$19.04 ,$222.00 ,$19.67 ,$74.06 ,$63.48 ,$19.04 ,$133.20 ,$188.70 ,$155.40 ,$19.67 ,$210.90 ,$168.72 ,$166.50 ,$32.37 ,$188.70 ,$19.04 ,$32.37 ,$19.04 ,$155.40 ,$19.67 ,$19.04 ,$19.04 ,$21.55 ,$188.70 ,$42.84 ,$204.24 ,$155.40 ,$91.48 ,$91.48 ,$135.20 ,$91.48 ,$153.40 ,$199.80 ,$154.62 ,$19.23 ,$175.38 ,$20.85 ,$22.85 ,$22.85 ,$19.04 ,$22.85 ,$159.84 ,$137.64 ,$159.84 ,$159.84 ,$177.60 
ST NICHOLAS HOSPITAL - ACUTE,30500142,85260,HC FACTOR X,305,1 ,$157.00 ,$78.50 ,$17.90 ,$157.00 ,$18.50 ,$69.62 ,$59.67 ,$17.90 ,$94.20 ,$133.45 ,$109.90 ,$18.50 ,$149.15 ,$119.32 ,$117.75 ,$30.43 ,$133.45 ,$17.90 ,$30.43 ,$17.90 ,$109.90 ,$18.50 ,$17.90 ,$17.90 ,$20.26 ,$133.45 ,$40.28 ,$144.44 ,$109.90 ,$86.06 ,$86.06 ,$95.61 ,$86.06 ,$108.49 ,$141.30 ,$109.35 ,$18.08 ,$124.03 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30500144,85270,HC FACTOR XI,305,1 ,$168.00 ,$84.00 ,$17.90 ,$168.00 ,$18.50 ,$69.62 ,$59.67 ,$17.90 ,$100.80 ,$142.80 ,$117.60 ,$18.50 ,$159.60 ,$127.68 ,$126.00 ,$30.43 ,$142.80 ,$17.90 ,$30.43 ,$17.90 ,$117.60 ,$18.50 ,$17.90 ,$17.90 ,$20.26 ,$142.80 ,$40.28 ,$154.56 ,$117.60 ,$86.06 ,$86.06 ,$102.31 ,$86.06 ,$116.09 ,$151.20 ,$117.01 ,$18.08 ,$132.72 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30500146,85280,HC FACTOR XII,305,1 ,$123.00 ,$61.50 ,$19.35 ,$123.00 ,$19.99 ,$75.25 ,$64.50 ,$19.35 ,$73.80 ,$104.55 ,$86.10 ,$19.99 ,$116.85 ,$93.48 ,$92.25 ,$32.90 ,$104.55 ,$19.35 ,$32.90 ,$19.35 ,$86.10 ,$19.99 ,$19.35 ,$19.35 ,$21.90 ,$104.55 ,$43.54 ,$113.16 ,$86.10 ,$93.00 ,$93.00 ,$74.91 ,$93.00 ,$84.99 ,$110.70 ,$85.67 ,$19.54 ,$97.17 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30500147,85291,HC FACTOR XIII SOL SCR,305,1 ,$56.00 ,$28.00 ,$9.11 ,$56.00 ,$9.41 ,$34.58 ,$29.64 ,$9.11 ,$33.60 ,$47.60 ,$39.20 ,$9.41 ,$53.20 ,$42.56 ,$42.00 ,$15.49 ,$47.60 ,$9.11 ,$15.49 ,$9.11 ,$39.20 ,$9.41 ,$9.11 ,$9.11 ,$10.31 ,$47.60 ,$20.50 ,$51.52 ,$39.20 ,$42.76 ,$42.76 ,$34.10 ,$42.76 ,$38.70 ,$50.40 ,$39.00 ,$9.20 ,$44.24 ,$9.97 ,$10.93 ,$10.93 ,$9.11 ,$10.93 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30500150,85300,HC ANTITHROMBIN III,305,1 ,$146.00 ,$73.00 ,$11.85 ,$146.00 ,$12.24 ,$46.10 ,$39.51 ,$11.85 ,$87.60 ,$124.10 ,$102.20 ,$12.24 ,$138.70 ,$110.96 ,$109.50 ,$20.15 ,$124.10 ,$11.85 ,$20.15 ,$11.85 ,$102.20 ,$12.24 ,$11.85 ,$11.85 ,$13.41 ,$124.10 ,$26.66 ,$134.32 ,$102.20 ,$56.96 ,$56.96 ,$88.91 ,$56.96 ,$100.89 ,$131.40 ,$101.69 ,$11.97 ,$115.34 ,$12.97 ,$14.22 ,$14.22 ,$11.85 ,$14.22 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30500151,85301,HC ANTITHROMBIN III AG,305,1 ,$101.00 ,$50.50 ,$10.81 ,$101.00 ,$11.17 ,$42.04 ,$36.03 ,$10.81 ,$60.60 ,$85.85 ,$70.70 ,$11.17 ,$95.95 ,$76.76 ,$75.75 ,$18.38 ,$85.85 ,$10.81 ,$18.38 ,$10.81 ,$70.70 ,$11.17 ,$10.81 ,$10.81 ,$12.23 ,$85.85 ,$24.32 ,$92.92 ,$70.70 ,$51.96 ,$51.96 ,$61.51 ,$51.96 ,$69.79 ,$90.90 ,$70.35 ,$10.92 ,$79.79 ,$11.84 ,$12.97 ,$12.97 ,$10.81 ,$12.97 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30500153,85302,HC PROTEIN C AG,305,1 ,$146.00 ,$73.00 ,$12.01 ,$146.00 ,$12.41 ,$46.73 ,$40.05 ,$12.01 ,$87.60 ,$124.10 ,$102.20 ,$12.41 ,$138.70 ,$110.96 ,$109.50 ,$20.42 ,$124.10 ,$12.01 ,$20.42 ,$12.01 ,$102.20 ,$12.41 ,$12.01 ,$12.01 ,$13.59 ,$124.10 ,$27.02 ,$134.32 ,$102.20 ,$57.77 ,$57.77 ,$88.91 ,$57.77 ,$100.89 ,$131.40 ,$101.69 ,$12.13 ,$115.34 ,$13.15 ,$14.41 ,$14.41 ,$12.01 ,$14.41 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30500154,85303,HC PROTEIN C ACTIVITY,305,1 ,$123.00 ,$61.50 ,$13.84 ,$123.00 ,$14.30 ,$53.80 ,$46.11 ,$13.84 ,$73.80 ,$104.55 ,$86.10 ,$14.30 ,$116.85 ,$93.48 ,$92.25 ,$23.53 ,$104.55 ,$13.84 ,$23.53 ,$13.84 ,$86.10 ,$14.30 ,$13.84 ,$13.84 ,$15.66 ,$104.55 ,$31.14 ,$113.16 ,$86.10 ,$66.47 ,$66.47 ,$74.91 ,$66.47 ,$84.99 ,$110.70 ,$85.67 ,$13.98 ,$97.17 ,$15.16 ,$16.61 ,$16.61 ,$13.84 ,$16.61 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30500155,85303,HC PROTEIN C ACTIVITY (2),305,1 ,$87.00 ,$43.50 ,$13.84 ,$87.00 ,$14.30 ,$53.80 ,$46.11 ,$13.84 ,$52.20 ,$73.95 ,$60.90 ,$14.30 ,$82.65 ,$66.12 ,$65.25 ,$23.53 ,$73.95 ,$13.84 ,$23.53 ,$13.84 ,$60.90 ,$14.30 ,$13.84 ,$13.84 ,$15.66 ,$73.95 ,$31.14 ,$80.04 ,$60.90 ,$66.47 ,$66.47 ,$52.98 ,$66.47 ,$60.12 ,$78.30 ,$60.60 ,$13.98 ,$68.73 ,$15.16 ,$16.61 ,$16.61 ,$13.84 ,$16.61 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,30500156,85305,HC PROTEIN S TOTAL,305,1 ,$146.00 ,$73.00 ,$11.61 ,$146.00 ,$12.00 ,$45.15 ,$38.70 ,$11.61 ,$87.60 ,$124.10 ,$102.20 ,$12.00 ,$138.70 ,$110.96 ,$109.50 ,$19.74 ,$124.10 ,$11.61 ,$19.74 ,$11.61 ,$102.20 ,$12.00 ,$11.61 ,$11.61 ,$13.14 ,$124.10 ,$26.12 ,$134.32 ,$102.20 ,$55.76 ,$55.76 ,$88.91 ,$55.76 ,$100.89 ,$131.40 ,$101.69 ,$11.73 ,$115.34 ,$12.72 ,$13.93 ,$13.93 ,$11.61 ,$13.93 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30500158,85306,HC PROTEIN S FREE (2),305,1 ,$134.00 ,$67.00 ,$15.32 ,$134.00 ,$15.83 ,$59.61 ,$51.09 ,$15.32 ,$80.40 ,$113.90 ,$93.80 ,$15.83 ,$127.30 ,$101.84 ,$100.50 ,$26.04 ,$113.90 ,$15.32 ,$26.04 ,$15.32 ,$93.80 ,$15.83 ,$15.32 ,$15.32 ,$17.34 ,$113.90 ,$34.47 ,$123.28 ,$93.80 ,$68.66 ,$68.66 ,$81.61 ,$68.66 ,$92.59 ,$120.60 ,$93.33 ,$15.47 ,$105.86 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30500159,85306,HC PROTEIN S FREE,305,1 ,$146.00 ,$73.00 ,$15.32 ,$146.00 ,$15.83 ,$59.61 ,$51.09 ,$15.32 ,$87.60 ,$124.10 ,$102.20 ,$15.83 ,$138.70 ,$110.96 ,$109.50 ,$26.04 ,$124.10 ,$15.32 ,$26.04 ,$15.32 ,$102.20 ,$15.83 ,$15.32 ,$15.32 ,$17.34 ,$124.10 ,$34.47 ,$134.32 ,$102.20 ,$68.66 ,$68.66 ,$88.91 ,$68.66 ,$100.89 ,$131.40 ,$101.69 ,$15.47 ,$115.34 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30500161,85306,HC PROTEIN S FREE ACT,305,1 ,$171.00 ,$85.50 ,$15.32 ,$171.00 ,$15.83 ,$59.61 ,$51.09 ,$15.32 ,$102.60 ,$145.35 ,$119.70 ,$15.83 ,$162.45 ,$129.96 ,$128.25 ,$26.04 ,$145.35 ,$15.32 ,$26.04 ,$15.32 ,$119.70 ,$15.83 ,$15.32 ,$15.32 ,$17.34 ,$145.35 ,$34.47 ,$157.32 ,$119.70 ,$68.66 ,$68.66 ,$104.14 ,$68.66 ,$118.16 ,$153.90 ,$119.10 ,$15.47 ,$135.09 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$123.12 ,$106.02 ,$123.12 ,$123.12 ,$136.80 
ST NICHOLAS HOSPITAL - ACUTE,30500163,85306,HC PROTEIN S FREE QD,305,1 ,$178.00 ,$89.00 ,$15.32 ,$178.00 ,$15.83 ,$59.61 ,$51.09 ,$15.32 ,$106.80 ,$151.30 ,$124.60 ,$15.83 ,$169.10 ,$135.28 ,$133.50 ,$26.04 ,$151.30 ,$15.32 ,$26.04 ,$15.32 ,$124.60 ,$15.83 ,$15.32 ,$15.32 ,$17.34 ,$151.30 ,$34.47 ,$163.76 ,$124.60 ,$68.66 ,$68.66 ,$108.40 ,$68.66 ,$123.00 ,$160.20 ,$123.98 ,$15.47 ,$140.62 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$128.16 ,$110.36 ,$128.16 ,$128.16 ,$142.40 
ST NICHOLAS HOSPITAL - ACUTE,30500164,85307,HC ACTIV PROTEIN C RESIST,305,1 ,$134.00 ,$67.00 ,$15.32 ,$134.00 ,$15.83 ,$59.61 ,$51.09 ,$15.32 ,$80.40 ,$113.90 ,$93.80 ,$15.83 ,$127.30 ,$101.84 ,$100.50 ,$26.04 ,$113.90 ,$15.32 ,$26.04 ,$15.32 ,$93.80 ,$15.83 ,$15.32 ,$15.32 ,$17.34 ,$113.90 ,$34.47 ,$123.28 ,$93.80 ,$68.66 ,$68.66 ,$81.61 ,$68.66 ,$92.59 ,$120.60 ,$93.33 ,$15.47 ,$105.86 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30500165,85335,HC FACTOR VIII INHIB,305,1 ,$224.00 ,$112.00 ,$12.87 ,$224.00 ,$13.30 ,$50.05 ,$42.90 ,$12.87 ,$134.40 ,$190.40 ,$156.80 ,$13.30 ,$212.80 ,$170.24 ,$168.00 ,$21.88 ,$190.40 ,$12.87 ,$21.88 ,$12.87 ,$156.80 ,$13.30 ,$12.87 ,$12.87 ,$14.57 ,$190.40 ,$28.96 ,$206.08 ,$156.80 ,$61.86 ,$61.86 ,$136.42 ,$61.86 ,$154.78 ,$201.60 ,$156.02 ,$13.00 ,$176.96 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30500166,85335,HC FACTOR IX INHIB,305,1 ,$228.00 ,$114.00 ,$12.87 ,$228.00 ,$13.30 ,$50.05 ,$42.90 ,$12.87 ,$136.80 ,$193.80 ,$159.60 ,$13.30 ,$216.60 ,$173.28 ,$171.00 ,$21.88 ,$193.80 ,$12.87 ,$21.88 ,$12.87 ,$159.60 ,$13.30 ,$12.87 ,$12.87 ,$14.57 ,$193.80 ,$28.96 ,$209.76 ,$159.60 ,$61.86 ,$61.86 ,$138.85 ,$61.86 ,$157.55 ,$205.20 ,$158.80 ,$13.00 ,$180.12 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$164.16 ,$141.36 ,$164.16 ,$164.16 ,$182.40 
ST NICHOLAS HOSPITAL - ACUTE,30500167,85335,HC FACTOR XIII INHIB,305,1 ,$263.00 ,$131.50 ,$12.87 ,$263.00 ,$13.30 ,$50.05 ,$42.90 ,$12.87 ,$157.80 ,$223.55 ,$184.10 ,$13.30 ,$249.85 ,$199.88 ,$197.25 ,$21.88 ,$223.55 ,$12.87 ,$21.88 ,$12.87 ,$184.10 ,$13.30 ,$12.87 ,$12.87 ,$14.57 ,$223.55 ,$28.96 ,$241.96 ,$184.10 ,$61.86 ,$61.86 ,$160.17 ,$61.86 ,$181.73 ,$236.70 ,$183.18 ,$13.00 ,$207.77 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$189.36 ,$163.06 ,$189.36 ,$189.36 ,$210.40 
ST NICHOLAS HOSPITAL - ACUTE,30500168,85347,HC ACTIVATED CLOTTING TIME,305,1 ,$105.00 ,$52.50 ,$4.28 ,$105.00 ,$4.42 ,$16.56 ,$14.19 ,$4.28 ,$63.00 ,$89.25 ,$73.50 ,$4.42 ,$99.75 ,$79.80 ,$78.75 ,$7.28 ,$89.25 ,$4.28 ,$7.28 ,$4.28 ,$73.50 ,$4.42 ,$4.28 ,$4.28 ,$4.84 ,$89.25 ,$9.63 ,$96.60 ,$73.50 ,$20.47 ,$20.47 ,$63.95 ,$20.47 ,$72.56 ,$94.50 ,$73.13 ,$4.32 ,$82.95 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,30500169,85347,HC ACTIVATED CLOTTING TIME (TEG),305,1 ,$78.00 ,$39.00 ,$4.28 ,$78.00 ,$4.42 ,$16.56 ,$14.19 ,$4.28 ,$46.80 ,$66.30 ,$54.60 ,$4.42 ,$74.10 ,$59.28 ,$58.50 ,$7.28 ,$66.30 ,$4.28 ,$7.28 ,$4.28 ,$54.60 ,$4.42 ,$4.28 ,$4.28 ,$4.84 ,$66.30 ,$9.63 ,$71.76 ,$54.60 ,$20.47 ,$20.47 ,$47.50 ,$20.47 ,$53.90 ,$70.20 ,$54.33 ,$4.32 ,$61.62 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500171,85347,HC ACTIVATED CLOTTING TIME (IACT),305,1 ,$67.00 ,$33.50 ,$4.28 ,$67.00 ,$4.42 ,$16.56 ,$14.19 ,$4.28 ,$40.20 ,$56.95 ,$46.90 ,$4.42 ,$63.65 ,$50.92 ,$50.25 ,$7.28 ,$56.95 ,$4.28 ,$7.28 ,$4.28 ,$46.90 ,$4.42 ,$4.28 ,$4.28 ,$4.84 ,$56.95 ,$9.63 ,$61.64 ,$46.90 ,$20.47 ,$20.47 ,$40.80 ,$20.47 ,$46.30 ,$60.30 ,$46.67 ,$4.32 ,$52.93 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30500172,85347,HC ACTIVATED CLOTTING TIME (HRACT),305,1 ,$27.00 ,$13.50 ,$4.28 ,$27.00 ,$4.42 ,$16.56 ,$14.19 ,$4.28 ,$16.20 ,$22.95 ,$18.90 ,$4.42 ,$25.65 ,$20.52 ,$20.25 ,$7.28 ,$22.95 ,$4.28 ,$7.28 ,$4.28 ,$18.90 ,$4.42 ,$4.28 ,$4.28 ,$4.84 ,$22.95 ,$9.63 ,$24.84 ,$18.90 ,$20.47 ,$20.47 ,$16.44 ,$20.47 ,$18.66 ,$24.30 ,$18.81 ,$4.32 ,$21.33 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$21.60 
ST NICHOLAS HOSPITAL - ACUTE,30500173,85347,HC ACTIVATED CLOTTING TIME (HDR),305,1 ,$22.00 ,$11.00 ,$4.28 ,$22.00 ,$4.42 ,$16.56 ,$14.19 ,$4.28 ,$13.20 ,$18.70 ,$15.40 ,$4.42 ,$20.90 ,$16.72 ,$16.50 ,$7.28 ,$18.70 ,$4.28 ,$7.28 ,$4.28 ,$15.40 ,$4.42 ,$4.28 ,$4.28 ,$4.84 ,$18.70 ,$9.63 ,$20.24 ,$15.40 ,$20.47 ,$20.47 ,$13.40 ,$20.47 ,$15.20 ,$19.80 ,$15.32 ,$4.32 ,$17.38 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$15.84 ,$13.64 ,$15.84 ,$15.84 ,$17.60 
ST NICHOLAS HOSPITAL - ACUTE,30500174,85362,HC FDP/FSP AGGLUT SQ,305,1 ,$53.00 ,$26.50 ,$6.89 ,$53.00 ,$7.12 ,$26.78 ,$22.95 ,$6.89 ,$31.80 ,$45.05 ,$37.10 ,$7.12 ,$50.35 ,$40.28 ,$39.75 ,$11.71 ,$45.05 ,$6.89 ,$11.71 ,$6.89 ,$37.10 ,$7.12 ,$6.89 ,$6.89 ,$7.80 ,$45.05 ,$15.50 ,$48.76 ,$37.10 ,$33.11 ,$33.11 ,$32.28 ,$33.11 ,$36.62 ,$47.70 ,$36.91 ,$6.96 ,$41.87 ,$7.55 ,$8.27 ,$8.27 ,$6.89 ,$8.27 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30500175,85379,HC D DIMER QN,305,1 ,$78.00 ,$39.00 ,$10.18 ,$78.00 ,$10.52 ,$39.59 ,$33.93 ,$10.18 ,$46.80 ,$66.30 ,$54.60 ,$10.52 ,$74.10 ,$59.28 ,$58.50 ,$17.31 ,$66.30 ,$10.18 ,$17.31 ,$10.18 ,$54.60 ,$10.52 ,$10.18 ,$10.18 ,$11.52 ,$66.30 ,$22.91 ,$71.76 ,$54.60 ,$38.96 ,$38.96 ,$47.50 ,$38.96 ,$53.90 ,$70.20 ,$54.33 ,$10.28 ,$61.62 ,$11.15 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500176,85384,HC FIBRINOGEN,305,1 ,$78.00 ,$39.00 ,$9.72 ,$78.00 ,$10.04 ,$34.02 ,$29.16 ,$9.72 ,$46.80 ,$66.30 ,$54.60 ,$10.04 ,$74.10 ,$59.28 ,$58.50 ,$16.52 ,$66.30 ,$9.72 ,$16.52 ,$9.72 ,$54.60 ,$10.04 ,$9.72 ,$9.72 ,$11.00 ,$66.30 ,$21.87 ,$71.76 ,$54.60 ,$40.79 ,$40.79 ,$47.50 ,$40.79 ,$53.90 ,$70.20 ,$54.33 ,$9.82 ,$61.62 ,$10.64 ,$11.66 ,$11.66 ,$9.72 ,$11.66 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500177,85384,HC FIBRINOGEN (TEG),305,1 ,$67.00 ,$33.50 ,$9.72 ,$67.00 ,$10.04 ,$34.02 ,$29.16 ,$9.72 ,$40.20 ,$56.95 ,$46.90 ,$10.04 ,$63.65 ,$50.92 ,$50.25 ,$16.52 ,$56.95 ,$9.72 ,$16.52 ,$9.72 ,$46.90 ,$10.04 ,$9.72 ,$9.72 ,$11.00 ,$56.95 ,$21.87 ,$61.64 ,$46.90 ,$40.79 ,$40.79 ,$40.80 ,$40.79 ,$46.30 ,$60.30 ,$46.67 ,$9.82 ,$52.93 ,$10.64 ,$11.66 ,$11.66 ,$9.72 ,$11.66 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30500179,85385,HC FIBRINOGEN AG,305,1 ,$67.00 ,$33.50 ,$11.94 ,$67.00 ,$11.94 ,$50.61 ,$43.38 ,$14.46 ,$40.20 ,$56.95 ,$46.90 ,$11.94 ,$63.65 ,$50.92 ,$50.25 ,$24.58 ,$56.95 ,$14.46 ,$24.58 ,$14.46 ,$46.90 ,$11.94 ,$14.46 ,$14.46 ,$16.37 ,$56.95 ,$32.54 ,$61.64 ,$46.90 ,$40.79 ,$40.79 ,$40.80 ,$40.79 ,$46.30 ,$60.30 ,$46.67 ,$14.60 ,$52.93 ,$12.66 ,$17.35 ,$17.35 ,$14.46 ,$17.35 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30500181,85410,HC ALPHA 2 ANTIPLASMIN,305,1 ,$202.00 ,$101.00 ,$7.71 ,$202.00 ,$7.97 ,$29.96 ,$25.68 ,$7.71 ,$121.20 ,$171.70 ,$141.40 ,$7.97 ,$191.90 ,$153.52 ,$151.50 ,$13.11 ,$171.70 ,$7.71 ,$13.11 ,$7.71 ,$141.40 ,$7.97 ,$7.71 ,$7.71 ,$8.73 ,$171.70 ,$17.35 ,$185.84 ,$141.40 ,$37.06 ,$37.06 ,$123.02 ,$37.06 ,$139.58 ,$181.80 ,$140.69 ,$7.79 ,$159.58 ,$8.45 ,$9.25 ,$9.25 ,$7.71 ,$9.25 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30500182,85415,HC PLASMINGEN ACTIV INHIB,305,1 ,$250.00 ,$125.00 ,$17.19 ,$250.00 ,$17.76 ,$66.85 ,$57.30 ,$17.19 ,$150.00 ,$212.50 ,$175.00 ,$17.76 ,$237.50 ,$190.00 ,$187.50 ,$29.22 ,$212.50 ,$17.19 ,$29.22 ,$17.19 ,$175.00 ,$17.76 ,$17.19 ,$17.19 ,$19.46 ,$212.50 ,$38.68 ,$230.00 ,$175.00 ,$82.64 ,$82.64 ,$152.25 ,$82.64 ,$172.75 ,$225.00 ,$174.13 ,$17.36 ,$197.50 ,$18.83 ,$20.63 ,$20.63 ,$17.19 ,$20.63 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,30500184,85420,HC PLASMINOGEN ACTIVITY,305,1 ,$235.00 ,$117.50 ,$6.53 ,$235.00 ,$6.75 ,$25.41 ,$21.78 ,$6.53 ,$141.00 ,$199.75 ,$164.50 ,$6.75 ,$223.25 ,$178.60 ,$176.25 ,$11.10 ,$199.75 ,$6.53 ,$11.10 ,$6.53 ,$164.50 ,$6.75 ,$6.53 ,$6.53 ,$7.39 ,$199.75 ,$14.69 ,$216.20 ,$164.50 ,$31.42 ,$31.42 ,$143.12 ,$31.42 ,$162.39 ,$211.50 ,$163.68 ,$6.60 ,$185.65 ,$7.16 ,$7.84 ,$7.84 ,$6.53 ,$7.84 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,30500185,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$168.00 ,$84.00 ,$7.73 ,$168.00 ,$7.99 ,$30.07 ,$25.77 ,$7.73 ,$100.80 ,$142.80 ,$117.60 ,$7.99 ,$159.60 ,$127.68 ,$126.00 ,$13.14 ,$142.80 ,$7.73 ,$13.14 ,$7.73 ,$117.60 ,$7.99 ,$7.73 ,$7.73 ,$8.75 ,$142.80 ,$17.39 ,$154.56 ,$117.60 ,$37.20 ,$37.20 ,$102.31 ,$37.20 ,$116.09 ,$151.20 ,$117.01 ,$7.81 ,$132.72 ,$8.47 ,$9.28 ,$9.28 ,$7.73 ,$9.28 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30500186,85461,HC FETAL HGB ROSETTE,305,1 ,$67.00 ,$33.50 ,$9.33 ,$67.00 ,$9.33 ,$32.76 ,$28.08 ,$9.36 ,$40.20 ,$56.95 ,$46.90 ,$9.33 ,$63.65 ,$50.92 ,$50.25 ,$15.91 ,$56.95 ,$9.36 ,$15.91 ,$9.36 ,$46.90 ,$9.33 ,$9.36 ,$9.36 ,$10.59 ,$56.95 ,$21.06 ,$61.64 ,$46.90 ,$31.88 ,$31.88 ,$40.80 ,$31.88 ,$46.30 ,$60.30 ,$46.67 ,$9.45 ,$52.93 ,$9.89 ,$11.23 ,$11.23 ,$9.36 ,$11.23 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30500187,85520,HC HEPARIN ASSAY,305,1 ,$190.00 ,$95.00 ,$13.09 ,$190.00 ,$13.53 ,$50.93 ,$43.65 ,$13.09 ,$114.00 ,$161.50 ,$133.00 ,$13.53 ,$180.50 ,$144.40 ,$142.50 ,$22.25 ,$161.50 ,$13.09 ,$22.25 ,$13.09 ,$133.00 ,$13.53 ,$13.09 ,$13.09 ,$14.82 ,$161.50 ,$29.45 ,$174.80 ,$133.00 ,$53.68 ,$53.68 ,$115.71 ,$53.68 ,$131.29 ,$171.00 ,$132.34 ,$13.22 ,$150.10 ,$14.34 ,$15.71 ,$15.71 ,$13.09 ,$15.71 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30500188,85520,HC HEPARIN ASSAY (LOW MOLE),305,1 ,$190.00 ,$95.00 ,$13.09 ,$190.00 ,$13.53 ,$50.93 ,$43.65 ,$13.09 ,$114.00 ,$161.50 ,$133.00 ,$13.53 ,$180.50 ,$144.40 ,$142.50 ,$22.25 ,$161.50 ,$13.09 ,$22.25 ,$13.09 ,$133.00 ,$13.53 ,$13.09 ,$13.09 ,$14.82 ,$161.50 ,$29.45 ,$174.80 ,$133.00 ,$53.68 ,$53.68 ,$115.71 ,$53.68 ,$131.29 ,$171.00 ,$132.34 ,$13.22 ,$150.10 ,$14.34 ,$15.71 ,$15.71 ,$13.09 ,$15.71 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30500189,85520,HC HPT,305,1 ,$59.00 ,$29.50 ,$13.09 ,$59.00 ,$13.53 ,$50.93 ,$43.65 ,$13.09 ,$35.40 ,$50.15 ,$41.30 ,$13.53 ,$56.05 ,$44.84 ,$44.25 ,$22.25 ,$50.15 ,$13.09 ,$22.25 ,$13.09 ,$41.30 ,$13.53 ,$13.09 ,$13.09 ,$14.82 ,$50.15 ,$29.45 ,$54.28 ,$41.30 ,$53.68 ,$53.68 ,$35.93 ,$53.68 ,$40.77 ,$53.10 ,$41.09 ,$13.22 ,$46.61 ,$14.34 ,$15.71 ,$15.71 ,$13.09 ,$15.71 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$47.20 
ST NICHOLAS HOSPITAL - ACUTE,30500190,85540,HC LEUKOCYTE ALK PHOS,305,1 ,$140.00 ,$70.00 ,$8.60 ,$140.00 ,$8.89 ,$33.46 ,$28.68 ,$8.60 ,$84.00 ,$119.00 ,$98.00 ,$8.89 ,$133.00 ,$106.40 ,$105.00 ,$14.62 ,$119.00 ,$8.60 ,$14.62 ,$8.60 ,$98.00 ,$8.89 ,$8.60 ,$8.60 ,$9.73 ,$119.00 ,$19.35 ,$128.80 ,$98.00 ,$41.36 ,$41.36 ,$85.26 ,$41.36 ,$96.74 ,$126.00 ,$97.51 ,$8.69 ,$110.60 ,$9.42 ,$10.32 ,$10.32 ,$8.60 ,$10.32 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$112.00 
ST NICHOLAS HOSPITAL - ACUTE,30500191,85557,HC OSMOTIC FRAG RBC INCUB,305,1 ,$259.00 ,$129.50 ,$13.36 ,$259.00 ,$13.80 ,$51.94 ,$44.52 ,$13.36 ,$155.40 ,$220.15 ,$181.30 ,$13.80 ,$246.05 ,$196.84 ,$194.25 ,$22.71 ,$220.15 ,$13.36 ,$22.71 ,$13.36 ,$181.30 ,$13.80 ,$13.36 ,$13.36 ,$15.12 ,$220.15 ,$30.06 ,$238.28 ,$181.30 ,$64.22 ,$64.22 ,$157.73 ,$64.22 ,$178.97 ,$233.10 ,$180.39 ,$13.49 ,$204.61 ,$14.63 ,$16.03 ,$16.03 ,$13.36 ,$16.03 ,$186.48 ,$160.58 ,$186.48 ,$186.48 ,$207.20 
ST NICHOLAS HOSPITAL - ACUTE,30500192,85576,HC PLATELET AGGREGATION EA,305,1 ,$213.00 ,$106.50 ,$24.91 ,$213.00 ,$25.74 ,$87.19 ,$74.73 ,$24.91 ,$127.80 ,$181.05 ,$149.10 ,$25.74 ,$202.35 ,$161.88 ,$159.75 ,$42.35 ,$181.05 ,$24.91 ,$42.35 ,$24.91 ,$149.10 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$181.05 ,$56.05 ,$195.96 ,$149.10 ,$103.25 ,$103.25 ,$129.72 ,$103.25 ,$147.18 ,$191.70 ,$148.35 ,$25.16 ,$168.27 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,30500193,85576,HC PLATELET AGGREGATION EA (TEG),305,1 ,$78.00 ,$39.00 ,$24.91 ,$78.00 ,$25.74 ,$78.00 ,$74.73 ,$24.91 ,$46.80 ,$66.30 ,$54.60 ,$25.74 ,$74.10 ,$59.28 ,$58.50 ,$42.35 ,$66.30 ,$24.91 ,$42.35 ,$24.91 ,$54.60 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$66.30 ,$56.05 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$70.20 ,$54.33 ,$25.16 ,$61.62 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500195,85576,HC PLATELET AGGREGATION EA (ASSAY),305,1 ,$103.00 ,$51.50 ,$24.91 ,$103.00 ,$25.74 ,$87.19 ,$74.73 ,$24.91 ,$61.80 ,$87.55 ,$72.10 ,$25.74 ,$97.85 ,$78.28 ,$77.25 ,$42.35 ,$87.55 ,$24.91 ,$42.35 ,$24.91 ,$72.10 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$87.55 ,$56.05 ,$94.76 ,$72.10 ,$103.00 ,$103.00 ,$62.73 ,$103.00 ,$71.17 ,$92.70 ,$71.74 ,$25.16 ,$81.37 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$36.00 ,$18.00 ,$4.29 ,$36.00 ,$4.43 ,$15.30 ,$13.11 ,$4.29 ,$21.60 ,$30.60 ,$25.20 ,$4.43 ,$34.20 ,$27.36 ,$27.00 ,$7.29 ,$30.60 ,$4.29 ,$7.29 ,$4.29 ,$25.20 ,$4.43 ,$4.29 ,$4.29 ,$4.86 ,$30.60 ,$9.65 ,$33.12 ,$25.20 ,$18.92 ,$18.92 ,$21.92 ,$18.92 ,$24.88 ,$32.40 ,$25.07 ,$4.33 ,$28.44 ,$4.70 ,$5.15 ,$5.15 ,$4.29 ,$5.15 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30500197,85611,HC PT MIX STUDY,305,1 ,$48.00 ,$24.00 ,$3.94 ,$48.00 ,$4.07 ,$15.33 ,$13.14 ,$3.94 ,$28.80 ,$40.80 ,$33.60 ,$4.07 ,$45.60 ,$36.48 ,$36.00 ,$6.70 ,$40.80 ,$3.94 ,$6.70 ,$3.94 ,$33.60 ,$4.07 ,$3.94 ,$3.94 ,$4.46 ,$40.80 ,$8.87 ,$44.16 ,$33.60 ,$18.95 ,$18.95 ,$29.23 ,$18.95 ,$33.17 ,$43.20 ,$33.43 ,$3.98 ,$37.92 ,$4.31 ,$4.73 ,$4.73 ,$3.94 ,$4.73 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30500198,85613,HC RUSSELL VIPER VENOM SCR,305,1 ,$78.00 ,$39.00 ,$9.58 ,$78.00 ,$9.90 ,$37.24 ,$31.92 ,$9.58 ,$46.80 ,$66.30 ,$54.60 ,$9.90 ,$74.10 ,$59.28 ,$58.50 ,$16.29 ,$66.30 ,$9.58 ,$16.29 ,$9.58 ,$54.60 ,$9.90 ,$9.58 ,$9.58 ,$10.84 ,$66.30 ,$21.56 ,$71.76 ,$54.60 ,$46.01 ,$46.01 ,$47.50 ,$46.01 ,$53.90 ,$70.20 ,$54.33 ,$9.68 ,$61.62 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500200,85613,HC RUSSELL VIPER VENOM CONF,305,1 ,$78.00 ,$39.00 ,$9.58 ,$78.00 ,$9.90 ,$37.24 ,$31.92 ,$9.58 ,$46.80 ,$66.30 ,$54.60 ,$9.90 ,$74.10 ,$59.28 ,$58.50 ,$16.29 ,$66.30 ,$9.58 ,$16.29 ,$9.58 ,$54.60 ,$9.90 ,$9.58 ,$9.58 ,$10.84 ,$66.30 ,$21.56 ,$71.76 ,$54.60 ,$46.01 ,$46.01 ,$47.50 ,$46.01 ,$53.90 ,$70.20 ,$54.33 ,$9.68 ,$61.62 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500201,85613,HC RUSSELL VIPER VENOM DIL (DRVVT),305,1 ,$78.00 ,$39.00 ,$9.58 ,$78.00 ,$9.90 ,$37.24 ,$31.92 ,$9.58 ,$46.80 ,$66.30 ,$54.60 ,$9.90 ,$74.10 ,$59.28 ,$58.50 ,$16.29 ,$66.30 ,$9.58 ,$16.29 ,$9.58 ,$54.60 ,$9.90 ,$9.58 ,$9.58 ,$10.84 ,$66.30 ,$21.56 ,$71.76 ,$54.60 ,$46.01 ,$46.01 ,$47.50 ,$46.01 ,$53.90 ,$70.20 ,$54.33 ,$9.68 ,$61.62 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500202,85613,HC RUSSELL VIPER VENOM DIL,305,1 ,$137.00 ,$68.50 ,$9.58 ,$137.00 ,$9.90 ,$37.24 ,$31.92 ,$9.58 ,$82.20 ,$116.45 ,$95.90 ,$9.90 ,$130.15 ,$104.12 ,$102.75 ,$16.29 ,$116.45 ,$9.58 ,$16.29 ,$9.58 ,$95.90 ,$9.90 ,$9.58 ,$9.58 ,$10.84 ,$116.45 ,$21.56 ,$126.04 ,$95.90 ,$46.01 ,$46.01 ,$83.43 ,$46.01 ,$94.67 ,$123.30 ,$95.42 ,$9.68 ,$108.23 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$98.64 ,$84.94 ,$98.64 ,$98.64 ,$109.60 
ST NICHOLAS HOSPITAL - ACUTE,30500204,85651,HC SED RATE RBC NON AUTO,305,1 ,$46.00 ,$23.00 ,$4.01 ,$46.00 ,$4.01 ,$14.95 ,$12.81 ,$4.27 ,$27.60 ,$39.10 ,$32.20 ,$4.01 ,$43.70 ,$34.96 ,$34.50 ,$7.26 ,$39.10 ,$4.27 ,$7.26 ,$4.27 ,$32.20 ,$4.01 ,$4.27 ,$4.27 ,$4.83 ,$39.10 ,$9.61 ,$42.32 ,$32.20 ,$17.05 ,$17.05 ,$28.01 ,$17.05 ,$31.79 ,$41.40 ,$32.04 ,$4.31 ,$36.34 ,$4.25 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30500205,85652,HC SED RATE AUTO,305,1 ,$40.00 ,$20.00 ,$2.70 ,$40.00 ,$2.79 ,$10.50 ,$9.00 ,$2.70 ,$24.00 ,$34.00 ,$28.00 ,$2.79 ,$38.00 ,$30.40 ,$30.00 ,$4.59 ,$34.00 ,$2.70 ,$4.59 ,$2.70 ,$28.00 ,$2.79 ,$2.70 ,$2.70 ,$3.06 ,$34.00 ,$6.08 ,$36.80 ,$28.00 ,$13.00 ,$13.00 ,$24.36 ,$13.00 ,$27.64 ,$36.00 ,$27.86 ,$2.73 ,$31.60 ,$2.96 ,$3.24 ,$3.24 ,$2.70 ,$3.24 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30500206,85660,HC SICKLE CELL RBC,305,1 ,$67.00 ,$33.50 ,$5.51 ,$67.00 ,$5.69 ,$21.42 ,$18.36 ,$5.51 ,$40.20 ,$56.95 ,$46.90 ,$5.69 ,$63.65 ,$50.92 ,$50.25 ,$9.37 ,$56.95 ,$5.51 ,$9.37 ,$5.51 ,$46.90 ,$5.69 ,$5.51 ,$5.51 ,$6.24 ,$56.95 ,$12.40 ,$61.64 ,$46.90 ,$26.53 ,$26.53 ,$40.80 ,$26.53 ,$46.30 ,$60.30 ,$46.67 ,$5.57 ,$52.93 ,$6.03 ,$6.61 ,$6.61 ,$5.51 ,$6.61 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30500207,85670,HC THROMBIN TIME PLASMA,305,1 ,$101.00 ,$50.50 ,$1.16 ,$101.00 ,$1.16 ,$22.44 ,$19.23 ,$5.77 ,$60.60 ,$85.85 ,$70.70 ,$1.16 ,$95.95 ,$76.76 ,$75.75 ,$9.81 ,$85.85 ,$5.77 ,$9.81 ,$5.77 ,$70.70 ,$1.16 ,$5.77 ,$5.77 ,$6.53 ,$85.85 ,$12.98 ,$92.92 ,$70.70 ,$27.72 ,$27.72 ,$61.51 ,$27.72 ,$69.79 ,$90.90 ,$70.35 ,$5.83 ,$79.79 ,$1.23 ,$6.92 ,$6.92 ,$5.77 ,$6.92 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30500208,85705,HC HEX PHOSPHOLIPID NEUT,305,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$37.45 ,$32.10 ,$9.63 ,$33.60 ,$47.60 ,$39.20 ,$8.17 ,$53.20 ,$42.56 ,$42.00 ,$16.37 ,$47.60 ,$9.63 ,$16.37 ,$9.63 ,$39.20 ,$8.17 ,$9.63 ,$9.63 ,$10.90 ,$47.60 ,$21.67 ,$51.52 ,$39.20 ,$27.93 ,$27.93 ,$34.10 ,$27.93 ,$38.70 ,$50.40 ,$39.00 ,$9.73 ,$44.24 ,$8.66 ,$11.56 ,$11.56 ,$9.63 ,$11.56 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30500209,85730,HC PTT (LUPUS),305,1 ,$52.00 ,$26.00 ,$6.01 ,$52.00 ,$6.21 ,$23.35 ,$20.01 ,$6.01 ,$31.20 ,$44.20 ,$36.40 ,$6.21 ,$49.40 ,$39.52 ,$39.00 ,$10.22 ,$44.20 ,$6.01 ,$10.22 ,$6.01 ,$36.40 ,$6.21 ,$6.01 ,$6.01 ,$6.80 ,$44.20 ,$13.52 ,$47.84 ,$36.40 ,$28.85 ,$28.85 ,$31.67 ,$28.85 ,$35.93 ,$46.80 ,$36.22 ,$6.07 ,$41.08 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$41.60 
ST NICHOLAS HOSPITAL - ACUTE,30500210,85730,HC PTT (LUPUS ANTI),305,1 ,$87.00 ,$43.50 ,$6.01 ,$87.00 ,$6.21 ,$23.35 ,$20.01 ,$6.01 ,$52.20 ,$73.95 ,$60.90 ,$6.21 ,$82.65 ,$66.12 ,$65.25 ,$10.22 ,$73.95 ,$6.01 ,$10.22 ,$6.01 ,$60.90 ,$6.21 ,$6.01 ,$6.01 ,$6.80 ,$73.95 ,$13.52 ,$80.04 ,$60.90 ,$28.85 ,$28.85 ,$52.98 ,$28.85 ,$60.12 ,$78.30 ,$60.60 ,$6.07 ,$68.73 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,30500211,85730,HC PTT,305,1 ,$56.00 ,$28.00 ,$6.01 ,$56.00 ,$6.21 ,$23.35 ,$20.01 ,$6.01 ,$33.60 ,$47.60 ,$39.20 ,$6.21 ,$53.20 ,$42.56 ,$42.00 ,$10.22 ,$47.60 ,$6.01 ,$10.22 ,$6.01 ,$39.20 ,$6.21 ,$6.01 ,$6.01 ,$6.80 ,$47.60 ,$13.52 ,$51.52 ,$39.20 ,$28.85 ,$28.85 ,$34.10 ,$28.85 ,$38.70 ,$50.40 ,$39.00 ,$6.07 ,$44.24 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30500212,85730,HC APTT,305,1 ,$103.00 ,$51.50 ,$6.01 ,$103.00 ,$6.21 ,$23.35 ,$20.01 ,$6.01 ,$61.80 ,$87.55 ,$72.10 ,$6.21 ,$97.85 ,$78.28 ,$77.25 ,$10.22 ,$87.55 ,$6.01 ,$10.22 ,$6.01 ,$72.10 ,$6.21 ,$6.01 ,$6.01 ,$6.80 ,$87.55 ,$13.52 ,$94.76 ,$72.10 ,$28.85 ,$28.85 ,$62.73 ,$28.85 ,$71.17 ,$92.70 ,$71.74 ,$6.07 ,$81.37 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,30500213,85732,HC PTT MIXING STUDY,305,1 ,$78.00 ,$39.00 ,$6.47 ,$78.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$46.80 ,$66.30 ,$54.60 ,$6.69 ,$74.10 ,$59.28 ,$58.50 ,$11.00 ,$66.30 ,$6.47 ,$11.00 ,$6.47 ,$54.60 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$66.30 ,$14.56 ,$71.76 ,$54.60 ,$31.10 ,$31.10 ,$47.50 ,$31.10 ,$53.90 ,$70.20 ,$54.33 ,$6.53 ,$61.62 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30500214,85732,HC PTT MIXING STUDY (LUPUS),305,1 ,$26.00 ,$13.00 ,$6.47 ,$26.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$15.60 ,$22.10 ,$18.20 ,$6.69 ,$24.70 ,$19.76 ,$19.50 ,$11.00 ,$22.10 ,$6.47 ,$11.00 ,$6.47 ,$18.20 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$22.10 ,$14.56 ,$23.92 ,$18.20 ,$26.00 ,$26.00 ,$15.83 ,$26.00 ,$17.97 ,$23.40 ,$18.11 ,$6.53 ,$20.54 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$20.80 
ST NICHOLAS HOSPITAL - ACUTE,30500215,85732,HC PTT MIXING STUDY (24) HR,305,1 ,$65.00 ,$32.50 ,$6.47 ,$65.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$39.00 ,$55.25 ,$45.50 ,$6.69 ,$61.75 ,$49.40 ,$48.75 ,$11.00 ,$55.25 ,$6.47 ,$11.00 ,$6.47 ,$45.50 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$55.25 ,$14.56 ,$59.80 ,$45.50 ,$31.10 ,$31.10 ,$39.59 ,$31.10 ,$44.92 ,$58.50 ,$45.27 ,$6.53 ,$51.35 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$52.00 
ST NICHOLAS HOSPITAL - ACUTE,30500216,85732,HC PTT MIXING STUDY (PLASMA),305,1 ,$157.00 ,$78.50 ,$6.47 ,$157.00 ,$6.69 ,$25.13 ,$21.54 ,$6.47 ,$94.20 ,$133.45 ,$109.90 ,$6.69 ,$149.15 ,$119.32 ,$117.75 ,$11.00 ,$133.45 ,$6.47 ,$11.00 ,$6.47 ,$109.90 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$133.45 ,$14.56 ,$144.44 ,$109.90 ,$31.10 ,$31.10 ,$95.61 ,$31.10 ,$108.49 ,$141.30 ,$109.35 ,$6.53 ,$124.03 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30500217,85810,HC VISCOSITY,305,1 ,$90.00 ,$45.00 ,$11.67 ,$90.00 ,$12.06 ,$45.40 ,$38.91 ,$11.67 ,$54.00 ,$76.50 ,$63.00 ,$12.06 ,$85.50 ,$68.40 ,$67.50 ,$19.84 ,$76.50 ,$11.67 ,$19.84 ,$11.67 ,$63.00 ,$12.06 ,$11.67 ,$11.67 ,$13.21 ,$76.50 ,$26.26 ,$82.80 ,$63.00 ,$56.08 ,$56.08 ,$54.81 ,$56.08 ,$62.19 ,$81.00 ,$62.69 ,$11.79 ,$71.10 ,$12.78 ,$14.00 ,$14.00 ,$11.67 ,$14.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30500220,85576,HC PLTMAP ADP 85576,305,1 ,$101.00 ,$50.50 ,$24.91 ,$101.00 ,$25.74 ,$87.19 ,$74.73 ,$24.91 ,$60.60 ,$85.85 ,$70.70 ,$25.74 ,$95.95 ,$76.76 ,$75.75 ,$42.35 ,$85.85 ,$24.91 ,$42.35 ,$24.91 ,$70.70 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$85.85 ,$56.05 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$90.90 ,$70.35 ,$25.16 ,$79.79 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30500221,85576,HC PLTMAP AA 85576,305,1 ,$101.00 ,$50.50 ,$24.91 ,$101.00 ,$25.74 ,$87.19 ,$74.73 ,$24.91 ,$60.60 ,$85.85 ,$70.70 ,$25.74 ,$95.95 ,$76.76 ,$75.75 ,$42.35 ,$85.85 ,$24.91 ,$42.35 ,$24.91 ,$70.70 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$85.85 ,$56.05 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$90.90 ,$70.35 ,$25.16 ,$79.79 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30500222,85576,HC PLT MAP TEG 85576,305,1 ,$101.00 ,$50.50 ,$24.91 ,$101.00 ,$25.74 ,$87.19 ,$74.73 ,$24.91 ,$60.60 ,$85.85 ,$70.70 ,$25.74 ,$95.95 ,$76.76 ,$75.75 ,$42.35 ,$85.85 ,$24.91 ,$42.35 ,$24.91 ,$70.70 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$85.85 ,$56.05 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$90.90 ,$70.35 ,$25.16 ,$79.79 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30500223,85576,HC PLTINHIB ADP 85576,305,1 ,$146.00 ,$73.00 ,$24.91 ,$146.00 ,$25.74 ,$87.19 ,$74.73 ,$24.91 ,$87.60 ,$124.10 ,$102.20 ,$25.74 ,$138.70 ,$110.96 ,$109.50 ,$42.35 ,$124.10 ,$24.91 ,$42.35 ,$24.91 ,$102.20 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$124.10 ,$56.05 ,$134.32 ,$102.20 ,$103.25 ,$103.25 ,$88.91 ,$103.25 ,$100.89 ,$131.40 ,$101.69 ,$25.16 ,$115.34 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30500224,85576,HC PLTINHIB TEG 85576,305,1 ,$146.00 ,$73.00 ,$24.91 ,$146.00 ,$25.74 ,$87.19 ,$74.73 ,$24.91 ,$87.60 ,$124.10 ,$102.20 ,$25.74 ,$138.70 ,$110.96 ,$109.50 ,$42.35 ,$124.10 ,$24.91 ,$42.35 ,$24.91 ,$102.20 ,$25.74 ,$24.91 ,$24.91 ,$28.19 ,$124.10 ,$56.05 ,$134.32 ,$102.20 ,$103.25 ,$103.25 ,$88.91 ,$103.25 ,$100.89 ,$131.40 ,$101.69 ,$25.16 ,$115.34 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30500225,85245,HC RISTOCETIN COFACT MAYO,305,1 ,$109.00 ,$54.50 ,$22.94 ,$109.00 ,$23.70 ,$89.22 ,$76.47 ,$22.94 ,$65.40 ,$92.65 ,$76.30 ,$23.70 ,$103.55 ,$82.84 ,$81.75 ,$39.00 ,$92.65 ,$22.94 ,$39.00 ,$22.94 ,$76.30 ,$23.70 ,$22.94 ,$22.94 ,$25.96 ,$92.65 ,$51.62 ,$100.28 ,$76.30 ,$109.00 ,$109.00 ,$66.38 ,$109.00 ,$75.32 ,$98.10 ,$75.92 ,$23.17 ,$86.11 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,30500226,85246,HC VW FACTOR ANTIGEN MAYO,305,1 ,$288.00 ,$144.00 ,$22.94 ,$288.00 ,$23.70 ,$89.22 ,$76.47 ,$22.94 ,$172.80 ,$244.80 ,$201.60 ,$23.70 ,$273.60 ,$218.88 ,$216.00 ,$39.00 ,$244.80 ,$22.94 ,$39.00 ,$22.94 ,$201.60 ,$23.70 ,$22.94 ,$22.94 ,$25.96 ,$244.80 ,$51.62 ,$264.96 ,$201.60 ,$110.26 ,$110.26 ,$175.39 ,$110.26 ,$199.01 ,$259.20 ,$200.59 ,$23.17 ,$227.52 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$230.40 
ST NICHOLAS HOSPITAL - ACUTE,30500227,85240,HC FACTOR VIII ASSAY MAYO,305,1 ,$221.00 ,$110.50 ,$9.84 ,$221.00 ,$9.84 ,$69.62 ,$59.67 ,$17.90 ,$132.60 ,$187.85 ,$154.70 ,$9.84 ,$209.95 ,$167.96 ,$165.75 ,$30.43 ,$187.85 ,$17.90 ,$30.43 ,$17.90 ,$154.70 ,$9.84 ,$17.90 ,$17.90 ,$20.26 ,$187.85 ,$40.28 ,$203.32 ,$154.70 ,$33.61 ,$33.61 ,$134.59 ,$33.61 ,$152.71 ,$198.90 ,$153.93 ,$18.08 ,$174.59 ,$10.43 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$159.12 ,$137.02 ,$159.12 ,$159.12 ,$176.80 
ST NICHOLAS HOSPITAL - ACUTE,30500228,85397,HC VW FACTOR ACTIVITY MAYO,305,1 ,$288.00 ,$144.00 ,$30.86 ,$288.00 ,$31.89 ,$108.01 ,$92.58 ,$30.86 ,$172.80 ,$244.80 ,$201.60 ,$31.89 ,$273.60 ,$218.88 ,$216.00 ,$52.46 ,$244.80 ,$30.86 ,$52.46 ,$30.86 ,$201.60 ,$31.89 ,$30.86 ,$30.86 ,$34.93 ,$244.80 ,$69.44 ,$264.96 ,$201.60 ,$110.26 ,$110.26 ,$175.39 ,$110.26 ,$199.01 ,$259.20 ,$200.59 ,$31.17 ,$227.52 ,$33.80 ,$37.03 ,$37.03 ,$30.86 ,$37.03 ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$230.40 
ST NICHOLAS HOSPITAL - ACUTE,30500230,85055,HC IMMATURE PLATELET FRACTION,305,1 ,$202.00 ,$101.00 ,$18.97 ,$202.00 ,$18.97 ,$125.09 ,$107.22 ,$35.74 ,$121.20 ,$171.70 ,$141.40 ,$18.97 ,$191.90 ,$153.52 ,$151.50 ,$60.76 ,$171.70 ,$35.74 ,$60.76 ,$35.74 ,$141.40 ,$18.97 ,$35.74 ,$35.74 ,$40.45 ,$171.70 ,$80.42 ,$185.84 ,$141.40 ,$128.68 ,$128.68 ,$123.02 ,$128.68 ,$139.58 ,$181.80 ,$140.69 ,$36.10 ,$159.58 ,$20.11 ,$42.89 ,$42.89 ,$35.74 ,$42.89 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30500231,85260,HC FACTOR X CHROMOGENIC,305,1 ,$190.00 ,$95.00 ,$17.90 ,$190.00 ,$18.50 ,$69.62 ,$59.67 ,$17.90 ,$114.00 ,$161.50 ,$133.00 ,$18.50 ,$180.50 ,$144.40 ,$142.50 ,$30.43 ,$161.50 ,$17.90 ,$30.43 ,$17.90 ,$133.00 ,$18.50 ,$17.90 ,$17.90 ,$20.26 ,$161.50 ,$40.28 ,$174.80 ,$133.00 ,$86.06 ,$86.06 ,$115.71 ,$86.06 ,$131.29 ,$171.00 ,$132.34 ,$18.08 ,$150.10 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,30500320,85048,HC BLOOD COUNT LEUKO AUTO WITH NEUTROPHIL,305,1 ,$38.00 ,$19.00 ,$2.54 ,$38.00 ,$2.62 ,$9.87 ,$8.46 ,$2.54 ,$22.80 ,$32.30 ,$26.60 ,$2.62 ,$36.10 ,$28.88 ,$28.50 ,$4.32 ,$32.30 ,$2.54 ,$4.32 ,$2.54 ,$26.60 ,$2.62 ,$2.54 ,$2.54 ,$2.87 ,$32.30 ,$5.72 ,$34.96 ,$26.60 ,$12.19 ,$12.19 ,$23.14 ,$12.19 ,$26.26 ,$34.20 ,$26.47 ,$2.57 ,$30.02 ,$2.78 ,$3.05 ,$3.05 ,$2.54 ,$3.05 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30500321,85660,HC SICKLE CELL RBC (RC),305,1 ,$47.00 ,$23.50 ,$5.51 ,$47.00 ,$5.69 ,$21.42 ,$18.36 ,$5.51 ,$28.20 ,$39.95 ,$32.90 ,$5.69 ,$44.65 ,$35.72 ,$35.25 ,$9.37 ,$39.95 ,$5.51 ,$9.37 ,$5.51 ,$32.90 ,$5.69 ,$5.51 ,$5.51 ,$6.24 ,$39.95 ,$12.40 ,$43.24 ,$32.90 ,$26.53 ,$26.53 ,$28.62 ,$26.53 ,$32.48 ,$42.30 ,$32.74 ,$5.57 ,$37.13 ,$6.03 ,$6.61 ,$6.61 ,$5.51 ,$6.61 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$37.60 
ST NICHOLAS HOSPITAL - ACUTE,30500343,85549,HC MURAMIDASE,305,1 ,$88.00 ,$44.00 ,$18.75 ,$88.00 ,$19.37 ,$72.91 ,$62.49 ,$18.75 ,$52.80 ,$74.80 ,$61.60 ,$19.37 ,$83.60 ,$66.88 ,$66.00 ,$31.88 ,$74.80 ,$18.75 ,$31.88 ,$18.75 ,$61.60 ,$19.37 ,$18.75 ,$18.75 ,$21.22 ,$74.80 ,$42.19 ,$80.96 ,$61.60 ,$88.00 ,$88.00 ,$53.59 ,$88.00 ,$60.81 ,$79.20 ,$61.29 ,$18.94 ,$69.52 ,$20.53 ,$22.50 ,$22.50 ,$18.75 ,$22.50 ,$63.36 ,$54.56 ,$63.36 ,$63.36 ,$70.40 
ST NICHOLAS HOSPITAL - ACUTE,30500827,85611,HC PT MIX STUDY (PLASMA),305,1 ,$120.00 ,$60.00 ,$3.94 ,$120.00 ,$4.07 ,$15.33 ,$13.14 ,$3.94 ,$72.00 ,$102.00 ,$84.00 ,$4.07 ,$114.00 ,$91.20 ,$90.00 ,$6.70 ,$102.00 ,$3.94 ,$6.70 ,$3.94 ,$84.00 ,$4.07 ,$3.94 ,$3.94 ,$4.46 ,$102.00 ,$8.87 ,$110.40 ,$84.00 ,$18.95 ,$18.95 ,$73.08 ,$18.95 ,$82.92 ,$108.00 ,$83.58 ,$3.98 ,$94.80 ,$4.31 ,$4.73 ,$4.73 ,$3.94 ,$4.73 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,30540180,85397,HC MBC ADAMTS13 ACTIVITY-REF,305,1 ,$250.00 ,$125.00 ,$30.86 ,$250.00 ,$31.89 ,$108.01 ,$92.58 ,$30.86 ,$150.00 ,$212.50 ,$175.00 ,$31.89 ,$237.50 ,$190.00 ,$187.50 ,$52.46 ,$212.50 ,$30.86 ,$52.46 ,$30.86 ,$175.00 ,$31.89 ,$30.86 ,$30.86 ,$34.93 ,$212.50 ,$69.44 ,$230.00 ,$175.00 ,$110.26 ,$110.26 ,$152.25 ,$110.26 ,$172.75 ,$225.00 ,$174.13 ,$31.17 ,$197.50 ,$33.80 ,$37.03 ,$37.03 ,$30.86 ,$37.03 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,30600096,87480,HC CANDIDA SPECIES DNA SCREEN,306,1 ,$157.00 ,$78.50 ,$20.05 ,$157.00 ,$20.72 ,$77.98 ,$66.84 ,$20.05 ,$94.20 ,$133.45 ,$109.90 ,$20.72 ,$149.15 ,$119.32 ,$117.75 ,$34.09 ,$133.45 ,$20.05 ,$34.09 ,$20.05 ,$109.90 ,$20.72 ,$20.05 ,$20.05 ,$22.69 ,$133.45 ,$45.11 ,$144.44 ,$109.90 ,$96.38 ,$96.38 ,$95.61 ,$96.38 ,$108.49 ,$141.30 ,$109.35 ,$20.25 ,$124.03 ,$21.96 ,$24.06 ,$24.06 ,$20.05 ,$24.06 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30600097,87660,HC TRICHOMONAS DNA SCREEN,306,1 ,$157.00 ,$78.50 ,$20.05 ,$157.00 ,$20.72 ,$77.98 ,$66.84 ,$20.05 ,$94.20 ,$133.45 ,$109.90 ,$20.72 ,$149.15 ,$119.32 ,$117.75 ,$34.09 ,$133.45 ,$20.05 ,$34.09 ,$20.05 ,$109.90 ,$20.72 ,$20.05 ,$20.05 ,$22.69 ,$133.45 ,$45.11 ,$144.44 ,$109.90 ,$96.38 ,$96.38 ,$95.61 ,$96.38 ,$108.49 ,$141.30 ,$109.35 ,$20.25 ,$124.03 ,$21.96 ,$24.06 ,$24.06 ,$20.05 ,$24.06 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30600098,87510,HC G VAGINALIS DNA SCREEN,306,1 ,$157.00 ,$78.50 ,$20.05 ,$157.00 ,$20.72 ,$77.98 ,$66.84 ,$20.05 ,$94.20 ,$133.45 ,$109.90 ,$20.72 ,$149.15 ,$119.32 ,$117.75 ,$34.09 ,$133.45 ,$20.05 ,$34.09 ,$20.05 ,$109.90 ,$20.72 ,$20.05 ,$20.05 ,$22.69 ,$133.45 ,$45.11 ,$144.44 ,$109.90 ,$96.38 ,$96.38 ,$95.61 ,$96.38 ,$108.49 ,$141.30 ,$109.35 ,$20.25 ,$124.03 ,$21.96 ,$24.06 ,$24.06 ,$20.05 ,$24.06 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30600099,87496,HC CMV DNA QUAL PCR,306,1 ,$291.00 ,$145.50 ,$35.09 ,$291.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$174.60 ,$247.35 ,$203.70 ,$36.26 ,$276.45 ,$221.16 ,$218.25 ,$59.65 ,$247.35 ,$35.09 ,$59.65 ,$35.09 ,$203.70 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$247.35 ,$78.95 ,$267.72 ,$203.70 ,$168.63 ,$168.63 ,$177.22 ,$168.63 ,$201.08 ,$261.90 ,$202.68 ,$35.44 ,$229.89 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,30600101,87015,HC CONCENTRATION INFECTIOUS AGENT,306,1 ,$40.00 ,$20.00 ,$5.25 ,$40.00 ,$5.25 ,$25.97 ,$22.26 ,$6.68 ,$24.00 ,$34.00 ,$28.00 ,$5.25 ,$38.00 ,$30.40 ,$30.00 ,$11.36 ,$34.00 ,$6.68 ,$11.36 ,$6.68 ,$28.00 ,$5.25 ,$6.68 ,$6.68 ,$7.56 ,$34.00 ,$15.03 ,$36.80 ,$28.00 ,$17.93 ,$17.93 ,$24.36 ,$17.93 ,$27.64 ,$36.00 ,$27.86 ,$6.75 ,$31.60 ,$5.57 ,$8.02 ,$8.02 ,$6.68 ,$8.02 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30600102,87040,HC BLOOD CULTURE,306,1 ,$112.00 ,$56.00 ,$10.32 ,$112.00 ,$10.66 ,$40.15 ,$34.41 ,$10.32 ,$67.20 ,$95.20 ,$78.40 ,$10.66 ,$106.40 ,$85.12 ,$84.00 ,$17.54 ,$95.20 ,$10.32 ,$17.54 ,$10.32 ,$78.40 ,$10.66 ,$10.32 ,$10.32 ,$11.68 ,$95.20 ,$23.22 ,$103.04 ,$78.40 ,$49.63 ,$49.63 ,$68.21 ,$49.63 ,$77.39 ,$100.80 ,$78.01 ,$10.42 ,$88.48 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30600103,87045,HC STOOL CULTURE,306,1 ,$78.00 ,$39.00 ,$9.44 ,$78.00 ,$9.75 ,$36.72 ,$31.47 ,$9.44 ,$46.80 ,$66.30 ,$54.60 ,$9.75 ,$74.10 ,$59.28 ,$58.50 ,$16.05 ,$66.30 ,$9.44 ,$16.05 ,$9.44 ,$54.60 ,$9.75 ,$9.44 ,$9.44 ,$10.68 ,$66.30 ,$21.24 ,$71.76 ,$54.60 ,$45.37 ,$45.37 ,$47.50 ,$45.37 ,$53.90 ,$70.20 ,$54.33 ,$9.53 ,$61.62 ,$10.34 ,$11.33 ,$11.33 ,$9.44 ,$11.33 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600104,87046,HC STOOL CULTURE ADD ISO,306,1 ,$67.00 ,$33.50 ,$3.40 ,$67.00 ,$3.40 ,$36.72 ,$31.47 ,$9.44 ,$40.20 ,$56.95 ,$46.90 ,$3.40 ,$63.65 ,$50.92 ,$50.25 ,$16.05 ,$56.95 ,$9.44 ,$16.05 ,$9.44 ,$46.90 ,$3.40 ,$9.44 ,$9.44 ,$10.68 ,$56.95 ,$21.24 ,$61.64 ,$46.90 ,$45.37 ,$45.37 ,$40.80 ,$45.37 ,$46.30 ,$60.30 ,$46.67 ,$9.53 ,$52.93 ,$3.60 ,$11.33 ,$11.33 ,$9.44 ,$11.33 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600105,87070,HC BODY FLUID CULTURE (ENVIRO),306,1 ,$36.00 ,$18.00 ,$8.62 ,$36.00 ,$8.91 ,$33.50 ,$28.71 ,$8.62 ,$21.60 ,$30.60 ,$25.20 ,$8.91 ,$34.20 ,$27.36 ,$27.00 ,$14.65 ,$30.60 ,$8.62 ,$14.65 ,$8.62 ,$25.20 ,$8.91 ,$8.62 ,$8.62 ,$9.76 ,$30.60 ,$19.40 ,$33.12 ,$25.20 ,$36.00 ,$36.00 ,$21.92 ,$36.00 ,$24.88 ,$32.40 ,$25.07 ,$8.71 ,$28.44 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$28.80 
ST NICHOLAS HOSPITAL - ACUTE,30600106,87070,HC BODY FLUID CULTURE (THROAT),306,1 ,$66.00 ,$33.00 ,$8.62 ,$66.00 ,$8.91 ,$33.50 ,$28.71 ,$8.62 ,$39.60 ,$56.10 ,$46.20 ,$8.91 ,$62.70 ,$50.16 ,$49.50 ,$14.65 ,$56.10 ,$8.62 ,$14.65 ,$8.62 ,$46.20 ,$8.91 ,$8.62 ,$8.62 ,$9.76 ,$56.10 ,$19.40 ,$60.72 ,$46.20 ,$41.39 ,$41.39 ,$40.19 ,$41.39 ,$45.61 ,$59.40 ,$45.97 ,$8.71 ,$52.14 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$47.52 ,$40.92 ,$47.52 ,$47.52 ,$52.80 
ST NICHOLAS HOSPITAL - ACUTE,30600107,87070,HC BODY FLUID CULTURE (MISC),306,1 ,$114.00 ,$57.00 ,$8.62 ,$114.00 ,$8.91 ,$33.50 ,$28.71 ,$8.62 ,$68.40 ,$96.90 ,$79.80 ,$8.91 ,$108.30 ,$86.64 ,$85.50 ,$14.65 ,$96.90 ,$8.62 ,$14.65 ,$8.62 ,$79.80 ,$8.91 ,$8.62 ,$8.62 ,$9.76 ,$96.90 ,$19.40 ,$104.88 ,$79.80 ,$41.39 ,$41.39 ,$69.43 ,$41.39 ,$78.77 ,$102.60 ,$79.40 ,$8.71 ,$90.06 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$91.20 
ST NICHOLAS HOSPITAL - ACUTE,30600108,87081,HC BODY FLUID CULTURE (MRSA),306,1 ,$108.00 ,$54.00 ,$6.63 ,$108.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$64.80 ,$91.80 ,$75.60 ,$6.85 ,$102.60 ,$82.08 ,$81.00 ,$11.27 ,$91.80 ,$6.63 ,$11.27 ,$6.63 ,$75.60 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$91.80 ,$14.92 ,$99.36 ,$75.60 ,$31.88 ,$31.88 ,$65.77 ,$31.88 ,$74.63 ,$97.20 ,$75.22 ,$6.70 ,$85.32 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,30600109,87070,HC BODY FLUID CULTURE,306,1 ,$101.00 ,$50.50 ,$8.62 ,$101.00 ,$8.91 ,$33.50 ,$28.71 ,$8.62 ,$60.60 ,$85.85 ,$70.70 ,$8.91 ,$95.95 ,$76.76 ,$75.75 ,$14.65 ,$85.85 ,$8.62 ,$14.65 ,$8.62 ,$70.70 ,$8.91 ,$8.62 ,$8.62 ,$9.76 ,$85.85 ,$19.40 ,$92.92 ,$70.70 ,$41.39 ,$41.39 ,$61.51 ,$41.39 ,$69.79 ,$90.90 ,$70.35 ,$8.71 ,$79.79 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30600110,87070,HC WATER CULTURE,306,1 ,$13.00 ,$6.50 ,$6.50 ,$19.40 ,$8.91 ,$13.00 ,$13.00 ,$8.62 ,$7.80 ,$11.05 ,$9.10 ,$8.91 ,$12.35 ,$9.88 ,$9.75 ,$13.00 ,$11.05 ,$8.62 ,$13.00 ,$8.62 ,$9.10 ,$8.91 ,$8.62 ,$8.62 ,$9.76 ,$11.05 ,$19.40 ,$11.96 ,$9.10 ,$13.00 ,$13.00 ,$7.92 ,$13.00 ,$8.98 ,$11.70 ,$9.05 ,$8.71 ,$10.27 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$9.36 ,$8.06 ,$9.36 ,$9.36 ,$10.40 
ST NICHOLAS HOSPITAL - ACUTE,30600111,87070,"HC BODY FLUID CULTURE (CSF, WOUND,MISC)",306,1 ,$171.00 ,$85.50 ,$8.62 ,$171.00 ,$8.91 ,$33.50 ,$28.71 ,$8.62 ,$102.60 ,$145.35 ,$119.70 ,$8.91 ,$162.45 ,$129.96 ,$128.25 ,$14.65 ,$145.35 ,$8.62 ,$14.65 ,$8.62 ,$119.70 ,$8.91 ,$8.62 ,$8.62 ,$9.76 ,$145.35 ,$19.40 ,$157.32 ,$119.70 ,$41.39 ,$41.39 ,$104.14 ,$41.39 ,$118.16 ,$153.90 ,$119.10 ,$8.71 ,$135.09 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$123.12 ,$106.02 ,$123.12 ,$123.12 ,$136.80 
ST NICHOLAS HOSPITAL - ACUTE,30600115,87070,HC BODY FLUID CULTURE (CF),306,1 ,$269.00 ,$134.50 ,$8.62 ,$269.00 ,$8.91 ,$33.50 ,$28.71 ,$8.62 ,$161.40 ,$228.65 ,$188.30 ,$8.91 ,$255.55 ,$204.44 ,$201.75 ,$14.65 ,$228.65 ,$8.62 ,$14.65 ,$8.62 ,$188.30 ,$8.91 ,$8.62 ,$8.62 ,$9.76 ,$228.65 ,$19.40 ,$247.48 ,$188.30 ,$41.39 ,$41.39 ,$163.82 ,$41.39 ,$185.88 ,$242.10 ,$187.36 ,$8.71 ,$212.51 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600120,87075,HC CULTURE ANAEROBIC,306,1 ,$101.00 ,$50.50 ,$9.47 ,$101.00 ,$9.79 ,$36.82 ,$31.56 ,$9.47 ,$60.60 ,$85.85 ,$70.70 ,$9.79 ,$95.95 ,$76.76 ,$75.75 ,$16.10 ,$85.85 ,$9.47 ,$16.10 ,$9.47 ,$70.70 ,$9.79 ,$9.47 ,$9.47 ,$10.72 ,$85.85 ,$21.31 ,$92.92 ,$70.70 ,$45.48 ,$45.48 ,$61.51 ,$45.48 ,$69.79 ,$90.90 ,$70.35 ,$9.56 ,$79.79 ,$10.38 ,$11.36 ,$11.36 ,$9.47 ,$11.36 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30600121,87076,HC CULTURE ANAEROBIC ID,306,1 ,$67.00 ,$33.50 ,$8.08 ,$67.00 ,$8.35 ,$31.40 ,$26.91 ,$8.08 ,$40.20 ,$56.95 ,$46.90 ,$8.35 ,$63.65 ,$50.92 ,$50.25 ,$13.74 ,$56.95 ,$8.08 ,$13.74 ,$8.08 ,$46.90 ,$8.35 ,$8.08 ,$8.08 ,$9.14 ,$56.95 ,$18.18 ,$61.64 ,$46.90 ,$38.85 ,$38.85 ,$40.80 ,$38.85 ,$46.30 ,$60.30 ,$46.67 ,$8.16 ,$52.93 ,$8.85 ,$9.70 ,$9.70 ,$8.08 ,$9.70 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600122,87076,HC CULTURE ANAEROBIC ID (ORGANISM),306,1 ,$67.00 ,$33.50 ,$8.08 ,$67.00 ,$8.35 ,$31.40 ,$26.91 ,$8.08 ,$40.20 ,$56.95 ,$46.90 ,$8.35 ,$63.65 ,$50.92 ,$50.25 ,$13.74 ,$56.95 ,$8.08 ,$13.74 ,$8.08 ,$46.90 ,$8.35 ,$8.08 ,$8.08 ,$9.14 ,$56.95 ,$18.18 ,$61.64 ,$46.90 ,$38.85 ,$38.85 ,$40.80 ,$38.85 ,$46.30 ,$60.30 ,$46.67 ,$8.16 ,$52.93 ,$8.85 ,$9.70 ,$9.70 ,$8.08 ,$9.70 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600123,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$67.00 ,$33.50 ,$8.08 ,$67.00 ,$8.35 ,$31.40 ,$26.91 ,$8.08 ,$40.20 ,$56.95 ,$46.90 ,$8.35 ,$63.65 ,$50.92 ,$50.25 ,$13.74 ,$56.95 ,$8.08 ,$13.74 ,$8.08 ,$46.90 ,$8.35 ,$8.08 ,$8.08 ,$9.14 ,$56.95 ,$18.18 ,$61.64 ,$46.90 ,$38.85 ,$38.85 ,$40.80 ,$38.85 ,$46.30 ,$60.30 ,$46.67 ,$8.16 ,$52.93 ,$8.85 ,$9.70 ,$9.70 ,$8.08 ,$9.70 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600124,87081,HC CULTURE SCR (MRSA),306,1 ,$56.00 ,$28.00 ,$6.63 ,$56.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$33.60 ,$47.60 ,$39.20 ,$6.85 ,$53.20 ,$42.56 ,$42.00 ,$11.27 ,$47.60 ,$6.63 ,$11.27 ,$6.63 ,$39.20 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$47.60 ,$14.92 ,$51.52 ,$39.20 ,$31.88 ,$31.88 ,$34.10 ,$31.88 ,$38.70 ,$50.40 ,$39.00 ,$6.70 ,$44.24 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30600125,87081,HC CULTURE SCR (GRP B STREP),306,1 ,$74.00 ,$37.00 ,$6.63 ,$74.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$44.40 ,$62.90 ,$51.80 ,$6.85 ,$70.30 ,$56.24 ,$55.50 ,$11.27 ,$62.90 ,$6.63 ,$11.27 ,$6.63 ,$51.80 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$62.90 ,$14.92 ,$68.08 ,$51.80 ,$31.88 ,$31.88 ,$45.07 ,$31.88 ,$51.13 ,$66.60 ,$51.54 ,$6.70 ,$58.46 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$59.20 
ST NICHOLAS HOSPITAL - ACUTE,30600126,87081,HC CULTURE SCR (GC ONLY),306,1 ,$50.00 ,$25.00 ,$6.63 ,$50.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$30.00 ,$42.50 ,$35.00 ,$6.85 ,$47.50 ,$38.00 ,$37.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$6.63 ,$35.00 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$31.88 ,$31.88 ,$30.45 ,$31.88 ,$34.55 ,$45.00 ,$34.83 ,$6.70 ,$39.50 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30600127,87081,HC CULTURE SCR (LEGIONELLA),306,1 ,$50.00 ,$25.00 ,$6.63 ,$50.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$30.00 ,$42.50 ,$35.00 ,$6.85 ,$47.50 ,$38.00 ,$37.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$6.63 ,$35.00 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$31.88 ,$31.88 ,$30.45 ,$31.88 ,$34.55 ,$45.00 ,$34.83 ,$6.70 ,$39.50 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30600128,87081,HC CULTURE SCR (PERTUSSIS),306,1 ,$81.00 ,$40.50 ,$6.63 ,$81.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$48.60 ,$68.85 ,$56.70 ,$6.85 ,$76.95 ,$61.56 ,$60.75 ,$11.27 ,$68.85 ,$6.63 ,$11.27 ,$6.63 ,$56.70 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$68.85 ,$14.92 ,$74.52 ,$56.70 ,$31.88 ,$31.88 ,$49.33 ,$31.88 ,$55.97 ,$72.90 ,$56.42 ,$6.70 ,$63.99 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$64.80 
ST NICHOLAS HOSPITAL - ACUTE,30600129,87081,HC CULTURE SCR (GRP A STREP),306,1 ,$50.00 ,$25.00 ,$6.63 ,$50.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$30.00 ,$42.50 ,$35.00 ,$6.85 ,$47.50 ,$38.00 ,$37.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$6.63 ,$35.00 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$31.88 ,$31.88 ,$30.45 ,$31.88 ,$34.55 ,$45.00 ,$34.83 ,$6.70 ,$39.50 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30600130,87081,HC CULTURE SCR (VRE),306,1 ,$116.00 ,$58.00 ,$6.63 ,$116.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$69.60 ,$98.60 ,$81.20 ,$6.85 ,$110.20 ,$88.16 ,$87.00 ,$11.27 ,$98.60 ,$6.63 ,$11.27 ,$6.63 ,$81.20 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$98.60 ,$14.92 ,$106.72 ,$81.20 ,$31.88 ,$31.88 ,$70.64 ,$31.88 ,$80.16 ,$104.40 ,$80.79 ,$6.70 ,$91.64 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,30600131,87081,HC CULTURE (MRSA),306,1 ,$56.00 ,$28.00 ,$6.63 ,$56.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$33.60 ,$47.60 ,$39.20 ,$6.85 ,$53.20 ,$42.56 ,$42.00 ,$11.27 ,$47.60 ,$6.63 ,$11.27 ,$6.63 ,$39.20 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$47.60 ,$14.92 ,$51.52 ,$39.20 ,$31.88 ,$31.88 ,$34.10 ,$31.88 ,$38.70 ,$50.40 ,$39.00 ,$6.70 ,$44.24 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30600132,87081,HC CULTURE (CLO TEST),306,1 ,$50.00 ,$25.00 ,$6.63 ,$50.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$30.00 ,$42.50 ,$35.00 ,$6.85 ,$47.50 ,$38.00 ,$37.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$6.63 ,$35.00 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$31.88 ,$31.88 ,$30.45 ,$31.88 ,$34.55 ,$45.00 ,$34.83 ,$6.70 ,$39.50 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,30600133,87081,HC CULTURE SCR (BRUCELLA),306,1 ,$64.00 ,$32.00 ,$6.63 ,$64.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$38.40 ,$54.40 ,$44.80 ,$6.85 ,$60.80 ,$48.64 ,$48.00 ,$11.27 ,$54.40 ,$6.63 ,$11.27 ,$6.63 ,$44.80 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$54.40 ,$14.92 ,$58.88 ,$44.80 ,$31.88 ,$31.88 ,$38.98 ,$31.88 ,$44.22 ,$57.60 ,$44.58 ,$6.70 ,$50.56 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$46.08 ,$39.68 ,$46.08 ,$46.08 ,$51.20 
ST NICHOLAS HOSPITAL - ACUTE,30600134,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$67.00 ,$33.50 ,$8.07 ,$67.00 ,$8.34 ,$31.40 ,$26.91 ,$8.07 ,$40.20 ,$56.95 ,$46.90 ,$8.34 ,$63.65 ,$50.92 ,$50.25 ,$13.72 ,$56.95 ,$8.07 ,$13.72 ,$8.07 ,$46.90 ,$8.34 ,$8.07 ,$8.07 ,$9.13 ,$56.95 ,$18.16 ,$61.64 ,$46.90 ,$38.78 ,$38.78 ,$40.80 ,$38.78 ,$46.30 ,$60.30 ,$46.67 ,$8.15 ,$52.93 ,$8.84 ,$9.68 ,$9.68 ,$8.07 ,$9.68 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600135,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$67.00 ,$33.50 ,$8.09 ,$67.00 ,$8.36 ,$31.47 ,$26.97 ,$8.09 ,$40.20 ,$56.95 ,$46.90 ,$8.36 ,$63.65 ,$50.92 ,$50.25 ,$13.75 ,$56.95 ,$8.09 ,$13.75 ,$8.09 ,$46.90 ,$8.36 ,$8.09 ,$8.09 ,$9.16 ,$56.95 ,$18.20 ,$61.64 ,$46.90 ,$38.92 ,$38.92 ,$40.80 ,$38.92 ,$46.30 ,$60.30 ,$46.67 ,$8.17 ,$52.93 ,$8.86 ,$9.71 ,$9.71 ,$8.09 ,$9.71 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600136,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL,306,1 ,$134.00 ,$67.00 ,$7.71 ,$134.00 ,$7.97 ,$29.96 ,$25.68 ,$7.71 ,$80.40 ,$113.90 ,$93.80 ,$7.97 ,$127.30 ,$101.84 ,$100.50 ,$13.11 ,$113.90 ,$7.71 ,$13.11 ,$7.71 ,$93.80 ,$7.97 ,$7.71 ,$7.71 ,$8.73 ,$113.90 ,$17.35 ,$123.28 ,$93.80 ,$37.06 ,$37.06 ,$81.61 ,$37.06 ,$92.59 ,$120.60 ,$93.33 ,$7.79 ,$105.86 ,$8.45 ,$9.25 ,$9.25 ,$7.71 ,$9.25 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30600137,87101,HC CULTURE YEAST SKIN/HAIR/NAIL,306,1 ,$63.00 ,$31.50 ,$7.71 ,$63.00 ,$7.97 ,$29.96 ,$25.68 ,$7.71 ,$37.80 ,$53.55 ,$44.10 ,$7.97 ,$59.85 ,$47.88 ,$47.25 ,$13.11 ,$53.55 ,$7.71 ,$13.11 ,$7.71 ,$44.10 ,$7.97 ,$7.71 ,$7.71 ,$8.73 ,$53.55 ,$17.35 ,$57.96 ,$44.10 ,$37.06 ,$37.06 ,$38.37 ,$37.06 ,$43.53 ,$56.70 ,$43.88 ,$7.79 ,$49.77 ,$8.45 ,$9.25 ,$9.25 ,$7.71 ,$9.25 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$50.40 
ST NICHOLAS HOSPITAL - ACUTE,30600138,87102,HC CULTURE FUNGUS OTHER,306,1 ,$78.00 ,$39.00 ,$8.41 ,$78.00 ,$8.69 ,$32.69 ,$28.02 ,$8.41 ,$46.80 ,$66.30 ,$54.60 ,$8.69 ,$74.10 ,$59.28 ,$58.50 ,$14.30 ,$66.30 ,$8.41 ,$14.30 ,$8.41 ,$54.60 ,$8.69 ,$8.41 ,$8.41 ,$9.52 ,$66.30 ,$18.92 ,$71.76 ,$54.60 ,$40.37 ,$40.37 ,$47.50 ,$40.37 ,$53.90 ,$70.20 ,$54.33 ,$8.49 ,$61.62 ,$9.21 ,$10.09 ,$10.09 ,$8.41 ,$10.09 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600139,87102,HC CULTURE YEAST OTHER,306,1 ,$67.00 ,$33.50 ,$8.41 ,$67.00 ,$8.69 ,$32.69 ,$28.02 ,$8.41 ,$40.20 ,$56.95 ,$46.90 ,$8.69 ,$63.65 ,$50.92 ,$50.25 ,$14.30 ,$56.95 ,$8.41 ,$14.30 ,$8.41 ,$46.90 ,$8.69 ,$8.41 ,$8.41 ,$9.52 ,$56.95 ,$18.92 ,$61.64 ,$46.90 ,$40.37 ,$40.37 ,$40.80 ,$40.37 ,$46.30 ,$60.30 ,$46.67 ,$8.49 ,$52.93 ,$9.21 ,$10.09 ,$10.09 ,$8.41 ,$10.09 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600140,87103,HC CULTURE FUNGUS BLOOD,306,1 ,$168.00 ,$84.00 ,$12.68 ,$168.00 ,$12.68 ,$71.61 ,$61.38 ,$20.46 ,$100.80 ,$142.80 ,$117.60 ,$12.68 ,$159.60 ,$127.68 ,$126.00 ,$34.78 ,$142.80 ,$20.46 ,$34.78 ,$20.46 ,$117.60 ,$12.68 ,$20.46 ,$20.46 ,$23.16 ,$142.80 ,$46.04 ,$154.56 ,$117.60 ,$43.33 ,$43.33 ,$102.31 ,$43.33 ,$116.09 ,$151.20 ,$117.01 ,$20.66 ,$132.72 ,$13.44 ,$24.55 ,$24.55 ,$20.46 ,$24.55 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,30600142,87106,HC CULTURE FUNGUS ID,306,1 ,$96.00 ,$48.00 ,$10.32 ,$96.00 ,$10.66 ,$40.15 ,$34.41 ,$10.32 ,$57.60 ,$81.60 ,$67.20 ,$10.66 ,$91.20 ,$72.96 ,$72.00 ,$17.54 ,$81.60 ,$10.32 ,$17.54 ,$10.32 ,$67.20 ,$10.66 ,$10.32 ,$10.32 ,$11.68 ,$81.60 ,$23.22 ,$88.32 ,$67.20 ,$49.63 ,$49.63 ,$58.46 ,$49.63 ,$66.34 ,$86.40 ,$66.86 ,$10.42 ,$75.84 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$69.12 ,$59.52 ,$69.12 ,$69.12 ,$76.80 
ST NICHOLAS HOSPITAL - ACUTE,30600144,87106,HC CULTURE FUNGUS ID (MOLD),306,1 ,$133.00 ,$66.50 ,$10.32 ,$133.00 ,$10.66 ,$40.15 ,$34.41 ,$10.32 ,$79.80 ,$113.05 ,$93.10 ,$10.66 ,$126.35 ,$101.08 ,$99.75 ,$17.54 ,$113.05 ,$10.32 ,$17.54 ,$10.32 ,$93.10 ,$10.66 ,$10.32 ,$10.32 ,$11.68 ,$113.05 ,$23.22 ,$122.36 ,$93.10 ,$49.63 ,$49.63 ,$81.00 ,$49.63 ,$91.90 ,$119.70 ,$92.63 ,$10.42 ,$105.07 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$95.76 ,$82.46 ,$95.76 ,$95.76 ,$106.40 
ST NICHOLAS HOSPITAL - ACUTE,30600145,87107,HC CULTURE FUNGUS ID MOLD,306,1 ,$78.00 ,$39.00 ,$10.32 ,$78.00 ,$10.66 ,$40.15 ,$34.41 ,$10.32 ,$46.80 ,$66.30 ,$54.60 ,$10.66 ,$74.10 ,$59.28 ,$58.50 ,$17.54 ,$66.30 ,$10.32 ,$17.54 ,$10.32 ,$54.60 ,$10.66 ,$10.32 ,$10.32 ,$11.68 ,$66.30 ,$23.22 ,$71.76 ,$54.60 ,$49.63 ,$49.63 ,$47.50 ,$49.63 ,$53.90 ,$70.20 ,$54.33 ,$10.42 ,$61.62 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600146,87109,HC CULTURE MYCOPLASMA,306,1 ,$90.00 ,$45.00 ,$14.01 ,$90.00 ,$14.01 ,$59.85 ,$51.30 ,$15.39 ,$54.00 ,$76.50 ,$63.00 ,$14.01 ,$85.50 ,$68.40 ,$67.50 ,$26.16 ,$76.50 ,$15.39 ,$26.16 ,$15.39 ,$63.00 ,$14.01 ,$15.39 ,$15.39 ,$17.42 ,$76.50 ,$34.63 ,$82.80 ,$63.00 ,$47.87 ,$47.87 ,$54.81 ,$47.87 ,$62.19 ,$81.00 ,$62.69 ,$15.54 ,$71.10 ,$14.85 ,$18.47 ,$18.47 ,$15.39 ,$18.47 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30600147,87110,HC CULTURE CHLAMYDIA,306,1 ,$149.00 ,$74.50 ,$19.60 ,$149.00 ,$20.25 ,$76.20 ,$65.31 ,$19.60 ,$89.40 ,$126.65 ,$104.30 ,$20.25 ,$141.55 ,$113.24 ,$111.75 ,$33.32 ,$126.65 ,$19.60 ,$33.32 ,$19.60 ,$104.30 ,$20.25 ,$19.60 ,$19.60 ,$22.18 ,$126.65 ,$44.10 ,$137.08 ,$104.30 ,$94.16 ,$94.16 ,$90.74 ,$94.16 ,$102.96 ,$134.10 ,$103.78 ,$19.80 ,$117.71 ,$21.47 ,$23.52 ,$23.52 ,$19.60 ,$23.52 ,$107.28 ,$92.38 ,$107.28 ,$107.28 ,$119.20 
ST NICHOLAS HOSPITAL - ACUTE,30600148,87116,HC CULTURE AFB/TB/MYCOBACT,306,1 ,$78.00 ,$39.00 ,$10.80 ,$78.00 ,$11.16 ,$42.00 ,$36.00 ,$10.80 ,$46.80 ,$66.30 ,$54.60 ,$11.16 ,$74.10 ,$59.28 ,$58.50 ,$18.36 ,$66.30 ,$10.80 ,$18.36 ,$10.80 ,$54.60 ,$11.16 ,$10.80 ,$10.80 ,$12.22 ,$66.30 ,$24.30 ,$71.76 ,$54.60 ,$51.92 ,$51.92 ,$47.50 ,$51.92 ,$53.90 ,$70.20 ,$54.33 ,$10.91 ,$61.62 ,$11.83 ,$12.96 ,$12.96 ,$10.80 ,$12.96 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600149,87116,HC CULTURE AFB/TB/MYCOBACT (BLOOD),306,1 ,$162.00 ,$81.00 ,$10.80 ,$162.00 ,$11.16 ,$42.00 ,$36.00 ,$10.80 ,$97.20 ,$137.70 ,$113.40 ,$11.16 ,$153.90 ,$123.12 ,$121.50 ,$18.36 ,$137.70 ,$10.80 ,$18.36 ,$10.80 ,$113.40 ,$11.16 ,$10.80 ,$10.80 ,$12.22 ,$137.70 ,$24.30 ,$149.04 ,$113.40 ,$51.92 ,$51.92 ,$98.66 ,$51.92 ,$111.94 ,$145.80 ,$112.83 ,$10.91 ,$127.98 ,$11.83 ,$12.96 ,$12.96 ,$10.80 ,$12.96 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,30600150,87116,HC CULTURE AFB/TB/MYCOBACT (SMEAR),306,1 ,$85.00 ,$42.50 ,$10.80 ,$85.00 ,$11.16 ,$42.00 ,$36.00 ,$10.80 ,$51.00 ,$72.25 ,$59.50 ,$11.16 ,$80.75 ,$64.60 ,$63.75 ,$18.36 ,$72.25 ,$10.80 ,$18.36 ,$10.80 ,$59.50 ,$11.16 ,$10.80 ,$10.80 ,$12.22 ,$72.25 ,$24.30 ,$78.20 ,$59.50 ,$51.92 ,$51.92 ,$51.77 ,$51.92 ,$58.74 ,$76.50 ,$59.20 ,$10.91 ,$67.15 ,$11.83 ,$12.96 ,$12.96 ,$10.80 ,$12.96 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30600151,87118,HC MYCOBACTERIA ID BY HPLC,306,1 ,$157.00 ,$78.50 ,$14.61 ,$157.00 ,$15.10 ,$51.14 ,$43.83 ,$14.61 ,$94.20 ,$133.45 ,$109.90 ,$15.10 ,$149.15 ,$119.32 ,$117.75 ,$24.84 ,$133.45 ,$14.61 ,$24.84 ,$14.61 ,$109.90 ,$15.10 ,$14.61 ,$14.61 ,$16.54 ,$133.45 ,$32.87 ,$144.44 ,$109.90 ,$52.59 ,$52.59 ,$95.61 ,$52.59 ,$108.49 ,$141.30 ,$109.35 ,$14.76 ,$124.03 ,$16.01 ,$17.53 ,$17.53 ,$14.61 ,$17.53 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30600152,87140,HC CLT TYP IF EA ANTISER (RESP),306,1 ,$19.00 ,$9.50 ,$5.57 ,$19.00 ,$5.76 ,$19.00 ,$18.57 ,$5.57 ,$11.40 ,$16.15 ,$13.30 ,$5.76 ,$18.05 ,$14.44 ,$14.25 ,$9.47 ,$16.15 ,$5.57 ,$9.47 ,$5.57 ,$13.30 ,$5.76 ,$5.57 ,$5.57 ,$6.30 ,$16.15 ,$12.53 ,$17.48 ,$13.30 ,$19.00 ,$19.00 ,$11.57 ,$19.00 ,$13.13 ,$17.10 ,$13.23 ,$5.63 ,$15.01 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$15.20 
ST NICHOLAS HOSPITAL - ACUTE,30600153,87140,HC CLT TYP IF EA ANTISER (CHLAM PNEUMO 1),306,1 ,$38.00 ,$19.00 ,$5.57 ,$38.00 ,$5.76 ,$21.67 ,$18.57 ,$5.57 ,$22.80 ,$32.30 ,$26.60 ,$5.76 ,$36.10 ,$28.88 ,$28.50 ,$9.47 ,$32.30 ,$5.57 ,$9.47 ,$5.57 ,$26.60 ,$5.76 ,$5.57 ,$5.57 ,$6.30 ,$32.30 ,$12.53 ,$34.96 ,$26.60 ,$21.91 ,$21.91 ,$23.14 ,$21.91 ,$26.26 ,$34.20 ,$26.47 ,$5.63 ,$30.02 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30600154,87140,HC CLT TYP IF EA ANTISER (CHLAM PNEUMO 2),306,1 ,$38.00 ,$19.00 ,$5.57 ,$38.00 ,$5.76 ,$21.67 ,$18.57 ,$5.57 ,$22.80 ,$32.30 ,$26.60 ,$5.76 ,$36.10 ,$28.88 ,$28.50 ,$9.47 ,$32.30 ,$5.57 ,$9.47 ,$5.57 ,$26.60 ,$5.76 ,$5.57 ,$5.57 ,$6.30 ,$32.30 ,$12.53 ,$34.96 ,$26.60 ,$21.91 ,$21.91 ,$23.14 ,$21.91 ,$26.26 ,$34.20 ,$26.47 ,$5.63 ,$30.02 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,30600155,87140,HC CLT TYP IF EA ANTISER (CHLAM TRACH),306,1 ,$56.00 ,$28.00 ,$5.57 ,$56.00 ,$5.76 ,$21.67 ,$18.57 ,$5.57 ,$33.60 ,$47.60 ,$39.20 ,$5.76 ,$53.20 ,$42.56 ,$42.00 ,$9.47 ,$47.60 ,$5.57 ,$9.47 ,$5.57 ,$39.20 ,$5.76 ,$5.57 ,$5.57 ,$6.30 ,$47.60 ,$12.53 ,$51.52 ,$39.20 ,$21.91 ,$21.91 ,$34.10 ,$21.91 ,$38.70 ,$50.40 ,$39.00 ,$5.63 ,$44.24 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30600156,87140,HC FLU CONFIRM,306,1 ,$21.00 ,$10.50 ,$5.57 ,$21.00 ,$5.76 ,$21.00 ,$18.57 ,$5.57 ,$12.60 ,$17.85 ,$14.70 ,$5.76 ,$19.95 ,$15.96 ,$15.75 ,$9.47 ,$17.85 ,$5.57 ,$9.47 ,$5.57 ,$14.70 ,$5.76 ,$5.57 ,$5.57 ,$6.30 ,$17.85 ,$12.53 ,$19.32 ,$14.70 ,$21.00 ,$21.00 ,$12.79 ,$21.00 ,$14.51 ,$18.90 ,$14.63 ,$5.63 ,$16.59 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$15.12 ,$13.02 ,$15.12 ,$15.12 ,$16.80 
ST NICHOLAS HOSPITAL - ACUTE,30600157,87140,HC CLT TYP IF EA ANTISER (ADENO/ENTERO),306,1 ,$21.00 ,$10.50 ,$5.57 ,$21.00 ,$5.76 ,$21.00 ,$18.57 ,$5.57 ,$12.60 ,$17.85 ,$14.70 ,$5.76 ,$19.95 ,$15.96 ,$15.75 ,$9.47 ,$17.85 ,$5.57 ,$9.47 ,$5.57 ,$14.70 ,$5.76 ,$5.57 ,$5.57 ,$6.30 ,$17.85 ,$12.53 ,$19.32 ,$14.70 ,$21.00 ,$21.00 ,$12.79 ,$21.00 ,$14.51 ,$18.90 ,$14.63 ,$5.63 ,$16.59 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$15.12 ,$13.02 ,$15.12 ,$15.12 ,$16.80 
ST NICHOLAS HOSPITAL - ACUTE,30600158,87143,HC CULTURE TYPE GLC OR HPLC,306,1 ,$111.00 ,$55.50 ,$12.52 ,$111.00 ,$12.94 ,$48.72 ,$41.76 ,$12.52 ,$66.60 ,$94.35 ,$77.70 ,$12.94 ,$105.45 ,$84.36 ,$83.25 ,$21.28 ,$94.35 ,$12.52 ,$21.28 ,$12.52 ,$77.70 ,$12.94 ,$12.52 ,$12.52 ,$14.17 ,$94.35 ,$28.17 ,$102.12 ,$77.70 ,$60.20 ,$60.20 ,$67.60 ,$60.20 ,$76.70 ,$99.90 ,$77.31 ,$12.65 ,$87.69 ,$13.72 ,$15.02 ,$15.02 ,$12.52 ,$15.02 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$88.80 
ST NICHOLAS HOSPITAL - ACUTE,30600159,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$133.00 ,$66.50 ,$5.18 ,$133.00 ,$5.35 ,$20.13 ,$17.25 ,$5.18 ,$79.80 ,$113.05 ,$93.10 ,$5.35 ,$126.35 ,$101.08 ,$99.75 ,$8.81 ,$113.05 ,$5.18 ,$8.81 ,$5.18 ,$93.10 ,$5.35 ,$5.18 ,$5.18 ,$5.86 ,$113.05 ,$11.66 ,$122.36 ,$93.10 ,$24.87 ,$24.87 ,$81.00 ,$24.87 ,$91.90 ,$119.70 ,$92.63 ,$5.23 ,$105.07 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$95.76 ,$82.46 ,$95.76 ,$95.76 ,$106.40 
ST NICHOLAS HOSPITAL - ACUTE,30600160,87150,HC ID NUCLEAR ACID PROBE,306,1 ,$249.00 ,$124.50 ,$35.09 ,$249.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$149.40 ,$211.65 ,$174.30 ,$36.26 ,$236.55 ,$189.24 ,$186.75 ,$59.65 ,$211.65 ,$35.09 ,$59.65 ,$35.09 ,$174.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$211.65 ,$78.95 ,$229.08 ,$174.30 ,$168.63 ,$168.63 ,$151.64 ,$168.63 ,$172.06 ,$224.10 ,$173.43 ,$35.44 ,$196.71 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$179.28 ,$154.38 ,$179.28 ,$179.28 ,$199.20 
ST NICHOLAS HOSPITAL - ACUTE,30600161,87168,HC EXAM ARTHROPOD,306,1 ,$78.00 ,$39.00 ,$4.27 ,$78.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$46.80 ,$66.30 ,$54.60 ,$4.41 ,$74.10 ,$59.28 ,$58.50 ,$7.26 ,$66.30 ,$4.27 ,$7.26 ,$4.27 ,$54.60 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$66.30 ,$9.61 ,$71.76 ,$54.60 ,$20.50 ,$20.50 ,$47.50 ,$20.50 ,$53.90 ,$70.20 ,$54.33 ,$4.31 ,$61.62 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600162,87169,HC PARASITE ID,306,1 ,$78.00 ,$39.00 ,$4.31 ,$78.00 ,$4.45 ,$16.63 ,$14.25 ,$4.31 ,$46.80 ,$66.30 ,$54.60 ,$4.45 ,$74.10 ,$59.28 ,$58.50 ,$7.33 ,$66.30 ,$4.31 ,$7.33 ,$4.31 ,$54.60 ,$4.45 ,$4.31 ,$4.31 ,$4.88 ,$66.30 ,$9.70 ,$71.76 ,$54.60 ,$20.50 ,$20.50 ,$47.50 ,$20.50 ,$53.90 ,$70.20 ,$54.33 ,$4.35 ,$61.62 ,$4.72 ,$5.17 ,$5.17 ,$4.31 ,$5.17 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600163,87172,HC PINWORM EXAM,306,1 ,$27.00 ,$13.50 ,$4.27 ,$27.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$16.20 ,$22.95 ,$18.90 ,$4.41 ,$25.65 ,$20.52 ,$20.25 ,$7.26 ,$22.95 ,$4.27 ,$7.26 ,$4.27 ,$18.90 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$22.95 ,$9.61 ,$24.84 ,$18.90 ,$20.50 ,$20.50 ,$16.44 ,$20.50 ,$18.66 ,$24.30 ,$18.81 ,$4.31 ,$21.33 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$21.60 
ST NICHOLAS HOSPITAL - ACUTE,30600164,87177,HC SMEAR OVA PARASITE CONC/ID,306,1 ,$67.00 ,$33.50 ,$8.90 ,$67.00 ,$9.20 ,$34.62 ,$29.67 ,$8.90 ,$40.20 ,$56.95 ,$46.90 ,$9.20 ,$63.65 ,$50.92 ,$50.25 ,$15.13 ,$56.95 ,$8.90 ,$15.13 ,$8.90 ,$46.90 ,$9.20 ,$8.90 ,$8.90 ,$10.07 ,$56.95 ,$20.03 ,$61.64 ,$46.90 ,$42.76 ,$42.76 ,$40.80 ,$42.76 ,$46.30 ,$60.30 ,$46.67 ,$8.99 ,$52.93 ,$9.75 ,$10.68 ,$10.68 ,$8.90 ,$10.68 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600166,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$78.00 ,$39.00 ,$4.75 ,$78.00 ,$4.91 ,$18.45 ,$15.81 ,$4.75 ,$46.80 ,$66.30 ,$54.60 ,$4.91 ,$74.10 ,$59.28 ,$58.50 ,$8.08 ,$66.30 ,$4.75 ,$8.08 ,$4.75 ,$54.60 ,$4.91 ,$4.75 ,$4.75 ,$5.38 ,$66.30 ,$10.69 ,$71.76 ,$54.60 ,$22.83 ,$22.83 ,$47.50 ,$22.83 ,$53.90 ,$70.20 ,$54.33 ,$4.80 ,$61.62 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600167,87181,HC SENSITIVITY STUDY AGAR (GRADIENT),306,1 ,$153.00 ,$76.50 ,$4.75 ,$153.00 ,$4.91 ,$18.45 ,$15.81 ,$4.75 ,$91.80 ,$130.05 ,$107.10 ,$4.91 ,$145.35 ,$116.28 ,$114.75 ,$8.08 ,$130.05 ,$4.75 ,$8.08 ,$4.75 ,$107.10 ,$4.91 ,$4.75 ,$4.75 ,$5.38 ,$130.05 ,$10.69 ,$140.76 ,$107.10 ,$22.83 ,$22.83 ,$93.18 ,$22.83 ,$105.72 ,$137.70 ,$106.56 ,$4.80 ,$120.87 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,30600168,87184,HC SENSITIVITY DISK KB (HAEMOPHILUS),306,1 ,$56.00 ,$28.00 ,$7.48 ,$56.00 ,$7.73 ,$26.81 ,$22.98 ,$7.48 ,$33.60 ,$47.60 ,$39.20 ,$7.73 ,$53.20 ,$42.56 ,$42.00 ,$12.72 ,$47.60 ,$7.48 ,$12.72 ,$7.48 ,$39.20 ,$7.73 ,$7.48 ,$7.48 ,$8.47 ,$47.60 ,$16.83 ,$51.52 ,$39.20 ,$33.15 ,$33.15 ,$34.10 ,$33.15 ,$38.70 ,$50.40 ,$39.00 ,$7.55 ,$44.24 ,$8.19 ,$8.98 ,$8.98 ,$7.48 ,$8.98 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30600169,87184,HC SENSITIVITY DISK KB,306,1 ,$76.00 ,$38.00 ,$7.48 ,$76.00 ,$7.73 ,$26.81 ,$22.98 ,$7.48 ,$45.60 ,$64.60 ,$53.20 ,$7.73 ,$72.20 ,$57.76 ,$57.00 ,$12.72 ,$64.60 ,$7.48 ,$12.72 ,$7.48 ,$53.20 ,$7.73 ,$7.48 ,$7.48 ,$8.47 ,$64.60 ,$16.83 ,$69.92 ,$53.20 ,$33.15 ,$33.15 ,$46.28 ,$33.15 ,$52.52 ,$68.40 ,$52.93 ,$7.55 ,$60.04 ,$8.19 ,$8.98 ,$8.98 ,$7.48 ,$8.98 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$60.80 
ST NICHOLAS HOSPITAL - ACUTE,30600171,87185,HC BETA LACTAMASE,306,1 ,$56.00 ,$28.00 ,$4.75 ,$56.00 ,$4.91 ,$18.45 ,$15.81 ,$4.75 ,$33.60 ,$47.60 ,$39.20 ,$4.91 ,$53.20 ,$42.56 ,$42.00 ,$8.08 ,$47.60 ,$4.75 ,$8.08 ,$4.75 ,$39.20 ,$4.91 ,$4.75 ,$4.75 ,$5.38 ,$47.60 ,$10.69 ,$51.52 ,$39.20 ,$22.83 ,$22.83 ,$34.10 ,$22.83 ,$38.70 ,$50.40 ,$39.00 ,$4.80 ,$44.24 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,30600172,87186,HC SENSITIVITY MIC,306,1 ,$67.00 ,$33.50 ,$8.65 ,$67.00 ,$8.94 ,$33.64 ,$28.83 ,$8.65 ,$40.20 ,$56.95 ,$46.90 ,$8.94 ,$63.65 ,$50.92 ,$50.25 ,$14.71 ,$56.95 ,$8.65 ,$14.71 ,$8.65 ,$46.90 ,$8.94 ,$8.65 ,$8.65 ,$9.79 ,$56.95 ,$19.46 ,$61.64 ,$46.90 ,$41.57 ,$41.57 ,$40.80 ,$41.57 ,$46.30 ,$60.30 ,$46.67 ,$8.74 ,$52.93 ,$9.48 ,$10.38 ,$10.38 ,$8.65 ,$10.38 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600173,87186,HC SENSITIVITY MIC (SUSCEPT),306,1 ,$112.00 ,$56.00 ,$8.65 ,$112.00 ,$8.94 ,$33.64 ,$28.83 ,$8.65 ,$67.20 ,$95.20 ,$78.40 ,$8.94 ,$106.40 ,$85.12 ,$84.00 ,$14.71 ,$95.20 ,$8.65 ,$14.71 ,$8.65 ,$78.40 ,$8.94 ,$8.65 ,$8.65 ,$9.79 ,$95.20 ,$19.46 ,$103.04 ,$78.40 ,$41.57 ,$41.57 ,$68.21 ,$41.57 ,$77.39 ,$100.80 ,$78.01 ,$8.74 ,$88.48 ,$9.48 ,$10.38 ,$10.38 ,$8.65 ,$10.38 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$45.00 ,$22.50 ,$4.27 ,$45.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$27.00 ,$38.25 ,$31.50 ,$4.41 ,$42.75 ,$34.20 ,$33.75 ,$7.26 ,$38.25 ,$4.27 ,$7.26 ,$4.27 ,$31.50 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$38.25 ,$9.61 ,$41.40 ,$31.50 ,$20.50 ,$20.50 ,$27.41 ,$20.50 ,$31.10 ,$40.50 ,$31.34 ,$4.31 ,$35.55 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,30600175,87205,HC URINE FOR EOSINOPHILS,306,1 ,$74.00 ,$37.00 ,$4.27 ,$74.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$44.40 ,$62.90 ,$51.80 ,$4.41 ,$70.30 ,$56.24 ,$55.50 ,$7.26 ,$62.90 ,$4.27 ,$7.26 ,$4.27 ,$51.80 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$62.90 ,$9.61 ,$68.08 ,$51.80 ,$20.50 ,$20.50 ,$45.07 ,$20.50 ,$51.13 ,$66.60 ,$51.54 ,$4.31 ,$58.46 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$59.20 
ST NICHOLAS HOSPITAL - ACUTE,30600176,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$46.00 ,$23.00 ,$5.39 ,$46.00 ,$5.57 ,$20.97 ,$17.97 ,$5.39 ,$27.60 ,$39.10 ,$32.20 ,$5.57 ,$43.70 ,$34.96 ,$34.50 ,$9.16 ,$39.10 ,$5.39 ,$9.16 ,$5.39 ,$32.20 ,$5.57 ,$5.39 ,$5.39 ,$6.10 ,$39.10 ,$12.13 ,$42.32 ,$32.20 ,$25.86 ,$25.86 ,$28.01 ,$25.86 ,$31.79 ,$41.40 ,$32.04 ,$5.44 ,$36.34 ,$5.90 ,$6.47 ,$6.47 ,$5.39 ,$6.47 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,30600177,87206,HC SMEAR ACID FAST/FLUOR (FUNGUS),306,1 ,$134.00 ,$67.00 ,$5.39 ,$134.00 ,$5.57 ,$20.97 ,$17.97 ,$5.39 ,$80.40 ,$113.90 ,$93.80 ,$5.57 ,$127.30 ,$101.84 ,$100.50 ,$9.16 ,$113.90 ,$5.39 ,$9.16 ,$5.39 ,$93.80 ,$5.57 ,$5.39 ,$5.39 ,$6.10 ,$113.90 ,$12.13 ,$123.28 ,$93.80 ,$25.86 ,$25.86 ,$81.61 ,$25.86 ,$92.59 ,$120.60 ,$93.33 ,$5.44 ,$105.86 ,$5.90 ,$6.47 ,$6.47 ,$5.39 ,$6.47 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30600178,87206,HC SMEAR ACID FAST/FLUOR (CRYPTO),306,1 ,$80.00 ,$40.00 ,$5.39 ,$80.00 ,$5.57 ,$20.97 ,$17.97 ,$5.39 ,$48.00 ,$68.00 ,$56.00 ,$5.57 ,$76.00 ,$60.80 ,$60.00 ,$9.16 ,$68.00 ,$5.39 ,$9.16 ,$5.39 ,$56.00 ,$5.57 ,$5.39 ,$5.39 ,$6.10 ,$68.00 ,$12.13 ,$73.60 ,$56.00 ,$25.86 ,$25.86 ,$48.72 ,$25.86 ,$55.28 ,$72.00 ,$55.72 ,$5.44 ,$63.20 ,$5.90 ,$6.47 ,$6.47 ,$5.39 ,$6.47 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,30600179,87207,HC SPECIAL STAIN (MALARIA),306,1 ,$146.00 ,$73.00 ,$5.99 ,$146.00 ,$6.19 ,$23.31 ,$19.98 ,$5.99 ,$87.60 ,$124.10 ,$102.20 ,$6.19 ,$138.70 ,$110.96 ,$109.50 ,$10.18 ,$124.10 ,$5.99 ,$10.18 ,$5.99 ,$102.20 ,$6.19 ,$5.99 ,$5.99 ,$6.78 ,$124.10 ,$13.48 ,$134.32 ,$102.20 ,$28.81 ,$28.81 ,$88.91 ,$28.81 ,$100.89 ,$131.40 ,$101.69 ,$6.05 ,$115.34 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600180,87207,HC SPECIAL STAIN (TZANCK EVAL),306,1 ,$74.00 ,$37.00 ,$5.99 ,$74.00 ,$6.19 ,$23.31 ,$19.98 ,$5.99 ,$44.40 ,$62.90 ,$51.80 ,$6.19 ,$70.30 ,$56.24 ,$55.50 ,$10.18 ,$62.90 ,$5.99 ,$10.18 ,$5.99 ,$51.80 ,$6.19 ,$5.99 ,$5.99 ,$6.78 ,$62.90 ,$13.48 ,$68.08 ,$51.80 ,$28.81 ,$28.81 ,$45.07 ,$28.81 ,$51.13 ,$66.60 ,$51.54 ,$6.05 ,$58.46 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$59.20 
ST NICHOLAS HOSPITAL - ACUTE,30600181,87207,HC SPECIAL STAIN (HERPES),306,1 ,$81.00 ,$40.50 ,$5.99 ,$81.00 ,$6.19 ,$23.31 ,$19.98 ,$5.99 ,$48.60 ,$68.85 ,$56.70 ,$6.19 ,$76.95 ,$61.56 ,$60.75 ,$10.18 ,$68.85 ,$5.99 ,$10.18 ,$5.99 ,$56.70 ,$6.19 ,$5.99 ,$5.99 ,$6.78 ,$68.85 ,$13.48 ,$74.52 ,$56.70 ,$28.81 ,$28.81 ,$49.33 ,$28.81 ,$55.97 ,$72.90 ,$56.42 ,$6.05 ,$63.99 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$64.80 
ST NICHOLAS HOSPITAL - ACUTE,30600182,87209,HC OVA  AND  PARASITE W/STAIN,306,1 ,$90.00 ,$45.00 ,$17.98 ,$90.00 ,$18.58 ,$69.90 ,$59.91 ,$17.98 ,$54.00 ,$76.50 ,$63.00 ,$18.58 ,$85.50 ,$68.40 ,$67.50 ,$30.57 ,$76.50 ,$17.98 ,$30.57 ,$17.98 ,$63.00 ,$18.58 ,$17.98 ,$17.98 ,$20.35 ,$76.50 ,$40.46 ,$82.80 ,$63.00 ,$86.37 ,$86.37 ,$54.81 ,$86.37 ,$62.19 ,$81.00 ,$62.69 ,$18.16 ,$71.10 ,$19.69 ,$21.58 ,$21.58 ,$17.98 ,$21.58 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30600183,87210,HC SMEAR WET MOUNT,306,1 ,$32.00 ,$16.00 ,$5.82 ,$32.00 ,$6.00 ,$20.37 ,$17.46 ,$5.82 ,$19.20 ,$27.20 ,$22.40 ,$6.00 ,$30.40 ,$24.32 ,$24.00 ,$9.89 ,$27.20 ,$5.82 ,$9.89 ,$5.82 ,$22.40 ,$6.00 ,$5.82 ,$5.82 ,$6.59 ,$27.20 ,$13.10 ,$29.44 ,$22.40 ,$20.50 ,$20.50 ,$19.49 ,$20.50 ,$22.11 ,$28.80 ,$22.29 ,$5.88 ,$25.28 ,$6.36 ,$6.98 ,$6.98 ,$5.82 ,$6.98 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$25.60 
ST NICHOLAS HOSPITAL - ACUTE,30600184,87210,HC SMEAR WET MOUNT (FUNGUS),306,1 ,$45.00 ,$22.50 ,$5.82 ,$45.00 ,$6.00 ,$20.37 ,$17.46 ,$5.82 ,$27.00 ,$38.25 ,$31.50 ,$6.00 ,$42.75 ,$34.20 ,$33.75 ,$9.89 ,$38.25 ,$5.82 ,$9.89 ,$5.82 ,$31.50 ,$6.00 ,$5.82 ,$5.82 ,$6.59 ,$38.25 ,$13.10 ,$41.40 ,$31.50 ,$20.50 ,$20.50 ,$27.41 ,$20.50 ,$31.10 ,$40.50 ,$31.34 ,$5.88 ,$35.55 ,$6.36 ,$6.98 ,$6.98 ,$5.82 ,$6.98 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,30600185,87220,HC TISSUE KOH PREP,306,1 ,$53.00 ,$26.50 ,$4.27 ,$53.00 ,$4.41 ,$16.63 ,$14.25 ,$4.27 ,$31.80 ,$45.05 ,$37.10 ,$4.41 ,$50.35 ,$40.28 ,$39.75 ,$7.26 ,$45.05 ,$4.27 ,$7.26 ,$4.27 ,$37.10 ,$4.41 ,$4.27 ,$4.27 ,$4.83 ,$45.05 ,$9.61 ,$48.76 ,$37.10 ,$20.50 ,$20.50 ,$32.28 ,$20.50 ,$36.62 ,$47.70 ,$36.91 ,$4.31 ,$41.87 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,30600186,87230,HC TOXIN ANTITOXIN ASSAY,306,1 ,$131.00 ,$65.50 ,$19.74 ,$131.00 ,$20.40 ,$76.76 ,$65.79 ,$19.74 ,$78.60 ,$111.35 ,$91.70 ,$20.40 ,$124.45 ,$99.56 ,$98.25 ,$33.56 ,$111.35 ,$19.74 ,$33.56 ,$19.74 ,$91.70 ,$20.40 ,$19.74 ,$19.74 ,$22.34 ,$111.35 ,$44.42 ,$120.52 ,$91.70 ,$94.90 ,$94.90 ,$79.78 ,$94.90 ,$90.52 ,$117.90 ,$91.24 ,$19.94 ,$103.49 ,$21.62 ,$23.69 ,$23.69 ,$19.74 ,$23.69 ,$94.32 ,$81.22 ,$94.32 ,$94.32 ,$104.80 
ST NICHOLAS HOSPITAL - ACUTE,30600187,87252,HC CULTURE VIRUS ID TISS (CMV),306,1 ,$202.00 ,$101.00 ,$26.07 ,$202.00 ,$26.94 ,$101.40 ,$86.91 ,$26.07 ,$121.20 ,$171.70 ,$141.40 ,$26.94 ,$191.90 ,$153.52 ,$151.50 ,$44.32 ,$171.70 ,$26.07 ,$44.32 ,$26.07 ,$141.40 ,$26.94 ,$26.07 ,$26.07 ,$29.51 ,$171.70 ,$58.66 ,$185.84 ,$141.40 ,$125.26 ,$125.26 ,$123.02 ,$125.26 ,$139.58 ,$181.80 ,$140.69 ,$26.33 ,$159.58 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30600188,87252,HC CULTURE VIRUS ID TISS (HERPES),306,1 ,$202.00 ,$101.00 ,$26.07 ,$202.00 ,$26.94 ,$101.40 ,$86.91 ,$26.07 ,$121.20 ,$171.70 ,$141.40 ,$26.94 ,$191.90 ,$153.52 ,$151.50 ,$44.32 ,$171.70 ,$26.07 ,$44.32 ,$26.07 ,$141.40 ,$26.94 ,$26.07 ,$26.07 ,$29.51 ,$171.70 ,$58.66 ,$185.84 ,$141.40 ,$125.26 ,$125.26 ,$123.02 ,$125.26 ,$139.58 ,$181.80 ,$140.69 ,$26.33 ,$159.58 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30600189,87252,HC CULTURE VIRUS ID TISS (RESP),306,1 ,$114.00 ,$57.00 ,$26.07 ,$114.00 ,$26.94 ,$101.40 ,$86.91 ,$26.07 ,$68.40 ,$96.90 ,$79.80 ,$26.94 ,$108.30 ,$86.64 ,$85.50 ,$44.32 ,$96.90 ,$26.07 ,$44.32 ,$26.07 ,$79.80 ,$26.94 ,$26.07 ,$26.07 ,$29.51 ,$96.90 ,$58.66 ,$104.88 ,$79.80 ,$114.00 ,$114.00 ,$69.43 ,$114.00 ,$78.77 ,$102.60 ,$79.40 ,$26.33 ,$90.06 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$91.20 
ST NICHOLAS HOSPITAL - ACUTE,30600190,87252,HC CULTURE VIRUS ID TISS (ADENO/ENTER),306,1 ,$125.00 ,$62.50 ,$26.07 ,$125.00 ,$26.94 ,$101.40 ,$86.91 ,$26.07 ,$75.00 ,$106.25 ,$87.50 ,$26.94 ,$118.75 ,$95.00 ,$93.75 ,$44.32 ,$106.25 ,$26.07 ,$44.32 ,$26.07 ,$87.50 ,$26.94 ,$26.07 ,$26.07 ,$29.51 ,$106.25 ,$58.66 ,$115.00 ,$87.50 ,$125.00 ,$125.00 ,$76.13 ,$125.00 ,$86.38 ,$112.50 ,$87.06 ,$26.33 ,$98.75 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$100.00 
ST NICHOLAS HOSPITAL - ACUTE,30600193,87254,HC VIRUS ISOL SHELL ID (CMV),306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$87.60 ,$124.10 ,$102.20 ,$7.06 ,$138.70 ,$110.96 ,$109.50 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$19.56 ,$102.20 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$93.98 ,$93.98 ,$88.91 ,$93.98 ,$100.89 ,$131.40 ,$101.69 ,$19.76 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600194,87254,HC VIRUS ISOL SHELL ID (RESP),306,1 ,$92.00 ,$46.00 ,$7.06 ,$92.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$55.20 ,$78.20 ,$64.40 ,$7.06 ,$87.40 ,$69.92 ,$69.00 ,$33.25 ,$78.20 ,$19.56 ,$33.25 ,$19.56 ,$64.40 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$78.20 ,$44.01 ,$84.64 ,$64.40 ,$92.00 ,$92.00 ,$56.03 ,$92.00 ,$63.57 ,$82.80 ,$64.08 ,$19.76 ,$72.68 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,30600195,87254,HC VIRUS ISOL SHELL ID (VARI),306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$87.60 ,$124.10 ,$102.20 ,$7.06 ,$138.70 ,$110.96 ,$109.50 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$19.56 ,$102.20 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$93.98 ,$93.98 ,$88.91 ,$93.98 ,$100.89 ,$131.40 ,$101.69 ,$19.76 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600196,87254,HC VIRUS ISOL SHELL ID (CHLAM PNEUMO 1),306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$87.60 ,$124.10 ,$102.20 ,$7.06 ,$138.70 ,$110.96 ,$109.50 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$19.56 ,$102.20 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$93.98 ,$93.98 ,$88.91 ,$93.98 ,$100.89 ,$131.40 ,$101.69 ,$19.76 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600197,87254,HC VIRUS ISOL SHELL ID (CHLAM PNEUMO 2),306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$87.60 ,$124.10 ,$102.20 ,$7.06 ,$138.70 ,$110.96 ,$109.50 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$19.56 ,$102.20 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$93.98 ,$93.98 ,$88.91 ,$93.98 ,$100.89 ,$131.40 ,$101.69 ,$19.76 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600198,87254,HC VIRUS ISOL SHELL ID (CHLAM TRACH),306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$87.60 ,$124.10 ,$102.20 ,$7.06 ,$138.70 ,$110.96 ,$109.50 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$19.56 ,$102.20 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$93.98 ,$93.98 ,$88.91 ,$93.98 ,$100.89 ,$131.40 ,$101.69 ,$19.76 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600200,87260,HC IF ADENOVIRUS AG,306,1 ,$85.00 ,$42.50 ,$14.43 ,$85.00 ,$14.91 ,$50.51 ,$43.29 ,$14.43 ,$51.00 ,$72.25 ,$59.50 ,$14.91 ,$80.75 ,$64.60 ,$63.75 ,$24.53 ,$72.25 ,$14.43 ,$24.53 ,$14.43 ,$59.50 ,$14.91 ,$14.43 ,$14.43 ,$16.33 ,$72.25 ,$32.47 ,$78.20 ,$59.50 ,$57.63 ,$57.63 ,$51.77 ,$57.63 ,$58.74 ,$76.50 ,$59.20 ,$14.57 ,$67.15 ,$15.80 ,$17.32 ,$17.32 ,$14.43 ,$17.32 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30600201,87270,HC IF CHLAMYDIA AG,306,1 ,$109.00 ,$54.50 ,$11.98 ,$109.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$65.40 ,$92.65 ,$76.30 ,$12.38 ,$103.55 ,$82.84 ,$81.75 ,$20.37 ,$92.65 ,$11.98 ,$20.37 ,$11.98 ,$76.30 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$92.65 ,$26.96 ,$100.28 ,$76.30 ,$57.63 ,$57.63 ,$66.38 ,$57.63 ,$75.32 ,$98.10 ,$75.92 ,$12.10 ,$86.11 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,30600202,87273,HC IF HERPES SIMPLEX 2 AG,306,1 ,$85.00 ,$42.50 ,$11.98 ,$85.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$51.00 ,$72.25 ,$59.50 ,$12.38 ,$80.75 ,$64.60 ,$63.75 ,$20.37 ,$72.25 ,$11.98 ,$20.37 ,$11.98 ,$59.50 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$72.25 ,$26.96 ,$78.20 ,$59.50 ,$57.63 ,$57.63 ,$51.77 ,$57.63 ,$58.74 ,$76.50 ,$59.20 ,$12.10 ,$67.15 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30600203,87274,HC IF HERPES SIMPLEX 1 AG,306,1 ,$85.00 ,$42.50 ,$11.98 ,$85.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$51.00 ,$72.25 ,$59.50 ,$12.38 ,$80.75 ,$64.60 ,$63.75 ,$20.37 ,$72.25 ,$11.98 ,$20.37 ,$11.98 ,$59.50 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$72.25 ,$26.96 ,$78.20 ,$59.50 ,$57.63 ,$57.63 ,$51.77 ,$57.63 ,$58.74 ,$76.50 ,$59.20 ,$12.10 ,$67.15 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30600204,87275,HC IF INFLUENZA B AG,306,1 ,$109.00 ,$54.50 ,$12.25 ,$109.00 ,$12.66 ,$46.62 ,$39.96 ,$12.25 ,$65.40 ,$92.65 ,$76.30 ,$12.66 ,$103.55 ,$82.84 ,$81.75 ,$20.83 ,$92.65 ,$12.25 ,$20.83 ,$12.25 ,$76.30 ,$12.66 ,$12.25 ,$12.25 ,$13.86 ,$92.65 ,$27.56 ,$100.28 ,$76.30 ,$57.63 ,$57.63 ,$66.38 ,$57.63 ,$75.32 ,$98.10 ,$75.92 ,$12.37 ,$86.11 ,$13.42 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,30600205,87276,HC IF INFLUENZA A AG,306,1 ,$109.00 ,$54.50 ,$16.07 ,$109.00 ,$16.61 ,$56.25 ,$48.21 ,$16.07 ,$65.40 ,$92.65 ,$76.30 ,$16.61 ,$103.55 ,$82.84 ,$81.75 ,$27.32 ,$92.65 ,$16.07 ,$27.32 ,$16.07 ,$76.30 ,$16.61 ,$16.07 ,$16.07 ,$18.19 ,$92.65 ,$36.16 ,$100.28 ,$76.30 ,$57.63 ,$57.63 ,$66.38 ,$57.63 ,$75.32 ,$98.10 ,$75.92 ,$16.23 ,$86.11 ,$17.61 ,$19.28 ,$19.28 ,$16.07 ,$19.28 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,30600206,87278,HC IF LEGIONELLA AG,306,1 ,$67.00 ,$33.50 ,$15.60 ,$67.00 ,$16.12 ,$54.60 ,$46.80 ,$15.60 ,$40.20 ,$56.95 ,$46.90 ,$16.12 ,$63.65 ,$50.92 ,$50.25 ,$26.52 ,$56.95 ,$15.60 ,$26.52 ,$15.60 ,$46.90 ,$16.12 ,$15.60 ,$15.60 ,$17.66 ,$56.95 ,$35.10 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$15.76 ,$52.93 ,$17.09 ,$18.72 ,$18.72 ,$15.60 ,$18.72 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600207,87279,HC IF PARAFLUENZA AG,306,1 ,$85.00 ,$42.50 ,$16.43 ,$85.00 ,$16.86 ,$57.51 ,$49.29 ,$16.43 ,$51.00 ,$72.25 ,$59.50 ,$16.86 ,$80.75 ,$64.60 ,$63.75 ,$27.93 ,$72.25 ,$16.43 ,$27.93 ,$16.43 ,$59.50 ,$16.86 ,$16.43 ,$16.43 ,$18.60 ,$72.25 ,$36.97 ,$78.20 ,$59.50 ,$57.63 ,$57.63 ,$51.77 ,$57.63 ,$58.74 ,$76.50 ,$59.20 ,$16.59 ,$67.15 ,$17.87 ,$19.72 ,$19.72 ,$16.43 ,$19.72 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30600208,87280,HC IF RSV AG,306,1 ,$112.00 ,$56.00 ,$13.42 ,$112.00 ,$13.87 ,$46.97 ,$40.26 ,$13.42 ,$67.20 ,$95.20 ,$78.40 ,$13.87 ,$106.40 ,$85.12 ,$84.00 ,$22.81 ,$95.20 ,$13.42 ,$22.81 ,$13.42 ,$78.40 ,$13.87 ,$13.42 ,$13.42 ,$15.19 ,$95.20 ,$30.20 ,$103.04 ,$78.40 ,$57.63 ,$57.63 ,$68.21 ,$57.63 ,$77.39 ,$100.80 ,$78.01 ,$13.55 ,$88.48 ,$14.70 ,$16.10 ,$16.10 ,$13.42 ,$16.10 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30600209,87281,HC IF PNEUMOCYST CARINII AG,306,1 ,$112.00 ,$56.00 ,$11.98 ,$112.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$67.20 ,$95.20 ,$78.40 ,$12.38 ,$106.40 ,$85.12 ,$84.00 ,$20.37 ,$95.20 ,$11.98 ,$20.37 ,$11.98 ,$78.40 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$95.20 ,$26.96 ,$103.04 ,$78.40 ,$57.63 ,$57.63 ,$68.21 ,$57.63 ,$77.39 ,$100.80 ,$78.01 ,$12.10 ,$88.48 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30600210,87290,HC IF VARICELLA ZOETER AG,306,1 ,$109.00 ,$54.50 ,$13.42 ,$109.00 ,$13.87 ,$46.97 ,$40.26 ,$13.42 ,$65.40 ,$92.65 ,$76.30 ,$13.87 ,$103.55 ,$82.84 ,$81.75 ,$22.81 ,$92.65 ,$13.42 ,$22.81 ,$13.42 ,$76.30 ,$13.87 ,$13.42 ,$13.42 ,$15.19 ,$92.65 ,$30.20 ,$100.28 ,$76.30 ,$57.63 ,$57.63 ,$66.38 ,$57.63 ,$75.32 ,$98.10 ,$75.92 ,$13.55 ,$86.11 ,$14.70 ,$16.10 ,$16.10 ,$13.42 ,$16.10 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,30600211,87300,HC IF POLYVALENT MLT ORG AG,306,1 ,$85.00 ,$42.50 ,$8.66 ,$85.00 ,$8.66 ,$46.62 ,$39.96 ,$11.98 ,$51.00 ,$72.25 ,$59.50 ,$8.66 ,$80.75 ,$64.60 ,$63.75 ,$20.37 ,$72.25 ,$11.98 ,$20.37 ,$11.98 ,$59.50 ,$8.66 ,$11.98 ,$11.98 ,$13.56 ,$72.25 ,$26.96 ,$78.20 ,$59.50 ,$57.63 ,$57.63 ,$51.77 ,$57.63 ,$58.74 ,$76.50 ,$59.20 ,$12.10 ,$67.15 ,$9.18 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,30600212,87305,HC EIA QL ASPERGILLUS AG,306,1 ,$134.00 ,$67.00 ,$11.98 ,$134.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$80.40 ,$113.90 ,$93.80 ,$12.38 ,$127.30 ,$101.84 ,$100.50 ,$20.37 ,$113.90 ,$11.98 ,$20.37 ,$11.98 ,$93.80 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$113.90 ,$26.96 ,$123.28 ,$93.80 ,$57.63 ,$57.63 ,$81.61 ,$57.63 ,$92.59 ,$120.60 ,$93.33 ,$12.10 ,$105.86 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$109.00 ,$54.50 ,$11.98 ,$109.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$65.40 ,$92.65 ,$76.30 ,$12.38 ,$103.55 ,$82.84 ,$81.75 ,$20.37 ,$92.65 ,$11.98 ,$20.37 ,$11.98 ,$76.30 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$92.65 ,$26.96 ,$100.28 ,$76.30 ,$57.63 ,$57.63 ,$66.38 ,$57.63 ,$75.32 ,$98.10 ,$75.92 ,$12.10 ,$86.11 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,30600214,87327,HC EIA QL CRYPTOCOCCUS AG,306,1 ,$109.00 ,$54.50 ,$13.42 ,$109.00 ,$13.87 ,$46.97 ,$40.26 ,$13.42 ,$65.40 ,$92.65 ,$76.30 ,$13.87 ,$103.55 ,$82.84 ,$81.75 ,$22.81 ,$92.65 ,$13.42 ,$22.81 ,$13.42 ,$76.30 ,$13.87 ,$13.42 ,$13.42 ,$15.19 ,$92.65 ,$30.20 ,$100.28 ,$76.30 ,$57.63 ,$57.63 ,$66.38 ,$57.63 ,$75.32 ,$98.10 ,$75.92 ,$13.55 ,$86.11 ,$14.70 ,$16.10 ,$16.10 ,$13.42 ,$16.10 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,30600215,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$48.00 ,$24.00 ,$13.82 ,$48.00 ,$14.28 ,$48.00 ,$41.46 ,$13.82 ,$28.80 ,$40.80 ,$33.60 ,$14.28 ,$45.60 ,$36.48 ,$36.00 ,$23.49 ,$40.80 ,$13.82 ,$23.49 ,$13.82 ,$33.60 ,$14.28 ,$13.82 ,$13.82 ,$15.64 ,$40.80 ,$31.10 ,$44.16 ,$33.60 ,$48.00 ,$48.00 ,$29.23 ,$48.00 ,$33.17 ,$43.20 ,$33.43 ,$13.96 ,$37.92 ,$15.14 ,$16.58 ,$16.58 ,$13.82 ,$16.58 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$38.40 
ST NICHOLAS HOSPITAL - ACUTE,30600216,87329,HC EIA QL GIARDIA AG,306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$40.20 ,$56.95 ,$46.90 ,$12.38 ,$63.65 ,$50.92 ,$50.25 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$11.98 ,$46.90 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$12.10 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600217,87338,HC EIA QL H PYLORI AG STOOL,306,1 ,$134.00 ,$67.00 ,$14.38 ,$134.00 ,$14.86 ,$55.93 ,$47.94 ,$14.38 ,$80.40 ,$113.90 ,$93.80 ,$14.86 ,$127.30 ,$101.84 ,$100.50 ,$24.45 ,$113.90 ,$14.38 ,$24.45 ,$14.38 ,$93.80 ,$14.86 ,$14.38 ,$14.38 ,$16.28 ,$113.90 ,$32.36 ,$123.28 ,$93.80 ,$69.11 ,$69.11 ,$81.61 ,$69.11 ,$92.59 ,$120.60 ,$93.33 ,$14.52 ,$105.86 ,$15.75 ,$17.26 ,$17.26 ,$14.38 ,$17.26 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30600218,87340,HC EIA QL HEPATITIS B AG,306,1 ,$78.00 ,$39.00 ,$10.33 ,$78.00 ,$10.67 ,$40.18 ,$34.44 ,$10.33 ,$46.80 ,$66.30 ,$54.60 ,$10.67 ,$74.10 ,$59.28 ,$58.50 ,$17.56 ,$66.30 ,$10.33 ,$17.56 ,$10.33 ,$54.60 ,$10.67 ,$10.33 ,$10.33 ,$11.69 ,$66.30 ,$23.24 ,$71.76 ,$54.60 ,$49.67 ,$49.67 ,$47.50 ,$49.67 ,$53.90 ,$70.20 ,$54.33 ,$10.43 ,$61.62 ,$11.31 ,$12.40 ,$12.40 ,$10.33 ,$12.40 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600220,87341,HC EIA QL HEPATITIS B AG NEUT,306,1 ,$78.00 ,$39.00 ,$10.33 ,$78.00 ,$10.67 ,$40.18 ,$34.44 ,$10.33 ,$46.80 ,$66.30 ,$54.60 ,$10.67 ,$74.10 ,$59.28 ,$58.50 ,$17.56 ,$66.30 ,$10.33 ,$17.56 ,$10.33 ,$54.60 ,$10.67 ,$10.33 ,$10.33 ,$11.69 ,$66.30 ,$23.24 ,$71.76 ,$54.60 ,$49.67 ,$49.67 ,$47.50 ,$49.67 ,$53.90 ,$70.20 ,$54.33 ,$10.43 ,$61.62 ,$11.31 ,$12.40 ,$12.40 ,$10.33 ,$12.40 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600221,87350,HC HEPATITIS BE AG QL,306,1 ,$67.00 ,$33.50 ,$11.53 ,$67.00 ,$11.91 ,$44.84 ,$38.43 ,$11.53 ,$40.20 ,$56.95 ,$46.90 ,$11.91 ,$63.65 ,$50.92 ,$50.25 ,$19.60 ,$56.95 ,$11.53 ,$19.60 ,$11.53 ,$46.90 ,$11.91 ,$11.53 ,$11.53 ,$13.05 ,$56.95 ,$25.94 ,$61.64 ,$46.90 ,$55.41 ,$55.41 ,$40.80 ,$55.41 ,$46.30 ,$60.30 ,$46.67 ,$11.65 ,$52.93 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600222,87385,HC EIA QL HISTOPLASMA AG,306,1 ,$157.00 ,$78.50 ,$13.25 ,$157.00 ,$13.69 ,$46.62 ,$39.96 ,$13.25 ,$94.20 ,$133.45 ,$109.90 ,$13.69 ,$149.15 ,$119.32 ,$117.75 ,$22.53 ,$133.45 ,$13.25 ,$22.53 ,$13.25 ,$109.90 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$133.45 ,$29.81 ,$144.44 ,$109.90 ,$57.63 ,$57.63 ,$95.61 ,$57.63 ,$108.49 ,$141.30 ,$109.35 ,$13.38 ,$124.03 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30600223,87385,HC EIA QL HISTOPLASMA AG (URINE),306,1 ,$146.00 ,$73.00 ,$13.25 ,$146.00 ,$13.69 ,$46.62 ,$39.96 ,$13.25 ,$87.60 ,$124.10 ,$102.20 ,$13.69 ,$138.70 ,$110.96 ,$109.50 ,$22.53 ,$124.10 ,$13.25 ,$22.53 ,$13.25 ,$102.20 ,$13.69 ,$13.25 ,$13.25 ,$15.00 ,$124.10 ,$29.81 ,$134.32 ,$102.20 ,$57.63 ,$57.63 ,$88.91 ,$57.63 ,$100.89 ,$131.40 ,$101.69 ,$13.38 ,$115.34 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600224,87390,HC HIV 1 AG QL,306,1 ,$141.00 ,$70.50 ,$24.06 ,$141.00 ,$24.81 ,$84.21 ,$72.18 ,$24.06 ,$84.60 ,$119.85 ,$98.70 ,$24.81 ,$133.95 ,$107.16 ,$105.75 ,$40.90 ,$119.85 ,$24.06 ,$40.90 ,$24.06 ,$98.70 ,$24.81 ,$24.06 ,$24.06 ,$27.23 ,$119.85 ,$54.14 ,$129.72 ,$98.70 ,$84.75 ,$84.75 ,$85.87 ,$84.75 ,$97.43 ,$126.90 ,$98.21 ,$24.30 ,$111.39 ,$26.30 ,$28.87 ,$28.87 ,$24.06 ,$28.87 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,30600225,87400,HC EIA QL INFLUENZA A/B AG,306,1 ,$81.00 ,$40.50 ,$8.66 ,$81.00 ,$8.66 ,$49.46 ,$42.39 ,$14.13 ,$48.60 ,$68.85 ,$56.70 ,$8.66 ,$76.95 ,$61.56 ,$60.75 ,$24.02 ,$68.85 ,$14.13 ,$24.02 ,$14.13 ,$56.70 ,$8.66 ,$14.13 ,$14.13 ,$15.99 ,$68.85 ,$31.79 ,$74.52 ,$56.70 ,$57.63 ,$57.63 ,$49.33 ,$57.63 ,$55.97 ,$72.90 ,$56.42 ,$14.27 ,$63.99 ,$9.18 ,$16.96 ,$16.96 ,$14.13 ,$16.96 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$64.80 
ST NICHOLAS HOSPITAL - ACUTE,30600226,87420,HC RSV AG QL,306,1 ,$112.00 ,$56.00 ,$13.91 ,$112.00 ,$14.37 ,$48.69 ,$41.73 ,$13.91 ,$67.20 ,$95.20 ,$78.40 ,$14.37 ,$106.40 ,$85.12 ,$84.00 ,$23.65 ,$95.20 ,$13.91 ,$23.65 ,$13.91 ,$78.40 ,$14.37 ,$13.91 ,$13.91 ,$15.74 ,$95.20 ,$31.30 ,$103.04 ,$78.40 ,$57.63 ,$57.63 ,$68.21 ,$57.63 ,$77.39 ,$100.80 ,$78.01 ,$14.05 ,$88.48 ,$15.23 ,$16.69 ,$16.69 ,$13.91 ,$16.69 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30600227,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$40.20 ,$56.95 ,$46.90 ,$12.38 ,$63.65 ,$50.92 ,$50.25 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$11.98 ,$46.90 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$12.10 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600228,87430,HC RAPID STREP,306,1 ,$90.00 ,$45.00 ,$16.81 ,$90.00 ,$16.86 ,$58.84 ,$50.43 ,$16.81 ,$54.00 ,$76.50 ,$63.00 ,$16.86 ,$85.50 ,$68.40 ,$67.50 ,$28.58 ,$76.50 ,$16.81 ,$28.58 ,$16.81 ,$63.00 ,$16.86 ,$16.81 ,$16.81 ,$19.03 ,$76.50 ,$37.82 ,$82.80 ,$63.00 ,$57.63 ,$57.63 ,$54.81 ,$57.63 ,$62.19 ,$81.00 ,$62.69 ,$16.98 ,$71.10 ,$17.87 ,$20.17 ,$20.17 ,$16.81 ,$20.17 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30600229,87449,HC EIA QL MLT AG INF (RPD GRP B),306,1 ,$128.00 ,$64.00 ,$11.98 ,$128.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$76.80 ,$108.80 ,$89.60 ,$12.38 ,$121.60 ,$97.28 ,$96.00 ,$20.37 ,$108.80 ,$11.98 ,$20.37 ,$11.98 ,$89.60 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$108.80 ,$26.96 ,$117.76 ,$89.60 ,$57.63 ,$57.63 ,$77.95 ,$57.63 ,$88.45 ,$115.20 ,$89.15 ,$12.10 ,$101.12 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$102.40 
ST NICHOLAS HOSPITAL - ACUTE,30600230,87449,HC EIA QL MLT AG INF (LEGION),306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$40.20 ,$56.95 ,$46.90 ,$12.38 ,$63.65 ,$50.92 ,$50.25 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$11.98 ,$46.90 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$12.10 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600231,87449,HC EIA QL MLT AG INF (S. PNEUMO),306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$40.20 ,$56.95 ,$46.90 ,$12.38 ,$63.65 ,$50.92 ,$50.25 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$11.98 ,$46.90 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$12.10 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600232,87449,HC EIA QL MLT AG INF (NOROVIRUS),306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$40.20 ,$56.95 ,$46.90 ,$12.38 ,$63.65 ,$50.92 ,$50.25 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$11.98 ,$46.90 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$12.10 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600233,87449,HC EIA QL MLT AG INF (BLASTO),306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$40.20 ,$56.95 ,$46.90 ,$12.38 ,$63.65 ,$50.92 ,$50.25 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$11.98 ,$46.90 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$12.10 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600234,87449,HC EIA QL MLT AG INF (RPD FLU),306,1 ,$78.00 ,$39.00 ,$11.98 ,$78.00 ,$12.38 ,$46.62 ,$39.96 ,$11.98 ,$46.80 ,$66.30 ,$54.60 ,$12.38 ,$74.10 ,$59.28 ,$58.50 ,$20.37 ,$66.30 ,$11.98 ,$20.37 ,$11.98 ,$54.60 ,$12.38 ,$11.98 ,$11.98 ,$13.56 ,$66.30 ,$26.96 ,$71.76 ,$54.60 ,$57.63 ,$57.63 ,$47.50 ,$57.63 ,$53.90 ,$70.20 ,$54.33 ,$12.10 ,$61.62 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600235,87476,HC LYMES DNA DETECT PCR,306,1 ,$354.00 ,$177.00 ,$35.09 ,$354.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$212.40 ,$300.90 ,$247.80 ,$36.26 ,$336.30 ,$269.04 ,$265.50 ,$59.65 ,$300.90 ,$35.09 ,$59.65 ,$35.09 ,$247.80 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$300.90 ,$78.95 ,$325.68 ,$247.80 ,$168.63 ,$168.63 ,$215.59 ,$168.63 ,$244.61 ,$318.60 ,$246.56 ,$35.44 ,$279.66 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$254.88 ,$219.48 ,$254.88 ,$254.88 ,$283.20 
ST NICHOLAS HOSPITAL - ACUTE,30600236,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600237,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$269.00 ,$134.50 ,$37.27 ,$269.00 ,$38.51 ,$136.47 ,$116.97 ,$37.27 ,$161.40 ,$228.65 ,$188.30 ,$38.51 ,$255.55 ,$204.44 ,$201.75 ,$63.36 ,$228.65 ,$37.27 ,$63.36 ,$37.27 ,$188.30 ,$38.51 ,$37.27 ,$37.27 ,$42.18 ,$228.65 ,$83.86 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$37.64 ,$212.51 ,$40.82 ,$44.72 ,$44.72 ,$37.27 ,$44.72 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600238,87497,HC CMV QN,306,1 ,$258.00 ,$129.00 ,$42.84 ,$258.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$154.80 ,$219.30 ,$180.60 ,$44.27 ,$245.10 ,$196.08 ,$193.50 ,$72.83 ,$219.30 ,$42.84 ,$72.83 ,$42.84 ,$180.60 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$219.30 ,$96.39 ,$237.36 ,$180.60 ,$205.86 ,$205.86 ,$157.12 ,$205.86 ,$178.28 ,$232.20 ,$179.70 ,$43.27 ,$203.82 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,30600239,87498,HC ENTEROVIRUS AMP PROBE,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600240,87517,HC HEPATITIS B QN,306,1 ,$196.00 ,$98.00 ,$42.84 ,$196.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$117.60 ,$166.60 ,$137.20 ,$44.27 ,$186.20 ,$148.96 ,$147.00 ,$72.83 ,$166.60 ,$42.84 ,$72.83 ,$42.84 ,$137.20 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$166.60 ,$96.39 ,$180.32 ,$137.20 ,$196.00 ,$196.00 ,$119.36 ,$196.00 ,$135.44 ,$176.40 ,$136.51 ,$43.27 ,$154.84 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$141.12 ,$121.52 ,$141.12 ,$141.12 ,$156.80 
ST NICHOLAS HOSPITAL - ACUTE,30600241,87517,HC HEPATITIS B QN (PCR),306,1 ,$370.00 ,$185.00 ,$42.84 ,$370.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$222.00 ,$314.50 ,$259.00 ,$44.27 ,$351.50 ,$281.20 ,$277.50 ,$72.83 ,$314.50 ,$42.84 ,$72.83 ,$42.84 ,$259.00 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$314.50 ,$96.39 ,$340.40 ,$259.00 ,$205.86 ,$205.86 ,$225.33 ,$205.86 ,$255.67 ,$333.00 ,$257.71 ,$43.27 ,$292.30 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,30600242,87522,HC HEPATITIS C QN,306,1 ,$325.00 ,$162.50 ,$42.84 ,$325.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$195.00 ,$276.25 ,$227.50 ,$44.27 ,$308.75 ,$247.00 ,$243.75 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$42.84 ,$227.50 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$205.86 ,$205.86 ,$197.93 ,$205.86 ,$224.58 ,$292.50 ,$226.36 ,$43.27 ,$256.75 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30600243,87522,HC HEPATITIS C QN (BDNA),306,1 ,$246.00 ,$123.00 ,$42.84 ,$246.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$147.60 ,$209.10 ,$172.20 ,$44.27 ,$233.70 ,$186.96 ,$184.50 ,$72.83 ,$209.10 ,$42.84 ,$72.83 ,$42.84 ,$172.20 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$209.10 ,$96.39 ,$226.32 ,$172.20 ,$205.86 ,$205.86 ,$149.81 ,$205.86 ,$169.99 ,$221.40 ,$171.34 ,$43.27 ,$194.34 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,30600244,87529,HC HERPES SIMPLEX AMP,306,1 ,$179.00 ,$89.50 ,$35.09 ,$179.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$107.40 ,$152.15 ,$125.30 ,$36.26 ,$170.05 ,$136.04 ,$134.25 ,$59.65 ,$152.15 ,$35.09 ,$59.65 ,$35.09 ,$125.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$152.15 ,$78.95 ,$164.68 ,$125.30 ,$168.63 ,$168.63 ,$109.01 ,$168.63 ,$123.69 ,$161.10 ,$124.67 ,$35.44 ,$141.41 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,30600245,87535,HC PROBE HIV-1 AMP,306,1 ,$325.00 ,$162.50 ,$35.09 ,$325.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$195.00 ,$276.25 ,$227.50 ,$36.26 ,$308.75 ,$247.00 ,$243.75 ,$59.65 ,$276.25 ,$35.09 ,$59.65 ,$35.09 ,$227.50 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$276.25 ,$78.95 ,$299.00 ,$227.50 ,$168.63 ,$168.63 ,$197.93 ,$168.63 ,$224.58 ,$292.50 ,$226.36 ,$35.44 ,$256.75 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30600246,87536,HC HIV-1 QN,306,1 ,$325.00 ,$162.50 ,$85.10 ,$325.00 ,$87.93 ,$325.00 ,$283.65 ,$85.10 ,$195.00 ,$276.25 ,$227.50 ,$87.93 ,$308.75 ,$247.00 ,$243.75 ,$144.67 ,$276.25 ,$85.10 ,$144.67 ,$85.10 ,$227.50 ,$87.93 ,$85.10 ,$85.10 ,$96.32 ,$276.25 ,$191.48 ,$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$292.50 ,$226.36 ,$85.95 ,$256.75 ,$93.21 ,$102.12 ,$102.12 ,$85.10 ,$102.12 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30600247,87536,HC HIV-1 QN (2ND GEN),306,1 ,$325.00 ,$162.50 ,$85.10 ,$325.00 ,$87.93 ,$325.00 ,$283.65 ,$85.10 ,$195.00 ,$276.25 ,$227.50 ,$87.93 ,$308.75 ,$247.00 ,$243.75 ,$144.67 ,$276.25 ,$85.10 ,$144.67 ,$85.10 ,$227.50 ,$87.93 ,$85.10 ,$85.10 ,$96.32 ,$276.25 ,$191.48 ,$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$292.50 ,$226.36 ,$85.95 ,$256.75 ,$93.21 ,$102.12 ,$102.12 ,$85.10 ,$102.12 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30600248,87556,HC MTB COMPLEX PCR,306,1 ,$224.00 ,$112.00 ,$41.68 ,$224.00 ,$43.07 ,$145.88 ,$125.04 ,$41.68 ,$134.40 ,$190.40 ,$156.80 ,$43.07 ,$212.80 ,$170.24 ,$168.00 ,$70.86 ,$190.40 ,$41.68 ,$70.86 ,$41.68 ,$156.80 ,$43.07 ,$41.68 ,$41.68 ,$47.17 ,$190.40 ,$93.78 ,$206.08 ,$156.80 ,$168.63 ,$168.63 ,$136.42 ,$168.63 ,$154.78 ,$201.60 ,$156.02 ,$42.10 ,$176.96 ,$45.65 ,$50.02 ,$50.02 ,$41.68 ,$50.02 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30600249,87591,HC NEISSERIA AMP,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600250,87624,HC HPV AMP,306,1 ,$141.00 ,$70.50 ,$35.09 ,$141.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$84.60 ,$119.85 ,$98.70 ,$36.26 ,$133.95 ,$107.16 ,$105.75 ,$59.65 ,$119.85 ,$35.09 ,$59.65 ,$35.09 ,$98.70 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$119.85 ,$78.95 ,$129.72 ,$98.70 ,$141.00 ,$141.00 ,$85.87 ,$141.00 ,$97.43 ,$126.90 ,$98.21 ,$35.44 ,$111.39 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,30600252,87624,HC HPV AMP,306,1 ,$132.00 ,$66.00 ,$35.09 ,$132.00 ,$36.26 ,$132.00 ,$116.97 ,$35.09 ,$79.20 ,$112.20 ,$92.40 ,$36.26 ,$125.40 ,$100.32 ,$99.00 ,$59.65 ,$112.20 ,$35.09 ,$59.65 ,$35.09 ,$92.40 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$112.20 ,$78.95 ,$121.44 ,$92.40 ,$132.00 ,$132.00 ,$80.39 ,$132.00 ,$91.21 ,$118.80 ,$91.94 ,$35.44 ,$104.28 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$105.60 
ST NICHOLAS HOSPITAL - ACUTE,30600253,87624,HC HPV AMP (DNA),306,1 ,$141.00 ,$70.50 ,$35.09 ,$141.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$84.60 ,$119.85 ,$98.70 ,$36.26 ,$133.95 ,$107.16 ,$105.75 ,$59.65 ,$119.85 ,$35.09 ,$59.65 ,$35.09 ,$98.70 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$119.85 ,$78.95 ,$129.72 ,$98.70 ,$141.00 ,$141.00 ,$85.87 ,$141.00 ,$97.43 ,$126.90 ,$98.21 ,$35.44 ,$111.39 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,30600254,87640,HC STAPH AURE AMP PROBE,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600255,87641,HC MRSA AMP,306,1 ,$123.00 ,$61.50 ,$35.09 ,$123.00 ,$36.26 ,$123.00 ,$116.97 ,$35.09 ,$73.80 ,$104.55 ,$86.10 ,$36.26 ,$116.85 ,$93.48 ,$92.25 ,$59.65 ,$104.55 ,$35.09 ,$59.65 ,$35.09 ,$86.10 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$104.55 ,$78.95 ,$113.16 ,$86.10 ,$123.00 ,$123.00 ,$74.91 ,$123.00 ,$84.99 ,$110.70 ,$85.67 ,$35.44 ,$97.17 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,30600256,87798,HC INFECT AMP (BORDETELLA),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600257,87653,HC INFECT AMP (GRP B STREP),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600258,87798,HC INFECT AMP (PNEUMO),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600259,87798,HC INFECT AMP (WEST NILE),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600260,87798,HC INFECT AMP (PARVOVIRUS),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600261,87798,HC INFECT AMP (E CHAFF),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600262,87798,HC INFECT AMP (A PHAGO),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600263,87798,HC INFECT AMP (RSV),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600264,87798,HC INFECT AMP (INFLU),306,1 ,$62.00 ,$31.00 ,$31.00 ,$78.95 ,$36.26 ,$62.00 ,$62.00 ,$35.09 ,$37.20 ,$52.70 ,$43.40 ,$36.26 ,$58.90 ,$47.12 ,$46.50 ,$59.65 ,$52.70 ,$35.09 ,$59.65 ,$35.09 ,$43.40 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$52.70 ,$78.95 ,$57.04 ,$43.40 ,$62.00 ,$62.00 ,$37.76 ,$62.00 ,$42.84 ,$55.80 ,$43.18 ,$35.44 ,$48.98 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,30600265,87798,HC INFECT AMP (ENTEROVIRUS),306,1 ,$243.00 ,$121.50 ,$35.09 ,$243.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$145.80 ,$206.55 ,$170.10 ,$36.26 ,$230.85 ,$184.68 ,$182.25 ,$59.65 ,$206.55 ,$35.09 ,$59.65 ,$35.09 ,$170.10 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$206.55 ,$78.95 ,$223.56 ,$170.10 ,$168.63 ,$168.63 ,$147.99 ,$168.63 ,$167.91 ,$218.70 ,$169.25 ,$35.44 ,$191.97 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$174.96 ,$150.66 ,$174.96 ,$174.96 ,$194.40 
ST NICHOLAS HOSPITAL - ACUTE,30600267,87799,HC INFECT AGENT QN,306,1 ,$325.00 ,$162.50 ,$42.84 ,$325.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$195.00 ,$276.25 ,$227.50 ,$44.27 ,$308.75 ,$247.00 ,$243.75 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$42.84 ,$227.50 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$205.86 ,$205.86 ,$197.93 ,$205.86 ,$224.58 ,$292.50 ,$226.36 ,$43.27 ,$256.75 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30600268,87802,HC OPTICAL STREP B,306,1 ,$132.00 ,$66.00 ,$12.73 ,$132.00 ,$13.15 ,$46.62 ,$39.96 ,$12.73 ,$79.20 ,$112.20 ,$92.40 ,$13.15 ,$125.40 ,$100.32 ,$99.00 ,$21.64 ,$112.20 ,$12.73 ,$21.64 ,$12.73 ,$92.40 ,$13.15 ,$12.73 ,$12.73 ,$14.41 ,$112.20 ,$28.64 ,$121.44 ,$92.40 ,$57.63 ,$57.63 ,$80.39 ,$57.63 ,$91.21 ,$118.80 ,$91.94 ,$12.86 ,$104.28 ,$13.94 ,$15.28 ,$15.28 ,$12.73 ,$15.28 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$105.60 
ST NICHOLAS HOSPITAL - ACUTE,30600269,87807,HC QL RSV,306,1 ,$112.00 ,$56.00 ,$13.10 ,$112.00 ,$13.54 ,$46.62 ,$39.96 ,$13.10 ,$67.20 ,$95.20 ,$78.40 ,$13.54 ,$106.40 ,$85.12 ,$84.00 ,$22.27 ,$95.20 ,$13.10 ,$22.27 ,$13.10 ,$78.40 ,$13.54 ,$13.10 ,$13.10 ,$14.83 ,$95.20 ,$29.48 ,$103.04 ,$78.40 ,$57.63 ,$57.63 ,$68.21 ,$57.63 ,$77.39 ,$100.80 ,$78.01 ,$13.23 ,$88.48 ,$14.35 ,$15.72 ,$15.72 ,$13.10 ,$15.72 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30600270,87880,HC OPTICAL STREP,306,1 ,$90.00 ,$45.00 ,$16.53 ,$90.00 ,$16.86 ,$57.86 ,$49.59 ,$16.53 ,$54.00 ,$76.50 ,$63.00 ,$16.86 ,$85.50 ,$68.40 ,$67.50 ,$28.10 ,$76.50 ,$16.53 ,$28.10 ,$16.53 ,$63.00 ,$16.86 ,$16.53 ,$16.53 ,$18.71 ,$76.50 ,$37.19 ,$82.80 ,$63.00 ,$57.63 ,$57.63 ,$54.81 ,$57.63 ,$62.19 ,$81.00 ,$62.69 ,$16.70 ,$71.10 ,$17.87 ,$19.84 ,$19.84 ,$16.53 ,$19.84 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,30600271,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$67.00 ,$33.50 ,$16.07 ,$67.00 ,$16.61 ,$56.25 ,$48.21 ,$16.07 ,$40.20 ,$56.95 ,$46.90 ,$16.61 ,$63.65 ,$50.92 ,$50.25 ,$27.32 ,$56.95 ,$16.07 ,$27.32 ,$16.07 ,$46.90 ,$16.61 ,$16.07 ,$16.07 ,$18.19 ,$56.95 ,$36.16 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$16.23 ,$52.93 ,$17.61 ,$19.28 ,$19.28 ,$16.07 ,$19.28 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600272,87902,HC GENTOYPE HEP C,306,1 ,"$1,568.00 ",$784.00 ,$257.45 ,"$1,568.00 ",$266.02 ,"$1,001.18 ",$858.15 ,$257.45 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$266.02 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ",$437.67 ,"$1,332.80 ",$257.45 ,$437.67 ,$257.45 ,"$1,097.60 ",$266.02 ,$257.45 ,$257.45 ,$291.38 ,"$1,332.80 ",$579.26 ,"$1,442.56 ","$1,097.60 ","$1,237.21 ","$1,237.21 ",$954.91 ,"$1,237.21 ","$1,083.49 ","$1,411.20 ","$1,092.11 ",$260.02 ,"$1,238.72 ",$281.98 ,$308.94 ,$308.94 ,$257.45 ,$308.94 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,30600273,87801,HC INFECT MLT ORG AMP STAPH,306,1 ,$538.00 ,$269.00 ,$50.62 ,$538.00 ,$50.62 ,$272.97 ,$233.97 ,$70.20 ,$322.80 ,$457.30 ,$376.60 ,$50.62 ,$511.10 ,$408.88 ,$403.50 ,$119.34 ,$457.30 ,$70.20 ,$119.34 ,$70.20 ,$376.60 ,$50.62 ,$70.20 ,$70.20 ,$79.45 ,$457.30 ,$157.95 ,$494.96 ,$376.60 ,$337.32 ,$337.32 ,$327.64 ,$337.32 ,$371.76 ,$484.20 ,$374.72 ,$70.90 ,$425.02 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$430.40 
ST NICHOLAS HOSPITAL - ACUTE,30600275,87153,HC MYCOBACTERIA ID BY DNA SEQUENCING,306,1 ,$672.00 ,$336.00 ,$115.36 ,$672.00 ,$119.20 ,$448.60 ,$384.51 ,$115.36 ,$403.20 ,$571.20 ,$470.40 ,$119.20 ,$638.40 ,$510.72 ,$504.00 ,$196.11 ,$571.20 ,$115.36 ,$196.11 ,$115.36 ,$470.40 ,$119.20 ,$115.36 ,$115.36 ,$130.56 ,$571.20 ,$259.56 ,$618.24 ,$470.40 ,$554.39 ,$554.39 ,$409.25 ,$554.39 ,$464.35 ,$604.80 ,$468.05 ,$116.51 ,$530.88 ,$126.35 ,$138.43 ,$138.43 ,$115.36 ,$138.43 ,$483.84 ,$416.64 ,$483.84 ,$483.84 ,$537.60 
ST NICHOLAS HOSPITAL - ACUTE,30600280,87491,HC C TACH RNA TMA,306,1 ,$246.00 ,$123.00 ,$35.09 ,$246.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$147.60 ,$209.10 ,$172.20 ,$36.26 ,$233.70 ,$186.96 ,$184.50 ,$59.65 ,$209.10 ,$35.09 ,$59.65 ,$35.09 ,$172.20 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$209.10 ,$78.95 ,$226.32 ,$172.20 ,$168.63 ,$168.63 ,$149.81 ,$168.63 ,$169.99 ,$221.40 ,$171.34 ,$35.44 ,$194.34 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,30600281,87591,HC N GONOR RNA TMA,306,1 ,$246.00 ,$123.00 ,$35.09 ,$246.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$147.60 ,$209.10 ,$172.20 ,$36.26 ,$233.70 ,$186.96 ,$184.50 ,$59.65 ,$209.10 ,$35.09 ,$59.65 ,$35.09 ,$172.20 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$209.10 ,$78.95 ,$226.32 ,$172.20 ,$168.63 ,$168.63 ,$149.81 ,$168.63 ,$169.99 ,$221.40 ,$171.34 ,$35.44 ,$194.34 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,30600282,87899,HC INFECT AGENT DETECT OPT (SHIGA),306,1 ,$67.00 ,$33.50 ,$16.07 ,$67.00 ,$16.61 ,$56.25 ,$48.21 ,$16.07 ,$40.20 ,$56.95 ,$46.90 ,$16.61 ,$63.65 ,$50.92 ,$50.25 ,$27.32 ,$56.95 ,$16.07 ,$27.32 ,$16.07 ,$46.90 ,$16.61 ,$16.07 ,$16.07 ,$18.19 ,$56.95 ,$36.16 ,$61.64 ,$46.90 ,$57.63 ,$57.63 ,$40.80 ,$57.63 ,$46.30 ,$60.30 ,$46.67 ,$16.23 ,$52.93 ,$17.61 ,$19.28 ,$19.28 ,$16.07 ,$19.28 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600283,87804,HC QL INFLUENZA A/B,306,1 ,$101.00 ,$50.50 ,$16.55 ,$101.00 ,$16.86 ,$57.93 ,$49.65 ,$16.55 ,$60.60 ,$85.85 ,$70.70 ,$16.86 ,$95.95 ,$76.76 ,$75.75 ,$28.14 ,$85.85 ,$16.55 ,$28.14 ,$16.55 ,$70.70 ,$16.86 ,$16.55 ,$16.55 ,$18.73 ,$85.85 ,$37.24 ,$92.92 ,$70.70 ,$57.63 ,$57.63 ,$61.51 ,$57.63 ,$69.79 ,$90.90 ,$70.35 ,$16.72 ,$79.79 ,$17.87 ,$19.86 ,$19.86 ,$16.55 ,$19.86 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,30600285,87624,HC HPV HR GENOTYPES,306,1 ,$157.00 ,$78.50 ,$35.09 ,$157.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$94.20 ,$133.45 ,$109.90 ,$36.26 ,$149.15 ,$119.32 ,$117.75 ,$59.65 ,$133.45 ,$35.09 ,$59.65 ,$35.09 ,$109.90 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$133.45 ,$78.95 ,$144.44 ,$109.90 ,$157.00 ,$157.00 ,$95.61 ,$157.00 ,$108.49 ,$141.30 ,$109.35 ,$35.44 ,$124.03 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30600286,87625,HC HPV GENOTYPE 16 18/45,306,1 ,$157.00 ,$78.50 ,$38.30 ,$157.00 ,$38.30 ,$141.93 ,$121.65 ,$40.55 ,$94.20 ,$133.45 ,$109.90 ,$38.30 ,$149.15 ,$119.32 ,$117.75 ,$68.94 ,$133.45 ,$40.55 ,$68.94 ,$40.55 ,$109.90 ,$38.30 ,$40.55 ,$40.55 ,$45.89 ,$133.45 ,$91.24 ,$144.44 ,$109.90 ,$157.00 ,$157.00 ,$95.61 ,$157.00 ,$108.49 ,$141.30 ,$109.35 ,$40.96 ,$124.03 ,$40.60 ,$48.66 ,$48.66 ,$40.55 ,$48.66 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,30600288,87633,HC RESP VIRUS MAP-TECH 17 TARGETS,306,1 ,$896.00 ,$448.00 ,$416.78 ,$937.76 ,$430.66 ,$896.00 ,$896.00 ,$416.78 ,$537.60 ,$761.60 ,$627.20 ,$430.66 ,$851.20 ,$680.96 ,$672.00 ,$708.53 ,$761.60 ,$416.78 ,$708.53 ,$416.78 ,$627.20 ,$430.66 ,$416.78 ,$416.78 ,$471.71 ,$761.60 ,$937.76 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$420.95 ,$707.84 ,$456.50 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,30600289,87798,HC B. PERTUSSIS AP-TECH,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600290,87486,HC C PNEUMONIAE AP-TECH,306,1 ,$224.00 ,$112.00 ,$35.09 ,$224.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$134.40 ,$190.40 ,$156.80 ,$36.26 ,$212.80 ,$170.24 ,$168.00 ,$59.65 ,$190.40 ,$35.09 ,$59.65 ,$35.09 ,$156.80 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$190.40 ,$78.95 ,$206.08 ,$156.80 ,$168.63 ,$168.63 ,$136.42 ,$168.63 ,$154.78 ,$201.60 ,$156.02 ,$35.44 ,$176.96 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30600291,87581,HC M PNEUMONIAS AP-TECH,306,1 ,$224.00 ,$112.00 ,$35.09 ,$224.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$134.40 ,$190.40 ,$156.80 ,$36.26 ,$212.80 ,$170.24 ,$168.00 ,$59.65 ,$190.40 ,$35.09 ,$59.65 ,$35.09 ,$156.80 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$190.40 ,$78.95 ,$206.08 ,$156.80 ,$168.63 ,$168.63 ,$136.42 ,$168.63 ,$154.78 ,$201.60 ,$156.02 ,$35.44 ,$176.96 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,30600292,87798,HC INFECT AMP (EA ORG) MENI,306,1 ,$206.00 ,$103.00 ,$35.09 ,$206.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$123.60 ,$175.10 ,$144.20 ,$36.26 ,$195.70 ,$156.56 ,$154.50 ,$59.65 ,$175.10 ,$35.09 ,$59.65 ,$35.09 ,$144.20 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$175.10 ,$78.95 ,$189.52 ,$144.20 ,$168.63 ,$168.63 ,$125.45 ,$168.63 ,$142.35 ,$185.40 ,$143.48 ,$35.44 ,$162.74 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$148.32 ,$127.72 ,$148.32 ,$148.32 ,$164.80 
ST NICHOLAS HOSPITAL - ACUTE,30600293,87653,HC INFECT AMP (STREP B) MENI,306,1 ,$206.00 ,$103.00 ,$35.09 ,$206.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$123.60 ,$175.10 ,$144.20 ,$36.26 ,$195.70 ,$156.56 ,$154.50 ,$59.65 ,$175.10 ,$35.09 ,$59.65 ,$35.09 ,$144.20 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$175.10 ,$78.95 ,$189.52 ,$144.20 ,$168.63 ,$168.63 ,$125.45 ,$168.63 ,$142.35 ,$185.40 ,$143.48 ,$35.44 ,$162.74 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$148.32 ,$127.72 ,$148.32 ,$148.32 ,$164.80 
ST NICHOLAS HOSPITAL - ACUTE,30600294,87496,HC INFECT AMP (CMV) MENI,306,1 ,$159.00 ,$79.50 ,$35.09 ,$159.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$95.40 ,$135.15 ,$111.30 ,$36.26 ,$151.05 ,$120.84 ,$119.25 ,$59.65 ,$135.15 ,$35.09 ,$59.65 ,$35.09 ,$111.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$135.15 ,$78.95 ,$146.28 ,$111.30 ,$159.00 ,$159.00 ,$96.83 ,$159.00 ,$109.87 ,$143.10 ,$110.74 ,$35.44 ,$125.61 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$127.20 
ST NICHOLAS HOSPITAL - ACUTE,30600295,87532,HC INFECT AMP (HHSV6) MENI,306,1 ,$159.00 ,$79.50 ,$35.09 ,$159.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$95.40 ,$135.15 ,$111.30 ,$36.26 ,$151.05 ,$120.84 ,$119.25 ,$59.65 ,$135.15 ,$35.09 ,$59.65 ,$35.09 ,$111.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$135.15 ,$78.95 ,$146.28 ,$111.30 ,$159.00 ,$159.00 ,$96.83 ,$159.00 ,$109.87 ,$143.10 ,$110.74 ,$35.44 ,$125.61 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$127.20 
ST NICHOLAS HOSPITAL - ACUTE,30600296,87529,HC INFECT AMP (HSV 1 OR 2) MENI,306,1 ,$159.00 ,$79.50 ,$35.09 ,$159.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$95.40 ,$135.15 ,$111.30 ,$36.26 ,$151.05 ,$120.84 ,$119.25 ,$59.65 ,$135.15 ,$35.09 ,$59.65 ,$35.09 ,$111.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$135.15 ,$78.95 ,$146.28 ,$111.30 ,$159.00 ,$159.00 ,$96.83 ,$159.00 ,$109.87 ,$143.10 ,$110.74 ,$35.44 ,$125.61 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$127.20 
ST NICHOLAS HOSPITAL - ACUTE,30600297,87798,HC BABESIA SPECIES PCR B,306,1 ,$78.00 ,$39.00 ,$35.09 ,$78.95 ,$36.26 ,$78.00 ,$78.00 ,$35.09 ,$46.80 ,$66.30 ,$54.60 ,$36.26 ,$74.10 ,$59.28 ,$58.50 ,$59.65 ,$66.30 ,$35.09 ,$59.65 ,$35.09 ,$54.60 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$66.30 ,$78.95 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$70.20 ,$54.33 ,$35.44 ,$61.62 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600298,87798,HC DETECT AGENT NOS DNA AMP,306,1 ,$78.00 ,$39.00 ,$35.09 ,$78.95 ,$36.26 ,$78.00 ,$78.00 ,$35.09 ,$46.80 ,$66.30 ,$54.60 ,$36.26 ,$74.10 ,$59.28 ,$58.50 ,$59.65 ,$66.30 ,$35.09 ,$59.65 ,$35.09 ,$54.60 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$66.30 ,$78.95 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$70.20 ,$54.33 ,$35.44 ,$61.62 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,30600306,87207,HC SPECIAL STAIN INCL BODIES/PARASITES,306,1 ,$67.00 ,$33.50 ,$5.99 ,$67.00 ,$6.19 ,$23.31 ,$19.98 ,$5.99 ,$40.20 ,$56.95 ,$46.90 ,$6.19 ,$63.65 ,$50.92 ,$50.25 ,$10.18 ,$56.95 ,$5.99 ,$10.18 ,$5.99 ,$46.90 ,$6.19 ,$5.99 ,$5.99 ,$6.78 ,$56.95 ,$13.48 ,$61.64 ,$46.90 ,$28.81 ,$28.81 ,$40.80 ,$28.81 ,$46.30 ,$60.30 ,$46.67 ,$6.05 ,$52.93 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600316,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$112.00 ,$56.00 ,$24.08 ,$112.00 ,$24.88 ,$93.63 ,$80.25 ,$24.08 ,$67.20 ,$95.20 ,$78.40 ,$24.88 ,$106.40 ,$85.12 ,$84.00 ,$40.94 ,$95.20 ,$24.08 ,$40.94 ,$24.08 ,$78.40 ,$24.88 ,$24.08 ,$24.08 ,$27.25 ,$95.20 ,$54.18 ,$103.04 ,$78.40 ,$112.00 ,$112.00 ,$68.21 ,$112.00 ,$77.39 ,$100.80 ,$78.01 ,$24.32 ,$88.48 ,$26.37 ,$28.90 ,$28.90 ,$24.08 ,$28.90 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,30600332,87651,HC INFECT AMP (GRP A STREP),306,1 ,$248.00 ,$124.00 ,$35.09 ,$248.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$148.80 ,$210.80 ,$173.60 ,$36.26 ,$235.60 ,$188.48 ,$186.00 ,$59.65 ,$210.80 ,$35.09 ,$59.65 ,$35.09 ,$173.60 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$210.80 ,$78.95 ,$228.16 ,$173.60 ,$168.63 ,$168.63 ,$151.03 ,$168.63 ,$171.37 ,$223.20 ,$172.73 ,$35.44 ,$195.92 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$198.40 
ST NICHOLAS HOSPITAL - ACUTE,30600335,87799,HC INFECT AGENT QN BK VIRUS DNA,306,1 ,$325.00 ,$162.50 ,$42.84 ,$325.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$195.00 ,$276.25 ,$227.50 ,$44.27 ,$308.75 ,$247.00 ,$243.75 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$42.84 ,$227.50 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$205.86 ,$205.86 ,$197.93 ,$205.86 ,$224.58 ,$292.50 ,$226.36 ,$43.27 ,$256.75 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30600336,87507,HC IF AG DNA/RNA PROBE TQ 12-25 TARGETS,306,1 ,$942.00 ,$471.00 ,$416.78 ,$942.00 ,$430.66 ,$942.00 ,$942.00 ,$416.78 ,$565.20 ,$800.70 ,$659.40 ,$430.66 ,$894.90 ,$715.92 ,$706.50 ,$708.53 ,$800.70 ,$416.78 ,$708.53 ,$416.78 ,$659.40 ,$430.66 ,$416.78 ,$416.78 ,$471.71 ,$800.70 ,$937.76 ,$866.64 ,$659.40 ,$942.00 ,$942.00 ,$573.68 ,$942.00 ,$650.92 ,$847.80 ,$656.10 ,$420.95 ,$744.18 ,$456.50 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,$678.24 ,$584.04 ,$678.24 ,$678.24 ,$753.60 
ST NICHOLAS HOSPITAL - ACUTE,30600339,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,$896.00 ,$448.00 ,$416.78 ,$937.76 ,$430.66 ,$896.00 ,$896.00 ,$416.78 ,$537.60 ,$761.60 ,$627.20 ,$430.66 ,$851.20 ,$680.96 ,$672.00 ,$708.53 ,$761.60 ,$416.78 ,$708.53 ,$416.78 ,$627.20 ,$430.66 ,$416.78 ,$416.78 ,$471.71 ,$761.60 ,$937.76 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$420.95 ,$707.84 ,$456.50 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,30600341,87798,HC INFECT AMP (VZV VIRUS DNA QL RT PCR),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600343,87798,HC INFECT AMP (NOROVIRUS RNA QL RT PCR),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600344,87530,HC HSV QUANT  TYPE 1  AND  2 DNA QN RT PCR,306,1 ,$202.00 ,$101.00 ,$42.84 ,$202.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$121.20 ,$171.70 ,$141.40 ,$44.27 ,$191.90 ,$153.52 ,$151.50 ,$72.83 ,$171.70 ,$42.84 ,$72.83 ,$42.84 ,$141.40 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$171.70 ,$96.39 ,$185.84 ,$141.40 ,$202.00 ,$202.00 ,$123.02 ,$202.00 ,$139.58 ,$181.80 ,$140.69 ,$43.27 ,$159.58 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,30600345,87799,HC INFECT AGENT QN BK VIRUS DNA RT PCR URINE,306,1 ,$325.00 ,$162.50 ,$42.84 ,$325.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$195.00 ,$276.25 ,$227.50 ,$44.27 ,$308.75 ,$247.00 ,$243.75 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$42.84 ,$227.50 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$205.86 ,$205.86 ,$197.93 ,$205.86 ,$224.58 ,$292.50 ,$226.36 ,$43.27 ,$256.75 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,30600346,87798,HC INFECT AMP (B PERTUSSIS/PARA DNA QL RTPCR),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600347,87505,HC GI ENTERIC PATHOGEN PANEL 3-5 TARGETS,306,1 ,$437.00 ,$218.50 ,$128.29 ,$437.00 ,$132.56 ,$437.00 ,$427.62 ,$128.29 ,$262.20 ,$371.45 ,$305.90 ,$132.56 ,$415.15 ,$332.12 ,$327.75 ,$218.09 ,$371.45 ,$128.29 ,$218.09 ,$128.29 ,$305.90 ,$132.56 ,$128.29 ,$128.29 ,$145.20 ,$371.45 ,$288.65 ,$402.04 ,$305.90 ,$437.00 ,$437.00 ,$266.13 ,$437.00 ,$301.97 ,$393.30 ,$304.37 ,$129.57 ,$345.23 ,$140.51 ,$153.95 ,$153.95 ,$128.29 ,$153.95 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$349.60 
ST NICHOLAS HOSPITAL - ACUTE,30600348,87483,HC INFECT AMP CNS DNA/RNA 14 TARGETS,306,1 ,"$1,904.00 ",$952.00 ,$333.42 ,"$1,904.00 ",$333.42 ,"$1,620.82 ","$1,389.27 ",$416.78 ,"$1,142.40 ","$1,618.40 ","$1,332.80 ",$333.42 ,"$1,808.80 ","$1,447.04 ","$1,428.00 ",$708.53 ,"$1,618.40 ",$416.78 ,$708.53 ,$416.78 ,"$1,332.80 ",$333.42 ,$416.78 ,$416.78 ,$471.71 ,"$1,618.40 ",$937.76 ,"$1,751.68 ","$1,332.80 ","$1,631.28 ","$1,631.28 ","$1,159.54 ","$1,631.28 ","$1,315.66 ","$1,713.60 ","$1,326.14 ",$420.95 ,"$1,504.16 ",$353.43 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,"$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,523.20 "
ST NICHOLAS HOSPITAL - ACUTE,30600349,87798,HC INFECT AMP (ZIKA PCR SERUM),306,1 ,$327.00 ,$163.50 ,$35.09 ,$327.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$196.20 ,$277.95 ,$228.90 ,$36.26 ,$310.65 ,$248.52 ,$245.25 ,$59.65 ,$277.95 ,$35.09 ,$59.65 ,$35.09 ,$228.90 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$277.95 ,$78.95 ,$300.84 ,$228.90 ,$168.63 ,$168.63 ,$199.14 ,$168.63 ,$225.96 ,$294.30 ,$227.76 ,$35.44 ,$258.33 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$235.44 ,$202.74 ,$235.44 ,$235.44 ,$261.60 
ST NICHOLAS HOSPITAL - ACUTE,30600350,87798,HC INFECT AMP (ZIKA VIRUS REAL TIME PCR RNA QL),306,1 ,$560.00 ,$280.00 ,$35.09 ,$560.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$336.00 ,$476.00 ,$392.00 ,$36.26 ,$532.00 ,$425.60 ,$420.00 ,$59.65 ,$476.00 ,$35.09 ,$59.65 ,$35.09 ,$392.00 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$476.00 ,$78.95 ,$515.20 ,$392.00 ,$168.63 ,$168.63 ,$341.04 ,$168.63 ,$386.96 ,$504.00 ,$390.04 ,$35.44 ,$442.40 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,30600351,86628,HC CANDIDA AB  IGA IGG IBM,306,1 ,$41.00 ,$20.50 ,$8.17 ,$41.00 ,$8.17 ,$41.00 ,$40.02 ,$12.01 ,$24.60 ,$34.85 ,$28.70 ,$8.17 ,$38.95 ,$31.16 ,$30.75 ,$20.42 ,$34.85 ,$12.01 ,$20.42 ,$12.01 ,$28.70 ,$8.17 ,$12.01 ,$12.01 ,$13.59 ,$34.85 ,$27.02 ,$37.72 ,$28.70 ,$27.93 ,$27.93 ,$24.97 ,$27.93 ,$28.33 ,$36.90 ,$28.56 ,$12.13 ,$32.39 ,$8.66 ,$14.41 ,$14.41 ,$12.01 ,$14.41 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$32.80 
ST NICHOLAS HOSPITAL - ACUTE,30600352,87563,"HC INFECT AMP (MYCOPLASMA/UREAPLASMA PNL, PCR)",306,1 ,$269.00 ,$134.50 ,$28.07 ,$269.00 ,$28.07 ,$122.82 ,$105.27 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$28.07 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$28.07 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$123.61 ,$123.61 ,$163.82 ,$123.61 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$29.75 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600406,87254,HC VIRUS ISOL SHELL ID,306,1 ,$125.00 ,$62.50 ,$7.06 ,$125.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$75.00 ,$106.25 ,$87.50 ,$7.06 ,$118.75 ,$95.00 ,$93.75 ,$33.25 ,$106.25 ,$19.56 ,$33.25 ,$19.56 ,$87.50 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$106.25 ,$44.01 ,$115.00 ,$87.50 ,$93.98 ,$93.98 ,$76.13 ,$93.98 ,$86.38 ,$112.50 ,$87.06 ,$19.76 ,$98.75 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$100.00 
ST NICHOLAS HOSPITAL - ACUTE,30600478,87799,HC INFECT AGENT QN-90,306,1 ,$771.00 ,$385.50 ,$42.84 ,$771.00 ,$44.27 ,$166.60 ,$142.80 ,$42.84 ,$462.60 ,$655.35 ,$539.70 ,$44.27 ,$732.45 ,$585.96 ,$578.25 ,$72.83 ,$655.35 ,$42.84 ,$72.83 ,$42.84 ,$539.70 ,$44.27 ,$42.84 ,$42.84 ,$48.49 ,$655.35 ,$96.39 ,$709.32 ,$539.70 ,$205.86 ,$205.86 ,$469.54 ,$205.86 ,$532.76 ,$693.90 ,$537.00 ,$43.27 ,$609.09 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$555.12 ,$478.02 ,$555.12 ,$555.12 ,$616.80 
ST NICHOLAS HOSPITAL - ACUTE,30600498,87506,HC GI ENTERIC PATHOGEN PANEL 6-8 TARGETS,306,1 ,$526.00 ,$263.00 ,$232.94 ,$591.73 ,$232.94 ,$526.00 ,$526.00 ,$262.99 ,$315.60 ,$447.10 ,$368.20 ,$232.94 ,$499.70 ,$399.76 ,$394.50 ,$447.08 ,$447.10 ,$262.99 ,$447.08 ,$262.99 ,$368.20 ,$232.94 ,$262.99 ,$262.99 ,$297.65 ,$447.10 ,$591.73 ,$483.92 ,$368.20 ,$526.00 ,$526.00 ,$320.33 ,$526.00 ,$363.47 ,$473.40 ,$366.36 ,$265.62 ,$415.54 ,$246.92 ,$315.59 ,$315.59 ,$262.99 ,$315.59 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$420.80 
ST NICHOLAS HOSPITAL - ACUTE,30600499,87506,HC GI ENTERIC PATHOGEN PANEL 9-11 TARGETS,306,1 ,$605.00 ,$302.50 ,$232.94 ,$605.00 ,$232.94 ,$605.00 ,$605.00 ,$262.99 ,$363.00 ,$514.25 ,$423.50 ,$232.94 ,$574.75 ,$459.80 ,$453.75 ,$447.08 ,$514.25 ,$262.99 ,$447.08 ,$262.99 ,$423.50 ,$232.94 ,$262.99 ,$262.99 ,$297.65 ,$514.25 ,$591.73 ,$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$544.50 ,$421.38 ,$265.62 ,$477.95 ,$246.92 ,$315.59 ,$315.59 ,$262.99 ,$315.59 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,30600500,87254,HC VIRUS ISOL SHELL RESP RAPID CULTURE W/REFLEX,306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$87.60 ,$124.10 ,$102.20 ,$7.06 ,$138.70 ,$110.96 ,$109.50 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$19.56 ,$102.20 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$93.98 ,$93.98 ,$88.91 ,$93.98 ,$100.89 ,$131.40 ,$101.69 ,$19.76 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,30600501,87140,HC CLT TYP IF EA VIRAL RESP RAPID CULTURE REFLEX,306,1 ,$71.00 ,$35.50 ,$5.57 ,$71.00 ,$5.76 ,$21.67 ,$18.57 ,$5.57 ,$42.60 ,$60.35 ,$49.70 ,$5.76 ,$67.45 ,$53.96 ,$53.25 ,$9.47 ,$60.35 ,$5.57 ,$9.47 ,$5.57 ,$49.70 ,$5.76 ,$5.57 ,$5.57 ,$6.30 ,$60.35 ,$12.53 ,$65.32 ,$49.70 ,$21.91 ,$21.91 ,$43.24 ,$21.91 ,$49.06 ,$63.90 ,$49.45 ,$5.63 ,$56.09 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$56.80 
ST NICHOLAS HOSPITAL - ACUTE,30600540,87798,HC IF AGENT PARAPERTUSSIS DNA DETECTION METHOD,306,1 ,$358.00 ,$179.00 ,$35.09 ,$358.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$214.80 ,$304.30 ,$250.60 ,$36.26 ,$340.10 ,$272.08 ,$268.50 ,$59.65 ,$304.30 ,$35.09 ,$59.65 ,$35.09 ,$250.60 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$304.30 ,$78.95 ,$329.36 ,$250.60 ,$168.63 ,$168.63 ,$218.02 ,$168.63 ,$247.38 ,$322.20 ,$249.35 ,$35.44 ,$282.82 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,30600594,87150,HC CULTURE TYPING ID AMP PROBE TECH,306,1 ,$67.00 ,$33.50 ,$33.50 ,$78.95 ,$36.26 ,$67.00 ,$67.00 ,$35.09 ,$40.20 ,$56.95 ,$46.90 ,$36.26 ,$63.65 ,$50.92 ,$50.25 ,$59.65 ,$56.95 ,$35.09 ,$59.65 ,$35.09 ,$46.90 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$56.95 ,$78.95 ,$61.64 ,$46.90 ,$67.00 ,$67.00 ,$40.80 ,$67.00 ,$46.30 ,$60.30 ,$46.67 ,$35.44 ,$52.93 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30600595,87798,HC INFECT AMP (TICK BORNE PCR PNL CHAIN REACTION),306,1 ,$199.00 ,$99.50 ,$35.09 ,$199.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$119.40 ,$169.15 ,$139.30 ,$36.26 ,$189.05 ,$151.24 ,$149.25 ,$59.65 ,$169.15 ,$35.09 ,$59.65 ,$35.09 ,$139.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$169.15 ,$78.95 ,$183.08 ,$139.30 ,$168.63 ,$168.63 ,$121.19 ,$168.63 ,$137.51 ,$179.10 ,$138.60 ,$35.44 ,$157.21 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$143.28 ,$123.38 ,$143.28 ,$143.28 ,$159.20 
ST NICHOLAS HOSPITAL - ACUTE,30600596,87801,HC INFECT MLT ORG AMP TICK,306,1 ,$388.00 ,$194.00 ,$50.62 ,$388.00 ,$50.62 ,$272.97 ,$233.97 ,$70.20 ,$232.80 ,$329.80 ,$271.60 ,$50.62 ,$368.60 ,$294.88 ,$291.00 ,$119.34 ,$329.80 ,$70.20 ,$119.34 ,$70.20 ,$271.60 ,$50.62 ,$70.20 ,$70.20 ,$79.45 ,$329.80 ,$157.95 ,$356.96 ,$271.60 ,$337.32 ,$337.32 ,$236.29 ,$337.32 ,$268.11 ,$349.20 ,$270.24 ,$70.90 ,$306.52 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,30600597,87186,HC SENSITIVITY MIC FUNGUS,306,1 ,$403.00 ,$201.50 ,$8.65 ,$403.00 ,$8.94 ,$33.64 ,$28.83 ,$8.65 ,$241.80 ,$342.55 ,$282.10 ,$8.94 ,$382.85 ,$306.28 ,$302.25 ,$14.71 ,$342.55 ,$8.65 ,$14.71 ,$8.65 ,$282.10 ,$8.94 ,$8.65 ,$8.65 ,$9.79 ,$342.55 ,$19.46 ,$370.76 ,$282.10 ,$41.57 ,$41.57 ,$245.43 ,$41.57 ,$278.47 ,$362.70 ,$280.69 ,$8.74 ,$318.37 ,$9.48 ,$10.38 ,$10.38 ,$8.65 ,$10.38 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,30600616,87798,HC MYCOPL GENIT AMP PROBE,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$161.40 ,$228.65 ,$188.30 ,$36.26 ,$255.55 ,$204.44 ,$201.75 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$35.09 ,$188.30 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$168.63 ,$168.63 ,$163.82 ,$168.63 ,$185.88 ,$242.10 ,$187.36 ,$35.44 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,30600622,87081,HC CULTURE (H PYLORI),306,1 ,$134.00 ,$67.00 ,$6.63 ,$134.00 ,$6.85 ,$25.76 ,$22.08 ,$6.63 ,$80.40 ,$113.90 ,$93.80 ,$6.85 ,$127.30 ,$101.84 ,$100.50 ,$11.27 ,$113.90 ,$6.63 ,$11.27 ,$6.63 ,$93.80 ,$6.85 ,$6.63 ,$6.63 ,$7.50 ,$113.90 ,$14.92 ,$123.28 ,$93.80 ,$31.88 ,$31.88 ,$81.61 ,$31.88 ,$92.59 ,$120.60 ,$93.33 ,$6.70 ,$105.86 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,30600637,87635,HC COVID-19 LAB PCR TEST,306,1 ,$121.00 ,$60.50 ,$51.31 ,$121.00 ,$51.31 ,$121.00 ,$121.00 ,$51.31 ,$72.60 ,$102.85 ,$84.70 ,$51.31 ,$114.95 ,$91.96 ,$90.75 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$78.65 ,$84.70 ,$51.31 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$108.90 ,$84.28 ,$51.82 ,$95.59 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$96.80 
ST NICHOLAS HOSPITAL - ACUTE,30682011,87635,HC COVID-19 LAB TEST NON-CDC,306,1 ,$121.00 ,$60.50 ,$51.31 ,$121.00 ,$51.31 ,$121.00 ,$121.00 ,$51.31 ,$72.60 ,$102.85 ,$84.70 ,$51.31 ,$114.95 ,$91.96 ,$90.75 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$78.65 ,$84.70 ,$51.31 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$108.90 ,$84.28 ,$51.82 ,$95.59 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$96.80 
ST NICHOLAS HOSPITAL - ACUTE,30682013,87635,HC COVID-19 LAB TEST,306,1 ,$121.00 ,$60.50 ,$51.31 ,$121.00 ,$51.31 ,$121.00 ,$121.00 ,$51.31 ,$72.60 ,$102.85 ,$84.70 ,$51.31 ,$114.95 ,$91.96 ,$90.75 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$78.65 ,$84.70 ,$51.31 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$108.90 ,$84.28 ,$51.82 ,$95.59 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$96.80 
ST NICHOLAS HOSPITAL - ACUTE,30682014,86769,HC SARS-COV-2 COVID-19 ANTIBODY,306,1 ,$87.00 ,$43.50 ,$42.13 ,$94.79 ,$42.13 ,$87.00 ,$87.00 ,$42.13 ,$52.20 ,$73.95 ,$60.90 ,$42.13 ,$82.65 ,$66.12 ,$65.25 ,$71.62 ,$73.95 ,$42.13 ,$71.62 ,$56.55 ,$60.90 ,$42.13 ,$42.13 ,$42.13 ,$47.68 ,$73.95 ,$94.79 ,$80.04 ,$60.90 ,$87.00 ,$87.00 ,$52.98 ,$87.00 ,$60.12 ,$78.30 ,$60.60 ,$42.55 ,$68.73 ,$44.66 ,$50.56 ,$50.56 ,$42.13 ,$50.56 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,30682021,86769,HC SARS-COV-2 COVID-19 ANTIBODY IN-HOUSE,306,1 ,$87.00 ,$43.50 ,$42.13 ,$94.79 ,$42.13 ,$87.00 ,$87.00 ,$42.13 ,$52.20 ,$73.95 ,$60.90 ,$42.13 ,$82.65 ,$66.12 ,$65.25 ,$71.62 ,$73.95 ,$42.13 ,$71.62 ,$56.55 ,$60.90 ,$42.13 ,$42.13 ,$42.13 ,$47.68 ,$73.95 ,$94.79 ,$80.04 ,$60.90 ,$87.00 ,$87.00 ,$52.98 ,$87.00 ,$60.12 ,$78.30 ,$60.60 ,$42.55 ,$68.73 ,$44.66 ,$50.56 ,$50.56 ,$42.13 ,$50.56 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,30682023,87426,HC SARS COVID ANTIGEN TEST,306,1 ,$84.00 ,$42.00 ,$35.33 ,$84.00 ,$35.33 ,$84.00 ,$84.00 ,$35.33 ,$50.40 ,$71.40 ,$58.80 ,$35.33 ,$79.80 ,$63.84 ,$63.00 ,$76.89 ,$71.40 ,$35.33 ,$76.89 ,$54.60 ,$58.80 ,$35.33 ,$35.33 ,$35.33 ,$39.99 ,$71.40 ,$79.49 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$75.60 ,$58.51 ,$35.68 ,$66.36 ,$37.45 ,$54.44 ,$54.44 ,$35.33 ,$54.44 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,30682024,87635,HC SARS-COV-2 COVID-19 TEST,306,1 ,$121.00 ,$60.50 ,$51.31 ,$121.00 ,$51.31 ,$121.00 ,$121.00 ,$51.31 ,$72.60 ,$102.85 ,$84.70 ,$51.31 ,$114.95 ,$91.96 ,$90.75 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$78.65 ,$84.70 ,$51.31 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$108.90 ,$84.28 ,$51.82 ,$95.59 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$96.80 
ST NICHOLAS HOSPITAL - ACUTE,30682027,87661,HC TRICHOMONAS VAGINALIS AMPLIF,306,1 ,$170.00 ,$85.00 ,$35.09 ,$170.00 ,$36.26 ,$136.47 ,$116.97 ,$35.09 ,$102.00 ,$144.50 ,$119.00 ,$36.26 ,$161.50 ,$129.20 ,$127.50 ,$59.65 ,$144.50 ,$35.09 ,$59.65 ,$35.09 ,$119.00 ,$36.26 ,$35.09 ,$35.09 ,$39.71 ,$144.50 ,$78.95 ,$156.40 ,$119.00 ,$168.63 ,$168.63 ,$103.53 ,$168.63 ,$117.47 ,$153.00 ,$118.41 ,$35.44 ,$134.30 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$43.00 ,$21.50 ,$3.17 ,$43.00 ,$3.28 ,$12.32 ,$10.56 ,$3.17 ,$25.80 ,$36.55 ,$30.10 ,$3.28 ,$40.85 ,$32.68 ,$32.25 ,$5.39 ,$36.55 ,$3.17 ,$5.39 ,$3.17 ,$30.10 ,$3.28 ,$3.17 ,$3.17 ,$3.59 ,$36.55 ,$7.13 ,$39.56 ,$30.10 ,$15.22 ,$15.22 ,$26.19 ,$15.22 ,$29.71 ,$38.70 ,$29.95 ,$3.20 ,$33.97 ,$3.48 ,$3.80 ,$3.80 ,$3.17 ,$3.80 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,30700102,81003,HC URINALYSIS DIP STICK,307,1 ,$26.00 ,$13.00 ,$2.25 ,$26.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$15.60 ,$22.10 ,$18.20 ,$2.32 ,$24.70 ,$19.76 ,$19.50 ,$3.83 ,$22.10 ,$2.25 ,$3.83 ,$2.25 ,$18.20 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$22.10 ,$5.06 ,$23.92 ,$18.20 ,$10.78 ,$10.78 ,$15.83 ,$10.78 ,$17.97 ,$23.40 ,$18.11 ,$2.27 ,$20.54 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$20.80 
ST NICHOLAS HOSPITAL - ACUTE,30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$31.00 ,$15.50 ,$2.25 ,$31.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$18.60 ,$26.35 ,$21.70 ,$2.32 ,$29.45 ,$23.56 ,$23.25 ,$3.83 ,$26.35 ,$2.25 ,$3.83 ,$2.25 ,$21.70 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$26.35 ,$5.06 ,$28.52 ,$21.70 ,$10.78 ,$10.78 ,$18.88 ,$10.78 ,$21.42 ,$27.90 ,$21.59 ,$2.27 ,$24.49 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$24.80 
ST NICHOLAS HOSPITAL - ACUTE,30700105,81003,HC URINE ONE TEST ONLY,307,1 ,$21.00 ,$10.50 ,$2.25 ,$21.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$12.60 ,$17.85 ,$14.70 ,$2.32 ,$19.95 ,$15.96 ,$15.75 ,$3.83 ,$17.85 ,$2.25 ,$3.83 ,$2.25 ,$14.70 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$17.85 ,$5.06 ,$19.32 ,$14.70 ,$10.78 ,$10.78 ,$12.79 ,$10.78 ,$14.51 ,$18.90 ,$14.63 ,$2.27 ,$16.59 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$15.12 ,$13.02 ,$15.12 ,$15.12 ,$16.80 
ST NICHOLAS HOSPITAL - ACUTE,30700106,81003,HC URINALYSIS BLOOD,307,1 ,$40.00 ,$20.00 ,$2.25 ,$40.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$24.00 ,$34.00 ,$28.00 ,$2.32 ,$38.00 ,$30.40 ,$30.00 ,$3.83 ,$34.00 ,$2.25 ,$3.83 ,$2.25 ,$28.00 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$34.00 ,$5.06 ,$36.80 ,$28.00 ,$10.78 ,$10.78 ,$24.36 ,$10.78 ,$27.64 ,$36.00 ,$27.86 ,$2.27 ,$31.60 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,30700107,81003,HC URINALYSIS GLUCOSE,307,1 ,$17.00 ,$8.50 ,$2.25 ,$17.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$10.20 ,$14.45 ,$11.90 ,$2.32 ,$16.15 ,$12.92 ,$12.75 ,$3.83 ,$14.45 ,$2.25 ,$3.83 ,$2.25 ,$11.90 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$14.45 ,$5.06 ,$15.64 ,$11.90 ,$10.78 ,$10.78 ,$10.35 ,$10.78 ,$11.75 ,$15.30 ,$11.84 ,$2.27 ,$13.43 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,30700108,81003,HC URINALYSIS ACETONE OR PH,307,1 ,$25.00 ,$12.50 ,$2.25 ,$25.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$15.00 ,$21.25 ,$17.50 ,$2.32 ,$23.75 ,$19.00 ,$18.75 ,$3.83 ,$21.25 ,$2.25 ,$3.83 ,$2.25 ,$17.50 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$21.25 ,$5.06 ,$23.00 ,$17.50 ,$10.78 ,$10.78 ,$15.23 ,$10.78 ,$17.28 ,$22.50 ,$17.41 ,$2.27 ,$19.75 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30700109,81003,HC URINALYSIS PROTEIN,307,1 ,$25.00 ,$12.50 ,$2.25 ,$25.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$15.00 ,$21.25 ,$17.50 ,$2.32 ,$23.75 ,$19.00 ,$18.75 ,$3.83 ,$21.25 ,$2.25 ,$3.83 ,$2.25 ,$17.50 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$21.25 ,$5.06 ,$23.00 ,$17.50 ,$10.78 ,$10.78 ,$15.23 ,$10.78 ,$17.28 ,$22.50 ,$17.41 ,$2.27 ,$19.75 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30700110,81003,HC URINALYSIS KETONE,307,1 ,$25.00 ,$12.50 ,$2.25 ,$25.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$15.00 ,$21.25 ,$17.50 ,$2.32 ,$23.75 ,$19.00 ,$18.75 ,$3.83 ,$21.25 ,$2.25 ,$3.83 ,$2.25 ,$17.50 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$21.25 ,$5.06 ,$23.00 ,$17.50 ,$10.78 ,$10.78 ,$15.23 ,$10.78 ,$17.28 ,$22.50 ,$17.41 ,$2.27 ,$19.75 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30700111,81003,HC URINALYSIS SPECIFIC GRAVITY,307,1 ,$17.00 ,$8.50 ,$2.25 ,$17.00 ,$2.32 ,$8.72 ,$7.47 ,$2.25 ,$10.20 ,$14.45 ,$11.90 ,$2.32 ,$16.15 ,$12.92 ,$12.75 ,$3.83 ,$14.45 ,$2.25 ,$3.83 ,$2.25 ,$11.90 ,$2.32 ,$2.25 ,$2.25 ,$2.55 ,$14.45 ,$5.06 ,$15.64 ,$11.90 ,$10.78 ,$10.78 ,$10.35 ,$10.78 ,$11.75 ,$15.30 ,$11.84 ,$2.27 ,$13.43 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,30700113,81005,HC REDUCING SUBSTANCES,307,1 ,$71.00 ,$35.50 ,$2.17 ,$71.00 ,$2.24 ,$8.44 ,$7.23 ,$2.17 ,$42.60 ,$60.35 ,$49.70 ,$2.24 ,$67.45 ,$53.96 ,$53.25 ,$3.69 ,$60.35 ,$2.17 ,$3.69 ,$2.17 ,$49.70 ,$2.24 ,$2.17 ,$2.17 ,$2.46 ,$60.35 ,$4.88 ,$65.32 ,$49.70 ,$10.43 ,$10.43 ,$43.24 ,$10.43 ,$49.06 ,$63.90 ,$49.45 ,$2.19 ,$56.09 ,$2.37 ,$2.60 ,$2.60 ,$2.17 ,$2.60 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$56.80 
ST NICHOLAS HOSPITAL - ACUTE,30700114,81005,HC QUALITATIVE SUGARS SCREEN,307,1 ,$73.00 ,$36.50 ,$2.17 ,$73.00 ,$2.24 ,$8.44 ,$7.23 ,$2.17 ,$43.80 ,$62.05 ,$51.10 ,$2.24 ,$69.35 ,$55.48 ,$54.75 ,$3.69 ,$62.05 ,$2.17 ,$3.69 ,$2.17 ,$51.10 ,$2.24 ,$2.17 ,$2.17 ,$2.46 ,$62.05 ,$4.88 ,$67.16 ,$51.10 ,$10.43 ,$10.43 ,$44.46 ,$10.43 ,$50.44 ,$65.70 ,$50.84 ,$2.19 ,$57.67 ,$2.37 ,$2.60 ,$2.60 ,$2.17 ,$2.60 ,$52.56 ,$45.26 ,$52.56 ,$52.56 ,$58.40 
ST NICHOLAS HOSPITAL - ACUTE,30700115,81015,HC URINALYSIS MICRO ONLY,307,1 ,$24.00 ,$12.00 ,$3.05 ,$24.00 ,$3.15 ,$11.87 ,$10.17 ,$3.05 ,$14.40 ,$20.40 ,$16.80 ,$3.15 ,$22.80 ,$18.24 ,$18.00 ,$5.19 ,$20.40 ,$3.05 ,$5.19 ,$3.05 ,$16.80 ,$3.15 ,$3.05 ,$3.05 ,$3.45 ,$20.40 ,$6.86 ,$22.08 ,$16.80 ,$14.62 ,$14.62 ,$14.62 ,$14.62 ,$16.58 ,$21.60 ,$16.72 ,$3.08 ,$18.96 ,$3.34 ,$3.66 ,$3.66 ,$3.05 ,$3.66 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$19.20 
ST NICHOLAS HOSPITAL - ACUTE,30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$67.00 ,$33.50 ,$8.61 ,$67.00 ,$8.90 ,$30.14 ,$25.83 ,$8.61 ,$40.20 ,$56.95 ,$46.90 ,$8.90 ,$63.65 ,$50.92 ,$50.25 ,$14.64 ,$56.95 ,$8.61 ,$14.64 ,$8.61 ,$46.90 ,$8.90 ,$8.61 ,$8.61 ,$9.74 ,$56.95 ,$19.37 ,$61.64 ,$46.90 ,$30.40 ,$30.40 ,$40.80 ,$30.40 ,$46.30 ,$60.30 ,$46.67 ,$8.70 ,$52.93 ,$9.43 ,$10.33 ,$10.33 ,$8.61 ,$10.33 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$53.60 
ST NICHOLAS HOSPITAL - ACUTE,30700117,81050,HC VOLUME MEASUREMENT URINE,307,1 ,$25.00 ,$12.50 ,$3.64 ,$25.00 ,$3.76 ,$12.74 ,$10.92 ,$3.64 ,$15.00 ,$21.25 ,$17.50 ,$3.76 ,$23.75 ,$19.00 ,$18.75 ,$6.19 ,$21.25 ,$3.64 ,$6.19 ,$3.64 ,$17.50 ,$3.76 ,$3.64 ,$3.64 ,$4.12 ,$21.25 ,$8.19 ,$23.00 ,$17.50 ,$14.41 ,$14.41 ,$15.23 ,$14.41 ,$17.28 ,$22.50 ,$17.41 ,$3.68 ,$19.75 ,$3.99 ,$4.37 ,$4.37 ,$3.64 ,$4.37 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,30900001,N/A,HC SLIDE PROCESSING FEE,309,1 ,$11.00 ,$5.50 ,$4.62 ,$11.00 , N/A ,$7.12 ,$7.12 , N/A ,$6.60 ,$9.35 ,$7.70 , N/A ,$10.45 ,$8.36 ,$8.25 , N/A ,$9.35 , N/A , N/A ,$7.15 ,$7.70 , N/A , N/A , N/A ,$4.62 ,$9.35 , N/A ,$10.12 ,$7.70 ,$5.58 ,$6.70 ,$6.70 ,$6.70 ,$7.60 ,$9.90 ,$7.66 , N/A ,$8.69 , N/A ,$5.50 ,$5.50 , N/A ,$5.50 ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$8.80 
ST NICHOLAS HOSPITAL - ACUTE,30900002,89300,HC POST VASECTOMY SEMEN ANALYSIS,309,1 ,$83.00 ,$41.50 ,$9.84 ,$83.00 ,$10.17 ,$34.72 ,$29.76 ,$9.84 ,$49.80 ,$70.55 ,$58.10 ,$10.17 ,$78.85 ,$63.08 ,$62.25 ,$16.73 ,$70.55 ,$9.84 ,$16.73 ,$9.84 ,$58.10 ,$10.17 ,$9.84 ,$9.84 ,$11.14 ,$70.55 ,$22.14 ,$76.36 ,$58.10 ,$42.87 ,$42.87 ,$50.55 ,$42.87 ,$57.35 ,$74.70 ,$57.81 ,$9.94 ,$65.57 ,$10.78 ,$11.81 ,$11.81 ,$9.84 ,$11.81 ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$66.40 
ST NICHOLAS HOSPITAL - ACUTE,30900199,87254,HC VIRUS ISOL SHELL ID,309,1 ,$139.00 ,$69.50 ,$7.06 ,$139.00 ,$7.06 ,$76.06 ,$65.19 ,$19.56 ,$83.40 ,$118.15 ,$97.30 ,$7.06 ,$132.05 ,$105.64 ,$104.25 ,$33.25 ,$118.15 ,$19.56 ,$33.25 ,$19.56 ,$97.30 ,$7.06 ,$19.56 ,$19.56 ,$22.14 ,$118.15 ,$44.01 ,$127.88 ,$97.30 ,$93.98 ,$93.98 ,$84.65 ,$93.98 ,$96.05 ,$125.10 ,$96.81 ,$19.76 ,$109.81 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$111.20 
ST NICHOLAS HOSPITAL - ACUTE,31000001,N/A,HC AUTOPSY PER BLOCK-CLINICS,310,1 ,$17.00 ,$8.50 ,$7.14 ,$17.00 , N/A ,$11.00 ,$11.00 , N/A ,$10.20 ,$14.45 ,$11.90 , N/A ,$16.15 ,$12.92 ,$12.75 , N/A ,$14.45 , N/A , N/A ,$11.05 ,$11.90 , N/A , N/A , N/A ,$7.14 ,$14.45 , N/A ,$15.64 ,$11.90 ,$8.62 ,$10.35 ,$10.35 ,$10.35 ,$11.75 ,$15.30 ,$11.84 , N/A ,$13.43 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$13.60 
ST NICHOLAS HOSPITAL - ACUTE,31000002,N/A,HC AUTOPSY PER BLOCK-IN HOUSE,310,1 ,$37.00 ,$18.50 ,$15.54 ,$37.00 , N/A ,$23.94 ,$23.94 , N/A ,$22.20 ,$31.45 ,$25.90 , N/A ,$35.15 ,$28.12 ,$27.75 , N/A ,$31.45 , N/A , N/A ,$24.05 ,$25.90 , N/A , N/A , N/A ,$15.54 ,$31.45 , N/A ,$34.04 ,$25.90 ,$18.77 ,$22.52 ,$22.53 ,$22.52 ,$25.57 ,$33.30 ,$25.77 , N/A ,$29.23 , N/A ,$18.50 ,$18.50 , N/A ,$18.50 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$29.60 
ST NICHOLAS HOSPITAL - ACUTE,31000003,N/A,HC MORGUE USE,310,1 ,$224.00 ,$112.00 ,$94.08 ,$224.00 , N/A ,$144.91 ,$144.91 , N/A ,$134.40 ,$190.40 ,$156.80 , N/A ,$212.80 ,$170.24 ,$168.00 , N/A ,$190.40 , N/A , N/A ,$145.60 ,$156.80 , N/A , N/A , N/A ,$94.08 ,$190.40 , N/A ,$206.08 ,$156.80 ,$113.61 ,$136.35 ,$136.42 ,$136.35 ,$154.78 ,$201.60 ,$156.02 , N/A ,$176.96 , N/A ,$112.00 ,$112.00 , N/A ,$112.00 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,31000006,88312,HC AUTOPSY SPECIAL STAIN LEVEL I,310,1 ,$28.00 ,$14.00 ,$6.95 ,$110.24 ,$6.95 ,$28.00 ,$28.00 ,$49.00 ,$16.80 ,$23.80 ,$19.60 ,$6.95 ,$26.60 ,$21.28 ,$21.00 ,$28.00 ,$23.80 ,$49.00 ,$28.00 ,$28.00 ,$19.60 ,$6.95 ,$49.00 ,$49.00 ,$11.76 ,$23.80 ,$110.24 ,$25.76 ,$19.60 ,$28.00 ,$28.00 ,$17.05 ,$28.00 ,$19.35 ,$25.20 ,$19.50 ,$49.49 ,$22.12 ,$7.37 ,$28.00 ,$28.00 ,$49.00 ,$28.00 ,$20.16 ,$17.36 ,$20.16 ,$20.16 ,$22.40 
ST NICHOLAS HOSPITAL - ACUTE,31000007,88312,HC AUTOPSY SPECIAL STAIN LEVEL II,310,1 ,$34.00 ,$17.00 ,$6.95 ,$110.24 ,$6.95 ,$34.00 ,$34.00 ,$49.00 ,$20.40 ,$28.90 ,$23.80 ,$6.95 ,$32.30 ,$25.84 ,$25.50 ,$34.00 ,$28.90 ,$49.00 ,$34.00 ,$34.00 ,$23.80 ,$6.95 ,$49.00 ,$49.00 ,$14.28 ,$28.90 ,$110.24 ,$31.28 ,$23.80 ,$34.00 ,$34.00 ,$20.71 ,$34.00 ,$23.49 ,$30.60 ,$23.68 ,$49.49 ,$26.86 ,$7.37 ,$34.00 ,$34.00 ,$49.00 ,$34.00 ,$24.48 ,$21.08 ,$24.48 ,$24.48 ,$27.20 
ST NICHOLAS HOSPITAL - ACUTE,31000008,88341,HC AUTOPSY IMMUNOPEROXIDASE QL,310,1 ,$49.00 ,$24.50 ,$12.70 ,$49.00 ,$12.70 ,$49.00 ,$49.00 , N/A ,$29.40 ,$41.65 ,$34.30 ,$12.70 ,$46.55 ,$37.24 ,$36.75 ,$49.00 ,$41.65 , N/A ,$49.00 ,$49.00 ,$34.30 ,$12.70 , N/A , N/A ,$20.58 ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$29.83 ,$33.86 ,$44.10 ,$34.13 , N/A ,$38.71 ,$13.46 ,$49.00 ,$49.00 , N/A ,$49.00 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,31000009,88360,HC AUTOPSY IMMUNOPEROXIDASE QN,310,1 ,$56.00 ,$28.00 ,$12.70 ,$330.88 ,$12.70 ,$56.00 ,$56.00 ,$147.06 ,$33.60 ,$47.60 ,$39.20 ,$12.70 ,$53.20 ,$42.56 ,$42.00 ,$56.00 ,$47.60 ,$147.06 ,$56.00 ,$56.00 ,$39.20 ,$12.70 ,$147.06 ,$147.06 ,$23.52 ,$47.60 ,$330.88 ,$51.52 ,$39.20 ,$56.00 ,$56.00 ,$34.10 ,$56.00 ,$38.70 ,$50.40 ,$39.00 ,$148.53 ,$44.24 ,$13.46 ,$56.00 ,$56.00 ,$147.06 ,$56.00 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,31000010,81206,HC BCR/ABL1 GENE MAJOR BP,310,1 ,$851.00 ,$425.50 ,$163.96 ,$851.00 ,$169.42 ,$637.63 ,$546.54 ,$163.96 ,$510.60 ,$723.35 ,$595.70 ,$169.42 ,$808.45 ,$646.76 ,$638.25 ,$278.73 ,$723.35 ,$163.96 ,$278.73 ,$163.96 ,$595.70 ,$169.42 ,$163.96 ,$163.96 ,$185.57 ,$723.35 ,$368.91 ,$782.92 ,$595.70 ,$787.97 ,$787.97 ,$518.26 ,$787.97 ,$588.04 ,$765.90 ,$592.72 ,$165.60 ,$672.29 ,$179.59 ,$196.75 ,$196.75 ,$163.96 ,$196.75 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,31000011,81206,HC BCR/ABL1 GENE MAJOR BP QUEST,310,1 ,$470.00 ,$235.00 ,$163.96 ,$470.00 ,$169.42 ,$470.00 ,$470.00 ,$163.96 ,$282.00 ,$399.50 ,$329.00 ,$169.42 ,$446.50 ,$357.20 ,$352.50 ,$278.73 ,$399.50 ,$163.96 ,$278.73 ,$163.96 ,$329.00 ,$169.42 ,$163.96 ,$163.96 ,$185.57 ,$399.50 ,$368.91 ,$432.40 ,$329.00 ,$470.00 ,$470.00 ,$286.23 ,$470.00 ,$324.77 ,$423.00 ,$327.36 ,$165.60 ,$371.30 ,$179.59 ,$196.75 ,$196.75 ,$163.96 ,$196.75 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,31000012,81207,HC BCR/ABL1 GENE MINOR BP,310,1 ,"$1,030.00 ",$515.00 ,$144.84 ,"$1,030.00 ",$149.66 ,$563.26 ,$482.79 ,$144.84 ,$618.00 ,$875.50 ,$721.00 ,$149.66 ,$978.50 ,$782.80 ,$772.50 ,$246.23 ,$875.50 ,$144.84 ,$246.23 ,$144.84 ,$721.00 ,$149.66 ,$144.84 ,$144.84 ,$163.93 ,$875.50 ,$325.89 ,$947.60 ,$721.00 ,$696.03 ,$696.03 ,$627.27 ,$696.03 ,$711.73 ,$927.00 ,$717.40 ,$146.29 ,$813.70 ,$158.64 ,$173.81 ,$173.81 ,$144.84 ,$173.81 ,$741.60 ,$638.60 ,$741.60 ,$741.60 ,$824.00 
ST NICHOLAS HOSPITAL - ACUTE,31000013,81226,HC CYP2D6 GENE COM VARIANTS,310,1 ,"$1,792.00 ",$896.00 ,$126.90 ,"$1,792.00 ",$126.90 ,"$1,578.19 ","$1,352.73 ",$450.91 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$126.90 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$766.55 ,"$1,523.20 ",$450.91 ,$766.55 ,$450.91 ,"$1,254.40 ",$126.90 ,$450.91 ,$450.91 ,$510.34 ,"$1,523.20 ","$1,014.55 ","$1,648.64 ","$1,254.40 ","$1,590.77 ","$1,590.77 ","$1,091.33 ","$1,590.77 ","$1,238.27 ","$1,612.80 ","$1,248.13 ",$455.42 ,"$1,415.68 ",$134.51 ,$541.09 ,$541.09 ,$450.91 ,$541.09 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,31000014,81228,HC CYTOGEN MICRARRAY COPY NO,310,1 ,"$2,262.00 ","$1,131.00 ",$516.91 ,"$2,262.00 ",$516.91 ,"$2,262.00 ","$2,262.00 ",$900.00 ,"$1,357.20 ","$1,922.70 ","$1,583.40 ",$516.91 ,"$2,148.90 ","$1,719.12 ","$1,696.50 ","$1,530.00 ","$1,922.70 ",$900.00 ,"$1,530.00 ",$900.00 ,"$1,583.40 ",$516.91 ,$900.00 ,$900.00 ,"$1,018.62 ","$1,922.70 ","$2,025.00 ","$2,081.04 ","$1,583.40 ","$2,262.00 ","$2,262.00 ","$1,377.56 ","$2,262.00 ","$1,563.04 ","$2,035.80 ","$1,575.48 ",$909.00 ,"$1,786.98 ",$547.92 ,"$1,080.00 ","$1,080.00 ",$900.00 ,"$1,080.00 ","$1,628.64 ","$1,402.44 ","$1,628.64 ","$1,628.64 ","$1,809.60 "
ST NICHOLAS HOSPITAL - ACUTE,31000015,81240,HC F2 GENE ANAL 20210G A VAR,310,1 ,$269.00 ,$134.50 ,$53.70 ,$269.00 ,$53.70 ,$229.92 ,$197.07 ,$65.69 ,$161.40 ,$228.65 ,$188.30 ,$53.70 ,$255.55 ,$204.44 ,$201.75 ,$111.67 ,$228.65 ,$65.69 ,$111.67 ,$65.69 ,$188.30 ,$53.70 ,$65.69 ,$65.69 ,$74.35 ,$228.65 ,$147.80 ,$247.48 ,$188.30 ,$236.47 ,$236.47 ,$163.82 ,$236.47 ,$185.88 ,$242.10 ,$187.36 ,$66.35 ,$212.51 ,$56.92 ,$78.83 ,$78.83 ,$65.69 ,$78.83 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,31000016,81241,HC F5 GENE ANAL LEIDEN VAR,310,1 ,$269.00 ,$134.50 ,$66.70 ,$269.00 ,$66.70 ,$256.80 ,$220.11 ,$73.37 ,$161.40 ,$228.65 ,$188.30 ,$66.70 ,$255.55 ,$204.44 ,$201.75 ,$124.73 ,$228.65 ,$73.37 ,$124.73 ,$73.37 ,$188.30 ,$66.70 ,$73.37 ,$73.37 ,$83.04 ,$228.65 ,$165.08 ,$247.48 ,$188.30 ,$269.00 ,$269.00 ,$163.82 ,$269.00 ,$185.88 ,$242.10 ,$187.36 ,$74.10 ,$212.51 ,$70.70 ,$88.04 ,$88.04 ,$73.37 ,$88.04 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,31000017,81243,HC FMR1 GENE CHARACTERZTN,310,1 ,$269.00 ,$134.50 ,$54.46 ,$269.00 ,$54.46 ,$199.64 ,$171.12 , N/A ,$161.40 ,$228.65 ,$188.30 ,$54.46 ,$255.55 ,$204.44 ,$201.75 ,$96.97 ,$228.65 , N/A ,$96.97 ,$57.04 ,$188.30 ,$54.46 , N/A , N/A ,$64.56 ,$228.65 ,$161.40 ,$247.48 ,$188.30 ,$200.93 ,$200.93 ,$163.82 ,$200.93 ,$185.88 ,$242.10 ,$187.36 , N/A ,$212.51 ,$57.73 ,$68.45 ,$68.45 , N/A ,$68.45 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,31000018,81256,HC HFE GENE,310,1 ,$482.00 ,$241.00 ,$65.36 ,$482.00 ,$67.54 ,$254.17 ,$217.86 ,$65.36 ,$289.20 ,$409.70 ,$337.40 ,$67.54 ,$457.90 ,$366.32 ,$361.50 ,$111.11 ,$409.70 ,$65.36 ,$111.11 ,$65.36 ,$337.40 ,$67.54 ,$65.36 ,$65.36 ,$73.97 ,$409.70 ,$147.06 ,$443.44 ,$337.40 ,$314.11 ,$314.11 ,$293.54 ,$314.11 ,$333.06 ,$433.80 ,$335.71 ,$66.01 ,$380.78 ,$71.59 ,$78.43 ,$78.43 ,$65.36 ,$78.43 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,31000019,81261,HC IGH GENE REARRNG AMP METH,310,1 ,"$1,813.00 ",$906.50 ,$197.99 ,"$1,813.00 ",$204.58 ,$769.97 ,$659.97 ,$197.99 ,"$1,087.80 ","$1,541.05 ","$1,269.10 ",$204.58 ,"$1,722.35 ","$1,377.88 ","$1,359.75 ",$336.58 ,"$1,541.05 ",$197.99 ,$336.58 ,$197.99 ,"$1,269.10 ",$204.58 ,$197.99 ,$197.99 ,$224.09 ,"$1,541.05 ",$445.48 ,"$1,667.96 ","$1,269.10 ",$951.49 ,$951.49 ,"$1,104.12 ",$951.49 ,"$1,252.78 ","$1,631.70 ","$1,262.75 ",$199.97 ,"$1,432.27 ",$216.85 ,$237.59 ,$237.59 ,$197.99 ,$237.59 ,"$1,305.36 ","$1,124.06 ","$1,305.36 ","$1,305.36 ","$1,450.40 "
ST NICHOLAS HOSPITAL - ACUTE,31000020,81264,HC IGK REARRANGE CLONAL POP,310,1 ,"$1,813.00 ",$906.50 ,$162.98 ,"$1,813.00 ",$162.98 ,$604.56 ,$518.19 ,$172.73 ,"$1,087.80 ","$1,541.05 ","$1,269.10 ",$162.98 ,"$1,722.35 ","$1,377.88 ","$1,359.75 ",$293.64 ,"$1,541.05 ",$172.73 ,$293.64 ,$172.73 ,"$1,269.10 ",$162.98 ,$172.73 ,$172.73 ,$195.50 ,"$1,541.05 ",$388.64 ,"$1,667.96 ","$1,269.10 ",$717.62 ,$717.62 ,"$1,104.12 ",$717.62 ,"$1,252.78 ","$1,631.70 ","$1,262.75 ",$174.46 ,"$1,432.27 ",$172.76 ,$207.28 ,$207.28 ,$172.73 ,$207.28 ,"$1,305.36 ","$1,124.06 ","$1,305.36 ","$1,305.36 ","$1,450.40 "
ST NICHOLAS HOSPITAL - ACUTE,31000021,81275,HC KRAS GENE,310,1 ,"$1,053.00 ",$526.50 ,$157.98 ,"$1,053.00 ",$157.98 ,$676.38 ,$579.75 ,$193.25 ,$631.80 ,$895.05 ,$737.10 ,$157.98 ,"$1,000.35 ",$800.28 ,$789.75 ,$328.53 ,$895.05 ,$193.25 ,$328.53 ,$193.25 ,$737.10 ,$157.98 ,$193.25 ,$193.25 ,$218.72 ,$895.05 ,$434.81 ,$968.76 ,$737.10 ,$695.64 ,$695.64 ,$641.28 ,$695.64 ,$727.62 ,$947.70 ,$733.41 ,$195.18 ,$831.87 ,$167.46 ,$231.90 ,$231.90 ,$193.25 ,$231.90 ,$758.16 ,$652.86 ,$758.16 ,$758.16 ,$842.40 
ST NICHOLAS HOSPITAL - ACUTE,31000022,81291,HC MTHFR ISOLATION,310,1 ,$336.00 ,$168.00 ,$13.61 ,$336.00 ,$13.61 ,$228.69 ,$196.02 ,$65.34 ,$201.60 ,$285.60 ,$235.20 ,$13.61 ,$319.20 ,$255.36 ,$252.00 ,$111.08 ,$285.60 ,$65.34 ,$111.08 ,$65.34 ,$235.20 ,$13.61 ,$65.34 ,$65.34 ,$73.95 ,$285.60 ,$147.02 ,$309.12 ,$235.20 ,$209.77 ,$209.77 ,$204.62 ,$209.77 ,$232.18 ,$302.40 ,$234.02 ,$65.99 ,$265.44 ,$14.43 ,$78.41 ,$78.41 ,$65.34 ,$78.41 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,31000023,81301,HC MSI MICROSAT INSTAB,310,1 ,"$1,221.00 ",$610.50 ,$316.03 ,"$1,221.00 ",$316.03 ,"$1,219.96 ","$1,045.68 ",$348.56 ,$732.60 ,"$1,037.85 ",$854.70 ,$316.03 ,"$1,159.95 ",$927.96 ,$915.75 ,$592.55 ,"$1,037.85 ",$348.56 ,$592.55 ,$348.56 ,$854.70 ,$316.03 ,$348.56 ,$348.56 ,$394.50 ,"$1,037.85 ",$784.26 ,"$1,123.32 ",$854.70 ,"$1,221.00 ","$1,221.00 ",$743.59 ,"$1,221.00 ",$843.71 ,"$1,098.90 ",$850.43 ,$352.05 ,$964.59 ,$334.99 ,$418.27 ,$418.27 ,$348.56 ,$418.27 ,$879.12 ,$757.02 ,$879.12 ,$879.12 ,$976.80 
ST NICHOLAS HOSPITAL - ACUTE,31000024,81291,HC MTHFR GENE BC,310,1 ,$336.00 ,$168.00 ,$13.61 ,$336.00 ,$13.61 ,$228.69 ,$196.02 ,$65.34 ,$201.60 ,$285.60 ,$235.20 ,$13.61 ,$319.20 ,$255.36 ,$252.00 ,$111.08 ,$285.60 ,$65.34 ,$111.08 ,$65.34 ,$235.20 ,$13.61 ,$65.34 ,$65.34 ,$73.95 ,$285.60 ,$147.02 ,$309.12 ,$235.20 ,$209.77 ,$209.77 ,$204.62 ,$209.77 ,$232.18 ,$302.40 ,$234.02 ,$65.99 ,$265.44 ,$14.43 ,$78.41 ,$78.41 ,$65.34 ,$78.41 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,31000025,81301,HC HNCP MICROSATL INSTABLTY,310,1 ,$585.00 ,$292.50 ,$292.50 ,$784.26 ,$316.03 ,$585.00 ,$585.00 ,$348.56 ,$351.00 ,$497.25 ,$409.50 ,$316.03 ,$555.75 ,$444.60 ,$438.75 ,$585.00 ,$497.25 ,$348.56 ,$585.00 ,$348.56 ,$409.50 ,$316.03 ,$348.56 ,$348.56 ,$394.50 ,$497.25 ,$784.26 ,$538.20 ,$409.50 ,$585.00 ,$585.00 ,$356.27 ,$585.00 ,$404.24 ,$526.50 ,$407.45 ,$352.05 ,$462.15 ,$334.99 ,$418.27 ,$418.27 ,$348.56 ,$418.27 ,$421.20 ,$362.70 ,$421.20 ,$421.20 ,$468.00 
ST NICHOLAS HOSPITAL - ACUTE,31000026,81315,HC PML/RARAL COM BRKPNTS,310,1 ,$974.00 ,$487.00 ,$207.31 ,$974.00 ,$214.21 ,$806.23 ,$691.05 ,$207.31 ,$584.40 ,$827.90 ,$681.80 ,$214.21 ,$925.30 ,$740.24 ,$730.50 ,$352.43 ,$827.90 ,$207.31 ,$352.43 ,$207.31 ,$681.80 ,$214.21 ,$207.31 ,$207.31 ,$234.63 ,$827.90 ,$466.45 ,$896.08 ,$681.80 ,$974.00 ,$974.00 ,$593.17 ,$974.00 ,$673.03 ,$876.60 ,$678.39 ,$209.38 ,$769.46 ,$227.06 ,$248.77 ,$248.77 ,$207.31 ,$248.77 ,$701.28 ,$603.88 ,$701.28 ,$701.28 ,$779.20 
ST NICHOLAS HOSPITAL - ACUTE,31000027,81331,HC SNRPN/UBE3A GENE,310,1 ,$370.00 ,$185.00 ,$51.07 ,$370.00 ,$52.77 ,$178.75 ,$153.21 ,$51.07 ,$222.00 ,$314.50 ,$259.00 ,$52.77 ,$351.50 ,$281.20 ,$277.50 ,$86.82 ,$314.50 ,$51.07 ,$86.82 ,$51.07 ,$259.00 ,$52.77 ,$51.07 ,$51.07 ,$57.80 ,$314.50 ,$114.91 ,$340.40 ,$259.00 ,$179.90 ,$179.90 ,$225.33 ,$179.90 ,$255.67 ,$333.00 ,$257.71 ,$51.58 ,$292.30 ,$55.94 ,$61.28 ,$61.28 ,$51.07 ,$61.28 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,31000028,81332,HC SERPINA1 GENE,310,1 ,"$1,062.00 ",$531.00 ,$13.61 ,"$1,062.00 ",$13.61 ,$169.75 ,$145.50 ,$43.65 ,$637.20 ,$902.70 ,$743.40 ,$13.61 ,"$1,008.90 ",$807.12 ,$796.50 ,$74.21 ,$902.70 ,$43.65 ,$74.21 ,$43.65 ,$743.40 ,$13.61 ,$43.65 ,$43.65 ,$49.40 ,$902.70 ,$98.21 ,$977.04 ,$743.40 ,$209.77 ,$209.77 ,$646.76 ,$209.77 ,$733.84 ,$955.80 ,$739.68 ,$44.09 ,$838.98 ,$14.43 ,$52.38 ,$52.38 ,$43.65 ,$52.38 ,$764.64 ,$658.44 ,$764.64 ,$764.64 ,$849.60 
ST NICHOLAS HOSPITAL - ACUTE,31000029,81383,HC HLA II TYPING ALLELE HR,310,1 ,$712.00 ,$356.00 ,$109.13 ,$712.00 ,$112.76 ,$424.41 ,$363.78 ,$109.13 ,$427.20 ,$605.20 ,$498.40 ,$112.76 ,$676.40 ,$541.12 ,$534.00 ,$185.52 ,$605.20 ,$109.13 ,$185.52 ,$109.13 ,$498.40 ,$112.76 ,$109.13 ,$109.13 ,$123.51 ,$605.20 ,$245.54 ,$655.04 ,$498.40 ,$524.44 ,$524.44 ,$433.61 ,$524.44 ,$491.99 ,$640.80 ,$495.91 ,$110.22 ,$562.48 ,$119.53 ,$130.96 ,$130.96 ,$109.13 ,$130.96 ,$512.64 ,$441.44 ,$512.64 ,$512.64 ,$569.60 
ST NICHOLAS HOSPITAL - ACUTE,31000030,81400,HC DPD MOPATH PROCEDURE L1,310,1 ,$420.00 ,$210.00 ,$51.17 ,$420.00 ,$51.17 ,$223.86 ,$191.88 ,$63.96 ,$252.00 ,$357.00 ,$294.00 ,$51.17 ,$399.00 ,$319.20 ,$315.00 ,$108.73 ,$357.00 ,$63.96 ,$108.73 ,$63.96 ,$294.00 ,$51.17 ,$63.96 ,$63.96 ,$72.39 ,$357.00 ,$143.91 ,$386.40 ,$294.00 ,$225.31 ,$225.31 ,$255.78 ,$225.31 ,$290.22 ,$378.00 ,$292.53 ,$64.60 ,$331.80 ,$54.24 ,$76.75 ,$76.75 ,$63.96 ,$76.75 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,31000031,81401,HC HUNT MOPATH PROCEDURE L2,310,1 ,$448.00 ,$224.00 ,$109.60 ,$448.00 ,$109.60 ,$448.00 ,$411.00 , N/A ,$268.80 ,$380.80 ,$313.60 ,$109.60 ,$425.60 ,$340.48 ,$336.00 ,$232.90 ,$380.80 , N/A ,$232.90 ,$137.00 ,$313.60 ,$109.60 , N/A , N/A ,$155.06 ,$380.80 ,$268.80 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$403.20 ,$312.03 , N/A ,$353.92 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$358.40 
ST NICHOLAS HOSPITAL - ACUTE,31000032,81402,HC TCR MOPATH PROCED L3,310,1 ,$588.00 ,$294.00 ,$120.26 ,$588.00 ,$120.26 ,$526.16 ,$450.99 , N/A ,$352.80 ,$499.80 ,$411.60 ,$120.26 ,$558.60 ,$446.88 ,$441.00 ,$255.56 ,$499.80 , N/A ,$255.56 ,$150.33 ,$411.60 ,$120.26 , N/A , N/A ,$170.14 ,$499.80 ,$352.80 ,$540.96 ,$411.60 ,$529.55 ,$529.55 ,$358.09 ,$529.55 ,$406.31 ,$529.20 ,$409.54 , N/A ,$464.52 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 ,$423.36 ,$364.56 ,$423.36 ,$423.36 ,$470.40 
ST NICHOLAS HOSPITAL - ACUTE,31000033,81270,HC JAK2 GENE,310,1 ,$560.00 ,$280.00 ,$91.66 ,$560.00 ,$94.71 ,$356.48 ,$305.55 ,$91.66 ,$336.00 ,$476.00 ,$392.00 ,$94.71 ,$532.00 ,$425.60 ,$420.00 ,$155.82 ,$476.00 ,$91.66 ,$155.82 ,$91.66 ,$392.00 ,$94.71 ,$91.66 ,$91.66 ,$103.74 ,$476.00 ,$206.24 ,$515.20 ,$392.00 ,$440.54 ,$440.54 ,$341.04 ,$440.54 ,$386.96 ,$504.00 ,$390.04 ,$92.58 ,$442.40 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,31000050,81241,HC FACTOR V GENE ANALYSIS (HR2),310,1 ,$416.00 ,$208.00 ,$66.70 ,$416.00 ,$66.70 ,$256.80 ,$220.11 ,$73.37 ,$249.60 ,$353.60 ,$291.20 ,$66.70 ,$395.20 ,$316.16 ,$312.00 ,$124.73 ,$353.60 ,$73.37 ,$124.73 ,$73.37 ,$291.20 ,$66.70 ,$73.37 ,$73.37 ,$83.04 ,$353.60 ,$165.08 ,$382.72 ,$291.20 ,$293.68 ,$293.68 ,$253.34 ,$293.68 ,$287.46 ,$374.40 ,$289.74 ,$74.10 ,$328.64 ,$70.70 ,$88.04 ,$88.04 ,$73.37 ,$88.04 ,$299.52 ,$257.92 ,$299.52 ,$299.52 ,$332.80 
ST NICHOLAS HOSPITAL - ACUTE,31000051,81220,HC CFTR GENE ANALYSIS,310,1 ,$818.00 ,$409.00 ,$210.00 ,"$1,252.35 ",$210.00 ,$818.00 ,$818.00 ,$556.60 ,$490.80 ,$695.30 ,$572.60 ,$210.00 ,$777.10 ,$621.68 ,$613.50 ,$818.00 ,$695.30 ,$556.60 ,$818.00 ,$556.60 ,$572.60 ,$210.00 ,$556.60 ,$556.60 ,$629.96 ,$695.30 ,"$1,252.35 ",$752.56 ,$572.60 ,$818.00 ,$818.00 ,$498.16 ,$818.00 ,$565.24 ,$736.20 ,$569.74 ,$562.17 ,$646.22 ,$222.60 ,$667.92 ,$667.92 ,$556.60 ,$667.92 ,$588.96 ,$507.16 ,$588.96 ,$588.96 ,$654.40 
ST NICHOLAS HOSPITAL - ACUTE,31000052,81332,HC SERPINA1 GENE ANALYSIS (AAT),310,1 ,$750.00 ,$375.00 ,$13.61 ,$750.00 ,$13.61 ,$169.75 ,$145.50 ,$43.65 ,$450.00 ,$637.50 ,$525.00 ,$13.61 ,$712.50 ,$570.00 ,$562.50 ,$74.21 ,$637.50 ,$43.65 ,$74.21 ,$43.65 ,$525.00 ,$13.61 ,$43.65 ,$43.65 ,$49.40 ,$637.50 ,$98.21 ,$690.00 ,$525.00 ,$209.77 ,$209.77 ,$456.75 ,$209.77 ,$518.25 ,$675.00 ,$522.38 ,$44.09 ,$592.50 ,$14.43 ,$52.38 ,$52.38 ,$43.65 ,$52.38 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$600.00 
ST NICHOLAS HOSPITAL - ACUTE,31000053,81342,HC TRG GENE ARRANGEMENT ANALYSIS,310,1 ,"$1,313.00 ",$656.50 ,$201.50 ,"$1,313.00 ",$208.21 ,$783.58 ,$671.64 ,$201.50 ,$787.80 ,"$1,116.05 ",$919.10 ,$208.21 ,"$1,247.35 ",$997.88 ,$984.75 ,$342.55 ,"$1,116.05 ",$201.50 ,$342.55 ,$201.50 ,$919.10 ,$208.21 ,$201.50 ,$201.50 ,$228.06 ,"$1,116.05 ",$453.38 ,"$1,207.96 ",$919.10 ,$968.36 ,$968.36 ,$799.62 ,$968.36 ,$907.28 ,"$1,181.70 ",$914.50 ,$203.52 ,"$1,037.27 ",$220.70 ,$241.80 ,$241.80 ,$201.50 ,$241.80 ,$945.36 ,$814.06 ,$945.36 ,$945.36 ,"$1,050.40 "
ST NICHOLAS HOSPITAL - ACUTE,31000054,81261,HC AMPLIFIED METH IG GRA,310,1 ,$493.00 ,$246.50 ,$197.99 ,$493.00 ,$204.58 ,$493.00 ,$493.00 ,$197.99 ,$295.80 ,$419.05 ,$345.10 ,$204.58 ,$468.35 ,$374.68 ,$369.75 ,$336.58 ,$419.05 ,$197.99 ,$336.58 ,$197.99 ,$345.10 ,$204.58 ,$197.99 ,$197.99 ,$224.09 ,$419.05 ,$445.48 ,$453.56 ,$345.10 ,$493.00 ,$493.00 ,$300.24 ,$493.00 ,$340.66 ,$443.70 ,$343.37 ,$199.97 ,$389.47 ,$216.85 ,$237.59 ,$237.59 ,$197.99 ,$237.59 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,31000055,81264,HC EVAL CLONAL POP IG GRA,310,1 ,$493.00 ,$246.50 ,$162.98 ,$493.00 ,$162.98 ,$493.00 ,$493.00 ,$172.73 ,$295.80 ,$419.05 ,$345.10 ,$162.98 ,$468.35 ,$374.68 ,$369.75 ,$293.64 ,$419.05 ,$172.73 ,$293.64 ,$172.73 ,$345.10 ,$162.98 ,$172.73 ,$172.73 ,$195.50 ,$419.05 ,$388.64 ,$453.56 ,$345.10 ,$493.00 ,$493.00 ,$300.24 ,$493.00 ,$340.66 ,$443.70 ,$343.37 ,$174.46 ,$389.47 ,$172.76 ,$207.28 ,$207.28 ,$172.73 ,$207.28 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,31000060,81241,HC F5 GENE ANAL LEIDEN VAR,310,1 ,$373.00 ,$186.50 ,$66.70 ,$373.00 ,$66.70 ,$256.80 ,$220.11 ,$73.37 ,$223.80 ,$317.05 ,$261.10 ,$66.70 ,$354.35 ,$283.48 ,$279.75 ,$124.73 ,$317.05 ,$73.37 ,$124.73 ,$73.37 ,$261.10 ,$66.70 ,$73.37 ,$73.37 ,$83.04 ,$317.05 ,$165.08 ,$343.16 ,$261.10 ,$293.68 ,$293.68 ,$227.16 ,$293.68 ,$257.74 ,$335.70 ,$259.79 ,$74.10 ,$294.67 ,$70.70 ,$88.04 ,$88.04 ,$73.37 ,$88.04 ,$268.56 ,$231.26 ,$268.56 ,$268.56 ,$298.40 
ST NICHOLAS HOSPITAL - ACUTE,31000061,81256,HC HFE GENE ANALYSIS,310,1 ,$92.00 ,$46.00 ,$46.00 ,$147.06 ,$67.54 ,$92.00 ,$92.00 ,$65.36 ,$55.20 ,$78.20 ,$64.40 ,$67.54 ,$87.40 ,$69.92 ,$69.00 ,$92.00 ,$78.20 ,$65.36 ,$92.00 ,$65.36 ,$64.40 ,$67.54 ,$65.36 ,$65.36 ,$73.97 ,$78.20 ,$147.06 ,$84.64 ,$64.40 ,$92.00 ,$92.00 ,$56.03 ,$92.00 ,$63.57 ,$82.80 ,$64.08 ,$66.01 ,$72.68 ,$71.59 ,$78.43 ,$78.43 ,$65.36 ,$78.43 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,31000062,81270,HC JAK2 GENE ANALYSIS,310,1 ,"$1,210.00 ",$605.00 ,$91.66 ,"$1,210.00 ",$94.71 ,$356.48 ,$305.55 ,$91.66 ,$726.00 ,"$1,028.50 ",$847.00 ,$94.71 ,"$1,149.50 ",$919.60 ,$907.50 ,$155.82 ,"$1,028.50 ",$91.66 ,$155.82 ,$91.66 ,$847.00 ,$94.71 ,$91.66 ,$91.66 ,$103.74 ,"$1,028.50 ",$206.24 ,"$1,113.20 ",$847.00 ,$440.54 ,$440.54 ,$736.89 ,$440.54 ,$836.11 ,"$1,089.00 ",$842.77 ,$92.58 ,$955.90 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$871.20 ,$750.20 ,$871.20 ,$871.20 ,$968.00 
ST NICHOLAS HOSPITAL - ACUTE,31000073,81207,HC BCR/ABL1 GENE MINOR BP QUEST,310,1 ,$336.00 ,$168.00 ,$144.84 ,$336.00 ,$149.66 ,$336.00 ,$336.00 ,$144.84 ,$201.60 ,$285.60 ,$235.20 ,$149.66 ,$319.20 ,$255.36 ,$252.00 ,$246.23 ,$285.60 ,$144.84 ,$246.23 ,$144.84 ,$235.20 ,$149.66 ,$144.84 ,$144.84 ,$163.93 ,$285.60 ,$325.89 ,$309.12 ,$235.20 ,$336.00 ,$336.00 ,$204.62 ,$336.00 ,$232.18 ,$302.40 ,$234.02 ,$146.29 ,$265.44 ,$158.64 ,$173.81 ,$173.81 ,$144.84 ,$173.81 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,31000101,83540,HC IRON LIVER TISSUE,310,1 ,$112.00 ,$56.00 ,$6.47 ,$112.00 ,$6.69 ,$25.17 ,$21.57 ,$6.47 ,$67.20 ,$95.20 ,$78.40 ,$6.69 ,$106.40 ,$85.12 ,$84.00 ,$11.00 ,$95.20 ,$6.47 ,$11.00 ,$6.47 ,$78.40 ,$6.69 ,$6.47 ,$6.47 ,$7.32 ,$95.20 ,$14.56 ,$103.04 ,$78.40 ,$31.10 ,$31.10 ,$68.21 ,$31.10 ,$77.39 ,$100.80 ,$78.01 ,$6.53 ,$88.48 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,31000102,80500,HC CLINAL PATH CONSULT LTD,310,1 ,$153.00 ,$76.50 ,$22.15 ,$153.00 , N/A ,$68.07 ,$58.34 , N/A ,$91.80 ,$130.05 ,$107.10 , N/A ,$145.35 ,$116.28 ,$114.75 ,$36.26 ,$130.05 , N/A ,$36.26 ,$22.15 ,$107.10 , N/A , N/A , N/A ,$64.26 ,$130.05 , N/A ,$140.76 ,$107.10 ,$77.60 ,$93.13 ,$93.18 ,$93.13 ,$105.72 ,$137.70 ,$106.56 , N/A ,$120.87 , N/A ,$76.50 ,$76.50 , N/A ,$76.50 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,31000105,81313,HC PROSTATE CANCER ANTIGEN 3,310,1 ,"$1,344.00 ",$672.00 ,$37.31 ,"$1,344.00 ",$37.31 ,$892.68 ,$765.15 ,$255.05 ,$806.40 ,"$1,142.40 ",$940.80 ,$37.31 ,"$1,276.80 ","$1,021.44 ","$1,008.00 ",$433.59 ,"$1,142.40 ",$255.05 ,$433.59 ,$255.05 ,$940.80 ,$37.31 ,$255.05 ,$255.05 ,$288.67 ,"$1,142.40 ",$573.86 ,"$1,236.48 ",$940.80 ,$916.79 ,$916.79 ,$818.50 ,$916.79 ,$928.70 ,"$1,209.60 ",$936.10 ,$257.60 ,"$1,061.76 ",$39.55 ,$306.06 ,$306.06 ,$255.05 ,$306.06 ,$967.68 ,$833.28 ,$967.68 ,$967.68 ,"$1,075.20 "
ST NICHOLAS HOSPITAL - ACUTE,31000106,81401,HC MOPATH PROC L2,310,1 ,$459.00 ,$229.50 ,$109.60 ,$459.00 ,$109.60 ,$459.00 ,$411.00 , N/A ,$275.40 ,$390.15 ,$321.30 ,$109.60 ,$436.05 ,$348.84 ,$344.25 ,$232.90 ,$390.15 , N/A ,$232.90 ,$137.00 ,$321.30 ,$109.60 , N/A , N/A ,$155.06 ,$390.15 ,$275.40 ,$422.28 ,$321.30 ,$459.00 ,$459.00 ,$279.53 ,$459.00 ,$317.17 ,$413.10 ,$319.69 , N/A ,$362.61 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,31000109,81170,HC ABL1 GENE ANALYSIS KINASE DOMAIN,310,1 ,$470.00 ,$235.00 ,$195.07 ,$675.00 ,$195.07 ,$470.00 ,$470.00 ,$300.00 ,$282.00 ,$399.50 ,$329.00 ,$195.07 ,$446.50 ,$357.20 ,$352.50 ,$470.00 ,$399.50 ,$300.00 ,$470.00 ,$300.00 ,$329.00 ,$195.07 ,$300.00 ,$300.00 ,$339.54 ,$399.50 ,$675.00 ,$432.40 ,$329.00 ,$470.00 ,$470.00 ,$286.23 ,$470.00 ,$324.77 ,$423.00 ,$327.36 ,$303.00 ,$371.30 ,$206.77 ,$360.00 ,$360.00 ,$300.00 ,$360.00 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,31000110,81218,HC CEBPA GENE ANALYSIS FULL SEQUENCE,310,1 ,$470.00 ,$235.00 ,$195.07 ,$544.28 ,$195.07 ,$470.00 ,$470.00 ,$241.90 ,$282.00 ,$399.50 ,$329.00 ,$195.07 ,$446.50 ,$357.20 ,$352.50 ,$411.23 ,$399.50 ,$241.90 ,$411.23 ,$241.90 ,$329.00 ,$195.07 ,$241.90 ,$241.90 ,$273.78 ,$399.50 ,$544.28 ,$432.40 ,$329.00 ,$470.00 ,$470.00 ,$286.23 ,$470.00 ,$324.77 ,$423.00 ,$327.36 ,$244.32 ,$371.30 ,$206.77 ,$290.28 ,$290.28 ,$241.90 ,$290.28 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,31000111,81219,HC CALR GENE ANALYSIS EXON 9,310,1 ,$470.00 ,$235.00 ,$98.08 ,$470.00 ,$98.08 ,$470.00 ,$405.42 ,$121.63 ,$282.00 ,$399.50 ,$329.00 ,$98.08 ,$446.50 ,$357.20 ,$352.50 ,$206.77 ,$399.50 ,$121.63 ,$206.77 ,$121.63 ,$329.00 ,$98.08 ,$121.63 ,$121.63 ,$137.66 ,$399.50 ,$273.67 ,$432.40 ,$329.00 ,$431.87 ,$431.87 ,$286.23 ,$431.87 ,$324.77 ,$423.00 ,$327.36 ,$122.85 ,$371.30 ,$103.96 ,$145.96 ,$145.96 ,$121.63 ,$145.96 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,31000112,81226,HC CYP2D6 GENE ANALYSIS COMMON VARIANTS,310,1 ,$605.00 ,$302.50 ,$126.90 ,"$1,014.55 ",$126.90 ,$605.00 ,$605.00 ,$450.91 ,$363.00 ,$514.25 ,$423.50 ,$126.90 ,$574.75 ,$459.80 ,$453.75 ,$605.00 ,$514.25 ,$450.91 ,$605.00 ,$450.91 ,$423.50 ,$126.90 ,$450.91 ,$450.91 ,$510.34 ,$514.25 ,"$1,014.55 ",$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$544.50 ,$421.38 ,$455.42 ,$477.95 ,$134.51 ,$541.09 ,$541.09 ,$450.91 ,$541.09 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,31000113,81245,HC FLT3 GENE ANALYSIS INT TANDEM DUP VARIANTS,310,1 ,$280.00 ,$140.00 ,$132.74 ,$372.40 ,$132.74 ,$280.00 ,$280.00 ,$165.51 ,$168.00 ,$238.00 ,$196.00 ,$132.74 ,$266.00 ,$212.80 ,$210.00 ,$280.00 ,$238.00 ,$165.51 ,$280.00 ,$165.51 ,$196.00 ,$132.74 ,$165.51 ,$165.51 ,$187.32 ,$238.00 ,$372.40 ,$257.60 ,$196.00 ,$280.00 ,$280.00 ,$170.52 ,$280.00 ,$193.48 ,$252.00 ,$195.02 ,$167.17 ,$221.20 ,$140.70 ,$198.61 ,$198.61 ,$165.51 ,$198.61 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,31000114,81246,HC FL53 GENE ANALYSIS TYROSINE KINASE VARIANTS,310,1 ,$235.00 ,$117.50 ,$83.00 ,$235.00 ,$85.76 ,$235.00 ,$235.00 ,$83.00 ,$141.00 ,$199.75 ,$164.50 ,$85.76 ,$223.25 ,$178.60 ,$176.25 ,$141.10 ,$199.75 ,$83.00 ,$141.10 ,$83.00 ,$164.50 ,$85.76 ,$83.00 ,$83.00 ,$93.94 ,$199.75 ,$186.75 ,$216.20 ,$164.50 ,$235.00 ,$235.00 ,$143.12 ,$235.00 ,$162.39 ,$211.50 ,$163.68 ,$83.83 ,$185.65 ,$90.91 ,$99.60 ,$99.60 ,$83.00 ,$99.60 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,31000115,81257,HC HBA1/HBA2 GENE ANALYSIS COM DELETE OR VARIANTS,310,1 ,$627.00 ,$313.50 ,$102.26 ,$627.00 ,$105.67 ,$357.91 ,$306.78 , N/A ,$376.20 ,$532.95 ,$438.90 ,$105.67 ,$595.65 ,$476.52 ,$470.25 ,$173.84 ,$532.95 , N/A ,$173.84 ,$102.26 ,$438.90 ,$105.67 , N/A , N/A ,$115.74 ,$532.95 ,$376.20 ,$576.84 ,$438.90 ,$360.22 ,$360.22 ,$381.84 ,$360.22 ,$433.26 ,$564.30 ,$436.71 , N/A ,$495.33 ,$112.01 ,$122.71 ,$122.71 , N/A ,$122.71 ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$501.60 
ST NICHOLAS HOSPITAL - ACUTE,31000116,81261,HC IGH GENE ANALYSIS REARRANGEMENT AMP,310,1 ,$595.00 ,$297.50 ,$197.99 ,$595.00 ,$204.58 ,$595.00 ,$595.00 ,$197.99 ,$357.00 ,$505.75 ,$416.50 ,$204.58 ,$565.25 ,$452.20 ,$446.25 ,$336.58 ,$505.75 ,$197.99 ,$336.58 ,$197.99 ,$416.50 ,$204.58 ,$197.99 ,$197.99 ,$224.09 ,$505.75 ,$445.48 ,$547.40 ,$416.50 ,$595.00 ,$595.00 ,$362.36 ,$595.00 ,$411.15 ,$535.50 ,$414.42 ,$199.97 ,$470.05 ,$216.85 ,$237.59 ,$237.59 ,$197.99 ,$237.59 ,$428.40 ,$368.90 ,$428.40 ,$428.40 ,$476.00 
ST NICHOLAS HOSPITAL - ACUTE,31000117,81263,HC IGH VAR REG SOMATIC MUTATION ANALYSIS,310,1 ,$773.00 ,$386.50 ,$294.52 ,$773.00 ,$304.33 ,$773.00 ,$773.00 ,$294.52 ,$463.80 ,$657.05 ,$541.10 ,$304.33 ,$734.35 ,$587.48 ,$579.75 ,$500.68 ,$657.05 ,$294.52 ,$500.68 ,$294.52 ,$541.10 ,$304.33 ,$294.52 ,$294.52 ,$333.34 ,$657.05 ,$662.67 ,$711.16 ,$541.10 ,$773.00 ,$773.00 ,$470.76 ,$773.00 ,$534.14 ,$695.70 ,$538.39 ,$297.47 ,$610.67 ,$322.59 ,$353.42 ,$353.42 ,$294.52 ,$353.42 ,$556.56 ,$479.26 ,$556.56 ,$556.56 ,$618.40 
ST NICHOLAS HOSPITAL - ACUTE,31000118,81272,HC V KIT GENE ANALYSIS TARGETED SEQ,310,1 ,$560.00 ,$280.00 ,$195.07 ,$741.40 ,$195.07 ,$560.00 ,$560.00 ,$329.51 ,$336.00 ,$476.00 ,$392.00 ,$195.07 ,$532.00 ,$425.60 ,$420.00 ,$560.00 ,$476.00 ,$329.51 ,$560.00 ,$329.51 ,$392.00 ,$195.07 ,$329.51 ,$329.51 ,$372.94 ,$476.00 ,$741.40 ,$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$390.04 ,$332.81 ,$442.40 ,$206.77 ,$395.41 ,$395.41 ,$329.51 ,$395.41 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,31000119,81315,HC PML/RARALPHA ANALYSIS COMMON BRKPNTS QL/QN,310,1 ,$571.00 ,$285.50 ,$207.31 ,$571.00 ,$214.21 ,$571.00 ,$571.00 ,$207.31 ,$342.60 ,$485.35 ,$399.70 ,$214.21 ,$542.45 ,$433.96 ,$428.25 ,$352.43 ,$485.35 ,$207.31 ,$352.43 ,$207.31 ,$399.70 ,$214.21 ,$207.31 ,$207.31 ,$234.63 ,$485.35 ,$466.45 ,$525.32 ,$399.70 ,$571.00 ,$571.00 ,$347.74 ,$571.00 ,$394.56 ,$513.90 ,$397.70 ,$209.38 ,$451.09 ,$227.06 ,$248.77 ,$248.77 ,$207.31 ,$248.77 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$456.80 
ST NICHOLAS HOSPITAL - ACUTE,31000120,81350,HC UGT1A1 GENE ANALYSIS COM VARIANTS,310,1 ,$700.00 ,$350.00 ,$37.31 ,$700.00 ,$37.31 ,$700.00 ,$700.00 ,$234.00 ,$420.00 ,$595.00 ,$490.00 ,$37.31 ,$665.00 ,$532.00 ,$525.00 ,$397.80 ,$595.00 ,$234.00 ,$397.80 ,$234.00 ,$490.00 ,$37.31 ,$234.00 ,$234.00 ,$264.84 ,$595.00 ,$526.50 ,$644.00 ,$490.00 ,$700.00 ,$700.00 ,$426.30 ,$700.00 ,$483.70 ,$630.00 ,$487.55 ,$236.34 ,$553.00 ,$39.55 ,$280.80 ,$280.80 ,$234.00 ,$280.80 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,31000121,81401,HC MOPATH PROC (ABL),310,1 ,$560.00 ,$280.00 ,$109.60 ,$560.00 ,$109.60 ,$479.50 ,$411.00 , N/A ,$336.00 ,$476.00 ,$392.00 ,$109.60 ,$532.00 ,$425.60 ,$420.00 ,$232.90 ,$476.00 , N/A ,$232.90 ,$137.00 ,$392.00 ,$109.60 , N/A , N/A ,$155.06 ,$476.00 ,$336.00 ,$515.20 ,$392.00 ,$482.60 ,$482.60 ,$341.04 ,$482.60 ,$386.96 ,$504.00 ,$390.04 , N/A ,$442.40 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,31000123,81401,HC MOPATH PROC (CBFB),310,1 ,$560.00 ,$280.00 ,$109.60 ,$560.00 ,$109.60 ,$479.50 ,$411.00 , N/A ,$336.00 ,$476.00 ,$392.00 ,$109.60 ,$532.00 ,$425.60 ,$420.00 ,$232.90 ,$476.00 , N/A ,$232.90 ,$137.00 ,$392.00 ,$109.60 , N/A , N/A ,$155.06 ,$476.00 ,$336.00 ,$515.20 ,$392.00 ,$482.60 ,$482.60 ,$341.04 ,$482.60 ,$386.96 ,$504.00 ,$390.04 , N/A ,$442.40 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,31000124,81402,HC MOPATH PROC (BCL2) L3,310,1 ,$560.00 ,$280.00 ,$120.26 ,$560.00 ,$120.26 ,$526.16 ,$450.99 , N/A ,$336.00 ,$476.00 ,$392.00 ,$120.26 ,$532.00 ,$425.60 ,$420.00 ,$255.56 ,$476.00 , N/A ,$255.56 ,$150.33 ,$392.00 ,$120.26 , N/A , N/A ,$170.14 ,$476.00 ,$336.00 ,$515.20 ,$392.00 ,$529.55 ,$529.55 ,$341.04 ,$529.55 ,$386.96 ,$504.00 ,$390.04 , N/A ,$442.40 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,31000134,81210,HC BRAF GENE ANALYS V600E VAR-90,310,1 ,$869.00 ,$434.50 ,$143.40 ,$869.00 ,$143.40 ,$613.90 ,$526.20 ,$175.40 ,$521.40 ,$738.65 ,$608.30 ,$143.40 ,$825.55 ,$660.44 ,$651.75 ,$298.18 ,$738.65 ,$175.40 ,$298.18 ,$175.40 ,$608.30 ,$143.40 ,$175.40 ,$175.40 ,$198.52 ,$738.65 ,$394.65 ,$799.48 ,$608.30 ,$631.43 ,$631.43 ,$529.22 ,$631.43 ,$600.48 ,$782.10 ,$605.26 ,$177.15 ,$686.51 ,$152.00 ,$210.48 ,$210.48 ,$175.40 ,$210.48 ,$625.68 ,$538.78 ,$625.68 ,$625.68 ,$695.20 
ST NICHOLAS HOSPITAL - ACUTE,31000202,81229,HC CYTOGENOMIC MICROARRAY ASSAY,310,1 ,"$2,128.00 ","$1,064.00 ",$608.00 ,"$2,610.00 ",$608.00 ,"$2,128.00 ","$2,128.00 ","$1,160.00 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$608.00 ,"$2,021.60 ","$1,617.28 ","$1,596.00 ","$1,972.00 ","$1,808.80 ","$1,160.00 ","$1,972.00 ","$1,160.00 ","$1,489.60 ",$608.00 ,"$1,160.00 ","$1,160.00 ","$1,312.89 ","$1,808.80 ","$2,610.00 ","$1,957.76 ","$1,489.60 ","$2,128.00 ","$2,128.00 ","$1,295.95 ","$2,128.00 ","$1,470.45 ","$1,915.20 ","$1,482.15 ","$1,171.60 ","$1,681.12 ",$644.48 ,"$1,392.00 ","$1,392.00 ","$1,160.00 ","$1,392.00 ","$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,702.40 "
ST NICHOLAS HOSPITAL - ACUTE,31000210,81235,HC EGFR GENE COM VARIANTS 29 PANEL,310,1 ,"$1,344.00 ",$672.00 ,$264.01 ,"$1,344.00 ",$264.01 ,"$1,136.03 ",$973.74 ,$324.58 ,$806.40 ,"$1,142.40 ",$940.80 ,$264.01 ,"$1,276.80 ","$1,021.44 ","$1,008.00 ",$551.79 ,"$1,142.40 ",$324.58 ,$551.79 ,$324.58 ,$940.80 ,$264.01 ,$324.58 ,$324.58 ,$367.36 ,"$1,142.40 ",$730.31 ,"$1,236.48 ",$940.80 ,"$1,162.49 ","$1,162.49 ",$818.50 ,"$1,162.49 ",$928.70 ,"$1,209.60 ",$936.10 ,$327.83 ,"$1,061.76 ",$279.85 ,$389.50 ,$389.50 ,$324.58 ,$389.50 ,$967.68 ,$833.28 ,$967.68 ,$967.68 ,"$1,075.20 "
ST NICHOLAS HOSPITAL - ACUTE,31000211,81210,HC BRAF GENE ANALYS V600E VAR,310,1 ,$538.00 ,$269.00 ,$143.40 ,$538.00 ,$143.40 ,$538.00 ,$526.20 ,$175.40 ,$322.80 ,$457.30 ,$376.60 ,$143.40 ,$511.10 ,$408.88 ,$403.50 ,$298.18 ,$457.30 ,$175.40 ,$298.18 ,$175.40 ,$376.60 ,$143.40 ,$175.40 ,$175.40 ,$198.52 ,$457.30 ,$394.65 ,$494.96 ,$376.60 ,$538.00 ,$538.00 ,$327.64 ,$538.00 ,$371.76 ,$484.20 ,$374.72 ,$177.15 ,$425.02 ,$152.00 ,$210.48 ,$210.48 ,$175.40 ,$210.48 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$430.40 
ST NICHOLAS HOSPITAL - ACUTE,31000212,81445,HC GENE SEQ SOLID ORGAN NEOPLASM 5-50 GENES,310,1 ,"$2,240.00 ","$1,120.00 ",$478.33 ,"$2,240.00 ",$478.33 ,"$2,092.69 ","$1,793.73 ",$597.91 ,"$1,344.00 ","$1,904.00 ","$1,568.00 ",$478.33 ,"$2,128.00 ","$1,702.40 ","$1,680.00 ","$1,016.45 ","$1,904.00 ",$597.91 ,"$1,016.45 ",$597.91 ,"$1,568.00 ",$478.33 ,$597.91 ,$597.91 ,$676.71 ,"$1,904.00 ","$1,345.30 ","$2,060.80 ","$1,568.00 ","$2,106.20 ","$2,106.20 ","$1,364.16 ","$2,106.20 ","$1,547.84 ","$2,016.00 ","$1,560.16 ",$603.89 ,"$1,769.60 ",$507.03 ,$717.49 ,$717.49 ,$597.91 ,$717.49 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,31000231,81229,HC CHROMOSOMAL MICROARRAY,310,1 ,"$2,688.00 ","$1,344.00 ",$608.00 ,"$2,688.00 ",$608.00 ,"$2,688.00 ","$2,688.00 ","$1,160.00 ","$1,612.80 ","$2,284.80 ","$1,881.60 ",$608.00 ,"$2,553.60 ","$2,042.88 ","$2,016.00 ","$1,972.00 ","$2,284.80 ","$1,160.00 ","$1,972.00 ","$1,160.00 ","$1,881.60 ",$608.00 ,"$1,160.00 ","$1,160.00 ","$1,312.89 ","$2,284.80 ","$2,610.00 ","$2,472.96 ","$1,881.60 ","$2,688.00 ","$2,688.00 ","$1,636.99 ","$2,688.00 ","$1,857.41 ","$2,419.20 ","$1,872.19 ","$1,171.60 ","$2,123.52 ",$644.48 ,"$1,392.00 ","$1,392.00 ","$1,160.00 ","$1,392.00 ","$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$2,150.40 "
ST NICHOLAS HOSPITAL - ACUTE,31000235,81219,HC MUTATION ANALYSIS CALRETICULIN,310,1 ,$588.00 ,$294.00 ,$98.08 ,$588.00 ,$98.08 ,$472.99 ,$405.42 ,$121.63 ,$352.80 ,$499.80 ,$411.60 ,$98.08 ,$558.60 ,$446.88 ,$441.00 ,$206.77 ,$499.80 ,$121.63 ,$206.77 ,$121.63 ,$411.60 ,$98.08 ,$121.63 ,$121.63 ,$137.66 ,$499.80 ,$273.67 ,$540.96 ,$411.60 ,$431.87 ,$431.87 ,$358.09 ,$431.87 ,$406.31 ,$529.20 ,$409.54 ,$122.85 ,$464.52 ,$103.96 ,$145.96 ,$145.96 ,$121.63 ,$145.96 ,$423.36 ,$364.56 ,$423.36 ,$423.36 ,$470.40 
ST NICHOLAS HOSPITAL - ACUTE,31000236,81403,HC MOLECULAR PATH MUTATION ANALYSIS EXON 12,310,1 ,$448.00 ,$224.00 ,$148.16 ,$448.00 ,$148.16 ,$448.00 ,$448.00 , N/A ,$268.80 ,$380.80 ,$313.60 ,$148.16 ,$425.60 ,$340.48 ,$336.00 ,$314.84 ,$380.80 , N/A ,$314.84 ,$185.20 ,$313.60 ,$148.16 , N/A , N/A ,$209.61 ,$380.80 ,$268.80 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$403.20 ,$312.03 , N/A ,$353.92 ,$157.05 ,$222.24 ,$222.24 , N/A ,$222.24 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$358.40 
ST NICHOLAS HOSPITAL - ACUTE,31000237,81402,HC MOLECULAR PATH MUTATION ANALYSIS MPL,310,1 ,$420.00 ,$210.00 ,$120.26 ,$420.00 ,$120.26 ,$420.00 ,$420.00 , N/A ,$252.00 ,$357.00 ,$294.00 ,$120.26 ,$399.00 ,$319.20 ,$315.00 ,$255.56 ,$357.00 , N/A ,$255.56 ,$150.33 ,$294.00 ,$120.26 , N/A , N/A ,$170.14 ,$357.00 ,$252.00 ,$386.40 ,$294.00 ,$420.00 ,$420.00 ,$255.78 ,$420.00 ,$290.22 ,$378.00 ,$292.53 , N/A ,$331.80 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,31000238,81479,HC MUTATION ANALYSIS CSF3R,310,1 ,$336.00 ,$168.00 ,$13.61 ,$336.00 ,$13.61 ,$217.36 ,$217.36 , N/A ,$201.60 ,$285.60 ,$235.20 ,$13.61 ,$319.20 ,$255.36 ,$252.00 , N/A ,$285.60 , N/A , N/A ,$218.40 ,$235.20 ,$13.61 , N/A , N/A ,$141.12 ,$285.60 ,$201.60 ,$309.12 ,$235.20 ,$170.42 ,$204.52 ,$204.62 ,$204.52 ,$232.18 ,$302.40 ,$234.02 , N/A ,$265.44 ,$14.43 ,$168.00 ,$168.00 , N/A ,$168.00 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,31000239,81270,HC JAK2 MUTATION ANALYSIS,310,1 ,$403.00 ,$201.50 ,$91.66 ,$403.00 ,$94.71 ,$356.48 ,$305.55 ,$91.66 ,$241.80 ,$342.55 ,$282.10 ,$94.71 ,$382.85 ,$306.28 ,$302.25 ,$155.82 ,$342.55 ,$91.66 ,$155.82 ,$91.66 ,$282.10 ,$94.71 ,$91.66 ,$91.66 ,$103.74 ,$342.55 ,$206.24 ,$370.76 ,$282.10 ,$403.00 ,$403.00 ,$245.43 ,$403.00 ,$278.47 ,$362.70 ,$280.69 ,$92.58 ,$318.37 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31000244,81271,HC HTT GENE ANALYSIS DETECT ABNORMAL ALLELES,310,1 ,$442.00 ,$221.00 ,$109.60 ,$442.00 ,$109.60 ,$442.00 ,$411.00 ,$137.00 ,$265.20 ,$375.70 ,$309.40 ,$109.60 ,$419.90 ,$335.92 ,$331.50 ,$232.90 ,$375.70 ,$137.00 ,$232.90 ,$137.00 ,$309.40 ,$109.60 ,$137.00 ,$137.00 ,$155.06 ,$375.70 ,$308.25 ,$406.64 ,$309.40 ,$442.00 ,$442.00 ,$269.18 ,$442.00 ,$305.42 ,$397.80 ,$307.85 ,$138.37 ,$349.18 ,$116.18 ,$164.40 ,$164.40 ,$137.00 ,$164.40 ,$318.24 ,$274.04 ,$318.24 ,$318.24 ,$353.60 
ST NICHOLAS HOSPITAL - ACUTE,31000265,81445,HC GENE SEQ NEOPLASM 5-50 GENES LUNG W/REARRANG TUMOR,310,1 ,"$3,360.00 ","$1,680.00 ",$478.33 ,"$3,360.00 ",$478.33 ,"$2,092.69 ","$1,793.73 ",$597.91 ,"$2,016.00 ","$2,856.00 ","$2,352.00 ",$478.33 ,"$3,192.00 ","$2,553.60 ","$2,520.00 ","$1,016.45 ","$2,856.00 ",$597.91 ,"$1,016.45 ",$597.91 ,"$2,352.00 ",$478.33 ,$597.91 ,$597.91 ,$676.71 ,"$2,856.00 ","$1,345.30 ","$3,091.20 ","$2,352.00 ","$2,106.20 ","$2,106.20 ","$2,046.24 ","$2,106.20 ","$2,321.76 ","$3,024.00 ","$2,340.24 ",$603.89 ,"$2,654.40 ",$507.03 ,$717.49 ,$717.49 ,$597.91 ,$717.49 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,31000273,81270,HC JAK2 V617F MUTATION DETECTION B/BM,310,1 ,$427.00 ,$213.50 ,$91.66 ,$427.00 ,$94.71 ,$356.48 ,$305.55 ,$91.66 ,$256.20 ,$362.95 ,$298.90 ,$94.71 ,$405.65 ,$324.52 ,$320.25 ,$155.82 ,$362.95 ,$91.66 ,$155.82 ,$91.66 ,$298.90 ,$94.71 ,$91.66 ,$91.66 ,$103.74 ,$362.95 ,$206.24 ,$392.84 ,$298.90 ,$427.00 ,$427.00 ,$260.04 ,$427.00 ,$295.06 ,$384.30 ,$297.41 ,$92.58 ,$337.33 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$307.44 ,$264.74 ,$307.44 ,$307.44 ,$341.60 
ST NICHOLAS HOSPITAL - ACUTE,31000274,81305,HC MYD88 L265P GENE MUTATION ANALYSIS,310,1 ,$768.00 ,$384.00 ,$140.32 ,$768.00 ,$140.32 ,$613.90 ,$526.20 ,$175.40 ,$460.80 ,$652.80 ,$537.60 ,$140.32 ,$729.60 ,$583.68 ,$576.00 ,$298.18 ,$652.80 ,$175.40 ,$298.18 ,$175.40 ,$537.60 ,$140.32 ,$175.40 ,$175.40 ,$198.52 ,$652.80 ,$394.65 ,$706.56 ,$537.60 ,$677.68 ,$677.68 ,$467.71 ,$677.68 ,$530.69 ,$691.20 ,$534.91 ,$177.15 ,$606.72 ,$148.74 ,$210.48 ,$210.48 ,$175.40 ,$210.48 ,$552.96 ,$476.16 ,$552.96 ,$552.96 ,$614.40 
ST NICHOLAS HOSPITAL - ACUTE,31040107,81311,HC NRAS GENE VARIANTS EXON 2 AND 3,310,1 ,$762.00 ,$381.00 ,$175.10 ,$762.00 ,$175.10 ,$762.00 ,$762.00 ,$295.79 ,$457.20 ,$647.70 ,$533.40 ,$175.10 ,$723.90 ,$579.12 ,$571.50 ,$502.84 ,$647.70 ,$295.79 ,$502.84 ,$295.79 ,$533.40 ,$175.10 ,$295.79 ,$295.79 ,$334.78 ,$647.70 ,$665.53 ,$701.04 ,$533.40 ,$762.00 ,$762.00 ,$464.06 ,$762.00 ,$526.54 ,$685.80 ,$530.73 ,$298.75 ,$601.98 ,$185.61 ,$354.95 ,$354.95 ,$295.79 ,$354.95 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,31040108,81404,HC MOLECULAR PATH PROC LEVEL 5,310,1 ,$448.00 ,$224.00 ,$219.86 ,$448.00 ,$219.86 ,$448.00 ,$448.00 , N/A ,$268.80 ,$380.80 ,$313.60 ,$219.86 ,$425.60 ,$340.48 ,$336.00 ,$448.00 ,$380.80 , N/A ,$448.00 ,$274.83 ,$313.60 ,$219.86 , N/A , N/A ,$311.05 ,$380.80 ,$268.80 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$403.20 ,$312.03 , N/A ,$353.92 ,$233.05 ,$329.80 ,$329.80 , N/A ,$329.80 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$358.40 
ST NICHOLAS HOSPITAL - ACUTE,31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$168.00 ,$84.00 ,$3.02 ,$168.00 ,$3.02 ,$139.26 ,$119.36 ,$33.38 ,$100.80 ,$142.80 ,$117.60 ,$3.02 ,$159.60 ,$127.68 ,$126.00 ,$110.33 ,$142.80 ,$33.38 ,$110.33 ,$66.68 ,$117.60 ,$3.02 ,$33.38 ,$33.38 ,$70.56 ,$142.80 ,$75.09 ,$154.56 ,$117.60 ,$75.42 ,$75.42 ,$102.31 ,$75.42 ,$116.09 ,$151.20 ,$117.01 ,$33.71 ,$132.72 ,$3.20 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,31100102,88108,HC CYTOPATH CONCENTRATION,311,1 ,$235.00 ,$117.50 ,$3.02 ,$235.00 ,$3.02 ,$127.19 ,$109.02 ,$33.38 ,$141.00 ,$199.75 ,$164.50 ,$3.02 ,$223.25 ,$178.60 ,$176.25 ,$105.49 ,$199.75 ,$33.38 ,$105.49 ,$60.29 ,$164.50 ,$3.02 ,$33.38 ,$33.38 ,$98.70 ,$199.75 ,$75.09 ,$216.20 ,$164.50 ,$75.42 ,$75.42 ,$143.12 ,$75.42 ,$162.39 ,$211.50 ,$163.68 ,$33.71 ,$185.65 ,$3.20 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,31100103,88108,HC CYTOPATH CONCENTRATION (BF),311,1 ,$217.00 ,$108.50 ,$3.02 ,$217.00 ,$3.02 ,$127.19 ,$109.02 ,$33.38 ,$130.20 ,$184.45 ,$151.90 ,$3.02 ,$206.15 ,$164.92 ,$162.75 ,$105.49 ,$184.45 ,$33.38 ,$105.49 ,$60.29 ,$151.90 ,$3.02 ,$33.38 ,$33.38 ,$91.14 ,$184.45 ,$75.09 ,$199.64 ,$151.90 ,$75.42 ,$75.42 ,$132.15 ,$75.42 ,$149.95 ,$195.30 ,$151.14 ,$33.71 ,$171.43 ,$3.20 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$156.24 ,$134.54 ,$156.24 ,$156.24 ,$173.60 
ST NICHOLAS HOSPITAL - ACUTE,31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$190.00 ,$95.00 ,$9.06 ,$190.00 ,$9.06 ,$130.81 ,$112.12 ,$49.00 ,$114.00 ,$161.50 ,$133.00 ,$9.06 ,$180.50 ,$144.40 ,$142.50 ,$109.23 ,$161.50 ,$49.00 ,$109.23 ,$65.65 ,$133.00 ,$9.06 ,$49.00 ,$49.00 ,$79.80 ,$161.50 ,$110.24 ,$174.80 ,$133.00 ,$138.86 ,$138.86 ,$115.71 ,$138.86 ,$131.29 ,$171.00 ,$132.34 ,$49.49 ,$150.10 ,$9.60 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,31100107,88142,HC THINPREP PAP,311,1 ,$157.00 ,$78.50 ,$20.26 ,$157.00 ,$20.93 ,$78.79 ,$67.53 ,$20.26 ,$94.20 ,$133.45 ,$109.90 ,$20.93 ,$149.15 ,$119.32 ,$117.75 ,$34.44 ,$133.45 ,$20.26 ,$34.44 ,$20.26 ,$109.90 ,$20.93 ,$20.26 ,$20.26 ,$22.93 ,$133.45 ,$45.59 ,$144.44 ,$109.90 ,$97.36 ,$97.36 ,$95.61 ,$97.36 ,$108.49 ,$141.30 ,$109.35 ,$20.46 ,$124.03 ,$22.19 ,$24.31 ,$24.31 ,$20.26 ,$24.31 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,31100108,88150,HC PAP SMEAR DIAG UP TO 3 SLIDES,311,1 ,$81.00 ,$40.50 ,$14.86 ,$81.00 ,$14.86 ,$52.47 ,$44.97 ,$15.92 ,$48.60 ,$68.85 ,$56.70 ,$14.86 ,$76.95 ,$61.56 ,$60.75 ,$27.06 ,$68.85 ,$15.92 ,$27.06 ,$15.12 ,$56.70 ,$14.86 ,$15.92 ,$15.92 ,$18.02 ,$68.85 ,$35.82 ,$74.52 ,$56.70 ,$50.80 ,$50.80 ,$49.33 ,$50.80 ,$55.97 ,$72.90 ,$56.42 ,$16.08 ,$63.99 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$64.80 
ST NICHOLAS HOSPITAL - ACUTE,31100109,88155,HC CYTOPATH MATURATION INDEX,311,1 ,$45.00 ,$22.50 ,$8.42 ,$45.00 ,$8.42 ,$45.00 ,$43.95 ,$14.65 ,$27.00 ,$38.25 ,$31.50 ,$8.42 ,$42.75 ,$34.20 ,$33.75 ,$24.91 ,$38.25 ,$14.65 ,$24.91 ,$14.65 ,$31.50 ,$8.42 ,$14.65 ,$14.65 ,$16.58 ,$38.25 ,$32.96 ,$41.40 ,$31.50 ,$28.81 ,$28.81 ,$27.41 ,$28.81 ,$31.10 ,$40.50 ,$31.34 ,$14.80 ,$35.55 ,$8.93 ,$17.58 ,$17.58 ,$14.65 ,$17.58 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$190.00 ,$95.00 ,$3.02 ,$190.00 ,$3.02 ,$151.33 ,$129.71 ,$24.36 ,$114.00 ,$161.50 ,$133.00 ,$3.02 ,$180.50 ,$144.40 ,$142.50 ,$117.32 ,$161.50 ,$24.36 ,$117.32 ,$69.31 ,$133.00 ,$3.02 ,$24.36 ,$24.36 ,$79.80 ,$161.50 ,$54.81 ,$174.80 ,$133.00 ,$75.42 ,$75.42 ,$115.71 ,$75.42 ,$131.29 ,$171.00 ,$132.34 ,$24.60 ,$150.10 ,$3.20 ,$27.59 ,$27.59 ,$24.36 ,$27.59 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,31100111,88160,HC CYTOPATH SMEAR NON GYN (TZANK),311,1 ,$190.00 ,$95.00 ,$3.02 ,$190.00 ,$3.02 ,$151.33 ,$129.71 ,$24.36 ,$114.00 ,$161.50 ,$133.00 ,$3.02 ,$180.50 ,$144.40 ,$142.50 ,$117.32 ,$161.50 ,$24.36 ,$117.32 ,$69.31 ,$133.00 ,$3.02 ,$24.36 ,$24.36 ,$79.80 ,$161.50 ,$54.81 ,$174.80 ,$133.00 ,$75.42 ,$75.42 ,$115.71 ,$75.42 ,$131.29 ,$171.00 ,$132.34 ,$24.60 ,$150.10 ,$3.20 ,$27.59 ,$27.59 ,$24.36 ,$27.59 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,31100112,88162,HC CYTOPATH SMEAR OVER 5 SLIDES,311,1 ,$280.00 ,$140.00 ,$12.46 ,$280.00 ,$12.46 ,$190.39 ,$163.20 ,$49.00 ,$168.00 ,$238.00 ,$196.00 ,$12.46 ,$266.00 ,$212.80 ,$210.00 ,$186.00 ,$238.00 ,$49.00 ,$186.00 ,$96.62 ,$196.00 ,$12.46 ,$49.00 ,$49.00 ,$117.60 ,$238.00 ,$110.24 ,$257.60 ,$196.00 ,$75.42 ,$75.42 ,$170.52 ,$75.42 ,$193.48 ,$252.00 ,$195.02 ,$49.49 ,$221.20 ,$13.21 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,31100113,88164,HC CYTOPATH SCR BETHESDA,311,1 ,$69.00 ,$34.50 ,$14.86 ,$69.00 ,$14.86 ,$52.47 ,$44.97 ,$15.92 ,$41.40 ,$58.65 ,$48.30 ,$14.86 ,$65.55 ,$52.44 ,$51.75 ,$27.06 ,$58.65 ,$15.92 ,$27.06 ,$15.12 ,$48.30 ,$14.86 ,$15.92 ,$15.92 ,$18.02 ,$58.65 ,$35.82 ,$63.48 ,$48.30 ,$50.80 ,$50.80 ,$42.02 ,$50.80 ,$47.68 ,$62.10 ,$48.06 ,$16.08 ,$54.51 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$55.20 
ST NICHOLAS HOSPITAL - ACUTE,31100114,88172,HC FINE NEEDLE EVAL,311,1 ,$141.00 ,$70.50 ,$12.46 ,$330.88 ,$12.46 ,$65.62 ,$56.25 ,$147.06 ,$84.60 ,$119.85 ,$98.70 ,$12.46 ,$133.95 ,$107.16 ,$105.75 ,$89.71 ,$119.85 ,$147.06 ,$89.71 ,$54.93 ,$98.70 ,$12.46 ,$147.06 ,$147.06 ,$59.22 ,$119.85 ,$330.88 ,$129.72 ,$98.70 ,$75.42 ,$75.42 ,$85.87 ,$75.42 ,$97.43 ,$126.90 ,$98.21 ,$148.53 ,$111.39 ,$13.21 ,$141.00 ,$141.00 ,$147.06 ,$141.00 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$403.00 ,$201.50 ,$11.57 ,$403.00 ,$11.57 ,$272.48 ,$233.55 ,$49.00 ,$241.80 ,$342.55 ,$282.10 ,$11.57 ,$382.85 ,$306.28 ,$302.25 ,$257.18 ,$342.55 ,$49.00 ,$257.18 ,$150.75 ,$282.10 ,$11.57 ,$49.00 ,$49.00 ,$169.26 ,$342.55 ,$110.24 ,$370.76 ,$282.10 ,$138.86 ,$138.86 ,$245.43 ,$138.86 ,$278.47 ,$362.70 ,$280.69 ,$49.49 ,$318.37 ,$12.26 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31100116,88177,HC FINE NEEDLE EVAL ADDL,311,1 ,$101.00 ,$50.50 ,$8.66 ,$101.00 ,$12.46 ,$24.14 ,$20.69 , N/A ,$60.60 ,$85.85 ,$70.70 ,$12.46 ,$95.95 ,$76.76 ,$75.75 ,$47.60 ,$85.85 , N/A ,$47.60 ,$29.32 ,$70.70 ,$12.46 , N/A , N/A ,$42.42 ,$85.85 , N/A ,$92.92 ,$70.70 ,$41.85 ,$41.85 ,$61.51 ,$41.85 ,$69.79 ,$90.90 ,$70.35 , N/A ,$79.79 ,$13.21 ,$8.66 ,$8.66 , N/A ,$8.66 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,31100117,88182,HC T AND B CELL QN FLOWCYT,311,1 ,$151.00 ,$75.50 ,$12.46 ,$151.00 ,$12.46 ,$151.00 ,$151.00 ,$49.00 ,$90.60 ,$128.35 ,$105.70 ,$12.46 ,$143.45 ,$114.76 ,$113.25 ,$151.00 ,$128.35 ,$49.00 ,$151.00 ,$133.74 ,$105.70 ,$12.46 ,$49.00 ,$49.00 ,$63.42 ,$128.35 ,$110.24 ,$138.92 ,$105.70 ,$138.86 ,$138.86 ,$91.96 ,$138.86 ,$104.34 ,$135.90 ,$105.17 ,$49.49 ,$119.29 ,$13.21 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$120.80 
ST NICHOLAS HOSPITAL - ACUTE,31100118,88182,HC T AND B CELL QN FLOWCYT (DNA CELL CYCLE),311,1 ,$616.00 ,$308.00 ,$12.46 ,$616.00 ,$12.46 ,$320.00 ,$274.28 ,$49.00 ,$369.60 ,$523.60 ,$431.20 ,$12.46 ,$585.20 ,$468.16 ,$462.00 ,$239.58 ,$523.60 ,$49.00 ,$239.58 ,$133.74 ,$431.20 ,$12.46 ,$49.00 ,$49.00 ,$258.72 ,$523.60 ,$110.24 ,$566.72 ,$431.20 ,$138.86 ,$138.86 ,$375.14 ,$138.86 ,$425.66 ,$554.40 ,$429.04 ,$49.49 ,$486.64 ,$13.21 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$492.80 
ST NICHOLAS HOSPITAL - ACUTE,31100119,88184,HC FLOW CYTO 1ST MARKER (CD4),311,1 ,$31.00 ,$15.50 ,$9.06 ,$646.13 ,$9.06 ,$31.00 ,$31.00 ,$287.17 ,$18.60 ,$26.35 ,$21.70 ,$9.06 ,$29.45 ,$23.56 ,$23.25 ,$31.00 ,$26.35 ,$287.17 ,$31.00 ,$31.00 ,$21.70 ,$9.06 ,$287.17 ,$287.17 ,$13.02 ,$26.35 ,$646.13 ,$28.52 ,$21.70 ,$31.00 ,$31.00 ,$18.88 ,$31.00 ,$21.42 ,$27.90 ,$21.59 ,$290.04 ,$24.49 ,$9.60 ,$31.00 ,$31.00 ,$287.17 ,$31.00 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$24.80 
ST NICHOLAS HOSPITAL - ACUTE,31100120,88184,HC FLOW CYTO 1ST MARKER (PCLI),311,1 ,$77.00 ,$38.50 ,$9.06 ,$646.13 ,$9.06 ,$77.00 ,$77.00 ,$287.17 ,$46.20 ,$65.45 ,$53.90 ,$9.06 ,$73.15 ,$58.52 ,$57.75 ,$77.00 ,$65.45 ,$287.17 ,$77.00 ,$64.28 ,$53.90 ,$9.06 ,$287.17 ,$287.17 ,$32.34 ,$65.45 ,$646.13 ,$70.84 ,$53.90 ,$77.00 ,$77.00 ,$46.89 ,$77.00 ,$53.21 ,$69.30 ,$53.63 ,$290.04 ,$60.83 ,$9.60 ,$77.00 ,$77.00 ,$287.17 ,$77.00 ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$61.60 
ST NICHOLAS HOSPITAL - ACUTE,31100121,88184,HC FLOW CYTO 1ST MARKER,311,1 ,$470.00 ,$235.00 ,$9.06 ,$646.13 ,$9.06 ,$225.40 ,$193.20 ,$287.17 ,$282.00 ,$399.50 ,$329.00 ,$9.06 ,$446.50 ,$357.20 ,$352.50 ,$110.08 ,$399.50 ,$287.17 ,$110.08 ,$64.28 ,$329.00 ,$9.06 ,$287.17 ,$287.17 ,$197.40 ,$399.50 ,$646.13 ,$432.40 ,$329.00 ,$138.86 ,$138.86 ,$286.23 ,$138.86 ,$324.77 ,$423.00 ,$327.36 ,$290.04 ,$371.30 ,$9.60 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,31100122,88184,HC FLOW CYTO 1ST MARKER (MM),311,1 ,$152.00 ,$76.00 ,$9.06 ,$646.13 ,$9.06 ,$152.00 ,$152.00 ,$287.17 ,$91.20 ,$129.20 ,$106.40 ,$9.06 ,$144.40 ,$115.52 ,$114.00 ,$110.08 ,$129.20 ,$287.17 ,$110.08 ,$64.28 ,$106.40 ,$9.06 ,$287.17 ,$287.17 ,$63.84 ,$129.20 ,$646.13 ,$139.84 ,$106.40 ,$138.86 ,$138.86 ,$92.57 ,$138.86 ,$105.03 ,$136.80 ,$105.87 ,$290.04 ,$120.08 ,$9.60 ,$152.00 ,$152.00 ,$287.17 ,$152.00 ,$109.44 ,$94.24 ,$109.44 ,$109.44 ,$121.60 
ST NICHOLAS HOSPITAL - ACUTE,31100124,88185,HC FLOW CYTO EA ADD MARKER (PCLI),311,1 ,$77.00 ,$38.50 ,$12.46 ,$77.00 ,$12.46 ,$77.00 ,$71.39 , N/A ,$46.20 ,$65.45 ,$53.90 ,$12.46 ,$73.15 ,$58.52 ,$57.75 ,$35.46 ,$65.45 , N/A ,$35.46 ,$21.23 ,$53.90 ,$12.46 , N/A , N/A ,$32.34 ,$65.45 , N/A ,$70.84 ,$53.90 ,$64.67 ,$64.67 ,$46.89 ,$64.67 ,$53.21 ,$69.30 ,$53.63 , N/A ,$60.83 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$61.60 
ST NICHOLAS HOSPITAL - ACUTE,31100125,88185,HC FLOW CYTO EA ADD MARKER (PNH),311,1 ,$78.00 ,$39.00 ,$12.46 ,$78.00 ,$12.46 ,$78.00 ,$71.39 , N/A ,$46.80 ,$66.30 ,$54.60 ,$12.46 ,$74.10 ,$59.28 ,$58.50 ,$35.46 ,$66.30 , N/A ,$35.46 ,$21.23 ,$54.60 ,$12.46 , N/A , N/A ,$32.76 ,$66.30 , N/A ,$71.76 ,$54.60 ,$64.67 ,$64.67 ,$47.50 ,$64.67 ,$53.90 ,$70.20 ,$54.33 , N/A ,$61.62 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,31100126,88185,HC FLOW CYTO EA ADD MARKER,311,1 ,$291.00 ,$145.50 ,$12.46 ,$291.00 ,$12.46 ,$83.29 ,$71.39 , N/A ,$174.60 ,$247.35 ,$203.70 ,$12.46 ,$276.45 ,$221.16 ,$218.25 ,$35.46 ,$247.35 , N/A ,$35.46 ,$21.23 ,$203.70 ,$12.46 , N/A , N/A ,$122.22 ,$247.35 , N/A ,$267.72 ,$203.70 ,$64.67 ,$64.67 ,$177.22 ,$64.67 ,$201.08 ,$261.90 ,$202.68 , N/A ,$229.89 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31100128,88185,HC T AND B MAKERS ADDL,311,1 ,$77.00 ,$38.50 ,$12.46 ,$77.00 ,$12.46 ,$77.00 ,$71.39 , N/A ,$46.20 ,$65.45 ,$53.90 ,$12.46 ,$73.15 ,$58.52 ,$57.75 ,$35.46 ,$65.45 , N/A ,$35.46 ,$21.23 ,$53.90 ,$12.46 , N/A , N/A ,$32.34 ,$65.45 , N/A ,$70.84 ,$53.90 ,$64.67 ,$64.67 ,$46.89 ,$64.67 ,$53.21 ,$69.30 ,$53.63 , N/A ,$60.83 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$61.60 
ST NICHOLAS HOSPITAL - ACUTE,31100131,88230,HC TISSUE CLT NONNEO (CHROMO),311,1 ,$561.00 ,$280.50 ,$70.04 ,$561.00 ,$70.04 ,$453.04 ,$388.32 ,$116.49 ,$336.60 ,$476.85 ,$392.70 ,$70.04 ,$532.95 ,$426.36 ,$420.75 ,$198.03 ,$476.85 ,$116.49 ,$198.03 ,$116.49 ,$392.70 ,$70.04 ,$116.49 ,$116.49 ,$131.84 ,$476.85 ,$262.10 ,$516.12 ,$392.70 ,$239.36 ,$239.36 ,$341.65 ,$239.36 ,$387.65 ,$504.90 ,$390.74 ,$117.65 ,$443.19 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$403.92 ,$347.82 ,$403.92 ,$403.92 ,$448.80 
ST NICHOLAS HOSPITAL - ACUTE,31100132,88230,HC TISSUE CLT NONNEO (FRAG X),311,1 ,$158.00 ,$79.00 ,$70.04 ,$262.10 ,$70.04 ,$158.00 ,$158.00 ,$116.49 ,$94.80 ,$134.30 ,$110.60 ,$70.04 ,$150.10 ,$120.08 ,$118.50 ,$158.00 ,$134.30 ,$116.49 ,$158.00 ,$116.49 ,$110.60 ,$70.04 ,$116.49 ,$116.49 ,$131.84 ,$134.30 ,$262.10 ,$145.36 ,$110.60 ,$158.00 ,$158.00 ,$96.22 ,$158.00 ,$109.18 ,$142.20 ,$110.05 ,$117.65 ,$124.82 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$113.76 ,$97.96 ,$113.76 ,$113.76 ,$126.40 
ST NICHOLAS HOSPITAL - ACUTE,31100133,88230,HC TISSUE CLT NONNEO (HRS),311,1 ,$299.00 ,$149.50 ,$70.04 ,$299.00 ,$70.04 ,$299.00 ,$299.00 ,$116.49 ,$179.40 ,$254.15 ,$209.30 ,$70.04 ,$284.05 ,$227.24 ,$224.25 ,$198.03 ,$254.15 ,$116.49 ,$198.03 ,$116.49 ,$209.30 ,$70.04 ,$116.49 ,$116.49 ,$131.84 ,$254.15 ,$262.10 ,$275.08 ,$209.30 ,$239.36 ,$239.36 ,$182.09 ,$239.36 ,$206.61 ,$269.10 ,$208.25 ,$117.65 ,$236.21 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$239.20 
ST NICHOLAS HOSPITAL - ACUTE,31100134,88230,HC TISSUE CLT NONNEO (FXS),311,1 ,$118.00 ,$59.00 ,$59.00 ,$262.10 ,$70.04 ,$118.00 ,$118.00 ,$116.49 ,$70.80 ,$100.30 ,$82.60 ,$70.04 ,$112.10 ,$89.68 ,$88.50 ,$118.00 ,$100.30 ,$116.49 ,$118.00 ,$116.49 ,$82.60 ,$70.04 ,$116.49 ,$116.49 ,$118.00 ,$100.30 ,$262.10 ,$108.56 ,$82.60 ,$118.00 ,$118.00 ,$71.86 ,$118.00 ,$81.54 ,$106.20 ,$82.19 ,$117.65 ,$93.22 ,$74.24 ,$118.00 ,$118.00 ,$116.49 ,$118.00 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$94.40 
ST NICHOLAS HOSPITAL - ACUTE,31100135,88230,HC TISSUE CLT NONNEO (MAYO),311,1 ,$559.00 ,$279.50 ,$70.04 ,$559.00 ,$70.04 ,$453.04 ,$388.32 ,$116.49 ,$335.40 ,$475.15 ,$391.30 ,$70.04 ,$531.05 ,$424.84 ,$419.25 ,$198.03 ,$475.15 ,$116.49 ,$198.03 ,$116.49 ,$391.30 ,$70.04 ,$116.49 ,$116.49 ,$131.84 ,$475.15 ,$262.10 ,$514.28 ,$391.30 ,$239.36 ,$239.36 ,$340.43 ,$239.36 ,$386.27 ,$503.10 ,$389.34 ,$117.65 ,$441.61 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$402.48 ,$346.58 ,$402.48 ,$402.48 ,$447.20 
ST NICHOLAS HOSPITAL - ACUTE,31100136,88230,HC TISSUE CLT NONNEO (LYMPHO),311,1 ,$453.00 ,$226.50 ,$70.04 ,$453.00 ,$70.04 ,$453.00 ,$388.32 ,$116.49 ,$271.80 ,$385.05 ,$317.10 ,$70.04 ,$430.35 ,$344.28 ,$339.75 ,$198.03 ,$385.05 ,$116.49 ,$198.03 ,$116.49 ,$317.10 ,$70.04 ,$116.49 ,$116.49 ,$131.84 ,$385.05 ,$262.10 ,$416.76 ,$317.10 ,$239.36 ,$239.36 ,$275.88 ,$239.36 ,$313.02 ,$407.70 ,$315.51 ,$117.65 ,$357.87 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$326.16 ,$280.86 ,$326.16 ,$326.16 ,$362.40 
ST NICHOLAS HOSPITAL - ACUTE,31100137,88233,HC TISSUE CULT SKIN/OTH SOLID,311,1 ,$399.00 ,$199.50 ,$70.04 ,$399.00 ,$70.04 ,$399.00 ,$399.00 ,$140.73 ,$239.40 ,$339.15 ,$279.30 ,$70.04 ,$379.05 ,$303.24 ,$299.25 ,$239.24 ,$339.15 ,$140.73 ,$239.24 ,$140.73 ,$279.30 ,$70.04 ,$140.73 ,$140.73 ,$159.28 ,$339.15 ,$316.64 ,$367.08 ,$279.30 ,$239.36 ,$239.36 ,$242.99 ,$239.36 ,$275.71 ,$359.10 ,$277.90 ,$142.14 ,$315.21 ,$74.24 ,$168.88 ,$168.88 ,$140.73 ,$168.88 ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$319.20 
ST NICHOLAS HOSPITAL - ACUTE,31100138,88233,HC TISSUE CULT SKIN/OTH SOLID (CHROMO),311,1 ,$914.00 ,$457.00 ,$70.04 ,$914.00 ,$70.04 ,$547.26 ,$469.08 ,$140.73 ,$548.40 ,$776.90 ,$639.80 ,$70.04 ,$868.30 ,$694.64 ,$685.50 ,$239.24 ,$776.90 ,$140.73 ,$239.24 ,$140.73 ,$639.80 ,$70.04 ,$140.73 ,$140.73 ,$159.28 ,$776.90 ,$316.64 ,$840.88 ,$639.80 ,$239.36 ,$239.36 ,$556.63 ,$239.36 ,$631.57 ,$822.60 ,$636.60 ,$142.14 ,$722.06 ,$74.24 ,$168.88 ,$168.88 ,$140.73 ,$168.88 ,$658.08 ,$566.68 ,$658.08 ,$658.08 ,$731.20 
ST NICHOLAS HOSPITAL - ACUTE,31100139,88235,HC TISSUE CULT AMNIO/CHORION,311,1 ,$602.00 ,$301.00 ,$70.04 ,$602.00 ,$70.04 ,$572.71 ,$490.89 ,$150.30 ,$361.20 ,$511.70 ,$421.40 ,$70.04 ,$571.90 ,$457.52 ,$451.50 ,$255.51 ,$511.70 ,$150.30 ,$255.51 ,$150.30 ,$421.40 ,$70.04 ,$150.30 ,$150.30 ,$170.11 ,$511.70 ,$338.18 ,$553.84 ,$421.40 ,$239.36 ,$239.36 ,$366.62 ,$239.36 ,$415.98 ,$541.80 ,$419.29 ,$151.80 ,$475.58 ,$74.24 ,$180.36 ,$180.36 ,$150.30 ,$180.36 ,$433.44 ,$373.24 ,$433.44 ,$433.44 ,$481.60 
ST NICHOLAS HOSPITAL - ACUTE,31100140,88237,HC TISSUE CULT BONE/BLD (CHROMO QD),311,1 ,$439.00 ,$219.50 ,$70.04 ,$439.00 ,$70.04 ,$439.00 ,$431.25 ,$143.75 ,$263.40 ,$373.15 ,$307.30 ,$70.04 ,$417.05 ,$333.64 ,$329.25 ,$244.38 ,$373.15 ,$143.75 ,$244.38 ,$143.75 ,$307.30 ,$70.04 ,$143.75 ,$143.75 ,$162.70 ,$373.15 ,$323.44 ,$403.88 ,$307.30 ,$239.36 ,$239.36 ,$267.35 ,$239.36 ,$303.35 ,$395.10 ,$305.76 ,$145.19 ,$346.81 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$316.08 ,$272.18 ,$316.08 ,$316.08 ,$351.20 
ST NICHOLAS HOSPITAL - ACUTE,31100142,88237,HC TISSUE CULT BONE/BLD (DC),311,1 ,$512.00 ,$256.00 ,$70.04 ,$512.00 ,$70.04 ,$503.13 ,$431.25 ,$143.75 ,$307.20 ,$435.20 ,$358.40 ,$70.04 ,$486.40 ,$389.12 ,$384.00 ,$244.38 ,$435.20 ,$143.75 ,$244.38 ,$143.75 ,$358.40 ,$70.04 ,$143.75 ,$143.75 ,$162.70 ,$435.20 ,$323.44 ,$471.04 ,$358.40 ,$239.36 ,$239.36 ,$311.81 ,$239.36 ,$353.79 ,$460.80 ,$356.61 ,$145.19 ,$404.48 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$368.64 ,$317.44 ,$368.64 ,$368.64 ,$409.60 
ST NICHOLAS HOSPITAL - ACUTE,31100143,88237,HC TISSUE CULT BONE/BLD (CHROMO),311,1 ,$367.00 ,$183.50 ,$70.04 ,$367.00 ,$70.04 ,$367.00 ,$367.00 ,$143.75 ,$220.20 ,$311.95 ,$256.90 ,$70.04 ,$348.65 ,$278.92 ,$275.25 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$143.75 ,$256.90 ,$70.04 ,$143.75 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$239.36 ,$239.36 ,$223.50 ,$239.36 ,$253.60 ,$330.30 ,$255.62 ,$145.19 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$293.60 
ST NICHOLAS HOSPITAL - ACUTE,31100144,88237,HC TISSUE CULT BONE/BLD,311,1 ,$367.00 ,$183.50 ,$70.04 ,$367.00 ,$70.04 ,$367.00 ,$367.00 ,$143.75 ,$220.20 ,$311.95 ,$256.90 ,$70.04 ,$348.65 ,$278.92 ,$275.25 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$143.75 ,$256.90 ,$70.04 ,$143.75 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$239.36 ,$239.36 ,$223.50 ,$239.36 ,$253.60 ,$330.30 ,$255.62 ,$145.19 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$293.60 
ST NICHOLAS HOSPITAL - ACUTE,31100145,88237,HC TISSUE CULT BONE/BLD (CHROMO 1),311,1 ,$367.00 ,$183.50 ,$70.04 ,$367.00 ,$70.04 ,$367.00 ,$367.00 ,$143.75 ,$220.20 ,$311.95 ,$256.90 ,$70.04 ,$348.65 ,$278.92 ,$275.25 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$143.75 ,$256.90 ,$70.04 ,$143.75 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$239.36 ,$239.36 ,$223.50 ,$239.36 ,$253.60 ,$330.30 ,$255.62 ,$145.19 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$293.60 
ST NICHOLAS HOSPITAL - ACUTE,31100146,88237,HC TISSUE CULT BONE/BLD (CHROMO 2),311,1 ,$367.00 ,$183.50 ,$70.04 ,$367.00 ,$70.04 ,$367.00 ,$367.00 ,$143.75 ,$220.20 ,$311.95 ,$256.90 ,$70.04 ,$348.65 ,$278.92 ,$275.25 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$143.75 ,$256.90 ,$70.04 ,$143.75 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$239.36 ,$239.36 ,$223.50 ,$239.36 ,$253.60 ,$330.30 ,$255.62 ,$145.19 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$293.60 
ST NICHOLAS HOSPITAL - ACUTE,31100148,88239,HC TISSUE CULT TUMOR,311,1 ,$496.00 ,$248.00 ,$70.04 ,$496.00 ,$70.04 ,$496.00 ,$491.73 ,$147.52 ,$297.60 ,$421.60 ,$347.20 ,$70.04 ,$471.20 ,$376.96 ,$372.00 ,$250.78 ,$421.60 ,$147.52 ,$250.78 ,$147.52 ,$347.20 ,$70.04 ,$147.52 ,$147.52 ,$166.96 ,$421.60 ,$331.92 ,$456.32 ,$347.20 ,$239.36 ,$239.36 ,$302.06 ,$239.36 ,$342.74 ,$446.40 ,$345.46 ,$149.00 ,$391.84 ,$74.24 ,$177.02 ,$177.02 ,$147.52 ,$177.02 ,$357.12 ,$307.52 ,$357.12 ,$357.12 ,$396.80 
ST NICHOLAS HOSPITAL - ACUTE,31100150,88239,HC TISSUE CULT TUMOR (LYM),311,1 ,$648.00 ,$324.00 ,$70.04 ,$648.00 ,$70.04 ,$573.69 ,$491.73 ,$147.52 ,$388.80 ,$550.80 ,$453.60 ,$70.04 ,$615.60 ,$492.48 ,$486.00 ,$250.78 ,$550.80 ,$147.52 ,$250.78 ,$147.52 ,$453.60 ,$70.04 ,$147.52 ,$147.52 ,$166.96 ,$550.80 ,$331.92 ,$596.16 ,$453.60 ,$239.36 ,$239.36 ,$394.63 ,$239.36 ,$447.77 ,$583.20 ,$451.33 ,$149.00 ,$511.92 ,$74.24 ,$177.02 ,$177.02 ,$147.52 ,$177.02 ,$466.56 ,$401.76 ,$466.56 ,$466.56 ,$518.40 
ST NICHOLAS HOSPITAL - ACUTE,31100151,88240,HC CRYOPRESERVATION,311,1 ,$49.00 ,$24.50 ,$9.83 ,$49.00 ,$9.83 ,$45.75 ,$39.21 ,$13.07 ,$29.40 ,$41.65 ,$34.30 ,$9.83 ,$46.55 ,$37.24 ,$36.75 ,$22.22 ,$41.65 ,$13.07 ,$22.22 ,$13.07 ,$34.30 ,$9.83 ,$13.07 ,$13.07 ,$14.79 ,$41.65 ,$29.41 ,$45.08 ,$34.30 ,$33.57 ,$33.57 ,$29.84 ,$33.57 ,$33.86 ,$44.10 ,$34.13 ,$13.20 ,$38.71 ,$10.42 ,$15.68 ,$15.68 ,$13.07 ,$15.68 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$39.20 
ST NICHOLAS HOSPITAL - ACUTE,31100152,88248,HC FXS CHROM ANALYSIS,311,1 ,$281.00 ,$140.50 ,$140.50 ,$389.63 ,$178.94 ,$281.00 ,$281.00 ,$173.17 ,$168.60 ,$238.85 ,$196.70 ,$178.94 ,$266.95 ,$213.56 ,$210.75 ,$281.00 ,$238.85 ,$173.17 ,$281.00 ,$173.17 ,$196.70 ,$178.94 ,$173.17 ,$173.17 ,$195.99 ,$238.85 ,$389.63 ,$258.52 ,$196.70 ,$281.00 ,$281.00 ,$171.13 ,$281.00 ,$194.17 ,$252.90 ,$195.72 ,$174.90 ,$221.99 ,$189.68 ,$207.80 ,$207.80 ,$173.17 ,$207.80 ,$202.32 ,$174.22 ,$202.32 ,$202.32 ,$224.80 
ST NICHOLAS HOSPITAL - ACUTE,31100153,88262,HC CHROM COUNT 15-20/2 (QD),311,1 ,$701.00 ,$350.50 ,$125.49 ,$701.00 ,$129.67 ,$484.72 ,$415.47 ,$125.49 ,$420.60 ,$595.85 ,$490.70 ,$129.67 ,$665.95 ,$532.76 ,$525.75 ,$213.33 ,$595.85 ,$125.49 ,$213.33 ,$125.49 ,$490.70 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$595.85 ,$282.35 ,$644.92 ,$490.70 ,$598.98 ,$598.98 ,$426.91 ,$598.98 ,$484.39 ,$630.90 ,$488.25 ,$126.74 ,$553.79 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$504.72 ,$434.62 ,$504.72 ,$504.72 ,$560.80 
ST NICHOLAS HOSPITAL - ACUTE,31100154,88262,HC CHROM COUNT 15-20/2 (FRAG X),311,1 ,$156.00 ,$78.00 ,$78.00 ,$282.35 ,$129.67 ,$156.00 ,$156.00 ,$125.49 ,$93.60 ,$132.60 ,$109.20 ,$129.67 ,$148.20 ,$118.56 ,$117.00 ,$156.00 ,$132.60 ,$125.49 ,$156.00 ,$125.49 ,$109.20 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$132.60 ,$282.35 ,$143.52 ,$109.20 ,$156.00 ,$156.00 ,$95.00 ,$156.00 ,$107.80 ,$140.40 ,$108.65 ,$126.74 ,$123.24 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$112.32 ,$96.72 ,$112.32 ,$112.32 ,$124.80 
ST NICHOLAS HOSPITAL - ACUTE,31100155,88299,HC CYTOGENIC STUDY (LYMPH),311,1 ,$464.00 ,$232.00 ,$13.61 ,$464.00 ,$13.61 ,$300.16 ,$300.16 ,$49.00 ,$278.40 ,$394.40 ,$324.80 ,$13.61 ,$440.80 ,$352.64 ,$348.00 , N/A ,$394.40 ,$49.00 , N/A , N/A ,$324.80 ,$13.61 ,$49.00 ,$49.00 ,$194.88 ,$394.40 ,$110.24 ,$426.88 ,$324.80 ,$75.42 ,$75.42 ,$282.58 ,$75.42 ,$320.62 ,$417.60 ,$323.18 ,$49.49 ,$366.56 ,$14.43 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$334.08 ,$287.68 ,$334.08 ,$334.08 ,$371.20 
ST NICHOLAS HOSPITAL - ACUTE,31100156,88262,HC CHROM COUNT 15-20/2 (HRS),311,1 ,$297.00 ,$148.50 ,$125.49 ,$297.00 ,$129.67 ,$297.00 ,$297.00 ,$125.49 ,$178.20 ,$252.45 ,$207.90 ,$129.67 ,$282.15 ,$225.72 ,$222.75 ,$213.33 ,$252.45 ,$125.49 ,$213.33 ,$125.49 ,$207.90 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$252.45 ,$282.35 ,$273.24 ,$207.90 ,$297.00 ,$297.00 ,$180.87 ,$297.00 ,$205.23 ,$267.30 ,$206.86 ,$126.74 ,$234.63 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$213.84 ,$184.14 ,$213.84 ,$213.84 ,$237.60 
ST NICHOLAS HOSPITAL - ACUTE,31100157,88262,HC CHROM COUNT 15-20/2 (MAYO),311,1 ,$760.00 ,$380.00 ,$125.49 ,$760.00 ,$129.67 ,$484.72 ,$415.47 ,$125.49 ,$456.00 ,$646.00 ,$532.00 ,$129.67 ,$722.00 ,$577.60 ,$570.00 ,$213.33 ,$646.00 ,$125.49 ,$213.33 ,$125.49 ,$532.00 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$646.00 ,$282.35 ,$699.20 ,$532.00 ,$598.98 ,$598.98 ,$462.84 ,$598.98 ,$525.16 ,$684.00 ,$529.34 ,$126.74 ,$600.40 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,31100160,88262,HC CHROM COUNT 15-20/2 (KARO),311,1 ,$498.00 ,$249.00 ,$125.49 ,$498.00 ,$129.67 ,$484.72 ,$415.47 ,$125.49 ,$298.80 ,$423.30 ,$348.60 ,$129.67 ,$473.10 ,$378.48 ,$373.50 ,$213.33 ,$423.30 ,$125.49 ,$213.33 ,$125.49 ,$348.60 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$423.30 ,$282.35 ,$458.16 ,$348.60 ,$498.00 ,$498.00 ,$303.28 ,$498.00 ,$344.12 ,$448.20 ,$346.86 ,$126.74 ,$393.42 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$358.56 ,$308.76 ,$358.56 ,$358.56 ,$398.40 
ST NICHOLAS HOSPITAL - ACUTE,31100161,88262,HC CHROM COUNT 15-20/2,311,1 ,$486.00 ,$243.00 ,$125.49 ,$486.00 ,$129.67 ,$484.72 ,$415.47 ,$125.49 ,$291.60 ,$413.10 ,$340.20 ,$129.67 ,$461.70 ,$369.36 ,$364.50 ,$213.33 ,$413.10 ,$125.49 ,$213.33 ,$125.49 ,$340.20 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$413.10 ,$282.35 ,$447.12 ,$340.20 ,$486.00 ,$486.00 ,$295.97 ,$486.00 ,$335.83 ,$437.40 ,$338.50 ,$126.74 ,$383.94 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$349.92 ,$301.32 ,$349.92 ,$349.92 ,$388.80 
ST NICHOLAS HOSPITAL - ACUTE,31100162,88262,HC CHROM COUNT 15-20/2 (AUTOP),311,1 ,$507.00 ,$253.50 ,$125.49 ,$507.00 ,$129.67 ,$484.72 ,$415.47 ,$125.49 ,$304.20 ,$430.95 ,$354.90 ,$129.67 ,$481.65 ,$385.32 ,$380.25 ,$213.33 ,$430.95 ,$125.49 ,$213.33 ,$125.49 ,$354.90 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$430.95 ,$282.35 ,$466.44 ,$354.90 ,$507.00 ,$507.00 ,$308.76 ,$507.00 ,$350.34 ,$456.30 ,$353.13 ,$126.74 ,$400.53 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$405.60 
ST NICHOLAS HOSPITAL - ACUTE,31100163,88262,HC CHROM COUNT 15-20/2 (LYM),311,1 ,$726.00 ,$363.00 ,$125.49 ,$726.00 ,$129.67 ,$484.72 ,$415.47 ,$125.49 ,$435.60 ,$617.10 ,$508.20 ,$129.67 ,$689.70 ,$551.76 ,$544.50 ,$213.33 ,$617.10 ,$125.49 ,$213.33 ,$125.49 ,$508.20 ,$129.67 ,$125.49 ,$125.49 ,$142.03 ,$617.10 ,$282.35 ,$667.92 ,$508.20 ,$598.98 ,$598.98 ,$442.13 ,$598.98 ,$501.67 ,$653.40 ,$505.66 ,$126.74 ,$573.54 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$522.72 ,$450.12 ,$522.72 ,$522.72 ,$580.80 
ST NICHOLAS HOSPITAL - ACUTE,31100164,88299,HC CYTOGENIC STUDY (STLBRT1),311,1 ,$455.00 ,$227.50 ,$13.61 ,$455.00 ,$13.61 ,$294.34 ,$294.34 ,$49.00 ,$273.00 ,$386.75 ,$318.50 ,$13.61 ,$432.25 ,$345.80 ,$341.25 , N/A ,$386.75 ,$49.00 , N/A , N/A ,$318.50 ,$13.61 ,$49.00 ,$49.00 ,$191.10 ,$386.75 ,$110.24 ,$418.60 ,$318.50 ,$75.42 ,$75.42 ,$277.10 ,$75.42 ,$314.41 ,$409.50 ,$316.91 ,$49.49 ,$359.45 ,$14.43 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$327.60 ,$282.10 ,$327.60 ,$327.60 ,$364.00 
ST NICHOLAS HOSPITAL - ACUTE,31100165,88264,HC CYTOGENIC STUDY (HEMA BLD),311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$144.61 ,$550.20 ,$779.45 ,$641.90 ,$149.43 ,$871.15 ,$696.92 ,$687.75 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$144.61 ,$641.90 ,$149.43 ,$144.61 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$598.98 ,$598.98 ,$558.45 ,$598.98 ,$633.65 ,$825.30 ,$638.69 ,$146.06 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$733.60 
ST NICHOLAS HOSPITAL - ACUTE,31100166,88264,HC CHROM ANLYS ANALYZE 20,311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$144.61 ,$550.20 ,$779.45 ,$641.90 ,$149.43 ,$871.15 ,$696.92 ,$687.75 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$144.61 ,$641.90 ,$149.43 ,$144.61 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$598.98 ,$598.98 ,$558.45 ,$598.98 ,$633.65 ,$825.30 ,$638.69 ,$146.06 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$733.60 
ST NICHOLAS HOSPITAL - ACUTE,31100167,88264,HC CHROM ANLYS ANALZYE 20 (KARO),311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$144.61 ,$550.20 ,$779.45 ,$641.90 ,$149.43 ,$871.15 ,$696.92 ,$687.75 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$144.61 ,$641.90 ,$149.43 ,$144.61 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$598.98 ,$598.98 ,$558.45 ,$598.98 ,$633.65 ,$825.30 ,$638.69 ,$146.06 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$733.60 
ST NICHOLAS HOSPITAL - ACUTE,31100168,88264,HC CHROM ANLYS ANALZYE 20 (DC),311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$144.61 ,$550.20 ,$779.45 ,$641.90 ,$149.43 ,$871.15 ,$696.92 ,$687.75 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$144.61 ,$641.90 ,$149.43 ,$144.61 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$598.98 ,$598.98 ,$558.45 ,$598.98 ,$633.65 ,$825.30 ,$638.69 ,$146.06 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$733.60 
ST NICHOLAS HOSPITAL - ACUTE,31100169,88264,HC CYTOGENIC STUDY (BM),311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$144.61 ,$550.20 ,$779.45 ,$641.90 ,$149.43 ,$871.15 ,$696.92 ,$687.75 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$144.61 ,$641.90 ,$149.43 ,$144.61 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$598.98 ,$598.98 ,$558.45 ,$598.98 ,$633.65 ,$825.30 ,$638.69 ,$146.06 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$733.60 
ST NICHOLAS HOSPITAL - ACUTE,31100170,88299,HC CYTOGENIC STUDY (SOLID),311,1 ,$594.00 ,$297.00 ,$13.61 ,$594.00 ,$13.61 ,$384.26 ,$384.26 ,$49.00 ,$356.40 ,$504.90 ,$415.80 ,$13.61 ,$564.30 ,$451.44 ,$445.50 , N/A ,$504.90 ,$49.00 , N/A , N/A ,$415.80 ,$13.61 ,$49.00 ,$49.00 ,$249.48 ,$504.90 ,$110.24 ,$546.48 ,$415.80 ,$75.42 ,$75.42 ,$361.75 ,$75.42 ,$410.45 ,$534.60 ,$413.72 ,$49.49 ,$469.26 ,$14.43 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$475.20 
ST NICHOLAS HOSPITAL - ACUTE,31100172,88271,HC MCG DNA PROBE (HER2),311,1 ,$248.00 ,$124.00 ,$20.36 ,$248.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$148.80 ,$210.80 ,$173.60 ,$20.36 ,$235.60 ,$188.48 ,$186.00 ,$36.41 ,$210.80 ,$21.42 ,$36.41 ,$21.42 ,$173.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$210.80 ,$48.20 ,$228.16 ,$173.60 ,$69.57 ,$69.57 ,$151.03 ,$69.57 ,$171.37 ,$223.20 ,$172.73 ,$21.63 ,$195.92 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$198.40 
ST NICHOLAS HOSPITAL - ACUTE,31100173,88271,HC MCG DNA PROBE (PARDER WILLI),311,1 ,$432.00 ,$216.00 ,$20.36 ,$432.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$259.20 ,$367.20 ,$302.40 ,$20.36 ,$410.40 ,$328.32 ,$324.00 ,$36.41 ,$367.20 ,$21.42 ,$36.41 ,$21.42 ,$302.40 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$367.20 ,$48.20 ,$397.44 ,$302.40 ,$69.57 ,$69.57 ,$263.09 ,$69.57 ,$298.51 ,$388.80 ,$300.89 ,$21.63 ,$341.28 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$311.04 ,$267.84 ,$311.04 ,$311.04 ,$345.60 
ST NICHOLAS HOSPITAL - ACUTE,31100174,88271,HC MCG DNA PROBE(FISH),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100175,88271,HC MCG DNA PROBE (FISH B CELL),311,1 ,$302.00 ,$151.00 ,$20.36 ,$302.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$181.20 ,$256.70 ,$211.40 ,$20.36 ,$286.90 ,$229.52 ,$226.50 ,$36.41 ,$256.70 ,$21.42 ,$36.41 ,$21.42 ,$211.40 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$256.70 ,$48.20 ,$277.84 ,$211.40 ,$69.57 ,$69.57 ,$183.92 ,$69.57 ,$208.68 ,$271.80 ,$210.34 ,$21.63 ,$238.58 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$241.60 
ST NICHOLAS HOSPITAL - ACUTE,31100177,88271,HC MCG DNA PROBE (FISH DNA),311,1 ,$189.00 ,$94.50 ,$20.36 ,$189.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$113.40 ,$160.65 ,$132.30 ,$20.36 ,$179.55 ,$143.64 ,$141.75 ,$36.41 ,$160.65 ,$21.42 ,$36.41 ,$21.42 ,$132.30 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$160.65 ,$48.20 ,$173.88 ,$132.30 ,$69.57 ,$69.57 ,$115.10 ,$69.57 ,$130.60 ,$170.10 ,$131.64 ,$21.63 ,$149.31 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$151.20 
ST NICHOLAS HOSPITAL - ACUTE,31100178,88271,HC MCG DNA PROBE (T CELL),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100179,88271,HC MCG DNA PROBE (B CELL LYMPH),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100180,88271,HC MCG DNA PROBE (AML),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100181,88271,HC MCG DNA PROBE (MYCN),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100182,88271,HC MCG DNA PROBE (MDS),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100183,88271,HC MCG DNA PROBE (EACH),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100184,88271,HC MCG DNA PROBE (T CELL FISH),311,1 ,$189.00 ,$94.50 ,$20.36 ,$189.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$113.40 ,$160.65 ,$132.30 ,$20.36 ,$179.55 ,$143.64 ,$141.75 ,$36.41 ,$160.65 ,$21.42 ,$36.41 ,$21.42 ,$132.30 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$160.65 ,$48.20 ,$173.88 ,$132.30 ,$69.57 ,$69.57 ,$115.10 ,$69.57 ,$130.60 ,$170.10 ,$131.64 ,$21.63 ,$149.31 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$151.20 
ST NICHOLAS HOSPITAL - ACUTE,31100185,88271,HC MCG DNA PROBE (CLL),311,1 ,$216.00 ,$108.00 ,$20.36 ,$216.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$129.60 ,$183.60 ,$151.20 ,$20.36 ,$205.20 ,$164.16 ,$162.00 ,$36.41 ,$183.60 ,$21.42 ,$36.41 ,$21.42 ,$151.20 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$183.60 ,$48.20 ,$198.72 ,$151.20 ,$69.57 ,$69.57 ,$131.54 ,$69.57 ,$149.26 ,$194.40 ,$150.44 ,$21.63 ,$170.64 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$172.80 
ST NICHOLAS HOSPITAL - ACUTE,31100186,88271,HC MCG DNA PROBE (BCR),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100187,88271,HC MCG DNA PROBE (B CELL ALL),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100188,88271,HC MCG DNA PROBE (B CELL ALL),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100189,88271,HC MCG DNA PROBE (T CELL LYMPH),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$64.80 ,$91.80 ,$75.60 ,$20.36 ,$102.60 ,$82.08 ,$81.00 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$21.42 ,$75.60 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$69.57 ,$69.57 ,$65.77 ,$69.57 ,$74.63 ,$97.20 ,$75.22 ,$21.63 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100191,88273,HC MCG CHROM INSITU 10-30 (PARDER WILLI),311,1 ,$496.00 ,$248.00 ,$34.81 ,$496.00 ,$35.97 ,$124.95 ,$107.10 ,$34.81 ,$297.60 ,$421.60 ,$347.20 ,$35.97 ,$471.20 ,$376.96 ,$372.00 ,$59.18 ,$421.60 ,$34.81 ,$59.18 ,$34.81 ,$347.20 ,$35.97 ,$34.81 ,$34.81 ,$39.40 ,$421.60 ,$78.32 ,$456.32 ,$347.20 ,$154.43 ,$154.43 ,$302.06 ,$154.43 ,$342.74 ,$446.40 ,$345.46 ,$35.16 ,$391.84 ,$38.13 ,$41.77 ,$41.77 ,$34.81 ,$41.77 ,$357.12 ,$307.52 ,$357.12 ,$357.12 ,$396.80 
ST NICHOLAS HOSPITAL - ACUTE,31100192,88273,HC MCG CHROM INSITU 10-30,311,1 ,$189.00 ,$94.50 ,$34.81 ,$189.00 ,$35.97 ,$124.95 ,$107.10 ,$34.81 ,$113.40 ,$160.65 ,$132.30 ,$35.97 ,$179.55 ,$143.64 ,$141.75 ,$59.18 ,$160.65 ,$34.81 ,$59.18 ,$34.81 ,$132.30 ,$35.97 ,$34.81 ,$34.81 ,$39.40 ,$160.65 ,$78.32 ,$173.88 ,$132.30 ,$154.43 ,$154.43 ,$115.10 ,$154.43 ,$130.60 ,$170.10 ,$131.64 ,$35.16 ,$149.31 ,$38.13 ,$41.77 ,$41.77 ,$34.81 ,$41.77 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$151.20 
ST NICHOLAS HOSPITAL - ACUTE,31100193,88274,HC MCG INTERPHASE INSITU 25 (HER2),311,1 ,$216.00 ,$108.00 ,$42.38 ,$216.00 ,$43.79 ,$148.33 ,$127.14 ,$42.38 ,$129.60 ,$183.60 ,$151.20 ,$43.79 ,$205.20 ,$164.16 ,$162.00 ,$72.05 ,$183.60 ,$42.38 ,$72.05 ,$42.38 ,$151.20 ,$43.79 ,$42.38 ,$42.38 ,$47.97 ,$183.60 ,$95.36 ,$198.72 ,$151.20 ,$167.29 ,$167.29 ,$131.54 ,$167.29 ,$149.26 ,$194.40 ,$150.44 ,$42.80 ,$170.64 ,$46.42 ,$50.86 ,$50.86 ,$42.38 ,$50.86 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$172.80 
ST NICHOLAS HOSPITAL - ACUTE,31100194,88274,HC MCG INTERPHASE INSITU 25 (MYCN),311,1 ,$216.00 ,$108.00 ,$42.38 ,$216.00 ,$43.79 ,$148.33 ,$127.14 ,$42.38 ,$129.60 ,$183.60 ,$151.20 ,$43.79 ,$205.20 ,$164.16 ,$162.00 ,$72.05 ,$183.60 ,$42.38 ,$72.05 ,$42.38 ,$151.20 ,$43.79 ,$42.38 ,$42.38 ,$47.97 ,$183.60 ,$95.36 ,$198.72 ,$151.20 ,$167.29 ,$167.29 ,$131.54 ,$167.29 ,$149.26 ,$194.40 ,$150.44 ,$42.80 ,$170.64 ,$46.42 ,$50.86 ,$50.86 ,$42.38 ,$50.86 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$172.80 
ST NICHOLAS HOSPITAL - ACUTE,31100195,88275,HC MCG INTERPH INSITU 100 (CML),311,1 ,$291.00 ,$145.50 ,$51.19 ,$291.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$174.60 ,$247.35 ,$203.70 ,$52.89 ,$276.45 ,$221.16 ,$218.25 ,$87.02 ,$247.35 ,$51.19 ,$87.02 ,$51.19 ,$203.70 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$247.35 ,$115.18 ,$267.72 ,$203.70 ,$193.00 ,$193.00 ,$177.22 ,$193.00 ,$201.08 ,$261.90 ,$202.68 ,$51.70 ,$229.89 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31100196,88275,HC MCG INTERPH INSITU 100 (B CELL FISH),311,1 ,$594.00 ,$297.00 ,$51.19 ,$594.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$356.40 ,$504.90 ,$415.80 ,$52.89 ,$564.30 ,$451.44 ,$445.50 ,$87.02 ,$504.90 ,$51.19 ,$87.02 ,$51.19 ,$415.80 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$504.90 ,$115.18 ,$546.48 ,$415.80 ,$193.00 ,$193.00 ,$361.75 ,$193.00 ,$410.45 ,$534.60 ,$413.72 ,$51.70 ,$469.26 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$475.20 
ST NICHOLAS HOSPITAL - ACUTE,31100197,88275,HC MCG INTERPH INSITU 100 ADDITIONAL,311,1 ,$108.00 ,$54.00 ,$51.19 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$51.19 ,$64.80 ,$91.80 ,$75.60 ,$52.89 ,$102.60 ,$82.08 ,$81.00 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$51.19 ,$75.60 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$97.20 ,$75.22 ,$51.70 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100198,88275,HC MCG INTERPH INSITU 100 (T CELL),311,1 ,$141.00 ,$70.50 ,$51.19 ,$141.00 ,$52.89 ,$141.00 ,$141.00 ,$51.19 ,$84.60 ,$119.85 ,$98.70 ,$52.89 ,$133.95 ,$107.16 ,$105.75 ,$87.02 ,$119.85 ,$51.19 ,$87.02 ,$51.19 ,$98.70 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$119.85 ,$115.18 ,$129.72 ,$98.70 ,$141.00 ,$141.00 ,$85.87 ,$141.00 ,$97.43 ,$126.90 ,$98.21 ,$51.70 ,$111.39 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,31100199,88275,HC MCG INTERPH INSITU 100 (B CELL LYMPH),311,1 ,$227.00 ,$113.50 ,$51.19 ,$227.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$136.20 ,$192.95 ,$158.90 ,$52.89 ,$215.65 ,$172.52 ,$170.25 ,$87.02 ,$192.95 ,$51.19 ,$87.02 ,$51.19 ,$158.90 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$192.95 ,$115.18 ,$208.84 ,$158.90 ,$193.00 ,$193.00 ,$138.24 ,$193.00 ,$156.86 ,$204.30 ,$158.11 ,$51.70 ,$179.33 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$181.60 
ST NICHOLAS HOSPITAL - ACUTE,31100200,88275,HC MCG INTERPH INSITU 100 (AML),311,1 ,$227.00 ,$113.50 ,$51.19 ,$227.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$136.20 ,$192.95 ,$158.90 ,$52.89 ,$215.65 ,$172.52 ,$170.25 ,$87.02 ,$192.95 ,$51.19 ,$87.02 ,$51.19 ,$158.90 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$192.95 ,$115.18 ,$208.84 ,$158.90 ,$193.00 ,$193.00 ,$138.24 ,$193.00 ,$156.86 ,$204.30 ,$158.11 ,$51.70 ,$179.33 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$181.60 
ST NICHOLAS HOSPITAL - ACUTE,31100201,88275,HC MCG INTERPH INSITU 100 (MDS),311,1 ,$324.00 ,$162.00 ,$51.19 ,$324.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$194.40 ,$275.40 ,$226.80 ,$52.89 ,$307.80 ,$246.24 ,$243.00 ,$87.02 ,$275.40 ,$51.19 ,$87.02 ,$51.19 ,$226.80 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$275.40 ,$115.18 ,$298.08 ,$226.80 ,$193.00 ,$193.00 ,$197.32 ,$193.00 ,$223.88 ,$291.60 ,$225.67 ,$51.70 ,$255.96 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$233.28 ,$200.88 ,$233.28 ,$233.28 ,$259.20 
ST NICHOLAS HOSPITAL - ACUTE,31100202,88275,HC MCG INTERPH INSITU 100 (PCPD),311,1 ,$108.00 ,$54.00 ,$51.19 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$51.19 ,$64.80 ,$91.80 ,$75.60 ,$52.89 ,$102.60 ,$82.08 ,$81.00 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$51.19 ,$75.60 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$97.20 ,$75.22 ,$51.70 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100203,88275,HC MCG INTERPH INSITU 100 (T CELL FISH),311,1 ,$189.00 ,$94.50 ,$51.19 ,$189.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$113.40 ,$160.65 ,$132.30 ,$52.89 ,$179.55 ,$143.64 ,$141.75 ,$87.02 ,$160.65 ,$51.19 ,$87.02 ,$51.19 ,$132.30 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$160.65 ,$115.18 ,$173.88 ,$132.30 ,$189.00 ,$189.00 ,$115.10 ,$189.00 ,$130.60 ,$170.10 ,$131.64 ,$51.70 ,$149.31 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$151.20 
ST NICHOLAS HOSPITAL - ACUTE,31100204,88275,HC MCG INTERPH INSITU 100 (CLL),311,1 ,$108.00 ,$54.00 ,$51.19 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$51.19 ,$64.80 ,$91.80 ,$75.60 ,$52.89 ,$102.60 ,$82.08 ,$81.00 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$51.19 ,$75.60 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$97.20 ,$75.22 ,$51.70 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100205,88275,HC MCG INTERPH INSITU 100 (BCR),311,1 ,$216.00 ,$108.00 ,$51.19 ,$216.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$129.60 ,$183.60 ,$151.20 ,$52.89 ,$205.20 ,$164.16 ,$162.00 ,$87.02 ,$183.60 ,$51.19 ,$87.02 ,$51.19 ,$151.20 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$183.60 ,$115.18 ,$198.72 ,$151.20 ,$193.00 ,$193.00 ,$131.54 ,$193.00 ,$149.26 ,$194.40 ,$150.44 ,$51.70 ,$170.64 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$172.80 
ST NICHOLAS HOSPITAL - ACUTE,31100206,88275,HC MCG INTERPH INSITU 100 (B CELL),311,1 ,$244.00 ,$122.00 ,$51.19 ,$244.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$146.40 ,$207.40 ,$170.80 ,$52.89 ,$231.80 ,$185.44 ,$183.00 ,$87.02 ,$207.40 ,$51.19 ,$87.02 ,$51.19 ,$170.80 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$207.40 ,$115.18 ,$224.48 ,$170.80 ,$193.00 ,$193.00 ,$148.60 ,$193.00 ,$168.60 ,$219.60 ,$169.95 ,$51.70 ,$192.76 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$175.68 ,$151.28 ,$175.68 ,$175.68 ,$195.20 
ST NICHOLAS HOSPITAL - ACUTE,31100207,88275,HC MCG INTERPH INSITU 100 (B CELL ALL),311,1 ,$108.00 ,$54.00 ,$51.19 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$51.19 ,$64.80 ,$91.80 ,$75.60 ,$52.89 ,$102.60 ,$82.08 ,$81.00 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$51.19 ,$75.60 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$97.20 ,$75.22 ,$51.70 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100208,88275,HC MCG INTERPH INSITU 100 (T CELL LYMPH),311,1 ,$108.00 ,$54.00 ,$51.19 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$51.19 ,$64.80 ,$91.80 ,$75.60 ,$52.89 ,$102.60 ,$82.08 ,$81.00 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$51.19 ,$75.60 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$97.20 ,$75.22 ,$51.70 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,31100209,88275,HC MCG INTERPH INSITU 100 (T CELL LYMPHOMA),311,1 ,$189.00 ,$94.50 ,$51.19 ,$189.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$113.40 ,$160.65 ,$132.30 ,$52.89 ,$179.55 ,$143.64 ,$141.75 ,$87.02 ,$160.65 ,$51.19 ,$87.02 ,$51.19 ,$132.30 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$160.65 ,$115.18 ,$173.88 ,$132.30 ,$189.00 ,$189.00 ,$115.10 ,$189.00 ,$130.60 ,$170.10 ,$131.64 ,$51.70 ,$149.31 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$151.20 
ST NICHOLAS HOSPITAL - ACUTE,31100210,88275,HC MCG INTERPH INSITU 100 (B CELL LYMPHOMA),311,1 ,$194.00 ,$97.00 ,$51.19 ,$194.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$116.40 ,$164.90 ,$135.80 ,$52.89 ,$184.30 ,$147.44 ,$145.50 ,$87.02 ,$164.90 ,$51.19 ,$87.02 ,$51.19 ,$135.80 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$164.90 ,$115.18 ,$178.48 ,$135.80 ,$193.00 ,$193.00 ,$118.15 ,$193.00 ,$134.05 ,$174.60 ,$135.12 ,$51.70 ,$153.26 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$155.20 
ST NICHOLAS HOSPITAL - ACUTE,31100211,88280,HC CHROM ADDL KARYO,311,1 ,$270.00 ,$135.00 ,$33.47 ,$270.00 ,$34.58 ,$117.15 ,$100.41 ,$33.47 ,$162.00 ,$229.50 ,$189.00 ,$34.58 ,$256.50 ,$205.20 ,$202.50 ,$56.90 ,$229.50 ,$33.47 ,$56.90 ,$33.47 ,$189.00 ,$34.58 ,$33.47 ,$33.47 ,$37.88 ,$229.50 ,$75.31 ,$248.40 ,$189.00 ,$120.61 ,$120.61 ,$164.43 ,$120.61 ,$186.57 ,$243.00 ,$188.06 ,$33.80 ,$213.30 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,31100212,88280,HC CHROM ADDL KARYO (T),311,1 ,$312.00 ,$156.00 ,$33.47 ,$312.00 ,$34.58 ,$117.15 ,$100.41 ,$33.47 ,$187.20 ,$265.20 ,$218.40 ,$34.58 ,$296.40 ,$237.12 ,$234.00 ,$56.90 ,$265.20 ,$33.47 ,$56.90 ,$33.47 ,$218.40 ,$34.58 ,$33.47 ,$33.47 ,$37.88 ,$265.20 ,$75.31 ,$287.04 ,$218.40 ,$120.61 ,$120.61 ,$190.01 ,$120.61 ,$215.59 ,$280.80 ,$217.31 ,$33.80 ,$246.48 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$224.64 ,$193.44 ,$224.64 ,$224.64 ,$249.60 
ST NICHOLAS HOSPITAL - ACUTE,31100213,88280,HC CHROM ADDL KARYO (L),311,1 ,$185.00 ,$92.50 ,$33.47 ,$185.00 ,$34.58 ,$117.15 ,$100.41 ,$33.47 ,$111.00 ,$157.25 ,$129.50 ,$34.58 ,$175.75 ,$140.60 ,$138.75 ,$56.90 ,$157.25 ,$33.47 ,$56.90 ,$33.47 ,$129.50 ,$34.58 ,$33.47 ,$33.47 ,$37.88 ,$157.25 ,$75.31 ,$170.20 ,$129.50 ,$120.61 ,$120.61 ,$112.67 ,$120.61 ,$127.84 ,$166.50 ,$128.85 ,$33.80 ,$146.15 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$148.00 
ST NICHOLAS HOSPITAL - ACUTE,31100214,88289,HC CHROM ADDL HIGH RES (HRS),311,1 ,$299.00 ,$149.50 ,$34.43 ,$299.00 ,$35.58 ,$133.91 ,$114.78 ,$34.43 ,$179.40 ,$254.15 ,$209.30 ,$35.58 ,$284.05 ,$227.24 ,$224.25 ,$58.53 ,$254.15 ,$34.43 ,$58.53 ,$34.43 ,$209.30 ,$35.58 ,$34.43 ,$34.43 ,$38.97 ,$254.15 ,$77.47 ,$275.08 ,$209.30 ,$165.49 ,$165.49 ,$182.09 ,$165.49 ,$206.61 ,$269.10 ,$208.25 ,$34.77 ,$236.21 ,$37.71 ,$41.32 ,$41.32 ,$34.43 ,$41.32 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$239.20 
ST NICHOLAS HOSPITAL - ACUTE,31100215,88289,HC CHROM ADDL HIGH RES (FXS),311,1 ,$118.00 ,$59.00 ,$34.43 ,$118.00 ,$35.58 ,$118.00 ,$114.78 ,$34.43 ,$70.80 ,$100.30 ,$82.60 ,$35.58 ,$112.10 ,$89.68 ,$88.50 ,$58.53 ,$100.30 ,$34.43 ,$58.53 ,$34.43 ,$82.60 ,$35.58 ,$34.43 ,$34.43 ,$38.97 ,$100.30 ,$77.47 ,$108.56 ,$82.60 ,$118.00 ,$118.00 ,$71.86 ,$118.00 ,$81.54 ,$106.20 ,$82.19 ,$34.77 ,$93.22 ,$37.71 ,$41.32 ,$41.32 ,$34.43 ,$41.32 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$94.40 
ST NICHOLAS HOSPITAL - ACUTE,31100218,P3000,HC PAP SMEAR SCREEN (UP TO 3),311,1 ,$66.00 ,$33.00 ,$14.86 ,$66.00 ,$14.86 ,$52.47 ,$44.97 ,$15.92 ,$39.60 ,$56.10 ,$46.20 ,$14.86 ,$62.70 ,$50.16 ,$49.50 ,$27.06 ,$56.10 ,$15.92 ,$27.06 ,$15.12 ,$46.20 ,$14.86 ,$15.92 ,$15.92 ,$18.02 ,$56.10 ,$35.82 ,$60.72 ,$46.20 ,$50.80 ,$50.80 ,$40.19 ,$50.80 ,$45.61 ,$59.40 ,$45.97 ,$16.08 ,$52.14 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$47.52 ,$40.92 ,$47.52 ,$47.52 ,$52.80 
ST NICHOLAS HOSPITAL - ACUTE,31100219,P3000,HC PAP SMEAR SLIDE SCREEN,311,1 ,$57.00 ,$28.50 ,$14.86 ,$57.00 ,$14.86 ,$52.47 ,$44.97 ,$15.92 ,$34.20 ,$48.45 ,$39.90 ,$14.86 ,$54.15 ,$43.32 ,$42.75 ,$27.06 ,$48.45 ,$15.92 ,$27.06 ,$15.12 ,$39.90 ,$14.86 ,$15.92 ,$15.92 ,$18.02 ,$48.45 ,$35.82 ,$52.44 ,$39.90 ,$50.80 ,$50.80 ,$34.71 ,$50.80 ,$39.39 ,$51.30 ,$39.70 ,$16.08 ,$45.03 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$45.60 
ST NICHOLAS HOSPITAL - ACUTE,31100220,88274,HC INTERPHASE 20-99 CELLS FISH,311,1 ,$130.00 ,$65.00 ,$42.38 ,$130.00 ,$43.79 ,$130.00 ,$127.14 ,$42.38 ,$78.00 ,$110.50 ,$91.00 ,$43.79 ,$123.50 ,$98.80 ,$97.50 ,$72.05 ,$110.50 ,$42.38 ,$72.05 ,$42.38 ,$91.00 ,$43.79 ,$42.38 ,$42.38 ,$47.97 ,$110.50 ,$95.36 ,$119.60 ,$91.00 ,$130.00 ,$130.00 ,$79.17 ,$130.00 ,$89.83 ,$117.00 ,$90.55 ,$42.80 ,$102.70 ,$46.42 ,$50.86 ,$50.86 ,$42.38 ,$50.86 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,31100221,88271,HC MCG DNA PROBE (B CELL),311,1 ,$132.00 ,$66.00 ,$20.36 ,$132.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$79.20 ,$112.20 ,$92.40 ,$20.36 ,$125.40 ,$100.32 ,$99.00 ,$36.41 ,$112.20 ,$21.42 ,$36.41 ,$21.42 ,$92.40 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$112.20 ,$48.20 ,$121.44 ,$92.40 ,$69.57 ,$69.57 ,$80.39 ,$69.57 ,$91.21 ,$118.80 ,$91.94 ,$21.63 ,$104.28 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$105.60 
ST NICHOLAS HOSPITAL - ACUTE,31100222,88299,HC CYTOGENIC STUDY,311,1 ,$532.00 ,$266.00 ,$13.61 ,$532.00 ,$13.61 ,$344.15 ,$344.15 ,$49.00 ,$319.20 ,$452.20 ,$372.40 ,$13.61 ,$505.40 ,$404.32 ,$399.00 , N/A ,$452.20 ,$49.00 , N/A , N/A ,$372.40 ,$13.61 ,$49.00 ,$49.00 ,$223.44 ,$452.20 ,$110.24 ,$489.44 ,$372.40 ,$75.42 ,$75.42 ,$323.99 ,$75.42 ,$367.61 ,$478.80 ,$370.54 ,$49.49 ,$420.28 ,$14.43 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$383.04 ,$329.84 ,$383.04 ,$383.04 ,$425.60 
ST NICHOLAS HOSPITAL - ACUTE,31100223,88280,HC ADDITIONAL KARYO EACH (DC),311,1 ,$234.00 ,$117.00 ,$33.47 ,$234.00 ,$34.58 ,$117.15 ,$100.41 ,$33.47 ,$140.40 ,$198.90 ,$163.80 ,$34.58 ,$222.30 ,$177.84 ,$175.50 ,$56.90 ,$198.90 ,$33.47 ,$56.90 ,$33.47 ,$163.80 ,$34.58 ,$33.47 ,$33.47 ,$37.88 ,$198.90 ,$75.31 ,$215.28 ,$163.80 ,$120.61 ,$120.61 ,$142.51 ,$120.61 ,$161.69 ,$210.60 ,$162.98 ,$33.80 ,$184.86 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$168.48 ,$145.08 ,$168.48 ,$168.48 ,$187.20 
ST NICHOLAS HOSPITAL - ACUTE,31100232,88271,HC MCG DNA PROBE (QST EACH),311,1 ,$162.00 ,$81.00 ,$20.36 ,$162.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$97.20 ,$137.70 ,$113.40 ,$20.36 ,$153.90 ,$123.12 ,$121.50 ,$36.41 ,$137.70 ,$21.42 ,$36.41 ,$21.42 ,$113.40 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$137.70 ,$48.20 ,$149.04 ,$113.40 ,$69.57 ,$69.57 ,$98.66 ,$69.57 ,$111.94 ,$145.80 ,$112.83 ,$21.63 ,$127.98 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,31100233,88275,HC MCG INTERPH INSITU 100 (FISH MDS MY),311,1 ,$242.00 ,$121.00 ,$51.19 ,$242.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$145.20 ,$205.70 ,$169.40 ,$52.89 ,$229.90 ,$183.92 ,$181.50 ,$87.02 ,$205.70 ,$51.19 ,$87.02 ,$51.19 ,$169.40 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$205.70 ,$115.18 ,$222.64 ,$169.40 ,$193.00 ,$193.00 ,$147.38 ,$193.00 ,$167.22 ,$217.80 ,$168.55 ,$51.70 ,$191.18 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$193.60 
ST NICHOLAS HOSPITAL - ACUTE,31100234,88275,HC MCG INTERPH INSITU 100 (FISH AMLM3/BURKITT),311,1 ,$242.00 ,$121.00 ,$51.19 ,$242.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$145.20 ,$205.70 ,$169.40 ,$52.89 ,$229.90 ,$183.92 ,$181.50 ,$87.02 ,$205.70 ,$51.19 ,$87.02 ,$51.19 ,$169.40 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$205.70 ,$115.18 ,$222.64 ,$169.40 ,$193.00 ,$193.00 ,$147.38 ,$193.00 ,$167.22 ,$217.80 ,$168.55 ,$51.70 ,$191.18 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$193.60 
ST NICHOLAS HOSPITAL - ACUTE,31100235,88275,HC MCG INTERPH INSITU 100 (FISH AML/HES/AMLETO/IGH),311,1 ,$242.00 ,$121.00 ,$51.19 ,$242.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$145.20 ,$205.70 ,$169.40 ,$52.89 ,$229.90 ,$183.92 ,$181.50 ,$87.02 ,$205.70 ,$51.19 ,$87.02 ,$51.19 ,$169.40 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$205.70 ,$115.18 ,$222.64 ,$169.40 ,$193.00 ,$193.00 ,$147.38 ,$193.00 ,$167.22 ,$217.80 ,$168.55 ,$51.70 ,$191.18 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$193.60 
ST NICHOLAS HOSPITAL - ACUTE,31100236,88275,HC MCG INTERPH INSITU 100 (FISH ESO),311,1 ,$253.00 ,$126.50 ,$51.19 ,$253.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$151.80 ,$215.05 ,$177.10 ,$52.89 ,$240.35 ,$192.28 ,$189.75 ,$87.02 ,$215.05 ,$51.19 ,$87.02 ,$51.19 ,$177.10 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$215.05 ,$115.18 ,$232.76 ,$177.10 ,$193.00 ,$193.00 ,$154.08 ,$193.00 ,$174.82 ,$227.70 ,$176.21 ,$51.70 ,$199.87 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$182.16 ,$156.86 ,$182.16 ,$182.16 ,$202.40 
ST NICHOLAS HOSPITAL - ACUTE,31100237,88275,HC MCG INTERPH INSITU 100 (FISH IGHBCL2/MCL),311,1 ,$281.00 ,$140.50 ,$51.19 ,$281.00 ,$52.89 ,$179.17 ,$153.57 ,$51.19 ,$168.60 ,$238.85 ,$196.70 ,$52.89 ,$266.95 ,$213.56 ,$210.75 ,$87.02 ,$238.85 ,$51.19 ,$87.02 ,$51.19 ,$196.70 ,$52.89 ,$51.19 ,$51.19 ,$57.94 ,$238.85 ,$115.18 ,$258.52 ,$196.70 ,$193.00 ,$193.00 ,$171.13 ,$193.00 ,$194.17 ,$252.90 ,$195.72 ,$51.70 ,$221.99 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$202.32 ,$174.22 ,$202.32 ,$202.32 ,$224.80 
ST NICHOLAS HOSPITAL - ACUTE,31100285,88271,HC MCG DNA PROBE(FISH) LUNG CANCER ROS1,311,1 ,$853.00 ,$426.50 ,$20.36 ,$853.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$511.80 ,$725.05 ,$597.10 ,$20.36 ,$810.35 ,$648.28 ,$639.75 ,$36.41 ,$725.05 ,$21.42 ,$36.41 ,$21.42 ,$597.10 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$725.05 ,$48.20 ,$784.76 ,$597.10 ,$69.57 ,$69.57 ,$519.48 ,$69.57 ,$589.42 ,$767.70 ,$594.11 ,$21.63 ,$673.87 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$614.16 ,$528.86 ,$614.16 ,$614.16 ,$682.40 
ST NICHOLAS HOSPITAL - ACUTE,31100286,88271,HC MCG DNA PROBE(FISH) LUNG CANCER ALK,311,1 ,$755.00 ,$377.50 ,$20.36 ,$755.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$453.00 ,$641.75 ,$528.50 ,$20.36 ,$717.25 ,$573.80 ,$566.25 ,$36.41 ,$641.75 ,$21.42 ,$36.41 ,$21.42 ,$528.50 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$641.75 ,$48.20 ,$694.60 ,$528.50 ,$69.57 ,$69.57 ,$459.80 ,$69.57 ,$521.71 ,$679.50 ,$525.86 ,$21.63 ,$596.45 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$543.60 ,$468.10 ,$543.60 ,$543.60 ,$604.00 
ST NICHOLAS HOSPITAL - ACUTE,31100309,88121,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC COMP ASSIST,311,1 ,$589.00 ,$294.50 ,$12.46 ,$646.13 ,$12.46 ,$589.00 ,$589.00 ,$287.17 ,$353.40 ,$500.65 ,$412.30 ,$12.46 ,$559.55 ,$447.64 ,$441.75 ,$589.00 ,$500.65 ,$287.17 ,$589.00 ,$428.59 ,$412.30 ,$12.46 ,$287.17 ,$287.17 ,$247.38 ,$500.65 ,$646.13 ,$541.88 ,$412.30 ,$589.00 ,$589.00 ,$358.70 ,$589.00 ,$407.00 ,$530.10 ,$410.24 ,$290.04 ,$465.31 ,$13.21 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$424.08 ,$365.18 ,$424.08 ,$424.08 ,$471.20 
ST NICHOLAS HOSPITAL - ACUTE,31100315,88271,HC PLASMA CELL PROLIF SORT FISH PROBE/REPORT,311,1 ,$444.00 ,$222.00 ,$20.36 ,$444.00 ,$20.36 ,$83.30 ,$71.40 ,$21.42 ,$266.40 ,$377.40 ,$310.80 ,$20.36 ,$421.80 ,$337.44 ,$333.00 ,$36.41 ,$377.40 ,$21.42 ,$36.41 ,$21.42 ,$310.80 ,$20.36 ,$21.42 ,$21.42 ,$24.24 ,$377.40 ,$48.20 ,$408.48 ,$310.80 ,$69.57 ,$69.57 ,$270.40 ,$69.57 ,$306.80 ,$399.60 ,$309.25 ,$21.63 ,$350.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$319.68 ,$275.28 ,$319.68 ,$319.68 ,$355.20 
ST NICHOLAS HOSPITAL - ACUTE,31100316,88184,HC PCPDS PRE ANAL CELL SORT BM 1 MARKER,311,1 ,$88.00 ,$44.00 ,$9.06 ,$646.13 ,$9.06 ,$88.00 ,$88.00 ,$287.17 ,$52.80 ,$74.80 ,$61.60 ,$9.06 ,$83.60 ,$66.88 ,$66.00 ,$88.00 ,$74.80 ,$287.17 ,$88.00 ,$64.28 ,$61.60 ,$9.06 ,$287.17 ,$287.17 ,$36.96 ,$74.80 ,$646.13 ,$80.96 ,$61.60 ,$88.00 ,$88.00 ,$53.59 ,$88.00 ,$60.81 ,$79.20 ,$61.29 ,$290.04 ,$69.52 ,$9.60 ,$88.00 ,$88.00 ,$287.17 ,$88.00 ,$63.36 ,$54.56 ,$63.36 ,$63.36 ,$70.40 
ST NICHOLAS HOSPITAL - ACUTE,31100317,88185,HC PCPDS PRE ANAL CELL SORT BM ADDNT MARKER,311,1 ,$29.00 ,$14.50 ,$12.18 ,$29.00 ,$12.46 ,$29.00 ,$29.00 , N/A ,$17.40 ,$24.65 ,$20.30 ,$12.46 ,$27.55 ,$22.04 ,$21.75 ,$29.00 ,$24.65 , N/A ,$29.00 ,$21.23 ,$20.30 ,$12.46 , N/A , N/A ,$12.18 ,$24.65 , N/A ,$26.68 ,$20.30 ,$29.00 ,$29.00 ,$17.66 ,$29.00 ,$20.04 ,$26.10 ,$20.20 , N/A ,$22.91 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 ,$20.88 ,$17.98 ,$20.88 ,$20.88 ,$23.20 
ST NICHOLAS HOSPITAL - ACUTE,31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$109.00 ,$54.50 ,$6.95 ,$109.00 ,$6.95 ,$37.86 ,$32.45 ,$24.36 ,$65.40 ,$92.65 ,$76.30 ,$6.95 ,$103.55 ,$82.84 ,$81.75 ,$24.45 ,$92.65 ,$24.36 ,$24.45 ,$14.76 ,$76.30 ,$6.95 ,$24.36 ,$24.36 ,$45.78 ,$92.65 ,$54.81 ,$100.28 ,$76.30 ,$75.42 ,$75.42 ,$66.38 ,$75.42 ,$75.32 ,$98.10 ,$75.92 ,$24.60 ,$86.11 ,$7.37 ,$27.59 ,$27.59 ,$24.36 ,$27.59 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$224.00 ,$112.00 ,$6.95 ,$224.00 ,$6.95 ,$80.11 ,$68.66 ,$24.36 ,$134.40 ,$190.40 ,$156.80 ,$6.95 ,$212.80 ,$170.24 ,$168.00 ,$51.22 ,$190.40 ,$24.36 ,$51.22 ,$29.58 ,$156.80 ,$6.95 ,$24.36 ,$24.36 ,$94.08 ,$190.40 ,$54.81 ,$206.08 ,$156.80 ,$75.42 ,$75.42 ,$136.42 ,$75.42 ,$154.78 ,$201.60 ,$156.02 ,$24.60 ,$176.96 ,$7.37 ,$27.59 ,$27.59 ,$24.36 ,$27.59 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$280.00 ,$140.00 ,$6.95 ,$280.00 ,$6.95 ,$97.01 ,$83.15 ,$49.00 ,$168.00 ,$238.00 ,$196.00 ,$6.95 ,$266.00 ,$212.80 ,$210.00 ,$67.61 ,$238.00 ,$49.00 ,$67.61 ,$39.68 ,$196.00 ,$6.95 ,$49.00 ,$49.00 ,$117.60 ,$238.00 ,$110.24 ,$257.60 ,$196.00 ,$138.86 ,$138.86 ,$170.52 ,$138.86 ,$193.48 ,$252.00 ,$195.02 ,$49.49 ,$221.20 ,$7.37 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,31200105,88305,HC CELLIENT CELL BLOCK,312,1 ,$114.00 ,$57.00 ,$12.70 ,$114.00 ,$12.70 ,$101.84 ,$87.29 ,$49.00 ,$68.40 ,$96.90 ,$79.80 ,$12.70 ,$108.30 ,$86.64 ,$85.50 ,$114.00 ,$96.90 ,$49.00 ,$114.00 ,$68.74 ,$79.80 ,$12.70 ,$49.00 ,$49.00 ,$47.88 ,$96.90 ,$110.24 ,$104.88 ,$79.80 ,$114.00 ,$114.00 ,$69.43 ,$114.00 ,$78.77 ,$102.60 ,$79.40 ,$49.49 ,$90.06 ,$13.46 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$91.20 
ST NICHOLAS HOSPITAL - ACUTE,31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$336.00 ,$168.00 ,$12.70 ,$336.00 ,$12.70 ,$101.84 ,$87.29 ,$49.00 ,$201.60 ,$285.60 ,$235.20 ,$12.70 ,$319.20 ,$255.36 ,$252.00 ,$117.06 ,$285.60 ,$49.00 ,$117.06 ,$68.74 ,$235.20 ,$12.70 ,$49.00 ,$49.00 ,$141.12 ,$285.60 ,$110.24 ,$309.12 ,$235.20 ,$138.86 ,$138.86 ,$204.62 ,$138.86 ,$232.18 ,$302.40 ,$234.02 ,$49.49 ,$265.44 ,$13.46 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,31200109,88305,HC GROSS  AND  MICRO LEVEL IV (BM),312,1 ,$286.00 ,$143.00 ,$12.70 ,$286.00 ,$12.70 ,$101.84 ,$87.29 ,$49.00 ,$171.60 ,$243.10 ,$200.20 ,$12.70 ,$271.70 ,$217.36 ,$214.50 ,$117.06 ,$243.10 ,$49.00 ,$117.06 ,$68.74 ,$200.20 ,$12.70 ,$49.00 ,$49.00 ,$120.12 ,$243.10 ,$110.24 ,$263.12 ,$200.20 ,$138.86 ,$138.86 ,$174.17 ,$138.86 ,$197.63 ,$257.40 ,$199.20 ,$49.49 ,$225.94 ,$13.46 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$205.92 ,$177.32 ,$205.92 ,$205.92 ,$228.80 
ST NICHOLAS HOSPITAL - ACUTE,31200110,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,"$1,098.00 ",$549.00 ,$12.70 ,"$1,098.00 ",$12.70 ,$623.75 ,$534.65 ,$287.17 ,$658.80 ,$933.30 ,$768.60 ,$12.70 ,"$1,043.10 ",$834.48 ,$823.50 ,$467.89 ,$933.30 ,$287.17 ,$467.89 ,$268.71 ,$768.60 ,$12.70 ,$287.17 ,$287.17 ,$461.16 ,$933.30 ,$646.13 ,"$1,010.16 ",$768.60 ,$233.62 ,$233.62 ,$668.68 ,$233.62 ,$758.72 ,$988.20 ,$764.76 ,$290.04 ,$867.42 ,$13.46 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$878.40 
ST NICHOLAS HOSPITAL - ACUTE,31200112,88307,HC GROSS  AND  MICRO LEVEL V ( >3),312,1 ,"$1,098.00 ",$549.00 ,$12.70 ,"$1,098.00 ",$12.70 ,$623.75 ,$534.65 ,$287.17 ,$658.80 ,$933.30 ,$768.60 ,$12.70 ,"$1,043.10 ",$834.48 ,$823.50 ,$467.89 ,$933.30 ,$287.17 ,$467.89 ,$268.71 ,$768.60 ,$12.70 ,$287.17 ,$287.17 ,$461.16 ,$933.30 ,$646.13 ,"$1,010.16 ",$768.60 ,$233.62 ,$233.62 ,$668.68 ,$233.62 ,$758.72 ,$988.20 ,$764.76 ,$290.04 ,$867.42 ,$13.46 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$878.40 
ST NICHOLAS HOSPITAL - ACUTE,31200113,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,"$1,568.00 ",$784.00 ,$12.70 ,"$1,568.00 ",$12.70 ,$875.27 ,$750.24 ,$646.16 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$12.70 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ",$713.27 ,"$1,332.80 ",$646.16 ,$713.27 ,$409.19 ,"$1,097.60 ",$12.70 ,$646.16 ,$646.16 ,$658.56 ,"$1,332.80 ","$1,453.86 ","$1,442.56 ","$1,097.60 ",$682.93 ,$682.93 ,$954.91 ,$682.93 ,"$1,083.49 ","$1,411.20 ","$1,092.11 ",$652.62 ,"$1,238.72 ",$13.46 ,$753.84 ,$753.84 ,$646.16 ,$753.84 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200115,88309,HC GROSS  AND  MICRO LEVEL VI ( >5),312,1 ,"$1,568.00 ",$784.00 ,$12.70 ,"$1,568.00 ",$12.70 ,$875.27 ,$750.24 ,$646.16 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$12.70 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ",$713.27 ,"$1,332.80 ",$646.16 ,$713.27 ,$409.19 ,"$1,097.60 ",$12.70 ,$646.16 ,$646.16 ,$658.56 ,"$1,332.80 ","$1,453.86 ","$1,442.56 ","$1,097.60 ",$682.93 ,$682.93 ,$954.91 ,$682.93 ,"$1,083.49 ","$1,411.20 ","$1,092.11 ",$652.62 ,"$1,238.72 ",$13.46 ,$753.84 ,$753.84 ,$646.16 ,$753.84 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,31200116,88311,HC DECALCIFICATION,312,1 ,$78.00 ,$39.00 ,$10.82 ,$78.00 ,$12.70 ,$29.41 ,$25.21 , N/A ,$46.80 ,$66.30 ,$54.60 ,$12.70 ,$74.10 ,$59.28 ,$58.50 ,$33.86 ,$66.30 , N/A ,$33.86 ,$20.88 ,$54.60 ,$12.70 , N/A , N/A ,$32.76 ,$66.30 , N/A ,$71.76 ,$54.60 ,$39.31 ,$39.31 ,$47.50 ,$39.31 ,$53.90 ,$70.20 ,$54.33 , N/A ,$61.62 ,$13.46 ,$10.82 ,$10.82 , N/A ,$10.82 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,31200119,88312,HC SPECIAL STAIN I (STEINER),312,1 ,$157.00 ,$78.50 ,$6.95 ,$157.00 ,$6.95 ,$157.00 ,$157.00 ,$49.00 ,$94.20 ,$133.45 ,$109.90 ,$6.95 ,$149.15 ,$119.32 ,$117.75 ,$157.00 ,$133.45 ,$49.00 ,$157.00 ,$102.26 ,$109.90 ,$6.95 ,$49.00 ,$49.00 ,$65.94 ,$133.45 ,$110.24 ,$144.44 ,$109.90 ,$75.42 ,$75.42 ,$95.61 ,$75.42 ,$108.49 ,$141.30 ,$109.35 ,$49.49 ,$124.03 ,$7.37 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,31200120,88312,HC SPECIAL STAIN I (WARTHIN-STARRY),312,1 ,$141.00 ,$70.50 ,$6.95 ,$141.00 ,$6.95 ,$141.00 ,$141.00 ,$49.00 ,$84.60 ,$119.85 ,$98.70 ,$6.95 ,$133.95 ,$107.16 ,$105.75 ,$141.00 ,$119.85 ,$49.00 ,$141.00 ,$102.26 ,$98.70 ,$6.95 ,$49.00 ,$49.00 ,$59.22 ,$119.85 ,$110.24 ,$129.72 ,$98.70 ,$75.42 ,$75.42 ,$85.87 ,$75.42 ,$97.43 ,$126.90 ,$98.21 ,$49.49 ,$111.39 ,$7.37 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,31200122,88312,HC SPECIAL STAIN I (AFB),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$49.00 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$121.60 ,$120.00 ,$160.00 ,$136.00 ,$49.00 ,$160.00 ,$102.26 ,$112.00 ,$6.95 ,$49.00 ,$49.00 ,$67.20 ,$136.00 ,$110.24 ,$147.20 ,$112.00 ,$75.42 ,$75.42 ,$97.44 ,$75.42 ,$110.56 ,$144.00 ,$111.44 ,$49.49 ,$126.40 ,$7.37 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,31200123,88312,HC SPECIAL STAIN I,312,1 ,$358.00 ,$179.00 ,$6.95 ,$358.00 ,$6.95 ,$247.90 ,$212.49 ,$49.00 ,$214.80 ,$304.30 ,$250.60 ,$6.95 ,$340.10 ,$272.08 ,$268.50 ,$184.52 ,$304.30 ,$49.00 ,$184.52 ,$102.26 ,$250.60 ,$6.95 ,$49.00 ,$49.00 ,$150.36 ,$304.30 ,$110.24 ,$329.36 ,$250.60 ,$75.42 ,$75.42 ,$218.02 ,$75.42 ,$247.38 ,$322.20 ,$249.35 ,$49.49 ,$282.82 ,$7.37 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,31200124,88312,HC SPECIAL STAIN I (GIEMSA OR PAS),312,1 ,$358.00 ,$179.00 ,$6.95 ,$358.00 ,$6.95 ,$247.90 ,$212.49 ,$49.00 ,$214.80 ,$304.30 ,$250.60 ,$6.95 ,$340.10 ,$272.08 ,$268.50 ,$184.52 ,$304.30 ,$49.00 ,$184.52 ,$102.26 ,$250.60 ,$6.95 ,$49.00 ,$49.00 ,$150.36 ,$304.30 ,$110.24 ,$329.36 ,$250.60 ,$75.42 ,$75.42 ,$218.02 ,$75.42 ,$247.38 ,$322.20 ,$249.35 ,$49.49 ,$282.82 ,$7.37 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$286.40 
ST NICHOLAS HOSPITAL - ACUTE,31200125,88313,HC SPECIAL STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$221.16 ,$218.25 ,$131.95 ,$247.35 ,$33.38 ,$131.95 ,$73.28 ,$203.70 ,$6.95 ,$33.38 ,$33.38 ,$122.22 ,$247.35 ,$75.09 ,$267.72 ,$203.70 ,$75.42 ,$75.42 ,$177.22 ,$75.42 ,$201.08 ,$261.90 ,$202.68 ,$33.71 ,$229.89 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200126,88313,HC SPECIAL STAIN II (OIL RED),312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$221.16 ,$218.25 ,$131.95 ,$247.35 ,$33.38 ,$131.95 ,$73.28 ,$203.70 ,$6.95 ,$33.38 ,$33.38 ,$122.22 ,$247.35 ,$75.09 ,$267.72 ,$203.70 ,$75.42 ,$75.42 ,$177.22 ,$75.42 ,$201.08 ,$261.90 ,$202.68 ,$33.71 ,$229.89 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200127,88313,HC SPECIAL STAIN II (SUDAN BLACK),312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$221.16 ,$218.25 ,$131.95 ,$247.35 ,$33.38 ,$131.95 ,$73.28 ,$203.70 ,$6.95 ,$33.38 ,$33.38 ,$122.22 ,$247.35 ,$75.09 ,$267.72 ,$203.70 ,$75.42 ,$75.42 ,$177.22 ,$75.42 ,$201.08 ,$261.90 ,$202.68 ,$33.71 ,$229.89 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200128,88313,HC SPECIAL STAIN II (MISC),312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$221.16 ,$218.25 ,$131.95 ,$247.35 ,$33.38 ,$131.95 ,$73.28 ,$203.70 ,$6.95 ,$33.38 ,$33.38 ,$122.22 ,$247.35 ,$75.09 ,$267.72 ,$203.70 ,$75.42 ,$75.42 ,$177.22 ,$75.42 ,$201.08 ,$261.90 ,$202.68 ,$33.71 ,$229.89 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200129,88313,HC SPECIAL STAIN II (MAST CELL),312,1 ,$143.00 ,$71.50 ,$6.95 ,$143.00 ,$6.95 ,$143.00 ,$143.00 ,$33.38 ,$85.80 ,$121.55 ,$100.10 ,$6.95 ,$135.85 ,$108.68 ,$107.25 ,$131.95 ,$121.55 ,$33.38 ,$131.95 ,$73.28 ,$100.10 ,$6.95 ,$33.38 ,$33.38 ,$60.06 ,$121.55 ,$75.09 ,$131.56 ,$100.10 ,$75.42 ,$75.42 ,$87.09 ,$75.42 ,$98.81 ,$128.70 ,$99.60 ,$33.71 ,$112.97 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$102.96 ,$88.66 ,$102.96 ,$102.96 ,$114.40 
ST NICHOLAS HOSPITAL - ACUTE,31200130,88313,HC SPECIAL STAIN II (CONGO RED),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$33.38 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$121.60 ,$120.00 ,$131.95 ,$136.00 ,$33.38 ,$131.95 ,$73.28 ,$112.00 ,$6.95 ,$33.38 ,$33.38 ,$67.20 ,$136.00 ,$75.09 ,$147.20 ,$112.00 ,$75.42 ,$75.42 ,$97.44 ,$75.42 ,$110.56 ,$144.00 ,$111.44 ,$33.71 ,$126.40 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,31200131,88313,HC SPECIAL STAIN II (FE),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$33.38 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$121.60 ,$120.00 ,$131.95 ,$136.00 ,$33.38 ,$131.95 ,$73.28 ,$112.00 ,$6.95 ,$33.38 ,$33.38 ,$67.20 ,$136.00 ,$75.09 ,$147.20 ,$112.00 ,$75.42 ,$75.42 ,$97.44 ,$75.42 ,$110.56 ,$144.00 ,$111.44 ,$33.71 ,$126.40 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,31200132,88313,HC SPECIAL STAIN II (PAS),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$33.38 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$121.60 ,$120.00 ,$131.95 ,$136.00 ,$33.38 ,$131.95 ,$73.28 ,$112.00 ,$6.95 ,$33.38 ,$33.38 ,$67.20 ,$136.00 ,$75.09 ,$147.20 ,$112.00 ,$75.42 ,$75.42 ,$97.44 ,$75.42 ,$110.56 ,$144.00 ,$111.44 ,$33.71 ,$126.40 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,31200133,88313,HC SPECIAL STAIN II (ALCIAN BLUE/PAS),312,1 ,$274.00 ,$137.00 ,$6.95 ,$274.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$164.40 ,$232.90 ,$191.80 ,$6.95 ,$260.30 ,$208.24 ,$205.50 ,$131.95 ,$232.90 ,$33.38 ,$131.95 ,$73.28 ,$191.80 ,$6.95 ,$33.38 ,$33.38 ,$115.08 ,$232.90 ,$75.09 ,$252.08 ,$191.80 ,$75.42 ,$75.42 ,$166.87 ,$75.42 ,$189.33 ,$246.60 ,$190.84 ,$33.71 ,$216.46 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$219.20 
ST NICHOLAS HOSPITAL - ACUTE,31200134,88313,HC SPECIAL STAIN II (ELASTIC),312,1 ,$251.00 ,$125.50 ,$6.95 ,$251.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$150.60 ,$213.35 ,$175.70 ,$6.95 ,$238.45 ,$190.76 ,$188.25 ,$131.95 ,$213.35 ,$33.38 ,$131.95 ,$73.28 ,$175.70 ,$6.95 ,$33.38 ,$33.38 ,$105.42 ,$213.35 ,$75.09 ,$230.92 ,$175.70 ,$75.42 ,$75.42 ,$152.86 ,$75.42 ,$173.44 ,$225.90 ,$174.82 ,$33.71 ,$198.29 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$180.72 ,$155.62 ,$180.72 ,$180.72 ,$200.80 
ST NICHOLAS HOSPITAL - ACUTE,31200135,88313,HC SPECIAL STAIN II (HALE'S COLLOIDAL FE),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$193.80 ,$191.25 ,$131.95 ,$216.75 ,$33.38 ,$131.95 ,$73.28 ,$178.50 ,$6.95 ,$33.38 ,$33.38 ,$107.10 ,$216.75 ,$75.09 ,$234.60 ,$178.50 ,$75.42 ,$75.42 ,$155.30 ,$75.42 ,$176.21 ,$229.50 ,$177.61 ,$33.71 ,$201.45 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,31200136,88313,HC SPECIAL STAIN II (MUCICARMINE),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$193.80 ,$191.25 ,$131.95 ,$216.75 ,$33.38 ,$131.95 ,$73.28 ,$178.50 ,$6.95 ,$33.38 ,$33.38 ,$107.10 ,$216.75 ,$75.09 ,$234.60 ,$178.50 ,$75.42 ,$75.42 ,$155.30 ,$75.42 ,$176.21 ,$229.50 ,$177.61 ,$33.71 ,$201.45 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,31200137,88313,HC SPECIAL STAIN II (ALCIAN BL W/HYALUR),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$193.80 ,$191.25 ,$131.95 ,$216.75 ,$33.38 ,$131.95 ,$73.28 ,$178.50 ,$6.95 ,$33.38 ,$33.38 ,$107.10 ,$216.75 ,$75.09 ,$234.60 ,$178.50 ,$75.42 ,$75.42 ,$155.30 ,$75.42 ,$176.21 ,$229.50 ,$177.61 ,$33.71 ,$201.45 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,31200138,88313,HC SPECIAL STAIN II (ARGENTAFFIN),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$193.80 ,$191.25 ,$131.95 ,$216.75 ,$33.38 ,$131.95 ,$73.28 ,$178.50 ,$6.95 ,$33.38 ,$33.38 ,$107.10 ,$216.75 ,$75.09 ,$234.60 ,$178.50 ,$75.42 ,$75.42 ,$155.30 ,$75.42 ,$176.21 ,$229.50 ,$177.61 ,$33.71 ,$201.45 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,31200139,88313,HC SPECIAL STAIN II (BIELSCHOWSKY SILVER),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$193.80 ,$191.25 ,$131.95 ,$216.75 ,$33.38 ,$131.95 ,$73.28 ,$178.50 ,$6.95 ,$33.38 ,$33.38 ,$107.10 ,$216.75 ,$75.09 ,$234.60 ,$178.50 ,$75.42 ,$75.42 ,$155.30 ,$75.42 ,$176.21 ,$229.50 ,$177.61 ,$33.71 ,$201.45 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,31200140,88313,HC SPECIAL STAIN II (ALCIAN/PAS W DIASTASE),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$193.80 ,$191.25 ,$131.95 ,$216.75 ,$33.38 ,$131.95 ,$73.28 ,$178.50 ,$6.95 ,$33.38 ,$33.38 ,$107.10 ,$216.75 ,$75.09 ,$234.60 ,$178.50 ,$75.42 ,$75.42 ,$155.30 ,$75.42 ,$176.21 ,$229.50 ,$177.61 ,$33.71 ,$201.45 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,31200142,88313,HC SPECIAL STAIN II (RHODAMINE),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$193.80 ,$191.25 ,$131.95 ,$216.75 ,$33.38 ,$131.95 ,$73.28 ,$178.50 ,$6.95 ,$33.38 ,$33.38 ,$107.10 ,$216.75 ,$75.09 ,$234.60 ,$178.50 ,$75.42 ,$75.42 ,$155.30 ,$75.42 ,$176.21 ,$229.50 ,$177.61 ,$33.71 ,$201.45 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$204.00 
ST NICHOLAS HOSPITAL - ACUTE,31200143,88313,HC SPECIAL STAIN II (TRICHROME),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$33.38 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$121.60 ,$120.00 ,$131.95 ,$136.00 ,$33.38 ,$131.95 ,$73.28 ,$112.00 ,$6.95 ,$33.38 ,$33.38 ,$67.20 ,$136.00 ,$75.09 ,$147.20 ,$112.00 ,$75.42 ,$75.42 ,$97.44 ,$75.42 ,$110.56 ,$144.00 ,$111.44 ,$33.71 ,$126.40 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,31200144,88313,HC SPECIAL STAIN II (RETICULUM),312,1 ,$251.00 ,$125.50 ,$6.95 ,$251.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$150.60 ,$213.35 ,$175.70 ,$6.95 ,$238.45 ,$190.76 ,$188.25 ,$131.95 ,$213.35 ,$33.38 ,$131.95 ,$73.28 ,$175.70 ,$6.95 ,$33.38 ,$33.38 ,$105.42 ,$213.35 ,$75.09 ,$230.92 ,$175.70 ,$75.42 ,$75.42 ,$152.86 ,$75.42 ,$173.44 ,$225.90 ,$174.82 ,$33.71 ,$198.29 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$180.72 ,$155.62 ,$180.72 ,$180.72 ,$200.80 
ST NICHOLAS HOSPITAL - ACUTE,31200145,88313,HC SPECIAL STAIN II (ALCIAN BLUE),312,1 ,$274.00 ,$137.00 ,$6.95 ,$274.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$164.40 ,$232.90 ,$191.80 ,$6.95 ,$260.30 ,$208.24 ,$205.50 ,$131.95 ,$232.90 ,$33.38 ,$131.95 ,$73.28 ,$191.80 ,$6.95 ,$33.38 ,$33.38 ,$115.08 ,$232.90 ,$75.09 ,$252.08 ,$191.80 ,$75.42 ,$75.42 ,$166.87 ,$75.42 ,$189.33 ,$246.60 ,$190.84 ,$33.71 ,$216.46 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$219.20 
ST NICHOLAS HOSPITAL - ACUTE,31200146,88313,HC SPECIAL STAIN II (PAS W/DIGEST),312,1 ,$274.00 ,$137.00 ,$6.95 ,$274.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$164.40 ,$232.90 ,$191.80 ,$6.95 ,$260.30 ,$208.24 ,$205.50 ,$131.95 ,$232.90 ,$33.38 ,$131.95 ,$73.28 ,$191.80 ,$6.95 ,$33.38 ,$33.38 ,$115.08 ,$232.90 ,$75.09 ,$252.08 ,$191.80 ,$75.42 ,$75.42 ,$166.87 ,$75.42 ,$189.33 ,$246.60 ,$190.84 ,$33.71 ,$216.46 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$219.20 
ST NICHOLAS HOSPITAL - ACUTE,31200147,88313,HC SPECIAL STAIN II (RENAL BX LGHT MICRO),312,1 ,$924.00 ,$462.00 ,$6.95 ,$924.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$554.40 ,$785.40 ,$646.80 ,$6.95 ,$877.80 ,$702.24 ,$693.00 ,$131.95 ,$785.40 ,$33.38 ,$131.95 ,$73.28 ,$646.80 ,$6.95 ,$33.38 ,$33.38 ,$388.08 ,$785.40 ,$75.09 ,$850.08 ,$646.80 ,$75.42 ,$75.42 ,$562.72 ,$75.42 ,$638.48 ,$831.60 ,$643.57 ,$33.71 ,$729.96 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$665.28 ,$572.88 ,$665.28 ,$665.28 ,$739.20 
ST NICHOLAS HOSPITAL - ACUTE,31200150,88313,HC SPECIAL STAIN II (WARTHIN STARRY),312,1 ,$146.00 ,$73.00 ,$6.95 ,$146.00 ,$6.95 ,$146.00 ,$146.00 ,$33.38 ,$87.60 ,$124.10 ,$102.20 ,$6.95 ,$138.70 ,$110.96 ,$109.50 ,$131.95 ,$124.10 ,$33.38 ,$131.95 ,$73.28 ,$102.20 ,$6.95 ,$33.38 ,$33.38 ,$61.32 ,$124.10 ,$75.09 ,$134.32 ,$102.20 ,$75.42 ,$75.42 ,$88.91 ,$75.42 ,$100.89 ,$131.40 ,$101.69 ,$33.71 ,$115.34 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$116.80 
ST NICHOLAS HOSPITAL - ACUTE,31200151,88313,HC SPECIAL STAIN II (ESTERASE MIX),312,1 ,$115.00 ,$57.50 ,$6.95 ,$115.00 ,$6.95 ,$115.00 ,$115.00 ,$33.38 ,$69.00 ,$97.75 ,$80.50 ,$6.95 ,$109.25 ,$87.40 ,$86.25 ,$115.00 ,$97.75 ,$33.38 ,$115.00 ,$73.28 ,$80.50 ,$6.95 ,$33.38 ,$33.38 ,$48.30 ,$97.75 ,$75.09 ,$105.80 ,$80.50 ,$75.42 ,$75.42 ,$70.04 ,$75.42 ,$79.47 ,$103.50 ,$80.10 ,$33.71 ,$90.85 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00 
ST NICHOLAS HOSPITAL - ACUTE,31200152,88313,HC SPECIAL STAIN II (ESTERASE SPEC),312,1 ,$171.00 ,$85.50 ,$6.95 ,$171.00 ,$6.95 ,$171.00 ,$171.00 ,$33.38 ,$102.60 ,$145.35 ,$119.70 ,$6.95 ,$162.45 ,$129.96 ,$128.25 ,$131.95 ,$145.35 ,$33.38 ,$131.95 ,$73.28 ,$119.70 ,$6.95 ,$33.38 ,$33.38 ,$71.82 ,$145.35 ,$75.09 ,$157.32 ,$119.70 ,$75.42 ,$75.42 ,$104.14 ,$75.42 ,$118.16 ,$153.90 ,$119.10 ,$33.71 ,$135.09 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$123.12 ,$106.02 ,$123.12 ,$123.12 ,$136.80 
ST NICHOLAS HOSPITAL - ACUTE,31200153,88313,HC SPECIAL STAIN II (ESTERASE NONSPEC),312,1 ,$184.00 ,$92.00 ,$6.95 ,$184.00 ,$6.95 ,$184.00 ,$175.24 ,$33.38 ,$110.40 ,$156.40 ,$128.80 ,$6.95 ,$174.80 ,$139.84 ,$138.00 ,$131.95 ,$156.40 ,$33.38 ,$131.95 ,$73.28 ,$128.80 ,$6.95 ,$33.38 ,$33.38 ,$77.28 ,$156.40 ,$75.09 ,$169.28 ,$128.80 ,$75.42 ,$75.42 ,$112.06 ,$75.42 ,$127.14 ,$165.60 ,$128.16 ,$33.71 ,$145.36 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$147.20 
ST NICHOLAS HOSPITAL - ACUTE,31200155,88313,HC HISTOCHEM CHEMICAL STAIN,312,1 ,$262.00 ,$131.00 ,$6.95 ,$262.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$157.20 ,$222.70 ,$183.40 ,$6.95 ,$248.90 ,$199.12 ,$196.50 ,$131.95 ,$222.70 ,$33.38 ,$131.95 ,$73.28 ,$183.40 ,$6.95 ,$33.38 ,$33.38 ,$110.04 ,$222.70 ,$75.09 ,$241.04 ,$183.40 ,$75.42 ,$75.42 ,$159.56 ,$75.42 ,$181.04 ,$235.80 ,$182.48 ,$33.71 ,$206.98 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$188.64 ,$162.44 ,$188.64 ,$188.64 ,$209.60 
ST NICHOLAS HOSPITAL - ACUTE,31200156,88319,HC HISTOCHEM ENZYME STAIN,312,1 ,$246.00 ,$123.00 ,$12.70 ,"$1,453.86 ",$12.70 ,$237.04 ,$203.17 ,$646.16 ,$147.60 ,$209.10 ,$172.20 ,$12.70 ,$233.70 ,$186.96 ,$184.50 ,$228.45 ,$209.10 ,$646.16 ,$228.45 ,$108.41 ,$172.20 ,$12.70 ,$646.16 ,$646.16 ,$103.32 ,$209.10 ,"$1,453.86 ",$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$221.40 ,$171.34 ,$652.62 ,$194.34 ,$13.46 ,$246.00 ,$246.00 ,$646.16 ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,31200157,88319,HC HISTOCHEM ENZYME STAIN (LEUKO),312,1 ,$246.00 ,$123.00 ,$12.70 ,"$1,453.86 ",$12.70 ,$237.04 ,$203.17 ,$646.16 ,$147.60 ,$209.10 ,$172.20 ,$12.70 ,$233.70 ,$186.96 ,$184.50 ,$228.45 ,$209.10 ,$646.16 ,$228.45 ,$108.41 ,$172.20 ,$12.70 ,$646.16 ,$646.16 ,$103.32 ,$209.10 ,"$1,453.86 ",$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$221.40 ,$171.34 ,$652.62 ,$194.34 ,$13.46 ,$246.00 ,$246.00 ,$646.16 ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,31200159,88321,HC CONSULT REFERRED SLIDES,312,1 ,$249.00 ,$124.50 ,$11.57 ,$249.00 ,$11.57 ,$249.00 ,$249.00 ,$33.38 ,$149.40 ,$211.65 ,$174.30 ,$11.57 ,$236.55 ,$189.24 ,$186.75 ,$158.97 ,$211.65 ,$33.38 ,$158.97 ,$98.23 ,$174.30 ,$11.57 ,$33.38 ,$33.38 ,$104.58 ,$211.65 ,$75.09 ,$229.08 ,$174.30 ,$75.42 ,$75.42 ,$151.64 ,$75.42 ,$172.06 ,$224.10 ,$173.43 ,$33.71 ,$196.71 ,$12.26 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$179.28 ,$154.38 ,$179.28 ,$179.28 ,$199.20 
ST NICHOLAS HOSPITAL - ACUTE,31200162,88321,HC CONSULT REFERRED SLIDES (MUSCLE),312,1 ,$737.00 ,$368.50 ,$11.57 ,$737.00 ,$11.57 ,$294.81 ,$252.69 ,$33.38 ,$442.20 ,$626.45 ,$515.90 ,$11.57 ,$700.15 ,$560.12 ,$552.75 ,$158.97 ,$626.45 ,$33.38 ,$158.97 ,$98.23 ,$515.90 ,$11.57 ,$33.38 ,$33.38 ,$309.54 ,$626.45 ,$75.09 ,$678.04 ,$515.90 ,$75.42 ,$75.42 ,$448.83 ,$75.42 ,$509.27 ,$663.30 ,$513.32 ,$33.71 ,$582.23 ,$12.26 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$530.64 ,$456.94 ,$530.64 ,$530.64 ,$589.60 
ST NICHOLAS HOSPITAL - ACUTE,31200163,88321,HC CONSULT REFERRED SLIDES (MAYO),312,1 ,$515.00 ,$257.50 ,$11.57 ,$515.00 ,$11.57 ,$294.81 ,$252.69 ,$33.38 ,$309.00 ,$437.75 ,$360.50 ,$11.57 ,$489.25 ,$391.40 ,$386.25 ,$158.97 ,$437.75 ,$33.38 ,$158.97 ,$98.23 ,$360.50 ,$11.57 ,$33.38 ,$33.38 ,$216.30 ,$437.75 ,$75.09 ,$473.80 ,$360.50 ,$75.42 ,$75.42 ,$313.64 ,$75.42 ,$355.87 ,$463.50 ,$358.70 ,$33.71 ,$406.85 ,$12.26 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$412.00 
ST NICHOLAS HOSPITAL - ACUTE,31200164,88323,HC CONSULT/SLIDE PREP,312,1 ,$414.00 ,$207.00 ,$11.57 ,$414.00 ,$11.57 ,$89.77 ,$76.94 ,$49.00 ,$248.40 ,$351.90 ,$289.80 ,$11.57 ,$393.30 ,$314.64 ,$310.50 ,$187.99 ,$351.90 ,$49.00 ,$187.99 ,$114.34 ,$289.80 ,$11.57 ,$49.00 ,$49.00 ,$173.88 ,$351.90 ,$110.24 ,$380.88 ,$289.80 ,$138.86 ,$138.86 ,$252.13 ,$138.86 ,$286.07 ,$372.60 ,$288.35 ,$49.49 ,$327.06 ,$12.26 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$331.20 
ST NICHOLAS HOSPITAL - ACUTE,31200165,88323,HC CONSULT/SLIDE PREP (CUTAN),312,1 ,$74.00 ,$37.00 ,$11.57 ,$110.24 ,$11.57 ,$74.00 ,$74.00 ,$49.00 ,$44.40 ,$62.90 ,$51.80 ,$11.57 ,$70.30 ,$56.24 ,$55.50 ,$74.00 ,$62.90 ,$49.00 ,$74.00 ,$74.00 ,$51.80 ,$11.57 ,$49.00 ,$49.00 ,$31.08 ,$62.90 ,$110.24 ,$68.08 ,$51.80 ,$74.00 ,$74.00 ,$45.07 ,$74.00 ,$51.13 ,$66.60 ,$51.54 ,$49.49 ,$58.46 ,$12.26 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$59.20 
ST NICHOLAS HOSPITAL - ACUTE,31200167,88325,HC CONSULT PATH REV/REP (CYTO),312,1 ,"$1,120.00 ",$560.00 ,$11.57 ,"$1,120.00 ",$11.57 ,$522.54 ,$447.90 ,$147.06 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$851.20 ,$840.00 ,$259.54 ,$952.00 ,$147.06 ,$259.54 ,$172.41 ,$784.00 ,$11.57 ,$147.06 ,$147.06 ,$470.40 ,$952.00 ,$330.88 ,"$1,030.40 ",$784.00 ,$233.62 ,$233.62 ,$682.08 ,$233.62 ,$773.92 ,"$1,008.00 ",$780.08 ,$148.53 ,$884.80 ,$12.26 ,$59.36 ,$59.36 ,$147.06 ,$59.36 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,31200168,88325,HC CONSULT PATH REV/REP (PERI NERVE),312,1 ,"$1,120.00 ",$560.00 ,$11.57 ,"$1,120.00 ",$11.57 ,$522.54 ,$447.90 ,$147.06 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$851.20 ,$840.00 ,$259.54 ,$952.00 ,$147.06 ,$259.54 ,$172.41 ,$784.00 ,$11.57 ,$147.06 ,$147.06 ,$470.40 ,$952.00 ,$330.88 ,"$1,030.40 ",$784.00 ,$233.62 ,$233.62 ,$682.08 ,$233.62 ,$773.92 ,"$1,008.00 ",$780.08 ,$148.53 ,$884.80 ,$12.26 ,$59.36 ,$59.36 ,$147.06 ,$59.36 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,31200169,88325,HC CONSULT PATH REV/REP (HEMATOPATH),312,1 ,"$1,120.00 ",$560.00 ,$11.57 ,"$1,120.00 ",$11.57 ,$522.54 ,$447.90 ,$147.06 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$851.20 ,$840.00 ,$259.54 ,$952.00 ,$147.06 ,$259.54 ,$172.41 ,$784.00 ,$11.57 ,$147.06 ,$147.06 ,$470.40 ,$952.00 ,$330.88 ,"$1,030.40 ",$784.00 ,$233.62 ,$233.62 ,$682.08 ,$233.62 ,$773.92 ,"$1,008.00 ",$780.08 ,$148.53 ,$884.80 ,$12.26 ,$59.36 ,$59.36 ,$147.06 ,$59.36 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,31200170,88325,HC CONSULT PATH REV/REP (RENAL PATH),312,1 ,"$1,120.00 ",$560.00 ,$11.57 ,"$1,120.00 ",$11.57 ,$522.54 ,$447.90 ,$147.06 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$851.20 ,$840.00 ,$259.54 ,$952.00 ,$147.06 ,$259.54 ,$172.41 ,$784.00 ,$11.57 ,$147.06 ,$147.06 ,$470.40 ,$952.00 ,$330.88 ,"$1,030.40 ",$784.00 ,$233.62 ,$233.62 ,$682.08 ,$233.62 ,$773.92 ,"$1,008.00 ",$780.08 ,$148.53 ,$884.80 ,$12.26 ,$59.36 ,$59.36 ,$147.06 ,$59.36 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,31200171,88325,HC CONSULT PATH REV/REP,312,1 ,"$1,120.00 ",$560.00 ,$11.57 ,"$1,120.00 ",$11.57 ,$522.54 ,$447.90 ,$147.06 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$851.20 ,$840.00 ,$259.54 ,$952.00 ,$147.06 ,$259.54 ,$172.41 ,$784.00 ,$11.57 ,$147.06 ,$147.06 ,$470.40 ,$952.00 ,$330.88 ,"$1,030.40 ",$784.00 ,$233.62 ,$233.62 ,$682.08 ,$233.62 ,$773.92 ,"$1,008.00 ",$780.08 ,$148.53 ,$884.80 ,$12.26 ,$59.36 ,$59.36 ,$147.06 ,$59.36 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$258.00 ,$129.00 ,$11.57 ,$330.88 ,$11.57 ,$111.49 ,$95.57 ,$147.06 ,$154.80 ,$219.30 ,$180.60 ,$11.57 ,$245.10 ,$196.08 ,$193.50 ,$168.62 ,$219.30 ,$147.06 ,$168.62 ,$96.72 ,$180.60 ,$11.57 ,$147.06 ,$147.06 ,$108.36 ,$219.30 ,$330.88 ,$237.36 ,$180.60 ,$138.86 ,$138.86 ,$157.12 ,$138.86 ,$178.28 ,$232.20 ,$179.70 ,$148.53 ,$203.82 ,$12.26 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$206.40 
ST NICHOLAS HOSPITAL - ACUTE,31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$190.00 ,$95.00 ,$11.57 ,$190.00 ,$11.57 ,$72.87 ,$62.46 , N/A ,$114.00 ,$161.50 ,$133.00 ,$11.57 ,$180.50 ,$144.40 ,$142.50 ,$89.37 ,$161.50 , N/A ,$89.37 ,$53.38 ,$133.00 ,$11.57 , N/A , N/A ,$79.80 ,$161.50 , N/A ,$174.80 ,$133.00 ,$64.67 ,$64.67 ,$115.71 ,$64.67 ,$131.29 ,$171.00 ,$132.34 , N/A ,$150.10 ,$12.26 ,$27.72 ,$27.72 , N/A ,$27.72 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,31200175,88333,HC CONSULT PATH SURG CYTO INIT,312,1 ,$123.00 ,$61.50 ,$11.57 ,"$1,453.86 ",$11.57 ,$84.94 ,$72.80 ,$646.16 ,$73.80 ,$104.55 ,$86.10 ,$11.57 ,$116.85 ,$93.48 ,$92.25 ,$123.00 ,$104.55 ,$646.16 ,$123.00 ,$88.86 ,$86.10 ,$11.57 ,$646.16 ,$646.16 ,$51.66 ,$104.55 ,"$1,453.86 ",$113.16 ,$86.10 ,$123.00 ,$123.00 ,$74.91 ,$123.00 ,$84.99 ,$110.70 ,$85.67 ,$652.62 ,$97.17 ,$12.26 ,$123.00 ,$123.00 ,$646.16 ,$123.00 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,31200176,88334,HC CONSULT PATH SURG EA ADDL,312,1 ,$174.00 ,$87.00 ,$11.57 ,$174.00 ,$11.57 ,$56.74 ,$48.63 , N/A ,$104.40 ,$147.90 ,$121.80 ,$11.57 ,$165.30 ,$132.24 ,$130.50 ,$92.99 ,$147.90 , N/A ,$92.99 ,$55.92 ,$121.80 ,$11.57 , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$64.67 ,$64.67 ,$105.97 ,$64.67 ,$120.23 ,$156.60 ,$121.19 , N/A ,$137.46 ,$12.26 ,$21.65 ,$21.65 , N/A ,$21.65 ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$139.20 
ST NICHOLAS HOSPITAL - ACUTE,31200177,88341,HC IMMUNOHISTOCHEM EA AB,312,1 ,$101.00 ,$50.50 ,$12.70 ,$101.00 ,$12.70 ,$101.00 ,$101.00 , N/A ,$60.60 ,$85.85 ,$70.70 ,$12.70 ,$95.95 ,$76.76 ,$75.75 ,$101.00 ,$85.85 , N/A ,$101.00 ,$90.19 ,$70.70 ,$12.70 , N/A , N/A ,$42.42 ,$85.85 , N/A ,$92.92 ,$70.70 ,$51.23 ,$61.48 ,$61.51 ,$61.48 ,$69.79 ,$90.90 ,$70.35 , N/A ,$79.79 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,31200182,88341,HC IMMUNOHISTOCHEM EA AB T2,312,1 ,$274.00 ,$137.00 ,$12.70 ,$274.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$164.40 ,$232.90 ,$191.80 ,$12.70 ,$260.30 ,$208.24 ,$205.50 ,$145.06 ,$232.90 , N/A ,$145.06 ,$90.19 ,$191.80 ,$12.70 , N/A , N/A ,$115.08 ,$232.90 , N/A ,$252.08 ,$191.80 ,$138.97 ,$166.78 ,$166.87 ,$166.78 ,$189.33 ,$246.60 ,$190.84 , N/A ,$216.46 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$219.20 
ST NICHOLAS HOSPITAL - ACUTE,31200183,88341,HC IMMUNOHISTOCHEM EA AB T3,312,1 ,$342.00 ,$171.00 ,$12.70 ,$342.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$205.20 ,$290.70 ,$239.40 ,$12.70 ,$324.90 ,$259.92 ,$256.50 ,$145.06 ,$290.70 , N/A ,$145.06 ,$90.19 ,$239.40 ,$12.70 , N/A , N/A ,$143.64 ,$290.70 , N/A ,$314.64 ,$239.40 ,$173.46 ,$208.18 ,$208.28 ,$208.18 ,$236.32 ,$307.80 ,$238.20 , N/A ,$270.18 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$246.24 ,$212.04 ,$246.24 ,$246.24 ,$273.60 
ST NICHOLAS HOSPITAL - ACUTE,31200184,88341,HC IMMUNOHISTOCHEM EA AB T4,312,1 ,$272.00 ,$136.00 ,$12.70 ,$272.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$163.20 ,$231.20 ,$190.40 ,$12.70 ,$258.40 ,$206.72 ,$204.00 ,$145.06 ,$231.20 , N/A ,$145.06 ,$90.19 ,$190.40 ,$12.70 , N/A , N/A ,$114.24 ,$231.20 , N/A ,$250.24 ,$190.40 ,$137.96 ,$165.57 ,$165.65 ,$165.57 ,$187.95 ,$244.80 ,$189.45 , N/A ,$214.88 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$195.84 ,$168.64 ,$195.84 ,$195.84 ,$217.60 
ST NICHOLAS HOSPITAL - ACUTE,31200185,88341,HC IMMUNOHISTOCHEM EA AB T5,312,1 ,$366.00 ,$183.00 ,$12.70 ,$366.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$219.60 ,$311.10 ,$256.20 ,$12.70 ,$347.70 ,$278.16 ,$274.50 ,$145.06 ,$311.10 , N/A ,$145.06 ,$90.19 ,$256.20 ,$12.70 , N/A , N/A ,$153.72 ,$311.10 , N/A ,$336.72 ,$256.20 ,$185.64 ,$222.78 ,$222.89 ,$222.78 ,$252.91 ,$329.40 ,$254.92 , N/A ,$289.14 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$263.52 ,$226.92 ,$263.52 ,$263.52 ,$292.80 
ST NICHOLAS HOSPITAL - ACUTE,31200186,88346,HC IF DIRECT,312,1 ,$101.00 ,$50.50 ,$12.70 ,$646.13 ,$12.70 ,$101.00 ,$101.00 ,$287.17 ,$60.60 ,$85.85 ,$70.70 ,$12.70 ,$95.95 ,$76.76 ,$75.75 ,$101.00 ,$85.85 ,$287.17 ,$101.00 ,$101.00 ,$70.70 ,$12.70 ,$287.17 ,$287.17 ,$42.42 ,$85.85 ,$646.13 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$90.90 ,$70.35 ,$290.04 ,$79.79 ,$13.46 ,$101.00 ,$101.00 ,$287.17 ,$101.00 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,31200187,88346,HC IF DIRECT (RENAL BX),312,1 ,$101.00 ,$50.50 ,$12.70 ,$646.13 ,$12.70 ,$101.00 ,$101.00 ,$287.17 ,$60.60 ,$85.85 ,$70.70 ,$12.70 ,$95.95 ,$76.76 ,$75.75 ,$101.00 ,$85.85 ,$287.17 ,$101.00 ,$101.00 ,$70.70 ,$12.70 ,$287.17 ,$287.17 ,$42.42 ,$85.85 ,$646.13 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$90.90 ,$70.35 ,$290.04 ,$79.79 ,$13.46 ,$101.00 ,$101.00 ,$287.17 ,$101.00 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,31200188,88346,HC IF DIRECT (CUTANEOUS),312,1 ,$101.00 ,$50.50 ,$12.70 ,$646.13 ,$12.70 ,$101.00 ,$101.00 ,$287.17 ,$60.60 ,$85.85 ,$70.70 ,$12.70 ,$95.95 ,$76.76 ,$75.75 ,$101.00 ,$85.85 ,$287.17 ,$101.00 ,$101.00 ,$70.70 ,$12.70 ,$287.17 ,$287.17 ,$42.42 ,$85.85 ,$646.13 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$90.90 ,$70.35 ,$290.04 ,$79.79 ,$13.46 ,$101.00 ,$101.00 ,$287.17 ,$101.00 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$80.80 
ST NICHOLAS HOSPITAL - ACUTE,31200189,88348,HC ELECTRON MICRO DIAG,312,1 ,"$3,360.00 ","$1,680.00 ",$12.70 ,"$3,360.00 ",$12.70 ,$954.61 ,$818.24 ,$646.16 ,"$2,016.00 ","$2,856.00 ","$2,352.00 ",$12.70 ,"$3,192.00 ","$2,553.60 ","$2,520.00 ",$742.65 ,"$2,856.00 ",$646.16 ,$742.65 ,$374.97 ,"$2,352.00 ",$12.70 ,$646.16 ,$646.16 ,"$1,411.20 ","$2,856.00 ","$1,453.86 ","$3,091.20 ","$2,352.00 ",$682.93 ,$682.93 ,"$2,046.24 ",$682.93 ,"$2,321.76 ","$3,024.00 ","$2,340.24 ",$652.62 ,"$2,654.40 ",$13.46 ,$753.84 ,$753.84 ,$646.16 ,$753.84 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,31200190,88348,HC ELECTRON MICRO DIAG MAYO,312,1 ,"$1,635.00 ",$817.50 ,$12.70 ,"$1,635.00 ",$12.70 ,$954.61 ,$818.24 ,$646.16 ,$981.00 ,"$1,389.75 ","$1,144.50 ",$12.70 ,"$1,553.25 ","$1,242.60 ","$1,226.25 ",$742.65 ,"$1,389.75 ",$646.16 ,$742.65 ,$374.97 ,"$1,144.50 ",$12.70 ,$646.16 ,$646.16 ,$686.70 ,"$1,389.75 ","$1,453.86 ","$1,504.20 ","$1,144.50 ",$682.93 ,$682.93 ,$995.72 ,$682.93 ,"$1,129.79 ","$1,471.50 ","$1,138.78 ",$652.62 ,"$1,291.65 ",$13.46 ,$753.84 ,$753.84 ,$646.16 ,$753.84 ,"$1,177.20 ","$1,013.70 ","$1,177.20 ","$1,177.20 ","$1,308.00 "
ST NICHOLAS HOSPITAL - ACUTE,31200191,88360,HC MORPHO ANLYS TUMOR MAN (PR),312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$147.06 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$306.28 ,$302.25 ,$198.32 ,$342.55 ,$147.06 ,$198.32 ,$122.01 ,$282.10 ,$12.70 ,$147.06 ,$147.06 ,$169.26 ,$342.55 ,$330.88 ,$370.76 ,$282.10 ,$138.86 ,$138.86 ,$245.43 ,$138.86 ,$278.47 ,$362.70 ,$280.69 ,$148.53 ,$318.37 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31200192,88360,HC MORPHO ANLYS TUMOR MAN (ER),312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$147.06 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$306.28 ,$302.25 ,$198.32 ,$342.55 ,$147.06 ,$198.32 ,$122.01 ,$282.10 ,$12.70 ,$147.06 ,$147.06 ,$169.26 ,$342.55 ,$330.88 ,$370.76 ,$282.10 ,$138.86 ,$138.86 ,$245.43 ,$138.86 ,$278.47 ,$362.70 ,$280.69 ,$148.53 ,$318.37 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$147.06 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$306.28 ,$302.25 ,$198.32 ,$342.55 ,$147.06 ,$198.32 ,$122.01 ,$282.10 ,$12.70 ,$147.06 ,$147.06 ,$169.26 ,$342.55 ,$330.88 ,$370.76 ,$282.10 ,$138.86 ,$138.86 ,$245.43 ,$138.86 ,$278.47 ,$362.70 ,$280.69 ,$148.53 ,$318.37 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31200194,88360,HC MORPHO ANLYS TUMOR MAN (HER2),312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$147.06 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$306.28 ,$302.25 ,$198.32 ,$342.55 ,$147.06 ,$198.32 ,$122.01 ,$282.10 ,$12.70 ,$147.06 ,$147.06 ,$169.26 ,$342.55 ,$330.88 ,$370.76 ,$282.10 ,$138.86 ,$138.86 ,$245.43 ,$138.86 ,$278.47 ,$362.70 ,$280.69 ,$148.53 ,$318.37 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31200201,88360,HC MORPHO ANLYS TUMOR MAN (DCMH),312,1 ,$319.00 ,$159.50 ,$12.70 ,$330.88 ,$12.70 ,$285.32 ,$244.56 ,$147.06 ,$191.40 ,$271.15 ,$223.30 ,$12.70 ,$303.05 ,$242.44 ,$239.25 ,$198.32 ,$271.15 ,$147.06 ,$198.32 ,$122.01 ,$223.30 ,$12.70 ,$147.06 ,$147.06 ,$133.98 ,$271.15 ,$330.88 ,$293.48 ,$223.30 ,$138.86 ,$138.86 ,$194.27 ,$138.86 ,$220.43 ,$287.10 ,$222.18 ,$148.53 ,$252.01 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$229.68 ,$197.78 ,$229.68 ,$229.68 ,$255.20 
ST NICHOLAS HOSPITAL - ACUTE,31200202,88361,HC MORPHO ANLYS COMP ASSIST,312,1 ,$479.00 ,$239.50 ,$12.70 ,$646.13 ,$12.70 ,$288.94 ,$247.66 ,$287.17 ,$287.40 ,$407.15 ,$335.30 ,$12.70 ,$455.05 ,$364.04 ,$359.25 ,$198.10 ,$407.15 ,$287.17 ,$198.10 ,$123.91 ,$335.30 ,$12.70 ,$287.17 ,$287.17 ,$201.18 ,$407.15 ,$646.13 ,$440.68 ,$335.30 ,$138.86 ,$138.86 ,$291.71 ,$138.86 ,$330.99 ,$431.10 ,$333.62 ,$290.04 ,$378.41 ,$13.46 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$344.88 ,$296.98 ,$344.88 ,$344.88 ,$383.20 
ST NICHOLAS HOSPITAL - ACUTE,31200203,88363,HC EXAM ARCHIVE TISS MOL ANLYS,312,1 ,$125.00 ,$62.50 ,$3.02 ,$125.00 ,$3.02 ,$69.27 ,$59.38 ,$24.36 ,$75.00 ,$106.25 ,$87.50 ,$3.02 ,$118.75 ,$95.00 ,$93.75 ,$37.64 ,$106.25 ,$24.36 ,$37.64 ,$23.18 ,$87.50 ,$3.02 ,$24.36 ,$24.36 ,$52.50 ,$106.25 ,$54.81 ,$115.00 ,$87.50 ,$75.42 ,$75.42 ,$76.13 ,$75.42 ,$86.38 ,$112.50 ,$87.06 ,$24.60 ,$98.75 ,$3.20 ,$27.59 ,$27.59 ,$24.36 ,$27.59 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$100.00 
ST NICHOLAS HOSPITAL - ACUTE,31200204,88365,HC IN SITU HYBRID (FISH),312,1 ,$557.00 ,$278.50 ,$12.70 ,$557.00 ,$12.70 ,$448.28 ,$384.24 ,$147.06 ,$334.20 ,$473.45 ,$389.90 ,$12.70 ,$529.15 ,$423.32 ,$417.75 ,$294.10 ,$473.45 ,$147.06 ,$294.10 ,$175.38 ,$389.90 ,$12.70 ,$147.06 ,$147.06 ,$233.94 ,$473.45 ,$330.88 ,$512.44 ,$389.90 ,$138.86 ,$138.86 ,$339.21 ,$138.86 ,$384.89 ,$501.30 ,$387.95 ,$148.53 ,$440.03 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$445.60 
ST NICHOLAS HOSPITAL - ACUTE,31200207,88365,HC IN SITU HYBRID (FISH) HER2,312,1 ,$557.00 ,$278.50 ,$12.70 ,$557.00 ,$12.70 ,$448.28 ,$384.24 ,$147.06 ,$334.20 ,$473.45 ,$389.90 ,$12.70 ,$529.15 ,$423.32 ,$417.75 ,$294.10 ,$473.45 ,$147.06 ,$294.10 ,$175.38 ,$389.90 ,$12.70 ,$147.06 ,$147.06 ,$233.94 ,$473.45 ,$330.88 ,$512.44 ,$389.90 ,$138.86 ,$138.86 ,$339.21 ,$138.86 ,$384.89 ,$501.30 ,$387.95 ,$148.53 ,$440.03 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$445.60 
ST NICHOLAS HOSPITAL - ACUTE,31200208,88368,HC MORPHO ANLYS IN SITU HYBRID,312,1 ,$414.00 ,$207.00 ,$12.70 ,$646.13 ,$12.70 ,$286.53 ,$245.59 ,$287.17 ,$248.40 ,$351.90 ,$289.80 ,$12.70 ,$393.30 ,$314.64 ,$310.50 ,$222.99 ,$351.90 ,$287.17 ,$222.99 ,$128.00 ,$289.80 ,$12.70 ,$287.17 ,$287.17 ,$173.88 ,$351.90 ,$646.13 ,$380.88 ,$289.80 ,$138.86 ,$138.86 ,$252.13 ,$138.86 ,$286.07 ,$372.60 ,$288.35 ,$290.04 ,$327.06 ,$13.46 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$331.20 
ST NICHOLAS HOSPITAL - ACUTE,31200210,88399,HC ACGH ARRAY,312,1 ,"$2,055.00 ","$1,027.50 ",$3.02 ,"$2,055.00 ",$3.02 ,"$1,329.38 ","$1,329.38 ",$49.00 ,"$1,233.00 ","$1,746.75 ","$1,438.50 ",$3.02 ,"$1,952.25 ","$1,561.80 ","$1,541.25 ", N/A ,"$1,746.75 ",$49.00 , N/A , N/A ,"$1,438.50 ",$3.02 ,$49.00 ,$49.00 ,$863.10 ,"$1,746.75 ",$110.24 ,"$1,890.60 ","$1,438.50 ",$75.42 ,$75.42 ,"$1,251.50 ",$75.42 ,"$1,420.01 ","$1,849.50 ","$1,431.31 ",$49.49 ,"$1,623.45 ",$3.20 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,"$1,479.60 ","$1,274.10 ","$1,479.60 ","$1,479.60 ","$1,644.00 "
ST NICHOLAS HOSPITAL - ACUTE,31200212,G0416,HC PROSTATE NEEDLE BX SAMPLING 1-20 SPEC,312,1 ,$521.00 ,$260.50 ,$12.70 ,$646.13 ,$12.70 ,$337.03 ,$337.03 ,$287.17 ,$312.60 ,$442.85 ,$364.70 ,$12.70 ,$494.95 ,$395.96 ,$390.75 ,$521.00 ,$442.85 ,$287.17 ,$521.00 ,$334.75 ,$364.70 ,$12.70 ,$287.17 ,$287.17 ,$218.82 ,$442.85 ,$646.13 ,$479.32 ,$364.70 ,$521.00 ,$521.00 ,$317.29 ,$521.00 ,$360.01 ,$468.90 ,$362.88 ,$290.04 ,$411.59 ,$13.46 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$375.12 ,$323.02 ,$375.12 ,$375.12 ,$416.80 
ST NICHOLAS HOSPITAL - ACUTE,31200213,88313,HC SPECIAL STAIN II (BM CLOT),312,1 ,$217.00 ,$108.50 ,$6.95 ,$217.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$130.20 ,$184.45 ,$151.90 ,$6.95 ,$206.15 ,$164.92 ,$162.75 ,$131.95 ,$184.45 ,$33.38 ,$131.95 ,$73.28 ,$151.90 ,$6.95 ,$33.38 ,$33.38 ,$91.14 ,$184.45 ,$75.09 ,$199.64 ,$151.90 ,$75.42 ,$75.42 ,$132.15 ,$75.42 ,$149.95 ,$195.30 ,$151.14 ,$33.71 ,$171.43 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$156.24 ,$134.54 ,$156.24 ,$156.24 ,$173.60 
ST NICHOLAS HOSPITAL - ACUTE,31200214,88348,HC ELECTROMICROSCOPE SCAN,312,1 ,"$1,120.00 ",$560.00 ,$12.70 ,"$1,453.86 ",$12.70 ,$954.61 ,$818.24 ,$646.16 ,$672.00 ,$952.00 ,$784.00 ,$12.70 ,"$1,064.00 ",$851.20 ,$840.00 ,$742.65 ,$952.00 ,$646.16 ,$742.65 ,$374.97 ,$784.00 ,$12.70 ,$646.16 ,$646.16 ,$470.40 ,$952.00 ,"$1,453.86 ","$1,030.40 ",$784.00 ,$682.93 ,$682.93 ,$682.08 ,$682.93 ,$773.92 ,"$1,008.00 ",$780.08 ,$652.62 ,$884.80 ,$13.46 ,$753.84 ,$753.84 ,$646.16 ,$753.84 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,31200215,88341,HC MLH-1 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$12.70 ,$370.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$222.00 ,$314.50 ,$259.00 ,$12.70 ,$351.50 ,$281.20 ,$277.50 ,$145.06 ,$314.50 , N/A ,$145.06 ,$90.19 ,$259.00 ,$12.70 , N/A , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$225.22 ,$255.67 ,$333.00 ,$257.71 , N/A ,$292.30 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,31200216,88341,HC MSH-2 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$12.70 ,$370.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$222.00 ,$314.50 ,$259.00 ,$12.70 ,$351.50 ,$281.20 ,$277.50 ,$145.06 ,$314.50 , N/A ,$145.06 ,$90.19 ,$259.00 ,$12.70 , N/A , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$225.22 ,$255.67 ,$333.00 ,$257.71 , N/A ,$292.30 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,31200217,88341,HC MSH-3 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$12.70 ,$370.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$222.00 ,$314.50 ,$259.00 ,$12.70 ,$351.50 ,$281.20 ,$277.50 ,$145.06 ,$314.50 , N/A ,$145.06 ,$90.19 ,$259.00 ,$12.70 , N/A , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$225.22 ,$255.67 ,$333.00 ,$257.71 , N/A ,$292.30 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,31200218,88341,HC PMS-2 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$12.70 ,$370.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$222.00 ,$314.50 ,$259.00 ,$12.70 ,$351.50 ,$281.20 ,$277.50 ,$145.06 ,$314.50 , N/A ,$145.06 ,$90.19 ,$259.00 ,$12.70 , N/A , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$225.22 ,$255.67 ,$333.00 ,$257.71 , N/A ,$292.30 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$291.00 ,$145.50 ,$12.70 ,$330.88 ,$12.70 ,$238.24 ,$204.21 ,$147.06 ,$174.60 ,$247.35 ,$203.70 ,$12.70 ,$276.45 ,$221.16 ,$218.25 ,$165.67 ,$247.35 ,$147.06 ,$165.67 ,$102.56 ,$203.70 ,$12.70 ,$147.06 ,$147.06 ,$122.22 ,$247.35 ,$330.88 ,$267.72 ,$203.70 ,$138.23 ,$138.23 ,$177.22 ,$138.23 ,$201.08 ,$261.90 ,$202.68 ,$148.53 ,$229.89 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200221,88341,HC IP STAIN ADDITIONAL,312,1 ,$370.00 ,$185.00 ,$12.70 ,$370.00 ,$12.70 ,$216.08 ,$185.21 , N/A ,$222.00 ,$314.50 ,$259.00 ,$12.70 ,$351.50 ,$281.20 ,$277.50 ,$145.06 ,$314.50 , N/A ,$145.06 ,$90.19 ,$259.00 ,$12.70 , N/A , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$225.22 ,$255.67 ,$333.00 ,$257.71 , N/A ,$292.30 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,31200226,88323,HC CONSULT SLIDE PREP LV II,312,1 ,$448.00 ,$224.00 ,$11.57 ,$448.00 ,$11.57 ,$89.77 ,$76.94 ,$49.00 ,$268.80 ,$380.80 ,$313.60 ,$11.57 ,$425.60 ,$340.48 ,$336.00 ,$187.99 ,$380.80 ,$49.00 ,$187.99 ,$114.34 ,$313.60 ,$11.57 ,$49.00 ,$49.00 ,$188.16 ,$380.80 ,$110.24 ,$412.16 ,$313.60 ,$138.86 ,$138.86 ,$272.83 ,$138.86 ,$309.57 ,$403.20 ,$312.03 ,$49.49 ,$353.92 ,$12.26 ,$59.36 ,$59.36 ,$49.00 ,$59.36 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$358.40 
ST NICHOLAS HOSPITAL - ACUTE,31200228,81479,HC IBD SCREEN-UNLISTED,312,1 ,$179.00 ,$89.50 ,$13.61 ,$179.00 ,$13.61 ,$115.80 ,$115.80 , N/A ,$107.40 ,$152.15 ,$125.30 ,$13.61 ,$170.05 ,$136.04 ,$134.25 , N/A ,$152.15 , N/A , N/A ,$116.35 ,$125.30 ,$13.61 , N/A , N/A ,$75.18 ,$152.15 ,$107.40 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$108.96 ,$123.69 ,$161.10 ,$124.67 , N/A ,$141.41 ,$14.43 ,$89.50 ,$89.50 , N/A ,$89.50 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,31200229,88368,HC I KAPPA ISH,312,1 ,$896.00 ,$448.00 ,$12.70 ,$896.00 ,$12.70 ,$286.53 ,$245.59 ,$287.17 ,$537.60 ,$761.60 ,$627.20 ,$12.70 ,$851.20 ,$680.96 ,$672.00 ,$222.99 ,$761.60 ,$287.17 ,$222.99 ,$128.00 ,$627.20 ,$12.70 ,$287.17 ,$287.17 ,$376.32 ,$761.60 ,$646.13 ,$824.32 ,$627.20 ,$138.86 ,$138.86 ,$545.66 ,$138.86 ,$619.14 ,$806.40 ,$624.06 ,$290.04 ,$707.84 ,$13.46 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,31200230,88369,HC I LAMBDA ISH-ADDITIONAL,312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$264.80 ,$226.97 , N/A ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$306.28 ,$302.25 ,$188.94 ,$342.55 , N/A ,$188.94 ,$111.46 ,$282.10 ,$12.70 , N/A , N/A ,$169.26 ,$342.55 , N/A ,$370.76 ,$282.10 ,$204.40 ,$245.31 ,$245.43 ,$245.31 ,$278.47 ,$362.70 ,$280.69 , N/A ,$318.37 ,$13.46 ,$99.18 ,$99.18 , N/A ,$99.18 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31200231,88313,HC PERIODIC ACID SCHIFF STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$221.16 ,$218.25 ,$131.95 ,$247.35 ,$33.38 ,$131.95 ,$73.28 ,$203.70 ,$6.95 ,$33.38 ,$33.38 ,$122.22 ,$247.35 ,$75.09 ,$267.72 ,$203.70 ,$75.42 ,$75.42 ,$177.22 ,$75.42 ,$201.08 ,$261.90 ,$202.68 ,$33.71 ,$229.89 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200232,88313,HC MASSONS TRICHROME STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$221.16 ,$218.25 ,$131.95 ,$247.35 ,$33.38 ,$131.95 ,$73.28 ,$203.70 ,$6.95 ,$33.38 ,$33.38 ,$122.22 ,$247.35 ,$75.09 ,$267.72 ,$203.70 ,$75.42 ,$75.42 ,$177.22 ,$75.42 ,$201.08 ,$261.90 ,$202.68 ,$33.71 ,$229.89 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200233,88313,HC JONES METH SILVER STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$33.38 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$221.16 ,$218.25 ,$131.95 ,$247.35 ,$33.38 ,$131.95 ,$73.28 ,$203.70 ,$6.95 ,$33.38 ,$33.38 ,$122.22 ,$247.35 ,$75.09 ,$267.72 ,$203.70 ,$75.42 ,$75.42 ,$177.22 ,$75.42 ,$201.08 ,$261.90 ,$202.68 ,$33.71 ,$229.89 ,$7.37 ,$40.12 ,$40.12 ,$33.38 ,$40.12 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,31200234,88346,HC IGG1 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$646.13 ,$12.70 ,$153.00 ,$153.00 ,$287.17 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$116.28 ,$114.75 ,$153.00 ,$130.05 ,$287.17 ,$153.00 ,$122.84 ,$107.10 ,$12.70 ,$287.17 ,$287.17 ,$64.26 ,$130.05 ,$646.13 ,$140.76 ,$107.10 ,$138.86 ,$138.86 ,$93.18 ,$138.86 ,$105.72 ,$137.70 ,$106.56 ,$290.04 ,$120.87 ,$13.46 ,$153.00 ,$153.00 ,$287.17 ,$153.00 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,31200235,88381,HC MICRODISSECTION MANUAL,312,1 ,$280.00 ,$140.00 ,$6.95 ,$280.00 ,$6.95 ,$280.00 ,$280.00 , N/A ,$168.00 ,$238.00 ,$196.00 ,$6.95 ,$266.00 ,$212.80 ,$210.00 ,$280.00 ,$238.00 , N/A ,$280.00 ,$173.71 ,$196.00 ,$6.95 , N/A , N/A ,$117.60 ,$238.00 , N/A ,$257.60 ,$196.00 ,$280.00 ,$280.00 ,$170.52 ,$280.00 ,$193.48 ,$252.00 ,$195.02 , N/A ,$221.20 ,$7.37 ,$188.39 ,$188.39 , N/A ,$188.39 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,31200236,88346,HC IGG3 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$646.13 ,$12.70 ,$153.00 ,$153.00 ,$287.17 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$116.28 ,$114.75 ,$153.00 ,$130.05 ,$287.17 ,$153.00 ,$122.84 ,$107.10 ,$12.70 ,$287.17 ,$287.17 ,$64.26 ,$130.05 ,$646.13 ,$140.76 ,$107.10 ,$138.86 ,$138.86 ,$93.18 ,$138.86 ,$105.72 ,$137.70 ,$106.56 ,$290.04 ,$120.87 ,$13.46 ,$153.00 ,$153.00 ,$287.17 ,$153.00 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,31200237,88346,HC IGG4 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$646.13 ,$12.70 ,$153.00 ,$153.00 ,$287.17 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$116.28 ,$114.75 ,$153.00 ,$130.05 ,$287.17 ,$153.00 ,$122.84 ,$107.10 ,$12.70 ,$287.17 ,$287.17 ,$64.26 ,$130.05 ,$646.13 ,$140.76 ,$107.10 ,$138.86 ,$138.86 ,$93.18 ,$138.86 ,$105.72 ,$137.70 ,$106.56 ,$290.04 ,$120.87 ,$13.46 ,$153.00 ,$153.00 ,$287.17 ,$153.00 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,31200238,88346,HC IGG2 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$646.13 ,$12.70 ,$153.00 ,$153.00 ,$287.17 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$116.28 ,$114.75 ,$153.00 ,$130.05 ,$287.17 ,$153.00 ,$122.84 ,$107.10 ,$12.70 ,$287.17 ,$287.17 ,$64.26 ,$130.05 ,$646.13 ,$140.76 ,$107.10 ,$138.86 ,$138.86 ,$93.18 ,$138.86 ,$105.72 ,$137.70 ,$106.56 ,$290.04 ,$120.87 ,$13.46 ,$153.00 ,$153.00 ,$287.17 ,$153.00 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$122.40 
ST NICHOLAS HOSPITAL - ACUTE,31200239,88368,HC HER2 DUAL ISH,312,1 ,$896.00 ,$448.00 ,$12.70 ,$896.00 ,$12.70 ,$286.53 ,$245.59 ,$287.17 ,$537.60 ,$761.60 ,$627.20 ,$12.70 ,$851.20 ,$680.96 ,$672.00 ,$222.99 ,$761.60 ,$287.17 ,$222.99 ,$128.00 ,$627.20 ,$12.70 ,$287.17 ,$287.17 ,$376.32 ,$761.60 ,$646.13 ,$824.32 ,$627.20 ,$138.86 ,$138.86 ,$545.66 ,$138.86 ,$619.14 ,$806.40 ,$624.06 ,$290.04 ,$707.84 ,$13.46 ,$340.09 ,$340.09 ,$287.17 ,$340.09 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,31200240,88365,HC EPSTEIN BARR ISH,312,1 ,$347.00 ,$173.50 ,$12.70 ,$347.00 ,$12.70 ,$347.00 ,$347.00 ,$147.06 ,$208.20 ,$294.95 ,$242.90 ,$12.70 ,$329.65 ,$263.72 ,$260.25 ,$294.10 ,$294.95 ,$147.06 ,$294.10 ,$175.38 ,$242.90 ,$12.70 ,$147.06 ,$147.06 ,$145.74 ,$294.95 ,$330.88 ,$319.24 ,$242.90 ,$138.86 ,$138.86 ,$211.32 ,$138.86 ,$239.78 ,$312.30 ,$241.69 ,$148.53 ,$274.13 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$277.60 
ST NICHOLAS HOSPITAL - ACUTE,31200241,88369,HC HER2 DUAL ISH - ADDITIONAL,312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$264.80 ,$226.97 , N/A ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$306.28 ,$302.25 ,$188.94 ,$342.55 , N/A ,$188.94 ,$111.46 ,$282.10 ,$12.70 , N/A , N/A ,$169.26 ,$342.55 , N/A ,$370.76 ,$282.10 ,$204.40 ,$245.31 ,$245.43 ,$245.31 ,$278.47 ,$362.70 ,$280.69 , N/A ,$318.37 ,$13.46 ,$99.18 ,$99.18 , N/A ,$99.18 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31200242,88368,HC ISH,312,1 ,$311.00 ,$155.50 ,$12.70 ,$646.13 ,$12.70 ,$286.53 ,$245.59 ,$287.17 ,$186.60 ,$264.35 ,$217.70 ,$12.70 ,$295.45 ,$236.36 ,$233.25 ,$222.99 ,$264.35 ,$287.17 ,$222.99 ,$128.00 ,$217.70 ,$12.70 ,$287.17 ,$287.17 ,$130.62 ,$264.35 ,$646.13 ,$286.12 ,$217.70 ,$138.86 ,$138.86 ,$189.40 ,$138.86 ,$214.90 ,$279.90 ,$216.61 ,$290.04 ,$245.69 ,$13.46 ,$311.00 ,$311.00 ,$287.17 ,$311.00 ,$223.92 ,$192.82 ,$223.92 ,$223.92 ,$248.80 
ST NICHOLAS HOSPITAL - ACUTE,31200243,88369,HC ISH ADDITIONAL,312,1 ,$311.00 ,$155.50 ,$12.70 ,$311.00 ,$12.70 ,$264.80 ,$226.97 , N/A ,$186.60 ,$264.35 ,$217.70 ,$12.70 ,$295.45 ,$236.36 ,$233.25 ,$188.94 ,$264.35 , N/A ,$188.94 ,$111.46 ,$217.70 ,$12.70 , N/A , N/A ,$130.62 ,$264.35 , N/A ,$286.12 ,$217.70 ,$157.74 ,$189.31 ,$189.40 ,$189.31 ,$214.90 ,$279.90 ,$216.61 , N/A ,$245.69 ,$13.46 ,$99.18 ,$99.18 , N/A ,$99.18 ,$223.92 ,$192.82 ,$223.92 ,$223.92 ,$248.80 
ST NICHOLAS HOSPITAL - ACUTE,31200245,88350,HC IMMUNOFLUOR PER SPEC EA ADDN SINGLE STAIN,312,1 ,$235.00 ,$117.50 ,$12.70 ,$235.00 ,$12.70 ,$162.96 ,$139.68 , N/A ,$141.00 ,$199.75 ,$164.50 ,$12.70 ,$223.25 ,$178.60 ,$176.25 ,$193.56 ,$199.75 , N/A ,$193.56 ,$90.02 ,$164.50 ,$12.70 , N/A , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$163.68 , N/A ,$185.65 ,$13.46 ,$76.66 ,$76.66 , N/A ,$76.66 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,31200251,88350,HC IMMUNOFLUOR PER SPEC EA ADDL STAIN (CUTANEOUS),312,1 ,$123.00 ,$61.50 ,$12.70 ,$123.00 ,$12.70 ,$123.00 ,$123.00 , N/A ,$73.80 ,$104.55 ,$86.10 ,$12.70 ,$116.85 ,$93.48 ,$92.25 ,$123.00 ,$104.55 , N/A ,$123.00 ,$90.02 ,$86.10 ,$12.70 , N/A , N/A ,$51.66 ,$104.55 , N/A ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$74.87 ,$84.99 ,$110.70 ,$85.67 , N/A ,$97.17 ,$13.46 ,$76.66 ,$76.66 , N/A ,$76.66 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,31200278,88364,HC IN SITU HYBRID(FISH) EA ADL-90,312,1 ,$557.00 ,$278.50 ,$12.70 ,$557.00 ,$12.70 ,$328.78 ,$281.81 , N/A ,$334.20 ,$473.45 ,$389.90 ,$12.70 ,$529.15 ,$423.32 ,$417.75 ,$226.07 ,$473.45 , N/A ,$226.07 ,$134.06 ,$389.90 ,$12.70 , N/A , N/A ,$233.94 ,$473.45 , N/A ,$512.44 ,$389.90 ,$282.51 ,$339.05 ,$339.21 ,$339.05 ,$384.89 ,$501.30 ,$387.95 , N/A ,$440.03 ,$13.46 ,$125.16 ,$125.16 , N/A ,$125.16 ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$445.60 
ST NICHOLAS HOSPITAL - ACUTE,31200284,88377,HC MORPH ANLZ INST HYB EA MTPL-90,312,1 ,$521.00 ,$260.50 ,$12.70 ,$521.00 ,$12.70 ,$521.00 ,$521.00 ,$147.06 ,$312.60 ,$442.85 ,$364.70 ,$12.70 ,$494.95 ,$395.96 ,$390.75 ,$521.00 ,$442.85 ,$147.06 ,$521.00 ,$392.45 ,$364.70 ,$12.70 ,$147.06 ,$147.06 ,$218.82 ,$442.85 ,$330.88 ,$479.32 ,$364.70 ,$521.00 ,$521.00 ,$317.29 ,$521.00 ,$360.01 ,$468.90 ,$362.88 ,$148.53 ,$411.59 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$375.12 ,$323.02 ,$375.12 ,$375.12 ,$416.80 
ST NICHOLAS HOSPITAL - ACUTE,31200291,88360,HC MORPHO ANALYSIS TUMOR MANUAL PD-L1,312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$147.06 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$306.28 ,$302.25 ,$198.32 ,$342.55 ,$147.06 ,$198.32 ,$122.01 ,$282.10 ,$12.70 ,$147.06 ,$147.06 ,$169.26 ,$342.55 ,$330.88 ,$370.76 ,$282.10 ,$138.86 ,$138.86 ,$245.43 ,$138.86 ,$278.47 ,$362.70 ,$280.69 ,$148.53 ,$318.37 ,$13.46 ,$172.20 ,$172.20 ,$147.06 ,$172.20 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,31200318,88381,HC MICRODISSECTION MANUAL LUNG PANEL,312,1 ,$123.00 ,$61.50 ,$6.95 ,$123.00 ,$6.95 ,$123.00 ,$123.00 , N/A ,$73.80 ,$104.55 ,$86.10 ,$6.95 ,$116.85 ,$93.48 ,$92.25 ,$123.00 ,$104.55 , N/A ,$123.00 ,$123.00 ,$86.10 ,$6.95 , N/A , N/A ,$51.66 ,$104.55 , N/A ,$113.16 ,$86.10 ,$123.00 ,$123.00 ,$74.91 ,$123.00 ,$84.99 ,$110.70 ,$85.67 , N/A ,$97.17 ,$7.37 ,$123.00 ,$123.00 , N/A ,$123.00 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,32000002,21116,HC TMJ INJECTION,361,1 ,$585.00 ,$292.50 ,$95.13 ,$585.00 ,$95.13 ,$585.00 ,$585.00 , N/A ,$351.00 ,$497.25 ,$409.50 ,$95.13 ,$555.75 ,$444.60 ,$438.75 ,$585.00 ,$497.25 , N/A ,$585.00 ,$585.00 ,$409.50 ,$95.13 , N/A , N/A ,$585.00 ,$497.25 , N/A ,$538.20 ,$409.50 ,$585.00 ,$585.00 ,$356.27 ,$585.00 ,$404.24 ,$526.50 ,$407.45 , N/A ,$462.15 ,$100.84 ,$585.00 ,$585.00 , N/A ,$585.00 ,$421.20 ,$362.70 ,$421.20 ,$421.20 ,$468.00 
ST NICHOLAS HOSPITAL - ACUTE,32000003,22510,HC VERTEBROPLASTY INJ PERC THOR,320,1 ,"$5,500.00 ","$2,750.00 ",$451.00 ,"$6,282.73 ","$1,461.70 ","$3,557.95 ","$3,557.95 ","$2,792.32 ","$3,300.00 ","$4,675.00 ","$3,850.00 ","$1,461.70 ","$5,225.00 ","$4,180.00 ","$4,125.00 ",$832.05 ,"$4,675.00 ","$2,792.32 ",$832.05 ,"$1,771.70 ","$3,850.00 ","$1,461.70 ","$2,792.32 ","$2,792.32 ","$2,310.00 ","$4,675.00 ","$6,282.73 ","$5,060.00 ","$3,850.00 ","$4,794.94 ","$5,993.67 ","$3,349.50 ","$5,993.67 ","$3,800.50 ","$4,950.00 ","$3,830.75 ","$2,820.24 ","$4,345.00 ","$1,549.40 ",$451.00 ,$451.00 ,"$2,792.32 ",$451.00 ,"$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$4,400.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000004,22511,HC VERTEBROPLASTY INJ PERC LUMBAR,320,1 ,"$5,500.00 ","$2,750.00 ",$451.00 ,"$6,282.73 ","$1,461.70 ","$3,557.95 ","$3,557.95 ","$2,792.32 ","$3,300.00 ","$4,675.00 ","$3,850.00 ","$1,461.70 ","$5,225.00 ","$4,180.00 ","$4,125.00 ",$782.75 ,"$4,675.00 ","$2,792.32 ",$782.75 ,"$1,754.66 ","$3,850.00 ","$1,461.70 ","$2,792.32 ","$2,792.32 ","$2,310.00 ","$4,675.00 ","$6,282.73 ","$5,060.00 ","$3,850.00 ","$4,794.94 ","$5,993.67 ","$3,349.50 ","$5,993.67 ","$3,800.50 ","$4,950.00 ","$3,830.75 ","$2,820.24 ","$4,345.00 ","$1,549.40 ",$451.00 ,$451.00 ,"$2,792.32 ",$451.00 ,"$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$4,400.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000005,22512,HC VERTEBROPLASTY INJ PERC ADDL,320,1 ,"$5,500.00 ","$2,750.00 ",$392.10 ,"$5,993.67 ","$1,461.70 ","$3,557.95 ","$3,557.95 ", N/A ,"$3,300.00 ","$4,675.00 ","$3,850.00 ","$1,461.70 ","$5,225.00 ","$4,180.00 ","$4,125.00 ",$392.10 ,"$4,675.00 ", N/A ,$392.10 ,$832.53 ,"$3,850.00 ","$1,461.70 ", N/A , N/A ,"$2,310.00 ","$4,675.00 ", N/A ,"$5,060.00 ","$3,850.00 ","$4,794.94 ","$5,993.67 ","$3,349.50 ","$5,993.67 ","$3,800.50 ","$4,950.00 ","$3,830.75 ", N/A ,"$4,345.00 ","$1,549.40 ",$451.00 ,$451.00 , N/A ,$451.00 ,"$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$4,400.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$661.00 ,$330.50 ,$95.13 ,$661.00 ,$95.13 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$95.13 ,$627.95 ,$502.36 ,$495.75 ,$97.56 ,$561.85 , N/A ,$97.56 ,$148.79 ,$462.70 ,$95.13 , N/A , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$991.00 ,$495.50 ,$97.56 ,$991.00 ,$142.69 ,$641.08 ,$641.08 , N/A ,$594.60 ,$842.35 ,$693.70 ,$142.69 ,$941.45 ,$753.16 ,$743.25 ,$97.56 ,$842.35 , N/A ,$97.56 ,$148.79 ,$693.70 ,$142.69 , N/A , N/A ,$416.22 ,$842.35 , N/A ,$911.72 ,$693.70 ,$991.00 ,$991.00 ,$603.52 ,$991.00 ,$684.78 ,$891.90 ,$690.23 , N/A ,$782.89 ,$151.25 ,$451.00 ,$451.00 , N/A ,$451.00 ,$713.52 ,$614.42 ,$713.52 ,$713.52 ,$792.80 
ST NICHOLAS HOSPITAL - ACUTE,32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$661.00 ,$330.50 ,$95.13 ,$661.00 ,$95.13 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$95.13 ,$627.95 ,$502.36 ,$495.75 ,$129.54 ,$561.85 , N/A ,$129.54 ,$174.71 ,$462.70 ,$95.13 , N/A , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$661.00 ,$330.50 ,$95.13 ,$661.00 ,$95.13 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$95.13 ,$627.95 ,$502.36 ,$495.75 ,$142.80 ,$561.85 , N/A ,$142.80 ,$179.76 ,$462.70 ,$95.13 , N/A , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$661.00 ,$330.50 ,$95.13 ,$661.00 ,$95.13 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$95.13 ,$627.95 ,$502.36 ,$495.75 ,$132.16 ,$561.85 , N/A ,$132.16 ,$212.48 ,$462.70 ,$95.13 , N/A , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000013,27095,HC INJ ARTHROGRAPHY HIP,320,1 ,$661.00 ,$330.50 ,$95.13 ,$661.00 ,$95.13 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$95.13 ,$627.95 ,$502.36 ,$495.75 ,$158.24 ,$561.85 , N/A ,$158.24 ,$283.88 ,$462.70 ,$95.13 , N/A , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000014,27324,HC BX SOFT TX THIGH/KNEE DEEP,361,1 ,"$4,202.00 ","$2,101.00 ",$547.96 ,"$5,260.19 ",$547.96 ,"$4,202.00 ","$4,202.00 ","$2,337.86 ","$2,521.20 ","$3,571.70 ","$2,941.40 ",$547.96 ,"$3,991.90 ","$3,193.52 ","$3,151.50 ","$2,815.00 ","$3,571.70 ","$2,337.86 ","$2,815.00 ","$2,717.00 ","$2,941.40 ",$547.96 ,"$2,337.86 ","$2,337.86 ","$4,202.00 ","$3,571.70 ","$5,260.19 ","$3,865.84 ","$2,941.40 ","$1,703.02 ","$2,128.52 ","$2,559.02 ","$2,128.52 ","$2,903.58 ","$3,781.80 ","$2,926.69 ","$2,361.24 ","$3,319.58 ",$580.84 ,"$4,202.00 ","$4,202.00 ","$2,337.86 ","$4,202.00 ","$3,025.44 ","$2,605.24 ","$3,025.44 ","$3,025.44 ","$3,361.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$636.00 ,$318.00 ,$76.77 ,$636.00 ,$95.13 ,$411.43 ,$411.43 , N/A ,$381.60 ,$540.60 ,$445.20 ,$95.13 ,$604.20 ,$483.36 ,$477.00 ,$76.77 ,$540.60 , N/A ,$76.77 ,$152.82 ,$445.20 ,$95.13 , N/A , N/A ,$267.12 ,$540.60 , N/A ,$585.12 ,$445.20 ,$636.00 ,$636.00 ,$387.32 ,$636.00 ,$439.48 ,$572.40 ,$442.97 , N/A ,$502.44 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$508.80 
ST NICHOLAS HOSPITAL - ACUTE,32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$954.00 ,$477.00 ,$76.77 ,$954.00 ,$142.69 ,$617.14 ,$617.14 , N/A ,$572.40 ,$810.90 ,$667.80 ,$142.69 ,$906.30 ,$725.04 ,$715.50 ,$76.77 ,$810.90 , N/A ,$76.77 ,$152.82 ,$667.80 ,$142.69 , N/A , N/A ,$400.68 ,$810.90 , N/A ,$877.68 ,$667.80 ,$954.00 ,$954.00 ,$580.99 ,$954.00 ,$659.21 ,$858.60 ,$664.46 , N/A ,$753.66 ,$151.25 ,$451.00 ,$451.00 , N/A ,$451.00 ,$686.88 ,$591.48 ,$686.88 ,$686.88 ,$763.20 
ST NICHOLAS HOSPITAL - ACUTE,32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$661.00 ,$330.50 ,$95.13 ,$661.00 ,$95.13 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$95.13 ,$627.95 ,$502.36 ,$495.75 ,$98.69 ,$561.85 , N/A ,$98.69 ,$195.07 ,$462.70 ,$95.13 , N/A , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000017,28899,HC UNLISTED PROCEDURE TOE OR FOOT,361,1 ,$590.00 ,$295.00 ,$139.53 ,$590.00 ,$139.53 ,$590.00 ,$590.00 ,$203.23 ,$354.00 ,$501.50 ,$413.00 ,$139.53 ,$560.50 ,$448.40 ,$442.50 ,$590.00 ,$501.50 ,$203.23 ,$590.00 ,$590.00 ,$413.00 ,$139.53 ,$203.23 ,$203.23 ,$590.00 ,$501.50 ,$457.26 ,$542.80 ,$413.00 , N/A , N/A ,$359.31 , N/A ,$407.69 ,$531.00 ,$410.94 ,$205.26 ,$466.10 ,$147.90 ,$590.00 ,$590.00 ,$203.23 ,$590.00 ,$424.80 ,$365.80 ,$424.80 ,$424.80 ,$472.00 
ST NICHOLAS HOSPITAL - ACUTE,32000018,32550,HC INSERT CATH PLEURAL INDWELL W/,320,1 ,"$4,202.00 ","$2,101.00 ",$299.20 ,"$7,058.37 ",$299.20 ,"$2,718.27 ","$2,718.27 ","$3,137.05 ","$2,521.20 ","$3,571.70 ","$2,941.40 ",$299.20 ,"$3,991.90 ","$3,193.52 ","$3,151.50 ",$391.67 ,"$3,571.70 ","$3,137.05 ",$391.67 ,$764.11 ,"$2,941.40 ",$299.20 ,"$3,137.05 ","$3,137.05 ","$1,764.84 ","$3,571.70 ","$7,058.37 ","$3,865.84 ","$2,941.40 ","$1,703.02 ","$2,128.52 ","$2,559.02 ","$2,128.52 ","$2,903.58 ","$3,781.80 ","$2,926.69 ","$3,168.42 ","$3,319.58 ",$317.15 ,$451.00 ,$451.00 ,"$3,137.05 ",$451.00 ,"$3,025.44 ","$2,605.24 ","$3,025.44 ","$3,025.44 ","$3,361.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,185.00 ",$592.50 ,$149.78 ,"$3,119.68 ",$299.20 ,$766.58 ,$766.58 ,"$1,386.53 ",$711.00 ,"$1,007.25 ",$829.50 ,$299.20 ,"$1,125.75 ",$900.60 ,$888.75 ,$295.38 ,"$1,007.25 ","$1,386.53 ",$295.38 ,$149.78 ,$829.50 ,$299.20 ,"$1,386.53 ","$1,386.53 ",$497.70 ,"$1,007.25 ","$3,119.68 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,"$1,400.40 ",$936.15 ,$317.15 ,$451.00 ,$451.00 ,"$1,386.53 ",$451.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,32000020,32552,HC REMOVAL TUNNELED PLEURAL CATH,320,1 ,"$1,401.00 ",$700.50 ,$177.57 ,"$1,401.00 ",$299.20 ,$906.31 ,$906.31 ,$532.96 ,$840.60 ,"$1,190.85 ",$980.70 ,$299.20 ,"$1,330.95 ","$1,064.76 ","$1,050.75 ",$303.11 ,"$1,190.85 ",$532.96 ,$303.11 ,$177.57 ,$980.70 ,$299.20 ,$532.96 ,$532.96 ,$588.42 ,"$1,190.85 ","$1,199.16 ","$1,288.92 ",$980.70 ,"$1,401.00 ","$1,401.00 ",$853.21 ,"$1,401.00 ",$968.09 ,"$1,260.90 ",$975.80 ,$538.29 ,"$1,106.79 ",$317.15 ,$451.00 ,$451.00 ,$532.96 ,$451.00 ,"$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ","$1,120.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000021,32561,HC INSTILL FIBRO CHEST TUBE INIT,320,1 ,$870.00 ,$435.00 ,$90.72 ,"$1,199.16 ",$299.20 ,$562.80 ,$562.80 ,$532.96 ,$522.00 ,$739.50 ,$609.00 ,$299.20 ,$826.50 ,$661.20 ,$652.50 ,$131.59 ,$739.50 ,$532.96 ,$131.59 ,$90.72 ,$609.00 ,$299.20 ,$532.96 ,$532.96 ,$365.40 ,$739.50 ,"$1,199.16 ",$800.40 ,$609.00 ,$870.00 ,$870.00 ,$529.83 ,$870.00 ,$601.17 ,$783.00 ,$605.96 ,$538.29 ,$687.30 ,$317.15 ,$451.00 ,$451.00 ,$532.96 ,$451.00 ,$626.40 ,$539.40 ,$626.40 ,$626.40 ,$696.00 
ST NICHOLAS HOSPITAL - ACUTE,32000022,32562,HC INSTILL FIBRO CHEST TUBE SUBSQ DAY,320,1 ,$870.00 ,$435.00 ,$81.54 ,"$1,199.16 ",$299.20 ,$562.80 ,$562.80 ,$532.96 ,$522.00 ,$739.50 ,$609.00 ,$299.20 ,$826.50 ,$661.20 ,$652.50 ,$116.54 ,$739.50 ,$532.96 ,$116.54 ,$81.54 ,$609.00 ,$299.20 ,$532.96 ,$532.96 ,$365.40 ,$739.50 ,"$1,199.16 ",$800.40 ,$609.00 ,$870.00 ,$870.00 ,$529.83 ,$870.00 ,$601.17 ,$783.00 ,$605.96 ,$538.29 ,$687.30 ,$317.15 ,$451.00 ,$451.00 ,$532.96 ,$451.00 ,$626.40 ,$539.40 ,$626.40 ,$626.40 ,$696.00 
ST NICHOLAS HOSPITAL - ACUTE,32000026,36000,HC IV START > 3YR OLD,320,1 ,$139.00 ,$69.50 ,$17.65 ,$139.00 ,$18.43 ,$89.92 ,$89.92 , N/A ,$83.40 ,$118.15 ,$97.30 ,$18.43 ,$132.05 ,$105.64 ,$104.25 ,$17.65 ,$118.15 , N/A ,$17.65 ,$27.16 ,$97.30 ,$18.43 , N/A , N/A ,$58.38 ,$118.15 , N/A ,$127.88 ,$97.30 ,$139.00 ,$139.00 ,$84.65 ,$139.00 ,$96.05 ,$125.10 ,$96.81 , N/A ,$109.81 ,$19.54 ,$139.00 ,$139.00 , N/A ,$139.00 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$111.20 
ST NICHOLAS HOSPITAL - ACUTE,32000027,36002,HC INJ PSEUDOANEURYSM (THROMBIN),320,1 ,$717.00 ,$358.50 ,$148.99 ,"$1,199.16 ",$264.62 ,$463.83 ,$463.83 ,$532.96 ,$430.20 ,$609.45 ,$501.90 ,$264.62 ,$681.15 ,$544.92 ,$537.75 ,$197.27 ,$609.45 ,$532.96 ,$197.27 ,$148.99 ,$501.90 ,$264.62 ,$532.96 ,$532.96 ,$301.14 ,$609.45 ,"$1,199.16 ",$659.64 ,$501.90 ,$717.00 ,$717.00 ,$436.65 ,$717.00 ,$495.45 ,$645.30 ,$499.39 ,$538.29 ,$566.43 ,$280.50 ,$451.00 ,$451.00 ,$532.96 ,$451.00 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$573.60 
ST NICHOLAS HOSPITAL - ACUTE,32000028,36005,HC VENOGRAM INJECTION 36005,320,1 ,$824.00 ,$412.00 ,$90.38 ,$824.00 ,$199.61 ,$533.05 ,$533.05 , N/A ,$494.40 ,$700.40 ,$576.80 ,$199.61 ,$782.80 ,$626.24 ,$618.00 ,$90.38 ,$700.40 , N/A ,$90.38 ,$287.87 ,$576.80 ,$199.61 , N/A , N/A ,$346.08 ,$700.40 , N/A ,$758.08 ,$576.80 ,$824.00 ,$824.00 ,$501.82 ,$824.00 ,$569.38 ,$741.60 ,$573.92 , N/A ,$650.96 ,$211.59 ,$451.00 ,$451.00 , N/A ,$451.00 ,$593.28 ,$510.88 ,$593.28 ,$593.28 ,$659.20 
ST NICHOLAS HOSPITAL - ACUTE,32000029,36410,HC VENIPUNCTURE > AGE 3 REQUIR MD,361,1 ,$108.00 ,$54.00 ,$18.43 ,$108.00 ,$18.43 ,$108.00 ,$108.00 , N/A ,$64.80 ,$91.80 ,$75.60 ,$18.43 ,$102.60 ,$82.08 ,$81.00 ,$108.00 ,$91.80 , N/A ,$108.00 ,$108.00 ,$75.60 ,$18.43 , N/A , N/A ,$108.00 ,$91.80 , N/A ,$99.36 ,$75.60 , N/A , N/A ,$65.77 , N/A ,$74.63 ,$97.20 ,$75.22 , N/A ,$85.32 ,$19.54 , N/A , N/A , N/A , N/A ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$549.00 ,$274.50 ,$70.21 ,$549.00 ,$95.13 ,$355.15 ,$355.15 ,$201.71 ,$329.40 ,$466.65 ,$384.30 ,$95.13 ,$521.55 ,$417.24 ,$411.75 ,$70.21 ,$466.65 ,$201.71 ,$70.21 ,$117.37 ,$384.30 ,$95.13 ,$201.71 ,$201.71 ,$230.58 ,$466.65 ,$453.85 ,$505.08 ,$384.30 ,$549.00 ,$549.00 ,$334.34 ,$549.00 ,$379.36 ,$494.10 ,$382.38 ,$203.73 ,$433.71 ,$100.84 ,$451.00 ,$451.00 ,$201.71 ,$451.00 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$439.20 
ST NICHOLAS HOSPITAL - ACUTE,32000032,42400,HC BX GLAND SALIVARY NEEDLE,320,1 ,"$1,185.00 ",$592.50 ,$100.43 ,"$1,380.55 ",$288.55 ,$766.58 ,$766.58 ,$613.58 ,$711.00 ,"$1,007.25 ",$829.50 ,$288.55 ,"$1,125.75 ",$900.60 ,$888.75 ,$102.66 ,"$1,007.25 ",$613.58 ,$102.66 ,$100.43 ,$829.50 ,$288.55 ,$613.58 ,$613.58 ,$497.70 ,"$1,007.25 ","$1,380.55 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$619.72 ,$936.15 ,$305.86 ,$451.00 ,$451.00 ,$613.58 ,$451.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,32000033,42550,HC SIALOGRAM INJECTION,320,1 ,$428.00 ,$214.00 ,$95.13 ,$428.00 ,$95.13 ,$276.87 ,$276.87 , N/A ,$256.80 ,$363.80 ,$299.60 ,$95.13 ,$406.60 ,$325.28 ,$321.00 ,$120.85 ,$363.80 , N/A ,$120.85 ,$150.16 ,$299.60 ,$95.13 , N/A , N/A ,$179.76 ,$363.80 , N/A ,$393.76 ,$299.60 ,$428.00 ,$428.00 ,$260.65 ,$428.00 ,$295.75 ,$385.20 ,$298.10 , N/A ,$338.12 ,$100.84 ,$428.00 ,$428.00 , N/A ,$428.00 ,$308.16 ,$265.36 ,$308.16 ,$308.16 ,$342.40 
ST NICHOLAS HOSPITAL - ACUTE,32000034,43274,HC ERCP W/PLACE STENT,320,1 ,"$3,160.00 ","$1,580.00 ",$451.00 ,"$11,167.16 ","$1,349.46 ","$2,044.20 ","$2,044.20 ","$4,963.18 ","$1,896.00 ","$2,686.00 ","$2,212.00 ","$1,349.46 ","$3,002.00 ","$2,401.60 ","$2,370.00 ",$895.54 ,"$2,686.00 ","$4,963.18 ",$895.54 ,$452.81 ,"$2,212.00 ","$1,349.46 ","$4,963.18 ","$4,963.18 ","$1,327.20 ","$2,686.00 ","$11,167.16 ","$2,907.20 ","$2,212.00 ","$1,921.55 ","$2,401.67 ","$1,924.44 ","$2,401.67 ","$2,183.56 ","$2,844.00 ","$2,200.94 ","$5,012.81 ","$2,496.40 ","$1,430.43 ",$451.00 ,$451.00 ,"$4,963.18 ",$451.00 ,"$2,275.20 ","$1,959.20 ","$2,275.20 ","$2,275.20 ","$2,528.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$431.00 ,$215.50 ,$39.87 ,$602.10 ,$211.20 ,$278.81 ,$278.81 ,$267.60 ,$258.60 ,$366.35 ,$301.70 ,$211.20 ,$409.45 ,$327.56 ,$323.25 ,$78.06 ,$366.35 ,$267.60 ,$78.06 ,$39.87 ,$301.70 ,$211.20 ,$267.60 ,$267.60 ,$181.02 ,$366.35 ,$602.10 ,$396.52 ,$301.70 ,$431.00 ,$431.00 ,$262.48 ,$431.00 ,$297.82 ,$387.90 ,$300.19 ,$270.28 ,$340.49 ,$223.87 ,$431.00 ,$431.00 ,$267.60 ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,32000036,43761,HC REPOSITION G-TUBE,320,1 ,$905.00 ,$452.50 ,$62.73 ,$905.00 ,$62.73 ,$585.44 ,$585.44 ,$262.38 ,$543.00 ,$769.25 ,$633.50 ,$62.73 ,$859.75 ,$687.80 ,$678.75 ,$198.09 ,$769.25 ,$262.38 ,$198.09 ,$117.46 ,$633.50 ,$62.73 ,$262.38 ,$262.38 ,$380.10 ,$769.25 ,$590.35 ,$832.60 ,$633.50 ,$905.00 ,$905.00 ,$551.15 ,$905.00 ,$625.36 ,$814.50 ,$630.33 ,$265.00 ,$714.95 ,$66.49 ,$451.00 ,$451.00 ,$262.38 ,$451.00 ,$651.60 ,$561.10 ,$651.60 ,$651.60 ,$724.00 
ST NICHOLAS HOSPITAL - ACUTE,32000038,44500,HC INTRO TUBE GI LONG,320,1 ,$566.00 ,$283.00 ,$19.22 ,"$1,795.12 ",$211.20 ,$366.15 ,$366.15 ,$797.83 ,$339.60 ,$481.10 ,$396.20 ,$211.20 ,$537.70 ,$430.16 ,$424.50 ,$37.86 ,$481.10 ,$797.83 ,$37.86 ,$19.22 ,$396.20 ,$211.20 ,$797.83 ,$797.83 ,$237.72 ,$481.10 ,"$1,795.12 ",$520.72 ,$396.20 ,$566.00 ,$566.00 ,$344.69 ,$566.00 ,$391.11 ,$509.40 ,$394.22 ,$805.81 ,$447.14 ,$223.87 ,$451.00 ,$451.00 ,$797.83 ,$451.00 ,$407.52 ,$350.92 ,$407.52 ,$407.52 ,$452.80 
ST NICHOLAS HOSPITAL - ACUTE,32000043,47536,HC CHG PERC BIL DRAIN CATH,320,1 ,"$2,500.00 ","$1,250.00 ",$253.69 ,"$7,058.37 ",$791.20 ,"$1,617.25 ","$1,617.25 ","$3,137.05 ","$1,500.00 ","$2,125.00 ","$1,750.00 ",$791.20 ,"$2,375.00 ","$1,900.00 ","$1,875.00 ",$253.69 ,"$2,125.00 ","$3,137.05 ",$253.69 ,$679.22 ,"$1,750.00 ",$791.20 ,"$3,137.05 ","$3,137.05 ","$1,050.00 ","$2,125.00 ","$7,058.37 ","$2,300.00 ","$1,750.00 ","$1,921.55 ","$2,401.67 ","$1,522.50 ","$2,401.67 ","$1,727.50 ","$2,250.00 ","$1,741.25 ","$3,168.42 ","$1,975.00 ",$838.67 ,$451.00 ,$451.00 ,"$3,137.05 ",$451.00 ,"$1,800.00 ","$1,550.00 ","$1,800.00 ","$1,800.00 ","$2,000.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000044,47535,HC REVISE/REINSERT TUBE TRNSHEPAT,320,1 ,"$3,590.00 ","$1,795.00 ",$378.45 ,"$7,058.37 ",$791.20 ,"$2,322.37 ","$2,322.37 ","$3,137.05 ","$2,154.00 ","$3,051.50 ","$2,513.00 ",$791.20 ,"$3,410.50 ","$2,728.40 ","$2,692.50 ",$378.45 ,"$3,051.50 ","$3,137.05 ",$378.45 ,$965.06 ,"$2,513.00 ",$791.20 ,"$3,137.05 ","$3,137.05 ","$1,507.80 ","$3,051.50 ","$7,058.37 ","$3,302.80 ","$2,513.00 ","$1,921.55 ","$2,401.67 ","$2,186.31 ","$2,401.67 ","$2,480.69 ","$3,231.00 ","$2,500.44 ","$3,168.42 ","$2,836.10 ",$838.67 ,$451.00 ,$451.00 ,"$3,137.05 ",$451.00 ,"$2,584.80 ","$2,225.80 ","$2,584.80 ","$2,584.80 ","$2,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000045,47542,HC ENDO BILIARY W/DIL BILI DUCT,320,1 ,"$2,500.00 ","$1,250.00 ",$261.56 ,"$2,500.00 ",$791.20 ,"$1,617.25 ","$1,617.25 ", N/A ,"$1,500.00 ","$2,125.00 ","$1,750.00 ",$791.20 ,"$2,375.00 ","$1,900.00 ","$1,875.00 ",$261.56 ,"$2,125.00 ", N/A ,$261.56 ,$505.56 ,"$1,750.00 ",$791.20 , N/A , N/A ,"$1,050.00 ","$2,125.00 ", N/A ,"$2,300.00 ","$1,750.00 ","$1,921.55 ","$2,401.67 ","$1,522.50 ","$2,401.67 ","$1,727.50 ","$2,250.00 ","$1,741.25 ", N/A ,"$1,975.00 ",$838.67 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$1,800.00 ","$1,550.00 ","$1,800.00 ","$1,800.00 ","$2,000.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000046,47539,HC ENDO BILIARY DIL DUCT W/STENT,320,1 ,"$2,586.00 ","$1,293.00 ",$451.00 ,"$11,225.46 ",$791.20 ,"$1,672.88 ","$1,672.88 ","$4,989.09 ","$1,551.60 ","$2,198.10 ","$1,810.20 ",$791.20 ,"$2,456.70 ","$1,965.36 ","$1,939.50 ",$812.56 ,"$2,198.10 ","$4,989.09 ",$812.56 ,"$2,586.00 ","$1,810.20 ",$791.20 ,"$4,989.09 ","$4,989.09 ","$1,086.12 ","$2,198.10 ","$11,225.46 ","$2,379.12 ","$1,810.20 ","$4,794.94 ","$5,993.67 ","$1,574.87 ","$5,993.67 ","$1,786.93 ","$2,327.40 ","$1,801.15 ","$5,038.98 ","$2,042.94 ",$838.67 ,$451.00 ,$451.00 ,"$4,989.09 ",$451.00 ,"$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$2,068.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000049,49406,HC DRAIN ABSC PERITONEAL PERC,320,1 ,"$4,100.00 ","$2,050.00 ",$232.13 ,"$4,100.00 ",$232.13 ,"$2,652.29 ","$2,652.29 ","$1,387.33 ","$2,460.00 ","$3,485.00 ","$2,870.00 ",$232.13 ,"$3,895.00 ","$3,116.00 ","$3,075.00 ",$378.00 ,"$3,485.00 ","$1,387.33 ",$378.00 ,$860.35 ,"$2,870.00 ",$232.13 ,"$1,387.33 ","$1,387.33 ","$1,722.00 ","$3,485.00 ","$3,121.49 ","$3,772.00 ","$2,870.00 ","$1,921.55 ","$2,401.67 ","$2,496.90 ","$2,401.67 ","$2,833.10 ","$3,690.00 ","$2,855.65 ","$1,401.20 ","$3,239.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$3,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000051,49406,HC DRN ABSC RETROPERITONEAL PERC,320,1 ,"$4,369.00 ","$2,184.50 ",$232.13 ,"$4,369.00 ",$232.13 ,"$2,826.31 ","$2,826.31 ","$1,387.33 ","$2,621.40 ","$3,713.65 ","$3,058.30 ",$232.13 ,"$4,150.55 ","$3,320.44 ","$3,276.75 ",$378.00 ,"$3,713.65 ","$1,387.33 ",$378.00 ,$860.35 ,"$3,058.30 ",$232.13 ,"$1,387.33 ","$1,387.33 ","$1,834.98 ","$3,713.65 ","$3,121.49 ","$4,019.48 ","$3,058.30 ","$1,921.55 ","$2,401.67 ","$2,660.72 ","$2,401.67 ","$3,018.98 ","$3,932.10 ","$3,043.01 ","$1,401.20 ","$3,451.51 ",$246.06 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$3,145.68 ","$2,708.78 ","$3,145.68 ","$3,145.68 ","$3,495.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000052,49400,HC INJ PERITONEAL CAVITY,361,1 ,$558.00 ,$279.00 ,$95.13 ,$558.00 ,$95.13 ,$558.00 ,$558.00 , N/A ,$334.80 ,$474.30 ,$390.60 ,$95.13 ,$530.10 ,$424.08 ,$418.50 ,$558.00 ,$474.30 , N/A ,$558.00 ,$362.70 ,$390.60 ,$95.13 , N/A , N/A ,$558.00 ,$474.30 , N/A ,$513.36 ,$390.60 ,$558.00 ,$558.00 ,$339.82 ,$558.00 ,$385.58 ,$502.20 ,$388.65 , N/A ,$440.82 ,$100.84 ,$558.00 ,$558.00 , N/A ,$558.00 ,$401.76 ,$345.96 ,$401.76 ,$401.76 ,$446.40 
ST NICHOLAS HOSPITAL - ACUTE,32000053,49423,HC EXCHG CATH ABSC/CYST DRAIN,320,1 ,"$2,000.00 ","$1,000.00 ",$136.16 ,"$3,603.33 ",$232.13 ,"$1,293.80 ","$1,293.80 ","$1,601.48 ","$1,200.00 ","$1,700.00 ","$1,400.00 ",$232.13 ,"$1,900.00 ","$1,520.00 ","$1,500.00 ",$136.16 ,"$1,700.00 ","$1,601.48 ",$136.16 ,$581.52 ,"$1,400.00 ",$232.13 ,"$1,601.48 ","$1,601.48 ",$840.00 ,"$1,700.00 ","$3,603.33 ","$1,840.00 ","$1,400.00 ","$1,703.02 ","$2,000.00 ","$1,218.00 ","$2,000.00 ","$1,382.00 ","$1,800.00 ","$1,393.00 ","$1,617.49 ","$1,580.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,601.48 ",$451.00 ,"$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000054,49424,HC INJ CONTRAST ABSC/CYST,320,1 ,$762.00 ,$381.00 ,$72.98 ,$762.00 ,$95.13 ,$492.94 ,$492.94 , N/A ,$457.20 ,$647.70 ,$533.40 ,$95.13 ,$723.90 ,$579.12 ,$571.50 ,$72.98 ,$647.70 , N/A ,$72.98 ,$163.64 ,$533.40 ,$95.13 , N/A , N/A ,$320.04 ,$647.70 , N/A ,$701.04 ,$533.40 ,$762.00 ,$762.00 ,$464.06 ,$762.00 ,$526.54 ,$685.80 ,$530.73 , N/A ,$601.98 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,32000055,49427,HC INJ PREV PLACED SHUNT,320,1 ,$490.00 ,$245.00 ,$38.30 ,$490.00 ,$95.13 ,$316.98 ,$316.98 , N/A ,$294.00 ,$416.50 ,$343.00 ,$95.13 ,$465.50 ,$372.40 ,$367.50 ,$75.05 ,$416.50 , N/A ,$75.05 ,$38.30 ,$343.00 ,$95.13 , N/A , N/A ,$205.80 ,$416.50 , N/A ,$450.80 ,$343.00 ,$490.00 ,$490.00 ,$298.41 ,$490.00 ,$338.59 ,$441.00 ,$341.29 , N/A ,$387.10 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$352.80 ,$303.80 ,$352.80 ,$352.80 ,$392.00 
ST NICHOLAS HOSPITAL - ACUTE,32000056,49440,HC INSERT GASTRO TUBE FLUORO,320,1 ,"$1,831.00 ",$915.50 ,$211.20 ,"$3,603.33 ",$211.20 ,"$1,184.47 ","$1,184.47 ","$1,601.48 ","$1,098.60 ","$1,556.35 ","$1,281.70 ",$211.20 ,"$1,739.45 ","$1,391.56 ","$1,373.25 ",$392.58 ,"$1,556.35 ","$1,601.48 ",$392.58 ,$911.60 ,"$1,281.70 ",$211.20 ,"$1,601.48 ","$1,601.48 ",$769.02 ,"$1,556.35 ","$3,603.33 ","$1,684.52 ","$1,281.70 ","$1,831.00 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,647.90 ","$1,275.29 ","$1,617.49 ","$1,446.49 ",$223.87 ,$451.00 ,$451.00 ,"$1,601.48 ",$451.00 ,"$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,464.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000057,49441,HC INSERT DUODEN/JEJUN TBE FLUORO,320,1 ,"$3,189.00 ","$1,594.50 ",$211.20 ,"$3,603.33 ",$211.20 ,"$2,062.96 ","$2,062.96 ","$1,601.48 ","$1,913.40 ","$2,710.65 ","$2,232.30 ",$211.20 ,"$3,029.55 ","$2,423.64 ","$2,391.75 ",$456.92 ,"$2,710.65 ","$1,601.48 ",$456.92 ,"$1,029.63 ","$2,232.30 ",$211.20 ,"$1,601.48 ","$1,601.48 ","$1,339.38 ","$2,710.65 ","$3,603.33 ","$2,933.88 ","$2,232.30 ","$1,921.55 ","$2,401.67 ","$1,942.10 ","$2,401.67 ","$2,203.60 ","$2,870.10 ","$2,221.14 ","$1,617.49 ","$2,519.31 ",$223.87 ,$451.00 ,$451.00 ,"$1,601.48 ",$451.00 ,"$2,296.08 ","$1,977.18 ","$2,296.08 ","$2,296.08 ","$2,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000058,49442,HC INSERT CECOS/OTHR TBE FLUORO,320,1 ,"$3,017.00 ","$1,508.50 ",$401.51 ,"$3,017.00 ",$705.71 ,"$1,951.70 ","$1,951.70 ","$1,022.46 ","$1,810.20 ","$2,564.45 ","$2,111.90 ",$705.71 ,"$2,866.15 ","$2,292.92 ","$2,262.75 ",$401.51 ,"$2,564.45 ","$1,022.46 ",$401.51 ,$864.22 ,"$2,111.90 ",$705.71 ,"$1,022.46 ","$1,022.46 ","$1,267.14 ","$2,564.45 ","$2,300.53 ","$2,775.64 ","$2,111.90 ","$1,921.55 ","$2,401.67 ","$1,837.35 ","$2,401.67 ","$2,084.75 ","$2,715.30 ","$2,101.34 ","$1,032.68 ","$2,383.43 ",$748.05 ,$451.00 ,$451.00 ,"$1,022.46 ",$451.00 ,"$2,172.24 ","$1,870.54 ","$2,172.24 ","$2,172.24 ","$2,413.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000059,49446,HC CHG G-TB TO GJ-TB PERC FLUORO,320,1 ,"$2,047.00 ","$1,023.50 ",$211.20 ,"$3,603.33 ",$211.20 ,"$1,324.20 ","$1,324.20 ","$1,601.48 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$211.20 ,"$1,944.65 ","$1,555.72 ","$1,535.25 ",$283.78 ,"$1,739.95 ","$1,601.48 ",$283.78 ,$876.64 ,"$1,432.90 ",$211.20 ,"$1,601.48 ","$1,601.48 ",$859.74 ,"$1,739.95 ","$3,603.33 ","$1,883.24 ","$1,432.90 ","$1,921.55 ","$2,047.00 ","$1,246.62 ","$2,047.00 ","$1,414.48 ","$1,842.30 ","$1,425.74 ","$1,617.49 ","$1,617.13 ",$223.87 ,$451.00 ,$451.00 ,"$1,601.48 ",$451.00 ,"$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,637.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$2,429.00 ","$1,214.50 ",$126.40 ,"$2,429.00 ",$211.20 ,"$1,571.32 ","$1,571.32 ",$797.83 ,"$1,457.40 ","$2,064.65 ","$1,700.30 ",$211.20 ,"$2,307.55 ","$1,846.04 ","$1,821.75 ",$126.40 ,"$2,064.65 ",$797.83 ,$126.40 ,$642.30 ,"$1,700.30 ",$211.20 ,$797.83 ,$797.83 ,"$1,020.18 ","$2,064.65 ","$1,795.12 ","$2,234.68 ","$1,700.30 ","$1,703.02 ","$2,128.52 ","$1,479.26 ","$2,128.52 ","$1,678.44 ","$2,186.10 ","$1,691.80 ",$805.81 ,"$1,918.91 ",$223.87 ,$451.00 ,$451.00 ,$797.83 ,$451.00 ,"$1,748.88 ","$1,505.98 ","$1,748.88 ","$1,748.88 ","$1,943.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000061,49451,HC RPLC DUODEN/JEJUN TB FLUORO,320,1 ,"$1,293.00 ",$646.50 ,$171.95 ,"$1,795.12 ",$211.20 ,$836.44 ,$836.44 ,$797.83 ,$775.80 ,"$1,099.05 ",$905.10 ,$211.20 ,"$1,228.35 ",$982.68 ,$969.75 ,$171.95 ,"$1,099.05 ",$797.83 ,$171.95 ,$695.60 ,$905.10 ,$211.20 ,$797.83 ,$797.83 ,$543.06 ,"$1,099.05 ","$1,795.12 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,$805.81 ,"$1,021.47 ",$223.87 ,$451.00 ,$451.00 ,$797.83 ,$451.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000062,49452,HC RPLC GASTRO-JEJUN TB FLUORO,361,1 ,"$1,185.00 ",$592.50 ,$211.20 ,"$1,795.12 ",$211.20 ,"$1,185.00 ","$1,185.00 ",$797.83 ,$711.00 ,"$1,007.25 ",$829.50 ,$211.20 ,"$1,125.75 ",$900.60 ,$888.75 ,"$1,185.00 ","$1,007.25 ",$797.83 ,"$1,185.00 ",$770.25 ,$829.50 ,$211.20 ,$797.83 ,$797.83 ,"$1,185.00 ","$1,007.25 ","$1,795.12 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$805.81 ,$936.15 ,$223.87 ,"$1,185.00 ","$1,185.00 ",$797.83 ,"$1,185.00 ",$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$474.00 ,$237.00 ,$37.92 ,$510.48 ,$37.92 ,$306.63 ,$306.63 ,$226.88 ,$284.40 ,$402.90 ,$331.80 ,$37.92 ,$450.30 ,$360.24 ,$355.50 ,$59.06 ,$402.90 ,$226.88 ,$59.06 ,$148.65 ,$331.80 ,$37.92 ,$226.88 ,$226.88 ,$199.08 ,$402.90 ,$510.48 ,$436.08 ,$331.80 ,$474.00 ,$474.00 ,$288.67 ,$474.00 ,$327.53 ,$426.60 ,$330.14 ,$229.15 ,$374.46 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,32000065,49999,HC ABD/PERITONEUM/OMNTM UNLSTD,320,1 ,"$2,400.00 ","$1,200.00 ",$232.13 ,"$2,400.00 ",$232.13 ,"$1,552.56 ","$1,552.56 ",$797.83 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$232.13 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ", N/A ,"$2,040.00 ",$797.83 , N/A , N/A ,"$1,680.00 ",$232.13 ,$797.83 ,$797.83 ,"$1,008.00 ","$2,040.00 ","$1,795.12 ","$2,208.00 ","$1,680.00 ","$1,217.28 ","$1,460.88 ","$1,461.60 ","$1,460.88 ","$1,658.40 ","$2,160.00 ","$1,671.60 ",$805.81 ,"$1,896.00 ",$246.06 ,$451.00 ,$451.00 ,$797.83 ,$451.00 ,"$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000066,49405,HC DRN ABSC PERIRENAL  PERC,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,121.49 ",$232.13 ,$905.66 ,$905.66 ,"$1,387.33 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$378.66 ,"$1,190.00 ","$1,387.33 ",$378.66 ,$860.46 ,$980.00 ,$232.13 ,"$1,387.33 ","$1,387.33 ",$588.00 ,"$1,190.00 ","$3,121.49 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,260.00 ",$975.10 ,"$1,401.20 ","$1,106.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000067,50382,HC CHANGE URETERAL STENT PERCU,320,1 ,"$3,986.00 ","$1,993.00 ",$451.00 ,"$3,986.00 ",$474.08 ,"$2,578.54 ","$2,578.54 ","$1,765.45 ","$2,391.60 ","$3,388.10 ","$2,790.20 ",$474.08 ,"$3,786.70 ","$3,029.36 ","$2,989.50 ",$487.86 ,"$3,388.10 ","$1,765.45 ",$487.86 ,"$1,071.82 ","$2,790.20 ",$474.08 ,"$1,765.45 ","$1,765.45 ","$1,674.12 ","$3,388.10 ","$3,972.27 ","$3,667.12 ","$2,790.20 ","$1,703.02 ","$2,128.52 ","$2,427.47 ","$2,128.52 ","$2,754.33 ","$3,587.40 ","$2,776.25 ","$1,783.10 ","$3,148.94 ",$502.52 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$2,869.92 ","$2,471.32 ","$2,869.92 ","$2,869.92 ","$3,188.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000068,50384,HC REM URETERAL STENT PERCU,320,1 ,"$2,801.00 ","$1,400.50 ",$437.78 ,"$3,972.27 ",$474.08 ,"$1,811.97 ","$1,811.97 ","$1,765.45 ","$1,680.60 ","$2,380.85 ","$1,960.70 ",$474.08 ,"$2,660.95 ","$2,128.76 ","$2,100.75 ",$437.78 ,"$2,380.85 ","$1,765.45 ",$437.78 ,$875.22 ,"$1,960.70 ",$474.08 ,"$1,765.45 ","$1,765.45 ","$1,176.42 ","$2,380.85 ","$3,972.27 ","$2,576.92 ","$1,960.70 ","$1,703.02 ","$2,128.52 ","$1,705.81 ","$2,128.52 ","$1,935.49 ","$2,520.90 ","$1,950.90 ","$1,783.10 ","$2,212.79 ",$502.52 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$2,016.72 ","$1,736.62 ","$2,016.72 ","$2,016.72 ","$2,240.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000069,50385,HC URETERAL STENT CHNG USING SNARE,320,1 ,"$3,500.00 ","$1,750.00 ",$416.77 ,"$3,972.27 ",$474.08 ,"$2,264.15 ","$2,264.15 ","$1,765.45 ","$2,100.00 ","$2,975.00 ","$2,450.00 ",$474.08 ,"$3,325.00 ","$2,660.00 ","$2,625.00 ",$416.77 ,"$2,975.00 ","$1,765.45 ",$416.77 ,"$1,052.85 ","$2,450.00 ",$474.08 ,"$1,765.45 ","$1,765.45 ","$1,470.00 ","$2,975.00 ","$3,972.27 ","$3,220.00 ","$2,450.00 ","$1,703.02 ","$2,128.52 ","$2,131.50 ","$2,128.52 ","$2,418.50 ","$3,150.00 ","$2,437.75 ","$1,783.10 ","$2,765.00 ",$502.52 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$2,520.00 ","$2,170.00 ","$2,520.00 ","$2,520.00 ","$2,800.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000070,50386,HC URETERAL STENT REMOVAL USNG SNARE,320,1 ,"$1,500.00 ",$750.00 ,$310.39 ,"$3,972.27 ",$474.08 ,$970.35 ,$970.35 ,"$1,765.45 ",$900.00 ,"$1,275.00 ","$1,050.00 ",$474.08 ,"$1,425.00 ","$1,140.00 ","$1,125.00 ",$310.39 ,"$1,275.00 ","$1,765.45 ",$310.39 ,$720.92 ,"$1,050.00 ",$474.08 ,"$1,765.45 ","$1,765.45 ",$630.00 ,"$1,275.00 ","$3,972.27 ","$1,380.00 ","$1,050.00 ","$1,500.00 ","$1,500.00 ",$913.50 ,"$1,500.00 ","$1,036.50 ","$1,350.00 ","$1,044.75 ","$1,783.10 ","$1,185.00 ",$502.52 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ","$1,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000071,50387,HC CHANGE EXT/INT URET STENT,320,1 ,"$2,187.00 ","$1,093.50 ",$161.13 ,"$3,972.27 ",$474.08 ,"$1,414.77 ","$1,414.77 ","$1,765.45 ","$1,312.20 ","$1,858.95 ","$1,530.90 ",$474.08 ,"$2,077.65 ","$1,662.12 ","$1,640.25 ",$161.13 ,"$1,858.95 ","$1,765.45 ",$161.13 ,$534.80 ,"$1,530.90 ",$474.08 ,"$1,765.45 ","$1,765.45 ",$918.54 ,"$1,858.95 ","$3,972.27 ","$2,012.04 ","$1,530.90 ","$1,703.02 ","$2,128.52 ","$1,331.88 ","$2,128.52 ","$1,511.22 ","$1,968.30 ","$1,523.25 ","$1,783.10 ","$1,727.73 ",$502.52 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$1,574.64 ","$1,355.94 ","$1,574.64 ","$1,574.64 ","$1,749.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000072,50389,HC REM NEPHRO TUBE FLUORO,320,1 ,"$1,000.00 ",$500.00 ,$102.85 ,"$1,276.32 ",$119.36 ,$646.90 ,$646.90 ,$567.25 ,$600.00 ,$850.00 ,$700.00 ,$119.36 ,$950.00 ,$760.00 ,$750.00 ,$102.85 ,$850.00 ,$567.25 ,$102.85 ,$366.11 ,$700.00 ,$119.36 ,$567.25 ,$567.25 ,$420.00 ,$850.00 ,"$1,276.32 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$900.00 ,$696.50 ,$572.92 ,$790.00 ,$126.52 ,$451.00 ,$451.00 ,$567.25 ,$451.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$3,017.00 ","$1,508.50 ",$392.53 ,"$6,820.92 ",$924.12 ,"$1,951.70 ","$1,951.70 ","$3,031.52 ","$1,810.20 ","$2,564.45 ","$2,111.90 ",$924.12 ,"$2,866.15 ","$2,292.92 ","$2,262.75 ",$392.53 ,"$2,564.45 ","$3,031.52 ",$392.53 ,"$1,015.76 ","$2,111.90 ",$924.12 ,"$3,031.52 ","$3,031.52 ","$1,267.14 ","$2,564.45 ","$6,820.92 ","$2,775.64 ","$2,111.90 ","$1,703.02 ","$2,128.52 ","$1,837.35 ","$2,128.52 ","$2,084.75 ","$2,715.30 ","$2,101.34 ","$3,061.84 ","$2,383.43 ",$979.57 ,$451.00 ,$451.00 ,"$3,031.52 ",$451.00 ,"$2,172.24 ","$1,870.54 ","$2,172.24 ","$2,172.24 ","$2,413.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$4,526.00 ","$2,263.00 ",$392.53 ,"$6,820.92 ","$1,386.17 ","$2,927.87 ","$2,927.87 ","$3,031.52 ","$2,715.60 ","$3,847.10 ","$3,168.20 ","$1,386.17 ","$4,299.70 ","$3,439.76 ","$3,394.50 ",$392.53 ,"$3,847.10 ","$3,031.52 ",$392.53 ,"$1,015.76 ","$3,168.20 ","$1,386.17 ","$3,031.52 ","$3,031.52 ","$1,900.92 ","$3,847.10 ","$6,820.92 ","$4,163.92 ","$3,168.20 ","$2,554.53 ","$3,192.78 ","$2,756.33 ","$3,192.78 ","$3,127.47 ","$4,073.40 ","$3,152.36 ","$3,061.84 ","$3,575.54 ","$1,469.34 ",$451.00 ,$451.00 ,"$3,031.52 ",$451.00 ,"$3,258.72 ","$2,806.12 ","$3,258.72 ","$3,258.72 ","$3,620.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000078,50396,HC MANOMETRIC STUDIES-NEPHROSTOMY,320,1 ,$776.00 ,$388.00 ,$115.30 ,"$1,276.32 ",$119.36 ,$501.99 ,$501.99 ,$567.25 ,$465.60 ,$659.60 ,$543.20 ,$119.36 ,$737.20 ,$589.76 ,$582.00 ,$226.24 ,$659.60 ,$567.25 ,$226.24 ,$115.30 ,$543.20 ,$119.36 ,$567.25 ,$567.25 ,$325.92 ,$659.60 ,"$1,276.32 ",$713.92 ,$543.20 ,$776.00 ,$776.00 ,$472.58 ,$776.00 ,$536.22 ,$698.40 ,$540.48 ,$572.92 ,$613.04 ,$126.52 ,$451.00 ,$451.00 ,$567.25 ,$451.00 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$620.80 
ST NICHOLAS HOSPITAL - ACUTE,32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$4,201.00 ","$2,100.50 ",$192.37 ,"$4,201.00 ",$711.12 ,"$2,717.63 ","$2,717.63 ","$1,765.45 ","$2,520.60 ","$3,570.85 ","$2,940.70 ",$711.12 ,"$3,990.95 ","$3,192.76 ","$3,150.75 ",$192.37 ,"$3,570.85 ","$1,765.45 ",$192.37 ,$548.97 ,"$2,940.70 ",$711.12 ,"$1,765.45 ","$1,765.45 ","$1,764.42 ","$3,570.85 ","$3,972.27 ","$3,864.92 ","$2,940.70 ","$2,554.53 ","$3,192.78 ","$2,558.41 ","$3,192.78 ","$2,902.89 ","$3,780.90 ","$2,926.00 ","$1,783.10 ","$3,318.79 ",$753.79 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$3,024.72 ","$2,604.62 ","$3,024.72 ","$3,024.72 ","$3,360.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$2,801.00 ","$1,400.50 ",$192.37 ,"$3,972.27 ",$474.08 ,"$1,811.97 ","$1,811.97 ","$1,765.45 ","$1,680.60 ","$2,380.85 ","$1,960.70 ",$474.08 ,"$2,660.95 ","$2,128.76 ","$2,100.75 ",$192.37 ,"$2,380.85 ","$1,765.45 ",$192.37 ,$548.97 ,"$1,960.70 ",$474.08 ,"$1,765.45 ","$1,765.45 ","$1,176.42 ","$2,380.85 ","$3,972.27 ","$2,576.92 ","$1,960.70 ","$1,703.02 ","$2,128.52 ","$1,705.81 ","$2,128.52 ","$1,935.49 ","$2,520.90 ","$1,950.90 ","$1,783.10 ","$2,212.79 ",$502.52 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$2,016.72 ","$1,736.62 ","$2,016.72 ","$2,016.72 ","$2,240.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000080,50553,HC ENDO RENAL ESTAB W/CATH,320,1 ,"$3,375.00 ","$1,687.50 ",$375.21 ,"$9,787.87 ",$924.12 ,"$2,183.29 ","$2,183.29 ","$4,350.17 ","$2,025.00 ","$2,868.75 ","$2,362.50 ",$924.12 ,"$3,206.25 ","$2,565.00 ","$2,531.25 ",$600.40 ,"$2,868.75 ","$4,350.17 ",$600.40 ,$375.21 ,"$2,362.50 ",$924.12 ,"$4,350.17 ","$4,350.17 ","$1,417.50 ","$2,868.75 ","$9,787.87 ","$3,105.00 ","$2,362.50 ","$1,703.02 ","$2,128.52 ","$2,055.38 ","$2,128.52 ","$2,332.13 ","$3,037.50 ","$2,350.69 ","$4,393.67 ","$2,666.25 ",$979.57 ,$451.00 ,$451.00 ,"$4,350.17 ",$451.00 ,"$2,430.00 ","$2,092.50 ","$2,430.00 ","$2,430.00 ","$2,700.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000083,50690,HC INJ ILEAL CONDUIT,320,1 ,$616.00 ,$308.00 ,$95.13 ,$616.00 ,$95.13 ,$398.49 ,$398.49 , N/A ,$369.60 ,$523.60 ,$431.20 ,$95.13 ,$585.20 ,$468.16 ,$462.00 ,$134.73 ,$523.60 , N/A ,$134.73 ,$105.48 ,$431.20 ,$95.13 , N/A , N/A ,$258.72 ,$523.60 , N/A ,$566.72 ,$431.20 ,$616.00 ,$616.00 ,$375.14 ,$616.00 ,$425.66 ,$554.40 ,$429.04 , N/A ,$486.64 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$492.80 
ST NICHOLAS HOSPITAL - ACUTE,32000085,51600,HC INJ CYSTOGRAM,320,1 ,$526.00 ,$263.00 ,$85.03 ,$526.00 ,$95.13 ,$340.27 ,$340.27 , N/A ,$315.60 ,$447.10 ,$368.20 ,$95.13 ,$499.70 ,$399.76 ,$394.50 ,$85.03 ,$447.10 , N/A ,$85.03 ,$200.97 ,$368.20 ,$95.13 , N/A , N/A ,$220.92 ,$447.10 , N/A ,$483.92 ,$368.20 ,$526.00 ,$526.00 ,$320.33 ,$526.00 ,$363.47 ,$473.40 ,$366.36 , N/A ,$415.54 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$420.80 
ST NICHOLAS HOSPITAL - ACUTE,32000086,51610,HC INJ URETHROCYSTOGRAM RETRO,320,1 ,$571.00 ,$285.50 ,$95.13 ,$571.00 ,$95.13 ,$369.38 ,$369.38 , N/A ,$342.60 ,$485.35 ,$399.70 ,$95.13 ,$542.45 ,$433.96 ,$428.25 ,$123.57 ,$485.35 , N/A ,$123.57 ,$116.92 ,$399.70 ,$95.13 , N/A , N/A ,$239.82 ,$485.35 , N/A ,$525.32 ,$399.70 ,$571.00 ,$571.00 ,$347.74 ,$571.00 ,$394.56 ,$513.90 ,$397.70 , N/A ,$451.09 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$456.80 
ST NICHOLAS HOSPITAL - ACUTE,32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,$571.00 ,$285.50 ,$95.13 ,$571.00 ,$95.13 ,$369.38 ,$369.38 , N/A ,$342.60 ,$485.35 ,$399.70 ,$95.13 ,$542.45 ,$433.96 ,$428.25 ,$109.06 ,$485.35 , N/A ,$109.06 ,$188.30 ,$399.70 ,$95.13 , N/A , N/A ,$239.82 ,$485.35 , N/A ,$525.32 ,$399.70 ,$571.00 ,$571.00 ,$347.74 ,$571.00 ,$394.56 ,$513.90 ,$397.70 , N/A ,$451.09 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$456.80 
ST NICHOLAS HOSPITAL - ACUTE,32000089,61070,HC PUNCT ASP/INJ SHUNT TUBE,320,1 ,$873.00 ,$436.50 ,$54.07 ,"$1,408.74 ",$136.73 ,$564.74 ,$564.74 ,$626.11 ,$523.80 ,$742.05 ,$611.10 ,$136.73 ,$829.35 ,$663.48 ,$654.75 ,$107.48 ,$742.05 ,$626.11 ,$107.48 ,$54.07 ,$611.10 ,$136.73 ,$626.11 ,$626.11 ,$366.66 ,$742.05 ,"$1,408.74 ",$803.16 ,$611.10 ,$873.00 ,$873.00 ,$531.66 ,$873.00 ,$603.24 ,$785.70 ,$608.04 ,$632.37 ,$689.67 ,$144.93 ,$451.00 ,$451.00 ,$626.11 ,$451.00 ,$628.56 ,$541.26 ,$628.56 ,$628.56 ,$698.40 
ST NICHOLAS HOSPITAL - ACUTE,32000090,62272,HC LUMBAR PUNCTURE DRAIN,320,1 ,$894.00 ,$447.00 ,$164.39 ,"$1,408.74 ",$268.66 ,$578.33 ,$578.33 ,$626.11 ,$536.40 ,$759.90 ,$625.80 ,$268.66 ,$849.30 ,$679.44 ,$670.50 ,$164.39 ,$759.90 ,$626.11 ,$164.39 ,$174.45 ,$625.80 ,$268.66 ,$626.11 ,$626.11 ,$375.48 ,$759.90 ,"$1,408.74 ",$822.48 ,$625.80 ,$894.00 ,$894.00 ,$544.45 ,$894.00 ,$617.75 ,$804.60 ,$622.67 ,$632.37 ,$706.26 ,$284.78 ,$451.00 ,$451.00 ,$626.11 ,$451.00 ,$643.68 ,$554.28 ,$643.68 ,$643.68 ,$715.20 
ST NICHOLAS HOSPITAL - ACUTE,32000091,62284,HC INJ MYELOGRAM,320,1 ,$930.00 ,$465.00 ,$95.13 ,$930.00 ,$95.13 ,$601.62 ,$601.62 , N/A ,$558.00 ,$790.50 ,$651.00 ,$95.13 ,$883.50 ,$706.80 ,$697.50 ,$163.82 ,$790.50 , N/A ,$163.82 ,$192.61 ,$651.00 ,$95.13 , N/A , N/A ,$390.60 ,$790.50 , N/A ,$855.60 ,$651.00 ,$930.00 ,$930.00 ,$566.37 ,$930.00 ,$642.63 ,$837.00 ,$647.75 , N/A ,$734.70 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$669.60 ,$576.60 ,$669.60 ,$669.60 ,$744.00 
ST NICHOLAS HOSPITAL - ACUTE,32000093,62290,HC INJ DISKOGRAM LUMBAR EA LEVEL,320,1 ,"$1,904.00 ",$952.00 ,$95.13 ,"$1,904.00 ",$95.13 ,"$1,231.70 ","$1,231.70 ", N/A ,"$1,142.40 ","$1,618.40 ","$1,332.80 ",$95.13 ,"$1,808.80 ","$1,447.04 ","$1,428.00 ",$313.38 ,"$1,618.40 ", N/A ,$313.38 ,$344.42 ,"$1,332.80 ",$95.13 , N/A , N/A ,$799.68 ,"$1,618.40 ", N/A ,"$1,751.68 ","$1,332.80 ","$1,703.02 ","$1,904.00 ","$1,159.54 ","$1,904.00 ","$1,315.66 ","$1,713.60 ","$1,326.14 ", N/A ,"$1,504.16 ",$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,523.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000094,62291,HC INJ DISKOGRAM CERVICAL EA LVL,320,1 ,"$1,176.00 ",$588.00 ,$95.13 ,"$1,176.00 ",$95.13 ,$760.75 ,$760.75 , N/A ,$705.60 ,$999.60 ,$823.20 ,$95.13 ,"$1,117.20 ",$893.76 ,$882.00 ,$290.55 ,$999.60 , N/A ,$290.55 ,$326.32 ,$823.20 ,$95.13 , N/A , N/A ,$493.92 ,$999.60 , N/A ,"$1,081.92 ",$823.20 ,"$1,176.00 ","$1,176.00 ",$716.18 ,"$1,176.00 ",$812.62 ,"$1,058.40 ",$819.08 , N/A ,$929.04 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$846.72 ,$729.12 ,$846.72 ,$846.72 ,$940.80 
ST NICHOLAS HOSPITAL - ACUTE,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$280.00 ,$140.00 ,$17.98 ,$280.00 ,$17.98 ,$90.58 ,$80.52 ,$79.76 ,$168.00 ,$238.00 ,$196.00 ,$17.98 ,$266.00 ,$212.80 ,$210.00 ,$47.01 ,$238.00 ,$79.76 ,$47.01 ,$21.35 ,$196.00 ,$17.98 ,$79.76 ,$79.76 ,$117.60 ,$238.00 ,$179.45 ,$257.60 ,$196.00 ,$207.78 ,$207.78 ,$170.52 ,$207.78 ,$193.48 ,$252.00 ,$195.02 ,$80.56 ,$221.20 ,$19.06 ,$280.00 ,$280.00 ,$79.76 ,$280.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,32000099,70030,HC FOREIGN BODY EYE BOTH,320,1 ,$280.00 ,$140.00 ,$17.98 ,$280.00 ,$17.98 ,$90.58 ,$80.52 ,$79.76 ,$168.00 ,$238.00 ,$196.00 ,$17.98 ,$266.00 ,$212.80 ,$210.00 ,$47.01 ,$238.00 ,$79.76 ,$47.01 ,$21.35 ,$196.00 ,$17.98 ,$79.76 ,$79.76 ,$117.60 ,$238.00 ,$179.45 ,$257.60 ,$196.00 ,$207.78 ,$207.78 ,$170.52 ,$207.78 ,$193.48 ,$252.00 ,$195.02 ,$80.56 ,$221.20 ,$19.06 ,$280.00 ,$280.00 ,$79.76 ,$280.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$118.52 ,$105.35 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$63.69 ,$390.15 ,$107.35 ,$63.69 ,$28.20 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$329.30 ,$329.30 ,$279.53 ,$329.30 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$172.84 ,$153.63 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$92.43 ,$314.50 ,$107.35 ,$92.43 ,$40.53 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$87.48 ,$77.76 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$44.32 ,$314.50 ,$79.76 ,$44.32 ,$19.98 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$130.93 ,$116.38 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$69.72 ,$390.15 ,$107.35 ,$69.72 ,$30.94 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$329.30 ,$329.30 ,$279.53 ,$329.30 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$110.76 ,$98.45 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$59.02 ,$314.50 ,$79.76 ,$59.02 ,$26.14 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$129.38 ,$115.01 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$69.70 ,$390.15 ,$107.35 ,$69.70 ,$30.94 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$207.78 ,$207.78 ,$279.53 ,$207.78 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$98.34 ,$87.41 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.66 ,$314.50 ,$79.76 ,$47.66 ,$21.01 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$113.86 ,$101.21 ,$79.76 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$54.35 ,$390.15 ,$79.76 ,$54.35 ,$24.09 ,$321.30 ,$17.98 ,$79.76 ,$79.76 ,$192.78 ,$390.15 ,$179.45 ,$422.28 ,$321.30 ,$207.78 ,$207.78 ,$279.53 ,$207.78 ,$317.17 ,$413.10 ,$319.69 ,$80.56 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000109,70240,HC SELLA TURCICA,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.66 ,$314.50 ,$79.76 ,$47.66 ,$22.38 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$53.69 ,$314.50 ,$107.35 ,$53.69 ,$24.09 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$129.38 ,$115.01 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$62.36 ,$390.15 ,$107.35 ,$62.36 ,$28.20 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$329.30 ,$329.30 ,$279.53 ,$329.30 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$160.42 ,$142.60 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$83.74 ,$314.50 ,$79.76 ,$83.74 ,$37.45 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000114,70336,HC MRI TMJ,320,1 ,"$3,360.00 ","$1,680.00 ",$79.99 ,"$3,360.00 ",$79.99 ,"$1,048.74 ",$932.21 ,$226.88 ,"$2,016.00 ","$2,856.00 ","$2,352.00 ",$79.99 ,"$3,192.00 ","$2,553.60 ","$2,520.00 ",$422.77 ,"$2,856.00 ",$226.88 ,$422.77 ,$224.90 ,"$2,352.00 ",$79.99 ,$226.88 ,$226.88 ,"$1,411.20 ","$2,856.00 ",$510.48 ,"$3,091.20 ","$2,352.00 ","$1,068.02 ","$1,068.02 ","$2,046.24 ","$1,068.02 ","$2,321.76 ","$3,024.00 ","$2,340.24 ",$229.15 ,"$2,654.40 ",$84.79 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000115,70355,HC XRAY PAN MANDIBLE/MAXLA,320,1 ,$370.00 ,$185.00 ,$7.99 ,$370.00 ,$17.98 ,$37.81 ,$33.61 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$15.58 ,$314.50 ,$79.76 ,$15.58 ,$7.99 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$154.46 ,$154.46 ,$225.33 ,$154.46 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$45.00 ,$314.50 ,$79.76 ,$45.00 ,$20.32 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000120,70390,HC XRAY SIALOGRAPHY,320,1 ,$622.00 ,$311.00 ,$37.92 ,$622.00 ,$37.92 ,$365.29 ,$324.70 ,$226.88 ,$373.20 ,$528.70 ,$435.40 ,$37.92 ,$590.90 ,$472.72 ,$466.50 ,$204.69 ,$528.70 ,$226.88 ,$204.69 ,$89.51 ,$435.40 ,$37.92 ,$226.88 ,$226.88 ,$261.24 ,$528.70 ,$510.48 ,$572.24 ,$435.40 ,$622.00 ,$622.00 ,$378.80 ,$622.00 ,$429.80 ,$559.80 ,$433.22 ,$229.15 ,$491.38 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$447.84 ,$385.64 ,$447.84 ,$447.84 ,$497.60 
ST NICHOLAS HOSPITAL - ACUTE,32000121,71045,HC XR CHEST 1V,320,1 ,$321.00 ,$160.50 ,$15.53 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$33.64 ,$272.85 ,$79.76 ,$33.64 ,$15.53 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000122,71045,HC XR CHEST 1V OR,320,1 ,$321.00 ,$160.50 ,$15.53 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$33.64 ,$272.85 ,$79.76 ,$33.64 ,$15.53 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000124,71045,HC XR CHEST 1V EMPLOYEE,320,1 ,$321.00 ,$160.50 ,$15.53 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$33.64 ,$272.85 ,$79.76 ,$33.64 ,$15.53 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000125,71045,HC XR CHEST 1V PORTABLE,320,1 ,$321.00 ,$160.50 ,$15.53 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$33.64 ,$272.85 ,$79.76 ,$33.64 ,$15.53 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000126,71045,HC XR CHEST 1V INFANT,320,1 ,$321.00 ,$160.50 ,$15.53 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$33.64 ,$272.85 ,$79.76 ,$33.64 ,$15.53 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000127,71046,HC XR CHEST 2V,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$89.03 ,$79.14 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$45.65 ,$272.85 ,$79.76 ,$45.65 ,$20.66 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000128,71046,HC XR CHEST 2V CORPORATE,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$89.03 ,$79.14 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$45.65 ,$272.85 ,$79.76 ,$45.65 ,$20.66 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000129,71046,HC XR CHEST 2V PORTABLE,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$89.03 ,$79.14 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$45.65 ,$272.85 ,$79.76 ,$45.65 ,$20.66 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$110.76 ,$98.45 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$58.34 ,$272.85 ,$79.76 ,$58.34 ,$26.14 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000133,71048,HC XR CHEST 4+V,320,1 ,$439.00 ,$219.50 ,$17.98 ,$439.00 ,$17.98 ,$115.41 ,$102.59 ,$107.35 ,$263.40 ,$373.15 ,$307.30 ,$17.98 ,$417.05 ,$333.64 ,$329.25 ,$62.36 ,$373.15 ,$107.35 ,$62.36 ,$27.17 ,$307.30 ,$17.98 ,$107.35 ,$107.35 ,$184.38 ,$373.15 ,$241.53 ,$403.88 ,$307.30 ,$425.70 ,$425.70 ,$267.35 ,$425.70 ,$303.35 ,$395.10 ,$305.76 ,$108.42 ,$346.81 ,$19.06 ,$439.00 ,$439.00 ,$107.35 ,$439.00 ,$316.08 ,$272.18 ,$316.08 ,$316.08 ,$351.20 
ST NICHOLAS HOSPITAL - ACUTE,32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$89.03 ,$79.14 ,$79.76 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$243.96 ,$240.75 ,$45.65 ,$272.85 ,$79.76 ,$45.65 ,$20.66 ,$224.70 ,$17.98 ,$79.76 ,$79.76 ,$134.82 ,$272.85 ,$179.45 ,$295.32 ,$224.70 ,$222.69 ,$222.69 ,$195.49 ,$222.69 ,$221.81 ,$288.90 ,$223.58 ,$80.56 ,$253.59 ,$19.06 ,$321.00 ,$321.00 ,$79.76 ,$321.00 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$256.80 
ST NICHOLAS HOSPITAL - ACUTE,32000137,71100,HC XR RIBS 2V UNI,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$99.89 ,$88.79 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$51.66 ,$314.50 ,$79.76 ,$51.66 ,$23.06 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$560.00 ,$280.00 ,$17.98 ,$560.00 ,$17.98 ,$110.76 ,$98.45 ,$107.35 ,$336.00 ,$476.00 ,$392.00 ,$17.98 ,$532.00 ,$425.60 ,$420.00 ,$58.34 ,$476.00 ,$107.35 ,$58.34 ,$26.14 ,$392.00 ,$17.98 ,$107.35 ,$107.35 ,$235.20 ,$476.00 ,$241.53 ,$515.20 ,$392.00 ,$329.30 ,$329.30 ,$341.04 ,$329.30 ,$386.96 ,$504.00 ,$390.04 ,$108.42 ,$442.40 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$113.86 ,$101.21 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$59.70 ,$390.15 ,$107.35 ,$59.70 ,$26.83 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$329.30 ,$329.30 ,$279.53 ,$329.30 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$560.00 ,$280.00 ,$17.98 ,$560.00 ,$17.98 ,$140.24 ,$124.66 ,$107.35 ,$336.00 ,$476.00 ,$392.00 ,$17.98 ,$532.00 ,$425.60 ,$420.00 ,$74.39 ,$476.00 ,$107.35 ,$74.39 ,$33.34 ,$392.00 ,$17.98 ,$107.35 ,$107.35 ,$235.20 ,$476.00 ,$241.53 ,$515.20 ,$392.00 ,$329.30 ,$329.30 ,$341.04 ,$329.30 ,$386.96 ,$504.00 ,$390.04 ,$108.42 ,$442.40 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000141,71120,HC XR STERNUM 2+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$90.58 ,$80.52 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$48.32 ,$314.50 ,$79.76 ,$48.32 ,$21.35 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$113.86 ,$101.21 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$61.71 ,$314.50 ,$79.76 ,$61.71 ,$27.17 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,057.81 ","$1,057.81 ","$1,583.40 ","$1,057.81 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,677.50 ",$510.48 ,"$2,898.00 ","$2,205.00 ","$1,068.02 ","$1,068.02 ","$1,918.35 ","$1,068.02 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$229.15 ,"$2,488.50 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$705.42 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$705.42 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$705.42 ,$705.42 ,"$1,422.18 ","$2,677.50 ","$1,587.19 ","$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$712.47 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$705.42 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$392.00 ,$196.00 ,$15.18 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$32.94 ,$333.20 ,$79.76 ,$32.94 ,$15.18 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000156,72020,HC XR C-SPINE 1V,320,1 ,$392.00 ,$196.00 ,$15.18 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$32.94 ,$333.20 ,$79.76 ,$32.94 ,$15.18 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000157,72020,HC XR SPINE 1V (L SPINE/ T SPINE) OR,320,1 ,$392.00 ,$196.00 ,$15.18 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$32.94 ,$333.20 ,$79.76 ,$32.94 ,$15.18 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000158,72020,HC XR SPINE 1V (C SPINE/L SPINE),320,1 ,$392.00 ,$196.00 ,$15.18 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$32.94 ,$333.20 ,$79.76 ,$32.94 ,$15.18 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000160,72020,HC XR SPINE 1V (T SPINE),320,1 ,$392.00 ,$196.00 ,$15.18 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$32.94 ,$333.20 ,$79.76 ,$32.94 ,$15.18 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000161,72020,HC XR L-SPINE 1V,320,1 ,$392.00 ,$196.00 ,$15.18 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$32.94 ,$333.20 ,$79.76 ,$32.94 ,$15.18 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000162,72040,HC XR C-SPINE 2V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$79.76 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$374.68 ,$369.75 ,$57.01 ,$419.05 ,$79.76 ,$57.01 ,$25.46 ,$345.10 ,$17.98 ,$79.76 ,$79.76 ,$207.06 ,$419.05 ,$179.45 ,$453.56 ,$345.10 ,$207.78 ,$207.78 ,$300.24 ,$207.78 ,$340.66 ,$443.70 ,$343.37 ,$80.56 ,$389.47 ,$19.06 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,32000163,72040,HC XR C-SPINE 3V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$79.76 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$374.68 ,$369.75 ,$57.01 ,$419.05 ,$79.76 ,$57.01 ,$25.46 ,$345.10 ,$17.98 ,$79.76 ,$79.76 ,$207.06 ,$419.05 ,$179.45 ,$453.56 ,$345.10 ,$207.78 ,$207.78 ,$300.24 ,$207.78 ,$340.66 ,$443.70 ,$343.37 ,$80.56 ,$389.47 ,$19.06 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$79.76 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$374.68 ,$369.75 ,$57.01 ,$419.05 ,$79.76 ,$57.01 ,$25.46 ,$345.10 ,$17.98 ,$79.76 ,$79.76 ,$207.06 ,$419.05 ,$179.45 ,$453.56 ,$345.10 ,$207.78 ,$207.78 ,$300.24 ,$207.78 ,$340.66 ,$443.70 ,$343.37 ,$80.56 ,$389.47 ,$19.06 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,32000165,72040,HC XR C-SPINE CLEAR 3V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$79.76 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$374.68 ,$369.75 ,$57.01 ,$419.05 ,$79.76 ,$57.01 ,$25.46 ,$345.10 ,$17.98 ,$79.76 ,$79.76 ,$207.06 ,$419.05 ,$179.45 ,$453.56 ,$345.10 ,$207.78 ,$207.78 ,$300.24 ,$207.78 ,$340.66 ,$443.70 ,$343.37 ,$80.56 ,$389.47 ,$19.06 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,32000167,72040,HC XR C-SPINE 2-3V OBLS,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$79.76 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$374.68 ,$369.75 ,$57.01 ,$419.05 ,$79.76 ,$57.01 ,$25.46 ,$345.10 ,$17.98 ,$79.76 ,$79.76 ,$207.06 ,$419.05 ,$179.45 ,$453.56 ,$345.10 ,$207.78 ,$207.78 ,$300.24 ,$207.78 ,$340.66 ,$443.70 ,$343.37 ,$80.56 ,$389.47 ,$19.06 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$526.00 ,$263.00 ,$17.98 ,$526.00 ,$17.98 ,$149.56 ,$132.94 ,$107.35 ,$315.60 ,$447.10 ,$368.20 ,$17.98 ,$499.70 ,$399.76 ,$394.50 ,$79.75 ,$447.10 ,$107.35 ,$79.75 ,$35.05 ,$368.20 ,$17.98 ,$107.35 ,$107.35 ,$220.92 ,$447.10 ,$241.53 ,$483.92 ,$368.20 ,$329.30 ,$329.30 ,$320.33 ,$329.30 ,$363.47 ,$473.40 ,$366.36 ,$108.42 ,$415.54 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$420.80 
ST NICHOLAS HOSPITAL - ACUTE,32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$180.60 ,$160.53 ,$107.35 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$519.08 ,$512.25 ,$95.10 ,$580.55 ,$107.35 ,$95.10 ,$42.25 ,$478.10 ,$17.98 ,$107.35 ,$107.35 ,$286.86 ,$580.55 ,$241.53 ,$628.36 ,$478.10 ,$329.30 ,$329.30 ,$415.95 ,$329.30 ,$471.95 ,$614.70 ,$475.71 ,$108.42 ,$539.57 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,32000172,72070,HC XR T-SPINE 2V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$98.34 ,$87.41 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$45.65 ,$314.50 ,$107.35 ,$45.65 ,$20.33 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000174,72072,HC XR T-SPINE 3V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$56.35 ,$314.50 ,$107.35 ,$56.35 ,$25.46 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$329.30 ,$329.30 ,$225.33 ,$329.30 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$426.00 ,$213.00 ,$17.98 ,$426.00 ,$17.98 ,$109.20 ,$97.07 ,$107.35 ,$255.60 ,$362.10 ,$298.20 ,$17.98 ,$404.70 ,$323.76 ,$319.50 ,$57.69 ,$362.10 ,$107.35 ,$57.69 ,$25.46 ,$298.20 ,$17.98 ,$107.35 ,$107.35 ,$178.92 ,$362.10 ,$241.53 ,$391.92 ,$298.20 ,$207.78 ,$207.78 ,$259.43 ,$207.78 ,$294.37 ,$383.40 ,$296.71 ,$108.42 ,$336.54 ,$19.06 ,$426.00 ,$426.00 ,$107.35 ,$426.00 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$340.80 
ST NICHOLAS HOSPITAL - ACUTE,32000179,72100,HC XR L-SPINE 2-3V CORPORATE,320,1 ,$426.00 ,$213.00 ,$17.98 ,$426.00 ,$17.98 ,$109.20 ,$97.07 ,$107.35 ,$255.60 ,$362.10 ,$298.20 ,$17.98 ,$404.70 ,$323.76 ,$319.50 ,$57.69 ,$362.10 ,$107.35 ,$57.69 ,$25.46 ,$298.20 ,$17.98 ,$107.35 ,$107.35 ,$178.92 ,$362.10 ,$241.53 ,$391.92 ,$298.20 ,$207.78 ,$207.78 ,$259.43 ,$207.78 ,$294.37 ,$383.40 ,$296.71 ,$108.42 ,$336.54 ,$19.06 ,$426.00 ,$426.00 ,$107.35 ,$426.00 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$340.80 
ST NICHOLAS HOSPITAL - ACUTE,32000180,72100,HC XR L-SPINE 2V OR,320,1 ,$426.00 ,$213.00 ,$17.98 ,$426.00 ,$17.98 ,$109.20 ,$97.07 ,$107.35 ,$255.60 ,$362.10 ,$298.20 ,$17.98 ,$404.70 ,$323.76 ,$319.50 ,$57.69 ,$362.10 ,$107.35 ,$57.69 ,$25.46 ,$298.20 ,$17.98 ,$107.35 ,$107.35 ,$178.92 ,$362.10 ,$241.53 ,$391.92 ,$298.20 ,$207.78 ,$207.78 ,$259.43 ,$207.78 ,$294.37 ,$383.40 ,$296.71 ,$108.42 ,$336.54 ,$19.06 ,$426.00 ,$426.00 ,$107.35 ,$426.00 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$340.80 
ST NICHOLAS HOSPITAL - ACUTE,32000181,72110,HC XR L-SPINE 4+V,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$152.66 ,$135.70 ,$107.35 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$519.08 ,$512.25 ,$77.06 ,$580.55 ,$107.35 ,$77.06 ,$33.68 ,$478.10 ,$17.98 ,$107.35 ,$107.35 ,$286.86 ,$580.55 ,$241.53 ,$628.36 ,$478.10 ,$329.30 ,$329.30 ,$415.95 ,$329.30 ,$471.95 ,$614.70 ,$475.71 ,$108.42 ,$539.57 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,32000182,72110,HC XR L-SPINE 5V OBLIQUES,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$152.66 ,$135.70 ,$107.35 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$519.08 ,$512.25 ,$77.06 ,$580.55 ,$107.35 ,$77.06 ,$33.68 ,$478.10 ,$17.98 ,$107.35 ,$107.35 ,$286.86 ,$580.55 ,$241.53 ,$628.36 ,$478.10 ,$329.30 ,$329.30 ,$415.95 ,$329.30 ,$471.95 ,$614.70 ,$475.71 ,$108.42 ,$539.57 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,32000183,72120,HC XR L-SPINE BENDING ONLY MIN 4V,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$137.14 ,$121.90 ,$107.35 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$519.08 ,$512.25 ,$59.70 ,$580.55 ,$107.35 ,$59.70 ,$26.83 ,$478.10 ,$17.98 ,$107.35 ,$107.35 ,$286.86 ,$580.55 ,$241.53 ,$628.36 ,$478.10 ,$329.30 ,$329.30 ,$415.95 ,$329.30 ,$471.95 ,$614.70 ,$475.71 ,$108.42 ,$539.57 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$180.60 ,$160.53 ,$107.35 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$519.08 ,$512.25 ,$94.42 ,$580.55 ,$107.35 ,$94.42 ,$42.25 ,$478.10 ,$17.98 ,$107.35 ,$107.35 ,$286.86 ,$580.55 ,$241.53 ,$628.36 ,$478.10 ,$329.30 ,$329.30 ,$415.95 ,$329.30 ,$471.95 ,$614.70 ,$475.71 ,$108.42 ,$539.57 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,32000186,72170,HC XR PELVIS 1-2V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$104.55 ,$92.93 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$38.29 ,$314.50 ,$107.35 ,$38.29 ,$18.61 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000188,72170,HC XR PELVIS 1-2V FROG,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$104.55 ,$92.93 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$38.29 ,$314.50 ,$107.35 ,$38.29 ,$18.61 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$124.72 ,$110.87 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$59.70 ,$314.50 ,$107.35 ,$59.70 ,$26.49 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$56.35 ,$314.50 ,$107.35 ,$56.35 ,$25.12 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.66 ,$314.50 ,$79.76 ,$47.66 ,$21.35 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000194,62302,HC XR MYELOGRAM C-SPINE,320,1 ,"$2,262.00 ","$1,131.00 ",$184.15 ,"$2,262.00 ",$184.15 ,"$1,463.29 ","$1,463.29 ",$705.42 ,"$1,357.20 ","$1,922.70 ","$1,583.40 ",$184.15 ,"$2,148.90 ","$1,719.12 ","$1,696.50 ",$233.50 ,"$1,922.70 ",$705.42 ,$233.50 ,$252.33 ,"$1,583.40 ",$184.15 ,$705.42 ,$705.42 ,$950.04 ,"$1,922.70 ","$1,587.19 ","$2,081.04 ","$1,583.40 ","$1,703.02 ","$2,128.52 ","$1,377.56 ","$2,128.52 ","$1,563.04 ","$2,035.80 ","$1,575.48 ",$712.47 ,"$1,786.98 ",$195.20 ,$451.00 ,$451.00 ,$705.42 ,$451.00 ,"$1,628.64 ","$1,402.44 ","$1,628.64 ","$1,628.64 ","$1,809.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000195,62303,HC XR MYELOGRAM T-SPINE,320,1 ,"$1,831.00 ",$915.50 ,$184.15 ,"$1,831.00 ",$184.15 ,"$1,184.47 ","$1,184.47 ",$705.42 ,"$1,098.60 ","$1,556.35 ","$1,281.70 ",$184.15 ,"$1,739.45 ","$1,391.56 ","$1,373.25 ",$234.15 ,"$1,556.35 ",$705.42 ,$234.15 ,$257.13 ,"$1,281.70 ",$184.15 ,$705.42 ,$705.42 ,$769.02 ,"$1,556.35 ","$1,587.19 ","$1,684.52 ","$1,281.70 ","$1,703.02 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,647.90 ","$1,275.29 ",$712.47 ,"$1,446.49 ",$195.20 ,$451.00 ,$451.00 ,$705.42 ,$451.00 ,"$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,464.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000196,62304,HC XR MYELOGRAM L-SPINE,320,1 ,"$1,831.00 ",$915.50 ,$184.15 ,"$1,831.00 ",$184.15 ,"$1,184.47 ","$1,184.47 ",$705.42 ,"$1,098.60 ","$1,556.35 ","$1,281.70 ",$184.15 ,"$1,739.45 ","$1,391.56 ","$1,373.25 ",$229.99 ,"$1,556.35 ",$705.42 ,$229.99 ,$248.83 ,"$1,281.70 ",$184.15 ,$705.42 ,$705.42 ,$769.02 ,"$1,556.35 ","$1,587.19 ","$1,684.52 ","$1,281.70 ","$1,703.02 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,647.90 ","$1,275.29 ",$712.47 ,"$1,446.49 ",$195.20 ,$451.00 ,$451.00 ,$705.42 ,$451.00 ,"$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,464.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000197,62305,HC XR MYELOGRAM >2 REGIONS,320,1 ,"$2,155.00 ","$1,077.50 ",$184.15 ,"$2,155.00 ",$184.15 ,"$1,394.07 ","$1,394.07 ",$705.42 ,"$1,293.00 ","$1,831.75 ","$1,508.50 ",$184.15 ,"$2,047.25 ","$1,637.80 ","$1,616.25 ",$239.95 ,"$1,831.75 ",$705.42 ,$239.95 ,$270.94 ,"$1,508.50 ",$184.15 ,$705.42 ,$705.42 ,$905.10 ,"$1,831.75 ","$1,587.19 ","$1,982.60 ","$1,508.50 ","$1,703.02 ","$2,128.52 ","$1,312.40 ","$2,128.52 ","$1,489.11 ","$1,939.50 ","$1,500.96 ",$712.47 ,"$1,702.45 ",$195.20 ,$451.00 ,$451.00 ,$705.42 ,$451.00 ,"$1,551.60 ","$1,336.10 ","$1,551.60 ","$1,551.60 ","$1,724.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000198,72285,HC XR DISKOGRAM C- OR T-SPINE,320,1 ,"$2,240.00 ","$1,120.00 ",$60.39 ,"$3,895.50 ",$184.15 ,$251.99 ,$223.99 ,"$1,731.33 ","$1,344.00 ","$1,904.00 ","$1,568.00 ",$184.15 ,"$2,128.00 ","$1,702.40 ","$1,680.00 ",$142.56 ,"$1,904.00 ","$1,731.33 ",$142.56 ,$60.39 ,"$1,568.00 ",$184.15 ,"$1,731.33 ","$1,731.33 ",$940.80 ,"$1,904.00 ","$3,895.50 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$2,016.00 ","$1,560.16 ","$1,748.64 ","$1,769.60 ",$195.20 ,$451.00 ,$451.00 ,"$1,731.33 ",$451.00 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000200,72295,HC XR DISKOGRAM L-SPINE,320,1 ,"$2,912.00 ","$1,456.00 ",$61.76 ,"$3,895.50 ",$184.15 ,$258.20 ,$229.51 ,"$1,731.33 ","$1,747.20 ","$2,475.20 ","$2,038.40 ",$184.15 ,"$2,766.40 ","$2,213.12 ","$2,184.00 ",$144.57 ,"$2,475.20 ","$1,731.33 ",$144.57 ,$61.76 ,"$2,038.40 ",$184.15 ,"$1,731.33 ","$1,731.33 ","$1,223.04 ","$2,475.20 ","$3,895.50 ","$2,679.04 ","$2,038.40 ","$2,912.00 ","$2,912.00 ","$1,773.41 ","$2,912.00 ","$2,012.19 ","$2,620.80 ","$2,028.21 ","$1,748.64 ","$2,300.48 ",$195.20 ,$451.00 ,$451.00 ,"$1,731.33 ",$451.00 ,"$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$2,329.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000201,73000,HC XRAY CLAVICLE,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$89.03 ,$79.14 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$47.66 ,$333.20 ,$79.76 ,$47.66 ,$21.69 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000202,73000,HC XRAY CLAVICLE 2V OR,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$89.03 ,$79.14 ,$79.76 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$297.92 ,$294.00 ,$47.66 ,$333.20 ,$79.76 ,$47.66 ,$21.69 ,$274.40 ,$17.98 ,$79.76 ,$79.76 ,$164.64 ,$333.20 ,$179.45 ,$360.64 ,$274.40 ,$207.78 ,$207.78 ,$238.73 ,$207.78 ,$270.87 ,$352.80 ,$273.03 ,$80.56 ,$309.68 ,$19.06 ,$392.00 ,$392.00 ,$79.76 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,32000204,73010,HC XRAY SCAPULA,320,1 ,$414.00 ,$207.00 ,$17.58 ,$414.00 ,$17.98 ,$98.34 ,$87.41 ,$107.35 ,$248.40 ,$351.90 ,$289.80 ,$17.98 ,$393.30 ,$314.64 ,$310.50 ,$29.62 ,$351.90 ,$107.35 ,$29.62 ,$17.58 ,$289.80 ,$17.98 ,$107.35 ,$107.35 ,$173.88 ,$351.90 ,$241.53 ,$380.88 ,$289.80 ,$207.78 ,$207.78 ,$252.13 ,$207.78 ,$286.07 ,$372.60 ,$288.35 ,$108.42 ,$327.06 ,$19.06 ,$414.00 ,$414.00 ,$107.35 ,$414.00 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$331.20 
ST NICHOLAS HOSPITAL - ACUTE,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$370.00 ,$185.00 ,$12.79 ,$370.00 ,$17.98 ,$67.30 ,$59.82 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$27.61 ,$314.50 ,$79.76 ,$27.61 ,$12.79 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$370.00 ,$185.00 ,$22.38 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$50.33 ,$314.50 ,$79.76 ,$50.33 ,$22.38 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$370.00 ,$185.00 ,$22.38 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$50.33 ,$314.50 ,$79.76 ,$50.33 ,$22.38 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000209,73030,HC XRAY SHOULDER TRAUMA (MIN 2V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$89.03 ,$79.14 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$50.33 ,$314.50 ,$79.76 ,$50.33 ,$22.38 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,792.00 ",$896.00 ,$56.88 ,"$1,792.00 ",$56.88 ,$362.18 ,$321.94 ,$363.09 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$56.88 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$212.05 ,"$1,523.20 ",$363.09 ,$212.05 ,$89.16 ,"$1,254.40 ",$56.88 ,$363.09 ,$363.09 ,$752.64 ,"$1,523.20 ",$816.96 ,"$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,612.80 ","$1,248.13 ",$366.72 ,"$1,415.68 ",$60.29 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,792.00 ",$896.00 ,$56.88 ,"$1,792.00 ",$56.88 ,$362.18 ,$321.94 ,$363.09 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$56.88 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$212.05 ,"$1,523.20 ",$363.09 ,$212.05 ,$89.16 ,"$1,254.40 ",$56.88 ,$363.09 ,$363.09 ,$752.64 ,"$1,523.20 ",$816.96 ,"$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,612.80 ","$1,248.13 ",$366.72 ,"$1,415.68 ",$60.29 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$115.41 ,$102.59 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$38.29 ,$314.50 ,$79.76 ,$38.29 ,$20.67 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.64 ,$314.50 ,$79.76 ,$47.64 ,$21.69 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.64 ,$314.50 ,$79.76 ,$47.64 ,$21.69 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$370.00 ,$185.00 ,$18.95 ,$370.00 ,$26.97 ,$81.27 ,$72.24 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$41.66 ,$314.50 ,$79.76 ,$41.66 ,$18.95 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$370.00 ,$185.00 ,$18.95 ,$370.00 ,$26.97 ,$81.27 ,$72.24 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$41.66 ,$314.50 ,$79.76 ,$41.66 ,$18.95 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000219,73070,HC XRAY ELBOW (2 V) OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$81.27 ,$72.24 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$41.66 ,$314.50 ,$79.76 ,$41.66 ,$18.95 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$90.58 ,$80.52 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.66 ,$314.50 ,$79.76 ,$47.66 ,$21.01 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$90.58 ,$80.52 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.66 ,$314.50 ,$79.76 ,$47.66 ,$21.01 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,$974.00 ,$487.00 ,$37.92 ,$974.00 ,$37.92 ,$335.80 ,$298.49 ,$363.09 ,$584.40 ,$827.90 ,$681.80 ,$37.92 ,$925.30 ,$740.24 ,$730.50 ,$172.63 ,$827.90 ,$363.09 ,$172.63 ,$80.26 ,$681.80 ,$37.92 ,$363.09 ,$363.09 ,$409.08 ,$827.90 ,$816.96 ,$896.08 ,$681.80 ,$974.00 ,$974.00 ,$593.17 ,$974.00 ,$673.03 ,$876.60 ,$678.39 ,$366.72 ,$769.46 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$701.28 ,$603.88 ,$701.28 ,$701.28 ,$779.20 
ST NICHOLAS HOSPITAL - ACUTE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$370.00 ,$185.00 ,$19.29 ,$370.00 ,$26.97 ,$84.37 ,$75.00 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$42.31 ,$314.50 ,$79.76 ,$42.31 ,$19.29 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$370.00 ,$185.00 ,$19.29 ,$370.00 ,$26.97 ,$84.37 ,$75.00 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$42.31 ,$314.50 ,$79.76 ,$42.31 ,$19.29 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$89.03 ,$79.14 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$47.64 ,$314.50 ,$107.35 ,$47.64 ,$21.00 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$329.30 ,$329.30 ,$225.33 ,$329.30 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$23.06 ,$370.00 ,$26.97 ,$101.44 ,$90.17 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$51.00 ,$314.50 ,$79.76 ,$51.00 ,$23.06 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$23.06 ,$370.00 ,$26.97 ,$101.44 ,$90.17 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$51.00 ,$314.50 ,$79.76 ,$51.00 ,$23.06 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$120.07 ,$106.73 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$64.35 ,$314.50 ,$79.76 ,$64.35 ,$28.54 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$120.07 ,$106.73 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$64.35 ,$314.50 ,$79.76 ,$64.35 ,$28.54 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000235,73110,HC XRAY WRIST COMP MIN 3 V + NAVIC,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$120.07 ,$106.73 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$64.35 ,$314.50 ,$79.76 ,$64.35 ,$28.54 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,$974.00 ,$487.00 ,$37.92 ,$974.00 ,$37.92 ,$390.12 ,$346.77 ,$363.09 ,$584.40 ,$827.90 ,$681.80 ,$37.92 ,$925.30 ,$740.24 ,$730.50 ,$221.42 ,$827.90 ,$363.09 ,$221.42 ,$94.31 ,$681.80 ,$37.92 ,$363.09 ,$363.09 ,$409.08 ,$827.90 ,$816.96 ,$896.08 ,$681.80 ,$974.00 ,$974.00 ,$593.17 ,$974.00 ,$673.03 ,$876.60 ,$678.39 ,$366.72 ,$769.46 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$701.28 ,$603.88 ,$701.28 ,$701.28 ,$779.20 
ST NICHOLAS HOSPITAL - ACUTE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$89.03 ,$79.14 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$45.65 ,$314.50 ,$107.35 ,$45.65 ,$20.66 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$89.03 ,$79.14 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$45.65 ,$314.50 ,$107.35 ,$45.65 ,$20.66 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$106.10 ,$94.31 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$55.68 ,$314.50 ,$79.76 ,$55.68 ,$24.77 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$106.10 ,$94.31 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$55.68 ,$314.50 ,$79.76 ,$55.68 ,$24.77 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$115.41 ,$102.59 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$61.01 ,$314.50 ,$79.76 ,$61.01 ,$27.18 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000243,73140,HC XRAY FINGER MIN 2 VIEWS MULTI,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$115.41 ,$102.59 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$61.01 ,$314.50 ,$79.76 ,$61.01 ,$27.18 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,792.00 ",$896.00 ,$37.92 ,"$1,792.00 ",$37.92 ,$363.74 ,$323.32 ,$363.09 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$37.92 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$214.06 ,"$1,523.20 ",$363.09 ,$214.06 ,$89.85 ,"$1,254.40 ",$37.92 ,$363.09 ,$363.09 ,$752.64 ,"$1,523.20 ",$816.96 ,"$1,648.64 ","$1,254.40 ","$1,229.42 ","$1,229.42 ","$1,091.33 ","$1,229.42 ","$1,238.27 ","$1,612.80 ","$1,248.13 ",$366.72 ,"$1,415.68 ",$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000253,73525,HC XRAY HIP ARTHRGRPHY OR,320,1 ,"$1,792.00 ",$896.00 ,$37.92 ,"$1,792.00 ",$37.92 ,$363.74 ,$323.32 ,$363.09 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$37.92 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$214.06 ,"$1,523.20 ",$363.09 ,$214.06 ,$89.85 ,"$1,254.40 ",$37.92 ,$363.09 ,$363.09 ,$752.64 ,"$1,523.20 ",$816.96 ,"$1,648.64 ","$1,254.40 ","$1,229.42 ","$1,229.42 ","$1,091.33 ","$1,229.42 ","$1,238.27 ","$1,612.80 ","$1,248.13 ",$366.72 ,"$1,415.68 ",$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$103.00 ,$91.55 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$51.68 ,$314.50 ,$79.76 ,$51.68 ,$23.75 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$103.00 ,$91.55 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$51.68 ,$314.50 ,$79.76 ,$51.68 ,$23.75 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$120.07 ,$106.73 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$63.04 ,$314.50 ,$79.76 ,$63.04 ,$28.20 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$120.07 ,$106.73 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$63.04 ,$314.50 ,$79.76 ,$63.04 ,$28.20 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$130.93 ,$116.38 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$70.38 ,$314.50 ,$107.35 ,$70.38 ,$30.94 ,$259.00 ,$26.97 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$130.93 ,$116.38 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$70.38 ,$314.50 ,$107.35 ,$70.38 ,$30.94 ,$259.00 ,$26.97 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000267,73565,HC XR KNEE STAND,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$123.17 ,$109.49 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$63.69 ,$314.50 ,$79.76 ,$63.69 ,$28.54 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,120.00 ",$560.00 ,$37.92 ,"$1,120.00 ",$37.92 ,$428.92 ,$381.26 ,$363.09 ,$672.00 ,$952.00 ,$784.00 ,$37.92 ,"$1,064.00 ",$851.20 ,$840.00 ,$242.13 ,$952.00 ,$363.09 ,$242.13 ,$103.20 ,$784.00 ,$37.92 ,$363.09 ,$363.09 ,$470.40 ,$952.00 ,$816.96 ,"$1,030.40 ",$784.00 ,"$1,120.00 ","$1,120.00 ",$682.08 ,"$1,120.00 ",$773.92 ,"$1,008.00 ",$780.08 ,$366.72 ,$884.80 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,120.00 ",$560.00 ,$37.92 ,"$1,120.00 ",$37.92 ,$428.92 ,$381.26 ,$363.09 ,$672.00 ,$952.00 ,$784.00 ,$37.92 ,"$1,064.00 ",$851.20 ,$840.00 ,$242.13 ,$952.00 ,$363.09 ,$242.13 ,$103.20 ,$784.00 ,$37.92 ,$363.09 ,$363.09 ,$470.40 ,$952.00 ,$816.96 ,"$1,030.40 ",$784.00 ,"$1,120.00 ","$1,120.00 ",$682.08 ,"$1,120.00 ",$773.92 ,"$1,008.00 ",$780.08 ,$366.72 ,$884.80 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$370.00 ,$185.00 ,$21.35 ,$370.00 ,$26.97 ,$92.13 ,$81.90 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$46.99 ,$314.50 ,$79.76 ,$46.99 ,$21.35 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$370.00 ,$185.00 ,$21.35 ,$370.00 ,$26.97 ,$92.13 ,$81.90 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$46.99 ,$314.50 ,$79.76 ,$46.99 ,$21.35 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$370.00 ,$185.00 ,$21.00 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$47.64 ,$314.50 ,$79.76 ,$47.64 ,$21.00 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$370.00 ,$185.00 ,$21.00 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$47.64 ,$314.50 ,$79.76 ,$47.64 ,$21.00 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$96.79 ,$86.03 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$48.32 ,$314.50 ,$79.76 ,$48.32 ,$22.03 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$96.79 ,$86.03 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$48.32 ,$314.50 ,$79.76 ,$48.32 ,$22.03 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$24.77 ,$370.00 ,$26.97 ,$106.10 ,$94.31 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$56.33 ,$314.50 ,$79.76 ,$56.33 ,$24.77 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$24.77 ,$370.00 ,$26.97 ,$106.10 ,$94.31 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$56.33 ,$314.50 ,$79.76 ,$56.33 ,$24.77 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,456.00 ",$728.00 ,$37.92 ,"$1,456.00 ",$37.92 ,$388.57 ,$345.39 ,$363.09 ,$873.60 ,"$1,237.60 ","$1,019.20 ",$37.92 ,"$1,383.20 ","$1,106.56 ","$1,092.00 ",$213.38 ,"$1,237.60 ",$363.09 ,$213.38 ,$94.99 ,"$1,019.20 ",$37.92 ,$363.09 ,$363.09 ,$611.52 ,"$1,237.60 ",$816.96 ,"$1,339.52 ","$1,019.20 ","$1,229.42 ","$1,229.42 ",$886.70 ,"$1,229.42 ","$1,006.10 ","$1,310.40 ","$1,014.10 ",$366.72 ,"$1,150.24 ",$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$370.00 ,$185.00 ,$18.96 ,$370.00 ,$26.97 ,$82.82 ,$73.62 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$40.98 ,$314.50 ,$79.76 ,$40.98 ,$18.96 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$370.00 ,$185.00 ,$18.96 ,$370.00 ,$26.97 ,$82.82 ,$73.62 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$40.98 ,$314.50 ,$79.76 ,$40.98 ,$18.96 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$311.67 ,$311.67 ,$225.33 ,$311.67 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000280,73620,HC XRAY FOOT (2 V) OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$40.98 ,$314.50 ,$79.76 ,$40.98 ,$18.96 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$555.00 ,$277.50 ,$23.06 ,$555.00 ,$26.97 ,$98.34 ,$87.41 ,$79.76 ,$333.00 ,$471.75 ,$388.50 ,$26.97 ,$527.25 ,$421.80 ,$416.25 ,$52.34 ,$471.75 ,$79.76 ,$52.34 ,$23.06 ,$388.50 ,$26.97 ,$79.76 ,$79.76 ,$233.10 ,$471.75 ,$179.45 ,$510.60 ,$388.50 ,$311.67 ,$311.67 ,$338.00 ,$311.67 ,$383.51 ,$499.50 ,$386.56 ,$80.56 ,$438.45 ,$28.59 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$444.00 
ST NICHOLAS HOSPITAL - ACUTE,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$98.34 ,$87.41 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$52.34 ,$314.50 ,$79.76 ,$52.34 ,$23.06 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$555.00 ,$277.50 ,$18.95 ,$555.00 ,$26.97 ,$81.27 ,$72.24 ,$79.76 ,$333.00 ,$471.75 ,$388.50 ,$26.97 ,$527.25 ,$421.80 ,$416.25 ,$41.64 ,$471.75 ,$79.76 ,$41.64 ,$18.95 ,$388.50 ,$26.97 ,$79.76 ,$79.76 ,$233.10 ,$471.75 ,$179.45 ,$510.60 ,$388.50 ,$311.67 ,$311.67 ,$338.00 ,$311.67 ,$383.51 ,$499.50 ,$386.56 ,$80.56 ,$438.45 ,$28.59 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$444.00 
ST NICHOLAS HOSPITAL - ACUTE,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$81.27 ,$72.24 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$41.64 ,$314.50 ,$79.76 ,$41.64 ,$18.95 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$95.24 ,$84.65 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$44.98 ,$314.50 ,$79.76 ,$44.98 ,$20.32 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$555.00 ,$277.50 ,$20.32 ,$555.00 ,$26.97 ,$95.24 ,$84.65 ,$79.76 ,$333.00 ,$471.75 ,$388.50 ,$26.97 ,$527.25 ,$421.80 ,$416.25 ,$44.98 ,$471.75 ,$79.76 ,$44.98 ,$20.32 ,$388.50 ,$26.97 ,$79.76 ,$79.76 ,$233.10 ,$471.75 ,$179.45 ,$510.60 ,$388.50 ,$311.67 ,$311.67 ,$338.00 ,$311.67 ,$383.51 ,$499.50 ,$386.56 ,$80.56 ,$438.45 ,$28.59 ,$451.00 ,$451.00 ,$79.76 ,$451.00 ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$444.00 
ST NICHOLAS HOSPITAL - ACUTE,32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$42.31 ,$314.50 ,$79.76 ,$42.31 ,$18.95 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$222.69 ,$222.69 ,$225.33 ,$222.69 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000292,74018,HC XRAY ABDOMEN 1V SHUNTOGRAM,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$42.31 ,$314.50 ,$79.76 ,$42.31 ,$18.95 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$222.69 ,$222.69 ,$225.33 ,$222.69 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$99.89 ,$88.79 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$50.98 ,$314.50 ,$107.35 ,$50.98 ,$23.06 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000295,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V BABY PORT),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$99.89 ,$88.79 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$50.98 ,$314.50 ,$107.35 ,$50.98 ,$23.06 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000296,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V BABY,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$99.89 ,$88.79 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$50.98 ,$314.50 ,$107.35 ,$50.98 ,$23.06 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000297,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V)FLAT,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$99.89 ,$88.79 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$50.98 ,$314.50 ,$107.35 ,$50.98 ,$23.06 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,$526.00 ,$263.00 ,$17.98 ,$526.00 ,$17.98 ,$130.93 ,$116.38 ,$107.35 ,$315.60 ,$447.10 ,$368.20 ,$17.98 ,$499.70 ,$399.76 ,$394.50 ,$69.04 ,$447.10 ,$107.35 ,$69.04 ,$30.95 ,$368.20 ,$17.98 ,$107.35 ,$107.35 ,$220.92 ,$447.10 ,$241.53 ,$483.92 ,$368.20 ,$329.30 ,$329.30 ,$320.33 ,$329.30 ,$363.47 ,$473.40 ,$366.36 ,$108.42 ,$415.54 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$420.80 
ST NICHOLAS HOSPITAL - ACUTE,32000299,74190,HC S AND I PERITONEOGRAM,320,1 ,$661.00 ,$330.50 ,$37.92 ,"$1,071.96 ",$37.92 ,$146.01 ,$129.78 ,$476.43 ,$396.60 ,$561.85 ,$462.70 ,$37.92 ,$627.95 ,$502.36 ,$495.75 ,$108.24 ,$561.85 ,$476.43 ,$108.24 ,$50.89 ,$462.70 ,$37.92 ,$476.43 ,$476.43 ,$277.62 ,$561.85 ,"$1,071.96 ",$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$594.90 ,$460.39 ,$481.19 ,$522.19 ,$40.20 ,$451.00 ,$451.00 ,$476.43 ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$605.00 ,$302.50 ,$17.98 ,$605.00 ,$17.98 ,$273.72 ,$243.31 ,$176.13 ,$363.00 ,$514.25 ,$423.50 ,$17.98 ,$574.75 ,$459.80 ,$453.75 ,$143.89 ,$514.25 ,$176.13 ,$143.89 ,$63.47 ,$423.50 ,$17.98 ,$176.13 ,$176.13 ,$254.10 ,$514.25 ,$396.28 ,$556.60 ,$423.50 ,$368.99 ,$368.99 ,$368.45 ,$368.99 ,$418.06 ,$544.50 ,$421.38 ,$177.89 ,$477.95 ,$19.06 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$616.00 ,$308.00 ,$37.92 ,$616.00 ,$37.92 ,$438.23 ,$389.54 ,$176.13 ,$369.60 ,$523.60 ,$431.20 ,$37.92 ,$585.20 ,$468.16 ,$462.00 ,$209.39 ,$523.60 ,$176.13 ,$209.39 ,$98.75 ,$431.20 ,$37.92 ,$176.13 ,$176.13 ,$258.72 ,$523.60 ,$396.28 ,$566.72 ,$431.20 ,$368.99 ,$368.99 ,$375.14 ,$368.99 ,$425.66 ,$554.40 ,$429.04 ,$177.89 ,$486.64 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$492.80 
ST NICHOLAS HOSPITAL - ACUTE,32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,$616.00 ,$308.00 ,$37.92 ,$616.00 ,$37.92 ,$380.81 ,$338.50 ,$176.13 ,$369.60 ,$523.60 ,$431.20 ,$37.92 ,$585.20 ,$468.16 ,$462.00 ,$175.97 ,$523.60 ,$176.13 ,$175.97 ,$76.49 ,$431.20 ,$37.92 ,$176.13 ,$176.13 ,$258.72 ,$523.60 ,$396.28 ,$566.72 ,$431.20 ,$547.93 ,$547.93 ,$375.14 ,$547.93 ,$425.66 ,$554.40 ,$429.04 ,$177.89 ,$486.64 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$492.80 
ST NICHOLAS HOSPITAL - ACUTE,32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,$952.00 ,$476.00 ,$37.92 ,$952.00 ,$37.92 ,$442.89 ,$393.68 ,$176.13 ,$571.20 ,$809.20 ,$666.40 ,$37.92 ,$904.40 ,$723.52 ,$714.00 ,$202.68 ,$809.20 ,$176.13 ,$202.68 ,$89.51 ,$666.40 ,$37.92 ,$176.13 ,$176.13 ,$399.84 ,$809.20 ,$396.28 ,$875.84 ,$666.40 ,$547.93 ,$547.93 ,$579.77 ,$547.93 ,$657.83 ,$856.80 ,$663.07 ,$177.89 ,$752.08 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$761.60 
ST NICHOLAS HOSPITAL - ACUTE,32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,$952.00 ,$476.00 ,$37.92 ,$952.00 ,$37.92 ,$442.89 ,$393.68 ,$176.13 ,$571.20 ,$809.20 ,$666.40 ,$37.92 ,$904.40 ,$723.52 ,$714.00 ,$202.68 ,$809.20 ,$176.13 ,$202.68 ,$89.51 ,$666.40 ,$37.92 ,$176.13 ,$176.13 ,$399.84 ,$809.20 ,$396.28 ,$875.84 ,$666.40 ,$547.93 ,$547.93 ,$579.77 ,$547.93 ,$657.83 ,$856.80 ,$663.07 ,$177.89 ,$752.08 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$761.60 
ST NICHOLAS HOSPITAL - ACUTE,32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$717.00 ,$358.50 ,$37.92 ,$717.00 ,$37.92 ,$388.57 ,$345.39 ,$176.13 ,$430.20 ,$609.45 ,$501.90 ,$37.92 ,$681.15 ,$544.92 ,$537.75 ,$174.64 ,$609.45 ,$176.13 ,$174.64 ,$76.83 ,$501.90 ,$37.92 ,$176.13 ,$176.13 ,$301.14 ,$609.45 ,$396.28 ,$659.64 ,$501.90 ,$368.99 ,$368.99 ,$436.65 ,$368.99 ,$495.45 ,$645.30 ,$499.39 ,$177.89 ,$566.43 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$573.60 
ST NICHOLAS HOSPITAL - ACUTE,32000312,74018,HC SITZ MARKER STUDY,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$42.31 ,$314.50 ,$79.76 ,$42.31 ,$18.95 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$222.69 ,$222.69 ,$225.33 ,$222.69 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000314,74251,HC SMALL BOWEL VIA ENTEROCLY TUBE,320,1 ,"$1,098.00 ",$549.00 ,$37.92 ,"$1,098.00 ",$37.92 ,"$1,098.00 ","$1,098.00 ",$176.13 ,$658.80 ,$933.30 ,$768.60 ,$37.92 ,"$1,043.10 ",$834.48 ,$823.50 ,$659.14 ,$933.30 ,$176.13 ,$659.14 ,$330.28 ,$768.60 ,$37.92 ,$176.13 ,$176.13 ,$461.16 ,$933.30 ,$396.28 ,"$1,010.16 ",$768.60 ,$547.93 ,$547.93 ,$668.68 ,$547.93 ,$758.72 ,$988.20 ,$764.76 ,$177.89 ,$867.42 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$878.40 
ST NICHOLAS HOSPITAL - ACUTE,32000315,74270,HC XRAY COLON BARIUM,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$551.53 ,$490.25 ,$176.13 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$579.12 ,$571.50 ,$218.08 ,$647.70 ,$176.13 ,$218.08 ,$98.07 ,$533.40 ,$37.92 ,$176.13 ,$176.13 ,$320.04 ,$647.70 ,$396.28 ,$701.04 ,$533.40 ,$547.93 ,$547.93 ,$464.06 ,$547.93 ,$526.54 ,$685.80 ,$530.73 ,$177.89 ,$601.98 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$551.53 ,$490.25 ,$176.13 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$579.12 ,$571.50 ,$218.08 ,$647.70 ,$176.13 ,$218.08 ,$98.07 ,$533.40 ,$37.92 ,$176.13 ,$176.13 ,$320.04 ,$647.70 ,$396.28 ,$701.04 ,$533.40 ,$547.93 ,$547.93 ,$464.06 ,$547.93 ,$526.54 ,$685.80 ,$530.73 ,$177.89 ,$601.98 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$551.53 ,$490.25 ,$176.13 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$579.12 ,$571.50 ,$218.08 ,$647.70 ,$176.13 ,$218.08 ,$98.07 ,$533.40 ,$37.92 ,$176.13 ,$176.13 ,$320.04 ,$647.70 ,$396.28 ,$701.04 ,$533.40 ,$547.93 ,$547.93 ,$464.06 ,$547.93 ,$526.54 ,$685.80 ,$530.73 ,$177.89 ,$601.98 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,32000320,74280,HC XRAY COLON BARIUM AIR CONTRAST,320,1 ,"$1,098.00 ",$549.00 ,$37.92 ,"$1,098.00 ",$37.92 ,$775.02 ,$688.91 ,$176.13 ,$658.80 ,$933.30 ,$768.60 ,$37.92 ,"$1,043.10 ",$834.48 ,$823.50 ,$336.36 ,$933.30 ,$176.13 ,$336.36 ,$152.53 ,$768.60 ,$37.92 ,$176.13 ,$176.13 ,$461.16 ,$933.30 ,$396.28 ,"$1,010.16 ",$768.60 ,$547.93 ,$547.93 ,$668.68 ,$547.93 ,$758.72 ,$988.20 ,$764.76 ,$177.89 ,$867.42 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$878.40 
ST NICHOLAS HOSPITAL - ACUTE,32000322,74283,HC THERAPEUTIC COLON,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$568.60 ,$505.43 ,$176.13 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$579.12 ,$571.50 ,$323.65 ,$647.70 ,$176.13 ,$323.65 ,$138.83 ,$533.40 ,$37.92 ,$176.13 ,$176.13 ,$320.04 ,$647.70 ,$396.28 ,$701.04 ,$533.40 ,$547.93 ,$547.93 ,$464.06 ,$547.93 ,$526.54 ,$685.80 ,$530.73 ,$177.89 ,$601.98 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$773.00 ,$386.50 ,$46.25 ,$773.00 ,$56.46 ,$145.60 ,$129.42 , N/A ,$463.80 ,$657.05 ,$541.10 ,$56.46 ,$734.35 ,$587.48 ,$579.75 ,$98.36 ,$657.05 , N/A ,$98.36 ,$46.25 ,$541.10 ,$56.46 , N/A , N/A ,$324.66 ,$657.05 , N/A ,$711.16 ,$541.10 ,$392.07 ,$470.53 ,$470.76 ,$470.53 ,$534.14 ,$695.70 ,$538.39 , N/A ,$610.67 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$556.56 ,$479.26 ,$556.56 ,$556.56 ,$618.40 
ST NICHOLAS HOSPITAL - ACUTE,32000325,47531,HC XRAY CHOLANGIOGRAM THRU CATH,320,1 ,"$1,680.00 ",$840.00 ,$135.98 ,"$7,058.37 ",$573.58 ,"$1,086.79 ","$1,086.79 ","$3,137.05 ","$1,008.00 ","$1,428.00 ","$1,176.00 ",$573.58 ,"$1,596.00 ","$1,276.80 ","$1,260.00 ",$135.98 ,"$1,428.00 ","$3,137.05 ",$135.98 ,$376.30 ,"$1,176.00 ",$573.58 ,"$3,137.05 ","$3,137.05 ",$705.60 ,"$1,428.00 ","$7,058.37 ","$1,545.60 ","$1,176.00 ","$1,680.00 ","$1,680.00 ","$1,023.12 ","$1,680.00 ","$1,160.88 ","$1,512.00 ","$1,170.12 ","$3,168.42 ","$1,327.20 ",$607.99 ,$451.00 ,$451.00 ,"$3,137.05 ",$451.00 ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000326,47532,HC PERCUTAN CHOLANGIOGRAM,320,1 ,"$2,128.00 ","$1,064.00 ",$407.68 ,"$7,058.37 ",$573.58 ,"$1,376.60 ","$1,376.60 ","$3,137.05 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$573.58 ,"$2,021.60 ","$1,617.28 ","$1,596.00 ",$407.68 ,"$1,808.80 ","$3,137.05 ",$407.68 ,$825.54 ,"$1,489.60 ",$573.58 ,"$3,137.05 ","$3,137.05 ",$893.76 ,"$1,808.80 ","$7,058.37 ","$1,957.76 ","$1,489.60 ","$1,921.55 ","$2,128.00 ","$1,295.95 ","$2,128.00 ","$1,470.45 ","$1,915.20 ","$1,482.15 ","$3,168.42 ","$1,681.12 ",$607.99 ,$451.00 ,$451.00 ,"$3,137.05 ",$451.00 ,"$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,702.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000327,47544,HC XRAY REM BILE DUCT STONE,320,1 ,"$3,562.00 ","$1,781.00 ",$300.02 ,"$3,562.00 ",$791.20 ,"$2,304.26 ","$2,304.26 ", N/A ,"$2,137.20 ","$3,027.70 ","$2,493.40 ",$791.20 ,"$3,383.90 ","$2,707.12 ","$2,671.50 ",$300.02 ,"$3,027.70 ", N/A ,$300.02 ,$968.95 ,"$2,493.40 ",$791.20 , N/A , N/A ,"$1,496.04 ","$3,027.70 ", N/A ,"$3,277.04 ","$2,493.40 ","$1,921.55 ","$2,401.67 ","$2,169.26 ","$2,401.67 ","$2,461.34 ","$3,205.80 ","$2,480.93 ", N/A ,"$2,813.98 ",$838.67 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$2,564.64 ","$2,208.44 ","$2,564.64 ","$2,564.64 ","$2,849.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000328,74328,HC XRAY ERCP BILIARY ONLY,320,1 ,"$1,109.00 ",$554.50 ,$56.46 ,"$1,109.00 ",$56.46 ,$354.41 ,$315.03 , N/A ,$665.40 ,$942.65 ,$776.30 ,$56.46 ,"$1,053.55 ",$842.84 ,$831.75 ,$261.13 ,$942.65 , N/A ,$261.13 ,$122.78 ,$776.30 ,$56.46 , N/A , N/A ,$465.78 ,$942.65 , N/A ,"$1,020.28 ",$776.30 ,$562.48 ,$675.05 ,$675.38 ,$675.05 ,$766.32 ,$998.10 ,$772.42 , N/A ,$876.11 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$798.48 ,$687.58 ,$798.48 ,$798.48 ,$887.20 
ST NICHOLAS HOSPITAL - ACUTE,32000329,74329,HC ERCP PANCREATIC,320,1 ,"$1,109.00 ",$554.50 ,$56.46 ,"$1,109.00 ",$56.46 ,$282.88 ,$251.45 , N/A ,$665.40 ,$942.65 ,$776.30 ,$56.46 ,"$1,053.55 ",$842.84 ,$831.75 ,$261.13 ,$942.65 , N/A ,$261.13 ,$122.78 ,$776.30 ,$56.46 , N/A , N/A ,$465.78 ,$942.65 , N/A ,"$1,020.28 ",$776.30 ,$562.48 ,$675.05 ,$675.38 ,$675.05 ,$766.32 ,$998.10 ,$772.42 , N/A ,$876.11 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$798.48 ,$687.58 ,$798.48 ,$798.48 ,$887.20 
ST NICHOLAS HOSPITAL - ACUTE,32000330,74330,HC XRAY ERCP CATH BILIARY AND PANCREAS,320,1 ,"$1,456.00 ",$728.00 ,$56.46 ,"$1,456.00 ",$56.46 ,$524.84 ,$466.52 , N/A ,$873.60 ,"$1,237.60 ","$1,019.20 ",$56.46 ,"$1,383.20 ","$1,106.56 ","$1,092.00 ",$261.13 ,"$1,237.60 ", N/A ,$261.13 ,$122.78 ,"$1,019.20 ",$56.46 , N/A , N/A ,$611.52 ,"$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ",$738.48 ,$886.27 ,$886.70 ,$886.27 ,"$1,006.10 ","$1,310.40 ","$1,014.10 ", N/A ,"$1,150.24 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000331,74340,HC INTRODUCTION LONG GI TUBE,320,1 ,$644.00 ,$322.00 ,$56.46 ,$644.00 ,$56.46 ,$346.65 ,$308.13 , N/A ,$386.40 ,$547.40 ,$450.80 ,$56.46 ,$611.80 ,$489.44 ,$483.00 ,$217.22 ,$547.40 , N/A ,$217.22 ,$102.13 ,$450.80 ,$56.46 , N/A , N/A ,$270.48 ,$547.40 , N/A ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$392.00 ,$445.00 ,$579.60 ,$448.55 , N/A ,$508.76 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$515.20 
ST NICHOLAS HOSPITAL - ACUTE,32000333,74363,HC BILIARY DILITAT W OR W/O STENT,320,1 ,"$1,714.00 ",$857.00 ,$56.46 ,"$1,714.00 ",$56.46 ,$341.43 ,$303.49 , N/A ,"$1,028.40 ","$1,456.90 ","$1,199.80 ",$56.46 ,"$1,628.30 ","$1,302.64 ","$1,285.50 ",$217.22 ,"$1,456.90 ", N/A ,$217.22 ,$102.13 ,"$1,199.80 ",$56.46 , N/A , N/A ,$719.88 ,"$1,456.90 ", N/A ,"$1,576.88 ","$1,199.80 ",$869.34 ,"$1,043.31 ","$1,043.83 ","$1,043.31 ","$1,184.37 ","$1,542.60 ","$1,193.80 ", N/A ,"$1,354.06 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$1,234.08 ","$1,062.68 ","$1,234.08 ","$1,234.08 ","$1,371.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000335,74400,HC XRAY IVP W OR W/O TOMO,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$411.85 ,$366.09 ,$176.13 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$680.96 ,$672.00 ,$230.11 ,$761.60 ,$176.13 ,$230.11 ,$99.44 ,$627.20 ,$37.92 ,$176.13 ,$176.13 ,$376.32 ,$761.60 ,$396.28 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$177.89 ,$707.84 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,32000337,74410,HC XRAY UROGRAM IVP DRIP TECH,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$421.16 ,$374.37 ,$176.13 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$680.96 ,$672.00 ,$239.46 ,$761.60 ,$176.13 ,$239.46 ,$101.83 ,$627.20 ,$37.92 ,$176.13 ,$176.13 ,$376.32 ,$761.60 ,$396.28 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$177.89 ,$707.84 ,$40.20 ,$451.00 ,$451.00 ,$176.13 ,$451.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,$739.00 ,$369.50 ,$37.92 ,$816.96 ,$37.92 ,$199.22 ,$177.09 ,$363.09 ,$443.40 ,$628.15 ,$517.30 ,$37.92 ,$702.05 ,$561.64 ,$554.25 ,$104.45 ,$628.15 ,$363.09 ,$104.45 ,$46.36 ,$517.30 ,$37.92 ,$363.09 ,$363.09 ,$310.38 ,$628.15 ,$816.96 ,$679.88 ,$517.30 ,$739.00 ,$739.00 ,$450.05 ,$739.00 ,$510.65 ,$665.10 ,$514.71 ,$366.72 ,$583.81 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$532.08 ,$458.18 ,$532.08 ,$532.08 ,$591.20 
ST NICHOLAS HOSPITAL - ACUTE,32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,$739.00 ,$369.50 ,$37.92 ,$816.96 ,$37.92 ,$478.06 ,$478.06 ,$363.09 ,$443.40 ,$628.15 ,$517.30 ,$37.92 ,$702.05 ,$561.64 ,$554.25 ,$230.75 ,$628.15 ,$363.09 ,$230.75 ,$50.89 ,$517.30 ,$37.92 ,$363.09 ,$363.09 ,$310.38 ,$628.15 ,$816.96 ,$679.88 ,$517.30 ,$739.00 ,$739.00 ,$450.05 ,$739.00 ,$510.65 ,$665.10 ,$514.71 ,$366.72 ,$583.81 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$532.08 ,$458.18 ,$532.08 ,$532.08 ,$591.20 
ST NICHOLAS HOSPITAL - ACUTE,32000341,50431,HC ANGIO NEPHROSTGRAM,320,1 ,$762.00 ,$381.00 ,$119.36 ,"$1,276.32 ",$119.36 ,$492.94 ,$492.94 ,$567.25 ,$457.20 ,$647.70 ,$533.40 ,$119.36 ,$723.90 ,$579.12 ,$571.50 ,$126.24 ,$647.70 ,$567.25 ,$126.24 ,$252.06 ,$533.40 ,$119.36 ,$567.25 ,$567.25 ,$320.04 ,$647.70 ,"$1,276.32 ",$701.04 ,$533.40 ,$762.00 ,$762.00 ,$464.06 ,$762.00 ,$526.54 ,$685.80 ,$530.73 ,$572.92 ,$601.98 ,$126.52 ,$451.00 ,$451.00 ,$567.25 ,$451.00 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,32000342,74425,HC XR UROGRAM ANTE (LOOPOGRAM SVG),320,1 ,$739.00 ,$369.50 ,$37.92 ,$816.96 ,$37.92 ,$478.06 ,$478.06 ,$363.09 ,$443.40 ,$628.15 ,$517.30 ,$37.92 ,$702.05 ,$561.64 ,$554.25 ,$230.75 ,$628.15 ,$363.09 ,$230.75 ,$50.89 ,$517.30 ,$37.92 ,$363.09 ,$363.09 ,$310.38 ,$628.15 ,$816.96 ,$679.88 ,$517.30 ,$739.00 ,$739.00 ,$450.05 ,$739.00 ,$510.65 ,$665.10 ,$514.71 ,$366.72 ,$583.81 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$532.08 ,$458.18 ,$532.08 ,$532.08 ,$591.20 
ST NICHOLAS HOSPITAL - ACUTE,32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,$941.00 ,$470.50 ,$23.07 ,$941.00 ,$37.92 ,$99.89 ,$88.79 ,$363.09 ,$564.60 ,$799.85 ,$658.70 ,$37.92 ,$893.95 ,$715.16 ,$705.75 ,$51.00 ,$799.85 ,$363.09 ,$51.00 ,$23.07 ,$658.70 ,$37.92 ,$363.09 ,$363.09 ,$395.22 ,$799.85 ,$816.96 ,$865.72 ,$658.70 ,$933.30 ,$933.30 ,$573.07 ,$933.30 ,$650.23 ,$846.90 ,$655.41 ,$366.72 ,$743.39 ,$40.20 ,$451.00 ,$451.00 ,$363.09 ,$451.00 ,$677.52 ,$583.42 ,$677.52 ,$677.52 ,$752.80 
ST NICHOLAS HOSPITAL - ACUTE,32000344,74450,HC CYSTOURETHROGRAM RETROGRADE,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$226.89 ,$201.68 ,$226.88 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$680.96 ,$672.00 ,$120.77 ,$761.60 ,$226.88 ,$120.77 ,$56.78 ,$627.20 ,$37.92 ,$226.88 ,$226.88 ,$376.32 ,$761.60 ,$510.48 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$229.15 ,$707.84 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,32000345,74450,HC CYSTOURETHROGRAM RETRO OR,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$226.89 ,$201.68 ,$226.88 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$680.96 ,$672.00 ,$120.77 ,$761.60 ,$226.88 ,$120.77 ,$56.78 ,$627.20 ,$37.92 ,$226.88 ,$226.88 ,$376.32 ,$761.60 ,$510.48 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$229.15 ,$707.84 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$321.83 ,$286.07 ,$226.88 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$680.96 ,$672.00 ,$181.98 ,$761.60 ,$226.88 ,$181.98 ,$77.86 ,$627.20 ,$37.92 ,$226.88 ,$226.88 ,$376.32 ,$761.60 ,$510.48 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$229.15 ,$707.84 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,32000348,74470,HC RENAL CYST STUDY S AND I,320,1 ,$750.00 ,$375.00 ,$37.92 ,"$1,071.96 ",$37.92 ,$194.33 ,$172.74 ,$476.43 ,$450.00 ,$637.50 ,$525.00 ,$37.92 ,$712.50 ,$570.00 ,$562.50 ,$103.46 ,$637.50 ,$476.43 ,$103.46 ,$48.65 ,$525.00 ,$37.92 ,$476.43 ,$476.43 ,$315.00 ,$637.50 ,"$1,071.96 ",$690.00 ,$525.00 ,$750.00 ,$750.00 ,$456.75 ,$750.00 ,$518.25 ,$675.00 ,$522.38 ,$481.19 ,$592.50 ,$40.20 ,$451.00 ,$451.00 ,$476.43 ,$451.00 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$600.00 
ST NICHOLAS HOSPITAL - ACUTE,32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$4,100.00 ","$2,050.00 ",$395.36 ,"$6,820.92 ",$711.12 ,"$2,652.29 ","$2,652.29 ","$3,031.52 ","$2,460.00 ","$3,485.00 ","$2,870.00 ",$711.12 ,"$3,895.00 ","$3,116.00 ","$3,075.00 ",$395.36 ,"$3,485.00 ","$3,031.52 ",$395.36 ,$865.94 ,"$2,870.00 ",$711.12 ,"$3,031.52 ","$3,031.52 ","$1,722.00 ","$3,485.00 ","$6,820.92 ","$3,772.00 ","$2,870.00 ","$2,882.33 ","$3,602.51 ","$2,496.90 ","$3,602.51 ","$2,833.10 ","$3,690.00 ","$2,855.65 ","$3,061.84 ","$3,239.00 ",$753.79 ,$451.00 ,$451.00 ,"$3,031.52 ",$451.00 ,"$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$3,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$4,100.00 ","$2,050.00 ",$395.36 ,"$6,820.92 ",$711.12 ,"$2,652.29 ","$2,652.29 ","$3,031.52 ","$2,460.00 ","$3,485.00 ","$2,870.00 ",$711.12 ,"$3,895.00 ","$3,116.00 ","$3,075.00 ",$395.36 ,"$3,485.00 ","$3,031.52 ",$395.36 ,$865.94 ,"$2,870.00 ",$711.12 ,"$3,031.52 ","$3,031.52 ","$1,722.00 ","$3,485.00 ","$6,820.92 ","$3,772.00 ","$2,870.00 ","$2,882.33 ","$3,602.51 ","$2,496.90 ","$3,602.51 ","$2,833.10 ","$3,690.00 ","$2,855.65 ","$3,061.84 ","$3,239.00 ",$753.79 ,$451.00 ,$451.00 ,"$3,031.52 ",$451.00 ,"$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$3,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$1,904.00 ",$952.00 ,$56.46 ,"$3,972.27 ",$56.46 ,$290.79 ,$258.48 ,"$1,765.45 ","$1,142.40 ","$1,618.40 ","$1,332.80 ",$56.46 ,"$1,808.80 ","$1,447.04 ","$1,428.00 ",$163.26 ,"$1,618.40 ","$1,765.45 ",$163.26 ,$69.99 ,"$1,332.80 ",$56.46 ,"$1,765.45 ","$1,765.45 ",$799.68 ,"$1,618.40 ","$3,972.27 ","$1,751.68 ","$1,332.80 ","$1,904.00 ","$1,904.00 ","$1,159.54 ","$1,904.00 ","$1,315.66 ","$1,713.60 ","$1,326.14 ","$1,783.10 ","$1,504.16 ",$59.85 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,523.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$1,904.00 ",$952.00 ,$56.46 ,"$3,972.27 ",$56.46 ,$290.79 ,$258.48 ,"$1,765.45 ","$1,142.40 ","$1,618.40 ","$1,332.80 ",$56.46 ,"$1,808.80 ","$1,447.04 ","$1,428.00 ",$163.26 ,"$1,618.40 ","$1,765.45 ",$163.26 ,$69.99 ,"$1,332.80 ",$56.46 ,"$1,765.45 ","$1,765.45 ",$799.68 ,"$1,618.40 ","$3,972.27 ","$1,751.68 ","$1,332.80 ","$1,904.00 ","$1,904.00 ","$1,159.54 ","$1,904.00 ","$1,315.66 ","$1,713.60 ","$1,326.14 ","$1,783.10 ","$1,504.16 ",$59.85 ,$451.00 ,$451.00 ,"$1,765.45 ",$451.00 ,"$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,523.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$750.00 ,$375.00 ,$37.92 ,$750.00 ,$37.92 ,$275.27 ,$244.69 ,$226.88 ,$450.00 ,$637.50 ,$525.00 ,$37.92 ,$712.50 ,$570.00 ,$562.50 ,$159.92 ,$637.50 ,$226.88 ,$159.92 ,$68.27 ,$525.00 ,$37.92 ,$226.88 ,$226.88 ,$315.00 ,$637.50 ,$510.48 ,$690.00 ,$525.00 ,$750.00 ,$750.00 ,$456.75 ,$750.00 ,$518.25 ,$675.00 ,$522.38 ,$229.15 ,$592.50 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$600.00 
ST NICHOLAS HOSPITAL - ACUTE,32000355,75605,HC THORACIC AORTA,320,1 ,"$4,144.00 ","$2,072.00 ",$72.04 ,"$10,579.35 ","$1,293.09 ",$340.46 ,$302.63 ,"$4,701.93 ","$2,486.40 ","$3,522.40 ","$2,900.80 ","$1,293.09 ","$3,936.80 ","$3,149.44 ","$3,108.00 ",$135.40 ,"$3,522.40 ","$4,701.93 ",$135.40 ,$72.04 ,"$2,900.80 ","$1,293.09 ","$4,701.93 ","$4,701.93 ","$1,740.48 ","$3,522.40 ","$10,579.35 ","$3,812.48 ","$2,900.80 ","$4,144.00 ","$4,144.00 ","$2,523.70 ","$4,144.00 ","$2,863.50 ","$3,729.60 ","$2,886.30 ","$4,748.95 ","$3,273.76 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,701.93 ",$451.00 ,"$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$3,315.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000356,75625,HC ABDOMINAL AORTAGRAM 75625,320,1 ,"$4,144.00 ","$2,072.00 ",$65.88 ,"$6,350.83 ",$573.58 ,$332.70 ,$295.73 ,"$2,822.59 ","$2,486.40 ","$3,522.40 ","$2,900.80 ",$573.58 ,"$3,936.80 ","$3,149.44 ","$3,108.00 ",$121.16 ,"$3,522.40 ","$2,822.59 ",$121.16 ,$65.88 ,"$2,900.80 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,740.48 ","$3,522.40 ","$6,350.83 ","$3,812.48 ","$2,900.80 ","$4,144.00 ","$4,144.00 ","$2,523.70 ","$4,144.00 ","$2,863.50 ","$3,729.60 ","$2,886.30 ","$2,850.82 ","$3,273.76 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$3,315.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000357,75630,HC AORTA WITH RUNOFF 75630,320,1 ,"$4,368.00 ","$2,184.00 ",$69.64 ,"$6,350.83 ",$573.58 ,$338.90 ,$301.25 ,"$2,822.59 ","$2,620.80 ","$3,712.80 ","$3,057.60 ",$573.58 ,"$4,149.60 ","$3,319.68 ","$3,276.00 ",$129.87 ,"$3,712.80 ","$2,822.59 ",$129.87 ,$69.64 ,"$3,057.60 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,834.56 ","$3,712.80 ","$6,350.83 ","$4,018.56 ","$3,057.60 ","$4,368.00 ","$4,368.00 ","$2,660.11 ","$4,368.00 ","$3,018.29 ","$3,931.20 ","$3,042.31 ","$2,850.82 ","$3,450.72 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$3,144.96 ","$2,708.16 ","$3,144.96 ","$3,144.96 ","$3,494.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000370,75705,HC ANGIO SPINAL,320,1 ,"$2,240.00 ","$1,120.00 ",$129.01 ,"$10,579.35 ","$1,293.09 ",$589.34 ,$523.86 ,"$4,701.93 ","$1,344.00 ","$1,904.00 ","$1,568.00 ","$1,293.09 ","$2,128.00 ","$1,702.40 ","$1,680.00 ",$257.71 ,"$1,904.00 ","$4,701.93 ",$257.71 ,$129.01 ,"$1,568.00 ","$1,293.09 ","$4,701.93 ","$4,701.93 ",$940.80 ,"$1,904.00 ","$10,579.35 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$2,016.00 ","$1,560.16 ","$4,748.95 ","$1,769.60 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,701.93 ",$451.00 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000371,75710,HC ANGIO EXTREMITY UNI 75710,320,1 ,"$1,792.00 ",$896.00 ,$74.44 ,"$6,350.83 ",$573.58 ,$352.87 ,$313.66 ,"$2,822.59 ","$1,075.20 ","$1,523.20 ","$1,254.40 ",$573.58 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$138.54 ,"$1,523.20 ","$2,822.59 ",$138.54 ,$74.44 ,"$1,254.40 ",$573.58 ,"$2,822.59 ","$2,822.59 ",$752.64 ,"$1,523.20 ","$6,350.83 ","$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,612.80 ","$1,248.13 ","$2,850.82 ","$1,415.68 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000372,75710,HC ANGIO EXTREMITY UNI OR,320,1 ,"$1,792.00 ",$896.00 ,$74.44 ,"$6,350.83 ",$573.58 ,$352.87 ,$313.66 ,"$2,822.59 ","$1,075.20 ","$1,523.20 ","$1,254.40 ",$573.58 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$138.54 ,"$1,523.20 ","$2,822.59 ",$138.54 ,$74.44 ,"$1,254.40 ",$573.58 ,"$2,822.59 ","$2,822.59 ",$752.64 ,"$1,523.20 ","$6,350.83 ","$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,612.80 ","$1,248.13 ","$2,850.82 ","$1,415.68 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000373,75716,HC ANGIO EXTREMITY BILAT 75716,320,1 ,"$2,688.00 ","$1,344.00 ",$75.92 ,"$6,350.83 ",$573.58 ,$357.53 ,$317.80 ,"$2,822.59 ","$1,612.80 ","$2,284.80 ","$1,881.60 ",$573.58 ,"$2,553.60 ","$2,042.88 ","$2,016.00 ",$142.78 ,"$2,284.80 ","$2,822.59 ",$142.78 ,$75.92 ,"$1,881.60 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,128.96 ","$2,284.80 ","$6,350.83 ","$2,472.96 ","$1,881.60 ","$2,688.00 ","$2,688.00 ","$1,636.99 ","$2,688.00 ","$1,857.41 ","$2,419.20 ","$1,872.19 ","$2,850.82 ","$2,123.52 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$2,150.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000375,36251,HC ANGIO SEL RENAL UNILA 36251,320,1 ,"$3,248.00 ","$1,624.00 ",$451.00 ,"$6,350.83 ","$1,293.09 ","$2,101.13 ","$2,101.13 ","$2,822.59 ","$1,948.80 ","$2,760.80 ","$2,273.60 ","$1,293.09 ","$3,085.60 ","$2,468.48 ","$2,436.00 ",$480.07 ,"$2,760.80 ","$2,822.59 ",$480.07 ,"$1,351.44 ","$2,273.60 ","$1,293.09 ","$2,822.59 ","$2,822.59 ","$1,364.16 ","$2,760.80 ","$6,350.83 ","$2,988.16 ","$2,273.60 ","$1,703.02 ","$2,128.52 ","$1,978.03 ","$2,128.52 ","$2,244.37 ","$2,923.20 ","$2,262.23 ","$2,850.82 ","$2,565.92 ","$1,370.68 ",$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,338.56 ","$2,013.76 ","$2,338.56 ","$2,338.56 ","$2,598.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000376,36252,HC ANGIO SEL RENAL BILAT 36252,320,1 ,"$3,248.00 ","$1,624.00 ",$451.00 ,"$6,350.83 ","$1,293.09 ","$2,101.13 ","$2,101.13 ","$2,822.59 ","$1,948.80 ","$2,760.80 ","$2,273.60 ","$1,293.09 ","$3,085.60 ","$2,468.48 ","$2,436.00 ",$659.59 ,"$2,760.80 ","$2,822.59 ",$659.59 ,"$1,446.47 ","$2,273.60 ","$1,293.09 ","$2,822.59 ","$2,822.59 ","$1,364.16 ","$2,760.80 ","$6,350.83 ","$2,988.16 ","$2,273.60 ","$1,703.02 ","$2,128.52 ","$1,978.03 ","$2,128.52 ","$2,244.37 ","$2,923.20 ","$2,262.23 ","$2,850.82 ","$2,565.92 ","$1,370.68 ",$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,338.56 ","$2,013.76 ","$2,338.56 ","$2,338.56 ","$2,598.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000378,75726,"HC ANGIO VISERAL, SEL, OR SUPRASEL 75726",320,1 ,"$2,240.00 ","$1,120.00 ",$82.66 ,"$10,579.35 ","$1,293.09 ",$390.12 ,$346.77 ,"$4,701.93 ","$1,344.00 ","$1,904.00 ","$1,568.00 ","$1,293.09 ","$2,128.00 ","$1,702.40 ","$1,680.00 ",$154.12 ,"$1,904.00 ","$4,701.93 ",$154.12 ,$82.66 ,"$1,568.00 ","$1,293.09 ","$4,701.93 ","$4,701.93 ",$940.80 ,"$1,904.00 ","$10,579.35 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$2,016.00 ","$1,560.16 ","$4,748.95 ","$1,769.60 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,701.93 ",$451.00 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000382,75731,HC ANGIO ADRENAL UNILATERAL,320,1 ,"$2,912.00 ","$1,456.00 ",$101.61 ,"$6,350.83 ",$573.58 ,$479.15 ,$425.91 ,"$2,822.59 ","$1,747.20 ","$2,475.20 ","$2,038.40 ",$573.58 ,"$2,766.40 ","$2,213.12 ","$2,184.00 ",$192.88 ,"$2,475.20 ","$2,822.59 ",$192.88 ,$101.61 ,"$2,038.40 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,223.04 ","$2,475.20 ","$6,350.83 ","$2,679.04 ","$2,038.40 ","$2,912.00 ","$2,912.00 ","$1,773.41 ","$2,912.00 ","$2,012.19 ","$2,620.80 ","$2,028.21 ","$2,850.82 ","$2,300.48 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$2,329.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000383,75733,HC ANGIO ADRENAL BILATERAL,320,1 ,"$5,712.00 ","$2,856.00 ",$107.55 ,"$6,350.83 ",$573.58 ,$506.10 ,$449.86 ,"$2,822.59 ","$3,427.20 ","$4,855.20 ","$3,998.40 ",$573.58 ,"$5,426.40 ","$4,341.12 ","$4,284.00 ",$212.03 ,"$4,855.20 ","$2,822.59 ",$212.03 ,$107.55 ,"$3,998.40 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$2,399.04 ","$4,855.20 ","$6,350.83 ","$5,255.04 ","$3,998.40 ","$5,712.00 ","$5,712.00 ","$3,478.61 ","$5,712.00 ","$3,946.99 ","$5,140.80 ","$3,978.41 ","$2,850.82 ","$4,512.48 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$4,112.64 ","$3,541.44 ","$4,112.64 ","$4,112.64 ","$4,569.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000384,75736,HC ANGIO PELVIC SELECT,320,1 ,"$2,240.00 ","$1,120.00 ",$92.36 ,"$10,579.35 ","$1,293.09 ",$435.69 ,$387.28 ,"$4,701.93 ","$1,344.00 ","$1,904.00 ","$1,568.00 ","$1,293.09 ","$2,128.00 ","$1,702.40 ","$1,680.00 ",$176.85 ,"$1,904.00 ","$4,701.93 ",$176.85 ,$92.36 ,"$1,568.00 ","$1,293.09 ","$4,701.93 ","$4,701.93 ",$940.80 ,"$1,904.00 ","$10,579.35 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$2,016.00 ","$1,560.16 ","$4,748.95 ","$1,769.60 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,701.93 ",$451.00 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000385,75741,HC ANGIO PULMONARY UNILAT,320,1 ,"$3,360.00 ","$1,680.00 ",$76.49 ,"$6,350.83 ",$573.58 ,$360.63 ,$320.56 ,"$2,822.59 ","$2,016.00 ","$2,856.00 ","$2,352.00 ",$573.58 ,"$3,192.00 ","$2,553.60 ","$2,520.00 ",$141.20 ,"$2,856.00 ","$2,822.59 ",$141.20 ,$76.49 ,"$2,352.00 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,411.20 ","$2,856.00 ","$6,350.83 ","$3,091.20 ","$2,352.00 ","$3,360.00 ","$3,360.00 ","$2,046.24 ","$3,360.00 ","$2,321.76 ","$3,024.00 ","$2,340.24 ","$2,850.82 ","$2,654.40 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000386,75743,HC ANGIO PULMONARY BILAT,320,1 ,"$3,920.00 ","$1,960.00 ",$77.52 ,"$6,350.83 ",$573.58 ,$365.29 ,$324.70 ,"$2,822.59 ","$2,352.00 ","$3,332.00 ","$2,744.00 ",$573.58 ,"$3,724.00 ","$2,979.20 ","$2,940.00 ",$143.42 ,"$3,332.00 ","$2,822.59 ",$143.42 ,$77.52 ,"$2,744.00 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,646.40 ","$3,332.00 ","$6,350.83 ","$3,606.40 ","$2,744.00 ","$3,920.00 ","$3,920.00 ","$2,387.28 ","$3,920.00 ","$2,708.72 ","$3,528.00 ","$2,730.28 ","$2,850.82 ","$3,096.80 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,822.40 ","$2,430.40 ","$2,822.40 ","$2,822.40 ","$3,136.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000387,75746,HC ANGIO PULMONARY NONSELECT,320,1 ,"$2,688.00 ","$1,344.00 ",$85.17 ,"$6,350.83 ",$573.58 ,$399.43 ,$355.05 ,"$2,822.59 ","$1,612.80 ","$2,284.80 ","$1,881.60 ",$573.58 ,"$2,553.60 ","$2,042.88 ","$2,016.00 ",$160.80 ,"$2,284.80 ","$2,822.59 ",$160.80 ,$85.17 ,"$1,881.60 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,128.96 ","$2,284.80 ","$6,350.83 ","$2,472.96 ","$1,881.60 ","$2,688.00 ","$2,688.00 ","$1,636.99 ","$2,688.00 ","$1,857.41 ","$2,419.20 ","$1,872.19 ","$2,850.82 ","$2,123.52 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$2,150.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000388,75756,HC ANGIO INTERNAL MAMMARY,320,1 ,"$2,240.00 ","$1,120.00 ",$103.32 ,"$6,350.83 ",$573.58 ,$490.01 ,$435.57 ,"$2,822.59 ","$1,344.00 ","$1,904.00 ","$1,568.00 ",$573.58 ,"$2,128.00 ","$1,702.40 ","$1,680.00 ",$206.25 ,"$1,904.00 ","$2,822.59 ",$206.25 ,$103.32 ,"$1,568.00 ",$573.58 ,"$2,822.59 ","$2,822.59 ",$940.80 ,"$1,904.00 ","$6,350.83 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$2,016.00 ","$1,560.16 ","$2,850.82 ","$1,769.60 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000389,75774,HC ANGIO EA VESSEL ADDL 75774,320,1 ,"$1,120.00 ",$560.00 ,$56.62 ,"$1,370.68 ","$1,293.09 ",$284.58 ,$252.96 , N/A ,$672.00 ,$952.00 ,$784.00 ,"$1,293.09 ","$1,064.00 ",$851.20 ,$840.00 ,$102.44 ,$952.00 , N/A ,$102.44 ,$56.62 ,$784.00 ,"$1,293.09 ", N/A , N/A ,$470.40 ,$952.00 , N/A ,"$1,030.40 ",$784.00 ,$568.06 ,$681.74 ,$682.08 ,$681.74 ,$773.92 ,"$1,008.00 ",$780.08 , N/A ,$884.80 ,"$1,370.68 ",$451.00 ,$451.00 , N/A ,$451.00 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,32000391,75803,HC LYMPHANGIOGRAPHY LEGS,320,1 ,"$2,240.00 ","$1,120.00 ",$210.90 ,"$3,119.68 ",$264.62 ,$857.23 ,$761.98 ,"$1,386.53 ","$1,344.00 ","$1,904.00 ","$1,568.00 ",$264.62 ,"$2,128.00 ","$1,702.40 ","$1,680.00 ",$448.56 ,"$1,904.00 ","$1,386.53 ",$448.56 ,$210.90 ,"$1,568.00 ",$264.62 ,"$1,386.53 ","$1,386.53 ",$940.80 ,"$1,904.00 ","$3,119.68 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$2,016.00 ","$1,560.16 ","$1,400.40 ","$1,769.60 ",$280.50 ,$451.00 ,$451.00 ,"$1,386.53 ",$451.00 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000392,75807,HC LYMPHANGIOGRAPHY ABDOM,320,1 ,"$2,128.00 ","$1,064.00 ",$356.66 ,"$6,350.83 ",$573.58 ,$920.83 ,$818.51 ,"$2,822.59 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$573.58 ,"$2,021.60 ","$1,617.28 ","$1,596.00 ",$758.56 ,"$1,808.80 ","$2,822.59 ",$758.56 ,$356.66 ,"$1,489.60 ",$573.58 ,"$2,822.59 ","$2,822.59 ",$893.76 ,"$1,808.80 ","$6,350.83 ","$1,957.76 ","$1,489.60 ","$2,128.00 ","$2,128.00 ","$1,295.95 ","$2,128.00 ","$1,470.45 ","$1,915.20 ","$1,482.15 ","$2,850.82 ","$1,681.12 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,702.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000393,75809,HC SHUNTOGRAM NONVASCULAR,320,1 ,$627.00 ,$313.50 ,$37.92 ,$627.00 ,$37.92 ,$310.97 ,$276.42 ,$107.35 ,$376.20 ,$532.95 ,$438.90 ,$37.92 ,$595.65 ,$476.52 ,$470.25 ,$118.49 ,$532.95 ,$107.35 ,$118.49 ,$64.85 ,$438.90 ,$37.92 ,$107.35 ,$107.35 ,$263.34 ,$532.95 ,$241.53 ,$576.84 ,$438.90 ,$329.30 ,$329.30 ,$381.84 ,$329.30 ,$433.26 ,$564.30 ,$436.71 ,$108.42 ,$495.33 ,$40.20 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$501.60 
ST NICHOLAS HOSPITAL - ACUTE,32000394,75810,HC SPLENOPORTOGRAPHY,320,1 ,"$3,584.00 ","$1,792.00 ",$264.62 ,"$6,350.83 ",$264.62 ,"$1,683.43 ","$1,496.38 ","$2,822.59 ","$2,150.40 ","$3,046.40 ","$2,508.80 ",$264.62 ,"$3,404.80 ","$2,723.84 ","$2,688.00 ","$1,042.38 ","$3,046.40 ","$2,822.59 ","$1,042.38 ",$490.10 ,"$2,508.80 ",$264.62 ,"$2,822.59 ","$2,822.59 ","$1,505.28 ","$3,046.40 ","$6,350.83 ","$3,297.28 ","$2,508.80 ","$3,584.00 ","$3,584.00 ","$2,182.66 ","$3,584.00 ","$2,476.54 ","$3,225.60 ","$2,496.26 ","$2,850.82 ","$2,831.36 ",$280.50 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,580.48 ","$2,222.08 ","$2,580.48 ","$2,580.48 ","$2,867.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000395,75820,HC VENOGRAM EXTREMITY UNI 75820,320,1 ,"$1,456.00 ",$728.00 ,$70.33 ,"$3,119.68 ",$264.62 ,$334.25 ,$297.11 ,"$1,386.53 ",$873.60 ,"$1,237.60 ","$1,019.20 ",$264.62 ,"$1,383.20 ","$1,106.56 ","$1,092.00 ",$121.83 ,"$1,237.60 ","$1,386.53 ",$121.83 ,$70.33 ,"$1,019.20 ",$264.62 ,"$1,386.53 ","$1,386.53 ",$611.52 ,"$1,237.60 ","$3,119.68 ","$1,339.52 ","$1,019.20 ","$1,456.00 ","$1,456.00 ",$886.70 ,"$1,456.00 ","$1,006.10 ","$1,310.40 ","$1,014.10 ","$1,400.40 ","$1,150.24 ",$280.50 ,$451.00 ,$451.00 ,"$1,386.53 ",$451.00 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000397,75822,HC VENOGRAM EXTREMITY BILAT,320,1 ,"$1,792.00 ",$896.00 ,$71.35 ,"$3,119.68 ",$264.62 ,$342.01 ,$304.01 ,"$1,386.53 ","$1,075.20 ","$1,523.20 ","$1,254.40 ",$264.62 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ",$131.20 ,"$1,523.20 ","$1,386.53 ",$131.20 ,$71.35 ,"$1,254.40 ",$264.62 ,"$1,386.53 ","$1,386.53 ",$752.64 ,"$1,523.20 ","$3,119.68 ","$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,612.80 ","$1,248.13 ","$1,400.40 ","$1,415.68 ",$280.50 ,$451.00 ,$451.00 ,"$1,386.53 ",$451.00 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000398,75825,HC VENOGRAPHY CAVAL INFERIOR,320,1 ,"$3,248.00 ","$1,624.00 ",$67.59 ,"$6,350.83 ",$573.58 ,$324.94 ,$288.83 ,"$2,822.59 ","$1,948.80 ","$2,760.80 ","$2,273.60 ",$573.58 ,"$3,085.60 ","$2,468.48 ","$2,436.00 ",$123.18 ,"$2,760.80 ","$2,822.59 ",$123.18 ,$67.59 ,"$2,273.60 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,364.16 ","$2,760.80 ","$6,350.83 ","$2,988.16 ","$2,273.60 ","$3,248.00 ","$3,248.00 ","$1,978.03 ","$3,248.00 ","$2,244.37 ","$2,923.20 ","$2,262.23 ","$2,850.82 ","$2,565.92 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,338.56 ","$2,013.76 ","$2,338.56 ","$2,338.56 ","$2,598.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000399,75827,HC VENOGRAPHY CAVAL SUPERIOR,320,1 ,"$2,576.00 ","$1,288.00 ",$72.04 ,"$3,119.68 ",$264.62 ,$343.56 ,$305.39 ,"$1,386.53 ","$1,545.60 ","$2,189.60 ","$1,803.20 ",$264.62 ,"$2,447.20 ","$1,957.76 ","$1,932.00 ",$133.87 ,"$2,189.60 ","$1,386.53 ",$133.87 ,$72.04 ,"$1,803.20 ",$264.62 ,"$1,386.53 ","$1,386.53 ","$1,081.92 ","$2,189.60 ","$3,119.68 ","$2,369.92 ","$1,803.20 ","$2,576.00 ","$2,576.00 ","$1,568.78 ","$2,576.00 ","$1,780.02 ","$2,318.40 ","$1,794.18 ","$1,400.40 ","$2,035.04 ",$280.50 ,$451.00 ,$451.00 ,"$1,386.53 ",$451.00 ,"$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$2,060.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000400,75831,HC VENOGRAM RENAL UNILAT,320,1 ,"$3,024.00 ","$1,512.00 ",$73.75 ,"$6,350.83 ",$573.58 ,$352.87 ,$313.66 ,"$2,822.59 ","$1,814.40 ","$2,570.40 ","$2,116.80 ",$573.58 ,"$2,872.80 ","$2,298.24 ","$2,268.00 ",$135.87 ,"$2,570.40 ","$2,822.59 ",$135.87 ,$73.75 ,"$2,116.80 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,270.08 ","$2,570.40 ","$6,350.83 ","$2,782.08 ","$2,116.80 ","$3,024.00 ","$3,024.00 ","$1,841.62 ","$3,024.00 ","$2,089.58 ","$2,721.60 ","$2,106.22 ","$2,850.82 ","$2,388.96 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,177.28 ","$1,874.88 ","$2,177.28 ","$2,177.28 ","$2,419.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000401,75833,HC VENOGRAM RENAL BILAT,320,1 ,"$3,360.00 ","$1,680.00 ",$81.40 ,"$6,350.83 ",$573.58 ,$382.92 ,$340.38 ,"$2,822.59 ","$2,016.00 ","$2,856.00 ","$2,352.00 ",$573.58 ,"$3,192.00 ","$2,553.60 ","$2,520.00 ",$155.45 ,"$2,856.00 ","$2,822.59 ",$155.45 ,$81.40 ,"$2,352.00 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,411.20 ","$2,856.00 ","$6,350.83 ","$3,091.20 ","$2,352.00 ","$3,360.00 ","$3,360.00 ","$2,046.24 ","$3,360.00 ","$2,321.76 ","$3,024.00 ","$2,340.24 ","$2,850.82 ","$2,654.40 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000402,75840,HC VENOGRAM ADRENAL UNILAT,320,1 ,"$2,688.00 ","$1,344.00 ",$80.26 ,"$6,350.83 ",$573.58 ,$379.26 ,$337.12 ,"$2,822.59 ","$1,612.80 ","$2,284.80 ","$1,881.60 ",$573.58 ,"$2,553.60 ","$2,042.88 ","$2,016.00 ",$149.24 ,"$2,284.80 ","$2,822.59 ",$149.24 ,$80.26 ,"$1,881.60 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,128.96 ","$2,284.80 ","$6,350.83 ","$2,472.96 ","$1,881.60 ","$2,688.00 ","$2,688.00 ","$1,636.99 ","$2,688.00 ","$1,857.41 ","$2,419.20 ","$1,872.19 ","$2,850.82 ","$2,123.52 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$2,150.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000403,75842,HC VENOGRAM ADRENAL BILAT,320,1 ,"$2,912.00 ","$1,456.00 ",$92.36 ,"$10,579.35 ","$1,293.09 ",$435.69 ,$387.28 ,"$4,701.93 ","$1,747.20 ","$2,475.20 ","$2,038.40 ","$1,293.09 ","$2,766.40 ","$2,213.12 ","$2,184.00 ",$173.49 ,"$2,475.20 ","$4,701.93 ",$173.49 ,$92.36 ,"$2,038.40 ","$1,293.09 ","$4,701.93 ","$4,701.93 ","$1,223.04 ","$2,475.20 ","$10,579.35 ","$2,679.04 ","$2,038.40 ","$2,912.00 ","$2,912.00 ","$1,773.41 ","$2,912.00 ","$2,012.19 ","$2,620.80 ","$2,028.21 ","$4,748.95 ","$2,300.48 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,701.93 ",$451.00 ,"$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$2,329.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000404,75860,HC VENOGRAPHY SINUS/ JUGULAR,320,1 ,"$2,128.00 ","$1,064.00 ",$78.54 ,"$6,350.83 ",$573.58 ,$369.94 ,$328.84 ,"$2,822.59 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$573.58 ,"$2,021.60 ","$1,617.28 ","$1,596.00 ",$145.22 ,"$1,808.80 ","$2,822.59 ",$145.22 ,$78.54 ,"$1,489.60 ",$573.58 ,"$2,822.59 ","$2,822.59 ",$893.76 ,"$1,808.80 ","$6,350.83 ","$1,957.76 ","$1,489.60 ","$2,128.00 ","$2,128.00 ","$1,295.95 ","$2,128.00 ","$1,470.45 ","$1,915.20 ","$1,482.15 ","$2,850.82 ","$1,681.12 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,702.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000406,75870,HC VENOGRAM SUPERIOR SAGITTAL,320,1 ,"$2,016.00 ","$1,008.00 ",$114.85 ,"$6,350.83 ",$264.62 ,$537.56 ,$477.83 ,"$2,822.59 ","$1,209.60 ","$1,713.60 ","$1,411.20 ",$264.62 ,"$1,915.20 ","$1,532.16 ","$1,512.00 ",$204.71 ,"$1,713.60 ","$2,822.59 ",$204.71 ,$114.85 ,"$1,411.20 ",$264.62 ,"$2,822.59 ","$2,822.59 ",$846.72 ,"$1,713.60 ","$6,350.83 ","$1,854.72 ","$1,411.20 ","$1,151.83 ","$1,151.83 ","$1,227.74 ","$1,151.83 ","$1,393.06 ","$1,814.40 ","$1,404.14 ","$2,850.82 ","$1,592.64 ",$280.50 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$1,451.52 ","$1,249.92 ","$1,451.52 ","$1,451.52 ","$1,612.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000407,75872,HC VENOGRAM EPIDURAL,320,1 ,"$2,352.00 ","$1,176.00 ",$80.26 ,"$2,352.00 ",$264.62 ,$379.26 ,$337.12 ,$532.96 ,"$1,411.20 ","$1,999.20 ","$1,646.40 ",$264.62 ,"$2,234.40 ","$1,787.52 ","$1,764.00 ",$149.24 ,"$1,999.20 ",$532.96 ,$149.24 ,$80.26 ,"$1,646.40 ",$264.62 ,$532.96 ,$532.96 ,$987.84 ,"$1,999.20 ","$1,199.16 ","$2,163.84 ","$1,646.40 ","$2,352.00 ","$2,352.00 ","$1,432.37 ","$2,352.00 ","$1,625.23 ","$2,116.80 ","$1,638.17 ",$538.29 ,"$1,858.08 ",$280.50 ,$451.00 ,$451.00 ,$532.96 ,$451.00 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,881.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000408,75880,HC VENOGRAM ORBITAL,320,1 ,"$1,456.00 ",$728.00 ,$80.26 ,"$1,456.00 ",$264.62 ,$377.70 ,$335.74 ,$532.96 ,$873.60 ,"$1,237.60 ","$1,019.20 ",$264.62 ,"$1,383.20 ","$1,106.56 ","$1,092.00 ",$148.58 ,"$1,237.60 ",$532.96 ,$148.58 ,$80.26 ,"$1,019.20 ",$264.62 ,$532.96 ,$532.96 ,$611.52 ,"$1,237.60 ","$1,199.16 ","$1,339.52 ","$1,019.20 ","$1,456.00 ","$1,456.00 ",$886.70 ,"$1,456.00 ","$1,006.10 ","$1,310.40 ","$1,014.10 ",$538.29 ,"$1,150.24 ",$280.50 ,$451.00 ,$451.00 ,$532.96 ,$451.00 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000409,75885,HC TRANSHEPATIC PORTOGRAPHY W/ HEMO,320,1 ,"$3,584.00 ","$1,792.00 ",$77.87 ,"$6,350.83 ",$573.58 ,$366.84 ,$326.08 ,"$2,822.59 ","$2,150.40 ","$3,046.40 ","$2,508.80 ",$573.58 ,"$3,404.80 ","$2,723.84 ","$2,688.00 ",$142.54 ,"$3,046.40 ","$2,822.59 ",$142.54 ,$77.87 ,"$2,508.80 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,505.28 ","$3,046.40 ","$6,350.83 ","$3,297.28 ","$2,508.80 ","$3,584.00 ","$3,584.00 ","$2,182.66 ","$3,584.00 ","$2,476.54 ","$3,225.60 ","$2,496.26 ","$2,850.82 ","$2,831.36 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,580.48 ","$2,222.08 ","$2,580.48 ","$2,580.48 ","$2,867.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000411,75889,HC VENOGRAM HEPATIC W/HEMO,320,1 ,$776.00 ,$388.00 ,$77.86 ,"$6,350.83 ",$573.58 ,$368.39 ,$327.46 ,"$2,822.59 ",$465.60 ,$659.60 ,$543.20 ,$573.58 ,$737.20 ,$589.76 ,$582.00 ,$143.89 ,$659.60 ,"$2,822.59 ",$143.89 ,$77.86 ,$543.20 ,$573.58 ,"$2,822.59 ","$2,822.59 ",$325.92 ,$659.60 ,"$6,350.83 ",$713.92 ,$543.20 ,$776.00 ,$776.00 ,$472.58 ,$776.00 ,$536.22 ,$698.40 ,$540.48 ,"$2,850.82 ",$613.04 ,$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$620.80 
ST NICHOLAS HOSPITAL - ACUTE,32000412,75891,HC VENOGRAM HEPATIC W/O HEMO,320,1 ,"$3,472.00 ","$1,736.00 ",$78.89 ,"$6,350.83 ",$573.58 ,$373.05 ,$331.60 ,"$2,822.59 ","$2,083.20 ","$2,951.20 ","$2,430.40 ",$573.58 ,"$3,298.40 ","$2,638.72 ","$2,604.00 ",$144.57 ,"$2,951.20 ","$2,822.59 ",$144.57 ,$78.89 ,"$2,430.40 ",$573.58 ,"$2,822.59 ","$2,822.59 ","$1,458.24 ","$2,951.20 ","$6,350.83 ","$3,194.24 ","$2,430.40 ","$3,472.00 ","$3,472.00 ","$2,114.45 ","$3,472.00 ","$2,399.15 ","$3,124.80 ","$2,418.25 ","$2,850.82 ","$2,742.88 ",$607.99 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,"$2,499.84 ","$2,152.64 ","$2,499.84 ","$2,499.84 ","$2,777.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000413,75893,HC VENOGRAM SAMPLING CATH,320,1 ,"$4,704.00 ","$2,352.00 ",$84.72 ,"$10,579.35 ","$1,293.09 ",$394.78 ,$350.91 ,"$4,701.93 ","$2,822.40 ","$3,998.40 ","$3,292.80 ","$1,293.09 ","$4,468.80 ","$3,575.04 ","$3,528.00 ",$155.92 ,"$3,998.40 ","$4,701.93 ",$155.92 ,$84.72 ,"$3,292.80 ","$1,293.09 ","$4,701.93 ","$4,701.93 ","$1,975.68 ","$3,998.40 ","$10,579.35 ","$4,327.68 ","$3,292.80 ","$4,704.00 ","$4,704.00 ","$2,864.74 ","$4,704.00 ","$3,250.46 ","$4,233.60 ","$3,276.34 ","$4,748.95 ","$3,716.16 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,701.93 ",$451.00 ,"$3,386.88 ","$2,916.48 ","$3,386.88 ","$3,386.88 ","$3,763.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000414,75894,HC TRANSCATH EMBOLIZATION 75894,320,1 ,"$4,704.00 ","$2,352.00 ",$56.46 ,"$4,704.00 ",$56.46 ,"$4,112.36 ","$3,655.43 ", N/A ,"$2,822.40 ","$3,998.40 ","$3,292.80 ",$56.46 ,"$4,468.80 ","$3,575.04 ","$3,528.00 ","$1,997.46 ","$3,998.40 ", N/A ,"$1,997.46 ",$939.15 ,"$3,292.80 ",$56.46 , N/A , N/A ,"$1,975.68 ","$3,998.40 ", N/A ,"$4,327.68 ","$3,292.80 ","$2,385.87 ","$2,863.32 ","$2,864.74 ","$2,863.32 ","$3,250.46 ","$4,233.60 ","$3,276.34 ", N/A ,"$3,716.16 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$3,386.88 ","$2,916.48 ","$3,386.88 ","$3,386.88 ","$3,763.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000417,75898,HC TRANSCATH ANGIO EXIST 75898,320,1 ,"$1,120.00 ",$560.00 ,$40.90 ,"$6,350.83 ",$264.62 ,$190.79 ,$169.59 ,"$2,822.59 ",$672.00 ,$952.00 ,$784.00 ,$264.62 ,"$1,064.00 ",$851.20 ,$840.00 ,$86.98 ,$952.00 ,"$2,822.59 ",$86.98 ,$40.90 ,$784.00 ,$264.62 ,"$2,822.59 ","$2,822.59 ",$470.40 ,$952.00 ,"$6,350.83 ","$1,030.40 ",$784.00 ,"$1,120.00 ","$1,120.00 ",$682.08 ,"$1,120.00 ",$773.92 ,"$1,008.00 ",$780.08 ,"$2,850.82 ",$884.80 ,$280.50 ,$451.00 ,$451.00 ,"$2,822.59 ",$451.00 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$896.00 
ST NICHOLAS HOSPITAL - ACUTE,32000421,75901,HC REMOVE PERICATH OBST CV CATH,320,1 ,$806.00 ,$403.00 ,$56.46 ,$806.00 ,$56.46 ,$767.26 ,$682.01 , N/A ,$483.60 ,$685.10 ,$564.20 ,$56.46 ,$765.70 ,$612.56 ,$604.50 ,$433.45 ,$685.10 , N/A ,$433.45 ,$187.23 ,$564.20 ,$56.46 , N/A , N/A ,$338.52 ,$685.10 , N/A ,$741.52 ,$564.20 ,$408.80 ,$490.61 ,$490.85 ,$490.61 ,$556.95 ,$725.40 ,$561.38 , N/A ,$636.74 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$580.32 ,$499.72 ,$580.32 ,$580.32 ,$644.80 
ST NICHOLAS HOSPITAL - ACUTE,32000422,75902,HC REMOVE INTRALUMN OBST CV CATH,320,1 ,$672.00 ,$336.00 ,$56.46 ,$672.00 ,$56.46 ,$259.75 ,$230.89 , N/A ,$403.20 ,$571.20 ,$470.40 ,$56.46 ,$638.40 ,$510.72 ,$504.00 ,$150.57 ,$571.20 , N/A ,$150.57 ,$63.48 ,$470.40 ,$56.46 , N/A , N/A ,$282.24 ,$571.20 , N/A ,$618.24 ,$470.40 ,$340.84 ,$409.05 ,$409.25 ,$409.05 ,$464.35 ,$604.80 ,$468.05 , N/A ,$530.88 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$483.84 ,$416.64 ,$483.84 ,$483.84 ,$537.60 
ST NICHOLAS HOSPITAL - ACUTE,32000423,37191,HC IVC FILTER PLACEMENT 37191,320,1 ,"$8,300.00 ","$4,150.00 ",$420.11 ,"$10,579.35 ","$1,123.24 ","$5,369.27 ","$5,369.27 ","$4,701.93 ","$4,980.00 ","$7,055.00 ","$5,810.00 ","$1,123.24 ","$7,885.00 ","$6,308.00 ","$6,225.00 ",$420.11 ,"$7,055.00 ","$4,701.93 ",$420.11 ,"$2,325.28 ","$5,810.00 ","$1,123.24 ","$4,701.93 ","$4,701.93 ","$3,486.00 ","$7,055.00 ","$10,579.35 ","$7,636.00 ","$5,810.00 ","$4,794.94 ","$5,993.67 ","$5,054.70 ","$5,993.67 ","$5,735.30 ","$7,470.00 ","$5,780.95 ","$4,748.95 ","$6,557.00 ","$1,190.63 ",$451.00 ,$451.00 ,"$4,701.93 ",$451.00 ,"$5,976.00 ","$5,146.00 ","$5,976.00 ","$5,976.00 ","$6,640.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000435,75970,HC TRANSCATH BX,320,1 ,"$2,800.00 ","$1,400.00 ",$56.46 ,"$2,800.00 ",$56.46 ,"$1,717.57 ","$1,526.73 ", N/A ,"$1,680.00 ","$2,380.00 ","$1,960.00 ",$56.46 ,"$2,660.00 ","$2,128.00 ","$2,100.00 ",$954.50 ,"$2,380.00 ", N/A ,$954.50 ,$448.78 ,"$1,960.00 ",$56.46 , N/A , N/A ,"$1,176.00 ","$2,380.00 ", N/A ,"$2,576.00 ","$1,960.00 ","$1,420.16 ","$1,704.36 ","$1,705.20 ","$1,704.36 ","$1,934.80 ","$2,520.00 ","$1,950.20 ", N/A ,"$2,212.00 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$2,016.00 ","$1,736.00 ","$2,016.00 ","$2,016.00 ","$2,240.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000436,75970,HC TRANSCATH BX TRNJUG LIVER,320,1 ,"$2,800.00 ","$1,400.00 ",$56.46 ,"$2,800.00 ",$56.46 ,"$1,717.57 ","$1,526.73 ", N/A ,"$1,680.00 ","$2,380.00 ","$1,960.00 ",$56.46 ,"$2,660.00 ","$2,128.00 ","$2,100.00 ",$954.50 ,"$2,380.00 ", N/A ,$954.50 ,$448.78 ,"$1,960.00 ",$56.46 , N/A , N/A ,"$1,176.00 ","$2,380.00 ", N/A ,"$2,576.00 ","$1,960.00 ","$1,420.16 ","$1,704.36 ","$1,705.20 ","$1,704.36 ","$1,934.80 ","$2,520.00 ","$1,950.20 ", N/A ,"$2,212.00 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$2,016.00 ","$1,736.00 ","$2,016.00 ","$2,016.00 ","$2,240.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000438,47533,HC TRANSHEPATIC DRAINAGE,320,1 ,"$6,572.00 ","$3,286.00 ",$451.00 ,"$7,058.37 ",$791.20 ,"$4,251.43 ","$4,251.43 ","$3,137.05 ","$3,943.20 ","$5,586.20 ","$4,600.40 ",$791.20 ,"$6,243.40 ","$4,994.72 ","$4,929.00 ",$511.13 ,"$5,586.20 ","$3,137.05 ",$511.13 ,"$1,225.16 ","$4,600.40 ",$791.20 ,"$3,137.05 ","$3,137.05 ","$2,760.24 ","$5,586.20 ","$7,058.37 ","$6,046.24 ","$4,600.40 ","$1,703.02 ","$2,128.52 ","$4,002.35 ","$2,128.52 ","$4,541.25 ","$5,914.80 ","$4,577.40 ","$3,168.42 ","$5,191.88 ",$838.67 ,$451.00 ,$451.00 ,"$3,137.05 ",$451.00 ,"$4,731.84 ","$4,074.64 ","$4,731.84 ","$4,731.84 ","$5,257.60 "
ST NICHOLAS HOSPITAL - ACUTE,32000439,47534,HC PLACE BILIARY DRAINAGE CATH,320,1 ,"$6,895.00 ","$3,447.50 ",$451.00 ,"$7,058.37 ",$791.20 ,"$4,460.38 ","$4,460.38 ","$3,137.05 ","$4,137.00 ","$5,860.75 ","$4,826.50 ",$791.20 ,"$6,550.25 ","$5,240.20 ","$5,171.25 ",$713.15 ,"$5,860.75 ","$3,137.05 ",$713.15 ,"$1,393.10 ","$4,826.50 ",$791.20 ,"$3,137.05 ","$3,137.05 ","$2,895.90 ","$5,860.75 ","$7,058.37 ","$6,343.40 ","$4,826.50 ","$4,794.94 ","$5,993.67 ","$4,199.06 ","$5,993.67 ","$4,764.45 ","$6,205.50 ","$4,802.37 ","$3,168.42 ","$5,447.05 ",$838.67 ,$451.00 ,$451.00 ,"$3,137.05 ",$451.00 ,"$4,964.40 ","$4,274.90 ","$4,964.40 ","$4,964.40 ","$5,516.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000440,75984,HC CHANGE PERC DRAINAGE TUBE OR CATH,320,1 ,$874.00 ,$437.00 ,$56.46 ,$874.00 ,$56.46 ,$293.90 ,$261.24 , N/A ,$524.40 ,$742.90 ,$611.80 ,$56.46 ,$830.30 ,$664.24 ,$655.50 ,$119.82 ,$742.90 , N/A ,$119.82 ,$61.42 ,$611.80 ,$56.46 , N/A , N/A ,$367.08 ,$742.90 , N/A ,$804.08 ,$611.80 ,$443.29 ,$532.00 ,$532.27 ,$532.00 ,$603.93 ,$786.60 ,$608.74 , N/A ,$690.46 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$699.20 
ST NICHOLAS HOSPITAL - ACUTE,32000440,75984,HC CHANGE PERC DRAINAGE TUBE OR CATH,320,1 ,$874.00 ,$437.00 ,$56.46 ,$874.00 ,$56.46 ,$293.90 ,$261.24 , N/A ,$524.40 ,$742.90 ,$611.80 ,$56.46 ,$830.30 ,$664.24 ,$655.50 ,$119.82 ,$742.90 , N/A ,$119.82 ,$61.42 ,$611.80 ,$56.46 , N/A , N/A ,$367.08 ,$742.90 , N/A ,$804.08 ,$611.80 ,$443.29 ,$532.00 ,$532.27 ,$532.00 ,$603.93 ,$786.60 ,$608.74 , N/A ,$690.46 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$699.20 
ST NICHOLAS HOSPITAL - ACUTE,32000444,49406,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER,320,1 ,"$1,300.00 ",$650.00 ,$232.13 ,"$3,121.49 ",$232.13 ,$840.97 ,$840.97 ,"$1,387.33 ",$780.00 ,"$1,105.00 ",$910.00 ,$232.13 ,"$1,235.00 ",$988.00 ,$975.00 ,$378.00 ,"$1,105.00 ","$1,387.33 ",$378.00 ,$860.35 ,$910.00 ,$232.13 ,"$1,387.33 ","$1,387.33 ",$546.00 ,"$1,105.00 ","$3,121.49 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,"$1,170.00 ",$905.45 ,"$1,401.20 ","$1,027.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,"$1,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$1,456.00 ",$728.00 ,$56.46 ,"$1,456.00 ",$56.46 ,$273.72 ,$243.31 , N/A ,$873.60 ,"$1,237.60 ","$1,019.20 ",$56.46 ,"$1,383.20 ","$1,106.56 ","$1,092.00 ",$118.51 ,"$1,237.60 ", N/A ,$118.51 ,$60.40 ,"$1,019.20 ",$56.46 , N/A , N/A ,$611.52 ,"$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ",$738.48 ,$886.27 ,$886.70 ,$886.27 ,"$1,006.10 ","$1,310.40 ","$1,014.10 ", N/A ,"$1,150.24 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000446,75989,HC GUID FOR PERC CHEST TUBE INSERTION,320,1 ,"$1,456.00 ",$728.00 ,$56.46 ,"$1,456.00 ",$56.46 ,$273.72 ,$243.31 , N/A ,$873.60 ,"$1,237.60 ","$1,019.20 ",$56.46 ,"$1,383.20 ","$1,106.56 ","$1,092.00 ",$118.51 ,"$1,237.60 ", N/A ,$118.51 ,$60.40 ,"$1,019.20 ",$56.46 , N/A , N/A ,$611.52 ,"$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ",$738.48 ,$886.27 ,$886.70 ,$886.27 ,"$1,006.10 ","$1,310.40 ","$1,014.10 ", N/A ,"$1,150.24 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$560.00 ,$280.00 ,$25.12 ,$560.00 ,$37.92 ,$137.14 ,$121.90 ,$226.88 ,$336.00 ,$476.00 ,$392.00 ,$37.92 ,$532.00 ,$425.60 ,$420.00 ,$55.00 ,$476.00 ,$226.88 ,$55.00 ,$25.12 ,$392.00 ,$37.92 ,$226.88 ,$226.88 ,$235.20 ,$476.00 ,$510.48 ,$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$390.04 ,$229.15 ,$442.40 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000450,76000,HC FLUORO CARM < 1 HR,320,1 ,$560.00 ,$280.00 ,$25.12 ,$560.00 ,$37.92 ,$137.14 ,$121.90 ,$226.88 ,$336.00 ,$476.00 ,$392.00 ,$37.92 ,$532.00 ,$425.60 ,$420.00 ,$55.00 ,$476.00 ,$226.88 ,$55.00 ,$25.12 ,$392.00 ,$37.92 ,$226.88 ,$226.88 ,$235.20 ,$476.00 ,$510.48 ,$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$390.04 ,$229.15 ,$442.40 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000452,N/A,HC FLUORO  OARM/CARM <1 HR OR,360,1 ,$987.00 ,$493.50 ,$493.50 ,$987.00 , N/A , N/A , N/A , N/A ,$592.20 ,$838.95 ,$690.90 , N/A ,$937.65 ,$750.12 ,$740.25 , N/A ,$838.95 , N/A , N/A , N/A ,$690.90 , N/A , N/A , N/A , N/A ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$600.79 ,$682.02 ,$888.30 ,$687.45 , N/A ,$779.73 , N/A , N/A , N/A , N/A , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$789.60 
ST NICHOLAS HOSPITAL - ACUTE,32000453,N/A,HC FLUOROSCOPY UP TO 1 HR SEED OR,360,1 ,$987.00 ,$493.50 ,$493.50 ,$987.00 , N/A , N/A , N/A , N/A ,$592.20 ,$838.95 ,$690.90 , N/A ,$937.65 ,$750.12 ,$740.25 , N/A ,$838.95 , N/A , N/A , N/A ,$690.90 , N/A , N/A , N/A , N/A ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$600.79 ,$682.02 ,$888.30 ,$687.45 , N/A ,$779.73 , N/A , N/A , N/A , N/A , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$789.60 
ST NICHOLAS HOSPITAL - ACUTE,32000455,N/A,HC FLUORO MINI CARM < 1 HR OR,360,1 ,$987.00 ,$493.50 ,$493.50 ,$987.00 , N/A , N/A , N/A , N/A ,$592.20 ,$838.95 ,$690.90 , N/A ,$937.65 ,$750.12 ,$740.25 , N/A ,$838.95 , N/A , N/A , N/A ,$690.90 , N/A , N/A , N/A , N/A ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$600.79 ,$682.02 ,$888.30 ,$687.45 , N/A ,$779.73 , N/A , N/A , N/A , N/A , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$789.60 
ST NICHOLAS HOSPITAL - ACUTE,32000456,N/A,HC CARM FLUORO > 1 HR OR,360,1 ,"$1,050.00 ",$525.00 ,$525.00 ,"$1,050.00 ", N/A , N/A , N/A , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$798.00 ,$787.50 , N/A ,$892.50 , N/A , N/A , N/A ,$735.00 , N/A , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$639.14 ,$725.55 ,$945.00 ,$731.33 , N/A ,$829.50 , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$840.00 
ST NICHOLAS HOSPITAL - ACUTE,32000464,76010,HC BABYGRAM,320,1 ,$336.00 ,$168.00 ,$17.98 ,$336.00 ,$17.98 ,$78.16 ,$69.48 ,$79.76 ,$201.60 ,$285.60 ,$235.20 ,$17.98 ,$319.20 ,$255.36 ,$252.00 ,$41.66 ,$285.60 ,$79.76 ,$41.66 ,$18.61 ,$235.20 ,$17.98 ,$79.76 ,$79.76 ,$141.12 ,$285.60 ,$179.45 ,$309.12 ,$235.20 ,$207.78 ,$207.78 ,$204.62 ,$207.78 ,$232.18 ,$302.40 ,$234.02 ,$80.56 ,$265.44 ,$19.06 ,$336.00 ,$336.00 ,$79.76 ,$336.00 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,32000465,76080,HC ABSCESS FISTULA OR SINUS TRACT,320,1 ,$728.00 ,$364.00 ,$31.62 ,"$1,071.96 ",$37.92 ,$134.04 ,$119.14 ,$476.43 ,$436.80 ,$618.80 ,$509.60 ,$37.92 ,$691.60 ,$553.28 ,$546.00 ,$71.05 ,$618.80 ,$476.43 ,$71.05 ,$31.62 ,$509.60 ,$37.92 ,$476.43 ,$476.43 ,$305.76 ,$618.80 ,"$1,071.96 ",$669.76 ,$509.60 ,$728.00 ,$728.00 ,$443.35 ,$728.00 ,$503.05 ,$655.20 ,$507.05 ,$481.19 ,$575.12 ,$40.20 ,$451.00 ,$451.00 ,$476.43 ,$451.00 ,$524.16 ,$451.36 ,$524.16 ,$524.16 ,$582.40 
ST NICHOLAS HOSPITAL - ACUTE,32000466,76080,HC ABSCESS FISTULA DRAINAGE CATH CHECK,320,1 ,$728.00 ,$364.00 ,$31.62 ,"$1,071.96 ",$37.92 ,$134.04 ,$119.14 ,$476.43 ,$436.80 ,$618.80 ,$509.60 ,$37.92 ,$691.60 ,$553.28 ,$546.00 ,$71.05 ,$618.80 ,$476.43 ,$71.05 ,$31.62 ,$509.60 ,$37.92 ,$476.43 ,$476.43 ,$305.76 ,$618.80 ,"$1,071.96 ",$669.76 ,$509.60 ,$728.00 ,$728.00 ,$443.35 ,$728.00 ,$503.05 ,$655.20 ,$507.05 ,$481.19 ,$575.12 ,$40.20 ,$451.00 ,$451.00 ,$476.43 ,$451.00 ,$524.16 ,$451.36 ,$524.16 ,$524.16 ,$582.40 
ST NICHOLAS HOSPITAL - ACUTE,32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$428.00 ,$214.00 ,$25.80 ,"$1,071.96 ",$37.92 ,$36.26 ,$32.23 ,$476.43 ,$256.80 ,$363.80 ,$299.60 ,$37.92 ,$406.60 ,$325.28 ,$321.00 ,$50.35 ,$363.80 ,$476.43 ,$50.35 ,$25.80 ,$299.60 ,$37.92 ,$476.43 ,$476.43 ,$179.76 ,$363.80 ,"$1,071.96 ",$393.76 ,$299.60 ,$428.00 ,$428.00 ,$260.65 ,$428.00 ,$295.75 ,$385.20 ,$298.10 ,$481.19 ,$338.12 ,$40.20 ,$428.00 ,$428.00 ,$476.43 ,$428.00 ,$308.16 ,$265.36 ,$308.16 ,$308.16 ,$342.40 
ST NICHOLAS HOSPITAL - ACUTE,32000472,76101,HC RADIOLOGICAL EXAM COMPLEX UNI,320,1 ,$896.00 ,$448.00 ,$67.71 ,$896.00 , N/A ,$286.14 ,$254.34 , N/A ,$537.60 ,$761.60 ,$627.20 , N/A ,$851.20 ,$680.96 ,$672.00 ,$149.34 ,$761.60 , N/A ,$149.34 ,$67.71 ,$627.20 , N/A , N/A , N/A ,$376.32 ,$761.60 , N/A ,$824.32 ,$627.20 ,$454.45 ,$545.40 ,$545.66 ,$545.40 ,$619.14 ,$806.40 ,$624.06 , N/A ,$707.84 , N/A ,$451.00 ,$451.00 , N/A ,$451.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$504.00 ,$252.00 ,$56.46 ,$504.00 ,$56.46 ,$312.52 ,$277.80 , N/A ,$302.40 ,$428.40 ,$352.80 ,$56.46 ,$478.80 ,$383.04 ,$378.00 ,$169.29 ,$428.40 , N/A ,$169.29 ,$74.44 ,$352.80 ,$56.46 , N/A , N/A ,$211.68 ,$428.40 , N/A ,$463.68 ,$352.80 ,$255.63 ,$306.78 ,$306.94 ,$306.78 ,$348.26 ,$453.60 ,$351.04 , N/A ,$398.16 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$362.88 ,$312.48 ,$362.88 ,$362.88 ,$403.20 
ST NICHOLAS HOSPITAL - ACUTE,32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$560.00 ,$280.00 ,$56.46 ,$560.00 ,$56.46 ,$320.28 ,$284.69 , N/A ,$336.00 ,$476.00 ,$392.00 ,$56.46 ,$532.00 ,$425.60 ,$420.00 ,$179.31 ,$476.00 , N/A ,$179.31 ,$77.18 ,$392.00 ,$56.46 , N/A , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$340.87 ,$386.96 ,$504.00 ,$390.04 , N/A ,$442.40 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000477,77002,HC FLUORO NEEDLE PLACEMENT BX ASP IN,320,1 ,$560.00 ,$280.00 ,$56.46 ,$560.00 ,$56.46 ,$320.28 ,$284.69 , N/A ,$336.00 ,$476.00 ,$392.00 ,$56.46 ,$532.00 ,$425.60 ,$420.00 ,$179.31 ,$476.00 , N/A ,$179.31 ,$77.18 ,$392.00 ,$56.46 , N/A , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$340.87 ,$386.96 ,$504.00 ,$390.04 , N/A ,$442.40 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000478,77002,HC FLUORO NEEDLE PLACEMENT LOCAL,320,1 ,$560.00 ,$280.00 ,$56.46 ,$560.00 ,$56.46 ,$320.28 ,$284.69 , N/A ,$336.00 ,$476.00 ,$392.00 ,$56.46 ,$532.00 ,$425.60 ,$420.00 ,$179.31 ,$476.00 , N/A ,$179.31 ,$77.18 ,$392.00 ,$56.46 , N/A , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$340.87 ,$386.96 ,$504.00 ,$390.04 , N/A ,$442.40 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000479,77002,HC FLUORO NEEDLE PLACEMENT HIP,320,1 ,$560.00 ,$280.00 ,$56.46 ,$560.00 ,$56.46 ,$320.28 ,$284.69 , N/A ,$336.00 ,$476.00 ,$392.00 ,$56.46 ,$532.00 ,$425.60 ,$420.00 ,$179.31 ,$476.00 , N/A ,$179.31 ,$77.18 ,$392.00 ,$56.46 , N/A , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$340.87 ,$386.96 ,$504.00 ,$390.04 , N/A ,$442.40 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,$616.00 ,$308.00 ,$56.46 ,$616.00 ,$56.46 ,$295.45 ,$262.62 , N/A ,$369.60 ,$523.60 ,$431.20 ,$56.46 ,$585.20 ,$468.16 ,$462.00 ,$153.91 ,$523.60 , N/A ,$153.91 ,$68.27 ,$431.20 ,$56.46 , N/A , N/A ,$258.72 ,$523.60 , N/A ,$566.72 ,$431.20 ,$312.44 ,$374.96 ,$375.14 ,$374.96 ,$425.66 ,$554.40 ,$429.04 , N/A ,$486.64 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$492.80 
ST NICHOLAS HOSPITAL - ACUTE,32000483,19283,HC MAMM STER GUIDE BRST NDL PL,320,1 ,"$1,300.00 ",$650.00 ,$194.20 ,"$1,380.55 ",$258.03 ,$840.97 ,$840.97 ,$613.58 ,$780.00 ,"$1,105.00 ",$910.00 ,$258.03 ,"$1,235.00 ",$988.00 ,$975.00 ,$194.20 ,"$1,105.00 ",$613.58 ,$194.20 ,$264.47 ,$910.00 ,$258.03 ,$613.58 ,$613.58 ,$546.00 ,"$1,105.00 ","$1,380.55 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,"$1,170.00 ",$905.45 ,$619.72 ,"$1,027.00 ",$273.51 ,$451.00 ,$451.00 ,$613.58 ,$451.00 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,"$1,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000486,19283,HC MAMM STER GUIDE BRST STEREO CORE,320,1 ,"$1,300.00 ",$650.00 ,$194.20 ,"$1,380.55 ",$258.03 ,$840.97 ,$840.97 ,$613.58 ,$780.00 ,"$1,105.00 ",$910.00 ,$258.03 ,"$1,235.00 ",$988.00 ,$975.00 ,$194.20 ,"$1,105.00 ",$613.58 ,$194.20 ,$264.47 ,$910.00 ,$258.03 ,$613.58 ,$613.58 ,$546.00 ,"$1,105.00 ","$1,380.55 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,"$1,170.00 ",$905.45 ,$619.72 ,"$1,027.00 ",$273.51 ,$451.00 ,$451.00 ,$613.58 ,$451.00 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,"$1,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$3,000.00 ","$1,500.00 ",$319.86 ,"$3,121.49 ",$439.46 ,"$1,940.70 ","$1,940.70 ","$1,387.33 ","$1,800.00 ","$2,550.00 ","$2,100.00 ",$439.46 ,"$2,850.00 ","$2,280.00 ","$2,250.00 ",$319.86 ,"$2,550.00 ","$1,387.33 ",$319.86 ,$592.69 ,"$2,100.00 ",$439.46 ,"$1,387.33 ","$1,387.33 ","$1,260.00 ","$2,550.00 ","$3,121.49 ","$2,760.00 ","$2,100.00 ","$1,921.55 ","$2,401.67 ","$1,827.00 ","$2,401.67 ","$2,073.00 ","$2,700.00 ","$2,089.50 ","$1,401.20 ","$2,370.00 ",$465.83 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$2,160.00 ","$1,860.00 ","$2,160.00 ","$2,160.00 ","$2,400.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$3,000.00 ","$1,500.00 ",$319.86 ,"$3,121.49 ",$439.46 ,"$1,940.70 ","$1,940.70 ","$1,387.33 ","$1,800.00 ","$2,550.00 ","$2,100.00 ",$439.46 ,"$2,850.00 ","$2,280.00 ","$2,250.00 ",$319.86 ,"$2,550.00 ","$1,387.33 ",$319.86 ,$592.69 ,"$2,100.00 ",$439.46 ,"$1,387.33 ","$1,387.33 ","$1,260.00 ","$2,550.00 ","$3,121.49 ","$2,760.00 ","$2,100.00 ","$1,921.55 ","$2,401.67 ","$1,827.00 ","$2,401.67 ","$2,073.00 ","$2,700.00 ","$2,089.50 ","$1,401.20 ","$2,370.00 ",$465.83 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$2,160.00 ","$1,860.00 ","$2,160.00 ","$2,160.00 ","$2,400.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000488,19284,HC MAMM STER GUIDE BRST MAMMT STEREO CORE ADDN,361,1 ,$150.00 ,$75.00 ,$75.00 ,"$2,401.67 ",$258.03 ,$150.00 ,$150.00 , N/A ,$90.00 ,$127.50 ,$105.00 ,$258.03 ,$142.50 ,$114.00 ,$112.50 ,$150.00 ,$127.50 , N/A ,$150.00 ,$97.50 ,$105.00 ,$258.03 , N/A , N/A ,$150.00 ,$127.50 , N/A ,$138.00 ,$105.00 ,"$1,921.55 ","$2,401.67 ",$91.35 ,"$2,401.67 ",$103.65 ,$135.00 ,$104.48 , N/A ,$118.50 ,$273.51 ,$150.00 ,$150.00 , N/A ,$150.00 ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$120.00 
ST NICHOLAS HOSPITAL - ACUTE,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,$740.00 ,$370.00 ,$193.79 ,"$1,380.55 ",$258.03 ,$478.71 ,$478.71 ,$613.58 ,$444.00 ,$629.00 ,$518.00 ,$258.03 ,$703.00 ,$562.40 ,$555.00 ,$193.79 ,$629.00 ,$613.58 ,$193.79 ,$238.78 ,$518.00 ,$258.03 ,$613.58 ,$613.58 ,$310.80 ,$629.00 ,"$1,380.55 ",$680.80 ,$518.00 ,$740.00 ,$740.00 ,$450.66 ,$740.00 ,$511.34 ,$666.00 ,$515.41 ,$619.72 ,$584.60 ,$273.51 ,$451.00 ,$451.00 ,$613.58 ,$451.00 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$592.00 
ST NICHOLAS HOSPITAL - ACUTE,32000490,77053,HC GALACTOGRAM SINGLE DUCT,320,1 ,$856.00 ,$428.00 ,$37.10 ,$856.00 ,$37.92 ,$171.29 ,$152.25 ,$226.88 ,$513.60 ,$727.60 ,$599.20 ,$37.92 ,$813.20 ,$650.56 ,$642.00 ,$71.71 ,$727.60 ,$226.88 ,$71.71 ,$37.10 ,$599.20 ,$37.92 ,$226.88 ,$226.88 ,$359.52 ,$727.60 ,$510.48 ,$787.52 ,$599.20 ,$856.00 ,$856.00 ,$521.30 ,$856.00 ,$591.50 ,$770.40 ,$596.20 ,$229.15 ,$676.24 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$616.32 ,$530.72 ,$616.32 ,$616.32 ,$684.80 
ST NICHOLAS HOSPITAL - ACUTE,32000491,77054,HC GALACTOGRAM MULTI DUCT,320,1 ,$856.00 ,$428.00 ,$37.92 ,$856.00 ,$37.92 ,$227.16 ,$201.92 ,$226.88 ,$513.60 ,$727.60 ,$599.20 ,$37.92 ,$813.20 ,$650.56 ,$642.00 ,$94.44 ,$727.60 ,$226.88 ,$94.44 ,$48.74 ,$599.20 ,$37.92 ,$226.88 ,$226.88 ,$359.52 ,$727.60 ,$510.48 ,$787.52 ,$599.20 ,$856.00 ,$856.00 ,$521.30 ,$856.00 ,$591.50 ,$770.40 ,$596.20 ,$229.15 ,$676.24 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$616.32 ,$530.72 ,$616.32 ,$616.32 ,$684.80 
ST NICHOLAS HOSPITAL - ACUTE,32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$99.89 ,$88.79 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$63.69 ,$390.15 ,$107.35 ,$63.69 ,$28.89 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$207.78 ,$207.78 ,$279.53 ,$207.78 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000493,77074,HC BONE SURVEY LIMITED,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$194.57 ,$172.95 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$88.42 ,$390.15 ,$107.35 ,$88.42 ,$39.16 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$329.30 ,$329.30 ,$279.53 ,$329.30 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,$605.00 ,$302.50 ,$37.92 ,$605.00 ,$37.92 ,$283.03 ,$251.58 ,$107.35 ,$363.00 ,$514.25 ,$423.50 ,$37.92 ,$574.75 ,$459.80 ,$453.75 ,$145.90 ,$514.25 ,$107.35 ,$145.90 ,$64.50 ,$423.50 ,$37.92 ,$107.35 ,$107.35 ,$254.10 ,$514.25 ,$241.53 ,$556.60 ,$423.50 ,$329.30 ,$329.30 ,$368.45 ,$329.30 ,$418.06 ,$544.50 ,$421.38 ,$108.42 ,$477.95 ,$40.20 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$286.14 ,$254.34 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$147.23 ,$390.15 ,$107.35 ,$147.23 ,$65.19 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$329.30 ,$329.30 ,$279.53 ,$329.30 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000496,77080,HC BONE DENSITY DXA,320,1 ,$694.00 ,$347.00 ,$24.93 ,$694.00 ,$24.93 ,$130.93 ,$116.38 ,$107.35 ,$416.40 ,$589.90 ,$485.80 ,$24.93 ,$659.30 ,$527.44 ,$520.50 ,$54.33 ,$589.90 ,$107.35 ,$54.33 ,$28.20 ,$485.80 ,$24.93 ,$107.35 ,$107.35 ,$291.48 ,$589.90 ,$241.53 ,$638.48 ,$485.80 ,$326.68 ,$326.68 ,$422.65 ,$326.68 ,$479.55 ,$624.60 ,$483.37 ,$108.42 ,$548.26 ,$26.43 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$555.20 
ST NICHOLAS HOSPITAL - ACUTE,32000499,0238T,HC TRNLUM PERIP ATHRC ILIAC ARTY 0238T,320,1 ,"$12,928.00 ","$6,464.00 ",$451.00 ,"$35,629.75 ","$3,445.58 ","$8,363.12 ","$8,363.12 ","$15,835.45 ","$7,756.80 ","$10,988.80 ","$9,049.60 ","$3,445.58 ","$12,281.60 ","$9,825.28 ","$9,696.00 ","$12,928.00 ","$10,988.80 ","$15,835.45 ","$12,928.00 ",$752.17 ,"$9,049.60 ","$3,445.58 ","$15,835.45 ","$15,835.45 ","$5,429.76 ","$10,988.80 ","$35,629.75 ","$11,893.76 ","$9,049.60 ","$1,703.02 ","$2,128.52 ","$7,873.15 ","$2,128.52 ","$8,933.25 ","$11,635.20 ","$9,004.35 ","$15,993.80 ","$10,213.12 ","$3,652.31 ",$451.00 ,$451.00 ,"$15,835.45 ",$451.00 ,"$9,308.16 ","$8,015.36 ","$9,308.16 ","$9,308.16 ","$10,342.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$560.00 ,$280.00 ,$25.12 ,$560.00 ,$37.92 ,$137.14 ,$121.90 ,$226.88 ,$336.00 ,$476.00 ,$392.00 ,$37.92 ,$532.00 ,$425.60 ,$420.00 ,$55.00 ,$476.00 ,$226.88 ,$55.00 ,$25.12 ,$392.00 ,$37.92 ,$226.88 ,$226.88 ,$235.20 ,$476.00 ,$510.48 ,$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$390.04 ,$229.15 ,$442.40 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,32000503,20501,HC INJ TRACT SINOGRAM DIAG,320,1 ,$452.00 ,$226.00 ,$72.30 ,$452.00 ,$95.13 ,$292.40 ,$292.40 , N/A ,$271.20 ,$384.20 ,$316.40 ,$95.13 ,$429.40 ,$343.52 ,$339.00 ,$72.30 ,$384.20 , N/A ,$72.30 ,$133.50 ,$316.40 ,$95.13 , N/A , N/A ,$189.84 ,$384.20 , N/A ,$415.84 ,$316.40 ,$452.00 ,$452.00 ,$275.27 ,$452.00 ,$312.33 ,$406.80 ,$314.82 , N/A ,$357.08 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$361.60 
ST NICHOLAS HOSPITAL - ACUTE,32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$388.00 ,$194.00 ,$53.63 ,$579.62 ,$75.55 ,$251.00 ,$251.00 ,$257.61 ,$232.80 ,$329.80 ,$271.60 ,$75.55 ,$368.60 ,$294.88 ,$291.00 ,$72.78 ,$329.80 ,$257.61 ,$72.78 ,$53.63 ,$271.60 ,$75.55 ,$257.61 ,$257.61 ,$162.96 ,$329.80 ,$579.62 ,$356.96 ,$271.60 ,$388.00 ,$388.00 ,$236.29 ,$388.00 ,$268.11 ,$349.20 ,$270.24 ,$260.19 ,$306.52 ,$80.08 ,$388.00 ,$388.00 ,$257.61 ,$388.00 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,32000506,20553,HC INJ TRIGGER PT 3+ MUSC GROUP,320,1 ,$431.00 ,$215.50 ,$61.68 ,$579.62 ,$75.55 ,$278.81 ,$278.81 ,$257.61 ,$258.60 ,$366.35 ,$301.70 ,$75.55 ,$409.45 ,$327.56 ,$323.25 ,$82.70 ,$366.35 ,$257.61 ,$82.70 ,$61.68 ,$301.70 ,$75.55 ,$257.61 ,$257.61 ,$181.02 ,$366.35 ,$579.62 ,$396.52 ,$301.70 ,$431.00 ,$431.00 ,$262.48 ,$431.00 ,$297.82 ,$387.90 ,$300.19 ,$260.19 ,$340.49 ,$80.08 ,$431.00 ,$431.00 ,$257.61 ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,32000508,74775,HC VAGINOGRAM,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$229.95 ,$204.40 ,$226.88 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$680.96 ,$672.00 ,$120.77 ,$761.60 ,$226.88 ,$120.77 ,$56.78 ,$627.20 ,$37.92 ,$226.88 ,$226.88 ,$376.32 ,$761.60 ,$510.48 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$806.40 ,$624.06 ,$229.15 ,$707.84 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,32000509,77072,HC BONE AGE STUDIES,320,1 ,$594.00 ,$297.00 ,$14.84 ,$594.00 ,$17.98 ,$62.64 ,$55.68 ,$107.35 ,$356.40 ,$504.90 ,$415.80 ,$17.98 ,$564.30 ,$451.44 ,$445.50 ,$33.62 ,$504.90 ,$107.35 ,$33.62 ,$14.84 ,$415.80 ,$17.98 ,$107.35 ,$107.35 ,$249.48 ,$504.90 ,$241.53 ,$546.48 ,$415.80 ,$207.78 ,$207.78 ,$361.75 ,$207.78 ,$410.45 ,$534.60 ,$413.72 ,$108.42 ,$469.26 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$475.20 
ST NICHOLAS HOSPITAL - ACUTE,32000515,G0278,HC ILIAC ARTERY ANGIO W CATH G0278,320,1 ,$683.00 ,$341.50 ,$12.80 ,"$1,370.68 ","$1,293.09 ",$441.83 ,$441.83 , N/A ,$409.80 ,$580.55 ,$478.10 ,"$1,293.09 ",$648.85 ,$519.08 ,$512.25 ,$25.22 ,$580.55 , N/A ,$25.22 ,$12.80 ,$478.10 ,"$1,293.09 ", N/A , N/A ,$286.86 ,$580.55 , N/A ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$415.74 ,$471.95 ,$614.70 ,$475.71 , N/A ,$539.57 ,"$1,370.68 ",$451.00 ,$451.00 , N/A ,$451.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,32000525,N/A,HC CARM FLUORO <1 HR OR,360,1 ,$987.00 ,$493.50 ,$493.50 ,$987.00 , N/A , N/A , N/A , N/A ,$592.20 ,$838.95 ,$690.90 , N/A ,$937.65 ,$750.12 ,$740.25 , N/A ,$838.95 , N/A , N/A , N/A ,$690.90 , N/A , N/A , N/A , N/A ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$600.79 ,$682.02 ,$888.30 ,$687.45 , N/A ,$779.73 , N/A , N/A , N/A , N/A , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$789.60 
ST NICHOLAS HOSPITAL - ACUTE,32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,"$1,185.00 ",$592.50 ,$173.41 ,"$1,199.16 ",$299.20 ,$766.58 ,$766.58 ,$532.96 ,$711.00 ,"$1,007.25 ",$829.50 ,$299.20 ,"$1,125.75 ",$900.60 ,$888.75 ,$173.41 ,"$1,007.25 ",$532.96 ,$173.41 ,$215.85 ,$829.50 ,$299.20 ,$532.96 ,$532.96 ,$497.70 ,"$1,007.25 ","$1,199.16 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$538.29 ,$936.15 ,$317.15 ,$451.00 ,$451.00 ,$532.96 ,$451.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,293.00 ",$646.50 ,$214.70 ,"$1,798.74 ",$448.80 ,$836.44 ,$836.44 ,$799.44 ,$775.80 ,"$1,099.05 ",$905.10 ,$448.80 ,"$1,228.35 ",$982.68 ,$969.75 ,$214.70 ,"$1,099.05 ",$799.44 ,$214.70 ,$302.98 ,$905.10 ,$448.80 ,$799.44 ,$799.44 ,$543.06 ,"$1,099.05 ","$1,798.74 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,$807.43 ,"$1,021.47 ",$475.73 ,$451.00 ,$451.00 ,$799.44 ,$451.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,293.00 ",$646.50 ,$214.70 ,"$1,798.74 ",$448.80 ,$836.44 ,$836.44 ,$799.44 ,$775.80 ,"$1,099.05 ",$905.10 ,$448.80 ,"$1,228.35 ",$982.68 ,$969.75 ,$214.70 ,"$1,099.05 ",$799.44 ,$214.70 ,$302.98 ,$905.10 ,$448.80 ,$799.44 ,$799.44 ,$543.06 ,"$1,099.05 ","$1,798.74 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,$807.43 ,"$1,021.47 ",$475.73 ,$451.00 ,$451.00 ,$799.44 ,$451.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000532,32556,HC PLEURAL DRAINAGE W/O IMAGING 32556,450,1 ,"$1,185.00 ",$592.50 ,$299.20 ,"$3,603.33 ",$299.20 ,$766.58 ,$766.58 ,"$1,601.48 ",$711.00 ,"$1,007.25 ",$829.50 ,$299.20 ,"$1,125.75 ",$900.60 ,$888.75 ,$770.25 ,"$1,007.25 ","$1,601.48 ",$770.25 ,$770.25 ,$829.50 ,$299.20 ,"$1,601.48 ","$1,601.48 ",$571.36 ,"$1,007.25 ","$3,603.33 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$721.31 ,$818.84 ,"$1,066.50 ",$825.35 ,"$1,617.49 ",$936.15 ,$317.15 ,$685.00 ,$685.00 ,"$1,601.48 ",$685.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,32000533,32557,HC PLEURAL DRAINAGE W/IMAGING 32557,320,1 ,"$1,939.00 ",$969.50 ,$291.84 ,"$3,119.68 ",$299.20 ,"$1,254.34 ","$1,254.34 ","$1,386.53 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$299.20 ,"$1,842.05 ","$1,473.64 ","$1,454.25 ",$291.84 ,"$1,648.15 ","$1,386.53 ",$291.84 ,$600.70 ,"$1,357.30 ",$299.20 ,"$1,386.53 ","$1,386.53 ",$814.38 ,"$1,648.15 ","$3,119.68 ","$1,783.88 ","$1,357.30 ","$1,703.02 ","$1,939.00 ","$1,180.85 ","$1,939.00 ","$1,339.85 ","$1,745.10 ","$1,350.51 ","$1,400.40 ","$1,531.81 ",$317.15 ,$451.00 ,$451.00 ,"$1,386.53 ",$451.00 ,"$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,32000540,N/A,HC FLUORO OARM  > 1 HR OR,360,1 ,"$1,050.00 ",$525.00 ,$525.00 ,"$1,050.00 ", N/A , N/A , N/A , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$798.00 ,$787.50 , N/A ,$892.50 , N/A , N/A , N/A ,$735.00 , N/A , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$639.14 ,$725.55 ,$945.00 ,$731.33 , N/A ,$829.50 , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$840.00 
ST NICHOLAS HOSPITAL - ACUTE,32000542,20551,HC INJ TENDON ORIGIN,320,1 ,$431.00 ,$215.50 ,$54.14 ,$579.62 ,$75.55 ,$278.81 ,$278.81 ,$257.61 ,$258.60 ,$366.35 ,$301.70 ,$75.55 ,$409.45 ,$327.56 ,$323.25 ,$75.81 ,$366.35 ,$257.61 ,$75.81 ,$54.14 ,$301.70 ,$75.55 ,$257.61 ,$257.61 ,$181.02 ,$366.35 ,$579.62 ,$396.52 ,$301.70 ,$431.00 ,$431.00 ,$262.48 ,$431.00 ,$297.82 ,$387.90 ,$300.19 ,$260.19 ,$340.49 ,$80.08 ,$431.00 ,$431.00 ,$257.61 ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,32000548,51100,HC ASPIRATE BLADDER BY NEEDLE,320,1 ,$399.00 ,$199.50 ,$66.18 ,$590.35 ,$119.36 ,$258.11 ,$258.11 ,$262.38 ,$239.40 ,$339.15 ,$279.30 ,$119.36 ,$379.05 ,$303.24 ,$299.25 ,$74.60 ,$339.15 ,$262.38 ,$74.60 ,$66.18 ,$279.30 ,$119.36 ,$262.38 ,$262.38 ,$167.58 ,$339.15 ,$590.35 ,$367.08 ,$279.30 ,$399.00 ,$399.00 ,$242.99 ,$399.00 ,$275.71 ,$359.10 ,$277.90 ,$265.00 ,$315.21 ,$126.52 ,$399.00 ,$399.00 ,$262.38 ,$399.00 ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$319.20 
ST NICHOLAS HOSPITAL - ACUTE,32000560,49460,HC MECHAN REMOVAL OF OBSTRUCT MATERIAL FROM G/J/D TUBE FLUOR/CONT,320,1 ,"$1,100.00 ",$550.00 ,$93.81 ,"$1,795.12 ",$211.20 ,$711.59 ,$711.59 ,$797.83 ,$660.00 ,$935.00 ,$770.00 ,$211.20 ,"$1,045.00 ",$836.00 ,$825.00 ,$93.81 ,$935.00 ,$797.83 ,$93.81 ,$711.66 ,$770.00 ,$211.20 ,$797.83 ,$797.83 ,$462.00 ,$935.00 ,"$1,795.12 ","$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$990.00 ,$766.15 ,$805.81 ,$869.00 ,$223.87 ,$451.00 ,$451.00 ,$797.83 ,$451.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,32000561,49405,HC ABSCESS DRAIN KIDN/LIV/SPLN/LUNG VISERAL 49405,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,121.49 ",$232.13 ,$905.66 ,$905.66 ,"$1,387.33 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$378.66 ,"$1,190.00 ","$1,387.33 ",$378.66 ,$860.46 ,$980.00 ,$232.13 ,"$1,387.33 ","$1,387.33 ",$588.00 ,"$1,190.00 ","$3,121.49 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,260.00 ",$975.10 ,"$1,401.20 ","$1,106.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000562,49406,HC ABSCESS DRAIN PERI/ RETROPER PERC 49406,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,121.49 ",$232.13 ,$905.66 ,$905.66 ,"$1,387.33 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$378.00 ,"$1,190.00 ","$1,387.33 ",$378.00 ,$860.35 ,$980.00 ,$232.13 ,"$1,387.33 ","$1,387.33 ",$588.00 ,"$1,190.00 ","$3,121.49 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,260.00 ",$975.10 ,"$1,401.20 ","$1,106.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000563,49407,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER TV OR TR,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,121.49 ",$232.13 ,$905.66 ,$905.66 ,"$1,387.33 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$398.99 ,"$1,190.00 ","$1,387.33 ",$398.99 ,$705.79 ,$980.00 ,$232.13 ,"$1,387.33 ","$1,387.33 ",$588.00 ,"$1,190.00 ","$3,121.49 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,260.00 ",$975.10 ,"$1,401.20 ","$1,106.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,387.33 ",$451.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000564,0075T,HC STENT VERTEBRAL EXTRACRANIAL 0075T,320,1 ,"$8,295.00 ","$4,147.50 ",$451.00 ,"$8,295.00 ","$1,851.24 ","$5,366.04 ","$5,366.04 ", N/A ,"$4,977.00 ","$7,050.75 ","$5,806.50 ","$1,851.24 ","$7,880.25 ","$6,304.20 ","$6,221.25 ","$2,589.23 ","$7,050.75 ", N/A ,"$2,589.23 ","$4,455.82 ","$5,806.50 ","$1,851.24 ", N/A , N/A ,"$3,483.90 ","$7,050.75 ", N/A ,"$7,631.40 ","$5,806.50 ","$4,794.94 ","$5,993.67 ","$5,051.66 ","$5,993.67 ","$5,731.85 ","$7,465.50 ","$5,777.47 ", N/A ,"$6,553.05 ","$1,962.31 ",$451.00 ,$451.00 , N/A ,$451.00 ,"$5,972.40 ","$5,142.90 ","$5,972.40 ","$5,972.40 ","$6,636.00 "
ST NICHOLAS HOSPITAL - ACUTE,32000565,37218,HC STENT CAROTID INTRATHORACIC 37218,320,1 ,"$1,177.00 ",$588.50 ,$451.00 ,"$3,741.59 ","$3,529.80 ",$761.40 ,$761.40 , N/A ,$706.20 ,"$1,000.45 ",$823.90 ,"$3,529.80 ","$1,118.15 ",$894.52 ,$882.75 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ",$768.04 ,$823.90 ,"$3,529.80 ", N/A , N/A ,$494.34 ,"$1,000.45 ", N/A ,"$1,082.84 ",$823.90 ,$596.97 ,$716.44 ,$716.79 ,$716.44 ,$813.31 ,"$1,059.30 ",$819.78 , N/A ,$929.83 ,"$3,741.59 ",$451.00 ,$451.00 , N/A ,$451.00 ,$847.44 ,$729.74 ,$847.44 ,$847.44 ,$941.60 
ST NICHOLAS HOSPITAL - ACUTE,32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$59.02 ,$314.50 ,$79.76 ,$59.02 ,$26.15 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000568,70190,HC XR EYE SOCKETS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$110.76 ,$98.45 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$54.35 ,$314.50 ,$79.76 ,$54.35 ,$25.80 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$115.41 ,$102.59 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$59.70 ,$314.50 ,$79.76 ,$59.70 ,$26.83 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$204.15 ,$204.15 ,$225.33 ,$204.15 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$211.64 ,$188.12 ,$107.35 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$109.82 ,$314.50 ,$107.35 ,$109.82 ,$49.09 ,$259.00 ,$17.98 ,$107.35 ,$107.35 ,$155.40 ,$314.50 ,$241.53 ,$340.40 ,$259.00 ,$338.10 ,$338.10 ,$225.33 ,$338.10 ,$255.67 ,$333.00 ,$257.71 ,$108.42 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$107.35 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000572,72083,HC XR SPINE/CERV SCOLIOSIS 4-5VW,320,1 ,$414.00 ,$207.00 ,$17.98 ,$414.00 ,$17.98 ,$253.54 ,$225.37 ,$107.35 ,$248.40 ,$351.90 ,$289.80 ,$17.98 ,$393.30 ,$314.64 ,$310.50 ,$122.51 ,$351.90 ,$107.35 ,$122.51 ,$57.66 ,$289.80 ,$17.98 ,$107.35 ,$107.35 ,$173.88 ,$351.90 ,$241.53 ,$380.88 ,$289.80 ,$414.00 ,$414.00 ,$252.13 ,$414.00 ,$286.07 ,$372.60 ,$288.35 ,$108.42 ,$327.06 ,$19.06 ,$414.00 ,$414.00 ,$107.35 ,$414.00 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$331.20 
ST NICHOLAS HOSPITAL - ACUTE,32000573,72084,HC XR SPINE/CERV SCOLIOSIS 6+VW,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$297.00 ,$264.00 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$156.58 ,$390.15 ,$107.35 ,$156.58 ,$69.30 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$459.00 ,$459.00 ,$279.53 ,$459.00 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$92.13 ,$81.90 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$46.33 ,$314.50 ,$79.76 ,$46.33 ,$21.01 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$204.15 ,$204.15 ,$225.33 ,$204.15 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$414.00 ,$207.00 ,$17.98 ,$414.00 ,$17.98 ,$137.14 ,$121.90 ,$79.76 ,$248.40 ,$351.90 ,$289.80 ,$17.98 ,$393.30 ,$314.64 ,$310.50 ,$71.71 ,$351.90 ,$79.76 ,$71.71 ,$32.31 ,$289.80 ,$17.98 ,$79.76 ,$79.76 ,$173.88 ,$351.90 ,$179.45 ,$380.88 ,$289.80 ,$204.15 ,$204.15 ,$252.13 ,$204.15 ,$286.07 ,$372.60 ,$288.35 ,$80.56 ,$327.06 ,$19.06 ,$414.00 ,$414.00 ,$79.76 ,$414.00 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$331.20 
ST NICHOLAS HOSPITAL - ACUTE,32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$171.29 ,$152.25 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$91.10 ,$390.15 ,$107.35 ,$91.10 ,$40.19 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$338.10 ,$338.10 ,$279.53 ,$338.10 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$116.96 ,$103.97 ,$107.35 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$348.84 ,$344.25 ,$60.35 ,$390.15 ,$107.35 ,$60.35 ,$27.17 ,$321.30 ,$17.98 ,$107.35 ,$107.35 ,$192.78 ,$390.15 ,$241.53 ,$422.28 ,$321.30 ,$338.10 ,$338.10 ,$279.53 ,$338.10 ,$317.17 ,$413.10 ,$319.69 ,$108.42 ,$362.61 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$367.20 
ST NICHOLAS HOSPITAL - ACUTE,32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$504.00 ,$252.00 ,$17.98 ,$504.00 ,$17.98 ,$151.11 ,$134.32 ,$107.35 ,$302.40 ,$428.40 ,$352.80 ,$17.98 ,$478.80 ,$383.04 ,$378.00 ,$78.39 ,$428.40 ,$107.35 ,$78.39 ,$35.39 ,$352.80 ,$17.98 ,$107.35 ,$107.35 ,$211.68 ,$428.40 ,$241.53 ,$463.68 ,$352.80 ,$338.10 ,$338.10 ,$306.94 ,$338.10 ,$348.26 ,$453.60 ,$351.04 ,$108.42 ,$398.16 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$362.88 ,$312.48 ,$362.88 ,$362.88 ,$403.20 
ST NICHOLAS HOSPITAL - ACUTE,32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$549.00 ,$274.50 ,$17.98 ,$549.00 ,$17.98 ,$183.70 ,$163.29 ,$107.35 ,$329.40 ,$466.65 ,$384.30 ,$17.98 ,$521.55 ,$417.24 ,$411.75 ,$92.43 ,$466.65 ,$107.35 ,$92.43 ,$41.21 ,$384.30 ,$17.98 ,$107.35 ,$107.35 ,$230.58 ,$466.65 ,$241.53 ,$505.08 ,$384.30 ,$549.00 ,$549.00 ,$334.34 ,$549.00 ,$379.36 ,$494.10 ,$382.38 ,$108.42 ,$433.71 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$439.20 
ST NICHOLAS HOSPITAL - ACUTE,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$85.92 ,$76.38 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$41.66 ,$314.50 ,$79.76 ,$41.66 ,$19.64 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$204.15 ,$204.15 ,$225.33 ,$204.15 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$370.00 ,$185.00 ,$24.09 ,$370.00 ,$26.97 ,$104.55 ,$92.93 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$52.34 ,$314.50 ,$79.76 ,$52.34 ,$24.09 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$306.23 ,$306.23 ,$225.33 ,$306.23 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$370.00 ,$185.00 ,$24.09 ,$370.00 ,$26.97 ,$104.55 ,$92.93 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$281.20 ,$277.50 ,$52.34 ,$314.50 ,$79.76 ,$52.34 ,$24.09 ,$259.00 ,$26.97 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$306.23 ,$306.23 ,$225.33 ,$306.23 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$28.59 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,32000586,72265,HC XR MYELOGRAPHY L-SPINE,320,1 ,"$2,078.00 ","$1,039.00 ",$59.36 ,"$2,078.00 ",$184.15 ,$245.78 ,$218.47 ,$705.42 ,"$1,246.80 ","$1,766.30 ","$1,454.60 ",$184.15 ,"$1,974.10 ","$1,579.28 ","$1,558.50 ",$140.55 ,"$1,766.30 ",$705.42 ,$140.55 ,$59.36 ,"$1,454.60 ",$184.15 ,$705.42 ,$705.42 ,$872.76 ,"$1,766.30 ","$1,587.19 ","$1,911.76 ","$1,454.60 ","$2,078.00 ","$2,078.00 ","$1,265.50 ","$2,078.00 ","$1,435.90 ","$1,870.20 ","$1,447.33 ",$712.47 ,"$1,641.62 ",$195.20 ,$451.00 ,$451.00 ,$705.42 ,$451.00 ,"$1,496.16 ","$1,288.36 ","$1,496.16 ","$1,496.16 ","$1,662.40 "
ST NICHOLAS HOSPITAL - ACUTE,32000604,70371,HC SPEECH EVAL W/CINE/VIDEO RECORDING,320,1 ,$661.00 ,$330.50 ,$37.92 ,$661.00 ,$37.92 ,$241.13 ,$214.33 ,$226.88 ,$396.60 ,$561.85 ,$462.70 ,$37.92 ,$627.95 ,$502.36 ,$495.75 ,$129.19 ,$561.85 ,$226.88 ,$129.19 ,$62.11 ,$462.70 ,$37.92 ,$226.88 ,$226.88 ,$277.62 ,$561.85 ,$510.48 ,$608.12 ,$462.70 ,$567.64 ,$567.64 ,$402.55 ,$567.64 ,$456.75 ,$594.90 ,$460.39 ,$229.15 ,$522.19 ,$40.20 ,$451.00 ,$451.00 ,$226.88 ,$451.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,32000611,G1004,HC RAD AUC CDSM NATL DECISION SUPPORT COMPANY,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,$168.00 ,$84.00 ,$37.92 ,$168.00 ,$37.92 ,$168.00 ,$168.00 , N/A ,$100.80 ,$142.80 ,$117.60 ,$37.92 ,$159.60 ,$127.68 ,$126.00 ,$103.14 ,$142.80 , N/A ,$103.14 ,$45.55 ,$117.60 ,$37.92 , N/A , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$117.01 , N/A ,$132.72 ,$40.20 ,$168.00 ,$168.00 , N/A ,$168.00 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,32000613,G1002,HC RAD AUC CDSM MEDCURRENT,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000614,G1003,HC RAD AUC CDSM MEDICALIS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000615,G1005,HC RAD AUC CDSM NATIONAL IMAGING ASSOCIATES,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000616,G1006,HC RAD AUC CDSM TEST APPROPRIATE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000617,G1007,HC RAD AUC CDSM AIM SPECIALTY HEALTH,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000618,G1008,HC RAD AUC CDSM CRANBERRY PEAK,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000619,G1009,HC RAD AUC CDSM SAGE HEALTH MGMT SOLUTIONS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000620,G1010,HC RAD AUC CDSM STANSON,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000621,G1011,HC RAD AUC CDSM QUALIFIED TOOL NOS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,32000623,G1001,HC RAD AUC CDSM EVICORE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,33300001,C1717,HC HDR BRACHYTX SOURCE IR192,333,1 ,"$1,008.00 ",$504.00 ,$131.61 ,"$1,008.00 ",$131.61 ,$652.08 ,$652.08 ,$341.72 ,$604.80 ,$856.80 ,$705.60 ,$131.61 ,$957.60 ,$766.08 ,$756.00 ,$655.20 ,$856.80 ,$341.72 ,$655.20 ,$655.20 ,$705.60 ,$131.61 ,$341.72 ,$341.72 ,$400.52 ,$856.80 ,$768.87 ,$927.36 ,$705.60 ,$511.26 ,$613.57 ,$613.87 ,$613.57 ,$696.53 ,$907.20 ,$702.07 ,$345.14 ,$796.32 ,$139.51 ,"$1,008.00 ","$1,008.00 ",$341.72 ,"$1,008.00 ",$725.76 ,$624.96 ,$725.76 ,$725.76 ,$806.40 
ST NICHOLAS HOSPITAL - ACUTE,33300006,C2639,HC IODINE 125 PER SOURCE NON STRANDED,333,1 ,$118.00 ,$59.00 ,$34.82 ,$139.51 ,$131.61 ,$76.33 ,$76.33 ,$34.82 ,$70.80 ,$100.30 ,$82.60 ,$131.61 ,$112.10 ,$89.68 ,$88.50 ,$76.70 ,$100.30 ,$34.82 ,$76.70 ,$76.70 ,$82.60 ,$131.61 ,$34.82 ,$34.82 ,$118.00 ,$100.30 ,$78.35 ,$108.56 ,$82.60 ,$59.85 ,$71.83 ,$71.86 ,$71.83 ,$81.54 ,$106.20 ,$82.19 ,$35.17 ,$93.22 ,$139.51 ,$118.00 ,$118.00 ,$34.82 ,$118.00 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$94.40 
ST NICHOLAS HOSPITAL - ACUTE,33300009,77285,HC SIMULATION INTERMED,333,1 ,"$1,510.00 ",$755.00 ,$60.15 ,"$1,510.00 ",$60.15 ,"$1,510.00 ","$1,510.00 ",$333.90 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$60.15 ,"$1,434.50 ","$1,147.60 ","$1,132.50 ",$981.50 ,"$1,283.50 ",$333.90 ,$981.50 ,$981.50 ,"$1,057.00 ",$60.15 ,$333.90 ,$333.90 ,$400.52 ,"$1,283.50 ",$751.27 ,"$1,389.20 ","$1,057.00 ","$1,128.12 ","$1,128.12 ",$919.59 ,"$1,128.12 ","$1,043.41 ","$1,359.00 ","$1,051.72 ",$337.24 ,"$1,192.90 ",$63.76 ,"$1,510.00 ","$1,510.00 ",$333.90 ,"$1,510.00 ","$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ","$1,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300010,77290,HC SIMULATION COMPLEX,333,1 ,"$3,129.00 ","$1,564.50 ",$60.15 ,"$3,129.00 ",$60.15 ,"$1,876.96 ","$1,668.41 ",$333.90 ,"$1,877.40 ","$2,659.65 ","$2,190.30 ",$60.15 ,"$2,972.55 ","$2,378.04 ","$2,346.75 ","$2,033.85 ","$2,659.65 ",$333.90 ,"$2,033.85 ","$2,033.85 ","$2,190.30 ",$60.15 ,$333.90 ,$333.90 ,$400.52 ,"$2,659.65 ",$751.27 ,"$2,878.68 ","$2,190.30 ","$1,128.12 ","$1,128.12 ","$1,905.56 ","$1,128.12 ","$2,162.14 ","$2,816.10 ","$2,179.35 ",$337.24 ,"$2,471.91 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$333.90 ,"$1,859.00 ","$2,252.88 ","$1,939.98 ","$2,252.88 ","$2,252.88 ","$2,503.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300011,77295,HC SIMULATION 3-D,333,1 ,"$7,013.00 ","$3,506.50 ",$345.96 ,"$7,013.00 ",$345.96 ,"$1,165.28 ","$1,035.80 ","$1,245.10 ","$4,207.80 ","$5,961.05 ","$4,909.10 ",$345.96 ,"$6,662.35 ","$5,329.88 ","$5,259.75 ","$4,558.45 ","$5,961.05 ","$1,245.10 ","$4,558.45 ","$4,558.45 ","$4,909.10 ",$345.96 ,"$1,245.10 ","$1,245.10 ",$400.52 ,"$5,961.05 ","$2,801.47 ","$6,451.96 ","$4,909.10 ","$3,754.96 ","$3,754.96 ","$4,270.92 ","$3,754.96 ","$4,845.98 ","$6,311.70 ","$4,884.55 ","$1,257.55 ","$5,540.27 ",$366.72 ,"$1,859.00 ","$1,859.00 ","$1,245.10 ","$1,859.00 ","$5,049.36 ","$4,348.06 ","$5,049.36 ","$5,049.36 ","$5,610.40 "
ST NICHOLAS HOSPITAL - ACUTE,33300015,77300,HC DOSIMETRY CALCULATION BASIC,333,1 ,$842.00 ,$421.00 ,$60.15 ,$842.00 ,$60.15 ,$148.01 ,$131.56 ,$125.11 ,$505.20 ,$715.70 ,$589.40 ,$60.15 ,$799.90 ,$639.92 ,$631.50 ,$547.30 ,$715.70 ,$125.11 ,$547.30 ,$547.30 ,$589.40 ,$60.15 ,$125.11 ,$125.11 ,$400.52 ,$715.70 ,$281.50 ,$774.64 ,$589.40 ,$415.39 ,$415.39 ,$512.78 ,$415.39 ,$581.82 ,$757.80 ,$586.45 ,$126.36 ,$665.18 ,$63.76 ,$842.00 ,$842.00 ,$125.11 ,$842.00 ,$606.24 ,$522.04 ,$606.24 ,$606.24 ,$673.60 
ST NICHOLAS HOSPITAL - ACUTE,33300016,77300,HC DOSIMETRY CALCULATION,333,1 ,$842.00 ,$421.00 ,$60.15 ,$842.00 ,$60.15 ,$148.01 ,$131.56 ,$125.11 ,$505.20 ,$715.70 ,$589.40 ,$60.15 ,$799.90 ,$639.92 ,$631.50 ,$547.30 ,$715.70 ,$125.11 ,$547.30 ,$547.30 ,$589.40 ,$60.15 ,$125.11 ,$125.11 ,$400.52 ,$715.70 ,$281.50 ,$774.64 ,$589.40 ,$415.39 ,$415.39 ,$512.78 ,$415.39 ,$581.82 ,$757.80 ,$586.45 ,$126.36 ,$665.18 ,$63.76 ,$842.00 ,$842.00 ,$125.11 ,$842.00 ,$606.24 ,$522.04 ,$606.24 ,$606.24 ,$673.60 
ST NICHOLAS HOSPITAL - ACUTE,33300017,77301,HC IMRT TX PLAN,333,1 ,"$5,610.00 ","$2,805.00 ",$345.96 ,"$5,610.00 ",$345.96 ,"$5,610.00 ","$5,610.00 ","$1,245.10 ","$3,366.00 ","$4,768.50 ","$3,927.00 ",$345.96 ,"$5,329.50 ","$4,263.60 ","$4,207.50 ","$3,646.50 ","$4,768.50 ","$1,245.10 ","$3,646.50 ","$3,646.50 ","$3,927.00 ",$345.96 ,"$1,245.10 ","$1,245.10 ",$400.52 ,"$4,768.50 ","$2,801.47 ","$5,161.20 ","$3,927.00 ","$3,754.96 ","$3,754.96 ","$3,416.49 ","$3,754.96 ","$3,876.51 ","$5,049.00 ","$3,907.37 ","$1,257.55 ","$4,431.90 ",$366.72 ,"$1,859.00 ","$1,859.00 ","$1,245.10 ","$1,859.00 ","$4,039.20 ","$3,478.20 ","$4,039.20 ","$4,039.20 ","$4,488.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300019,77306,HC ISODOSE PLAN SIMPLE COMPUTER PLAN,333,1 ,$831.00 ,$415.50 ,$36.91 ,$831.00 ,$36.91 ,$333.26 ,$296.23 ,$333.90 ,$498.60 ,$706.35 ,$581.70 ,$36.91 ,$789.45 ,$631.56 ,$623.25 ,$540.15 ,$706.35 ,$333.90 ,$540.15 ,$540.15 ,$581.70 ,$36.91 ,$333.90 ,$333.90 ,$400.52 ,$706.35 ,$751.27 ,$764.52 ,$581.70 ,$402.94 ,$402.94 ,$506.08 ,$402.94 ,$574.22 ,$747.90 ,$578.79 ,$337.24 ,$656.49 ,$39.12 ,$831.00 ,$831.00 ,$333.90 ,$831.00 ,$598.32 ,$515.22 ,$598.32 ,$598.32 ,$664.80 
ST NICHOLAS HOSPITAL - ACUTE,33300023,77307,HC ISODOSE PLAN COMPLEX COMPUTER PLAN,333,1 ,"$3,129.00 ","$1,564.50 ",$60.15 ,"$3,129.00 ",$60.15 ,$602.32 ,$535.40 ,$333.90 ,"$1,877.40 ","$2,659.65 ","$2,190.30 ",$60.15 ,"$2,972.55 ","$2,378.04 ","$2,346.75 ","$2,033.85 ","$2,659.65 ",$333.90 ,"$2,033.85 ","$2,033.85 ","$2,190.30 ",$60.15 ,$333.90 ,$333.90 ,$400.52 ,"$2,659.65 ",$751.27 ,"$2,878.68 ","$2,190.30 ",$402.94 ,$402.94 ,"$1,905.56 ",$402.94 ,"$2,162.14 ","$2,816.10 ","$2,179.35 ",$337.24 ,"$2,471.91 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$333.90 ,"$1,859.00 ","$2,252.88 ","$1,939.98 ","$2,252.88 ","$2,252.88 ","$2,503.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300024,77321,HC PORT PLAN SPECIAL,333,1 ,"$1,942.00 ",$971.00 ,$60.15 ,"$1,942.00 ",$60.15 ,$191.46 ,$170.19 ,$333.90 ,"$1,165.20 ","$1,650.70 ","$1,359.40 ",$60.15 ,"$1,844.90 ","$1,475.92 ","$1,456.50 ","$1,262.30 ","$1,650.70 ",$333.90 ,"$1,262.30 ","$1,262.30 ","$1,359.40 ",$60.15 ,$333.90 ,$333.90 ,$400.52 ,"$1,650.70 ",$751.27 ,"$1,786.64 ","$1,359.40 ","$1,128.12 ","$1,128.12 ","$1,182.68 ","$1,128.12 ","$1,341.92 ","$1,747.80 ","$1,352.60 ",$337.24 ,"$1,534.18 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$333.90 ,"$1,859.00 ","$1,398.24 ","$1,204.04 ","$1,398.24 ","$1,398.24 ","$1,553.60 "
ST NICHOLAS HOSPITAL - ACUTE,33300027,77318,HC BRACHY ISODOSE PLAN COMPLEX,333,1 ,"$1,834.00 ",$917.00 ,$60.15 ,"$1,834.00 ",$60.15 ,"$1,012.19 ",$899.73 ,$333.90 ,"$1,100.40 ","$1,558.90 ","$1,283.80 ",$60.15 ,"$1,742.30 ","$1,393.84 ","$1,375.50 ","$1,192.10 ","$1,558.90 ",$333.90 ,"$1,192.10 ","$1,192.10 ","$1,283.80 ",$60.15 ,$333.90 ,$333.90 ,$400.52 ,"$1,558.90 ",$751.27 ,"$1,687.28 ","$1,283.80 ","$1,120.03 ","$1,120.03 ","$1,116.91 ","$1,120.03 ","$1,267.29 ","$1,650.60 ","$1,277.38 ",$337.24 ,"$1,448.86 ",$63.76 ,"$1,834.00 ","$1,834.00 ",$333.90 ,"$1,834.00 ","$1,320.48 ","$1,137.08 ","$1,320.48 ","$1,320.48 ","$1,467.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300029,77331,HC DOSIMETRY CALCULATION SPECIAL,333,1 ,$604.00 ,$302.00 ,$36.91 ,$604.00 ,$36.91 ,$82.82 ,$73.62 ,$125.11 ,$362.40 ,$513.40 ,$422.80 ,$36.91 ,$573.80 ,$459.04 ,$453.00 ,$392.60 ,$513.40 ,$125.11 ,$392.60 ,$392.60 ,$422.80 ,$36.91 ,$125.11 ,$125.11 ,$400.52 ,$513.40 ,$281.50 ,$555.68 ,$422.80 ,$415.39 ,$415.39 ,$367.84 ,$415.39 ,$417.36 ,$543.60 ,$420.69 ,$126.36 ,$477.16 ,$39.12 ,$604.00 ,$604.00 ,$125.11 ,$604.00 ,$434.88 ,$374.48 ,$434.88 ,$434.88 ,$483.20 
ST NICHOLAS HOSPITAL - ACUTE,33300030,77332,HC TREATMENT DEVICE SIMPLE,333,1 ,$723.00 ,$361.50 ,$36.91 ,$723.00 ,$36.91 ,$124.72 ,$110.87 ,$125.11 ,$433.80 ,$614.55 ,$506.10 ,$36.91 ,$686.85 ,$549.48 ,$542.25 ,$469.95 ,$614.55 ,$125.11 ,$469.95 ,$469.95 ,$506.10 ,$36.91 ,$125.11 ,$125.11 ,$400.52 ,$614.55 ,$281.50 ,$665.16 ,$506.10 ,$723.00 ,$723.00 ,$440.31 ,$723.00 ,$499.59 ,$650.70 ,$503.57 ,$126.36 ,$571.17 ,$39.12 ,$723.00 ,$723.00 ,$125.11 ,$723.00 ,$520.56 ,$448.26 ,$520.56 ,$520.56 ,$578.40 
ST NICHOLAS HOSPITAL - ACUTE,33300031,77333,HC TREATMENT DEVICE INTERM,333,1 ,"$1,079.00 ",$539.50 ,$36.91 ,"$1,079.00 ",$36.91 ,$306.31 ,$272.28 ,$125.11 ,$647.40 ,$917.15 ,$755.30 ,$36.91 ,"$1,025.05 ",$820.04 ,$809.25 ,$701.35 ,$917.15 ,$125.11 ,$701.35 ,$701.35 ,$755.30 ,$36.91 ,$125.11 ,$125.11 ,$400.52 ,$917.15 ,$281.50 ,$992.68 ,$755.30 ,$773.50 ,$773.50 ,$657.11 ,$773.50 ,$745.59 ,$971.10 ,$751.52 ,$126.36 ,$852.41 ,$39.12 ,"$1,079.00 ","$1,079.00 ",$125.11 ,"$1,079.00 ",$776.88 ,$668.98 ,$776.88 ,$776.88 ,$863.20 
ST NICHOLAS HOSPITAL - ACUTE,33300032,77334,HC TREATMENT DEVICE COMPLEX,333,1 ,"$2,050.00 ","$1,025.00 ",$60.15 ,"$2,050.00 ",$60.15 ,$297.00 ,$264.00 ,$333.90 ,"$1,230.00 ","$1,742.50 ","$1,435.00 ",$60.15 ,"$1,947.50 ","$1,558.00 ","$1,537.50 ","$1,332.50 ","$1,742.50 ",$333.90 ,"$1,332.50 ","$1,332.50 ","$1,435.00 ",$60.15 ,$333.90 ,$333.90 ,$400.52 ,"$1,742.50 ",$751.27 ,"$1,886.00 ","$1,435.00 ",$773.50 ,$773.50 ,"$1,248.45 ",$773.50 ,"$1,416.55 ","$1,845.00 ","$1,427.83 ",$337.24 ,"$1,619.50 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$333.90 ,"$1,859.00 ","$1,476.00 ","$1,271.00 ","$1,476.00 ","$1,476.00 ","$1,640.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300033,77336,HC MEDICAL PHYSICS CONTINUING,333,1 ,$896.00 ,$448.00 ,$36.91 ,$896.00 ,$36.91 ,$344.82 ,$306.51 ,$125.11 ,$537.60 ,$761.60 ,$627.20 ,$36.91 ,$851.20 ,$680.96 ,$672.00 ,$582.40 ,$761.60 ,$125.11 ,$582.40 ,$582.40 ,$627.20 ,$36.91 ,$125.11 ,$125.11 ,$400.52 ,$761.60 ,$281.50 ,$824.32 ,$627.20 ,$415.39 ,$415.39 ,$545.66 ,$415.39 ,$619.14 ,$806.40 ,$624.06 ,$126.36 ,$707.84 ,$39.12 ,$896.00 ,$896.00 ,$125.11 ,$896.00 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$716.80 
ST NICHOLAS HOSPITAL - ACUTE,33300034,77338,HC MLC DEVICE FOR IMRT,333,1 ,"$2,697.00 ","$1,348.50 ",$60.15 ,"$2,697.00 ",$60.15 ,"$1,198.43 ","$1,065.28 ",$333.90 ,"$1,618.20 ","$2,292.45 ","$1,887.90 ",$60.15 ,"$2,562.15 ","$2,049.72 ","$2,022.75 ","$1,753.05 ","$2,292.45 ",$333.90 ,"$1,753.05 ","$1,753.05 ","$1,887.90 ",$60.15 ,$333.90 ,$333.90 ,$400.52 ,"$2,292.45 ",$751.27 ,"$2,481.24 ","$1,887.90 ","$1,128.12 ","$1,128.12 ","$1,642.47 ","$1,128.12 ","$1,863.63 ","$2,427.30 ","$1,878.46 ",$337.24 ,"$2,130.63 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$333.90 ,"$1,859.00 ","$1,941.84 ","$1,672.14 ","$1,941.84 ","$1,941.84 ","$2,157.60 "
ST NICHOLAS HOSPITAL - ACUTE,33300036,77370,HC SPECIAL MED PHYSICS CONSULT,333,1 ,"$1,510.00 ",$755.00 ,$36.91 ,"$1,510.00 ",$36.91 ,$534.44 ,$475.06 ,$125.11 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$36.91 ,"$1,434.50 ","$1,147.60 ","$1,132.50 ",$981.50 ,"$1,283.50 ",$125.11 ,$981.50 ,$981.50 ,"$1,057.00 ",$36.91 ,$125.11 ,$125.11 ,$400.52 ,"$1,283.50 ",$281.50 ,"$1,389.20 ","$1,057.00 ",$415.39 ,$415.39 ,$919.59 ,$415.39 ,"$1,043.41 ","$1,359.00 ","$1,051.72 ",$126.36 ,"$1,192.90 ",$39.12 ,"$1,510.00 ","$1,510.00 ",$125.11 ,"$1,510.00 ","$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ","$1,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300037,77402,HC RAD THRPY SIMPLE >1MEV,333,1 ,"$1,187.00 ",$593.50 ,$57.48 ,"$1,187.00 ",$57.48 ,$627.58 ,$557.85 ,$118.11 ,$712.20 ,"$1,008.95 ",$830.90 ,$57.48 ,"$1,127.65 ",$902.12 ,$890.25 ,$771.55 ,"$1,008.95 ",$118.11 ,$771.55 ,$771.55 ,$830.90 ,$57.48 ,$118.11 ,$118.11 ,$400.52 ,"$1,008.95 ",$265.75 ,"$1,092.04 ",$830.90 ,$377.72 ,$377.72 ,$722.88 ,$377.72 ,$820.22 ,"$1,068.30 ",$826.75 ,$119.29 ,$937.73 ,$60.93 ,"$1,187.00 ","$1,187.00 ",$118.11 ,"$1,187.00 ",$854.64 ,$735.94 ,$854.64 ,$854.64 ,$949.60 
ST NICHOLAS HOSPITAL - ACUTE,33300041,77407,HC RAD THRPY INTERMEDIATE,333,1 ,"$1,079.00 ",$539.50 ,$57.48 ,"$1,079.00 ",$57.48 ,$863.49 ,$767.54 ,$238.34 ,$647.40 ,$917.15 ,$755.30 ,$57.48 ,"$1,025.05 ",$820.04 ,$809.25 ,$701.35 ,$917.15 ,$238.34 ,$701.35 ,$701.35 ,$755.30 ,$57.48 ,$238.34 ,$238.34 ,$400.52 ,$917.15 ,$536.26 ,$992.68 ,$755.30 ,$377.72 ,$377.72 ,$657.11 ,$377.72 ,$745.59 ,$971.10 ,$751.52 ,$240.72 ,$852.41 ,$60.93 ,"$1,079.00 ","$1,079.00 ",$238.34 ,"$1,079.00 ",$776.88 ,$668.98 ,$776.88 ,$776.88 ,$863.20 
ST NICHOLAS HOSPITAL - ACUTE,33300045,77412,HC RAD THRPY COMPLEX,333,1 ,"$1,510.00 ",$755.00 ,$57.48 ,"$1,510.00 ",$57.48 ,"$1,155.27 ","$1,026.91 ",$238.34 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$57.48 ,"$1,434.50 ","$1,147.60 ","$1,132.50 ",$981.50 ,"$1,283.50 ",$238.34 ,$981.50 ,$981.50 ,"$1,057.00 ",$57.48 ,$238.34 ,$238.34 ,$400.52 ,"$1,283.50 ",$536.26 ,"$1,389.20 ","$1,057.00 ",$696.64 ,$696.64 ,$919.59 ,$696.64 ,"$1,043.41 ","$1,359.00 ","$1,051.72 ",$240.72 ,"$1,192.90 ",$60.93 ,"$1,510.00 ","$1,510.00 ",$238.34 ,"$1,510.00 ","$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ","$1,208.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300051,77386,HC IMRT TREATMENT COMPLEX,333,1 ,"$3,992.00 ","$1,996.00 ",$152.93 ,"$3,992.00 ",$152.93 ,"$1,557.38 ","$1,384.34 ",$534.97 ,"$2,395.20 ","$3,393.20 ","$2,794.40 ",$152.93 ,"$3,792.40 ","$3,033.92 ","$2,994.00 ","$2,594.80 ","$3,393.20 ",$534.97 ,"$2,594.80 ","$2,594.80 ","$2,794.40 ",$152.93 ,$534.97 ,$534.97 ,$400.52 ,"$3,393.20 ","$1,203.68 ","$3,672.64 ","$2,794.40 ","$1,807.94 ","$1,807.94 ","$2,431.13 ","$1,807.94 ","$2,758.47 ","$3,592.80 ","$2,780.43 ",$540.32 ,"$3,153.68 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$534.97 ,"$1,859.00 ","$2,874.24 ","$2,475.04 ","$2,874.24 ","$2,874.24 ","$3,193.60 "
ST NICHOLAS HOSPITAL - ACUTE,33300052,77417,HC PORT FILMS,333,1 ,$572.00 ,$286.00 ,$17.98 ,$572.00 ,$17.98 ,$48.68 ,$43.27 , N/A ,$343.20 ,$486.20 ,$400.40 ,$17.98 ,$543.40 ,$434.72 ,$429.00 ,$371.80 ,$486.20 , N/A ,$371.80 ,$371.80 ,$400.40 ,$17.98 , N/A , N/A ,$400.52 ,$486.20 , N/A ,$526.24 ,$400.40 ,$290.12 ,$348.18 ,$348.35 ,$348.18 ,$395.25 ,$514.80 ,$398.40 , N/A ,$451.88 ,$19.06 ,$572.00 ,$572.00 , N/A ,$572.00 ,$411.84 ,$354.64 ,$411.84 ,$411.84 ,$457.60 
ST NICHOLAS HOSPITAL - ACUTE,33300053,77417,HC PORT FILMS 5+ SRS SRT IMRT,333,1 ,$572.00 ,$286.00 ,$17.98 ,$572.00 ,$17.98 ,$48.68 ,$43.27 , N/A ,$343.20 ,$486.20 ,$400.40 ,$17.98 ,$543.40 ,$434.72 ,$429.00 ,$371.80 ,$486.20 , N/A ,$371.80 ,$371.80 ,$400.40 ,$17.98 , N/A , N/A ,$400.52 ,$486.20 , N/A ,$526.24 ,$400.40 ,$290.12 ,$348.18 ,$348.35 ,$348.18 ,$395.25 ,$514.80 ,$398.40 , N/A ,$451.88 ,$19.06 ,$572.00 ,$572.00 , N/A ,$572.00 ,$411.84 ,$354.64 ,$411.84 ,$411.84 ,$457.60 
ST NICHOLAS HOSPITAL - ACUTE,33300054,77385,HC IMRT TREATMENT SIMPLE,333,1 ,"$3,560.00 ","$1,780.00 ",$152.93 ,"$3,560.00 ",$152.93 ,"$1,555.69 ","$1,382.84 ",$534.97 ,"$2,136.00 ","$3,026.00 ","$2,492.00 ",$152.93 ,"$3,382.00 ","$2,705.60 ","$2,670.00 ","$2,314.00 ","$3,026.00 ",$534.97 ,"$2,314.00 ","$2,314.00 ","$2,492.00 ",$152.93 ,$534.97 ,$534.97 ,$400.52 ,"$3,026.00 ","$1,203.68 ","$3,275.20 ","$2,492.00 ","$1,807.94 ","$1,807.94 ","$2,168.04 ","$1,807.94 ","$2,459.96 ","$3,204.00 ","$2,479.54 ",$540.32 ,"$2,812.40 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$534.97 ,"$1,859.00 ","$2,563.20 ","$2,207.20 ","$2,563.20 ","$2,563.20 ","$2,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,33300055,77387,HC STEREOSCOPIC X RAY GUIDANCE,333,1 ,$507.00 ,$253.50 ,$36.91 ,$507.00 ,$36.91 ,$349.65 ,$310.80 , N/A ,$304.20 ,$430.95 ,$354.90 ,$36.91 ,$481.65 ,$385.32 ,$380.25 ,$329.55 ,$430.95 , N/A ,$329.55 ,$329.55 ,$354.90 ,$36.91 , N/A , N/A ,$400.52 ,$430.95 , N/A ,$466.44 ,$354.90 ,$257.15 ,$308.61 ,$308.76 ,$308.61 ,$350.34 ,$456.30 ,$353.13 , N/A ,$400.53 ,$39.12 ,$507.00 ,$507.00 , N/A ,$507.00 ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$405.60 
ST NICHOLAS HOSPITAL - ACUTE,33300057,77470,HC SPECIAL TREATMENT PROCEDURE,333,1 ,"$2,374.00 ","$1,187.00 ",$98.45 ,"$2,374.00 ",$152.93 ,$110.76 ,$98.45 ,$534.97 ,"$1,424.40 ","$2,017.90 ","$1,661.80 ",$152.93 ,"$2,255.30 ","$1,804.24 ","$1,780.50 ","$1,543.10 ","$2,017.90 ",$534.97 ,"$1,543.10 ","$1,543.10 ","$1,661.80 ",$152.93 ,$534.97 ,$534.97 ,$400.52 ,"$2,017.90 ","$1,203.68 ","$2,184.08 ","$1,661.80 ","$1,497.14 ","$1,497.14 ","$1,445.77 ","$1,497.14 ","$1,640.43 ","$2,136.60 ","$1,653.49 ",$540.32 ,"$1,875.46 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$534.97 ,"$1,859.00 ","$1,709.28 ","$1,471.88 ","$1,709.28 ","$1,709.28 ","$1,899.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300058,77470,HC SPECIAL TREATMENT PROCEDURE IMRT HDT BID SRS,333,1 ,"$2,374.00 ","$1,187.00 ",$98.45 ,"$2,374.00 ",$152.93 ,$110.76 ,$98.45 ,$534.97 ,"$1,424.40 ","$2,017.90 ","$1,661.80 ",$152.93 ,"$2,255.30 ","$1,804.24 ","$1,780.50 ","$1,543.10 ","$2,017.90 ",$534.97 ,"$1,543.10 ","$1,543.10 ","$1,661.80 ",$152.93 ,$534.97 ,$534.97 ,$400.52 ,"$2,017.90 ","$1,203.68 ","$2,184.08 ","$1,661.80 ","$1,497.14 ","$1,497.14 ","$1,445.77 ","$1,497.14 ","$1,640.43 ","$2,136.60 ","$1,653.49 ",$540.32 ,"$1,875.46 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$534.97 ,"$1,859.00 ","$1,709.28 ","$1,471.88 ","$1,709.28 ","$1,709.28 ","$1,899.20 "
ST NICHOLAS HOSPITAL - ACUTE,33300065,77778,HC INTERSTITIAL APPL-COMPLE,333,1 ,"$5,826.00 ","$2,913.00 ",$400.52 ,"$5,826.00 ",$452.88 ,"$1,696.34 ","$1,507.86 ",$699.46 ,"$3,495.60 ","$4,952.10 ","$4,078.20 ",$452.88 ,"$5,534.70 ","$4,427.76 ","$4,369.50 ","$3,786.90 ","$4,952.10 ",$699.46 ,"$3,786.90 ","$3,786.90 ","$4,078.20 ",$452.88 ,$699.46 ,$699.46 ,$400.52 ,"$4,952.10 ","$1,573.79 ","$5,359.92 ","$4,078.20 ","$3,615.48 ","$3,615.48 ","$3,548.03 ","$3,615.48 ","$4,025.77 ","$5,243.40 ","$4,057.81 ",$706.45 ,"$4,602.54 ",$480.05 ,"$1,859.00 ","$1,859.00 ",$699.46 ,"$1,859.00 ","$4,194.72 ","$3,612.12 ","$4,194.72 ","$4,194.72 ","$4,660.80 "
ST NICHOLAS HOSPITAL - ACUTE,33300072,77373,HC SRT TREATMENT,333,1 ,"$10,573.00 ","$5,286.50 ",$452.88 ,"$10,573.00 ",$452.88 ,"$5,662.17 ","$5,033.04 ","$1,710.06 ","$6,343.80 ","$8,987.05 ","$7,401.10 ",$452.88 ,"$10,044.35 ","$8,035.48 ","$7,929.75 ","$6,872.45 ","$8,987.05 ","$1,710.06 ","$6,872.45 ","$6,872.45 ","$7,401.10 ",$452.88 ,"$1,710.06 ","$1,710.06 ", N/A ,"$8,987.05 ","$3,847.65 ","$9,727.16 ","$7,401.10 ","$6,961.09 ","$6,961.09 ","$6,438.96 ","$6,961.09 ","$7,305.94 ","$9,515.70 ","$7,364.09 ","$1,727.16 ","$8,352.67 ",$480.05 ,"$4,105.00 ","$4,105.00 ","$1,710.06 ","$4,105.00 ","$7,612.56 ","$6,555.26 ","$7,612.56 ","$7,612.56 ","$8,458.40 "
ST NICHOLAS HOSPITAL - ACUTE,33300084,77293,HC RESPIRATORY MOTION MGMT SIM,333,1 ,$594.00 ,$297.00 ,$36.91 ,$594.00 ,$36.91 ,$594.00 ,$594.00 , N/A ,$356.40 ,$504.90 ,$415.80 ,$36.91 ,$564.30 ,$451.44 ,$445.50 ,$386.10 ,$504.90 , N/A ,$386.10 ,$386.10 ,$415.80 ,$36.91 , N/A , N/A ,$400.52 ,$504.90 , N/A ,$546.48 ,$415.80 ,$301.28 ,$361.57 ,$361.75 ,$361.57 ,$410.45 ,$534.60 ,$413.72 , N/A ,$469.26 ,$39.12 ,$594.00 ,$594.00 , N/A ,$594.00 ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$475.20 
ST NICHOLAS HOSPITAL - ACUTE,33301001,31575,HC LARYNGOSCOPY FLEX FIBEROPTC,333,1 ,$275.00 ,$137.50 ,$34.89 ,$365.20 ,$34.89 ,$177.90 ,$177.90 ,$162.31 ,$165.00 ,$233.75 ,$192.50 ,$34.89 ,$261.25 ,$209.00 ,$206.25 ,$178.75 ,$233.75 ,$162.31 ,$178.75 ,$178.75 ,$192.50 ,$34.89 ,$162.31 ,$162.31 ,$275.00 ,$233.75 ,$365.20 ,$253.00 ,$192.50 ,$275.00 ,$275.00 ,$167.48 ,$275.00 ,$190.03 ,$247.50 ,$191.54 ,$163.93 ,$217.25 ,$36.98 ,$275.00 ,$275.00 ,$162.31 ,$275.00 ,$198.00 ,$170.50 ,$198.00 ,$198.00 ,$220.00 
ST NICHOLAS HOSPITAL - ACUTE,33301002,49411,HC PLCMT INSTST DEV ABD/PELV/RETR,333,1 ,"$3,696.00 ","$1,848.00 ",$400.52 ,"$3,696.00 ",$549.97 ,"$2,390.94 ","$2,390.94 ","$1,245.10 ","$2,217.60 ","$3,141.60 ","$2,587.20 ",$549.97 ,"$3,511.20 ","$2,808.96 ","$2,772.00 ","$2,402.40 ","$3,141.60 ","$1,245.10 ","$2,402.40 ","$2,402.40 ","$2,587.20 ",$549.97 ,"$1,245.10 ","$1,245.10 ",$400.52 ,"$3,141.60 ","$2,801.47 ","$3,400.32 ","$2,587.20 ","$1,703.02 ","$2,128.52 ","$2,250.86 ","$2,128.52 ","$2,553.94 ","$3,326.40 ","$2,574.26 ","$1,257.55 ","$2,919.84 ",$582.97 ,"$1,859.00 ","$1,859.00 ","$1,245.10 ","$1,859.00 ","$2,661.12 ","$2,291.52 ","$2,661.12 ","$2,661.12 ","$2,956.80 "
ST NICHOLAS HOSPITAL - ACUTE,33301005,77280,HC SIMULATION SMP,333,1 ,"$1,079.00 ",$539.50 ,$36.91 ,"$1,079.00 ",$36.91 ,"$1,051.28 ",$934.47 ,$125.11 ,$647.40 ,$917.15 ,$755.30 ,$36.91 ,"$1,025.05 ",$820.04 ,$809.25 ,$701.35 ,$917.15 ,$125.11 ,$701.35 ,$701.35 ,$755.30 ,$36.91 ,$125.11 ,$125.11 ,$400.52 ,$917.15 ,$281.50 ,$992.68 ,$755.30 ,$415.39 ,$415.39 ,$657.11 ,$415.39 ,$745.59 ,$971.10 ,$751.52 ,$126.36 ,$852.41 ,$39.12 ,"$1,079.00 ","$1,079.00 ",$125.11 ,"$1,079.00 ",$776.88 ,$668.98 ,$776.88 ,$776.88 ,$863.20 
ST NICHOLAS HOSPITAL - ACUTE,33301008,77399,HC IMAGE FUSION DOSIMETRY,333,1 ,$281.00 ,$140.50 ,$36.91 ,$281.50 ,$36.91 ,$181.78 ,$181.78 ,$125.11 ,$168.60 ,$238.85 ,$196.70 ,$36.91 ,$266.95 ,$213.56 ,$210.75 ,$182.65 ,$238.85 ,$125.11 ,$182.65 ,$182.65 ,$196.70 ,$36.91 ,$125.11 ,$125.11 ,$281.00 ,$238.85 ,$281.50 ,$258.52 ,$196.70 ,$281.00 ,$281.00 ,$171.13 ,$281.00 ,$194.17 ,$252.90 ,$195.72 ,$126.36 ,$221.99 ,$39.12 ,$281.00 ,$281.00 ,$125.11 ,$281.00 ,$202.32 ,$174.22 ,$202.32 ,$202.32 ,$224.80 
ST NICHOLAS HOSPITAL - ACUTE,33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$605.00 ,$302.50 ,$13.88 ,$605.00 ,$13.88 ,$391.37 ,$391.37 ,$201.71 ,$363.00 ,$514.25 ,$423.50 ,$13.88 ,$574.75 ,$459.80 ,$453.75 ,$393.25 ,$514.25 ,$201.71 ,$393.25 ,$393.25 ,$423.50 ,$13.88 ,$201.71 ,$201.71 ,$279.46 ,$514.25 ,$453.85 ,$556.60 ,$423.50 ,$306.86 ,$368.26 ,$368.45 ,$368.26 ,$418.06 ,$544.50 ,$421.38 ,$203.73 ,$477.95 ,$14.71 ,$605.00 ,$605.00 ,$201.71 ,$605.00 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$347.00 ,$173.50 ,$13.88 ,$347.00 ,$13.88 ,$224.47 ,$224.47 ,$61.13 ,$208.20 ,$294.95 ,$242.90 ,$13.88 ,$329.65 ,$263.72 ,$260.25 ,$225.55 ,$294.95 ,$61.13 ,$225.55 ,$225.55 ,$242.90 ,$13.88 ,$61.13 ,$61.13 ,$279.46 ,$294.95 ,$137.55 ,$319.24 ,$242.90 ,$176.00 ,$211.22 ,$211.32 ,$211.22 ,$239.78 ,$312.30 ,$241.69 ,$61.74 ,$274.13 ,$14.71 ,$347.00 ,$347.00 ,$61.13 ,$347.00 ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$277.60 
ST NICHOLAS HOSPITAL - ACUTE,33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$930.00 ,$465.00 ,$95.17 ,$930.00 ,$95.17 ,$601.62 ,$601.62 ,$314.39 ,$558.00 ,$790.50 ,$651.00 ,$95.17 ,$883.50 ,$706.80 ,$697.50 ,$604.50 ,$790.50 ,$314.39 ,$604.50 ,$604.50 ,$651.00 ,$95.17 ,$314.39 ,$314.39 ,$279.46 ,$790.50 ,$707.37 ,$855.60 ,$651.00 ,$471.70 ,$566.09 ,$566.37 ,$566.09 ,$642.63 ,$837.00 ,$647.75 ,$317.53 ,$734.70 ,$100.88 ,$930.00 ,$930.00 ,$314.39 ,$930.00 ,$669.60 ,$576.60 ,$669.60 ,$669.60 ,$744.00 
ST NICHOLAS HOSPITAL - ACUTE,33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$235.00 ,$117.50 ,$61.13 ,$235.00 ,$161.07 ,$152.02 ,$152.02 ,$61.13 ,$141.00 ,$199.75 ,$164.50 ,$161.07 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 ,$61.13 ,$152.75 ,$152.75 ,$164.50 ,$161.07 ,$61.13 ,$61.13 ,$235.00 ,$199.75 ,$137.55 ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$163.68 ,$61.74 ,$185.65 ,$170.73 ,$235.00 ,$235.00 ,$61.13 ,$235.00 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,33500008,96417,HC CHEMO IV INFUSION EA ADDL <1H,335,1 ,$336.00 ,$168.00 ,$61.13 ,$336.00 ,$95.17 ,$217.36 ,$217.36 ,$61.13 ,$201.60 ,$285.60 ,$235.20 ,$95.17 ,$319.20 ,$255.36 ,$252.00 ,$218.40 ,$285.60 ,$61.13 ,$218.40 ,$218.40 ,$235.20 ,$95.17 ,$61.13 ,$61.13 ,$279.46 ,$285.60 ,$137.55 ,$309.12 ,$235.20 ,$170.42 ,$204.52 ,$204.62 ,$204.52 ,$232.18 ,$302.40 ,$234.02 ,$61.74 ,$265.44 ,$100.88 ,$336.00 ,$336.00 ,$61.13 ,$336.00 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,33500012,96450,HC CHEMO CNS,335,1 ,"$1,019.00 ",$509.50 ,$161.07 ,"$1,019.00 ",$161.07 ,$659.19 ,$659.19 ,$314.39 ,$611.40 ,$866.15 ,$713.30 ,$161.07 ,$968.05 ,$774.44 ,$764.25 ,$662.35 ,$866.15 ,$314.39 ,$662.35 ,$662.35 ,$713.30 ,$161.07 ,$314.39 ,$314.39 ,$279.46 ,$866.15 ,$707.37 ,$937.48 ,$713.30 ,$516.84 ,$620.27 ,$620.57 ,$620.27 ,$704.13 ,$917.10 ,$709.73 ,$317.53 ,$805.01 ,$170.73 ,"$1,019.00 ","$1,019.00 ",$314.39 ,"$1,019.00 ",$733.68 ,$631.78 ,$733.68 ,$733.68 ,$815.20 
ST NICHOLAS HOSPITAL - ACUTE,33500013,96402,HC CHEMOTHERAPY INJECTION-HORMONAL ANTI-NEO,335,1 ,$235.00 ,$117.50 ,$13.88 ,$235.00 ,$13.88 ,$152.02 ,$152.02 ,$61.13 ,$141.00 ,$199.75 ,$164.50 ,$13.88 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 ,$61.13 ,$152.75 ,$152.75 ,$164.50 ,$13.88 ,$61.13 ,$61.13 ,$235.00 ,$199.75 ,$137.55 ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$163.68 ,$61.74 ,$185.65 ,$14.71 ,$235.00 ,$235.00 ,$61.13 ,$235.00 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$512.00 ,$256.00 ,$120.53 ,$836.29 ,$120.53 ,$319.29 ,$283.81 ,$371.68 ,$307.20 ,$435.20 ,$358.40 ,$120.53 ,$486.40 ,$389.12 ,$384.00 ,$332.80 ,$435.20 ,$371.68 ,$332.80 ,$332.80 ,$358.40 ,$120.53 ,$371.68 ,$371.68 ,$512.00 ,$435.20 ,$836.29 ,$471.04 ,$358.40 ,$508.64 ,$508.64 ,$311.81 ,$508.64 ,$353.79 ,$460.80 ,$356.61 ,$375.40 ,$404.48 ,$127.76 ,$512.00 ,$512.00 ,$371.68 ,$512.00 ,$368.64 ,$317.44 ,$368.64 ,$368.64 ,$409.60 
ST NICHOLAS HOSPITAL - ACUTE,34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,569.00 ",$784.50 ,$120.53 ,"$1,569.00 ",$120.53 ,$967.05 ,$859.60 ,$371.68 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$120.53 ,"$1,490.55 ","$1,192.44 ","$1,176.75 ","$1,019.85 ","$1,333.65 ",$371.68 ,"$1,019.85 ","$1,019.85 ","$1,098.30 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,333.65 ",$836.29 ,"$1,443.48 ","$1,098.30 ","$1,039.61 ","$1,039.61 ",$955.52 ,"$1,039.61 ","$1,084.18 ","$1,412.10 ","$1,092.81 ",$375.40 ,"$1,239.51 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ","$1,255.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000006,78013,HC NM THYROID SCAN,340,1 ,$994.00 ,$497.00 ,$120.53 ,$994.00 ,$120.53 ,$776.15 ,$689.91 ,$371.68 ,$596.40 ,$844.90 ,$695.80 ,$120.53 ,$944.30 ,$755.44 ,$745.50 ,$646.10 ,$844.90 ,$371.68 ,$646.10 ,$646.10 ,$695.80 ,$120.53 ,$371.68 ,$371.68 ,$580.41 ,$844.90 ,$836.29 ,$914.48 ,$695.80 ,$664.48 ,$664.48 ,$605.35 ,$664.48 ,$686.85 ,$894.60 ,$692.32 ,$375.40 ,$785.26 ,$127.76 ,$994.00 ,$994.00 ,$371.68 ,$994.00 ,$715.68 ,$616.28 ,$715.68 ,$715.68 ,$795.20 
ST NICHOLAS HOSPITAL - ACUTE,34000007,78018,HC NM THYROID CA METS WHOLE BODY,340,1 ,"$2,092.00 ","$1,046.00 ",$120.53 ,"$2,092.00 ",$120.53 ,"$1,215.93 ","$1,080.83 ",$482.51 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$120.53 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ",$482.51 ,"$1,359.80 ","$1,359.80 ","$1,464.40 ",$120.53 ,$482.51 ,$482.51 ,$580.41 ,"$1,778.20 ","$1,085.64 ","$1,924.64 ","$1,464.40 ","$1,386.80 ","$1,386.80 ","$1,274.03 ","$1,386.80 ","$1,445.57 ","$1,882.80 ","$1,457.08 ",$487.34 ,"$1,652.68 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,"$1,161.05 ","$1,032.04 ",$371.68 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$371.68 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$302.87 ,$371.68 ,$371.68 ,$580.41 ,"$1,422.05 ",$836.29 ,"$1,539.16 ","$1,171.10 ","$1,039.61 ","$1,039.61 ","$1,018.86 ","$1,039.61 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$375.40 ,"$1,321.67 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000010,78102,"HC BONE MARROW IMAGING, LTD",340,1 ,"$1,046.00 ",$523.00 ,$120.53 ,"$1,046.00 ",$120.53 ,$639.57 ,$568.51 ,$371.68 ,$627.60 ,$889.10 ,$732.20 ,$120.53 ,$993.70 ,$794.96 ,$784.50 ,$679.90 ,$889.10 ,$371.68 ,$679.90 ,$679.90 ,$732.20 ,$120.53 ,$371.68 ,$371.68 ,$580.41 ,$889.10 ,$836.29 ,$962.32 ,$732.20 ,"$1,046.00 ","$1,046.00 ",$637.01 ,"$1,046.00 ",$722.79 ,$941.40 ,$728.54 ,$375.40 ,$826.34 ,$127.76 ,"$1,046.00 ","$1,046.00 ",$371.68 ,"$1,046.00 ",$753.12 ,$648.52 ,$753.12 ,$753.12 ,$836.80 
ST NICHOLAS HOSPITAL - ACUTE,34000011,78104,HC BONE MARROW IMAGING WHOLE BODY,340,1 ,"$1,360.00 ",$680.00 ,$120.53 ,"$1,360.00 ",$120.53 ,$936.01 ,$832.01 ,$371.68 ,$816.00 ,"$1,156.00 ",$952.00 ,$120.53 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$371.68 ,$884.00 ,$884.00 ,$952.00 ,$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,156.00 ",$836.29 ,"$1,251.20 ",$952.00 ,"$1,254.84 ","$1,254.84 ",$828.24 ,"$1,254.84 ",$939.76 ,"$1,224.00 ",$947.24 ,$375.40 ,"$1,074.40 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$2,092.00 ","$1,046.00 ",$302.87 ,"$2,092.00 ",$302.87 ,"$1,330.78 ","$1,182.92 ",$482.51 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$302.87 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ",$482.51 ,"$1,359.80 ","$1,359.80 ","$1,464.40 ",$302.87 ,$482.51 ,$482.51 ,$580.41 ,"$1,778.20 ","$1,085.64 ","$1,924.64 ","$1,464.40 ","$1,254.84 ","$1,254.84 ","$1,274.03 ","$1,254.84 ","$1,445.57 ","$1,882.80 ","$1,457.08 ",$487.34 ,"$1,652.68 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000015,78201,HC LIVER IMAGING STATIC,340,1 ,"$1,150.00 ",$575.00 ,$302.87 ,"$1,150.00 ",$302.87 ,$755.97 ,$671.97 ,$482.51 ,$690.00 ,$977.50 ,$805.00 ,$302.87 ,"$1,092.50 ",$874.00 ,$862.50 ,$747.50 ,$977.50 ,$482.51 ,$747.50 ,$747.50 ,$805.00 ,$302.87 ,$482.51 ,$482.51 ,$580.41 ,$977.50 ,"$1,085.64 ","$1,058.00 ",$805.00 ,"$1,150.00 ","$1,150.00 ",$700.35 ,"$1,150.00 ",$794.65 ,"$1,035.00 ",$800.98 ,$487.34 ,$908.50 ,$321.04 ,"$1,150.00 ","$1,150.00 ",$482.51 ,"$1,150.00 ",$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,360.00 ",$680.00 ,$302.87 ,"$1,360.00 ",$302.87 ,$760.63 ,$676.11 ,$371.68 ,$816.00 ,"$1,156.00 ",$952.00 ,$302.87 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$371.68 ,$884.00 ,$884.00 ,$952.00 ,$302.87 ,$371.68 ,$371.68 ,$580.41 ,"$1,156.00 ",$836.29 ,"$1,251.20 ",$952.00 ,"$1,349.87 ","$1,349.87 ",$828.24 ,"$1,349.87 ",$939.76 ,"$1,224.00 ",$947.24 ,$375.40 ,"$1,074.40 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$2,092.00 ","$1,046.00 ",$120.53 ,"$2,092.00 ",$120.53 ,"$1,312.16 ","$1,166.36 ",$371.68 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$120.53 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ",$371.68 ,"$1,359.80 ","$1,359.80 ","$1,464.40 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,778.20 ",$836.29 ,"$1,924.64 ","$1,464.40 ","$1,349.87 ","$1,349.87 ","$1,274.03 ","$1,349.87 ","$1,445.57 ","$1,882.80 ","$1,457.08 ",$375.40 ,"$1,652.68 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000024,78261,HC GASTRIC MUCOSA IMAGING,340,1 ,"$1,046.00 ",$523.00 ,$120.53 ,"$1,046.00 ",$120.53 ,$774.60 ,$688.53 ,$371.68 ,$627.60 ,$889.10 ,$732.20 ,$120.53 ,$993.70 ,$794.96 ,$784.50 ,$679.90 ,$889.10 ,$371.68 ,$679.90 ,$679.90 ,$732.20 ,$120.53 ,$371.68 ,$371.68 ,$580.41 ,$889.10 ,$836.29 ,$962.32 ,$732.20 ,"$1,046.00 ","$1,046.00 ",$637.01 ,"$1,046.00 ",$722.79 ,$941.40 ,$728.54 ,$375.40 ,$826.34 ,$127.76 ,"$1,046.00 ","$1,046.00 ",$371.68 ,"$1,046.00 ",$753.12 ,$648.52 ,$753.12 ,$753.12 ,$836.80 
ST NICHOLAS HOSPITAL - ACUTE,34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$1,673.00 ",$836.50 ,$120.53 ,"$1,673.00 ",$120.53 ,"$1,323.02 ","$1,176.02 ",$371.68 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$120.53 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$371.68 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,422.05 ",$836.29 ,"$1,539.16 ","$1,171.10 ","$1,173.08 ","$1,173.08 ","$1,018.86 ","$1,173.08 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$375.40 ,"$1,321.67 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000027,78278,HC GI BLEED SCAN,340,1 ,"$1,883.00 ",$941.50 ,$302.87 ,"$1,883.00 ",$302.87 ,"$1,341.65 ","$1,192.58 ",$371.68 ,"$1,129.80 ","$1,600.55 ","$1,318.10 ",$302.87 ,"$1,788.85 ","$1,431.08 ","$1,412.25 ","$1,223.95 ","$1,600.55 ",$371.68 ,"$1,223.95 ","$1,223.95 ","$1,318.10 ",$302.87 ,$371.68 ,$371.68 ,$580.41 ,"$1,600.55 ",$836.29 ,"$1,732.36 ","$1,318.10 ","$1,173.08 ","$1,173.08 ","$1,146.75 ","$1,173.08 ","$1,301.15 ","$1,694.70 ","$1,311.51 ",$375.40 ,"$1,487.57 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,355.76 ","$1,167.46 ","$1,355.76 ","$1,355.76 ","$1,506.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,778.00 ",$889.00 ,$120.53 ,"$1,778.00 ",$120.53 ,"$1,327.68 ","$1,180.16 ",$371.68 ,"$1,066.80 ","$1,511.30 ","$1,244.60 ",$120.53 ,"$1,689.10 ","$1,351.28 ","$1,333.50 ","$1,155.70 ","$1,511.30 ",$371.68 ,"$1,155.70 ","$1,155.70 ","$1,244.60 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,511.30 ",$836.29 ,"$1,635.76 ","$1,244.60 ","$1,173.08 ","$1,173.08 ","$1,082.80 ","$1,173.08 ","$1,228.60 ","$1,600.20 ","$1,238.38 ",$375.40 ,"$1,404.62 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,280.16 ","$1,102.36 ","$1,280.16 ","$1,280.16 ","$1,422.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,360.00 ",$680.00 ,$120.53 ,"$1,360.00 ",$120.53 ,$890.44 ,$791.50 ,$371.68 ,$816.00 ,"$1,156.00 ",$952.00 ,$120.53 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$371.68 ,$884.00 ,$884.00 ,$952.00 ,$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,156.00 ",$836.29 ,"$1,251.20 ",$952.00 ,"$1,173.69 ","$1,173.69 ",$828.24 ,"$1,173.69 ",$939.76 ,"$1,224.00 ",$947.24 ,$375.40 ,"$1,074.40 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$1,987.00 ",$993.50 ,$120.53 ,"$1,987.00 ",$120.53 ,"$1,162.60 ","$1,033.42 ",$371.68 ,"$1,192.20 ","$1,688.95 ","$1,390.90 ",$120.53 ,"$1,887.65 ","$1,510.12 ","$1,490.25 ","$1,291.55 ","$1,688.95 ",$371.68 ,"$1,291.55 ","$1,291.55 ","$1,390.90 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,688.95 ",$836.29 ,"$1,828.04 ","$1,390.90 ","$1,173.69 ","$1,173.69 ","$1,210.08 ","$1,173.69 ","$1,373.02 ","$1,788.30 ","$1,383.95 ",$375.40 ,"$1,569.73 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,430.64 ","$1,231.94 ","$1,430.64 ","$1,430.64 ","$1,589.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$2,196.00 ","$1,098.00 ",$120.53 ,"$2,196.00 ",$120.53 ,"$1,324.58 ","$1,177.40 ",$371.68 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$120.53 ,"$2,086.20 ","$1,668.96 ","$1,647.00 ","$1,427.40 ","$1,866.60 ",$371.68 ,"$1,427.40 ","$1,427.40 ","$1,537.20 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,866.60 ",$836.29 ,"$2,020.32 ","$1,537.20 ","$1,173.69 ","$1,173.69 ","$1,337.36 ","$1,173.69 ","$1,517.44 ","$1,976.40 ","$1,529.51 ",$375.40 ,"$1,734.84 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,756.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$4,393.00 ","$2,196.50 ",$302.87 ,"$4,393.00 ",$302.87 ,"$1,215.93 ","$1,080.83 ","$1,288.50 ","$2,635.80 ","$3,734.05 ","$3,075.10 ",$302.87 ,"$4,173.35 ","$3,338.68 ","$3,294.75 ","$2,855.45 ","$3,734.05 ","$1,288.50 ","$2,855.45 ","$2,855.45 ","$3,075.10 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$3,734.05 ","$2,899.11 ","$4,041.56 ","$3,075.10 ","$4,179.69 ","$4,179.69 ","$2,675.34 ","$4,179.69 ","$3,035.56 ","$3,953.70 ","$3,059.72 ","$1,301.39 ","$3,470.47 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$3,162.96 ","$2,723.66 ","$3,162.96 ","$3,162.96 ","$3,514.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000036,78451,HC HT MUSCLE IMAGE SPECT SINGLE REST ONLY,340,1 ,"$4,393.00 ","$2,196.50 ",$302.87 ,"$4,393.00 ",$302.87 ,"$1,215.93 ","$1,080.83 ","$1,288.50 ","$2,635.80 ","$3,734.05 ","$3,075.10 ",$302.87 ,"$4,173.35 ","$3,338.68 ","$3,294.75 ","$2,855.45 ","$3,734.05 ","$1,288.50 ","$2,855.45 ","$2,855.45 ","$3,075.10 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$3,734.05 ","$2,899.11 ","$4,041.56 ","$3,075.10 ","$4,179.69 ","$4,179.69 ","$2,675.34 ","$4,179.69 ","$3,035.56 ","$3,953.70 ","$3,059.72 ","$1,301.39 ","$3,470.47 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$3,162.96 ","$2,723.66 ","$3,162.96 ","$3,162.96 ","$3,514.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$4,811.00 ","$2,405.50 ",$302.87 ,"$4,811.00 ",$302.87 ,"$1,757.16 ","$1,561.92 ","$1,288.50 ","$2,886.60 ","$4,089.35 ","$3,367.70 ",$302.87 ,"$4,570.45 ","$3,656.36 ","$3,608.25 ","$3,127.15 ","$4,089.35 ","$1,288.50 ","$3,127.15 ","$3,127.15 ","$3,367.70 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$4,089.35 ","$2,899.11 ","$4,426.12 ","$3,367.70 ","$4,179.69 ","$4,179.69 ","$2,929.90 ","$4,179.69 ","$3,324.40 ","$4,329.90 ","$3,350.86 ","$1,301.39 ","$3,800.69 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$3,463.92 ","$2,982.82 ","$3,463.92 ","$3,463.92 ","$3,848.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000044,78472,HC MUGA RESTING SGL,340,1 ,"$2,196.00 ","$1,098.00 ",$120.53 ,"$2,196.00 ",$120.53 ,$807.19 ,$717.50 ,$371.68 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$120.53 ,"$2,086.20 ","$1,668.96 ","$1,647.00 ","$1,427.40 ","$1,866.60 ",$371.68 ,"$1,427.40 ","$1,427.40 ","$1,537.20 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,866.60 ",$836.29 ,"$2,020.32 ","$1,537.20 ","$1,388.05 ","$1,388.05 ","$1,337.36 ","$1,388.05 ","$1,517.44 ","$1,976.40 ","$1,529.51 ",$375.40 ,"$1,734.84 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,756.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000045,78473,HC MUGA RESTING MULTI,340,1 ,"$2,301.00 ","$1,150.50 ",$120.53 ,"$2,301.00 ",$120.53 ,$974.81 ,$866.50 ,$371.68 ,"$1,380.60 ","$1,955.85 ","$1,610.70 ",$120.53 ,"$2,185.95 ","$1,748.76 ","$1,725.75 ","$1,495.65 ","$1,955.85 ",$371.68 ,"$1,495.65 ","$1,495.65 ","$1,610.70 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,955.85 ",$836.29 ,"$2,116.92 ","$1,610.70 ","$1,388.05 ","$1,388.05 ","$1,401.31 ","$1,388.05 ","$1,589.99 ","$2,070.90 ","$1,602.65 ",$375.40 ,"$1,817.79 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,656.72 ","$1,426.62 ","$1,656.72 ","$1,656.72 ","$1,840.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000046,78499,HC THALLIUM VIABILITY,340,1 ,"$1,360.00 ",$680.00 ,$120.53 ,"$1,360.00 ",$120.53 ,$879.78 ,$879.78 ,$371.68 ,$816.00 ,"$1,156.00 ",$952.00 ,$120.53 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$371.68 ,$884.00 ,$884.00 ,$952.00 ,$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,156.00 ",$836.29 ,"$1,251.20 ",$952.00 ,"$1,360.00 ","$1,360.00 ",$828.24 ,"$1,360.00 ",$939.76 ,"$1,224.00 ",$947.24 ,$375.40 ,"$1,074.40 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000047,78580,HC LUNG PERFUS,340,1 ,"$1,569.00 ",$784.50 ,$302.87 ,"$1,569.00 ",$302.87 ,$901.86 ,$801.66 ,$371.68 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$302.87 ,"$1,490.55 ","$1,192.44 ","$1,176.75 ","$1,019.85 ","$1,333.65 ",$371.68 ,"$1,019.85 ","$1,019.85 ","$1,098.30 ",$302.87 ,$371.68 ,$371.68 ,$580.41 ,"$1,333.65 ",$836.29 ,"$1,443.48 ","$1,098.30 ","$1,108.71 ","$1,108.71 ",$955.52 ,"$1,108.71 ","$1,084.18 ","$1,412.10 ","$1,092.81 ",$375.40 ,"$1,239.51 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ","$1,255.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,"$1,259.39 ","$1,119.46 ",$482.51 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$482.51 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$302.87 ,$482.51 ,$482.51 ,$580.41 ,"$1,422.05 ","$1,085.64 ","$1,539.16 ","$1,171.10 ","$1,561.07 ","$1,561.07 ","$1,018.86 ","$1,561.07 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$487.34 ,"$1,321.67 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000049,78582,HC LUNG PERFUS  AND  SCAN,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,"$1,259.39 ","$1,119.46 ",$482.51 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$482.51 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$302.87 ,$482.51 ,$482.51 ,$580.41 ,"$1,422.05 ","$1,085.64 ","$1,539.16 ","$1,171.10 ","$1,561.07 ","$1,561.07 ","$1,018.86 ","$1,561.07 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$487.34 ,"$1,321.67 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000050,78579,HC PULM VENT W/IMG,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,$724.37 ,$643.88 ,$371.68 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$371.68 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$302.87 ,$371.68 ,$371.68 ,$580.41 ,"$1,422.05 ",$836.29 ,"$1,539.16 ","$1,171.10 ","$1,108.71 ","$1,108.71 ","$1,018.86 ","$1,108.71 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$375.40 ,"$1,321.67 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000051,78582,HC PULM VENT  AND  PERF W/IMG   L,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,"$1,259.39 ","$1,119.46 ",$482.51 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$482.51 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$302.87 ,$482.51 ,$482.51 ,$580.41 ,"$1,422.05 ","$1,085.64 ","$1,539.16 ","$1,171.10 ","$1,561.07 ","$1,561.07 ","$1,018.86 ","$1,561.07 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$487.34 ,"$1,321.67 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000052,78579,HC LUNG SCAN-VENTILATION,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,$724.37 ,$643.88 ,$371.68 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$371.68 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$302.87 ,$371.68 ,$371.68 ,$580.41 ,"$1,422.05 ",$836.29 ,"$1,539.16 ","$1,171.10 ","$1,108.71 ","$1,108.71 ","$1,018.86 ","$1,108.71 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$375.40 ,"$1,321.67 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000056,78630,HC CISTERNOGRAPHY,340,1 ,"$2,615.00 ","$1,307.50 ",$302.87 ,"$2,615.00 ",$302.87 ,"$1,358.72 ","$1,207.75 ",$482.51 ,"$1,569.00 ","$2,222.75 ","$1,830.50 ",$302.87 ,"$2,484.25 ","$1,987.40 ","$1,961.25 ","$1,699.75 ","$2,222.75 ",$482.51 ,"$1,699.75 ","$1,699.75 ","$1,830.50 ",$302.87 ,$482.51 ,$482.51 ,$580.41 ,"$2,222.75 ","$1,085.64 ","$2,405.80 ","$1,830.50 ","$1,931.78 ","$1,931.78 ","$1,592.54 ","$1,931.78 ","$1,806.97 ","$2,353.50 ","$1,821.35 ",$487.34 ,"$2,065.85 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,882.80 ","$1,621.30 ","$1,882.80 ","$1,882.80 ","$2,092.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000058,78650,HC CSF LEAK DETECTION,340,1 ,"$2,615.00 ","$1,307.50 ",$302.87 ,"$2,899.11 ",$302.87 ,"$1,108.84 ",$985.64 ,"$1,288.50 ","$1,569.00 ","$2,222.75 ","$1,830.50 ",$302.87 ,"$2,484.25 ","$1,987.40 ","$1,961.25 ","$1,699.75 ","$2,222.75 ","$1,288.50 ","$1,699.75 ","$1,699.75 ","$1,830.50 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$2,222.75 ","$2,899.11 ","$2,405.80 ","$1,830.50 ","$1,931.78 ","$1,931.78 ","$1,592.54 ","$1,931.78 ","$1,806.97 ","$2,353.50 ","$1,821.35 ","$1,301.39 ","$2,065.85 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$1,882.80 ","$1,621.30 ","$1,882.80 ","$1,882.80 ","$2,092.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$2,405.00 ","$1,202.50 ",$120.53 ,"$2,405.00 ",$120.53 ,$830.47 ,$738.19 ,$482.51 ,"$1,443.00 ","$2,044.25 ","$1,683.50 ",$120.53 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ",$482.51 ,"$1,563.25 ","$1,563.25 ","$1,683.50 ",$120.53 ,$482.51 ,$482.51 ,$580.41 ,"$2,044.25 ","$1,085.64 ","$2,212.60 ","$1,683.50 ","$1,510.91 ","$1,510.91 ","$1,464.65 ","$1,510.91 ","$1,661.86 ","$2,164.50 ","$1,675.08 ",$487.34 ,"$1,899.95 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$2,405.00 ","$1,202.50 ",$120.53 ,"$2,405.00 ",$120.53 ,$525.28 ,$466.92 ,$482.51 ,"$1,443.00 ","$2,044.25 ","$1,683.50 ",$120.53 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ",$482.51 ,"$1,563.25 ","$1,563.25 ","$1,683.50 ",$120.53 ,$482.51 ,$482.51 ,$580.41 ,"$2,044.25 ","$1,085.64 ","$2,212.60 ","$1,683.50 ","$1,510.91 ","$1,510.91 ","$1,464.65 ","$1,510.91 ","$1,661.86 ","$2,164.50 ","$1,675.08 ",$487.34 ,"$1,899.95 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000066,78740,HC URETERAL REFLUX STUDY,340,1 ,"$1,464.00 ",$732.00 ,$120.53 ,"$1,464.00 ",$120.53 ,$852.20 ,$757.51 ,$371.68 ,$878.40 ,"$1,244.40 ","$1,024.80 ",$120.53 ,"$1,390.80 ","$1,112.64 ","$1,098.00 ",$951.60 ,"$1,244.40 ",$371.68 ,$951.60 ,$951.60 ,"$1,024.80 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,244.40 ",$836.29 ,"$1,346.88 ","$1,024.80 ","$1,464.00 ","$1,464.00 ",$891.58 ,"$1,464.00 ","$1,011.62 ","$1,317.60 ","$1,019.68 ",$375.40 ,"$1,156.56 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,054.08 ",$907.68 ,"$1,054.08 ","$1,054.08 ","$1,171.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000068,78800,HC TUMOR LOCAL LIMITED,340,1 ,"$1,255.00 ",$627.50 ,$302.87 ,"$1,255.00 ",$302.87 ,$717.17 ,$637.49 ,$371.68 ,$753.00 ,"$1,066.75 ",$878.50 ,$302.87 ,"$1,192.25 ",$953.80 ,$941.25 ,$815.75 ,"$1,066.75 ",$371.68 ,$815.75 ,$815.75 ,$878.50 ,$302.87 ,$371.68 ,$371.68 ,$580.41 ,"$1,066.75 ",$836.29 ,"$1,154.60 ",$878.50 ,"$1,255.00 ","$1,255.00 ",$764.30 ,"$1,255.00 ",$867.21 ,"$1,129.50 ",$874.11 ,$375.40 ,$991.45 ,$321.04 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ",$903.60 ,$778.10 ,$903.60 ,$903.60 ,"$1,004.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$2,092.00 ","$1,046.00 ",$302.87 ,"$2,899.11 ",$302.87 ,"$1,254.73 ","$1,115.32 ","$1,288.50 ","$1,255.20 ","$1,778.20 ","$1,464.40 ",$302.87 ,"$1,987.40 ","$1,589.92 ","$1,569.00 ","$1,359.80 ","$1,778.20 ","$1,288.50 ","$1,359.80 ","$1,359.80 ","$1,464.40 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$1,778.20 ","$2,899.11 ","$1,924.64 ","$1,464.40 ","$2,092.00 ","$2,092.00 ","$1,274.03 ","$2,092.00 ","$1,445.57 ","$1,882.80 ","$1,457.08 ","$1,301.39 ","$1,652.68 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,673.60 "
ST NICHOLAS HOSPITAL - ACUTE,34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$2,405.00 ","$1,202.50 ",$302.87 ,"$2,899.11 ",$302.87 ,"$1,288.88 ","$1,145.67 ","$1,288.50 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$302.87 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ","$1,288.50 ","$1,563.25 ","$1,563.25 ","$1,683.50 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$2,044.25 ","$2,899.11 ","$2,212.60 ","$1,683.50 ","$2,380.28 ","$2,380.28 ","$1,464.65 ","$2,380.28 ","$1,661.86 ","$2,164.50 ","$1,675.08 ","$1,301.39 ","$1,899.95 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000072,78803,HC TUMOR IMAGING (SPECT) MIBG,340,1 ,"$2,405.00 ","$1,202.50 ",$302.87 ,"$2,899.11 ",$302.87 ,"$1,288.88 ","$1,145.67 ","$1,288.50 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$302.87 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ","$1,288.50 ","$1,563.25 ","$1,563.25 ","$1,683.50 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$2,044.25 ","$2,899.11 ","$2,212.60 ","$1,683.50 ","$2,380.28 ","$2,380.28 ","$1,464.65 ","$2,380.28 ","$1,661.86 ","$2,164.50 ","$1,675.08 ","$1,301.39 ","$1,899.95 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000075,78803,HC TUMOR IMAGING (SPECT) OCTREO,340,1 ,"$2,405.00 ","$1,202.50 ",$302.87 ,"$2,899.11 ",$302.87 ,"$1,288.88 ","$1,145.67 ","$1,288.50 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$302.87 ,"$2,284.75 ","$1,827.80 ","$1,803.75 ","$1,563.25 ","$2,044.25 ","$1,288.50 ","$1,563.25 ","$1,563.25 ","$1,683.50 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$2,044.25 ","$2,899.11 ","$2,212.60 ","$1,683.50 ","$2,380.28 ","$2,380.28 ","$1,464.65 ","$2,380.28 ","$1,661.86 ","$2,164.50 ","$1,675.08 ","$1,301.39 ","$1,899.95 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,924.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000077,78804,HC TUMOR/INF-WHOLE BODY-MULT DAY,340,1 ,"$4,811.00 ","$2,405.50 ",$302.87 ,"$4,811.00 ",$302.87 ,"$2,305.59 ","$2,049.41 ","$1,288.50 ","$2,886.60 ","$4,089.35 ","$3,367.70 ",$302.87 ,"$4,570.45 ","$3,656.36 ","$3,608.25 ","$3,127.15 ","$4,089.35 ","$1,288.50 ","$3,127.15 ","$3,127.15 ","$3,367.70 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$4,089.35 ","$2,899.11 ","$4,426.12 ","$3,367.70 ","$4,193.46 ","$4,193.46 ","$2,929.90 ","$4,193.46 ","$3,324.40 ","$4,329.90 ","$3,350.86 ","$1,301.39 ","$3,800.69 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$3,463.92 ","$2,982.82 ","$3,463.92 ","$3,463.92 ","$3,848.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000081,79005,HC NM RADIOPAHARM THRPY ORAL,340,1 ,"$1,360.00 ",$680.00 ,$98.11 ,"$1,360.00 ",$98.11 ,$216.86 ,$192.76 ,$249.49 ,$816.00 ,"$1,156.00 ",$952.00 ,$98.11 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$249.49 ,$884.00 ,$884.00 ,$952.00 ,$98.11 ,$249.49 ,$249.49 ,$580.41 ,"$1,156.00 ",$561.35 ,"$1,251.20 ",$952.00 ,$926.82 ,$926.82 ,$828.24 ,$926.82 ,$939.76 ,"$1,224.00 ",$947.24 ,$251.98 ,"$1,074.40 ",$104.00 ,"$1,192.00 ","$1,192.00 ",$249.49 ,"$1,192.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000082,79005,HC NM RADIOPAHARM THRPY HYPERTHYROID,340,1 ,"$1,360.00 ",$680.00 ,$98.11 ,"$1,360.00 ",$98.11 ,$216.86 ,$192.76 ,$249.49 ,$816.00 ,"$1,156.00 ",$952.00 ,$98.11 ,"$1,292.00 ","$1,033.60 ","$1,020.00 ",$884.00 ,"$1,156.00 ",$249.49 ,$884.00 ,$884.00 ,$952.00 ,$98.11 ,$249.49 ,$249.49 ,$580.41 ,"$1,156.00 ",$561.35 ,"$1,251.20 ",$952.00 ,$926.82 ,$926.82 ,$828.24 ,$926.82 ,$939.76 ,"$1,224.00 ",$947.24 ,$251.98 ,"$1,074.40 ",$104.00 ,"$1,192.00 ","$1,192.00 ",$249.49 ,"$1,192.00 ",$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,34000083,79101,HC NM RADIOPAHARM THRPY IV,340,1 ,"$1,569.00 ",$784.50 ,$98.11 ,"$1,569.00 ",$98.11 ,$216.29 ,$192.26 ,$249.49 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$98.11 ,"$1,490.55 ","$1,192.44 ","$1,176.75 ","$1,019.85 ","$1,333.65 ",$249.49 ,"$1,019.85 ","$1,019.85 ","$1,098.30 ",$98.11 ,$249.49 ,$249.49 ,$580.41 ,"$1,333.65 ",$561.35 ,"$1,443.48 ","$1,098.30 ",$926.82 ,$926.82 ,$955.52 ,$926.82 ,"$1,084.18 ","$1,412.10 ","$1,092.81 ",$251.98 ,"$1,239.51 ",$104.00 ,"$1,192.00 ","$1,192.00 ",$249.49 ,"$1,192.00 ","$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ","$1,255.20 "
ST NICHOLAS HOSPITAL - ACUTE,34000091,78598,HC NM PULM VENT AND PERF DIFF W/IMG,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,"$1,180.24 ","$1,049.10 ",$482.51 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,271.48 ","$1,254.75 ","$1,087.45 ","$1,422.05 ",$482.51 ,"$1,087.45 ","$1,087.45 ","$1,171.10 ",$302.87 ,$482.51 ,$482.51 ,$580.41 ,"$1,422.05 ","$1,085.64 ","$1,539.16 ","$1,171.10 ","$1,561.07 ","$1,561.07 ","$1,018.86 ","$1,561.07 ","$1,156.04 ","$1,505.70 ","$1,165.24 ",$487.34 ,"$1,321.67 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,338.40 "
ST NICHOLAS HOSPITAL - ACUTE,34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$2,196.00 ","$1,098.00 ",$120.53 ,"$2,196.00 ",$120.53 ,"$1,795.40 ","$1,595.91 ",$482.51 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$120.53 ,"$2,086.20 ","$1,668.96 ","$1,647.00 ","$1,427.40 ","$1,866.60 ",$482.51 ,"$1,427.40 ","$1,427.40 ","$1,537.20 ",$120.53 ,$482.51 ,$482.51 ,$580.41 ,"$1,866.60 ","$1,085.64 ","$2,020.32 ","$1,537.20 ","$1,349.87 ","$1,349.87 ","$1,337.36 ","$1,349.87 ","$1,517.44 ","$1,976.40 ","$1,529.51 ",$487.34 ,"$1,734.84 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$482.51 ,"$1,192.00 ","$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,756.80 "
ST NICHOLAS HOSPITAL - ACUTE,34000093,78071,HC PARATHYROID IMG W/SPECT 78071,340,1 ,"$2,301.00 ","$1,150.50 ",$120.53 ,"$2,301.00 ",$120.53 ,"$1,330.78 ","$1,182.92 ",$371.68 ,"$1,380.60 ","$1,955.85 ","$1,610.70 ",$120.53 ,"$2,185.95 ","$1,748.76 ","$1,725.75 ","$1,495.65 ","$1,955.85 ",$371.68 ,"$1,495.65 ","$1,495.65 ","$1,610.70 ",$120.53 ,$371.68 ,$371.68 ,$580.41 ,"$1,955.85 ",$836.29 ,"$2,116.92 ","$1,610.70 ","$2,301.00 ","$2,301.00 ","$1,401.31 ","$2,301.00 ","$1,589.99 ","$2,070.90 ","$1,602.65 ",$375.40 ,"$1,817.79 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$371.68 ,"$1,192.00 ","$1,656.72 ","$1,426.62 ","$1,656.72 ","$1,656.72 ","$1,840.80 "
ST NICHOLAS HOSPITAL - ACUTE,34100007,A9538,HC NM PYROPHOSPHATE 99M VIAL,343,1 ,$90.00 ,$45.00 ,$37.80 ,$90.00 , N/A ,$58.22 ,$58.22 , N/A ,$54.00 ,$76.50 ,$63.00 , N/A ,$85.50 ,$68.40 ,$67.50 ,$46.70 ,$76.50 , N/A ,$46.70 ,$58.50 ,$63.00 , N/A , N/A , N/A ,$37.80 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 , N/A ,$71.10 , N/A , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,34100020,0042T,HC CT CEREBRAL PERFUSION W/BLOOD FLOW,351,1 ,"$2,100.00 ","$1,050.00 ",$99.26 ,"$2,100.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,260.00 ","$1,785.00 ","$1,470.00 ",$99.26 ,"$1,995.00 ","$1,596.00 ","$1,575.00 ","$1,171.00 ","$1,785.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,470.00 ",$99.26 , N/A , N/A ,$471.80 ,"$1,785.00 ", N/A ,"$1,932.00 ","$1,470.00 ","$1,065.12 ","$1,278.27 ","$1,278.90 ","$1,278.27 ","$1,451.10 ","$1,890.00 ","$1,462.65 ", N/A ,"$1,659.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,34100033,78831,HC TUMOR LOCAL SPECT MULT AREA 1 DAY OR SGL AREA W/MULT DAYS,341,1 ,"$2,562.00 ","$1,281.00 ",$302.87 ,"$2,899.11 ",$302.87 ,"$2,562.00 ","$2,435.98 ","$1,288.50 ","$1,537.20 ","$2,177.70 ","$1,793.40 ",$302.87 ,"$2,433.90 ","$1,947.12 ","$1,921.50 ","$1,665.30 ","$2,177.70 ","$1,288.50 ","$1,665.30 ","$1,665.30 ","$1,793.40 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$2,177.70 ","$2,899.11 ","$2,357.04 ","$1,793.40 ","$2,562.00 ","$2,562.00 ","$1,560.26 ","$2,562.00 ","$1,770.34 ","$2,305.80 ","$1,784.43 ","$1,301.39 ","$2,023.98 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$1,844.64 ","$1,588.44 ","$1,844.64 ","$1,844.64 ","$2,049.60 "
ST NICHOLAS HOSPITAL - ACUTE,34100034,78830,HC TUMOR IMAGING SPECT W/CT SGL AREA 1 DAY,341,1 ,"$2,562.00 ","$1,281.00 ",$302.87 ,"$2,899.11 ",$302.87 ,"$1,846.99 ","$1,641.77 ","$1,288.50 ","$1,537.20 ","$2,177.70 ","$1,793.40 ",$302.87 ,"$2,433.90 ","$1,947.12 ","$1,921.50 ","$1,665.30 ","$2,177.70 ","$1,288.50 ","$1,665.30 ","$1,665.30 ","$1,793.40 ",$302.87 ,"$1,288.50 ","$1,288.50 ",$580.41 ,"$2,177.70 ","$2,899.11 ","$2,357.04 ","$1,793.40 ","$2,562.00 ","$2,562.00 ","$1,560.26 ","$2,562.00 ","$1,770.34 ","$2,305.80 ","$1,784.43 ","$1,301.39 ","$2,023.98 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,288.50 ","$1,192.00 ","$1,844.64 ","$1,588.44 ","$1,844.64 ","$1,844.64 ","$2,049.60 "
ST NICHOLAS HOSPITAL - ACUTE,34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$454.00 ,$227.00 ,$190.68 ,$454.00 , N/A ,$293.69 ,$293.69 , N/A ,$272.40 ,$385.90 ,$317.80 , N/A ,$431.30 ,$345.04 ,$340.50 ,$218.42 ,$385.90 , N/A ,$218.42 ,$295.10 ,$317.80 , N/A , N/A , N/A ,$190.68 ,$385.90 , N/A ,$417.68 ,$317.80 ,$230.27 ,$276.35 ,$276.49 ,$276.35 ,$313.71 ,$408.60 ,$316.21 , N/A ,$358.66 , N/A , N/A , N/A , N/A , N/A ,$326.88 ,$281.48 ,$326.88 ,$326.88 ,$363.20 
ST NICHOLAS HOSPITAL - ACUTE,34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$162.00 ,$81.00 ,$33.56 ,$162.00 , N/A ,$104.80 ,$104.80 , N/A ,$97.20 ,$137.70 ,$113.40 , N/A ,$153.90 ,$123.12 ,$121.50 ,$33.56 ,$137.70 , N/A ,$33.56 ,$105.30 ,$113.40 , N/A , N/A , N/A ,$68.04 ,$137.70 , N/A ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$98.61 ,$111.94 ,$145.80 ,$112.83 , N/A ,$127.98 , N/A , N/A , N/A , N/A , N/A ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,34300006,A9505,HC DIAGNUCLIDE THALL 201 PER MCI,343,1 ,$134.00 ,$67.00 ,$56.28 ,$134.00 , N/A ,$86.68 ,$86.68 , N/A ,$80.40 ,$113.90 ,$93.80 , N/A ,$127.30 ,$101.84 ,$100.50 ,$61.98 ,$113.90 , N/A ,$61.98 ,$87.10 ,$93.80 , N/A , N/A , N/A ,$56.28 ,$113.90 , N/A ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$81.57 ,$92.59 ,$120.60 ,$93.33 , N/A ,$105.86 , N/A , N/A , N/A , N/A , N/A ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,34300007,A9507,HC DIAGNUCLIDE PROSTASCINT,343,1 ,"$6,832.00 ","$3,416.00 ","$2,793.78 ","$6,832.00 ", N/A ,"$4,419.62 ","$4,419.62 ", N/A ,"$4,099.20 ","$5,807.20 ","$4,782.40 ", N/A ,"$6,490.40 ","$5,192.32 ","$5,124.00 ","$2,793.78 ","$5,807.20 ", N/A ,"$2,793.78 ","$4,440.80 ","$4,782.40 ", N/A , N/A , N/A ,"$2,869.44 ","$5,807.20 ", N/A ,"$6,285.44 ","$4,782.40 ","$3,465.19 ","$4,158.64 ","$4,160.69 ","$4,158.64 ","$4,720.91 ","$6,148.80 ","$4,758.49 ", N/A ,"$5,397.28 ", N/A , N/A , N/A , N/A , N/A ,"$4,919.04 ","$4,235.84 ","$4,919.04 ","$4,919.04 ","$5,465.60 "
ST NICHOLAS HOSPITAL - ACUTE,34300009,A9512,HC TECHNETIUM TC99 PERTECH PER MCI,343,1 ,$50.00 ,$25.00 ,$21.00 ,$50.00 , N/A ,$32.35 ,$32.35 , N/A ,$30.00 ,$42.50 ,$35.00 , N/A ,$47.50 ,$38.00 ,$37.50 ,$37.40 ,$42.50 , N/A ,$37.40 ,$32.50 ,$35.00 , N/A , N/A , N/A ,$21.00 ,$42.50 , N/A ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.83 , N/A ,$39.50 , N/A , N/A , N/A , N/A , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$84.00 ,$42.00 ,$35.28 ,$84.00 , N/A ,$54.34 ,$54.34 , N/A ,$50.40 ,$71.40 ,$58.80 , N/A ,$79.80 ,$63.84 ,$63.00 ,$84.00 ,$71.40 , N/A ,$84.00 ,$54.60 ,$58.80 , N/A , N/A , N/A ,$35.28 ,$71.40 , N/A ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$51.13 ,$58.04 ,$75.60 ,$58.51 , N/A ,$66.36 , N/A , N/A , N/A , N/A , N/A ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,34300011,A9517,HC DIAGNUCLIDE I131 CAPS PER MCI,343,1 ,$230.00 ,$115.00 ,$20.12 ,$230.00 ,$142.31 ,$148.79 ,$148.79 ,$20.12 ,$138.00 ,$195.50 ,$161.00 ,$142.31 ,$218.50 ,$174.80 ,$172.50 ,$72.83 ,$195.50 ,$20.12 ,$72.83 ,$149.50 ,$161.00 ,$142.31 ,$20.12 ,$20.12 ,$23.42 ,$195.50 ,$45.27 ,$211.60 ,$161.00 ,$30.00 ,$30.00 ,$140.07 ,$30.00 ,$158.93 ,$207.00 ,$160.20 ,$20.32 ,$181.70 ,$150.85 ,$33.20 ,$33.20 ,$20.12 ,$33.20 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,34300012,A9521,HC DIAGNUCLIDE CERETEC,343,1 ,"$2,598.00 ","$1,299.00 ","$1,091.16 ","$2,598.00 ", N/A ,"$1,680.65 ","$1,680.65 ", N/A ,"$1,558.80 ","$2,208.30 ","$1,818.60 ", N/A ,"$2,468.10 ","$1,974.48 ","$1,948.50 ","$2,598.00 ","$2,208.30 ", N/A ,"$2,598.00 ","$1,688.70 ","$1,818.60 ", N/A , N/A , N/A ,"$1,091.16 ","$2,208.30 ", N/A ,"$2,390.16 ","$1,818.60 ","$1,317.71 ","$1,581.40 ","$1,582.18 ","$1,581.40 ","$1,795.22 ","$2,338.20 ","$1,809.51 ", N/A ,"$2,052.42 ", N/A , N/A , N/A , N/A , N/A ,"$1,870.56 ","$1,610.76 ","$1,870.56 ","$1,870.56 ","$2,078.40 "
ST NICHOLAS HOSPITAL - ACUTE,34300014,A9528,HC DIAGNUCLIDE I131 NECK/CHST,343,1 ,$213.00 ,$106.50 ,$69.16 ,$213.00 , N/A ,$137.79 ,$137.79 , N/A ,$127.80 ,$181.05 ,$149.10 , N/A ,$202.35 ,$161.88 ,$159.75 ,$69.16 ,$181.05 , N/A ,$69.16 ,$138.45 ,$149.10 , N/A , N/A , N/A ,$89.46 ,$181.05 , N/A ,$195.96 ,$149.10 ,$108.03 ,$129.65 ,$129.72 ,$129.65 ,$147.18 ,$191.70 ,$148.35 , N/A ,$168.27 , N/A , N/A , N/A , N/A , N/A ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,34300015,A9530,HC THERAPEUTIC ISOTOPE SOLUTION PER MCI,343,1 ,$56.00 ,$28.00 ,$13.34 ,$150.85 ,$142.31 ,$36.23 ,$36.23 ,$13.34 ,$33.60 ,$47.60 ,$39.20 ,$142.31 ,$53.20 ,$42.56 ,$42.00 ,$36.40 ,$47.60 ,$13.34 ,$36.40 ,$36.40 ,$39.20 ,$142.31 ,$13.34 ,$13.34 ,$15.12 ,$47.60 ,$30.02 ,$51.52 ,$39.20 ,$19.37 ,$19.37 ,$34.10 ,$19.37 ,$38.70 ,$50.40 ,$39.00 ,$13.47 ,$44.24 ,$150.85 ,$22.01 ,$22.01 ,$13.34 ,$22.01 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$44.80 
ST NICHOLAS HOSPITAL - ACUTE,34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$202.00 ,$101.00 ,$84.84 ,$202.00 , N/A ,$130.67 ,$130.67 , N/A ,$121.20 ,$171.70 ,$141.40 , N/A ,$191.90 ,$153.52 ,$151.50 ,$101.66 ,$171.70 , N/A ,$101.66 ,$131.30 ,$141.40 , N/A , N/A , N/A ,$84.84 ,$171.70 , N/A ,$185.84 ,$141.40 ,$102.45 ,$122.96 ,$123.02 ,$122.96 ,$139.58 ,$181.80 ,$140.69 , N/A ,$159.58 , N/A , N/A , N/A , N/A , N/A ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$174.00 ,$87.00 ,$63.92 ,$174.00 , N/A ,$112.56 ,$112.56 , N/A ,$104.40 ,$147.90 ,$121.80 , N/A ,$165.30 ,$132.24 ,$130.50 ,$63.92 ,$147.90 , N/A ,$63.92 ,$113.10 ,$121.80 , N/A , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$105.91 ,$120.23 ,$156.60 ,$121.19 , N/A ,$137.46 , N/A , N/A , N/A , N/A , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$139.20 
ST NICHOLAS HOSPITAL - ACUTE,34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$706.00 ,$353.00 ,$61.20 ,$706.00 , N/A ,$456.71 ,$456.71 , N/A ,$423.60 ,$600.10 ,$494.20 , N/A ,$670.70 ,$536.56 ,$529.50 ,$61.20 ,$600.10 , N/A ,$61.20 ,$458.90 ,$494.20 , N/A , N/A , N/A ,$296.52 ,$600.10 , N/A ,$649.52 ,$494.20 ,$358.08 ,$429.74 ,$429.95 ,$429.74 ,$487.85 ,$635.40 ,$491.73 , N/A ,$557.74 , N/A , N/A , N/A , N/A , N/A ,$508.32 ,$437.72 ,$508.32 ,$508.32 ,$564.80 
ST NICHOLAS HOSPITAL - ACUTE,34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$269.00 ,$134.50 ,$112.98 ,$269.00 , N/A ,$174.02 ,$174.02 , N/A ,$161.40 ,$228.65 ,$188.30 , N/A ,$255.55 ,$204.44 ,$201.75 ,$269.00 ,$228.65 , N/A ,$269.00 ,$174.85 ,$188.30 , N/A , N/A , N/A ,$112.98 ,$228.65 , N/A ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$163.74 ,$185.88 ,$242.10 ,$187.36 , N/A ,$212.51 , N/A , N/A , N/A , N/A , N/A ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$2,912.00 ","$1,456.00 ","$1,223.04 ","$2,912.00 ", N/A ,"$1,883.77 ","$1,883.77 ", N/A ,"$1,747.20 ","$2,475.20 ","$2,038.40 ", N/A ,"$2,766.40 ","$2,213.12 ","$2,184.00 ","$2,912.00 ","$2,475.20 ", N/A ,"$2,912.00 ","$1,892.80 ","$2,038.40 ", N/A , N/A , N/A ,"$1,223.04 ","$2,475.20 ", N/A ,"$2,679.04 ","$2,038.40 ","$1,476.97 ","$1,772.53 ","$1,773.41 ","$1,772.53 ","$2,012.19 ","$2,620.80 ","$2,028.21 ", N/A ,"$2,300.48 ", N/A , N/A , N/A , N/A , N/A ,"$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$2,329.60 "
ST NICHOLAS HOSPITAL - ACUTE,34300025,A9548,HC DIAGNUCLIDE IN-111 WB PER.5MCI,343,1 ,"$4,855.00 ","$2,427.50 ",$842.91 ,"$4,855.00 ", N/A ,"$3,140.70 ","$3,140.70 ", N/A ,"$2,913.00 ","$4,126.75 ","$3,398.50 ", N/A ,"$4,612.25 ","$3,689.80 ","$3,641.25 ",$842.91 ,"$4,126.75 ", N/A ,$842.91 ,"$3,155.75 ","$3,398.50 ", N/A , N/A , N/A ,"$2,039.10 ","$4,126.75 ", N/A ,"$4,466.60 ","$3,398.50 ","$2,462.46 ","$2,955.24 ","$2,956.70 ","$2,955.24 ","$3,354.81 ","$4,369.50 ","$3,381.51 ", N/A ,"$3,835.45 ", N/A , N/A , N/A , N/A , N/A ,"$3,495.60 ","$3,010.10 ","$3,495.60 ","$3,495.60 ","$3,884.00 "
ST NICHOLAS HOSPITAL - ACUTE,34300026,A9548,HC DIAGNUCLIDE IN-111 DTPA,343,1 ,"$4,855.00 ","$2,427.50 ",$842.91 ,"$4,855.00 ", N/A ,"$3,140.70 ","$3,140.70 ", N/A ,"$2,913.00 ","$4,126.75 ","$3,398.50 ", N/A ,"$4,612.25 ","$3,689.80 ","$3,641.25 ",$842.91 ,"$4,126.75 ", N/A ,$842.91 ,"$3,155.75 ","$3,398.50 ", N/A , N/A , N/A ,"$2,039.10 ","$4,126.75 ", N/A ,"$4,466.60 ","$3,398.50 ","$2,462.46 ","$2,955.24 ","$2,956.70 ","$2,955.24 ","$3,354.81 ","$4,369.50 ","$3,381.51 ", N/A ,"$3,835.45 ", N/A , N/A , N/A , N/A , N/A ,"$3,495.60 ","$3,010.10 ","$3,495.60 ","$3,495.60 ","$3,884.00 "
ST NICHOLAS HOSPITAL - ACUTE,34300029,A9552,HC DIAGNUCLIDE 18FDG,343,1 ,"$1,165.00 ",$582.50 ,$489.30 ,"$1,165.00 ", N/A ,$753.64 ,$753.64 , N/A ,$699.00 ,$990.25 ,$815.50 , N/A ,"$1,106.75 ",$885.40 ,$873.75 ,$544.34 ,$990.25 , N/A ,$544.34 ,$757.25 ,$815.50 , N/A , N/A , N/A ,$489.30 ,$990.25 , N/A ,"$1,071.80 ",$815.50 ,$590.89 ,$709.14 ,$709.49 ,$709.14 ,$805.02 ,"$1,048.50 ",$811.42 , N/A ,$920.35 , N/A , N/A , N/A , N/A , N/A ,$838.80 ,$722.30 ,$838.80 ,$838.80 ,$932.00 
ST NICHOLAS HOSPITAL - ACUTE,34300031,A9556,HC DIAGNUCLIDE GA67 PER MCI,343,1 ,$123.00 ,$61.50 ,$51.66 ,$123.00 , N/A ,$79.57 ,$79.57 , N/A ,$73.80 ,$104.55 ,$86.10 , N/A ,$116.85 ,$93.48 ,$92.25 ,$123.00 ,$104.55 , N/A ,$123.00 ,$79.95 ,$86.10 , N/A , N/A , N/A ,$51.66 ,$104.55 , N/A ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$74.87 ,$84.99 ,$110.70 ,$85.67 , N/A ,$97.17 , N/A , N/A , N/A , N/A , N/A ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,34300035,A9560,HC TC99M GI BLD MUGA UP TO 30MCI,343,1 ,$347.00 ,$173.50 ,$145.74 ,$347.00 , N/A ,$224.47 ,$224.47 , N/A ,$208.20 ,$294.95 ,$242.90 , N/A ,$329.65 ,$263.72 ,$260.25 ,$181.42 ,$294.95 , N/A ,$181.42 ,$225.55 ,$242.90 , N/A , N/A , N/A ,$145.74 ,$294.95 , N/A ,$319.24 ,$242.90 ,$176.00 ,$211.22 ,$211.32 ,$211.22 ,$239.78 ,$312.30 ,$241.69 , N/A ,$274.13 , N/A , N/A , N/A , N/A , N/A ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$277.60 
ST NICHOLAS HOSPITAL - ACUTE,34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$347.00 ,$173.50 ,$145.74 ,$347.00 , N/A ,$224.47 ,$224.47 , N/A ,$208.20 ,$294.95 ,$242.90 , N/A ,$329.65 ,$263.72 ,$260.25 ,$181.42 ,$294.95 , N/A ,$181.42 ,$225.55 ,$242.90 , N/A , N/A , N/A ,$145.74 ,$294.95 , N/A ,$319.24 ,$242.90 ,$176.00 ,$211.22 ,$211.32 ,$211.22 ,$239.78 ,$312.30 ,$241.69 , N/A ,$274.13 , N/A , N/A , N/A , N/A , N/A ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$277.60 
ST NICHOLAS HOSPITAL - ACUTE,34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,$986.00 ,$493.00 ,$414.12 ,$986.00 , N/A ,$637.84 ,$637.84 , N/A ,$591.60 ,$838.10 ,$690.20 , N/A ,$936.70 ,$749.36 ,$739.50 ,$986.00 ,$838.10 , N/A ,$986.00 ,$640.90 ,$690.20 , N/A , N/A , N/A ,$414.12 ,$838.10 , N/A ,$907.12 ,$690.20 ,$500.10 ,$600.18 ,$600.47 ,$600.18 ,$681.33 ,$887.40 ,$686.75 , N/A ,$778.94 , N/A , N/A , N/A , N/A , N/A ,$709.92 ,$611.32 ,$709.92 ,$709.92 ,$788.80 
ST NICHOLAS HOSPITAL - ACUTE,34300038,A9572,HC DIAGNUCLIDE OCTREOTIDE PER DOSE UP TO 6MCI,343,1 ,"$7,834.00 ","$3,917.00 ","$3,290.28 ","$7,834.00 ", N/A ,"$5,067.81 ","$5,067.81 ", N/A ,"$4,700.40 ","$6,658.90 ","$5,483.80 ", N/A ,"$7,442.30 ","$5,953.84 ","$5,875.50 ","$7,834.00 ","$6,658.90 ", N/A ,"$7,834.00 ","$5,092.10 ","$5,483.80 ", N/A , N/A , N/A ,"$3,290.28 ","$6,658.90 ", N/A ,"$7,207.28 ","$5,483.80 ","$3,973.40 ","$4,768.56 ","$4,770.91 ","$4,768.56 ","$5,413.29 ","$7,050.60 ","$5,456.38 ", N/A ,"$6,188.86 ", N/A , N/A , N/A , N/A , N/A ,"$5,640.48 ","$4,857.08 ","$5,640.48 ","$5,640.48 ","$6,267.20 "
ST NICHOLAS HOSPITAL - ACUTE,34300039,A9582,HC DIAGNUCLIDE I 123 MIBG,343,1 ,"$6,955.00 ","$3,477.50 ","$2,921.10 ","$6,955.00 ", N/A ,"$4,499.19 ","$4,499.19 ", N/A ,"$4,173.00 ","$5,911.75 ","$4,868.50 ", N/A ,"$6,607.25 ","$5,285.80 ","$5,216.25 ","$6,955.00 ","$5,911.75 ", N/A ,"$6,955.00 ","$4,520.75 ","$4,868.50 ", N/A , N/A , N/A ,"$2,921.10 ","$5,911.75 ", N/A ,"$6,398.60 ","$4,868.50 ","$3,527.58 ","$4,233.51 ","$4,235.60 ","$4,233.51 ","$4,805.91 ","$6,259.50 ","$4,844.16 ", N/A ,"$5,494.45 ", N/A , N/A , N/A , N/A , N/A ,"$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$5,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$274.00 ,$137.00 ,$26.29 ,$274.00 ,$26.29 ,$260.21 ,$173.48 , N/A ,$164.40 ,$232.90 ,$191.80 ,$26.29 ,$260.30 ,$208.24 ,$205.50 ,$196.61 ,$232.90 , N/A ,$196.61 ,$178.10 ,$191.80 ,$26.29 , N/A , N/A ,$130.89 ,$232.90 , N/A ,$252.08 ,$191.80 ,$167.69 ,$167.69 ,$166.87 ,$167.69 ,$189.33 ,$246.60 ,$190.84 , N/A ,$216.46 ,$27.87 , N/A , N/A , N/A , N/A ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$219.20 
ST NICHOLAS HOSPITAL - ACUTE,34300049,A9509,HC DIAGNUCLIDE I123 CAP PER MILLICURIE,343,1 ,$538.00 ,$269.00 ,$225.96 ,$538.00 , N/A ,$348.03 ,$348.03 , N/A ,$322.80 ,$457.30 ,$376.60 , N/A ,$511.10 ,$408.88 ,$403.50 ,$538.00 ,$457.30 , N/A ,$538.00 ,$349.70 ,$376.60 , N/A , N/A , N/A ,$225.96 ,$457.30 , N/A ,$494.96 ,$376.60 ,$272.87 ,$327.48 ,$327.64 ,$327.48 ,$371.76 ,$484.20 ,$374.72 , N/A ,$425.02 , N/A , N/A , N/A , N/A , N/A ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$430.40 
ST NICHOLAS HOSPITAL - ACUTE,34300052,A9539,HC DIAGNUCLIDE DTPA AEROSOL,343,1 ,$174.00 ,$87.00 ,$63.92 ,$174.00 , N/A ,$112.56 ,$112.56 , N/A ,$104.40 ,$147.90 ,$121.80 , N/A ,$165.30 ,$132.24 ,$130.50 ,$63.92 ,$147.90 , N/A ,$63.92 ,$113.10 ,$121.80 , N/A , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$105.91 ,$120.23 ,$156.60 ,$121.19 , N/A ,$137.46 , N/A , N/A , N/A , N/A , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$139.20 
ST NICHOLAS HOSPITAL - ACUTE,34300053,A9606,HC NUCLIDE XOFIGO PER MICROCURIE,636,1 ,$207.00 ,$103.50 ,$103.50 ,"$4,407.30 ","$4,157.83 ", N/A , N/A ,$148.93 ,$124.20 ,$175.95 ,$144.90 ,"$4,157.83 ",$196.65 ,$157.32 ,$155.25 ,$207.00 ,$175.95 ,$148.93 ,$207.00 ,$134.55 ,$144.90 ,"$4,157.83 ",$148.93 ,$148.93 , N/A ,$175.95 ,$335.08 ,$190.44 ,$144.90 , N/A , N/A ,$126.06 , N/A ,$143.04 ,$186.30 ,$144.18 ,$150.42 ,$163.53 ,"$4,407.30 ",$207.00 ,$207.00 ,$148.93 ,$207.00 ,$149.04 ,$128.34 ,$149.04 ,$149.04 ,$165.60 
ST NICHOLAS HOSPITAL - ACUTE,34300054,A9587,HC GALLIUM GA-68 DOTATATE DIAG 0.1 MCI,343,1 ,$141.00 ,$70.50 ,$59.22 ,$141.00 , N/A ,$91.21 ,$91.21 , N/A ,$84.60 ,$119.85 ,$98.70 , N/A ,$133.95 ,$107.16 ,$105.75 ,$132.23 ,$119.85 , N/A ,$132.23 ,$91.65 ,$98.70 , N/A , N/A , N/A ,$59.22 ,$119.85 , N/A ,$129.72 ,$98.70 ,$71.52 ,$85.83 ,$85.87 ,$85.83 ,$97.43 ,$126.90 ,$98.21 , N/A ,$111.39 , N/A , N/A , N/A , N/A , N/A ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$112.80 
ST NICHOLAS HOSPITAL - ACUTE,34300055,A9588,HC FLUCICLOVINE F-18 DIAG 1 MCI,343,1 ,$952.00 ,$476.00 ,$399.84 ,$952.00 , N/A ,$615.85 ,$615.85 , N/A ,$571.20 ,$809.20 ,$666.40 , N/A ,$904.40 ,$723.52 ,$714.00 ,$817.02 ,$809.20 , N/A ,$817.02 ,$618.80 ,$666.40 , N/A , N/A , N/A ,$399.84 ,$809.20 , N/A ,$875.84 ,$666.40 ,$482.85 ,$579.48 ,$579.77 ,$579.48 ,$657.83 ,$856.80 ,$663.07 , N/A ,$752.08 , N/A , N/A , N/A , N/A , N/A ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$761.60 
ST NICHOLAS HOSPITAL - ACUTE,34300060,A9520,HC DIAGNUCLIDE TC-99 TILMANOCEPT DIAG UP TO 0.5 MCI,343,1 ,"$1,169.00 ",$584.50 ,$490.98 ,"$1,169.00 ", N/A ,$756.23 ,$756.23 , N/A ,$701.40 ,$993.65 ,$818.30 , N/A ,"$1,110.55 ",$888.44 ,$876.75 ,$958.39 ,$993.65 , N/A ,$958.39 ,$759.85 ,$818.30 , N/A , N/A , N/A ,$490.98 ,$993.65 , N/A ,"$1,075.48 ",$818.30 ,$592.92 ,$711.57 ,$711.92 ,$711.57 ,$807.78 ,"$1,052.10 ",$814.21 , N/A ,$923.51 , N/A , N/A , N/A , N/A , N/A ,$841.68 ,$724.78 ,$841.68 ,$841.68 ,$935.20 
ST NICHOLAS HOSPITAL - ACUTE,34300066,Q9969,HC TC-99M NON-HUE ADD-ON PER STUDY DOSE,343,1 ,$11.00 ,$5.50 ,$4.62 ,$22.50 , N/A ,$7.12 ,$7.12 ,$10.00 ,$6.60 ,$9.35 ,$7.70 , N/A ,$10.45 ,$8.36 ,$8.25 ,$7.15 ,$9.35 ,$10.00 ,$7.15 ,$7.15 ,$7.70 , N/A ,$10.00 ,$10.00 ,$4.62 ,$9.35 ,$22.50 ,$10.12 ,$7.70 ,$5.58 ,$6.70 ,$6.70 ,$6.70 ,$7.60 ,$9.90 ,$7.66 ,$10.10 ,$8.69 , N/A ,$11.00 ,$11.00 ,$10.00 ,$11.00 ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$8.80 
ST NICHOLAS HOSPITAL - ACUTE,34300071,A9592,HC COPPER CU-64 DOTATATE DIAGNOSTIC 1 MILLICURIE,343,1 ,"$2,850.00 ","$1,425.00 ",$918.52 ,"$2,850.00 ", N/A ,"$1,843.67 ","$1,843.67 ",$918.52 ,"$1,710.00 ","$2,422.50 ","$1,995.00 ", N/A ,"$2,707.50 ","$2,166.00 ","$2,137.50 ","$1,852.50 ","$2,422.50 ",$918.52 ,"$1,852.50 ","$1,852.50 ","$1,995.00 ", N/A ,$918.52 ,$918.52 ,"$1,197.00 ","$2,422.50 ","$2,066.68 ","$2,622.00 ","$1,995.00 ","$1,445.52 ","$1,734.80 ","$1,735.65 ","$1,734.80 ","$1,969.35 ","$2,565.00 ","$1,985.03 ",$927.71 ,"$2,251.50 ", N/A ,"$1,515.56 ","$1,515.56 ",$918.52 ,"$1,515.56 ","$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$2,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,34300072,A9595,"HC PIFLUFOLASTAT F-18, DIAGNOSTIC, 1 MILLICURIE",343,1 ,"$1,579.00 ",$789.50 ,$541.78 ,"$1,579.00 ", N/A ,"$1,021.46 ","$1,021.46 ",$541.78 ,$947.40 ,"$1,342.15 ","$1,105.30 ", N/A ,"$1,500.05 ","$1,200.04 ","$1,184.25 ","$1,026.35 ","$1,342.15 ",$541.78 ,"$1,026.35 ","$1,026.35 ","$1,105.30 ", N/A ,$541.78 ,$541.78 ,$663.18 ,"$1,342.15 ","$1,219.00 ","$1,452.68 ","$1,105.30 ",$800.87 ,$961.14 ,$961.61 ,$961.14 ,"$1,091.09 ","$1,421.10 ","$1,099.77 ",$547.20 ,"$1,247.41 ", N/A ,$893.94 ,$893.94 ,$541.78 ,$893.94 ,"$1,136.88 ",$978.98 ,"$1,136.88 ","$1,136.88 ","$1,263.20 "
ST NICHOLAS HOSPITAL - ACUTE,35000002,20615,HC ASP/INJ CYST BONE,350,1 ,$991.00 ,$495.50 ,$154.70 ,"$3,303.09 ",$154.70 ,$991.00 ,$991.00 ,$613.58 ,$594.60 ,$842.35 ,$693.70 ,$154.70 ,$941.45 ,$753.16 ,$743.25 ,$991.00 ,$842.35 ,$613.58 ,$991.00 ,$991.00 ,$693.70 ,$154.70 ,$613.58 ,$613.58 ,$471.80 ,$842.35 ,"$1,380.55 ",$911.72 ,$693.70 ,"$2,642.26 ","$3,303.09 ",$603.52 ,"$3,303.09 ",$684.78 ,$891.90 ,$690.23 ,$619.72 ,$782.89 ,$163.98 ,$991.00 ,$991.00 ,$613.58 ,$991.00 ,$713.52 ,$614.42 ,$713.52 ,$713.52 ,$792.80 
ST NICHOLAS HOSPITAL - ACUTE,35000003,20982,HC ABLATION BONE TUMOR RADIOFREQUENCY,350,1 ,"$5,279.00 ","$2,639.50 ",$471.80 ,"$13,895.93 ",$547.96 ,"$1,140.00 ","$1,119.00 ","$6,175.97 ","$3,167.40 ","$4,487.15 ","$3,695.30 ",$547.96 ,"$5,015.05 ","$4,012.04 ","$3,959.25 ","$1,171.00 ","$4,487.15 ","$6,175.97 ","$1,171.00 ","$1,126.00 ","$3,695.30 ",$547.96 ,"$6,175.97 ","$6,175.97 ",$471.80 ,"$4,487.15 ","$13,895.93 ","$4,856.68 ","$3,695.30 ","$1,703.02 ","$2,128.52 ","$3,214.91 ","$2,128.52 ","$3,647.79 ","$4,751.10 ","$3,676.82 ","$6,237.73 ","$4,170.41 ",$580.84 ,"$1,136.00 ","$1,136.00 ","$6,175.97 ","$1,136.00 ","$3,800.88 ","$3,272.98 ","$3,800.88 ","$3,800.88 ","$4,223.20 "
ST NICHOLAS HOSPITAL - ACUTE,35000006,21550,HC BX TISSUE NECK/THORAX,350,1 ,"$2,370.00 ","$1,185.00 ",$471.80 ,"$3,121.49 ",$704.46 ,"$1,140.00 ","$1,119.00 ","$1,387.33 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$704.46 ,"$2,251.50 ","$1,801.20 ","$1,777.50 ","$1,171.00 ","$2,014.50 ","$1,387.33 ","$1,171.00 ","$1,126.00 ","$1,659.00 ",$704.46 ,"$1,387.33 ","$1,387.33 ",$471.80 ,"$2,014.50 ","$3,121.49 ","$2,180.40 ","$1,659.00 ","$1,703.02 ","$2,128.52 ","$1,443.33 ","$2,128.52 ","$1,637.67 ","$2,133.00 ","$1,650.71 ","$1,401.20 ","$1,872.30 ",$746.73 ,"$1,136.00 ","$1,136.00 ","$1,387.33 ","$1,136.00 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,896.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000013,32400,HC BX PLEURA NEEDLE PERC,350,1 ,"$1,100.00 ",$550.00 ,$299.20 ,"$3,121.49 ",$299.20 ,"$1,100.00 ","$1,100.00 ","$1,387.33 ",$660.00 ,$935.00 ,$770.00 ,$299.20 ,"$1,045.00 ",$836.00 ,$825.00 ,"$1,100.00 ",$935.00 ,"$1,387.33 ","$1,100.00 ","$1,100.00 ",$770.00 ,$299.20 ,"$1,387.33 ","$1,387.33 ",$471.80 ,$935.00 ,"$3,121.49 ","$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$990.00 ,$766.15 ,"$1,401.20 ",$869.00 ,$317.15 ,"$1,100.00 ","$1,100.00 ","$1,387.33 ","$1,100.00 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,35000018,47000,HC BX LIVER NEEDLE PERC,350,1 ,"$1,724.00 ",$862.00 ,$232.13 ,"$3,121.49 ",$232.13 ,"$1,140.00 ","$1,119.00 ","$1,387.33 ","$1,034.40 ","$1,465.40 ","$1,206.80 ",$232.13 ,"$1,637.80 ","$1,310.24 ","$1,293.00 ","$1,171.00 ","$1,465.40 ","$1,387.33 ","$1,171.00 ","$1,126.00 ","$1,206.80 ",$232.13 ,"$1,387.33 ","$1,387.33 ",$471.80 ,"$1,465.40 ","$3,121.49 ","$1,586.08 ","$1,206.80 ","$1,703.02 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,551.60 ","$1,200.77 ","$1,401.20 ","$1,361.96 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,387.33 ","$1,136.00 ","$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,379.20 "
ST NICHOLAS HOSPITAL - ACUTE,35000019,47001,HC BIOPSY LIVER OTHER PROC,350,1 ,"$2,330.00 ","$1,165.00 ",$232.13 ,"$2,330.00 ",$232.13 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,398.00 ","$1,980.50 ","$1,631.00 ",$232.13 ,"$2,213.50 ","$1,770.80 ","$1,747.50 ","$1,171.00 ","$1,980.50 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,631.00 ",$232.13 , N/A , N/A ,$471.80 ,"$1,980.50 ", N/A ,"$2,143.60 ","$1,631.00 ","$1,703.02 ","$2,128.52 ","$1,418.97 ","$2,128.52 ","$1,610.03 ","$2,097.00 ","$1,622.85 ", N/A ,"$1,840.70 ",$246.06 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,677.60 ","$1,444.60 ","$1,677.60 ","$1,677.60 ","$1,864.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000020,49405,HC PERC DRN ABSC/HEM/CYST VISCERAL,350,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,121.49 ",$232.13 ,"$1,140.00 ","$1,119.00 ","$1,387.33 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ","$1,171.00 ","$1,190.00 ","$1,387.33 ","$1,171.00 ","$1,126.00 ",$980.00 ,$232.13 ,"$1,387.33 ","$1,387.33 ",$471.80 ,"$1,190.00 ","$3,121.49 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,260.00 ",$975.10 ,"$1,401.20 ","$1,106.00 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,387.33 ","$1,136.00 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000021,47382,HC ABLATION TUMR LIVER RADIO PERC,350,1 ,"$7,200.00 ","$3,600.00 ",$471.80 ,"$11,225.46 ","$2,004.41 ","$1,140.00 ","$1,119.00 ","$4,989.09 ","$4,320.00 ","$6,120.00 ","$5,040.00 ","$2,004.41 ","$6,840.00 ","$5,472.00 ","$5,400.00 ","$1,171.00 ","$6,120.00 ","$4,989.09 ","$1,171.00 ","$1,126.00 ","$5,040.00 ","$2,004.41 ","$4,989.09 ","$4,989.09 ",$471.80 ,"$6,120.00 ","$11,225.46 ","$6,624.00 ","$5,040.00 ","$4,794.94 ","$5,993.67 ","$4,384.80 ","$5,993.67 ","$4,975.20 ","$6,480.00 ","$5,014.80 ","$5,038.98 ","$5,688.00 ","$2,124.67 ","$1,136.00 ","$1,136.00 ","$4,989.09 ","$1,136.00 ","$5,184.00 ","$4,464.00 ","$5,184.00 ","$5,184.00 ","$5,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000023,48102,HC BX PANCREAS NEEDLE PERC,350,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,121.49 ",$232.13 ,"$1,140.00 ","$1,119.00 ","$1,387.33 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ","$1,171.00 ","$1,190.00 ","$1,387.33 ","$1,171.00 ","$1,126.00 ",$980.00 ,$232.13 ,"$1,387.33 ","$1,387.33 ",$471.80 ,"$1,190.00 ","$3,121.49 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,260.00 ",$975.10 ,"$1,401.20 ","$1,106.00 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,387.33 ","$1,136.00 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000025,49180,HC ABDOM/RETRO/MASS BIOP,350,1 ,"$1,508.00 ",$754.00 ,$232.13 ,"$3,121.49 ",$232.13 ,"$1,140.00 ","$1,119.00 ","$1,387.33 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$232.13 ,"$1,432.60 ","$1,146.08 ","$1,131.00 ","$1,171.00 ","$1,281.80 ","$1,387.33 ","$1,171.00 ","$1,126.00 ","$1,055.60 ",$232.13 ,"$1,387.33 ","$1,387.33 ",$471.80 ,"$1,281.80 ","$3,121.49 ","$1,387.36 ","$1,055.60 ","$1,508.00 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,357.20 ","$1,050.32 ","$1,401.20 ","$1,191.32 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,387.33 ","$1,136.00 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ","$1,206.40 "
ST NICHOLAS HOSPITAL - ACUTE,35000026,50200,"HC PERC BIOPSY/KIDNEY, NEEDLE",350,1 ,"$1,724.00 ",$862.00 ,$471.80 ,"$3,121.49 ",$474.08 ,"$1,140.00 ","$1,119.00 ","$1,387.33 ","$1,034.40 ","$1,465.40 ","$1,206.80 ",$474.08 ,"$1,637.80 ","$1,310.24 ","$1,293.00 ","$1,171.00 ","$1,465.40 ","$1,387.33 ","$1,171.00 ","$1,126.00 ","$1,206.80 ",$474.08 ,"$1,387.33 ","$1,387.33 ",$471.80 ,"$1,465.40 ","$3,121.49 ","$1,586.08 ","$1,206.80 ","$1,703.02 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,551.60 ","$1,200.77 ","$1,401.20 ","$1,361.96 ",$502.52 ,"$1,136.00 ","$1,136.00 ","$1,387.33 ","$1,136.00 ","$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,379.20 "
ST NICHOLAS HOSPITAL - ACUTE,35000027,50390,HC RENAL CYST/PELVIS ASP/INJ,350,1 ,"$1,508.00 ",$754.00 ,$119.36 ,"$1,508.00 ",$119.36 ,"$1,140.00 ","$1,119.00 ",$613.58 ,$904.80 ,"$1,281.80 ","$1,055.60 ",$119.36 ,"$1,432.60 ","$1,146.08 ","$1,131.00 ","$1,171.00 ","$1,281.80 ",$613.58 ,"$1,171.00 ","$1,126.00 ","$1,055.60 ",$119.36 ,$613.58 ,$613.58 ,$471.80 ,"$1,281.80 ","$1,380.55 ","$1,387.36 ","$1,055.60 ","$1,508.00 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,357.20 ","$1,050.32 ",$619.72 ,"$1,191.32 ",$126.52 ,"$1,136.00 ","$1,136.00 ",$613.58 ,"$1,136.00 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ","$1,206.40 "
ST NICHOLAS HOSPITAL - ACUTE,35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,$948.00 ,$474.00 ,$288.55 ,"$1,380.55 ",$288.55 ,$948.00 ,$948.00 ,$613.58 ,$568.80 ,$805.80 ,$663.60 ,$288.55 ,$900.60 ,$720.48 ,$711.00 ,$948.00 ,$805.80 ,$613.58 ,$948.00 ,$948.00 ,$663.60 ,$288.55 ,$613.58 ,$613.58 ,$471.80 ,$805.80 ,"$1,380.55 ",$872.16 ,$663.60 ,$948.00 ,$948.00 ,$577.33 ,$948.00 ,$655.07 ,$853.20 ,$660.28 ,$619.72 ,$748.92 ,$305.86 ,$948.00 ,$948.00 ,$613.58 ,$948.00 ,$682.56 ,$587.76 ,$682.56 ,$682.56 ,$758.40 
ST NICHOLAS HOSPITAL - ACUTE,35000035,64680,HC DEST NERVE CELIAC PLEXUS,350,1 ,"$1,724.00 ",$862.00 ,$364.34 ,"$1,826.27 ",$364.34 ,"$1,140.00 ","$1,119.00 ",$811.67 ,"$1,034.40 ","$1,465.40 ","$1,206.80 ",$364.34 ,"$1,637.80 ","$1,310.24 ","$1,293.00 ","$1,171.00 ","$1,465.40 ",$811.67 ,"$1,171.00 ","$1,126.00 ","$1,206.80 ",$364.34 ,$811.67 ,$811.67 ,$471.80 ,"$1,465.40 ","$1,826.27 ","$1,586.08 ","$1,206.80 ","$1,724.00 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,551.60 ","$1,200.77 ",$819.79 ,"$1,361.96 ",$386.20 ,"$1,136.00 ","$1,136.00 ",$811.67 ,"$1,136.00 ","$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,379.20 "
ST NICHOLAS HOSPITAL - ACUTE,35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$99.26 ,"$1,800.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$99.26 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$99.26 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000044,70486,HC CT SINUSES UNENHANCED/STEREOTACTIC,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,400.00 ","$1,200.00 ",$99.26 ,"$2,400.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$99.26 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$1,171.00 ","$2,040.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,680.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,040.00 ",$396.28 ,"$2,208.00 ","$1,680.00 ","$1,015.90 ","$1,015.90 ","$1,461.60 ","$1,015.90 ","$1,658.40 ","$2,160.00 ","$1,671.60 ",$177.89 ,"$1,896.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,057.81 ","$1,057.81 ","$1,583.40 ","$1,057.81 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$1,400.00 ",$700.00 ,$121.52 ,"$1,400.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,$840.00 ,"$1,190.00 ",$980.00 ,$121.52 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ","$1,171.00 ","$1,190.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ",$980.00 ,$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$1,190.00 ",$396.28 ,"$1,288.00 ",$980.00 ,"$1,057.81 ","$1,057.81 ",$852.60 ,"$1,057.81 ",$967.40 ,"$1,260.00 ",$975.10 ,$177.89 ,"$1,106.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,677.50 ",$510.48 ,"$2,898.00 ","$2,205.00 ","$1,068.02 ","$1,068.02 ","$1,918.35 ","$1,068.02 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$229.15 ,"$2,488.50 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$363.09 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$363.09 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$363.09 ,$363.09 ,$471.80 ,"$1,870.00 ",$816.96 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$366.72 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$363.09 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000056,72127,HC CT C-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$363.09 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$363.09 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$363.09 ,$363.09 ,$471.80 ,"$1,870.00 ",$816.96 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$366.72 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$363.09 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,057.81 ","$1,057.81 ","$1,583.40 ","$1,057.81 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000068,N/A,HC CT GUIDED VERTEBROPLASTY PERC,350,1 ,$987.00 ,$493.50 ,$471.80 ,$987.00 , N/A ,$987.00 ,$987.00 , N/A ,$592.20 ,$838.95 ,$690.90 , N/A ,$937.65 ,$750.12 ,$740.25 ,$987.00 ,$838.95 , N/A ,$987.00 ,$987.00 ,$690.90 , N/A , N/A , N/A ,$471.80 ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$600.79 ,$682.02 ,$888.30 ,$687.45 , N/A ,$779.73 , N/A ,$987.00 ,$987.00 , N/A ,$987.00 ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$789.60 
ST NICHOLAS HOSPITAL - ACUTE,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$363.09 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$363.09 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$363.09 ,$363.09 ,$471.80 ,"$1,870.00 ",$816.96 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$366.72 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$363.09 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$2,400.00 ","$1,200.00 ",$99.26 ,"$2,400.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$99.26 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$1,171.00 ","$2,040.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,680.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,040.00 ",$396.28 ,"$2,208.00 ","$1,680.00 ","$1,015.90 ","$1,015.90 ","$1,461.60 ","$1,015.90 ","$1,658.40 ","$2,160.00 ","$1,671.60 ",$177.89 ,"$1,896.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,057.81 ","$1,057.81 ","$1,583.40 ","$1,057.81 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$54.96 ,"$1,800.00 ",$54.96 ,"$1,140.00 ","$1,119.00 ",$221.13 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$54.96 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$221.13 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$54.96 ,$221.13 ,$221.13 ,$471.80 ,"$1,530.00 ",$497.55 ,"$1,656.00 ","$1,260.00 ",$687.32 ,$687.32 ,"$1,096.20 ",$687.32 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$223.34 ,"$1,422.00 ",$58.26 ,"$1,136.00 ","$1,136.00 ",$221.13 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$54.96 ,"$1,800.00 ",$54.96 ,"$1,140.00 ","$1,119.00 ",$221.13 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$54.96 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$221.13 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$54.96 ,$221.13 ,$221.13 ,$471.80 ,"$1,530.00 ",$497.55 ,"$1,656.00 ","$1,260.00 ",$687.32 ,$687.32 ,"$1,096.20 ",$687.32 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$223.34 ,"$1,422.00 ",$58.26 ,"$1,136.00 ","$1,136.00 ",$221.13 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,057.81 ","$1,057.81 ","$1,583.40 ","$1,057.81 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,530.00 ",$241.53 ,"$1,656.00 ","$1,260.00 ",$458.21 ,$458.21 ,"$1,096.20 ",$458.21 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$108.42 ,"$1,422.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,171.00 ","$1,870.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,540.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,870.00 ",$396.28 ,"$2,024.00 ","$1,540.00 ",$902.14 ,$902.14 ,"$1,339.80 ",$902.14 ,"$1,520.20 ","$1,980.00 ","$1,532.30 ",$177.89 ,"$1,738.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,015.90 ","$1,015.90 ","$1,583.40 ","$1,015.90 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,057.81 ","$1,057.81 ","$1,583.40 ","$1,057.81 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$3,600.00 ","$1,800.00 ",$99.26 ,"$3,600.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$226.88 ,"$2,160.00 ","$3,060.00 ","$2,520.00 ",$99.26 ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$1,171.00 ","$3,060.00 ",$226.88 ,"$1,171.00 ","$1,126.00 ","$2,520.00 ",$99.26 ,$226.88 ,$226.88 ,$471.80 ,"$3,060.00 ",$510.48 ,"$3,312.00 ","$2,520.00 ",$876.02 ,$876.02 ,"$2,192.40 ",$876.02 ,"$2,487.60 ","$3,240.00 ","$2,507.40 ",$229.15 ,"$2,844.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$226.88 ,"$1,136.00 ","$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$4,200.00 ","$2,100.00 ",$99.26 ,"$4,200.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$363.09 ,"$2,520.00 ","$3,570.00 ","$2,940.00 ",$99.26 ,"$3,990.00 ","$3,192.00 ","$3,150.00 ","$1,171.00 ","$3,570.00 ",$363.09 ,"$1,171.00 ","$1,126.00 ","$2,940.00 ",$99.26 ,$363.09 ,$363.09 ,$471.80 ,"$3,570.00 ",$816.96 ,"$3,864.00 ","$2,940.00 ","$1,413.47 ","$1,413.47 ","$2,557.80 ","$1,413.47 ","$2,902.20 ","$3,780.00 ","$2,925.30 ",$366.72 ,"$3,318.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$363.09 ,"$1,136.00 ","$3,024.00 ","$2,604.00 ","$3,024.00 ","$3,024.00 ","$3,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$4,900.00 ","$2,450.00 ",$99.26 ,"$4,900.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$363.09 ,"$2,940.00 ","$4,165.00 ","$3,430.00 ",$99.26 ,"$4,655.00 ","$3,724.00 ","$3,675.00 ","$1,171.00 ","$4,165.00 ",$363.09 ,"$1,171.00 ","$1,126.00 ","$3,430.00 ",$99.26 ,$363.09 ,$363.09 ,$471.80 ,"$4,165.00 ",$816.96 ,"$4,508.00 ","$3,430.00 ","$1,413.47 ","$1,413.47 ","$2,984.10 ","$1,413.47 ","$3,385.90 ","$4,410.00 ","$3,412.85 ",$366.72 ,"$3,871.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$363.09 ,"$1,136.00 ","$3,528.00 ","$3,038.00 ","$3,528.00 ","$3,528.00 ","$3,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000086,74261,HC CT VIRTUAL COLONOSCOPY DX,350,1 ,"$1,600.00 ",$800.00 ,$36.64 ,"$1,600.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$107.35 ,$960.00 ,"$1,360.00 ","$1,120.00 ",$36.64 ,"$1,520.00 ","$1,216.00 ","$1,200.00 ","$1,171.00 ","$1,360.00 ",$107.35 ,"$1,171.00 ","$1,126.00 ","$1,120.00 ",$36.64 ,$107.35 ,$107.35 ,$471.80 ,"$1,360.00 ",$241.53 ,"$1,472.00 ","$1,120.00 ",$458.21 ,$458.21 ,$974.40 ,$458.21 ,"$1,105.60 ","$1,440.00 ","$1,114.40 ",$108.42 ,"$1,264.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$107.35 ,"$1,136.00 ","$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ","$1,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,"$1,600.00 ",$800.00 ,$36.64 ,"$1,600.00 ",$36.64 ,"$1,140.00 ","$1,119.00 ",$79.76 ,$960.00 ,"$1,360.00 ","$1,120.00 ",$36.64 ,"$1,520.00 ","$1,216.00 ","$1,200.00 ","$1,171.00 ","$1,360.00 ",$79.76 ,"$1,171.00 ","$1,126.00 ","$1,120.00 ",$36.64 ,$79.76 ,$79.76 ,$471.80 ,"$1,360.00 ",$179.45 ,"$1,472.00 ","$1,120.00 ",$80.08 ,$80.08 ,$974.40 ,$80.08 ,"$1,105.60 ","$1,440.00 ","$1,114.40 ",$80.56 ,"$1,264.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$79.76 ,"$1,136.00 ","$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ","$1,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000088,N/A,HC CT HRT W/O DYE W/CA TEST (PROMO),350,1 ,$49.95 ,$24.98 ,$24.98 ,$49.95 , N/A ,$49.95 ,$49.95 , N/A ,$29.97 ,$42.46 ,$34.97 , N/A ,$47.45 ,$37.96 ,$37.46 ,$49.95 ,$42.46 , N/A ,$49.95 ,$49.95 ,$34.97 , N/A , N/A , N/A ,$49.95 ,$42.46 , N/A ,$45.95 ,$34.97 ,$25.33 ,$30.40 ,$30.42 ,$30.40 ,$34.52 ,$44.96 ,$34.79 , N/A ,$39.46 , N/A ,$49.95 ,$49.95 , N/A ,$49.95 ,$35.96 ,$30.97 ,$35.96 ,$35.96 ,$39.96 
ST NICHOLAS HOSPITAL - ACUTE,35000089,75572,HC CT HEART WO/W CONT FUNCT EVAL,350,1 ,"$1,800.00 ",$900.00 ,$99.26 ,"$1,800.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$99.26 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,530.00 ",$396.28 ,"$1,656.00 ","$1,260.00 ",$804.36 ,$804.36 ,"$1,096.20 ",$804.36 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$177.89 ,"$1,422.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000090,75573,HC CT HRT W/3D IMAGE CONGEN,350,1 ,"$1,800.00 ",$900.00 ,$99.26 ,"$1,800.00 ",$99.26 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$99.26 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$99.26 ,$176.13 ,$176.13 ,$471.80 ,"$1,530.00 ",$396.28 ,"$1,656.00 ","$1,260.00 ",$804.36 ,$804.36 ,"$1,096.20 ",$804.36 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$177.89 ,"$1,422.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000091,75574,HC CT CARD ANGIO W/CALC SCORING,350,1 ,"$1,800.00 ",$900.00 ,$121.52 ,"$1,800.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$121.52 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$1,530.00 ",$396.28 ,"$1,656.00 ","$1,260.00 ",$804.36 ,$804.36 ,"$1,096.20 ",$804.36 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$177.89 ,"$1,422.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000094,75574,HC CTA HEART CORONARY W/CONTRAST 3D POST,350,1 ,"$1,800.00 ",$900.00 ,$121.52 ,"$1,800.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$121.52 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,171.00 ","$1,530.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,260.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$1,530.00 ",$396.28 ,"$1,656.00 ","$1,260.00 ",$804.36 ,$804.36 ,"$1,096.20 ",$804.36 ,"$1,243.80 ","$1,620.00 ","$1,253.70 ",$177.89 ,"$1,422.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$176.13 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,976.00 ","$1,950.00 ","$1,171.00 ","$2,210.00 ",$176.13 ,"$1,171.00 ","$1,126.00 ","$1,820.00 ",$121.52 ,$176.13 ,$176.13 ,$471.80 ,"$2,210.00 ",$396.28 ,"$2,392.00 ","$1,820.00 ","$1,057.81 ","$1,057.81 ","$1,583.40 ","$1,057.81 ","$1,796.60 ","$2,340.00 ","$1,810.90 ",$177.89 ,"$2,054.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$176.13 ,"$1,136.00 ","$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$2,080.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000099,76376,HC 3D RENDER CT NOT REQUIRE INDEP,350,1 ,$694.00 ,$347.00 ,$347.00 ,$694.00 , N/A ,$694.00 ,$694.00 , N/A ,$416.40 ,$589.90 ,$485.80 , N/A ,$659.30 ,$527.44 ,$520.50 ,$694.00 ,$589.90 , N/A ,$694.00 ,$694.00 ,$485.80 , N/A , N/A , N/A ,$471.80 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$422.44 ,$479.55 ,$624.60 ,$483.37 , N/A ,$548.26 , N/A ,$694.00 ,$694.00 , N/A ,$694.00 ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$555.20 
ST NICHOLAS HOSPITAL - ACUTE,35000100,76377,HC 3D RENDER CT REQUIRES INDEPENDENT,350,1 ,$784.00 ,$392.00 ,$392.00 ,$784.00 , N/A ,$784.00 ,$784.00 , N/A ,$470.40 ,$666.40 ,$548.80 , N/A ,$744.80 ,$595.84 ,$588.00 ,$784.00 ,$666.40 , N/A ,$784.00 ,$784.00 ,$548.80 , N/A , N/A , N/A ,$471.80 ,$666.40 , N/A ,$721.28 ,$548.80 ,$397.64 ,$477.22 ,$477.46 ,$477.22 ,$541.74 ,$705.60 ,$546.06 , N/A ,$619.36 , N/A ,$784.00 ,$784.00 , N/A ,$784.00 ,$564.48 ,$486.08 ,$564.48 ,$564.48 ,$627.20 
ST NICHOLAS HOSPITAL - ACUTE,35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,"$1,100.00 ",$550.00 ,$36.64 ,"$1,100.00 ",$36.64 ,"$1,100.00 ","$1,100.00 ",$79.76 ,$660.00 ,$935.00 ,$770.00 ,$36.64 ,"$1,045.00 ",$836.00 ,$825.00 ,"$1,100.00 ",$935.00 ,$79.76 ,"$1,100.00 ","$1,100.00 ",$770.00 ,$36.64 ,$79.76 ,$79.76 ,$471.80 ,$935.00 ,$179.45 ,"$1,012.00 ",$770.00 ,$288.27 ,$288.27 ,$669.90 ,$288.27 ,$760.10 ,$990.00 ,$766.15 ,$80.56 ,$869.00 ,$38.84 ,"$1,100.00 ","$1,100.00 ",$79.76 ,"$1,100.00 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,35000103,76497,HC UNLISTED CT PROC,350,1 ,$475.00 ,$237.50 ,$36.64 ,$475.00 ,$36.64 ,$475.00 ,$475.00 ,$79.76 ,$285.00 ,$403.75 ,$332.50 ,$36.64 ,$451.25 ,$361.00 ,$356.25 ,$475.00 ,$403.75 ,$79.76 ,$475.00 ,$475.00 ,$332.50 ,$36.64 ,$79.76 ,$79.76 ,$471.80 ,$403.75 ,$179.45 ,$437.00 ,$332.50 ,$288.27 ,$288.27 ,$289.28 ,$288.27 ,$328.23 ,$427.50 ,$330.84 ,$80.56 ,$375.25 ,$38.84 ,$475.00 ,$475.00 ,$79.76 ,$475.00 ,$342.00 ,$294.50 ,$342.00 ,$342.00 ,$380.00 
ST NICHOLAS HOSPITAL - ACUTE,35000104,77011,HC CT GUIDED LOCALIZATION STEREO,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,190.00 ",$29.23 , N/A , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,184.05 ", N/A ,"$1,343.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000105,77011,HC CT GUIDED LOCALIZATION STEREO SINUS,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,190.00 ",$29.23 , N/A , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,184.05 ", N/A ,"$1,343.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,190.00 ",$29.23 , N/A , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,184.05 ", N/A ,"$1,343.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000108,77012,HC CT GUIDED NEEDLE PLACEMENT JOINT INJ,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,190.00 ",$29.23 , N/A , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,184.05 ", N/A ,"$1,343.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000110,77014,HC CT GUIDED THRPY PLACEMENT,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,190.00 ",$29.23 , N/A , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,184.05 ", N/A ,"$1,343.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000111,77014,HC CT GUIDED THRPY PLACEMENT UNENHAN,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,140.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$1,190.00 ",$29.23 , N/A , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,184.05 ", N/A ,"$1,343.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000112,77387,HC CT GUIDED THRPY PLACEMENT CONE BEAM,350,1 ,$507.00 ,$253.50 ,$36.91 ,$507.00 ,$36.91 ,$507.00 ,$507.00 , N/A ,$304.20 ,$430.95 ,$354.90 ,$36.91 ,$481.65 ,$385.32 ,$380.25 ,$507.00 ,$430.95 , N/A ,$507.00 ,$507.00 ,$354.90 ,$36.91 , N/A , N/A ,$471.80 ,$430.95 , N/A ,$466.44 ,$354.90 ,$257.15 ,$308.61 ,$308.76 ,$308.61 ,$350.34 ,$456.30 ,$353.13 , N/A ,$400.53 ,$39.12 ,$507.00 ,$507.00 , N/A ,$507.00 ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$405.60 
ST NICHOLAS HOSPITAL - ACUTE,35000113,51102,HC ASPIRATION OF BLADDER AND INSERT SUPRAPUBIC CATH,350,1 ,"$3,447.00 ","$1,723.50 ",$471.80 ,"$3,972.27 ",$490.13 ,"$1,140.00 ","$1,119.00 ","$1,765.45 ","$2,068.20 ","$2,929.95 ","$2,412.90 ",$490.13 ,"$3,274.65 ","$2,619.72 ","$2,585.25 ","$1,171.00 ","$2,929.95 ","$1,765.45 ","$1,171.00 ","$1,126.00 ","$2,412.90 ",$490.13 ,"$1,765.45 ","$1,765.45 ",$471.80 ,"$2,929.95 ","$3,972.27 ","$3,171.24 ","$2,412.90 ","$1,703.02 ","$2,128.52 ","$2,099.22 ","$2,128.52 ","$2,381.88 ","$3,102.30 ","$2,400.84 ","$1,783.10 ","$2,723.13 ",$519.54 ,"$1,136.00 ","$1,136.00 ","$1,765.45 ","$1,136.00 ","$2,481.84 ","$2,137.14 ","$2,481.84 ","$2,481.84 ","$2,757.60 "
ST NICHOLAS HOSPITAL - ACUTE,35000116,64510,HC INJECT STELLATE GANGLION,350,1 ,"$1,433.00 ",$716.50 ,$364.34 ,"$1,826.27 ",$364.34 ,"$1,140.00 ","$1,119.00 ",$811.67 ,$859.80 ,"$1,218.05 ","$1,003.10 ",$364.34 ,"$1,361.35 ","$1,089.08 ","$1,074.75 ","$1,171.00 ","$1,218.05 ",$811.67 ,"$1,171.00 ","$1,126.00 ","$1,003.10 ",$364.34 ,$811.67 ,$811.67 ,$471.80 ,"$1,218.05 ","$1,826.27 ","$1,318.36 ","$1,003.10 ","$1,433.00 ","$1,433.00 ",$872.70 ,"$1,433.00 ",$990.20 ,"$1,289.70 ",$998.08 ,$819.79 ,"$1,132.07 ",$386.20 ,"$1,136.00 ","$1,136.00 ",$811.67 ,"$1,136.00 ","$1,031.76 ",$888.46 ,"$1,031.76 ","$1,031.76 ","$1,146.40 "
ST NICHOLAS HOSPITAL - ACUTE,35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$4,800.00 ","$2,400.00 ",$121.52 ,"$4,800.00 ",$121.52 ,"$1,140.00 ","$1,119.00 ",$363.09 ,"$2,880.00 ","$4,080.00 ","$3,360.00 ",$121.52 ,"$4,560.00 ","$3,648.00 ","$3,600.00 ","$1,171.00 ","$4,080.00 ",$363.09 ,"$1,171.00 ","$1,126.00 ","$3,360.00 ",$121.52 ,$363.09 ,$363.09 ,$471.80 ,"$4,080.00 ",$816.96 ,"$4,416.00 ","$3,360.00 ","$1,413.47 ","$1,413.47 ","$2,923.20 ","$1,413.47 ","$3,316.80 ","$4,320.00 ","$3,343.20 ",$366.72 ,"$3,792.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$363.09 ,"$1,136.00 ","$3,456.00 ","$2,976.00 ","$3,456.00 ","$3,456.00 ","$3,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000132,G0260,HC INJECTION SACRO JOINT W/ ANESTH,350,1 ,"$1,831.00 ",$915.50 ,$154.70 ,"$1,831.00 ",$154.70 ,"$1,140.00 ","$1,119.00 ",$626.11 ,"$1,098.60 ","$1,556.35 ","$1,281.70 ",$154.70 ,"$1,739.45 ","$1,391.56 ","$1,373.25 ","$1,171.00 ","$1,556.35 ",$626.11 ,"$1,171.00 ","$1,126.00 ","$1,281.70 ",$154.70 ,$626.11 ,$626.11 ,$471.80 ,"$1,556.35 ","$1,408.74 ","$1,684.52 ","$1,281.70 ","$1,831.00 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,647.90 ","$1,275.29 ",$632.37 ,"$1,446.49 ",$163.98 ,"$1,136.00 ","$1,136.00 ",$626.11 ,"$1,136.00 ","$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,464.80 "
ST NICHOLAS HOSPITAL - ACUTE,35000132,G0260,HC INJECTION SACRO JOINT W/ ANESTH,350,1 ,"$1,831.00 ",$915.50 ,$154.70 ,"$1,831.00 ",$154.70 ,"$1,140.00 ","$1,119.00 ",$626.11 ,"$1,098.60 ","$1,556.35 ","$1,281.70 ",$154.70 ,"$1,739.45 ","$1,391.56 ","$1,373.25 ","$1,171.00 ","$1,556.35 ",$626.11 ,"$1,171.00 ","$1,126.00 ","$1,281.70 ",$154.70 ,$626.11 ,$626.11 ,$471.80 ,"$1,556.35 ","$1,408.74 ","$1,684.52 ","$1,281.70 ","$1,831.00 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,647.90 ","$1,275.29 ",$632.37 ,"$1,446.49 ",$163.98 ,"$1,136.00 ","$1,136.00 ",$626.11 ,"$1,136.00 ","$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,464.80 "
ST NICHOLAS HOSPITAL - ACUTE,35000135,22513,HC VERTEBROPLASTY INJ PERC THOR  KYPHOPLASTY,350,1 ,"$5,200.00 ","$2,600.00 ",$471.80 ,"$13,895.93 ","$1,461.70 ","$1,140.00 ","$1,119.00 ","$6,175.97 ","$3,120.00 ","$4,420.00 ","$3,640.00 ","$1,461.70 ","$4,940.00 ","$3,952.00 ","$3,900.00 ","$1,171.00 ","$4,420.00 ","$6,175.97 ","$1,171.00 ","$1,126.00 ","$3,640.00 ","$1,461.70 ","$6,175.97 ","$6,175.97 ",$471.80 ,"$4,420.00 ","$13,895.93 ","$4,784.00 ","$3,640.00 ","$4,794.94 ","$5,993.67 ","$3,166.80 ","$5,993.67 ","$3,593.20 ","$4,680.00 ","$3,621.80 ","$6,237.73 ","$4,108.00 ","$1,549.40 ","$1,136.00 ","$1,136.00 ","$6,175.97 ","$1,136.00 ","$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$4,160.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000136,22514,HC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,350,1 ,"$5,200.00 ","$2,600.00 ",$471.80 ,"$13,895.93 ","$1,461.70 ","$1,140.00 ","$1,119.00 ","$6,175.97 ","$3,120.00 ","$4,420.00 ","$3,640.00 ","$1,461.70 ","$4,940.00 ","$3,952.00 ","$3,900.00 ","$1,171.00 ","$4,420.00 ","$6,175.97 ","$1,171.00 ","$1,126.00 ","$3,640.00 ","$1,461.70 ","$6,175.97 ","$6,175.97 ",$471.80 ,"$4,420.00 ","$13,895.93 ","$4,784.00 ","$3,640.00 ","$4,794.94 ","$5,993.67 ","$3,166.80 ","$5,993.67 ","$3,593.20 ","$4,680.00 ","$3,621.80 ","$6,237.73 ","$4,108.00 ","$1,549.40 ","$1,136.00 ","$1,136.00 ","$6,175.97 ","$1,136.00 ","$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$4,160.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000137,22515,HC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,350,1 ,"$5,200.00 ","$2,600.00 ",$471.80 ,"$5,993.67 ","$3,220.01 ","$1,140.00 ","$1,119.00 ", N/A ,"$3,120.00 ","$4,420.00 ","$3,640.00 ","$3,220.01 ","$4,940.00 ","$3,952.00 ","$3,900.00 ","$1,171.00 ","$4,420.00 ", N/A ,"$1,171.00 ","$1,126.00 ","$3,640.00 ","$3,220.01 ", N/A , N/A ,$471.80 ,"$4,420.00 ", N/A ,"$4,784.00 ","$3,640.00 ","$4,794.94 ","$5,993.67 ","$3,166.80 ","$5,993.67 ","$3,593.20 ","$4,680.00 ","$3,621.80 ", N/A ,"$4,108.00 ","$3,413.21 ","$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ","$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$4,160.00 "
ST NICHOLAS HOSPITAL - ACUTE,35000151,G0288,HC CT RECONSTRUCTION AORTA FOR VASC SURG,350,1 ,$220.00 ,$110.00 ,$110.00 ,$220.00 , N/A ,$220.00 ,$220.00 , N/A ,$132.00 ,$187.00 ,$154.00 , N/A ,$209.00 ,$167.20 ,$165.00 ,$220.00 ,$187.00 , N/A ,$220.00 ,$220.00 ,$154.00 , N/A , N/A , N/A ,$220.00 ,$187.00 , N/A ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 , N/A ,$173.80 , N/A ,$220.00 ,$220.00 , N/A ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,"$1,100.00 ",$550.00 ,$36.64 ,"$1,100.00 ",$36.64 ,"$1,100.00 ","$1,100.00 ",$107.35 ,$660.00 ,$935.00 ,$770.00 ,$36.64 ,"$1,045.00 ",$836.00 ,$825.00 ,"$1,100.00 ",$935.00 ,$107.35 ,"$1,100.00 ","$1,100.00 ",$770.00 ,$36.64 ,$107.35 ,$107.35 ,$471.80 ,$935.00 ,$241.53 ,"$1,012.00 ",$770.00 ,$477.04 ,$477.04 ,$669.90 ,$477.04 ,$760.10 ,$990.00 ,$766.15 ,$108.42 ,$869.00 ,$38.84 ,"$1,100.00 ","$1,100.00 ",$107.35 ,"$1,100.00 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,36000002,N/A,HC MINOR PROCEDURE,360,1 ,$158.00 ,$79.00 ,$79.00 ,$158.00 , N/A , N/A , N/A , N/A ,$94.80 ,$134.30 ,$110.60 , N/A ,$150.10 ,$120.08 ,$118.50 , N/A ,$134.30 , N/A , N/A , N/A ,$110.60 , N/A , N/A , N/A , N/A ,$134.30 , N/A ,$145.36 ,$110.60 ,$80.14 ,$96.17 ,$96.22 ,$96.17 ,$109.18 ,$142.20 ,$110.05 , N/A ,$124.82 , N/A , N/A , N/A , N/A , N/A ,$113.76 ,$97.96 ,$113.76 ,$113.76 ,$126.40 
ST NICHOLAS HOSPITAL - ACUTE,36000003,N/A,HC SCHEDULED PROCEDURE,360,1 ,"$1,680.00 ",$840.00 ,$840.00 ,"$1,680.00 ", N/A , N/A , N/A , N/A ,"$1,008.00 ","$1,428.00 ","$1,176.00 ", N/A ,"$1,596.00 ","$1,276.80 ","$1,260.00 ", N/A ,"$1,428.00 ", N/A , N/A , N/A ,"$1,176.00 ", N/A , N/A , N/A , N/A ,"$1,428.00 ", N/A ,"$1,545.60 ","$1,176.00 ",$852.10 ,"$1,022.62 ","$1,023.12 ","$1,022.62 ","$1,160.88 ","$1,512.00 ","$1,170.12 ", N/A ,"$1,327.20 ", N/A , N/A , N/A , N/A , N/A ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000004,N/A,HC SCHEDULED PROCEDURE LIMITED,360,1 ,$935.00 ,$467.50 ,$467.50 ,$935.00 , N/A , N/A , N/A , N/A ,$561.00 ,$794.75 ,$654.50 , N/A ,$888.25 ,$710.60 ,$701.25 , N/A ,$794.75 , N/A , N/A , N/A ,$654.50 , N/A , N/A , N/A , N/A ,$794.75 , N/A ,$860.20 ,$654.50 ,$474.23 ,$569.13 ,$569.42 ,$569.13 ,$646.09 ,$841.50 ,$651.23 , N/A ,$738.65 , N/A , N/A , N/A , N/A , N/A ,$673.20 ,$579.70 ,$673.20 ,$673.20 ,$748.00 
ST NICHOLAS HOSPITAL - ACUTE,36000011,N/A,HC HYPOTHERMIA TOTAL BODY,360,1 ,$431.00 ,$215.50 ,$215.50 ,$431.00 , N/A , N/A , N/A , N/A ,$258.60 ,$366.35 ,$301.70 , N/A ,$409.45 ,$327.56 ,$323.25 , N/A ,$366.35 , N/A , N/A , N/A ,$301.70 , N/A , N/A , N/A , N/A ,$366.35 , N/A ,$396.52 ,$301.70 ,$218.60 ,$262.35 ,$262.48 ,$262.35 ,$297.82 ,$387.90 ,$300.19 , N/A ,$340.49 , N/A , N/A , N/A , N/A , N/A ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,36000017,N/A,HC XRAY HIP PINNING OR,360,1 ,"$1,050.00 ",$525.00 ,$525.00 ,"$1,050.00 ", N/A , N/A , N/A , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$798.00 ,$787.50 , N/A ,$892.50 , N/A , N/A , N/A ,$735.00 , N/A , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$639.14 ,$725.55 ,$945.00 ,$731.33 , N/A ,$829.50 , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$840.00 
ST NICHOLAS HOSPITAL - ACUTE,36000018,N/A,HC FLUORO FOR BRONCHOSCOPY,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000022,N/A,HC UMBILICAL CANNULATION,360,1 ,$221.00 ,$110.50 ,$110.50 ,$221.00 , N/A , N/A , N/A , N/A ,$132.60 ,$187.85 ,$154.70 , N/A ,$209.95 ,$167.96 ,$165.75 , N/A ,$187.85 , N/A , N/A , N/A ,$154.70 , N/A , N/A , N/A , N/A ,$187.85 , N/A ,$203.32 ,$154.70 ,$112.09 ,$134.52 ,$134.59 ,$134.52 ,$152.71 ,$198.90 ,$153.93 , N/A ,$174.59 , N/A , N/A , N/A , N/A , N/A ,$159.12 ,$137.02 ,$159.12 ,$159.12 ,$176.80 
ST NICHOLAS HOSPITAL - ACUTE,36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$291.00 ,$145.50 ,$51.36 ,$398.39 ,$51.36 ,$291.00 ,$291.00 ,$177.06 ,$174.60 ,$247.35 ,$203.70 ,$51.36 ,$276.45 ,$221.16 ,$218.25 ,$291.00 ,$247.35 ,$177.06 ,$291.00 ,$291.00 ,$203.70 ,$51.36 ,$177.06 ,$177.06 ,$291.00 ,$247.35 ,$398.39 ,$267.72 ,$203.70 ,$291.00 ,$291.00 ,$177.22 ,$291.00 ,$201.08 ,$261.90 ,$202.68 ,$178.83 ,$229.89 ,$54.44 ,$291.00 ,$291.00 ,$177.06 ,$291.00 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,"$1,939.00 ",$969.50 ,$344.84 ,"$3,121.49 ",$344.84 ,"$1,939.00 ","$1,939.00 ","$1,387.33 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$344.84 ,"$1,842.05 ","$1,473.64 ","$1,454.25 ","$1,939.00 ","$1,648.15 ","$1,387.33 ","$1,939.00 ","$1,939.00 ","$1,357.30 ",$344.84 ,"$1,387.33 ","$1,387.33 ","$1,939.00 ","$1,648.15 ","$3,121.49 ","$1,783.88 ","$1,357.30 ","$1,703.02 ","$1,939.00 ","$1,180.85 ","$1,939.00 ","$1,339.85 ","$1,745.10 ","$1,350.51 ","$1,401.20 ","$1,531.81 ",$365.53 ,"$1,939.00 ","$1,939.00 ","$1,387.33 ","$1,939.00 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$463.00 ,$231.50 ,$51.36 ,$766.80 ,$51.36 ,$463.00 ,$463.00 ,$340.80 ,$277.80 ,$393.55 ,$324.10 ,$51.36 ,$439.85 ,$351.88 ,$347.25 ,$463.00 ,$393.55 ,$340.80 ,$463.00 ,$463.00 ,$324.10 ,$51.36 ,$340.80 ,$340.80 ,$463.00 ,$393.55 ,$766.80 ,$425.96 ,$324.10 ,$463.00 ,$463.00 ,$281.97 ,$463.00 ,$319.93 ,$416.70 ,$322.48 ,$344.21 ,$365.77 ,$54.44 ,$463.00 ,$463.00 ,$340.80 ,$463.00 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$370.40 
ST NICHOLAS HOSPITAL - ACUTE,36000035,10030,HC GUIDE CATHET FLUID DRAINAGE,360,1 ,"$1,293.00 ",$646.50 ,$344.84 ,"$1,380.55 ",$344.84 ,"$1,293.00 ","$1,293.00 ",$613.58 ,$775.80 ,"$1,099.05 ",$905.10 ,$344.84 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ",$613.58 ,"$1,293.00 ",$840.45 ,$905.10 ,$344.84 ,$613.58 ,$613.58 ,"$1,293.00 ","$1,099.05 ","$1,380.55 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,$619.72 ,"$1,021.47 ",$365.53 ,"$1,293.00 ","$1,293.00 ",$613.58 ,"$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000050,12031,HC WOUND REPAIR INTERMEDIATE FACIL,761,1 ,$700.00 ,$350.00 ,$118.09 ,$766.80 ,$118.09 ,$700.00 ,$700.00 ,$340.80 ,$420.00 ,$595.00 ,$490.00 ,$118.09 ,$665.00 ,$532.00 ,$525.00 ,$700.00 ,$595.00 ,$340.80 ,$700.00 ,$700.00 ,$490.00 ,$118.09 ,$340.80 ,$340.80 ,$294.00 ,$595.00 ,$766.80 ,$644.00 ,$490.00 ,$700.00 ,$700.00 ,$426.30 ,$700.00 ,$483.70 ,$630.00 ,$487.55 ,$344.21 ,$553.00 ,$125.18 ,$420.00 ,$420.00 ,$340.80 ,$420.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,36000078,19000,HC ASP CYST BREAST,360,1 ,$797.00 ,$398.50 ,$198.34 ,"$1,380.55 ",$198.34 ,$797.00 ,$797.00 ,$613.58 ,$478.20 ,$677.45 ,$557.90 ,$198.34 ,$757.15 ,$605.72 ,$597.75 ,$797.00 ,$677.45 ,$613.58 ,$797.00 ,$797.00 ,$557.90 ,$198.34 ,$613.58 ,$613.58 ,$797.00 ,$677.45 ,"$1,380.55 ",$733.24 ,$557.90 ,$797.00 ,$797.00 ,$485.37 ,$797.00 ,$550.73 ,$717.30 ,$555.11 ,$619.72 ,$629.63 ,$210.24 ,$797.00 ,$797.00 ,$613.58 ,$797.00 ,$573.84 ,$494.14 ,$573.84 ,$573.84 ,$637.60 
ST NICHOLAS HOSPITAL - ACUTE,36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$409.00 ,$204.50 ,$198.34 ,"$2,128.52 ",$198.34 ,$409.00 ,$409.00 , N/A ,$245.40 ,$347.65 ,$286.30 ,$198.34 ,$388.55 ,$310.84 ,$306.75 ,$409.00 ,$347.65 , N/A ,$409.00 ,$409.00 ,$286.30 ,$198.34 , N/A , N/A ,$409.00 ,$347.65 , N/A ,$376.28 ,$286.30 ,"$1,703.02 ","$2,128.52 ",$249.08 ,"$2,128.52 ",$282.62 ,$368.10 ,$284.87 , N/A ,$323.11 ,$210.24 ,$409.00 ,$409.00 , N/A ,$409.00 ,$294.48 ,$253.58 ,$294.48 ,$294.48 ,$327.20 
ST NICHOLAS HOSPITAL - ACUTE,36000080,19020,HC BREAST ABSCESS DRAINAGE,360,1 ,"$2,681.00 ","$1,340.50 ",$439.46 ,"$3,121.49 ",$439.46 ,"$2,681.00 ","$2,681.00 ","$1,387.33 ","$1,608.60 ","$2,278.85 ","$1,876.70 ",$439.46 ,"$2,546.95 ","$2,037.56 ","$2,010.75 ","$2,681.00 ","$2,278.85 ","$1,387.33 ","$2,681.00 ","$2,681.00 ","$1,876.70 ",$439.46 ,"$1,387.33 ","$1,387.33 ","$2,681.00 ","$2,278.85 ","$3,121.49 ","$2,466.52 ","$1,876.70 ","$1,921.55 ","$2,401.67 ","$1,632.73 ","$2,401.67 ","$1,852.57 ","$2,412.90 ","$1,867.32 ","$1,401.20 ","$2,117.99 ",$465.83 ,"$2,681.00 ","$2,681.00 ","$1,387.33 ","$2,681.00 ","$1,930.32 ","$1,662.22 ","$1,930.32 ","$1,930.32 ","$2,144.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000081,19030,HC INJECTION GALACTOGRAM,360,1 ,$317.00 ,$158.50 ,$95.13 ,$317.00 ,$95.13 ,$317.00 ,$317.00 , N/A ,$190.20 ,$269.45 ,$221.90 ,$95.13 ,$301.15 ,$240.92 ,$237.75 ,$317.00 ,$269.45 , N/A ,$317.00 ,$317.00 ,$221.90 ,$95.13 , N/A , N/A ,$317.00 ,$269.45 , N/A ,$291.64 ,$221.90 ,$317.00 ,$317.00 ,$193.05 ,$317.00 ,$219.05 ,$285.30 ,$220.79 , N/A ,$250.43 ,$100.84 ,$317.00 ,$317.00 , N/A ,$317.00 ,$228.24 ,$196.54 ,$228.24 ,$228.24 ,$253.60 
ST NICHOLAS HOSPITAL - ACUTE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,000.00 ","$2,000.00 ",$659.19 ,"$5,260.19 ",$659.19 ,"$4,000.00 ","$3,641.00 ","$2,337.86 ","$2,400.00 ","$3,400.00 ","$2,800.00 ",$659.19 ,"$3,800.00 ","$3,040.00 ","$3,000.00 ","$4,000.00 ","$3,400.00 ","$2,337.86 ","$4,000.00 ","$2,600.00 ","$2,800.00 ",$659.19 ,"$2,337.86 ","$2,337.86 ","$3,733.65 ","$3,400.00 ","$5,260.19 ","$3,680.00 ","$2,800.00 ","$2,882.33 ","$3,602.51 ","$2,436.00 ","$3,602.51 ","$2,764.00 ","$3,600.00 ","$2,786.00 ","$2,361.24 ","$3,160.00 ",$698.74 ,"$4,000.00 ","$4,000.00 ","$2,337.86 ","$4,000.00 ","$2,880.00 ","$2,480.00 ","$2,880.00 ","$2,880.00 ","$3,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,000.00 ","$2,000.00 ",$659.19 ,"$5,260.19 ",$659.19 ,"$4,000.00 ","$3,641.00 ","$2,337.86 ","$2,400.00 ","$3,400.00 ","$2,800.00 ",$659.19 ,"$3,800.00 ","$3,040.00 ","$3,000.00 ","$4,000.00 ","$3,400.00 ","$2,337.86 ","$4,000.00 ","$2,600.00 ","$2,800.00 ",$659.19 ,"$2,337.86 ","$2,337.86 ","$3,733.65 ","$3,400.00 ","$5,260.19 ","$3,680.00 ","$2,800.00 ","$2,882.33 ","$3,602.51 ","$2,436.00 ","$3,602.51 ","$2,764.00 ","$3,600.00 ","$2,786.00 ","$2,361.24 ","$3,160.00 ",$698.74 ,"$4,000.00 ","$4,000.00 ","$2,337.86 ","$4,000.00 ","$2,880.00 ","$2,480.00 ","$2,880.00 ","$2,880.00 ","$3,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,500.00 ",$750.00 ,$258.03 ,"$1,500.00 ",$258.03 ,"$1,500.00 ","$1,500.00 ",$613.58 ,$900.00 ,"$1,275.00 ","$1,050.00 ",$258.03 ,"$1,425.00 ","$1,140.00 ","$1,125.00 ","$1,500.00 ","$1,275.00 ",$613.58 ,"$1,500.00 ",$975.00 ,"$1,050.00 ",$258.03 ,$613.58 ,$613.58 ,"$1,500.00 ","$1,275.00 ","$1,380.55 ","$1,380.00 ","$1,050.00 ","$1,500.00 ","$1,500.00 ",$913.50 ,"$1,500.00 ","$1,036.50 ","$1,350.00 ","$1,044.75 ",$619.72 ,"$1,185.00 ",$273.51 ,"$1,500.00 ","$1,500.00 ",$613.58 ,"$1,500.00 ","$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ","$1,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000086,19286,HC PLCMNT NEEDLE LOC WIRE BRST ADDL,360,1 ,$130.00 ,$65.00 ,$65.00 ,"$2,401.67 ",$258.03 ,$130.00 ,$130.00 , N/A ,$78.00 ,$110.50 ,$91.00 ,$258.03 ,$123.50 ,$98.80 ,$97.50 ,$130.00 ,$110.50 , N/A ,$130.00 ,$84.50 ,$91.00 ,$258.03 , N/A , N/A ,$130.00 ,$110.50 , N/A ,$119.60 ,$91.00 ,"$1,921.55 ","$2,401.67 ",$79.17 ,"$2,401.67 ",$89.83 ,$117.00 ,$90.55 , N/A ,$102.70 ,$273.51 ,$130.00 ,$130.00 , N/A ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$1,293.00 ",$646.50 ,$198.34 ,"$3,121.49 ",$198.34 ,"$1,293.00 ","$1,293.00 ","$1,387.33 ",$775.80 ,"$1,099.05 ",$905.10 ,$198.34 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ","$1,387.33 ","$1,293.00 ","$1,293.00 ",$905.10 ,$198.34 ,"$1,387.33 ","$1,387.33 ","$1,293.00 ","$1,099.05 ","$3,121.49 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,"$1,401.20 ","$1,021.47 ",$210.24 ,"$1,293.00 ","$1,293.00 ","$1,387.33 ","$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000089,20220,HC BX BONE NEEDLE SUPERFIC FAC,360,1 ,"$1,508.00 ",$754.00 ,$198.34 ,"$3,121.49 ",$198.34 ,"$1,508.00 ","$1,508.00 ","$1,387.33 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$198.34 ,"$1,432.60 ","$1,146.08 ","$1,131.00 ","$1,508.00 ","$1,281.80 ","$1,387.33 ","$1,508.00 ","$1,508.00 ","$1,055.60 ",$198.34 ,"$1,387.33 ","$1,387.33 ","$1,508.00 ","$1,281.80 ","$3,121.49 ","$1,387.36 ","$1,055.60 ","$1,508.00 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,357.20 ","$1,050.32 ","$1,401.20 ","$1,191.32 ",$210.24 ,"$1,508.00 ","$1,508.00 ","$1,387.33 ","$1,508.00 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ","$1,206.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000090,20225,HC BX BONE NEEDLE DEEP,360,1 ,"$2,370.00 ","$1,185.00 ",$547.96 ,"$3,121.49 ",$547.96 ,"$2,370.00 ","$2,370.00 ","$1,387.33 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$547.96 ,"$2,251.50 ","$1,801.20 ","$1,777.50 ","$2,370.00 ","$2,014.50 ","$1,387.33 ","$2,370.00 ","$2,370.00 ","$1,659.00 ",$547.96 ,"$1,387.33 ","$1,387.33 ","$2,370.00 ","$2,014.50 ","$3,121.49 ","$2,180.40 ","$1,659.00 ","$1,921.55 ","$2,370.00 ","$1,443.33 ","$2,370.00 ","$1,637.67 ","$2,133.00 ","$1,650.71 ","$1,401.20 ","$1,872.30 ",$580.84 ,"$2,370.00 ","$2,370.00 ","$1,387.33 ","$2,370.00 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,896.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000101,29085,HC CAST APPL; HAND AND FOREARM,360,1 ,$253.00 ,$126.50 ,$59.15 ,$313.43 ,$59.15 ,$253.00 ,$253.00 ,$139.30 ,$151.80 ,$215.05 ,$177.10 ,$59.15 ,$240.35 ,$192.28 ,$189.75 ,$253.00 ,$215.05 ,$139.30 ,$253.00 ,$253.00 ,$177.10 ,$59.15 ,$139.30 ,$139.30 ,$253.00 ,$215.05 ,$313.43 ,$232.76 ,$177.10 ,$253.00 ,$253.00 ,$154.08 ,$253.00 ,$174.82 ,$227.70 ,$176.21 ,$140.69 ,$199.87 ,$62.70 ,$253.00 ,$253.00 ,$139.30 ,$253.00 ,$182.16 ,$156.86 ,$182.16 ,$182.16 ,$202.40 
ST NICHOLAS HOSPITAL - ACUTE,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,$250.00 ,$125.00 ,$125.00 ,"$2,401.67 ",$439.46 ,$250.00 ,$250.00 , N/A ,$150.00 ,$212.50 ,$175.00 ,$439.46 ,$237.50 ,$190.00 ,$187.50 ,$250.00 ,$212.50 , N/A ,$250.00 ,$162.50 ,$175.00 ,$439.46 , N/A , N/A ,$250.00 ,$212.50 , N/A ,$230.00 ,$175.00 ,"$1,921.55 ","$2,401.67 ",$152.25 ,"$2,401.67 ",$172.75 ,$225.00 ,$174.13 , N/A ,$197.50 ,$465.83 ,$250.00 ,$250.00 , N/A ,$250.00 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,$230.00 ,$115.00 ,$115.00 ,"$2,401.67 ",$439.46 ,$230.00 ,$230.00 , N/A ,$138.00 ,$195.50 ,$161.00 ,$439.46 ,$218.50 ,$174.80 ,$172.50 ,$230.00 ,$195.50 , N/A ,$230.00 ,$149.50 ,$161.00 ,$439.46 , N/A , N/A ,$230.00 ,$195.50 , N/A ,$211.60 ,$161.00 ,"$1,921.55 ","$2,401.67 ",$140.07 ,"$2,401.67 ",$158.93 ,$207.00 ,$160.20 , N/A ,$181.70 ,$465.83 ,$230.00 ,$230.00 , N/A ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,36000110,19085,HC BX BREAST 1ST LESION MR IMAG,360,1 ,"$1,000.00 ",$500.00 ,$439.46 ,"$3,121.49 ",$439.46 ,"$1,000.00 ","$1,000.00 ","$1,387.33 ",$600.00 ,$850.00 ,$700.00 ,$439.46 ,$950.00 ,$760.00 ,$750.00 ,"$1,000.00 ",$850.00 ,"$1,387.33 ","$1,000.00 ",$650.00 ,$700.00 ,$439.46 ,"$1,387.33 ","$1,387.33 ","$1,000.00 ",$850.00 ,"$3,121.49 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$900.00 ,$696.50 ,"$1,401.20 ",$790.00 ,$465.83 ,"$1,000.00 ","$1,000.00 ","$1,387.33 ","$1,000.00 ",$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,36000111,19086,HC BX BREAST ADDN LESION MR IMAG,360,1 ,$280.00 ,$140.00 ,$140.00 ,"$2,401.67 ",$439.46 ,$280.00 ,$280.00 , N/A ,$168.00 ,$238.00 ,$196.00 ,$439.46 ,$266.00 ,$212.80 ,$210.00 ,$280.00 ,$238.00 , N/A ,$280.00 ,$182.00 ,$196.00 ,$439.46 , N/A , N/A ,$280.00 ,$238.00 , N/A ,$257.60 ,$196.00 ,"$1,921.55 ","$2,401.67 ",$170.52 ,"$2,401.67 ",$193.48 ,$252.00 ,$195.02 , N/A ,$221.20 ,$465.83 ,$280.00 ,$280.00 , N/A ,$280.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,36000112,19287,HC PERCUTAN DEV BREAST 1ST MR GUIDE,360,1 ,$340.00 ,$170.00 ,$170.00 ,"$1,380.55 ",$258.03 ,$340.00 ,$340.00 ,$613.58 ,$204.00 ,$289.00 ,$238.00 ,$258.03 ,$323.00 ,$258.40 ,$255.00 ,$340.00 ,$289.00 ,$613.58 ,$340.00 ,$221.00 ,$238.00 ,$258.03 ,$613.58 ,$613.58 ,$340.00 ,$289.00 ,"$1,380.55 ",$312.80 ,$238.00 ,$340.00 ,$340.00 ,$207.06 ,$340.00 ,$234.94 ,$306.00 ,$236.81 ,$619.72 ,$268.60 ,$273.51 ,$340.00 ,$340.00 ,$613.58 ,$340.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,36000113,19288,HC PERCUTAN DEV BREAST ADDN MR GUIDE,360,1 ,$105.00 ,$52.50 ,$52.50 ,"$2,401.67 ",$258.03 ,$105.00 ,$105.00 , N/A ,$63.00 ,$89.25 ,$73.50 ,$258.03 ,$99.75 ,$79.80 ,$78.75 ,$105.00 ,$89.25 , N/A ,$105.00 ,$68.25 ,$73.50 ,$258.03 , N/A , N/A ,$105.00 ,$89.25 , N/A ,$96.60 ,$73.50 ,"$1,921.55 ","$2,401.67 ",$63.95 ,"$2,401.67 ",$72.56 ,$94.50 ,$73.13 , N/A ,$82.95 ,$273.51 ,$105.00 ,$105.00 , N/A ,$105.00 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$150.00 ,$75.00 ,$75.00 ,"$2,401.67 ",$258.03 ,$150.00 ,$150.00 , N/A ,$90.00 ,$127.50 ,$105.00 ,$258.03 ,$142.50 ,$114.00 ,$112.50 ,$150.00 ,$127.50 , N/A ,$150.00 ,$97.50 ,$105.00 ,$258.03 , N/A , N/A ,$150.00 ,$127.50 , N/A ,$138.00 ,$105.00 ,"$1,921.55 ","$2,401.67 ",$91.35 ,"$2,401.67 ",$103.65 ,$135.00 ,$104.48 , N/A ,$118.50 ,$273.51 ,$150.00 ,$150.00 , N/A ,$150.00 ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$120.00 
ST NICHOLAS HOSPITAL - ACUTE,36000115,19284,HC BREAST STEREO NDL LOC BX ADDN LESION,360,1 ,$150.00 ,$75.00 ,$75.00 ,"$2,401.67 ",$258.03 ,$150.00 ,$150.00 , N/A ,$90.00 ,$127.50 ,$105.00 ,$258.03 ,$142.50 ,$114.00 ,$112.50 ,$150.00 ,$127.50 , N/A ,$150.00 ,$97.50 ,$105.00 ,$258.03 , N/A , N/A ,$150.00 ,$127.50 , N/A ,$138.00 ,$105.00 ,"$1,921.55 ","$2,401.67 ",$91.35 ,"$2,401.67 ",$103.65 ,$135.00 ,$104.48 , N/A ,$118.50 ,$273.51 ,$150.00 ,$150.00 , N/A ,$150.00 ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$120.00 
ST NICHOLAS HOSPITAL - ACUTE,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,$130.00 ,$65.00 ,$65.00 ,"$2,401.67 ",$258.03 ,$130.00 ,$130.00 , N/A ,$78.00 ,$110.50 ,$91.00 ,$258.03 ,$123.50 ,$98.80 ,$97.50 ,$130.00 ,$110.50 , N/A ,$130.00 ,$84.50 ,$91.00 ,$258.03 , N/A , N/A ,$130.00 ,$110.50 , N/A ,$119.60 ,$91.00 ,"$1,921.55 ","$2,401.67 ",$79.17 ,"$2,401.67 ",$89.83 ,$117.00 ,$90.55 , N/A ,$102.70 ,$273.51 ,$130.00 ,$130.00 , N/A ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,36000119,36471,HC INJ SCLEROSING SOLUTN MULT VEIN,360,1 ,$356.00 ,$178.00 ,$177.80 ,$766.80 ,$177.80 ,$356.00 ,$356.00 ,$340.80 ,$213.60 ,$302.60 ,$249.20 ,$177.80 ,$338.20 ,$270.56 ,$267.00 ,$356.00 ,$302.60 ,$340.80 ,$356.00 ,$356.00 ,$249.20 ,$177.80 ,$340.80 ,$340.80 ,$356.00 ,$302.60 ,$766.80 ,$327.52 ,$249.20 ,$356.00 ,$356.00 ,$216.80 ,$356.00 ,$246.00 ,$320.40 ,$247.95 ,$344.21 ,$281.24 ,$188.47 ,$356.00 ,$356.00 ,$340.80 ,$356.00 ,$256.32 ,$220.72 ,$256.32 ,$256.32 ,$284.80 
ST NICHOLAS HOSPITAL - ACUTE,36000120,36481,HC CATH VEIN PORTAL PERC,360,1 ,"$1,955.00 ",$977.50 ,$199.61 ,"$1,955.00 ",$199.61 ,"$1,955.00 ","$1,955.00 ", N/A ,"$1,173.00 ","$1,661.75 ","$1,368.50 ",$199.61 ,"$1,857.25 ","$1,485.80 ","$1,466.25 ","$1,955.00 ","$1,661.75 ", N/A ,"$1,955.00 ","$1,955.00 ","$1,368.50 ",$199.61 , N/A , N/A ,"$1,955.00 ","$1,661.75 ", N/A ,"$1,798.60 ","$1,368.50 ","$1,703.02 ","$1,955.00 ","$1,190.60 ","$1,955.00 ","$1,350.91 ","$1,759.50 ","$1,361.66 ", N/A ,"$1,544.45 ",$211.59 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$1,407.60 ","$1,212.10 ","$1,407.60 ","$1,407.60 ","$1,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000121,36500,HC CATH VENOUS BLOOD SELECT SMPL,360,1 ,"$1,000.00 ",$500.00 ,$199.61 ,"$1,000.00 ",$199.61 ,"$1,000.00 ","$1,000.00 ", N/A ,$600.00 ,$850.00 ,$700.00 ,$199.61 ,$950.00 ,$760.00 ,$750.00 ,"$1,000.00 ",$850.00 , N/A ,"$1,000.00 ","$1,000.00 ",$700.00 ,$199.61 , N/A , N/A ,"$1,000.00 ",$850.00 , N/A ,$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$900.00 ,$696.50 , N/A ,$790.00 ,$211.59 ,"$1,000.00 ","$1,000.00 ", N/A ,"$1,000.00 ",$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,36000122,36555,HC INS CATH CV NON-TUNL <5 YRS,360,1 ,"$3,124.00 ","$1,562.00 ",$353.23 ,"$6,350.83 ",$353.23 ,"$3,124.00 ","$3,124.00 ","$2,822.59 ","$1,874.40 ","$2,655.40 ","$2,186.80 ",$353.23 ,"$2,967.80 ","$2,374.24 ","$2,343.00 ","$2,815.00 ","$2,655.40 ","$2,822.59 ","$2,815.00 ","$2,717.00 ","$2,186.80 ",$353.23 ,"$2,822.59 ","$2,822.59 ","$2,489.10 ","$2,655.40 ","$6,350.83 ","$2,874.08 ","$2,186.80 ","$1,703.02 ","$2,128.52 ","$1,902.52 ","$2,128.52 ","$2,158.68 ","$2,811.60 ","$2,175.87 ","$2,850.82 ","$2,467.96 ",$374.42 ,"$2,687.00 ","$2,687.00 ","$2,822.59 ","$2,687.00 ","$2,249.28 ","$1,936.88 ","$2,249.28 ","$2,249.28 ","$2,499.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$2,693.00 ","$1,346.50 ",$353.23 ,"$6,350.83 ",$353.23 ,"$2,693.00 ","$2,693.00 ","$2,822.59 ","$1,615.80 ","$2,289.05 ","$1,885.10 ",$353.23 ,"$2,558.35 ","$2,046.68 ","$2,019.75 ","$2,693.00 ","$2,289.05 ","$2,822.59 ","$2,693.00 ","$2,693.00 ","$1,885.10 ",$353.23 ,"$2,822.59 ","$2,822.59 ","$2,489.10 ","$2,289.05 ","$6,350.83 ","$2,477.56 ","$1,885.10 ","$1,703.02 ","$2,128.52 ","$1,640.04 ","$2,128.52 ","$1,860.86 ","$2,423.70 ","$1,875.67 ","$2,850.82 ","$2,127.47 ",$374.42 ,"$2,687.00 ","$2,687.00 ","$2,822.59 ","$2,687.00 ","$1,938.96 ","$1,669.66 ","$1,938.96 ","$1,938.96 ","$2,154.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000124,36557,HC INSERT TUNNELED CVC <5 YEARS OLD,360,1 ,"$2,575.00 ","$1,287.50 ",$689.93 ,"$10,579.35 ",$689.93 ,"$2,575.00 ","$2,575.00 ","$4,701.93 ","$1,545.00 ","$2,188.75 ","$1,802.50 ",$689.93 ,"$2,446.25 ","$1,957.00 ","$1,931.25 ","$2,575.00 ","$2,188.75 ","$4,701.93 ","$2,575.00 ","$2,575.00 ","$1,802.50 ",$689.93 ,"$4,701.93 ","$4,701.93 ","$2,575.00 ","$2,188.75 ","$10,579.35 ","$2,369.00 ","$1,802.50 ","$1,921.55 ","$2,401.67 ","$1,568.18 ","$2,401.67 ","$1,779.33 ","$2,317.50 ","$1,793.49 ","$4,748.95 ","$2,034.25 ",$731.33 ,"$2,575.00 ","$2,575.00 ","$4,701.93 ","$2,575.00 ","$1,854.00 ","$1,596.50 ","$1,854.00 ","$1,854.00 ","$2,060.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000125,36558,HC INSERT TUNNELED CVC > 5 YEARS OLD,360,1 ,"$4,632.00 ","$2,316.00 ",$689.93 ,"$6,350.83 ",$689.93 ,"$4,632.00 ","$4,632.00 ","$2,822.59 ","$2,779.20 ","$3,937.20 ","$3,242.40 ",$689.93 ,"$4,400.40 ","$3,520.32 ","$3,474.00 ","$4,620.00 ","$3,937.20 ","$2,822.59 ","$4,620.00 ","$3,716.00 ","$3,242.40 ",$689.93 ,"$2,822.59 ","$2,822.59 ","$4,632.00 ","$3,937.20 ","$6,350.83 ","$4,261.44 ","$3,242.40 ","$1,921.55 ","$2,401.67 ","$2,820.89 ","$2,401.67 ","$3,200.71 ","$4,168.80 ","$3,226.19 ","$2,850.82 ","$3,659.28 ",$731.33 ,"$4,632.00 ","$4,632.00 ","$2,822.59 ","$4,632.00 ","$3,335.04 ","$2,871.84 ","$3,335.04 ","$3,335.04 ","$3,705.60 "
ST NICHOLAS HOSPITAL - ACUTE,36000126,36560,HC INS DEVICE CV W/PORT <5 YRS,360,1 ,"$4,740.00 ","$2,370.00 ",$689.93 ,"$6,350.83 ",$689.93 ,"$4,740.00 ","$4,740.00 ","$2,822.59 ","$2,844.00 ","$4,029.00 ","$3,318.00 ",$689.93 ,"$4,503.00 ","$3,602.40 ","$3,555.00 ","$4,740.00 ","$4,029.00 ","$2,822.59 ","$4,740.00 ","$4,740.00 ","$3,318.00 ",$689.93 ,"$2,822.59 ","$2,822.59 ","$4,740.00 ","$4,029.00 ","$6,350.83 ","$4,360.80 ","$3,318.00 ","$2,642.26 ","$3,303.09 ","$2,886.66 ","$3,303.09 ","$3,275.34 ","$4,266.00 ","$3,301.41 ","$2,850.82 ","$3,744.60 ",$731.33 ,"$4,740.00 ","$4,740.00 ","$2,822.59 ","$4,740.00 ","$3,412.80 ","$2,938.80 ","$3,412.80 ","$3,412.80 ","$3,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$5,925.00 ","$2,962.50 ",$689.93 ,"$6,350.83 ",$689.93 ,"$5,925.00 ","$5,925.00 ","$2,822.59 ","$3,555.00 ","$5,036.25 ","$4,147.50 ",$689.93 ,"$5,628.75 ","$4,503.00 ","$4,443.75 ","$5,925.00 ","$5,036.25 ","$2,822.59 ","$5,925.00 ","$4,875.00 ","$4,147.50 ",$689.93 ,"$2,822.59 ","$2,822.59 ","$5,657.04 ","$5,036.25 ","$6,350.83 ","$5,451.00 ","$4,147.50 ","$2,642.26 ","$3,303.09 ","$3,608.33 ","$3,303.09 ","$4,094.18 ","$5,332.50 ","$4,126.76 ","$2,850.82 ","$4,680.75 ",$731.33 ,"$5,925.00 ","$5,925.00 ","$2,822.59 ","$5,925.00 ","$4,266.00 ","$3,673.50 ","$4,266.00 ","$4,266.00 ","$4,740.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000131,36568,HC INS CATH PERIPH CV W/O PORT <5,360,1 ,"$1,293.00 ",$646.50 ,$353.23 ,"$3,119.68 ",$353.23 ,"$1,293.00 ","$1,293.00 ","$1,386.53 ",$775.80 ,"$1,099.05 ",$905.10 ,$353.23 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ","$1,386.53 ","$1,293.00 ","$1,293.00 ",$905.10 ,$353.23 ,"$1,386.53 ","$1,386.53 ","$1,293.00 ","$1,099.05 ","$3,119.68 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,"$1,400.40 ","$1,021.47 ",$374.42 ,"$1,293.00 ","$1,293.00 ","$1,386.53 ","$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$1,616.00 ",$808.00 ,$353.23 ,"$3,119.68 ",$353.23 ,"$1,616.00 ","$1,616.00 ","$1,386.53 ",$969.60 ,"$1,373.60 ","$1,131.20 ",$353.23 ,"$1,535.20 ","$1,228.16 ","$1,212.00 ","$1,616.00 ","$1,373.60 ","$1,386.53 ","$1,616.00 ","$1,616.00 ","$1,131.20 ",$353.23 ,"$1,386.53 ","$1,386.53 ","$1,616.00 ","$1,373.60 ","$3,119.68 ","$1,486.72 ","$1,131.20 ","$1,616.00 ","$1,616.00 ",$984.14 ,"$1,616.00 ","$1,116.66 ","$1,454.40 ","$1,125.54 ","$1,400.40 ","$1,276.64 ",$374.42 ,"$1,616.00 ","$1,616.00 ","$1,386.53 ","$1,616.00 ","$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ","$1,292.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000134,36578,HC REPLACE CATH CV W/PORT/PUMP,360,1 ,"$2,973.00 ","$1,486.50 ",$229.60 ,"$6,350.83 ",$229.60 ,"$2,973.00 ","$2,973.00 ","$2,822.59 ","$1,783.80 ","$2,527.05 ","$2,081.10 ",$229.60 ,"$2,824.35 ","$2,259.48 ","$2,229.75 ","$2,973.00 ","$2,527.05 ","$2,822.59 ","$2,973.00 ","$2,973.00 ","$2,081.10 ",$229.60 ,"$2,822.59 ","$2,822.59 ","$2,973.00 ","$2,527.05 ","$6,350.83 ","$2,735.16 ","$2,081.10 ","$1,921.55 ","$2,401.67 ","$1,810.56 ","$2,401.67 ","$2,054.34 ","$2,675.70 ","$2,070.69 ","$2,850.82 ","$2,348.67 ",$243.38 ,"$2,973.00 ","$2,973.00 ","$2,822.59 ","$2,973.00 ","$2,140.56 ","$1,843.26 ","$2,140.56 ","$2,140.56 ","$2,378.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000135,36580,HC REPL CATH CV NON-TNL W/O PORT,360,1 ,"$2,586.00 ","$1,293.00 ",$353.23 ,"$3,119.68 ",$353.23 ,"$2,586.00 ","$2,586.00 ","$1,386.53 ","$1,551.60 ","$2,198.10 ","$1,810.20 ",$353.23 ,"$2,456.70 ","$1,965.36 ","$1,939.50 ","$2,586.00 ","$2,198.10 ","$1,386.53 ","$2,586.00 ","$2,586.00 ","$1,810.20 ",$353.23 ,"$1,386.53 ","$1,386.53 ","$2,489.10 ","$2,198.10 ","$3,119.68 ","$2,379.12 ","$1,810.20 ","$1,703.02 ","$2,128.52 ","$1,574.87 ","$2,128.52 ","$1,786.93 ","$2,327.40 ","$1,801.15 ","$1,400.40 ","$2,042.94 ",$374.42 ,"$2,586.00 ","$2,586.00 ","$1,386.53 ","$2,586.00 ","$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$2,068.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000136,36581,HC REPL CATH CV TNL W/O PORT,360,1 ,"$3,986.00 ","$1,993.00 ",$689.93 ,"$6,350.83 ",$689.93 ,"$3,986.00 ","$3,986.00 ","$2,822.59 ","$2,391.60 ","$3,388.10 ","$2,790.20 ",$689.93 ,"$3,786.70 ","$3,029.36 ","$2,989.50 ","$3,986.00 ","$3,388.10 ","$2,822.59 ","$3,986.00 ","$3,716.00 ","$2,790.20 ",$689.93 ,"$2,822.59 ","$2,822.59 ","$3,986.00 ","$3,388.10 ","$6,350.83 ","$3,667.12 ","$2,790.20 ","$1,921.55 ","$2,401.67 ","$2,427.47 ","$2,401.67 ","$2,754.33 ","$3,587.40 ","$2,776.25 ","$2,850.82 ","$3,148.94 ",$731.33 ,"$3,986.00 ","$3,986.00 ","$2,822.59 ","$3,986.00 ","$2,869.92 ","$2,471.32 ","$2,869.92 ","$2,869.92 ","$3,188.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000137,36582,HC REPL DEVICE CV TNL W/PORT,360,1 ,"$6,033.00 ","$3,016.50 ",$689.93 ,"$6,350.83 ",$689.93 ,"$6,033.00 ","$6,033.00 ","$2,822.59 ","$3,619.80 ","$5,128.05 ","$4,223.10 ",$689.93 ,"$5,731.35 ","$4,585.08 ","$4,524.75 ","$6,033.00 ","$5,128.05 ","$2,822.59 ","$6,033.00 ","$4,875.00 ","$4,223.10 ",$689.93 ,"$2,822.59 ","$2,822.59 ","$5,657.04 ","$5,128.05 ","$6,350.83 ","$5,550.36 ","$4,223.10 ","$2,642.26 ","$3,303.09 ","$3,674.10 ","$3,303.09 ","$4,168.80 ","$5,429.70 ","$4,201.98 ","$2,850.82 ","$4,766.07 ",$731.33 ,"$6,033.00 ","$6,033.00 ","$2,822.59 ","$6,033.00 ","$4,343.76 ","$3,740.46 ","$4,343.76 ","$4,343.76 ","$4,826.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000139,36584,HC REPL PICC W/O PORT/PUMP,360,1 ,"$2,370.00 ","$1,185.00 ",$353.23 ,"$3,119.68 ",$353.23 ,"$2,370.00 ","$2,370.00 ","$1,386.53 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$353.23 ,"$2,251.50 ","$1,801.20 ","$1,777.50 ","$2,370.00 ","$2,014.50 ","$1,386.53 ","$2,370.00 ","$2,370.00 ","$1,659.00 ",$353.23 ,"$1,386.53 ","$1,386.53 ","$2,370.00 ","$2,014.50 ","$3,119.68 ","$2,180.40 ","$1,659.00 ","$1,703.02 ","$2,128.52 ","$1,443.33 ","$2,128.52 ","$1,637.67 ","$2,133.00 ","$1,650.71 ","$1,400.40 ","$1,872.30 ",$374.42 ,"$2,370.00 ","$2,370.00 ","$1,386.53 ","$2,370.00 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,896.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$1,077.00 ",$538.50 ,$229.60 ,"$1,199.16 ",$229.60 ,"$1,077.00 ","$1,077.00 ",$532.96 ,$646.20 ,$915.45 ,$753.90 ,$229.60 ,"$1,023.15 ",$818.52 ,$807.75 ,"$1,077.00 ",$915.45 ,$532.96 ,"$1,077.00 ","$1,077.00 ",$753.90 ,$229.60 ,$532.96 ,$532.96 ,"$1,077.00 ",$915.45 ,"$1,199.16 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$969.30 ,$750.13 ,$538.29 ,$850.83 ,$243.38 ,"$1,077.00 ","$1,077.00 ",$532.96 ,"$1,077.00 ",$775.44 ,$667.74 ,$775.44 ,$775.44 ,$861.60 
ST NICHOLAS HOSPITAL - ACUTE,36000142,36590,HC REM TNL CV ACC W/PORT/PUMP,360,1 ,"$2,370.00 ","$1,185.00 ",$229.60 ,"$3,119.68 ",$229.60 ,"$2,370.00 ","$2,081.00 ","$1,386.53 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$229.60 ,"$2,251.50 ","$1,801.20 ","$1,777.50 ","$2,370.00 ","$2,014.50 ","$1,386.53 ","$2,370.00 ","$2,370.00 ","$1,659.00 ",$229.60 ,"$1,386.53 ","$1,386.53 ","$2,370.00 ","$2,014.50 ","$3,119.68 ","$2,180.40 ","$1,659.00 ","$1,703.02 ","$2,128.52 ","$1,443.33 ","$2,128.52 ","$1,637.67 ","$2,133.00 ","$1,650.71 ","$1,400.40 ","$1,872.30 ",$243.38 ,"$2,370.00 ","$2,370.00 ","$1,386.53 ","$2,370.00 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,896.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000144,36595,HC REM PERICATHETER MAT CV DEV,360,1 ,"$3,986.00 ","$1,993.00 ",$229.60 ,"$6,350.83 ",$229.60 ,"$3,986.00 ","$3,986.00 ","$2,822.59 ","$2,391.60 ","$3,388.10 ","$2,790.20 ",$229.60 ,"$3,786.70 ","$3,029.36 ","$2,989.50 ","$3,986.00 ","$3,388.10 ","$2,822.59 ","$3,986.00 ","$2,590.90 ","$2,790.20 ",$229.60 ,"$2,822.59 ","$2,822.59 ","$3,986.00 ","$3,388.10 ","$6,350.83 ","$3,667.12 ","$2,790.20 ","$1,703.02 ","$2,128.52 ","$2,427.47 ","$2,128.52 ","$2,754.33 ","$3,587.40 ","$2,776.25 ","$2,850.82 ","$3,148.94 ",$243.38 ,"$3,986.00 ","$3,986.00 ","$2,822.59 ","$3,986.00 ","$2,869.92 ","$2,471.32 ","$2,869.92 ","$2,869.92 ","$3,188.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000145,36596,HC REM INTRALUM MAT CV LUMEN,360,1 ,"$1,783.00 ",$891.50 ,$229.60 ,"$3,119.68 ",$229.60 ,"$1,783.00 ","$1,783.00 ","$1,386.53 ","$1,069.80 ","$1,515.55 ","$1,248.10 ",$229.60 ,"$1,693.85 ","$1,355.08 ","$1,337.25 ","$1,783.00 ","$1,515.55 ","$1,386.53 ","$1,783.00 ","$1,158.95 ","$1,248.10 ",$229.60 ,"$1,386.53 ","$1,386.53 ","$1,783.00 ","$1,515.55 ","$3,119.68 ","$1,640.36 ","$1,248.10 ","$1,703.02 ","$1,783.00 ","$1,085.85 ","$1,783.00 ","$1,232.05 ","$1,604.70 ","$1,241.86 ","$1,400.40 ","$1,408.57 ",$243.38 ,"$1,783.00 ","$1,783.00 ","$1,386.53 ","$1,783.00 ","$1,283.76 ","$1,105.46 ","$1,283.76 ","$1,283.76 ","$1,426.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000146,36597,HC REPOSITION CENTRAL VENOUS CATH,360,1 ,"$2,047.00 ","$1,023.50 ",$229.60 ,"$3,119.68 ",$229.60 ,"$2,047.00 ","$2,047.00 ","$1,386.53 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$229.60 ,"$1,944.65 ","$1,555.72 ","$1,535.25 ","$2,047.00 ","$1,739.95 ","$1,386.53 ","$2,047.00 ","$1,330.55 ","$1,432.90 ",$229.60 ,"$1,386.53 ","$1,386.53 ","$2,047.00 ","$1,739.95 ","$3,119.68 ","$1,883.24 ","$1,432.90 ","$1,703.02 ","$2,047.00 ","$1,246.62 ","$2,047.00 ","$1,414.48 ","$1,842.30 ","$1,425.74 ","$1,400.40 ","$1,617.13 ",$243.38 ,"$2,047.00 ","$2,047.00 ","$1,386.53 ","$2,047.00 ","$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,637.60 "
ST NICHOLAS HOSPITAL - ACUTE,36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,$696.00 ,$348.00 ,$199.61 ,$696.00 ,$199.61 ,$696.00 ,$696.00 , N/A ,$417.60 ,$591.60 ,$487.20 ,$199.61 ,$661.20 ,$528.96 ,$522.00 ,$696.00 ,$591.60 , N/A ,$696.00 ,$696.00 ,$487.20 ,$199.61 , N/A , N/A ,$696.00 ,$591.60 , N/A ,$640.32 ,$487.20 ,$353.01 ,$423.66 ,$423.86 ,$423.66 ,$480.94 ,$626.40 ,$484.76 , N/A ,$549.84 ,$211.59 ,$696.00 ,$696.00 , N/A ,$696.00 ,$501.12 ,$431.52 ,$501.12 ,$501.12 ,$556.80 
ST NICHOLAS HOSPITAL - ACUTE,36000149,36810,HC HEMODIAYLSIS CATH INSERTION,360,1 ,"$4,168.00 ","$2,084.00 ",$689.93 ,"$6,350.83 ",$689.93 ,"$4,168.00 ","$4,168.00 ","$2,822.59 ","$2,500.80 ","$3,542.80 ","$2,917.60 ",$689.93 ,"$3,959.60 ","$3,167.68 ","$3,126.00 ","$4,168.00 ","$3,542.80 ","$2,822.59 ","$4,168.00 ","$4,168.00 ","$2,917.60 ",$689.93 ,"$2,822.59 ","$2,822.59 ","$4,168.00 ","$3,542.80 ","$6,350.83 ","$3,834.56 ","$2,917.60 ","$2,642.26 ","$3,303.09 ","$2,538.31 ","$3,303.09 ","$2,880.09 ","$3,751.20 ","$2,903.01 ","$2,850.82 ","$3,292.72 ",$731.33 ,"$4,168.00 ","$4,168.00 ","$2,822.59 ","$4,168.00 ","$3,000.96 ","$2,584.16 ","$3,000.96 ","$3,000.96 ","$3,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000154,37182,HC TIPS,360,1 ,"$12,928.00 ","$6,464.00 ","$1,921.55 ","$12,928.00 ","$3,445.58 ","$10,079.00 ","$7,413.00 ", N/A ,"$7,756.80 ","$10,988.80 ","$9,049.60 ","$3,445.58 ","$12,281.60 ","$9,825.28 ","$9,696.00 ","$6,993.00 ","$10,988.80 ", N/A ,"$6,993.00 ","$8,403.20 ","$9,049.60 ","$3,445.58 ", N/A , N/A ,"$12,928.00 ","$10,988.80 ", N/A ,"$11,893.76 ","$9,049.60 ","$1,921.55 ","$2,401.67 ","$7,873.15 ","$2,401.67 ","$8,933.25 ","$11,635.20 ","$9,004.35 ", N/A ,"$10,213.12 ","$3,652.31 ","$10,114.00 ","$10,114.00 ", N/A ,"$10,114.00 ","$9,308.16 ","$8,015.36 ","$9,308.16 ","$9,308.16 ","$10,342.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000156,37183,HC TIPS REVISION,360,1 ,"$11,851.00 ","$5,925.50 ","$1,851.24 ","$11,851.00 ","$1,851.24 ","$11,851.00 ","$9,884.00 ","$4,886.95 ","$7,110.60 ","$10,073.35 ","$8,295.70 ","$1,851.24 ","$11,258.45 ","$9,006.76 ","$8,888.25 ","$6,993.00 ","$10,073.35 ","$4,886.95 ","$6,993.00 ","$7,703.15 ","$8,295.70 ","$1,851.24 ","$4,886.95 ","$4,886.95 ","$7,919.86 ","$10,073.35 ","$10,995.64 ","$10,902.92 ","$8,295.70 ","$1,921.55 ","$2,401.67 ","$7,217.26 ","$2,401.67 ","$8,189.04 ","$10,665.90 ","$8,254.22 ","$4,935.82 ","$9,362.29 ","$1,962.31 ","$10,114.00 ","$10,114.00 ","$4,886.95 ","$10,114.00 ","$8,532.72 ","$7,347.62 ","$8,532.72 ","$8,532.72 ","$9,480.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,"$1,077.00 ",$538.50 ,$373.15 ,"$3,121.49 ",$373.15 ,"$1,077.00 ","$1,077.00 ","$1,387.33 ",$646.20 ,$915.45 ,$753.90 ,$373.15 ,"$1,023.15 ",$818.52 ,$807.75 ,"$1,077.00 ",$915.45 ,"$1,387.33 ","$1,077.00 ","$1,077.00 ",$753.90 ,$373.15 ,"$1,387.33 ","$1,387.33 ","$1,077.00 ",$915.45 ,"$3,121.49 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$969.30 ,$750.13 ,"$1,401.20 ",$850.83 ,$395.54 ,"$1,077.00 ","$1,077.00 ","$1,387.33 ","$1,077.00 ",$775.44 ,$667.74 ,$775.44 ,$775.44 ,$861.60 
ST NICHOLAS HOSPITAL - ACUTE,36000158,38221,HC BX BONE MARROW ONLY,360,1 ,$776.00 ,$388.00 ,$373.15 ,"$3,121.49 ",$373.15 ,$776.00 ,$776.00 ,"$1,387.33 ",$465.60 ,$659.60 ,$543.20 ,$373.15 ,$737.20 ,$589.76 ,$582.00 ,$776.00 ,$659.60 ,"$1,387.33 ",$776.00 ,$776.00 ,$543.20 ,$373.15 ,"$1,387.33 ","$1,387.33 ",$776.00 ,$659.60 ,"$3,121.49 ",$713.92 ,$543.20 ,$776.00 ,$776.00 ,$472.58 ,$776.00 ,$536.22 ,$698.40 ,$540.48 ,"$1,401.20 ",$613.04 ,$395.54 ,$776.00 ,$776.00 ,"$1,387.33 ",$776.00 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$620.80 
ST NICHOLAS HOSPITAL - ACUTE,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$1,939.00 ",$969.50 ,$360.88 ,"$3,121.49 ",$360.88 ,"$1,939.00 ","$1,939.00 ","$1,387.33 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$360.88 ,"$1,842.05 ","$1,473.64 ","$1,454.25 ","$1,939.00 ","$1,648.15 ","$1,387.33 ","$1,939.00 ","$1,939.00 ","$1,357.30 ",$360.88 ,"$1,387.33 ","$1,387.33 ","$1,939.00 ","$1,648.15 ","$3,121.49 ","$1,783.88 ","$1,357.30 ","$1,703.02 ","$1,939.00 ","$1,180.85 ","$1,939.00 ","$1,339.85 ","$1,745.10 ","$1,350.51 ","$1,401.20 ","$1,531.81 ",$382.53 ,"$1,939.00 ","$1,939.00 ","$1,387.33 ","$1,939.00 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,$851.00 ,$425.50 ,$120.53 ,$851.00 ,$120.53 ,$851.00 ,$851.00 ,$371.68 ,$510.60 ,$723.35 ,$595.70 ,$120.53 ,$808.45 ,$646.76 ,$638.25 ,$851.00 ,$723.35 ,$371.68 ,$851.00 ,$851.00 ,$595.70 ,$120.53 ,$371.68 ,$371.68 ,$851.00 ,$723.35 ,$836.29 ,$782.92 ,$595.70 ,$851.00 ,$851.00 ,$518.26 ,$851.00 ,$588.04 ,$765.90 ,$592.72 ,$375.40 ,$672.29 ,$127.76 ,$851.00 ,$851.00 ,$371.68 ,$851.00 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,36000162,38999,HC HEMIC OR LYMPHATIC SYSTEM UNLISTED,360,1 ,"$1,900.00 ",$950.00 ,$391.36 ,"$1,900.00 ",$907.87 ,"$1,900.00 ","$1,900.00 ",$391.36 ,"$1,140.00 ","$1,615.00 ","$1,330.00 ",$907.87 ,"$1,805.00 ","$1,444.00 ","$1,425.00 ","$1,900.00 ","$1,615.00 ",$391.36 ,"$1,900.00 ","$1,900.00 ","$1,330.00 ",$907.87 ,$391.36 ,$391.36 ,"$1,900.00 ","$1,615.00 ",$880.56 ,"$1,748.00 ","$1,330.00 ", N/A , N/A ,"$1,157.10 ", N/A ,"$1,312.90 ","$1,710.00 ","$1,323.35 ",$395.27 ,"$1,501.00 ",$962.34 ,"$1,900.00 ","$1,900.00 ",$391.36 ,"$1,900.00 ","$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000163,43246,HC PLACE G-TUBE PERC,360,1 ,"$2,205.00 ","$1,102.50 ",$300.43 ,"$3,603.33 ",$300.43 ,"$2,205.00 ","$2,205.00 ","$1,601.48 ","$1,323.00 ","$1,874.25 ","$1,543.50 ",$300.43 ,"$2,094.75 ","$1,675.80 ","$1,653.75 ","$2,205.00 ","$1,874.25 ","$1,601.48 ","$2,205.00 ","$2,205.00 ","$1,543.50 ",$300.43 ,"$1,601.48 ","$1,601.48 ","$2,205.00 ","$1,874.25 ","$3,603.33 ","$2,028.60 ","$1,543.50 ","$1,921.55 ","$2,205.00 ","$1,342.85 ","$2,205.00 ","$1,523.66 ","$1,984.50 ","$1,535.78 ","$1,617.49 ","$1,741.95 ",$318.46 ,"$2,205.00 ","$2,205.00 ","$1,601.48 ","$2,205.00 ","$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000167,44640,HC TISSUE CLOSURE INTESTNL FISTULA,360,1 ,$220.00 ,$110.00 ,$110.00 ,"$5,993.67 ","$1,584.98 ",$220.00 ,$220.00 , N/A ,$132.00 ,$187.00 ,$154.00 ,"$1,584.98 ",$209.00 ,$167.20 ,$165.00 ,$220.00 ,$187.00 , N/A ,$220.00 ,$220.00 ,$154.00 ,"$1,584.98 ", N/A , N/A ,$220.00 ,$187.00 , N/A ,$202.40 ,$154.00 ,"$4,794.94 ","$5,993.67 ",$133.98 ,"$5,993.67 ",$152.02 ,$198.00 ,$153.23 , N/A ,$173.80 ,"$1,680.08 ",$220.00 ,$220.00 , N/A ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,36000168,44799,"HC UNLISTED PROC, INTESTINE",360,1 ,$500.00 ,$250.00 ,$250.00 ,"$1,795.12 ",$627.59 ,$500.00 ,$500.00 ,$797.83 ,$300.00 ,$425.00 ,$350.00 ,$627.59 ,$475.00 ,$380.00 ,$375.00 ,$500.00 ,$425.00 ,$797.83 ,$500.00 ,$500.00 ,$350.00 ,$627.59 ,$797.83 ,$797.83 ,$500.00 ,$425.00 ,"$1,795.12 ",$460.00 ,$350.00 , N/A , N/A ,$304.50 , N/A ,$345.50 ,$450.00 ,$348.25 ,$805.81 ,$395.00 ,$665.25 ,$500.00 ,$500.00 ,$797.83 ,$500.00 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,36000171,47490,HC CHOLECYSTOSTOMY PERC,360,1 ,"$3,400.00 ","$1,700.00 ",$791.20 ,"$7,058.37 ",$791.20 ,"$3,400.00 ","$3,400.00 ","$3,137.05 ","$2,040.00 ","$2,890.00 ","$2,380.00 ",$791.20 ,"$3,230.00 ","$2,584.00 ","$2,550.00 ","$2,815.00 ","$2,890.00 ","$3,137.05 ","$2,815.00 ","$2,717.00 ","$2,380.00 ",$791.20 ,"$3,137.05 ","$3,137.05 ","$3,400.00 ","$2,890.00 ","$7,058.37 ","$3,128.00 ","$2,380.00 ","$4,794.94 ","$5,993.67 ","$2,070.60 ","$5,993.67 ","$2,349.40 ","$3,060.00 ","$2,368.10 ","$3,168.42 ","$2,686.00 ",$838.67 ,"$3,400.00 ","$3,400.00 ","$3,137.05 ","$3,400.00 ","$2,448.00 ","$2,108.00 ","$2,448.00 ","$2,448.00 ","$2,720.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000175,49220,HC STAGING CELIOTOMY,360,1 ,$555.00 ,$277.50 ,$277.50 ,"$5,993.67 ", N/A , N/A , N/A , N/A ,$333.00 ,$471.75 ,$388.50 , N/A ,$527.25 ,$421.80 ,$416.25 ,$555.00 ,$471.75 , N/A ,$555.00 ,$555.00 ,$388.50 , N/A , N/A , N/A ,$555.00 ,$471.75 , N/A ,$510.60 ,$388.50 ,"$4,794.94 ","$5,993.67 ",$338.00 ,"$5,993.67 ",$383.51 ,$499.50 ,$386.56 , N/A ,$438.45 , N/A , N/A , N/A , N/A , N/A ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$444.00 
ST NICHOLAS HOSPITAL - ACUTE,36000176,49418,HC INSERT INTRAPERITONEAL CATH,360,1 ,"$6,572.00 ","$3,286.00 ","$1,169.72 ","$7,058.37 ","$1,169.72 ","$6,572.00 ","$6,572.00 ","$3,137.05 ","$3,943.20 ","$5,586.20 ","$4,600.40 ","$1,169.72 ","$6,243.40 ","$4,994.72 ","$4,929.00 ","$6,572.00 ","$5,586.20 ","$3,137.05 ","$6,572.00 ","$4,271.80 ","$4,600.40 ","$1,169.72 ","$3,137.05 ","$3,137.05 ","$5,657.04 ","$5,586.20 ","$7,058.37 ","$6,046.24 ","$4,600.40 ","$1,703.02 ","$2,128.52 ","$4,002.35 ","$2,128.52 ","$4,541.25 ","$5,914.80 ","$4,577.40 ","$3,168.42 ","$5,191.88 ","$1,239.90 ","$6,572.00 ","$6,572.00 ","$3,137.05 ","$6,572.00 ","$4,731.84 ","$4,074.64 ","$4,731.84 ","$4,731.84 ","$5,257.60 "
ST NICHOLAS HOSPITAL - ACUTE,36000177,49421,HC INS CATH DRAIN PERITONEAL PERM,360,1 ,"$4,655.00 ","$2,327.50 ","$1,169.72 ","$7,058.37 ","$1,169.72 ","$4,655.00 ","$4,655.00 ","$3,137.05 ","$2,793.00 ","$3,956.75 ","$3,258.50 ","$1,169.72 ","$4,422.25 ","$3,537.80 ","$3,491.25 ","$2,815.00 ","$3,956.75 ","$3,137.05 ","$2,815.00 ","$2,717.00 ","$3,258.50 ","$1,169.72 ","$3,137.05 ","$3,137.05 ","$4,655.00 ","$3,956.75 ","$7,058.37 ","$4,282.60 ","$3,258.50 ","$1,703.02 ","$2,128.52 ","$2,834.90 ","$2,128.52 ","$3,216.61 ","$4,189.50 ","$3,242.21 ","$3,168.42 ","$3,677.45 ","$1,239.90 ","$4,655.00 ","$4,655.00 ","$3,137.05 ","$4,655.00 ","$3,351.60 ","$2,886.10 ","$3,351.60 ","$3,351.60 ","$3,724.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000178,49422,HC REM CATH INTRAPERITONEAL,360,1 ,"$4,740.00 ","$2,370.00 ",$232.13 ,"$6,350.83 ",$232.13 ,"$4,740.00 ","$4,740.00 ","$2,822.59 ","$2,844.00 ","$4,029.00 ","$3,318.00 ",$232.13 ,"$4,503.00 ","$3,602.40 ","$3,555.00 ","$2,815.00 ","$4,029.00 ","$2,822.59 ","$2,815.00 ","$2,717.00 ","$3,318.00 ",$232.13 ,"$2,822.59 ","$2,822.59 ","$4,525.63 ","$4,029.00 ","$6,350.83 ","$4,360.80 ","$3,318.00 ","$1,703.02 ","$2,128.52 ","$2,886.66 ","$2,128.52 ","$3,275.34 ","$4,266.00 ","$3,301.41 ","$2,850.82 ","$3,744.60 ",$246.06 ,"$4,740.00 ","$4,740.00 ","$2,822.59 ","$4,740.00 ","$3,412.80 ","$2,938.80 ","$3,412.80 ","$3,412.80 ","$3,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000183,51710,HC CHG TUBE CYSTOSTOMY CPLX,360,1 ,"$1,939.00 ",$969.50 ,$62.73 ,"$1,939.00 ",$62.73 ,"$1,939.00 ","$1,939.00 ",$567.25 ,"$1,163.40 ","$1,648.15 ","$1,357.30 ",$62.73 ,"$1,842.05 ","$1,473.64 ","$1,454.25 ","$1,939.00 ","$1,648.15 ",$567.25 ,"$1,939.00 ","$1,939.00 ","$1,357.30 ",$62.73 ,$567.25 ,$567.25 ,"$1,697.11 ","$1,648.15 ","$1,276.32 ","$1,783.88 ","$1,357.30 ","$1,703.02 ","$1,939.00 ","$1,180.85 ","$1,939.00 ","$1,339.85 ","$1,745.10 ","$1,350.51 ",$572.92 ,"$1,531.81 ",$66.49 ,"$1,939.00 ","$1,939.00 ",$567.25 ,"$1,939.00 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000187,54150,HC CIRCUMCISION OP,360,1 ,"$1,293.00 ",$646.50 ,$616.68 ,"$3,972.27 ",$616.68 ,"$1,293.00 ","$1,293.00 ","$1,765.45 ",$775.80 ,"$1,099.05 ",$905.10 ,$616.68 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ","$1,765.45 ","$1,293.00 ","$1,293.00 ",$905.10 ,$616.68 ,"$1,765.45 ","$1,765.45 ","$1,293.00 ","$1,099.05 ","$3,972.27 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,"$1,783.10 ","$1,021.47 ",$653.68 ,"$1,293.00 ","$1,293.00 ","$1,765.45 ","$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000188,55700,HC BX PROSTATE NEEDLE/PUNCH,360,1 ,"$2,478.00 ","$1,239.00 ",$478.93 ,"$3,972.27 ",$478.93 ,"$2,478.00 ","$2,478.00 ","$1,765.45 ","$1,486.80 ","$2,106.30 ","$1,734.60 ",$478.93 ,"$2,354.10 ","$1,883.28 ","$1,858.50 ","$2,478.00 ","$2,106.30 ","$1,765.45 ","$2,478.00 ","$2,478.00 ","$1,734.60 ",$478.93 ,"$1,765.45 ","$1,765.45 ","$2,478.00 ","$2,106.30 ","$3,972.27 ","$2,279.76 ","$1,734.60 ","$1,921.55 ","$2,401.67 ","$1,509.10 ","$2,401.67 ","$1,712.30 ","$2,230.20 ","$1,725.93 ","$1,783.10 ","$1,957.62 ",$507.67 ,"$2,478.00 ","$2,478.00 ","$1,765.45 ","$2,478.00 ","$1,784.16 ","$1,536.36 ","$1,784.16 ","$1,784.16 ","$1,982.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000189,58100,HC BIOPSY OF UTERUS PERCUTANEOUS,360,1 ,$549.00 ,$274.50 ,$143.77 ,$549.00 ,$143.77 ,$549.00 ,$549.00 ,$167.98 ,$329.40 ,$466.65 ,$384.30 ,$143.77 ,$521.55 ,$417.24 ,$411.75 ,$549.00 ,$466.65 ,$167.98 ,$549.00 ,$549.00 ,$384.30 ,$143.77 ,$167.98 ,$167.98 ,$549.00 ,$466.65 ,$377.95 ,$505.08 ,$384.30 ,$549.00 ,$549.00 ,$334.34 ,$549.00 ,$379.36 ,$494.10 ,$382.38 ,$169.66 ,$433.71 ,$152.40 ,$549.00 ,$549.00 ,$167.98 ,$549.00 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$439.20 
ST NICHOLAS HOSPITAL - ACUTE,36000190,61624,HC OCC/EMB TRANSCATH CNS PERC,360,1 ,"$5,200.00 ","$2,600.00 ","$2,600.00 ","$5,993.67 ","$3,529.80 ","$5,200.00 ","$5,200.00 ", N/A ,"$3,120.00 ","$4,420.00 ","$3,640.00 ","$3,529.80 ","$4,940.00 ","$3,952.00 ","$3,900.00 ","$2,815.00 ","$4,420.00 ", N/A ,"$2,815.00 ","$2,717.00 ","$3,640.00 ","$3,529.80 ", N/A , N/A ,"$5,200.00 ","$4,420.00 ", N/A ,"$4,784.00 ","$3,640.00 ","$4,794.94 ","$5,993.67 ","$3,166.80 ","$5,993.67 ","$3,593.20 ","$4,680.00 ","$3,621.80 ", N/A ,"$4,108.00 ","$3,741.59 ","$5,200.00 ","$5,200.00 ", N/A ,"$5,200.00 ","$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$4,160.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000191,61626,HC OCC/EMB TRANSCATH EXT CRAN VSS,360,1 ,"$12,000.00 ","$6,000.00 ","$3,529.80 ","$22,283.90 ","$3,529.80 ","$12,000.00 ","$11,705.00 ","$9,903.96 ","$7,200.00 ","$10,200.00 ","$8,400.00 ","$3,529.80 ","$11,400.00 ","$9,120.00 ","$9,000.00 ","$6,993.00 ","$10,200.00 ","$9,903.96 ","$6,993.00 ","$7,800.00 ","$8,400.00 ","$3,529.80 ","$9,903.96 ","$9,903.96 ","$12,000.00 ","$10,200.00 ","$22,283.90 ","$11,040.00 ","$8,400.00 ","$4,794.94 ","$5,993.67 ","$7,308.00 ","$5,993.67 ","$8,292.00 ","$10,800.00 ","$8,358.00 ","$10,003.00 ","$9,480.00 ","$3,741.59 ","$10,114.00 ","$10,114.00 ","$9,903.96 ","$10,114.00 ","$8,640.00 ","$7,440.00 ","$8,640.00 ","$8,640.00 ","$9,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000193,62267,HC DISC ASPIRATION,360,1 ,"$1,508.00 ",$754.00 ,$268.66 ,"$1,508.00 ",$268.66 ,"$1,508.00 ","$1,508.00 ",$613.58 ,$904.80 ,"$1,281.80 ","$1,055.60 ",$268.66 ,"$1,432.60 ","$1,146.08 ","$1,131.00 ","$1,508.00 ","$1,281.80 ",$613.58 ,"$1,508.00 ",$980.20 ,"$1,055.60 ",$268.66 ,$613.58 ,$613.58 ,"$1,508.00 ","$1,281.80 ","$1,380.55 ","$1,387.36 ","$1,055.60 ","$1,508.00 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,357.20 ","$1,050.32 ",$619.72 ,"$1,191.32 ",$284.78 ,"$1,508.00 ","$1,508.00 ",$613.58 ,"$1,508.00 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ","$1,206.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,077.00 ",$538.50 ,$268.66 ,"$1,408.74 ",$268.66 ,"$1,077.00 ","$1,077.00 ",$626.11 ,$646.20 ,$915.45 ,$753.90 ,$268.66 ,"$1,023.15 ",$818.52 ,$807.75 ,"$1,077.00 ",$915.45 ,$626.11 ,"$1,077.00 ","$1,077.00 ",$753.90 ,$268.66 ,$626.11 ,$626.11 ,"$1,077.00 ",$915.45 ,"$1,408.74 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$969.30 ,$750.13 ,$632.37 ,$850.83 ,$284.78 ,"$1,077.00 ","$1,077.00 ",$626.11 ,"$1,077.00 ",$775.44 ,$667.74 ,$775.44 ,$775.44 ,$861.60 
ST NICHOLAS HOSPITAL - ACUTE,36000195,10160,HC ASP BULLA FAC,761,1 ,$463.00 ,$231.50 ,$51.36 ,$766.80 ,$51.36 ,$463.00 ,$463.00 ,$340.80 ,$277.80 ,$393.55 ,$324.10 ,$51.36 ,$439.85 ,$351.88 ,$347.25 ,$463.00 ,$393.55 ,$340.80 ,$463.00 ,$463.00 ,$324.10 ,$51.36 ,$340.80 ,$340.80 ,$194.46 ,$393.55 ,$766.80 ,$425.96 ,$324.10 ,$463.00 ,$463.00 ,$281.97 ,$463.00 ,$319.93 ,$416.70 ,$322.48 ,$344.21 ,$365.77 ,$54.44 ,$277.80 ,$277.80 ,$340.80 ,$277.80 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$370.40 
ST NICHOLAS HOSPITAL - ACUTE,36000223,36575,HC REPAIR CATH CV W/O PORT/PUMP,360,1 ,"$1,805.00 ",$902.50 ,$229.60 ,"$1,805.00 ",$229.60 ,"$1,805.00 ","$1,805.00 ",$532.96 ,"$1,083.00 ","$1,534.25 ","$1,263.50 ",$229.60 ,"$1,714.75 ","$1,371.80 ","$1,353.75 ","$1,805.00 ","$1,534.25 ",$532.96 ,"$1,805.00 ","$1,805.00 ","$1,263.50 ",$229.60 ,$532.96 ,$532.96 ,"$1,697.11 ","$1,534.25 ","$1,199.16 ","$1,660.60 ","$1,263.50 ","$1,805.00 ","$1,805.00 ","$1,099.25 ","$1,805.00 ","$1,247.26 ","$1,624.50 ","$1,257.18 ",$538.29 ,"$1,425.95 ",$243.38 ,"$1,805.00 ","$1,805.00 ",$532.96 ,"$1,805.00 ","$1,299.60 ","$1,119.10 ","$1,299.60 ","$1,299.60 ","$1,444.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000240,42300,HC DRAIN ABSC PAROTID SMP,360,1 ,"$1,724.00 ",$862.00 ,$288.55 ,"$3,001.04 ",$288.55 ,"$1,724.00 ","$1,724.00 ","$1,333.79 ","$1,034.40 ","$1,465.40 ","$1,206.80 ",$288.55 ,"$1,637.80 ","$1,310.24 ","$1,293.00 ","$1,724.00 ","$1,465.40 ","$1,333.79 ","$1,724.00 ","$1,724.00 ","$1,206.80 ",$288.55 ,"$1,333.79 ","$1,333.79 ","$1,724.00 ","$1,465.40 ","$3,001.04 ","$1,586.08 ","$1,206.80 ","$1,703.02 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,551.60 ","$1,200.77 ","$1,347.13 ","$1,361.96 ",$305.86 ,"$1,724.00 ","$1,724.00 ","$1,333.79 ","$1,724.00 ","$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,379.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000250,49419,HC INSERT TUN IP CATH W/PORT,360,1 ,"$4,756.00 ","$2,378.00 ","$1,169.72 ","$10,579.35 ","$1,169.72 ","$4,756.00 ","$4,756.00 ","$4,701.93 ","$2,853.60 ","$4,042.60 ","$3,329.20 ","$1,169.72 ","$4,518.20 ","$3,614.56 ","$3,567.00 ","$2,815.00 ","$4,042.60 ","$4,701.93 ","$2,815.00 ","$2,717.00 ","$3,329.20 ","$1,169.72 ","$4,701.93 ","$4,701.93 ","$4,756.00 ","$4,042.60 ","$10,579.35 ","$4,375.52 ","$3,329.20 ","$1,703.02 ","$2,128.52 ","$2,896.40 ","$2,128.52 ","$3,286.40 ","$4,280.40 ","$3,312.55 ","$4,748.95 ","$3,757.24 ","$1,239.90 ","$4,756.00 ","$4,756.00 ","$4,701.93 ","$4,756.00 ","$3,424.32 ","$2,948.72 ","$3,424.32 ","$3,424.32 ","$3,804.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000300,64635,HC RADIOFREQ;LUMBO/SACRAL;SINGLE,360,1 ,"$3,200.00 ","$1,600.00 ",$268.66 ,"$3,895.50 ",$268.66 ,"$3,200.00 ","$3,200.00 ","$1,731.33 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$268.66 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$1,731.33 ","$3,200.00 ","$2,080.00 ","$2,240.00 ",$268.66 ,"$1,731.33 ","$1,731.33 ","$3,200.00 ","$2,720.00 ","$3,895.50 ","$2,944.00 ","$2,240.00 ","$1,703.02 ","$2,128.52 ","$1,948.80 ","$2,128.52 ","$2,211.20 ","$2,880.00 ","$2,228.80 ","$1,748.64 ","$2,528.00 ",$284.78 ,"$3,200.00 ","$3,200.00 ","$1,731.33 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000301,64636,HC RADIOFREQ;LUMBO/SACRAL;ADDTL,360,1 ,$700.00 ,$350.00 ,$268.66 ,"$2,128.52 ",$268.66 ,$700.00 ,$700.00 , N/A ,$420.00 ,$595.00 ,$490.00 ,$268.66 ,$665.00 ,$532.00 ,$525.00 ,$700.00 ,$595.00 , N/A ,$700.00 ,$455.00 ,$490.00 ,$268.66 , N/A , N/A ,$700.00 ,$595.00 , N/A ,$644.00 ,$490.00 ,"$1,703.02 ","$2,128.52 ",$426.30 ,"$2,128.52 ",$483.70 ,$630.00 ,$487.55 , N/A ,$553.00 ,$284.78 ,$700.00 ,$700.00 , N/A ,$700.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,36000302,64633,HC RADIOFREQ;CERV/THOR;SINGLE,360,1 ,"$3,200.00 ","$1,600.00 ",$268.66 ,"$3,895.50 ",$268.66 ,"$3,200.00 ","$3,200.00 ","$1,731.33 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$268.66 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$1,731.33 ","$3,200.00 ","$2,080.00 ","$2,240.00 ",$268.66 ,"$1,731.33 ","$1,731.33 ","$3,200.00 ","$2,720.00 ","$3,895.50 ","$2,944.00 ","$2,240.00 ","$1,703.02 ","$2,128.52 ","$1,948.80 ","$2,128.52 ","$2,211.20 ","$2,880.00 ","$2,228.80 ","$1,748.64 ","$2,528.00 ",$284.78 ,"$3,200.00 ","$3,200.00 ","$1,731.33 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000303,64634,HC RADIOFREQ;CERV/THOR;ADDTL,360,1 ,$700.00 ,$350.00 ,$268.66 ,"$2,128.52 ",$268.66 ,$700.00 ,$700.00 , N/A ,$420.00 ,$595.00 ,$490.00 ,$268.66 ,$665.00 ,$532.00 ,$525.00 ,$700.00 ,$595.00 , N/A ,$700.00 ,$455.00 ,$490.00 ,$268.66 , N/A , N/A ,$700.00 ,$595.00 , N/A ,$644.00 ,$490.00 ,"$1,703.02 ","$2,128.52 ",$426.30 ,"$2,128.52 ",$483.70 ,$630.00 ,$487.55 , N/A ,$553.00 ,$284.78 ,$700.00 ,$700.00 , N/A ,$700.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,36000304,64640,HC RADIOFREQ;PERIPHERAL NERVE,360,1 ,"$2,316.00 ","$1,158.00 ",$364.34 ,"$2,316.00 ",$364.34 ,"$2,316.00 ","$2,081.00 ",$811.67 ,"$1,389.60 ","$1,968.60 ","$1,621.20 ",$364.34 ,"$2,200.20 ","$1,760.16 ","$1,737.00 ","$2,316.00 ","$1,968.60 ",$811.67 ,"$2,316.00 ","$2,316.00 ","$1,621.20 ",$364.34 ,$811.67 ,$811.67 ,"$1,697.11 ","$1,968.60 ","$1,826.27 ","$2,130.72 ","$1,621.20 ","$1,703.02 ","$2,128.52 ","$1,410.44 ","$2,128.52 ","$1,600.36 ","$2,084.40 ","$1,613.09 ",$819.79 ,"$1,829.64 ",$386.20 ,"$2,316.00 ","$2,316.00 ",$811.67 ,"$2,316.00 ","$1,667.52 ","$1,435.92 ","$1,667.52 ","$1,667.52 ","$1,852.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000311,64420,HC INJ INTERCOSTAL NERVE;SINGLE,360,1 ,$803.00 ,$401.50 ,$136.73 ,"$1,408.74 ",$136.73 ,$803.00 ,$803.00 ,$626.11 ,$481.80 ,$682.55 ,$562.10 ,$136.73 ,$762.85 ,$610.28 ,$602.25 ,$803.00 ,$682.55 ,$626.11 ,$803.00 ,$803.00 ,$562.10 ,$136.73 ,$626.11 ,$626.11 ,$803.00 ,$682.55 ,"$1,408.74 ",$738.76 ,$562.10 ,$803.00 ,$803.00 ,$489.03 ,$803.00 ,$554.87 ,$722.70 ,$559.29 ,$632.37 ,$634.37 ,$144.93 ,$803.00 ,$803.00 ,$626.11 ,$803.00 ,$578.16 ,$497.86 ,$578.16 ,$578.16 ,$642.40 
ST NICHOLAS HOSPITAL - ACUTE,36000313,64493,HC INJ FACET LUMBO SACRAL;SINGLE,360,1 ,"$2,478.00 ","$1,239.00 ",$268.66 ,"$2,478.00 ",$268.66 ,"$2,478.00 ","$2,081.00 ",$811.67 ,"$1,486.80 ","$2,106.30 ","$1,734.60 ",$268.66 ,"$2,354.10 ","$1,883.28 ","$1,858.50 ","$2,478.00 ","$2,106.30 ",$811.67 ,"$2,478.00 ","$1,610.70 ","$1,734.60 ",$268.66 ,$811.67 ,$811.67 ,"$1,697.11 ","$2,106.30 ","$1,826.27 ","$2,279.76 ","$1,734.60 ","$1,703.02 ","$2,128.52 ","$1,509.10 ","$2,128.52 ","$1,712.30 ","$2,230.20 ","$1,725.93 ",$819.79 ,"$1,957.62 ",$284.78 ,"$2,478.00 ","$2,478.00 ",$811.67 ,"$2,478.00 ","$1,784.16 ","$1,536.36 ","$1,784.16 ","$1,784.16 ","$1,982.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000314,64494,HC INJ FACET LUMBO/SACRAL;2ND LEVEL,360,1 ,$431.00 ,$215.50 ,$215.50 ,"$2,128.52 ",$268.66 ,$431.00 ,$431.00 , N/A ,$258.60 ,$366.35 ,$301.70 ,$268.66 ,$409.45 ,$327.56 ,$323.25 ,$431.00 ,$366.35 , N/A ,$431.00 ,$280.15 ,$301.70 ,$268.66 , N/A , N/A ,$431.00 ,$366.35 , N/A ,$396.52 ,$301.70 ,"$1,703.02 ","$2,128.52 ",$262.48 ,"$2,128.52 ",$297.82 ,$387.90 ,$300.19 , N/A ,$340.49 ,$284.78 ,$431.00 ,$431.00 , N/A ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,36000315,64495,HC INJ FACET LUMBO/SACRAL;3RD LEVEL,360,1 ,$431.00 ,$215.50 ,$215.50 ,"$2,128.52 ",$268.66 ,$431.00 ,$431.00 , N/A ,$258.60 ,$366.35 ,$301.70 ,$268.66 ,$409.45 ,$327.56 ,$323.25 ,$431.00 ,$366.35 , N/A ,$431.00 ,$280.15 ,$301.70 ,$268.66 , N/A , N/A ,$431.00 ,$366.35 , N/A ,$396.52 ,$301.70 ,"$1,703.02 ","$2,128.52 ",$262.48 ,"$2,128.52 ",$297.82 ,$387.90 ,$300.19 , N/A ,$340.49 ,$284.78 ,$431.00 ,$431.00 , N/A ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,36000316,64490,HC INJ FACET CER/THORACIC;SINGLE,360,1 ,"$2,478.00 ","$1,239.00 ",$268.66 ,"$2,478.00 ",$268.66 ,"$2,478.00 ","$2,081.00 ",$811.67 ,"$1,486.80 ","$2,106.30 ","$1,734.60 ",$268.66 ,"$2,354.10 ","$1,883.28 ","$1,858.50 ","$2,478.00 ","$2,106.30 ",$811.67 ,"$2,478.00 ","$1,610.70 ","$1,734.60 ",$268.66 ,$811.67 ,$811.67 ,"$1,697.11 ","$2,106.30 ","$1,826.27 ","$2,279.76 ","$1,734.60 ","$1,703.02 ","$2,128.52 ","$1,509.10 ","$2,128.52 ","$1,712.30 ","$2,230.20 ","$1,725.93 ",$819.79 ,"$1,957.62 ",$284.78 ,"$2,478.00 ","$2,478.00 ",$811.67 ,"$2,478.00 ","$1,784.16 ","$1,536.36 ","$1,784.16 ","$1,784.16 ","$1,982.40 "
ST NICHOLAS HOSPITAL - ACUTE,36000317,64491,HC INJ FACET CER/THORACIC 2ND LEVEL,360,1 ,$431.00 ,$215.50 ,$215.50 ,"$2,128.52 ",$268.66 ,$431.00 ,$431.00 , N/A ,$258.60 ,$366.35 ,$301.70 ,$268.66 ,$409.45 ,$327.56 ,$323.25 ,$431.00 ,$366.35 , N/A ,$431.00 ,$280.15 ,$301.70 ,$268.66 , N/A , N/A ,$431.00 ,$366.35 , N/A ,$396.52 ,$301.70 ,"$1,703.02 ","$2,128.52 ",$262.48 ,"$2,128.52 ",$297.82 ,$387.90 ,$300.19 , N/A ,$340.49 ,$284.78 ,$431.00 ,$431.00 , N/A ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,36000318,64492,HC INJ FACET CER/THORACIC 3RD LEVEL,360,1 ,$400.00 ,$200.00 ,$200.00 ,"$2,128.52 ",$268.66 ,$400.00 ,$400.00 , N/A ,$240.00 ,$340.00 ,$280.00 ,$268.66 ,$380.00 ,$304.00 ,$300.00 ,$400.00 ,$340.00 , N/A ,$400.00 ,$260.00 ,$280.00 ,$268.66 , N/A , N/A ,$400.00 ,$340.00 , N/A ,$368.00 ,$280.00 ,"$1,703.02 ","$2,128.52 ",$243.60 ,"$2,128.52 ",$276.40 ,$360.00 ,$278.60 , N/A ,$316.00 ,$284.78 ,$400.00 ,$400.00 , N/A ,$400.00 ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$320.00 
ST NICHOLAS HOSPITAL - ACUTE,36000322,64479,HC INJ TRANSF CERV/THORACIC SINGLE,360,1 ,"$1,541.00 ",$770.50 ,$268.66 ,"$1,826.27 ",$268.66 ,"$1,541.00 ","$1,541.00 ",$811.67 ,$924.60 ,"$1,309.85 ","$1,078.70 ",$268.66 ,"$1,463.95 ","$1,171.16 ","$1,155.75 ","$1,541.00 ","$1,309.85 ",$811.67 ,"$1,541.00 ","$1,541.00 ","$1,078.70 ",$268.66 ,$811.67 ,$811.67 ,"$1,541.00 ","$1,309.85 ","$1,826.27 ","$1,417.72 ","$1,078.70 ","$1,541.00 ","$1,541.00 ",$938.47 ,"$1,541.00 ","$1,064.83 ","$1,386.90 ","$1,073.31 ",$819.79 ,"$1,217.39 ",$284.78 ,"$1,541.00 ","$1,541.00 ",$811.67 ,"$1,541.00 ","$1,109.52 ",$955.42 ,"$1,109.52 ","$1,109.52 ","$1,232.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000323,64480,HC INJ TRANSF CERV/THORACIC ADDL,360,1 ,$786.00 ,$393.00 ,$268.66 ,"$2,128.52 ",$268.66 ,$786.00 ,$786.00 , N/A ,$471.60 ,$668.10 ,$550.20 ,$268.66 ,$746.70 ,$597.36 ,$589.50 ,$786.00 ,$668.10 , N/A ,$786.00 ,$786.00 ,$550.20 ,$268.66 , N/A , N/A ,$786.00 ,$668.10 , N/A ,$723.12 ,$550.20 ,"$1,703.02 ","$2,128.52 ",$478.67 ,"$2,128.52 ",$543.13 ,$707.40 ,$547.45 , N/A ,$620.94 ,$284.78 ,$786.00 ,$786.00 , N/A ,$786.00 ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$628.80 
ST NICHOLAS HOSPITAL - ACUTE,36000324,64483,HC INJ TRANSF LUMBAR SACRAL SINGLE,360,1 ,"$1,939.00 ",$969.50 ,$268.66 ,"$1,939.00 ",$268.66 ,"$1,939.00 ","$1,939.00 ",$811.67 ,"$1,163.40 ","$1,648.15 ","$1,357.30 ",$268.66 ,"$1,842.05 ","$1,473.64 ","$1,454.25 ","$1,939.00 ","$1,648.15 ",$811.67 ,"$1,939.00 ","$1,939.00 ","$1,357.30 ",$268.66 ,$811.67 ,$811.67 ,"$1,697.11 ","$1,648.15 ","$1,826.27 ","$1,783.88 ","$1,357.30 ","$1,703.02 ","$1,939.00 ","$1,180.85 ","$1,939.00 ","$1,339.85 ","$1,745.10 ","$1,350.51 ",$819.79 ,"$1,531.81 ",$284.78 ,"$1,939.00 ","$1,939.00 ",$811.67 ,"$1,939.00 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000325,64484,HC INJ TRANSF LUMBAR SACRAL ADDL,360,1 ,$786.00 ,$393.00 ,$268.66 ,"$2,128.52 ",$268.66 ,$786.00 ,$786.00 , N/A ,$471.60 ,$668.10 ,$550.20 ,$268.66 ,$746.70 ,$597.36 ,$589.50 ,$786.00 ,$668.10 , N/A ,$786.00 ,$786.00 ,$550.20 ,$268.66 , N/A , N/A ,$786.00 ,$668.10 , N/A ,$723.12 ,$550.20 ,"$1,703.02 ","$2,128.52 ",$478.67 ,"$2,128.52 ",$543.13 ,$707.40 ,$547.45 , N/A ,$620.94 ,$284.78 ,$786.00 ,$786.00 , N/A ,$786.00 ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$628.80 
ST NICHOLAS HOSPITAL - ACUTE,36000326,64405,HC NERVE BLOCK; OCCIPITAL,360,1 ,"$1,002.00 ",$501.00 ,$136.73 ,"$1,002.00 ",$136.73 ,"$1,002.00 ","$1,002.00 ",$257.61 ,$601.20 ,$851.70 ,$701.40 ,$136.73 ,$951.90 ,$761.52 ,$751.50 ,"$1,002.00 ",$851.70 ,$257.61 ,"$1,002.00 ","$1,002.00 ",$701.40 ,$136.73 ,$257.61 ,$257.61 ,"$1,002.00 ",$851.70 ,$579.62 ,$921.84 ,$701.40 ,"$1,002.00 ","$1,002.00 ",$610.22 ,"$1,002.00 ",$692.38 ,$901.80 ,$697.89 ,$260.19 ,$791.58 ,$144.93 ,"$1,002.00 ","$1,002.00 ",$257.61 ,"$1,002.00 ",$721.44 ,$621.24 ,$721.44 ,$721.44 ,$801.60 
ST NICHOLAS HOSPITAL - ACUTE,36000328,64418,HC NERVE BLOCK;SUPRACAPULAR,360,1 ,"$1,849.00 ",$924.50 ,$136.73 ,"$1,849.00 ",$136.73 ,"$1,849.00 ","$1,849.00 ",$626.11 ,"$1,109.40 ","$1,571.65 ","$1,294.30 ",$136.73 ,"$1,756.55 ","$1,405.24 ","$1,386.75 ","$1,849.00 ","$1,571.65 ",$626.11 ,"$1,849.00 ","$1,849.00 ","$1,294.30 ",$136.73 ,$626.11 ,$626.11 ,"$1,697.11 ","$1,571.65 ","$1,408.74 ","$1,701.08 ","$1,294.30 ","$1,703.02 ","$1,849.00 ","$1,126.04 ","$1,849.00 ","$1,277.66 ","$1,664.10 ","$1,287.83 ",$632.37 ,"$1,460.71 ",$144.93 ,"$1,849.00 ","$1,849.00 ",$626.11 ,"$1,849.00 ","$1,331.28 ","$1,146.38 ","$1,331.28 ","$1,331.28 ","$1,479.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000339,64461,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC SINGLE,360,1 ,$830.00 ,$415.00 ,$268.66 ,"$1,408.74 ",$268.66 ,$830.00 ,$830.00 ,$626.11 ,$498.00 ,$705.50 ,$581.00 ,$268.66 ,$788.50 ,$630.80 ,$622.50 ,$830.00 ,$705.50 ,$626.11 ,$830.00 ,$539.50 ,$581.00 ,$268.66 ,$626.11 ,$626.11 ,$830.00 ,$705.50 ,"$1,408.74 ",$763.60 ,$581.00 ,$830.00 ,$830.00 ,$505.47 ,$830.00 ,$573.53 ,$747.00 ,$578.10 ,$632.37 ,$655.70 ,$284.78 ,$830.00 ,$830.00 ,$626.11 ,$830.00 ,$597.60 ,$514.60 ,$597.60 ,$597.60 ,$664.00 
ST NICHOLAS HOSPITAL - ACUTE,36000340,64462,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC 2ND AND ADDN ADD ON,360,1 ,$215.00 ,$107.50 ,$107.50 ,"$2,128.52 ",$268.66 ,$215.00 ,$215.00 , N/A ,$129.00 ,$182.75 ,$150.50 ,$268.66 ,$204.25 ,$163.40 ,$161.25 ,$215.00 ,$182.75 , N/A ,$215.00 ,$139.75 ,$150.50 ,$268.66 , N/A , N/A ,$215.00 ,$182.75 , N/A ,$197.80 ,$150.50 ,"$1,703.02 ","$2,128.52 ",$130.94 ,"$2,128.52 ",$148.57 ,$193.50 ,$149.75 , N/A ,$169.85 ,$284.78 ,$215.00 ,$215.00 , N/A ,$215.00 ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$172.00 
ST NICHOLAS HOSPITAL - ACUTE,36000341,64463,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC CATH CONTINUOUS,360,1 ,$792.00 ,$396.00 ,$268.66 ,"$1,408.74 ",$268.66 ,$792.00 ,$792.00 ,$626.11 ,$475.20 ,$673.20 ,$554.40 ,$268.66 ,$752.40 ,$601.92 ,$594.00 ,$792.00 ,$673.20 ,$626.11 ,$792.00 ,$514.80 ,$554.40 ,$268.66 ,$626.11 ,$626.11 ,$792.00 ,$673.20 ,"$1,408.74 ",$728.64 ,$554.40 ,$792.00 ,$792.00 ,$482.33 ,$792.00 ,$547.27 ,$712.80 ,$551.63 ,$632.37 ,$625.68 ,$284.78 ,$792.00 ,$792.00 ,$626.11 ,$792.00 ,$570.24 ,$491.04 ,$570.24 ,$570.24 ,$633.60 
ST NICHOLAS HOSPITAL - ACUTE,36000440,31622,HC BRONCHOSCOPY DIAG W/W/O WASHING,360,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,319.18 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,815.00 ","$2,465.00 ","$1,475.19 ","$2,815.00 ","$2,717.00 ","$2,030.00 ",$515.71 ,"$1,475.19 ","$1,475.19 ","$2,489.10 ","$2,465.00 ","$3,319.18 ","$2,668.00 ","$2,030.00 ","$1,703.02 ","$2,128.52 ","$1,766.10 ","$2,128.52 ","$2,003.90 ","$2,610.00 ","$2,019.85 ","$1,489.94 ","$2,291.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000569,64486,HC TAP BLOCK W/INJ UNILT,360,1 ,$948.00 ,$474.00 ,$136.73 ,$948.00 ,$136.73 ,$948.00 ,$948.00 , N/A ,$568.80 ,$805.80 ,$663.60 ,$136.73 ,$900.60 ,$720.48 ,$711.00 ,$948.00 ,$805.80 , N/A ,$948.00 ,$616.20 ,$663.60 ,$136.73 , N/A , N/A ,$948.00 ,$805.80 , N/A ,$872.16 ,$663.60 ,$948.00 ,$948.00 ,$577.33 ,$948.00 ,$655.07 ,$853.20 ,$660.28 , N/A ,$748.92 ,$144.93 ,$948.00 ,$948.00 , N/A ,$948.00 ,$682.56 ,$587.76 ,$682.56 ,$682.56 ,$758.40 
ST NICHOLAS HOSPITAL - ACUTE,36000690,34701,HC ENDOVASC RPR AORTA GRAFT OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$19,096.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$18,703.60 ","$18,457.50 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$15,996.50 ","$17,227.00 ","$5,616.20 ", N/A , N/A ,"$15,834.06 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$12,482.19 ","$14,980.11 ","$14,987.49 ","$14,980.11 ","$17,005.51 ","$22,149.00 ","$17,140.87 ", N/A ,"$19,441.90 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000691,34702,HC ENDOVASC RPR AORTA GRAFT W/RUPTURE,360,1 ,"$34,240.00 ","$17,120.00 ","$3,803.00 ","$34,240.00 ","$5,616.20 ","$19,096.00 ","$11,705.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$26,022.40 ","$25,680.00 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$22,256.00 ","$23,968.00 ","$5,616.20 ", N/A , N/A ,"$15,834.06 ","$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ","$17,366.53 ","$20,841.89 ","$20,852.16 ","$20,841.89 ","$23,659.84 ","$30,816.00 ","$23,848.16 ", N/A ,"$27,049.60 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000692,34703,HC ENDOVASC RPR AORTA-UNILAC GRAFT OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$19,096.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$18,703.60 ","$18,457.50 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$15,996.50 ","$17,227.00 ","$5,616.20 ", N/A , N/A ,"$15,834.06 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$12,482.19 ","$14,980.11 ","$14,987.49 ","$14,980.11 ","$17,005.51 ","$22,149.00 ","$17,140.87 ", N/A ,"$19,441.90 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000693,34704,HC ENDOVASC RPR AORTA-UNILAC GRAFT W/RUPTURE,360,1 ,"$34,240.00 ","$17,120.00 ","$3,803.00 ","$34,240.00 ","$5,616.20 ","$19,096.00 ","$11,705.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$26,022.40 ","$25,680.00 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$22,256.00 ","$23,968.00 ","$5,616.20 ", N/A , N/A ,"$15,834.06 ","$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ","$17,366.53 ","$20,841.89 ","$20,852.16 ","$20,841.89 ","$23,659.84 ","$30,816.00 ","$23,848.16 ", N/A ,"$27,049.60 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000694,34705,HC ENDOVASC RPR AORTA-BILIAC GRAFT OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$19,096.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$18,703.60 ","$18,457.50 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$15,996.50 ","$17,227.00 ","$5,616.20 ", N/A , N/A ,"$15,834.06 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$12,482.19 ","$14,980.11 ","$14,987.49 ","$14,980.11 ","$17,005.51 ","$22,149.00 ","$17,140.87 ", N/A ,"$19,441.90 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000695,34706,HC ENDOVASC RPR AORTA-BILIAC GRAFT W/RUPTURE,360,1 ,"$34,240.00 ","$17,120.00 ","$3,803.00 ","$34,240.00 ","$5,616.20 ","$19,096.00 ","$11,705.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$26,022.40 ","$25,680.00 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$22,256.00 ","$23,968.00 ","$5,616.20 ", N/A , N/A ,"$15,834.06 ","$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ","$17,366.53 ","$20,841.89 ","$20,852.16 ","$20,841.89 ","$23,659.84 ","$30,816.00 ","$23,848.16 ", N/A ,"$27,049.60 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000696,34709,HC PLACE PROSTH ILIAC ARTERY PER VESSEL,360,1 ,"$3,531.00 ","$1,765.50 ","$1,765.50 ","$5,953.17 ","$5,616.20 ","$3,531.00 ","$3,531.00 ", N/A ,"$2,118.60 ","$3,001.35 ","$2,471.70 ","$5,616.20 ","$3,354.45 ","$2,683.56 ","$2,648.25 ","$3,531.00 ","$3,001.35 ", N/A ,"$3,531.00 ","$2,295.15 ","$2,471.70 ","$5,616.20 ", N/A , N/A ,"$3,531.00 ","$3,001.35 ", N/A ,"$3,248.52 ","$2,471.70 ","$1,790.92 ","$2,149.32 ","$2,150.38 ","$2,149.32 ","$2,439.92 ","$3,177.90 ","$2,459.34 ", N/A ,"$2,789.49 ","$5,953.17 ","$3,531.00 ","$3,531.00 ", N/A ,"$3,531.00 ","$2,542.32 ","$2,189.22 ","$2,542.32 ","$2,542.32 ","$2,824.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000697,34710,HC PLACE PROSTH REPAIR ABDOM ARTERY INIT VESSEL,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$16,974.00 ","$9,884.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$18,703.60 ","$18,457.50 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$15,996.50 ","$17,227.00 ","$5,616.20 ", N/A , N/A ,"$7,919.86 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$12,482.19 ","$14,980.11 ","$14,987.49 ","$14,980.11 ","$17,005.51 ","$22,149.00 ","$17,140.87 ", N/A ,"$19,441.90 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000698,34711,HC PLACE PROSTH REPAIR ABDOM ARTERY EA ADDL VESSEL,360,1 ,"$3,531.00 ","$1,765.50 ","$1,765.50 ","$5,953.17 ","$5,616.20 ","$3,531.00 ","$3,531.00 ", N/A ,"$2,118.60 ","$3,001.35 ","$2,471.70 ","$5,616.20 ","$3,354.45 ","$2,683.56 ","$2,648.25 ","$3,531.00 ","$3,001.35 ", N/A ,"$3,531.00 ","$2,295.15 ","$2,471.70 ","$5,616.20 ", N/A , N/A ,"$3,531.00 ","$3,001.35 ", N/A ,"$3,248.52 ","$2,471.70 ","$1,790.92 ","$2,149.32 ","$2,150.38 ","$2,149.32 ","$2,439.92 ","$3,177.90 ","$2,459.34 ", N/A ,"$2,789.49 ","$5,953.17 ","$3,531.00 ","$3,531.00 ", N/A ,"$3,531.00 ","$2,542.32 ","$2,189.22 ","$2,542.32 ","$2,542.32 ","$2,824.80 "
ST NICHOLAS HOSPITAL - ACUTE,36000699,34707,HC ENDOVASC RPR ILIAC ARTERY OTHER THAN RUPTURE,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$16,974.00 ","$9,884.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$18,703.60 ","$18,457.50 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$15,996.50 ","$17,227.00 ","$5,616.20 ", N/A , N/A ,"$7,919.86 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$12,482.19 ","$14,980.11 ","$14,987.49 ","$14,980.11 ","$17,005.51 ","$22,149.00 ","$17,140.87 ", N/A ,"$19,441.90 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000700,34708,HC ENDOVASC RPR ILIAC ARTERY W/RUPTURE,360,1 ,"$34,240.00 ","$17,120.00 ","$3,803.00 ","$34,240.00 ","$5,616.20 ","$16,974.00 ","$9,884.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$26,022.40 ","$25,680.00 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$22,256.00 ","$23,968.00 ","$5,616.20 ", N/A , N/A ,"$7,919.86 ","$29,104.00 ", N/A ,"$31,500.80 ","$23,968.00 ","$17,366.53 ","$20,841.89 ","$20,852.16 ","$20,841.89 ","$23,659.84 ","$30,816.00 ","$23,848.16 ", N/A ,"$27,049.60 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$27,392.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000722,N/A,HC BRONCHOSCOPY W/DILATION/FX REDUCTION,360,1 ,"$3,360.00 ","$1,680.00 ","$1,680.00 ","$3,360.00 ", N/A , N/A , N/A , N/A ,"$2,016.00 ","$2,856.00 ","$2,352.00 ", N/A ,"$3,192.00 ","$2,553.60 ","$2,520.00 ", N/A ,"$2,856.00 ", N/A , N/A , N/A ,"$2,352.00 ", N/A , N/A , N/A , N/A ,"$2,856.00 ", N/A ,"$3,091.20 ","$2,352.00 ","$1,704.19 ","$2,045.23 ","$2,046.24 ","$2,045.23 ","$2,321.76 ","$3,024.00 ","$2,340.24 ", N/A ,"$2,654.40 ", N/A , N/A , N/A , N/A , N/A ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,36000747,65426,HC EXCIS/TRANSP PTERYGIUM W/GRAFT,360,1 ,"$6,244.00 ","$3,122.00 ","$1,020.40 ","$6,244.00 ","$1,020.40 ","$4,138.00 ","$3,641.00 ","$1,973.07 ","$3,746.40 ","$5,307.40 ","$4,370.80 ","$1,020.40 ","$5,931.80 ","$4,745.44 ","$4,683.00 ","$6,244.00 ","$5,307.40 ","$1,973.07 ","$6,244.00 ","$6,244.00 ","$4,370.80 ","$1,020.40 ","$1,973.07 ","$1,973.07 ","$4,525.63 ","$5,307.40 ","$4,439.41 ","$5,744.48 ","$4,370.80 ","$3,367.17 ","$4,208.70 ","$3,802.60 ","$4,208.70 ","$4,314.60 ","$5,619.60 ","$4,348.95 ","$1,992.80 ","$4,932.76 ","$1,081.62 ","$5,058.00 ","$5,058.00 ","$1,973.07 ","$5,058.00 ","$4,495.68 ","$3,871.28 ","$4,495.68 ","$4,495.68 ","$4,995.20 "
ST NICHOLAS HOSPITAL - ACUTE,36000750,31599,HC LARYNX SURG PROC UNLISTED,360,1 ,$617.00 ,$308.50 ,$208.60 ,$617.00 ,$288.55 ,$617.00 ,$617.00 ,$208.60 ,$370.20 ,$524.45 ,$431.90 ,$288.55 ,$586.15 ,$468.92 ,$462.75 ,$617.00 ,$524.45 ,$208.60 ,$617.00 ,$617.00 ,$431.90 ,$288.55 ,$208.60 ,$208.60 ,$617.00 ,$524.45 ,$469.36 ,$567.64 ,$431.90 , N/A , N/A ,$375.75 , N/A ,$426.35 ,$555.30 ,$429.74 ,$210.69 ,$487.43 ,$305.86 ,$617.00 ,$617.00 ,$208.60 ,$617.00 ,$444.24 ,$382.54 ,$444.24 ,$444.24 ,$493.60 
ST NICHOLAS HOSPITAL - ACUTE,36000752,45390,HC COLONOSCOPY W/RESECTION,360,1 ,"$7,347.00 ","$3,673.50 ",$642.82 ,"$7,347.00 ",$642.82 ,"$4,138.00 ","$3,641.00 ","$2,408.81 ","$4,408.20 ","$6,244.95 ","$5,142.90 ",$642.82 ,"$6,979.65 ","$5,583.72 ","$5,510.25 ","$6,993.00 ","$6,244.95 ","$2,408.81 ","$6,993.00 ","$4,775.55 ","$5,142.90 ",$642.82 ,"$2,408.81 ","$2,408.81 ","$2,489.10 ","$6,244.95 ","$5,419.83 ","$6,759.24 ","$5,142.90 ","$1,921.55 ","$2,401.67 ","$4,474.32 ","$2,401.67 ","$5,076.78 ","$6,612.30 ","$5,117.19 ","$2,432.90 ","$5,804.13 ",$681.39 ,"$4,016.00 ","$4,016.00 ","$2,408.81 ","$4,016.00 ","$5,289.84 ","$4,555.14 ","$5,289.84 ","$5,289.84 ","$5,877.60 "
ST NICHOLAS HOSPITAL - ACUTE,36000761,54115,HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE,360,1 ,"$7,359.00 ","$3,679.50 ",$616.68 ,"$7,359.00 ",$616.68 ,"$7,359.00 ","$6,763.00 ","$2,337.86 ","$4,415.40 ","$6,255.15 ","$5,151.30 ",$616.68 ,"$6,991.05 ","$5,592.84 ","$5,519.25 ","$2,815.00 ","$6,255.15 ","$2,337.86 ","$2,815.00 ","$2,717.00 ","$5,151.30 ",$616.68 ,"$2,337.86 ","$2,337.86 ","$4,525.63 ","$6,255.15 ","$5,260.19 ","$6,770.28 ","$5,151.30 ","$1,703.02 ","$2,128.52 ","$4,481.63 ","$2,128.52 ","$5,085.07 ","$6,623.10 ","$5,125.54 ","$2,361.24 ","$5,813.61 ",$653.68 ,"$5,058.00 ","$5,058.00 ","$2,337.86 ","$5,058.00 ","$5,298.48 ","$4,562.58 ","$5,298.48 ","$5,298.48 ","$5,887.20 "
ST NICHOLAS HOSPITAL - ACUTE,36010135,N/A,HC MINOR TREATMENT ROOM LEVEL 1,360,1 ,"$1,008.00 ",$504.00 ,$504.00 ,"$1,008.00 ", N/A , N/A , N/A , N/A ,$604.80 ,$856.80 ,$705.60 , N/A ,$957.60 ,$766.08 ,$756.00 , N/A ,$856.80 , N/A , N/A , N/A ,$705.60 , N/A , N/A , N/A , N/A ,$856.80 , N/A ,$927.36 ,$705.60 ,$511.26 ,$613.57 ,$613.87 ,$613.57 ,$696.53 ,$907.20 ,$702.07 , N/A ,$796.32 , N/A , N/A , N/A , N/A , N/A ,$725.76 ,$624.96 ,$725.76 ,$725.76 ,$806.40 
ST NICHOLAS HOSPITAL - ACUTE,36030001,N/A,HC ABDOMINOPLASTY MINI,360,1 ,"$2,780.00 ","$1,390.00 ","$1,390.00 ","$2,780.00 ", N/A , N/A , N/A , N/A ,"$1,668.00 ","$2,363.00 ","$1,946.00 ", N/A ,"$2,641.00 ","$2,112.80 ","$2,085.00 ", N/A ,"$2,363.00 ", N/A , N/A , N/A ,"$1,946.00 ", N/A , N/A , N/A , N/A ,"$2,363.00 ", N/A ,"$2,557.60 ","$1,946.00 ","$1,410.02 ","$1,692.19 ","$1,693.02 ","$1,692.19 ","$1,920.98 ","$2,502.00 ","$1,936.27 ", N/A ,"$2,196.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$2,224.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030002,N/A,HC ABDOMINOPLASTY OPEN/ENDOSCOPIC,360,1 ,"$3,389.00 ","$1,694.50 ","$1,694.50 ","$3,389.00 ", N/A , N/A , N/A , N/A ,"$2,033.40 ","$2,880.65 ","$2,372.30 ", N/A ,"$3,219.55 ","$2,575.64 ","$2,541.75 ", N/A ,"$2,880.65 ", N/A , N/A , N/A ,"$2,372.30 ", N/A , N/A , N/A , N/A ,"$2,880.65 ", N/A ,"$3,117.88 ","$2,372.30 ","$1,718.90 ","$2,062.88 ","$2,063.90 ","$2,062.88 ","$2,341.80 ","$3,050.10 ","$2,360.44 ", N/A ,"$2,677.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,440.08 ","$2,101.18 ","$2,440.08 ","$2,440.08 ","$2,711.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030003,N/A,HC BLEPHAROPLASTY LOWER,360,1 ,"$1,558.00 ",$779.00 ,$779.00 ,"$1,558.00 ", N/A , N/A , N/A , N/A ,$934.80 ,"$1,324.30 ","$1,090.60 ", N/A ,"$1,480.10 ","$1,184.08 ","$1,168.50 ", N/A ,"$1,324.30 ", N/A , N/A , N/A ,"$1,090.60 ", N/A , N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$948.35 ,"$1,076.58 ","$1,402.20 ","$1,085.15 ", N/A ,"$1,230.82 ", N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ","$1,246.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030004,N/A,HC BLEPHAROPLASTY UPPER,360,1 ,$948.00 ,$474.00 ,$474.00 ,$948.00 , N/A , N/A , N/A , N/A ,$568.80 ,$805.80 ,$663.60 , N/A ,$900.60 ,$720.48 ,$711.00 , N/A ,$805.80 , N/A , N/A , N/A ,$663.60 , N/A , N/A , N/A , N/A ,$805.80 , N/A ,$872.16 ,$663.60 ,$480.83 ,$577.05 ,$577.33 ,$577.05 ,$655.07 ,$853.20 ,$660.28 , N/A ,$748.92 , N/A , N/A , N/A , N/A , N/A ,$682.56 ,$587.76 ,$682.56 ,$682.56 ,$758.40 
ST NICHOLAS HOSPITAL - ACUTE,36030005,N/A,HC BLEPHAROPLASTY UPPER/LOWER,360,1 ,"$2,170.00 ","$1,085.00 ","$1,085.00 ","$2,170.00 ", N/A , N/A , N/A , N/A ,"$1,302.00 ","$1,844.50 ","$1,519.00 ", N/A ,"$2,061.50 ","$1,649.20 ","$1,627.50 ", N/A ,"$1,844.50 ", N/A , N/A , N/A ,"$1,519.00 ", N/A , N/A , N/A , N/A ,"$1,844.50 ", N/A ,"$1,996.40 ","$1,519.00 ","$1,100.62 ","$1,320.88 ","$1,321.53 ","$1,320.88 ","$1,499.47 ","$1,953.00 ","$1,511.41 ", N/A ,"$1,714.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030006,N/A,HC BRACHIOPLASTY (ARM LIFT),360,1 ,"$2,780.00 ","$1,390.00 ","$1,390.00 ","$2,780.00 ", N/A , N/A , N/A , N/A ,"$1,668.00 ","$2,363.00 ","$1,946.00 ", N/A ,"$2,641.00 ","$2,112.80 ","$2,085.00 ", N/A ,"$2,363.00 ", N/A , N/A , N/A ,"$1,946.00 ", N/A , N/A , N/A , N/A ,"$2,363.00 ", N/A ,"$2,557.60 ","$1,946.00 ","$1,410.02 ","$1,692.19 ","$1,693.02 ","$1,692.19 ","$1,920.98 ","$2,502.00 ","$1,936.27 ", N/A ,"$2,196.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$2,224.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030008,N/A,HC BREAST AUGMENTATION (BILAT),360,1 ,"$2,170.00 ","$1,085.00 ","$1,085.00 ","$2,170.00 ", N/A , N/A , N/A , N/A ,"$1,302.00 ","$1,844.50 ","$1,519.00 ", N/A ,"$2,061.50 ","$1,649.20 ","$1,627.50 ", N/A ,"$1,844.50 ", N/A , N/A , N/A ,"$1,519.00 ", N/A , N/A , N/A , N/A ,"$1,844.50 ", N/A ,"$1,996.40 ","$1,519.00 ","$1,100.62 ","$1,320.88 ","$1,321.53 ","$1,320.88 ","$1,499.47 ","$1,953.00 ","$1,511.41 ", N/A ,"$1,714.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030009,N/A,HC BREAST LIFT W/IMPLANTS (MASTOP,360,1 ,"$4,612.00 ","$2,306.00 ","$2,306.00 ","$4,612.00 ", N/A , N/A , N/A , N/A ,"$2,767.20 ","$3,920.20 ","$3,228.40 ", N/A ,"$4,381.40 ","$3,505.12 ","$3,459.00 ", N/A ,"$3,920.20 ", N/A , N/A , N/A ,"$3,228.40 ", N/A , N/A , N/A , N/A ,"$3,920.20 ", N/A ,"$4,243.04 ","$3,228.40 ","$2,339.21 ","$2,807.32 ","$2,808.71 ","$2,807.32 ","$3,186.89 ","$4,150.80 ","$3,212.26 ", N/A ,"$3,643.48 ", N/A , N/A , N/A , N/A , N/A ,"$3,320.64 ","$2,859.44 ","$3,320.64 ","$3,320.64 ","$3,689.60 "
ST NICHOLAS HOSPITAL - ACUTE,36030010,N/A,HC BREAST LIFT(MASTOPEXY),360,1 ,"$2,780.00 ","$1,390.00 ","$1,390.00 ","$2,780.00 ", N/A , N/A , N/A , N/A ,"$1,668.00 ","$2,363.00 ","$1,946.00 ", N/A ,"$2,641.00 ","$2,112.80 ","$2,085.00 ", N/A ,"$2,363.00 ", N/A , N/A , N/A ,"$1,946.00 ", N/A , N/A , N/A , N/A ,"$2,363.00 ", N/A ,"$2,557.60 ","$1,946.00 ","$1,410.02 ","$1,692.19 ","$1,693.02 ","$1,692.19 ","$1,920.98 ","$2,502.00 ","$1,936.27 ", N/A ,"$2,196.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$2,224.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030011,N/A,HC BREAST REDUCTION BILATERAL,360,1 ,"$4,001.00 ","$2,000.50 ","$2,000.50 ","$4,001.00 ", N/A , N/A , N/A , N/A ,"$2,400.60 ","$3,400.85 ","$2,800.70 ", N/A ,"$3,800.95 ","$3,040.76 ","$3,000.75 ", N/A ,"$3,400.85 ", N/A , N/A , N/A ,"$2,800.70 ", N/A , N/A , N/A , N/A ,"$3,400.85 ", N/A ,"$3,680.92 ","$2,800.70 ","$2,029.31 ","$2,435.41 ","$2,436.61 ","$2,435.41 ","$2,764.69 ","$3,600.90 ","$2,786.70 ", N/A ,"$3,160.79 ", N/A , N/A , N/A , N/A , N/A ,"$2,880.72 ","$2,480.62 ","$2,880.72 ","$2,880.72 ","$3,200.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030014,N/A,HC BROW LIFT ENDOSCOPIC,360,1 ,"$3,389.00 ","$1,694.50 ","$1,694.50 ","$3,389.00 ", N/A , N/A , N/A , N/A ,"$2,033.40 ","$2,880.65 ","$2,372.30 ", N/A ,"$3,219.55 ","$2,575.64 ","$2,541.75 ", N/A ,"$2,880.65 ", N/A , N/A , N/A ,"$2,372.30 ", N/A , N/A , N/A , N/A ,"$2,880.65 ", N/A ,"$3,117.88 ","$2,372.30 ","$1,718.90 ","$2,062.88 ","$2,063.90 ","$2,062.88 ","$2,341.80 ","$3,050.10 ","$2,360.44 ", N/A ,"$2,677.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,440.08 ","$2,101.18 ","$2,440.08 ","$2,440.08 ","$2,711.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030015,N/A,HC BROW LIFT OPEN,360,1 ,"$2,170.00 ","$1,085.00 ","$1,085.00 ","$2,170.00 ", N/A , N/A , N/A , N/A ,"$1,302.00 ","$1,844.50 ","$1,519.00 ", N/A ,"$2,061.50 ","$1,649.20 ","$1,627.50 ", N/A ,"$1,844.50 ", N/A , N/A , N/A ,"$1,519.00 ", N/A , N/A , N/A , N/A ,"$1,844.50 ", N/A ,"$1,996.40 ","$1,519.00 ","$1,100.62 ","$1,320.88 ","$1,321.53 ","$1,320.88 ","$1,499.47 ","$1,953.00 ","$1,511.41 ", N/A ,"$1,714.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,736.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030017,N/A,HC FACELIFT (RHYTIDECTOMY),360,1 ,"$4,612.00 ","$2,306.00 ","$2,306.00 ","$4,612.00 ", N/A , N/A , N/A , N/A ,"$2,767.20 ","$3,920.20 ","$3,228.40 ", N/A ,"$4,381.40 ","$3,505.12 ","$3,459.00 ", N/A ,"$3,920.20 ", N/A , N/A , N/A ,"$3,228.40 ", N/A , N/A , N/A , N/A ,"$3,920.20 ", N/A ,"$4,243.04 ","$3,228.40 ","$2,339.21 ","$2,807.32 ","$2,808.71 ","$2,807.32 ","$3,186.89 ","$4,150.80 ","$3,212.26 ", N/A ,"$3,643.48 ", N/A , N/A , N/A , N/A , N/A ,"$3,320.64 ","$2,859.44 ","$3,320.64 ","$3,320.64 ","$3,689.60 "
ST NICHOLAS HOSPITAL - ACUTE,36030055,N/A,HC NECKLIFT (PLATSYMAPLASTY),360,1 ,"$2,780.00 ","$1,390.00 ","$1,390.00 ","$2,780.00 ", N/A , N/A , N/A , N/A ,"$1,668.00 ","$2,363.00 ","$1,946.00 ", N/A ,"$2,641.00 ","$2,112.80 ","$2,085.00 ", N/A ,"$2,363.00 ", N/A , N/A , N/A ,"$1,946.00 ", N/A , N/A , N/A , N/A ,"$2,363.00 ", N/A ,"$2,557.60 ","$1,946.00 ","$1,410.02 ","$1,692.19 ","$1,693.02 ","$1,692.19 ","$1,920.98 ","$2,502.00 ","$1,936.27 ", N/A ,"$2,196.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$2,224.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030056,N/A,HC RHINOPLASTY (2 HR),360,1 ,"$3,389.00 ","$1,694.50 ","$1,694.50 ","$3,389.00 ", N/A , N/A , N/A , N/A ,"$2,033.40 ","$2,880.65 ","$2,372.30 ", N/A ,"$3,219.55 ","$2,575.64 ","$2,541.75 ", N/A ,"$2,880.65 ", N/A , N/A , N/A ,"$2,372.30 ", N/A , N/A , N/A , N/A ,"$2,880.65 ", N/A ,"$3,117.88 ","$2,372.30 ","$1,718.90 ","$2,062.88 ","$2,063.90 ","$2,062.88 ","$2,341.80 ","$3,050.10 ","$2,360.44 ", N/A ,"$2,677.31 ", N/A , N/A , N/A , N/A , N/A ,"$2,440.08 ","$2,101.18 ","$2,440.08 ","$2,440.08 ","$2,711.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030112,N/A,HC DENTAL 0-90 MIN ASC,360,1 ,"$6,615.00 ","$3,307.50 ","$3,307.50 ","$6,615.00 ", N/A , N/A , N/A , N/A ,"$3,969.00 ","$5,622.75 ","$4,630.50 ", N/A ,"$6,284.25 ","$5,027.40 ","$4,961.25 ", N/A ,"$5,622.75 ", N/A , N/A , N/A ,"$4,630.50 ", N/A , N/A , N/A , N/A ,"$5,622.75 ", N/A ,"$6,085.80 ","$4,630.50 ","$3,355.13 ","$4,026.55 ","$4,028.54 ","$4,026.55 ","$4,570.97 ","$5,953.50 ","$4,607.35 ", N/A ,"$5,225.85 ", N/A , N/A , N/A , N/A , N/A ,"$4,762.80 ","$4,101.30 ","$4,762.80 ","$4,762.80 ","$5,292.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030113,N/A,HC DENTAL 91-150 MIN ASC,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030114,N/A,HC DENTAL 151 AND GREATER ASC,360,1 ,"$1,890.00 ",$945.00 ,$945.00 ,"$1,890.00 ", N/A , N/A , N/A , N/A ,"$1,134.00 ","$1,606.50 ","$1,323.00 ", N/A ,"$1,795.50 ","$1,436.40 ","$1,417.50 ", N/A ,"$1,606.50 ", N/A , N/A , N/A ,"$1,323.00 ", N/A , N/A , N/A , N/A ,"$1,606.50 ", N/A ,"$1,738.80 ","$1,323.00 ",$958.61 ,"$1,150.44 ","$1,151.01 ","$1,150.44 ","$1,305.99 ","$1,701.00 ","$1,316.39 ", N/A ,"$1,493.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,360.80 ","$1,171.80 ","$1,360.80 ","$1,360.80 ","$1,512.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030120,N/A,HC LIPOSUCTION MINI,360,1 ,"$1,360.00 ",$680.00 ,$680.00 ,"$1,360.00 ", N/A , N/A , N/A , N/A ,$816.00 ,"$1,156.00 ",$952.00 , N/A ,"$1,292.00 ","$1,033.60 ","$1,020.00 ", N/A ,"$1,156.00 ", N/A , N/A , N/A ,$952.00 , N/A , N/A , N/A , N/A ,"$1,156.00 ", N/A ,"$1,251.20 ",$952.00 ,$689.79 ,$827.83 ,$828.24 ,$827.83 ,$939.76 ,"$1,224.00 ",$947.24 , N/A ,"$1,074.40 ", N/A , N/A , N/A , N/A , N/A ,$979.20 ,$843.20 ,$979.20 ,$979.20 ,"$1,088.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030121,N/A,HC LIPOSUCTION MEDIUM,360,1 ,"$2,038.00 ","$1,019.00 ","$1,019.00 ","$2,038.00 ", N/A , N/A , N/A , N/A ,"$1,222.80 ","$1,732.30 ","$1,426.60 ", N/A ,"$1,936.10 ","$1,548.88 ","$1,528.50 ", N/A ,"$1,732.30 ", N/A , N/A , N/A ,"$1,426.60 ", N/A , N/A , N/A , N/A ,"$1,732.30 ", N/A ,"$1,874.96 ","$1,426.60 ","$1,033.67 ","$1,240.53 ","$1,241.14 ","$1,240.53 ","$1,408.26 ","$1,834.20 ","$1,419.47 ", N/A ,"$1,610.02 ", N/A , N/A , N/A , N/A , N/A ,"$1,467.36 ","$1,263.56 ","$1,467.36 ","$1,467.36 ","$1,630.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030122,N/A,HC LIPOSUCTION FULL,360,1 ,"$2,717.00 ","$1,358.50 ","$1,358.50 ","$2,717.00 ", N/A , N/A , N/A , N/A ,"$1,630.20 ","$2,309.45 ","$1,901.90 ", N/A ,"$2,581.15 ","$2,064.92 ","$2,037.75 ", N/A ,"$2,309.45 ", N/A , N/A , N/A ,"$1,901.90 ", N/A , N/A , N/A , N/A ,"$2,309.45 ", N/A ,"$2,499.64 ","$1,901.90 ","$1,378.06 ","$1,653.84 ","$1,654.65 ","$1,653.84 ","$1,877.45 ","$2,445.30 ","$1,892.39 ", N/A ,"$2,146.43 ", N/A , N/A , N/A , N/A , N/A ,"$1,956.24 ","$1,684.54 ","$1,956.24 ","$1,956.24 ","$2,173.60 "
ST NICHOLAS HOSPITAL - ACUTE,36030123,N/A,HC SLIM LIPO PRO MINI,360,1 ,"$1,666.00 ",$833.00 ,$833.00 ,"$1,666.00 ", N/A , N/A , N/A , N/A ,$999.60 ,"$1,416.10 ","$1,166.20 ", N/A ,"$1,582.70 ","$1,266.16 ","$1,249.50 ", N/A ,"$1,416.10 ", N/A , N/A , N/A ,"$1,166.20 ", N/A , N/A , N/A , N/A ,"$1,416.10 ", N/A ,"$1,532.72 ","$1,166.20 ",$845.00 ,"$1,014.09 ","$1,014.59 ","$1,014.09 ","$1,151.21 ","$1,499.40 ","$1,160.37 ", N/A ,"$1,316.14 ", N/A , N/A , N/A , N/A , N/A ,"$1,199.52 ","$1,032.92 ","$1,199.52 ","$1,199.52 ","$1,332.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030124,N/A,HC SLIM LIPO PRO MEDIUM,360,1 ,"$2,345.00 ","$1,172.50 ","$1,172.50 ","$2,345.00 ", N/A , N/A , N/A , N/A ,"$1,407.00 ","$1,993.25 ","$1,641.50 ", N/A ,"$2,227.75 ","$1,782.20 ","$1,758.75 ", N/A ,"$1,993.25 ", N/A , N/A , N/A ,"$1,641.50 ", N/A , N/A , N/A , N/A ,"$1,993.25 ", N/A ,"$2,157.40 ","$1,641.50 ","$1,189.38 ","$1,427.40 ","$1,428.11 ","$1,427.40 ","$1,620.40 ","$2,110.50 ","$1,633.29 ", N/A ,"$1,852.55 ", N/A , N/A , N/A , N/A , N/A ,"$1,688.40 ","$1,453.90 ","$1,688.40 ","$1,688.40 ","$1,876.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030125,N/A,HC SLIM LIPO PRO FULL,360,1 ,"$3,024.00 ","$1,512.00 ","$1,512.00 ","$3,024.00 ", N/A , N/A , N/A , N/A ,"$1,814.40 ","$2,570.40 ","$2,116.80 ", N/A ,"$2,872.80 ","$2,298.24 ","$2,268.00 ", N/A ,"$2,570.40 ", N/A , N/A , N/A ,"$2,116.80 ", N/A , N/A , N/A , N/A ,"$2,570.40 ", N/A ,"$2,782.08 ","$2,116.80 ","$1,533.77 ","$1,840.71 ","$1,841.62 ","$1,840.71 ","$2,089.58 ","$2,721.60 ","$2,106.22 ", N/A ,"$2,388.96 ", N/A , N/A , N/A , N/A , N/A ,"$2,177.28 ","$1,874.88 ","$2,177.28 ","$2,177.28 ","$2,419.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030200,N/A,HC HEROLD COSMETIC 0-60 MIN,360,1 ,$800.00 ,$400.00 ,$400.00 ,$800.00 , N/A , N/A , N/A , N/A ,$480.00 ,$680.00 ,$560.00 , N/A ,$760.00 ,$608.00 ,$600.00 , N/A ,$680.00 , N/A , N/A , N/A ,$560.00 , N/A , N/A , N/A , N/A ,$680.00 , N/A ,$736.00 ,$560.00 ,$405.76 ,$486.96 ,$487.20 ,$486.96 ,$552.80 ,$720.00 ,$557.20 , N/A ,$632.00 , N/A , N/A , N/A , N/A , N/A ,$576.00 ,$496.00 ,$576.00 ,$576.00 ,$640.00 
ST NICHOLAS HOSPITAL - ACUTE,36030201,N/A,HC HEROLD COSMETIC 61-90 MIN,360,1 ,"$1,150.00 ",$575.00 ,$575.00 ,"$1,150.00 ", N/A , N/A , N/A , N/A ,$690.00 ,$977.50 ,$805.00 , N/A ,"$1,092.50 ",$874.00 ,$862.50 , N/A ,$977.50 , N/A , N/A , N/A ,$805.00 , N/A , N/A , N/A , N/A ,$977.50 , N/A ,"$1,058.00 ",$805.00 ,$583.28 ,$700.01 ,$700.35 ,$700.01 ,$794.65 ,"$1,035.00 ",$800.98 , N/A ,$908.50 , N/A , N/A , N/A , N/A , N/A ,$828.00 ,$713.00 ,$828.00 ,$828.00 ,$920.00 
ST NICHOLAS HOSPITAL - ACUTE,36030202,N/A,HC HEROLD COSMETIC  91-120 MIN,360,1 ,"$1,300.00 ",$650.00 ,$650.00 ,"$1,300.00 ", N/A , N/A , N/A , N/A ,$780.00 ,"$1,105.00 ",$910.00 , N/A ,"$1,235.00 ",$988.00 ,$975.00 , N/A ,"$1,105.00 ", N/A , N/A , N/A ,$910.00 , N/A , N/A , N/A , N/A ,"$1,105.00 ", N/A ,"$1,196.00 ",$910.00 ,$659.36 ,$791.31 ,$791.70 ,$791.31 ,$898.30 ,"$1,170.00 ",$905.45 , N/A ,"$1,027.00 ", N/A , N/A , N/A , N/A , N/A ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,"$1,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030203,N/A,HC HEROLD COSMETIC 121-150 MIN,360,1 ,"$1,500.00 ",$750.00 ,$750.00 ,"$1,500.00 ", N/A , N/A , N/A , N/A ,$900.00 ,"$1,275.00 ","$1,050.00 ", N/A ,"$1,425.00 ","$1,140.00 ","$1,125.00 ", N/A ,"$1,275.00 ", N/A , N/A , N/A ,"$1,050.00 ", N/A , N/A , N/A , N/A ,"$1,275.00 ", N/A ,"$1,380.00 ","$1,050.00 ",$760.80 ,$913.05 ,$913.50 ,$913.05 ,"$1,036.50 ","$1,350.00 ","$1,044.75 ", N/A ,"$1,185.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ","$1,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030204,N/A,HC HEROLD COSMETIC 151-180 MIN,360,1 ,"$1,650.00 ",$825.00 ,$825.00 ,"$1,650.00 ", N/A , N/A , N/A , N/A ,$990.00 ,"$1,402.50 ","$1,155.00 ", N/A ,"$1,567.50 ","$1,254.00 ","$1,237.50 ", N/A ,"$1,402.50 ", N/A , N/A , N/A ,"$1,155.00 ", N/A , N/A , N/A , N/A ,"$1,402.50 ", N/A ,"$1,518.00 ","$1,155.00 ",$836.88 ,"$1,004.36 ","$1,004.85 ","$1,004.36 ","$1,140.15 ","$1,485.00 ","$1,149.23 ", N/A ,"$1,303.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,188.00 ","$1,023.00 ","$1,188.00 ","$1,188.00 ","$1,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030205,N/A,HC HEROLD COSMETIC 181-210 MIN,360,1 ,"$1,800.00 ",$900.00 ,$900.00 ,"$1,800.00 ", N/A , N/A , N/A , N/A ,"$1,080.00 ","$1,530.00 ","$1,260.00 ", N/A ,"$1,710.00 ","$1,368.00 ","$1,350.00 ", N/A ,"$1,530.00 ", N/A , N/A , N/A ,"$1,260.00 ", N/A , N/A , N/A , N/A ,"$1,530.00 ", N/A ,"$1,656.00 ","$1,260.00 ",$912.96 ,"$1,095.66 ","$1,096.20 ","$1,095.66 ","$1,243.80 ","$1,620.00 ","$1,253.70 ", N/A ,"$1,422.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030206,N/A,HC HEROLD COSMETIC 211-240 MIN,360,1 ,"$2,000.00 ","$1,000.00 ","$1,000.00 ","$2,000.00 ", N/A , N/A , N/A , N/A ,"$1,200.00 ","$1,700.00 ","$1,400.00 ", N/A ,"$1,900.00 ","$1,520.00 ","$1,500.00 ", N/A ,"$1,700.00 ", N/A , N/A , N/A ,"$1,400.00 ", N/A , N/A , N/A , N/A ,"$1,700.00 ", N/A ,"$1,840.00 ","$1,400.00 ","$1,014.40 ","$1,217.40 ","$1,218.00 ","$1,217.40 ","$1,382.00 ","$1,800.00 ","$1,393.00 ", N/A ,"$1,580.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030207,N/A,HC HEROLD COSMETIC 241-270 MIN,360,1 ,"$2,150.00 ","$1,075.00 ","$1,075.00 ","$2,150.00 ", N/A , N/A , N/A , N/A ,"$1,290.00 ","$1,827.50 ","$1,505.00 ", N/A ,"$2,042.50 ","$1,634.00 ","$1,612.50 ", N/A ,"$1,827.50 ", N/A , N/A , N/A ,"$1,505.00 ", N/A , N/A , N/A , N/A ,"$1,827.50 ", N/A ,"$1,978.00 ","$1,505.00 ","$1,090.48 ","$1,308.71 ","$1,309.35 ","$1,308.71 ","$1,485.65 ","$1,935.00 ","$1,497.48 ", N/A ,"$1,698.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,548.00 ","$1,333.00 ","$1,548.00 ","$1,548.00 ","$1,720.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030208,N/A,HC HEROLD COSMETIC 271-300 MIN,360,1 ,"$2,300.00 ","$1,150.00 ","$1,150.00 ","$2,300.00 ", N/A , N/A , N/A , N/A ,"$1,380.00 ","$1,955.00 ","$1,610.00 ", N/A ,"$2,185.00 ","$1,748.00 ","$1,725.00 ", N/A ,"$1,955.00 ", N/A , N/A , N/A ,"$1,610.00 ", N/A , N/A , N/A , N/A ,"$1,955.00 ", N/A ,"$2,116.00 ","$1,610.00 ","$1,166.56 ","$1,400.01 ","$1,400.70 ","$1,400.01 ","$1,589.30 ","$2,070.00 ","$1,601.95 ", N/A ,"$1,817.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,656.00 ","$1,426.00 ","$1,656.00 ","$1,656.00 ","$1,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030209,N/A,HC HEROLD COSMETIC 301-330 MIN,360,1 ,"$2,450.00 ","$1,225.00 ","$1,225.00 ","$2,450.00 ", N/A , N/A , N/A , N/A ,"$1,470.00 ","$2,082.50 ","$1,715.00 ", N/A ,"$2,327.50 ","$1,862.00 ","$1,837.50 ", N/A ,"$2,082.50 ", N/A , N/A , N/A ,"$1,715.00 ", N/A , N/A , N/A , N/A ,"$2,082.50 ", N/A ,"$2,254.00 ","$1,715.00 ","$1,242.64 ","$1,491.32 ","$1,492.05 ","$1,491.32 ","$1,692.95 ","$2,205.00 ","$1,706.43 ", N/A ,"$1,935.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,764.00 ","$1,519.00 ","$1,764.00 ","$1,764.00 ","$1,960.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030210,N/A,HC HEROLD COSMETIC 331+ MIN,360,1 ,"$2,650.00 ","$1,325.00 ","$1,325.00 ","$2,650.00 ", N/A , N/A , N/A , N/A ,"$1,590.00 ","$2,252.50 ","$1,855.00 ", N/A ,"$2,517.50 ","$2,014.00 ","$1,987.50 ", N/A ,"$2,252.50 ", N/A , N/A , N/A ,"$1,855.00 ", N/A , N/A , N/A , N/A ,"$2,252.50 ", N/A ,"$2,438.00 ","$1,855.00 ","$1,344.08 ","$1,613.06 ","$1,613.85 ","$1,613.06 ","$1,831.15 ","$2,385.00 ","$1,845.73 ", N/A ,"$2,093.50 ", N/A , N/A , N/A , N/A , N/A ,"$1,908.00 ","$1,643.00 ","$1,908.00 ","$1,908.00 ","$2,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030211,N/A,HC HEROLD COSMETIC BREAST AUGMENTATION,360,1 ,$850.00 ,$425.00 ,$425.00 ,$850.00 , N/A , N/A , N/A , N/A ,$510.00 ,$722.50 ,$595.00 , N/A ,$807.50 ,$646.00 ,$637.50 , N/A ,$722.50 , N/A , N/A , N/A ,$595.00 , N/A , N/A , N/A , N/A ,$722.50 , N/A ,$782.00 ,$595.00 ,$431.12 ,$517.40 ,$517.65 ,$517.40 ,$587.35 ,$765.00 ,$592.03 , N/A ,$671.50 , N/A , N/A , N/A , N/A , N/A ,$612.00 ,$527.00 ,$612.00 ,$612.00 ,$680.00 
ST NICHOLAS HOSPITAL - ACUTE,36030300,N/A,HC CAMPBELL BROW LIFT,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030301,N/A,HC CAMPBELL BLEPHAROPLASTY LOWER,360,1 ,$971.00 ,$485.50 ,$485.50 ,$971.00 , N/A , N/A , N/A , N/A ,$582.60 ,$825.35 ,$679.70 , N/A ,$922.45 ,$737.96 ,$728.25 , N/A ,$825.35 , N/A , N/A , N/A ,$679.70 , N/A , N/A , N/A , N/A ,$825.35 , N/A ,$893.32 ,$679.70 ,$492.49 ,$591.05 ,$591.34 ,$591.05 ,$670.96 ,$873.90 ,$676.30 , N/A ,$767.09 , N/A , N/A , N/A , N/A , N/A ,$699.12 ,$602.02 ,$699.12 ,$699.12 ,$776.80 
ST NICHOLAS HOSPITAL - ACUTE,36030302,N/A,HC CAMPBELL BLEPHAROPLASTY UPPER,360,1 ,$709.00 ,$354.50 ,$354.50 ,$709.00 , N/A , N/A , N/A , N/A ,$425.40 ,$602.65 ,$496.30 , N/A ,$673.55 ,$538.84 ,$531.75 , N/A ,$602.65 , N/A , N/A , N/A ,$496.30 , N/A , N/A , N/A , N/A ,$602.65 , N/A ,$652.28 ,$496.30 ,$359.60 ,$431.57 ,$431.78 ,$431.57 ,$489.92 ,$638.10 ,$493.82 , N/A ,$560.11 , N/A , N/A , N/A , N/A , N/A ,$510.48 ,$439.58 ,$510.48 ,$510.48 ,$567.20 
ST NICHOLAS HOSPITAL - ACUTE,36030303,N/A,HC CAMPBELL BLEPHAROPLASTY UPPER/LOWER,360,1 ,"$1,418.00 ",$709.00 ,$709.00 ,"$1,418.00 ", N/A , N/A , N/A , N/A ,$850.80 ,"$1,205.30 ",$992.60 , N/A ,"$1,347.10 ","$1,077.68 ","$1,063.50 ", N/A ,"$1,205.30 ", N/A , N/A , N/A ,$992.60 , N/A , N/A , N/A , N/A ,"$1,205.30 ", N/A ,"$1,304.56 ",$992.60 ,$719.21 ,$863.14 ,$863.56 ,$863.14 ,$979.84 ,"$1,276.20 ",$987.64 , N/A ,"$1,120.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,020.96 ",$879.16 ,"$1,020.96 ","$1,020.96 ","$1,134.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030304,N/A,HC CAMPBELL MINI-FACELIFT,360,1 ,$735.00 ,$367.50 ,$367.50 ,$735.00 , N/A , N/A , N/A , N/A ,$441.00 ,$624.75 ,$514.50 , N/A ,$698.25 ,$558.60 ,$551.25 , N/A ,$624.75 , N/A , N/A , N/A ,$514.50 , N/A , N/A , N/A , N/A ,$624.75 , N/A ,$676.20 ,$514.50 ,$372.79 ,$447.39 ,$447.62 ,$447.39 ,$507.89 ,$661.50 ,$511.93 , N/A ,$580.65 , N/A , N/A , N/A , N/A , N/A ,$529.20 ,$455.70 ,$529.20 ,$529.20 ,$588.00 
ST NICHOLAS HOSPITAL - ACUTE,36030305,N/A,HC CAMPBELL DEEP PLANE FACELIFT,360,1 ,"$1,470.00 ",$735.00 ,$735.00 ,"$1,470.00 ", N/A , N/A , N/A , N/A ,$882.00 ,"$1,249.50 ","$1,029.00 ", N/A ,"$1,396.50 ","$1,117.20 ","$1,102.50 ", N/A ,"$1,249.50 ", N/A , N/A , N/A ,"$1,029.00 ", N/A , N/A , N/A , N/A ,"$1,249.50 ", N/A ,"$1,352.40 ","$1,029.00 ",$745.58 ,$894.79 ,$895.23 ,$894.79 ,"$1,015.77 ","$1,323.00 ","$1,023.86 ", N/A ,"$1,161.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,058.40 ",$911.40 ,"$1,058.40 ","$1,058.40 ","$1,176.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030306,N/A,HC CAMPBELL FACIAL IMPLANTS,360,1 ,$420.00 ,$210.00 ,$210.00 ,$420.00 , N/A , N/A , N/A , N/A ,$252.00 ,$357.00 ,$294.00 , N/A ,$399.00 ,$319.20 ,$315.00 , N/A ,$357.00 , N/A , N/A , N/A ,$294.00 , N/A , N/A , N/A , N/A ,$357.00 , N/A ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 , N/A ,$331.80 , N/A , N/A , N/A , N/A , N/A ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,36030307,N/A,HC CAMPBELL OTOPLASTY,360,1 ,"$1,470.00 ",$735.00 ,$735.00 ,"$1,470.00 ", N/A , N/A , N/A , N/A ,$882.00 ,"$1,249.50 ","$1,029.00 ", N/A ,"$1,396.50 ","$1,117.20 ","$1,102.50 ", N/A ,"$1,249.50 ", N/A , N/A , N/A ,"$1,029.00 ", N/A , N/A , N/A , N/A ,"$1,249.50 ", N/A ,"$1,352.40 ","$1,029.00 ",$745.58 ,$894.79 ,$895.23 ,$894.79 ,"$1,015.77 ","$1,323.00 ","$1,023.86 ", N/A ,"$1,161.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,058.40 ",$911.40 ,"$1,058.40 ","$1,058.40 ","$1,176.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030308,N/A,HC CAMPBELL RHINOPLASTY,360,1 ,"$1,391.00 ",$695.50 ,$695.50 ,"$1,391.00 ", N/A , N/A , N/A , N/A ,$834.60 ,"$1,182.35 ",$973.70 , N/A ,"$1,321.45 ","$1,057.16 ","$1,043.25 ", N/A ,"$1,182.35 ", N/A , N/A , N/A ,$973.70 , N/A , N/A , N/A , N/A ,"$1,182.35 ", N/A ,"$1,279.72 ",$973.70 ,$705.52 ,$846.70 ,$847.12 ,$846.70 ,$961.18 ,"$1,251.90 ",$968.83 , N/A ,"$1,098.89 ", N/A , N/A , N/A , N/A , N/A ,"$1,001.52 ",$862.42 ,"$1,001.52 ","$1,001.52 ","$1,112.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030309,N/A,HC CAMPBELL ERBIUM LASER,360,1 ,$630.00 ,$315.00 ,$315.00 ,$630.00 , N/A , N/A , N/A , N/A ,$378.00 ,$535.50 ,$441.00 , N/A ,$598.50 ,$478.80 ,$472.50 , N/A ,$535.50 , N/A , N/A , N/A ,$441.00 , N/A , N/A , N/A , N/A ,$535.50 , N/A ,$579.60 ,$441.00 ,$319.54 ,$383.48 ,$383.67 ,$383.48 ,$435.33 ,$567.00 ,$438.80 , N/A ,$497.70 , N/A , N/A , N/A , N/A , N/A ,$453.60 ,$390.60 ,$453.60 ,$453.60 ,$504.00 
ST NICHOLAS HOSPITAL - ACUTE,36030310,N/A,HC CAMPBELL COMPREHENSIVE REJUVENATION,360,1 ,"$3,150.00 ","$1,575.00 ","$1,575.00 ","$3,150.00 ", N/A , N/A , N/A , N/A ,"$1,890.00 ","$2,677.50 ","$2,205.00 ", N/A ,"$2,992.50 ","$2,394.00 ","$2,362.50 ", N/A ,"$2,677.50 ", N/A , N/A , N/A ,"$2,205.00 ", N/A , N/A , N/A , N/A ,"$2,677.50 ", N/A ,"$2,898.00 ","$2,205.00 ","$1,597.68 ","$1,917.41 ","$1,918.35 ","$1,917.41 ","$2,176.65 ","$2,835.00 ","$2,193.98 ", N/A ,"$2,488.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030311,N/A,HC CAMPBELL LIPO HEAD AND NECK,360,1 ,$315.00 ,$157.50 ,$157.50 ,$315.00 , N/A , N/A , N/A , N/A ,$189.00 ,$267.75 ,$220.50 , N/A ,$299.25 ,$239.40 ,$236.25 , N/A ,$267.75 , N/A , N/A , N/A ,$220.50 , N/A , N/A , N/A , N/A ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$191.74 ,$217.67 ,$283.50 ,$219.40 , N/A ,$248.85 , N/A , N/A , N/A , N/A , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,36030312,N/A,HC CAMPBELL COLLAGEN BOTOX INJECTION,360,1 ,$420.00 ,$210.00 ,$210.00 ,$420.00 , N/A , N/A , N/A , N/A ,$252.00 ,$357.00 ,$294.00 , N/A ,$399.00 ,$319.20 ,$315.00 , N/A ,$357.00 , N/A , N/A , N/A ,$294.00 , N/A , N/A , N/A , N/A ,$357.00 , N/A ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 , N/A ,$331.80 , N/A , N/A , N/A , N/A , N/A ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,36030313,N/A,HC CAMPBELL CHIN IMPLANT,360,1 ,$919.00 ,$459.50 ,$459.50 ,$919.00 , N/A , N/A , N/A , N/A ,$551.40 ,$781.15 ,$643.30 , N/A ,$873.05 ,$698.44 ,$689.25 , N/A ,$781.15 , N/A , N/A , N/A ,$643.30 , N/A , N/A , N/A , N/A ,$781.15 , N/A ,$845.48 ,$643.30 ,$466.12 ,$559.40 ,$559.67 ,$559.40 ,$635.03 ,$827.10 ,$640.08 , N/A ,$726.01 , N/A , N/A , N/A , N/A , N/A ,$661.68 ,$569.78 ,$661.68 ,$661.68 ,$735.20 
ST NICHOLAS HOSPITAL - ACUTE,36030314,N/A,HC CAMPBELL SKIN TISSUE PROCEDURE,360,1 ,"$1,076.00 ",$538.00 ,$538.00 ,"$1,076.00 ", N/A , N/A , N/A , N/A ,$645.60 ,$914.60 ,$753.20 , N/A ,"$1,022.20 ",$817.76 ,$807.00 , N/A ,$914.60 , N/A , N/A , N/A ,$753.20 , N/A , N/A , N/A , N/A ,$914.60 , N/A ,$989.92 ,$753.20 ,$545.75 ,$654.96 ,$655.28 ,$654.96 ,$743.52 ,$968.40 ,$749.43 , N/A ,$850.04 , N/A , N/A , N/A , N/A , N/A ,$774.72 ,$667.12 ,$774.72 ,$774.72 ,$860.80 
ST NICHOLAS HOSPITAL - ACUTE,36030315,N/A,HC CAMPBELL RHYTIDECTOMY,360,1 ,"$1,916.00 ",$958.00 ,$958.00 ,"$1,916.00 ", N/A , N/A , N/A , N/A ,"$1,149.60 ","$1,628.60 ","$1,341.20 ", N/A ,"$1,820.20 ","$1,456.16 ","$1,437.00 ", N/A ,"$1,628.60 ", N/A , N/A , N/A ,"$1,341.20 ", N/A , N/A , N/A , N/A ,"$1,628.60 ", N/A ,"$1,762.72 ","$1,341.20 ",$971.80 ,"$1,166.27 ","$1,166.84 ","$1,166.27 ","$1,323.96 ","$1,724.40 ","$1,334.49 ", N/A ,"$1,513.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,379.52 ","$1,187.92 ","$1,379.52 ","$1,379.52 ","$1,532.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030316,N/A,HC CAMPBELL FAT GRAFTING,360,1 ,$525.00 ,$262.50 ,$262.50 ,$525.00 , N/A , N/A , N/A , N/A ,$315.00 ,$446.25 ,$367.50 , N/A ,$498.75 ,$399.00 ,$393.75 , N/A ,$446.25 , N/A , N/A , N/A ,$367.50 , N/A , N/A , N/A , N/A ,$446.25 , N/A ,$483.00 ,$367.50 ,$266.28 ,$319.57 ,$319.73 ,$319.57 ,$362.78 ,$472.50 ,$365.66 , N/A ,$414.75 , N/A , N/A , N/A , N/A , N/A ,$378.00 ,$325.50 ,$378.00 ,$378.00 ,$420.00 
ST NICHOLAS HOSPITAL - ACUTE,36030317,N/A,HC CAMPBELL MINI W/PLATYSMA PLICATION,360,1 ,$945.00 ,$472.50 ,$472.50 ,$945.00 , N/A , N/A , N/A , N/A ,$567.00 ,$803.25 ,$661.50 , N/A ,$897.75 ,$718.20 ,$708.75 , N/A ,$803.25 , N/A , N/A , N/A ,$661.50 , N/A , N/A , N/A , N/A ,$803.25 , N/A ,$869.40 ,$661.50 ,$479.30 ,$575.22 ,$575.51 ,$575.22 ,$653.00 ,$850.50 ,$658.19 , N/A ,$746.55 , N/A , N/A , N/A , N/A , N/A ,$680.40 ,$585.90 ,$680.40 ,$680.40 ,$756.00 
ST NICHOLAS HOSPITAL - ACUTE,36030318,N/A,HC CAMPBELL MINOR DORSUM RHINOPLASTY,360,1 ,$525.00 ,$262.50 ,$262.50 ,$525.00 , N/A , N/A , N/A , N/A ,$315.00 ,$446.25 ,$367.50 , N/A ,$498.75 ,$399.00 ,$393.75 , N/A ,$446.25 , N/A , N/A , N/A ,$367.50 , N/A , N/A , N/A , N/A ,$446.25 , N/A ,$483.00 ,$367.50 ,$266.28 ,$319.57 ,$319.73 ,$319.57 ,$362.78 ,$472.50 ,$365.66 , N/A ,$414.75 , N/A , N/A , N/A , N/A , N/A ,$378.00 ,$325.50 ,$378.00 ,$378.00 ,$420.00 
ST NICHOLAS HOSPITAL - ACUTE,36030325,N/A,HC BUTZ ABDOMINOPLASTY,360,1 ,"$2,100.00 ","$1,050.00 ","$1,050.00 ","$2,100.00 ", N/A , N/A , N/A , N/A ,"$1,260.00 ","$1,785.00 ","$1,470.00 ", N/A ,"$1,995.00 ","$1,596.00 ","$1,575.00 ", N/A ,"$1,785.00 ", N/A , N/A , N/A ,"$1,470.00 ", N/A , N/A , N/A , N/A ,"$1,785.00 ", N/A ,"$1,932.00 ","$1,470.00 ","$1,065.12 ","$1,278.27 ","$1,278.90 ","$1,278.27 ","$1,451.10 ","$1,890.00 ","$1,462.65 ", N/A ,"$1,659.00 ", N/A , N/A , N/A , N/A , N/A ,"$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030326,N/A,HC BUTZ BLEPHAROPLASTY UPPER/LOWER,360,1 ,"$1,418.00 ",$709.00 ,$709.00 ,"$1,418.00 ", N/A , N/A , N/A , N/A ,$850.80 ,"$1,205.30 ",$992.60 , N/A ,"$1,347.10 ","$1,077.68 ","$1,063.50 ", N/A ,"$1,205.30 ", N/A , N/A , N/A ,$992.60 , N/A , N/A , N/A , N/A ,"$1,205.30 ", N/A ,"$1,304.56 ",$992.60 ,$719.21 ,$863.14 ,$863.56 ,$863.14 ,$979.84 ,"$1,276.20 ",$987.64 , N/A ,"$1,120.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,020.96 ",$879.16 ,"$1,020.96 ","$1,020.96 ","$1,134.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030327,N/A,HC BUTZ BLEPHAROPLASTY LOWER,360,1 ,$971.00 ,$485.50 ,$485.50 ,$971.00 , N/A , N/A , N/A , N/A ,$582.60 ,$825.35 ,$679.70 , N/A ,$922.45 ,$737.96 ,$728.25 , N/A ,$825.35 , N/A , N/A , N/A ,$679.70 , N/A , N/A , N/A , N/A ,$825.35 , N/A ,$893.32 ,$679.70 ,$492.49 ,$591.05 ,$591.34 ,$591.05 ,$670.96 ,$873.90 ,$676.30 , N/A ,$767.09 , N/A , N/A , N/A , N/A , N/A ,$699.12 ,$602.02 ,$699.12 ,$699.12 ,$776.80 
ST NICHOLAS HOSPITAL - ACUTE,36030328,N/A,HC BUTZ BLEPHAROPLASTY UPPER,360,1 ,$709.00 ,$354.50 ,$354.50 ,$709.00 , N/A , N/A , N/A , N/A ,$425.40 ,$602.65 ,$496.30 , N/A ,$673.55 ,$538.84 ,$531.75 , N/A ,$602.65 , N/A , N/A , N/A ,$496.30 , N/A , N/A , N/A , N/A ,$602.65 , N/A ,$652.28 ,$496.30 ,$359.60 ,$431.57 ,$431.78 ,$431.57 ,$489.92 ,$638.10 ,$493.82 , N/A ,$560.11 , N/A , N/A , N/A , N/A , N/A ,$510.48 ,$439.58 ,$510.48 ,$510.48 ,$567.20 
ST NICHOLAS HOSPITAL - ACUTE,36030329,N/A,HC BUTZ BRACHIOPLASTY(BILATERAL),360,1 ,"$1,628.00 ",$814.00 ,$814.00 ,"$1,628.00 ", N/A , N/A , N/A , N/A ,$976.80 ,"$1,383.80 ","$1,139.60 ", N/A ,"$1,546.60 ","$1,237.28 ","$1,221.00 ", N/A ,"$1,383.80 ", N/A , N/A , N/A ,"$1,139.60 ", N/A , N/A , N/A , N/A ,"$1,383.80 ", N/A ,"$1,497.76 ","$1,139.60 ",$825.72 ,$990.96 ,$991.45 ,$990.96 ,"$1,124.95 ","$1,465.20 ","$1,133.90 ", N/A ,"$1,286.12 ", N/A , N/A , N/A , N/A , N/A ,"$1,172.16 ","$1,009.36 ","$1,172.16 ","$1,172.16 ","$1,302.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030330,N/A,HC BUTZ BREAST AUGMENTATION (BILATERAL),360,1 ,"$1,286.00 ",$643.00 ,$643.00 ,"$1,286.00 ", N/A , N/A , N/A , N/A ,$771.60 ,"$1,093.10 ",$900.20 , N/A ,"$1,221.70 ",$977.36 ,$964.50 , N/A ,"$1,093.10 ", N/A , N/A , N/A ,$900.20 , N/A , N/A , N/A , N/A ,"$1,093.10 ", N/A ,"$1,183.12 ",$900.20 ,$652.26 ,$782.79 ,$783.17 ,$782.79 ,$888.63 ,"$1,157.40 ",$895.70 , N/A ,"$1,015.94 ", N/A , N/A , N/A , N/A , N/A ,$925.92 ,$797.32 ,$925.92 ,$925.92 ,"$1,028.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030331,N/A,HC BUTZ BREAST IMPLANT UNILATERAL,360,1 ,$814.00 ,$407.00 ,$407.00 ,$814.00 , N/A , N/A , N/A , N/A ,$488.40 ,$691.90 ,$569.80 , N/A ,$773.30 ,$618.64 ,$610.50 , N/A ,$691.90 , N/A , N/A , N/A ,$569.80 , N/A , N/A , N/A , N/A ,$691.90 , N/A ,$748.88 ,$569.80 ,$412.86 ,$495.48 ,$495.73 ,$495.48 ,$562.47 ,$732.60 ,$566.95 , N/A ,$643.06 , N/A , N/A , N/A , N/A , N/A ,$586.08 ,$504.68 ,$586.08 ,$586.08 ,$651.20 
ST NICHOLAS HOSPITAL - ACUTE,36030332,N/A,HC BUTZ BREAST REDUCTION (BILATERAL),360,1 ,"$2,021.00 ","$1,010.50 ","$1,010.50 ","$2,021.00 ", N/A , N/A , N/A , N/A ,"$1,212.60 ","$1,717.85 ","$1,414.70 ", N/A ,"$1,919.95 ","$1,535.96 ","$1,515.75 ", N/A ,"$1,717.85 ", N/A , N/A , N/A ,"$1,414.70 ", N/A , N/A , N/A , N/A ,"$1,717.85 ", N/A ,"$1,859.32 ","$1,414.70 ","$1,025.05 ","$1,230.18 ","$1,230.79 ","$1,230.18 ","$1,396.51 ","$1,818.90 ","$1,407.63 ", N/A ,"$1,596.59 ", N/A , N/A , N/A , N/A , N/A ,"$1,455.12 ","$1,253.02 ","$1,455.12 ","$1,455.12 ","$1,616.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030333,N/A,HC BUTZ BROW LIFT,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030334,N/A,HC BUTZ CANTHOPLASTY(BILATERAL),360,1 ,$840.00 ,$420.00 ,$420.00 ,$840.00 , N/A , N/A , N/A , N/A ,$504.00 ,$714.00 ,$588.00 , N/A ,$798.00 ,$638.40 ,$630.00 , N/A ,$714.00 , N/A , N/A , N/A ,$588.00 , N/A , N/A , N/A , N/A ,$714.00 , N/A ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$585.06 , N/A ,$663.60 , N/A , N/A , N/A , N/A , N/A ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,36030335,N/A,HC BUTZ CHIN IMPLANT,360,1 ,$919.00 ,$459.50 ,$459.50 ,$919.00 , N/A , N/A , N/A , N/A ,$551.40 ,$781.15 ,$643.30 , N/A ,$873.05 ,$698.44 ,$689.25 , N/A ,$781.15 , N/A , N/A , N/A ,$643.30 , N/A , N/A , N/A , N/A ,$781.15 , N/A ,$845.48 ,$643.30 ,$466.12 ,$559.40 ,$559.67 ,$559.40 ,$635.03 ,$827.10 ,$640.08 , N/A ,$726.01 , N/A , N/A , N/A , N/A , N/A ,$661.68 ,$569.78 ,$661.68 ,$661.68 ,$735.20 
ST NICHOLAS HOSPITAL - ACUTE,36030336,N/A,HC BUTZ FAT TRANSFER,360,1 ,"$2,021.00 ","$1,010.50 ","$1,010.50 ","$2,021.00 ", N/A , N/A , N/A , N/A ,"$1,212.60 ","$1,717.85 ","$1,414.70 ", N/A ,"$1,919.95 ","$1,535.96 ","$1,515.75 ", N/A ,"$1,717.85 ", N/A , N/A , N/A ,"$1,414.70 ", N/A , N/A , N/A , N/A ,"$1,717.85 ", N/A ,"$1,859.32 ","$1,414.70 ","$1,025.05 ","$1,230.18 ","$1,230.79 ","$1,230.18 ","$1,396.51 ","$1,818.90 ","$1,407.63 ", N/A ,"$1,596.59 ", N/A , N/A , N/A , N/A , N/A ,"$1,455.12 ","$1,253.02 ","$1,455.12 ","$1,455.12 ","$1,616.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030337,N/A,HC BUTZ GYNECOMASTY(BILATERAL),360,1 ,"$1,313.00 ",$656.50 ,$656.50 ,"$1,313.00 ", N/A , N/A , N/A , N/A ,$787.80 ,"$1,116.05 ",$919.10 , N/A ,"$1,247.35 ",$997.88 ,$984.75 , N/A ,"$1,116.05 ", N/A , N/A , N/A ,$919.10 , N/A , N/A , N/A , N/A ,"$1,116.05 ", N/A ,"$1,207.96 ",$919.10 ,$665.95 ,$799.22 ,$799.62 ,$799.22 ,$907.28 ,"$1,181.70 ",$914.50 , N/A ,"$1,037.27 ", N/A , N/A , N/A , N/A , N/A ,$945.36 ,$814.06 ,$945.36 ,$945.36 ,"$1,050.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030338,N/A,HC BUTZ LESION REMOVAL,360,1 ,$709.00 ,$354.50 ,$354.50 ,$709.00 , N/A , N/A , N/A , N/A ,$425.40 ,$602.65 ,$496.30 , N/A ,$673.55 ,$538.84 ,$531.75 , N/A ,$602.65 , N/A , N/A , N/A ,$496.30 , N/A , N/A , N/A , N/A ,$602.65 , N/A ,$652.28 ,$496.30 ,$359.60 ,$431.57 ,$431.78 ,$431.57 ,$489.92 ,$638.10 ,$493.82 , N/A ,$560.11 , N/A , N/A , N/A , N/A , N/A ,$510.48 ,$439.58 ,$510.48 ,$510.48 ,$567.20 
ST NICHOLAS HOSPITAL - ACUTE,36030339,N/A,HC BUTZ LIPO CHIN/NECK,360,1 ,$735.00 ,$367.50 ,$367.50 ,$735.00 , N/A , N/A , N/A , N/A ,$441.00 ,$624.75 ,$514.50 , N/A ,$698.25 ,$558.60 ,$551.25 , N/A ,$624.75 , N/A , N/A , N/A ,$514.50 , N/A , N/A , N/A , N/A ,$624.75 , N/A ,$676.20 ,$514.50 ,$372.79 ,$447.39 ,$447.62 ,$447.39 ,$507.89 ,$661.50 ,$511.93 , N/A ,$580.65 , N/A , N/A , N/A , N/A , N/A ,$529.20 ,$455.70 ,$529.20 ,$529.20 ,$588.00 
ST NICHOLAS HOSPITAL - ACUTE,36030340,N/A,HC BUTZ LIPO TORSO HIPS BUTTOCKS,360,1 ,"$1,418.00 ",$709.00 ,$709.00 ,"$1,418.00 ", N/A , N/A , N/A , N/A ,$850.80 ,"$1,205.30 ",$992.60 , N/A ,"$1,347.10 ","$1,077.68 ","$1,063.50 ", N/A ,"$1,205.30 ", N/A , N/A , N/A ,$992.60 , N/A , N/A , N/A , N/A ,"$1,205.30 ", N/A ,"$1,304.56 ",$992.60 ,$719.21 ,$863.14 ,$863.56 ,$863.14 ,$979.84 ,"$1,276.20 ",$987.64 , N/A ,"$1,120.22 ", N/A , N/A , N/A , N/A , N/A ,"$1,020.96 ",$879.16 ,"$1,020.96 ","$1,020.96 ","$1,134.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030341,N/A,HC BUTZ MATOPEXY,360,1 ,"$1,523.00 ",$761.50 ,$761.50 ,"$1,523.00 ", N/A , N/A , N/A , N/A ,$913.80 ,"$1,294.55 ","$1,066.10 ", N/A ,"$1,446.85 ","$1,157.48 ","$1,142.25 ", N/A ,"$1,294.55 ", N/A , N/A , N/A ,"$1,066.10 ", N/A , N/A , N/A , N/A ,"$1,294.55 ", N/A ,"$1,401.16 ","$1,066.10 ",$772.47 ,$927.05 ,$927.51 ,$927.05 ,"$1,052.39 ","$1,370.70 ","$1,060.77 ", N/A ,"$1,203.17 ", N/A , N/A , N/A , N/A , N/A ,"$1,096.56 ",$944.26 ,"$1,096.56 ","$1,096.56 ","$1,218.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030342,N/A,HC BUTZ OTOPLASTY,360,1 ,"$1,470.00 ",$735.00 ,$735.00 ,"$1,470.00 ", N/A , N/A , N/A , N/A ,$882.00 ,"$1,249.50 ","$1,029.00 ", N/A ,"$1,396.50 ","$1,117.20 ","$1,102.50 ", N/A ,"$1,249.50 ", N/A , N/A , N/A ,"$1,029.00 ", N/A , N/A , N/A , N/A ,"$1,249.50 ", N/A ,"$1,352.40 ","$1,029.00 ",$745.58 ,$894.79 ,$895.23 ,$894.79 ,"$1,015.77 ","$1,323.00 ","$1,023.86 ", N/A ,"$1,161.30 ", N/A , N/A , N/A , N/A , N/A ,"$1,058.40 ",$911.40 ,"$1,058.40 ","$1,058.40 ","$1,176.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030343,N/A,HC BUTZ RHINOPLASTY,360,1 ,"$1,391.00 ",$695.50 ,$695.50 ,"$1,391.00 ", N/A , N/A , N/A , N/A ,$834.60 ,"$1,182.35 ",$973.70 , N/A ,"$1,321.45 ","$1,057.16 ","$1,043.25 ", N/A ,"$1,182.35 ", N/A , N/A , N/A ,$973.70 , N/A , N/A , N/A , N/A ,"$1,182.35 ", N/A ,"$1,279.72 ",$973.70 ,$705.52 ,$846.70 ,$847.12 ,$846.70 ,$961.18 ,"$1,251.90 ",$968.83 , N/A ,"$1,098.89 ", N/A , N/A , N/A , N/A , N/A ,"$1,001.52 ",$862.42 ,"$1,001.52 ","$1,001.52 ","$1,112.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030344,N/A,HC BUTZ RHINOPLASTY TIP,360,1 ,$971.00 ,$485.50 ,$485.50 ,$971.00 , N/A , N/A , N/A , N/A ,$582.60 ,$825.35 ,$679.70 , N/A ,$922.45 ,$737.96 ,$728.25 , N/A ,$825.35 , N/A , N/A , N/A ,$679.70 , N/A , N/A , N/A , N/A ,$825.35 , N/A ,$893.32 ,$679.70 ,$492.49 ,$591.05 ,$591.34 ,$591.05 ,$670.96 ,$873.90 ,$676.30 , N/A ,$767.09 , N/A , N/A , N/A , N/A , N/A ,$699.12 ,$602.02 ,$699.12 ,$699.12 ,$776.80 
ST NICHOLAS HOSPITAL - ACUTE,36030345,N/A,HC BUTZ RHYTIDECTOMY,360,1 ,"$1,916.00 ",$958.00 ,$958.00 ,"$1,916.00 ", N/A , N/A , N/A , N/A ,"$1,149.60 ","$1,628.60 ","$1,341.20 ", N/A ,"$1,820.20 ","$1,456.16 ","$1,437.00 ", N/A ,"$1,628.60 ", N/A , N/A , N/A ,"$1,341.20 ", N/A , N/A , N/A , N/A ,"$1,628.60 ", N/A ,"$1,762.72 ","$1,341.20 ",$971.80 ,"$1,166.27 ","$1,166.84 ","$1,166.27 ","$1,323.96 ","$1,724.40 ","$1,334.49 ", N/A ,"$1,513.64 ", N/A , N/A , N/A , N/A , N/A ,"$1,379.52 ","$1,187.92 ","$1,379.52 ","$1,379.52 ","$1,532.80 "
ST NICHOLAS HOSPITAL - ACUTE,36030346,N/A,HC BUTZ SCAR REVISION,360,1 ,$761.00 ,$380.50 ,$380.50 ,$761.00 , N/A , N/A , N/A , N/A ,$456.60 ,$646.85 ,$532.70 , N/A ,$722.95 ,$578.36 ,$570.75 , N/A ,$646.85 , N/A , N/A , N/A ,$532.70 , N/A , N/A , N/A , N/A ,$646.85 , N/A ,$700.12 ,$532.70 ,$385.98 ,$463.22 ,$463.45 ,$463.22 ,$525.85 ,$684.90 ,$530.04 , N/A ,$601.19 , N/A , N/A , N/A , N/A , N/A ,$547.92 ,$471.82 ,$547.92 ,$547.92 ,$608.80 
ST NICHOLAS HOSPITAL - ACUTE,36030347,N/A,HC BUTZ SEPTOPLASTY,360,1 ,"$1,024.00 ",$512.00 ,$512.00 ,"$1,024.00 ", N/A , N/A , N/A , N/A ,$614.40 ,$870.40 ,$716.80 , N/A ,$972.80 ,$778.24 ,$768.00 , N/A ,$870.40 , N/A , N/A , N/A ,$716.80 , N/A , N/A , N/A , N/A ,$870.40 , N/A ,$942.08 ,$716.80 ,$519.37 ,$623.31 ,$623.62 ,$623.31 ,$707.58 ,$921.60 ,$713.22 , N/A ,$808.96 , N/A , N/A , N/A , N/A , N/A ,$737.28 ,$634.88 ,$737.28 ,$737.28 ,$819.20 
ST NICHOLAS HOSPITAL - ACUTE,36030348,N/A,HC BUTZ THIGH LIFT (BILATERAL),360,1 ,"$1,654.00 ",$827.00 ,$827.00 ,"$1,654.00 ", N/A , N/A , N/A , N/A ,$992.40 ,"$1,405.90 ","$1,157.80 ", N/A ,"$1,571.30 ","$1,257.04 ","$1,240.50 ", N/A ,"$1,405.90 ", N/A , N/A , N/A ,"$1,157.80 ", N/A , N/A , N/A , N/A ,"$1,405.90 ", N/A ,"$1,521.68 ","$1,157.80 ",$838.91 ,"$1,006.79 ","$1,007.29 ","$1,006.79 ","$1,142.91 ","$1,488.60 ","$1,152.01 ", N/A ,"$1,306.66 ", N/A , N/A , N/A , N/A , N/A ,"$1,190.88 ","$1,025.48 ","$1,190.88 ","$1,190.88 ","$1,323.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030349,N/A,HC BUTZ TORSOPLASTY FULL,360,1 ,"$2,284.00 ","$1,142.00 ","$1,142.00 ","$2,284.00 ", N/A , N/A , N/A , N/A ,"$1,370.40 ","$1,941.40 ","$1,598.80 ", N/A ,"$2,169.80 ","$1,735.84 ","$1,713.00 ", N/A ,"$1,941.40 ", N/A , N/A , N/A ,"$1,598.80 ", N/A , N/A , N/A , N/A ,"$1,941.40 ", N/A ,"$2,101.28 ","$1,598.80 ","$1,158.44 ","$1,390.27 ","$1,390.96 ","$1,390.27 ","$1,578.24 ","$2,055.60 ","$1,590.81 ", N/A ,"$1,804.36 ", N/A , N/A , N/A , N/A , N/A ,"$1,644.48 ","$1,416.08 ","$1,644.48 ","$1,644.48 ","$1,827.20 "
ST NICHOLAS HOSPITAL - ACUTE,36030350,N/A,HC BUTZ TORSOPLASTY PARTIAL,360,1 ,"$1,575.00 ",$787.50 ,$787.50 ,"$1,575.00 ", N/A , N/A , N/A , N/A ,$945.00 ,"$1,338.75 ","$1,102.50 ", N/A ,"$1,496.25 ","$1,197.00 ","$1,181.25 ", N/A ,"$1,338.75 ", N/A , N/A , N/A ,"$1,102.50 ", N/A , N/A , N/A , N/A ,"$1,338.75 ", N/A ,"$1,449.00 ","$1,102.50 ",$798.84 ,$958.70 ,$959.18 ,$958.70 ,"$1,088.33 ","$1,417.50 ","$1,096.99 ", N/A ,"$1,244.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,134.00 ",$976.50 ,"$1,134.00 ","$1,134.00 ","$1,260.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030351,N/A,HC BUTZ COSMETIC ADDL 30MIN,360,1 ,$158.00 ,$79.00 ,$79.00 ,$158.00 , N/A , N/A , N/A , N/A ,$94.80 ,$134.30 ,$110.60 , N/A ,$150.10 ,$120.08 ,$118.50 , N/A ,$134.30 , N/A , N/A , N/A ,$110.60 , N/A , N/A , N/A , N/A ,$134.30 , N/A ,$145.36 ,$110.60 ,$80.14 ,$96.17 ,$96.22 ,$96.17 ,$109.18 ,$142.20 ,$110.05 , N/A ,$124.82 , N/A , N/A , N/A , N/A , N/A ,$113.76 ,$97.96 ,$113.76 ,$113.76 ,$126.40 
ST NICHOLAS HOSPITAL - ACUTE,36030400,N/A,HC REFRACTIVE LENS STANDARD,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030401,N/A,HC REFRACTIVE LENS TORIC,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030402,N/A,HC REFRACTIVE LENS MULTIFOCAL,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030403,N/A,HC DENTAL CASE PACKAGE SSC CASH ONLY,360,1 ,"$1,313.00 ",$656.50 ,$656.50 ,"$1,313.00 ", N/A , N/A , N/A , N/A ,$787.80 ,"$1,116.05 ",$919.10 , N/A ,"$1,247.35 ",$997.88 ,$984.75 , N/A ,"$1,116.05 ", N/A , N/A , N/A ,$919.10 , N/A , N/A , N/A , N/A ,"$1,116.05 ", N/A ,"$1,207.96 ",$919.10 ,$665.95 ,$799.22 ,$799.62 ,$799.22 ,$907.28 ,"$1,181.70 ",$914.50 , N/A ,"$1,037.27 ", N/A , N/A , N/A , N/A , N/A ,$945.36 ,$814.06 ,$945.36 ,$945.36 ,"$1,050.40 "
ST NICHOLAS HOSPITAL - ACUTE,36030404,N/A,HC PIGGYBACK LENS PACKAGE SSC,360,1 ,"$1,260.00 ",$630.00 ,$630.00 ,"$1,260.00 ", N/A , N/A , N/A , N/A ,$756.00 ,"$1,071.00 ",$882.00 , N/A ,"$1,197.00 ",$957.60 ,$945.00 , N/A ,"$1,071.00 ", N/A , N/A , N/A ,$882.00 , N/A , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 , N/A ,$995.40 , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,36030405,0232T,HC INJECTION PLATELET RICH PLASMA,360,1 ,$377.00 ,$188.50 ,$144.58 ,$602.10 ,$144.58 ,$377.00 ,$377.00 ,$267.60 ,$226.20 ,$320.45 ,$263.90 ,$144.58 ,$358.15 ,$286.52 ,$282.75 ,$377.00 ,$320.45 ,$267.60 ,$377.00 ,$245.05 ,$263.90 ,$144.58 ,$267.60 ,$267.60 ,$377.00 ,$320.45 ,$602.10 ,$346.84 ,$263.90 ,$377.00 ,$377.00 ,$229.59 ,$377.00 ,$260.51 ,$339.30 ,$262.58 ,$270.28 ,$297.83 ,$153.25 ,$377.00 ,$377.00 ,$267.60 ,$377.00 ,$271.44 ,$233.74 ,$271.44 ,$271.44 ,$301.60 
ST NICHOLAS HOSPITAL - ACUTE,36030406,0232T,HC INJECTION BONE MARROW,360,1 ,"$1,185.00 ",$592.50 ,$144.58 ,"$1,185.00 ",$144.58 ,"$1,185.00 ","$1,185.00 ",$267.60 ,$711.00 ,"$1,007.25 ",$829.50 ,$144.58 ,"$1,125.75 ",$900.60 ,$888.75 ,"$1,185.00 ","$1,007.25 ",$267.60 ,"$1,185.00 ",$770.25 ,$829.50 ,$144.58 ,$267.60 ,$267.60 ,"$1,185.00 ","$1,007.25 ",$602.10 ,"$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$270.28 ,$936.15 ,$153.25 ,"$1,185.00 ","$1,185.00 ",$267.60 ,"$1,185.00 ",$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,36040025,N/A,HC SURGICAL SUITE PER 15 MINS,360,1 ,"$1,050.00 ",$525.00 ,$525.00 ,"$1,050.00 ", N/A , N/A , N/A , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$798.00 ,$787.50 , N/A ,$892.50 , N/A , N/A , N/A ,$735.00 , N/A , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$639.14 ,$725.55 ,$945.00 ,$731.33 , N/A ,$829.50 , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$840.00 
ST NICHOLAS HOSPITAL - ACUTE,36040027,N/A,HC SURGICAL PROCEDURE PER 15 MINS CATH/RAD ONC,360,1 ,"$1,050.00 ",$525.00 ,$525.00 ,"$1,050.00 ", N/A , N/A , N/A , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$798.00 ,$787.50 , N/A ,$892.50 , N/A , N/A , N/A ,$735.00 , N/A , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$639.14 ,$725.55 ,$945.00 ,$731.33 , N/A ,$829.50 , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$840.00 
ST NICHOLAS HOSPITAL - ACUTE,36050178,N/A,HC LITHOTRIPSY SHOCKWAVE,360,1 ,"$4,500.00 ","$2,250.00 ","$2,250.00 ","$4,500.00 ", N/A , N/A , N/A , N/A ,"$2,700.00 ","$3,825.00 ","$3,150.00 ", N/A ,"$4,275.00 ","$3,420.00 ","$3,375.00 ", N/A ,"$3,825.00 ", N/A , N/A , N/A ,"$3,150.00 ", N/A , N/A , N/A , N/A ,"$3,825.00 ", N/A ,"$4,140.00 ","$3,150.00 ","$2,282.40 ","$2,739.15 ","$2,740.50 ","$2,739.15 ","$3,109.50 ","$4,050.00 ","$3,134.25 ", N/A ,"$3,555.00 ", N/A , N/A , N/A , N/A , N/A ,"$3,240.00 ","$2,790.00 ","$3,240.00 ","$3,240.00 ","$3,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,36050640,N/A,HC LASER FOR CATARACT SURGERY,360,1 ,$611.00 ,$305.50 ,$305.50 ,$611.00 , N/A , N/A , N/A , N/A ,$366.60 ,$519.35 ,$427.70 , N/A ,$580.45 ,$464.36 ,$458.25 , N/A ,$519.35 , N/A , N/A , N/A ,$427.70 , N/A , N/A , N/A , N/A ,$519.35 , N/A ,$562.12 ,$427.70 ,$309.90 ,$371.92 ,$372.10 ,$371.92 ,$422.20 ,$549.90 ,$425.56 , N/A ,$482.69 , N/A , N/A , N/A , N/A , N/A ,$439.92 ,$378.82 ,$439.92 ,$439.92 ,$488.80 
ST NICHOLAS HOSPITAL - ACUTE,36060001,N/A,HC OR LEVEL 1 BASE,360,1 ,"$3,780.00 ","$1,890.00 ","$1,890.00 ","$3,780.00 ", N/A , N/A , N/A , N/A ,"$2,268.00 ","$3,213.00 ","$2,646.00 ", N/A ,"$3,591.00 ","$2,872.80 ","$2,835.00 ", N/A ,"$3,213.00 ", N/A , N/A , N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A ,"$3,213.00 ", N/A ,"$3,477.60 ","$2,646.00 ","$1,917.22 ","$2,300.89 ","$2,302.02 ","$2,300.89 ","$2,611.98 ","$3,402.00 ","$2,632.77 ", N/A ,"$2,986.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$3,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,36060002,N/A,HC OR LEVEL 2 BASE,360,1 ,"$5,460.00 ","$2,730.00 ","$2,730.00 ","$5,460.00 ", N/A , N/A , N/A , N/A ,"$3,276.00 ","$4,641.00 ","$3,822.00 ", N/A ,"$5,187.00 ","$4,149.60 ","$4,095.00 ", N/A ,"$4,641.00 ", N/A , N/A , N/A ,"$3,822.00 ", N/A , N/A , N/A , N/A ,"$4,641.00 ", N/A ,"$5,023.20 ","$3,822.00 ","$2,769.31 ","$3,323.50 ","$3,325.14 ","$3,323.50 ","$3,772.86 ","$4,914.00 ","$3,802.89 ", N/A ,"$4,313.40 ", N/A , N/A , N/A , N/A , N/A ,"$3,931.20 ","$3,385.20 ","$3,931.20 ","$3,931.20 ","$4,368.00 "
ST NICHOLAS HOSPITAL - ACUTE,36060003,N/A,HC OR LEVEL 3 BASE,360,1 ,"$7,035.00 ","$3,517.50 ","$3,517.50 ","$7,035.00 ", N/A , N/A , N/A , N/A ,"$4,221.00 ","$5,979.75 ","$4,924.50 ", N/A ,"$6,683.25 ","$5,346.60 ","$5,276.25 ", N/A ,"$5,979.75 ", N/A , N/A , N/A ,"$4,924.50 ", N/A , N/A , N/A , N/A ,"$5,979.75 ", N/A ,"$6,472.20 ","$4,924.50 ","$3,568.15 ","$4,282.20 ","$4,284.32 ","$4,282.20 ","$4,861.19 ","$6,331.50 ","$4,899.88 ", N/A ,"$5,557.65 ", N/A , N/A , N/A , N/A , N/A ,"$5,065.20 ","$4,361.70 ","$5,065.20 ","$5,065.20 ","$5,628.00 "
ST NICHOLAS HOSPITAL - ACUTE,36060004,N/A,HC OR LEVEL 4 BASE,360,1 ,"$9,765.00 ","$4,882.50 ","$4,882.50 ","$9,765.00 ", N/A , N/A , N/A , N/A ,"$5,859.00 ","$8,300.25 ","$6,835.50 ", N/A ,"$9,276.75 ","$7,421.40 ","$7,323.75 ", N/A ,"$8,300.25 ", N/A , N/A , N/A ,"$6,835.50 ", N/A , N/A , N/A , N/A ,"$8,300.25 ", N/A ,"$8,983.80 ","$6,835.50 ","$4,952.81 ","$5,943.96 ","$5,946.89 ","$5,943.96 ","$6,747.62 ","$8,788.50 ","$6,801.32 ", N/A ,"$7,714.35 ", N/A , N/A , N/A , N/A , N/A ,"$7,030.80 ","$6,054.30 ","$7,030.80 ","$7,030.80 ","$7,812.00 "
ST NICHOLAS HOSPITAL - ACUTE,36060005,N/A,HC OR LEVEL 5 BASE,360,1 ,"$11,550.00 ","$5,775.00 ","$5,775.00 ","$11,550.00 ", N/A , N/A , N/A , N/A ,"$6,930.00 ","$9,817.50 ","$8,085.00 ", N/A ,"$10,972.50 ","$8,778.00 ","$8,662.50 ", N/A ,"$9,817.50 ", N/A , N/A , N/A ,"$8,085.00 ", N/A , N/A , N/A , N/A ,"$9,817.50 ", N/A ,"$10,626.00 ","$8,085.00 ","$5,858.16 ","$7,030.49 ","$7,033.95 ","$7,030.49 ","$7,981.05 ","$10,395.00 ","$8,044.58 ", N/A ,"$9,124.50 ", N/A , N/A , N/A , N/A , N/A ,"$8,316.00 ","$7,161.00 ","$8,316.00 ","$8,316.00 ","$9,240.00 "
ST NICHOLAS HOSPITAL - ACUTE,36060006,N/A,HC OR LEVEL 6 BASE,360,1 ,"$14,700.00 ","$7,350.00 ","$7,350.00 ","$14,700.00 ", N/A , N/A , N/A , N/A ,"$8,820.00 ","$12,495.00 ","$10,290.00 ", N/A ,"$13,965.00 ","$11,172.00 ","$11,025.00 ", N/A ,"$12,495.00 ", N/A , N/A , N/A ,"$10,290.00 ", N/A , N/A , N/A , N/A ,"$12,495.00 ", N/A ,"$13,524.00 ","$10,290.00 ","$7,455.84 ","$8,947.89 ","$8,952.30 ","$8,947.89 ","$10,157.70 ","$13,230.00 ","$10,238.55 ", N/A ,"$11,613.00 ", N/A , N/A , N/A , N/A , N/A ,"$10,584.00 ","$9,114.00 ","$10,584.00 ","$10,584.00 ","$11,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,36060007,N/A,HC OR LEVEL 1 PER MIN,360,1 ,$15.75 ,$7.88 ,$7.88 ,$15.75 , N/A , N/A , N/A , N/A ,$9.45 ,$13.39 ,$11.03 , N/A ,$14.96 ,$11.97 ,$11.81 , N/A ,$13.39 , N/A , N/A , N/A ,$11.03 , N/A , N/A , N/A , N/A ,$13.39 , N/A ,$14.49 ,$11.03 ,$7.99 ,$9.59 ,$9.59 ,$9.59 ,$10.88 ,$14.18 ,$10.97 , N/A ,$12.44 , N/A , N/A , N/A , N/A , N/A ,$11.34 ,$9.77 ,$11.34 ,$11.34 ,$12.60 
ST NICHOLAS HOSPITAL - ACUTE,36060008,N/A,HC OR LEVEL 2 PER MIN,360,1 ,$38.00 ,$19.00 ,$19.00 ,$38.00 , N/A , N/A , N/A , N/A ,$22.80 ,$32.30 ,$26.60 , N/A ,$36.10 ,$28.88 ,$28.50 , N/A ,$32.30 , N/A , N/A , N/A ,$26.60 , N/A , N/A , N/A , N/A ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$23.13 ,$26.26 ,$34.20 ,$26.47 , N/A ,$30.02 , N/A , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$30.40 
ST NICHOLAS HOSPITAL - ACUTE,36060009,N/A,HC OR LEVEL 3 PER MIN,360,1 ,$53.00 ,$26.50 ,$26.50 ,$53.00 , N/A , N/A , N/A , N/A ,$31.80 ,$45.05 ,$37.10 , N/A ,$50.35 ,$40.28 ,$39.75 , N/A ,$45.05 , N/A , N/A , N/A ,$37.10 , N/A , N/A , N/A , N/A ,$45.05 , N/A ,$48.76 ,$37.10 ,$26.88 ,$32.26 ,$32.28 ,$32.26 ,$36.62 ,$47.70 ,$36.91 , N/A ,$41.87 , N/A , N/A , N/A , N/A , N/A ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,36060010,N/A,HC OR LEVEL 4 PER MIN,360,1 ,$84.00 ,$42.00 ,$42.00 ,$84.00 , N/A , N/A , N/A , N/A ,$50.40 ,$71.40 ,$58.80 , N/A ,$79.80 ,$63.84 ,$63.00 , N/A ,$71.40 , N/A , N/A , N/A ,$58.80 , N/A , N/A , N/A , N/A ,$71.40 , N/A ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$51.13 ,$58.04 ,$75.60 ,$58.51 , N/A ,$66.36 , N/A , N/A , N/A , N/A , N/A ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,36060011,N/A,HC OR LEVEL 5 PER MIN,360,1 ,$95.00 ,$47.50 ,$47.50 ,$95.00 , N/A , N/A , N/A , N/A ,$57.00 ,$80.75 ,$66.50 , N/A ,$90.25 ,$72.20 ,$71.25 , N/A ,$80.75 , N/A , N/A , N/A ,$66.50 , N/A , N/A , N/A , N/A ,$80.75 , N/A ,$87.40 ,$66.50 ,$48.18 ,$57.83 ,$57.86 ,$57.83 ,$65.65 ,$85.50 ,$66.17 , N/A ,$75.05 , N/A , N/A , N/A , N/A , N/A ,$68.40 ,$58.90 ,$68.40 ,$68.40 ,$76.00 
ST NICHOLAS HOSPITAL - ACUTE,36060012,N/A,HC OR LEVEL 6 PER MIN,360,1 ,$105.00 ,$52.50 ,$52.50 ,$105.00 , N/A , N/A , N/A , N/A ,$63.00 ,$89.25 ,$73.50 , N/A ,$99.75 ,$79.80 ,$78.75 , N/A ,$89.25 , N/A , N/A , N/A ,$73.50 , N/A , N/A , N/A , N/A ,$89.25 , N/A ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$73.13 , N/A ,$82.95 , N/A , N/A , N/A , N/A , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,$809.00 ,$404.50 ,$136.73 ,$809.00 ,$136.73 ,$809.00 ,$809.00 ,$257.61 ,$485.40 ,$687.65 ,$566.30 ,$136.73 ,$768.55 ,$614.84 ,$606.75 ,$809.00 ,$687.65 ,$257.61 ,$809.00 ,$809.00 ,$566.30 ,$136.73 ,$257.61 ,$257.61 ,$809.00 ,$687.65 ,$579.62 ,$744.28 ,$566.30 ,$809.00 ,$809.00 ,$492.68 ,$809.00 ,$559.02 ,$728.10 ,$563.47 ,$260.19 ,$639.11 ,$144.93 ,$809.00 ,$809.00 ,$257.61 ,$809.00 ,$582.48 ,$501.58 ,$582.48 ,$582.48 ,$647.20 
ST NICHOLAS HOSPITAL - ACUTE,36100001,47537,HC REM BIL CATH W G SI CHOLANG,361,1 ,"$1,500.00 ",$750.00 ,$62.73 ,"$1,795.12 ",$62.73 ,"$1,500.00 ","$1,500.00 ",$797.83 ,$900.00 ,"$1,275.00 ","$1,050.00 ",$62.73 ,"$1,425.00 ","$1,140.00 ","$1,125.00 ","$1,500.00 ","$1,275.00 ",$797.83 ,"$1,500.00 ",$975.00 ,"$1,050.00 ",$62.73 ,$797.83 ,$797.83 ,"$1,500.00 ","$1,275.00 ","$1,795.12 ","$1,380.00 ","$1,050.00 ","$1,500.00 ","$1,500.00 ",$913.50 ,"$1,500.00 ","$1,036.50 ","$1,350.00 ","$1,044.75 ",$805.81 ,"$1,185.00 ",$66.49 ,"$1,500.00 ","$1,500.00 ",$797.83 ,"$1,500.00 ","$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ","$1,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100002,47538,HC PLC BILE SNT W G SI EX/REMOVAL CHOLANG,361,1 ,"$8,295.00 ","$4,147.50 ",$791.20 ,"$11,225.46 ",$791.20 ,"$8,295.00 ","$8,295.00 ","$4,989.09 ","$4,977.00 ","$7,050.75 ","$5,806.50 ",$791.20 ,"$7,880.25 ","$6,304.20 ","$6,221.25 ","$6,993.00 ","$7,050.75 ","$4,989.09 ","$6,993.00 ","$5,391.75 ","$5,806.50 ",$791.20 ,"$4,989.09 ","$4,989.09 ","$7,919.86 ","$7,050.75 ","$11,225.46 ","$7,631.40 ","$5,806.50 ","$4,794.94 ","$5,993.67 ","$5,051.66 ","$5,993.67 ","$5,731.85 ","$7,465.50 ","$5,777.47 ","$5,038.98 ","$6,553.05 ",$838.67 ,"$8,295.00 ","$8,295.00 ","$4,989.09 ","$8,295.00 ","$5,972.40 ","$5,142.90 ","$5,972.40 ","$5,972.40 ","$6,636.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100003,47540,HC PLC BILE SNT W GD SI  NEW ACCESS,361,1 ,"$10,000.00 ","$5,000.00 ","$2,004.41 ","$11,225.46 ","$2,004.41 ","$10,000.00 ","$9,468.00 ","$4,989.09 ","$6,000.00 ","$8,500.00 ","$7,000.00 ","$2,004.41 ","$9,500.00 ","$7,600.00 ","$7,500.00 ","$6,993.00 ","$8,500.00 ","$4,989.09 ","$6,993.00 ","$6,500.00 ","$7,000.00 ","$2,004.41 ","$4,989.09 ","$4,989.09 ","$7,919.86 ","$8,500.00 ","$11,225.46 ","$9,200.00 ","$7,000.00 ","$3,147.60 ","$3,934.50 ","$6,090.00 ","$3,934.50 ","$6,910.00 ","$9,000.00 ","$6,965.00 ","$5,038.98 ","$7,900.00 ","$2,124.67 ","$8,832.00 ","$8,832.00 ","$4,989.09 ","$8,832.00 ","$7,200.00 ","$6,200.00 ","$7,200.00 ","$7,200.00 ","$8,000.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100004,50430,HC INJ NEPH URET W G SI NEW ACCESS,361,1 ,"$2,016.00 ","$1,008.00 ",$119.36 ,"$4,208.70 ",$119.36 ,"$2,016.00 ","$2,016.00 ",$567.25 ,"$1,209.60 ","$1,713.60 ","$1,411.20 ",$119.36 ,"$1,915.20 ","$1,532.16 ","$1,512.00 ","$2,016.00 ","$1,713.60 ",$567.25 ,"$2,016.00 ","$1,310.40 ","$1,411.20 ",$119.36 ,$567.25 ,$567.25 ,"$1,697.11 ","$1,713.60 ","$1,276.32 ","$1,854.72 ","$1,411.20 ","$3,367.17 ","$4,208.70 ","$1,227.74 ","$4,208.70 ","$1,393.06 ","$1,814.40 ","$1,404.14 ",$572.92 ,"$1,592.64 ",$126.52 ,"$2,016.00 ","$2,016.00 ",$567.25 ,"$2,016.00 ","$1,451.52 ","$1,249.92 ","$1,451.52 ","$1,451.52 ","$1,612.80 "
ST NICHOLAS HOSPITAL - ACUTE,36100005,50433,HC PL NEPH CAT W GD S AND I NEW ACCESS,361,1 ,"$6,400.00 ","$3,200.00 ",$924.12 ,"$6,820.92 ",$924.12 ,"$4,138.00 ","$3,641.00 ","$3,031.52 ","$3,840.00 ","$5,440.00 ","$4,480.00 ",$924.12 ,"$6,080.00 ","$4,864.00 ","$4,800.00 ","$6,400.00 ","$5,440.00 ","$3,031.52 ","$6,400.00 ","$4,160.00 ","$4,480.00 ",$924.12 ,"$3,031.52 ","$3,031.52 ","$4,525.63 ","$5,440.00 ","$6,820.92 ","$5,888.00 ","$4,480.00 ","$1,921.55 ","$2,401.67 ","$3,897.60 ","$2,401.67 ","$4,422.40 ","$5,760.00 ","$4,457.60 ","$3,061.84 ","$5,056.00 ",$979.57 ,"$5,058.00 ","$5,058.00 ","$3,031.52 ","$5,058.00 ","$4,608.00 ","$3,968.00 ","$4,608.00 ","$4,608.00 ","$5,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100006,50434,HC CONVERT NEPH CTH NEPHUR CTH WG S AND I EXST TRACT,361,1 ,"$6,600.00 ","$3,300.00 ",$474.08 ,"$6,600.00 ",$474.08 ,"$4,138.00 ","$3,641.00 ","$1,765.45 ","$3,960.00 ","$5,610.00 ","$4,620.00 ",$474.08 ,"$6,270.00 ","$5,016.00 ","$4,950.00 ","$6,600.00 ","$5,610.00 ","$1,765.45 ","$6,600.00 ","$4,290.00 ","$4,620.00 ",$474.08 ,"$1,765.45 ","$1,765.45 ","$2,489.10 ","$5,610.00 ","$3,972.27 ","$6,072.00 ","$4,620.00 ","$1,921.55 ","$2,401.67 ","$4,019.40 ","$2,401.67 ","$4,560.60 ","$5,940.00 ","$4,596.90 ","$1,783.10 ","$5,214.00 ",$502.52 ,"$2,687.00 ","$2,687.00 ","$1,765.45 ","$2,687.00 ","$4,752.00 ","$4,092.00 ","$4,752.00 ","$4,752.00 ","$5,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100007,50606,HC ENDO BX URETER/RENAL PELVIS W/G SI,361,1 ,$470.00 ,$235.00 ,$235.00 ,"$2,308.92 ","$2,178.23 ",$470.00 ,$470.00 , N/A ,$282.00 ,$399.50 ,$329.00 ,"$2,178.23 ",$446.50 ,$357.20 ,$352.50 ,$470.00 ,$399.50 , N/A ,$470.00 ,$305.50 ,$329.00 ,"$2,178.23 ", N/A , N/A ,$470.00 ,$399.50 , N/A ,$432.40 ,$329.00 ,"$1,703.02 ","$2,128.52 ",$286.23 ,"$2,128.52 ",$324.77 ,$423.00 ,$327.36 , N/A ,$371.30 ,"$2,308.92 ",$470.00 ,$470.00 , N/A ,$470.00 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$376.00 
ST NICHOLAS HOSPITAL - ACUTE,36100008,50694,HC PL URT STNT W G SI NEW ACCESS WO NEPH CATH,361,1 ,"$6,033.00 ","$3,016.50 ",$924.12 ,"$6,820.92 ",$924.12 ,"$6,033.00 ","$6,033.00 ","$3,031.52 ","$3,619.80 ","$5,128.05 ","$4,223.10 ",$924.12 ,"$5,731.35 ","$4,585.08 ","$4,524.75 ","$6,033.00 ","$5,128.05 ","$3,031.52 ","$6,033.00 ","$3,921.45 ","$4,223.10 ",$924.12 ,"$3,031.52 ","$3,031.52 ","$5,657.04 ","$5,128.05 ","$6,820.92 ","$5,550.36 ","$4,223.10 ","$1,921.55 ","$2,401.67 ","$3,674.10 ","$2,401.67 ","$4,168.80 ","$5,429.70 ","$4,201.98 ","$3,061.84 ","$4,766.07 ",$979.57 ,"$6,033.00 ","$6,033.00 ","$3,031.52 ","$6,033.00 ","$4,343.76 ","$3,740.46 ","$4,343.76 ","$4,343.76 ","$4,826.40 "
ST NICHOLAS HOSPITAL - ACUTE,36100009,50695,HC PL URT STNT W G SI NEW ACCESS WITH NEPH CATH,361,1 ,"$19,392.00 ","$9,696.00 ",$924.12 ,"$19,392.00 ",$924.12 ,"$7,426.00 ","$6,763.00 ","$3,031.52 ","$11,635.20 ","$16,483.20 ","$13,574.40 ",$924.12 ,"$18,422.40 ","$14,737.92 ","$14,544.00 ","$6,993.00 ","$16,483.20 ","$3,031.52 ","$6,993.00 ","$12,604.80 ","$13,574.40 ",$924.12 ,"$3,031.52 ","$3,031.52 ","$5,657.04 ","$16,483.20 ","$6,820.92 ","$17,840.64 ","$13,574.40 ","$3,147.60 ","$3,934.50 ","$11,809.73 ","$3,934.50 ","$13,399.87 ","$17,452.80 ","$13,506.53 ","$3,061.84 ","$15,319.68 ",$979.57 ,"$6,651.00 ","$6,651.00 ","$3,031.52 ","$6,651.00 ","$13,962.24 ","$12,023.04 ","$13,962.24 ","$13,962.24 ","$15,513.60 "
ST NICHOLAS HOSPITAL - ACUTE,36100010,50705,HC URETERAL EMBOL OR OCCLUSION W/G SI,361,1 ,$400.00 ,$200.00 ,$200.00 ,"$2,308.92 ","$2,178.23 ",$400.00 ,$400.00 , N/A ,$240.00 ,$340.00 ,$280.00 ,"$2,178.23 ",$380.00 ,$304.00 ,$300.00 ,$400.00 ,$340.00 , N/A ,$400.00 ,$260.00 ,$280.00 ,"$2,178.23 ", N/A , N/A ,$400.00 ,$340.00 , N/A ,$368.00 ,$280.00 ,"$1,703.02 ","$2,128.52 ",$243.60 ,"$2,128.52 ",$276.40 ,$360.00 ,$278.60 , N/A ,$316.00 ,"$2,308.92 ",$400.00 ,$400.00 , N/A ,$400.00 ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$320.00 
ST NICHOLAS HOSPITAL - ACUTE,36100011,49185,HC SCLEROTHERAPY FLUID COLLECTION PERC INJECT IG SI,361,1 ,"$2,586.00 ","$1,293.00 ",$232.13 ,"$2,586.00 ",$232.13 ,"$2,586.00 ","$2,081.00 ",$613.58 ,"$1,551.60 ","$2,198.10 ","$1,810.20 ",$232.13 ,"$2,456.70 ","$1,965.36 ","$1,939.50 ","$2,586.00 ","$2,198.10 ",$613.58 ,"$2,586.00 ","$1,680.90 ","$1,810.20 ",$232.13 ,$613.58 ,$613.58 ,"$2,489.10 ","$2,198.10 ","$1,380.55 ","$2,379.12 ","$1,810.20 ","$1,703.02 ","$2,128.52 ","$1,574.87 ","$2,128.52 ","$1,786.93 ","$2,327.40 ","$1,801.15 ",$619.72 ,"$2,042.94 ",$246.06 ,"$2,586.00 ","$2,586.00 ",$613.58 ,"$2,586.00 ","$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$2,068.80 "
ST NICHOLAS HOSPITAL - ACUTE,36100012,50706,HC BALLOON DILATION URETERAL IG SI,361,1 ,$580.00 ,$290.00 ,$290.00 ,"$2,401.67 ","$2,178.23 ",$580.00 ,$580.00 , N/A ,$348.00 ,$493.00 ,$406.00 ,"$2,178.23 ",$551.00 ,$440.80 ,$435.00 ,$580.00 ,$493.00 , N/A ,$580.00 ,$377.00 ,$406.00 ,"$2,178.23 ", N/A , N/A ,$580.00 ,$493.00 , N/A ,$533.60 ,$406.00 ,"$1,921.55 ","$2,401.67 ",$353.22 ,"$2,401.67 ",$400.78 ,$522.00 ,$403.97 , N/A ,$458.20 ,"$2,308.92 ",$580.00 ,$580.00 , N/A ,$580.00 ,$417.60 ,$359.60 ,$417.60 ,$417.60 ,$464.00 
ST NICHOLAS HOSPITAL - ACUTE,36100013,47541,HC PLCMENT ACCESS BILIARY TREE BOWEL PERC IG SI,361,1 ,"$4,400.00 ","$2,200.00 ","$1,703.02 ","$7,058.37 ","$2,004.41 ","$4,400.00 ","$4,400.00 ","$3,137.05 ","$2,640.00 ","$3,740.00 ","$3,080.00 ","$2,004.41 ","$4,180.00 ","$3,344.00 ","$3,300.00 ","$4,400.00 ","$3,740.00 ","$3,137.05 ","$4,400.00 ","$2,860.00 ","$3,080.00 ","$2,004.41 ","$3,137.05 ","$3,137.05 ","$4,400.00 ","$3,740.00 ","$7,058.37 ","$4,048.00 ","$3,080.00 ","$1,703.02 ","$2,128.52 ","$2,679.60 ","$2,128.52 ","$3,040.40 ","$3,960.00 ","$3,064.60 ","$3,168.42 ","$3,476.00 ","$2,124.67 ","$4,400.00 ","$4,400.00 ","$3,137.05 ","$4,400.00 ","$3,168.00 ","$2,728.00 ","$3,168.00 ","$3,168.00 ","$3,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100024,G0259,HC INJ ARTHROGRAM SACROILIAC JNT,361,1 ,"$1,616.00 ",$808.00 ,$154.70 ,"$1,616.00 ",$154.70 , N/A , N/A , N/A ,$969.60 ,"$1,373.60 ","$1,131.20 ",$154.70 ,"$1,535.20 ","$1,228.16 ","$1,212.00 ","$1,616.00 ","$1,373.60 ", N/A ,"$1,616.00 ","$1,050.40 ","$1,131.20 ",$154.70 , N/A , N/A , N/A ,"$1,373.60 ", N/A ,"$1,486.72 ","$1,131.20 ",$819.64 ,$983.66 ,$984.14 ,$983.66 ,"$1,116.66 ","$1,454.40 ","$1,125.54 ", N/A ,"$1,276.64 ",$163.98 ,"$1,616.00 ","$1,616.00 ", N/A ,"$1,616.00 ","$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ","$1,292.80 "
ST NICHOLAS HOSPITAL - ACUTE,36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,408.74 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$626.11 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ",$626.11 ,"$1,293.00 ",$840.45 ,$905.10 ,$268.66 ,$626.11 ,$626.11 ,"$1,293.00 ","$1,099.05 ","$1,408.74 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,$632.37 ,"$1,021.47 ",$284.78 ,"$1,293.00 ","$1,293.00 ",$626.11 ,"$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$2,047.00 ","$1,023.50 ",$268.66 ,"$2,047.00 ",$268.66 ,"$2,047.00 ","$2,047.00 ",$626.11 ,"$1,228.20 ","$1,739.95 ","$1,432.90 ",$268.66 ,"$1,944.65 ","$1,555.72 ","$1,535.25 ","$2,047.00 ","$1,739.95 ",$626.11 ,"$2,047.00 ","$1,330.55 ","$1,432.90 ",$268.66 ,$626.11 ,$626.11 ,"$2,047.00 ","$1,739.95 ","$1,408.74 ","$1,883.24 ","$1,432.90 ","$1,703.02 ","$2,047.00 ","$1,246.62 ","$2,047.00 ","$1,414.48 ","$1,842.30 ","$1,425.74 ",$632.37 ,"$1,617.13 ",$284.78 ,"$2,047.00 ","$2,047.00 ",$626.11 ,"$2,047.00 ","$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,637.60 "
ST NICHOLAS HOSPITAL - ACUTE,36100102,62322,HC INJ INTRLAMNR LUM/SAC W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,408.74 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$626.11 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ",$626.11 ,"$1,293.00 ",$840.45 ,$905.10 ,$268.66 ,$626.11 ,$626.11 ,"$1,293.00 ","$1,099.05 ","$1,408.74 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,$632.37 ,"$1,021.47 ",$284.78 ,"$1,293.00 ","$1,293.00 ",$626.11 ,"$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$1,616.00 ",$808.00 ,$268.66 ,"$1,616.00 ",$268.66 ,"$1,616.00 ","$1,616.00 ",$626.11 ,$969.60 ,"$1,373.60 ","$1,131.20 ",$268.66 ,"$1,535.20 ","$1,228.16 ","$1,212.00 ","$1,616.00 ","$1,373.60 ",$626.11 ,"$1,616.00 ","$1,050.40 ","$1,131.20 ",$268.66 ,$626.11 ,$626.11 ,"$1,616.00 ","$1,373.60 ","$1,408.74 ","$1,486.72 ","$1,131.20 ","$1,616.00 ","$1,616.00 ",$984.14 ,"$1,616.00 ","$1,116.66 ","$1,454.40 ","$1,125.54 ",$632.37 ,"$1,276.64 ",$284.78 ,"$1,616.00 ","$1,616.00 ",$626.11 ,"$1,616.00 ","$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ","$1,292.80 "
ST NICHOLAS HOSPITAL - ACUTE,36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,826.27 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$811.67 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ",$811.67 ,"$1,293.00 ",$840.45 ,$905.10 ,$268.66 ,$811.67 ,$811.67 ,"$1,293.00 ","$1,099.05 ","$1,826.27 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,"$1,163.70 ",$900.57 ,$819.79 ,"$1,021.47 ",$284.78 ,"$1,293.00 ","$1,293.00 ",$811.67 ,"$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36100107,62327,HC INJ W/CATH LUM/SAC W/GUIDE,361,1 ,"$1,616.00 ",$808.00 ,$268.66 ,"$1,826.27 ",$268.66 ,"$1,616.00 ","$1,616.00 ",$811.67 ,$969.60 ,"$1,373.60 ","$1,131.20 ",$268.66 ,"$1,535.20 ","$1,228.16 ","$1,212.00 ","$1,616.00 ","$1,373.60 ",$811.67 ,"$1,616.00 ","$1,050.40 ","$1,131.20 ",$268.66 ,$811.67 ,$811.67 ,"$1,616.00 ","$1,373.60 ","$1,826.27 ","$1,486.72 ","$1,131.20 ","$1,616.00 ","$1,616.00 ",$984.14 ,"$1,616.00 ","$1,116.66 ","$1,454.40 ","$1,125.54 ",$819.79 ,"$1,276.64 ",$284.78 ,"$1,616.00 ","$1,616.00 ",$811.67 ,"$1,616.00 ","$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ","$1,292.80 "
ST NICHOLAS HOSPITAL - ACUTE,36100108,29445,HC APPL CAST LEG RIGID CONTACT -BIL,361,1 ,"$1,002.00 ",$501.00 ,$88.73 ,"$1,002.00 ",$88.73 ,"$1,002.00 ","$1,002.00 ",$356.80 ,$601.20 ,$851.70 ,$701.40 ,$88.73 ,$951.90 ,$761.52 ,$751.50 ,"$1,002.00 ",$851.70 ,$356.80 ,"$1,002.00 ","$1,002.00 ",$701.40 ,$88.73 ,$356.80 ,$356.80 ,"$1,002.00 ",$851.70 ,$802.79 ,$921.84 ,$701.40 ,"$1,002.00 ","$1,002.00 ",$610.22 ,"$1,002.00 ",$692.38 ,$901.80 ,$697.89 ,$360.37 ,$791.58 ,$94.05 ,"$1,002.00 ","$1,002.00 ",$356.80 ,"$1,002.00 ",$721.44 ,$621.24 ,$721.44 ,$721.44 ,$801.60 
ST NICHOLAS HOSPITAL - ACUTE,36100135,31625,HC BRONCHOSCOPY BX SGL/MULT SITES,361,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,319.18 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$1,475.19 ","$2,900.00 ","$2,900.00 ","$2,030.00 ",$515.71 ,"$1,475.19 ","$1,475.19 ","$2,489.10 ","$2,465.00 ","$3,319.18 ","$2,668.00 ","$2,030.00 ","$1,921.55 ","$2,401.67 ","$1,766.10 ","$2,401.67 ","$2,003.90 ","$2,610.00 ","$2,019.85 ","$1,489.94 ","$2,291.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100136,31627,HC BRONCHOSCOPY NAVAGATIONAL,361,1 ,"$2,900.00 ","$1,450.00 ",$56.46 ,"$2,900.00 ",$56.46 ,"$2,900.00 ","$2,900.00 ", N/A ,"$1,740.00 ","$2,465.00 ","$2,030.00 ",$56.46 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ", N/A ,"$2,900.00 ","$1,885.00 ","$2,030.00 ",$56.46 , N/A , N/A ,"$2,900.00 ","$2,465.00 ", N/A ,"$2,668.00 ","$2,030.00 ","$1,921.55 ","$2,401.67 ","$1,766.10 ","$2,401.67 ","$2,003.90 ","$2,610.00 ","$2,019.85 ", N/A ,"$2,291.00 ",$59.85 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100137,31629,HC BRONCHOSCOPY W/ASP BX TRANSHC BRONCH,361,1 ,"$3,200.00 ","$1,600.00 ",$515.71 ,"$6,872.06 ",$515.71 ,"$3,200.00 ","$3,200.00 ","$3,054.25 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$515.71 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$3,054.25 ","$3,200.00 ","$3,200.00 ","$2,240.00 ",$515.71 ,"$3,054.25 ","$3,054.25 ","$3,200.00 ","$2,720.00 ","$6,872.06 ","$2,944.00 ","$2,240.00 ","$1,921.55 ","$2,401.67 ","$1,948.80 ","$2,401.67 ","$2,211.20 ","$2,880.00 ","$2,228.80 ","$3,084.79 ","$2,528.00 ",$546.65 ,"$3,200.00 ","$3,200.00 ","$3,054.25 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100140,31623,HC BRONCHOSCOPY W/BRUSHING,361,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,319.18 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$1,475.19 ","$2,900.00 ","$2,900.00 ","$2,030.00 ",$515.71 ,"$1,475.19 ","$1,475.19 ","$2,489.10 ","$2,465.00 ","$3,319.18 ","$2,668.00 ","$2,030.00 ","$1,921.55 ","$2,401.67 ","$1,766.10 ","$2,401.67 ","$2,003.90 ","$2,610.00 ","$2,019.85 ","$1,489.94 ","$2,291.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100141,31628,HC BRONCHOSCOPY W/BX TRANSHC BRONCH SGL,361,1 ,"$3,200.00 ","$1,600.00 ",$515.71 ,"$6,872.06 ",$515.71 ,"$3,200.00 ","$3,200.00 ","$3,054.25 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$515.71 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$3,054.25 ","$3,200.00 ","$3,200.00 ","$2,240.00 ",$515.71 ,"$3,054.25 ","$3,054.25 ","$3,200.00 ","$2,720.00 ","$6,872.06 ","$2,944.00 ","$2,240.00 ","$1,921.55 ","$2,401.67 ","$1,948.80 ","$2,401.67 ","$2,211.20 ","$2,880.00 ","$2,228.80 ","$3,084.79 ","$2,528.00 ",$546.65 ,"$3,200.00 ","$3,200.00 ","$3,054.25 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100143,31624,HC BRONCHOSCOPY W/LAVAGE ALVEOLAR,361,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,319.18 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$1,475.19 ","$2,900.00 ","$2,900.00 ","$2,030.00 ",$515.71 ,"$1,475.19 ","$1,475.19 ","$2,489.10 ","$2,465.00 ","$3,319.18 ","$2,668.00 ","$2,030.00 ","$1,921.55 ","$2,401.67 ","$1,766.10 ","$2,401.67 ","$2,003.90 ","$2,610.00 ","$2,019.85 ","$1,489.94 ","$2,291.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,475.19 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100158,20983,HC ABLATION TUMOR BONE PERC W/GUIDANCE CRYO,361,1 ,"$5,279.00 ","$2,639.50 ",$547.96 ,"$13,895.93 ",$547.96 ,"$5,279.00 ","$5,279.00 ","$6,175.97 ","$3,167.40 ","$4,487.15 ","$3,695.30 ",$547.96 ,"$5,015.05 ","$4,012.04 ","$3,959.25 ","$5,279.00 ","$4,487.15 ","$6,175.97 ","$5,279.00 ","$3,431.35 ","$3,695.30 ",$547.96 ,"$6,175.97 ","$6,175.97 ","$5,279.00 ","$4,487.15 ","$13,895.93 ","$4,856.68 ","$3,695.30 ","$1,703.02 ","$2,128.52 ","$3,214.91 ","$2,128.52 ","$3,647.79 ","$4,751.10 ","$3,676.82 ","$6,237.73 ","$4,170.41 ",$580.84 ,"$5,279.00 ","$5,279.00 ","$6,175.97 ","$5,279.00 ","$3,800.88 ","$3,272.98 ","$3,800.88 ","$3,800.88 ","$4,223.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100178,62264,HC INJ LYSIS EPID ADHESIONS W/RAD LOCAL 1 DAY,361,1 ,"$1,681.00 ",$840.50 ,$268.66 ,"$1,826.27 ",$268.66 ,"$1,681.00 ","$1,681.00 ",$811.67 ,"$1,008.60 ","$1,428.85 ","$1,176.70 ",$268.66 ,"$1,596.95 ","$1,277.56 ","$1,260.75 ","$1,681.00 ","$1,428.85 ",$811.67 ,"$1,681.00 ","$1,681.00 ","$1,176.70 ",$268.66 ,$811.67 ,$811.67 ,"$1,681.00 ","$1,428.85 ","$1,826.27 ","$1,546.52 ","$1,176.70 ","$1,681.00 ","$1,681.00 ","$1,023.73 ","$1,681.00 ","$1,161.57 ","$1,512.90 ","$1,170.82 ",$819.79 ,"$1,327.99 ",$284.78 ,"$1,681.00 ","$1,681.00 ",$811.67 ,"$1,681.00 ","$1,210.32 ","$1,042.22 ","$1,210.32 ","$1,210.32 ","$1,344.80 "
ST NICHOLAS HOSPITAL - ACUTE,36100196,64447,HC FEMORAL NERVE BLOCK SINGLE,361,1 ,$668.00 ,$334.00 ,$136.73 ,"$1,408.74 ",$136.73 ,$668.00 ,$668.00 ,$626.11 ,$400.80 ,$567.80 ,$467.60 ,$136.73 ,$634.60 ,$507.68 ,$501.00 ,$668.00 ,$567.80 ,$626.11 ,$668.00 ,$434.20 ,$467.60 ,$136.73 ,$626.11 ,$626.11 ,$668.00 ,$567.80 ,"$1,408.74 ",$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$601.20 ,$465.26 ,$632.37 ,$527.72 ,$144.93 ,$668.00 ,$668.00 ,$626.11 ,$668.00 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$534.40 
ST NICHOLAS HOSPITAL - ACUTE,36100227,31635,HC BRONCHOSCOPY W/REM FOREIGN BODY,361,1 ,"$3,200.00 ","$1,600.00 ",$515.71 ,"$3,319.18 ",$515.71 ,"$3,200.00 ","$3,200.00 ","$1,475.19 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$515.71 ,"$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$1,475.19 ","$3,200.00 ","$3,200.00 ","$2,240.00 ",$515.71 ,"$1,475.19 ","$1,475.19 ","$2,489.10 ","$2,720.00 ","$3,319.18 ","$2,944.00 ","$2,240.00 ","$1,921.55 ","$2,401.67 ","$1,948.80 ","$2,401.67 ","$2,211.20 ","$2,880.00 ","$2,228.80 ","$1,489.94 ","$2,528.00 ",$546.65 ,"$3,200.00 ","$3,200.00 ","$1,475.19 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100228,31641,HC BRONCHOSCOPY W/TUMOR DESTRUCTION,361,1 ,"$3,200.00 ","$1,600.00 ","$1,069.97 ","$6,872.06 ","$1,069.97 ","$3,200.00 ","$3,200.00 ","$3,054.25 ","$1,920.00 ","$2,720.00 ","$2,240.00 ","$1,069.97 ","$3,040.00 ","$2,432.00 ","$2,400.00 ","$3,200.00 ","$2,720.00 ","$3,054.25 ","$3,200.00 ","$3,200.00 ","$2,240.00 ","$1,069.97 ","$3,054.25 ","$3,054.25 ","$3,200.00 ","$2,720.00 ","$6,872.06 ","$2,944.00 ","$2,240.00 ","$1,921.55 ","$2,401.67 ","$1,948.80 ","$2,401.67 ","$2,211.20 ","$2,880.00 ","$2,228.80 ","$3,084.79 ","$2,528.00 ","$1,134.17 ","$3,200.00 ","$3,200.00 ","$3,054.25 ","$3,200.00 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$2,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100232,11103,HC BIOPSY SKIN TANGENTIAL ADDL LESN,361,1 ,$162.00 ,$81.00 ,$81.00 ,"$2,128.52 ",$139.95 , N/A , N/A , N/A ,$97.20 ,$137.70 ,$113.40 ,$139.95 ,$153.90 ,$123.12 ,$121.50 ,$162.00 ,$137.70 , N/A ,$162.00 ,$105.30 ,$113.40 ,$139.95 , N/A , N/A , N/A ,$137.70 , N/A ,$149.04 ,$113.40 ,"$1,703.02 ","$2,128.52 ",$98.66 ,"$2,128.52 ",$111.94 ,$145.80 ,$112.83 , N/A ,$127.98 ,$148.35 ,$162.00 ,$162.00 , N/A ,$162.00 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,36100233,11105,HC BIOPSY SKIN PUNCH ADDL LESN,361,1 ,$162.00 ,$81.00 ,$81.00 ,"$2,128.52 ",$139.95 , N/A , N/A , N/A ,$97.20 ,$137.70 ,$113.40 ,$139.95 ,$153.90 ,$123.12 ,$121.50 ,$162.00 ,$137.70 , N/A ,$162.00 ,$105.30 ,$113.40 ,$139.95 , N/A , N/A , N/A ,$137.70 , N/A ,$149.04 ,$113.40 ,"$1,703.02 ","$2,128.52 ",$98.66 ,"$2,128.52 ",$111.94 ,$145.80 ,$112.83 , N/A ,$127.98 ,$148.35 ,$162.00 ,$162.00 , N/A ,$162.00 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,36100234,11107,HC BIOPSY SKIN INCISIONAL ADDL LESN,361,1 ,$162.00 ,$81.00 ,$81.00 ,"$2,128.52 ",$139.95 , N/A , N/A , N/A ,$97.20 ,$137.70 ,$113.40 ,$139.95 ,$153.90 ,$123.12 ,$121.50 ,$162.00 ,$137.70 , N/A ,$162.00 ,$105.30 ,$113.40 ,$139.95 , N/A , N/A , N/A ,$137.70 , N/A ,$149.04 ,$113.40 ,"$1,703.02 ","$2,128.52 ",$98.66 ,"$2,128.52 ",$111.94 ,$145.80 ,$112.83 , N/A ,$127.98 ,$148.35 ,$162.00 ,$162.00 , N/A ,$162.00 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,36100235,11102,HC BIOPSY SKIN TANGENTIAL INIT LESN,361,1 ,$334.00 ,$167.00 ,$139.95 ,$398.39 ,$139.95 ,$334.00 ,$334.00 ,$177.06 ,$200.40 ,$283.90 ,$233.80 ,$139.95 ,$317.30 ,$253.84 ,$250.50 ,$334.00 ,$283.90 ,$177.06 ,$334.00 ,$217.10 ,$233.80 ,$139.95 ,$177.06 ,$177.06 ,$334.00 ,$283.90 ,$398.39 ,$307.28 ,$233.80 ,$334.00 ,$334.00 ,$203.41 ,$334.00 ,$230.79 ,$300.60 ,$232.63 ,$178.83 ,$263.86 ,$148.35 ,$334.00 ,$334.00 ,$177.06 ,$334.00 ,$240.48 ,$207.08 ,$240.48 ,$240.48 ,$267.20 
ST NICHOLAS HOSPITAL - ACUTE,36100236,11104,HC BIOPSY SKIN PUNCH INIT LESN,361,1 ,$334.00 ,$167.00 ,$139.95 ,$766.80 ,$139.95 ,$334.00 ,$334.00 ,$340.80 ,$200.40 ,$283.90 ,$233.80 ,$139.95 ,$317.30 ,$253.84 ,$250.50 ,$334.00 ,$283.90 ,$340.80 ,$334.00 ,$217.10 ,$233.80 ,$139.95 ,$340.80 ,$340.80 ,$334.00 ,$283.90 ,$766.80 ,$307.28 ,$233.80 ,$334.00 ,$334.00 ,$203.41 ,$334.00 ,$230.79 ,$300.60 ,$232.63 ,$344.21 ,$263.86 ,$148.35 ,$334.00 ,$334.00 ,$340.80 ,$334.00 ,$240.48 ,$207.08 ,$240.48 ,$240.48 ,$267.20 
ST NICHOLAS HOSPITAL - ACUTE,36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,$334.00 ,$167.00 ,$139.95 ,"$1,161.91 ",$139.95 ,$334.00 ,$334.00 ,$516.40 ,$200.40 ,$283.90 ,$233.80 ,$139.95 ,$317.30 ,$253.84 ,$250.50 ,$334.00 ,$283.90 ,$516.40 ,$334.00 ,$217.10 ,$233.80 ,$139.95 ,$516.40 ,$516.40 ,$334.00 ,$283.90 ,"$1,161.91 ",$307.28 ,$233.80 ,$334.00 ,$334.00 ,$203.41 ,$334.00 ,$230.79 ,$300.60 ,$232.63 ,$521.56 ,$263.86 ,$148.35 ,$334.00 ,$334.00 ,$516.40 ,$334.00 ,$240.48 ,$207.08 ,$240.48 ,$240.48 ,$267.20 
ST NICHOLAS HOSPITAL - ACUTE,36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$198.34 ,"$1,380.55 ",$198.34 ,"$1,185.00 ","$1,185.00 ",$613.58 ,$711.00 ,"$1,007.25 ",$829.50 ,$198.34 ,"$1,125.75 ",$900.60 ,$888.75 ,"$1,185.00 ","$1,007.25 ",$613.58 ,"$1,185.00 ",$770.25 ,$829.50 ,$198.34 ,$613.58 ,$613.58 ,"$1,185.00 ","$1,007.25 ","$1,380.55 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$619.72 ,$936.15 ,$210.24 ,"$1,185.00 ","$1,185.00 ",$613.58 ,"$1,185.00 ",$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$198.34 ,"$2,401.67 ",$198.34 , N/A , N/A , N/A ,$355.80 ,$504.05 ,$415.10 ,$198.34 ,$563.35 ,$450.68 ,$444.75 ,$593.00 ,$504.05 , N/A ,$593.00 ,$385.45 ,$415.10 ,$198.34 , N/A , N/A , N/A ,$504.05 , N/A ,$545.56 ,$415.10 ,"$1,921.55 ","$2,401.67 ",$361.14 ,"$2,401.67 ",$409.76 ,$533.70 ,$413.02 , N/A ,$468.47 ,$210.24 ,$593.00 ,$593.00 , N/A ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,36100240,10007,HC ASP FINE NDL W/FLUORO GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$198.34 ,"$1,380.55 ",$198.34 ,"$1,185.00 ","$1,185.00 ",$613.58 ,$711.00 ,"$1,007.25 ",$829.50 ,$198.34 ,"$1,125.75 ",$900.60 ,$888.75 ,"$1,185.00 ","$1,007.25 ",$613.58 ,"$1,185.00 ",$770.25 ,$829.50 ,$198.34 ,$613.58 ,$613.58 ,"$1,185.00 ","$1,007.25 ","$1,380.55 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$619.72 ,$936.15 ,$210.24 ,"$1,185.00 ","$1,185.00 ",$613.58 ,"$1,185.00 ",$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,36100241,10008,HC ASP FINE NDL W/FLUORO GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$198.34 ,"$2,401.67 ",$198.34 , N/A , N/A , N/A ,$355.80 ,$504.05 ,$415.10 ,$198.34 ,$563.35 ,$450.68 ,$444.75 ,$593.00 ,$504.05 , N/A ,$593.00 ,$385.45 ,$415.10 ,$198.34 , N/A , N/A , N/A ,$504.05 , N/A ,$545.56 ,$415.10 ,"$1,921.55 ","$2,401.67 ",$361.14 ,"$2,401.67 ",$409.76 ,$533.70 ,$413.02 , N/A ,$468.47 ,$210.24 ,$593.00 ,$593.00 , N/A ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,36100242,10009,HC ASP FINE NDL W/CT GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$198.34 ,"$1,380.55 ",$198.34 ,"$1,185.00 ","$1,185.00 ",$613.58 ,$711.00 ,"$1,007.25 ",$829.50 ,$198.34 ,"$1,125.75 ",$900.60 ,$888.75 ,"$1,185.00 ","$1,007.25 ",$613.58 ,"$1,185.00 ",$770.25 ,$829.50 ,$198.34 ,$613.58 ,$613.58 ,"$1,185.00 ","$1,007.25 ","$1,380.55 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$619.72 ,$936.15 ,$210.24 ,"$1,185.00 ","$1,185.00 ",$613.58 ,"$1,185.00 ",$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,36100243,10010,HC ASP FINE NDL W/CT GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$198.34 ,"$2,401.67 ",$198.34 , N/A , N/A , N/A ,$355.80 ,$504.05 ,$415.10 ,$198.34 ,$563.35 ,$450.68 ,$444.75 ,$593.00 ,$504.05 , N/A ,$593.00 ,$385.45 ,$415.10 ,$198.34 , N/A , N/A , N/A ,$504.05 , N/A ,$545.56 ,$415.10 ,"$1,921.55 ","$2,401.67 ",$361.14 ,"$2,401.67 ",$409.76 ,$533.70 ,$413.02 , N/A ,$468.47 ,$210.24 ,$593.00 ,$593.00 , N/A ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,36100246,36572,HC INS CATH PERIPH CV W/O PORT W/GUIDANCE <5,361,1 ,"$2,856.00 ","$1,428.00 ",$353.23 ,"$3,303.09 ",$353.23 ,"$2,652.00 ","$2,081.00 ",$532.96 ,"$1,713.60 ","$2,427.60 ","$1,999.20 ",$353.23 ,"$2,713.20 ","$2,170.56 ","$2,142.00 ","$2,856.00 ","$2,427.60 ",$532.96 ,"$2,856.00 ","$1,856.40 ","$1,999.20 ",$353.23 ,$532.96 ,$532.96 ,"$2,856.00 ","$2,427.60 ","$1,199.16 ","$2,627.52 ","$1,999.20 ","$2,642.26 ","$3,303.09 ","$1,739.30 ","$3,303.09 ","$1,973.50 ","$2,570.40 ","$1,989.20 ",$538.29 ,"$2,256.24 ",$374.42 ,"$2,687.00 ","$2,687.00 ",$532.96 ,"$2,687.00 ","$2,056.32 ","$1,770.72 ","$2,056.32 ","$2,056.32 ","$2,284.80 "
ST NICHOLAS HOSPITAL - ACUTE,36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,"$3,124.00 ","$1,562.00 ",$353.23 ,"$3,303.09 ",$353.23 ,"$3,124.00 ","$3,124.00 ","$1,386.53 ","$1,874.40 ","$2,655.40 ","$2,186.80 ",$353.23 ,"$2,967.80 ","$2,374.24 ","$2,343.00 ","$3,124.00 ","$2,655.40 ","$1,386.53 ","$3,124.00 ","$2,030.60 ","$2,186.80 ",$353.23 ,"$1,386.53 ","$1,386.53 ","$3,124.00 ","$2,655.40 ","$3,119.68 ","$2,874.08 ","$2,186.80 ","$2,642.26 ","$3,303.09 ","$1,902.52 ","$3,303.09 ","$2,158.68 ","$2,811.60 ","$2,175.87 ","$1,400.40 ","$2,467.96 ",$374.42 ,"$3,124.00 ","$3,124.00 ","$1,386.53 ","$3,124.00 ","$2,249.28 ","$1,936.88 ","$2,249.28 ","$2,249.28 ","$2,499.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100264,33016,HC PERICARDIOCENTESIS W/ OR W/O IMAGING,361,1 ,"$1,819.00 ",$909.50 ,$299.20 ,"$3,119.68 ",$299.20 ,"$1,819.00 ","$1,819.00 ","$1,386.53 ","$1,091.40 ","$1,546.15 ","$1,273.30 ",$299.20 ,"$1,728.05 ","$1,382.44 ","$1,364.25 ","$1,819.00 ","$1,546.15 ","$1,386.53 ","$1,819.00 ","$1,182.35 ","$1,273.30 ",$299.20 ,"$1,386.53 ","$1,386.53 ","$1,819.00 ","$1,546.15 ","$3,119.68 ","$1,673.48 ","$1,273.30 ",$922.60 ,"$1,107.23 ","$1,107.77 ","$1,107.23 ","$1,256.93 ","$1,637.10 ","$1,266.93 ","$1,400.40 ","$1,437.01 ",$317.15 ,"$1,819.00 ","$1,819.00 ","$1,386.53 ","$1,819.00 ","$1,309.68 ","$1,127.78 ","$1,309.68 ","$1,309.68 ","$1,455.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100265,33017,HC PERICARDIAL DRAINAGE =>6 YRS W/O CONGENITAL CARDIAC ANOMALY,361,1 ,"$2,247.00 ","$1,123.50 ",$299.20 ,"$2,247.00 ",$299.20 ,"$2,247.00 ","$2,247.00 ", N/A ,"$1,348.20 ","$1,909.95 ","$1,572.90 ",$299.20 ,"$2,134.65 ","$1,707.72 ","$1,685.25 ","$2,247.00 ","$1,909.95 ", N/A ,"$2,247.00 ","$1,460.55 ","$1,572.90 ",$299.20 , N/A , N/A ,"$2,247.00 ","$1,909.95 ", N/A ,"$2,067.24 ","$1,572.90 ","$1,139.68 ","$1,367.75 ","$1,368.42 ","$1,367.75 ","$1,552.68 ","$2,022.30 ","$1,565.04 ", N/A ,"$1,775.13 ",$317.15 ,"$2,247.00 ","$2,247.00 ", N/A ,"$2,247.00 ","$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,797.60 "
ST NICHOLAS HOSPITAL - ACUTE,36100270,62328,HC LUMBAR PUNCTURE DIAGNOSTIC W/FLUORO OR CT GUID,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,408.74 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$626.11 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ",$626.11 ,"$1,293.00 ",$840.45 ,$905.10 ,$268.66 ,$626.11 ,$626.11 ,"$1,293.00 ","$1,099.05 ","$1,408.74 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,$632.37 ,"$1,021.47 ",$284.78 ,"$1,293.00 ","$1,293.00 ",$626.11 ,"$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36100271,62329,HC LUMBAR PUNCTURE THERAPEUTIC/DRAINAGE W//FLUORO OR CT GUID,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,408.74 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$626.11 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$982.68 ,$969.75 ,"$1,293.00 ","$1,099.05 ",$626.11 ,"$1,293.00 ",$840.45 ,$905.10 ,$268.66 ,$626.11 ,$626.11 ,"$1,293.00 ","$1,099.05 ","$1,408.74 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,$632.37 ,"$1,021.47 ",$284.78 ,"$1,293.00 ","$1,293.00 ",$626.11 ,"$1,293.00 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,36100275,64625,HC ABLATION RF NERVES SI JOINT W/FLUORO OR CT GUID,361,1 ,"$3,555.00 ","$1,777.50 ",$432.02 ,"$3,895.50 ",$432.02 ,"$3,555.00 ","$3,555.00 ","$1,731.33 ","$2,133.00 ","$3,021.75 ","$2,488.50 ",$432.02 ,"$3,377.25 ","$2,701.80 ","$2,666.25 ","$3,555.00 ","$3,021.75 ","$1,731.33 ","$3,555.00 ","$2,310.75 ","$2,488.50 ",$432.02 ,"$1,731.33 ","$1,731.33 ","$3,555.00 ","$3,021.75 ","$3,895.50 ","$3,270.60 ","$2,488.50 ","$1,803.10 ","$2,163.93 ","$2,165.00 ","$2,163.93 ","$2,456.51 ","$3,199.50 ","$2,476.06 ","$1,748.64 ","$2,808.45 ",$457.94 ,"$3,555.00 ","$3,555.00 ","$1,731.33 ","$3,555.00 ","$2,559.60 ","$2,204.10 ","$2,559.60 ","$2,559.60 ","$2,844.00 "
ST NICHOLAS HOSPITAL - ACUTE,36100281,32408,HC CORE NDL BX LUNG/MEDIASTINUM PERQ W IMG,361,1 ,"$4,404.00 ","$2,202.00 ",$299.20 ,"$4,404.00 ",$299.20 ,"$4,138.00 ","$3,641.00 ","$1,387.33 ","$2,642.40 ","$3,743.40 ","$3,082.80 ",$299.20 ,"$4,183.80 ","$3,347.04 ","$3,303.00 ","$4,404.00 ","$3,743.40 ","$1,387.33 ","$4,404.00 ","$2,862.60 ","$3,082.80 ",$299.20 ,"$1,387.33 ","$1,387.33 ","$3,959.93 ","$3,743.40 ","$3,121.49 ","$4,051.68 ","$3,082.80 ","$2,233.71 ","$2,680.71 ","$2,682.04 ","$2,680.71 ","$3,043.16 ","$3,963.60 ","$3,067.39 ","$1,401.20 ","$3,479.16 ",$317.15 ,"$4,016.00 ","$4,016.00 ","$1,387.33 ","$4,016.00 ","$3,170.88 ","$2,730.48 ","$3,170.88 ","$3,170.88 ","$3,523.20 "
ST NICHOLAS HOSPITAL - ACUTE,36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,$250.00 ,$125.00 ,$125.00 ,"$3,972.27 ",$922.69 ,$161.73 ,$161.73 ,"$1,765.45 ",$150.00 ,$212.50 ,$175.00 ,$922.69 ,$237.50 ,$190.00 ,$187.50 ,$162.50 ,$212.50 ,"$1,765.45 ",$162.50 ,$162.50 ,$175.00 ,$922.69 ,"$1,765.45 ","$1,765.45 ",$250.00 ,$212.50 ,"$3,972.27 ",$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$174.13 ,"$1,783.10 ",$197.50 ,$978.05 ,$250.00 ,$250.00 ,"$1,765.45 ",$250.00 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,37000002,N/A,HC DIFFICULT AIRWAY CHARGE,370,1 ,$924.00 ,$462.00 ,$388.08 ,$924.00 , N/A ,$597.74 ,$597.74 , N/A ,$554.40 ,$785.40 ,$646.80 , N/A ,$877.80 ,$702.24 ,$693.00 ,$600.60 ,$785.40 , N/A ,$600.60 ,$600.60 ,$646.80 , N/A , N/A , N/A ,$388.08 ,$785.40 , N/A ,$850.08 ,$646.80 ,$468.65 ,$562.44 ,$562.72 ,$562.44 ,$638.48 ,$831.60 ,$643.57 , N/A ,$729.96 , N/A ,$554.40 ,$554.40 , N/A ,$554.40 ,$665.28 ,$572.88 ,$665.28 ,$665.28 ,$739.20 
ST NICHOLAS HOSPITAL - ACUTE,37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,"$1,100.00 ",$550.00 ,$208.60 ,"$1,100.00 ",$285.38 ,"$1,100.00 ","$1,100.00 ",$208.60 ,$660.00 ,$935.00 ,$770.00 ,$285.38 ,"$1,045.00 ",$836.00 ,$825.00 ,"$1,100.00 ",$935.00 ,$208.60 ,"$1,100.00 ","$1,100.00 ",$770.00 ,$285.38 ,$208.60 ,$208.60 ,"$1,100.00 ",$935.00 ,$469.36 ,"$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$990.00 ,$766.15 ,$210.69 ,$869.00 ,$302.50 ,"$1,100.00 ","$1,100.00 ",$208.60 ,"$1,100.00 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,$819.00 ,$409.50 ,$343.98 ,"$1,826.27 ",$364.34 ,$529.81 ,$529.81 ,$811.67 ,$491.40 ,$696.15 ,$573.30 ,$364.34 ,$778.05 ,$622.44 ,$614.25 ,$532.35 ,$696.15 ,$811.67 ,$532.35 ,$532.35 ,$573.30 ,$364.34 ,$811.67 ,$811.67 ,$343.98 ,$696.15 ,"$1,826.27 ",$753.48 ,$573.30 ,$819.00 ,$819.00 ,$498.77 ,$819.00 ,$565.93 ,$737.10 ,$570.43 ,$819.79 ,$647.01 ,$386.20 ,$491.40 ,$491.40 ,$811.67 ,$491.40 ,$589.68 ,$507.78 ,$589.68 ,$589.68 ,$655.20 
ST NICHOLAS HOSPITAL - ACUTE,37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$80.00 ,$40.00 ,$7.51 ,$80.00 ,$7.51 ,$51.75 ,$51.75 , N/A ,$48.00 ,$68.00 ,$56.00 ,$7.51 ,$76.00 ,$60.80 ,$60.00 ,$52.00 ,$68.00 , N/A ,$52.00 ,$52.00 ,$56.00 ,$7.51 , N/A , N/A ,$33.60 ,$68.00 , N/A ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$55.72 , N/A ,$63.20 ,$7.96 ,$48.00 ,$48.00 , N/A ,$48.00 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$80.00 ,$40.00 ,$7.51 ,$80.00 ,$7.51 ,$51.75 ,$51.75 , N/A ,$48.00 ,$68.00 ,$56.00 ,$7.51 ,$76.00 ,$60.80 ,$60.00 ,$52.00 ,$68.00 , N/A ,$52.00 ,$52.00 ,$56.00 ,$7.51 , N/A , N/A ,$33.60 ,$68.00 , N/A ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$55.72 , N/A ,$63.20 ,$7.96 ,$48.00 ,$48.00 , N/A ,$48.00 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,37000021,64447,HC FEMORAL NERVE BLOCK SINGLE,370,1 ,$668.00 ,$334.00 ,$136.73 ,"$1,408.74 ",$136.73 ,$432.13 ,$432.13 ,$626.11 ,$400.80 ,$567.80 ,$467.60 ,$136.73 ,$634.60 ,$507.68 ,$501.00 ,$434.20 ,$567.80 ,$626.11 ,$434.20 ,$434.20 ,$467.60 ,$136.73 ,$626.11 ,$626.11 ,$280.56 ,$567.80 ,"$1,408.74 ",$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$601.20 ,$465.26 ,$632.37 ,$527.72 ,$144.93 ,$400.80 ,$400.80 ,$626.11 ,$400.80 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$534.40 
ST NICHOLAS HOSPITAL - ACUTE,37000022,64415,HC INTRASCALENE BLOCK SINGLE,370,1 ,$668.00 ,$334.00 ,$280.56 ,"$1,826.27 ",$364.34 ,$432.13 ,$432.13 ,$811.67 ,$400.80 ,$567.80 ,$467.60 ,$364.34 ,$634.60 ,$507.68 ,$501.00 ,$434.20 ,$567.80 ,$811.67 ,$434.20 ,$434.20 ,$467.60 ,$364.34 ,$811.67 ,$811.67 ,$280.56 ,$567.80 ,"$1,826.27 ",$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$601.20 ,$465.26 ,$819.79 ,$527.72 ,$386.20 ,$400.80 ,$400.80 ,$811.67 ,$400.80 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$534.40 
ST NICHOLAS HOSPITAL - ACUTE,37000023,64416,HC INTRASCALENE BLOCK CONTINUOUS,370,1 ,"$2,473.00 ","$1,236.50 ",$364.34 ,"$2,473.00 ",$364.34 ,"$1,599.78 ","$1,599.78 ",$811.67 ,"$1,483.80 ","$2,102.05 ","$1,731.10 ",$364.34 ,"$2,349.35 ","$1,879.48 ","$1,854.75 ","$1,607.45 ","$2,102.05 ",$811.67 ,"$1,607.45 ","$1,607.45 ","$1,731.10 ",$364.34 ,$811.67 ,$811.67 ,"$1,038.66 ","$2,102.05 ","$1,826.27 ","$2,275.16 ","$1,731.10 ","$1,703.02 ","$2,128.52 ","$1,506.06 ","$2,128.52 ","$1,708.84 ","$2,225.70 ","$1,722.44 ",$819.79 ,"$1,953.67 ",$386.20 ,"$1,483.80 ","$1,483.80 ",$811.67 ,"$1,483.80 ","$1,780.56 ","$1,533.26 ","$1,780.56 ","$1,780.56 ","$1,978.40 "
ST NICHOLAS HOSPITAL - ACUTE,37000024,N/A,HC EPIDURAL NERVE BLOCK,370,1 ,$651.00 ,$325.50 ,$273.42 ,$651.00 , N/A ,$421.13 ,$421.13 , N/A ,$390.60 ,$553.35 ,$455.70 , N/A ,$618.45 ,$494.76 ,$488.25 ,$423.15 ,$553.35 , N/A ,$423.15 ,$423.15 ,$455.70 , N/A , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$396.26 ,$449.84 ,$585.90 ,$453.42 , N/A ,$514.29 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$520.80 
ST NICHOLAS HOSPITAL - ACUTE,37000026,N/A,HC ANES BLOCK PERIPHERAL,370,1 ,$651.00 ,$325.50 ,$273.42 ,$651.00 , N/A ,$421.13 ,$421.13 , N/A ,$390.60 ,$553.35 ,$455.70 , N/A ,$618.45 ,$494.76 ,$488.25 ,$423.15 ,$553.35 , N/A ,$423.15 ,$423.15 ,$455.70 , N/A , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$396.26 ,$449.84 ,$585.90 ,$453.42 , N/A ,$514.29 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$520.80 
ST NICHOLAS HOSPITAL - ACUTE,37000027,N/A,HC ANES SPINAL,370,1 ,$651.00 ,$325.50 ,$273.42 ,$651.00 , N/A ,$421.13 ,$421.13 , N/A ,$390.60 ,$553.35 ,$455.70 , N/A ,$618.45 ,$494.76 ,$488.25 ,$423.15 ,$553.35 , N/A ,$423.15 ,$423.15 ,$455.70 , N/A , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$396.26 ,$449.84 ,$585.90 ,$453.42 , N/A ,$514.29 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$520.80 
ST NICHOLAS HOSPITAL - ACUTE,37000028,N/A,HC ANES CENTRAL LINE,370,1 ,$651.00 ,$325.50 ,$273.42 ,$651.00 , N/A ,$421.13 ,$421.13 , N/A ,$390.60 ,$553.35 ,$455.70 , N/A ,$618.45 ,$494.76 ,$488.25 ,$423.15 ,$553.35 , N/A ,$423.15 ,$423.15 ,$455.70 , N/A , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$396.26 ,$449.84 ,$585.90 ,$453.42 , N/A ,$514.29 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$520.80 
ST NICHOLAS HOSPITAL - ACUTE,37000050,N/A,HC BIER BLOCK ANES INIT,370,1 ,$819.00 ,$409.50 ,$343.98 ,$819.00 , N/A ,$529.81 ,$529.81 , N/A ,$491.40 ,$696.15 ,$573.30 , N/A ,$778.05 ,$622.44 ,$614.25 ,$532.35 ,$696.15 , N/A ,$532.35 ,$532.35 ,$573.30 , N/A , N/A , N/A ,$343.98 ,$696.15 , N/A ,$753.48 ,$573.30 ,$415.40 ,$498.53 ,$498.77 ,$498.53 ,$565.93 ,$737.10 ,$570.43 , N/A ,$647.01 , N/A ,$491.40 ,$491.40 , N/A ,$491.40 ,$589.68 ,$507.78 ,$589.68 ,$589.68 ,$655.20 
ST NICHOLAS HOSPITAL - ACUTE,37000051,N/A,HC BIER BLOCK ANES ADDL,370,1 ,$168.00 ,$84.00 ,$70.56 ,$168.00 , N/A ,$108.68 ,$108.68 , N/A ,$100.80 ,$142.80 ,$117.60 , N/A ,$159.60 ,$127.68 ,$126.00 ,$109.20 ,$142.80 , N/A ,$109.20 ,$109.20 ,$117.60 , N/A , N/A , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$117.01 , N/A ,$132.72 , N/A ,$100.80 ,$100.80 , N/A ,$100.80 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,37000052,N/A,HC GENERAL ANES INIT,370,1 ,"$1,470.00 ",$735.00 ,$617.40 ,"$1,470.00 ", N/A ,$950.94 ,$950.94 , N/A ,$882.00 ,"$1,249.50 ","$1,029.00 ", N/A ,"$1,396.50 ","$1,117.20 ","$1,102.50 ",$955.50 ,"$1,249.50 ", N/A ,$955.50 ,$955.50 ,"$1,029.00 ", N/A , N/A , N/A ,$617.40 ,"$1,249.50 ", N/A ,"$1,352.40 ","$1,029.00 ",$745.58 ,$894.79 ,$895.23 ,$894.79 ,"$1,015.77 ","$1,323.00 ","$1,023.86 ", N/A ,"$1,161.30 ", N/A ,$882.00 ,$882.00 , N/A ,$882.00 ,"$1,058.40 ",$911.40 ,"$1,058.40 ","$1,058.40 ","$1,176.00 "
ST NICHOLAS HOSPITAL - ACUTE,37000053,N/A,HC GENERAL ANES ADDL,370,1 ,$200.00 ,$100.00 ,$84.00 ,$200.00 , N/A ,$129.38 ,$129.38 , N/A ,$120.00 ,$170.00 ,$140.00 , N/A ,$190.00 ,$152.00 ,$150.00 ,$130.00 ,$170.00 , N/A ,$130.00 ,$130.00 ,$140.00 , N/A , N/A , N/A ,$84.00 ,$170.00 , N/A ,$184.00 ,$140.00 ,$101.44 ,$121.74 ,$121.80 ,$121.74 ,$138.20 ,$180.00 ,$139.30 , N/A ,$158.00 , N/A ,$120.00 ,$120.00 , N/A ,$120.00 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,37000054,N/A,HC MONITORED ANES INIT,370,1 ,$651.00 ,$325.50 ,$273.42 ,$651.00 , N/A ,$421.13 ,$421.13 , N/A ,$390.60 ,$553.35 ,$455.70 , N/A ,$618.45 ,$494.76 ,$488.25 ,$423.15 ,$553.35 , N/A ,$423.15 ,$423.15 ,$455.70 , N/A , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$396.26 ,$449.84 ,$585.90 ,$453.42 , N/A ,$514.29 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$520.80 
ST NICHOLAS HOSPITAL - ACUTE,37000055,N/A,HC MONITORED ANES ADDL,370,1 ,$168.00 ,$84.00 ,$70.56 ,$168.00 , N/A ,$108.68 ,$108.68 , N/A ,$100.80 ,$142.80 ,$117.60 , N/A ,$159.60 ,$127.68 ,$126.00 ,$109.20 ,$142.80 , N/A ,$109.20 ,$109.20 ,$117.60 , N/A , N/A , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$117.01 , N/A ,$132.72 , N/A ,$100.80 ,$100.80 , N/A ,$100.80 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,37000056,N/A,HC SPINAL ANES INIT,370,1 ,"$1,470.00 ",$735.00 ,$617.40 ,"$1,470.00 ", N/A ,$950.94 ,$950.94 , N/A ,$882.00 ,"$1,249.50 ","$1,029.00 ", N/A ,"$1,396.50 ","$1,117.20 ","$1,102.50 ",$955.50 ,"$1,249.50 ", N/A ,$955.50 ,$955.50 ,"$1,029.00 ", N/A , N/A , N/A ,$617.40 ,"$1,249.50 ", N/A ,"$1,352.40 ","$1,029.00 ",$745.58 ,$894.79 ,$895.23 ,$894.79 ,"$1,015.77 ","$1,323.00 ","$1,023.86 ", N/A ,"$1,161.30 ", N/A ,$882.00 ,$882.00 , N/A ,$882.00 ,"$1,058.40 ",$911.40 ,"$1,058.40 ","$1,058.40 ","$1,176.00 "
ST NICHOLAS HOSPITAL - ACUTE,37000057,N/A,HC SPINAL ANES ADDL,370,1 ,$168.00 ,$84.00 ,$70.56 ,$168.00 , N/A ,$108.68 ,$108.68 , N/A ,$100.80 ,$142.80 ,$117.60 , N/A ,$159.60 ,$127.68 ,$126.00 ,$109.20 ,$142.80 , N/A ,$109.20 ,$109.20 ,$117.60 , N/A , N/A , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$117.01 , N/A ,$132.72 , N/A ,$100.80 ,$100.80 , N/A ,$100.80 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,37000058,N/A,HC CARDIAC ANES INIT,370,1 ,"$4,305.00 ","$2,152.50 ","$1,808.10 ","$4,305.00 ", N/A ,"$2,784.90 ","$2,784.90 ", N/A ,"$2,583.00 ","$3,659.25 ","$3,013.50 ", N/A ,"$4,089.75 ","$3,271.80 ","$3,228.75 ","$2,798.25 ","$3,659.25 ", N/A ,"$2,798.25 ","$2,798.25 ","$3,013.50 ", N/A , N/A , N/A ,"$1,808.10 ","$3,659.25 ", N/A ,"$3,960.60 ","$3,013.50 ","$2,183.50 ","$2,620.45 ","$2,621.75 ","$2,620.45 ","$2,974.76 ","$3,874.50 ","$2,998.43 ", N/A ,"$3,400.95 ", N/A ,"$2,583.00 ","$2,583.00 ", N/A ,"$2,583.00 ","$3,099.60 ","$2,669.10 ","$3,099.60 ","$3,099.60 ","$3,444.00 "
ST NICHOLAS HOSPITAL - ACUTE,37000059,N/A,HC CARDIAC ANES ADDL,370,1 ,$326.00 ,$163.00 ,$136.92 ,$326.00 , N/A ,$210.89 ,$210.89 , N/A ,$195.60 ,$277.10 ,$228.20 , N/A ,$309.70 ,$247.76 ,$244.50 ,$211.90 ,$277.10 , N/A ,$211.90 ,$211.90 ,$228.20 , N/A , N/A , N/A ,$136.92 ,$277.10 , N/A ,$299.92 ,$228.20 ,$165.35 ,$198.44 ,$198.53 ,$198.44 ,$225.27 ,$293.40 ,$227.06 , N/A ,$257.54 , N/A ,$195.60 ,$195.60 , N/A ,$195.60 ,$234.72 ,$202.12 ,$234.72 ,$234.72 ,$260.80 
ST NICHOLAS HOSPITAL - ACUTE,37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$380.00 ,$190.00 ,$7.51 ,$380.00 ,$7.51 ,$245.82 ,$245.82 , N/A ,$228.00 ,$323.00 ,$266.00 ,$7.51 ,$361.00 ,$288.80 ,$285.00 ,$247.00 ,$323.00 , N/A ,$247.00 ,$247.00 ,$266.00 ,$7.51 , N/A , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$231.31 ,$262.58 ,$342.00 ,$264.67 , N/A ,$300.20 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$304.00 
ST NICHOLAS HOSPITAL - ACUTE,37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$380.00 ,$190.00 ,$7.51 ,$380.00 ,$7.51 ,$245.82 ,$245.82 , N/A ,$228.00 ,$323.00 ,$266.00 ,$7.51 ,$361.00 ,$288.80 ,$285.00 ,$247.00 ,$323.00 , N/A ,$247.00 ,$247.00 ,$266.00 ,$7.51 , N/A , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$231.31 ,$262.58 ,$342.00 ,$264.67 , N/A ,$300.20 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$304.00 
ST NICHOLAS HOSPITAL - ACUTE,37000074,99155,HC MODERATE SEDATION DIFF PHY <5YR 1ST 15MIN,370,1 ,$380.00 ,$190.00 ,$7.51 ,$380.00 ,$7.51 ,$245.82 ,$245.82 , N/A ,$228.00 ,$323.00 ,$266.00 ,$7.51 ,$361.00 ,$288.80 ,$285.00 ,$247.00 ,$323.00 , N/A ,$247.00 ,$247.00 ,$266.00 ,$7.51 , N/A , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$231.31 ,$262.58 ,$342.00 ,$264.67 , N/A ,$300.20 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$304.00 
ST NICHOLAS HOSPITAL - ACUTE,37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,$380.00 ,$190.00 ,$7.51 ,$380.00 ,$7.51 ,$245.82 ,$245.82 , N/A ,$228.00 ,$323.00 ,$266.00 ,$7.51 ,$361.00 ,$288.80 ,$285.00 ,$247.00 ,$323.00 , N/A ,$247.00 ,$247.00 ,$266.00 ,$7.51 , N/A , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$231.31 ,$262.58 ,$342.00 ,$264.67 , N/A ,$300.20 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$304.00 
ST NICHOLAS HOSPITAL - ACUTE,37001000,1967,HC EPIDURAL/SPINAL FOR LABOR,370,1 ,$856.00 ,$428.00 ,$359.52 ,$856.00 , N/A ,$553.75 ,$553.75 , N/A ,$513.60 ,$727.60 ,$599.20 , N/A ,$813.20 ,$650.56 ,$642.00 ,$556.40 ,$727.60 , N/A ,$556.40 ,$556.40 ,$599.20 , N/A , N/A , N/A ,$359.52 ,$727.60 , N/A ,$787.52 ,$599.20 ,$434.16 ,$521.05 ,$521.30 ,$521.05 ,$591.50 ,$770.40 ,$596.20 , N/A ,$676.24 , N/A ,$513.60 ,$513.60 , N/A ,$513.60 ,$616.32 ,$530.72 ,$616.32 ,$616.32 ,$684.80 
ST NICHOLAS HOSPITAL - ACUTE,39000103,P9012,HC CRYOPRECIPITATE EA UNIT,390,1 ,$202.00 ,$101.00 ,$46.72 ,$202.00 ,$46.72 ,$130.67 ,$130.67 ,$81.53 ,$121.20 ,$171.70 ,$141.40 ,$46.72 ,$191.90 ,$153.52 ,$151.50 ,$131.30 ,$171.70 ,$81.53 ,$131.30 ,$131.30 ,$141.40 ,$46.72 ,$81.53 ,$81.53 ,$202.00 ,$171.70 ,$183.44 ,$185.84 ,$141.40 ,$202.00 ,$202.00 ,$123.02 ,$202.00 ,$139.58 ,$181.80 ,$140.69 ,$82.35 ,$159.58 ,$49.52 ,$202.00 ,$202.00 ,$81.53 ,$202.00 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,39000105,P9012,HC CRYOPRECIPITATE EA UNIT (RC),390,1 ,$202.00 ,$101.00 ,$46.72 ,$202.00 ,$46.72 ,$130.67 ,$130.67 ,$81.53 ,$121.20 ,$171.70 ,$141.40 ,$46.72 ,$191.90 ,$153.52 ,$151.50 ,$131.30 ,$171.70 ,$81.53 ,$131.30 ,$131.30 ,$141.40 ,$46.72 ,$81.53 ,$81.53 ,$202.00 ,$171.70 ,$183.44 ,$185.84 ,$141.40 ,$202.00 ,$202.00 ,$123.02 ,$202.00 ,$139.58 ,$181.80 ,$140.69 ,$82.35 ,$159.58 ,$49.52 ,$202.00 ,$202.00 ,$81.53 ,$202.00 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,39000107,P9016,HC RED CELLS L/R EA,390,1 ,$392.00 ,$196.00 ,$192.39 ,$432.88 ,$392.00 ,$253.58 ,$253.58 ,$192.39 ,$235.20 ,$333.20 ,$274.40 ,$392.00 ,$372.40 ,$297.92 ,$294.00 ,$254.80 ,$333.20 ,$192.39 ,$254.80 ,$254.80 ,$274.40 ,$392.00 ,$192.39 ,$192.39 ,$392.00 ,$333.20 ,$432.88 ,$360.64 ,$274.40 ,$392.00 ,$392.00 ,$238.73 ,$392.00 ,$270.87 ,$352.80 ,$273.03 ,$194.31 ,$309.68 ,$415.52 ,$392.00 ,$392.00 ,$192.39 ,$392.00 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$313.60 
ST NICHOLAS HOSPITAL - ACUTE,39000110,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$246.00 ,$123.00 ,$38.65 ,$246.00 ,$38.65 ,$159.14 ,$159.14 ,$84.40 ,$147.60 ,$209.10 ,$172.20 ,$38.65 ,$233.70 ,$186.96 ,$184.50 ,$159.90 ,$209.10 ,$84.40 ,$159.90 ,$159.90 ,$172.20 ,$38.65 ,$84.40 ,$84.40 ,$246.00 ,$209.10 ,$189.90 ,$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$221.40 ,$171.34 ,$85.24 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$84.40 ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,39000112,P9017,HC FRESH FROZEN PLASMA EA (AD-RC),390,1 ,$246.00 ,$123.00 ,$38.65 ,$246.00 ,$38.65 ,$159.14 ,$159.14 ,$84.40 ,$147.60 ,$209.10 ,$172.20 ,$38.65 ,$233.70 ,$186.96 ,$184.50 ,$159.90 ,$209.10 ,$84.40 ,$159.90 ,$159.90 ,$172.20 ,$38.65 ,$84.40 ,$84.40 ,$246.00 ,$209.10 ,$189.90 ,$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$221.40 ,$171.34 ,$85.24 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$84.40 ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,39000116,P9021,HC RED CELLS PACKED EA,390,1 ,$448.00 ,$224.00 ,$46.72 ,$448.00 ,$46.72 ,$289.81 ,$289.81 ,$140.53 ,$268.80 ,$380.80 ,$313.60 ,$46.72 ,$425.60 ,$340.48 ,$336.00 ,$291.20 ,$380.80 ,$140.53 ,$291.20 ,$291.20 ,$313.60 ,$46.72 ,$140.53 ,$140.53 ,$448.00 ,$380.80 ,$316.19 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$403.20 ,$312.03 ,$141.94 ,$353.92 ,$49.52 ,$448.00 ,$448.00 ,$140.53 ,$448.00 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$358.40 
ST NICHOLAS HOSPITAL - ACUTE,39000120,P9035,HC PLATELETS PHER L/R EA,390,1 ,"$1,568.00 ",$784.00 ,$117.41 ,"$1,568.00 ",$117.41 ,"$1,014.34 ","$1,014.34 ",$496.91 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$117.41 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ","$1,019.20 ","$1,332.80 ",$496.91 ,"$1,019.20 ","$1,019.20 ","$1,097.60 ",$117.41 ,$496.91 ,$496.91 ,$454.83 ,"$1,332.80 ","$1,118.05 ","$1,442.56 ","$1,097.60 ","$1,568.00 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,411.20 ","$1,092.11 ",$501.88 ,"$1,238.72 ",$124.45 ,$460.00 ,$460.00 ,$496.91 ,$460.00 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,39000122,P9037,HC PLATELETS PHER L/R IRR EA,390,1 ,"$1,568.00 ",$784.00 ,$117.41 ,"$1,568.00 ",$117.41 ,"$1,014.34 ","$1,014.34 ",$630.32 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$117.41 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ","$1,019.20 ","$1,332.80 ",$630.32 ,"$1,019.20 ","$1,019.20 ","$1,097.60 ",$117.41 ,$630.32 ,$630.32 ,$454.83 ,"$1,332.80 ","$1,418.22 ","$1,442.56 ","$1,097.60 ","$1,568.00 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,411.20 ","$1,092.11 ",$636.62 ,"$1,238.72 ",$124.45 ,$460.00 ,$460.00 ,$630.32 ,$460.00 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,39000124,P9040,HC RED CELLS L/R IRR EA,390,1 ,$862.00 ,$431.00 ,$46.72 ,$862.00 ,$46.72 ,$557.63 ,$557.63 ,$266.03 ,$517.20 ,$732.70 ,$603.40 ,$46.72 ,$818.90 ,$655.12 ,$646.50 ,$560.30 ,$732.70 ,$266.03 ,$560.30 ,$560.30 ,$603.40 ,$46.72 ,$266.03 ,$266.03 ,$454.83 ,$732.70 ,$598.57 ,$793.04 ,$603.40 ,$862.00 ,$862.00 ,$524.96 ,$862.00 ,$595.64 ,$775.80 ,$600.38 ,$268.69 ,$680.98 ,$49.52 ,$460.00 ,$460.00 ,$266.03 ,$460.00 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$689.60 
ST NICHOLAS HOSPITAL - ACUTE,39000126,P9040,HC RED CELLS L/R IRR EA (DIRECTED),390,1 ,$862.00 ,$431.00 ,$46.72 ,$862.00 ,$46.72 ,$557.63 ,$557.63 ,$266.03 ,$517.20 ,$732.70 ,$603.40 ,$46.72 ,$818.90 ,$655.12 ,$646.50 ,$560.30 ,$732.70 ,$266.03 ,$560.30 ,$560.30 ,$603.40 ,$46.72 ,$266.03 ,$266.03 ,$454.83 ,$732.70 ,$598.57 ,$793.04 ,$603.40 ,$862.00 ,$862.00 ,$524.96 ,$862.00 ,$595.64 ,$775.80 ,$600.38 ,$268.69 ,$680.98 ,$49.52 ,$460.00 ,$460.00 ,$266.03 ,$460.00 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$689.60 
ST NICHOLAS HOSPITAL - ACUTE,39000132,P9052,HC PLT APHER/PHER L/R HLA EA,390,1 ,"$2,352.00 ","$1,176.00 ",$117.41 ,"$2,352.00 ",$117.41 ,"$1,521.51 ","$1,521.51 ",$822.11 ,"$1,411.20 ","$1,999.20 ","$1,646.40 ",$117.41 ,"$2,234.40 ","$1,787.52 ","$1,764.00 ","$1,528.80 ","$1,999.20 ",$822.11 ,"$1,528.80 ","$1,528.80 ","$1,646.40 ",$117.41 ,$822.11 ,$822.11 ,$454.83 ,"$1,999.20 ","$1,849.75 ","$2,163.84 ","$1,646.40 ","$2,352.00 ","$2,352.00 ","$1,432.37 ","$2,352.00 ","$1,625.23 ","$2,116.80 ","$1,638.17 ",$830.33 ,"$1,858.08 ",$124.45 ,$460.00 ,$460.00 ,$822.11 ,$460.00 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,881.60 "
ST NICHOLAS HOSPITAL - ACUTE,39000133,P9052,HC PLT APHER/PHER L/R HLA EA (IRRAD),390,1 ,"$2,352.00 ","$1,176.00 ",$117.41 ,"$2,352.00 ",$117.41 ,"$1,521.51 ","$1,521.51 ",$822.11 ,"$1,411.20 ","$1,999.20 ","$1,646.40 ",$117.41 ,"$2,234.40 ","$1,787.52 ","$1,764.00 ","$1,528.80 ","$1,999.20 ",$822.11 ,"$1,528.80 ","$1,528.80 ","$1,646.40 ",$117.41 ,$822.11 ,$822.11 ,$454.83 ,"$1,999.20 ","$1,849.75 ","$2,163.84 ","$1,646.40 ","$2,352.00 ","$2,352.00 ","$1,432.37 ","$2,352.00 ","$1,625.23 ","$2,116.80 ","$1,638.17 ",$830.33 ,"$1,858.08 ",$124.45 ,$460.00 ,$460.00 ,$822.11 ,$460.00 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,881.60 "
ST NICHOLAS HOSPITAL - ACUTE,39000140,P9058,HC RBC LEUKORED CMV NEG IRRAD,390,1 ,$806.00 ,$403.00 ,$46.72 ,$806.00 ,$46.72 ,$521.40 ,$521.40 ,$248.99 ,$483.60 ,$685.10 ,$564.20 ,$46.72 ,$765.70 ,$612.56 ,$604.50 ,$523.90 ,$685.10 ,$248.99 ,$523.90 ,$523.90 ,$564.20 ,$46.72 ,$248.99 ,$248.99 ,$454.83 ,$685.10 ,$560.23 ,$741.52 ,$564.20 ,$806.00 ,$806.00 ,$490.85 ,$806.00 ,$556.95 ,$725.40 ,$561.38 ,$251.48 ,$636.74 ,$49.52 ,$460.00 ,$460.00 ,$248.99 ,$460.00 ,$580.32 ,$499.72 ,$580.32 ,$580.32 ,$644.80 
ST NICHOLAS HOSPITAL - ACUTE,39000204,P9073,HC PLATELETS PHERESIS PATH REDUCED EA UN,390,1 ,"$1,139.00 ",$569.50 ,$117.41 ,"$1,341.29 ",$117.41 ,$736.82 ,$736.82 ,$596.13 ,$683.40 ,$968.15 ,$797.30 ,$117.41 ,"$1,082.05 ",$865.64 ,$854.25 ,$740.35 ,$968.15 ,$596.13 ,$740.35 ,$740.35 ,$797.30 ,$117.41 ,$596.13 ,$596.13 ,$454.83 ,$968.15 ,"$1,341.29 ","$1,047.88 ",$797.30 ,"$1,139.00 ","$1,139.00 ",$693.65 ,"$1,139.00 ",$787.05 ,"$1,025.10 ",$793.31 ,$602.09 ,$899.81 ,$124.45 ,$460.00 ,$460.00 ,$596.13 ,$460.00 ,$820.08 ,$706.18 ,$820.08 ,$820.08 ,$911.20 
ST NICHOLAS HOSPITAL - ACUTE,39000209,P9040,HC RED CELLS L/R IRR EA SALINE WASH (RC),390,1 ,$946.00 ,$473.00 ,$46.72 ,$946.00 ,$46.72 ,$611.97 ,$611.97 ,$266.03 ,$567.60 ,$804.10 ,$662.20 ,$46.72 ,$898.70 ,$718.96 ,$709.50 ,$614.90 ,$804.10 ,$266.03 ,$614.90 ,$614.90 ,$662.20 ,$46.72 ,$266.03 ,$266.03 ,$454.83 ,$804.10 ,$598.57 ,$870.32 ,$662.20 ,$946.00 ,$946.00 ,$576.11 ,$946.00 ,$653.69 ,$851.40 ,$658.89 ,$268.69 ,$747.34 ,$49.52 ,$460.00 ,$460.00 ,$266.03 ,$460.00 ,$681.12 ,$586.52 ,$681.12 ,$681.12 ,$756.80 
ST NICHOLAS HOSPITAL - ACUTE,39000211,P9059,HC COVID CONVALESCENT PLASMA,390,1 ,"$1,594.00 ",$797.00 ,$46.72 ,"$1,594.00 ",$46.72 ,"$1,031.16 ","$1,031.16 ",$72.64 ,$956.40 ,"$1,354.90 ","$1,115.80 ",$46.72 ,"$1,514.30 ","$1,211.44 ","$1,195.50 ","$1,036.10 ","$1,354.90 ",$72.64 ,"$1,036.10 ","$1,036.10 ","$1,115.80 ",$46.72 ,$72.64 ,$72.64 ,$454.83 ,"$1,354.90 ",$163.44 ,"$1,466.48 ","$1,115.80 ",$264.55 ,$264.55 ,$970.75 ,$264.55 ,"$1,101.45 ","$1,434.60 ","$1,110.22 ",$73.37 ,"$1,259.26 ",$49.52 ,$460.00 ,$460.00 ,$72.64 ,$460.00 ,"$1,147.68 ",$988.28 ,"$1,147.68 ","$1,147.68 ","$1,275.20 "
ST NICHOLAS HOSPITAL - ACUTE,39100001,36430,HC BLOOD PROD ADMIN,391,1 ,$937.00 ,$468.50 ,$144.58 ,$937.00 ,$144.58 ,$606.15 ,$606.15 ,$391.36 ,$562.20 ,$796.45 ,$655.90 ,$144.58 ,$890.15 ,$712.12 ,$702.75 ,$609.05 ,$796.45 ,$391.36 ,$609.05 ,$609.05 ,$655.90 ,$144.58 ,$391.36 ,$391.36 ,$454.83 ,$796.45 ,$880.56 ,$862.04 ,$655.90 ,$475.25 ,$570.35 ,$570.63 ,$570.35 ,$647.47 ,$843.30 ,$652.62 ,$395.27 ,$740.23 ,$153.25 ,$460.00 ,$460.00 ,$391.36 ,$460.00 ,$674.64 ,$580.94 ,$674.64 ,$674.64 ,$749.60 
ST NICHOLAS HOSPITAL - ACUTE,39100002,36430,HC MASSIVE TRANSFUSION,391,1 ,$937.00 ,$468.50 ,$144.58 ,$937.00 ,$144.58 ,$606.15 ,$606.15 ,$391.36 ,$562.20 ,$796.45 ,$655.90 ,$144.58 ,$890.15 ,$712.12 ,$702.75 ,$609.05 ,$796.45 ,$391.36 ,$609.05 ,$609.05 ,$655.90 ,$144.58 ,$391.36 ,$391.36 ,$454.83 ,$796.45 ,$880.56 ,$862.04 ,$655.90 ,$475.25 ,$570.35 ,$570.63 ,$570.35 ,$647.47 ,$843.30 ,$652.62 ,$395.27 ,$740.23 ,$153.25 ,$460.00 ,$460.00 ,$391.36 ,$460.00 ,$674.64 ,$580.94 ,$674.64 ,$674.64 ,$749.60 
ST NICHOLAS HOSPITAL - ACUTE,40100001,77067,HC MAMM SCREEN BI W/CAD SELF REFERRAL,401,1 ,$296.00 ,$148.00 ,$15.90 ,$296.00 ,$15.90 ,$296.00 ,$208.00 ,$89.75 ,$177.60 ,$251.60 ,$207.20 ,$15.90 ,$281.20 ,$224.96 ,$222.00 ,$183.99 ,$251.60 ,$89.75 ,$183.99 ,$94.64 ,$207.20 ,$15.90 ,$89.75 ,$89.75 ,$158.40 ,$251.60 ,$201.94 ,$272.32 ,$207.20 ,$296.00 ,$296.00 ,$180.26 ,$296.00 ,$204.54 ,$266.40 ,$206.16 ,$90.65 ,$233.84 ,$16.85 ,$163.00 ,$163.00 ,$89.75 ,$163.00 ,$213.12 ,$183.52 ,$213.12 ,$213.12 ,$236.80 
ST NICHOLAS HOSPITAL - ACUTE,40100002,77067,HC MAMM SCREEN BI W/CAD CORPORATE,403,1 ,$134.30 ,$67.15 ,$15.90 ,$201.94 ,$15.90 ,$134.30 ,$134.30 ,$89.75 ,$80.58 ,$114.16 ,$94.01 ,$15.90 ,$127.59 ,$102.07 ,$100.73 ,$134.30 ,$114.16 ,$89.75 ,$134.30 ,$94.64 ,$94.01 ,$15.90 ,$89.75 ,$89.75 ,$134.30 ,$114.16 ,$201.94 ,$123.56 ,$94.01 ,$134.30 ,$134.30 ,$81.79 ,$134.30 ,$92.80 ,$120.87 ,$93.54 ,$90.65 ,$106.10 ,$16.85 ,$134.30 ,$134.30 ,$89.75 ,$134.30 ,$96.70 ,$83.27 ,$96.70 ,$96.70 ,$107.44 
ST NICHOLAS HOSPITAL - ACUTE,40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$318.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$349.60 ,$345.00 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$114.17 ,$322.00 ,$15.90 ,$108.66 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$386.72 ,$386.72 ,$280.14 ,$386.72 ,$317.86 ,$414.00 ,$320.39 ,$109.75 ,$363.40 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$318.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$349.60 ,$345.00 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$114.17 ,$322.00 ,$15.90 ,$108.66 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$386.72 ,$386.72 ,$280.14 ,$386.72 ,$317.86 ,$414.00 ,$320.39 ,$109.75 ,$363.40 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$318.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$349.60 ,$345.00 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$114.17 ,$322.00 ,$15.90 ,$108.66 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$386.72 ,$386.72 ,$280.14 ,$386.72 ,$317.86 ,$414.00 ,$320.39 ,$109.75 ,$363.40 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100006,77066,HC MAMMOGRAM DIAG W/CAD UPGRADE BIL,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$318.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$349.60 ,$345.00 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$114.17 ,$322.00 ,$15.90 ,$108.66 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$386.72 ,$386.72 ,$280.14 ,$386.72 ,$317.86 ,$414.00 ,$320.39 ,$109.75 ,$363.40 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$318.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$266.00 ,$262.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$89.50 ,$245.00 ,$15.90 ,$85.19 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$302.57 ,$302.57 ,$213.15 ,$302.57 ,$241.85 ,$315.00 ,$243.78 ,$86.04 ,$276.50 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$318.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$266.00 ,$262.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$89.50 ,$245.00 ,$15.90 ,$85.19 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$302.57 ,$302.57 ,$213.15 ,$302.57 ,$241.85 ,$315.00 ,$243.78 ,$86.04 ,$276.50 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$318.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$266.00 ,$262.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$89.50 ,$245.00 ,$15.90 ,$85.19 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$302.57 ,$302.57 ,$213.15 ,$302.57 ,$241.85 ,$315.00 ,$243.78 ,$86.04 ,$276.50 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100010,77065,HC MAMMOGRAM DIAG UNIL W/CAD UPGRADE,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$318.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$266.00 ,$262.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$89.50 ,$245.00 ,$15.90 ,$85.19 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$302.57 ,$302.57 ,$213.15 ,$302.57 ,$241.85 ,$315.00 ,$243.78 ,$86.04 ,$276.50 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$130.00 ,$65.00 ,$15.90 ,$130.00 ,$15.90 ,$84.10 ,$84.10 ,$22.82 ,$78.00 ,$110.50 ,$91.00 ,$15.90 ,$123.50 ,$98.80 ,$97.50 ,$46.76 ,$110.50 ,$22.82 ,$46.76 ,$23.97 ,$91.00 ,$15.90 ,$22.82 ,$22.82 ,$130.00 ,$110.50 ,$51.35 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 ,$23.05 ,$102.70 ,$16.85 ,$130.00 ,$130.00 ,$22.82 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,40200001,93880,HC CAROTID BI US SELF SCREEN,402,1 ,$80.00 ,$40.00 ,$40.00 ,$510.48 ,$52.74 ,$80.00 ,$80.00 ,$226.88 ,$48.00 ,$68.00 ,$56.00 ,$52.74 ,$76.00 ,$60.80 ,$60.00 ,$80.00 ,$68.00 ,$226.88 ,$80.00 ,$80.00 ,$56.00 ,$52.74 ,$226.88 ,$226.88 ,$80.00 ,$68.00 ,$510.48 ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$55.72 ,$229.15 ,$63.20 ,$55.90 ,$80.00 ,$80.00 ,$226.88 ,$80.00 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,40200005,21925,HC BX SOFT TISSUE BACK/FLANK DEEP,402,1 ,"$3,878.00 ","$1,939.00 ",$305.48 ,"$3,878.00 ",$547.96 ,$584.00 ,$536.00 ,"$1,387.33 ","$2,326.80 ","$3,296.30 ","$2,714.60 ",$547.96 ,"$3,684.10 ","$2,947.28 ","$2,908.50 ",$722.36 ,"$3,296.30 ","$1,387.33 ",$722.36 ,$446.42 ,"$2,714.60 ",$547.96 ,"$1,387.33 ","$1,387.33 ",$305.48 ,"$3,296.30 ","$3,121.49 ","$3,567.76 ","$2,714.60 ","$1,921.55 ","$2,401.67 ","$2,361.70 ","$2,401.67 ","$2,679.70 ","$3,490.20 ","$2,701.03 ","$1,401.20 ","$3,063.62 ",$580.84 ,$512.00 ,$512.00 ,"$1,387.33 ",$512.00 ,"$2,792.16 ","$2,404.36 ","$2,792.16 ","$2,792.16 ","$3,102.40 "
ST NICHOLAS HOSPITAL - ACUTE,40200007,51798,HC US BLADDER SCAN,402,1 ,$183.00 ,$91.50 ,$9.71 ,$183.00 ,$22.63 ,$183.00 ,$183.00 ,$54.89 ,$109.80 ,$155.55 ,$128.10 ,$22.63 ,$173.85 ,$139.08 ,$137.25 ,$20.25 ,$155.55 ,$54.89 ,$20.25 ,$9.71 ,$128.10 ,$22.63 ,$54.89 ,$54.89 ,$183.00 ,$155.55 ,$123.49 ,$168.36 ,$128.10 ,$183.00 ,$183.00 ,$111.45 ,$183.00 ,$126.45 ,$164.70 ,$127.46 ,$55.44 ,$144.57 ,$23.99 ,$183.00 ,$183.00 ,$54.89 ,$183.00 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,40200009,49407,HC DRAIN ABSC PELVIC TRNSVAG PERC,402,1 ,"$2,400.00 ","$1,200.00 ",$232.13 ,"$3,121.49 ",$232.13 ,$584.00 ,$536.00 ,"$1,387.33 ","$1,440.00 ","$2,040.00 ","$1,680.00 ",$232.13 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ",$398.99 ,"$2,040.00 ","$1,387.33 ",$398.99 ,$705.79 ,"$1,680.00 ",$232.13 ,"$1,387.33 ","$1,387.33 ",$305.48 ,"$2,040.00 ","$3,121.49 ","$2,208.00 ","$1,680.00 ","$1,921.55 ","$2,400.00 ","$1,461.60 ","$2,400.00 ","$1,658.40 ","$2,160.00 ","$1,671.60 ","$1,401.20 ","$1,896.00 ",$246.06 ,$512.00 ,$512.00 ,"$1,387.33 ",$512.00 ,"$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,40200012,76506,HC US ENCEPHALOGRAM,402,1 ,$900.00 ,$450.00 ,$34.74 ,$900.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$540.00 ,$765.00 ,$630.00 ,$34.74 ,$855.00 ,$684.00 ,$675.00 ,$170.62 ,$765.00 ,$107.35 ,$170.62 ,$79.92 ,$630.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$765.00 ,$241.53 ,$828.00 ,$630.00 ,$487.55 ,$487.55 ,$548.10 ,$487.55 ,$621.90 ,$810.00 ,$626.85 ,$108.42 ,$711.00 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$648.00 ,$558.00 ,$648.00 ,$648.00 ,$720.00 
ST NICHOLAS HOSPITAL - ACUTE,40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,$790.00 ,$395.00 ,$34.74 ,$790.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$474.00 ,$671.50 ,$553.00 ,$34.74 ,$750.50 ,$600.40 ,$592.50 ,$170.60 ,$671.50 ,$107.35 ,$170.60 ,$84.37 ,$553.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$671.50 ,$241.53 ,$726.80 ,$553.00 ,$487.55 ,$487.55 ,$481.11 ,$487.55 ,$545.89 ,$711.00 ,$550.24 ,$108.42 ,$624.10 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$568.80 ,$489.80 ,$568.80 ,$568.80 ,$632.00 
ST NICHOLAS HOSPITAL - ACUTE,40200014,76604,HC US CHEST,402,1 ,$580.00 ,$290.00 ,$34.74 ,$580.00 ,$34.74 ,$580.00 ,$536.00 ,$107.35 ,$348.00 ,$493.00 ,$406.00 ,$34.74 ,$551.00 ,$440.80 ,$435.00 ,$61.03 ,$493.00 ,$107.35 ,$61.03 ,$48.07 ,$406.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$493.00 ,$241.53 ,$533.60 ,$406.00 ,$487.55 ,$487.55 ,$353.22 ,$487.55 ,$400.78 ,$522.00 ,$403.97 ,$108.42 ,$458.20 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$417.60 ,$359.60 ,$417.60 ,$417.60 ,$464.00 
ST NICHOLAS HOSPITAL - ACUTE,40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$340.00 ,$34.74 ,$680.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$408.00 ,$578.00 ,$476.00 ,$34.74 ,$646.00 ,$516.80 ,$510.00 ,$137.86 ,$578.00 ,$107.35 ,$137.86 ,$67.93 ,$476.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$578.00 ,$241.53 ,$625.60 ,$476.00 ,$326.48 ,$326.48 ,$414.12 ,$326.48 ,$469.88 ,$612.00 ,$473.62 ,$108.42 ,$537.20 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$544.00 
ST NICHOLAS HOSPITAL - ACUTE,40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$340.00 ,$34.74 ,$680.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$408.00 ,$578.00 ,$476.00 ,$34.74 ,$646.00 ,$516.80 ,$510.00 ,$137.86 ,$578.00 ,$107.35 ,$137.86 ,$67.93 ,$476.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$578.00 ,$241.53 ,$625.60 ,$476.00 ,$326.48 ,$326.48 ,$414.12 ,$326.48 ,$469.88 ,$612.00 ,$473.62 ,$108.42 ,$537.20 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$544.00 
ST NICHOLAS HOSPITAL - ACUTE,40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$275.00 ,$34.74 ,$550.00 ,$34.74 ,$550.00 ,$536.00 ,$79.76 ,$330.00 ,$467.50 ,$385.00 ,$34.74 ,$522.50 ,$418.00 ,$412.50 ,$105.12 ,$467.50 ,$79.76 ,$105.12 ,$51.49 ,$385.00 ,$34.74 ,$79.76 ,$79.76 ,$305.48 ,$467.50 ,$179.45 ,$506.00 ,$385.00 ,$326.48 ,$326.48 ,$334.95 ,$326.48 ,$380.05 ,$495.00 ,$383.08 ,$80.56 ,$434.50 ,$36.82 ,$512.00 ,$512.00 ,$79.76 ,$512.00 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$275.00 ,$34.74 ,$550.00 ,$34.74 ,$550.00 ,$536.00 ,$79.76 ,$330.00 ,$467.50 ,$385.00 ,$34.74 ,$522.50 ,$418.00 ,$412.50 ,$105.12 ,$467.50 ,$79.76 ,$105.12 ,$51.49 ,$385.00 ,$34.74 ,$79.76 ,$79.76 ,$305.48 ,$467.50 ,$179.45 ,$506.00 ,$385.00 ,$326.48 ,$326.48 ,$334.95 ,$326.48 ,$380.05 ,$495.00 ,$383.08 ,$80.56 ,$434.50 ,$36.82 ,$512.00 ,$512.00 ,$79.76 ,$512.00 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,100.00 ",$550.00 ,$52.74 ,"$1,100.00 ",$52.74 ,$584.00 ,$536.00 ,$107.35 ,$660.00 ,$935.00 ,$770.00 ,$52.74 ,"$1,045.00 ",$836.00 ,$825.00 ,$159.26 ,$935.00 ,$107.35 ,$159.26 ,$78.89 ,$770.00 ,$52.74 ,$107.35 ,$107.35 ,$305.48 ,$935.00 ,$241.53 ,"$1,012.00 ",$770.00 ,$487.55 ,$487.55 ,$669.90 ,$487.55 ,$760.10 ,$990.00 ,$766.15 ,$108.42 ,$869.00 ,$55.90 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200018,76705,HC US ABDOMEN LTD,402,1 ,$820.00 ,$410.00 ,$34.74 ,$820.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$492.00 ,$697.00 ,$574.00 ,$34.74 ,$779.00 ,$623.20 ,$615.00 ,$119.84 ,$697.00 ,$107.35 ,$119.84 ,$59.37 ,$574.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$697.00 ,$241.53 ,$754.40 ,$574.00 ,$487.55 ,$487.55 ,$499.38 ,$487.55 ,$566.62 ,$738.00 ,$571.13 ,$108.42 ,$647.80 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$656.00 
ST NICHOLAS HOSPITAL - ACUTE,40200019,76770,HC US RETROPERITIONEAL,402,1 ,$810.00 ,$405.00 ,$52.74 ,$810.00 ,$52.74 ,$584.00 ,$536.00 ,$107.35 ,$486.00 ,$688.50 ,$567.00 ,$52.74 ,$769.50 ,$615.60 ,$607.50 ,$148.58 ,$688.50 ,$107.35 ,$148.58 ,$73.41 ,$567.00 ,$52.74 ,$107.35 ,$107.35 ,$305.48 ,$688.50 ,$241.53 ,$745.20 ,$567.00 ,$487.55 ,$487.55 ,$493.29 ,$487.55 ,$559.71 ,$729.00 ,$564.17 ,$108.42 ,$639.90 ,$55.90 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$648.00 
ST NICHOLAS HOSPITAL - ACUTE,40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$740.00 ,$370.00 ,$28.55 ,$740.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$444.00 ,$629.00 ,$518.00 ,$34.74 ,$703.00 ,$562.40 ,$555.00 ,$60.35 ,$629.00 ,$107.35 ,$60.35 ,$28.55 ,$518.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$629.00 ,$241.53 ,$680.80 ,$518.00 ,$487.55 ,$487.55 ,$450.66 ,$487.55 ,$511.34 ,$666.00 ,$515.41 ,$108.42 ,$584.60 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$592.00 
ST NICHOLAS HOSPITAL - ACUTE,40200021,76776,HC US KIDNEY TRANSPLANT W/DOPPLER,402,1 ,$820.00 ,$410.00 ,$34.74 ,$820.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$492.00 ,$697.00 ,$574.00 ,$34.74 ,$779.00 ,$623.20 ,$615.00 ,$227.63 ,$697.00 ,$107.35 ,$227.63 ,$113.25 ,$574.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$697.00 ,$241.53 ,$754.40 ,$574.00 ,$487.55 ,$487.55 ,$499.38 ,$487.55 ,$566.62 ,$738.00 ,$571.13 ,$108.42 ,$647.80 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$656.00 
ST NICHOLAS HOSPITAL - ACUTE,40200022,76800,HC US SPINAL CANAL  AND  CONTENTS,402,1 ,$500.00 ,$250.00 ,$34.74 ,$500.00 ,$34.74 ,$500.00 ,$500.00 ,$107.35 ,$300.00 ,$425.00 ,$350.00 ,$34.74 ,$475.00 ,$380.00 ,$375.00 ,$175.30 ,$425.00 ,$107.35 ,$175.30 ,$81.29 ,$350.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$425.00 ,$241.53 ,$460.00 ,$350.00 ,$326.24 ,$326.24 ,$304.50 ,$326.24 ,$345.50 ,$450.00 ,$348.25 ,$108.42 ,$395.00 ,$36.82 ,$500.00 ,$500.00 ,$107.35 ,$500.00 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,$650.00 ,$325.00 ,$31.94 ,$650.00 ,$31.94 ,$584.00 ,$536.00 ,$107.35 ,$390.00 ,$552.50 ,$455.00 ,$31.94 ,$617.50 ,$494.00 ,$487.50 ,$141.88 ,$552.50 ,$107.35 ,$141.88 ,$69.64 ,$455.00 ,$31.94 ,$107.35 ,$107.35 ,$305.48 ,$552.50 ,$241.53 ,$598.00 ,$455.00 ,$487.55 ,$487.55 ,$395.85 ,$487.55 ,$449.15 ,$585.00 ,$452.73 ,$108.42 ,$513.50 ,$33.86 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$520.00 
ST NICHOLAS HOSPITAL - ACUTE,40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$360.00 ,$180.00 ,$20.89 ,$360.00 ,$31.94 ,$360.00 ,$360.00 , N/A ,$216.00 ,$306.00 ,$252.00 ,$31.94 ,$342.00 ,$273.60 ,$270.00 ,$42.76 ,$306.00 , N/A ,$42.76 ,$20.89 ,$252.00 ,$31.94 , N/A , N/A ,$305.48 ,$306.00 , N/A ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$219.13 ,$248.76 ,$324.00 ,$250.74 , N/A ,$284.40 ,$33.86 ,$360.00 ,$360.00 , N/A ,$360.00 ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$288.00 
ST NICHOLAS HOSPITAL - ACUTE,40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,$820.00 ,$410.00 ,$31.94 ,$820.00 ,$31.94 ,$584.00 ,$536.00 ,$107.35 ,$492.00 ,$697.00 ,$574.00 ,$31.94 ,$779.00 ,$623.20 ,$615.00 ,$176.65 ,$697.00 ,$107.35 ,$176.65 ,$86.77 ,$574.00 ,$31.94 ,$107.35 ,$107.35 ,$305.48 ,$697.00 ,$241.53 ,$754.40 ,$574.00 ,$487.55 ,$487.55 ,$499.38 ,$487.55 ,$566.62 ,$738.00 ,$571.13 ,$108.42 ,$647.80 ,$33.86 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$656.00 
ST NICHOLAS HOSPITAL - ACUTE,40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,$440.00 ,$220.00 ,$31.94 ,$440.00 ,$31.94 ,$440.00 ,$440.00 , N/A ,$264.00 ,$374.00 ,$308.00 ,$31.94 ,$418.00 ,$334.40 ,$330.00 ,$83.07 ,$374.00 , N/A ,$83.07 ,$40.53 ,$308.00 ,$31.94 , N/A , N/A ,$305.48 ,$374.00 , N/A ,$404.80 ,$308.00 ,$223.17 ,$267.83 ,$267.96 ,$267.83 ,$304.04 ,$396.00 ,$306.46 , N/A ,$347.60 ,$33.86 ,$440.00 ,$440.00 , N/A ,$440.00 ,$316.80 ,$272.80 ,$316.80 ,$316.80 ,$352.00 
ST NICHOLAS HOSPITAL - ACUTE,40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,$930.00 ,$465.00 ,$31.94 ,$930.00 ,$31.94 ,$584.00 ,$536.00 ,$226.88 ,$558.00 ,$790.50 ,$651.00 ,$31.94 ,$883.50 ,$706.80 ,$697.50 ,$165.23 ,$790.50 ,$226.88 ,$165.23 ,$79.34 ,$651.00 ,$31.94 ,$226.88 ,$226.88 ,$305.48 ,$790.50 ,$510.48 ,$855.60 ,$651.00 ,$691.44 ,$691.44 ,$566.37 ,$691.44 ,$642.63 ,$837.00 ,$647.75 ,$229.15 ,$734.70 ,$33.86 ,$512.00 ,$512.00 ,$226.88 ,$512.00 ,$669.60 ,$576.60 ,$669.60 ,$669.60 ,$744.00 
ST NICHOLAS HOSPITAL - ACUTE,40200029,76812,HC US PREGNANCY DETAILED ADDL,402,1 ,$425.00 ,$212.50 ,$31.94 ,$425.00 ,$31.94 ,$425.00 ,$425.00 , N/A ,$255.00 ,$361.25 ,$297.50 ,$31.94 ,$403.75 ,$323.00 ,$318.75 ,$216.28 ,$361.25 , N/A ,$216.28 ,$105.72 ,$297.50 ,$31.94 , N/A , N/A ,$305.48 ,$361.25 , N/A ,$391.00 ,$297.50 ,$215.56 ,$258.70 ,$258.83 ,$258.70 ,$293.68 ,$382.50 ,$296.01 , N/A ,$335.75 ,$33.86 ,$425.00 ,$425.00 , N/A ,$425.00 ,$306.00 ,$263.50 ,$306.00 ,$306.00 ,$340.00 
ST NICHOLAS HOSPITAL - ACUTE,40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$460.00 ,$230.00 ,$31.94 ,$460.00 ,$31.94 ,$460.00 ,$460.00 ,$107.35 ,$276.00 ,$391.00 ,$322.00 ,$31.94 ,$437.00 ,$349.60 ,$345.00 ,$138.54 ,$391.00 ,$107.35 ,$138.54 ,$67.93 ,$322.00 ,$31.94 ,$107.35 ,$107.35 ,$305.48 ,$391.00 ,$241.53 ,$423.20 ,$322.00 ,$326.24 ,$326.24 ,$280.14 ,$326.24 ,$317.86 ,$414.00 ,$320.39 ,$108.42 ,$363.40 ,$33.86 ,$460.00 ,$460.00 ,$107.35 ,$460.00 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,40200031,76815,HC US FETAL HEART BEAT,402,1 ,$480.00 ,$240.00 ,$31.94 ,$480.00 ,$31.94 ,$480.00 ,$480.00 ,$107.35 ,$288.00 ,$408.00 ,$336.00 ,$31.94 ,$456.00 ,$364.80 ,$360.00 ,$101.13 ,$408.00 ,$107.35 ,$101.13 ,$49.43 ,$336.00 ,$31.94 ,$107.35 ,$107.35 ,$305.48 ,$408.00 ,$241.53 ,$441.60 ,$336.00 ,$480.00 ,$480.00 ,$292.32 ,$480.00 ,$331.68 ,$432.00 ,$334.32 ,$108.42 ,$379.20 ,$33.86 ,$480.00 ,$480.00 ,$107.35 ,$480.00 ,$345.60 ,$297.60 ,$345.60 ,$345.60 ,$384.00 
ST NICHOLAS HOSPITAL - ACUTE,40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,$630.00 ,$315.00 ,$31.94 ,$630.00 ,$31.94 ,$584.00 ,$536.00 ,$107.35 ,$378.00 ,$535.50 ,$441.00 ,$31.94 ,$598.50 ,$478.80 ,$472.50 ,$114.49 ,$535.50 ,$107.35 ,$114.49 ,$55.94 ,$441.00 ,$31.94 ,$107.35 ,$107.35 ,$305.48 ,$535.50 ,$241.53 ,$579.60 ,$441.00 ,$487.55 ,$487.55 ,$383.67 ,$487.55 ,$435.33 ,$567.00 ,$438.80 ,$108.42 ,$497.70 ,$33.86 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$453.60 ,$390.60 ,$453.60 ,$453.60 ,$504.00 
ST NICHOLAS HOSPITAL - ACUTE,40200033,76818,HC US FETAL BIO PROFILE W/NST,402,1 ,$700.00 ,$350.00 ,$31.94 ,$700.00 ,$31.94 ,$584.00 ,$536.00 ,$107.35 ,$420.00 ,$595.00 ,$490.00 ,$31.94 ,$665.00 ,$532.00 ,$525.00 ,$128.04 ,$595.00 ,$107.35 ,$128.04 ,$62.91 ,$490.00 ,$31.94 ,$107.35 ,$107.35 ,$305.48 ,$595.00 ,$241.53 ,$644.00 ,$490.00 ,$487.55 ,$487.55 ,$426.30 ,$487.55 ,$483.70 ,$630.00 ,$487.55 ,$108.42 ,$553.00 ,$33.86 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,$570.00 ,$285.00 ,$31.94 ,$570.00 ,$31.94 ,$570.00 ,$536.00 ,$107.35 ,$342.00 ,$484.50 ,$399.00 ,$31.94 ,$541.50 ,$433.20 ,$427.50 ,$93.11 ,$484.50 ,$107.35 ,$93.11 ,$46.35 ,$399.00 ,$31.94 ,$107.35 ,$107.35 ,$305.48 ,$484.50 ,$241.53 ,$524.40 ,$399.00 ,$487.55 ,$487.55 ,$347.13 ,$487.55 ,$393.87 ,$513.00 ,$397.01 ,$108.42 ,$450.30 ,$33.86 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$410.40 ,$353.40 ,$410.40 ,$410.40 ,$456.00 
ST NICHOLAS HOSPITAL - ACUTE,40200038,76830,HC US TRANSVAGINAL,402,1 ,$760.00 ,$380.00 ,$34.74 ,$760.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$456.00 ,$646.00 ,$532.00 ,$34.74 ,$722.00 ,$577.60 ,$570.00 ,$175.30 ,$646.00 ,$107.35 ,$175.30 ,$85.05 ,$532.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$646.00 ,$241.53 ,$699.20 ,$532.00 ,$487.55 ,$487.55 ,$462.84 ,$487.55 ,$525.16 ,$684.00 ,$529.34 ,$108.42 ,$600.40 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,40200040,76856,HC US PELVIS NON OB,402,1 ,$880.00 ,$440.00 ,$52.74 ,$880.00 ,$52.74 ,$584.00 ,$536.00 ,$107.35 ,$528.00 ,$748.00 ,$616.00 ,$52.74 ,$836.00 ,$668.80 ,$660.00 ,$147.23 ,$748.00 ,$107.35 ,$147.23 ,$72.38 ,$616.00 ,$52.74 ,$107.35 ,$107.35 ,$305.48 ,$748.00 ,$241.53 ,$809.60 ,$616.00 ,$487.55 ,$487.55 ,$535.92 ,$487.55 ,$608.08 ,$792.00 ,$612.92 ,$108.42 ,$695.20 ,$55.90 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$704.00 
ST NICHOLAS HOSPITAL - ACUTE,40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$690.00 ,$345.00 ,$22.72 ,$690.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$414.00 ,$586.50 ,$483.00 ,$34.74 ,$655.50 ,$524.40 ,$517.50 ,$48.32 ,$586.50 ,$107.35 ,$48.32 ,$22.72 ,$483.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$586.50 ,$241.53 ,$634.80 ,$483.00 ,$326.24 ,$326.24 ,$420.21 ,$326.24 ,$476.79 ,$621.00 ,$480.59 ,$108.42 ,$545.10 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$496.80 ,$427.80 ,$496.80 ,$496.80 ,$552.00 
ST NICHOLAS HOSPITAL - ACUTE,40200042,76870,HC US SCROTUM,402,1 ,$740.00 ,$370.00 ,$34.74 ,$740.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$444.00 ,$629.00 ,$518.00 ,$34.74 ,$703.00 ,$562.40 ,$555.00 ,$141.88 ,$629.00 ,$107.35 ,$141.88 ,$70.33 ,$518.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$629.00 ,$241.53 ,$680.80 ,$518.00 ,$487.55 ,$487.55 ,$450.66 ,$487.55 ,$511.34 ,$666.00 ,$515.41 ,$108.42 ,$584.60 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$592.00 
ST NICHOLAS HOSPITAL - ACUTE,40200043,76872,HC ULTRA BX PROS,402,1 ,$327.00 ,$163.50 ,$34.74 ,$327.00 ,$34.74 ,$327.00 ,$327.00 ,$107.35 ,$196.20 ,$277.95 ,$228.90 ,$34.74 ,$310.65 ,$248.52 ,$245.25 ,$327.00 ,$277.95 ,$107.35 ,$327.00 ,$118.96 ,$228.90 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$277.95 ,$241.53 ,$300.84 ,$228.90 ,$327.00 ,$327.00 ,$199.14 ,$327.00 ,$225.96 ,$294.30 ,$227.76 ,$108.42 ,$258.33 ,$36.82 ,$327.00 ,$327.00 ,$107.35 ,$327.00 ,$235.44 ,$202.74 ,$235.44 ,$235.44 ,$261.60 
ST NICHOLAS HOSPITAL - ACUTE,40200044,76873,HC US TRANSRECTAL PROSTATE VOLUME,402,1 ,$690.00 ,$345.00 ,$52.74 ,$690.00 ,$52.74 ,$584.00 ,$536.00 ,$107.35 ,$414.00 ,$586.50 ,$483.00 ,$52.74 ,$655.50 ,$524.40 ,$517.50 ,$196.68 ,$586.50 ,$107.35 ,$196.68 ,$93.62 ,$483.00 ,$52.74 ,$107.35 ,$107.35 ,$305.48 ,$586.50 ,$241.53 ,$634.80 ,$483.00 ,$690.00 ,$690.00 ,$420.21 ,$690.00 ,$476.79 ,$621.00 ,$480.59 ,$108.42 ,$545.10 ,$55.90 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$496.80 ,$427.80 ,$496.80 ,$496.80 ,$552.00 
ST NICHOLAS HOSPITAL - ACUTE,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$810.00 ,$405.00 ,$34.74 ,$810.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$486.00 ,$688.50 ,$567.00 ,$34.74 ,$769.50 ,$615.60 ,$607.50 ,$56.35 ,$688.50 ,$107.35 ,$56.35 ,$44.30 ,$567.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$688.50 ,$241.53 ,$745.20 ,$567.00 ,$731.33 ,$731.33 ,$493.29 ,$731.33 ,$559.71 ,$729.00 ,$564.17 ,$108.42 ,$639.90 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$648.00 
ST NICHOLAS HOSPITAL - ACUTE,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$810.00 ,$405.00 ,$34.74 ,$810.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$486.00 ,$688.50 ,$567.00 ,$34.74 ,$769.50 ,$615.60 ,$607.50 ,$56.35 ,$688.50 ,$107.35 ,$56.35 ,$44.30 ,$567.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$688.50 ,$241.53 ,$745.20 ,$567.00 ,$731.33 ,$731.33 ,$493.29 ,$731.33 ,$559.71 ,$729.00 ,$564.17 ,$108.42 ,$639.90 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$648.00 
ST NICHOLAS HOSPITAL - ACUTE,40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$550.00 ,$275.00 ,$31.28 ,$550.00 ,$34.74 ,$550.00 ,$536.00 ,$107.35 ,$330.00 ,$467.50 ,$385.00 ,$34.74 ,$522.50 ,$418.00 ,$412.50 ,$65.70 ,$467.50 ,$107.35 ,$65.70 ,$31.28 ,$385.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$467.50 ,$241.53 ,$506.00 ,$385.00 ,$326.24 ,$326.24 ,$334.95 ,$326.24 ,$380.05 ,$495.00 ,$383.08 ,$108.42 ,$434.50 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$440.00 
ST NICHOLAS HOSPITAL - ACUTE,40200048,76885,HC US HIPS INFANT DYNAMIC,402,1 ,$540.00 ,$270.00 ,$34.74 ,$540.00 ,$34.74 ,$540.00 ,$536.00 ,$79.76 ,$324.00 ,$459.00 ,$378.00 ,$34.74 ,$513.00 ,$410.40 ,$405.00 ,$205.57 ,$459.00 ,$79.76 ,$205.57 ,$102.53 ,$378.00 ,$34.74 ,$79.76 ,$79.76 ,$305.48 ,$459.00 ,$179.45 ,$496.80 ,$378.00 ,$326.24 ,$326.24 ,$328.86 ,$326.24 ,$373.14 ,$486.00 ,$376.11 ,$80.56 ,$426.60 ,$36.82 ,$512.00 ,$512.00 ,$79.76 ,$512.00 ,$388.80 ,$334.80 ,$388.80 ,$388.80 ,$432.00 
ST NICHOLAS HOSPITAL - ACUTE,40200050,76936,HC US GUIDED COMPRESSION RPR,402,1 ,$952.00 ,$476.00 ,$56.46 ,$952.00 ,$56.46 ,$584.00 ,$536.00 ,$260.95 ,$571.20 ,$809.20 ,$666.40 ,$56.46 ,$904.40 ,$723.52 ,$714.00 ,$336.32 ,$809.20 ,$260.95 ,$336.32 ,$165.66 ,$666.40 ,$56.46 ,$260.95 ,$260.95 ,$305.48 ,$809.20 ,$587.13 ,$875.84 ,$666.40 ,$474.86 ,$474.86 ,$579.77 ,$474.86 ,$657.83 ,$856.80 ,$663.07 ,$263.56 ,$752.08 ,$59.85 ,$512.00 ,$512.00 ,$260.95 ,$512.00 ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$761.60 
ST NICHOLAS HOSPITAL - ACUTE,40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$530.00 ,$265.00 ,$21.24 ,$530.00 ,$35.55 ,$530.00 ,$530.00 , N/A ,$318.00 ,$450.50 ,$371.00 ,$35.55 ,$503.50 ,$402.80 ,$397.50 ,$51.48 ,$450.50 , N/A ,$51.48 ,$21.24 ,$371.00 ,$35.55 , N/A , N/A ,$305.48 ,$450.50 , N/A ,$487.60 ,$371.00 ,$268.82 ,$322.61 ,$322.77 ,$322.61 ,$366.23 ,$477.00 ,$369.15 , N/A ,$418.70 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 ,$381.60 ,$328.60 ,$381.60 ,$381.60 ,$424.00 
ST NICHOLAS HOSPITAL - ACUTE,40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,000.00 ",$500.00 ,$24.43 ,"$1,000.00 ",$35.55 ,$584.00 ,$536.00 , N/A ,$600.00 ,$850.00 ,$700.00 ,$35.55 ,$950.00 ,$760.00 ,$750.00 ,$54.35 ,$850.00 , N/A ,$54.35 ,$24.43 ,$700.00 ,$35.55 , N/A , N/A ,$305.48 ,$850.00 , N/A ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$696.50 , N/A ,$790.00 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200057,76942,HC US GUIDED NEEDLE BX THORA,402,1 ,"$1,000.00 ",$500.00 ,$24.43 ,"$1,000.00 ",$35.55 ,$584.00 ,$536.00 , N/A ,$600.00 ,$850.00 ,$700.00 ,$35.55 ,$950.00 ,$760.00 ,$750.00 ,$54.35 ,$850.00 , N/A ,$54.35 ,$24.43 ,$700.00 ,$35.55 , N/A , N/A ,$305.48 ,$850.00 , N/A ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$696.50 , N/A ,$790.00 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200061,76965,HC US GUIDED INTERSTITIAL THRPY,402,1 ,$120.00 ,$60.00 ,$24.09 ,$120.00 ,$35.55 ,$120.00 ,$120.00 , N/A ,$72.00 ,$102.00 ,$84.00 ,$35.55 ,$114.00 ,$91.20 ,$90.00 ,$51.68 ,$102.00 , N/A ,$51.68 ,$24.09 ,$84.00 ,$35.55 , N/A , N/A ,$120.00 ,$102.00 , N/A ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$73.04 ,$82.92 ,$108.00 ,$83.58 , N/A ,$94.80 ,$37.68 ,$120.00 ,$120.00 , N/A ,$120.00 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,40200062,76998,HC US INTRAOPERATIVE,402,1 ,"$1,200.00 ",$600.00 ,$35.55 ,"$1,200.00 ",$35.55 ,$584.00 ,$536.00 , N/A ,$720.00 ,"$1,020.00 ",$840.00 ,$35.55 ,"$1,140.00 ",$912.00 ,$900.00 ,$103.26 ,"$1,020.00 ", N/A ,$103.26 ,$48.55 ,$840.00 ,$35.55 , N/A , N/A ,$305.48 ,"$1,020.00 ", N/A ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$730.44 ,$829.20 ,"$1,080.00 ",$835.80 , N/A ,$948.00 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,40200063,76999,HC UNLISTED PROCEDURE ULTRASOUND,402,1 ,$420.00 ,$210.00 ,$34.74 ,$420.00 ,$34.74 ,$420.00 ,$420.00 ,$79.76 ,$252.00 ,$357.00 ,$294.00 ,$34.74 ,$399.00 ,$319.20 ,$315.00 , N/A ,$357.00 ,$79.76 , N/A , N/A ,$294.00 ,$34.74 ,$79.76 ,$79.76 ,$305.48 ,$357.00 ,$179.45 ,$386.40 ,$294.00 ,$326.24 ,$326.24 ,$255.78 ,$326.24 ,$290.22 ,$378.00 ,$292.53 ,$80.56 ,$331.80 ,$36.82 ,$420.00 ,$420.00 ,$79.76 ,$420.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,"$1,100.00 ",$550.00 ,$52.74 ,"$1,100.00 ",$52.74 ,$584.00 ,$536.00 ,$226.88 ,$660.00 ,$935.00 ,$770.00 ,$52.74 ,"$1,045.00 ",$836.00 ,$825.00 ,$423.86 ,$935.00 ,$226.88 ,$423.86 ,$211.67 ,$770.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,$935.00 ,$510.48 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$766.15 ,$229.15 ,$869.00 ,$55.90 ,$512.00 ,$512.00 ,$226.88 ,$512.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200066,93975,HC DUPLEX ABD/PEL/RETRO CMPL RENAL,402,1 ,"$1,100.00 ",$550.00 ,$52.74 ,"$1,100.00 ",$52.74 ,$584.00 ,$536.00 ,$226.88 ,$660.00 ,$935.00 ,$770.00 ,$52.74 ,"$1,045.00 ",$836.00 ,$825.00 ,$423.86 ,$935.00 ,$226.88 ,$423.86 ,$211.67 ,$770.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,$935.00 ,$510.48 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$766.15 ,$229.15 ,$869.00 ,$55.90 ,$512.00 ,$512.00 ,$226.88 ,$512.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200067,93975,HC DUPLEX ABD/PEL/RETRO CMPL AORTA,402,1 ,"$1,100.00 ",$550.00 ,$52.74 ,"$1,100.00 ",$52.74 ,$584.00 ,$536.00 ,$226.88 ,$660.00 ,$935.00 ,$770.00 ,$52.74 ,"$1,045.00 ",$836.00 ,$825.00 ,$423.86 ,$935.00 ,$226.88 ,$423.86 ,$211.67 ,$770.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,$935.00 ,$510.48 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$766.15 ,$229.15 ,$869.00 ,$55.90 ,$512.00 ,$512.00 ,$226.88 ,$512.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,40200068,93976,HC DUPLEX ABD/PEL/RETRO LTD,402,1 ,"$1,000.00 ",$500.00 ,$52.74 ,"$1,000.00 ",$52.74 ,$584.00 ,$536.00 ,$107.35 ,$600.00 ,$850.00 ,$700.00 ,$52.74 ,$950.00 ,$760.00 ,$750.00 ,$241.67 ,$850.00 ,$107.35 ,$241.67 ,$119.76 ,$700.00 ,$52.74 ,$107.35 ,$107.35 ,$305.48 ,$850.00 ,$241.53 ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$696.50 ,$108.42 ,$790.00 ,$55.90 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,000.00 ",$500.00 ,$52.74 ,"$1,000.00 ",$52.74 ,$584.00 ,$536.00 ,$107.35 ,$600.00 ,$850.00 ,$700.00 ,$52.74 ,$950.00 ,$760.00 ,$750.00 ,$241.67 ,$850.00 ,$107.35 ,$241.67 ,$119.76 ,$700.00 ,$52.74 ,$107.35 ,$107.35 ,$305.48 ,$850.00 ,$241.53 ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$608.70 ,$691.00 ,$900.00 ,$696.50 ,$108.42 ,$790.00 ,$55.90 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,921,1 ,$860.00 ,$430.00 ,$52.74 ,$860.00 ,$52.74 ,$556.33 ,$556.33 ,$226.88 ,$516.00 ,$731.00 ,$602.00 ,$52.74 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$226.88 ,$559.00 ,$559.00 ,$602.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,$731.00 ,$510.48 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$598.99 ,$229.15 ,$679.40 ,$55.90 ,$465.00 ,$465.00 ,$226.88 ,$465.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,$660.00 ,$330.00 ,$34.74 ,$660.00 ,$34.74 ,$584.00 ,$536.00 ,$107.35 ,$396.00 ,$561.00 ,$462.00 ,$34.74 ,$627.00 ,$501.60 ,$495.00 ,$188.87 ,$561.00 ,$107.35 ,$188.87 ,$92.70 ,$462.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$561.00 ,$241.53 ,$607.20 ,$462.00 ,$334.75 ,$401.74 ,$401.94 ,$401.74 ,$456.06 ,$594.00 ,$459.69 ,$108.42 ,$521.40 ,$36.82 ,$512.00 ,$512.00 ,$107.35 ,$512.00 ,$475.20 ,$409.20 ,$475.20 ,$475.20 ,$528.00 
ST NICHOLAS HOSPITAL - ACUTE,40200075,76706,HC US AORTA (SCREENING),402,1 ,$500.00 ,$250.00 ,$34.74 ,$500.00 ,$34.74 ,$500.00 ,$500.00 ,$107.35 ,$300.00 ,$425.00 ,$350.00 ,$34.74 ,$475.00 ,$380.00 ,$375.00 ,$161.93 ,$425.00 ,$107.35 ,$161.93 ,$83.00 ,$350.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$425.00 ,$241.53 ,$460.00 ,$350.00 ,$395.75 ,$395.75 ,$304.50 ,$395.75 ,$345.50 ,$450.00 ,$348.25 ,$108.42 ,$395.00 ,$36.82 ,$500.00 ,$500.00 ,$107.35 ,$500.00 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,40200077,76706,HC ABD AORTA US SELF SCREEN CORP,402,1 ,$57.00 ,$28.50 ,$28.50 ,$241.53 ,$34.74 ,$57.00 ,$57.00 ,$107.35 ,$34.20 ,$48.45 ,$39.90 ,$34.74 ,$54.15 ,$43.32 ,$42.75 ,$57.00 ,$48.45 ,$107.35 ,$57.00 ,$57.00 ,$39.90 ,$34.74 ,$107.35 ,$107.35 ,$57.00 ,$48.45 ,$241.53 ,$52.44 ,$39.90 ,$57.00 ,$57.00 ,$34.71 ,$57.00 ,$39.39 ,$51.30 ,$39.70 ,$108.42 ,$45.03 ,$36.82 ,$57.00 ,$57.00 ,$107.35 ,$57.00 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$45.60 
ST NICHOLAS HOSPITAL - ACUTE,40200096,76512,HC OPHTHALMIC US DIAG B-SCAN,402,1 ,$318.00 ,$159.00 ,$20.32 ,$318.00 ,$34.74 ,$318.00 ,$318.00 ,$107.35 ,$190.80 ,$270.30 ,$222.60 ,$34.74 ,$302.10 ,$241.68 ,$238.50 ,$34.30 ,$270.30 ,$107.35 ,$34.30 ,$20.32 ,$222.60 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$270.30 ,$241.53 ,$292.56 ,$222.60 ,$318.00 ,$318.00 ,$193.66 ,$318.00 ,$219.74 ,$286.20 ,$221.49 ,$108.42 ,$251.22 ,$36.82 ,$318.00 ,$318.00 ,$107.35 ,$318.00 ,$228.96 ,$197.16 ,$228.96 ,$228.96 ,$254.40 
ST NICHOLAS HOSPITAL - ACUTE,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$318.00 ,$208.00 ,$89.75 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$266.00 ,$262.50 ,$183.99 ,$297.50 ,$89.75 ,$183.99 ,$94.64 ,$245.00 ,$15.90 ,$89.75 ,$89.75 ,$158.40 ,$297.50 ,$201.94 ,$322.00 ,$245.00 ,$319.86 ,$319.86 ,$213.15 ,$319.86 ,$241.85 ,$315.00 ,$243.78 ,$90.65 ,$276.50 ,$16.85 ,$163.00 ,$163.00 ,$89.75 ,$163.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$318.00 ,$208.00 ,$89.75 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$266.00 ,$262.50 ,$183.99 ,$297.50 ,$89.75 ,$183.99 ,$94.64 ,$245.00 ,$15.90 ,$89.75 ,$89.75 ,$158.40 ,$297.50 ,$201.94 ,$322.00 ,$245.00 ,$319.86 ,$319.86 ,$213.15 ,$319.86 ,$241.85 ,$315.00 ,$243.78 ,$90.65 ,$276.50 ,$16.85 ,$163.00 ,$163.00 ,$89.75 ,$163.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$130.00 ,$65.00 ,$15.90 ,$130.00 ,$15.90 ,$84.10 ,$84.10 ,$22.82 ,$78.00 ,$110.50 ,$91.00 ,$15.90 ,$123.50 ,$98.80 ,$97.50 ,$46.76 ,$110.50 ,$22.82 ,$46.76 ,$23.97 ,$91.00 ,$15.90 ,$22.82 ,$22.82 ,$130.00 ,$110.50 ,$51.35 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 ,$23.05 ,$102.70 ,$16.85 ,$130.00 ,$130.00 ,$22.82 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,40300008,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL CORPORATE,403,1 ,$40.00 ,$20.00 ,$15.90 ,$51.35 ,$15.90 ,$25.88 ,$25.88 ,$22.82 ,$24.00 ,$34.00 ,$28.00 ,$15.90 ,$38.00 ,$30.40 ,$30.00 ,$40.00 ,$34.00 ,$22.82 ,$40.00 ,$23.97 ,$28.00 ,$15.90 ,$22.82 ,$22.82 ,$40.00 ,$34.00 ,$51.35 ,$36.80 ,$28.00 ,$20.29 ,$24.35 ,$24.36 ,$24.35 ,$27.64 ,$36.00 ,$27.86 ,$23.05 ,$31.60 ,$16.85 ,$40.00 ,$40.00 ,$22.82 ,$40.00 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,40400003,78814,HC PET W/CT TUMR LIMITED AREA,404,1 ,"$7,007.00 ","$3,503.50 ",$411.24 ,"$7,007.00 ",$411.24 ,"$4,562.00 ","$4,266.00 ","$1,459.32 ","$4,204.20 ","$5,955.95 ","$4,904.90 ",$411.24 ,"$6,656.65 ","$5,325.32 ","$5,255.25 ","$5,800.64 ","$5,955.95 ","$1,459.32 ","$5,800.64 ","$2,727.31 ","$4,904.90 ",$411.24 ,"$1,459.32 ","$1,459.32 ","$2,559.25 ","$5,955.95 ","$3,283.47 ","$6,446.44 ","$4,904.90 ","$4,748.43 ","$4,748.43 ","$4,267.26 ","$4,748.43 ","$4,841.84 ","$6,306.30 ","$4,880.38 ","$1,473.91 ","$5,535.53 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,459.32 ","$3,879.00 ","$5,045.04 ","$4,344.34 ","$5,045.04 ","$5,045.04 ","$5,605.60 "
ST NICHOLAS HOSPITAL - ACUTE,40400004,78815,HC PET W/CT TUMR SKULL MID-THIGH,404,1 ,"$7,321.00 ","$3,660.50 ",$411.24 ,"$7,321.00 ",$411.24 ,"$4,562.00 ","$4,266.00 ","$1,459.32 ","$4,392.60 ","$6,222.85 ","$5,124.70 ",$411.24 ,"$6,954.95 ","$5,563.96 ","$5,490.75 ","$5,800.64 ","$6,222.85 ","$1,459.32 ","$5,800.64 ","$2,727.31 ","$5,124.70 ",$411.24 ,"$1,459.32 ","$1,459.32 ","$2,559.25 ","$6,222.85 ","$3,283.47 ","$6,735.32 ","$5,124.70 ","$4,748.43 ","$4,748.43 ","$4,458.49 ","$4,748.43 ","$5,058.81 ","$6,588.90 ","$5,099.08 ","$1,473.91 ","$5,783.59 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,459.32 ","$3,879.00 ","$5,271.12 ","$4,539.02 ","$5,271.12 ","$5,271.12 ","$5,856.80 "
ST NICHOLAS HOSPITAL - ACUTE,40400005,78816,HC PET W/CT MELAN IMAG WHOLE BODY,404,1 ,"$7,321.00 ","$3,660.50 ",$411.24 ,"$7,321.00 ",$411.24 ,"$4,562.00 ","$4,266.00 ","$1,459.32 ","$4,392.60 ","$6,222.85 ","$5,124.70 ",$411.24 ,"$6,954.95 ","$5,563.96 ","$5,490.75 ","$5,800.64 ","$6,222.85 ","$1,459.32 ","$5,800.64 ","$2,727.31 ","$5,124.70 ",$411.24 ,"$1,459.32 ","$1,459.32 ","$2,559.25 ","$6,222.85 ","$3,283.47 ","$6,735.32 ","$5,124.70 ","$4,748.43 ","$4,748.43 ","$4,458.49 ","$4,748.43 ","$5,058.81 ","$6,588.90 ","$5,099.08 ","$1,473.91 ","$5,783.59 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,459.32 ","$3,879.00 ","$5,271.12 ","$4,539.02 ","$5,271.12 ","$5,271.12 ","$5,856.80 "
ST NICHOLAS HOSPITAL - ACUTE,40400006,78608,HC PET BRAIN LIMITED ALZHEIMERS,404,1 ,"$7,007.00 ","$3,503.50 ",$411.24 ,"$7,007.00 ",$411.24 ,"$4,562.00 ","$4,266.00 ","$1,459.32 ","$4,204.20 ","$5,955.95 ","$4,904.90 ",$411.24 ,"$6,656.65 ","$5,325.32 ","$5,255.25 ","$4,640.52 ","$5,955.95 ","$1,459.32 ","$4,640.52 ","$2,181.85 ","$4,904.90 ",$411.24 ,"$1,459.32 ","$1,459.32 ","$2,559.25 ","$5,955.95 ","$3,283.47 ","$6,446.44 ","$4,904.90 ","$4,748.43 ","$4,748.43 ","$4,267.26 ","$4,748.43 ","$4,841.84 ","$6,306.30 ","$4,880.38 ","$1,473.91 ","$5,535.53 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,459.32 ","$3,879.00 ","$5,045.04 ","$4,344.34 ","$5,045.04 ","$5,045.04 ","$5,605.60 "
ST NICHOLAS HOSPITAL - ACUTE,41000005,92950,HC CPR,480,1 ,$749.00 ,$374.50 ,$260.95 ,$749.00 ,$285.38 ,$484.53 ,$484.53 ,$260.95 ,$449.40 ,$636.65 ,$524.30 ,$285.38 ,$711.55 ,$569.24 ,$561.75 ,$486.85 ,$636.65 ,$260.95 ,$486.85 ,$486.85 ,$524.30 ,$285.38 ,$260.95 ,$260.95 ,$749.00 ,$636.65 ,$587.13 ,$689.08 ,$524.30 ,$379.89 ,$455.92 ,$456.14 ,$455.92 ,$517.56 ,$674.10 ,$521.68 ,$263.56 ,$591.71 ,$302.50 ,$749.00 ,$749.00 ,$260.95 ,$749.00 ,$539.28 ,$464.38 ,$539.28 ,$539.28 ,$599.20 
ST NICHOLAS HOSPITAL - ACUTE,41000008,N/A,HC HIGH FLOW OXYGEN CANNULA,410,1 ,$84.00 ,$42.00 ,$42.00 ,$84.00 , N/A ,$54.34 ,$54.34 , N/A ,$50.40 ,$71.40 ,$58.80 , N/A ,$79.80 ,$63.84 ,$63.00 ,$54.60 ,$71.40 , N/A ,$54.60 ,$54.60 ,$58.80 , N/A , N/A , N/A ,$84.00 ,$71.40 , N/A ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$51.13 ,$58.04 ,$75.60 ,$58.51 , N/A ,$66.36 , N/A ,$84.00 ,$84.00 , N/A ,$84.00 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,080.78 ",$202.16 ,$640.43 ,$640.43 ,$480.35 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$752.40 ,$742.50 ,$643.50 ,$841.50 ,$480.35 ,$643.50 ,$643.50 ,$693.00 ,$202.16 ,$480.35 ,$480.35 ,$89.38 ,$841.50 ,"$1,080.78 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$602.61 ,$684.09 ,$891.00 ,$689.54 ,$485.15 ,$782.10 ,$214.29 ,$91.00 ,$91.00 ,$480.35 ,$91.00 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$792.00 
ST NICHOLAS HOSPITAL - ACUTE,41000010,94002,HC VENTIL HI FREQ INTL DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,080.78 ",$202.16 ,$640.43 ,$640.43 ,$480.35 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$752.40 ,$742.50 ,$643.50 ,$841.50 ,$480.35 ,$643.50 ,$643.50 ,$693.00 ,$202.16 ,$480.35 ,$480.35 ,$89.38 ,$841.50 ,"$1,080.78 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$602.61 ,$684.09 ,$891.00 ,$689.54 ,$485.15 ,$782.10 ,$214.29 ,$91.00 ,$91.00 ,$480.35 ,$91.00 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$792.00 
ST NICHOLAS HOSPITAL - ACUTE,41000012,94002,HC VENT SEDATED INTL DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,080.78 ",$202.16 ,$640.43 ,$640.43 ,$480.35 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$752.40 ,$742.50 ,$643.50 ,$841.50 ,$480.35 ,$643.50 ,$643.50 ,$693.00 ,$202.16 ,$480.35 ,$480.35 ,$89.38 ,$841.50 ,"$1,080.78 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$602.61 ,$684.09 ,$891.00 ,$689.54 ,$485.15 ,$782.10 ,$214.29 ,$91.00 ,$91.00 ,$480.35 ,$91.00 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$792.00 
ST NICHOLAS HOSPITAL - ACUTE,41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$280.00 ,$140.00 ,$38.97 ,$417.00 ,$38.97 ,$181.13 ,$181.13 ,$185.34 ,$168.00 ,$238.00 ,$196.00 ,$38.97 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$185.34 ,$182.00 ,$182.00 ,$196.00 ,$38.97 ,$185.34 ,$185.34 ,$89.38 ,$238.00 ,$417.00 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$187.19 ,$221.20 ,$41.31 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,41000014,94002,HC VENT WEANING FIRST DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,080.78 ",$202.16 ,$640.43 ,$640.43 ,$480.35 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$752.40 ,$742.50 ,$643.50 ,$841.50 ,$480.35 ,$643.50 ,$643.50 ,$693.00 ,$202.16 ,$480.35 ,$480.35 ,$89.38 ,$841.50 ,"$1,080.78 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$602.61 ,$684.09 ,$891.00 ,$689.54 ,$485.15 ,$782.10 ,$214.29 ,$91.00 ,$91.00 ,$480.35 ,$91.00 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$792.00 
ST NICHOLAS HOSPITAL - ACUTE,41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,080.78 ",$202.16 ,$491.64 ,$491.64 ,$480.35 ,$456.00 ,$646.00 ,$532.00 ,$202.16 ,$722.00 ,$577.60 ,$570.00 ,$494.00 ,$646.00 ,$480.35 ,$494.00 ,$494.00 ,$532.00 ,$202.16 ,$480.35 ,$480.35 ,$89.38 ,$646.00 ,"$1,080.78 ",$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$462.61 ,$525.16 ,$684.00 ,$529.34 ,$485.15 ,$600.40 ,$214.29 ,$91.00 ,$91.00 ,$480.35 ,$91.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,41000028,94003,HC VENT HI FREQ SUBQ DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,080.78 ",$202.16 ,$491.64 ,$491.64 ,$480.35 ,$456.00 ,$646.00 ,$532.00 ,$202.16 ,$722.00 ,$577.60 ,$570.00 ,$494.00 ,$646.00 ,$480.35 ,$494.00 ,$494.00 ,$532.00 ,$202.16 ,$480.35 ,$480.35 ,$89.38 ,$646.00 ,"$1,080.78 ",$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$462.61 ,$525.16 ,$684.00 ,$529.34 ,$485.15 ,$600.40 ,$214.29 ,$91.00 ,$91.00 ,$480.35 ,$91.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$280.00 ,$140.00 ,$38.97 ,$417.00 ,$38.97 ,$181.13 ,$181.13 ,$185.34 ,$168.00 ,$238.00 ,$196.00 ,$38.97 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$185.34 ,$182.00 ,$182.00 ,$196.00 ,$38.97 ,$185.34 ,$185.34 ,$89.38 ,$238.00 ,$417.00 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$187.19 ,$221.20 ,$41.31 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,41000030,94003,HC VENT WEANING SUBQ DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,080.78 ",$202.16 ,$491.64 ,$491.64 ,$480.35 ,$456.00 ,$646.00 ,$532.00 ,$202.16 ,$722.00 ,$577.60 ,$570.00 ,$494.00 ,$646.00 ,$480.35 ,$494.00 ,$494.00 ,$532.00 ,$202.16 ,$480.35 ,$480.35 ,$89.38 ,$646.00 ,"$1,080.78 ",$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$462.61 ,$525.16 ,$684.00 ,$529.34 ,$485.15 ,$600.40 ,$214.29 ,$91.00 ,$91.00 ,$480.35 ,$91.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$291.00 ,$145.50 ,$16.35 ,$417.00 ,$16.35 ,$188.25 ,$188.25 ,$185.34 ,$174.60 ,$247.35 ,$203.70 ,$16.35 ,$276.45 ,$221.16 ,$218.25 ,$189.15 ,$247.35 ,$185.34 ,$189.15 ,$189.15 ,$203.70 ,$16.35 ,$185.34 ,$185.34 ,$89.38 ,$247.35 ,$417.00 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$177.13 ,$201.08 ,$261.90 ,$202.68 ,$187.19 ,$229.89 ,$17.33 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,41000036,94640,HC HELI OX PROCEDURE,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000040,94640,HC EZ PAP TREATMENT,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000042,94640,HC SPUTUM SPECIMEN INDUCTION,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000043,94640,HC PERI NEB WITH INSTRUCTION,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000044,94640,HC UPDRAFT W/INSTRUCT AND EVAL,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000045,94640,HC AEROSOL GENERATOR CONT,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000046,94640,HC HIGH EFF NEB AERO EACH,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000047,94640,HC HIGH EFF NEB AERO W/INSTR/TEACH DEVICE,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000049,94642,HC AEROSOL INHALATION PENTAMIDINE,410,1 ,$183.00 ,$91.50 ,$16.35 ,$417.00 ,$16.35 ,$118.38 ,$118.38 ,$185.34 ,$109.80 ,$155.55 ,$128.10 ,$16.35 ,$173.85 ,$139.08 ,$137.25 ,$118.95 ,$155.55 ,$185.34 ,$118.95 ,$118.95 ,$128.10 ,$16.35 ,$185.34 ,$185.34 ,$89.38 ,$155.55 ,$417.00 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$111.39 ,$126.45 ,$164.70 ,$127.46 ,$187.19 ,$144.57 ,$17.33 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$246.00 ,$123.00 ,$16.35 ,$250.16 ,$16.35 ,$159.14 ,$159.14 ,$111.18 ,$147.60 ,$209.10 ,$172.20 ,$16.35 ,$233.70 ,$186.96 ,$184.50 ,$159.90 ,$209.10 ,$111.18 ,$159.90 ,$159.90 ,$172.20 ,$16.35 ,$111.18 ,$111.18 ,$89.38 ,$209.10 ,$250.16 ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$149.74 ,$169.99 ,$221.40 ,$171.34 ,$112.29 ,$194.34 ,$17.33 ,$91.00 ,$91.00 ,$111.18 ,$91.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$46.00 ,$23.00 ,$16.35 ,$46.00 ,$16.35 ,$29.76 ,$29.76 , N/A ,$27.60 ,$39.10 ,$32.20 ,$16.35 ,$43.70 ,$34.96 ,$34.50 ,$29.90 ,$39.10 , N/A ,$29.90 ,$29.90 ,$32.20 ,$16.35 , N/A , N/A ,$46.00 ,$39.10 , N/A ,$42.32 ,$32.20 ,$23.33 ,$28.00 ,$28.01 ,$28.00 ,$31.79 ,$41.40 ,$32.04 , N/A ,$36.34 ,$17.33 ,$46.00 ,$46.00 , N/A ,$46.00 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$36.80 
ST NICHOLAS HOSPITAL - ACUTE,41000052,94660,HC CPAP,410,1 ,$310.00 ,$155.00 ,$38.97 ,$417.00 ,$38.97 ,$200.54 ,$200.54 ,$185.34 ,$186.00 ,$263.50 ,$217.00 ,$38.97 ,$294.50 ,$235.60 ,$232.50 ,$201.50 ,$263.50 ,$185.34 ,$201.50 ,$201.50 ,$217.00 ,$38.97 ,$185.34 ,$185.34 ,$89.38 ,$263.50 ,$417.00 ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$188.70 ,$214.21 ,$279.00 ,$215.92 ,$187.19 ,$244.90 ,$41.31 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$248.00 
ST NICHOLAS HOSPITAL - ACUTE,41000053,94660,HC CPAP DAILY EST PT,410,1 ,$140.00 ,$70.00 ,$38.97 ,$417.00 ,$38.97 ,$90.57 ,$90.57 ,$185.34 ,$84.00 ,$119.00 ,$98.00 ,$38.97 ,$133.00 ,$106.40 ,$105.00 ,$91.00 ,$119.00 ,$185.34 ,$91.00 ,$91.00 ,$98.00 ,$38.97 ,$185.34 ,$185.34 ,$89.38 ,$119.00 ,$417.00 ,$128.80 ,$98.00 ,$71.01 ,$85.22 ,$85.26 ,$85.22 ,$96.74 ,$126.00 ,$97.51 ,$187.19 ,$110.60 ,$41.31 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$112.00 
ST NICHOLAS HOSPITAL - ACUTE,41000055,99211,HC CPAP THERAPY CONSULT INITIAL,510,1 ,$381.00 ,$190.50 ,$38.23 ,$381.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$228.60 ,$323.85 ,$266.70 ,$38.23 ,$361.95 ,$289.56 ,$285.75 ,$104.00 ,$323.85 , N/A ,$104.00 ,$56.00 ,$266.70 ,$38.23 , N/A , N/A ,$64.61 ,$323.85 , N/A ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$231.91 ,$263.27 ,$342.90 ,$265.37 , N/A ,$300.99 ,$40.52 ,$228.60 ,$228.60 , N/A ,$228.60 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$183.00 ,$91.50 ,$16.35 ,$417.00 ,$16.35 ,$118.38 ,$118.38 ,$185.34 ,$109.80 ,$155.55 ,$128.10 ,$16.35 ,$173.85 ,$139.08 ,$137.25 ,$118.95 ,$155.55 ,$185.34 ,$118.95 ,$118.95 ,$128.10 ,$16.35 ,$185.34 ,$185.34 ,$89.38 ,$155.55 ,$417.00 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$111.39 ,$126.45 ,$164.70 ,$127.46 ,$187.19 ,$144.57 ,$17.33 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$97.00 ,$48.50 ,$16.35 ,$250.16 ,$16.35 ,$62.75 ,$62.75 ,$111.18 ,$58.20 ,$82.45 ,$67.90 ,$16.35 ,$92.15 ,$73.72 ,$72.75 ,$63.05 ,$82.45 ,$111.18 ,$63.05 ,$63.05 ,$67.90 ,$16.35 ,$111.18 ,$111.18 ,$89.38 ,$82.45 ,$250.16 ,$89.24 ,$67.90 ,$49.20 ,$59.04 ,$59.07 ,$59.04 ,$67.03 ,$87.30 ,$67.56 ,$112.29 ,$76.63 ,$17.33 ,$91.00 ,$91.00 ,$111.18 ,$91.00 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$97.00 ,$48.50 ,$16.35 ,$250.16 ,$16.35 ,$62.75 ,$62.75 ,$111.18 ,$58.20 ,$82.45 ,$67.90 ,$16.35 ,$92.15 ,$73.72 ,$72.75 ,$63.05 ,$82.45 ,$111.18 ,$63.05 ,$63.05 ,$67.90 ,$16.35 ,$111.18 ,$111.18 ,$89.38 ,$82.45 ,$250.16 ,$89.24 ,$67.90 ,$49.20 ,$59.04 ,$59.07 ,$59.04 ,$67.03 ,$87.30 ,$67.56 ,$112.29 ,$76.63 ,$17.33 ,$91.00 ,$91.00 ,$111.18 ,$91.00 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$75.00 ,$37.50 ,$16.35 ,$250.16 ,$16.35 ,$48.52 ,$48.52 ,$111.18 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$111.18 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$111.18 ,$111.18 ,$75.00 ,$63.75 ,$250.16 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$112.29 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$111.18 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$75.00 ,$37.50 ,$16.35 ,$250.16 ,$16.35 ,$48.52 ,$48.52 ,$111.18 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$111.18 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$111.18 ,$111.18 ,$75.00 ,$63.75 ,$250.16 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$112.29 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$111.18 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000065,94799,HC CARBON MONOXIDE TEST,410,1 ,$123.00 ,$61.50 ,$16.35 ,$309.74 ,$16.35 ,$79.57 ,$79.57 ,$137.66 ,$73.80 ,$104.55 ,$86.10 ,$16.35 ,$116.85 ,$93.48 ,$92.25 ,$79.95 ,$104.55 ,$137.66 ,$79.95 ,$79.95 ,$86.10 ,$16.35 ,$137.66 ,$137.66 ,$89.38 ,$104.55 ,$309.74 ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$74.87 ,$84.99 ,$110.70 ,$85.67 ,$139.04 ,$97.17 ,$17.33 ,$91.00 ,$91.00 ,$137.66 ,$91.00 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,41000066,94799,HC SEDATION BAGGING,410,1 ,$123.00 ,$61.50 ,$16.35 ,$309.74 ,$16.35 ,$79.57 ,$79.57 ,$137.66 ,$73.80 ,$104.55 ,$86.10 ,$16.35 ,$116.85 ,$93.48 ,$92.25 ,$79.95 ,$104.55 ,$137.66 ,$79.95 ,$79.95 ,$86.10 ,$16.35 ,$137.66 ,$137.66 ,$89.38 ,$104.55 ,$309.74 ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$74.87 ,$84.99 ,$110.70 ,$85.67 ,$139.04 ,$97.17 ,$17.33 ,$91.00 ,$91.00 ,$137.66 ,$91.00 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$98.40 
ST NICHOLAS HOSPITAL - ACUTE,41000067,94799,HC PEP THERAPY FLUTTER,410,1 ,$420.00 ,$210.00 ,$16.35 ,$420.00 ,$16.35 ,$271.70 ,$271.70 ,$137.66 ,$252.00 ,$357.00 ,$294.00 ,$16.35 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$137.66 ,$273.00 ,$273.00 ,$294.00 ,$16.35 ,$137.66 ,$137.66 ,$89.38 ,$357.00 ,$309.74 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 ,$139.04 ,$331.80 ,$17.33 ,$91.00 ,$91.00 ,$137.66 ,$91.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$86.00 ,$43.00 ,$11.17 ,$86.00 ,$11.17 ,$55.63 ,$55.63 ,$24.36 ,$51.60 ,$73.10 ,$60.20 ,$11.17 ,$81.70 ,$65.36 ,$64.50 ,$55.90 ,$73.10 ,$24.36 ,$55.90 ,$55.90 ,$60.20 ,$11.17 ,$24.36 ,$24.36 ,$86.00 ,$73.10 ,$54.81 ,$79.12 ,$60.20 ,$43.62 ,$52.35 ,$52.37 ,$52.35 ,$59.43 ,$77.40 ,$59.90 ,$24.60 ,$67.94 ,$11.84 ,$86.00 ,$86.00 ,$24.36 ,$86.00 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$68.80 
ST NICHOLAS HOSPITAL - ACUTE,41000069,G0238,HC RESP THRP FUNCTION,410,1 ,$92.00 ,$46.00 ,$11.17 ,$92.00 ,$11.17 ,$59.51 ,$59.51 ,$24.36 ,$55.20 ,$78.20 ,$64.40 ,$11.17 ,$87.40 ,$69.92 ,$69.00 ,$59.80 ,$78.20 ,$24.36 ,$59.80 ,$59.80 ,$64.40 ,$11.17 ,$24.36 ,$24.36 ,$89.38 ,$78.20 ,$54.81 ,$84.64 ,$64.40 ,$46.66 ,$56.00 ,$56.03 ,$56.00 ,$63.57 ,$82.80 ,$64.08 ,$24.60 ,$72.68 ,$11.84 ,$91.00 ,$91.00 ,$24.36 ,$91.00 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$183.00 ,$91.50 ,$11.17 ,$183.00 ,$11.17 ,$118.38 ,$118.38 ,$33.38 ,$109.80 ,$155.55 ,$128.10 ,$11.17 ,$173.85 ,$139.08 ,$137.25 ,$118.95 ,$155.55 ,$33.38 ,$118.95 ,$118.95 ,$128.10 ,$11.17 ,$33.38 ,$33.38 ,$89.38 ,$155.55 ,$75.09 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$111.39 ,$126.45 ,$164.70 ,$127.46 ,$33.71 ,$144.57 ,$11.84 ,$91.00 ,$91.00 ,$33.38 ,$91.00 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,41000071,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$75.00 ,$37.50 ,$11.17 ,$75.00 ,$11.17 ,$48.52 ,$48.52 ,$24.36 ,$45.00 ,$63.75 ,$52.50 ,$11.17 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$24.36 ,$48.75 ,$48.75 ,$52.50 ,$11.17 ,$24.36 ,$24.36 ,$75.00 ,$63.75 ,$54.81 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$24.60 ,$59.25 ,$11.84 ,$75.00 ,$75.00 ,$24.36 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41000072,G0238,HC RESP THRP FUNC-59,410,1 ,$92.00 ,$46.00 ,$11.17 ,$92.00 ,$11.17 ,$59.51 ,$59.51 ,$24.36 ,$55.20 ,$78.20 ,$64.40 ,$11.17 ,$87.40 ,$69.92 ,$69.00 ,$59.80 ,$78.20 ,$24.36 ,$59.80 ,$59.80 ,$64.40 ,$11.17 ,$24.36 ,$24.36 ,$89.38 ,$78.20 ,$54.81 ,$84.64 ,$64.40 ,$46.66 ,$56.00 ,$56.03 ,$56.00 ,$63.57 ,$82.80 ,$64.08 ,$24.60 ,$72.68 ,$11.84 ,$91.00 ,$91.00 ,$24.36 ,$91.00 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$533.00 ,$266.50 ,$38.97 ,$533.00 ,$38.97 ,$344.80 ,$344.80 ,$185.34 ,$319.80 ,$453.05 ,$373.10 ,$38.97 ,$506.35 ,$405.08 ,$399.75 ,$346.45 ,$453.05 ,$185.34 ,$346.45 ,$346.45 ,$373.10 ,$38.97 ,$185.34 ,$185.34 ,$89.38 ,$453.05 ,$417.00 ,$490.36 ,$373.10 ,$270.34 ,$324.44 ,$324.60 ,$324.44 ,$368.30 ,$479.70 ,$371.23 ,$187.19 ,$421.07 ,$41.31 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$383.76 ,$330.46 ,$383.76 ,$383.76 ,$426.40 
ST NICHOLAS HOSPITAL - ACUTE,41000087,94669,HC MECHANICAL CHEST WALL OSCILLATION INITIAL,410,1 ,$567.00 ,$283.50 ,$16.35 ,$567.00 ,$16.35 ,$366.79 ,$366.79 ,$185.34 ,$340.20 ,$481.95 ,$396.90 ,$16.35 ,$538.65 ,$430.92 ,$425.25 ,$368.55 ,$481.95 ,$185.34 ,$368.55 ,$368.55 ,$396.90 ,$16.35 ,$185.34 ,$185.34 ,$89.38 ,$481.95 ,$417.00 ,$521.64 ,$396.90 ,$287.58 ,$345.13 ,$345.30 ,$345.13 ,$391.80 ,$510.30 ,$394.92 ,$187.19 ,$447.93 ,$17.33 ,$91.00 ,$91.00 ,$185.34 ,$91.00 ,$408.24 ,$351.54 ,$408.24 ,$408.24 ,$453.60 
ST NICHOLAS HOSPITAL - ACUTE,41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$75.00 ,$37.50 ,$16.35 ,$417.00 ,$16.35 ,$48.52 ,$48.52 ,$185.34 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 ,$185.34 ,$48.75 ,$48.75 ,$52.50 ,$16.35 ,$185.34 ,$185.34 ,$75.00 ,$63.75 ,$417.00 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 ,$187.19 ,$59.25 ,$17.33 ,$75.00 ,$75.00 ,$185.34 ,$75.00 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,41300000,99183,HC HYPERBARIC O2 PER SESSION,413,1 ,"$3,447.00 ","$1,723.50 ",$857.61 ,"$3,447.00 ", N/A ,"$2,229.86 ","$2,229.86 ", N/A ,"$2,068.20 ","$2,929.95 ","$2,412.90 ", N/A ,"$3,274.65 ","$2,619.72 ","$2,585.25 ","$2,240.55 ","$2,929.95 ", N/A ,"$2,240.55 ","$2,240.55 ","$2,412.90 ", N/A , N/A , N/A ,$857.61 ,"$2,929.95 ", N/A ,"$3,171.24 ","$2,412.90 ","$1,748.32 ","$2,098.19 ","$2,099.22 ","$2,098.19 ","$2,381.88 ","$3,102.30 ","$2,400.84 ", N/A ,"$2,723.13 ", N/A ,"$2,656.00 ","$2,656.00 ", N/A ,"$2,656.00 ","$2,481.84 ","$2,137.14 ","$2,481.84 ","$2,481.84 ","$2,757.60 "
ST NICHOLAS HOSPITAL - ACUTE,41300002,G0277,HC HYPERBARIC O2 PER 30 MIN,413,1 ,$593.00 ,$296.50 ,$117.59 ,$593.00 ,$118.09 ,$383.61 ,$383.61 ,$117.59 ,$355.80 ,$504.05 ,$415.10 ,$118.09 ,$563.35 ,$450.68 ,$444.75 ,$385.45 ,$504.05 ,$117.59 ,$385.45 ,$385.45 ,$415.10 ,$118.09 ,$117.59 ,$117.59 ,$593.00 ,$504.05 ,$264.58 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$360.96 ,$409.76 ,$533.70 ,$413.02 ,$118.77 ,$468.47 ,$125.18 ,$593.00 ,$593.00 ,$117.59 ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,41300003,G0277,HC HYPERBARIC O2 PER 30 MIN,413,1 ,$593.00 ,$296.50 ,$117.59 ,$593.00 ,$118.09 ,$383.61 ,$383.61 ,$117.59 ,$355.80 ,$504.05 ,$415.10 ,$118.09 ,$563.35 ,$450.68 ,$444.75 ,$385.45 ,$504.05 ,$117.59 ,$385.45 ,$385.45 ,$415.10 ,$118.09 ,$117.59 ,$117.59 ,$593.00 ,$504.05 ,$264.58 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$360.96 ,$409.76 ,$533.70 ,$413.02 ,$118.77 ,$468.47 ,$125.18 ,$593.00 ,$593.00 ,$117.59 ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,41300004,99183,HC HYPERBARIC O2 PER SESSION,413,1 ,"$3,447.00 ","$1,723.50 ",$857.61 ,"$3,447.00 ", N/A ,"$2,229.86 ","$2,229.86 ", N/A ,"$2,068.20 ","$2,929.95 ","$2,412.90 ", N/A ,"$3,274.65 ","$2,619.72 ","$2,585.25 ","$2,240.55 ","$2,929.95 ", N/A ,"$2,240.55 ","$2,240.55 ","$2,412.90 ", N/A , N/A , N/A ,$857.61 ,"$2,929.95 ", N/A ,"$3,171.24 ","$2,412.90 ","$1,748.32 ","$2,098.19 ","$2,099.22 ","$2,098.19 ","$2,381.88 ","$3,102.30 ","$2,400.84 ", N/A ,"$2,723.13 ", N/A ,"$2,656.00 ","$2,656.00 ", N/A ,"$2,656.00 ","$2,481.84 ","$2,137.14 ","$2,481.84 ","$2,481.84 ","$2,757.60 "
ST NICHOLAS HOSPITAL - ACUTE,42000008,95992,HC CANNALITH REPOSITIONING,420,1 ,$134.00 ,$67.00 ,$12.86 ,$134.00 , N/A ,$134.00 ,$134.00 ,$42.34 ,$80.40 ,$113.90 ,$93.80 , N/A ,$127.30 ,$101.84 ,$100.50 ,$87.10 ,$113.90 ,$42.34 ,$87.10 ,$87.10 ,$93.80 , N/A ,$42.34 ,$42.34 ,$109.75 ,$113.90 ,$95.27 ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$81.57 ,$92.59 ,$120.60 ,$93.33 ,$42.76 ,$105.86 ,$12.86 ,$134.00 ,$134.00 ,$42.34 ,$134.00 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,42000009,97012,HC TRACTION MECH APP,420,1 ,$100.00 ,$50.00 ,$10.75 ,$100.00 ,$25.78 ,$100.00 ,$100.00 ,$13.97 ,$60.00 ,$85.00 ,$70.00 ,$25.78 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$13.97 ,$65.00 ,$65.00 ,$70.00 ,$25.78 ,$13.97 ,$13.97 ,$100.00 ,$85.00 ,$31.43 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$14.11 ,$79.00 ,$10.75 ,$100.00 ,$100.00 ,$13.97 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000010,97016,HC APPLY VASOPNEUMATIC DEVICE,420,1 ,$90.00 ,$45.00 ,$10.75 ,$90.00 ,$25.19 ,$90.00 ,$90.00 ,$11.55 ,$54.00 ,$76.50 ,$63.00 ,$25.19 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$11.55 ,$58.50 ,$58.50 ,$63.00 ,$25.19 ,$11.55 ,$11.55 ,$90.00 ,$76.50 ,$25.99 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 ,$11.67 ,$71.10 ,$10.75 ,$90.00 ,$90.00 ,$11.55 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000020,97022,HC FLUIDOTHERAPY,420,1 ,$110.00 ,$55.00 ,$10.75 ,$110.00 ,$25.78 ,$110.00 ,$110.00 ,$16.74 ,$66.00 ,$93.50 ,$77.00 ,$25.78 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$16.74 ,$71.50 ,$71.50 ,$77.00 ,$25.78 ,$16.74 ,$16.74 ,$109.75 ,$93.50 ,$37.67 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$16.91 ,$86.90 ,$10.75 ,$110.00 ,$110.00 ,$16.74 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$90.00 ,$45.00 ,$10.75 ,$90.00 ,$22.38 ,$90.00 ,$90.00 ,$14.30 ,$54.00 ,$76.50 ,$63.00 ,$22.38 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$14.30 ,$58.50 ,$58.50 ,$63.00 ,$22.38 ,$14.30 ,$14.30 ,$90.00 ,$76.50 ,$32.18 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 ,$14.44 ,$71.10 ,$10.75 ,$90.00 ,$90.00 ,$14.30 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000026,97032,HC TENS; EA 15 MIN,420,1 ,$90.00 ,$45.00 ,$10.75 ,$90.00 ,$22.38 ,$90.00 ,$90.00 ,$14.30 ,$54.00 ,$76.50 ,$63.00 ,$22.38 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$14.30 ,$58.50 ,$58.50 ,$63.00 ,$22.38 ,$14.30 ,$14.30 ,$90.00 ,$76.50 ,$32.18 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 ,$14.44 ,$71.10 ,$10.75 ,$90.00 ,$90.00 ,$14.30 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$110.00 ,$55.00 ,$10.75 ,$110.00 ,$23.51 ,$110.00 ,$110.00 ,$19.21 ,$66.00 ,$93.50 ,$77.00 ,$23.51 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$19.21 ,$71.50 ,$71.50 ,$77.00 ,$23.51 ,$19.21 ,$19.21 ,$109.75 ,$93.50 ,$43.22 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$19.40 ,$86.90 ,$10.75 ,$110.00 ,$110.00 ,$19.21 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$90.00 ,$45.00 ,$10.75 ,$90.00 ,$18.49 ,$90.00 ,$90.00 ,$13.89 ,$54.00 ,$76.50 ,$63.00 ,$18.49 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$13.89 ,$58.50 ,$58.50 ,$63.00 ,$18.49 ,$13.89 ,$13.89 ,$90.00 ,$76.50 ,$31.25 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 ,$14.03 ,$71.10 ,$10.75 ,$90.00 ,$90.00 ,$13.89 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$12.86 ,$100.00 ,$19.63 ,$100.00 ,$100.00 ,$28.82 ,$60.00 ,$85.00 ,$70.00 ,$19.63 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$28.82 ,$65.00 ,$65.00 ,$70.00 ,$19.63 ,$28.82 ,$28.82 ,$100.00 ,$85.00 ,$64.85 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$29.11 ,$79.00 ,$12.86 ,$100.00 ,$100.00 ,$28.82 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$130.00 ,$65.00 ,$12.86 ,$130.00 ,$19.32 ,$130.00 ,$130.00 ,$33.48 ,$78.00 ,$110.50 ,$91.00 ,$19.32 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$33.48 ,$84.50 ,$84.50 ,$91.00 ,$19.32 ,$33.48 ,$33.48 ,$109.75 ,$110.50 ,$75.33 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 ,$33.81 ,$102.70 ,$12.86 ,$130.00 ,$130.00 ,$33.48 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$10.75 ,$100.00 ,$16.47 ,$100.00 ,$100.00 ,$28.82 ,$60.00 ,$85.00 ,$70.00 ,$16.47 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$28.82 ,$65.00 ,$65.00 ,$70.00 ,$16.47 ,$28.82 ,$28.82 ,$100.00 ,$85.00 ,$64.85 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$29.11 ,$79.00 ,$10.75 ,$100.00 ,$100.00 ,$28.82 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$10.75 ,$100.00 ,$23.41 ,$100.00 ,$100.00 ,$29.17 ,$60.00 ,$85.00 ,$70.00 ,$23.41 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$29.17 ,$65.00 ,$65.00 ,$70.00 ,$23.41 ,$29.17 ,$29.17 ,$100.00 ,$85.00 ,$65.63 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$29.46 ,$79.00 ,$10.75 ,$100.00 ,$100.00 ,$29.17 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$12.86 ,$100.00 ,$25.53 ,$100.00 ,$100.00 ,$26.50 ,$60.00 ,$85.00 ,$70.00 ,$25.53 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$26.50 ,$65.00 ,$65.00 ,$70.00 ,$25.53 ,$26.50 ,$26.50 ,$100.00 ,$85.00 ,$59.63 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$26.77 ,$79.00 ,$12.86 ,$100.00 ,$100.00 ,$26.50 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$120.00 ,$60.00 ,$12.86 ,$120.00 ,$18.05 ,$120.00 ,$120.00 ,$36.29 ,$72.00 ,$102.00 ,$84.00 ,$18.05 ,$114.00 ,$91.20 ,$90.00 ,$78.00 ,$102.00 ,$36.29 ,$78.00 ,$78.00 ,$84.00 ,$18.05 ,$36.29 ,$36.29 ,$109.75 ,$102.00 ,$81.65 ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$73.04 ,$82.92 ,$108.00 ,$83.58 ,$36.65 ,$94.80 ,$12.86 ,$120.00 ,$120.00 ,$36.29 ,$120.00 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,42000068,97597,HC DEBR SKIN PART THICKNESS <20CM,420,1 ,$388.00 ,$194.00 ,$42.35 ,$388.00 ,$42.35 ,$276.00 ,$218.00 ,$98.76 ,$232.80 ,$329.80 ,$271.60 ,$42.35 ,$368.60 ,$294.88 ,$291.00 ,$252.20 ,$329.80 ,$98.76 ,$252.20 ,$252.20 ,$271.60 ,$42.35 ,$98.76 ,$98.76 ,$109.75 ,$329.80 ,$222.21 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$99.75 ,$306.52 ,$62.23 ,$258.00 ,$258.00 ,$98.76 ,$258.00 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,42000083,97598,HC DEBR SKIN PART THICKNESS EA ADDN>20CM FACIL,420,1 ,$172.00 ,$86.00 ,$35.14 ,$334.00 ,$35.14 ,$172.00 ,$172.00 , N/A ,$103.20 ,$146.20 ,$120.40 ,$35.14 ,$163.40 ,$130.72 ,$129.00 ,$111.80 ,$146.20 , N/A ,$111.80 ,$111.80 ,$120.40 ,$35.14 , N/A , N/A ,$109.75 ,$146.20 , N/A ,$158.24 ,$120.40 ,$87.24 ,$104.70 ,$104.75 ,$104.70 ,$118.85 ,$154.80 ,$119.80 , N/A ,$135.88 ,$334.00 ,$172.00 ,$172.00 , N/A ,$172.00 ,$123.84 ,$106.64 ,$123.84 ,$123.84 ,$137.60 
ST NICHOLAS HOSPITAL - ACUTE,42000084,97602,HC DEBRIDEMENT NONSELECTIVE,420,1 ,$151.00 ,$75.50 ,$75.50 ,$151.00 , N/A ,$151.00 ,$151.00 , N/A ,$90.60 ,$128.35 ,$105.70 , N/A ,$143.45 ,$114.76 ,$113.25 ,$98.15 ,$128.35 , N/A ,$98.15 ,$98.15 ,$105.70 , N/A , N/A , N/A ,$109.75 ,$128.35 , N/A ,$138.92 ,$105.70 ,$76.59 ,$91.91 ,$91.96 ,$91.91 ,$104.34 ,$135.90 ,$105.17 , N/A ,$119.29 ,$125.18 ,$151.00 ,$151.00 , N/A ,$151.00 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$120.80 
ST NICHOLAS HOSPITAL - ACUTE,42000085,97605,HC NWPT <50 SQ CM FAC,420,1 ,$215.00 ,$107.50 ,$41.41 ,$215.00 , N/A ,$215.00 ,$215.00 ,$41.41 ,$129.00 ,$182.75 ,$150.50 , N/A ,$204.25 ,$163.40 ,$161.25 ,$139.75 ,$182.75 ,$41.41 ,$139.75 ,$139.75 ,$150.50 , N/A ,$41.41 ,$41.41 ,$109.75 ,$182.75 ,$93.17 ,$197.80 ,$150.50 ,$109.05 ,$130.87 ,$130.94 ,$130.87 ,$148.57 ,$193.50 ,$149.75 ,$41.82 ,$169.85 ,$62.23 ,$215.00 ,$215.00 ,$41.41 ,$215.00 ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$172.00 
ST NICHOLAS HOSPITAL - ACUTE,42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$280.00 ,$140.00 ,$49.00 ,$280.00 , N/A ,$276.00 ,$218.00 ,$49.00 ,$168.00 ,$238.00 ,$196.00 , N/A ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$49.00 ,$182.00 ,$182.00 ,$196.00 , N/A ,$49.00 ,$49.00 ,$109.75 ,$238.00 ,$110.25 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$49.49 ,$221.20 ,$125.18 ,$258.00 ,$258.00 ,$49.00 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$12.86 ,$100.00 , N/A ,$100.00 ,$100.00 ,$32.73 ,$60.00 ,$85.00 ,$70.00 , N/A ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$32.73 ,$65.00 ,$65.00 ,$70.00 , N/A ,$32.73 ,$32.73 ,$100.00 ,$85.00 ,$73.64 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$33.06 ,$79.00 ,$12.86 ,$100.00 ,$100.00 ,$32.73 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000094,97761,HC PROSTHETIC TRAINING EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$12.86 ,$100.00 ,$21.40 ,$100.00 ,$100.00 ,$40.65 ,$60.00 ,$85.00 ,$70.00 ,$21.40 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$40.65 ,$65.00 ,$65.00 ,$70.00 ,$21.40 ,$40.65 ,$40.65 ,$100.00 ,$85.00 ,$91.46 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$41.06 ,$79.00 ,$12.86 ,$100.00 ,$100.00 ,$40.65 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000110,G0283,HC ELECT STIM(UNATTEND) OTHER,420,1 ,$119.00 ,$59.50 ,$10.75 ,$119.00 ,$22.38 ,$119.00 ,$119.00 ,$11.87 ,$71.40 ,$101.15 ,$83.30 ,$22.38 ,$113.05 ,$90.44 ,$89.25 ,$77.35 ,$101.15 ,$11.87 ,$77.35 ,$77.35 ,$83.30 ,$22.38 ,$11.87 ,$11.87 ,$109.75 ,$101.15 ,$26.71 ,$109.48 ,$83.30 ,$60.36 ,$72.44 ,$72.47 ,$72.44 ,$82.23 ,$107.10 ,$82.88 ,$11.99 ,$94.01 ,$10.75 ,$119.00 ,$119.00 ,$11.87 ,$119.00 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$95.20 
ST NICHOLAS HOSPITAL - ACUTE,42000122,97150,HC GROUP TREATMENT 60MIN,420,1 ,$100.00 ,$50.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$17.31 ,$60.00 ,$85.00 ,$70.00 ,$6.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$17.31 ,$65.00 ,$65.00 ,$70.00 ,$6.08 ,$17.31 ,$17.31 ,$100.00 ,$85.00 ,$38.95 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 ,$17.48 ,$79.00 ,$12.86 ,$100.00 ,$100.00 ,$17.31 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,42000145,97597,HC DEBR SKIN INIT 20CM/NWPT/WRAP,420,1 ,$388.00 ,$194.00 ,$42.35 ,$388.00 ,$42.35 ,$276.00 ,$218.00 ,$98.76 ,$232.80 ,$329.80 ,$271.60 ,$42.35 ,$368.60 ,$294.88 ,$291.00 ,$252.20 ,$329.80 ,$98.76 ,$252.20 ,$252.20 ,$271.60 ,$42.35 ,$98.76 ,$98.76 ,$109.75 ,$329.80 ,$222.21 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$99.75 ,$306.52 ,$62.23 ,$258.00 ,$258.00 ,$98.76 ,$258.00 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,42000146,97597,HC DEBR SKIN INIT 20CM/NWPT/BILWRAP,420,1 ,$388.00 ,$194.00 ,$42.35 ,$388.00 ,$42.35 ,$276.00 ,$218.00 ,$98.76 ,$232.80 ,$329.80 ,$271.60 ,$42.35 ,$368.60 ,$294.88 ,$291.00 ,$252.20 ,$329.80 ,$98.76 ,$252.20 ,$252.20 ,$271.60 ,$42.35 ,$98.76 ,$98.76 ,$109.75 ,$329.80 ,$222.21 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$99.75 ,$306.52 ,$62.23 ,$258.00 ,$258.00 ,$98.76 ,$258.00 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,42000216,99366,HC MEDICAL TEAM CONFERENCE W/PATIENT NON-PHYSICIAN,420,1 ,$134.00 ,$67.00 ,$34.50 ,$134.00 , N/A ,$134.00 ,$134.00 , N/A ,$80.40 ,$113.90 ,$93.80 , N/A ,$127.30 ,$101.84 ,$100.50 ,$87.10 ,$113.90 , N/A ,$87.10 ,$87.10 ,$93.80 , N/A , N/A , N/A ,$109.75 ,$113.90 , N/A ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$81.57 ,$92.59 ,$120.60 ,$93.33 , N/A ,$105.86 ,$34.50 ,$134.00 ,$134.00 , N/A ,$134.00 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$210.00 ,$105.00 ,$62.66 ,$220.55 ,$62.66 ,$210.00 ,$210.00 ,$98.02 ,$126.00 ,$178.50 ,$147.00 ,$62.66 ,$199.50 ,$159.60 ,$157.50 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$136.50 ,$147.00 ,$62.66 ,$98.02 ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$99.00 ,$165.90 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$110.00 ,$55.00 ,$55.00 ,$151.94 ,$62.66 ,$110.00 ,$110.00 ,$67.53 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$71.50 ,$77.00 ,$62.66 ,$67.53 ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$68.21 ,$86.90 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$110.00 ,$55.00 ,$55.00 ,$151.94 ,$62.66 ,$110.00 ,$110.00 ,$67.53 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$71.50 ,$77.00 ,$62.66 ,$67.53 ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$68.21 ,$86.90 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$110.00 ,$55.00 ,$55.00 ,$151.94 ,$62.66 ,$110.00 ,$110.00 ,$67.53 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$71.50 ,$77.00 ,$62.66 ,$67.53 ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$68.21 ,$86.90 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$110.00 ,$55.00 ,$55.00 ,$151.94 ,$62.66 ,$110.00 ,$110.00 ,$67.53 ,$66.00 ,$93.50 ,$77.00 ,$62.66 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$71.50 ,$77.00 ,$62.66 ,$67.53 ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$68.21 ,$86.90 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$110.00 ,$55.00 ,$10.75 ,$110.00 ,$20.93 ,$110.00 ,$110.00 ,$32.08 ,$66.00 ,$93.50 ,$77.00 ,$20.93 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$32.08 ,$71.50 ,$71.50 ,$77.00 ,$20.93 ,$32.08 ,$32.08 ,$109.75 ,$93.50 ,$72.18 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$32.40 ,$86.90 ,$10.75 ,$110.00 ,$110.00 ,$32.08 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,43000024,97542,HC SEATING CLINIC EA 15 MIN,430,1 ,$80.00 ,$40.00 ,$12.86 ,$80.00 ,$18.94 ,$80.00 ,$80.00 ,$31.16 ,$48.00 ,$68.00 ,$56.00 ,$18.94 ,$76.00 ,$60.80 ,$60.00 ,$52.00 ,$68.00 ,$31.16 ,$52.00 ,$52.00 ,$56.00 ,$18.94 ,$31.16 ,$31.16 ,$80.00 ,$68.00 ,$70.11 ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$55.72 ,$31.47 ,$63.20 ,$12.86 ,$80.00 ,$80.00 ,$31.16 ,$80.00 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$110.00 ,$55.00 ,$12.86 ,$110.00 , N/A ,$110.00 ,$110.00 ,$47.50 ,$66.00 ,$93.50 ,$77.00 , N/A ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 ,$47.50 ,$71.50 ,$71.50 ,$77.00 , N/A ,$47.50 ,$47.50 ,$109.75 ,$93.50 ,$106.88 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 ,$47.98 ,$86.90 ,$12.86 ,$110.00 ,$110.00 ,$47.50 ,$110.00 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$90.00 ,$45.00 ,$12.86 ,$90.00 , N/A ,$90.00 ,$90.00 ,$22.40 ,$54.00 ,$76.50 ,$63.00 , N/A ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$22.40 ,$58.50 ,$58.50 ,$63.00 , N/A ,$22.40 ,$22.40 ,$90.00 ,$76.50 ,$50.40 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 ,$22.62 ,$71.10 ,$12.86 ,$90.00 ,$90.00 ,$22.40 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$90.00 ,$45.00 ,$12.86 ,$90.00 , N/A ,$90.00 ,$90.00 ,$21.71 ,$54.00 ,$76.50 ,$63.00 , N/A ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$21.71 ,$58.50 ,$58.50 ,$63.00 , N/A ,$21.71 ,$21.71 ,$90.00 ,$76.50 ,$48.85 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 ,$21.93 ,$71.10 ,$12.86 ,$90.00 ,$90.00 ,$21.71 ,$90.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$220.00 ,$110.00 ,$61.48 ,$222.01 ,$62.66 ,$220.00 ,$218.00 ,$98.67 ,$132.00 ,$187.00 ,$154.00 ,$62.66 ,$209.00 ,$167.20 ,$165.00 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$143.00 ,$154.00 ,$62.66 ,$98.67 ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$133.91 ,$152.02 ,$198.00 ,$153.23 ,$99.66 ,$173.80 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$176.00 
ST NICHOLAS HOSPITAL - ACUTE,43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$130.00 ,$65.00 ,$61.48 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$67.86 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$84.50 ,$91.00 ,$62.66 ,$67.86 ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 ,$68.54 ,$102.70 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$130.00 ,$65.00 ,$61.48 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$67.86 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$84.50 ,$91.00 ,$62.66 ,$67.86 ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 ,$68.54 ,$102.70 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$130.00 ,$65.00 ,$61.48 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$67.86 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$84.50 ,$91.00 ,$62.66 ,$67.86 ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 ,$68.54 ,$102.70 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$130.00 ,$65.00 ,$61.48 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$67.86 ,$78.00 ,$110.50 ,$91.00 ,$62.66 ,$123.50 ,$98.80 ,$97.50 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$84.50 ,$91.00 ,$62.66 ,$67.86 ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 ,$68.54 ,$102.70 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$276.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$182.00 ,$196.00 ,$47.91 ,$75.17 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$75.92 ,$221.20 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$276.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$182.00 ,$196.00 ,$47.91 ,$75.17 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$75.92 ,$221.20 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$276.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$182.00 ,$196.00 ,$47.91 ,$75.17 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$75.92 ,$221.20 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$276.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$182.00 ,$196.00 ,$47.91 ,$75.17 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$75.92 ,$221.20 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$276.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$182.00 ,$196.00 ,$48.82 ,$83.40 ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$84.23 ,$221.20 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$276.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$182.00 ,$196.00 ,$48.82 ,$83.40 ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$84.23 ,$221.20 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$276.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$182.00 ,$196.00 ,$48.82 ,$83.40 ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$84.23 ,$221.20 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$276.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$182.00 ,$196.00 ,$48.82 ,$83.40 ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$84.23 ,$221.20 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,44400016,92610,HC DYSHPAGIA THERAPY,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400021,92610,HC DYSPHAGIA REEVALUATION 15MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400022,92610,HC DYSPHAGIA REEVALUATION 30MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400023,92610,HC DYSPHAGIA REEVALUATION 45MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400024,92610,HC EVAL SWALLOW-ORAL FEED,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400025,92610,HC DYSPHAGIA EVALUATION,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400029,92611,HC DYSPHAGIA EVAL-VIDEO 15MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400030,92611,HC DYSPHAGIA EVAL-VIDEO 30MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400031,92611,HC DYSPHAGIA EVAL-VIDEO 45MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400032,92611,HC DYSPHAGIA EVAL-VIDEO 60MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400034,92611,HC DYSPHAGIA RE-EVAL VIDEO 15MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400040,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$218.00 ,$130.27 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$169.00 ,$182.00 ,$30.27 ,$130.27 ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$131.57 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400041,92522,HC EVALUATE SPEECH PRODUCTION 15MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$218.00 ,$109.09 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$169.00 ,$182.00 ,$24.58 ,$109.09 ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$110.18 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$276.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$279.50 ,$301.00 ,$48.63 ,$223.11 ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$299.50 ,$225.34 ,$339.70 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400043,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 15MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$218.00 ,$107.46 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$149.50 ,$161.00 ,$25.62 ,$107.46 ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$108.53 ,$181.70 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,44400048,92610,HC DYSPHAGIA REEVALUATION 60MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$276.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$258.40 ,$255.00 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$221.00 ,$238.00 ,$72.23 ,$83.19 ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$84.02 ,$268.60 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,44400049,92611,HC DYSPHAGIA RE-EVAL VIDEO 30MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400050,92611,HC DYSPHAGIA RE-EVAL VIDEO 45MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400051,92611,HC DYSPHAGIA RE-EVAL VIDEO 60MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$276.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$296.40 ,$292.50 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$253.50 ,$273.00 ,$116.92 ,$89.02 ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$237.39 ,$269.49 ,$351.00 ,$271.64 ,$89.91 ,$308.10 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$312.00 
ST NICHOLAS HOSPITAL - ACUTE,44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$218.00 ,$130.27 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$169.00 ,$182.00 ,$30.27 ,$130.27 ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$131.57 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$218.00 ,$130.27 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$169.00 ,$182.00 ,$30.27 ,$130.27 ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$131.57 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400054,92521,HC EVALUATION OF SPEECH FLUENCY 60MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$218.00 ,$130.27 ,$156.00 ,$221.00 ,$182.00 ,$30.27 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$169.00 ,$182.00 ,$30.27 ,$130.27 ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$131.57 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400055,92522,HC EVALUATE SPEECH PRODUCTION 30MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$218.00 ,$109.09 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$169.00 ,$182.00 ,$24.58 ,$109.09 ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$110.18 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400056,92522,HC EVALUATE SPEECH PRODUCTION 45MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$218.00 ,$109.09 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$169.00 ,$182.00 ,$24.58 ,$109.09 ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$110.18 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400057,92522,HC EVALUATE SPEECH PRODUCTION 60MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$218.00 ,$109.09 ,$156.00 ,$221.00 ,$182.00 ,$24.58 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$169.00 ,$182.00 ,$24.58 ,$109.09 ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 ,$110.18 ,$205.40 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$276.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$279.50 ,$301.00 ,$48.63 ,$223.11 ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$299.50 ,$225.34 ,$339.70 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$276.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$279.50 ,$301.00 ,$48.63 ,$223.11 ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$299.50 ,$225.34 ,$339.70 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$276.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$326.80 ,$322.50 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$279.50 ,$301.00 ,$48.63 ,$223.11 ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$261.74 ,$297.13 ,$387.00 ,$299.50 ,$225.34 ,$339.70 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$344.00 
ST NICHOLAS HOSPITAL - ACUTE,44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$218.00 ,$107.46 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$149.50 ,$161.00 ,$25.62 ,$107.46 ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$108.53 ,$181.70 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$218.00 ,$107.46 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$149.50 ,$161.00 ,$25.62 ,$107.46 ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$108.53 ,$181.70 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$218.00 ,$107.46 ,$138.00 ,$195.50 ,$161.00 ,$25.62 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$149.50 ,$161.00 ,$25.62 ,$107.46 ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$108.53 ,$181.70 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$840.00 ,$420.00 ,$51.36 ,$840.00 ,$51.36 ,$543.40 ,$543.40 ,$340.80 ,$504.00 ,$714.00 ,$588.00 ,$51.36 ,$798.00 ,$638.40 ,$630.00 ,$546.00 ,$714.00 ,$340.80 ,$546.00 ,$546.00 ,$588.00 ,$51.36 ,$340.80 ,$340.80 ,$571.36 ,$714.00 ,$766.80 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$585.06 ,$344.21 ,$663.60 ,$54.44 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$474.00 ,$237.00 ,$51.36 ,"$1,380.55 ",$51.36 ,$306.63 ,$306.63 ,$613.58 ,$284.40 ,$402.90 ,$331.80 ,$51.36 ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 ,$613.58 ,$308.10 ,$308.10 ,$331.80 ,$51.36 ,$613.58 ,$613.58 ,$474.00 ,$402.90 ,"$1,380.55 ",$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 ,$619.72 ,$374.46 ,$54.44 ,$474.00 ,$474.00 ,$613.58 ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,45000004,10081,HC I AND D CYST PILONIDAL CPLX,450,1 ,"$2,586.00 ","$1,293.00 ",$344.84 ,"$2,586.00 ",$344.84 ,"$1,672.88 ","$1,672.88 ",$613.58 ,"$1,551.60 ","$2,198.10 ","$1,810.20 ",$344.84 ,"$2,456.70 ","$1,965.36 ","$1,939.50 ","$1,680.90 ","$2,198.10 ",$613.58 ,"$1,680.90 ","$1,680.90 ","$1,810.20 ",$344.84 ,$613.58 ,$613.58 ,$571.36 ,"$2,198.10 ","$1,380.55 ","$2,379.12 ","$1,810.20 ","$1,311.62 ","$1,574.10 ","$1,574.87 ","$1,574.10 ","$1,786.93 ","$2,327.40 ","$1,801.15 ",$619.72 ,"$2,042.94 ",$365.53 ,$685.00 ,$685.00 ,$613.58 ,$685.00 ,"$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$2,068.80 "
ST NICHOLAS HOSPITAL - ACUTE,45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$388.00 ,$194.00 ,$51.36 ,$766.80 ,$51.36 ,$251.00 ,$251.00 ,$340.80 ,$232.80 ,$329.80 ,$271.60 ,$51.36 ,$368.60 ,$294.88 ,$291.00 ,$252.20 ,$329.80 ,$340.80 ,$252.20 ,$252.20 ,$271.60 ,$51.36 ,$340.80 ,$340.80 ,$388.00 ,$329.80 ,$766.80 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$344.21 ,$306.52 ,$54.44 ,$388.00 ,$388.00 ,$340.80 ,$388.00 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$291.00 ,$145.50 ,$20.60 ,$398.39 ,$20.60 ,$188.25 ,$188.25 ,$177.06 ,$174.60 ,$247.35 ,$203.70 ,$20.60 ,$276.45 ,$221.16 ,$218.25 ,$189.15 ,$247.35 ,$177.06 ,$189.15 ,$189.15 ,$203.70 ,$20.60 ,$177.06 ,$177.06 ,$291.00 ,$247.35 ,$398.39 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$177.13 ,$201.08 ,$261.90 ,$202.68 ,$178.83 ,$229.89 ,$21.84 ,$291.00 ,$291.00 ,$177.06 ,$291.00 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,45000010,11732,HC AVULSION NAIL PL PT/CO EA ADDL FAC,450,1 ,$232.00 ,$116.00 ,$20.60 ,$232.00 ,$20.60 ,$150.08 ,$150.08 , N/A ,$139.20 ,$197.20 ,$162.40 ,$20.60 ,$220.40 ,$176.32 ,$174.00 ,$150.80 ,$197.20 , N/A ,$150.80 ,$150.80 ,$162.40 ,$20.60 , N/A , N/A ,$232.00 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$141.22 ,$160.31 ,$208.80 ,$161.59 , N/A ,$183.28 ,$21.84 ,$232.00 ,$232.00 , N/A ,$232.00 ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$185.60 
ST NICHOLAS HOSPITAL - ACUTE,45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$151.00 ,$75.50 ,$20.60 ,$250.16 ,$20.60 ,$97.68 ,$97.68 ,$111.18 ,$90.60 ,$128.35 ,$105.70 ,$20.60 ,$143.45 ,$114.76 ,$113.25 ,$98.15 ,$128.35 ,$111.18 ,$98.15 ,$98.15 ,$105.70 ,$20.60 ,$111.18 ,$111.18 ,$151.00 ,$128.35 ,$250.16 ,$138.92 ,$105.70 ,$76.59 ,$91.91 ,$91.96 ,$91.91 ,$104.34 ,$135.90 ,$105.17 ,$112.29 ,$119.29 ,$21.84 ,$151.00 ,$151.00 ,$111.18 ,$151.00 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$120.80 
ST NICHOLAS HOSPITAL - ACUTE,45000012,11760,HC REPAIR NAIL BED,450,1 ,$463.00 ,$231.50 ,$20.60 ,"$1,161.91 ",$20.60 ,$299.51 ,$299.51 ,$516.40 ,$277.80 ,$393.55 ,$324.10 ,$20.60 ,$439.85 ,$351.88 ,$347.25 ,$300.95 ,$393.55 ,$516.40 ,$300.95 ,$300.95 ,$324.10 ,$20.60 ,$516.40 ,$516.40 ,$463.00 ,$393.55 ,"$1,161.91 ",$425.96 ,$324.10 ,$234.83 ,$281.83 ,$281.97 ,$281.83 ,$319.93 ,$416.70 ,$322.48 ,$521.56 ,$365.77 ,$21.84 ,$463.00 ,$463.00 ,$516.40 ,$463.00 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$370.40 
ST NICHOLAS HOSPITAL - ACUTE,45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,$399.00 ,$199.50 ,$20.60 ,$766.80 ,$20.60 ,$258.11 ,$258.11 ,$340.80 ,$239.40 ,$339.15 ,$279.30 ,$20.60 ,$379.05 ,$303.24 ,$299.25 ,$259.35 ,$339.15 ,$340.80 ,$259.35 ,$259.35 ,$279.30 ,$20.60 ,$340.80 ,$340.80 ,$399.00 ,$339.15 ,$766.80 ,$367.08 ,$279.30 ,$202.37 ,$242.87 ,$242.99 ,$242.87 ,$275.71 ,$359.10 ,$277.90 ,$344.21 ,$315.21 ,$21.84 ,$399.00 ,$399.00 ,$340.80 ,$399.00 ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$319.20 
ST NICHOLAS HOSPITAL - ACUTE,45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$549.00 ,$274.50 ,$58.71 ,$549.00 ,$58.71 ,$355.15 ,$355.15 ,$177.06 ,$329.40 ,$466.65 ,$384.30 ,$58.71 ,$521.55 ,$417.24 ,$411.75 ,$356.85 ,$466.65 ,$177.06 ,$356.85 ,$356.85 ,$384.30 ,$58.71 ,$177.06 ,$177.06 ,$549.00 ,$466.65 ,$398.39 ,$505.08 ,$384.30 ,$278.45 ,$334.18 ,$334.34 ,$334.18 ,$379.36 ,$494.10 ,$382.38 ,$178.83 ,$433.71 ,$62.23 ,$549.00 ,$549.00 ,$177.06 ,$549.00 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$439.20 
ST NICHOLAS HOSPITAL - ACUTE,45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$603.00 ,$301.50 ,$58.71 ,$603.00 ,$58.71 ,$390.08 ,$390.08 ,$177.06 ,$361.80 ,$512.55 ,$422.10 ,$58.71 ,$572.85 ,$458.28 ,$452.25 ,$391.95 ,$512.55 ,$177.06 ,$391.95 ,$391.95 ,$422.10 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$512.55 ,$398.39 ,$554.76 ,$422.10 ,$305.84 ,$367.05 ,$367.23 ,$367.05 ,$416.67 ,$542.70 ,$419.99 ,$178.83 ,$476.37 ,$62.23 ,$603.00 ,$603.00 ,$177.06 ,$603.00 ,$434.16 ,$373.86 ,$434.16 ,$434.16 ,$482.40 
ST NICHOLAS HOSPITAL - ACUTE,45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$657.00 ,$328.50 ,$58.71 ,$657.00 ,$58.71 ,$425.01 ,$425.01 ,$177.06 ,$394.20 ,$558.45 ,$459.90 ,$58.71 ,$624.15 ,$499.32 ,$492.75 ,$427.05 ,$558.45 ,$177.06 ,$427.05 ,$427.05 ,$459.90 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$558.45 ,$398.39 ,$604.44 ,$459.90 ,$333.23 ,$399.92 ,$400.11 ,$399.92 ,$453.99 ,$591.30 ,$457.60 ,$178.83 ,$519.03 ,$62.23 ,$657.00 ,$657.00 ,$177.06 ,$657.00 ,$473.04 ,$407.34 ,$473.04 ,$473.04 ,$525.60 
ST NICHOLAS HOSPITAL - ACUTE,45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$711.00 ,$355.50 ,$58.71 ,$766.80 ,$58.71 ,$459.95 ,$459.95 ,$340.80 ,$426.60 ,$604.35 ,$497.70 ,$58.71 ,$675.45 ,$540.36 ,$533.25 ,$462.15 ,$604.35 ,$340.80 ,$462.15 ,$462.15 ,$497.70 ,$58.71 ,$340.80 ,$340.80 ,$571.36 ,$604.35 ,$766.80 ,$654.12 ,$497.70 ,$360.62 ,$432.79 ,$433.00 ,$432.79 ,$491.30 ,$639.90 ,$495.21 ,$344.21 ,$561.69 ,$62.23 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$511.92 ,$440.82 ,$511.92 ,$511.92 ,$568.80 
ST NICHOLAS HOSPITAL - ACUTE,45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$765.00 ,$382.50 ,$58.71 ,$766.80 ,$58.71 ,$494.88 ,$494.88 ,$340.80 ,$459.00 ,$650.25 ,$535.50 ,$58.71 ,$726.75 ,$581.40 ,$573.75 ,$497.25 ,$650.25 ,$340.80 ,$497.25 ,$497.25 ,$535.50 ,$58.71 ,$340.80 ,$340.80 ,$571.36 ,$650.25 ,$766.80 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$465.66 ,$528.62 ,$688.50 ,$532.82 ,$344.21 ,$604.35 ,$62.23 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$612.00 
ST NICHOLAS HOSPITAL - ACUTE,45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$786.00 ,$393.00 ,$58.71 ,$786.00 ,$58.71 ,$508.46 ,$508.46 ,$177.06 ,$471.60 ,$668.10 ,$550.20 ,$58.71 ,$746.70 ,$597.36 ,$589.50 ,$510.90 ,$668.10 ,$177.06 ,$510.90 ,$510.90 ,$550.20 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$668.10 ,$398.39 ,$723.12 ,$550.20 ,$398.66 ,$478.44 ,$478.67 ,$478.44 ,$543.13 ,$707.40 ,$547.45 ,$178.83 ,$620.94 ,$62.23 ,$685.00 ,$685.00 ,$177.06 ,$685.00 ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$628.80 
ST NICHOLAS HOSPITAL - ACUTE,45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$679.00 ,$339.50 ,$58.71 ,$679.00 ,$58.71 ,$439.25 ,$439.25 ,$177.06 ,$407.40 ,$577.15 ,$475.30 ,$58.71 ,$645.05 ,$516.04 ,$509.25 ,$441.35 ,$577.15 ,$177.06 ,$441.35 ,$441.35 ,$475.30 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$577.15 ,$398.39 ,$624.68 ,$475.30 ,$344.39 ,$413.31 ,$413.51 ,$413.31 ,$469.19 ,$611.10 ,$472.92 ,$178.83 ,$536.41 ,$62.23 ,$679.00 ,$679.00 ,$177.06 ,$679.00 ,$488.88 ,$420.98 ,$488.88 ,$488.88 ,$543.20 
ST NICHOLAS HOSPITAL - ACUTE,45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$743.00 ,$371.50 ,$58.71 ,$743.00 ,$58.71 ,$480.65 ,$480.65 ,$177.06 ,$445.80 ,$631.55 ,$520.10 ,$58.71 ,$705.85 ,$564.68 ,$557.25 ,$482.95 ,$631.55 ,$177.06 ,$482.95 ,$482.95 ,$520.10 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$631.55 ,$398.39 ,$683.56 ,$520.10 ,$376.85 ,$452.26 ,$452.49 ,$452.26 ,$513.41 ,$668.70 ,$517.50 ,$178.83 ,$586.97 ,$62.23 ,$685.00 ,$685.00 ,$177.06 ,$685.00 ,$534.96 ,$460.66 ,$534.96 ,$534.96 ,$594.40 
ST NICHOLAS HOSPITAL - ACUTE,45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$765.00 ,$382.50 ,$58.71 ,$765.00 ,$58.71 ,$494.88 ,$494.88 ,$177.06 ,$459.00 ,$650.25 ,$535.50 ,$58.71 ,$726.75 ,$581.40 ,$573.75 ,$497.25 ,$650.25 ,$177.06 ,$497.25 ,$497.25 ,$535.50 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$650.25 ,$398.39 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$465.66 ,$528.62 ,$688.50 ,$532.82 ,$178.83 ,$604.35 ,$62.23 ,$685.00 ,$685.00 ,$177.06 ,$685.00 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$612.00 
ST NICHOLAS HOSPITAL - ACUTE,45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$786.00 ,$393.00 ,$58.71 ,$786.00 ,$58.71 ,$508.46 ,$508.46 ,$177.06 ,$471.60 ,$668.10 ,$550.20 ,$58.71 ,$746.70 ,$597.36 ,$589.50 ,$510.90 ,$668.10 ,$177.06 ,$510.90 ,$510.90 ,$550.20 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$668.10 ,$398.39 ,$723.12 ,$550.20 ,$398.66 ,$478.44 ,$478.67 ,$478.44 ,$543.13 ,$707.40 ,$547.45 ,$178.83 ,$620.94 ,$62.23 ,$685.00 ,$685.00 ,$177.06 ,$685.00 ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$628.80 
ST NICHOLAS HOSPITAL - ACUTE,45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$797.00 ,$398.50 ,$58.71 ,$797.00 ,$58.71 ,$515.58 ,$515.58 ,$340.80 ,$478.20 ,$677.45 ,$557.90 ,$58.71 ,$757.15 ,$605.72 ,$597.75 ,$518.05 ,$677.45 ,$340.80 ,$518.05 ,$518.05 ,$557.90 ,$58.71 ,$340.80 ,$340.80 ,$571.36 ,$677.45 ,$766.80 ,$733.24 ,$557.90 ,$404.24 ,$485.13 ,$485.37 ,$485.13 ,$550.73 ,$717.30 ,$555.11 ,$344.21 ,$629.63 ,$62.23 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$573.84 ,$494.14 ,$573.84 ,$573.84 ,$637.60 
ST NICHOLAS HOSPITAL - ACUTE,45000025,12017,HC SIMP F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$819.00 ,$409.50 ,$58.71 ,$819.00 ,$58.71 ,$529.81 ,$529.81 ,$340.80 ,$491.40 ,$696.15 ,$573.30 ,$58.71 ,$778.05 ,$622.44 ,$614.25 ,$532.35 ,$696.15 ,$340.80 ,$532.35 ,$532.35 ,$573.30 ,$58.71 ,$340.80 ,$340.80 ,$571.36 ,$696.15 ,$766.80 ,$753.48 ,$573.30 ,$415.40 ,$498.53 ,$498.77 ,$498.53 ,$565.93 ,$737.10 ,$570.43 ,$344.21 ,$647.01 ,$62.23 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$589.68 ,$507.78 ,$589.68 ,$589.68 ,$655.20 
ST NICHOLAS HOSPITAL - ACUTE,45000026,12018,HC SIMP F/E/E/N/L/MM OVER 30CM,450,1 ,$840.00 ,$420.00 ,$58.71 ,$840.00 ,$58.71 ,$543.40 ,$543.40 ,$177.06 ,$504.00 ,$714.00 ,$588.00 ,$58.71 ,$798.00 ,$638.40 ,$630.00 ,$546.00 ,$714.00 ,$177.06 ,$546.00 ,$546.00 ,$588.00 ,$58.71 ,$177.06 ,$177.06 ,$571.36 ,$714.00 ,$398.39 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$585.06 ,$178.83 ,$663.60 ,$62.23 ,$685.00 ,$685.00 ,$177.06 ,$685.00 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$1,293.00 ",$646.50 ,$118.09 ,"$1,293.00 ",$118.09 ,$836.44 ,$836.44 ,$516.40 ,$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$982.68 ,$969.75 ,$840.45 ,"$1,099.05 ",$516.40 ,$840.45 ,$840.45 ,$905.10 ,$118.09 ,$516.40 ,$516.40 ,$571.36 ,"$1,099.05 ","$1,161.91 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,$521.56 ,"$1,021.47 ",$125.18 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000028,12021,HC SIMP SUPERFICIAL DEHISCENC/PAK,450,1 ,$508.00 ,$254.00 ,$118.09 ,$766.80 ,$118.09 ,$328.63 ,$328.63 ,$340.80 ,$304.80 ,$431.80 ,$355.60 ,$118.09 ,$482.60 ,$386.08 ,$381.00 ,$330.20 ,$431.80 ,$340.80 ,$330.20 ,$330.20 ,$355.60 ,$118.09 ,$340.80 ,$340.80 ,$508.00 ,$431.80 ,$766.80 ,$467.36 ,$355.60 ,$257.66 ,$309.22 ,$309.37 ,$309.22 ,$351.03 ,$457.20 ,$353.82 ,$344.21 ,$401.32 ,$125.18 ,$508.00 ,$508.00 ,$340.80 ,$508.00 ,$365.76 ,$314.96 ,$365.76 ,$365.76 ,$406.40 
ST NICHOLAS HOSPITAL - ACUTE,45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$700.00 ,$350.00 ,$118.09 ,$766.80 ,$118.09 ,$452.83 ,$452.83 ,$340.80 ,$420.00 ,$595.00 ,$490.00 ,$118.09 ,$665.00 ,$532.00 ,$525.00 ,$455.00 ,$595.00 ,$340.80 ,$455.00 ,$455.00 ,$490.00 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$595.00 ,$766.80 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$426.09 ,$483.70 ,$630.00 ,$487.55 ,$344.21 ,$553.00 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$776.00 ,$388.00 ,$118.09 ,$776.00 ,$118.09 ,$501.99 ,$501.99 ,$340.80 ,$465.60 ,$659.60 ,$543.20 ,$118.09 ,$737.20 ,$589.76 ,$582.00 ,$504.40 ,$659.60 ,$340.80 ,$504.40 ,$504.40 ,$543.20 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$659.60 ,$766.80 ,$713.92 ,$543.20 ,$393.59 ,$472.35 ,$472.58 ,$472.35 ,$536.22 ,$698.40 ,$540.48 ,$344.21 ,$613.04 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$620.80 
ST NICHOLAS HOSPITAL - ACUTE,45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$840.00 ,$420.00 ,$118.09 ,$840.00 ,$118.09 ,$543.40 ,$543.40 ,$340.80 ,$504.00 ,$714.00 ,$588.00 ,$118.09 ,$798.00 ,$638.40 ,$630.00 ,$546.00 ,$714.00 ,$340.80 ,$546.00 ,$546.00 ,$588.00 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$714.00 ,$766.80 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$585.06 ,$344.21 ,$663.60 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,$916.00 ,$458.00 ,$118.09 ,$916.00 ,$118.09 ,$592.56 ,$592.56 ,$340.80 ,$549.60 ,$778.60 ,$641.20 ,$118.09 ,$870.20 ,$696.16 ,$687.00 ,$595.40 ,$778.60 ,$340.80 ,$595.40 ,$595.40 ,$641.20 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$778.60 ,$766.80 ,$842.72 ,$641.20 ,$464.60 ,$557.57 ,$557.84 ,$557.57 ,$632.96 ,$824.40 ,$637.99 ,$344.21 ,$723.64 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$659.52 ,$567.92 ,$659.52 ,$659.52 ,$732.80 
ST NICHOLAS HOSPITAL - ACUTE,45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,$980.00 ,$490.00 ,$118.09 ,"$1,161.91 ",$118.09 ,$633.96 ,$633.96 ,$516.40 ,$588.00 ,$833.00 ,$686.00 ,$118.09 ,$931.00 ,$744.80 ,$735.00 ,$637.00 ,$833.00 ,$516.40 ,$637.00 ,$637.00 ,$686.00 ,$118.09 ,$516.40 ,$516.40 ,$571.36 ,$833.00 ,"$1,161.91 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$596.53 ,$677.18 ,$882.00 ,$682.57 ,$521.56 ,$774.20 ,$125.18 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$784.00 
ST NICHOLAS HOSPITAL - ACUTE,45000034,12037,HC INTRM S/A/T/EXT OVER 30CM,450,1 ,"$1,293.00 ",$646.50 ,$118.09 ,"$3,799.81 ",$118.09 ,$836.44 ,$836.44 ,"$1,688.81 ",$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$982.68 ,$969.75 ,$840.45 ,"$1,099.05 ","$1,688.81 ",$840.45 ,$840.45 ,$905.10 ,$118.09 ,"$1,688.81 ","$1,688.81 ",$571.36 ,"$1,099.05 ","$3,799.81 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,"$1,705.70 ","$1,021.47 ",$125.18 ,$685.00 ,$685.00 ,"$1,688.81 ",$685.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$636.00 ,$318.00 ,$118.09 ,$766.80 ,$118.09 ,$411.43 ,$411.43 ,$340.80 ,$381.60 ,$540.60 ,$445.20 ,$118.09 ,$604.20 ,$483.36 ,$477.00 ,$413.40 ,$540.60 ,$340.80 ,$413.40 ,$413.40 ,$445.20 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$540.60 ,$766.80 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$387.13 ,$439.48 ,$572.40 ,$442.97 ,$344.21 ,$502.44 ,$125.18 ,$636.00 ,$636.00 ,$340.80 ,$636.00 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$508.80 
ST NICHOLAS HOSPITAL - ACUTE,45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$700.00 ,$350.00 ,$118.09 ,$766.80 ,$118.09 ,$452.83 ,$452.83 ,$340.80 ,$420.00 ,$595.00 ,$490.00 ,$118.09 ,$665.00 ,$532.00 ,$525.00 ,$455.00 ,$595.00 ,$340.80 ,$455.00 ,$455.00 ,$490.00 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$595.00 ,$766.80 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$426.09 ,$483.70 ,$630.00 ,$487.55 ,$344.21 ,$553.00 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$776.00 ,$388.00 ,$118.09 ,"$1,161.91 ",$118.09 ,$501.99 ,$501.99 ,$516.40 ,$465.60 ,$659.60 ,$543.20 ,$118.09 ,$737.20 ,$589.76 ,$582.00 ,$504.40 ,$659.60 ,$516.40 ,$504.40 ,$504.40 ,$543.20 ,$118.09 ,$516.40 ,$516.40 ,$571.36 ,$659.60 ,"$1,161.91 ",$713.92 ,$543.20 ,$393.59 ,$472.35 ,$472.58 ,$472.35 ,$536.22 ,$698.40 ,$540.48 ,$521.56 ,$613.04 ,$125.18 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$620.80 
ST NICHOLAS HOSPITAL - ACUTE,45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,$916.00 ,$458.00 ,$118.09 ,"$1,161.91 ",$118.09 ,$592.56 ,$592.56 ,$516.40 ,$549.60 ,$778.60 ,$641.20 ,$118.09 ,$870.20 ,$696.16 ,$687.00 ,$595.40 ,$778.60 ,$516.40 ,$595.40 ,$595.40 ,$641.20 ,$118.09 ,$516.40 ,$516.40 ,$571.36 ,$778.60 ,"$1,161.91 ",$842.72 ,$641.20 ,$464.60 ,$557.57 ,$557.84 ,$557.57 ,$632.96 ,$824.40 ,$637.99 ,$521.56 ,$723.64 ,$125.18 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$659.52 ,$567.92 ,$659.52 ,$659.52 ,$732.80 
ST NICHOLAS HOSPITAL - ACUTE,45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,$980.00 ,$490.00 ,$118.09 ,"$1,161.91 ",$118.09 ,$633.96 ,$633.96 ,$516.40 ,$588.00 ,$833.00 ,$686.00 ,$118.09 ,$931.00 ,$744.80 ,$735.00 ,$637.00 ,$833.00 ,$516.40 ,$637.00 ,$637.00 ,$686.00 ,$118.09 ,$516.40 ,$516.40 ,$571.36 ,$833.00 ,"$1,161.91 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$596.53 ,$677.18 ,$882.00 ,$682.57 ,$521.56 ,$774.20 ,$125.18 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$784.00 
ST NICHOLAS HOSPITAL - ACUTE,45000040,12047,HC INTRM N/H/F/GEN OVER 30CM,450,1 ,"$1,293.00 ",$646.50 ,$118.09 ,"$3,799.81 ",$118.09 ,$836.44 ,$836.44 ,"$1,688.81 ",$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$982.68 ,$969.75 ,$840.45 ,"$1,099.05 ","$1,688.81 ",$840.45 ,$840.45 ,$905.10 ,$118.09 ,"$1,688.81 ","$1,688.81 ",$571.36 ,"$1,099.05 ","$3,799.81 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,"$1,705.70 ","$1,021.47 ",$125.18 ,$685.00 ,$685.00 ,"$1,688.81 ",$685.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$679.00 ,$339.50 ,$118.09 ,$766.80 ,$118.09 ,$439.25 ,$439.25 ,$340.80 ,$407.40 ,$577.15 ,$475.30 ,$118.09 ,$645.05 ,$516.04 ,$509.25 ,$441.35 ,$577.15 ,$340.80 ,$441.35 ,$441.35 ,$475.30 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$577.15 ,$766.80 ,$624.68 ,$475.30 ,$344.39 ,$413.31 ,$413.51 ,$413.31 ,$469.19 ,$611.10 ,$472.92 ,$344.21 ,$536.41 ,$125.18 ,$679.00 ,$679.00 ,$340.80 ,$679.00 ,$488.88 ,$420.98 ,$488.88 ,$488.88 ,$543.20 
ST NICHOLAS HOSPITAL - ACUTE,45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$743.00 ,$371.50 ,$118.09 ,$766.80 ,$118.09 ,$480.65 ,$480.65 ,$340.80 ,$445.80 ,$631.55 ,$520.10 ,$118.09 ,$705.85 ,$564.68 ,$557.25 ,$482.95 ,$631.55 ,$340.80 ,$482.95 ,$482.95 ,$520.10 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$631.55 ,$766.80 ,$683.56 ,$520.10 ,$376.85 ,$452.26 ,$452.49 ,$452.26 ,$513.41 ,$668.70 ,$517.50 ,$344.21 ,$586.97 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$534.96 ,$460.66 ,$534.96 ,$534.96 ,$594.40 
ST NICHOLAS HOSPITAL - ACUTE,45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$808.00 ,$404.00 ,$118.09 ,$808.00 ,$118.09 ,$522.70 ,$522.70 ,$340.80 ,$484.80 ,$686.80 ,$565.60 ,$118.09 ,$767.60 ,$614.08 ,$606.00 ,$525.20 ,$686.80 ,$340.80 ,$525.20 ,$525.20 ,$565.60 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$686.80 ,$766.80 ,$743.36 ,$565.60 ,$409.82 ,$491.83 ,$492.07 ,$491.83 ,$558.33 ,$727.20 ,$562.77 ,$344.21 ,$638.32 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$581.76 ,$500.96 ,$581.76 ,$581.76 ,$646.40 
ST NICHOLAS HOSPITAL - ACUTE,45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,$883.00 ,$441.50 ,$118.09 ,$883.00 ,$118.09 ,$571.21 ,$571.21 ,$340.80 ,$529.80 ,$750.55 ,$618.10 ,$118.09 ,$838.85 ,$671.08 ,$662.25 ,$573.95 ,$750.55 ,$340.80 ,$573.95 ,$573.95 ,$618.10 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$750.55 ,$766.80 ,$812.36 ,$618.10 ,$447.86 ,$537.48 ,$537.75 ,$537.48 ,$610.15 ,$794.70 ,$615.01 ,$344.21 ,$697.57 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$635.76 ,$547.46 ,$635.76 ,$635.76 ,$706.40 
ST NICHOLAS HOSPITAL - ACUTE,45000045,12055,HC INTRM F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$943.00 ,$471.50 ,$118.09 ,$943.00 ,$118.09 ,$610.03 ,$610.03 ,$340.80 ,$565.80 ,$801.55 ,$660.10 ,$118.09 ,$895.85 ,$716.68 ,$707.25 ,$612.95 ,$801.55 ,$340.80 ,$612.95 ,$612.95 ,$660.10 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$801.55 ,$766.80 ,$867.56 ,$660.10 ,$478.29 ,$574.00 ,$574.29 ,$574.00 ,$651.61 ,$848.70 ,$656.80 ,$344.21 ,$744.97 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$678.96 ,$584.66 ,$678.96 ,$678.96 ,$754.40 
ST NICHOLAS HOSPITAL - ACUTE,45000046,12056,HC INTRM F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$980.00 ,$490.00 ,$118.09 ,$980.00 ,$118.09 ,$633.96 ,$633.96 ,$340.80 ,$588.00 ,$833.00 ,$686.00 ,$118.09 ,$931.00 ,$744.80 ,$735.00 ,$637.00 ,$833.00 ,$340.80 ,$637.00 ,$637.00 ,$686.00 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,$833.00 ,$766.80 ,$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$596.53 ,$677.18 ,$882.00 ,$682.57 ,$344.21 ,$774.20 ,$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$784.00 
ST NICHOLAS HOSPITAL - ACUTE,45000047,12057,HC INTRM F/E/E/N/L/MM OVER 30.0CM,450,1 ,"$1,293.00 ",$646.50 ,$118.09 ,"$1,293.00 ",$118.09 ,$836.44 ,$836.44 ,$340.80 ,$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$982.68 ,$969.75 ,$840.45 ,"$1,099.05 ",$340.80 ,$840.45 ,$840.45 ,$905.10 ,$118.09 ,$340.80 ,$340.80 ,$571.36 ,"$1,099.05 ",$766.80 ,"$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,$344.21 ,"$1,021.47 ",$125.18 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,$980.00 ,$490.00 ,$139.95 ,"$1,161.91 ",$139.95 ,$633.96 ,$633.96 ,$516.40 ,$588.00 ,$833.00 ,$686.00 ,$139.95 ,$931.00 ,$744.80 ,$735.00 ,$637.00 ,$833.00 ,$516.40 ,$637.00 ,$637.00 ,$686.00 ,$139.95 ,$516.40 ,$516.40 ,$571.36 ,$833.00 ,"$1,161.91 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$596.53 ,$677.18 ,$882.00 ,$682.57 ,$521.56 ,$774.20 ,$148.35 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$784.00 
ST NICHOLAS HOSPITAL - ACUTE,45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,$980.00 ,$490.00 ,$139.95 ,"$1,161.91 ",$139.95 ,$633.96 ,$633.96 ,$516.40 ,$588.00 ,$833.00 ,$686.00 ,$139.95 ,$931.00 ,$744.80 ,$735.00 ,$637.00 ,$833.00 ,$516.40 ,$637.00 ,$637.00 ,$686.00 ,$139.95 ,$516.40 ,$516.40 ,$571.36 ,$833.00 ,"$1,161.91 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$596.53 ,$677.18 ,$882.00 ,$682.57 ,$521.56 ,$774.20 ,$148.35 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$784.00 
ST NICHOLAS HOSPITAL - ACUTE,45000050,13102,HC CMPLX TRUNK EA ADDL 5 CM OR LESS,450,1 ,$539.00 ,$269.50 ,$139.95 ,$539.00 ,$139.95 ,$348.68 ,$348.68 , N/A ,$323.40 ,$458.15 ,$377.30 ,$139.95 ,$512.05 ,$409.64 ,$404.25 ,$350.35 ,$458.15 , N/A ,$350.35 ,$350.35 ,$377.30 ,$139.95 , N/A , N/A ,$539.00 ,$458.15 , N/A ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$328.09 ,$372.45 ,$485.10 ,$375.41 , N/A ,$425.81 ,$148.35 ,$539.00 ,$539.00 , N/A ,$539.00 ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$431.20 
ST NICHOLAS HOSPITAL - ACUTE,45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,$980.00 ,$490.00 ,$139.95 ,"$1,161.91 ",$139.95 ,$633.96 ,$633.96 ,$516.40 ,$588.00 ,$833.00 ,$686.00 ,$139.95 ,$931.00 ,$744.80 ,$735.00 ,$637.00 ,$833.00 ,$516.40 ,$637.00 ,$637.00 ,$686.00 ,$139.95 ,$516.40 ,$516.40 ,$571.36 ,$833.00 ,"$1,161.91 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$596.53 ,$677.18 ,$882.00 ,$682.57 ,$521.56 ,$774.20 ,$148.35 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$784.00 
ST NICHOLAS HOSPITAL - ACUTE,45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,"$1,293.00 ",$646.50 ,$139.95 ,"$1,293.00 ",$139.95 ,$836.44 ,$836.44 ,$516.40 ,$775.80 ,"$1,099.05 ",$905.10 ,$139.95 ,"$1,228.35 ",$982.68 ,$969.75 ,$840.45 ,"$1,099.05 ",$516.40 ,$840.45 ,$840.45 ,$905.10 ,$139.95 ,$516.40 ,$516.40 ,$571.36 ,"$1,099.05 ","$1,161.91 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,$521.56 ,"$1,021.47 ",$148.35 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000053,13122,HC CMPLX S/A/L EA ADDL 5 CM OR LESS,450,1 ,$539.00 ,$269.50 ,$139.95 ,$539.00 ,$139.95 ,$348.68 ,$348.68 , N/A ,$323.40 ,$458.15 ,$377.30 ,$139.95 ,$512.05 ,$409.64 ,$404.25 ,$350.35 ,$458.15 , N/A ,$350.35 ,$350.35 ,$377.30 ,$139.95 , N/A , N/A ,$539.00 ,$458.15 , N/A ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$328.09 ,$372.45 ,$485.10 ,$375.41 , N/A ,$425.81 ,$148.35 ,$539.00 ,$539.00 , N/A ,$539.00 ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$431.20 
ST NICHOLAS HOSPITAL - ACUTE,45000054,13131,HC CMPLX F/C/C/M/N/A/G/H/F 1.1-2.5 CM,450,1 ,"$1,293.00 ",$646.50 ,$139.95 ,"$1,293.00 ",$139.95 ,$836.44 ,$836.44 ,$340.80 ,$775.80 ,"$1,099.05 ",$905.10 ,$139.95 ,"$1,228.35 ",$982.68 ,$969.75 ,$840.45 ,"$1,099.05 ",$340.80 ,$840.45 ,$840.45 ,$905.10 ,$139.95 ,$340.80 ,$340.80 ,$571.36 ,"$1,099.05 ",$766.80 ,"$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,$344.21 ,"$1,021.47 ",$148.35 ,$685.00 ,$685.00 ,$340.80 ,$685.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000055,13132,HC CMPLX F/C/C/M/N/A/G/H/F 2.6-7.5 CM,450,1 ,"$1,401.00 ",$700.50 ,$139.95 ,"$1,401.00 ",$139.95 ,$906.31 ,$906.31 ,$516.40 ,$840.60 ,"$1,190.85 ",$980.70 ,$139.95 ,"$1,330.95 ","$1,064.76 ","$1,050.75 ",$910.65 ,"$1,190.85 ",$516.40 ,$910.65 ,$910.65 ,$980.70 ,$139.95 ,$516.40 ,$516.40 ,$571.36 ,"$1,190.85 ","$1,161.91 ","$1,288.92 ",$980.70 ,$710.59 ,$852.79 ,$853.21 ,$852.79 ,$968.09 ,"$1,260.90 ",$975.80 ,$521.56 ,"$1,106.79 ",$148.35 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,"$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ","$1,120.80 "
ST NICHOLAS HOSPITAL - ACUTE,45000056,13133,HC CMPLX F/C/C/M/N/A/G/H/F EA ADDL 5 CM OR LESS,450,1 ,$539.00 ,$269.50 ,$139.95 ,$539.00 ,$139.95 ,$348.68 ,$348.68 , N/A ,$323.40 ,$458.15 ,$377.30 ,$139.95 ,$512.05 ,$409.64 ,$404.25 ,$350.35 ,$458.15 , N/A ,$350.35 ,$350.35 ,$377.30 ,$139.95 , N/A , N/A ,$539.00 ,$458.15 , N/A ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$328.09 ,$372.45 ,$485.10 ,$375.41 , N/A ,$425.81 ,$148.35 ,$539.00 ,$539.00 , N/A ,$539.00 ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$431.20 
ST NICHOLAS HOSPITAL - ACUTE,45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,"$1,293.00 ",$646.50 ,$139.95 ,"$1,293.00 ",$139.95 ,$836.44 ,$836.44 ,$516.40 ,$775.80 ,"$1,099.05 ",$905.10 ,$139.95 ,"$1,228.35 ",$982.68 ,$969.75 ,$840.45 ,"$1,099.05 ",$516.40 ,$840.45 ,$840.45 ,$905.10 ,$139.95 ,$516.40 ,$516.40 ,$571.36 ,"$1,099.05 ","$1,161.91 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$787.05 ,$893.46 ,"$1,163.70 ",$900.57 ,$521.56 ,"$1,021.47 ",$148.35 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,"$1,034.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,"$1,401.00 ",$700.50 ,$139.95 ,"$1,401.00 ",$139.95 ,$906.31 ,$906.31 ,$516.40 ,$840.60 ,"$1,190.85 ",$980.70 ,$139.95 ,"$1,330.95 ","$1,064.76 ","$1,050.75 ",$910.65 ,"$1,190.85 ",$516.40 ,$910.65 ,$910.65 ,$980.70 ,$139.95 ,$516.40 ,$516.40 ,$571.36 ,"$1,190.85 ","$1,161.91 ","$1,288.92 ",$980.70 ,$710.59 ,$852.79 ,$853.21 ,$852.79 ,$968.09 ,"$1,260.90 ",$975.80 ,$521.56 ,"$1,106.79 ",$148.35 ,$685.00 ,$685.00 ,$516.40 ,$685.00 ,"$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ","$1,120.80 "
ST NICHOLAS HOSPITAL - ACUTE,45000060,13153,HC CMPLX E/N/E/L EA ADDL 5 CM OR LESS,450,1 ,$743.00 ,$371.50 ,$360.88 ,$743.00 ,$360.88 ,$480.65 ,$480.65 , N/A ,$445.80 ,$631.55 ,$520.10 ,$360.88 ,$705.85 ,$564.68 ,$557.25 ,$482.95 ,$631.55 , N/A ,$482.95 ,$482.95 ,$520.10 ,$360.88 , N/A , N/A ,$571.36 ,$631.55 , N/A ,$683.56 ,$520.10 ,$376.85 ,$452.26 ,$452.49 ,$452.26 ,$513.41 ,$668.70 ,$517.50 , N/A ,$586.97 ,$382.53 ,$685.00 ,$685.00 , N/A ,$685.00 ,$534.96 ,$460.66 ,$534.96 ,$534.96 ,$594.40 
ST NICHOLAS HOSPITAL - ACUTE,45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$183.00 ,$91.50 ,$58.71 ,$398.39 ,$58.71 ,$118.38 ,$118.38 ,$177.06 ,$109.80 ,$155.55 ,$128.10 ,$58.71 ,$173.85 ,$139.08 ,$137.25 ,$118.95 ,$155.55 ,$177.06 ,$118.95 ,$118.95 ,$128.10 ,$58.71 ,$177.06 ,$177.06 ,$183.00 ,$155.55 ,$398.39 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$111.39 ,$126.45 ,$164.70 ,$127.46 ,$178.83 ,$144.57 ,$62.23 ,$183.00 ,$183.00 ,$177.06 ,$183.00 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$146.40 
ST NICHOLAS HOSPITAL - ACUTE,45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$409.00 ,$204.50 ,$58.71 ,$409.00 ,$58.71 ,$264.58 ,$264.58 ,$177.06 ,$245.40 ,$347.65 ,$286.30 ,$58.71 ,$388.55 ,$310.84 ,$306.75 ,$265.85 ,$347.65 ,$177.06 ,$265.85 ,$265.85 ,$286.30 ,$58.71 ,$177.06 ,$177.06 ,$409.00 ,$347.65 ,$398.39 ,$376.28 ,$286.30 ,$207.44 ,$248.96 ,$249.08 ,$248.96 ,$282.62 ,$368.10 ,$284.87 ,$178.83 ,$323.11 ,$62.23 ,$409.00 ,$409.00 ,$177.06 ,$409.00 ,$294.48 ,$253.58 ,$294.48 ,$294.48 ,$327.20 
ST NICHOLAS HOSPITAL - ACUTE,45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$474.00 ,$237.00 ,$58.71 ,$474.00 ,$58.71 ,$306.63 ,$306.63 ,$177.06 ,$284.40 ,$402.90 ,$331.80 ,$58.71 ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 ,$177.06 ,$308.10 ,$308.10 ,$331.80 ,$58.71 ,$177.06 ,$177.06 ,$474.00 ,$402.90 ,$398.39 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 ,$178.83 ,$374.46 ,$62.23 ,$474.00 ,$474.00 ,$177.06 ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$571.00 ,$285.50 ,$118.09 ,$766.80 ,$118.09 ,$369.38 ,$369.38 ,$340.80 ,$342.60 ,$485.35 ,$399.70 ,$118.09 ,$542.45 ,$433.96 ,$428.25 ,$371.15 ,$485.35 ,$340.80 ,$371.15 ,$371.15 ,$399.70 ,$118.09 ,$340.80 ,$340.80 ,$571.00 ,$485.35 ,$766.80 ,$525.32 ,$399.70 ,$289.61 ,$347.57 ,$347.74 ,$347.57 ,$394.56 ,$513.90 ,$397.70 ,$344.21 ,$451.09 ,$125.18 ,$571.00 ,$571.00 ,$340.80 ,$571.00 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$456.80 
ST NICHOLAS HOSPITAL - ACUTE,45000065,16035,HC ESCHARATOMY; INITIAL,450,1 ,$474.00 ,$237.00 ,$118.09 ,$766.80 ,$118.09 ,$306.63 ,$306.63 ,$340.80 ,$284.40 ,$402.90 ,$331.80 ,$118.09 ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 ,$340.80 ,$308.10 ,$308.10 ,$331.80 ,$118.09 ,$340.80 ,$340.80 ,$474.00 ,$402.90 ,$766.80 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 ,$344.21 ,$374.46 ,$125.18 ,$474.00 ,$474.00 ,$340.80 ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,45000066,16036,HC ESCHARATOMY; EACH ADDL,450,1 ,$226.00 ,$113.00 ,$113.00 ,$226.00 ,$118.09 ,$146.20 ,$146.20 , N/A ,$135.60 ,$192.10 ,$158.20 ,$118.09 ,$214.70 ,$171.76 ,$169.50 ,$146.90 ,$192.10 , N/A ,$146.90 ,$146.90 ,$158.20 ,$118.09 , N/A , N/A ,$226.00 ,$192.10 , N/A ,$207.92 ,$158.20 ,$114.63 ,$137.57 ,$137.63 ,$137.57 ,$156.17 ,$203.40 ,$157.41 , N/A ,$178.54 ,$125.18 ,$226.00 ,$226.00 , N/A ,$226.00 ,$162.72 ,$140.12 ,$162.72 ,$162.72 ,$180.80 
ST NICHOLAS HOSPITAL - ACUTE,45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,$388.00 ,$194.00 ,$51.36 ,$398.39 ,$51.36 ,$251.00 ,$251.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$51.36 ,$368.60 ,$294.88 ,$291.00 ,$252.20 ,$329.80 ,$177.06 ,$252.20 ,$252.20 ,$271.60 ,$51.36 ,$177.06 ,$177.06 ,$388.00 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$54.44 ,$388.00 ,$388.00 ,$177.06 ,$388.00 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,45000068,20103,HC EXPL PENTR WOUND EXTREMITY,450,1 ,"$1,185.00 ",$592.50 ,$118.09 ,"$1,380.55 ",$118.09 ,$766.58 ,$766.58 ,$613.58 ,$711.00 ,"$1,007.25 ",$829.50 ,$118.09 ,"$1,125.75 ",$900.60 ,$888.75 ,$770.25 ,"$1,007.25 ",$613.58 ,$770.25 ,$770.25 ,$829.50 ,$118.09 ,$613.58 ,$613.58 ,$571.36 ,"$1,007.25 ","$1,380.55 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$721.31 ,$818.84 ,"$1,066.50 ",$825.35 ,$619.72 ,$936.15 ,$125.18 ,$685.00 ,$685.00 ,$613.58 ,$685.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$474.00 ,$237.00 ,$75.55 ,$579.62 ,$75.55 ,$306.63 ,$306.63 ,$257.61 ,$284.40 ,$402.90 ,$331.80 ,$75.55 ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 ,$257.61 ,$308.10 ,$308.10 ,$331.80 ,$75.55 ,$257.61 ,$257.61 ,$474.00 ,$402.90 ,$579.62 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 ,$260.19 ,$374.46 ,$80.08 ,$474.00 ,$474.00 ,$257.61 ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$700.00 ,$350.00 ,$75.55 ,$700.00 ,$75.55 ,$452.83 ,$452.83 ,$257.61 ,$420.00 ,$595.00 ,$490.00 ,$75.55 ,$665.00 ,$532.00 ,$525.00 ,$455.00 ,$595.00 ,$257.61 ,$455.00 ,$455.00 ,$490.00 ,$75.55 ,$257.61 ,$257.61 ,$571.36 ,$595.00 ,$579.62 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$426.09 ,$483.70 ,$630.00 ,$487.55 ,$260.19 ,$553.00 ,$80.08 ,$685.00 ,$685.00 ,$257.61 ,$685.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$700.00 ,$350.00 ,$113.33 ,$869.43 ,$113.33 ,$452.83 ,$452.83 ,$386.41 ,$420.00 ,$595.00 ,$490.00 ,$113.33 ,$665.00 ,$532.00 ,$525.00 ,$455.00 ,$595.00 ,$386.41 ,$455.00 ,$455.00 ,$490.00 ,$113.33 ,$386.41 ,$386.41 ,$571.36 ,$595.00 ,$869.43 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$426.09 ,$483.70 ,$630.00 ,$487.55 ,$390.27 ,$553.00 ,$120.13 ,$685.00 ,$685.00 ,$386.41 ,$685.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$700.00 ,$350.00 ,$113.33 ,$869.43 ,$113.33 ,$452.83 ,$452.83 ,$386.41 ,$420.00 ,$595.00 ,$490.00 ,$113.33 ,$665.00 ,$532.00 ,$525.00 ,$455.00 ,$595.00 ,$386.41 ,$455.00 ,$455.00 ,$490.00 ,$113.33 ,$386.41 ,$386.41 ,$571.36 ,$595.00 ,$869.43 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$426.09 ,$483.70 ,$630.00 ,$487.55 ,$390.27 ,$553.00 ,$120.13 ,$685.00 ,$685.00 ,$386.41 ,$685.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,45000072,20612,HC INJ GANGLION CYST,450,1 ,$528.00 ,$264.00 ,$75.55 ,$579.62 ,$75.55 ,$341.56 ,$341.56 ,$257.61 ,$316.80 ,$448.80 ,$369.60 ,$75.55 ,$501.60 ,$401.28 ,$396.00 ,$343.20 ,$448.80 ,$257.61 ,$343.20 ,$343.20 ,$369.60 ,$75.55 ,$257.61 ,$257.61 ,$528.00 ,$448.80 ,$579.62 ,$485.76 ,$369.60 ,$267.80 ,$321.39 ,$321.55 ,$321.39 ,$364.85 ,$475.20 ,$367.75 ,$260.19 ,$417.12 ,$80.08 ,$528.00 ,$528.00 ,$257.61 ,$528.00 ,$380.16 ,$327.36 ,$380.16 ,$380.16 ,$422.40 
ST NICHOLAS HOSPITAL - ACUTE,45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,$894.00 ,$447.00 ,$139.53 ,$894.00 ,$139.53 ,$578.33 ,$578.33 ,$203.23 ,$536.40 ,$759.90 ,$625.80 ,$139.53 ,$849.30 ,$679.44 ,$670.50 ,$581.10 ,$759.90 ,$203.23 ,$581.10 ,$581.10 ,$625.80 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$759.90 ,$457.26 ,$822.48 ,$625.80 ,$453.44 ,$544.18 ,$544.45 ,$544.18 ,$617.75 ,$804.60 ,$622.67 ,$205.26 ,$706.26 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$643.68 ,$554.28 ,$643.68 ,$643.68 ,$715.20 
ST NICHOLAS HOSPITAL - ACUTE,45000075,23655,HC TX DISL SHLDR W/MAN/ANES CLS,450,1 ,"$1,508.00 ",$754.00 ,$310.07 ,"$3,090.03 ",$310.07 ,$975.53 ,$975.53 ,"$1,373.35 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$310.07 ,"$1,432.60 ","$1,146.08 ","$1,131.00 ",$980.20 ,"$1,281.80 ","$1,373.35 ",$980.20 ,$980.20 ,"$1,055.60 ",$310.07 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$1,281.80 ","$3,090.03 ","$1,387.36 ","$1,055.60 ",$764.86 ,$917.92 ,$918.37 ,$917.92 ,"$1,042.03 ","$1,357.20 ","$1,050.32 ","$1,387.08 ","$1,191.32 ",$328.67 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ","$1,206.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$571.00 ,$285.50 ,$139.53 ,$571.00 ,$139.53 ,$369.38 ,$369.38 ,$203.23 ,$342.60 ,$485.35 ,$399.70 ,$139.53 ,$542.45 ,$433.96 ,$428.25 ,$371.15 ,$485.35 ,$203.23 ,$371.15 ,$371.15 ,$399.70 ,$139.53 ,$203.23 ,$203.23 ,$571.00 ,$485.35 ,$457.26 ,$525.32 ,$399.70 ,$289.61 ,$347.57 ,$347.74 ,$347.57 ,$394.56 ,$513.90 ,$397.70 ,$205.26 ,$451.09 ,$147.90 ,$571.00 ,$571.00 ,$203.23 ,$571.00 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$456.80 
ST NICHOLAS HOSPITAL - ACUTE,45000077,24605,HC CL TX ELBOW DISLOCATION W ANESTH,450,1 ,"$1,427.00 ",$713.50 ,$310.07 ,"$3,090.03 ",$310.07 ,$923.13 ,$923.13 ,"$1,373.35 ",$856.20 ,"$1,212.95 ",$998.90 ,$310.07 ,"$1,355.65 ","$1,084.52 ","$1,070.25 ",$927.55 ,"$1,212.95 ","$1,373.35 ",$927.55 ,$927.55 ,$998.90 ,$310.07 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$1,212.95 ","$3,090.03 ","$1,312.84 ",$998.90 ,$723.77 ,$868.61 ,$869.04 ,$868.61 ,$986.06 ,"$1,284.30 ",$993.91 ,"$1,387.08 ","$1,127.33 ",$328.67 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$1,027.44 ",$884.74 ,"$1,027.44 ","$1,027.44 ","$1,141.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$528.00 ,$264.00 ,$139.53 ,$528.00 ,$139.53 ,$341.56 ,$341.56 ,$203.23 ,$316.80 ,$448.80 ,$369.60 ,$139.53 ,$501.60 ,$401.28 ,$396.00 ,$343.20 ,$448.80 ,$203.23 ,$343.20 ,$343.20 ,$369.60 ,$139.53 ,$203.23 ,$203.23 ,$528.00 ,$448.80 ,$457.26 ,$485.76 ,$369.60 ,$267.80 ,$321.39 ,$321.55 ,$321.39 ,$364.85 ,$475.20 ,$367.75 ,$205.26 ,$417.12 ,$147.90 ,$528.00 ,$528.00 ,$203.23 ,$528.00 ,$380.16 ,$327.36 ,$380.16 ,$380.16 ,$422.40 
ST NICHOLAS HOSPITAL - ACUTE,45000081,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP,450,1 ,$830.00 ,$415.00 ,$139.53 ,"$3,090.03 ",$139.53 ,$536.93 ,$536.93 ,"$1,373.35 ",$498.00 ,$705.50 ,$581.00 ,$139.53 ,$788.50 ,$630.80 ,$622.50 ,$539.50 ,$705.50 ,"$1,373.35 ",$539.50 ,$539.50 ,$581.00 ,$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,$705.50 ,"$3,090.03 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$505.22 ,$573.53 ,$747.00 ,$578.10 ,"$1,387.08 ",$655.70 ,$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,$597.60 ,$514.60 ,$597.60 ,$597.60 ,$664.00 
ST NICHOLAS HOSPITAL - ACUTE,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$830.00 ,$415.00 ,$139.53 ,"$3,090.03 ",$139.53 ,$536.93 ,$536.93 ,"$1,373.35 ",$498.00 ,$705.50 ,$581.00 ,$139.53 ,$788.50 ,$630.80 ,$622.50 ,$539.50 ,$705.50 ,"$1,373.35 ",$539.50 ,$539.50 ,$581.00 ,$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,$705.50 ,"$3,090.03 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$505.22 ,$573.53 ,$747.00 ,$578.10 ,"$1,387.08 ",$655.70 ,$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,$597.60 ,$514.60 ,$597.60 ,$597.60 ,$664.00 
ST NICHOLAS HOSPITAL - ACUTE,45000083,26010,HC DRAIN ABSC FINGER SIMPLE,450,1 ,$431.00 ,$215.50 ,$51.36 ,$431.00 ,$51.36 ,$278.81 ,$278.81 ,$177.06 ,$258.60 ,$366.35 ,$301.70 ,$51.36 ,$409.45 ,$327.56 ,$323.25 ,$280.15 ,$366.35 ,$177.06 ,$280.15 ,$280.15 ,$301.70 ,$51.36 ,$177.06 ,$177.06 ,$431.00 ,$366.35 ,$398.39 ,$396.52 ,$301.70 ,$218.60 ,$262.35 ,$262.48 ,$262.35 ,$297.82 ,$387.90 ,$300.19 ,$178.83 ,$340.49 ,$54.44 ,$431.00 ,$431.00 ,$177.06 ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,45000084,26011,HC DRAIN ABSC FINGER COMPLCD,450,1 ,"$4,221.00 ","$2,110.50 ",$344.84 ,"$4,221.00 ",$344.84 ,"$2,730.56 ","$2,730.56 ","$1,387.33 ","$2,532.60 ","$3,587.85 ","$2,954.70 ",$344.84 ,"$4,009.95 ","$3,207.96 ","$3,165.75 ","$2,743.65 ","$3,587.85 ","$1,387.33 ","$2,743.65 ","$2,743.65 ","$2,954.70 ",$344.84 ,"$1,387.33 ","$1,387.33 ",$571.36 ,"$3,587.85 ","$3,121.49 ","$3,883.32 ","$2,954.70 ","$2,140.89 ","$2,569.32 ","$2,570.59 ","$2,569.32 ","$2,916.71 ","$3,798.90 ","$2,939.93 ","$1,401.20 ","$3,334.59 ",$365.53 ,$685.00 ,$685.00 ,"$1,387.33 ",$685.00 ,"$3,039.12 ","$2,617.02 ","$3,039.12 ","$3,039.12 ","$3,376.80 "
ST NICHOLAS HOSPITAL - ACUTE,45000085,26410,HC RPR TENDON HAND EXTEN W/O,450,1 ,"$2,047.00 ","$1,023.50 ",$415.99 ,"$3,090.03 ",$415.99 ,"$1,324.20 ","$1,324.20 ","$1,373.35 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$415.99 ,"$1,944.65 ","$1,555.72 ","$1,535.25 ","$1,330.55 ","$1,739.95 ","$1,373.35 ","$1,330.55 ","$1,330.55 ","$1,432.90 ",$415.99 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$1,739.95 ","$3,090.03 ","$1,883.24 ","$1,432.90 ","$1,038.24 ","$1,246.01 ","$1,246.62 ","$1,246.01 ","$1,414.48 ","$1,842.30 ","$1,425.74 ","$1,387.08 ","$1,617.13 ",$440.95 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,637.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000086,26418,HC RPR EXTEN TENDON FNGR W/O FREE,450,1 ,"$2,047.00 ","$1,023.50 ",$415.99 ,"$3,090.03 ",$415.99 ,"$1,324.20 ","$1,324.20 ","$1,373.35 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$415.99 ,"$1,944.65 ","$1,555.72 ","$1,535.25 ","$1,330.55 ","$1,739.95 ","$1,373.35 ","$1,330.55 ","$1,330.55 ","$1,432.90 ",$415.99 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$1,739.95 ","$3,090.03 ","$1,883.24 ","$1,432.90 ","$1,038.24 ","$1,246.01 ","$1,246.62 ","$1,246.01 ","$1,414.48 ","$1,842.30 ","$1,425.74 ","$1,387.08 ","$1,617.13 ",$440.95 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,637.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000087,26725,HC TX FX PHALANX PROX W/MAN CLS,450,1 ,$765.00 ,$382.50 ,$139.53 ,$765.00 ,$139.53 ,$494.88 ,$494.88 ,$203.23 ,$459.00 ,$650.25 ,$535.50 ,$139.53 ,$726.75 ,$581.40 ,$573.75 ,$497.25 ,$650.25 ,$203.23 ,$497.25 ,$497.25 ,$535.50 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$650.25 ,$457.26 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$465.66 ,$528.62 ,$688.50 ,$532.82 ,$205.26 ,$604.35 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$612.00 
ST NICHOLAS HOSPITAL - ACUTE,45000088,26742,HC TX FX (M-P)(I-P) JT W/MAN,450,1 ,$808.00 ,$404.00 ,$139.53 ,"$3,090.03 ",$139.53 ,$522.70 ,$522.70 ,"$1,373.35 ",$484.80 ,$686.80 ,$565.60 ,$139.53 ,$767.60 ,$614.08 ,$606.00 ,$525.20 ,$686.80 ,"$1,373.35 ",$525.20 ,$525.20 ,$565.60 ,$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,$686.80 ,"$3,090.03 ",$743.36 ,$565.60 ,$409.82 ,$491.83 ,$492.07 ,$491.83 ,$558.33 ,$727.20 ,$562.77 ,"$1,387.08 ",$638.32 ,$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,$581.76 ,$500.96 ,$581.76 ,$581.76 ,$646.40 
ST NICHOLAS HOSPITAL - ACUTE,45000089,26755,HC TX FX PHALANX DIST W/MAN CLS,450,1 ,$765.00 ,$382.50 ,$139.53 ,$765.00 ,$139.53 ,$494.88 ,$494.88 ,$203.23 ,$459.00 ,$650.25 ,$535.50 ,$139.53 ,$726.75 ,$581.40 ,$573.75 ,$497.25 ,$650.25 ,$203.23 ,$497.25 ,$497.25 ,$535.50 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$650.25 ,$457.26 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$465.66 ,$528.62 ,$688.50 ,$532.82 ,$205.26 ,$604.35 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$612.00 
ST NICHOLAS HOSPITAL - ACUTE,45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$851.00 ,$425.50 ,$139.53 ,$851.00 ,$139.53 ,$550.51 ,$550.51 ,$203.23 ,$510.60 ,$723.35 ,$595.70 ,$139.53 ,$808.45 ,$646.76 ,$638.25 ,$553.15 ,$723.35 ,$203.23 ,$553.15 ,$553.15 ,$595.70 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$723.35 ,$457.26 ,$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$518.00 ,$588.04 ,$765.90 ,$592.72 ,$205.26 ,$672.29 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$2,801.00 ","$1,400.50 ",$415.99 ,"$6,282.73 ",$415.99 ,"$1,811.97 ","$1,811.97 ","$2,792.32 ","$1,680.60 ","$2,380.85 ","$1,960.70 ",$415.99 ,"$2,660.95 ","$2,128.76 ","$2,100.75 ","$1,820.65 ","$2,380.85 ","$2,792.32 ","$1,820.65 ","$1,820.65 ","$1,960.70 ",$415.99 ,"$2,792.32 ","$2,792.32 ",$571.36 ,"$2,380.85 ","$6,282.73 ","$2,576.92 ","$1,960.70 ","$1,420.67 ","$1,704.97 ","$1,705.81 ","$1,704.97 ","$1,935.49 ","$2,520.90 ","$1,950.90 ","$2,820.24 ","$2,212.79 ",$440.95 ,$685.00 ,$685.00 ,"$2,792.32 ",$685.00 ,"$2,016.72 ","$1,736.62 ","$2,016.72 ","$2,016.72 ","$2,240.80 "
ST NICHOLAS HOSPITAL - ACUTE,45000092,27250,HC TX DISCL HIP CLOSED W/O ANES,450,1 ,$722.00 ,$361.00 ,$139.53 ,$722.00 ,$139.53 ,$467.06 ,$467.06 ,$203.23 ,$433.20 ,$613.70 ,$505.40 ,$139.53 ,$685.90 ,$548.72 ,$541.50 ,$469.30 ,$613.70 ,$203.23 ,$469.30 ,$469.30 ,$505.40 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$613.70 ,$457.26 ,$664.24 ,$505.40 ,$366.20 ,$439.48 ,$439.70 ,$439.48 ,$498.90 ,$649.80 ,$502.87 ,$205.26 ,$570.38 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$519.84 ,$447.64 ,$519.84 ,$519.84 ,$577.60 
ST NICHOLAS HOSPITAL - ACUTE,45000093,27252,HC CL TX HIP DISLOCATION; TRAUMATIC W ANESTH,450,1 ,"$1,160.00 ",$580.00 ,$310.07 ,"$3,090.03 ",$310.07 ,$750.40 ,$750.40 ,"$1,373.35 ",$696.00 ,$986.00 ,$812.00 ,$310.07 ,"$1,102.00 ",$881.60 ,$870.00 ,$754.00 ,$986.00 ,"$1,373.35 ",$754.00 ,$754.00 ,$812.00 ,$310.07 ,"$1,373.35 ","$1,373.35 ",$571.36 ,$986.00 ,"$3,090.03 ","$1,067.20 ",$812.00 ,$588.35 ,$706.09 ,$706.44 ,$706.09 ,$801.56 ,"$1,044.00 ",$807.94 ,"$1,387.08 ",$916.40 ,$328.67 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,$835.20 ,$719.20 ,$835.20 ,$835.20 ,$928.00 
ST NICHOLAS HOSPITAL - ACUTE,45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$851.00 ,$425.50 ,$139.53 ,$851.00 ,$139.53 ,$550.51 ,$550.51 ,$203.23 ,$510.60 ,$723.35 ,$595.70 ,$139.53 ,$808.45 ,$646.76 ,$638.25 ,$553.15 ,$723.35 ,$203.23 ,$553.15 ,$553.15 ,$595.70 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$723.35 ,$457.26 ,$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$518.00 ,$588.04 ,$765.90 ,$592.72 ,$205.26 ,$672.29 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,45000095,27266,HC CL TX POST HIP ARTHROPLASTY DISLOCAT W ANESTH,450,1 ,"$1,831.00 ",$915.50 ,$310.07 ,"$3,090.03 ",$310.07 ,"$1,184.47 ","$1,184.47 ","$1,373.35 ","$1,098.60 ","$1,556.35 ","$1,281.70 ",$310.07 ,"$1,739.45 ","$1,391.56 ","$1,373.25 ","$1,190.15 ","$1,556.35 ","$1,373.35 ","$1,190.15 ","$1,190.15 ","$1,281.70 ",$310.07 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$1,556.35 ","$3,090.03 ","$1,684.52 ","$1,281.70 ",$928.68 ,"$1,114.53 ","$1,115.08 ","$1,114.53 ","$1,265.22 ","$1,647.90 ","$1,275.29 ","$1,387.08 ","$1,446.49 ",$328.67 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,464.80 "
ST NICHOLAS HOSPITAL - ACUTE,45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$722.00 ,$361.00 ,$139.53 ,$722.00 ,$139.53 ,$467.06 ,$467.06 ,$203.23 ,$433.20 ,$613.70 ,$505.40 ,$139.53 ,$685.90 ,$548.72 ,$541.50 ,$469.30 ,$613.70 ,$203.23 ,$469.30 ,$469.30 ,$505.40 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$613.70 ,$457.26 ,$664.24 ,$505.40 ,$366.20 ,$439.48 ,$439.70 ,$439.48 ,$498.90 ,$649.80 ,$502.87 ,$205.26 ,$570.38 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$519.84 ,$447.64 ,$519.84 ,$519.84 ,$577.60 
ST NICHOLAS HOSPITAL - ACUTE,45000097,28190,HC REM FB FOOT SUBQ,450,1 ,$905.00 ,$452.50 ,$139.95 ,"$1,380.55 ",$139.95 ,$585.44 ,$585.44 ,$613.58 ,$543.00 ,$769.25 ,$633.50 ,$139.95 ,$859.75 ,$687.80 ,$678.75 ,$588.25 ,$769.25 ,$613.58 ,$588.25 ,$588.25 ,$633.50 ,$139.95 ,$613.58 ,$613.58 ,$571.36 ,$769.25 ,"$1,380.55 ",$832.60 ,$633.50 ,$459.02 ,$550.87 ,$551.15 ,$550.87 ,$625.36 ,$814.50 ,$630.33 ,$619.72 ,$714.95 ,$148.35 ,$685.00 ,$685.00 ,$613.58 ,$685.00 ,$651.60 ,$561.10 ,$651.60 ,$651.60 ,$724.00 
ST NICHOLAS HOSPITAL - ACUTE,45000098,29065,HC APPL CAST ARM LONG,450,1 ,$302.00 ,$151.00 ,$59.15 ,$535.20 ,$59.15 ,$195.36 ,$195.36 ,$237.87 ,$181.20 ,$256.70 ,$211.40 ,$59.15 ,$286.90 ,$229.52 ,$226.50 ,$196.30 ,$256.70 ,$237.87 ,$196.30 ,$196.30 ,$211.40 ,$59.15 ,$237.87 ,$237.87 ,$302.00 ,$256.70 ,$535.20 ,$277.84 ,$211.40 ,$153.17 ,$183.83 ,$183.92 ,$183.83 ,$208.68 ,$271.80 ,$210.34 ,$240.25 ,$238.58 ,$62.70 ,$302.00 ,$302.00 ,$237.87 ,$302.00 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$241.60 
ST NICHOLAS HOSPITAL - ACUTE,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,$302.00 ,$151.00 ,$59.15 ,$535.20 ,$59.15 ,$195.36 ,$195.36 ,$237.87 ,$181.20 ,$256.70 ,$211.40 ,$59.15 ,$286.90 ,$229.52 ,$226.50 ,$196.30 ,$256.70 ,$237.87 ,$196.30 ,$196.30 ,$211.40 ,$59.15 ,$237.87 ,$237.87 ,$302.00 ,$256.70 ,$535.20 ,$277.84 ,$211.40 ,$153.17 ,$183.83 ,$183.92 ,$183.83 ,$208.68 ,$271.80 ,$210.34 ,$240.25 ,$238.58 ,$62.70 ,$302.00 ,$302.00 ,$237.87 ,$302.00 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$241.60 
ST NICHOLAS HOSPITAL - ACUTE,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$420.00 ,$210.00 ,$13.65 ,$420.00 ,$13.65 ,$271.70 ,$271.70 ,$139.30 ,$252.00 ,$357.00 ,$294.00 ,$13.65 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$139.30 ,$273.00 ,$273.00 ,$294.00 ,$13.65 ,$139.30 ,$139.30 ,$420.00 ,$357.00 ,$313.43 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 ,$140.69 ,$331.80 ,$14.47 ,$420.00 ,$420.00 ,$139.30 ,$420.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$302.00 ,$151.00 ,$13.65 ,$302.00 ,$13.65 ,$195.36 ,$195.36 ,$111.18 ,$181.20 ,$256.70 ,$211.40 ,$13.65 ,$286.90 ,$229.52 ,$226.50 ,$196.30 ,$256.70 ,$111.18 ,$196.30 ,$196.30 ,$211.40 ,$13.65 ,$111.18 ,$111.18 ,$302.00 ,$256.70 ,$250.16 ,$277.84 ,$211.40 ,$153.17 ,$183.83 ,$183.92 ,$183.83 ,$208.68 ,$271.80 ,$210.34 ,$112.29 ,$238.58 ,$14.47 ,$302.00 ,$302.00 ,$111.18 ,$302.00 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$241.60 
ST NICHOLAS HOSPITAL - ACUTE,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$269.00 ,$134.50 ,$13.65 ,$269.00 ,$13.65 ,$174.02 ,$174.02 ,$111.18 ,$161.40 ,$228.65 ,$188.30 ,$13.65 ,$255.55 ,$204.44 ,$201.75 ,$174.85 ,$228.65 ,$111.18 ,$174.85 ,$174.85 ,$188.30 ,$13.65 ,$111.18 ,$111.18 ,$269.00 ,$228.65 ,$250.16 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$163.74 ,$185.88 ,$242.10 ,$187.36 ,$112.29 ,$212.51 ,$14.47 ,$269.00 ,$269.00 ,$111.18 ,$269.00 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$345.00 ,$172.50 ,$13.65 ,$345.00 ,$13.65 ,$223.18 ,$223.18 ,$111.18 ,$207.00 ,$293.25 ,$241.50 ,$13.65 ,$327.75 ,$262.20 ,$258.75 ,$224.25 ,$293.25 ,$111.18 ,$224.25 ,$224.25 ,$241.50 ,$13.65 ,$111.18 ,$111.18 ,$345.00 ,$293.25 ,$250.16 ,$317.40 ,$241.50 ,$174.98 ,$210.00 ,$210.11 ,$210.00 ,$238.40 ,$310.50 ,$240.29 ,$112.29 ,$272.55 ,$14.47 ,$345.00 ,$345.00 ,$111.18 ,$345.00 ,$248.40 ,$213.90 ,$248.40 ,$248.40 ,$276.00 
ST NICHOLAS HOSPITAL - ACUTE,45000104,29131,HC APPL FINGER SPLINT DYNAMIC,450,1 ,$269.00 ,$134.50 ,$13.65 ,$269.00 ,$13.65 ,$174.02 ,$174.02 ,$54.89 ,$161.40 ,$228.65 ,$188.30 ,$13.65 ,$255.55 ,$204.44 ,$201.75 ,$174.85 ,$228.65 ,$54.89 ,$174.85 ,$174.85 ,$188.30 ,$13.65 ,$54.89 ,$54.89 ,$269.00 ,$228.65 ,$123.49 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$163.74 ,$185.88 ,$242.10 ,$187.36 ,$55.44 ,$212.51 ,$14.47 ,$269.00 ,$269.00 ,$54.89 ,$269.00 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,45000105,29240,HC STRAPPING SHLDR,450,1 ,$269.00 ,$134.50 ,$13.65 ,$269.00 ,$13.65 ,$174.02 ,$174.02 ,$111.18 ,$161.40 ,$228.65 ,$188.30 ,$13.65 ,$255.55 ,$204.44 ,$201.75 ,$174.85 ,$228.65 ,$111.18 ,$174.85 ,$174.85 ,$188.30 ,$13.65 ,$111.18 ,$111.18 ,$269.00 ,$228.65 ,$250.16 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$163.74 ,$185.88 ,$242.10 ,$187.36 ,$112.29 ,$212.51 ,$14.47 ,$269.00 ,$269.00 ,$111.18 ,$269.00 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$420.00 ,$210.00 ,$59.15 ,$535.20 ,$59.15 ,$271.70 ,$271.70 ,$237.87 ,$252.00 ,$357.00 ,$294.00 ,$59.15 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$237.87 ,$273.00 ,$273.00 ,$294.00 ,$59.15 ,$237.87 ,$237.87 ,$420.00 ,$357.00 ,$535.20 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 ,$240.25 ,$331.80 ,$62.70 ,$420.00 ,$420.00 ,$237.87 ,$420.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$420.00 ,$210.00 ,$13.65 ,$420.00 ,$13.65 ,$271.70 ,$271.70 ,$139.30 ,$252.00 ,$357.00 ,$294.00 ,$13.65 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$139.30 ,$273.00 ,$273.00 ,$294.00 ,$13.65 ,$139.30 ,$139.30 ,$420.00 ,$357.00 ,$313.43 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 ,$140.69 ,$331.80 ,$14.47 ,$420.00 ,$420.00 ,$139.30 ,$420.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$420.00 ,$210.00 ,$13.65 ,$420.00 ,$13.65 ,$271.70 ,$271.70 ,$139.30 ,$252.00 ,$357.00 ,$294.00 ,$13.65 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$139.30 ,$273.00 ,$273.00 ,$294.00 ,$13.65 ,$139.30 ,$139.30 ,$420.00 ,$357.00 ,$313.43 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 ,$140.69 ,$331.80 ,$14.47 ,$420.00 ,$420.00 ,$139.30 ,$420.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,45000109,29705,HC REM/BIV CAST ARM/LEG,450,1 ,$474.00 ,$237.00 ,$59.15 ,$535.20 ,$59.15 ,$306.63 ,$306.63 ,$237.87 ,$284.40 ,$402.90 ,$331.80 ,$59.15 ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 ,$237.87 ,$308.10 ,$308.10 ,$331.80 ,$59.15 ,$237.87 ,$237.87 ,$474.00 ,$402.90 ,$535.20 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 ,$240.25 ,$374.46 ,$62.70 ,$474.00 ,$474.00 ,$237.87 ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,45000110,30300,HC REM FB INTRANASAL,450,1 ,$377.00 ,$188.50 ,$34.89 ,$377.00 ,$34.89 ,$243.88 ,$243.88 ,$111.18 ,$226.20 ,$320.45 ,$263.90 ,$34.89 ,$358.15 ,$286.52 ,$282.75 ,$245.05 ,$320.45 ,$111.18 ,$245.05 ,$245.05 ,$263.90 ,$34.89 ,$111.18 ,$111.18 ,$377.00 ,$320.45 ,$250.16 ,$346.84 ,$263.90 ,$191.21 ,$229.48 ,$229.59 ,$229.48 ,$260.51 ,$339.30 ,$262.58 ,$112.29 ,$297.83 ,$36.98 ,$377.00 ,$377.00 ,$111.18 ,$377.00 ,$271.44 ,$233.74 ,$271.44 ,$271.44 ,$301.60 
ST NICHOLAS HOSPITAL - ACUTE,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$388.00 ,$194.00 ,$34.89 ,$388.00 ,$34.89 ,$251.00 ,$251.00 ,$111.18 ,$232.80 ,$329.80 ,$271.60 ,$34.89 ,$368.60 ,$294.88 ,$291.00 ,$252.20 ,$329.80 ,$111.18 ,$252.20 ,$252.20 ,$271.60 ,$34.89 ,$111.18 ,$111.18 ,$388.00 ,$329.80 ,$250.16 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$112.29 ,$306.52 ,$36.98 ,$388.00 ,$388.00 ,$111.18 ,$388.00 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$474.00 ,$237.00 ,$34.89 ,$474.00 ,$34.89 ,$306.63 ,$306.63 ,$111.18 ,$284.40 ,$402.90 ,$331.80 ,$34.89 ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 ,$111.18 ,$308.10 ,$308.10 ,$331.80 ,$34.89 ,$111.18 ,$111.18 ,$474.00 ,$402.90 ,$250.16 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 ,$112.29 ,$374.46 ,$36.98 ,$474.00 ,$474.00 ,$111.18 ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$431.00 ,$215.50 ,$34.89 ,$431.00 ,$34.89 ,$278.81 ,$278.81 ,$111.18 ,$258.60 ,$366.35 ,$301.70 ,$34.89 ,$409.45 ,$327.56 ,$323.25 ,$280.15 ,$366.35 ,$111.18 ,$280.15 ,$280.15 ,$301.70 ,$34.89 ,$111.18 ,$111.18 ,$431.00 ,$366.35 ,$250.16 ,$396.52 ,$301.70 ,$218.60 ,$262.35 ,$262.48 ,$262.35 ,$297.82 ,$387.90 ,$300.19 ,$112.29 ,$340.49 ,$36.98 ,$431.00 ,$431.00 ,$111.18 ,$431.00 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$344.80 
ST NICHOLAS HOSPITAL - ACUTE,45000114,31238,HC NASAL ENDO W EPISTAX CONTROL,450,1 ,"$3,100.00 ","$1,550.00 ",$571.36 ,"$3,319.18 ",$611.34 ,"$2,005.39 ","$2,005.39 ","$1,475.19 ","$1,860.00 ","$2,635.00 ","$2,170.00 ",$611.34 ,"$2,945.00 ","$2,356.00 ","$2,325.00 ","$2,015.00 ","$2,635.00 ","$1,475.19 ","$2,015.00 ","$2,015.00 ","$2,170.00 ",$611.34 ,"$1,475.19 ","$1,475.19 ",$571.36 ,"$2,635.00 ","$3,319.18 ","$2,852.00 ","$2,170.00 ","$1,572.32 ","$1,886.97 ","$1,887.90 ","$1,886.97 ","$2,142.10 ","$2,790.00 ","$2,159.15 ","$1,489.94 ","$2,449.00 ",$648.02 ,$685.00 ,$685.00 ,"$1,475.19 ",$685.00 ,"$2,232.00 ","$1,922.00 ","$2,232.00 ","$2,232.00 ","$2,480.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000116,31720,HC ASP CATH NASOTRACHEAL,450,1 ,$248.00 ,$124.00 ,$16.35 ,$417.00 ,$16.35 ,$160.43 ,$160.43 ,$185.34 ,$148.80 ,$210.80 ,$173.60 ,$16.35 ,$235.60 ,$188.48 ,$186.00 ,$161.20 ,$210.80 ,$185.34 ,$161.20 ,$161.20 ,$173.60 ,$16.35 ,$185.34 ,$185.34 ,$248.00 ,$210.80 ,$417.00 ,$228.16 ,$173.60 ,$125.79 ,$150.96 ,$151.03 ,$150.96 ,$171.37 ,$223.20 ,$172.73 ,$187.19 ,$195.92 ,$17.33 ,$248.00 ,$248.00 ,$185.34 ,$248.00 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$198.40 
ST NICHOLAS HOSPITAL - ACUTE,45000123,36400,HC IV START < 3 YEARS OLD (MD),450,1 ,$172.00 ,$86.00 ,$0.73 ,$172.00 ,$0.73 ,$111.27 ,$111.27 , N/A ,$103.20 ,$146.20 ,$120.40 ,$0.73 ,$163.40 ,$130.72 ,$129.00 ,$111.80 ,$146.20 , N/A ,$111.80 ,$111.80 ,$120.40 ,$0.73 , N/A , N/A ,$172.00 ,$146.20 , N/A ,$158.24 ,$120.40 ,$87.24 ,$104.70 ,$104.75 ,$104.70 ,$118.85 ,$154.80 ,$119.80 , N/A ,$135.88 ,$0.77 ,$172.00 ,$172.00 , N/A ,$172.00 ,$123.84 ,$106.64 ,$123.84 ,$123.84 ,$137.60 
ST NICHOLAS HOSPITAL - ACUTE,45000124,36406,HC VENIPUNCTURE <3YR VEIN OTHR,450,1 ,$30.00 ,$15.00 ,$0.73 ,$30.00 ,$0.73 ,$19.41 ,$19.41 , N/A ,$18.00 ,$25.50 ,$21.00 ,$0.73 ,$28.50 ,$22.80 ,$22.50 ,$19.50 ,$25.50 , N/A ,$19.50 ,$19.50 ,$21.00 ,$0.73 , N/A , N/A ,$30.00 ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$18.26 ,$20.73 ,$27.00 ,$20.90 , N/A ,$23.70 ,$0.77 ,$30.00 ,$30.00 , N/A ,$30.00 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$582.00 ,$291.00 ,$75.55 ,$602.10 ,$75.55 ,$376.50 ,$376.50 ,$267.60 ,$349.20 ,$494.70 ,$407.40 ,$75.55 ,$552.90 ,$442.32 ,$436.50 ,$378.30 ,$494.70 ,$267.60 ,$378.30 ,$378.30 ,$407.40 ,$75.55 ,$267.60 ,$267.60 ,$571.36 ,$494.70 ,$602.10 ,$535.44 ,$407.40 ,$295.19 ,$354.26 ,$354.44 ,$354.26 ,$402.16 ,$523.80 ,$405.36 ,$270.28 ,$459.78 ,$80.08 ,$582.00 ,$582.00 ,$267.60 ,$582.00 ,$419.04 ,$360.84 ,$419.04 ,$419.04 ,$465.60 
ST NICHOLAS HOSPITAL - ACUTE,45000133,40650,HC RPR LIP FULL THICK VERMILN,450,1 ,"$1,077.00 ",$538.50 ,$288.55 ,"$1,077.00 ",$288.55 ,$696.71 ,$696.71 ,$445.94 ,$646.20 ,$915.45 ,$753.90 ,$288.55 ,"$1,023.15 ",$818.52 ,$807.75 ,$700.05 ,$915.45 ,$445.94 ,$700.05 ,$700.05 ,$753.90 ,$288.55 ,$445.94 ,$445.94 ,$571.36 ,$915.45 ,"$1,003.36 ",$990.84 ,$753.90 ,$546.25 ,$655.57 ,$655.89 ,$655.57 ,$744.21 ,$969.30 ,$750.13 ,$450.40 ,$850.83 ,$305.86 ,$685.00 ,$685.00 ,$445.94 ,$685.00 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$861.60 
ST NICHOLAS HOSPITAL - ACUTE,45000134,40652,HC RPR LIP UP 1/2 VERTICAL,450,1 ,"$1,077.00 ",$538.50 ,$288.55 ,"$1,077.00 ",$288.55 ,$696.71 ,$696.71 ,$445.94 ,$646.20 ,$915.45 ,$753.90 ,$288.55 ,"$1,023.15 ",$818.52 ,$807.75 ,$700.05 ,$915.45 ,$445.94 ,$700.05 ,$700.05 ,$753.90 ,$288.55 ,$445.94 ,$445.94 ,$571.36 ,$915.45 ,"$1,003.36 ",$990.84 ,$753.90 ,$546.25 ,$655.57 ,$655.89 ,$655.57 ,$744.21 ,$969.30 ,$750.13 ,$450.40 ,$850.83 ,$305.86 ,$685.00 ,$685.00 ,$445.94 ,$685.00 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$861.60 
ST NICHOLAS HOSPITAL - ACUTE,45000135,40654,HC RPR LIP CPLX,450,1 ,"$1,508.00 ",$754.00 ,$288.55 ,"$3,001.04 ",$288.55 ,$975.53 ,$975.53 ,"$1,333.79 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$288.55 ,"$1,432.60 ","$1,146.08 ","$1,131.00 ",$980.20 ,"$1,281.80 ","$1,333.79 ",$980.20 ,$980.20 ,"$1,055.60 ",$288.55 ,"$1,333.79 ","$1,333.79 ",$571.36 ,"$1,281.80 ","$3,001.04 ","$1,387.36 ","$1,055.60 ",$764.86 ,$917.92 ,$918.37 ,$917.92 ,"$1,042.03 ","$1,357.20 ","$1,050.32 ","$1,347.13 ","$1,191.32 ",$305.86 ,$685.00 ,$685.00 ,"$1,333.79 ",$685.00 ,"$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ","$1,206.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000136,40800,HC DRAINAGE MOUTH LESION,450,1 ,"$1,813.00 ",$906.50 ,$34.89 ,"$1,813.00 ",$34.89 ,"$1,172.83 ","$1,172.83 ",$613.58 ,"$1,087.80 ","$1,541.05 ","$1,269.10 ",$34.89 ,"$1,722.35 ","$1,377.88 ","$1,359.75 ","$1,178.45 ","$1,541.05 ",$613.58 ,"$1,178.45 ","$1,178.45 ","$1,269.10 ",$34.89 ,$613.58 ,$613.58 ,$571.36 ,"$1,541.05 ","$1,380.55 ","$1,667.96 ","$1,269.10 ",$919.55 ,"$1,103.57 ","$1,104.12 ","$1,103.57 ","$1,252.78 ","$1,631.70 ","$1,262.75 ",$619.72 ,"$1,432.27 ",$36.98 ,$685.00 ,$685.00 ,$613.58 ,$685.00 ,"$1,305.36 ","$1,124.06 ","$1,305.36 ","$1,305.36 ","$1,450.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000137,40830,HC LAC REPAIR VESTIBULE MOUTH 2.5 CM OR LESS,450,1 ,$636.00 ,$318.00 ,$34.89 ,$636.00 ,$34.89 ,$411.43 ,$411.43 ,$208.60 ,$381.60 ,$540.60 ,$445.20 ,$34.89 ,$604.20 ,$483.36 ,$477.00 ,$413.40 ,$540.60 ,$208.60 ,$413.40 ,$413.40 ,$445.20 ,$34.89 ,$208.60 ,$208.60 ,$571.36 ,$540.60 ,$469.36 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$387.13 ,$439.48 ,$572.40 ,$442.97 ,$210.69 ,$502.44 ,$36.98 ,$636.00 ,$636.00 ,$208.60 ,$636.00 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$508.80 
ST NICHOLAS HOSPITAL - ACUTE,45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$560.00 ,$280.00 ,$34.89 ,$602.10 ,$34.89 ,$362.26 ,$362.26 ,$267.60 ,$336.00 ,$476.00 ,$392.00 ,$34.89 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,$267.60 ,$364.00 ,$364.00 ,$392.00 ,$34.89 ,$267.60 ,$267.60 ,$560.00 ,$476.00 ,$602.10 ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$340.87 ,$386.96 ,$504.00 ,$390.04 ,$270.28 ,$442.40 ,$36.98 ,$560.00 ,$560.00 ,$267.60 ,$560.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$420.00 ,$210.00 ,$34.89 ,$420.00 ,$34.89 ,$271.70 ,$271.70 ,$111.18 ,$252.00 ,$357.00 ,$294.00 ,$34.89 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$111.18 ,$273.00 ,$273.00 ,$294.00 ,$34.89 ,$111.18 ,$111.18 ,$420.00 ,$357.00 ,$250.16 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$255.65 ,$290.22 ,$378.00 ,$292.53 ,$112.29 ,$331.80 ,$36.98 ,$420.00 ,$420.00 ,$111.18 ,$420.00 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,45000140,42700,HC I AND D ABSC PERITONSILLAR,450,1 ,$636.00 ,$318.00 ,$34.89 ,$636.00 ,$34.89 ,$411.43 ,$411.43 ,$208.60 ,$381.60 ,$540.60 ,$445.20 ,$34.89 ,$604.20 ,$483.36 ,$477.00 ,$413.40 ,$540.60 ,$208.60 ,$413.40 ,$413.40 ,$445.20 ,$34.89 ,$208.60 ,$208.60 ,$571.36 ,$540.60 ,$469.36 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$387.13 ,$439.48 ,$572.40 ,$442.97 ,$210.69 ,$502.44 ,$36.98 ,$636.00 ,$636.00 ,$208.60 ,$636.00 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$508.80 
ST NICHOLAS HOSPITAL - ACUTE,45000141,42809,HC REMOVE PHARYNX FOREIGN BODY,450,1 ,$215.00 ,$107.50 ,$34.89 ,$602.10 ,$34.89 ,$139.08 ,$139.08 ,$267.60 ,$129.00 ,$182.75 ,$150.50 ,$34.89 ,$204.25 ,$163.40 ,$161.25 ,$139.75 ,$182.75 ,$267.60 ,$139.75 ,$139.75 ,$150.50 ,$34.89 ,$267.60 ,$267.60 ,$215.00 ,$182.75 ,$602.10 ,$197.80 ,$150.50 ,$109.05 ,$130.87 ,$130.94 ,$130.87 ,$148.57 ,$193.50 ,$149.75 ,$270.28 ,$169.85 ,$36.98 ,$215.00 ,$215.00 ,$267.60 ,$215.00 ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$172.00 
ST NICHOLAS HOSPITAL - ACUTE,45000143,43753,HC GASTRIC LAVAGE,450,1 ,$636.00 ,$318.00 ,$211.20 ,$636.00 ,$211.20 ,$411.43 ,$411.43 ,$260.95 ,$381.60 ,$540.60 ,$445.20 ,$211.20 ,$604.20 ,$483.36 ,$477.00 ,$413.40 ,$540.60 ,$260.95 ,$413.40 ,$413.40 ,$445.20 ,$211.20 ,$260.95 ,$260.95 ,$571.36 ,$540.60 ,$587.13 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$387.13 ,$439.48 ,$572.40 ,$442.97 ,$263.56 ,$502.44 ,$223.87 ,$636.00 ,$636.00 ,$260.95 ,$636.00 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$508.80 
ST NICHOLAS HOSPITAL - ACUTE,45000146,46040,HC INCISION RECTAL ABSCESS,450,1 ,"$2,693.00 ","$1,346.50 ",$462.68 ,"$2,693.00 ",$462.68 ,"$1,742.10 ","$1,742.10 ","$1,022.46 ","$1,615.80 ","$2,289.05 ","$1,885.10 ",$462.68 ,"$2,558.35 ","$2,046.68 ","$2,019.75 ","$1,750.45 ","$2,289.05 ","$1,022.46 ","$1,750.45 ","$1,750.45 ","$1,885.10 ",$462.68 ,"$1,022.46 ","$1,022.46 ",$571.36 ,"$2,289.05 ","$2,300.53 ","$2,477.56 ","$1,885.10 ","$1,365.89 ","$1,639.23 ","$1,640.04 ","$1,639.23 ","$1,860.86 ","$2,423.70 ","$1,875.67 ","$1,032.68 ","$2,127.47 ",$490.44 ,$685.00 ,$685.00 ,"$1,022.46 ",$685.00 ,"$1,938.96 ","$1,669.66 ","$1,938.96 ","$1,938.96 ","$2,154.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$1,185.00 ",$592.50 ,$462.68 ,"$1,760.56 ",$462.68 ,$766.58 ,$766.58 ,$782.47 ,$711.00 ,"$1,007.25 ",$829.50 ,$462.68 ,"$1,125.75 ",$900.60 ,$888.75 ,$770.25 ,"$1,007.25 ",$782.47 ,$770.25 ,$770.25 ,$829.50 ,$462.68 ,$782.47 ,$782.47 ,$571.36 ,"$1,007.25 ","$1,760.56 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$721.31 ,$818.84 ,"$1,066.50 ",$825.35 ,$790.29 ,$936.15 ,$490.44 ,$685.00 ,$685.00 ,$782.47 ,$685.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$474.00 ,$237.00 ,$237.00 ,$590.35 ,$462.68 ,$306.63 ,$306.63 ,$262.38 ,$284.40 ,$402.90 ,$331.80 ,$462.68 ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 ,$262.38 ,$308.10 ,$308.10 ,$331.80 ,$462.68 ,$262.38 ,$262.38 ,$474.00 ,$402.90 ,$590.35 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 ,$265.00 ,$374.46 ,$490.44 ,$474.00 ,$474.00 ,$262.38 ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,45000149,46320,HC EXCISION THROMBOSED HEMORRHOID; EXTERNAL,450,1 ,"$2,370.00 ","$1,185.00 ",$462.68 ,"$2,370.00 ",$462.68 ,"$1,533.15 ","$1,533.15 ","$1,022.46 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$462.68 ,"$2,251.50 ","$1,801.20 ","$1,777.50 ","$1,540.50 ","$2,014.50 ","$1,022.46 ","$1,540.50 ","$1,540.50 ","$1,659.00 ",$462.68 ,"$1,022.46 ","$1,022.46 ",$571.36 ,"$2,014.50 ","$2,300.53 ","$2,180.40 ","$1,659.00 ","$1,202.06 ","$1,442.62 ","$1,443.33 ","$1,442.62 ","$1,637.67 ","$2,133.00 ","$1,650.71 ","$1,032.68 ","$1,872.30 ",$490.44 ,$685.00 ,$685.00 ,"$1,022.46 ",$685.00 ,"$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,896.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000150,46600,HC ANOSCOPY,450,1 ,$230.00 ,$115.00 ,$56.46 ,$250.16 ,$56.46 ,$148.79 ,$148.79 ,$111.18 ,$138.00 ,$195.50 ,$161.00 ,$56.46 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$111.18 ,$149.50 ,$149.50 ,$161.00 ,$56.46 ,$111.18 ,$111.18 ,$230.00 ,$195.50 ,$250.16 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$112.29 ,$181.70 ,$59.85 ,$230.00 ,$230.00 ,$111.18 ,$230.00 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,45000151,46608,HC ANOSCOPY W FB REMOVAL,450,1 ,"$2,200.00 ","$1,100.00 ",$304.93 ,"$2,200.00 ",$304.93 ,"$1,423.18 ","$1,423.18 ",$782.47 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$304.93 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$1,430.00 ","$1,870.00 ",$782.47 ,"$1,430.00 ","$1,430.00 ","$1,540.00 ",$304.93 ,$782.47 ,$782.47 ,$571.36 ,"$1,870.00 ","$1,760.56 ","$2,024.00 ","$1,540.00 ","$1,115.84 ","$1,339.14 ","$1,339.80 ","$1,339.14 ","$1,520.20 ","$1,980.00 ","$1,532.30 ",$790.29 ,"$1,738.00 ",$323.23 ,$685.00 ,$685.00 ,$782.47 ,$685.00 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$517.00 ,$258.50 ,$22.63 ,$590.35 ,$22.63 ,$334.45 ,$334.45 ,$262.38 ,$310.20 ,$439.45 ,$361.90 ,$22.63 ,$491.15 ,$392.92 ,$387.75 ,$336.05 ,$439.45 ,$262.38 ,$336.05 ,$336.05 ,$361.90 ,$22.63 ,$262.38 ,$262.38 ,$517.00 ,$439.45 ,$590.35 ,$475.64 ,$361.90 ,$262.22 ,$314.70 ,$314.85 ,$314.70 ,$357.25 ,$465.30 ,$360.09 ,$265.00 ,$408.43 ,$23.99 ,$517.00 ,$517.00 ,$262.38 ,$517.00 ,$372.24 ,$320.54 ,$372.24 ,$372.24 ,$413.60 
ST NICHOLAS HOSPITAL - ACUTE,45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,$593.00 ,$296.50 ,$62.73 ,$593.00 ,$62.73 ,$383.61 ,$383.61 ,$262.38 ,$355.80 ,$504.05 ,$415.10 ,$62.73 ,$563.35 ,$450.68 ,$444.75 ,$385.45 ,$504.05 ,$262.38 ,$385.45 ,$385.45 ,$415.10 ,$62.73 ,$262.38 ,$262.38 ,$571.36 ,$504.05 ,$590.35 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$360.96 ,$409.76 ,$533.70 ,$413.02 ,$265.00 ,$468.47 ,$66.49 ,$593.00 ,$593.00 ,$262.38 ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,$452.00 ,$226.00 ,$22.63 ,$590.35 ,$22.63 ,$292.40 ,$292.40 ,$262.38 ,$271.20 ,$384.20 ,$316.40 ,$22.63 ,$429.40 ,$343.52 ,$339.00 ,$293.80 ,$384.20 ,$262.38 ,$293.80 ,$293.80 ,$316.40 ,$22.63 ,$262.38 ,$262.38 ,$452.00 ,$384.20 ,$590.35 ,$415.84 ,$316.40 ,$229.25 ,$275.13 ,$275.27 ,$275.13 ,$312.33 ,$406.80 ,$314.82 ,$265.00 ,$357.08 ,$23.99 ,$452.00 ,$452.00 ,$262.38 ,$452.00 ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$361.60 
ST NICHOLAS HOSPITAL - ACUTE,45000160,54450,HC MANIP FORESKIN STRETCH,450,1 ,$776.00 ,$388.00 ,$119.36 ,$776.00 ,$119.36 ,$501.99 ,$501.99 ,$262.38 ,$465.60 ,$659.60 ,$543.20 ,$119.36 ,$737.20 ,$589.76 ,$582.00 ,$504.40 ,$659.60 ,$262.38 ,$504.40 ,$504.40 ,$543.20 ,$119.36 ,$262.38 ,$262.38 ,$571.36 ,$659.60 ,$590.35 ,$713.92 ,$543.20 ,$393.59 ,$472.35 ,$472.58 ,$472.35 ,$536.22 ,$698.40 ,$540.48 ,$265.00 ,$613.04 ,$126.52 ,$685.00 ,$685.00 ,$262.38 ,$685.00 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$620.80 
ST NICHOLAS HOSPITAL - ACUTE,45000161,54700,HC I AND D EPIDIDYMIS TESTIS OR SCROTAL SPACE,450,1 ,"$2,047.00 ","$1,023.50 ",$571.36 ,"$3,972.27 ",$646.68 ,"$1,324.20 ","$1,324.20 ","$1,765.45 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$646.68 ,"$1,944.65 ","$1,555.72 ","$1,535.25 ","$1,330.55 ","$1,739.95 ","$1,765.45 ","$1,330.55 ","$1,330.55 ","$1,432.90 ",$646.68 ,"$1,765.45 ","$1,765.45 ",$571.36 ,"$1,739.95 ","$3,972.27 ","$1,883.24 ","$1,432.90 ","$1,038.24 ","$1,246.01 ","$1,246.62 ","$1,246.01 ","$1,414.48 ","$1,842.30 ","$1,425.74 ","$1,783.10 ","$1,617.13 ",$685.48 ,$685.00 ,$685.00 ,"$1,765.45 ",$685.00 ,"$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,637.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000162,55100,HC DRAIN ABSC SCROTAL WALL,450,1 ,$937.00 ,$468.50 ,$468.50 ,"$3,121.49 ",$646.68 ,$606.15 ,$606.15 ,"$1,387.33 ",$562.20 ,$796.45 ,$655.90 ,$646.68 ,$890.15 ,$712.12 ,$702.75 ,$609.05 ,$796.45 ,"$1,387.33 ",$609.05 ,$609.05 ,$655.90 ,$646.68 ,"$1,387.33 ","$1,387.33 ",$571.36 ,$796.45 ,"$3,121.49 ",$862.04 ,$655.90 ,$475.25 ,$570.35 ,$570.63 ,$570.35 ,$647.47 ,$843.30 ,$652.62 ,"$1,401.20 ",$740.23 ,$685.48 ,$685.00 ,$685.00 ,"$1,387.33 ",$685.00 ,$674.64 ,$580.94 ,$674.64 ,$674.64 ,$749.60 
ST NICHOLAS HOSPITAL - ACUTE,45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$593.00 ,$296.50 ,$61.96 ,$625.69 ,$61.96 ,$383.61 ,$383.61 ,$278.09 ,$355.80 ,$504.05 ,$415.10 ,$61.96 ,$563.35 ,$450.68 ,$444.75 ,$385.45 ,$504.05 ,$278.09 ,$385.45 ,$385.45 ,$415.10 ,$61.96 ,$278.09 ,$278.09 ,$571.36 ,$504.05 ,$625.69 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$360.96 ,$409.76 ,$533.70 ,$413.02 ,$280.87 ,$468.47 ,$65.68 ,$593.00 ,$593.00 ,$278.09 ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$506.00 ,$253.00 ,$61.96 ,$506.00 ,$61.96 ,$327.33 ,$327.33 ,$167.98 ,$303.60 ,$430.10 ,$354.20 ,$61.96 ,$480.70 ,$384.56 ,$379.50 ,$328.90 ,$430.10 ,$167.98 ,$328.90 ,$328.90 ,$354.20 ,$61.96 ,$167.98 ,$167.98 ,$506.00 ,$430.10 ,$377.95 ,$465.52 ,$354.20 ,$256.64 ,$308.00 ,$308.15 ,$308.00 ,$349.65 ,$455.40 ,$352.43 ,$169.66 ,$399.74 ,$65.68 ,$506.00 ,$506.00 ,$167.98 ,$506.00 ,$364.32 ,$313.72 ,$364.32 ,$364.32 ,$404.80 
ST NICHOLAS HOSPITAL - ACUTE,45000165,58301,HC REM DVC INTRAUTERINE,450,1 ,$226.00 ,$113.00 ,$61.96 ,$625.69 ,$61.96 ,$146.20 ,$146.20 ,$278.09 ,$135.60 ,$192.10 ,$158.20 ,$61.96 ,$214.70 ,$171.76 ,$169.50 ,$146.90 ,$192.10 ,$278.09 ,$146.90 ,$146.90 ,$158.20 ,$61.96 ,$278.09 ,$278.09 ,$226.00 ,$192.10 ,$625.69 ,$207.92 ,$158.20 ,$114.63 ,$137.57 ,$137.63 ,$137.57 ,$156.17 ,$203.40 ,$157.41 ,$280.87 ,$178.54 ,$65.68 ,$226.00 ,$226.00 ,$278.09 ,$226.00 ,$162.72 ,$140.12 ,$162.72 ,$162.72 ,$180.80 
ST NICHOLAS HOSPITAL - ACUTE,45000166,59414,HC DELIVERY OF PLACENTA,450,1 ,"$3,447.00 ","$1,723.50 ",$571.36 ,"$5,820.65 ",$595.75 ,"$2,229.86 ","$2,229.86 ","$2,586.95 ","$2,068.20 ","$2,929.95 ","$2,412.90 ",$595.75 ,"$3,274.65 ","$2,619.72 ","$2,585.25 ","$2,240.55 ","$2,929.95 ","$2,586.95 ","$2,240.55 ","$2,240.55 ","$2,412.90 ",$595.75 ,"$2,586.95 ","$2,586.95 ",$571.36 ,"$2,929.95 ","$5,820.65 ","$3,171.24 ","$2,412.90 ","$1,748.32 ","$2,098.19 ","$2,099.22 ","$2,098.19 ","$2,381.88 ","$3,102.30 ","$2,400.84 ","$2,612.82 ","$2,723.13 ",$631.50 ,$685.00 ,$685.00 ,"$2,586.95 ",$685.00 ,"$2,481.84 ","$2,137.14 ","$2,481.84 ","$2,481.84 ","$2,757.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000168,64400,HC DENTAL BLOCK,450,1 ,$765.00 ,$382.50 ,$136.73 ,$765.00 ,$136.73 ,$494.88 ,$494.88 ,$257.61 ,$459.00 ,$650.25 ,$535.50 ,$136.73 ,$726.75 ,$581.40 ,$573.75 ,$497.25 ,$650.25 ,$257.61 ,$497.25 ,$497.25 ,$535.50 ,$136.73 ,$257.61 ,$257.61 ,$571.36 ,$650.25 ,$579.62 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$465.66 ,$528.62 ,$688.50 ,$532.82 ,$260.19 ,$604.35 ,$144.93 ,$685.00 ,$685.00 ,$257.61 ,$685.00 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$612.00 
ST NICHOLAS HOSPITAL - ACUTE,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$380.00 ,$190.00 ,$136.73 ,$579.62 ,$136.73 ,$245.82 ,$245.82 ,$257.61 ,$228.00 ,$323.00 ,$266.00 ,$136.73 ,$361.00 ,$288.80 ,$285.00 ,$247.00 ,$323.00 ,$257.61 ,$247.00 ,$247.00 ,$266.00 ,$136.73 ,$257.61 ,$257.61 ,$380.00 ,$323.00 ,$579.62 ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$231.31 ,$262.58 ,$342.00 ,$264.67 ,$260.19 ,$300.20 ,$144.93 ,$380.00 ,$380.00 ,$257.61 ,$380.00 ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$304.00 
ST NICHOLAS HOSPITAL - ACUTE,45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,$830.00 ,$415.00 ,$136.73 ,"$1,408.74 ",$136.73 ,$536.93 ,$536.93 ,$626.11 ,$498.00 ,$705.50 ,$581.00 ,$136.73 ,$788.50 ,$630.80 ,$622.50 ,$539.50 ,$705.50 ,$626.11 ,$539.50 ,$539.50 ,$581.00 ,$136.73 ,$626.11 ,$626.11 ,$571.36 ,$705.50 ,"$1,408.74 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$505.22 ,$573.53 ,$747.00 ,$578.10 ,$632.37 ,$655.70 ,$144.93 ,$685.00 ,$685.00 ,$626.11 ,$685.00 ,$597.60 ,$514.60 ,$597.60 ,$597.60 ,$664.00 
ST NICHOLAS HOSPITAL - ACUTE,45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$381.00 ,$190.50 ,$22.85 ,$381.00 ,$22.85 ,$246.47 ,$246.47 ,$111.18 ,$228.60 ,$323.85 ,$266.70 ,$22.85 ,$361.95 ,$289.56 ,$285.75 ,$247.65 ,$323.85 ,$111.18 ,$247.65 ,$247.65 ,$266.70 ,$22.85 ,$111.18 ,$111.18 ,$381.00 ,$323.85 ,$250.16 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$231.91 ,$263.27 ,$342.90 ,$265.37 ,$112.29 ,$300.99 ,$24.22 ,$381.00 ,$381.00 ,$111.18 ,$381.00 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,45000172,65210,HC REM EYE FB CONJUCT EMBED,450,1 ,$381.00 ,$190.50 ,$22.85 ,$602.10 ,$22.85 ,$246.47 ,$246.47 ,$267.60 ,$228.60 ,$323.85 ,$266.70 ,$22.85 ,$361.95 ,$289.56 ,$285.75 ,$247.65 ,$323.85 ,$267.60 ,$247.65 ,$247.65 ,$266.70 ,$22.85 ,$267.60 ,$267.60 ,$381.00 ,$323.85 ,$602.10 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$231.91 ,$263.27 ,$342.90 ,$265.37 ,$270.28 ,$300.99 ,$24.22 ,$381.00 ,$381.00 ,$267.60 ,$381.00 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$381.00 ,$190.50 ,$22.85 ,$602.10 ,$22.85 ,$246.47 ,$246.47 ,$267.60 ,$228.60 ,$323.85 ,$266.70 ,$22.85 ,$361.95 ,$289.56 ,$285.75 ,$247.65 ,$323.85 ,$267.60 ,$247.65 ,$247.65 ,$266.70 ,$22.85 ,$267.60 ,$267.60 ,$381.00 ,$323.85 ,$602.10 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$231.91 ,$263.27 ,$342.90 ,$265.37 ,$270.28 ,$300.99 ,$24.22 ,$381.00 ,$381.00 ,$267.60 ,$381.00 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,45000174,65222,HC REM FB CORNL W/ SLIT LA,450,1 ,$403.00 ,$201.50 ,$22.85 ,$403.00 ,$22.85 ,$260.70 ,$260.70 ,$111.18 ,$241.80 ,$342.55 ,$282.10 ,$22.85 ,$382.85 ,$306.28 ,$302.25 ,$261.95 ,$342.55 ,$111.18 ,$261.95 ,$261.95 ,$282.10 ,$22.85 ,$111.18 ,$111.18 ,$403.00 ,$342.55 ,$250.16 ,$370.76 ,$282.10 ,$204.40 ,$245.31 ,$245.43 ,$245.31 ,$278.47 ,$362.70 ,$280.69 ,$112.29 ,$318.37 ,$24.22 ,$403.00 ,$403.00 ,$111.18 ,$403.00 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$322.40 
ST NICHOLAS HOSPITAL - ACUTE,45000175,65235,HC REMOVE FB EYE; INTRAOCULAR ANTERIOR CHAMBER,450,1 ,"$2,128.00 ","$1,064.00 ",$288.75 ,"$4,607.02 ",$288.75 ,"$1,376.60 ","$1,376.60 ","$2,047.56 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$288.75 ,"$2,021.60 ","$1,617.28 ","$1,596.00 ","$1,383.20 ","$1,808.80 ","$2,047.56 ","$1,383.20 ","$1,383.20 ","$1,489.60 ",$288.75 ,"$2,047.56 ","$2,047.56 ",$571.36 ,"$1,808.80 ","$4,607.02 ","$1,957.76 ","$1,489.60 ","$1,079.32 ","$1,295.31 ","$1,295.95 ","$1,295.31 ","$1,470.45 ","$1,915.20 ","$1,482.15 ","$2,068.04 ","$1,681.12 ",$306.08 ,$685.00 ,$685.00 ,"$2,047.56 ",$685.00 ,"$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,702.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000176,65260,HC REMOVE FB EYE; INTRAOCULAR POSTERIOR SEGMENT,450,1 ,$974.00 ,$487.00 ,$340.28 ,"$4,607.02 ",$340.28 ,$630.08 ,$630.08 ,"$2,047.56 ",$584.40 ,$827.90 ,$681.80 ,$340.28 ,$925.30 ,$740.24 ,$730.50 ,$633.10 ,$827.90 ,"$2,047.56 ",$633.10 ,$633.10 ,$681.80 ,$340.28 ,"$2,047.56 ","$2,047.56 ",$571.36 ,$827.90 ,"$4,607.02 ",$896.08 ,$681.80 ,$494.01 ,$592.87 ,$593.17 ,$592.87 ,$673.03 ,$876.60 ,$678.39 ,"$2,068.04 ",$769.46 ,$360.70 ,$685.00 ,$685.00 ,"$2,047.56 ",$685.00 ,$701.28 ,$603.88 ,$701.28 ,$701.28 ,$779.20 
ST NICHOLAS HOSPITAL - ACUTE,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$560.00 ,$280.00 ,$98.99 ,$580.34 ,$98.99 ,$362.26 ,$362.26 ,$257.93 ,$336.00 ,$476.00 ,$392.00 ,$98.99 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,$257.93 ,$364.00 ,$364.00 ,$392.00 ,$98.99 ,$257.93 ,$257.93 ,$560.00 ,$476.00 ,$580.34 ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$340.87 ,$386.96 ,$504.00 ,$390.04 ,$260.51 ,$442.40 ,$104.93 ,$560.00 ,$560.00 ,$257.93 ,$560.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,$526.00 ,$263.00 ,$98.99 ,$580.34 ,$98.99 ,$340.27 ,$340.27 ,$257.93 ,$315.60 ,$447.10 ,$368.20 ,$98.99 ,$499.70 ,$399.76 ,$394.50 ,$341.90 ,$447.10 ,$257.93 ,$341.90 ,$341.90 ,$368.20 ,$98.99 ,$257.93 ,$257.93 ,$526.00 ,$447.10 ,$580.34 ,$483.92 ,$368.20 ,$266.79 ,$320.18 ,$320.33 ,$320.18 ,$363.47 ,$473.40 ,$366.36 ,$260.51 ,$415.54 ,$104.93 ,$526.00 ,$526.00 ,$257.93 ,$526.00 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$420.80 
ST NICHOLAS HOSPITAL - ACUTE,45000179,69000,HC DRAIN ABSC/HEMA EAR EXT SMP,450,1 ,$496.00 ,$248.00 ,$34.89 ,"$1,380.55 ",$34.89 ,$320.86 ,$320.86 ,$613.58 ,$297.60 ,$421.60 ,$347.20 ,$34.89 ,$471.20 ,$376.96 ,$372.00 ,$322.40 ,$421.60 ,$613.58 ,$322.40 ,$322.40 ,$347.20 ,$34.89 ,$613.58 ,$613.58 ,$496.00 ,$421.60 ,"$1,380.55 ",$456.32 ,$347.20 ,$251.57 ,$301.92 ,$302.06 ,$301.92 ,$342.74 ,$446.40 ,$345.46 ,$619.72 ,$391.84 ,$36.98 ,$496.00 ,$496.00 ,$613.58 ,$496.00 ,$357.12 ,$307.52 ,$357.12 ,$357.12 ,$396.80 
ST NICHOLAS HOSPITAL - ACUTE,45000180,69005,HC I AND D ABSCESS EXTERNAL EAR CMPLX,450,1 ,"$1,454.00 ",$727.00 ,$288.55 ,"$3,121.49 ",$288.55 ,$940.59 ,$940.59 ,"$1,387.33 ",$872.40 ,"$1,235.90 ","$1,017.80 ",$288.55 ,"$1,381.30 ","$1,105.04 ","$1,090.50 ",$945.10 ,"$1,235.90 ","$1,387.33 ",$945.10 ,$945.10 ,"$1,017.80 ",$288.55 ,"$1,387.33 ","$1,387.33 ",$571.36 ,"$1,235.90 ","$3,121.49 ","$1,337.68 ","$1,017.80 ",$737.47 ,$885.05 ,$885.49 ,$885.05 ,"$1,004.71 ","$1,308.60 ","$1,012.71 ","$1,401.20 ","$1,148.66 ",$305.86 ,$685.00 ,$685.00 ,"$1,387.33 ",$685.00 ,"$1,046.88 ",$901.48 ,"$1,046.88 ","$1,046.88 ","$1,163.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000181,69200,HC FB REMOVAL EAR,450,1 ,$215.00 ,$107.50 ,$34.89 ,$250.16 ,$34.89 ,$139.08 ,$139.08 ,$111.18 ,$129.00 ,$182.75 ,$150.50 ,$34.89 ,$204.25 ,$163.40 ,$161.25 ,$139.75 ,$182.75 ,$111.18 ,$139.75 ,$139.75 ,$150.50 ,$34.89 ,$111.18 ,$111.18 ,$215.00 ,$182.75 ,$250.16 ,$197.80 ,$150.50 ,$109.05 ,$130.87 ,$130.94 ,$130.87 ,$148.57 ,$193.50 ,$149.75 ,$112.29 ,$169.85 ,$36.98 ,$215.00 ,$215.00 ,$111.18 ,$215.00 ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$172.00 
ST NICHOLAS HOSPITAL - ACUTE,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$108.00 ,$54.00 ,$34.89 ,$123.49 ,$34.89 ,$69.87 ,$69.87 ,$54.89 ,$64.80 ,$91.80 ,$75.60 ,$34.89 ,$102.60 ,$82.08 ,$81.00 ,$70.20 ,$91.80 ,$54.89 ,$70.20 ,$70.20 ,$75.60 ,$34.89 ,$54.89 ,$54.89 ,$108.00 ,$91.80 ,$123.49 ,$99.36 ,$75.60 ,$54.78 ,$65.74 ,$65.77 ,$65.74 ,$74.63 ,$97.20 ,$75.22 ,$55.44 ,$85.32 ,$36.98 ,$108.00 ,$108.00 ,$54.89 ,$108.00 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,45000185,92511,HC NASOPHARYNGOSCOPY,450,1 ,$310.00 ,$155.00 ,$34.89 ,$365.20 ,$34.89 ,$200.54 ,$200.54 ,$162.31 ,$186.00 ,$263.50 ,$217.00 ,$34.89 ,$294.50 ,$235.60 ,$232.50 ,$201.50 ,$263.50 ,$162.31 ,$201.50 ,$201.50 ,$217.00 ,$34.89 ,$162.31 ,$162.31 ,$310.00 ,$263.50 ,$365.20 ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$188.70 ,$214.21 ,$279.00 ,$215.92 ,$163.93 ,$244.90 ,$36.98 ,$310.00 ,$310.00 ,$162.31 ,$310.00 ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$248.00 
ST NICHOLAS HOSPITAL - ACUTE,45000186,92953,HC TEMPORARY EXTERNAL PACING,450,1 ,"$1,185.00 ",$592.50 ,$202.92 ,"$1,246.28 ",$202.92 ,$766.58 ,$766.58 ,$553.90 ,$711.00 ,"$1,007.25 ",$829.50 ,$202.92 ,"$1,125.75 ",$900.60 ,$888.75 ,$770.25 ,"$1,007.25 ",$553.90 ,$770.25 ,$770.25 ,$829.50 ,$202.92 ,$553.90 ,$553.90 ,$571.36 ,"$1,007.25 ","$1,246.28 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$721.31 ,$818.84 ,"$1,066.50 ",$825.35 ,$559.44 ,$936.15 ,$215.10 ,$685.00 ,$685.00 ,$553.90 ,$685.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,45000187,92977,HC THROMBOLYSIS CORONARY IV INFS,450,1 ,$863.00 ,$431.50 ,$161.07 ,$863.00 ,$161.07 ,$558.27 ,$558.27 ,$314.39 ,$517.80 ,$733.55 ,$604.10 ,$161.07 ,$819.85 ,$655.88 ,$647.25 ,$560.95 ,$733.55 ,$314.39 ,$560.95 ,$560.95 ,$604.10 ,$161.07 ,$314.39 ,$314.39 ,$571.36 ,$733.55 ,$707.37 ,$793.96 ,$604.10 ,$437.71 ,$525.31 ,$525.57 ,$525.31 ,$596.33 ,$776.70 ,$601.08 ,$317.53 ,$681.77 ,$170.73 ,$685.00 ,$685.00 ,$314.39 ,$685.00 ,$621.36 ,$535.06 ,$621.36 ,$621.36 ,$690.40 
ST NICHOLAS HOSPITAL - ACUTE,45000188,99281,HC ER LEVEL 1,450,1 ,$170.00 ,$85.00 ,$38.23 ,$170.00 ,$38.23 ,$170.00 ,$170.00 ,$71.52 ,$102.00 ,$144.50 ,$119.00 ,$38.23 ,$161.50 ,$129.20 ,$127.50 ,$170.00 ,$144.50 ,$71.52 ,$170.00 ,$170.00 ,$119.00 ,$38.23 ,$71.52 ,$71.52 ,$170.00 ,$144.50 ,$160.92 ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$103.48 ,$117.47 ,$153.00 ,$118.41 ,$72.24 ,$134.30 ,$40.52 ,$170.00 ,$170.00 ,$71.52 ,$170.00 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,45000189,99282,HC ER LEVEL 2,450,1 ,$340.00 ,$170.00 ,$38.23 ,$340.00 ,$38.23 ,$340.00 ,$340.00 ,$129.51 ,$204.00 ,$289.00 ,$238.00 ,$38.23 ,$323.00 ,$258.40 ,$255.00 ,$340.00 ,$289.00 ,$129.51 ,$340.00 ,$340.00 ,$238.00 ,$38.23 ,$129.51 ,$129.51 ,$340.00 ,$289.00 ,$291.41 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 ,$130.81 ,$268.60 ,$40.52 ,$340.00 ,$340.00 ,$129.51 ,$340.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,45000190,99283,HC ER LEVEL 3,450,1 ,"$1,200.00 ",$600.00 ,$38.23 ,"$1,200.00 ",$38.23 ,"$1,114.00 ",$988.00 ,$228.18 ,$720.00 ,"$1,020.00 ",$840.00 ,$38.23 ,"$1,140.00 ",$912.00 ,$900.00 ,"$1,200.00 ","$1,020.00 ",$228.18 ,"$1,200.00 ","$1,200.00 ",$840.00 ,$38.23 ,$228.18 ,$228.18 ,"$1,074.84 ","$1,020.00 ",$513.41 ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$730.44 ,$829.20 ,"$1,080.00 ",$835.80 ,$230.46 ,$948.00 ,$40.52 ,"$1,200.00 ","$1,200.00 ",$228.18 ,"$1,200.00 ",$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,45000191,99284,HC ER LEVEL 4,450,1 ,"$1,800.00 ",$900.00 ,$38.23 ,"$1,800.00 ",$38.23 ,"$1,800.00 ","$1,800.00 ",$358.68 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$38.23 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,800.00 ","$1,530.00 ",$358.68 ,"$1,800.00 ","$1,800.00 ","$1,260.00 ",$38.23 ,$358.68 ,$358.68 ,"$1,800.00 ","$1,530.00 ",$807.03 ,"$1,656.00 ","$1,260.00 ",$912.96 ,"$1,095.66 ","$1,096.20 ","$1,095.66 ","$1,243.80 ","$1,620.00 ","$1,253.70 ",$362.27 ,"$1,422.00 ",$40.52 ,"$1,800.00 ","$1,800.00 ",$358.68 ,"$1,800.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000192,99285,HC ER LEVEL 5,450,1 ,"$2,400.00 ","$1,200.00 ",$38.23 ,"$2,400.00 ",$38.23 ,"$2,400.00 ","$2,400.00 ",$514.84 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$38.23 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$2,400.00 ","$2,040.00 ",$514.84 ,"$2,400.00 ","$2,400.00 ","$1,680.00 ",$38.23 ,$514.84 ,$514.84 ,"$2,375.96 ","$2,040.00 ","$1,158.39 ","$2,208.00 ","$1,680.00 ","$1,217.28 ","$1,460.88 ","$1,461.60 ","$1,460.88 ","$1,658.40 ","$2,160.00 ","$1,671.60 ",$519.99 ,"$1,896.00 ",$40.52 ,"$2,400.00 ","$2,400.00 ",$514.84 ,"$2,400.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$2,900.00 ","$1,450.00 ",$38.23 ,"$2,900.00 ",$38.23 ,"$2,900.00 ","$2,900.00 ",$734.45 ,"$1,740.00 ","$2,465.00 ","$2,030.00 ",$38.23 ,"$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ",$734.45 ,"$2,900.00 ","$1,885.00 ","$2,030.00 ",$38.23 ,$734.45 ,$734.45 ,"$2,900.00 ","$2,465.00 ","$1,652.51 ","$2,668.00 ","$2,030.00 ","$1,470.88 ","$1,765.23 ","$1,766.10 ","$1,765.23 ","$2,003.90 ","$2,610.00 ","$2,019.85 ",$741.79 ,"$2,291.00 ",$40.52 ,"$2,900.00 ","$2,900.00 ",$734.45 ,"$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000194,99285,HC ER LEVEL 5 SANE,450,1 ,"$2,400.00 ","$1,200.00 ",$38.23 ,"$2,400.00 ",$38.23 ,"$2,400.00 ","$2,400.00 ",$514.84 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$38.23 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$2,400.00 ","$2,040.00 ",$514.84 ,"$2,400.00 ","$2,400.00 ","$1,680.00 ",$38.23 ,$514.84 ,$514.84 ,"$2,375.96 ","$2,040.00 ","$1,158.39 ","$2,208.00 ","$1,680.00 ","$1,217.28 ","$1,460.88 ","$1,461.60 ","$1,460.88 ","$1,658.40 ","$2,160.00 ","$1,671.60 ",$519.99 ,"$1,896.00 ",$40.52 ,"$2,400.00 ","$2,400.00 ",$514.84 ,"$2,400.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$510.00 ,$255.00 ,$38.23 ,$510.00 ,$38.23 ,$329.92 ,$329.92 , N/A ,$306.00 ,$433.50 ,$357.00 ,$38.23 ,$484.50 ,$387.60 ,$382.50 ,$331.50 ,$433.50 , N/A ,$331.50 ,$331.50 ,$357.00 ,$38.23 , N/A , N/A ,$510.00 ,$433.50 , N/A ,$469.20 ,$357.00 ,$258.67 ,$310.44 ,$310.59 ,$310.44 ,$352.41 ,$459.00 ,$355.22 , N/A ,$402.90 ,$40.52 ,$510.00 ,$510.00 , N/A ,$510.00 ,$367.20 ,$316.20 ,$367.20 ,$367.20 ,$408.00 
ST NICHOLAS HOSPITAL - ACUTE,45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,$830.00 ,$415.00 ,$139.53 ,"$3,090.03 ",$139.53 ,$536.93 ,$536.93 ,"$1,373.35 ",$498.00 ,$705.50 ,$581.00 ,$139.53 ,$788.50 ,$630.80 ,$622.50 ,$539.50 ,$705.50 ,"$1,373.35 ",$539.50 ,$539.50 ,$581.00 ,$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,$705.50 ,"$3,090.03 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$505.22 ,$573.53 ,$747.00 ,$578.10 ,"$1,387.08 ",$655.70 ,$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,$597.60 ,$514.60 ,$597.60 ,$597.60 ,$664.00 
ST NICHOLAS HOSPITAL - ACUTE,45000197,26700,HC TX DISL (M-P) W/O ANES CLS,450,1 ,$765.00 ,$382.50 ,$139.53 ,$765.00 ,$139.53 ,$494.88 ,$494.88 ,$203.23 ,$459.00 ,$650.25 ,$535.50 ,$139.53 ,$726.75 ,$581.40 ,$573.75 ,$497.25 ,$650.25 ,$203.23 ,$497.25 ,$497.25 ,$535.50 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$650.25 ,$457.26 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$465.66 ,$528.62 ,$688.50 ,$532.82 ,$205.26 ,$604.35 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$612.00 
ST NICHOLAS HOSPITAL - ACUTE,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$463.00 ,$231.50 ,$34.89 ,$463.00 ,$34.89 ,$299.51 ,$299.51 ,$203.23 ,$277.80 ,$393.55 ,$324.10 ,$34.89 ,$439.85 ,$351.88 ,$347.25 ,$300.95 ,$393.55 ,$203.23 ,$300.95 ,$300.95 ,$324.10 ,$34.89 ,$203.23 ,$203.23 ,$463.00 ,$393.55 ,$457.26 ,$425.96 ,$324.10 ,$234.83 ,$281.83 ,$281.97 ,$281.83 ,$319.93 ,$416.70 ,$322.48 ,$205.26 ,$365.77 ,$36.98 ,$463.00 ,$463.00 ,$203.23 ,$463.00 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$370.40 
ST NICHOLAS HOSPITAL - ACUTE,45000199,35207,HC RPR VESSEL HAND/FINGER,450,1 ,"$3,638.00 ","$1,819.00 ",$571.36 ,"$6,350.83 ",$681.85 ,"$2,353.42 ","$2,353.42 ","$2,822.59 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$681.85 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$2,364.70 ","$3,092.30 ","$2,822.59 ","$2,364.70 ","$2,364.70 ","$2,546.60 ",$681.85 ,"$2,822.59 ","$2,822.59 ",$571.36 ,"$3,092.30 ","$6,350.83 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,533.87 ","$2,850.82 ","$2,874.02 ",$722.76 ,$685.00 ,$685.00 ,"$2,822.59 ",$685.00 ,"$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000200,35206,HC RPR VESSEL EXTREM UPR,450,1 ,"$3,638.00 ","$1,819.00 ",$571.36 ,"$6,350.83 ",$681.85 ,"$2,353.42 ","$2,353.42 ","$2,822.59 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$681.85 ,"$3,456.10 ","$2,764.88 ","$2,728.50 ","$2,364.70 ","$3,092.30 ","$2,822.59 ","$2,364.70 ","$2,364.70 ","$2,546.60 ",$681.85 ,"$2,822.59 ","$2,822.59 ",$571.36 ,"$3,092.30 ","$6,350.83 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,533.87 ","$2,850.82 ","$2,874.02 ",$722.76 ,$685.00 ,$685.00 ,"$2,822.59 ",$685.00 ,"$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,45000202,26645,HC CL TX CARPOMETACARPAL FRAC DISLOC THUMB,450,1 ,$733.00 ,$366.50 ,$139.53 ,"$3,090.03 ",$139.53 ,$474.18 ,$474.18 ,"$1,373.35 ",$439.80 ,$623.05 ,$513.10 ,$139.53 ,$696.35 ,$557.08 ,$549.75 ,$476.45 ,$623.05 ,"$1,373.35 ",$476.45 ,$476.45 ,$513.10 ,$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,$623.05 ,"$3,090.03 ",$674.36 ,$513.10 ,$371.78 ,$446.18 ,$446.40 ,$446.18 ,$506.50 ,$659.70 ,$510.53 ,"$1,387.08 ",$579.07 ,$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,$527.76 ,$454.46 ,$527.76 ,$527.76 ,$586.40 
ST NICHOLAS HOSPITAL - ACUTE,45000203,27840,HC TX DISL ANKE W/O ANES CLS,450,1 ,$593.00 ,$296.50 ,$139.53 ,$593.00 ,$139.53 ,$383.61 ,$383.61 ,$203.23 ,$355.80 ,$504.05 ,$415.10 ,$139.53 ,$563.35 ,$450.68 ,$444.75 ,$385.45 ,$504.05 ,$203.23 ,$385.45 ,$385.45 ,$415.10 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$504.05 ,$457.26 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$360.96 ,$409.76 ,$533.70 ,$413.02 ,$205.26 ,$468.47 ,$147.90 ,$593.00 ,$593.00 ,$203.23 ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,"$1,400.00 ",$700.00 ,$547.96 ,"$3,121.49 ",$547.96 ,$905.66 ,$905.66 ,"$1,387.33 ",$840.00 ,"$1,190.00 ",$980.00 ,$547.96 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$910.00 ,"$1,190.00 ","$1,387.33 ",$910.00 ,$910.00 ,$980.00 ,$547.96 ,"$1,387.33 ","$1,387.33 ",$571.36 ,"$1,190.00 ","$3,121.49 ","$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$852.18 ,$967.40 ,"$1,260.00 ",$975.10 ,"$1,401.20 ","$1,106.00 ",$580.84 ,$685.00 ,$685.00 ,"$1,387.33 ",$685.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000205,31605,HC TRACHEOSTOMY,450,1 ,"$1,300.00 ",$650.00 ,$208.60 ,"$1,300.00 ",$647.13 ,$840.97 ,$840.97 ,$208.60 ,$780.00 ,"$1,105.00 ",$910.00 ,$647.13 ,"$1,235.00 ",$988.00 ,$975.00 ,$845.00 ,"$1,105.00 ",$208.60 ,$845.00 ,$845.00 ,$910.00 ,$647.13 ,$208.60 ,$208.60 ,$571.36 ,"$1,105.00 ",$469.36 ,"$1,196.00 ",$910.00 ,$659.36 ,$791.31 ,$791.70 ,$791.31 ,$898.30 ,"$1,170.00 ",$905.45 ,$210.69 ,"$1,027.00 ",$685.96 ,$685.00 ,$685.00 ,$208.60 ,$685.00 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,"$1,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000206,36405,HC VENIPUNCTURE SCALP VEIN <3YRS,450,1 ,$45.00 ,$22.50 ,$0.73 ,$45.00 ,$0.73 ,$29.11 ,$29.11 , N/A ,$27.00 ,$38.25 ,$31.50 ,$0.73 ,$42.75 ,$34.20 ,$33.75 ,$29.25 ,$38.25 , N/A ,$29.25 ,$29.25 ,$31.50 ,$0.73 , N/A , N/A ,$45.00 ,$38.25 , N/A ,$41.40 ,$31.50 ,$22.82 ,$27.39 ,$27.41 ,$27.39 ,$31.10 ,$40.50 ,$31.34 , N/A ,$35.55 ,$0.77 ,$45.00 ,$45.00 , N/A ,$45.00 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,45000207,49084,HC PERITONEAL LAVAGE,450,1 ,$965.00 ,$482.50 ,$232.13 ,"$1,795.12 ",$232.13 ,$624.26 ,$624.26 ,$797.83 ,$579.00 ,$820.25 ,$675.50 ,$232.13 ,$916.75 ,$733.40 ,$723.75 ,$627.25 ,$820.25 ,$797.83 ,$627.25 ,$627.25 ,$675.50 ,$232.13 ,$797.83 ,$797.83 ,$571.36 ,$820.25 ,"$1,795.12 ",$887.80 ,$675.50 ,$489.45 ,$587.40 ,$587.69 ,$587.40 ,$666.82 ,$868.50 ,$672.12 ,$805.81 ,$762.35 ,$246.06 ,$685.00 ,$685.00 ,$797.83 ,$685.00 ,$694.80 ,$598.30 ,$694.80 ,$694.80 ,$772.00 
ST NICHOLAS HOSPITAL - ACUTE,45000212,25690,HC CLSD WRIST DISLOC,450,1 ,"$4,182.57 ","$2,091.29 ",$139.53 ,"$4,182.57 ",$139.53 ,"$2,705.70 ","$2,705.70 ","$1,373.35 ","$2,509.54 ","$3,555.18 ","$2,927.80 ",$139.53 ,"$3,973.44 ","$3,178.75 ","$3,136.93 ","$2,718.67 ","$3,555.18 ","$1,373.35 ","$2,718.67 ","$2,718.67 ","$2,927.80 ",$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$3,555.18 ","$3,090.03 ","$3,847.96 ","$2,927.80 ","$2,121.40 ","$2,545.93 ","$2,547.19 ","$2,545.93 ","$2,890.16 ","$3,764.31 ","$2,913.16 ","$1,387.08 ","$3,304.23 ",$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$3,011.45 ","$2,593.19 ","$3,011.45 ","$3,011.45 ","$3,346.06 "
ST NICHOLAS HOSPITAL - ACUTE,45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$755.00 ,$377.50 ,$95.17 ,$755.00 ,$95.17 ,$488.41 ,$488.41 ,$314.39 ,$453.00 ,$641.75 ,$528.50 ,$95.17 ,$717.25 ,$573.80 ,$566.25 ,$490.75 ,$641.75 ,$314.39 ,$490.75 ,$490.75 ,$528.50 ,$95.17 ,$314.39 ,$314.39 ,$571.36 ,$641.75 ,$707.37 ,$694.60 ,$528.50 ,$382.94 ,$459.57 ,$459.80 ,$459.57 ,$521.71 ,$679.50 ,$525.86 ,$317.53 ,$596.45 ,$100.88 ,$685.00 ,$685.00 ,$314.39 ,$685.00 ,$543.60 ,$468.10 ,$543.60 ,$543.60 ,$604.00 
ST NICHOLAS HOSPITAL - ACUTE,45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$1,394.00 ",$697.00 ,$139.53 ,"$3,090.03 ",$139.53 ,$901.78 ,$901.78 ,"$1,373.35 ",$836.40 ,"$1,184.90 ",$975.80 ,$139.53 ,"$1,324.30 ","$1,059.44 ","$1,045.50 ",$906.10 ,"$1,184.90 ","$1,373.35 ",$906.10 ,$906.10 ,$975.80 ,$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$1,184.90 ","$3,090.03 ","$1,282.48 ",$975.80 ,$707.04 ,$848.53 ,$848.95 ,$848.53 ,$963.25 ,"$1,254.60 ",$970.92 ,"$1,387.08 ","$1,101.26 ",$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$1,003.68 ",$864.28 ,"$1,003.68 ","$1,003.68 ","$1,115.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000227,25600,HC CLSD DIS.RADIUS W/O MANIP,450,1 ,$600.87 ,$300.44 ,$139.53 ,$600.87 ,$139.53 ,$388.70 ,$388.70 ,$203.23 ,$360.52 ,$510.74 ,$420.61 ,$139.53 ,$570.83 ,$456.66 ,$450.65 ,$390.57 ,$510.74 ,$203.23 ,$390.57 ,$390.57 ,$420.61 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$510.74 ,$457.26 ,$552.80 ,$420.61 ,$304.76 ,$365.75 ,$365.93 ,$365.75 ,$415.20 ,$540.78 ,$418.51 ,$205.26 ,$474.69 ,$147.90 ,$600.87 ,$600.87 ,$203.23 ,$600.87 ,$432.63 ,$372.54 ,$432.63 ,$432.63 ,$480.70 
ST NICHOLAS HOSPITAL - ACUTE,45000228,26750,HC CLSD DIST PHALANGEAL W/O MANIP,450,1 ,$697.00 ,$348.50 ,$139.53 ,$697.00 ,$139.53 ,$450.89 ,$450.89 ,$203.23 ,$418.20 ,$592.45 ,$487.90 ,$139.53 ,$662.15 ,$529.72 ,$522.75 ,$453.05 ,$592.45 ,$203.23 ,$453.05 ,$453.05 ,$487.90 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$592.45 ,$457.26 ,$641.24 ,$487.90 ,$353.52 ,$424.26 ,$424.47 ,$424.26 ,$481.63 ,$627.30 ,$485.46 ,$205.26 ,$550.63 ,$147.90 ,$685.00 ,$685.00 ,$203.23 ,$685.00 ,$501.84 ,$432.14 ,$501.84 ,$501.84 ,$557.60 
ST NICHOLAS HOSPITAL - ACUTE,45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$668.00 ,$334.00 ,$139.53 ,$668.00 ,$139.53 ,$432.13 ,$432.13 ,$203.23 ,$400.80 ,$567.80 ,$467.60 ,$139.53 ,$634.60 ,$507.68 ,$501.00 ,$434.20 ,$567.80 ,$203.23 ,$434.20 ,$434.20 ,$467.60 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$567.80 ,$457.26 ,$614.56 ,$467.60 ,$338.81 ,$406.61 ,$406.81 ,$406.61 ,$461.59 ,$601.20 ,$465.26 ,$205.26 ,$527.72 ,$147.90 ,$668.00 ,$668.00 ,$203.23 ,$668.00 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$534.40 
ST NICHOLAS HOSPITAL - ACUTE,45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$599.00 ,$299.50 ,$139.53 ,$599.00 ,$139.53 ,$387.49 ,$387.49 ,$203.23 ,$359.40 ,$509.15 ,$419.30 ,$139.53 ,$569.05 ,$455.24 ,$449.25 ,$389.35 ,$509.15 ,$203.23 ,$389.35 ,$389.35 ,$419.30 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$509.15 ,$457.26 ,$551.08 ,$419.30 ,$303.81 ,$364.61 ,$364.79 ,$364.61 ,$413.91 ,$539.10 ,$417.20 ,$205.26 ,$473.21 ,$147.90 ,$599.00 ,$599.00 ,$203.23 ,$599.00 ,$431.28 ,$371.38 ,$431.28 ,$431.28 ,$479.20 
ST NICHOLAS HOSPITAL - ACUTE,45000249,28515,HC TOE FX W/MANIP,450,1 ,$620.00 ,$310.00 ,$139.53 ,$620.00 ,$139.53 ,$401.08 ,$401.08 ,$203.23 ,$372.00 ,$527.00 ,$434.00 ,$139.53 ,$589.00 ,$471.20 ,$465.00 ,$403.00 ,$527.00 ,$203.23 ,$403.00 ,$403.00 ,$434.00 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$527.00 ,$457.26 ,$570.40 ,$434.00 ,$314.46 ,$377.39 ,$377.58 ,$377.39 ,$428.42 ,$558.00 ,$431.83 ,$205.26 ,$489.80 ,$147.90 ,$620.00 ,$620.00 ,$203.23 ,$620.00 ,$446.40 ,$384.40 ,$446.40 ,$446.40 ,$496.00 
ST NICHOLAS HOSPITAL - ACUTE,45000252,20520,HC MUSCLE FB REM W/ INC,450,1 ,"$4,100.00 ","$2,050.00 ",$547.96 ,"$4,100.00 ",$547.96 ,"$2,652.29 ","$2,652.29 ","$1,387.33 ","$2,460.00 ","$3,485.00 ","$2,870.00 ",$547.96 ,"$3,895.00 ","$3,116.00 ","$3,075.00 ","$2,665.00 ","$3,485.00 ","$1,387.33 ","$2,665.00 ","$2,665.00 ","$2,870.00 ",$547.96 ,"$1,387.33 ","$1,387.33 ",$571.36 ,"$3,485.00 ","$3,121.49 ","$3,772.00 ","$2,870.00 ","$2,079.52 ","$2,495.67 ","$2,496.90 ","$2,495.67 ","$2,833.10 ","$3,690.00 ","$2,855.65 ","$1,401.20 ","$3,239.00 ",$580.84 ,$685.00 ,$685.00 ,"$1,387.33 ",$685.00 ,"$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$3,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,$647.00 ,$323.50 ,$139.53 ,$647.00 ,$139.53 ,$418.54 ,$418.54 ,$203.23 ,$388.20 ,$549.95 ,$452.90 ,$139.53 ,$614.65 ,$491.72 ,$485.25 ,$420.55 ,$549.95 ,$203.23 ,$420.55 ,$420.55 ,$452.90 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$549.95 ,$457.26 ,$595.24 ,$452.90 ,$328.16 ,$393.83 ,$394.02 ,$393.83 ,$447.08 ,$582.30 ,$450.64 ,$205.26 ,$511.13 ,$147.90 ,$647.00 ,$647.00 ,$203.23 ,$647.00 ,$465.84 ,$401.14 ,$465.84 ,$465.84 ,$517.60 
ST NICHOLAS HOSPITAL - ACUTE,45000270,20606,HC ARTHROCNT ASP/INJ JT INTRM W/ULTRA,450,1 ,$959.00 ,$479.50 ,$154.70 ,"$1,408.74 ",$154.70 ,$620.38 ,$620.38 ,$626.11 ,$575.40 ,$815.15 ,$671.30 ,$154.70 ,$911.05 ,$728.84 ,$719.25 ,$623.35 ,$815.15 ,$626.11 ,$623.35 ,$623.35 ,$671.30 ,$154.70 ,$626.11 ,$626.11 ,$571.36 ,$815.15 ,"$1,408.74 ",$882.28 ,$671.30 ,$486.40 ,$583.74 ,$584.03 ,$583.74 ,$662.67 ,$863.10 ,$667.94 ,$632.37 ,$757.61 ,$163.98 ,$685.00 ,$685.00 ,$626.11 ,$685.00 ,$690.48 ,$594.58 ,$690.48 ,$690.48 ,$767.20 
ST NICHOLAS HOSPITAL - ACUTE,45000271,20604,HC ARTHROCNT ASP/INJ JT SMALL W/ULTRA,450,1 ,$927.00 ,$463.50 ,$154.70 ,$927.00 ,$154.70 ,$599.68 ,$599.68 ,$257.61 ,$556.20 ,$787.95 ,$648.90 ,$154.70 ,$880.65 ,$704.52 ,$695.25 ,$602.55 ,$787.95 ,$257.61 ,$602.55 ,$602.55 ,$648.90 ,$154.70 ,$257.61 ,$257.61 ,$571.36 ,$787.95 ,$579.62 ,$852.84 ,$648.90 ,$470.17 ,$564.26 ,$564.54 ,$564.26 ,$640.56 ,$834.30 ,$645.66 ,$260.19 ,$732.33 ,$163.98 ,$685.00 ,$685.00 ,$257.61 ,$685.00 ,$667.44 ,$574.74 ,$667.44 ,$667.44 ,$741.60 
ST NICHOLAS HOSPITAL - ACUTE,45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,"$1,185.00 ",$592.50 ,$154.70 ,"$1,185.00 ",$154.70 ,$766.58 ,$766.58 ,$257.61 ,$711.00 ,"$1,007.25 ",$829.50 ,$154.70 ,"$1,125.75 ",$900.60 ,$888.75 ,$770.25 ,"$1,007.25 ",$257.61 ,$770.25 ,$770.25 ,$829.50 ,$154.70 ,$257.61 ,$257.61 ,$571.36 ,"$1,007.25 ",$579.62 ,"$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$721.31 ,$818.84 ,"$1,066.50 ",$825.35 ,$260.19 ,$936.15 ,$163.98 ,$685.00 ,$685.00 ,$257.61 ,$685.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$129.00 ,$64.50 ,$34.89 ,$129.00 ,$34.89 ,$83.45 ,$83.45 ,$54.89 ,$77.40 ,$109.65 ,$90.30 ,$34.89 ,$122.55 ,$98.04 ,$96.75 ,$83.85 ,$109.65 ,$54.89 ,$83.85 ,$83.85 ,$90.30 ,$34.89 ,$54.89 ,$54.89 ,$129.00 ,$109.65 ,$123.49 ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$78.52 ,$89.14 ,$116.10 ,$89.85 ,$55.44 ,$101.91 ,$36.98 ,$129.00 ,$129.00 ,$54.89 ,$129.00 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,45000281,N/A,HC ED PROC LEVEL 1,450,1 ,$315.00 ,$157.50 ,$157.50 ,$315.00 , N/A ,$203.77 ,$203.77 , N/A ,$189.00 ,$267.75 ,$220.50 , N/A ,$299.25 ,$239.40 ,$236.25 ,$204.75 ,$267.75 , N/A ,$204.75 ,$204.75 ,$220.50 , N/A , N/A , N/A ,$315.00 ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$191.74 ,$217.67 ,$283.50 ,$219.40 , N/A ,$248.85 , N/A ,$315.00 ,$315.00 , N/A ,$315.00 ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,45000282,N/A,HC ED PROC LEVEL 2,450,1 ,$525.00 ,$262.50 ,$262.50 ,$525.00 , N/A ,$339.62 ,$339.62 , N/A ,$315.00 ,$446.25 ,$367.50 , N/A ,$498.75 ,$399.00 ,$393.75 ,$341.25 ,$446.25 , N/A ,$341.25 ,$341.25 ,$367.50 , N/A , N/A , N/A ,$525.00 ,$446.25 , N/A ,$483.00 ,$367.50 ,$266.28 ,$319.57 ,$319.73 ,$319.57 ,$362.78 ,$472.50 ,$365.66 , N/A ,$414.75 , N/A ,$525.00 ,$525.00 , N/A ,$525.00 ,$378.00 ,$325.50 ,$378.00 ,$378.00 ,$420.00 
ST NICHOLAS HOSPITAL - ACUTE,45000283,N/A,HC ED PROC LEVEL 3,450,1 ,"$1,050.00 ",$525.00 ,$525.00 ,"$1,050.00 ", N/A ,$679.25 ,$679.25 , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$798.00 ,$787.50 ,$682.50 ,$892.50 , N/A ,$682.50 ,$682.50 ,$735.00 , N/A , N/A , N/A ,$571.36 ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$639.14 ,$725.55 ,$945.00 ,$731.33 , N/A ,$829.50 , N/A ,$685.00 ,$685.00 , N/A ,$685.00 ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$840.00 
ST NICHOLAS HOSPITAL - ACUTE,45000284,N/A,HC ED PROC LEVEL 4,450,1 ,"$2,100.00 ","$1,050.00 ",$571.36 ,"$2,100.00 ", N/A ,"$1,358.49 ","$1,358.49 ", N/A ,"$1,260.00 ","$1,785.00 ","$1,470.00 ", N/A ,"$1,995.00 ","$1,596.00 ","$1,575.00 ","$1,365.00 ","$1,785.00 ", N/A ,"$1,365.00 ","$1,365.00 ","$1,470.00 ", N/A , N/A , N/A ,$571.36 ,"$1,785.00 ", N/A ,"$1,932.00 ","$1,470.00 ","$1,065.12 ","$1,278.27 ","$1,278.90 ","$1,278.27 ","$1,451.10 ","$1,890.00 ","$1,462.65 ", N/A ,"$1,659.00 ", N/A ,$685.00 ,$685.00 , N/A ,$685.00 ,"$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000285,N/A,HC ED PROC LEVEL 5,450,1 ,"$3,150.00 ","$1,575.00 ",$571.36 ,"$3,150.00 ", N/A ,"$2,037.74 ","$2,037.74 ", N/A ,"$1,890.00 ","$2,677.50 ","$2,205.00 ", N/A ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,047.50 ","$2,677.50 ", N/A ,"$2,047.50 ","$2,047.50 ","$2,205.00 ", N/A , N/A , N/A ,$571.36 ,"$2,677.50 ", N/A ,"$2,898.00 ","$2,205.00 ","$1,597.68 ","$1,917.41 ","$1,918.35 ","$1,917.41 ","$2,176.65 ","$2,835.00 ","$2,193.98 ", N/A ,"$2,488.50 ", N/A ,$685.00 ,$685.00 , N/A ,$685.00 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000287,11402,HC EXCISION LESION BENIGN TRUNK/ARM/LEG 1.1-2.0CM,450,1 ,"$1,260.00 ",$630.00 ,$139.95 ,"$1,380.55 ",$139.95 ,$815.09 ,$815.09 ,$613.58 ,$756.00 ,"$1,071.00 ",$882.00 ,$139.95 ,"$1,197.00 ",$957.60 ,$945.00 ,$819.00 ,"$1,071.00 ",$613.58 ,$819.00 ,$819.00 ,$882.00 ,$139.95 ,$613.58 ,$613.58 ,$571.36 ,"$1,071.00 ","$1,380.55 ","$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$766.96 ,$870.66 ,"$1,134.00 ",$877.59 ,$619.72 ,$995.40 ,$148.35 ,$685.00 ,$685.00 ,$613.58 ,$685.00 ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,"$1,008.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000303,24620,HC CLOSED TX ELBOW FRACTURE W/MANIP,450,1 ,"$4,380.00 ","$2,190.00 ",$139.53 ,"$4,380.00 ",$139.53 ,"$2,833.42 ","$2,833.42 ","$1,373.35 ","$2,628.00 ","$3,723.00 ","$3,066.00 ",$139.53 ,"$4,161.00 ","$3,328.80 ","$3,285.00 ","$2,847.00 ","$3,723.00 ","$1,373.35 ","$2,847.00 ","$2,847.00 ","$3,066.00 ",$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$3,723.00 ","$3,090.03 ","$4,029.60 ","$3,066.00 ","$2,221.54 ","$2,666.11 ","$2,667.42 ","$2,666.11 ","$3,026.58 ","$3,942.00 ","$3,050.67 ","$1,387.08 ","$3,460.20 ",$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$3,153.60 ","$2,715.60 ","$3,153.60 ","$3,153.60 ","$3,504.00 "
ST NICHOLAS HOSPITAL - ACUTE,45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$670.00 ,$335.00 ,$139.53 ,$670.00 ,$139.53 ,$433.42 ,$433.42 ,$203.23 ,$402.00 ,$569.50 ,$469.00 ,$139.53 ,$636.50 ,$509.20 ,$502.50 ,$435.50 ,$569.50 ,$203.23 ,$435.50 ,$435.50 ,$469.00 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$569.50 ,$457.26 ,$616.40 ,$469.00 ,$339.82 ,$407.83 ,$408.03 ,$407.83 ,$462.97 ,$603.00 ,$466.66 ,$205.26 ,$529.30 ,$147.90 ,$670.00 ,$670.00 ,$203.23 ,$670.00 ,$482.40 ,$415.40 ,$482.40 ,$482.40 ,$536.00 
ST NICHOLAS HOSPITAL - ACUTE,45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$493.00 ,$246.50 ,$34.89 ,$493.00 ,$34.89 ,$318.92 ,$318.92 ,$162.31 ,$295.80 ,$419.05 ,$345.10 ,$34.89 ,$468.35 ,$374.68 ,$369.75 ,$320.45 ,$419.05 ,$162.31 ,$320.45 ,$320.45 ,$345.10 ,$34.89 ,$162.31 ,$162.31 ,$493.00 ,$419.05 ,$365.20 ,$453.56 ,$345.10 ,$250.05 ,$300.09 ,$300.24 ,$300.09 ,$340.66 ,$443.70 ,$343.37 ,$163.93 ,$389.47 ,$36.98 ,$493.00 ,$493.00 ,$162.31 ,$493.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,45000326,24670,HC CLOSED TX FX ULNAR PROX END W/MANIP,450,1 ,$558.00 ,$279.00 ,$139.53 ,$558.00 ,$139.53 ,$360.97 ,$360.97 ,$203.23 ,$334.80 ,$474.30 ,$390.60 ,$139.53 ,$530.10 ,$424.08 ,$418.50 ,$362.70 ,$474.30 ,$203.23 ,$362.70 ,$362.70 ,$390.60 ,$139.53 ,$203.23 ,$203.23 ,$558.00 ,$474.30 ,$457.26 ,$513.36 ,$390.60 ,$283.02 ,$339.65 ,$339.82 ,$339.65 ,$385.58 ,$502.20 ,$388.65 ,$205.26 ,$440.82 ,$147.90 ,$558.00 ,$558.00 ,$203.23 ,$558.00 ,$401.76 ,$345.96 ,$401.76 ,$401.76 ,$446.40 
ST NICHOLAS HOSPITAL - ACUTE,45000327,26765,HC TX FX OPEN FINGER/THUMB W/INT FIX EACH,450,1 ,"$8,248.17 ","$4,124.09 ",$571.36 ,"$8,248.17 ","$1,668.49 ","$5,335.74 ","$5,335.74 ","$2,792.32 ","$4,948.90 ","$7,010.94 ","$5,773.72 ","$1,668.49 ","$7,835.76 ","$6,268.61 ","$6,186.13 ","$5,361.31 ","$7,010.94 ","$2,792.32 ","$5,361.31 ","$5,361.31 ","$5,773.72 ","$1,668.49 ","$2,792.32 ","$2,792.32 ",$571.36 ,"$7,010.94 ","$6,282.73 ","$7,588.32 ","$5,773.72 ","$4,183.47 ","$5,020.66 ","$5,023.14 ","$5,020.66 ","$5,699.49 ","$7,423.35 ","$5,744.85 ","$2,820.24 ","$6,516.05 ","$1,768.60 ",$685.00 ,$685.00 ,"$2,792.32 ",$685.00 ,"$5,938.68 ","$5,113.87 ","$5,938.68 ","$5,938.68 ","$6,598.54 "
ST NICHOLAS HOSPITAL - ACUTE,45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,$599.10 ,$299.55 ,$139.53 ,$599.10 ,$139.53 ,$387.56 ,$387.56 ,$203.23 ,$359.46 ,$509.24 ,$419.37 ,$139.53 ,$569.15 ,$455.32 ,$449.33 ,$389.42 ,$509.24 ,$203.23 ,$389.42 ,$389.42 ,$419.37 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$509.24 ,$457.26 ,$551.17 ,$419.37 ,$303.86 ,$364.67 ,$364.85 ,$364.67 ,$413.98 ,$539.19 ,$417.27 ,$205.26 ,$473.29 ,$147.90 ,$599.10 ,$599.10 ,$203.23 ,$599.10 ,$431.35 ,$371.44 ,$431.35 ,$431.35 ,$479.28 
ST NICHOLAS HOSPITAL - ACUTE,45000329,27752,HC CLSD TX FX TIBIAL SHAFT W/MANIP,450,1 ,"$4,207.00 ","$2,103.50 ",$139.53 ,"$4,207.00 ",$139.53 ,"$2,721.51 ","$2,721.51 ","$1,373.35 ","$2,524.20 ","$3,575.95 ","$2,944.90 ",$139.53 ,"$3,996.65 ","$3,197.32 ","$3,155.25 ","$2,734.55 ","$3,575.95 ","$1,373.35 ","$2,734.55 ","$2,734.55 ","$2,944.90 ",$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$3,575.95 ","$3,090.03 ","$3,870.44 ","$2,944.90 ","$2,133.79 ","$2,560.80 ","$2,562.06 ","$2,560.80 ","$2,907.04 ","$3,786.30 ","$2,930.18 ","$1,387.08 ","$3,323.53 ",$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$3,029.04 ","$2,608.34 ","$3,029.04 ","$3,029.04 ","$3,365.60 "
ST NICHOLAS HOSPITAL - ACUTE,45000331,27788,HC CLOSED TX FX DISTAL FIBULAR W/MANIP,450,1 ,$549.00 ,$274.50 ,$139.53 ,$549.00 ,$139.53 ,$355.15 ,$355.15 ,$203.23 ,$329.40 ,$466.65 ,$384.30 ,$139.53 ,$521.55 ,$417.24 ,$411.75 ,$356.85 ,$466.65 ,$203.23 ,$356.85 ,$356.85 ,$384.30 ,$139.53 ,$203.23 ,$203.23 ,$549.00 ,$466.65 ,$457.26 ,$505.08 ,$384.30 ,$278.45 ,$334.18 ,$334.34 ,$334.18 ,$379.36 ,$494.10 ,$382.38 ,$205.26 ,$433.71 ,$147.90 ,$549.00 ,$549.00 ,$203.23 ,$549.00 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$439.20 
ST NICHOLAS HOSPITAL - ACUTE,45000500,57200,HC REPAIR SUTURE VAGINA COLPORRHAPHY,450,1 ,"$7,644.00 ","$3,822.00 ",$571.36 ,"$7,644.00 ",$764.59 ,"$4,944.90 ","$4,944.90 ","$2,586.95 ","$4,586.40 ","$6,497.40 ","$5,350.80 ",$764.59 ,"$7,261.80 ","$5,809.44 ","$5,733.00 ","$4,968.60 ","$6,497.40 ","$2,586.95 ","$4,968.60 ","$4,968.60 ","$5,350.80 ",$764.59 ,"$2,586.95 ","$2,586.95 ",$571.36 ,"$6,497.40 ","$5,820.65 ","$7,032.48 ","$5,350.80 ","$3,877.04 ","$4,652.90 ","$4,655.20 ","$4,652.90 ","$5,282.00 ","$6,879.60 ","$5,324.05 ","$2,612.82 ","$6,038.76 ",$810.47 ,$685.00 ,$685.00 ,"$2,586.95 ",$685.00 ,"$5,503.68 ","$4,739.28 ","$5,503.68 ","$5,503.68 ","$6,115.20 "
ST NICHOLAS HOSPITAL - ACUTE,45000736,21337,HC CLOSED TX FX NASAL SEPTAL,450,1 ,"$5,255.00 ","$2,627.50 ",$288.55 ,"$6,069.20 ",$288.55 ,"$3,399.46 ","$3,399.46 ","$2,697.42 ","$3,153.00 ","$4,466.75 ","$3,678.50 ",$288.55 ,"$4,992.25 ","$3,993.80 ","$3,941.25 ","$3,415.75 ","$4,466.75 ","$2,697.42 ","$3,415.75 ","$3,415.75 ","$3,678.50 ",$288.55 ,"$2,697.42 ","$2,697.42 ",$571.36 ,"$4,466.75 ","$6,069.20 ","$4,834.60 ","$3,678.50 ","$2,665.34 ","$3,198.72 ","$3,200.30 ","$3,198.72 ","$3,631.21 ","$4,729.50 ","$3,660.11 ","$2,724.39 ","$4,151.45 ",$305.86 ,$685.00 ,$685.00 ,"$2,697.42 ",$685.00 ,"$3,783.60 ","$3,258.10 ","$3,783.60 ","$3,783.60 ","$4,204.00 "
ST NICHOLAS HOSPITAL - ACUTE,45001168,52281,HC CYSTOURETHROSCOPY W/CALIBRATION/DILATION,450,1 ,"$5,205.01 ","$2,602.51 ",$490.13 ,"$5,205.01 ",$490.13 ,"$3,367.12 ","$3,367.12 ","$1,765.45 ","$3,123.01 ","$4,424.26 ","$3,643.51 ",$490.13 ,"$4,944.76 ","$3,955.81 ","$3,903.76 ","$3,383.26 ","$4,424.26 ","$1,765.45 ","$3,383.26 ","$3,383.26 ","$3,643.51 ",$490.13 ,"$1,765.45 ","$1,765.45 ",$571.36 ,"$4,424.26 ","$3,972.27 ","$4,788.61 ","$3,643.51 ","$2,639.98 ","$3,168.29 ","$3,169.85 ","$3,168.29 ","$3,596.66 ","$4,684.51 ","$3,625.29 ","$1,783.10 ","$4,111.96 ",$519.54 ,$685.00 ,$685.00 ,"$1,765.45 ",$685.00 ,"$3,747.61 ","$3,227.11 ","$3,747.61 ","$3,747.61 ","$4,164.01 "
ST NICHOLAS HOSPITAL - ACUTE,45001272,23665,HC TX FX DISLOC SHOULDER HUMERW/MANIP,450,1 ,"$4,380.00 ","$2,190.00 ",$139.53 ,"$4,380.00 ",$139.53 ,"$2,833.42 ","$2,833.42 ","$1,373.35 ","$2,628.00 ","$3,723.00 ","$3,066.00 ",$139.53 ,"$4,161.00 ","$3,328.80 ","$3,285.00 ","$2,847.00 ","$3,723.00 ","$1,373.35 ","$2,847.00 ","$2,847.00 ","$3,066.00 ",$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$3,723.00 ","$3,090.03 ","$4,029.60 ","$3,066.00 ","$2,221.54 ","$2,666.11 ","$2,667.42 ","$2,666.11 ","$3,026.58 ","$3,942.00 ","$3,050.67 ","$1,387.08 ","$3,460.20 ",$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$3,153.60 ","$2,715.60 ","$3,153.60 ","$3,153.60 ","$3,504.00 "
ST NICHOLAS HOSPITAL - ACUTE,45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$4,057.50 ","$2,028.75 ",$139.53 ,"$4,057.50 ",$139.53 ,"$2,624.80 ","$2,624.80 ","$1,373.35 ","$2,434.50 ","$3,448.88 ","$2,840.25 ",$139.53 ,"$3,854.63 ","$3,083.70 ","$3,043.13 ","$2,637.38 ","$3,448.88 ","$1,373.35 ","$2,637.38 ","$2,637.38 ","$2,840.25 ",$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$3,448.88 ","$3,090.03 ","$3,732.90 ","$2,840.25 ","$2,057.96 ","$2,469.80 ","$2,471.02 ","$2,469.80 ","$2,803.73 ","$3,651.75 ","$2,826.05 ","$1,387.08 ","$3,205.43 ",$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$2,921.40 ","$2,515.65 ","$2,921.40 ","$2,921.40 ","$3,246.00 "
ST NICHOLAS HOSPITAL - ACUTE,45001291,27502,HC TX FX FEMUR W/MAN W/W/O TRACTION,450,1 ,"$4,031.00 ","$2,015.50 ",$139.53 ,"$4,031.00 ",$139.53 ,"$2,607.65 ","$2,607.65 ","$1,373.35 ","$2,418.60 ","$3,426.35 ","$2,821.70 ",$139.53 ,"$3,829.45 ","$3,063.56 ","$3,023.25 ","$2,620.15 ","$3,426.35 ","$1,373.35 ","$2,620.15 ","$2,620.15 ","$2,821.70 ",$139.53 ,"$1,373.35 ","$1,373.35 ",$571.36 ,"$3,426.35 ","$3,090.03 ","$3,708.52 ","$2,821.70 ","$2,044.52 ","$2,453.67 ","$2,454.88 ","$2,453.67 ","$2,785.42 ","$3,627.90 ","$2,807.59 ","$1,387.08 ","$3,184.49 ",$147.90 ,$685.00 ,$685.00 ,"$1,373.35 ",$685.00 ,"$2,902.32 ","$2,499.22 ","$2,902.32 ","$2,902.32 ","$3,224.80 "
ST NICHOLAS HOSPITAL - ACUTE,45001303,28208,HC REPAIR TENDON EXTENSOR FOOT,450,1 ,"$8,491.00 ","$4,245.50 ",$571.36 ,"$8,491.00 ",$677.53 ,"$5,492.83 ","$5,492.83 ","$2,792.32 ","$5,094.60 ","$7,217.35 ","$5,943.70 ",$677.53 ,"$8,066.45 ","$6,453.16 ","$6,368.25 ","$5,519.15 ","$7,217.35 ","$2,792.32 ","$5,519.15 ","$5,519.15 ","$5,943.70 ",$677.53 ,"$2,792.32 ","$2,792.32 ",$571.36 ,"$7,217.35 ","$6,282.73 ","$7,811.72 ","$5,943.70 ","$4,306.64 ","$5,168.47 ","$5,171.02 ","$5,168.47 ","$5,867.28 ","$7,641.90 ","$5,913.98 ","$2,820.24 ","$6,707.89 ",$718.18 ,$685.00 ,$685.00 ,"$2,792.32 ",$685.00 ,"$6,113.52 ","$5,264.42 ","$6,113.52 ","$6,113.52 ","$6,792.80 "
ST NICHOLAS HOSPITAL - ACUTE,45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$765.00 ,$382.50 ,$62.73 ,$765.00 ,$62.73 ,$494.88 ,$494.88 ,$262.38 ,$459.00 ,$650.25 ,$535.50 ,$62.73 ,$726.75 ,$581.40 ,$573.75 ,$497.25 ,$650.25 ,$262.38 ,$497.25 ,$497.25 ,$535.50 ,$62.73 ,$262.38 ,$262.38 ,$571.36 ,$650.25 ,$590.35 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$465.66 ,$528.62 ,$688.50 ,$532.82 ,$265.00 ,$604.35 ,$66.49 ,$685.00 ,$685.00 ,$262.38 ,$685.00 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$612.00 
ST NICHOLAS HOSPITAL - ACUTE,45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,"$1,008.00 ",$504.00 ,$62.73 ,"$1,008.00 ",$62.73 ,$652.08 ,$652.08 ,$262.38 ,$604.80 ,$856.80 ,$705.60 ,$62.73 ,$957.60 ,$766.08 ,$756.00 ,$655.20 ,$856.80 ,$262.38 ,$655.20 ,$655.20 ,$705.60 ,$62.73 ,$262.38 ,$262.38 ,$571.36 ,$856.80 ,$590.35 ,$927.36 ,$705.60 ,$511.26 ,$613.57 ,$613.87 ,$613.57 ,$696.53 ,$907.20 ,$702.07 ,$265.00 ,$796.32 ,$66.49 ,$685.00 ,$685.00 ,$262.38 ,$685.00 ,$725.76 ,$624.96 ,$725.76 ,$725.76 ,$806.40 
ST NICHOLAS HOSPITAL - ACUTE,45001343,37799,HC REPAIR/SUTURE MINOR VESSEL,450,1 ,"$1,628.00 ",$814.00 ,$532.96 ,"$1,628.00 ",$681.85 ,"$1,053.15 ","$1,053.15 ",$532.96 ,$976.80 ,"$1,383.80 ","$1,139.60 ",$681.85 ,"$1,546.60 ","$1,237.28 ","$1,221.00 ","$1,058.20 ","$1,383.80 ",$532.96 ,"$1,058.20 ","$1,058.20 ","$1,139.60 ",$681.85 ,$532.96 ,$532.96 ,$571.36 ,"$1,383.80 ","$1,199.16 ","$1,497.76 ","$1,139.60 ",$825.72 ,$990.96 ,$991.45 ,$990.96 ,"$1,124.95 ","$1,465.20 ","$1,133.90 ",$538.29 ,"$1,286.12 ",$722.76 ,$685.00 ,$685.00 ,$532.96 ,$685.00 ,"$1,172.16 ","$1,009.36 ","$1,172.16 ","$1,172.16 ","$1,302.40 "
ST NICHOLAS HOSPITAL - ACUTE,45001355,25660,HC CLTX RDCRPL/INTERCARPL DISLC 1 >BONES W MAN,450,1 ,$647.00 ,$323.50 ,$139.53 ,$647.00 ,$139.53 ,$418.54 ,$418.54 ,$203.23 ,$388.20 ,$549.95 ,$452.90 ,$139.53 ,$614.65 ,$491.72 ,$485.25 ,$420.55 ,$549.95 ,$203.23 ,$420.55 ,$420.55 ,$452.90 ,$139.53 ,$203.23 ,$203.23 ,$571.36 ,$549.95 ,$457.26 ,$595.24 ,$452.90 ,$328.16 ,$393.83 ,$394.02 ,$393.83 ,$447.08 ,$582.30 ,$450.64 ,$205.26 ,$511.13 ,$147.90 ,$647.00 ,$647.00 ,$203.23 ,$647.00 ,$465.84 ,$401.14 ,$465.84 ,$465.84 ,$517.60 
ST NICHOLAS HOSPITAL - ACUTE,45001360,31577,HC LARYNGOSCOPY FLX RMVL FOREIGN BODY(S),450,1 ,"$1,097.00 ",$548.50 ,$238.77 ,"$1,097.00 ",$238.77 ,$709.65 ,$709.65 ,$370.61 ,$658.20 ,$932.45 ,$767.90 ,$238.77 ,"$1,042.15 ",$833.72 ,$822.75 ,$713.05 ,$932.45 ,$370.61 ,$713.05 ,$713.05 ,$767.90 ,$238.77 ,$370.61 ,$370.61 ,$571.36 ,$932.45 ,$833.88 ,"$1,009.24 ",$767.90 ,$556.40 ,$667.74 ,$668.07 ,$667.74 ,$758.03 ,$987.30 ,$764.06 ,$374.32 ,$866.63 ,$253.10 ,$685.00 ,$685.00 ,$370.61 ,$685.00 ,$789.84 ,$680.14 ,$789.84 ,$789.84 ,$877.60 
ST NICHOLAS HOSPITAL - ACUTE,46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$426.00 ,$213.00 ,$16.35 ,$426.00 ,$16.35 ,$275.58 ,$275.58 ,$137.66 ,$255.60 ,$362.10 ,$298.20 ,$16.35 ,$404.70 ,$323.76 ,$319.50 ,$276.90 ,$362.10 ,$137.66 ,$276.90 ,$276.90 ,$298.20 ,$16.35 ,$137.66 ,$137.66 ,$348.47 ,$362.10 ,$309.74 ,$391.92 ,$298.20 ,$216.07 ,$259.31 ,$259.43 ,$259.31 ,$294.37 ,$383.40 ,$296.71 ,$139.04 ,$336.54 ,$17.33 ,$426.00 ,$426.00 ,$137.66 ,$426.00 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$340.80 
ST NICHOLAS HOSPITAL - ACUTE,46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$762.00 ,$381.00 ,$32.14 ,$762.00 ,$32.14 ,$492.94 ,$492.94 ,$260.95 ,$457.20 ,$647.70 ,$533.40 ,$32.14 ,$723.90 ,$579.12 ,$571.50 ,$495.30 ,$647.70 ,$260.95 ,$495.30 ,$495.30 ,$533.40 ,$32.14 ,$260.95 ,$260.95 ,$348.47 ,$647.70 ,$587.13 ,$701.04 ,$533.40 ,$386.49 ,$463.83 ,$464.06 ,$463.83 ,$526.54 ,$685.80 ,$530.73 ,$263.56 ,$601.98 ,$34.07 ,$625.00 ,$625.00 ,$260.95 ,$625.00 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$609.60 
ST NICHOLAS HOSPITAL - ACUTE,46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,"$1,086.00 ",$543.00 ,$32.14 ,"$1,086.00 ",$32.14 ,$702.53 ,$702.53 ,$260.95 ,$651.60 ,$923.10 ,$760.20 ,$32.14 ,"$1,031.70 ",$825.36 ,$814.50 ,$705.90 ,$923.10 ,$260.95 ,$705.90 ,$705.90 ,$760.20 ,$32.14 ,$260.95 ,$260.95 ,$348.47 ,$923.10 ,$587.13 ,$999.12 ,$760.20 ,$550.82 ,$661.05 ,$661.37 ,$661.05 ,$750.43 ,$977.40 ,$756.40 ,$263.56 ,$857.94 ,$34.07 ,$625.00 ,$625.00 ,$260.95 ,$625.00 ,$781.92 ,$673.32 ,$781.92 ,$781.92 ,$868.80 
ST NICHOLAS HOSPITAL - ACUTE,46000007,94150,HC VITAL CAPACITY TOTAL,460,1 ,$168.00 ,$84.00 ,$16.35 ,$309.74 ,$16.35 ,$108.68 ,$108.68 ,$137.66 ,$100.80 ,$142.80 ,$117.60 ,$16.35 ,$159.60 ,$127.68 ,$126.00 ,$109.20 ,$142.80 ,$137.66 ,$109.20 ,$109.20 ,$117.60 ,$16.35 ,$137.66 ,$137.66 ,$168.00 ,$142.80 ,$309.74 ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$117.01 ,$139.04 ,$132.72 ,$17.33 ,$168.00 ,$168.00 ,$137.66 ,$168.00 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,46000008,94729,HC RESIDUAL LUNG CAPACITY,460,1 ,$336.00 ,$168.00 ,$16.35 ,$336.00 ,$16.35 ,$217.36 ,$217.36 , N/A ,$201.60 ,$285.60 ,$235.20 ,$16.35 ,$319.20 ,$255.36 ,$252.00 ,$218.40 ,$285.60 , N/A ,$218.40 ,$218.40 ,$235.20 ,$16.35 , N/A , N/A ,$336.00 ,$285.60 , N/A ,$309.12 ,$235.20 ,$170.42 ,$204.52 ,$204.62 ,$204.52 ,$232.18 ,$302.40 ,$234.02 , N/A ,$265.44 ,$17.33 ,$336.00 ,$336.00 , N/A ,$336.00 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,46000009,94250,HC EXPIRED GAS COLLECTION,460,1 ,$168.00 ,$84.00 ,$84.00 ,$168.00 , N/A ,$108.68 ,$108.68 , N/A ,$100.80 ,$142.80 ,$117.60 , N/A ,$159.60 ,$127.68 ,$126.00 ,$109.20 ,$142.80 , N/A ,$109.20 ,$109.20 ,$117.60 , N/A , N/A , N/A ,$168.00 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$102.26 ,$116.09 ,$151.20 ,$117.01 , N/A ,$132.72 , N/A ,$168.00 ,$168.00 , N/A ,$168.00 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,46000010,94726,HC THORACIC GAS VOLUME,460,1 ,$560.00 ,$280.00 ,$32.14 ,$587.13 ,$32.14 ,$362.26 ,$362.26 ,$260.95 ,$336.00 ,$476.00 ,$392.00 ,$32.14 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,$260.95 ,$364.00 ,$364.00 ,$392.00 ,$32.14 ,$260.95 ,$260.95 ,$348.47 ,$476.00 ,$587.13 ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$340.87 ,$386.96 ,$504.00 ,$390.04 ,$263.56 ,$442.40 ,$34.07 ,$560.00 ,$560.00 ,$260.95 ,$560.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,46000011,94727,HC NITROGEN WASHOUT CURVE,460,1 ,$325.00 ,$162.50 ,$16.35 ,$325.00 ,$16.35 ,$210.24 ,$210.24 ,$137.66 ,$195.00 ,$276.25 ,$227.50 ,$16.35 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 ,$137.66 ,$211.25 ,$211.25 ,$227.50 ,$16.35 ,$137.66 ,$137.66 ,$325.00 ,$276.25 ,$309.74 ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$197.83 ,$224.58 ,$292.50 ,$226.36 ,$139.04 ,$256.75 ,$17.33 ,$325.00 ,$325.00 ,$137.66 ,$325.00 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,46000012,94728,HC AIRFLOW RESISTANCE,460,1 ,$246.00 ,$123.00 ,$32.14 ,$587.13 ,$32.14 ,$159.14 ,$159.14 ,$260.95 ,$147.60 ,$209.10 ,$172.20 ,$32.14 ,$233.70 ,$186.96 ,$184.50 ,$159.90 ,$209.10 ,$260.95 ,$159.90 ,$159.90 ,$172.20 ,$32.14 ,$260.95 ,$260.95 ,$246.00 ,$209.10 ,$587.13 ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$149.74 ,$169.99 ,$221.40 ,$171.34 ,$263.56 ,$194.34 ,$34.07 ,$246.00 ,$246.00 ,$260.95 ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,46000014,94618,HC WALK TEST 6 MIN,460,1 ,$526.00 ,$263.00 ,$16.35 ,$526.00 ,$16.35 ,$340.27 ,$340.27 ,$111.18 ,$315.60 ,$447.10 ,$368.20 ,$16.35 ,$499.70 ,$399.76 ,$394.50 ,$341.90 ,$447.10 ,$111.18 ,$341.90 ,$341.90 ,$368.20 ,$16.35 ,$111.18 ,$111.18 ,$348.47 ,$447.10 ,$250.16 ,$483.92 ,$368.20 ,$266.79 ,$320.18 ,$320.33 ,$320.18 ,$363.47 ,$473.40 ,$366.36 ,$112.29 ,$415.54 ,$17.33 ,$526.00 ,$526.00 ,$111.18 ,$526.00 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$420.80 
ST NICHOLAS HOSPITAL - ACUTE,46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$336.00 ,$168.00 ,$16.35 ,$336.00 ,$16.35 ,$217.36 ,$217.36 , N/A ,$201.60 ,$285.60 ,$235.20 ,$16.35 ,$319.20 ,$255.36 ,$252.00 ,$218.40 ,$285.60 , N/A ,$218.40 ,$218.40 ,$235.20 ,$16.35 , N/A , N/A ,$336.00 ,$285.60 , N/A ,$309.12 ,$235.20 ,$170.42 ,$204.52 ,$204.62 ,$204.52 ,$232.18 ,$302.40 ,$234.02 , N/A ,$265.44 ,$17.33 ,$336.00 ,$336.00 , N/A ,$336.00 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$268.80 
ST NICHOLAS HOSPITAL - ACUTE,46000018,94762,HC OXIMETRY OVERNIGHT,460,1 ,$269.00 ,$134.50 ,$16.35 ,$309.74 ,$16.35 ,$174.02 ,$174.02 ,$137.66 ,$161.40 ,$228.65 ,$188.30 ,$16.35 ,$255.55 ,$204.44 ,$201.75 ,$174.85 ,$228.65 ,$137.66 ,$174.85 ,$174.85 ,$188.30 ,$16.35 ,$137.66 ,$137.66 ,$269.00 ,$228.65 ,$309.74 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$163.74 ,$185.88 ,$242.10 ,$187.36 ,$139.04 ,$212.51 ,$17.33 ,$269.00 ,$269.00 ,$137.66 ,$269.00 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,46000020,95801,HC APNEALINK STUDY/SAT,460,1 ,$360.00 ,$180.00 ,$44.39 ,$360.00 ,$44.39 ,$232.88 ,$232.88 ,$111.18 ,$216.00 ,$306.00 ,$252.00 ,$44.39 ,$342.00 ,$273.60 ,$270.00 ,$234.00 ,$306.00 ,$111.18 ,$234.00 ,$234.00 ,$252.00 ,$44.39 ,$111.18 ,$111.18 ,$348.47 ,$306.00 ,$250.16 ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$219.13 ,$248.76 ,$324.00 ,$250.74 ,$112.29 ,$284.40 ,$47.05 ,$360.00 ,$360.00 ,$111.18 ,$360.00 ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$288.00 
ST NICHOLAS HOSPITAL - ACUTE,46000022,94200,HC MAXIMAL VOL VENTILATION,942,1 ,$224.00 ,$112.00 ,$16.35 ,$224.00 ,$16.35 ,$144.91 ,$144.91 ,$54.89 ,$134.40 ,$190.40 ,$156.80 ,$16.35 ,$212.80 ,$170.24 ,$168.00 ,$145.60 ,$190.40 ,$54.89 ,$145.60 ,$145.60 ,$156.80 ,$16.35 ,$54.89 ,$54.89 ,$130.11 ,$190.40 ,$123.49 ,$206.08 ,$156.80 ,$113.61 ,$136.35 ,$136.42 ,$136.35 ,$154.78 ,$201.60 ,$156.02 ,$55.44 ,$176.96 ,$17.33 ,$133.00 ,$133.00 ,$54.89 ,$133.00 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,46000031,94681,HC CO2/O2 UPTAKE EXPIRED GAS,460,1 ,$795.00 ,$397.50 ,$32.14 ,$795.00 ,$32.14 ,$514.29 ,$514.29 ,$260.95 ,$477.00 ,$675.75 ,$556.50 ,$32.14 ,$755.25 ,$604.20 ,$596.25 ,$516.75 ,$675.75 ,$260.95 ,$516.75 ,$516.75 ,$556.50 ,$32.14 ,$260.95 ,$260.95 ,$348.47 ,$675.75 ,$587.13 ,$731.40 ,$556.50 ,$403.22 ,$483.92 ,$484.16 ,$483.92 ,$549.35 ,$715.50 ,$553.72 ,$263.56 ,$628.05 ,$34.07 ,$625.00 ,$625.00 ,$260.95 ,$625.00 ,$572.40 ,$492.90 ,$572.40 ,$572.40 ,$636.00 
ST NICHOLAS HOSPITAL - ACUTE,46000032,94750,HC PULMONARY COMPLIANCE STUDY,460,1 ,$291.00 ,$145.50 ,$145.50 ,$291.00 , N/A ,$188.25 ,$188.25 , N/A ,$174.60 ,$247.35 ,$203.70 , N/A ,$276.45 ,$221.16 ,$218.25 ,$189.15 ,$247.35 , N/A ,$189.15 ,$189.15 ,$203.70 , N/A , N/A , N/A ,$291.00 ,$247.35 , N/A ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$177.13 ,$201.08 ,$261.90 ,$202.68 , N/A ,$229.89 , N/A ,$291.00 ,$291.00 , N/A ,$291.00 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,46000033,94617,HC EXERCISE TEST BRONCHOSPASM,460,1 ,$291.00 ,$145.50 ,$16.35 ,$291.00 ,$16.35 ,$188.25 ,$188.25 ,$111.18 ,$174.60 ,$247.35 ,$203.70 ,$16.35 ,$276.45 ,$221.16 ,$218.25 ,$189.15 ,$247.35 ,$111.18 ,$189.15 ,$189.15 ,$203.70 ,$16.35 ,$111.18 ,$111.18 ,$291.00 ,$247.35 ,$250.16 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$177.13 ,$201.08 ,$261.90 ,$202.68 ,$112.29 ,$229.89 ,$17.33 ,$291.00 ,$291.00 ,$111.18 ,$291.00 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$232.80 
ST NICHOLAS HOSPITAL - ACUTE,46000034,95070,HC INHALATION BRONCHIAL CHALLENGE TEST W/HISTAMINE/METHACHOLINE,460,1 ,$709.00 ,$354.50 ,$13.37 ,"$1,082.93 ",$13.37 ,$458.65 ,$458.65 ,$481.30 ,$425.40 ,$602.65 ,$496.30 ,$13.37 ,$673.55 ,$538.84 ,$531.75 ,$460.85 ,$602.65 ,$481.30 ,$460.85 ,$460.85 ,$496.30 ,$13.37 ,$481.30 ,$481.30 ,$348.47 ,$602.65 ,"$1,082.93 ",$652.28 ,$496.30 ,$359.60 ,$431.57 ,$431.78 ,$431.57 ,$489.92 ,$638.10 ,$493.82 ,$486.11 ,$560.11 ,$14.17 ,$625.00 ,$625.00 ,$481.30 ,$625.00 ,$510.48 ,$439.58 ,$510.48 ,$510.48 ,$567.20 
ST NICHOLAS HOSPITAL - ACUTE,47000000,92585,HC AUDITORY EVOKED POTENT COMPR,470,1 ,$806.00 ,$403.00 ,$76.94 ,$806.00 , N/A ,$521.40 ,$521.40 , N/A ,$483.60 ,$685.10 ,$564.20 , N/A ,$765.70 ,$612.56 ,$604.50 ,$523.90 ,$685.10 , N/A ,$523.90 ,$523.90 ,$564.20 , N/A , N/A , N/A ,$76.94 ,$685.10 , N/A ,$741.52 ,$564.20 ,$408.80 ,$490.61 ,$490.85 ,$490.61 ,$556.95 ,$725.40 ,$561.38 , N/A ,$636.74 , N/A ,$79.00 ,$79.00 , N/A ,$79.00 ,$580.32 ,$499.72 ,$580.32 ,$580.32 ,$644.80 
ST NICHOLAS HOSPITAL - ACUTE,47000001,92587,HC DISTORTION EVOKED POTENT LTD,470,1 ,$190.00 ,$95.00 ,$25.66 ,$587.13 ,$25.66 ,$122.91 ,$122.91 ,$260.95 ,$114.00 ,$161.50 ,$133.00 ,$25.66 ,$180.50 ,$144.40 ,$142.50 ,$123.50 ,$161.50 ,$260.95 ,$123.50 ,$123.50 ,$133.00 ,$25.66 ,$260.95 ,$260.95 ,$76.94 ,$161.50 ,$587.13 ,$174.80 ,$133.00 ,$96.37 ,$115.65 ,$115.71 ,$115.65 ,$131.29 ,$171.00 ,$132.34 ,$263.56 ,$150.10 ,$27.20 ,$79.00 ,$79.00 ,$260.95 ,$79.00 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,47000003,92586,HC NEWBORN HEARING SCREENING,470,1 ,$280.00 ,$140.00 ,$76.94 ,$280.00 , N/A ,$181.13 ,$181.13 , N/A ,$168.00 ,$238.00 ,$196.00 , N/A ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 , N/A ,$182.00 ,$182.00 ,$196.00 , N/A , N/A , N/A ,$76.94 ,$238.00 , N/A ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 , N/A ,$221.20 , N/A ,$79.00 ,$79.00 , N/A ,$79.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,47000090,92650,HC AEP SCR AUDITORY POT W STIMULI,470,1 ,$250.00 ,$125.00 ,$10.87 ,$250.00 ,$10.87 ,$161.73 ,$161.73 , N/A ,$150.00 ,$212.50 ,$175.00 ,$10.87 ,$237.50 ,$190.00 ,$187.50 ,$162.50 ,$212.50 , N/A ,$162.50 ,$162.50 ,$175.00 ,$10.87 , N/A , N/A ,$76.94 ,$212.50 , N/A ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$174.13 , N/A ,$197.50 ,$11.52 ,$79.00 ,$79.00 , N/A ,$79.00 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,47000091,92651,HC AEP HEARING STATUS DETER BB STIM I AND R,470,1 ,$405.00 ,$202.50 ,$25.66 ,$405.00 ,$25.66 ,$261.99 ,$261.99 ,$137.66 ,$243.00 ,$344.25 ,$283.50 ,$25.66 ,$384.75 ,$307.80 ,$303.75 ,$263.25 ,$344.25 ,$137.66 ,$263.25 ,$263.25 ,$283.50 ,$25.66 ,$137.66 ,$137.66 ,$76.94 ,$344.25 ,$309.74 ,$372.60 ,$283.50 ,$205.42 ,$246.52 ,$246.65 ,$246.52 ,$279.86 ,$364.50 ,$282.08 ,$139.04 ,$319.95 ,$27.20 ,$79.00 ,$79.00 ,$137.66 ,$79.00 ,$291.60 ,$251.10 ,$291.60 ,$291.60 ,$324.00 
ST NICHOLAS HOSPITAL - ACUTE,47100009,92558,HC AUD EVOKED OTOACOUS EMISSIONS SCREENING,471,1 ,$214.00 ,$107.00 ,$10.87 ,$214.00 ,$10.87 ,$138.44 ,$138.44 , N/A ,$128.40 ,$181.90 ,$149.80 ,$10.87 ,$203.30 ,$162.64 ,$160.50 ,$139.10 ,$181.90 , N/A ,$139.10 ,$139.10 ,$149.80 ,$10.87 , N/A , N/A ,$76.94 ,$181.90 , N/A ,$196.88 ,$149.80 ,$108.54 ,$130.26 ,$130.33 ,$130.26 ,$147.87 ,$192.60 ,$149.05 , N/A ,$169.06 ,$11.52 ,$79.00 ,$79.00 , N/A ,$79.00 ,$154.08 ,$132.68 ,$154.08 ,$154.08 ,$171.20 
ST NICHOLAS HOSPITAL - ACUTE,48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$1,616.00 ",$808.00 ,$202.92 ,"$1,616.00 ",$202.92 ,"$1,045.39 ","$1,045.39 ",$553.90 ,$969.60 ,"$1,373.60 ","$1,131.20 ",$202.92 ,"$1,535.20 ","$1,228.16 ","$1,212.00 ","$1,050.40 ","$1,373.60 ",$553.90 ,"$1,050.40 ","$1,050.40 ","$1,131.20 ",$202.92 ,$553.90 ,$553.90 ,$930.02 ,"$1,373.60 ","$1,246.28 ","$1,486.72 ","$1,131.20 ",$819.64 ,$983.66 ,$984.14 ,$983.66 ,"$1,116.66 ","$1,454.40 ","$1,125.54 ",$559.44 ,"$1,276.64 ",$215.10 ,"$1,292.00 ","$1,292.00 ",$553.90 ,"$1,292.00 ","$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ","$1,292.80 "
ST NICHOLAS HOSPITAL - ACUTE,48000007,93281,HC MULTI CHAM PACEMAKER ANALYSIS,480,1 ,$157.00 ,$78.50 ,$12.10 ,$157.00 ,$12.10 ,$101.56 ,$101.56 ,$36.72 ,$94.20 ,$133.45 ,$109.90 ,$12.10 ,$149.15 ,$119.32 ,$117.75 ,$102.05 ,$133.45 ,$36.72 ,$102.05 ,$102.05 ,$109.90 ,$12.10 ,$36.72 ,$36.72 ,$157.00 ,$133.45 ,$82.61 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$95.57 ,$108.49 ,$141.30 ,$109.35 ,$37.09 ,$124.03 ,$12.83 ,$157.00 ,$157.00 ,$36.72 ,$157.00 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$125.60 
ST NICHOLAS HOSPITAL - ACUTE,48000008,G0269,HC PLACE OCCLUSIVE DEVICE A/VV G0269,480,1 ,$474.00 ,$237.00 ,$237.00 ,$474.00 , N/A ,$306.63 ,$306.63 , N/A ,$284.40 ,$402.90 ,$331.80 , N/A ,$450.30 ,$360.24 ,$355.50 ,$308.10 ,$402.90 , N/A ,$308.10 ,$308.10 ,$331.80 , N/A , N/A , N/A ,$474.00 ,$402.90 , N/A ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$288.52 ,$327.53 ,$426.60 ,$330.14 , N/A ,$374.46 , N/A ,$474.00 ,$474.00 , N/A ,$474.00 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,48000011,93285,HC LOOP RECORDER PROGRAMMING,480,1 ,$118.00 ,$59.00 ,$12.10 ,$118.00 ,$12.10 ,$76.33 ,$76.33 ,$36.72 ,$70.80 ,$100.30 ,$82.60 ,$12.10 ,$112.10 ,$89.68 ,$88.50 ,$76.70 ,$100.30 ,$36.72 ,$76.70 ,$76.70 ,$82.60 ,$12.10 ,$36.72 ,$36.72 ,$118.00 ,$100.30 ,$82.61 ,$108.56 ,$82.60 ,$59.85 ,$71.83 ,$71.86 ,$71.83 ,$81.54 ,$106.20 ,$82.19 ,$37.09 ,$93.22 ,$12.83 ,$118.00 ,$118.00 ,$36.72 ,$118.00 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$94.40 
ST NICHOLAS HOSPITAL - ACUTE,48000012,93261,HC S-ICD INTERROGATION,480,1 ,$112.00 ,$56.00 ,$12.10 ,$112.00 ,$12.10 ,$72.45 ,$72.45 ,$36.72 ,$67.20 ,$95.20 ,$78.40 ,$12.10 ,$106.40 ,$85.12 ,$84.00 ,$72.80 ,$95.20 ,$36.72 ,$72.80 ,$72.80 ,$78.40 ,$12.10 ,$36.72 ,$36.72 ,$112.00 ,$95.20 ,$82.61 ,$103.04 ,$78.40 ,$56.81 ,$68.17 ,$68.21 ,$68.17 ,$77.39 ,$100.80 ,$78.01 ,$37.09 ,$88.48 ,$12.83 ,$112.00 ,$112.00 ,$36.72 ,$112.00 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,48000017,93640,HC EP EVAL CARDIO/DEFIB LEADS,480,1 ,"$2,961.00 ","$1,480.50 ",$930.02 ,"$2,961.00 ","$1,946.45 ","$1,915.47 ","$1,915.47 ", N/A ,"$1,776.60 ","$2,516.85 ","$2,072.70 ","$1,946.45 ","$2,812.95 ","$2,250.36 ","$2,220.75 ","$1,924.65 ","$2,516.85 ", N/A ,"$1,924.65 ","$1,924.65 ","$2,072.70 ","$1,946.45 ", N/A , N/A ,$930.02 ,"$2,516.85 ", N/A ,"$2,724.12 ","$2,072.70 ","$1,501.82 ","$1,802.36 ","$1,803.25 ","$1,802.36 ","$2,046.05 ","$2,664.90 ","$2,062.34 ", N/A ,"$2,339.19 ","$2,063.24 ","$1,292.00 ","$1,292.00 ", N/A ,"$1,292.00 ","$2,131.92 ","$1,835.82 ","$2,131.92 ","$2,131.92 ","$2,368.80 "
ST NICHOLAS HOSPITAL - ACUTE,48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$109.00 ,$54.50 ,$52.64 ,$123.49 ,$52.64 ,$70.51 ,$70.51 ,$54.89 ,$65.40 ,$92.65 ,$76.30 ,$52.64 ,$103.55 ,$82.84 ,$81.75 ,$70.85 ,$92.65 ,$54.89 ,$70.85 ,$70.85 ,$76.30 ,$52.64 ,$54.89 ,$54.89 ,$109.00 ,$92.65 ,$123.49 ,$100.28 ,$76.30 ,$55.28 ,$66.35 ,$66.38 ,$66.35 ,$75.32 ,$98.10 ,$75.92 ,$55.44 ,$86.11 ,$55.80 ,$109.00 ,$109.00 ,$54.89 ,$109.00 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$87.20 
ST NICHOLAS HOSPITAL - ACUTE,48100002,33206,HC INS/REPL PCMKR PERM ATRIAL 33206,481,1 ,"$7,918.00 ","$3,959.00 ","$2,606.72 ","$23,067.71 ","$2,606.72 ","$7,918.00 ","$7,918.00 ","$10,252.32 ","$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,606.72 ","$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,918.00 ","$6,730.30 ","$10,252.32 ","$7,918.00 ","$7,918.00 ","$5,542.60 ","$2,606.72 ","$10,252.32 ","$10,252.32 ","$7,918.00 ","$6,730.30 ","$23,067.71 ","$7,284.56 ","$5,542.60 ","$4,794.94 ","$5,993.67 ","$4,822.06 ","$5,993.67 ","$5,471.34 ","$7,126.20 ","$5,514.89 ","$10,354.84 ","$6,255.22 ","$2,763.12 ","$7,918.00 ","$7,918.00 ","$10,252.32 ","$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100003,33207,HC INS/REPL PACEMKR PERM VENTRIC 33207,481,1 ,"$7,918.00 ","$3,959.00 ","$2,606.72 ","$23,067.71 ","$2,606.72 ","$7,918.00 ","$7,918.00 ","$10,252.32 ","$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,606.72 ","$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,918.00 ","$6,730.30 ","$10,252.32 ","$7,918.00 ","$7,918.00 ","$5,542.60 ","$2,606.72 ","$10,252.32 ","$10,252.32 ","$7,918.00 ","$6,730.30 ","$23,067.71 ","$7,284.56 ","$5,542.60 ","$4,794.94 ","$5,993.67 ","$4,822.06 ","$5,993.67 ","$5,471.34 ","$7,126.20 ","$5,514.89 ","$10,354.84 ","$6,255.22 ","$2,763.12 ","$7,918.00 ","$7,918.00 ","$10,252.32 ","$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100004,33208,HC INS/REPL PACEMKR PERM A/V 33208,481,1 ,"$8,881.00 ","$4,440.50 ","$2,606.72 ","$23,067.71 ","$2,606.72 ","$8,881.00 ","$8,881.00 ","$10,252.32 ","$5,328.60 ","$7,548.85 ","$6,216.70 ","$2,606.72 ","$8,436.95 ","$6,749.56 ","$6,660.75 ","$8,881.00 ","$7,548.85 ","$10,252.32 ","$8,881.00 ","$8,881.00 ","$6,216.70 ","$2,606.72 ","$10,252.32 ","$10,252.32 ","$8,881.00 ","$7,548.85 ","$23,067.71 ","$8,170.52 ","$6,216.70 ","$4,794.94 ","$5,993.67 ","$5,408.53 ","$5,993.67 ","$6,136.77 ","$7,992.90 ","$6,185.62 ","$10,354.84 ","$7,015.99 ","$2,763.12 ","$8,881.00 ","$8,881.00 ","$10,252.32 ","$8,881.00 ","$6,394.32 ","$5,506.22 ","$6,394.32 ","$6,394.32 ","$7,104.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100005,33210,HC INS/REPL TPM SGL ELEC/CATH 33210,481,1 ,"$4,280.00 ","$2,140.00 ",$533.72 ,"$18,099.91 ",$533.72 ,"$4,280.00 ","$4,280.00 ","$8,044.40 ","$2,568.00 ","$3,638.00 ","$2,996.00 ",$533.72 ,"$4,066.00 ","$3,252.80 ","$3,210.00 ","$4,280.00 ","$3,638.00 ","$8,044.40 ","$4,280.00 ","$4,280.00 ","$2,996.00 ",$533.72 ,"$8,044.40 ","$8,044.40 ","$4,280.00 ","$3,638.00 ","$18,099.91 ","$3,937.60 ","$2,996.00 ","$4,794.94 ","$5,993.67 ","$2,606.52 ","$5,993.67 ","$2,957.48 ","$3,852.00 ","$2,981.02 ","$8,124.84 ","$3,381.20 ",$565.74 ,"$4,280.00 ","$4,280.00 ","$8,044.40 ","$4,280.00 ","$3,081.60 ","$2,653.60 ","$3,081.60 ","$3,081.60 ","$3,424.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100006,33212,HC INS PULSE GEN SGL CHAMBER 33212,481,1 ,"$7,918.00 ","$3,959.00 ","$2,606.72 ","$18,099.91 ","$2,606.72 ","$7,918.00 ","$7,918.00 ","$8,044.40 ","$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,606.72 ","$7,522.10 ","$6,017.68 ","$5,938.50 ","$6,668.00 ","$6,730.30 ","$8,044.40 ","$6,668.00 ","$4,875.00 ","$5,542.60 ","$2,606.72 ","$8,044.40 ","$8,044.40 ","$7,918.00 ","$6,730.30 ","$18,099.91 ","$7,284.56 ","$5,542.60 ","$4,794.94 ","$5,993.67 ","$4,822.06 ","$5,993.67 ","$5,471.34 ","$7,126.20 ","$5,514.89 ","$8,124.84 ","$6,255.22 ","$2,763.12 ","$7,918.00 ","$7,918.00 ","$8,044.40 ","$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100007,33213,HC INS PULSE GEN DUAL CHAMBER 33213,481,1 ,"$10,031.00 ","$5,015.50 ","$2,606.72 ","$23,067.71 ","$2,606.72 ","$10,031.00 ","$10,031.00 ","$10,252.32 ","$6,018.60 ","$8,526.35 ","$7,021.70 ","$2,606.72 ","$9,529.45 ","$7,623.56 ","$7,523.25 ","$6,668.00 ","$8,526.35 ","$10,252.32 ","$6,668.00 ","$4,875.00 ","$7,021.70 ","$2,606.72 ","$10,252.32 ","$10,252.32 ","$10,031.00 ","$8,526.35 ","$23,067.71 ","$9,228.52 ","$7,021.70 ","$2,642.26 ","$3,303.09 ","$6,108.88 ","$3,303.09 ","$6,931.42 ","$9,027.90 ","$6,986.59 ","$10,354.84 ","$7,924.49 ","$2,763.12 ","$10,031.00 ","$10,031.00 ","$10,252.32 ","$10,031.00 ","$7,222.32 ","$6,219.22 ","$7,222.32 ","$7,222.32 ","$8,024.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100008,33214,HC UPGRADE PACEMAKER SYSTEM 33214,481,1 ,"$14,156.00 ","$7,078.00 ","$2,606.72 ","$23,067.71 ","$2,606.72 ","$14,156.00 ","$11,705.00 ","$10,252.32 ","$8,493.60 ","$12,032.60 ","$9,909.20 ","$2,606.72 ","$13,448.20 ","$10,758.56 ","$10,617.00 ","$14,156.00 ","$12,032.60 ","$10,252.32 ","$14,156.00 ","$14,156.00 ","$9,909.20 ","$2,606.72 ","$10,252.32 ","$10,252.32 ","$14,156.00 ","$12,032.60 ","$23,067.71 ","$13,023.52 ","$9,909.20 ","$4,794.94 ","$5,993.67 ","$8,621.00 ","$5,993.67 ","$9,781.80 ","$12,740.40 ","$9,859.65 ","$10,354.84 ","$11,183.24 ","$2,763.12 ","$14,156.00 ","$14,156.00 ","$10,252.32 ","$14,156.00 ","$10,192.32 ","$8,776.72 ","$10,192.32 ","$10,192.32 ","$11,324.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100009,33215,HC REPOSITION PACE/DEFIB LEAD 33215,481,1 ,"$3,424.00 ","$1,712.00 ",$533.72 ,"$6,350.83 ",$533.72 ,"$3,424.00 ","$3,424.00 ","$2,822.59 ","$2,054.40 ","$2,910.40 ","$2,396.80 ",$533.72 ,"$3,252.80 ","$2,602.24 ","$2,568.00 ","$3,424.00 ","$2,910.40 ","$2,822.59 ","$3,424.00 ","$2,225.60 ","$2,396.80 ",$533.72 ,"$2,822.59 ","$2,822.59 ","$3,424.00 ","$2,910.40 ","$6,350.83 ","$3,150.08 ","$2,396.80 ","$4,794.94 ","$5,993.67 ","$2,085.22 ","$5,993.67 ","$2,365.98 ","$3,081.60 ","$2,384.82 ","$2,850.82 ","$2,704.96 ",$565.74 ,"$3,424.00 ","$3,424.00 ","$2,822.59 ","$3,424.00 ","$2,465.28 ","$2,122.88 ","$2,465.28 ","$2,465.28 ","$2,739.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100010,33216,HC INS ELECTRODE SGL CHAMBER 33216,481,1 ,"$5,901.00 ","$2,950.50 ",$533.72 ,"$18,099.91 ",$533.72 ,"$5,901.00 ","$5,901.00 ","$8,044.40 ","$3,540.60 ","$5,015.85 ","$4,130.70 ",$533.72 ,"$5,605.95 ","$4,484.76 ","$4,425.75 ","$5,901.00 ","$5,015.85 ","$8,044.40 ","$5,901.00 ","$3,835.65 ","$4,130.70 ",$533.72 ,"$8,044.40 ","$8,044.40 ","$5,901.00 ","$5,015.85 ","$18,099.91 ","$5,428.92 ","$4,130.70 ","$4,794.94 ","$5,993.67 ","$3,593.71 ","$5,993.67 ","$4,077.59 ","$5,310.90 ","$4,110.05 ","$8,124.84 ","$4,661.79 ",$565.74 ,"$5,901.00 ","$5,901.00 ","$8,044.40 ","$5,901.00 ","$4,248.72 ","$3,658.62 ","$4,248.72 ","$4,248.72 ","$4,720.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100011,33217,HC INS ELECTRODE DUAL CHAMBER 33217,481,1 ,"$5,778.00 ","$2,889.00 ",$533.72 ,"$18,099.91 ",$533.72 ,"$5,778.00 ","$5,778.00 ","$8,044.40 ","$3,466.80 ","$4,911.30 ","$4,044.60 ",$533.72 ,"$5,489.10 ","$4,391.28 ","$4,333.50 ","$5,778.00 ","$4,911.30 ","$8,044.40 ","$5,778.00 ","$3,755.70 ","$4,044.60 ",$533.72 ,"$8,044.40 ","$8,044.40 ","$5,778.00 ","$4,911.30 ","$18,099.91 ","$5,315.76 ","$4,044.60 ","$4,794.94 ","$5,993.67 ","$3,518.80 ","$5,993.67 ","$3,992.60 ","$5,200.20 ","$4,024.38 ","$8,124.84 ","$4,564.62 ",$565.74 ,"$5,778.00 ","$5,778.00 ","$8,044.40 ","$5,778.00 ","$4,160.16 ","$3,582.36 ","$4,160.16 ","$4,160.16 ","$4,622.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100012,33222,HC REVISE PACEMAKER POCKET 33222,481,1 ,"$3,424.00 ","$1,712.00 ",$533.72 ,"$3,799.81 ",$533.72 ,"$3,424.00 ","$3,424.00 ","$1,688.81 ","$2,054.40 ","$2,910.40 ","$2,396.80 ",$533.72 ,"$3,252.80 ","$2,602.24 ","$2,568.00 ","$3,424.00 ","$2,910.40 ","$1,688.81 ","$3,424.00 ","$3,424.00 ","$2,396.80 ",$533.72 ,"$1,688.81 ","$1,688.81 ","$3,424.00 ","$2,910.40 ","$3,799.81 ","$3,150.08 ","$2,396.80 ","$1,703.02 ","$2,128.52 ","$2,085.22 ","$2,128.52 ","$2,365.98 ","$3,081.60 ","$2,384.82 ","$1,705.70 ","$2,704.96 ",$565.74 ,"$3,424.00 ","$3,424.00 ","$1,688.81 ","$3,424.00 ","$2,465.28 ","$2,122.88 ","$2,465.28 ","$2,465.28 ","$2,739.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100013,33223,HC REVISE C-D POCKET 33223,481,1 ,"$3,007.00 ","$1,503.50 ",$533.72 ,"$3,799.81 ",$533.72 ,"$3,007.00 ","$3,007.00 ","$1,688.81 ","$1,804.20 ","$2,555.95 ","$2,104.90 ",$533.72 ,"$2,856.65 ","$2,285.32 ","$2,255.25 ","$3,007.00 ","$2,555.95 ","$1,688.81 ","$3,007.00 ","$3,007.00 ","$2,104.90 ",$533.72 ,"$1,688.81 ","$1,688.81 ","$3,007.00 ","$2,555.95 ","$3,799.81 ","$2,766.44 ","$2,104.90 ","$1,703.02 ","$2,128.52 ","$1,831.26 ","$2,128.52 ","$2,077.84 ","$2,706.30 ","$2,094.38 ","$1,705.70 ","$2,375.53 ",$565.74 ,"$3,007.00 ","$3,007.00 ","$1,688.81 ","$3,007.00 ","$2,165.04 ","$1,864.34 ","$2,165.04 ","$2,165.04 ","$2,405.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100014,33224,HC INSERT LV PACING ELECTRODE 33224,481,1 ,"$8,507.00 ","$4,253.50 ","$2,606.72 ","$23,067.71 ","$2,606.72 ","$8,507.00 ","$8,507.00 ","$10,252.32 ","$5,104.20 ","$7,230.95 ","$5,954.90 ","$2,606.72 ","$8,081.65 ","$6,465.32 ","$6,380.25 ","$6,993.00 ","$7,230.95 ","$10,252.32 ","$6,993.00 ","$5,529.55 ","$5,954.90 ","$2,606.72 ","$10,252.32 ","$10,252.32 ","$8,507.00 ","$7,230.95 ","$23,067.71 ","$7,826.44 ","$5,954.90 ","$4,794.94 ","$5,993.67 ","$5,180.76 ","$5,993.67 ","$5,878.34 ","$7,656.30 ","$5,925.13 ","$10,354.84 ","$6,720.53 ","$2,763.12 ","$8,507.00 ","$8,507.00 ","$10,252.32 ","$8,507.00 ","$6,125.04 ","$5,274.34 ","$6,125.04 ","$6,125.04 ","$6,805.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100015,33225,HC INS LV PACING ELCT W/C-D/PACE 33225,481,1 ,"$8,346.00 ","$4,173.00 ","$2,606.72 ","$8,346.00 ","$2,606.72 ","$8,346.00 ","$4,923.00 ", N/A ,"$5,007.60 ","$7,094.10 ","$5,842.20 ","$2,606.72 ","$7,928.70 ","$6,342.96 ","$6,259.50 ","$6,993.00 ","$7,094.10 ", N/A ,"$6,993.00 ","$5,424.90 ","$5,842.20 ","$2,606.72 ", N/A , N/A ,"$8,346.00 ","$7,094.10 ", N/A ,"$7,678.32 ","$5,842.20 ","$4,794.94 ","$5,993.67 ","$5,082.71 ","$5,993.67 ","$5,767.09 ","$7,511.40 ","$5,812.99 ", N/A ,"$6,593.34 ","$2,763.12 ","$8,346.00 ","$8,346.00 ", N/A ,"$8,346.00 ","$6,009.12 ","$5,174.52 ","$6,009.12 ","$6,009.12 ","$6,676.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100016,33226,HC REPOSITION LV ELECTRODE 33226,481,1 ,"$3,852.00 ","$1,926.00 ","$1,926.00 ","$6,350.83 ","$2,195.90 ","$3,852.00 ","$3,852.00 ","$2,822.59 ","$2,311.20 ","$3,274.20 ","$2,696.40 ","$2,195.90 ","$3,659.40 ","$2,927.52 ","$2,889.00 ","$3,852.00 ","$3,274.20 ","$2,822.59 ","$3,852.00 ","$2,503.80 ","$2,696.40 ","$2,195.90 ","$2,822.59 ","$2,822.59 ","$3,852.00 ","$3,274.20 ","$6,350.83 ","$3,543.84 ","$2,696.40 ","$4,794.94 ","$5,993.67 ","$2,345.87 ","$5,993.67 ","$2,661.73 ","$3,466.80 ","$2,682.92 ","$2,850.82 ","$3,043.08 ","$2,327.65 ","$3,852.00 ","$3,852.00 ","$2,822.59 ","$3,852.00 ","$2,773.44 ","$2,388.24 ","$2,773.44 ","$2,773.44 ","$3,081.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100017,33233,HC REMOVE PPM 33233,481,1 ,"$3,638.00 ","$1,819.00 ","$1,819.00 ","$18,099.91 ","$2,195.90 ","$3,638.00 ","$3,638.00 ","$8,044.40 ","$2,182.80 ","$3,092.30 ","$2,546.60 ","$2,195.90 ","$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ","$8,044.40 ","$3,638.00 ","$3,638.00 ","$2,546.60 ","$2,195.90 ","$8,044.40 ","$8,044.40 ","$3,638.00 ","$3,092.30 ","$18,099.91 ","$3,346.96 ","$2,546.60 ","$4,794.94 ","$5,993.67 ","$2,215.54 ","$5,993.67 ","$2,513.86 ","$3,274.20 ","$2,533.87 ","$8,124.84 ","$2,874.02 ","$2,327.65 ","$3,638.00 ","$3,638.00 ","$8,044.40 ","$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100018,33234,HC REMOVE ELECTRODE SGL 33234,481,1 ,"$3,092.00 ","$1,546.00 ",$533.72 ,"$7,639.38 ",$533.72 ,"$3,092.00 ","$3,092.00 ","$3,395.28 ","$1,855.20 ","$2,628.20 ","$2,164.40 ",$533.72 ,"$2,937.40 ","$2,349.92 ","$2,319.00 ","$2,815.00 ","$2,628.20 ","$3,395.28 ","$2,815.00 ","$2,717.00 ","$2,164.40 ",$533.72 ,"$3,395.28 ","$3,395.28 ","$3,092.00 ","$2,628.20 ","$7,639.38 ","$2,844.64 ","$2,164.40 ","$4,794.94 ","$5,993.67 ","$1,883.03 ","$5,993.67 ","$2,136.57 ","$2,782.80 ","$2,153.58 ","$3,429.23 ","$2,442.68 ",$565.74 ,"$3,092.00 ","$3,092.00 ","$3,395.28 ","$3,092.00 ","$2,226.24 ","$1,917.04 ","$2,226.24 ","$2,226.24 ","$2,473.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100019,33235,HC REMOVE ELECTRODE DUAL 33235,481,1 ,"$2,461.00 ","$1,230.50 ",$533.72 ,"$7,639.38 ",$533.72 ,"$2,461.00 ","$2,461.00 ","$3,395.28 ","$1,476.60 ","$2,091.85 ","$1,722.70 ",$533.72 ,"$2,337.95 ","$1,870.36 ","$1,845.75 ","$2,461.00 ","$2,091.85 ","$3,395.28 ","$2,461.00 ","$2,461.00 ","$1,722.70 ",$533.72 ,"$3,395.28 ","$3,395.28 ","$2,461.00 ","$2,091.85 ","$7,639.38 ","$2,264.12 ","$1,722.70 ","$4,794.94 ","$5,993.67 ","$1,498.75 ","$5,993.67 ","$1,700.55 ","$2,214.90 ","$1,714.09 ","$3,429.23 ","$1,944.19 ",$565.74 ,"$2,461.00 ","$2,461.00 ","$3,395.28 ","$2,461.00 ","$1,771.92 ","$1,525.82 ","$1,771.92 ","$1,771.92 ","$1,968.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100020,33240,HC INSERT SGL/DUAL CHAMBER C-D 33240,481,1 ,"$12,498.00 ","$6,249.00 ","$4,794.94 ","$51,158.10 ","$7,815.70 ","$12,498.00 ","$12,498.00 ","$22,736.93 ","$7,498.80 ","$10,623.30 ","$8,748.60 ","$7,815.70 ","$11,873.10 ","$9,498.48 ","$9,373.50 ","$12,498.00 ","$10,623.30 ","$22,736.93 ","$12,498.00 ","$12,498.00 ","$8,748.60 ","$7,815.70 ","$22,736.93 ","$22,736.93 ","$12,498.00 ","$10,623.30 ","$51,158.10 ","$11,498.16 ","$8,748.60 ","$4,794.94 ","$5,993.67 ","$7,611.28 ","$5,993.67 ","$8,636.12 ","$11,248.20 ","$8,704.86 ","$22,964.30 ","$9,873.42 ","$8,284.64 ","$12,498.00 ","$12,498.00 ","$22,736.93 ","$12,498.00 ","$8,998.56 ","$7,748.76 ","$8,998.56 ","$8,998.56 ","$9,998.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100022,33241,HC REMOVE C-D PULSE GENERATOR 33241,481,1 ,"$3,103.00 ","$1,551.50 ","$1,551.50 ","$7,639.38 ","$2,195.90 ","$3,103.00 ","$3,103.00 ","$3,395.28 ","$1,861.80 ","$2,637.55 ","$2,172.10 ","$2,195.90 ","$2,947.85 ","$2,358.28 ","$2,327.25 ","$2,815.00 ","$2,637.55 ","$3,395.28 ","$2,815.00 ","$2,717.00 ","$2,172.10 ","$2,195.90 ","$3,395.28 ","$3,395.28 ","$3,103.00 ","$2,637.55 ","$7,639.38 ","$2,854.76 ","$2,172.10 ","$4,794.94 ","$5,993.67 ","$1,889.73 ","$5,993.67 ","$2,144.17 ","$2,792.70 ","$2,161.24 ","$3,429.23 ","$2,451.37 ","$2,327.65 ","$3,103.00 ","$3,103.00 ","$3,395.28 ","$3,103.00 ","$2,234.16 ","$1,923.86 ","$2,234.16 ","$2,234.16 ","$2,482.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100023,33244,HC REMOVE C-D ELECTRODES 33244,481,1 ,"$2,782.00 ","$1,391.00 ",$533.72 ,"$7,639.38 ",$533.72 ,"$2,782.00 ","$2,782.00 ","$3,395.28 ","$1,669.20 ","$2,364.70 ","$1,947.40 ",$533.72 ,"$2,642.90 ","$2,114.32 ","$2,086.50 ","$2,782.00 ","$2,364.70 ","$3,395.28 ","$2,782.00 ","$2,782.00 ","$1,947.40 ",$533.72 ,"$3,395.28 ","$3,395.28 ","$2,782.00 ","$2,364.70 ","$7,639.38 ","$2,559.44 ","$1,947.40 ","$4,794.94 ","$5,993.67 ","$1,694.24 ","$5,993.67 ","$1,922.36 ","$2,503.80 ","$1,937.66 ","$3,429.23 ","$2,197.78 ",$565.74 ,"$2,782.00 ","$2,782.00 ","$3,395.28 ","$2,782.00 ","$2,003.04 ","$1,724.84 ","$2,003.04 ","$2,003.04 ","$2,225.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100024,33249,HC INS/REPOS DEFIB LEAD/GEN 33249,481,1 ,"$19,260.00 ","$9,630.00 ","$4,794.94 ","$72,872.20 ","$7,815.70 ","$19,260.00 ","$13,525.00 ","$32,387.64 ","$11,556.00 ","$16,371.00 ","$13,482.00 ","$7,815.70 ","$18,297.00 ","$14,637.60 ","$14,445.00 ","$19,260.00 ","$16,371.00 ","$32,387.64 ","$19,260.00 ","$19,260.00 ","$13,482.00 ","$7,815.70 ","$32,387.64 ","$32,387.64 ","$19,260.00 ","$16,371.00 ","$72,872.20 ","$17,719.20 ","$13,482.00 ","$4,794.94 ","$5,993.67 ","$11,729.34 ","$5,993.67 ","$13,308.66 ","$17,334.00 ","$13,414.59 ","$32,711.52 ","$15,215.40 ","$8,284.64 ","$19,260.00 ","$19,260.00 ","$32,387.64 ","$19,260.00 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$15,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100028,33285,HC IMPLANT CARDIAC EVENT RECORDER,481,1 ,"$6,099.00 ","$3,049.50 ","$2,606.72 ","$18,099.91 ","$2,606.72 ","$6,099.00 ","$6,099.00 ","$8,044.40 ","$3,659.40 ","$5,184.15 ","$4,269.30 ","$2,606.72 ","$5,794.05 ","$4,635.24 ","$4,574.25 ","$6,099.00 ","$5,184.15 ","$8,044.40 ","$6,099.00 ","$3,964.35 ","$4,269.30 ","$2,606.72 ","$8,044.40 ","$8,044.40 ","$6,099.00 ","$5,184.15 ","$18,099.91 ","$5,611.08 ","$4,269.30 ","$4,794.94 ","$5,993.67 ","$3,714.29 ","$5,993.67 ","$4,214.41 ","$5,489.10 ","$4,247.95 ","$8,124.84 ","$4,818.21 ","$2,763.12 ","$6,099.00 ","$6,099.00 ","$8,044.40 ","$6,099.00 ","$4,391.28 ","$3,781.38 ","$4,391.28 ","$4,391.28 ","$4,879.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100029,33286,HC REMOVE CARDIAC EVENT RECORDER,481,1 ,"$1,712.00 ",$856.00 ,$533.72 ,"$5,993.67 ",$533.72 ,"$1,712.00 ","$1,712.00 ",$613.58 ,"$1,027.20 ","$1,455.20 ","$1,198.40 ",$533.72 ,"$1,626.40 ","$1,301.12 ","$1,284.00 ","$1,712.00 ","$1,455.20 ",$613.58 ,"$1,712.00 ","$1,112.80 ","$1,198.40 ",$533.72 ,$613.58 ,$613.58 ,"$1,712.00 ","$1,455.20 ","$1,380.55 ","$1,575.04 ","$1,198.40 ","$4,794.94 ","$5,993.67 ","$1,042.61 ","$5,993.67 ","$1,182.99 ","$1,540.80 ","$1,192.41 ",$619.72 ,"$1,352.48 ",$565.74 ,"$1,712.00 ","$1,712.00 ",$613.58 ,"$1,712.00 ","$1,232.64 ","$1,061.44 ","$1,232.64 ","$1,232.64 ","$1,369.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100030,33967,HC IABP INSERTION 33967,481,1 ,"$2,247.00 ","$1,123.50 ","$1,123.50 ","$5,993.67 ","$2,606.72 ","$2,247.00 ","$2,247.00 ", N/A ,"$1,348.20 ","$1,909.95 ","$1,572.90 ","$2,606.72 ","$2,134.65 ","$1,707.72 ","$1,685.25 ","$2,247.00 ","$1,909.95 ", N/A ,"$2,247.00 ","$2,247.00 ","$1,572.90 ","$2,606.72 ", N/A , N/A ,"$2,247.00 ","$1,909.95 ", N/A ,"$2,067.24 ","$1,572.90 ","$4,794.94 ","$5,993.67 ","$1,368.42 ","$5,993.67 ","$1,552.68 ","$2,022.30 ","$1,565.04 ", N/A ,"$1,775.13 ","$2,763.12 ","$2,247.00 ","$2,247.00 ", N/A ,"$2,247.00 ","$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,797.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100032,33968,HC REMV BALLN INTRA-AORTIC PERC,481,1 ,"$2,262.00 ","$1,131.00 ","$1,131.00 ","$5,993.67 ","$2,195.90 ","$2,262.00 ","$2,262.00 ", N/A ,"$1,357.20 ","$1,922.70 ","$1,583.40 ","$2,195.90 ","$2,148.90 ","$1,719.12 ","$1,696.50 ","$2,262.00 ","$1,922.70 ", N/A ,"$2,262.00 ","$2,262.00 ","$1,583.40 ","$2,195.90 ", N/A , N/A ,"$2,262.00 ","$1,922.70 ", N/A ,"$2,081.04 ","$1,583.40 ","$4,794.94 ","$5,993.67 ","$1,377.56 ","$5,993.67 ","$1,563.04 ","$2,035.80 ","$1,575.48 ", N/A ,"$1,786.98 ","$2,327.65 ","$2,262.00 ","$2,262.00 ", N/A ,"$2,262.00 ","$1,628.64 ","$1,402.44 ","$1,628.64 ","$1,628.64 ","$1,809.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100034,35226,HC REPAIR BLOOD VESSEL,481,1 ,"$1,876.00 ",$938.00 ,$613.58 ,"$5,993.67 ",$681.85 ,"$1,876.00 ","$1,876.00 ",$613.58 ,"$1,125.60 ","$1,594.60 ","$1,313.20 ",$681.85 ,"$1,782.20 ","$1,425.76 ","$1,407.00 ","$1,876.00 ","$1,594.60 ",$613.58 ,"$1,876.00 ","$1,876.00 ","$1,313.20 ",$681.85 ,$613.58 ,$613.58 ,"$1,876.00 ","$1,594.60 ","$1,380.55 ","$1,725.92 ","$1,313.20 ","$4,794.94 ","$5,993.67 ","$1,142.48 ","$5,993.67 ","$1,296.32 ","$1,688.40 ","$1,306.63 ",$619.72 ,"$1,482.04 ",$722.76 ,"$1,876.00 ","$1,876.00 ",$613.58 ,"$1,876.00 ","$1,350.72 ","$1,163.12 ","$1,350.72 ","$1,350.72 ","$1,500.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100039,36010,HC INTRO CATH VENA CAVA SUP/IN,481,1 ,"$1,232.00 ",$616.00 ,$199.61 ,"$1,232.00 ",$199.61 ,"$1,232.00 ","$1,232.00 ", N/A ,$739.20 ,"$1,047.20 ",$862.40 ,$199.61 ,"$1,170.40 ",$936.32 ,$924.00 ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,232.00 ","$1,232.00 ",$862.40 ,$199.61 , N/A , N/A ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,133.44 ",$862.40 ,"$1,232.00 ","$1,232.00 ",$750.29 ,"$1,232.00 ",$851.31 ,"$1,108.80 ",$858.09 , N/A ,$973.28 ,$211.59 ,"$1,232.00 ","$1,232.00 ", N/A ,"$1,232.00 ",$887.04 ,$763.84 ,$887.04 ,$887.04 ,$985.60 
ST NICHOLAS HOSPITAL - ACUTE,48100040,36011,"HC CATH PLCMT VENOUS, 1ST ORDER",481,1 ,"$1,017.00 ",$508.50 ,$199.61 ,"$1,017.00 ",$199.61 ,"$1,017.00 ","$1,017.00 ", N/A ,$610.20 ,$864.45 ,$711.90 ,$199.61 ,$966.15 ,$772.92 ,$762.75 ,"$1,017.00 ",$864.45 , N/A ,"$1,017.00 ","$1,017.00 ",$711.90 ,$199.61 , N/A , N/A ,"$1,017.00 ",$864.45 , N/A ,$935.64 ,$711.90 ,"$1,017.00 ","$1,017.00 ",$619.35 ,"$1,017.00 ",$702.75 ,$915.30 ,$708.34 , N/A ,$803.43 ,$211.59 ,"$1,017.00 ","$1,017.00 ", N/A ,"$1,017.00 ",$732.24 ,$630.54 ,$732.24 ,$732.24 ,$813.60 
ST NICHOLAS HOSPITAL - ACUTE,48100041,36012,"HC CATH PLCMT VENOUS, 2ND ORDER",481,1 ,"$1,177.00 ",$588.50 ,$199.61 ,"$1,177.00 ",$199.61 ,"$1,177.00 ","$1,177.00 ", N/A ,$706.20 ,"$1,000.45 ",$823.90 ,$199.61 ,"$1,118.15 ",$894.52 ,$882.75 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,177.00 ",$823.90 ,$199.61 , N/A , N/A ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,082.84 ",$823.90 ,"$1,177.00 ","$1,177.00 ",$716.79 ,"$1,177.00 ",$813.31 ,"$1,059.30 ",$819.78 , N/A ,$929.83 ,$211.59 ,"$1,177.00 ","$1,177.00 ", N/A ,"$1,177.00 ",$847.44 ,$729.74 ,$847.44 ,$847.44 ,$941.60 
ST NICHOLAS HOSPITAL - ACUTE,48100042,36013,HC INTRO CATH ARTERY HEART/PULM,481,1 ,$803.00 ,$401.50 ,$199.61 ,$803.00 ,$199.61 ,$803.00 ,$803.00 , N/A ,$481.80 ,$682.55 ,$562.10 ,$199.61 ,$762.85 ,$610.28 ,$602.25 ,$803.00 ,$682.55 , N/A ,$803.00 ,$803.00 ,$562.10 ,$199.61 , N/A , N/A ,$803.00 ,$682.55 , N/A ,$738.76 ,$562.10 ,$803.00 ,$803.00 ,$489.03 ,$803.00 ,$554.87 ,$722.70 ,$559.29 , N/A ,$634.37 ,$211.59 ,$803.00 ,$803.00 , N/A ,$803.00 ,$578.16 ,$497.86 ,$578.16 ,$578.16 ,$642.40 
ST NICHOLAS HOSPITAL - ACUTE,48100043,36014,HC SELECT CATH L/R PULM ART,481,1 ,"$1,177.00 ",$588.50 ,$199.61 ,"$1,177.00 ",$199.61 ,"$1,177.00 ","$1,177.00 ", N/A ,$706.20 ,"$1,000.45 ",$823.90 ,$199.61 ,"$1,118.15 ",$894.52 ,$882.75 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,177.00 ",$823.90 ,$199.61 , N/A , N/A ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,082.84 ",$823.90 ,"$1,177.00 ","$1,177.00 ",$716.79 ,"$1,177.00 ",$813.31 ,"$1,059.30 ",$819.78 , N/A ,$929.83 ,$211.59 ,"$1,177.00 ","$1,177.00 ", N/A ,"$1,177.00 ",$847.44 ,$729.74 ,$847.44 ,$847.44 ,$941.60 
ST NICHOLAS HOSPITAL - ACUTE,48100044,36015,HC PLACE CATH ARTERY PULM SEG,481,1 ,$770.00 ,$385.00 ,$199.61 ,$770.00 ,$199.61 ,$770.00 ,$770.00 , N/A ,$462.00 ,$654.50 ,$539.00 ,$199.61 ,$731.50 ,$585.20 ,$577.50 ,$770.00 ,$654.50 , N/A ,$770.00 ,$770.00 ,$539.00 ,$199.61 , N/A , N/A ,$770.00 ,$654.50 , N/A ,$708.40 ,$539.00 ,$770.00 ,$770.00 ,$468.93 ,$770.00 ,$532.07 ,$693.00 ,$536.31 , N/A ,$608.30 ,$211.59 ,$770.00 ,$770.00 , N/A ,$770.00 ,$554.40 ,$477.40 ,$554.40 ,$554.40 ,$616.00 
ST NICHOLAS HOSPITAL - ACUTE,48100045,36100,HC INTRO CATH/NDLE CAROTID/VERTB,481,1 ,"$1,568.00 ",$784.00 ,$199.61 ,"$1,568.00 ",$199.61 ,"$1,568.00 ","$1,568.00 ", N/A ,$940.80 ,"$1,332.80 ","$1,097.60 ",$199.61 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ","$1,568.00 ","$1,332.80 ", N/A ,"$1,568.00 ","$1,568.00 ","$1,097.60 ",$199.61 , N/A , N/A ,"$1,568.00 ","$1,332.80 ", N/A ,"$1,442.56 ","$1,097.60 ","$1,568.00 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,411.20 ","$1,092.11 ", N/A ,"$1,238.72 ",$211.59 ,"$1,568.00 ","$1,568.00 ", N/A ,"$1,568.00 ","$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100047,36140,HC INTRO NDL/CATH ARTERY EXTREM 36140,481,1 ,"$1,232.00 ",$616.00 ,$199.61 ,"$1,232.00 ",$199.61 ,"$1,232.00 ","$1,232.00 ", N/A ,$739.20 ,"$1,047.20 ",$862.40 ,$199.61 ,"$1,170.40 ",$936.32 ,$924.00 ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,232.00 ","$1,232.00 ",$862.40 ,$199.61 , N/A , N/A ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,133.44 ",$862.40 ,"$1,232.00 ","$1,232.00 ",$750.29 ,"$1,232.00 ",$851.31 ,"$1,108.80 ",$858.09 , N/A ,$973.28 ,$211.59 ,"$1,232.00 ","$1,232.00 ", N/A ,"$1,232.00 ",$887.04 ,$763.84 ,$887.04 ,$887.04 ,$985.60 
ST NICHOLAS HOSPITAL - ACUTE,48100050,36160,HC INTRO AORTIC TRANSLUMBR,481,1 ,$535.00 ,$267.50 ,$199.61 ,$535.00 ,$199.61 ,$535.00 ,$535.00 , N/A ,$321.00 ,$454.75 ,$374.50 ,$199.61 ,$508.25 ,$406.60 ,$401.25 ,$535.00 ,$454.75 , N/A ,$535.00 ,$535.00 ,$374.50 ,$199.61 , N/A , N/A ,$535.00 ,$454.75 , N/A ,$492.20 ,$374.50 ,$535.00 ,$535.00 ,$325.82 ,$535.00 ,$369.69 ,$481.50 ,$372.63 , N/A ,$422.65 ,$211.59 ,$535.00 ,$535.00 , N/A ,$535.00 ,$385.20 ,$331.70 ,$385.20 ,$385.20 ,$428.00 
ST NICHOLAS HOSPITAL - ACUTE,48100051,36200,HC INTRO CATH AORTA 36200,481,1 ,"$1,568.00 ",$784.00 ,$199.61 ,"$1,568.00 ",$199.61 ,"$1,568.00 ","$1,568.00 ", N/A ,$940.80 ,"$1,332.80 ","$1,097.60 ",$199.61 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ","$1,568.00 ","$1,332.80 ", N/A ,"$1,568.00 ","$1,568.00 ","$1,097.60 ",$199.61 , N/A , N/A ,"$1,568.00 ","$1,332.80 ", N/A ,"$1,442.56 ","$1,097.60 ","$1,568.00 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,411.20 ","$1,092.11 ", N/A ,"$1,238.72 ",$211.59 ,"$1,568.00 ","$1,568.00 ", N/A ,"$1,568.00 ","$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100052,36215,HC PLACE CATH THOR/BRAC 1ST ORDER 36215,481,1 ,$773.00 ,$386.50 ,$199.61 ,$773.00 ,$199.61 ,$773.00 ,$773.00 , N/A ,$463.80 ,$657.05 ,$541.10 ,$199.61 ,$734.35 ,$587.48 ,$579.75 ,$773.00 ,$657.05 , N/A ,$773.00 ,$773.00 ,$541.10 ,$199.61 , N/A , N/A ,$773.00 ,$657.05 , N/A ,$711.16 ,$541.10 ,$773.00 ,$773.00 ,$470.76 ,$773.00 ,$534.14 ,$695.70 ,$538.39 , N/A ,$610.67 ,$211.59 ,$773.00 ,$773.00 , N/A ,$773.00 ,$556.56 ,$479.26 ,$556.56 ,$556.56 ,$618.40 
ST NICHOLAS HOSPITAL - ACUTE,48100053,36216,HC PL CATH THOR/BRAC 2ND ORDER 36216,481,1 ,"$1,568.00 ",$784.00 ,$199.61 ,"$1,568.00 ",$199.61 ,"$1,568.00 ","$1,568.00 ", N/A ,$940.80 ,"$1,332.80 ","$1,097.60 ",$199.61 ,"$1,489.60 ","$1,191.68 ","$1,176.00 ","$1,568.00 ","$1,332.80 ", N/A ,"$1,568.00 ","$1,568.00 ","$1,097.60 ",$199.61 , N/A , N/A ,"$1,568.00 ","$1,332.80 ", N/A ,"$1,442.56 ","$1,097.60 ","$1,568.00 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,411.20 ","$1,092.11 ", N/A ,"$1,238.72 ",$211.59 ,"$1,568.00 ","$1,568.00 ", N/A ,"$1,568.00 ","$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ","$1,254.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100054,36217,HC PL CATH THOR/BRAC 3RD ORDER 36217,481,1 ,"$1,680.00 ",$840.00 ,$199.61 ,"$1,680.00 ",$199.61 ,"$1,680.00 ","$1,680.00 ", N/A ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$199.61 ,"$1,596.00 ","$1,276.80 ","$1,260.00 ","$1,680.00 ","$1,428.00 ", N/A ,"$1,680.00 ","$1,680.00 ","$1,176.00 ",$199.61 , N/A , N/A ,"$1,680.00 ","$1,428.00 ", N/A ,"$1,545.60 ","$1,176.00 ","$1,680.00 ","$1,680.00 ","$1,023.12 ","$1,680.00 ","$1,160.88 ","$1,512.00 ","$1,170.12 ", N/A ,"$1,327.20 ",$211.59 ,"$1,680.00 ","$1,680.00 ", N/A ,"$1,680.00 ","$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100055,36218,HC PL CATH THOR/BRAC ADDL 36218,481,1 ,$750.00 ,$375.00 ,$199.61 ,"$2,128.52 ",$199.61 ,$750.00 ,$750.00 , N/A ,$450.00 ,$637.50 ,$525.00 ,$199.61 ,$712.50 ,$570.00 ,$562.50 ,$750.00 ,$637.50 , N/A ,$750.00 ,$750.00 ,$525.00 ,$199.61 , N/A , N/A ,$750.00 ,$637.50 , N/A ,$690.00 ,$525.00 ,"$1,703.02 ","$2,128.52 ",$456.75 ,"$2,128.52 ",$518.25 ,$675.00 ,$522.38 , N/A ,$592.50 ,$211.59 ,$750.00 ,$750.00 , N/A ,$750.00 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$600.00 
ST NICHOLAS HOSPITAL - ACUTE,48100056,36245,HC ABD 1ST ORDER 36245,481,1 ,"$1,792.00 ",$896.00 ,$199.61 ,"$1,792.00 ",$199.61 ,"$1,792.00 ","$1,792.00 ", N/A ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$199.61 ,"$1,702.40 ","$1,361.92 ","$1,344.00 ","$1,792.00 ","$1,523.20 ", N/A ,"$1,792.00 ","$1,792.00 ","$1,254.40 ",$199.61 , N/A , N/A ,"$1,792.00 ","$1,523.20 ", N/A ,"$1,648.64 ","$1,254.40 ","$1,703.02 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,612.80 ","$1,248.13 ", N/A ,"$1,415.68 ",$211.59 ,"$1,792.00 ","$1,792.00 ", N/A ,"$1,792.00 ","$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,433.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100057,36246,HC ABD INITIAL 2ND ORDER 36246,481,1 ,"$1,456.00 ",$728.00 ,$199.61 ,"$1,456.00 ",$199.61 ,"$1,456.00 ","$1,456.00 ", N/A ,$873.60 ,"$1,237.60 ","$1,019.20 ",$199.61 ,"$1,383.20 ","$1,106.56 ","$1,092.00 ","$1,456.00 ","$1,237.60 ", N/A ,"$1,456.00 ","$1,456.00 ","$1,019.20 ",$199.61 , N/A , N/A ,"$1,456.00 ","$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ","$1,456.00 ","$1,456.00 ",$886.70 ,"$1,456.00 ","$1,006.10 ","$1,310.40 ","$1,014.10 ", N/A ,"$1,150.24 ",$211.59 ,"$1,456.00 ","$1,456.00 ", N/A ,"$1,456.00 ","$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ","$1,164.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100058,36247,HC ABD INT 3RD/PLUS ORDER 36247,481,1 ,"$1,680.00 ",$840.00 ,$199.61 ,"$1,680.00 ",$199.61 ,"$1,680.00 ","$1,680.00 ", N/A ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$199.61 ,"$1,596.00 ","$1,276.80 ","$1,260.00 ","$1,680.00 ","$1,428.00 ", N/A ,"$1,680.00 ","$1,680.00 ","$1,176.00 ",$199.61 , N/A , N/A ,"$1,680.00 ","$1,428.00 ", N/A ,"$1,545.60 ","$1,176.00 ","$1,680.00 ","$1,680.00 ","$1,023.12 ","$1,680.00 ","$1,160.88 ","$1,512.00 ","$1,170.12 ", N/A ,"$1,327.20 ",$211.59 ,"$1,680.00 ","$1,680.00 ", N/A ,"$1,680.00 ","$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100059,36248,HC ABD ADDL 2ND/PLUS ORDER 36248,481,1 ,"$1,232.00 ",$616.00 ,$199.61 ,"$2,128.52 ",$199.61 ,"$1,232.00 ","$1,232.00 ", N/A ,$739.20 ,"$1,047.20 ",$862.40 ,$199.61 ,"$1,170.40 ",$936.32 ,$924.00 ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,232.00 ","$1,232.00 ",$862.40 ,$199.61 , N/A , N/A ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,133.44 ",$862.40 ,"$1,703.02 ","$2,128.52 ",$750.29 ,"$2,128.52 ",$851.31 ,"$1,108.80 ",$858.09 , N/A ,$973.28 ,$211.59 ,"$1,232.00 ","$1,232.00 ", N/A ,"$1,232.00 ",$887.04 ,$763.84 ,$887.04 ,$887.04 ,$985.60 
ST NICHOLAS HOSPITAL - ACUTE,48100060,37184,HC PERIPH THROMBECK ONLY W/TPA 37184,481,1 ,"$4,600.00 ","$2,300.00 ","$1,851.24 ","$22,283.90 ","$1,851.24 ","$4,600.00 ","$4,600.00 ","$9,903.96 ","$2,760.00 ","$3,910.00 ","$3,220.00 ","$1,851.24 ","$4,370.00 ","$3,496.00 ","$3,450.00 ","$4,600.00 ","$3,910.00 ","$9,903.96 ","$4,600.00 ","$2,990.00 ","$3,220.00 ","$1,851.24 ","$9,903.96 ","$9,903.96 ","$4,600.00 ","$3,910.00 ","$22,283.90 ","$4,232.00 ","$3,220.00 ","$4,794.94 ","$5,993.67 ","$2,801.40 ","$5,993.67 ","$3,178.60 ","$4,140.00 ","$3,203.90 ","$10,003.00 ","$3,634.00 ","$1,962.31 ","$4,600.00 ","$4,600.00 ","$9,903.96 ","$4,600.00 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$3,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100061,37185,HC PRIM PERC THROMB EA ADDL 37185,481,1 ,"$3,500.00 ","$1,750.00 ","$1,750.00 ","$5,993.67 ","$1,851.24 ","$3,500.00 ","$3,500.00 ", N/A ,"$2,100.00 ","$2,975.00 ","$2,450.00 ","$1,851.24 ","$3,325.00 ","$2,660.00 ","$2,625.00 ","$3,500.00 ","$2,975.00 ", N/A ,"$3,500.00 ","$2,275.00 ","$2,450.00 ","$1,851.24 ", N/A , N/A ,"$3,500.00 ","$2,975.00 ", N/A ,"$3,220.00 ","$2,450.00 ","$4,794.94 ","$5,993.67 ","$2,131.50 ","$5,993.67 ","$2,418.50 ","$3,150.00 ","$2,437.75 ", N/A ,"$2,765.00 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$2,520.00 ","$2,170.00 ","$2,520.00 ","$2,520.00 ","$2,800.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100062,37186,HC SEC PERC THROMB EA VESSEL ADDL 37186,481,1 ,"$3,500.00 ","$1,750.00 ","$1,750.00 ","$5,993.67 ","$3,445.58 ","$3,500.00 ","$3,500.00 ", N/A ,"$2,100.00 ","$2,975.00 ","$2,450.00 ","$3,445.58 ","$3,325.00 ","$2,660.00 ","$2,625.00 ","$3,500.00 ","$2,975.00 ", N/A ,"$3,500.00 ","$2,275.00 ","$2,450.00 ","$3,445.58 ", N/A , N/A ,"$3,500.00 ","$2,975.00 ", N/A ,"$3,220.00 ","$2,450.00 ","$4,794.94 ","$5,993.67 ","$2,131.50 ","$5,993.67 ","$2,418.50 ","$3,150.00 ","$2,437.75 ", N/A ,"$2,765.00 ","$3,652.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$2,520.00 ","$2,170.00 ","$2,520.00 ","$2,520.00 ","$2,800.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100065,37200,HC BIOPSY TRANSCATHETER,481,1 ,"$2,300.00 ","$1,150.00 ","$1,123.24 ","$10,579.35 ","$1,123.24 ","$2,300.00 ","$2,300.00 ","$4,701.93 ","$1,380.00 ","$1,955.00 ","$1,610.00 ","$1,123.24 ","$2,185.00 ","$1,748.00 ","$1,725.00 ","$2,300.00 ","$1,955.00 ","$4,701.93 ","$2,300.00 ","$2,300.00 ","$1,610.00 ","$1,123.24 ","$4,701.93 ","$4,701.93 ","$2,300.00 ","$1,955.00 ","$10,579.35 ","$2,116.00 ","$1,610.00 ","$4,794.94 ","$5,993.67 ","$1,400.70 ","$5,993.67 ","$1,589.30 ","$2,070.00 ","$1,601.95 ","$4,748.95 ","$1,817.00 ","$1,190.63 ","$2,300.00 ","$2,300.00 ","$4,701.93 ","$2,300.00 ","$1,656.00 ","$1,426.00 ","$1,656.00 ","$1,656.00 ","$1,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100067,61650,HC THPY INFS NON-THROMBO INTITIAL,481,1 ,"$1,600.00 ",$800.00 ,$800.00 ,"$5,993.67 ","$3,529.80 ","$1,600.00 ","$1,600.00 ", N/A ,$960.00 ,"$1,360.00 ","$1,120.00 ","$3,529.80 ","$1,520.00 ","$1,216.00 ","$1,200.00 ","$1,600.00 ","$1,360.00 ", N/A ,"$1,600.00 ","$1,040.00 ","$1,120.00 ","$3,529.80 ", N/A , N/A ,"$1,600.00 ","$1,360.00 ", N/A ,"$1,472.00 ","$1,120.00 ","$4,794.94 ","$5,993.67 ",$974.40 ,"$5,993.67 ","$1,105.60 ","$1,440.00 ","$1,114.40 ", N/A ,"$1,264.00 ","$3,741.59 ","$1,600.00 ","$1,600.00 ", N/A ,"$1,600.00 ","$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ","$1,280.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100069,37241,HC OCCL/EMBOL TRANSCATH PERC 37241,481,1 ,"$6,700.00 ","$3,350.00 ","$3,350.00 ","$22,283.90 ","$3,445.58 ","$6,700.00 ","$6,700.00 ","$9,903.96 ","$4,020.00 ","$5,695.00 ","$4,690.00 ","$3,445.58 ","$6,365.00 ","$5,092.00 ","$5,025.00 ","$6,700.00 ","$5,695.00 ","$9,903.96 ","$6,700.00 ","$4,355.00 ","$4,690.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$6,700.00 ","$5,695.00 ","$22,283.90 ","$6,164.00 ","$4,690.00 ","$4,794.94 ","$5,993.67 ","$4,080.30 ","$5,993.67 ","$4,629.70 ","$6,030.00 ","$4,666.55 ","$10,003.00 ","$5,293.00 ","$3,652.31 ","$6,700.00 ","$6,700.00 ","$9,903.96 ","$6,700.00 ","$4,824.00 ","$4,154.00 ","$4,824.00 ","$4,824.00 ","$5,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100070,37236,HC PL STENT INTRAVAS PERC INIT 37236,481,1 ,"$8,132.00 ","$4,066.00 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$8,132.00 ","$8,132.00 ","$9,903.96 ","$4,879.20 ","$6,912.20 ","$5,692.40 ","$3,445.58 ","$7,725.40 ","$6,180.32 ","$6,099.00 ","$6,993.00 ","$6,912.20 ","$9,903.96 ","$6,993.00 ","$5,285.80 ","$5,692.40 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$8,132.00 ","$6,912.20 ","$22,283.90 ","$7,481.44 ","$5,692.40 ","$4,794.94 ","$5,993.67 ","$4,952.39 ","$5,993.67 ","$5,619.21 ","$7,318.80 ","$5,663.94 ","$10,003.00 ","$6,424.28 ","$3,652.31 ","$8,132.00 ","$8,132.00 ","$9,903.96 ","$8,132.00 ","$5,855.04 ","$5,041.84 ","$5,855.04 ","$5,855.04 ","$6,505.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100071,37237,HC PLACE STENT PERC ADDL 37237,481,1 ,"$6,992.00 ","$3,496.00 ","$3,445.58 ","$6,992.00 ","$3,445.58 ","$6,992.00 ","$4,923.00 ", N/A ,"$4,195.20 ","$5,943.20 ","$4,894.40 ","$3,445.58 ","$6,642.40 ","$5,313.92 ","$5,244.00 ","$6,992.00 ","$5,943.20 ", N/A ,"$6,992.00 ","$4,544.80 ","$4,894.40 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$5,943.20 ", N/A ,"$6,432.64 ","$4,894.40 ","$4,794.94 ","$5,993.67 ","$4,258.13 ","$5,993.67 ","$4,831.47 ","$6,292.80 ","$4,869.93 ", N/A ,"$5,523.68 ","$3,652.31 ","$6,992.00 ","$6,992.00 ", N/A ,"$6,992.00 ","$5,034.24 ","$4,335.04 ","$5,034.24 ","$5,034.24 ","$5,593.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100075,37243,HC EMBOLIZATION UTERINE FIBROID,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,764.00 ","$6,675.00 ","$6,993.00 ","$7,565.00 ","$9,903.96 ","$6,993.00 ","$5,785.00 ","$6,230.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$8,900.00 ","$7,565.00 ","$22,283.90 ","$8,188.00 ","$6,230.00 ","$4,794.94 ","$5,993.67 ","$5,420.10 ","$5,993.67 ","$6,149.90 ","$8,010.00 ","$6,198.85 ","$10,003.00 ","$7,031.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$8,900.00 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$7,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100076,37215,HC PL STENT TRNSCATH CAROT ART W/ 37215,481,1 ,"$6,700.00 ","$3,350.00 ","$3,350.00 ","$6,700.00 ","$3,529.80 ","$6,700.00 ","$6,700.00 ", N/A ,"$4,020.00 ","$5,695.00 ","$4,690.00 ","$3,529.80 ","$6,365.00 ","$5,092.00 ","$5,025.00 ","$6,700.00 ","$5,695.00 ", N/A ,"$6,700.00 ","$4,355.00 ","$4,690.00 ","$3,529.80 ", N/A , N/A ,"$6,700.00 ","$5,695.00 ", N/A ,"$6,164.00 ","$4,690.00 ","$4,794.94 ","$5,993.67 ","$4,080.30 ","$5,993.67 ","$4,629.70 ","$6,030.00 ","$4,666.55 ", N/A ,"$5,293.00 ","$3,741.59 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$4,824.00 ","$4,154.00 ","$4,824.00 ","$4,824.00 ","$5,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$7,597.00 ","$3,798.50 ","$2,776.86 ","$22,283.90 ","$2,776.86 ","$7,597.00 ","$7,597.00 ","$9,903.96 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$2,776.86 ","$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,597.00 ","$6,457.45 ","$9,903.96 ","$7,597.00 ","$4,938.05 ","$5,317.90 ","$2,776.86 ","$9,903.96 ","$9,903.96 ","$7,597.00 ","$6,457.45 ","$22,283.90 ","$6,989.24 ","$5,317.90 ","$7,192.41 ","$8,990.51 ","$4,626.57 ","$8,990.51 ","$5,249.53 ","$6,837.30 ","$5,291.31 ","$10,003.00 ","$6,001.63 ","$2,943.47 ","$7,597.00 ","$7,597.00 ","$9,903.96 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$7,597.00 ","$3,798.50 ","$2,776.86 ","$22,283.90 ","$2,776.86 ","$7,597.00 ","$7,597.00 ","$9,903.96 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$2,776.86 ","$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,597.00 ","$6,457.45 ","$9,903.96 ","$7,597.00 ","$4,938.05 ","$5,317.90 ","$2,776.86 ","$9,903.96 ","$9,903.96 ","$7,597.00 ","$6,457.45 ","$22,283.90 ","$6,989.24 ","$5,317.90 ","$7,192.41 ","$8,990.51 ","$4,626.57 ","$8,990.51 ","$5,249.53 ","$6,837.30 ","$5,291.31 ","$10,003.00 ","$6,001.63 ","$2,943.47 ","$7,597.00 ","$7,597.00 ","$9,903.96 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$18,190.00 ","$9,095.00 ","$5,168.37 ","$35,629.75 ","$5,168.37 ","$18,190.00 ","$11,705.00 ","$15,835.45 ","$10,914.00 ","$15,461.50 ","$12,733.00 ","$5,168.37 ","$17,280.50 ","$13,824.40 ","$13,642.50 ","$10,489.50 ","$15,461.50 ","$15,835.45 ","$10,489.50 ","$11,823.50 ","$12,733.00 ","$5,168.37 ","$15,835.45 ","$15,835.45 ","$18,190.00 ","$15,461.50 ","$35,629.75 ","$16,734.80 ","$12,733.00 ","$7,192.41 ","$8,990.51 ","$11,077.71 ","$8,990.51 ","$12,569.29 ","$16,371.00 ","$12,669.34 ","$15,993.80 ","$14,370.10 ","$5,478.47 ","$15,171.00 ","$15,171.00 ","$15,835.45 ","$15,171.00 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$14,552.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$18,190.00 ","$9,095.00 ","$5,168.37 ","$35,629.75 ","$5,168.37 ","$18,190.00 ","$11,705.00 ","$15,835.45 ","$10,914.00 ","$15,461.50 ","$12,733.00 ","$5,168.37 ","$17,280.50 ","$13,824.40 ","$13,642.50 ","$10,489.50 ","$15,461.50 ","$15,835.45 ","$10,489.50 ","$11,823.50 ","$12,733.00 ","$5,168.37 ","$15,835.45 ","$15,835.45 ","$18,190.00 ","$15,461.50 ","$35,629.75 ","$16,734.80 ","$12,733.00 ","$7,192.41 ","$8,990.51 ","$11,077.71 ","$8,990.51 ","$12,569.29 ","$16,371.00 ","$12,669.34 ","$15,993.80 ","$14,370.10 ","$5,478.47 ","$15,171.00 ","$15,171.00 ","$15,835.45 ","$15,171.00 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$14,552.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100079,37222,HC RVC EN PRC ICA W/ANG EA AD VS 37222,481,1 ,"$6,206.00 ","$3,103.00 ","$3,103.00 ","$6,206.00 ","$3,445.58 ","$6,206.00 ","$4,923.00 ", N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ","$3,445.58 ","$5,895.70 ","$4,716.56 ","$4,654.50 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$4,033.90 ","$4,344.20 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$4,794.94 ","$5,993.67 ","$3,779.45 ","$5,993.67 ","$4,288.35 ","$5,585.40 ","$4,322.48 ", N/A ,"$4,902.74 ","$3,652.31 ","$6,206.00 ","$6,206.00 ", N/A ,"$6,206.00 ","$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$4,964.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100080,37223,HC RVC EN PRC ICA W/TRN ST AD VS 37223,481,1 ,"$7,918.00 ","$3,959.00 ","$3,445.58 ","$7,918.00 ","$3,445.58 ","$7,918.00 ","$4,923.00 ", N/A ,"$4,750.80 ","$6,730.30 ","$5,542.60 ","$3,445.58 ","$7,522.10 ","$6,017.68 ","$5,938.50 ","$6,993.00 ","$6,730.30 ", N/A ,"$6,993.00 ","$5,146.70 ","$5,542.60 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$4,794.94 ","$5,993.67 ","$4,822.06 ","$5,993.67 ","$5,471.34 ","$7,126.20 ","$5,514.89 ", N/A ,"$6,255.22 ","$3,652.31 ","$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$6,955.00 ","$3,477.50 ","$2,776.86 ","$22,283.90 ","$2,776.86 ","$6,955.00 ","$6,955.00 ","$9,903.96 ","$4,173.00 ","$5,911.75 ","$4,868.50 ","$2,776.86 ","$6,607.25 ","$5,285.80 ","$5,216.25 ","$6,955.00 ","$5,911.75 ","$9,903.96 ","$6,955.00 ","$4,520.75 ","$4,868.50 ","$2,776.86 ","$9,903.96 ","$9,903.96 ","$6,955.00 ","$5,911.75 ","$22,283.90 ","$6,398.60 ","$4,868.50 ","$7,192.41 ","$8,990.51 ","$4,235.60 ","$8,990.51 ","$4,805.91 ","$6,259.50 ","$4,844.16 ","$10,003.00 ","$5,494.45 ","$2,943.47 ","$6,955.00 ","$6,955.00 ","$9,903.96 ","$6,955.00 ","$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$5,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$6,955.00 ","$3,477.50 ","$2,776.86 ","$22,283.90 ","$2,776.86 ","$6,955.00 ","$6,955.00 ","$9,903.96 ","$4,173.00 ","$5,911.75 ","$4,868.50 ","$2,776.86 ","$6,607.25 ","$5,285.80 ","$5,216.25 ","$6,955.00 ","$5,911.75 ","$9,903.96 ","$6,955.00 ","$4,520.75 ","$4,868.50 ","$2,776.86 ","$9,903.96 ","$9,903.96 ","$6,955.00 ","$5,911.75 ","$22,283.90 ","$6,398.60 ","$4,868.50 ","$7,192.41 ","$8,990.51 ","$4,235.60 ","$8,990.51 ","$4,805.91 ","$6,259.50 ","$4,844.16 ","$10,003.00 ","$5,494.45 ","$2,943.47 ","$6,955.00 ","$6,955.00 ","$9,903.96 ","$6,955.00 ","$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$5,564.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100082,37225,HC RVC EN PRC F/P W/ANT INT VSL 37225,481,1 ,"$20,330.00 ","$10,165.00 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$19,096.00 ","$11,705.00 ","$9,903.96 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$3,445.58 ","$19,313.50 ","$15,450.80 ","$15,247.50 ","$6,993.00 ","$17,280.50 ","$9,903.96 ","$6,993.00 ","$13,214.50 ","$14,231.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$15,834.06 ","$17,280.50 ","$22,283.90 ","$18,703.60 ","$14,231.00 ","$4,794.94 ","$5,993.67 ","$12,380.97 ","$5,993.67 ","$14,048.03 ","$18,297.00 ","$14,159.85 ","$10,003.00 ","$16,060.70 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,903.96 ","$10,114.00 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$20,330.00 ","$10,165.00 ","$5,168.37 ","$35,629.75 ","$5,168.37 ","$19,096.00 ","$11,705.00 ","$15,835.45 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$5,168.37 ","$19,313.50 ","$15,450.80 ","$15,247.50 ","$10,489.50 ","$17,280.50 ","$15,835.45 ","$10,489.50 ","$13,214.50 ","$14,231.00 ","$5,168.37 ","$15,835.45 ","$15,835.45 ","$20,330.00 ","$17,280.50 ","$35,629.75 ","$18,703.60 ","$14,231.00 ","$7,192.41 ","$8,990.51 ","$12,380.97 ","$8,990.51 ","$14,048.03 ","$18,297.00 ","$14,159.85 ","$15,993.80 ","$16,060.70 ","$5,478.47 ","$15,171.00 ","$15,171.00 ","$15,835.45 ","$15,171.00 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$20,330.00 ","$10,165.00 ","$5,168.37 ","$35,629.75 ","$5,168.37 ","$19,096.00 ","$11,705.00 ","$15,835.45 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$5,168.37 ","$19,313.50 ","$15,450.80 ","$15,247.50 ","$10,489.50 ","$17,280.50 ","$15,835.45 ","$10,489.50 ","$13,214.50 ","$14,231.00 ","$5,168.37 ","$15,835.45 ","$15,835.45 ","$20,330.00 ","$17,280.50 ","$35,629.75 ","$18,703.60 ","$14,231.00 ","$7,192.41 ","$8,990.51 ","$12,380.97 ","$8,990.51 ","$14,048.03 ","$18,297.00 ","$14,159.85 ","$15,993.80 ","$16,060.70 ","$5,478.47 ","$15,171.00 ","$15,171.00 ","$15,835.45 ","$15,171.00 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100084,37227,HC RVC EN PRC F/P W/AN/TR ST INT 37227,481,1 ,"$22,470.00 ","$11,235.00 ","$3,445.58 ","$35,629.75 ","$3,445.58 ","$20,157.00 ","$13,525.00 ","$15,835.45 ","$13,482.00 ","$19,099.50 ","$15,729.00 ","$3,445.58 ","$21,346.50 ","$17,077.20 ","$16,852.50 ","$6,993.00 ","$19,099.50 ","$15,835.45 ","$6,993.00 ","$14,605.50 ","$15,729.00 ","$3,445.58 ","$15,835.45 ","$15,835.45 ","$18,996.34 ","$19,099.50 ","$35,629.75 ","$20,672.40 ","$15,729.00 ","$4,794.94 ","$5,993.67 ","$13,684.23 ","$5,993.67 ","$15,526.77 ","$20,223.00 ","$15,650.36 ","$15,993.80 ","$17,751.30 ","$3,652.31 ","$14,302.00 ","$14,302.00 ","$15,835.45 ","$14,302.00 ","$16,178.40 ","$13,931.40 ","$16,178.40 ","$16,178.40 ","$17,976.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$7,276.00 ","$3,638.00 ","$1,851.24 ","$22,283.90 ","$1,851.24 ","$7,276.00 ","$7,276.00 ","$9,903.96 ","$4,365.60 ","$6,184.60 ","$5,093.20 ","$1,851.24 ","$6,912.20 ","$5,529.76 ","$5,457.00 ","$6,993.00 ","$6,184.60 ","$9,903.96 ","$6,993.00 ","$4,729.40 ","$5,093.20 ","$1,851.24 ","$9,903.96 ","$9,903.96 ","$7,276.00 ","$6,184.60 ","$22,283.90 ","$6,693.92 ","$5,093.20 ","$4,794.94 ","$5,993.67 ","$4,431.08 ","$5,993.67 ","$5,027.72 ","$6,548.40 ","$5,067.73 ","$10,003.00 ","$5,748.04 ","$1,962.31 ","$7,276.00 ","$7,276.00 ","$9,903.96 ","$7,276.00 ","$5,238.72 ","$4,511.12 ","$5,238.72 ","$5,238.72 ","$5,820.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$7,276.00 ","$3,638.00 ","$1,851.24 ","$22,283.90 ","$1,851.24 ","$7,276.00 ","$7,276.00 ","$9,903.96 ","$4,365.60 ","$6,184.60 ","$5,093.20 ","$1,851.24 ","$6,912.20 ","$5,529.76 ","$5,457.00 ","$6,993.00 ","$6,184.60 ","$9,903.96 ","$6,993.00 ","$4,729.40 ","$5,093.20 ","$1,851.24 ","$9,903.96 ","$9,903.96 ","$7,276.00 ","$6,184.60 ","$22,283.90 ","$6,693.92 ","$5,093.20 ","$4,794.94 ","$5,993.67 ","$4,431.08 ","$5,993.67 ","$5,027.72 ","$6,548.40 ","$5,067.73 ","$10,003.00 ","$5,748.04 ","$1,962.31 ","$7,276.00 ","$7,276.00 ","$9,903.96 ","$7,276.00 ","$5,238.72 ","$4,511.12 ","$5,238.72 ","$5,238.72 ","$5,820.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100086,37229,HC RVC EN PRC T/P W/ANT INT VSL 37229,481,1 ,"$19,260.00 ","$9,630.00 ","$3,445.58 ","$35,629.75 ","$3,445.58 ","$19,260.00 ","$13,525.00 ","$15,835.45 ","$11,556.00 ","$16,371.00 ","$13,482.00 ","$3,445.58 ","$18,297.00 ","$14,637.60 ","$14,445.00 ","$6,993.00 ","$16,371.00 ","$15,835.45 ","$6,993.00 ","$12,519.00 ","$13,482.00 ","$3,445.58 ","$15,835.45 ","$15,835.45 ","$18,996.34 ","$16,371.00 ","$35,629.75 ","$17,719.20 ","$13,482.00 ","$4,794.94 ","$5,993.67 ","$11,729.34 ","$5,993.67 ","$13,308.66 ","$17,334.00 ","$13,414.59 ","$15,993.80 ","$15,215.40 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$15,835.45 ","$10,114.00 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$15,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100087,37230,HC RVC EN PRC T/P W/TRN SNT IN VS 37230,481,1 ,"$19,260.00 ","$9,630.00 ","$3,445.58 ","$35,629.75 ","$3,445.58 ","$19,260.00 ","$13,525.00 ","$15,835.45 ","$11,556.00 ","$16,371.00 ","$13,482.00 ","$3,445.58 ","$18,297.00 ","$14,637.60 ","$14,445.00 ","$6,993.00 ","$16,371.00 ","$15,835.45 ","$6,993.00 ","$12,519.00 ","$13,482.00 ","$3,445.58 ","$15,835.45 ","$15,835.45 ","$18,996.34 ","$16,371.00 ","$35,629.75 ","$17,719.20 ","$13,482.00 ","$4,794.94 ","$5,993.67 ","$11,729.34 ","$5,993.67 ","$13,308.66 ","$17,334.00 ","$13,414.59 ","$15,993.80 ","$15,215.40 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$15,835.45 ","$10,114.00 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$15,408.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100088,37231,HC RVC EN PRC T/P W/AN/TR ST IN V 37231,481,1 ,"$24,610.00 ","$12,305.00 ","$3,445.58 ","$35,629.75 ","$3,445.58 ","$20,157.00 ","$13,525.00 ","$15,835.45 ","$14,766.00 ","$20,918.50 ","$17,227.00 ","$3,445.58 ","$23,379.50 ","$18,703.60 ","$18,457.50 ","$6,993.00 ","$20,918.50 ","$15,835.45 ","$6,993.00 ","$15,996.50 ","$17,227.00 ","$3,445.58 ","$15,835.45 ","$15,835.45 ","$18,996.34 ","$20,918.50 ","$35,629.75 ","$22,641.20 ","$17,227.00 ","$4,794.94 ","$5,993.67 ","$14,987.49 ","$5,993.67 ","$17,005.51 ","$22,149.00 ","$17,140.87 ","$15,993.80 ","$19,441.90 ","$3,652.31 ","$14,302.00 ","$14,302.00 ","$15,835.45 ","$14,302.00 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$19,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100089,37232,HC RVC EN PRC T/P W/ANG EA AD VS 37232,481,1 ,"$6,099.00 ","$3,049.50 ","$3,049.50 ","$6,099.00 ","$3,445.58 ","$6,099.00 ","$4,923.00 ", N/A ,"$3,659.40 ","$5,184.15 ","$4,269.30 ","$3,445.58 ","$5,794.05 ","$4,635.24 ","$4,574.25 ","$6,099.00 ","$5,184.15 ", N/A ,"$6,099.00 ","$3,964.35 ","$4,269.30 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$5,184.15 ", N/A ,"$5,611.08 ","$4,269.30 ","$4,794.94 ","$5,993.67 ","$3,714.29 ","$5,993.67 ","$4,214.41 ","$5,489.10 ","$4,247.95 ", N/A ,"$4,818.21 ","$3,652.31 ","$6,099.00 ","$6,099.00 ", N/A ,"$6,099.00 ","$4,391.28 ","$3,781.38 ","$4,391.28 ","$4,391.28 ","$4,879.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100090,37233,HC RVC EN PRC T/P W/ANT EA AD VS 37233,481,1 ,"$14,215.00 ","$7,107.50 ","$3,445.58 ","$14,215.00 ","$3,445.58 ","$8,912.00 ","$4,923.00 ", N/A ,"$8,529.00 ","$12,082.75 ","$9,950.50 ","$3,445.58 ","$13,504.25 ","$10,803.40 ","$10,661.25 ","$6,993.00 ","$12,082.75 ", N/A ,"$6,993.00 ","$9,239.75 ","$9,950.50 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$12,082.75 ", N/A ,"$13,077.80 ","$9,950.50 ","$4,794.94 ","$5,993.67 ","$8,656.94 ","$5,993.67 ","$9,822.57 ","$12,793.50 ","$9,900.75 ", N/A ,"$11,229.85 ","$3,652.31 ","$10,114.00 ","$10,114.00 ", N/A ,"$10,114.00 ","$10,234.80 ","$8,813.30 ","$10,234.80 ","$10,234.80 ","$11,372.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100091,37234,HC RVC EN PRC T/P W/TRN SNT EA VS 37234,481,1 ,"$9,202.00 ","$4,601.00 ","$3,445.58 ","$9,202.00 ","$3,445.58 ","$8,912.00 ","$4,923.00 ", N/A ,"$5,521.20 ","$7,821.70 ","$6,441.40 ","$3,445.58 ","$8,741.90 ","$6,993.52 ","$6,901.50 ","$6,993.00 ","$7,821.70 ", N/A ,"$6,993.00 ","$5,981.30 ","$6,441.40 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$7,821.70 ", N/A ,"$8,465.84 ","$6,441.40 ","$4,794.94 ","$5,993.67 ","$5,604.02 ","$5,993.67 ","$6,358.58 ","$8,281.80 ","$6,409.19 ", N/A ,"$7,269.58 ","$3,652.31 ","$8,832.00 ","$8,832.00 ", N/A ,"$8,832.00 ","$6,625.44 ","$5,705.24 ","$6,625.44 ","$6,625.44 ","$7,361.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100092,37235,HC RVC EN PRC T/P W/AN/TR ST AD V 37235,481,1 ,"$8,881.00 ","$4,440.50 ","$3,445.58 ","$8,881.00 ","$3,445.58 ","$8,881.00 ","$4,923.00 ", N/A ,"$5,328.60 ","$7,548.85 ","$6,216.70 ","$3,445.58 ","$8,436.95 ","$6,749.56 ","$6,660.75 ","$6,993.00 ","$7,548.85 ", N/A ,"$6,993.00 ","$5,772.65 ","$6,216.70 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$7,548.85 ", N/A ,"$8,170.52 ","$6,216.70 ","$4,794.94 ","$5,993.67 ","$5,408.53 ","$5,993.67 ","$6,136.77 ","$7,992.90 ","$6,185.62 ", N/A ,"$7,015.99 ","$3,652.31 ","$8,832.00 ","$8,832.00 ", N/A ,"$8,832.00 ","$6,394.32 ","$5,506.22 ","$6,394.32 ","$6,394.32 ","$7,104.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100093,37252,HC US VASCULAR NON-CORONARY INIT 37252,481,1 ,"$2,200.00 ","$1,100.00 ",$573.58 ,"$2,200.00 ",$573.58 ,"$2,200.00 ","$2,200.00 ", N/A ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$573.58 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$2,200.00 ","$1,870.00 ", N/A ,"$2,200.00 ","$1,430.00 ","$1,540.00 ",$573.58 , N/A , N/A ,"$2,200.00 ","$1,870.00 ", N/A ,"$2,024.00 ","$1,540.00 ","$1,703.02 ","$2,128.52 ","$1,339.80 ","$2,128.52 ","$1,520.20 ","$1,980.00 ","$1,532.30 ", N/A ,"$1,738.00 ",$607.99 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100094,37253,HC US VASCULAR NON-CORON ADDL EA 37253,481,1 ,"$2,000.00 ","$1,000.00 ",$573.58 ,"$2,128.52 ",$573.58 ,"$2,000.00 ","$2,000.00 ", N/A ,"$1,200.00 ","$1,700.00 ","$1,400.00 ",$573.58 ,"$1,900.00 ","$1,520.00 ","$1,500.00 ","$2,000.00 ","$1,700.00 ", N/A ,"$2,000.00 ","$1,300.00 ","$1,400.00 ",$573.58 , N/A , N/A ,"$2,000.00 ","$1,700.00 ", N/A ,"$1,840.00 ","$1,400.00 ","$1,703.02 ","$2,128.52 ","$1,218.00 ","$2,128.52 ","$1,382.00 ","$1,800.00 ","$1,393.00 ", N/A ,"$1,580.00 ",$607.99 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100096,92973,HC PTC TRANSLUM CORONARY THROMB 92973,481,1 ,"$4,601.00 ","$2,300.50 ","$1,902.00 ","$4,601.00 ","$2,701.18 ", N/A , N/A , N/A ,"$2,760.60 ","$3,910.85 ","$3,220.70 ","$2,701.18 ","$4,370.95 ","$3,496.76 ","$3,450.75 ","$4,601.00 ","$3,910.85 ", N/A ,"$4,601.00 ","$2,990.65 ","$3,220.70 ","$2,701.18 ", N/A , N/A , N/A ,"$3,910.85 ", N/A ,"$4,232.92 ","$3,220.70 ","$2,333.63 ","$2,800.63 ","$2,802.01 ","$2,800.63 ","$3,179.29 ","$4,140.90 ","$3,204.60 ", N/A ,"$3,634.79 ","$2,863.25 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$3,312.72 ","$2,852.62 ","$3,312.72 ","$3,312.72 ","$3,680.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100097,92978,HC INTRAVASCULAR ULTRSOUND INTIAL 92978,481,1 ,"$2,200.00 ","$1,100.00 ",$56.46 ,"$2,200.00 ",$56.46 ,"$2,200.00 ","$2,200.00 ", N/A ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$56.46 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$2,200.00 ","$1,870.00 ", N/A ,"$2,200.00 ","$1,430.00 ","$1,540.00 ",$56.46 , N/A , N/A , N/A ,"$1,870.00 ", N/A ,"$2,024.00 ","$1,540.00 ","$1,115.84 ","$1,339.14 ","$1,339.80 ","$1,339.14 ","$1,520.20 ","$1,980.00 ","$1,532.30 ", N/A ,"$1,738.00 ",$59.85 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100098,92979,HC INTRAVASCULAR ULTRSOUND EA ADD 92979,481,1 ,"$1,700.00 ",$850.00 ,$56.46 ,"$1,700.00 ",$56.46 , N/A , N/A , N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$56.46 ,"$1,615.00 ","$1,292.00 ","$1,275.00 ","$1,700.00 ","$1,445.00 ", N/A ,"$1,700.00 ","$1,105.00 ","$1,190.00 ",$56.46 , N/A , N/A , N/A ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ","$1,034.79 ","$1,174.70 ","$1,530.00 ","$1,184.05 ", N/A ,"$1,343.00 ",$59.85 ,"$1,700.00 ","$1,700.00 ", N/A ,"$1,700.00 ","$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100103,92986,HC VALVULOPLASTY AORTIC VALVE 92986,481,1 ,"$8,025.00 ","$4,012.50 ","$2,701.18 ","$10,995.64 ","$2,701.18 ","$8,025.00 ","$8,025.00 ","$4,886.95 ","$4,815.00 ","$6,821.25 ","$5,617.50 ","$2,701.18 ","$7,623.75 ","$6,099.00 ","$6,018.75 ","$2,815.00 ","$6,821.25 ","$4,886.95 ","$2,815.00 ","$2,717.00 ","$5,617.50 ","$2,701.18 ","$4,886.95 ","$4,886.95 ","$7,919.86 ","$6,821.25 ","$10,995.64 ","$7,383.00 ","$5,617.50 ","$4,070.28 ","$4,884.82 ","$4,887.23 ","$4,884.82 ","$5,545.28 ","$7,222.50 ","$5,589.41 ","$4,935.82 ","$6,339.75 ","$2,863.25 ","$8,025.00 ","$8,025.00 ","$4,886.95 ","$8,025.00 ","$5,778.00 ","$4,975.50 ","$5,778.00 ","$5,778.00 ","$6,420.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100104,92987,HC VALVULOPLASTY MITRAL VALVE 92987,481,1 ,"$9,630.00 ","$4,815.00 ","$2,701.18 ","$22,283.90 ","$2,701.18 ","$9,630.00 ","$9,630.00 ","$9,903.96 ","$5,778.00 ","$8,185.50 ","$6,741.00 ","$2,701.18 ","$9,148.50 ","$7,318.80 ","$7,222.50 ","$2,815.00 ","$8,185.50 ","$9,903.96 ","$2,815.00 ","$2,717.00 ","$6,741.00 ","$2,701.18 ","$9,903.96 ","$9,903.96 ","$9,630.00 ","$8,185.50 ","$22,283.90 ","$8,859.60 ","$6,741.00 ","$4,884.34 ","$5,861.78 ","$5,864.67 ","$5,861.78 ","$6,654.33 ","$8,667.00 ","$6,707.30 ","$10,003.00 ","$7,607.70 ","$2,863.25 ","$8,832.00 ","$8,832.00 ","$9,903.96 ","$8,832.00 ","$6,933.60 ","$5,970.60 ","$6,933.60 ","$6,933.60 ","$7,704.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100107,93451,HC CATH RIGHT HEART 93451,481,1 ,"$5,778.00 ","$2,889.00 ",$739.39 ,"$6,433.13 ",$739.39 ,"$5,778.00 ","$5,778.00 ","$2,859.17 ","$3,466.80 ","$4,911.30 ","$4,044.60 ",$739.39 ,"$5,489.10 ","$4,391.28 ","$4,333.50 ","$5,778.00 ","$4,911.30 ","$2,859.17 ","$5,778.00 ","$3,755.70 ","$4,044.60 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$4,911.30 ","$6,433.13 ","$5,315.76 ","$4,044.60 ","$2,930.60 ","$3,517.07 ","$3,518.80 ","$3,517.07 ","$3,992.60 ","$5,200.20 ","$4,024.38 ","$2,887.76 ","$4,564.62 ",$783.75 ,"$5,778.00 ","$5,778.00 ","$2,859.17 ","$5,778.00 ","$4,160.16 ","$3,582.36 ","$4,160.16 ","$4,160.16 ","$4,622.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100108,93452,HC LHC ONLY NO COROS 93452,481,1 ,"$7,490.00 ","$3,745.00 ",$739.39 ,"$7,490.00 ",$739.39 ,"$7,490.00 ","$7,490.00 ","$2,859.17 ","$4,494.00 ","$6,366.50 ","$5,243.00 ",$739.39 ,"$7,115.50 ","$5,692.40 ","$5,617.50 ","$6,993.00 ","$6,366.50 ","$2,859.17 ","$6,993.00 ","$4,868.50 ","$5,243.00 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$6,366.50 ","$6,433.13 ","$6,890.80 ","$5,243.00 ","$3,798.93 ","$4,559.16 ","$4,561.41 ","$4,559.16 ","$5,175.59 ","$6,741.00 ","$5,216.79 ","$2,887.76 ","$5,917.10 ",$783.75 ,"$7,490.00 ","$7,490.00 ","$2,859.17 ","$7,490.00 ","$5,392.80 ","$4,643.80 ","$5,392.80 ","$5,392.80 ","$5,992.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100109,93453,HC RHC/LHC ONLY/NO CORS 93453,481,1 ,"$8,346.00 ","$4,173.00 ",$739.39 ,"$8,346.00 ",$739.39 ,"$8,346.00 ","$8,346.00 ","$2,859.17 ","$5,007.60 ","$7,094.10 ","$5,842.20 ",$739.39 ,"$7,928.70 ","$6,342.96 ","$6,259.50 ","$6,993.00 ","$7,094.10 ","$2,859.17 ","$6,993.00 ","$5,424.90 ","$5,842.20 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$7,094.10 ","$6,433.13 ","$7,678.32 ","$5,842.20 ","$4,233.09 ","$5,080.21 ","$5,082.71 ","$5,080.21 ","$5,767.09 ","$7,511.40 ","$5,812.99 ","$2,887.76 ","$6,593.34 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$6,009.12 ","$5,174.52 ","$6,009.12 ","$6,009.12 ","$6,676.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100110,93454,HC CORONARY ANGIO ONLY/NO LV 93454,481,1 ,"$11,770.00 ","$5,885.00 ",$739.39 ,"$11,770.00 ",$739.39 ,"$11,770.00 ","$11,770.00 ","$2,859.17 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$739.39 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$6,993.00 ","$10,004.50 ","$2,859.17 ","$6,993.00 ","$7,650.50 ","$8,239.00 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$10,004.50 ","$6,433.13 ","$10,828.40 ","$8,239.00 ","$5,969.74 ","$7,164.40 ","$7,167.93 ","$7,164.40 ","$8,133.07 ","$10,593.00 ","$8,197.81 ","$2,887.76 ","$9,298.30 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100111,93455,HC CORO ANGIO  AND  GRAFTS ONLY NO LV 93455,481,1 ,"$10,700.00 ","$5,350.00 ",$739.39 ,"$10,700.00 ",$739.39 ,"$10,700.00 ","$10,700.00 ","$2,859.17 ","$6,420.00 ","$9,095.00 ","$7,490.00 ",$739.39 ,"$10,165.00 ","$8,132.00 ","$8,025.00 ","$6,993.00 ","$9,095.00 ","$2,859.17 ","$6,993.00 ","$6,955.00 ","$7,490.00 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$9,095.00 ","$6,433.13 ","$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,513.09 ","$7,393.70 ","$9,630.00 ","$7,452.55 ","$2,887.76 ","$8,453.00 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100112,93456,HC RHC CORONARY ANGIO/NO LV 93456,481,1 ,"$9,416.00 ","$4,708.00 ",$739.39 ,"$9,416.00 ",$739.39 ,"$9,416.00 ","$9,416.00 ","$2,859.17 ","$5,649.60 ","$8,003.60 ","$6,591.20 ",$739.39 ,"$8,945.20 ","$7,156.16 ","$7,062.00 ","$6,993.00 ","$8,003.60 ","$2,859.17 ","$6,993.00 ","$6,120.40 ","$6,591.20 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$8,003.60 ","$6,433.13 ","$8,662.72 ","$6,591.20 ","$4,775.80 ","$5,731.52 ","$5,734.34 ","$5,731.52 ","$6,506.46 ","$8,474.40 ","$6,558.24 ","$2,887.76 ","$7,438.64 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$6,779.52 ","$5,837.92 ","$6,779.52 ","$6,779.52 ","$7,532.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100113,93457,HC RHC CORO ANGIO  AND  GRAFTS/NO LV 93457,481,1 ,"$10,379.00 ","$5,189.50 ",$739.39 ,"$10,379.00 ",$739.39 ,"$10,379.00 ","$10,379.00 ","$2,859.17 ","$6,227.40 ","$8,822.15 ","$7,265.30 ",$739.39 ,"$9,860.05 ","$7,888.04 ","$7,784.25 ","$6,993.00 ","$8,822.15 ","$2,859.17 ","$6,993.00 ","$6,746.35 ","$7,265.30 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$8,822.15 ","$6,433.13 ","$9,548.68 ","$7,265.30 ","$5,264.23 ","$6,317.70 ","$6,320.81 ","$6,317.70 ","$7,171.89 ","$9,341.10 ","$7,228.97 ","$2,887.76 ","$8,199.41 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$7,472.88 ","$6,434.98 ","$7,472.88 ","$7,472.88 ","$8,303.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100114,93458,HC CORONARY ANGIO WITH LV 93458,481,1 ,"$10,700.00 ","$5,350.00 ",$739.39 ,"$10,700.00 ",$739.39 ,"$10,700.00 ","$10,700.00 ","$2,859.17 ","$6,420.00 ","$9,095.00 ","$7,490.00 ",$739.39 ,"$10,165.00 ","$8,132.00 ","$8,025.00 ","$6,993.00 ","$9,095.00 ","$2,859.17 ","$6,993.00 ","$6,955.00 ","$7,490.00 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$9,095.00 ","$6,433.13 ","$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,513.09 ","$7,393.70 ","$9,630.00 ","$7,452.55 ","$2,887.76 ","$8,453.00 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100115,93459,HC CORONARY ANGIO W GRAFTS AND LV 93459,481,1 ,"$8,774.00 ","$4,387.00 ",$739.39 ,"$8,774.00 ",$739.39 ,"$8,774.00 ","$8,774.00 ","$2,859.17 ","$5,264.40 ","$7,457.90 ","$6,141.80 ",$739.39 ,"$8,335.30 ","$6,668.24 ","$6,580.50 ","$6,993.00 ","$7,457.90 ","$2,859.17 ","$6,993.00 ","$5,703.10 ","$6,141.80 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$7,457.90 ","$6,433.13 ","$8,072.08 ","$6,141.80 ","$4,450.17 ","$5,340.73 ","$5,343.37 ","$5,340.73 ","$6,062.83 ","$7,896.60 ","$6,111.09 ","$2,887.76 ","$6,931.46 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$6,317.28 ","$5,439.88 ","$6,317.28 ","$6,317.28 ","$7,019.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100116,93460,HC RHC/LHC/CORONAY ANGIO AND LV 93460,481,1 ,"$9,309.00 ","$4,654.50 ",$739.39 ,"$9,309.00 ",$739.39 ,"$9,309.00 ","$9,309.00 ","$2,859.17 ","$5,585.40 ","$7,912.65 ","$6,516.30 ",$739.39 ,"$8,843.55 ","$7,074.84 ","$6,981.75 ","$6,993.00 ","$7,912.65 ","$2,859.17 ","$6,993.00 ","$6,050.85 ","$6,516.30 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$7,912.65 ","$6,433.13 ","$8,564.28 ","$6,516.30 ","$4,721.52 ","$5,666.39 ","$5,669.18 ","$5,666.39 ","$6,432.52 ","$8,378.10 ","$6,483.72 ","$2,887.76 ","$7,354.11 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$6,702.48 ","$5,771.58 ","$6,702.48 ","$6,702.48 ","$7,447.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100117,93461,HC RHC/LHC/CORON ANGIO GRAFTS  AND LV 93461,481,1 ,"$11,770.00 ","$5,885.00 ",$739.39 ,"$11,770.00 ",$739.39 ,"$11,770.00 ","$11,770.00 ","$2,859.17 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$739.39 ,"$11,181.50 ","$8,945.20 ","$8,827.50 ","$6,993.00 ","$10,004.50 ","$2,859.17 ","$6,993.00 ","$7,650.50 ","$8,239.00 ",$739.39 ,"$2,859.17 ","$2,859.17 ","$5,657.04 ","$10,004.50 ","$6,433.13 ","$10,828.40 ","$8,239.00 ","$5,969.74 ","$7,164.40 ","$7,167.93 ","$7,164.40 ","$8,133.07 ","$10,593.00 ","$8,197.81 ","$2,887.76 ","$9,298.30 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,859.17 ","$7,543.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100118,93463,HC NITRIC OXIDE STUDY 93463,481,1 ,$482.00 ,$241.00 ,$13.88 ,$482.00 ,$13.88 ,$482.00 ,$482.00 , N/A ,$289.20 ,$409.70 ,$337.40 ,$13.88 ,$457.90 ,$366.32 ,$361.50 ,$482.00 ,$409.70 , N/A ,$482.00 ,$313.30 ,$337.40 ,$13.88 , N/A , N/A , N/A ,$409.70 , N/A ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$293.39 ,$333.06 ,$433.80 ,$335.71 , N/A ,$380.78 ,$14.71 ,$482.00 ,$482.00 , N/A ,$482.00 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,48100119,93567,HC AORTAGRAM 93567,481,1 ,$845.00 ,$422.50 ,$95.13 ,$845.00 ,$95.13 ,$845.00 ,$845.00 , N/A ,$507.00 ,$718.25 ,$591.50 ,$95.13 ,$802.75 ,$642.20 ,$633.75 ,$845.00 ,$718.25 , N/A ,$845.00 ,$549.25 ,$591.50 ,$95.13 , N/A , N/A , N/A ,$718.25 , N/A ,$777.40 ,$591.50 ,$428.58 ,$514.35 ,$514.61 ,$514.35 ,$583.90 ,$760.50 ,$588.54 , N/A ,$667.55 ,$100.84 ,$845.00 ,$845.00 , N/A ,$845.00 ,$608.40 ,$523.90 ,$608.40 ,$608.40 ,$676.00 
ST NICHOLAS HOSPITAL - ACUTE,48100120,93571,HC INTRAVASC DOPP COLOR FLOW INIT 93571,481,1 ,"$1,500.00 ",$750.00 ,$573.58 ,"$1,500.00 ",$573.58 ,"$1,500.00 ","$1,500.00 ", N/A ,$900.00 ,"$1,275.00 ","$1,050.00 ",$573.58 ,"$1,425.00 ","$1,140.00 ","$1,125.00 ","$1,500.00 ","$1,275.00 ", N/A ,"$1,500.00 ",$975.00 ,"$1,050.00 ",$573.58 , N/A , N/A ,"$1,500.00 ","$1,275.00 ", N/A ,"$1,380.00 ","$1,050.00 ",$760.80 ,$913.05 ,$913.50 ,$913.05 ,"$1,036.50 ","$1,350.00 ","$1,044.75 ", N/A ,"$1,185.00 ",$607.99 ,"$1,500.00 ","$1,500.00 ", N/A ,"$1,500.00 ","$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ","$1,200.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100121,93572,HC INTRAVASC DOPP COLOR FLOW ADDL 93572,481,1 ,$780.00 ,$390.00 ,$390.00 ,$780.00 ,$573.58 ,$780.00 ,$780.00 , N/A ,$468.00 ,$663.00 ,$546.00 ,$573.58 ,$741.00 ,$592.80 ,$585.00 ,$780.00 ,$663.00 , N/A ,$780.00 ,$507.00 ,$546.00 ,$573.58 , N/A , N/A , N/A ,$663.00 , N/A ,$717.60 ,$546.00 ,$395.62 ,$474.79 ,$475.02 ,$474.79 ,$538.98 ,$702.00 ,$543.27 , N/A ,$616.20 ,$607.99 ,$780.00 ,$780.00 , N/A ,$780.00 ,$561.60 ,$483.60 ,$561.60 ,$561.60 ,$624.00 
ST NICHOLAS HOSPITAL - ACUTE,48100122,93580,HC PTC W/IMPLNT ATRIAL 93580,481,1 ,"$11,770.00 ","$5,885.00 ","$3,174.49 ","$35,629.75 ","$3,174.49 ","$11,770.00 ","$11,770.00 ","$15,835.45 ","$7,062.00 ","$10,004.50 ","$8,239.00 ","$3,174.49 ","$11,181.50 ","$8,945.20 ","$8,827.50 ","$6,993.00 ","$10,004.50 ","$15,835.45 ","$6,993.00 ","$7,650.50 ","$8,239.00 ","$3,174.49 ","$15,835.45 ","$15,835.45 ","$11,770.00 ","$10,004.50 ","$35,629.75 ","$10,828.40 ","$8,239.00 ","$5,969.74 ","$7,164.40 ","$7,167.93 ","$7,164.40 ","$8,133.07 ","$10,593.00 ","$8,197.81 ","$15,993.80 ","$9,298.30 ","$3,364.96 ","$11,770.00 ","$11,770.00 ","$15,835.45 ","$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100123,93600,HC HIS BUNDLE RECORDING,481,1 ,"$3,638.00 ","$1,819.00 ","$1,819.00 ","$13,484.92 ","$1,946.45 ","$3,638.00 ","$3,638.00 ","$5,993.30 ","$2,182.80 ","$3,092.30 ","$2,546.60 ","$1,946.45 ","$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ","$5,993.30 ","$3,638.00 ","$3,638.00 ","$2,546.60 ","$1,946.45 ","$5,993.30 ","$5,993.30 ","$3,638.00 ","$3,092.30 ","$13,484.92 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,533.87 ","$6,053.23 ","$2,874.02 ","$2,063.24 ","$3,638.00 ","$3,638.00 ","$5,993.30 ","$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100124,93602,HC INTRA-ATRIAL RECORDING,481,1 ,"$3,782.00 ","$1,891.00 ","$1,891.00 ","$13,484.92 ","$1,946.45 ","$3,782.00 ","$3,782.00 ","$5,993.30 ","$2,269.20 ","$3,214.70 ","$2,647.40 ","$1,946.45 ","$3,592.90 ","$2,874.32 ","$2,836.50 ","$3,782.00 ","$3,214.70 ","$5,993.30 ","$3,782.00 ","$3,782.00 ","$2,647.40 ","$1,946.45 ","$5,993.30 ","$5,993.30 ","$3,782.00 ","$3,214.70 ","$13,484.92 ","$3,479.44 ","$2,647.40 ","$1,918.23 ","$2,302.10 ","$2,303.24 ","$2,302.10 ","$2,613.36 ","$3,403.80 ","$2,634.16 ","$6,053.23 ","$2,987.78 ","$2,063.24 ","$3,782.00 ","$3,782.00 ","$5,993.30 ","$3,782.00 ","$2,723.04 ","$2,344.84 ","$2,723.04 ","$2,723.04 ","$3,025.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100125,93609,HC TACHYCARDIA SITE MAPPING 93609,481,1 ,"$3,777.00 ","$1,888.50 ","$1,888.50 ","$5,441.17 ","$5,133.18 ","$3,777.00 ","$3,777.00 ", N/A ,"$2,266.20 ","$3,210.45 ","$2,643.90 ","$5,133.18 ","$3,588.15 ","$2,870.52 ","$2,832.75 ","$3,777.00 ","$3,210.45 ", N/A ,"$3,777.00 ","$3,777.00 ","$2,643.90 ","$5,133.18 ", N/A , N/A ,"$3,777.00 ","$3,210.45 ", N/A ,"$3,474.84 ","$2,643.90 ","$1,915.69 ","$2,299.06 ","$2,300.19 ","$2,299.06 ","$2,609.91 ","$3,399.30 ","$2,630.68 ", N/A ,"$2,983.83 ","$5,441.17 ","$3,777.00 ","$3,777.00 ", N/A ,"$3,777.00 ","$2,719.44 ","$2,341.74 ","$2,719.44 ","$2,719.44 ","$3,021.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100126,93612,HC EP INTRAVENTRIC PACING,481,1 ,"$5,152.00 ","$2,576.00 ","$1,946.45 ","$13,484.92 ","$1,946.45 ","$5,152.00 ","$5,152.00 ","$5,993.30 ","$3,091.20 ","$4,379.20 ","$3,606.40 ","$1,946.45 ","$4,894.40 ","$3,915.52 ","$3,864.00 ","$5,152.00 ","$4,379.20 ","$5,993.30 ","$5,152.00 ","$5,152.00 ","$3,606.40 ","$1,946.45 ","$5,993.30 ","$5,993.30 ","$5,152.00 ","$4,379.20 ","$13,484.92 ","$4,739.84 ","$3,606.40 ","$2,613.09 ","$3,136.02 ","$3,137.57 ","$3,136.02 ","$3,560.03 ","$4,636.80 ","$3,588.37 ","$6,053.23 ","$4,070.08 ","$2,063.24 ","$5,152.00 ","$5,152.00 ","$5,993.30 ","$5,152.00 ","$3,709.44 ","$3,194.24 ","$3,709.44 ","$3,709.44 ","$4,121.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100127,93613,HC EP INTRACARDIAC 3-D MAPPING 93613,481,1 ,"$10,700.00 ","$5,350.00 ","$5,133.18 ","$10,700.00 ","$5,133.18 ","$10,700.00 ","$10,700.00 ", N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ","$5,133.18 ","$10,165.00 ","$8,132.00 ","$8,025.00 ","$10,700.00 ","$9,095.00 ", N/A ,"$10,700.00 ","$10,700.00 ","$7,490.00 ","$5,133.18 ", N/A , N/A ,"$10,700.00 ","$9,095.00 ", N/A ,"$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,513.09 ","$7,393.70 ","$9,630.00 ","$7,452.55 ", N/A ,"$8,453.00 ","$5,441.17 ","$6,801.00 ","$6,801.00 ", N/A ,"$6,801.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100128,93619,HC EP COMPREHENSIVE W/O ARRHYTHMI 93619,481,1 ,"$8,400.00 ","$4,200.00 ","$4,200.00 ","$13,484.92 ","$5,133.18 ","$8,400.00 ","$8,400.00 ","$5,993.30 ","$5,040.00 ","$7,140.00 ","$5,880.00 ","$5,133.18 ","$7,980.00 ","$6,384.00 ","$6,300.00 ","$8,400.00 ","$7,140.00 ","$5,993.30 ","$8,400.00 ","$8,400.00 ","$5,880.00 ","$5,133.18 ","$5,993.30 ","$5,993.30 ","$8,400.00 ","$7,140.00 ","$13,484.92 ","$7,728.00 ","$5,880.00 ","$4,260.48 ","$5,113.08 ","$5,115.60 ","$5,113.08 ","$5,804.40 ","$7,560.00 ","$5,850.60 ","$6,053.23 ","$6,636.00 ","$5,441.17 ","$8,400.00 ","$8,400.00 ","$5,993.30 ","$8,400.00 ","$6,048.00 ","$5,208.00 ","$6,048.00 ","$6,048.00 ","$6,720.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100129,93620,HC EP COMPREHENSIVE W/ ARRHYTHMIA 93620,481,1 ,"$7,952.00 ","$3,976.00 ","$3,976.00 ","$13,484.92 ","$5,133.18 ","$7,952.00 ","$7,952.00 ","$5,993.30 ","$4,771.20 ","$6,759.20 ","$5,566.40 ","$5,133.18 ","$7,554.40 ","$6,043.52 ","$5,964.00 ","$7,952.00 ","$6,759.20 ","$5,993.30 ","$7,952.00 ","$7,952.00 ","$5,566.40 ","$5,133.18 ","$5,993.30 ","$5,993.30 ","$7,952.00 ","$6,759.20 ","$13,484.92 ","$7,315.84 ","$5,566.40 ","$4,033.25 ","$4,840.38 ","$4,842.77 ","$4,840.38 ","$5,494.83 ","$7,156.80 ","$5,538.57 ","$6,053.23 ","$6,282.08 ","$5,441.17 ","$7,952.00 ","$7,952.00 ","$5,993.30 ","$7,952.00 ","$5,725.44 ","$4,930.24 ","$5,725.44 ","$5,725.44 ","$6,361.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100130,93621,HC EP COMPREHENSIVE W/LT ATRIUM 93621,481,1 ,"$7,840.00 ","$3,920.00 ","$3,920.00 ","$7,840.00 ","$5,133.18 ","$7,840.00 ","$7,840.00 ", N/A ,"$4,704.00 ","$6,664.00 ","$5,488.00 ","$5,133.18 ","$7,448.00 ","$5,958.40 ","$5,880.00 ","$7,840.00 ","$6,664.00 ", N/A ,"$7,840.00 ","$7,840.00 ","$5,488.00 ","$5,133.18 ", N/A , N/A ,"$7,840.00 ","$6,664.00 ", N/A ,"$7,212.80 ","$5,488.00 ","$3,976.45 ","$4,772.21 ","$4,774.56 ","$4,772.21 ","$5,417.44 ","$7,056.00 ","$5,460.56 ", N/A ,"$6,193.60 ","$5,441.17 ","$6,801.00 ","$6,801.00 ", N/A ,"$6,801.00 ","$5,644.80 ","$4,860.80 ","$5,644.80 ","$5,644.80 ","$6,272.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100131,93622,HC EP COMPREHENSIVE W/LT VENTRIC 93622,481,1 ,"$5,376.00 ","$2,688.00 ","$2,688.00 ","$5,441.17 ","$5,133.18 ","$5,376.00 ","$5,376.00 ", N/A ,"$3,225.60 ","$4,569.60 ","$3,763.20 ","$5,133.18 ","$5,107.20 ","$4,085.76 ","$4,032.00 ","$5,376.00 ","$4,569.60 ", N/A ,"$5,376.00 ","$5,376.00 ","$3,763.20 ","$5,133.18 ", N/A , N/A ,"$5,376.00 ","$4,569.60 ", N/A ,"$4,945.92 ","$3,763.20 ","$2,726.71 ","$3,272.37 ","$3,273.98 ","$3,272.37 ","$3,714.82 ","$4,838.40 ","$3,744.38 ", N/A ,"$4,247.04 ","$5,441.17 ","$5,376.00 ","$5,376.00 ", N/A ,"$5,376.00 ","$3,870.72 ","$3,333.12 ","$3,870.72 ","$3,870.72 ","$4,300.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100132,93623,HC EP IV DRUG INFUSION PACING 93623,481,1 ,"$2,782.00 ","$1,391.00 ","$1,391.00 ","$5,441.17 ","$5,133.18 ","$2,782.00 ","$2,782.00 ", N/A ,"$1,669.20 ","$2,364.70 ","$1,947.40 ","$5,133.18 ","$2,642.90 ","$2,114.32 ","$2,086.50 ","$2,782.00 ","$2,364.70 ", N/A ,"$2,782.00 ","$2,782.00 ","$1,947.40 ","$5,133.18 ", N/A , N/A ,"$2,782.00 ","$2,364.70 ", N/A ,"$2,559.44 ","$1,947.40 ","$1,411.03 ","$1,693.40 ","$1,694.24 ","$1,693.40 ","$1,922.36 ","$2,503.80 ","$1,937.66 ", N/A ,"$2,197.78 ","$5,441.17 ","$2,782.00 ","$2,782.00 ", N/A ,"$2,782.00 ","$2,003.04 ","$1,724.84 ","$2,003.04 ","$2,003.04 ","$2,225.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100133,93641,HC EP EVAL CARDIO/DEFIB GENERATOR 93641,481,1 ,"$2,464.00 ","$1,232.00 ","$1,232.00 ","$2,464.00 ","$1,946.45 ", N/A , N/A , N/A ,"$1,478.40 ","$2,094.40 ","$1,724.80 ","$1,946.45 ","$2,340.80 ","$1,872.64 ","$1,848.00 ","$2,464.00 ","$2,094.40 ", N/A ,"$2,464.00 ","$1,601.60 ","$1,724.80 ","$1,946.45 ", N/A , N/A , N/A ,"$2,094.40 ", N/A ,"$2,266.88 ","$1,724.80 ","$1,249.74 ","$1,499.84 ","$1,500.58 ","$1,499.84 ","$1,702.62 ","$2,217.60 ","$1,716.18 ", N/A ,"$1,946.56 ","$2,063.24 ","$2,464.00 ","$2,464.00 ", N/A ,"$2,464.00 ","$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,971.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100134,93641,HC ICD TESTING 93641,481,1 ,"$2,464.00 ","$1,232.00 ","$1,232.00 ","$2,464.00 ","$1,946.45 ", N/A , N/A , N/A ,"$1,478.40 ","$2,094.40 ","$1,724.80 ","$1,946.45 ","$2,340.80 ","$1,872.64 ","$1,848.00 ","$2,464.00 ","$2,094.40 ", N/A ,"$2,464.00 ","$1,601.60 ","$1,724.80 ","$1,946.45 ", N/A , N/A , N/A ,"$2,094.40 ", N/A ,"$2,266.88 ","$1,724.80 ","$1,249.74 ","$1,499.84 ","$1,500.58 ","$1,499.84 ","$1,702.62 ","$2,217.60 ","$1,716.18 ", N/A ,"$1,946.56 ","$2,063.24 ","$2,464.00 ","$2,464.00 ", N/A ,"$2,464.00 ","$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,971.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100135,93642,HC EP EVAL CARDIO/DEFIB SGL/DUAL 93642,481,1 ,"$2,464.00 ","$1,232.00 ","$1,098.21 ","$2,470.97 ","$1,946.45 ", N/A , N/A ,"$1,098.21 ","$1,478.40 ","$2,094.40 ","$1,724.80 ","$1,946.45 ","$2,340.80 ","$1,872.64 ","$1,848.00 ","$2,464.00 ","$2,094.40 ","$1,098.21 ","$2,464.00 ","$1,601.60 ","$1,724.80 ","$1,946.45 ","$1,098.21 ","$1,098.21 ", N/A ,"$2,094.40 ","$2,470.97 ","$2,266.88 ","$1,724.80 ","$1,249.74 ","$1,499.84 ","$1,500.58 ","$1,499.84 ","$1,702.62 ","$2,217.60 ","$1,716.18 ","$1,109.19 ","$1,946.56 ","$2,063.24 ","$2,464.00 ","$2,464.00 ","$1,098.21 ","$2,464.00 ","$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,971.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100136,93650,HC ABLATION ATRIOVENTRICULAR FNCT 93650,481,1 ,"$5,671.00 ","$2,835.50 ","$2,835.50 ","$13,484.92 ","$5,133.18 ","$5,671.00 ","$5,671.00 ","$5,993.30 ","$3,402.60 ","$4,820.35 ","$3,969.70 ","$5,133.18 ","$5,387.45 ","$4,309.96 ","$4,253.25 ","$5,671.00 ","$4,820.35 ","$5,993.30 ","$5,671.00 ","$5,671.00 ","$3,969.70 ","$5,133.18 ","$5,993.30 ","$5,993.30 ","$5,671.00 ","$4,820.35 ","$13,484.92 ","$5,217.32 ","$3,969.70 ","$2,876.33 ","$3,451.94 ","$3,453.64 ","$3,451.94 ","$3,918.66 ","$5,103.90 ","$3,949.85 ","$6,053.23 ","$4,480.09 ","$5,441.17 ","$5,671.00 ","$5,671.00 ","$5,993.30 ","$5,671.00 ","$4,083.12 ","$3,516.02 ","$4,083.12 ","$4,083.12 ","$4,536.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100139,93660,HC TILT TABLE EVALUATION 93660,481,1 ,"$1,751.00 ",$875.50 ,$52.64 ,"$1,751.00 ",$52.64 ,"$1,751.00 ","$1,751.00 ",$481.30 ,"$1,050.60 ","$1,488.35 ","$1,225.70 ",$52.64 ,"$1,663.45 ","$1,330.76 ","$1,313.25 ","$1,751.00 ","$1,488.35 ",$481.30 ,"$1,751.00 ","$1,138.15 ","$1,225.70 ",$52.64 ,$481.30 ,$481.30 ,"$1,751.00 ","$1,488.35 ","$1,082.93 ","$1,610.92 ","$1,225.70 ",$888.11 ,"$1,065.83 ","$1,066.36 ","$1,065.83 ","$1,209.94 ","$1,575.90 ","$1,219.57 ",$486.11 ,"$1,383.29 ",$55.80 ,"$1,751.00 ","$1,751.00 ",$481.30 ,"$1,751.00 ","$1,260.72 ","$1,085.62 ","$1,260.72 ","$1,260.72 ","$1,400.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100140,93662,HC EP INTRACARDIAC ECHO INTERVENT 93662,481,1 ,"$3,811.00 ","$1,905.50 ","$1,902.00 ","$5,441.17 ","$5,133.18 ","$3,811.00 ","$3,811.00 ", N/A ,"$2,286.60 ","$3,239.35 ","$2,667.70 ","$5,133.18 ","$3,620.45 ","$2,896.36 ","$2,858.25 ","$3,811.00 ","$3,239.35 ", N/A ,"$3,811.00 ","$2,477.15 ","$2,667.70 ","$5,133.18 ", N/A , N/A , N/A ,"$3,239.35 ", N/A ,"$3,506.12 ","$2,667.70 ","$1,932.94 ","$2,319.76 ","$2,320.90 ","$2,319.76 ","$2,633.40 ","$3,429.90 ","$2,654.36 ", N/A ,"$3,010.69 ","$5,441.17 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$2,743.92 ","$2,362.82 ","$2,743.92 ","$2,743.92 ","$3,048.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100150,93503,HC PLACEMENT SWANZ GAN CATH MONIT 93503,481,1 ,"$2,675.00 ","$1,337.50 ",$353.23 ,"$3,119.68 ",$353.23 ,"$2,675.00 ","$2,675.00 ","$1,386.53 ","$1,605.00 ","$2,273.75 ","$1,872.50 ",$353.23 ,"$2,541.25 ","$2,033.00 ","$2,006.25 ","$2,675.00 ","$2,273.75 ","$1,386.53 ","$2,675.00 ","$1,738.75 ","$1,872.50 ",$353.23 ,"$1,386.53 ","$1,386.53 ","$2,675.00 ","$2,273.75 ","$3,119.68 ","$2,461.00 ","$1,872.50 ","$1,356.76 ","$1,628.27 ","$1,629.08 ","$1,628.27 ","$1,848.43 ","$2,407.50 ","$1,863.14 ","$1,400.40 ","$2,113.25 ",$374.42 ,"$2,675.00 ","$2,675.00 ","$1,386.53 ","$2,675.00 ","$1,926.00 ","$1,658.50 ","$1,926.00 ","$1,926.00 ","$2,140.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100151,33227,HC REM/REPL PCMKR PUL GEN SGL 33227,481,1 ,"$5,564.00 ","$2,782.00 ","$2,606.72 ","$18,099.91 ","$2,606.72 ","$5,564.00 ","$5,564.00 ","$8,044.40 ","$3,338.40 ","$4,729.40 ","$3,894.80 ","$2,606.72 ","$5,285.80 ","$4,228.64 ","$4,173.00 ","$5,564.00 ","$4,729.40 ","$8,044.40 ","$5,564.00 ","$5,564.00 ","$3,894.80 ","$2,606.72 ","$8,044.40 ","$8,044.40 ","$5,564.00 ","$4,729.40 ","$18,099.91 ","$5,118.88 ","$3,894.80 ","$4,794.94 ","$5,993.67 ","$3,388.48 ","$5,993.67 ","$3,844.72 ","$5,007.60 ","$3,875.33 ","$8,124.84 ","$4,395.56 ","$2,763.12 ","$5,564.00 ","$5,564.00 ","$8,044.40 ","$5,564.00 ","$4,006.08 ","$3,449.68 ","$4,006.08 ","$4,006.08 ","$4,451.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100152,33228,HC REM/REPL PCMKR PUL GEN DUAL 33228,481,1 ,"$6,313.00 ","$3,156.50 ","$2,606.72 ","$23,067.71 ","$2,606.72 ","$6,313.00 ","$6,313.00 ","$10,252.32 ","$3,787.80 ","$5,366.05 ","$4,419.10 ","$2,606.72 ","$5,997.35 ","$4,797.88 ","$4,734.75 ","$6,313.00 ","$5,366.05 ","$10,252.32 ","$6,313.00 ","$4,103.45 ","$4,419.10 ","$2,606.72 ","$10,252.32 ","$10,252.32 ","$6,313.00 ","$5,366.05 ","$23,067.71 ","$5,807.96 ","$4,419.10 ","$4,794.94 ","$5,993.67 ","$3,844.62 ","$5,993.67 ","$4,362.28 ","$5,681.70 ","$4,397.00 ","$10,354.84 ","$4,987.27 ","$2,763.12 ","$6,313.00 ","$6,313.00 ","$10,252.32 ","$6,313.00 ","$4,545.36 ","$3,914.06 ","$4,545.36 ","$4,545.36 ","$5,050.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100153,33229,HC REM/REPL PCMKR PUL GEN MULT 33229,481,1 ,"$8,667.00 ","$4,333.50 ","$2,606.72 ","$41,317.72 ","$2,606.72 ","$8,667.00 ","$8,667.00 ","$18,363.43 ","$5,200.20 ","$7,366.95 ","$6,066.90 ","$2,606.72 ","$8,233.65 ","$6,586.92 ","$6,500.25 ","$8,667.00 ","$7,366.95 ","$18,363.43 ","$8,667.00 ","$8,667.00 ","$6,066.90 ","$2,606.72 ","$18,363.43 ","$18,363.43 ","$8,667.00 ","$7,366.95 ","$41,317.72 ","$7,973.64 ","$6,066.90 ","$4,794.94 ","$5,993.67 ","$5,278.20 ","$5,993.67 ","$5,988.90 ","$7,800.30 ","$6,036.57 ","$18,547.06 ","$6,846.93 ","$2,763.12 ","$8,667.00 ","$8,667.00 ","$18,363.43 ","$8,667.00 ","$6,240.24 ","$5,373.54 ","$6,240.24 ","$6,240.24 ","$6,933.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100154,33262,HC REM/REPL DEFIB PUL GEN SGL 33262,481,1 ,"$13,910.00 ","$6,955.00 ","$4,794.94 ","$51,158.10 ","$7,815.70 ","$13,910.00 ","$13,525.00 ","$22,736.93 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$7,815.70 ","$13,214.50 ","$10,571.60 ","$10,432.50 ","$13,910.00 ","$11,823.50 ","$22,736.93 ","$13,910.00 ","$13,910.00 ","$9,737.00 ","$7,815.70 ","$22,736.93 ","$22,736.93 ","$13,910.00 ","$11,823.50 ","$51,158.10 ","$12,797.20 ","$9,737.00 ","$4,794.94 ","$5,993.67 ","$8,471.19 ","$5,993.67 ","$9,611.81 ","$12,519.00 ","$9,688.32 ","$22,964.30 ","$10,988.90 ","$8,284.64 ","$13,910.00 ","$13,910.00 ","$22,736.93 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100155,33263,HC REM/REPL DEFIB PUL GEN DUAL 33263,481,1 ,"$13,910.00 ","$6,955.00 ","$4,794.94 ","$51,158.10 ","$7,815.70 ","$13,910.00 ","$13,525.00 ","$22,736.93 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$7,815.70 ","$13,214.50 ","$10,571.60 ","$10,432.50 ","$13,910.00 ","$11,823.50 ","$22,736.93 ","$13,910.00 ","$13,910.00 ","$9,737.00 ","$7,815.70 ","$22,736.93 ","$22,736.93 ","$13,910.00 ","$11,823.50 ","$51,158.10 ","$12,797.20 ","$9,737.00 ","$4,794.94 ","$5,993.67 ","$8,471.19 ","$5,993.67 ","$9,611.81 ","$12,519.00 ","$9,688.32 ","$22,964.30 ","$10,988.90 ","$8,284.64 ","$13,910.00 ","$13,910.00 ","$22,736.93 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100156,33264,HC REM/REPL DEFIB PUL GEN MULT 33264,481,1 ,"$18,190.00 ","$9,095.00 ","$4,794.94 ","$72,872.20 ","$7,815.70 ","$18,190.00 ","$13,525.00 ","$32,387.64 ","$10,914.00 ","$15,461.50 ","$12,733.00 ","$7,815.70 ","$17,280.50 ","$13,824.40 ","$13,642.50 ","$18,190.00 ","$15,461.50 ","$32,387.64 ","$18,190.00 ","$18,190.00 ","$12,733.00 ","$7,815.70 ","$32,387.64 ","$32,387.64 ","$18,190.00 ","$15,461.50 ","$72,872.20 ","$16,734.80 ","$12,733.00 ","$4,794.94 ","$5,993.67 ","$11,077.71 ","$5,993.67 ","$12,569.29 ","$16,371.00 ","$12,669.34 ","$32,711.52 ","$14,370.10 ","$8,284.64 ","$18,190.00 ","$18,190.00 ","$32,387.64 ","$18,190.00 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$14,552.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100157,0075T,HC TRANSCATH XCRAN STENT PLCMT,481,1 ,"$8,295.00 ","$4,147.50 ","$1,851.24 ","$8,295.00 ","$1,851.24 ","$7,426.00 ","$6,763.00 ", N/A ,"$4,977.00 ","$7,050.75 ","$5,806.50 ","$1,851.24 ","$7,880.25 ","$6,304.20 ","$6,221.25 ","$6,993.00 ","$7,050.75 ", N/A ,"$6,993.00 ","$5,391.75 ","$5,806.50 ","$1,851.24 ", N/A , N/A ,"$8,295.00 ","$7,050.75 ", N/A ,"$7,631.40 ","$5,806.50 ","$4,794.94 ","$5,993.67 ","$5,051.66 ","$5,993.67 ","$5,731.85 ","$7,465.50 ","$5,777.47 ", N/A ,"$6,553.05 ","$1,962.31 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$5,972.40 ","$5,142.90 ","$5,972.40 ","$5,972.40 ","$6,636.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100158,0237T,HC ARTHERECTOMY BRACHIOCEPHA PERC 0237T,481,1 ,"$10,849.00 ","$5,424.50 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$10,849.00 ","$10,849.00 ","$9,903.96 ","$6,509.40 ","$9,221.65 ","$7,594.30 ","$3,445.58 ","$10,306.55 ","$8,245.24 ","$8,136.75 ","$6,993.00 ","$9,221.65 ","$9,903.96 ","$6,993.00 ","$7,051.85 ","$7,594.30 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$10,849.00 ","$9,221.65 ","$22,283.90 ","$9,981.08 ","$7,594.30 ","$4,794.94 ","$5,993.67 ","$6,607.04 ","$5,993.67 ","$7,496.66 ","$9,764.10 ","$7,556.33 ","$10,003.00 ","$8,570.71 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,903.96 ","$10,114.00 ","$7,811.28 ","$6,726.38 ","$7,811.28 ","$7,811.28 ","$8,679.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100160,33270,HC INS/REP SUBQ DEFIBRILLATOR 33270,481,1 ,"$25,129.00 ","$12,564.50 ","$4,794.94 ","$72,872.20 ","$7,815.70 ","$20,157.00 ","$13,525.00 ","$32,387.64 ","$15,077.40 ","$21,359.65 ","$17,590.30 ","$7,815.70 ","$23,872.55 ","$19,098.04 ","$18,846.75 ","$6,993.00 ","$21,359.65 ","$32,387.64 ","$6,993.00 ","$16,333.85 ","$17,590.30 ","$7,815.70 ","$32,387.64 ","$32,387.64 ","$18,996.34 ","$21,359.65 ","$72,872.20 ","$23,118.68 ","$17,590.30 ","$4,794.94 ","$5,993.67 ","$15,303.56 ","$5,993.67 ","$17,364.14 ","$22,616.10 ","$17,502.35 ","$32,711.52 ","$19,851.91 ","$8,284.64 ","$25,129.00 ","$25,129.00 ","$32,387.64 ","$25,129.00 ","$18,092.88 ","$15,579.98 ","$18,092.88 ","$18,092.88 ","$20,103.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100165,93462,HC LHC TRANSEPTAL PUNCTURE 93462,481,1 ,"$5,671.00 ","$2,835.50 ",$739.39 ,"$5,671.00 ",$739.39 ,"$5,671.00 ","$5,671.00 ", N/A ,"$3,402.60 ","$4,820.35 ","$3,969.70 ",$739.39 ,"$5,387.45 ","$4,309.96 ","$4,253.25 ","$5,671.00 ","$4,820.35 ", N/A ,"$5,671.00 ","$3,686.15 ","$3,969.70 ",$739.39 , N/A , N/A , N/A ,"$4,820.35 ", N/A ,"$5,217.32 ","$3,969.70 ","$2,876.33 ","$3,451.94 ","$3,453.64 ","$3,451.94 ","$3,918.66 ","$5,103.90 ","$3,949.85 ", N/A ,"$4,480.09 ",$783.75 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$4,083.12 ","$3,516.02 ","$4,083.12 ","$4,083.12 ","$4,536.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100170,93566,HC RT VENT OR AORTIC ANGIOGRAM,481,1 ,"$1,225.00 ",$612.50 ,$95.13 ,"$1,225.00 ",$95.13 , N/A , N/A , N/A ,$735.00 ,"$1,041.25 ",$857.50 ,$95.13 ,"$1,163.75 ",$931.00 ,$918.75 ,"$1,225.00 ","$1,041.25 ", N/A ,"$1,225.00 ",$796.25 ,$857.50 ,$95.13 , N/A , N/A , N/A ,"$1,041.25 ", N/A ,"$1,127.00 ",$857.50 ,$621.32 ,$745.66 ,$746.03 ,$745.66 ,$846.48 ,"$1,102.50 ",$853.21 , N/A ,$967.75 ,$100.84 ,"$1,225.00 ","$1,225.00 ", N/A ,"$1,225.00 ",$882.00 ,$759.50 ,$882.00 ,$882.00 ,$980.00 
ST NICHOLAS HOSPITAL - ACUTE,48100171,36253,HC PLC CATH RENAL ANGIO 1< UNI,481,1 ,"$2,464.00 ","$1,232.00 ","$1,232.00 ","$10,579.35 ","$1,293.09 ","$2,464.00 ","$2,464.00 ","$4,701.93 ","$1,478.40 ","$2,094.40 ","$1,724.80 ","$1,293.09 ","$2,340.80 ","$1,872.64 ","$1,848.00 ","$2,464.00 ","$2,094.40 ","$4,701.93 ","$2,464.00 ","$1,601.60 ","$1,724.80 ","$1,293.09 ","$4,701.93 ","$4,701.93 ","$2,464.00 ","$2,094.40 ","$10,579.35 ","$2,266.88 ","$1,724.80 ","$1,703.02 ","$2,128.52 ","$1,500.58 ","$2,128.52 ","$1,702.62 ","$2,217.60 ","$1,716.18 ","$4,748.95 ","$1,946.56 ","$1,370.68 ","$2,464.00 ","$2,464.00 ","$4,701.93 ","$2,464.00 ","$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,971.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100173,37193,HC FILTER REMOVAL,481,1 ,"$5,885.00 ","$2,942.50 ","$1,123.24 ","$6,350.83 ","$1,123.24 ","$5,885.00 ","$5,885.00 ","$2,822.59 ","$3,531.00 ","$5,002.25 ","$4,119.50 ","$1,123.24 ","$5,590.75 ","$4,472.60 ","$4,413.75 ","$5,885.00 ","$5,002.25 ","$2,822.59 ","$5,885.00 ","$3,825.25 ","$4,119.50 ","$1,123.24 ","$2,822.59 ","$2,822.59 ","$5,657.04 ","$5,002.25 ","$6,350.83 ","$5,414.20 ","$4,119.50 ","$4,794.94 ","$5,993.67 ","$3,583.97 ","$5,993.67 ","$4,066.54 ","$5,296.50 ","$4,098.90 ","$2,850.82 ","$4,649.15 ","$1,190.63 ","$5,885.00 ","$5,885.00 ","$2,822.59 ","$5,885.00 ","$4,237.20 ","$3,648.70 ","$4,237.20 ","$4,237.20 ","$4,708.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100174,33230,HC INS DEFIB PULSE GEN W/EST DUAL,481,1 ,"$15,103.00 ","$7,551.50 ","$4,794.94 ","$51,158.10 ","$7,815.70 ","$15,103.00 ","$13,525.00 ","$22,736.93 ","$9,061.80 ","$12,837.55 ","$10,572.10 ","$7,815.70 ","$14,347.85 ","$11,478.28 ","$11,327.25 ","$15,103.00 ","$12,837.55 ","$22,736.93 ","$15,103.00 ","$15,103.00 ","$10,572.10 ","$7,815.70 ","$22,736.93 ","$22,736.93 ","$15,103.00 ","$12,837.55 ","$51,158.10 ","$13,894.76 ","$10,572.10 ","$4,794.94 ","$5,993.67 ","$9,197.73 ","$5,993.67 ","$10,436.17 ","$13,592.70 ","$10,519.24 ","$22,964.30 ","$11,931.37 ","$8,284.64 ","$15,103.00 ","$15,103.00 ","$22,736.93 ","$15,103.00 ","$10,874.16 ","$9,363.86 ","$10,874.16 ","$10,874.16 ","$12,082.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100175,33231,HC INS DEFIB PULSE GEN W/EST MULT,481,1 ,"$16,280.00 ","$8,140.00 ","$4,794.94 ","$72,872.20 ","$7,815.70 ","$16,280.00 ","$13,525.00 ","$32,387.64 ","$9,768.00 ","$13,838.00 ","$11,396.00 ","$7,815.70 ","$15,466.00 ","$12,372.80 ","$12,210.00 ","$16,280.00 ","$13,838.00 ","$32,387.64 ","$16,280.00 ","$16,280.00 ","$11,396.00 ","$7,815.70 ","$32,387.64 ","$32,387.64 ","$16,280.00 ","$13,838.00 ","$72,872.20 ","$14,977.60 ","$11,396.00 ","$4,794.94 ","$5,993.67 ","$9,914.52 ","$5,993.67 ","$11,249.48 ","$14,652.00 ","$11,339.02 ","$32,711.52 ","$12,861.20 ","$8,284.64 ","$16,280.00 ","$16,280.00 ","$32,387.64 ","$16,280.00 ","$11,721.60 ","$10,093.60 ","$11,721.60 ","$11,721.60 ","$13,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100176,37216,HC PL STENT TRNSCATH CAROT ART W/O,481,1 ,"$5,500.00 ","$2,750.00 ","$2,750.00 ","$5,993.67 ","$3,529.80 ","$5,500.00 ","$5,500.00 ", N/A ,"$3,300.00 ","$4,675.00 ","$3,850.00 ","$3,529.80 ","$5,225.00 ","$4,180.00 ","$4,125.00 ","$5,500.00 ","$4,675.00 ", N/A ,"$5,500.00 ","$3,575.00 ","$3,850.00 ","$3,529.80 ", N/A , N/A ,"$5,500.00 ","$4,675.00 ", N/A ,"$5,060.00 ","$3,850.00 ","$4,794.94 ","$5,993.67 ","$3,349.50 ","$5,993.67 ","$3,800.50 ","$4,950.00 ","$3,830.75 ", N/A ,"$4,345.00 ","$3,741.59 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$4,400.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100177,93464,HC EXERCISE W/HEMODYNAMIC MEAS 93464,481,1 ,$706.00 ,$353.00 ,$52.64 ,$706.00 ,$52.64 ,$706.00 ,$706.00 , N/A ,$423.60 ,$600.10 ,$494.20 ,$52.64 ,$670.70 ,$536.56 ,$529.50 ,$706.00 ,$600.10 , N/A ,$706.00 ,$458.90 ,$494.20 ,$52.64 , N/A , N/A , N/A ,$600.10 , N/A ,$649.52 ,$494.20 ,$358.08 ,$429.74 ,$429.95 ,$429.74 ,$487.85 ,$635.40 ,$491.73 , N/A ,$557.74 ,$55.80 ,$706.00 ,$706.00 , N/A ,$706.00 ,$508.32 ,$437.72 ,$508.32 ,$508.32 ,$564.80 
ST NICHOLAS HOSPITAL - ACUTE,48100178,93565,HC LT VENT OR AORTIC ANGIOGRAM 93565,481,1 ,"$1,134.00 ",$567.00 ,$95.13 ,"$1,134.00 ",$95.13 , N/A , N/A , N/A ,$680.40 ,$963.90 ,$793.80 ,$95.13 ,"$1,077.30 ",$861.84 ,$850.50 ,"$1,134.00 ",$963.90 , N/A ,"$1,134.00 ",$737.10 ,$793.80 ,$95.13 , N/A , N/A , N/A ,$963.90 , N/A ,"$1,043.28 ",$793.80 ,$575.16 ,$690.27 ,$690.61 ,$690.27 ,$783.59 ,"$1,020.60 ",$789.83 , N/A ,$895.86 ,$100.84 ,"$1,134.00 ","$1,134.00 ", N/A ,"$1,134.00 ",$816.48 ,$703.08 ,$816.48 ,$816.48 ,$907.20 
ST NICHOLAS HOSPITAL - ACUTE,48100179,93568,HC PULMONARY ANGIOGRAM,481,1 ,"$1,471.00 ",$735.50 ,$95.13 ,"$1,471.00 ",$95.13 , N/A , N/A , N/A ,$882.60 ,"$1,250.35 ","$1,029.70 ",$95.13 ,"$1,397.45 ","$1,117.96 ","$1,103.25 ","$1,471.00 ","$1,250.35 ", N/A ,"$1,471.00 ",$956.15 ,"$1,029.70 ",$95.13 , N/A , N/A , N/A ,"$1,250.35 ", N/A ,"$1,353.32 ","$1,029.70 ",$746.09 ,$895.40 ,$895.84 ,$895.40 ,"$1,016.46 ","$1,323.90 ","$1,024.55 ", N/A ,"$1,162.09 ",$100.84 ,"$1,471.00 ","$1,471.00 ", N/A ,"$1,471.00 ","$1,059.12 ",$912.02 ,"$1,059.12 ","$1,059.12 ","$1,176.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100181,37212,HC VENOUS THROMBOLYSIS; INIT DAY 37212,481,1 ,"$3,100.00 ","$1,550.00 ","$1,123.24 ","$6,350.83 ","$1,123.24 ","$3,100.00 ","$3,100.00 ","$2,822.59 ","$1,860.00 ","$2,635.00 ","$2,170.00 ","$1,123.24 ","$2,945.00 ","$2,356.00 ","$2,325.00 ","$3,100.00 ","$2,635.00 ","$2,822.59 ","$3,100.00 ","$2,015.00 ","$2,170.00 ","$1,123.24 ","$2,822.59 ","$2,822.59 ","$3,100.00 ","$2,635.00 ","$6,350.83 ","$2,852.00 ","$2,170.00 ","$4,794.94 ","$5,993.67 ","$1,887.90 ","$5,993.67 ","$2,142.10 ","$2,790.00 ","$2,159.15 ","$2,850.82 ","$2,449.00 ","$1,190.63 ","$3,100.00 ","$3,100.00 ","$2,822.59 ","$3,100.00 ","$2,232.00 ","$1,922.00 ","$2,232.00 ","$2,232.00 ","$2,480.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100182,37214,HC THROMBO CESS/CLOS; SUBSQ DAY 37214,481,1 ,"$3,800.00 ","$1,900.00 ","$1,123.24 ","$6,350.83 ","$1,123.24 ","$3,800.00 ","$3,641.00 ","$2,822.59 ","$2,280.00 ","$3,230.00 ","$2,660.00 ","$1,123.24 ","$3,610.00 ","$2,888.00 ","$2,850.00 ","$3,800.00 ","$3,230.00 ","$2,822.59 ","$3,800.00 ","$2,470.00 ","$2,660.00 ","$1,123.24 ","$2,822.59 ","$2,822.59 ","$3,800.00 ","$3,230.00 ","$6,350.83 ","$3,496.00 ","$2,660.00 ","$4,794.94 ","$5,993.67 ","$2,314.20 ","$5,993.67 ","$2,625.80 ","$3,420.00 ","$2,646.70 ","$2,850.82 ","$3,002.00 ","$1,190.63 ","$2,687.00 ","$2,687.00 ","$2,822.59 ","$2,687.00 ","$2,736.00 ","$2,356.00 ","$2,736.00 ","$2,736.00 ","$3,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100183,36225,HC CATH PLCMT SEL SUBCL/INOM VERTEB UNI 36225,481,1 ,"$5,824.00 ","$2,912.00 ","$1,293.09 ","$6,350.83 ","$1,293.09 ","$5,824.00 ","$5,824.00 ","$2,822.59 ","$3,494.40 ","$4,950.40 ","$4,076.80 ","$1,293.09 ","$5,532.80 ","$4,426.24 ","$4,368.00 ","$5,824.00 ","$4,950.40 ","$2,822.59 ","$5,824.00 ","$3,785.60 ","$4,076.80 ","$1,293.09 ","$2,822.59 ","$2,822.59 ","$5,657.04 ","$4,950.40 ","$6,350.83 ","$5,358.08 ","$4,076.80 ","$1,703.02 ","$2,128.52 ","$3,546.82 ","$2,128.52 ","$4,024.38 ","$5,241.60 ","$4,056.42 ","$2,850.82 ","$4,600.96 ","$1,370.68 ","$5,824.00 ","$5,824.00 ","$2,822.59 ","$5,824.00 ","$4,193.28 ","$3,610.88 ","$4,193.28 ","$4,193.28 ","$4,659.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100184,36228,HC CATH PLCMT SEL EA INTRACRN BRANCH UNI 36228,481,1 ,"$2,688.00 ","$1,344.00 ","$1,293.09 ","$2,688.00 ","$1,293.09 ","$2,688.00 ","$2,688.00 ", N/A ,"$1,612.80 ","$2,284.80 ","$1,881.60 ","$1,293.09 ","$2,553.60 ","$2,042.88 ","$2,016.00 ","$2,688.00 ","$2,284.80 ", N/A ,"$2,688.00 ","$1,747.20 ","$1,881.60 ","$1,293.09 ", N/A , N/A ,"$2,688.00 ","$2,284.80 ", N/A ,"$2,472.96 ","$1,881.60 ","$1,703.02 ","$2,128.52 ","$1,636.99 ","$2,128.52 ","$1,857.41 ","$2,419.20 ","$1,872.19 ", N/A ,"$2,123.52 ","$1,370.68 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$2,150.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100185,37211,HC ARTRL THROMBOLYSIS; INIT DAY 37211,481,1 ,"$4,600.00 ","$2,300.00 ","$1,123.24 ","$10,579.35 ","$1,123.24 ","$4,600.00 ","$4,600.00 ","$4,701.93 ","$2,760.00 ","$3,910.00 ","$3,220.00 ","$1,123.24 ","$4,370.00 ","$3,496.00 ","$3,450.00 ","$4,600.00 ","$3,910.00 ","$4,701.93 ","$4,600.00 ","$2,990.00 ","$3,220.00 ","$1,123.24 ","$4,701.93 ","$4,701.93 ","$4,600.00 ","$3,910.00 ","$10,579.35 ","$4,232.00 ","$3,220.00 ","$4,794.94 ","$5,993.67 ","$2,801.40 ","$5,993.67 ","$3,178.60 ","$4,140.00 ","$3,203.90 ","$4,748.95 ","$3,634.00 ","$1,190.63 ","$4,600.00 ","$4,600.00 ","$4,701.93 ","$4,600.00 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$3,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100186,37213,HC ARTRL/VENOUS THROMBOLYSIS; SUBSQ DAY 37213,481,1 ,"$3,800.00 ","$1,900.00 ","$1,123.24 ","$6,350.83 ","$1,123.24 ","$3,800.00 ","$3,641.00 ","$2,822.59 ","$2,280.00 ","$3,230.00 ","$2,660.00 ","$1,123.24 ","$3,610.00 ","$2,888.00 ","$2,850.00 ","$3,800.00 ","$3,230.00 ","$2,822.59 ","$3,800.00 ","$2,470.00 ","$2,660.00 ","$1,123.24 ","$2,822.59 ","$2,822.59 ","$3,800.00 ","$3,230.00 ","$6,350.83 ","$3,496.00 ","$2,660.00 ","$4,794.94 ","$5,993.67 ","$2,314.20 ","$5,993.67 ","$2,625.80 ","$3,420.00 ","$2,646.70 ","$2,850.82 ","$3,002.00 ","$1,190.63 ","$2,687.00 ","$2,687.00 ","$2,822.59 ","$2,687.00 ","$2,736.00 ","$2,356.00 ","$2,736.00 ","$2,736.00 ","$3,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100187,37197,HC TRANSCATH RETRVAL FOREIGN BODY 37197,481,1 ,"$2,900.00 ","$1,450.00 ","$1,123.24 ","$6,350.83 ","$1,123.24 ","$2,900.00 ","$2,900.00 ","$2,822.59 ","$1,740.00 ","$2,465.00 ","$2,030.00 ","$1,123.24 ","$2,755.00 ","$2,204.00 ","$2,175.00 ","$2,900.00 ","$2,465.00 ","$2,822.59 ","$2,900.00 ","$1,885.00 ","$2,030.00 ","$1,123.24 ","$2,822.59 ","$2,822.59 ","$2,900.00 ","$2,465.00 ","$6,350.83 ","$2,668.00 ","$2,030.00 ","$4,794.94 ","$5,993.67 ","$1,766.10 ","$5,993.67 ","$2,003.90 ","$2,610.00 ","$2,019.85 ","$2,850.82 ","$2,291.00 ","$1,190.63 ","$2,900.00 ","$2,900.00 ","$2,822.59 ","$2,900.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$2,320.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100188,36221,HC CATH PLCMT NON SEL THORAC AORTA 36221,481,1 ,"$4,928.00 ","$2,464.00 ","$1,293.09 ","$6,350.83 ","$1,293.09 ","$4,928.00 ","$4,928.00 ","$2,822.59 ","$2,956.80 ","$4,188.80 ","$3,449.60 ","$1,293.09 ","$4,681.60 ","$3,745.28 ","$3,696.00 ","$4,928.00 ","$4,188.80 ","$2,822.59 ","$4,928.00 ","$3,203.20 ","$3,449.60 ","$1,293.09 ","$2,822.59 ","$2,822.59 ","$4,928.00 ","$4,188.80 ","$6,350.83 ","$4,533.76 ","$3,449.60 ","$1,703.02 ","$2,128.52 ","$3,001.15 ","$2,128.52 ","$3,405.25 ","$4,435.20 ","$3,432.35 ","$2,850.82 ","$3,893.12 ","$1,370.68 ","$4,928.00 ","$4,928.00 ","$2,822.59 ","$4,928.00 ","$3,548.16 ","$3,055.36 ","$3,548.16 ","$3,548.16 ","$3,942.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$5,488.00 ","$2,744.00 ","$1,939.64 ","$6,350.83 ","$1,939.64 ","$5,488.00 ","$5,488.00 ","$2,822.59 ","$3,292.80 ","$4,664.80 ","$3,841.60 ","$1,939.64 ","$5,213.60 ","$4,170.88 ","$4,116.00 ","$5,488.00 ","$4,664.80 ","$2,822.59 ","$5,488.00 ","$3,567.20 ","$3,841.60 ","$1,939.64 ","$2,822.59 ","$2,822.59 ","$5,488.00 ","$4,664.80 ","$6,350.83 ","$5,048.96 ","$3,841.60 ","$2,554.53 ","$3,192.78 ","$3,342.19 ","$3,192.78 ","$3,792.21 ","$4,939.20 ","$3,822.39 ","$2,850.82 ","$4,335.52 ","$2,056.02 ","$5,488.00 ","$5,488.00 ","$2,822.59 ","$5,488.00 ","$3,951.36 ","$3,402.56 ","$3,951.36 ","$3,951.36 ","$4,390.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$5,488.00 ","$2,744.00 ","$1,939.64 ","$6,350.83 ","$1,939.64 ","$5,488.00 ","$5,488.00 ","$2,822.59 ","$3,292.80 ","$4,664.80 ","$3,841.60 ","$1,939.64 ","$5,213.60 ","$4,170.88 ","$4,116.00 ","$5,488.00 ","$4,664.80 ","$2,822.59 ","$5,488.00 ","$3,567.20 ","$3,841.60 ","$1,939.64 ","$2,822.59 ","$2,822.59 ","$5,488.00 ","$4,664.80 ","$6,350.83 ","$5,048.96 ","$3,841.60 ","$2,554.53 ","$3,192.78 ","$3,342.19 ","$3,192.78 ","$3,792.21 ","$4,939.20 ","$3,822.39 ","$2,850.82 ","$4,335.52 ","$2,056.02 ","$5,488.00 ","$5,488.00 ","$2,822.59 ","$5,488.00 ","$3,951.36 ","$3,402.56 ","$3,951.36 ","$3,951.36 ","$4,390.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100190,36223,HC CATH PLCMT SEL COM CAR/INOM INTRACRN UNI 36223,481,1 ,"$9,968.00 ","$4,984.00 ","$1,293.09 ","$10,579.35 ","$1,293.09 ","$9,968.00 ","$7,413.00 ","$4,701.93 ","$5,980.80 ","$8,472.80 ","$6,977.60 ","$1,293.09 ","$9,469.60 ","$7,575.68 ","$7,476.00 ","$6,993.00 ","$8,472.80 ","$4,701.93 ","$6,993.00 ","$6,479.20 ","$6,977.60 ","$1,293.09 ","$4,701.93 ","$4,701.93 ","$5,657.04 ","$8,472.80 ","$10,579.35 ","$9,170.56 ","$6,977.60 ","$1,703.02 ","$2,128.52 ","$6,070.51 ","$2,128.52 ","$6,887.89 ","$8,971.20 ","$6,942.71 ","$4,748.95 ","$7,874.72 ","$1,370.68 ","$8,832.00 ","$8,832.00 ","$4,701.93 ","$8,832.00 ","$7,176.96 ","$6,180.16 ","$7,176.96 ","$7,176.96 ","$7,974.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100191,36224,HC CATH PLCMT SEL INTERNAL CAR UNI 36224,481,1 ,"$5,152.00 ","$2,576.00 ","$1,293.09 ","$10,579.35 ","$1,293.09 ","$5,152.00 ","$5,152.00 ","$4,701.93 ","$3,091.20 ","$4,379.20 ","$3,606.40 ","$1,293.09 ","$4,894.40 ","$3,915.52 ","$3,864.00 ","$5,152.00 ","$4,379.20 ","$4,701.93 ","$5,152.00 ","$3,348.80 ","$3,606.40 ","$1,293.09 ","$4,701.93 ","$4,701.93 ","$5,152.00 ","$4,379.20 ","$10,579.35 ","$4,739.84 ","$3,606.40 ","$1,703.02 ","$2,128.52 ","$3,137.57 ","$2,128.52 ","$3,560.03 ","$4,636.80 ","$3,588.37 ","$4,748.95 ","$4,070.08 ","$1,370.68 ","$5,152.00 ","$5,152.00 ","$4,701.93 ","$5,152.00 ","$3,709.44 ","$3,194.24 ","$3,709.44 ","$3,709.44 ","$4,121.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100192,36226,HC CATH PLCMT SEL VERTEBRAL UNI 36226,481,1 ,"$7,840.00 ","$3,920.00 ","$1,293.09 ","$10,579.35 ","$1,293.09 ","$7,840.00 ","$7,413.00 ","$4,701.93 ","$4,704.00 ","$6,664.00 ","$5,488.00 ","$1,293.09 ","$7,448.00 ","$5,958.40 ","$5,880.00 ","$6,993.00 ","$6,664.00 ","$4,701.93 ","$6,993.00 ","$5,096.00 ","$5,488.00 ","$1,293.09 ","$4,701.93 ","$4,701.93 ","$7,840.00 ","$6,664.00 ","$10,579.35 ","$7,212.80 ","$5,488.00 ","$1,703.02 ","$2,128.52 ","$4,774.56 ","$2,128.52 ","$5,417.44 ","$7,056.00 ","$5,460.56 ","$4,748.95 ","$6,193.60 ","$1,370.68 ","$7,840.00 ","$7,840.00 ","$4,701.93 ","$7,840.00 ","$5,644.80 ","$4,860.80 ","$5,644.80 ","$5,644.80 ","$6,272.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100193,36227,HC CATH PLCMT SEL EXTERNAL CAR UNI 36227,481,1 ,"$2,240.00 ","$1,120.00 ","$1,120.00 ","$2,240.00 ","$1,293.09 ","$2,240.00 ","$2,240.00 ", N/A ,"$1,344.00 ","$1,904.00 ","$1,568.00 ","$1,293.09 ","$2,128.00 ","$1,702.40 ","$1,680.00 ","$2,240.00 ","$1,904.00 ", N/A ,"$2,240.00 ","$1,456.00 ","$1,568.00 ","$1,293.09 ", N/A , N/A ,"$2,240.00 ","$1,904.00 ", N/A ,"$2,060.80 ","$1,568.00 ","$1,703.02 ","$2,128.52 ","$1,364.16 ","$2,128.52 ","$1,547.84 ","$2,016.00 ","$1,560.16 ", N/A ,"$1,769.60 ","$1,370.68 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100200,92920,HC PTCA SINGL MAJ ART/BRANCH 92920,481,1 ,"$7,597.00 ","$3,798.50 ","$2,701.18 ","$10,995.64 ","$2,701.18 ","$7,597.00 ","$7,597.00 ","$4,886.95 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$2,701.18 ","$7,217.15 ","$5,773.72 ","$5,697.75 ","$7,597.00 ","$6,457.45 ","$4,886.95 ","$7,597.00 ","$7,597.00 ","$5,317.90 ","$2,701.18 ","$4,886.95 ","$4,886.95 ","$7,597.00 ","$6,457.45 ","$10,995.64 ","$6,989.24 ","$5,317.90 ","$4,794.94 ","$5,993.67 ","$4,626.57 ","$5,993.67 ","$5,249.53 ","$6,837.30 ","$5,291.31 ","$4,935.82 ","$6,001.63 ","$2,863.25 ","$7,597.00 ","$7,597.00 ","$4,886.95 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100201,92921,HC PTCA EA ADDL BRANCH MAJ ART 92921,481,1 ,"$5,136.00 ","$2,568.00 ","$2,568.00 ","$5,993.67 ","$2,701.18 ","$5,136.00 ","$5,136.00 ", N/A ,"$3,081.60 ","$4,365.60 ","$3,595.20 ","$2,701.18 ","$4,879.20 ","$3,903.36 ","$3,852.00 ","$5,136.00 ","$4,365.60 ", N/A ,"$5,136.00 ","$5,136.00 ","$3,595.20 ","$2,701.18 ", N/A , N/A , N/A ,"$4,365.60 ", N/A ,"$4,725.12 ","$3,595.20 ","$4,794.94 ","$5,993.67 ","$3,127.82 ","$5,993.67 ","$3,548.98 ","$4,622.40 ","$3,577.22 ", N/A ,"$4,057.44 ","$2,863.25 ","$5,136.00 ","$5,136.00 ", N/A ,"$5,136.00 ","$3,697.92 ","$3,184.32 ","$3,697.92 ","$3,697.92 ","$4,108.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100202,92924,HC ROTOBLATOR SINGL MAJ ART/BRANCH 92924,481,1 ,"$14,980.00 ","$7,490.00 ","$2,701.18 ","$22,283.90 ","$2,701.18 ","$14,980.00 ","$14,980.00 ","$9,903.96 ","$8,988.00 ","$12,733.00 ","$10,486.00 ","$2,701.18 ","$14,231.00 ","$11,384.80 ","$11,235.00 ","$14,980.00 ","$12,733.00 ","$9,903.96 ","$14,980.00 ","$14,980.00 ","$10,486.00 ","$2,701.18 ","$9,903.96 ","$9,903.96 ","$14,980.00 ","$12,733.00 ","$22,283.90 ","$13,781.60 ","$10,486.00 ","$4,794.94 ","$5,993.67 ","$9,122.82 ","$5,993.67 ","$10,351.18 ","$13,482.00 ","$10,433.57 ","$10,003.00 ","$11,834.20 ","$2,863.25 ","$13,600.00 ","$13,600.00 ","$9,903.96 ","$13,600.00 ","$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$11,984.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100203,92925,HC ROTOBLATOR EA ADDL BRANCH MAJ ART 92925,481,1 ,"$8,849.00 ","$4,424.50 ","$2,701.18 ","$8,849.00 ","$2,701.18 ","$8,849.00 ","$8,849.00 ", N/A ,"$5,309.40 ","$7,521.65 ","$6,194.30 ","$2,701.18 ","$8,406.55 ","$6,725.24 ","$6,636.75 ","$8,849.00 ","$7,521.65 ", N/A ,"$8,849.00 ","$8,849.00 ","$6,194.30 ","$2,701.18 ", N/A , N/A , N/A ,"$7,521.65 ", N/A ,"$8,141.08 ","$6,194.30 ","$4,794.94 ","$5,993.67 ","$5,389.04 ","$5,993.67 ","$6,114.66 ","$7,964.10 ","$6,163.33 ", N/A ,"$6,990.71 ","$2,863.25 ","$8,849.00 ","$8,849.00 ", N/A ,"$8,849.00 ","$6,371.28 ","$5,486.38 ","$6,371.28 ","$6,371.28 ","$7,079.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100204,92928,HC BMS SINGL MAJ ART/BRANCH 92928,481,1 ,"$10,700.00 ","$5,350.00 ","$2,701.18 ","$22,283.90 ","$2,701.18 ","$10,700.00 ","$10,700.00 ","$9,903.96 ","$6,420.00 ","$9,095.00 ","$7,490.00 ","$2,701.18 ","$10,165.00 ","$8,132.00 ","$8,025.00 ","$6,993.00 ","$9,095.00 ","$9,903.96 ","$6,993.00 ","$6,955.00 ","$7,490.00 ","$2,701.18 ","$9,903.96 ","$9,903.96 ","$10,700.00 ","$9,095.00 ","$22,283.90 ","$9,844.00 ","$7,490.00 ","$4,794.94 ","$5,993.67 ","$6,516.30 ","$5,993.67 ","$7,393.70 ","$9,630.00 ","$7,452.55 ","$10,003.00 ","$8,453.00 ","$2,863.25 ","$10,700.00 ","$10,700.00 ","$9,903.96 ","$10,700.00 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$8,560.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100205,92929,HC BMS EA ADDL BRANCH MAJ ART 92929,481,1 ,"$11,770.00 ","$5,885.00 ","$2,701.18 ","$11,770.00 ","$2,701.18 ","$11,770.00 ","$11,770.00 ", N/A ,"$7,062.00 ","$10,004.50 ","$8,239.00 ","$2,701.18 ","$11,181.50 ","$8,945.20 ","$8,827.50 ","$6,993.00 ","$10,004.50 ", N/A ,"$6,993.00 ","$7,650.50 ","$8,239.00 ","$2,701.18 ", N/A , N/A ,"$11,770.00 ","$10,004.50 ", N/A ,"$10,828.40 ","$8,239.00 ","$4,794.94 ","$5,993.67 ","$7,167.93 ","$5,993.67 ","$8,133.07 ","$10,593.00 ","$8,197.81 ", N/A ,"$9,298.30 ","$2,863.25 ","$11,770.00 ","$11,770.00 ", N/A ,"$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100206,92933,HC ROTOBLATOR/BMS SINGL MAJ ART/BRANCH 92933,481,1 ,"$20,330.00 ","$10,165.00 ","$2,701.18 ","$35,629.75 ","$2,701.18 ","$20,330.00 ","$20,330.00 ","$15,835.45 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$2,701.18 ","$19,313.50 ","$15,450.80 ","$15,247.50 ","$6,993.00 ","$17,280.50 ","$15,835.45 ","$6,993.00 ","$13,214.50 ","$14,231.00 ","$2,701.18 ","$15,835.45 ","$15,835.45 ","$16,836.49 ","$17,280.50 ","$35,629.75 ","$18,703.60 ","$14,231.00 ","$4,794.94 ","$5,993.67 ","$12,380.97 ","$5,993.67 ","$14,048.03 ","$18,297.00 ","$14,159.85 ","$15,993.80 ","$16,060.70 ","$2,863.25 ","$16,692.00 ","$16,692.00 ","$15,835.45 ","$16,692.00 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$16,264.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100207,92934,HC ROTOBLATOR/BMS EA ADDL BRANCH MAJ ART 92934,481,1 ,"$15,338.00 ","$7,669.00 ","$2,701.18 ","$15,338.00 ","$2,701.18 ","$15,338.00 ","$15,338.00 ", N/A ,"$9,202.80 ","$13,037.30 ","$10,736.60 ","$2,701.18 ","$14,571.10 ","$11,656.88 ","$11,503.50 ","$6,993.00 ","$13,037.30 ", N/A ,"$6,993.00 ","$9,969.70 ","$10,736.60 ","$2,701.18 ", N/A , N/A ,"$15,338.00 ","$13,037.30 ", N/A ,"$14,110.96 ","$10,736.60 ","$4,794.94 ","$5,993.67 ","$9,340.84 ","$5,993.67 ","$10,598.56 ","$13,804.20 ","$10,682.92 ", N/A ,"$12,117.02 ","$2,863.25 ","$15,338.00 ","$15,338.00 ", N/A ,"$15,338.00 ","$11,043.36 ","$9,509.56 ","$11,043.36 ","$11,043.36 ","$12,270.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100208,92937,HC BYPASS GRAFT BMS SINGL MAJ ART/BRANCH 92937,481,1 ,"$13,910.00 ","$6,955.00 ","$2,701.18 ","$22,283.90 ","$2,701.18 ","$13,910.00 ","$13,910.00 ","$9,903.96 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$2,701.18 ","$13,214.50 ","$10,571.60 ","$10,432.50 ","$6,993.00 ","$11,823.50 ","$9,903.96 ","$6,993.00 ","$9,041.50 ","$9,737.00 ","$2,701.18 ","$9,903.96 ","$9,903.96 ","$13,910.00 ","$11,823.50 ","$22,283.90 ","$12,797.20 ","$9,737.00 ","$4,794.94 ","$5,993.67 ","$8,471.19 ","$5,993.67 ","$9,611.81 ","$12,519.00 ","$9,688.32 ","$10,003.00 ","$10,988.90 ","$2,863.25 ","$13,910.00 ","$13,910.00 ","$9,903.96 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100209,92938,HC BYPASS GRAFT BMS EA ADDL BRNCH MAJ ART 92938,481,1 ,"$7,918.00 ","$3,959.00 ","$2,701.18 ","$7,918.00 ","$2,701.18 ","$7,918.00 ","$7,918.00 ", N/A ,"$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,701.18 ","$7,522.10 ","$6,017.68 ","$5,938.50 ","$6,993.00 ","$6,730.30 ", N/A ,"$6,993.00 ","$5,146.70 ","$5,542.60 ","$2,701.18 ", N/A , N/A ,"$7,918.00 ","$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$4,794.94 ","$5,993.67 ","$4,822.06 ","$5,993.67 ","$5,471.34 ","$7,126.20 ","$5,514.89 ", N/A ,"$6,255.22 ","$2,863.25 ","$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100210,92941,HC STEMI/NSTEMI BMS SING VESS 92941,481,1 ,"$14,980.00 ","$7,490.00 ","$2,701.18 ","$14,980.00 ","$2,701.18 ","$14,980.00 ","$14,980.00 ", N/A ,"$8,988.00 ","$12,733.00 ","$10,486.00 ","$2,701.18 ","$14,231.00 ","$11,384.80 ","$11,235.00 ","$6,993.00 ","$12,733.00 ", N/A ,"$6,993.00 ","$9,737.00 ","$10,486.00 ","$2,701.18 ", N/A , N/A ,"$14,980.00 ","$12,733.00 ", N/A ,"$13,781.60 ","$10,486.00 ","$4,794.94 ","$5,993.67 ","$9,122.82 ","$5,993.67 ","$10,351.18 ","$13,482.00 ","$10,433.57 ", N/A ,"$11,834.20 ","$2,863.25 ","$14,980.00 ","$14,980.00 ", N/A ,"$14,980.00 ","$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$11,984.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100211,92943,HC CTO BMS SING MAJ ART/BRNCH 92943,481,1 ,"$16,050.00 ","$8,025.00 ","$2,701.18 ","$22,283.90 ","$2,701.18 ","$16,050.00 ","$16,050.00 ","$9,903.96 ","$9,630.00 ","$13,642.50 ","$11,235.00 ","$2,701.18 ","$15,247.50 ","$12,198.00 ","$12,037.50 ","$6,993.00 ","$13,642.50 ","$9,903.96 ","$6,993.00 ","$10,432.50 ","$11,235.00 ","$2,701.18 ","$9,903.96 ","$9,903.96 ","$16,050.00 ","$13,642.50 ","$22,283.90 ","$14,766.00 ","$11,235.00 ","$4,794.94 ","$5,993.67 ","$9,774.45 ","$5,993.67 ","$11,090.55 ","$14,445.00 ","$11,178.83 ","$10,003.00 ","$12,679.50 ","$2,863.25 ","$16,050.00 ","$16,050.00 ","$9,903.96 ","$16,050.00 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$12,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100212,92944,HC CTO BMS EA ADD BNCH MAJ ART 92944,481,1 ,"$12,840.00 ","$6,420.00 ","$2,701.18 ","$12,840.00 ","$2,701.18 ","$12,840.00 ","$12,840.00 ", N/A ,"$7,704.00 ","$10,914.00 ","$8,988.00 ","$2,701.18 ","$12,198.00 ","$9,758.40 ","$9,630.00 ","$6,993.00 ","$10,914.00 ", N/A ,"$6,993.00 ","$8,346.00 ","$8,988.00 ","$2,701.18 ", N/A , N/A ,"$12,840.00 ","$10,914.00 ", N/A ,"$11,812.80 ","$8,988.00 ","$4,794.94 ","$5,993.67 ","$7,819.56 ","$5,993.67 ","$8,872.44 ","$11,556.00 ","$8,943.06 ", N/A ,"$10,143.60 ","$2,863.25 ","$12,840.00 ","$12,840.00 ", N/A ,"$12,840.00 ","$9,244.80 ","$7,960.80 ","$9,244.80 ","$9,244.80 ","$10,272.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100213,93653,HC EP STUDY PLUS SVT ABLATION 93653,481,1 ,"$21,400.00 ","$10,700.00 ","$5,133.18 ","$47,605.90 ","$5,133.18 ","$21,400.00 ","$21,400.00 ","$21,158.18 ","$12,840.00 ","$18,190.00 ","$14,980.00 ","$5,133.18 ","$20,330.00 ","$16,264.00 ","$16,050.00 ","$15,977.00 ","$18,190.00 ","$21,158.18 ","$15,977.00 ","$13,371.00 ","$14,980.00 ","$5,133.18 ","$21,158.18 ","$21,158.18 ","$15,839.71 ","$18,190.00 ","$47,605.90 ","$19,688.00 ","$14,980.00 ","$10,854.08 ","$13,026.18 ","$13,032.60 ","$13,026.18 ","$14,787.40 ","$19,260.00 ","$14,905.10 ","$21,369.76 ","$16,906.00 ","$5,441.17 ","$18,544.00 ","$18,544.00 ","$21,158.18 ","$18,544.00 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$17,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100214,93654,HC EP STUDY PLUS VT ABLATION 93654,481,1 ,"$21,400.00 ","$10,700.00 ","$5,133.18 ","$47,605.90 ","$5,133.18 ","$21,400.00 ","$21,400.00 ","$21,158.18 ","$12,840.00 ","$18,190.00 ","$14,980.00 ","$5,133.18 ","$20,330.00 ","$16,264.00 ","$16,050.00 ","$15,977.00 ","$18,190.00 ","$21,158.18 ","$15,977.00 ","$13,371.00 ","$14,980.00 ","$5,133.18 ","$21,158.18 ","$21,158.18 ","$15,839.71 ","$18,190.00 ","$47,605.90 ","$19,688.00 ","$14,980.00 ","$10,854.08 ","$13,026.18 ","$13,032.60 ","$13,026.18 ","$14,787.40 ","$19,260.00 ","$14,905.10 ","$21,369.76 ","$16,906.00 ","$5,441.17 ","$18,544.00 ","$18,544.00 ","$21,158.18 ","$18,544.00 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$17,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100215,93655,HC ADD ON ABLAT POST ABLAT ORIG RHYTHM 93655,481,1 ,"$3,638.00 ","$1,819.00 ","$1,819.00 ","$5,441.17 ","$5,133.18 ","$3,638.00 ","$3,638.00 ", N/A ,"$2,182.80 ","$3,092.30 ","$2,546.60 ","$5,133.18 ","$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ", N/A ,"$3,638.00 ","$3,638.00 ","$2,546.60 ","$5,133.18 ", N/A , N/A ,"$3,638.00 ","$3,092.30 ", N/A ,"$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,533.87 ", N/A ,"$2,874.02 ","$5,441.17 ","$3,638.00 ","$3,638.00 ", N/A ,"$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100216,93656,HC EP STUDY PLUS AFIB ABLATION 93656,481,1 ,"$21,400.00 ","$10,700.00 ","$5,133.18 ","$47,605.90 ","$5,133.18 ","$21,400.00 ","$21,400.00 ","$21,158.18 ","$12,840.00 ","$18,190.00 ","$14,980.00 ","$5,133.18 ","$20,330.00 ","$16,264.00 ","$16,050.00 ","$15,977.00 ","$18,190.00 ","$21,158.18 ","$15,977.00 ","$13,371.00 ","$14,980.00 ","$5,133.18 ","$21,158.18 ","$21,158.18 ","$15,839.71 ","$18,190.00 ","$47,605.90 ","$19,688.00 ","$14,980.00 ","$10,854.08 ","$13,026.18 ","$13,032.60 ","$13,026.18 ","$14,787.40 ","$19,260.00 ","$14,905.10 ","$21,369.76 ","$16,906.00 ","$5,441.17 ","$18,544.00 ","$18,544.00 ","$21,158.18 ","$18,544.00 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$17,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100217,93657,HC ADD ON AFIB ABLAT POST COMPL PVI 93657,481,1 ,"$3,638.00 ","$1,819.00 ","$1,819.00 ","$5,441.17 ","$5,133.18 ","$3,638.00 ","$3,638.00 ", N/A ,"$2,182.80 ","$3,092.30 ","$2,546.60 ","$5,133.18 ","$3,456.10 ","$2,764.88 ","$2,728.50 ","$3,638.00 ","$3,092.30 ", N/A ,"$3,638.00 ","$3,638.00 ","$2,546.60 ","$5,133.18 ", N/A , N/A ,"$3,638.00 ","$3,092.30 ", N/A ,"$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,214.45 ","$2,513.86 ","$3,274.20 ","$2,533.87 ", N/A ,"$2,874.02 ","$5,441.17 ","$3,638.00 ","$3,638.00 ", N/A ,"$3,638.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,910.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100218,C9600,HC DES SING MAJ ART/BRNCH C9600,481,1 ,"$11,770.00 ","$5,885.00 ","$2,701.18 ","$22,283.90 ","$2,701.18 ","$11,770.00 ","$11,770.00 ","$9,903.96 ","$7,062.00 ","$10,004.50 ","$8,239.00 ","$2,701.18 ","$11,181.50 ","$8,945.20 ","$8,827.50 ","$11,770.00 ","$10,004.50 ","$9,903.96 ","$11,770.00 ","$11,770.00 ","$8,239.00 ","$2,701.18 ","$9,903.96 ","$9,903.96 ","$11,770.00 ","$10,004.50 ","$22,283.90 ","$10,828.40 ","$8,239.00 ","$4,794.94 ","$5,993.67 ","$7,167.93 ","$5,993.67 ","$8,133.07 ","$10,593.00 ","$8,197.81 ","$10,003.00 ","$9,298.30 ","$2,863.25 ","$11,770.00 ","$11,770.00 ","$9,903.96 ","$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100219,C9601,HC DES EA ADD BNCH MAJ ART C9601,481,1 ,"$11,770.00 ","$5,885.00 ","$2,701.18 ","$11,770.00 ","$2,701.18 ","$11,770.00 ","$11,770.00 ", N/A ,"$7,062.00 ","$10,004.50 ","$8,239.00 ","$2,701.18 ","$11,181.50 ","$8,945.20 ","$8,827.50 ","$11,770.00 ","$10,004.50 ", N/A ,"$11,770.00 ","$11,770.00 ","$8,239.00 ","$2,701.18 ", N/A , N/A ,"$11,770.00 ","$10,004.50 ", N/A ,"$10,828.40 ","$8,239.00 ","$5,969.74 ","$7,164.40 ","$7,167.93 ","$7,164.40 ","$8,133.07 ","$10,593.00 ","$8,197.81 ", N/A ,"$9,298.30 ","$2,863.25 ","$11,770.00 ","$11,770.00 ", N/A ,"$11,770.00 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$9,416.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100220,C9602,HC ROTOBLAT/DES SING MAJ ART/BRNCH C9602,481,1 ,"$16,050.00 ","$8,025.00 ","$2,701.18 ","$35,629.75 ","$2,701.18 ","$16,050.00 ","$16,050.00 ","$15,835.45 ","$9,630.00 ","$13,642.50 ","$11,235.00 ","$2,701.18 ","$15,247.50 ","$12,198.00 ","$12,037.50 ","$16,050.00 ","$13,642.50 ","$15,835.45 ","$16,050.00 ","$16,050.00 ","$11,235.00 ","$2,701.18 ","$15,835.45 ","$15,835.45 ","$16,050.00 ","$13,642.50 ","$35,629.75 ","$14,766.00 ","$11,235.00 ","$8,140.56 ","$9,769.64 ","$9,774.45 ","$9,769.64 ","$11,090.55 ","$14,445.00 ","$11,178.83 ","$15,993.80 ","$12,679.50 ","$2,863.25 ","$16,050.00 ","$16,050.00 ","$15,835.45 ","$16,050.00 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$12,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100221,C9603,HC ROTOBLAT/DES EA ADD BNCH MAJ ART C9603,481,1 ,"$15,338.00 ","$7,669.00 ","$2,701.18 ","$15,338.00 ","$2,701.18 ","$15,338.00 ","$15,338.00 ", N/A ,"$9,202.80 ","$13,037.30 ","$10,736.60 ","$2,701.18 ","$14,571.10 ","$11,656.88 ","$11,503.50 ","$15,338.00 ","$13,037.30 ", N/A ,"$15,338.00 ","$15,338.00 ","$10,736.60 ","$2,701.18 ", N/A , N/A ,"$15,338.00 ","$13,037.30 ", N/A ,"$14,110.96 ","$10,736.60 ","$7,779.43 ","$9,336.24 ","$9,340.84 ","$9,336.24 ","$10,598.56 ","$13,804.20 ","$10,682.92 ", N/A ,"$12,117.02 ","$2,863.25 ","$15,338.00 ","$15,338.00 ", N/A ,"$15,338.00 ","$11,043.36 ","$9,509.56 ","$11,043.36 ","$11,043.36 ","$12,270.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100222,C9604,HC BYPASS GRAFT DES SING MAJ ART/BRNCH C9604,481,1 ,"$13,910.00 ","$6,955.00 ","$2,701.18 ","$22,283.90 ","$2,701.18 ","$13,910.00 ","$13,910.00 ","$9,903.96 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$2,701.18 ","$13,214.50 ","$10,571.60 ","$10,432.50 ","$13,910.00 ","$11,823.50 ","$9,903.96 ","$13,910.00 ","$13,910.00 ","$9,737.00 ","$2,701.18 ","$9,903.96 ","$9,903.96 ","$13,910.00 ","$11,823.50 ","$22,283.90 ","$12,797.20 ","$9,737.00 ","$7,055.15 ","$8,467.02 ","$8,471.19 ","$8,467.02 ","$9,611.81 ","$12,519.00 ","$9,688.32 ","$10,003.00 ","$10,988.90 ","$2,863.25 ","$13,910.00 ","$13,910.00 ","$9,903.96 ","$13,910.00 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$11,128.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100223,C9605,HC BYPASS GRFT DES EA ADD BRNCH MAJ ART C9605,481,1 ,"$7,918.00 ","$3,959.00 ","$2,701.18 ","$7,918.00 ","$2,701.18 ","$7,918.00 ","$7,918.00 ", N/A ,"$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,701.18 ","$7,522.10 ","$6,017.68 ","$5,938.50 ","$7,918.00 ","$6,730.30 ", N/A ,"$7,918.00 ","$7,918.00 ","$5,542.60 ","$2,701.18 ", N/A , N/A ,"$7,918.00 ","$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$4,016.01 ","$4,819.69 ","$4,822.06 ","$4,819.69 ","$5,471.34 ","$7,126.20 ","$5,514.89 ", N/A ,"$6,255.22 ","$2,863.25 ","$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$6,334.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100224,C9607,HC CTO DES SING MAJ ART/BRNCH C9607,481,1 ,"$16,050.00 ","$8,025.00 ","$2,701.18 ","$35,629.75 ","$2,701.18 ","$16,050.00 ","$16,050.00 ","$15,835.45 ","$9,630.00 ","$13,642.50 ","$11,235.00 ","$2,701.18 ","$15,247.50 ","$12,198.00 ","$12,037.50 ","$16,050.00 ","$13,642.50 ","$15,835.45 ","$16,050.00 ","$16,050.00 ","$11,235.00 ","$2,701.18 ","$15,835.45 ","$15,835.45 ","$16,050.00 ","$13,642.50 ","$35,629.75 ","$14,766.00 ","$11,235.00 ","$8,140.56 ","$9,769.64 ","$9,774.45 ","$9,769.64 ","$11,090.55 ","$14,445.00 ","$11,178.83 ","$15,993.80 ","$12,679.50 ","$2,863.25 ","$16,050.00 ","$16,050.00 ","$15,835.45 ","$16,050.00 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$12,840.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100225,C9608,HC CTO DES EA ADD BRNCH MAJ ART C9608,481,1 ,"$12,744.00 ","$6,372.00 ","$2,701.18 ","$12,744.00 ","$2,701.18 ","$12,744.00 ","$12,744.00 ", N/A ,"$7,646.40 ","$10,832.40 ","$8,920.80 ","$2,701.18 ","$12,106.80 ","$9,685.44 ","$9,558.00 ","$12,744.00 ","$10,832.40 ", N/A ,"$12,744.00 ","$12,744.00 ","$8,920.80 ","$2,701.18 ", N/A , N/A ,"$12,744.00 ","$10,832.40 ", N/A ,"$11,724.48 ","$8,920.80 ","$6,463.76 ","$7,757.27 ","$7,761.10 ","$7,757.27 ","$8,806.10 ","$11,469.60 ","$8,876.20 ", N/A ,"$10,067.76 ","$2,863.25 ","$12,744.00 ","$12,744.00 ", N/A ,"$12,744.00 ","$9,175.68 ","$7,901.28 ","$9,175.68 ","$9,175.68 ","$10,195.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100226,C9606,HC STEMI/NSTEMI DES SINGL VESSEL C9606,481,1 ,"$14,980.00 ","$7,490.00 ","$2,701.18 ","$14,980.00 ","$2,701.18 ","$14,980.00 ","$14,980.00 ", N/A ,"$8,988.00 ","$12,733.00 ","$10,486.00 ","$2,701.18 ","$14,231.00 ","$11,384.80 ","$11,235.00 ","$14,980.00 ","$12,733.00 ", N/A ,"$14,980.00 ","$14,980.00 ","$10,486.00 ","$2,701.18 ", N/A , N/A ,"$14,980.00 ","$12,733.00 ", N/A ,"$13,781.60 ","$10,486.00 ","$7,597.86 ","$9,118.33 ","$9,122.82 ","$9,118.33 ","$10,351.18 ","$13,482.00 ","$10,433.57 ", N/A ,"$11,834.20 ","$2,863.25 ","$14,980.00 ","$14,980.00 ", N/A ,"$14,980.00 ","$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$11,984.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100227,93286,HC PRE OR POST PACEMAKER EVAL 93286,481,1 ,$213.00 ,$106.50 ,$12.10 ,$213.00 ,$12.10 , N/A , N/A , N/A ,$127.80 ,$181.05 ,$149.10 ,$12.10 ,$202.35 ,$161.88 ,$159.75 ,$213.00 ,$181.05 , N/A ,$213.00 ,$138.45 ,$149.10 ,$12.10 , N/A , N/A , N/A ,$181.05 , N/A ,$195.96 ,$149.10 ,$108.03 ,$129.65 ,$129.72 ,$129.65 ,$147.18 ,$191.70 ,$148.35 , N/A ,$168.27 ,$12.83 , N/A , N/A , N/A , N/A ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$170.40 
ST NICHOLAS HOSPITAL - ACUTE,48100230,37241,HC VENOUS EMBO FOR VEIN MALFORMATION 37241,481,1 ,"$6,700.00 ","$3,350.00 ","$3,350.00 ","$22,283.90 ","$3,445.58 ","$6,700.00 ","$6,700.00 ","$9,903.96 ","$4,020.00 ","$5,695.00 ","$4,690.00 ","$3,445.58 ","$6,365.00 ","$5,092.00 ","$5,025.00 ","$6,700.00 ","$5,695.00 ","$9,903.96 ","$6,700.00 ","$4,355.00 ","$4,690.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$6,700.00 ","$5,695.00 ","$22,283.90 ","$6,164.00 ","$4,690.00 ","$4,794.94 ","$5,993.67 ","$4,080.30 ","$5,993.67 ","$4,629.70 ","$6,030.00 ","$4,666.55 ","$10,003.00 ","$5,293.00 ","$3,652.31 ","$6,700.00 ","$6,700.00 ","$9,903.96 ","$6,700.00 ","$4,824.00 ","$4,154.00 ","$4,824.00 ","$4,824.00 ","$5,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100231,37242,HC ARTERIAL EMBO FOR AVM ANER PRE/PST AAA 37242,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,764.00 ","$6,675.00 ","$6,993.00 ","$7,565.00 ","$9,903.96 ","$6,993.00 ","$5,785.00 ","$6,230.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$8,900.00 ","$7,565.00 ","$22,283.90 ","$8,188.00 ","$6,230.00 ","$4,794.94 ","$5,993.67 ","$5,420.10 ","$5,993.67 ","$6,149.90 ","$8,010.00 ","$6,198.85 ","$10,003.00 ","$7,031.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$8,900.00 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$7,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100232,37243,HC EMBOLIZATION OF TUMOR UFE CHEMO 37243,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,764.00 ","$6,675.00 ","$6,993.00 ","$7,565.00 ","$9,903.96 ","$6,993.00 ","$5,785.00 ","$6,230.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$8,900.00 ","$7,565.00 ","$22,283.90 ","$8,188.00 ","$6,230.00 ","$4,794.94 ","$5,993.67 ","$5,420.10 ","$5,993.67 ","$6,149.90 ","$8,010.00 ","$6,198.85 ","$10,003.00 ","$7,031.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$8,900.00 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$7,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100233,37244,HC EMBOLIZATION FOR HEMORRAGE ART/VEN 37244,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,764.00 ","$6,675.00 ","$6,993.00 ","$7,565.00 ","$9,903.96 ","$6,993.00 ","$5,785.00 ","$6,230.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$8,900.00 ","$7,565.00 ","$22,283.90 ","$8,188.00 ","$6,230.00 ","$4,794.94 ","$5,993.67 ","$5,420.10 ","$5,993.67 ","$6,149.90 ","$8,010.00 ","$6,198.85 ","$10,003.00 ","$7,031.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,903.96 ","$8,900.00 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$7,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100234,37236,HC STENT INIT ARTERY UPPER EXT VISCERAL 37236,481,1 ,"$8,132.00 ","$4,066.00 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$8,132.00 ","$8,132.00 ","$9,903.96 ","$4,879.20 ","$6,912.20 ","$5,692.40 ","$3,445.58 ","$7,725.40 ","$6,180.32 ","$6,099.00 ","$6,993.00 ","$6,912.20 ","$9,903.96 ","$6,993.00 ","$5,285.80 ","$5,692.40 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$8,132.00 ","$6,912.20 ","$22,283.90 ","$7,481.44 ","$5,692.40 ","$4,794.94 ","$5,993.67 ","$4,952.39 ","$5,993.67 ","$5,619.21 ","$7,318.80 ","$5,663.94 ","$10,003.00 ","$6,424.28 ","$3,652.31 ","$8,132.00 ","$8,132.00 ","$9,903.96 ","$8,132.00 ","$5,855.04 ","$5,041.84 ","$5,855.04 ","$5,855.04 ","$6,505.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100235,37237,HC STENT ADDN ARTERY UPPER EXT VISERAL 37237,481,1 ,"$6,992.00 ","$3,496.00 ","$3,445.58 ","$6,992.00 ","$3,445.58 ","$6,992.00 ","$4,923.00 ", N/A ,"$4,195.20 ","$5,943.20 ","$4,894.40 ","$3,445.58 ","$6,642.40 ","$5,313.92 ","$5,244.00 ","$6,992.00 ","$5,943.20 ", N/A ,"$6,992.00 ","$4,544.80 ","$4,894.40 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$5,943.20 ", N/A ,"$6,432.64 ","$4,894.40 ","$4,794.94 ","$5,993.67 ","$4,258.13 ","$5,993.67 ","$4,831.47 ","$6,292.80 ","$4,869.93 ", N/A ,"$5,523.68 ","$3,652.31 ","$6,992.00 ","$6,992.00 ", N/A ,"$6,992.00 ","$5,034.24 ","$4,335.04 ","$5,034.24 ","$5,034.24 ","$5,593.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100236,37238,HC STENT INIT VENOUS UPPER EXT VISERAL 37238,481,1 ,"$9,523.00 ","$4,761.50 ","$3,445.58 ","$22,283.90 ","$3,445.58 ","$9,523.00 ","$9,523.00 ","$9,903.96 ","$5,713.80 ","$8,094.55 ","$6,666.10 ","$3,445.58 ","$9,046.85 ","$7,237.48 ","$7,142.25 ","$6,993.00 ","$8,094.55 ","$9,903.96 ","$6,993.00 ","$6,189.95 ","$6,666.10 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$9,523.00 ","$8,094.55 ","$22,283.90 ","$8,761.16 ","$6,666.10 ","$4,794.94 ","$5,993.67 ","$5,799.51 ","$5,993.67 ","$6,580.39 ","$8,570.70 ","$6,632.77 ","$10,003.00 ","$7,523.17 ","$3,652.31 ","$9,523.00 ","$9,523.00 ","$9,903.96 ","$9,523.00 ","$6,856.56 ","$5,904.26 ","$6,856.56 ","$6,856.56 ","$7,618.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100237,37239,HC STENT ADDN VENOUS UPPER EXT VISERAL 37239,481,1 ,"$4,815.00 ","$2,407.50 ","$2,407.50 ","$5,993.67 ","$3,445.58 ","$4,815.00 ","$4,815.00 ", N/A ,"$2,889.00 ","$4,092.75 ","$3,370.50 ","$3,445.58 ","$4,574.25 ","$3,659.40 ","$3,611.25 ","$4,815.00 ","$4,092.75 ", N/A ,"$4,815.00 ","$3,129.75 ","$3,370.50 ","$3,445.58 ", N/A , N/A ,"$3,959.93 ","$4,092.75 ", N/A ,"$4,429.80 ","$3,370.50 ","$4,794.94 ","$5,993.67 ","$2,932.34 ","$5,993.67 ","$3,327.17 ","$4,333.50 ","$3,353.65 ", N/A ,"$3,803.85 ","$3,652.31 ","$4,815.00 ","$4,815.00 ", N/A ,"$4,815.00 ","$3,466.80 ","$2,985.30 ","$3,466.80 ","$3,466.80 ","$3,852.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100238,37217,HC STENT CAROTID OPEN 37217,481,1 ,"$6,490.00 ","$3,245.00 ","$3,245.00 ","$6,490.00 ","$3,529.80 ","$6,490.00 ","$6,490.00 ", N/A ,"$3,894.00 ","$5,516.50 ","$4,543.00 ","$3,529.80 ","$6,165.50 ","$4,932.40 ","$4,867.50 ","$6,490.00 ","$5,516.50 ", N/A ,"$6,490.00 ","$4,218.50 ","$4,543.00 ","$3,529.80 ", N/A , N/A ,"$6,490.00 ","$5,516.50 ", N/A ,"$5,970.80 ","$4,543.00 ","$4,794.94 ","$5,993.67 ","$3,952.41 ","$5,993.67 ","$4,484.59 ","$5,841.00 ","$4,520.29 ", N/A ,"$5,127.10 ","$3,741.59 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ","$4,672.80 ","$4,023.80 ","$4,672.80 ","$4,672.80 ","$5,192.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100239,93724,HC EP EVAL PACEMAKER SYSTEM 93724,481,1 ,"$2,240.00 ","$1,120.00 ",$46.02 ,"$2,240.00 ",$46.02 , N/A , N/A ,$269.22 ,"$1,344.00 ","$1,904.00 ","$1,568.00 ",$46.02 ,"$2,128.00 ","$1,702.40 ","$1,680.00 ","$2,240.00 ","$1,904.00 ",$269.22 ,"$2,240.00 ","$1,456.00 ","$1,568.00 ",$46.02 ,$269.22 ,$269.22 , N/A ,"$1,904.00 ",$605.75 ,"$2,060.80 ","$1,568.00 ","$1,136.13 ","$1,363.49 ","$1,364.16 ","$1,363.49 ","$1,547.84 ","$2,016.00 ","$1,560.16 ",$271.91 ,"$1,769.60 ",$48.78 , N/A , N/A ,$269.22 , N/A ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,792.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100255,61651,HC THPY INFS NON-THROMBO ADDNT,481,1 ,$815.00 ,$407.50 ,$407.50 ,"$3,741.59 ","$3,529.80 ",$815.00 ,$815.00 , N/A ,$489.00 ,$692.75 ,$570.50 ,"$3,529.80 ",$774.25 ,$619.40 ,$611.25 ,$815.00 ,$692.75 , N/A ,$815.00 ,$529.75 ,$570.50 ,"$3,529.80 ", N/A , N/A ,$815.00 ,$692.75 , N/A ,$749.80 ,$570.50 ,"$1,703.02 ","$2,128.52 ",$496.34 ,"$2,128.52 ",$563.17 ,$733.50 ,$567.65 , N/A ,$643.85 ,"$3,741.59 ",$815.00 ,$815.00 , N/A ,$815.00 ,$586.80 ,$505.30 ,$586.80 ,$586.80 ,$652.00 
ST NICHOLAS HOSPITAL - ACUTE,48100263,36902,HC INTRO CATH/CIRCUIT W/ANGIO 36902,481,1 ,"$14,402.00 ","$7,201.00 ","$1,123.24 ","$14,402.00 ","$1,123.24 ","$14,402.00 ","$9,884.00 ","$4,886.95 ","$8,641.20 ","$12,241.70 ","$10,081.40 ","$1,123.24 ","$13,681.90 ","$10,945.52 ","$10,801.50 ","$6,993.00 ","$12,241.70 ","$4,886.95 ","$6,993.00 ","$9,361.30 ","$10,081.40 ","$1,123.24 ","$4,886.95 ","$4,886.95 ","$7,919.86 ","$12,241.70 ","$10,995.64 ","$13,249.84 ","$10,081.40 ","$1,703.02 ","$2,128.52 ","$8,770.82 ","$2,128.52 ","$9,951.78 ","$12,961.80 ","$10,030.99 ","$4,935.82 ","$11,377.58 ","$1,190.63 ","$8,832.00 ","$8,832.00 ","$4,886.95 ","$8,832.00 ","$10,369.44 ","$8,929.24 ","$10,369.44 ","$10,369.44 ","$11,521.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100264,36905,HC THROMBECTOMY/INFUS CIRCUIT W/ANGIO 36905,481,1 ,"$29,180.00 ","$14,590.00 ","$1,851.24 ","$29,180.00 ","$1,851.24 ","$19,096.00 ","$11,705.00 ","$9,903.96 ","$17,508.00 ","$24,803.00 ","$20,426.00 ","$1,851.24 ","$27,721.00 ","$22,176.80 ","$21,885.00 ","$6,993.00 ","$24,803.00 ","$9,903.96 ","$6,993.00 ","$18,967.00 ","$20,426.00 ","$1,851.24 ","$9,903.96 ","$9,903.96 ","$15,834.06 ","$24,803.00 ","$22,283.90 ","$26,845.60 ","$20,426.00 ","$4,794.94 ","$5,993.67 ","$17,770.62 ","$5,993.67 ","$20,163.38 ","$26,262.00 ","$20,323.87 ","$10,003.00 ","$23,052.20 ","$1,962.31 ","$10,114.00 ","$10,114.00 ","$9,903.96 ","$10,114.00 ","$21,009.60 ","$18,091.60 ","$21,009.60 ","$21,009.60 ","$23,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100265,36907,HC ANGIOPLASTY CTR DIALYSIS SEGMENT 36907,481,1 ,"$9,481.00 ","$4,740.50 ","$1,851.24 ","$9,481.00 ","$1,851.24 ", N/A , N/A , N/A ,"$5,688.60 ","$8,058.85 ","$6,636.70 ","$1,851.24 ","$9,006.95 ","$7,205.56 ","$7,110.75 ","$6,993.00 ","$8,058.85 ", N/A ,"$6,993.00 ","$6,162.65 ","$6,636.70 ","$1,851.24 ", N/A , N/A , N/A ,"$8,058.85 ", N/A ,"$8,722.52 ","$6,636.70 ","$4,794.94 ","$5,993.67 ","$5,773.93 ","$5,993.67 ","$6,551.37 ","$8,532.90 ","$6,603.52 ", N/A ,"$7,489.99 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$6,826.32 ","$5,878.22 ","$6,826.32 ","$6,826.32 ","$7,584.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100266,37246,HC ANGIOPLASTY TRANLUM BALN INIT ARTERY 37246,481,1 ,"$7,597.00 ","$3,798.50 ","$1,123.24 ","$10,995.64 ","$1,123.24 ","$7,597.00 ","$7,597.00 ","$4,886.95 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$1,123.24 ","$7,217.15 ","$5,773.72 ","$5,697.75 ","$6,993.00 ","$6,457.45 ","$4,886.95 ","$6,993.00 ","$4,938.05 ","$5,317.90 ","$1,123.24 ","$4,886.95 ","$4,886.95 ","$7,597.00 ","$6,457.45 ","$10,995.64 ","$6,989.24 ","$5,317.90 ","$4,794.94 ","$5,993.67 ","$4,626.57 ","$5,993.67 ","$5,249.53 ","$6,837.30 ","$5,291.31 ","$4,935.82 ","$6,001.63 ","$1,190.63 ","$7,597.00 ","$7,597.00 ","$4,886.95 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100267,37247,HC ANGIOPLASTY TRANLUM BALN ADDL ARTERY 37247,481,1 ,"$6,206.00 ","$3,103.00 ","$1,851.24 ","$6,206.00 ","$1,851.24 ", N/A , N/A , N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ","$1,851.24 ","$5,895.70 ","$4,716.56 ","$4,654.50 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$4,033.90 ","$4,344.20 ","$1,851.24 ", N/A , N/A , N/A ,"$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$4,794.94 ","$5,993.67 ","$3,779.45 ","$5,993.67 ","$4,288.35 ","$5,585.40 ","$4,322.48 ", N/A ,"$4,902.74 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$4,964.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100268,37248,HC ANGIOPLASTY TRANLUM BALN INIT VEIN 37248,481,1 ,"$7,597.00 ","$3,798.50 ","$1,123.24 ","$10,995.64 ","$1,123.24 ","$7,597.00 ","$7,597.00 ","$4,886.95 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$1,123.24 ","$7,217.15 ","$5,773.72 ","$5,697.75 ","$6,993.00 ","$6,457.45 ","$4,886.95 ","$6,993.00 ","$4,938.05 ","$5,317.90 ","$1,123.24 ","$4,886.95 ","$4,886.95 ","$7,597.00 ","$6,457.45 ","$10,995.64 ","$6,989.24 ","$5,317.90 ","$4,794.94 ","$5,993.67 ","$4,626.57 ","$5,993.67 ","$5,249.53 ","$6,837.30 ","$5,291.31 ","$4,935.82 ","$6,001.63 ","$1,190.63 ","$7,597.00 ","$7,597.00 ","$4,886.95 ","$7,597.00 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$6,077.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100269,37249,HC ANGIOPLASTY TRANLUM BALN ADDL VEIN 37249,481,1 ,"$6,206.00 ","$3,103.00 ","$1,851.24 ","$6,206.00 ","$1,851.24 ", N/A , N/A , N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ","$1,851.24 ","$5,895.70 ","$4,716.56 ","$4,654.50 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$4,033.90 ","$4,344.20 ","$1,851.24 ", N/A , N/A , N/A ,"$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$4,794.94 ","$5,993.67 ","$3,779.45 ","$5,993.67 ","$4,288.35 ","$5,585.40 ","$4,322.48 ", N/A ,"$4,902.74 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$4,964.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100270,36908,HC PLACE STENT CENTRAL DIAL SEGMENT 36908,481,1 ,"$11,058.00 ","$5,529.00 ","$1,851.24 ","$11,058.00 ","$1,851.24 ", N/A , N/A , N/A ,"$6,634.80 ","$9,399.30 ","$7,740.60 ","$1,851.24 ","$10,505.10 ","$8,404.08 ","$8,293.50 ","$6,993.00 ","$9,399.30 ", N/A ,"$6,993.00 ","$7,187.70 ","$7,740.60 ","$1,851.24 ", N/A , N/A , N/A ,"$9,399.30 ", N/A ,"$10,173.36 ","$7,740.60 ","$4,794.94 ","$5,993.67 ","$6,734.32 ","$5,993.67 ","$7,641.08 ","$9,952.20 ","$7,701.90 ", N/A ,"$8,735.82 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$7,961.76 ","$6,855.96 ","$7,961.76 ","$7,961.76 ","$8,846.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100271,36909,HC DIAL CIRCUIT VASC EMBOL/OCCUL 36909,481,1 ,"$9,523.00 ","$4,761.50 ","$1,902.00 ","$9,523.00 ","$3,445.58 ", N/A , N/A , N/A ,"$5,713.80 ","$8,094.55 ","$6,666.10 ","$3,445.58 ","$9,046.85 ","$7,237.48 ","$7,142.25 ","$6,993.00 ","$8,094.55 ", N/A ,"$6,993.00 ","$6,189.95 ","$6,666.10 ","$3,445.58 ", N/A , N/A , N/A ,"$8,094.55 ", N/A ,"$8,761.16 ","$6,666.10 ","$4,794.94 ","$5,993.67 ","$5,799.51 ","$5,993.67 ","$6,580.39 ","$8,570.70 ","$6,632.77 ", N/A ,"$7,523.17 ","$3,652.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ","$6,856.56 ","$5,904.26 ","$6,856.56 ","$6,856.56 ","$7,618.40 "
ST NICHOLAS HOSPITAL - ACUTE,48100272,36901,HC INTRO CATH DIALYSIS CIRCUIT 36901,481,1 ,"$4,086.00 ","$2,043.00 ",$573.58 ,"$4,086.00 ",$573.58 ,"$4,086.00 ","$3,641.00 ","$1,386.53 ","$2,451.60 ","$3,473.10 ","$2,860.20 ",$573.58 ,"$3,881.70 ","$3,105.36 ","$3,064.50 ","$4,086.00 ","$3,473.10 ","$1,386.53 ","$4,086.00 ","$2,655.90 ","$2,860.20 ",$573.58 ,"$1,386.53 ","$1,386.53 ","$4,086.00 ","$3,473.10 ","$3,119.68 ","$3,759.12 ","$2,860.20 ","$1,703.02 ","$2,128.52 ","$2,488.37 ","$2,128.52 ","$2,823.43 ","$3,677.40 ","$2,845.90 ","$1,400.40 ","$3,227.94 ",$607.99 ,"$4,016.00 ","$4,016.00 ","$1,386.53 ","$4,016.00 ","$2,941.92 ","$2,533.32 ","$2,941.92 ","$2,941.92 ","$3,268.80 "
ST NICHOLAS HOSPITAL - ACUTE,48100273,36903,HC INTRO CATH/CIRCUIT W/STENT 36903,481,1 ,"$29,180.00 ","$14,590.00 ","$1,703.02 ","$29,180.00 ","$3,445.58 ","$19,096.00 ","$11,705.00 ","$9,903.96 ","$17,508.00 ","$24,803.00 ","$20,426.00 ","$3,445.58 ","$27,721.00 ","$22,176.80 ","$21,885.00 ","$6,993.00 ","$24,803.00 ","$9,903.96 ","$6,993.00 ","$18,967.00 ","$20,426.00 ","$3,445.58 ","$9,903.96 ","$9,903.96 ","$15,834.06 ","$24,803.00 ","$22,283.90 ","$26,845.60 ","$20,426.00 ","$1,703.02 ","$2,128.52 ","$17,770.62 ","$2,128.52 ","$20,163.38 ","$26,262.00 ","$20,323.87 ","$10,003.00 ","$23,052.20 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,903.96 ","$10,114.00 ","$21,009.60 ","$18,091.60 ","$21,009.60 ","$21,009.60 ","$23,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,48100274,36904,HC THROMBECTOMY/INFUS DIALYSIS CIRCUIT 36904,481,1 ,"$14,402.00 ","$7,201.00 ","$1,123.24 ","$14,402.00 ","$1,123.24 ","$14,402.00 ","$9,884.00 ","$4,886.95 ","$8,641.20 ","$12,241.70 ","$10,081.40 ","$1,123.24 ","$13,681.90 ","$10,945.52 ","$10,801.50 ","$6,993.00 ","$12,241.70 ","$4,886.95 ","$6,993.00 ","$9,361.30 ","$10,081.40 ","$1,123.24 ","$4,886.95 ","$4,886.95 ","$7,919.86 ","$12,241.70 ","$10,995.64 ","$13,249.84 ","$10,081.40 ","$1,703.02 ","$2,128.52 ","$8,770.82 ","$2,128.52 ","$9,951.78 ","$12,961.80 ","$10,030.99 ","$4,935.82 ","$11,377.58 ","$1,190.63 ","$8,832.00 ","$8,832.00 ","$4,886.95 ","$8,832.00 ","$10,369.44 ","$8,929.24 ","$10,369.44 ","$10,369.44 ","$11,521.60 "
ST NICHOLAS HOSPITAL - ACUTE,48100275,36906,HC THROMBECTOMY/INFUS CIRCUIT W/STENT 36906,481,1 ,"$46,674.00 ","$23,337.00 ","$1,703.02 ","$46,674.00 ","$3,445.58 ","$20,157.00 ","$13,525.00 ","$15,835.45 ","$28,004.40 ","$39,672.90 ","$32,671.80 ","$3,445.58 ","$44,340.30 ","$35,472.24 ","$35,005.50 ","$6,993.00 ","$39,672.90 ","$15,835.45 ","$6,993.00 ","$30,338.10 ","$32,671.80 ","$3,445.58 ","$15,835.45 ","$15,835.45 ","$18,996.34 ","$39,672.90 ","$35,629.75 ","$42,940.08 ","$32,671.80 ","$1,703.02 ","$2,128.52 ","$28,424.47 ","$2,128.52 ","$32,251.73 ","$42,006.60 ","$32,508.44 ","$15,993.80 ","$36,872.46 ","$3,652.31 ","$14,302.00 ","$14,302.00 ","$15,835.45 ","$14,302.00 ","$33,605.28 ","$28,937.88 ","$33,605.28 ","$33,605.28 ","$37,339.20 "
ST NICHOLAS HOSPITAL - ACUTE,48100277,93288,HC INTERROG DEVICE EVAL PACEMAKER SYSTEM,481,1 ,$134.00 ,$67.00 ,$12.10 ,$134.00 ,$12.10 ,$134.00 ,$134.00 ,$36.72 ,$80.40 ,$113.90 ,$93.80 ,$12.10 ,$127.30 ,$101.84 ,$100.50 ,$134.00 ,$113.90 ,$36.72 ,$134.00 ,$87.10 ,$93.80 ,$12.10 ,$36.72 ,$36.72 , N/A ,$113.90 ,$82.61 ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$81.57 ,$92.59 ,$120.60 ,$93.33 ,$37.09 ,$105.86 ,$12.83 , N/A , N/A ,$36.72 , N/A ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,48100492,34712,HC TRANSCATH DELV FIX DEVICE W/S AND I,481,1 ,"$1,070.00 ",$535.00 ,$535.00 ,"$5,953.17 ","$5,616.20 ","$1,070.00 ","$1,070.00 ", N/A ,$642.00 ,$909.50 ,$749.00 ,"$5,616.20 ","$1,016.50 ",$813.20 ,$802.50 ,"$1,070.00 ",$909.50 , N/A ,"$1,070.00 ",$695.50 ,$749.00 ,"$5,616.20 ", N/A , N/A ,"$1,070.00 ",$909.50 , N/A ,$984.40 ,$749.00 ,$542.70 ,$651.31 ,$651.63 ,$651.31 ,$739.37 ,$963.00 ,$745.26 , N/A ,$845.30 ,"$5,953.17 ","$1,070.00 ","$1,070.00 ", N/A ,"$1,070.00 ",$770.40 ,$663.40 ,$770.40 ,$770.40 ,$856.00 
ST NICHOLAS HOSPITAL - ACUTE,48100493,34713,HC PERQ ACCESS/CLOSURE FEM ARTY ENDOGRAFT UNI,481,1 ,$471.00 ,$235.50 ,$235.50 ,"$5,953.17 ","$5,616.20 ", N/A , N/A , N/A ,$282.60 ,$400.35 ,$329.70 ,"$5,616.20 ",$447.45 ,$357.96 ,$353.25 ,$471.00 ,$400.35 , N/A ,$471.00 ,$306.15 ,$329.70 ,"$5,616.20 ", N/A , N/A , N/A ,$400.35 , N/A ,$433.32 ,$329.70 ,$238.89 ,$286.70 ,$286.84 ,$286.70 ,$325.46 ,$423.90 ,$328.05 , N/A ,$372.09 ,"$5,953.17 ",$471.00 ,$471.00 , N/A ,$471.00 ,$339.12 ,$292.02 ,$339.12 ,$339.12 ,$376.80 
ST NICHOLAS HOSPITAL - ACUTE,48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,232.00 ",$616.00 ,$52.64 ,"$1,232.00 ",$52.64 ,$796.98 ,$796.98 ,$260.95 ,$739.20 ,"$1,047.20 ",$862.40 ,$52.64 ,"$1,170.40 ",$936.32 ,$924.00 ,$800.80 ,"$1,047.20 ",$260.95 ,$800.80 ,$800.80 ,$862.40 ,$52.64 ,$260.95 ,$260.95 ,$633.59 ,"$1,047.20 ",$587.13 ,"$1,133.44 ",$862.40 ,$833.21 ,$833.21 ,$750.29 ,$833.21 ,$851.31 ,"$1,108.80 ",$858.09 ,$263.56 ,$973.28 ,$55.80 ,$784.00 ,$784.00 ,$260.95 ,$784.00 ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$985.60 
ST NICHOLAS HOSPITAL - ACUTE,48200001,93017,HC STRESS TEST TRACING ONLY CORPORATE,482,1 ,$139.00 ,$69.50 ,$52.64 ,$587.13 ,$52.64 ,$89.92 ,$89.92 ,$260.95 ,$83.40 ,$118.15 ,$97.30 ,$52.64 ,$132.05 ,$105.64 ,$104.25 ,$90.35 ,$118.15 ,$260.95 ,$90.35 ,$90.35 ,$97.30 ,$52.64 ,$260.95 ,$260.95 ,$139.00 ,$118.15 ,$587.13 ,$127.88 ,$97.30 ,$139.00 ,$139.00 ,$84.65 ,$139.00 ,$96.05 ,$125.10 ,$96.81 ,$263.56 ,$109.81 ,$55.80 ,$139.00 ,$139.00 ,$260.95 ,$139.00 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$111.20 
ST NICHOLAS HOSPITAL - ACUTE,48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$2,000.00 ","$1,000.00 ",$145.75 ,"$2,000.00 ",$145.75 ,"$1,293.80 ","$1,293.80 ",$476.43 ,"$1,200.00 ","$1,700.00 ","$1,400.00 ",$145.75 ,"$1,900.00 ","$1,520.00 ","$1,500.00 ","$1,300.00 ","$1,700.00 ",$476.43 ,"$1,300.00 ","$1,300.00 ","$1,400.00 ",$145.75 ,$476.43 ,$476.43 ,$305.48 ,"$1,700.00 ","$1,071.96 ","$1,840.00 ","$1,400.00 ","$1,457.82 ","$1,457.82 ","$1,218.00 ","$1,457.82 ","$1,382.00 ","$1,800.00 ","$1,393.00 ",$481.19 ,"$1,580.00 ",$154.50 ,$516.00 ,$516.00 ,$476.43 ,$516.00 ,"$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,600.00 "
ST NICHOLAS HOSPITAL - ACUTE,48300001,93307,HC ECHOCARDIOGRAM 2D W/O DOP,483,1 ,"$1,720.00 ",$860.00 ,$145.75 ,"$1,720.00 ",$145.75 ,"$1,112.67 ","$1,112.67 ",$226.88 ,"$1,032.00 ","$1,462.00 ","$1,204.00 ",$145.75 ,"$1,634.00 ","$1,307.20 ","$1,290.00 ","$1,118.00 ","$1,462.00 ",$226.88 ,"$1,118.00 ","$1,118.00 ","$1,204.00 ",$145.75 ,$226.88 ,$226.88 ,$305.48 ,"$1,462.00 ",$510.48 ,"$1,582.40 ","$1,204.00 ","$1,457.82 ","$1,457.82 ","$1,047.48 ","$1,457.82 ","$1,188.52 ","$1,548.00 ","$1,197.98 ",$229.15 ,"$1,358.80 ",$154.50 ,$516.00 ,$516.00 ,$226.88 ,$516.00 ,"$1,238.40 ","$1,066.40 ","$1,238.40 ","$1,238.40 ","$1,376.00 "
ST NICHOLAS HOSPITAL - ACUTE,48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$880.00 ,$440.00 ,$145.75 ,$880.00 ,$145.75 ,$569.27 ,$569.27 ,$226.88 ,$528.00 ,$748.00 ,$616.00 ,$145.75 ,$836.00 ,$668.80 ,$660.00 ,$572.00 ,$748.00 ,$226.88 ,$572.00 ,$572.00 ,$616.00 ,$145.75 ,$226.88 ,$226.88 ,$305.48 ,$748.00 ,$510.48 ,$809.60 ,$616.00 ,$855.28 ,$855.28 ,$535.92 ,$855.28 ,$608.08 ,$792.00 ,$612.92 ,$229.15 ,$695.20 ,$154.50 ,$516.00 ,$516.00 ,$226.88 ,$516.00 ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$704.00 
ST NICHOLAS HOSPITAL - ACUTE,48300003,93312,HC ECHO TEE CMPL W/PF,483,1 ,"$2,500.00 ","$1,250.00 ",$145.75 ,"$2,500.00 ",$145.75 ,"$1,617.25 ","$1,617.25 ",$476.43 ,"$1,500.00 ","$2,125.00 ","$1,750.00 ",$145.75 ,"$2,375.00 ","$1,900.00 ","$1,875.00 ","$1,625.00 ","$2,125.00 ",$476.43 ,"$1,625.00 ","$1,625.00 ","$1,750.00 ",$145.75 ,$476.43 ,$476.43 ,$305.48 ,"$2,125.00 ","$1,071.96 ","$2,300.00 ","$1,750.00 ","$2,028.08 ","$2,028.08 ","$1,522.50 ","$2,028.08 ","$1,727.50 ","$2,250.00 ","$1,741.25 ",$481.19 ,"$1,975.00 ",$154.50 ,$516.00 ,$516.00 ,$476.43 ,$516.00 ,"$1,800.00 ","$1,550.00 ","$1,800.00 ","$1,800.00 ","$2,000.00 "
ST NICHOLAS HOSPITAL - ACUTE,48300004,93316,HC ECHO TEE CONGT CARDIAC ANOM PROBE,483,1 ,"$1,040.00 ",$520.00 ,$145.75 ,"$1,071.96 ",$145.75 ,$672.78 ,$672.78 ,$476.43 ,$624.00 ,$884.00 ,$728.00 ,$145.75 ,$988.00 ,$790.40 ,$780.00 ,$676.00 ,$884.00 ,$476.43 ,$676.00 ,$676.00 ,$728.00 ,$145.75 ,$476.43 ,$476.43 ,$305.48 ,$884.00 ,"$1,071.96 ",$956.80 ,$728.00 ,"$1,040.00 ","$1,040.00 ",$633.36 ,"$1,040.00 ",$718.64 ,$936.00 ,$724.36 ,$481.19 ,$821.60 ,$154.50 ,$516.00 ,$516.00 ,$476.43 ,$516.00 ,$748.80 ,$644.80 ,$748.80 ,$748.80 ,$832.00 
ST NICHOLAS HOSPITAL - ACUTE,48300005,93320,HC ECHO DOPPLER,483,1 ,$540.00 ,$270.00 ,$145.75 ,$540.00 ,$145.75 ,$349.33 ,$349.33 , N/A ,$324.00 ,$459.00 ,$378.00 ,$145.75 ,$513.00 ,$410.40 ,$405.00 ,$351.00 ,$459.00 , N/A ,$351.00 ,$351.00 ,$378.00 ,$145.75 , N/A , N/A ,$305.48 ,$459.00 , N/A ,$496.80 ,$378.00 ,$273.89 ,$328.70 ,$328.86 ,$328.70 ,$373.14 ,$486.00 ,$376.11 , N/A ,$426.60 ,$154.50 ,$516.00 ,$516.00 , N/A ,$516.00 ,$388.80 ,$334.80 ,$388.80 ,$388.80 ,$432.00 
ST NICHOLAS HOSPITAL - ACUTE,48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$500.00 ,$250.00 ,$34.74 ,$500.00 ,$34.74 ,$323.45 ,$323.45 , N/A ,$300.00 ,$425.00 ,$350.00 ,$34.74 ,$475.00 ,$380.00 ,$375.00 ,$325.00 ,$425.00 , N/A ,$325.00 ,$325.00 ,$350.00 ,$34.74 , N/A , N/A ,$305.48 ,$425.00 , N/A ,$460.00 ,$350.00 ,$253.60 ,$304.35 ,$304.50 ,$304.35 ,$345.50 ,$450.00 ,$348.25 , N/A ,$395.00 ,$36.82 ,$500.00 ,$500.00 , N/A ,$500.00 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,48300007,93350,HC ECHO REST  AND  STRESS W/PF,483,1 ,"$1,900.00 ",$950.00 ,$145.75 ,"$1,900.00 ",$145.75 ,"$1,229.11 ","$1,229.11 ",$476.43 ,"$1,140.00 ","$1,615.00 ","$1,330.00 ",$145.75 ,"$1,805.00 ","$1,444.00 ","$1,425.00 ","$1,235.00 ","$1,615.00 ",$476.43 ,"$1,235.00 ","$1,235.00 ","$1,330.00 ",$145.75 ,$476.43 ,$476.43 ,$305.48 ,"$1,615.00 ","$1,071.96 ","$1,748.00 ","$1,330.00 ","$1,457.82 ","$1,457.82 ","$1,157.10 ","$1,457.82 ","$1,312.90 ","$1,710.00 ","$1,323.35 ",$481.19 ,"$1,501.00 ",$154.50 ,$516.00 ,$516.00 ,$476.43 ,$516.00 ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,48300008,93303,HC ECHO PEDS CONGENITAL,483,1 ,"$2,425.00 ","$1,212.50 ",$145.75 ,"$2,425.00 ",$145.75 ,"$1,568.73 ","$1,568.73 ",$476.43 ,"$1,455.00 ","$2,061.25 ","$1,697.50 ",$145.75 ,"$2,303.75 ","$1,843.00 ","$1,818.75 ","$1,576.25 ","$2,061.25 ",$476.43 ,"$1,576.25 ","$1,576.25 ","$1,697.50 ",$145.75 ,$476.43 ,$476.43 ,$305.48 ,"$2,061.25 ","$1,071.96 ","$2,231.00 ","$1,697.50 ","$2,028.08 ","$2,028.08 ","$1,476.83 ","$2,028.08 ","$1,675.68 ","$2,182.50 ","$1,689.01 ",$481.19 ,"$1,915.75 ",$154.50 ,$516.00 ,$516.00 ,$476.43 ,$516.00 ,"$1,746.00 ","$1,503.50 ","$1,746.00 ","$1,746.00 ","$1,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,48300009,93304,HC ECHO PEDS CONGENITAL LMTD,483,1 ,"$1,810.00 ",$905.00 ,$145.75 ,"$1,810.00 ",$145.75 ,"$1,170.89 ","$1,170.89 ",$476.43 ,"$1,086.00 ","$1,538.50 ","$1,267.00 ",$145.75 ,"$1,719.50 ","$1,375.60 ","$1,357.50 ","$1,176.50 ","$1,538.50 ",$476.43 ,"$1,176.50 ","$1,176.50 ","$1,267.00 ",$145.75 ,$476.43 ,$476.43 ,$305.48 ,"$1,538.50 ","$1,071.96 ","$1,665.20 ","$1,267.00 ","$1,457.82 ","$1,457.82 ","$1,102.29 ","$1,457.82 ","$1,250.71 ","$1,629.00 ","$1,260.67 ",$481.19 ,"$1,429.90 ",$154.50 ,$516.00 ,$516.00 ,$476.43 ,$516.00 ,"$1,303.20 ","$1,122.20 ","$1,303.20 ","$1,303.20 ","$1,448.00 "
ST NICHOLAS HOSPITAL - ACUTE,48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$455.00 ,$227.50 ,$145.75 ,$455.00 ,$145.75 ,$294.34 ,$294.34 , N/A ,$273.00 ,$386.75 ,$318.50 ,$145.75 ,$432.25 ,$345.80 ,$341.25 ,$295.75 ,$386.75 , N/A ,$295.75 ,$295.75 ,$318.50 ,$145.75 , N/A , N/A ,$305.48 ,$386.75 , N/A ,$418.60 ,$318.50 ,$230.78 ,$276.96 ,$277.10 ,$276.96 ,$314.41 ,$409.50 ,$316.91 , N/A ,$359.45 ,$154.50 ,$455.00 ,$455.00 , N/A ,$455.00 ,$327.60 ,$282.10 ,$327.60 ,$327.60 ,$364.00 
ST NICHOLAS HOSPITAL - ACUTE,48300011,93351,HC ECHO 2D STRESS CONT MONITORING,483,1 ,"$2,425.00 ","$1,212.50 ",$145.75 ,"$2,425.00 ",$145.75 ,"$1,568.73 ","$1,568.73 ",$476.43 ,"$1,455.00 ","$2,061.25 ","$1,697.50 ",$145.75 ,"$2,303.75 ","$1,843.00 ","$1,818.75 ","$1,576.25 ","$2,061.25 ",$476.43 ,"$1,576.25 ","$1,576.25 ","$1,697.50 ",$145.75 ,$476.43 ,$476.43 ,$305.48 ,"$2,061.25 ","$1,071.96 ","$2,231.00 ","$1,697.50 ","$2,028.08 ","$2,028.08 ","$1,476.83 ","$2,028.08 ","$1,675.68 ","$2,182.50 ","$1,689.01 ",$481.19 ,"$1,915.75 ",$154.50 ,$516.00 ,$516.00 ,$476.43 ,$516.00 ,"$1,746.00 ","$1,503.50 ","$1,746.00 ","$1,746.00 ","$1,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$1,100.00 ",$550.00 ,$145.75 ,"$1,100.00 ",$145.75 ,$711.59 ,$711.59 ,$363.09 ,$660.00 ,$935.00 ,$770.00 ,$145.75 ,"$1,045.00 ",$836.00 ,$825.00 ,$715.00 ,$935.00 ,$363.09 ,$715.00 ,$715.00 ,$770.00 ,$145.75 ,$363.09 ,$363.09 ,$305.48 ,$935.00 ,$816.96 ,"$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$990.00 ,$766.15 ,$366.72 ,$869.00 ,$154.50 ,$516.00 ,$516.00 ,$363.09 ,$516.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,48300018,C8928,HC ECHO TTE 2D STRESS W/W/O CONT  AND  W/CONT W/PF,483,1 ,"$1,961.00 ",$980.50 ,$145.75 ,"$1,961.00 ",$145.75 ,"$1,268.57 ","$1,268.57 ",$705.42 ,"$1,176.60 ","$1,666.85 ","$1,372.70 ",$145.75 ,"$1,862.95 ","$1,490.36 ","$1,470.75 ","$1,274.65 ","$1,666.85 ",$705.42 ,"$1,274.65 ","$1,274.65 ","$1,372.70 ",$145.75 ,$705.42 ,$705.42 ,$305.48 ,"$1,666.85 ","$1,587.19 ","$1,804.12 ","$1,372.70 ","$1,961.00 ","$1,961.00 ","$1,194.25 ","$1,961.00 ","$1,355.05 ","$1,764.90 ","$1,365.84 ",$712.47 ,"$1,549.19 ",$154.50 ,$516.00 ,$516.00 ,$705.42 ,$516.00 ,"$1,411.92 ","$1,215.82 ","$1,411.92 ","$1,411.92 ","$1,568.80 "
ST NICHOLAS HOSPITAL - ACUTE,48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$1,961.00 ",$980.50 ,$145.75 ,"$1,961.00 ",$145.75 ,"$1,268.57 ","$1,268.57 ",$705.42 ,"$1,176.60 ","$1,666.85 ","$1,372.70 ",$145.75 ,"$1,862.95 ","$1,490.36 ","$1,470.75 ","$1,274.65 ","$1,666.85 ",$705.42 ,"$1,274.65 ","$1,274.65 ","$1,372.70 ",$145.75 ,$705.42 ,$705.42 ,$305.48 ,"$1,666.85 ","$1,587.19 ","$1,804.12 ","$1,372.70 ","$1,961.00 ","$1,961.00 ","$1,194.25 ","$1,961.00 ","$1,355.05 ","$1,764.90 ","$1,365.84 ",$712.47 ,"$1,549.19 ",$154.50 ,$516.00 ,$516.00 ,$705.42 ,$516.00 ,"$1,411.92 ","$1,215.82 ","$1,411.92 ","$1,411.92 ","$1,568.80 "
ST NICHOLAS HOSPITAL - ACUTE,51000001,N/A,HC DISCONTINUED PROCEDURE,510,1 ,"$1,050.00 ",$525.00 ,$56.00 ,"$1,050.00 ", N/A ,$133.00 ,$104.00 , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$798.00 ,$787.50 ,$104.00 ,$892.50 , N/A ,$104.00 ,$56.00 ,$735.00 , N/A , N/A , N/A ,$64.61 ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$639.14 ,$725.55 ,$945.00 ,$731.33 , N/A ,$829.50 , N/A ,$630.00 ,$630.00 , N/A ,$630.00 ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$840.00 
ST NICHOLAS HOSPITAL - ACUTE,51000003,10180,HC I AND D WOUND POST OP COMPLEX,510,1 ,"$7,127.00 ","$3,563.50 ",$56.00 ,"$7,127.00 ",$315.09 ,$133.00 ,$104.00 ,"$2,337.86 ","$4,276.20 ","$6,057.95 ","$4,988.90 ",$315.09 ,"$6,770.65 ","$5,416.52 ","$5,345.25 ",$104.00 ,"$6,057.95 ","$2,337.86 ",$104.00 ,$56.00 ,"$4,988.90 ",$315.09 ,"$2,337.86 ","$2,337.86 ",$64.61 ,"$6,057.95 ","$5,260.19 ","$6,556.84 ","$4,988.90 ","$1,921.55 ","$2,401.67 ","$4,340.34 ","$2,401.67 ","$4,924.76 ","$6,414.30 ","$4,963.96 ","$2,361.24 ","$5,630.33 ",$334.00 ,"$4,276.20 ","$4,276.20 ","$2,337.86 ","$4,276.20 ","$5,131.44 ","$4,418.74 ","$5,131.44 ","$5,131.44 ","$5,701.60 "
ST NICHOLAS HOSPITAL - ACUTE,51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,$506.00 ,$253.00 ,$56.00 ,$766.80 ,$118.09 ,$133.00 ,$104.00 ,$340.80 ,$303.60 ,$430.10 ,$354.20 ,$118.09 ,$480.70 ,$384.56 ,$379.50 ,$104.00 ,$430.10 ,$340.80 ,$104.00 ,$56.00 ,$354.20 ,$118.09 ,$340.80 ,$340.80 ,$64.61 ,$430.10 ,$766.80 ,$465.52 ,$354.20 ,$506.00 ,$506.00 ,$308.15 ,$506.00 ,$349.65 ,$455.40 ,$352.43 ,$344.21 ,$399.74 ,$125.18 ,$303.60 ,$303.60 ,$340.80 ,$303.60 ,$364.32 ,$313.72 ,$364.32 ,$364.32 ,$404.80 
ST NICHOLAS HOSPITAL - ACUTE,51000006,11043,HC DEBR SKIN/SUBQ TISSUE/MUSCLE FAC,510,1 ,"$1,077.00 ",$538.50 ,$56.00 ,"$1,161.91 ",$118.09 ,$133.00 ,$104.00 ,$516.40 ,$646.20 ,$915.45 ,$753.90 ,$118.09 ,"$1,023.15 ",$818.52 ,$807.75 ,$104.00 ,$915.45 ,$516.40 ,$104.00 ,$56.00 ,$753.90 ,$118.09 ,$516.40 ,$516.40 ,$64.61 ,$915.45 ,"$1,161.91 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$969.30 ,$750.13 ,$521.56 ,$850.83 ,$125.18 ,$646.20 ,$646.20 ,$516.40 ,$646.20 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$861.60 
ST NICHOLAS HOSPITAL - ACUTE,51000007,11044,HC DEBR SKIN/SUB TIS/MUS/BONE INT 20 FAC,510,1 ,"$2,370.00 ","$1,185.00 ",$56.00 ,"$3,121.49 ",$315.09 ,$133.00 ,$104.00 ,"$1,387.33 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$315.09 ,"$2,251.50 ","$1,801.20 ","$1,777.50 ",$104.00 ,"$2,014.50 ","$1,387.33 ",$104.00 ,$56.00 ,"$1,659.00 ",$315.09 ,"$1,387.33 ","$1,387.33 ",$64.61 ,"$2,014.50 ","$3,121.49 ","$2,180.40 ","$1,659.00 ","$1,921.55 ","$2,370.00 ","$1,443.33 ","$2,370.00 ","$1,637.67 ","$2,133.00 ","$1,650.71 ","$1,401.20 ","$1,872.30 ",$334.00 ,"$1,422.00 ","$1,422.00 ","$1,387.33 ","$1,422.00 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,896.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000008,N/A,HC LIFETIME EX 3D/WK COUPLE,510,1 ,$126.00 ,$63.00 ,$56.00 ,$126.00 , N/A ,$126.00 ,$104.00 , N/A ,$75.60 ,$107.10 ,$88.20 , N/A ,$119.70 ,$95.76 ,$94.50 ,$104.00 ,$107.10 , N/A ,$104.00 ,$56.00 ,$88.20 , N/A , N/A , N/A ,$64.61 ,$107.10 , N/A ,$115.92 ,$88.20 ,$63.91 ,$76.70 ,$76.73 ,$76.70 ,$87.07 ,$113.40 ,$87.76 , N/A ,$99.54 , N/A ,$75.60 ,$75.60 , N/A ,$75.60 ,$90.72 ,$78.12 ,$90.72 ,$90.72 ,$100.80 
ST NICHOLAS HOSPITAL - ACUTE,51000009,11045,HC DEBR SKIN/SUBQ TIS EA ADL 20CM FAC,510,1 ,$108.00 ,$54.00 ,$54.00 ,$334.00 ,$315.09 ,$108.00 ,$104.00 , N/A ,$64.80 ,$91.80 ,$75.60 ,$315.09 ,$102.60 ,$82.08 ,$81.00 ,$104.00 ,$91.80 , N/A ,$104.00 ,$56.00 ,$75.60 ,$315.09 , N/A , N/A ,$64.61 ,$91.80 , N/A ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$97.20 ,$75.22 , N/A ,$85.32 ,$334.00 ,$64.80 ,$64.80 , N/A ,$64.80 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$86.40 
ST NICHOLAS HOSPITAL - ACUTE,51000010,11046,HC DEBR SKIN/SUBQ MUS/FAS ADL 20C FAC,510,1 ,$786.00 ,$393.00 ,$56.00 ,$786.00 ,$315.09 ,$133.00 ,$104.00 , N/A ,$471.60 ,$668.10 ,$550.20 ,$315.09 ,$746.70 ,$597.36 ,$589.50 ,$104.00 ,$668.10 , N/A ,$104.00 ,$56.00 ,$550.20 ,$315.09 , N/A , N/A ,$64.61 ,$668.10 , N/A ,$723.12 ,$550.20 ,$786.00 ,$786.00 ,$478.67 ,$786.00 ,$543.13 ,$707.40 ,$547.45 , N/A ,$620.94 ,$334.00 ,$471.60 ,$471.60 , N/A ,$471.60 ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$628.80 
ST NICHOLAS HOSPITAL - ACUTE,51000011,11047,HC DEBR SKIN/SUB TIS/MUS/BN ADL 20C FAC,510,1 ,"$1,497.00 ",$748.50 ,$56.00 ,"$1,497.00 ",$315.09 ,$133.00 ,$104.00 , N/A ,$898.20 ,"$1,272.45 ","$1,047.90 ",$315.09 ,"$1,422.15 ","$1,137.72 ","$1,122.75 ",$104.00 ,"$1,272.45 ", N/A ,$104.00 ,$56.00 ,"$1,047.90 ",$315.09 , N/A , N/A ,$64.61 ,"$1,272.45 ", N/A ,"$1,377.24 ","$1,047.90 ","$1,497.00 ","$1,497.00 ",$911.67 ,"$1,497.00 ","$1,034.43 ","$1,347.30 ","$1,042.66 ", N/A ,"$1,182.63 ",$334.00 ,$898.20 ,$898.20 , N/A ,$898.20 ,"$1,077.84 ",$928.14 ,"$1,077.84 ","$1,077.84 ","$1,197.60 "
ST NICHOLAS HOSPITAL - ACUTE,51000012,11055,HC PARING LESN BENIGN 1 FAC,510,1 ,$162.00 ,$81.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$97.20 ,$137.70 ,$113.40 ,$51.36 ,$153.90 ,$123.12 ,$121.50 ,$104.00 ,$137.70 ,$177.06 ,$104.00 ,$56.00 ,$113.40 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$137.70 ,$398.39 ,$149.04 ,$113.40 ,$162.00 ,$162.00 ,$98.66 ,$162.00 ,$111.94 ,$145.80 ,$112.83 ,$178.83 ,$127.98 ,$54.44 ,$97.20 ,$97.20 ,$177.06 ,$97.20 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,51000014,11056,HC PARING LESN BENIGN 2-4 FAC,510,1 ,$194.00 ,$97.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$116.40 ,$164.90 ,$135.80 ,$51.36 ,$184.30 ,$147.44 ,$145.50 ,$104.00 ,$164.90 ,$177.06 ,$104.00 ,$56.00 ,$135.80 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$164.90 ,$398.39 ,$178.48 ,$135.80 ,$194.00 ,$194.00 ,$118.15 ,$194.00 ,$134.05 ,$174.60 ,$135.12 ,$178.83 ,$153.26 ,$54.44 ,$116.40 ,$116.40 ,$177.06 ,$116.40 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$155.20 
ST NICHOLAS HOSPITAL - ACUTE,51000021,11719,HC TRIM NAILS NONDYSTROPHIC FAC,510,1 ,$129.00 ,$64.50 ,$20.60 ,$129.00 ,$20.60 ,$129.00 ,$104.00 ,$54.89 ,$77.40 ,$109.65 ,$90.30 ,$20.60 ,$122.55 ,$98.04 ,$96.75 ,$104.00 ,$109.65 ,$54.89 ,$104.00 ,$56.00 ,$90.30 ,$20.60 ,$54.89 ,$54.89 ,$64.61 ,$109.65 ,$123.49 ,$118.68 ,$90.30 ,$129.00 ,$129.00 ,$78.56 ,$129.00 ,$89.14 ,$116.10 ,$89.85 ,$55.44 ,$101.91 ,$21.84 ,$77.40 ,$77.40 ,$54.89 ,$77.40 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,51000023,11720,HC DEBR NAIL(S) UP TO 5,510,1 ,$97.00 ,$48.50 ,$20.60 ,$123.49 ,$20.60 ,$97.00 ,$97.00 ,$54.89 ,$58.20 ,$82.45 ,$67.90 ,$20.60 ,$92.15 ,$73.72 ,$72.75 ,$97.00 ,$82.45 ,$54.89 ,$97.00 ,$56.00 ,$67.90 ,$20.60 ,$54.89 ,$54.89 ,$64.61 ,$82.45 ,$123.49 ,$89.24 ,$67.90 ,$97.00 ,$97.00 ,$59.07 ,$97.00 ,$67.03 ,$87.30 ,$67.56 ,$55.44 ,$76.63 ,$21.84 ,$58.20 ,$58.20 ,$54.89 ,$58.20 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$77.60 
ST NICHOLAS HOSPITAL - ACUTE,51000024,11721,HC DEBR NAIL(S) 6 OR MORE,510,1 ,$129.00 ,$64.50 ,$20.60 ,$129.00 ,$20.60 ,$129.00 ,$104.00 ,$54.89 ,$77.40 ,$109.65 ,$90.30 ,$20.60 ,$122.55 ,$98.04 ,$96.75 ,$104.00 ,$109.65 ,$54.89 ,$104.00 ,$56.00 ,$90.30 ,$20.60 ,$54.89 ,$54.89 ,$64.61 ,$109.65 ,$123.49 ,$118.68 ,$90.30 ,$129.00 ,$129.00 ,$78.56 ,$129.00 ,$89.14 ,$116.10 ,$89.85 ,$55.44 ,$101.91 ,$21.84 ,$77.40 ,$77.40 ,$54.89 ,$77.40 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$103.20 
ST NICHOLAS HOSPITAL - ACUTE,51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,"$1,185.00 ",$592.50 ,$56.00 ,"$1,185.00 ",$139.95 ,$133.00 ,$104.00 ,$340.80 ,$711.00 ,"$1,007.25 ",$829.50 ,$139.95 ,"$1,125.75 ",$900.60 ,$888.75 ,$104.00 ,"$1,007.25 ",$340.80 ,$104.00 ,$56.00 ,$829.50 ,$139.95 ,$340.80 ,$340.80 ,$64.61 ,"$1,007.25 ",$766.80 ,"$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$344.21 ,$936.15 ,$148.35 ,$711.00 ,$711.00 ,$340.80 ,$711.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,51000026,15002,HC WND PREP REC ST T/A/L<100,510,1 ,"$1,235.00 ",$617.50 ,$56.00 ,"$3,799.81 ",$315.09 ,$133.00 ,$104.00 ,"$1,688.81 ",$741.00 ,"$1,049.75 ",$864.50 ,$315.09 ,"$1,173.25 ",$938.60 ,$926.25 ,$104.00 ,"$1,049.75 ","$1,688.81 ",$104.00 ,$56.00 ,$864.50 ,$315.09 ,"$1,688.81 ","$1,688.81 ",$64.61 ,"$1,049.75 ","$3,799.81 ","$1,136.20 ",$864.50 ,"$1,235.00 ","$1,235.00 ",$752.12 ,"$1,235.00 ",$853.39 ,"$1,111.50 ",$860.18 ,"$1,705.70 ",$975.65 ,$334.00 ,$741.00 ,$741.00 ,"$1,688.81 ",$741.00 ,$889.20 ,$765.70 ,$889.20 ,$889.20 ,$988.00 
ST NICHOLAS HOSPITAL - ACUTE,51000027,15004,HC WND PREP REC ST F/N/H/F/G<100,510,1 ,"$1,060.00 ",$530.00 ,$56.00 ,"$1,161.91 ",$315.09 ,$133.00 ,$104.00 ,$516.40 ,$636.00 ,$901.00 ,$742.00 ,$315.09 ,"$1,007.00 ",$805.60 ,$795.00 ,$104.00 ,$901.00 ,$516.40 ,$104.00 ,$56.00 ,$742.00 ,$315.09 ,$516.40 ,$516.40 ,$64.61 ,$901.00 ,"$1,161.91 ",$975.20 ,$742.00 ,"$1,060.00 ","$1,060.00 ",$645.54 ,"$1,060.00 ",$732.46 ,$954.00 ,$738.29 ,$521.56 ,$837.40 ,$334.00 ,$636.00 ,$636.00 ,$516.40 ,$636.00 ,$763.20 ,$657.20 ,$763.20 ,$763.20 ,$848.00 
ST NICHOLAS HOSPITAL - ACUTE,51000028,15100,HC AUTOGRPH T A L 100SQCM< FAC,510,1 ,"$3,997.00 ","$1,998.50 ",$56.00 ,"$3,997.00 ",$615.10 ,$133.00 ,$104.00 ,"$1,688.81 ","$2,398.20 ","$3,397.45 ","$2,797.90 ",$615.10 ,"$3,797.15 ","$3,037.72 ","$2,997.75 ",$104.00 ,"$3,397.45 ","$1,688.81 ",$104.00 ,$56.00 ,"$2,797.90 ",$615.10 ,"$1,688.81 ","$1,688.81 ",$64.61 ,"$3,397.45 ","$3,799.81 ","$3,677.24 ","$2,797.90 ","$1,921.55 ","$2,401.67 ","$2,434.17 ","$2,401.67 ","$2,761.93 ","$3,597.30 ","$2,783.91 ","$1,705.70 ","$3,157.63 ",$652.01 ,"$2,398.20 ","$2,398.20 ","$1,688.81 ","$2,398.20 ","$2,877.84 ","$2,478.14 ","$2,877.84 ","$2,877.84 ","$3,197.60 "
ST NICHOLAS HOSPITAL - ACUTE,51000044,15786,HC ABRASION LESION SINGLE,510,1 ,$312.00 ,$156.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$187.20 ,$265.20 ,$218.40 ,$51.36 ,$296.40 ,$237.12 ,$234.00 ,$104.00 ,$265.20 ,$177.06 ,$104.00 ,$56.00 ,$218.40 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$265.20 ,$398.39 ,$287.04 ,$218.40 ,$312.00 ,$312.00 ,$190.01 ,$312.00 ,$215.59 ,$280.80 ,$217.31 ,$178.83 ,$246.48 ,$54.44 ,$187.20 ,$187.20 ,$177.06 ,$187.20 ,$224.64 ,$193.44 ,$224.64 ,$224.64 ,$249.60 
ST NICHOLAS HOSPITAL - ACUTE,51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$636.00 ,$318.00 ,$56.00 ,$707.37 ,$95.17 ,$133.00 ,$104.00 ,$314.39 ,$381.60 ,$540.60 ,$445.20 ,$95.17 ,$604.20 ,$483.36 ,$477.00 ,$104.00 ,$540.60 ,$314.39 ,$104.00 ,$56.00 ,$445.20 ,$95.17 ,$314.39 ,$314.39 ,$64.61 ,$540.60 ,$707.37 ,$585.12 ,$445.20 ,$636.00 ,$636.00 ,$387.32 ,$636.00 ,$439.48 ,$572.40 ,$442.97 ,$317.53 ,$502.44 ,$100.88 ,$381.60 ,$381.60 ,$314.39 ,$381.60 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$508.80 
ST NICHOLAS HOSPITAL - ACUTE,51000052,29445,HC APPL CAST LEG RIGID CONTACT FAC,510,1 ,$668.00 ,$334.00 ,$56.00 ,$668.00 ,$59.15 ,$133.00 ,$104.00 ,$237.87 ,$400.80 ,$567.80 ,$467.60 ,$59.15 ,$634.60 ,$507.68 ,$501.00 ,$104.00 ,$567.80 ,$237.87 ,$104.00 ,$56.00 ,$467.60 ,$59.15 ,$237.87 ,$237.87 ,$64.61 ,$567.80 ,$535.20 ,$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$601.20 ,$465.26 ,$240.25 ,$527.72 ,$62.70 ,$400.80 ,$400.80 ,$237.87 ,$400.80 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$534.40 
ST NICHOLAS HOSPITAL - ACUTE,51000053,29580,HC APPLY UNNA BOOT,510,1 ,$334.00 ,$167.00 ,$56.00 ,$470.15 ,$88.73 ,$133.00 ,$104.00 ,$208.96 ,$200.40 ,$283.90 ,$233.80 ,$88.73 ,$317.30 ,$253.84 ,$250.50 ,$104.00 ,$283.90 ,$208.96 ,$104.00 ,$56.00 ,$233.80 ,$88.73 ,$208.96 ,$208.96 ,$64.61 ,$283.90 ,$470.15 ,$307.28 ,$233.80 ,$334.00 ,$334.00 ,$203.41 ,$334.00 ,$230.79 ,$300.60 ,$232.63 ,$211.05 ,$263.86 ,$94.05 ,$200.40 ,$200.40 ,$208.96 ,$200.40 ,$240.48 ,$207.08 ,$240.48 ,$240.48 ,$267.20 
ST NICHOLAS HOSPITAL - ACUTE,51000053,29580,HC APPLY UNNA BOOT,510,1 ,$334.00 ,$167.00 ,$56.00 ,$470.15 ,$88.73 ,$133.00 ,$104.00 ,$208.96 ,$200.40 ,$283.90 ,$233.80 ,$88.73 ,$317.30 ,$253.84 ,$250.50 ,$104.00 ,$283.90 ,$208.96 ,$104.00 ,$56.00 ,$233.80 ,$88.73 ,$208.96 ,$208.96 ,$64.61 ,$283.90 ,$470.15 ,$307.28 ,$233.80 ,$334.00 ,$334.00 ,$203.41 ,$334.00 ,$230.79 ,$300.60 ,$232.63 ,$211.05 ,$263.86 ,$94.05 ,$200.40 ,$200.40 ,$208.96 ,$200.40 ,$240.48 ,$207.08 ,$240.48 ,$240.48 ,$267.20 
ST NICHOLAS HOSPITAL - ACUTE,51000055,29581,HC APPLY MULTI COMP LOWER LEG FAC,510,1 ,$345.00 ,$172.50 ,$56.00 ,$470.15 ,$88.73 ,$133.00 ,$104.00 ,$208.96 ,$207.00 ,$293.25 ,$241.50 ,$88.73 ,$327.75 ,$262.20 ,$258.75 ,$104.00 ,$293.25 ,$208.96 ,$104.00 ,$56.00 ,$241.50 ,$88.73 ,$208.96 ,$208.96 ,$64.61 ,$293.25 ,$470.15 ,$317.40 ,$241.50 ,$345.00 ,$345.00 ,$210.11 ,$345.00 ,$238.40 ,$310.50 ,$240.29 ,$211.05 ,$272.55 ,$94.05 ,$207.00 ,$207.00 ,$208.96 ,$207.00 ,$248.40 ,$213.90 ,$248.40 ,$248.40 ,$276.00 
ST NICHOLAS HOSPITAL - ACUTE,51000055,29581,HC APPLY MULTI COMP LOWER LEG FAC,510,1 ,$345.00 ,$172.50 ,$56.00 ,$470.15 ,$88.73 ,$133.00 ,$104.00 ,$208.96 ,$207.00 ,$293.25 ,$241.50 ,$88.73 ,$327.75 ,$262.20 ,$258.75 ,$104.00 ,$293.25 ,$208.96 ,$104.00 ,$56.00 ,$241.50 ,$88.73 ,$208.96 ,$208.96 ,$64.61 ,$293.25 ,$470.15 ,$317.40 ,$241.50 ,$345.00 ,$345.00 ,$210.11 ,$345.00 ,$238.40 ,$310.50 ,$240.29 ,$211.05 ,$272.55 ,$94.05 ,$207.00 ,$207.00 ,$208.96 ,$207.00 ,$248.40 ,$213.90 ,$248.40 ,$248.40 ,$276.00 
ST NICHOLAS HOSPITAL - ACUTE,51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$112.00 ,$56.00 ,$13.88 ,$137.55 ,$13.88 ,$72.45 ,$72.45 ,$61.13 ,$67.20 ,$95.20 ,$78.40 ,$13.88 ,$106.40 ,$85.12 ,$84.00 ,$72.80 ,$95.20 ,$61.13 ,$72.80 ,$72.80 ,$78.40 ,$13.88 ,$61.13 ,$61.13 ,$47.04 ,$95.20 ,$137.55 ,$103.04 ,$78.40 ,$56.81 ,$68.17 ,$68.21 ,$68.17 ,$77.39 ,$100.80 ,$78.01 ,$61.74 ,$88.48 ,$14.71 ,$56.00 ,$56.00 ,$61.13 ,$56.00 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$89.60 
ST NICHOLAS HOSPITAL - ACUTE,51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$224.00 ,$112.00 ,$13.88 ,$453.85 ,$13.88 ,$144.91 ,$144.91 ,$201.71 ,$134.40 ,$190.40 ,$156.80 ,$13.88 ,$212.80 ,$170.24 ,$168.00 ,$145.60 ,$190.40 ,$201.71 ,$145.60 ,$145.60 ,$156.80 ,$13.88 ,$201.71 ,$201.71 ,$94.08 ,$190.40 ,$453.85 ,$206.08 ,$156.80 ,$113.61 ,$136.35 ,$136.42 ,$136.35 ,$154.78 ,$201.60 ,$156.02 ,$203.73 ,$176.96 ,$14.71 ,$112.00 ,$112.00 ,$201.71 ,$112.00 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$179.20 
ST NICHOLAS HOSPITAL - ACUTE,51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$179.00 ,$89.50 ,$13.88 ,$179.00 ,$13.88 ,$115.80 ,$115.80 ,$39.46 ,$107.40 ,$152.15 ,$125.30 ,$13.88 ,$170.05 ,$136.04 ,$134.25 ,$116.35 ,$152.15 ,$39.46 ,$116.35 ,$116.35 ,$125.30 ,$13.88 ,$39.46 ,$39.46 ,$75.18 ,$152.15 ,$88.78 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$108.96 ,$123.69 ,$161.10 ,$124.67 ,$39.85 ,$141.41 ,$14.71 ,$89.50 ,$89.50 ,$39.46 ,$89.50 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$179.00 ,$89.50 ,$13.88 ,$179.00 ,$13.88 ,$115.80 ,$115.80 , N/A ,$107.40 ,$152.15 ,$125.30 ,$13.88 ,$170.05 ,$136.04 ,$134.25 ,$116.35 ,$152.15 , N/A ,$116.35 ,$116.35 ,$125.30 ,$13.88 , N/A , N/A ,$75.18 ,$152.15 , N/A ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$108.96 ,$123.69 ,$161.10 ,$124.67 , N/A ,$141.41 ,$14.71 ,$89.50 ,$89.50 , N/A ,$89.50 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$143.20 
ST NICHOLAS HOSPITAL - ACUTE,51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$134.00 ,$67.00 ,$13.88 ,$134.00 ,$13.88 ,$133.00 ,$104.00 ,$54.89 ,$80.40 ,$113.90 ,$93.80 ,$13.88 ,$127.30 ,$101.84 ,$100.50 ,$104.00 ,$113.90 ,$54.89 ,$104.00 ,$56.00 ,$93.80 ,$13.88 ,$54.89 ,$54.89 ,$64.61 ,$113.90 ,$123.49 ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$81.57 ,$92.59 ,$120.60 ,$93.33 ,$55.44 ,$105.86 ,$14.71 ,$80.40 ,$80.40 ,$54.89 ,$80.40 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,51000072,97597,HC DEBR SKIN PART THICKNESS <20CM FAC,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000078,97597,HC DEBR SKIN INTL CAST REMOVAL/APPLY FACIL,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000079,97597,HC DEBR SKIN INTL 20CM BIL UNNA FACIL,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000080,97597,HC DEBR SKIN INTL 20CM NWPT/UNNA FAC,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000083,97597,HC DEBR SKIN INTL 20CM WRAP BILAT FAC,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000084,97597,HC DEBR SKIN INTL 20CM WRAP FACILITY,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000086,97597,HC DEBR SKIN INTL 20CM/UNNA FACILITY,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000087,97597,HC DEBR SKIN INTL NWPT 20CM FACIL,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000088,G0296,HC CLINIC VISIT CONSULT LOW DOSE LUNG SCREEN,510,1 ,$103.00 ,$51.50 ,$38.23 ,$166.00 ,$38.23 ,$103.00 ,$103.00 ,$73.78 ,$61.80 ,$87.55 ,$72.10 ,$38.23 ,$97.85 ,$78.28 ,$77.25 ,$103.00 ,$87.55 ,$73.78 ,$103.00 ,$56.00 ,$72.10 ,$38.23 ,$73.78 ,$73.78 ,$64.61 ,$87.55 ,$166.00 ,$94.76 ,$72.10 ,$52.24 ,$62.70 ,$62.73 ,$62.70 ,$71.17 ,$92.70 ,$71.74 ,$74.52 ,$81.37 ,$40.52 ,$61.80 ,$61.80 ,$73.78 ,$61.80 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$247.00 ,$123.50 ,$38.23 ,$247.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$148.20 ,$209.95 ,$172.90 ,$38.23 ,$234.65 ,$187.72 ,$185.25 ,$104.00 ,$209.95 , N/A ,$104.00 ,$56.00 ,$172.90 ,$38.23 , N/A , N/A ,$64.61 ,$209.95 , N/A ,$227.24 ,$172.90 ,$125.28 ,$150.35 ,$150.42 ,$150.35 ,$170.68 ,$222.30 ,$172.04 , N/A ,$195.13 ,$40.52 ,$148.20 ,$148.20 , N/A ,$148.20 ,$177.84 ,$153.14 ,$177.84 ,$177.84 ,$197.60 
ST NICHOLAS HOSPITAL - ACUTE,51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$299.00 ,$149.50 ,$38.23 ,$299.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$179.40 ,$254.15 ,$209.30 ,$38.23 ,$284.05 ,$227.24 ,$224.25 ,$104.00 ,$254.15 , N/A ,$104.00 ,$56.00 ,$209.30 ,$38.23 , N/A , N/A ,$64.61 ,$254.15 , N/A ,$275.08 ,$209.30 ,$151.65 ,$182.00 ,$182.09 ,$182.00 ,$206.61 ,$269.10 ,$208.25 , N/A ,$236.21 ,$40.52 ,$179.40 ,$179.40 , N/A ,$179.40 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$239.20 
ST NICHOLAS HOSPITAL - ACUTE,51000109,99204,HC CLINIC VISIT COMPLEX NEW,510,1 ,$340.00 ,$170.00 ,$38.23 ,$340.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$204.00 ,$289.00 ,$238.00 ,$38.23 ,$323.00 ,$258.40 ,$255.00 ,$104.00 ,$289.00 , N/A ,$104.00 ,$56.00 ,$238.00 ,$38.23 , N/A , N/A ,$64.61 ,$289.00 , N/A ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$206.96 ,$234.94 ,$306.00 ,$236.81 , N/A ,$268.60 ,$40.52 ,$204.00 ,$204.00 , N/A ,$204.00 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$272.00 
ST NICHOLAS HOSPITAL - ACUTE,51000113,99205,HC CLINIC VISIT COMPREH NEW,510,1 ,$412.00 ,$206.00 ,$38.23 ,$412.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$247.20 ,$350.20 ,$288.40 ,$38.23 ,$391.40 ,$313.12 ,$309.00 ,$104.00 ,$350.20 , N/A ,$104.00 ,$56.00 ,$288.40 ,$38.23 , N/A , N/A ,$64.61 ,$350.20 , N/A ,$379.04 ,$288.40 ,$208.97 ,$250.78 ,$250.91 ,$250.78 ,$284.69 ,$370.80 ,$286.96 , N/A ,$325.48 ,$40.52 ,$247.20 ,$247.20 , N/A ,$247.20 ,$296.64 ,$255.44 ,$296.64 ,$296.64 ,$329.60 
ST NICHOLAS HOSPITAL - ACUTE,51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$227.00 ,$113.50 ,$38.23 ,$227.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$136.20 ,$192.95 ,$158.90 ,$38.23 ,$215.65 ,$172.52 ,$170.25 ,$104.00 ,$192.95 , N/A ,$104.00 ,$56.00 ,$158.90 ,$38.23 , N/A , N/A ,$64.61 ,$192.95 , N/A ,$208.84 ,$158.90 ,$115.13 ,$138.17 ,$138.24 ,$138.17 ,$156.86 ,$204.30 ,$158.11 , N/A ,$179.33 ,$40.52 ,$136.20 ,$136.20 , N/A ,$136.20 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$181.60 
ST NICHOLAS HOSPITAL - ACUTE,51000115,99211,HC LACTATION EST PAT-BRIEF,510,1 ,$227.00 ,$113.50 ,$38.23 ,$227.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$136.20 ,$192.95 ,$158.90 ,$38.23 ,$215.65 ,$172.52 ,$170.25 ,$104.00 ,$192.95 , N/A ,$104.00 ,$56.00 ,$158.90 ,$38.23 , N/A , N/A ,$64.61 ,$192.95 , N/A ,$208.84 ,$158.90 ,$115.13 ,$138.17 ,$138.24 ,$138.17 ,$156.86 ,$204.30 ,$158.11 , N/A ,$179.33 ,$40.52 ,$136.20 ,$136.20 , N/A ,$136.20 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$181.60 
ST NICHOLAS HOSPITAL - ACUTE,51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$237.00 ,$118.50 ,$38.23 ,$237.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$142.20 ,$201.45 ,$165.90 ,$38.23 ,$225.15 ,$180.12 ,$177.75 ,$104.00 ,$201.45 , N/A ,$104.00 ,$56.00 ,$165.90 ,$38.23 , N/A , N/A ,$64.61 ,$201.45 , N/A ,$218.04 ,$165.90 ,$120.21 ,$144.26 ,$144.33 ,$144.26 ,$163.77 ,$213.30 ,$165.07 , N/A ,$187.23 ,$40.52 ,$142.20 ,$142.20 , N/A ,$142.20 ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$189.60 
ST NICHOLAS HOSPITAL - ACUTE,51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$288.00 ,$144.00 ,$38.23 ,$288.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$172.80 ,$244.80 ,$201.60 ,$38.23 ,$273.60 ,$218.88 ,$216.00 ,$104.00 ,$244.80 , N/A ,$104.00 ,$56.00 ,$201.60 ,$38.23 , N/A , N/A ,$64.61 ,$244.80 , N/A ,$264.96 ,$201.60 ,$146.07 ,$175.31 ,$175.39 ,$175.31 ,$199.01 ,$259.20 ,$200.59 , N/A ,$227.52 ,$40.52 ,$172.80 ,$172.80 , N/A ,$172.80 ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$230.40 
ST NICHOLAS HOSPITAL - ACUTE,51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$319.00 ,$159.50 ,$38.23 ,$319.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$191.40 ,$271.15 ,$223.30 ,$38.23 ,$303.05 ,$242.44 ,$239.25 ,$104.00 ,$271.15 , N/A ,$104.00 ,$56.00 ,$223.30 ,$38.23 , N/A , N/A ,$64.61 ,$271.15 , N/A ,$293.48 ,$223.30 ,$161.80 ,$194.18 ,$194.27 ,$194.18 ,$220.43 ,$287.10 ,$222.18 , N/A ,$252.01 ,$40.52 ,$191.40 ,$191.40 , N/A ,$191.40 ,$229.68 ,$197.78 ,$229.68 ,$229.68 ,$255.20 
ST NICHOLAS HOSPITAL - ACUTE,51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$402.00 ,$201.00 ,$38.23 ,$402.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$241.20 ,$341.70 ,$281.40 ,$38.23 ,$381.90 ,$305.52 ,$301.50 ,$104.00 ,$341.70 , N/A ,$104.00 ,$56.00 ,$281.40 ,$38.23 , N/A , N/A ,$64.61 ,$341.70 , N/A ,$369.84 ,$281.40 ,$203.89 ,$244.70 ,$244.82 ,$244.70 ,$277.78 ,$361.80 ,$279.99 , N/A ,$317.58 ,$40.52 ,$241.20 ,$241.20 , N/A ,$241.20 ,$289.44 ,$249.24 ,$289.44 ,$289.44 ,$321.60 
ST NICHOLAS HOSPITAL - ACUTE,51000145,G0127,HC TRIM NAILS DYSTROPHIC FAC,510,1 ,$119.00 ,$59.50 ,$20.60 ,$123.49 ,$20.60 ,$119.00 ,$104.00 ,$54.89 ,$71.40 ,$101.15 ,$83.30 ,$20.60 ,$113.05 ,$90.44 ,$89.25 ,$104.00 ,$101.15 ,$54.89 ,$104.00 ,$56.00 ,$83.30 ,$20.60 ,$54.89 ,$54.89 ,$64.61 ,$101.15 ,$123.49 ,$109.48 ,$83.30 ,$60.36 ,$72.44 ,$72.47 ,$72.44 ,$82.23 ,$107.10 ,$82.88 ,$55.44 ,$94.01 ,$21.84 ,$71.40 ,$71.40 ,$54.89 ,$71.40 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$95.20 
ST NICHOLAS HOSPITAL - ACUTE,51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$47.00 ,$23.50 ,$0.73 ,$47.00 ,$0.73 ,$10.50 ,$9.00 ,$3.00 ,$28.20 ,$39.95 ,$32.90 ,$0.73 ,$44.65 ,$35.72 ,$35.25 ,$5.10 ,$39.95 ,$3.00 ,$5.10 ,$3.00 ,$32.90 ,$0.73 ,$3.00 ,$3.00 ,$3.40 ,$39.95 ,$6.75 ,$43.24 ,$32.90 ,$10.57 ,$10.57 ,$28.62 ,$10.57 ,$32.48 ,$42.30 ,$32.74 ,$3.03 ,$37.13 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$37.60 
ST NICHOLAS HOSPITAL - ACUTE,51000159,16020,HC BURN DRS  AND /OR DEBRID <5% FACIL,510,1 ,$409.00 ,$204.50 ,$56.00 ,$409.00 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$245.40 ,$347.65 ,$286.30 ,$58.71 ,$388.55 ,$310.84 ,$306.75 ,$104.00 ,$347.65 ,$177.06 ,$104.00 ,$56.00 ,$286.30 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$347.65 ,$398.39 ,$376.28 ,$286.30 ,$409.00 ,$409.00 ,$249.08 ,$409.00 ,$282.62 ,$368.10 ,$284.87 ,$178.83 ,$323.11 ,$62.23 ,$245.40 ,$245.40 ,$177.06 ,$245.40 ,$294.48 ,$253.58 ,$294.48 ,$294.48 ,$327.20 
ST NICHOLAS HOSPITAL - ACUTE,51000160,16020,HC BURN DR AND OR DEBRD NWPT <5% FACILITY,510,1 ,$409.00 ,$204.50 ,$56.00 ,$409.00 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$245.40 ,$347.65 ,$286.30 ,$58.71 ,$388.55 ,$310.84 ,$306.75 ,$104.00 ,$347.65 ,$177.06 ,$104.00 ,$56.00 ,$286.30 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$347.65 ,$398.39 ,$376.28 ,$286.30 ,$409.00 ,$409.00 ,$249.08 ,$409.00 ,$282.62 ,$368.10 ,$284.87 ,$178.83 ,$323.11 ,$62.23 ,$245.40 ,$245.40 ,$177.06 ,$245.40 ,$294.48 ,$253.58 ,$294.48 ,$294.48 ,$327.20 
ST NICHOLAS HOSPITAL - ACUTE,51000161,17110,HC DESTRUCT BENIGN LESION <15 FACIL,510,1 ,$162.00 ,$81.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$97.20 ,$137.70 ,$113.40 ,$51.36 ,$153.90 ,$123.12 ,$121.50 ,$104.00 ,$137.70 ,$177.06 ,$104.00 ,$56.00 ,$113.40 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$137.70 ,$398.39 ,$149.04 ,$113.40 ,$162.00 ,$162.00 ,$98.66 ,$162.00 ,$111.94 ,$145.80 ,$112.83 ,$178.83 ,$127.98 ,$54.44 ,$97.20 ,$97.20 ,$177.06 ,$97.20 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,51000162,97597,HC AWC WITH CHEM CAUTERY,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000164,17250,HC CHEM CAUTERY/NWPT FACILITY,510,1 ,$388.00 ,$194.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$51.36 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$388.00 ,$388.00 ,$236.29 ,$388.00 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$54.44 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000169,17250,HC CHEM CAUTERY FACILITY,510,1 ,$388.00 ,$194.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$51.36 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$388.00 ,$388.00 ,$236.29 ,$388.00 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$54.44 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000170,97597,HC AWC>20SQCM/CAUT/UNNA FACIL,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$205.00 ,$102.50 ,$22.63 ,$250.16 ,$22.63 ,$133.00 ,$104.00 ,$111.18 ,$123.00 ,$174.25 ,$143.50 ,$22.63 ,$194.75 ,$155.80 ,$153.75 ,$104.00 ,$174.25 ,$111.18 ,$104.00 ,$56.00 ,$143.50 ,$22.63 ,$111.18 ,$111.18 ,$64.61 ,$174.25 ,$250.16 ,$188.60 ,$143.50 ,$205.00 ,$205.00 ,$124.85 ,$205.00 ,$141.66 ,$184.50 ,$142.78 ,$112.29 ,$161.95 ,$23.99 ,$123.00 ,$123.00 ,$111.18 ,$123.00 ,$147.60 ,$127.10 ,$147.60 ,$147.60 ,$164.00 
ST NICHOLAS HOSPITAL - ACUTE,51000172,51702,HC CATH BLADDER SMP,510,1 ,$205.00 ,$102.50 ,$22.63 ,$250.16 ,$22.63 ,$133.00 ,$104.00 ,$111.18 ,$123.00 ,$174.25 ,$143.50 ,$22.63 ,$194.75 ,$155.80 ,$153.75 ,$104.00 ,$174.25 ,$111.18 ,$104.00 ,$56.00 ,$143.50 ,$22.63 ,$111.18 ,$111.18 ,$64.61 ,$174.25 ,$250.16 ,$188.60 ,$143.50 ,$205.00 ,$205.00 ,$124.85 ,$205.00 ,$141.66 ,$184.50 ,$142.78 ,$112.29 ,$161.95 ,$23.99 ,$123.00 ,$123.00 ,$111.18 ,$123.00 ,$147.60 ,$127.10 ,$147.60 ,$147.60 ,$164.00 
ST NICHOLAS HOSPITAL - ACUTE,51000173,51703,HC CATH BLADDER CPLX,510,1 ,$366.00 ,$183.00 ,$22.63 ,$366.00 ,$22.63 ,$133.00 ,$104.00 ,$137.66 ,$219.60 ,$311.10 ,$256.20 ,$22.63 ,$347.70 ,$278.16 ,$274.50 ,$104.00 ,$311.10 ,$137.66 ,$104.00 ,$56.00 ,$256.20 ,$22.63 ,$137.66 ,$137.66 ,$64.61 ,$311.10 ,$309.74 ,$336.72 ,$256.20 ,$366.00 ,$366.00 ,$222.89 ,$366.00 ,$252.91 ,$329.40 ,$254.92 ,$139.04 ,$289.14 ,$23.99 ,$219.60 ,$219.60 ,$137.66 ,$219.60 ,$263.52 ,$226.92 ,$263.52 ,$263.52 ,$292.80 
ST NICHOLAS HOSPITAL - ACUTE,51000175,94780,HC CARSEAT ANALYSIS FIRST 60MIN,510,1 ,$190.00 ,$95.00 ,$16.35 ,$190.00 ,$16.35 ,$133.00 ,$104.00 ,$33.38 ,$114.00 ,$161.50 ,$133.00 ,$16.35 ,$180.50 ,$144.40 ,$142.50 ,$104.00 ,$161.50 ,$33.38 ,$104.00 ,$56.00 ,$133.00 ,$16.35 ,$33.38 ,$33.38 ,$64.61 ,$161.50 ,$75.09 ,$174.80 ,$133.00 ,$96.37 ,$115.65 ,$115.71 ,$115.65 ,$131.29 ,$171.00 ,$132.34 ,$33.71 ,$150.10 ,$17.33 ,$114.00 ,$114.00 ,$33.38 ,$114.00 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$152.00 
ST NICHOLAS HOSPITAL - ACUTE,51000176,99213,HC CHANGE EXER ASSESS EVAL,510,1 ,$134.00 ,$67.00 ,$38.23 ,$134.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$80.40 ,$113.90 ,$93.80 ,$38.23 ,$127.30 ,$101.84 ,$100.50 ,$104.00 ,$113.90 , N/A ,$104.00 ,$56.00 ,$93.80 ,$38.23 , N/A , N/A ,$64.61 ,$113.90 , N/A ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$81.57 ,$92.59 ,$120.60 ,$93.33 , N/A ,$105.86 ,$40.52 ,$80.40 ,$80.40 , N/A ,$80.40 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$107.20 
ST NICHOLAS HOSPITAL - ACUTE,51000184,99211,HC L AND D OUTPATIENT TREATMENT,510,1 ,$216.00 ,$108.00 ,$38.23 ,$216.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$129.60 ,$183.60 ,$151.20 ,$38.23 ,$205.20 ,$164.16 ,$162.00 ,$104.00 ,$183.60 , N/A ,$104.00 ,$56.00 ,$151.20 ,$38.23 , N/A , N/A ,$64.61 ,$183.60 , N/A ,$198.72 ,$151.20 ,$109.56 ,$131.48 ,$131.54 ,$131.48 ,$149.26 ,$194.40 ,$150.44 , N/A ,$170.64 ,$40.52 ,$129.60 ,$129.60 , N/A ,$129.60 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$172.80 
ST NICHOLAS HOSPITAL - ACUTE,51000187,99212,HC LACTATION EST PAT-LIMITED,510,1 ,$237.00 ,$118.50 ,$38.23 ,$237.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$142.20 ,$201.45 ,$165.90 ,$38.23 ,$225.15 ,$180.12 ,$177.75 ,$104.00 ,$201.45 , N/A ,$104.00 ,$56.00 ,$165.90 ,$38.23 , N/A , N/A ,$64.61 ,$201.45 , N/A ,$218.04 ,$165.90 ,$120.21 ,$144.26 ,$144.33 ,$144.26 ,$163.77 ,$213.30 ,$165.07 , N/A ,$187.23 ,$40.52 ,$142.20 ,$142.20 , N/A ,$142.20 ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$189.60 
ST NICHOLAS HOSPITAL - ACUTE,51000188,99213,HC LACTATION EST PAT-INTERM,510,1 ,$288.00 ,$144.00 ,$38.23 ,$288.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$172.80 ,$244.80 ,$201.60 ,$38.23 ,$273.60 ,$218.88 ,$216.00 ,$104.00 ,$244.80 , N/A ,$104.00 ,$56.00 ,$201.60 ,$38.23 , N/A , N/A ,$64.61 ,$244.80 , N/A ,$264.96 ,$201.60 ,$146.07 ,$175.31 ,$175.39 ,$175.31 ,$199.01 ,$259.20 ,$200.59 , N/A ,$227.52 ,$40.52 ,$172.80 ,$172.80 , N/A ,$172.80 ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$230.40 
ST NICHOLAS HOSPITAL - ACUTE,51000189,99214,HC LACTATION EST PAT-COMPLEX,510,1 ,$319.00 ,$159.50 ,$38.23 ,$319.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$191.40 ,$271.15 ,$223.30 ,$38.23 ,$303.05 ,$242.44 ,$239.25 ,$104.00 ,$271.15 , N/A ,$104.00 ,$56.00 ,$223.30 ,$38.23 , N/A , N/A ,$64.61 ,$271.15 , N/A ,$293.48 ,$223.30 ,$161.80 ,$194.18 ,$194.27 ,$194.18 ,$220.43 ,$287.10 ,$222.18 , N/A ,$252.01 ,$40.52 ,$191.40 ,$191.40 , N/A ,$191.40 ,$229.68 ,$197.78 ,$229.68 ,$229.68 ,$255.20 
ST NICHOLAS HOSPITAL - ACUTE,51000190,99215,HC LACTATION EST PAT-COMPRH,510,1 ,$402.00 ,$201.00 ,$38.23 ,$402.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$241.20 ,$341.70 ,$281.40 ,$38.23 ,$381.90 ,$305.52 ,$301.50 ,$104.00 ,$341.70 , N/A ,$104.00 ,$56.00 ,$281.40 ,$38.23 , N/A , N/A ,$64.61 ,$341.70 , N/A ,$369.84 ,$281.40 ,$203.89 ,$244.70 ,$244.82 ,$244.70 ,$277.78 ,$361.80 ,$279.99 , N/A ,$317.58 ,$40.52 ,$241.20 ,$241.20 , N/A ,$241.20 ,$289.44 ,$249.24 ,$289.44 ,$289.44 ,$321.60 
ST NICHOLAS HOSPITAL - ACUTE,51000191,99211,HC OP SCHED DRESSING CHANGE,510,1 ,$227.00 ,$113.50 ,$38.23 ,$227.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$136.20 ,$192.95 ,$158.90 ,$38.23 ,$215.65 ,$172.52 ,$170.25 ,$104.00 ,$192.95 , N/A ,$104.00 ,$56.00 ,$158.90 ,$38.23 , N/A , N/A ,$64.61 ,$192.95 , N/A ,$208.84 ,$158.90 ,$115.13 ,$138.17 ,$138.24 ,$138.17 ,$156.86 ,$204.30 ,$158.11 , N/A ,$179.33 ,$40.52 ,$136.20 ,$136.20 , N/A ,$136.20 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$181.60 
ST NICHOLAS HOSPITAL - ACUTE,51000192,99212,HC PEG CHECK OR REMOVAL (NON INCISIONAL),510,1 ,$237.00 ,$118.50 ,$38.23 ,$237.00 ,$38.23 ,$133.00 ,$104.00 , N/A ,$142.20 ,$201.45 ,$165.90 ,$38.23 ,$225.15 ,$180.12 ,$177.75 ,$104.00 ,$201.45 , N/A ,$104.00 ,$56.00 ,$165.90 ,$38.23 , N/A , N/A ,$64.61 ,$201.45 , N/A ,$218.04 ,$165.90 ,$120.21 ,$144.26 ,$144.33 ,$144.26 ,$163.77 ,$213.30 ,$165.07 , N/A ,$187.23 ,$40.52 ,$142.20 ,$142.20 , N/A ,$142.20 ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$189.60 
ST NICHOLAS HOSPITAL - ACUTE,51000198,29445,HC APPL/REMOVE CAST FACILITY,510,1 ,$668.00 ,$334.00 ,$56.00 ,$668.00 ,$59.15 ,$133.00 ,$104.00 ,$237.87 ,$400.80 ,$567.80 ,$467.60 ,$59.15 ,$634.60 ,$507.68 ,$501.00 ,$104.00 ,$567.80 ,$237.87 ,$104.00 ,$56.00 ,$467.60 ,$59.15 ,$237.87 ,$237.87 ,$64.61 ,$567.80 ,$535.20 ,$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$601.20 ,$465.26 ,$240.25 ,$527.72 ,$62.70 ,$400.80 ,$400.80 ,$237.87 ,$400.80 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$534.40 
ST NICHOLAS HOSPITAL - ACUTE,51000201,29799,HC REMOVAL REVISION LEGCAST FACILITY,510,1 ,$312.00 ,$156.00 ,$13.65 ,$313.43 ,$13.65 ,$133.00 ,$104.00 ,$139.30 ,$187.20 ,$265.20 ,$218.40 ,$13.65 ,$296.40 ,$237.12 ,$234.00 ,$104.00 ,$265.20 ,$139.30 ,$104.00 ,$56.00 ,$218.40 ,$13.65 ,$139.30 ,$139.30 ,$64.61 ,$265.20 ,$313.43 ,$287.04 ,$218.40 ,$158.25 ,$189.91 ,$190.01 ,$189.91 ,$215.59 ,$280.80 ,$217.31 ,$140.69 ,$246.48 ,$14.47 ,$187.20 ,$187.20 ,$139.30 ,$187.20 ,$224.64 ,$193.44 ,$224.64 ,$224.64 ,$249.60 
ST NICHOLAS HOSPITAL - ACUTE,51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$1,675.00 ",$837.50 ,$56.00 ,"$1,675.00 ",$490.13 ,$133.00 ,$104.00 ,$567.25 ,"$1,005.00 ","$1,423.75 ","$1,172.50 ",$490.13 ,"$1,591.25 ","$1,273.00 ","$1,256.25 ",$104.00 ,"$1,423.75 ",$567.25 ,$104.00 ,$56.00 ,"$1,172.50 ",$490.13 ,$567.25 ,$567.25 ,$64.61 ,"$1,423.75 ","$1,276.32 ","$1,541.00 ","$1,172.50 ","$1,675.00 ","$1,675.00 ","$1,020.08 ","$1,675.00 ","$1,157.43 ","$1,507.50 ","$1,166.64 ",$572.92 ,"$1,323.25 ",$519.54 ,"$1,005.00 ","$1,005.00 ",$567.25 ,"$1,005.00 ","$1,206.00 ","$1,038.50 ","$1,206.00 ","$1,206.00 ","$1,340.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000233,57500,HC BIOPSY/EXCISE CERVICAL LESION,510,1 ,"$1,185.00 ",$592.50 ,$56.00 ,"$1,406.46 ",$143.77 ,$133.00 ,$104.00 ,$625.09 ,$711.00 ,"$1,007.25 ",$829.50 ,$143.77 ,"$1,125.75 ",$900.60 ,$888.75 ,$104.00 ,"$1,007.25 ",$625.09 ,$104.00 ,$56.00 ,$829.50 ,$143.77 ,$625.09 ,$625.09 ,$64.61 ,"$1,007.25 ","$1,406.46 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$631.34 ,$936.15 ,$152.40 ,$711.00 ,$711.00 ,$625.09 ,$711.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,51000237,58300,HC INSERT INTRAUTERINE DEVICE,510,1 ,$292.00 ,$146.00 ,$56.00 ,$292.00 ,$61.96 ,$133.00 ,$104.00 , N/A ,$175.20 ,$248.20 ,$204.40 ,$61.96 ,$277.40 ,$221.92 ,$219.00 ,$104.00 ,$248.20 , N/A ,$104.00 ,$56.00 ,$204.40 ,$61.96 , N/A , N/A ,$64.61 ,$248.20 , N/A ,$268.64 ,$204.40 ,$292.00 ,$292.00 ,$177.83 ,$292.00 ,$201.77 ,$262.80 ,$203.38 , N/A ,$230.68 ,$65.68 ,$175.20 ,$175.20 , N/A ,$175.20 ,$210.24 ,$181.04 ,$210.24 ,$210.24 ,$233.60 
ST NICHOLAS HOSPITAL - ACUTE,51000315,38222,HC BM ASPIRATION (BX/ASP SAME SITE),360,1 ,"$1,401.00 ",$700.50 ,$373.15 ,"$5,260.19 ",$373.15 ,"$1,401.00 ","$1,401.00 ","$2,337.86 ",$840.60 ,"$1,190.85 ",$980.70 ,$373.15 ,"$1,330.95 ","$1,064.76 ","$1,050.75 ","$1,401.00 ","$1,190.85 ","$2,337.86 ","$1,401.00 ",$910.65 ,$980.70 ,$373.15 ,"$2,337.86 ","$2,337.86 ","$1,401.00 ","$1,190.85 ","$5,260.19 ","$1,288.92 ",$980.70 ,"$1,401.00 ","$1,401.00 ",$853.21 ,"$1,401.00 ",$968.09 ,"$1,260.90 ",$975.80 ,"$2,361.24 ","$1,106.79 ",$395.54 ,"$1,401.00 ","$1,401.00 ","$2,337.86 ","$1,401.00 ","$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ","$1,120.80 "
ST NICHOLAS HOSPITAL - ACUTE,51000320,94781,HC CARSEAT ANALYSIS  EA ADDN 30MIN,510,1 ,$130.00 ,$65.00 ,$16.35 ,$130.00 ,$16.35 ,$130.00 ,$104.00 , N/A ,$78.00 ,$110.50 ,$91.00 ,$16.35 ,$123.50 ,$98.80 ,$97.50 ,$104.00 ,$110.50 , N/A ,$104.00 ,$56.00 ,$91.00 ,$16.35 , N/A , N/A ,$64.61 ,$110.50 , N/A ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$79.13 ,$89.83 ,$117.00 ,$90.55 , N/A ,$102.70 ,$17.33 ,$78.00 ,$78.00 , N/A ,$78.00 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$104.00 
ST NICHOLAS HOSPITAL - ACUTE,51000325,15271,HC APL SKIN SUB TAL<100 INT 25CM,761,1 ,"$1,200.00 ",$600.00 ,$504.00 ,"$3,799.81 ",$615.10 ,"$1,200.00 ","$1,200.00 ","$1,688.81 ",$720.00 ,"$1,020.00 ",$840.00 ,$615.10 ,"$1,140.00 ",$912.00 ,$900.00 ,"$1,200.00 ","$1,020.00 ","$1,688.81 ","$1,200.00 ",$780.00 ,$840.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$504.00 ,"$1,020.00 ","$3,799.81 ","$1,104.00 ",$840.00 ,"$1,200.00 ","$1,200.00 ",$730.80 ,"$1,200.00 ",$829.20 ,"$1,080.00 ",$835.80 ,"$1,705.70 ",$948.00 ,$652.01 ,$720.00 ,$720.00 ,"$1,688.81 ",$720.00 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,51000326,15272,HC APL SKIN SUB TAL<100 ADL 25CM,761,1 ,$370.00 ,$185.00 ,$155.40 ,$652.01 ,$615.10 ,$370.00 ,$370.00 , N/A ,$222.00 ,$314.50 ,$259.00 ,$615.10 ,$351.50 ,$281.20 ,$277.50 ,$370.00 ,$314.50 , N/A ,$370.00 ,$240.50 ,$259.00 ,$615.10 , N/A , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$333.00 ,$257.71 , N/A ,$292.30 ,$652.01 ,$222.00 ,$222.00 , N/A ,$222.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,51000327,15273,HC APL SKIN SUB TAL>100 INT 100CM,761,1 ,"$1,300.00 ",$650.00 ,$546.00 ,"$7,811.85 ",$615.10 ,"$1,300.00 ","$1,300.00 ","$3,471.93 ",$780.00 ,"$1,105.00 ",$910.00 ,$615.10 ,"$1,235.00 ",$988.00 ,$975.00 ,"$1,300.00 ","$1,105.00 ","$3,471.93 ","$1,300.00 ",$845.00 ,$910.00 ,$615.10 ,"$3,471.93 ","$3,471.93 ",$546.00 ,"$1,105.00 ","$7,811.85 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,"$1,170.00 ",$905.45 ,"$3,506.65 ","$1,027.00 ",$652.01 ,$780.00 ,$780.00 ,"$3,471.93 ",$780.00 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,"$1,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000328,15274,HC APL SKIN SUB TAL>100 ADL 100CM,761,1 ,$690.00 ,$345.00 ,$289.80 ,$690.00 ,$615.10 ,$690.00 ,$690.00 , N/A ,$414.00 ,$586.50 ,$483.00 ,$615.10 ,$655.50 ,$524.40 ,$517.50 ,$690.00 ,$586.50 , N/A ,$690.00 ,$448.50 ,$483.00 ,$615.10 , N/A , N/A ,$289.80 ,$586.50 , N/A ,$634.80 ,$483.00 ,$690.00 ,$690.00 ,$420.21 ,$690.00 ,$476.79 ,$621.00 ,$480.59 , N/A ,$545.10 ,$652.01 ,$414.00 ,$414.00 , N/A ,$414.00 ,$496.80 ,$427.80 ,$496.80 ,$496.80 ,$552.00 
ST NICHOLAS HOSPITAL - ACUTE,51000329,15275,HC APL SKIN SUB OTH<100 INT 25CM,761,1 ,"$1,200.00 ",$600.00 ,$504.00 ,"$3,799.81 ",$615.10 ,"$1,200.00 ","$1,200.00 ","$1,688.81 ",$720.00 ,"$1,020.00 ",$840.00 ,$615.10 ,"$1,140.00 ",$912.00 ,$900.00 ,"$1,200.00 ","$1,020.00 ","$1,688.81 ","$1,200.00 ",$780.00 ,$840.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$504.00 ,"$1,020.00 ","$3,799.81 ","$1,104.00 ",$840.00 ,"$1,200.00 ","$1,200.00 ",$730.80 ,"$1,200.00 ",$829.20 ,"$1,080.00 ",$835.80 ,"$1,705.70 ",$948.00 ,$652.01 ,$720.00 ,$720.00 ,"$1,688.81 ",$720.00 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,51000330,15276,HC APL SKIN SUB OTH<100 ADL 25CM,761,1 ,$350.00 ,$175.00 ,$147.00 ,$652.01 ,$615.10 ,$350.00 ,$350.00 , N/A ,$210.00 ,$297.50 ,$245.00 ,$615.10 ,$332.50 ,$266.00 ,$262.50 ,$350.00 ,$297.50 , N/A ,$350.00 ,$227.50 ,$245.00 ,$615.10 , N/A , N/A ,$147.00 ,$297.50 , N/A ,$322.00 ,$245.00 ,$350.00 ,$350.00 ,$213.15 ,$350.00 ,$241.85 ,$315.00 ,$243.78 , N/A ,$276.50 ,$652.01 ,$210.00 ,$210.00 , N/A ,$210.00 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$280.00 
ST NICHOLAS HOSPITAL - ACUTE,51000331,15277,HC APL SKIN SUB OTH>100 INT 100CM,761,1 ,"$1,000.00 ",$500.00 ,$420.00 ,"$3,799.81 ",$615.10 ,"$1,000.00 ","$1,000.00 ","$1,688.81 ",$600.00 ,$850.00 ,$700.00 ,$615.10 ,$950.00 ,$760.00 ,$750.00 ,"$1,000.00 ",$850.00 ,"$1,688.81 ","$1,000.00 ",$650.00 ,$700.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$420.00 ,$850.00 ,"$3,799.81 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$900.00 ,$696.50 ,"$1,705.70 ",$790.00 ,$652.01 ,$600.00 ,$600.00 ,"$1,688.81 ",$600.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,51000332,15278,HC APL SKIN SUB OTH>100 ADL 100CM,761,1 ,$850.00 ,$425.00 ,$357.00 ,$850.00 ,$615.10 ,$850.00 ,$850.00 , N/A ,$510.00 ,$722.50 ,$595.00 ,$615.10 ,$807.50 ,$646.00 ,$637.50 ,$850.00 ,$722.50 , N/A ,$850.00 ,$552.50 ,$595.00 ,$615.10 , N/A , N/A ,$357.00 ,$722.50 , N/A ,$782.00 ,$595.00 ,$850.00 ,$850.00 ,$517.65 ,$850.00 ,$587.35 ,$765.00 ,$592.03 , N/A ,$671.50 ,$652.01 ,$510.00 ,$510.00 , N/A ,$510.00 ,$612.00 ,$527.00 ,$612.00 ,$612.00 ,$680.00 
ST NICHOLAS HOSPITAL - ACUTE,51000333,15271,HC APL SKIN SUB TAL<100 INT 25CM W/PROC,761,1 ,"$1,200.00 ",$600.00 ,$504.00 ,"$3,799.81 ",$615.10 ,"$1,200.00 ","$1,200.00 ","$1,688.81 ",$720.00 ,"$1,020.00 ",$840.00 ,$615.10 ,"$1,140.00 ",$912.00 ,$900.00 ,"$1,200.00 ","$1,020.00 ","$1,688.81 ","$1,200.00 ",$780.00 ,$840.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$504.00 ,"$1,020.00 ","$3,799.81 ","$1,104.00 ",$840.00 ,"$1,200.00 ","$1,200.00 ",$730.80 ,"$1,200.00 ",$829.20 ,"$1,080.00 ",$835.80 ,"$1,705.70 ",$948.00 ,$652.01 ,$720.00 ,$720.00 ,"$1,688.81 ",$720.00 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,51000334,15273,HC APL SKIN SUB TAL>100 INT 100CM W/PROC,761,1 ,"$1,300.00 ",$650.00 ,$546.00 ,"$7,811.85 ",$615.10 ,"$1,300.00 ","$1,300.00 ","$3,471.93 ",$780.00 ,"$1,105.00 ",$910.00 ,$615.10 ,"$1,235.00 ",$988.00 ,$975.00 ,"$1,300.00 ","$1,105.00 ","$3,471.93 ","$1,300.00 ",$845.00 ,$910.00 ,$615.10 ,"$3,471.93 ","$3,471.93 ",$546.00 ,"$1,105.00 ","$7,811.85 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,"$1,170.00 ",$905.45 ,"$3,506.65 ","$1,027.00 ",$652.01 ,$780.00 ,$780.00 ,"$3,471.93 ",$780.00 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,"$1,040.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000335,15275,HC APL SKIN SUB OTH<100 INT 25CM W/PROC,761,1 ,"$1,200.00 ",$600.00 ,$504.00 ,"$3,799.81 ",$615.10 ,"$1,200.00 ","$1,200.00 ","$1,688.81 ",$720.00 ,"$1,020.00 ",$840.00 ,$615.10 ,"$1,140.00 ",$912.00 ,$900.00 ,"$1,200.00 ","$1,020.00 ","$1,688.81 ","$1,200.00 ",$780.00 ,$840.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$504.00 ,"$1,020.00 ","$3,799.81 ","$1,104.00 ",$840.00 ,"$1,200.00 ","$1,200.00 ",$730.80 ,"$1,200.00 ",$829.20 ,"$1,080.00 ",$835.80 ,"$1,705.70 ",$948.00 ,$652.01 ,$720.00 ,$720.00 ,"$1,688.81 ",$720.00 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,51000336,15277,HC APL SKIN SUB OTH>100 INT 100CM W/PROC,761,1 ,"$1,000.00 ",$500.00 ,$420.00 ,"$3,799.81 ",$615.10 ,"$1,000.00 ","$1,000.00 ","$1,688.81 ",$600.00 ,$850.00 ,$700.00 ,$615.10 ,$950.00 ,$760.00 ,$750.00 ,"$1,000.00 ",$850.00 ,"$1,688.81 ","$1,000.00 ",$650.00 ,$700.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$420.00 ,$850.00 ,"$3,799.81 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$900.00 ,$696.50 ,"$1,705.70 ",$790.00 ,$652.01 ,$600.00 ,$600.00 ,"$1,688.81 ",$600.00 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,51000348,16025,HC BURN DRESS/DEB 5-10% TOTAL FACIL,761,1 ,$474.00 ,$237.00 ,$58.71 ,$474.00 ,$58.71 ,$474.00 ,$474.00 ,$177.06 ,$284.40 ,$402.90 ,$331.80 ,$58.71 ,$450.30 ,$360.24 ,$355.50 ,$474.00 ,$402.90 ,$177.06 ,$474.00 ,$474.00 ,$331.80 ,$58.71 ,$177.06 ,$177.06 ,$199.08 ,$402.90 ,$398.39 ,$436.08 ,$331.80 ,$474.00 ,$474.00 ,$288.67 ,$474.00 ,$327.53 ,$426.60 ,$330.14 ,$178.83 ,$374.46 ,$62.23 ,$284.40 ,$284.40 ,$177.06 ,$284.40 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$379.20 
ST NICHOLAS HOSPITAL - ACUTE,51000350,16030,HC BURN DRESS  AND /OR DEBRID >10% FACIL,761,1 ,$571.00 ,$285.50 ,$118.09 ,$766.80 ,$118.09 ,$571.00 ,$571.00 ,$340.80 ,$342.60 ,$485.35 ,$399.70 ,$118.09 ,$542.45 ,$433.96 ,$428.25 ,$571.00 ,$485.35 ,$340.80 ,$571.00 ,$371.15 ,$399.70 ,$118.09 ,$340.80 ,$340.80 ,$239.82 ,$485.35 ,$766.80 ,$525.32 ,$399.70 ,$571.00 ,$571.00 ,$347.74 ,$571.00 ,$394.56 ,$513.90 ,$397.70 ,$344.21 ,$451.09 ,$125.18 ,$342.60 ,$342.60 ,$340.80 ,$342.60 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$456.80 
ST NICHOLAS HOSPITAL - ACUTE,51000352,11057,HC PARING LESN BENIGN >4 FAC,510,1 ,$248.00 ,$124.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$148.80 ,$210.80 ,$173.60 ,$51.36 ,$235.60 ,$188.48 ,$186.00 ,$104.00 ,$210.80 ,$177.06 ,$104.00 ,$56.00 ,$173.60 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$210.80 ,$398.39 ,$228.16 ,$173.60 ,$248.00 ,$248.00 ,$151.03 ,$248.00 ,$171.37 ,$223.20 ,$172.73 ,$178.83 ,$195.92 ,$54.44 ,$148.80 ,$148.80 ,$177.06 ,$148.80 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$198.40 
ST NICHOLAS HOSPITAL - ACUTE,51000400,29580,HC APPLY UNNA BOOT BILAT FAC,510,1 ,$496.00 ,$248.00 ,$56.00 ,$496.00 ,$88.73 ,$133.00 ,$104.00 ,$208.96 ,$297.60 ,$421.60 ,$347.20 ,$88.73 ,$471.20 ,$376.96 ,$372.00 ,$104.00 ,$421.60 ,$208.96 ,$104.00 ,$56.00 ,$347.20 ,$88.73 ,$208.96 ,$208.96 ,$64.61 ,$421.60 ,$470.15 ,$456.32 ,$347.20 ,$496.00 ,$496.00 ,$302.06 ,$496.00 ,$342.74 ,$446.40 ,$345.46 ,$211.05 ,$391.84 ,$94.05 ,$297.60 ,$297.60 ,$208.96 ,$297.60 ,$357.12 ,$307.52 ,$357.12 ,$357.12 ,$396.80 
ST NICHOLAS HOSPITAL - ACUTE,51000401,29581,HC APPLY MULTI COMP LWR LEG BIL FAC,510,1 ,$345.00 ,$172.50 ,$56.00 ,$470.15 ,$88.73 ,$133.00 ,$104.00 ,$208.96 ,$207.00 ,$293.25 ,$241.50 ,$88.73 ,$327.75 ,$262.20 ,$258.75 ,$104.00 ,$293.25 ,$208.96 ,$104.00 ,$56.00 ,$241.50 ,$88.73 ,$208.96 ,$208.96 ,$64.61 ,$293.25 ,$470.15 ,$317.40 ,$241.50 ,$345.00 ,$345.00 ,$210.11 ,$345.00 ,$238.40 ,$310.50 ,$240.29 ,$211.05 ,$272.55 ,$94.05 ,$207.00 ,$207.00 ,$208.96 ,$207.00 ,$248.40 ,$213.90 ,$248.40 ,$248.40 ,$276.00 
ST NICHOLAS HOSPITAL - ACUTE,51000407,11200,HC REMOVAL SKIN TAG LESIONS <=15 FAC,510,1 ,$269.00 ,$134.50 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$161.40 ,$228.65 ,$188.30 ,$51.36 ,$255.55 ,$204.44 ,$201.75 ,$104.00 ,$228.65 ,$177.06 ,$104.00 ,$56.00 ,$188.30 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$228.65 ,$398.39 ,$247.48 ,$188.30 ,$269.00 ,$269.00 ,$163.82 ,$269.00 ,$185.88 ,$242.10 ,$187.36 ,$178.83 ,$212.51 ,$54.44 ,$161.40 ,$161.40 ,$177.06 ,$161.40 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$215.20 
ST NICHOLAS HOSPITAL - ACUTE,51000414,10140,HC I AND D HEMATOMA/SEROMA/FLUID BIL UNNA FAC,510,1 ,"$1,939.00 ",$969.50 ,$56.00 ,"$3,121.49 ",$344.84 ,$133.00 ,$104.00 ,"$1,387.33 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$344.84 ,"$1,842.05 ","$1,473.64 ","$1,454.25 ",$104.00 ,"$1,648.15 ","$1,387.33 ",$104.00 ,$56.00 ,"$1,357.30 ",$344.84 ,"$1,387.33 ","$1,387.33 ",$64.61 ,"$1,648.15 ","$3,121.49 ","$1,783.88 ","$1,357.30 ","$1,703.02 ","$1,939.00 ","$1,180.85 ","$1,939.00 ","$1,339.85 ","$1,745.10 ","$1,350.51 ","$1,401.20 ","$1,531.81 ",$365.53 ,"$1,163.40 ","$1,163.40 ","$1,387.33 ","$1,163.40 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,51000419,97597,HC AWC/CHEM CAUTERY/CAST FACIL,761,1 ,$356.00 ,$178.00 ,$58.71 ,$398.39 ,$58.71 ,$356.00 ,$356.00 ,$177.06 ,$213.60 ,$302.60 ,$249.20 ,$58.71 ,$338.20 ,$270.56 ,$267.00 ,$356.00 ,$302.60 ,$177.06 ,$356.00 ,$231.40 ,$249.20 ,$58.71 ,$177.06 ,$177.06 ,$149.52 ,$302.60 ,$398.39 ,$327.52 ,$249.20 ,$180.56 ,$216.70 ,$216.80 ,$216.70 ,$246.00 ,$320.40 ,$247.95 ,$178.83 ,$281.24 ,$62.23 ,$213.60 ,$213.60 ,$177.06 ,$213.60 ,$256.32 ,$220.72 ,$256.32 ,$256.32 ,$284.80 
ST NICHOLAS HOSPITAL - ACUTE,51000420,10140,HC I AND D HEMATOMA/SEROMA/FLUID/WRAP FACIL,761,1 ,"$1,939.00 ",$969.50 ,$344.84 ,"$3,121.49 ",$344.84 ,"$1,939.00 ","$1,939.00 ","$1,387.33 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$344.84 ,"$1,842.05 ","$1,473.64 ","$1,454.25 ","$1,939.00 ","$1,648.15 ","$1,387.33 ","$1,939.00 ","$1,939.00 ","$1,357.30 ",$344.84 ,"$1,387.33 ","$1,387.33 ",$814.38 ,"$1,648.15 ","$3,121.49 ","$1,783.88 ","$1,357.30 ","$1,703.02 ","$1,939.00 ","$1,180.85 ","$1,939.00 ","$1,339.85 ","$1,745.10 ","$1,350.51 ","$1,401.20 ","$1,531.81 ",$365.53 ,"$1,163.40 ","$1,163.40 ","$1,387.33 ","$1,163.40 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,551.20 "
ST NICHOLAS HOSPITAL - ACUTE,51000421,97597,HC AWC/CHEM CAUTERY/WRAP FACIL,761,1 ,$388.00 ,$194.00 ,$58.71 ,$398.39 ,$58.71 ,$388.00 ,$388.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$388.00 ,$329.80 ,$177.06 ,$388.00 ,$252.20 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$162.96 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000424,97597,HC DEBR SKIN INTL 20CM/BIOPSY FAC,510,1 ,$388.00 ,$194.00 ,$56.00 ,$398.39 ,$58.71 ,$133.00 ,$104.00 ,$177.06 ,$232.80 ,$329.80 ,$271.60 ,$58.71 ,$368.60 ,$294.88 ,$291.00 ,$104.00 ,$329.80 ,$177.06 ,$104.00 ,$56.00 ,$271.60 ,$58.71 ,$177.06 ,$177.06 ,$64.61 ,$329.80 ,$398.39 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$236.18 ,$268.11 ,$349.20 ,$270.24 ,$178.83 ,$306.52 ,$62.23 ,$232.80 ,$232.80 ,$177.06 ,$232.80 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$310.40 
ST NICHOLAS HOSPITAL - ACUTE,51000425,15110,HC EPIDRM A-GRFT TRNK/ARM/LEG CM,510,1 ,"$2,400.00 ","$1,200.00 ",$56.00 ,"$3,799.81 ",$615.10 ,$133.00 ,$104.00 ,"$1,688.81 ","$1,440.00 ","$2,040.00 ","$1,680.00 ",$615.10 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ",$104.00 ,"$2,040.00 ","$1,688.81 ",$104.00 ,$56.00 ,"$1,680.00 ",$615.10 ,"$1,688.81 ","$1,688.81 ",$64.61 ,"$2,040.00 ","$3,799.81 ","$2,208.00 ","$1,680.00 ","$1,921.55 ","$2,400.00 ","$1,461.60 ","$2,400.00 ","$1,658.40 ","$2,160.00 ","$1,671.60 ","$1,705.70 ","$1,896.00 ",$652.01 ,"$1,440.00 ","$1,440.00 ","$1,688.81 ","$1,440.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000426,15115,HC EPIDRM A-GRFT FACE/NCK/HF/G,510,1 ,"$1,800.00 ",$900.00 ,$56.00 ,"$3,799.81 ",$615.10 ,$133.00 ,$104.00 ,"$1,688.81 ","$1,080.00 ","$1,530.00 ","$1,260.00 ",$615.10 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ",$104.00 ,"$1,530.00 ","$1,688.81 ",$104.00 ,$56.00 ,"$1,260.00 ",$615.10 ,"$1,688.81 ","$1,688.81 ",$64.61 ,"$1,530.00 ","$3,799.81 ","$1,656.00 ","$1,260.00 ","$1,800.00 ","$1,800.00 ","$1,096.20 ","$1,800.00 ","$1,243.80 ","$1,620.00 ","$1,253.70 ","$1,705.70 ","$1,422.00 ",$652.01 ,"$1,080.00 ","$1,080.00 ","$1,688.81 ","$1,080.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000427,17999,HC UNLISTED SKIN TISSUE PROCEDURE,510,1 ,$210.00 ,$105.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$126.00 ,$178.50 ,$147.00 ,$51.36 ,$199.50 ,$159.60 ,$157.50 ,$104.00 ,$178.50 ,$177.06 ,$104.00 ,$56.00 ,$147.00 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$178.50 ,$398.39 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$127.83 ,$145.11 ,$189.00 ,$146.27 ,$178.83 ,$165.90 ,$54.44 ,$126.00 ,$126.00 ,$177.06 ,$126.00 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$168.00 
ST NICHOLAS HOSPITAL - ACUTE,51000428,15111,HC EPIDRM A-GRFT TRNK/ARM/LEG CM ADDN 100,510,1 ,$195.00 ,$97.50 ,$56.00 ,$652.01 ,$615.10 ,$133.00 ,$104.00 , N/A ,$117.00 ,$165.75 ,$136.50 ,$615.10 ,$185.25 ,$148.20 ,$146.25 ,$104.00 ,$165.75 , N/A ,$104.00 ,$56.00 ,$136.50 ,$615.10 , N/A , N/A ,$64.61 ,$165.75 , N/A ,$179.40 ,$136.50 ,$195.00 ,$195.00 ,$118.76 ,$195.00 ,$134.75 ,$175.50 ,$135.82 , N/A ,$154.05 ,$652.01 ,$117.00 ,$117.00 , N/A ,$117.00 ,$140.40 ,$120.90 ,$140.40 ,$140.40 ,$156.00 
ST NICHOLAS HOSPITAL - ACUTE,51000429,15116,HC EPIDRM A-GRFT FACE/NCK/HF/G CM ADDN 100,510,1 ,$195.00 ,$97.50 ,$56.00 ,$652.01 ,$615.10 ,$133.00 ,$104.00 , N/A ,$117.00 ,$165.75 ,$136.50 ,$615.10 ,$185.25 ,$148.20 ,$146.25 ,$104.00 ,$165.75 , N/A ,$104.00 ,$56.00 ,$136.50 ,$615.10 , N/A , N/A ,$64.61 ,$165.75 , N/A ,$179.40 ,$136.50 ,$195.00 ,$195.00 ,$118.76 ,$195.00 ,$134.75 ,$175.50 ,$135.82 , N/A ,$154.05 ,$652.01 ,$117.00 ,$117.00 , N/A ,$117.00 ,$140.40 ,$120.90 ,$140.40 ,$140.40 ,$156.00 
ST NICHOLAS HOSPITAL - ACUTE,51000430,15110,HC EPIDRM A-GRFT TRNK ARMS LEGS FIRST 100CM W/PROC,510,1 ,"$2,400.00 ","$1,200.00 ",$56.00 ,"$3,799.81 ",$615.10 ,$133.00 ,$104.00 ,"$1,688.81 ","$1,440.00 ","$2,040.00 ","$1,680.00 ",$615.10 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ",$104.00 ,"$2,040.00 ","$1,688.81 ",$104.00 ,$56.00 ,"$1,680.00 ",$615.10 ,"$1,688.81 ","$1,688.81 ",$64.61 ,"$2,040.00 ","$3,799.81 ","$2,208.00 ","$1,680.00 ","$1,921.55 ","$2,400.00 ","$1,461.60 ","$2,400.00 ","$1,658.40 ","$2,160.00 ","$1,671.60 ","$1,705.70 ","$1,896.00 ",$652.01 ,"$1,440.00 ","$1,440.00 ","$1,688.81 ","$1,440.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000431,15115,HC EPIDRM A-GRFT FACE SCLP HAND ETC FIRST 100CM W/PROC,510,1 ,"$1,800.00 ",$900.00 ,$56.00 ,"$3,799.81 ",$615.10 ,$133.00 ,$104.00 ,"$1,688.81 ","$1,080.00 ","$1,530.00 ","$1,260.00 ",$615.10 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ",$104.00 ,"$1,530.00 ","$1,688.81 ",$104.00 ,$56.00 ,"$1,260.00 ",$615.10 ,"$1,688.81 ","$1,688.81 ",$64.61 ,"$1,530.00 ","$3,799.81 ","$1,656.00 ","$1,260.00 ","$1,800.00 ","$1,800.00 ","$1,096.20 ","$1,800.00 ","$1,243.80 ","$1,620.00 ","$1,253.70 ","$1,705.70 ","$1,422.00 ",$652.01 ,"$1,080.00 ","$1,080.00 ","$1,688.81 ","$1,080.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,51000442,95999,HC UNLISTED NEURO DIAGNOSTIC PROC,510,1 ,$463.00 ,$231.50 ,$42.84 ,$463.00 ,$42.84 ,$133.00 ,$104.00 ,$137.66 ,$277.80 ,$393.55 ,$324.10 ,$42.84 ,$439.85 ,$351.88 ,$347.25 ,$104.00 ,$393.55 ,$137.66 ,$104.00 ,$56.00 ,$324.10 ,$42.84 ,$137.66 ,$137.66 ,$64.61 ,$393.55 ,$309.74 ,$425.96 ,$324.10 ,$234.83 ,$281.83 ,$281.97 ,$281.83 ,$319.93 ,$416.70 ,$322.48 ,$139.04 ,$365.77 ,$45.41 ,$277.80 ,$277.80 ,$137.66 ,$277.80 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$370.40 
ST NICHOLAS HOSPITAL - ACUTE,51000444,11982,HC REMOVAL DRUG IMPLANT DEVICE,510,1 ,$812.00 ,$406.00 ,$51.36 ,$812.00 ,$51.36 ,$133.00 ,$104.00 ,$267.60 ,$487.20 ,$690.20 ,$568.40 ,$51.36 ,$771.40 ,$617.12 ,$609.00 ,$104.00 ,$690.20 ,$267.60 ,$104.00 ,$56.00 ,$568.40 ,$51.36 ,$267.60 ,$267.60 ,$64.61 ,$690.20 ,$602.10 ,$747.04 ,$568.40 ,$812.00 ,$812.00 ,$494.51 ,$812.00 ,$561.09 ,$730.80 ,$565.56 ,$270.28 ,$641.48 ,$54.44 ,$487.20 ,$487.20 ,$267.60 ,$487.20 ,$584.64 ,$503.44 ,$584.64 ,$584.64 ,$649.60 
ST NICHOLAS HOSPITAL - ACUTE,51000450,C5271,HC APL SKIN SUB TAL<100 INT 25CM LOW,510,1 ,$846.00 ,$423.00 ,$56.00 ,"$1,161.91 ",$615.10 ,$133.00 ,$104.00 ,$516.40 ,$507.60 ,$719.10 ,$592.20 ,$615.10 ,$803.70 ,$642.96 ,$634.50 ,$104.00 ,$719.10 ,$516.40 ,$104.00 ,$56.00 ,$592.20 ,$615.10 ,$516.40 ,$516.40 ,$64.61 ,$719.10 ,"$1,161.91 ",$778.32 ,$592.20 ,$429.09 ,$514.96 ,$515.21 ,$514.96 ,$584.59 ,$761.40 ,$589.24 ,$521.56 ,$668.34 ,$652.01 ,$507.60 ,$507.60 ,$516.40 ,$507.60 ,$609.12 ,$524.52 ,$609.12 ,$609.12 ,$676.80 
ST NICHOLAS HOSPITAL - ACUTE,51000451,C5271,HC APL SKIN SUB TAL<100 INT 25CM W/PROC LOW,510,1 ,$846.00 ,$423.00 ,$56.00 ,"$1,161.91 ",$615.10 ,$133.00 ,$104.00 ,$516.40 ,$507.60 ,$719.10 ,$592.20 ,$615.10 ,$803.70 ,$642.96 ,$634.50 ,$104.00 ,$719.10 ,$516.40 ,$104.00 ,$56.00 ,$592.20 ,$615.10 ,$516.40 ,$516.40 ,$64.61 ,$719.10 ,"$1,161.91 ",$778.32 ,$592.20 ,$429.09 ,$514.96 ,$515.21 ,$514.96 ,$584.59 ,$761.40 ,$589.24 ,$521.56 ,$668.34 ,$652.01 ,$507.60 ,$507.60 ,$516.40 ,$507.60 ,$609.12 ,$524.52 ,$609.12 ,$609.12 ,$676.80 
ST NICHOLAS HOSPITAL - ACUTE,51000452,C5272,HC APL SKIN SUB TAL<100 ADL 25CM LOW,510,1 ,$372.00 ,$186.00 ,$56.00 ,$652.01 ,$615.10 ,$133.00 ,$104.00 , N/A ,$223.20 ,$316.20 ,$260.40 ,$615.10 ,$353.40 ,$282.72 ,$279.00 ,$104.00 ,$316.20 , N/A ,$104.00 ,$56.00 ,$260.40 ,$615.10 , N/A , N/A ,$64.61 ,$316.20 , N/A ,$342.24 ,$260.40 ,$188.68 ,$226.44 ,$226.55 ,$226.44 ,$257.05 ,$334.80 ,$259.10 , N/A ,$293.88 ,$652.01 ,$223.20 ,$223.20 , N/A ,$223.20 ,$267.84 ,$230.64 ,$267.84 ,$267.84 ,$297.60 
ST NICHOLAS HOSPITAL - ACUTE,51000453,C5273,HC APL SKIN SUB TAL>100 INT 100CM LOW,510,1 ,"$1,126.00 ",$563.00 ,$56.00 ,"$3,799.81 ",$615.10 ,$133.00 ,$104.00 ,"$1,688.81 ",$675.60 ,$957.10 ,$788.20 ,$615.10 ,"$1,069.70 ",$855.76 ,$844.50 ,$104.00 ,$957.10 ,"$1,688.81 ",$104.00 ,$56.00 ,$788.20 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$64.61 ,$957.10 ,"$3,799.81 ","$1,035.92 ",$788.20 ,$571.11 ,$685.40 ,$685.73 ,$685.40 ,$778.07 ,"$1,013.40 ",$784.26 ,"$1,705.70 ",$889.54 ,$652.01 ,$675.60 ,$675.60 ,"$1,688.81 ",$675.60 ,$810.72 ,$698.12 ,$810.72 ,$810.72 ,$900.80 
ST NICHOLAS HOSPITAL - ACUTE,51000454,C5273,HC APL SKIN SUB TAL>100 INT 100CM W/PROC LOW,510,1 ,"$1,126.00 ",$563.00 ,$56.00 ,"$3,799.81 ",$615.10 ,$133.00 ,$104.00 ,"$1,688.81 ",$675.60 ,$957.10 ,$788.20 ,$615.10 ,"$1,069.70 ",$855.76 ,$844.50 ,$104.00 ,$957.10 ,"$1,688.81 ",$104.00 ,$56.00 ,$788.20 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$64.61 ,$957.10 ,"$3,799.81 ","$1,035.92 ",$788.20 ,$571.11 ,$685.40 ,$685.73 ,$685.40 ,$778.07 ,"$1,013.40 ",$784.26 ,"$1,705.70 ",$889.54 ,$652.01 ,$675.60 ,$675.60 ,"$1,688.81 ",$675.60 ,$810.72 ,$698.12 ,$810.72 ,$810.72 ,$900.80 
ST NICHOLAS HOSPITAL - ACUTE,51000455,C5274,HC APL SKIN SUB TAL>100 ADL 100CM LOW,510,1 ,$672.00 ,$336.00 ,$56.00 ,$672.00 ,$615.10 ,$133.00 ,$104.00 , N/A ,$403.20 ,$571.20 ,$470.40 ,$615.10 ,$638.40 ,$510.72 ,$504.00 ,$104.00 ,$571.20 , N/A ,$104.00 ,$56.00 ,$470.40 ,$615.10 , N/A , N/A ,$64.61 ,$571.20 , N/A ,$618.24 ,$470.40 ,$340.84 ,$409.05 ,$409.25 ,$409.05 ,$464.35 ,$604.80 ,$468.05 , N/A ,$530.88 ,$652.01 ,$403.20 ,$403.20 , N/A ,$403.20 ,$483.84 ,$416.64 ,$483.84 ,$483.84 ,$537.60 
ST NICHOLAS HOSPITAL - ACUTE,51000456,C5275,HC APL SKIN SUB OTH<100 INT 25CM LOW,510,1 ,$851.00 ,$425.50 ,$56.00 ,"$1,161.91 ",$615.10 ,$133.00 ,$104.00 ,$516.40 ,$510.60 ,$723.35 ,$595.70 ,$615.10 ,$808.45 ,$646.76 ,$638.25 ,$104.00 ,$723.35 ,$516.40 ,$104.00 ,$56.00 ,$595.70 ,$615.10 ,$516.40 ,$516.40 ,$64.61 ,$723.35 ,"$1,161.91 ",$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$518.00 ,$588.04 ,$765.90 ,$592.72 ,$521.56 ,$672.29 ,$652.01 ,$510.60 ,$510.60 ,$516.40 ,$510.60 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,51000457,C5275,HC APL SKIN SUB OTH<100 INT 25CM W/PROC LOW,510,1 ,$851.00 ,$425.50 ,$56.00 ,"$1,161.91 ",$615.10 ,$133.00 ,$104.00 ,$516.40 ,$510.60 ,$723.35 ,$595.70 ,$615.10 ,$808.45 ,$646.76 ,$638.25 ,$104.00 ,$723.35 ,$516.40 ,$104.00 ,$56.00 ,$595.70 ,$615.10 ,$516.40 ,$516.40 ,$64.61 ,$723.35 ,"$1,161.91 ",$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$518.00 ,$588.04 ,$765.90 ,$592.72 ,$521.56 ,$672.29 ,$652.01 ,$510.60 ,$510.60 ,$516.40 ,$510.60 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,51000458,C5276,HC APL SKIN SUB OTH<100 ADL 25CM LOW,510,1 ,$334.00 ,$167.00 ,$56.00 ,$652.01 ,$615.10 ,$133.00 ,$104.00 , N/A ,$200.40 ,$283.90 ,$233.80 ,$615.10 ,$317.30 ,$253.84 ,$250.50 ,$104.00 ,$283.90 , N/A ,$104.00 ,$56.00 ,$233.80 ,$615.10 , N/A , N/A ,$64.61 ,$283.90 , N/A ,$307.28 ,$233.80 ,$169.40 ,$203.31 ,$203.41 ,$203.31 ,$230.79 ,$300.60 ,$232.63 , N/A ,$263.86 ,$652.01 ,$200.40 ,$200.40 , N/A ,$200.40 ,$240.48 ,$207.08 ,$240.48 ,$240.48 ,$267.20 
ST NICHOLAS HOSPITAL - ACUTE,51000459,C5277,HC APL SKIN SUB OTH>100 INT 100CM LOW,510,1 ,$943.00 ,$471.50 ,$56.00 ,"$1,161.91 ",$615.10 ,$133.00 ,$104.00 ,$516.40 ,$565.80 ,$801.55 ,$660.10 ,$615.10 ,$895.85 ,$716.68 ,$707.25 ,$104.00 ,$801.55 ,$516.40 ,$104.00 ,$56.00 ,$660.10 ,$615.10 ,$516.40 ,$516.40 ,$64.61 ,$801.55 ,"$1,161.91 ",$867.56 ,$660.10 ,$478.29 ,$574.00 ,$574.29 ,$574.00 ,$651.61 ,$848.70 ,$656.80 ,$521.56 ,$744.97 ,$652.01 ,$565.80 ,$565.80 ,$516.40 ,$565.80 ,$678.96 ,$584.66 ,$678.96 ,$678.96 ,$754.40 
ST NICHOLAS HOSPITAL - ACUTE,51000460,C5277,HC APL SKIN SUB OTH>100 INT 100CM W/PROC LOW,510,1 ,$943.00 ,$471.50 ,$56.00 ,"$1,161.91 ",$615.10 ,$133.00 ,$104.00 ,$516.40 ,$565.80 ,$801.55 ,$660.10 ,$615.10 ,$895.85 ,$716.68 ,$707.25 ,$104.00 ,$801.55 ,$516.40 ,$104.00 ,$56.00 ,$660.10 ,$615.10 ,$516.40 ,$516.40 ,$64.61 ,$801.55 ,"$1,161.91 ",$867.56 ,$660.10 ,$478.29 ,$574.00 ,$574.29 ,$574.00 ,$651.61 ,$848.70 ,$656.80 ,$521.56 ,$744.97 ,$652.01 ,$565.80 ,$565.80 ,$516.40 ,$565.80 ,$678.96 ,$584.66 ,$678.96 ,$678.96 ,$754.40 
ST NICHOLAS HOSPITAL - ACUTE,51000461,C5278,HC APL SKIN SUB OTH>100 ADL 100CM LOW,510,1 ,$873.00 ,$436.50 ,$56.00 ,$873.00 ,$615.10 ,$133.00 ,$104.00 , N/A ,$523.80 ,$742.05 ,$611.10 ,$615.10 ,$829.35 ,$663.48 ,$654.75 ,$104.00 ,$742.05 , N/A ,$104.00 ,$56.00 ,$611.10 ,$615.10 , N/A , N/A ,$64.61 ,$742.05 , N/A ,$803.16 ,$611.10 ,$442.79 ,$531.40 ,$531.66 ,$531.40 ,$603.24 ,$785.70 ,$608.04 , N/A ,$689.67 ,$652.01 ,$523.80 ,$523.80 , N/A ,$523.80 ,$628.56 ,$541.26 ,$628.56 ,$628.56 ,$698.40 
ST NICHOLAS HOSPITAL - ACUTE,51000462,11900,HC INJECT SKIN LESIONS </W 7 FAC,510,1 ,$178.00 ,$89.00 ,$51.36 ,$398.39 ,$51.36 ,$133.00 ,$104.00 ,$177.06 ,$106.80 ,$151.30 ,$124.60 ,$51.36 ,$169.10 ,$135.28 ,$133.50 ,$104.00 ,$151.30 ,$177.06 ,$104.00 ,$56.00 ,$124.60 ,$51.36 ,$177.06 ,$177.06 ,$64.61 ,$151.30 ,$398.39 ,$163.76 ,$124.60 ,$178.00 ,$178.00 ,$108.40 ,$178.00 ,$123.00 ,$160.20 ,$123.98 ,$178.83 ,$140.62 ,$54.44 ,$106.80 ,$106.80 ,$177.06 ,$106.80 ,$128.16 ,$110.36 ,$128.16 ,$128.16 ,$142.40 
ST NICHOLAS HOSPITAL - ACUTE,51000478,11042,HC DEBR SKIN/SUBQ TISS INIT W/PROC 20CM,510,1 ,$506.00 ,$253.00 ,$56.00 ,$766.80 ,$118.09 ,$133.00 ,$104.00 ,$340.80 ,$303.60 ,$430.10 ,$354.20 ,$118.09 ,$480.70 ,$384.56 ,$379.50 ,$104.00 ,$430.10 ,$340.80 ,$104.00 ,$56.00 ,$354.20 ,$118.09 ,$340.80 ,$340.80 ,$64.61 ,$430.10 ,$766.80 ,$465.52 ,$354.20 ,$506.00 ,$506.00 ,$308.15 ,$506.00 ,$349.65 ,$455.40 ,$352.43 ,$344.21 ,$399.74 ,$125.18 ,$303.60 ,$303.60 ,$340.80 ,$303.60 ,$364.32 ,$313.72 ,$364.32 ,$364.32 ,$404.80 
ST NICHOLAS HOSPITAL - ACUTE,51001002,N/A,HC REST EXER ASSESS EVAL,510,1 ,$58.00 ,$29.00 ,$29.00 ,$58.00 , N/A ,$58.00 ,$58.00 , N/A ,$34.80 ,$49.30 ,$40.60 , N/A ,$55.10 ,$44.08 ,$43.50 ,$58.00 ,$49.30 , N/A ,$58.00 ,$56.00 ,$40.60 , N/A , N/A , N/A ,$58.00 ,$49.30 , N/A ,$53.36 ,$40.60 ,$29.42 ,$35.30 ,$35.32 ,$35.30 ,$40.08 ,$52.20 ,$40.40 , N/A ,$45.82 , N/A ,$34.80 ,$34.80 , N/A ,$34.80 ,$41.76 ,$35.96 ,$41.76 ,$41.76 ,$46.40 
ST NICHOLAS HOSPITAL - ACUTE,51001003,N/A,HC REST EXER THER LEVEL I SESSION,510,1 ,$11.55 ,$5.78 ,$5.78 ,$11.55 , N/A ,$11.55 ,$11.55 , N/A ,$6.93 ,$9.82 ,$8.09 , N/A ,$10.97 ,$8.78 ,$8.66 ,$11.55 ,$9.82 , N/A ,$11.55 ,$11.55 ,$8.09 , N/A , N/A , N/A ,$11.55 ,$9.82 , N/A ,$10.63 ,$8.09 ,$5.86 ,$7.03 ,$7.03 ,$7.03 ,$7.98 ,$10.40 ,$8.04 , N/A ,$9.12 , N/A ,$6.93 ,$6.93 , N/A ,$6.93 ,$8.32 ,$7.16 ,$8.32 ,$8.32 ,$9.24 
ST NICHOLAS HOSPITAL - ACUTE,51001005,N/A,HC LIFETIME EX MONTH 3D/WK,510,1 ,$53.00 ,$26.50 ,$26.50 ,$53.00 , N/A ,$53.00 ,$53.00 , N/A ,$31.80 ,$45.05 ,$37.10 , N/A ,$50.35 ,$40.28 ,$39.75 ,$53.00 ,$45.05 , N/A ,$53.00 ,$53.00 ,$37.10 , N/A , N/A , N/A ,$53.00 ,$45.05 , N/A ,$48.76 ,$37.10 ,$26.88 ,$32.26 ,$32.28 ,$32.26 ,$36.62 ,$47.70 ,$36.91 , N/A ,$41.87 , N/A ,$31.80 ,$31.80 , N/A ,$31.80 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,51001006,N/A,HC LIFETIME EX MONTHLY 2D/WK,510,1 ,$42.00 ,$21.00 ,$21.00 ,$42.00 , N/A ,$42.00 ,$42.00 , N/A ,$25.20 ,$35.70 ,$29.40 , N/A ,$39.90 ,$31.92 ,$31.50 ,$42.00 ,$35.70 , N/A ,$42.00 ,$42.00 ,$29.40 , N/A , N/A , N/A ,$42.00 ,$35.70 , N/A ,$38.64 ,$29.40 ,$21.30 ,$25.57 ,$25.58 ,$25.57 ,$29.02 ,$37.80 ,$29.25 , N/A ,$33.18 , N/A ,$25.20 ,$25.20 , N/A ,$25.20 ,$30.24 ,$26.04 ,$30.24 ,$30.24 ,$33.60 
ST NICHOLAS HOSPITAL - ACUTE,51001007,N/A,HC LIFETIME EX PER SESSION,510,1 ,$8.40 ,$4.20 ,$4.20 ,$8.40 , N/A ,$8.40 ,$8.40 , N/A ,$5.04 ,$7.14 ,$5.88 , N/A ,$7.98 ,$6.38 ,$6.30 ,$8.40 ,$7.14 , N/A ,$8.40 ,$8.40 ,$5.88 , N/A , N/A , N/A ,$8.40 ,$7.14 , N/A ,$7.73 ,$5.88 ,$4.26 ,$5.11 ,$5.12 ,$5.11 ,$5.80 ,$7.56 ,$5.85 , N/A ,$6.64 , N/A ,$5.04 ,$5.04 , N/A ,$5.04 ,$6.05 ,$5.21 ,$6.05 ,$6.05 ,$6.72 
ST NICHOLAS HOSPITAL - ACUTE,61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,677.50 ",$510.48 ,"$2,898.00 ","$2,205.00 ","$1,068.02 ","$1,068.02 ","$1,918.35 ","$1,068.02 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$229.15 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$156.81 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,677.50 ",$510.48 ,"$2,898.00 ","$2,205.00 ","$1,068.02 ","$1,068.02 ","$1,918.35 ","$1,068.02 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$229.15 ,"$2,488.50 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$119.98 ,"$2,415.00 ",$119.98 ,"$1,352.00 ","$1,327.00 ",$515.43 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$515.43 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$119.98 ,$515.43 ,$515.43 ,"$1,422.18 ","$2,052.75 ","$1,159.72 ","$2,221.80 ","$1,690.50 ","$1,602.03 ","$1,602.03 ","$1,470.74 ","$1,602.03 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$520.58 ,"$1,907.85 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$515.43 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$119.98 ,"$2,415.00 ",$119.98 ,"$1,352.00 ","$1,327.00 ",$515.43 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$515.43 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$119.98 ,$515.43 ,$515.43 ,"$1,422.18 ","$2,052.75 ","$1,159.72 ","$2,221.80 ","$1,690.50 ","$1,602.03 ","$1,602.03 ","$1,470.74 ","$1,602.03 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$520.58 ,"$1,907.85 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$515.43 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,352.00 ","$1,327.00 ",$831.40 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$831.40 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$210.22 ,$831.40 ,$831.40 ,"$1,422.18 ","$2,052.75 ","$1,870.65 ","$2,221.80 ","$1,690.50 ","$2,317.85 ","$2,317.85 ","$1,470.74 ","$2,317.85 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$839.71 ,"$1,907.85 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$831.40 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,352.00 ","$1,327.00 ",$831.40 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$831.40 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$210.22 ,$831.40 ,$831.40 ,"$1,422.18 ","$2,052.75 ","$1,870.65 ","$2,221.80 ","$1,690.50 ","$2,317.85 ","$2,317.85 ","$1,470.74 ","$2,317.85 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$839.71 ,"$1,907.85 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$831.40 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$705.42 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$705.42 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$705.42 ,$705.42 ,"$1,422.18 ","$2,052.75 ","$1,587.19 ","$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$712.47 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$705.42 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$705.42 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$705.42 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$705.42 ,$705.42 ,"$1,422.18 ","$2,052.75 ","$1,587.19 ","$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$712.47 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$705.42 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$119.98 ,"$2,415.00 ",$119.98 ,"$1,352.00 ","$1,327.00 ",$515.43 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$515.43 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$119.98 ,$515.43 ,$515.43 ,"$1,422.18 ","$2,052.75 ","$1,159.72 ","$2,221.80 ","$1,690.50 ","$1,602.03 ","$1,602.03 ","$1,470.74 ","$1,602.03 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$520.58 ,"$1,907.85 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$515.43 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$119.98 ,"$2,415.00 ",$119.98 ,"$1,352.00 ","$1,327.00 ",$515.43 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$515.43 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$119.98 ,$515.43 ,$515.43 ,"$1,422.18 ","$2,052.75 ","$1,159.72 ","$2,221.80 ","$1,690.50 ","$1,602.03 ","$1,602.03 ","$1,470.74 ","$1,602.03 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$520.58 ,"$1,907.85 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$515.43 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$705.42 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$705.42 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$705.42 ,$705.42 ,"$1,422.18 ","$2,052.75 ","$1,587.19 ","$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$712.47 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$705.42 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$705.42 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$705.42 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$705.42 ,$705.42 ,"$1,422.18 ","$2,052.75 ","$1,587.19 ","$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$712.47 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$705.42 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,785.91 ","$1,785.91 ","$1,470.74 ","$1,785.91 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,677.50 ",$510.48 ,"$2,898.00 ","$2,205.00 ","$1,068.02 ","$1,068.02 ","$1,918.35 ","$1,068.02 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$229.15 ,"$2,488.50 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000044,76498,HC UNLISTED MRI PROC,610,1 ,"$2,415.00 ","$1,207.50 ",$79.76 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$79.76 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$79.76 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$79.76 ,$79.76 ,"$1,422.18 ","$2,052.75 ",$179.45 ,"$2,221.80 ","$1,690.50 ","$1,068.02 ","$1,068.02 ","$1,470.74 ","$1,068.02 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$80.56 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$79.76 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000048,19085,HC BREAST BIOPSY MRI GUIDE NEEDLE PLACE,610,1 ,"$1,000.00 ",$500.00 ,$439.46 ,"$3,121.49 ",$439.46 ,"$1,000.00 ","$1,000.00 ","$1,387.33 ",$600.00 ,$850.00 ,$700.00 ,$439.46 ,$950.00 ,$760.00 ,$750.00 ,"$1,000.00 ",$850.00 ,"$1,387.33 ","$1,000.00 ","$1,000.00 ",$700.00 ,$439.46 ,"$1,387.33 ","$1,387.33 ","$1,000.00 ",$850.00 ,"$3,121.49 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$900.00 ,$696.50 ,"$1,401.20 ",$790.00 ,$465.83 ,"$1,000.00 ","$1,000.00 ","$1,387.33 ","$1,000.00 ",$720.00 ,$620.00 ,$720.00 ,$720.00 ,$800.00 
ST NICHOLAS HOSPITAL - ACUTE,61000049,19287,HC MRI GUIDE NEEDLE PLACE LOC,610,1 ,"$2,200.00 ","$1,100.00 ",$258.03 ,"$2,200.00 ",$258.03 ,"$1,352.00 ","$1,327.00 ",$613.58 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$258.03 ,"$2,090.00 ","$1,672.00 ","$1,650.00 ","$2,194.00 ","$1,870.00 ",$613.58 ,"$2,194.00 ","$1,664.00 ","$1,540.00 ",$258.03 ,$613.58 ,$613.58 ,"$1,422.18 ","$1,870.00 ","$1,380.55 ","$2,024.00 ","$1,540.00 ","$1,921.55 ","$2,200.00 ","$1,339.80 ","$2,200.00 ","$1,520.20 ","$1,980.00 ","$1,532.30 ",$619.72 ,"$1,738.00 ",$273.51 ,"$1,350.00 ","$1,350.00 ",$613.58 ,"$1,350.00 ","$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,760.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,677.50 ",$510.48 ,"$2,898.00 ","$2,205.00 ","$1,068.02 ","$1,068.02 ","$1,918.35 ","$1,068.02 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$229.15 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000058,77047,HC MRI BREAST BI W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,677.50 ",$510.48 ,"$2,898.00 ","$2,205.00 ","$3,150.00 ","$3,150.00 ","$1,918.35 ","$3,150.00 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$229.15 ,"$2,488.50 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000062,C8911,HC MRA CHEST W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000068,C8918,HC MRA PELVIS W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000071,C8934,HC MRA UPPR EXT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$156.81 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,052.75 ",$816.96 ,"$2,221.80 ","$1,690.50 ","$1,545.23 ","$1,545.23 ","$1,470.74 ","$1,545.23 ","$1,668.77 ","$2,173.50 ","$1,682.05 ",$366.72 ,"$1,907.85 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,785.91 ","$1,785.91 ","$1,918.35 ","$1,785.91 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,352.00 ","$1,327.00 ",$363.09 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,394.00 ","$2,362.50 ","$2,194.00 ","$2,677.50 ",$363.09 ,"$2,194.00 ","$1,664.00 ","$2,205.00 ",$140.15 ,$363.09 ,$363.09 ,"$1,422.18 ","$2,677.50 ",$816.96 ,"$2,898.00 ","$2,205.00 ","$1,545.23 ","$1,545.23 ","$1,918.35 ","$1,545.23 ","$2,176.65 ","$2,835.00 ","$2,193.98 ",$366.72 ,"$2,488.50 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$363.09 ,"$1,350.00 ","$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000077,74712,HC MRI FETAL PLACENTA/MATERN PELVIC SINGLE,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ",$226.88 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ",$226.88 ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 ,$226.88 ,$226.88 ,"$1,422.18 ","$2,052.75 ",$510.48 ,"$2,221.80 ","$1,690.50 ",$918.49 ,$918.49 ,"$1,470.74 ",$918.49 ,"$1,668.77 ","$2,173.50 ","$1,682.05 ",$229.15 ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$226.88 ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,61000078,74713,HC MRI FETAL PLACENTA/MATERN PELVIC EA ADDN,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,352.00 ","$1,327.00 ", N/A ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,835.40 ","$1,811.25 ","$2,194.00 ","$2,052.75 ", N/A ,"$2,194.00 ","$1,664.00 ","$1,690.50 ",$79.99 , N/A , N/A ,"$1,422.18 ","$2,052.75 ", N/A ,"$2,221.80 ","$1,690.50 ","$1,224.89 ","$1,470.01 ","$1,470.74 ","$1,470.01 ","$1,668.77 ","$2,173.50 ","$1,682.05 ", N/A ,"$1,907.85 ",$84.79 ,"$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ","$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,932.00 "
ST NICHOLAS HOSPITAL - ACUTE,62100008,C1750,HC PERM CATH ANGIO,621,1 ,$750.00 ,$375.00 ,$315.00 ,$750.00 , N/A ,$485.18 ,$485.18 , N/A ,$450.00 ,$637.50 ,$525.00 , N/A ,$712.50 ,$570.00 ,$562.50 ,$487.50 ,$637.50 , N/A ,$487.50 ,$487.50 ,$525.00 , N/A , N/A , N/A ,$315.00 ,$637.50 , N/A ,$690.00 ,$525.00 ,$380.40 ,$456.53 ,$456.75 ,$456.53 ,$518.25 ,$675.00 ,$522.38 , N/A ,$592.50 , N/A ,$450.00 ,$450.00 , N/A ,$450.00 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$600.00 
ST NICHOLAS HOSPITAL - ACUTE,62100027,C2627,HC CATH SUPRAPUBIC-SYSTOSCOPIC,621,1 ,$202.00 ,$101.00 ,$84.84 ,$202.00 , N/A ,$130.67 ,$130.67 , N/A ,$121.20 ,$171.70 ,$141.40 , N/A ,$191.90 ,$153.52 ,$151.50 ,$131.30 ,$171.70 , N/A ,$131.30 ,$131.30 ,$141.40 , N/A , N/A , N/A ,$84.84 ,$171.70 , N/A ,$185.84 ,$141.40 ,$102.45 ,$122.96 ,$123.02 ,$122.96 ,$139.58 ,$181.80 ,$140.69 , N/A ,$159.58 , N/A ,$121.20 ,$121.20 , N/A ,$121.20 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,62100046,N/A,HC ANGIO PVA VIAL,621,1 ,$683.00 ,$341.50 ,$286.86 ,$683.00 , N/A ,$441.83 ,$441.83 , N/A ,$409.80 ,$580.55 ,$478.10 , N/A ,$648.85 ,$519.08 ,$512.25 ,$443.95 ,$580.55 , N/A ,$443.95 ,$443.95 ,$478.10 , N/A , N/A , N/A ,$286.86 ,$580.55 , N/A ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$415.74 ,$471.95 ,$614.70 ,$475.71 , N/A ,$539.57 , N/A ,$409.80 ,$409.80 , N/A ,$409.80 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,62100073,C1757,HC CATHETER INFUSION/ASPIRATION,621,1 ,"$1,180.00 ",$590.00 ,$495.60 ,"$1,180.00 ", N/A ,$763.34 ,$763.34 , N/A ,$708.00 ,"$1,003.00 ",$826.00 , N/A ,"$1,121.00 ",$896.80 ,$885.00 ,$767.00 ,"$1,003.00 ", N/A ,$767.00 ,$767.00 ,$826.00 , N/A , N/A , N/A ,$495.60 ,"$1,003.00 ", N/A ,"$1,085.60 ",$826.00 ,$598.50 ,$718.27 ,$718.62 ,$718.27 ,$815.38 ,"$1,062.00 ",$821.87 , N/A ,$932.20 , N/A ,$708.00 ,$708.00 , N/A ,$708.00 ,$849.60 ,$731.60 ,$849.60 ,$849.60 ,$944.00 
ST NICHOLAS HOSPITAL - ACUTE,62100113,N/A,HC TERUMO EMBOLIZATION COIL,621,1 ,"$2,675.00 ","$1,337.50 ","$1,123.50 ","$2,675.00 ", N/A ,"$1,730.46 ","$1,730.46 ", N/A ,"$1,605.00 ","$2,273.75 ","$1,872.50 ", N/A ,"$2,541.25 ","$2,033.00 ","$2,006.25 ","$1,738.75 ","$2,273.75 ", N/A ,"$1,738.75 ","$1,738.75 ","$1,872.50 ", N/A , N/A , N/A ,"$1,123.50 ","$2,273.75 ", N/A ,"$2,461.00 ","$1,872.50 ","$1,356.76 ","$1,628.27 ","$1,629.08 ","$1,628.27 ","$1,848.43 ","$2,407.50 ","$1,863.14 ", N/A ,"$2,113.25 ", N/A ,"$1,605.00 ","$1,605.00 ", N/A ,"$1,605.00 ","$1,926.00 ","$1,658.50 ","$1,926.00 ","$1,926.00 ","$2,140.00 "
ST NICHOLAS HOSPITAL - ACUTE,62100118,N/A,HSHS HC TRAY BIOPSY,621,1 ,$27.00 ,$13.50 ,$11.34 ,$27.00 , N/A ,$17.47 ,$17.47 , N/A ,$16.20 ,$22.95 ,$18.90 , N/A ,$25.65 ,$20.52 ,$20.25 ,$17.55 ,$22.95 , N/A ,$17.55 ,$17.55 ,$18.90 , N/A , N/A , N/A ,$11.34 ,$22.95 , N/A ,$24.84 ,$18.90 ,$13.69 ,$16.43 ,$16.44 ,$16.43 ,$18.66 ,$24.30 ,$18.81 , N/A ,$21.33 , N/A ,$16.20 ,$16.20 , N/A ,$16.20 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$21.60 
ST NICHOLAS HOSPITAL - ACUTE,62200001,C1759,HC CATHETER INTRACARDIAC ECHO,622,1 ,"$5,900.00 ","$2,950.00 ","$2,478.00 ","$5,900.00 ", N/A ,"$3,816.71 ","$3,816.71 ", N/A ,"$3,540.00 ","$5,015.00 ","$4,130.00 ", N/A ,"$5,605.00 ","$4,484.00 ","$4,425.00 ","$3,835.00 ","$5,015.00 ", N/A ,"$3,835.00 ","$3,835.00 ","$4,130.00 ", N/A , N/A , N/A ,"$2,478.00 ","$5,015.00 ", N/A ,"$5,428.00 ","$4,130.00 ","$2,992.48 ","$3,591.33 ","$3,593.10 ","$3,591.33 ","$4,076.90 ","$5,310.00 ","$4,109.35 ", N/A ,"$4,661.00 ", N/A ,"$3,540.00 ","$3,540.00 ", N/A ,"$3,540.00 ","$4,248.00 ","$3,658.00 ","$4,248.00 ","$4,248.00 ","$4,720.00 "
ST NICHOLAS HOSPITAL - ACUTE,62200006,C1726,HC BALLOON DILATOR,622,1 ,$455.00 ,$227.50 ,$191.10 ,$455.00 , N/A ,$294.34 ,$294.34 , N/A ,$273.00 ,$386.75 ,$318.50 , N/A ,$432.25 ,$345.80 ,$341.25 ,$295.75 ,$386.75 , N/A ,$295.75 ,$295.75 ,$318.50 , N/A , N/A , N/A ,$191.10 ,$386.75 , N/A ,$418.60 ,$318.50 ,$230.78 ,$276.96 ,$277.10 ,$276.96 ,$314.41 ,$409.50 ,$316.91 , N/A ,$359.45 , N/A ,$273.00 ,$273.00 , N/A ,$273.00 ,$327.60 ,$282.10 ,$327.60 ,$327.60 ,$364.00 
ST NICHOLAS HOSPITAL - ACUTE,63600001,Q4101,HC APLIGRAF PER 1 SQ CM,636,1 ,$83.00 ,$41.50 ,$34.45 ,$83.00 , N/A ,$68.49 ,$45.66 , N/A ,$49.80 ,$70.55 ,$58.10 , N/A ,$78.85 ,$63.08 ,$62.25 ,$51.75 ,$70.55 , N/A ,$51.75 ,$53.95 ,$58.10 , N/A , N/A , N/A ,$34.45 ,$70.55 , N/A ,$76.36 ,$58.10 ,$44.14 ,$44.14 ,$50.55 ,$44.14 ,$57.35 ,$74.70 ,$57.81 , N/A ,$65.57 , N/A , N/A , N/A , N/A , N/A ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$66.40 
ST NICHOLAS HOSPITAL - ACUTE,63600003,Q4102,HC OASIS PER SQ CENTIMETER,636,1 ,$31.00 ,$15.50 ,$11.09 ,$31.00 , N/A ,$22.05 ,$14.70 , N/A ,$18.60 ,$26.35 ,$21.70 , N/A ,$29.45 ,$23.56 ,$23.25 ,$16.66 ,$26.35 , N/A ,$16.66 ,$20.15 ,$21.70 , N/A , N/A , N/A ,$11.09 ,$26.35 , N/A ,$28.52 ,$21.70 ,$14.21 ,$14.21 ,$18.88 ,$14.21 ,$21.42 ,$27.90 ,$21.59 , N/A ,$24.49 , N/A , N/A , N/A , N/A , N/A ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$24.80 
ST NICHOLAS HOSPITAL - ACUTE,63600006,Q4106,HC DERMAGRAFT PER SQ CM,636,1 ,$88.00 ,$44.00 ,$36.18 ,$88.00 , N/A ,$71.93 ,$47.96 , N/A ,$52.80 ,$74.80 ,$61.60 , N/A ,$83.60 ,$66.88 ,$66.00 ,$54.35 ,$74.80 , N/A ,$54.35 ,$57.20 ,$61.60 , N/A , N/A , N/A ,$36.18 ,$74.80 , N/A ,$80.96 ,$61.60 ,$46.36 ,$46.36 ,$53.59 ,$46.36 ,$60.81 ,$79.20 ,$61.29 , N/A ,$69.52 , N/A , N/A , N/A , N/A , N/A ,$63.36 ,$54.56 ,$63.36 ,$63.36 ,$70.40 
ST NICHOLAS HOSPITAL - ACUTE,63600007,Q4107,HC GRAFT JACKET PER SQ CM,636,1 ,$367.00 ,$183.50 ,$104.80 ,$367.00 , N/A ,$208.33 ,$138.89 , N/A ,$220.20 ,$311.95 ,$256.90 , N/A ,$348.65 ,$278.92 ,$275.25 ,$121.82 ,$311.95 , N/A ,$121.82 ,$238.55 ,$256.90 , N/A , N/A , N/A ,$104.80 ,$311.95 , N/A ,$337.64 ,$256.90 ,$134.26 ,$134.26 ,$223.50 ,$134.26 ,$253.60 ,$330.30 ,$255.62 , N/A ,$289.93 , N/A , N/A , N/A , N/A , N/A ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$293.60 
ST NICHOLAS HOSPITAL - ACUTE,63600008,Q4121,HC THERASKIN PER SQ CM,636,1 ,$79.00 ,$39.50 ,$39.50 ,$79.00 , N/A ,$79.00 ,$65.73 , N/A ,$47.40 ,$67.15 ,$55.30 , N/A ,$75.05 ,$60.04 ,$59.25 ,$74.49 ,$67.15 , N/A ,$74.49 ,$51.35 ,$55.30 , N/A , N/A , N/A ,$49.60 ,$67.15 , N/A ,$72.68 ,$55.30 ,$63.54 ,$63.54 ,$48.11 ,$63.54 ,$54.59 ,$71.10 ,$55.02 , N/A ,$62.41 , N/A , N/A , N/A , N/A , N/A ,$56.88 ,$48.98 ,$56.88 ,$56.88 ,$63.20 
ST NICHOLAS HOSPITAL - ACUTE,63600009,Q4186,HC EPIFIX PER SQ CM,636,1 ,$857.86 ,$428.93 ,$174.65 ,$857.86 , N/A ,$347.20 ,$231.47 , N/A ,$514.72 ,$729.18 ,$600.50 , N/A ,$814.97 ,$651.97 ,$643.40 ,$262.33 ,$729.18 , N/A ,$262.33 ,$557.61 ,$600.50 , N/A , N/A , N/A ,$174.65 ,$729.18 , N/A ,$789.23 ,$600.50 ,$223.75 ,$223.75 ,$522.44 ,$223.75 ,$592.78 ,$772.07 ,$597.50 , N/A ,$677.71 , N/A , N/A , N/A , N/A , N/A ,$617.66 ,$531.87 ,$617.66 ,$617.66 ,$686.29 
ST NICHOLAS HOSPITAL - ACUTE,63600010,Q4124,HC OASIS TRI LAYER ULTRA,636,1 ,$31.00 ,$15.50 ,$13.02 ,$31.00 , N/A ,$20.05 ,$20.05 , N/A ,$18.60 ,$26.35 ,$21.70 , N/A ,$29.45 ,$23.56 ,$23.25 ,$20.15 ,$26.35 , N/A ,$20.15 ,$20.15 ,$21.70 , N/A , N/A , N/A ,$13.02 ,$26.35 , N/A ,$28.52 ,$21.70 ,$15.72 ,$18.87 ,$18.88 ,$18.87 ,$21.42 ,$27.90 ,$21.59 , N/A ,$24.49 , N/A , N/A , N/A , N/A , N/A ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$24.80 
ST NICHOLAS HOSPITAL - ACUTE,63600011,Q4113,HC GRAFT JACKET EXPRESS PER 1CC,636,1 ,"$2,996.00 ","$1,498.00 ","$1,040.75 ","$2,996.00 ", N/A ,"$2,068.99 ","$1,379.33 ", N/A ,"$1,797.60 ","$2,546.60 ","$2,097.20 ", N/A ,"$2,846.20 ","$2,276.96 ","$2,247.00 ","$1,563.24 ","$2,546.60 ", N/A ,"$1,563.24 ","$1,947.40 ","$2,097.20 ", N/A , N/A , N/A ,"$1,040.75 ","$2,546.60 ", N/A ,"$2,756.32 ","$2,097.20 ","$1,333.35 ","$1,333.35 ","$1,824.56 ","$1,333.35 ","$2,070.24 ","$2,696.40 ","$2,086.71 ", N/A ,"$2,366.84 ", N/A , N/A , N/A , N/A , N/A ,"$2,157.12 ","$1,857.52 ","$2,157.12 ","$2,157.12 ","$2,396.80 "
ST NICHOLAS HOSPITAL - ACUTE,63600013,Q4133,HC GRAFIX PER SQ CENTIMETER,636,1 ,$471.00 ,$235.50 ,$151.73 ,$471.00 , N/A ,$301.64 ,$201.09 , N/A ,$282.60 ,$400.35 ,$329.70 , N/A ,$447.45 ,$357.96 ,$353.25 ,$227.90 ,$400.35 , N/A ,$227.90 ,$306.15 ,$329.70 , N/A , N/A , N/A ,$151.73 ,$400.35 , N/A ,$433.32 ,$329.70 ,$194.39 ,$194.39 ,$286.84 ,$194.39 ,$325.46 ,$423.90 ,$328.05 , N/A ,$372.09 , N/A , N/A , N/A , N/A , N/A ,$339.12 ,$292.02 ,$339.12 ,$339.12 ,$376.80 
ST NICHOLAS HOSPITAL - ACUTE,63600014,Q4196,HC PURAPLY ANTIMICROBIAL PER SQ CENTIMETER,636,1 ,$264.00 ,$132.00 ,$125.23 ,$264.00 , N/A ,$248.96 ,$165.98 , N/A ,$158.40 ,$224.40 ,$184.80 , N/A ,$250.80 ,$200.64 ,$198.00 ,$188.11 ,$224.40 , N/A ,$188.11 ,$171.60 ,$184.80 , N/A , N/A , N/A ,$125.23 ,$224.40 , N/A ,$242.88 ,$184.80 ,$160.44 ,$160.44 ,$160.78 ,$160.44 ,$182.42 ,$237.60 ,$183.88 , N/A ,$208.56 , N/A , N/A , N/A , N/A , N/A ,$190.08 ,$163.68 ,$190.08 ,$190.08 ,$211.20 
ST NICHOLAS HOSPITAL - ACUTE,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 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST NICHOLAS HOSPITAL - ACUTE,63600020,90384,"HC RHO IG, FULL-DOSE, IM",636,1 ,$298.00 ,$149.00 ,$26.29 ,$298.00 ,$26.29 ,$192.78 ,$192.78 , N/A ,$178.80 ,$253.30 ,$208.60 ,$26.29 ,$283.10 ,$226.48 ,$223.50 ,$235.60 ,$253.30 , N/A ,$235.60 ,$193.70 ,$208.60 ,$26.29 , N/A , N/A ,$125.16 ,$253.30 , N/A ,$274.16 ,$208.60 ,$151.15 ,$181.39 ,$181.48 ,$181.39 ,$205.92 ,$268.20 ,$207.56 , N/A ,$235.42 ,$27.87 , N/A , N/A , N/A , N/A ,$214.56 ,$184.76 ,$214.56 ,$214.56 ,$238.40 
ST NICHOLAS HOSPITAL - ACUTE,63600027,J7330,"HC AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANTED",636,1 ,"$146,802.00 ","$73,401.00 ","$56,791.27 ","$146,802.00 ", N/A ,"$94,966.21 ","$94,966.21 ", N/A ,"$88,081.20 ","$124,781.70 ","$102,761.40 ", N/A ,"$139,461.90 ","$111,569.52 ","$110,101.50 ","$56,791.27 ","$124,781.70 ", N/A ,"$56,791.27 ","$95,421.30 ","$102,761.40 ", N/A , N/A , N/A ,"$61,656.84 ","$124,781.70 ", N/A ,"$135,057.84 ","$102,761.40 ","$74,457.97 ","$89,358.38 ","$89,402.42 ","$89,358.38 ","$101,440.18 ","$132,121.80 ","$102,247.59 ", N/A ,"$115,973.58 ", N/A , N/A , N/A , N/A , N/A ,"$105,697.44 ","$91,017.24 ","$105,697.44 ","$105,697.44 ","$117,441.60 "
ST NICHOLAS HOSPITAL - ACUTE,63600028,A4641,"HC RADIOPHARMACEUTICAL, DX, NOC",636,1 ,$454.00 ,$227.00 ,$190.68 ,$454.00 , N/A ,$293.69 ,$293.69 , N/A ,$272.40 ,$385.90 ,$317.80 , N/A ,$431.30 ,$345.04 ,$340.50 , N/A ,$385.90 , N/A , N/A ,$295.10 ,$317.80 , N/A , N/A , N/A ,$190.68 ,$385.90 , N/A ,$417.68 ,$317.80 ,$230.27 ,$276.35 ,$276.49 ,$276.35 ,$313.71 ,$408.60 ,$316.21 , N/A ,$358.66 , N/A , N/A , N/A , N/A , N/A ,$326.88 ,$281.48 ,$326.88 ,$326.88 ,$363.20 
ST NICHOLAS HOSPITAL - ACUTE,63600150,90686,HC COMMUNITY FLU VACCINE SNS,636,1 ,$21.00 ,$10.50 ,$6.51 ,$21.00 ,$8.50 ,$21.00 ,$21.00 ,$6.51 ,$12.60 ,$17.85 ,$14.70 ,$8.50 ,$19.95 ,$15.96 ,$15.75 ,$21.00 ,$17.85 ,$6.51 ,$21.00 ,$13.65 ,$14.70 ,$8.50 ,$6.51 ,$6.51 ,$21.00 ,$17.85 ,$14.65 ,$19.32 ,$14.70 ,$21.00 ,$21.00 ,$12.79 ,$21.00 ,$14.51 ,$18.90 ,$14.63 ,$6.58 ,$16.59 ,$9.01 ,$21.00 ,$21.00 ,$6.51 ,$21.00 ,$15.12 ,$13.02 ,$15.12 ,$15.12 ,$16.80 
ST NICHOLAS HOSPITAL - ACUTE,63600175,Q9967,HC CONTRAST ISOVUE 300-399 PER ML,636,1 ,$3.20 ,$1.60 ,$0.14 ,$3.20 , N/A ,$0.27 ,$0.18 , N/A ,$1.92 ,$2.72 ,$2.24 , N/A ,$3.04 ,$2.43 ,$2.40 ,$0.20 ,$2.72 , N/A ,$0.20 ,$2.08 ,$2.24 , N/A , N/A , N/A ,$0.14 ,$2.72 , N/A ,$2.94 ,$2.24 ,$0.17 ,$0.17 ,$1.95 ,$0.17 ,$2.21 ,$2.88 ,$2.23 , N/A ,$2.53 , N/A , N/A , N/A , N/A , N/A ,$2.30 ,$1.98 ,$2.30 ,$2.30 ,$2.56 
ST NICHOLAS HOSPITAL - ACUTE,63600177,Q9967,HC CONTRAST VISIPAQUE 300-399 PER ML,636,1 ,$3.20 ,$1.60 ,$0.14 ,$3.20 , N/A ,$0.27 ,$0.18 , N/A ,$1.92 ,$2.72 ,$2.24 , N/A ,$3.04 ,$2.43 ,$2.40 ,$0.20 ,$2.72 , N/A ,$0.20 ,$2.08 ,$2.24 , N/A , N/A , N/A ,$0.14 ,$2.72 , N/A ,$2.94 ,$2.24 ,$0.17 ,$0.17 ,$1.95 ,$0.17 ,$2.21 ,$2.88 ,$2.23 , N/A ,$2.53 , N/A , N/A , N/A , N/A , N/A ,$2.30 ,$1.98 ,$2.30 ,$2.30 ,$2.56 
ST NICHOLAS HOSPITAL - ACUTE,63600178,J1644,HC HEPARIN SODIUM PER 1000 UNITS,636,1 ,$12.70 ,$6.35 ,$0.28 ,$12.70 , N/A ,$0.56 ,$0.38 , N/A ,$7.62 ,$10.80 ,$8.89 , N/A ,$12.07 ,$9.65 ,$9.53 ,$0.43 ,$10.80 , N/A ,$0.43 ,$8.26 ,$8.89 , N/A , N/A , N/A ,$0.28 ,$10.80 , N/A ,$11.68 ,$8.89 ,$0.36 ,$0.36 ,$7.73 ,$0.36 ,$8.78 ,$11.43 ,$8.85 , N/A ,$10.03 , N/A , N/A , N/A , N/A , N/A ,$9.14 ,$7.87 ,$9.14 ,$9.14 ,$10.16 
ST NICHOLAS HOSPITAL - ACUTE,63600180,Q9963,HC GASTROGRAFIN PER ML RAD ONC,636,1 ,$1.25 ,$0.63 ,$0.22 ,$1.25 , N/A ,$0.43 ,$0.29 , N/A ,$0.75 ,$1.06 ,$0.88 , N/A ,$1.19 ,$0.95 ,$0.94 ,$0.32 ,$1.06 , N/A ,$0.32 ,$0.81 ,$0.88 , N/A , N/A , N/A ,$0.22 ,$1.06 , N/A ,$1.15 ,$0.88 ,$0.28 ,$0.28 ,$0.76 ,$0.28 ,$0.86 ,$1.13 ,$0.87 , N/A ,$0.99 , N/A , N/A , N/A , N/A , N/A ,$0.90 ,$0.78 ,$0.90 ,$0.90 ,$1.00 
ST NICHOLAS HOSPITAL - ACUTE,63600182,Q9958,HC CYSTOGRAFIN DILUTE 18% PER ML,636,1 ,$0.16 ,$0.08 ,$0.08 ,$0.16 , N/A ,$0.16 ,$0.11 , N/A ,$0.10 ,$0.14 ,$0.11 , N/A ,$0.15 ,$0.12 ,$0.12 ,$0.12 ,$0.14 , N/A ,$0.12 ,$0.10 ,$0.11 , N/A , N/A , N/A ,$0.08 ,$0.14 , N/A ,$0.15 ,$0.11 ,$0.10 ,$0.10 ,$0.10 ,$0.10 ,$0.11 ,$0.14 ,$0.11 , N/A ,$0.13 , N/A , N/A , N/A , N/A , N/A ,$0.12 ,$0.10 ,$0.12 ,$0.12 ,$0.13 
ST NICHOLAS HOSPITAL - ACUTE,63600190,Q4160,HC NUSHIELD PER SQ CM,636,1 ,$693.00 ,$346.50 ,$108.58 ,$693.00 , N/A ,$215.87 ,$143.91 , N/A ,$415.80 ,$589.05 ,$485.10 , N/A ,$658.35 ,$526.68 ,$519.75 ,$163.10 ,$589.05 , N/A ,$163.10 ,$450.45 ,$485.10 , N/A , N/A , N/A ,$108.58 ,$589.05 , N/A ,$637.56 ,$485.10 ,$139.11 ,$139.11 ,$422.04 ,$139.11 ,$478.86 ,$623.70 ,$482.67 , N/A ,$547.47 , N/A , N/A , N/A , N/A , N/A ,$498.96 ,$429.66 ,$498.96 ,$498.96 ,$554.40 
ST NICHOLAS HOSPITAL - ACUTE,68200002,N/A,HC LEVEL 2 TRAUMA ACTIVATION <30 MINS,682,1 ,"$3,360.00 ","$1,680.00 ","$1,411.20 ","$3,360.00 ", N/A ,"$2,173.58 ","$2,173.58 ", N/A ,"$2,016.00 ","$2,856.00 ","$2,352.00 ", N/A ,"$3,192.00 ","$2,553.60 ","$2,520.00 ","$2,184.00 ","$2,856.00 ", N/A ,"$2,184.00 ","$2,184.00 ","$2,352.00 ", N/A , N/A , N/A ,"$1,411.20 ","$2,856.00 ", N/A ,"$3,091.20 ","$2,352.00 ","$1,704.19 ","$2,045.23 ","$2,046.24 ","$2,045.23 ","$2,321.76 ","$3,024.00 ","$2,340.24 ", N/A ,"$2,654.40 ", N/A ,"$2,016.00 ","$2,016.00 ", N/A ,"$2,016.00 ","$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,68400002,G0390,HC LEVEL 2 TRAUMA  ACTIVATION,684,1 ,"$2,912.00 ","$1,456.00 ",$38.23 ,"$2,912.00 ",$38.23 ,"$1,883.77 ","$1,883.77 ", N/A ,"$1,747.20 ","$2,475.20 ","$2,038.40 ",$38.23 ,"$2,766.40 ","$2,213.12 ","$2,184.00 ","$1,892.80 ","$2,475.20 ", N/A ,"$1,892.80 ","$1,892.80 ","$2,038.40 ",$38.23 , N/A , N/A ,"$1,223.04 ","$2,475.20 ", N/A ,"$2,679.04 ","$2,038.40 ","$1,476.97 ","$1,772.53 ","$1,773.41 ","$1,772.53 ","$2,012.19 ","$2,620.80 ","$2,028.21 ", N/A ,"$2,300.48 ",$40.52 ,"$1,747.20 ","$1,747.20 ", N/A ,"$1,747.20 ","$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$2,329.60 "
ST NICHOLAS HOSPITAL - ACUTE,71000002,N/A,HC RECOVERY CLASS 2 PER 15 MINS,710,1 ,$557.00 ,$278.50 ,$233.94 ,$557.00 , N/A ,$360.32 ,$360.32 , N/A ,$334.20 ,$473.45 ,$389.90 , N/A ,$529.15 ,$423.32 ,$417.75 ,$362.05 ,$473.45 , N/A ,$362.05 ,$362.05 ,$389.90 , N/A , N/A , N/A ,$233.94 ,$473.45 , N/A ,$512.44 ,$389.90 ,$282.51 ,$339.05 ,$339.21 ,$339.05 ,$384.89 ,$501.30 ,$387.95 , N/A ,$440.03 , N/A ,$334.20 ,$334.20 , N/A ,$334.20 ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$445.60 
ST NICHOLAS HOSPITAL - ACUTE,71000003,N/A,HC RECOVERY CLASS 3 PER 15 MINS,710,1 ,$662.00 ,$331.00 ,$278.04 ,$662.00 , N/A ,$428.25 ,$428.25 , N/A ,$397.20 ,$562.70 ,$463.40 , N/A ,$628.90 ,$503.12 ,$496.50 ,$430.30 ,$562.70 , N/A ,$430.30 ,$430.30 ,$463.40 , N/A , N/A , N/A ,$278.04 ,$562.70 , N/A ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$402.96 ,$457.44 ,$595.80 ,$461.08 , N/A ,$522.98 , N/A ,$397.20 ,$397.20 , N/A ,$397.20 ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$529.60 
ST NICHOLAS HOSPITAL - ACUTE,71000004,N/A,HC RECOVERY CLASS 4 PER 15 MINS,710,1 ,$777.00 ,$388.50 ,$326.34 ,$777.00 , N/A ,$502.64 ,$502.64 , N/A ,$466.20 ,$660.45 ,$543.90 , N/A ,$738.15 ,$590.52 ,$582.75 ,$505.05 ,$660.45 , N/A ,$505.05 ,$505.05 ,$543.90 , N/A , N/A , N/A ,$326.34 ,$660.45 , N/A ,$714.84 ,$543.90 ,$394.09 ,$472.96 ,$473.19 ,$472.96 ,$536.91 ,$699.30 ,$541.18 , N/A ,$613.83 , N/A ,$466.20 ,$466.20 , N/A ,$466.20 ,$559.44 ,$481.74 ,$559.44 ,$559.44 ,$621.60 
ST NICHOLAS HOSPITAL - ACUTE,71000005,N/A,HC RECOVERY PER HOUR-ICU PATIENT,710,1 ,"$2,205.00 ","$1,102.50 ",$926.10 ,"$2,205.00 ", N/A ,"$1,426.41 ","$1,426.41 ", N/A ,"$1,323.00 ","$1,874.25 ","$1,543.50 ", N/A ,"$2,094.75 ","$1,675.80 ","$1,653.75 ","$1,433.25 ","$1,874.25 ", N/A ,"$1,433.25 ","$1,433.25 ","$1,543.50 ", N/A , N/A , N/A ,$926.10 ,"$1,874.25 ", N/A ,"$2,028.60 ","$1,543.50 ","$1,118.38 ","$1,342.18 ","$1,342.85 ","$1,342.18 ","$1,523.66 ","$1,984.50 ","$1,535.78 ", N/A ,"$1,741.95 ", N/A ,"$1,323.00 ","$1,323.00 ", N/A ,"$1,323.00 ","$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,71000006,N/A,HC SHORT STAY EXTENDED,710,1 ,"$1,155.00 ",$577.50 ,$485.10 ,"$1,155.00 ", N/A ,$747.17 ,$747.17 , N/A ,$693.00 ,$981.75 ,$808.50 , N/A ,"$1,097.25 ",$877.80 ,$866.25 ,$750.75 ,$981.75 , N/A ,$750.75 ,$750.75 ,$808.50 , N/A , N/A , N/A ,$485.10 ,$981.75 , N/A ,"$1,062.60 ",$808.50 ,$585.82 ,$703.05 ,$703.40 ,$703.05 ,$798.11 ,"$1,039.50 ",$804.46 , N/A ,$912.45 , N/A ,$693.00 ,$693.00 , N/A ,$693.00 ,$831.60 ,$716.10 ,$831.60 ,$831.60 ,$924.00 
ST NICHOLAS HOSPITAL - ACUTE,71000009,N/A,HC GI RECOVERY PER HOUR,710,1 ,$777.00 ,$388.50 ,$326.34 ,$777.00 , N/A ,$502.64 ,$502.64 , N/A ,$466.20 ,$660.45 ,$543.90 , N/A ,$738.15 ,$590.52 ,$582.75 ,$505.05 ,$660.45 , N/A ,$505.05 ,$505.05 ,$543.90 , N/A , N/A , N/A ,$326.34 ,$660.45 , N/A ,$714.84 ,$543.90 ,$394.09 ,$472.96 ,$473.19 ,$472.96 ,$536.91 ,$699.30 ,$541.18 , N/A ,$613.83 , N/A ,$466.20 ,$466.20 , N/A ,$466.20 ,$559.44 ,$481.74 ,$559.44 ,$559.44 ,$621.60 
ST NICHOLAS HOSPITAL - ACUTE,71000013,N/A,HC RECOVERY PER HOUR-L AND D SURGICAL,710,1 ,$557.00 ,$278.50 ,$233.94 ,$557.00 , N/A ,$360.32 ,$360.32 , N/A ,$334.20 ,$473.45 ,$389.90 , N/A ,$529.15 ,$423.32 ,$417.75 ,$362.05 ,$473.45 , N/A ,$362.05 ,$362.05 ,$389.90 , N/A , N/A , N/A ,$233.94 ,$473.45 , N/A ,$512.44 ,$389.90 ,$282.51 ,$339.05 ,$339.21 ,$339.05 ,$384.89 ,$501.30 ,$387.95 , N/A ,$440.03 , N/A ,$334.20 ,$334.20 , N/A ,$334.20 ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$445.60 
ST NICHOLAS HOSPITAL - ACUTE,71000015,N/A,HC PHASE II RECOVERY 1 HOUR,710,1 ,$525.00 ,$262.50 ,$220.50 ,$525.00 , N/A ,$339.62 ,$339.62 , N/A ,$315.00 ,$446.25 ,$367.50 , N/A ,$498.75 ,$399.00 ,$393.75 ,$341.25 ,$446.25 , N/A ,$341.25 ,$341.25 ,$367.50 , N/A , N/A , N/A ,$220.50 ,$446.25 , N/A ,$483.00 ,$367.50 ,$266.28 ,$319.57 ,$319.73 ,$319.57 ,$362.78 ,$472.50 ,$365.66 , N/A ,$414.75 , N/A ,$315.00 ,$315.00 , N/A ,$315.00 ,$378.00 ,$325.50 ,$378.00 ,$378.00 ,$420.00 
ST NICHOLAS HOSPITAL - ACUTE,71000025,N/A,HC GI RECOVERY EA  ADDN'T HOUR,710,1 ,$105.00 ,$52.50 ,$44.10 ,$105.00 , N/A ,$67.92 ,$67.92 , N/A ,$63.00 ,$89.25 ,$73.50 , N/A ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 , N/A ,$68.25 ,$68.25 ,$73.50 , N/A , N/A , N/A ,$44.10 ,$89.25 , N/A ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$73.13 , N/A ,$82.95 , N/A ,$63.00 ,$63.00 , N/A ,$63.00 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,71000100,N/A,HC SHORT STAY 1 HR SURGERY,710,1 ,"$1,155.00 ",$577.50 ,$485.10 ,"$1,155.00 ", N/A ,$747.17 ,$747.17 , N/A ,$693.00 ,$981.75 ,$808.50 , N/A ,"$1,097.25 ",$877.80 ,$866.25 ,$750.75 ,$981.75 , N/A ,$750.75 ,$750.75 ,$808.50 , N/A , N/A , N/A ,$485.10 ,$981.75 , N/A ,"$1,062.60 ",$808.50 ,$585.82 ,$703.05 ,$703.40 ,$703.05 ,$798.11 ,"$1,039.50 ",$804.46 , N/A ,$912.45 , N/A ,$693.00 ,$693.00 , N/A ,$693.00 ,$831.60 ,$716.10 ,$831.60 ,$831.60 ,$924.00 
ST NICHOLAS HOSPITAL - ACUTE,71000101,N/A,HC SHORT STAY ADDN HR SURGERY,710,1 ,$441.00 ,$220.50 ,$185.22 ,$441.00 , N/A ,$285.28 ,$285.28 , N/A ,$264.60 ,$374.85 ,$308.70 , N/A ,$418.95 ,$335.16 ,$330.75 ,$286.65 ,$374.85 , N/A ,$286.65 ,$286.65 ,$308.70 , N/A , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$268.44 ,$304.73 ,$396.90 ,$307.16 , N/A ,$348.39 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$352.80 
ST NICHOLAS HOSPITAL - ACUTE,71000102,N/A,HC SHORT STAY 5 > HR SURGERY,710,1 ,$441.00 ,$220.50 ,$185.22 ,$441.00 , N/A ,$285.28 ,$285.28 , N/A ,$264.60 ,$374.85 ,$308.70 , N/A ,$418.95 ,$335.16 ,$330.75 ,$286.65 ,$374.85 , N/A ,$286.65 ,$286.65 ,$308.70 , N/A , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$268.44 ,$304.73 ,$396.90 ,$307.16 , N/A ,$348.39 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$352.80 
ST NICHOLAS HOSPITAL - ACUTE,71000200,N/A,HC RECOVERY CLASS 2 INIT,710,1 ,$662.00 ,$331.00 ,$278.04 ,$662.00 , N/A ,$428.25 ,$428.25 , N/A ,$397.20 ,$562.70 ,$463.40 , N/A ,$628.90 ,$503.12 ,$496.50 ,$430.30 ,$562.70 , N/A ,$430.30 ,$430.30 ,$463.40 , N/A , N/A , N/A ,$278.04 ,$562.70 , N/A ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$402.96 ,$457.44 ,$595.80 ,$461.08 , N/A ,$522.98 , N/A ,$397.20 ,$397.20 , N/A ,$397.20 ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$529.60 
ST NICHOLAS HOSPITAL - ACUTE,71000201,N/A,HC RECOVERY CLASS 2 ADDL,710,1 ,$441.00 ,$220.50 ,$185.22 ,$441.00 , N/A ,$285.28 ,$285.28 , N/A ,$264.60 ,$374.85 ,$308.70 , N/A ,$418.95 ,$335.16 ,$330.75 ,$286.65 ,$374.85 , N/A ,$286.65 ,$286.65 ,$308.70 , N/A , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$268.44 ,$304.73 ,$396.90 ,$307.16 , N/A ,$348.39 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$352.80 
ST NICHOLAS HOSPITAL - ACUTE,71000202,N/A,HC RECOVERY CLASS 3 INIT,710,1 ,$882.00 ,$441.00 ,$370.44 ,$882.00 , N/A ,$570.57 ,$570.57 , N/A ,$529.20 ,$749.70 ,$617.40 , N/A ,$837.90 ,$670.32 ,$661.50 ,$573.30 ,$749.70 , N/A ,$573.30 ,$573.30 ,$617.40 , N/A , N/A , N/A ,$370.44 ,$749.70 , N/A ,$811.44 ,$617.40 ,$447.35 ,$536.87 ,$537.14 ,$536.87 ,$609.46 ,$793.80 ,$614.31 , N/A ,$696.78 , N/A ,$529.20 ,$529.20 , N/A ,$529.20 ,$635.04 ,$546.84 ,$635.04 ,$635.04 ,$705.60 
ST NICHOLAS HOSPITAL - ACUTE,71000203,N/A,HC RECOVERY CLASS 3 ADDL,710,1 ,$441.00 ,$220.50 ,$185.22 ,$441.00 , N/A ,$285.28 ,$285.28 , N/A ,$264.60 ,$374.85 ,$308.70 , N/A ,$418.95 ,$335.16 ,$330.75 ,$286.65 ,$374.85 , N/A ,$286.65 ,$286.65 ,$308.70 , N/A , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$268.44 ,$304.73 ,$396.90 ,$307.16 , N/A ,$348.39 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$352.80 
ST NICHOLAS HOSPITAL - ACUTE,71000204,N/A,HC RECOVERY CLASS 4 INIT,710,1 ,"$1,155.00 ",$577.50 ,$485.10 ,"$1,155.00 ", N/A ,$747.17 ,$747.17 , N/A ,$693.00 ,$981.75 ,$808.50 , N/A ,"$1,097.25 ",$877.80 ,$866.25 ,$750.75 ,$981.75 , N/A ,$750.75 ,$750.75 ,$808.50 , N/A , N/A , N/A ,$485.10 ,$981.75 , N/A ,"$1,062.60 ",$808.50 ,$585.82 ,$703.05 ,$703.40 ,$703.05 ,$798.11 ,"$1,039.50 ",$804.46 , N/A ,$912.45 , N/A ,$693.00 ,$693.00 , N/A ,$693.00 ,$831.60 ,$716.10 ,$831.60 ,$831.60 ,$924.00 
ST NICHOLAS HOSPITAL - ACUTE,71000205,N/A,HC RECOVERY CLASS 4 ADDL,710,1 ,$662.00 ,$331.00 ,$278.04 ,$662.00 , N/A ,$428.25 ,$428.25 , N/A ,$397.20 ,$562.70 ,$463.40 , N/A ,$628.90 ,$503.12 ,$496.50 ,$430.30 ,$562.70 , N/A ,$430.30 ,$430.30 ,$463.40 , N/A , N/A , N/A ,$278.04 ,$562.70 , N/A ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$402.96 ,$457.44 ,$595.80 ,$461.08 , N/A ,$522.98 , N/A ,$397.20 ,$397.20 , N/A ,$397.20 ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$529.60 
ST NICHOLAS HOSPITAL - ACUTE,71101072,71101,HC XR RIBS CHEST MIN 3 VIEW-PRV 72 HR,320,1 ,$560.00 ,$280.00 ,$17.98 ,$560.00 ,$17.98 ,$110.76 ,$98.45 ,$107.35 ,$336.00 ,$476.00 ,$392.00 ,$17.98 ,$532.00 ,$425.60 ,$420.00 ,$58.34 ,$476.00 ,$107.35 ,$58.34 ,$26.14 ,$392.00 ,$17.98 ,$107.35 ,$107.35 ,$235.20 ,$476.00 ,$241.53 ,$515.20 ,$392.00 ,$329.30 ,$329.30 ,$341.04 ,$329.30 ,$386.96 ,$504.00 ,$390.04 ,$108.42 ,$442.40 ,$19.06 ,$451.00 ,$451.00 ,$107.35 ,$451.00 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,72000008,59412,HC EXTERNAL CEPHALIC VERSION,720,1 ,"$2,400.00 ","$1,200.00 ",$204.42 ,"$5,820.65 ",$204.42 ,"$1,552.56 ","$1,552.56 ","$2,586.95 ","$1,440.00 ","$2,040.00 ","$1,680.00 ",$204.42 ,"$2,280.00 ","$1,824.00 ","$1,800.00 ","$1,560.00 ","$2,040.00 ","$2,586.95 ","$1,560.00 ","$1,560.00 ","$1,680.00 ",$204.42 ,"$2,586.95 ","$2,586.95 ",$438.99 ,"$2,040.00 ","$5,820.65 ","$2,208.00 ","$1,680.00 ","$1,703.02 ","$2,128.52 ","$1,461.60 ","$2,128.52 ","$1,658.40 ","$2,160.00 ","$1,671.60 ","$2,612.82 ","$1,896.00 ",$216.69 ,"$1,314.00 ","$1,314.00 ","$2,586.95 ","$1,314.00 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,72000009,99464,HC ATTEND HIGH RISK DELIVERY,720,1 ,$299.00 ,$149.50 ,$149.50 ,$299.00 , N/A ,$193.42 ,$193.42 , N/A ,$179.40 ,$254.15 ,$209.30 , N/A ,$284.05 ,$227.24 ,$224.25 ,$194.35 ,$254.15 , N/A ,$194.35 ,$194.35 ,$209.30 , N/A , N/A , N/A ,$299.00 ,$254.15 , N/A ,$275.08 ,$209.30 ,$151.65 ,$182.00 ,$182.09 ,$182.00 ,$206.61 ,$269.10 ,$208.25 , N/A ,$236.21 , N/A ,$299.00 ,$299.00 , N/A ,$299.00 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$239.20 
ST NICHOLAS HOSPITAL - ACUTE,72000024,59410,HC VAGINAL DELIVERY ONLY INCLUDES POSTPARTUM CARE,720,1 ,"$2,620.00 ","$1,310.00 ",$438.99 ,"$5,993.67 ",$681.83 ,"$1,694.88 ","$1,694.88 ", N/A ,"$1,572.00 ","$2,227.00 ","$1,834.00 ",$681.83 ,"$2,489.00 ","$1,991.20 ","$1,965.00 ","$1,703.00 ","$2,227.00 ", N/A ,"$1,703.00 ","$1,703.00 ","$1,834.00 ",$681.83 , N/A , N/A ,$438.99 ,"$2,227.00 ", N/A ,"$2,410.40 ","$1,834.00 ","$4,794.94 ","$5,993.67 ","$1,595.58 ","$5,993.67 ","$1,810.42 ","$2,358.00 ","$1,824.83 ", N/A ,"$2,069.80 ",$722.74 ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ","$1,886.40 ","$1,624.40 ","$1,886.40 ","$1,886.40 ","$2,096.00 "
ST NICHOLAS HOSPITAL - ACUTE,72100001,N/A,HC LABOR LEVEL I PER HOUR,721,1 ,$107.00 ,$53.50 ,$53.50 ,$107.00 , N/A ,$69.22 ,$69.22 , N/A ,$64.20 ,$90.95 ,$74.90 , N/A ,$101.65 ,$81.32 ,$80.25 ,$69.55 ,$90.95 , N/A ,$69.55 ,$69.55 ,$74.90 , N/A , N/A , N/A ,$107.00 ,$90.95 , N/A ,$98.44 ,$74.90 ,$54.27 ,$65.13 ,$65.16 ,$65.13 ,$73.94 ,$96.30 ,$74.53 , N/A ,$84.53 , N/A ,$107.00 ,$107.00 , N/A ,$107.00 ,$77.04 ,$66.34 ,$77.04 ,$77.04 ,$85.60 
ST NICHOLAS HOSPITAL - ACUTE,72100002,N/A,HC LABOR LEVEL II PER HOUR,721,1 ,$160.00 ,$80.00 ,$80.00 ,$160.00 , N/A ,$103.50 ,$103.50 , N/A ,$96.00 ,$136.00 ,$112.00 , N/A ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 , N/A , N/A , N/A ,$160.00 ,$136.00 , N/A ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$111.44 , N/A ,$126.40 , N/A ,$160.00 ,$160.00 , N/A ,$160.00 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,72100003,N/A,HC LABOR LEVEL III PER HOUR,721,1 ,$180.00 ,$90.00 ,$90.00 ,$180.00 , N/A ,$116.44 ,$116.44 , N/A ,$108.00 ,$153.00 ,$126.00 , N/A ,$171.00 ,$136.80 ,$135.00 ,$117.00 ,$153.00 , N/A ,$117.00 ,$117.00 ,$126.00 , N/A , N/A , N/A ,$180.00 ,$153.00 , N/A ,$165.60 ,$126.00 ,$91.30 ,$109.57 ,$109.62 ,$109.57 ,$124.38 ,$162.00 ,$125.37 , N/A ,$142.20 , N/A ,$180.00 ,$180.00 , N/A ,$180.00 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$144.00 
ST NICHOLAS HOSPITAL - ACUTE,72200002,N/A,HC DELIVERY CHARGE LEVEL I,722,1 ,"$2,179.00 ","$1,089.50 ",$438.99 ,"$2,179.00 ", N/A ,"$1,409.60 ","$1,409.60 ", N/A ,"$1,307.40 ","$1,852.15 ","$1,525.30 ", N/A ,"$2,070.05 ","$1,656.04 ","$1,634.25 ","$1,416.35 ","$1,852.15 ", N/A ,"$1,416.35 ","$1,416.35 ","$1,525.30 ", N/A , N/A , N/A ,$438.99 ,"$1,852.15 ", N/A ,"$2,004.68 ","$1,525.30 ","$1,105.19 ","$1,326.36 ","$1,327.01 ","$1,326.36 ","$1,505.69 ","$1,961.10 ","$1,517.67 ", N/A ,"$1,721.41 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ","$1,568.88 ","$1,350.98 ","$1,568.88 ","$1,568.88 ","$1,743.20 "
ST NICHOLAS HOSPITAL - ACUTE,72200003,N/A,HC DELIVERY CHARGE LEVEL II,722,1 ,"$4,095.00 ","$2,047.50 ",$438.99 ,"$4,095.00 ", N/A ,"$2,649.06 ","$2,649.06 ", N/A ,"$2,457.00 ","$3,480.75 ","$2,866.50 ", N/A ,"$3,890.25 ","$3,112.20 ","$3,071.25 ","$2,661.75 ","$3,480.75 ", N/A ,"$2,661.75 ","$2,661.75 ","$2,866.50 ", N/A , N/A , N/A ,$438.99 ,"$3,480.75 ", N/A ,"$3,767.40 ","$2,866.50 ","$2,076.98 ","$2,492.63 ","$2,493.86 ","$2,492.63 ","$2,829.65 ","$3,685.50 ","$2,852.17 ", N/A ,"$3,235.05 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ","$2,948.40 ","$2,538.90 ","$2,948.40 ","$2,948.40 ","$3,276.00 "
ST NICHOLAS HOSPITAL - ACUTE,72200004,N/A,HC DELIVERY CHARGE LEVEL III,722,1 ,"$4,410.00 ","$2,205.00 ",$438.99 ,"$4,410.00 ", N/A ,"$2,852.83 ","$2,852.83 ", N/A ,"$2,646.00 ","$3,748.50 ","$3,087.00 ", N/A ,"$4,189.50 ","$3,351.60 ","$3,307.50 ","$2,866.50 ","$3,748.50 ", N/A ,"$2,866.50 ","$2,866.50 ","$3,087.00 ", N/A , N/A , N/A ,$438.99 ,"$3,748.50 ", N/A ,"$4,057.20 ","$3,087.00 ","$2,236.75 ","$2,684.37 ","$2,685.69 ","$2,684.37 ","$3,047.31 ","$3,969.00 ","$3,071.57 ", N/A ,"$3,483.90 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ","$3,175.20 ","$2,734.20 ","$3,175.20 ","$3,175.20 ","$3,528.00 "
ST NICHOLAS HOSPITAL - ACUTE,72200005,N/A,HC C-SECT INIT 1 HR SINGLE,722,1 ,"$4,410.00 ","$2,205.00 ",$438.99 ,"$4,410.00 ", N/A ,"$2,852.83 ","$2,852.83 ", N/A ,"$2,646.00 ","$3,748.50 ","$3,087.00 ", N/A ,"$4,189.50 ","$3,351.60 ","$3,307.50 ","$2,866.50 ","$3,748.50 ", N/A ,"$2,866.50 ","$2,866.50 ","$3,087.00 ", N/A , N/A , N/A ,$438.99 ,"$3,748.50 ", N/A ,"$4,057.20 ","$3,087.00 ","$2,236.75 ","$2,684.37 ","$2,685.69 ","$2,684.37 ","$3,047.31 ","$3,969.00 ","$3,071.57 ", N/A ,"$3,483.90 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ","$3,175.20 ","$2,734.20 ","$3,175.20 ","$3,175.20 ","$3,528.00 "
ST NICHOLAS HOSPITAL - ACUTE,72200008,N/A,HC C-SECT ADDL 1/2 HR,722,1 ,$441.00 ,$220.50 ,$220.50 ,$441.00 , N/A ,$285.28 ,$285.28 , N/A ,$264.60 ,$374.85 ,$308.70 , N/A ,$418.95 ,$335.16 ,$330.75 ,$286.65 ,$374.85 , N/A ,$286.65 ,$286.65 ,$308.70 , N/A , N/A , N/A ,$438.99 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$268.44 ,$304.73 ,$396.90 ,$307.16 , N/A ,$348.39 , N/A ,$441.00 ,$441.00 , N/A ,$441.00 ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$352.80 
ST NICHOLAS HOSPITAL - ACUTE,72200010,N/A,HC OUTPATIENT DELIVERY LEVEL 1,722,1 ,"$3,675.00 ","$1,837.50 ",$438.99 ,"$3,675.00 ", N/A ,"$2,377.36 ","$2,377.36 ", N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ","$2,388.75 ","$3,123.75 ", N/A ,"$2,388.75 ","$2,388.75 ","$2,572.50 ", N/A , N/A , N/A ,$438.99 ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ","$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,72200011,N/A,HC OUTPATIENT DELIVERY LEVEL 2,722,1 ,"$3,885.00 ","$1,942.50 ",$438.99 ,"$3,885.00 ", N/A ,"$2,513.21 ","$2,513.21 ", N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ","$2,525.25 ","$3,302.25 ", N/A ,"$2,525.25 ","$2,525.25 ","$2,719.50 ", N/A , N/A , N/A ,$438.99 ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ","$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,72200012,N/A,HC OUTPATIENT DELIVERY LEVEL 3,360,1 ,"$4,200.00 ","$2,100.00 ","$2,100.00 ","$4,200.00 ", N/A , N/A , N/A , N/A ,"$2,520.00 ","$3,570.00 ","$2,940.00 ", N/A ,"$3,990.00 ","$3,192.00 ","$3,150.00 ", N/A ,"$3,570.00 ", N/A , N/A , N/A ,"$2,940.00 ", N/A , N/A , N/A , N/A ,"$3,570.00 ", N/A ,"$3,864.00 ","$2,940.00 ","$2,130.24 ","$2,556.54 ","$2,557.80 ","$2,556.54 ","$2,902.20 ","$3,780.00 ","$2,925.30 ", N/A ,"$3,318.00 ", N/A , N/A , N/A , N/A , N/A ,"$3,024.00 ","$2,604.00 ","$3,024.00 ","$3,024.00 ","$3,360.00 "
ST NICHOLAS HOSPITAL - ACUTE,72300001,N/A,HC CIRCUMCISION IP,723,1 ,$99.00 ,$49.50 ,$41.58 ,$99.00 , N/A ,$64.04 ,$64.04 , N/A ,$59.40 ,$84.15 ,$69.30 , N/A ,$94.05 ,$75.24 ,$74.25 ,$64.35 ,$84.15 , N/A ,$64.35 ,$64.35 ,$69.30 , N/A , N/A , N/A ,$41.58 ,$84.15 , N/A ,$91.08 ,$69.30 ,$50.21 ,$60.26 ,$60.29 ,$60.26 ,$68.41 ,$89.10 ,$68.95 , N/A ,$78.21 , N/A ,$59.40 ,$59.40 , N/A ,$59.40 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$79.20 
ST NICHOLAS HOSPITAL - ACUTE,73000002,93005,HC EKG,730,1 ,$202.00 ,$101.00 ,$8.28 ,$202.00 ,$8.28 ,$130.67 ,$130.67 ,$54.89 ,$121.20 ,$171.70 ,$141.40 ,$8.28 ,$191.90 ,$153.52 ,$151.50 ,$131.30 ,$171.70 ,$54.89 ,$131.30 ,$131.30 ,$141.40 ,$8.28 ,$54.89 ,$54.89 ,$140.29 ,$171.70 ,$123.49 ,$185.84 ,$141.40 ,$92.52 ,$92.52 ,$123.02 ,$92.52 ,$139.58 ,$181.80 ,$140.69 ,$55.44 ,$159.58 ,$8.78 ,$142.00 ,$142.00 ,$54.89 ,$142.00 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$161.60 
ST NICHOLAS HOSPITAL - ACUTE,73000003,93041,HC EKG RHYTHM STRIP TRACING,730,1 ,$168.00 ,$84.00 ,$8.28 ,$168.00 ,$8.28 ,$108.68 ,$108.68 ,$54.89 ,$100.80 ,$142.80 ,$117.60 ,$8.28 ,$159.60 ,$127.68 ,$126.00 ,$109.20 ,$142.80 ,$54.89 ,$109.20 ,$109.20 ,$117.60 ,$8.28 ,$54.89 ,$54.89 ,$140.29 ,$142.80 ,$123.49 ,$154.56 ,$117.60 ,$168.00 ,$168.00 ,$102.31 ,$168.00 ,$116.09 ,$151.20 ,$117.01 ,$55.44 ,$132.72 ,$8.78 ,$142.00 ,$142.00 ,$54.89 ,$142.00 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$134.40 
ST NICHOLAS HOSPITAL - ACUTE,73000004,93242,HC EXT ECG >48HR LESS THN EQUAL TO 7D RECORDING,730,1 ,$114.00 ,$57.00 ,$21.45 ,$123.49 ,$21.45 ,$73.75 ,$73.75 ,$54.89 ,$68.40 ,$96.90 ,$79.80 ,$21.45 ,$108.30 ,$86.64 ,$85.50 ,$74.10 ,$96.90 ,$54.89 ,$74.10 ,$74.10 ,$79.80 ,$21.45 ,$54.89 ,$54.89 ,$114.00 ,$96.90 ,$123.49 ,$104.88 ,$79.80 ,$57.82 ,$69.39 ,$69.43 ,$69.39 ,$78.77 ,$102.60 ,$79.40 ,$55.44 ,$90.06 ,$22.74 ,$114.00 ,$114.00 ,$54.89 ,$114.00 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$91.20 
ST NICHOLAS HOSPITAL - ACUTE,73000005,93243,HC EXT ECG >48HR LESS THN EQUAL TO 7D SCAN A/R,730,1 ,$187.00 ,$93.50 ,$21.45 ,$250.16 ,$21.45 ,$120.97 ,$120.97 ,$111.18 ,$112.20 ,$158.95 ,$130.90 ,$21.45 ,$177.65 ,$142.12 ,$140.25 ,$121.55 ,$158.95 ,$111.18 ,$121.55 ,$121.55 ,$130.90 ,$21.45 ,$111.18 ,$111.18 ,$140.29 ,$158.95 ,$250.16 ,$172.04 ,$130.90 ,$94.85 ,$113.83 ,$113.88 ,$113.83 ,$129.22 ,$168.30 ,$130.25 ,$112.29 ,$147.73 ,$22.74 ,$142.00 ,$142.00 ,$111.18 ,$142.00 ,$134.64 ,$115.94 ,$134.64 ,$134.64 ,$149.60 
ST NICHOLAS HOSPITAL - ACUTE,73000006,93246,HC EXT ECG >7D<15D RECORDING,730,1 ,$187.00 ,$93.50 ,$21.45 ,$187.00 ,$21.45 ,$120.97 ,$120.97 ,$54.89 ,$112.20 ,$158.95 ,$130.90 ,$21.45 ,$177.65 ,$142.12 ,$140.25 ,$121.55 ,$158.95 ,$54.89 ,$121.55 ,$121.55 ,$130.90 ,$21.45 ,$54.89 ,$54.89 ,$140.29 ,$158.95 ,$123.49 ,$172.04 ,$130.90 ,$94.85 ,$113.83 ,$113.88 ,$113.83 ,$129.22 ,$168.30 ,$130.25 ,$55.44 ,$147.73 ,$22.74 ,$142.00 ,$142.00 ,$54.89 ,$142.00 ,$134.64 ,$115.94 ,$134.64 ,$134.64 ,$149.60 
ST NICHOLAS HOSPITAL - ACUTE,73000007,93247,HC EXT ECG >7D<15D SCAN A/R,730,1 ,$376.00 ,$188.00 ,$21.45 ,$376.00 ,$21.45 ,$243.23 ,$243.23 ,$111.18 ,$225.60 ,$319.60 ,$263.20 ,$21.45 ,$357.20 ,$285.76 ,$282.00 ,$244.40 ,$319.60 ,$111.18 ,$244.40 ,$244.40 ,$263.20 ,$21.45 ,$111.18 ,$111.18 ,$140.29 ,$319.60 ,$250.16 ,$345.92 ,$263.20 ,$190.71 ,$228.87 ,$228.98 ,$228.87 ,$259.82 ,$338.40 ,$261.88 ,$112.29 ,$297.04 ,$22.74 ,$142.00 ,$142.00 ,$111.18 ,$142.00 ,$270.72 ,$233.12 ,$270.72 ,$270.72 ,$300.80 
ST NICHOLAS HOSPITAL - ACUTE,73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$493.00 ,$246.50 ,$21.45 ,$493.00 ,$21.45 ,$318.92 ,$318.92 ,$111.18 ,$295.80 ,$419.05 ,$345.10 ,$21.45 ,$468.35 ,$374.68 ,$369.75 ,$320.45 ,$419.05 ,$111.18 ,$320.45 ,$320.45 ,$345.10 ,$21.45 ,$111.18 ,$111.18 ,$211.57 ,$419.05 ,$250.16 ,$453.56 ,$345.10 ,$250.05 ,$300.09 ,$300.24 ,$300.09 ,$340.66 ,$443.70 ,$343.37 ,$112.29 ,$389.47 ,$22.74 ,$493.00 ,$493.00 ,$111.18 ,$493.00 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$394.40 
ST NICHOLAS HOSPITAL - ACUTE,73100001,93226,HC HOLTER SCAN  AND  REPORT 24 HR,731,1 ,$627.00 ,$313.50 ,$21.45 ,$627.00 ,$21.45 ,$405.61 ,$405.61 ,$111.18 ,$376.20 ,$532.95 ,$438.90 ,$21.45 ,$595.65 ,$476.52 ,$470.25 ,$407.55 ,$532.95 ,$111.18 ,$407.55 ,$407.55 ,$438.90 ,$21.45 ,$111.18 ,$111.18 ,$211.57 ,$532.95 ,$250.16 ,$576.84 ,$438.90 ,$318.01 ,$381.65 ,$381.84 ,$381.65 ,$433.26 ,$564.30 ,$436.71 ,$112.29 ,$495.33 ,$22.74 ,$539.00 ,$539.00 ,$111.18 ,$539.00 ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$501.60 
ST NICHOLAS HOSPITAL - ACUTE,73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,$717.00 ,$358.50 ,$21.45 ,$717.00 ,$21.45 ,$463.83 ,$463.83 ,$111.18 ,$430.20 ,$609.45 ,$501.90 ,$21.45 ,$681.15 ,$544.92 ,$537.75 ,$466.05 ,$609.45 ,$111.18 ,$466.05 ,$466.05 ,$501.90 ,$21.45 ,$111.18 ,$111.18 ,$211.57 ,$609.45 ,$250.16 ,$659.64 ,$501.90 ,$363.66 ,$436.44 ,$436.65 ,$436.44 ,$495.45 ,$645.30 ,$499.39 ,$112.29 ,$566.43 ,$22.74 ,$539.00 ,$539.00 ,$111.18 ,$539.00 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$573.60 
ST NICHOLAS HOSPITAL - ACUTE,73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$280.00 ,$140.00 ,$21.45 ,$280.00 ,$21.45 ,$181.13 ,$181.13 ,$36.72 ,$168.00 ,$238.00 ,$196.00 ,$21.45 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$36.72 ,$182.00 ,$182.00 ,$196.00 ,$21.45 ,$36.72 ,$36.72 ,$211.57 ,$238.00 ,$82.61 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$170.44 ,$193.48 ,$252.00 ,$195.02 ,$37.09 ,$221.20 ,$22.74 ,$280.00 ,$280.00 ,$36.72 ,$280.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,73100006,0296T,HC HOLTER MONITOR RECORDING EXTENDED >48HRS <21DAYS,731,1 ,$627.00 ,$313.50 ,$211.57 ,$627.00 , N/A ,$405.61 ,$405.61 , N/A ,$376.20 ,$532.95 ,$438.90 , N/A ,$595.65 ,$476.52 ,$470.25 ,$407.55 ,$532.95 , N/A ,$407.55 ,$407.55 ,$438.90 , N/A , N/A , N/A ,$211.57 ,$532.95 , N/A ,$576.84 ,$438.90 ,$318.01 ,$381.65 ,$381.84 ,$381.65 ,$433.26 ,$564.30 ,$436.71 , N/A ,$495.33 , N/A ,$539.00 ,$539.00 , N/A ,$539.00 ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$501.60 
ST NICHOLAS HOSPITAL - ACUTE,73100007,0297T,HC HOLTER MONITOR SCAN  AND  REPORT EXTENDED >48HRS <21DAYS,731,1 ,$717.00 ,$358.50 ,$211.57 ,$717.00 , N/A ,$463.83 ,$463.83 , N/A ,$430.20 ,$609.45 ,$501.90 , N/A ,$681.15 ,$544.92 ,$537.75 ,$466.05 ,$609.45 , N/A ,$466.05 ,$466.05 ,$501.90 , N/A , N/A , N/A ,$211.57 ,$609.45 , N/A ,$659.64 ,$501.90 ,$363.66 ,$436.44 ,$436.65 ,$436.44 ,$495.45 ,$645.30 ,$499.39 , N/A ,$566.43 , N/A ,$539.00 ,$539.00 , N/A ,$539.00 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$573.60 
ST NICHOLAS HOSPITAL - ACUTE,73660072,73660,HC XRAY TOE MIN 2 VIEW-PRV 72 HR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$95.24 ,$84.65 ,$79.76 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$281.20 ,$277.50 ,$44.98 ,$314.50 ,$79.76 ,$44.98 ,$20.32 ,$259.00 ,$17.98 ,$79.76 ,$79.76 ,$155.40 ,$314.50 ,$179.45 ,$340.40 ,$259.00 ,$207.78 ,$207.78 ,$225.33 ,$207.78 ,$255.67 ,$333.00 ,$257.71 ,$80.56 ,$292.30 ,$19.06 ,$370.00 ,$370.00 ,$79.76 ,$370.00 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$296.00 
ST NICHOLAS HOSPITAL - ACUTE,74000001,95803,HC ACTIGRAPHY TESTING 72HR TO 14 DAYS,740,1 ,$600.00 ,$300.00 ,$21.45 ,$600.00 ,$21.45 ,$600.00 ,$600.00 ,$54.89 ,$360.00 ,$510.00 ,$420.00 ,$21.45 ,$570.00 ,$456.00 ,$450.00 ,$390.00 ,$510.00 ,$54.89 ,$390.00 ,$390.00 ,$420.00 ,$21.45 ,$54.89 ,$54.89 ,$600.00 ,$510.00 ,$123.49 ,$552.00 ,$420.00 ,$304.32 ,$365.22 ,$365.40 ,$365.22 ,$414.60 ,$540.00 ,$417.90 ,$55.44 ,$474.00 ,$22.74 ,$452.00 ,$452.00 ,$54.89 ,$452.00 ,$432.00 ,$372.00 ,$432.00 ,$432.00 ,$480.00 
ST NICHOLAS HOSPITAL - ACUTE,74000002,95805,HC MULTIPLE SLEEP LATENCY,740,1 ,"$3,600.00 ","$1,800.00 ",$239.33 ,"$3,600.00 ",$239.33 ,"$3,183.00 ","$2,705.00 ",$481.30 ,"$2,160.00 ","$3,060.00 ","$2,520.00 ",$239.33 ,"$3,420.00 ","$2,736.00 ","$2,700.00 ","$2,340.00 ","$3,060.00 ",$481.30 ,"$2,340.00 ","$2,340.00 ","$2,520.00 ",$239.33 ,$481.30 ,$481.30 ,"$2,262.82 ","$3,060.00 ","$1,082.93 ","$3,312.00 ","$2,520.00 ","$1,825.92 ","$2,191.32 ","$2,192.40 ","$2,191.32 ","$2,487.60 ","$3,240.00 ","$2,507.40 ",$486.11 ,"$2,844.00 ",$253.69 ,"$3,585.00 ","$3,585.00 ",$481.30 ,"$3,585.00 ","$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,880.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000006,95810,HC SLEEP STUDY,740,1 ,"$4,600.00 ","$2,300.00 ",$239.33 ,"$4,600.00 ",$239.33 ,"$3,183.00 ","$2,705.00 ",$453.57 ,"$2,760.00 ","$3,910.00 ","$3,220.00 ",$239.33 ,"$4,370.00 ","$3,496.00 ","$3,450.00 ","$2,990.00 ","$3,910.00 ",$453.57 ,"$2,990.00 ","$2,990.00 ","$3,220.00 ",$239.33 ,$453.57 ,$453.57 ,"$2,262.82 ","$3,910.00 ","$1,020.53 ","$4,232.00 ","$3,220.00 ","$2,333.12 ","$2,800.02 ","$2,801.40 ","$2,800.02 ","$3,178.60 ","$4,140.00 ","$3,203.90 ",$458.11 ,"$3,634.00 ",$253.69 ,"$3,585.00 ","$3,585.00 ",$453.57 ,"$3,585.00 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$3,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000006,95810,HC SLEEP STUDY,740,1 ,"$4,600.00 ","$2,300.00 ",$239.33 ,"$4,600.00 ",$239.33 ,"$3,183.00 ","$2,705.00 ",$453.57 ,"$2,760.00 ","$3,910.00 ","$3,220.00 ",$239.33 ,"$4,370.00 ","$3,496.00 ","$3,450.00 ","$2,990.00 ","$3,910.00 ",$453.57 ,"$2,990.00 ","$2,990.00 ","$3,220.00 ",$239.33 ,$453.57 ,$453.57 ,"$2,262.82 ","$3,910.00 ","$1,020.53 ","$4,232.00 ","$3,220.00 ","$2,333.12 ","$2,800.02 ","$2,801.40 ","$2,800.02 ","$3,178.60 ","$4,140.00 ","$3,203.90 ",$458.11 ,"$3,634.00 ",$253.69 ,"$3,585.00 ","$3,585.00 ",$453.57 ,"$3,585.00 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$3,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000008,95810,HC SLEEP STUDY ONE ON ONE,740,1 ,"$4,900.00 ","$2,450.00 ",$239.33 ,"$4,900.00 ",$239.33 ,"$3,183.00 ","$2,705.00 ",$907.14 ,"$2,940.00 ","$4,165.00 ","$3,430.00 ",$239.33 ,"$4,655.00 ","$3,724.00 ","$3,675.00 ","$3,185.00 ","$4,165.00 ",$907.14 ,"$3,185.00 ","$3,185.00 ","$3,430.00 ",$239.33 ,$907.14 ,$907.14 ,"$2,262.82 ","$4,165.00 ","$2,041.06 ","$4,508.00 ","$3,430.00 ","$2,485.28 ","$2,982.63 ","$2,984.10 ","$2,982.63 ","$3,385.90 ","$4,410.00 ","$3,412.85 ",$916.21 ,"$3,871.00 ",$253.69 ,"$3,585.00 ","$3,585.00 ",$907.14 ,"$3,585.00 ","$3,528.00 ","$3,038.00 ","$3,528.00 ","$3,528.00 ","$3,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$4,900.00 ","$2,450.00 ",$239.33 ,"$4,900.00 ",$239.33 ,"$3,183.00 ","$2,705.00 ",$907.14 ,"$2,940.00 ","$4,165.00 ","$3,430.00 ",$239.33 ,"$4,655.00 ","$3,724.00 ","$3,675.00 ","$3,185.00 ","$4,165.00 ",$907.14 ,"$3,185.00 ","$3,185.00 ","$3,430.00 ",$239.33 ,$907.14 ,$907.14 ,"$2,262.82 ","$4,165.00 ","$2,041.06 ","$4,508.00 ","$3,430.00 ","$2,485.28 ","$2,982.63 ","$2,984.10 ","$2,982.63 ","$3,385.90 ","$4,410.00 ","$3,412.85 ",$916.21 ,"$3,871.00 ",$253.69 ,"$3,585.00 ","$3,585.00 ",$907.14 ,"$3,585.00 ","$3,528.00 ","$3,038.00 ","$3,528.00 ","$3,528.00 ","$3,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$4,900.00 ","$2,450.00 ",$239.33 ,"$4,900.00 ",$239.33 ,"$3,183.00 ","$2,705.00 ",$907.14 ,"$2,940.00 ","$4,165.00 ","$3,430.00 ",$239.33 ,"$4,655.00 ","$3,724.00 ","$3,675.00 ","$3,185.00 ","$4,165.00 ",$907.14 ,"$3,185.00 ","$3,185.00 ","$3,430.00 ",$239.33 ,$907.14 ,$907.14 ,"$2,262.82 ","$4,165.00 ","$2,041.06 ","$4,508.00 ","$3,430.00 ","$2,485.28 ","$2,982.63 ","$2,984.10 ","$2,982.63 ","$3,385.90 ","$4,410.00 ","$3,412.85 ",$916.21 ,"$3,871.00 ",$253.69 ,"$3,585.00 ","$3,585.00 ",$907.14 ,"$3,585.00 ","$3,528.00 ","$3,038.00 ","$3,528.00 ","$3,528.00 ","$3,920.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000012,95812,HC EEG MONITOR 41-60 MIN,740,1 ,$963.00 ,$481.50 ,$159.10 ,$963.00 ,$159.10 ,$622.96 ,$622.96 ,$260.95 ,$577.80 ,$818.55 ,$674.10 ,$159.10 ,$914.85 ,$731.88 ,$722.25 ,$625.95 ,$818.55 ,$260.95 ,$625.95 ,$625.95 ,$674.10 ,$159.10 ,$260.95 ,$260.95 ,$404.46 ,$818.55 ,$587.13 ,$885.96 ,$674.10 ,$488.43 ,$586.18 ,$586.47 ,$586.18 ,$665.43 ,$866.70 ,$670.73 ,$263.56 ,$760.77 ,$168.65 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,$693.36 ,$597.06 ,$693.36 ,$693.36 ,$770.40 
ST NICHOLAS HOSPITAL - ACUTE,74000013,95813,HC EEG MONITOR > 1 HR,740,1 ,"$1,680.00 ",$840.00 ,$159.10 ,"$1,680.00 ",$159.10 ,"$1,086.79 ","$1,086.79 ",$260.95 ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$159.10 ,"$1,596.00 ","$1,276.80 ","$1,260.00 ","$1,092.00 ","$1,428.00 ",$260.95 ,"$1,092.00 ","$1,092.00 ","$1,176.00 ",$159.10 ,$260.95 ,$260.95 ,$705.60 ,"$1,428.00 ",$587.13 ,"$1,545.60 ","$1,176.00 ",$852.10 ,"$1,022.62 ","$1,023.12 ","$1,022.62 ","$1,160.88 ","$1,512.00 ","$1,170.12 ",$263.56 ,"$1,327.20 ",$168.65 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000014,95816,HC EEG AWAKE/DROWSY,740,1 ,$851.00 ,$425.50 ,$100.32 ,$851.00 ,$100.32 ,$550.51 ,$550.51 ,$260.95 ,$510.60 ,$723.35 ,$595.70 ,$100.32 ,$808.45 ,$646.76 ,$638.25 ,$553.15 ,$723.35 ,$260.95 ,$553.15 ,$553.15 ,$595.70 ,$100.32 ,$260.95 ,$260.95 ,$357.42 ,$723.35 ,$587.13 ,$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$518.00 ,$588.04 ,$765.90 ,$592.72 ,$263.56 ,$672.29 ,$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$680.80 
ST NICHOLAS HOSPITAL - ACUTE,74000016,95819,HC EEG AWAKE/ASLEEP,740,1 ,"$1,680.00 ",$840.00 ,$100.32 ,"$1,680.00 ",$100.32 ,"$1,086.79 ","$1,086.79 ",$260.95 ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$100.32 ,"$1,596.00 ","$1,276.80 ","$1,260.00 ","$1,092.00 ","$1,428.00 ",$260.95 ,"$1,092.00 ","$1,092.00 ","$1,176.00 ",$100.32 ,$260.95 ,$260.95 ,$705.60 ,"$1,428.00 ",$587.13 ,"$1,545.60 ","$1,176.00 ",$852.10 ,"$1,022.62 ","$1,023.12 ","$1,022.62 ","$1,160.88 ","$1,512.00 ","$1,170.12 ",$263.56 ,"$1,327.20 ",$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000020,95824,HC EEG CEREBRAL DEATH EVAL,740,1 ,"$1,075.00 ",$537.50 ,$100.32 ,"$1,082.93 ",$100.32 ,$695.42 ,$695.42 ,$481.30 ,$645.00 ,$913.75 ,$752.50 ,$100.32 ,"$1,021.25 ",$817.00 ,$806.25 ,$698.75 ,$913.75 ,$481.30 ,$698.75 ,$698.75 ,$752.50 ,$100.32 ,$481.30 ,$481.30 ,$451.50 ,$913.75 ,"$1,082.93 ",$989.00 ,$752.50 ,$545.24 ,$654.35 ,$654.68 ,$654.35 ,$742.83 ,$967.50 ,$748.74 ,$486.11 ,$849.25 ,$106.34 ,$452.00 ,$452.00 ,$481.30 ,$452.00 ,$774.00 ,$666.50 ,$774.00 ,$774.00 ,$860.00 
ST NICHOLAS HOSPITAL - ACUTE,74000032,95957,HC EEG DIGITAL ANLYS,740,1 ,$661.00 ,$330.50 ,$12.10 ,$661.00 ,$12.10 ,$427.60 ,$427.60 , N/A ,$396.60 ,$561.85 ,$462.70 ,$12.10 ,$627.95 ,$502.36 ,$495.75 ,$429.65 ,$561.85 , N/A ,$429.65 ,$429.65 ,$462.70 ,$12.10 , N/A , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$335.26 ,$402.35 ,$402.55 ,$402.35 ,$456.75 ,$594.90 ,$460.39 , N/A ,$522.19 ,$12.83 ,$452.00 ,$452.00 , N/A ,$452.00 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$528.80 
ST NICHOLAS HOSPITAL - ACUTE,74000033,95939,HC TCMEP UPPER AND LOWER,740,1 ,$784.00 ,$392.00 ,$42.84 ,"$2,041.06 ",$42.84 ,$507.17 ,$507.17 ,$907.14 ,$470.40 ,$666.40 ,$548.80 ,$42.84 ,$744.80 ,$595.84 ,$588.00 ,$509.60 ,$666.40 ,$907.14 ,$509.60 ,$509.60 ,$548.80 ,$42.84 ,$907.14 ,$907.14 ,$329.28 ,$666.40 ,"$2,041.06 ",$721.28 ,$548.80 ,$397.64 ,$477.22 ,$477.46 ,$477.22 ,$541.74 ,$705.60 ,$546.06 ,$916.21 ,$619.36 ,$45.41 ,$452.00 ,$452.00 ,$907.14 ,$452.00 ,$564.48 ,$486.08 ,$564.48 ,$564.48 ,$627.20 
ST NICHOLAS HOSPITAL - ACUTE,74000035,G0399,HC SLEEP STUDY HOME ADULT,740,1 ,$638.00 ,$319.00 ,$44.39 ,$638.00 ,$44.39 ,$638.00 ,$638.00 ,$137.66 ,$382.80 ,$542.30 ,$446.60 ,$44.39 ,$606.10 ,$484.88 ,$478.50 ,$414.70 ,$542.30 ,$137.66 ,$414.70 ,$414.70 ,$446.60 ,$44.39 ,$137.66 ,$137.66 ,$509.13 ,$542.30 ,$309.74 ,$586.96 ,$446.60 ,$323.59 ,$388.35 ,$388.54 ,$388.35 ,$440.86 ,$574.20 ,$444.37 ,$139.04 ,$504.02 ,$47.05 ,$638.00 ,$638.00 ,$137.66 ,$638.00 ,$459.36 ,$395.56 ,$459.36 ,$459.36 ,$510.40 
ST NICHOLAS HOSPITAL - ACUTE,74000043,95940,HC NEURO TEST INTRAOPER PER 15MIN,740,1 ,$246.00 ,$123.00 ,$103.32 ,$246.00 , N/A ,$159.14 ,$159.14 , N/A ,$147.60 ,$209.10 ,$172.20 , N/A ,$233.70 ,$186.96 ,$184.50 ,$159.90 ,$209.10 , N/A ,$159.90 ,$159.90 ,$172.20 , N/A , N/A , N/A ,$103.32 ,$209.10 , N/A ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$149.74 ,$169.99 ,$221.40 ,$171.34 , N/A ,$194.34 , N/A ,$246.00 ,$246.00 , N/A ,$246.00 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$196.80 
ST NICHOLAS HOSPITAL - ACUTE,74000082,95700,HC EEG CONT RECORDING W/VIDEO ADMIN TECH MINIMUM 8 CHANNELS,740,1 ,"$3,136.00 ","$1,568.00 ",$100.32 ,"$3,136.00 ",$100.32 ,"$2,028.68 ","$2,028.68 ",$260.95 ,"$1,881.60 ","$2,665.60 ","$2,195.20 ",$100.32 ,"$2,979.20 ","$2,383.36 ","$2,352.00 ","$2,038.40 ","$2,665.60 ",$260.95 ,"$2,038.40 ","$2,038.40 ","$2,195.20 ",$100.32 ,$260.95 ,$260.95 ,"$1,317.12 ","$2,665.60 ",$587.13 ,"$2,885.12 ","$2,195.20 ","$1,590.58 ","$1,908.88 ","$1,909.82 ","$1,908.88 ","$2,166.98 ","$2,822.40 ","$2,184.22 ",$263.56 ,"$2,477.44 ",$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$2,257.92 ","$1,944.32 ","$2,257.92 ","$2,257.92 ","$2,508.80 "
ST NICHOLAS HOSPITAL - ACUTE,74000083,95705,HC EEG W/O VIDEO BY TECH 2-12 HOURS UNMONITORED,740,1 ,"$3,024.00 ","$1,512.00 ",$100.32 ,"$3,024.00 ",$100.32 ,"$1,956.23 ","$1,956.23 ",$260.95 ,"$1,814.40 ","$2,570.40 ","$2,116.80 ",$100.32 ,"$2,872.80 ","$2,298.24 ","$2,268.00 ","$1,965.60 ","$2,570.40 ",$260.95 ,"$1,965.60 ","$1,965.60 ","$2,116.80 ",$100.32 ,$260.95 ,$260.95 ,"$1,270.08 ","$2,570.40 ",$587.13 ,"$2,782.08 ","$2,116.80 ","$1,533.77 ","$1,840.71 ","$1,841.62 ","$1,840.71 ","$2,089.58 ","$2,721.60 ","$2,106.22 ",$263.56 ,"$2,388.96 ",$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$2,177.28 ","$1,874.88 ","$2,177.28 ","$2,177.28 ","$2,419.20 "
ST NICHOLAS HOSPITAL - ACUTE,74000084,95706,HC EEG W/O VIDEO BY TECH 2-12 HOURS W/INTERMITTENT MONITORING,740,1 ,"$3,360.00 ","$1,680.00 ",$100.32 ,"$3,360.00 ",$100.32 ,"$2,173.58 ","$2,173.58 ",$260.95 ,"$2,016.00 ","$2,856.00 ","$2,352.00 ",$100.32 ,"$3,192.00 ","$2,553.60 ","$2,520.00 ","$2,184.00 ","$2,856.00 ",$260.95 ,"$2,184.00 ","$2,184.00 ","$2,352.00 ",$100.32 ,$260.95 ,$260.95 ,"$1,411.20 ","$2,856.00 ",$587.13 ,"$3,091.20 ","$2,352.00 ","$1,704.19 ","$2,045.23 ","$2,046.24 ","$2,045.23 ","$2,321.76 ","$3,024.00 ","$2,340.24 ",$263.56 ,"$2,654.40 ",$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000085,95707,HC EEG W/O VIDEO BY TECH 2-12 HOURS W/CONTINUOUS REAL-TIME MONITORING,740,1 ,"$3,920.00 ","$1,960.00 ",$100.32 ,"$3,920.00 ",$100.32 ,"$2,535.85 ","$2,535.85 ",$260.95 ,"$2,352.00 ","$3,332.00 ","$2,744.00 ",$100.32 ,"$3,724.00 ","$2,979.20 ","$2,940.00 ","$2,548.00 ","$3,332.00 ",$260.95 ,"$2,548.00 ","$2,548.00 ","$2,744.00 ",$100.32 ,$260.95 ,$260.95 ,"$1,646.40 ","$3,332.00 ",$587.13 ,"$3,606.40 ","$2,744.00 ","$1,988.22 ","$2,386.10 ","$2,387.28 ","$2,386.10 ","$2,708.72 ","$3,528.00 ","$2,730.28 ",$263.56 ,"$3,096.80 ",$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$2,822.40 ","$2,430.40 ","$2,822.40 ","$2,822.40 ","$3,136.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000086,95708,HC EEG W/O VIDEO BY TECH 12-26 HOURS EACH INCREMENT UNMONITORED,740,1 ,"$5,600.00 ","$2,800.00 ",$159.10 ,"$5,600.00 ",$159.10 ,"$3,622.64 ","$3,622.64 ",$481.30 ,"$3,360.00 ","$4,760.00 ","$3,920.00 ",$159.10 ,"$5,320.00 ","$4,256.00 ","$4,200.00 ","$3,640.00 ","$4,760.00 ",$481.30 ,"$3,640.00 ","$3,640.00 ","$3,920.00 ",$159.10 ,$481.30 ,$481.30 ,"$2,352.00 ","$4,760.00 ","$1,082.93 ","$5,152.00 ","$3,920.00 ","$2,840.32 ","$3,408.72 ","$3,410.40 ","$3,408.72 ","$3,869.60 ","$5,040.00 ","$3,900.40 ",$486.11 ,"$4,424.00 ",$168.65 ,$452.00 ,$452.00 ,$481.30 ,$452.00 ,"$4,032.00 ","$3,472.00 ","$4,032.00 ","$4,032.00 ","$4,480.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000087,95709,HC EEG W/O VIDEO BY TECH 12-26 HOURS EACH INCREMENT W/INTERMITTENT MONITORING,740,1 ,"$5,936.00 ","$2,968.00 ",$159.10 ,"$5,936.00 ",$159.10 ,"$3,840.00 ","$3,840.00 ",$481.30 ,"$3,561.60 ","$5,045.60 ","$4,155.20 ",$159.10 ,"$5,639.20 ","$4,511.36 ","$4,452.00 ","$3,858.40 ","$5,045.60 ",$481.30 ,"$3,858.40 ","$3,858.40 ","$4,155.20 ",$159.10 ,$481.30 ,$481.30 ,"$2,493.12 ","$5,045.60 ","$1,082.93 ","$5,461.12 ","$4,155.20 ","$3,010.74 ","$3,613.24 ","$3,615.02 ","$3,613.24 ","$4,101.78 ","$5,342.40 ","$4,134.42 ",$486.11 ,"$4,689.44 ",$168.65 ,$452.00 ,$452.00 ,$481.30 ,$452.00 ,"$4,273.92 ","$3,680.32 ","$4,273.92 ","$4,273.92 ","$4,748.80 "
ST NICHOLAS HOSPITAL - ACUTE,74000089,95711,HC VEEG W/VIDEO BY TECH 2-12 HOURS UNMONITORED,740,1 ,"$3,024.00 ","$1,512.00 ",$100.32 ,"$3,024.00 ",$100.32 ,"$1,956.23 ","$1,956.23 ",$260.95 ,"$1,814.40 ","$2,570.40 ","$2,116.80 ",$100.32 ,"$2,872.80 ","$2,298.24 ","$2,268.00 ","$1,965.60 ","$2,570.40 ",$260.95 ,"$1,965.60 ","$1,965.60 ","$2,116.80 ",$100.32 ,$260.95 ,$260.95 ,"$1,270.08 ","$2,570.40 ",$587.13 ,"$2,782.08 ","$2,116.80 ","$1,533.77 ","$1,840.71 ","$1,841.62 ","$1,840.71 ","$2,089.58 ","$2,721.60 ","$2,106.22 ",$263.56 ,"$2,388.96 ",$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$2,177.28 ","$1,874.88 ","$2,177.28 ","$2,177.28 ","$2,419.20 "
ST NICHOLAS HOSPITAL - ACUTE,74000090,95712,HC VEEG W/VIDEO BY TECH 2-12 HOURS W/INTERMITTENT MONITORING,740,1 ,"$3,360.00 ","$1,680.00 ",$100.32 ,"$3,360.00 ",$100.32 ,"$2,173.58 ","$2,173.58 ",$260.95 ,"$2,016.00 ","$2,856.00 ","$2,352.00 ",$100.32 ,"$3,192.00 ","$2,553.60 ","$2,520.00 ","$2,184.00 ","$2,856.00 ",$260.95 ,"$2,184.00 ","$2,184.00 ","$2,352.00 ",$100.32 ,$260.95 ,$260.95 ,"$1,411.20 ","$2,856.00 ",$587.13 ,"$3,091.20 ","$2,352.00 ","$1,704.19 ","$2,045.23 ","$2,046.24 ","$2,045.23 ","$2,321.76 ","$3,024.00 ","$2,340.24 ",$263.56 ,"$2,654.40 ",$106.34 ,$452.00 ,$452.00 ,$260.95 ,$452.00 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000091,95713,HC VEEG W/VIDEO BY TECH 2-12 HOURS W/CONTINUOUS REAL-TIME MONITORING,740,1 ,"$3,920.00 ","$1,960.00 ",$100.32 ,"$3,920.00 ",$100.32 ,"$2,535.85 ","$2,535.85 ",$481.30 ,"$2,352.00 ","$3,332.00 ","$2,744.00 ",$100.32 ,"$3,724.00 ","$2,979.20 ","$2,940.00 ","$2,548.00 ","$3,332.00 ",$481.30 ,"$2,548.00 ","$2,548.00 ","$2,744.00 ",$100.32 ,$481.30 ,$481.30 ,"$1,646.40 ","$3,332.00 ","$1,082.93 ","$3,606.40 ","$2,744.00 ","$1,988.22 ","$2,386.10 ","$2,387.28 ","$2,386.10 ","$2,708.72 ","$3,528.00 ","$2,730.28 ",$486.11 ,"$3,096.80 ",$106.34 ,$452.00 ,$452.00 ,$481.30 ,$452.00 ,"$2,822.40 ","$2,430.40 ","$2,822.40 ","$2,822.40 ","$3,136.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000092,95714,HC VEEG W/VIDEO BY TECH 12-26 HOURS EACH INCREMENT UNMONITORED,740,1 ,"$5,600.00 ","$2,800.00 ",$159.10 ,"$5,600.00 ",$159.10 ,"$3,622.64 ","$3,622.64 ",$481.30 ,"$3,360.00 ","$4,760.00 ","$3,920.00 ",$159.10 ,"$5,320.00 ","$4,256.00 ","$4,200.00 ","$3,640.00 ","$4,760.00 ",$481.30 ,"$3,640.00 ","$3,640.00 ","$3,920.00 ",$159.10 ,$481.30 ,$481.30 ,"$2,352.00 ","$4,760.00 ","$1,082.93 ","$5,152.00 ","$3,920.00 ","$2,840.32 ","$3,408.72 ","$3,410.40 ","$3,408.72 ","$3,869.60 ","$5,040.00 ","$3,900.40 ",$486.11 ,"$4,424.00 ",$168.65 ,$452.00 ,$452.00 ,$481.30 ,$452.00 ,"$4,032.00 ","$3,472.00 ","$4,032.00 ","$4,032.00 ","$4,480.00 "
ST NICHOLAS HOSPITAL - ACUTE,74000093,95715,HC VEEG W/VIDEO BY TECH 12-26 HOURS EACH INCREMENT W/INTERMITTENT MONITORING,740,1 ,"$5,936.00 ","$2,968.00 ",$159.10 ,"$5,936.00 ",$159.10 ,"$3,840.00 ","$3,840.00 ",$481.30 ,"$3,561.60 ","$5,045.60 ","$4,155.20 ",$159.10 ,"$5,639.20 ","$4,511.36 ","$4,452.00 ","$3,858.40 ","$5,045.60 ",$481.30 ,"$3,858.40 ","$3,858.40 ","$4,155.20 ",$159.10 ,$481.30 ,$481.30 ,"$2,493.12 ","$5,045.60 ","$1,082.93 ","$5,461.12 ","$4,155.20 ","$3,010.74 ","$3,613.24 ","$3,615.02 ","$3,613.24 ","$4,101.78 ","$5,342.40 ","$4,134.42 ",$486.11 ,"$4,689.44 ",$168.65 ,$452.00 ,$452.00 ,$481.30 ,$452.00 ,"$4,273.92 ","$3,680.32 ","$4,273.92 ","$4,273.92 ","$4,748.80 "
ST NICHOLAS HOSPITAL - ACUTE,74000095,95800,HC SLP STDY UNATTENDED,740,1 ,$419.00 ,$209.50 ,$44.39 ,$419.00 ,$44.39 ,$419.00 ,$419.00 ,$137.66 ,$251.40 ,$356.15 ,$293.30 ,$44.39 ,$398.05 ,$318.44 ,$314.25 ,$272.35 ,$356.15 ,$137.66 ,$272.35 ,$272.35 ,$293.30 ,$44.39 ,$137.66 ,$137.66 ,$419.00 ,$356.15 ,$309.74 ,$385.48 ,$293.30 ,$212.52 ,$255.05 ,$255.17 ,$255.05 ,$289.53 ,$377.10 ,$291.83 ,$139.04 ,$331.01 ,$47.05 ,$419.00 ,$419.00 ,$137.66 ,$419.00 ,$301.68 ,$259.78 ,$301.68 ,$301.68 ,$335.20 
ST NICHOLAS HOSPITAL - ACUTE,75000001,N/A,HC COLONOSCOPY,750,1 ,"$3,465.00 ","$1,732.50 ","$1,732.50 ","$3,465.00 ", N/A , N/A , N/A , N/A ,"$2,079.00 ","$2,945.25 ","$2,425.50 ", N/A ,"$3,291.75 ","$2,633.40 ","$2,598.75 ", N/A ,"$2,945.25 ", N/A , N/A , N/A ,"$2,425.50 ", N/A , N/A , N/A , N/A ,"$2,945.25 ", N/A ,"$3,187.80 ","$2,425.50 ","$1,757.45 ","$2,109.15 ","$2,110.19 ","$2,109.15 ","$2,394.32 ","$3,118.50 ","$2,413.37 ", N/A ,"$2,737.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000002,N/A,HC COLONOSCOPY W/BX,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000003,N/A,HC COLONOSCOPY W/ SNARE,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000004,N/A,HC COLONOSCOPY W HOT BX,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000005,N/A,HC COLONOSCOPY W/CONTROL BLEEDING OR ERBE,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000007,N/A,HC COLONOSCOPY W/ REMOVAL FB,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000008,N/A,HC COLONOSCOPY W/ BALLOON DILATION,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000009,N/A,HC COLONOSCOPY/DECOMP,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000010,N/A,HC COLONOSCOPY W/STENT,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000011,N/A,HC COLONOSCOPY W/ SUBMUCOSAL INJ,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000013,N/A,HC CAPSULE ENDOSCOPY,750,1 ,"$3,045.00 ","$1,522.50 ","$1,522.50 ","$3,045.00 ", N/A , N/A , N/A , N/A ,"$1,827.00 ","$2,588.25 ","$2,131.50 ", N/A ,"$2,892.75 ","$2,314.20 ","$2,283.75 ", N/A ,"$2,588.25 ", N/A , N/A , N/A ,"$2,131.50 ", N/A , N/A , N/A , N/A ,"$2,588.25 ", N/A ,"$2,801.40 ","$2,131.50 ","$1,544.42 ","$1,853.49 ","$1,854.41 ","$1,853.49 ","$2,104.10 ","$2,740.50 ","$2,120.84 ", N/A ,"$2,405.55 ", N/A , N/A , N/A , N/A , N/A ,"$2,192.40 ","$1,887.90 ","$2,192.40 ","$2,192.40 ","$2,436.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000014,N/A,HC EGD,750,1 ,"$3,255.00 ","$1,627.50 ","$1,627.50 ","$3,255.00 ", N/A , N/A , N/A , N/A ,"$1,953.00 ","$2,766.75 ","$2,278.50 ", N/A ,"$3,092.25 ","$2,473.80 ","$2,441.25 ", N/A ,"$2,766.75 ", N/A , N/A , N/A ,"$2,278.50 ", N/A , N/A , N/A , N/A ,"$2,766.75 ", N/A ,"$2,994.60 ","$2,278.50 ","$1,650.94 ","$1,981.32 ","$1,982.30 ","$1,981.32 ","$2,249.21 ","$2,929.50 ","$2,267.11 ", N/A ,"$2,571.45 ", N/A , N/A , N/A , N/A , N/A ,"$2,343.60 ","$2,018.10 ","$2,343.60 ","$2,343.60 ","$2,604.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000015,N/A,HC EGD/BIOPSY,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000016,N/A,HC EGD/ERBE,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000017,N/A,HC EGD/HEMOSTASIS,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000018,N/A,HC EGD/BANDING,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000019,N/A,HC EGD W/DILAT ESOPH BALLOON,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000020,N/A,HC EGD/FB REMOVAL,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000021,N/A,HC EGD/PEG PLACEMENT,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000022,N/A,HC EGD W/DILAT ESOPH GD WIRE,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000023,N/A,HC EGD/HOT BX,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000024,N/A,HC EGD/PYLORIC DILATION,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000025,N/A,HC EGD/SCLEROTHERAPY,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000026,N/A,HC EGD/SNARE,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000028,N/A,HC EGD/STENT,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000029,N/A,HC ENTEROSCOPY BALLOON,750,1 ,"$3,780.00 ","$1,890.00 ","$1,890.00 ","$3,780.00 ", N/A , N/A , N/A , N/A ,"$2,268.00 ","$3,213.00 ","$2,646.00 ", N/A ,"$3,591.00 ","$2,872.80 ","$2,835.00 ", N/A ,"$3,213.00 ", N/A , N/A , N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A ,"$3,213.00 ", N/A ,"$3,477.60 ","$2,646.00 ","$1,917.22 ","$2,300.89 ","$2,302.02 ","$2,300.89 ","$2,611.98 ","$3,402.00 ","$2,632.77 ", N/A ,"$2,986.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$3,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000030,N/A,HC ENTEROSCOPY BALLOON/HEMOSTASIS,750,1 ,"$3,780.00 ","$1,890.00 ","$1,890.00 ","$3,780.00 ", N/A , N/A , N/A , N/A ,"$2,268.00 ","$3,213.00 ","$2,646.00 ", N/A ,"$3,591.00 ","$2,872.80 ","$2,835.00 ", N/A ,"$3,213.00 ", N/A , N/A , N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A ,"$3,213.00 ", N/A ,"$3,477.60 ","$2,646.00 ","$1,917.22 ","$2,300.89 ","$2,302.02 ","$2,300.89 ","$2,611.98 ","$3,402.00 ","$2,632.77 ", N/A ,"$2,986.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$3,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000031,N/A,HC BRAVO PH STUDY,750,1 ,"$1,785.00 ",$892.50 ,$892.50 ,"$1,785.00 ", N/A , N/A , N/A , N/A ,"$1,071.00 ","$1,517.25 ","$1,249.50 ", N/A ,"$1,695.75 ","$1,356.60 ","$1,338.75 ", N/A ,"$1,517.25 ", N/A , N/A , N/A ,"$1,249.50 ", N/A , N/A , N/A , N/A ,"$1,517.25 ", N/A ,"$1,642.20 ","$1,249.50 ",$905.35 ,"$1,086.53 ","$1,087.07 ","$1,086.53 ","$1,233.44 ","$1,606.50 ","$1,243.25 ", N/A ,"$1,410.15 ", N/A , N/A , N/A , N/A , N/A ,"$1,285.20 ","$1,106.70 ","$1,285.20 ","$1,285.20 ","$1,428.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000032,N/A,HC HEMORRHOID BAND WITH SCOPE,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000033,N/A,HC STOMA COLONOSCOPY,750,1 ,"$3,465.00 ","$1,732.50 ","$1,732.50 ","$3,465.00 ", N/A , N/A , N/A , N/A ,"$2,079.00 ","$2,945.25 ","$2,425.50 ", N/A ,"$3,291.75 ","$2,633.40 ","$2,598.75 ", N/A ,"$2,945.25 ", N/A , N/A , N/A ,"$2,425.50 ", N/A , N/A , N/A , N/A ,"$2,945.25 ", N/A ,"$3,187.80 ","$2,425.50 ","$1,757.45 ","$2,109.15 ","$2,110.19 ","$2,109.15 ","$2,394.32 ","$3,118.50 ","$2,413.37 ", N/A ,"$2,737.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000034,N/A,HC STOMA COLONOSCOPY W/ HOT BX,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000035,N/A,HC STOMA COLONOSCOPY W/ SNARE,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000036,N/A,HC STOMA COLONOSCOPY W/BX,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000037,N/A,HC STOMA COLONOSCOPY W/ HEMOSTASIS,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000038,N/A,HC EGD/EMR,750,1 ,"$2,205.00 ","$1,102.50 ","$1,102.50 ","$2,205.00 ", N/A , N/A , N/A , N/A ,"$1,323.00 ","$1,874.25 ","$1,543.50 ", N/A ,"$2,094.75 ","$1,675.80 ","$1,653.75 ", N/A ,"$1,874.25 ", N/A , N/A , N/A ,"$1,543.50 ", N/A , N/A , N/A , N/A ,"$1,874.25 ", N/A ,"$2,028.60 ","$1,543.50 ","$1,118.38 ","$1,342.18 ","$1,342.85 ","$1,342.18 ","$1,523.66 ","$1,984.50 ","$1,535.78 ", N/A ,"$1,741.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000039,N/A,HC ENTEROSCOPY,750,1 ,"$3,465.00 ","$1,732.50 ","$1,732.50 ","$3,465.00 ", N/A , N/A , N/A , N/A ,"$2,079.00 ","$2,945.25 ","$2,425.50 ", N/A ,"$3,291.75 ","$2,633.40 ","$2,598.75 ", N/A ,"$2,945.25 ", N/A , N/A , N/A ,"$2,425.50 ", N/A , N/A , N/A , N/A ,"$2,945.25 ", N/A ,"$3,187.80 ","$2,425.50 ","$1,757.45 ","$2,109.15 ","$2,110.19 ","$2,109.15 ","$2,394.32 ","$3,118.50 ","$2,413.37 ", N/A ,"$2,737.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000040,N/A,HC ENTEROSCOPY W/ HOT BX,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000041,N/A,HC ENTEROSCOPY W/HEMOSTATIS,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000042,N/A,HC ENTEROSCOPY W/ BIOPSY,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000043,N/A,HC ENTEROSCOPY W/ ABLATION,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000044,N/A,HC ENTEROSCOPY W/SNARE,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000045,N/A,HC ENTEROSCOPY W/ STENT,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000046,N/A,HC ERCP,750,1 ,"$5,040.00 ","$2,520.00 ","$2,520.00 ","$5,040.00 ", N/A , N/A , N/A , N/A ,"$3,024.00 ","$4,284.00 ","$3,528.00 ", N/A ,"$4,788.00 ","$3,830.40 ","$3,780.00 ", N/A ,"$4,284.00 ", N/A , N/A , N/A ,"$3,528.00 ", N/A , N/A , N/A , N/A ,"$4,284.00 ", N/A ,"$4,636.80 ","$3,528.00 ","$2,556.29 ","$3,067.85 ","$3,069.36 ","$3,067.85 ","$3,482.64 ","$4,536.00 ","$3,510.36 ", N/A ,"$3,981.60 ", N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$4,032.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000047,N/A,HC ERCP W/ STENT PLACEMENT,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000048,N/A,HC ERCP W/ FB REMOVAL OR STENT REMOVAL,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000049,N/A,HC ERCP W/ BALLOON DILATION,750,1 ,"$5,040.00 ","$2,520.00 ","$2,520.00 ","$5,040.00 ", N/A , N/A , N/A , N/A ,"$3,024.00 ","$4,284.00 ","$3,528.00 ", N/A ,"$4,788.00 ","$3,830.40 ","$3,780.00 ", N/A ,"$4,284.00 ", N/A , N/A , N/A ,"$3,528.00 ", N/A , N/A , N/A , N/A ,"$4,284.00 ", N/A ,"$4,636.80 ","$3,528.00 ","$2,556.29 ","$3,067.85 ","$3,069.36 ","$3,067.85 ","$3,482.64 ","$4,536.00 ","$3,510.36 ", N/A ,"$3,981.60 ", N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$4,032.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000050,N/A,HC ERCP W/ BIOPSY,750,1 ,"$5,040.00 ","$2,520.00 ","$2,520.00 ","$5,040.00 ", N/A , N/A , N/A , N/A ,"$3,024.00 ","$4,284.00 ","$3,528.00 ", N/A ,"$4,788.00 ","$3,830.40 ","$3,780.00 ", N/A ,"$4,284.00 ", N/A , N/A , N/A ,"$3,528.00 ", N/A , N/A , N/A , N/A ,"$4,284.00 ", N/A ,"$4,636.80 ","$3,528.00 ","$2,556.29 ","$3,067.85 ","$3,069.36 ","$3,067.85 ","$3,482.64 ","$4,536.00 ","$3,510.36 ", N/A ,"$3,981.60 ", N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$4,032.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000051,N/A,HC ERCP W/LITHOTRIPSY,750,1 ,"$5,040.00 ","$2,520.00 ","$2,520.00 ","$5,040.00 ", N/A , N/A , N/A , N/A ,"$3,024.00 ","$4,284.00 ","$3,528.00 ", N/A ,"$4,788.00 ","$3,830.40 ","$3,780.00 ", N/A ,"$4,284.00 ", N/A , N/A , N/A ,"$3,528.00 ", N/A , N/A , N/A , N/A ,"$4,284.00 ", N/A ,"$4,636.80 ","$3,528.00 ","$2,556.29 ","$3,067.85 ","$3,069.36 ","$3,067.85 ","$3,482.64 ","$4,536.00 ","$3,510.36 ", N/A ,"$3,981.60 ", N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$4,032.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000052,N/A,HC ERCP W/ SPHINCTEROTOMY,750,1 ,"$5,040.00 ","$2,520.00 ","$2,520.00 ","$5,040.00 ", N/A , N/A , N/A , N/A ,"$3,024.00 ","$4,284.00 ","$3,528.00 ", N/A ,"$4,788.00 ","$3,830.40 ","$3,780.00 ", N/A ,"$4,284.00 ", N/A , N/A , N/A ,"$3,528.00 ", N/A , N/A , N/A , N/A ,"$4,284.00 ", N/A ,"$4,636.80 ","$3,528.00 ","$2,556.29 ","$3,067.85 ","$3,069.36 ","$3,067.85 ","$3,482.64 ","$4,536.00 ","$3,510.36 ", N/A ,"$3,981.60 ", N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$4,032.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000053,N/A,HC ERCP W/ STONE REMOVAL,750,1 ,"$5,040.00 ","$2,520.00 ","$2,520.00 ","$5,040.00 ", N/A , N/A , N/A , N/A ,"$3,024.00 ","$4,284.00 ","$3,528.00 ", N/A ,"$4,788.00 ","$3,830.40 ","$3,780.00 ", N/A ,"$4,284.00 ", N/A , N/A , N/A ,"$3,528.00 ", N/A , N/A , N/A , N/A ,"$4,284.00 ", N/A ,"$4,636.80 ","$3,528.00 ","$2,556.29 ","$3,067.85 ","$3,069.36 ","$3,067.85 ","$3,482.64 ","$4,536.00 ","$3,510.36 ", N/A ,"$3,981.60 ", N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$4,032.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000055,N/A,HC ESOPHAGOSCOPY,750,1 ,"$3,150.00 ","$1,575.00 ","$1,575.00 ","$3,150.00 ", N/A , N/A , N/A , N/A ,"$1,890.00 ","$2,677.50 ","$2,205.00 ", N/A ,"$2,992.50 ","$2,394.00 ","$2,362.50 ", N/A ,"$2,677.50 ", N/A , N/A , N/A ,"$2,205.00 ", N/A , N/A , N/A , N/A ,"$2,677.50 ", N/A ,"$2,898.00 ","$2,205.00 ","$1,597.68 ","$1,917.41 ","$1,918.35 ","$1,917.41 ","$2,176.65 ","$2,835.00 ","$2,193.98 ", N/A ,"$2,488.50 ", N/A , N/A , N/A , N/A , N/A ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$2,520.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000056,N/A,HC ESOPHAGOSCOPY 360 ABLATION HALO,750,1 ,"$4,935.00 ","$2,467.50 ","$2,467.50 ","$4,935.00 ", N/A , N/A , N/A , N/A ,"$2,961.00 ","$4,194.75 ","$3,454.50 ", N/A ,"$4,688.25 ","$3,750.60 ","$3,701.25 ", N/A ,"$4,194.75 ", N/A , N/A , N/A ,"$3,454.50 ", N/A , N/A , N/A , N/A ,"$4,194.75 ", N/A ,"$4,540.20 ","$3,454.50 ","$2,503.03 ","$3,003.93 ","$3,005.42 ","$3,003.93 ","$3,410.09 ","$4,441.50 ","$3,437.23 ", N/A ,"$3,898.65 ", N/A , N/A , N/A , N/A , N/A ,"$3,553.20 ","$3,059.70 ","$3,553.20 ","$3,553.20 ","$3,948.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000057,N/A,HC ESOPHAGOSCOPY 90 ABLATION HALO,750,1 ,"$4,935.00 ","$2,467.50 ","$2,467.50 ","$4,935.00 ", N/A , N/A , N/A , N/A ,"$2,961.00 ","$4,194.75 ","$3,454.50 ", N/A ,"$4,688.25 ","$3,750.60 ","$3,701.25 ", N/A ,"$4,194.75 ", N/A , N/A , N/A ,"$3,454.50 ", N/A , N/A , N/A , N/A ,"$4,194.75 ", N/A ,"$4,540.20 ","$3,454.50 ","$2,503.03 ","$3,003.93 ","$3,005.42 ","$3,003.93 ","$3,410.09 ","$4,441.50 ","$3,437.23 ", N/A ,"$3,898.65 ", N/A , N/A , N/A , N/A , N/A ,"$3,553.20 ","$3,059.70 ","$3,553.20 ","$3,553.20 ","$3,948.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000058,N/A,HC ENDOSCOPIC ULTRASOUND,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000059,N/A,HC ESOPHAGOSCOPY W/ FB REMOVAL,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000060,N/A,HC ESOPHAGOSCOPY W/ STENT PLACEMENT,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000061,N/A,HC FISSURE INJECTION,750,1 ,"$2,205.00 ","$1,102.50 ","$1,102.50 ","$2,205.00 ", N/A , N/A , N/A , N/A ,"$1,323.00 ","$1,874.25 ","$1,543.50 ", N/A ,"$2,094.75 ","$1,675.80 ","$1,653.75 ", N/A ,"$1,874.25 ", N/A , N/A , N/A ,"$1,543.50 ", N/A , N/A , N/A , N/A ,"$1,874.25 ", N/A ,"$2,028.60 ","$1,543.50 ","$1,118.38 ","$1,342.18 ","$1,342.85 ","$1,342.18 ","$1,523.66 ","$1,984.50 ","$1,535.78 ", N/A ,"$1,741.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000063,N/A,HC EUS W/ FNA AND CORE NEEDLE,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000064,N/A,HC EUS W/ FNA AND ECHOTIP,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000066,N/A,HC HYDROGEN BREATH TEST,750,1 ,$599.00 ,$299.50 ,$299.50 ,$599.00 , N/A , N/A , N/A , N/A ,$359.40 ,$509.15 ,$419.30 , N/A ,$569.05 ,$455.24 ,$449.25 , N/A ,$509.15 , N/A , N/A , N/A ,$419.30 , N/A , N/A , N/A , N/A ,$509.15 , N/A ,$551.08 ,$419.30 ,$303.81 ,$364.61 ,$364.79 ,$364.61 ,$413.91 ,$539.10 ,$417.20 , N/A ,$473.21 , N/A , N/A , N/A , N/A , N/A ,$431.28 ,$371.38 ,$431.28 ,$431.28 ,$479.20 
ST NICHOLAS HOSPITAL - ACUTE,75000067,N/A,HC ILEOSCOPY STOMA,750,1 ,"$3,360.00 ","$1,680.00 ","$1,680.00 ","$3,360.00 ", N/A , N/A , N/A , N/A ,"$2,016.00 ","$2,856.00 ","$2,352.00 ", N/A ,"$3,192.00 ","$2,553.60 ","$2,520.00 ", N/A ,"$2,856.00 ", N/A , N/A , N/A ,"$2,352.00 ", N/A , N/A , N/A , N/A ,"$2,856.00 ", N/A ,"$3,091.20 ","$2,352.00 ","$1,704.19 ","$2,045.23 ","$2,046.24 ","$2,045.23 ","$2,321.76 ","$3,024.00 ","$2,340.24 ", N/A ,"$2,654.40 ", N/A , N/A , N/A , N/A , N/A ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,688.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000068,N/A,HC ILEOSCOPY STOMA W/ BX,750,1 ,"$3,780.00 ","$1,890.00 ","$1,890.00 ","$3,780.00 ", N/A , N/A , N/A , N/A ,"$2,268.00 ","$3,213.00 ","$2,646.00 ", N/A ,"$3,591.00 ","$2,872.80 ","$2,835.00 ", N/A ,"$3,213.00 ", N/A , N/A , N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A ,"$3,213.00 ", N/A ,"$3,477.60 ","$2,646.00 ","$1,917.22 ","$2,300.89 ","$2,302.02 ","$2,300.89 ","$2,611.98 ","$3,402.00 ","$2,632.77 ", N/A ,"$2,986.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$3,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000069,N/A,HC LIVER BIOPSY,750,1 ,"$1,785.00 ",$892.50 ,$892.50 ,"$1,785.00 ", N/A , N/A , N/A , N/A ,"$1,071.00 ","$1,517.25 ","$1,249.50 ", N/A ,"$1,695.75 ","$1,356.60 ","$1,338.75 ", N/A ,"$1,517.25 ", N/A , N/A , N/A ,"$1,249.50 ", N/A , N/A , N/A , N/A ,"$1,517.25 ", N/A ,"$1,642.20 ","$1,249.50 ",$905.35 ,"$1,086.53 ","$1,087.07 ","$1,086.53 ","$1,233.44 ","$1,606.50 ","$1,243.25 ", N/A ,"$1,410.15 ", N/A , N/A , N/A , N/A , N/A ,"$1,285.20 ","$1,106.70 ","$1,285.20 ","$1,285.20 ","$1,428.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000070,N/A,HC POUCHOSCOPY,750,1 ,"$3,465.00 ","$1,732.50 ","$1,732.50 ","$3,465.00 ", N/A , N/A , N/A , N/A ,"$2,079.00 ","$2,945.25 ","$2,425.50 ", N/A ,"$3,291.75 ","$2,633.40 ","$2,598.75 ", N/A ,"$2,945.25 ", N/A , N/A , N/A ,"$2,425.50 ", N/A , N/A , N/A , N/A ,"$2,945.25 ", N/A ,"$3,187.80 ","$2,425.50 ","$1,757.45 ","$2,109.15 ","$2,110.19 ","$2,109.15 ","$2,394.32 ","$3,118.50 ","$2,413.37 ", N/A ,"$2,737.35 ", N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,772.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000071,N/A,HC POUCHOSCOPY W/BX,750,1 ,"$3,780.00 ","$1,890.00 ","$1,890.00 ","$3,780.00 ", N/A , N/A , N/A , N/A ,"$2,268.00 ","$3,213.00 ","$2,646.00 ", N/A ,"$3,591.00 ","$2,872.80 ","$2,835.00 ", N/A ,"$3,213.00 ", N/A , N/A , N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A ,"$3,213.00 ", N/A ,"$3,477.60 ","$2,646.00 ","$1,917.22 ","$2,300.89 ","$2,302.02 ","$2,300.89 ","$2,611.98 ","$3,402.00 ","$2,632.77 ", N/A ,"$2,986.20 ", N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$3,024.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000073,N/A,HC SIGMOIDOSCOPY,750,1 ,"$1,995.00 ",$997.50 ,$997.50 ,"$1,995.00 ", N/A , N/A , N/A , N/A ,"$1,197.00 ","$1,695.75 ","$1,396.50 ", N/A ,"$1,895.25 ","$1,516.20 ","$1,496.25 ", N/A ,"$1,695.75 ", N/A , N/A , N/A ,"$1,396.50 ", N/A , N/A , N/A , N/A ,"$1,695.75 ", N/A ,"$1,835.40 ","$1,396.50 ","$1,011.86 ","$1,214.36 ","$1,214.96 ","$1,214.36 ","$1,378.55 ","$1,795.50 ","$1,389.52 ", N/A ,"$1,576.05 ", N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000074,N/A,HC SIGMOIDOSCOPY W/BX,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000075,N/A,HC SIGMOIDOSCOPY W/ HOT BX,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000076,N/A,HC SIGMOIDOSCOPY  W/ FB REMOVAL,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000077,N/A,HC SIGMOIDOSCOPY  W/ SNARE,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000078,N/A,HC SIGMOIDOSCOPY  W/ HEMOSTASIS,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000079,N/A,HC SIGMOIDOSCOPY  W/ DECOMPRESSION,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000080,N/A,HC SIGMOIDOSCOPY W/ ABLATION,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000081,N/A,HC SIGMOIDOSCOPY SEDATED W/ SUBMUCOSAL INJ,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000082,N/A,HC SIGMOIDOSCOPY SEDATED W/ BALLOON DIL,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000083,N/A,HC SIGMOIDOSCOPY SEDATED W/ STENT,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000084,N/A,HC SIGMOIDOSCOPY  W/ ERBE,750,1 ,"$3,885.00 ","$1,942.50 ","$1,942.50 ","$3,885.00 ", N/A , N/A , N/A , N/A ,"$2,331.00 ","$3,302.25 ","$2,719.50 ", N/A ,"$3,690.75 ","$2,952.60 ","$2,913.75 ", N/A ,"$3,302.25 ", N/A , N/A , N/A ,"$2,719.50 ", N/A , N/A , N/A , N/A ,"$3,302.25 ", N/A ,"$3,574.20 ","$2,719.50 ","$1,970.47 ","$2,364.80 ","$2,365.97 ","$2,364.80 ","$2,684.54 ","$3,496.50 ","$2,705.90 ", N/A ,"$3,069.15 ", N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$3,108.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000085,N/A,HC EUS RECTAL ULTRASOUND,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000092,N/A,HC TATTOOING/ENDOSCOPIC,750,1 ,"$1,890.00 ",$945.00 ,$945.00 ,"$1,890.00 ", N/A , N/A , N/A , N/A ,"$1,134.00 ","$1,606.50 ","$1,323.00 ", N/A ,"$1,795.50 ","$1,436.40 ","$1,417.50 ", N/A ,"$1,606.50 ", N/A , N/A , N/A ,"$1,323.00 ", N/A , N/A , N/A , N/A ,"$1,606.50 ", N/A ,"$1,738.80 ","$1,323.00 ",$958.61 ,"$1,150.44 ","$1,151.01 ","$1,150.44 ","$1,305.99 ","$1,701.00 ","$1,316.39 ", N/A ,"$1,493.10 ", N/A , N/A , N/A , N/A , N/A ,"$1,360.80 ","$1,171.80 ","$1,360.80 ","$1,360.80 ","$1,512.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000093,N/A,HC EGD/ SUBMUCOSAL INJ,750,1 ,"$3,675.00 ","$1,837.50 ","$1,837.50 ","$3,675.00 ", N/A , N/A , N/A , N/A ,"$2,205.00 ","$3,123.75 ","$2,572.50 ", N/A ,"$3,491.25 ","$2,793.00 ","$2,756.25 ", N/A ,"$3,123.75 ", N/A , N/A , N/A ,"$2,572.50 ", N/A , N/A , N/A , N/A ,"$3,123.75 ", N/A ,"$3,381.00 ","$2,572.50 ","$1,863.96 ","$2,236.97 ","$2,238.08 ","$2,236.97 ","$2,539.43 ","$3,307.50 ","$2,559.64 ", N/A ,"$2,903.25 ", N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,940.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000094,N/A,HC PEG TUBE CHANGE,750,1 ,$399.00 ,$199.50 ,$199.50 ,$399.00 , N/A , N/A , N/A , N/A ,$239.40 ,$339.15 ,$279.30 , N/A ,$379.05 ,$303.24 ,$299.25 , N/A ,$339.15 , N/A , N/A , N/A ,$279.30 , N/A , N/A , N/A , N/A ,$339.15 , N/A ,$367.08 ,$279.30 ,$202.37 ,$242.87 ,$242.99 ,$242.87 ,$275.71 ,$359.10 ,$277.90 , N/A ,$315.21 , N/A , N/A , N/A , N/A , N/A ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$319.20 
ST NICHOLAS HOSPITAL - ACUTE,75000097,91034,HC ACID REFLUX TEST NASAL PH ELEC,750,1 ,$862.00 ,$431.00 ,$211.20 ,"$1,082.93 ",$211.20 ,$862.00 ,$862.00 ,$481.30 ,$517.20 ,$732.70 ,$603.40 ,$211.20 ,$818.90 ,$655.12 ,$646.50 ,$862.00 ,$732.70 ,$481.30 ,$862.00 ,$560.30 ,$603.40 ,$211.20 ,$481.30 ,$481.30 ,$862.00 ,$732.70 ,"$1,082.93 ",$793.04 ,$603.40 , N/A , N/A ,$524.96 , N/A ,$595.64 ,$775.80 ,$600.38 ,$486.11 ,$680.98 ,$223.87 ,$862.00 ,$862.00 ,$481.30 ,$862.00 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$689.60 
ST NICHOLAS HOSPITAL - ACUTE,75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$1,800.00 ",$900.00 ,$232.13 ,"$1,800.00 ",$232.13 ,"$1,800.00 ","$1,800.00 ",$797.83 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$232.13 ,"$1,710.00 ","$1,368.00 ","$1,350.00 ","$1,800.00 ","$1,530.00 ",$797.83 ,"$1,800.00 ","$1,170.00 ","$1,260.00 ",$232.13 ,$797.83 ,$797.83 ,"$1,697.11 ","$1,530.00 ","$1,795.12 ","$1,656.00 ","$1,260.00 ","$1,800.00 ","$1,800.00 ","$1,096.20 ","$1,800.00 ","$1,243.80 ","$1,620.00 ","$1,253.70 ",$805.81 ,"$1,422.00 ",$246.06 ,"$1,800.00 ","$1,800.00 ",$797.83 ,"$1,800.00 ","$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,440.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000102,N/A,HC SECONDARY GI PROC COLONOSCOPY,750,1 ,"$2,205.00 ","$1,102.50 ","$1,102.50 ","$2,205.00 ", N/A , N/A , N/A , N/A ,"$1,323.00 ","$1,874.25 ","$1,543.50 ", N/A ,"$2,094.75 ","$1,675.80 ","$1,653.75 ", N/A ,"$1,874.25 ", N/A , N/A , N/A ,"$1,543.50 ", N/A , N/A , N/A , N/A ,"$1,874.25 ", N/A ,"$2,028.60 ","$1,543.50 ","$1,118.38 ","$1,342.18 ","$1,342.85 ","$1,342.18 ","$1,523.66 ","$1,984.50 ","$1,535.78 ", N/A ,"$1,741.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000103,N/A,HC SECONDARY GI PROC EGD,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000104,N/A,HC SECONDARY GI PROC ERCP,750,1 ,"$2,835.00 ","$1,417.50 ","$1,417.50 ","$2,835.00 ", N/A , N/A , N/A , N/A ,"$1,701.00 ","$2,409.75 ","$1,984.50 ", N/A ,"$2,693.25 ","$2,154.60 ","$2,126.25 ", N/A ,"$2,409.75 ", N/A , N/A , N/A ,"$1,984.50 ", N/A , N/A , N/A , N/A ,"$2,409.75 ", N/A ,"$2,608.20 ","$1,984.50 ","$1,437.91 ","$1,725.66 ","$1,726.52 ","$1,725.66 ","$1,958.99 ","$2,551.50 ","$1,974.58 ", N/A ,"$2,239.65 ", N/A , N/A , N/A , N/A , N/A ,"$2,041.20 ","$1,757.70 ","$2,041.20 ","$2,041.20 ","$2,268.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000105,N/A,HC SECONDARY GI PROC EUS,750,1 ,"$2,310.00 ","$1,155.00 ","$1,155.00 ","$2,310.00 ", N/A , N/A , N/A , N/A ,"$1,386.00 ","$1,963.50 ","$1,617.00 ", N/A ,"$2,194.50 ","$1,755.60 ","$1,732.50 ", N/A ,"$1,963.50 ", N/A , N/A , N/A ,"$1,617.00 ", N/A , N/A , N/A , N/A ,"$1,963.50 ", N/A ,"$2,125.20 ","$1,617.00 ","$1,171.63 ","$1,406.10 ","$1,406.79 ","$1,406.10 ","$1,596.21 ","$2,079.00 ","$1,608.92 ", N/A ,"$1,824.90 ", N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,848.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000106,N/A,HC SECONDARY GI PROC ENTEROSCOPY,750,1 ,"$2,205.00 ","$1,102.50 ","$1,102.50 ","$2,205.00 ", N/A , N/A , N/A , N/A ,"$1,323.00 ","$1,874.25 ","$1,543.50 ", N/A ,"$2,094.75 ","$1,675.80 ","$1,653.75 ", N/A ,"$1,874.25 ", N/A , N/A , N/A ,"$1,543.50 ", N/A , N/A , N/A , N/A ,"$1,874.25 ", N/A ,"$2,028.60 ","$1,543.50 ","$1,118.38 ","$1,342.18 ","$1,342.85 ","$1,342.18 ","$1,523.66 ","$1,984.50 ","$1,535.78 ", N/A ,"$1,741.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000107,N/A,HC SECONDARY PROCEDURE SIGMOIDOSCOPY,750,1 ,"$2,205.00 ","$1,102.50 ","$1,102.50 ","$2,205.00 ", N/A , N/A , N/A , N/A ,"$1,323.00 ","$1,874.25 ","$1,543.50 ", N/A ,"$2,094.75 ","$1,675.80 ","$1,653.75 ", N/A ,"$1,874.25 ", N/A , N/A , N/A ,"$1,543.50 ", N/A , N/A , N/A , N/A ,"$1,874.25 ", N/A ,"$2,028.60 ","$1,543.50 ","$1,118.38 ","$1,342.18 ","$1,342.85 ","$1,342.18 ","$1,523.66 ","$1,984.50 ","$1,535.78 ", N/A ,"$1,741.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000114,N/A,HC ERCP W/STENT REPLACEMENT,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000115,46999,HC ANOSCOPY/INJECTION SOLESTA,750,1 ,"$2,100.00 ","$1,050.00 ",$462.68 ,"$2,100.00 ",$462.68 ,"$2,100.00 ","$2,100.00 ",$782.47 ,"$1,260.00 ","$1,785.00 ","$1,470.00 ",$462.68 ,"$1,995.00 ","$1,596.00 ","$1,575.00 ","$2,100.00 ","$1,785.00 ",$782.47 ,"$2,100.00 ","$2,100.00 ","$1,470.00 ",$462.68 ,$782.47 ,$782.47 ,"$2,100.00 ","$1,785.00 ","$1,760.56 ","$1,932.00 ","$1,470.00 ", N/A , N/A ,"$1,278.90 ", N/A ,"$1,451.10 ","$1,890.00 ","$1,462.65 ",$790.29 ,"$1,659.00 ",$490.44 ,"$2,100.00 ","$2,100.00 ",$782.47 ,"$2,100.00 ","$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,680.00 "
ST NICHOLAS HOSPITAL - ACUTE,75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,"$1,100.00 ",$550.00 ,$232.13 ,"$1,795.12 ",$232.13 ,"$1,100.00 ","$1,100.00 ",$797.83 ,$660.00 ,$935.00 ,$770.00 ,$232.13 ,"$1,045.00 ",$836.00 ,$825.00 ,"$1,100.00 ",$935.00 ,$797.83 ,"$1,100.00 ",$715.00 ,$770.00 ,$232.13 ,$797.83 ,$797.83 ,"$1,100.00 ",$935.00 ,"$1,795.12 ","$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$990.00 ,$766.15 ,$805.81 ,$869.00 ,$246.06 ,"$1,100.00 ","$1,100.00 ",$797.83 ,"$1,100.00 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,75001004,N/A,HC ESOPHAGEAL MOTILITY/MANOMETRY,750,1 ,"$2,205.00 ","$1,102.50 ","$1,102.50 ","$2,205.00 ", N/A , N/A , N/A , N/A ,"$1,323.00 ","$1,874.25 ","$1,543.50 ", N/A ,"$2,094.75 ","$1,675.80 ","$1,653.75 ", N/A ,"$1,874.25 ", N/A , N/A , N/A ,"$1,543.50 ", N/A , N/A , N/A , N/A ,"$1,874.25 ", N/A ,"$2,028.60 ","$1,543.50 ","$1,118.38 ","$1,342.18 ","$1,342.85 ","$1,342.18 ","$1,523.66 ","$1,984.50 ","$1,535.78 ", N/A ,"$1,741.95 ", N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,764.00 "
ST NICHOLAS HOSPITAL - ACUTE,75001005,99215,HC PEG REMOVAL W/SEDATION (GI),750,1 ,$402.00 ,$201.00 ,$38.23 ,$402.00 ,$38.23 , N/A , N/A , N/A ,$241.20 ,$341.70 ,$281.40 ,$38.23 ,$381.90 ,$305.52 ,$301.50 ,$402.00 ,$341.70 , N/A ,$402.00 ,$261.30 ,$281.40 ,$38.23 , N/A , N/A , N/A ,$341.70 , N/A ,$369.84 ,$281.40 ,$203.89 ,$244.70 ,$244.82 ,$244.70 ,$277.78 ,$361.80 ,$279.99 , N/A ,$317.58 ,$40.52 , N/A , N/A , N/A , N/A ,$289.44 ,$249.24 ,$289.44 ,$289.44 ,$321.60 
ST NICHOLAS HOSPITAL - ACUTE,75001052,N/A,HC COLONSCOPY FLEX W/BAND LIGATION,750,1 ,"$6,090.00 ","$3,045.00 ","$3,045.00 ","$6,090.00 ", N/A , N/A , N/A , N/A ,"$3,654.00 ","$5,176.50 ","$4,263.00 ", N/A ,"$5,785.50 ","$4,628.40 ","$4,567.50 ", N/A ,"$5,176.50 ", N/A , N/A , N/A ,"$4,263.00 ", N/A , N/A , N/A , N/A ,"$5,176.50 ", N/A ,"$5,602.80 ","$4,263.00 ","$3,088.85 ","$3,706.98 ","$3,708.81 ","$3,706.98 ","$4,208.19 ","$5,481.00 ","$4,241.69 ", N/A ,"$4,811.10 ", N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$4,872.00 "
ST NICHOLAS HOSPITAL - ACUTE,75001066,N/A,HC ESOPHAGOSCOPY FLEXIBLE DX W/BRUSH/WASH -43200,750,1 ,"$2,352.00 ","$1,176.00 ","$1,176.00 ","$2,352.00 ", N/A , N/A , N/A , N/A ,"$1,411.20 ","$1,999.20 ","$1,646.40 ", N/A ,"$2,234.40 ","$1,787.52 ","$1,764.00 ", N/A ,"$1,999.20 ", N/A , N/A , N/A ,"$1,646.40 ", N/A , N/A , N/A , N/A ,"$1,999.20 ", N/A ,"$2,163.84 ","$1,646.40 ","$1,192.93 ","$1,431.66 ","$1,432.37 ","$1,431.66 ","$1,625.23 ","$2,116.80 ","$1,638.17 ", N/A ,"$1,858.08 ", N/A , N/A , N/A , N/A , N/A ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,881.60 "
ST NICHOLAS HOSPITAL - ACUTE,75001076,N/A,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$2,428.80 ","$1,214.40 ","$1,214.40 ","$2,428.80 ", N/A , N/A , N/A , N/A ,"$1,457.28 ","$2,064.48 ","$1,700.16 ", N/A ,"$2,307.36 ","$1,845.89 ","$1,821.60 ", N/A ,"$2,064.48 ", N/A , N/A , N/A ,"$1,700.16 ", N/A , N/A , N/A , N/A ,"$2,064.48 ", N/A ,"$2,234.50 ","$1,700.16 ","$1,231.89 ","$1,478.41 ","$1,479.14 ","$1,478.41 ","$1,678.30 ","$2,185.92 ","$1,691.66 ", N/A ,"$1,918.75 ", N/A , N/A , N/A , N/A , N/A ,"$1,748.74 ","$1,505.86 ","$1,748.74 ","$1,748.74 ","$1,943.04 "
ST NICHOLAS HOSPITAL - ACUTE,75001096,N/A,HC ERCP W/SPHINCTEROTOMY - 43262,750,1 ,"$8,951.25 ","$4,475.63 ","$4,475.63 ","$8,951.25 ", N/A , N/A , N/A , N/A ,"$5,370.75 ","$7,608.56 ","$6,265.88 ", N/A ,"$8,503.69 ","$6,802.95 ","$6,713.44 ", N/A ,"$7,608.56 ", N/A , N/A , N/A ,"$6,265.88 ", N/A , N/A , N/A , N/A ,"$7,608.56 ", N/A ,"$8,235.15 ","$6,265.88 ","$4,540.07 ","$5,448.63 ","$5,451.31 ","$5,448.63 ","$6,185.31 ","$8,056.13 ","$6,234.55 ", N/A ,"$7,071.49 ", N/A , N/A , N/A , N/A , N/A ,"$6,444.90 ","$5,549.78 ","$6,444.90 ","$6,444.90 ","$7,161.00 "
ST NICHOLAS HOSPITAL - ACUTE,75001106,N/A,HC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS - 43450,750,1 ,"$3,570.00 ","$1,785.00 ","$1,785.00 ","$3,570.00 ", N/A , N/A , N/A , N/A ,"$2,142.00 ","$3,034.50 ","$2,499.00 ", N/A ,"$3,391.50 ","$2,713.20 ","$2,677.50 ", N/A ,"$3,034.50 ", N/A , N/A , N/A ,"$2,499.00 ", N/A , N/A , N/A , N/A ,"$3,034.50 ", N/A ,"$3,284.40 ","$2,499.00 ","$1,810.70 ","$2,173.06 ","$2,174.13 ","$2,173.06 ","$2,466.87 ","$3,213.00 ","$2,486.51 ", N/A ,"$2,820.30 ", N/A , N/A , N/A , N/A , N/A ,"$2,570.40 ","$2,213.40 ","$2,570.40 ","$2,570.40 ","$2,856.00 "
ST NICHOLAS HOSPITAL - ACUTE,75001138,N/A,HC PREPARE FECAL MICROBIOTA - 44705,750,1 ,"$1,575.00 ",$787.50 ,$787.50 ,"$1,575.00 ", N/A , N/A , N/A , N/A ,$945.00 ,"$1,338.75 ","$1,102.50 ", N/A ,"$1,496.25 ","$1,197.00 ","$1,181.25 ", N/A ,"$1,338.75 ", N/A , N/A , N/A ,"$1,102.50 ", N/A , N/A , N/A , N/A ,"$1,338.75 ", N/A ,"$1,449.00 ","$1,102.50 ",$798.84 ,$958.70 ,$959.18 ,$958.70 ,"$1,088.33 ","$1,417.50 ","$1,096.99 ", N/A ,"$1,244.25 ", N/A , N/A , N/A , N/A , N/A ,"$1,134.00 ",$976.50 ,"$1,134.00 ","$1,134.00 ","$1,260.00 "
ST NICHOLAS HOSPITAL - ACUTE,75001176,N/A,HC ANOSCOPY W/BIOPSY SGL/MULT - 46606,750,1 ,"$3,022.00 ","$1,511.00 ","$1,511.00 ","$3,022.00 ", N/A , N/A , N/A , N/A ,"$1,813.20 ","$2,568.70 ","$2,115.40 ", N/A ,"$2,870.90 ","$2,296.72 ","$2,266.50 ", N/A ,"$2,568.70 ", N/A , N/A , N/A ,"$2,115.40 ", N/A , N/A , N/A , N/A ,"$2,568.70 ", N/A ,"$2,780.24 ","$2,115.40 ","$1,532.76 ","$1,839.49 ","$1,840.40 ","$1,839.49 ","$2,088.20 ","$2,719.80 ","$2,104.82 ", N/A ,"$2,387.38 ", N/A , N/A , N/A , N/A , N/A ,"$2,175.84 ","$1,873.64 ","$2,175.84 ","$2,175.84 ","$2,417.60 "
ST NICHOLAS HOSPITAL - ACUTE,75001193,91035,HC ACID REFLUX TEST MUCOSAL ELECTRODE- 91035,750,1 ,"$1,444.00 ",$722.00 ,$211.20 ,"$1,444.00 ",$211.20 ,"$1,444.00 ","$1,444.00 ",$481.30 ,$866.40 ,"$1,227.40 ","$1,010.80 ",$211.20 ,"$1,371.80 ","$1,097.44 ","$1,083.00 ","$1,444.00 ","$1,227.40 ",$481.30 ,"$1,444.00 ",$938.60 ,"$1,010.80 ",$211.20 ,$481.30 ,$481.30 ,"$1,444.00 ","$1,227.40 ","$1,082.93 ","$1,328.48 ","$1,010.80 ", N/A , N/A ,$879.40 , N/A ,$997.80 ,"$1,299.60 ","$1,005.75 ",$486.11 ,"$1,140.76 ",$223.87 ,"$1,444.00 ","$1,444.00 ",$481.30 ,"$1,444.00 ","$1,039.68 ",$895.28 ,"$1,039.68 ","$1,039.68 ","$1,155.20 "
ST NICHOLAS HOSPITAL - ACUTE,75001223,N/A,HC SMALL BOWEL ENDOSCOPY- 44378,750,1 ,"$2,006.00 ","$1,003.00 ","$1,003.00 ","$2,006.00 ", N/A , N/A , N/A , N/A ,"$1,203.60 ","$1,705.10 ","$1,404.20 ", N/A ,"$1,905.70 ","$1,524.56 ","$1,504.50 ", N/A ,"$1,705.10 ", N/A , N/A , N/A ,"$1,404.20 ", N/A , N/A , N/A , N/A ,"$1,705.10 ", N/A ,"$1,845.52 ","$1,404.20 ","$1,017.44 ","$1,221.05 ","$1,221.65 ","$1,221.05 ","$1,386.15 ","$1,805.40 ","$1,397.18 ", N/A ,"$1,584.74 ", N/A , N/A , N/A , N/A , N/A ,"$1,444.32 ","$1,243.72 ","$1,444.32 ","$1,444.32 ","$1,604.80 "
ST NICHOLAS HOSPITAL - ACUTE,76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$1,185.00 ",$592.50 ,$268.66 ,"$1,408.74 ",$268.66 ,$766.58 ,$766.58 ,$626.11 ,$711.00 ,"$1,007.25 ",$829.50 ,$268.66 ,"$1,125.75 ",$900.60 ,$888.75 ,$770.25 ,"$1,007.25 ",$626.11 ,$770.25 ,$770.25 ,$829.50 ,$268.66 ,$626.11 ,$626.11 ,$497.70 ,"$1,007.25 ","$1,408.74 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,"$1,066.50 ",$825.35 ,$632.37 ,$936.15 ,$284.78 ,$711.00 ,$711.00 ,$626.11 ,$711.00 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$948.00 
ST NICHOLAS HOSPITAL - ACUTE,76100001,29700,HC REMOVE/REVISION CAST,761,1 ,$237.00 ,$118.50 ,$59.15 ,$535.20 ,$59.15 ,$237.00 ,$237.00 ,$237.87 ,$142.20 ,$201.45 ,$165.90 ,$59.15 ,$225.15 ,$180.12 ,$177.75 ,$237.00 ,$201.45 ,$237.87 ,$237.00 ,$237.00 ,$165.90 ,$59.15 ,$237.87 ,$237.87 ,$99.54 ,$201.45 ,$535.20 ,$218.04 ,$165.90 ,$237.00 ,$237.00 ,$144.33 ,$237.00 ,$163.77 ,$213.30 ,$165.07 ,$240.25 ,$187.23 ,$62.70 ,$142.20 ,$142.20 ,$237.87 ,$142.20 ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$189.60 
ST NICHOLAS HOSPITAL - ACUTE,76100054,64999,HC GANGLION IMPAR BLOCK,761,1 ,"$1,330.00 ",$665.00 ,$136.73 ,"$1,330.00 ",$136.73 ,"$1,330.00 ","$1,330.00 ",$257.61 ,$798.00 ,"$1,130.50 ",$931.00 ,$136.73 ,"$1,263.50 ","$1,010.80 ",$997.50 ,"$1,330.00 ","$1,130.50 ",$257.61 ,"$1,330.00 ","$1,330.00 ",$931.00 ,$136.73 ,$257.61 ,$257.61 ,$558.60 ,"$1,130.50 ",$579.62 ,"$1,223.60 ",$931.00 ,$674.58 ,$809.57 ,$809.97 ,$809.57 ,$919.03 ,"$1,197.00 ",$926.35 ,$260.19 ,"$1,050.70 ",$144.93 ,$798.00 ,$798.00 ,$257.61 ,$798.00 ,$957.60 ,$824.60 ,$957.60 ,$957.60 ,"$1,064.00 "
ST NICHOLAS HOSPITAL - ACUTE,76200004,G0378,HC CDTU LV I PER HOUR,762,1 ,$166.00 ,$83.00 ,$83.00 ,$166.00 , N/A ,$166.00 ,$166.00 , N/A ,$99.60 ,$141.10 ,$116.20 , N/A ,$157.70 ,$126.16 ,$124.50 ,$107.90 ,$141.10 , N/A ,$107.90 ,$107.90 ,$116.20 , N/A , N/A , N/A ,$166.00 ,$141.10 , N/A ,$152.72 ,$116.20 ,$84.20 ,$101.04 ,$101.09 ,$101.04 ,$114.71 ,$149.40 ,$115.62 , N/A ,$131.14 , N/A ,$166.00 ,$166.00 , N/A ,$166.00 ,$119.52 ,$102.92 ,$119.52 ,$119.52 ,$132.80 
ST NICHOLAS HOSPITAL - ACUTE,76200005,G0378,HC CDTU LV II PER HOUR,762,1 ,$207.00 ,$103.50 ,$103.50 ,$207.00 , N/A ,$207.00 ,$207.00 , N/A ,$124.20 ,$175.95 ,$144.90 , N/A ,$196.65 ,$157.32 ,$155.25 ,$134.55 ,$175.95 , N/A ,$134.55 ,$134.55 ,$144.90 , N/A , N/A , N/A ,$207.00 ,$175.95 , N/A ,$190.44 ,$144.90 ,$104.99 ,$126.00 ,$126.06 ,$126.00 ,$143.04 ,$186.30 ,$144.18 , N/A ,$163.53 , N/A ,$207.00 ,$207.00 , N/A ,$207.00 ,$149.04 ,$128.34 ,$149.04 ,$149.04 ,$165.60 
ST NICHOLAS HOSPITAL - ACUTE,76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$383.00 ,$191.50 ,$38.23 ,$383.00 ,$38.23 ,$383.00 ,$383.00 , N/A ,$229.80 ,$325.55 ,$268.10 ,$38.23 ,$363.85 ,$291.08 ,$287.25 ,$248.95 ,$325.55 , N/A ,$248.95 ,$248.95 ,$268.10 ,$38.23 , N/A , N/A ,$383.00 ,$325.55 , N/A ,$352.36 ,$268.10 ,$194.26 ,$233.13 ,$233.25 ,$233.13 ,$264.65 ,$344.70 ,$266.76 , N/A ,$302.57 ,$40.52 ,$383.00 ,$383.00 , N/A ,$383.00 ,$275.76 ,$237.46 ,$275.76 ,$275.76 ,$306.40 
ST NICHOLAS HOSPITAL - ACUTE,76200013,N/A,HC OBSERVATION PER HOUR NO CODE,762,1 ,$383.00 ,$191.50 ,$191.50 ,$383.00 , N/A ,$383.00 ,$383.00 , N/A ,$229.80 ,$325.55 ,$268.10 , N/A ,$363.85 ,$291.08 ,$287.25 ,$248.95 ,$325.55 , N/A ,$248.95 ,$248.95 ,$268.10 , N/A , N/A , N/A ,$383.00 ,$325.55 , N/A ,$352.36 ,$268.10 ,$194.26 ,$233.13 ,$233.25 ,$233.13 ,$264.65 ,$344.70 ,$266.76 , N/A ,$302.57 , N/A ,$383.00 ,$383.00 , N/A ,$383.00 ,$275.76 ,$237.46 ,$275.76 ,$275.76 ,$306.40 
ST NICHOLAS HOSPITAL - ACUTE,77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$78.00 ,$39.00 ,$12.08 ,$137.55 ,$12.08 ,$50.46 ,$50.46 ,$61.13 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$59.28 ,$58.50 ,$50.70 ,$66.30 ,$61.13 ,$50.70 ,$50.70 ,$54.60 ,$12.08 ,$61.13 ,$61.13 ,$32.76 ,$66.30 ,$137.55 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$47.48 ,$53.90 ,$70.20 ,$54.33 ,$61.74 ,$61.62 ,$12.80 , N/A , N/A ,$61.13 , N/A ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,77100001,90471,HC RABIES VACC ADMIN IM,771,1 ,$78.00 ,$39.00 ,$12.08 ,$137.55 ,$12.08 ,$50.46 ,$50.46 ,$61.13 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$59.28 ,$58.50 ,$50.70 ,$66.30 ,$61.13 ,$50.70 ,$50.70 ,$54.60 ,$12.08 ,$61.13 ,$61.13 ,$32.76 ,$66.30 ,$137.55 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$47.48 ,$53.90 ,$70.20 ,$54.33 ,$61.74 ,$61.62 ,$12.80 , N/A , N/A ,$61.13 , N/A ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$53.00 ,$26.50 ,$12.08 ,$53.00 ,$12.08 ,$34.29 ,$34.29 , N/A ,$31.80 ,$45.05 ,$37.10 ,$12.08 ,$50.35 ,$40.28 ,$39.75 ,$34.45 ,$45.05 , N/A ,$34.45 ,$34.45 ,$37.10 ,$12.08 , N/A , N/A ,$22.26 ,$45.05 , N/A ,$48.76 ,$37.10 ,$26.88 ,$32.26 ,$32.28 ,$32.26 ,$36.62 ,$47.70 ,$36.91 , N/A ,$41.87 ,$12.80 , N/A , N/A , N/A , N/A ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$42.40 
ST NICHOLAS HOSPITAL - ACUTE,77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$78.00 ,$39.00 ,$12.08 ,$88.78 ,$12.08 ,$50.46 ,$50.46 ,$39.46 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$59.28 ,$58.50 ,$50.70 ,$66.30 ,$39.46 ,$50.70 ,$50.70 ,$54.60 ,$12.08 ,$39.46 ,$39.46 ,$32.76 ,$66.30 ,$88.78 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$47.48 ,$53.90 ,$70.20 ,$54.33 ,$39.85 ,$61.62 ,$12.80 , N/A , N/A ,$39.46 , N/A ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,77100004,G0008,HC ADMIN INFLUENZA COMMUNITY VACCINE,771,1 ,$78.00 ,$39.00 ,$12.08 ,$88.78 ,$12.08 ,$50.46 ,$50.46 ,$39.46 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$59.28 ,$58.50 ,$50.70 ,$66.30 ,$39.46 ,$50.70 ,$50.70 ,$54.60 ,$12.08 ,$39.46 ,$39.46 ,$32.76 ,$66.30 ,$88.78 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$47.48 ,$53.90 ,$70.20 ,$54.33 ,$39.85 ,$61.62 ,$12.80 , N/A , N/A ,$39.46 , N/A ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$90.00 ,$45.00 ,$12.08 ,$90.00 ,$12.08 ,$58.22 ,$58.22 ,$39.46 ,$54.00 ,$76.50 ,$63.00 ,$12.08 ,$85.50 ,$68.40 ,$67.50 ,$58.50 ,$76.50 ,$39.46 ,$58.50 ,$58.50 ,$63.00 ,$12.08 ,$39.46 ,$39.46 ,$37.80 ,$76.50 ,$88.78 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$54.78 ,$62.19 ,$81.00 ,$62.69 ,$39.85 ,$71.10 ,$12.80 , N/A , N/A ,$39.46 , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$72.00 
ST NICHOLAS HOSPITAL - ACUTE,77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$78.00 ,$39.00 ,$12.08 ,$88.78 ,$12.08 ,$50.46 ,$50.46 ,$39.46 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$59.28 ,$58.50 ,$50.70 ,$66.30 ,$39.46 ,$50.70 ,$50.70 ,$54.60 ,$12.08 ,$39.46 ,$39.46 ,$32.76 ,$66.30 ,$88.78 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$47.48 ,$53.90 ,$70.20 ,$54.33 ,$39.85 ,$61.62 ,$12.80 , N/A , N/A ,$39.46 , N/A ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$62.40 
ST NICHOLAS HOSPITAL - ACUTE,77100009,0001A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100010,0002A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100011,0011A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100012,0012A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5M SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100013,0021A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 , N/A ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 ,$12.08 , N/A , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 , N/A ,$79.00 ,$12.80 , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100014,0022A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 , N/A ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 ,$12.08 , N/A , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 , N/A ,$79.00 ,$12.80 , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100015,0031A,HC ADMINISTRATION SARS-COV-2 VACCINE AD26 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100016,0041A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 , N/A ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 ,$12.08 , N/A , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 , N/A ,$79.00 ,$12.80 , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100017,0042A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 , N/A ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 ,$12.08 , N/A , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 , N/A ,$79.00 ,$12.80 , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100018,0003A,HC ADM SARSCOV2 30MCG/0.3ML 3RD - PFIZER,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100019,0013A,HC ADM SARSCOV2 100MCG/0.5ML 3RD - MODERNA,771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100020,0051A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, FIRST DOSE",771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100021,0052A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, SECOND DOSE",771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100022,0053A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, THIRD DOSE",771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100024,0054A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, BOOSTER DOSE",771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100025,0064A,"HC ADMIN SARS-COV-2 VACCINE 50MCG/0.25ML, BOOSTER DOSE",771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100028,0034A,"HC ADMIN SARS-COV-2 VACCINE JOHNSON  AND  JOHNSON, BOOSTER DOSE",771,1 ,$100.00 ,$50.00 ,$12.08 ,$100.00 ,$12.08 ,$64.69 ,$64.69 ,$38.62 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$38.62 ,$65.00 ,$65.00 ,$70.00 ,$12.08 ,$38.62 ,$38.62 ,$42.00 ,$85.00 ,$86.89 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$39.01 ,$79.00 ,$12.80 , N/A , N/A ,$38.62 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,77100029,M0220,"HC INTRAVENOUS INFUSION,  TIXAGEVIMAB AND CILGAVIMAB ADMINISTRATION",771,1 ,$100.00 ,$50.00 ,$13.88 ,$100.00 ,$13.88 ,$64.69 ,$64.69 , N/A ,$60.00 ,$85.00 ,$70.00 ,$13.88 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$65.00 ,$70.00 ,$13.88 , N/A , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$60.87 ,$69.10 ,$90.00 ,$69.65 , N/A ,$79.00 ,$14.71 , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$250.00 ,$125.00 ,$2.57 ,$250.00 ,$2.57 ,$161.73 ,$161.73 ,$27.59 ,$150.00 ,$212.50 ,$175.00 ,$2.57 ,$237.50 ,$190.00 ,$187.50 ,$54.91 ,$212.50 ,$27.59 ,$54.91 ,$162.50 ,$175.00 ,$2.57 ,$27.59 ,$27.59 ,$105.00 ,$212.50 ,$62.08 ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$174.13 ,$27.87 ,$197.50 ,$2.72 ,$27.00 ,$27.00 ,$27.59 ,$27.00 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,78000085,99202,PC CLINIC VISIT LIMITED NEW- 95,961,1 ,$200.00 ,$100.00 ,$38.23 ,$200.00 ,$38.23 ,$129.38 ,$129.38 , N/A ,$120.00 ,$170.00 ,$140.00 ,$38.23 ,$190.00 ,$152.00 ,$150.00 ,$130.00 ,$170.00 , N/A ,$130.00 ,$130.00 ,$140.00 ,$38.23 , N/A , N/A ,$84.00 ,$170.00 , N/A ,$184.00 ,$140.00 ,$101.44 ,$121.74 ,$121.80 ,$121.74 ,$138.20 ,$180.00 ,$139.30 , N/A ,$158.00 ,$40.52 , N/A , N/A , N/A , N/A ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$160.00 
ST NICHOLAS HOSPITAL - ACUTE,78000086,99203,PC CLINIC VISIT INTERM NEW - 95,961,1 ,$240.00 ,$120.00 ,$38.23 ,$240.00 ,$38.23 ,$155.26 ,$155.26 , N/A ,$144.00 ,$204.00 ,$168.00 ,$38.23 ,$228.00 ,$182.40 ,$180.00 ,$156.00 ,$204.00 , N/A ,$156.00 ,$156.00 ,$168.00 ,$38.23 , N/A , N/A ,$100.80 ,$204.00 , N/A ,$220.80 ,$168.00 ,$121.73 ,$146.09 ,$146.16 ,$146.09 ,$165.84 ,$216.00 ,$167.16 , N/A ,$189.60 ,$40.52 , N/A , N/A , N/A , N/A ,$172.80 ,$148.80 ,$172.80 ,$172.80 ,$192.00 
ST NICHOLAS HOSPITAL - ACUTE,78000087,99204,PC CLINIC VISIT COMPLEX NEW - 95,961,1 ,$290.00 ,$145.00 ,$38.23 ,$290.00 ,$38.23 ,$187.60 ,$187.60 , N/A ,$174.00 ,$246.50 ,$203.00 ,$38.23 ,$275.50 ,$220.40 ,$217.50 ,$188.50 ,$246.50 , N/A ,$188.50 ,$188.50 ,$203.00 ,$38.23 , N/A , N/A ,$121.80 ,$246.50 , N/A ,$266.80 ,$203.00 ,$147.09 ,$176.52 ,$176.61 ,$176.52 ,$200.39 ,$261.00 ,$201.99 , N/A ,$229.10 ,$40.52 , N/A , N/A , N/A , N/A ,$208.80 ,$179.80 ,$208.80 ,$208.80 ,$232.00 
ST NICHOLAS HOSPITAL - ACUTE,78000088,99205,PC CLINIC VISIT COMPREH NEW - 95,961,1 ,$375.00 ,$187.50 ,$38.23 ,$375.00 ,$38.23 ,$242.59 ,$242.59 , N/A ,$225.00 ,$318.75 ,$262.50 ,$38.23 ,$356.25 ,$285.00 ,$281.25 ,$243.75 ,$318.75 , N/A ,$243.75 ,$243.75 ,$262.50 ,$38.23 , N/A , N/A ,$157.50 ,$318.75 , N/A ,$345.00 ,$262.50 ,$190.20 ,$228.26 ,$228.38 ,$228.26 ,$259.13 ,$337.50 ,$261.19 , N/A ,$296.25 ,$40.52 , N/A , N/A , N/A , N/A ,$270.00 ,$232.50 ,$270.00 ,$270.00 ,$300.00 
ST NICHOLAS HOSPITAL - ACUTE,78000089,99211,PC CLINIC VISIT BRIEF ESTAB - 95,961,1 ,$185.00 ,$92.50 ,$38.23 ,$185.00 ,$38.23 ,$119.68 ,$119.68 , N/A ,$111.00 ,$157.25 ,$129.50 ,$38.23 ,$175.75 ,$140.60 ,$138.75 ,$120.25 ,$157.25 , N/A ,$120.25 ,$120.25 ,$129.50 ,$38.23 , N/A , N/A ,$77.70 ,$157.25 , N/A ,$170.20 ,$129.50 ,$93.83 ,$112.61 ,$112.67 ,$112.61 ,$127.84 ,$166.50 ,$128.85 , N/A ,$146.15 ,$40.52 , N/A , N/A , N/A , N/A ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$148.00 
ST NICHOLAS HOSPITAL - ACUTE,78000090,99212,PC CLINIC VISIT LIMITED ESTAB - 95,961,1 ,$195.00 ,$97.50 ,$38.23 ,$195.00 ,$38.23 ,$126.15 ,$126.15 , N/A ,$117.00 ,$165.75 ,$136.50 ,$38.23 ,$185.25 ,$148.20 ,$146.25 ,$126.75 ,$165.75 , N/A ,$126.75 ,$126.75 ,$136.50 ,$38.23 , N/A , N/A ,$81.90 ,$165.75 , N/A ,$179.40 ,$136.50 ,$98.90 ,$118.70 ,$118.76 ,$118.70 ,$134.75 ,$175.50 ,$135.82 , N/A ,$154.05 ,$40.52 , N/A , N/A , N/A , N/A ,$140.40 ,$120.90 ,$140.40 ,$140.40 ,$156.00 
ST NICHOLAS HOSPITAL - ACUTE,78000091,99213,PC CLINIC VISIT INTERM ESTAB - 95,961,1 ,$235.00 ,$117.50 ,$38.23 ,$235.00 ,$38.23 ,$152.02 ,$152.02 , N/A ,$141.00 ,$199.75 ,$164.50 ,$38.23 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$38.23 , N/A , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$163.68 , N/A ,$185.65 ,$40.52 , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,78000092,99214,PC CLINIC VISIT COMPLEX ESTAB - 95,961,1 ,$260.00 ,$130.00 ,$38.23 ,$260.00 ,$38.23 ,$168.19 ,$168.19 , N/A ,$156.00 ,$221.00 ,$182.00 ,$38.23 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 , N/A ,$169.00 ,$169.00 ,$182.00 ,$38.23 , N/A , N/A ,$109.20 ,$221.00 , N/A ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 , N/A ,$205.40 ,$40.52 , N/A , N/A , N/A , N/A ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,78000093,99215,PC CLINIC VISIT COMPREH ESTAB - 95,983,1 ,$325.00 ,$162.50 ,$38.23 ,$325.00 ,$38.23 ,$210.24 ,$210.24 , N/A ,$195.00 ,$276.25 ,$227.50 ,$38.23 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 , N/A ,$211.25 ,$211.25 ,$227.50 ,$38.23 , N/A , N/A ,$136.50 ,$276.25 , N/A ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$197.83 ,$224.58 ,$292.50 ,$226.36 , N/A ,$256.75 ,$40.52 , N/A , N/A , N/A , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,78000191,G0508,PC TELEHEALTH CRITICAL CARE CONSULT 60 MIN - 95,961,1 ,$250.00 ,$125.00 ,$38.23 ,$250.00 ,$38.23 ,$161.73 ,$161.73 , N/A ,$150.00 ,$212.50 ,$175.00 ,$38.23 ,$237.50 ,$190.00 ,$187.50 ,$162.50 ,$212.50 , N/A ,$162.50 ,$162.50 ,$175.00 ,$38.23 , N/A , N/A ,$105.00 ,$212.50 , N/A ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$152.18 ,$172.75 ,$225.00 ,$174.13 , N/A ,$197.50 ,$40.52 , N/A , N/A , N/A , N/A ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$200.00 
ST NICHOLAS HOSPITAL - ACUTE,80100000,90999,HC RENAL DIALYSIS IP,801,1 ,$730.00 ,$365.00 ,$240.37 ,$730.00 ,$240.37 ,$472.24 ,$472.24 , N/A ,$438.00 ,$620.50 ,$511.00 ,$240.37 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$240.37 , N/A , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$508.45 , N/A ,$576.70 ,$254.79 ,$438.00 ,$438.00 , N/A ,$438.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,80100008,G0491,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD IP,801,1 ,$730.00 ,$365.00 ,$240.37 ,$730.00 ,$240.37 ,$472.24 ,$472.24 , N/A ,$438.00 ,$620.50 ,$511.00 ,$240.37 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$240.37 , N/A , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$508.45 , N/A ,$576.70 ,$254.79 ,$438.00 ,$438.00 , N/A ,$438.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,80100009,G0492,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD W/PHY EVAL IP,801,1 ,$730.00 ,$365.00 ,$240.37 ,$730.00 ,$240.37 ,$472.24 ,$472.24 , N/A ,$438.00 ,$620.50 ,$511.00 ,$240.37 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$240.37 , N/A , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$508.45 , N/A ,$576.70 ,$254.79 ,$438.00 ,$438.00 , N/A ,$438.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,82100000,90999,HC RENAL DIALYSIS OP,821,1 ,$730.00 ,$365.00 ,$240.37 ,$730.00 ,$240.37 ,$730.00 ,$730.00 , N/A ,$438.00 ,$620.50 ,$511.00 ,$240.37 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$240.37 , N/A , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$508.45 , N/A ,$576.70 ,$254.79 ,$730.00 ,$730.00 , N/A ,$730.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,82100003,G0491,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD OP,821,1 ,$730.00 ,$365.00 ,$240.37 ,$730.00 ,$240.37 ,$730.00 ,$730.00 , N/A ,$438.00 ,$620.50 ,$511.00 ,$240.37 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$240.37 , N/A , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$508.45 , N/A ,$576.70 ,$254.79 ,$730.00 ,$730.00 , N/A ,$730.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,82100004,G0492,HC RENAL DIALYSIS W/KIDNEY INJ W/O ESRD W/PHY EVAL OP,821,1 ,$730.00 ,$365.00 ,$240.37 ,$730.00 ,$240.37 ,$730.00 ,$730.00 , N/A ,$438.00 ,$620.50 ,$511.00 ,$240.37 ,$693.50 ,$554.80 ,$547.50 ,$474.50 ,$620.50 , N/A ,$474.50 ,$474.50 ,$511.00 ,$240.37 , N/A , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$444.35 ,$504.43 ,$657.00 ,$508.45 , N/A ,$576.70 ,$254.79 ,$730.00 ,$730.00 , N/A ,$730.00 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$584.00 
ST NICHOLAS HOSPITAL - ACUTE,87426072,87426,HC CORONAVIRUS AG AI PREVEA 72HR,300,1 ,$84.00 ,$42.00 ,$35.33 ,$84.00 ,$35.33 ,$84.00 ,$84.00 ,$35.33 ,$50.40 ,$71.40 ,$58.80 ,$35.33 ,$79.80 ,$63.84 ,$63.00 ,$76.89 ,$71.40 ,$35.33 ,$76.89 ,$54.60 ,$58.80 ,$35.33 ,$35.33 ,$35.33 ,$39.99 ,$71.40 ,$79.49 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$75.60 ,$58.51 ,$35.68 ,$66.36 ,$37.45 ,$54.44 ,$54.44 ,$35.33 ,$54.44 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$67.20 
ST NICHOLAS HOSPITAL - ACUTE,92000001,59020,HC TEST STRESS FETAL,920,1 ,$539.00 ,$269.50 ,$57.86 ,$539.00 ,$57.86 ,$348.68 ,$348.68 ,$167.98 ,$323.40 ,$458.15 ,$377.30 ,$57.86 ,$512.05 ,$409.64 ,$404.25 ,$350.35 ,$458.15 ,$167.98 ,$350.35 ,$350.35 ,$377.30 ,$57.86 ,$167.98 ,$167.98 ,$305.48 ,$458.15 ,$377.95 ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$328.09 ,$372.45 ,$485.10 ,$375.41 ,$169.66 ,$425.81 ,$61.33 ,$449.00 ,$449.00 ,$167.98 ,$449.00 ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$431.20 
ST NICHOLAS HOSPITAL - ACUTE,92000002,59025,HC TEST NON STRESS FETAL,920,1 ,$452.00 ,$226.00 ,$57.86 ,$452.00 ,$57.86 ,$292.40 ,$292.40 ,$167.98 ,$271.20 ,$384.20 ,$316.40 ,$57.86 ,$429.40 ,$343.52 ,$339.00 ,$293.80 ,$384.20 ,$167.98 ,$293.80 ,$293.80 ,$316.40 ,$57.86 ,$167.98 ,$167.98 ,$305.48 ,$384.20 ,$377.95 ,$415.84 ,$316.40 ,$229.25 ,$275.13 ,$275.27 ,$275.13 ,$312.33 ,$406.80 ,$314.82 ,$169.66 ,$357.08 ,$61.33 ,$449.00 ,$449.00 ,$167.98 ,$449.00 ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$361.60 
ST NICHOLAS HOSPITAL - ACUTE,92100001,N/A,HC PULSE VOLUME RECORD BI,921,1 ,$273.00 ,$136.50 ,$136.50 ,$273.00 , N/A ,$176.60 ,$176.60 , N/A ,$163.80 ,$232.05 ,$191.10 , N/A ,$259.35 ,$207.48 ,$204.75 ,$177.45 ,$232.05 , N/A ,$177.45 ,$177.45 ,$191.10 , N/A , N/A , N/A ,$273.00 ,$232.05 , N/A ,$251.16 ,$191.10 ,$138.47 ,$166.18 ,$166.26 ,$166.18 ,$188.64 ,$245.70 ,$190.14 , N/A ,$215.67 , N/A ,$273.00 ,$273.00 , N/A ,$273.00 ,$196.56 ,$169.26 ,$196.56 ,$196.56 ,$218.40 
ST NICHOLAS HOSPITAL - ACUTE,92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$1,200.00 ",$600.00 ,$52.74 ,"$1,200.00 ",$52.74 ,$776.28 ,$776.28 ,$226.88 ,$720.00 ,"$1,020.00 ",$840.00 ,$52.74 ,"$1,140.00 ",$912.00 ,$900.00 ,$780.00 ,"$1,020.00 ",$226.88 ,$780.00 ,$780.00 ,$840.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,"$1,020.00 ",$510.48 ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$730.44 ,$829.20 ,"$1,080.00 ",$835.80 ,$229.15 ,$948.00 ,$55.90 ,$465.00 ,$465.00 ,$226.88 ,$465.00 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$960.00 
ST NICHOLAS HOSPITAL - ACUTE,92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,$590.00 ,$295.00 ,$34.74 ,$590.00 ,$34.74 ,$381.67 ,$381.67 ,$107.35 ,$354.00 ,$501.50 ,$413.00 ,$34.74 ,$560.50 ,$448.40 ,$442.50 ,$383.50 ,$501.50 ,$107.35 ,$383.50 ,$383.50 ,$413.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$501.50 ,$241.53 ,$542.80 ,$413.00 ,$299.25 ,$359.13 ,$359.31 ,$359.13 ,$407.69 ,$531.00 ,$410.94 ,$108.42 ,$466.10 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$424.80 ,$365.80 ,$424.80 ,$424.80 ,$472.00 
ST NICHOLAS HOSPITAL - ACUTE,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$482.00 ,$241.00 ,$34.74 ,$482.00 ,$34.74 ,$311.81 ,$311.81 ,$55.59 ,$289.20 ,$409.70 ,$337.40 ,$34.74 ,$457.90 ,$366.32 ,$361.50 ,$313.30 ,$409.70 ,$55.59 ,$313.30 ,$313.30 ,$337.40 ,$34.74 ,$55.59 ,$55.59 ,$305.48 ,$409.70 ,$125.08 ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$293.39 ,$333.06 ,$433.80 ,$335.71 ,$56.15 ,$380.78 ,$36.82 ,$465.00 ,$465.00 ,$55.59 ,$465.00 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$482.00 ,$241.00 ,$34.74 ,$482.00 ,$34.74 ,$311.81 ,$311.81 ,$55.59 ,$289.20 ,$409.70 ,$337.40 ,$34.74 ,$457.90 ,$366.32 ,$361.50 ,$313.30 ,$409.70 ,$55.59 ,$313.30 ,$313.30 ,$337.40 ,$34.74 ,$55.59 ,$55.59 ,$305.48 ,$409.70 ,$125.08 ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$293.39 ,$333.06 ,$433.80 ,$335.71 ,$56.15 ,$380.78 ,$36.82 ,$465.00 ,$465.00 ,$55.59 ,$465.00 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,92100006,93922,HC TCPO2/SPP UNILATERAL 1-2 LEVELS W/FULL STUDY - 93922,921,1 ,$482.00 ,$241.00 ,$34.74 ,$482.00 ,$34.74 ,$311.81 ,$311.81 ,$111.18 ,$289.20 ,$409.70 ,$337.40 ,$34.74 ,$457.90 ,$366.32 ,$361.50 ,$313.30 ,$409.70 ,$111.18 ,$313.30 ,$313.30 ,$337.40 ,$34.74 ,$111.18 ,$111.18 ,$305.48 ,$409.70 ,$250.16 ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$293.39 ,$333.06 ,$433.80 ,$335.71 ,$112.29 ,$380.78 ,$36.82 ,$465.00 ,$465.00 ,$111.18 ,$465.00 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,92100007,93922,HC TCPO2/SPP UNILATERAL 3 OR MORE LEVEL - 93922,921,1 ,$482.00 ,$241.00 ,$34.74 ,$482.00 ,$34.74 ,$311.81 ,$311.81 ,$111.18 ,$289.20 ,$409.70 ,$337.40 ,$34.74 ,$457.90 ,$366.32 ,$361.50 ,$313.30 ,$409.70 ,$111.18 ,$313.30 ,$313.30 ,$337.40 ,$34.74 ,$111.18 ,$111.18 ,$305.48 ,$409.70 ,$250.16 ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$293.39 ,$333.06 ,$433.80 ,$335.71 ,$112.29 ,$380.78 ,$36.82 ,$465.00 ,$465.00 ,$111.18 ,$465.00 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,92100011,93922,HC TCPO2 UNLIATERAL 1-2 LEVEL - 93922-52,921,1 ,$482.00 ,$241.00 ,$34.74 ,$482.00 ,$34.74 ,$311.81 ,$311.81 ,$55.59 ,$289.20 ,$409.70 ,$337.40 ,$34.74 ,$457.90 ,$366.32 ,$361.50 ,$313.30 ,$409.70 ,$55.59 ,$313.30 ,$313.30 ,$337.40 ,$34.74 ,$55.59 ,$55.59 ,$305.48 ,$409.70 ,$125.08 ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$293.39 ,$333.06 ,$433.80 ,$335.71 ,$56.15 ,$380.78 ,$36.82 ,$465.00 ,$465.00 ,$55.59 ,$465.00 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$385.60 
ST NICHOLAS HOSPITAL - ACUTE,92100023,93923,HC TCPO2/ABI/PPG MULT LEVELS,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$137.66 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$519.08 ,$512.25 ,$443.95 ,$580.55 ,$137.66 ,$443.95 ,$443.95 ,$478.10 ,$52.64 ,$137.66 ,$137.66 ,$305.48 ,$580.55 ,$309.74 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$415.74 ,$471.95 ,$614.70 ,$475.71 ,$139.04 ,$539.57 ,$55.80 ,$465.00 ,$465.00 ,$137.66 ,$465.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,92100026,93923,HC TCPO2/SPP BIL 1-2 LEVELS W/FULL STUDY -93923,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$137.66 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$519.08 ,$512.25 ,$443.95 ,$580.55 ,$137.66 ,$443.95 ,$443.95 ,$478.10 ,$52.64 ,$137.66 ,$137.66 ,$305.48 ,$580.55 ,$309.74 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$415.74 ,$471.95 ,$614.70 ,$475.71 ,$139.04 ,$539.57 ,$55.80 ,$465.00 ,$465.00 ,$137.66 ,$465.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,92100027,93923,HC TCPO2/SPP BIL 3 OR MORE LEVELS - 93923,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$137.66 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$519.08 ,$512.25 ,$443.95 ,$580.55 ,$137.66 ,$443.95 ,$443.95 ,$478.10 ,$52.64 ,$137.66 ,$137.66 ,$305.48 ,$580.55 ,$309.74 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$415.74 ,$471.95 ,$614.70 ,$475.71 ,$139.04 ,$539.57 ,$55.80 ,$465.00 ,$465.00 ,$137.66 ,$465.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$137.66 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$519.08 ,$512.25 ,$443.95 ,$580.55 ,$137.66 ,$443.95 ,$443.95 ,$478.10 ,$52.64 ,$137.66 ,$137.66 ,$305.48 ,$580.55 ,$309.74 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$415.74 ,$471.95 ,$614.70 ,$475.71 ,$139.04 ,$539.57 ,$55.80 ,$465.00 ,$465.00 ,$137.66 ,$465.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$137.66 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$519.08 ,$512.25 ,$443.95 ,$580.55 ,$137.66 ,$443.95 ,$443.95 ,$478.10 ,$52.64 ,$137.66 ,$137.66 ,$305.48 ,$580.55 ,$309.74 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$415.74 ,$471.95 ,$614.70 ,$475.71 ,$139.04 ,$539.57 ,$55.80 ,$465.00 ,$465.00 ,$137.66 ,$465.00 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$546.40 
ST NICHOLAS HOSPITAL - ACUTE,92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$1,232.00 ",$616.00 ,$34.74 ,"$1,232.00 ",$34.74 ,$796.98 ,$796.98 ,$260.95 ,$739.20 ,"$1,047.20 ",$862.40 ,$34.74 ,"$1,170.40 ",$936.32 ,$924.00 ,$800.80 ,"$1,047.20 ",$260.95 ,$800.80 ,$800.80 ,$862.40 ,$34.74 ,$260.95 ,$260.95 ,$305.48 ,"$1,047.20 ",$587.13 ,"$1,133.44 ",$862.40 ,$624.87 ,$749.92 ,$750.29 ,$749.92 ,$851.31 ,"$1,108.80 ",$858.09 ,$263.56 ,$973.28 ,$36.82 ,$465.00 ,$465.00 ,$260.95 ,$465.00 ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$985.60 
ST NICHOLAS HOSPITAL - ACUTE,92100033,93924,HC DOPPLER ARTERY UPP EXT STRESS,921,1 ,"$1,232.00 ",$616.00 ,$34.74 ,"$1,232.00 ",$34.74 ,$796.98 ,$796.98 ,$260.95 ,$739.20 ,"$1,047.20 ",$862.40 ,$34.74 ,"$1,170.40 ",$936.32 ,$924.00 ,$800.80 ,"$1,047.20 ",$260.95 ,$800.80 ,$800.80 ,$862.40 ,$34.74 ,$260.95 ,$260.95 ,$305.48 ,"$1,047.20 ",$587.13 ,"$1,133.44 ",$862.40 ,$624.87 ,$749.92 ,$750.29 ,$749.92 ,$851.31 ,"$1,108.80 ",$858.09 ,$263.56 ,$973.28 ,$36.82 ,$465.00 ,$465.00 ,$260.95 ,$465.00 ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$985.60 
ST NICHOLAS HOSPITAL - ACUTE,92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$1,400.00 ",$700.00 ,$52.74 ,"$1,400.00 ",$52.74 ,$905.66 ,$905.66 ,$226.88 ,$840.00 ,"$1,190.00 ",$980.00 ,$52.74 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$910.00 ,"$1,190.00 ",$226.88 ,$910.00 ,$910.00 ,$980.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,"$1,190.00 ",$510.48 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$852.18 ,$967.40 ,"$1,260.00 ",$975.10 ,$229.15 ,"$1,106.00 ",$55.90 ,$465.00 ,$465.00 ,$226.88 ,$465.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,$840.00 ,$420.00 ,$34.74 ,$840.00 ,$34.74 ,$543.40 ,$543.40 ,$107.35 ,$504.00 ,$714.00 ,$588.00 ,$34.74 ,$798.00 ,$638.40 ,$630.00 ,$546.00 ,$714.00 ,$107.35 ,$546.00 ,$546.00 ,$588.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$714.00 ,$241.53 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$585.06 ,$108.42 ,$663.60 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,92100036,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT PSEUD,921,1 ,$840.00 ,$420.00 ,$34.74 ,$840.00 ,$34.74 ,$543.40 ,$543.40 ,$107.35 ,$504.00 ,$714.00 ,$588.00 ,$34.74 ,$798.00 ,$638.40 ,$630.00 ,$546.00 ,$714.00 ,$107.35 ,$546.00 ,$546.00 ,$588.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$714.00 ,$241.53 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$511.31 ,$580.44 ,$756.00 ,$585.06 ,$108.42 ,$663.60 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$672.00 
ST NICHOLAS HOSPITAL - ACUTE,92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$1,100.00 ",$550.00 ,$34.74 ,"$1,100.00 ",$34.74 ,$711.59 ,$711.59 ,$226.88 ,$660.00 ,$935.00 ,$770.00 ,$34.74 ,"$1,045.00 ",$836.00 ,$825.00 ,$715.00 ,$935.00 ,$226.88 ,$715.00 ,$715.00 ,$770.00 ,$34.74 ,$226.88 ,$226.88 ,$305.48 ,$935.00 ,$510.48 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$669.57 ,$760.10 ,$990.00 ,$766.15 ,$229.15 ,$869.00 ,$36.82 ,$465.00 ,$465.00 ,$226.88 ,$465.00 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$880.00 
ST NICHOLAS HOSPITAL - ACUTE,92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,$760.00 ,$380.00 ,$34.74 ,$760.00 ,$34.74 ,$491.64 ,$491.64 ,$107.35 ,$456.00 ,$646.00 ,$532.00 ,$34.74 ,$722.00 ,$577.60 ,$570.00 ,$494.00 ,$646.00 ,$107.35 ,$494.00 ,$494.00 ,$532.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$646.00 ,$241.53 ,$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$462.61 ,$525.16 ,$684.00 ,$529.34 ,$108.42 ,$600.40 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,92100039,93931,HC DUPLEX ARTRL UPR EXT PSEUD ONLY,921,1 ,$760.00 ,$380.00 ,$34.74 ,$760.00 ,$34.74 ,$491.64 ,$491.64 ,$107.35 ,$456.00 ,$646.00 ,$532.00 ,$34.74 ,$722.00 ,$577.60 ,$570.00 ,$494.00 ,$646.00 ,$107.35 ,$494.00 ,$494.00 ,$532.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$646.00 ,$241.53 ,$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$462.61 ,$525.16 ,$684.00 ,$529.34 ,$108.42 ,$600.40 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$608.00 
ST NICHOLAS HOSPITAL - ACUTE,92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$1,400.00 ",$700.00 ,$52.74 ,"$1,400.00 ",$52.74 ,$905.66 ,$905.66 ,$226.88 ,$840.00 ,"$1,190.00 ",$980.00 ,$52.74 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$910.00 ,"$1,190.00 ",$226.88 ,$910.00 ,$910.00 ,$980.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,"$1,190.00 ",$510.48 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$852.18 ,$967.40 ,"$1,260.00 ",$975.10 ,$229.15 ,"$1,106.00 ",$55.90 ,$465.00 ,$465.00 ,$226.88 ,$465.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,92100042,93970,HC DUPLEX VENOUS EXT BI UPPER,921,1 ,"$1,400.00 ",$700.00 ,$52.74 ,"$1,400.00 ",$52.74 ,$905.66 ,$905.66 ,$226.88 ,$840.00 ,"$1,190.00 ",$980.00 ,$52.74 ,"$1,330.00 ","$1,064.00 ","$1,050.00 ",$910.00 ,"$1,190.00 ",$226.88 ,$910.00 ,$910.00 ,$980.00 ,$52.74 ,$226.88 ,$226.88 ,$305.48 ,"$1,190.00 ",$510.48 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$852.18 ,$967.40 ,"$1,260.00 ",$975.10 ,$229.15 ,"$1,106.00 ",$55.90 ,$465.00 ,$465.00 ,$226.88 ,$465.00 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ","$1,120.00 "
ST NICHOLAS HOSPITAL - ACUTE,92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,$860.00 ,$430.00 ,$34.74 ,$860.00 ,$34.74 ,$556.33 ,$556.33 ,$107.35 ,$516.00 ,$731.00 ,$602.00 ,$34.74 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$107.35 ,$559.00 ,$559.00 ,$602.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$731.00 ,$241.53 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$598.99 ,$108.42 ,$679.40 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,92100044,93971,HC VENOUS REFLUX ASSESSMENT UNILAT,921,1 ,$860.00 ,$430.00 ,$34.74 ,$860.00 ,$34.74 ,$556.33 ,$556.33 ,$107.35 ,$516.00 ,$731.00 ,$602.00 ,$34.74 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$107.35 ,$559.00 ,$559.00 ,$602.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$731.00 ,$241.53 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$598.99 ,$108.42 ,$679.40 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,92100045,93971,HC DUPLEX VENOUS EXT UNI/LMTD UPPER,921,1 ,$860.00 ,$430.00 ,$34.74 ,$860.00 ,$34.74 ,$556.33 ,$556.33 ,$107.35 ,$516.00 ,$731.00 ,$602.00 ,$34.74 ,$817.00 ,$653.60 ,$645.00 ,$559.00 ,$731.00 ,$107.35 ,$559.00 ,$559.00 ,$602.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$731.00 ,$241.53 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$523.48 ,$594.26 ,$774.00 ,$598.99 ,$108.42 ,$679.40 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$688.00 
ST NICHOLAS HOSPITAL - ACUTE,92100046,93990,HC DUPLEX HEMODIALYSIS ACCESS,921,1 ,$700.00 ,$350.00 ,$34.74 ,$700.00 ,$34.74 ,$452.83 ,$452.83 ,$107.35 ,$420.00 ,$595.00 ,$490.00 ,$34.74 ,$665.00 ,$532.00 ,$525.00 ,$455.00 ,$595.00 ,$107.35 ,$455.00 ,$455.00 ,$490.00 ,$34.74 ,$107.35 ,$107.35 ,$305.48 ,$595.00 ,$241.53 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$426.09 ,$483.70 ,$630.00 ,$487.55 ,$108.42 ,$553.00 ,$36.82 ,$465.00 ,$465.00 ,$107.35 ,$465.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$560.00 
ST NICHOLAS HOSPITAL - ACUTE,92200001,95861,HC EMG TWO EXTREMITIES,922,1 ,$582.00 ,$291.00 ,$42.84 ,$582.00 ,$42.84 ,$376.50 ,$376.50 ,$111.18 ,$349.20 ,$494.70 ,$407.40 ,$42.84 ,$552.90 ,$442.32 ,$436.50 ,$378.30 ,$494.70 ,$111.18 ,$378.30 ,$378.30 ,$407.40 ,$42.84 ,$111.18 ,$111.18 ,$257.96 ,$494.70 ,$250.16 ,$535.44 ,$407.40 ,$295.19 ,$354.26 ,$354.44 ,$354.26 ,$402.16 ,$523.80 ,$405.36 ,$112.29 ,$459.78 ,$45.41 ,$582.00 ,$582.00 ,$111.18 ,$582.00 ,$419.04 ,$360.84 ,$419.04 ,$419.04 ,$465.60 
ST NICHOLAS HOSPITAL - ACUTE,92200004,95872,HC EMG SINGLE FIBER DENSITY,922,1 ,$646.00 ,$323.00 ,$42.84 ,$646.00 ,$42.84 ,$417.90 ,$417.90 ,$137.66 ,$387.60 ,$549.10 ,$452.20 ,$42.84 ,$613.70 ,$490.96 ,$484.50 ,$419.90 ,$549.10 ,$137.66 ,$419.90 ,$419.90 ,$452.20 ,$42.84 ,$137.66 ,$137.66 ,$257.96 ,$549.10 ,$309.74 ,$594.32 ,$452.20 ,$327.65 ,$393.22 ,$393.41 ,$393.22 ,$446.39 ,$581.40 ,$449.94 ,$139.04 ,$510.34 ,$45.41 ,$646.00 ,$646.00 ,$137.66 ,$646.00 ,$465.12 ,$400.52 ,$465.12 ,$465.12 ,$516.80 
ST NICHOLAS HOSPITAL - ACUTE,92200015,95938,HC SSEP UPPER AND LOWER,922,1 ,"$1,680.00 ",$840.00 ,$42.84 ,"$1,680.00 ",$42.84 ,"$1,086.79 ","$1,086.79 ",$481.30 ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$42.84 ,"$1,596.00 ","$1,276.80 ","$1,260.00 ","$1,092.00 ","$1,428.00 ",$481.30 ,"$1,092.00 ","$1,092.00 ","$1,176.00 ",$42.84 ,$481.30 ,$481.30 ,$257.96 ,"$1,428.00 ","$1,082.93 ","$1,545.60 ","$1,176.00 ",$852.10 ,"$1,022.62 ","$1,023.12 ","$1,022.62 ","$1,160.88 ","$1,512.00 ","$1,170.12 ",$486.11 ,"$1,327.20 ",$45.41 ,$812.00 ,$812.00 ,$481.30 ,$812.00 ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,344.00 "
ST NICHOLAS HOSPITAL - ACUTE,92200028,95868,HC EMG CRANIAL NERVE BILAT,922,1 ,$593.00 ,$296.50 ,$42.84 ,$593.00 ,$42.84 ,$383.61 ,$383.61 ,$260.95 ,$355.80 ,$504.05 ,$415.10 ,$42.84 ,$563.35 ,$450.68 ,$444.75 ,$385.45 ,$504.05 ,$260.95 ,$385.45 ,$385.45 ,$415.10 ,$42.84 ,$260.95 ,$260.95 ,$257.96 ,$504.05 ,$587.13 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$360.96 ,$409.76 ,$533.70 ,$413.02 ,$263.56 ,$468.47 ,$45.41 ,$593.00 ,$593.00 ,$260.95 ,$593.00 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$474.40 
ST NICHOLAS HOSPITAL - ACUTE,92200029,95870,HC EMG NON LIMB,922,1 ,$226.00 ,$113.00 ,$42.84 ,$250.16 ,$42.84 ,$146.20 ,$146.20 ,$111.18 ,$135.60 ,$192.10 ,$158.20 ,$42.84 ,$214.70 ,$171.76 ,$169.50 ,$146.90 ,$192.10 ,$111.18 ,$146.90 ,$146.90 ,$158.20 ,$42.84 ,$111.18 ,$111.18 ,$226.00 ,$192.10 ,$250.16 ,$207.92 ,$158.20 ,$114.63 ,$137.57 ,$137.63 ,$137.57 ,$156.17 ,$203.40 ,$157.41 ,$112.29 ,$178.54 ,$45.41 ,$226.00 ,$226.00 ,$111.18 ,$226.00 ,$162.72 ,$140.12 ,$162.72 ,$162.72 ,$180.80 
ST NICHOLAS HOSPITAL - ACUTE,93280072,93280,HC PRGM DEVICE EVAL DUAL PREVEA 72HR,480,1 ,$116.00 ,$58.00 ,$12.10 ,$116.00 ,$12.10 ,$75.04 ,$75.04 ,$36.72 ,$69.60 ,$98.60 ,$81.20 ,$12.10 ,$110.20 ,$88.16 ,$87.00 ,$75.40 ,$98.60 ,$36.72 ,$75.40 ,$75.40 ,$81.20 ,$12.10 ,$36.72 ,$36.72 ,$116.00 ,$98.60 ,$82.61 ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$70.61 ,$80.16 ,$104.40 ,$80.79 ,$37.09 ,$91.64 ,$12.83 ,$116.00 ,$116.00 ,$36.72 ,$116.00 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$92.80 
ST NICHOLAS HOSPITAL - ACUTE,94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$248.00 ,$124.00 ,$18.43 ,$250.16 ,$18.43 ,$160.43 ,$160.43 ,$111.18 ,$148.80 ,$210.80 ,$173.60 ,$18.43 ,$235.60 ,$188.48 ,$186.00 ,$161.20 ,$210.80 ,$111.18 ,$161.20 ,$161.20 ,$173.60 ,$18.43 ,$111.18 ,$111.18 ,$216.10 ,$210.80 ,$250.16 ,$228.16 ,$173.60 ,$125.79 ,$150.96 ,$151.03 ,$150.96 ,$171.37 ,$223.20 ,$172.73 ,$112.29 ,$195.92 ,$19.54 ,$219.00 ,$219.00 ,$111.18 ,$219.00 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$198.40 
ST NICHOLAS HOSPITAL - ACUTE,94200005,97802,HC NUTRITION THRPY EVAL 15 MIN,942,1 ,$103.00 ,$51.50 ,$30.45 ,$103.00 ,$61.74 ,$66.63 ,$66.63 ,$30.45 ,$61.80 ,$87.55 ,$72.10 ,$61.74 ,$97.85 ,$78.28 ,$77.25 ,$66.95 ,$87.55 ,$30.45 ,$66.95 ,$66.95 ,$72.10 ,$61.74 ,$30.45 ,$30.45 ,$103.00 ,$87.55 ,$80.60 ,$94.76 ,$72.10 ,$52.24 ,$62.70 ,$62.73 ,$62.70 ,$71.17 ,$92.70 ,$71.74 ,$30.75 ,$81.37 ,$65.44 ,$103.00 ,$103.00 ,$30.45 ,$103.00 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$82.40 
ST NICHOLAS HOSPITAL - ACUTE,94200006,97803,HC NUTRITION THRPY RE-EVAL 15 MIN,942,1 ,$87.00 ,$43.50 ,$26.44 ,$87.00 ,$61.74 ,$56.28 ,$56.28 ,$26.44 ,$52.20 ,$73.95 ,$60.90 ,$61.74 ,$82.65 ,$66.12 ,$65.25 ,$56.55 ,$73.95 ,$26.44 ,$56.55 ,$56.55 ,$60.90 ,$61.74 ,$26.44 ,$26.44 ,$87.00 ,$73.95 ,$69.98 ,$80.04 ,$60.90 ,$44.13 ,$52.96 ,$52.98 ,$52.96 ,$60.12 ,$78.30 ,$60.60 ,$26.70 ,$68.73 ,$65.44 ,$87.00 ,$87.00 ,$26.44 ,$87.00 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$69.60 
ST NICHOLAS HOSPITAL - ACUTE,94200008,99406,HC SMOKING CESSATION PULM 3-10MIN,942,1 ,$43.00 ,$21.50 ,$7.57 ,$58.30 ,$7.57 ,$27.82 ,$27.82 ,$25.91 ,$25.80 ,$36.55 ,$30.10 ,$7.57 ,$40.85 ,$32.68 ,$32.25 ,$27.95 ,$36.55 ,$25.91 ,$27.95 ,$27.95 ,$30.10 ,$7.57 ,$25.91 ,$25.91 ,$43.00 ,$36.55 ,$58.30 ,$39.56 ,$30.10 ,$21.81 ,$26.17 ,$26.19 ,$26.17 ,$29.71 ,$38.70 ,$29.95 ,$26.17 ,$33.97 ,$8.02 ,$43.00 ,$43.00 ,$25.91 ,$43.00 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$34.40 
ST NICHOLAS HOSPITAL - ACUTE,94200009,99407,HC SMOKING CESSATION PULM >10 MIN,942,1 ,$62.00 ,$31.00 ,$7.57 ,$62.00 ,$7.57 ,$40.11 ,$40.11 ,$25.91 ,$37.20 ,$52.70 ,$43.40 ,$7.57 ,$58.90 ,$47.12 ,$46.50 ,$40.30 ,$52.70 ,$25.91 ,$40.30 ,$40.30 ,$43.40 ,$7.57 ,$25.91 ,$25.91 ,$62.00 ,$52.70 ,$58.30 ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$37.74 ,$42.84 ,$55.80 ,$43.18 ,$26.17 ,$48.98 ,$8.02 ,$62.00 ,$62.00 ,$25.91 ,$62.00 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$49.60 
ST NICHOLAS HOSPITAL - ACUTE,94200011,G0108,HC DIABETES SELF MGT ED 30 MIN,942,1 ,$160.00 ,$80.00 ,$20.62 ,$160.00 ,$20.62 ,$103.50 ,$103.50 ,$53.50 ,$96.00 ,$136.00 ,$112.00 ,$20.62 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 ,$53.50 ,$104.00 ,$104.00 ,$112.00 ,$20.62 ,$53.50 ,$53.50 ,$130.11 ,$136.00 ,$120.38 ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$97.39 ,$110.56 ,$144.00 ,$111.44 ,$54.04 ,$126.40 ,$21.86 ,$133.00 ,$133.00 ,$53.50 ,$133.00 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,94201000,N/A,HC NUTRITION SUPPORT IP,942,1 ,$58.00 ,$29.00 ,$29.00 ,$58.00 , N/A ,$37.52 ,$37.52 , N/A ,$34.80 ,$49.30 ,$40.60 , N/A ,$55.10 ,$44.08 ,$43.50 ,$37.70 ,$49.30 , N/A ,$37.70 ,$37.70 ,$40.60 , N/A , N/A , N/A ,$58.00 ,$49.30 , N/A ,$53.36 ,$40.60 ,$29.42 ,$35.30 ,$35.32 ,$35.30 ,$40.08 ,$52.20 ,$40.40 , N/A ,$45.82 , N/A ,$58.00 ,$58.00 , N/A ,$58.00 ,$41.76 ,$35.96 ,$41.76 ,$41.76 ,$46.40 
ST NICHOLAS HOSPITAL - ACUTE,94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$72.00 ,$36.00 ,$36.00 ,$257.52 ,$47.12 ,$72.00 ,$72.00 ,$114.45 ,$43.20 ,$61.20 ,$50.40 ,$47.12 ,$68.40 ,$54.72 ,$54.00 ,$46.80 ,$61.20 ,$114.45 ,$46.80 ,$46.80 ,$50.40 ,$47.12 ,$114.45 ,$114.45 ,$72.00 ,$61.20 ,$257.52 ,$66.24 ,$50.40 ,$36.52 ,$43.83 ,$43.85 ,$43.83 ,$49.75 ,$64.80 ,$50.15 ,$115.59 ,$56.88 ,$49.95 ,$72.00 ,$72.00 ,$114.45 ,$72.00 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$57.60 
ST NICHOLAS HOSPITAL - ACUTE,94300005,93798,HC CARDIAC REHAB W/EKG SESSION (PH2),943,1 ,$381.00 ,$190.50 ,$47.12 ,$381.00 ,$47.12 ,$381.00 ,$381.00 ,$114.45 ,$228.60 ,$323.85 ,$266.70 ,$47.12 ,$361.95 ,$289.56 ,$285.75 ,$247.65 ,$323.85 ,$114.45 ,$247.65 ,$247.65 ,$266.70 ,$47.12 ,$114.45 ,$114.45 ,$130.11 ,$323.85 ,$257.52 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$231.91 ,$263.27 ,$342.90 ,$265.37 ,$115.59 ,$300.99 ,$49.95 ,$381.00 ,$381.00 ,$114.45 ,$381.00 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$443.00 ,$221.50 ,$47.12 ,$443.00 ,$47.12 ,$443.00 ,$443.00 ,$114.45 ,$265.80 ,$376.55 ,$310.10 ,$47.12 ,$420.85 ,$336.68 ,$332.25 ,$287.95 ,$376.55 ,$114.45 ,$287.95 ,$287.95 ,$310.10 ,$47.12 ,$114.45 ,$114.45 ,$130.11 ,$376.55 ,$257.52 ,$407.56 ,$310.10 ,$224.69 ,$269.65 ,$269.79 ,$269.65 ,$306.11 ,$398.70 ,$308.55 ,$115.59 ,$349.97 ,$49.95 ,$443.00 ,$443.00 ,$114.45 ,$443.00 ,$318.96 ,$274.66 ,$318.96 ,$318.96 ,$354.40 
ST NICHOLAS HOSPITAL - ACUTE,94300013,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$85.00 ,$42.50 ,$42.50 ,$257.52 ,$47.12 ,$85.00 ,$85.00 ,$114.45 ,$51.00 ,$72.25 ,$59.50 ,$47.12 ,$80.75 ,$64.60 ,$63.75 ,$55.25 ,$72.25 ,$114.45 ,$55.25 ,$55.25 ,$59.50 ,$47.12 ,$114.45 ,$114.45 ,$85.00 ,$72.25 ,$257.52 ,$78.20 ,$59.50 ,$43.11 ,$51.74 ,$51.77 ,$51.74 ,$58.74 ,$76.50 ,$59.20 ,$115.59 ,$67.15 ,$49.95 ,$85.00 ,$85.00 ,$114.45 ,$85.00 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$68.00 
ST NICHOLAS HOSPITAL - ACUTE,94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$381.00 ,$190.50 ,$47.12 ,$381.00 ,$47.12 ,$381.00 ,$381.00 ,$114.45 ,$228.60 ,$323.85 ,$266.70 ,$47.12 ,$361.95 ,$289.56 ,$285.75 ,$247.65 ,$323.85 ,$114.45 ,$247.65 ,$247.65 ,$266.70 ,$47.12 ,$114.45 ,$114.45 ,$130.11 ,$323.85 ,$257.52 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$231.91 ,$263.27 ,$342.90 ,$265.37 ,$115.59 ,$300.99 ,$49.95 ,$381.00 ,$381.00 ,$114.45 ,$381.00 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$304.80 
ST NICHOLAS HOSPITAL - ACUTE,94800001,94625,HC PHY/QHP OP PULM RHB W/O MNTR,948,1 ,$162.00 ,$81.00 ,$11.17 ,$162.00 ,$11.17 ,$104.80 ,$104.80 ,$54.89 ,$97.20 ,$137.70 ,$113.40 ,$11.17 ,$153.90 ,$123.12 ,$121.50 ,$105.30 ,$137.70 ,$54.89 ,$105.30 ,$105.30 ,$113.40 ,$11.17 ,$54.89 ,$54.89 ,$68.04 ,$137.70 ,$123.49 ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$98.61 ,$111.94 ,$145.80 ,$112.83 ,$55.44 ,$127.98 ,$11.84 ,$81.00 ,$81.00 ,$54.89 ,$81.00 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,94800002,94626,HC PHY/QHP OP PULM RHB W/MNTR,948,1 ,$162.00 ,$81.00 ,$11.17 ,$162.00 ,$11.17 ,$104.80 ,$104.80 ,$54.89 ,$97.20 ,$137.70 ,$113.40 ,$11.17 ,$153.90 ,$123.12 ,$121.50 ,$105.30 ,$137.70 ,$54.89 ,$105.30 ,$105.30 ,$113.40 ,$11.17 ,$54.89 ,$54.89 ,$68.04 ,$137.70 ,$123.49 ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$98.61 ,$111.94 ,$145.80 ,$112.83 ,$55.44 ,$127.98 ,$11.84 ,$81.00 ,$81.00 ,$54.89 ,$81.00 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$129.60 
ST NICHOLAS HOSPITAL - ACUTE,96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$25.00 ,$12.50 ,$10.50 ,$25.00 , N/A ,$16.17 ,$16.17 , N/A ,$15.00 ,$21.25 ,$17.50 , N/A ,$23.75 ,$19.00 ,$18.75 ,$16.25 ,$21.25 , N/A ,$16.25 ,$16.25 ,$17.50 , N/A , N/A , N/A ,$10.50 ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$15.22 ,$17.28 ,$22.50 ,$17.41 , N/A ,$19.75 , N/A , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$50.00 ,$25.00 ,$21.00 ,$50.00 , N/A ,$32.35 ,$32.35 , N/A ,$30.00 ,$42.50 ,$35.00 , N/A ,$47.50 ,$38.00 ,$37.50 ,$32.50 ,$42.50 , N/A ,$32.50 ,$32.50 ,$35.00 , N/A , N/A , N/A ,$21.00 ,$42.50 , N/A ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.83 , N/A ,$39.50 , N/A , N/A , N/A , N/A , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$75.00 ,$37.50 ,$31.50 ,$75.00 , N/A ,$48.52 ,$48.52 , N/A ,$45.00 ,$63.75 ,$52.50 , N/A ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 , N/A ,$48.75 ,$48.75 ,$52.50 , N/A , N/A , N/A ,$31.50 ,$63.75 , N/A ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 , N/A ,$59.25 , N/A , N/A , N/A , N/A , N/A ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,96000047,99421,PC ONLINE DIG E/M SVC 5-10 MIN-95,960,1 ,$35.00 ,$17.50 ,$14.70 ,$40.52 ,$38.23 ,$22.64 ,$22.64 , N/A ,$21.00 ,$29.75 ,$24.50 ,$38.23 ,$33.25 ,$26.60 ,$26.25 ,$22.75 ,$29.75 , N/A ,$22.75 ,$22.75 ,$24.50 ,$38.23 , N/A , N/A ,$14.70 ,$29.75 , N/A ,$32.20 ,$24.50 ,$17.75 ,$21.30 ,$21.32 ,$21.30 ,$24.19 ,$31.50 ,$24.38 , N/A ,$27.65 ,$40.52 , N/A , N/A , N/A , N/A ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$28.00 
ST NICHOLAS HOSPITAL - ACUTE,96000048,99422,PC ONLINE DIG E/M SVC 11-20 MIN-95,960,1 ,$70.00 ,$35.00 ,$29.40 ,$70.00 ,$38.23 ,$45.28 ,$45.28 , N/A ,$42.00 ,$59.50 ,$49.00 ,$38.23 ,$66.50 ,$53.20 ,$52.50 ,$45.50 ,$59.50 , N/A ,$45.50 ,$45.50 ,$49.00 ,$38.23 , N/A , N/A ,$29.40 ,$59.50 , N/A ,$64.40 ,$49.00 ,$35.50 ,$42.61 ,$42.63 ,$42.61 ,$48.37 ,$63.00 ,$48.76 , N/A ,$55.30 ,$40.52 , N/A , N/A , N/A , N/A ,$50.40 ,$43.40 ,$50.40 ,$50.40 ,$56.00 
ST NICHOLAS HOSPITAL - ACUTE,96000049,99423,PC ONLINE DIG E/M SVC 21+ MIN-95,960,1 ,$105.00 ,$52.50 ,$38.23 ,$105.00 ,$38.23 ,$67.92 ,$67.92 , N/A ,$63.00 ,$89.25 ,$73.50 ,$38.23 ,$99.75 ,$79.80 ,$78.75 ,$68.25 ,$89.25 , N/A ,$68.25 ,$68.25 ,$73.50 ,$38.23 , N/A , N/A ,$44.10 ,$89.25 , N/A ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$63.91 ,$72.56 ,$94.50 ,$73.13 , N/A ,$82.95 ,$40.52 , N/A , N/A , N/A , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$84.00 
ST NICHOLAS HOSPITAL - ACUTE,96000051,G2012,PC BRIEF CHECK IN BY MD/QHP-95,960,1 ,$30.00 ,$15.00 ,$12.60 ,$30.00 ,$13.65 ,$19.41 ,$19.41 , N/A ,$18.00 ,$25.50 ,$21.00 ,$13.65 ,$28.50 ,$22.80 ,$22.50 ,$19.50 ,$25.50 , N/A ,$19.50 ,$19.50 ,$21.00 ,$13.65 , N/A , N/A ,$12.60 ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$18.26 ,$20.73 ,$27.00 ,$20.90 , N/A ,$23.70 ,$14.47 , N/A , N/A , N/A , N/A ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$24.00 
ST NICHOLAS HOSPITAL - ACUTE,96080010,57410,PC PELVIC EXAM UNDER ANEST 57410,960,1 ,$485.00 ,$242.50 ,$61.96 ,"$5,820.65 ",$61.96 ,$313.75 ,$313.75 ,"$2,586.95 ",$291.00 ,$412.25 ,$339.50 ,$61.96 ,$460.75 ,$368.60 ,$363.75 ,$315.25 ,$412.25 ,"$2,586.95 ",$315.25 ,$315.25 ,$339.50 ,$61.96 ,"$2,586.95 ","$2,586.95 ",$203.70 ,$412.25 ,"$5,820.65 ",$446.20 ,$339.50 ,$485.00 ,$485.00 ,$295.37 ,$485.00 ,$335.14 ,$436.50 ,$337.80 ,"$2,612.82 ",$383.15 ,$65.68 , N/A , N/A ,"$2,586.95 ", N/A ,$349.20 ,$300.70 ,$349.20 ,$349.20 ,$388.00 
ST NICHOLAS HOSPITAL - ACUTE,96100003,90792,PC EVAL PSYCH DIAG W/MED SERVICE MD,961,1 ,$150.00 ,$75.00 ,$63.00 ,$296.84 ,$82.53 ,$97.04 ,$97.04 ,$131.93 ,$90.00 ,$127.50 ,$105.00 ,$82.53 ,$142.50 ,$114.00 ,$112.50 ,$97.50 ,$127.50 ,$131.93 ,$97.50 ,$97.50 ,$105.00 ,$82.53 ,$131.93 ,$131.93 ,$63.00 ,$127.50 ,$296.84 ,$138.00 ,$105.00 ,$76.08 ,$91.31 ,$91.35 ,$91.31 ,$103.65 ,$135.00 ,$104.48 ,$133.25 ,$118.50 ,$87.48 , N/A , N/A ,$131.93 , N/A ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$120.00 
ST NICHOLAS HOSPITAL - ACUTE,97380047,57155,PC INSERTION TANDEM OR OVOID VAG BRACHYTHERAPY,973,1 ,"$1,240.00 ",$620.00 ,$520.80 ,"$9,782.66 ",$549.97 ,$802.16 ,$802.16 ,"$4,347.85 ",$744.00 ,"$1,054.00 ",$868.00 ,$549.97 ,"$1,178.00 ",$942.40 ,$930.00 ,$806.00 ,"$1,054.00 ","$4,347.85 ",$806.00 ,$806.00 ,$868.00 ,$549.97 ,"$4,347.85 ","$4,347.85 ",$520.80 ,"$1,054.00 ","$9,782.66 ","$1,140.80 ",$868.00 ,"$1,240.00 ","$1,240.00 ",$755.16 ,"$1,240.00 ",$856.84 ,"$1,116.00 ",$863.66 ,"$4,391.33 ",$979.60 ,$582.97 , N/A , N/A ,"$4,347.85 ", N/A ,$892.80 ,$768.80 ,$892.80 ,$892.80 ,$992.00 
ST NICHOLAS HOSPITAL - ACUTE,97500079,G0121,PC COLONSCOPY CANCER SCREENING NOT HIGH RISK,975,1 ,"$1,170.00 ",$585.00 ,$304.93 ,"$1,760.56 ",$304.93 ,$756.87 ,$756.87 ,$782.47 ,$702.00 ,$994.50 ,$819.00 ,$304.93 ,"$1,111.50 ",$889.20 ,$877.50 ,$760.50 ,$994.50 ,$782.47 ,$760.50 ,$760.50 ,$819.00 ,$304.93 ,$782.47 ,$782.47 ,$491.40 ,$994.50 ,"$1,760.56 ","$1,076.40 ",$819.00 ,"$1,170.00 ","$1,170.00 ",$712.53 ,"$1,170.00 ",$808.47 ,"$1,053.00 ",$814.91 ,$790.29 ,$924.30 ,$323.23 , N/A , N/A ,$782.47 , N/A ,$842.40 ,$725.40 ,$842.40 ,$842.40 ,$936.00 
ST NICHOLAS HOSPITAL - ACUTE,98180479,69209,"PC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL",981,1 ,$40.00 ,$20.00 ,$16.80 ,$123.49 ,$34.89 ,$25.88 ,$25.88 ,$54.89 ,$24.00 ,$34.00 ,$28.00 ,$34.89 ,$38.00 ,$30.40 ,$30.00 ,$26.00 ,$34.00 ,$54.89 ,$26.00 ,$26.00 ,$28.00 ,$34.89 ,$54.89 ,$54.89 ,$16.80 ,$34.00 ,$123.49 ,$36.80 ,$28.00 ,$40.00 ,$40.00 ,$24.36 ,$40.00 ,$27.64 ,$36.00 ,$27.86 ,$55.44 ,$31.60 ,$36.98 , N/A , N/A ,$54.89 , N/A ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$32.00 
ST NICHOLAS HOSPITAL - ACUTE,98180947,G0425,PC TELEHEALTH CONSULT 30 MIN,981,1 ,$300.00 ,$150.00 ,$38.23 ,$300.00 ,$38.23 ,$194.07 ,$194.07 , N/A ,$180.00 ,$255.00 ,$210.00 ,$38.23 ,$285.00 ,$228.00 ,$225.00 ,$195.00 ,$255.00 , N/A ,$195.00 ,$195.00 ,$210.00 ,$38.23 , N/A , N/A ,$126.00 ,$255.00 , N/A ,$276.00 ,$210.00 ,$152.16 ,$182.61 ,$182.70 ,$182.61 ,$207.30 ,$270.00 ,$208.95 , N/A ,$237.00 ,$40.52 , N/A , N/A , N/A , N/A ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$240.00 
ST NICHOLAS HOSPITAL - ACUTE,98180948,G0426,PC TELEHEALTH CONSULT 50 MIN,981,1 ,$400.00 ,$200.00 ,$38.23 ,$400.00 ,$38.23 ,$258.76 ,$258.76 , N/A ,$240.00 ,$340.00 ,$280.00 ,$38.23 ,$380.00 ,$304.00 ,$300.00 ,$260.00 ,$340.00 , N/A ,$260.00 ,$260.00 ,$280.00 ,$38.23 , N/A , N/A ,$168.00 ,$340.00 , N/A ,$368.00 ,$280.00 ,$202.88 ,$243.48 ,$243.60 ,$243.48 ,$276.40 ,$360.00 ,$278.60 , N/A ,$316.00 ,$40.52 , N/A , N/A , N/A , N/A ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$320.00 
ST NICHOLAS HOSPITAL - ACUTE,98180949,G0427,PC TELEHEALTH CONSULT 70 MIN,981,1 ,$500.00 ,$250.00 ,$38.23 ,$500.00 ,$38.23 ,$323.45 ,$323.45 , N/A ,$300.00 ,$425.00 ,$350.00 ,$38.23 ,$475.00 ,$380.00 ,$375.00 ,$325.00 ,$425.00 , N/A ,$325.00 ,$325.00 ,$350.00 ,$38.23 , N/A , N/A ,$210.00 ,$425.00 , N/A ,$460.00 ,$350.00 ,$253.60 ,$304.35 ,$304.50 ,$304.35 ,$345.50 ,$450.00 ,$348.25 , N/A ,$395.00 ,$40.52 , N/A , N/A , N/A , N/A ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$400.00 
ST NICHOLAS HOSPITAL - ACUTE,98180978,G0508,PC TELEHEALTH CRITICAL CARE CONSULT 60 MIN,981,1 ,$600.00 ,$300.00 ,$38.23 ,$600.00 ,$38.23 ,$388.14 ,$388.14 , N/A ,$360.00 ,$510.00 ,$420.00 ,$38.23 ,$570.00 ,$456.00 ,$450.00 ,$390.00 ,$510.00 , N/A ,$390.00 ,$390.00 ,$420.00 ,$38.23 , N/A , N/A ,$252.00 ,$510.00 , N/A ,$552.00 ,$420.00 ,$304.32 ,$365.22 ,$365.40 ,$365.22 ,$414.60 ,$540.00 ,$417.90 , N/A ,$474.00 ,$40.52 , N/A , N/A , N/A , N/A ,$432.00 ,$372.00 ,$432.00 ,$432.00 ,$480.00 
ST NICHOLAS HOSPITAL - ACUTE,98200003,99203,PC CLINIC VISIT INTERM NEW PRO,982,1 ,$240.00 ,$120.00 ,$38.23 ,$240.00 ,$38.23 ,$155.26 ,$155.26 , N/A ,$144.00 ,$204.00 ,$168.00 ,$38.23 ,$228.00 ,$182.40 ,$180.00 ,$156.00 ,$204.00 , N/A ,$156.00 ,$156.00 ,$168.00 ,$38.23 , N/A , N/A ,$100.80 ,$204.00 , N/A ,$220.80 ,$168.00 ,$121.73 ,$146.09 ,$146.16 ,$146.09 ,$165.84 ,$216.00 ,$167.16 , N/A ,$189.60 ,$40.52 , N/A , N/A , N/A , N/A ,$172.80 ,$148.80 ,$172.80 ,$172.80 ,$192.00 
ST NICHOLAS HOSPITAL - ACUTE,98200004,99204,PC CLINIC VISIT COMPLEX NEW PRO,982,1 ,$290.00 ,$145.00 ,$38.23 ,$290.00 ,$38.23 ,$187.60 ,$187.60 , N/A ,$174.00 ,$246.50 ,$203.00 ,$38.23 ,$275.50 ,$220.40 ,$217.50 ,$188.50 ,$246.50 , N/A ,$188.50 ,$188.50 ,$203.00 ,$38.23 , N/A , N/A ,$121.80 ,$246.50 , N/A ,$266.80 ,$203.00 ,$147.09 ,$176.52 ,$176.61 ,$176.52 ,$200.39 ,$261.00 ,$201.99 , N/A ,$229.10 ,$40.52 , N/A , N/A , N/A , N/A ,$208.80 ,$179.80 ,$208.80 ,$208.80 ,$232.00 
ST NICHOLAS HOSPITAL - ACUTE,98200005,99205,PC CLINIC VISIT COMPREH NEW PRO,982,1 ,$375.00 ,$187.50 ,$38.23 ,$375.00 ,$38.23 ,$242.59 ,$242.59 , N/A ,$225.00 ,$318.75 ,$262.50 ,$38.23 ,$356.25 ,$285.00 ,$281.25 ,$243.75 ,$318.75 , N/A ,$243.75 ,$243.75 ,$262.50 ,$38.23 , N/A , N/A ,$157.50 ,$318.75 , N/A ,$345.00 ,$262.50 ,$190.20 ,$228.26 ,$228.38 ,$228.26 ,$259.13 ,$337.50 ,$261.19 , N/A ,$296.25 ,$40.52 , N/A , N/A , N/A , N/A ,$270.00 ,$232.50 ,$270.00 ,$270.00 ,$300.00 
ST NICHOLAS HOSPITAL - ACUTE,98200006,99211,PC CLINIC VISIT BRIEF EST PRO,982,1 ,$185.00 ,$92.50 ,$38.23 ,$185.00 ,$38.23 ,$119.68 ,$119.68 , N/A ,$111.00 ,$157.25 ,$129.50 ,$38.23 ,$175.75 ,$140.60 ,$138.75 ,$120.25 ,$157.25 , N/A ,$120.25 ,$120.25 ,$129.50 ,$38.23 , N/A , N/A ,$77.70 ,$157.25 , N/A ,$170.20 ,$129.50 ,$93.83 ,$112.61 ,$112.67 ,$112.61 ,$127.84 ,$166.50 ,$128.85 , N/A ,$146.15 ,$40.52 , N/A , N/A , N/A , N/A ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$148.00 
ST NICHOLAS HOSPITAL - ACUTE,98200007,99212,PC CLINIC VISIT LIMIT EST PRO,982,1 ,$195.00 ,$97.50 ,$38.23 ,$195.00 ,$38.23 ,$126.15 ,$126.15 , N/A ,$117.00 ,$165.75 ,$136.50 ,$38.23 ,$185.25 ,$148.20 ,$146.25 ,$126.75 ,$165.75 , N/A ,$126.75 ,$126.75 ,$136.50 ,$38.23 , N/A , N/A ,$81.90 ,$165.75 , N/A ,$179.40 ,$136.50 ,$98.90 ,$118.70 ,$118.76 ,$118.70 ,$134.75 ,$175.50 ,$135.82 , N/A ,$154.05 ,$40.52 , N/A , N/A , N/A , N/A ,$140.40 ,$120.90 ,$140.40 ,$140.40 ,$156.00 
ST NICHOLAS HOSPITAL - ACUTE,98200008,99213,PC CLINIC VISIT INTERM EST PRO,982,1 ,$235.00 ,$117.50 ,$38.23 ,$235.00 ,$38.23 ,$152.02 ,$152.02 , N/A ,$141.00 ,$199.75 ,$164.50 ,$38.23 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$38.23 , N/A , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$163.68 , N/A ,$185.65 ,$40.52 , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,98200009,99214,PC CLINIC VISIT COMPLX EST PRO,982,1 ,$260.00 ,$130.00 ,$38.23 ,$260.00 ,$38.23 ,$168.19 ,$168.19 , N/A ,$156.00 ,$221.00 ,$182.00 ,$38.23 ,$247.00 ,$197.60 ,$195.00 ,$169.00 ,$221.00 , N/A ,$169.00 ,$169.00 ,$182.00 ,$38.23 , N/A , N/A ,$109.20 ,$221.00 , N/A ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$158.26 ,$179.66 ,$234.00 ,$181.09 , N/A ,$205.40 ,$40.52 , N/A , N/A , N/A , N/A ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$208.00 
ST NICHOLAS HOSPITAL - ACUTE,98200010,99215,PC CLINIC VISIT COMPRH EST PRO,982,1 ,$325.00 ,$162.50 ,$38.23 ,$325.00 ,$38.23 ,$210.24 ,$210.24 , N/A ,$195.00 ,$276.25 ,$227.50 ,$38.23 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 , N/A ,$211.25 ,$211.25 ,$227.50 ,$38.23 , N/A , N/A ,$136.50 ,$276.25 , N/A ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$197.83 ,$224.58 ,$292.50 ,$226.36 , N/A ,$256.75 ,$40.52 , N/A , N/A , N/A , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98200079,99417,PC PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN,982,1 ,$92.00 ,$46.00 ,$38.64 ,$92.00 , N/A ,$59.51 ,$59.51 , N/A ,$55.20 ,$78.20 ,$64.40 , N/A ,$87.40 ,$69.92 ,$69.00 ,$59.80 ,$78.20 , N/A ,$59.80 ,$59.80 ,$64.40 , N/A , N/A , N/A ,$38.64 ,$78.20 , N/A ,$84.64 ,$64.40 ,$46.66 ,$56.00 ,$56.03 ,$56.00 ,$63.57 ,$82.80 ,$64.08 , N/A ,$72.68 , N/A , N/A , N/A , N/A , N/A ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$73.60 
ST NICHOLAS HOSPITAL - ACUTE,98280006,99406,PC SMOKING/TOBACCO COUNSELING 3 TO 10 MIN.,982,1 ,$50.00 ,$25.00 ,$7.57 ,$58.30 ,$7.57 ,$32.35 ,$32.35 ,$25.91 ,$30.00 ,$42.50 ,$35.00 ,$7.57 ,$47.50 ,$38.00 ,$37.50 ,$32.50 ,$42.50 ,$25.91 ,$32.50 ,$32.50 ,$35.00 ,$7.57 ,$25.91 ,$25.91 ,$21.00 ,$42.50 ,$58.30 ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.83 ,$26.17 ,$39.50 ,$8.02 , N/A , N/A ,$25.91 , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,98280007,99407,PC SMOKING CESSATION > 10 MINUTES,982,1 ,$80.00 ,$40.00 ,$7.57 ,$80.00 ,$7.57 ,$51.75 ,$51.75 ,$25.91 ,$48.00 ,$68.00 ,$56.00 ,$7.57 ,$76.00 ,$60.80 ,$60.00 ,$52.00 ,$68.00 ,$25.91 ,$52.00 ,$52.00 ,$56.00 ,$7.57 ,$25.91 ,$25.91 ,$33.60 ,$68.00 ,$58.30 ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$48.70 ,$55.28 ,$72.00 ,$55.72 ,$26.17 ,$63.20 ,$8.02 , N/A , N/A ,$25.91 , N/A ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$64.00 
ST NICHOLAS HOSPITAL - ACUTE,98280009,99441,PC TELEPHONE E/M 5-10 MINS OF MEDICAL DISCUSSION,982,1 ,$25.00 ,$12.50 ,$10.50 ,$40.52 ,$38.23 ,$16.17 ,$16.17 , N/A ,$15.00 ,$21.25 ,$17.50 ,$38.23 ,$23.75 ,$19.00 ,$18.75 ,$16.25 ,$21.25 , N/A ,$16.25 ,$16.25 ,$17.50 ,$38.23 , N/A , N/A ,$10.50 ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$15.22 ,$17.28 ,$22.50 ,$17.41 , N/A ,$19.75 ,$40.52 , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$20.00 
ST NICHOLAS HOSPITAL - ACUTE,98280010,99442,PC TELEPHONE E/M 11-20 MINS OF MEDICAL DISCUSSION,982,1 ,$50.00 ,$25.00 ,$21.00 ,$50.00 ,$38.23 ,$32.35 ,$32.35 , N/A ,$30.00 ,$42.50 ,$35.00 ,$38.23 ,$47.50 ,$38.00 ,$37.50 ,$32.50 ,$42.50 , N/A ,$32.50 ,$32.50 ,$35.00 ,$38.23 , N/A , N/A ,$21.00 ,$42.50 , N/A ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$30.44 ,$34.55 ,$45.00 ,$34.83 , N/A ,$39.50 ,$40.52 , N/A , N/A , N/A , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$40.00 
ST NICHOLAS HOSPITAL - ACUTE,98280011,99443,PC TELEPHONE E/M 21-30 MINS OF MEDICAL DISCUSSION,982,1 ,$75.00 ,$37.50 ,$31.50 ,$75.00 ,$38.23 ,$48.52 ,$48.52 , N/A ,$45.00 ,$63.75 ,$52.50 ,$38.23 ,$71.25 ,$57.00 ,$56.25 ,$48.75 ,$63.75 , N/A ,$48.75 ,$48.75 ,$52.50 ,$38.23 , N/A , N/A ,$31.50 ,$63.75 , N/A ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$45.65 ,$51.83 ,$67.50 ,$52.24 , N/A ,$59.25 ,$40.52 , N/A , N/A , N/A , N/A ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$60.00 
ST NICHOLAS HOSPITAL - ACUTE,98300001,10060,PC I AND D ABSC SMP PRO,983,1 ,$375.00 ,$187.50 ,$51.36 ,$398.39 ,$51.36 ,$242.59 ,$242.59 ,$177.06 ,$225.00 ,$318.75 ,$262.50 ,$51.36 ,$356.25 ,$285.00 ,$281.25 ,$243.75 ,$318.75 ,$177.06 ,$243.75 ,$243.75 ,$262.50 ,$51.36 ,$177.06 ,$177.06 ,$157.50 ,$318.75 ,$398.39 ,$345.00 ,$262.50 ,$375.00 ,$375.00 ,$228.38 ,$375.00 ,$259.13 ,$337.50 ,$261.19 ,$178.83 ,$296.25 ,$54.44 , N/A , N/A ,$177.06 , N/A ,$270.00 ,$232.50 ,$270.00 ,$270.00 ,$300.00 
ST NICHOLAS HOSPITAL - ACUTE,98300004,11042,PC DEBR SKIN/SUBQ TISS INIT 20CM PRO,983,1 ,$460.00 ,$230.00 ,$118.09 ,$766.80 ,$118.09 ,$297.57 ,$297.57 ,$340.80 ,$276.00 ,$391.00 ,$322.00 ,$118.09 ,$437.00 ,$349.60 ,$345.00 ,$299.00 ,$391.00 ,$340.80 ,$299.00 ,$299.00 ,$322.00 ,$118.09 ,$340.80 ,$340.80 ,$193.20 ,$391.00 ,$766.80 ,$423.20 ,$322.00 ,$460.00 ,$460.00 ,$280.14 ,$460.00 ,$317.86 ,$414.00 ,$320.39 ,$344.21 ,$363.40 ,$125.18 , N/A , N/A ,$340.80 , N/A ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,98300005,11042,PC DEBR SKIN/SUBQ TISS/PROC INIT 20CM PRO,983,1 ,$460.00 ,$230.00 ,$118.09 ,$766.80 ,$118.09 ,$297.57 ,$297.57 ,$340.80 ,$276.00 ,$391.00 ,$322.00 ,$118.09 ,$437.00 ,$349.60 ,$345.00 ,$299.00 ,$391.00 ,$340.80 ,$299.00 ,$299.00 ,$322.00 ,$118.09 ,$340.80 ,$340.80 ,$193.20 ,$391.00 ,$766.80 ,$423.20 ,$322.00 ,$460.00 ,$460.00 ,$280.14 ,$460.00 ,$317.86 ,$414.00 ,$320.39 ,$344.21 ,$363.40 ,$125.18 , N/A , N/A ,$340.80 , N/A ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$368.00 
ST NICHOLAS HOSPITAL - ACUTE,98300006,11043,PC DEBR SKIN/SUBQ TISSUE/MUSCLE PRO,983,1 ,$585.00 ,$292.50 ,$118.09 ,"$1,161.91 ",$118.09 ,$378.44 ,$378.44 ,$516.40 ,$351.00 ,$497.25 ,$409.50 ,$118.09 ,$555.75 ,$444.60 ,$438.75 ,$380.25 ,$497.25 ,$516.40 ,$380.25 ,$380.25 ,$409.50 ,$118.09 ,$516.40 ,$516.40 ,$245.70 ,$497.25 ,"$1,161.91 ",$538.20 ,$409.50 ,$585.00 ,$585.00 ,$356.27 ,$585.00 ,$404.24 ,$526.50 ,$407.45 ,$521.56 ,$462.15 ,$125.18 , N/A , N/A ,$516.40 , N/A ,$421.20 ,$362.70 ,$421.20 ,$421.20 ,$468.00 
ST NICHOLAS HOSPITAL - ACUTE,98300008,11044,PC DEBR SKIN/SUB TIS/MUS/BONE INT 20 PRO,983,1 ,"$1,295.00 ",$647.50 ,$315.09 ,"$3,121.49 ",$315.09 ,$837.74 ,$837.74 ,"$1,387.33 ",$777.00 ,"$1,100.75 ",$906.50 ,$315.09 ,"$1,230.25 ",$984.20 ,$971.25 ,$841.75 ,"$1,100.75 ","$1,387.33 ",$841.75 ,$841.75 ,$906.50 ,$315.09 ,"$1,387.33 ","$1,387.33 ",$543.90 ,"$1,100.75 ","$3,121.49 ","$1,191.40 ",$906.50 ,"$1,295.00 ","$1,295.00 ",$788.66 ,"$1,295.00 ",$894.85 ,"$1,165.50 ",$901.97 ,"$1,401.20 ","$1,023.05 ",$334.00 , N/A , N/A ,"$1,387.33 ", N/A ,$932.40 ,$802.90 ,$932.40 ,$932.40 ,"$1,036.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300009,11044,PC DEBR SKIN/SUB TIS/MUS/BONE INT 20PROC PRO,983,1 ,"$1,295.00 ",$647.50 ,$315.09 ,"$3,121.49 ",$315.09 ,$837.74 ,$837.74 ,"$1,387.33 ",$777.00 ,"$1,100.75 ",$906.50 ,$315.09 ,"$1,230.25 ",$984.20 ,$971.25 ,$841.75 ,"$1,100.75 ","$1,387.33 ",$841.75 ,$841.75 ,$906.50 ,$315.09 ,"$1,387.33 ","$1,387.33 ",$543.90 ,"$1,100.75 ","$3,121.49 ","$1,191.40 ",$906.50 ,"$1,295.00 ","$1,295.00 ",$788.66 ,"$1,295.00 ",$894.85 ,"$1,165.50 ",$901.97 ,"$1,401.20 ","$1,023.05 ",$334.00 , N/A , N/A ,"$1,387.33 ", N/A ,$932.40 ,$802.90 ,$932.40 ,$932.40 ,"$1,036.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300010,11045,PC DEBR SKIN/SUBQ TIS EA ADL 20CM PRO,983,1 ,$110.00 ,$55.00 ,$46.20 ,$334.00 ,$315.09 ,$71.16 ,$71.16 , N/A ,$66.00 ,$93.50 ,$77.00 ,$315.09 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 , N/A ,$71.50 ,$71.50 ,$77.00 ,$315.09 , N/A , N/A ,$46.20 ,$93.50 , N/A ,$101.20 ,$77.00 ,$110.00 ,$110.00 ,$66.99 ,$110.00 ,$76.01 ,$99.00 ,$76.62 , N/A ,$86.90 ,$334.00 , N/A , N/A , N/A , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,98300011,11046,PC DEBR SKIN/SUBQ MUS/FAS ADL 20C PRO,983,1 ,$230.00 ,$115.00 ,$96.60 ,$334.00 ,$315.09 ,$148.79 ,$148.79 , N/A ,$138.00 ,$195.50 ,$161.00 ,$315.09 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 , N/A ,$149.50 ,$149.50 ,$161.00 ,$315.09 , N/A , N/A ,$96.60 ,$195.50 , N/A ,$211.60 ,$161.00 ,$230.00 ,$230.00 ,$140.07 ,$230.00 ,$158.93 ,$207.00 ,$160.20 , N/A ,$181.70 ,$334.00 , N/A , N/A , N/A , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300012,11047,PC DEBR SKIN/SUB TIS/MUS/BN ADL 20C PRO,983,1 ,$385.00 ,$192.50 ,$161.70 ,$385.00 ,$315.09 ,$249.06 ,$249.06 , N/A ,$231.00 ,$327.25 ,$269.50 ,$315.09 ,$365.75 ,$292.60 ,$288.75 ,$250.25 ,$327.25 , N/A ,$250.25 ,$250.25 ,$269.50 ,$315.09 , N/A , N/A ,$161.70 ,$327.25 , N/A ,$354.20 ,$269.50 ,$385.00 ,$385.00 ,$234.47 ,$385.00 ,$266.04 ,$346.50 ,$268.15 , N/A ,$304.15 ,$334.00 , N/A , N/A , N/A , N/A ,$277.20 ,$238.70 ,$277.20 ,$277.20 ,$308.00 
ST NICHOLAS HOSPITAL - ACUTE,98300013,11055,PC PARING LESN BENIGN 1 PRO,983,1 ,$160.00 ,$80.00 ,$51.36 ,$398.39 ,$51.36 ,$103.50 ,$103.50 ,$177.06 ,$96.00 ,$136.00 ,$112.00 ,$51.36 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 ,$177.06 ,$104.00 ,$104.00 ,$112.00 ,$51.36 ,$177.06 ,$177.06 ,$67.20 ,$136.00 ,$398.39 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 ,$178.83 ,$126.40 ,$54.44 , N/A , N/A ,$177.06 , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300014,11056,PC PARING LESN BENIGN 2-4 PRO,983,1 ,$230.00 ,$115.00 ,$51.36 ,$398.39 ,$51.36 ,$148.79 ,$148.79 ,$177.06 ,$138.00 ,$195.50 ,$161.00 ,$51.36 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$177.06 ,$149.50 ,$149.50 ,$161.00 ,$51.36 ,$177.06 ,$177.06 ,$96.60 ,$195.50 ,$398.39 ,$211.60 ,$161.00 ,$230.00 ,$230.00 ,$140.07 ,$230.00 ,$158.93 ,$207.00 ,$160.20 ,$178.83 ,$181.70 ,$54.44 , N/A , N/A ,$177.06 , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300019,15100,PC AUTOGRPH T A L 100SQCM< PRO,983,1 ,"$2,795.00 ","$1,397.50 ",$615.10 ,"$3,799.81 ",$615.10 ,"$1,808.09 ","$1,808.09 ","$1,688.81 ","$1,677.00 ","$2,375.75 ","$1,956.50 ",$615.10 ,"$2,655.25 ","$2,124.20 ","$2,096.25 ","$1,816.75 ","$2,375.75 ","$1,688.81 ","$1,816.75 ","$1,816.75 ","$1,956.50 ",$615.10 ,"$1,688.81 ","$1,688.81 ","$1,173.90 ","$2,375.75 ","$3,799.81 ","$2,571.40 ","$1,956.50 ","$1,921.55 ","$2,401.67 ","$1,702.16 ","$2,401.67 ","$1,931.35 ","$2,515.50 ","$1,946.72 ","$1,705.70 ","$2,208.05 ",$652.01 , N/A , N/A ,"$1,688.81 ", N/A ,"$2,012.40 ","$1,732.90 ","$2,012.40 ","$2,012.40 ","$2,236.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300020,15101,PC AUTOGRPH T A L EA ADD100CM PRO,983,1 ,$880.00 ,$440.00 ,$369.60 ,"$3,303.09 ",$615.10 ,$569.27 ,$569.27 , N/A ,$528.00 ,$748.00 ,$616.00 ,$615.10 ,$836.00 ,$668.80 ,$660.00 ,$572.00 ,$748.00 , N/A ,$572.00 ,$572.00 ,$616.00 ,$615.10 , N/A , N/A ,$369.60 ,$748.00 , N/A ,$809.60 ,$616.00 ,"$2,642.26 ","$3,303.09 ",$535.92 ,"$3,303.09 ",$608.08 ,$792.00 ,$612.92 , N/A ,$695.20 ,$652.01 , N/A , N/A , N/A , N/A ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$704.00 
ST NICHOLAS HOSPITAL - ACUTE,98300021,15120,PC AUTOGRPH F F DG 100SQCM< PRO,983,1 ,"$4,495.00 ","$2,247.50 ",$615.10 ,"$7,811.85 ",$615.10 ,"$2,907.82 ","$2,907.82 ","$3,471.93 ","$2,697.00 ","$3,820.75 ","$3,146.50 ",$615.10 ,"$4,270.25 ","$3,416.20 ","$3,371.25 ","$2,921.75 ","$3,820.75 ","$3,471.93 ","$2,921.75 ","$2,921.75 ","$3,146.50 ",$615.10 ,"$3,471.93 ","$3,471.93 ","$1,887.90 ","$3,820.75 ","$7,811.85 ","$4,135.40 ","$3,146.50 ","$1,921.55 ","$2,401.67 ","$2,737.46 ","$2,401.67 ","$3,106.05 ","$4,045.50 ","$3,130.77 ","$3,506.65 ","$3,551.05 ",$652.01 , N/A , N/A ,"$3,471.93 ", N/A ,"$3,236.40 ","$2,786.90 ","$3,236.40 ","$3,236.40 ","$3,596.00 "
ST NICHOLAS HOSPITAL - ACUTE,98300022,15121,PC AUTOGRPH F F DG EA ADD 100CM PRO,983,1 ,"$2,247.00 ","$1,123.50 ",$615.10 ,"$3,303.09 ",$615.10 ,"$1,453.58 ","$1,453.58 ", N/A ,"$1,348.20 ","$1,909.95 ","$1,572.90 ",$615.10 ,"$2,134.65 ","$1,707.72 ","$1,685.25 ","$1,460.55 ","$1,909.95 ", N/A ,"$1,460.55 ","$1,460.55 ","$1,572.90 ",$615.10 , N/A , N/A ,$943.74 ,"$1,909.95 ", N/A ,"$2,067.24 ","$1,572.90 ","$2,642.26 ","$3,303.09 ","$1,368.42 ","$3,303.09 ","$1,552.68 ","$2,022.30 ","$1,565.04 ", N/A ,"$1,775.13 ",$652.01 , N/A , N/A , N/A , N/A ,"$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,797.60 "
ST NICHOLAS HOSPITAL - ACUTE,98300028,16020,PC BURN DRESS  AND /OR DEBRIDE PRO <5%,983,1 ,$280.00 ,$140.00 ,$58.71 ,$398.39 ,$58.71 ,$181.13 ,$181.13 ,$177.06 ,$168.00 ,$238.00 ,$196.00 ,$58.71 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$177.06 ,$182.00 ,$182.00 ,$196.00 ,$58.71 ,$177.06 ,$177.06 ,$117.60 ,$238.00 ,$398.39 ,$257.60 ,$196.00 ,$280.00 ,$280.00 ,$170.52 ,$280.00 ,$193.48 ,$252.00 ,$195.02 ,$178.83 ,$221.20 ,$62.23 , N/A , N/A ,$177.06 , N/A ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,98300029,16020,PC BURN DRESS  AND OR DEBRD NWPT PRO<5%,983,1 ,$280.00 ,$140.00 ,$58.71 ,$398.39 ,$58.71 ,$181.13 ,$181.13 ,$177.06 ,$168.00 ,$238.00 ,$196.00 ,$58.71 ,$266.00 ,$212.80 ,$210.00 ,$182.00 ,$238.00 ,$177.06 ,$182.00 ,$182.00 ,$196.00 ,$58.71 ,$177.06 ,$177.06 ,$117.60 ,$238.00 ,$398.39 ,$257.60 ,$196.00 ,$280.00 ,$280.00 ,$170.52 ,$280.00 ,$193.48 ,$252.00 ,$195.02 ,$178.83 ,$221.20 ,$62.23 , N/A , N/A ,$177.06 , N/A ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$224.00 
ST NICHOLAS HOSPITAL - ACUTE,98300030,17250,PC CHEM CAUTERY/NWPT PRO,983,1 ,$270.00 ,$135.00 ,$51.36 ,$398.39 ,$51.36 ,$174.66 ,$174.66 ,$177.06 ,$162.00 ,$229.50 ,$189.00 ,$51.36 ,$256.50 ,$205.20 ,$202.50 ,$175.50 ,$229.50 ,$177.06 ,$175.50 ,$175.50 ,$189.00 ,$51.36 ,$177.06 ,$177.06 ,$113.40 ,$229.50 ,$398.39 ,$248.40 ,$189.00 ,$270.00 ,$270.00 ,$164.43 ,$270.00 ,$186.57 ,$243.00 ,$188.06 ,$178.83 ,$213.30 ,$54.44 , N/A , N/A ,$177.06 , N/A ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,98300031,17250,PC CHEM CAUTERY PRO,983,1 ,$270.00 ,$135.00 ,$51.36 ,$398.39 ,$51.36 ,$174.66 ,$174.66 ,$177.06 ,$162.00 ,$229.50 ,$189.00 ,$51.36 ,$256.50 ,$205.20 ,$202.50 ,$175.50 ,$229.50 ,$177.06 ,$175.50 ,$175.50 ,$189.00 ,$51.36 ,$177.06 ,$177.06 ,$113.40 ,$229.50 ,$398.39 ,$248.40 ,$189.00 ,$270.00 ,$270.00 ,$164.43 ,$270.00 ,$186.57 ,$243.00 ,$188.06 ,$178.83 ,$213.30 ,$54.44 , N/A , N/A ,$177.06 , N/A ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,98300032,97597,PC AWC WITH CHEM CAUTERY PRO,983,1 ,$270.00 ,$135.00 ,$58.71 ,$398.39 ,$58.71 ,$174.66 ,$174.66 ,$177.06 ,$162.00 ,$229.50 ,$189.00 ,$58.71 ,$256.50 ,$205.20 ,$202.50 ,$175.50 ,$229.50 ,$177.06 ,$175.50 ,$175.50 ,$189.00 ,$58.71 ,$177.06 ,$177.06 ,$113.40 ,$229.50 ,$398.39 ,$248.40 ,$189.00 ,$136.94 ,$164.35 ,$164.43 ,$164.35 ,$186.57 ,$243.00 ,$188.06 ,$178.83 ,$213.30 ,$62.23 , N/A , N/A ,$177.06 , N/A ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$216.00 
ST NICHOLAS HOSPITAL - ACUTE,98300036,29580,PC UNNA BOOT APPLICATION PRO,983,1 ,$215.00 ,$107.50 ,$59.15 ,$313.43 ,$59.15 ,$139.08 ,$139.08 ,$139.30 ,$129.00 ,$182.75 ,$150.50 ,$59.15 ,$204.25 ,$163.40 ,$161.25 ,$139.75 ,$182.75 ,$139.30 ,$139.75 ,$139.75 ,$150.50 ,$59.15 ,$139.30 ,$139.30 ,$90.30 ,$182.75 ,$313.43 ,$197.80 ,$150.50 ,$215.00 ,$215.00 ,$130.94 ,$215.00 ,$148.57 ,$193.50 ,$149.75 ,$140.69 ,$169.85 ,$62.70 , N/A , N/A ,$139.30 , N/A ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$172.00 
ST NICHOLAS HOSPITAL - ACUTE,98300038,29581,PC APPL MULTI COMP LOWER LEG PRO,983,1 ,$400.00 ,$200.00 ,$59.15 ,$400.00 ,$59.15 ,$258.76 ,$258.76 ,$139.30 ,$240.00 ,$340.00 ,$280.00 ,$59.15 ,$380.00 ,$304.00 ,$300.00 ,$260.00 ,$340.00 ,$139.30 ,$260.00 ,$260.00 ,$280.00 ,$59.15 ,$139.30 ,$139.30 ,$168.00 ,$340.00 ,$313.43 ,$368.00 ,$280.00 ,$400.00 ,$400.00 ,$243.60 ,$400.00 ,$276.40 ,$360.00 ,$278.60 ,$140.69 ,$316.00 ,$62.70 , N/A , N/A ,$139.30 , N/A ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$320.00 
ST NICHOLAS HOSPITAL - ACUTE,98300039,29581,PC APPL BIL MULT COMP LOWLEG PRO,983,1 ,$600.00 ,$300.00 ,$59.15 ,$600.00 ,$59.15 ,$388.14 ,$388.14 ,$139.30 ,$360.00 ,$510.00 ,$420.00 ,$59.15 ,$570.00 ,$456.00 ,$450.00 ,$390.00 ,$510.00 ,$139.30 ,$390.00 ,$390.00 ,$420.00 ,$59.15 ,$139.30 ,$139.30 ,$252.00 ,$510.00 ,$313.43 ,$552.00 ,$420.00 ,$600.00 ,$600.00 ,$365.40 ,$600.00 ,$414.60 ,$540.00 ,$417.90 ,$140.69 ,$474.00 ,$62.70 , N/A , N/A ,$139.30 , N/A ,$432.00 ,$372.00 ,$432.00 ,$432.00 ,$480.00 
ST NICHOLAS HOSPITAL - ACUTE,98300043,97597,PC DEBR SKIN INTL 20CM PRO,983,1 ,$205.00 ,$102.50 ,$58.71 ,$398.39 ,$58.71 ,$132.61 ,$132.61 ,$177.06 ,$123.00 ,$174.25 ,$143.50 ,$58.71 ,$194.75 ,$155.80 ,$153.75 ,$133.25 ,$174.25 ,$177.06 ,$133.25 ,$133.25 ,$143.50 ,$58.71 ,$177.06 ,$177.06 ,$86.10 ,$174.25 ,$398.39 ,$188.60 ,$143.50 ,$103.98 ,$124.78 ,$124.85 ,$124.78 ,$141.66 ,$184.50 ,$142.78 ,$178.83 ,$161.95 ,$62.23 , N/A , N/A ,$177.06 , N/A ,$147.60 ,$127.10 ,$147.60 ,$147.60 ,$164.00 
ST NICHOLAS HOSPITAL - ACUTE,98300049,97598,PC DEBR SKIN PART THICKNESS EA ADDN>20CM PRO,983,1 ,$230.00 ,$115.00 ,$96.60 ,$334.00 ,$315.09 ,$148.79 ,$148.79 , N/A ,$138.00 ,$195.50 ,$161.00 ,$315.09 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 , N/A ,$149.50 ,$149.50 ,$161.00 ,$315.09 , N/A , N/A ,$96.60 ,$195.50 , N/A ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 , N/A ,$181.70 ,$334.00 , N/A , N/A , N/A , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300050,97605,PC NWPT <50 SQ CM PRO,983,1 ,$120.00 ,$60.00 ,$50.40 ,$398.39 ,$58.71 ,$77.63 ,$77.63 ,$177.06 ,$72.00 ,$102.00 ,$84.00 ,$58.71 ,$114.00 ,$91.20 ,$90.00 ,$78.00 ,$102.00 ,$177.06 ,$78.00 ,$78.00 ,$84.00 ,$58.71 ,$177.06 ,$177.06 ,$50.40 ,$102.00 ,$398.39 ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$73.04 ,$82.92 ,$108.00 ,$83.58 ,$178.83 ,$94.80 ,$62.23 , N/A , N/A ,$177.06 , N/A ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$96.00 
ST NICHOLAS HOSPITAL - ACUTE,98300051,97606,PC NWPT >50 SQ CM PRO,983,1 ,$230.00 ,$115.00 ,$96.60 ,$766.80 ,$118.09 ,$148.79 ,$148.79 ,$340.80 ,$138.00 ,$195.50 ,$161.00 ,$118.09 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 ,$340.80 ,$149.50 ,$149.50 ,$161.00 ,$118.09 ,$340.80 ,$340.80 ,$96.60 ,$195.50 ,$766.80 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 ,$344.21 ,$181.70 ,$125.18 , N/A , N/A ,$340.80 , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98300054,G0127,PC TRIM NAILS DYSTROPHIC PRO,983,1 ,$45.00 ,$22.50 ,$18.90 ,$123.49 ,$20.60 ,$29.11 ,$29.11 ,$54.89 ,$27.00 ,$38.25 ,$31.50 ,$20.60 ,$42.75 ,$34.20 ,$33.75 ,$29.25 ,$38.25 ,$54.89 ,$29.25 ,$29.25 ,$31.50 ,$20.60 ,$54.89 ,$54.89 ,$18.90 ,$38.25 ,$123.49 ,$41.40 ,$31.50 ,$22.82 ,$27.39 ,$27.41 ,$27.39 ,$31.10 ,$40.50 ,$31.34 ,$55.44 ,$35.55 ,$21.84 , N/A , N/A ,$54.89 , N/A ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$36.00 
ST NICHOLAS HOSPITAL - ACUTE,98300075,99183,PC HYPERBARIC 02 HSHS PRO FEE,983,1 ,$920.00 ,$460.00 ,$386.40 ,$920.00 , N/A ,$595.15 ,$595.15 , N/A ,$552.00 ,$782.00 ,$644.00 , N/A ,$874.00 ,$699.20 ,$690.00 ,$598.00 ,$782.00 , N/A ,$598.00 ,$598.00 ,$644.00 , N/A , N/A , N/A ,$386.40 ,$782.00 , N/A ,$846.40 ,$644.00 ,$466.62 ,$560.00 ,$560.28 ,$560.00 ,$635.72 ,$828.00 ,$640.78 , N/A ,$726.80 , N/A , N/A , N/A , N/A , N/A ,$662.40 ,$570.40 ,$662.40 ,$662.40 ,$736.00 
ST NICHOLAS HOSPITAL - ACUTE,98300080,15271,PC APL SKIN SUB TAL<100 INT 25CM PRO,983,1 ,$560.00 ,$280.00 ,$235.20 ,"$3,799.81 ",$615.10 ,$362.26 ,$362.26 ,"$1,688.81 ",$336.00 ,$476.00 ,$392.00 ,$615.10 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,"$1,688.81 ",$364.00 ,$364.00 ,$392.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$235.20 ,$476.00 ,"$3,799.81 ",$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$390.04 ,"$1,705.70 ",$442.40 ,$652.01 , N/A , N/A ,"$1,688.81 ", N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,98300081,15271,PC APL SKIN SUB TAL<100 INT 25CM PRO W/PROC,983,1 ,$560.00 ,$280.00 ,$235.20 ,"$3,799.81 ",$615.10 ,$362.26 ,$362.26 ,"$1,688.81 ",$336.00 ,$476.00 ,$392.00 ,$615.10 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,"$1,688.81 ",$364.00 ,$364.00 ,$392.00 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$235.20 ,$476.00 ,"$3,799.81 ",$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$390.04 ,"$1,705.70 ",$442.40 ,$652.01 , N/A , N/A ,"$1,688.81 ", N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,98300082,15272,PC APL SKIN SUB TAL<100 ADL 25CM PRO,983,1 ,$110.00 ,$55.00 ,$46.20 ,$652.01 ,$615.10 ,$71.16 ,$71.16 , N/A ,$66.00 ,$93.50 ,$77.00 ,$615.10 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 , N/A ,$71.50 ,$71.50 ,$77.00 ,$615.10 , N/A , N/A ,$46.20 ,$93.50 , N/A ,$101.20 ,$77.00 ,$110.00 ,$110.00 ,$66.99 ,$110.00 ,$76.01 ,$99.00 ,$76.62 , N/A ,$86.90 ,$652.01 , N/A , N/A , N/A , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,98300086,15275,PC APL SKIN SUB OTH<100 INT 25CM PRO,983,1 ,$605.00 ,$302.50 ,$254.10 ,"$3,799.81 ",$615.10 ,$391.37 ,$391.37 ,"$1,688.81 ",$363.00 ,$514.25 ,$423.50 ,$615.10 ,$574.75 ,$459.80 ,$453.75 ,$393.25 ,$514.25 ,"$1,688.81 ",$393.25 ,$393.25 ,$423.50 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$254.10 ,$514.25 ,"$3,799.81 ",$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$544.50 ,$421.38 ,"$1,705.70 ",$477.95 ,$652.01 , N/A , N/A ,"$1,688.81 ", N/A ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,98300087,15275,PC APL SKIN SUB OTH<100 INT 25CM W/PROC PRO,983,1 ,$605.00 ,$302.50 ,$254.10 ,"$3,799.81 ",$615.10 ,$391.37 ,$391.37 ,"$1,688.81 ",$363.00 ,$514.25 ,$423.50 ,$615.10 ,$574.75 ,$459.80 ,$453.75 ,$393.25 ,$514.25 ,"$1,688.81 ",$393.25 ,$393.25 ,$423.50 ,$615.10 ,"$1,688.81 ","$1,688.81 ",$254.10 ,$514.25 ,"$3,799.81 ",$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$544.50 ,$421.38 ,"$1,705.70 ",$477.95 ,$652.01 , N/A , N/A ,"$1,688.81 ", N/A ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$484.00 
ST NICHOLAS HOSPITAL - ACUTE,98300088,15276,PC APL SKIN SUB OTH<100 ADL 25CM PRO,983,1 ,$145.00 ,$72.50 ,$60.90 ,$652.01 ,$615.10 ,$93.80 ,$93.80 , N/A ,$87.00 ,$123.25 ,$101.50 ,$615.10 ,$137.75 ,$110.20 ,$108.75 ,$94.25 ,$123.25 , N/A ,$94.25 ,$94.25 ,$101.50 ,$615.10 , N/A , N/A ,$60.90 ,$123.25 , N/A ,$133.40 ,$101.50 ,$145.00 ,$145.00 ,$88.31 ,$145.00 ,$100.20 ,$130.50 ,$100.99 , N/A ,$114.55 ,$652.01 , N/A , N/A , N/A , N/A ,$104.40 ,$89.90 ,$104.40 ,$104.40 ,$116.00 
ST NICHOLAS HOSPITAL - ACUTE,98300092,10140,PC I AND D HEMATOMA/SEROMA/FLUID PRO,983,1 ,$560.00 ,$280.00 ,$235.20 ,"$3,121.49 ",$344.84 ,$362.26 ,$362.26 ,"$1,387.33 ",$336.00 ,$476.00 ,$392.00 ,$344.84 ,$532.00 ,$425.60 ,$420.00 ,$364.00 ,$476.00 ,"$1,387.33 ",$364.00 ,$364.00 ,$392.00 ,$344.84 ,"$1,387.33 ","$1,387.33 ",$235.20 ,$476.00 ,"$3,121.49 ",$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$504.00 ,$390.04 ,"$1,401.20 ",$442.40 ,$365.53 , N/A , N/A ,"$1,387.33 ", N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$448.00 
ST NICHOLAS HOSPITAL - ACUTE,98300095,11057,PC PARING LESN BENIGN >4 PRO,983,1 ,$290.00 ,$145.00 ,$51.36 ,$398.39 ,$51.36 ,$187.60 ,$187.60 ,$177.06 ,$174.00 ,$246.50 ,$203.00 ,$51.36 ,$275.50 ,$220.40 ,$217.50 ,$188.50 ,$246.50 ,$177.06 ,$188.50 ,$188.50 ,$203.00 ,$51.36 ,$177.06 ,$177.06 ,$121.80 ,$246.50 ,$398.39 ,$266.80 ,$203.00 ,$290.00 ,$290.00 ,$176.61 ,$290.00 ,$200.39 ,$261.00 ,$201.99 ,$178.83 ,$229.10 ,$54.44 , N/A , N/A ,$177.06 , N/A ,$208.80 ,$179.80 ,$208.80 ,$208.80 ,$232.00 
ST NICHOLAS HOSPITAL - ACUTE,98300122,11900,PC INJECT SKIN LESIONS </W 7 PRO,983,1 ,$100.00 ,$50.00 ,$42.00 ,$398.39 ,$51.36 ,$64.69 ,$64.69 ,$177.06 ,$60.00 ,$85.00 ,$70.00 ,$51.36 ,$95.00 ,$76.00 ,$75.00 ,$65.00 ,$85.00 ,$177.06 ,$65.00 ,$65.00 ,$70.00 ,$51.36 ,$177.06 ,$177.06 ,$42.00 ,$85.00 ,$398.39 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$90.00 ,$69.65 ,$178.83 ,$79.00 ,$54.44 , N/A , N/A ,$177.06 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$80.00 
ST NICHOLAS HOSPITAL - ACUTE,98300124,11730,PC AVULSION NAIL PLATE SINGLE PRO,983,1 ,$315.00 ,$157.50 ,$20.60 ,$398.39 ,$20.60 ,$203.77 ,$203.77 ,$177.06 ,$189.00 ,$267.75 ,$220.50 ,$20.60 ,$299.25 ,$239.40 ,$236.25 ,$204.75 ,$267.75 ,$177.06 ,$204.75 ,$204.75 ,$220.50 ,$20.60 ,$177.06 ,$177.06 ,$132.30 ,$267.75 ,$398.39 ,$289.80 ,$220.50 ,$315.00 ,$315.00 ,$191.84 ,$315.00 ,$217.67 ,$283.50 ,$219.40 ,$178.83 ,$248.85 ,$21.84 , N/A , N/A ,$177.06 , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,98300145,11102,PC BIOPSY SKIN TANGENTIAL INIT LESN,983,1 ,$325.00 ,$162.50 ,$136.50 ,$398.39 ,$139.95 ,$210.24 ,$210.24 ,$177.06 ,$195.00 ,$276.25 ,$227.50 ,$139.95 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 ,$177.06 ,$211.25 ,$211.25 ,$227.50 ,$139.95 ,$177.06 ,$177.06 ,$136.50 ,$276.25 ,$398.39 ,$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$292.50 ,$226.36 ,$178.83 ,$256.75 ,$148.35 , N/A , N/A ,$177.06 , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98300146,11104,PC BIOPSY SKIN PUNCH INIT LESN,983,1 ,$325.00 ,$162.50 ,$136.50 ,$766.80 ,$139.95 ,$210.24 ,$210.24 ,$340.80 ,$195.00 ,$276.25 ,$227.50 ,$139.95 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 ,$340.80 ,$211.25 ,$211.25 ,$227.50 ,$139.95 ,$340.80 ,$340.80 ,$136.50 ,$276.25 ,$766.80 ,$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$292.50 ,$226.36 ,$344.21 ,$256.75 ,$148.35 , N/A , N/A ,$340.80 , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98300147,11106,PC BIOPSY SKIN INCISIONAL INIT LESN,983,1 ,$325.00 ,$162.50 ,$136.50 ,"$1,161.91 ",$139.95 ,$210.24 ,$210.24 ,$516.40 ,$195.00 ,$276.25 ,$227.50 ,$139.95 ,$308.75 ,$247.00 ,$243.75 ,$211.25 ,$276.25 ,$516.40 ,$211.25 ,$211.25 ,$227.50 ,$139.95 ,$516.40 ,$516.40 ,$136.50 ,$276.25 ,"$1,161.91 ",$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$292.50 ,$226.36 ,$521.56 ,$256.75 ,$148.35 , N/A , N/A ,$516.40 , N/A ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$260.00 
ST NICHOLAS HOSPITAL - ACUTE,98300148,11103,PC BIOPSY SKIN TANGENTIAL ADDL LESN,983,1 ,$160.00 ,$80.00 ,$67.20 ,$160.00 ,$139.95 ,$103.50 ,$103.50 , N/A ,$96.00 ,$136.00 ,$112.00 ,$139.95 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 ,$139.95 , N/A , N/A ,$67.20 ,$136.00 , N/A ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 , N/A ,$126.40 ,$148.35 , N/A , N/A , N/A , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300149,11105,PC BIOPSY SKIN PUNCH ADDL LESN,983,1 ,$160.00 ,$80.00 ,$67.20 ,$160.00 ,$139.95 ,$103.50 ,$103.50 , N/A ,$96.00 ,$136.00 ,$112.00 ,$139.95 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 ,$139.95 , N/A , N/A ,$67.20 ,$136.00 , N/A ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 , N/A ,$126.40 ,$148.35 , N/A , N/A , N/A , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300150,11107,PC BIOPSY SKIN INCISIONAL ADDL LESN,983,1 ,$160.00 ,$80.00 ,$67.20 ,$160.00 ,$139.95 ,$103.50 ,$103.50 , N/A ,$96.00 ,$136.00 ,$112.00 ,$139.95 ,$152.00 ,$121.60 ,$120.00 ,$104.00 ,$136.00 , N/A ,$104.00 ,$104.00 ,$112.00 ,$139.95 , N/A , N/A ,$67.20 ,$136.00 , N/A ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$144.00 ,$111.44 , N/A ,$126.40 ,$148.35 , N/A , N/A , N/A , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$128.00 
ST NICHOLAS HOSPITAL - ACUTE,98300151,43762,PC REPLACE GASTRO TUBE PERC,983,1 ,$420.00 ,$210.00 ,$62.73 ,$590.35 ,$62.73 ,$271.70 ,$271.70 ,$262.38 ,$252.00 ,$357.00 ,$294.00 ,$62.73 ,$399.00 ,$319.20 ,$315.00 ,$273.00 ,$357.00 ,$262.38 ,$273.00 ,$273.00 ,$294.00 ,$62.73 ,$262.38 ,$262.38 ,$176.40 ,$357.00 ,$590.35 ,$386.40 ,$294.00 ,$420.00 ,$420.00 ,$255.78 ,$420.00 ,$290.22 ,$378.00 ,$292.53 ,$265.00 ,$331.80 ,$66.49 , N/A , N/A ,$262.38 , N/A ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$336.00 
ST NICHOLAS HOSPITAL - ACUTE,98300152,43763,PC REPLACE GASTRO TUBE PERC W/REVISE TRACT,983,1 ,$440.00 ,$220.00 ,$62.73 ,$590.35 ,$62.73 ,$284.64 ,$284.64 ,$262.38 ,$264.00 ,$374.00 ,$308.00 ,$62.73 ,$418.00 ,$334.40 ,$330.00 ,$286.00 ,$374.00 ,$262.38 ,$286.00 ,$286.00 ,$308.00 ,$62.73 ,$262.38 ,$262.38 ,$184.80 ,$374.00 ,$590.35 ,$404.80 ,$308.00 ,$440.00 ,$440.00 ,$267.96 ,$440.00 ,$304.04 ,$396.00 ,$306.46 ,$265.00 ,$347.60 ,$66.49 , N/A , N/A ,$262.38 , N/A ,$316.80 ,$272.80 ,$316.80 ,$316.80 ,$352.00 
ST NICHOLAS HOSPITAL - ACUTE,98800013,99221,PC INITIAL HOSPITAL CARE LVL 1 LOW 30MIN,987,1 ,$230.00 ,$115.00 ,$38.23 ,$230.00 ,$38.23 ,$148.79 ,$148.79 , N/A ,$138.00 ,$195.50 ,$161.00 ,$38.23 ,$218.50 ,$174.80 ,$172.50 ,$149.50 ,$195.50 , N/A ,$149.50 ,$149.50 ,$161.00 ,$38.23 , N/A , N/A ,$96.60 ,$195.50 , N/A ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$140.00 ,$158.93 ,$207.00 ,$160.20 , N/A ,$181.70 ,$40.52 , N/A , N/A , N/A , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$184.00 
ST NICHOLAS HOSPITAL - ACUTE,98800015,99222,PC INITIAL HOSPITAL CARE LVL 2 MOD 50MIN,987,1 ,$310.00 ,$155.00 ,$38.23 ,$310.00 ,$38.23 ,$200.54 ,$200.54 , N/A ,$186.00 ,$263.50 ,$217.00 ,$38.23 ,$294.50 ,$235.60 ,$232.50 ,$201.50 ,$263.50 , N/A ,$201.50 ,$201.50 ,$217.00 ,$38.23 , N/A , N/A ,$130.20 ,$263.50 , N/A ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$188.70 ,$214.21 ,$279.00 ,$215.92 , N/A ,$244.90 ,$40.52 , N/A , N/A , N/A , N/A ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$248.00 
ST NICHOLAS HOSPITAL - ACUTE,98800016,99223,PC INITIAL HOSPITAL CARE LVL 3 HIGH 70MIN,987,1 ,$450.00 ,$225.00 ,$38.23 ,$450.00 ,$38.23 ,$291.11 ,$291.11 , N/A ,$270.00 ,$382.50 ,$315.00 ,$38.23 ,$427.50 ,$342.00 ,$337.50 ,$292.50 ,$382.50 , N/A ,$292.50 ,$292.50 ,$315.00 ,$38.23 , N/A , N/A ,$189.00 ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$273.92 ,$310.95 ,$405.00 ,$313.43 , N/A ,$355.50 ,$40.52 , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$360.00 
ST NICHOLAS HOSPITAL - ACUTE,98800017,99231,PC SUBSQ HOSPITAL CARE LVL 1 LOW 15MIN,987,1 ,$110.00 ,$55.00 ,$38.23 ,$110.00 ,$38.23 ,$71.16 ,$71.16 , N/A ,$66.00 ,$93.50 ,$77.00 ,$38.23 ,$104.50 ,$83.60 ,$82.50 ,$71.50 ,$93.50 , N/A ,$71.50 ,$71.50 ,$77.00 ,$38.23 , N/A , N/A ,$46.20 ,$93.50 , N/A ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$66.96 ,$76.01 ,$99.00 ,$76.62 , N/A ,$86.90 ,$40.52 , N/A , N/A , N/A , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$88.00 
ST NICHOLAS HOSPITAL - ACUTE,98800018,99232,PC SUBSQ HOSPITAL CARE LVL 2 MOD 25MIN,987,1 ,$170.00 ,$85.00 ,$38.23 ,$170.00 ,$38.23 ,$109.97 ,$109.97 , N/A ,$102.00 ,$144.50 ,$119.00 ,$38.23 ,$161.50 ,$129.20 ,$127.50 ,$110.50 ,$144.50 , N/A ,$110.50 ,$110.50 ,$119.00 ,$38.23 , N/A , N/A ,$71.40 ,$144.50 , N/A ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$103.48 ,$117.47 ,$153.00 ,$118.41 , N/A ,$134.30 ,$40.52 , N/A , N/A , N/A , N/A ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$136.00 
ST NICHOLAS HOSPITAL - ACUTE,98800019,99233,PC SUBSQ HOSPITAL CARE LVL 3 HIGH 35MIN,987,1 ,$235.00 ,$117.50 ,$38.23 ,$235.00 ,$38.23 ,$152.02 ,$152.02 , N/A ,$141.00 ,$199.75 ,$164.50 ,$38.23 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$38.23 , N/A , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$163.68 , N/A ,$185.65 ,$40.52 , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,98880000,99251,PC INPATIENT CONSULTATION 1 LIMITED 20MIN,988,1 ,$235.00 ,$117.50 ,$38.23 ,$235.00 ,$38.23 ,$152.02 ,$152.02 , N/A ,$141.00 ,$199.75 ,$164.50 ,$38.23 ,$223.25 ,$178.60 ,$176.25 ,$152.75 ,$199.75 , N/A ,$152.75 ,$152.75 ,$164.50 ,$38.23 , N/A , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$143.04 ,$162.39 ,$211.50 ,$163.68 , N/A ,$185.65 ,$40.52 , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$188.00 
ST NICHOLAS HOSPITAL - ACUTE,98880001,99252,PC INPATIENT CONSULTATION 2 LOW 40MIN,988,1 ,$315.00 ,$157.50 ,$38.23 ,$315.00 ,$38.23 ,$203.77 ,$203.77 , N/A ,$189.00 ,$267.75 ,$220.50 ,$38.23 ,$299.25 ,$239.40 ,$236.25 ,$204.75 ,$267.75 , N/A ,$204.75 ,$204.75 ,$220.50 ,$38.23 , N/A , N/A ,$132.30 ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$191.74 ,$217.67 ,$283.50 ,$219.40 , N/A ,$248.85 ,$40.52 , N/A , N/A , N/A , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$252.00 
ST NICHOLAS HOSPITAL - ACUTE,98880002,99253,PC INPATIENT CONSULTATION 3 MOD 55MIN,988,1 ,$395.00 ,$197.50 ,$38.23 ,$395.00 ,$38.23 ,$255.53 ,$255.53 , N/A ,$237.00 ,$335.75 ,$276.50 ,$38.23 ,$375.25 ,$300.20 ,$296.25 ,$256.75 ,$335.75 , N/A ,$256.75 ,$256.75 ,$276.50 ,$38.23 , N/A , N/A ,$165.90 ,$335.75 , N/A ,$363.40 ,$276.50 ,$200.34 ,$240.44 ,$240.56 ,$240.44 ,$272.95 ,$355.50 ,$275.12 , N/A ,$312.05 ,$40.52 , N/A , N/A , N/A , N/A ,$284.40 ,$244.90 ,$284.40 ,$284.40 ,$316.00 
ST NICHOLAS HOSPITAL - ACUTE,98880003,99254,PC INPATIENT CONSULTATION 4 MOD-HIGH 80MIN,988,1 ,$545.00 ,$272.50 ,$38.23 ,$545.00 ,$38.23 ,$352.56 ,$352.56 , N/A ,$327.00 ,$463.25 ,$381.50 ,$38.23 ,$517.75 ,$414.20 ,$408.75 ,$354.25 ,$463.25 , N/A ,$354.25 ,$354.25 ,$381.50 ,$38.23 , N/A , N/A ,$228.90 ,$463.25 , N/A ,$501.40 ,$381.50 ,$276.42 ,$331.74 ,$331.91 ,$331.74 ,$376.60 ,$490.50 ,$379.59 , N/A ,$430.55 ,$40.52 , N/A , N/A , N/A , N/A ,$392.40 ,$337.90 ,$392.40 ,$392.40 ,$436.00 
ST NICHOLAS HOSPITAL - ACUTE,98880004,99255,PC INPATIENT CONSULTATION 5 HIGH 110MIN,988,1 ,$680.00 ,$340.00 ,$38.23 ,$680.00 ,$38.23 ,$439.89 ,$439.89 , N/A ,$408.00 ,$578.00 ,$476.00 ,$38.23 ,$646.00 ,$516.80 ,$510.00 ,$442.00 ,$578.00 , N/A ,$442.00 ,$442.00 ,$476.00 ,$38.23 , N/A , N/A ,$285.60 ,$578.00 , N/A ,$625.60 ,$476.00 ,$344.90 ,$413.92 ,$414.12 ,$413.92 ,$469.88 ,$612.00 ,$473.62 , N/A ,$537.20 ,$40.52 , N/A , N/A , N/A , N/A ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$544.00 
ST NICHOLAS HOSPITAL - ACUTE,98880005,G0296,PC CLINIC COUNSELING FOR LOW DOSE LUNG SCREEN,988,1 ,$115.00 ,$57.50 ,$38.23 ,$166.00 ,$38.23 ,$74.39 ,$74.39 ,$73.78 ,$69.00 ,$97.75 ,$80.50 ,$38.23 ,$109.25 ,$87.40 ,$86.25 ,$74.75 ,$97.75 ,$73.78 ,$74.75 ,$74.75 ,$80.50 ,$38.23 ,$73.78 ,$73.78 ,$48.30 ,$97.75 ,$166.00 ,$105.80 ,$80.50 ,$58.33 ,$70.00 ,$70.04 ,$70.00 ,$79.47 ,$103.50 ,$80.10 ,$74.52 ,$90.85 ,$40.52 , N/A , N/A ,$73.78 , N/A ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$92.00